AHPRA recognition for paramedicine one step closer

In a tweet by the Australian Health Practioners Regulatory Agency (AHPRA) Paul Fisher has been named as the new Executive Officer for the new Paramedicine board of AHPRA. This furthers the progress of creating national recognition of paramedics and a register of qualified paramedics.

I think this is a step who’s time has well and truely come. The UK has already created a national body and registration for paramedics. Australian states regulate paramedics within their borders, however as registered nurses know moving from state to state brought about logistical and clinical differences which caused unnecessary delay and red tape. Having a national paramedicine register through AHPRA will provide important benefits for paramedics, employers and the general public.

  • A universal code of standards will more clearly define the paramedic’s role.
  • Entry educational requirements will be universal. Meaning a paramedic could train in one state and obtain a position in another.
  • Paramedics in general will have less difficulty obtaining positions in other states. Employers as well will have a central repository for validating a potential paramedic’s qualifications.
  • The term ‘paramedic’ will nationally become a protected title.
  • Those not qualified to be paramedics would have difficulty decieving employers in other states.

As an emergency department registered nurse I see first-hand the great work paramedics do in stabilizing patients before arriving to our department. Giving them the national recognition that AHPRA provides will ensure universal quality throughout Australia. It will also standardize the care given to patients throughout Australia.

What do you think?

Until next time.

Ray

AHPRA- National regulation of paramedicine moves a step closer

HCPC- UK listing of paramedics

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Where do doctor’s prescriptions end and pharmacists dispensing begin?

An article in news.com.au on Tuesday ( the 24th) has brought up an interesting question in my mind, where does the line exist between pharmacy dispensing of medications and requiring a doctor’s prescription?

The article describes the debate over restricting medications containing codeine to prescription-only, requiring patients wanting these medications to see their doctor’s first before obtaining the drug. The Thearputic Goods Administration was indicating a change in codeine-related products from pharmacy-dispensed to prescription in 2016, although debate over the issue is heading up as the deadline for the change is February next year.

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Pharmacy representatives state this would affect the quality of analgesic care for patients by requiring them to see their doctor first. Physician groups are stating that low-dose codeine found in these medications show on therapeutic benefit, and the restriction would prevent misuse. Politicians are stuck in the middle in wanting to satisfy both sides.

So what is the issue with codeine? It is addictive and potentially harmful in high doses. Codeine is an opiate, an analgesic similar to Morphine. Therefore, its properties of pain relief can lead to addiction if misused. The Sydney Morning Herald stated that 12% of Australians surveyed exceeded the recommended daily dose of analgesic medications containing codeine. While the codeine dose is quite small the issue with this worrying fact is the potential for overdosing on paracetamol and ibuprofen; both have potentially toxic effects if too much is in the human body. An article by NPS Medwise has shown that when codeine has been consumed to lethal levels, although being accidental in nature, the number of deaths are double that of deaths related to stronger prescription medication such as morphine.

So why take it away from pharmacists hands? Simply control and monitoring. Even in my role within a public hospital I see frequently patients who travel from one hospital to another asking for pain relief, sometimes discharging and presenting to multiple hospitals in the course of a day. I am sure that most pharmacists are very conscientious and ethically-responsible people. However, a patient could approach one pharmacy let’s say in the morning and buy a codeine-related product, and then travel to a completely different area in the afternoon approach another for more product. This individual may not even intend to do this, instead they may work in the city and travel from home in a completely different area by public transport. The second pharmacist would not have knowledge of the previous purchase and therefore would not question the transaction.

A doctor’s prescription requires individuals to physically see a doctor. A record of the prescriptions would exist and could be tracked. Additionally, higher consumption could trigger the doctor to investigate the reasons for the increased usage and try to eliminate the cause of pain in the first place.

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 While I have no issue with pharmacists as I think they are very competent and ethical practitioners I do support the moving the responsibility of codeine release from pharmacists to doctors.  Codeine is an opiate, and most opiates (along with other analgesics of similar strength) are classified as schedule eight restricted due to their addictive properties. The low doses of codeine and the toxic properties of the main ingredients (paracetamol and ibuprofen) mean that overdosing on these over-the-counter medications can lead to serious health consequences. Finally, as I stated above requiring a prescription can then lead a doctor to investigate, and hopefully treat, the source of pain rather than continuing to mask it through analgesics.

What do you think of codeine-related products requiring a prescription? Does it even matter to you?

Until next time,

Ray

News.com.au- MPs push to water down ban on codeine sales without prescription

New Scientist- Australia bans non-prescription codeine to fight opioid crisis

Therapeutic Goods Administration- Update on the proposal for the rescheduling of codeine products

Sydney Morning Herald- More than 2 million Australians exceeding recommended medicine dosage, worrying doctors

NPS Medwise- Codeine-related deaths: a cause for concern

Another wake-up call to revamp the aged care sector

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The Australian newspaper has reported that federal aged care minister Ken Wyatt has released several recommendations from an independent review into aged care facilities which, if implemented, may lead to changes within the Residential Aged Care Facilities (RACF) community.

In a side note from minister Wyatt he stated in a speech to the National Press Club that up to 40% of aged care residents never receive visitors. While I cannot say I agree with that high figure I will agree that there are a significant number of residents who do not receive any visits from friends or family. This may be simply due to family and friends dying out, as does happen with age, or to family dynamics. But it does create a lonely environment for those residents. The advantage of aged care facilities for these residents is the social atmosphere of other residents and staff. In all of the aged care homes I have worked in and visited I can say emphatically that the care staff do interact and provide social connection with the residents.

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While all of the recommendations from minister Wyatt were not laid out in the article one particular recommendation was worthy of note to prompt me in writing this post. Minister Wyatt has called for annual re-accreditation to be conducted spontaneously without prior notice given to aged care facilities or their parent companies. To me if this is done effectively it could serve to lead to increased compliance and overall adherence to the governing federal policies for RACFs.

Currently, when a facility is nearing the end of their accreditation period the governing agency, the Australian Aged Care Quality Agency, will usually notify the RACF of the date of their re-accreditation visit with several weeks notice. This starts a chain of events where numerous corporate representatives invade the facility and start pouring through the documentation and policies ensuring that the facility meets the four standards required for re-accreditation. Oftentimes this process sees months and sometimes years of inaction or bending of rules suddenly become corrected. Resources are brought in to ensure compliance. Documentation is mulled over and errors corrected. On the day everything is perfect. The accreditors are treated like royalty for their two or three day visits, and once passed the same routine resumes.

But an unannounced visit would change this. Facilities would not be aware in advance of a visit, as the current unannounced visits are conducted. But unlike unannounced visits the re-accreditation looks closely at all standards. Facilities would need to enact processes and procedures which would require ongoing compliance, not just rushing in and fixing everything up just before they show up at the door. While it may not fix all of the issues and solve all of the complaints in RACFs it would at least serve as a start to ensuring that facilities RUN as they should, not to just look good on paper once every three years.

Until next time.

Ray

The Australian- Crisis in aged-care industry prompts wave of reform

The Aged Care Quality Agency website

Support for voluntarily assisted suicide coming from the AMSA

As reported in Sky News, and validated by myself from the Australian Medical Students’ Association (AMSA), that the AMSA members have voted to endorse a policy which supports Voluntarily Assisted Suicide (VAS) should it become legal in Australia.

The press release (which can be accessed here) details that the association recognizes that VAS is not yet legal in Australia, and can only be implemented once legalized. Additionally, VAS should not be a replacement for a quality palliative care program; nor should it be implemented unless all other treatment options have been exhausted.

The press release by the AMSA is a measured and logical approach to the idea of physician assisted euthanasia. There has been discussion recently in the media regarding this issue, with quite far-flung statements being made both ways. Here is my opinion on the matter which has come from work as a palliative care social worker, aged care manager, aged care nurse and emergency department nurse:

  1. Reasonable and sound-minded individuals do not want to end their life.
  2. Certain illnesses and chronic conditions can cause such pain and suffering that NO palliative treatment can mitigate the debilitating symptoms and lead to a good quality existence.
  3. All treatment options, assisted suicide amongst them, need to be measured against that quality of life test.
  4. In this country, as in many others, when the family pet has become too sick to lead such a quality existence their owners are given the choice to end the animal’s life with dignity and without suffering. However, because we are human and not a domesticated animal some are meant to suffer a painful and meaningless existence while their body deteriorates to the point of failure. If our beloved pets are given such an option why not our human family members?
  5. Voluntarily assisted suicide (or physician assisted suicide) does not mean the doctor or health professional is condoning people ending their life. Neither is it (as I heard on the radio yesterday) a violation of the Hippocratic Oath. It is a trained health professional allowing a person-centered care plan which details how they wish to proceed with their medical care. This, to me, is similar to how we now implement not-for-resuscitation orders.

The Australian Medical Association’s code of ethics expands on the Hippocratic Oath, and point 1.4 section c I think says it succinctly

Respect the right of a severely and terminally ill patient to receive treatment for pain and suffering, even when such therapy may shorten a patient’s life.

For those in the medical community I can hear you already saying “but Ray, that’s not what this statement is intended for.” I know that. But what it does is highlight the need for ALL health professionals to recognize that there comes a point where we must pull back and allow patients to shorten their life; if that shortening comes with dignity, control and comfort.

I have been, and always will be a supporter of a balanced and reasonable assisted dying policy. Let us make sure there are safeguards in place to prevent misuse. Let us make sure there are processes in place to ensure death is peaceful and quick. But most of all let us allow an individual with no hope of recovery and only staring at a prolonged existence of suffering and decay to choose when they decide to end their life.

I would very much like to hear your opinions.

Until next time,

Ray

Sky News- Doctors in training support assisted dying

Australian Medical Student Association- press release

Australian Medical Association- code of ethics

A champion amongst their own. Former patient becomes mental health nurse of the year

 

An article on the ABC news website has highlighted the great achievement of nurse Matthew Ball, a former patient of the mental health system who later went on to register as a nurse and as of today has become the Mental Health nurse of the year according to the Australian College of Mental Health Nurses.

According to the article Matthew was diagnosed with a psychotic illness which left him hearing voices. Through his work and that of mental health nurses he has rid himself of the voices, rather he can now understand what triggers the voices and allow himself to overcome their debilitating effect.

I applaud Matthew and all others who choose to turn their situation around and overcome what stops them to achieve goals. I am sure Matthew makes a great registered nurse as he has not only the understanding of what living with a mental illness is like, but has also been a consumer of mental health services and understands that perspective.

I am not a mental health nurse, nor have I ever suffered from a mental health illness. However, in the emergency department we see those who do suffer and work closely with mental health nurses. It is an invaluable area of nursing which deserves such good-news stories.

Until next time

Ray

 

ABC News- Mental health patient becomes Australia’s best mental health nurse

Sorry for the time away

To my followers and the greater WordPress community I want to apologize for the lack of posts in the recent months. I have had some personal issues going on, including moving to a new suburb. This has kept me away from the computer (which was also packed away).

I am back and ready to again bring Australian-based health news to the greater health community.

Look for new articles coming soon!

Ray