Pharmacists Lucy Wong and Tamsin
Willis with their awards from NZHPA
Conference 2018.
BOPDHB Pharmacy team at the conference from left: Donna Gardiner,
Cindy Mortimer, Lucy Wong, Tamsin Willis and Adele Harrex.
Success for pharmacists at
national conference
I’m home now what do I do with my
medication?
A team led by Tauranga Hospital Pharmacist Tamsin Willis with
Ashleigh Eaden and Kelly Hiha was awarded the Best Poster by a
Technician sponsored by NZHPA.
This Health Quality Safety Commission (HQSC) co-design project
worked directly with consumers to identify and improve patient
understanding of medication information at discharge.
Tauranga Hospital Pharmacist Adele Harrex presented on two
projects about utilising a Pharmacist Prescriber’s advanced skills
There are significant opportunities to prescribe in a general medical team,
in keeping with local policy.
Table 1: Prescriptions items written in a three month period (April – Jun 2018)
Prescription type
COPD
VTE
Team plan
Medicines
reconciliation error
error
Atrial Prescription
fibrill
prevalent
ation (AF)
Defined area of practice
Original
Original
15
51
Expanded
8
is becoming
in our agein
Rechart
Discharge
Number of items
10
25
Expanded Expanded
Expanded more
Expanded
4
8
Example
Clinical review, stopped unnecessary inhaler
Patient with previous VTE, high risk, so
enoxaparin prescribed
Nystatin documented for painful oral thrush
(palliative patient), not yet prescribed
Usual insulin omitted for mental health patient
rd, Tauran
Prednisone recharted at 20mg inadvertently,
ga
The risin
g tide o
Can we st f IV Iron Infusions.
em the fl
ow?
instead of 5mg
Results
No house officer available in ward
Prescription written / faxed to community while
g population
patients and
This digita
and
their famil
l resou
information
ies are keen
Limitation
prescription
team still rce
on round,
facilitating faster discharge
has been
least 20 patie
about this
for
shown to
s /
its treatm
condition
nts. The clinic
at
Total
121
ent.
and
often still
Centred Car Patient
al pharm
invol
funded antic There are now seve
patient watc ved in the education acist is
ral
oagulant
e
options for that medical, nursing and pharmacy
Anticoagu
Survey results
demonstrate
staff
hes have confidence in pharmacist
Investigate with the Pharmacy Council NZ
lation educ
Patient centr
patients.
visits to answ the clip, then the process e.g.
ation commented
prescribing.
Doctors
on the ability to pick up errors
and
that pharmacist pharm
prescribers
ed communica
er feel
(PCNZ) who set the prescriber competencies, undertake
is a task regul
ques
acist have
tions and
n by clinic
rapport to
understan
tion requires
arly value the accessibility
chec
al pharm
be developed
ding.
planned good
knowledge
of
medicines.
Nurses
of
the
pharmacist
on
the
ward.
My
prescribing
k
University of Otago academic, and Clinical
Phar
acist
to make a
macy techn
their story
have
s. We
, and patie
digita across
. Just beca
ician of a junior doctor.
ated
with this skills
nts to tell
carry
areas of practice with alloc
similar
/ safety to that
Lead for Medicine BOPDHB, if a local
l resou to
time on
1 support
use
educ now
rce more
inform
video to patie
wards may s that Gardiner,D
to
ation
help
1
ation
Tau
proce
, doesn’t mean we give patients
provide inform
ran
show the
policy change would provide appropriate
nts and
ss and poten
; Stre
ga er Hos
answ
Example
from
survey data to the ward pharm
ation comments
they ‘buy
tially
pita or l BOPDH idea, or
K 1 ; Bok
questions
will be et,
to a wider
clinical governance for wider prescribing.
adhe
or, A in’ 2 to the
acist.
rent
patient group
refer
chec
to a new
B,
klist ran
Tau
approach 2
Feedback
. Intr
medicine.
A policy change was written and approved
What
concerns do you have?
Do you have confidence in pharmacist
to Auc
A
education
odu majo
patient centr ga.
been large
ctio
klan
is not entire
by the Hospital Medicines Committee, then
n of – has
ed.
prescribers?
ly
rity
posit
“Nil
it’s
the
future”
Registrar.
Howe
Anaemia
ly sity
patie
ver, these d Uni
used as a
ver
during pregn ive with the
nts gaini
risk of than
video
incorporated into my PCNZ Prescribing
tool to help
of their antic is assoc
, Aucklan
ng good ancy
“more likely to pick up prescribing error
a ture
prema
unde
iated
patients make s can be
decisions
oagu
delive
with
rstan
d.
What
are
the
advantages
of
a
pharmacist
lant.
Res
ry
increa
ding
and
Practice Plan. This enabled me to prescribe Aim doctor who is rushing” Registrar. Early interventions
abou
Video is broke
four sectio
ults medi 27 wome t anticoagu
sed
maternal/ch
their own
ns:
aimed
ild morta
n down into
AF, dabig
anaemia in
prescriber
as part
of the
cine in partic
at preve
lity. MDT?
n completed lation, and which
widely, in collaboration with the clinical team.
dabigatran
atran
nting iron
pregn
versu
ular, will the suit
To produce “less likely to have a discrepancy between
deficie
oral iron supple ancy
includ
survey
and
ncy s warfa
rivaro
e to
ry advic
dietar
“easy
talk y educa
to,
convenience
of being
on the
rin, Dieta
them best. Pres
a brief, free,
xaba
Many
provi
menta
e: patients
n. Rivar
ng tion
tion
adverse effects
resource, admission
to be
cribed Iron
and oxaban
but the
results
like the digita
discharge”
officer.
e, digita House
most
ward,
able
to
check”
Nurse.
that would and onlin
are double
is ● 21 (78%) wome
suppleme
and their
resou
limited
watch
l
rce
l
impac
by
ed
nature of
provi
families with
nts
wher
section so
n receiv
t on comp
Intravenous
e they can
the ● 22 (80%) women were
ed dietar
liance.
far. increasing own
information de patients and their
iron can be
y advice take
red meat
inform
Updated BOP Policy: Health options for
given presc
failed or is
such contr
and ation
utilised once
about antic
as ol of their supplements but
green
,
watc
riptions for
inapp
●
the treatm
leafy
16(60
oral therap
only 18 (66%)
h veget
oagulation
at a time
ropriate i.e.
it more
%) implem
due to previo
iron
before birth
ables. than once
ent of AF.
y has
not tolera
ented that
had them
suits
us experience
is too short
of their pregn
dietar
ted, or the
Professionals Roles and
them.
, and
filled, mainly
y chang
Bay of
for oral
with
period
ancy.
es
●
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Responsibilities
Pharmacist
– Designated
Prescriber
Prescribing within an individual
pharmacists defined area of practice,
submitted to PCNZ
Method
Narrow
defined area
of practice
I’m home
now
with my m – what do I do
edication
?
Plenty
One area I can prescribe in, is VTE prophylaxis. Do you
I can prescribe
medicines on discharge. Do you have confidence
therapy to
take effect
Side effect
markedly VTE DHB use of IV
have confidence in a pharmacist prescriber completing
in a
pharmacist prescriber
doing
iron
. this?
increased
s/Issues
with diet:
in an effort in pregnancy has
blood transf
assessment and prescribing enoxaparin if appropriate?
Cost
to
Resources
usions postn
atally.
9
reduc
9
e the
8
need for
7
8
6
7
over the cours
e
At 32 weeks
gestation
starte
only 9
side effect
s.
d on a therap
(33%) wome
Willis T, Ead
eutic dose
n
of quality
● Only 12
of elemental had been
(37%)
iron.
and 3 wome red meat was a barrie en A and
200 mg daily) were prescribed
Hiha K,
n
a treatment
hyperemes could not eat adequ r for 1 participant
elemental
Contex
dose (100-
their Bay
of of Ple
is or reduc
ate amou
pregnancy.
at any stage
nty iron
nts due to
ed appet
t
Dis
trict Health
Board, Tau
ranga
BOP DHB
Experience Patient
Sur
(Sep 2016
vey
Measurem
- Sep 2017
ent of imp
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rovement
ite.
during
OTC
already 5
BOPDHB allows pharmacists with
Expanded
4
Q4: Number
of
Supp
lements
revie
able onlin
What’s my respondants
3
prescribing authorisation to:
area
of
wed to ensu avail
4
Q1: Number of
e were
Prescribed
Range
● medic
2
re that
ine called
13 (48%)
• Prescribe admission medicines, if they
prescribing
To investigate
respondants
3
elemental
and how do
this resou
Average
there was
iron dose/da
1
Average gestatio
rce.
I take it? 1 wome ? n What
is it for? When
have been prescribed by a doctor within the after policy
2
y
a gap for
30-265 mg
given to wome the advice and
n Started
made my supple
What were given
Treatment
ments
0
advice
advice routin Leaflets,
82.7 mg
websites
infusions
1
last 6 months
change
dose
ent Sometimes No, this to is the
n who receiv Yes, treatm
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can be
medications that chang
always
Mostly
have been regarding iron
in the anten
200 mg daily) (100-
and the
26 weeks
ely given 0
are quest
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ased over
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atal
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er.
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as “magical”. e
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ff governance
liaised with dwise or their GP
and
Ferritin:
any chang
and
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● Initial
if/ pat
● OTC
is clinical
place
at BOPDHB
medical
teams
nne
recorded and qualitative feedback was
for on
community
antenatal for
es.
ensure medic
and Presc
d
responsibility
cha
ts
blood
pharmacies going
ribed Iron
nge of s were taken for
- Which
avera
● 13 (48%)
future pharmacist prescribers. the
The
benefits
obtained from members of the clinical team
Supplemen
on discharge, ation changes were
to
ge initial
supplements
all women
of the wome
• To impro
Hb being
ts:
followed throug
and comp
team
your
Con
were
with
114 g/L.
Dose,
and
15 weeks
n had ferritin
● ve
a
pharmacist
prescriber
in
a
general
medical
“You
I can prescribe medicines based on the - team
plan freque
e.g. from
by way of a survey of 12 health professionals
broug
6(22%
the
liance
clu
h
qualit
ht
, 8 (29%)
aids kept
sion
ncy, timing fantastic or
y of be
on all
receive about ) would
job presc
inform
of which were taken at or before
ribed. clinical
up to date.
consid
supple in ments
notes or verbal advice. Do you have confidence
a pharmacist
mcg/L theref
and durati
ation
bookin
Feedback:
setting,
other
setting
with
support
ered that
have done a
(92% response rate). PDSA cycles Patient
were
used
their
Anticoagulation education
g. the
anaem
on of al, or patient
already below
2. We utilise
medic
patien
ore consid
Test of chan
ic from
ations.
prescriber doing this?
ts initial
- Side effect taken. they are profession
We
• could
this d the
Impro
ered
have
study.
the
deficie
ge
ve
videos
of
the
clinical
team
be
applied
to
many
30
BOP
4
to refine the data collection form, and when
produced
s/ barriers
communica
(High risk
nt for the
DHB
survey (Sept
understand - look
to ent
to treatm
dealt with friendly
a useful digita
tion comp
purpose of
patients)
that
professiona
9
2016 – Sept patient experience
● All ferritin
them. and easy
en
New
Zealand
n = 19
developing the survey.
limen
ls and patien betwe
transit.”
health
keywo
the
l resou
in how
they hospitals.
ts
8
2017), using
care
levels taken
them &
rds
pharm
using
rce
to
‘medi
●
can
ts
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about
• Improve pa
acist educ
reach patie
mcg/L. cation’ (n=12 after 21 weeks
the
s were forward
7
medic
(n=49
ation
ations
tient unders
) to graph
nts
1) and ‘side
Transit lounge nurse
, and
were
that . migh
6
- Initial and investigated
get tandin
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the overa
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t otherwise
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subsequent for each respondent
ll
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ations
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confi
ation
t experience
ve or negat
before
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dence
.
particular).
antenatal
now going
at in
all. This
4
available
Conclu
ive.
Q3: Number of
bloods (Hb
as
home onlin
Acknowledgements:
.
- Iron studie
sio
respondants
Discharge
3
in
e at BOPDHB resource is
in
Rx Review
the n
s (Ferritin).
proce While
Contact: [email protected]
2
Patient Educatio
ss of dietar
• 73 % at least
and we
Adele Print, “I’m
University
publi y shing
and OTC
n
maternity
for full publi supple
pleas of Otago
1
that
intervention 1 clinical
Bay of Plenty District Health Board (BOPDHB)
• 68 % received
it on the intern are
carers appea
Referrals
you
ed
School
use. mentary advice
• Avg. 2.91
0
In
add of Pharmacy
• 47 % medicatio education
well tolera
rs to c be
et this study, the major
from
Yes, always
Mostly
Sometimes No, this is the
• 21 % referred
interventions/patien
riva were Me
well implem
n card
ted,
ab
lat
40
40
35
35
30
30
25
20
25
Positive
Negative
5
20
15
10
15
10
0
5
ack obtained
questionn
aire. The
via a
Measuring the Improvement
final versi
for use
The paper looked at an innovative pharmacist discharge
service collaborating with health care professionals at the point
of discharge. The service ensuring the correct medication
prescription, patient education and adherence support including
seamless transfer back to community pharmacy.
Results
Developm
ent of a di
educatio
gital reso
n on Antic
urce for pa
oagulatio
Author: Har
tient
rex A, Gar
n for Atria
dner A, Mc
Kenzie E,
l Fibrillat
Bay of Ple
Backgroun
nty Distric
ion
d
t Health Boa
The pharmacist prescriber course is
demanding post-graduate certificate, made
easier by starting with a narrow ‘defined
area of practice.’ BOPDHB is a medium
sized hospital where most pharmacists are
‘generalists’ so the ability to prescribe more
widely has potential benefits for patients.
The hospital inpatient setting provides a
collaborative and supportive environment
that facilitates a new prescriber being able to
prescribe more widely.
Whakatane Hospital Pharmacist Lucy Wong was awarded the
Best Paper in Medication Safety/Innovation sponsored by Health
Quality Safety Commission.
Author: Harrex A, Bay of Plenty District Health Board, Tauranga
Background
Faster equals Smarter Better Safer?
Integration of a Pharmacist Prescriber Role
into a General Medical Team
0
Provision of
medicines
information
Circle the number
that best matches
the following questions:
How well did this
video help you or
your family/whanau
what the medicine
understand
is used for?
Poorly
1
Excellent
2
3
4
5
Did the structure
of the presentation
(the order in which
information was presented)
the
make sense to you?
Confusing
1
Easy to follow
2
3
4
5
Was the visual information
helpful in aiding understanding
spoken content?
of the
Not helpful
1
Beneficial
2
3
4
5
Has this presentation
made you feel comfortable
medication?
taking this new
Not at all
1
Very comfortable
2
3
4
5
Was the online format
helpful to learn about
Not at all
this new medication?
1
Very helpful
2
3
4
5
Did you find any part(s)
of the video confusing?
Not at all
1
2
3
4
Patient feedb
ack form
Experienced
side effect(s) Re-admit or GP
visit needed
Privacy
concerns
Please answer the
following questions
and discuss
comments/concerns
with the pharmacist
Do you know when
to take your medicine?
⃝ Yes
⃝ No
Do you know the
side effects to watch
out for?
⃝ Yes
⃝ No
Do you know where
to look or who to
talk to if you want
information?
more
⃝ Yes
⃝ No
Do you know when
to go and see your
GP?
⃝ Yes
⃝ No
Do you think this
video will be beneficial
for other patients
on this medication?
starting
⃝ Yes
⃝ No
medical teams
Would you use this
video at home to
answer any questions responsibility
help others understand
or to
this medication?
⃝ Yes
⃝ No
After viewing this
presentation did you
still want to discuss
medication with a
the
pharmacist?
⃝ Yes
⃝ No
Pharmacist to complete
Questions asked by
the patient
thods
the amou
General
rox Teams
le BOPDHB
e sta Medical
ented and
nt of iron
ge as aban in, to deficiency requires
required to
prescr Team
November 2018
Nursing
BOPDHB
large
food
treat
it Ward 2C at
WBOP
treatment
ity
doses of oral of the women did
Com
not receiv
mu iron
iron daily)
t
• (Max. 7)
• 31% scripts
prepared by
volumes of
is go
and supple
a
e
pharmacis
iron Pha
I was given
ibe
and those nity (100-200mg of
t
OTC Supp
ing worked with
rma
that did had
elemental
lots of
side effect
Cons d more We
Ackn ments
This make relatively expensive
cy s, Sur
helpfu leme
owle . dgem
ially
Taura
a high occur
and to be financ
l inform
most of vey
ult
nts
challe
s it impractical
nga nging
taken
ation
which were
Hosp for
relief medic
ents:
mo tal
rence of
used
about during ant cardi hospi
ital many
Dr Dean
re. and
comm
and
ward
in conjun
my new
not
ation. The
”
staff, n and
unity
Bodd
preg medic
olo part
as
ction
pharm
ington wome
nanc ine.”
given yed
short cours treated with any
gist of oral
with
should be 3. We surve
acies
the iron.
adequate
treatm
and the cardio
, and
es that result
Patient startin y
ent
Prescribe
time pharm
doses
Partn HB
programme HQSC BOPD
unity
Weste studie comm
to have
logy
ts of presc
ers Pharmacists patien
ed
g
r
“I felt that
• “Magical”
• 26 % complianc
e aids
• 5 % expired
meds removed
Medwise/GP
• 32 % liaised
communit with
y
pharmacy
in Care Co-D
did not
Feedback
rn Bay
s sugge
the desire
ribed team
acies
(Septembe
of Plenty
Ferriti
st that
Survey
esign
Rennie, Nitin
n is a Keryn
r 2017
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July 2018)
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help
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discharged quickly.”
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30
Gestation
s.
patient narr
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Prescribed
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oral iron
standing of identified patients
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condition,
25
27
ured
and felt uninv the treatment of their
Novembe
previous meds that I haven’t misse
r 2018
They highli
olved in their
11 completed Lack
ght
d off
of official
/ discrepanci
in inconsistent
care.
identified”
that can 20 exist the difference in
“Lack of detail
es have been
None
guidelines
practice. The
literacy levels
with
betwe
is
result
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medication
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know what the need
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reconciliatio
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for IV iron: , as oral
from prescribed iron daily
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n has alread this helps
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supplements
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● Ensur
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ted studie
e iron
iron daily
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and
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Iron
supplements
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rds”. at
subsequent
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ularly med
are
10-60mg Elemental
booking and
Heartburn
antenatal
review of
) but they
Iron
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from OTC
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it or anythi
bloods.
medications
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5
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at
prescribed”
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stools
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to treat deficie en 100-200 mg
they wante
of elemental
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0
iron daily
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explain why
Ferritin Leve
Pre pregnancy
changes were
wome
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the
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taking tablet n on how to avoid/
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25-32 weeks
And I Gestation
treat
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100
the every ine s with food, using laxativ side effects e.g.
here (in hospit this, like I get struck
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to identi
better fy than
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nt.
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doses
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out.
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up bloods
60
Elderly Patien
4-6 weeks
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after initiati
t.
1stFerritin
of resource
Monthly supply
er with patien
level (mcg/L)
• Lack of
ng oral therap outcome
of Ferinject
issues:
40
to Maternity
ts towards
availability
has
y.
a shared
of pharmacists
on wards.
Seeing health positively changed
Interim Ferritin
20
our practi
and techn
(mcg/L)
ce.
icians
invaluable. care from a patien
• Limited
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patient increa feel taking a little
is
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re / paper
0
to infusion
extra
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(vanco ’t thin
based syste
10
(mcg/L)
Footnote
health outco ses patient involvemen time with a
20
mycin k that me
pharmacy
ms.
30
mes.
Draft guidelines
card syste
t and impro
need a suitab
)
Gestation
40
were
(weeks)
importa was one dication implemented in BOPDHB
ves
Conta m.
le
medic
ct:
in
of
ation
August 2017
Donna.gard
nt one
the ver
as a result
Sever
of the spike
iner@BOPD
s…”
in IV iron
y
use. Key theme
Dispensing
Bay of Plent
HB.govt.nz
couldn e C.Diff
figures would
s that emerg
suggest that
y
Distri
pat
their
’t acc
ct Healt
presence
ed through
has made
a significant
ess ient who impact
the captu h Board (BOP
on reducing
antibio
after
re phase
DHB)
the
need for IV
hou
:
Confusing
5
Patient suggestions
after viewing the
for further improvement:
presentation:
rivaroxaban
Elevit pregnan
cy (60mg
elemental
iron)
Engage/Ca
pture
Key Sugges
tions
The conference focused on the role of both hospital and
community pharmacists working with other health professionals to
improve the quality and safety of patient care.
Tauranga Hospital Pharmacist Donna Gardner presented on a
project identifying opportunities to improve the effectiveness of
oral iron therapy and reduce the need for intravenous iron for
pregnant women.
Understan
d
Lessons
learnt
50
45
40
35
30
Putting the WELL in Wellington was the
theme of this year’s NZ Hospital Pharmacists’
Association (NZHPA) Conference hosted
in the capital last month. The BOPDHB
Pharmacy team was well presented and
received two awards.
in the inpatient medical setting and developing online educational
packages for anticoagulants. The latter has also sparked interest
for national use.
By Cindy Mortimer, Manager, Pharmacy team.
25
20
15
Vials Issued
10
5
0
Month of issue
rs.
tics
For furthe
r inform
ation see
https://www.
full case
study availa
Resources/A hqsc.govt.nz/assets
ble at:
/Consu
-pharmacy-se
rvice-on-disc mer-Engagement/
harge-BOP-J
Acknowled
un-2018.pdf
gements:
Byrne N
(Consumer),
L (Ko Awate
Health Quality
& Safety
BOP DHB a), BOP DHB Tauran
Commission
Quality and
ga
, Maher
Patient Safety Hospital Pharmacy
Department,
.
Contact:
Tamsin.willis@
iron.
Confused
Unprepared
Unanswere
d
Questions
“My neighbou
r advised
me what to
do”
“Shipped
me
like cargo” out
.nz
Assumptions
/ Lack
of detail
Novembe
r 2018
Anticoagulat
ion: What
is the plan
with
aspirin?
Paper based
systems
Free text
/ no decisio
n
support
Systems
bopdhb.govt
When was
dose given? the last
Next due?
Medication cha
nges / need to
synchronise
with existing
meds
Image from:
https://ww
w.rwjf.org
/en/library
source=H
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Clunky
Novembe
r 2018
Wasted time
Frustrated
References:
1
2
9d0b-
Questions
that featured
URL: www.hqsc.go
in the Health
Quality &
vt.nz/our-
Safety Commiss
programm
Health Quality
es/patient-safety-w
ion’s Patient
& Safety Commiss
Safety Week
Survey. W
eek.
ellington:
2017.
ion.
partners-in-care/pu Health Quality & S 2017. Raising the
Bar on the
afety Com
blications
National Patient
mission. URL: ww
-and-reso
urces/pub
Experience
w.hqsc.go
lication/2927.
vt.nz/our-
programm
es/
21