Clinical pharmacy

Fourteen clinical pharmacists improve the quality use of medicines for a wide range of surgical patients admitted to The Alfred and Sandringham sites. We work across the continuum of care with clinical pharmacy services in pre-admission clinic, theatres and surgical wards.

Training is also provided to undergrauates, intern pharmacists, pharmacy residents and clinical pharmacy fellows.

Innovative pharmacist-led collaborative programs led by this team include charting of medications pre-operatively and on admission, opioid de-escalation and perioperative allergy clinic. Our surgical pharmacists work in four subspecialty teams:

• Burns
• Trauma
• Surgical specialties
• Perioperative medicine

Clinical pharmacists improve the care of patients at The Alfred, Caulfield Hospital and in our local community.

A dedicated clinical pharmacist is an intergral part of the multidisciplinary team on both wards of The Alfred's Adult Psychiatry inpatient unit and the Aged Psychiatry Service at Caulfield, ensuring the safe and appropriate use of medication. 

The clincal pharmacy service is not limited to the inpatient units with a third pharmacist providing clinical pharmacist support across the Alfred Psychiatry Community Program and attendance at the Waiora Clinic, St Kilda Road Clinic and Alma Road Community Care Units.

The development of the community based pharmacist role has enabled better communication upon transfer of care and understanding of the Alfred Psychiatry Department as a whole.

A team of ten clinical pharmacists in conjunction with ward-based technicians support the quality use of medicines at Caulfield Hospital, which hosts our Aged Care and Rehabilation services as well as the newly opened Acquired Brain Injury Unit.

Pharmacist led initiatives at Caulfield include self-medication trials and outpatient care at the General Medicine Clinics.

A team of 21 pharmacists and technicians provide a comprehensive clinical pharmacy service across a diverse range of medical specialty units. Our aim is to ensure the highest quality use of medicines in all our patients.

Our services are delivered across all four sites within Alfred Health with pharmacists working in both the inpatient and the ambulatory setting (day admitted and outpatients). The team contributes to ongoing practice based clinical research and educational activities involving the training of interns, undergraduate and overseas students.

The Medical Specialties team also supports candidates in the department’s PhD programs and provides fellowship programs in Cancer Services and Infectious Diseases.

We cover the specialty areas of:

• Cancer services 
• HIV
• Infectious diseases
• Renal services
• Rheumatology
• Endocrinology
• Dermatology
• Gastroenterology

Fifteen clinical pharmacists provide an extensive clinical service, 7 days a week, to the General Medical Unit, Emergency Department (ED), Stroke Unit, Hospital-in-the-Home (HITH), and Sandringham Hospital.

Innovative extended practice roles for pharmacists within the directorate include pharmacist-led anticoagulation, discharge summary completion, partnered pharmacist charting on admission and pharmacist participation in Stroke Calls and Sepsis Alerts. There is a strong focus on collaborative research and education within the directorate and the pharmacy team is involved in several multidisciplinary projects at any given time.

Training and mentoring is provided to undergraduates, intern pharmacists and junior pharmacists and a Clinical Fellowships are offered in General Medicine and Emergency Medicine. The Acute and Emergency team also supports pharmacists undertaking postgraduate studies including masters and PhD candidates. 

Acute Medicine - Alfred

Acute Medicine incorporates General Mecicine, Stroke, Neurology and Hospital in the Home (HITH).

General Medicine at The Alfred is a dynamic well supported unit with an education and research focus. The unit specialises in the care of complex medical patients.

Alfred Health HITH provides acute home nursing care to a wide variety of patients within the metropolitan area and across the state. The HITH team consists of highly skilled nurses who coordinate and provide patient care in the community. A dedicated clinical pharmacist provides significant input into this valuable program.

The clinical pharmacy service to Acute Medicine is provided to both inpatients and outpatients of the General Medical Unit from 8am to 8pm 7 days a week

Emergency & Trauma Centre - Alfred

The Emergency & Trauma Centre is a purpose-built modern facility consisting of resuscitation and trauma bays, fully monitored general cubicles, rapid assessment cubicles, fast-track cubicles and a co-located emergency short-stay unit.

The clinical pharmacy service to the ED is provided from 7am to 9pm 7 days a week

Sandringham Hospital

Clinical pharmacy services are provided to the General Medical Unit, Surgical Unit, Emergency Department and Hospital-in-the-home at Sandringham Hospital 7 days a week.

Alfred Health became a Totally Smokefree environment in May 2008 as a reflection of the organisation’s commitment to providing a safe, healthy and comfortable smoke free environment for all.  This initiative means that smoking is not permitted anywhere within the property boundaries of The Alfred, Caulfield Hospital or Sandringham Hospital.

A presentation to hospital can provide an incentive for patients to quit smoking. At Alfred Health, policies are in place to support patients to become non-smokers.

Inpatient Totally Smoke Free

Alfred Health Clinical Pharmacists pioneer clinical leadership in the identification of smoking status, assessment of nicotine dependency and subsequent therapeutic approaches to managing the complexity of nicotine withdrawal and smoking cessation quit attempts among inpatients.

Nicotine replacement therapy is initiated by clinical pharmacists in accordance with agreed upon treatment algorithm to minimise nicotine withdrawal effects and to facilitate successful quit attempts.  Nicotine replacement therapy is available in transdermal patch, gum, lozenge, mouthspray and inhalator forms at no cost to the patients during their stay. For patients attempting long term smoking cessation, a time-limited supply of nicotine replacement therapy may be provided as a discharge medication.

Those inpatients with complex dependency can be referred to the Intensive Smoking Cessation Service. If deemed necessary, these patients can be followed up as a part of the Smoke Free Clinic.

Outpatient Smoke Free Clinic

An outpatient based Smoke Free Clinic commenced in October 2013.The Smoke Free Clinic provides outpatient specialist smoking cessation support for existing Alfred Health patients who experience nicotine dependency associated with complex co morbidities.

Patients who attend the clinic receive intensive counselling support and have access to a range of pharmacotherapies to assist them to reduce and cease smoking. The clinic is only available for current patients of Alfred Health, and external referrals are not currently accepted.If you are interested in this service, please discuss with your Medical Specialist, Allied Health Professional or Clinic Nurses for a referral.

Find out more about the Smokefree Clinic.

Clinical Pharmacists in these specialty areas provide timely and evidence-based care to these complex and critically ill patients. In addition to clinical practice, our pharmacists in these areas are highly active in clinical and practice-based research and the education of pharmacy interns, undergraduates, postgraduate and overseas Doctor of Pharmacy students.

Clinical Pharmacy Fellowships are available in each of the below specialty areas. Please contact us if you are interested in advancing your practice with a Fellowship in one of these specialties.

Intensive Care Unit

Critical care clinical pharmacists are integral members of the multidisciplinary ICU team.

In the Alfred ICU, a team of four clinical pharmacists, including specialist and rotational training posts, and a pharmacy technician support the four pod structure of one of Australia’s largest and busiest ICUs. We provide a seven day a week clinical pharmacy service to the ICU, the hyperbaric unit, medical emergency team (MET), and ICU liaison team. The clinical pharmacists attend ICU rounds and work collaboratively with ICU medical, nursing and other allied health staff to ensure optimal drug therapy and outcomes for patients. Clinical pharmacists in the ICU have been demonstrated to reduce mortality and morbidity, improve medication safety and effectively manage drug costs.

Cardiology Services

Four clinical pharmacists optimise pharmacotherapy through direct patient care activities in conjunction with the various Cardiac Services provided at The Alfred. These services are provided to the inpatient general cardiology unit, the inpatient cardiothoracic unit, and the in- and out-patient advanced heart failure and heart transplant unit, including a nurse and pharmacist led uptitration clinic for heart failure patients.

Respiratory Service

Four clinical pharmacists are involved in direct patient care with a range of respiratory conditions with the inpatient and ambulatory care settings. The respiratory services includes care provided for adult and paediatric lung transplantation, adult cystic fibrosis, general respiratory, asthma and allergic conditions. Innovative pharmacy services that are highly utilised in the respiratory service are pharmacist led therapeutic drug monitoring and pharmacist led nicotine replacement therapy. 

The Alfred Hospital Pharmacy Department provides ongoing specialist pharmaceutical care and monitoring to a wide scope of clinical domains for managing patients beyond their inpatient hospital stay. Regular comprehensive pharmaceutical review into medication therapy and management strategies improves the quality use of medicines, prevents serious adverse drug reactions and allows greater collaboration with Specialist Medical, Nurses, and other Allied Health Staff. Improved access to specialist clinical pharmacists allows patients to discuss a wide range of pharmaceutical issues and allows for tailored pharmaceutical education and care.

Psychiatry

A senior clinical pharmacist provides support across the Alfred Psychiatry Community Programs including attendance at the Waiora Clinic and St Kilda Road Clinic. The development of the community based pharmacist role has enabled better communication upon transfer of care and understanding of the Alfred Psychiatry Department as a whole.

Heart Transplantation and Heart Failure 

As a part of the comprehensive Cardiology Pharmacy Team, a senior clinical pharmacist provides ongoing specialist support to patients with heart transplants, ventricular assist devices and chronic heart failure. The pharmacist plays an integral role in the safe, effective and appropriate use of medications as well as collaborating with the multidisciplinary team for optimising patient care. The pharmacist provides specialised medication education and support to doctors, nurses, patients and their carers. The pharmacist and this service is actively involved in clinical research and participating and presenting at national and international meetings.  

Chronic Kidney Disease and Renal Transplantation

The Renal pharmacist attends the Alfred Hospital Renal Clinic and is actively involved in the care of ambulatory renal patients across the spectrum of renal disease. This includes acute renal failure, chronic renal failure, end stage renal failure, renal replacement therapies and renal transplantation. The pharmacist's role includes activities such as facilitating clinical care decision making, medication reconciliation, patient education and liaison with other healthcare providers where appropriate. 

Lung Transplantation

The lung transplant ambulatory care pharmacist plays an essential role as part of the multidisciplinary transplant team and is involved in the ongoing care of over 400 lung transplant recipients. The role of the ambulatory care pharmacist begins from time of discharge from hospital post-transplant and may continue for many years after. Responsibilities include ongoing medication education and adherence reviews as well as continued optimisation and monitoring of pharmacotherapy to facilitate best patient outcomes.

Smoke Free Clinic

The Smoke Free Clinic provides and co-ordinates evidence based smoking cessation services to current Alfred Health patients to assist them to quit smoking. Directed therapies and support is tailored to each individual based on past experiences, history, preferences and lifestyles. The team collaborates extensively with primary care providers, family members and patient carers. The team are actively involved in promotion and education of smoking cessation strategies within Alfred Health, other Victorian health services and community organisations.       

Oncology and Haematology

Pharmacists attend the Haematology clinics with the aim to facilitate clinical queries relating to medication, perform medication review and education for recently discharged and complex patients, manage and procure specialist and compassionate medications and provide a platform for comprehensive medication reconciliation for patients admitted to Hospital from clinic.

Infectious Diseases and HIV

The infectious diseases team have a strong role in Ambulatory care of HIV-infected patients.

The clinical team share work in two dispensaries (Melbourne Sexual Health and the Alfred Hospital) and attend clinics at both sites.

Roles include complex medication problem solving, medicines information for clinicians (including General Practitioners), counselling and education on newly starting or switching antiretrovirals, active participation at multidisciplinary meetings, attendance at complex metabolic clinics and providing a comprehensive review of medications at the patient's annual health check.

Inflammatory Bowel Disease

The gastroenterology pharmacist attends the IBD clinic on Wednesday mornings and works closely with the IBD team of consultants, nurses and dietician. The pharmacist specialises in thiopurine metabolite monitoring. All new patients commencing thiopurines receive education on initial consultation followed by regular phone calls, blood monitoring and clinic reviews to ensure safety, tolerability, therapeutic dosing and adherence.

Anaesthesia and Peri-operative Medicine

Clinical pharmacists are an important member of the Pre-admission Clinic (PAC) multidisciplinary team. The PAC pharmacists contribute to optimising pre-operative medication management through the provision of a thorough medication history, advice on with-holding medications and smoking cessation.  In addition, medication transcription of pre-morbid and post-op medications by the PAC pharmacists ensures appropriate continuum of care during the peri-operative period.

The Alfred Hospital Peri-operative Allergy Clinic commenced November 2014 and is the first to involve a dedicated clinical pharmacist.  The Senior Peri-operative Medicine Pharmacist is an integral member of the team of 3 – Consultant Anaesthetist, Pharmacist and Anaesthetic Registrar – who provide appropriate review, follow-up and testing of patients with reported intra-op anaphylaxis.

General Medical Unit Outpatient Clinic (The Alfred, Caulfield Hospital, Sandringham Hospital)

The clinical pharmacists from the General Medical Unit provide a clinical service to the General Medical Unit Outpatient Clinic, which provides a broad scope of clinical services, including optimising and rationalisation of complex medication management, holistic review of medication use and safety, assessment of medication adherence strategies and education and support for patients and their families. There is scope for pharmacists to review both patients with chronic complex care needs, as well as patients who have had a recent hospital admission in the General Medicine Unit. For these post-discharge patients, they may be followed-up by pharmacists in clinic via a telephone call or in a face-to-face appointment.                       

Hospital Outreach and Hospital Admission Risk Program (HARP)

An experienced clinical Pharmacist is available to visit patients at home who are managed under a HARP service (Hospital Admission Risk Program) with the aim of reviewing and optimising medication management and compliance, providing education and conducting a comprehensive review of medications. The findings and recommendations from this visit are documented in a report which is sent to both the GP and the Community Pharmacy. Liaison with these and other health care professionals is undertaken as required. 

Specially trained pharmacists and technicians provide aseptic and non-aseptic compounding services to inpatients, outpatients and day patients admitted to The Alfred, Caulfield and Sandringham sites. A team of two pharmacists and 3 technicians compound a range of preparations including chemotherapy, antibiotics, allergy skin prick tests, creams and oral mixtures which are not commercially available.

We work collaboratively with clinical pharmacists and doctors to customise preparations to meet each patient’s specific needs. All products are prepared according to Good Manufacturing Practice and strict standards and procedures are in place to ensure products are prepared to the highest standard.