Natalie Raffoul MPS
Natalie Raffoul is a pharmacist and the Cardiovascular Risk Reduction Manager for the Heart Foundation.
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[post_content] => Since 1 December 2024, Queensland-based pharmacists have been able to administer Abrysvo to pregnant patients to protect infants from severe Respiratory Syncytial Virus (RSV), following an expansion to the Queensland Paediatric Respiratory Syncytial Virus Prevention Program.
While Abrysvo will be added to the National Immunisation Program (NIP), as per the federal government’s announcement last month, the vaccine is currently funded by the Queensland government – although the administration fee is not covered at this stage.
But given Abrysvo is a relatively new vaccine, pharmacists will need to factor in pregnancy risk perception into strategies to encourage vaccine uptake.
After vaccinating her first patient against RSV, community pharmacist Anna Chang MPS, based in Brisbane, told Australian Pharmacist what should be considered.
Know how the vaccine needs to be prepared
The mixing instructions for Abrysvo are ‘unique’, said Ms Chang.
The vaccine comes with a lyophilised vaccine powder (vial), vial adapter and pre-filled syringe containing diluent. To prepare the vaccine, the vial adapter must be attached by centering it over the vial stopper and pushing straight down to avoid leaks.
Using a syringe held by the Luer lock adapter, the vial adapter must then be connected – with the entire diluent injected into the vial.
After swirling the vial until the powder is fully dissolved, the vial must be inverted and the complete 0.5 mL dose withdrawn into the syringe. Once the adapter is disconnected and a sterile needle attached, the vaccine is ready for intramuscular injection.
‘I haven’t seen a vaccine that is the same as this,’ she said. ‘We all had to look at the instruction sheet line by line and work it out.’
Take a strategic approach to opportunistic vaccination
Vaccination against RSV is recommended for pregnant patients at 28 to 36 weeks gestation. With the pertussis vaccine recommended at 20–32 weeks gestation, this is an opportune time to discuss protection against RSV.
Noting that a pregnant patient was booked in for a whooping cough vaccine at 31 weeks gestation, the week before her pharmacy received stock of Abrysvo, Ms Chang opted to take this approach.
‘I had her name in my calendar to call her and check if she wanted it when I actually got the stock,’ she said.
After receiving the green light from her obstetrician, the patient came back in 2 weeks after receiving her whooping cough vaccine.
‘The obstetrician wasn’t [promoting] it yet, so she [had to] ask if she should get it or not,’ said Ms Chang. ‘And for the cost saving she thought, “Why not go ahead?’”
At the moment, Ms Chang’s team is letting pregnant patients booked in for other vaccines know that funded Abrysvo vaccines are now available in community pharmacies.
‘We have been doing quite a bit of NIP [funded] whooping cough vaccinations for pregnant patients, so they are [ideal candidates],’ said Ms Chang.
Abrysvo can be co-administered with the whooping cough vaccine, if within the right window (28–32 weeks gestation).
‘We will [also] offer for them to come back the next week, but you still have to make sure not to leave it too late,’ she said.
What to do if the vaccine window is missed
While Abrysvo can be administered beyond 36 weeks gestation, infants are unlikely to be adequately protected unless they are born at least 2 weeks after their mother received the vaccine.
‘If you get the vaccine earlier you're covered if you have a premature baby,’ Ms Chang added.
‘And if you do miss that window and go past 36 weeks or have a premature baby, the baby can still be vaccinated [with nirsevimab] instead.’
The need for newborn vaccination is determined by if and when the pregnant woman received the RSV vaccine, said Ms Chang.
‘They should be asked to advise their obstetrician, midwife or the hospital of receiving the vaccine,’ she added.
Spread the word among other healthcare professionals
While Ms Chang thinks there has been more media coverage of RSV vaccination in 2024, there is unlikely to be widespread awareness of its availability, and benefits.
‘People talk a lot about the flu vaccine and COVID-19 vaccines, but RSV vaccination is [somewhat] new,’ she said.
Pharmacists can discuss the importance of RSV vaccination in pregnancy by letting patients know that it protects infants against severe RSV disease when they are most susceptible, with a clinical trial finding vaccine efficacy of 57% against hospitalisation for RSV for up to 6 months.
But pregnant patients may need assurance from multiple trusted healthcare sources that it’s safe to get vaccinated against RSV, advised Ms Chang.
‘I’ve sent letters to the nearby obstetricians to let them know that we’re [offering this vaccine],’ she said. ‘And in the new year we will let the GPs know.’
Be prepared to answer patients’ questions
Along with queries about vaccine efficacy and timeframe, pregnant patients may want to know about the potential adverse effects.
According to clinical trials, ‘very common’ adverse events include headache, myalgia and injection site pain.
Vaccination might provide protection for pregnant women against RSV disease. However, RSV is typically mild in adults, and clinical trials have not specifically assessed the vaccine's efficacy in protecting the mother.
‘[While] there is no data available on the duration of antibodies for the women, [pharmacists could] advise [patients] that it has shown to give protection for 12–16 months for older adults in the clinical studies.’
[post_title] => A pharmacist’s guide to RSV vaccination for pregnant patients
[post_excerpt] => One of the first pharmacists to administer an RSV vaccine to a pregnant patient explains how to promote, prepare and administer Abrysvo.
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[title_attribute] => A pharmacist’s guide to RSV vaccination for pregnant patients
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[post_content] => With the festive season in full swing and the summer heat rising, pharmacists are at the forefront of helping patients navigate holiday health challenges.
Dive into Australian Pharmacist’s essential guide to keep your community safe this festive season.
Protect your patients against summer risks
With another festive season upon us, and the Bureau of Meteorology predicting extreme summer heat, pharmacists have an important role in keeping patients and families safe and healthy.
This includes advice around alcohol consumption with medicines, protection against mosquito-borne diseases and preventing dehydration.
And while the festive season is merry for some, it can be a difficult time of year for many. This means pharmacists should be on high alert to patients who could be taking higher-than-prescribed medication – potentially for doses for stronger sedation or self-harm.
Refer to this handy pharmacist advice piece by PSA’s resident clinical expert Shani Pickering as a go-to summer guide.
Raise awareness of new sun safety guidelines
The one-size-fits-all approach to sun safety is now out, with a tailored approach based on skin type, now the way to go.
The new sun protection guidelines, released earlier this year, are designed around skin cancer risk. While those with pale skin need to rely on a full suite of sun protection measures when the UV index is ≥3, those with deeply pigmented skin must ensure they get enough vitamin D to avoid a deficiency.
Before your patients start presenting in droves for their summer sun block, give AP’s sun safety guide a squizz.
And while you’re at it, make sure you’re abreast of the sunscreen myths floating around on social media – and how to dispel them.
Be alert to new illicit drug threats this festival season
Every year, the summer season ushers in a wave of music festivals, attended by thousands of revellers nationwide. But this season threatens to be different, with the deadly synthetic opioids, nitazenes, having infiltrated the illicit market.
While seasoned opioid users will have some tolerance to nitazenes, known to be more potent than fentanyl, it has been detected in other illicit drugs such as MDMA and cocaine – which can lead to rapid overdose in casual drug users. In fact, the potent opioids are thought to be linked to mass overdose deaths in Victoria this year.
While there are pill testing services available in Victoria, the ACT and Queensland, Australia’s most populous state, New South Wales, has yet to implement drug checking.
Expert Professor Suzi Nielsen MPS broke down the risks for AP earlier this year, outlining a revised approach to harm reduction.
Navigate summertime nicks, scrapes and scalds
The warmer months often mean more time spent outdoors, leading to increased risks of cuts and scrapes on the beach to nasty insect bites and burns from summer grilling.
With the most common wounds encountered in pharmacy being abrasions, cuts and burns, it's important for pharmacists to know the ABC’s of wound care. This includes providing therapeutic products, guidance on the right dressing selection and when to refer on.
AP’s Management of acute wounds commonly seen in community pharmacy CPD can help to bring you up to speed. And with infections such as cellulitis also more common during the summer months, this wound infection CPD can help pharmacists keep patients safe from harm.
Help patients take the (blood) pressure down this Christmas
The holiday period can come with an excess of stress, salty foods and alcohol consumption – all of which can play havoc with blood pressure. But with recent research finding that most patients aren’t monitoring their blood pressure correctly, it’s important for patients to know what’s artificially, and actually, inflating their blood pressure this holiday season.
This recent AP article analyses where patients get it wrong and how pharmacists can help them take an accurate blood pressure reading. And with low-density lipoprotein cholesterol also more likely to spike after a bit of holiday indulgence, pharmacists can help patients calculate their cardiovascular risk with the new Australian Cardiovascular risk calculator.
Prevent the festive season becoming a headache
Migraine triggers are plentiful during the holiday period, from extreme heat and bright lights, to poor diet and lack of sleep. Migraine and tension headaches can be managed through non-pharmacological strategies, such as stress reduction, obtaining adequate sleep and regular exercise. But pharmacists can also prescribe a number of triptans, where appropriate, and Schedule 3 medicines.
To help patients make it through the holiday season migraine free, read PSA’s Migraine and tension-type headache CPD.
Happy holidays from AP!
[post_title] => A prescription for a safer festive season
[post_excerpt] => With the festive season in full swing, pharmacists are at the forefront of helping patients navigate holiday health challenges.
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[post_content] => 2024 National Credentialed Diabetes Educator of the Year Julie Kha MPS loves collaborating to deliver better outcomes for her patients.
What led you to pharmacy?
Pharmacy was an exciting choice, enabling an understanding of how medicines can affect us, which can then be communicated to patients to ensure they are informed how to best achieve their shared health goals.
As a profession, pharmacy also offers incredible flexibility with an increasingly specialised workforce.
For example, pharmacists or credentialed pharmacists have now extended into various practice settings such as general practice and aged care – with a continual expansion of scope of practice for those who undertake additional training.
Why did you decide to become a credentialed diabetes educator?
During my formative years, I was fortunate to work alongside the first Australian pharmacist credentialed diabetes educator (CDE) Kirrily Chambers.
I noticed the impact she had on the lives of people with diabetes and their families as they exited the consult room where she worked in private practice and I wanted to generate that same impact from each patient interaction I had.
I was also fortunate to have come across another pharmacist CDE, Cindy Tolba, who was working in a diverse community where English is not the primary language.
Here, she utilised family members and even generated her own resources in the patient’s own language to better convey the workings and impact of diabetes.
Not too surprisingly, my Asian heritage played a role with our increased risk of diabetes. Dr Chris Verrall, an advocate for individualised patient goals, encouraged me to complete my accredited pharmacist requirement and then become a CDE.
How do you support patients who have been newly diagnosed?
Collaboration with the patient’s GP is where we work best. During the early stages, the patient may require time to navigate their new diagnosis and have many questions, or none at all. This takes time that GPs, who are underfunded and in short supply, don’t always have.
Establishing a person-centred approach is also of utmost importance. From this, an individualised plan can be generated to provide personalised education and support with resources and tools to empower the person with diabetes to be in a position where they are able to self-manage this chronic condition.
I had one patient whose glycated haemoglobin (HbA1c) remained elevated despite the addition of insulin.
Following a discussion about injection technique, and more importantly injection site rotation, it was discovered that the abdomen had developed areas of lipohypertrophy as ‘these areas didn’t hurt as much’.
After collaboration with the GP, the person with diabetes was just as excited to hear their insulin dose would be decreasing with a follow-up review scheduled soon thereafter.
How will pharmacists’ roles evolve in chronic disease management?
I was delighted to hear about the partnered prescribing models in our South Australian public hospitals.
With the right education and collaboration, I believe we can develop a similar model to our Canadian pharmacist colleagues, who provide structured chronic disease management programs in collaboration with GPs, practice nurses and other allied health to improve patient outcomes.
I believe one of the first steps would be to incorporate pharmacist CDEs into the hospital system, both public and private, to encourage greater interprofessional collaboration.
I’m proud to be part of pharmacy in this era of change and excited for our pharmacists of the future.
Advice for pharmacists looking to specialise in diabetes care?
Pursue your passion with a group of like-minded colleagues and mentors.
This way, your continuous learning will ensure the outcomes of each person with diabetes, and their families, are improved via an individualised approach and collaboration with the
best evidence-based practice.
A day in the life of Julie Kha MPS, Credentialed Diabetes Pharmacist, Adelaide, SA.
| 8.00 am | Before hitting the road Organise paperwork and plan (travel routes) for the day. |
| 9.00 am | Client education Meet diabetes education clients to understand their health goals to ensure personalised care. Transfer a concession card number into the National Diabetes Services Scheme (NDSS) for a person with type 1 diabetes; she was pleased to learn her costs would be further reduced! Review Libre 2 sensor data for a patient with type 2 diabetes who is on insulin. He was surprised about the impact of his banh mi (sandwich) lunch on his interstitial glucose levels. |
| 1–2.00 pm | Lunch break Replying to emails and returning GP and patient calls. |
| 2–6.00 pm | Clinical afternoon Finalise reports for GPs and specialists. Follow up with any high-risk patients e.g. persons with chronic kidney disease (CKD) or persons with diabetes and still titrating insulin. Remind a patient with type 2 diabetes on a sodium-glucose cotransporter-2 (SGLT2) inhibitor to stop her tablet 3 days prior to her colonoscopy next week. |
| 6.00 pm | Home Medicines Review Meet the last patient of the day for a Home Medicines Review after hours because they work full time. Discover they are taking a NSAID for arthritis pain on top of their ACE inhibitor and diuretic; looks like a call to the GP is in order tomorrow morning to discuss the triple whammy and the risk of acute kidney injury! |
| 8-9.30 pm | Remains of the day Continue writing reports and, if time permits, peruse the Australian Stock Exchange (ASX) movements! |
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[post_content] => When an injection doesn’t go as planned, it can be stressful for both patients and pharmacists. Here’s how to calmly handle these situations while maintaining safety and trust.
Yesterday morning, a mother of two came into a Queensland-based pharmacy requesting emergency contraception.
During the consultation, pharmacist Grace Quach MPS, PSA MIMS Intern Pharmacist of the Year 2023, asked the patient when she had her last period.
‘She had just had a baby 2 months ago, so she hadn't had her period for 9 months, or a normal period since,’ said Ms Quach. ‘However, she did have a Depo Provera injection last week.’
[caption id="attachment_23324" align="aligncenter" width="600"]
Grace Quach MPS[/caption]
The patient then revealed that a nurse, supervised by a doctor, administered the injectable contraceptive but pulled out the needle too quickly – leaving the medicine to dribble down her arm.
The GP brushed it off, saying ‘I'm not sure if you’ll get the full amount of protection. See how you go’, leaving the patient stunned.
While mistakes are bound to happen during vaccinations or when administering medicines by injection, there are certain do’s and dont’s that should be followed.
What if a vaccine is partially administered?
If the process of administering a vaccine is interrupted (for example by syringe-needle disconnection), pharmacists should ask themselves:
For example, this could entail letting a patient know that more than 50% of the vaccine was administered, if this was the case, which is deemed enough to form an immune response according to ATAGI.
‘The patient [should not be put in a position] where they are unsure of whether or not they've received correct treatment once they leave the vaccination [or medicine by injection] room,’ said Ms Jadeja ‘That also reduces trust in that healthcare professional, which is not a good scenario at the end of the day.’ PSA’s Pharmacist-to-Pharmacist Advice Line offers expert advice to members in real time. The Pharmacist Advice Line is an exclusive member service offering professional advice from a senior pharmacist on technical, ethical and practice questions. This includes:
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[post_content] => Missing the mark: why Australians are getting blood pressure checks wrong and what pharmacists can do to help.
More than one in three (34%) of Australian adults have high blood pressure. Of those diagnosed with hypertension, a staggering 68% have uncontrolled blood pressure.
Effectively managing hypertension is the most powerful method of lowering the risk of cardiovascular disease; reducing blood pressure by 5 mm Hg can decrease the probability of adverse cardiovascular events by 10%.
Yet new research found that most Australians don’t know how to measure their blood pressure accurately, nor are they getting advice on how to do so from healthcare professionals – including pharmacists.
Lead researcher Dr Niamh Chapman, Senior Research Fellow at the University of Sydney, explains where patients are getting it wrong, and the vital role pharmacists can play in blood pressure management.
Improper measurement methods are skewing results
While most patients knew they should be seated, have their back supported and remain silent during blood pressure measurement to ensure accurate readings, they weren't aware they should take multiple readings across different intervals conducted over several days.
‘They were doing it really frequently, (either) every week or every day,’ said Dr Chapman.
But the frequency of readings should depend on how they inform care. For example, if a patient needs a review of their blood pressure medications every 6 months, they could take their blood pressure at bi-annual intervals, following recommended steps, before visiting their GP for a script renewal, she said.
Table featured in the Conversation
When participants had a headache, felt unwell or were a bit stressed – this often served as a prompt for them to measure their blood pressure. However, all these factors can cause a variation in blood pressure results.
‘We know high blood pressure doesn't have any symptoms,’ said Dr Chapman. ‘To understand your risk of heart disease, stroke or dementia, that's not the best time to measure your blood pressure.’
Healthcare advice is lacking
Among people who measured their blood pressure at home, less than 20% received advice about how and when to do this from a doctor, nurse or pharmacist, said Dr Chapman.
The at-home devices patients used to measure their blood pressure were also not often clinically validated, which requires testing under an international protocol to assess the device’s reliability to deliver accurate blood pressure readings.
‘The [Therapeutic Goods Administration] only requires devices to be safe in terms of electrical safety, not [in accordance with] this rigorous accuracy testing,’ she said.
In further, as-yet-to-be-published research conducted by the University of Sydney, it was unearthed that most people buy blood pressure monitors from community pharmacists.
‘[But] only half of the devices that were purchased from pharmacies met this standard, and there's very little point-of-sale advice about what to do and what device to buy,’ said Dr Chapman.
Inaccurate readings could inform care decisions
Nearly 80% of people took often inaccurate at-home readings to their next doctor’s appointment. While not following the recommended steps is more likely to result in higher blood pressure readings, a tendency to opt for more favourable results was observed among respondents.
‘They were often taking lots of measurements, then trusting the lowest number, which was also a common [approach among] physicians,’ she said.
These readings were used to inform care decisions, such as confirming a diagnosis of hypertension or deciding whether to add or remove a medicine.
‘Often the home blood pressure measurements were valued by clinicians, because they can be performed more consistently and are more in-depth than one-off readings in a clinic,’ Dr Chapman added.
Pharmacists can improve the accuracy of blood pressure readings
As trusted healthcare providers, pharmacists have several opportunities to relay important messages to patients, said Dr Chapman.
‘Given most people buy their blood pressure device from pharmacies, it’s a great opportunity to provide basic training about how to use it, how to fit the cuff properly, what steps to follow, and when to take action,’ she said.
‘They can also provide education when people are refilling scripts for anti-hypertensive medications.’
First and foremost, pharmacists should advise patients to obtain a validated device according to national and international clinical guidelines, said Dr Chapman. This online tool can be used to check the validation status of blood pressure monitors.
From there, pharmacists should explain how to take a structured approach to at-home blood pressure readings. For example, this could entail taking blood pressure readings once a month, over 3–5 days in the morning and evening, she said.
‘The person should be seated, have 5 minutes rest and take two readings each time they measure their blood pressure, using the average of those.’
This BP Toolkit helps patients take and record their blood pressure averages in a way that's easy for their doctor to digest.
‘To simplify things for both patients and doctors, we created a 10-steps guide for measuring blood pressure, with a report [format] that makes it easier to understand what number to use to inform care,’ said Dr Chapman.
An even bigger role is in the works for pharmacists
As part of the National Hypertension Taskforce to improve blood pressure control, a big part of Dr Chapman’s focus is working with pharmacists to take a team-based approach to hypertension management.
This includes conducting a randomised controlled trial in 2025, in collaboration with PSA, to test the 'BP Toolkit’ – an educational support package designed to improve blood pressure control.
When patients visit the pharmacy for their blood pressure medication, they will be screened and offered a blood pressure check. Those in the intervention group will receive a counselling session with a pharmacist, covering medication adherence, lifestyle changes, action planning, and goal setting.
‘We'll look at delivering formal patient education and counseling, perhaps as part of a MedsCheck, to help improve blood pressure control,’ she said.
‘The goal is to deliver education that supports the patient to know whether or not they should go back to their doctor, and if they do go back to the doctor, what they should talk about.’
Dr Chapman is hoping to develop concrete evidence of the value pharmacists add to chronic disease management.
‘We will be [funding] the pharmacy sites for undertaking the blood pressure measurement and providing an additional payment for delivering the education to the intervention group,’ she said.
‘With that information, we want to demonstrate a fundable model to deliver this [service] that mirrors what happens with [Medicare Benefits Schedule] and [Pharmaceutical Benefits Scheme] items.’
Evidence shows that team-based care involving pharmacists can significantly improve blood pressure control.
‘What we now need to do is demonstrate what an appropriate fee-for-service model is and how this is sustainable and scalable within the context of Australia at a national level,’ said Dr Chapman.
Working closely with local consumer advisors on this research, a key takeout for Dr Chapman is the peace of mind one patient, a stroke survivor, was able to achieve after following recommended at-home blood pressure measurement guidelines.
‘The [relief] they got from measuring their blood pressure in a structured way once a month, instead of every day where it jumps around and they don’t know what the numbers mean, is the most valuable thing as a stroke survivor – allowing them to relax and know that their blood pressure is under control and they're reducing their risk of stroke,’ she said.
[post_title] => The real risks of wrong blood pressure readings
[post_excerpt] => Missing the mark: why Australians are getting blood pressure readings wrong and what pharmacists can do to help.
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[post_content] => Since 1 December 2024, Queensland-based pharmacists have been able to administer Abrysvo to pregnant patients to protect infants from severe Respiratory Syncytial Virus (RSV), following an expansion to the Queensland Paediatric Respiratory Syncytial Virus Prevention Program.
While Abrysvo will be added to the National Immunisation Program (NIP), as per the federal government’s announcement last month, the vaccine is currently funded by the Queensland government – although the administration fee is not covered at this stage.
But given Abrysvo is a relatively new vaccine, pharmacists will need to factor in pregnancy risk perception into strategies to encourage vaccine uptake.
After vaccinating her first patient against RSV, community pharmacist Anna Chang MPS, based in Brisbane, told Australian Pharmacist what should be considered.
Know how the vaccine needs to be prepared
The mixing instructions for Abrysvo are ‘unique’, said Ms Chang.
The vaccine comes with a lyophilised vaccine powder (vial), vial adapter and pre-filled syringe containing diluent. To prepare the vaccine, the vial adapter must be attached by centering it over the vial stopper and pushing straight down to avoid leaks.
Using a syringe held by the Luer lock adapter, the vial adapter must then be connected – with the entire diluent injected into the vial.
After swirling the vial until the powder is fully dissolved, the vial must be inverted and the complete 0.5 mL dose withdrawn into the syringe. Once the adapter is disconnected and a sterile needle attached, the vaccine is ready for intramuscular injection.
‘I haven’t seen a vaccine that is the same as this,’ she said. ‘We all had to look at the instruction sheet line by line and work it out.’
Take a strategic approach to opportunistic vaccination
Vaccination against RSV is recommended for pregnant patients at 28 to 36 weeks gestation. With the pertussis vaccine recommended at 20–32 weeks gestation, this is an opportune time to discuss protection against RSV.
Noting that a pregnant patient was booked in for a whooping cough vaccine at 31 weeks gestation, the week before her pharmacy received stock of Abrysvo, Ms Chang opted to take this approach.
‘I had her name in my calendar to call her and check if she wanted it when I actually got the stock,’ she said.
After receiving the green light from her obstetrician, the patient came back in 2 weeks after receiving her whooping cough vaccine.
‘The obstetrician wasn’t [promoting] it yet, so she [had to] ask if she should get it or not,’ said Ms Chang. ‘And for the cost saving she thought, “Why not go ahead?’”
At the moment, Ms Chang’s team is letting pregnant patients booked in for other vaccines know that funded Abrysvo vaccines are now available in community pharmacies.
‘We have been doing quite a bit of NIP [funded] whooping cough vaccinations for pregnant patients, so they are [ideal candidates],’ said Ms Chang.
Abrysvo can be co-administered with the whooping cough vaccine, if within the right window (28–32 weeks gestation).
‘We will [also] offer for them to come back the next week, but you still have to make sure not to leave it too late,’ she said.
What to do if the vaccine window is missed
While Abrysvo can be administered beyond 36 weeks gestation, infants are unlikely to be adequately protected unless they are born at least 2 weeks after their mother received the vaccine.
‘If you get the vaccine earlier you're covered if you have a premature baby,’ Ms Chang added.
‘And if you do miss that window and go past 36 weeks or have a premature baby, the baby can still be vaccinated [with nirsevimab] instead.’
The need for newborn vaccination is determined by if and when the pregnant woman received the RSV vaccine, said Ms Chang.
‘They should be asked to advise their obstetrician, midwife or the hospital of receiving the vaccine,’ she added.
Spread the word among other healthcare professionals
While Ms Chang thinks there has been more media coverage of RSV vaccination in 2024, there is unlikely to be widespread awareness of its availability, and benefits.
‘People talk a lot about the flu vaccine and COVID-19 vaccines, but RSV vaccination is [somewhat] new,’ she said.
Pharmacists can discuss the importance of RSV vaccination in pregnancy by letting patients know that it protects infants against severe RSV disease when they are most susceptible, with a clinical trial finding vaccine efficacy of 57% against hospitalisation for RSV for up to 6 months.
But pregnant patients may need assurance from multiple trusted healthcare sources that it’s safe to get vaccinated against RSV, advised Ms Chang.
‘I’ve sent letters to the nearby obstetricians to let them know that we’re [offering this vaccine],’ she said. ‘And in the new year we will let the GPs know.’
Be prepared to answer patients’ questions
Along with queries about vaccine efficacy and timeframe, pregnant patients may want to know about the potential adverse effects.
According to clinical trials, ‘very common’ adverse events include headache, myalgia and injection site pain.
Vaccination might provide protection for pregnant women against RSV disease. However, RSV is typically mild in adults, and clinical trials have not specifically assessed the vaccine's efficacy in protecting the mother.
‘[While] there is no data available on the duration of antibodies for the women, [pharmacists could] advise [patients] that it has shown to give protection for 12–16 months for older adults in the clinical studies.’
[post_title] => A pharmacist’s guide to RSV vaccination for pregnant patients
[post_excerpt] => One of the first pharmacists to administer an RSV vaccine to a pregnant patient explains how to promote, prepare and administer Abrysvo.
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[post_content] => With the festive season in full swing and the summer heat rising, pharmacists are at the forefront of helping patients navigate holiday health challenges.
Dive into Australian Pharmacist’s essential guide to keep your community safe this festive season.
Protect your patients against summer risks
With another festive season upon us, and the Bureau of Meteorology predicting extreme summer heat, pharmacists have an important role in keeping patients and families safe and healthy.
This includes advice around alcohol consumption with medicines, protection against mosquito-borne diseases and preventing dehydration.
And while the festive season is merry for some, it can be a difficult time of year for many. This means pharmacists should be on high alert to patients who could be taking higher-than-prescribed medication – potentially for doses for stronger sedation or self-harm.
Refer to this handy pharmacist advice piece by PSA’s resident clinical expert Shani Pickering as a go-to summer guide.
Raise awareness of new sun safety guidelines
The one-size-fits-all approach to sun safety is now out, with a tailored approach based on skin type, now the way to go.
The new sun protection guidelines, released earlier this year, are designed around skin cancer risk. While those with pale skin need to rely on a full suite of sun protection measures when the UV index is ≥3, those with deeply pigmented skin must ensure they get enough vitamin D to avoid a deficiency.
Before your patients start presenting in droves for their summer sun block, give AP’s sun safety guide a squizz.
And while you’re at it, make sure you’re abreast of the sunscreen myths floating around on social media – and how to dispel them.
Be alert to new illicit drug threats this festival season
Every year, the summer season ushers in a wave of music festivals, attended by thousands of revellers nationwide. But this season threatens to be different, with the deadly synthetic opioids, nitazenes, having infiltrated the illicit market.
While seasoned opioid users will have some tolerance to nitazenes, known to be more potent than fentanyl, it has been detected in other illicit drugs such as MDMA and cocaine – which can lead to rapid overdose in casual drug users. In fact, the potent opioids are thought to be linked to mass overdose deaths in Victoria this year.
While there are pill testing services available in Victoria, the ACT and Queensland, Australia’s most populous state, New South Wales, has yet to implement drug checking.
Expert Professor Suzi Nielsen MPS broke down the risks for AP earlier this year, outlining a revised approach to harm reduction.
Navigate summertime nicks, scrapes and scalds
The warmer months often mean more time spent outdoors, leading to increased risks of cuts and scrapes on the beach to nasty insect bites and burns from summer grilling.
With the most common wounds encountered in pharmacy being abrasions, cuts and burns, it's important for pharmacists to know the ABC’s of wound care. This includes providing therapeutic products, guidance on the right dressing selection and when to refer on.
AP’s Management of acute wounds commonly seen in community pharmacy CPD can help to bring you up to speed. And with infections such as cellulitis also more common during the summer months, this wound infection CPD can help pharmacists keep patients safe from harm.
Help patients take the (blood) pressure down this Christmas
The holiday period can come with an excess of stress, salty foods and alcohol consumption – all of which can play havoc with blood pressure. But with recent research finding that most patients aren’t monitoring their blood pressure correctly, it’s important for patients to know what’s artificially, and actually, inflating their blood pressure this holiday season.
This recent AP article analyses where patients get it wrong and how pharmacists can help them take an accurate blood pressure reading. And with low-density lipoprotein cholesterol also more likely to spike after a bit of holiday indulgence, pharmacists can help patients calculate their cardiovascular risk with the new Australian Cardiovascular risk calculator.
Prevent the festive season becoming a headache
Migraine triggers are plentiful during the holiday period, from extreme heat and bright lights, to poor diet and lack of sleep. Migraine and tension headaches can be managed through non-pharmacological strategies, such as stress reduction, obtaining adequate sleep and regular exercise. But pharmacists can also prescribe a number of triptans, where appropriate, and Schedule 3 medicines.
To help patients make it through the holiday season migraine free, read PSA’s Migraine and tension-type headache CPD.
Happy holidays from AP!
[post_title] => A prescription for a safer festive season
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[post_content] => 2024 National Credentialed Diabetes Educator of the Year Julie Kha MPS loves collaborating to deliver better outcomes for her patients.
What led you to pharmacy?
Pharmacy was an exciting choice, enabling an understanding of how medicines can affect us, which can then be communicated to patients to ensure they are informed how to best achieve their shared health goals.
As a profession, pharmacy also offers incredible flexibility with an increasingly specialised workforce.
For example, pharmacists or credentialed pharmacists have now extended into various practice settings such as general practice and aged care – with a continual expansion of scope of practice for those who undertake additional training.
Why did you decide to become a credentialed diabetes educator?
During my formative years, I was fortunate to work alongside the first Australian pharmacist credentialed diabetes educator (CDE) Kirrily Chambers.
I noticed the impact she had on the lives of people with diabetes and their families as they exited the consult room where she worked in private practice and I wanted to generate that same impact from each patient interaction I had.
I was also fortunate to have come across another pharmacist CDE, Cindy Tolba, who was working in a diverse community where English is not the primary language.
Here, she utilised family members and even generated her own resources in the patient’s own language to better convey the workings and impact of diabetes.
Not too surprisingly, my Asian heritage played a role with our increased risk of diabetes. Dr Chris Verrall, an advocate for individualised patient goals, encouraged me to complete my accredited pharmacist requirement and then become a CDE.
How do you support patients who have been newly diagnosed?
Collaboration with the patient’s GP is where we work best. During the early stages, the patient may require time to navigate their new diagnosis and have many questions, or none at all. This takes time that GPs, who are underfunded and in short supply, don’t always have.
Establishing a person-centred approach is also of utmost importance. From this, an individualised plan can be generated to provide personalised education and support with resources and tools to empower the person with diabetes to be in a position where they are able to self-manage this chronic condition.
I had one patient whose glycated haemoglobin (HbA1c) remained elevated despite the addition of insulin.
Following a discussion about injection technique, and more importantly injection site rotation, it was discovered that the abdomen had developed areas of lipohypertrophy as ‘these areas didn’t hurt as much’.
After collaboration with the GP, the person with diabetes was just as excited to hear their insulin dose would be decreasing with a follow-up review scheduled soon thereafter.
How will pharmacists’ roles evolve in chronic disease management?
I was delighted to hear about the partnered prescribing models in our South Australian public hospitals.
With the right education and collaboration, I believe we can develop a similar model to our Canadian pharmacist colleagues, who provide structured chronic disease management programs in collaboration with GPs, practice nurses and other allied health to improve patient outcomes.
I believe one of the first steps would be to incorporate pharmacist CDEs into the hospital system, both public and private, to encourage greater interprofessional collaboration.
I’m proud to be part of pharmacy in this era of change and excited for our pharmacists of the future.
Advice for pharmacists looking to specialise in diabetes care?
Pursue your passion with a group of like-minded colleagues and mentors.
This way, your continuous learning will ensure the outcomes of each person with diabetes, and their families, are improved via an individualised approach and collaboration with the
best evidence-based practice.
A day in the life of Julie Kha MPS, Credentialed Diabetes Pharmacist, Adelaide, SA.
| 8.00 am | Before hitting the road Organise paperwork and plan (travel routes) for the day. |
| 9.00 am | Client education Meet diabetes education clients to understand their health goals to ensure personalised care. Transfer a concession card number into the National Diabetes Services Scheme (NDSS) for a person with type 1 diabetes; she was pleased to learn her costs would be further reduced! Review Libre 2 sensor data for a patient with type 2 diabetes who is on insulin. He was surprised about the impact of his banh mi (sandwich) lunch on his interstitial glucose levels. |
| 1–2.00 pm | Lunch break Replying to emails and returning GP and patient calls. |
| 2–6.00 pm | Clinical afternoon Finalise reports for GPs and specialists. Follow up with any high-risk patients e.g. persons with chronic kidney disease (CKD) or persons with diabetes and still titrating insulin. Remind a patient with type 2 diabetes on a sodium-glucose cotransporter-2 (SGLT2) inhibitor to stop her tablet 3 days prior to her colonoscopy next week. |
| 6.00 pm | Home Medicines Review Meet the last patient of the day for a Home Medicines Review after hours because they work full time. Discover they are taking a NSAID for arthritis pain on top of their ACE inhibitor and diuretic; looks like a call to the GP is in order tomorrow morning to discuss the triple whammy and the risk of acute kidney injury! |
| 8-9.30 pm | Remains of the day Continue writing reports and, if time permits, peruse the Australian Stock Exchange (ASX) movements! |
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[post_content] => When an injection doesn’t go as planned, it can be stressful for both patients and pharmacists. Here’s how to calmly handle these situations while maintaining safety and trust.
Yesterday morning, a mother of two came into a Queensland-based pharmacy requesting emergency contraception.
During the consultation, pharmacist Grace Quach MPS, PSA MIMS Intern Pharmacist of the Year 2023, asked the patient when she had her last period.
‘She had just had a baby 2 months ago, so she hadn't had her period for 9 months, or a normal period since,’ said Ms Quach. ‘However, she did have a Depo Provera injection last week.’
[caption id="attachment_23324" align="aligncenter" width="600"] Grace Quach MPS[/caption]
The patient then revealed that a nurse, supervised by a doctor, administered the injectable contraceptive but pulled out the needle too quickly – leaving the medicine to dribble down her arm.
The GP brushed it off, saying ‘I'm not sure if you’ll get the full amount of protection. See how you go’, leaving the patient stunned.
While mistakes are bound to happen during vaccinations or when administering medicines by injection, there are certain do’s and dont’s that should be followed.
What if a vaccine is partially administered?
If the process of administering a vaccine is interrupted (for example by syringe-needle disconnection), pharmacists should ask themselves:
For example, this could entail letting a patient know that more than 50% of the vaccine was administered, if this was the case, which is deemed enough to form an immune response according to ATAGI.
‘The patient [should not be put in a position] where they are unsure of whether or not they've received correct treatment once they leave the vaccination [or medicine by injection] room,’ said Ms Jadeja ‘That also reduces trust in that healthcare professional, which is not a good scenario at the end of the day.’ PSA’s Pharmacist-to-Pharmacist Advice Line offers expert advice to members in real time. The Pharmacist Advice Line is an exclusive member service offering professional advice from a senior pharmacist on technical, ethical and practice questions. This includes:td_module_mega_menu Object
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[post_content] => Missing the mark: why Australians are getting blood pressure checks wrong and what pharmacists can do to help.
More than one in three (34%) of Australian adults have high blood pressure. Of those diagnosed with hypertension, a staggering 68% have uncontrolled blood pressure.
Effectively managing hypertension is the most powerful method of lowering the risk of cardiovascular disease; reducing blood pressure by 5 mm Hg can decrease the probability of adverse cardiovascular events by 10%.
Yet new research found that most Australians don’t know how to measure their blood pressure accurately, nor are they getting advice on how to do so from healthcare professionals – including pharmacists.
Lead researcher Dr Niamh Chapman, Senior Research Fellow at the University of Sydney, explains where patients are getting it wrong, and the vital role pharmacists can play in blood pressure management.
Improper measurement methods are skewing results
While most patients knew they should be seated, have their back supported and remain silent during blood pressure measurement to ensure accurate readings, they weren't aware they should take multiple readings across different intervals conducted over several days.
‘They were doing it really frequently, (either) every week or every day,’ said Dr Chapman.
But the frequency of readings should depend on how they inform care. For example, if a patient needs a review of their blood pressure medications every 6 months, they could take their blood pressure at bi-annual intervals, following recommended steps, before visiting their GP for a script renewal, she said.
Table featured in the Conversation
When participants had a headache, felt unwell or were a bit stressed – this often served as a prompt for them to measure their blood pressure. However, all these factors can cause a variation in blood pressure results.
‘We know high blood pressure doesn't have any symptoms,’ said Dr Chapman. ‘To understand your risk of heart disease, stroke or dementia, that's not the best time to measure your blood pressure.’
Healthcare advice is lacking
Among people who measured their blood pressure at home, less than 20% received advice about how and when to do this from a doctor, nurse or pharmacist, said Dr Chapman.
The at-home devices patients used to measure their blood pressure were also not often clinically validated, which requires testing under an international protocol to assess the device’s reliability to deliver accurate blood pressure readings.
‘The [Therapeutic Goods Administration] only requires devices to be safe in terms of electrical safety, not [in accordance with] this rigorous accuracy testing,’ she said.
In further, as-yet-to-be-published research conducted by the University of Sydney, it was unearthed that most people buy blood pressure monitors from community pharmacists.
‘[But] only half of the devices that were purchased from pharmacies met this standard, and there's very little point-of-sale advice about what to do and what device to buy,’ said Dr Chapman.
Inaccurate readings could inform care decisions
Nearly 80% of people took often inaccurate at-home readings to their next doctor’s appointment. While not following the recommended steps is more likely to result in higher blood pressure readings, a tendency to opt for more favourable results was observed among respondents.
‘They were often taking lots of measurements, then trusting the lowest number, which was also a common [approach among] physicians,’ she said.
These readings were used to inform care decisions, such as confirming a diagnosis of hypertension or deciding whether to add or remove a medicine.
‘Often the home blood pressure measurements were valued by clinicians, because they can be performed more consistently and are more in-depth than one-off readings in a clinic,’ Dr Chapman added.
Pharmacists can improve the accuracy of blood pressure readings
As trusted healthcare providers, pharmacists have several opportunities to relay important messages to patients, said Dr Chapman.
‘Given most people buy their blood pressure device from pharmacies, it’s a great opportunity to provide basic training about how to use it, how to fit the cuff properly, what steps to follow, and when to take action,’ she said.
‘They can also provide education when people are refilling scripts for anti-hypertensive medications.’
First and foremost, pharmacists should advise patients to obtain a validated device according to national and international clinical guidelines, said Dr Chapman. This online tool can be used to check the validation status of blood pressure monitors.
From there, pharmacists should explain how to take a structured approach to at-home blood pressure readings. For example, this could entail taking blood pressure readings once a month, over 3–5 days in the morning and evening, she said.
‘The person should be seated, have 5 minutes rest and take two readings each time they measure their blood pressure, using the average of those.’
This BP Toolkit helps patients take and record their blood pressure averages in a way that's easy for their doctor to digest.
‘To simplify things for both patients and doctors, we created a 10-steps guide for measuring blood pressure, with a report [format] that makes it easier to understand what number to use to inform care,’ said Dr Chapman.
An even bigger role is in the works for pharmacists
As part of the National Hypertension Taskforce to improve blood pressure control, a big part of Dr Chapman’s focus is working with pharmacists to take a team-based approach to hypertension management.
This includes conducting a randomised controlled trial in 2025, in collaboration with PSA, to test the 'BP Toolkit’ – an educational support package designed to improve blood pressure control.
When patients visit the pharmacy for their blood pressure medication, they will be screened and offered a blood pressure check. Those in the intervention group will receive a counselling session with a pharmacist, covering medication adherence, lifestyle changes, action planning, and goal setting.
‘We'll look at delivering formal patient education and counseling, perhaps as part of a MedsCheck, to help improve blood pressure control,’ she said.
‘The goal is to deliver education that supports the patient to know whether or not they should go back to their doctor, and if they do go back to the doctor, what they should talk about.’
Dr Chapman is hoping to develop concrete evidence of the value pharmacists add to chronic disease management.
‘We will be [funding] the pharmacy sites for undertaking the blood pressure measurement and providing an additional payment for delivering the education to the intervention group,’ she said.
‘With that information, we want to demonstrate a fundable model to deliver this [service] that mirrors what happens with [Medicare Benefits Schedule] and [Pharmaceutical Benefits Scheme] items.’
Evidence shows that team-based care involving pharmacists can significantly improve blood pressure control.
‘What we now need to do is demonstrate what an appropriate fee-for-service model is and how this is sustainable and scalable within the context of Australia at a national level,’ said Dr Chapman.
Working closely with local consumer advisors on this research, a key takeout for Dr Chapman is the peace of mind one patient, a stroke survivor, was able to achieve after following recommended at-home blood pressure measurement guidelines.
‘The [relief] they got from measuring their blood pressure in a structured way once a month, instead of every day where it jumps around and they don’t know what the numbers mean, is the most valuable thing as a stroke survivor – allowing them to relax and know that their blood pressure is under control and they're reducing their risk of stroke,’ she said.
[post_title] => The real risks of wrong blood pressure readings
[post_excerpt] => Missing the mark: why Australians are getting blood pressure readings wrong and what pharmacists can do to help.
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[post_content] => Since 1 December 2024, Queensland-based pharmacists have been able to administer Abrysvo to pregnant patients to protect infants from severe Respiratory Syncytial Virus (RSV), following an expansion to the Queensland Paediatric Respiratory Syncytial Virus Prevention Program.
While Abrysvo will be added to the National Immunisation Program (NIP), as per the federal government’s announcement last month, the vaccine is currently funded by the Queensland government – although the administration fee is not covered at this stage.
But given Abrysvo is a relatively new vaccine, pharmacists will need to factor in pregnancy risk perception into strategies to encourage vaccine uptake.
After vaccinating her first patient against RSV, community pharmacist Anna Chang MPS, based in Brisbane, told Australian Pharmacist what should be considered.
Know how the vaccine needs to be prepared
The mixing instructions for Abrysvo are ‘unique’, said Ms Chang.
The vaccine comes with a lyophilised vaccine powder (vial), vial adapter and pre-filled syringe containing diluent. To prepare the vaccine, the vial adapter must be attached by centering it over the vial stopper and pushing straight down to avoid leaks.
Using a syringe held by the Luer lock adapter, the vial adapter must then be connected – with the entire diluent injected into the vial.
After swirling the vial until the powder is fully dissolved, the vial must be inverted and the complete 0.5 mL dose withdrawn into the syringe. Once the adapter is disconnected and a sterile needle attached, the vaccine is ready for intramuscular injection.
‘I haven’t seen a vaccine that is the same as this,’ she said. ‘We all had to look at the instruction sheet line by line and work it out.’
Take a strategic approach to opportunistic vaccination
Vaccination against RSV is recommended for pregnant patients at 28 to 36 weeks gestation. With the pertussis vaccine recommended at 20–32 weeks gestation, this is an opportune time to discuss protection against RSV.
Noting that a pregnant patient was booked in for a whooping cough vaccine at 31 weeks gestation, the week before her pharmacy received stock of Abrysvo, Ms Chang opted to take this approach.
‘I had her name in my calendar to call her and check if she wanted it when I actually got the stock,’ she said.
After receiving the green light from her obstetrician, the patient came back in 2 weeks after receiving her whooping cough vaccine.
‘The obstetrician wasn’t [promoting] it yet, so she [had to] ask if she should get it or not,’ said Ms Chang. ‘And for the cost saving she thought, “Why not go ahead?’”
At the moment, Ms Chang’s team is letting pregnant patients booked in for other vaccines know that funded Abrysvo vaccines are now available in community pharmacies.
‘We have been doing quite a bit of NIP [funded] whooping cough vaccinations for pregnant patients, so they are [ideal candidates],’ said Ms Chang.
Abrysvo can be co-administered with the whooping cough vaccine, if within the right window (28–32 weeks gestation).
‘We will [also] offer for them to come back the next week, but you still have to make sure not to leave it too late,’ she said.
What to do if the vaccine window is missed
While Abrysvo can be administered beyond 36 weeks gestation, infants are unlikely to be adequately protected unless they are born at least 2 weeks after their mother received the vaccine.
‘If you get the vaccine earlier you're covered if you have a premature baby,’ Ms Chang added.
‘And if you do miss that window and go past 36 weeks or have a premature baby, the baby can still be vaccinated [with nirsevimab] instead.’
The need for newborn vaccination is determined by if and when the pregnant woman received the RSV vaccine, said Ms Chang.
‘They should be asked to advise their obstetrician, midwife or the hospital of receiving the vaccine,’ she added.
Spread the word among other healthcare professionals
While Ms Chang thinks there has been more media coverage of RSV vaccination in 2024, there is unlikely to be widespread awareness of its availability, and benefits.
‘People talk a lot about the flu vaccine and COVID-19 vaccines, but RSV vaccination is [somewhat] new,’ she said.
Pharmacists can discuss the importance of RSV vaccination in pregnancy by letting patients know that it protects infants against severe RSV disease when they are most susceptible, with a clinical trial finding vaccine efficacy of 57% against hospitalisation for RSV for up to 6 months.
But pregnant patients may need assurance from multiple trusted healthcare sources that it’s safe to get vaccinated against RSV, advised Ms Chang.
‘I’ve sent letters to the nearby obstetricians to let them know that we’re [offering this vaccine],’ she said. ‘And in the new year we will let the GPs know.’
Be prepared to answer patients’ questions
Along with queries about vaccine efficacy and timeframe, pregnant patients may want to know about the potential adverse effects.
According to clinical trials, ‘very common’ adverse events include headache, myalgia and injection site pain.
Vaccination might provide protection for pregnant women against RSV disease. However, RSV is typically mild in adults, and clinical trials have not specifically assessed the vaccine's efficacy in protecting the mother.
‘[While] there is no data available on the duration of antibodies for the women, [pharmacists could] advise [patients] that it has shown to give protection for 12–16 months for older adults in the clinical studies.’
[post_title] => A pharmacist’s guide to RSV vaccination for pregnant patients
[post_excerpt] => One of the first pharmacists to administer an RSV vaccine to a pregnant patient explains how to promote, prepare and administer Abrysvo.
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[post_content] => With the festive season in full swing and the summer heat rising, pharmacists are at the forefront of helping patients navigate holiday health challenges.
Dive into Australian Pharmacist’s essential guide to keep your community safe this festive season.
Protect your patients against summer risks
With another festive season upon us, and the Bureau of Meteorology predicting extreme summer heat, pharmacists have an important role in keeping patients and families safe and healthy.
This includes advice around alcohol consumption with medicines, protection against mosquito-borne diseases and preventing dehydration.
And while the festive season is merry for some, it can be a difficult time of year for many. This means pharmacists should be on high alert to patients who could be taking higher-than-prescribed medication – potentially for doses for stronger sedation or self-harm.
Refer to this handy pharmacist advice piece by PSA’s resident clinical expert Shani Pickering as a go-to summer guide.
Raise awareness of new sun safety guidelines
The one-size-fits-all approach to sun safety is now out, with a tailored approach based on skin type, now the way to go.
The new sun protection guidelines, released earlier this year, are designed around skin cancer risk. While those with pale skin need to rely on a full suite of sun protection measures when the UV index is ≥3, those with deeply pigmented skin must ensure they get enough vitamin D to avoid a deficiency.
Before your patients start presenting in droves for their summer sun block, give AP’s sun safety guide a squizz.
And while you’re at it, make sure you’re abreast of the sunscreen myths floating around on social media – and how to dispel them.
Be alert to new illicit drug threats this festival season
Every year, the summer season ushers in a wave of music festivals, attended by thousands of revellers nationwide. But this season threatens to be different, with the deadly synthetic opioids, nitazenes, having infiltrated the illicit market.
While seasoned opioid users will have some tolerance to nitazenes, known to be more potent than fentanyl, it has been detected in other illicit drugs such as MDMA and cocaine – which can lead to rapid overdose in casual drug users. In fact, the potent opioids are thought to be linked to mass overdose deaths in Victoria this year.
While there are pill testing services available in Victoria, the ACT and Queensland, Australia’s most populous state, New South Wales, has yet to implement drug checking.
Expert Professor Suzi Nielsen MPS broke down the risks for AP earlier this year, outlining a revised approach to harm reduction.
Navigate summertime nicks, scrapes and scalds
The warmer months often mean more time spent outdoors, leading to increased risks of cuts and scrapes on the beach to nasty insect bites and burns from summer grilling.
With the most common wounds encountered in pharmacy being abrasions, cuts and burns, it's important for pharmacists to know the ABC’s of wound care. This includes providing therapeutic products, guidance on the right dressing selection and when to refer on.
AP’s Management of acute wounds commonly seen in community pharmacy CPD can help to bring you up to speed. And with infections such as cellulitis also more common during the summer months, this wound infection CPD can help pharmacists keep patients safe from harm.
Help patients take the (blood) pressure down this Christmas
The holiday period can come with an excess of stress, salty foods and alcohol consumption – all of which can play havoc with blood pressure. But with recent research finding that most patients aren’t monitoring their blood pressure correctly, it’s important for patients to know what’s artificially, and actually, inflating their blood pressure this holiday season.
This recent AP article analyses where patients get it wrong and how pharmacists can help them take an accurate blood pressure reading. And with low-density lipoprotein cholesterol also more likely to spike after a bit of holiday indulgence, pharmacists can help patients calculate their cardiovascular risk with the new Australian Cardiovascular risk calculator.
Prevent the festive season becoming a headache
Migraine triggers are plentiful during the holiday period, from extreme heat and bright lights, to poor diet and lack of sleep. Migraine and tension headaches can be managed through non-pharmacological strategies, such as stress reduction, obtaining adequate sleep and regular exercise. But pharmacists can also prescribe a number of triptans, where appropriate, and Schedule 3 medicines.
To help patients make it through the holiday season migraine free, read PSA’s Migraine and tension-type headache CPD.
Happy holidays from AP!
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[post_content] => 2024 National Credentialed Diabetes Educator of the Year Julie Kha MPS loves collaborating to deliver better outcomes for her patients.
What led you to pharmacy?
Pharmacy was an exciting choice, enabling an understanding of how medicines can affect us, which can then be communicated to patients to ensure they are informed how to best achieve their shared health goals.
As a profession, pharmacy also offers incredible flexibility with an increasingly specialised workforce.
For example, pharmacists or credentialed pharmacists have now extended into various practice settings such as general practice and aged care – with a continual expansion of scope of practice for those who undertake additional training.
Why did you decide to become a credentialed diabetes educator?
During my formative years, I was fortunate to work alongside the first Australian pharmacist credentialed diabetes educator (CDE) Kirrily Chambers.
I noticed the impact she had on the lives of people with diabetes and their families as they exited the consult room where she worked in private practice and I wanted to generate that same impact from each patient interaction I had.
I was also fortunate to have come across another pharmacist CDE, Cindy Tolba, who was working in a diverse community where English is not the primary language.
Here, she utilised family members and even generated her own resources in the patient’s own language to better convey the workings and impact of diabetes.
Not too surprisingly, my Asian heritage played a role with our increased risk of diabetes. Dr Chris Verrall, an advocate for individualised patient goals, encouraged me to complete my accredited pharmacist requirement and then become a CDE.
How do you support patients who have been newly diagnosed?
Collaboration with the patient’s GP is where we work best. During the early stages, the patient may require time to navigate their new diagnosis and have many questions, or none at all. This takes time that GPs, who are underfunded and in short supply, don’t always have.
Establishing a person-centred approach is also of utmost importance. From this, an individualised plan can be generated to provide personalised education and support with resources and tools to empower the person with diabetes to be in a position where they are able to self-manage this chronic condition.
I had one patient whose glycated haemoglobin (HbA1c) remained elevated despite the addition of insulin.
Following a discussion about injection technique, and more importantly injection site rotation, it was discovered that the abdomen had developed areas of lipohypertrophy as ‘these areas didn’t hurt as much’.
After collaboration with the GP, the person with diabetes was just as excited to hear their insulin dose would be decreasing with a follow-up review scheduled soon thereafter.
How will pharmacists’ roles evolve in chronic disease management?
I was delighted to hear about the partnered prescribing models in our South Australian public hospitals.
With the right education and collaboration, I believe we can develop a similar model to our Canadian pharmacist colleagues, who provide structured chronic disease management programs in collaboration with GPs, practice nurses and other allied health to improve patient outcomes.
I believe one of the first steps would be to incorporate pharmacist CDEs into the hospital system, both public and private, to encourage greater interprofessional collaboration.
I’m proud to be part of pharmacy in this era of change and excited for our pharmacists of the future.
Advice for pharmacists looking to specialise in diabetes care?
Pursue your passion with a group of like-minded colleagues and mentors.
This way, your continuous learning will ensure the outcomes of each person with diabetes, and their families, are improved via an individualised approach and collaboration with the
best evidence-based practice.
A day in the life of Julie Kha MPS, Credentialed Diabetes Pharmacist, Adelaide, SA.
| 8.00 am | Before hitting the road Organise paperwork and plan (travel routes) for the day. |
| 9.00 am | Client education Meet diabetes education clients to understand their health goals to ensure personalised care. Transfer a concession card number into the National Diabetes Services Scheme (NDSS) for a person with type 1 diabetes; she was pleased to learn her costs would be further reduced! Review Libre 2 sensor data for a patient with type 2 diabetes who is on insulin. He was surprised about the impact of his banh mi (sandwich) lunch on his interstitial glucose levels. |
| 1–2.00 pm | Lunch break Replying to emails and returning GP and patient calls. |
| 2–6.00 pm | Clinical afternoon Finalise reports for GPs and specialists. Follow up with any high-risk patients e.g. persons with chronic kidney disease (CKD) or persons with diabetes and still titrating insulin. Remind a patient with type 2 diabetes on a sodium-glucose cotransporter-2 (SGLT2) inhibitor to stop her tablet 3 days prior to her colonoscopy next week. |
| 6.00 pm | Home Medicines Review Meet the last patient of the day for a Home Medicines Review after hours because they work full time. Discover they are taking a NSAID for arthritis pain on top of their ACE inhibitor and diuretic; looks like a call to the GP is in order tomorrow morning to discuss the triple whammy and the risk of acute kidney injury! |
| 8-9.30 pm | Remains of the day Continue writing reports and, if time permits, peruse the Australian Stock Exchange (ASX) movements! |
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[post_content] => When an injection doesn’t go as planned, it can be stressful for both patients and pharmacists. Here’s how to calmly handle these situations while maintaining safety and trust.
Yesterday morning, a mother of two came into a Queensland-based pharmacy requesting emergency contraception.
During the consultation, pharmacist Grace Quach MPS, PSA MIMS Intern Pharmacist of the Year 2023, asked the patient when she had her last period.
‘She had just had a baby 2 months ago, so she hadn't had her period for 9 months, or a normal period since,’ said Ms Quach. ‘However, she did have a Depo Provera injection last week.’
[caption id="attachment_23324" align="aligncenter" width="600"] Grace Quach MPS[/caption]
The patient then revealed that a nurse, supervised by a doctor, administered the injectable contraceptive but pulled out the needle too quickly – leaving the medicine to dribble down her arm.
The GP brushed it off, saying ‘I'm not sure if you’ll get the full amount of protection. See how you go’, leaving the patient stunned.
While mistakes are bound to happen during vaccinations or when administering medicines by injection, there are certain do’s and dont’s that should be followed.
What if a vaccine is partially administered?
If the process of administering a vaccine is interrupted (for example by syringe-needle disconnection), pharmacists should ask themselves:
For example, this could entail letting a patient know that more than 50% of the vaccine was administered, if this was the case, which is deemed enough to form an immune response according to ATAGI.
‘The patient [should not be put in a position] where they are unsure of whether or not they've received correct treatment once they leave the vaccination [or medicine by injection] room,’ said Ms Jadeja ‘That also reduces trust in that healthcare professional, which is not a good scenario at the end of the day.’ PSA’s Pharmacist-to-Pharmacist Advice Line offers expert advice to members in real time. The Pharmacist Advice Line is an exclusive member service offering professional advice from a senior pharmacist on technical, ethical and practice questions. This includes:td_module_mega_menu Object
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[post_content] => Missing the mark: why Australians are getting blood pressure checks wrong and what pharmacists can do to help.
More than one in three (34%) of Australian adults have high blood pressure. Of those diagnosed with hypertension, a staggering 68% have uncontrolled blood pressure.
Effectively managing hypertension is the most powerful method of lowering the risk of cardiovascular disease; reducing blood pressure by 5 mm Hg can decrease the probability of adverse cardiovascular events by 10%.
Yet new research found that most Australians don’t know how to measure their blood pressure accurately, nor are they getting advice on how to do so from healthcare professionals – including pharmacists.
Lead researcher Dr Niamh Chapman, Senior Research Fellow at the University of Sydney, explains where patients are getting it wrong, and the vital role pharmacists can play in blood pressure management.
Improper measurement methods are skewing results
While most patients knew they should be seated, have their back supported and remain silent during blood pressure measurement to ensure accurate readings, they weren't aware they should take multiple readings across different intervals conducted over several days.
‘They were doing it really frequently, (either) every week or every day,’ said Dr Chapman.
But the frequency of readings should depend on how they inform care. For example, if a patient needs a review of their blood pressure medications every 6 months, they could take their blood pressure at bi-annual intervals, following recommended steps, before visiting their GP for a script renewal, she said.
Table featured in the Conversation
When participants had a headache, felt unwell or were a bit stressed – this often served as a prompt for them to measure their blood pressure. However, all these factors can cause a variation in blood pressure results.
‘We know high blood pressure doesn't have any symptoms,’ said Dr Chapman. ‘To understand your risk of heart disease, stroke or dementia, that's not the best time to measure your blood pressure.’
Healthcare advice is lacking
Among people who measured their blood pressure at home, less than 20% received advice about how and when to do this from a doctor, nurse or pharmacist, said Dr Chapman.
The at-home devices patients used to measure their blood pressure were also not often clinically validated, which requires testing under an international protocol to assess the device’s reliability to deliver accurate blood pressure readings.
‘The [Therapeutic Goods Administration] only requires devices to be safe in terms of electrical safety, not [in accordance with] this rigorous accuracy testing,’ she said.
In further, as-yet-to-be-published research conducted by the University of Sydney, it was unearthed that most people buy blood pressure monitors from community pharmacists.
‘[But] only half of the devices that were purchased from pharmacies met this standard, and there's very little point-of-sale advice about what to do and what device to buy,’ said Dr Chapman.
Inaccurate readings could inform care decisions
Nearly 80% of people took often inaccurate at-home readings to their next doctor’s appointment. While not following the recommended steps is more likely to result in higher blood pressure readings, a tendency to opt for more favourable results was observed among respondents.
‘They were often taking lots of measurements, then trusting the lowest number, which was also a common [approach among] physicians,’ she said.
These readings were used to inform care decisions, such as confirming a diagnosis of hypertension or deciding whether to add or remove a medicine.
‘Often the home blood pressure measurements were valued by clinicians, because they can be performed more consistently and are more in-depth than one-off readings in a clinic,’ Dr Chapman added.
Pharmacists can improve the accuracy of blood pressure readings
As trusted healthcare providers, pharmacists have several opportunities to relay important messages to patients, said Dr Chapman.
‘Given most people buy their blood pressure device from pharmacies, it’s a great opportunity to provide basic training about how to use it, how to fit the cuff properly, what steps to follow, and when to take action,’ she said.
‘They can also provide education when people are refilling scripts for anti-hypertensive medications.’
First and foremost, pharmacists should advise patients to obtain a validated device according to national and international clinical guidelines, said Dr Chapman. This online tool can be used to check the validation status of blood pressure monitors.
From there, pharmacists should explain how to take a structured approach to at-home blood pressure readings. For example, this could entail taking blood pressure readings once a month, over 3–5 days in the morning and evening, she said.
‘The person should be seated, have 5 minutes rest and take two readings each time they measure their blood pressure, using the average of those.’
This BP Toolkit helps patients take and record their blood pressure averages in a way that's easy for their doctor to digest.
‘To simplify things for both patients and doctors, we created a 10-steps guide for measuring blood pressure, with a report [format] that makes it easier to understand what number to use to inform care,’ said Dr Chapman.
An even bigger role is in the works for pharmacists
As part of the National Hypertension Taskforce to improve blood pressure control, a big part of Dr Chapman’s focus is working with pharmacists to take a team-based approach to hypertension management.
This includes conducting a randomised controlled trial in 2025, in collaboration with PSA, to test the 'BP Toolkit’ – an educational support package designed to improve blood pressure control.
When patients visit the pharmacy for their blood pressure medication, they will be screened and offered a blood pressure check. Those in the intervention group will receive a counselling session with a pharmacist, covering medication adherence, lifestyle changes, action planning, and goal setting.
‘We'll look at delivering formal patient education and counseling, perhaps as part of a MedsCheck, to help improve blood pressure control,’ she said.
‘The goal is to deliver education that supports the patient to know whether or not they should go back to their doctor, and if they do go back to the doctor, what they should talk about.’
Dr Chapman is hoping to develop concrete evidence of the value pharmacists add to chronic disease management.
‘We will be [funding] the pharmacy sites for undertaking the blood pressure measurement and providing an additional payment for delivering the education to the intervention group,’ she said.
‘With that information, we want to demonstrate a fundable model to deliver this [service] that mirrors what happens with [Medicare Benefits Schedule] and [Pharmaceutical Benefits Scheme] items.’
Evidence shows that team-based care involving pharmacists can significantly improve blood pressure control.
‘What we now need to do is demonstrate what an appropriate fee-for-service model is and how this is sustainable and scalable within the context of Australia at a national level,’ said Dr Chapman.
Working closely with local consumer advisors on this research, a key takeout for Dr Chapman is the peace of mind one patient, a stroke survivor, was able to achieve after following recommended at-home blood pressure measurement guidelines.
‘The [relief] they got from measuring their blood pressure in a structured way once a month, instead of every day where it jumps around and they don’t know what the numbers mean, is the most valuable thing as a stroke survivor – allowing them to relax and know that their blood pressure is under control and they're reducing their risk of stroke,’ she said.
[post_title] => The real risks of wrong blood pressure readings
[post_excerpt] => Missing the mark: why Australians are getting blood pressure readings wrong and what pharmacists can do to help.
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[post_content] => Since 1 December 2024, Queensland-based pharmacists have been able to administer Abrysvo to pregnant patients to protect infants from severe Respiratory Syncytial Virus (RSV), following an expansion to the Queensland Paediatric Respiratory Syncytial Virus Prevention Program.
While Abrysvo will be added to the National Immunisation Program (NIP), as per the federal government’s announcement last month, the vaccine is currently funded by the Queensland government – although the administration fee is not covered at this stage.
But given Abrysvo is a relatively new vaccine, pharmacists will need to factor in pregnancy risk perception into strategies to encourage vaccine uptake.
After vaccinating her first patient against RSV, community pharmacist Anna Chang MPS, based in Brisbane, told Australian Pharmacist what should be considered.
Know how the vaccine needs to be prepared
The mixing instructions for Abrysvo are ‘unique’, said Ms Chang.
The vaccine comes with a lyophilised vaccine powder (vial), vial adapter and pre-filled syringe containing diluent. To prepare the vaccine, the vial adapter must be attached by centering it over the vial stopper and pushing straight down to avoid leaks.
Using a syringe held by the Luer lock adapter, the vial adapter must then be connected – with the entire diluent injected into the vial.
After swirling the vial until the powder is fully dissolved, the vial must be inverted and the complete 0.5 mL dose withdrawn into the syringe. Once the adapter is disconnected and a sterile needle attached, the vaccine is ready for intramuscular injection.
‘I haven’t seen a vaccine that is the same as this,’ she said. ‘We all had to look at the instruction sheet line by line and work it out.’
Take a strategic approach to opportunistic vaccination
Vaccination against RSV is recommended for pregnant patients at 28 to 36 weeks gestation. With the pertussis vaccine recommended at 20–32 weeks gestation, this is an opportune time to discuss protection against RSV.
Noting that a pregnant patient was booked in for a whooping cough vaccine at 31 weeks gestation, the week before her pharmacy received stock of Abrysvo, Ms Chang opted to take this approach.
‘I had her name in my calendar to call her and check if she wanted it when I actually got the stock,’ she said.
After receiving the green light from her obstetrician, the patient came back in 2 weeks after receiving her whooping cough vaccine.
‘The obstetrician wasn’t [promoting] it yet, so she [had to] ask if she should get it or not,’ said Ms Chang. ‘And for the cost saving she thought, “Why not go ahead?’”
At the moment, Ms Chang’s team is letting pregnant patients booked in for other vaccines know that funded Abrysvo vaccines are now available in community pharmacies.
‘We have been doing quite a bit of NIP [funded] whooping cough vaccinations for pregnant patients, so they are [ideal candidates],’ said Ms Chang.
Abrysvo can be co-administered with the whooping cough vaccine, if within the right window (28–32 weeks gestation).
‘We will [also] offer for them to come back the next week, but you still have to make sure not to leave it too late,’ she said.
What to do if the vaccine window is missed
While Abrysvo can be administered beyond 36 weeks gestation, infants are unlikely to be adequately protected unless they are born at least 2 weeks after their mother received the vaccine.
‘If you get the vaccine earlier you're covered if you have a premature baby,’ Ms Chang added.
‘And if you do miss that window and go past 36 weeks or have a premature baby, the baby can still be vaccinated [with nirsevimab] instead.’
The need for newborn vaccination is determined by if and when the pregnant woman received the RSV vaccine, said Ms Chang.
‘They should be asked to advise their obstetrician, midwife or the hospital of receiving the vaccine,’ she added.
Spread the word among other healthcare professionals
While Ms Chang thinks there has been more media coverage of RSV vaccination in 2024, there is unlikely to be widespread awareness of its availability, and benefits.
‘People talk a lot about the flu vaccine and COVID-19 vaccines, but RSV vaccination is [somewhat] new,’ she said.
Pharmacists can discuss the importance of RSV vaccination in pregnancy by letting patients know that it protects infants against severe RSV disease when they are most susceptible, with a clinical trial finding vaccine efficacy of 57% against hospitalisation for RSV for up to 6 months.
But pregnant patients may need assurance from multiple trusted healthcare sources that it’s safe to get vaccinated against RSV, advised Ms Chang.
‘I’ve sent letters to the nearby obstetricians to let them know that we’re [offering this vaccine],’ she said. ‘And in the new year we will let the GPs know.’
Be prepared to answer patients’ questions
Along with queries about vaccine efficacy and timeframe, pregnant patients may want to know about the potential adverse effects.
According to clinical trials, ‘very common’ adverse events include headache, myalgia and injection site pain.
Vaccination might provide protection for pregnant women against RSV disease. However, RSV is typically mild in adults, and clinical trials have not specifically assessed the vaccine's efficacy in protecting the mother.
‘[While] there is no data available on the duration of antibodies for the women, [pharmacists could] advise [patients] that it has shown to give protection for 12–16 months for older adults in the clinical studies.’
[post_title] => A pharmacist’s guide to RSV vaccination for pregnant patients
[post_excerpt] => One of the first pharmacists to administer an RSV vaccine to a pregnant patient explains how to promote, prepare and administer Abrysvo.
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[post_content] => With the festive season in full swing and the summer heat rising, pharmacists are at the forefront of helping patients navigate holiday health challenges.
Dive into Australian Pharmacist’s essential guide to keep your community safe this festive season.
Protect your patients against summer risks
With another festive season upon us, and the Bureau of Meteorology predicting extreme summer heat, pharmacists have an important role in keeping patients and families safe and healthy.
This includes advice around alcohol consumption with medicines, protection against mosquito-borne diseases and preventing dehydration.
And while the festive season is merry for some, it can be a difficult time of year for many. This means pharmacists should be on high alert to patients who could be taking higher-than-prescribed medication – potentially for doses for stronger sedation or self-harm.
Refer to this handy pharmacist advice piece by PSA’s resident clinical expert Shani Pickering as a go-to summer guide.
Raise awareness of new sun safety guidelines
The one-size-fits-all approach to sun safety is now out, with a tailored approach based on skin type, now the way to go.
The new sun protection guidelines, released earlier this year, are designed around skin cancer risk. While those with pale skin need to rely on a full suite of sun protection measures when the UV index is ≥3, those with deeply pigmented skin must ensure they get enough vitamin D to avoid a deficiency.
Before your patients start presenting in droves for their summer sun block, give AP’s sun safety guide a squizz.
And while you’re at it, make sure you’re abreast of the sunscreen myths floating around on social media – and how to dispel them.
Be alert to new illicit drug threats this festival season
Every year, the summer season ushers in a wave of music festivals, attended by thousands of revellers nationwide. But this season threatens to be different, with the deadly synthetic opioids, nitazenes, having infiltrated the illicit market.
While seasoned opioid users will have some tolerance to nitazenes, known to be more potent than fentanyl, it has been detected in other illicit drugs such as MDMA and cocaine – which can lead to rapid overdose in casual drug users. In fact, the potent opioids are thought to be linked to mass overdose deaths in Victoria this year.
While there are pill testing services available in Victoria, the ACT and Queensland, Australia’s most populous state, New South Wales, has yet to implement drug checking.
Expert Professor Suzi Nielsen MPS broke down the risks for AP earlier this year, outlining a revised approach to harm reduction.
Navigate summertime nicks, scrapes and scalds
The warmer months often mean more time spent outdoors, leading to increased risks of cuts and scrapes on the beach to nasty insect bites and burns from summer grilling.
With the most common wounds encountered in pharmacy being abrasions, cuts and burns, it's important for pharmacists to know the ABC’s of wound care. This includes providing therapeutic products, guidance on the right dressing selection and when to refer on.
AP’s Management of acute wounds commonly seen in community pharmacy CPD can help to bring you up to speed. And with infections such as cellulitis also more common during the summer months, this wound infection CPD can help pharmacists keep patients safe from harm.
Help patients take the (blood) pressure down this Christmas
The holiday period can come with an excess of stress, salty foods and alcohol consumption – all of which can play havoc with blood pressure. But with recent research finding that most patients aren’t monitoring their blood pressure correctly, it’s important for patients to know what’s artificially, and actually, inflating their blood pressure this holiday season.
This recent AP article analyses where patients get it wrong and how pharmacists can help them take an accurate blood pressure reading. And with low-density lipoprotein cholesterol also more likely to spike after a bit of holiday indulgence, pharmacists can help patients calculate their cardiovascular risk with the new Australian Cardiovascular risk calculator.
Prevent the festive season becoming a headache
Migraine triggers are plentiful during the holiday period, from extreme heat and bright lights, to poor diet and lack of sleep. Migraine and tension headaches can be managed through non-pharmacological strategies, such as stress reduction, obtaining adequate sleep and regular exercise. But pharmacists can also prescribe a number of triptans, where appropriate, and Schedule 3 medicines.
To help patients make it through the holiday season migraine free, read PSA’s Migraine and tension-type headache CPD.
Happy holidays from AP!
[post_title] => A prescription for a safer festive season
[post_excerpt] => With the festive season in full swing, pharmacists are at the forefront of helping patients navigate holiday health challenges.
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[title_attribute] => A prescription for a safer festive season
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[post_content] => 2024 National Credentialed Diabetes Educator of the Year Julie Kha MPS loves collaborating to deliver better outcomes for her patients.
What led you to pharmacy?
Pharmacy was an exciting choice, enabling an understanding of how medicines can affect us, which can then be communicated to patients to ensure they are informed how to best achieve their shared health goals.
As a profession, pharmacy also offers incredible flexibility with an increasingly specialised workforce.
For example, pharmacists or credentialed pharmacists have now extended into various practice settings such as general practice and aged care – with a continual expansion of scope of practice for those who undertake additional training.
Why did you decide to become a credentialed diabetes educator?
During my formative years, I was fortunate to work alongside the first Australian pharmacist credentialed diabetes educator (CDE) Kirrily Chambers.
I noticed the impact she had on the lives of people with diabetes and their families as they exited the consult room where she worked in private practice and I wanted to generate that same impact from each patient interaction I had.
I was also fortunate to have come across another pharmacist CDE, Cindy Tolba, who was working in a diverse community where English is not the primary language.
Here, she utilised family members and even generated her own resources in the patient’s own language to better convey the workings and impact of diabetes.
Not too surprisingly, my Asian heritage played a role with our increased risk of diabetes. Dr Chris Verrall, an advocate for individualised patient goals, encouraged me to complete my accredited pharmacist requirement and then become a CDE.
How do you support patients who have been newly diagnosed?
Collaboration with the patient’s GP is where we work best. During the early stages, the patient may require time to navigate their new diagnosis and have many questions, or none at all. This takes time that GPs, who are underfunded and in short supply, don’t always have.
Establishing a person-centred approach is also of utmost importance. From this, an individualised plan can be generated to provide personalised education and support with resources and tools to empower the person with diabetes to be in a position where they are able to self-manage this chronic condition.
I had one patient whose glycated haemoglobin (HbA1c) remained elevated despite the addition of insulin.
Following a discussion about injection technique, and more importantly injection site rotation, it was discovered that the abdomen had developed areas of lipohypertrophy as ‘these areas didn’t hurt as much’.
After collaboration with the GP, the person with diabetes was just as excited to hear their insulin dose would be decreasing with a follow-up review scheduled soon thereafter.
How will pharmacists’ roles evolve in chronic disease management?
I was delighted to hear about the partnered prescribing models in our South Australian public hospitals.
With the right education and collaboration, I believe we can develop a similar model to our Canadian pharmacist colleagues, who provide structured chronic disease management programs in collaboration with GPs, practice nurses and other allied health to improve patient outcomes.
I believe one of the first steps would be to incorporate pharmacist CDEs into the hospital system, both public and private, to encourage greater interprofessional collaboration.
I’m proud to be part of pharmacy in this era of change and excited for our pharmacists of the future.
Advice for pharmacists looking to specialise in diabetes care?
Pursue your passion with a group of like-minded colleagues and mentors.
This way, your continuous learning will ensure the outcomes of each person with diabetes, and their families, are improved via an individualised approach and collaboration with the
best evidence-based practice.
A day in the life of Julie Kha MPS, Credentialed Diabetes Pharmacist, Adelaide, SA.
| 8.00 am | Before hitting the road Organise paperwork and plan (travel routes) for the day. |
| 9.00 am | Client education Meet diabetes education clients to understand their health goals to ensure personalised care. Transfer a concession card number into the National Diabetes Services Scheme (NDSS) for a person with type 1 diabetes; she was pleased to learn her costs would be further reduced! Review Libre 2 sensor data for a patient with type 2 diabetes who is on insulin. He was surprised about the impact of his banh mi (sandwich) lunch on his interstitial glucose levels. |
| 1–2.00 pm | Lunch break Replying to emails and returning GP and patient calls. |
| 2–6.00 pm | Clinical afternoon Finalise reports for GPs and specialists. Follow up with any high-risk patients e.g. persons with chronic kidney disease (CKD) or persons with diabetes and still titrating insulin. Remind a patient with type 2 diabetes on a sodium-glucose cotransporter-2 (SGLT2) inhibitor to stop her tablet 3 days prior to her colonoscopy next week. |
| 6.00 pm | Home Medicines Review Meet the last patient of the day for a Home Medicines Review after hours because they work full time. Discover they are taking a NSAID for arthritis pain on top of their ACE inhibitor and diuretic; looks like a call to the GP is in order tomorrow morning to discuss the triple whammy and the risk of acute kidney injury! |
| 8-9.30 pm | Remains of the day Continue writing reports and, if time permits, peruse the Australian Stock Exchange (ASX) movements! |
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[post_content] => When an injection doesn’t go as planned, it can be stressful for both patients and pharmacists. Here’s how to calmly handle these situations while maintaining safety and trust.
Yesterday morning, a mother of two came into a Queensland-based pharmacy requesting emergency contraception.
During the consultation, pharmacist Grace Quach MPS, PSA MIMS Intern Pharmacist of the Year 2023, asked the patient when she had her last period.
‘She had just had a baby 2 months ago, so she hadn't had her period for 9 months, or a normal period since,’ said Ms Quach. ‘However, she did have a Depo Provera injection last week.’
[caption id="attachment_23324" align="aligncenter" width="600"] Grace Quach MPS[/caption]
The patient then revealed that a nurse, supervised by a doctor, administered the injectable contraceptive but pulled out the needle too quickly – leaving the medicine to dribble down her arm.
The GP brushed it off, saying ‘I'm not sure if you’ll get the full amount of protection. See how you go’, leaving the patient stunned.
While mistakes are bound to happen during vaccinations or when administering medicines by injection, there are certain do’s and dont’s that should be followed.
What if a vaccine is partially administered?
If the process of administering a vaccine is interrupted (for example by syringe-needle disconnection), pharmacists should ask themselves:
For example, this could entail letting a patient know that more than 50% of the vaccine was administered, if this was the case, which is deemed enough to form an immune response according to ATAGI.
‘The patient [should not be put in a position] where they are unsure of whether or not they've received correct treatment once they leave the vaccination [or medicine by injection] room,’ said Ms Jadeja ‘That also reduces trust in that healthcare professional, which is not a good scenario at the end of the day.’ PSA’s Pharmacist-to-Pharmacist Advice Line offers expert advice to members in real time. The Pharmacist Advice Line is an exclusive member service offering professional advice from a senior pharmacist on technical, ethical and practice questions. This includes:td_module_mega_menu Object
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[post_content] => Missing the mark: why Australians are getting blood pressure checks wrong and what pharmacists can do to help.
More than one in three (34%) of Australian adults have high blood pressure. Of those diagnosed with hypertension, a staggering 68% have uncontrolled blood pressure.
Effectively managing hypertension is the most powerful method of lowering the risk of cardiovascular disease; reducing blood pressure by 5 mm Hg can decrease the probability of adverse cardiovascular events by 10%.
Yet new research found that most Australians don’t know how to measure their blood pressure accurately, nor are they getting advice on how to do so from healthcare professionals – including pharmacists.
Lead researcher Dr Niamh Chapman, Senior Research Fellow at the University of Sydney, explains where patients are getting it wrong, and the vital role pharmacists can play in blood pressure management.
Improper measurement methods are skewing results
While most patients knew they should be seated, have their back supported and remain silent during blood pressure measurement to ensure accurate readings, they weren't aware they should take multiple readings across different intervals conducted over several days.
‘They were doing it really frequently, (either) every week or every day,’ said Dr Chapman.
But the frequency of readings should depend on how they inform care. For example, if a patient needs a review of their blood pressure medications every 6 months, they could take their blood pressure at bi-annual intervals, following recommended steps, before visiting their GP for a script renewal, she said.
Table featured in the Conversation
When participants had a headache, felt unwell or were a bit stressed – this often served as a prompt for them to measure their blood pressure. However, all these factors can cause a variation in blood pressure results.
‘We know high blood pressure doesn't have any symptoms,’ said Dr Chapman. ‘To understand your risk of heart disease, stroke or dementia, that's not the best time to measure your blood pressure.’
Healthcare advice is lacking
Among people who measured their blood pressure at home, less than 20% received advice about how and when to do this from a doctor, nurse or pharmacist, said Dr Chapman.
The at-home devices patients used to measure their blood pressure were also not often clinically validated, which requires testing under an international protocol to assess the device’s reliability to deliver accurate blood pressure readings.
‘The [Therapeutic Goods Administration] only requires devices to be safe in terms of electrical safety, not [in accordance with] this rigorous accuracy testing,’ she said.
In further, as-yet-to-be-published research conducted by the University of Sydney, it was unearthed that most people buy blood pressure monitors from community pharmacists.
‘[But] only half of the devices that were purchased from pharmacies met this standard, and there's very little point-of-sale advice about what to do and what device to buy,’ said Dr Chapman.
Inaccurate readings could inform care decisions
Nearly 80% of people took often inaccurate at-home readings to their next doctor’s appointment. While not following the recommended steps is more likely to result in higher blood pressure readings, a tendency to opt for more favourable results was observed among respondents.
‘They were often taking lots of measurements, then trusting the lowest number, which was also a common [approach among] physicians,’ she said.
These readings were used to inform care decisions, such as confirming a diagnosis of hypertension or deciding whether to add or remove a medicine.
‘Often the home blood pressure measurements were valued by clinicians, because they can be performed more consistently and are more in-depth than one-off readings in a clinic,’ Dr Chapman added.
Pharmacists can improve the accuracy of blood pressure readings
As trusted healthcare providers, pharmacists have several opportunities to relay important messages to patients, said Dr Chapman.
‘Given most people buy their blood pressure device from pharmacies, it’s a great opportunity to provide basic training about how to use it, how to fit the cuff properly, what steps to follow, and when to take action,’ she said.
‘They can also provide education when people are refilling scripts for anti-hypertensive medications.’
First and foremost, pharmacists should advise patients to obtain a validated device according to national and international clinical guidelines, said Dr Chapman. This online tool can be used to check the validation status of blood pressure monitors.
From there, pharmacists should explain how to take a structured approach to at-home blood pressure readings. For example, this could entail taking blood pressure readings once a month, over 3–5 days in the morning and evening, she said.
‘The person should be seated, have 5 minutes rest and take two readings each time they measure their blood pressure, using the average of those.’
This BP Toolkit helps patients take and record their blood pressure averages in a way that's easy for their doctor to digest.
‘To simplify things for both patients and doctors, we created a 10-steps guide for measuring blood pressure, with a report [format] that makes it easier to understand what number to use to inform care,’ said Dr Chapman.
An even bigger role is in the works for pharmacists
As part of the National Hypertension Taskforce to improve blood pressure control, a big part of Dr Chapman’s focus is working with pharmacists to take a team-based approach to hypertension management.
This includes conducting a randomised controlled trial in 2025, in collaboration with PSA, to test the 'BP Toolkit’ – an educational support package designed to improve blood pressure control.
When patients visit the pharmacy for their blood pressure medication, they will be screened and offered a blood pressure check. Those in the intervention group will receive a counselling session with a pharmacist, covering medication adherence, lifestyle changes, action planning, and goal setting.
‘We'll look at delivering formal patient education and counseling, perhaps as part of a MedsCheck, to help improve blood pressure control,’ she said.
‘The goal is to deliver education that supports the patient to know whether or not they should go back to their doctor, and if they do go back to the doctor, what they should talk about.’
Dr Chapman is hoping to develop concrete evidence of the value pharmacists add to chronic disease management.
‘We will be [funding] the pharmacy sites for undertaking the blood pressure measurement and providing an additional payment for delivering the education to the intervention group,’ she said.
‘With that information, we want to demonstrate a fundable model to deliver this [service] that mirrors what happens with [Medicare Benefits Schedule] and [Pharmaceutical Benefits Scheme] items.’
Evidence shows that team-based care involving pharmacists can significantly improve blood pressure control.
‘What we now need to do is demonstrate what an appropriate fee-for-service model is and how this is sustainable and scalable within the context of Australia at a national level,’ said Dr Chapman.
Working closely with local consumer advisors on this research, a key takeout for Dr Chapman is the peace of mind one patient, a stroke survivor, was able to achieve after following recommended at-home blood pressure measurement guidelines.
‘The [relief] they got from measuring their blood pressure in a structured way once a month, instead of every day where it jumps around and they don’t know what the numbers mean, is the most valuable thing as a stroke survivor – allowing them to relax and know that their blood pressure is under control and they're reducing their risk of stroke,’ she said.
[post_title] => The real risks of wrong blood pressure readings
[post_excerpt] => Missing the mark: why Australians are getting blood pressure readings wrong and what pharmacists can do to help.
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.
