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RAN

Remote Pharmacy – A Review from a Remote Nurse

by Robbo on August 4, 2009

in Pharmacy,Professional Services,Remote health

This was written for me some time ago by Melissa, a Remote Area Nurse I worked with in 2008.

Working in a remote area as a health professional is a very challenging role. Unlike working in an urban or rural hospital situation, where there are a multitude of doctors, nurses, allied health professionals and pharmacists available 24 hours a day, remote health clinics rarely have a variety of health professionals, let alone the ones which are essential. Having a pharmacist located within the region is not only rare, but is highly valuable and appreciated.

There are many times when having a pharmacist nearby is a definite advantage. Questions over medication interactions, brand names, etc can easily be sorted by pharmacist who is only a phone call away and is well familiar with the medications commonly utilised in the area. Pharmacists are a fount of knowledge about medications, drug interactions, and side effects. This is not only helpful for doctors, so that they do not prescribe medications which interact, but also for nurses who may need help with understanding certain medications, interactions and side effects.

Having a pharmacist as a part of the remote health team helped immensely in streamlining patients medications when they have been discharged from hospital. Commonly, patients are discharged from hospital without any consultation with Medical and/or Nursing staff, with patients discharged on new or altered medications, which may not be readily available in the remote clinic. Having a pharmacist who is actively involved in helping with patient discharges means that any new or altered dose medications a patient may require can be ordered and, hopefully, arrive prior to the patient returning to the community. The pharmacist can also help to organise new remote scripts when patients’ medications have been changed by a hospital or specialist.

Transportation of medical supplies and medications in remote areas is not merely a matter of placing an order and it arriving in a day or two. It takes time to get medications and medical supplies transported out, mostly by airplane, and having a remote health pharmacist has certainly helped with this. Whilst it is impossible to know exactly how much medication a clinic will use in a given month, the pharmacist can be instrumental in helping to calculate average usage and to assess what minimum level of medication stock should be kept in a clinic.

When a medication inadvertently does run out before the next order is due/arrives, having a pharmacist nearby is handy. By calling the pharmacist who has a general idea of what clinics have what medications and the levels of medication in each clinic, the pharmacist can organise to have emergency supplies transferred from another clinic to the clinic in need. This can also be useful for medications whose expiration date is coming up. Because the pharmacist has knowledge about which clinics and patients use certain medications, close to expiration date medications and vaccines can be transferred to where they are most likely to be used in order to help prevent wastage.

A remote health pharmacist can also spend time with individual patients and explain their individual medications, changes to their medications, and how to use medication devices such as dosette boxes and insulin pens. Whilst nursing and medical staff aim to explain the medication prescribed to the individual, often they do not have the time or the expertise of knowledge which a pharmacist has. Having a pharmacist travel from remote clinic to remote clinic means that patients who require extra explanations can have a visit booked with the pharmacist for that express purpose.

Tagged as: interaction, logistics, medication, nursing, Pharmacy, RAN, remote

{ 4 comments }

Team Work in Remote Health Services

by Robbo on October 18, 2008

in Indigenous,NT Intervention,Remote health

The following article appeared in 6minutes about nurses, GPs and teamwork in one remote health service.

Many concerns have been expressed over an expanded role for nurses in future General Practice. One area that may be neglected is the effect on team structure.

I have worked in teams with nurses in the past where there was a great cooperation between nurses and doctors and for many years my immediate boss in several jobs was a nurse. I have been an advocate of nurse practitioners. However 18mths ago I moved to a remote area of NT where there has been a shortage of doctors for many years. Because nurses have been given extra powers and have managed without a doctor for many years, they resent our presence and our input. I am now leaving, for the same reason my predecessors did. There is no teamwork with nurses who say “I am an independent practitioner.” Doctors are regularly asked ” Are you looking after this patient or am I?’. If we are, the nurse leaves!

I do not want to be waited on, and have always been happy to value add in those areas where I have more expertise than the nurse, such as in physical examination, complicated diagnosis and pharmacology. I believe antenatal patients do benefit from seeing a doctor twice during the pregnancy and not being managed totally by a midwife. We are regularly not called for such emergencies as the birth of a prem baby, or a patient with an AMI having reteplase and developing VT as a perfusion arrhythmia!

I am not an independent practitioner – I want to work in a team where everyone has their own area of expertise recognised.

Please, Ms Roxon, do not change all general practices to this model which is not working in NT.

I think it is a little unjust to say a system does not work based on one example. Dr Alex Hope, a remote GP for many years placed the following post into the CARPA (Central Australia Rural Practitioners Association) discussion group (as well as commenting at 6minutes).

G’day All,
You may be interested in this link to 6minutes.com.au which is pertinent to remote GPs and remote clinics in the NT.
I’ve never come across this doctor, but her comment encapsulates a problem that collectively we should have fixed by now.

For myself, I have to admit I gave up working on the structural end of the problem 7 years ago. Soon after getting involved with the Division I was involved in discussions about two remote GP positions where the GP suffered especially as a result of impossible working conditions in a government clinic.

After 5 years of involvement in the system through the Division and the then NTRHWA I couldn’t see that there was much happening for the blackfellas in the scrub as a result, nor for the GPs (and other staff) who were prevented from making the best use of their skills because of the structural limitations they worked under. I thought my energies and skills would be better spent on making the model work on the ground, and it’s quite enough to keep me fully occupied.

Reading this post by the Galiwinku GP gave me a strong feeling of deja vue.

Where is the blockage in the system?
Are we really on track to fixing things using the opportunities offered by phase III of Mad Mal’s invasion?
Does this strategic review of Nicola Roxon’s offer another opportunity to move things along?

I really do believe that we should be proud of the functional examples
of primary health care delivery in Aboriginal Australia, and that it
does offer a model to the mainstream.

How can we foster and generalise it?

There are many ways in which health is provided out bush. It may be nurses provided by a government department and fly-in, fly-out doctors. It could even be a large community with a core group of nurses working for a long intervals in-between doctors out visiting for a short term contract. In others, all staff are employed by the health service with roles clearly defined. Some clinics are with sole GPs making their money by bulk-billing Medicare for their consults with patients. Staff turn-over is high amongst doctors and remote area nurses. This also affects patients and other health workers who have just got used to someone and then relationships have to be developed over again. Continuity of care can also be disrupted. Despite all this and the remoteness of some health services the majority of those I have been involved in over 10years or so work well.

There are also the flash in the pan visits. Pharmacists visiting under the S100 support allowance may fly or drive in(if flown in often the nurse has to leave the clinic to pick them up), physicians may visit under MSOAP arrangements, other organisations such as NPY also visit, or depending on your location, ring about a patient and want to become involved.

Funding is often not long term. Over the last twelve months as an example our planes were flying only with 3 month contracts from DOTARS. “Mr Smith, we can fly you in to get to hospital for your operation. We just don’t know when we can get you home”.

Funding needs to be provided over a longer term and adequate funding needs to be provided. Access Economics suggest the funding needs to be increased by $150m, $250m, $350m, $400m, $500m per annum over 5 years and then sustained at this level until the Indigenous Australian health gap closes. Oxfam and other agencies regularly suggest $400 million is required now and then every year to provide equitable access to healthcare.

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