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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Where is the care in health care?

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

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Kay Dunkley is a pharmacist who has worked in hospital and organisational pharmacy for over 20 years.  She has a broad experience working in public hospitals and in providing support to health professionals through government funded bodies and professional organisations.  Kay also has a strong interest in the health and well being of health professionals and especially the role of peer support.  Kay first became involved as a volunteer with the Pharmacists’ Support Service, a group which has been providing telephone support for pharmacists in Victoria since 1995.  In 2005 Kay became the Program Coordinator for the Pharmacists’ Support Service and has assisted the service to become an independent organisation which is currently seeking to expand to provide support to pharmacists throughout Australia.  In 2007, when AMA Victoria approached the Pharmaceutical Society of Australia (Victorian Branch) with a view to establishing their own Peer Support Service; Kay accepted an invitation to assist.  The AMA Victoria Peer Support Service commenced operation in February 2008.  Kay currently coordinates both of these services and also works part-time as a consultant pharmacist in Residential Care Facilities.

I have recently been experiencing health care from a different angle as I have accompanied my elderly mother through a prolonged period of hospitalisation (seven weeks) in five different hospitals, both public and private.  As my mother has short term memory loss and I have her medical power of attorney I believed it was very important to be involved in my mother’s journey through the health care system.  This has provided a very different perspective from either being a care provider in my role as a pharmacist or even from the times I have been a patient.

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During the seven weeks of hospitalisation I observed treatment and care provided by a wide range of health professionals and ancillary staff. 
At no time did I observe negligence and everyone was pleasant and probably doing their best. 
However the limitations and pressure on the health care system were evident. 
A Friday night spent in an Emergency Department of a major outer metropolitan hospital illustrated this well.
 Ambulances backed up; people sent home throughout the night to make room for recent arrivals; no cubicle for my mother hence no privacy and bright light through-out the night; numerous “code greys” due to aggressive and agitated patients; police presence; doctors trying to take histories from confused elderly patients; patients refusing care, a patient suddenly taking a turn for the worse and being rushed off to “resus”; trolleys being quickly cleaned and prepared for the next patient and the cleaner methodically working his way around the department throughout the night.
Despite this the nursing staff, who did not stop moving, remained cheerful, polite and mostly patient.  The junior doctors nursed their coffees as they moved between endless paperwork, the telephone and attending to patients.
I was told that the hospital was completely full that night and so no beds were available for new admissions until discharges occurred the next morning. 
Some patients opted for transfer to local private hospitals but others were too unwell to have this choice or did not have the necessary private health insurance. 
There were no pharmacists present overnight in the Emergency Department at this particular hospital and yet I saw plenty of opportunities for them to assist. 
For example taking medication histories, clarifying medication administration, ensuring those being discharged were given the information and advice they needed. 
I was informed that out of hours pharmacy services at this hospital are limited due budget constraints.

During this journey the biggest difficulty I encountered was communication and in particular information not being passed on between the various team members. 
The same medical information had to be provided many times and requests were often not conveyed to other members of the team. 
The messages I received were also mixed. 
I would be advised of one treatment and management plan only to have someone else tell me something quite different. 
I probably developed a reputation as a “pushy” relative and certainly was asked by one staff member “Are you the daughter?” as she handed over paperwork for me to sign.
Having worked in hospital pharmacy and having worked at this particular hospital I understood the systems in place and knew what to expect. 
It would have been very difficult for a less well informed family member to navigate the system.

Certainly my mother was not able to understand what was happening.
I now understand why relatives often become angry and aggressive with staff in hospitals as confusion and anxiety overtake them.
One of the best examples of care I saw over that time was a member of the kitchen staff coming to my mother’s bedside to discuss her meal orders.  She crouched down by the bedside, looked her in the face and spoke to my mother by name. 
She knew her likes and dislikes and made suggestions as to which menu items my mother may prefer.  On the other hand the “private” specialist in the public hospital did not once make direct contact or discuss my mother’s care with me.

Discharge planning from rehabilitation was excellent and the return to health care in the community has occurred smoothly. 
Of particular note was the seamless transfer of discharge medication history to the local pharmacy so that her “pack” could be prepared and delivered on the day she returned home.
Likewise the messages of good wishes from the local pharmacy and encouragement to just ask if you need anything else delivered, and that would have included items from the supermarket. 
I accompanied my mother a week after discharge on her first visit to her local pharmacy, which also includes a small café, and the warm greetings including hugs from the staff and the free coffee to welcome her back really made her day.  It was evident that this level of care is offered to all the “regulars” as they were greeted by name.  I now realise that this type of care is far more important to an older person than expert diagnosis and knowledge.

Dr Ranjana Srivastava, in her monthly article, “the Doctor is in” in “the (Melbourne) magazine” that comes with “The Age” puts it so well in her quote in the June 2012 edition:

“The rushing tide of patients makes it shamefully easy to forget the person behind the patient, especially when there is little meaningful connection.” 
Dr Srivastava is an oncologist and I also thoroughly recommend her book “tell me the truth: conversations with my patients about life and death.” 
I believe that health care must include compassion and when health care providers start to lose that, it is time for them to take a break and attend to their own needs.  Every patient you deal with must be your mother, father, brother, sister, daughter or son.

Pharmacists who feel stressed and burnt out can talk anonymously to a colleague over the phone through the Pharmacists’ Support Service.  The service is available for the cost of a local call (mobile rates may apply) on 1300 244 910 between 8am and 11pm every day of the year.

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