HOSPITAL NEWS PHARMACY NEWS
12 The Ramsay Way 2017 | 03
Michelle Lynch
Pharmacy
Innovation: Patient
Care Pathways
Ramsay Pharmacy showcased the innovative
Patient Care Pathway (PCP) at the annual
flagship Pharmaceutical Society of Australia
conference (PSA17) held in Sydney from 28
to 30 July and was represented by Rebecca
Livori, Clinical and Quality Use of Medicine
Pharmacist, Ramsay Pharmacy.
The theme of PSA17 was leading pharmacy innovation
with the Ramsay Pharmacy poster on PCP selected and
presented as part of the ‘Pioneering Clinical Practice and
Research’ stream. The PCP has 5 core elements to the
program and demonstrates Ramsay Pharmacy’s focus
on the continuum of better patient care from hospital to
the community and the approach to minimising patient
medication misadventure, particularly at discharge
where the potential for error is heightened.
Conference attendees commended the program,
commenting that it represented a step forward
in “out-of-the-box” patient care. In the initial PCP
pilot at Greenslopes Private Hospital, 45 patients
were enrolled in the PCP and 65% of these patients
continued with the program past the initial four week
period.
The Ramsay Patient Care Pathway will continue to
be rolled out across an increasing number of sites
and to patients
who would
benefit from
a medication
management
program at the
transition of care.
New PET/CT scanner
a win for patients
Doctors will have even greater ability to detect and monitor a range of conditions at
Greenslopes Private Hospital, thanks to the arrival of a state-of-the-art PET/CT system with
revolutionary FlowMotion technology.
The Siemens Biograph mCT Flow 64 is the first of its
kind to be installed at a private hospital in South East
Queensland.
The technology is based on a single continuous motion,
rather than stop-and-go technology, which reduces the
imaging time for patients.
Queensland X-Ray PET/CT Coordinator John Barlow said
it is used for the staging and restaging of most cancers
including lung, colorectal, prostate and breast cancer.
Some PET tracers can also detect osteoblastic processes
and the presence of amyloid plaques in the brain, which
are indicators of Alzheimer’s disease.
“The most common PET study involves an injection of
a radioactive glucose which is metabolised by tumour
cells. The PET/CT scanner is used to measure how much
of the tracer is metabolised and therefore how active the
tumour is.”
Mr Barlow said comparing pre and post treatment
imaging means medical staff can measure how effective
that treatment has been.
The PET/CT scanner and associated equipment are
housed in a new Queensland X-Ray facility, located on
the Lower Ground level of the Administration Building at
Greenslopes Private Hospital.
The site is also fitted with a comprehensive real-time
radiation monitoring system. This allows staff to track
radiation levels using highly sensitive detectors and
unique computer software.
At the end of 2017, Queensland X-Ray will move one of its
Nuclear Medicine departments into the same footprint.
This means patients will be able to access a range of
bulk-billed tests including bone scans, cerebral perfusion,
hepatobiliary scans, gastrointestinal studies, myocardial
perfusions scans and thyroid scans at Greenslopes Private
Hospital.
Another successful trip to New Caledonia was
recently carried out by the Cardiac, Vascular and
Nursing staff of Strathfield Private Hospital.
The medical team consisted of Cardiologists Prof Wilcox
and Dr McGrady, Cardiac surgeons; Prof Bannon and
Dr Bayfield, Vascular surgeons Dr Qasabian and Dr Loa,
CAFAT Liaison officer Jacqueline Waters and Cardiac
Nurses – Marie Jennings and Cassandra Board.
The aim of the visit was to revise the current services
provided to New Caledonian patients and their referring
doctors.
The trip included a visit to the Department of Evasan – to
discuss the coordination and transfer of patients to and from
Australia, as well as a visit to the newly opened hospital-
Medipol.
The new hospital is extremely well equipped with state of
the art Facilities.
Medipol provides services for New Caledonia and the
surrounding islands and it is anticipated the new hospital
will receive over 60,000 emergency consultations per
year.
The visit incorporated a Multidisciplinary Team meeting to
review complex patients and discuss optimal approaches
to their care. It also provided
the opportunity for our cardiac team to review
current inpatients.
Currently Ramsay Health are working with Medipol to set
up Coviu – an online communication platform to enhance
information sharing between the two facilities.
The team also met up with the New Caledonian nurses
who earlier this year visited various Ramsay Hospitals as
part of the very successful nurse exchange program which
commenced at Strathfield Private in 2015.
This program has proved to be an invaluable resource for
improving the care provided to our patients.
The Ramsay Pharmacy
Continuum of Care:
Reducing Medication Misadventure
Peter Giannopoulos, Rebecca Livori*, Michelle Lynch, Hayley Walters & Leah Proud
Ramsay Pharmacy Group
Our Solution
Ramsay Community Pharmacies are primarily located near
Ramsay Private Hospitals, providing a key opportunity
to ensure continuity of care for patients. The Ramsay
program aims to provide ongoing care and support to
Ramsay Health Care patients as they transition from the
hospital setting into the care of community providers.
Step 1:
Inpatients at high risk of MRPs are identified, usually by the
pharmacist, and referred to the opt-in program.
Step 2:
At discharge, the patient receives their discharge medication
as prescribed in a dose-administration aid (if desired)
and medicines education. All medicines provided are
accompanied by printed information, including a
medicines list.
Step 3:
Within 10 days of discharge, a pharmacist will conduct
a HMR to identify and rectify any MRPs, and provide
education and support to the patient.
Step 4:
Regular liaison with the patient’s general practitioner, as
well as any other health professionals or community
services to ensure everyone is up-to-date on the
patient’s transition home.
Step 5:
Weekly telephone contact with their pharmacist ensures
any problems or medicines questions are addressed. The
weekly dose-administration aid is delivered to the patient
(free of charge) ensuring easy access to
their medicines.
Key benefits of the program include accessible medication
advice and support as well as a seamless flow of information
between the hospital, general practitioner, other health
professionals, and the pharmacy. Patients have reported
feeling supported in their transition to home, regardless
of their reason for admission. Furthermore, patients often
continue to use their preferred dose administration aid past
the formal period of the program, preferring the medicines
support offered by the system.
Background
In Australia, up to 12% of all medical hospital admissions and
20-30% of all admissions for patients over 65 years occur due
to medication-related problems (MRPs), at significant cost and
morbidity to patients and the healthcare system.1 Approximately
50% of patients do not adhere to their prescribed medication
regimen for chronic illnesses,2 contributing to suboptimal health
outcomes, and increased healthcare costs. Transitions of care,
for example, from the acute to primary care setting, are a known
susceptibility for errors in medication management.3 As the
custodians of medicines and medication experts, pharmacists
are ideally placed to coordinate patient care between health
professionals, the patient, their family and any services.
Ramsay Pharmacy
The Ramsay Pharmacy vision is to deliver better care. We
endeavour to incorporate this into every aspect of our practice
throughout the patient journey, including professional services
and programs to ultimately deliver better health outcomes for all
patients. One way we have identified to achieve better care, is
to focus on and ensure excellent handover occurs at transitions
of care, concentrating on the continuum of care. Ensuring
accurate and timely handover is an essential component of a
safe culture.1,4,5 Reminder packaging, often in the form of doseadministration
aids (DAAs) may improve medication adherence,
especially combined with other medication management
strategies such as a home medicines review (HMR) and ongoing
patient education.6 Previous Australian controlled trials have
demonstrated the effectiveness of HMRs3,7 as part of a discharge
liaison service, and this became a cornerstone of the Ramsay
continuum of care.
Up to 12% of all medical hospital
admissions and 20-30% of all
admissions for patients over
References
1. Australian Commission on Safety and Quality in Health Care. Literature Review : Medication Safety in Australia Internet. Vol. 147, ACSQHC. Sydney; 2013. 1-37 p.
Risk factors for
non-adherence
to medication2,6,8
• Five or more regular medicines
• High dose frequency, especially more than
twice daily
• Complex regimens
• Cognitive impairment
• History of poor adherence to medicines
• Living alone
• Difficulty manipulating packaging
• Multiple prescribers
• High medication costs
Ramsay Pharmacy
in close proximity
to key sites
Reflection &
Recommendations
In the three month pilot at one facility, 45 patients were enrolled
and participated in the program, and 65% of participants
continued with their dose-administration aid past the initial
four week period. Formalising and expanding the support
provided to a patient by their community pharmacy can have
an advantageous impact on their transition to home, reducing
susceptibility to medication misadventure and associated
readmissions. This positions pharmacies as the “health hub” for
patient care post discharge and provides meaningful support for
patients to ensure best possible health outcomes.
65% of participants continued
with their dose-administration aid
past the initial four week period
Available from: http://www.safetyandquality.gov.au/wp-content/uploads/2014/02/Literature-Review-Medication-Safety-in-Australia-2013.pdf%5Cnhttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3908618&tool=pmcentrez&rendertype=abstract
2. Sabaté E. Adherence to long-term therapies: Evidence for action. European Journal of Cardiovascular Nursing Internet. 2003;2(4):323. Available from: http://www.who.int/chp/knowledge/publications/adherence_full_report.pdf?ua=1
3. Australian Commission on Safety and Quality in Health Care. Second National Report on Patient Safety Improving Medication Safety. National Coordinating Council for Medication Error Reporting Internet. 2002;(July):101. Available from: http://www.safetyandquality.gov.au/%5Cnhttp://www.dcita.gov.au/cca
4. Jeffcott SA, Evans SM, Cameron PA, Chin GSM, Ibrahim JE. Improving measurement in clinical handover. Quality and Safety in Health Care Internet. 2009;18(4):272–6. Available from: http://qualitysafety.bmj.com/lookup/doi/10.1136/qshc.2007.024570
5. T Bomba D, Prakash R. A description of handover processes in an Australian public hospital. Australian Health Review Internet. 2005;29(1):68–79. Available from: http://www.publish.csiro.au/paper/AH050068
6. Etty-Leal MG. The role of dose administration aids in medication management for older people. Journal of Pharmacy Practice and Research Internet. 2017;47(3):241–7. Available from: http://doi.wiley.com/10.1002/jppr.1344
7. Roughead EE, Barratt JD, Ramsay E, Pratt N, Ryan P, Peck R, et al. The effectiveness of collaborative medicine reviews in delaying time to next hospitalization for patients with heart failure in the practice setting: Results of a cohort study. Circulation: Heart Failure. 2009;2(5):424–8.
8. Australian Department of Health and Ageing & Price Waterhouse Coopers. Evaluation of the DAA/PMP Programs. 2010; June. Available from: https://www.health.gov.au/internet/main/publishing.nsf/Content/F520A0D5EDEA0172CA257BF0001D7B4D/$File/DAA PMP Report.pdf
65 years occur due to
medication-related problems
Patients treated
in RHC facility
Patient
information
remains up
to date and
accessible for
Ramsay
Pharmacy
& RHC
With patient
consent
patient
medication
information
transferred to
pharmacy post
discharge
Follow up care
and allied health
services provided
by retail pharmacy
STRATHFIELD DOCTORS
VISIT NEW CALEDONIA