Andrew Roberts – who is better known to friends, patients, colleagues and Twitter followers as Robbo – has one of the more unusual jobs in Australian pharmacy.

He lives in a remote Western Australian community of about 100 people about 150kms from the NT and SA border. He works for an Aboriginal health service that covers 250,000 square kilometres.

“Just think of England, with those important bits of Wales and Scotland chopped off,” he says.

Robbo travels between 45,000 and 60,000 kilometres a year, “most of it on dirt”, he adds.

But he is not nearly as isolated as that description might make him sound – because he is connected with a wide professional and social network via social media.

Robbo blogs regularly at Bite the Dust, where he posts a mix of professional and personal observations, looking at the issues of remote, rural and Indigenous health and life out bush.

Amongst other colourful photography, the blog features a series of photos of abandoned cars called “Wreck of the Week”.

He started the website about ten years ago to provide a contact point for people wanting to hire him as a locum. He began blogging about three years ago, out of a sense of frustration that professional pharmacy organisations were neglecting the interests of rural and remote pharmacy.

As he writes on the blog: “A lack of interest and action in these issues by my professional bodies, with the pharmacy owner’s association (Pharmacy Guild of Australia) wanting to control all “community” pharmacist activities through pharmacies I believe is hindering the provision of quality pharmacist services to those in remote, and to a lesser extent, rural areas.”

Robbo's blog

However, Robbo’s engagement with social media is certainly focusing wider attention on the issues of remote and Indigenous health and pharmacy.

On Twitter, he has more than 1,200 followers, including many health professionals and health organisations, Aboriginal leaders, politicians and journalists.

He is featured in the Pharmacist Coalition for Health Reform’s new campaign called “pharmacists: the best kept secret in healthcare”, and believes other pharmacists could also use social media to advance the profession and public health.

Robbo says Twitter has expanded his professional network, and also directs him to useful health and medical information and articles. He also uses Twitter to engage in discussions with other health professionals, and to have specific questions answered.

“Most people on Twitter are there because they’re willing to share,” he says.

Robbo's Twitter profile

Robbo is active in the Health Care and Social Media Australia New Zealand (#hcsmanz) Twitter chat group, and encourages other pharmacists to check out Twitter.

“For me, Twitter has been great in terms of networking, and it’s turned into a bit of a social tool as well,” he says. “It broadens your knowledge base. You’re getting exposed to a multiplicity of views.”

Robbo grew up in country Victoria, and his first job in pharmacy was as a delivery boy. After graduating in 1987, he took locum jobs in rural and remote areas across the country, eventually ending up in Alice Springs.

He began his current job about six years ago, working as part of a primary health care team that spans ten clinics. His role includes counselling patients, educating health workers, reviewing prescriptions and systems, running drug evaluation reviews, and providing advice to doctors and nurses.

“The most important thing for me is working with patients to increase understanding and health literacy,” he says.

While pharmacists have not traditionally been included in remote health teams, Robbo would like to see many more colleagues in similar roles as himself.

“You wouldn’t build a new hospital without having a pharmacy department, you wouldn’t build a new suburb without having a pharmacy in there, and yet there seems to be this philosophical view that we’renot needed out bush,” he says. “But we can make a real difference.”

As well as the professional satisfaction of feeling that he is making a difference, Robbo enjoys being part of the community.

“When you get accepted by a local community, you have a place and that’s very, very rewarding. For me it’s working with wonderful people in a wonderful part of the country.”

Directors of hospital pharmacies across Australia and the Western Pacific Region will be asked to complete a series of surveys in coming months about details of their practice.

The surveys are part of a project by University of Sydney researchers that aims to provide better understanding of barriers and facilitators to optimum hospital pharmacy practice.

The surveys will ask about several aspects of the Basel Statements, which encompass a vision for the future of hospital pharmacy, as agreed at an international meeting of hospital pharmacists in Basel, Switzerland, in 2008 (see footnote for more detail).

According to hospital pharmacist, Mr Jonathan Penm, who is conducting the surveys as part of his PhD, they will help provide a map of hospital pharmacy in a variety of countries and settings.

“We will be trying to understand not just what is going on – but also to understand the reasons behind current practice,” Mr Penm says.

“The findings may lay the basis for subsequent interventions.”

Read the rest of this entry »

As director of pharmacy for the Central Queensland Health Services District, Robert Forsythe has been involved in an innovative program to improve patient care at Rockhampton Hospital.

Below is a short profile of Mr Forsythe, followed by a Q and A session about his experiences introducing a program to encourage the use of patients’ own medicines in hospital. “We must not kid ourselves that any change is ever simple,” he says.

But Mr Forsythe’s main message for policy makers is that Australia needs a single source of funding for pharmaceuticals.

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The Profile: Bringing a world of experience to Central Queensland

After graduating from Queen’s University in Belfast in 1994, Robert Forsythe wasn’t sure where his career would lead but knew he wanted a job where he would be making a difference to patients.

His first hospital job took him to Guernsey in the Channel Islands, during which time he undertook a long-distance postgraduate qualification in clinical pharmacy, including a placement at a London hospital.

In many ways his experiences on the isolated islands proved helpful in preparing him for working in regional Queensland.

“We didn’t have big pharmacy wholesalers down the road, the airport used to get fogbound,” he says. “We used to have to be very self sufficient and to rely on other places to provide services for our patients. In some ways it was very much the same as here in Rockhampton.” Read the rest of this entry »

Dr Danielle Stowasser has worn many professional hats during her career as a hospital pharmacist. Amongst other things, she’s also been a software designer, academic, bureaucrat and corporate CEO.

In her latest role, as clinical advisor to the National Prescribing Service, Dr Stowasser is developing some new resources and training programs for hospital pharmacists.

The thread that has linked Dr Stowasser’s many roles over the past 20 years is an abiding concern for patient safety.

“Safety is very important,” she says. “It’s fundamental to pharmacists’ role.”

Dr Stowasser’s appreciation for patient safety issues developed early, when she took up a job at Royal Darwin Hospital after graduating from the Victorian College of Pharmacy in 1989.

During two-and-a-half years in Darwin, often working with remote and Indigenous communities, she saw first-hand the problems that can arise with cross-cultural communication and remote service delivery.

“It gave me a greater understanding of the needs that different consumers have in different areas of health,” she says.

The benefits of rural practice

Now, she strongly recommends working in rural and remote areas to young graduates, telling them it will bring experience and opportunities they would rarely get in cities.

“I loved it,” she says. “I was one of ten pharmacists at the hospital, rather than 100.  It gave me the best opportunities because I could do a range of things.”

On her way back to Melbourne from Darwin, Dr Stowasser took a job at Greenslopes Repatriation Hospital in Brisbane, expecting to stay in Queensland for a year. But she met her husband, and is still there, 18 years later.

At Greenslopes, she was fortunate to work with colleagues who believed in innovation, and there she developed a taste for research.

When the hospital was privatised, she was offered a job at the University of Queensland as a research officer doing a program on medicines liaison, which led into doing a PhD.

As part of her doctoral studies, she helped set up a randomised controlled trial evaluating the impact of placing pharmacists in pre-admission clinics for surgery patients. While this is common now, it was radical at that time.

The trial, which ran from 1996 to 1999 with clinics in the Princess Alexandra Hospital in Brisbane and St Vincent’s Hospital in Sydney, found the pharmacy care dramatically improved patient outcomes, by reducing the number of problems occurring around medicines use, such as patients being sent home without their correct medications.

“We significantly reduced the incidence of hospital readmission from medicines-related problems,” says Dr Stowasser.

During this period she became interested in software, and developed a computer program to generate a medicines list on admission and discharge, which was subsequently implemented by about 200 hospitals across Queensland.

After finishing her PhD, Dr Stowasser spent several years working for Queensland Health, establishing a state-wide quality use of medicines unit that is now Medication Services Queensland.

She also worked on the implementation of a state-wide pharmacy computer system, and a national inpatient medication chart, which is now in around 2,000 hospitals and has been shown to significantly improve medication safety and use.

“We found that it improved the quality of prescribing, and reduced errors in prescribing,” she says.

Another safety gain came from lobbying the manufacturers of potassium chloride to use different packaging so it couldn’t be confused with saline ampoules, as had happened in the past with sometimes fatal consequences.

Dr Stowasser also worked with the Queensland Health Quality and Complaints Commission, as director of quality and standards, but realised she preferred working within frameworks that encouraged professional buy-in, rather than punitive regulatory approaches.

From that experience, she learnt “that regulation will result in change but it may not result in change in attitudes and beliefs”.

“You actually have to change attitudes and beliefs to have long-term sustainability,” she says.

Dr Stowasser then left the public service to work as a CEO for a private IT firm, called Charm Health, for two years. “I absolutely loved it,” she says.

Reaching out to hospital pharmacists

But when a job came up as clinical advisor with the National Prescribing Service, she was ready to return to working for public health.

Her current role involves being the clinical spokesperson for the NPS, running the therapeutic topics management group, and providing strategic advice.

The NPS has previously largely focused on resources and services for GPs, with forthcoming programs targeting antibiotic resistance, antipsychotic prescribing, including in nursing homes, and heart failure.

While many of these issues are also important for hospital practice, the NPS is now gearing up to develop resources and training specifically for hospital pharmacists.

Dr Stowasser is keen to hear from hospital pharmacists about what particular areas or issues they’d like the NPS to address.

• To suggest topics, contact dstowasserATnps.org.au

Despite predictable opposition from the AMA, moves are afoot to extend the professional role of pharmacists.

In its 2011/12 budget submission, the Pharmaceutical Society of Australia called for a federally-funded network of liaison pharmacists, with one salaried pharmacist for every Medicare Local to improve cost-effective health services for consumers with mental illness.  The Society of Hospital Pharmacists of Australia has been supporting the inclusion of pharmacists in the clinics for some years.

Meanwhile, our fourth post at this new blog for hospital pharmacists profiles a mover-and-shaker in the profession, Associate Professor Lisa Nissen, who talks about her longstanding interest in expanding the roles of pharmacists.

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Building a future for pharmacy

After working in rural and metropolitan hospitals for four years after graduating from the University of Queensland in 1993, Lisa Nissen reached a make-or-break point in her relationship with pharmacy.

Frustrated by a lack of options for a career in clinical pharmacy, she applied to study medicine.

But when the acceptance from medical school came through, she opted to remain with her first love.

“I weighed up going to medical school or going back and doing a PhD,” she says. “The PhD won, basically because I love pharmacy.

“I wasn’t going to do medicine because I didn’t like pharmacy, it was because I wanted to do more.

“So I decided to go into clinical research and pharmacy practice research, to help build the profession, and get involved in shaping the profession of the future. I wanted people to like pharmacy like I like it.”

Now an associate professor at her alma mater, Lisa, 38, remains an enthusiastic advocate for a broader scope of practice for her profession. Read the rest of this entry »

Welcome to the third post on this new blog for hospital pharmacists. This month we profile someone who has recently been acknowledged by his peers for his tremendous contribution to clinical pharmacy practice.

Teamwork is what keeps this hospital pharmacist excited about going to work

Most mornings, hospital pharmacist Garth Birdsey is to be found on ward rounds, checking the progress of patients suffering acute coronary events or who have heart failure or other such problems.

He generally makes the rounds in the company of a medical registrar, two residents, and a nurse specialist. They typically see about 30 patients before lunch.

Mr Birdsey, who works in cardiac services at Barwon Health, based in Geelong Hospital in Victoria, was recently awarded the 2010 Australian Clinical Pharmacy Award. This recognises outstanding contribution to clinical pharmacy practice by a member of the Society of Hospital Pharmacists of Australia.

In an interview with Who’s Talking, it soon becomes blindingly obvious that Mr Birdsey is one of those fortunate people who genuinely loves going to work.

One of its main pleasures, he says, is the opportunity to work with patients as part of a collaborative, multidisciplinary team. His experience is a million miles from the turf wars between doctors, nurses and other health professionals that so often dominate the headlines. Read the rest of this entry »

Welcome to the second post on this new blog for hospital pharmacists. It reports on calls for a system to enable national assessment of the cost effectiveness of high-cost hospital medicines. If you have suggestions for other topics for stories and interviewees, please send these through via the comments section.

On the agenda: national assessment of the cost effectiveness of high-cost hospital medicines

Australia should move to establishing a national mechanism for assessing the cost effectiveness of high-cost medicines used in hospitals, according to a senior expert.

Professor Paul Seale, who has previously chaired the NSW Therapeutic Advisory Group and the Council of Australian Therapeutic Advisory Groups (CATAG), says high-level discussions are underway to advance this proposal.

Ideally, the Pharmaceutical Benefits Advisory Committee (PBAC) would assess the cost effectiveness of medicines used in hospitals as well as the community, he says.

Professor Seale, Professor of Clinical Pharmacology at the University of Sydney, says the current approach – whereby individual hospitals do their own assessments of high-cost medicines – results in significant inequities, as well as budgetary pressures.

For example, patients at one hospital may have access to medicines that are not available to patients at other hospitals, he says. Read the rest of this entry »

Welcome to the first post on this new blog for hospital pharmacists. It will feature articles about issues that I hope will be of interest to hospital pharmacists. I look forward to your suggestions about topics for stories and interviews, and to your comments on the posts.

Robotics and pharmacy

Will robotics provide an effective and affordable mechanism for reducing occupational health and safety risks to hospital pharmacists who are involved in preparing chemotherapy treatments?

While conclusive answers to this question are not yet available, some hints are likely to emerge at the Society of Hospital Pharmacists of Australia (SHPA) national conference in Melbourne this month.

Mrs Sue Kirsa, the head of pharmacy at the Peter McCallum Hospital in Melbourne, will be discussing her team’s experience in trialling the use of a robot in preparing cytotoxic drugs.

Sue explains that the project arose out of a 2006 study involving ten Victorian hospitals that showed contaminated surfaces in clean rooms where pharmacists and pharmacy technicians prepare chemotherapy drugs for administration. These findings confirmed similar research conducted in other countries over the previous 20 to 30 years that had also raised occupational health and safety concerns. Read the rest of this entry »