National President’s Message: COVID-19 Update

3 June 2020

 

The COVID-19 pandemic has passed 6 million reported cases globally, and the global death toll is nearing 400,000 people. As other comparable countries have struggled to get the pandemic under control their health systems have been overwhelmed. In contrast, our health system and its health professionals pivoted to quickly create capacity which thankfully has not been needed.

 

Australia can credit its extraordinary success in supressing COVID-19 to date to several factors: decisive and collaborative leadership; respect for medical evidence and population health expertise, health systems designed to protect public health, and the natural advantage of being an island nation. Perhaps most significantly, Australia success comes from a community of over 25 million people who have collectively recognised, respected and adhered to extraordinary tough stay-at-home public health orders.

 

Our success hasn’t however been without its problems. The issues faced by many of you including panic buying, inadequate infection control support, legislative disparities between governments, communication of regulatory changes and the abuse and threats that you were subjected to informed PSA’s submission to the COVID-19 Senate Inquiry. These problems are opportunities to better prepare for future health emergencies, which PSA detailed in 17 recommendations within our submission which was lodged last week.

 

As society adjusts to a post-lockdown COVID-normal, some potentially long-term benefits are emerging. The embedding of telehealth and electronic prescribing as mainstream features of our health system will have long term benefits for the health of Australians and the health professionals who serve them. There is hope last Friday’s announcement to replace COAG with the National Cabinet will usher in an era of reform, reduced red-tape and focus on outcomes rather than process, particularly in our health systems.

 

I encourage you to reflect on what silver-linings you want to embed permanently to take into your COVID-normal and post-COVID practice.

 

Supporting you with electronic prescriptions: starting now

 

The Australian Digital Health Agency has published further details of how electronic prescription communities of interest will be established through June this year to support the phased implementation.

 

Communities of interest are effectively an area where real-life testing is undertaken on a system. For electronic prescriptions, communities of interest will help demonstrate how well prescription delivery services, prescribe, dispense, and third-party intermediary applications integrate and work together. Anglesea, where the first primary care electronic prescription was prescribed and dispensed in May, is the first community of interest with more being established during June.

 

While initially, the electronic prescribing communities of interest will only test the token model, the Active Script List Model will begin to be tested in communities of interest from August 2020.

 

If you know a prescriber who is keen to get on board with electronic prescriptions, I encourage those of you who are pharmacy owners or managers to reach out to your software vendors to help you get ready and possibly be part of a community of interest.

 

Last week’s webinar saw very high interest with so many of you having questions regarding electronic scripts and how they will be implemented. Unfortunately, due to the sheer volume of questions we weren’t able to get through everyone’s queries in the allocated time, but there are lots of options over the next few weeks to help you get the information you need.

 

PSA’s new electronic prescribing support line is staffed by experienced pharmacists who have access to the latest workflow information on how to adopt electronic prescriptions. I encourage you to contact them with your questions via 1300 955 162 (8:30am to 5:00pm AEST, Monday to Friday) or email ep@psa.org.au.

 

There will also be further webinars hosted by PSA and the Agency, as well as our dedicated electronic prescribing webpage: www.psa.org.au/ep.

 

Looking for some career innovation and inspiration?

 

Tonight, Lauren Burton, PSA’s early career pharmacist board director, will chat with 10 pharmacists who have each taken very different paths through the profession. Lauren will help draw out what a ‘normal’ day in their practice looks like, what drives them in their professional role, and how they forged their path.

 

I strongly encourage all members, particularly early career pharmacists and those at a career cross-roads to join, what should be, a magnificent showcase of the profession tonight.

 

You can register for the live session here.

 

Opioid changes

 

Yesterday’s PBS June updates saw revision to listing of many opioid medicines, including paracetamol/codeine and tramadol listings. These changes include introduction of streamlined authorities, reduced quantities and reduced repeats.

 

As with all PBS changes, there are a few bumps in the transition period as it can take time for prescribers to become aware of the change – particularly if prescribing software is not updated on the first day of the month. I encourage you to reach out to prescribers to help communicate this change.

 

The PBS changes represent an opportunity to talk with patients and prescribers about potentially inappropriate prescribing of opioid medicines – particularly where large quantities or a large number of repeats are prescribed for either PBS or non-PBS supply.

 

Opioids are major contributor to medicine harm in Australia. These PBS changes are one of a series of initiatives being rolled out in coming months to improve medicine safety in the prescribing, supply and use of opioids – such as reduced pack sizes, real-time prescription monitoring and updated guidelines. PSA continues to work collaboratively with government agencies and key medicine stakeholders to lead and embed these important changes which are so important in reducing the harms caused by opioid medicines in the Australian community.

 

Bushfire recovery: supporting resilience

 

As the Royal Commission into National Natural Disaster Arrangements (more commonly known as the ‘Bushfire Royal Commission’) hearings are underway, there has been a renewed political focus on helping affected Australians recover from the trauma of summer. I wrote a few weeks ago about mental health first aid training available to pharmacists in bushfire affection regions of Australia. The training, supported by the federal government, ran online over a number of video sessions.

 

I’m pleased to report these workshops were completely booked out with extremely positive feedback from those of you who participated. I was particularly taken with some of your feedback, including the following reflective post:

“I found myself constantly thinking back to past HMRs where these skills would have been super handy or perhaps I tried to apply these skills unknowingly, but now I have a framework to help me nut out the issues.”

 

I’m proud PSA has been involved in such important work which will help those of you in affected areas support recovery and build resilience in your communities.

 

Stay up to date

 

Stay tuned to our social media channels and dedicated COVID-19 microsite to stay up to date with the information you need.

 

Sincerely,

Associate Professor Chris Freeman

National President

Pharmaceutical Society of Australia

National President’s Message: COVID-19 Update

26 May 2020

 

As the pandemic grows by more than 100,000 new cases globally each day and the epicentre shifts to South America, in Australia, it feels like the worst is behind us with only 5-10 new cases reported nationally each day.

 

In the past week, Premiers and Chief Ministers around the country have announced and implemented a modest winding back of restrictions, which have included guidance on modifications needed to reopen business and the community in a modified ‘COVID-normal’ way. In doing so, they have emphasised these restrictions are likely to be our new normal for a long, long time – likely to be normal until a vaccine is developed.

 

There are positive signals on the vaccine development front with a US biotechnology company beginning human trials in Australia (Melbourne and Brisbane) of a coronavirus vaccine. The trial will focus on the safety aspects of the vaccine and will also look for early signs of effectiveness. There is now about a dozen experimental vaccines which are in early stages of testing or on the eve of commencing, mostly in the US, Europe, and China.

 

As the rest of Australia transitions from lockdown to COVID-normal, actively consider; what does your COVID-normal looks like? What semi-permanent changes do you need to make to your practice? How will you maintain increased infection control, physical distancing for staff/patients and supporting unwell people stay-at-home (staff and customers) until a vaccine is developed? What temporary signage and process workarounds need to become embedded as being more permanent?

 

Supporting you with electronic prescriptions: starting now

 

Temporary digital image prescriptions during COVID-19 have been critical to ensure the supply of medicines during the global pandemic – but it has put significant pressure on you with regulatory confusion and in some instances has put pharmacists in regulatory peril.

 

I welcome the imminent implementation of electronic prescribing in a staged and planned approach – which will see a safer, clearer and more secure prescribing model, supporting pharmacists and protect patient’s privacy and safety.

 

I am confident that the work PSA has done with the Australian Digital Health Agency will result in the reduction of many of the bugbears and regulatory issues of digital image prescribing and paper prescriptions.

 

As electronic prescriptions go live, it’s important you what to do when the first patient presents an electronic prescription to you in your practice.

 

To support you, PSA, in partnership with the Agency now offers a dedicated electronic prescribing support line for pharmacists. The support line is staffed by experienced pharmacists who have access to the latest workflow information on how to adopt electronic prescriptions.

 

You can contact the support line on 1300 955 162 (8:30am to 7:00pm AEST, Monday to Friday) or email ep@psa.org.au.

 

PSA has also created a dedicated electronic prescribing webpage which contains all the latest up to date information and resources for pharmacists: www.psa.org.au/ep.

 

Webinar: Electronic prescriptions

 

This Wednesday night, the agency’s Andrew Matthews MPS, Director of Medicine Safety Programs, and Kate Ellis Manager, Provider Adoption will join me to discuss everything you need to know about electronic prescriptions and answer your questions.

 

7.30pm (EST) Wednesday 27 May

Register here.

 

PBS opioid changes from 1 June

 

The Australian Government, through the Department of Health, is implementing a range of changes to minimise the harms to Australians caused by opioid medicines. One of these measures is PBS changes which affect prescriptions written from 1 June.

 

These PBS changes include amendments to existing restriction requirements and arrangements for increased quantities and repeats. In addition, there are new Restricted Benefit listings for smaller maximum quantities of immediate release opioids, with no increased quantities or repeats, for patients requiring short-term relief of acute severe pain.

 

The 1 June PBS changes affect most opioid Controlled Drugs, as well as tramadol and paracetamol+codeine combination products.

 

I encourage you to start socialising these changes with your patients and medical colleagues to help transition as smoothly as possible to these new arrangements.

 

Supporting Australians to put their health first

 

On behalf of PSA, I am pleased to join with other peak bodies and consumer support groups in calling Australians to take action to avoid a second wave of health problems from reduced screening, management and monitoring of serious health conditions.

 

This call, in an open letter to Australians, encourages people to get the health care they need, whether that be screening, getting treatments from an allied health provider or having a telehealth consultation with their pharmacist.

 

Now is the time to reach out to patients who have disengaged from managing their chronic health conditions, particularly those who you may not have seen for a while. This can include undertaking medicine reviews, calling patients you haven’t seen for a while, discussing adherence during repeat dispensing or providing recommendations for screening services when non-prescription medicine requests warrant.

 

Provisions for medicine review services (e.g. Medschecks, HMRs) to be conducted via telehealth are available and I encourage you to promote them to your patients where they provide an avenue for people trying to avoid public contact to get the expert pharmacist care they need.

 

Medicine limits and restrictions remain

 

I am pleased to hear many of the medicine shortages which arose in March and April from increased patient demand for prescription and non-prescription medicines – in particularly salbutamol, paediatric analgesics, hydroxychloroquine – are well on their way to returning to more stable levels.

 

Back in March, PSA, together with the Government, the Pharmacy Guild of Australia and the National Pharmaceutical Services Association agreed to dispensing and supply limits for nominated medicines. Your hard work, the work of all pharmacists and the work of suppliers has been absolutely essential to restoring stability in the supply chain; helping medicines be available for everyone.

 

Limitations to the Schedule 3 listing of salbutamol are a permanent regulatory change; meaning the single inhaler limit and requirement for the patient to provide evidence of medical diagnosis of a respiratory condition or dispensing history at the supplying pharmacy remain.

 

As we move to a COVID-normal environment, it is essential adherence to these limits continue to maintain ongoing stability of the supply change. As many of you are aware, a large number of medicines remain out-of-stock or on constrained supply. Continuing to play our part helps ensure essential medicines will be available to as many Australians as possible when they need them. Something more important than ever as we focus on consumers with management of their chronic health conditions.

 

The non-COVID19 curves likely to rebound

 

Social distancing hasn’t just flattened and squashed the COVID-19 curve, it has also limited the transmission of other infectious diseases. Confirmed cases of other notifiable infectious diseases such as influenza, chlamydia and norovirus have been significantly lower in recent months. While some of this may be attributed to people not seeking usual medical care and pathology testing, limited social interaction and increased infection control measures has seen dramatic drops in community prevalence of these conditions.

 

The graduated return to workplaces, schools and social gatherings in a COVID-normal community will likely see increased rates of non-COVID infectious diseases, with health authorities renewing calls for influenza vaccination this week.

 

When responding to queries about respiratory conditions, the messages we have become accustomed to during COVID-19 remain the same: Stay at home if sick. Get tested if you have unexplained fever or any respiratory symptoms. Maintain physical distancing. Limit social interaction if vulnerable. Download the COVIDSafe App.

 

Your voice to parliament: highlighting the lessons of COVID-19

 

This week PSA will be submitting its response to the Senate Inquiry into the health response to COVID-19, which will highlight the challenges faced with medicines shortages, digital image prescribing and regulatory confusion. It will outline important lessons learnt as well as examine the extraordinary strength and purpose pharmacists demonstrated in supporting Australians under unparalleled pressure and community panic.

 

In the submission we will be highlighting the challenges faced with medicine shortages, digital image prescribing, regulatory confusion between the Commonwealth and state jurisdictions and the challenges with the TGA’s Serious Shortage Medicine Substitution Notices.

 

I will share the submission with you once it has been published on the Senate’s website.

 

Providing further clarity on emergency supply options

 

How well do you know your state/territory legal requirements for phoned/faxed prescriptions?

 

What conditions need to be met to use the emergency supply ‘3-day rule’ if someone doesn’t meet the requirements for Expanded Continued Dispensing (or one month emergency non-PBS supply during where allowed)?

 

The application of these requirements has been a point of tension with prescribers during COVID-19 where they need to be followed when prescriptions aren’t eligible to be supplied under temporary COVID-19 provisions (digital image prescriptions and Expanded Continued Dispensing).

 

Our dedicated COVID-19 microsite has been updated with state-specific mapping these requirements to help clarify requirements for prescriptions unable to be supplied as digital image prescriptions or under Expanded Continued Dispensing arrangements.

 

The microsite also continues to be updated daily with information relevant to your practice.

 

Sincerely,

Associate Professor Chris Freeman

National President

Pharmaceutical Society of Australia

National President’s Message: COVID-19 Update

19 May 2020

 

Two months ago when COVID-19 led to the rapid implementation of Stage 3 restrictions, it seemed impossible that by mid-May we would have seen cafes and restaurants reopening, boot camps recommencing and multiple jurisdictions achieving zero active known COVID-19 cases. For many in the community, there is a feeling that the worst of the pandemic is behind us, and there is agitation to return to our pre-pandemic lives.

 

I echo the sentiments of Professor Michael Kidd, Deputy Chief Medical Officer on Saturday that everyone must remain vigilant, and that the relaxation of restrictions is not a signal the pandemic is over and not a signal to return to life as it was pre-COVID-19. In the past few days, we have seen news headlines of new cases prompting workplace shutdowns, including multiple fast food stores, a furniture warehouse and a department store. We have also seen public criticism of people who attended workplaces providing health support when unwell.

 

We are moving into a ‘business as unusual’ environment where we reopen our community in a way which recognises and respects the ongoing presence of a virus to which we currently have no effective pharmacological treatment or community immunity.

 

In your practice, to your family and to your friends, promote and exhibit the modified norms: ongoing physical distancing, rigorous hand hygiene, staying home and being tested if sick and enhanced cleaning.

 

Serious Shortage Medicine Substitution system falls seriously short

 

You would likely be aware that the TGA last week published the first Serious Shortage Medicine Substitution Notice (SSSN) as part of its medicine shortages initiative. The initiative is meant to help patients continue to access medicines without delay during stock shortages, but the way it has been set up will make this difficult to achieve.

 

In this case, metformin XR 500mg is expected to be out of stock until at least early June. The TGA SSSN outlines three permitted substitutions based on total daily dose:

• 1500mg daily: substitute with metformin 1000mg XR and metformin 500mg IR
• 1000mg daily: metformin 1000mg XR
• 500mg daily: metformin 500mg IR

 

The permitted quantity to supply aligns to the equivalent doses to what was prescribed.

 

Does an SSSN make substitution by pharmacists legal?

 

As laws governing supply of medicines are state/territory-specific, whether you are allowed to make this substitution depends on where you practice – and each state and territory has incorporated it differently.

 

You are allowed to make the substitution unless you are practising in Victoria or South Australia – neither state has issued a public health order required to enable the substitution. For a more complete understanding of the regulation in your location, click here.

 

Is an SSSN recognised for PBS supply?

 

No. There is no provision to supply under the PBS when medicines are substituted under this approach. Even through metformin XR is a relatively low-cost medicine, this increase in out-of-pocket costs is a problem for some patients. For more expensive medicines, lack of PBS eligibility will render the SSSN impractical as patients will be better off delaying treatment to get an alternate prescription from their doctor.

 

When therapeutic substitution for medicine shortages was first tabled jointly by both the PSA and the Pharmacy Guild of Australia, this is not the model we put forward. In our view, the system is too complicated, too slow to respond to shortages, too inflexible to take into account local medicine shortages, and too bureaucratic to recognise pharmacists’ competence to make, what are largely, straightforward substitutions.

 

PSA will continue to work with state, territory and federal governments to improve patient access to medicines during shortages – with our first priority being to improve the workability of these arrangements. Together with the Guild, we will be following up with state and territories to modify state regulation to improve this system for pharmacists and the health and safety of patients.

 

Electronic prescriptions just a few weeks away

 

Electronic prescriptions remain a hot topic and one of strong interest to the profession, particularly as many of you are weighted down under a mountain of administratively complex digital image prescriptions.

 

Electronic prescriptions remain on target for implementation from the end of this month, with some prescribing and dispensing software providers expected to include its functionality in June software updates.

 

Last Wednesday night, I hosted an electronic prescriptions webinar in partnership with the Australian Digital Health Agency. We had more than 500 pharmacists join us for the live event, with a high level of engagement, interest and questions regarding how the initiative will work.

 

Webinars on electronic prescriptions will become a fortnightly event in coming months to ensure your questions and as you start to see them come through in your practice.

 

National Mental Health and Wellbeing Pandemic Response Plan

 

National Cabinet, last Friday, unanimously agreed to a nationally consistent approach to responding to mental health challenges which arise from the pandemic. The approach is described in the National Mental Health and Wellbeing Pandemic Response Plan, with suicide prevention a strong focus. The plan consists of:

1. Data and modelling: including a focus on real-time data to identify emerging issues
2. Outreach: focused on helping vulnerable communities, including older Australians, carers of people with mental illness, culturally and linguistically diverse communities and indigenous Australians
3. Connectivity: including a public communications campaign titled: “It’s OK not to be OK”

 

The approach will work towards a ‘no-wrong-door’ approach to services, that wherever a person goes, they will be connected to part of the health system that can provide the services people need.

 

As I discussed last week, pharmacists are often a first point of contact for trauma-affected communities. Patients you interact with will present with signs and symptoms of mental health challenges, which can include reaching out to you in an indirect way. In supporting the ‘no-wrong-door’ approach outlined in the plan, I encourage you to know what options are available in your area and to connect patients to these services.

 

If you live in an eligible bushfire affected and have not already done so, I encourage you to sign up for the fully funded Mental Health First Aid training being run during May and June. Details the dates for these two-part workshops in your area are available here. If you don’t live in these areas, I encourage you to investigate other MHFA training in your area, such as those offered through PSA.

 

Webinar: MATOD in the time of COVID-19

 

As Australia cautiously eases restrictions, we are on a path towards ‘business as unusual’. So what will ‘business as unusual’ look like for your opioid substitution patients and services?

 

Join me on Wednesday night as Pene Wood, Lecturer of Clinical Pharmacy at LaTrobe University joins me to discuss the arrangements in place to support people living with opioid dependence on methadone or buprenorphine therapy.

 

7.30pm (EST) Wednesday 20 May

 

Register here.

 

Stay up-to-date

 

Our dedicated COVID-19 microsite has been updated with state-specific mapping of how the TGA SSSNs apply in each state and territory – as well as daily updates with information relevant to you.

 

Sincerely,

Associate Professor Chris Freeman

National President

Pharmaceutical Society of Australia

National President’s Message: COVID-19 Update

12 May 2020

 

Friday’s release of the Roadmap to a COVID Safe Australia marks a significant shift in Australia’s response to COVID-19. It marks significant achievements in Australia’s work to supress transmission of COVID-19 in the community. It marks a shift towards reopening businesses in forced hibernation. And it marks a shift towards social and family interactions.

 

Both from a sense of achievement and risk, the key change is that it marks a shift towards exponentially more human-to-human interaction in the Australian community.

 

All federal, state and territory leaders have reinforced, repeatedly, that this represents risk of increased transmission of COVID-19 and the risk of outbreaks. They have emphasised the roadmaps each jurisdiction is adopting are incremental stages.

 

As frontline health providers and as members of the Australian community you have an important role to play in helping your community transition to a COVID-Safe ways of living.

 

As people start to mingle more in returning to workplaces, cafes, restaurants, gyms, schools, swimming pools, shopping centres and on public transport; physical distancing, hand hygiene and staying home if they are sick is more important now than ever.

 

Be familiar with your local restrictions. Understand how the roadmap will roll-out in your area. Make more permanent changes to your work environment to make it COVID-Safe. Keep referring anyone with even mild respiratory symptoms to testing centres. Reinforce public health messages message with your patients constantly.

 

Collectively we can all make a huge difference in making Australia COVID safe.

 

Electronic prescriptions

 

Last week marked a significant milestone towards the introduction of electronic prescriptions. The first genuine and legally valid electronic prescription was created, stored and dispensed last week in Angelsea, Victoria.

 

Unlike digital image prescriptions, which are – sometimes poor quality – electronic reproductions of paper prescriptions, electronic prescriptions are completely paperless. They will reduce transcription errors and interpretation errors. They will also help consumers access their prescriptions where and when they want them.

 

PSA has been working with the Australian Digital Health Agency (the Agency), for some time on the workflow, support and resources needed to help with an effective and smooth transition to electronic prescriptions. I will continue to keep you updated in coming weeks and months as we welcome this evolution in pharmacy practice.

 

In the leadup to the introduction of electronic prescriptions at the end of the month, I’m pleased to be hosting this week’s Wednesday webinar, in partnership with the Agency to go through the important things you need to know, and answer all your questions.

 

Registration is open to all pharmacists, and available here.

 

Secure messaging

 

As electronic prescriptions advance towards its go-live date, work continues in the development of secure messaging systems. Secure messaging is the safe, encrypted transfer of information between health professionals; more secure, convenient and timely than current communication methods such as post and fax.

 

PSA is working with the Agency to help ensure the systems and technology work for pharmacists, and is seeking your input on what you need the system to do, and your insight into the current way you send and receive information to/from other health professionals. This can include routine sharing of records and data between services (e.g. faxing a dispensing history or Continued Dispensing Notice) or actual person-person communication such as contacting a prescriber directly about an issue or for additional information.

 

I encourage you to participate in the survey which is open until 17 May.

 

Mental health support for bushfire affected Australians

 

Last summer’s horrific bushfire season created significant individual and collective trauma for affected communities. While the media coverage of the recovery has been muted somewhat by COVID-19, colleagues in those areas have described to me the pain and struggle which those communities have and continue to experience.

 

I’m therefore pleased to report that PSA is partnering with the Australian Government to upskill pharmacists and pharmacy support staff in bushfire-affected areas, to support mental health in communities affected by the 2019-20 bushfires.

 

Pharmacists are often a first point of contact for trauma-affected communities and Mental Health First Aid training aims to improve frontline workers’ ability to support community members, promote their own resilience and psychological recovery from the 2019-20 bushfires, and support the resilience and wellbeing of frontline workers’ and their employers.

 

The course has both an eLearning component and two (2) virtual workshops of 2.5 hours each regarding the symptoms, causes and evidence-based treatments for mental health conditions, the early warning signs of mental illness, possible crisis situations arising from mental health problems, addressing crisis situations and the importance of intervening before a crisis develops.

 

The course is fully funded for pharmacists in affected areas and is being run during May and June. Details the dates for the two-part workshop for your area and logistics are available here.

 

Scheduling changes announced: triptans and paracetamol SR

 

The TGA late last week released a series of final scheduling decisions, announcing the following changes relevant to pharmacists:

• Sumatriptan 50mg (2 doses): New Schedule 3 entry from 1 February 2021
• Zolmitriptan 2.5mg (2 doses): New Schedule 3 entry from 1 February 2021
• Mometasone 0.1% (up to 15g): New Schedule 3 entry from 1 June 2020
• Paracetamol modified-release (up to 665mg: Packs of up to 100 tabs become Schedule 3 on 1 June 2020

 

I welcome these changes, particularly in regard to improving access to migraine medicines for people with stable migraine given the immediate need for symptom relieving medicines when a migraine strikes. As new Pharmacist Only Medicines, PSA will be preparing guidance documents to support safe, appropriate supply of these products.

 

To be clear, these changes remain well within the scope of practice of pharmacists, and I have encouraged the medical profession to refrain from providing comment outside their own scope of practice, that is the training and competencies of pharmacists.

 

As we all know, acute presentations like migraines don’t always present 9am to 5pm, Mondays to Fridays.

 

I encourage you to start socialising the change for modified release paracetamol to patients now to reduce confusion in June.

 

Pharmacists advice line

 

Following your feedback, we have worked to improve the way in which we respond to member practice queries. One of ways we are doing this is through the launch of a direct pharmacist-to-pharmacist advice line, offering professional advice from a senior pharmacist exclusively to PSA members.

 

Call on 1300 369 772 between 8.30am to 5.00pm AEST weekdays for professional advice and support on:

• Practice-related queries including APF, professional practice standards and guidelines, competency standards
• Ethics related queries including Code of Ethics and/or ethical dilemmas
• Technical queries about medicines, compounding and medicine availability
• Regulatory queries about legislation and policy matters
• Registration queries including CPD requirements and AHPRA requirements.

 

Stay up-to-date

 

Our dedicated COVID-19 microsite has been updated with state-specific plans to the COVIDSafe Australia Roadmap released last week. PSA will continue to communicate changes with you via this site, social media and in this weekly column.

 

Sincerely,

Associate Professor Chris Freeman
National President
Pharmaceutical Society of Australia

Award nomination form

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