Welcome to i2P (Information to Pharmacists) E-Magazine for Monday 3 August 2015.
Now that the political scene is focused more on the Speaker of our parliament, Bronwyn Bishop, and her extraordinary expense allowance (as well as other politicians) we see how “the other half lives”.
But we already knew that, and it does not give you hope for the future when you understand the calibre of the people making decisions on our behalf, being exposed to the “light of day.”

Anyhow, it gave me the chance to revisit the i2P research archives as I pondered the aftermath of the 6CPA agreement, which includes the “time bomb” of a review into location rules, and the attempts occurring to adapt a clinical services model with a community pharmacy.
That drew me to resources that we held on “triage”, and then it dawned on me that the process of triage could hold major potential for pharmacy development.
Here’s the background.

In my previous life as the head of a hospital pharmacy department there was an event of high regional rainfall, which caused severe flooding in the town of Grafton.
Patients became at risk in one or more nursing homes in the lower lying areas, and it was decided to evacuate the patients resident in these homes.

Where to put them?

Well, Lismore Base Hospital was the decision, and the next step was how could we prepare in advance?
As usual, there was no immediate information as to numbers, or people with any acute problems that may have needed drugs the hospital may not have stocked.
Confusion was the order of the day!

All this happened early on a Friday afternoon, so I rang home and advised that I may be home late.
As the afternoon dragged on and without any information channelled by hospital managers, I decided to contact the nursing homes involved directly.
Fortunately, I was able to speak to a competent person at the Grafton end who was equally confused, but was able to liaise efficiently.

Thus I was able to have medication charts faxed through and the same person offered to contact the other two nursing homes involved and organise them to do the same.
At last something to do!

I then liaised with senior nurses in Lismore Hospital and provided them with estimated numbers arriving, estimated time of arrival (6pm), how they were arriving (in buses) and could ward space be organised in advance.

The children’s ward had minimal patients, so they were relocated to the Women’s Care Unit and extra beds installed for the new patients.
Pharmacy then organised the patient charts for each bed and from those charts organised a temporary imprest stock for the ward (given that it was now a week-end and costly “call backs” for rostered pharmacists needed to be kept at a minimum).

Then the wait for patients and when they arrived, the nurses took over and all settled into a quiet routine.

In a subsequent review to see what could have been done better, it emerged that this really was a minor disaster, yet there was insufficient patient emergency space within a 30 minute drive from Grafton.
The other glaring problem was the lack of communication from our own senior management and what appeared to be little forward planning capacity concerning the welfare of the patients.
Those events shaped my thoughts along the lines of electronic document exchanges (before they actually existed), private homes as emergency patient accommodation (patients not requiring intensive or supervised treatment) and the process of triage.

I also remembered thinking that if a densely populated city was to undergo a major disaster from warfare or some other natural event, I believe the hospital system could never have coped – then and now!

I have always been against the concept of location rules for pharmacy because the approval number system was not flexible enough and it inflated the purchase values of pharmacies unnecessarily, plus inhibited new pharmacists and new innovation entering the system.

Government has generally supported location rules because they could see value in having pharmacies in a networked and convenient location pattern for PBS delivery.

However, with the commoditisation of the PBS and near the end of its life cycle as a product, the reality is that if a Colesworth advanced an argument that they could provide a more efficient distribution system at a cheaper cost – they could influence government to change its mind in Coleworth’s favour.

Then I began to ask myself if there was any other strategic benefit that could reinforce and actually validate location rules.
So that led me back to disaster management, triage in a range of formats at different levels and an opportunity for “pharmacy in the home” type services.
I began to see opportunity at every level.

Because there is a disaster looming very rapidly and that is the rapidly ageing and chronically ill demographic of the Australian population that government planning has not even caught up with, let alone gotten ahead of.
And that’s even before we even think of the unexpected – some sort of major terrorist attack on a thickly populated city (or a major event within a city).
Think a repeat of a modification of the 9/11 tragedy.

And there may be a pandemic or two interspersed as new infections appear throughout the world.

So I documented my thoughts in the article titled: The Opportunity for Pharmacist Provided Triaged Service which is an article I hope all pharmacists and health planners read, because it has had some years of thought behind it.

Mark Neuenschwander is back with a patient perspective on hospital care.
In his article “Paint the Ceilings” he points out that most hospital patients mostly see the ceiling as they lie in bed.
If the paintwork needs repair, give the patient a bit of optimism by freshening up the paintwork to make the patient experience more welcoming.
Patients walking into pharmacies see different forms of those ceilings, so what are you going to do to make your community pharmacy more welcoming?

Mouhamad Zoghbi is back with his impressions of PSA15, mostly positive.
Read his account in “PSA15-It’s Now or Never” and work out what you might professionally be doing over the next one to five years.

In a rather dark article Mark Coleman reports on what mainstream media has not been reporting on, and describes a series of suspicious deaths/murders that occurred last month, in a small number of US southern states. They appear to target holistic medical practitioners that are joined through their high profiles, and their ability to communicate new research in the areas of cancer, autism and vaccine safety.
Read his report in “Nine holistic Health Practitioners die- Others disappeared” and ask the same question he asks…..”Could they?”

Gerald Quigley is back and he has an article titled “(Clinical) Trials and Errors”.
It really is time that official pharmacy took steps to be part of the verification of drug evidence because it is not just he alone who is questioning the accuracy of drug information (particularly the information that has emanated from Pharma sources).
Globally, many health practitioners have ceased relying on faulty drug databases and have begun to rely on their own sources and experiences.

And we provide a report titled “Vaccination Update” which contains material from three separate authors.
It also highlights why pharmacists must give informed consent if they are involved in vaccination, and why the legislative push for mandatory vaccination must be officially opposed.
All pharmacists need to be front and centre on these issues, for despite what we are being told by government and drug manufacturers, many vaccines are simply not safe.

Loretta Marron is also back this month with some tips on how (and how not to) treat the embarrassing problem of bed wetting.
Read her article “Bogus bed wetting interventions”.

And, as usual, we have the week’s media releases for PSA and NPS.

Enjoy your read for this week.

Neil Johnston, Editor
Monday 3 August 2015