Introduction
This paper examines the Tasmanian portion of a four state study commissioned by the Australian Council of Ambulance Authorities in order to examine the expanded scope of practice for Australian rural paramedics. The objectives of this paper were to describe the expanded role for the rural paramedic on the East Coast of Tasmania and determine what factors facilitate this role.
Methods
This study uses qualitative methods. Three sources of data were used for this study: a) semi-structured interviews with key informants; b) direct observation of key processes and events, and c) review of documents describing the paramedic role and required organisational and educational support. The semi-structured interviews included questions relating to the role of the paramedic, involvement with other health disciplines, and interactions within the general community.
Results
The study revealed how paramedics on the East Coast of Tasmania have developed a multidisciplinary and multifaceted approach to health care. Emergency care does not end at the hospital doorstep and involves co-operation between paramedics and hospital staff in ongoing care. Doctors and other health professionals who have previously been involved in after hours call outs, training of volunteer ambulance personnel are now free from these additional and often time-consuming tasks. Paramedics have been welcomed as part of the health care team in the area and have been responsible for development of effective working relationships with hospital staff and doctors, volunteers and community members. An important part of these relationships is the health education provided by paramedics.
Conclusion
Emergency response in rural areas is only a small part of paramedic practice. This study has identified elements of rural paramedic practice that highlight the importance of a multidisciplinary and community based response to patient care in rural areas namely community involvement, organisational support, professional support, and appropriate education and training. Much of these are rooted in a footing of informality. The move from informality to a more formal framework will perhaps enable rural paramedic practice to emerge as a discipline in its own right, as an integral part of a rural multidisciplinary health care team.
Background
Independent prescribing by pharmacists is designed to:
▸ improve the quality of service to patients without compromising patient safety
▸ make it easier for patients to get the medicines they need
▸ make better use of the skills of healthcare professionals
▸ contribute to the introduction of flexible team working.
Initial experiences
We implemented pharmacist prescribing in the neonatal intensive care unit (NICU) at the Southern General Hospital, Glasgow, Scotland, in March 2005. The main barrier at the time was the large unlicensed medicine usage, resolved by subsequent changes in legislation.
UK survey of pharmacist prescribing in neonatal units
An electronic survey received 45 responses. Just under half (47%) were prescribers, with 40% being independent prescribers. Most were prescribing in NICU or high dependency units (70%). 19% of those qualified were not prescribing.
Benefits of pharmacist prescribing
Improvement in safety was seen as a benefit of pharmacist prescribing, with potential reduction in communication errors and the ability to make timely correction of prescriptions.
Barriers to implementation
Many areas reported no barriers, with support from both consultants and nursing staff. Lack of funding and time to undertake the required training was seen as barriers by some.
Conclusions
Non-medical prescribing is intended to encourage a team approach to the care and management of patients and to make the best use of the skills of trained healthcare professionals and pharmacist prescribing is an important addition to the healthcare of premature infants.
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