Medicines management and the role of a pharmacist is often overlooked during EMT development. Pharmacy plays a major role in every medical operation and has been pivotal in both maintaining deployment readiness, enhancing quality use of medicines while on deployment and ensuring team health.
Medicine supply, dispensing and storage overseas follows Australian and host country medicines rules. Medicines are tailored according to local medicine availability, guidelines and disease profiles.
Medicines are labelled in English and local language. Medicine counselling involves local staff where possible to ensure clear information is given.
AUSMAT have the ability to transport cold chain medicines where needed. Data loggers are included with medicines to ensure that they are not heat affected in transit.
The medicines cache
The medicines cache is based on the World Health Organization Essential Medicines List. Availability of medicines in Australia, transport considerations of some medicines and familiarity of the drugs by Australian clinicians limited its use in its original form. One of the initial roles of the pharmacist was to lead a multidisciplinary review of medicines and develop an appropriate formulary to support evidenced based best practice on deployment.
Medicines kits undergo continuous review to ensure service needs are met and contemporary evidence is reflected. Review involves a multidisciplinary team, and medicines are considered based on clinical need, transportability and feasibility.
Some medicines are considered hazardous when transported and require specific management including packaging and handling, overseen by an approved dangerous goods handler. AUSMAT have developed specific protocols for the management of high risk items, streamlining this process at time of deployment.
Training and policy development
In a field hospital, there are less resources and equipment than staff are used too. For example, infusion pumps are not readily available, so medicines are given via push where suitable. As this is not standard practice in most hospitals, detailed protocols are needed.
The pharmacy team ensure staff are protected from diseases while on deployment by ensuring each team member has all recommended immunisations.
The pharmacy team also monitor staff allergies and disease states to determine whether extra medicines should be added to the staff health kit.
There are strict import/export criteria for medicines for each country. A license is required for Australia and the host country. This is arranged prior to deployment.
While on deployment, the AUSMAT pharmacist fills both clinical pharmacist and technical supply roles. Standard clinical services include ward rounds and chart reviews, patient counselling and drug information.
Technical areas of oversight include:
Medicines need to be secured while in the field hospital. As our field hospital is often in a tent, the medicine boxes need to be lockable. Balance needs to be achieved to ensure that the medicines are secured to prevent theft or accidental overdose, but still ensure appropriate staff members have access.
Storage and use considerations
A large volume of medicines are taken, therefore there are clear instructions on the layout and location of each medicine. Stock usage is recorded, monitored and reviewed after the deployment.
The conditions on a deployment are often hot, humid and wet, therefore packing in water proof packaging and monitoring of temperatures are also important. Discarding of medicines in-country is not recommended, but if done needs to be incinerated or in a concrete slurry. Disposal of medicines is coordinated by the pharmacist in conjunction with the logisticians.
Temperatures of refrigerated and room temperature medicines both need to be monitored and recorded as most room temperature medicines suggest a maximum temperature of 25 to 30 degrees. This is achieved using data loggers for all medicines.