Maintaining standards

The PSA’s WA Pharmacist of the Year Richard Smirk serves as the Clinical Advisor Pharmacy at the Australian Health Practitioner Regulation Agency (Ahpra) in Perth.
The PSA’s WA Pharmacist of the Year Richard Smirk

The PSA’s WA Pharmacist of the Year Richard Smirk serves as the Clinical Advisor Pharmacy at the Australian Health Practitioner Regulation Agency (Ahpra) in Perth.

How did you get into pharmacy?

My local pharmacist also happened to be a local sporting hero. When career choice time came, I attended an open day at the WA Institute of Technology’s Pharmacy Department and was drawn in. It was the mystique of the healing properties of drugs, the confidence of a stable career and the attraction of belonging to a group of like-minded people. I started as a community locum around regional WA, managed pharmacies and eventually became a pharmacy owner. Over the course of 20 years, I owned three. While at my last one, in beachside Scarborough, I accepted the challenge of working at Ahpra.

Your biggest day-to-day challenges?

In my role as an advisor for Ahpra I provide clinical and practice-specific advice on pharmacy and medicine-related matters. We manage the Pharmacy Board of Australia’s oral examination for interns. One of our daily roles is providing clinical advice on complaints against health practitioners. Key to this is understanding why the complaint was made and working out what circumstances the pharmacist practitioner had faced. We provide vital background information, based on the Board’s codes and guidelines and professional practice standards and legislation so investigators can better understand the situation and potential for any public risk.

What is the most satisfying part?

Working with the fantastic team of Ahpra advisors across Australia. They bring a wide variety of experience in different areas including hospital, community, compounding, education and practice experience, which provides a well of knowledge that will ultimately support the profession and help to protect the public. 

Any particularly fulfilling experiences? 

The Pharmacy Board’s oral examinations are a challenging time not only for interns, but also examiners and Ahpra staff. By ensuring the exams run smoothly and that examiners are well prepared, we provide the smoothest opportunity for interns to demonstrate their competence. Our reward is seeing those candidates achieve their goals and move into the profession.

Where else do you think your role will take you?

Ahpra is still a young organisation, so we continue to learn, adopt and embrace change. As such, our roles as Clinical Advisors have also changed and become more focused on how we view practitioner risk and the steps required to manage it.

How can enthusiastic pharmacists be supported to do the ‘right thing’ and follow the rules in difficult situations?

All pharmacists face challenges trying to balance client care and meet all the regulatory requirements – poisons regulations, PBS rules and the Pharmacy Board’s Codes and guidelines. In a difficult situation, a young pharmacist should look at the risk of harm to the client, either from supplying or denying them a medicine, while at the same time considering how their actions would meet the Board’s expected standards of practice.

Inappropriate communication is a cause often given in client complaints to Ahpra. Young pharmacists need to understand their professional responsibilities and be firm in their decision making. After all, they will be the ones taking the responsibility. It always helps to have the benefit of strong, positive professional role models.

What is your message for the profession to protect themselves and the public?

Despite their inherent risk, medicines are only as safe as we allow them to be. A pharmacist has both the expertise, and the responsibility, to ensure medicines are appropriate for the client. It is essential pharmacists understand and incorporate the broader view of quality use of medicines, ensure optimising medication efficacy and minimising client risk.

It is wise to remember, when it comes to understanding drugs and making therapeutic decisions, we need to work in partnerships with consumers. The challenge is to ensure the steps you take support and protect the client to the best of your abilities, in a way that is empathetic to them and respectful to prescribers. And, if you are not sure, ask! 

DAY IN THE LIFE  Richard Smirk, Clinical Advisor Pharmacy at Ahpra (working from home, a much shorter commute).

8.00 am – Waking up to the world

After an early jog around City Beach, log into Ahpra systems, examine the work queues and prioritise importance. Urgent matters are usually already underway with colleagues in the eastern states.

8.45 am – The first huddle

Videoconference with all Clinical Advisors. Review of recently completed cases and preparations for presentations around new issues. For consistency of advice, discussion includes matters involving examination question writing goals and progress towards next round of pharmacy oral examinations. 

10.00 am – The legal eagle

Videoconference Ahpra legal team member who is considering recommending imposing prescribing restrictions on a medical practitioner. We provide background information and explanations on matters such as the Therapeutic Goods Act, products on the ARTG and the scheduling of medicines on the Poisons Standard. This helps ensure conditions imposed on any registration are appropriate and able to be monitored. 

11.00 am – Setting the questions

Work on exam question so  it meets our standards and assesses competencies that must be met. Responses and outcomes need to be benchmarked against several references to ensure the question is robust and supported by best practice standards. Work through multiple drafts and even then, the question will need validation by two other clinical advisors.

12 pm – That’s a RAP

Videoconference meeting with colleagues from the Ahpra Perth office’s Reconciliation Action Plan (RAP) committee to finalising NAIDOC Week plans. 

1.00 pm – Competency call

Phone discussion with colleague on assessment of portfolios for podiatrists applying for endorsement for scheduled medicines.

2.00 pm – Notification support

Meeting with Ahpra notifications investigator and a pharmacist responding to a complaint. To support investigator, I ensure he understands the pharmacist’s responses – discussed later in a de-brief.

3.00 pm – Alert!

As colleagues on east coast head home, a high-risk notification alert appears in our system from a member of the public about an alleged dispensing error. After rapid investigation, I determine dispensing error was an improperly explained generic substitution. May have been inadequate communication, so notification is assigned a ‘medium’ risk rating to public.

5.00 pm – Knock-off time

File clinical advice and risk assessment. Commute back upstairs to see who is cooking dinner.

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