Professional ethics in pharmacy: the Australian experience

Objective The profession of pharmacy has the unique characteristic of having both professional and business orientations. There is today, in addition to this unique characteristic, a strong shift in pharmacy towards more involvement in patient‐centred health care, and increased emphasis on the patient's best interests and autonomy, within a framework of what is known as ‘bioethics’. With this shift of professional focus comes a heightened level of responsibility due to increased expectations of the patient and greater involvement in healthcare and decision making at a personal level with the patient. There is therefore inherent in this increased involvement an increased propensity for ethical problems to arise. The aim of this study is to investigate the application of ethical theory in the practice of pharmacy in New South Wales (NSW), Australia. Method Semi‐structured interviews were carried out with 25 practitioners. The content of transcribed interviews was qualitatively analysed for emerging themes. Themes were identified by the primary researcher and independently validated by the other investigators. Key findings The majority of pharmacists interviewed in NSW Australia practised within a theoretical framework of ‘best interests of the patient’. Pharmacists experienced dilemmas in practice involving a number of ethical principles. Pharmacists relied on common sense to circumvent such dilemmas and never referred to their professional code of ethics. There appeared to be a general lack of training, and a varying perception of difficulty with decision making, regarding ethical dilemmas encountered, depending on issues such as legal requirements, personal opinions or financial demands. Conclusion Findings of this study indicated primarily that pharmacists in Australia regard the ethical principle of ‘best interest’ of the patient as the fundamental framework within which they practice. Pharmacists experience ethical dilemmas in practice, predominantly in the community setting, relying on logical reasoning, practical skills and personal morals to manage the situation, rather than consulting with a code of ethics. Also of significance in this study was the finding that financial pressure had a strong negative impact on the decision making and application of ethical principles of younger pharmacists in practice.     

Adverse reactions to complementary medicines: the Australian pharmacy experience

Objectives The primary aim was to determine the prevalence of adverse reactions to over‐the‐counter complementary medicines and their severity, as described by consumers. Secondary aims were to identify consumers' reporting behaviours and understanding of the AUST L designation on product labels. Methods An anonymous, self‐administered survey was completed by randomly selected pharmacy customers at 60 community pharmacy locations between August 2008 and February 2009. Key findings Of the 1121 survey participants (response rate 62%), 72% had used a complementary medicine product in the previous 12 months, and 7% of this group (n = 55) reported having experienced an adverse reaction at some time. Of these, 71% described the reaction as mild and not requiring treatment, 22% as moderate and/or requiring advice from a healthcare professional and 7% (n = 4) described it as severe and requiring hospitalisation. If they were to report the reaction, it was most commonly to a medical practitioner. Most (88%) of complementary medicine consumers had never noticed the term ‘AUST L’. Conclusions Complementary medicines are widely used by pharmacy customers. Adverse reactions to these products are under‐reported to healthcare authorities. Most adverse reactions are mild and serious reactions are rare. Customers have little awareness of the designation AUST L.     

An advanced pharmacy practice experience in sports pharmacy

Objective

To establish and evaluate an advanced pharmacy practice experience (APPE) in sports pharmacy.

Design

Students actively participated in a variety of activities for this new 6-week elective APPE, including drug-testing collections, delivering presentations, and providing drug information. Students also learned about assays, compounding, and dispensing medications specifically for athletes, and visited various athletic medical facilities. Student were given written and practical certification examinations for drug-testing collections, and their specimen measurements were compared to those obtained by the testing laboratory for validation; satisfaction surveys were obtained from testing sites; and presentation evaluations were obtained from audience participants.

Assessment

Students were able to accurately measure pH and specific gravity of urine samples and all students passed the certification examination. Students rated the APPE very high. Also, students received high satisfaction ratings on surveys administered to the officials of the schools where they tested and members of the groups to whom they gave presentations.

Conclusion

Students gained experience and insight into the various roles of pharmacists in sports pharmacy and developed confidence in their ability to conduct drug-testing collections.     

Considering pharmacy workflow in the context of Australian community pharmacy: A pilot time and motion study

Background

Given time pressures on primary care physicians, utilising pharmacists for chronic disease management is of great interest. However, limited data are available on the current workflow in community pharmacies to guide these discussions.

Mandatory continuing professional education in pharmacy: the Singapore experience

Background Mandatory Continuing Professional Education (CPE) for the renewal of pharmacists’ practising certificate was implemented in Singapore in 2008 Objective To study pharmacists’ perceptions and attitudes about the impact of mandatory CPE in Singapore. Setting Singapore. Method Internet-based questionnaire survey, conducted between May and June 2011. Main outcome measure Pharmacists’ perceptions and attitudes toward mandatory CPE and the perceived difficulty in fulfilling the CPE requirements. Results The overall survey response rate was 52 % (840/1,609). Of the respondents, 32 % were non-practising, 49 % were practising in patient care areas, and 19 % were practising in non-patient care areas. More than half the pharmacists agreed that mandatory CPE (1) enhanced or increased their knowledge base and skills (70 %; 95 % CI 67–73 %), (2) motivated them to continually learn (64 %; 95 % CI, 60–67 %), and (3) motivated them to reflect on their professional practice or work (58 %; 95 % CI, 54–61 %). Mandatory CPE was not perceived to enhance or increase employability. Non-practising pharmacists appeared to have the greatest difficulty meeting the CPE requirements. Conclusions In general, pharmacists value mandatory CPE more for positive professional reasons than for employability reasons. The survey results may serve as useful baseline data for future studies of pharmacists’ perceptions and attitudes toward CPE in Singapore.     

Managing training programs for pharmacy employees

Principles for managing training programs for supportive personnel and new pharmacist employees in hospital pharmacy departments are discussed, and ongoing staff development activities are described. General management objectives of training programs are outlined. Training programs for supportive personnel should include general theory, such as basic pharmacology and metric conversions, and practice in the specific skills required for the job. The practical component of the training program should be based on a job analysis, and behavioral objectives of the training program should be developed. Various approaches for structuring and monitoring training programs for supportive personnel are described. Besides mastering specific practice skills, new pharmacist employees must become thoroughly familiar with the pharmacy department's policy and procedure manual. Hospital pharmacy managers should implement ongoing activities for developing the decision-making, interpersonal, and practice skills of staff pharmacists. Well-organized training programs can effectively raise the performance standards of pharmacy departments and decrease the time spent in monitoring, evaluating, and correcting performance deficiencies of the staff.     

Managing clinical pharmacists and clinical pharmacy services

One of the ironies in the use of power in today's management setting is that the manager of workers at a high level of readiness is actually giving more power to subordinates as a leadership strategy. Indeed, the empowered manager may achieve goals by shifting responsibility from the manager to the employee, providing a vision for subordinates, providing resources when possible, and providing the freedom to accomplish organizational goals. The challenge for the manager is to determine employee level of readiness and to assess that readiness for different assignments and varying responsibilities. Given the proper situation, the manager may paradoxically gain power (influence over others) by giving others a high degree of responsibility for their actions.     

Impact of a pharmacy technician on clinical pharmacy services in an Australian hospital

International Journal of Clinical Pharmacy - Background There is increasing recognition for the role of pharmacy technicians in obtaining medication histories and performing administrative tasks...     

Integration of an introductory pharmacy practice experience with an advanced pharmacy practice experience in adult internal medicine

Objective. To describe the development, implementation, and assessment of an internal medicine introductory pharmacy practice experience (IPPE) that was integrated with an existing advanced pharmacy practice experience (APPE) in internal medicine.Design. A structured IPPE was designed for first-, second-, and third-year pharmacy (P1, P2, and P3) students. Activities for the IPPE were based on the established APPE and the individual learner''s educational level.Assessment. Students reported a greater understanding of clinical pharmacists’ roles, increased confidence in their clinical skills, and better preparation for APPEs. Peers viewed the approach as innovative and transferable to other practice settings. Participating faculty members provided a greater number of contact hours compared to traditional one-time site visits.Conclusions. Integrating an IPPE with an existing APPE is an effective and efficient way to provide patient care experiences for students in the P1-P3 years in accordance with accreditation standards.     

我院开展临床药学工作的点滴体会

随着时代的发展,人类的进步,人们对卫生保健的要求也有了很大的提高,药学部门要建立以患者为中心的药学管理工作模式;开展以合理用药为核心的临床药学工作,参与临床查房、会诊;开展药物不良反应监测;开展合理用药监测;定期开展药学信息的收集和整理,建立药品信息网络.     

Third-year pharmacy students' work experience and attitudes and perceptions of the pharmacy profession

Objectives

To describe PharmD students'' work experiences and activities; examine their attitudes towards their work; examine perceptions of preceptor pharmacists they worked with; and determine important issues associated with career preference.

Methods

A written survey was administered to third-year doctor of pharmacy (PharmD) students at 8 colleges and schools of pharmacy in the Midwest.

Results

Five hundred thirty-three students (response rate = 70.4%) completed the survey instrument. Nearly 100% of PharmD students reported working in a pharmacy by the time their advanced pharmacy practice experiences (APPEs) began. Seventy-eight percent reported working in a community pharmacy, and 67% had worked in a chain community pharmacy. For all practice settings, students reported spending 69% of their time on activities such as compounding, dispensing, and distribution of drug products.

Conclusions

Most students are working in community pharmacy (mainly chain) positions where their primary function is traditional drug product dispensing and distribution. Having a controllable work schedule was the variable most strongly associated with career choice for all students.     

A capstone advanced pharmacy practice experience in research

Objective

To implement a required capstone experience in research for pharmacy students, assess course outcomes, and solicit mentors'' and students'' opinions regarding the structure and efficacy of the course.

Design

Fourth-year pharmacy students chose a research project, selected a mentor, and completed a 5-week capstone advanced pharmacy practice experience (APPE), during which they wrote a research paper and presented their research at a poster session.

Assessment

Eighty students completed the capstone experience in 2008-2009 and 56 faculty and non-faculty pharmacists served as mentors. Based on their responses on a course evaluation, the students'' experience with their mentor and course instructor were positive. Thirty-one mentors completed a survey on which they indicated their overall support of the capstone project, but wanted their role to be better defined and felt the students needed to have additional training in statistics, survey question design, and the IRB process before completing the APPE.

Conclusion

The capstone APPE was perceived by students and mentors as a positive learning experience that allowed the student to take information from the curriculum and apply it to a real-world situation. Additional research is needed to determine whether pharmacy students will use the research skills acquired in their future careers.