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It
wasn't the right tablet for the right person at the right time.
It was the right groundwork with the right support (Division of
General Practice) at the right time.
To
understand the process we have to travel back to the cross-roads
to understand the rules, procedures and experience that eventually
became the catalyst for pharmacy involvemment in the Division
of General Practice.
The initial path was that of hospital pharmacy. Establishing a
hospital pharmacy department without any hospital pharmacy experience,
but the real bonus of not having inherited practices to follow.
So:
****The department did not do outpatient dispensing.
Reason- the pharmacist believed supplying 4 days of cheaper
brands of medications only contributed to patient confusion, and
was not an efficient use of the pharmacist time.
Result- patients were given their discharge prescription,
had counselling and explanations as needed, were given a list
to take to their GP and pharmacist. This began the process of
cooperation between the doctors, community and hospital pharmacist.
****The department did not provide monthly statistics of the numbers
of issues to the wards, interventions etc.
Reason- the pharmacist did not believe that a page of statistics
proved the value of the pharmacy department
Result- the pharmacist produced a monthly report (sent
to both the CEO and the medical director)detailing a positive
action taken by the department, eg pharmacist involvement in the
treatment of a leg-ulcer, spot audits on particular drug use and
recommendations for improvement. The report was able
to be understood by all the members of the hospital board. This
began the process of cooperation between the management of the
hospital and the pharmacist
****The department set up, but did not maintain the drug cupboards
Reason- accountability for medications was a joint nursing/pharmacy
initiative. If medications were taken from stock cupboards the
the nurses had the responsibility of recording items used. The
pharmacist then had time for real pharmacy practice - explaining
about optimum pain relief in a mini lecture to nurses instead
of counting pills in a cupboard. This began the process of cooperation
between nurses and pharmacy.
****the pharmacist undertook audits of drug use eg while supplying
antibiotics to the wards, kept a record of pertinent information.
Extremely interesting that all cases of MRSI were imported from
city hospital, or the result of multiple prophylactic antibiotic
prescribing in elderly chesty patients.
Reason- keeping records at the time of supply entailed
very little extra work.
The project was extremely good for doctor/pharmacist relationships,
and also to show the hospital management that the department could
assist in research projects.
The
biggest problems were not with the other professions, but with
the hospital pharmacy. Most of the participants at the annual
Chief Pharmacists Conferences were from city hospitals. Large
departments. Following traditional and well established practices.
Doing research and projects, yes, but often pharmacy initiated
- not as a result of queries or needs from the nurses or doctors.
I find it interesting that these large departments were very much
self-contained within their structural boundaries. Informal interaction
with other hospital staff was often minimal.
I tried each year to explain the rural situation - twice as many
people/pharmacist as well as the constraints of distance, lack
of locums, and the large number of small hospitals without a pharmacy
department or any pharmacy service (other than supply), but great
opportunities for pharmacy.
Corresponding
nursing conferences were the exact opposite - consisting of many
more Directors of
Nursing from hospitals without pharmacy involvement (and we can
manage quite nicely,thank-you) than from the relatively few large
city hospitals. For pharmacy to have any impact I believed that
we needed to make ourselves indispensible experts in medication
management - especially with assistance to nursing staff.
My
approach in the establishment of two pharmacy departments was
so successful that at the end of two years in each the departments
had expanded to have extra pharmacists and technicians on the
staff. All this without the pharmacist having to justify the need
for extra staff - the nurses, doctors and management all recognised
the value of the pharmacy department.
I believe these practises are a vital part of the groundwork.
Sole pharmacy departments established along traditional lines
in the same era are still sole pharmacy departments, where the
pharmacist has difficulty justifying expenses and practises.
If
our destination is to be greater cooperation with the medical
profession through the Divisions of General Practice, DMMRs and
the National Prescribing Service we have to really concentrate
an the relationships bit. We have to know our stuff, and find
ways for the nurses to start looking for
our involvement. With the nurses on side we will win.
It
took this aged pharmacist 20 years to become the stimulis for
the successful projects with the West Victorian Division of General
Practice. The profession doesn't have the luxury of time any more.
Community pharmacists have to be entrepreneurial - to find ways
to adapt some of the above hospital pharmacy procedures in their
particular sphere of influence.
There are District Nurses, residential care facilities, community
health centres, community outreach through local organisations
and papers etc.
Pharmacies can be restructured to give the pharmacist more freedom.
There can be flexibility in the way we practice - both in hospital
and community environments (community is the next step in my process)
I
believe we have to stop saying that we can't afford or have time
to be involved in DMMRs etc..
The city pharmacy departments couldn't by themselves justify their
existence, hence cut-backs, amalgamations, decreased services.
Pharmacists, whatever their sphere of practice, must promote themselves
to all other health professionals as the experts in medication
management. This is vital groundwork.
Once
the groundwork is done the West Victorian Division of General
Practice may be able assist.
The recently concluded Pharmacy/GP liaison project has produceda
"How To" book to assist all the Divisions of General
Practice across the country incorporate pharmacists and pharmacy
activities into their
structures.
Contact Catherine Mackay at the West Vic Division of General
Practice in Ararat for more information. Phone 03 5352 4804.
It may just help a pharmacist or two
get the process underway more quickly.
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