National President’s Message: COVID-19 Update

7 April 2020

 

I know that some pharmacists are nearly at breaking point. The concern that keeps me up at night is that this is only the start, and that our workforce unlike any other health worker, has over the past six weeks endured panic buying, hoarding and during the midst of all of this attempting to deliver the same level of healthcare that we always have.

 

I also know that you, working with your local teams and doctors have been fixing the challenges associated with the implementation of image-based prescribing, where doctors can send you an email, fax or text of a copy of the prescription. I know this has been challenging with a lack of information about what to do. We, like you have been frustrated about this, and will continue to work through these challenges so that you can work in safety, and patients can stay at home.

 

I know that the lead-up to the Easter break is frantically busy in pharmacy. While the busyness will still be there, this year Easter will be different from any year before – both professionally and at home.

 

I know many of you are all already exhausted and are working endlessly in a constantly changing and challenging work environment. Fatigue is getting to a point where the initial acute response and energy that was required from us all in our workplaces is taking a toll.

 

Taking care of yourself and managing your mental health and psychological well-being during this time is as important as managing your physical health.

 

If you can, I urge you to please try to take some time out over the Easter break to try to recharge and connect with those most important to you. If you can’t take the time out this long weekend, look for opportunities to do so as soon as possible as this pandemic will be ongoing for a while.

 

It is important to reach out to colleagues and those close to you if you are struggling psychologically as well as utilising the Pharmacists’ Support Service and other mental health support systems. This is not a sprint; it’s a marathon.

 

Medicine reviews: the need for follow-up visits and telehealth

 

We continue to work with the Department of Health and the Minister for Health on ensuring that medicine management reviews can be performed through telehealth arrangements.

 

I would like to thank Minister Hunt and the Department for the positive approach to addressing this issue. We are of the view that these services remain critical in the COVID-19 pandemic.

 

In addition to telehealth, PSA has been strongly advocating for the introduction of follow-up visits for HMRs and RMMRs enacting the recommendations from the interim report from the Royal Commission on Aged Care Safety and Quality.

 

As you will know, it is not possible to solve all medicine safety problems for most people in a single intervention or review. COVID-19 has amplified the need to introduce this as soon as possible to ensure that medicine-related harm does not magnify because of the pandemic.

 

Some problems take multiple reviews to address. Other problems may not emerge until more significant problems have been sorted.

 

Follow-up visits provides an opportunity for pharmacists to deliver subsequent consultations based on an individual patient’s circumstances and clinical need. The timeline for and need for follow up should be determined at the time of the initial review.

 

I believe there is real merit in also reviewing and removing the caps on Medscheck services at this point to allow more consultations to be conducted, including by telehealth, to enable pharmacists to check-in on people at home to ensure that they are using their medicines appropriately.

 

Customer abuse

 

We have been hearing from our members concerning reports about physical assaults on you and your staff.

 

This is unacceptable. This is not okay. This sort of the behaviour from members of the public is reprehensible and it is important that you are all safe in your workplace.

 

Australia’s leaders have appropriately declared zero tolerance of any abusive behaviour towards you and other health professionals on the front line of this pandemic.

 

The Western Australian Government, though the advocacy of health professional peak bodies including the PSA, has passed legislation which means people who threaten or abuse pharmacists and other health professionals will face up to 10 years jail. PSA is writing to all State and Territory governments to mirror these laws. PSA wants to send a clear message for pharmacists to the community, threats and abuse are unacceptable.

 

I am heartened to hear reports of police supporting you when there are reports of violence of abuse and I encourage you to contact them when you need to.

 

I want to thank all of you for being professional and not accepting unacceptable behaviour while protecting Australian’s medicine supply through enforcing limits as people try to unnecessarily stockpile.

 

COVID-19: Health system update

 

With international and state border quarantine measures now in place for the foreseeable future, suppressing COVID-19 transmission is now focussed on introducing measures to better detect community transmission.

 

Most jurisdictions are now revising their testing criteria for COVID-19 to include much broader groups of people with coronavirus symptoms such as workers with community contact in their role, vulnerable people and older Australians. You should be familiar with the testing criteria in your area and the locations where testing is available. We know that this does shift over time, and the best place to understand the details of testing is here.

 

The use of masks remains a vexed issue. Personal Protective Equipment is not in surplus supply. That is why the recommendations for the use of face masks in the general community remains unchanged at this stage, that is reserved for those at high risk such as immunocompromised, suspected contact and need to leave the house for any reason. Individuals may choose to use cloth or masks made of other materials as recommended by the WHO.

 

We will continue to follow Australian advice when it comes to PPE, though individual pharmacists should choose the measures that they believe give them an appropriate level of comfort especially if close contact with patients is present.

 

I, of course, will keep you informed if the advice from the Government changes in regards to face masks.

 

In the interim keeping the high level of adherence to hand hygiene. Physical distancing and screening out at-risk patients.

 

Vaccinations

 

Many of you have contacted me and PSA seeking advice on the risk of COVID-19 transmission during vaccination. The best thing you can do to keep yourself and your patients as safe as possible is a strong initial screening process.

 

Many medical practices and pharmacies have automated booking and reminder systems so if you haven’t done this already, please add these warnings ASAP. You can set them up upon the patient booking and also in the reminder emails/texts to patients.

 

The other measure you can take is to ensure clear signage is displayed throughout the pharmacy about these risk and precautions

 

Use this as an opportunity to remind your patients of the physical distancing when they are in the pharmacy especially during their 15 mins observation period as well as hand hygiene and cough etiquette. Providing access to hand sanitiser on the way in and at stations in your pharmacy is essential.

 

As it is not an aerosol-generating procedure current advice for primary care is that immunisation presents a low risk of transmission to the healthcare provider. Where PPE is in such short supply, the use of masks are not currently recommended.

 

As the risk of community exposure increases public health agencies are reviewing their recommendations. I will keep you informed of evolving advice from the Chief Medical Officer. And of course, if a staff member is unwell we would ask them to follow advice and not attend work.

 

To find out the advice from your particular state or territory health department you can access information here.

 

Pharmacy shutdowns due to COVID-19

 

In most pharmacy environments, it is likely most of your work colleagues would be considered a close contact if you were to become COVID-19 positive. For most pharmacists in Australia this could threaten the ability of your workplace or business to continue operating.

 

We have already seen a handful of community pharmacies have to temporarily close after a positive COVID-19 result, as well as seen reports of some hospital staffing challenges following need to self-isolate groups of health practitioners.

 

As an essential community services, whether that be in a community pharmacy, hospital or other health setting, it is important pharmacists have contingencies which ensure their patients have access to ongoing pharmacist care and access to medicines.

 

Common contingencies include:

• Separating pharmacists and pharmacy staff into discrete teams who do not work with each other during COVID-19 (e.g. ‘Team A’ and ‘Team B’). Handover between these teams should be minimal and done remotely if possible.
• Discussion with colleagues in nearby pharmacies to identify possible options to support continuity of care if your business has to temporarily suspend operations
• Undertaking activities such as medicine review, medicine counselling or administrative tasks where possible from self-isolation if you are well enough to do so
• Minimising physical and longer consultations with patients unless necessary to do so.

 

There are also government measures that need to be seriously addressed to support community pharmacy as an essential workplace.

 

The Government’s JobKeeper package should be extended to all community pharmacies across the country to ensure they remain open, appropriately staffed and safe.

 

The JobKeeper package as announced by the Government necessitating a 30% reduction in revenue, simply does not address the increased cost of keeping community pharmacies open in this dire time.

 

I was also heartened to see the Rural Pharmacy Network of Australia (RPNA) suggest a rural guarantee for Australian community pharmacies. This suggestion, as a temporary supplement to the Rural Pharmacy Maintenance Allowance, is sensible.

 

Keeping unwell patients out of your pharmacy

 

It’s becoming well-known that the best defence our community has against COVID-19 is physical distancing. This means keeping potential cases outside of health care settings and environments not designed to assess and manage people who are potentially coronavirus-positive.

 

Patients should not be coming into a pharmacy if they have any of the possible COVID-19 symptoms: particularly fever, cough, sore throat or shortness of breath.

 

People presenting with these symptoms should be supported outside the pharmacy through contactless means (such as telephone, car window-drop, home delivery or post) and also referred to the coronavirus hotline for further guidance as appropriate.

 

Much like other providers of essential services, signage and screening of people at the entrances to premises can help achieve this.

 

While community pharmacies are generally exempt from public gathering limits, physical distancing should be observed at all times – that being maintaining 1.5m distances as far as practical between all people at all times – staff and patients included.

 

Therapeutic substitution

 

Last week the Australian Government announced it will implement changes to allow pharmacists to substitute dose strengths or forms of medicines without prior approval from the prescribing doctor, if a medicine is unavailable at the time of dispensing.

 

We continue to work through this measure in a meaningful way with the Department of Health, through the Therapeutic Goods Administration.

 

I want to make sure that red tape is removed from this process and that bureaucratic approvals are removed from the end goal which is to ensure your patients get the medicine they need at the dose they need. I will keep you informed of progress in this area.

 

These substitutions are well-within the existing skillset of every pharmacist within Australia and are well-overdue, but they must not be mired in unnecessary bureaucracy and approvals.

 

A pharmacist can substitute 2 x 20mg of a molecule to make 40mg, we don’t need bureaucrats to tell us we can do it.

 

It is important to note that these changes have not yet come into effect. Specific details of the changes are yet to be released and I will continue to work with the Government on this commitment.

 

COVID-19 webinar

 

Tomorrow night we’ll be continuing our COVID-19 Webinar series, this time the third webinar in our series will focus on what pharmacists in both hospital and community settings can do to support immunocompromised patients.

 

These are the patients who have the potential to be greatly affected by medicines supply, and are most at risk for developing infection. And, in the case of chemotherapy patients, we’re seeing more of them be initiated on, and managed through, community pharmacy.

 

I’ll be joined by Australia’s only dual infectious disease and rheumatologist physician, Associate Professor Alistair Reid, who is eminently qualified to answer all your questions about both infection control and supporting your patients. If you would like to join us please register here.

 

Stay up-to-date

 

I encourage you to go to visit our dedicated COVID-19 website which is continually updated with the latest information that you need to be supported while you care for the community during the COVID-19 crisis. There are a series of FAQs on the website and can be found here.

 

Please contact our team or myself for support, feedback or any inquiries you may have at membership@psa.org.au.

 

In closing, I want to wish you and your loved ones the very best over this long weekend. From all of us @YourPSA, we wish you to be safe and to thank you again for all your support and for all the essential work you do as pharmacists.

 

Sincerely,

Associate Professor Chris Freeman
National President
Pharmaceutical Society of Australia

National President’s Message: COVID-19 Update

1 April 2020

 

The past week has been tough for everyone. Tough for Australians who have lost their jobs. Tough for families who need to keep distance from their loved ones. Tough for pharmacists and their teams working extended hours with little rest to support the health needs of Australians. And I know that number of you already feel like you’re at breaking point.

 

I am so proud at how pharmacists everywhere are adapting, innovating and providing inspiration to their colleagues while caring for their community.

 

These are just some of the extraordinary measures pharmacists are undertaking to ensure they continue to provide a safe environment for them, their staff and the best healthcare for their communities.

 

As another week of unprecedented challenges looms, in today’s message I have detailed just some of the changes and issues that have arisen this past week.

 

Job Keeper announcement

 

The Prime Minister and Treasurer yesterday announced a once in a lifetime $130bn package to support the income of Australian employees during COVID-19.  At first glance, the majority of pharmacists and pharmacy staff would not be eligible for this payment as the businesses must have revenue projected to decline >30% year-on-year to be eligible.

 

The initial surge in demand for community pharmacy will mean it’s unlikely you might see a >30% decline in revenue. PSA is very conscious that this might change as the pandemic develops and there may be dips in revenue, particularly in discretionary front-of-pharmacy spending.

 

This will occur at a time when costs of providing essential pharmacist services to the community are significantly higher due to PPE, cleaning requirements and the need to adopt to alternative medicine delivery models.

 

PSA is engaging the Treasury and the ATO to see if there are some specific concessions which can be made for pharmacy. In all the daily conversations I have had with bureaucrats and elected officials, it’s clear the Government is very aware of the immense challenges pharmacists face and try to work towards access to measures which provide stability for pharmacists, their employers and most importantly the community during the COVID-19 pandemic.

 

Expanded Continued Dispensing during COVID-19: ensuring continuity of access to essential medicines.

 

The Health Minister this morning announced an expansion to Continued Dispensing – Emergency measures which will see Australians able to access any PBS/RPBS medicine (excluding S100 medicines) in an emergency without a prescription.

 

This is an extension of the funding arrangements announced earlier this year in response to the bushfire crisis. It is a measure that I have been in constant communication with the Government about over the past couple of months and I welcome this announcement.

 

In the past week, Western Australia, NSW, Victoria, South Australian, Tasmania and ACT governments have all moved to ensure continuity of access to medicines through expanded emergency supply provisions (for PBS and non-PBS medicines). I understand all other jurisdictions are also rapidly undertaking regulatory work needed to enable access to this initiative.

 

These measures provide sensible and pragmatic options to continue essential medicines if prescribers are unexpectedly unavailable or consumers are unexpectedly isolated at home.

 

It is vitally important the profession is judicious in their use of these provisions. Professional guidelines, state regulatory instruments and Continued Dispensing Program Rules govern the scope and limitations of this service. Patients can only access this initiative when it is impractical for them to access a prescription from their regular doctor – and they can only access each PBS/RPBS medicine once in a 12-month period via this initiative.

 

An Addendum to the Continued Dispensing Guidelines will shortly be published on PSA’s website, along with FAQs and other supporting resources.

 

Therapeutic Substitution

 

The Australian Government also announced today it will implement changes to allow pharmacists to substitute dose strengths or forms of medicines without prior approval from the prescribing doctor, if a medicine is unavailable at the time of dispensing.

 

The changes, which I have been working on with the Government and Department of Health over recent months, will allow a pharmacist to dispense different strengths of a product (such as two 20mg tablets in place of a 40mg tablet), or a different dose form of the same medicine (such as a capsule instead of a tablet).

 

Specific details have not yet been released, but the Commonwealth has advised the changes will be implemented through the Scheduling Policy Framework and Poisons Standard, with implementation by States and Territories and the Government through the TGA.

 

I strongly supports this announcement and will continue to work with the Government on this commitment and potential expansion of these substitution measures. I will provide guidance to members in my weekly messages to you on this common sense initiative as more information becomes available.

 

Infection control: Protecting yourself, your colleagues and your community

 

I’ve heard from many of you regarding your concerns on how to protect you and your colleagues from transmission of COVID-19 in your workplace.  This has seen many pharmacists work to develop changes to their work environments, including innovative adjustments to workflow, such as one way customer flow, limiting patient numbers in your pharmacy or closing premises for brief periods for cleaning and breaks.

 

Hand hygiene and social distancing remain the most significant protection against COVID-19, and as far as possible pharmacists should be working with their colleagues and patients to maintain these protections at all times.

 

As the influenza season approaches, concerns regarding how vaccinations can be safely administered by pharmacists during a phase of COVID-19 community transmission has increased.

 

At this stage, PSA’s advice remains that vaccination proceeds, but that pharmacists perform appropriate close contact measures such as measuring a surgical mask at least, along with using gloves and hand sanitiser. This includes not vaccinating anyone with fever or cold and flu like symptoms.

 

Limits on medicines

 

The introduction of these limits have been particularly difficult for pharmacists, particularly in the face of consumer aggression and abuse at imposing restrictions on the volumes of medicines they can access.

 

While some lines are starting to return towards normal stock levels with wholesalers, it is vital these limits continue to be enforced.  This will ensure our medicine supply chain will withstand the pressures thrown at it during the COVID-19 pandemic.

 

Where multiple months’ supply of medicines are requested, particularly by people who are self-isolating, pharmacists should encourage other options such as medicine delivery services.

 

Evidence requirements for supply of salbutamol as a Pharmacist Only Medicine

 

An amendment to the SUSMP last week provided legal backing to the announcement pharmacists require evidence of medical diagnosis of a respiratory condition or dispensing history for salbutamol MDI to legally supply salbutamol MDI as a Pharmacist Only Medicine (Schedule 3).

 

Members have reported this measure has been generally well received by those with long-standing conditions such as COPD, bronchiectasis and chronic asthma in providing confidence in being able to access vital medicines. I have also received reports about aggression and confusion from some people seeking salbutamol who were unaware of this change.

 

Anecdotally, members have reported to me that this evidence change has identified a large number of consumers who appear to be self-managing respiratory symptoms with salbutamol at a frequency suggestive of the need for medical review for an undiagnosed condition.

 

It is important these people receive an appropriate diagnosis and therapy in the early stages of the COVID-19 pandemic as we know COVID-19 infection outcomes for people with respiratory conditions are more severe than those for the general population.

 

FAQs and resources on this issue are available on the PSA COVID-19 website.

 

Immunisation Webinar – Covid-19: Your Immunisation Questions Answered.

 

I would like to thank so many of you for attending our COVID-19 webinar last Wednesday. We had more than 500 pharmacists attend the webinar and I would like to thank Associate Professor Charlotte Hespe who stood in for Professor Robert Booy.

 

You had some insightful questions that demonstrated the pressures that pharmacists have been under. And in response to your many questions about vaccination during COVID-19 with the upcoming influenza season, I will be running another webinar tomorrow night from 7.30pm to 8.30pm AEDT with Associate Professor Hespe on the topic of immunisations and how to vaccinate your patients safely.

 

I encourage you to register here and ask any questions you may have on immunisation and any other COVID-19 questions you are uncertain about.

 

Medicine reviews via telehealth

 

On Sunday, the Health Minister made strong announcements to support telehealth services, such as GP and psychology consultations, during the COVID-19 pandemic, declaring “As of tomorrow, we will have universal telehealth available in Australia and that “Everything which can be done by telehealth will be done by telehealth”.

 

I will continue to work with the Department of Health and the Minister for Health to ensure that medicine management programs are available to be delivered where appropriate by telehealth arrangements.

 

Now, more than ever, it is critical to minimise adverse drug outcomes in the community and aged care settings, to free hospital beds for the national response to COVID-19 and I will continue to work on this measure and keep you informed of progress.

 

Personal Protective Equipment (PPE)

 

I have been hearing from many members about the use of PPE. This includes everything from whether pharmacists and pharmacy staff should be routinely wearing PPE to how pharmacies can access PPE. These are important questions in a rapidly evolving environment and I’m keen to address these concerns as quickly as possible.

 

PSA is in the process of developing FAQs to complement existing primary care guidelines for pharmacist and pharmacy staff which will be published on the PSA COVID-19 microsite.

 

In the meantime, the Department of Health has issued interim guidance for the use of PPE, intended for practitioners in primary health care settings. Read the interim advice here.

 

To obtain PPE for your pharmacy from the National Medicines Stockpile, contact your local Primary Health Network. The contact details for all 31 PHNs can be accessed here.

 

PSA

 

Your PSA teams around the country are now predominantly in work-from-home arrangements; liaising with government agencies, supporting you on the phone, and developing resources which helps the profession to play its role in the pandemic response.

 

I am pleased this transition has been a smooth one and members continue to be able to access all member services.

 

Keep up to date

 

Our dedicated COVID-19 website is continually updated with the latest information that you need to be supported while you care for the community during the COVID-19 crisis.

 

Please contact our team or myself for support, feedback or inquiries you may have at membership@psa.org.au.

 

This is another pivotal week in Australia’s pandemic response.  One of the most important ways you can contribute to Australia’s response this week is to echo public health messages on social distancing to your patients: #StayatHome – if you are not buying essential supplies, working, exercising locally or seeking essential health care you must stay at home.

 

PSA anticipates further announcements which affect pharmacist care through this week. Your PSA will keep you up-to-date on these announcements as they happen.

 

Sincerely,

Associate Professor Chris Freeman
National President
Pharmaceutical Society of Australia