Why would a complex ambulance service not employ a pharmacist?


ECP Pharmacist - drug drawer

Pharmacists have an enormous amount to offer by entering the ambulance world and other less typical environments, writes Dr Peter Hayball

Why would a complex ambulance service not employ a pharmacist?

Are there other, more qualified healthcare professionals capable of performing tasks ranging from complex drug distribution (involving Schedule 8 medicines), medication safety through to consulting on best and worst medicines for paramedic clinical protocols?

Chris Alderman succinctly depicted a traditional pharmacist stereotype and I would have embellished subtly with the wary, resinous scent of (likely oxidised) cade oil further repelling the customer from the confines of the dispensary; available at http://onlinelibrary.wiley.com/doi/10.1002/jppr.1129/full.

Jane, an 82-year-old with Alzheimer’s disease who resides in an outer Adelaide suburb nursing home, experiences a terrifying episode of BPSD at 2am.

Minh Jo (not her real name) is a petite Malaysian enrolled nurse who single-handedly tries desperately to de-escalate the situation as well as trying to pacify other residents who’ve been awoken by the commotion.

Her only solution is to ring 000 and an extended-care paramedic (ECP) is quickly in attendance to assess Jane trying to ascertain the trigger for her rapidly deteriorating behaviour and hopefully, to provide a solution which would avoid a transport to a hospital emergency department which is likely to exacerbate Jane’s intense distress.

This is a scenario that has been extensively researched, discussed and planned by an ambulance paramedic manager and ambulance pharmacist.

The ECP has a range of pharmacological interventions she can draw upon depending on the nature of the trigger; it transpires that Jane is suffering from a recurrence of a urinary tract infection which was detected at the bedside using a urine dip-stick test strip and a course of trimethoprim is immediately supplied by the paramedic from a carefully crafted drug formulary in the ambulance which includes risperidone should an antipsychotic have been necessary.

Inappropriate prescribing of multiple anticholinergics, which have the potential to exacerbate Jane’s BPSD, is noted in Jane’s medication chart and a consultant pharmacist RMMR referral is activated by the ECP via Jane’s GP.

Multiple health-care professionals working together, as in this case study, is immensely satisfying for all involved and mostly results in a vastly improved patient outcome. Pharmacists have an extraordinarily powerful reputation among their professional colleagues, possibly with the exception of the cade-oil infused pharmacist inhabitant, and too often as pharmacists we find ourselves competing with, and frustrated by, members of our own profession.

Be prepared to talk to other professionals, take some risks that you may be wrong and offer an opinion. Hiding behind the excuse that we need to consult a compendium before we offer a professional opinion can slow, paralyse or indeed catastrophise the decision-making process.

Remember the oft-quoted adage that “medicine is a grey art” where concrete evidence-based, randomised clinical trials may simply not exist for our clinical scenario or patient cohort and we need instead to rely on experience, scientific principals and a proactive mindset.

I’ve discovered in the ambulance world that what we in the pharmacy world consider to be scientifically black and white, such as pharmaceutical chemistry principles that model physicochemical drug degradation and shelf-life, are similarly shaded grey in the real world of pre-hospital medicine.

To be successful in complex, shared-care patient treatment paradigms, pharmacists must be prepared to offer a professional opinion, relying on our extraordinarily broad training in medical and physical sciences as well as our proficiency with patient and inter-professional communication.

I know many of the younger pharmacy graduates have been understandably dismayed by the profligate tertiary education sector in Australia; however, it is exactly this sort of workplace environment which forces the hungry amongst us to seek new opportunities and there are plenty out there.

Dr Peter Hayball BPharm BSc(Hons) PhD AACPA is the Principal Pharmacist, South Australian Ambulance Service

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