Complete guide to Australian hospital pharmacy — medication safety, e-prescribing, antimicrobial stewardship (AMS), PBS (Pharmaceutical Benefits Scheme), SHPA standards, and pharmacy software.
NSQHS Standard 4 (Medication Safety) and Standard 3 (Infection Control) require medication safety and antimicrobial stewardship. PBS subsidises medications. This guide covers Australian hospital pharmacy.
Hospital Pharmacy Services
| Service | Description | NSQHS Standard |
|---|---|---|
| Medication reconciliation | Reconcile medications at admission, transfer, discharge | Standard 4 |
| Clinical pharmacy | Ward-based clinical pharmacy services | Standard 4 |
| Dispensing | Accurate and safe medication dispensing | Standard 4 |
| AMS | Antimicrobial stewardship programme | Standard 3 |
| High-risk medications | Special management for high-risk meds | Standard 4 |
| Medication incidents | Report and learn from medication incidents | Standard 4 |
| Therapeutic guidelines | Evidence-based medication guidelines | Standard 4 |
| Patient education | Educate patients about medications | Standard 4 |
E-Prescribing in Australia
- Electronic prescription: Doctor generates electronic prescription
- Token/SMS: Patient receives token via SMS or email
- Pharmacy access: Pharmacy accesses prescription via token
- Dispensing: Pharmacy dispenses medication
- PBS claiming: Pharmacy claims PBS benefit electronically
- My Health Record: Prescription uploaded to My Health Record
- Active Ingredient Prescribing: Active ingredient name on all prescriptions (mandatory from 2023)
High-Risk Medications
| Medication | Risk | Management |
|---|---|---|
| Insulin | Hypoglycaemia, dosing errors | Independent double-check, sliding scale protocols |
| Anticoagulants | Bleeding, dosing errors | INR monitoring, dosing protocols |
| Opioids | Respiratory depression, overdose | Pain management protocols, naloxone availability |
| Chemotherapy | Toxicity, dosing errors | Independent double-check, protocols |
| Concentrated electrolytes | Fatal if misadministered | Restricted storage, standardised concentrations |
| Heparin | Bleeding, dosing errors | Independent double-check, weight-based protocols |
Frequently Asked Questions
- What is PBS and how does it affect hospital pharmacy?
- PBS (Pharmaceutical Benefits Scheme) is the Australian government's medication subsidy programme. PBS subsidises most medications for Australian residents. For hospital pharmacy: 1) Public hospitals — state governments fund medications (PBS doesn't apply to inpatients in most states), 2) Private hospitals — PBS applies, 3) Discharge medications — PBS applies, 4. Outpatient medications — PBS applies.
- What is SHPA?
- SHPA (Society of Hospital Pharmacists of Australia) is the professional body for Australian hospital pharmacists. SHPA standards cover: 1) Medication safety, 2) Clinical pharmacy services, 3. Dispensing standards, 4. Antimicrobial stewardship, 5. Medication reconciliation, 6. Pharmacy operations. SHPA publishes the Journal of Pharmacy Practice and Research.
- What is antimicrobial stewardship in Australian hospitals?
- Antimicrobial stewardship (AMS) is mandatory in Australian hospitals (NSQHS Standard 3). AMS programme includes: 1) AMS team (pharmacist, microbiologist, ID physician), 2) Antibiotic guidelines (Therapeutic Guidelines — Antibiotic), 3. Restricted antibiotic authorisation, 4. IV-to-oral switching, 5. Antibiotic review, 6. AMS auditing, 7. Resistance surveillance (AURA — Australian Antimicrobial Use & Resistance).