s Washing my Hands of the Whole Mess | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2009         Volume. 1 No. 2   
Information to Pharmacists


From the desk of the editor

Welcome to the July edition of i2P, and of course, the first week of the new financial year.

Note that we are developing a new range of categories for you to follow e.g. health politics, hospital news, an expanded IT offer and we will be developing the category of anti-ageing medicine

Also, out of interest, could I refer you to the e-publications category located immediately below our columnists. If you click on the link contained there, you will find a range of e-publications that are recommended reading.

The first publication noted is the Pharmacist Activist written by Dr Daniel A. Hussar of the faculty of the Philadelphia College of Pharmacy at the University of the Sciences in Philadelphia. He is a pharmacy advocate.

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Recent Comments

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I’ve seen the future…….and I’m not happy, Jan!

Chris Wright

The ubiquitous Mrs Wright, in her quest to unearth a new erotic shopping experience, ushered this writer to a new Coles store located at the all very nice and leafy suburb of Ivanhoe in Melbourne recently.
This is contemporary retailing at its best, no doubt influenced by the gurus at Westfarmers and the rapidly changing retail climate in Australia, which of course involves the future of Pharmacy in some way….but more about Pharmacy later.

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Pharmacists losing their mojo

Neil Retallick

I read some market research recently that ought to concern community pharmacists across the country, as well as the Pharmacy Guild of Australia.
Groups of average Australians were brought together for a series of focus groups to discuss the community pharmacy landscape as they see it.
Some of the feedback was disconcerting.

Comments: 3

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Has the horse bolted?

Ken Stafford

Some twenty years ago uneasy tremors were running through hospital pharmacy here in Perth. Hospital management had suggested to one of my fellow Chief Pharmacists that the hospital needed a total parenteral and intravenous additive service (IVAS) .
When it was pointed out that this would be very labour intensive and the pharmacy did not have sufficient staff to provide it, the comment was that “nurses would be happy to run such a service”.

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Independent Pharmacist Practitioners

James Ellerson

In the region where I practice, GP’s are reluctant to comply with a patient request for a Home Medication Review.
The stock standard phrase is “I can do that for you” and so in frustration a patient will turn to me, in a professional, or quite commonly in a social setting, and asks if it is possible for me to perform a review without the doctor’s involvement.

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Disgraceful – discuss

Pat Gallagher

Disgraceful – discuss
The newspapers have been chock-a-block the past few days with dire tales but true about the black hole we are about to enter with the insane policy to re-regulate the ‘workplace’ to suit the union paymaster cliques.
While I never voted for Keating I did admire him a little bit this morning when I read a quote of his from the bad old days.
He said to some union goose: “you are carrying the jobs of (100,000) dead men around your shoulders”.
Giving a dead hand to this union unfettered power play will ensure that the nation will soon look like NSW; where the government is actually the plaything of a few loosely combined public ‘service’ union mugs.
Depending on how large your pharmacy is, in terms of overall staffing, you will soon be touched by the coming dead hand of the new/old order.

Comments: 3

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UK Dispensing Errors Under Review

Staff Writer

The recent furore in the UK over pharmacist Elizabeth Lee receiving a conviction for a criminal offence and subsequently a suspended jail sentence, has really lit a fire under the imbalances that exist when a pharmacy dispensing error is made.
The dispensing pharmacist or the supervising pharmacist under current UK legislation, has been made to bear the brunt of legal responsibility, with pharmacy owners escaping with little pain.
According to an article in PJ Online "In many cases, all that the employer needs to establish is that he had standard operating procedures in place and that the employee or locum had simply not complied with them. In these cases, the employer can walk away leaving the employee or locum to face the, often damaging, consequences".
There is now a rush in the UK to have current legislation amended to reflect a more proportionate responsibility for all parties involved.

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A New Ministery - Indigenous, Rural and Regional Health

Staff Writer

The appointment for the first time of a Minister for Indigenous, Rural and Regional Health and Regional Service Delivery is an important strategic recognition of the special needs and circumstances facing people in Australia's rural and remote communities.
People in the bush will expect this position to be part of a permanent increase in the Government's commitment to rural communities.
In welcoming Minister Warren Snowdon to the new position, Dr Jenny May, Chairperson of the National Rural Health Alliance (NRHA), said the appointment will be important both for substantive policy reasons and to boost the place of rural issues on the political agenda.

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NZ fish killed by water quality

Staff Writer

The following news item was recently published in Science Alert. It would seem that the pristine environment of New Zealand is under attack. The reasons are similar to those findings in Australia surrounding the protection of the Great Barrier Reef.

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New theory for global diabetes epidemic

Staff Writer

A new "fertility first" hypothesis published this week by a group of international experts in the American Journal of Human Biology, proposes that the global epidemic of Type 2 diabetes has its origins in the struggle, over millennia, to sustain human fertility in environments defined by famine.
A surprising and important implication for us in the modern world is that this hypothesis gives cause for optimism that the modern epidemics of diabetes and cardiovascular disease will diminish.
Source: Sydney University

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Immune system key discovered

Staff Writer

A team of Monash University researchers has discovered the importance of a protein, which could improve the way the drug interferon is used to strengthen the human immune system.
Published online in the prestigious journal Immunity, the findings show that the protein promyelocytic leukemia zinc finger (PLZF) is a key player in the body's immune response to disease, increasing our understanding of the function of the immune system.(Source: Science Alert )

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Political suspicions raised as China cracks down on bogus online health info

Staff Writer

China is notable for its authoritarian approach to the Internet and other forms of media communications.
Restrictions on Internet activity may have some long-term implications for Australia, particularly as these restrictions are intruding into the health arena.
Source: Tech.Blorge

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Senior Pharmacists - A Valuable Resource

Staff Writer

Little thought seems to have occurred in maintaining and supporting mature aged pharmacists in the workplace.
Given that this group of pharmacists is the one with the "corporate memory" of the profession, with many having started life as compounding pharmacists and counter-prescribers, there is a wealth of untapped intellectual resource that could be internally utilised in mentoring or even training pharmacists in how to sell a professional service.
This group of pharmacists is concerned with the development of retail clinics proposing to do almost exactly what they were successfully doing 30-40 years ago.
What went wrong?

Well, there is plenty of evidence to illustrate that the process of commoditising medicines is the primary reason for this loss, because if you strip everything out of a process to sell at the cheapest possible price, you get a barren professional offering
Source: Science Alert

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Terry White Makes a Move

Staff Writer


It is clear that the Terry White pharmacy group is on the move with the recent purchase of Pharmacy Direct and a restructure of its own management. Terry has had a distinguished pharmacy career and his stewardship will see possibly the strongest pharmacy group in Australia emerge He is opening up the opportunity for equity for senior members of his management team.
The following excerpt extracted from pharmacy media reports explains the process.

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Washing my Hands of the Whole Mess

Mark Neuenschwander

articles by this author...

Mark Neuenschwander has earned his reputation as one of the nations' leading authorities on dispensing and point of administration automation. Whether writing, lecturing or problem solving with a client, Mark communicates in terms and concepts that are easy to grasp and apply. His fresh perspective and keen insight stem from having invested thousands of hours in research and in-depth consulting with clients.

I’ve been thinking about neckties, kindergarten, stethoscopes, and staph.

I don’t wear neckties. As a matter of fact, when friends see me wearing something other than a black silk crewneck, they ask if something’s wrong.
My dress code didn’t impress one clinical director at a hospital where I had been brought in to help them craft a master plan for implementing bar-code and RFID-verification technologies.
I learned, long after the engagement, that she was upset when I showed up without a white shirt and a double Windsor. (I should mention that her portfolio included instituting measures to reduce the spread of hospital-induced infections.)
Anyway, while exploring how bar coding might improve patient safety in her department, her first question was bold:

“What if we installed RFID readers on faucets and sanitizers to identify physicians who fail to disinfect their hands between patients?”
The idea might be ahead of its time, but I found it interesting.

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In October 2008, the American Society for Quality (ASQ) issued a news release entitled “From Hand Washing to Handheld Devices,” in which James Lelvett, M.D., chair of ASQ’s Healthcare Division, said, "Hand washing is still the most important thing that anyone can do to prevent hospital-acquired conditions."

Good reminder. But healthcare professionals learned that hand washing was the right thing to do long before they received degrees or began reading journals. In his coffee-table classic, >> All I Really Need to Know I Learned in Kindergarten, Robert Fulghum makes the case that we all learned this when we were five. Wash your hands before you eat and Flush are the center-two lessons of his Kindergarten Credo after all.

Candidly, I’d like to see Wash your hands repeated after Flush—especially when I land on articles like “Half of doctors' neckties contained dangerous bacteria, new study.”

This study, conducted five years ago at the New York Hospital Medical Center of Queens, revealed that nearly half the neckties worn by 42 doctors contained bacteria, which could cause serious infections. When the research team scraped samples off the ties and cultured them, they found that one in three harbored staphlococcus aureus.

A year earlier, the British Medical Journal had weighed in on the issue with an article entitled “Doctors should abandon ties and avoid nose rings.”—a serious paper that’s a fun read. Come on. Nose rings?

Anyway, UK physician Jim McCaul’s analysis makes sense: "There is no point being careful about gelling your hands between patients if your tie has just landed in something nasty and then landed on the next patient."

Makes me wonder where straightening neckties typically falls in sequence with flushing and washing. Perhaps hospitals should consider providing access to hand sanitizer in bathroom stalls as well as in hallways.

This got me thinking about patient-care tools. Physicians may ditch neckties but not their stethoscopes. Here’s an idea for a 60-Minutes segment: A week in the life of a stethoscope.

Fourteen years ago, a disturbing study published in the in the Annuls of Emergency Medicine revealed that 89 percent of the stethoscopes evaluated (133 of 150) in an emergency-practice setting were contaminated with staphylococci. The study noted that while contamination is greatly reduced by frequent cleaning with alcohol or nonionic detergent, only 48 percent of healthcare providers cleaned their stethoscopes daily or weekly, 37 percent monthly, and 7 percent yearly. Seven percent had never cleaned their stethoscopes.

Is it unreasonable to expect that they be cleaned between patients?

Before I wash my hands and eat lunch, think with me about the plethora of automated tools caregivers are using with patients these days—from computer keyboards, mice, and touch screens, to handhelds, bar-code scanners, and infusion pumps. It seems foolish to be obsessive about entering accurate rates into infusion pumps or giving the exact dose of the right medications to the right patients while being laissez-faire about cleaning these devices and the hands that touch them between patients.

I used to think it would be a while before we would find RFID readers monitoring hand washing in hospitals. Then I read about a new 'Breathalyzer for the hands" in testing at a Florida hospital. In any instance, when we find ourselves in hospitals, we do well to remember what we learned in kindergarten.

I think I’ll clean my keyboard and pass on the nose ring.

What do you think?
Mark Neuenschwander

mark@hospitalrx.com Download PDF

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