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National President’s Message: COVID-19 Update

6 May 2020

 

This week marks a significant decision point for Australia’s return to a more normal life. Following seven weeks of Stage 3 public movement restrictions, the National Cabinet is meeting today and on Friday to consider a pathway to moving to Level 2 restrictions. While last week saw some jurisdictions make small adjustments to Stage 3 restrictions last week, National Cabinet will consider much more significant changes when it meets. This is cause for cautious but growing optimism.

 

As recent public debates over school closures, public recreation activities and physical distancing requirements have shown, there is significant community confusions over the public health measures. This confusion is likely to grow as restrictions change, potentially at different rates in different locations.

 

As public health ambassadors, we all have a responsibility to help our patients and community navigate these restrictions and provide confidence in the expert advice they provide to our governments. It is vitally important you are across the restrictions relevant to your area, the rationale for them and that you demonstrate them in your work.

 

This week, I’d like to update you on the following:

 

Electronic prescriptions

 

Electronic prescriptions will begin to be available from the end of May 2020. Long promised, the introduction of electronic prescriptions will mark one of the most significant changes to pharmacist workflow since the computerisation of dispensaries in the 1980s.

 

Electronic prescriptions are paperless prescriptions, where the legal copy of the prescription is fully-digital and exists in the Electronic Prescription Repository.

 

Electronic prescriptions will initially be accessed through tokens, where patients are provided with a unique QR barcode sent via SMS, email or an app (if the patient has one) or printed on paper during the consultation. This will be similar to technology that the patient is already familiar with such as an electronic boarding pass for a flight or online ticket to a sporting event or concert.

 

To access the prescriptions, the QR code (token) is scanned and downloaded via prescription exchange servers (for example, eRx/MediSecure etc.) directly into dispensing software for dispensing. PSA has been working with the Australian Digital Health Agency and other peak bodies to inform implementation which supports pharmacist workflow, particularly in relation to professional, legal and medicine safety obligations.

 

In the lead up to the launch of electronic prescriptions at the end of the month, I encourage you and your colleagues to review the Agency’s information page on electronic prescriptions, including vital information on how to prepare your practice.

 

Pharmacy interns: supporting flexibility and certainty

 

The intern year is a tough year, even without the added stress of COVID-19. As I’ve written previously, PSA has been working with the Pharmacy Board of Australia (PBA) to recognise the challenges COVID-19 has created for interns and seek appropriate flexibility to ensure interns can meet the requirements of general registration in a way which does not play undue stress on their health or employment – particularly in relation to burnout.

 

I’m pleased that PBA last week announced interim modifications to these requirements, including:

• reducing supervised practice hours required from 1824 hours to 1575 hours
• waiving the requirement for a minimum of 80 hours of supervised practice during any four consecutive calendar week
• waiving the requirement for at least 152 hours of supervised practice under the supervision of an individual preceptor
• sensible changes to the examination requirements, including delaying the June and July written exams to October in an online exam, and changing requirements to sit the oral exam.

 

More detailed information can be found on the PBA’s website and the Australian Pharmacy Council (APC) website.

 

PSA fought hard for these sensible changes, and I welcome these announcements which provide certainty and more flexibility for interns.

 

Practice issues: declining supply

 

During COVID-19, pharmacists have been subject to unacceptable abuse and aggression from patients when declining supply of medicines to enforce supply limits and new restrictions aimed at maintaining the integrity of the supply chain and supporting the safe use of medicines.

 

PDL has provided advice which supports guidance provided by PSA in relation to declining requests for salbutamol and hydroxychloroquine where supply is not appropriate or legal.

 

Following notifications, PDL has recently provided practice advice to help pharmacists responding to requests for medicines affected by regulatory changes:

• inform patients of the regulatory changes during the supply process
• explain the reasons for these changes and the limitations the changes place on pharmacists
• discuss with patients the factors which led to your decision to agree to or decline supply
• provide recommendations to facilitate continuity of care (e.g. seeking medical review for consideration of bronchospasm in a person not diagnosed with asthma)

 

While recognising this may take additional time, PDL has emphasised the importance of good communication in reducing the likelihood of confusion of allegations of discrimination. I join with PDL in strongly urging all pharmacists to document any decision to decline supply of medicines, particularly salbutamol and hydroxychloroquine.

 

Promoting public health measures to your patients

 

As I touched on in the introduction, public health messages can be confusing to patients, particularly when there is local variation to restrictions which is difficult for national media to effectively communicate.

 

As we move towards a likely progression to Stage 2 restrictions, it is important you convey the staged approach to restrictions, including:

• the likely need for physical distancing to be ongoing for some time, and demonstrating this in your practise
• importance of patients undergoing COVID-19 testing, even in cases of mild symptoms
• benefits of those who are vulnerable in continuing to exercise caution and limit public contact
• potential for localised restrictions in response to outbreaks

 

Indeed, clamping down on local outbreaks will become one of the most critical parts of Australia’s pandemic response. In revealing Australia has met 11 of the 15 measures required to provide confidence in relaxing restrictions, the CMO and Prime Minister have emphasised the need to increase capacity for rapid contact tracing.

 

The most effective way this can be achieved is through increased uptake of the COVIDSafe app. I encourage you to continue to promote the app to your patients and to your teams to help speed up contact tracing when positive cases are detected. The Melbourne meat-packing plant outbreak this week shows just how quickly the virus can spread and the importance of rapid contact tracing.

 

WHO Medicines Without Harm: Australia’s response

 

The Australian Commission on Safety and Quality in Health Care have released Australia’s response to Medication without Harm – WHO Global Patient Safety Challenge. The global challenges aims to reduce the harm caused by medicines by 50% by 2025.

 

The Commission have described Australia’s goal as reducing medicine errors, adverse drug events and medication-related hospital admissions by 50% by 2025. This is an ambitious goal.

 

As described last year in PSA’s watershed report, Medicine Safety: Take Care, medicine safety problems result in 250,000 hospital admissions and 450,000 emergency department presentations, of which 50% are avoidable.

 

The response focuses Australia’s efforts in polypharmacy, high-risk medicines and transitions of care. These areas have been identified in PSA’s medicine safety report series as the areas of highest patient medicine safety risk. Success in these areas will go a long way to achieving this goal of 50% reduced harm.

 

As medicine experts, pharmacists have the most significant role to play in reducing medicine-related harm. Pivotal in Australia achieving this goal will be policy settings and funding which support pharmacists in their roles as leaders in medicine safety.

 

As your representative body, PSA will ensure medicine safety is front and centre in everything we and pharmacists do, including ensuring the upcoming 7th Community Pharmacy Agreement adequately addresses the medicine safety challenge and supports pharmacists to address this issue.

 

Weekly webinar: COVID-19 related burnout

 

Last Wednesday, I was joined 7CPA lead negotiator Dr Shane Jackson and pharmacist and Queensland ECP of the year 2019 Nicolette Ellis. We talked about COVID-19 and telehealth, particularly the follow-up services that have been announced for HMRs and RMMRs. COVID-19 has driven uptake of telehealth much faster than anticipated, including the recent announcement by the Government that pharmacists can deliver HMRs, RMMRs and MedsChecks to eligible patients via telehealth.

 

During Stage 3 restrictions you have dealt with increased workload, panic buying, medicines shortages, inappropriate off-label prescribing, irate customers and the stress of self-isolating from family and friends to prevent transmission of the virus. I’ve seen the toll it’s taken on you. You’ve been put in situations that have caused incredible stress.

 

Join us as tomorrow night as discuss burnout, reducing your emotional load, and managing conflict, including de-escalating irate customers who may take their frustrations out on you. I’ll be joined by Gary West from PDL, and Kay Dunkley from PSS to answer your questions about how to look after yourself. The webinar is available be at 7.30PM EST Wednesday night. Register here.

 

Stay up-to-date

 

Our dedicated COVID-19 microsite continues to see strong traffic. There will be further updates in the coming days with state-specific mapping of temporary amendment to First Aid and CPR requirements for vaccination during COVID-19.

 

In this week’s videos I talk about the importance of the COVIDSafe app and call for increased penalties for assault against pharmacists.

 

Sincerely,

Associate Professor Chris Freeman

National President

Pharmaceutical Society of Australia

Update on internship requirements and examinations

PSA have been advocating on behalf of interns to the Pharmacy Board of Australia (PBA) to ensure that interns are not delayed in the journey to general registration due to the impacts of Covid-19.

 

The PBA has today announced some interim modifications to some of the requirements for general registration and examinations.

 

The main changes are:

• The number of supervised practice hours required for general registration has reduced from 1824 hours to 1575 hours
• Interns are no longer required to complete a minimum of 80 hours of supervised practice during any four consecutive calendar week
• Intern no longer have to complete a minimum of 152 hours of supervised practice under the supervision of an individual preceptor for those hours to count towards supervised practice.

 

Examinations Update:

• A pass in the written examination will not be required to sit the October oral exam
• To be eligible to sit the October oral exam, interns are required to have completed 75% of the revised supervised practice hours (1181 hours).

 

More detailed information can be found on the PBA’s website and the Australian Pharmacy Council (APC) website.

 

At this time, we would encourage you to focus on maximising your workplace experience and completing your ITP assignments to prepare yourself for the examinations and general registration.

 

We appreciate these changes will impact you all differently so please contact us on 1300 369 772 or learnersupport@psa.org.au if you have any questions/would like to discuss.

National President’s Message: COVID-19 Update

National President’s Message: COVID-19 Update

 

 

21 April 2020

 

I want to start by congratulating you and your families for your sacrifice and discipline during this unprecedented global pandemic. This week we have started to not only see the curve flatten, but community transmission all but fall away. Without being complacent, Australia is arguably in the strongest global position to defeat the virus, but the economic impacts of which will be felt for decades.

 

You continue to amaze me for your resilience, dedication to the profession and community and ability to care. The rate of regulatory changes from all levels of Government continues at a frenetic pace and it can be understandably difficult to keep up. The last seven days saw the introduction of telehealth medicine review services, follow-up visits for HMRs/RMMRs, changes to pharmacist vaccination and regulatory changes at state/territory level for digital image prescriptions.

 

In this week’s column, I want to work through a number of these changes with you to help reduce confusion and keep you informed on how we are working to help reduce some of the pain-points you are constantly experiencing in your daily practice.

 

Changes to medicine review services

 

I open this week’s President’s message with two significant announcements relating to medicine review services. The first is the announcement that Government will fund pharmacist delivery of medicine management reviews via telehealth. The second is the introduction of up to two follow-up consultations for HMRs and RMMRs, where needed by patients, to help manage medicine-related problems.

 

Telehealth

6CPA medicine review program services can now be delivered by telehealth to eligible patients. These services include HMRs, RMMRs, Medschecks and Diabetes Medschecks. Subject to eligibility criteria (which includes the vast majority of patients) patients can start accessing these remunerated pharmacist services through video or phone consultation from today.

 

To support you in these changes, we have developed resources to help you conduct these services in a new delivery mode. You should particularly be aware of the privacy and encryption levels of the tools which you use.

 

AHPRA and the Department of Health have reminded health professionals delivering telehealth services that many free platforms do not have adequate encryption for delivery of health services. The Department of Health notes telehealth can be provided through video calling apps and software such as Zoom, Skype, FaceTime, Duo, GoToMeeting and others.

 

I cannot tell you how hard PSA staff and elected representatives have fought for these changes. The outcome of this work is that from today you can pivot to providing these services in a new online format for those patients who are eligible, often vulnerable, and who need these services.

 

I will be facilitating an upcoming webinar on telehealth and electronic prescriptions where we will be able to provide you with practical guidance on digital health advancements during COVID-19.

 

Follow-up consultations: HMRs and RMMRs

 

Today is momentous as it marks the start of remunerated follow-up visits for HMR and RMMR services. Follow-up consultations means patients can receive additional review services to help resolve complex and multifaceted medicine problems after the initial review.

 

Follow-up consultations are essential in supporting a more effective cycle of care and helping pharmacists be more effective in resolving medicine safety problems. With 250,000 hospital admissions each year due to medicine-related problems, the safe and quality use of medicines is more important than ever.

 

PSA has updated the practice guidelines to support and reflect current best practice when providing these services:

• Guidelines for Comprehensive Medication Management Reviews: including new guidance for HMRs and RMMRs on considerations for recommending and undertaking follow-ups after the initial review, support for collaboration and communication with the healthcare team and describes the role of pharmacists as part of this team when providing medication management review services.
• Guidelines for Quality Use of Medicines (QUM) services: best practice guidance for pharmacists providing QUM services in residential aged care facilities. Be guided on how to plan and undertake QUM activities that form part of a QUM Plan and contribute to continuous quality improvement.

 

The guidelines have been developed with funding provided by the Department of Health.

 

These funded follow-ups have been the subject of many months of discussions between PSA and the Department of Health and the Health Minister. I have long advocated for a system that allows for medicine reviews to be conducted frequently that is dependent on patient’s needs, with meaningful follow-up and I commend the Government for making this necessary change.

 

Digital image prescriptions

 

Digital image prescriptions remain a challenge. This important initiative to enable telehealth medical consultations remains haphazard and burdensome in its implementation.

 

Where are digital image prescriptions legal?

 

The past week has seen South Australia, NSW and Tasmania join Victoria and WA in making regulatory moves to enable lawful supply of prescriptions from an electronic digital image.

 

ACT Health advised our members in Canberra late last week that digital image prescriptions fall within existing ACT poisons regulations. In the Northern Territory the ability to supply medicines off electronic image-based prescriptions is enabled under existing legislation.

 

This leaves Queensland, alone, as the only jurisdiction in which digital image prescriptions are not currently permissible. PSA understands that enabling regulation in Queensland is currently being held up due to advice that the measure requires an act of Parliament.

 

Confusion reigns

The state and federal interface always causes confusion – and it is unsurprising that confusion is rife at a time in which changes are happening so quickly. But what I am hearing, loud and clear, is that you are wearing an incredible administrative burden from this confusion, often in the time-consuming role of communicating government regulatory changes to medical colleagues.

 

I am receiving reports some prescribers and their staff are:

• sending prescriptions as digital image prescriptions and then sending the originals to the pharmacy; the original hard copy prescription must be retained by the prescriber for compliance and audit purposes.
• refusing to supply original prescriptions for medicines not eligible for supply under the arrangement (e.g. Controlled Drugs (most states)); prescribers are responsible to ensure phone/fax orders (i.e. prescription owing) are dispatched to you without delay.
• requesting pre-paid return addressed envelopes to supply original prescriptions to pharmacies.
• requesting you send staff to collect prescriptions at their clinics.

 

However, most of all, I’m receiving reports that this is becoming a point of friction with prescribers at a time it is more important than ever we all work collaboratively to support and facilitate the safe supply of medicines.

 

Risk in unannounced changed: NSW and S4D

In introducing digital image prescription arrangements last Friday, NSW Health added five new substances to S4D (pregabalin, quetiapine, tramadol, zolpidem and zopiclone). Given their potential for abuse and diversion, this change made a lot of sense and is welcome.

 

What didn’t make a lot of sense was to effect this change on the day it was announced, in effect ripping six months off the expiry date for these prescriptions overnight without warning. These changes were a surprise and not included in the announcement for digital image prescriptions the weekend prior.

 

In failing to announce this change in advance:

• Patients on long-term stable therapy (particularly quetiapine and pregabalin) may have been left overnight without a valid prescription requiring them to see a doctor immediately to arrange ongoing therapy
• Those of you in NSW were in a dangerous position where you may have been completely unaware of this change and likely to have unwittingly supplied medicines outside of its validity period.

 

We have worked to quickly communicate this change to members via our microsite and social media. PSA continues to work with NSW Health to help communicate these changes to the profession and more wisely to ensure both yourselves and prescribers are aware of these changes and not exposed to professional risk.

 

Demonstrating the need for pharmacist expertise in government

 

The genesis of confusion was the Government factsheets which did not effectively communicate that state and territory regulatory changes were required prior to supplying of medicines under this arrangement become lawful.

 

While developing sound policy implementation is difficult in this rapidly evolving environment, it is unlikely this oversight would have occurred if an Australian Chief Pharmacist existed within the Department of Health which signed off on the information. I will continue to raise this with the Department in my meetings with officials.

 

Providing clarity

 

PSA’s teams around Australia are in regular contact with Health Departments to help clarify details on these interim arrangements to help inform members around the country. To help you keep track of the plethora of changes affecting your practice, we have rejigged the way we present this information on PSA COVID-19 microsite.

 

From today, state-specific regulatory information is available side-by-side with PBS eligibility requirements for special arrangements such as digital image prescriptions and continued dispensing. You can find it here.

I trust this will make it easier to find critical information quickly when you need it. I would value feedback, as there is the potential to expand this format to other areas of pharmacy practice (vaccination, opioid replacement etc.) Our microsite will continue to be updated daily, and I will continue to keep you informed of major changes through my weekly email and PSA’s social media channels.

 

Pharmacy Interns

 

In my email last week, I raised the fact that I have heard from a number of pharmacy interns in regard to their concerns about completing their required hours should they have to go into quarantine or self-isolation.

 

Interns have particularly communicated to me a fear of the potential for repeated 14-day self-isolation periods following potential COVID-19 exposures, and the stress associated with how this impacts on their required intern hours or even ongoing employment at the end of the year.

 

I understand these fears. There is a real potential that any of you may be required to self-isolate for 14 days multiple times during the pandemic. I have raised a number of issues on your behalf directly with the Australian Pharmacy Council and the Pharmacy Board of Australia. I have asked for urgent review of the requirements this year to provide the flexibility and certainty that you need.

 

While there is nothing to announce yet, I am confident am confident there will be changes announced shortly to help you satisfy the requirements of general registration within the regular 12-month time frame. It concerns me that there is not the clarity required that you need in a time of higher than usual stress levels, and that this might exacerbate mental health concerns of our intern pharmacists.

 

Rural and remote Australia

 

During the week, PSA CEO, Mark Kinsela, attended the Rural and Remote Health COVID-19 meeting with the Federal Minister for Rural Health Mark Coulton. It was welcome to hear the minister specifically recognise pharmacists for the great work that you are all doing in your communities.

 

In addition to state and territory government testing centres, the Government is supporting the establishing of respiratory testing clinics including eight in rural and remote centres. These are being delivered through the PHNs and you should make yourself familiar with the testing facilities available for you, your patients and your staff in your local area.

 

The Government remains focussed on supporting the mental health of rural Australians, including the health workforce. The Government has supported resources to support your mental health well-being. Up-to-date links for support can be sourced via our microsite.

 

The minister also outlined the Government is looking at investing further resources to support locum services, including greater flexibility for access. In a sensible measure for rural and remote Australia, the ACCC has provided flexibility to pharmacy wholesalers who have been provided exemptions to coordinate medicine distribution during COVID-19. The minister also outlined ongoing monitoring of medicine supply chains, and reported a stabilisation of supply in recent weeks, which is consistent with reports from those of you in rural and remote area.

 

During the meeting, Mark raised a number of issues of concern directly with the minister, including:

• Access to PPE and medicines supply issues in rural and remote pharmacy
• Need for support and planning for single pharmacy towns to ensure continuity of access to medicine should key personnel be required to self-isolate due to infection or exposure to COVID-19
• COVID-19 testing for pharmacy staff
• Challenges with pharmacy interns – pharmacy closures, isolation, and preceptor access.

 

We are attending these meetings weekly and will report back to you progress on these issues. Being in these meetings and able to raise concerns directly to the minister is helping us to achieve timely and pragmatic solutions to the problems you, in our rural and remote communities, are facing.

 

Therapeutic substitution

 

As I reported last week, the direction the initiative has taken is not acceptable and therefore we cannot support it without significant change.

 

I will continue to work on your behalf with Government to work towards a model of therapeutic substitution during out-of-stock situations which actually works, and which recognises the skills and knowledge of pharmacists. It shouldn’t be this hard. It is in your capability and you can certainly be trusted to work out that 2 x 250mg tablets = 1 x 500mg tablet.

 

Risk of complacency

 

The continued reduction of daily COVID-19 notifications is extraordinary in the context of the global pandemic progression. Australia’s strong infection control response and island advantage has seen the curve flattened beyond our most optimistic prediction.

 

This has led to agitation from some Australian voices to relax our physical distancing and ‘Stay at Home’ directives, and risks community complacency in vigilance against COVID-19 exposure.

 

I endorse the sentiments of population health experts and chief medical officers in reinforcing the ongoing importance of physical distancing and Stay at Home directives. As health care ambassadors, it is important that you and your staff continue to reinforce these messages with your patients and support them to continue to access pharmacist care consistent with these recommendations.

 

This includes;

• Actively encouraging delivery and contact-free options for people over 70 years who should be self-isolating at home
• Discouraging people who are unwell from entering a pharmacy
• Encouraging people with fever or acute respiratory symptoms to seek advice and testing for COVID-19
• Encourage and demonstrate physical distancing in the pharmacy

 

There are positive signs however the community must remain vigilant. One aspect of this is the overwhelming demand for influenza vaccine we have already seen. I welcome the Health Minister’s recent announcement of an additional 3 million influenza vaccines available to Australians through community pharmacy and GPs in the coming months.

 

We are continuing to work with Government to ensure there is adequate influenza vaccine supply in Australia and we have been assured there are nearly 8 million vaccines for the private market this year, up from close to 7 million vaccines last year.

 

Weekly Webinar

 

Last Wednesday, I was joined in our webinar by PSA’s new General Manager for Policy and Engagement, Chris Campbell. The webinar focused on the best way to set up your pharmacy or pharmacy practice to accommodate the changes and new ways of working to protect you, your staff and your patients during COVID-19.

 

This practical topic created intense interest and positive feedback and I would like to thank Chris for joining me and answering all your questions.

 

COVID-19 has shown us the damaging impact which stigma can have in our society. In this week’s webinar, we focus on the issue of stigma through the lens of Hepatitis C in the second instalment of PSA’s ‘Facing Up To…’ series.

 

Jarrod McMaugh MPS will talk with a person living with Hepatitis C to help us see the impact and effect of stigma through their eyes. They’ll discuss barriers to treatment, stigma, and the importance of testing, contextualised within what can be done during COVID-19 isolation measures to limit the spread of the disease and support patients living with the condition.

 

Help face up to the stigma experienced by people living with Hepatitis C. Bring the questions you’ve always wanted to ask but were too scared to. This is your opportunity to hear someone speak openly about their lived experience of Hepatitis C and the stigma that surrounds it in a safe environment.

 

The webinar will be run twice (7.30PM EST and 9.00pm EST) so as many of you as possible can join the conversation.

 

Register here.

 

Stay 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. There are series of FAQs on the website and can be found here.

 

Your PSA team are working hard to keep you informed and support you during the pandemic. Keep feeding back the issues and concerns which you are working through to help us help you. Please contact us at membership@psa.org.au.

 

Week-in and week-out you are showing that our profession is dedicated, reliable, dependable and worthy of the trust that our society places in you all. The pandemic and physical distancing requirements will continue to be with us all for some time and patients will look to you for reassurance and support. Never underestimate the value of a 30-second conversation or a caring word towards your patients at a time when they are struggling. The work you do every single hour and every single day enhances our community during this pandemic.

 

Sincerely,

Associate Professor Chris Freeman

National President

Pharmaceutical Society of Australia

National President’s Message: COVID-19 Update

14 April 2020

 

I know that Easter for many of you was spent on the frontline, working to address this COVID-19 crisis that is enveloping us. I know that for many of us, COVID-19 is consuming not only our personal lives but our work lives.

 

There has been some good news in the last few days with some promising developments. Physical distancing, testing and quarantine measures are consolidating the flattening of the curve, with a rise in cases of about 2 per cent overall cases. This is a call for real hope and real aspiration.

 

PSA has been working over Easter to address the issues affecting you, and the policy and regulatory changes that have been made by State or Territory and Commonwealth Governments continues to change the health landscape which we work in.

 

Digital Image Prescriptions

 

I am getting an enormous amount of feedback, concern and frustration from you all on the issue of digital image prescriptions and the increasing confusion, workload and stress that this measure is causing.

 

Many of you from all around Australia are being left in a quandary and are stuck in the middle between the federal legislative instrument and the state and territory regulations. This is causing profession-wide confusion, greater workload and more administration at an already frantically busy time.

 

There is particular confusion given the Australian Government factsheets did not effectively communicate that state and territory regulatory changes were required prior to supplying of medicines under this arrangement become lawful.

 

Victoria and WA are currently the only jurisdictions where supply under this PBS special arrangement can be lawfully made at present. NSW has announced digital image prescription arrangements which will commence this Friday (17 April). These states have shown terrific leadership in this case and all other states and territories should follow suit with a matter of urgency.

 

I have made representations about this issue with both the Department of Health and Minister of Health’s office. I have made it clear that it is unacceptable that pharmacists are expected to break the law to provide patients with their medicines. GPs are heeding Commonwealth advice that they can send prescriptions electronically without forwarding a hard copy with the legislation in the states playing catching up.

 

PSA is working with the state and territory governments to accelerate this as quickly as possible in a way to minimise the additional burden this has caused you all. We understand what the Government is attempting to do in keeping the community safe – but this has to be done in a way that does not expose pharmacists to professional risks from being forced to break the law.

 

Personal Protective Equipment (PPE)

 

I was pleased to see the Australian Government announce last week that it will distribute 500,000 masks to pharmacy workers.

 

This is a good start as there has been significant and increasing demand for face masks and personal protective equipment for pharmacists working on the frontline face-to-face with patients. But we must ensure that pharmacists, like other frontline health workers, receive the adequate protection they need to care for their patients.

 

While the advice from Government regarding PPE has not changed, I will continue to work with the Government on your behalf to ensure there is adequate supply of personal protective equipment when it is needed for you all throughout this pandemic.

 

I understand some of you are having difficulties sourcing the PPE through your PHNs. If you are please let me know and we will follow up with the PHNs for you.

 

Therapeutic substitution

 

I am frustrated to report that work on the therapeutic substitution arrangements recently forshadowed by the Health Minister are not progressing well.

 

The Australian Government’s current proposed model involves a protocol being issued by the TGA to instruct pharmacists on how they should respond to every shortage.

 

This is not workable and is unacceptable to us. Being able to substitute strength and dose is well within a pharmacists’ skills and knowledge. In fact, it treats pharmacists with contempt at the time when we are providing vital healthcare to our communities. We will be providing you, our members with information later this week, and we may urge you to contact your local members to discuss this issue with them.

 

In a profession where we are accountable for making complex medicine safety decisions, it is inconceivable that the Government would see the need to advise pharmacists that 2 X 20 mg tablet equals one 40mg tablet.

 

We have long called for a Chief Pharmacist to be located within the Commonwealth Department of Health. A pharmacist, like the Chief Medical Officer and Chief Nurse who would be there fighting for the role of pharmacists in this pandemic. We will again make this call, so we know that pharmacists will have a voice, and that medicines policy advice comes from medicines experts – pharmacists.

 

Pharmacy closures

 

I have heard of pharmacies being forced to close due to isolation requirements for staff in NSW and West Australia. Pharmacists, who come into contact with a member of the public who is COVID-19 positive, are unlikely to be considered close contacts and therefore not likely to need to self-isolate for 14 days.

 

However, should a staff member become COVID-19 positive it is highly likely that anyone who has worked with them would be considered close contact during the period of working together and would need to self-isolate. In some small pharmacies this could mean your entire workforce would need to isolate.

 

If pharmacies are forced to close, particularly in a rural or remote area, there are serious implications for medicine supply, particularly if other staff are unavailable.

 

It is therefore essential that you either separate your workforce of if that is not possible, introduce additional measures to protect your team including additional restrictions on the number of patients in your pharmacy.

 

Pharmacy Interns

 

I have had a number of pharmacy interns contact me in regards to concerns about completing their required hours should they have to go into quarantine or self-isolation, and I know this is currently the case for a small number of interns across the country. While the Pharmacy Board’s response to this issue indicates that they may consider options for supervision, I am recommending that they do more to assist interns affected by COVID-19.

 

Simply put, there must be a relaxation of the supervised hours requirements for pharmacy interns and representatives of the PSA will meet with the Pharmacy Board this week and we will strenuously put the case for relaxation of the supervised hours requirements. Until this is dealt with and dealt with quickly, I am concerned that this will put undue stress on our pharmacy interns and exacerbate anxiety and stress at this time.

 

I will also stress that the Pharmacy Board should make representation to the Commonwealth as their agents for public safety to waive the fees of all pharmacists for re-registration in 2020.

 

Webinar COVID-19: Pharmacy layout and protection

 

Last Wednesday, I was joined by Associate Professor Alistair Reid, who as well as being Australia’s only rheumatologist and infectious disease physician, delivered valuable insights on treating COVID-19 in immunocompromised patients, medicines supply issues and herd immunity. His comments were supremely practical and, if you missed it, I encourage you to watch the recording here.

 

This week’s webinar to be held tomorrow night from 7.30pm-8.30pm will focus on the best way to set up your pharmacy or pharmacy practice to accommodate the changes and new ways of working to protect you, your staff and your patients during COVID-19. I will be joined by Queensland Branch President Chris Campbell to answer your questions on these topics. You can register for the webinar here.

 

Volunteer your expertise

 

I know that significant expertise lies in our membership and a large number of you work in a variety of practice settings. I would like to encourage you to offer your expertise to your fellow pharmacists by joining our COVID-19 pharmacy register where you can lead and be involved in creating resources and tools for your fellow pharmacists in tackling the COVID-19 pandemic. We will be establishing the sign-up to this register in the coming week, so stay tuned, if you can’t wait, feel free to email me or the membership team with your area of interest.

 

Stay up-to-date

 

I am pleased to tell you that visits to our dedicated COVID-19 website have more than doubled over the past month. The site 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 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.

 

As we move into a more stable period of our pandemic response, I am confident that the profession will continue to serve the community with compassion, care and professionalism that has been evident from the moment that the pandemic started.

 

Sincerely,

Associate Professor Chris Freeman
National President
Pharmaceutical Society of Australia

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

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