KARL STABEN

I joined the pharmacy team at Royal Darwin Hospital as a P2 level pharmacist, rotating 6 monthly between wards as assigned. I have taken both formal and informal training to develop my competency as a clinical pharmacist. Having been in this role for almost six years, I am well familiarised with departmental guidelines and policies and my practice is aligned.

In July 2023 I was the successful applicant for Acting Lead Pharmacist Emergency Medicine (P3 Position) for a period of three months backfilling long service leave. Since then I have been working at Top End Mental Health Service as the inpatient unit pharmacist.

I have produced documents such as Standard Operating Procedures, and drafting a discussion document for the NT Drugs and Therapeutics Committee for the proposed addition of Memantine to the formulary. I have identified and undertaken a number of Quality Improvement projects described below, and I am a member of the TEHS Health Literacy Committee.

My duties in my current role include:

• Provide ward based clinical pharmacy service
• Collect accurate medication histories
• Chart reviews and medication reconciliation
• Provision of advice and medication recommendations to medical and nursing staff
• Supervision, teaching and support of pharmacy students, interns and pharmacy technician staff
• Provision of educational inservices to pharmacists, nurses, and residents/registrars.
• Lead quality improvement activities

I have experience in P3 level duties including:

• Line manage and coordinate the pharmacist team in ED and MAPU
• Provide professional leadership and specialist clinical advice to medical, nursing, and other clinical staff as appropriate..
• Develop, implement and maintain clinical guidelines to support best practice.
• Take an active role in the senior pharmacy team through attendance at meetings and other activities as required.
• Follow defined service quality standards, work health and safety policies and procedures relating to the work being undertaken in order to ensure high quality, safe services and workplaces.

I have varied experience, having worked in the following areas:

ED, Rapid Assessment and Planning Unit, Coronary Care Unit, Medical Ward, Surgical Ward, Orthopaedic Ward, Infectious Disease Ward, Hospital in the Home, Mental Health, Geriatric Evaluation and Management ward, Rehabilitation Ward, Covid of Concern, Dispensary, Senior Antimicrobial Pharmacist cover (2 weeks), Senior Pharmacist Emergency Department (3 months)

Education

I enjoy providing education to peers. A sample of the presentations/teaching I have provided include:

• Medication “Traps” - Target audience nursing staff. Focuses on medications which are likely to cause errors, and provides information on safe modification of dosage forms. Presented on many wards over the years, modified each time to be relevant to the work area.
• Alcohol and AWS - Target audience Pharmacists/Nurses. Provides background history and statistics, harm quantification, and teaches TEHS AWS protocols.
• Scabies In The Age of Increasing Drug Resistance - Target audience Pharmacists. Brief info on scabies and diagnostic grading. Discusses scabies treatments, mechanisms of action, and mechanisms of resistance and prevalence in the NT. Also looks at the future of scabies treatment.
• Nausea and Vomiting Tutorial- Target audience Intern Pharmacists. Teaches the mechanisms of N&V, and the correct use of antiemetics.
• Medication Quiz - Target audience RMO/Registrars. Designed as an interactive quiz and discussion to increase awareness of common side effects (and some less common but interesting ones), medications that cause electrolyte imbalances, as well as touching on some dose equivalence.
• Basic Life Support essential training - Target audience of all relevant staff. Although assessment is the only requirement for the essential training, I always provide training on the entire BLS process before running assessments. My 16 years with St John Ambulance Volunteers has provided me with a wealth of practical experience that I can share here. I thoroughly enjoy this, and always receive strong positive feedback.

Quality Improvement

During my time at Royal Darwin Hospital I have undertaken several quality improvement projects after identifying shortcomings in services. Some examples of these are:

• Identified that medical discharge summaries written at RDPH on Clinical Work Stations (CWS) did not appear to be delivered to some remote health clinics. Further investigation found that when Community Controlled Organisations had taken on clinics previously under NT Health, addresses had not been updated on CWS. This led to discharge summaries continuing to be sent to old NTG emails, not the new providers. In some cases such as Milingimbi Health clinic, this issue had been ongoing for years. I identified the staff in both the IT domain and Remote Primary Health Pharmacist who had oversight for updating these changes, and informed them. Together we were able to promptly update the address list and ensure that this aspect was added to the handover process for future clinic changes.
• I noted that patients supplied insulin on discharge from RDPH were only supplied with needles if they were new start patients. Indigenous patients from remote locations may not be discharging immediately home, are often at a disadvantage or unsure of how to source insulin needles in Darwin. I sourced sample packs of 10 insulin needles, negotiating the ongoing free supply and delivery of sufficient quantities to our hospital. After writing an SOP for the Purchasing Officer to ensure continual ordering, I worked with the Dispensary manager at RDH to ensure all staff were aware of this new resource for their discharging patients.
• In my current role, I noted that the process for managing Leave Medications was not in line with TEHS practice, was not medico legally correct, and had resulted in at least one instance of patient harm. Within two working days of identifying this issue, I was able to inform all relevant medical and nursing staff of the correct procedure, and then provide follow-up education. The Standard Operating Procedure was withdrawn and updated. Follow-up spot audits performed showed good uptake and within approximately two weeks practice was in line with TEHS guidelines and being correctly legally recorded.
• Review of Riskman incidents revealed a trend of errors occurring afterhours where the wards afterhours coordinators were not following medication related procedures, causing significant liability and follow-up remedial work. Discussed with nurses working this roster, discovered they have no succinct list of procedures to reference. Took relevant procedures from the Pharmacy Department On call pharmacist folder and added other relevant procures from PGC. Provided to afterhours coordinators to have on their F drive to reference after hours. This action has shown a decrease in afterhours incidents, as the nursing staff feel more supported in this role.
• Identified that poor communication between pharmacy and nursing staff regarding the progress of leave/discharge medications was resulting in multiple phone calls per patient being made to the pharmacy. This was causing significant disruptions to patient flow and staff workflow. Identified existing software (MIYA) as the best option due to ease of update and visibility on the ward. Discussed several options with stakeholders. Changes to MIYA layout were required to ensure visibility, I followed up and subsequent changes were made. Rolled out new process which proved popular. Reduced average daily phone calls to pharmacy (regarding discharge meds) from ~15-20/day down to ~2/day.

TEHS Health Literacy Committee

The Health Literacy Committee is a team of health professionals that reviews all documents produced within the Top End Health Service, with a view to ensure that health literacy requirements are met. Varied documents from posters to brochures and booklets are first reviewed and endorsed if suitable for consumer testing. After consumer testing and feedback is supplied, the team will re-review and a decision will be made if the document will be approved. Where further work is required to ensure that requirements are met, feedback is provided to the author. The committee meets monthly, and also undertakes out of session reviews. I applied to join the committee 11 months ago, and have been able to make meaningful contributions.

• I worked in the capacity of locum pharmacist in Darwin area community pharmacies until offered a position at Royal Darwin Hospital.

At Gove Amcal I worked two roles within the business. Section 100 supply and support to 11 Remote Health Centres, and the community pharmacy shopfront, where I managed the dispensary for ~1.5 years.

My primary focus in the s100 supply was building relationships with clinic managers and ensuring their needs were met. When I started in the role, I found that there were some preexisting frustrations that Yirrkala and Gapuwiyak clinics held, as they did not feel as though the service we were providing was meeting the clinics requirements. I was able to build a relationship with the clinic managers with regular communication, listening to their needs and making sustainable changes to processes.

As a private business, judicious financial management was a priority. I took opportunities to reduce waste and increase efficiency to reduce costs. Some examples of where I saved costs:

• The Section 100 contracts required a pharmacist to visit each clinic a minimum of 2 times per year. Most of the clinics required the hire of a charter plane with the average cost being approximately $1,000 return trip. Through my relationships built with staff in the Department of Health, I became aware that the department regularly chartered flights from Gove to the remote communities, and they often flew with empty seats. I negotiated permission to utilise empty seats when available, and performed all of my clinic visits without having to spend business funds to charter aircraft. In my first year alone, I saved the business approximately $18,000 on charter flights.
• The business had been ordering schedule 8 drugs frequently in small quantities. On top of the cost of the stock there was also a charge per line (irrespective of order quantity) for schedule 8 handling. By ordering larger quantities less frequently I was able to reduce not only the cost of ordering the schedule 8 drugs but also reduce wages, by significantly reducing handling time. This small change alone tangibly saved the business approximately $1,900 per annum.

My duties in this role included:

• Ensuring safe and legal supply of medicines, including medication suitability and counselling
• Manage and provide Opioid Substitution Therapy (Methadone/Suboxone)
• Daily ordering of stock for the dispensary, maintaining supply with unreliable freight to remote location
• Preform required PBS reporting for the business
• Banking
• Section 100 supply of medicines and imprest to remote clinics
• Logistics of stock moment to remote communities/homelands were traditional freight options do not exist
• Review medication profiles using electronic health systems Communicare and PCIS
• Undertake 2 support visits to each remote health clinic per annum. (Liaise with clinic managers to ensure needs are met, Undertake audits, Provide education)

• I began working in community pharmacy in the second year of my Pharmacy degree.