td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11303 [post_author] => 235 [post_date] => 2020-09-16 13:57:28 [post_date_gmt] => 2020-09-16 03:57:28 [post_content] => Pharmacists from across the globe came together to share their experiences of the COVID-19 pandemic at the annual International Pharmaceutical Federation (FIP) congress – held virtually – this week. Panelists from Australia, Italy, Spain, Sweden, the United Kingdom (UK) and the United States (US) spoke about the challenges faced by pharmacists in their home countries in a session at FIP Virtual 2020. While the details of each situation were different, broad themes were common: a drastic increase in workload, uncertainty over new processes and legislation, and a commitment by pharmacists to serve their communities. To date, 52 pharmacists and pharmacy technicians from eight countries, chiefly Spain (19), Italy (11), Turkey and the United Kingdom (eight each), three from the US and one each from China, Belgium and Morocco, have died from COVID-19, according to FIP. [caption id="attachment_11306" align="alignright" width="232"] Ravi Sharma, Director for England of the Royal Pharmaceutical Society. (Image: FIP)[/caption] In the UK, pharmacy teams were upskilled quickly to enable them to work in areas such as critical care and mental health, said Ravi Sharma, Director for England of the Royal Pharmaceutical Society. ‘A lesson to come out of the pandemic is that we have gaps in our primary care integration – our healthcare system is not very joined up,’ he said. ‘There is now an opportunity to think about how pharmacy can become truly integrated into the healthcare system.’ Community pharmacies were a ‘pivotal part’ of the UK’s health response, Mr Sharma said, and the only healthcare service asked by the government to remain open. ‘Pharmacies are a gateway to the NHS [National Health Service] – we know 1 million consultations were happening in community pharmacies per week during the height of the pandemic,’ he said. ‘They were not only providing medicines but also health advice.’ Mr Sharma said the Royal Pharmaceutical Society had released an ethical decision-making framework to support pharmacists to make decisions about patient care. ‘This gave pharmacists the flexibility to use their clinical autonomy to make decisions in collaboration with other healthcare professionals in a safe and effective way,’ he said. Speaking from the US, CEO and Vice President of the American Society of Health-System Pharmacists Kasey Thompson said legislation held pharmacists back. 'One of the areas we’ve spoken about for so many years is making healthcare more convenient for patients and bringing healthcare to their homes,’ he said. ‘Something I was surprised about was how restrictive our laws and regulations were in regards to the provision of telehealth.’ Sonia Ruiz Moran, Director of International Affairs at the General Pharmaceutical Council of Spain, said the pandemic had increased the public’s understanding about the vital role of pharmacists. ‘Pharmacists have assisted 30 million people during the pandemic, which is about 60% of the entire population,’ she said. ‘There were 2.2 million people who received telehealth from pharmacists. More than 90% of Spaniards have an increased perception of pharmacy as an essential part of healthcare.’ FIP Community Pharmacy Sector President Lars-Ake Soderlund echoed these comments and said there had been a 'welcome reset' of the public's perception of the role of pharmacists.'When other healthcare facilities closed their doors, hospital and community pharmacies remained open,' he said.'We can conclude that pharmacists have once again shown that we are essential to the health of our communities and to the continued functioning of our health systems.'This goes for pharmacists in academia, science, educational activities, in industry, the supply chain, hospital and community pharmacy – we are all on the frontline in fighting this disease.'
Australian pharmacists at FIP[caption id="attachment_11304" align="alignright" width="249"] Parisa Aslani FPS is one of three new Vice Presidents of FIP.[/caption] Australia has been well-represented at the virtual congress, with University of Sydney Pharmacy School Professor of Medicines Use Optimisation Parisa Aslani FPS elected as one of three new Vice Presidents of FIP. PSA National President Associate Professor Chris Freeman said it was great to see Australian pharmacy represented on the world stage. ‘The honour of being named Vice President of the FIP follows significant dedication and leadership at the highest levels and presents a great opportunity to better connect Australian pharmacy practice to the rest of the world,’ he said. A/Prof Freeman also congratulated Monash University’s Faculty of Pharmacy and Pharmaceutical Sciences Dean Professor Bill Charman MPS on winning the inaugural Kamal K. Midha Award for Exceptional Leadership. Prof Charman was also one of eight pharmacists and pharmaceutical scientists to be made an FIP Fellow during the opening ceremony. ‘An FIP Fellowship recognises individual members of FIP who have exhibited strong leadership internationally and distinguished themselves in pharmacy practice or the pharmaceutical sciences,’ he said. ‘To also receive the very first Kamal K. Midha Award shows Professor Charman’s significant service and leadership in advancing the pharmacy profession.’ Professor Ross McKinnon from Flinders University was also named the new chair of the Board of Pharmaceutical Sciences. [post_title] => Pandemic dominates FIP 2020 [post_excerpt] => Pharmacists from across the globe came together to share their experiences of the COVID-19 pandemic at the annual FIP congress – held virtually – this week. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => pandemic-dominates-fip-2020 [to_ping] => [pinged] => https://www.australianpharmacist.com.au/covid-19-digital-image-prescriptions/ [post_modified] => 2020-09-16 18:00:35 [post_modified_gmt] => 2020-09-16 08:00:35 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=11303 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Pandemic dominates FIP 2020 [title] => Pandemic dominates FIP 2020 [href] => https://www.australianpharmacist.com.au/pandemic-dominates-fip-2020/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 11310 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11296 [post_author] => 1703 [post_date] => 2020-09-16 13:05:15 [post_date_gmt] => 2020-09-16 03:05:15 [post_content] => Three Western Australian (WA) pharmacists have been recognised for their high standards, professionalism and commitment to pharmacy in the PSA WA pharmacy awards. Angela Boyatzis MPS received the Pharmacist of the Year Award, Pascale Ng Cheong Tin FPS was presented with the Lifetime Achievement Award and Karis Butler MPS received Early Career Pharmacist of the Year. PSA WA President Dr Fei Sim congratulated Ms Boyatzis on her impressive work in the area of sleep management. ‘Angela has not only trained extensively in the area of sleep but has also implemented this service in her pharmacy for her patients, and trained colleagues,’ she said. ‘Over the years, she has strengthened ties with other health professionals, including doctors, physiotherapists and dietitian, and she is driven to provide the best health care to her many patients.’ Ms Boyatzis said she had always wanted to help people find simple and achievable solutions to their health problems. ‘In many cases, guiding people through a combination of lifestyle advice, and complementary as well as traditional medicines, can lead to long-lasting and sustainable positive health outcomes,’ she told Australian Pharmacist. Ms Boyatzis worked as a pharmacist in the United Kingdom before returning to Perth to work at St John of God Hospital, in education roles at Curtin University, and for the Pharmaceutical Council of WA. She returned to retail pharmacy 10 years ago, and is currently an Amcal Community Pharmacy partner, offering screening, diagnosis and support for sleep apnoea. ‘Being available for our sleep patients throughout the entire treatment journey, and beyond, is key to success,’ she said. ‘Communicating with their GP and providing reports and results is also a unique aspect of our treatment model. ‘I am proud to say patients (after treatment) have been able to complete a full day of work leading to a job promotion, exercise and lose weight, reduce blood pressure medicines, share a bed with a partner again, and improve their mental health.’ Ms Boyatzis is also an advocate for sustainability, providing a selection of sustainable alternatives to many traditional pharmacy products, and introducing progressive waste management strategies.
Educating future pharmacistsIn congratulating Ms Ng on her lifetime achievement award, Dr Sim pointed to her dedication to educating the next generation of pharmacists over more than 30 years. 'Her positive impact has been felt by many and the positive feedback from her students, who are now pharmacists, is testimony to her selfless character and enthusiasm in educating future pharmacists,’ Dr Sim said. 'As a longstanding fellow of PSA who keeps giving back to the profession, Pascale is indeed a real asset to pharmacy.' In 2017, Ms Ng won the prestigious Eric Kirk Memorial Award for an outstanding contribution to the development of professional practice in pharmacy. ‘It was a proud moment, and now the lifetime achievement award has made this doubly wonderful,’ she told AP. Ms Ng came to pharmacy later in life, migrating to Perth in 1986 from Mauritius and gaining admittance to the then 3-year Bachelor of Pharmacy degree in 1988 at the age of 33. She had three boys under 10, two of whom are now themselves pharmacists. ‘Pharmacy provided me with the perfect combination of patient, physiology and medicines,’ Ms Ng said. ‘I owned a small community pharmacy for 10 years in Myaree before I transitioned into education, teaching clinical pharmacy for 12 years at Curtin University. ‘When I finished university, I was asked to do a few tutorials and found that devising ways to explain complex concepts was natural to me and students responded to me positively.’ Ms Ng currently lectures part-time at Charles Darwin University and remains passionate about the pharmacy profession. ‘I am especially proud when I meet ex-students in pharmacies, and they tell me how my teaching has influenced them in the way they work,’ she said. ‘When I write lectures, it is not just about the diseases or the treatments, it is also about how the patient is to be understood and respected during the interaction. ‘Patients may not remember what you tell them, but they remember how you made them feel.’
Improving burns careDr Sim also paid tribute to Early Career Pharmacist of the Year Karis Butler, who has improved burns management and care provided to patients in her community pharmacy. ‘Noticing a gap when it came to burns management, Karis has worked tirelessly towards closing this gap, working closely with the Fiona Wood Foundation and guiding other pharmacists on how to implement important steps when it came to burns management,’ Dr Sim said. Ms Butler, a pharmacist at Terry White Chemmart, told AP she was inspired to start this work after her partner was hospitalised with a burns injury in 2013 and she was put in touch with the foundation. ‘I am passionate about early assessment and referral of burn injuries, as I have seen first-hand how this can affect the outcomes,’ Ms Butler said. ‘I have referred a number of burn injuries where at times the patient was reluctant to go to hospital, but later came back to thank me for [referring them]. ‘The ultimate goal is to achieve scarless healing.’ A research article Ms Butler worked on has provided a reference tool for pharmacists to use. [post_title] => Meet the 2020 PSA WA pharmacy award winners [post_excerpt] => Three pharmacists have been recognised for their high standards, professionalism and commitment to pharmacy in the PSA WA pharmacy awards. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => 2020-psa-wa-pharmacy-award-winners [to_ping] => [pinged] => [post_modified] => 2020-09-16 18:00:56 [post_modified_gmt] => 2020-09-16 08:00:56 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=11296 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Meet the 2020 PSA WA pharmacy award winners [title] => Meet the 2020 PSA WA pharmacy award winners [href] => https://www.australianpharmacist.com.au/2020-psa-wa-pharmacy-award-winners/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 11297 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11240 [post_author] => 1703 [post_date] => 2020-09-09 11:30:36 [post_date_gmt] => 2020-09-09 01:30:36 [post_content] => People from culturally and linguistically diverse backgrounds experience higher rates of adverse outcomes from poor medicines management, including medicine-related hospital admissions. Reducing this inequality and promoting the safe use of medicines within multicultural communities is the main focus of New South Wales Multicultural Health Week, from 7 to 11 September.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11235 [post_author] => 235 [post_date] => 2020-09-09 11:05:44 [post_date_gmt] => 2020-09-09 01:05:44 [post_content] => While the pandemic may be keeping Australians apart physically, for one intern pharmacist, it has been the perfect time to bring the generations in her community together. Working at the Gerald Burns Pharmacy in Bicton, Western Australia, Tahlia Parisella set up a penpal program between patients at the pharmacy and a local primary school after seeing firsthand the loneliness and social isolation experienced by many older people. ‘When I started my internship last year, I would do our weekly medicines deliveries, mainly Webster-paks,’ she told Australian Pharmacist. ‘A lot of our elderly patients would want me to come inside to have a cup of tea or coffee and a chat. Sometimes I was the only person they would see for a week, or at least a few days.’ Determined to help, and needing a project for her public health promotion, Ms Parisella and her preceptor landed on the idea of a letter exchange. They were inspired by the television show ‘Old People’s Home for 4 Year Olds’, which shows the positive impact socialising with younger (and older) generations can have. ‘In the show, the four-year-olds went into the nursing home to spend time with elderly people, and the health outcomes for the older group increased dramatically,’ Ms Parisella said. ‘We wanted to emulate this in a community pharmacy setting, and find a safe way to facilitate communication between elderly patients who are vulnerable and lonely, and primary school kids who might not get to interact with older people. ‘Social isolation has become so much more prominent because of COVID-19, and with pharmacists being so accessible to older patients it was a good option for us to reach out to them and see if we could help.’ Over the past 2 months, 25 patients have participated in the program, along with 25 students in Years 4 to Year 6 at Bicton Primary School. The two groups send each other regular letters, writing about everything from TikTok to what it was like living through a world war. ‘We’ve had really good feedback from our elderly patients; we often get people coming in and asking if their next letter has arrived,’ Ms Parisella said. ‘People have said it’s their favourite thing about this year … Some have the most incredible stories to share and are prone to being a bit lonely and vulnerable [and] this program gives them something to look forward to.’ The initial plan also involved the penpals meeting in person, although COVID-19 has put that on hold for now. But even without a physical meet-up, the program has still helped create connections between two groups who might not otherwise interact. ‘The whole project was about loneliness and social isolation,’ Ms Parisella said. ‘These are linked to things like cognitive decline, cardiovascular disease … They have been shown to be as detrimental as more common risk factors like obesity. So that’s what I wanted to target.’ PSA WA Branch President Dr Fei Sim said the public health program showcased how integral community pharmacists are within their communities. ‘It provides an alternative lens to holistic healthcare provided by pharmacists in the community, which extends beyond conventional consultations [and is] very innovative and impactful,’ she said. ‘While a lot of the focus has been on COVID-19 in recent times, it is important we don’t neglect other health conditions, including those relating to mental health. ‘I commend Tahlia and her colleagues for setting up this program that is not only heartwarming but of great benefit to both the patients and school children and is something that could easily be implemented in other pharmacies.’ [post_title] => Pharmacy intern connects generations during pandemic [post_excerpt] => Pharmacy intern Tahlia Parisella took an innovative approach to her public health promotion during the pandemic. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => pharmacy-intern-connects-generations-during-pandemic [to_ping] => [pinged] => [post_modified] => 2020-09-10 12:51:07 [post_modified_gmt] => 2020-09-10 02:51:07 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=11235 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Pharmacy intern connects generations during pandemic [title] => Pharmacy intern connects generations during pandemic [href] => https://www.australianpharmacist.com.au/pharmacy-intern-connects-generations-during-pandemic/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 11237 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11190 [post_author] => 235 [post_date] => 2020-09-02 11:56:01 [post_date_gmt] => 2020-09-02 01:56:01 [post_content] => Increasing numbers of pharmacies across the country are now accepting electronic prescriptions, with pharmacists reporting the new system is making life easier – after a little patient education. Andrew Robinson MPS from Amcal+ Pharmacy Tooronga in Melbourne, said quite a few electronic prescriptions were now coming into the pharmacy each day, across a range of patients and prescription types. Although pharmacists needed to adapt to the new workflow, implementing electronic prescriptions was not as hard as keeping up with rapid legislative changes during the pandemic, he said. ‘I think any pharmacist will find the workflow changes a challenge, but not as difficult as they might imagine,’ Mr Robinson told Australian Pharmacist. ‘It's more getting into the habit of checking a virtual queue rather than a physical one, although we are still using the physical baskets as well. The key is to get it up and running and then refine the way you manage the scripts in and out.’ The increase in faxed and emailed prescriptions in recent months highlighted the usefulness of electronic prescriptions, Mr Robinson said, and how they will ultimately make pharmacists’ – and patients’ – lives simpler. ‘The pandemic has made our workload much more cumbersome and less efficient due to many faxes and emails from doctors for patients with no warning or notification,’ he said. ‘But if e-scripts were widely available, it would be much easier as the script would be with the patient, even if they had not physically seen the doctor. ‘It’s a game changer now, and will be into the future.’ Using an electronic token was also more practical, he said, with no staples or prescriptions pulled from the depths of someone’s handbag. ‘And there is nothing [physical] to return to the patient; it is all very easy,’ he added. Monique Allekian, pharmacist manager at Chemist Warehouse Victoria Gardens, also in Melbourne, said her pharmacy was receiving about five to 10 electronic prescriptions per day. ‘I think that’s going to increase – we’ve had a lot of medical centres call and ask if the pharmacy accepts e-scripts,’ she said. ‘There are benefits for everyone: patients, pharmacists and prescribers.’ A key benefit for patients is having easy access to their prescription, while for pharmacists it is about ease of use, she said. ‘I was surprised how easy it was,’ Ms Allekian told AP. ‘The QR code can only be used once, so there’s no risk of duplication. There’s also less paperwork and less chance of a dispensing error, because once you scan it all the information is there.’ Ms Allekian said this means pharmacists could dispense scripts more efficiently and more accurately. [caption id="attachment_11193" align="alignright" width="248"] Monique Allekian[/caption]
Focus on patient educationThe main challenge lies with patients that have multiple prescriptions and repeats, as the current system requires a different token for each prescription. However, this will become easier with the introduction of the Active Script List later this year, which will allow patients to give consent for a pharmacy to access all their prescriptions. ‘Patient management of the tokens is a bit tricky for patients with several tokens or repeats,’ Mr Robinson said. ‘If the patient has a one-off item it is so easy, but managing multiple in an SMS chain, or email, is a little overwhelming for some, which means it is a bit more work for us trying to help them find and manage those tokens. ‘We have ended up printing tokens for patients with scripts on file and adding the token to the physical file as there is no other way for them to manage them all at this stage.’ Ms Allekian agreed, and said patient education was important. ‘The big challenge is if a patient is on multiple medicines, then loading five different links can become a bit tedious, but that will change,’ she said. ‘Another challenge is when patients come back for their second repeat and are confused where their script is. [Electronic prescriptions] are a new thing for them as well, so they need to be educated. ‘We show them that we can easily press a button and they receive their repeats straight away. As patients get used to it and it gets rolled out more extensively, it will become easier.’ Overall, patients have given positive feedback about the changes, and Ms Allekian said many were eager to use the new system. ‘Most people come in and are excited about it,’ she said. ‘Some people are unsure exactly how it works, so when we dispense the prescription we counsel them and let them know they’ll get a text with their repeat.’Do you have questions about electronic prescriptions? Call PSA's electronic prescriptions advice line on 1300 955 162 between 8.30 am to 7.00 pm AEST or click here to send an email.[post_title] => Pharmacists on 'game-changing' electronic prescriptions [post_excerpt] => Increasing numbers of pharmacies are now accepting electronic prescriptions, with pharmacists reporting the new system is making life easier. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => pharmacists-game-changing-electronic-prescriptions [to_ping] => [pinged] => [post_modified] => 2020-09-02 17:26:35 [post_modified_gmt] => 2020-09-02 07:26:35 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=11190 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Pharmacists on ‘game-changing’ electronic prescriptions [title] => Pharmacists on ‘game-changing’ electronic prescriptions [href] => https://www.australianpharmacist.com.au/pharmacists-game-changing-electronic-prescriptions/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 11192 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11294 [post_author] => 23 [post_date] => 2020-09-16 13:16:44 [post_date_gmt] => 2020-09-16 03:16:44 [post_content] => The Therapeutic Goods Administration (TGA) has delivered an interim decision to down-schedule low dose cannabidiol from Prescription Only Medicine (S4) to Pharmacist Only Medicine (S3), with additional Appendix M controls, to allow greater access for patients.1 Stakeholders and companies in the cannabis industry have welcomed the move, but some say evidence to support the efficacy of low dose cannabidiol is lacking. Down-scheduling would apply to oral, oral mucosal and sublingual formulations of cannabidiol (CBD) products with requirements including a maximum recommended daily dose of 60 mg or less in packs containing 30 days’ supply or less, where CBD comprises at least 98% of the total cannabinoid content in the product. An additional condition specified in Appendix M, to allow it to be provided by a pharmacist, is that supply is limited to medicines on the Australian Register of Therapeutic Goods.1 PSA provided a submission in response to the proposed amendments, where it acknowledged that greater access to CBD was consistent with the current policy approach and reforms around medicinal cannabis availability and use in Australia.2 However, PSA did not support a separate proposal to exempt from scheduling cannabidiol as 98% or greater of total cannabinoid content, and 0.2% or less of tetrahydrocannabinol content, citing ‘significant concerns around safety implications for patients and carers, as well as the broader public’. 2 PSA National President Associate Professor Chris Freeman noted that the down-scheduling was not requested by the pharmacy profession. ‘Whilst low dose cannabidiol may be relatively safe, it is important that it has a therapeutic purpose and evidence behind the claims,’ Prof Freeman said. The submission also contended that evidence was limited in different indications and patient groups.2 The PSA believes additional Appendix M controls are needed, and did not support the inclusion of CBD in Appendix H (able to be advertised to the public).2 The published outcomes, however, are interim decisions and subject to further public consultation.
Stakeholder responseCBD is one of more than 100 compounds known as cannabinoids found in the cannabis (marijuana) plant, Cannabis sativa. It is the second most prevalent of the active ingredients in cannabis, but is not psychoactive, unlike tetrahydrocannabinol (THC). Brisbane community pharmacist and Executive Chairman and CEO of MedReleaf Australia Russell Harding has seen the benefits of CBD and combination CBD products for patients with many conditions since medicinal cannabis was legalised in 2016. Side effects have been generally mild, he told Australian Pharmacist. As with others working in the cannabis industry, he is eager to see greater accessibility of medicinal cannabis for the vulnerable and disadvantaged. However, he has reservations about the TGA decision. Although clinical trials are underway, Mr Harding believes there is little evidence to support a daily dose of 60 mg and thinks a more appropriate dose would be much higher – at least 200 mg daily. And even low-dose CBD would be cost-prohibitive without a government subsidy, ‘either as a mandated good manufacturing practice-compliant registration process or a new Aust-C category for medicinal cannabis’, he said. Mr Harding foresees the challenges in bringing a low-dose CBD product to market and to achieve ARTG listings with a whole plant medicine. He believes it will be a long time coming.
Challenges for pharmacistsDebbie Rigby FPS, well-known consultant clinical pharmacist, referred to the ‘hype, hope and hoops’ of CBD. ‘Down-scheduling will reduce the hoops, but would probably escalate the hype and hope,’ she told AP. Although down-scheduling would increase access for patients who are likely to benefit from its use, it would bring some challenges for community pharmacists. ‘I think the community’s expectations on the benefits of CBD are often unrealistic and influenced by media and anecdotal hype and false hope,’ Ms Rigby said. ‘A sound understanding of the evidence of benefit and absence of benefit would be essential for community pharmacists.’ ‘As an accredited pharmacist conducting Home Medicines Reviews, I have been asked about the use of CBD and usually spend some time discussing the evidence (or lack of) with patients, as well as considering the potential for drug interactions with the other medicines. We must remain evidence-based in our approach, whilst respecting the consumer’s rights and preferences.’ References
[post_title] => Should cannabidiol be down-scheduled to S3? [post_excerpt] => The Therapeutic Goods Administration (TGA) has delivered an interim decision to down-schedule low dose cannabidiol. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => should-cannabidiol-be-down-scheduled-to-s3 [to_ping] => [pinged] => [post_modified] => 2020-09-16 18:00:50 [post_modified_gmt] => 2020-09-16 08:00:50 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=11294 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Should cannabidiol be down-scheduled to S3? [title] => Should cannabidiol be down-scheduled to S3? [href] => https://www.australianpharmacist.com.au/should-cannabidiol-be-down-scheduled-to-s3/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 11300 )
- Australian Government Department of Health: Therapeutic Goods Administration. Notice of interim decisions to amend (or not amend) the current Poisons Standard. 2020. At: www.tga.gov.au/sites/default/files/notice-interim-decisions-proposed-amendments-poisons-standard-acms-and-joint-acms-accs-meetings-june-2020.pdf
- Pharmaceutical Society of Australia. Consultation: Proposed amendments to the Poisons Standard – Joint ACMS-ACCS meeting. 2020. At: www.tga.gov.au/sites/default/files/public-submissions-scheduling-matters-referred-acms-31-and-joint-acms-accs-25-meetings-held-june-2020-psa-01.pdf
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11249 [post_author] => 23 [post_date] => 2020-09-09 11:49:18 [post_date_gmt] => 2020-09-09 01:49:18 [post_content] => For the fifth year in a row, more than 2,000 Australians lost their lives to overdose in 2018, according to Australia’s Annual Overdose Report 2020 from Penington Institute. Opioids were the drug group most identified in unintentional overdose deaths, followed by benzodiazepines and stimulants, and alcohol was a contributing factor. The impact of the COVID-19 pandemic is yet to be determined, but is expected to be considerable.1 The 2018 overdose findings included1:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11182 [post_author] => 1703 [post_date] => 2020-09-02 11:43:49 [post_date_gmt] => 2020-09-02 01:43:49 [post_content] => The National Asthma Council Australia has released an updated version of its Australian Asthma Handbook, which includes a new treatment option for adults and adolescents (aged 12 years and over) with mild asthma.
For more information on the Australian Asthma Handbook Update, don’t miss PSA’s webinar on 30 September. For more information and to register, click here.[post_title] => New recommendations for patients with mild asthma [post_excerpt] => The latest version of the Australian Asthma Handbook includes a new treatment option for adults and adolescents with mild asthma. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => new-treatment-recommendations-patients-asthma [to_ping] => [pinged] => [post_modified] => 2020-09-02 17:27:16 [post_modified_gmt] => 2020-09-02 07:27:16 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=11182 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => New recommendations for patients with mild asthma [title] => New recommendations for patients with mild asthma [href] => https://www.australianpharmacist.com.au/new-treatment-recommendations-patients-asthma/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 11188 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11180 [post_author] => 23 [post_date] => 2020-09-02 11:23:18 [post_date_gmt] => 2020-09-02 01:23:18 [post_content] => Pharmacists, prescribers and patients have been told by the Therapeutic Goods Administration (TGA) to expect a shortage of Estradot (estradiol) hormone replacement therapy (HRT) transdermal products until July 2021. The shortages prompted the TGA to authorise five overseas-registered products, also named Estradot, in strengths 25, 37.5, 50, 75 and 100 microgram for import and supply until 1 August 2021 (unless lapsed earlier), under Section 19A of the Therapeutic Goods Act 1989. However, there is a delay in the supply of some of these authorised replacements. As a result, the TGA has issued Serious Shortage Substitution Notices for Estradot 25 and Estradot 100 patches. These notices allow pharmacists to replace prescriptions for the patches with the same strength of either Estraderm MX or Climara patches.1 Pharmacist Ruth Colwell MPS from Shaw Road Pharmacy in Brisbane’s inner north said she found the shortages frustrating. ‘Communicating with prescribers is time consuming and interrupts workflow,’ she told Australian Pharmacist. ‘Patients become frustrated when unable to source their intended product and can find it confusing coping with their potential side effects if their doctor then prescribes an alternative. ‘Hopefully this [TGA substitution] will make things a little easier both for the patient and the pharmacist.’ Under the TGA protocol for the Serious Shortage Substitution Notices issued for Estradot 25 and 100 patches1:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11127 [post_author] => 23 [post_date] => 2020-08-26 12:50:31 [post_date_gmt] => 2020-08-26 02:50:31 [post_content] => Mandatory double-checking as it is currently performed does not reduce the incidence or severity of medication administration errors compared with single-checking, an Australian observational study conducted in a large paediatric hospital has found. Considering the time and cost involved, more effective safety measures may be warranted in modern clinical settings, according to the study authors.1 The global prevalence of medication errors in paediatric inpatients is high. Patients are vulnerable and have low physiological reserves to manage the effect of errors. As a measure to minimise errors and their associated harm, double-checking medication administration is recommended in paediatric hospitals and has been part of nursing practice for decades. Evidence to support its effectiveness is very limited, however.1 In this research, hospital policy required independent double-checking by registered nurses. This involved one nurse verifying in front of another nurse the medication order, correct dose for patient weight, time of last dose administration, medication and solvent/diluent when applicable, dose calculation, preparation and patient identification. The crucial aspect of double-checking is that it is independent and done without the administering nurse sharing information with the checking nurse. In contrast, if a nurse shares information (for example, the name of the drug to be checked), it could lead to two people making the same mistake i.e. confirmation bias. Sharing information beforehand is known as primed double-checking. Although nurses in the study believed that double-checking was necessary and they were highly compliant, it was rarely done independently. Primed double-checking was prevalent despite the hospital policy for independence. Checking was also considered less important for ‘safer’ medicines such as topical preparations, leading researchers to ask whether different checking was needed for different tasks. Little safety benefit was found with primed double-checking in addition to single-checking. The effectiveness of independent double-checking was unable to be determined, leaving this question unanswered. Continuation of the current practice seems questionable according to the authors, who posed questions about the value of clinical judgment rather than policy-mandated double-checking. Changes in technological developments, presentations, packaging and administration equipment over the past 50 years have added to the demands on nursing staff faced with preparation and administration of medicines, the authors concluded, and there must be updated, innovative checking processes for today’s clinical settings.
Lessons for pharmacistsWhile the research focused on nursing practice, lead author of the study and Director of the Centre for Health Systems and Safety Research at Macquarie University Professor Johanna Westbrook acknowledged the important role pharmacists play in promoting medicine safety in hospitals. She advised that pharmacists involved in double-checking medication supply in hospital or community pharmacy settings should continue to follow existing recommendations that promote the importance of independent double-checking until further research evidence was available. ‘This could be particularly relevant for double checks for dispensing controlled drugs, as well as packing medication dose administration aids,’ she told Australian Pharmacist. Prof Westbrook said the study demonstrated that medication errors remained a significant safety issue in hospitals, and that multiple strategies were likely to be required to address the problem. Reference
[post_title] => Double-checking does not always reduce medication errors [post_excerpt] => Mandatory double-checking as it is currently performed does not reduce the incidence or severity of medication administration errors compared with single-checking, an Australian study has found. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => double-checking-medication-administration-errors-study [to_ping] => [pinged] => https://www.australianpharmacist.com.au/a-tragic-medication-error/ [post_modified] => 2020-08-27 09:21:29 [post_modified_gmt] => 2020-08-26 23:21:29 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=11127 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Double-checking does not always reduce medication errors [title] => Double-checking does not always reduce medication errors [href] => https://www.australianpharmacist.com.au/double-checking-medication-administration-errors-study/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 11130 )
- Westbrook J, Li L, Raban M, et al. Associations between double-checking and medication administration errors: a direct observational study of paediatric inpatients. Qual Saf 2020;0:1–11.
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Case scenarioJoe is 45 years old. Since he left school, he has worked in the construction industry. For the past 10 years Joe has worked in a joinery making timber windows and has experienced prolonged exposure to high levels of noise. Joe always talks very loudly when he comes into the pharmacy. He mentions that he has a constant ringing in his ears and asks your advice on how he can stop it.
Learning objectivesAfter successful completion of this CPD activity, pharmacists should be able to:
|SUBJECTIVE||Only the affected person can hear the sound (e.g. normal blood flow, sign of a tumour or blood vessel damage)|
|PRIMARY||No identified cause other than hearing loss if present|
|SECONDARY||Known specific cause|
|ACUTE OR RECENT ONSET||Apparent for <6 months|
|CHRONIC||Apparent for >6 months
|EXTERNAL EAR||Cerumen impaction Otitis externa|
|MIDDLE EAR||Otitis media Cholesteatoma|
|Do you find the tinnitus bothersome or non-bothersome?||
|When did the tinnitus begin?||
|Is the tinnitus constant or pulsatile?||
|Is the tinnitus unilateral or bilateral?||
|Is the tinnitus associated with otological (ear) symptoms (e.g. blocked ear sensation, ear pain, and vertigo)?||
|Is your hearing affected? If so, is the hearing loss sudden?||
|Do you think the tinnitus is due to prolonged exposure to noise, either occupational or social?||
|Are you taking any medicines?||
|How are you feeling? Depressed? Anxious?||
Case scenario continuedYou have known Joe for about 5 years. During this time, you have observed his increasing difficulty communicating. He tells you he is also experiencing difficulty participating in work activities as well as social events due to tinnitus. He has expressed sadness at his lack of personal relationships often because others do not understand tinnitus, which is adversely affecting his life. You refer Joe to his doctor, suggesting that he should have his tinnitus further investigated. A couple of months later, Joe returns to the pharmacy. On your advice, Joe had his tinnitus assessed. His GP sent him for an audiological assessment. It was found that Joe has significant hearing loss. As a result, Joe has hearing aids with a tinnitus masker fitted that he’s found beneficial. He has now been able to communicate better with his fellow workers and his family. However, Joe is still struggling to sleep. He asks if there’s something to help him sleep. You discuss this with Joe and acknowledge that many people with tinnitus experience poor quality sleep. When Joe leaves a noisy work environment for the quietness of his bedroom, the tinnitus is more noticeable. Joe also says he worries about the effects of not sleeping. You and Joe discuss sleep hygiene and the use of a sound generator during sleep to help improve his sleep quality. This background noise creates a background screen of noise, so that even if other noises occur in the environment or internally, such as with tinnitus, those noises are masked or screened out by the background or white noise. You also encourage Joe to seek the help of a tinnitus counsellor.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11214 [post_author] => 2903 [post_date] => 2020-09-09 03:41:34 [post_date_gmt] => 2020-09-08 17:41:34 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]Acute coronary syndrome significantly contributes to the morbidity and mortality of ischaemic heart disease, which remains the leading cause of death in Australia.1 It is estimated that 1.6% of Australians have experienced an acute myocardial infarction (MI),2 with an average of 157 people admitted to hospital for an acute MI each day in 2018.3 Acute coronary syndrome (ACS) refers to coronary ischaemia that presents with new or increasing symptoms.
|After reading this article, pharmacists should be able to:
|MODIFIABLE ISCHAEMIC HEART DISEASE RISK FACTORS||NON–MODIFIABLE ISCHAEMIC HEART DISEASE RISK FACTORS|
|COMMON SYMPTOMS OF ACS||LESS COMMON SYMPTOMS OF ACS|
|Aspirin||300 mg||Orally. Chewed or dissolved prior to swallowing if possible||Stat|
|Glyceryl trinitrate (GTN)||Spray||1–2 sprays (400–800 microgram)||Sublingually||Every 5 minutes as required for ongoing chest pain/discomfort, up to three doses*|
|Tablet||Half to one tablet (300–600 microgram)||Sublingually||Every 5 minutes as required for ongoing chest pain/discomfort, up to three doses*|
|Opioid analgesic||Fentanyl||25–50 microgram||Intravenously||Every 5–10 minutes as required for ongoing chest pain/discomfort|
|Morphine||2.5–5 mg||Intravenously||Every 5–10 minutes as required for ongoing chest pain/discomfort|
|RISK CLASSIFICATION||CLINICAL CHARACTERISTIC|
|Tenecteplase||30–50 mg (6,000–10,000 units) intravenous bolusa,b|
|Reteplase||10 units intravenous bolus, repeat once after 30 min|
|Alteplase||15g intravenous bolus, followed by intravenous infusion:
|DRUG||FIRST DOSE||REGULAR DOSE|
|Aspirin||300 mg orally (unless already administered as part of the management of chest pain of possible cardiac cause)||100–150 mg orally daily|
|PLUS (where indicated)|
|Ticagrelora||180 mg orally||90 mg orally twice daily|
|Prasugrelb||60 mg orally||10 mg orally daily|
|Clopidogrelc||STEMI: 600 mg orally STEMI and afibrinolysis: 300 mg orally NSTEACS: 300–600 mg orally||75 mg orally daily|
|Enoxaparin||1 mg subcutaneous injection, twice daily.|
|Enoxaparin (in patients who receive fibrinolytics)||30 mg intravenous bolus, then 1 mg subcutaneous twice daily|
|Unfractionated heparin||60 units/kg intravenous loading dose, then 12 units/kg/hour intravenous infusion, adjusted for APTT according to local protocol|
|Bivalirudin||0.1 mg/kg intravenous bolus, then 0.25 mg/kg/hour intravenous infusion|
|ASPIRIN: to prevent blood clots P2Y12 INHIBITOR: to prevent blood clots and stent thrombosis ACE INHIBITOR/ARB: to limit infarct size and reduce ventricular remodelling BETA BLOCKER: to maintain or improve ventricular function STATIN: to reduce blood cholesterol and stabilise arterial plaque NITRATE (SHORT-ACTING): to treat chest pain, as required|
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11162 [post_author] => 104 [post_date] => 2020-09-01 16:32:03 [post_date_gmt] => 2020-09-01 06:32:03 [post_content] =>
Case scenarioJordan, a young man in his early 20s, has come to ask what he can use for an itchy rash between his toes. The rash started about 1 week ago. He thinks it may be athlete’s foot. On inspection, you notice that the skin area between his fourth and fifth toes looks flaky. You also notice that he is wearing trainers. Jordan tells you that he wears trainers most of the time as he plays basketball in a local competition and trains often with his friends.
Learning objectivesAfter successful completion of this CPD activity, pharmacists should be able to:
|Tinea corporis, tinea cruris||Apply once or twice a day for 1–2 weeks||Apply once a day for 1 week||Apply once a day for 1 week||N/a|
|Tinea pedis||Apply once or twice a day for 1 week for interdigital type Apply for 2–4 weeks for plantar/ moccasin type||Apply once a day for 1 week||Apply once a day for 1 week for interdigital type Apply for 2–4 weeks for plantar/ moccasin type||Apply once only to both feet (interdigital) Wash off 24 hours later Not recommended for plantar/ moccasin type|
Case scenario continuedBased on the location and appearance of the rash, you agree with Jordan that he appears to have athlete’s foot (tinea pedis) between his toes. As the rash has been present for a relatively short time, and is restricted to the area between his toes, you recommend terbinafine cream. You advise him to apply a thin layer of the cream to the rash and surrounding skin daily after cleaning and drying the affected area. The cream should be applied to both feet, as both are often affected even though symptoms are not apparent on the other foot. Application should be done for 1 week and not ceased before that time if symptoms improve. If you think that compliance with therapy for one week may be unlikely, offer him the option of the liquid product, which is applied once only. You advise that Jordan should use a separate towel for the infected area. He should avoid wearing trainers except when playing sport, wear rubber thongs in change rooms and change his socks daily to avoid future infections. His trainers should be dried in the sun and dusted with tolnaftate powder or discarded if old. If the infection has not cleared in 2–3 weeks, he should see his doctor.
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Case scenarioSuzanne is a 22-year-old university student who presents to your pharmacy with a prescription for mometasone furoate 0.1% ointment to be applied once daily to an unsightly rash on both her elbows. The rash started a few weeks ago, just as she was about to undertake her university examinations. She says that her doctor has diagnosed her with a skin condition called psoriasis, and she is quite concerned after being told that this is an incurable disease. Suzanne is currently on the combined oral contraceptive pill but is otherwise healthy with no known allergies. You reassure Suzanne that although psoriasis is incurable, the majority of cases are mild and can be managed well. You provide advice on the use of mometasone furoate ointment and explain that there are a number of treatment options available should the current treatment fail to be effective. Anxiety associated with her recent university examinations may have triggered the psoriasis. You further advise Suzanne about avoidance of potential triggers for the condition and the various nonpharmacological strategies which may be used in conjunction with her ointment.
Learning objectivesAfter successful completion of this CPD activity, pharmacists should be able to:
|SEVERITY OF PLAQUE PSORIASIS||PASI SCORE (0–72)||DLQI SCORE (0–30)|
|Mild to moderate||≤10||≤10|
|Severe||≤10 or >10||>10
≤10 and include involvement of:
|Severe||>10||≤10 or >10|
|DRUG AND FORMULATIONS||STRENGTHS AVAILABLE||GENERAL DIRECTIONS|
||Variable potencies and strengths:
|Coal tar –
|Salicylic acid –
||Short contact treatment – Start with low strength for 5–10 minutes daily, increase strength and application time according to response|
Case scenario continuedSuzanne returns to your pharmacy 3 weeks later and tells you that after using the mometasone ointment as directed, the rash on her elbows has almost cleared up. She has stopped using the ointment and is now applying a simple moisturiser (sorbolene cream with glycerin 10%) twice a day to the affected area, as recommended by you. She tells you that she now has a better understanding of psoriasis and is much less anxious about the management of her condition.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11029 [post_author] => 2663 [post_date] => 2020-08-19 11:01:42 [post_date_gmt] => 2020-08-19 01:01:42 [post_content] =>
Annaleise, a pharmacist vaccinator, is delivering her first influenza vaccine outreach clinic in her local community. She has packed the various vaccines in a polystyrene cooler, carefully following instructions to sweat the ice bricks, wrap them in bubble wrap, layer the contents using insulating material (shredded paper) and placing the min/max thermometer probe into the middle of the vaccines. She ensures the vaccines do not touch the ice bricks. She has been advised the clinic venue is 15 minutes’ drive away and is scheduled for 2 hours’ duration. On departure from the pharmacy, Annaleise checks the min/max thermometer monitor and again upon arrival at the venue, then approximately every 15 minutes and records these on the chart.
An hour into delivering the outreach clinic, Annaleise is asked if she can extend her time as some clients have been delayed in getting to town from their remote station for their vaccinations. Annaleise is not sure that her cooler will be able to maintain cold chain and she did not bring spare ice bricks with her. She contacts a staff member at the pharmacy to deliver more ice bricks as soon as possible.
Learning objectivesAfter successful completion of this CPD activity, pharmacists should be able to:
Competency standards addressed (2016): 1.1, 1.3, 2.3, 2.4, 3.2
Vaccines are temperature-sensitive biological products that, to ensure potency, must be stored between 2 °C and 8 °C from the time of manufacture to the point of administration.1 Exposure to temperatures above this range may result in reduction of shelf-life, while exposure to freezing temperatures is likely to cause irreversible loss of vaccine potency.2 Ensuring vaccines and temperature sensitive medicines are not exposed to temperatures outside 2–8 °C is known as ‘cold chain management’. Pharmacists have a professional responsibility to administer efficacious and immunogenic vaccines. Breaches in the vaccine cold chain may result in the administration of vaccines that cannot elicit an immune response and therefore may leave the individual and community at risk of vaccine-preventable diseases.
When pharmacists deliver a mobile or outreach vaccination service there is a requirement for transport and short-term storage of vaccines outside of the pharmacy. As a result, the service requires additional cold chain monitoring and vigilance. The first article (Cold chain management and vaccines, July AP) in this two-part series covered vaccine cold chain management in the pharmacy setting. This follow-on article will cover cold chain management when delivering a mobile or outreach vaccination service.
Regulations in some jurisdictions (Victoria, ACT, NSW) currently allow pharmacists to administer vaccinations as part of a mobile or outreach service on behalf of a service provider (hospital, pharmacy, pharmacy depot).3,4 While both mobile and outreach vaccination services involve the delivery of offsite immunisation clinics away from the traditional pharmacy setting, the terms are not interchangeable. A mobile vaccination service is one that spans several days and involves travelling (usually long distances) and providing immunisation sessions at different sites.5 In contrast, an outreach vaccination service is shorter in duration (several hours), and the pharmacist vaccinator returns to the pharmacy setting (service provider) before the end of the day. Inherent in delivering an offsite vaccination service are challenges with cold chain management. One challenge is to transport vaccines and continuously maintain cold chain.
The pharmacist must ensure that they are prepared with enough stock and equipment for service delivery. This is likely to include the required number of vaccines, diluent, a complete anaphylaxis kit, appropriate size and number of portable insulated containers (for transport and short-term storage of temperature-sensitive medicines and vaccines), min/max thermometers and ice/gel packs. If providing a mobile service, where there is no electricity supply or refrigerator, the pharmacist should take additional ice and/or gel packs to replace the melted ones in the portable insulated container.5
Transporting temperature-sensitive medicines and vaccines
To deliver a mobile or outreach vaccination service, vaccines need to be removed from the purpose-built vaccine refrigerator located in the pharmacy and transported to the site of service delivery. To transport and store vaccines, a portable insulated container is used.
Portable insulated containers (standard coolers, vaccine carriers and cold boxes)
Portable insulated containers may be purpose-built (e.g. vaccine carriers and cold boxes) or domestic style (standard cooler). It is common for the term ‘cooler’ to be used to define these types of portable insulated containers; however, this is not technically correct as there are notable differences, including ‘cold life’ of the device. The ‘cold life’ of a container is the period of time after ice and/or gel packs have been added to the container, with a closed lid, until the temperature of the warmest point first reaches +10 °C, at a constant ambient temperature of +43 °C.⁶
When delivering an outreach service that requires vaccines to be outside of refrigeration for a short period (<8 hours), a domestic-style or standard cooler may be used to transport and store the vaccines. Standard coolers (commonly known as Eskys in Australia) have a limited ‘cold life’ of up to 8 hours. They are not suitable to store or transport vaccines for a prolonged period (>8 hours) or in extreme conditions (environmental temperatures <0 °C or >40 °C).1 Polystyrene coolers are only suitable for storing vaccines for up to 4 hours.5
When vaccines and/or temperature-sensitive medicines will be outside of a purpose-built refrigerator for a long period (>8 hours) or exposed to extreme environmental temperatures, a specialised vaccine cold box or carrier should be used.1 Both are purpose-built for short-term vaccine storage and maintain cold chain longer than standard coolers.⁷ Cold boxes are larger containers (6–25 L capacity) and generally transported in vehicles.⁸ A large (long range) vaccine cold box has a minimum cold life of 96 hours when exposed to temperatures up to +43 °C without being opened. Vaccine carriers are generally smaller than cold boxes.⁹ As the name suggests, carriers are light weight and transportable and therefore more commonly used by immunisation providers, when delivering offsite vaccination services. See Table 1.TABLE 1 – Differences between a vaccine cooler, carrier and cold box [table id=13 /]
Standard coolers, vaccine cold boxes and carriers are all passive cooling devices, they are not powered.⁸ All these devices require ice packs (ice bricks) or gel packs (cold packs) to lower the temperature inside the container to within the cold chain (between +2 °C and +8 °C).10 Ice packs are reusable, flat, rectangular plastic bottles filled with water that are placed in a freezer to be frozen.5 Gel packs are plastic sachets containing a water-based gel, which includes chemicals that depress the freezing point of the product, when removed from a freezer, they can have a temperature as low as –18 °C. Both ice and gel packs come in a range of sizes.
Every pharmacy should have a minimum of two sets of ice/gel packs for each passive cooling device. One set in the process of being frozen (i.e. in the freezer), the other set in use in the portable insulated container. Ice/gel packs taken directly from a standard freezer and placed in a vaccine container can lower the temperature in the device to below freezing, damaging vaccines that should be kept cold but not frozen.11 For this reason, when packing a portable insulated container, the ice and or gel packs will need to be conditioned.
Preparing ice packs5:
Conditioning an ice pack5:
Conditioning a gel pack5:
In general, gel packs, take slightly longer to condition than ice packs. It is advised to refer to manufacturer’s instructions on how to condition the gel pack in use.
The reason is that different products and brands contain varying amounts and types of the ingredient used to depress the freezing point of the gel pack. Some specialised vaccine cold boxes (e.g. CoolPak45) come with their own gel packs and do not require conditioning. It is acknowledged that many gel packs do not come with manufacturer’s instructions and the following can be used as a guide.5
A systematic review identified that vaccines placed with ice/gel packs inside portable insulated containers significantly increased risk of vaccine freezing during transport.12 This was due to two reasons: placing the vaccines too close to ice/gel packs and insufficient ice/gel pack conditioning.12 Both are an avoidable reason for vaccine damage. Exposing freeze-sensitive vaccines, particularly those containing an adjuvant, such as diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b (Hib) and hepatitis B to temperatures below 0 °C, can cause irreversible potency loss.1,13,14
The number of ice/gel packs required is dependent on the size, type and capacity of the cooler, the number of vaccines being transported, and the size and type of ice/gel packs used. Research shows that the number of ice/gel packs used influences the overall average internal temperature (°C), the absolute maximum internal temperature (°C) and the absolute minimum internal temperature (°C).15
How to pack a portable insulated container
Many purpose-built vaccine carriers and cold boxes come with manufacturer’s instructions on how to pack the container. Always refer to manufacturer’s instructions where available. If not available, the following guidance should be used.16
Before using the portable insulated container16:
Packing the portable insulated container 17:
The portable insulated container should be monitored every 15 minutes for the first 2 hours while the temperature stabilises, and then every hour with a min/max thermometer.⁵ In addition, a data logger can also be used to continually monitor temperature.
Temperature monitoring of the portable insulated container must be recorded. A temperature chart for mobile and outreach immunisation clinics, or emergency storage of vaccines is available from: www.health.gov.au/resources/publications/national-vaccine-storage-guidelines-strive-for-5
It is generally advised, that if there is a purpose-built vaccine refrigerator at the outreach or mobile site, vaccines should be transferred from the portable insulated container to the refrigerator.⁵
When delivering the offsite service, vaccines should only be taken from the portable insulated container or refrigerator as required. If vaccines are outside, they should be kept away from direct UV light (e.g. fluorescent) and sunlight to reduce the risk of potency loss.18 Unnecessary handling of vaccines and temperature-sensitive medicines should be avoided. During the offsite service, the current and minimum/maximum temperature of the portable insulated container must be recorded every hour. The min/max thermometer should be reset after each reading.
Case scenario continued
Annaliese receives the new ice bricks and she sets them aside to continue conditioning. Conscious that the cooler may be approaching 8 °C, she checks the temperature every 15 minutes. Once conditioned, she removes the old ice bricks and wraps the new ones in the bubble wrap and places them in the cooler. Annaliese continues to monitor the temperature closely and it maintains cold chain until the end of the clinic. After the clinic, Annaliese updates the pharmacy’s outreach vaccination clinic procedure to ensure a second set of ice bricks and cooler are taken to accommodate any potential need to extend the ‘cold life’ of the cooler. She also considers purchasing a domestic standard or specialised cooler, which have greater ‘cold life’, for any future outreach clinics.
Temperature-sensitive medicines and vaccines should always be kept within the cold chain. This includes transporting to and during pharmacist-delivered mobile or outreach vaccination services. To date, offsite pharmacist-delivered vaccination services have been well received and promote vaccine accessibility, increasing uptake and thereby decreasing vaccine-preventable disease.19
Pharmacists are playing a key role in the pandemic response to COVID-19. As co-circulation of the two viruses, influenza and coronavirus, is anticipated in this year’s winter months, to reduce individual and community risk there is an increased need to promote influenza vaccination uptake amongst all people. Many pharmacist vaccinators will be delivering offsite vaccination services to increase this uptake.
It is anticipated that a COVID-19 vaccine will be available within the next 12–18 months, with several vaccines in clinical trials at the time of writing. To enable herd immunity and mitigate the spread of COVID-19, as vaccinators, it is likely that pharmacists will be involved in a state- or nationally coordinated response to roll out the vaccine. Pharmacists should be ready to deliver both mobile and outreach vaccination services to improve vaccination uptake where jurisdictional regulation allows.
World Health Organization. Temperature sensitivity of vaccines. World Health Organization. 2006. At: https://apps.who.int/iris/bitstream/handle/10665/69387/WHO_IVB_06.10_eng.pdf?sequence=1&isAllowed=y
Ren Q, Xiong H, Li Y, et al. Evaluation of an outside-the-cold-chain vaccine delivery strategy in remote regions of western China. Public Health Rep. 2009;124(5):745–50.
Victorian Government Department of Health and Human Services. Victorian pharmacist-administered vaccination program expansion communique – March 2020. 2020. At: www2.health.vic.gov.au/Api/downloadmedia/%7BB1C2FD4A-F5B4-49A1-86CE-72697E786B94%7D
ACT Government. Medicines, poisons and therapeutic goods (Vaccinations by Ppharmacists) direction 2020 (No 1).2020. At: www.legislation.act.gov.au/di/2020-36/
Australian Government Department of Health. National vaccine storage guidelines ‘Strive for 5’. 2020. At: www.health.gov.au/resources/publications/national-vaccine-storage-guidelines-strive-for-5
World Health Organization. PQS performance specification: vaccine carrier. Geneva: World Health Organization. 2010.
World Health Organisation. Vaccine cold box Geneva, Switzerland: World Health Organisation; 2010. At: www.who.int/immunization_standards/vaccine_quality/pqs_e004_cb01_2_pps.pdf?ua=1
Robertson J, Franzel L, Maire D. Innovations in cold chain equipment for immunization supply chains. Vaccine. 2017;35(17):2252–9.
World Health Organisation. Vaccine carrier. 2010. At: www.who.int/immunization_standards/vaccine_quality/pqs_e004_vc01_vp2.pdf?ua=1
World Health Organization. Immunisation in practice, a practical resource resource guide for health workers. Module 3: The cold Cchain.2004. At: www.who.int/immunization/hpv/immunization_practice_module_3_cold_chain_who_2004.pdf
Kendal AP, Snyder R, Garrison PJ. Validation of cold chain procedures suitable for distribution of vaccines by public health programs in the USA. Vaccine 1997;15(12–13): 1459–65.
Matthias DM, Robertson J, Garrison MM, et al. Freezing temperatures in the vaccine cold chain: a systematic literature review. Vaccine 2007;25(20):3980–6.
Nelson CM, Wibisono H, Purwanto H, et al. Hepatitis B vaccine freezing in the Indonesian cold chain: evidence and solutions. Bull World Health Organ 2004;82:99–105.
Kumru OS, Joshi SB, Smith DE, et al. Vaccine instability in the cold chain: mechanisms, analysis and formulation strategies. Biologicals 2014;42(5):237–59.
Elliott M, Halbert G. Maintaining the cold chain shipping environment for Phase I clinical trial distribution. Int J Pharm 2005;299(1–2):49–54.
Sunshine Coast Public Health Unit. How to pack a cooler.2015. At: www.ourphn.org.au/wp-content/uploads/2017/04/How-to-pack-a-cooler.pdf
Queensland Government. KISS guide to vaccine management. 2010. At: www.yumpu.com/en/document/read/33697576/kiss-guide-to-vaccine-management-flipchart
Wright CY, Albers PN, Mathee A, et al. Sun protection to improve vaccine effectiveness in children in a high ambient ultraviolet radiation and rural environment: an intervention study. BMC Public Health 2017;17(1):37.
Bushell M, Naunton M, Kosari S, et al. Vaccination policy: pointing the needle: in expanded settings. Australian Pharmacist.2019;38(5):16.
ANGELA YOUNG BPharm (Hons), GradDipClinPharm is the Director of Pharmacy at Alice Springs Hospital, which oversees the distribution of vaccines to Central Australian urban and remote communities, in addition to delivering culturally responsive clinical pharmacy services in the acute care setting.
TOBIAS SPEARE BPharm (Hons), MPH, GDHR, MPS is the Pharmacy Academic at the Centre for Remote Health, Flinders University, in Alice Springs.[post_title] => Cold chain management in the outreach and mobile setting [post_excerpt] => A mobile or outreach vaccination service requires additional cold chain monitoring and vigilance. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => cold-chain-management-outreach-mobile-setting-cpd [to_ping] => [pinged] => [post_modified] => 2020-08-20 09:04:41 [post_modified_gmt] => 2020-08-19 23:04:41 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=11029 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Cold chain management in the outreach and mobile setting [title] => Cold chain management in the outreach and mobile setting [href] => https://www.australianpharmacist.com.au/cold-chain-management-outreach-mobile-setting-cpd/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( [td_post_template] => single_template_4 ) [is_review:protected] => [post_thumb_id:protected] => 11034 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11283 [post_author] => 175 [post_date] => 2020-09-16 04:46:18 [post_date_gmt] => 2020-09-15 18:46:18 [post_content] => Gunnedah-based Karen Carter FPS loves making a difference to patients’ health and wellbeing. She always knew she wanted to own a pharmacy. Now she has two – and her children Justin and Wendy have followed her into the profession.
What led you to pharmacy?I enjoyed chemistry and biology at school which led to me choosing pharmacy over optometry. Wanting to help people and work in the health area, pharmacy allowed me to combine my passion for science and to make a difference to patients.
Can you describe your initial years?After 3 years of pharmacy study at the University of Sydney I added the Diploma of Hospital Pharmacy. During university holidays I worked at Colless’ Pharmacy in Narrabri and enjoyed working in a community pharmacy where the pharmacist knew the patients and offered lots of advice. This experience was invaluable. During my diploma year I enjoyed working at different hospitals, then worked in the intensive care and renal units at Prince Henry Hospital – an opportunity to work in a team environment, educate nursing staff and be involved in antibiotic and patient-controlled analgesia policies.
Where else have you worked? How did you wind up with two pharmacies?I also worked in community pharmacies in Marrickville, Baulkham Hills, Glebe and Bondi Junction in Sydney while working at the hospital gaining as much experience as I could because I wanted to own my own pharmacy and provide the best healthcare to patients. I left Sydney for country locums in Forbes, Wee Waa and Quirindi before joining a partnership in Gunnedah. I eventually bought the pharmacy and after a few years merged two pharmacies in 2001. In 2009 with my husband David, who has a banking background, an opportunity arose so we bought Narrabri Pharmacy.
What led to accreditation?I have always enjoyed lifelong learning and became an accredited pharmacist in 2003 while juggling work and raising two children. The review process allowed me to have closer contact with patients and make suggestions to improve their health. I now travel to Bourke, Walgett, Wee Waa and Boggabri to perform Home Medicines Reviews (HMRs) and Residential Medication Management Reviews (RMMRs). I travel in a two-seater plane to Bourke and Walgett with the physiotherapist from Narrabri who is the pilot!
Tell us about other areas of operation.We have been involved in research projects such as diabetes screening using HbA1c testing, asthma and sleep studies with the University of Sydney. In Gunnedah we were involved with the Indigenous Medication Review Service (IMeRSe) study allowing a closer relationship with our Aboriginal and Torres Strait Islander patients. This took me to Brewarrina and Skype interviews at Cooktown. I am studying a Graduate Diploma in Wound Care at Monash University and incorporating wound care services in both pharmacies.
How are the services offered in a regional town pharmacy different to those in other pharmacies?A one-stop service store with most of our pharmacists accredited for vaccinations. We do HMRs, RMMRs and in-store medication reviews, provide equipment and screening for sleep apnoea and aids for daily living. Six pharmacists are trained in mental health first aid. We have an extensive patient delivery service to Gunnedah and Narrabri for personal medication packs or medicines. We have a beauty therapist in both stores, and cosmetics and giftware offer a department-style store in these country towns. We have attended AgQuip with sleep apnoea equipment and advised on sleep apnoea screening. We sponsor local events and sporting teams. A dispensing robot and Webster robot in Gunnedah have allowed more pharmacist time.
And the next generation?Our son Justin interned with us in 2019 and is now one of our registered pharmacists while our daughter Wendy is currently in the 4th year of her pharmacy degree. Pharmacy is a fantastic career and the future is bright with opportunity.
A DAY IN THE LIFE of Karen Carter FPS, an accredited, rural community pharmacist owner in Gunnedah and Narrabri, NSW.7.30 am - A quick trip Drive 132 kilometres to a Wee Waa residential aged care facility (RACF). 9.00 am - On the ground in an RACF Deliver education and interview patients/care staff for RMMRs. Notice a new patient is taking amitriptyline (anticholinergic) and donepezil (cholinesterase inhibitor). Family agrees to an RMMR. Discover patient has been chewing Panadol Osteo and Duodart. Ring GP to discuss ceasing amitriptyline, change formula of paracetamol and organise RMMR referral as patient has swallowing issues. Duodart changed to prazosin after review. 11.00 am - Drop into Narrabri Pit stop at my pharmacy to check on team, referrals for HMRs, collect reports and roster and drive the hour home, making phone calls (hands free) to accountant or remembering to change our ad for the radio station. 12.00 pm - Back in Gunnedah At Karen Carter Chemist in Gunnedah, check latest sleep apnoea clinic patient results after setting up a CPAP trial on previous day. Patient has improved from 64 on apnoea/hypopnea index (severe sleep apnoea) to 4. She slept 7 hours (husband also slept well); feels better. 2.00 pm - Afternoon variety Dispensing, vaccination service and checking dose administration aids, dress a wound, discuss using a spacer and demonstrate use. Noticed a patient taking Galvumet only once daily rather than twice daily prescribed dose. Spoke to him about bringing in medicines for a MedsCheck. 4.00 pm - Report writing Write up RMMR report from the morning and fax to Wee Waa RACF and doctor. 6.00 pm - Home work Closing time and head home to family. After dinner write up RMMR/HMR reports, tackle an essay for my Graduate Diploma in Wound Care or attend a webinar on e-scripts.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11152 [post_author] => 227 [post_date] => 2020-09-01 05:08:53 [post_date_gmt] => 2020-08-31 19:08:53 [post_content] => Loan Pham MPS, a daughter of Vietnamese refugees, has spent 14 years at one pharmacy. She loves it so much, she’s hoping to buy it.
What set you on the path to a career in pharmacy?Growing up in Sydney I always had a passion to work in the health sector. During my last year of studying for a Bachelor of Medical Science I decided to study pharmacy because I felt it would be a rewarding profession to be able to help those in the community.
How did you find the course structure at your chosen university and did it affect your later decision-making?I was accepted into the Master of Pharmacy graduate degree course at the University of Sydney in 2004, the year it was introduced. It was a 2-year course that included clinical placement. This gave me firsthand experience working in hospitals, mental health clinics and community pharmacy. I particularly enjoyed community pharmacy, which allowed me to interact with consumers.
What lessons did you learn as an intern?I did my internship at Blooms the Chemist Leichhardt and learnt invaluable skills, including that in community pharmacy you need to be compassionate, genuine and to empathise with your patients and to build trust as a health professional. I’ve been here ever since.
What made you consider a future in community pharmacy?Community pharmacy allows you the face-to-face contact with your patient and these patients tend to become regular consumers. We form a trusted relationship with our patients that allows us to provide medicines and advise patients on how to take medicines safely and understand the impact of what they are taking.
What were some of the highlights in your 14 years as a community pharmacist?Firstly, one of the highlights would be the people whom I have worked with and met. They have helped shape me into the pharmacist that I am today. Secondly, seeing community pharmacy evolve from focusing largely on dispensing medicines and then moving to the forefront of providing early intervention to patients by assessing and providing risk assessment. The introduction of pharmacists’ providing vaccinations has also resulted in pharmacists expanding their role in health services and further changing patients’ perception of community pharmacy as more than just dispensing medicines. Also, the introduction of My Health Record and digital health has allowed us to access information that will help with adverse drug interactions and managing the multiple medicines and chronic conditions of some patients, and to collaborate with other health professionals.
What is your next likely career step?The next step in my pharmacy career is to soon go into ownership of this pharmacy. I have been thinking about this for the past few years and am looking forward to this next phase in my career.
Where do you see yourself in 5–10 years?I see myself running a successful business. With the ever-changing landscape of community pharmacy, it’s important to be open to change and to continue to remain relevant to patients and consumers by improving the pharmacist’s role in the delivery and management of healthcare.
A TYPICAL DAY for Loan Pham MPS, community pharmacist at Blooms the Chemist, Leichhardt. NSW.8.30 am - The morning rush Dispense and counsel patients on new medicines. Provide advice and recommendations. One regular customer had a new antidepressant prescription. I advised on the importance of a washing out period between mirtazapine and then swapping over to sertraline. 12.00 pm - Making medicine use safer More dispensing. One of our regular patients, who is visually impaired, came in with a prescription for a reducing dose of prednisone that was to taper over a month. She was confused about what to do. To put her at ease, I told her we would pack the reduced prednisone in a dose administration aid so it would be easier for her to remember when to take it. 2.00 pm - Vaccines, pick-ups and delivery Administering flu vaccines via either prior appointment or to walk-ins. Organising medicines for deliveries or pick-ups for customers who have called or emailed requests because of COVID-19 and cannot come into the pharmacy as they are vulnerable and have been required to isolate. 4.30 pm - Supplier challenges A doctor calls about ordering medicinal cannabis CBD oil for a patient. Our usual supplier is out of stock long term, so I have to contact other suppliers. It took several days to find a cost-effective, appropriate-strength product. The doctor was contacted and a new Special Access Scheme approval form was organised. 7.30 pm - Keeping up with change At home, I take time to read up on changes to opioid prescribing and the introduction of electronic prescriptions. Then I check through emails not able to be attended to during the day, for instance those arriving after closing time including updates from head office.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11101 [post_author] => 175 [post_date] => 2020-08-26 05:24:35 [post_date_gmt] => 2020-08-25 19:24:35 [post_content] => From compounding to COVID-19, Amanda Fairjones BPharm Hons AACPA, MPS can get answers for all your member queries.
Describe your work and the tasks involved on a typical day.As a member of the PSA membership team, I help answer queries that may be practice related, or ethical, technical, regulatory or registration questions. My priority each day is to answer telephone calls and emails from members – often straight away, but sometimes the questions are more difficult and require further research. The PSA employs a wide variety of pharmacists and other professionals with expertise in different areas who can assist me when needed.
What other roles have you held that make you an ideal person to provide practice advice?Most of my career to date has been spent in private hospital pharmacy. As the Director of Pharmacy for a large surgical hospital for 10 years and, more recently, in two small private mental health facilities, I have both experience and knowledge to answer member queries. I’ve also had experience as a pharmacy owner and in community pharmacy and hold accreditation for Medication Management Review Services.
What does your role involve?Providing advice to PSA members throughout the COVID-19 pandemic has been the most interesting aspect of my role so far. I started with PSA in March 2020 – at the beginning of the pandemic – and, like all pharmacists, had to quickly adjust to the rapidly changing pharmacy landscape. Colleagues were facing challenges never encountered before, and information and legislation was changing rapidly. Members relied on PSA for professional, up-to-date advice.
What are the strongest member concerns at present?The most common concern is the coronavirus and resulting changes to practice. Members have been particularly concerned and are asking questions about digital prescriptions. The new legislation for this was introduced on a state-by-state basis, which caused confusion. Digital prescriptions has meant pharmacies must change process and engage with prescribers about retaining original prescriptions – which has provided challenges. Members interested in diversifying their role often ask about further education. Many hope to expand their knowledge and I have provided them with information on becoming MMR-accredited, a diabetes educator or on training as a general practice pharmacist.
What have you learnt about pharmacy practice in the role?Members often call the advice line for further information or interpretation of pharmacy legislation. Providing advice nationally has helped me learn about pharmacy practice across all states and territories. This has assisted me to become more familiar with the differences in legislation and practice guidelines for all jurisdictions. The role has also expanded my knowledge around immunisation. Many pharmacists train to become qualified immunisers with PSA, and this role is constantly evolving. Members often call to confirm they are informed in relation to regulatory and training requirements.
How is PSA helping support members?PSA is interested to hear from members about any issues, questions or ideas. Members are able to ask PSA for professional practice support and can contribute to PSA policies and advocacy issues. Information and feedback received from members via telephone, email or other means is collated and reviewed across the organisation – particularly during the height of the COVID-19 restrictions.
Further resourcesPharmacist to pharmacist advice line (members only): 1300 369 772 8.30 am–5 pm (EST) weekdays. [post_title] => Guidance and advice: PSA’s new practice expert [post_excerpt] => From compounding to COVID-19, Amanda Fairjones BPharm Hons AACPA, MPS can get answers for all your member queries. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => guidance-advice-psas-new-practice-expert [to_ping] => [pinged] => [post_modified] => 2020-08-26 11:06:17 [post_modified_gmt] => 2020-08-26 01:06:17 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=11101 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Guidance and advice: PSA’s new practice expert [title] => Guidance and advice: PSA’s new practice expert [href] => https://www.australianpharmacist.com.au/guidance-advice-psas-new-practice-expert/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 11116 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11028 [post_author] => 2662 [post_date] => 2020-08-19 11:21:02 [post_date_gmt] => 2020-08-19 01:21:02 [post_content] => The journey through the Australian healthcare system has been long and hard for this pharmacist patient.
I am one of the millions missing. One of the millions of people living with a rare disease for whom getting a correct diagnosis can take decades. We are a tribe of forgotten folks, who along the way are likely, at least once, to hear the comment: ‘It’s all in your head’.
I am a registered pharmacist. Yet I cannot perform my role due to chronic and debilitating illness. At 32, I was diagnosed by a clinical geneticist with Hypermobile Ehlers-Danlos syndrome (hEDS) a connective tissue disorder (CTD).
Chronic pain, extreme fatigue and neurological symptoms from brainstem compression resulted in my early departure from a career in pharmacy.
My first symptoms were a dislocation at 4 years of age. This should have been a red flag and led to some work-up by doctors. But of course, it did not.
Adolescence was full of migraines, orthostatic intolerance, generalised global body-wide aches and pain, soft tissue injury, chronic constipation and Raynaud’s phenomenon. But not one GP or specialist I consulted came remotely close to connecting the dots on these seemingly unrelated issues.
‘If you can’t connect the issues, think connective tissues.’ This is a phrase I would like all clinicians to know. I want it taught in medical, nursing, pharmacy and allied health faculties of learning. I strongly believe there are systemic failings that serve to delay or incorrectly diagnose patients with rare diseases, chronic illnesses and/or syndromes.
The biggest failing is that students are currently taught to look for horses, not zebras. This is a mistake and leads to delays such as mine. Recent research suggests that hEDS is not so rare after all. It has, perhaps, a prevalence of close to 1 in 500 – not 1 in 2,500 as previously determined.1,2 This misnomer, that zebras are rare, directly leads to many patient diagnoses being completely missed, while others are never able to shake the misdiagnoses they have been given.
My journey to diagnosis was filled with the likes of these phrases. ‘You’ve just got an achy body type… Hypermobility is benign… You just need to strengthen… A psychologist will help you.’ All the while my own research was telling me otherwise.
These dismissive statements play heavily on patients’ minds, undermining what they know to be true – that they are very ill.
Achieving my final and correct diagnosis from a clinical geneticist was extremely validating. But the path to get to this point was one of fighting the system, one that I had to drive from beginning to end. Misdiagnoses received along the way were fibromyalgia and myalgic encephalomyelitis, better known and stigmatised by the outdated term “chronic fatigue syndrome”.
While I now have a correct overarching diagnosis of CTD, my path to treatment continues. A lack of interest from clinicians who focus on CTDs and their comorbid conditions means I need to consult neurosurgeons in the United States.
I hope to change this is in future by engaging and educating clinicians from appropriate specialisations and via the establishment of a National Connective Tissue Disorder charity.
Hypermobile Ehlers-Danlos Syndrome is a heritable connective tissue disorder for which there is currently no genetic marker identified so diagnosis remains clinical.
A range of conditions including debilitating fatigue may also be present with loose, painful and unstable joints that can dislocate easily and frequently.
In Ms Linke’s case it has led to basilar invagination which has caused compression of her brainstem. She now needs to wear a neck brace.Janna Linke was recently re-registered on the APHRA pandemic sub-register to assist with the spread of COVID-19. She remains unable to work.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 10925 [post_author] => 1925 [post_date] => 2020-07-29 11:26:06 [post_date_gmt] => 2020-07-29 01:26:06 [post_content] => Kurtis Gray, a final year Master of Pharmacy student at the University of Western Australia (UWA), is the 2020 PSA Mylan Pharmacy Student of the Year. Mr Gray believes his decision to study pharmacy was the best he has made. He beat a strong field from around the country to take the prestigious award this month, following in the footsteps of UWA colleague Alice Hashiguchi, who won last year. Each of the state finalists were presented with a patient via webcam who acted out a variety of symptoms. After a consultation and the opportunity to ask follow-up questions for more information, the finalists recommended a course of treatment and advice before a panel of judges. ‘It was a tough competition but a great opportunity for us to put into practice what we have learnt,’ Mr Gray said afterwards. ‘I really enjoy providing advice about medication to people who are unwell, and this competition enabled me to demonstrate this.’ The win came at a good time for Mr Gray, who is looking for an internship. But what to choose? ‘I love the clinical aspect of pharmacy, so I could see myself becoming a clinical pharmacist specialising in psychiatric medications,’ he told Australian Pharmacist. ‘Alternatively, I would love to somehow work in a community pharmacy which specialises in treating the homeless and people with mental health issues. ‘However, I could just as easily see myself being a general practice or a rural pharmacist, working with the Aboriginal Medical Services.’ Mr Gray believes he is joining the profession at the perfect time. ‘I think Australian pharmacists have been brilliant during the pandemic and have really stepped up. All the front line, essential health care workers have worked incredibly hard to facilitate effective healthcare during difficult times,’ he said. ‘I believe the work done will not be forgotten, and will make it easier for us future pharmacists to continue to expand awareness of our capabilities.’ Mr Gray hopes the recognition of pharmacists’ work will increase to the point where the term “pharmacist” is synonymous with “clinician”. ‘The hard work will make it easier for the new generation of pharmacists to continue to pioneer and expand the profession,’ he said. ‘The self-care fact cards that we can give out to patients are brilliant. When you have 10 patients all needing your time and attention, these cards are a good way to ensure that everything you say to a patient will, at the very least, make it home with them. I make a point to try and give these to as many patients as possible.’ Thomas Duong, from Monash University (VIC) took home the People’s Choice award. [caption id="attachment_10928" align="alignright" width="308"] Thomas Duong won the People’s Choice award[/caption] It was a huge opportunity and responsibility to represent Monash in such a major competition, Mr Duong said, and he is also now looking for an internship. ‘I’m interested in hospital pharmacy with its clinical dynamics,’ he said. ‘I am also interested in doing research so I may consider that pathway to higher study.’ PSA National President Associate Professor Chris Freeman congratulated both students. ‘We saw a very strong field line up this year and it is great to see such talented and passionate pharmacy students showcasing their skills and knowledge,’ he said. ‘This competition provides students with the opportunity to grow and learn with active listening, gaining patient insights and patient understanding important skills that support medicine safety and maximise patient outcomes. ‘It is heartening to see the future of our profession in good hands,’ A/Prof Freeman said, ‘and we were impressed with the overall level of knowledge from students during both the state and national finals.’ As his prize, Mr Gray will receive funding for pharmacy-specific education from Mylan. Mylan Australia Product Manager David Lai said the standard of students competing at this year’s PSOTY was impressive again. ‘It gives me great confidence to know the future of our pharmacy industry lies within the hands of these students,’ Mr Lai said. ‘They have excelled beyond my expectations.’ This year’s finalists:
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