What role can pharmacy play in sports health and physical activity promotion? Chris Brooker investigates
In most community pharmacies it’s one of the categories that regularly turns over without being a particular focus within the store—but is it one that could become a key area of professional service development and growth?
As most of the best-selling sports injury related products fall into the Schedule 2 and Schedule 3 medicines, it’s an area over which pharmacy could, and probably should, be exerting greater effort and expertise.
So what exactly is the role of pharmacy in sports injury and wound care?
Well obviously pharmacies sell a range of products that aid in sports performance and in minor injury treatment or post-sport/exercise recovery.
And obviously hospital pharmacy has a regular role in aiding in the treatment of acute minor sports injuries.
But is there are a regular advisory and treatment role that community pharmacy can play with regard to sports medicines?
A matter of confidence
Sydney pharmacist Nick Logan says wound care and sports injury is a “highly rewarding section of the pharmacy to specialise in”.
At his Artarmon pharmacy he has pioneered the forward pharmacy, professional services concept, winning the 2009 Pharmacy of the Year award, while Nick himself was the 2009 PSA Pharmacist of the Year.
He has a strong interest in sports medicine, playing a role with the NSW Waratahs rugby team and the Sydney Swans.
At a pharmacy level, Mr Logan says it’s vital to “planogram the wound care section before you proceed to develop it”.
“This is really the be all and end all of planning. It’s also important you carefully select the products you stock, and where they are located – you don’t want to be scratching around through boxes trying to find something when you have someone present with a sporting injury. There’s no quicker way to lose credibility really.”
In addition, he says continuing professional education to retain proficiency in the field is vital.
“At the end of the day your service and advice needs to be fast, professional and effective if it is to be one of your core professional services, and if you want to make money from developing the area, and attract and retain patients.”
“A lot of personal interaction is required for this sort of patient visit. Your staff will need to be familiar with the key products and who they should pass on directly to you.”
“It’s generally not overly complicated,” he says when it comes to an assessment. “Firstly you assess whether the patient needs to be referred, then you follow a basic management protocol. This is again fairly straightforward, providing you understand which dressing to apply for which wound, and these are quite specific. Also, advice on using the ‘rest ice compression elevation’ procedure for stress or trauma injuries.”
“Again it comes down to being proficient and confident in applying this advice, and knowing which treatment or dressing to use in a particular case.”
Karalyn Huxhagen, community pharmacist and 2010 Pharmaceutical Society of Australia Pharmacist of the Year, agrees that it’s important for the pharmacist to play an active role.
Writing in AJP last year, she said: “this degree of intervention will take time and patience and you may not have the ability to spend this much time with a patient.
It is very important that the pharmacy staff are well trained and can provide this information and support under your guidance”.
“Personally I would have the pharmacy staff keep dispensing and answering the phone while I attended to the crisis,” she said. “If you want to build your pharmacy’s business and develop rapport with the customer, then the person in the white coat needs to be out on the floor giving great service to the customers”.
Ms Huxhagen gave an example of dealing with a bicycle injury in a child and said in that instance a wound care management plan had to be developed and “given to the Mum as she will not remember everything you say”.
- Wash the area and establish the extent of the injury. Crush injuries involving nerves and blood supply would need to be referred, and you are probably going to be babysitting.
- Ensure there are no foreign bodies embedded. If unsure, refer to the emergency department for investigation.
- Stop the bleeding. Products with a seaweed base are exceptionally good at stanching bleeding. Provide a product that she can cut and apply to the fingers under the dressing.
- Provide a product that can be applied over the seaweed dressing. This product will need to absorb exudate and blood and not stick to the wound.
- Provide a product to hold everything in place. The appropriate product will depend on the age of the patient and what they want to achieve. For example, if this patient had fragile skin, I would use Handyband cohesive as it does not stick to the actual skin and does not cause skin tears to occur. It does hold everything in place. If this patient was a barmaid wanting a water-resistant bandage then I would use Coban or a similar product.
- Provide protection, for example finger stalls/waterproof over bandage if you think they are needed.
- how to clean and redress the wounds;
- signs of infection and when to seek medical aid;
- the need for pain relief; and
- the need for good nutrition and skin care for wound healing rates to be maximised.
Making a career of it
Interestingly, there are some developments in the US and UK towards moving pharmacists into more specialised roles in sports medicine.
US pharmacy publication Pharmacy Times said a recent study published in the American Journal of Pharmaceutical Education, found pharmacy students expressed a strong desire to help athletes with their medication regimens, and many also called for more sports pharmacy education in university curricula.
While this generally referred to becoming involved with professional sports – either through compounding sports supplements or providing detailed advice on dietary supplements or advice on banned products to avoid – other US reports do say this applies to amateur sports and mainstream pharmacy as well.
A report in US sports medicine journal Aspetar referring to the “emerging speciality of sports pharmacy” said that clinical settings “may range from community-based pharmacy, which offers a convenient and accessible resource, to a hospital orthopaedic ward where a pharmacist may be involved as part of a multidisciplinary team in the monitoring and management of medication for injuries of an acute or chronic nature as a result of sport or exercise injury”.
“In all clinical settings, sports pharmacists can complement the work of the sports physician, physiotherapist, podiatrist and other healthcare professionals involved with athlete care,” the report said.
“The pharmacist’s role in sports medicine often co-exists with other health specialties and can form part of a holistic approach to patient care”.
“Most pharmacy degree courses are generalist in nature and therefore produce pharmacy graduates who have knowledge and skills across the whole range of pharmacy practice. It is at the post-graduate level that pharmacists become specialists in disciplines such as oncology, paediatrics psychopharmacy. With the increasing involvement of pharmacists in sport, it is clear that specialised training in the field of sports medicine for pharmacists is needed”.
The lowdown on wound dressings
Dressings can be used as primary and/or secondary dressings depending on the wound. Primary dressings are placed directly onto the wound. Secondary dressings are placed over a primary dressing.
The choice of dressing depends on the type of wound, where the wound is located on the body, the amount of exudate and patient characteristics.
Before choosing a dressing, the patient must be assessed. Any underlying disease that will impact on wound healing needs to be identified. Also, any patient concerns should be identified, considered and addressed.
Dressings that create the most suitable environment at the wound-dressing interface will:
- absorb excess exudate from the wound while keeping the wound optimally moist;
- allow gas (i.e. oxygen, water vapour, carbon dioxide) and fluid to pass in and out;
- not adhere to the wound minimising trauma to granulating tissue when removed;
- be comfortable and conform to the wound shape;
- keep the wound at a stable 37oC;
- protect the wound from mechanical and bacterial injury so to minimise particulate and toxic contamination;
- not require frequent changes (unless infected);
- be non-toxic, non-allergenic and non-sensitising; and
- absorb wound odour.
Wound dressings can be classified into inert (passive) and interactive/bioactive
Inert (passive) dressings
Inert dressings provide a protective covering over a wound. They can be used in dressing minor cuts and abrasions, as well as cleaning shallow wounds and minor burns.
Active dressings can be classed as either interactive or bioactive. They help to control the wound healing environment promoting normal healing, by either:
- combining with the exudate to form a gel
- controlling the flow of exudate from the wound into the dressing (e.g. films, hydrogels, foam dressings)
- delivering substances that actively assist in wound healing (e.g. hydrocolloids, alginates).
Microbial contamination on the surface of a wound can slow the healing process. If a wound is infected, systemic antibiotics are usually required along with an anti-infective dressing
To recommend the most appropriate dressing for the wound:
- review the appearance of the wound
- match the absorbency of the dressing to the amount of exudate from the wound
- look at the skin surrounding the wound
Source: PSA Action WoundCare supplementary materials 2016 (www.psa.org.au/wp-content/uploads/WoundCare_ACTIONkitSup_May16_FINAL.pdf) – this also contains a summary of dressings and a wound dressing selection tool.