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Australian Journal of Pharmacy : October 2006
hospital talk hospital talk John Low, hospital pharmacist (AAQHC) and the Australian Council on Healthcare Standards (ACHS) co-hosted the 4th Australian Conference on Safety and Quality in Health Care in Mel- bourne (21–23 August 2006). The con- ference boasted an impressive array of local and international speakers includ- ing Professor Lucian Leape, Professor of Health Policy at Harvard School of Pub- lic Health, Dr Robert Brook, Director of US-based RAND Health, and Dr Simon Eccles, National Clinical Lead for Hos- pitals for the UK National Health Scheme’s Connecting for Health. In his keynote address Professor Leape asked the question: ‘Where have we been and where are we going?’. He acknowl- edged that, while there is little evidence of any dramatic improvements in reducing the incidence of medical errors in the 11 years since the publication in this country of the Quality in Australian Health Care Study, there have been some significant advances. But what had been achieved had fallen well short of what was clearly possible. He identified the need for major structural and organisational change to ensure that safety is a true priority in healthcare. Professor Leape’s opening address was followed with three sobering case-studies of organisations in crisis: an overview of Bundaberg, what happened, why it hap- pened and planned initiatives to address the issues; Campbelltown—Camden three years on, solutions and strategies in place; and, King Edward Hospital six years on, what has worked and what has made the difference. Although none of these inquiries specifically involved phar- macy services there is little doubt that organisational change designed to address safety and quality issues must involve such a service. There were a number of recurring themes woven into the conference pre- sentations. Two that directly impacted on Safety and quality in healthcare R ECENTLY the Australasian Asso- ciation for Quality in Health Care (hospital) pharmacy were medication safety in all its manifestations and infor- mation flow about medicines between the hospital and the community. One of the most significant achieve- ments in the last five years for hospital- based pharmacy practice, with particular relevance to medication safety, has been the development of the National Inpa- tient Medication Card (NIMC). The pilot project clearly demonstrated an improve- ment in documentation and safe pre- scribing following improvements in the design of the inpatient medication chart and associated educational initiatives. Specific areas of improvement included: documentation of ADRs, drug dosing, fre- quency of administration, and prescribing drugs to which the patient had demon- strated an earlier allergy. The NIMC is now standard in all Queensland public hospitals and is being introduced in all other states. ...it was regrettable that there was no apparent involvement of the major pharmacy organisations [at the conference] It is clear from a number of the confer- ence presentations that medicine-based information flow between the community and the hospital, and vice versa, is a deal more problematic. This is because it involves not only the standardisation and/or interfacing of information man- agement systems to a degree not yet achieved in practice, but also issues of pri- vacy of health records. An optimistic address on the the subject of building a business case for an Australian shared electronic health record by Professor Peter Sprivulis acknowledged that while 34 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.87 OCTOBER 2006 technical problems, database structure and the issues of data collection did not present insurmountable problems, a shared electronic health record would offer few additional benefits if it relied on ‘opt-in’ participation from the health con- sumer. (An ‘opt-out’ system sees every- body as a participant and would remain in the system unless a concious decision is made not to participate by ‘opting out’). Given that the conference offered much in the way of ‘big picture’ themes associated with patient safety and quality, and a integral part of these themes were issues of medication management and information flow, it was regrettable that there was no apparent involvement of the major pharmacy organisations (and the number of pharmacists attending could have been counted on one’s fingers and toes). Dr Simon Eccles gave an informative and entertaining address on designing more effective models of care, and spent no small part of his talk debunking exist- ing healthcare structures where doctors were the only practitioners that could pre- scribe. It was, he suggested, a task that could just as easily be done by nurse prac- titioners! Pharmacy in this country has yet to have the debate on pharmacist prescrib- ing. While there have been some muted discussions within various groupings within the profession, there has been lit- tle, if any, engagement with practitioners or regulators outside pharmacy. Pharma- cists in the USA, UK, Ireland and South Africa have extended their role in this area, while nurse practitioners and optometrists within Australia have gained authorisation to prescribe, albeit with restrictions. If pharmacists in Australia do not actively engage in the safety and qual- ity movement, especially in the areas of medication management, then they may well be marginalised by major structural and organisational changes introduced to increase safety in healthcare. s