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Australian Journal of Pharmacy : November 2006
hospital talk hospital talk John Low, hospital pharmacist Hospital pharmacy workforce 2005 T he Journal of Pharmacy Practice and Research recently published a paper from O’Leary and Allinson which updated the findings of the 2001 and 2003 studies on Australia’s hospital pharmacy workforce.1 As with pharmacy practice in general, hospital pharmacy has long recognised that workforce issues can impact signifi- cantly on the delivery of health services. The major areas that have been previ- ously identified included clinical phar- macy services to hospital inpatients and the management of the interface between the hospital and the community through liaison services, also know as ‘continuum of pharmaceutical care’. Additional stresses have been felt for a considerable time within hospital practice through the introduction of Pharmaceuti- cal Benefits-based funding for drugs dis- pensed to non-admitted patients or patients being discharged from hospital. The understanding was the additional funding flowing to hospitals would sup- port the widespread implementation of the Australian Pharmacy Advisory Coun- cil continuum of pharmaceutical care guidelines. This document outlines the responsi- bilities of the admitting institution to ensure the development and coordination of a medication discharge place for each patient. It required a responsible person, identified as soon as practicable after admission, to be responsible for coordi- nating the development, implementation and monitoring of the medication dis- charge plan. Such an outcome requires, not only the existence of a mature and integrated pharmacy service within a hospital, but also the availability of staff resources to ensure such a service is available to all patients, especially those in higher risk categories. Any resource problems are exacerbated as in-patient length-of-stay times become shorter. There has long been an expectation that, as graduates from the plethora of newly established bachelor of pharmacy pro- grams flow through the system and become registered, the intractable vacancy rates, seen especially in New South Wales (13 per cent) and Queensland (18 per cent) will gradually diminish. While the figures from the survey sup- port such a contention, showing an over- all decrease in the vacancy rate over two years from 10 per cent in 2003 to 7 per cent in 2005, the authors warn of draw- ing any superficial conclusions. They identify limitations in the data in that there was a relatively disappointing response rate from principal referral hos- pitals in New South Wales and Queens- land (historically states with relatively high vacancy rates) coupled with a rela- tively high response from Victoria (a state with a relatively low and stable vacancy rate). Unless realistic award restructuring is undertaken, hospital pharmacy will still find it difficult to attract appropriately qualified practitioners to provide critical clinical services The question: ‘is the reduction from 10 per cent to 7 per cent a genuine reduction, or an artefact created by a skewed response rate?’ is not able to be deter- mined with any degree of certainty. 34 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.87 NOVEMBER 2006 The previous study undertaken in 2003 showed that Victoria, South Australia and Western Australia had demonstrated the most significant falls in vacancy rates through recruitment and retention poli- cies that focused on restructuring awards and having relatively large numbers of pre-registrant positions available to new graduates (the ‘train them and retain them’ principle). The vacancy rates in those states remain low in the current survey. However, vacancy rates in New South Wales and Queensland, where lit- tle has seemed to have been done in the past two years in regard to award restructuring, remained at previously high levels. There is little doubt that the increas- ing numbers of pharmacists graduating and registering will eventually enable even the most intractable vacancy rates to be addressed. However, given the types of services that hospital pharmacy will be expected to deliver, it will not be enough to ensure there are merely ‘bums on seats’. Salary structures and employ- ment conditions will still need to be appropriate for the skill-set required. Unless realistic award restructuring is undertaken, hospital pharmacy will still find it difficult to attract appropriately qualified practitioners to provide critical clinical services. There is little doubt that one of the main areas of focus for hospital pharmacy practice over the next decade will be med- ication safety. The activities of medication history taking, ensuring the accuracy of prescriptions, undertaking medication reviews and providing timely medication liaison services, will only be provided by systems that are fully staffed and ade- quately resourced. There are significant areas in Australia where there is little evi- dence of such staffing or resourcing. 1. O’Leary KM, Allinson YM. Snapshot of the Aus- tralian public hospital workforce in 2005. J Pharm Pract Res 2006; 36: 103–6. ¦