Sian Powell and Peter Guthrey FPS
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[post_content] => Mental health needs are rising, but so are questionable prescribing patterns. Pharmacists can help define the line between justified care and risky overreach.
Australia’s adolescent mental health crisis is escalating at a troubling pace. A landmark longitudinal study by Murdoch Children’s Research Institute revealed that by age 18, nearly three quarters (74 %) of Australian teenagers experienced clinically significant symptoms of anxiety or depression at least once – with many enduring chronic episodes spanning multiple school transitions and exam periods.
The Australian Bureau of Statistics confirms that in 2020–22, 38.8 % of 16–24 year‑olds reported a mental disorder in the past 12 months, dominated by anxiety (17.2 %). Contributing factors are complex: academic pressure, early puberty, growing social isolation, socioeconomic stress, and particularly, the impact of social media.
The increase in prescribing
Similarly, antidepressant prescribing among Australian adolescents is on the rise, raising concerns about off-label use and high-dose regimens – with the pharmacist’s role in ensuring safe and appropriate therapy more important than ever. A 2024 ABC report noted that psychotropic use in under‑18s more than doubled from 2013 to 2023.3
Between 2013 and 2019, Selective Serotonin Reuptake Inhibitor (SSRI) prescribing in adolescents steadily climbed, with GPs accounting for 55 % of prescriptions in 12–14 year‑olds and 78 % in 15–17 year‑olds.
According to consultant pharmacist Amanda Fuller, Clinical Lead at Medcast, the increase in antidepressant prescribing reflects a complex mix of demand, access issues, and public perception.
[caption id="attachment_29976" align="alignright" width="300"]
Amanda Fuller[/caption]
‘We’re seeing a growing awareness of mental health in young people, which is a positive shift,’ Ms Fuller said. ‘But when that’s combined with long waitlists for psychologists and psychiatrists, GPs often feel pressure to act quickly – particularly if there are concerns about deterioration or safety.’
This urgency is sometimes reinforced by family expectations. ‘Parents and carers may see antidepressants as a fast-acting solution while they wait for psychological support,’ she added.
Off-label use in high doses
Most prescribing for under-18s is off-label, which complicates matters, Ms Fuller said.
‘This places the responsibility on prescribers to weigh clinical judgment and available evidence against regulatory guidance.’
In Australia, only fluvoxamine and sertraline are approved by the Therapeutic Goods Administration (TGA) to treat obsessive-compulsive disorder (OCD) – in children aged 6 and 8 years and older, respectively. Others are used beyond their approved indications.
Fluoxetine remains the most commonly prescribed antidepressant in this cohort. ‘It’s the recommended first-line SSRI for adolescents and is the only one with consistent trial evidence showing efficacy over placebo in depression,’ Ms Fuller said. ‘But even then, the benefit was modest, placebo response rates were high, and study quality was poor, making interpretation difficult.’
In anxiety, the data is even less robust. ‘There’s limited evidence, though fluoxetine, fluvoxamine, and sertraline have shown some benefit in trials. But again, quality is a concern,’ she said.
Public understanding of antidepressants is also often shaped by outdated ideas, Ms Fuller said. ‘The “chemical imbalance” theory has been largely debunked, but it still drives the belief that medication is essential for treatment.’
More concerning is the increasing use of high-dose antidepressant regimens, sometimes exceeding standard adult doses.
‘We know higher doses are sometimes used in OCD, and prescribers may consider the adolescent’s physical maturity. But there’s no strong evidence to support routine high-dose use in this age group,’ she said.
Psychiatrists are more likely than GPs to prescribe these higher doses, often in complex or treatment-resistant cases. However, efficacy data for higher doses is lacking – even in adult populations.
‘In fluoxetine studies, response rates were actually highest between 20–40 mg daily,’ Ms Fuller said. ‘Going beyond that was linked to more [adverse] effects and increased dropout rates.’
The role of pharmacists
Pharmacists should take a proactive yet respectful approach when faced with uncertainty around an antidepressant prescription, Ms Fuller advised.
‘If something doesn’t add up – if you can’t confirm the indication, or there’s limited information about the treatment plan – it’s absolutely appropriate to contact the prescriber,’ she said.
Before doing so, she recommends checking key factors: ‘Clarify the diagnosis, assess for any psychosocial supports in place, confirm adherence and tolerance, and look at what the follow-up plan involves.’
When contacting prescribers, Ms Fuller urges pharmacists to approach conversations with collaboration, not correction. ‘Assume clinical reasoning is there – your role is to clarify, not challenge,’ she said ‘Focus on shared care, not prescription policing.”’
Australia’s adolescent mental health situation demands attention and pharmacists have a pivotal role in it. Soaring rates of depression, anxiety and antidepressant prescribing underscore the need for thoughtful, patient-centred care.
PSA25's session on ‘Dosing dilemmas’, presented by Ms Fuller, offers essential guidance on navigating adolescent antidepressant use – from informed dosing choices to structured monitoring and collaborative decision-making.
Haven’t registered for PSA25 yet? Don’t miss your chance – registrations are still open.
[post_title] => Why are so many teens prescribed high-dose antidepressants?
[post_excerpt] => Youth mental health needs are rising, but so too are questionable prescribing patterns of antidepressants.
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[post_content] => A look at Turlington’s 27‑ingredient balsam, its broad therapeutic claims and how it contrasts with today’s evidence‑based approaches.
Robert Turlington was a 21st Century pharmacist living in the 18th Century. But the Londoner wasn’t always the successful entrepreneur he later became. Instead, Turlington (1697–1766) began his working life as a weaver – and a bankrupt one at that – courtesy of his demanding specialty: silk.1
According to archaeologists Olive Jones and Allen Vegotsky, the ‘multidimensional’ challenges of the silk trade, along with the fallout from bankruptcy, had an unexpected upside. They pushed Turlington to develop skills in marketing, labour organisation and even fashion. This expertise helped him change careers and, in 1740, grow a one-man pharmaceutical operation into an early multinational success story.1
Let sales begin
By 1742, Turlington was selling his Balsam of Life into a market packed with competitors like Friar’s Balsam.2 Both elixirs were sold as treatments for several illnesses and injuries. But in no time, Turlington went beyond ‘several’, pitching his product as a veritable ‘cure-all’.1–5,10
‘The aforesaid Balsam is a certain relief for the gravel, cholic, rheumatism, gout, and sciatic pains, and all colds, coughs, consumptive, pectoral, asthmatical, and nervous disorders, &c. and for any cut, bruise, or the like, as thousands can testify who have been relieved thereby, in the above and other complaints, after every other resource has failed,’ claimed Turlington in a 46-page testimonial pamphlet, accompanying each sale.1
In line with the era’s one-product, multi-ailment ‘polypharmacy’ approach, Turlington’s ‘perfect friend to Nature’ initially contained 27 ingredients in an alcohol solution. Over time, that was reduced to just eight. The key ingredients remained plant-based balsams: gum benzoin, storax and Tolu and Peruvian balsam. Aromatic spices like cinnamon, saffron and nutmeg masked the balsams’ unpleasant taste.1,2,5,6,10
Originally sold in round vials, Turlington’s nostrum became so popular that in 1746 he introduced the first of several distinctively shaped bottles to deter imitators.
In 1754, he followed-up with a unique pear-shaped bottle, which continued to be used in different sizes for over 150 years.1,3,7
They remain collectors’ items to this very day.1,4,5,7,8
Promote, protect, expand
Turlington’s distinctively shaped bottles were more than eye-catching – they reflected a shrewd business strategy.
At a time when English medicines were unregulated, Turlington promptly acquired one of the country’s first medical patents.1,3 Granted by King George in 1744 and lasting until 1758, the patent gave Turlington the legal right to prosecute imitators and widely promote his ‘miracle cure’ – a task he embraced with gusto.1,3,8
‘He had the cachet of having the king’s approval of his medicine, a fake coat of arms, a memorable name, a booklet given free with every purchase, a fixed price, and testimonials from satisfied customers who provided information on ailments that could be treated successfully with Balsam of Life,’ note Jones and Vegotsky.1
In 1748, Turlington extended his patent to include Britain’s North American colonies. Geographic expansion soon followed with sales to the emerging United States, Canada, the West Indies and, yes, Australia. Of course, he also pushed into Scotland, Ireland and Europe.1,3,8–10
Did Turlington’s balsam work?
With so many ingredients in varying amounts, used to treat a wide range of conditions, it’s difficult to say how effective the balsam truly was. At best, balsams exhibit anti-inflammatory, antioxidant and antimicrobial effects.11
Whether it worked or not, Turlington’s balsam left an enduring legacy – in pharmacy history, and also on collectors’ shelves.
References
- Jones O, Vegotsky A. Turlington’s Balsam of Life. Northeast Historical Archaeology. 2016;45:1.
- Dayton L. Friar’s Balsam has a place in modern life. Australian Pharmacist 2024;43(7):66.
- Abbott A. Turlington’s Balsam of Life: Colonial American snake oil? University of Central Florida, Center for Humanities and Digital Research.
- Pope A. Turlington's Balsam, the 18th-century cure-all. Canadian Geographic 2016 7 July.
- Griffenhagen GB, Young JH. Old English patent medicines in America. Contributions from The Museum of History and Technology: Paper 10. Project Gutenberg EBook 30162.
- Dilworth LL, Riley CK, Stennett DK. Chapter 5 - Plant Constituents: Carbohydrates, oils, resins, balsams, and plant hormones. Pharmacognosy, Academic Press 61–80 2017.
- Jones OR. Essence of Peppermint, A history of the medicine and its bottle. Hist.Archaeol. 15(2):3, 28, 33.
- Kemp J. Bottles 1. Turlington's Balsam of Life: the 1754 design. Cures All Diseases.com. 2020.
- Young JH. The Toadstool Millionaires: Chapter 1. Quackwatch. 2002 29 Apr.
- Keys R. Turlington’s Balsam of Life. The Adverts 250 Project. 2022 17 Feb.
[post_title] => Lessons from one of the first medicinal patents
[post_excerpt] => Turlington's Balsam was pitched as a veritable ‘cure-all’ in the 18th century – and remains on collectors’ shelves today.
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[caption id="attachment_27199" align="alignright" width="225"]
This activity is sponsored by PDL. This information is general in nature and designed only to highlight issues for your consideration. Before acting on this information, you should consider your individual circumstances and needs, and obtain advice as appropriate.[/caption]
Joyce, 76, lives independently and takes seven regular medicines with various dosing frequencies. She struggles to manage her medicines, especially with frequent brand changes due to supply issues. To help herself remember, Joyce recently began placing her daily tablets in a dish on the kitchen bench. During a visit, her 6-year-old grandson mistook the tablets for lollies and was about to swallow them when he was stopped just in time. Joyce is shaken by the incident and distressed by what could have happened.
After reading this article, pharmacists should be able to:
|
Medicine safety is critical to improving health outcomes for children.1 However, ensuring safe and effective medicine use in paediatric populations presents unique challenges, due to differences in physiology, dosing requirements, and patterns of medicine use compared to adults.
Safety concerns arise because many medicines are prescribed off-label for children.2–5 Clinical trial data involving child populations is limited, with many trials not conducted in children. As a result, the safety and efficacy of medicines prescribed to children are often based on extrapolation from adult data.2,3,6
Medicine-related poisoning is also a key concern for medicine safety in children. In 2021–22 in Australia, 8,288 children were hospitalised due to poisoning-related injuries.7 Many of these hospitalisations were the result of accidental poisonings.1 An Australian review of emergency department data from 1 January 2015 to 31 December 2016 found that accidental exposure was the cause of 82% of poisoning cases involving preschool-aged children.8 Research shows that medicines, ‘including adult and paediatric over-the-counter and prescription medicines, are the leading cause of hospitalised unintentional poisonings’ in children in Australia.9,10
Unintentional exposures occur due to a variety of reasons. Data from the NSW Poisons Information Centre show that poisonings involving paracetamol–opioid combinations, ibuprofen–codeine combinations and oxycodone are common in children under 5 years of age.11 This is largely due to the inquisitive nature of children.5,11 Other reasons include therapeutic errors, such as incorrect dosing, incorrect dosing interval, incorrect patient or incorrect drug.11 This may be due to a dosing error by a parent or carer or unintended exposure to a medicine that was not intended for them.12
Risk factors for child poisoningSocioeconomic disadvantage has been found to increase the risk of unintentional poisoning in Australia.9 People who experience socioeconomic disadvantage often have ‘more comorbidities, use more medication, have less access to childcare and storage equipment and are more likely to experience overcrowding’.9 Living in rented premises has also been identified as a potential risk factor, possibly due to practical constraints on modifying living spaces for safe medicine storage.⁹ However, it’s important to note that evidence is limited and evolving, and challenges with secure storage may be experienced across a range of housing situations.
Changes in prescribing patterns and medicine use can also increase the risk of poisoning exposure to children. One example is the increase in the use of psychotropic medicines in children. ADHD is a common neurodevelopmental disorder among children and adolescents.15 Research shows there has been a twofold increase in the annual prevalence of ADHD medicine use – from 4.9 per 1,000 persons in 2013 to 9.7 per 1,000 persons in 2020 – in Australia.16 There has also been a trend towards increased diagnosis and pharmacological treatment of ADHD.6,17 Methylphenidate is the most commonly used medicine for ADHD in children, followed by lisdexamfetamine.16 The growing use of ADHD medicines may increase the risk of unintentional poisoning in children.17
Non-stimulant medicines such as clonidine, guanfacine and atomoxetine may also be used concurrently with stimulant medications, particularly in young children and adolescents.16 The off-label use of clonidine for children with ADHD remains problematic due to cases of poisonings and overdose from incorrect dosing.16,18 Clonidine has a narrow therapeutic index, meaning toxicity can occur even with even small dosing errors. The Therapeutic Goods Administration (TGA) has issued a safety alert warning to pharmacists and other health professionals about the risks associated with off-label clonidine use in children.19 Pharmacists should thoroughly counsel patients, parents and carers on the importance of correct dosing and proper storage of clonidine, given the high risk of toxicity from accidental overdose and unintentional poisoning. Compounding pharmacists may be asked to prepare clonidine suspensions, as they are not commercially available. Accuracy is essential when compounding medicines, particularly those such as clonidine, where the dose is prescribed in micrograms. Dosing errors can occur when the strength is incorrectly transcribed from micrograms to milligrams, significantly increasing the risk of poisoning exposure.
Another area of concern is medicine dosing in the school setting. The use of psychotropic medicines in children is increasing, and school-aged children may need to be dosed several times per day.20 This increases the risk of medication error and poisoning exposure. Data from the NSW Poisons Information Centre from January 2014 to June 2018 show that incidents involving methylphenidate were the fourth most common poisoning exposure in schools.20 The majority of methylphenidate incidents occurred due to medication errors, such as double dosing or medicine given to the wrong child.20 In this study, medication errors accounted for 11.6% of poisoning exposures.20 Clonidine and paracetamol were also involved in medication errors in schools.20 This highlights the need for school staff to be trained in medicine safety.20
Communication: Effective communication between pharmacists and patients, parents and carers is vital to ensure the safe use of medicines and an awareness of the potential risks that may come with a medicine. Communication should be tailored to account for the socioeconomic, cultural, or educational background of the patient or carer. Counselling should include not only the dose, frequency and duration of therapy for medicines prescribed to children, but also information about safe storage, accessibility and disposal of that medicine. Accessibility and disposal are relevant in any situation where a child might be present.12 Pharmacists should promote the return of unused or unwanted medicines to the pharmacy for safe disposal, helping to reduce the risk of poisoning exposure.
Clinical judgment: Pharmacists and dispensary technicians should implement procedures to flag medicines prescribed for children, ensuring dispensed products are checked for safety and appropriateness. This requires pharmacists to access resources relevant to medicines for children, including dosing guidelines and instructions for the preparation of compounded products. This can be particularly challenging when medicines are prescribed off-label, as information may be more difficult to locate; however, pharmacists are expected to undertake a risk assessment irrespective of the medicine being proprietary, compounded or off-label.
Third party supply: Administration of medicines to children by carers or school staff may involve an increased risk of error and adverse consequences. Consistently asking parents or carers whether a child’s medicine will be administered by a third party may enable the pharmacist to provide additional counselling or support via a dose administration aid (DAA) where appropriate.
Packaging: pharmacists should ensure that all medicines, including compounded preparations, are appropriately packaged using child-resistant closures.
Access to Poisons Information: In the event of a dosing error or suspected poisoning, pharmacists should act immediately by contacting the Poisons Information Centre on 13 11 26 (available Australia-wide), or call 000 if the situation appears life-threatening.9
Pharmacists who wish to enquire about dosing or other medicine-related information prior to dispensing can contact a medicines information centre in their state, as listed in Appendix E of the Australian Medicines Handbook (AMH).
Medicine safety in children requires vigilance, clear communication and proactive intervention by pharmacists. With limited clinical trial data and increasing use of off-label and high-risk medicines, pharmacists must assess individual risks, educate carers, and advocate for secure storage and appropriate administration.
By implementing tailored strategies and promoting awareness, pharmacists can play a pivotal role in preventing accidental poisonings and enhancing the safe use of medicines in children.
Case scenario continuedAt her next pharmacy visit, Joyce mentions the incident to the pharmacist. The pharmacist discusses the risks of leaving medicines unsecured, especially around children, and offers practical solutions. These include a weekly dose administration aid (DAA) to help with organisation, a medication reminder app for her phone, and advice on safe storage, such as using a lockable drawer or placing medicines on a high shelf in a cupboard out of children’s reach. Joyce is reassured by the support and feels more confident in managing her medicines safely moving forward. |
Dr Simone Henriksen (she/her) BPharm, LLB (Hons I), PhD (Law) is a community pharmacist with over 30 years’ experience. She is also a legal academic at the University of the Sunshine Coast. Her research areas include the regulation and clinical governance of health services in Australia.
Morna Falkland BPharm
Dr Simone Henriksen is a former employee of Pharmaceutical Defence Limited (PDL) and a member of the Pharmaceutical Society of Australia (PSA). This article was developed while in the role of PDL Professional Officer.
PDL is a sponsor of the Medicine safety: children and adolescent care report, which is cited in this article.
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[post_content] => After a nationwide search, Melbourne-based community pharmacist Anna Theophilos MPS has been appointed PSA’s inaugural Vaccination Ambassador. And she intends to shake things up.
With bold ideas and proven innovation, Ms Theophilos is set to transform pharmacist-led immunisation across Australia. She will work alongside PSA to elevate the voice of pharmacist immunisers throughout the country, driving public confidence and promoting vaccination.
In the aged care sector, Ms Theophilos has pioneered systems that ensure residents receive timely access to all National Immunisation Program and private vaccines. By introducing streamlined digital systems, she has significantly reduced the administrative burden on staff, making clinics easier to run and more efficient. The digital platform also allows facilities to immediately identify local vaccination gaps, while governing bodies are supported with live coverage data at the click of a button.
Under Ms Theophilos’s initiative, coverage rates within facilities rose from just 30% to an impressive 95%. From innovative outreach clinics to tailored services for children with sensory needs, her work reflects the evolving role of pharmacists in improving immunisation access for priority population groups.
https://www.youtube.com/shorts/xsedyMemFhs
Hosting the vaccination stream at PSA25 next week, Ms Theophilos told Australian Pharmacist why she’s passionate about vaccination and getting the immunisation message out to more Australians.
Tell us about your career in pharmacy so far.
I’ve been a pharmacist for 17 years – 16 of those as a business owner. Over that time, I’ve worn many hats, but what’s stayed constant is my desire to build services that respond meaningfully to the specific needs of my local community. Whether it’s dispensing, health education, or vaccination – I’ve always believed in combining clinical excellence with real, human connection.
How long have you been a pharmacist vaccinator?
I’ve been vaccinating since taking over my current business 3 years ago, and it quickly became a core part of my practice. What started within the four walls of the pharmacy has now expanded into aged care, home-based care, sensory-friendly clinics, and outreach models such as pop-up influenza clinics in schools or home visits for immunocompromised patients.
Why are you passionate about vaccination?
It’s an area where pharmacists can bring clarity, care and real impact. There’s so much noise and misinformation out there, and I believe people deserve to make informed decisions about vaccine-preventable diseases with confidence and trusted guidance. Pharmacists are able to provide not only trusted advice to individuals, but also to advance public health outcomes at scale. As a mum of two primary school-aged children, I also wanted to create an experience for their age group that felt calm, safe, and free of fear. How we approach their vaccination today shapes how they view health care tomorrow.
Have you been administering new vaccinations under the Victorian pharmacy pilots?
Yes! And I’ve really enjoyed being part of it. Administering travel vaccines has been particularly rewarding. It’s opened up conversations with patients who might never have considered vaccination. Like someone popping in for loperamide before a trip to Bali. Being up to date with the latest information has allowed pharmacists to offer truly comprehensive care, ensuring our community stays healthy before and after they board the plane.
What vaccine trends concern you, and how can pharmacists help to address them?
When I began working in aged care, I started collating data and was shocked to discover that only 8% of residents were up to date with all vaccines recommended in the Vaccination for Healthy Ageing – and just 30% with National Immunisation Program vaccinations. If those were childhood immunisation rates, we’d be outraged. So why aren’t we applying that same urgency to our older Australians? Over the past 18 months, it has become apparent that these low rates stem from fragmented care pathways and inconsistent funding – gaps that pharmacists are well-placed to address. I’ve worked tirelessly to understand the barriers and build practical, pharmacist-led pathways to improve access. And it has been successful. We can change this – and I believe we will.
What do you hope to achieve in your role as Vaccination Ambassador?
I want to elevate the role of pharmacists in immunisation – not just as vaccinators, but as system-shapers. I hope to bring attention to the work already happening in this space, advocate for sustainable funding and policy reform, and create momentum around models that reach underserved communities, aged care facilities and high-risk populations.
What are some of your first priorities?
One of my main goals is to help mobilise pharmacists across Australia to see this as part of our core mission – to prioritise it – and to feel just as confident administering a vaccine as they do dispensing a prescription. I also want to support clearer public messaging around vaccine-preventable diseases, and advocate for policy and funding frameworks that unlock our full capacity and skill set.
Where do you see pharmacists evolving in terms of vaccination?
It’s simple: all ages, all vaccines.
I see pharmacists becoming the number one provider of vaccinations in Australia. And not limited by age, setting or scope. We have the workforce, the accessibility and the trust. The opportunity is right in front of us.
What are you planning to share with delegates at PSA25?
That it’s time to take up this role with confidence and intentionality. For too long our scope has been underestimated or constrained. We have been told it’s not our place, that we need permission, or that we’re stepping on toes. But the data around vaccination rates tell a different story. It’s clear something needs to change. That something is us. Our profession. And we’re more than ready. We have the workforce, the access, and the trust of the public. Now is the time to lead.
Learn more about vaccinations from Anna Theophilos and others at PSA25, held in Sydney from 1–3 August. Register here to attend.
[post_title] => Meet PSA’s new Vaccination Ambassador
[post_excerpt] => After a nationwide search, Melbourne-based community pharmacist Anna Theophilos MPS has been appointed PSA’s Vaccination Ambassador.
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[post_content] => This year’s Pharmacy Shark Tank, held at PSA25 next week, is set to be a cracker – with some of the most exciting innovations yet, all powered by technology to solve real-world problems in pharmacy.
Australian Pharmacist caught up with some of the 2025 entrants to get a glimpse.
Working towards a more integrated healthcare system
As young pharmacists just entering the industry, Queensland-based brothers Alfred and Viknesh Bramasta have witnessed the errors that can occur when care is fragmented.
‘I'm currently doing my internship in a pharmacy in Queensland,’ Alfred said. ‘One of the major things we’ve seen is flaws in the software being developed, and we wanted to take the opportunity to make some improvements.’
The brothers developed a new software program, PillFlow, to record medication changes made by either GPs, hospital pharmacists or community pharmacists.
‘Right now, when a patient’s medication changes, the pharmacy and doctor often have to go back and forth by phone, email or fax just to confirm the new prescription,’ said Viknesh, a fourth-year pharmacy student who also works in a hospital pharmacy.
[caption id="attachment_29916" align="aligncenter" width="300"]
Viknesh Bramasta[/caption]
[caption id="attachment_29917" align="aligncenter" width="300"]
Alfred Bramasta[/caption]
Delays and communication gaps in the current process may affect both workflow efficiency and the quality of patient care.
Viknesh thinks PillFlow could change this.
‘Our main goal is to enhance patient safety,’ Viknesh said. ‘There can still be challenges in ensuring medication changes for DAA patients are clearly communicated, actioned, and recorded.’
By presenting PillFlow at Shark Tank, Alfred and Viknesh are keen to receive feedback from the judges and audience.
‘It’s a great avenue for us to test and share our idea directly with pharmacists,’ Viknesh said. ‘PSA has made the process really easy.’
Software developments are key to making pharmacists’ workloads more tolerable and improving medicine safety, Alfred said.
‘There's a lot that can be done to improve the workflow in community pharmacy, and innovation will be the main thing to ensure patients get the best benefit.’
Streamlining pharmacy workflows
After 5 years in community pharmacy, early career pharmacist Eric Khek has seen firsthand just how short-staffed the profession can be – especially during the peak of the COVID-19 pandemic.
‘So I've always been interested in how to improve efficiencies in the pharmacy,’ he said.
To do this, Eric created a self-service kiosk system to automate pharmacy processes.
‘When a patient presents to the pharmacy with an eScript, they can scan the eRx [barcode] and answer a couple of questions pharmacy assistants usually ask,’ he said.
[caption id="attachment_29921" align="aligncenter" width="300"]
Eric Khek[/caption]
The system also serves as a triage for minor ailments.
‘If a patient presents with a cough, for example, the self-service kiosk will activate a cough protocol and ask screening questions that you would find in the Australian Pharmaceutical Formulary and Handbook related to cough, such as “Do you have any breathing difficulties?” or “Are you coughing out any blood?”’
Through this innovation, Eric is hoping to not only improve pharmacy workflows but staff stress levels also.
‘We can miss asking important questions during stressful times which could potentially lead to medication errors,’ he said.
Entering Shark Tank should open up network opportunities, Eric thinks.
‘Hopefully I’ll be able to meet like-minded people to collaborate with me and take this product to the next level,’ he said.
With technology evolving at a rapid rate, it’s important that the pharmacy profession keeps up. ‘Around 40–50 years ago, we didn't even have a computer for dispensing,’ Eric said. ‘Harnessing the power of technology makes our lives easier.’
Enhancing learning with AI
Pharmacist and clinical educator Krysti-Lee Patterson MPS is leveraging the power of AI to improve how pharmacy students learn and prepare to practice as registered pharmacists.
Her innovation, The SMART project – an AI model used by the University of Technology Sydney – allows students to practise exam simulations with case scenarios.
‘We’ve essentially created ChatGPT for pharmacists,’ she said. ‘Using our AI models, we feed the platform with case scenarios that the lecturers have created – allowing the students to be able to practice under exam conditions.’
[caption id="attachment_21130" align="aligncenter" width="300"]
Krysti-Lee Patterson MPS[/caption]
The SMART project is designed to both save university staff time and improve pharmacy curricula.
‘The head of Pharmacy at UTS explained that a key challenge is that they're too low on time to be able to do one-on-one training or coaching with their students,’ Krysti-Lee said. ‘So one of the problems we’re trying to solve is saving time without reducing quality.’
Academics can also use data collected from the model to assess whether students are asking the same questions, and address any gaps in the course.
‘The next phase, which we're working on now, will actually allow you to speak to it – so students can practise their oral exams via our platform.’
With pharmacy being a heavily regulated industry, which can be adverse to risk and change, it’s important to showcase the innovations of budding entrepreneurs to strengthen the profession.
‘It's going to make things more efficient, have better outcomes for patients, and ultimately, make a difference to the health of Australians,’ Krysti-Lee said.
Catch the pitches of these three innovations at PSA25’s Pharmacy Shark Tank happening from 3:20 PM - 4:20 PM on Friday 1 August. Last minute registrations are closing soon, visit the PSA25 website to grab yours before it's too late.
[post_title] => What innovations could pharmacy soon see?
[post_excerpt] => This year’s Pharmacy Shark Tank, held at PSA25 next week, is set to be a cracker – with some of the most exciting innovations yet.
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[post_content] => Mental health needs are rising, but so are questionable prescribing patterns. Pharmacists can help define the line between justified care and risky overreach.
Australia’s adolescent mental health crisis is escalating at a troubling pace. A landmark longitudinal study by Murdoch Children’s Research Institute revealed that by age 18, nearly three quarters (74 %) of Australian teenagers experienced clinically significant symptoms of anxiety or depression at least once – with many enduring chronic episodes spanning multiple school transitions and exam periods.
The Australian Bureau of Statistics confirms that in 2020–22, 38.8 % of 16–24 year‑olds reported a mental disorder in the past 12 months, dominated by anxiety (17.2 %). Contributing factors are complex: academic pressure, early puberty, growing social isolation, socioeconomic stress, and particularly, the impact of social media.
The increase in prescribing
Similarly, antidepressant prescribing among Australian adolescents is on the rise, raising concerns about off-label use and high-dose regimens – with the pharmacist’s role in ensuring safe and appropriate therapy more important than ever. A 2024 ABC report noted that psychotropic use in under‑18s more than doubled from 2013 to 2023.3
Between 2013 and 2019, Selective Serotonin Reuptake Inhibitor (SSRI) prescribing in adolescents steadily climbed, with GPs accounting for 55 % of prescriptions in 12–14 year‑olds and 78 % in 15–17 year‑olds.
According to consultant pharmacist Amanda Fuller, Clinical Lead at Medcast, the increase in antidepressant prescribing reflects a complex mix of demand, access issues, and public perception.
[caption id="attachment_29976" align="alignright" width="300"] Amanda Fuller[/caption]
‘We’re seeing a growing awareness of mental health in young people, which is a positive shift,’ Ms Fuller said. ‘But when that’s combined with long waitlists for psychologists and psychiatrists, GPs often feel pressure to act quickly – particularly if there are concerns about deterioration or safety.’
This urgency is sometimes reinforced by family expectations. ‘Parents and carers may see antidepressants as a fast-acting solution while they wait for psychological support,’ she added.
Off-label use in high doses
Most prescribing for under-18s is off-label, which complicates matters, Ms Fuller said.
‘This places the responsibility on prescribers to weigh clinical judgment and available evidence against regulatory guidance.’
In Australia, only fluvoxamine and sertraline are approved by the Therapeutic Goods Administration (TGA) to treat obsessive-compulsive disorder (OCD) – in children aged 6 and 8 years and older, respectively. Others are used beyond their approved indications.
Fluoxetine remains the most commonly prescribed antidepressant in this cohort. ‘It’s the recommended first-line SSRI for adolescents and is the only one with consistent trial evidence showing efficacy over placebo in depression,’ Ms Fuller said. ‘But even then, the benefit was modest, placebo response rates were high, and study quality was poor, making interpretation difficult.’
In anxiety, the data is even less robust. ‘There’s limited evidence, though fluoxetine, fluvoxamine, and sertraline have shown some benefit in trials. But again, quality is a concern,’ she said.
Public understanding of antidepressants is also often shaped by outdated ideas, Ms Fuller said. ‘The “chemical imbalance” theory has been largely debunked, but it still drives the belief that medication is essential for treatment.’
More concerning is the increasing use of high-dose antidepressant regimens, sometimes exceeding standard adult doses.
‘We know higher doses are sometimes used in OCD, and prescribers may consider the adolescent’s physical maturity. But there’s no strong evidence to support routine high-dose use in this age group,’ she said.
Psychiatrists are more likely than GPs to prescribe these higher doses, often in complex or treatment-resistant cases. However, efficacy data for higher doses is lacking – even in adult populations.
‘In fluoxetine studies, response rates were actually highest between 20–40 mg daily,’ Ms Fuller said. ‘Going beyond that was linked to more [adverse] effects and increased dropout rates.’
The role of pharmacists
Pharmacists should take a proactive yet respectful approach when faced with uncertainty around an antidepressant prescription, Ms Fuller advised.
‘If something doesn’t add up – if you can’t confirm the indication, or there’s limited information about the treatment plan – it’s absolutely appropriate to contact the prescriber,’ she said.
Before doing so, she recommends checking key factors: ‘Clarify the diagnosis, assess for any psychosocial supports in place, confirm adherence and tolerance, and look at what the follow-up plan involves.’
When contacting prescribers, Ms Fuller urges pharmacists to approach conversations with collaboration, not correction. ‘Assume clinical reasoning is there – your role is to clarify, not challenge,’ she said ‘Focus on shared care, not prescription policing.”’
Australia’s adolescent mental health situation demands attention and pharmacists have a pivotal role in it. Soaring rates of depression, anxiety and antidepressant prescribing underscore the need for thoughtful, patient-centred care.
PSA25's session on ‘Dosing dilemmas’, presented by Ms Fuller, offers essential guidance on navigating adolescent antidepressant use – from informed dosing choices to structured monitoring and collaborative decision-making.
Haven’t registered for PSA25 yet? Don’t miss your chance – registrations are still open.
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[post_excerpt] => Youth mental health needs are rising, but so too are questionable prescribing patterns of antidepressants.
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[post_content] => A look at Turlington’s 27‑ingredient balsam, its broad therapeutic claims and how it contrasts with today’s evidence‑based approaches.
Robert Turlington was a 21st Century pharmacist living in the 18th Century. But the Londoner wasn’t always the successful entrepreneur he later became. Instead, Turlington (1697–1766) began his working life as a weaver – and a bankrupt one at that – courtesy of his demanding specialty: silk.1
According to archaeologists Olive Jones and Allen Vegotsky, the ‘multidimensional’ challenges of the silk trade, along with the fallout from bankruptcy, had an unexpected upside. They pushed Turlington to develop skills in marketing, labour organisation and even fashion. This expertise helped him change careers and, in 1740, grow a one-man pharmaceutical operation into an early multinational success story.1
Let sales begin
By 1742, Turlington was selling his Balsam of Life into a market packed with competitors like Friar’s Balsam.2 Both elixirs were sold as treatments for several illnesses and injuries. But in no time, Turlington went beyond ‘several’, pitching his product as a veritable ‘cure-all’.1–5,10
‘The aforesaid Balsam is a certain relief for the gravel, cholic, rheumatism, gout, and sciatic pains, and all colds, coughs, consumptive, pectoral, asthmatical, and nervous disorders, &c. and for any cut, bruise, or the like, as thousands can testify who have been relieved thereby, in the above and other complaints, after every other resource has failed,’ claimed Turlington in a 46-page testimonial pamphlet, accompanying each sale.1
In line with the era’s one-product, multi-ailment ‘polypharmacy’ approach, Turlington’s ‘perfect friend to Nature’ initially contained 27 ingredients in an alcohol solution. Over time, that was reduced to just eight. The key ingredients remained plant-based balsams: gum benzoin, storax and Tolu and Peruvian balsam. Aromatic spices like cinnamon, saffron and nutmeg masked the balsams’ unpleasant taste.1,2,5,6,10
Originally sold in round vials, Turlington’s nostrum became so popular that in 1746 he introduced the first of several distinctively shaped bottles to deter imitators.
In 1754, he followed-up with a unique pear-shaped bottle, which continued to be used in different sizes for over 150 years.1,3,7
They remain collectors’ items to this very day.1,4,5,7,8
Promote, protect, expand
Turlington’s distinctively shaped bottles were more than eye-catching – they reflected a shrewd business strategy.
At a time when English medicines were unregulated, Turlington promptly acquired one of the country’s first medical patents.1,3 Granted by King George in 1744 and lasting until 1758, the patent gave Turlington the legal right to prosecute imitators and widely promote his ‘miracle cure’ – a task he embraced with gusto.1,3,8
‘He had the cachet of having the king’s approval of his medicine, a fake coat of arms, a memorable name, a booklet given free with every purchase, a fixed price, and testimonials from satisfied customers who provided information on ailments that could be treated successfully with Balsam of Life,’ note Jones and Vegotsky.1
In 1748, Turlington extended his patent to include Britain’s North American colonies. Geographic expansion soon followed with sales to the emerging United States, Canada, the West Indies and, yes, Australia. Of course, he also pushed into Scotland, Ireland and Europe.1,3,8–10
Did Turlington’s balsam work?
With so many ingredients in varying amounts, used to treat a wide range of conditions, it’s difficult to say how effective the balsam truly was. At best, balsams exhibit anti-inflammatory, antioxidant and antimicrobial effects.11
Whether it worked or not, Turlington’s balsam left an enduring legacy – in pharmacy history, and also on collectors’ shelves.
References
- Jones O, Vegotsky A. Turlington’s Balsam of Life. Northeast Historical Archaeology. 2016;45:1.
- Dayton L. Friar’s Balsam has a place in modern life. Australian Pharmacist 2024;43(7):66.
- Abbott A. Turlington’s Balsam of Life: Colonial American snake oil? University of Central Florida, Center for Humanities and Digital Research.
- Pope A. Turlington's Balsam, the 18th-century cure-all. Canadian Geographic 2016 7 July.
- Griffenhagen GB, Young JH. Old English patent medicines in America. Contributions from The Museum of History and Technology: Paper 10. Project Gutenberg EBook 30162.
- Dilworth LL, Riley CK, Stennett DK. Chapter 5 - Plant Constituents: Carbohydrates, oils, resins, balsams, and plant hormones. Pharmacognosy, Academic Press 61–80 2017.
- Jones OR. Essence of Peppermint, A history of the medicine and its bottle. Hist.Archaeol. 15(2):3, 28, 33.
- Kemp J. Bottles 1. Turlington's Balsam of Life: the 1754 design. Cures All Diseases.com. 2020.
- Young JH. The Toadstool Millionaires: Chapter 1. Quackwatch. 2002 29 Apr.
- Keys R. Turlington’s Balsam of Life. The Adverts 250 Project. 2022 17 Feb.
[post_title] => Lessons from one of the first medicinal patents
[post_excerpt] => Turlington's Balsam was pitched as a veritable ‘cure-all’ in the 18th century – and remains on collectors’ shelves today.
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[caption id="attachment_27199" align="alignright" width="225"] This activity is sponsored by PDL. This information is general in nature and designed only to highlight issues for your consideration. Before acting on this information, you should consider your individual circumstances and needs, and obtain advice as appropriate.[/caption]
Joyce, 76, lives independently and takes seven regular medicines with various dosing frequencies. She struggles to manage her medicines, especially with frequent brand changes due to supply issues. To help herself remember, Joyce recently began placing her daily tablets in a dish on the kitchen bench. During a visit, her 6-year-old grandson mistook the tablets for lollies and was about to swallow them when he was stopped just in time. Joyce is shaken by the incident and distressed by what could have happened.
After reading this article, pharmacists should be able to:
|
Medicine safety is critical to improving health outcomes for children.1 However, ensuring safe and effective medicine use in paediatric populations presents unique challenges, due to differences in physiology, dosing requirements, and patterns of medicine use compared to adults.
Safety concerns arise because many medicines are prescribed off-label for children.2–5 Clinical trial data involving child populations is limited, with many trials not conducted in children. As a result, the safety and efficacy of medicines prescribed to children are often based on extrapolation from adult data.2,3,6
Medicine-related poisoning is also a key concern for medicine safety in children. In 2021–22 in Australia, 8,288 children were hospitalised due to poisoning-related injuries.7 Many of these hospitalisations were the result of accidental poisonings.1 An Australian review of emergency department data from 1 January 2015 to 31 December 2016 found that accidental exposure was the cause of 82% of poisoning cases involving preschool-aged children.8 Research shows that medicines, ‘including adult and paediatric over-the-counter and prescription medicines, are the leading cause of hospitalised unintentional poisonings’ in children in Australia.9,10
Unintentional exposures occur due to a variety of reasons. Data from the NSW Poisons Information Centre show that poisonings involving paracetamol–opioid combinations, ibuprofen–codeine combinations and oxycodone are common in children under 5 years of age.11 This is largely due to the inquisitive nature of children.5,11 Other reasons include therapeutic errors, such as incorrect dosing, incorrect dosing interval, incorrect patient or incorrect drug.11 This may be due to a dosing error by a parent or carer or unintended exposure to a medicine that was not intended for them.12
Risk factors for child poisoningSocioeconomic disadvantage has been found to increase the risk of unintentional poisoning in Australia.9 People who experience socioeconomic disadvantage often have ‘more comorbidities, use more medication, have less access to childcare and storage equipment and are more likely to experience overcrowding’.9 Living in rented premises has also been identified as a potential risk factor, possibly due to practical constraints on modifying living spaces for safe medicine storage.⁹ However, it’s important to note that evidence is limited and evolving, and challenges with secure storage may be experienced across a range of housing situations.
Changes in prescribing patterns and medicine use can also increase the risk of poisoning exposure to children. One example is the increase in the use of psychotropic medicines in children. ADHD is a common neurodevelopmental disorder among children and adolescents.15 Research shows there has been a twofold increase in the annual prevalence of ADHD medicine use – from 4.9 per 1,000 persons in 2013 to 9.7 per 1,000 persons in 2020 – in Australia.16 There has also been a trend towards increased diagnosis and pharmacological treatment of ADHD.6,17 Methylphenidate is the most commonly used medicine for ADHD in children, followed by lisdexamfetamine.16 The growing use of ADHD medicines may increase the risk of unintentional poisoning in children.17
Non-stimulant medicines such as clonidine, guanfacine and atomoxetine may also be used concurrently with stimulant medications, particularly in young children and adolescents.16 The off-label use of clonidine for children with ADHD remains problematic due to cases of poisonings and overdose from incorrect dosing.16,18 Clonidine has a narrow therapeutic index, meaning toxicity can occur even with even small dosing errors. The Therapeutic Goods Administration (TGA) has issued a safety alert warning to pharmacists and other health professionals about the risks associated with off-label clonidine use in children.19 Pharmacists should thoroughly counsel patients, parents and carers on the importance of correct dosing and proper storage of clonidine, given the high risk of toxicity from accidental overdose and unintentional poisoning. Compounding pharmacists may be asked to prepare clonidine suspensions, as they are not commercially available. Accuracy is essential when compounding medicines, particularly those such as clonidine, where the dose is prescribed in micrograms. Dosing errors can occur when the strength is incorrectly transcribed from micrograms to milligrams, significantly increasing the risk of poisoning exposure.
Another area of concern is medicine dosing in the school setting. The use of psychotropic medicines in children is increasing, and school-aged children may need to be dosed several times per day.20 This increases the risk of medication error and poisoning exposure. Data from the NSW Poisons Information Centre from January 2014 to June 2018 show that incidents involving methylphenidate were the fourth most common poisoning exposure in schools.20 The majority of methylphenidate incidents occurred due to medication errors, such as double dosing or medicine given to the wrong child.20 In this study, medication errors accounted for 11.6% of poisoning exposures.20 Clonidine and paracetamol were also involved in medication errors in schools.20 This highlights the need for school staff to be trained in medicine safety.20
Communication: Effective communication between pharmacists and patients, parents and carers is vital to ensure the safe use of medicines and an awareness of the potential risks that may come with a medicine. Communication should be tailored to account for the socioeconomic, cultural, or educational background of the patient or carer. Counselling should include not only the dose, frequency and duration of therapy for medicines prescribed to children, but also information about safe storage, accessibility and disposal of that medicine. Accessibility and disposal are relevant in any situation where a child might be present.12 Pharmacists should promote the return of unused or unwanted medicines to the pharmacy for safe disposal, helping to reduce the risk of poisoning exposure.
Clinical judgment: Pharmacists and dispensary technicians should implement procedures to flag medicines prescribed for children, ensuring dispensed products are checked for safety and appropriateness. This requires pharmacists to access resources relevant to medicines for children, including dosing guidelines and instructions for the preparation of compounded products. This can be particularly challenging when medicines are prescribed off-label, as information may be more difficult to locate; however, pharmacists are expected to undertake a risk assessment irrespective of the medicine being proprietary, compounded or off-label.
Third party supply: Administration of medicines to children by carers or school staff may involve an increased risk of error and adverse consequences. Consistently asking parents or carers whether a child’s medicine will be administered by a third party may enable the pharmacist to provide additional counselling or support via a dose administration aid (DAA) where appropriate.
Packaging: pharmacists should ensure that all medicines, including compounded preparations, are appropriately packaged using child-resistant closures.
Access to Poisons Information: In the event of a dosing error or suspected poisoning, pharmacists should act immediately by contacting the Poisons Information Centre on 13 11 26 (available Australia-wide), or call 000 if the situation appears life-threatening.9
Pharmacists who wish to enquire about dosing or other medicine-related information prior to dispensing can contact a medicines information centre in their state, as listed in Appendix E of the Australian Medicines Handbook (AMH).
Medicine safety in children requires vigilance, clear communication and proactive intervention by pharmacists. With limited clinical trial data and increasing use of off-label and high-risk medicines, pharmacists must assess individual risks, educate carers, and advocate for secure storage and appropriate administration.
By implementing tailored strategies and promoting awareness, pharmacists can play a pivotal role in preventing accidental poisonings and enhancing the safe use of medicines in children.
Case scenario continuedAt her next pharmacy visit, Joyce mentions the incident to the pharmacist. The pharmacist discusses the risks of leaving medicines unsecured, especially around children, and offers practical solutions. These include a weekly dose administration aid (DAA) to help with organisation, a medication reminder app for her phone, and advice on safe storage, such as using a lockable drawer or placing medicines on a high shelf in a cupboard out of children’s reach. Joyce is reassured by the support and feels more confident in managing her medicines safely moving forward. |
Dr Simone Henriksen (she/her) BPharm, LLB (Hons I), PhD (Law) is a community pharmacist with over 30 years’ experience. She is also a legal academic at the University of the Sunshine Coast. Her research areas include the regulation and clinical governance of health services in Australia.
Morna Falkland BPharm
Dr Simone Henriksen is a former employee of Pharmaceutical Defence Limited (PDL) and a member of the Pharmaceutical Society of Australia (PSA). This article was developed while in the role of PDL Professional Officer.
PDL is a sponsor of the Medicine safety: children and adolescent care report, which is cited in this article.
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[post_content] => After a nationwide search, Melbourne-based community pharmacist Anna Theophilos MPS has been appointed PSA’s inaugural Vaccination Ambassador. And she intends to shake things up.
With bold ideas and proven innovation, Ms Theophilos is set to transform pharmacist-led immunisation across Australia. She will work alongside PSA to elevate the voice of pharmacist immunisers throughout the country, driving public confidence and promoting vaccination.
In the aged care sector, Ms Theophilos has pioneered systems that ensure residents receive timely access to all National Immunisation Program and private vaccines. By introducing streamlined digital systems, she has significantly reduced the administrative burden on staff, making clinics easier to run and more efficient. The digital platform also allows facilities to immediately identify local vaccination gaps, while governing bodies are supported with live coverage data at the click of a button.
Under Ms Theophilos’s initiative, coverage rates within facilities rose from just 30% to an impressive 95%. From innovative outreach clinics to tailored services for children with sensory needs, her work reflects the evolving role of pharmacists in improving immunisation access for priority population groups.
https://www.youtube.com/shorts/xsedyMemFhs
Hosting the vaccination stream at PSA25 next week, Ms Theophilos told Australian Pharmacist why she’s passionate about vaccination and getting the immunisation message out to more Australians.
Tell us about your career in pharmacy so far.
I’ve been a pharmacist for 17 years – 16 of those as a business owner. Over that time, I’ve worn many hats, but what’s stayed constant is my desire to build services that respond meaningfully to the specific needs of my local community. Whether it’s dispensing, health education, or vaccination – I’ve always believed in combining clinical excellence with real, human connection.
How long have you been a pharmacist vaccinator?
I’ve been vaccinating since taking over my current business 3 years ago, and it quickly became a core part of my practice. What started within the four walls of the pharmacy has now expanded into aged care, home-based care, sensory-friendly clinics, and outreach models such as pop-up influenza clinics in schools or home visits for immunocompromised patients.
Why are you passionate about vaccination?
It’s an area where pharmacists can bring clarity, care and real impact. There’s so much noise and misinformation out there, and I believe people deserve to make informed decisions about vaccine-preventable diseases with confidence and trusted guidance. Pharmacists are able to provide not only trusted advice to individuals, but also to advance public health outcomes at scale. As a mum of two primary school-aged children, I also wanted to create an experience for their age group that felt calm, safe, and free of fear. How we approach their vaccination today shapes how they view health care tomorrow.
Have you been administering new vaccinations under the Victorian pharmacy pilots?
Yes! And I’ve really enjoyed being part of it. Administering travel vaccines has been particularly rewarding. It’s opened up conversations with patients who might never have considered vaccination. Like someone popping in for loperamide before a trip to Bali. Being up to date with the latest information has allowed pharmacists to offer truly comprehensive care, ensuring our community stays healthy before and after they board the plane.
What vaccine trends concern you, and how can pharmacists help to address them?
When I began working in aged care, I started collating data and was shocked to discover that only 8% of residents were up to date with all vaccines recommended in the Vaccination for Healthy Ageing – and just 30% with National Immunisation Program vaccinations. If those were childhood immunisation rates, we’d be outraged. So why aren’t we applying that same urgency to our older Australians? Over the past 18 months, it has become apparent that these low rates stem from fragmented care pathways and inconsistent funding – gaps that pharmacists are well-placed to address. I’ve worked tirelessly to understand the barriers and build practical, pharmacist-led pathways to improve access. And it has been successful. We can change this – and I believe we will.
What do you hope to achieve in your role as Vaccination Ambassador?
I want to elevate the role of pharmacists in immunisation – not just as vaccinators, but as system-shapers. I hope to bring attention to the work already happening in this space, advocate for sustainable funding and policy reform, and create momentum around models that reach underserved communities, aged care facilities and high-risk populations.
What are some of your first priorities?
One of my main goals is to help mobilise pharmacists across Australia to see this as part of our core mission – to prioritise it – and to feel just as confident administering a vaccine as they do dispensing a prescription. I also want to support clearer public messaging around vaccine-preventable diseases, and advocate for policy and funding frameworks that unlock our full capacity and skill set.
Where do you see pharmacists evolving in terms of vaccination?
It’s simple: all ages, all vaccines.
I see pharmacists becoming the number one provider of vaccinations in Australia. And not limited by age, setting or scope. We have the workforce, the accessibility and the trust. The opportunity is right in front of us.
What are you planning to share with delegates at PSA25?
That it’s time to take up this role with confidence and intentionality. For too long our scope has been underestimated or constrained. We have been told it’s not our place, that we need permission, or that we’re stepping on toes. But the data around vaccination rates tell a different story. It’s clear something needs to change. That something is us. Our profession. And we’re more than ready. We have the workforce, the access, and the trust of the public. Now is the time to lead.
Learn more about vaccinations from Anna Theophilos and others at PSA25, held in Sydney from 1–3 August. Register here to attend.
[post_title] => Meet PSA’s new Vaccination Ambassador
[post_excerpt] => After a nationwide search, Melbourne-based community pharmacist Anna Theophilos MPS has been appointed PSA’s Vaccination Ambassador.
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[post_content] => This year’s Pharmacy Shark Tank, held at PSA25 next week, is set to be a cracker – with some of the most exciting innovations yet, all powered by technology to solve real-world problems in pharmacy.
Australian Pharmacist caught up with some of the 2025 entrants to get a glimpse.
Working towards a more integrated healthcare system
As young pharmacists just entering the industry, Queensland-based brothers Alfred and Viknesh Bramasta have witnessed the errors that can occur when care is fragmented.
‘I'm currently doing my internship in a pharmacy in Queensland,’ Alfred said. ‘One of the major things we’ve seen is flaws in the software being developed, and we wanted to take the opportunity to make some improvements.’
The brothers developed a new software program, PillFlow, to record medication changes made by either GPs, hospital pharmacists or community pharmacists.
‘Right now, when a patient’s medication changes, the pharmacy and doctor often have to go back and forth by phone, email or fax just to confirm the new prescription,’ said Viknesh, a fourth-year pharmacy student who also works in a hospital pharmacy.
[caption id="attachment_29916" align="aligncenter" width="300"] Viknesh Bramasta[/caption]
[caption id="attachment_29917" align="aligncenter" width="300"] Alfred Bramasta[/caption]
Delays and communication gaps in the current process may affect both workflow efficiency and the quality of patient care.
Viknesh thinks PillFlow could change this.
‘Our main goal is to enhance patient safety,’ Viknesh said. ‘There can still be challenges in ensuring medication changes for DAA patients are clearly communicated, actioned, and recorded.’
By presenting PillFlow at Shark Tank, Alfred and Viknesh are keen to receive feedback from the judges and audience.
‘It’s a great avenue for us to test and share our idea directly with pharmacists,’ Viknesh said. ‘PSA has made the process really easy.’
Software developments are key to making pharmacists’ workloads more tolerable and improving medicine safety, Alfred said.
‘There's a lot that can be done to improve the workflow in community pharmacy, and innovation will be the main thing to ensure patients get the best benefit.’
Streamlining pharmacy workflows
After 5 years in community pharmacy, early career pharmacist Eric Khek has seen firsthand just how short-staffed the profession can be – especially during the peak of the COVID-19 pandemic.
‘So I've always been interested in how to improve efficiencies in the pharmacy,’ he said.
To do this, Eric created a self-service kiosk system to automate pharmacy processes.
‘When a patient presents to the pharmacy with an eScript, they can scan the eRx [barcode] and answer a couple of questions pharmacy assistants usually ask,’ he said.
[caption id="attachment_29921" align="aligncenter" width="300"] Eric Khek[/caption]
The system also serves as a triage for minor ailments.
‘If a patient presents with a cough, for example, the self-service kiosk will activate a cough protocol and ask screening questions that you would find in the Australian Pharmaceutical Formulary and Handbook related to cough, such as “Do you have any breathing difficulties?” or “Are you coughing out any blood?”’
Through this innovation, Eric is hoping to not only improve pharmacy workflows but staff stress levels also.
‘We can miss asking important questions during stressful times which could potentially lead to medication errors,’ he said.
Entering Shark Tank should open up network opportunities, Eric thinks.
‘Hopefully I’ll be able to meet like-minded people to collaborate with me and take this product to the next level,’ he said.
With technology evolving at a rapid rate, it’s important that the pharmacy profession keeps up. ‘Around 40–50 years ago, we didn't even have a computer for dispensing,’ Eric said. ‘Harnessing the power of technology makes our lives easier.’
Enhancing learning with AI
Pharmacist and clinical educator Krysti-Lee Patterson MPS is leveraging the power of AI to improve how pharmacy students learn and prepare to practice as registered pharmacists.
Her innovation, The SMART project – an AI model used by the University of Technology Sydney – allows students to practise exam simulations with case scenarios.
‘We’ve essentially created ChatGPT for pharmacists,’ she said. ‘Using our AI models, we feed the platform with case scenarios that the lecturers have created – allowing the students to be able to practice under exam conditions.’
[caption id="attachment_21130" align="aligncenter" width="300"] Krysti-Lee Patterson MPS[/caption]
The SMART project is designed to both save university staff time and improve pharmacy curricula.
‘The head of Pharmacy at UTS explained that a key challenge is that they're too low on time to be able to do one-on-one training or coaching with their students,’ Krysti-Lee said. ‘So one of the problems we’re trying to solve is saving time without reducing quality.’
Academics can also use data collected from the model to assess whether students are asking the same questions, and address any gaps in the course.
‘The next phase, which we're working on now, will actually allow you to speak to it – so students can practise their oral exams via our platform.’
With pharmacy being a heavily regulated industry, which can be adverse to risk and change, it’s important to showcase the innovations of budding entrepreneurs to strengthen the profession.
‘It's going to make things more efficient, have better outcomes for patients, and ultimately, make a difference to the health of Australians,’ Krysti-Lee said.
Catch the pitches of these three innovations at PSA25’s Pharmacy Shark Tank happening from 3:20 PM - 4:20 PM on Friday 1 August. Last minute registrations are closing soon, visit the PSA25 website to grab yours before it's too late.
[post_title] => What innovations could pharmacy soon see?
[post_excerpt] => This year’s Pharmacy Shark Tank, held at PSA25 next week, is set to be a cracker – with some of the most exciting innovations yet.
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[post_content] => Mental health needs are rising, but so are questionable prescribing patterns. Pharmacists can help define the line between justified care and risky overreach.
Australia’s adolescent mental health crisis is escalating at a troubling pace. A landmark longitudinal study by Murdoch Children’s Research Institute revealed that by age 18, nearly three quarters (74 %) of Australian teenagers experienced clinically significant symptoms of anxiety or depression at least once – with many enduring chronic episodes spanning multiple school transitions and exam periods.
The Australian Bureau of Statistics confirms that in 2020–22, 38.8 % of 16–24 year‑olds reported a mental disorder in the past 12 months, dominated by anxiety (17.2 %). Contributing factors are complex: academic pressure, early puberty, growing social isolation, socioeconomic stress, and particularly, the impact of social media.
The increase in prescribing
Similarly, antidepressant prescribing among Australian adolescents is on the rise, raising concerns about off-label use and high-dose regimens – with the pharmacist’s role in ensuring safe and appropriate therapy more important than ever. A 2024 ABC report noted that psychotropic use in under‑18s more than doubled from 2013 to 2023.3
Between 2013 and 2019, Selective Serotonin Reuptake Inhibitor (SSRI) prescribing in adolescents steadily climbed, with GPs accounting for 55 % of prescriptions in 12–14 year‑olds and 78 % in 15–17 year‑olds.
According to consultant pharmacist Amanda Fuller, Clinical Lead at Medcast, the increase in antidepressant prescribing reflects a complex mix of demand, access issues, and public perception.
[caption id="attachment_29976" align="alignright" width="300"] Amanda Fuller[/caption]
‘We’re seeing a growing awareness of mental health in young people, which is a positive shift,’ Ms Fuller said. ‘But when that’s combined with long waitlists for psychologists and psychiatrists, GPs often feel pressure to act quickly – particularly if there are concerns about deterioration or safety.’
This urgency is sometimes reinforced by family expectations. ‘Parents and carers may see antidepressants as a fast-acting solution while they wait for psychological support,’ she added.
Off-label use in high doses
Most prescribing for under-18s is off-label, which complicates matters, Ms Fuller said.
‘This places the responsibility on prescribers to weigh clinical judgment and available evidence against regulatory guidance.’
In Australia, only fluvoxamine and sertraline are approved by the Therapeutic Goods Administration (TGA) to treat obsessive-compulsive disorder (OCD) – in children aged 6 and 8 years and older, respectively. Others are used beyond their approved indications.
Fluoxetine remains the most commonly prescribed antidepressant in this cohort. ‘It’s the recommended first-line SSRI for adolescents and is the only one with consistent trial evidence showing efficacy over placebo in depression,’ Ms Fuller said. ‘But even then, the benefit was modest, placebo response rates were high, and study quality was poor, making interpretation difficult.’
In anxiety, the data is even less robust. ‘There’s limited evidence, though fluoxetine, fluvoxamine, and sertraline have shown some benefit in trials. But again, quality is a concern,’ she said.
Public understanding of antidepressants is also often shaped by outdated ideas, Ms Fuller said. ‘The “chemical imbalance” theory has been largely debunked, but it still drives the belief that medication is essential for treatment.’
More concerning is the increasing use of high-dose antidepressant regimens, sometimes exceeding standard adult doses.
‘We know higher doses are sometimes used in OCD, and prescribers may consider the adolescent’s physical maturity. But there’s no strong evidence to support routine high-dose use in this age group,’ she said.
Psychiatrists are more likely than GPs to prescribe these higher doses, often in complex or treatment-resistant cases. However, efficacy data for higher doses is lacking – even in adult populations.
‘In fluoxetine studies, response rates were actually highest between 20–40 mg daily,’ Ms Fuller said. ‘Going beyond that was linked to more [adverse] effects and increased dropout rates.’
The role of pharmacists
Pharmacists should take a proactive yet respectful approach when faced with uncertainty around an antidepressant prescription, Ms Fuller advised.
‘If something doesn’t add up – if you can’t confirm the indication, or there’s limited information about the treatment plan – it’s absolutely appropriate to contact the prescriber,’ she said.
Before doing so, she recommends checking key factors: ‘Clarify the diagnosis, assess for any psychosocial supports in place, confirm adherence and tolerance, and look at what the follow-up plan involves.’
When contacting prescribers, Ms Fuller urges pharmacists to approach conversations with collaboration, not correction. ‘Assume clinical reasoning is there – your role is to clarify, not challenge,’ she said ‘Focus on shared care, not prescription policing.”’
Australia’s adolescent mental health situation demands attention and pharmacists have a pivotal role in it. Soaring rates of depression, anxiety and antidepressant prescribing underscore the need for thoughtful, patient-centred care.
PSA25's session on ‘Dosing dilemmas’, presented by Ms Fuller, offers essential guidance on navigating adolescent antidepressant use – from informed dosing choices to structured monitoring and collaborative decision-making.
Haven’t registered for PSA25 yet? Don’t miss your chance – registrations are still open.
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[post_excerpt] => Youth mental health needs are rising, but so too are questionable prescribing patterns of antidepressants.
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[post_content] => A look at Turlington’s 27‑ingredient balsam, its broad therapeutic claims and how it contrasts with today’s evidence‑based approaches.
Robert Turlington was a 21st Century pharmacist living in the 18th Century. But the Londoner wasn’t always the successful entrepreneur he later became. Instead, Turlington (1697–1766) began his working life as a weaver – and a bankrupt one at that – courtesy of his demanding specialty: silk.1
According to archaeologists Olive Jones and Allen Vegotsky, the ‘multidimensional’ challenges of the silk trade, along with the fallout from bankruptcy, had an unexpected upside. They pushed Turlington to develop skills in marketing, labour organisation and even fashion. This expertise helped him change careers and, in 1740, grow a one-man pharmaceutical operation into an early multinational success story.1
Let sales begin
By 1742, Turlington was selling his Balsam of Life into a market packed with competitors like Friar’s Balsam.2 Both elixirs were sold as treatments for several illnesses and injuries. But in no time, Turlington went beyond ‘several’, pitching his product as a veritable ‘cure-all’.1–5,10
‘The aforesaid Balsam is a certain relief for the gravel, cholic, rheumatism, gout, and sciatic pains, and all colds, coughs, consumptive, pectoral, asthmatical, and nervous disorders, &c. and for any cut, bruise, or the like, as thousands can testify who have been relieved thereby, in the above and other complaints, after every other resource has failed,’ claimed Turlington in a 46-page testimonial pamphlet, accompanying each sale.1
In line with the era’s one-product, multi-ailment ‘polypharmacy’ approach, Turlington’s ‘perfect friend to Nature’ initially contained 27 ingredients in an alcohol solution. Over time, that was reduced to just eight. The key ingredients remained plant-based balsams: gum benzoin, storax and Tolu and Peruvian balsam. Aromatic spices like cinnamon, saffron and nutmeg masked the balsams’ unpleasant taste.1,2,5,6,10
Originally sold in round vials, Turlington’s nostrum became so popular that in 1746 he introduced the first of several distinctively shaped bottles to deter imitators.
In 1754, he followed-up with a unique pear-shaped bottle, which continued to be used in different sizes for over 150 years.1,3,7
They remain collectors’ items to this very day.1,4,5,7,8
Promote, protect, expand
Turlington’s distinctively shaped bottles were more than eye-catching – they reflected a shrewd business strategy.
At a time when English medicines were unregulated, Turlington promptly acquired one of the country’s first medical patents.1,3 Granted by King George in 1744 and lasting until 1758, the patent gave Turlington the legal right to prosecute imitators and widely promote his ‘miracle cure’ – a task he embraced with gusto.1,3,8
‘He had the cachet of having the king’s approval of his medicine, a fake coat of arms, a memorable name, a booklet given free with every purchase, a fixed price, and testimonials from satisfied customers who provided information on ailments that could be treated successfully with Balsam of Life,’ note Jones and Vegotsky.1
In 1748, Turlington extended his patent to include Britain’s North American colonies. Geographic expansion soon followed with sales to the emerging United States, Canada, the West Indies and, yes, Australia. Of course, he also pushed into Scotland, Ireland and Europe.1,3,8–10
Did Turlington’s balsam work?
With so many ingredients in varying amounts, used to treat a wide range of conditions, it’s difficult to say how effective the balsam truly was. At best, balsams exhibit anti-inflammatory, antioxidant and antimicrobial effects.11
Whether it worked or not, Turlington’s balsam left an enduring legacy – in pharmacy history, and also on collectors’ shelves.
References
- Jones O, Vegotsky A. Turlington’s Balsam of Life. Northeast Historical Archaeology. 2016;45:1.
- Dayton L. Friar’s Balsam has a place in modern life. Australian Pharmacist 2024;43(7):66.
- Abbott A. Turlington’s Balsam of Life: Colonial American snake oil? University of Central Florida, Center for Humanities and Digital Research.
- Pope A. Turlington's Balsam, the 18th-century cure-all. Canadian Geographic 2016 7 July.
- Griffenhagen GB, Young JH. Old English patent medicines in America. Contributions from The Museum of History and Technology: Paper 10. Project Gutenberg EBook 30162.
- Dilworth LL, Riley CK, Stennett DK. Chapter 5 - Plant Constituents: Carbohydrates, oils, resins, balsams, and plant hormones. Pharmacognosy, Academic Press 61–80 2017.
- Jones OR. Essence of Peppermint, A history of the medicine and its bottle. Hist.Archaeol. 15(2):3, 28, 33.
- Kemp J. Bottles 1. Turlington's Balsam of Life: the 1754 design. Cures All Diseases.com. 2020.
- Young JH. The Toadstool Millionaires: Chapter 1. Quackwatch. 2002 29 Apr.
- Keys R. Turlington’s Balsam of Life. The Adverts 250 Project. 2022 17 Feb.
[post_title] => Lessons from one of the first medicinal patents
[post_excerpt] => Turlington's Balsam was pitched as a veritable ‘cure-all’ in the 18th century – and remains on collectors’ shelves today.
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[caption id="attachment_27199" align="alignright" width="225"] This activity is sponsored by PDL. This information is general in nature and designed only to highlight issues for your consideration. Before acting on this information, you should consider your individual circumstances and needs, and obtain advice as appropriate.[/caption]
Joyce, 76, lives independently and takes seven regular medicines with various dosing frequencies. She struggles to manage her medicines, especially with frequent brand changes due to supply issues. To help herself remember, Joyce recently began placing her daily tablets in a dish on the kitchen bench. During a visit, her 6-year-old grandson mistook the tablets for lollies and was about to swallow them when he was stopped just in time. Joyce is shaken by the incident and distressed by what could have happened.
After reading this article, pharmacists should be able to:
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Medicine safety is critical to improving health outcomes for children.1 However, ensuring safe and effective medicine use in paediatric populations presents unique challenges, due to differences in physiology, dosing requirements, and patterns of medicine use compared to adults.
Safety concerns arise because many medicines are prescribed off-label for children.2–5 Clinical trial data involving child populations is limited, with many trials not conducted in children. As a result, the safety and efficacy of medicines prescribed to children are often based on extrapolation from adult data.2,3,6
Medicine-related poisoning is also a key concern for medicine safety in children. In 2021–22 in Australia, 8,288 children were hospitalised due to poisoning-related injuries.7 Many of these hospitalisations were the result of accidental poisonings.1 An Australian review of emergency department data from 1 January 2015 to 31 December 2016 found that accidental exposure was the cause of 82% of poisoning cases involving preschool-aged children.8 Research shows that medicines, ‘including adult and paediatric over-the-counter and prescription medicines, are the leading cause of hospitalised unintentional poisonings’ in children in Australia.9,10
Unintentional exposures occur due to a variety of reasons. Data from the NSW Poisons Information Centre show that poisonings involving paracetamol–opioid combinations, ibuprofen–codeine combinations and oxycodone are common in children under 5 years of age.11 This is largely due to the inquisitive nature of children.5,11 Other reasons include therapeutic errors, such as incorrect dosing, incorrect dosing interval, incorrect patient or incorrect drug.11 This may be due to a dosing error by a parent or carer or unintended exposure to a medicine that was not intended for them.12
Risk factors for child poisoningSocioeconomic disadvantage has been found to increase the risk of unintentional poisoning in Australia.9 People who experience socioeconomic disadvantage often have ‘more comorbidities, use more medication, have less access to childcare and storage equipment and are more likely to experience overcrowding’.9 Living in rented premises has also been identified as a potential risk factor, possibly due to practical constraints on modifying living spaces for safe medicine storage.⁹ However, it’s important to note that evidence is limited and evolving, and challenges with secure storage may be experienced across a range of housing situations.
Changes in prescribing patterns and medicine use can also increase the risk of poisoning exposure to children. One example is the increase in the use of psychotropic medicines in children. ADHD is a common neurodevelopmental disorder among children and adolescents.15 Research shows there has been a twofold increase in the annual prevalence of ADHD medicine use – from 4.9 per 1,000 persons in 2013 to 9.7 per 1,000 persons in 2020 – in Australia.16 There has also been a trend towards increased diagnosis and pharmacological treatment of ADHD.6,17 Methylphenidate is the most commonly used medicine for ADHD in children, followed by lisdexamfetamine.16 The growing use of ADHD medicines may increase the risk of unintentional poisoning in children.17
Non-stimulant medicines such as clonidine, guanfacine and atomoxetine may also be used concurrently with stimulant medications, particularly in young children and adolescents.16 The off-label use of clonidine for children with ADHD remains problematic due to cases of poisonings and overdose from incorrect dosing.16,18 Clonidine has a narrow therapeutic index, meaning toxicity can occur even with even small dosing errors. The Therapeutic Goods Administration (TGA) has issued a safety alert warning to pharmacists and other health professionals about the risks associated with off-label clonidine use in children.19 Pharmacists should thoroughly counsel patients, parents and carers on the importance of correct dosing and proper storage of clonidine, given the high risk of toxicity from accidental overdose and unintentional poisoning. Compounding pharmacists may be asked to prepare clonidine suspensions, as they are not commercially available. Accuracy is essential when compounding medicines, particularly those such as clonidine, where the dose is prescribed in micrograms. Dosing errors can occur when the strength is incorrectly transcribed from micrograms to milligrams, significantly increasing the risk of poisoning exposure.
Another area of concern is medicine dosing in the school setting. The use of psychotropic medicines in children is increasing, and school-aged children may need to be dosed several times per day.20 This increases the risk of medication error and poisoning exposure. Data from the NSW Poisons Information Centre from January 2014 to June 2018 show that incidents involving methylphenidate were the fourth most common poisoning exposure in schools.20 The majority of methylphenidate incidents occurred due to medication errors, such as double dosing or medicine given to the wrong child.20 In this study, medication errors accounted for 11.6% of poisoning exposures.20 Clonidine and paracetamol were also involved in medication errors in schools.20 This highlights the need for school staff to be trained in medicine safety.20
Communication: Effective communication between pharmacists and patients, parents and carers is vital to ensure the safe use of medicines and an awareness of the potential risks that may come with a medicine. Communication should be tailored to account for the socioeconomic, cultural, or educational background of the patient or carer. Counselling should include not only the dose, frequency and duration of therapy for medicines prescribed to children, but also information about safe storage, accessibility and disposal of that medicine. Accessibility and disposal are relevant in any situation where a child might be present.12 Pharmacists should promote the return of unused or unwanted medicines to the pharmacy for safe disposal, helping to reduce the risk of poisoning exposure.
Clinical judgment: Pharmacists and dispensary technicians should implement procedures to flag medicines prescribed for children, ensuring dispensed products are checked for safety and appropriateness. This requires pharmacists to access resources relevant to medicines for children, including dosing guidelines and instructions for the preparation of compounded products. This can be particularly challenging when medicines are prescribed off-label, as information may be more difficult to locate; however, pharmacists are expected to undertake a risk assessment irrespective of the medicine being proprietary, compounded or off-label.
Third party supply: Administration of medicines to children by carers or school staff may involve an increased risk of error and adverse consequences. Consistently asking parents or carers whether a child’s medicine will be administered by a third party may enable the pharmacist to provide additional counselling or support via a dose administration aid (DAA) where appropriate.
Packaging: pharmacists should ensure that all medicines, including compounded preparations, are appropriately packaged using child-resistant closures.
Access to Poisons Information: In the event of a dosing error or suspected poisoning, pharmacists should act immediately by contacting the Poisons Information Centre on 13 11 26 (available Australia-wide), or call 000 if the situation appears life-threatening.9
Pharmacists who wish to enquire about dosing or other medicine-related information prior to dispensing can contact a medicines information centre in their state, as listed in Appendix E of the Australian Medicines Handbook (AMH).
Medicine safety in children requires vigilance, clear communication and proactive intervention by pharmacists. With limited clinical trial data and increasing use of off-label and high-risk medicines, pharmacists must assess individual risks, educate carers, and advocate for secure storage and appropriate administration.
By implementing tailored strategies and promoting awareness, pharmacists can play a pivotal role in preventing accidental poisonings and enhancing the safe use of medicines in children.
Case scenario continuedAt her next pharmacy visit, Joyce mentions the incident to the pharmacist. The pharmacist discusses the risks of leaving medicines unsecured, especially around children, and offers practical solutions. These include a weekly dose administration aid (DAA) to help with organisation, a medication reminder app for her phone, and advice on safe storage, such as using a lockable drawer or placing medicines on a high shelf in a cupboard out of children’s reach. Joyce is reassured by the support and feels more confident in managing her medicines safely moving forward. |
Dr Simone Henriksen (she/her) BPharm, LLB (Hons I), PhD (Law) is a community pharmacist with over 30 years’ experience. She is also a legal academic at the University of the Sunshine Coast. Her research areas include the regulation and clinical governance of health services in Australia.
Morna Falkland BPharm
Dr Simone Henriksen is a former employee of Pharmaceutical Defence Limited (PDL) and a member of the Pharmaceutical Society of Australia (PSA). This article was developed while in the role of PDL Professional Officer.
PDL is a sponsor of the Medicine safety: children and adolescent care report, which is cited in this article.
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[post_content] => After a nationwide search, Melbourne-based community pharmacist Anna Theophilos MPS has been appointed PSA’s inaugural Vaccination Ambassador. And she intends to shake things up.
With bold ideas and proven innovation, Ms Theophilos is set to transform pharmacist-led immunisation across Australia. She will work alongside PSA to elevate the voice of pharmacist immunisers throughout the country, driving public confidence and promoting vaccination.
In the aged care sector, Ms Theophilos has pioneered systems that ensure residents receive timely access to all National Immunisation Program and private vaccines. By introducing streamlined digital systems, she has significantly reduced the administrative burden on staff, making clinics easier to run and more efficient. The digital platform also allows facilities to immediately identify local vaccination gaps, while governing bodies are supported with live coverage data at the click of a button.
Under Ms Theophilos’s initiative, coverage rates within facilities rose from just 30% to an impressive 95%. From innovative outreach clinics to tailored services for children with sensory needs, her work reflects the evolving role of pharmacists in improving immunisation access for priority population groups.
https://www.youtube.com/shorts/xsedyMemFhs
Hosting the vaccination stream at PSA25 next week, Ms Theophilos told Australian Pharmacist why she’s passionate about vaccination and getting the immunisation message out to more Australians.
Tell us about your career in pharmacy so far.
I’ve been a pharmacist for 17 years – 16 of those as a business owner. Over that time, I’ve worn many hats, but what’s stayed constant is my desire to build services that respond meaningfully to the specific needs of my local community. Whether it’s dispensing, health education, or vaccination – I’ve always believed in combining clinical excellence with real, human connection.
How long have you been a pharmacist vaccinator?
I’ve been vaccinating since taking over my current business 3 years ago, and it quickly became a core part of my practice. What started within the four walls of the pharmacy has now expanded into aged care, home-based care, sensory-friendly clinics, and outreach models such as pop-up influenza clinics in schools or home visits for immunocompromised patients.
Why are you passionate about vaccination?
It’s an area where pharmacists can bring clarity, care and real impact. There’s so much noise and misinformation out there, and I believe people deserve to make informed decisions about vaccine-preventable diseases with confidence and trusted guidance. Pharmacists are able to provide not only trusted advice to individuals, but also to advance public health outcomes at scale. As a mum of two primary school-aged children, I also wanted to create an experience for their age group that felt calm, safe, and free of fear. How we approach their vaccination today shapes how they view health care tomorrow.
Have you been administering new vaccinations under the Victorian pharmacy pilots?
Yes! And I’ve really enjoyed being part of it. Administering travel vaccines has been particularly rewarding. It’s opened up conversations with patients who might never have considered vaccination. Like someone popping in for loperamide before a trip to Bali. Being up to date with the latest information has allowed pharmacists to offer truly comprehensive care, ensuring our community stays healthy before and after they board the plane.
What vaccine trends concern you, and how can pharmacists help to address them?
When I began working in aged care, I started collating data and was shocked to discover that only 8% of residents were up to date with all vaccines recommended in the Vaccination for Healthy Ageing – and just 30% with National Immunisation Program vaccinations. If those were childhood immunisation rates, we’d be outraged. So why aren’t we applying that same urgency to our older Australians? Over the past 18 months, it has become apparent that these low rates stem from fragmented care pathways and inconsistent funding – gaps that pharmacists are well-placed to address. I’ve worked tirelessly to understand the barriers and build practical, pharmacist-led pathways to improve access. And it has been successful. We can change this – and I believe we will.
What do you hope to achieve in your role as Vaccination Ambassador?
I want to elevate the role of pharmacists in immunisation – not just as vaccinators, but as system-shapers. I hope to bring attention to the work already happening in this space, advocate for sustainable funding and policy reform, and create momentum around models that reach underserved communities, aged care facilities and high-risk populations.
What are some of your first priorities?
One of my main goals is to help mobilise pharmacists across Australia to see this as part of our core mission – to prioritise it – and to feel just as confident administering a vaccine as they do dispensing a prescription. I also want to support clearer public messaging around vaccine-preventable diseases, and advocate for policy and funding frameworks that unlock our full capacity and skill set.
Where do you see pharmacists evolving in terms of vaccination?
It’s simple: all ages, all vaccines.
I see pharmacists becoming the number one provider of vaccinations in Australia. And not limited by age, setting or scope. We have the workforce, the accessibility and the trust. The opportunity is right in front of us.
What are you planning to share with delegates at PSA25?
That it’s time to take up this role with confidence and intentionality. For too long our scope has been underestimated or constrained. We have been told it’s not our place, that we need permission, or that we’re stepping on toes. But the data around vaccination rates tell a different story. It’s clear something needs to change. That something is us. Our profession. And we’re more than ready. We have the workforce, the access, and the trust of the public. Now is the time to lead.
Learn more about vaccinations from Anna Theophilos and others at PSA25, held in Sydney from 1–3 August. Register here to attend.
[post_title] => Meet PSA’s new Vaccination Ambassador
[post_excerpt] => After a nationwide search, Melbourne-based community pharmacist Anna Theophilos MPS has been appointed PSA’s Vaccination Ambassador.
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[post_content] => This year’s Pharmacy Shark Tank, held at PSA25 next week, is set to be a cracker – with some of the most exciting innovations yet, all powered by technology to solve real-world problems in pharmacy.
Australian Pharmacist caught up with some of the 2025 entrants to get a glimpse.
Working towards a more integrated healthcare system
As young pharmacists just entering the industry, Queensland-based brothers Alfred and Viknesh Bramasta have witnessed the errors that can occur when care is fragmented.
‘I'm currently doing my internship in a pharmacy in Queensland,’ Alfred said. ‘One of the major things we’ve seen is flaws in the software being developed, and we wanted to take the opportunity to make some improvements.’
The brothers developed a new software program, PillFlow, to record medication changes made by either GPs, hospital pharmacists or community pharmacists.
‘Right now, when a patient’s medication changes, the pharmacy and doctor often have to go back and forth by phone, email or fax just to confirm the new prescription,’ said Viknesh, a fourth-year pharmacy student who also works in a hospital pharmacy.
[caption id="attachment_29916" align="aligncenter" width="300"] Viknesh Bramasta[/caption]
[caption id="attachment_29917" align="aligncenter" width="300"] Alfred Bramasta[/caption]
Delays and communication gaps in the current process may affect both workflow efficiency and the quality of patient care.
Viknesh thinks PillFlow could change this.
‘Our main goal is to enhance patient safety,’ Viknesh said. ‘There can still be challenges in ensuring medication changes for DAA patients are clearly communicated, actioned, and recorded.’
By presenting PillFlow at Shark Tank, Alfred and Viknesh are keen to receive feedback from the judges and audience.
‘It’s a great avenue for us to test and share our idea directly with pharmacists,’ Viknesh said. ‘PSA has made the process really easy.’
Software developments are key to making pharmacists’ workloads more tolerable and improving medicine safety, Alfred said.
‘There's a lot that can be done to improve the workflow in community pharmacy, and innovation will be the main thing to ensure patients get the best benefit.’
Streamlining pharmacy workflows
After 5 years in community pharmacy, early career pharmacist Eric Khek has seen firsthand just how short-staffed the profession can be – especially during the peak of the COVID-19 pandemic.
‘So I've always been interested in how to improve efficiencies in the pharmacy,’ he said.
To do this, Eric created a self-service kiosk system to automate pharmacy processes.
‘When a patient presents to the pharmacy with an eScript, they can scan the eRx [barcode] and answer a couple of questions pharmacy assistants usually ask,’ he said.
[caption id="attachment_29921" align="aligncenter" width="300"] Eric Khek[/caption]
The system also serves as a triage for minor ailments.
‘If a patient presents with a cough, for example, the self-service kiosk will activate a cough protocol and ask screening questions that you would find in the Australian Pharmaceutical Formulary and Handbook related to cough, such as “Do you have any breathing difficulties?” or “Are you coughing out any blood?”’
Through this innovation, Eric is hoping to not only improve pharmacy workflows but staff stress levels also.
‘We can miss asking important questions during stressful times which could potentially lead to medication errors,’ he said.
Entering Shark Tank should open up network opportunities, Eric thinks.
‘Hopefully I’ll be able to meet like-minded people to collaborate with me and take this product to the next level,’ he said.
With technology evolving at a rapid rate, it’s important that the pharmacy profession keeps up. ‘Around 40–50 years ago, we didn't even have a computer for dispensing,’ Eric said. ‘Harnessing the power of technology makes our lives easier.’
Enhancing learning with AI
Pharmacist and clinical educator Krysti-Lee Patterson MPS is leveraging the power of AI to improve how pharmacy students learn and prepare to practice as registered pharmacists.
Her innovation, The SMART project – an AI model used by the University of Technology Sydney – allows students to practise exam simulations with case scenarios.
‘We’ve essentially created ChatGPT for pharmacists,’ she said. ‘Using our AI models, we feed the platform with case scenarios that the lecturers have created – allowing the students to be able to practice under exam conditions.’
[caption id="attachment_21130" align="aligncenter" width="300"] Krysti-Lee Patterson MPS[/caption]
The SMART project is designed to both save university staff time and improve pharmacy curricula.
‘The head of Pharmacy at UTS explained that a key challenge is that they're too low on time to be able to do one-on-one training or coaching with their students,’ Krysti-Lee said. ‘So one of the problems we’re trying to solve is saving time without reducing quality.’
Academics can also use data collected from the model to assess whether students are asking the same questions, and address any gaps in the course.
‘The next phase, which we're working on now, will actually allow you to speak to it – so students can practise their oral exams via our platform.’
With pharmacy being a heavily regulated industry, which can be adverse to risk and change, it’s important to showcase the innovations of budding entrepreneurs to strengthen the profession.
‘It's going to make things more efficient, have better outcomes for patients, and ultimately, make a difference to the health of Australians,’ Krysti-Lee said.
Catch the pitches of these three innovations at PSA25’s Pharmacy Shark Tank happening from 3:20 PM - 4:20 PM on Friday 1 August. Last minute registrations are closing soon, visit the PSA25 website to grab yours before it's too late.
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[post_content] => Mental health needs are rising, but so are questionable prescribing patterns. Pharmacists can help define the line between justified care and risky overreach.
Australia’s adolescent mental health crisis is escalating at a troubling pace. A landmark longitudinal study by Murdoch Children’s Research Institute revealed that by age 18, nearly three quarters (74 %) of Australian teenagers experienced clinically significant symptoms of anxiety or depression at least once – with many enduring chronic episodes spanning multiple school transitions and exam periods.
The Australian Bureau of Statistics confirms that in 2020–22, 38.8 % of 16–24 year‑olds reported a mental disorder in the past 12 months, dominated by anxiety (17.2 %). Contributing factors are complex: academic pressure, early puberty, growing social isolation, socioeconomic stress, and particularly, the impact of social media.
The increase in prescribing
Similarly, antidepressant prescribing among Australian adolescents is on the rise, raising concerns about off-label use and high-dose regimens – with the pharmacist’s role in ensuring safe and appropriate therapy more important than ever. A 2024 ABC report noted that psychotropic use in under‑18s more than doubled from 2013 to 2023.3
Between 2013 and 2019, Selective Serotonin Reuptake Inhibitor (SSRI) prescribing in adolescents steadily climbed, with GPs accounting for 55 % of prescriptions in 12–14 year‑olds and 78 % in 15–17 year‑olds.
According to consultant pharmacist Amanda Fuller, Clinical Lead at Medcast, the increase in antidepressant prescribing reflects a complex mix of demand, access issues, and public perception.
[caption id="attachment_29976" align="alignright" width="300"] Amanda Fuller[/caption]
‘We’re seeing a growing awareness of mental health in young people, which is a positive shift,’ Ms Fuller said. ‘But when that’s combined with long waitlists for psychologists and psychiatrists, GPs often feel pressure to act quickly – particularly if there are concerns about deterioration or safety.’
This urgency is sometimes reinforced by family expectations. ‘Parents and carers may see antidepressants as a fast-acting solution while they wait for psychological support,’ she added.
Off-label use in high doses
Most prescribing for under-18s is off-label, which complicates matters, Ms Fuller said.
‘This places the responsibility on prescribers to weigh clinical judgment and available evidence against regulatory guidance.’
In Australia, only fluvoxamine and sertraline are approved by the Therapeutic Goods Administration (TGA) to treat obsessive-compulsive disorder (OCD) – in children aged 6 and 8 years and older, respectively. Others are used beyond their approved indications.
Fluoxetine remains the most commonly prescribed antidepressant in this cohort. ‘It’s the recommended first-line SSRI for adolescents and is the only one with consistent trial evidence showing efficacy over placebo in depression,’ Ms Fuller said. ‘But even then, the benefit was modest, placebo response rates were high, and study quality was poor, making interpretation difficult.’
In anxiety, the data is even less robust. ‘There’s limited evidence, though fluoxetine, fluvoxamine, and sertraline have shown some benefit in trials. But again, quality is a concern,’ she said.
Public understanding of antidepressants is also often shaped by outdated ideas, Ms Fuller said. ‘The “chemical imbalance” theory has been largely debunked, but it still drives the belief that medication is essential for treatment.’
More concerning is the increasing use of high-dose antidepressant regimens, sometimes exceeding standard adult doses.
‘We know higher doses are sometimes used in OCD, and prescribers may consider the adolescent’s physical maturity. But there’s no strong evidence to support routine high-dose use in this age group,’ she said.
Psychiatrists are more likely than GPs to prescribe these higher doses, often in complex or treatment-resistant cases. However, efficacy data for higher doses is lacking – even in adult populations.
‘In fluoxetine studies, response rates were actually highest between 20–40 mg daily,’ Ms Fuller said. ‘Going beyond that was linked to more [adverse] effects and increased dropout rates.’
The role of pharmacists
Pharmacists should take a proactive yet respectful approach when faced with uncertainty around an antidepressant prescription, Ms Fuller advised.
‘If something doesn’t add up – if you can’t confirm the indication, or there’s limited information about the treatment plan – it’s absolutely appropriate to contact the prescriber,’ she said.
Before doing so, she recommends checking key factors: ‘Clarify the diagnosis, assess for any psychosocial supports in place, confirm adherence and tolerance, and look at what the follow-up plan involves.’
When contacting prescribers, Ms Fuller urges pharmacists to approach conversations with collaboration, not correction. ‘Assume clinical reasoning is there – your role is to clarify, not challenge,’ she said ‘Focus on shared care, not prescription policing.”’
Australia’s adolescent mental health situation demands attention and pharmacists have a pivotal role in it. Soaring rates of depression, anxiety and antidepressant prescribing underscore the need for thoughtful, patient-centred care.
PSA25's session on ‘Dosing dilemmas’, presented by Ms Fuller, offers essential guidance on navigating adolescent antidepressant use – from informed dosing choices to structured monitoring and collaborative decision-making.
Haven’t registered for PSA25 yet? Don’t miss your chance – registrations are still open.
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[post_excerpt] => Youth mental health needs are rising, but so too are questionable prescribing patterns of antidepressants.
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[post_content] => A look at Turlington’s 27‑ingredient balsam, its broad therapeutic claims and how it contrasts with today’s evidence‑based approaches.
Robert Turlington was a 21st Century pharmacist living in the 18th Century. But the Londoner wasn’t always the successful entrepreneur he later became. Instead, Turlington (1697–1766) began his working life as a weaver – and a bankrupt one at that – courtesy of his demanding specialty: silk.1
According to archaeologists Olive Jones and Allen Vegotsky, the ‘multidimensional’ challenges of the silk trade, along with the fallout from bankruptcy, had an unexpected upside. They pushed Turlington to develop skills in marketing, labour organisation and even fashion. This expertise helped him change careers and, in 1740, grow a one-man pharmaceutical operation into an early multinational success story.1
Let sales begin
By 1742, Turlington was selling his Balsam of Life into a market packed with competitors like Friar’s Balsam.2 Both elixirs were sold as treatments for several illnesses and injuries. But in no time, Turlington went beyond ‘several’, pitching his product as a veritable ‘cure-all’.1–5,10
‘The aforesaid Balsam is a certain relief for the gravel, cholic, rheumatism, gout, and sciatic pains, and all colds, coughs, consumptive, pectoral, asthmatical, and nervous disorders, &c. and for any cut, bruise, or the like, as thousands can testify who have been relieved thereby, in the above and other complaints, after every other resource has failed,’ claimed Turlington in a 46-page testimonial pamphlet, accompanying each sale.1
In line with the era’s one-product, multi-ailment ‘polypharmacy’ approach, Turlington’s ‘perfect friend to Nature’ initially contained 27 ingredients in an alcohol solution. Over time, that was reduced to just eight. The key ingredients remained plant-based balsams: gum benzoin, storax and Tolu and Peruvian balsam. Aromatic spices like cinnamon, saffron and nutmeg masked the balsams’ unpleasant taste.1,2,5,6,10
Originally sold in round vials, Turlington’s nostrum became so popular that in 1746 he introduced the first of several distinctively shaped bottles to deter imitators.
In 1754, he followed-up with a unique pear-shaped bottle, which continued to be used in different sizes for over 150 years.1,3,7
They remain collectors’ items to this very day.1,4,5,7,8
Promote, protect, expand
Turlington’s distinctively shaped bottles were more than eye-catching – they reflected a shrewd business strategy.
At a time when English medicines were unregulated, Turlington promptly acquired one of the country’s first medical patents.1,3 Granted by King George in 1744 and lasting until 1758, the patent gave Turlington the legal right to prosecute imitators and widely promote his ‘miracle cure’ – a task he embraced with gusto.1,3,8
‘He had the cachet of having the king’s approval of his medicine, a fake coat of arms, a memorable name, a booklet given free with every purchase, a fixed price, and testimonials from satisfied customers who provided information on ailments that could be treated successfully with Balsam of Life,’ note Jones and Vegotsky.1
In 1748, Turlington extended his patent to include Britain’s North American colonies. Geographic expansion soon followed with sales to the emerging United States, Canada, the West Indies and, yes, Australia. Of course, he also pushed into Scotland, Ireland and Europe.1,3,8–10
Did Turlington’s balsam work?
With so many ingredients in varying amounts, used to treat a wide range of conditions, it’s difficult to say how effective the balsam truly was. At best, balsams exhibit anti-inflammatory, antioxidant and antimicrobial effects.11
Whether it worked or not, Turlington’s balsam left an enduring legacy – in pharmacy history, and also on collectors’ shelves.
References
- Jones O, Vegotsky A. Turlington’s Balsam of Life. Northeast Historical Archaeology. 2016;45:1.
- Dayton L. Friar’s Balsam has a place in modern life. Australian Pharmacist 2024;43(7):66.
- Abbott A. Turlington’s Balsam of Life: Colonial American snake oil? University of Central Florida, Center for Humanities and Digital Research.
- Pope A. Turlington's Balsam, the 18th-century cure-all. Canadian Geographic 2016 7 July.
- Griffenhagen GB, Young JH. Old English patent medicines in America. Contributions from The Museum of History and Technology: Paper 10. Project Gutenberg EBook 30162.
- Dilworth LL, Riley CK, Stennett DK. Chapter 5 - Plant Constituents: Carbohydrates, oils, resins, balsams, and plant hormones. Pharmacognosy, Academic Press 61–80 2017.
- Jones OR. Essence of Peppermint, A history of the medicine and its bottle. Hist.Archaeol. 15(2):3, 28, 33.
- Kemp J. Bottles 1. Turlington's Balsam of Life: the 1754 design. Cures All Diseases.com. 2020.
- Young JH. The Toadstool Millionaires: Chapter 1. Quackwatch. 2002 29 Apr.
- Keys R. Turlington’s Balsam of Life. The Adverts 250 Project. 2022 17 Feb.
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[post_excerpt] => Turlington's Balsam was pitched as a veritable ‘cure-all’ in the 18th century – and remains on collectors’ shelves today.
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[caption id="attachment_27199" align="alignright" width="225"] This activity is sponsored by PDL. This information is general in nature and designed only to highlight issues for your consideration. Before acting on this information, you should consider your individual circumstances and needs, and obtain advice as appropriate.[/caption]
Joyce, 76, lives independently and takes seven regular medicines with various dosing frequencies. She struggles to manage her medicines, especially with frequent brand changes due to supply issues. To help herself remember, Joyce recently began placing her daily tablets in a dish on the kitchen bench. During a visit, her 6-year-old grandson mistook the tablets for lollies and was about to swallow them when he was stopped just in time. Joyce is shaken by the incident and distressed by what could have happened.
After reading this article, pharmacists should be able to:
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Medicine safety is critical to improving health outcomes for children.1 However, ensuring safe and effective medicine use in paediatric populations presents unique challenges, due to differences in physiology, dosing requirements, and patterns of medicine use compared to adults.
Safety concerns arise because many medicines are prescribed off-label for children.2–5 Clinical trial data involving child populations is limited, with many trials not conducted in children. As a result, the safety and efficacy of medicines prescribed to children are often based on extrapolation from adult data.2,3,6
Medicine-related poisoning is also a key concern for medicine safety in children. In 2021–22 in Australia, 8,288 children were hospitalised due to poisoning-related injuries.7 Many of these hospitalisations were the result of accidental poisonings.1 An Australian review of emergency department data from 1 January 2015 to 31 December 2016 found that accidental exposure was the cause of 82% of poisoning cases involving preschool-aged children.8 Research shows that medicines, ‘including adult and paediatric over-the-counter and prescription medicines, are the leading cause of hospitalised unintentional poisonings’ in children in Australia.9,10
Unintentional exposures occur due to a variety of reasons. Data from the NSW Poisons Information Centre show that poisonings involving paracetamol–opioid combinations, ibuprofen–codeine combinations and oxycodone are common in children under 5 years of age.11 This is largely due to the inquisitive nature of children.5,11 Other reasons include therapeutic errors, such as incorrect dosing, incorrect dosing interval, incorrect patient or incorrect drug.11 This may be due to a dosing error by a parent or carer or unintended exposure to a medicine that was not intended for them.12
Risk factors for child poisoningSocioeconomic disadvantage has been found to increase the risk of unintentional poisoning in Australia.9 People who experience socioeconomic disadvantage often have ‘more comorbidities, use more medication, have less access to childcare and storage equipment and are more likely to experience overcrowding’.9 Living in rented premises has also been identified as a potential risk factor, possibly due to practical constraints on modifying living spaces for safe medicine storage.⁹ However, it’s important to note that evidence is limited and evolving, and challenges with secure storage may be experienced across a range of housing situations.
Changes in prescribing patterns and medicine use can also increase the risk of poisoning exposure to children. One example is the increase in the use of psychotropic medicines in children. ADHD is a common neurodevelopmental disorder among children and adolescents.15 Research shows there has been a twofold increase in the annual prevalence of ADHD medicine use – from 4.9 per 1,000 persons in 2013 to 9.7 per 1,000 persons in 2020 – in Australia.16 There has also been a trend towards increased diagnosis and pharmacological treatment of ADHD.6,17 Methylphenidate is the most commonly used medicine for ADHD in children, followed by lisdexamfetamine.16 The growing use of ADHD medicines may increase the risk of unintentional poisoning in children.17
Non-stimulant medicines such as clonidine, guanfacine and atomoxetine may also be used concurrently with stimulant medications, particularly in young children and adolescents.16 The off-label use of clonidine for children with ADHD remains problematic due to cases of poisonings and overdose from incorrect dosing.16,18 Clonidine has a narrow therapeutic index, meaning toxicity can occur even with even small dosing errors. The Therapeutic Goods Administration (TGA) has issued a safety alert warning to pharmacists and other health professionals about the risks associated with off-label clonidine use in children.19 Pharmacists should thoroughly counsel patients, parents and carers on the importance of correct dosing and proper storage of clonidine, given the high risk of toxicity from accidental overdose and unintentional poisoning. Compounding pharmacists may be asked to prepare clonidine suspensions, as they are not commercially available. Accuracy is essential when compounding medicines, particularly those such as clonidine, where the dose is prescribed in micrograms. Dosing errors can occur when the strength is incorrectly transcribed from micrograms to milligrams, significantly increasing the risk of poisoning exposure.
Another area of concern is medicine dosing in the school setting. The use of psychotropic medicines in children is increasing, and school-aged children may need to be dosed several times per day.20 This increases the risk of medication error and poisoning exposure. Data from the NSW Poisons Information Centre from January 2014 to June 2018 show that incidents involving methylphenidate were the fourth most common poisoning exposure in schools.20 The majority of methylphenidate incidents occurred due to medication errors, such as double dosing or medicine given to the wrong child.20 In this study, medication errors accounted for 11.6% of poisoning exposures.20 Clonidine and paracetamol were also involved in medication errors in schools.20 This highlights the need for school staff to be trained in medicine safety.20
Communication: Effective communication between pharmacists and patients, parents and carers is vital to ensure the safe use of medicines and an awareness of the potential risks that may come with a medicine. Communication should be tailored to account for the socioeconomic, cultural, or educational background of the patient or carer. Counselling should include not only the dose, frequency and duration of therapy for medicines prescribed to children, but also information about safe storage, accessibility and disposal of that medicine. Accessibility and disposal are relevant in any situation where a child might be present.12 Pharmacists should promote the return of unused or unwanted medicines to the pharmacy for safe disposal, helping to reduce the risk of poisoning exposure.
Clinical judgment: Pharmacists and dispensary technicians should implement procedures to flag medicines prescribed for children, ensuring dispensed products are checked for safety and appropriateness. This requires pharmacists to access resources relevant to medicines for children, including dosing guidelines and instructions for the preparation of compounded products. This can be particularly challenging when medicines are prescribed off-label, as information may be more difficult to locate; however, pharmacists are expected to undertake a risk assessment irrespective of the medicine being proprietary, compounded or off-label.
Third party supply: Administration of medicines to children by carers or school staff may involve an increased risk of error and adverse consequences. Consistently asking parents or carers whether a child’s medicine will be administered by a third party may enable the pharmacist to provide additional counselling or support via a dose administration aid (DAA) where appropriate.
Packaging: pharmacists should ensure that all medicines, including compounded preparations, are appropriately packaged using child-resistant closures.
Access to Poisons Information: In the event of a dosing error or suspected poisoning, pharmacists should act immediately by contacting the Poisons Information Centre on 13 11 26 (available Australia-wide), or call 000 if the situation appears life-threatening.9
Pharmacists who wish to enquire about dosing or other medicine-related information prior to dispensing can contact a medicines information centre in their state, as listed in Appendix E of the Australian Medicines Handbook (AMH).
Medicine safety in children requires vigilance, clear communication and proactive intervention by pharmacists. With limited clinical trial data and increasing use of off-label and high-risk medicines, pharmacists must assess individual risks, educate carers, and advocate for secure storage and appropriate administration.
By implementing tailored strategies and promoting awareness, pharmacists can play a pivotal role in preventing accidental poisonings and enhancing the safe use of medicines in children.
Case scenario continuedAt her next pharmacy visit, Joyce mentions the incident to the pharmacist. The pharmacist discusses the risks of leaving medicines unsecured, especially around children, and offers practical solutions. These include a weekly dose administration aid (DAA) to help with organisation, a medication reminder app for her phone, and advice on safe storage, such as using a lockable drawer or placing medicines on a high shelf in a cupboard out of children’s reach. Joyce is reassured by the support and feels more confident in managing her medicines safely moving forward. |
Dr Simone Henriksen (she/her) BPharm, LLB (Hons I), PhD (Law) is a community pharmacist with over 30 years’ experience. She is also a legal academic at the University of the Sunshine Coast. Her research areas include the regulation and clinical governance of health services in Australia.
Morna Falkland BPharm
Dr Simone Henriksen is a former employee of Pharmaceutical Defence Limited (PDL) and a member of the Pharmaceutical Society of Australia (PSA). This article was developed while in the role of PDL Professional Officer.
PDL is a sponsor of the Medicine safety: children and adolescent care report, which is cited in this article.
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[post_content] => After a nationwide search, Melbourne-based community pharmacist Anna Theophilos MPS has been appointed PSA’s inaugural Vaccination Ambassador. And she intends to shake things up.
With bold ideas and proven innovation, Ms Theophilos is set to transform pharmacist-led immunisation across Australia. She will work alongside PSA to elevate the voice of pharmacist immunisers throughout the country, driving public confidence and promoting vaccination.
In the aged care sector, Ms Theophilos has pioneered systems that ensure residents receive timely access to all National Immunisation Program and private vaccines. By introducing streamlined digital systems, she has significantly reduced the administrative burden on staff, making clinics easier to run and more efficient. The digital platform also allows facilities to immediately identify local vaccination gaps, while governing bodies are supported with live coverage data at the click of a button.
Under Ms Theophilos’s initiative, coverage rates within facilities rose from just 30% to an impressive 95%. From innovative outreach clinics to tailored services for children with sensory needs, her work reflects the evolving role of pharmacists in improving immunisation access for priority population groups.
https://www.youtube.com/shorts/xsedyMemFhs
Hosting the vaccination stream at PSA25 next week, Ms Theophilos told Australian Pharmacist why she’s passionate about vaccination and getting the immunisation message out to more Australians.
Tell us about your career in pharmacy so far.
I’ve been a pharmacist for 17 years – 16 of those as a business owner. Over that time, I’ve worn many hats, but what’s stayed constant is my desire to build services that respond meaningfully to the specific needs of my local community. Whether it’s dispensing, health education, or vaccination – I’ve always believed in combining clinical excellence with real, human connection.
How long have you been a pharmacist vaccinator?
I’ve been vaccinating since taking over my current business 3 years ago, and it quickly became a core part of my practice. What started within the four walls of the pharmacy has now expanded into aged care, home-based care, sensory-friendly clinics, and outreach models such as pop-up influenza clinics in schools or home visits for immunocompromised patients.
Why are you passionate about vaccination?
It’s an area where pharmacists can bring clarity, care and real impact. There’s so much noise and misinformation out there, and I believe people deserve to make informed decisions about vaccine-preventable diseases with confidence and trusted guidance. Pharmacists are able to provide not only trusted advice to individuals, but also to advance public health outcomes at scale. As a mum of two primary school-aged children, I also wanted to create an experience for their age group that felt calm, safe, and free of fear. How we approach their vaccination today shapes how they view health care tomorrow.
Have you been administering new vaccinations under the Victorian pharmacy pilots?
Yes! And I’ve really enjoyed being part of it. Administering travel vaccines has been particularly rewarding. It’s opened up conversations with patients who might never have considered vaccination. Like someone popping in for loperamide before a trip to Bali. Being up to date with the latest information has allowed pharmacists to offer truly comprehensive care, ensuring our community stays healthy before and after they board the plane.
What vaccine trends concern you, and how can pharmacists help to address them?
When I began working in aged care, I started collating data and was shocked to discover that only 8% of residents were up to date with all vaccines recommended in the Vaccination for Healthy Ageing – and just 30% with National Immunisation Program vaccinations. If those were childhood immunisation rates, we’d be outraged. So why aren’t we applying that same urgency to our older Australians? Over the past 18 months, it has become apparent that these low rates stem from fragmented care pathways and inconsistent funding – gaps that pharmacists are well-placed to address. I’ve worked tirelessly to understand the barriers and build practical, pharmacist-led pathways to improve access. And it has been successful. We can change this – and I believe we will.
What do you hope to achieve in your role as Vaccination Ambassador?
I want to elevate the role of pharmacists in immunisation – not just as vaccinators, but as system-shapers. I hope to bring attention to the work already happening in this space, advocate for sustainable funding and policy reform, and create momentum around models that reach underserved communities, aged care facilities and high-risk populations.
What are some of your first priorities?
One of my main goals is to help mobilise pharmacists across Australia to see this as part of our core mission – to prioritise it – and to feel just as confident administering a vaccine as they do dispensing a prescription. I also want to support clearer public messaging around vaccine-preventable diseases, and advocate for policy and funding frameworks that unlock our full capacity and skill set.
Where do you see pharmacists evolving in terms of vaccination?
It’s simple: all ages, all vaccines.
I see pharmacists becoming the number one provider of vaccinations in Australia. And not limited by age, setting or scope. We have the workforce, the accessibility and the trust. The opportunity is right in front of us.
What are you planning to share with delegates at PSA25?
That it’s time to take up this role with confidence and intentionality. For too long our scope has been underestimated or constrained. We have been told it’s not our place, that we need permission, or that we’re stepping on toes. But the data around vaccination rates tell a different story. It’s clear something needs to change. That something is us. Our profession. And we’re more than ready. We have the workforce, the access, and the trust of the public. Now is the time to lead.
Learn more about vaccinations from Anna Theophilos and others at PSA25, held in Sydney from 1–3 August. Register here to attend.
[post_title] => Meet PSA’s new Vaccination Ambassador
[post_excerpt] => After a nationwide search, Melbourne-based community pharmacist Anna Theophilos MPS has been appointed PSA’s Vaccination Ambassador.
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[post_content] => This year’s Pharmacy Shark Tank, held at PSA25 next week, is set to be a cracker – with some of the most exciting innovations yet, all powered by technology to solve real-world problems in pharmacy.
Australian Pharmacist caught up with some of the 2025 entrants to get a glimpse.
Working towards a more integrated healthcare system
As young pharmacists just entering the industry, Queensland-based brothers Alfred and Viknesh Bramasta have witnessed the errors that can occur when care is fragmented.
‘I'm currently doing my internship in a pharmacy in Queensland,’ Alfred said. ‘One of the major things we’ve seen is flaws in the software being developed, and we wanted to take the opportunity to make some improvements.’
The brothers developed a new software program, PillFlow, to record medication changes made by either GPs, hospital pharmacists or community pharmacists.
‘Right now, when a patient’s medication changes, the pharmacy and doctor often have to go back and forth by phone, email or fax just to confirm the new prescription,’ said Viknesh, a fourth-year pharmacy student who also works in a hospital pharmacy.
[caption id="attachment_29916" align="aligncenter" width="300"] Viknesh Bramasta[/caption]
[caption id="attachment_29917" align="aligncenter" width="300"] Alfred Bramasta[/caption]
Delays and communication gaps in the current process may affect both workflow efficiency and the quality of patient care.
Viknesh thinks PillFlow could change this.
‘Our main goal is to enhance patient safety,’ Viknesh said. ‘There can still be challenges in ensuring medication changes for DAA patients are clearly communicated, actioned, and recorded.’
By presenting PillFlow at Shark Tank, Alfred and Viknesh are keen to receive feedback from the judges and audience.
‘It’s a great avenue for us to test and share our idea directly with pharmacists,’ Viknesh said. ‘PSA has made the process really easy.’
Software developments are key to making pharmacists’ workloads more tolerable and improving medicine safety, Alfred said.
‘There's a lot that can be done to improve the workflow in community pharmacy, and innovation will be the main thing to ensure patients get the best benefit.’
Streamlining pharmacy workflows
After 5 years in community pharmacy, early career pharmacist Eric Khek has seen firsthand just how short-staffed the profession can be – especially during the peak of the COVID-19 pandemic.
‘So I've always been interested in how to improve efficiencies in the pharmacy,’ he said.
To do this, Eric created a self-service kiosk system to automate pharmacy processes.
‘When a patient presents to the pharmacy with an eScript, they can scan the eRx [barcode] and answer a couple of questions pharmacy assistants usually ask,’ he said.
[caption id="attachment_29921" align="aligncenter" width="300"] Eric Khek[/caption]
The system also serves as a triage for minor ailments.
‘If a patient presents with a cough, for example, the self-service kiosk will activate a cough protocol and ask screening questions that you would find in the Australian Pharmaceutical Formulary and Handbook related to cough, such as “Do you have any breathing difficulties?” or “Are you coughing out any blood?”’
Through this innovation, Eric is hoping to not only improve pharmacy workflows but staff stress levels also.
‘We can miss asking important questions during stressful times which could potentially lead to medication errors,’ he said.
Entering Shark Tank should open up network opportunities, Eric thinks.
‘Hopefully I’ll be able to meet like-minded people to collaborate with me and take this product to the next level,’ he said.
With technology evolving at a rapid rate, it’s important that the pharmacy profession keeps up. ‘Around 40–50 years ago, we didn't even have a computer for dispensing,’ Eric said. ‘Harnessing the power of technology makes our lives easier.’
Enhancing learning with AI
Pharmacist and clinical educator Krysti-Lee Patterson MPS is leveraging the power of AI to improve how pharmacy students learn and prepare to practice as registered pharmacists.
Her innovation, The SMART project – an AI model used by the University of Technology Sydney – allows students to practise exam simulations with case scenarios.
‘We’ve essentially created ChatGPT for pharmacists,’ she said. ‘Using our AI models, we feed the platform with case scenarios that the lecturers have created – allowing the students to be able to practice under exam conditions.’
[caption id="attachment_21130" align="aligncenter" width="300"] Krysti-Lee Patterson MPS[/caption]
The SMART project is designed to both save university staff time and improve pharmacy curricula.
‘The head of Pharmacy at UTS explained that a key challenge is that they're too low on time to be able to do one-on-one training or coaching with their students,’ Krysti-Lee said. ‘So one of the problems we’re trying to solve is saving time without reducing quality.’
Academics can also use data collected from the model to assess whether students are asking the same questions, and address any gaps in the course.
‘The next phase, which we're working on now, will actually allow you to speak to it – so students can practise their oral exams via our platform.’
With pharmacy being a heavily regulated industry, which can be adverse to risk and change, it’s important to showcase the innovations of budding entrepreneurs to strengthen the profession.
‘It's going to make things more efficient, have better outcomes for patients, and ultimately, make a difference to the health of Australians,’ Krysti-Lee said.
Catch the pitches of these three innovations at PSA25’s Pharmacy Shark Tank happening from 3:20 PM - 4:20 PM on Friday 1 August. Last minute registrations are closing soon, visit the PSA25 website to grab yours before it's too late.
[post_title] => What innovations could pharmacy soon see?
[post_excerpt] => This year’s Pharmacy Shark Tank, held at PSA25 next week, is set to be a cracker – with some of the most exciting innovations yet.
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.
