In consultation with key stakeholders, Kimberley Aboriginal Medical Services and WA Country Health Service developed a standard drug list for use in the Kimberley; the first edition of the Kimberley Standard Drug List (KSDL) was published in November 2005.

This standard drug list is largely defined by best practice guidelines and is intended to be used by Aboriginal community controlled health services (ACCHS) and remote primary health care clinics. It is also intended to be reflected in hospital imprest systems. It is hoped that this process of drug rationalisation promotes consistency in care across health services and consequently, has widespread benefits for both clinicians and patients.

To establish a regional consensus, the first stage of development involved circulation of a comprehensive drug list to Kimberley clinicians. The drug list included therapeutic classes relevant to the health priorities of the Kimberley population. Clinicians were asked to select their preferences in each therapeutic class and provide rationale for these preferences.

1. Essential drug list

This KDSL consists of drugs that the steering committee recommends should be easily accessible to the Kimberley population and hence, included in all clinic and hospital medication imprests.

2. Supplementary list

This KDSL consists of drugs that should be able to be accessed across the Kimberley but will not be required by all clinics to be kept on the shelves. Therefore, it is at the discretion of the local senior clinicians as to whether these drugs are included on the clinics imprest.

The KDSL also includes:

1. Emergency drug list (Essential, High Risk Intubation, Obstetric and Palliative Care)

2. Vaccines

3. Non-prescription medicines

The KDSL Steering Committee has been established as a Working Group of the Chronic-Disease Sub-committee to facilitate the updating and ongoing maintenance of the list. They meet once a year to review any new drugs which have been added to the PBS, new clinical data that has been reported, and to review any KSDL modification request forms submitted by clinicians.

The review considers the following criteria:

• Evidence based medicine/clinical trial data/national guidelines

• Regional preferences and protocols

• PBS indications and authority status (if applicable)

• Familiarity

• Drug costs

• Side Effect Profile/Interactions

• Patient Compliance

• Other Resources

What is it?

It is a list, or formulary, of medicines that are routinely available across both ACCHSs and WACHS remote primary health care clinics.

Why was it developed?

• To help clinics select a suitable and standard range of medication to manage acute and chronic conditions

• To minimise duplication of drug classes e.g., clinics stocking six different ACE-Inhibitors

• To help reduce wastage and expired medicine at clinics

• To ensure a highly mobile patient group are able to access their medication across all Kimberley clinics

Who selects the medicines for inclusion?

The KSDL is updated each year by a steering committee including medical, nursing and pharmacy ACCHS and WACHS representatives.

What criteria are used to determine inclusion on the KSDL?

• Availability on the PBS and approved indications (and hence through Section 100)

• Availability of suitable alternatives on the KSDL

• Patient issues: Does it improve adherence? Is it more efficacious? Does it cause less side-effects than alternatives? Is it suitable for packing in a Dose Administration Aid (DAA)?

Who should use it?

All clinic staff and all medical officers attending these clinics.

Visiting specialist service providers and providers in referral hospitals discharging clients back to Kimberley communities.

What if I want to prescribe something that is not on the KSDL?

You can prescribe non-KSDL items for patients.  The eligibility for these medicines to be covered under the S100 Remote Area Aboriginal Health Services (RAAHS) Program will then apply.  Non S100 medicines (KSDL or non KSDL) will incur a cost to the health service or patient.  These medicines will probably not be available from the clinic imprest and will require the medicines to be ordered from the contracted community pharmacy.

WACHS Clinics - If it is not on the PBS then seek advice from the Regional Pharmacist. All prescriptions should be accompanied by an ‘Individual Patient Supply Form’ detailing why a non-KSDL drug is necessary, and the form faxed to the Regional Pharmacy.

ACCHS Clinics - Medicines that are not KSDL and not PBS should have approval by the Senior Medical Officer (SMO) before an order is placed with the community pharmacy of the health services if funding the medications. When prescribing on MMEx, there is a prompt to complete the reason for selecting a medication not on the drug list for both S100 and non S100 medicines that are not on the KSDL.

Why do I have to complete an ‘Individual Patient Supply Form’ or include details in ‘reason for selecting off KSDL’ in MMEx for non-KSDL drugs?

This information is used to consider drugs for inclusion at each review meeting. The KDSL Steering Committee rely on clinician input to improve the KSDL.

I think a drug (or any other change) should be included on the KSDL, how do I let the steering committee know?

Feedback is welcome - please complete a ‘Modification Request Form’ or the request for additional imprest item form and send this to the WACHS Regional Pharmacist or the KAMS Pharmacist. Please include a rationale for inclusion and any supporting evidence.

What is the difference between the ‘essential’ and ‘supplementary’ lists?

Essential - includes all medicines that should be available at all clinics.

Supplementary - includes medicines that each clinic can elect to stock and is usually dependent on whether there is a patient attending the clinic on the medicine. It is not expected that all clinics stock every Supplementary item.

I have a patient on a non-KSDL ACE-Inhibitor, how do I switch them to a KSDL listed ACE-Inhibitor?

Drug Transfer Protocols are included in the KSDL to provide guidance based on the available evidence for switching between alternatives in a drug class.

Where can I find a copy of the KSDL?

Electronic copies are available on the WACHS Intranet or on the KAHPF Website. There is also a link in the MMEx.

What about an app for my iPhone?

Currently an app is not available.

I use MMEx, how do I preferentially choose KSDL medicines?

When adding a new medicine to a patient’s order, select the ‘KSDL’ search option – this only allows you to select KSDL listed medicines.