Orthopaedic pharmacy: more than a rotational role

Field: Health Professions (Health Sciences)

Clinical pharmacy service provision to patients with one (or more) of a whole range of musculoskeletal conditions is the basis of the work of an orthopaedic pharmacist.1 This includes patients with bone infections, arthritic conditions, fractures and those booked in for routine orthopaedic surgery, such as hip replacements. Orthopaedic pharmacists are also involved in the prevention and treatment of osteoporosis. Hospital pharmacy departments often allocate their clinical pharmacist(s) to the orthopaedic units as short-term rotational positions. The potential scope in this area for advanced practice promotes the emergence of orthopaedic specialist pharmacists in the future. The clinical care an orthopaedic pharmacist provides includes venous thromboembolism prophylaxis, antibiotic cover, management of adverse drug reactions (postoperative nausea and vomiting, opioid-induced constipation) and pain management.1 Preventing deep vein thrombosis in patients who are undergoing orthopaedic surgery can require a different approach than that used in normal surgical patients. Orthopaedic surgery immediately places all patients into a high-risk category,2, 3 regardless of any additional risk factors, because patients are often immobilised for longer periods of time. Antibiotic usage in orthopaedic patients, compared with general surgical patients, requires specific knowledge with a greater emphasis on agents with good bone penetration. Orthopaedic pharmacists at times play both antimicrobial and opioid stewardship roles in complex, high-risk orthopaedic patients. Currently, there are no orthopaedic pharmacists trained as supplementary prescribers in Australia. However, with advanced practice pathways, there is scope that could find these pharmacists in prime positions for advanced practice roles including, but not limited to, prescribing in orthopaedics, particularly if independent prescribing becomes a reality. Examples of this may include prescribing pharmacists running rheumatology clinics or inpatient de-escalating opioid prescribing. Multidisciplinary working is by no means confined to the clinical pharmacy setting in orthopaedics. Pharmacy representation in hospital orthopaedic infection prevention working groups and orthopaedic business meetings are just some examples where true integration can take place. The orthopaedic pharmacist is positioned to carry out pharmacoeconomic evaluations of the drugs4 used in the orthopaedic division of the hospital and contribute to research in this area,5, 6 which is made easier when the pharmacist is positioned there in a permanent capacity. As a consequence of working primarily in isolation in most Australian hospitals, it is particularly important for orthopaedic pharmacists to network. Because orthopaedic pharmacy has yet to position itself as a strong area of interest for junior pharmacists, and must convince pharmacy governing parties of the need for it to be considered a specialised area itself, clinical pharmacists, such as myself, have opted to advance our knowledge via integration with external organisations, including the Australian New Zealand Bone Mineral Society (ANZBMS) and the Australian and New Zealand Orthopaedic Research Society (ANZORS). Orthopaedic pharmacy is an ideal choice for those wanting to pursue a career in surgical clinical pharmacy. It encompasses both clinical and strategic responsibilities. The variety of work undertaken in a discrete area also makes it a good choice for those who wish to develop strong clinical knowledge in the area of musculoskeletal systems, contribute to orthopaedic-related research and pioneer an area unfamiliar in its potential range of expertise. The author declares that she has no conflicts of interest.