Prepared by Elaine Chan & Christopher Chircop Clinical Lead Pharmacists

Western Sydney Local Health District Jan 2019

PHARMACY SERVICES: Helping you look after your

patients

How safe are we in prescribing?

~ 600 medication incidents prevented per month

Top 10 medications for prescribing errors • Oxycodone

• Enoxaparin / heparin

• Amoxycillin/Clavulanate

• Fluticasone/Salmeterol Inhalers

• Sulfamethoxazole/trimethoprim

• Insulins

• Paracetamol

• Metformin

• Colecalciferol

Strategies for improving medication safety in the Australian healthcare setting

Systems to improve: Medicine administration and dispensing Prescribing (e.g. standardising practices,

electronic prescribing) Multidisciplinary care Pharmacy services

System-based approaches to understanding and preventing medication errors

• Australian Commission on Safety and Quality in Health Care (2013), Literature Review: Medication Safety in Australia. ACSQHC, Sydney.

High Risk Medicines (APINCH) • Antimicrobials or anti-infectives

• Potassium and other electrolytes

• Insulins

• Narcotics

• Chemotherapy

• Heparin and other anticoagulants

Inpatient Pharmacy Extension: 57324 Mon-Fri 08:20 – 18:00; Sat-Sun 08:20 – 13:30; After hours on call service via switch

Medicines Information Unit Extension: 56619 Mon-Fri 08:30 - 17:00

Sterile and Non-Sterile Manufacturing Extension: 55070 Mon-Fri 08:20 - 17:20

Outpatient Pharmacy & Clinical Trials Extension: 56542 Mon-Fri 09:00 – 17:00

Cancer Care Pharmacy Service Extension: 57348

Mon-Fri: 08:20-17:20

Hospital in the Home Pharmacists

Antimicrobial Stewardship Pharmacists

How can Pharmacy Help You?

• Provide medicines information

• Assist with therapeutic drug monitoring

• Clinical medication review and reconciliation

• Patient counselling, discharge liaison

• Anything to do with medications!

How do I get help from Pharmacy?

• Contact ward pharmacist directly Via Ward Pharmacist pager

• Call Inpatient Dispensary, Medicines information or Satellite pharmacies

Via switch or check phone numbers on the ward

How can you help us?

• Complete Medication Reconciliation and Medication Management Plans (MMP) for every patient

• Ask for help - avoid guessing or assuming if you are unsure of something

• Listen to us – we are trying to help as part of the multidisciplinary team

• Keep us informed - tell us when important changes to medications occur and when patients are being discharged so we can help as soon as possible

OTHER PHARMACY INFORMATION

Local Health District Drug Committee

• Promotes safe, appropriate and cost-effective use of drugs • Oversees the hospital formulary

• Screening of clinical trials for safety and quality

• Review of Medication incidents

• Review and update of medication related policies and guidelines

Drug Committee-approved documents

Drug Use Protocols, Policies and Guidelines, including: • Anticoagulation

• Antibiotics Aminoglycoside Vancomycin Sepsis

• Safe Use of Potassium Chloride

WSLHD intranet website: http://wslhdintranet.wsahs.nsw.gov.au

Hospital Formulary • List of medications approved for use within the hospital

• Generic drug list, not brand specific except if there are bioequivalence

issues.

• Brands stocked are determined by State Govt. contract/availability

• Approved by WSLHD Drug Committee based on safety, efficacy and cost

• Restrictions may apply - by prescriber, indication or by treatment protocol.

• Objective is to allow for safe and effective drug treatment

• Restrictions may also apply for high cost drugs.

• Require justification for use.

Hospital Formulary

• Search “Formulary” on the intranet

• Available on the intranet - http://wslhdintranet.wsahs.nsw.gov.au/Pharmacy-Directorate/WSLHD-Drug-Committee/Formulary/WSLHD-Formulary

• Generic drug list including restrictions

• Approved by the WSLHD Drug Committee

Non-formulary Medications

• Safety/cost aspects have not been reviewed by the WSLHD drug committee or a formulary application has not been made.

• Non-formulary medications may only be initiated in the hospital with approval from the WSLHD drug committee. • Two members of drug committee need to be

contacted for a telephone approval. • Patients admitted on a non-formulary medication may

continue on the medication without prior drug committee approval

Special Access Scheme (SAS) Medications

• Not marketed or registered in Australia. • Special requirements from the Therapeutic Goods

Administration (TGA) need to be fulfilled for its importation. • Category A or B or C form required

• Patient consent form is required for medico legal cover • Can be completed by a resident but preferrably the

registrar or consultant

• Patient requiring ongoing supplies often need to obtain the medication through our outpatient pharmacy • SAS medication is not a part of the PBS

Safe Use of Medicines Committee

• Reviews medication incidents and develops prevention strategies

• Oversees the development and implementation of medication safety policies and practices

• Includes Junior Medical Officers for input in the practical aspects of implementation

Hospital Outpatient Prescription Used to prescribe: • Highly Specialised Drugs (also

known as Section 100 drugs) • If you do not have a

prescriber number-cannot prescribe on PBS

• Medications that are not covered by the Pharmaceutical Benefits Scheme (PBS) but are essential to the patient’s treatment • Special Access Scheme

(SAS) medications

Hospital PBS prescriptions • S8 and S4D medications such

as benzodiazepines and opioids cannot be prescribed on this prescription

• If you do not have a prescriber

number you cannot prescribe on PBS program

• Prescriber number stays with you at all times

• Provider number (usually for procedures etc.) is dependent on the facility of practice and is not related to prescribing