How should an innovative service be implemented? (3 points)
- identify need
- negotiate contract
- set up service
Why is there a need for pharmacy influenza service?
-existing service does not provide adequate coverage
How was the pharmacy influenza service implemented? (7 points)
- contacted medical officer of health
- contacted waikato DHB for contract
- obtained appropriate training for Phx
- contacted pharmacy council to determine scope of practice
- contacted PDA to confirm professional indemnity insurance
- provide services via nursing staff while waiting for acceptance
- collected data to show how customers felt about the service
What is the process for Phx education for flu vaccine?(5 points)
- attend 2-day vaccinator training
- complete open book vaccinator exam
- complete assessment of clinical practice of vaccinator
- attend advance resuscitation course
- receive certificate of authorised influenza vaccinator
What are the benefits of pharmacy vaccines? (4 points)
- 533 out of 3600 pharmacies now do it
- 40-50,000 vaccines administered
- free vaccines for >65 years in waikato
- ahead of Aus by 3 years
What innovative services (vaccines) are planned for the future? (3 points)
- new reclassified vaccines: NMR and tavel vaccines
- Phx access to funded vaccines
- Phx expanding individual scopes of practice (admin IM inj, training to be phlebotomist, IV trained to admin inf)
What is the need for a pharmacy anticoagulation service? (2 points)
- current service is disjointed, complicated and inefficient
- takes 8-24 hours to complete, and the dose of warfarin & date of next test has to be relayed to Px by phone
What is the proposed pharmacy anticoagulation service? (7 points)
- Px to attend INR test in pharmacy at anytime
- Phx interview Px using counselling checklist
- Phx performs INR test using CoaguCheck XS Plus
- INR result entered into Px file in INR Online
- Warfarin dose advised & next test scheduled
- Px informed in writing, education provided if necessary
- Total time:
What are the benefits of pharmacy anticoagulation service?
- Pharmacy anticoagulation improved time in therapeutic range for warfarin and maintained it in therapeutic range
- increased patient compliance by giving more convenient, accessible service
What are some innovative services pharmacy can focus on next? (4 points)
- CV risk assessment
- ECG
- Point of care testing for clozapine
- Point of care testing for gout
Why is there a need for CV risk assessment in community pharmacy? (6 points)
- existing method has a time delay between first and last appointment of at least 24 hours
- Px needs to visit Dr/nurse for CVRA
- measurements are taken and Px is sent to lab for blood sample
- blood results are notified to the Dr/Nurse who combine other details to determine risk
- Dr/Nurse contacts Px by phone or 2nd appt to inform results
- lag time of implementation
What is the proposed community pharmacy CVRA service? (5 points)
- Px attends pharmacy for their intended purpose
- Phx performs lipid and HbA1c tests using Afinion test system and finger sample
- Risk calculated using info from Px entered into electronic assessment tool
- CV risk shown visually to Px on a graph
- Total time ~15 min and face-face consultation
What are the results of the community pharmacy CVRA?
-62 px were successfully assessed for their CV risk
Why is there a need for clozapine testing in a pharmacy? (2 points)
- 4K NZers are prescribed clozapine (PHARMAC)
- induces wide range of potentially fatal side effects: agranulocytosis, neutropenia, T2DM, metabolic synderome, etc
What are the problems with the current clozapine service? (5 points)
- long wait time causing unnecessary stress & anxiety to Px
- poor venous access in many Px
- limited healthcare resources mean increased risk of under-reporting of side effects
- limited role for Phx despite being first point of contact for Px
- 2 different blood monitoring systems do not communicate with each other
What is the proposed point of care clozapine service in pharmacies? (5 points)
- Px presents at pharmacy for blood collection
- ~10 min analysis, while Phx provides counselling
- after 10 min, Px with normal blood can collect medication from dispensary
- abnormal parameters will be referred to psychiatrist
- Clinical problems during consultation communicated to appropriate health professionals and Px’s blood would be available to all parties involved.
Does first POC clozapine service have a place in NZ pharmacy? (7 points)
-increases accessibility of clozapine -increases compliance -increases safety profile of clozapine -NZ health target for 2014-15 -HDC: improves safe use of antipsychotics -Implementing medicines NZ 2015-2020 -NZ national Phx service framework 2014
