Clinical pharmacy services supporting patient care

In this issue of the Journal of Pharmacy Practice and Research we have new Clinical Pharmacy Standards for the profession.¹ It has been a pleasure to work alongside so many others to help bring this important consensus document together and to have been involved in the earlier versions. The first comprehensive standard of practice for clinical pharmacy was published by the Society of Hospital Pharmacists of Australia in 1996 with updated versions subsequently released in 2005 and 2015.^2-4

As practice has evolved over time the new Advanced Pharmacy Australia Clinical Pharmacy Standards¹ have been adapted to incorporate a greater focus on describing the key quality elements for practice as well as focus on person centred care and interdisciplinary practice whilst proving guidance on prioritisation of the clinical pharmacy services.

The accompanying editorial authored by Advanced Pharmacy Australia President Tom Simpson shares his views on the importance of this work and described the Standards as a blueprint for patient care and an ‘instruction manual’ for how to design, implement, and measure the clinical pharmacy services that underpin contemporary medicines management.⁵ Dr Danielle McMullen, the President of the Australian Medical Association, describes the importance of collaboration between professions and the vision to implement innovative models of care safely, to improve patient outcomes and the experience as practitioner.⁶ This perspective from our medical colleagues is vital as it reinforces one of the key principles in our Standards; that interprofessional collaboration is essential to the delivery of efficient and effective person-centred care.

These Standards provide a framework and guidance for comprehensive and accountable clinical pharmacy services. The underpinning principle is to describe current best practice to support the basic rights of patients when accessing healthcare services, including access, safety, respect, partnership, information, privacy, and the right to give feedback. Comprehensive and accountable clinical pharmacy services are an essential component of contemporary health care. The challenge has been to describe the quality of practice for clinical pharmacy services in Australia, irrespective of service type (private and public hospitals, inpatients, outpatients or community-based services) or location (metropolitan, regional, rural, or remote).

A fundamental component of these Standards has been to provide clear guidance for the pharmacy workforce, which encompasses pharmacists, but also includes pharmacy technicians and assistants who play a pivotal role in the care provided. The scope of practice and role delineation between the professional scope of practice of pharmacists and that of pharmacy technicians and assistants required significant consideration. The basis of this was the underpinning principle that the scope of clinical practice is defined as the professional activities that a pharmacist is educated in (skills/knowledge), competent and authorised to perform, and for which they are accountable. Consequently, the scope of clinical practice when referred to in these Standards, relates to the clinical practice provided by pharmacists exercising their professional judgement.

As with all healthcare professions, pharmacists must be supported to practice at their full scope. Activities that do not require professional judgement can be undertaken by any member of the pharmacy workforce who has received the appropriate evidence-informed pharmacy and interprofessional training and education suitable for those roles. This needs to remain the key priority of the profession.

Structured, formalised, and recognised training programs for pharmacy technicians or assistants need to be developed to enable further expanded pharmacy technician and assistant roles to support clinical pharmacy services. Unfortunately, the training and recognition pathways in Australia for pharmacy technicians currently do not support a clinical scope of practice for pharmacy technician and assistant roles unlike those in place internationally, and until these are in place these roles remain aspirational. However, this in no way diminishes the wonderful contributions made by pharmacy technicians and assistants in clinical support roles. This provides the challenge for the future, a focus on robust evidence based educational programs that demonstrate competency, accountability, and formal recognition of those aspirational roles.

One of the other major changes to this version of the professional standards is the highlighting that interprofessional collaboration is essential to the delivery of efficient and effective person-centred care and that pharmacists need to be present at the point of decision-making to contribute to medicines-related decisions. This includes having clinical pharmacy services align with clinical units, including both inpatient and ambulatory settings, and developing strong interprofessional relationships and teams. Tom Simpson's comments also reflect this through the professional organisations championing of innovative models of care can maximise patient outcomes.⁵ The incorporation of collaborative prescribing models within these Standards is a clear example of such collaboration.

I hope, our profession, with the support and collaboration of others, will endeavour to bring these Standards to life, to continue to improve the care provided to the communities we support and guide person-centred pharmacy services.

Michael J. Dooley is Editor-in-Chief of the Journal of Pharmacy Practice and Research, author of Advanced Pharmacy Australia Clinical Pharmacy Standards and Director of the Victorian Voluntary Assisted Dying Service.

Michael J Dooley: 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.

Not Commissioned, not externally peer reviewed.

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