Today's advanced is tomorrow's standard

Abstract

Our Society exists because our members collectively seek to ensure that patients receive the greatest benefit possible from the medicines with which they are treated.

This is reflected in the very first sentence of our Constitution: “[t]he overriding purpose of the Society is to improve health outcomes from medicines use within hospitals and/or other healthcare facilities or settings (including the home) where pharmacists, the membership and other health professionals practice, through the use of pharmacist expertise in medicine management”.^1(p1)

If this statement is the why, the Advanced Pharmacy Australia Clinical Pharmacy Standards are the how.

The breadth of Advanced Pharmacy Australia's (AdPha's) Clinical Pharmacy Standards spans every element of the Australian health system in which patients, pharmacy practitioners, and medicines intersect and interact. Although it may appear to be a paradox, the Standards are both a foundation and a nexus point.

AdPha's Clinical Pharmacy Standards are a foundation because they are agnostic of care setting. Whether on a ward, in aged care, general practice, or at home, the person receiving care is wrapped in individual patient care activities, which blend into the interprofessional practice that ensures multidisciplinary input into evidence-based decisions. This is depicted in the concentric circles of the <Figure 1: Clinical pharmacy services>.²

Surrounding this person-centred care are three enablers: prioritisation to maximise impact; a skilled workforce; and innovation that ensures patients benefit from new approaches to care.

At the same time, the Standards are a nexus. The <Figure 1: Clinical pharmacy standards> shows the principles that wrap around the patient consistently, through all-important transitions of care.²

As well as a blueprint for patient care, the Standards represent an ‘instruction manual’ for how to design, implement, and measure the clinical pharmacy services that underpin contemporary medication management.

It is noteworthy this is achieved with a distinctly Australian flavour, reflecting our health system that is unique in the world. Around four-fifths of the references upon which the Standards are built are Australian, including 25 references to articles published in this journal, AdPha's flagship academic publication.² This reflects the deep expertise of our members and their contribution to evidence of pharmacy impact, nationally and globally.

The maturity of practice they represent is also noteworthy. The 2024 Standards don't only focus on what clinical pharmacy is, but on the entire supporting system that equips practitioners for the settings in which they practice.

The Standards link deeply with the Australian and New Zealand College of Advanced Pharmacy (ANZCAP), AdPha's practice recognition and development framework that includes Pharmacist Resident and Pharmacist Registrar training programs. The 2024 Standards expect that a pharmacist allocated to a specialty unit is provided with opportunities to develop, master, and mentor the specialist knowledge required. ANZCAP's training and recognition programs provide such pathways, a turning point in the maturity of our profession.

AdPha's Clinical Pharmacy Standards are truly contemporary. In 2024, scope of practice for pharmacists and pharmacy technicians is a live topic, with pharmacist prescribing now a reality, and a national review of scope of practice across healthcare workforces nearing completion.

As borne out by numerous research studies and patient outcome metrics, it is clear that maximum impact of pharmacist expertise can only be realised when the entire pharmacy workforce practices to the top of scope, including pharmacy technicians and assistants. A rising tide lifts all boats.

Whereas previous AdPha standards relegated the contributions of pharmacy technicians to ‘add on supports’, the 2024 Standard makes it clear: pharmacy technicians are integral to clinical pharmacy services. There is no pharmacy technician chapter in these pages, because these Standards don't consider the workforces in parallel, or in isolation. Rather, each element has been considered as relative to the pharmacist workforce, the pharmacy technician workforce, or both workforces working together as one.

Collaboration is a key theme woven through AdPha's Clinical Pharmacy Standards. Multidisciplinary collaboration is in the DNA of our organisation and its members; and the multidisciplinary team is the ‘native habitat’ in which advanced pharmacy is forged.

Collaborative prescribing has moved care beyond historical scope-limited and task-focused models, in which doctors prescribe, pharmacists reconcile, and then doctors amend. It is an evolution that pays double dividends: when pharmacists contribute their expertise up-front in the decision-making process, better outcomes are achieved for patients and the health system.

Returning to the core, the 2024 Standards represent a deep commitment to patient-centred care. It is easy for pharmacists to focus on ‘scientific’ predictors of the outcomes of care, such as pharmacogenomics and pharmacokinetics. But unless practitioners understand the values and goals that drive the decision-making of each patient, they cannot predict whether a medicine will be taken, or whether advice will be trusted.

Every patient's experience of the health system is unique; as is every patient's experience of illness, health, medicines and side-effects. Patient ‘compliance’ with the pharmacist's instructions is no longer the goal; what matters is whether each treatment plan aligns with and incorporates what matters to the patient it serves. The 2024 Standards proudly reflect AdPha's progressive values in patient empowerment.

The scope of the Standards mirrors the recent transformational journey of our organisation. While hospitals will always be the foundational focus of AdPha, our Society's goal is clear: we cannot serve our patients if we limit our focus to the care delivered within the hospital's four walls.

An even simpler perspective: we cannot solely focus on the five days a person may spend in hospital, disregarding the other 360 days of their year.

Complex medication management occurs in many settings — hospitals, aged care, general practice, hospital-in-the-home, transitions of care, and virtual pharmacy services — AdPha's Clinical Pharmacy Standards are for all settings, and all pharmacy practitioners.

The Standards may, to some, appear aspirational. They may not reflect current practice in every single health service, but they represent the ‘goal state’ for the journey our health system must take. Some health services will already be ‘there’; many will be earlier on their journey.

Should every hospital plan for and attain the many ratios and service attributes articulated in the Standards? Whatever the reality is today for the health service in which you practice, we can all agree the answer should be yes. The fact the Standards aspire to excellence does not excuse us as practitioners, or our health system leaders, from taking concrete steps to implement and achieve them. Our patients deserve the quality of health care that can only be achieved when these Standards are ubiquitously applied.

As reflecting in the accompanying editorial of Professor Michael Dooley, Editor-in-Chief, with the launch of each new version, the Standards have captured a moment in time, at which each version has been described as aspirational. With the hindsight of a decade of progress, the 2013 iteration can be read as a baseline.

Indeed, one of AdPha's guiding principles is that advancement is a journey, not an endpoint; the advanced of today is the standard practice of tomorrow.

Tom Simpson is Chair, Board of Directors of Advanced Pharmacy Australia and an employee of Tasmanian Health Service. Advanced Pharmacy Australia provides travel support to attend events in the author's capacity as Chair, Board of Directors. The author declares he has no additional conflicts of interest.

Tom Simpson: Conceptualisation; writing – original draft; writing – review and editing.

Ethics approval was not required for this editorial as it did not contain any human data or participants.

This editorial received no specific grant from any funding agency in the public, commercial, or not-for-profit sections.

Commissioned, not externally peer reviewed.