Surely A GP Shortage Should Not See Pharmacists Treating Patients Over Their Clinical Capacity?

 \This appeared last week:

These illnesses once needed a trip to the GP. Now a pharmacist can treat you

By Alexandra Smith

September 6, 2024 — 5.00am

The worsening GP shortage in NSW will see the state government broaden the conditions that pharmacists can treat in local chemist shops, including ear infections, stomach bugs and joint pain.

NSW Health is working on expanding the scope of practice for pharmacists to allow them to treat more conditions including middle ear infections, acute minor wound management, acute nausea and vomiting and gastro-oesophageal reflux disease.

Pharmacists will also be able to prescribe treatment for moderate acne and mild acute musculoskeletal pain.

Expanding the conditions pharmacists can diagnose and provide medication for is part of the NSW government’s push to alleviate pressure on GPs, which results in many patients turning to hospital emergency departments.

The number of GPs in NSW has been declining since 2018. There were about 9550 GPs in NSW in the 2022–23 financial year, down from 10,062 the year before.

At the same time, emergency departments are being swamped with patients. There were 792,841 visits to NSW emergency departments in the first three months of this year, the most of any quarter since the Bureau of Health Information started counting in 2010.

More than 490 pharmacies across the state have already participated in the oral contraceptive pill trial since it began in September last year, delivering more than 1800 consultations to women.

That trial followed the successful completion of the first phase of an earlier pharmacy trial, which saw more than 3300 NSW pharmacists provide more than 18,000 consultations to women aged 18 to 65 with symptoms of uncomplicated urinary tract infection (UTI).

The UTI service transitioned to usual pharmacy care on June 1, 2024.

Trial under way

The third and final phase of the trial allowing pharmacists to manage common minor skin conditions such as school sores and shingles is under way and will be running until early 2025.

NSW Health is consulting universities on the development of suitable training and the Pharmaceutical Society of Australia on upskilling pharmacists in clinical assessment, diagnosis, management, and documentation.

The health department has also agreed to authorise individual pharmacists who have completed the Queensland pilot training to deliver selected services in NSW from January 2025 onwards.

The Queensland government has been trialling a pilot that allows pharmacists to diagnose and treat up to 17 conditions, including shingles, mild psoriasis, wound management, swimmer’s ear, travel health and hypertension.

NSW Minister for Health Ryan Park, who made the announcement at the Pharmacy Guild’s Pharmacy Connect Conference on Thursday, said people should be able to access “as and when they need it”.

“We know that it is becoming more difficult to access a GP than ever before, with people often waiting days or even weeks before they can find an appointment,” Park said.

“By empowering pharmacists to undertake consultations on more conditions, we can relieve the pressure on GPs and end the wait times.”

Subject to appropriate training and ongoing work in implementation, the expanded services delivery could start in NSW pharmacies from 2026.

Here is the link:

https://www.smh.com.au/politics/nsw/these-illnesses-once-needed-a-trip-to-the-gp-now-a-pharmacist-can-treat-you-20240905-p5k85n.html

The key issue is to ensure that a pharmacist knows when he/she are out of their depth and to ensure a medical referral follows. The experienced pharmacist will have little to no problems but those who are a bit greener may struggle. Simple rule – if in any doubt –  refer on to the GP – and save yourself lots of grief!

I wonder where we can see what the planned extra pharmacist training involves? Anyone got a link?

David.

In Case Anyone Thought We Could Relax Our Guard We Have This To Sober Us Up!

This appeared last week:

Victorian hospital blunders led to 167 patient deaths

By Henrietta Cook

September 6, 2024 — 5.30am

A record 245 patients have died or suffered serious harm due to errors that unfolded at Victorian hospitals within a year.

Three patients died or suffered serious harm after surgery on the wrong part of their body, while four patients had foreign objects such as surgical sponges and dressings left inside them following surgery and other invasive procedures.

In one case, a woman who was admitted to hospital with a sore leg after falling off a step, developed blood clots in her lungs after being prescribed an inappropriate medication which left her on life-support.

The incidents are detailed in a Safer Care Victoria report published online last week, which revealed that approximately 167 patients died as a result of errors in Victorian hospitals in 2022-23.

It also documented several cases of missed testicular torsion that seriously harmed adolescent and young boys. These boys had arrived at emergency departments with acute abdominal pain.

In another case, a woman died after gastrointestinal complications caused by an antipsychotic medicine she was prescribed in hospital.

There were 245 sentinel events recorded in the state’s public and private hospitals in 2022-23, slightly more than the 240 incidents recorded the year before.

A sentinel event is an unexpected incident that leads to death or serious harm of a patient due to deficiencies in systems and process. This serious harm might involve a patient requiring life-saving surgical or medical intervention, shortened life expectancy or permanent or long-term loss of function.

Safer Care Victoria chief executive Louise McKinlay said sentinel events were tragic for patients, their families and hospital staff.

“These are terrible, catastrophic events,” she said. “No one goes to work to do harm but sadly things do go wrong.”

She said the stabilisation of sentinel events, following a sharp rise in previous years, indicated that the majority of incidents were now being reported. She said the data also illustrated improvements to transparency and the reporting culture of health services.

“This is not about blame,” she said. “It’s about understanding why did something happen and how do we stop it from happening again.”

Australian Medical Association Victorian president Dr Jill Tomlinson said sentinel events were more likely to occur when doctors were under pressure.

“Doctor’s don’t have ratios like nurses,” she said. “There can be very high workloads and unfortunately the more under pressure clinical staff are the greater the likelihood of avoidable harm to patients.”

She highlighted the recent coronial inquest into the preventable death of 19-month-old Victorian toddler Noah Souvatzis, who died on December 30, 2021, from meningitis. The coroner found that the toddler was discharged from Wangaratta hospital after an inadequate review by an under-trained, junior locum doctor on his first shift at the understaffed regional health service.

About one-third of the 245 incidents recorded in 2022-23 were for failing to recognise or respond to deteriorating patients. Issues relating to clinical process or procedure made up 24 per cent of cases, while medication errors were involved in 9 per cent of the incidents.

There was a slight decline in the number of sentinel events involving children, with 35 incidents involving them in 2022-23, compared with 38 children the year before. Around half of the incidents involving children related to patient deterioration.

Related Article

Shadow health minister Georgie Crozier said the numbers were not heading in the right direction and “much more needed to be done”.

“Our overwhelmed hospital emergency departments and other areas are clearly not coping if these numbers are rising, not decreasing,” she said.

Victorian Health Minister Mary-Anne Thomas said every sentinel event was a tragedy we needed to learn from.

“We are making significant changes to the way our health services respond to patient deterioration because we know this has historically, and unacceptably, been a significant factor in paediatric sentinel events,” she said.

Thomas said these changes included a new urgent helpline to ensure patient and family concerns are heard, the roll-out of standardised monitoring across all hospitals and a new 24/7 virtual paediatric consultation system.

The helpline, which was launched by Thomas last week, was announced last year after an almost doubling of sentinel events involving children.

It also followed advocacy from the parents of eight-year-old Amrita Lanka, who died in 2022 after arriving at Monash Children’s Hospital with myocarditis, an inflammation of the heart muscle.

Her parents resorted to asking the cleaners for help while Amrita deteriorated. She was struggling to breathe, had chest pain and a high heart rate, but doctors ignored or misinterpreted signs she was critically unwell.

Here is the link:

https://www.smh.com.au/national/victoria/victorian-hospital-blunders-lead-to-167-patient-deaths-20240905-p5k81x.html

There are a lot of sad and unhappy stories here but the overall message I take from these sagas is that a mixture of actually seeing the patient and applying common sense to what you see will save much suffering. Clear-eyed assessment and recognition that all is not well is not hard and insisting on senior review of what is going on can save a lot of lives!!!!

The other message is that procedures and routines are developed for a reason and it is vital to follow them - counting swabs etc. - to maximise safety! Short cuts can kill!

It is the old story that any experienced clinician needs about 2 seconds with the patient to recognize all is not well – and if action follows much good can flow! Where trouble ensues is when the doctor does not actually see the patient and so is not exposed to see the subtle clues that reveal the serious trouble!

I reckon it only takes about a year of clinical experience to be able to quickly recognize all is not well and seek / initiate help / action. With many even less time is needed!

Basic lesson is to clamp eyes on the patient and you will seldom, if ever, not do the right thing in terms of what is needed next and how soon! No one should ever be embarrassed about asking for a senior review and the seniors should respond promptly!

David.

NSW Health May Be Making Some Forward Steps With Patient Information Sharing.

I spotted this a few days ago:

Collaboration sets the stage for next phase of Single Digital Patient Record (SDPR)

29 August 2024

Building a landing zone for technology to take flight

eHealth NSW in partnership with the Single Digital Patient Record Implementation Authority (SDPRIA), Epic Systems and Amazon Web Services (AWS), completed the build of the SDPR hosting environment, known as the AWS Landing zone.

The AWS Landing Zone is a secure, scalable and foundation for how the electronic Medical Record (eMR) will be managed and deployed for SDPR.

Configuration phase moves a step closer to reality

Cutting-edge cloud technologies were developed for the AWS landing zone to improve service delivery. This core foundation means the focus now turns to configuring the SDPR to ensure it meets the needs of NSW Health staff, patients and the people of NSW.

SDPRIA Chief Executive Dr Teresa Anderson AM shares how this milestone is a fantastic outcome and yet another example of excellence in partnering.

“The achievement is the result of tireless collaboration between AWS, eHealth NSW technical teams and Epic Systems and I couldn’t be prouder of the result,” Dr Anderson said.

“It truly demonstrates that our Single Digital Patient Record now has the infrastructure capabilities and readiness, in addition to enhanced security and compliance to ensure it is ready for this exciting next phase of configuration,” - Dr Teresa Anderson AM, (SDPRIA) Chief Executive

Focus now on data migration and integration

The team will focus on data migration and integration, to enable a seamless transition and integration with other systems and workflows as well as ongoing testing and validation said SDPR Associate Director, Service Delivery, Rodney Daly.

“This step signifies the transition from planning and preparation to actual deployment and implementation, ensuring that we have the right infrastructure in place to support the high performance and reliability required for the Epic Systems eMR" - Rodney Daly, SDPR Associate Director

“This milestone while very technical will provide a number of improvements and benefits, including the easy scaling of resources to meet growing demands, enhanced security and improved performance,” said Mr Daly.

Find out more about the Single Digital Patient Record program.

The link points to this screed:

Single Digital Patient Record (SDPR)

The Single Digital Patient Record (SDPR) will provide a secure, holistic and integrated view of the care a patient receives across the NSW Health system. Clinicians will be able to access a patient’s medical information in real-time from a single source.

The Challenge

Clinical information is captured in many different systems across NSW Health. Currently, healthcare teams must access several platforms to get a comprehensive patient history. These include various electronic medical record systems, patient administration systems and laboratory information management systems. This makes it difficult to quickly access comprehensive information about a patient.

Some of these systems are also not connected statewide. This means different care teams must manually request patient information from other local health districts if a patient is visiting multiple health services. Data is routinely collected but is often unable to be shared or integrated in real time. This can create data duplication or information gaps that could affect providing the best patient care possible.

To solve these challenges, a single source of clinical information is needed.

The Plan

The SDPR program will transform how people experience and deliver care across the state, providing benefits for the people of NSW and the NSW Health workforce regardless of their location and role.

It will bring the state healthcare system together, unifying access to patient clinical information in one view. This will help to provide connected, transparent and safe care for any person at any public healthcare setting statewide.

The SDPR program will achieve this by partnering with NSW Health pillars, public health services, staff, clinical leaders and community members who support or interact with the statewide health service. This will include a statewide integration of electronic medical records (eMR), laboratory information management system (LIMS) and patient administration system (PAS).

SDPR will be delivered under the leadership of the Single Digital Patient Record Implementation Authority (SDPRIA). The Single Digital Patient Record Implementation Authority (SDPRIA) has been established to work in partnership with Local Health Districts, Specialty Networks, eHealth NSW, NSW Health Pathology, shared services, Pillar agencies, the Ministry of Health and the EPIC teams to lead the implementation of the SDPR program.

SDPR will be first available in the Hunter New England LHD and Justice Health and Forensic Mental Health Network, followed by a phased roll out schedule across the state. The overall implementation timeline is expected to be completed by 2028. This includes the configuration of the system and roll out.

The Outcome

For the first time in NSW, healthcare teams will be able to use the same digital clinical system to access patient information, record the care they provide, order diagnostic tests and manage medications, no matter which public hospital or community healthcare facility they work in.

The key features of the SDPR will include:

• Holistic, real-time patient information accessible from a single system
• Continuity of information provided within a single system across all NSW Health services
• Improved integration with medical devices and other clinical systems
• Intuitive, user-friendly design that, for example, pre-fills records based on historic patient data
• Secure access to patient records and clinical workflows via mobile devices
• Simplified clinical workflows and streamlined technical support
• Robust privacy and security functionality
• Increased analytics, dashboards and reporting to support ongoing enhancement of health services and patient safety.

The Benefits

Having one statewide system will support consistency and continuity of care, particularly for patients receiving care across multiple NSW Health settings.

For patients visiting NSW Health services, it will mean:

• A reduced need to recall and repeat health information
• A consistent experience regardless of where they seek care
• More informed discussions with their health care providers, so they are better able to make decisions about their own health.

For NSW Health clinicians, the SDPR will mean:

• Easier, faster and more consistent access to comprehensive, up-to-date patient records in a single secure system
• Enhanced clinical safety and quality, with less duplication of care across sites and providers
• Less admin, with streamlined record-keeping.

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Here is the overall link:

https://www.ehealth.nsw.gov.au/news/2024/single-digital-patient-record-infrastructure-milestone

This all sounds wonderful, but I am curious to know how much of this is beyond the ‘vapour-ware” stage and is actually doing what is intended?

Reading the announcement one really wonders how much of this grand plan is real at present.

It would be good to hear from those on the ground as to how much has thus far been achieved.

I can report – after a very recent stay at Royal North Shore that – at a ward level – virtually all documentation is electronic and is very widely used. (No one goes anywhere without their mobile terminal)

So at a hospital level real progress appears to have been made! I am now wondering what the impact has been?

Anyone care to comment from the work - face?

David.

p.s. Put another way by Adam Ang:

SDPR foundation developed

The "landing zone" for the Single Digital Patient Record (SDPR) in New South Wales has been set. 

According to eHealth NSW, the landing zone, developed with Epic and Amazon Web Services, is the "secure, scalable foundation" for managing and deploying the SDPR. The single EMR project is set to replace nine EMR platforms, six PAS, five pathology LIMS, and other clinical support systems across NSW public health services. 

This step ensures that the right infrastructure is "in place to support the high performance and reliability required for the Epic Systems EMR," said SDPR project associate director Rodney Daly. 

Following this, the project now focuses on configuring the SDPR to meet user requirements, as well as data migration and integration with other systems and workflows, on top of ongoing testing and validation. 

Here is the link:

https://www.healthcareitnews.com/news/anz/sdpr-landing-zone-established-and-more-nsw-briefs

 Reports from the field encouraged!

 D.