Fred J Boyd 2007 Award - jppr

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the guidelines for safe handling of cytotoxic drugs in pharmacy departments and hospital wards; they were updated in 1982 to include the recommendation of using a laminar flow cytotoxic drug safety cabinet. Unfortunately, the 80s were also the era of economic rationalism, recurrent cost-containment measures, Booz-Allen reviews, and perceived fat trimming. We struggled to justify the costs of clinical pharmacists. In 1985, the year I was appointed as Chief Pharmacist, there were no fewer than eight articles published in the AJHP on clinical pharmacist workloads and activities, and the first costing study was published to demonstrate cost justification of clinical services. These surveys and activities, published and promoted by SHPA, assisted pharmacy managers to promote clinical pharmacy as part of a comprehensive pharmacy service. Chris Doecke, at the 1991 Federal Conference, heralded the path of clinical pharmacy in the 1990s by asking the question, ‘Why are we still talking about putting theory into practice after 20 years. We must move to measuring improvement in patient outcomes, ensuring the quality of our services, focus on appropriate drug use and collaborate in changing prescribing practices’. Quality Assurance, Total Quality Management, and Quality Use of Medicines thus became the themes of the late 80s and 90s, focusing on not what we did, but what we achieved. Many initiatives were published and taken up to promote Quality Use of Medicines. In 1992, the Quality Assurance COSP published the first SHPA performance indicators and in 1996 Standards of Practice for Drug Usage Review were published. In 1993, pharmacoeconomics was the theme of the Sydney Federal Conference. There were many attempts, facilitated by SHPA, to train us in drug use economics, quality of life year assessments, decision analysis, pharmacoeconomic evaluations, and we tried to apply these principles to our drug and therapeutic committee decisions—in my case, a miserable failure. In the 90s we were called upon to provide evidence of the value of clinical pharmacy services. SHPA was unwavering in its support for pharmacy managers and in 1998 commissioned the clinical pharmacy intervention study demonstrating that routine review of patient drug therapy saves lives, improves patient care, reduces length of stay and saves money. Although, by the start of the new millennium, the quality and safety agenda had been taken up and clinical pharmacists were indelibly viewed as critical to safe medication practices, the study, finally published in 2003, confirmed the Safety and Quality Council’s view that the provision of clinical pharmacy services reduces medication incidents. This leads me to mention the overall health policy changes that have impacted over the past three decades on our ability to get on with saving lives. Although, I thought we did pretty well in the 70s (after all, it was before ACT self government and Royal Canberra Hospital was Commonwealth funded with what seemed like unlimited resources), the 1980s were times of constant change; curtailed staff levels, workload growth, oppressive financial restrictions, hospital closures (including my own, Royal Canberra Hospital) and amalgamations which led to major upheavals of pharmacy departments. In the 1990s, changing organisational structures in hospitals affected most pharmacies. Organisation restructuring was a feature of the 1995 Federal Conference in Melbourne. There was much debate in the AJHP about whether we should join an allied health division. There were issues of power and politics, seeking of greater recognition and greater resource allocation. There was the emergence of alternatives to the functionally based divisional structures to product-focused or matrix structures, with decentralised management and devolvement of costs. We also had DRGs, clinical costings, cost weights and casemix funding to contend with in the 90s, SHPA again being heavily involved in supporting pharmacy managers with these new considerations. And thence to the jargon of the new century: clinical streaming, patient-centred care, service integration, organisational capability, clinical and corporate governance, stakeholders, benchmarking, accountability, clinical risk management, frameworks, clinical and non-clinical outputs, flexible models. I would like to quote from ACT Health’s current Quality and Safety Strategic Plan: ‘The clinical governance framework has been established to provide explicit lines of accountability with a clearly defined management structure that allows facilitation, coordination, monitoring, evaluation and feedback of the services provided, and is based on a set of guiding dimensions to quality and safety that are built around four key interlocked strategic areas; clinical competence, clinical effectiveness, clinical risk management and system enhancement and accountability’. Well, good luck Neil! My message in mentioning just a few of the changes that our profession has seen over the period of my career is in the following questions: How did I manage these changes? How was I able to adapt to change? How did I find the information and gain the knowledge and competence to facilitate such changes? How did I become informed and educated in order to progress and introduce new services? The answer is SHPA. SHPA provides us conferences, seminars, lectures, the Journal, the bulletin, COSPs, guidelines, position statements, grants and awards, and advocacy to name but a few things. It provides us with the opportunities to build awareness and an understanding of the current environment, for networking, for sharing experiences, disseminating information, making lifelong friends and contacts, for learning and providing the know-how to institute change, progress and improve. Or to quote from the current CPD program it keeps us current, informed and connected. My career was and still is, inextricably tied to being a member of and being involved with SHPA. I am proud to have served on Federal Council, the State Branch Committee and various COSPs and to be involved with educating and informing others. However, I can’t begin to say how valuable that involvement has been to my own career. Being so well informed through this involvement has meant that I have been able to facilitate change, develop, and improve the services in the hospitals that I have worked. SHPA provides the way that our profession communicates and informs; so I urge you to get involved, give back to SHPA some of what it has given you. I know this will be a hard concept to grasp for the members of the Y generation in the audience, but I urge you to think about, not what SHPA can do for you, but what you can do for it. In closing I would like to use the words of the late Pam Nieman when she accepted this award in 1995 (and she would be very upset about missing this Conference). ‘We owe a debt to our profession. It serves us well through our lifetime —so we must give back to it’. Thank you SHPA, which is all of you, for what you have done for me. Sue Alexander delivered her oration on 10 November 2007 at the 28th SHPA Federal Conference in Sydney. Journal of Pharmacy Practice and Research Volume 37, No. 4, 2007 317
318 GlaxoSmithKline Medal of Merit Oration Rosemary Burke Firstly, I would like to thank the NSW Branch for nominating me, Federal Council for selecting me and GSK for sponsoring the award. I am honoured to receive it and feel quite humbled because peer recognition is the highest form of recognition. My background is of one who grew up with a father as a pharmacist and along with my sister and brothers: Sharon, Michael and Tony, spent many hours in Dad’s pharmacy at Riverwood in Sydney. We progressed from putting lids on bottles, to stamping repeat prescription pads and, finally, as we got older, to serving customers. Dad’s dispensary was a place of mystery and we loved watching him make up mixtures, creams and ointments. The first professional dictum I remember is ‘If in doubt throw it out’ which referred primarily to the extemporaneous side of pharmacy. He demanded that a quality product be produced that also looked like a quality product so that the patient would have confidence in what they were using or taking. If you had a doubt as to whether something was made correctly, perhaps because you were interrupted in the middle of manufacturing, you needed to rethink and start again. Safety was paramount. His other saying was ‘if in doubt check it out’ referring to that sixth sense most pharmacists have that something is not quite right and that knowing how to clarify a prescription and intervene was an important aspect of being a professional responsible pharmacist. Dad believed in a quality pharmacy service and always remembered the patient was at the centre of the practice of pharmacy. So from an age where I did not even know that being a pharmacist was to be my career path the two themes of patient safety and quality were already being ingrained. As I grew up the practice of pharmacy changed from a science of compatibilities and formulation to a communication profession. My practice is very different to my father’s and the practice of hospital pharmacy and the variety offered within it has also changed. I started in community pharmacy and later spent a short time teaching science in high schools (incidentally following in my mother’s footsteps who qualified as a teacher when I was finishing school). I, like many Australians, ventured overseas and became a backpacker pharmacist which was where I was first introduced to hospital pharmacy. When I returned to Australia I obtained a position at St George Hospital as a clinical pharmacist. The early definitions of clinical pharmacy are ‘at the bedside’ which does describe the practice of clinical ward pharmacy. It was later broadened into a definition that includes any practice site where pharmacists provide patient care that optimises the use of medication and promotes health, wellness, and disease prevention. This fits in well with Australia’s National Medicines Policy and Quality Use of Medicines which aims to ensure appropriate, judicious, safe and effective use of medicines. This is the core business of hospital pharmacists and those who work in our health system. Most pharmacists wish to practice in order to make a difference. In my days as a clinical ward pharmacist, I enjoyed Rosemary Burke, BPharm, Director of Pharmacy, Concord Hospital, Concord, New South Wales Address for correspondence: Rosemary Burke, Pharmacy Department, Concord Hospital, Concord NSW 2139, Australia E-mail: Rosemary.Burke@email.cs.nsw.gov.au the chance to intervene for a single patient in order to optimise their therapy, prevent an adverse reaction and counsel them about their medication use. I enjoyed practising patientcentred pharmacy whether it was in the dispensary or in the wards. The problem was that there was never enough time to do everything you wanted for everyone on the ward. You either gave a reasonable service to everyone or a quality service to a few. It was at St George and later at Prince Henry that I first started thinking about systems approaches to improvement that is what you could do for groups of patients at a time rather then focusing on the individual. We often think about systems approaches to the prevention of error, e.g. removal of potassium ampoules from the ward, moving to individual drawers for medication rather then trolleys and systematic approaches to dispensing. We need to broaden this focus so that there is a systems approach for all processes in order to improve and make things better for our patients and staff. Improvement can become a driver and change embraced rather then feared. This can involve the rethinking of various processes, not being too bound by the way we have always done things and looking at ways to redirect our resources to improve overall care. We do not practice in isolation but rather with other health professionals in a team environment. Often we need to work together to improve safety and quality. Interprofessional collaboration is one of the strengths of our practice. What is needed is not static nor is it an identical recipe for every hospital or practice setting. I have been the Director of Pharmacy at two hospitals: Wollongong and my current position at Concord. In both cases I was lucky to follow strong, capable and respected leaders in Margaret Duguid and Maria Kelly. While my role at both hospitals is in essence the same, the direction is slightly different. Wollongong Hospital is the largest hospital in the Illawarra region and at the time I was there it was described as being ‘on the road becoming a teaching hospital’. It had very close links with the local community, the Division of General Practice and the Illawarra Pharmacists Association. Furthering these links with the local community was a major focus of my time there. Although I was involved in many projects, the major achievement was setting up a community liaison pharmacy service which combined home visits and talks for multiple community interest groups. I was lucky enough to work alongside some wonderful pharmacists such as Margaret Jordan and Judy Mullan who have moved outside the hospital walls but still work to ensure the quality use of medicines. In contrast Concord is an established teaching hospital with a long tradition of service to the veteran community. But it had different priorities. The two areas I have been most involved with are medical handover (I co-chair the patient care committee) and electronic medication management. After five years of planning we finally went live on one ward last week. Once again I have worked with a multidisciplinary team of people where I have had to remember not to be too pharmacy centric but to look globally at what we want to achieve and how the needs of the patient can be best served. How can we improve the system while building in safety principles and encourage quality prescribing, administration Journal of Pharmacy Practice and Research Volume 37, No. 4, 2007
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Fred J Boyd 2007 Award - jppr

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