ANZCA BULLETIN - Focus on Indigenous health - Dr Richard Harris: Insight into the Thailand cave rescue
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
ANZCABULLETIN
SEPTEMBER 2018
Focus on
Indigenous
health
Dr Richard
Harris:
Insight into
the Thailand
cave rescue
Contents
4 President’s message 62 Opioids and chronic pain focus
5 Chief executive officer’s message of FPM forum
6 Letters to the editor 64 Anaesthetic history
8 ANZCA and FPM in the news 66 CPD: How some of our private
practitioners are completing
Opioid forum drives debate 10 ANZCA and government:
62
practice evaluation activities
FPM leads a timely discussion on real-time Indigenous health report
prescription monitoring and limiting prescriptions 67 Would you know how to respond
14 FPM meets Australia’s Minister for
on discharge as possible solutions to tackling the in an anaphylaxis emergency?
Health Greg Hunt
escalating use of opioids in the community. 69 Medical education – why would
19 ANZCA’s professional documents:
I want to do a course about that?!
What would you do?
70 Perioperative medicine attracts
22 Get ready for ANZCA National
Fatigue and the anaesthetist more trainees
41 Dr Marion Andrew and Professor David A Scott explore
the cultural and systemic issue of fatigue on specialists
and the importance of rostering and adapting hospital
systems to maximise recovery, sleep, health and
general wellbeing.
24
34
Anaesthesia Day
ANZCA drives new Indigenous
health strategy
Hero anaesthetist gives his all in
72
73
Common mistakes in audits
or research
Diploma of Advanced Diving
and Hyperbaric Medicine
Thailand rescue dive
76 Special interest group events
41 Fatigue – a cultural and systemic issue
78 New Zealand news
46 Safety and quality: Safe labelling
81 Australian news
College endorses new Indigenous 50 ANZCA Clinical Trials Network
24 health strategy
ANZCA’s strategy is underpinned by the principles of
partnership, participation, equity and accountability.
Significant inequities in health outcomes exist among
Indigenous and Torres Strait Islander people in Australia
52
54
59
ANZCA Research Foundation update
Library update
Faculty of Pain Medicine
88
91
Obituaries
Future meetings
and Māori in New Zealand but many fellows and trainees
are already playing a leading role to effect change.
34
Dr Richard “Harry” Harris
leads cave rescue
The Adelaide anaesthetist and cave diver
reveals to the Bulletin the challenges
of practising sedation deep inside an
underground cave in Thailand where he led
the medical response for the international ANZCA Bulletin Submitting letters and other Copyright
team that successfully rescued a group of The Australian and New Zealand material ANZCA may promote articles
12 young soccer players and their coach. College of Anaesthetists (ANZCA) We encourage the submission of that appear in the Bulletin in
is the professional medical body letters, news and feature stories. other forums such as the ANZCA
in Australia and New Zealand Please contact ANZCA Bulletin website and ANZCA social media
that conducts education, training Editor, Clea Hincks at chincks@ platforms.
and continuing professional anzca.edu.au if you would like to Copyright © 2018 by the Australian
development of anaesthetists contribute. Letters should be no and New Zealand College of
and specialist pain medicine more that 300 words and must Anaesthetists, all rights reserved.
physicians. ANZCA comprises contain your full name, address None of the contents of this
about 6700 fellows and 1500 and a daytime telephone number. publication may be reproduced,
trainees mainly in Australia They may be edited for clarity stored in a retrieval system or
and New Zealand. It serves the and length. transmitted in any form, by any
community by upholding the means without the prior written
highest standards of patient safety. Advertising inquiries permission of the publisher.
Cover: Lazarus, five, and mother To advertise in the ANZCA
Bulletin please contact Please note that any views
Joanne at the Gove District
How to avoid drug or opinions expressed in this
46
Hospital in Nhulunbuy, communications@anzca.edu.au.
publication are solely those of
errors East Arnhem Land.
Contacts the author and do not necessarily
Safe medical handling and Photo: Carolyn Jones represent those of ANZCA.
ANZCA
labelling requires vigilance to 630 St Kilda Road, Melbourne ISSN:
Medical editor:
prevent mishaps but read how Victoria 3004, Australia 1038-0981 (print)
Dr Nigel Robertson
more can be done to reduce Telephone +61 3 9510 6299 2206-5423 (online)
adverse events. Editor: Facsimile +61 3 9510 6786
Clea Hincks communications@anzca.edu.au
Perioperative
70
Art direction and design: www.anzca.edu.au
Christian Langstone Faculty of Pain Medicine
medicine attracts Production editor: Telephone +61 3 8517 5337
trainees Liane Reynolds painmed@anzca.edu.au
A local arm of the Advertising manager: www.fpm.anzca.edu.au
international organisation Vivienne Forbes
Trainees with an Interest in
Perioperative Medicine has
been formed in response to
growing interest in Australia
2 ANZCA Bulletin September 2018 and New Zealand. 3
President’s message Chief executive
officer’s message
I don’t wish to highlight specific Real-time prescription monitoring
examples, but I recollect that in the early Australia’s Chief Medical Officer Professor
years events occurred that placed extreme Brendan Murphy recently provided
pressure on the board, Australian Health an update on the development of real-
Practitioner Regulation Agency (AHPRA), time prescription monitoring (RTPM) in
and the national scheme. Australia.
The strong leadership from Jo Flynn Real-time prescription reporting and
and the whole medical board has been alerts will assist doctors and pharmacists
responsible for the maturing regulatory to identify patients who are at risk of
scheme that we have today. They had harm due to dependency, misuse or abuse
the vision for a truly effective model of controlled medicines, and patients
of medical practice regulation which who are diverting these medicines. Once
promotes the value of the medical fully implemented, a national RTPM
profession to the community while system will provide the capability for
fulfilling its responsibility to protect prescribers and pharmacists to check the
the public. The board has demonstrated system before writing or dispensing a
repeatedly that it is approachable and prescription for a high-risk medicine.
This edition of the Bulletin includes I have had the privilege of recently of 29 million), I am now, somewhat Medical Board of Australia willing to listen when medical colleges While monitoring of controlled
an interview with Dr Richard “Harry” attending the Annual Medical Symposium bizarrely, on first-name basis with over The Chair of the Medical Board of and other organisations seek clarification medicines is the responsibility of states
Harris during which he discusses the of Papua New Guinea along with Mr half of PNG’s specialist anaesthetists. Australia, Dr Joanna Flynn AM, and a or make suggestions for improvements. and territories, Professor Murphy has
extraordinary rescue of the boys trapped John Batten, the President of the Royal There is obviously much work to be done, number of members finish their final I congratulate Jo Flynn and the retiring advised that the Commonwealth is
in the cave complex in Thailand. His Australasian College of Surgeons (RACS). but I have developed a very real respect terms on the board at the end of August. members of the medical board for their working with all jurisdictions to develop
concern for the safety of his colleagues I presented some of our experiences for the achievements of our colleagues It is worth reflecting on the magnitude of untiring work in establishing our national a nationally consistent system. He made
was paramount, as he found himself in the in grappling with the challenges in PNG, and I look forward to working the changes that have been implemented scheme. the following points with regard to system
unenviable position of having to balance of delivering anaesthesia and pain together in partnership with them as to health practitioner regulation since development:
Doctors’ health
risks and potential adverse outcomes for medicine to far flung rural and remote collectively we strive for improved equity 2010. • Health ministers have agreed to
The Australian Medical Association
both those being rescued, and those doing communities, and shared some of the of access to safe anaesthesia. The close Prior to July 2010, all states and progress national real-time prescription
the rescuing. The reality was that the lessons we have learnt in relation to post- and effective collaboration of our college (AMA) has announced that the Doctors
territories in Australia had their own Health Services Pty Ltd (DrHS) which monitoring as a federated model, with
latter were compromising their own safety graduate training since we transitioned to with our societies in these endeavours regulation of practitioners. In the all jurisdictions committed to achieving
to a degree, despite all attempts to mitigate our new curriculum in 2013. is also clearly evident, and another is a subsidiary company of the AMA,
medical profession, that required eight is working on a proposal for a national a national solution.
these risks. The reality also is that Harry PNG is our nearest neighbour, with a exemplar of how well we can all work medical boards, all of whom did their
ultimately shouldered a significant burden population of over eight million, which together towards a common goal. telehealth service. DrHS has been • The RTPM system will be designed with
best to not only regulate the profession awarded $A1 million in Commonwealth the ability to prevent cross-border drug
of this responsibility. He had little choice, is expected to double by 2030-2035. The This month will see the launch of the according to legislation, but liaise with
and it is a responsibility that we all have to recent statements by the World Bank, the online learning course on anaphylaxis funding to develop the service. shopping abuses.
each other as well as the Medical Council The DrHS intention is to focus the
accept, and at times struggle with, within World Health Assembly and the Lancet (see page 67). This CPD Emergency of New Zealand to smooth cross-border • Regulators, doctors and pharmacists
the context of the nature of our work. Commission on Global Surgery have each Response will dramatically increase new service on mental health and to will be able to interface directly with
regulatory issues. complement existing local services, it
The June issue of the Bulletin discussed underscored the importance of providing accessibility to this activity, particularly In July 2010 the national law came into the RTPM system, enabling the real time
the selfless efforts of Dunedin anaesthetist universal access to safe and affordable for those of us who struggle to attend face- is easily accessible and provides strong receipt of relevant clinical information
effect and brought with it a single national protection for the privacy of doctors and
Dr Matthew Zacharias, working with surgery and anaesthesia. The fact that to-face workshops. I found the module to such as patient history.
medical board (the Medical Board of medical students who use the service.
Medecins Sans Frontieres (MSF) amidst more deaths in PNG are attributed to be engaging and instructive, and I learnt • The Commonwealth is working with
Australia) which became responsible for DrHS is also developing a national
the chaos in Iraq to provide anaesthesia lack of access to surgery than to HIV (2-3 a number of useful things relating to the jurisdictions on the development and
the registration and notifications about package for training doctors to treat
to victims of violence in that nation. per cent of the population), tuberculosis management of anaphylaxis (exactly what
doctors. The inaugural chair of the board other doctors, using funds secured from adaptation of jurisdiction-specific
Previous issues have described the work and malaria combined will be a surprise those things were I will keep to myself).
was Dr Flynn, who was the previous chair the Medical Board of Australia. The regulatory systems to provide a strong
of Dr Jenny Stedmon who volunteered to to many of us, and highlights the Those of us who are able to access a
of the Medical Board of Victoria. training program will be underpinned by technology interface and which will
assist in Sierra Leone during the height importance of the contribution our college face-to-face workshop will of course still
It was only nine years ago but much a national curriculum in doctors’ health achieve a national RTPM solution.
of the Ebola virus outbreak, of Dr Megan can offer. benefit from the “immersive” element of
Walmsley’s provision of emergency care in The Overseas Aid Committee has doing so. has happened to improve the regulation written by the Australasian Doctors’ ANZCA strongly supports the
the immediate aftermath of the avalanche been working towards progressing Welcome to Spring. I hope we all of the medical profession in Australia. Health Network (www.adhn.org.au) implementation of an RTPM system as
that swept through the Mt Everest Base an adequately trained and supported manage, amidst our busy work/study Every new scheme has its teething which is the umbrella organisation for a means of reducing the risk of harm to
Camp in 2016, and of Dr Bryce Curran’s workforce, the availability of appropriate schedules, to find the time to also enjoy problems and the new national scheme the doctors’ health advisory services in patients.
heroic efforts during the devastation of the equipment, and the establishment of the other important things in life, was no exception. In an international Australia and New Zealand.
2011 Christchurch earthquakes. Of course appropriate standards of professional including family and friends. sense, no other country in the world had It is anticipated that this national John Ilott
the list goes on of those colleagues who practice. With only 19 specialist to that time (or since, to my knowledge) training package will be ready by October Chief Executive Officer, ANZCA
have been willing to step up and outside anaesthetists, and 18 trainees for a Dr Rod Mitchell attempted such an ambitious change this year.
of their comfort zone in their preparedness population of eight million (Australia ANZCA President in the structure of health practitioner
to assist others, and we all acknowledge and New Zealand have well over 6000 regulation.
their selflessness in doing so. specialists for a combined population
Above: Dr Kylie Musgrave leading a tutorial
with anaesthetic service officers in PNG.
4 ANZCA Bulletin September 2018 5
Letters to the editor
Slow-release opioids
MARCH 2018 Full support for statement Slow-release opioids and APMSE Statement references Process not followed
ANZCABULLETIN
What’s in a name?
The recent position statement on slow- I write in response to Dr Tim Skinner’s In response to the position statement In response to the position statement The time has come to Some background • Scope of anaesthesia practice be clearly
explore – again – whether defined in our professional documents.
Anaesthesiology
Discussion on the title anaesthetist
we should align ourselves versus anaesthesiologist is not new. The
• A marketing or public relations group be
consulted re the need for and impact
with the majority and call following examples highlight this: of a name change.
ourselves “anaesthesiologists” 1998 • The marketing group advise on the best
or continue to be known
on the use of slow-release (SR) opioid on the use of slow-release opioid
In 1998, “Terminology – Anaesthetist/
release opioids in acute pain has seen
implementation of any such change.
letter published in the Bulletin in June, as “anaesthetists”, say the Anaesthesiologist” was discussed at the • That the first item be reviewed every
presidents of the three core October ANZCA Council meeting. The two years.
groups representing the following is extracted from the minutes
from this meeting: The relevance of the first item was that
Time for change?
specialty in Australia and the scope of practice of anaesthesia
“During consideration by the August
New Zealand. extended beyond the operating room into
Your feedback: Anaesthesiology:
preparations in the treatment of acute preparations in the treatment of acute
Executive of the President’s Report on
ANZCA continue to maintain its status at
preoperative assessment and preparation,
including the complete text accessible via Should we stay
the ASA Federal Executive Meeting
… the revival of the anaesthetist/ and into postoperative care and
Fellow and trainee surveys Your views on change
management, that is, perioperative care.
“anaesthetists” or anaesthesiologist debate was highlighted.
It was suggested that to widen discussion However, again, no change ensued.
could we become on this issue, information on the pro
and con arguments could be included in
2013
“anaesthesiologists”?
In 2013 the College undertook a survey
pain, inadequate evidence is provided pain, the document did not follow the
the publications of the College, ASA and that identified that one in 10 community
the forefront of pain management – a lead the link. Anaesthesia is the second
The most widespread term globally for
doctors who practice the specialty of
anaesthesia is anaesthesiologists (or
anesthesiologists).
This is a widely understood term and
NZSA. It was agreed by the Executive
that the matter of terminology should
be (highlighted) at Council for further
discussion.
“(It was noted) that this topic is being
members did not know that anaesthetists
were doctors, and that 50 per cent thought
that only some anaesthetists were
doctors.
2017
to support the recommendations in the process of development proscribed in A01
There are many ways this message can differentiates doctors in many countries increasingly debated and suggested that it
In 2017 a name change for the speciality
which is then followed by other nations.
most important medical be communicated via formal advocacy from non-specialist, or even non-medical should be undertaken in an open forum.
Acute Pain Management: Scientific
and lobbying, but this lacks traction if and specialists has been raised again by:
He noted that only the UK, Australia and
intervention – ever. the public view is ill-informed. Media
“anaesthetists”.
In Australia and New Zealand this New Zealand now use anaesthetist as • The Australian and the New Zealand
It sounds like a big call but consider for promotion and programs such as ANZCA’s distinction is not as essential because opposed to anaesthesiologist. Following societies of anaesthetists following on
a moment that after the management of National Anaesthesia Day are part of our protected name (by the Australian brief discussion, it was agreed that a case from discussion at the World Federation
infectious diseases (that is, public health, a strategy to enhance our profession’s Health Practitioner Regulation Agency or ‘for’ and ‘against’ should be published of Societies of Anaesthesiologists
document. Policy for the Development and Review of
antibiotics, vaccination/immunisation, identity in the Australian and New the Medical Council of New Zealand) is in the Bulletin. Dr Thompson undertook (WFSA) 2016 conference and the
Warning to What it does is to remind us of the
and antisepsis/sterilisation), anaesthesia Zealand communities. specialist anaesthetist. No one else is able to compile an article with input from European Society of Anaesthesiology in
Evidence (APMSE) summarises the
in its various forms enables life improving We will continue to do these things. to represent themselves using this term. interested parties.” 2017.
and life-saving interventions to be But maybe we need a more fundamental On the other hand, a strength of the No change ensued. • Informal discussions by ANZCA with the
provided to tens of millions of patients change to enhance our specialty’s identity title anaesthesiologist is that an “–ology” College of Anaesthetists of Ireland (CAI)
annually, radically improving their with the community while also aligning
What is an represents a discipline based on scientific 2004
In 2004, the then-ANZCA President
and the Royal College of Anaesthetists
Professional Documents.
quality and duration of life safely and our specialty’s name with a larger part of
anaesthetist?
rigour and research. It is certainly our (RCoA) in the UK.
effectively. the global community. research that has led to the sophisticated, Professor Michael Cousins established
basics, which seem to have been lost
• Feedback from ANZCA Fellows and
• Many direct claims made in the
The pioneers of our specialty were The following article is provided to safe and effective anaesthesia that we a taskforce chaired by Professor Guy
evidence available for different aspects
doctors:
trainees during the consultation period
[an-ees-the-tist]
predominantly medical practitioners who inform the discussion on whether we practice today. In the community, an Ludbrook to research, review and discuss
for the ANZCA Strategic Plan 2018-2022.
through innovation and the development should change the name of our specialty “–ologist” is more instantly recognised broadly with the fellowship a name
of safer and more efficient techniques laid from anaesthesia to anaesthesiology change to the speciality of anaesthesia • A specific request from Dr John
as a specialist or expert in the area of the
the foundations of what was to become and us from anaesthetists to to anaesthesiology and a name change Crowhurst through correspondence to
“–ology”.
We expect our college to provide
today a specialty. anaesthesiologists. from anaesthetist to anaesthesiologist. the Australian Society of Anaesthetists’
In clinical practice we deliver
Our specialty is based on expert As I stated in my previous president’s This taskforce did not make a firm (ASA's) Australian Anaesthetist
anaesthesia. It has been historically the
in modern practice. Namely, we are document do not have references
training and education, ongoing research message – let’s have the conversation, recommendation for change but produced magazine and formally to the ANZCA
practice to call the provider of anaesthesia
of acute pain medicine. Mention of
and development, and a high level of you will decide! a report for ANZCA Council in September chief executive officer and president
an anaesthetist. So, why should we even
Slow-release
professionalism. It is important for 2005 with the following recommendations at the 2017 ANZCA Annual General
think about changing?
our continued ability to progress these Professor David A Scott in summary: Meeting in Brisbane.
attributes for the care of ever-increasingly • In social media, an active Twitter
clear, reasoned and scientifically based
President, ANZCA
complex patients, that these standards conversation is ongoing debating the
reminded:
are maintained. merits of a name change.
that evidence in the text does not provided. In particular, this seems It is easy for the public, for politicians
and decision-makers, and even for our
professional peers, to underestimate how
“It has been historically the practice
to call the provider of anaesthesia
(continued next page)
opioid risks
dependent safe and effective anaesthesia
an anaesthetist. So, why should we
guidelines when there is a need. The
is upon skilled practitioners and ongoing
research.
even think about changing?”
• Opioids stand out as unique and indicate support for the use of a specific to relate to claims of harm caused by
SR opioids. For example; the first line process for the development of such
valuable agents when they are reserved technique/drug. For example, in APMSE professional documents is clearly
for patients who have the affective (2015), section 4.1.3.1 says “Intra-articular “The inappropriate use of slow-release I’m an anaesthesiologist
opioids for the treatment of acute pain outlined in A01 Policy for the Development
suffering, or distressing, component of bupivacaine . . . more effective than and Review of Professional Documents. English, like all languages, is a living
pain. morphine” in some patients. This does has been associated with a significant growing “meme”. It isn’t controlled by
risk of respiratory depression, resulting The development of this Position
• When the primary problem is of not support the use of intra-articular Statement did not follow this process. The societies, governments or advisory panels
in severe adverse events and deaths”
excessive nociception then there are bupivacaine – see section 5.8.2 and developers argue that the process is not – it adapts and changes with the needs of
does not have a reference provided as
two agents which are far more effective, chondrotoxicity risks. evidence. required as the document simply reflects its speakers. New words come, old words
these being local anaesthetic (but it Similarly, mention of slow-release a “point-of-view”, however, the title and go (see: selfie, hangry, etc) under no one’s
(SR) opioid studies is not the same as • None of the references provided directly formatting imply that the document is direction.
must be correctly applied to a nerve, support the statements they are linked to,
usually this is best done by a trained supporting their use. In fact, section actually a Statement of the Position held So, I’m going to start using
or do not support the recommendations by ANZCA and the FPM.
anaesthetist, and not just applied 5.1.1.2 notes that “CR formulations (also anaesthesiologist because both we and our
in the document. In particular, very few Of particular concern are A01 Items 2.8
indiscriminately) and anti-inflammatory referred to as slow-release . . .) may take of the references are about SR opioids. patients need it.
medications. 3-4 hours or more to reach peak effect . . . and 2.11. Why don’t you too?
For example; the statement “This
• Opioids therefore are best viewed as analgesic effect of the immediate release recommendation is in line with other 1.1. Item 2.8 requires a background paper You don’t need anyone’s approval.
“rescue” medications. Their routine opioid preparations will be seen within international guidelines, and statements be provided 1.2. Item 2.11 requires
use may be necessary in some about 45-60 minutes. This means that by regulatory authorities and government consultation with relevant groups and Dr Chris Jones MB BS FANZCA
circumstances, but this is then generally rapid titration to effect is easier and safer agencies” is referenced to Schug et al committees within ANZCA and the FPM New South Wales
viewed as a second-best option with immediate release formulations.” (2015). This document actually supports There should be a background paper
(exceptions including intrathecal This wording is unchanged from the 2005 the use of SR opioids with PCA as shown detailing the process of decision-making
morphine for lower segment caesarean and 2010 editions for which I was lead in this direct quote “In comparison with and the evidence considered.
section). editor. IV morphine patient controlled analgesia The New Zealand National Committees President’s message
By the early 1990s, it was clear that alone, controlled release oxycodone in of FPM and ANZCA were unaware of the
• Slow-release opioids are only indicated addition to morphine patient controlled
adding background infusions to patient statement before its publication. Other
in the circumstance of unrelenting, analgesia resulted in improved pain relief
controlled analgesia significantly interested parties may also have been • We will all be perioperative Number one. When I left Adelaide to
continuous, suffering pain. They are not and patient satisfaction after lumbar
practitioners, but some of us will
be “perioperative specialists”, who,
return to Alice Springs I was concerned
about professional isolation, and about
a shortcut remedy for non-troublesome increased the incidence of respiratory excluded from the development process. similarly to how pain specialists lead
pain medicine– will lead the education,
closing doors professionally. Professor
Don Moyes, the Director of Anaesthesia
depression – a risk well known to most discectomy and a lower incidence of Wider consultation would have led to
training, professional standards and
research into perioperative medicine
that will benefit us all.
at the Queen Elizabeth Hospital, told me
“I think it’s great you’re going to Alice.
Let me offer you a 0.1 FTE which you can
nociceptive signals. Nor will they nausea and vomiting, as well as earlier • Perioperative medicine will be led take as a one month block each year, to
reconnect with your colleagues. You’ve
provide meaningful analgesia in the anaesthetists. When reports of SR opioid significant improvements in the quality (but not owned) by anaesthetists,
because we are best placed to provide got my phone number, if ever you need
some advice, and whenever you do return
return of bowel function”. There are
the necessary co-ordination, logistical
there will be a job here for you”.
of this document and its applicability
support, vision and energy for this
circumstance of intermittent activity- use in acute pain management started collaboration. So the whole process of going out bush
was framed as a positive and supported
to appear, we (our Acute Pain Service) other similarly inconsistent references in to anaesthesia and pain medicine in
The second issue I want to discuss is how
we need to address all of the six domains
of healthcare delivery – safe, timely,
experience, with no worrying concerns
that I would be “forgotten”. The message
is that we can all be more encouraging,
related pain.
I come into this role with a somewhat
effective, efficient, equitable, patient- reassuring and supportive of young
the position statement. Australia and New Zealand.
different background to my predecessors.
I work in Adelaide, in intensive care
focused. (STEEP). people who are prepared to go and do a
could see no reason why SR opioids and anaesthesia, primarily in the outer
suburbs, in public and private.
Equity of healthcare relates to access,
treatment, and outcomes.
We have achieved absolute world-
stint in the bush.
Number two. Minority groups are more
likely to engage with a workforce whose
Where the position statement results in a would be less dangerous. This was ANZCA and the FPM need to produce high Exclusion of one of the partnership I previously spent the best part of
a decade in central Australia, mainly
with the Royal Flying Doctor Service,
in Indigenous primary health care
class excellence in delivering safe and
high quality clinical care. Our ongoing
challenge is to ensure that everyone in the
diversity includes representation from
their community. In addition, the Măori
pain medicine specialist in New Zealand,
change in practice then there are at least based on consideration of the relevant quality, scientifically robust policies and countries means that the document and retrieval medicine, and later as
the director of anaesthesia at the Alice
community benefits from that care. There
are three distinct groups who don’t enjoy
equity of that care Put very simply it
or the Aboriginal anaesthetist in northern
Australia provide valuable role models.
Through encouragement and support of
two conceivable causes: firstly because pharmacology. We decided against using guidelines. The position statement does cannot accurately reflect the position of
this is what needed to happen and SR opioids on a routine basis and I don’t not provide adequate scientific evidence for ANZCA or the FPM. Congratulations Rod Mitchell
secondly, because there has been mis- believe that our patients have been any its recommendations. We welcome a wider We welcome a wider debate on this
important issue, but Recommendations Congratulations to new ANZCA President
education of clinicians on the concepts the worse for it. debate on this important issue, but the Dr Rod Mitchell on his election to office,
that underpin the position statement. recommendations made in this statement made by the college need to be developed
Whether individuals choose to follow using robust processes. and his first editorial in the Bulletin.
The introduction of the position the statement or not, sound clinical do not reflect the references cited.
The editorial came across as being
statement has had zero impact on the judgement, a good understanding
Dr Duncan Wood FFPMANZCA FANZCA penned by someone who has had the
practice of the Acute Pain Service at of the pharmacology of the different Dr Colin Baird MRCP FRCA FFPMRCoA
Royal North Shore Hospital. Nothing has For the Womens Health Pain Team For the Womens Health Pain Team edges knocked off, and is genuine. Our
formulations and material contained in Women’s Health Anaesthesia fellow members need our care and, at
changed for us. This is as it should be. We the product information sheets, as well as Women’s Health Anaesthesia
do use slow-release opioids for carefully Auckland City Hospital Auckland City Hospital the same time, we must be spreading
appropriate monitoring, should always be Reverend Flynn’s concept of holding
selected patients with acute pain and in a part of any opioid prescription.
this circumstance I willingly provide my the mantle of safety for all patients
Editor’s note: The SR opioid document was a position statement from the college, not a
full support to my colleagues – as does throughout Australia and New Zealand in
Professor Pam Macintyre BMedSc professional document. As such, it is a point-of-view on practice expectations, albeit at
indeed also the position statement. a high level. It involved wide-ranging discussion at FPM Board level, and by the college’s this millennium. These are great goals for
MBBS MHA FANZCA FFPMANZCA
Safety and Quality Committee. These groups include representation from Australia and us all to have. Perioperative medicine is a
Acute Pain Service, Royal Adelaide
Dr Gavin Pattullo FANZCA FFPMANZCA Hospital
New Zealand, the ASA and NZSA, public and private practice, and clinicians and the concept whose time has come.
Director Acute Pain Service community. Notwithstanding this, the importance of timely communication with our fellows
Royal North Shore Hospital, Sydney is acknowledged, and something that we do strive to achieve. The faculty and the college Dr Andrew Bacon FANZCA
absolutely stand by the validity and evidence-base of the concerns and recommendations
expressed in the position statement.
Victoria
6 ANZCA Bulletin September 2018 7
ANZCA and FPM in the news
Thai cave rescue, chronic pain
and climate-smart anaesthesia
key topics for media
Adelaide fellow Dr Richard “Harry” Harris Melbourne anaesthetist Dr Jai Darvall August 31 to raise awareness of accidental Anaesthetist and pain medicine Dr Georgina Imberger, an anaesthetist
who played a leading role in the rescue of was interviewed by the Herald Sun, ABC Since the June 2018 edition of overdoses of combining prescription specialist Dr Jo Rotherham, chair of the at Western Health in Melbourne was
the 12 members of the Wild Boars soccer Radio Melbourne and Radio 3AW, about the ANZCA Bulletin, ANZCA and drugs. Dr Craigie said the risk was caused FPM Queensland regional committee, interviewed for ABC Radio Melbourne
team and their coach from a flooded cave the Royal Melbourne Hospital-based FPM have featured in: by the drugs depressing the central was interviewed for ABC Radio Brisbane’s about how she and other anaesthetists
complex in Northern Thailand, featured “Chewy trial”, which is studying the nervous system. The article followed Focus program by host Emma Griffiths are practising climate-smart anaesthesia
in dozens of local and international TV, benefits of chewing gum to relieve post- • 50 radio reports. a joint FPM ScriptWise media release for a 30 minute panel and question and in their hospitals. Dr Imberger was
radio, print and online media reports. A surgery nausea. Dr Darvall is leading the • Two print reports. warning of the dangers of combining answer segment on chronic pain. The interviewed ahead of the Victorian
renowned cave diver Dr Harris was the international study of 1200 patients at • 10 online reports. prescription drugs. The 800 word article segment attracted 23,000 listeners. Regional Committee’s joint ANZCA and
lead medical specialist for the 100-strong 30 local and international hospitals. The reached an audience of 232,000 people. Professor David Story, foundation ASA meeting, “Rising temperatures,
Australian and international rescue study received $A70,000 grant funding ABC Radio National’s Breakfast Chair of Anaesthesia at the University the heat is on” in Melbourne on July 28.
team. (Dr Harris writes for the ANZCA from the ANZCA Research Foundation. program interviewed Dr Craigie about of Melbourne and a 2017 recipient of The news item reached an audience of
Media releases since the previous
Bulletin on page 34). Dr Harris sedated The combined media reports reached an Bulletin: real-time prescription monitoring in ANZCA’s highest honour, the Robert 80,000 people and was broadcast to eight
the children so they could be carried out audience of 600,000 people across print, response to the release of the Penington Orton Medal, was a guest on ABC Radio Victorian regional ABC stations.
of the caves by their rescuers and was online and radio. Tuesday August 28: Institute’s annual Australian overdose Melbourne’s evening program with host
reportedly the last person out of the cave. The experiences of two ANZCA fellows report. The interview reached an audience David Astle for a 20-minute Explain This: Carolyn Jones
who have spoken candidly about their Combined use of opioids and
Dr Harris and his fellow rescue diver of 138,000 people. Anaesthesia segment. Professor Story Media Manager
benzodiazepines can be fatal,
and friend, Perth vet Dr Craig Challen, own cancer diagnoses was explored FPM Board member Dr Kieran Davis discussed the history of anaesthesia and
Faculty of Pain Medicine and
received the Star of Courage, Australia’s on ABC Radio National’s Life Matters was quoted in a New Zealand story “Solo latest developments in the specialty. The
ScriptWise warn
second highest civilian bravery award for program. NSW anaesthetists Dr Sancha mum locked in battle for funds to care for segment reached an audience of 20,000
“conspicuous courage in circumstances Robinson and Dr Robyn Smiles were Friday July 27: daughter battling CRPS” by stuff.co.nz people and was broadcast to eight ABC
of great peril” at a special ceremony at interviewed about how their experiences Climate-smart anaesthesia under about Complex Regional Pain Syndrome regional Victorian stations.
Government House in Canberra. They had influenced them in using the “care the microscope (CRPS). Dr Davis said more research was
were also awarded the Medal of the Order always” approach with their patients. needed to understand the causes of CRPS,
of Australia. An ABC TV Four Corners Dr Robinson was profiled in the March Wednesday June 13: how it progresses and the role of early
program Out of the Dark described Dr edition of the ANZCA Bulletin. The Radio Australia’s escalating opioid use treatment.
Harris as the linchpin of the rescue effort. National segment attracted an audience of focus of pain forum
Bravery medals were awarded to six 100,000 people.
A full list of media releases can
members of the Australian Federal Police One of the college’s past presidents, be found at www.anzca.edu.au/
and one navy chief petty officer for their Professor Kate Leslie, was interviewed communications/media
contribution to the search and rescue by the ABC’s Background Briefing
mission.
Dr Harris’s role and the anaesthesia
program about the potency of fentanyl
for the program’s investigation into drug
Supporting fellows and trainees through social media
skills he used in the rescue effort tampering by the Queensland Ambulance Social media channels like Twitter and Facebook are great ways to
Dr Craigie was interviewed by
sparked media interest in the specialty. Service. Professor Leslie said it would connect and collaborate with your fellow doctors, as well as to keep
Macquarie Media national radio host
ANZCA President Dr Rod Mitchell was be unusual for there to be no effect if a in touch with what the college is doing and what’s happening in the
Steve Price for a 10-minute segment
interviewed by ABC Radio Adelaide’s patient had been administered fentanyl wider world of anaesthesia. We’re always looking for new things
about medicinal cannabis on his evening
afternoon host Sonya Feldhoff about for pain relief. we can do to help our fellows and trainees get the most out of social
program which is broadcast on 50 stations
anaesthesia in the context of the cave The Sydney Morning Herald media, from running workshops to helping set up Facebook groups.
across Australia including 2GB in Sydney,
rescue and Dr Harris’s leadership during interviewed ANZCA fellow Dr Rob 3AW in Melbourne and 4BC in Brisbane. We’ve established a range of ANZCA-specific Twitter hashtags to
the mission. Dr Mitchell’s 15-minute Hackett about a campaign to standardise Dr Craigie told Price that scientific flag content relating to key areas and audiences of the college. For
interview explained the differences Australian hospital emergency numbers. evidence had shown that medicinal example, we use: #ANZCAlibrary to let people know about new
between sedation and anaesthesia and The move to have a uniform number is cannabis was not beneficial for chronic publications, apps, and library guides; #ANZCAtrainees for things
how Dr Harris had worked with the Thai supported by ANZCA, the Australian pain and that the community deserves like upcoming courses, events and resources; and #ANZCANZ,for
Navy SEALs to administer the sedation Resuscitation Council and the NSW accurate information. The interview (yup, you guessed it) New Zealand-related content.
to the boys. The interview reached an Health Minister Brad Hazzard. The story reached an audience of over 100,000 These hashtags are there for you to use too. Perhaps you want to
audience of 20,000 listeners. attracted 90,000 readers. people. share something you’ve read? Or ask a question? The Twittersphere’s a
Melbourne anaesthetist Dr Peter Seal The June edition of the Medical The FPM opioid forum held in June at busy place, so hashtags help you to target your tweets. You don’t have
was a guest on ABC Radio Melbourne’s Observer featured a cover story on chronic the college in Melbourne attracted media to have a Twitter account to access hashtagged content, so you can
“Known Unknowns” segment where he pain that focused heavily on the FPM. interest from ABC Radio Melbourne’s always take a look and see if it’s something that might be useful for
answered questions about anaesthesia The story included interviews with Dean afternoon program host Richelle Hunt. Dr you. But if you want to join the conversation, you’ll need to create an
and how Dr Harris used ketamine to Dr Meredith Craigie and Immediate Craigie was interviewed about the forum account. And don’t forget to follow us @ANZCA and @ANZCA_FPM.
prepare the boys for their journey out Past Dean Dr Chris Hayes on how pain in a 15-minute segment that attracted an If Facebook is more your thing, then make sure you follow us there – www.facebook.com/ANZCA1992. And if you’re an
of the cave. The 25 minute segment also medicine specialists are working to find audience of 35,000 listeners. ANZCA trainee, why not join one of the closed groups we’ve helped set up. These groups are completely private, and purely for
featured talkback calls from listeners and better ways to help those with chronic Dr Craigie was also interviewed by trainees in a particular jurisdiction, so they are a safe, secure forum in which to share your experiences as an ANZCA trainee.
reached an audience of 90,000 people in pain. The edition also includes a separate ABC online for a report which ran on And they’re proving to be a big hit. There are currently 218 members in the Victorian group; 170 in Queensland; 109 in New
Melbourne and regional Victoria. story on Professor Mark Hutchinson’s International Overdose Awareness Day on South Wales; and 152 in New Zealand. Trainees are using them for everything from promoting upcoming exam practice sessions
In New Zealand, Professor Simon presentation on chronic pain blood to selling second-hand textbooks. If you’re based in a region that still doesn’t have a group, why not contact your local trainee
Mitchell, head of Anaesthesiology at biomarkers at the faculty’s 2018 Refresher committee and ask if they have plans to set one up. We’re happy to give them a hand getting it up and running.
Auckland University and a professional Course Day in Sydney.
diver, was interviewed on Newstalk ZB.
8 ANZCA Bulletin September 2018 9
ANZCA and government: Building relationships
Indigenous health report
Australia
Latest report on Aboriginal and Real time prescription monitoring Important regulatory changes effective from July 2, 2018:
What doctors need to know
Torres Strait Islander health coming to Victoria The following regulatory changes, effective from July 2, 2018 Australian submissions:
are necessary to ensure complete and accurate patient data in • Department of Health – rural procedural training programs
The latest Overview of Aboriginal and The Victorian government’s SafeScript real-time prescription SafeScript and will require: review and reform options.
Torres Strait Islander health status monitoring system commences in October 2018, initially in
(2017) was recently released. Produced • Prescribers to include the patient's date of birth on all • Medical Board of Australia – draft revised “Good medical
the Western Victoria Primary Health Network catchment area.
annually by the Australian Indigenous prescriptions for medicines monitored through the system. practice: a code of conduct for doctors in Australia”.
SafeScript is computer software that allows prescription records
HealthInfoNet, the report provides a Prescribing software should prompt clinicians to include this
for high-risk medicines to be transmitted in real-time to a information for computer-generated scripts. The Department of • Medical Board of Australia – supervised practice
comprehensive summary of the most centralised database which can then be accessed by doctors and Health and Human Services is engaging with software vendors framework.
recent indicators of the health status of pharmacists during a consultation. to support this change.
Australia’s Aboriginal and Torres Strait FPM has been assisting the Victorian Department of Health • National Health and Medical Research Council –
Islander people. • Online registration for access to SafeScript will open later “Guidelines for guidelines” draft modules.
and Human Services on key policy and implementation aspects
The report highlights the significant this year. The Department of Health and Human Services
of SafeScript through an Expert Advisory Group.
differences between Aboriginal and is working with Australian Health Practitioner Regulation • Queensland Health – regulation of general, spinal or
SafeScript will monitor prescription medicines that are
Torres Strait Islander people and Agency (AHPRA) to fast-track and automate the registration epidural anaesthetic; or sedation, other than simple
causing the greatest harm to the Victorian community which process for access to SafeScript for clinicians.
non-Indigenous people on a wide sedation.
includes all Schedule 8 medicines, morphine, alprazolam,
range of measures of health status and methylphenidate and dexamphetamine and some Schedule 4 • To benefit from this automated on-line registration process, it
outcomes. For example: medicines including all benzodiazepines, zolpidem, quetiapine is important that Victorian clinicians ensure their registration
• For 2008-2012 the ratio of direct maternal death rates was 2.2 details with AHPRA, especially their principal place of practice
and codeine.
times higher for Aboriginal and Torres Strait Islander women and email address are up-to-date.
The data required for SafeScript will be collected
than for non-Indigenous women. automatically from Prescription Exchange Services (PES) which
support the electronic transfer of prescriptions from medical Anthony Wall
• In 2015-16, the age standardised hospital separation rate for Senior Policy Advisor, ANZCA
Aboriginal and Torres Strait Islander people was 2.5 times that clinics to pharmacies. When a prescription is issued at a medical
for non-Indigenous people. The vast majority of the difference clinic or dispensed at a pharmacy, the PES will send a record of
in hospital separation rates between the two populations is the prescription in real-time to SafeScript. No additional data
due to markedly higher separation rates for dialysis among entry will be necessary to record a prescription in SafeScript.
Aboriginal and Torres Strait Islander people. After an 18 month introductory period to allow health
• The median age at death for Aboriginal and Torres Strait practitioners to familiarise themselves with the system, from
Islander males in 2016 was 55.9 years – nearly 23 years less April 2020 it will be mandatory to check SafeScript prior to
than that for a non-Indigenous male. writing or dispensing a prescription for a high risk medicine.
There will be exceptions in some circumstances, including when
treating patients in hospitals, prisons, police gaols, aged care
and palliative care.
The Department of Health and Human Services has a range
of resources about the
introduction of SafeScript
available for health
professionals.
Victoria’s SafeScript
joins Tasmania’s Drugs
and Poisons Information
System Online Remote
Access (DORA) which began rolling out to Tasmanian
pharmacies and general practices in 2012. Since DORA
Source: Australian Indigenous HealthInfoNet 2018. Overview of commenced in Tasmania, deaths from Schedule opioid
Aboriginal and Torres Strait Islander health status 2017. eight analgesics drug overdoses have fallen significantly.
Progress is being made, for example over the past 10 years, the
median age at death for Aboriginal and Torres Strait Islander
males has increased by more than four years, and by nearly
three years for females. Overall however, the latest health
status report shows that there remains much work to be done
to achieve health outcomes for Aboriginal and Torres Strait
Islander people that are on par with those for non-Indigenous
people in Australia.
The full report can be accessed at healthinfonet.ecu.edu.au.
10 ANZCA Bulletin September 2018
ANZCA and government: Building relationships
New Zealand
Changing New Zealand’s health The Faculty of Pain Medicine has also been busy, submitting
on a significant inquiry into mental health and addiction in New
system Zealand. In its submission, the faculty’s NZNC explained that
chronic pain and mental health have a bidirectional relationship,
New Zealand’s health system is being put under the microscope
and it must be recognised that the high prevalence of chronic
with a high-powered review announced by the Minister of Health
pain in New Zealand will be contributing to poor mental health
at the end of May. Some commentators say this could mean a
in segments of the population.
much-needed revolution in health services while the opposition
pan it as an example of this government’s “review-it is”.
There is no doubting the grunt behind the broad health and
disability review with Helen Clark’s top advisor in the last Labour
government, Heather Simpson in the chair. The draft terms of New Zealand submissions:
reference are wide but the scattered nature of the health system • Civil Aviation Authority – definition of a crew member.
is singled out for scrutiny. The draft talks about the complicated
• Mental Health and Addiction Inquiry – government inquiry
mix of governance, ownership, business and accountability
into mental health and addiction.
models. “This complexity can get in the way of ensuring public
money is spent to invest in, and provide, healthcare to the public • Standards New Zealand – Draft New Zealand Standard:
in a coherent and smart way”. Ambulance and Paramedicine Services.
ANZCA’s New Zealand National Committee (NZNC) has
• Medical Council of New Zealand – statement on safe
submitted on the draft terms of reference also highlighting
practice in an environment of resource limitation.
the fragmented nature of health services. The NZNC has urged
that the review team include members with expertise in Māori • Via the Council of Medical Colleges – draft terms of
health, Pacific health, epidemiology, health economics, and reference for the Government Review of the Health and
those directly involved in acutely delivered medical services. The Disability Sector.
review will not give a final report until the beginning of 2020 and
changes will take time to implement so for now, work continues • Council of Medical Colleges – Professional Behaviours
on areas where ANZCA can have influence. Taskforce.
In May, Dr Jennifer Woods (NZNC Chair) and Dr Kerry Gunn • Medsafe – Codeine – draft alert communication.
(NZNC member) met with the Medical Director of Pharmac, Dr
John Wyeth, to discuss Pharmac’s work negotiating national • Medical Council of New Zealand – Consultation on fees
payable to the Medical Council.
contracts for anaesthesia devices, and to find out more about
how anaesthetists can best provide advice to Pharmac. The • Pharmac – Proposal to list a range of Medical Devices
NZNC will look at establishing a reference group of anaesthetists supplied by Device Technologies and Medipak.
with expertise in equipment, to help respond to Pharmac
• Ministry of Health – Proposed changes to the National
consultations. Dr Woods also attended a Health Workforce New
Health Index (NHI) system.
Zealand workshop to discuss the sustainability of the future
health workforce.
12 ANZCA Bulletin September 2018 13
FPM meets Australia’s Minister
for Health Greg Hunt
consultations of at least 45 minutes but The group has recommended that the
those with FRACGP, FANZCA, FRANZCP proposed reforms be amended to ensure
or FRACS as their primary specialty that current private health insurance
cannot access it. coverage is retained and be expanded
The extension of access would enhance to include pain management as a basic
the financial viability of consultations in inclusion across all proposed categories
pain medicine and reward appropriate (basic, bronze, silver and gold). More
provision of consultative practice rather expensive and lesser-used chronic pain
than the existing arrangements which
treatment options could be restricted to
FPM argues incentivise the practice of
interventions in pain management. silver and/or gold coverage, and these
Dr Craigie has written to the Chair of deliberations need to be made in close
the Medicare Benefits Schedule Review consultation with pain specialists and
Taskforce, Professor Bruce Robinson, consumers.
outlining the faculty’s argument for Pain MedsCheck
extending access for item number 132. FPM has written to Mr Hunt regarding
The Dean of FPM Dr Meredith Craigie, Immediate past FPM Dean, Dr Chris
the new $20-million Pharmaceutical
Vice-Dean Dr Michael Vagg and General Hayes, chairs the taskforce’s Pain
Manager Helen Morris met the Australian Management Clinical Committee and Society of Australia/Pharmacy Guild
Minister for Health Greg Hunt in several FPM fellows are also involved as trial program to help pharmacists
Melbourne on July 16 to discuss a range members of the clinical committee and prevent incorrect use and overuse of pain
of issues including the National Pain other taskforce committees. medication.
Strategy, opioid prescribing and the need Mr Hunt said he also believed the Under the Pain MedsCheck trial,
for a consistent national rollout of real proposal to fund licencing for rural and pharmacists will be resourced to provide
time prescription monitoring. remote health practitioners to complete face-to-face evaluation of a patient’s
Mr Hunt acknowledged FPM’s role as a the FPM Better Pain Management medicines and their pain management
valued advisor with Mr Hunt supporting Program had merit and was very strategies.
FPM’s central role in the development of interested in the faculty’s development of FPM is concerned that the scheme has
the National Action Plan on Chronic Pain a six month workplace-based Certificate been developed without appropriate input
Management. The FPM leadership advised in Clinical Pain Medicine for GPs or other from medical specialists and does not
Mr Hunt that the faculty would continue interested doctors to complete. adequately recognise that the successful
to work closely with Painaustralia Concerns about opioid prescribing treatment of chronic pain requires a
to develop the plan and ensure that were also discussed at the meeting multidisciplinary approach.
endometriosis, arthritis and osteoarthritis following the Chief Medical Officer
Pharmacies will receive $100 for an
are included to avoid fragmentation of Professor Brendan Murphy’s decision to
strategies. write to 5000 GPs warning them of the initial consultation and another $33 for a
Other topics focused on extending the risk of over prescribing opioids. The letter 15-minute follow-up three months later to
number of allied health visits for chronic warned 70 per cent of fatal opioid doses assess whether the intervention has made
pain patients, specialist pain medicine came from prescription drugs. a difference. Neither of these interactions
physician access to item number 132 and FPM has agreed to work with the is required to involve a patient’s primary
FPM educational initiatives to support federal Chief Medical Officer to develop pain physician.
rural and remote health practitioners. an online forum on opioid prescribing It follows an Australian government
FPM advised Mr Hunt that increasing for GPs. decision to ban pharmacists from selling
the number of allied health visits allowed codeine over the counter, which
under the GP Management Plan for Private health insurance came into effect in February.
chronic pain patients would make a The impact of proposed private health
difference to the lives of those affected insurance reforms on Australian
Clea Hincks
by chronic pain and reduce the burden of chronic pain patients was discussed at
Director, Safety and Advocacy
pain on society. a meeting between FPM, Painaustralia
Mr Hunt said he saw merit in FPM’s and the Australian Pain Society, and key
move to seek an extension of access to government officials in late August.
item number 132 – which is available to There is a strong view that the
consultant physicians – to all specialist reforms, due to come into effect in April
pain medicine physicians. This would 2019, will disproportionally impact
remove the anomaly whereby specialist chronic pain patients and have far-
pain medicine physicians who have reaching implications for millions of
FRACP or FAFRM as their initial specialty privately insured consumers who rely on
can access the item number which covers
existing coverage to access chronic pain
management.
14 ANZCA Bulletin September 2018
You can also read
