Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists


From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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Pharmacy Clinical Spaces

Neil Johnston

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Neil Johnston is a pharmacist who trained as a management consultant. He was the first consultant to service the pharmacy profession and commenced practice as a full time consultant in 1972, specialising in community pharmacy management, pharmacy systems, preventive medicine and the marketing of professional services. He has owned, or part-owned a total of six pharmacies during his career, and for a decade spent time both as a clinical pharmacist and Chief Pharmacist in the public hospital system. He has been editor of i2P since 2000.

Clinical spaces are those spaces dedicated for fee-paying clinical services..
To date, one of the difficulties of carving a suitable clinical space from a pharmacy environment is the ability to find a quiet spot as well as one that allows for speech privacy.
I have concluded that a range of different spaces are required to deliver pharmacy clinical services so that they are able to be differentiated by type of service and privacy level.
Thus a layout and design for the clinical spaces will become as important as the total layout for the entire pharmacy. Integrating the clinical environment into a retail space will be a significant challenge to overcome, but it is a challenge where creative pharmacists will be able to generate a range of unique pharmacy solutions.

While a counseling room fulfills most of the requirements, there is hesitancy by some pharmacy patients to enter an enclosed room.
Enclosed rooms also create a new set of problems in that if a patient requires some touching, it might later be deemed as “inappropriate” by the patient, resulting in some unwanted legal situation.
This has already occurred in the UK and a clinical assistant may need to be present for some interviews.

My research to date indicates that some form of cubicle may be required to conduct clinical conversations, closely located to a counseling room, may provide a more complete solution.
The example illustrated is actually a coffee shop where business executives meet over a cup of coffee. The privacy problem is similar to that of pharmacy conversations.
This particular environment has been designed with a means of dynamically moderating the noise levels.
By using an iPad and an environment that is fitted with the kind of recording equipment and noise cancelling materials one would probably expect to  find in a recording studio, you can manipulate various types of sound.
The system involves fitting environments with sound absorbing materials that are coupled with subwoofers and speakers.
Sound from the environment is recorded and sent to a digital processor which is then controlled by an iPad.
Sound levels from different sections of that environment can then be moderated accordingly.

By utilizing this equipment pharmacies can augment how sounds travel within specific sections of the pharmacy.
In the example illustrated, the equipment was seamlessly blended into the walls and the design of the establishment to remove any unsightliness or intrusions for patrons.
Pharmacies that have pelmets included within their design have a good carrier for installing this type of equipment with the front of the pelmet carrying the sound absorbing material, as well as the section above the pelmet.

With careful attention to design, a system of departmental signs can still coexist with soundproofing panels. The panels may even be able to carry suitable wording and become the actual department sign.
Certainly, the space above the pelmets would be an ideal location for the soundproof panels (note the example in the photograph).

If stronger suppressant levels are required in the cubicle located publicly in the pharmacy environment, it may be necessary to additionally fit “pink noise generators” to the cubicle itself. This type of system is simply described as noise-masking. This may be an over-kill for the cubicle environment, but it could cancel any conversations that need to remain absolutely private.

The clinical space may also have sound absorbing mats designed to geographically highlight the clinical space as well as absorb the sounds created in that space.
It becomes another point of difference to illustrate separation from other services e.g. dispensing.
The mats may also include a space for seminars or group patient discussions as another form of clinical space.

Remember also that because counseling rooms are generally made of thin construction materials, they may need sound absorbent panels on the side walls and roof. Pink noise generators can be located above the ceiling of the counseling room.

When pharmacists begin publicising their fee for clinical service activities they should expect strong criticism from the medical profession which, at that stage, should be mostly unfounded.
Valid criticisms need to be addressed.
Not having privacy surrounding clinical conversations is a valid criticism, but having a system similar to that described above will not only eliminate “noise” from patients, but it also cancels “noise” from the medical profession.

Latest projections for pharmacy bankruptcies in Australia should be creating the necessary stimulus for pharmacy change in direction. Last year 90 pharmacies entered into bankruptcy.
i2P predicted 110 new bankruptcies for 2012 but it seems that we may have erred on the conservative side, as media reports are starting to indicate that 2012 will have more bankruptcies than the whole of the previous 10 years.
The message is clear- keep doing what you are doing and join in the race to the bottom.
Think through a new direction, get out of the rat-race and begin to prosper in remunerative terms as well as in job satisfaction.

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