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.
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.
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 firstname.lastname@example.org.
Thank you again for all you support and for all that you do as Pharmacists.
Associate Professor Chris Freeman
Pharmaceutical Society of Australia