Beyond dispensing


hospital pharmacist medication chart

The future for pharmacy lies in decision making, patient-facing roles and building strong relationships with medical colleagues, says SHPA president Michael Dooley

With healthcare moving into an increasingly digital landscape, is hospital pharmacy keeping up?

Professor Michael Dooley, President of the Society of Hospital Pharmacists of Australia (SHPA), says the digital shift has become a great opportunity for pharmacists and is leading to new roles for the profession.

“A large proportion of hospitals are now implementing electronic medical records over the next three years. Medicines are a key component of that, and as a consequence the pharmacist involvement is really high,” he told AJP at the 10th National Medicines Symposium, hosted by NPS MedicineWise in Canberra this week.

Professor Dooley, who is also Director of Pharmacy at Alfred Health and a Professor of Clinical Pharmacy at Monash University, featured on a panel at the symposium discussing digital and personal healthcare.

“In a lot of organisations, the team that looks after the decision support are mainly pharmacists. Not only do you have traditional pharmacy services but now we have pharmacists getting involved in informatics, they’re helping to design and implement systems … so it’s a whole new avenue for practice and it’s integrating clinical practice with the digital systems to make care better,” he says.

“It’s a lot of work, it’s a lot of change and a lot of redesign, but there are certainly fantastic opportunities for pharmacists and fantastic opportunities to improve care.”

With some pharmacists voicing concerns that digital health records will add to already their already large workloads, Professor Dooley says he hopes these changes will eventually streamline clinical practice and allow pharmacists to work more directly with patients.

“I think there will be some significant efficiencies in the system around that, which hopefully will then free up pharmacists to do more advanced practice roles … [and] more patient-facing activities. But it’s up to the sites and the hospitals to be able to do that.

“It will make care safe because some of those issues around transcription errors, duplication, delays in care because someone hasn’t written something down, delays in care because the drug chart has to be rewritten, all of those things will be reduced which will help,” he says.

“It’s still dependent on smart people using smart technology, what we need is really smart pharmacists working at the top part of their scope of practice and hopefully these systems will free up their time to do that.

“It’s certainly not a passive thing … you still want to make sure people see the patient and not just look at a computer.

“So we have to be very aware of implementation. But we’re very excited that over time it will really make care better and lots of other opportunities to free up pharmacists’ time to really practice at that high level – at that advanced practice level – which is making decisions about which drugs to use and which medicines to use and which not to.”

Meanwhile, Professor Dooley doesn’t think hospital pharmacists will be replaced by these digital systems anytime soon.

“At our hospital there’s no push to replace pharmacists with these digital systems, if anything it’s made the pharmacy position stronger within the department and it’s made the role and opportunities for pharmacists within the service much stronger. We’re even creating new positions, and this is happening across the country.

“It’ll probably take five years to see the full benefits of these changes but pharmacy has to be absolutely at the coalface and take leadership positions in the implementation, where pharmacists in hospitals are taking an absolute key pivotal role in implementation which is exciting.”

Professor Michael Dooley featured on a panel at the symposium discussing digital and personal healthcare.
Professor Michael Dooley (second from right) featured on a panel at the symposium discussing digital and personal healthcare.

Pharmacists in demand

The ‘doctors versus pharmacists’ paradigm often seen across the community pharmacy landscape just doesn’t exist in hospital pharmacy, says Professor Dooley.

“Our experience, especially in the hospital environment, is that doctors overwhelmingly welcome pharmacist skills and their involvement in the care of patients. Same with the nursing staff, we get asked for more pharmacists every single day,” he tells AJP.

“It’s probably a lot harder when somebody doesn’t experience it. And it’s like anything, rarely do you spend money on or ask for something that you’ve never seen. And that’s just life. We need to see it to value it to then want it.

“And medical staff are like that, they need to see good pharmacists practising and make an impact on the patient, then they will ask for more. If they’re not seeing it, why would they ask for it?

“And I think it’s not a resistance on the medical staff, and not a resistance from nurses.

“It’s really about pharmacists being able to demonstrate how they can make care better, they’ve got to demonstrate that value.”

“The profession needs to be out there and needs to be engaging and demonstrating benefit. And then when people see the benefit, they value it and they ask for more.

“That’s what we’ve tried to do in hospitals, is to be innovative, implement new systems and then people will ask for them. And often do that without the funding, do it ourselves, show the benefit, then people will want more, then you may get the funding.

“So from the medical side, they’ve been overwhelmingly supportive of the pharmacy profession in my experience. Probably moreso than the pharmacy profession. But I see that all the time. So I’m very optimistic and my medical colleagues are forever asking for pharmacists to do more.”

 

Challenges in hospital pharmacy

The biggest challenge at the moment for hospital pharmacists is the increasing complexity of care, says Professor Dooley.

“Patients are more complicated, they have more comorbidities, length of stay is shorter – so care is more complicated,” he says.

“Where we used to have 40 opioids available we now have 160 different opioid presentations available. So we’re seeing more medications, more complexity, more complex patients coming through the system a lot quicker.

“It’s really about how do we minimise admissions when they’re not needed, how do we make care better during their stay, how do we transition patients out and how do we collaborate with providers post-discharge.

The other challenge is developing the educational capacity of pharmacists to be able to practice at their full scope of practice, he says, adding that this was the impetus behind the SHPA launching its Residency Program last year.

“In hospitals, we believe that not every pharmacist can do everything, there’s differences. Not every pharmacist can go work in ED, work in ICU, then work in an oncology ward, general med, acute psychiatry… our training needs to be more than just when we graduate.

“And that’s why we’ve implemented residency programs in hospitals, just like doctors do, to make sure that the basic building blocks of practice are really strong and then building the expertise on top of that. The contribution of pharmacists is really around that decision making, not the dispensing part.

“Dispensing is very important but the future for pharmacy is around developing cognitive services, influencing decision making, improving care of patients and facing patients.”

“Other components of what we do historically will probably be more likely move into automation in certain aspects, so we have to work with smart people and give them the knowledge, skills, experience and do that in a collaborative environment, working alongside doctors and nurses in that multidisciplinary environment, because that’s where the best education occurs.

“Doctors learn what pharmacists are thinking, pharmacists learn about what doctors are thinking, nurses learn about medications, pharmacists learn about the issues of administration of medications – because you work as a team. The training should be in the team.”

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