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[post_content] => As per the Therapeutic Goods Administration’s (TGA’s) Medicine shortages report database, today (3 July 2024) there are 407 current medicine shortages.
There have been an ongoing shortages of critical pain relief medicines for palliative care, following the discontinuation of oral liquid morphine (Ordine) from the Australian market in 2023, along with various strengths, brands and formulations of morphine sulfate pentahydrate and oxycodone hydrochloride.
These supply challenges are distressing for patients, families, and health professionals, who have been forced to grapple with fluctuating supplies week in and out.
‘For many clinicians, the challenges around a lack of guaranteed supply of medicines has been ongoing for 18 months or more,’ said Camilla Rowland, CEO of Palliative Care Australia.
Children and parents are also bearing the brunt of ongoing shortages, with azithromycin powder for oral suspension in short supply. The timing couldn’t be worse, with pneumonia cases continuing to surge in 2024 compared with the previous 5 years – with emergency department presentations in New South Wales in the 0–4 and 5–16 age groups significantly higher this year. Cases of pertussis, another indication for azithromycin and which can also lead to pneumonia, have also reached a 5-year high.
Azithromycin is also used for acute otitis media in Aboriginal and Torres Strait Islander children as a single dose, with the shortage having a critical impact on this population.
Some parents have reported visiting up to 10 pharmacies in search of the medicine, with the TGA reporting that shortages are expected to persist until November 2024.
‘We tried a number of different chemists. We went to three in person and probably called another dozen,’ said Sunshine Coast mother Kyanne Hooper, who was searching for azithromycin for her 16-month old son.
It doesn't help that pharmacists in most jurisdictions are unable to make sensible substitutions to dosage forms or within medicine classes – which could alleviate pressure on healthcare professionals, patients and parents.
With that in mind, Australian Pharmacist drills into the issues and the solutions – newly legislated and proposed – which could help to make a difference.
Critical medicines list urgently needed
When medicines are in long-term short supply, the TGA utilises the Section 19A instrument to facilitate the importation of medicines into Australia.
There are 128 current S19A approvals, including Timolol 0.5% w/v eye drops solution and paracetamol infusion.
However, while designed to backfill shortages, manufacturers of S19A medicines are also not subject to the same impending shortages notifications that apply to other medicines approved for use in Australia, explained PSA SA/NT State Manager Helen Stone MPS.
[caption id="attachment_22442" align="alignright" width="229"]
PSA SA/NT State Manager Helen Stone[/caption]
‘Normally, when medicines are approved by the TGA, the company that produces them is required to notify the TGA that they are unable to supply the Australian market,’ she said.
‘[Manufacturers] of S19A medicines don’t have the same obligation to inform the TGA when a shortage situation arises.’
Take morphine 5 mg/mL oral liquid (Ordine) for example. While discontinued by Mundipharma on 22 March 2024, the TGA announced that a replacement product, manufactured by Arrotex, would be available from 27 September.
‘Meanwhile, another replacement product was listed under S19A, which can no longer be supplied until later in July,’ said Ms Stone.
‘Often a product is listed, but then it can’t be supplied for a variety of commercial reasons, for example the manufacturer may have underestimated the quantities required in Australia or other supply issues they didn’t anticipate.’
The current process of waiting for pharma companies to report that they can’t supply medicines means patients face ongoing shortages of essential medicines.
To remedy that, the ultimate solution would be the creation of an essential formulary for Australia – a critical medicines list – which contains essential medicines such as oral liquid morphine and certain antibiotics.
‘When we identify that we must have those medicines in Australia, we can proactively work with pharma companies to make sure there’s always supply,’ she said.
PSA has long advocated for a critical medicines list, which is under consideration with the TGA, and submitted a response to the TGA’s Medicine shortages in Australia – Public consultation on challenges and opportunities – the results of which are expected imminently.
‘We could still use S19A for less critical medicines, but having an essential formulary with specific rules around it would give us another option in trying to manage critical shortages,’ Ms Stone added.
Queensland’s scope of practice pilot creates a better way
Despite most pharmacists being unable to make substitutions when medicines are in short supply, pharmacists participating in the Queensland Community Pharmacy Scope of Practice Pilot have the authority to do so.
The Extended Practice Authority (EPA) – Pharmacists Community pharmacy scope of practice pilot allows participating pharmacists to undertake therapeutic substitution and adaptation without needing prescriber approval, said PSA Queensland State Manager Nicole Floyd MPS.
[caption id="attachment_21592" align="alignright" width="233"]
PSA Queensland State Manager Nicole Floyd MPS[/caption]
‘Under part two of the EPA, an authority allows pharmacists participating in the pilot to amend a prescription,’ she said. ‘That means they can change the dosage form of a medication without the prescriber's approval, and also substitute a medicine for another drug within the same class.’
The EPA doesn’t just apply to medicines prescribed under the pilot, but extends to all medicines.
So if a parent presents to a pharmacy participating in the pilot with a prescription for azithromycin suspension, which cannot be supplied, pharmacists can offer stressed parents some relief.
While pharmacists should let prescribers know of any amendments to scripts, they can substitute the liquid azithromycin dosage form for tablets and advise parents to crush and disperse it without needing to obtain authority.
‘Any other pharmacists in Queensland who are not participating in the pilot or practising in other jurisdictions would have to go back to the prescriber to amend or request a new script,’ said Ms Floyd.
[post_title] => What can be done about ongoing medicine shortages?
[post_excerpt] => Palliative care patients and children bear the brunt of short supply of medicines. These legislative updates could help to make a difference.
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[post_content] => The Aged Care On-Site Pharmacist (ACOP) program kicks off today (1 July 2024). To improve Quality Use of Medicines (QUM) in aged care, seven pioneering pharmacists have trained to become ‘knowledge brokers’ through the Australia-wide EMBRACE trial.
The participating pharmacists have received funding to work across 19 residential aged care facilities (RACFs) operated by four aged care providers to establish the new role, which entails implementing the latest research findings and guidelines to improve medicine safety.
Led by Monash University’s Centre for Medicine Use and Safety, the 12-month trial – which kicked off in October 2023 – involves implementing Australia’s new Clinical Practice Guideline for the Appropriate Use of Psychotropic Medications in People Living with Dementia and in Residential Aged Care.
Four knowledge brokers share their experiences of participating in the EMBRACE trial so far.
What does the role entail?
For Jennifer Bakija MPS, a credentialed pharmacist who has been involved in the provision of medicine reviews in aged care for the last 2 decades, the knowledge broker role is an extension of what pharmacists do every day, including providing counselling and information on medicines.
‘Being on-site puts us into a unique perspective to see firsthand the challenges that RACF staff face,’ she added.
Central to the role is developing strong relationships across the facility, explained community pharmacist Clare Park.
‘We act as connecting pharmacists who develop relationships and networks with facility staff and stakeholders to improve QUM,’ she said.
But the main purpose of brokers is to facilitate the transfer and implementation of new information to various healthcare professionals, said on-site pharmacist Linda Ha.
‘The intent is to assist the RACF to align with current best practice guidelines and ensure the guidelines are taken up into practice,’ explained credentialed pharmacist Eva Stein MPS.
What tasks and responsibilities are involved?
To improve practice standards, knowledge brokers run staff education sessions, distribute monthly newsletters to reinforce learnings and engage with GPs, said Ms Ha.
‘We work with aged care staff to establish strategies to improve guideline adoption processes and facility concordance,’ she said.
Knowledge brokers also identify areas that need change and discuss implementation methods with management, incorporating best use of existing processes, resources, and staff, said Ms Stein.
‘I use the data and quality indicators for the site I am working with to structure activities that will lead them to achieve their targets and achieve best practice,’ said Ms Ha.
‘We also develop template forms to implement into the software system and encourage staff to use them, and attend key meetings such as MAC meetings,’ added Ms Park.
How does the knowledge broker role differ to existing pharmacist roles?
As opposed to working on an individual resident level, knowledge brokers operate at a systems level – which aligns closely with the clinical governance and QUM components of the ACOP role – to effect change within the RACF’s practices, said Ms Stein.
‘I have an RMMR background, and I am used to working at a resident level. I’ve had little interaction with management and didn’t feel embedded in the RACF team,’ she said.
‘As a knowledge broker I feel more engaged with the team and they are really enjoying having a pharmacist onboard too.’
Driving change management processes across the RACF ensures organisational compliance with new guidelines and best practices.
‘RACFs often operate under multilayered management levels, with multiple committees and subcommittees,’ said Ms Ha.
‘The knowledge broker pharmacist is able to act as a liaison between all these levels to champion appropriate QUM principles’ added Ms Bakija.
How can on-site pharmacists work as knowledge brokers?
Post-EMBRACE, there is potential for the creation of a separate funded role for on-site pharmacists in aged care.
The Monash team is developing a package of resources to support pharmacists to work as knowledge brokers, involving training on knowledge translation, using quality indicators, and developing and implementing local action plans.
For pharmacists taking on on-site roles this month, leveraging their contextual understanding and multidisciplinary relationships to drive continuous staff education, lead quality improvement initiatives and tailor strategies based on rapid feedback is a good place to start, said Ms Ha.
‘Our intimate knowledge of medicines is an important element that’s currently missing in RACF policy and procedure decision making,’ said Ms Stein. ‘Pharmacists’ unique knowledge base can be tapped into so we can take the lead when it comes to ensuring RACF compliance with medication-related guidelines and clinical care standards.’
Pharmacists will also need to develop a suite of skills and relationships to effectively engineer change.
‘You need to develop strong interpersonal and communication skills, seek opportunities to collaborate closely with various healthcare teams and understand their perspectives and challenges, experiment with different teaching methods to facilitate effective knowledge transfer, be open to feedback, and constantly refine your approaches based on the insights you gain,’ advised Ms Ha.
Getting to know the whole RACF team, what roles they fulfil and where the gaps are is integral to forming a bird’s-eye systems view, said Ms Stein.
‘Find out who is responsible for decision making, what the barriers are for each worker involved in the current processes (e.g. time, lack of education), and take time to understand the current processes in place,’ she said.
‘Be familiar with guidelines for use of medicines in the RACF setting and have a good understanding of how these should be applied,’ added Ms Bakija.
But it's also important to consider whether the role is the right fit.
‘The role of a knowledge broker is unique and challenging,’ said Ms Park. ‘If you are interested in exploring different aspects of the pharmacy profession and enjoy developing new relationships in various areas, becoming a knowledge broker could be an excellent choice for you.’
To find out more about EMBRACE project 1 or knowledge brokers, reach out to Dr Amanda Cross: amanda.cross@monash.edu
[post_title] => Preparing pharmacists for aged care governance
[post_excerpt] => As the ACOP program kicks off, this new intervention is designed to strengthen the systems level capacity of pharmacists in aged care.
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[post_content] => James Buckley MPS, fitness fanatic and partner at LiveLife Pharmacy Port Douglas, is full speed into the expanded Queensland prescribing pilot.
My high school chemistry teacher told me, ‘James, choose something you like, and something you’re good at’. I was good at chemistry at school and loved helping people, so why not do both? Pharmacy to me is about helping people understand their health through teaching them about their medicines. It’s rewarding to now formally prescribe S4 medicines, alongside existing scope of Schedule 2 and 3 medicines and lifestyle advice that will improve their health.
Tell us about prescribing under the Queensland Community Pharmacy Scope of Practice Pilot?
The pilot program gives pharmacists the ability to prescribe appropriate medicines for the patient’s condition as per the therapeutic guidelines, in many cases to suit the individual.
The structured protocols allow pharmacists to identify red flag and referral triggers for the patient and for us to practice safely and effectively.
Consult times allow for discussions between patient and pharmacist with the opportunity for all stages of the prescribing cycle. This includes information gathering, examination, therapeutic discussions, management and patient communication.
How does the service work?
When a patient presents to the pharmacy with symptoms, I take a brief history and offer a consultation.
During the consult, I take a detailed history including back-ground information, medical conditions, medicines and social history. Red flags for the patient’s condition are ruled out as part of the diagnostic framework, and appropriate physical examinations are conducted.
This can include taking vitals such as blood pressure, temperature and blood glucose levels and conducting an ear, nose, throat examination.
All the information is assessed and an appropriate treatment plan is agreed upon by both parties. This can include pharmacological or non-pharmacological treatment, lifestyle advice and preventative treatment, or a referral if warranted.
The patient is then reviewed for an appropriate follow-up date. After seeing patients for holistic care consults, there has been no apprehension to pay for the services.
For patients who are ineligible to participate or are price conscious, this feedback is also transmitted through the software as missed opportunities to provide health care to patients in need.
Introducing patients to the service?
Our pharmacists and staff are on the frontline explaining our services to patients at every opportunity. Our assistants are trained to refer any patient who presents with ear pain (among other conditions) to the pharmacist, resulting in an instant consultation. We also have a great relationship with the local GP clinic and hospital, so they refer patients to our trained pharmacists. Patients are often ecstatic, thrilled and relieved that we offer the service. They trust our knowledge and medicine expertise, and have no problems discussing their health with the prescribing pharmacist. We see people every day who are unable to see the doctor for weeks, and are desperate for our assistance.
What have you prescribed so far?
Within the first week I successfully reviewed patients and prescribed a course of antibiotic ear drops for an international patient who came to Australia to see the Great Barrier Reef and subsequently contracted an outer ear infection while diving. I also saw a concerned mother who presented with her child who had contracted a case of impetigo on the knee from school and could not see a doctor for 3 weeks. I was able to prescribe antibiotic ointment and oral antibiotics to treat the infection.
Advice for other ECPs?
Pharmacy is a constantly expanding and rewarding career. Find what you enjoy most and work hard to make your mark on the profession. I’ve always wanted to be a pharmacy owner, be the cornerstone of a community and provide exceptional services to people in need.
Find like-minded people and mentors who believe in you. I want to thank my mentors from LiveLife Pharmacy and PSA. I would not be here without them.
A day in the life of James Buckley MPS, Pharmacy Partner, LiveLife Pharmacy, Port Douglas, QLD
| 5.00 am |
Get up and moving Start the day with a HIIT class. Let’s do this! |
| 8.00 am |
First things first Open the pharmacy, review bookings – online orders, pharmacist consult bookings for COVID-19 and other vaccines. Our ear clinic for diving, flying and swimming infections from reef-based activities is constantly busy. All staff are trained to triage. We conduct multiple ear checks a day (10 is my daily record), especially on weekends when doctors are closed. |
| 9.00 am |
Vaccination clinic starts Administer shingles vaccine to a local couple. Other vaccines are booked online. All flu shots are free for Queensland residents and anyone aged 65+ is NIP-funded. |
| 11.00 am |
Oral contraceptive pill Miss Y needs to renew her contraceptive pill repeats that were misplaced. She was assessed and I was able to prescribe her regular medication. |
| 2.00 pm |
Prescribing time Miss P, aged 6, presents to the pharmacy with ear pain. She has been swimming a lot on her holiday and an examination is required. No red flags are present and she can safely be prescribed antibiotic ear drops. |
| 3.00 pm |
Touch base with staff Catch up with the team, which can be anything from helping with orders, professional development, staff training and upskilling on pharmacist consults or inducting new staff. On-the-floor quiz and teaching sessions with interns can include reviews of work in non-prescription areas, which for us is commonly bites and stings from mozzies and jellyfish and sunscreen uses for sunburn and (constant) heat rash. |
| 5.00 pm |
Winding down Instruct staff to finish, tidy dispensary, scan scripts, and get ready for the next day. |
| 6.00-9.00 pm | Home time Catch up with the ECP Community of Specialty Interest (CSI). Watch Netflix. Bed. |
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[post_content] => Mid-winter will be a busy time of year for pharmacists, with a range of practice, fee and career pathway updates kicking off on 1 July 2024.
Australian Pharmacist takes a look at the changes pharmacists will experience from next week.
1. Vaping ban comes into effect
The third tranche of vaping reform included in the Therapeutic Goods and other Legislation (Vaping Reforms) Bill 2024 will see all vape sales banned from general retailers from 1 July. Passing through the Senate this morning, the Bill limits the supply of all vapes strictly to community pharmacies from Monday.
These vaping products must adhere to quality and product standards including:
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[post_content] => Rabies causes an estimated 59,000 deaths annually, with almost half (40%) deaths occurring in children under 15. But underreporting could mean this death rate is much higher.
Post COVID-19, there has been an increase in rabies cases – with the abandonment of pets and a reduction in human-dog interaction leading to heightened aggression in dogs – who are responsible for most human rabies cases. Rabies hotspots include Asia, Africa and India, but 150 countries are considered high-risk rabies territories.
As we approach the winter school holidays and Australians escape the cold by heading overseas, pharmacists in New South Wales can now protect patients against the disease.
PSA advocacy was the key driver for the change to the NSW Pharmacist Vaccination Standards to allow pharmacists to administer the rabies vaccine, with the NSW Branch Committee working closely with the Ministry of Health to drive the change, said PSA NSW State Manager Amanda Fairjones MPS.
[caption id="attachment_25121" align="alignright" width="298"]
PSA NSW branch State Manager Amanda Fairjones MPS[/caption]
‘When undertaking travel health consultations, our members told us that it was the most common travel vaccine they were referring people back to their GP for,’ she said. ‘People were asking for it but we were unable to provide it.’
Having the vaccine available provides a great opportunity for pharmacists to sit down and have a chat to people about their travel vaccination needs, said Karen Carter FPS, Partner of Carter's Pharmacy Gunnedah and Owner Narrabri Pharmacy Narrabri in north-west NSW.
‘Because of the regime with some vaccines, we need to have them all done on one day or a week apart,’ she said. ‘ Now we can organise a vaccine regime to be completed at the pharmacy, rather than having to send patients back to their GP for part of it.’
Who is the vaccine indicated for?
Under the NSW Pharmacist Vaccination Standards, pharmacists can administer the rabies vaccine for pre-exposure prophylaxis treatment via intramuscular injection to people 5 years and over who are not immunocompromised.
‘When undertaking travel health consultations, our members told us that it was the most common travel vaccine they were referring people back to their GP for. People were asking for it but we were unable to provide it.'
amanda fairjones MPS
The Australian Immunisation Handbook (AIH), recommends pre-exposure rabies vaccine for:
Karen Carter FPS[/caption]
Post-exposure prophylaxis includes wound management, administration of rabies vaccine doses and human rabies immunoglobulin, taking into account:
If a prescriber writes a prescription for a vaccine – including the rabies vaccine – pharmacists are able to administer it in all states and territories other than Tasmania and South Australia.
However, in the case of the rabies vaccine, in Tasmania, authorised pharmacist immunisers can administer the rabies vaccine when prescribed by a medical or nurse practitioner.
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[post_content] => As per the Therapeutic Goods Administration’s (TGA’s) Medicine shortages report database, today (3 July 2024) there are 407 current medicine shortages.
There have been an ongoing shortages of critical pain relief medicines for palliative care, following the discontinuation of oral liquid morphine (Ordine) from the Australian market in 2023, along with various strengths, brands and formulations of morphine sulfate pentahydrate and oxycodone hydrochloride.
These supply challenges are distressing for patients, families, and health professionals, who have been forced to grapple with fluctuating supplies week in and out.
‘For many clinicians, the challenges around a lack of guaranteed supply of medicines has been ongoing for 18 months or more,’ said Camilla Rowland, CEO of Palliative Care Australia.
Children and parents are also bearing the brunt of ongoing shortages, with azithromycin powder for oral suspension in short supply. The timing couldn’t be worse, with pneumonia cases continuing to surge in 2024 compared with the previous 5 years – with emergency department presentations in New South Wales in the 0–4 and 5–16 age groups significantly higher this year. Cases of pertussis, another indication for azithromycin and which can also lead to pneumonia, have also reached a 5-year high.
Azithromycin is also used for acute otitis media in Aboriginal and Torres Strait Islander children as a single dose, with the shortage having a critical impact on this population.
Some parents have reported visiting up to 10 pharmacies in search of the medicine, with the TGA reporting that shortages are expected to persist until November 2024.
‘We tried a number of different chemists. We went to three in person and probably called another dozen,’ said Sunshine Coast mother Kyanne Hooper, who was searching for azithromycin for her 16-month old son.
It doesn't help that pharmacists in most jurisdictions are unable to make sensible substitutions to dosage forms or within medicine classes – which could alleviate pressure on healthcare professionals, patients and parents.
With that in mind, Australian Pharmacist drills into the issues and the solutions – newly legislated and proposed – which could help to make a difference.
Critical medicines list urgently needed
When medicines are in long-term short supply, the TGA utilises the Section 19A instrument to facilitate the importation of medicines into Australia.
There are 128 current S19A approvals, including Timolol 0.5% w/v eye drops solution and paracetamol infusion.
However, while designed to backfill shortages, manufacturers of S19A medicines are also not subject to the same impending shortages notifications that apply to other medicines approved for use in Australia, explained PSA SA/NT State Manager Helen Stone MPS.
[caption id="attachment_22442" align="alignright" width="229"] PSA SA/NT State Manager Helen Stone[/caption]
‘Normally, when medicines are approved by the TGA, the company that produces them is required to notify the TGA that they are unable to supply the Australian market,’ she said.
‘[Manufacturers] of S19A medicines don’t have the same obligation to inform the TGA when a shortage situation arises.’
Take morphine 5 mg/mL oral liquid (Ordine) for example. While discontinued by Mundipharma on 22 March 2024, the TGA announced that a replacement product, manufactured by Arrotex, would be available from 27 September.
‘Meanwhile, another replacement product was listed under S19A, which can no longer be supplied until later in July,’ said Ms Stone.
‘Often a product is listed, but then it can’t be supplied for a variety of commercial reasons, for example the manufacturer may have underestimated the quantities required in Australia or other supply issues they didn’t anticipate.’
The current process of waiting for pharma companies to report that they can’t supply medicines means patients face ongoing shortages of essential medicines.
To remedy that, the ultimate solution would be the creation of an essential formulary for Australia – a critical medicines list – which contains essential medicines such as oral liquid morphine and certain antibiotics.
‘When we identify that we must have those medicines in Australia, we can proactively work with pharma companies to make sure there’s always supply,’ she said.
PSA has long advocated for a critical medicines list, which is under consideration with the TGA, and submitted a response to the TGA’s Medicine shortages in Australia – Public consultation on challenges and opportunities – the results of which are expected imminently.
‘We could still use S19A for less critical medicines, but having an essential formulary with specific rules around it would give us another option in trying to manage critical shortages,’ Ms Stone added.
Queensland’s scope of practice pilot creates a better way
Despite most pharmacists being unable to make substitutions when medicines are in short supply, pharmacists participating in the Queensland Community Pharmacy Scope of Practice Pilot have the authority to do so.
The Extended Practice Authority (EPA) – Pharmacists Community pharmacy scope of practice pilot allows participating pharmacists to undertake therapeutic substitution and adaptation without needing prescriber approval, said PSA Queensland State Manager Nicole Floyd MPS.
[caption id="attachment_21592" align="alignright" width="233"] PSA Queensland State Manager Nicole Floyd MPS[/caption]
‘Under part two of the EPA, an authority allows pharmacists participating in the pilot to amend a prescription,’ she said. ‘That means they can change the dosage form of a medication without the prescriber's approval, and also substitute a medicine for another drug within the same class.’
The EPA doesn’t just apply to medicines prescribed under the pilot, but extends to all medicines.
So if a parent presents to a pharmacy participating in the pilot with a prescription for azithromycin suspension, which cannot be supplied, pharmacists can offer stressed parents some relief.
While pharmacists should let prescribers know of any amendments to scripts, they can substitute the liquid azithromycin dosage form for tablets and advise parents to crush and disperse it without needing to obtain authority.
‘Any other pharmacists in Queensland who are not participating in the pilot or practising in other jurisdictions would have to go back to the prescriber to amend or request a new script,’ said Ms Floyd.
[post_title] => What can be done about ongoing medicine shortages?
[post_excerpt] => Palliative care patients and children bear the brunt of short supply of medicines. These legislative updates could help to make a difference.
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[post_content] => The Aged Care On-Site Pharmacist (ACOP) program kicks off today (1 July 2024). To improve Quality Use of Medicines (QUM) in aged care, seven pioneering pharmacists have trained to become ‘knowledge brokers’ through the Australia-wide EMBRACE trial.
The participating pharmacists have received funding to work across 19 residential aged care facilities (RACFs) operated by four aged care providers to establish the new role, which entails implementing the latest research findings and guidelines to improve medicine safety.
Led by Monash University’s Centre for Medicine Use and Safety, the 12-month trial – which kicked off in October 2023 – involves implementing Australia’s new Clinical Practice Guideline for the Appropriate Use of Psychotropic Medications in People Living with Dementia and in Residential Aged Care.
Four knowledge brokers share their experiences of participating in the EMBRACE trial so far.
What does the role entail?
For Jennifer Bakija MPS, a credentialed pharmacist who has been involved in the provision of medicine reviews in aged care for the last 2 decades, the knowledge broker role is an extension of what pharmacists do every day, including providing counselling and information on medicines.
‘Being on-site puts us into a unique perspective to see firsthand the challenges that RACF staff face,’ she added.
Central to the role is developing strong relationships across the facility, explained community pharmacist Clare Park.
‘We act as connecting pharmacists who develop relationships and networks with facility staff and stakeholders to improve QUM,’ she said.
But the main purpose of brokers is to facilitate the transfer and implementation of new information to various healthcare professionals, said on-site pharmacist Linda Ha.
‘The intent is to assist the RACF to align with current best practice guidelines and ensure the guidelines are taken up into practice,’ explained credentialed pharmacist Eva Stein MPS.
What tasks and responsibilities are involved?
To improve practice standards, knowledge brokers run staff education sessions, distribute monthly newsletters to reinforce learnings and engage with GPs, said Ms Ha.
‘We work with aged care staff to establish strategies to improve guideline adoption processes and facility concordance,’ she said.
Knowledge brokers also identify areas that need change and discuss implementation methods with management, incorporating best use of existing processes, resources, and staff, said Ms Stein.
‘I use the data and quality indicators for the site I am working with to structure activities that will lead them to achieve their targets and achieve best practice,’ said Ms Ha.
‘We also develop template forms to implement into the software system and encourage staff to use them, and attend key meetings such as MAC meetings,’ added Ms Park.
How does the knowledge broker role differ to existing pharmacist roles?
As opposed to working on an individual resident level, knowledge brokers operate at a systems level – which aligns closely with the clinical governance and QUM components of the ACOP role – to effect change within the RACF’s practices, said Ms Stein.
‘I have an RMMR background, and I am used to working at a resident level. I’ve had little interaction with management and didn’t feel embedded in the RACF team,’ she said.
‘As a knowledge broker I feel more engaged with the team and they are really enjoying having a pharmacist onboard too.’
Driving change management processes across the RACF ensures organisational compliance with new guidelines and best practices.
‘RACFs often operate under multilayered management levels, with multiple committees and subcommittees,’ said Ms Ha.
‘The knowledge broker pharmacist is able to act as a liaison between all these levels to champion appropriate QUM principles’ added Ms Bakija.
How can on-site pharmacists work as knowledge brokers?
Post-EMBRACE, there is potential for the creation of a separate funded role for on-site pharmacists in aged care.
The Monash team is developing a package of resources to support pharmacists to work as knowledge brokers, involving training on knowledge translation, using quality indicators, and developing and implementing local action plans.
For pharmacists taking on on-site roles this month, leveraging their contextual understanding and multidisciplinary relationships to drive continuous staff education, lead quality improvement initiatives and tailor strategies based on rapid feedback is a good place to start, said Ms Ha.
‘Our intimate knowledge of medicines is an important element that’s currently missing in RACF policy and procedure decision making,’ said Ms Stein. ‘Pharmacists’ unique knowledge base can be tapped into so we can take the lead when it comes to ensuring RACF compliance with medication-related guidelines and clinical care standards.’
Pharmacists will also need to develop a suite of skills and relationships to effectively engineer change.
‘You need to develop strong interpersonal and communication skills, seek opportunities to collaborate closely with various healthcare teams and understand their perspectives and challenges, experiment with different teaching methods to facilitate effective knowledge transfer, be open to feedback, and constantly refine your approaches based on the insights you gain,’ advised Ms Ha.
Getting to know the whole RACF team, what roles they fulfil and where the gaps are is integral to forming a bird’s-eye systems view, said Ms Stein.
‘Find out who is responsible for decision making, what the barriers are for each worker involved in the current processes (e.g. time, lack of education), and take time to understand the current processes in place,’ she said.
‘Be familiar with guidelines for use of medicines in the RACF setting and have a good understanding of how these should be applied,’ added Ms Bakija.
But it's also important to consider whether the role is the right fit.
‘The role of a knowledge broker is unique and challenging,’ said Ms Park. ‘If you are interested in exploring different aspects of the pharmacy profession and enjoy developing new relationships in various areas, becoming a knowledge broker could be an excellent choice for you.’
To find out more about EMBRACE project 1 or knowledge brokers, reach out to Dr Amanda Cross: amanda.cross@monash.edu
[post_title] => Preparing pharmacists for aged care governance
[post_excerpt] => As the ACOP program kicks off, this new intervention is designed to strengthen the systems level capacity of pharmacists in aged care.
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[post_content] => James Buckley MPS, fitness fanatic and partner at LiveLife Pharmacy Port Douglas, is full speed into the expanded Queensland prescribing pilot.
My high school chemistry teacher told me, ‘James, choose something you like, and something you’re good at’. I was good at chemistry at school and loved helping people, so why not do both? Pharmacy to me is about helping people understand their health through teaching them about their medicines. It’s rewarding to now formally prescribe S4 medicines, alongside existing scope of Schedule 2 and 3 medicines and lifestyle advice that will improve their health.
Tell us about prescribing under the Queensland Community Pharmacy Scope of Practice Pilot?
The pilot program gives pharmacists the ability to prescribe appropriate medicines for the patient’s condition as per the therapeutic guidelines, in many cases to suit the individual.
The structured protocols allow pharmacists to identify red flag and referral triggers for the patient and for us to practice safely and effectively.
Consult times allow for discussions between patient and pharmacist with the opportunity for all stages of the prescribing cycle. This includes information gathering, examination, therapeutic discussions, management and patient communication.
How does the service work?
When a patient presents to the pharmacy with symptoms, I take a brief history and offer a consultation.
During the consult, I take a detailed history including back-ground information, medical conditions, medicines and social history. Red flags for the patient’s condition are ruled out as part of the diagnostic framework, and appropriate physical examinations are conducted.
This can include taking vitals such as blood pressure, temperature and blood glucose levels and conducting an ear, nose, throat examination.
All the information is assessed and an appropriate treatment plan is agreed upon by both parties. This can include pharmacological or non-pharmacological treatment, lifestyle advice and preventative treatment, or a referral if warranted.
The patient is then reviewed for an appropriate follow-up date. After seeing patients for holistic care consults, there has been no apprehension to pay for the services.
For patients who are ineligible to participate or are price conscious, this feedback is also transmitted through the software as missed opportunities to provide health care to patients in need.
Introducing patients to the service?
Our pharmacists and staff are on the frontline explaining our services to patients at every opportunity. Our assistants are trained to refer any patient who presents with ear pain (among other conditions) to the pharmacist, resulting in an instant consultation. We also have a great relationship with the local GP clinic and hospital, so they refer patients to our trained pharmacists. Patients are often ecstatic, thrilled and relieved that we offer the service. They trust our knowledge and medicine expertise, and have no problems discussing their health with the prescribing pharmacist. We see people every day who are unable to see the doctor for weeks, and are desperate for our assistance.
What have you prescribed so far?
Within the first week I successfully reviewed patients and prescribed a course of antibiotic ear drops for an international patient who came to Australia to see the Great Barrier Reef and subsequently contracted an outer ear infection while diving. I also saw a concerned mother who presented with her child who had contracted a case of impetigo on the knee from school and could not see a doctor for 3 weeks. I was able to prescribe antibiotic ointment and oral antibiotics to treat the infection.
Advice for other ECPs?
Pharmacy is a constantly expanding and rewarding career. Find what you enjoy most and work hard to make your mark on the profession. I’ve always wanted to be a pharmacy owner, be the cornerstone of a community and provide exceptional services to people in need.
Find like-minded people and mentors who believe in you. I want to thank my mentors from LiveLife Pharmacy and PSA. I would not be here without them.
A day in the life of James Buckley MPS, Pharmacy Partner, LiveLife Pharmacy, Port Douglas, QLD
| 5.00 am |
Get up and moving Start the day with a HIIT class. Let’s do this! |
| 8.00 am |
First things first Open the pharmacy, review bookings – online orders, pharmacist consult bookings for COVID-19 and other vaccines. Our ear clinic for diving, flying and swimming infections from reef-based activities is constantly busy. All staff are trained to triage. We conduct multiple ear checks a day (10 is my daily record), especially on weekends when doctors are closed. |
| 9.00 am |
Vaccination clinic starts Administer shingles vaccine to a local couple. Other vaccines are booked online. All flu shots are free for Queensland residents and anyone aged 65+ is NIP-funded. |
| 11.00 am |
Oral contraceptive pill Miss Y needs to renew her contraceptive pill repeats that were misplaced. She was assessed and I was able to prescribe her regular medication. |
| 2.00 pm |
Prescribing time Miss P, aged 6, presents to the pharmacy with ear pain. She has been swimming a lot on her holiday and an examination is required. No red flags are present and she can safely be prescribed antibiotic ear drops. |
| 3.00 pm |
Touch base with staff Catch up with the team, which can be anything from helping with orders, professional development, staff training and upskilling on pharmacist consults or inducting new staff. On-the-floor quiz and teaching sessions with interns can include reviews of work in non-prescription areas, which for us is commonly bites and stings from mozzies and jellyfish and sunscreen uses for sunburn and (constant) heat rash. |
| 5.00 pm |
Winding down Instruct staff to finish, tidy dispensary, scan scripts, and get ready for the next day. |
| 6.00-9.00 pm | Home time Catch up with the ECP Community of Specialty Interest (CSI). Watch Netflix. Bed. |
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[post_content] => Mid-winter will be a busy time of year for pharmacists, with a range of practice, fee and career pathway updates kicking off on 1 July 2024.
Australian Pharmacist takes a look at the changes pharmacists will experience from next week.
1. Vaping ban comes into effect
The third tranche of vaping reform included in the Therapeutic Goods and other Legislation (Vaping Reforms) Bill 2024 will see all vape sales banned from general retailers from 1 July. Passing through the Senate this morning, the Bill limits the supply of all vapes strictly to community pharmacies from Monday.
These vaping products must adhere to quality and product standards including:
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[post_content] => Rabies causes an estimated 59,000 deaths annually, with almost half (40%) deaths occurring in children under 15. But underreporting could mean this death rate is much higher.
Post COVID-19, there has been an increase in rabies cases – with the abandonment of pets and a reduction in human-dog interaction leading to heightened aggression in dogs – who are responsible for most human rabies cases. Rabies hotspots include Asia, Africa and India, but 150 countries are considered high-risk rabies territories.
As we approach the winter school holidays and Australians escape the cold by heading overseas, pharmacists in New South Wales can now protect patients against the disease.
PSA advocacy was the key driver for the change to the NSW Pharmacist Vaccination Standards to allow pharmacists to administer the rabies vaccine, with the NSW Branch Committee working closely with the Ministry of Health to drive the change, said PSA NSW State Manager Amanda Fairjones MPS.
[caption id="attachment_25121" align="alignright" width="298"] PSA NSW branch State Manager Amanda Fairjones MPS[/caption]
‘When undertaking travel health consultations, our members told us that it was the most common travel vaccine they were referring people back to their GP for,’ she said. ‘People were asking for it but we were unable to provide it.’
Having the vaccine available provides a great opportunity for pharmacists to sit down and have a chat to people about their travel vaccination needs, said Karen Carter FPS, Partner of Carter's Pharmacy Gunnedah and Owner Narrabri Pharmacy Narrabri in north-west NSW.
‘Because of the regime with some vaccines, we need to have them all done on one day or a week apart,’ she said. ‘ Now we can organise a vaccine regime to be completed at the pharmacy, rather than having to send patients back to their GP for part of it.’
Who is the vaccine indicated for?
Under the NSW Pharmacist Vaccination Standards, pharmacists can administer the rabies vaccine for pre-exposure prophylaxis treatment via intramuscular injection to people 5 years and over who are not immunocompromised.
‘When undertaking travel health consultations, our members told us that it was the most common travel vaccine they were referring people back to their GP for. People were asking for it but we were unable to provide it.'
amanda fairjones MPS
The Australian Immunisation Handbook (AIH), recommends pre-exposure rabies vaccine for:
Karen Carter FPS[/caption]
Post-exposure prophylaxis includes wound management, administration of rabies vaccine doses and human rabies immunoglobulin, taking into account:
If a prescriber writes a prescription for a vaccine – including the rabies vaccine – pharmacists are able to administer it in all states and territories other than Tasmania and South Australia.
However, in the case of the rabies vaccine, in Tasmania, authorised pharmacist immunisers can administer the rabies vaccine when prescribed by a medical or nurse practitioner.
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[post_content] => As per the Therapeutic Goods Administration’s (TGA’s) Medicine shortages report database, today (3 July 2024) there are 407 current medicine shortages.
There have been an ongoing shortages of critical pain relief medicines for palliative care, following the discontinuation of oral liquid morphine (Ordine) from the Australian market in 2023, along with various strengths, brands and formulations of morphine sulfate pentahydrate and oxycodone hydrochloride.
These supply challenges are distressing for patients, families, and health professionals, who have been forced to grapple with fluctuating supplies week in and out.
‘For many clinicians, the challenges around a lack of guaranteed supply of medicines has been ongoing for 18 months or more,’ said Camilla Rowland, CEO of Palliative Care Australia.
Children and parents are also bearing the brunt of ongoing shortages, with azithromycin powder for oral suspension in short supply. The timing couldn’t be worse, with pneumonia cases continuing to surge in 2024 compared with the previous 5 years – with emergency department presentations in New South Wales in the 0–4 and 5–16 age groups significantly higher this year. Cases of pertussis, another indication for azithromycin and which can also lead to pneumonia, have also reached a 5-year high.
Azithromycin is also used for acute otitis media in Aboriginal and Torres Strait Islander children as a single dose, with the shortage having a critical impact on this population.
Some parents have reported visiting up to 10 pharmacies in search of the medicine, with the TGA reporting that shortages are expected to persist until November 2024.
‘We tried a number of different chemists. We went to three in person and probably called another dozen,’ said Sunshine Coast mother Kyanne Hooper, who was searching for azithromycin for her 16-month old son.
It doesn't help that pharmacists in most jurisdictions are unable to make sensible substitutions to dosage forms or within medicine classes – which could alleviate pressure on healthcare professionals, patients and parents.
With that in mind, Australian Pharmacist drills into the issues and the solutions – newly legislated and proposed – which could help to make a difference.
Critical medicines list urgently needed
When medicines are in long-term short supply, the TGA utilises the Section 19A instrument to facilitate the importation of medicines into Australia.
There are 128 current S19A approvals, including Timolol 0.5% w/v eye drops solution and paracetamol infusion.
However, while designed to backfill shortages, manufacturers of S19A medicines are also not subject to the same impending shortages notifications that apply to other medicines approved for use in Australia, explained PSA SA/NT State Manager Helen Stone MPS.
[caption id="attachment_22442" align="alignright" width="229"] PSA SA/NT State Manager Helen Stone[/caption]
‘Normally, when medicines are approved by the TGA, the company that produces them is required to notify the TGA that they are unable to supply the Australian market,’ she said.
‘[Manufacturers] of S19A medicines don’t have the same obligation to inform the TGA when a shortage situation arises.’
Take morphine 5 mg/mL oral liquid (Ordine) for example. While discontinued by Mundipharma on 22 March 2024, the TGA announced that a replacement product, manufactured by Arrotex, would be available from 27 September.
‘Meanwhile, another replacement product was listed under S19A, which can no longer be supplied until later in July,’ said Ms Stone.
‘Often a product is listed, but then it can’t be supplied for a variety of commercial reasons, for example the manufacturer may have underestimated the quantities required in Australia or other supply issues they didn’t anticipate.’
The current process of waiting for pharma companies to report that they can’t supply medicines means patients face ongoing shortages of essential medicines.
To remedy that, the ultimate solution would be the creation of an essential formulary for Australia – a critical medicines list – which contains essential medicines such as oral liquid morphine and certain antibiotics.
‘When we identify that we must have those medicines in Australia, we can proactively work with pharma companies to make sure there’s always supply,’ she said.
PSA has long advocated for a critical medicines list, which is under consideration with the TGA, and submitted a response to the TGA’s Medicine shortages in Australia – Public consultation on challenges and opportunities – the results of which are expected imminently.
‘We could still use S19A for less critical medicines, but having an essential formulary with specific rules around it would give us another option in trying to manage critical shortages,’ Ms Stone added.
Queensland’s scope of practice pilot creates a better way
Despite most pharmacists being unable to make substitutions when medicines are in short supply, pharmacists participating in the Queensland Community Pharmacy Scope of Practice Pilot have the authority to do so.
The Extended Practice Authority (EPA) – Pharmacists Community pharmacy scope of practice pilot allows participating pharmacists to undertake therapeutic substitution and adaptation without needing prescriber approval, said PSA Queensland State Manager Nicole Floyd MPS.
[caption id="attachment_21592" align="alignright" width="233"] PSA Queensland State Manager Nicole Floyd MPS[/caption]
‘Under part two of the EPA, an authority allows pharmacists participating in the pilot to amend a prescription,’ she said. ‘That means they can change the dosage form of a medication without the prescriber's approval, and also substitute a medicine for another drug within the same class.’
The EPA doesn’t just apply to medicines prescribed under the pilot, but extends to all medicines.
So if a parent presents to a pharmacy participating in the pilot with a prescription for azithromycin suspension, which cannot be supplied, pharmacists can offer stressed parents some relief.
While pharmacists should let prescribers know of any amendments to scripts, they can substitute the liquid azithromycin dosage form for tablets and advise parents to crush and disperse it without needing to obtain authority.
‘Any other pharmacists in Queensland who are not participating in the pilot or practising in other jurisdictions would have to go back to the prescriber to amend or request a new script,’ said Ms Floyd.
[post_title] => What can be done about ongoing medicine shortages?
[post_excerpt] => Palliative care patients and children bear the brunt of short supply of medicines. These legislative updates could help to make a difference.
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[post_content] => The Aged Care On-Site Pharmacist (ACOP) program kicks off today (1 July 2024). To improve Quality Use of Medicines (QUM) in aged care, seven pioneering pharmacists have trained to become ‘knowledge brokers’ through the Australia-wide EMBRACE trial.
The participating pharmacists have received funding to work across 19 residential aged care facilities (RACFs) operated by four aged care providers to establish the new role, which entails implementing the latest research findings and guidelines to improve medicine safety.
Led by Monash University’s Centre for Medicine Use and Safety, the 12-month trial – which kicked off in October 2023 – involves implementing Australia’s new Clinical Practice Guideline for the Appropriate Use of Psychotropic Medications in People Living with Dementia and in Residential Aged Care.
Four knowledge brokers share their experiences of participating in the EMBRACE trial so far.
What does the role entail?
For Jennifer Bakija MPS, a credentialed pharmacist who has been involved in the provision of medicine reviews in aged care for the last 2 decades, the knowledge broker role is an extension of what pharmacists do every day, including providing counselling and information on medicines.
‘Being on-site puts us into a unique perspective to see firsthand the challenges that RACF staff face,’ she added.
Central to the role is developing strong relationships across the facility, explained community pharmacist Clare Park.
‘We act as connecting pharmacists who develop relationships and networks with facility staff and stakeholders to improve QUM,’ she said.
But the main purpose of brokers is to facilitate the transfer and implementation of new information to various healthcare professionals, said on-site pharmacist Linda Ha.
‘The intent is to assist the RACF to align with current best practice guidelines and ensure the guidelines are taken up into practice,’ explained credentialed pharmacist Eva Stein MPS.
What tasks and responsibilities are involved?
To improve practice standards, knowledge brokers run staff education sessions, distribute monthly newsletters to reinforce learnings and engage with GPs, said Ms Ha.
‘We work with aged care staff to establish strategies to improve guideline adoption processes and facility concordance,’ she said.
Knowledge brokers also identify areas that need change and discuss implementation methods with management, incorporating best use of existing processes, resources, and staff, said Ms Stein.
‘I use the data and quality indicators for the site I am working with to structure activities that will lead them to achieve their targets and achieve best practice,’ said Ms Ha.
‘We also develop template forms to implement into the software system and encourage staff to use them, and attend key meetings such as MAC meetings,’ added Ms Park.
How does the knowledge broker role differ to existing pharmacist roles?
As opposed to working on an individual resident level, knowledge brokers operate at a systems level – which aligns closely with the clinical governance and QUM components of the ACOP role – to effect change within the RACF’s practices, said Ms Stein.
‘I have an RMMR background, and I am used to working at a resident level. I’ve had little interaction with management and didn’t feel embedded in the RACF team,’ she said.
‘As a knowledge broker I feel more engaged with the team and they are really enjoying having a pharmacist onboard too.’
Driving change management processes across the RACF ensures organisational compliance with new guidelines and best practices.
‘RACFs often operate under multilayered management levels, with multiple committees and subcommittees,’ said Ms Ha.
‘The knowledge broker pharmacist is able to act as a liaison between all these levels to champion appropriate QUM principles’ added Ms Bakija.
How can on-site pharmacists work as knowledge brokers?
Post-EMBRACE, there is potential for the creation of a separate funded role for on-site pharmacists in aged care.
The Monash team is developing a package of resources to support pharmacists to work as knowledge brokers, involving training on knowledge translation, using quality indicators, and developing and implementing local action plans.
For pharmacists taking on on-site roles this month, leveraging their contextual understanding and multidisciplinary relationships to drive continuous staff education, lead quality improvement initiatives and tailor strategies based on rapid feedback is a good place to start, said Ms Ha.
‘Our intimate knowledge of medicines is an important element that’s currently missing in RACF policy and procedure decision making,’ said Ms Stein. ‘Pharmacists’ unique knowledge base can be tapped into so we can take the lead when it comes to ensuring RACF compliance with medication-related guidelines and clinical care standards.’
Pharmacists will also need to develop a suite of skills and relationships to effectively engineer change.
‘You need to develop strong interpersonal and communication skills, seek opportunities to collaborate closely with various healthcare teams and understand their perspectives and challenges, experiment with different teaching methods to facilitate effective knowledge transfer, be open to feedback, and constantly refine your approaches based on the insights you gain,’ advised Ms Ha.
Getting to know the whole RACF team, what roles they fulfil and where the gaps are is integral to forming a bird’s-eye systems view, said Ms Stein.
‘Find out who is responsible for decision making, what the barriers are for each worker involved in the current processes (e.g. time, lack of education), and take time to understand the current processes in place,’ she said.
‘Be familiar with guidelines for use of medicines in the RACF setting and have a good understanding of how these should be applied,’ added Ms Bakija.
But it's also important to consider whether the role is the right fit.
‘The role of a knowledge broker is unique and challenging,’ said Ms Park. ‘If you are interested in exploring different aspects of the pharmacy profession and enjoy developing new relationships in various areas, becoming a knowledge broker could be an excellent choice for you.’
To find out more about EMBRACE project 1 or knowledge brokers, reach out to Dr Amanda Cross: amanda.cross@monash.edu
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[post_content] => James Buckley MPS, fitness fanatic and partner at LiveLife Pharmacy Port Douglas, is full speed into the expanded Queensland prescribing pilot.
My high school chemistry teacher told me, ‘James, choose something you like, and something you’re good at’. I was good at chemistry at school and loved helping people, so why not do both? Pharmacy to me is about helping people understand their health through teaching them about their medicines. It’s rewarding to now formally prescribe S4 medicines, alongside existing scope of Schedule 2 and 3 medicines and lifestyle advice that will improve their health.
Tell us about prescribing under the Queensland Community Pharmacy Scope of Practice Pilot?
The pilot program gives pharmacists the ability to prescribe appropriate medicines for the patient’s condition as per the therapeutic guidelines, in many cases to suit the individual.
The structured protocols allow pharmacists to identify red flag and referral triggers for the patient and for us to practice safely and effectively.
Consult times allow for discussions between patient and pharmacist with the opportunity for all stages of the prescribing cycle. This includes information gathering, examination, therapeutic discussions, management and patient communication.
How does the service work?
When a patient presents to the pharmacy with symptoms, I take a brief history and offer a consultation.
During the consult, I take a detailed history including back-ground information, medical conditions, medicines and social history. Red flags for the patient’s condition are ruled out as part of the diagnostic framework, and appropriate physical examinations are conducted.
This can include taking vitals such as blood pressure, temperature and blood glucose levels and conducting an ear, nose, throat examination.
All the information is assessed and an appropriate treatment plan is agreed upon by both parties. This can include pharmacological or non-pharmacological treatment, lifestyle advice and preventative treatment, or a referral if warranted.
The patient is then reviewed for an appropriate follow-up date. After seeing patients for holistic care consults, there has been no apprehension to pay for the services.
For patients who are ineligible to participate or are price conscious, this feedback is also transmitted through the software as missed opportunities to provide health care to patients in need.
Introducing patients to the service?
Our pharmacists and staff are on the frontline explaining our services to patients at every opportunity. Our assistants are trained to refer any patient who presents with ear pain (among other conditions) to the pharmacist, resulting in an instant consultation. We also have a great relationship with the local GP clinic and hospital, so they refer patients to our trained pharmacists. Patients are often ecstatic, thrilled and relieved that we offer the service. They trust our knowledge and medicine expertise, and have no problems discussing their health with the prescribing pharmacist. We see people every day who are unable to see the doctor for weeks, and are desperate for our assistance.
What have you prescribed so far?
Within the first week I successfully reviewed patients and prescribed a course of antibiotic ear drops for an international patient who came to Australia to see the Great Barrier Reef and subsequently contracted an outer ear infection while diving. I also saw a concerned mother who presented with her child who had contracted a case of impetigo on the knee from school and could not see a doctor for 3 weeks. I was able to prescribe antibiotic ointment and oral antibiotics to treat the infection.
Advice for other ECPs?
Pharmacy is a constantly expanding and rewarding career. Find what you enjoy most and work hard to make your mark on the profession. I’ve always wanted to be a pharmacy owner, be the cornerstone of a community and provide exceptional services to people in need.
Find like-minded people and mentors who believe in you. I want to thank my mentors from LiveLife Pharmacy and PSA. I would not be here without them.
A day in the life of James Buckley MPS, Pharmacy Partner, LiveLife Pharmacy, Port Douglas, QLD
| 5.00 am |
Get up and moving Start the day with a HIIT class. Let’s do this! |
| 8.00 am |
First things first Open the pharmacy, review bookings – online orders, pharmacist consult bookings for COVID-19 and other vaccines. Our ear clinic for diving, flying and swimming infections from reef-based activities is constantly busy. All staff are trained to triage. We conduct multiple ear checks a day (10 is my daily record), especially on weekends when doctors are closed. |
| 9.00 am |
Vaccination clinic starts Administer shingles vaccine to a local couple. Other vaccines are booked online. All flu shots are free for Queensland residents and anyone aged 65+ is NIP-funded. |
| 11.00 am |
Oral contraceptive pill Miss Y needs to renew her contraceptive pill repeats that were misplaced. She was assessed and I was able to prescribe her regular medication. |
| 2.00 pm |
Prescribing time Miss P, aged 6, presents to the pharmacy with ear pain. She has been swimming a lot on her holiday and an examination is required. No red flags are present and she can safely be prescribed antibiotic ear drops. |
| 3.00 pm |
Touch base with staff Catch up with the team, which can be anything from helping with orders, professional development, staff training and upskilling on pharmacist consults or inducting new staff. On-the-floor quiz and teaching sessions with interns can include reviews of work in non-prescription areas, which for us is commonly bites and stings from mozzies and jellyfish and sunscreen uses for sunburn and (constant) heat rash. |
| 5.00 pm |
Winding down Instruct staff to finish, tidy dispensary, scan scripts, and get ready for the next day. |
| 6.00-9.00 pm | Home time Catch up with the ECP Community of Specialty Interest (CSI). Watch Netflix. Bed. |
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[post_content] => Mid-winter will be a busy time of year for pharmacists, with a range of practice, fee and career pathway updates kicking off on 1 July 2024.
Australian Pharmacist takes a look at the changes pharmacists will experience from next week.
1. Vaping ban comes into effect
The third tranche of vaping reform included in the Therapeutic Goods and other Legislation (Vaping Reforms) Bill 2024 will see all vape sales banned from general retailers from 1 July. Passing through the Senate this morning, the Bill limits the supply of all vapes strictly to community pharmacies from Monday.
These vaping products must adhere to quality and product standards including:
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[post_content] => Rabies causes an estimated 59,000 deaths annually, with almost half (40%) deaths occurring in children under 15. But underreporting could mean this death rate is much higher.
Post COVID-19, there has been an increase in rabies cases – with the abandonment of pets and a reduction in human-dog interaction leading to heightened aggression in dogs – who are responsible for most human rabies cases. Rabies hotspots include Asia, Africa and India, but 150 countries are considered high-risk rabies territories.
As we approach the winter school holidays and Australians escape the cold by heading overseas, pharmacists in New South Wales can now protect patients against the disease.
PSA advocacy was the key driver for the change to the NSW Pharmacist Vaccination Standards to allow pharmacists to administer the rabies vaccine, with the NSW Branch Committee working closely with the Ministry of Health to drive the change, said PSA NSW State Manager Amanda Fairjones MPS.
[caption id="attachment_25121" align="alignright" width="298"] PSA NSW branch State Manager Amanda Fairjones MPS[/caption]
‘When undertaking travel health consultations, our members told us that it was the most common travel vaccine they were referring people back to their GP for,’ she said. ‘People were asking for it but we were unable to provide it.’
Having the vaccine available provides a great opportunity for pharmacists to sit down and have a chat to people about their travel vaccination needs, said Karen Carter FPS, Partner of Carter's Pharmacy Gunnedah and Owner Narrabri Pharmacy Narrabri in north-west NSW.
‘Because of the regime with some vaccines, we need to have them all done on one day or a week apart,’ she said. ‘ Now we can organise a vaccine regime to be completed at the pharmacy, rather than having to send patients back to their GP for part of it.’
Who is the vaccine indicated for?
Under the NSW Pharmacist Vaccination Standards, pharmacists can administer the rabies vaccine for pre-exposure prophylaxis treatment via intramuscular injection to people 5 years and over who are not immunocompromised.
‘When undertaking travel health consultations, our members told us that it was the most common travel vaccine they were referring people back to their GP for. People were asking for it but we were unable to provide it.'
amanda fairjones MPS
The Australian Immunisation Handbook (AIH), recommends pre-exposure rabies vaccine for:
Karen Carter FPS[/caption]
Post-exposure prophylaxis includes wound management, administration of rabies vaccine doses and human rabies immunoglobulin, taking into account:
If a prescriber writes a prescription for a vaccine – including the rabies vaccine – pharmacists are able to administer it in all states and territories other than Tasmania and South Australia.
However, in the case of the rabies vaccine, in Tasmania, authorised pharmacist immunisers can administer the rabies vaccine when prescribed by a medical or nurse practitioner.
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[post_content] => As per the Therapeutic Goods Administration’s (TGA’s) Medicine shortages report database, today (3 July 2024) there are 407 current medicine shortages.
There have been an ongoing shortages of critical pain relief medicines for palliative care, following the discontinuation of oral liquid morphine (Ordine) from the Australian market in 2023, along with various strengths, brands and formulations of morphine sulfate pentahydrate and oxycodone hydrochloride.
These supply challenges are distressing for patients, families, and health professionals, who have been forced to grapple with fluctuating supplies week in and out.
‘For many clinicians, the challenges around a lack of guaranteed supply of medicines has been ongoing for 18 months or more,’ said Camilla Rowland, CEO of Palliative Care Australia.
Children and parents are also bearing the brunt of ongoing shortages, with azithromycin powder for oral suspension in short supply. The timing couldn’t be worse, with pneumonia cases continuing to surge in 2024 compared with the previous 5 years – with emergency department presentations in New South Wales in the 0–4 and 5–16 age groups significantly higher this year. Cases of pertussis, another indication for azithromycin and which can also lead to pneumonia, have also reached a 5-year high.
Azithromycin is also used for acute otitis media in Aboriginal and Torres Strait Islander children as a single dose, with the shortage having a critical impact on this population.
Some parents have reported visiting up to 10 pharmacies in search of the medicine, with the TGA reporting that shortages are expected to persist until November 2024.
‘We tried a number of different chemists. We went to three in person and probably called another dozen,’ said Sunshine Coast mother Kyanne Hooper, who was searching for azithromycin for her 16-month old son.
It doesn't help that pharmacists in most jurisdictions are unable to make sensible substitutions to dosage forms or within medicine classes – which could alleviate pressure on healthcare professionals, patients and parents.
With that in mind, Australian Pharmacist drills into the issues and the solutions – newly legislated and proposed – which could help to make a difference.
Critical medicines list urgently needed
When medicines are in long-term short supply, the TGA utilises the Section 19A instrument to facilitate the importation of medicines into Australia.
There are 128 current S19A approvals, including Timolol 0.5% w/v eye drops solution and paracetamol infusion.
However, while designed to backfill shortages, manufacturers of S19A medicines are also not subject to the same impending shortages notifications that apply to other medicines approved for use in Australia, explained PSA SA/NT State Manager Helen Stone MPS.
[caption id="attachment_22442" align="alignright" width="229"] PSA SA/NT State Manager Helen Stone[/caption]
‘Normally, when medicines are approved by the TGA, the company that produces them is required to notify the TGA that they are unable to supply the Australian market,’ she said.
‘[Manufacturers] of S19A medicines don’t have the same obligation to inform the TGA when a shortage situation arises.’
Take morphine 5 mg/mL oral liquid (Ordine) for example. While discontinued by Mundipharma on 22 March 2024, the TGA announced that a replacement product, manufactured by Arrotex, would be available from 27 September.
‘Meanwhile, another replacement product was listed under S19A, which can no longer be supplied until later in July,’ said Ms Stone.
‘Often a product is listed, but then it can’t be supplied for a variety of commercial reasons, for example the manufacturer may have underestimated the quantities required in Australia or other supply issues they didn’t anticipate.’
The current process of waiting for pharma companies to report that they can’t supply medicines means patients face ongoing shortages of essential medicines.
To remedy that, the ultimate solution would be the creation of an essential formulary for Australia – a critical medicines list – which contains essential medicines such as oral liquid morphine and certain antibiotics.
‘When we identify that we must have those medicines in Australia, we can proactively work with pharma companies to make sure there’s always supply,’ she said.
PSA has long advocated for a critical medicines list, which is under consideration with the TGA, and submitted a response to the TGA’s Medicine shortages in Australia – Public consultation on challenges and opportunities – the results of which are expected imminently.
‘We could still use S19A for less critical medicines, but having an essential formulary with specific rules around it would give us another option in trying to manage critical shortages,’ Ms Stone added.
Queensland’s scope of practice pilot creates a better way
Despite most pharmacists being unable to make substitutions when medicines are in short supply, pharmacists participating in the Queensland Community Pharmacy Scope of Practice Pilot have the authority to do so.
The Extended Practice Authority (EPA) – Pharmacists Community pharmacy scope of practice pilot allows participating pharmacists to undertake therapeutic substitution and adaptation without needing prescriber approval, said PSA Queensland State Manager Nicole Floyd MPS.
[caption id="attachment_21592" align="alignright" width="233"] PSA Queensland State Manager Nicole Floyd MPS[/caption]
‘Under part two of the EPA, an authority allows pharmacists participating in the pilot to amend a prescription,’ she said. ‘That means they can change the dosage form of a medication without the prescriber's approval, and also substitute a medicine for another drug within the same class.’
The EPA doesn’t just apply to medicines prescribed under the pilot, but extends to all medicines.
So if a parent presents to a pharmacy participating in the pilot with a prescription for azithromycin suspension, which cannot be supplied, pharmacists can offer stressed parents some relief.
While pharmacists should let prescribers know of any amendments to scripts, they can substitute the liquid azithromycin dosage form for tablets and advise parents to crush and disperse it without needing to obtain authority.
‘Any other pharmacists in Queensland who are not participating in the pilot or practising in other jurisdictions would have to go back to the prescriber to amend or request a new script,’ said Ms Floyd.
[post_title] => What can be done about ongoing medicine shortages?
[post_excerpt] => Palliative care patients and children bear the brunt of short supply of medicines. These legislative updates could help to make a difference.
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[post_content] => The Aged Care On-Site Pharmacist (ACOP) program kicks off today (1 July 2024). To improve Quality Use of Medicines (QUM) in aged care, seven pioneering pharmacists have trained to become ‘knowledge brokers’ through the Australia-wide EMBRACE trial.
The participating pharmacists have received funding to work across 19 residential aged care facilities (RACFs) operated by four aged care providers to establish the new role, which entails implementing the latest research findings and guidelines to improve medicine safety.
Led by Monash University’s Centre for Medicine Use and Safety, the 12-month trial – which kicked off in October 2023 – involves implementing Australia’s new Clinical Practice Guideline for the Appropriate Use of Psychotropic Medications in People Living with Dementia and in Residential Aged Care.
Four knowledge brokers share their experiences of participating in the EMBRACE trial so far.
What does the role entail?
For Jennifer Bakija MPS, a credentialed pharmacist who has been involved in the provision of medicine reviews in aged care for the last 2 decades, the knowledge broker role is an extension of what pharmacists do every day, including providing counselling and information on medicines.
‘Being on-site puts us into a unique perspective to see firsthand the challenges that RACF staff face,’ she added.
Central to the role is developing strong relationships across the facility, explained community pharmacist Clare Park.
‘We act as connecting pharmacists who develop relationships and networks with facility staff and stakeholders to improve QUM,’ she said.
But the main purpose of brokers is to facilitate the transfer and implementation of new information to various healthcare professionals, said on-site pharmacist Linda Ha.
‘The intent is to assist the RACF to align with current best practice guidelines and ensure the guidelines are taken up into practice,’ explained credentialed pharmacist Eva Stein MPS.
What tasks and responsibilities are involved?
To improve practice standards, knowledge brokers run staff education sessions, distribute monthly newsletters to reinforce learnings and engage with GPs, said Ms Ha.
‘We work with aged care staff to establish strategies to improve guideline adoption processes and facility concordance,’ she said.
Knowledge brokers also identify areas that need change and discuss implementation methods with management, incorporating best use of existing processes, resources, and staff, said Ms Stein.
‘I use the data and quality indicators for the site I am working with to structure activities that will lead them to achieve their targets and achieve best practice,’ said Ms Ha.
‘We also develop template forms to implement into the software system and encourage staff to use them, and attend key meetings such as MAC meetings,’ added Ms Park.
How does the knowledge broker role differ to existing pharmacist roles?
As opposed to working on an individual resident level, knowledge brokers operate at a systems level – which aligns closely with the clinical governance and QUM components of the ACOP role – to effect change within the RACF’s practices, said Ms Stein.
‘I have an RMMR background, and I am used to working at a resident level. I’ve had little interaction with management and didn’t feel embedded in the RACF team,’ she said.
‘As a knowledge broker I feel more engaged with the team and they are really enjoying having a pharmacist onboard too.’
Driving change management processes across the RACF ensures organisational compliance with new guidelines and best practices.
‘RACFs often operate under multilayered management levels, with multiple committees and subcommittees,’ said Ms Ha.
‘The knowledge broker pharmacist is able to act as a liaison between all these levels to champion appropriate QUM principles’ added Ms Bakija.
How can on-site pharmacists work as knowledge brokers?
Post-EMBRACE, there is potential for the creation of a separate funded role for on-site pharmacists in aged care.
The Monash team is developing a package of resources to support pharmacists to work as knowledge brokers, involving training on knowledge translation, using quality indicators, and developing and implementing local action plans.
For pharmacists taking on on-site roles this month, leveraging their contextual understanding and multidisciplinary relationships to drive continuous staff education, lead quality improvement initiatives and tailor strategies based on rapid feedback is a good place to start, said Ms Ha.
‘Our intimate knowledge of medicines is an important element that’s currently missing in RACF policy and procedure decision making,’ said Ms Stein. ‘Pharmacists’ unique knowledge base can be tapped into so we can take the lead when it comes to ensuring RACF compliance with medication-related guidelines and clinical care standards.’
Pharmacists will also need to develop a suite of skills and relationships to effectively engineer change.
‘You need to develop strong interpersonal and communication skills, seek opportunities to collaborate closely with various healthcare teams and understand their perspectives and challenges, experiment with different teaching methods to facilitate effective knowledge transfer, be open to feedback, and constantly refine your approaches based on the insights you gain,’ advised Ms Ha.
Getting to know the whole RACF team, what roles they fulfil and where the gaps are is integral to forming a bird’s-eye systems view, said Ms Stein.
‘Find out who is responsible for decision making, what the barriers are for each worker involved in the current processes (e.g. time, lack of education), and take time to understand the current processes in place,’ she said.
‘Be familiar with guidelines for use of medicines in the RACF setting and have a good understanding of how these should be applied,’ added Ms Bakija.
But it's also important to consider whether the role is the right fit.
‘The role of a knowledge broker is unique and challenging,’ said Ms Park. ‘If you are interested in exploring different aspects of the pharmacy profession and enjoy developing new relationships in various areas, becoming a knowledge broker could be an excellent choice for you.’
To find out more about EMBRACE project 1 or knowledge brokers, reach out to Dr Amanda Cross: amanda.cross@monash.edu
[post_title] => Preparing pharmacists for aged care governance
[post_excerpt] => As the ACOP program kicks off, this new intervention is designed to strengthen the systems level capacity of pharmacists in aged care.
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[post_content] => James Buckley MPS, fitness fanatic and partner at LiveLife Pharmacy Port Douglas, is full speed into the expanded Queensland prescribing pilot.
My high school chemistry teacher told me, ‘James, choose something you like, and something you’re good at’. I was good at chemistry at school and loved helping people, so why not do both? Pharmacy to me is about helping people understand their health through teaching them about their medicines. It’s rewarding to now formally prescribe S4 medicines, alongside existing scope of Schedule 2 and 3 medicines and lifestyle advice that will improve their health.
Tell us about prescribing under the Queensland Community Pharmacy Scope of Practice Pilot?
The pilot program gives pharmacists the ability to prescribe appropriate medicines for the patient’s condition as per the therapeutic guidelines, in many cases to suit the individual.
The structured protocols allow pharmacists to identify red flag and referral triggers for the patient and for us to practice safely and effectively.
Consult times allow for discussions between patient and pharmacist with the opportunity for all stages of the prescribing cycle. This includes information gathering, examination, therapeutic discussions, management and patient communication.
How does the service work?
When a patient presents to the pharmacy with symptoms, I take a brief history and offer a consultation.
During the consult, I take a detailed history including back-ground information, medical conditions, medicines and social history. Red flags for the patient’s condition are ruled out as part of the diagnostic framework, and appropriate physical examinations are conducted.
This can include taking vitals such as blood pressure, temperature and blood glucose levels and conducting an ear, nose, throat examination.
All the information is assessed and an appropriate treatment plan is agreed upon by both parties. This can include pharmacological or non-pharmacological treatment, lifestyle advice and preventative treatment, or a referral if warranted.
The patient is then reviewed for an appropriate follow-up date. After seeing patients for holistic care consults, there has been no apprehension to pay for the services.
For patients who are ineligible to participate or are price conscious, this feedback is also transmitted through the software as missed opportunities to provide health care to patients in need.
Introducing patients to the service?
Our pharmacists and staff are on the frontline explaining our services to patients at every opportunity. Our assistants are trained to refer any patient who presents with ear pain (among other conditions) to the pharmacist, resulting in an instant consultation. We also have a great relationship with the local GP clinic and hospital, so they refer patients to our trained pharmacists. Patients are often ecstatic, thrilled and relieved that we offer the service. They trust our knowledge and medicine expertise, and have no problems discussing their health with the prescribing pharmacist. We see people every day who are unable to see the doctor for weeks, and are desperate for our assistance.
What have you prescribed so far?
Within the first week I successfully reviewed patients and prescribed a course of antibiotic ear drops for an international patient who came to Australia to see the Great Barrier Reef and subsequently contracted an outer ear infection while diving. I also saw a concerned mother who presented with her child who had contracted a case of impetigo on the knee from school and could not see a doctor for 3 weeks. I was able to prescribe antibiotic ointment and oral antibiotics to treat the infection.
Advice for other ECPs?
Pharmacy is a constantly expanding and rewarding career. Find what you enjoy most and work hard to make your mark on the profession. I’ve always wanted to be a pharmacy owner, be the cornerstone of a community and provide exceptional services to people in need.
Find like-minded people and mentors who believe in you. I want to thank my mentors from LiveLife Pharmacy and PSA. I would not be here without them.
A day in the life of James Buckley MPS, Pharmacy Partner, LiveLife Pharmacy, Port Douglas, QLD
| 5.00 am |
Get up and moving Start the day with a HIIT class. Let’s do this! |
| 8.00 am |
First things first Open the pharmacy, review bookings – online orders, pharmacist consult bookings for COVID-19 and other vaccines. Our ear clinic for diving, flying and swimming infections from reef-based activities is constantly busy. All staff are trained to triage. We conduct multiple ear checks a day (10 is my daily record), especially on weekends when doctors are closed. |
| 9.00 am |
Vaccination clinic starts Administer shingles vaccine to a local couple. Other vaccines are booked online. All flu shots are free for Queensland residents and anyone aged 65+ is NIP-funded. |
| 11.00 am |
Oral contraceptive pill Miss Y needs to renew her contraceptive pill repeats that were misplaced. She was assessed and I was able to prescribe her regular medication. |
| 2.00 pm |
Prescribing time Miss P, aged 6, presents to the pharmacy with ear pain. She has been swimming a lot on her holiday and an examination is required. No red flags are present and she can safely be prescribed antibiotic ear drops. |
| 3.00 pm |
Touch base with staff Catch up with the team, which can be anything from helping with orders, professional development, staff training and upskilling on pharmacist consults or inducting new staff. On-the-floor quiz and teaching sessions with interns can include reviews of work in non-prescription areas, which for us is commonly bites and stings from mozzies and jellyfish and sunscreen uses for sunburn and (constant) heat rash. |
| 5.00 pm |
Winding down Instruct staff to finish, tidy dispensary, scan scripts, and get ready for the next day. |
| 6.00-9.00 pm | Home time Catch up with the ECP Community of Specialty Interest (CSI). Watch Netflix. Bed. |
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[post_content] => Mid-winter will be a busy time of year for pharmacists, with a range of practice, fee and career pathway updates kicking off on 1 July 2024.
Australian Pharmacist takes a look at the changes pharmacists will experience from next week.
1. Vaping ban comes into effect
The third tranche of vaping reform included in the Therapeutic Goods and other Legislation (Vaping Reforms) Bill 2024 will see all vape sales banned from general retailers from 1 July. Passing through the Senate this morning, the Bill limits the supply of all vapes strictly to community pharmacies from Monday.
These vaping products must adhere to quality and product standards including:
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[post_date] => 2024-06-24 13:18:39
[post_date_gmt] => 2024-06-24 03:18:39
[post_content] => Rabies causes an estimated 59,000 deaths annually, with almost half (40%) deaths occurring in children under 15. But underreporting could mean this death rate is much higher.
Post COVID-19, there has been an increase in rabies cases – with the abandonment of pets and a reduction in human-dog interaction leading to heightened aggression in dogs – who are responsible for most human rabies cases. Rabies hotspots include Asia, Africa and India, but 150 countries are considered high-risk rabies territories.
As we approach the winter school holidays and Australians escape the cold by heading overseas, pharmacists in New South Wales can now protect patients against the disease.
PSA advocacy was the key driver for the change to the NSW Pharmacist Vaccination Standards to allow pharmacists to administer the rabies vaccine, with the NSW Branch Committee working closely with the Ministry of Health to drive the change, said PSA NSW State Manager Amanda Fairjones MPS.
[caption id="attachment_25121" align="alignright" width="298"] PSA NSW branch State Manager Amanda Fairjones MPS[/caption]
‘When undertaking travel health consultations, our members told us that it was the most common travel vaccine they were referring people back to their GP for,’ she said. ‘People were asking for it but we were unable to provide it.’
Having the vaccine available provides a great opportunity for pharmacists to sit down and have a chat to people about their travel vaccination needs, said Karen Carter FPS, Partner of Carter's Pharmacy Gunnedah and Owner Narrabri Pharmacy Narrabri in north-west NSW.
‘Because of the regime with some vaccines, we need to have them all done on one day or a week apart,’ she said. ‘ Now we can organise a vaccine regime to be completed at the pharmacy, rather than having to send patients back to their GP for part of it.’
Who is the vaccine indicated for?
Under the NSW Pharmacist Vaccination Standards, pharmacists can administer the rabies vaccine for pre-exposure prophylaxis treatment via intramuscular injection to people 5 years and over who are not immunocompromised.
‘When undertaking travel health consultations, our members told us that it was the most common travel vaccine they were referring people back to their GP for. People were asking for it but we were unable to provide it.'
amanda fairjones MPS
The Australian Immunisation Handbook (AIH), recommends pre-exposure rabies vaccine for:
Karen Carter FPS[/caption]
Post-exposure prophylaxis includes wound management, administration of rabies vaccine doses and human rabies immunoglobulin, taking into account:
If a prescriber writes a prescription for a vaccine – including the rabies vaccine – pharmacists are able to administer it in all states and territories other than Tasmania and South Australia.
However, in the case of the rabies vaccine, in Tasmania, authorised pharmacist immunisers can administer the rabies vaccine when prescribed by a medical or nurse practitioner.
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.
