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[post_content] => Medication errors and poisonings are leading to a staggering number of avoidable hospitalisations among children and adolescents. Find out which medicines pose the biggest risks and how pharmacists can help turn the tide.
An alarming number of Australian children and adolescents are impacted by medicine-related harm. Every day, around 93 children present to emergency departments due to a medicine-related problem – half of which are preventable.
And adverse events due to medicines are all too commonplace, with an estimated 120,000 children aged 0–14 years affected in the last 6 months.
Along with the emotional and physical toll on children and their families, medicine-related harm also carries a significant financial burden to the tune of $130 million per annum.
These alarming statistics, and more, were highlighted in PSA’s Medicine safety: child and adolescent care report, released on Friday by PSA National President Associate Professor Fei Sim and Ged Kearney, Assistant Minister for Health and Aged Care Assistant Minister for Indigenous Health.
[caption id="attachment_28617" align="alignnone" width="500"]
PSA National President Associate Professor Fei Sim and Ged Kearney, Assistant Minister for Health and Aged Care Assistant Minister for Indigenous Health[/caption]
‘Our health system is failing children and adolescents,’ said A/Prof Sim. ‘As a health community, we must commit to doing better, but we also need to be given the resources and tools to do better.’
Here’s a look at the key findings and the tangible solutions pharmacists can employ to make a difference.
Steep increase in self-poisonings among teens
Poisoning remains a major risk for children and adolescents, leading to around 8 hospitalisations daily.
Younger children are particularly susceptible to poisoning, often due to accidental ingestion or dosing errors. In children under 5 years of age, poisoning admissions increased from 12% in 2013–14 to 16% in 2022–23, with medicines affecting the cardiovascular system the most common cause.
While concerning, the number of hospitalisations among children aged 5–9 remains relatively low. But poisonings – both accidental and intentional – are increasingly prevalent in adolescents.
Paracetamol and antidepressants are the leading causes of poisoning-related hospital admissions, particularly among girls aged 10–14 years and adolescent females aged 15–19 years. In fact, 68% of all pharmaceutical poisoning admissions in 2022–23 were in adolescents aged 15–19 years.
Beyond hospital data, the New South Wales Poisons Information Centre (PIC) receives thousands of calls each year; among adolescents, calls about antidepressant exposures, including fluoxetine and sertraline, are increasingly prominent.
Off-label medicine use fuelling adverse reactions
Many medicines prescribed for children have not been specifically tested in paediatric populations, leading to widespread off-label use.
An estimated 12–45% of medicines used in children are off-label, increasing the risk of adverse reactions. And while medicine-medicine interactions are understudied in Australian children, international evidence suggests that exposure to major drug interactions in paediatric patients may be higher than anticipated.
With diagnoses of autism and ADHD on the rise – conditions which are linked to sleep disturbances – many parents are administering melatonin off-label to children, often obtaining it online and perceiving it as a ‘natural product’ rather than a medicine.
But the NSW PIC has received a growing number of melatonin exposure-related calls, with nearly 850 in 2022 alone.
Poisonings linked to clonidine, prescribed off-label for ADHD, are also frequently reported. Due to its tablet formulation, clonidine has been associated with dosing errors, particularly among young children – who may accidentally take a whole tablet instead of the prescribed half or quarter of a tablet.
Treating mental health conditions comes with risks
The significant uptick of mental ill health in today’s youth has led to a massive increase in the use of medicines for mental health conditions in children, including antidepressants and ADHD medications.
While these medicines can be beneficial, they are also associated with risks, including cardiometabolic side effects from antipsychotics and dependency risks from stimulants. A key issue is the lack of health literacy among parents and caregivers, leading to medication errors, inappropriate dosing, or failure to recognise adverse effects.
Pharmacists critical to harm prevention
The report’s release coincides with new restrictions on paracetamol pack sizes, which came into effect on Saturday 1 February, to reduce risks of intentional overdose. Pharmacy medicine packs are now limited to 50 tablets in most states, with larger packs upscheduled to Pharmacist Only medicines.
‘Paracetamol and antidepressants are the leading causes of poisoning-related hospital admissions, particularly among girls aged 10–14 years.'
‘By involving pharmacists in the supply of larger paracetamol pack sizes, we strike the right balance between access and safety, giving pharmacists and pharmacy assistants the opportunity to help patients manage their pain effectively while reducing the risk of misuse and harm,’ said A/Prof Sim.
The report suggests that mandating an indication on prescriptions could also ensure pharmacists verify the appropriateness of each medication. For example, when a child receives an antibiotic, pharmacists can confirm it’s suitable for the specific infection and the patient’s age before dispensing.
Accurate dosing is another key priority area. Given children’s dosage often depends on weight and age, pharmacists should manually check every paediatric dose rather than relying solely on automated systems. For example, if a 15 kg child is prescribed amoxicillin, pharmacists should calculate an appropriate mg/kg dose and contact the prescriber if it exceeds recommended limits.
From a systems perspective, designing a national medicine safety monitoring system – akin to Canada’s AIMS (Assurance and Improvement in Medication Safety) – will allow pharmacists to log and analyse medication errors in real time. This data-driven approach helps identify trends in paediatric medicine use, preventing repeated mistakes.
Removing legal barriers so pharmacists can modify medication formulations, such as creating a liquid formulation of clonidine for a child who can’t swallow pills, can also reduce errors and improve adherence.
But beyond clinical responsibilities, pharmacists should educate parents, teachers, and caregivers on medicine safety. This includes guidance on correct administration techniques, such as using a syringe for accurate measurement, and safe storage practices to prevent accidental ingestion.
‘Pharmacists are critical to ensure the safe use of medicines and must be supported to do so,’ said A/Prof Sim.
‘That means adequately staffing children’s hospital wards with the expertise of pharmacists, investing in systems that capture the data needed for evidence-based policy, and improving the quality use of medicines whenever medicines are used.
‘It takes all of us, across all areas of practice and indeed across all health professions, to make a difference to the children and adolescents who rely on our care.’
Access PSA’s full Medicine safety: child and adolescent care report here.
[post_title] => Why are so many children harmed from medicines?
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[post_content] => Whether ‘tis nobler to use the foil bag to avoid the temperature excursions or . . . Putting William Shakespeare aside, what is the point of the foil bag?
Do foil bags keep medicines cold?
The National Vaccine Storage Guidelines ‘Strive for 5’ state that ‘foil bags commonly provided by pharmacists when vaccines are privately purchased are not effective in keeping vaccines at the correct temperature – for example, when the vaccine is left in a car or stored in a domestic refrigerator’.1
Suppliers of foil bags advise they are for transporting medicines that require short-term storage at a constant temperature until appropriate refrigeration can be reached.
They are not suitable for long-term storage.2 It is unclear whether foil bags provide thermal protection and for how long.
Some pharmacists use foil bags to remind the patient that the medicine in the bag needs to go in the fridge.
However, the patient should still be advised to take the medicine straight home to put it in the fridge and not to rely on the false sense of security that the foil bag will keep it cold while they ‘duck into the shops’.
What if the patient doesn’t have a fridge?
Not all patients have consistent access to a fridge (e.g. travelling, power outages, no fixed address).
It is useful to ask patients about this, and tailor your advice accordingly.
Cautionary Advisory Labels 6, 7a, 7b and 13 can supplement your verbal advice about storage where appropriate.3
For some medicines that require refrigeration, the approved Product Information (PI) contains guidance about room temperature storage options if refrigeration is unavailable or impractical.⁴
You can also offer to store the medicine or not-in-use containers at the pharmacy until needed (e.g. pending a doctor’s appointment, not-in-use insulin pens/cartridges).
Opened containers – in or out of the fridge?
It depends on the medicine.
The manufacturer has determined the stability and shelf-life of a medicine using the container and storage conditions outlined in the PI.
Keeping an in-use container in the fridge instead of at room temperature may extend its shelf-life. This might avoid wastage if the dose changes.
However, cold eye drops and injections can cause discomfort. They should generally be allowed to reach room temperature before they are administered.
In-use multi-dose injections or eye drops should be kept at room temperature unless otherwise advised by the PI.⁴
References
- Australian Government Department of Health. National Vaccine Storage Guidelines ‘Strive for 5’. 3rd edn. Canberra: Australian Government Department of Health; 2019.
- Stirling Fildes. Foil bags – medium. At: www.stirlingfildeshc.com.au/
- Sansom LN, ed. Australian Pharmaceutical Formulary and Handbook. 2024. At: https://apf.psa.org.au
- Medicines information. eMIMS cloud; [2024]. At: www.emims.com.au/Australia/drug/search
Our author
Claire Antrobus MPS (she/her) is PSA’s Manager – Practice Support.
[post_title] => To foil bag or not to foil bag, that is the question!
[post_excerpt] => Ever wondered about the point of foil bags and if they keep medicines cold? PSA clinical expert Claire Antrobus provides a helpful rundown.
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[post_content] => From February, pack sizes of paracetamol sold in pharmacies will change. Here’s what pharmacists need to know.
Come Saturday (1 February 2025), paracetamol in packs containing 50-100 tablets or capsules will shift to Schedule 3 following the final decision on paracetamol access controls made by the Therapeutic Goods Administration (TGA) in 2023.
The aim is to reduce the volume of paracetamol kept in people’s homes to prevent harm from intentional overdose. Each year, around 225 Australians are hospitalised with liver injury and 50 Australians die from paracetamol overdose. The highest rates of intentional overdose are among adolescents and young adults – particularly females.
Pharmacists can help to reduce the amount of surplus paracetamol available in homes by being ‘champions for the change’, said Peter Guthrey MPS, PSA Senior Pharmacist – Strategic Policy.
‘While pharmacists know paracetamol is very safe when taken at recommended doses, we also know the devastating impact of intentional or unintentional overdose.
‘On Friday, PSA will be releasing the next edition of our flagship medicine safety report series which contains concerning data on the use of medicines, including paracetamol, in children and adolescents.’
‘The data on intentional overdose involving paracetamol is alarming … Scheduling changes are not the full solution, but are a strategy which could make a positive difference if it changes the patterns of paracetamol supply.’
Other countries have gone much further than Australia in limiting access to paracetamol, through measures such as scheduling and limiting pack purchases,’ he said.
What are the changes?
The TGA’s decision includes changes to both pack sizes and packaging. The new regulations affect pain relief products containing paracetamol as the sole active ingredient and cold and flu medicines containing paracetamol in combination with other ingredients.
Access to liquid, modified release and Prescription Only paracetamol is not affected by the changes.
| Jurisdiction | Changes |
| Nationally |
|
| Western Australia and Queensland |
|
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[post_content] => NSW pharmacist Anna Barwick MPS was awarded the Medal of the Order of Australia (OAM) in the 2025 Australia Day Honours.
Ms Barwick founded PharmOnline, an innovative platform which connects Australian patients living in remote areas with pharmacy services. A pharmacy academic from Walcha, NSW, she previously served on PSA’s NSW Branch Committee, including holding the role of vice-president from 2014-2020.
PSA National President Associate Professor Fei Sim FPS acknowledged Ms Barwick’s enormous contribution to pharmacy profession.
‘Anna is a truly outstanding pharmacist. A pioneer of innovation, she has consistently transformed access to care in her community and beyond,’ said A/Prof Sim.
‘I have been privileged to see first-hand Anna’s work, and hope that others are as inspired and energised as I am by her contribution to the community and to the next generation of pharmacists.
‘Long recognised by the profession, having won PSA’s Pharmacy Shark Tank award in 2021 and NSW Pharmacist of the Year in 2021, I am excited to see her achievements recognised on the national stage.
‘On behalf of PSA and the pharmacy profession, I sincerely congratulate Anna on this well-deserved recognition.’
Read more about 2021 PSA Pharmacist of tee Year Anna Barwick's passion for rural and remote pharmacy here.
[post_title] => Rural healthcare advocate honoured
[post_excerpt] => NSW pharmacist Anna Barwick MPS was awarded the Medal of the Order of Australia (OAM) in the 2025 Australia Day Honours.
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[post_content] => Highest risk travellers need additional support – from pharmacists.
Which of the following travel is highest risk to a person’s health?
A. An adrenaline-pumping adventure holiday in Queenstown, New Zealand.
B. Buck’s weekend in Bali.
C. Staying with family members in Sri Lanka for 3 months on long service leave.
D. A week visiting the ancient temples in Angkor Wat, Cambodia.
While each of these examples do have some risks, (C) is an example of VFR travel, which is generally considered much higher risk than travel to similar locations for primarily tourism or business purposes.
So why is this? And what is a VFR traveller?
We asked Associate Professor Holly Seale, a social scientist at the School of Population Health, University of New South Wales, what pharmacists need to know about this travel cohort and the unique risks they experience.
What is VFR travel?
VFR is a public health construct – “visiting friends and relatives (VFR)”. It categorises travellers who travel to lower-income countries for the purpose of visiting friends and relatives. Often these travellers are ethnically distinct from the majority population of the country of residence.
The definition of VFR has been updated in recent years, which requires:
This differs from previous approaches to VFR travellers based on indirect factors for health risk (e.g. administrative category of migrant, country of birth, destination), factors that may not be directly relevant to determining adverse health or disease outcomes.
VFR travellers are more likely to:
They often stay with family members or friends, have less control over their diets and are more likely to drink untreated water. The health risk gradient between the source and destination may also be influenced by:
What are the main vaccine-preventable diseases of concern for VFR travel?Previous studies have described VFR travellers at being at increased risk of malaria, traveller’s diarrhoea, intestinal parasites, typhoid, paratyphoid, viral hepatitis, and tuberculosis in comparison to tourists and business travellers.2
Barriers include:
Additionally, VFR travel is often booked late, so the time period between booking and flying often limits the ability to fit in multi-dose vaccines. It also means there is insufficient time for recommended vaccinations or boosters to become effective.
Sometimes it’s also a system barrier. GPs who consult in a language other than English, were less likely to consider VFR travellers at higher risk compared with holiday travellers. These GPs may be VFR travellers themselves and therefore subject to the same cultural perceptions of risk as other VFR travellers.3
With a low perception of risk and inadequate pre-travel health-seeking behaviour, an opportunistic approach to provision of pre-travel health advice to VFR travellers is required.
Opportunistic conversations about travel, especially among immunisers who may share a common language, may assist with identifying future travel plans and provide more time for fitting in vaccination.
Undergoing advanced training in travel medicine, will also support understanding about vaccine recommendations, travel risks and destinations etc.
Associate Professor Holly Seale is a social scientist researching social and behavioural factors impacting engagement with infectious disease prevention strategies at the University of New South Wales.
Holly Seale is an investigator on research studies funded by the NHMRC and has previously received funding from NSW Ministry of Health, as well as from Sanofi Pasteur, Moderna and Pfizer for investigator-driven research and consulting fees.
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[post_content] => Medication errors and poisonings are leading to a staggering number of avoidable hospitalisations among children and adolescents. Find out which medicines pose the biggest risks and how pharmacists can help turn the tide.
An alarming number of Australian children and adolescents are impacted by medicine-related harm. Every day, around 93 children present to emergency departments due to a medicine-related problem – half of which are preventable.
And adverse events due to medicines are all too commonplace, with an estimated 120,000 children aged 0–14 years affected in the last 6 months.
Along with the emotional and physical toll on children and their families, medicine-related harm also carries a significant financial burden to the tune of $130 million per annum.
These alarming statistics, and more, were highlighted in PSA’s Medicine safety: child and adolescent care report, released on Friday by PSA National President Associate Professor Fei Sim and Ged Kearney, Assistant Minister for Health and Aged Care Assistant Minister for Indigenous Health.
[caption id="attachment_28617" align="alignnone" width="500"] PSA National President Associate Professor Fei Sim and Ged Kearney, Assistant Minister for Health and Aged Care Assistant Minister for Indigenous Health[/caption]
‘Our health system is failing children and adolescents,’ said A/Prof Sim. ‘As a health community, we must commit to doing better, but we also need to be given the resources and tools to do better.’
Here’s a look at the key findings and the tangible solutions pharmacists can employ to make a difference.
Steep increase in self-poisonings among teens
Poisoning remains a major risk for children and adolescents, leading to around 8 hospitalisations daily.
Younger children are particularly susceptible to poisoning, often due to accidental ingestion or dosing errors. In children under 5 years of age, poisoning admissions increased from 12% in 2013–14 to 16% in 2022–23, with medicines affecting the cardiovascular system the most common cause.
While concerning, the number of hospitalisations among children aged 5–9 remains relatively low. But poisonings – both accidental and intentional – are increasingly prevalent in adolescents.
Paracetamol and antidepressants are the leading causes of poisoning-related hospital admissions, particularly among girls aged 10–14 years and adolescent females aged 15–19 years. In fact, 68% of all pharmaceutical poisoning admissions in 2022–23 were in adolescents aged 15–19 years.
Beyond hospital data, the New South Wales Poisons Information Centre (PIC) receives thousands of calls each year; among adolescents, calls about antidepressant exposures, including fluoxetine and sertraline, are increasingly prominent.
Off-label medicine use fuelling adverse reactions
Many medicines prescribed for children have not been specifically tested in paediatric populations, leading to widespread off-label use.
An estimated 12–45% of medicines used in children are off-label, increasing the risk of adverse reactions. And while medicine-medicine interactions are understudied in Australian children, international evidence suggests that exposure to major drug interactions in paediatric patients may be higher than anticipated.
With diagnoses of autism and ADHD on the rise – conditions which are linked to sleep disturbances – many parents are administering melatonin off-label to children, often obtaining it online and perceiving it as a ‘natural product’ rather than a medicine.
But the NSW PIC has received a growing number of melatonin exposure-related calls, with nearly 850 in 2022 alone.
Poisonings linked to clonidine, prescribed off-label for ADHD, are also frequently reported. Due to its tablet formulation, clonidine has been associated with dosing errors, particularly among young children – who may accidentally take a whole tablet instead of the prescribed half or quarter of a tablet.
Treating mental health conditions comes with risks
The significant uptick of mental ill health in today’s youth has led to a massive increase in the use of medicines for mental health conditions in children, including antidepressants and ADHD medications.
While these medicines can be beneficial, they are also associated with risks, including cardiometabolic side effects from antipsychotics and dependency risks from stimulants. A key issue is the lack of health literacy among parents and caregivers, leading to medication errors, inappropriate dosing, or failure to recognise adverse effects.
Pharmacists critical to harm prevention
The report’s release coincides with new restrictions on paracetamol pack sizes, which came into effect on Saturday 1 February, to reduce risks of intentional overdose. Pharmacy medicine packs are now limited to 50 tablets in most states, with larger packs upscheduled to Pharmacist Only medicines.
‘Paracetamol and antidepressants are the leading causes of poisoning-related hospital admissions, particularly among girls aged 10–14 years.'
‘By involving pharmacists in the supply of larger paracetamol pack sizes, we strike the right balance between access and safety, giving pharmacists and pharmacy assistants the opportunity to help patients manage their pain effectively while reducing the risk of misuse and harm,’ said A/Prof Sim.
The report suggests that mandating an indication on prescriptions could also ensure pharmacists verify the appropriateness of each medication. For example, when a child receives an antibiotic, pharmacists can confirm it’s suitable for the specific infection and the patient’s age before dispensing.
Accurate dosing is another key priority area. Given children’s dosage often depends on weight and age, pharmacists should manually check every paediatric dose rather than relying solely on automated systems. For example, if a 15 kg child is prescribed amoxicillin, pharmacists should calculate an appropriate mg/kg dose and contact the prescriber if it exceeds recommended limits.
From a systems perspective, designing a national medicine safety monitoring system – akin to Canada’s AIMS (Assurance and Improvement in Medication Safety) – will allow pharmacists to log and analyse medication errors in real time. This data-driven approach helps identify trends in paediatric medicine use, preventing repeated mistakes.
Removing legal barriers so pharmacists can modify medication formulations, such as creating a liquid formulation of clonidine for a child who can’t swallow pills, can also reduce errors and improve adherence.
But beyond clinical responsibilities, pharmacists should educate parents, teachers, and caregivers on medicine safety. This includes guidance on correct administration techniques, such as using a syringe for accurate measurement, and safe storage practices to prevent accidental ingestion.
‘Pharmacists are critical to ensure the safe use of medicines and must be supported to do so,’ said A/Prof Sim.
‘That means adequately staffing children’s hospital wards with the expertise of pharmacists, investing in systems that capture the data needed for evidence-based policy, and improving the quality use of medicines whenever medicines are used.
‘It takes all of us, across all areas of practice and indeed across all health professions, to make a difference to the children and adolescents who rely on our care.’
Access PSA’s full Medicine safety: child and adolescent care report here.
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[post_content] => Whether ‘tis nobler to use the foil bag to avoid the temperature excursions or . . . Putting William Shakespeare aside, what is the point of the foil bag?
Do foil bags keep medicines cold?
The National Vaccine Storage Guidelines ‘Strive for 5’ state that ‘foil bags commonly provided by pharmacists when vaccines are privately purchased are not effective in keeping vaccines at the correct temperature – for example, when the vaccine is left in a car or stored in a domestic refrigerator’.1
Suppliers of foil bags advise they are for transporting medicines that require short-term storage at a constant temperature until appropriate refrigeration can be reached.
They are not suitable for long-term storage.2 It is unclear whether foil bags provide thermal protection and for how long.
Some pharmacists use foil bags to remind the patient that the medicine in the bag needs to go in the fridge.
However, the patient should still be advised to take the medicine straight home to put it in the fridge and not to rely on the false sense of security that the foil bag will keep it cold while they ‘duck into the shops’.
What if the patient doesn’t have a fridge?
Not all patients have consistent access to a fridge (e.g. travelling, power outages, no fixed address).
It is useful to ask patients about this, and tailor your advice accordingly.
Cautionary Advisory Labels 6, 7a, 7b and 13 can supplement your verbal advice about storage where appropriate.3
For some medicines that require refrigeration, the approved Product Information (PI) contains guidance about room temperature storage options if refrigeration is unavailable or impractical.⁴
You can also offer to store the medicine or not-in-use containers at the pharmacy until needed (e.g. pending a doctor’s appointment, not-in-use insulin pens/cartridges).
Opened containers – in or out of the fridge?
It depends on the medicine.
The manufacturer has determined the stability and shelf-life of a medicine using the container and storage conditions outlined in the PI.
Keeping an in-use container in the fridge instead of at room temperature may extend its shelf-life. This might avoid wastage if the dose changes.
However, cold eye drops and injections can cause discomfort. They should generally be allowed to reach room temperature before they are administered.
In-use multi-dose injections or eye drops should be kept at room temperature unless otherwise advised by the PI.⁴
References
- Australian Government Department of Health. National Vaccine Storage Guidelines ‘Strive for 5’. 3rd edn. Canberra: Australian Government Department of Health; 2019.
- Stirling Fildes. Foil bags – medium. At: www.stirlingfildeshc.com.au/
- Sansom LN, ed. Australian Pharmaceutical Formulary and Handbook. 2024. At: https://apf.psa.org.au
- Medicines information. eMIMS cloud; [2024]. At: www.emims.com.au/Australia/drug/search
Our author
Claire Antrobus MPS (she/her) is PSA’s Manager – Practice Support.
[post_title] => To foil bag or not to foil bag, that is the question!
[post_excerpt] => Ever wondered about the point of foil bags and if they keep medicines cold? PSA clinical expert Claire Antrobus provides a helpful rundown.
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[post_content] => From February, pack sizes of paracetamol sold in pharmacies will change. Here’s what pharmacists need to know.
Come Saturday (1 February 2025), paracetamol in packs containing 50-100 tablets or capsules will shift to Schedule 3 following the final decision on paracetamol access controls made by the Therapeutic Goods Administration (TGA) in 2023.
The aim is to reduce the volume of paracetamol kept in people’s homes to prevent harm from intentional overdose. Each year, around 225 Australians are hospitalised with liver injury and 50 Australians die from paracetamol overdose. The highest rates of intentional overdose are among adolescents and young adults – particularly females.
Pharmacists can help to reduce the amount of surplus paracetamol available in homes by being ‘champions for the change’, said Peter Guthrey MPS, PSA Senior Pharmacist – Strategic Policy.
‘While pharmacists know paracetamol is very safe when taken at recommended doses, we also know the devastating impact of intentional or unintentional overdose.
‘On Friday, PSA will be releasing the next edition of our flagship medicine safety report series which contains concerning data on the use of medicines, including paracetamol, in children and adolescents.’
‘The data on intentional overdose involving paracetamol is alarming … Scheduling changes are not the full solution, but are a strategy which could make a positive difference if it changes the patterns of paracetamol supply.’
Other countries have gone much further than Australia in limiting access to paracetamol, through measures such as scheduling and limiting pack purchases,’ he said.
What are the changes?
The TGA’s decision includes changes to both pack sizes and packaging. The new regulations affect pain relief products containing paracetamol as the sole active ingredient and cold and flu medicines containing paracetamol in combination with other ingredients.
Access to liquid, modified release and Prescription Only paracetamol is not affected by the changes.
| Jurisdiction | Changes |
| Nationally |
|
| Western Australia and Queensland |
|
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[post_content] => NSW pharmacist Anna Barwick MPS was awarded the Medal of the Order of Australia (OAM) in the 2025 Australia Day Honours.
Ms Barwick founded PharmOnline, an innovative platform which connects Australian patients living in remote areas with pharmacy services. A pharmacy academic from Walcha, NSW, she previously served on PSA’s NSW Branch Committee, including holding the role of vice-president from 2014-2020.
PSA National President Associate Professor Fei Sim FPS acknowledged Ms Barwick’s enormous contribution to pharmacy profession.
‘Anna is a truly outstanding pharmacist. A pioneer of innovation, she has consistently transformed access to care in her community and beyond,’ said A/Prof Sim.
‘I have been privileged to see first-hand Anna’s work, and hope that others are as inspired and energised as I am by her contribution to the community and to the next generation of pharmacists.
‘Long recognised by the profession, having won PSA’s Pharmacy Shark Tank award in 2021 and NSW Pharmacist of the Year in 2021, I am excited to see her achievements recognised on the national stage.
‘On behalf of PSA and the pharmacy profession, I sincerely congratulate Anna on this well-deserved recognition.’
Read more about 2021 PSA Pharmacist of tee Year Anna Barwick's passion for rural and remote pharmacy here.
[post_title] => Rural healthcare advocate honoured
[post_excerpt] => NSW pharmacist Anna Barwick MPS was awarded the Medal of the Order of Australia (OAM) in the 2025 Australia Day Honours.
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[post_content] => Highest risk travellers need additional support – from pharmacists.
Which of the following travel is highest risk to a person’s health?
A. An adrenaline-pumping adventure holiday in Queenstown, New Zealand.
B. Buck’s weekend in Bali.
C. Staying with family members in Sri Lanka for 3 months on long service leave.
D. A week visiting the ancient temples in Angkor Wat, Cambodia.
While each of these examples do have some risks, (C) is an example of VFR travel, which is generally considered much higher risk than travel to similar locations for primarily tourism or business purposes.
So why is this? And what is a VFR traveller?
We asked Associate Professor Holly Seale, a social scientist at the School of Population Health, University of New South Wales, what pharmacists need to know about this travel cohort and the unique risks they experience.
What is VFR travel?
VFR is a public health construct – “visiting friends and relatives (VFR)”. It categorises travellers who travel to lower-income countries for the purpose of visiting friends and relatives. Often these travellers are ethnically distinct from the majority population of the country of residence.
The definition of VFR has been updated in recent years, which requires:
This differs from previous approaches to VFR travellers based on indirect factors for health risk (e.g. administrative category of migrant, country of birth, destination), factors that may not be directly relevant to determining adverse health or disease outcomes.
VFR travellers are more likely to:
They often stay with family members or friends, have less control over their diets and are more likely to drink untreated water. The health risk gradient between the source and destination may also be influenced by:
What are the main vaccine-preventable diseases of concern for VFR travel?Previous studies have described VFR travellers at being at increased risk of malaria, traveller’s diarrhoea, intestinal parasites, typhoid, paratyphoid, viral hepatitis, and tuberculosis in comparison to tourists and business travellers.2
Barriers include:
Additionally, VFR travel is often booked late, so the time period between booking and flying often limits the ability to fit in multi-dose vaccines. It also means there is insufficient time for recommended vaccinations or boosters to become effective.
Sometimes it’s also a system barrier. GPs who consult in a language other than English, were less likely to consider VFR travellers at higher risk compared with holiday travellers. These GPs may be VFR travellers themselves and therefore subject to the same cultural perceptions of risk as other VFR travellers.3
With a low perception of risk and inadequate pre-travel health-seeking behaviour, an opportunistic approach to provision of pre-travel health advice to VFR travellers is required.
Opportunistic conversations about travel, especially among immunisers who may share a common language, may assist with identifying future travel plans and provide more time for fitting in vaccination.
Undergoing advanced training in travel medicine, will also support understanding about vaccine recommendations, travel risks and destinations etc.
Associate Professor Holly Seale is a social scientist researching social and behavioural factors impacting engagement with infectious disease prevention strategies at the University of New South Wales.
Holly Seale is an investigator on research studies funded by the NHMRC and has previously received funding from NSW Ministry of Health, as well as from Sanofi Pasteur, Moderna and Pfizer for investigator-driven research and consulting fees.
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[post_content] => Medication errors and poisonings are leading to a staggering number of avoidable hospitalisations among children and adolescents. Find out which medicines pose the biggest risks and how pharmacists can help turn the tide.
An alarming number of Australian children and adolescents are impacted by medicine-related harm. Every day, around 93 children present to emergency departments due to a medicine-related problem – half of which are preventable.
And adverse events due to medicines are all too commonplace, with an estimated 120,000 children aged 0–14 years affected in the last 6 months.
Along with the emotional and physical toll on children and their families, medicine-related harm also carries a significant financial burden to the tune of $130 million per annum.
These alarming statistics, and more, were highlighted in PSA’s Medicine safety: child and adolescent care report, released on Friday by PSA National President Associate Professor Fei Sim and Ged Kearney, Assistant Minister for Health and Aged Care Assistant Minister for Indigenous Health.
[caption id="attachment_28617" align="alignnone" width="500"] PSA National President Associate Professor Fei Sim and Ged Kearney, Assistant Minister for Health and Aged Care Assistant Minister for Indigenous Health[/caption]
‘Our health system is failing children and adolescents,’ said A/Prof Sim. ‘As a health community, we must commit to doing better, but we also need to be given the resources and tools to do better.’
Here’s a look at the key findings and the tangible solutions pharmacists can employ to make a difference.
Steep increase in self-poisonings among teens
Poisoning remains a major risk for children and adolescents, leading to around 8 hospitalisations daily.
Younger children are particularly susceptible to poisoning, often due to accidental ingestion or dosing errors. In children under 5 years of age, poisoning admissions increased from 12% in 2013–14 to 16% in 2022–23, with medicines affecting the cardiovascular system the most common cause.
While concerning, the number of hospitalisations among children aged 5–9 remains relatively low. But poisonings – both accidental and intentional – are increasingly prevalent in adolescents.
Paracetamol and antidepressants are the leading causes of poisoning-related hospital admissions, particularly among girls aged 10–14 years and adolescent females aged 15–19 years. In fact, 68% of all pharmaceutical poisoning admissions in 2022–23 were in adolescents aged 15–19 years.
Beyond hospital data, the New South Wales Poisons Information Centre (PIC) receives thousands of calls each year; among adolescents, calls about antidepressant exposures, including fluoxetine and sertraline, are increasingly prominent.
Off-label medicine use fuelling adverse reactions
Many medicines prescribed for children have not been specifically tested in paediatric populations, leading to widespread off-label use.
An estimated 12–45% of medicines used in children are off-label, increasing the risk of adverse reactions. And while medicine-medicine interactions are understudied in Australian children, international evidence suggests that exposure to major drug interactions in paediatric patients may be higher than anticipated.
With diagnoses of autism and ADHD on the rise – conditions which are linked to sleep disturbances – many parents are administering melatonin off-label to children, often obtaining it online and perceiving it as a ‘natural product’ rather than a medicine.
But the NSW PIC has received a growing number of melatonin exposure-related calls, with nearly 850 in 2022 alone.
Poisonings linked to clonidine, prescribed off-label for ADHD, are also frequently reported. Due to its tablet formulation, clonidine has been associated with dosing errors, particularly among young children – who may accidentally take a whole tablet instead of the prescribed half or quarter of a tablet.
Treating mental health conditions comes with risks
The significant uptick of mental ill health in today’s youth has led to a massive increase in the use of medicines for mental health conditions in children, including antidepressants and ADHD medications.
While these medicines can be beneficial, they are also associated with risks, including cardiometabolic side effects from antipsychotics and dependency risks from stimulants. A key issue is the lack of health literacy among parents and caregivers, leading to medication errors, inappropriate dosing, or failure to recognise adverse effects.
Pharmacists critical to harm prevention
The report’s release coincides with new restrictions on paracetamol pack sizes, which came into effect on Saturday 1 February, to reduce risks of intentional overdose. Pharmacy medicine packs are now limited to 50 tablets in most states, with larger packs upscheduled to Pharmacist Only medicines.
‘Paracetamol and antidepressants are the leading causes of poisoning-related hospital admissions, particularly among girls aged 10–14 years.'
‘By involving pharmacists in the supply of larger paracetamol pack sizes, we strike the right balance between access and safety, giving pharmacists and pharmacy assistants the opportunity to help patients manage their pain effectively while reducing the risk of misuse and harm,’ said A/Prof Sim.
The report suggests that mandating an indication on prescriptions could also ensure pharmacists verify the appropriateness of each medication. For example, when a child receives an antibiotic, pharmacists can confirm it’s suitable for the specific infection and the patient’s age before dispensing.
Accurate dosing is another key priority area. Given children’s dosage often depends on weight and age, pharmacists should manually check every paediatric dose rather than relying solely on automated systems. For example, if a 15 kg child is prescribed amoxicillin, pharmacists should calculate an appropriate mg/kg dose and contact the prescriber if it exceeds recommended limits.
From a systems perspective, designing a national medicine safety monitoring system – akin to Canada’s AIMS (Assurance and Improvement in Medication Safety) – will allow pharmacists to log and analyse medication errors in real time. This data-driven approach helps identify trends in paediatric medicine use, preventing repeated mistakes.
Removing legal barriers so pharmacists can modify medication formulations, such as creating a liquid formulation of clonidine for a child who can’t swallow pills, can also reduce errors and improve adherence.
But beyond clinical responsibilities, pharmacists should educate parents, teachers, and caregivers on medicine safety. This includes guidance on correct administration techniques, such as using a syringe for accurate measurement, and safe storage practices to prevent accidental ingestion.
‘Pharmacists are critical to ensure the safe use of medicines and must be supported to do so,’ said A/Prof Sim.
‘That means adequately staffing children’s hospital wards with the expertise of pharmacists, investing in systems that capture the data needed for evidence-based policy, and improving the quality use of medicines whenever medicines are used.
‘It takes all of us, across all areas of practice and indeed across all health professions, to make a difference to the children and adolescents who rely on our care.’
Access PSA’s full Medicine safety: child and adolescent care report here.
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[post_content] => Whether ‘tis nobler to use the foil bag to avoid the temperature excursions or . . . Putting William Shakespeare aside, what is the point of the foil bag?
Do foil bags keep medicines cold?
The National Vaccine Storage Guidelines ‘Strive for 5’ state that ‘foil bags commonly provided by pharmacists when vaccines are privately purchased are not effective in keeping vaccines at the correct temperature – for example, when the vaccine is left in a car or stored in a domestic refrigerator’.1
Suppliers of foil bags advise they are for transporting medicines that require short-term storage at a constant temperature until appropriate refrigeration can be reached.
They are not suitable for long-term storage.2 It is unclear whether foil bags provide thermal protection and for how long.
Some pharmacists use foil bags to remind the patient that the medicine in the bag needs to go in the fridge.
However, the patient should still be advised to take the medicine straight home to put it in the fridge and not to rely on the false sense of security that the foil bag will keep it cold while they ‘duck into the shops’.
What if the patient doesn’t have a fridge?
Not all patients have consistent access to a fridge (e.g. travelling, power outages, no fixed address).
It is useful to ask patients about this, and tailor your advice accordingly.
Cautionary Advisory Labels 6, 7a, 7b and 13 can supplement your verbal advice about storage where appropriate.3
For some medicines that require refrigeration, the approved Product Information (PI) contains guidance about room temperature storage options if refrigeration is unavailable or impractical.⁴
You can also offer to store the medicine or not-in-use containers at the pharmacy until needed (e.g. pending a doctor’s appointment, not-in-use insulin pens/cartridges).
Opened containers – in or out of the fridge?
It depends on the medicine.
The manufacturer has determined the stability and shelf-life of a medicine using the container and storage conditions outlined in the PI.
Keeping an in-use container in the fridge instead of at room temperature may extend its shelf-life. This might avoid wastage if the dose changes.
However, cold eye drops and injections can cause discomfort. They should generally be allowed to reach room temperature before they are administered.
In-use multi-dose injections or eye drops should be kept at room temperature unless otherwise advised by the PI.⁴
References
- Australian Government Department of Health. National Vaccine Storage Guidelines ‘Strive for 5’. 3rd edn. Canberra: Australian Government Department of Health; 2019.
- Stirling Fildes. Foil bags – medium. At: www.stirlingfildeshc.com.au/
- Sansom LN, ed. Australian Pharmaceutical Formulary and Handbook. 2024. At: https://apf.psa.org.au
- Medicines information. eMIMS cloud; [2024]. At: www.emims.com.au/Australia/drug/search
Our author
Claire Antrobus MPS (she/her) is PSA’s Manager – Practice Support.
[post_title] => To foil bag or not to foil bag, that is the question!
[post_excerpt] => Ever wondered about the point of foil bags and if they keep medicines cold? PSA clinical expert Claire Antrobus provides a helpful rundown.
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[post_content] => From February, pack sizes of paracetamol sold in pharmacies will change. Here’s what pharmacists need to know.
Come Saturday (1 February 2025), paracetamol in packs containing 50-100 tablets or capsules will shift to Schedule 3 following the final decision on paracetamol access controls made by the Therapeutic Goods Administration (TGA) in 2023.
The aim is to reduce the volume of paracetamol kept in people’s homes to prevent harm from intentional overdose. Each year, around 225 Australians are hospitalised with liver injury and 50 Australians die from paracetamol overdose. The highest rates of intentional overdose are among adolescents and young adults – particularly females.
Pharmacists can help to reduce the amount of surplus paracetamol available in homes by being ‘champions for the change’, said Peter Guthrey MPS, PSA Senior Pharmacist – Strategic Policy.
‘While pharmacists know paracetamol is very safe when taken at recommended doses, we also know the devastating impact of intentional or unintentional overdose.
‘On Friday, PSA will be releasing the next edition of our flagship medicine safety report series which contains concerning data on the use of medicines, including paracetamol, in children and adolescents.’
‘The data on intentional overdose involving paracetamol is alarming … Scheduling changes are not the full solution, but are a strategy which could make a positive difference if it changes the patterns of paracetamol supply.’
Other countries have gone much further than Australia in limiting access to paracetamol, through measures such as scheduling and limiting pack purchases,’ he said.
What are the changes?
The TGA’s decision includes changes to both pack sizes and packaging. The new regulations affect pain relief products containing paracetamol as the sole active ingredient and cold and flu medicines containing paracetamol in combination with other ingredients.
Access to liquid, modified release and Prescription Only paracetamol is not affected by the changes.
| Jurisdiction | Changes |
| Nationally |
|
| Western Australia and Queensland |
|
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[post_content] => NSW pharmacist Anna Barwick MPS was awarded the Medal of the Order of Australia (OAM) in the 2025 Australia Day Honours.
Ms Barwick founded PharmOnline, an innovative platform which connects Australian patients living in remote areas with pharmacy services. A pharmacy academic from Walcha, NSW, she previously served on PSA’s NSW Branch Committee, including holding the role of vice-president from 2014-2020.
PSA National President Associate Professor Fei Sim FPS acknowledged Ms Barwick’s enormous contribution to pharmacy profession.
‘Anna is a truly outstanding pharmacist. A pioneer of innovation, she has consistently transformed access to care in her community and beyond,’ said A/Prof Sim.
‘I have been privileged to see first-hand Anna’s work, and hope that others are as inspired and energised as I am by her contribution to the community and to the next generation of pharmacists.
‘Long recognised by the profession, having won PSA’s Pharmacy Shark Tank award in 2021 and NSW Pharmacist of the Year in 2021, I am excited to see her achievements recognised on the national stage.
‘On behalf of PSA and the pharmacy profession, I sincerely congratulate Anna on this well-deserved recognition.’
Read more about 2021 PSA Pharmacist of tee Year Anna Barwick's passion for rural and remote pharmacy here.
[post_title] => Rural healthcare advocate honoured
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[post_content] => Highest risk travellers need additional support – from pharmacists.
Which of the following travel is highest risk to a person’s health?
A. An adrenaline-pumping adventure holiday in Queenstown, New Zealand.
B. Buck’s weekend in Bali.
C. Staying with family members in Sri Lanka for 3 months on long service leave.
D. A week visiting the ancient temples in Angkor Wat, Cambodia.
While each of these examples do have some risks, (C) is an example of VFR travel, which is generally considered much higher risk than travel to similar locations for primarily tourism or business purposes.
So why is this? And what is a VFR traveller?
We asked Associate Professor Holly Seale, a social scientist at the School of Population Health, University of New South Wales, what pharmacists need to know about this travel cohort and the unique risks they experience.
What is VFR travel?
VFR is a public health construct – “visiting friends and relatives (VFR)”. It categorises travellers who travel to lower-income countries for the purpose of visiting friends and relatives. Often these travellers are ethnically distinct from the majority population of the country of residence.
The definition of VFR has been updated in recent years, which requires:
This differs from previous approaches to VFR travellers based on indirect factors for health risk (e.g. administrative category of migrant, country of birth, destination), factors that may not be directly relevant to determining adverse health or disease outcomes.
VFR travellers are more likely to:
They often stay with family members or friends, have less control over their diets and are more likely to drink untreated water. The health risk gradient between the source and destination may also be influenced by:
What are the main vaccine-preventable diseases of concern for VFR travel?Previous studies have described VFR travellers at being at increased risk of malaria, traveller’s diarrhoea, intestinal parasites, typhoid, paratyphoid, viral hepatitis, and tuberculosis in comparison to tourists and business travellers.2
Barriers include:
Additionally, VFR travel is often booked late, so the time period between booking and flying often limits the ability to fit in multi-dose vaccines. It also means there is insufficient time for recommended vaccinations or boosters to become effective.
Sometimes it’s also a system barrier. GPs who consult in a language other than English, were less likely to consider VFR travellers at higher risk compared with holiday travellers. These GPs may be VFR travellers themselves and therefore subject to the same cultural perceptions of risk as other VFR travellers.3
With a low perception of risk and inadequate pre-travel health-seeking behaviour, an opportunistic approach to provision of pre-travel health advice to VFR travellers is required.
Opportunistic conversations about travel, especially among immunisers who may share a common language, may assist with identifying future travel plans and provide more time for fitting in vaccination.
Undergoing advanced training in travel medicine, will also support understanding about vaccine recommendations, travel risks and destinations etc.
Associate Professor Holly Seale is a social scientist researching social and behavioural factors impacting engagement with infectious disease prevention strategies at the University of New South Wales.
Holly Seale is an investigator on research studies funded by the NHMRC and has previously received funding from NSW Ministry of Health, as well as from Sanofi Pasteur, Moderna and Pfizer for investigator-driven research and consulting fees.
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[post_content] => Medication errors and poisonings are leading to a staggering number of avoidable hospitalisations among children and adolescents. Find out which medicines pose the biggest risks and how pharmacists can help turn the tide.
An alarming number of Australian children and adolescents are impacted by medicine-related harm. Every day, around 93 children present to emergency departments due to a medicine-related problem – half of which are preventable.
And adverse events due to medicines are all too commonplace, with an estimated 120,000 children aged 0–14 years affected in the last 6 months.
Along with the emotional and physical toll on children and their families, medicine-related harm also carries a significant financial burden to the tune of $130 million per annum.
These alarming statistics, and more, were highlighted in PSA’s Medicine safety: child and adolescent care report, released on Friday by PSA National President Associate Professor Fei Sim and Ged Kearney, Assistant Minister for Health and Aged Care Assistant Minister for Indigenous Health.
[caption id="attachment_28617" align="alignnone" width="500"] PSA National President Associate Professor Fei Sim and Ged Kearney, Assistant Minister for Health and Aged Care Assistant Minister for Indigenous Health[/caption]
‘Our health system is failing children and adolescents,’ said A/Prof Sim. ‘As a health community, we must commit to doing better, but we also need to be given the resources and tools to do better.’
Here’s a look at the key findings and the tangible solutions pharmacists can employ to make a difference.
Steep increase in self-poisonings among teens
Poisoning remains a major risk for children and adolescents, leading to around 8 hospitalisations daily.
Younger children are particularly susceptible to poisoning, often due to accidental ingestion or dosing errors. In children under 5 years of age, poisoning admissions increased from 12% in 2013–14 to 16% in 2022–23, with medicines affecting the cardiovascular system the most common cause.
While concerning, the number of hospitalisations among children aged 5–9 remains relatively low. But poisonings – both accidental and intentional – are increasingly prevalent in adolescents.
Paracetamol and antidepressants are the leading causes of poisoning-related hospital admissions, particularly among girls aged 10–14 years and adolescent females aged 15–19 years. In fact, 68% of all pharmaceutical poisoning admissions in 2022–23 were in adolescents aged 15–19 years.
Beyond hospital data, the New South Wales Poisons Information Centre (PIC) receives thousands of calls each year; among adolescents, calls about antidepressant exposures, including fluoxetine and sertraline, are increasingly prominent.
Off-label medicine use fuelling adverse reactions
Many medicines prescribed for children have not been specifically tested in paediatric populations, leading to widespread off-label use.
An estimated 12–45% of medicines used in children are off-label, increasing the risk of adverse reactions. And while medicine-medicine interactions are understudied in Australian children, international evidence suggests that exposure to major drug interactions in paediatric patients may be higher than anticipated.
With diagnoses of autism and ADHD on the rise – conditions which are linked to sleep disturbances – many parents are administering melatonin off-label to children, often obtaining it online and perceiving it as a ‘natural product’ rather than a medicine.
But the NSW PIC has received a growing number of melatonin exposure-related calls, with nearly 850 in 2022 alone.
Poisonings linked to clonidine, prescribed off-label for ADHD, are also frequently reported. Due to its tablet formulation, clonidine has been associated with dosing errors, particularly among young children – who may accidentally take a whole tablet instead of the prescribed half or quarter of a tablet.
Treating mental health conditions comes with risks
The significant uptick of mental ill health in today’s youth has led to a massive increase in the use of medicines for mental health conditions in children, including antidepressants and ADHD medications.
While these medicines can be beneficial, they are also associated with risks, including cardiometabolic side effects from antipsychotics and dependency risks from stimulants. A key issue is the lack of health literacy among parents and caregivers, leading to medication errors, inappropriate dosing, or failure to recognise adverse effects.
Pharmacists critical to harm prevention
The report’s release coincides with new restrictions on paracetamol pack sizes, which came into effect on Saturday 1 February, to reduce risks of intentional overdose. Pharmacy medicine packs are now limited to 50 tablets in most states, with larger packs upscheduled to Pharmacist Only medicines.
‘Paracetamol and antidepressants are the leading causes of poisoning-related hospital admissions, particularly among girls aged 10–14 years.'
‘By involving pharmacists in the supply of larger paracetamol pack sizes, we strike the right balance between access and safety, giving pharmacists and pharmacy assistants the opportunity to help patients manage their pain effectively while reducing the risk of misuse and harm,’ said A/Prof Sim.
The report suggests that mandating an indication on prescriptions could also ensure pharmacists verify the appropriateness of each medication. For example, when a child receives an antibiotic, pharmacists can confirm it’s suitable for the specific infection and the patient’s age before dispensing.
Accurate dosing is another key priority area. Given children’s dosage often depends on weight and age, pharmacists should manually check every paediatric dose rather than relying solely on automated systems. For example, if a 15 kg child is prescribed amoxicillin, pharmacists should calculate an appropriate mg/kg dose and contact the prescriber if it exceeds recommended limits.
From a systems perspective, designing a national medicine safety monitoring system – akin to Canada’s AIMS (Assurance and Improvement in Medication Safety) – will allow pharmacists to log and analyse medication errors in real time. This data-driven approach helps identify trends in paediatric medicine use, preventing repeated mistakes.
Removing legal barriers so pharmacists can modify medication formulations, such as creating a liquid formulation of clonidine for a child who can’t swallow pills, can also reduce errors and improve adherence.
But beyond clinical responsibilities, pharmacists should educate parents, teachers, and caregivers on medicine safety. This includes guidance on correct administration techniques, such as using a syringe for accurate measurement, and safe storage practices to prevent accidental ingestion.
‘Pharmacists are critical to ensure the safe use of medicines and must be supported to do so,’ said A/Prof Sim.
‘That means adequately staffing children’s hospital wards with the expertise of pharmacists, investing in systems that capture the data needed for evidence-based policy, and improving the quality use of medicines whenever medicines are used.
‘It takes all of us, across all areas of practice and indeed across all health professions, to make a difference to the children and adolescents who rely on our care.’
Access PSA’s full Medicine safety: child and adolescent care report here.
[post_title] => Why are so many children harmed from medicines?
[post_excerpt] => Medication errors and poisonings are leading to a staggering number of avoidable hospitalisations among children and adolescents.
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[post_content] => Whether ‘tis nobler to use the foil bag to avoid the temperature excursions or . . . Putting William Shakespeare aside, what is the point of the foil bag?
Do foil bags keep medicines cold?
The National Vaccine Storage Guidelines ‘Strive for 5’ state that ‘foil bags commonly provided by pharmacists when vaccines are privately purchased are not effective in keeping vaccines at the correct temperature – for example, when the vaccine is left in a car or stored in a domestic refrigerator’.1
Suppliers of foil bags advise they are for transporting medicines that require short-term storage at a constant temperature until appropriate refrigeration can be reached.
They are not suitable for long-term storage.2 It is unclear whether foil bags provide thermal protection and for how long.
Some pharmacists use foil bags to remind the patient that the medicine in the bag needs to go in the fridge.
However, the patient should still be advised to take the medicine straight home to put it in the fridge and not to rely on the false sense of security that the foil bag will keep it cold while they ‘duck into the shops’.
What if the patient doesn’t have a fridge?
Not all patients have consistent access to a fridge (e.g. travelling, power outages, no fixed address).
It is useful to ask patients about this, and tailor your advice accordingly.
Cautionary Advisory Labels 6, 7a, 7b and 13 can supplement your verbal advice about storage where appropriate.3
For some medicines that require refrigeration, the approved Product Information (PI) contains guidance about room temperature storage options if refrigeration is unavailable or impractical.⁴
You can also offer to store the medicine or not-in-use containers at the pharmacy until needed (e.g. pending a doctor’s appointment, not-in-use insulin pens/cartridges).
Opened containers – in or out of the fridge?
It depends on the medicine.
The manufacturer has determined the stability and shelf-life of a medicine using the container and storage conditions outlined in the PI.
Keeping an in-use container in the fridge instead of at room temperature may extend its shelf-life. This might avoid wastage if the dose changes.
However, cold eye drops and injections can cause discomfort. They should generally be allowed to reach room temperature before they are administered.
In-use multi-dose injections or eye drops should be kept at room temperature unless otherwise advised by the PI.⁴
References
- Australian Government Department of Health. National Vaccine Storage Guidelines ‘Strive for 5’. 3rd edn. Canberra: Australian Government Department of Health; 2019.
- Stirling Fildes. Foil bags – medium. At: www.stirlingfildeshc.com.au/
- Sansom LN, ed. Australian Pharmaceutical Formulary and Handbook. 2024. At: https://apf.psa.org.au
- Medicines information. eMIMS cloud; [2024]. At: www.emims.com.au/Australia/drug/search
Our author
Claire Antrobus MPS (she/her) is PSA’s Manager – Practice Support.
[post_title] => To foil bag or not to foil bag, that is the question!
[post_excerpt] => Ever wondered about the point of foil bags and if they keep medicines cold? PSA clinical expert Claire Antrobus provides a helpful rundown.
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[post_content] => From February, pack sizes of paracetamol sold in pharmacies will change. Here’s what pharmacists need to know.
Come Saturday (1 February 2025), paracetamol in packs containing 50-100 tablets or capsules will shift to Schedule 3 following the final decision on paracetamol access controls made by the Therapeutic Goods Administration (TGA) in 2023.
The aim is to reduce the volume of paracetamol kept in people’s homes to prevent harm from intentional overdose. Each year, around 225 Australians are hospitalised with liver injury and 50 Australians die from paracetamol overdose. The highest rates of intentional overdose are among adolescents and young adults – particularly females.
Pharmacists can help to reduce the amount of surplus paracetamol available in homes by being ‘champions for the change’, said Peter Guthrey MPS, PSA Senior Pharmacist – Strategic Policy.
‘While pharmacists know paracetamol is very safe when taken at recommended doses, we also know the devastating impact of intentional or unintentional overdose.
‘On Friday, PSA will be releasing the next edition of our flagship medicine safety report series which contains concerning data on the use of medicines, including paracetamol, in children and adolescents.’
‘The data on intentional overdose involving paracetamol is alarming … Scheduling changes are not the full solution, but are a strategy which could make a positive difference if it changes the patterns of paracetamol supply.’
Other countries have gone much further than Australia in limiting access to paracetamol, through measures such as scheduling and limiting pack purchases,’ he said.
What are the changes?
The TGA’s decision includes changes to both pack sizes and packaging. The new regulations affect pain relief products containing paracetamol as the sole active ingredient and cold and flu medicines containing paracetamol in combination with other ingredients.
Access to liquid, modified release and Prescription Only paracetamol is not affected by the changes.
| Jurisdiction | Changes |
| Nationally |
|
| Western Australia and Queensland |
|
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[post_content] => NSW pharmacist Anna Barwick MPS was awarded the Medal of the Order of Australia (OAM) in the 2025 Australia Day Honours.
Ms Barwick founded PharmOnline, an innovative platform which connects Australian patients living in remote areas with pharmacy services. A pharmacy academic from Walcha, NSW, she previously served on PSA’s NSW Branch Committee, including holding the role of vice-president from 2014-2020.
PSA National President Associate Professor Fei Sim FPS acknowledged Ms Barwick’s enormous contribution to pharmacy profession.
‘Anna is a truly outstanding pharmacist. A pioneer of innovation, she has consistently transformed access to care in her community and beyond,’ said A/Prof Sim.
‘I have been privileged to see first-hand Anna’s work, and hope that others are as inspired and energised as I am by her contribution to the community and to the next generation of pharmacists.
‘Long recognised by the profession, having won PSA’s Pharmacy Shark Tank award in 2021 and NSW Pharmacist of the Year in 2021, I am excited to see her achievements recognised on the national stage.
‘On behalf of PSA and the pharmacy profession, I sincerely congratulate Anna on this well-deserved recognition.’
Read more about 2021 PSA Pharmacist of tee Year Anna Barwick's passion for rural and remote pharmacy here.
[post_title] => Rural healthcare advocate honoured
[post_excerpt] => NSW pharmacist Anna Barwick MPS was awarded the Medal of the Order of Australia (OAM) in the 2025 Australia Day Honours.
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[post_content] => Highest risk travellers need additional support – from pharmacists.
Which of the following travel is highest risk to a person’s health?
A. An adrenaline-pumping adventure holiday in Queenstown, New Zealand.
B. Buck’s weekend in Bali.
C. Staying with family members in Sri Lanka for 3 months on long service leave.
D. A week visiting the ancient temples in Angkor Wat, Cambodia.
While each of these examples do have some risks, (C) is an example of VFR travel, which is generally considered much higher risk than travel to similar locations for primarily tourism or business purposes.
So why is this? And what is a VFR traveller?
We asked Associate Professor Holly Seale, a social scientist at the School of Population Health, University of New South Wales, what pharmacists need to know about this travel cohort and the unique risks they experience.
What is VFR travel?
VFR is a public health construct – “visiting friends and relatives (VFR)”. It categorises travellers who travel to lower-income countries for the purpose of visiting friends and relatives. Often these travellers are ethnically distinct from the majority population of the country of residence.
The definition of VFR has been updated in recent years, which requires:
This differs from previous approaches to VFR travellers based on indirect factors for health risk (e.g. administrative category of migrant, country of birth, destination), factors that may not be directly relevant to determining adverse health or disease outcomes.
VFR travellers are more likely to:
They often stay with family members or friends, have less control over their diets and are more likely to drink untreated water. The health risk gradient between the source and destination may also be influenced by:
What are the main vaccine-preventable diseases of concern for VFR travel?Previous studies have described VFR travellers at being at increased risk of malaria, traveller’s diarrhoea, intestinal parasites, typhoid, paratyphoid, viral hepatitis, and tuberculosis in comparison to tourists and business travellers.2
Barriers include:
Additionally, VFR travel is often booked late, so the time period between booking and flying often limits the ability to fit in multi-dose vaccines. It also means there is insufficient time for recommended vaccinations or boosters to become effective.
Sometimes it’s also a system barrier. GPs who consult in a language other than English, were less likely to consider VFR travellers at higher risk compared with holiday travellers. These GPs may be VFR travellers themselves and therefore subject to the same cultural perceptions of risk as other VFR travellers.3
With a low perception of risk and inadequate pre-travel health-seeking behaviour, an opportunistic approach to provision of pre-travel health advice to VFR travellers is required.
Opportunistic conversations about travel, especially among immunisers who may share a common language, may assist with identifying future travel plans and provide more time for fitting in vaccination.
Undergoing advanced training in travel medicine, will also support understanding about vaccine recommendations, travel risks and destinations etc.
Associate Professor Holly Seale is a social scientist researching social and behavioural factors impacting engagement with infectious disease prevention strategies at the University of New South Wales.
Holly Seale is an investigator on research studies funded by the NHMRC and has previously received funding from NSW Ministry of Health, as well as from Sanofi Pasteur, Moderna and Pfizer for investigator-driven research and consulting fees.
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.
