It began in the middle of May this year. Under strict guidelines and monitoring, a group of advanced scope physiotherapists (ASPs) began to administer paracetamol and ibuprofen to suitable patients who had presented to the hospital’s emergency department (ED).

The success of the venture has seen it become a mainstay at the Western Australian hospital, only the second location in Australia (behind Queensland) to have this capability.

While it may seem a small win for ASPs to be able to administer medications that patients themselves could buy over the counter at any pharmacy, it has big implications for the physiotherapy profession of the future, says Tracy Hebden-Todd.

Tracy, the hospital’s head of the physiotherapy department, worked with a team behind the scenes for almost two years to pave the way for the change.

Having ASPs be able to administer paracetamol and ibuprofen has huge benefits for the patients, the ED staff, the ASPs and the hospital’s bottom line, Tracy says.

‘The ASP’s work in what’s called a fast-track environment in the emergency department.

'Generally, you’re bringing patients in with an aim to have them discharged within four hours,’ Tracy says.

‘The teams are doing a full assessment, arranging and reviewing imaging, then making a decision as to whether that patient needs to be admitted or referred on or if they can be safely discharged.

'It’s very fast, operationally—and pain relief is such an important part of that. You want to complete the assessment quickly, so you can move the patient through their journey.

'For physiotherapists in the emergency department, having to go away and ask a doctor, who could be in the middle of treating a very sick patient, for pain relief, and then [waiting while] they write up a script which then requires a doctor or nurse to check and administer, it is very time-consuming.’

To streamline efficiency, Tracy and her team began by reviewing a Queensland Health policy enabling ASPs to administer pain relief.

Sir Charles Gairdner Hospital deputy chief pharmacist Daniel Makarounas with ED ASP Patricia Lobo at the locked box containing the paracetamol and ibuprofen supplies.

‘I used a lot of their policy and adapted it to meet the needs of the relevant WA stakeholders following wide consultation,’ Tracy says.

‘There were a lot of hurdles to step over; it wasn’t just as simple as bringing the policy in. There were many layers of governance to navigate.

'First, we had to determine where the policy was going to sit; would it be a physio policy? An ED policy? A hospital policy?

'I was in contact with the Chief Allied Health Officer (WA) in seeking clarification about the scheduling of these drugs, which was an area I wasn’t really familiar with.

'I also liaised with Ahpra (WA), clinical governance and drug therapeutic committees within Sir Charles Gairdner Hospital.’

Tracy undertook her own physiotherapy training in the UK, where physiotherapists are able to administer more significant pain relief to patients, including injectable pain relief medication.

She says the ability for ASPs to administer paracetamol and ibuprofen at Sir Charles Gairdner Hospital’s ED has the potential to open up more possibilities for Australian physiotherapists along similar lines to the UK.

‘I think it just opens people’s minds, particularly among the medical and nursing professions, to the fact that physiotherapists are very skilled. That we have a lot of potential to expand our skill mix,’ Tracy says. 

‘There should be no limits to that, in my mind.

'Nurse practitioners are fantastic and I don’t want them to think that we are going to be competing with them.

'I think we should be running alongside them in advancing these roles. I see the opportunities out there, but it’s hard to push for it. This has taken me probably almost two years to accomplish.’

Patricia Lobo APAM, who works as an ASP at Sir Charles Gairdner Hospital’s ED, says the ability to administer the specific pain relief medication was conditional on many factors.

These included that the ASPs were approved by the hospital’s accreditation board, that the medications were stored in a locked box that only the ASPs could access, that they check precautions or contraindications of the medications in patients, and that patients given paracetamol and ibuprofen are aged between 15 and 65 and weigh over 50kgs.

The lengthy checklist also includes requirements that ASPs consider whether, physiologically, the patient is suitable to take paracetamol and ibuprofen from a heart, liver, kidney, clotting issues and potential pregnancy perspective.

As part of the current medication trial, the ASPs enter the patient details and medication chart into a REDCap program, which is audited by the ED fast track consultant.

Patricia says the patient cohort typically seen by ASPs at Sir Charles Gairdner Hospital includes those with single-system musculoskeletal injuries such as sprains, strains, fractures (once triaged), sporting injuries and joint dislocations, back and neck injuries as well as injuries to peripheral joints such as fingers, thumbs, feet and ankles.

‘In the ED we often see very acute injuries that might have occurred minutes to a couple of hours beforehand.

'Patients are brought in and what we have previously done is ask a registrar working with us to prescribe the pain relief.

'We provide the patient history, they write a medication chart, we take it to the nurse, the nurse gets it for us and then the nurse administers it to the patient,’ Patricia says.

‘On a very busy winter weekend when there are lots of sporting injuries coming in, among many other presentations, being able to administer paracetamol and ibuprofen streamlines patient management and ultimately saves time.’

Patricia says that in cases where stronger analgesia or anti-inflammatory medication is required, the ASPs would still consult the doctors they work with.

‘But to get the basic paracetamol and ibuprofen administering capacity is a big win for us. We’re happy with that.

'We are primary contact practitioners and this encourages our autonomous work... and we want to make sure that we do it right so that this can potentially be expanded to other hospitals and other departments.’