National President’s Message:
 COVID-19 Update

25 March 2020

 

I want to start by just acknowledging all the extraordinary work pharmacists are doing across the country during this global pandemic. Our profession is the bedrock of the community, and everyday pharmacists are stepping up day after day in some of the most challenging circumstances we have ever faced as a nation. Thank you.

 

As an essential service, pharmacists will continue to be challenged like never before as they are called upon by Governments and the community to protect the most vulnerable in our society and continue to care for their patients.

 

We have seen the very worst in our community and the very best. I know many of you, like the whole country, are feeling stressed and uncertain. We are here, we care about you and we will keep fighting to protect your profession, your livelihood and your future.

 

I am so grateful for all your feedback and ideas coming in over the last few weeks – these have formed the pillars for our lobbying, advocacy and campaigning. Today, I want to update you on some of the issues that have arisen since my last email on Friday and what the PSA is doing to support you with them. Please keep your feedback coming, we are strongest when we are OnePSA.

 

Continued Dispensing and Therapeutic Substitution

 

PSA continues to strongly advocate to the Federal Government in regards to continued dispensing and therapeutic substitution in anticipation of general practice workforce challenges and possible medicines shortages. We believe there should be:

• Permanent extension of emergency PBS Continued Dispensing initiative to allow for a single supply of a PBS medicine when patients are unable to obtain a prescription for essential medicine. This was successfully introduced for a limited time period during the summer bushfire crisis.
• Implementation of therapeutic substitution program to enable pharmacists to provide alternative dose forms, strengths and medicines within the same therapeutic class in a shortage.

 

A joint proposal from the PSA and the Guild regarding therapeutic substitution is with the Federal Government. These measures are vital to essential to ensuring continuity of medicine supply during the COVID-19 pandemic and we are positive that there will be some action from Government in this area. We will keep you informed on this measure.

 

Prescribing of hydroxychloroquine for COVID-19

 

We have been receiving reports from pharmacists that they have been presented with prescriptions from doctors and dentists prescribing hydroxychloroquine and other medicines that could have the potential to help those with COVID-19.

 

Late last week, I urged in an open letter to prescribers, which was also sent to the RACGP and to AMA, to cease prescribing hydroxychloroquine unless there was a genuine need and cease off-label prescribing.

 

Our strong advice to pharmacists has been to refuse the dispensing of hydroxychloroquine if there is not a genuine need for the approved indications– inflammatory conditions or the suppression and treatment of malaria.

 

The current stock of hydroxychloroquine needs to be managed sensibly, it needs to be available for those who are currently being prescribed this medicine, and it may also be needed for treatment of COVID-19 in the future. We are urging pharmacists to manage their existing stock if they have it sensibly, ensuring those who are currently prescribed the medicine have an existing supply.

 

In response to both the PSA and the Guild’s appeal to prescribers, Health Minister Hunt backed pharmacists to say no to dispensing these scripts if they believed they were for off-label.

 

Effective today, a new legislative instrument has come into force with additional controls to be applied to the prescribing of hydroxychloroquine. Initial treatment of a patient with hydroxychloroquine is now restricted to specialists in any of the following specialties: dermatology, intensive care medicine, pediatrics and child health, physician, and emergency medicine. To support pharmacists with this change, PSA has prepared the following FAQs.

 

We will continue to work with the Minister Hunt and the Therapeutic Goods Administration (TGA) with regards to the appropriate management of national stockpiles and medicines stock in Australia.

 

An update on the supply of S3 salbutamol

 

Further to the limits introduced last week on the supply of S3 salbutamol inhalers, as of today, a new legislative instrument has come into force to specify that its supply is limited to persons with evidence of a medically diagnosed lung condition, persons with a record of previous supply from the pharmacist, persons authorised under State or Territory law to use or supply salbutamol in the practice of their profession (such as medical practitioners) or for use in institutional first aid (e.g. schools and workplaces).

 

The new entry also specifies that supply is limited to one primary pack of salbutamol for each person with evidence of a medically diagnosed lung condition or previous supply from the pharmacist.
These changes to the Poisons Standard are designed to ensure availability of salbutamol inhalers for patients with a genuine need for their asthma condition.

 

Influenza

 

Late last week, I received a letter from the Chief Medical Officer Professor Brendan Murphy thanking pharmacists and healthcare workers for being prepared to put ourselves on the frontline of our national response to COVID-19. At a time when COVID-19 will converge with the upcoming influenza season immunisations are seen as critical during this time.

 

As you may be aware, I wrote to Professor Murphy, earlier this month seeking his support and consistent advice to pharmacists on providing vaccination services prior to the ATAGI recommendation of mid-April.

 

There is no doubt that there will be strains on the healthcare system over the coming weeks and months. Certainly, for patients who are not eligible for the NIP we believe that they should be vaccinated as soon as is practicable. For those who are NIP eligible they should ideally wait until early-mid April and we understand that NIP vaccines will be in distribution channels very shortly. We continue to make representations at the jurisdictional level where pharmacists DO NOT have access to the NIP, that as a matter of urgency this is corrected. This is now, really a matter of life and death.

 

Medicine limits and clarity on one months’ supply

Last week, the bold decision was made to start putting a limit on the dispensing and sale of certain medicines. This gives pharmacists the Government’s backing to say NO to patients who are pressuring them to dispense more than a month’s supply.

 

Since then PSA has fielded questions from members about what constitutes a one month supply and I would like to provide some clarity on this. PSA considered one month supply to be the equivalent to a standard PBS quantity. If however a medicine is in short supply, pharmacists are urged to use their professional judgement in determining a suitable quantity to supply.

 

PSA stands united with the Pharmacy Guild of Australia and the Department of Health on these measures. The Federal Government has now backed all pharmacies to limit dispensing of medicines to one month supply.

 

Medication reviews and limiting contact with patients

 

In response to concerns from pharmacists about conducting medication reviews and limiting their contact with patients, I have urged Minister for Health, the Hon. Greg Hunt, to allow pharmacists to conduct these reviews via telehealth arrangements.

 

We strongly believe that pharmacists being able to deliver these services remotely via telehealth will limit the impact on the healthcare system from otherwise avoidable hospital admissions and ED presentations resulting from unnecessary medicine-related harm.

 

We have recommended measures to the Department of Health which ensure pharmacists and their patients remain safe while delivering these vital services. We will keep members updated on the outcome of this proposal, through my weekly email, on our dedicate website and through our social media channels.

 

In the meantime, PSA has prepared FAQs related to conducting HMRs in the context of COVID-19.

 

I also urge pharmacists who conduct RMMRs for people in aged care facilities to engage with their facility regarding the ability to conduct these reviews.

 

Webinar – COVID-19: Your questions answered, with Infectious disease expert Robert Booy

 

Tomorrow night, I will be co-presenting a live webinar on COVID-19 with Professor Robert Booy who is a Senior Professorial Fellow at the National Centre for Immunisation Research and Surveillance.

 

We will be discussing infection control measures, medicine delivery services and immunisation during COVID-19. The webinar will be held from 7.30pm to 8.30pm AEDT and we will be available to answer your questions. You can still register for the webinar here.

 

Social distancing

 

I understand the Federal Government’s social distancing requirements is a challenge for many pharmacies and pharmacists, particularly maintaining safe distance between yourselves and patients. We have had many inquiries about how this can be done at pharmacies.

 

Pharmacies around the country introducing a number of different approaches to manage people who could pose as an affection risk. These measures have included Perspex barriers, splitting staff into shifts, signage and markings on the floors for patients to keep a distance of 1.5 metres.

 

I am proud of how innovative our profession has been to be able to continue to provide pharmacy services in a way to protect the pharmacist, staff and the community during the COVID-19 pandemic.

 

Resources for pharmacists

 

PSA has developed a number of resources for use in the pharmacy to support you in managing patient expectations and reducing infection risk to pharmacists and their staff. For example this includes a poster to advise customers of the supply of over the counter medicines. You can find this poster and others here, which you can download and print for use in your pharmacy.

 

Ahpra responds to COVID-19 queries

 

Ahpra and the National Boards are receiving a range of questions about how they will respond to requests for changes to the way that they register individuals in the context of managing the health sector impacts of COVID-19.

 

They are in the process of considering how regulatory requirements can adapt to emergency health service needs and support continuity of health service delivery, and are planning for different scenarios which may occur. You can keep up to date on Ahpra’s COVID-19 updates web page.

 

Stay up to date

 

PSA will continue to support you throughout this pandemic. 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.

 

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

 

Thank you again for all you support and for all that you do as Pharmacists.

 

Sincerely,

Associate Professor Chris Freeman
National President
Pharmaceutical Society of Australia

Important COVID-19 actions for pharmacists

20 March 2020

 

The last seven days have been some of the most extraordinary and stressful days most pharmacists will have experienced in their career. The progression of COVID-19 public health measures have been met with fear, anxiety and panic from consumers who have rushed to supermarkets and community pharmacies in an attempt to secure large quantities of medicines and other household goods.

 

The burden on pharmacists has been extreme with the profession responding to never-before-seen volumes of prescription and non-prescription requests in community pharmacy. Pharmacists in all practice settings have had their daily role upended by this public health emergency.

 

In extraordinary times, pharmacists step up and do extraordinary things. I am so immensely proud of the way in which pharmacists are responding to support Australians. Health Minister the Hon. Greg Hunt has echoed these sentiments in an open letter to pharmacists where he recognises and thanks the dedication and service of pharmacists to the Australian community under extreme pressure.

 

In this email, I want to address the issues our members have told us are the most significant challenges they are currently working with, and how we are working to help address these problems:

 

Demand for medicines

 

Demand for medicines has increased considerably in response to the COVID-19 pandemic which has the potential for numerous product lines to be out of stock and some pharmacists are being pressured and abused to provide unsafe quantities of medicine.

 

It is important you are familiar with these limits:

• pharmacists are required to limit dispensing of certain prescription products to one month supply at the prescribed dose, and sales of certain over-the-counter medicines to a maximum of one unit per purchase
• pharmacists are strongly encouraged to limit dispensing and sales of all other medicines to one months’ supply or one unit
• pharmacists are required to place paracetamol paediatric formulations behind the counter to assist in allocating supply equitably
• Supply of salbutamol inhalers are also subject to additional restrictions, assessment and recording requirements.

 

PSA stands united with the Pharmacy Guild of Australia and the Department of Health on these measures. The Federal Government has now backed all pharmacies to limit dispensing of medicines to one month supply. This gives pharmacists the Government’s backing to say NO to patients who are pressuring them to dispense more than a month’s supply.

 

To help you explain these changes to patients PSA has produced a poster you can use in your pharmacy or for social media.

 

Home Medicine Service

 

The Department of Health released Program Rules for the Home Medicines Service announced by the Health Minister Greg Hunt on Wednesday 11 March.  This service was announced by Minister Hunt last week as part of the Federal Government’s $2.4 billion COVID-19 health package.

 

PSA welcomed the announcement of the Home Medicine Service, noting it will be essential for Australians to limit COVID-19 exposure and ensure people can continue to take their essential medicines during the COVID-19 pandemic. However, we recognise the payments and program rules allocated to this service are insufficient to cover the costs of providing the service. We are concerned the $5.00 fee will result in uptake of the service being low, and therefore not achieve its crucial objective of supporting the health needs of people who are confined to their homes.

 

PSA is urgently liaising with the Department of Health to seek adjustments to the program rules to ensure the program is viable and protects the health of Australians during the COVID-19 pandemic over coming months.

 

Medicine management reviews: are telehealth consultations on the way?

 

PSA has provided a submission to the Department of Health to enable delivery of Medschecks, Diabetes Medschecks, Home Medicine Reviews and Residential Medication Management Reviews via telehealth during the COVID-19 pandemic. For the same reasons telehealth consultations have been temporarily extended to general practice, the same modifications need to be made for medicine review services.

 

We remain significantly concerned if there is a reduction in the delivery of these services there will be an increase in admissions to hospitals as a result of medicine related problems, placing strain on an already stretched health system.

 

Social distancing

 

Social distancing and hand washing is effective, and should be used throughout the community. This includes in health environments such as pharmacies. Pharmacists need to maintain strong hand hygiene and quickly implement measures to keep a distance of 1.5 metres between pharmacists, support staff and patients where possible.

 

I encourage pharmacists to think actively on adapting their work environment to protect themselves, their colleagues and their patients through measures such as:

• Talking to consumers from the other side of a counter or desk where possible. Do not ‘lean in’ to conversations.
• Encourage consumers queuing to give each other adequate space. Signage, floor markings and verbal instructions are important in helping achieve this
• Increasing the distance between chairs for patients waiting for prescriptions.
• Asking colleagues and consumers to stand further away in discussion and work areas

 

I encourage you to undertake the infection control training for health professionals which the federal government has made available.

 

Distribution of Personal Protective Equipment (PPE) Tranche 2

 

Yesterday the Australian Government has released new information on obtaining surgical masks and P2/N95 respirators for community pharmacy. This second tranche of PPE release provides for small quantities of masks to be provided for use by an unwell patient or staff protection.

 

We encourage all pharmacists to contact their PHN to secure PPE which is available. Find out more on how to secure PPE for you and your staff here.

 

Stay up to date

 

I encourage you register for a webinar next Wednesday night at 7.30pm AEDST where I will be co-presenting with Robert Booey, Head Clinical Research NCIRS will present on COVID-19, including discussion of infection control measures, medicine delivery services and immunising during COVID-19.

 

PSA’s dedicated COVID-19 website is rapidly updated, often multiple times daily, with the latest information pharmacists need to be across to support the community during the COVID-19 crisis.  Significant updates are amplified via our social media channels.

 

PSA supporting you and the profession

 

PSA’s teams across the country are working hard to ensure you are supported during the COVID crisis. This includes our network of officers around the country engaging with health departments, political leaders and health stakeholders to respond to member concerns and keep you informed.

 

From next week, I will be writing to you each Tuesday’s with key information regarding what pharmacists need to be across in supporting Australia’s COVID-19 response.

 

Please contact our team if there is any way in which PSA can help you in these unprecedented time.

 

Sincerely,

Associate Professor Chris Freeman
National President
Pharmaceutical Society of Australia

Pharmacists to limit dispensing and sales of medicines

The Federal Government has made a clear directive to the Australian public this week to stop stockpiling medicines to ensure the continuity of the medicine supply chain during the COVID-19 pandemic.

 

The Pharmaceutical Society of Australia has been hearing from you, our members, that pharmacists are being pressured to dispense unsafe quantities of medicines. In some cases this has included threats of abuse and physical violence.

 

This is unacceptable and has to stop. PSA is dedicated to protecting you, our frontline pharmacists, trying to do your best in these challenging times.

 

From today, the Federal Government is calling on Australians to not stockpile medicines.

 

The Federal Government has now backed all pharmacies to limit dispensing of medicines to one month supply.

 

This gives pharmacists the Government’s backing to say NO to patients who are pressuring them to dispense more than a month’s supply.

 

Peak doctor groups have been contacted by the Government and this message is being re-enforced with them too – prescribing clinicians will be asked to observe the same criteria.

 

There are more than enough medicines in the supply chain today – but if stockpiling continues, this may change.

 

Dispensing multiple months of medicines is unsafe, both for the patient and for the supply chain.

 

We are united and stand with you, as you go above and beyond to care for all Australians during this time.

 

The joint statement on the Limits on dispensing and sales off prescription and over-the-counter medicines to provide you with direction will be on our website here.