Evaluation of a new educational workplace-based program for provisionally registered pharmacists in Australia

OBJECTIVE

The Intern Foundation Program (IFP) is an innovative new program for intern pharmacists (provisionally registered pharmacists) that integrates academic theory with structured workplace learning and regular feedback, incorporates research training, and streamlines training of clinical educators (CEs). The aim of this research was to evaluate aspects of the IFP from the perspectives of both CEs and interns, gauging opinion about the impact on workload, structured workplace learning, addition of research training, CE-student relationships, CE standardized training, and intern transition to practice.

METHODS

Two focus groups were conducted to explore CE (N = 6) and pharmacy intern (N = 7) perspectives of the IFP. A topic guide was constructed to address the research aims. Thematic analysis was undertaken by two team members independently then in discussion.

RESULTS

Both the CE and intern groups reported that the IFP enabled more structured supervision and fostered a better intern-CE relationship with beneficial support from the university. IFP standardized rubrics and checklists used as part of workplace learning assisted with more consistent feedback for interns and training approaches for CEs alongside CE training. Participants also reported that undertaking a research project provided them with enhanced learning and new skill development.

CONCLUSIONS

Participants in the pilot agreed that the IFP is a valuable program, deemed complementary to the intern training program that assists intern transition to independent practice through implementation of a unique curriculum based largely on workplace learning, research training, fostering better CE-intern relationships, robust CE training, and close university-workplace support.

Multi-site evaluation of partnered pharmacist medication charting and in-hospital length of stay

AIMS

To undertake a multicentre evaluation of translation of a partnered pharmacist medication charting (PPMC) model in patients admitted to general medical units in public hospitals in the state of Victoria, Australia.

METHODS

Unblinded, prospective cohort study comparing patients before and after the intervention. Conducted in seven public hospitals in Victoria, Australia from 20 June 2016 to 30 June 2017. Patients admitted to general medical units were included in the study. Medication charting by pharmacists using a partnered pharmacist model was compared to traditional medication charting. The primary outcome variable was the length of inpatient hospital stay. Secondary outcome measures were medication errors detected within 24 h of the patients' admission, identified by an independent pharmacist assessor.

RESULTS

A total of 8648 patients were included in the study. Patients who had PPMC had reduced median length of inpatient hospital stay from 4.7 (interquartile range 2.8-8.2) days to 4.2 (interquartile range 2.3-7.5) days (P < 0.001). PPMC was associated with a reduction in the proportion of patients with at least 1 medication error from 66% to 3.6% with a number needed to treat to prevent 1 error of 1.6 (95% confidence interval: 1.57-1.64).

CONCLUSION

Expansion of the partnered pharmacist charting model across multiple organisations was effective and feasible and is recommended for adoption by health services.

Partnered pharmacist charting on admission in the General Medical and Emergency Short-stay Unit - a cluster-randomised controlled trial in patients with complex medication regimens

WHAT IS KNOWN AND OBJECTIVE

Patients admitted to general medical units and emergency short-stay units are often complex with multiple comorbidities, polypharmacy and at risk for drug-related problems associated with increased morbidity and mortality. The aim of this study was to evaluate the effectiveness of a partnered pharmacist charting model completed at the time of admission to prevent medication errors.

METHODS

We conducted an unblinded cluster randomized controlled trial comparing partnered pharmacist charting to standard medical charting among patients admitted to general medical units and emergency short-stay units with complex medication regimens or polypharmacy. This trial was conducted at an adult major referral hospital in metropolitan Melbourne, Australia, with an annual emergency department attendance of approximately 60 000 patients. The evaluation included patients' medication charts written in the period of 16 March 2015 to 27 July 2015. Patients randomized to the intervention were managed using the partnered pharmacist charting model. The primary outcome variable was a medication error identified by an independent assessor within 24 h of admission, who was not part of the patient's admission process.

RESULTS

Of the 473 patients who received standard medical staff charting during the study period, 372 (78·7%) had at least one medication error identified compared to 15 patients (3·7%) on the partnered pharmacist charting arm (P < 0·001). The relative risk of an error with standard medical charting was 21·4 (95% CI: 13·0-35·0) with a number needed to treat (NNT) to prevent one error of 1·3 (95% CI: 1·3-1·4), and the relative risk of a high or extreme risk error with standard medical charting was 150·9 (95% CI: 21·2-1072·9) with a NNT to prevent one high or extreme error of 2·7 (95% CI 2·4-3·1).

WHAT IS NEW AND CONCLUSION

Partnering between medical staff and pharmacists to jointly chart initial medications on admission significantly reduced inpatient medication errors (including errors of high and extreme risk) among general medical and emergency short-stay patients with complex medication regimens or polypharmacy.

Pharmacy education in the context of Australian practice

Accredited pharmacy programs in Australia provide a high standard of pharmacy education, attracting quality students. The principal pharmacy degree remains the 4-year bachelor of pharmacy degree; however, some universities offer graduate-entry master of pharmacy degrees taught in 6 semesters over a 2-year period. Curricula include enabling and applied pharmaceutical science, pharmacy practice, and clinical and experiential teaching, guided by competency standards and an indicative curriculum (a list of topics that are required to be included in a pharmacy degree curriculum before the program must be accredited by the Australian Pharmacy Council). Graduate numbers have increased approximately 250% with a dramatic increase from 6 pharmacy degree programs in 1997 to 21 such programs in 2008. Graduates must complete approximately 12 months of internship in a practice setting after graduation and prior to the competency-based registration examinations. An overview of pharmacy education in Australia is provided in the context of the healthcare system, a national system for subsidizing the cost of prescription medicines, the Australian National Medicines Policy and the practice of pharmacy. Furthermore, the innovations in practice and technology that will influence education in the future are discussed.

Australian national strategy for pharmacy preceptor education and support

OBJECTIVES

(i) To develop a national strategy for pharmacy preceptor education and support, with special consideration for rural and remote practitioners. (ii) To deliver an innovative national core pharmacist preceptor education and support model that could be customised for specific undergraduate programs.

DESIGN

A steering committee, with representatives from four Pharmacy Schools in three Australian states, was established to develop an educational curriculum and implementation strategy.

SETTING

The project was designed to provide an online educational program for preceptors of Australian pharmacy students, particularly those in rural areas.

SUBJECTS

The recipients of this program will primarily be rural pharmacy preceptors but could also be urban practitioners.

INTERVENTIONS

After consultation with an advisory group, the steering committee considered the educational content, delivery strategy and adaptability of the package to maintain its currency and links to universities, pharmacy boards and professional organisations: an extensive literature search was conducted; writers and an educational designer were employed. The steering committee reviewed and modified the content before transfer of the program to the worldwide web.

MAIN OUTCOME MEASURE

The development of a Pharmacy Preceptor Education Program suitable for national application and able to fulfil the needs of rural preceptors.

RESULTS

A Preceptor Education Program has been developed suitable for use in all Australian states and capable of meeting the needs of rural pharmacy preceptors.

CONCLUSIONS

Collaboration between four schools of pharmacy and pharmacy professional bodies has resulted in development of a flexible program for preceptors of undergraduate pharmacy students. This program can be developed for use by preceptors of pharmacy graduates, and in other disciplines.

Glycopeptide-induced vasculitis--cross-reactivity between vancomycin and teicoplanin

Teicoplanin has been suggested for use in patients suffering complications from vancomycin. We describe two patients who developed a vasculitic rash whilst on vancomycin with recrudescence of the rash with subsequent teicoplanin therapy.

Quantitative appraisal of Picolax (sodium picosulfate/magnesium citrate) in the preparation of the large bowel for elective surgery

The authors have investigated the metabolic sequelae Picolax bowel preparation in a group receiving their preparation either 24 hours (n = 17) or 48 hours (n = 18) before elective colonic resection. No significant changes in any metabolic parameter were found in the 24-hour group. In the 48-hour group, there was a significant decrease in serum sodium (P less than 0.005), serum chloride (P less than 0.005), pH (P less than 0.005), HCO3 (P less than 0.005), and base excess (P less than 0.005). Only 16 of 35 cases (46 percent) had an acceptable bowel preparation: 11 of 17 (65 percent) in the 24-hour group and 5 of 18 (28 percent) in the 48-hour group. Marker studies did not correlate with the quality of bowel preparation. The risk of potentially explosive intraluminal gas was increased if the bowel preparation was poor: 12 of 19 patients (63 percent) with a poor bowel preparation compared with 3 of 16 patients (19 percent) of those with an acceptable preparation (P less than 0.005). Picolax is a poor mechanical bowel preparation and is associated with unacceptable physiologic disturbance if given two days before surgery.

Recent experience with arterial embolism of the limbs in a vascular unit

A 5 1/2-year experience of 147 patients with arterial embolism of the limbs is reported. The mean age was 66.9 years, range 24-90 years and the male to female ratio was 1.07 to 1. Two distinct types of embolic episode with very different clinical consequences were recognised. Type I (64%) in which large emboli occluded the proximal arteries of the lower limb. They were usually treated by embolectomy and were followed by death or permanent disability in 63% of patients. Type II (36%) in which small emboli occluded the arterial supply of the upper limb or the arteries of the distal lower limb. Embolectomy was performed in only 60% of cases. Death was unusual and disability occurred largely as a consequence of non-surgical management. After occlusion of the aorta, iliac or femoral arteries embolectomy is necessary to save both life and limb while after embolism of the arm or distal lower limb it is essential for the preservation of function.