How to survive a 'black alert' in the Pharmacy Department

It is one of every NHS worker’s toughest moments when they hear the words 'black alert', especially if it the first time you are experiencing such a period.

This is the busiest period for any NHS employee and for the pharmacy department it is no exception. With winter pressures approaching this is likely to increase, in January 2017 The Guardian reported that at least 23 NHS hospitals were in black alert at one time...

So what does black alert actually mean?

There is a rating system for bed space within a hospital. It helps to assess what capacity the hospital has left. Black alert means that bed capacity has been reached and that the hospital needs to free up beds where possible, as quickly as possible, so as to allow new patients who need care bed space. Sometimes routine operations will be cancelled to free up space where possible.

NHS England classifies a black alert as a “serious incident”. It means that the hospital is under severe pressure and is unable to deliver certain actions and comprehensive emergency care. It is vital that the hospital does all it can to free bed space as quickly and efficiently as possible.


One of the main impacts for a Pharmacy department is that there is an increased demand on TTA turn around time and it is vital that the department does everything they can to ensure that patient waiting times do not increase. It is important to have a system in place that prioritises TTA’s as the pharmacy receives them and is based upon the expected discharge time.

Increased calls from department wishing to know how long a patient’s TTA will take is common. It is important to remain calm and professional during these periods. This is something that has been greatly improved with the introduction of electronic TTA status boards. These allow staff to see the status on a patient’s TTA from their computer or overhead monitor. It is paramount during black alerts that these systems are kept up to date, to allow discharges to take place as efficiently as possible.

Remain calm

During the time of a black alert the workforce is under pressure to turn around TTAs faster and allow patients that are medically fit to leave as quickly as possible. This increased demand makes these situations more stressful. It is important that as a worker in this situation that you ensure that you still take your breaks and your lunch break. Failing to do so can result in the pressure becoming more challenging to deal with (which may make it more likely to make mistakes), so it is healthy in these situations to give the mind a break.

The pharmacy department is under particular pressure during this period as there is an increased demand in TTA turn around, this is often the last thing nurses are waiting on to discharge a patient. It is therefore paramount that there is good communication between the pharmacy discharge team and the wards regarding patients to be discharged and the time of the expected discharge. If this is achieved, then the pressure on the pharmacy department is decreased, as you can organise the patient’s medication prior to discharge. This also relies on doctors having written up TTAs in a timely manor and no major changes being made prior to discharge. Therefore it is an important aim to establish and maintain a good relationship with the discharging doctors.


Black alerts are always a challenge for staff and it will continue to be the case whilst demand for services increases. Having good relationships with other staff, especially discharge doctors and ward staff is paramount to helping to reduce the pressure that the situation creates. It is also imperative to have good systems in place within the pharmacy department, so as to help reduce the impact of these situations. 

What other tips do you have for coping in these situations in your hospital?


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