Not-for-prof­it NPS Med­i­cineWise has devel­oped three new resources to pro­mote qual­i­ty use of med­i­cine (QUM) in the pro­vi­sion of med­i­cines to res­i­dents of remote Abo­rig­i­nal and Tor­res Strait Islander communities.

The resources are part of the S100 Remote Area Abo­rig­i­nal Health Ser­vices (RAAHS) Pro­gram and were devel­oped in con­sul­ta­tion with a range of stake­hold­ers. Their release coin­cides with the release of our April 2022 Magazine.

What new resources are available?

NPS MedicineWise’s new Online Resource Hub is designed to help health pro­fes­sion­als, includ­ing nurs­es and Abo­rig­i­nal health work­ers, to nav­i­gate state, ter­ri­to­ry, and local vari­a­tions, by pro­vid­ing curat­ed infor­ma­tion and links to tools and resources relat­ed to:

• Poli­cies, state leg­is­la­tion and scope of practice
• Med­ica­tion man­age­ment, includ­ing order­ing trans­port and stock management
• Clin­i­cal tools and resources includ­ing health pro­fes­sion­al and con­sumer resources
• Templates/​information focused on med­i­cine sup­ply and administration.

Eleanor McK­ean, Edu­ca­tion­al Vis­i­tor with NPS Med­i­cineWise and for­mer Thurs­day Island-based Phar­ma­cist, knows how chal­leng­ing it can be to find the cor­rect information.

“There is a lot of infor­ma­tion out there, but it’s across so many dif­fer­ent web­sites that unless you know what you’re look­ing for exact­ly… and even then, it can some­times be extreme­ly dif­fi­cult to find,” she says.

“Our curat­ed hub is designed to be a one-stop-shop… [so] you don’t have to do a Google search and go through 50 dif­fer­ent things to see if it’s what you wanted.” 

In col­lab­o­ra­tion with NT Health, NPS Med­i­cineWise has also devel­oped a Drug Room Audit, mod­elled on the NT Health PHC Drug Stor­age Room Audit, that could be utilised across all pri­ma­ry health care sites.

This resource pro­vides a stan­dard­ised approach for cen­tres to ensure appro­pri­ate stor­age con­di­tions and stock con­trol, while pro­mot­ing over­all qual­i­ty use of medicines.

“By hav­ing pro­ce­dures in place such as an audit to check that, for exam­ple, your fridge temp-era­ture is being mon­i­tored cor­rect­ly, that means that we might see less wastage,” Eleanor says.

The final resource is a QUM check­list for hand- over doc­u­ments to upskill new staff com­menc­ing work in RAAHS. It includes infor­ma­tion on con­tact details for phar­ma­cy ser­vices and the process­es of med­ica­tion trans­port, includ­ing in case of a cold chain breach.

“There’s often a lot of staff move­ment,” Eleanor says. ​“If there’s [an onboard­ing check­list] that’s there in the pri­ma­ry health cen­tre (PHC) ready to go it can help reduce some of that tran­si­tion when a new per­son comes through.”

Man­ag­ing tran­si­tions of care

With rel­e­vant infor­ma­tion often being hard to locate, the risk as a health provider is that you do some­thing that’s not approved in your cur­rent site.

“That might get brought up as a com­plaint to a health ser­vice, and it could also cause delays in patients receiv­ing appro­pri­ate med­ica­tions,” Eleanor says.

These delays can arise due to a lack of coor­di­na­tion between health ser­vices dur­ing tran­si­tions of care, which is an issue these resources are intend­ed to remedy. 

“Patients may come out of a hos­pi­tal in a large cen­tre, where maybe they were pre­scribed some­thing that’s not avail­able to them in their local com­mu­ni­ty,” Eleanor says. 

“They get back to the com­mu­ni­ty and may not have access to that for an extend­ed peri­od; for exam­ple, if it has to come by a barge and it takes a week. There may also be sea­son­al issues with flood­ing and access.

“Also, non-PBS (Phar­ma­ceu­ti­cal Ben­e­fits Scheme) med­i­cines aren’t cov­ered under the Sec­tion 100 Indige­nous Sup­ply Scheme, which is how most peo­ple get their med­ica­tions in these remote communities.

“That means that if you are treat­ing some­thing with a med­ica­tion that’s not on the PBS it may require a pay­ment… are patients able to pay? And, if they’re get­ting it from a state-run pri­ma­ry health cen­tre, who do they pay? Is there a facil­i­ty to take payment? 

“Some sites reduce this by hav­ing non-PBS items on their local formulary.”

Reduc­ing pres­sure on nurses

Long-term nurs­es often have the deep­est under-stand­ing of local med­ica­tion usage and supply.

How­ev­er, unless they are nurse prac­ti­tion­ers, they can­not sup­ply unless a med­ica­tion is writ­ten on a drug chart by a pre­scriber – a sit­u­a­tion that can high­light grey areas around scope of practice.

“A lot of remote area health cen­tres don’t have doc­tors, so they have nurs­es and Abo­rig­i­nal health pro­fes­sion­als hav­ing to do jobs they’re not tra­di­tion­al­ly trained for,” Eleanor says.

“Giv­en the extend­ed scope of prac­tice in remote set­tings, [health pro­fes­sion­als may be] doing pre­scrib­ing and sup­ply of med­ica­tions, coun­selling on med­ica­tions, acute care in a way that wouldn’t nec­es­sar­i­ly occur in a larg­er cen­tre. All these things are cre­at­ing pressure.

“The sheer num­ber of vis­it­ing prac­ti­tion­ers who often don’t under­stand local con­text can add pres­sure. That local knowl­edge is impor­tant to ensure the pre­scribers aren’t pre­scrib­ing med­ica­tions that are dif­fi­cult to get.”

NPS MedicineWise’s resources are designed to pro­vide clar­i­ty; to give access to CARPA or PCCM depend­ing on the site’s pref­er­ence, or to clar­i­fy what author­i­ties are required to pre­scribe med­ica­tions. This will hope­ful­ly reduce stress and improve health out­comes, by ensur­ing time­ly pro­vi­sion of the cor­rect med­i­cines in the cor­rect dosages.

“[These resources may] also poten­tial­ly lead to improved com­mu­ni­ca­tion – if peo­ple fol­low the links to cul­tur­al com­pe­tence cours­es we pro­vide as part of the web hub” Eleanor said. ​“This may mean peo­ple who are receiv­ing med­ica­tions bet­ter under­stand what they’re for, how to use them, how to dis­pose of them safety.”

Nav­i­gat­ing the med­ical labyrinth with confidence

“Nurs­es and AHPs are the back­bone of most pri­ma­ry health cen­tres,” Eleanor concludes.

“They’re the ones on the ground, treat­ing every­thing from birth through to death. Hav­ing all these resources means they have places to go when they’re fac­ing some­thing unfa­mil­iar – which they prob­a­bly will.”