If you work in a metropolitan health centre, an onsite or nearby pharmacist might be something you take for granted.
In Country Western Australia (WA), only 15 of the 100 plus health sites have regular onsite pharmacist resources.
Given the vastness and remoteness of the area, it would not be viable to employ a pharmacist at each site, meaning the situation is unlikely to change.
This places staff and patients at a disadvantage and heightens the risk of medication misadventure.
Demand for virtual pharmacists
Nikki Reynolds understands the impact of this better than most, having undertaken a Regional Chief Pharmacist role in Pilbara, between 2020 and 2023.
The Pilbara region in the north of WA covers a total area of 507,896 sq km and contains 9 WA Country Health sites.
With already stretched pharmacist resources at the two hub sites, Ms Reynolds saw first-hand how challenging it can be to provide virtual clinical pharmacy services to the peripheral hospitals.
Despite a pharmacist position being established to support remote inland sites, the role remained vacant two years following its creation.
After a family event forced Ms Reynolds to relocate back to Perth this year, she was invited to implement the first formal Virtual Clinical Pharmacist Service as an innovative means of addressing these workforce gaps.
She is now based in the WA Country Health Service Command Centre – an award-winning service providing 24/7 access to emergency and speciality services throughout Country WA. She also spends some time on the ground in a hybrid virtual capacity.
Five months into the pilot, what opportunities and challenges has Ms Reynolds uncovered in the realm of virtual healthcare?
Ahead of the Medication Safety & Efficiency Conference, she shares some insight.
Supporting technologies are key
One of the biggest challenges Ms Reynolds has faced in her virtual role has been the absence of an integrated electronic medical record (EMR). Currently, Western Australia is several years away from rolling out the technology for inpatient services.
“This makes it incredibly difficult to view medication charts and treatment changes in real-time,” she said.
“The current video conferencing technologies are inadequate to complete this review, and paper charts, as a whole, create a range of administrative and version control issues.”
One planned innovative technology to tackle this is the implementation of Assisted Reality Eyewear or “smart glasses”.
“This will provide real-time visibility of medication charts as well as the medications themselves, opening the potential for virtual dispensing and safety checks of high risk drugs.”
Earlier this year, Ms Reynolds also facilitated the transition to electronic prescribing for outpatients and emergency patients in Country WA.
“This is especially beneficial in a Telehealth setting whereby we have emergency physicians working all over the world, who were previously sending handwritten scripts in the post,” she said.
“Not only does this present a huge administrative burden, but risks around legal obligations, record keeping and visibility of patient treatment. In addition, patients appreciate the ease and flexibility of receiving a QR code to their mobile phone.”
Standardisation is essential
Technology can also help bring standardisation to pharmacy processes – an important tenet in a sector where variety is often seen between sites, areas and jurisdictions.
“In Country Western Australia we have seven regions, all of which have differing guidelines, processes and medication imprest lists.
“Harnessing technology to standardise and rationalise medication use not only creates safety in consistency, but ensures best practice and minimise waste.
“In the next 12-18 months we will be implementing updated contemporary medication imprest lists, smart pump libraries and electronic controlled medication registers.”
The potential is enormous
While the Command Centre has already earned national recognition, Ms Reynolds believes it has vast untapped potential in the virtual pharmacy space.
“Pharmacists are medication experts. We need a model whereby all patients, health sites and services have access to a clinical pharmacist. Once we have the workforce to support it, the opportunities are endless.”
After making the current model more robust, Ms Reynolds has ambitions to expand it to other sites.
She anticipates this will take the form of a hybrid model.
“A centralised hybrid model can not only deliver on the core functions of a clinical pharmacist in a virtual capacity, but temporarily deploy to support regions in critical need or staffing shortages. This provides a safety net for regional health teams and ensures patients always receive the best possible care”.
Other benefits of a virtual service include capacity for virtual safety checks and medication guidance, partnered charting programs, virtual antimicrobial stewardship rounds and an opportunity to upskill local staff.
“For example we might have a Community Pharmacist in a small country town who is not trained as a clinical pharmacist, but with virtual support can complete these tasks and learn these skills, all in the name of continuity of care and professional development.”
The shift cannot be delayed
Ms Reynolds says the lack of equity in regional healthcare is stark, compared with metropolitan sties, that the broader adoption of virtual clinical pharmacy services should be a priority across the state.
“Patients in the rural and remote areas are so disadvantaged, some of the small district sites have never had a pharmacist on site. Just to have that presence even in a virtual capacity would make all the difference.
“It will also reduce the burden on front-line staff who bear the brunt of limited resources and lack of specialist services.”
Sharing more about her ambitions to grow the model and reflecting on lessons learned, Ms Reynolds will present at the Medication Safety & Efficiency Conference, held 7-8 March 2024 at the Hilton Sydney.
Learn more and register your place here.
About Nikki Reynolds
Nikki Reynolds has been a hospital pharmacist for over thirteen years. As the first pharmacist for WA Country Health Services Command Centre, she is perfectly placed to implement change and address disadvantage with respect to the safe and effective use of medicines throughout country WA.
So far this year she has implemented a Virtual Clinical Pharmacy Service for remote sites in the Pilbara, facilitated ePrescribing for Outpatients and Emergency patients in a Telehealth setting and completed a large scale review and rationalisation of medication access across the state.