Kirsten Galbraith

Potential Support Roles for Pharmacy Technicians in Provision of Clinical Pharmacy Services

Objectives: To determine the current and possible future utilisation of pharmacy technicians in clinical pharmacy support roles in Australia. To use the information to develop a set of potential support tasks for pharmacy technicians working under the supervision of clinical pharmacists.

A Critical Evaluation of the Therapeutic Range of Indinavir

OBJECTIVE: To provide a summary of the patient population, study characteristics, and important findings of the key studies in the literature evaluating concentration—effect relationships and the therapeutic range for indinavir. DATA SOURCES: Literature search strategy involved using MEDLINE (1966–July 2001) and AIDSLINE (MEDSCAPE) databases (up to July 2001). Reference lists from primary literature and review articles were also examined, and conference abstracts were obtained. STUDY SELECTION: English-language articles were considered suitable for review if the clinical trials in HIV patients reported on concentration—effect relationships and/or pharmacokinetic breakpoints or threshold concentrations. A search of the literature identified 20 peer-reviewed references from 18 separate studies including journal articles and conference abstracts. DATA EXTRACTION: The targeted pharmacokinetic parameters and breakpoint values, the rationale for their selection or method of identification, and other study details and limitations were summarized. DISCUSSION: This article highlights the heterogeneity of studies evaluating the therapeutic range of indinavir and provides a summary of important findings of the key studies in the literature evaluating concentration-effect relationships and therapeutic range. Tables are provided to enable clinicians to make use of currently available information on the therapeutic range of indinavir. CONCLUSIONS: There is insufficient evidence to recommend a general therapeutic range for indinavir. Future investigations should incorporate both pharmacokinetics and pharmacodynamics in order to define a broadly applicable therapeutic range.

Partnered medication review and charting between the pharmacist and medical officer in the Emergency Short Stay and General Medicine Unit.

OBJECTIVE A partnered medication review and charting model involving a pharmacist and medical officer was implemented in the Emergency Short Stay Unit and General Medicine Unit of a major tertiary hospital. The aim of the study was to describe the safety and effectiveness of partnered medication charting in this setting. METHODS A partnered medication review and charting model was developed. Credentialed pharmacists charted pre-admission medications and venous thromboembolism prophylaxis in collaboration with the admitting medical officer. The pharmacist subsequently had a clinical discussion with the treating nurse regarding the medication management plan for the patient. A prospective audit was undertaken of all patients from the initiation of the service. RESULTS A total of 549 patients had medications charted by a pharmacist from the 14th of November 2012 to the 30th of April 2013. A total of 4765 medications were charted by pharmacists with 7 identified errors, corresponding to an error rate of 1.47 per 1000 medications charted. CONCLUSIONS Partnered medication review and charting by a pharmacist in the Emergency Short Stay and General Medicine unit is achievable, safe and effective. Benefits from the model extend beyond the pharmacist charting the medications, with clinical value added to the admission process through early collaboration with the medical officer. Further research is required to provide evidence to further support this collaborative model.

Reducing medication errors in hospital discharge summaries: a randomised controlled trial.

Objectives: To evaluate whether pharmacists completing the medication management plan in the medical discharge summary reduced the rate of medication errors in these summaries.

Partnered pharmacist charting on admission in the General Medical and Emergency Short‐stay Unit – a cluster‐randomised controlled trial in patients with complex medication regimens

Patients admitted to general medical units and emergency short‐stay units are often complex with multiple comorbidities, polypharmacy and at risk for drug‐related problems associated with increased morbidity and mortality. The aim of this study was to evaluate the effectiveness of a partnered pharmacist charting model completed at the time of admission to prevent medication errors.

Advanced practice: a survey of current perspectives of Australian pharmacists

An Advanced Pharmacy Practice Framework for Australia (the ‘APPF’) was published in October 2012. Further to the release of the APPF, the Advanced Pharmacy Practice Framework Steering Committee planned to develop an advanced practice recognition model for Australian pharmacists.

Highlights From the FIPEd Global Education Report

The International Pharmaceutical Federation Education Initiative (FIPEd) launched the 2013 FIPEd Global Education Report (available at: www.fip.org/educationreports) in September 2013. This is the first publication of its kind to provide a baseline on the current status and transformation of pharmacy and pharmaceutical science education worldwide. A foundation of scientific and professional education and training is a key factor for pharmacists to develop the capability to improve therapeutic outcomes, enhance patients’ safety and quality of life and help people to stay healthy, as well as advance science and practice. For pharmacy, contemporary forms of initial education and training are vital for the profession to meet the increasingly complex pharmaceutical and public health care demands of populations. The 2013 FIPEd Global Education Report was conducted using surveys in English, French, Portuguese, Arabic, Japanese, Chinese, and Spanish. This resulted in education and workforce data for 109 countries and territories representing around 175,000 pharmacy students and 2,500 education institutions worldwide. Data indicate that education, in both capacity and infrastructure, varies considerably between countries and World Health Organization (WHO) regions, and generally correlates with a country’s population size and economic development indicators. Those countries and territories with lower economic indicators tend to have relatively lower educational capacity and pharmacist production. African countries tend to have lower educational capacity and supply pipelines for pharmacists. This has implications for future parity for access to medicines and medicines expertise. There needs to be an ongoing effort to ensure capacity building linked with initial education and training to meet the health needs of populations. Initial education is key in the development of the health care workforce for the future; better science, better practice, and better health care are all linked to the responsible use of medicines. The proportion of the female undergraduate population is a majority globally, with some regions having an average female pharmacy student enrolment of more than 70%. The relative costs of pharmacy and pharmaceutical education also varies across countries and territories. Fourteen countries in this sample reported no direct student tuition fees (including Afghanistan, Austria, Czech Republic, Denmark, Estonia, Greece, Hungary, Malta, Poland, Serbia, Slovenia, Sweden, Turkey and Uruguay). For those countries in the sample that do charge a direct tuition fee (for domestic students in public universities) the correlation of direct tuition fee payments with gross national income (per capita) is significant. Similarly with the total student costs (ie, direct tuition fee plus public capitation contribution) there are strong positive correlations with gross national income. There is an associated variation in the relative contributions of direct (individual) and public contributions for initial undergraduate education in the higher education sectors. Respondents provided high-level information on quality assurance. Information was sought to characterize whether quality assurance and accreditation was in place within the country and the accrediting body responsible. Sixteen percent of respondents claimed to have no accreditation mechanisms. Of the 64 countries and territories who supplied data in this section, 38 (59%) indicated the existence of a national core curriculum or syllabus for initial education. Forty-seven countries and territories provided data on the proportion of time spent on science-based laboratory learning in the core curriculum, which ranged from 6% to 70%, with a sample mean of around 36% (one third) of curriculum time spent on laboratory-based learning. Degree titles and lengths vary, which suggests differences in content and education provision models between countries and regions. This variance suggests that additional research is needed to examine similarities and differences in the educational outcomes associated with differing degree titles and lengths. The 14 case studies included in the report provide an overview of the transformation that is occurring in pharmacy and pharmaceutical science education globally. Fourteen countries, Chile, Great Britain, Japan, Jordan, Malaysia, Namibia, Philippines, Portugal, Saudi Arabia, Switzerland, Thailand, UAE – Abu Dhabi, USA and Zimbabwe, were purposively sampled based on existing knowledge and asked a series of questions about pharmacy education, relating to current drivers, trends, innovations, transformation and links with national strategy for health care services. The case studies provide an overview of the transformation that is occurring in pharmacy and pharmaceutical science education globally. Notably, there is a shift to patient-centered, team-based practice and to clinically focused, integrated curricula with increasing opportunities for patient and practice-centered and interprofessional learning. Nonetheless, there is still a shortage of pharmacist academics and of clinical preceptors worldwide. The understanding of education and the factors that influence it are essential for human resource planning and for achieving universal access to medicines (Figure 1). We need to provide quality education that meets national and global standards and engage in a socially accountable manner to serve the needs of individual patients and society as a whole. Moreover, there needs to be a strong alignment between the outcomes of pharmacy education and the overall health needs of nations. Figure 1. Needs-based professional educational model.

Advanced pharmacy practice: aligning national action with global targets

Formalised advanced pharmacy practice is needed now more than ever for pharmacists to be able to competently manage increasingly complex patient services and demanding healthcare needs. Principally spearheaded by the International Pharmaceutical Federation, global efforts are guiding the development of foundation and advanced frameworks and facilitating their implementation. Australian action on practitioner development is largely aligned with international goals, but challenges remain in the face of establishing a sustainable national formal credentialing pathway. This paper reports on the latest global and local developments and discusses the opportunities available to continue to advance this agenda in line with global targets.

Transnational comparability of advanced pharmacy practice developmental frameworks: a country-level crossover mapping study

Previous work by the International Pharmaceutical Federation Education Initiative (FIPEd) demonstrates that even though some country‐specific variations occur in pharmacy practice, there exists a set of practice‐related competencies that are globally applicable. This study aimed to evaluate the transnational comparability of the Royal Pharmaceutical Society Advanced Pharmacy Framework (RPS‐APF, Great Britain) and the Advanced Pharmacy Practice Framework for Australia (APPF). The objective was to obtain preliminary data on the transnational applicability of the developmental competencies contained in the two frameworks.