NEW ZEALAND NATIONAL PHARMACIST SERVICES FRAMEWORK 2014
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
NEW ZEALAND
NATIONAL PHARMACIST SERVICES
FRAMEWORK
2014
Contents
Acknowledgements .............................................................................................................................................................................. 2
Introduction ......................................................................................................................................................................................... 2
Background .......................................................................................................................................................................................... 3
Over-arching Principles ........................................................................................................................................................................ 4
Pharmacy Services Illustrated .............................................................................................................................................................. 5
Medicines Management Services......................................................................................................................................................... 6
Health Promotion and Preventative Services ..................................................................................................................................... 11
Pharmacist Medicines Information Services ...................................................................................................................................... 14
Pharmacist-Only (Restricted) Medicines ............................................................................................................................................ 15
Pharmacist Prescribing ....................................................................................................................................................................... 16
Hospital Clinical Pharmacy Services ................................................................................................................................................... 17
References.......................................................................................................................................................................................... 22
Glossary .............................................................................................................................................................................................. 23
Acknowledgements
Pharmaceutical Society of New Zealand Project Team:
Elizabeth Plant, Bob Buckham, Richard Townley
The Pharmaceutical Society of New Zealand appreciates and acknowledges with thanks, the valuable input and feedback
received from the following organisations: Pharmacy Council of New Zealand, New Zealand Hospital Pharmacists
Association, Pharmacy Guild, Clinical Advisory Pharmacists Association, Ngā Kaitiaki o Te Puna Rongoā o Aotearoa (Māori
Pharmacists Association), Green Cross Health, Pharmac, New Zealand Medical Association, General Practice New Zealand,
Royal New Zealand College of General Practitioners, District Health Boards, Midland Community Pharmacy Group,
Midcentral Community Pharmacy Group, Canterbury Medicines Therapy Assessment (MTA) Peer Group, Medwise,
Canterbury Community Pharmacy Group, as well as the many individuals who submitted personal comments and
feedback.
© Pharmaceutical Society of New Zealand Inc. 2014
Introduction
The New Zealand National Pharmacist Services The National Executive of the Society discussed in-depth
Framework (the Framework) was developed in 2007 by and provided direction for the service identification and
District Health Boards of New Zealand (DHBNZ) and content.
intended for review in 2009.
In response to submissions received and survey analysis to
Following the dissolution of DHBNZ and subsequent the first consultation round, changes were made to the
discussions with District Health Boards Shared Services format, language, service descriptions and services in the
(DHBSS), responsibility for the framework passed to the Framework and were further considered by the key
Pharmaceutical Society of New Zealand Inc. (Society). stakeholders workshop in May 2014.
The Society undertook to conduct the review of the
Framework services and to re-present it to the health With numerous new pharmacist services coming into
sector as the pharmacy profession’s Framework of mainstream provision it is important to have a reference
Services from the Society. of up to date service descriptions for funders / payers /
employers and providers to refer to when choosing to
During 2013 the Society undertook a cross sector provide selected extended pharmacist services to their
consultation on a first draft of a revised Framework of populations.
Services. A detailed survey of Medicines Use Review
(MUR) pharmacist practitioners was conducted and The Framework enables flexible implementation of
feedback was received from individual pharmacists, pharmacist services on behalf of District Health Boards
National Medical and Pharmacist Organisations, General (DHBs), Primary Health Organisations (PHOs) or General
Practice Organisations, DHBs and Government Agencies. Practice Networks, pharmacy entities and other
Healthcare entities.
2The Framework enables:
o the promotion of optimal medicine-related There are two scopes of practice for pharmacists: the
outcomes from medicines; encouragement of “pharmacist scope” and the “pharmacist prescriber”
multidisciplinary work practices, primary-primary scope.
and primary-secondary collaboration and
integrated care It is important to have one reference source as a
o the utilisation of the opportunity for enhanced Framework of Services for the health sector. All extended
access that community pharmacy offers for the services in this Framework – apart from prescribing, can
promotion of public health and well-being and the be provided by a pharmacist competent in the pharmacist
encouragement of self-care; scope of practice. Most of these extended services do
o the optimisation of health by evaluating and have an extra element of educational qualification and/or
addressing where possible, the medication training. Prescribing can only be carried out by a
management needs of local populations and pharmacist competent in the pharmacist prescriber scope
individual patients; of practice.
o the development of medication management
services that enhance patient choice, access and This framework comprehensively defines pharmacist
convenience and provide a positive experience for services that are available for primary care and/or
patients and other providers of healthcare; secondary care sector use.
o the provision of a range of clinically effective and New service areas in the framework are in addition to base
cost-effective medication management services mandatory pharmacy services and designed to provide
o the development of an integrated approach to national consistency for users of pharmacist extended
planning and commissioning of innovative services
medication management services that contribute
to the development of primary health care and the Health practitioner competence requirements dictate that
optimisation of health outcomes regionally and all pharmacist services must be provided in line with
nationally. appropriate standards as defined by the Pharmacy Council
o alignment of services with specific pharmacist of New Zealand.
roles, such as those working in integrated health
organisations and/or general practices.
Background
In 2007, the Government highlighted the Optimal Use of medicines risks and benefits and best practice
Medicines as one of the key outcomes of The Medicines treatment options
New Zealand Strategy. The Strategy noted that: - Make services more available and provide
treatment in a way that recognises the needs of
Optimal use activities are crucial to ensuring that individuals, including cultural differences
medicines that are assessed as being high-quality,
safe and effective, are chosen, delivered and used in 2. Patients taking medicines to:
a way that ensures their potential to improve health - Be active participants in their health management
and prevent illness is maximised. Optimal use - Be able to make informed decisions about
activities also reduce wastage, enabling resources medicines
to be used effectively. - Understand the best way to use medicines (be
‘health literate’) and know where to go for
The Medicines Strategy also recommended that the
information and support
behaviours and practices to support optimal use need:
3. The medicines system to:
1. Prescribers and other health practitioners to:
- Monitor and disseminate information to minimise
- Consider the most suitable and cost-effective
the over-use, under-use, misuse and inappropriate
treatment options, including non-medicinal and
disposal of medicines
non-prescription alternatives
- Provide effective regulation and post-marketing
- Consider the safety and appropriateness (including
monitoring, in line with international best practice,
the risks and benefits) of medicine choice in
to ensure ongoing assessment of medicines safety
relation to clinical need
- Have systems to support optimal medicines use
- Develop medicines plans that are mutually agreed
practices, including safe medicines systems such as
with their patients
child-safe packaging and at-the-bedside medicines
- Work collaboratively with other health
verification systems
practitioners and services to provide continuity of
- Monitor and evaluate the outcomes of medicines
care and share up-to-date information on
use
3Actioning Medicines New Zealand, the action plan for Support initiatives to realise the potential of the
Medicines New Zealand provided a list of the actions which pharmacist workforce and address the barriers
“can and will be done” to deliver Medicines New Zealand to the delivery of innovative pharmacy and
outcomes and singled out the pharmacy profession as pharmacist services, including those identified at
having a key role in achieving the goals of the strategy, the health sector workshop in August 2009.
stating to:
Over-arching Principles
Māori Health national health strategies, and the pharmacist must
An overarching aim of the health and disability sector demonstrate knowledge of and appropriate linkages
is the improvement of health outcomes and reduction with prescribing practitioners and health and/or welfare
of health inequalities for Māori. Health providers are organisations, such as Government and non-
expected to provide health services that will contribute to Government support organisations, and secondary
realising this aim. This may be achieved through services, such as:
mechanisms that facilitate Māori access to services, Primary medical and nursing services, including
provision of appropriate pathways of care, which might PHO or other local organisation services
include but are not limited to matters such as referrals and Māori primary and community care providers
discharge planning, ensuring that pharmacist services are Pacific primary and community care providers
culturally competent and that services are provided that Consumer advocacy services, including Māori and
meet the health needs of Māori. It is expected that there Pacific Islands advocacy services
will be Māori participation in the decision making around, Community support and home nursing services
and delivery of, pharmacist services. Non-Government organisations
Secondary medical, surgical and rehabilitation
Services Linked with the Healthcare Team services
The success of the services is dependent on the Specialised services such as Mental Health, Child
development and maintenance of effective therapeutic health, Public health, Maternity, Oral health,
partnerships between those providing and those receiving Private specialists, etc.
the service. Service provision is consistent with local and
4Pharmacy Services Illustrated
Medicines Management Services:
Medicines Adherence Medicines Optimisation
CMM: Comprehensive Medicines Management
MTA: Medicines Therapy Assessment
CPAMS: Community Pharmacy Anticoagulation Management Service
MUR: Medicines Use Review
LTC: Pharmacy Long Term Conditions Service
CMM
For patients with complex clinical medication
management needs under the care of an integrated
health centre or primary health organisation
MTA Service
For patients where there are potential clinical concerns
related to safety or efficacy of prescribed medications
CPAMS
MUR Service
For patients with complex difficulties in
understanding and adhering to
prescribed medications
LTC Service
For eligible patients to optimise the
supply & use of prescribed medications
and to support adherence
Standard core dispensing
and over the counter
services with self-care
advice (Incl. pharmacist-
only, pharmacy, general
sale classified medicines)
Other Services / Roles:
Medicines Information Pharmacist-Only (Restricted) Medicines
Hospital Clinical Pharmacy Pharmacist Prescribing
Health Promotion and Preventative Services:
Health Education Immunisation Screening and Intervention
5Medicines Management Services
Patient-specific services that aim to ensure prescribed pharmacotherapy is understood and range of activities to improve utilisation and manage potential and/or actual harm from their
taken for optimal safety and efficacy. use or misuse. Issues identified through delivering medicines management services are reported
back to prescribers, and those that are outside of the scope of the service or capacity/capability
The focus of medicines management services is to optimise the benefits and reduce harm from of the pharmacist, are referred promptly on to other health professionals for management, as
medicines. They involve a discussion with the patient about their medicines and delivering a appropriate.
MEDICINES ADHERENCE MEDICINES OPTIMISATION
Medicines Adherence LEVEL 1 Medicines Adherence LEVEL 2 Medicines Optimisation LEVEL 1 Medicines Optimisation LEVEL 2 Optimising Specific Medicines
Long-Term Conditions Medicines Use Review Medicines Therapy Comprehensive Medicines E.g. Community Pharmacy
LTC MUR Assessment - MTA Management - CMM Anti-coagulation
Optimise supply and use Optimise medication Optimise medication efficacy Optimise management of Management Service -
of medications understanding and adherence prescribed medications CPAMS
Currently funded under the Pharmacy A comprehensive, systematic, A systematic, patient-centred clinical An autonomous pharmacist Specific medicines may be targeted
Definition
Services Agreement. Pharmacists will evaluation of a patient’s assessment of all medicines currently integrated in the healthcare team for optimisation, guided by defined
assist in the focussed management of understanding of and adherence to taken by a patient, identifying, providing support and advice on all testing/assessment criteria and
eligible patients to optimise the prescribed medication treatment. resolving and preventing medication- matters related to the medication standing orders as appropriate.
supply and use of prescribed related problems as well as management of patients with
medicines and to support adherence. Pharmacist aims to improve optimising the effectiveness of complex clinical needs. Example in current practice: CPAMS
understanding of and adherence to medication treatment.
medicines; identifying and addressing May or may not include Pharmacist The provision of INR point-of-care
factors linked to non-adherence Prescriber Scope of Practice (see testing by accredited community
behaviours as well as minimising Pharmacist Prescriber section). pharmacists and adjustment of
pharmaceutical waste. warfarin doses within a defined range
with the aid of an approved decision-
support system.
For the patient Eligible patients with chronic [In addition to Level 1 goals] [In addition to MUR goals] Patients with complex clinical The patient receives timely,
conditions who are prescribed regular management needs will, as part of an convenient and accessible
medication treatment will receive Patients with complex difficulties in Patients who may have concerns integrated healthcare environment, management of their warfarin
targeted assistance to ensure they understanding and adhering to about the effectiveness of their have prescribed medication treatment by a community
know what medications they are medications (and their medications, or may be experiencing treatment continually monitored pharmacist working collaboratively
prescribed, what they are prescribed family/whanau) receive personalised adverse effects, will be reviewed by a against treatment goals and regimen with the patient’s GP.
for and the directions for taking education and support to improve clinically experienced pharmacist. refined as required.
them. self-management. This is achieved
through tailored education for Patient’s medication-related
The patient has available a range of greater understanding of what their problems will be identified and
services to assist the collection and prescribed medications are through managed either directly by the
organisation of prescribed medicines, an agreed action plan to address pharmacist, or collaboratively with
and to manage any changes. adherence issues. the prescriber.
6Pharmacist is able to synchronise The patient is able to discuss with the
prescriptions and adjust the pharmacist:
frequency of dispensing to suit the Concerns or understanding of
patient’s needs and abilities. medicines
Access to and administration of
medicines
Adherence to medication
treatment.
For the Barriers to the prescribing, dispensing Supports patients to better Patient’s prescribed medication The pharmacist is an integrated The pharmacist actively contributes
and administration of prescribed understand and adhere to the regimen is collaboratively reviewed member of the prescriber’s wider to the primary care of patients by
prescriber /
medicines are identified and a plan prescribed regimen. Targeted to against treatment goals with the healthcare team and works reducing the burden of
health-system made to resolve these. patients who are experiencing prescriber, in the context of autonomously within the team anticoagulation management whilst
difficulties in understanding the identifying, resolving and preventing providing medicines management keeping the GP fully informed of
In conjunction with prescribers where purpose of and/or adhering to, medication-related problems; and support and advice at an individual results obtained and dosing
appropriate, assistance given to prescribed treatment are provided optimising the therapeutic benefits of and practice population level. management provided. Prescriber is
medicines reconciliation, with additional education and prescribed medication. notified directly of any patients with
synchronous prescribing and assistance with management; and/or results falling outside set
dispensing of medication. Minimises patients initiated on new or high-risk Pharmacist discusses aspects of parameters.
duplicate prescribing and resupply of medicines. adherence and utilisation of
treatment occurs on a regular, rather prescribed therapy with the patient. Provides improved accessibility and
than ad-hoc basis. Health beliefs or behaviours This is summarised and a care plan is convenience for patients.
contributing to non-adherence are developed with the prescriber based Improved multidisciplinary
identified and an agreed action plan on therapeutic priorities. management of patients taking
is developed with the patient to warfarin.
address these.
Improve multidisciplinary
management of patients prescribed
warfarin in the community
Training / Registered Pharmacist with no Standards-based Medicines Use Portfolio of evidence submitted for MTA Standards minimum level Formally assessed accreditation
additional qualification or training Review training & accreditation. accreditation and formally assessed expected. training.
Accreditation
required. Formally Assessed against Pharmacy against PSNZ Medicines Therapy Biennial recertification
Council Medicines Use Review Assessment Standards. Experience, qualifications, skills and
Some activities may be completed Standards. knowledge as considered appropriate
within an Intern Pharmacist Scope of MTA Standards require pharmacists to the role being fulfilled as a clinical
Practice. MUR pharmacists require knowledge to have defined pharmacotherapeutic pharmacist employed as an
and skills in behavioural change knowledge and skills at a minimum integrated member of a healthcare
management. post-graduate certificate level (or team.
equivalent) plus at least TWO years
patient orientated experience in a
hospital, community or primary care
setting post- registration.
Specific Service Pharmacy Council of New Zealand Medicines Use Review Competence PSNZ Pharmacist Medicines Therapy MTA Standards in addition to any Standard Operating Procedure
Competence Standards. Standards set by the Pharmacy Assessment Standards (endorsed by defined in accordance with CPAMS Standing Order
Standards
Council of New Zealand. the Pharmacy Council of New employment agreement with
Service delivered by all pharmacies as Zealand). healthcare practice Delivered as per the Community
per the Community Pharmacy Pharmacy Services Agreement.
Services Agreement.
7Eligibility Patients who: Patients living independently in the Patients who have one or more None specified. Patient population Patients are referred by a Medical
Have a diagnosed long-term community who have one or more chronic disease states; two or more service by the practice. Practitioner and consent to
condition as described in the LTC chronic disease states and meet one co-morbidities; and meet one or registration in the Community
Service Patient Eligibility or more of the following conditions: more of the following conditions: Pharmacy Anti- coagulation
Assessment Form Taking three or more medicines Taking four or more medicines Management Service. Stable and
Does not adhere or genuinely has and/or 12+ doses per day and/or 12+ doses per day Unstable INRs may be managed.
difficulty adhering to their Have multiple prescribers At increased risk of medicine-
medicines regime, either because Have had a recent admission to related problems Patients must:
of the complexity of that regime hospital (especially if there was a Are experiencing or are at risk of be referred by a Medical
or because of their personal or medicine change) experiencing sub-optimal response Practitioner who delegates point-
long-term condition’s Are taking or about to commence to pharmacotherapy of-care testing to a community
characteristics; and taking medicine(s) with a high risk Have experienced significant pharmacy service; and either:
Have a score of at least [20] of adverse effects, narrow changes in their medicine regimen be taking warfarin medication; or
following assessment using the therapeutic index and/or requires during the last 3 months be requiring warfarin loading and
LTC Service Patient Eligibility therapeutic monitoring, or is Taking or about to commence initial stabilisation; or
Assessment Form. suspected of being inappropriately taking one or more medicines with be overlapping warfarin
used. a high risk of adverse effects medication with low molecular
Have a particular medicine related Have signs/symptoms of a weight heparin (LMWH);
problem e.g. adverse reaction, non- medicine adverse effect be mobile and able to access the
adherence. Are taking medicine(s) with a services
Are non-adherent or unable to narrow therapeutic index and/or
manage their medicines requires therapeutic monitoring, Exclusions:
Have literacy or language where sub-therapeutic or toxic Patients with acquired or congenital
difficulties, dexterity problems, effects are suspected. coagulation disorders (such as anti-
impaired sight, or cognitive phospholipid syndrome, Protein C
deficiencies that impact on their deficiency) and/or those receiving
ability to manage medicines. active anti-neoplastic treatment. Refer
to service specification.
Patients who are non-compliant
and/or have not attended the service
without appropriate explanation
within 6 weeks.
Restrictions / As per LTC Access Criteria As per eligibility criteria. Medicines Review Service Standards Standing Order parameters.
Aged residential care excluded. Issues identified that are beyond the require pharmacists to recognise
Limitations
Activities to address adherence and adherence and education scope of personal limitations, to work within Mandatory review by Medical
understanding focus at the time of the service and/or capability of the these and to recognise need for, and Practitioner if INR is 4.0
dispensing. pharmacist to resolve, require facilitate patient referral to another
referral to other pharmacist health professional when
Medicines Management Services (e.g. appropriate.
MTA), or other Health Practitioners.
Service Regular engagement, as deemed Patients may self-refer into the In most cases it is expected that MTA Referrals not specifically required as A strong professional relationship
appropriate or agreed, with members service, or referrals may come from referrals will be initiated from a the service is delivered by a must be in place between the
Linkages
of the patient’s multidisciplinary care their usual community pharmacist, recommendation of a member of the pharmacist who is a fully integrated Medical Practitioner and
team, in particular, engagement with prescribers, hospital or primary- patient’s healthcare team. member of the healthcare team.
their key medical practitioner(s). secondary care liaison pharmacists,
8Primary Health Care Nurses, Nurse Pharmacists providing MTA services Reports and recommendations are Pharmacy/Pharmacist providing
Practitioners, and/or other healthcare often work as part of a sent to the GP and where available, this Service.
providers. multidisciplinary team to optimise the entered into the shared care record. The Pharmacy must have the
selection of medicines for and the appropriate secure IT connection to
For the provision of Medicines utilisation of medicines by individual allow electronic linkage with
Adherence Services there will not patients, with reports and general practice.
necessarily be access to clinical recommendations going to the GP
information and the interaction and where available, entered into the
In addition to the calibration
supplied by the manufacturer the
and intervention is largely with shared care record.
pharmacy arranges quality
patients rather than providers.
assurance reviews with an agreed
Service is dependent on the
local laboratory in each DHB and/or
Pharmacists must demonstrate development and maintenance of
an external quality assurance
knowledge of and appropriate effective therapeutic partnerships
provider.
linkages with prescribing practitioners between the various health
and health and/or welfare professionals involved in an individual
organisations, such as Government patient’s care along with the patient
and non-Government support themselves and their family / whanau
organisations, and secondary / caregivers.
services.
The MTA pharmacist will recognise
national and regional healthcare
priorities and strategies and deliver
MTA services within the context of
these.
Setting Community Pharmacy Community Pharmacy Community Pharmacy Integrated Health Centre Community Pharmacy
Hospital Pharmacy Hospital Pharmacy Primary Health Organisation Must be provided from premises that
PHO/Integrated Health-based PHO/Integrated Health-based General Practice conform to relevant standards issued
Pharmacists Pharmacists Private consultant practitioners by the Ministry of Health or PSNZ.
Private consultant practitioners Private consultant practitioners Service may be delivered in other
Service may be delivered in other Service may be delivered in other settings as appropriate to the patient
settings as appropriate to the patient settings as appropriate to the patient e.g. Patient’s home, marae, ‘clinics’
e.g. Patient’s home, marae, ‘clinics’ e.g. Patient’s home, marae, ‘clinics’
Reporting Regular engagement (as deemed Provision of a record of all current Pharmacist is expected to have access Reporting into the integrated health INR results and dosing
appropriate), with members of the medicines to the prescriber; and to to patient clinical records and will record In accordance with practice recommendations reported to
multidisciplinary care team in the patient unless practical contribute to these and/or report policies. prescriber via decision support
particular medical practitioner(s), in circumstances dictate that it would into the integrated health record as software (i.e. ‘INR Online’).
order to provide members with not be beneficial appropriate. Pharmacy reports information in
information about the patient’s accordance with the
progress in improving management Reporting of suspected significant MTA Standards require pharmacists Pharmaceutical Transactions Data
of their medications. adverse medicine effects or to practise effective working Specification, the Procedures
therapeutic issues to prescribers relationships within the Manual, and the terms and
Reporting into integrated health and/or entered into the shared care multidisciplinary healthcare team. conditions set out in the service
record as appropriate. record where available. agreement.
Quarterly Reporting
9Service Medicines Information: Provide Includes that as described for LTC As for MUR Services, in addition: As for MTA Services, in addition to Assess patient history / symptoms,
information about prescribed Services with the exception of any applicable criteria described in an or factors that may influence the
Activities /
medicines to supplement dispensing dispensing services. Assessment of the level of employment agreement. results (e.g. a missed dose of
Outputs advice. adherence in the context of the warfarin)
Detailed assessment of level of potential effect on clinical Comprehensive clinical perform INR test as per device and
Medicines reconciliation: Obtaining understanding of prescribed outcomes. assessment of the safety and decision support instructions
the most accurate list of medicines, treatment and supplementing Assess clinical status based on all efficacy of medication treatment warfarin dose adjustment
allergies and adverse drug reactions knowledge gaps as required. available information, including against therapeutic goals and in supported by decision support tool
and comparing this with the clinical notes. accordance with applicable advise patient of INR result and
prescribed medicines and Assessment of level of adherence to Review appropriateness of therapy guidelines and/or best practice. new dose of warfarin
documented allergies and adverse prescribed medications and reasons and compare against alternative Proactive advice to prescribers provide counselling and education
drug reactions. Any discrepancies are or behaviours behind non-adherence. therapy options as appropriate and the healthcare team on about warfarin
documented and reconciled. Review cost-effectiveness of medication management options provide the Medical Practitioner
Formulation of an agreed action plan therapy including appropriate monitoring with results and changes to the
Synchronisation: Pharmacist helps with the patient to address adherence Identify and evaluate actual and of treatment warfarin regime.
coordinate prescribing written by all issues. potential medicine therapy As applicable, support in the Request medical review by
prescribers who have the care of the problems prescribing of medications in Medical Practitioner if INR exceeds
patient to assist regular supply of Formal referral and report to other • Negotiate treatment goals and accordance with Pharmacist limits of advice
medicines and accommodation of health professionals, of issues timelines for attainment of goals Prescriber scope and area of contacting Medical Practitioner
regimen changes. identified beyond the scope of the with both patient and medical practice. directly if concerned about the
service or pharmacist. practitioner. Provision of medicines patient’s symptoms, results, or the
Reminders: Utilisation and • Reporting of suspected significant information services, as applicable dose recommendation;
individualisation of various Removal of out of date medicines and adverse medicine effects to role. maintain record of care &
technologies and services aimed at medicines that are no longer required Formulate and document a management plan
assisting patients’ adherence. (with permission) pharmaceutical care plan participation in quality assurance
Contribute to multidisciplinary programme;
Adherence support: assists the Provision of health behaviour team on the formulation and audit anticoagulant management
patient to adhere to and persevere changing strategies aimed at documentation of a comprehensive auditing compliance for timeliness
with their medicines regime and to improving lifestyle factors. care plan, and to assist the team in of testing to identify Patients with
manage any prescribed changes. modifying the care plan based on compliance issues
regular assessment of the patient’s record incidence of adverse events
Medication Management Plan: a status. (in particular the incidence of
living, long term record that outlines Provision of health behaviour bleeding) including hospital
how the pharmacist is working with changing strategies aimed at admissions.
the patient to improve medicines improving lifestyle
adherence over time. Recommend therapeutic medicine
monitoring using target
Dispensing services, with dispensing concentration intervention as
frequency tailored to need: appropriate.
Pharmacists manage the frequency of
Provide accurate and timely
dispensing in such a way to assist
medicines information to health
adherence, convenience (to the
professionals and patients.
patient and prescriber(s) and allows
regular treatment monitoring and
clinic appointments.
10Health Promotion and Preventative Services
Services for individuals and/or populations utilising the accessibility and knowledge of pharmacists to improve understanding of medicines and to contribute to public health programmes and/or
health targets.
Health Education Services Immunisation Services Screening and Intervention Services
Definition Services provided to individuals or populations of patients in Pharmacist vaccinators contribute to and enhance the success Targeted health screening/monitoring utilising testing
specified/targeted health areas as part of locally or nationally of local and national immunisation programmes through procedures available and appropriate for a pharmacy setting,
coordinated DHB, PHO or Ministry approved public health utilising their public accessibility to: that integrates with national and/or local health promotion
programmes. Administer funded and unfunded vaccines to eligible people. activities and strategies (as available).
Reduce demand on other primary healthcare providers for
Pharmacist-provided health education services may include the vaccination services for people ineligible for funded Examples may include: cholesterol, gout, glycated
identification of individual or groups of patients to whom vaccines. haemoglobin, blood glucose, blood pressure measurements,
specified health information should be provided. Increase population uptake of immunisation. and screening for infectious disease (e.g., Group A
Streptococcus, chlamydia), among others.
Specifications for any individual service would be developed in A pharmacist vaccinator has successfully completed a Ministry
accordance with delivery requirements and service aims. of Health-approved vaccinator training course and subsequent Result of screening measurement tool directs course of action
independent clinical assessment in accordance with the which may include:
Examples of such services might include immunisation Immunisation Standards. referral for full medical assessment/management
promotion, smoking cessation, self-care of medicines, cardiac provision of a pharmacist-only medicine
rehabilitation (focussed on medicines use), brand switch Pharmacist vaccinators undertake the same training and provision of a prescription medicine in accordance with a
counselling, diabetes medication use, mental health accreditation as other authorised vaccinators but may standing order, or
medication use, administration requirements for medications administer those vaccines which have been classified as being data collected provided into a multidisciplinary shared-care
(e.g. use of insulin pens, asthma inhalers and spacers etc.), able to be administered by a registered pharmacist who has plan
marae-based medication/health education for Māori. successfully completed a vaccinator training course approved
by the Ministry of Health and who is complying with the
immunisation standards of the Ministry of Health, without the Specifications for any individual service would be developed in
need for a prescription or standing order. accordance with delivery requirements and service aims while
also considering the National Screening Unit’s Principles of
Documentation of immunisation, reporting and notification in screening and screening assessment criteria.
accordance with the Immunisation Standards and patient
confidentiality requirements. Services will be delivered in accordance with the HDC Code of
Health and Disability Services Consumers' Rights, including the
right to make an informed choice and give informed consent.
For the patient Patient receives targeted education and advice on the Patient benefits from convenience and accessibility of Individuals or targeted populations receive evidence-based
presentation and management of specific health topics, pharmacists and receives immunisation(s) for the prevention health screening for specific health conditions which present a
utilising the accessibility and knowledge of their pharmacist. of disease in accordance with health needs. risk of harm. Results are managed in accordance with
appropriately developed guidance and/or standing orders in
Populations and individuals attending a pharmacy will receive order to mitigate that harm.
health promotion information on the benefits of immunisation
in general, for the prevention of disease.
Where immunisation needs are outside of the pharmacist-
delivered immunisation service, pharmacists will refer patients
to their GP.
11For the Minimise barriers to achieving health goals by utilising the Pharmacist vaccinator workforce actively contributes to Pharmacist workforce actively contributes to national and local
accessibility and knowledge of pharmacists, individuals or national and local immunisation targets through increasing health screening activities. Where appropriate, such services
prescriber /
populations of a target group receive specific education aimed accessibility of vaccines. Pharmacists also actively contribute may include aspects of management and/or referral to other
health system to improve understanding and ultimately health outcomes. to immunisation promotion and are a readily accessible health- practitioner.
professional source of information and advice on vaccine-
preventable disease.
Training / None specified. Pharmacist vaccinators must successfully complete a Ministry As appropriate to the service, in accordance with scope and
As appropriate to the service, in accordance with scope and of Health-approved vaccinator training course and subsequent standards of practice.
Accreditation
standards of practice. independent clinical assessment, then maintain their
authorisation in accordance with the Immunisation Standards.
The Pharmacy Council Statement on Pharmacist Vaccinators
states that pharmacists who offer a vaccination service must
undertake resuscitation training equivalent to that of NZRC
Rescuer Level 4. The following five skills must be included in
the training: infant, child and adult Cardiac Pulmonary
Resuscitation (CPR) including mouth-to-mouth, mouth-to-mask
and the management of choking
Specific Service Standards for any individual service would be developed in Ministry of Health Immunisation Standards Standards for any individual service would be developed in
accordance with service aims and delivery requirements. National Guidelines for Vaccine Storage and Distribution accordance with service aims and delivery requirements.
Standards
Pharmacy Council Statement on Pharmacist Vaccinators
Guidance described in the Ministry of Health Immunisation Pharmacist screening and intervention services will be
Handbook evidence-based and any medical devices used will be of
appropriate standard and quality.
Service Users Target population or patient groups as defined by DHBs, PHOs, Target population or patient groups as defined by the National Target population or patient groups as defined by DHBs, PHOs,
Ministry of Health and/or other local or national public health Immunisation Schedule and those self-referred patients who Ministry of Health and/or other local or national public health
programmes. are eligible for vaccination. programmes.
Eligibility Eligibility criteria for any individual service would be developed As per Immunisation Standards, the indications for the Eligibility criteria for any individual service would be developed
in accordance with service aims and delivery requirements. respective vaccinations, and as per the medicines classification in accordance with service aims and delivery requirements.
for those vaccines classified as able to be administer by
pharmacist vaccinators.
Service To be defined in accordance with service aims and delivery Pharmacists to have effective links with the following services: Screening and intervention programmes delivered in a
Linkages requirements. Local immunisation coordinators collaborative manner through strong links to general practice
The Immunisation Advisory Centre (IMAC) and the wider multidisciplinary team where appropriate.
Examples of service linkages may include: General practice
Consumer advocacy services, including Māori and Pacific Local Medical Officers of Health Pharmacists will have defined outcomes that are managed
Island advocacy services. Local DHB appropriately within the service (e.g. through the provision of
DHB public/population health services, Ministry of Health Pharmac treatment), or will refer to other services for comprehensive
public health campaigns, PHO health promotion assessment or management as agreed with relevant members
programmes. Pharmacists to notify the patient’s general practitioner of of the wider healthcare team.
Pharmac, Māori Health providers, GPNZ or similar. administration of vaccines, with the consent of the patient.
Pharmacists will record information in the National
Immunisation Register as this becomes available.
12Setting Services will be delivered in a facility and setting Community pharmacy and/or offsite from a community Delivered in a facility and/or settings appropriate to the target
appropriate to the target patient or population groups. pharmacy when provided in accordance with relevant guidance patient or population groups and in accordance with any
A private area must be utilised for discussions with patients and standards standards or codes of practice.
and their family/whanau.
Services may be delivered by pharmacists working in Pharmacist Immunisation Services must be provided from
community or hospital pharmacy, PHO/Integrated Health- premises conforming to relevant standards issued by the
centres or as private consultant practitioners. Ministry of Health and/or The Pharmacy Council of New
Zealand.
Facilities at which vaccines will be stored and administered by
the pharmacist will provide for cold chain storage as well as
privacy and management of adverse events (including
anaphylaxis). Facilities will comply with the requirements of
the Immunisation Standards and Guidelines for Vaccine
Storage and Distribution.
Pharmacists will provide the service in a manner that enables
the patient to understand evidence-based information about
vaccines and the illnesses they prevent.
Pharmacists will obtain and document informed consent to
administer vaccines on that basis and in accordance with the
individual requirements of the vaccine(s).
Reporting Requirements developed in accordance with specific service General practice to be notified of the administration of a Requirements developed in accordance with specific service
aims and delivery requirements. vaccine under the service, with the consent of the patient. aims and delivery requirements, in consultation with all
members of the healthcare team with service linkages.
National immunisation register as available.
Documentation of the consent, administration, storage and
transport of all immunisations in accordance with Ministry of
Health requirements.
Service • Provision of generic, non-specific population-based Safe provision and administration of approved vaccines to Provision of targeted screening and intervention for diseases or
education to patients or other health professionals patients. illnesses in accordance with defined national or local public
Activities /
• Provision of specific education targeted at eligible health strategies or initiatives and following appropriate
Outputs individuals Active participation in the promotion and education of guidelines and best practice.
• Provision of health behaviour changing strategies aimed at immunisation as a public health benefit.
improving lifestyles of individual patients.
Documentation of vaccination, reporting and notification in
accordance with patient confidentiality requirements.
Enhanced national uptake of immunisation.
13Pharmacist Medicines Information Services
Services utilising pharmacists’ specialised knowledge of pharmacotherapy to support patients, health professionals, and health providers
with the optimal use of medicines.
Pharmacist Medicines Information Services
Definition Medicines Information is the provision of evidence-based information about medicines and advice on their therapeutic use.
The focus of Pharmacist Medicines Information Services is on information provision to healthcare providers that enables
those providers to optimise their effective utilisation of pharmaceuticals.
Medicines information services aim to:
• assist providers with the rational and quality use of medicines for a given patient, patient group or population
• locally implement national or regional appropriate use of medicines campaigns that aim to impact on the demand for
certain medicines or classes of medicines
• reduce the risk of adverse medicine events associated with the transition between providers of health services
• provide independent, accurate and relevant medicines information to health professionals, thus contributing to patient
care and the optimal use of medications
Medicines information services may reactively respond to specific requests for advice, as well as proactively provide
guidance on specific topics.
For the Prescribers and other healthcare professionals are provided with independent, evidence-based information about
medications and advice on their therapeutic use and optimisation.
prescriber /
health-system
Training / New Zealand Hospital Pharmacists Association. Medicines Information Group: Medicines Information Training Manual
Recommended: Post-Graduate Certificate in Pharmacy (Endorsed in Medicines Management)
Accreditation
Pharmacists providing this service will have relevant post-graduate clinical qualification(s) or work experience to
demonstrate general pharmaceutical knowledge in core areas and/or specialist pharmaceutical knowledge in one or more
defined areas.
Service Users General practitioners, specialists, registrars, house officers, midwives, dentists, veterinarians, optometrists, nurse
practitioners and any other prescribers or health professionals.
Health service providers concerned with the optimal and cost-effective use of medicines.
Restrictions / In accordance with specific service aims and delivery requirements.
Limitations
Service It is intended that Pharmacists will provide Medicines Information Services that are consistent with Government health
strategies.
Linkages
As appropriate, the service may provide links between members of the multidisciplinary healthcare team, and/or identify
clinical situations requiring more advanced assessment or interpretation.
Setting Specialist hospital medicines information centres
Hospital pharmacies
PHOs/Integrated health centres utilising appropriately qualified pharmacists (e.g. specific MI pharmacist, CMM pharmacists)
Private consultant practitioners
Reporting Quality assurance procedures to be in place to help ensure services are of a sufficiently high standard.
Examples include standard operating procedures, proactive peer review prior to provision of information, induction training
for new staff, retrospective audits
Service Non-exhaustive list of activities may include:
Provision of information and advice either retrospectively in response to a direct enquiry, or prospectively by issuing general
Activities /
guidance on a particular topic. Pharmacists providing this service interpret and apply evidence-based information on a
Outputs population or individual patient basis to:
• Outline the appropriateness of medicine options for a patient according to their individual clinical status
• Provide advice on the cost effectiveness of medicine options
• Facilitate best practice medicines utilisation through the development and/or implementation of localised guidelines,
analysis and feedback of medicines utilisation data, educational interaction with prescribers and other providers of
healthcare, and the provision of objective, comparative and unbiased medicines information
• Facilitate the smooth transition between providers of health services.
As appropriate, pharmacists providing the service may generate and utilise reports (e.g. medicine utilisation/dispensing
history) to assist:
• Other providers of healthcare with individual patient management and quality use of medicines
• Hospital admission and/or discharge management, including managing prescriptions from multiple providers for
individual patients.
Appropriate use of medicines campaign participation
Pharmacists providing the service to actively participate in national or regional appropriate use of medicines campaigns to
address the demand for certain medicines, as determined by the DHB or PHOs.
14Pharmacist-Only (Restricted) Medicines
Pharmacist-only medicines are available for those patients assessed as appropriate for supply and are mostly unfunded if not supplied in
accordance with a prescription. Opportunities are available for specific medicines to be funded for those patients meeting appropriate
assessment criteria, in accordance with a nationally or locally delivered health programme.
Pharmacist-Only (Restricted) Medicines
Definition A pharmacist-only (restricted) medicine is a medicine classified as such under the Medicines Regulations that may only be sold
by retail by a pharmacist in a pharmacy or hospital; or in accordance with a standing order. Pharmacist-Only Medicines are
regarded within the profession as pharmacist-prescribed medicines. Accordingly, the pharmacist is expected to undertake an
appropriate consultation with the patient, fully considering any specific practice guidelines or protocols prior to making the
decision to supply a pharmacist-only medicine.
References to ‘pharmacist-only’ medicines also includes those medicines which are classified as prescription medicines “except
when supplied by a registered pharmacist…” or words to similar effect. Such medicines remain classified as ‘prescription
medicines’ but may be supplied by pharmacists under conditions defined in the classification statement for that medicine.
Pharmacists have special legislative and professional responsibilities in controlling the supply, storage, recording and advertising
of these medicines. Pharmacist-only medicines are not usually funded by the health system unless listed in the Pharmaceutical
Schedule and prescribed by an authorised prescriber; or specific medicines are funded as part of a local healthcare initiative
(such as the Emergency Contraceptive Pill).
For the patient Patients have the ability to obtain readily-accessible, efficacious medicines, where the sale is supervised by a health professional
who identifies the need and appropriateness for the medicine, and gives individualised information and advice. Patients are
referred to their general practitioner where management using a pharmacist-only or other over the counter medicine would be
inappropriate.
For the Ailments suitable for management through advice and/or the use of a pharmacist-only medicine can be cared for by
pharmacists. However more serious ailments beyond the scope of over the counter management are referred for medical
prescriber /
assessment.
health system
Training / Registration within the Pharmacist Scope of Practice (or Intern Pharmacist Scope of Practice when under the supervision of a
Pharmacist)
Accreditation
Training must be successfully completed where the classification of a medicine, or Pharmacy Council standards requires it.
Training and accreditation is a mandatory requirement for the provision of trimethoprim, levonorgestrel (emergency
contraception) and vaccines by pharmacists.
Specific Service • Pharmacy Council Code of Ethics for Pharmacists
• PSNZ Pharmacy Practice Handbook
Standards
• Standards, Guidelines and/or Protocols for the supply of specific pharmacist-only medicines as available when defined by the
Pharmacy Council and/or Pharmaceutical Society of NZ.
• Pharmacy Council Protocol for the Sale or Supply of Pharmacist-Only Medicines for Chronic Conditions (POMCC)
Pharmacists must have procedures to ensure that pharmacy staff always refer patients to the pharmacist when:
• a Pharmacist-Only Medicine is requested; or
• a Pharmacist-Only Medicine could be a suitable treatment for symptoms described by the patient.
Service Refer to or consult with the patient's medical practitioner and/or other health professionals as appropriate and agreed to by the
patient.
Linkages
Setting / Sales of Pharmacist-Only Medicines may only be made from a registered pharmacy or from a hospital.
A private area that enables confidential patient consultations to be undertaken is required.
Facilities
Reporting Medicines Regulations require the documentation of the sale of pharmacist-only (restricted) medicines and set out the details
which must be recorded in the register of pharmacist-only medicines.
Pharmacists are encouraged to record provision of pharmacist-only medicines using electronic methods and process the sale
through their computers as they would when dispensing a prescription. The Medicines Regulations require recording of the
following information:
• date of transaction; name and address of purchaser (if the purchaser is not the patient, it is recommended that the details of
the sale are also recorded in the patient's history); name and quantity of medicine sold; name of pharmacist making the sale.
Service Assessment of the condition to be treated:
• history of the signs/symptoms or disease process
Activities /
• current medications and any other treatments
Outputs • patient’s known risk factors e.g. allergies, pregnancy, contraindications and precautions of the medication
Assessment of the appropriateness of the pharmacist-only medicine supply considering potential adverse reactions, interactions
and side effects; while also considering possible non-medication therapy or referral for further medical attention.
Provision of patient-individualised advice using verbal and written information on: adverse effects; precautions; correct use and
storage of the medicine; when the patient should seek medical advice; and the availability of the pharmacist for further
information if required.
15You can also read
