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 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.
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.
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.
Associate Professor Chris Freeman
Pharmaceutical Society of Australia