td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30283 [post_author] => 3410 [post_date] => 2025-08-11 12:10:58 [post_date_gmt] => 2025-08-11 02:10:58 [post_content] => The Australian Technical Advisory Group on Immunisation (ATAGI) has made an unusual move by issuing a statement on RSV vaccination errors. There have been numerous reports to the Therapeutic Goods Administration (TGA) of RSV vaccines being administered to the wrong patient. As of 13 June 2025, there have been:
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 29863 [post_author] => 1925 [post_date] => 2025-08-08 10:00:48 [post_date_gmt] => 2025-08-08 00:00:48 [post_content] =>How pharmacists are trained to deal with life-threatening calls – from medicine misadventure to ingestion of pesticides.
An average of more than 550 calls a day are taken – largely by pharmacists – at Australia’s four Poisons Information Centres (PICs). That’s more than 200,000 calls a year.
Exposures to medicine, chemicals, household products, bites, stings and plants account for the majority of calls to PICs – about 80%. The remaining 20% are largely medicine-related queries. Over the past 2 years, seven of the top 10 most common substance exposures have been medicines.
The PICs are separate state organisations that work together to support the 24-hour Poisons Hotline (131126). One quarter of the PIC calls received overall are from health professionals. These include paramedics, nurses, emergency department (ED) and intensive care unit (ICU) doctors, general practitioners (GPs), mental health professionals and pharmacists. Operating with extended opening hours, the NSW PIC is the largest. It takes half the national calls. In 2024 that was over 117,000.
According to its Senior Pharmacist Poisons Information, Genevieve Adamo MPS, most poisonings are accidental.
‘However, 17% of our calls relate to deliberate self-poisoning,’ she says.
‘These are usually our most serious cases because of the large amount and the combinations taken. We also advise on therapeutic errors, recreational and occupational exposures. We encourage pharmacists to call the PIC about any exposure, particularly deliberate ingestions. If a patient has collapsed or is not breathing, we advise them to call 000 and start cardiopulmonary resuscitation. The PIC will transfer calls to 000 if necessary.’
Most Specialists in Poisons Information (SPIs) in Australia are pharmacists. SPIs perform an individual risk assessment for each case – taking a detailed history, including patient details, the substance exposure, dose/amount, time and type of exposure, symptoms and signs.
For cases already assessed by a health professional, the clinical assessment including any investigations or treatments already carried out, is also considered. All of these factors influence the risk assessment and management plan.
The PIC has access to several specific toxicology resources. These include Therapeutic Guidelines, the National Poisons Register, POISINDEX and Toxinz.
As many exposures involve medicines, resources such as the Australian Medicines Handbook (AMH) and the Monthly Index of Medical Specialities (MIMS) are also used.
‘Information on the risk of toxicity from various exposures relies on publication from actual poisonings – not clinical trials – so there may not be published answers for all clinical scenarios,’ says Ms Adamo. ‘We must consider available evidence, first principles and theoretical risks when formulating an individual management plan for each case.’
Finding the required information, and quickly collating it into an individualised risk assessment and management plan, requires training and practice, she says.
‘We look for pharmacists with a sound knowledge of pharmacology and pharmacokinetics, relevant clinical experience and excellent communication skills. In NSW the PIC internal training program consists of 12 bespoke modules, including toxidromes (toxic syndromes), communication, pesticides, household chemicals, toxicology of specific drugs and drug classes, toxinology and plant toxicology.
‘Along with the theory, trainee SPIs will listen to real-time calls and then progress to supervised call-taking after completing the bulk of the training. The trainee will complete a written exam before they can be rostered to take calls with a “buddy”.
‘Each SPI is required to pass a second exam before they are eligible to work independently and be rostered to the more complex and busy overnight shifts. This whole process usually takes 6 months.
‘The demands of the role,’ says Ms Adamo, ‘require a degree of resilience to cope with the prevalence of self-harm, along with patience to deal with often distressed and sometimes argumentative callers. Most SPIs agree these demands are outweighed by the professional rewards of working in such a clinically interesting and challenging area.’
SPIs are supported by a team of clinical toxicologists, medical specialists who consult on serious life-threatening poisonings, and provide ongoing education and research opportunities for SPIs.
AP spoke to two PIC pharmacists.
Case 1
Kristy Carter (she/her)
Specialist in Poisons Information, NSW Poisons Information Centre
Around midday, I answered the phone to an emergency doctor who was managing a toddler inadvertently given a 10-fold dose of risperidone liquid earlier that morning and the previous morning.
The child was noticeably drowsy the day before, had slept longer than normal overnight and, after another dose that morning, had become agitated, restless and experienced a dystonic episode with abnormal head posturing and eyes deviating upwards. My colleague mentioned speaking to paramedics earlier that day about the child and promptly referred the child to hospital.
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Once in hospital, the child appeared more alert, and the dystonic reaction settled. The doctor on the phone to me requested advice on management and monitoring. I advised the doctor about the clinical effects anticipated with the dosing error and when benzatropine was appropriate. This was a particularly concerning overdose in a child. Clinical effects included central nervous system (CNS) depression, dystonic reactions and anticholinergic effects such as tachycardia, agitation, restlessness and urinary retention.
Uncommon abnormalities included QT prolongation, hypotension and seizures. We discussed monitoring periods and what other investigations were needed. I encouraged them to call back if there was any deterioration or changes, particularly if there were further dystonic reactions.
Within an hour, the emergency doctor called back to report the cervical and ocular dystonias had returned – as well as new opisthotonos. The child was becoming very distressed. We discussed benzatropine dosage and when to use pro re nata (PRN) dosing overnight. The toddler had a good response to the initial dose and was discharged the next day with extra education around dosing provided to the caregivers.
The NSW Poisons Information Centre (PIC) has received many calls regarding 10-fold risperidone errors. Between September 2023 and September 2024, there were 25 cases of at least 10-fold risperidone liquid dosing errors in children aged 3–14 years.
This was particularly alarming, given paediatric patients are more susceptible to the adverse effects of risperidone. Even the smallest overdose can cause serious symptoms. We identified these errors as being mainly due to misunderstanding of dosing instructions and incorrect use of the provided dosing syringe. We knew that increasing awareness and reporting was needed to prevent further poisonings.
The NSW PIC reported these cases to the Therapeutic Goods Administration (TGA). As a result, there have since been mandatory updates to the Product Information and Consumer Medicines Information for risperidone liquid products. The revision includes clearer dosing instructions and illustrations to help ensure correct dosing.
A public safety alert and medicines safety update were both published by the TGA in May 2025. This case is a reminder of one of the roles that pharmacists can play in medication safety and the role of PICs in identifying and preventing medicine errors.
Case 2
Louise Edwards (she/her)
Specialist in Poisons Information, WA Poisons Information Centre
I received a call about an adult family member, who had been discovered drowsy with evidence he’d had one large vomit with a strong smell. He would not reveal what he had ingested.
The caller reported that the man had drunk a large amount of alcohol earlier in the day.
In his room, the family found empty packets of paracetamol, quetiapine, ibuprofen, and a bottle of a pesticide containing chlorpyrifos, suggesting a deliberate self-poisoning.
To help identify the ingredient in the pesticide (chlorpyrifos), I referred to the National Poisons Register. For the other substances, I referred to the Toxicology Handbook, Micromedex and Toxinz, which allowed me to understand the time of onset to symptoms, time required to monitor, possible clinical outcomes (given the unknown number of tablets in each case), and details of antidotes used in organophosphate poisoning. I also referred to the WAPIC Medical Assessment Guidelines to remind myself of local protocols.
Because the patient was still conscious and breathing, I advised the caller to get him to hospital by ambulance. I also advised them to take the tablet packets so the doctors there could work out how many might have been ingested. I also managed a call from ambulance personnel once they arrived to assist the patient. The ambulance journey to the hospital was only 10 minutes, and with no further signs of significant toxicity, there was no requirement for the patient to be transferred to a clinical toxicologist.
First responders/health professionals often experience concern about their own exposure when there are strange chemicals involved. I advised that in this case, the smell from hydrocarbons in the vomit, and potential future vomits, was not a significant risk, as long as they followed appropriate protocols to reduce the possibility of minor symptoms.
A call from the hospital before the patient’s arrival included similar concerns about “off-gassing”. I repeated the advice I had given the ambulance staff. I also advised them to call us back to be transferred to our on-call clinical toxicologist (local WAPIC protocol guidelines) once the patient had been assessed.
Usually, if it had been only the ingested pharmaceuticals, I would have advised on the assessment of paracetamol blood levels and liver function test results for considering N-acetyl cysteine (NAC), advised on potential symptoms, time required to monitor, important screening and other tests regarding quetiapine and ibuprofen, including the risk of seizures and coma with quetiapine, and the additive risk of CNS depression with alcohol and quetiapine.
In this case, the clinical toxicologist would have covered these points in their own advice, given they needed to also assess and advise the doctor about the chlorpyrifos exposure.
The hospital later called me to speak with the clinical toxicologist. I took initial details, such as that the patient was GCS 14, chest clear, managing airways, no further gastrointestinal symptoms or evidence of further bodily secretions, or other features of cholinergic toxidrome.
The patient received NAC for paracetamol and assumed small chlorpyrifos ingestion.
Among other lessons learned in this incident was the importance of providing information about off-gassing risk to ensure a potential patient receives timely support.
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td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30197 [post_author] => 3410 [post_date] => 2025-08-06 14:21:58 [post_date_gmt] => 2025-08-06 04:21:58 [post_content] => Vaccination is one of the most cost-effective and life-saving health interventions, saving over 150 million lives worldwide in the last half century. In Australia, we’re lucky enough to have enhanced vaccination access via the National Immunisation Program (NIP). Between 2005 and 2015, the overall burden of illness, disability and premature death from the 17 vaccine-preventable diseases covered under the NIP fell by 30%. Yet since the COVID-19 pandemic, vaccination rates have continued to drop – particularly in vulnerable groups. Pharmacist immunisers, who have recently become significant contributors to Australia’s vaccination effort, now have a unique opportunity to build on this success and turn things around, David Laffan – Assistant Secretary, Immunisation Access and Engagement at the federal Department of Health, Disability and Ageing – told delegates at PSA25 last week. ‘Pharmacies in Australia have provided over 13% of all vaccinations administered in 2024–25 – and a double-digit share of many of them,’ he said. Here, Australian Pharmacist highlights the impact pharmacists have had on vaccination rates, and where we can grow even further.Record number of COVID-19 vaccinations administered by pharmacists
The two largest vaccinations by volume provided by pharmacies are influenza and COVID-19, Mr Laffan said. While COVID-19 vaccination rates in the general population remain low – with only 9% coverage over the past 12 months – pharmacists have administered a substantial proportion of those doses. ‘Vaccination rates in June 2025 for the COVID-19 Vaccination in Community Pharmacy (CVCP) Program were the highest they've been since the first half of 2023,’ he said.Pharmacists overtake GPs as aged care vaccinators
Pharmacists have played a significant role in increasing vaccination rates for aged care residents, who are particularly vulnerable to severe complications, hospitalisation and death. ‘This year, 59% of residents over the age of 75 received a COVID-19 dose in the last 6 months, a big increase from less than 40% a year ago,’ Mr Laffan said. In May this year, pharmacists delivered over 41% of COVID-19 vaccinations in residential aged care homes, compared to 38% administered by GPs. ‘So for the first time, pharmacists have provided more COVID-19 vaccines in residential aged care than general practitioners,’ he said. While co-administration of COVID-19 and influenza vaccines has been encouraged, it has not been enthusiastically embraced by the public. ‘This winter, only about one in four COVID-19 and flu vaccines were co-administered,’ Mr Laffan said. ‘So there's also an opportunity there.’ Come November, when the new Aged Care Act will commence, offering COVID-19 and influenza vaccines will become a registration requirement. ‘Aged care providers will also be required to offer their residents shingles and pneumococcal vaccines if they're eligible under the NIP.’RSV vaccination program heralded a success
The new maternal RSV program, launched in February 2025, has had strong uptake – significantly reducing the burden of disease. ‘Early data indicates about 60% of pregnant women are accessing the maternal vaccine and about a further 20% accessing the monoclonal antibody offered by the states and territories after birth,’ Mr Laffan said. Maternal immunisation reduces the risk of severe RSV disease in infants under 6 months of age by around 70%. ‘These immunisations being made available through the RSV program are estimated to keep 10,000 infants out of hospital each year, and we've already seen a 40% reduction in RSV notifications for young children since the introduction of the [the program],’ he said. ‘That's an incredible success.’Concerning fall in vaccination rates across age groups
Despite these recent successes, immunisation rates for many vaccines are low or falling. In fact, every childhood vaccine on the NIP schedule has lower uptake in 2024 than 2020. ‘This decline means that this year, there will be an additional 15,000 babies unvaccinated compared to pre-COVID immunisation rates,’ Mr Laffan said. Mistrust, fuelled by misinformation and disinformation, has contributed significantly to vaccine hesitancy. And it’s not childhood vaccination rates that are in decline. The preliminary findings from the National Centre for Immunisation Research and Surveillance’s annual immunisation coverage report found that adolescent vaccination rates are also particularly low. ‘For example, only 70% of children turning 17 have received a meningococcal vaccination in 2024,’ he said. ‘Older people are at high risk of infection and serious illness, yet only a third are vaccinated for shingles and less than half are vaccinated for pneumococcal.’ The rates of vaccination in First Nations’ children are even lower in the 1 year and 2 year old cohorts. Similarly, human papillomavirus coverage rates are declining – except for a spike in 2022–23 caused by the move to a single-dose schedule. ‘There is a significant opportunity for community pharmacy to assist in lifting these rates,’ Mr Laffan added.NIPVIP could be the saving grace
The NCIRS interim report highlighted that key barriers to vaccination uptake in children include difficulty of access and cost. Since its inception on 1 January 2024, the National Immunisation Program Vaccinations in Pharmacy is helping to break down these barriers. ‘Opening up NIP vaccines to community pharmacies has been a really important step in improving equity,’ Mr Laffan said. ‘The NIPVIP program has improved access by enabling community pharmacies to significantly increase the number of sites that can vaccinate. In turn, consumers benefit from the convenience of your locations. This also further represents an area of significant growth potential.’ NIPVIP vaccinations are up almost 50% from 2024, demonstrating the capacity for growth for pharmacy vaccinations. ‘[In] NIPVIP’s first month of operation, pharmacies claimed 1,400 vaccination services,’ he said. ‘Since then, nearly 34 million vaccinations have been provided and over 4,750 pharmacies have registered for NIPVIP.’And the NIPVIP program is only set to expand
The increase in this year's winter vaccinations are in part attributable to the uptick in NIPVIP participation – and pharmacies becoming more recognised and accepted as trusted NIP vaccination providers. Federal Minister for Health, Disability and Ageing Mark Butler hinted that the program is set to expand when launching the National Immunisation Strategy for Australia 2025–2030 in June this year. ‘One of the goals within the strategy is to harmonise relevant workforce policies, training and accreditation across all states and territories, Mr Laffan said. ‘And part of this priority involves developing strategies to safely enable health professionals, including community pharmacists, to work to their full scope of practice, which the NIP helps to facilitate.’ The department is also working to harmonise NIPVIP and CVCP to ensure vaccination is embedded into routine primary care service delivery following Australia exiting the emergency stage of the pandemic – including aligning payment rates. ‘I know from many of my conversations with you that you are looking forward to having one less ordering system to deal with when it comes to COVID-19 vaccines, so we'll continue to harmonise the programs and look at ways to streamline systems and reduce barriers,’ he said. Community pharmacies are recognised as providing a vital channel of access to vaccinations, with work underway to operationalise the National Immunisation strategy through a National implementation plan. ‘This plan is about collaboration across governments, sectors and communities to drive improved vaccination outcomes … to ensure that every Australian has equitable access to life-saving vaccines,’ Mr Laffan said. ‘To this end, I've invited the PSA to engage with the department about future vaccination priorities … to ensure that the profession has a say in future government considerations.’ [post_title] => Pharmacists are driving an increase in vaccination rates, says vaccine expert [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => pharmacists-are-driving-an-increase-in-vaccination-rates-says-vaccine-expert [to_ping] => [pinged] => [post_modified] => 2025-08-06 16:45:20 [post_modified_gmt] => 2025-08-06 06:45:20 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30197 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Pharmacists are driving an increase in vaccination rates, says vaccine expert [title] => Pharmacists are driving an increase in vaccination rates, says vaccine expert [href] => https://www.australianpharmacist.com.au/pharmacists-are-driving-an-increase-in-vaccination-rates-says-vaccine-expert/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30215 [authorType] => )
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30123 [post_author] => 7479 [post_date] => 2025-08-04 14:47:08 [post_date_gmt] => 2025-08-04 04:47:08 [post_content] => A record 38 pharmacists have been inducted as Fellows of the PSA at the annual Fellows Dinner, recognising leadership, advocacy, and service to the profession over an extended period. PSA National President Associate Professor Fei Sim FPS congratulated the 2025 cohort, saying: ‘This year’s Fellows showcase the passion, leadership and drive for excellence that define our profession’. ‘Being awarded Fellowship is a recognition of the sustained and outstanding contributions many pharmacists make to PSA and the broader pharmacy profession. ‘On behalf of PSA, I extend my congratulations to each of these remarkable pharmacists, and thank them for their enduring service and dedication to driving our profession forward.’ In addition to 38 Fellows, PSA has also recognised Rhonda White AO and Terry White AO as PSA Life Fellows. ‘In particular I’d like to acknowledge and congratulate Rhonda and Terry White, two stalwarts of Australian pharmacy who we are proud to recognise as Life Fellows of the PSA. ‘Together, Terry and Rhonda have changed the course of Australian pharmacy, championing accessible, patient-centred care and inspiring generations of pharmacists through their leadership. ‘PSA is proud to honour their lifelong dedication to community pharmacy.’ Among the 2025 cohort are a number of PSA staff who have had a significant impact on the pharmacy profession. ‘The PSA team are the backbone of our organisation, working unbelievably hard to support pharmacists across the country. For these members of our team, who are also pharmacists themselves, the drive to make an impact on their profession is particularly strong. ‘Congratulations to Caroyln, Claire, Chris, Quyen, Peter, Jarrod, Kay, Helen and Ella, these recognitions are very well deserved,’ A/Prof Sim said. Full list of PSA Fellows inducted in 2025:
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30101 [post_author] => 3410 [post_date] => 2025-08-04 14:19:38 [post_date_gmt] => 2025-08-04 04:19:38 [post_content] => PSA’s biggest ever national conference wrapped on Sunday 3 August after 3 full days of learning and networking. The rainy weather didn’t stop more than 1,200 pharmacists from all areas of practice and corners of the country coming together at Sydney’s International Convention Centre (ICC) to further their knowledge and practice with Australia’s leading pharmacy voices. [gallery type="flexslider" size="full" ids="30118,30113,30115,30116,30117,30119"] If you weren't able to make it down to the conference, Australian Pharmacist has captured some of the best moments.WA student clinches 2025 Pharmacy Student of the Year
Curtin University student Maxime Watts took out the 2025 PSA Viatris Pharmacy Student of the Year (PSOTY) award, as well as the People’s Choice award – as voted by PSA25 delegates. [gallery type="flexslider" size="full" ids="30105,30106"] ‘I feel incredibly grateful to receive this recognition,’ Ms Waters told AP. ‘Pharmacy has become something I’m genuinely passionate about, and to have my work acknowledged in this way means so much. I’m looking forward to starting my career and continuing to learn within such a supportive profession.’ Seeing the next generation of pharmacists showcase their skills is a highlight of the PSA national conference, said PSA National President Associate Professor Fei Sim FPS. ‘These are our future pharmacists, our future leaders, and I must say I’m very confident our profession is in good hands,’ she said. ‘Each of the students who participated in the PSOTY competition has demonstrated impressive professionalism, skill, and dedication. On behalf of PSA, I wish them all the best in what I’m sure will be successful and rewarding careers as pharmacists.’Pharmacist glitterati dazzle at the Gala Dinner
Pharmacists donned sequins, sparkles and feathers at Saturday night’s gala dinner, themed carnivàle. [gallery type="flexslider" size="full" ids="30103,30104,30107,30108,30109,30110,30111"] Delegates were transported to downtown Rio, with professional dancers putting on a colorful and acrobatic display – before hitting the dance floor to show off their own moves. See if you can spot your friends and colleagues in the crowd.Closing out PSA’s biggest conference ever
To cap off the weekend, PSA and the Australasian Pharmaceutical Science Association (APSA) presented the Outstanding Poster Presentation to Jade Swarbrick for her presentation ADHD in GP settings. The Outstanding Oral Presentation went to Kym Ramsey for his presentation Utilising rural community pharmacists to screen for chronic diseases. PSA and PDL once again joined forces to present the 2025 Volunteer of the Year Award to Madeline Scarlett, as voted by PSA25 delegates, in recognition of her positivity and helpfulness across the weekend. Closing the event, PSA National President Associate Professor Fei Sim FPS highlighted the significance of PSA membership reaching 20,000 for the first time – reflecting the growing confidence pharmacists have in PSA as their professional home. ‘Every year I leave this conference feeling a renewed sense of belonging and passion for this profession,’ she said. ‘Thank you to everyone who made PSA25 a success – our delegates, volunteers, branch committees, staff, speakers and partners – I’m truly inspired by every single one of you. ‘Whether you’re a student, early career pharmacist, or seasoned practitioner, PSA is proud to be your professional home, giving you the tools and the support you need to build the pharmacy career you want.’ See you all again next year at PSA26, held in Sydney at the ICC from Friday 31 July to Sunday 2 August. [post_title] => Rain fails to dampen PSA’s most successful conference yet [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => rain-fails-to-dampen-psas-most-successful-conference-yet [to_ping] => [pinged] => [post_modified] => 2025-08-06 15:50:45 [post_modified_gmt] => 2025-08-06 05:50:45 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30101 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Rain fails to dampen PSA’s most successful conference yet [title] => Rain fails to dampen PSA’s most successful conference yet [href] => https://www.australianpharmacist.com.au/rain-fails-to-dampen-psas-most-successful-conference-yet/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30121 [authorType] => )
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30283 [post_author] => 3410 [post_date] => 2025-08-11 12:10:58 [post_date_gmt] => 2025-08-11 02:10:58 [post_content] => The Australian Technical Advisory Group on Immunisation (ATAGI) has made an unusual move by issuing a statement on RSV vaccination errors. There have been numerous reports to the Therapeutic Goods Administration (TGA) of RSV vaccines being administered to the wrong patient. As of 13 June 2025, there have been:
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 29863 [post_author] => 1925 [post_date] => 2025-08-08 10:00:48 [post_date_gmt] => 2025-08-08 00:00:48 [post_content] =>How pharmacists are trained to deal with life-threatening calls – from medicine misadventure to ingestion of pesticides.
An average of more than 550 calls a day are taken – largely by pharmacists – at Australia’s four Poisons Information Centres (PICs). That’s more than 200,000 calls a year.
Exposures to medicine, chemicals, household products, bites, stings and plants account for the majority of calls to PICs – about 80%. The remaining 20% are largely medicine-related queries. Over the past 2 years, seven of the top 10 most common substance exposures have been medicines.
The PICs are separate state organisations that work together to support the 24-hour Poisons Hotline (131126). One quarter of the PIC calls received overall are from health professionals. These include paramedics, nurses, emergency department (ED) and intensive care unit (ICU) doctors, general practitioners (GPs), mental health professionals and pharmacists. Operating with extended opening hours, the NSW PIC is the largest. It takes half the national calls. In 2024 that was over 117,000.
According to its Senior Pharmacist Poisons Information, Genevieve Adamo MPS, most poisonings are accidental.
‘However, 17% of our calls relate to deliberate self-poisoning,’ she says.
‘These are usually our most serious cases because of the large amount and the combinations taken. We also advise on therapeutic errors, recreational and occupational exposures. We encourage pharmacists to call the PIC about any exposure, particularly deliberate ingestions. If a patient has collapsed or is not breathing, we advise them to call 000 and start cardiopulmonary resuscitation. The PIC will transfer calls to 000 if necessary.’
Most Specialists in Poisons Information (SPIs) in Australia are pharmacists. SPIs perform an individual risk assessment for each case – taking a detailed history, including patient details, the substance exposure, dose/amount, time and type of exposure, symptoms and signs.
For cases already assessed by a health professional, the clinical assessment including any investigations or treatments already carried out, is also considered. All of these factors influence the risk assessment and management plan.
The PIC has access to several specific toxicology resources. These include Therapeutic Guidelines, the National Poisons Register, POISINDEX and Toxinz.
As many exposures involve medicines, resources such as the Australian Medicines Handbook (AMH) and the Monthly Index of Medical Specialities (MIMS) are also used.
‘Information on the risk of toxicity from various exposures relies on publication from actual poisonings – not clinical trials – so there may not be published answers for all clinical scenarios,’ says Ms Adamo. ‘We must consider available evidence, first principles and theoretical risks when formulating an individual management plan for each case.’
Finding the required information, and quickly collating it into an individualised risk assessment and management plan, requires training and practice, she says.
‘We look for pharmacists with a sound knowledge of pharmacology and pharmacokinetics, relevant clinical experience and excellent communication skills. In NSW the PIC internal training program consists of 12 bespoke modules, including toxidromes (toxic syndromes), communication, pesticides, household chemicals, toxicology of specific drugs and drug classes, toxinology and plant toxicology.
‘Along with the theory, trainee SPIs will listen to real-time calls and then progress to supervised call-taking after completing the bulk of the training. The trainee will complete a written exam before they can be rostered to take calls with a “buddy”.
‘Each SPI is required to pass a second exam before they are eligible to work independently and be rostered to the more complex and busy overnight shifts. This whole process usually takes 6 months.
‘The demands of the role,’ says Ms Adamo, ‘require a degree of resilience to cope with the prevalence of self-harm, along with patience to deal with often distressed and sometimes argumentative callers. Most SPIs agree these demands are outweighed by the professional rewards of working in such a clinically interesting and challenging area.’
SPIs are supported by a team of clinical toxicologists, medical specialists who consult on serious life-threatening poisonings, and provide ongoing education and research opportunities for SPIs.
AP spoke to two PIC pharmacists.
Case 1
Kristy Carter (she/her)
Specialist in Poisons Information, NSW Poisons Information Centre
Around midday, I answered the phone to an emergency doctor who was managing a toddler inadvertently given a 10-fold dose of risperidone liquid earlier that morning and the previous morning.
The child was noticeably drowsy the day before, had slept longer than normal overnight and, after another dose that morning, had become agitated, restless and experienced a dystonic episode with abnormal head posturing and eyes deviating upwards. My colleague mentioned speaking to paramedics earlier that day about the child and promptly referred the child to hospital.
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Once in hospital, the child appeared more alert, and the dystonic reaction settled. The doctor on the phone to me requested advice on management and monitoring. I advised the doctor about the clinical effects anticipated with the dosing error and when benzatropine was appropriate. This was a particularly concerning overdose in a child. Clinical effects included central nervous system (CNS) depression, dystonic reactions and anticholinergic effects such as tachycardia, agitation, restlessness and urinary retention.
Uncommon abnormalities included QT prolongation, hypotension and seizures. We discussed monitoring periods and what other investigations were needed. I encouraged them to call back if there was any deterioration or changes, particularly if there were further dystonic reactions.
Within an hour, the emergency doctor called back to report the cervical and ocular dystonias had returned – as well as new opisthotonos. The child was becoming very distressed. We discussed benzatropine dosage and when to use pro re nata (PRN) dosing overnight. The toddler had a good response to the initial dose and was discharged the next day with extra education around dosing provided to the caregivers.
The NSW Poisons Information Centre (PIC) has received many calls regarding 10-fold risperidone errors. Between September 2023 and September 2024, there were 25 cases of at least 10-fold risperidone liquid dosing errors in children aged 3–14 years.
This was particularly alarming, given paediatric patients are more susceptible to the adverse effects of risperidone. Even the smallest overdose can cause serious symptoms. We identified these errors as being mainly due to misunderstanding of dosing instructions and incorrect use of the provided dosing syringe. We knew that increasing awareness and reporting was needed to prevent further poisonings.
The NSW PIC reported these cases to the Therapeutic Goods Administration (TGA). As a result, there have since been mandatory updates to the Product Information and Consumer Medicines Information for risperidone liquid products. The revision includes clearer dosing instructions and illustrations to help ensure correct dosing.
A public safety alert and medicines safety update were both published by the TGA in May 2025. This case is a reminder of one of the roles that pharmacists can play in medication safety and the role of PICs in identifying and preventing medicine errors.
Case 2
Louise Edwards (she/her)
Specialist in Poisons Information, WA Poisons Information Centre
I received a call about an adult family member, who had been discovered drowsy with evidence he’d had one large vomit with a strong smell. He would not reveal what he had ingested.
The caller reported that the man had drunk a large amount of alcohol earlier in the day.
In his room, the family found empty packets of paracetamol, quetiapine, ibuprofen, and a bottle of a pesticide containing chlorpyrifos, suggesting a deliberate self-poisoning.
To help identify the ingredient in the pesticide (chlorpyrifos), I referred to the National Poisons Register. For the other substances, I referred to the Toxicology Handbook, Micromedex and Toxinz, which allowed me to understand the time of onset to symptoms, time required to monitor, possible clinical outcomes (given the unknown number of tablets in each case), and details of antidotes used in organophosphate poisoning. I also referred to the WAPIC Medical Assessment Guidelines to remind myself of local protocols.
Because the patient was still conscious and breathing, I advised the caller to get him to hospital by ambulance. I also advised them to take the tablet packets so the doctors there could work out how many might have been ingested. I also managed a call from ambulance personnel once they arrived to assist the patient. The ambulance journey to the hospital was only 10 minutes, and with no further signs of significant toxicity, there was no requirement for the patient to be transferred to a clinical toxicologist.
First responders/health professionals often experience concern about their own exposure when there are strange chemicals involved. I advised that in this case, the smell from hydrocarbons in the vomit, and potential future vomits, was not a significant risk, as long as they followed appropriate protocols to reduce the possibility of minor symptoms.
A call from the hospital before the patient’s arrival included similar concerns about “off-gassing”. I repeated the advice I had given the ambulance staff. I also advised them to call us back to be transferred to our on-call clinical toxicologist (local WAPIC protocol guidelines) once the patient had been assessed.
Usually, if it had been only the ingested pharmaceuticals, I would have advised on the assessment of paracetamol blood levels and liver function test results for considering N-acetyl cysteine (NAC), advised on potential symptoms, time required to monitor, important screening and other tests regarding quetiapine and ibuprofen, including the risk of seizures and coma with quetiapine, and the additive risk of CNS depression with alcohol and quetiapine.
In this case, the clinical toxicologist would have covered these points in their own advice, given they needed to also assess and advise the doctor about the chlorpyrifos exposure.
The hospital later called me to speak with the clinical toxicologist. I took initial details, such as that the patient was GCS 14, chest clear, managing airways, no further gastrointestinal symptoms or evidence of further bodily secretions, or other features of cholinergic toxidrome.
The patient received NAC for paracetamol and assumed small chlorpyrifos ingestion.
Among other lessons learned in this incident was the importance of providing information about off-gassing risk to ensure a potential patient receives timely support.
[post_title] => On the ground with poisons information specialists [post_excerpt] => How pharmacists are trained to deal with life-threatening calls – from medicine misadventure to ingestion of pesticides. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => life-as-a-poisons-information-specialist [to_ping] => [pinged] => [post_modified] => 2025-08-11 14:58:42 [post_modified_gmt] => 2025-08-11 04:58:42 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=29863 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => On the ground with poisons information specialists [title] => On the ground with poisons information specialists [href] => https://www.australianpharmacist.com.au/life-as-a-poisons-information-specialist/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30280 [authorType] => )
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30197 [post_author] => 3410 [post_date] => 2025-08-06 14:21:58 [post_date_gmt] => 2025-08-06 04:21:58 [post_content] => Vaccination is one of the most cost-effective and life-saving health interventions, saving over 150 million lives worldwide in the last half century. In Australia, we’re lucky enough to have enhanced vaccination access via the National Immunisation Program (NIP). Between 2005 and 2015, the overall burden of illness, disability and premature death from the 17 vaccine-preventable diseases covered under the NIP fell by 30%. Yet since the COVID-19 pandemic, vaccination rates have continued to drop – particularly in vulnerable groups. Pharmacist immunisers, who have recently become significant contributors to Australia’s vaccination effort, now have a unique opportunity to build on this success and turn things around, David Laffan – Assistant Secretary, Immunisation Access and Engagement at the federal Department of Health, Disability and Ageing – told delegates at PSA25 last week. ‘Pharmacies in Australia have provided over 13% of all vaccinations administered in 2024–25 – and a double-digit share of many of them,’ he said. Here, Australian Pharmacist highlights the impact pharmacists have had on vaccination rates, and where we can grow even further.Record number of COVID-19 vaccinations administered by pharmacists
The two largest vaccinations by volume provided by pharmacies are influenza and COVID-19, Mr Laffan said. While COVID-19 vaccination rates in the general population remain low – with only 9% coverage over the past 12 months – pharmacists have administered a substantial proportion of those doses. ‘Vaccination rates in June 2025 for the COVID-19 Vaccination in Community Pharmacy (CVCP) Program were the highest they've been since the first half of 2023,’ he said.Pharmacists overtake GPs as aged care vaccinators
Pharmacists have played a significant role in increasing vaccination rates for aged care residents, who are particularly vulnerable to severe complications, hospitalisation and death. ‘This year, 59% of residents over the age of 75 received a COVID-19 dose in the last 6 months, a big increase from less than 40% a year ago,’ Mr Laffan said. In May this year, pharmacists delivered over 41% of COVID-19 vaccinations in residential aged care homes, compared to 38% administered by GPs. ‘So for the first time, pharmacists have provided more COVID-19 vaccines in residential aged care than general practitioners,’ he said. While co-administration of COVID-19 and influenza vaccines has been encouraged, it has not been enthusiastically embraced by the public. ‘This winter, only about one in four COVID-19 and flu vaccines were co-administered,’ Mr Laffan said. ‘So there's also an opportunity there.’ Come November, when the new Aged Care Act will commence, offering COVID-19 and influenza vaccines will become a registration requirement. ‘Aged care providers will also be required to offer their residents shingles and pneumococcal vaccines if they're eligible under the NIP.’RSV vaccination program heralded a success
The new maternal RSV program, launched in February 2025, has had strong uptake – significantly reducing the burden of disease. ‘Early data indicates about 60% of pregnant women are accessing the maternal vaccine and about a further 20% accessing the monoclonal antibody offered by the states and territories after birth,’ Mr Laffan said. Maternal immunisation reduces the risk of severe RSV disease in infants under 6 months of age by around 70%. ‘These immunisations being made available through the RSV program are estimated to keep 10,000 infants out of hospital each year, and we've already seen a 40% reduction in RSV notifications for young children since the introduction of the [the program],’ he said. ‘That's an incredible success.’Concerning fall in vaccination rates across age groups
Despite these recent successes, immunisation rates for many vaccines are low or falling. In fact, every childhood vaccine on the NIP schedule has lower uptake in 2024 than 2020. ‘This decline means that this year, there will be an additional 15,000 babies unvaccinated compared to pre-COVID immunisation rates,’ Mr Laffan said. Mistrust, fuelled by misinformation and disinformation, has contributed significantly to vaccine hesitancy. And it’s not childhood vaccination rates that are in decline. The preliminary findings from the National Centre for Immunisation Research and Surveillance’s annual immunisation coverage report found that adolescent vaccination rates are also particularly low. ‘For example, only 70% of children turning 17 have received a meningococcal vaccination in 2024,’ he said. ‘Older people are at high risk of infection and serious illness, yet only a third are vaccinated for shingles and less than half are vaccinated for pneumococcal.’ The rates of vaccination in First Nations’ children are even lower in the 1 year and 2 year old cohorts. Similarly, human papillomavirus coverage rates are declining – except for a spike in 2022–23 caused by the move to a single-dose schedule. ‘There is a significant opportunity for community pharmacy to assist in lifting these rates,’ Mr Laffan added.NIPVIP could be the saving grace
The NCIRS interim report highlighted that key barriers to vaccination uptake in children include difficulty of access and cost. Since its inception on 1 January 2024, the National Immunisation Program Vaccinations in Pharmacy is helping to break down these barriers. ‘Opening up NIP vaccines to community pharmacies has been a really important step in improving equity,’ Mr Laffan said. ‘The NIPVIP program has improved access by enabling community pharmacies to significantly increase the number of sites that can vaccinate. In turn, consumers benefit from the convenience of your locations. This also further represents an area of significant growth potential.’ NIPVIP vaccinations are up almost 50% from 2024, demonstrating the capacity for growth for pharmacy vaccinations. ‘[In] NIPVIP’s first month of operation, pharmacies claimed 1,400 vaccination services,’ he said. ‘Since then, nearly 34 million vaccinations have been provided and over 4,750 pharmacies have registered for NIPVIP.’And the NIPVIP program is only set to expand
The increase in this year's winter vaccinations are in part attributable to the uptick in NIPVIP participation – and pharmacies becoming more recognised and accepted as trusted NIP vaccination providers. Federal Minister for Health, Disability and Ageing Mark Butler hinted that the program is set to expand when launching the National Immunisation Strategy for Australia 2025–2030 in June this year. ‘One of the goals within the strategy is to harmonise relevant workforce policies, training and accreditation across all states and territories, Mr Laffan said. ‘And part of this priority involves developing strategies to safely enable health professionals, including community pharmacists, to work to their full scope of practice, which the NIP helps to facilitate.’ The department is also working to harmonise NIPVIP and CVCP to ensure vaccination is embedded into routine primary care service delivery following Australia exiting the emergency stage of the pandemic – including aligning payment rates. ‘I know from many of my conversations with you that you are looking forward to having one less ordering system to deal with when it comes to COVID-19 vaccines, so we'll continue to harmonise the programs and look at ways to streamline systems and reduce barriers,’ he said. Community pharmacies are recognised as providing a vital channel of access to vaccinations, with work underway to operationalise the National Immunisation strategy through a National implementation plan. ‘This plan is about collaboration across governments, sectors and communities to drive improved vaccination outcomes … to ensure that every Australian has equitable access to life-saving vaccines,’ Mr Laffan said. ‘To this end, I've invited the PSA to engage with the department about future vaccination priorities … to ensure that the profession has a say in future government considerations.’ [post_title] => Pharmacists are driving an increase in vaccination rates, says vaccine expert [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => pharmacists-are-driving-an-increase-in-vaccination-rates-says-vaccine-expert [to_ping] => [pinged] => [post_modified] => 2025-08-06 16:45:20 [post_modified_gmt] => 2025-08-06 06:45:20 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30197 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Pharmacists are driving an increase in vaccination rates, says vaccine expert [title] => Pharmacists are driving an increase in vaccination rates, says vaccine expert [href] => https://www.australianpharmacist.com.au/pharmacists-are-driving-an-increase-in-vaccination-rates-says-vaccine-expert/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30215 [authorType] => )
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30123 [post_author] => 7479 [post_date] => 2025-08-04 14:47:08 [post_date_gmt] => 2025-08-04 04:47:08 [post_content] => A record 38 pharmacists have been inducted as Fellows of the PSA at the annual Fellows Dinner, recognising leadership, advocacy, and service to the profession over an extended period. PSA National President Associate Professor Fei Sim FPS congratulated the 2025 cohort, saying: ‘This year’s Fellows showcase the passion, leadership and drive for excellence that define our profession’. ‘Being awarded Fellowship is a recognition of the sustained and outstanding contributions many pharmacists make to PSA and the broader pharmacy profession. ‘On behalf of PSA, I extend my congratulations to each of these remarkable pharmacists, and thank them for their enduring service and dedication to driving our profession forward.’ In addition to 38 Fellows, PSA has also recognised Rhonda White AO and Terry White AO as PSA Life Fellows. ‘In particular I’d like to acknowledge and congratulate Rhonda and Terry White, two stalwarts of Australian pharmacy who we are proud to recognise as Life Fellows of the PSA. ‘Together, Terry and Rhonda have changed the course of Australian pharmacy, championing accessible, patient-centred care and inspiring generations of pharmacists through their leadership. ‘PSA is proud to honour their lifelong dedication to community pharmacy.’ Among the 2025 cohort are a number of PSA staff who have had a significant impact on the pharmacy profession. ‘The PSA team are the backbone of our organisation, working unbelievably hard to support pharmacists across the country. For these members of our team, who are also pharmacists themselves, the drive to make an impact on their profession is particularly strong. ‘Congratulations to Caroyln, Claire, Chris, Quyen, Peter, Jarrod, Kay, Helen and Ella, these recognitions are very well deserved,’ A/Prof Sim said. Full list of PSA Fellows inducted in 2025:
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30101 [post_author] => 3410 [post_date] => 2025-08-04 14:19:38 [post_date_gmt] => 2025-08-04 04:19:38 [post_content] => PSA’s biggest ever national conference wrapped on Sunday 3 August after 3 full days of learning and networking. The rainy weather didn’t stop more than 1,200 pharmacists from all areas of practice and corners of the country coming together at Sydney’s International Convention Centre (ICC) to further their knowledge and practice with Australia’s leading pharmacy voices. [gallery type="flexslider" size="full" ids="30118,30113,30115,30116,30117,30119"] If you weren't able to make it down to the conference, Australian Pharmacist has captured some of the best moments.WA student clinches 2025 Pharmacy Student of the Year
Curtin University student Maxime Watts took out the 2025 PSA Viatris Pharmacy Student of the Year (PSOTY) award, as well as the People’s Choice award – as voted by PSA25 delegates. [gallery type="flexslider" size="full" ids="30105,30106"] ‘I feel incredibly grateful to receive this recognition,’ Ms Waters told AP. ‘Pharmacy has become something I’m genuinely passionate about, and to have my work acknowledged in this way means so much. I’m looking forward to starting my career and continuing to learn within such a supportive profession.’ Seeing the next generation of pharmacists showcase their skills is a highlight of the PSA national conference, said PSA National President Associate Professor Fei Sim FPS. ‘These are our future pharmacists, our future leaders, and I must say I’m very confident our profession is in good hands,’ she said. ‘Each of the students who participated in the PSOTY competition has demonstrated impressive professionalism, skill, and dedication. On behalf of PSA, I wish them all the best in what I’m sure will be successful and rewarding careers as pharmacists.’Pharmacist glitterati dazzle at the Gala Dinner
Pharmacists donned sequins, sparkles and feathers at Saturday night’s gala dinner, themed carnivàle. [gallery type="flexslider" size="full" ids="30103,30104,30107,30108,30109,30110,30111"] Delegates were transported to downtown Rio, with professional dancers putting on a colorful and acrobatic display – before hitting the dance floor to show off their own moves. See if you can spot your friends and colleagues in the crowd.Closing out PSA’s biggest conference ever
To cap off the weekend, PSA and the Australasian Pharmaceutical Science Association (APSA) presented the Outstanding Poster Presentation to Jade Swarbrick for her presentation ADHD in GP settings. The Outstanding Oral Presentation went to Kym Ramsey for his presentation Utilising rural community pharmacists to screen for chronic diseases. PSA and PDL once again joined forces to present the 2025 Volunteer of the Year Award to Madeline Scarlett, as voted by PSA25 delegates, in recognition of her positivity and helpfulness across the weekend. Closing the event, PSA National President Associate Professor Fei Sim FPS highlighted the significance of PSA membership reaching 20,000 for the first time – reflecting the growing confidence pharmacists have in PSA as their professional home. ‘Every year I leave this conference feeling a renewed sense of belonging and passion for this profession,’ she said. ‘Thank you to everyone who made PSA25 a success – our delegates, volunteers, branch committees, staff, speakers and partners – I’m truly inspired by every single one of you. ‘Whether you’re a student, early career pharmacist, or seasoned practitioner, PSA is proud to be your professional home, giving you the tools and the support you need to build the pharmacy career you want.’ See you all again next year at PSA26, held in Sydney at the ICC from Friday 31 July to Sunday 2 August. [post_title] => Rain fails to dampen PSA’s most successful conference yet [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => rain-fails-to-dampen-psas-most-successful-conference-yet [to_ping] => [pinged] => [post_modified] => 2025-08-06 15:50:45 [post_modified_gmt] => 2025-08-06 05:50:45 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30101 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Rain fails to dampen PSA’s most successful conference yet [title] => Rain fails to dampen PSA’s most successful conference yet [href] => https://www.australianpharmacist.com.au/rain-fails-to-dampen-psas-most-successful-conference-yet/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30121 [authorType] => )
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30283 [post_author] => 3410 [post_date] => 2025-08-11 12:10:58 [post_date_gmt] => 2025-08-11 02:10:58 [post_content] => The Australian Technical Advisory Group on Immunisation (ATAGI) has made an unusual move by issuing a statement on RSV vaccination errors. There have been numerous reports to the Therapeutic Goods Administration (TGA) of RSV vaccines being administered to the wrong patient. As of 13 June 2025, there have been:
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 29863 [post_author] => 1925 [post_date] => 2025-08-08 10:00:48 [post_date_gmt] => 2025-08-08 00:00:48 [post_content] =>How pharmacists are trained to deal with life-threatening calls – from medicine misadventure to ingestion of pesticides.
An average of more than 550 calls a day are taken – largely by pharmacists – at Australia’s four Poisons Information Centres (PICs). That’s more than 200,000 calls a year.
Exposures to medicine, chemicals, household products, bites, stings and plants account for the majority of calls to PICs – about 80%. The remaining 20% are largely medicine-related queries. Over the past 2 years, seven of the top 10 most common substance exposures have been medicines.
The PICs are separate state organisations that work together to support the 24-hour Poisons Hotline (131126). One quarter of the PIC calls received overall are from health professionals. These include paramedics, nurses, emergency department (ED) and intensive care unit (ICU) doctors, general practitioners (GPs), mental health professionals and pharmacists. Operating with extended opening hours, the NSW PIC is the largest. It takes half the national calls. In 2024 that was over 117,000.
According to its Senior Pharmacist Poisons Information, Genevieve Adamo MPS, most poisonings are accidental.
‘However, 17% of our calls relate to deliberate self-poisoning,’ she says.
‘These are usually our most serious cases because of the large amount and the combinations taken. We also advise on therapeutic errors, recreational and occupational exposures. We encourage pharmacists to call the PIC about any exposure, particularly deliberate ingestions. If a patient has collapsed or is not breathing, we advise them to call 000 and start cardiopulmonary resuscitation. The PIC will transfer calls to 000 if necessary.’
Most Specialists in Poisons Information (SPIs) in Australia are pharmacists. SPIs perform an individual risk assessment for each case – taking a detailed history, including patient details, the substance exposure, dose/amount, time and type of exposure, symptoms and signs.
For cases already assessed by a health professional, the clinical assessment including any investigations or treatments already carried out, is also considered. All of these factors influence the risk assessment and management plan.
The PIC has access to several specific toxicology resources. These include Therapeutic Guidelines, the National Poisons Register, POISINDEX and Toxinz.
As many exposures involve medicines, resources such as the Australian Medicines Handbook (AMH) and the Monthly Index of Medical Specialities (MIMS) are also used.
‘Information on the risk of toxicity from various exposures relies on publication from actual poisonings – not clinical trials – so there may not be published answers for all clinical scenarios,’ says Ms Adamo. ‘We must consider available evidence, first principles and theoretical risks when formulating an individual management plan for each case.’
Finding the required information, and quickly collating it into an individualised risk assessment and management plan, requires training and practice, she says.
‘We look for pharmacists with a sound knowledge of pharmacology and pharmacokinetics, relevant clinical experience and excellent communication skills. In NSW the PIC internal training program consists of 12 bespoke modules, including toxidromes (toxic syndromes), communication, pesticides, household chemicals, toxicology of specific drugs and drug classes, toxinology and plant toxicology.
‘Along with the theory, trainee SPIs will listen to real-time calls and then progress to supervised call-taking after completing the bulk of the training. The trainee will complete a written exam before they can be rostered to take calls with a “buddy”.
‘Each SPI is required to pass a second exam before they are eligible to work independently and be rostered to the more complex and busy overnight shifts. This whole process usually takes 6 months.
‘The demands of the role,’ says Ms Adamo, ‘require a degree of resilience to cope with the prevalence of self-harm, along with patience to deal with often distressed and sometimes argumentative callers. Most SPIs agree these demands are outweighed by the professional rewards of working in such a clinically interesting and challenging area.’
SPIs are supported by a team of clinical toxicologists, medical specialists who consult on serious life-threatening poisonings, and provide ongoing education and research opportunities for SPIs.
AP spoke to two PIC pharmacists.
Case 1
Kristy Carter (she/her)
Specialist in Poisons Information, NSW Poisons Information Centre
Around midday, I answered the phone to an emergency doctor who was managing a toddler inadvertently given a 10-fold dose of risperidone liquid earlier that morning and the previous morning.
The child was noticeably drowsy the day before, had slept longer than normal overnight and, after another dose that morning, had become agitated, restless and experienced a dystonic episode with abnormal head posturing and eyes deviating upwards. My colleague mentioned speaking to paramedics earlier that day about the child and promptly referred the child to hospital.
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Once in hospital, the child appeared more alert, and the dystonic reaction settled. The doctor on the phone to me requested advice on management and monitoring. I advised the doctor about the clinical effects anticipated with the dosing error and when benzatropine was appropriate. This was a particularly concerning overdose in a child. Clinical effects included central nervous system (CNS) depression, dystonic reactions and anticholinergic effects such as tachycardia, agitation, restlessness and urinary retention.
Uncommon abnormalities included QT prolongation, hypotension and seizures. We discussed monitoring periods and what other investigations were needed. I encouraged them to call back if there was any deterioration or changes, particularly if there were further dystonic reactions.
Within an hour, the emergency doctor called back to report the cervical and ocular dystonias had returned – as well as new opisthotonos. The child was becoming very distressed. We discussed benzatropine dosage and when to use pro re nata (PRN) dosing overnight. The toddler had a good response to the initial dose and was discharged the next day with extra education around dosing provided to the caregivers.
The NSW Poisons Information Centre (PIC) has received many calls regarding 10-fold risperidone errors. Between September 2023 and September 2024, there were 25 cases of at least 10-fold risperidone liquid dosing errors in children aged 3–14 years.
This was particularly alarming, given paediatric patients are more susceptible to the adverse effects of risperidone. Even the smallest overdose can cause serious symptoms. We identified these errors as being mainly due to misunderstanding of dosing instructions and incorrect use of the provided dosing syringe. We knew that increasing awareness and reporting was needed to prevent further poisonings.
The NSW PIC reported these cases to the Therapeutic Goods Administration (TGA). As a result, there have since been mandatory updates to the Product Information and Consumer Medicines Information for risperidone liquid products. The revision includes clearer dosing instructions and illustrations to help ensure correct dosing.
A public safety alert and medicines safety update were both published by the TGA in May 2025. This case is a reminder of one of the roles that pharmacists can play in medication safety and the role of PICs in identifying and preventing medicine errors.
Case 2
Louise Edwards (she/her)
Specialist in Poisons Information, WA Poisons Information Centre
I received a call about an adult family member, who had been discovered drowsy with evidence he’d had one large vomit with a strong smell. He would not reveal what he had ingested.
The caller reported that the man had drunk a large amount of alcohol earlier in the day.
In his room, the family found empty packets of paracetamol, quetiapine, ibuprofen, and a bottle of a pesticide containing chlorpyrifos, suggesting a deliberate self-poisoning.
To help identify the ingredient in the pesticide (chlorpyrifos), I referred to the National Poisons Register. For the other substances, I referred to the Toxicology Handbook, Micromedex and Toxinz, which allowed me to understand the time of onset to symptoms, time required to monitor, possible clinical outcomes (given the unknown number of tablets in each case), and details of antidotes used in organophosphate poisoning. I also referred to the WAPIC Medical Assessment Guidelines to remind myself of local protocols.
Because the patient was still conscious and breathing, I advised the caller to get him to hospital by ambulance. I also advised them to take the tablet packets so the doctors there could work out how many might have been ingested. I also managed a call from ambulance personnel once they arrived to assist the patient. The ambulance journey to the hospital was only 10 minutes, and with no further signs of significant toxicity, there was no requirement for the patient to be transferred to a clinical toxicologist.
First responders/health professionals often experience concern about their own exposure when there are strange chemicals involved. I advised that in this case, the smell from hydrocarbons in the vomit, and potential future vomits, was not a significant risk, as long as they followed appropriate protocols to reduce the possibility of minor symptoms.
A call from the hospital before the patient’s arrival included similar concerns about “off-gassing”. I repeated the advice I had given the ambulance staff. I also advised them to call us back to be transferred to our on-call clinical toxicologist (local WAPIC protocol guidelines) once the patient had been assessed.
Usually, if it had been only the ingested pharmaceuticals, I would have advised on the assessment of paracetamol blood levels and liver function test results for considering N-acetyl cysteine (NAC), advised on potential symptoms, time required to monitor, important screening and other tests regarding quetiapine and ibuprofen, including the risk of seizures and coma with quetiapine, and the additive risk of CNS depression with alcohol and quetiapine.
In this case, the clinical toxicologist would have covered these points in their own advice, given they needed to also assess and advise the doctor about the chlorpyrifos exposure.
The hospital later called me to speak with the clinical toxicologist. I took initial details, such as that the patient was GCS 14, chest clear, managing airways, no further gastrointestinal symptoms or evidence of further bodily secretions, or other features of cholinergic toxidrome.
The patient received NAC for paracetamol and assumed small chlorpyrifos ingestion.
Among other lessons learned in this incident was the importance of providing information about off-gassing risk to ensure a potential patient receives timely support.
[post_title] => On the ground with poisons information specialists [post_excerpt] => How pharmacists are trained to deal with life-threatening calls – from medicine misadventure to ingestion of pesticides. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => life-as-a-poisons-information-specialist [to_ping] => [pinged] => [post_modified] => 2025-08-11 14:58:42 [post_modified_gmt] => 2025-08-11 04:58:42 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=29863 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => On the ground with poisons information specialists [title] => On the ground with poisons information specialists [href] => https://www.australianpharmacist.com.au/life-as-a-poisons-information-specialist/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30280 [authorType] => )
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30197 [post_author] => 3410 [post_date] => 2025-08-06 14:21:58 [post_date_gmt] => 2025-08-06 04:21:58 [post_content] => Vaccination is one of the most cost-effective and life-saving health interventions, saving over 150 million lives worldwide in the last half century. In Australia, we’re lucky enough to have enhanced vaccination access via the National Immunisation Program (NIP). Between 2005 and 2015, the overall burden of illness, disability and premature death from the 17 vaccine-preventable diseases covered under the NIP fell by 30%. Yet since the COVID-19 pandemic, vaccination rates have continued to drop – particularly in vulnerable groups. Pharmacist immunisers, who have recently become significant contributors to Australia’s vaccination effort, now have a unique opportunity to build on this success and turn things around, David Laffan – Assistant Secretary, Immunisation Access and Engagement at the federal Department of Health, Disability and Ageing – told delegates at PSA25 last week. ‘Pharmacies in Australia have provided over 13% of all vaccinations administered in 2024–25 – and a double-digit share of many of them,’ he said. Here, Australian Pharmacist highlights the impact pharmacists have had on vaccination rates, and where we can grow even further.Record number of COVID-19 vaccinations administered by pharmacists
The two largest vaccinations by volume provided by pharmacies are influenza and COVID-19, Mr Laffan said. While COVID-19 vaccination rates in the general population remain low – with only 9% coverage over the past 12 months – pharmacists have administered a substantial proportion of those doses. ‘Vaccination rates in June 2025 for the COVID-19 Vaccination in Community Pharmacy (CVCP) Program were the highest they've been since the first half of 2023,’ he said.Pharmacists overtake GPs as aged care vaccinators
Pharmacists have played a significant role in increasing vaccination rates for aged care residents, who are particularly vulnerable to severe complications, hospitalisation and death. ‘This year, 59% of residents over the age of 75 received a COVID-19 dose in the last 6 months, a big increase from less than 40% a year ago,’ Mr Laffan said. In May this year, pharmacists delivered over 41% of COVID-19 vaccinations in residential aged care homes, compared to 38% administered by GPs. ‘So for the first time, pharmacists have provided more COVID-19 vaccines in residential aged care than general practitioners,’ he said. While co-administration of COVID-19 and influenza vaccines has been encouraged, it has not been enthusiastically embraced by the public. ‘This winter, only about one in four COVID-19 and flu vaccines were co-administered,’ Mr Laffan said. ‘So there's also an opportunity there.’ Come November, when the new Aged Care Act will commence, offering COVID-19 and influenza vaccines will become a registration requirement. ‘Aged care providers will also be required to offer their residents shingles and pneumococcal vaccines if they're eligible under the NIP.’RSV vaccination program heralded a success
The new maternal RSV program, launched in February 2025, has had strong uptake – significantly reducing the burden of disease. ‘Early data indicates about 60% of pregnant women are accessing the maternal vaccine and about a further 20% accessing the monoclonal antibody offered by the states and territories after birth,’ Mr Laffan said. Maternal immunisation reduces the risk of severe RSV disease in infants under 6 months of age by around 70%. ‘These immunisations being made available through the RSV program are estimated to keep 10,000 infants out of hospital each year, and we've already seen a 40% reduction in RSV notifications for young children since the introduction of the [the program],’ he said. ‘That's an incredible success.’Concerning fall in vaccination rates across age groups
Despite these recent successes, immunisation rates for many vaccines are low or falling. In fact, every childhood vaccine on the NIP schedule has lower uptake in 2024 than 2020. ‘This decline means that this year, there will be an additional 15,000 babies unvaccinated compared to pre-COVID immunisation rates,’ Mr Laffan said. Mistrust, fuelled by misinformation and disinformation, has contributed significantly to vaccine hesitancy. And it’s not childhood vaccination rates that are in decline. The preliminary findings from the National Centre for Immunisation Research and Surveillance’s annual immunisation coverage report found that adolescent vaccination rates are also particularly low. ‘For example, only 70% of children turning 17 have received a meningococcal vaccination in 2024,’ he said. ‘Older people are at high risk of infection and serious illness, yet only a third are vaccinated for shingles and less than half are vaccinated for pneumococcal.’ The rates of vaccination in First Nations’ children are even lower in the 1 year and 2 year old cohorts. Similarly, human papillomavirus coverage rates are declining – except for a spike in 2022–23 caused by the move to a single-dose schedule. ‘There is a significant opportunity for community pharmacy to assist in lifting these rates,’ Mr Laffan added.NIPVIP could be the saving grace
The NCIRS interim report highlighted that key barriers to vaccination uptake in children include difficulty of access and cost. Since its inception on 1 January 2024, the National Immunisation Program Vaccinations in Pharmacy is helping to break down these barriers. ‘Opening up NIP vaccines to community pharmacies has been a really important step in improving equity,’ Mr Laffan said. ‘The NIPVIP program has improved access by enabling community pharmacies to significantly increase the number of sites that can vaccinate. In turn, consumers benefit from the convenience of your locations. This also further represents an area of significant growth potential.’ NIPVIP vaccinations are up almost 50% from 2024, demonstrating the capacity for growth for pharmacy vaccinations. ‘[In] NIPVIP’s first month of operation, pharmacies claimed 1,400 vaccination services,’ he said. ‘Since then, nearly 34 million vaccinations have been provided and over 4,750 pharmacies have registered for NIPVIP.’And the NIPVIP program is only set to expand
The increase in this year's winter vaccinations are in part attributable to the uptick in NIPVIP participation – and pharmacies becoming more recognised and accepted as trusted NIP vaccination providers. Federal Minister for Health, Disability and Ageing Mark Butler hinted that the program is set to expand when launching the National Immunisation Strategy for Australia 2025–2030 in June this year. ‘One of the goals within the strategy is to harmonise relevant workforce policies, training and accreditation across all states and territories, Mr Laffan said. ‘And part of this priority involves developing strategies to safely enable health professionals, including community pharmacists, to work to their full scope of practice, which the NIP helps to facilitate.’ The department is also working to harmonise NIPVIP and CVCP to ensure vaccination is embedded into routine primary care service delivery following Australia exiting the emergency stage of the pandemic – including aligning payment rates. ‘I know from many of my conversations with you that you are looking forward to having one less ordering system to deal with when it comes to COVID-19 vaccines, so we'll continue to harmonise the programs and look at ways to streamline systems and reduce barriers,’ he said. Community pharmacies are recognised as providing a vital channel of access to vaccinations, with work underway to operationalise the National Immunisation strategy through a National implementation plan. ‘This plan is about collaboration across governments, sectors and communities to drive improved vaccination outcomes … to ensure that every Australian has equitable access to life-saving vaccines,’ Mr Laffan said. ‘To this end, I've invited the PSA to engage with the department about future vaccination priorities … to ensure that the profession has a say in future government considerations.’ [post_title] => Pharmacists are driving an increase in vaccination rates, says vaccine expert [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => pharmacists-are-driving-an-increase-in-vaccination-rates-says-vaccine-expert [to_ping] => [pinged] => [post_modified] => 2025-08-06 16:45:20 [post_modified_gmt] => 2025-08-06 06:45:20 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30197 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Pharmacists are driving an increase in vaccination rates, says vaccine expert [title] => Pharmacists are driving an increase in vaccination rates, says vaccine expert [href] => https://www.australianpharmacist.com.au/pharmacists-are-driving-an-increase-in-vaccination-rates-says-vaccine-expert/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30215 [authorType] => )
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30123 [post_author] => 7479 [post_date] => 2025-08-04 14:47:08 [post_date_gmt] => 2025-08-04 04:47:08 [post_content] => A record 38 pharmacists have been inducted as Fellows of the PSA at the annual Fellows Dinner, recognising leadership, advocacy, and service to the profession over an extended period. PSA National President Associate Professor Fei Sim FPS congratulated the 2025 cohort, saying: ‘This year’s Fellows showcase the passion, leadership and drive for excellence that define our profession’. ‘Being awarded Fellowship is a recognition of the sustained and outstanding contributions many pharmacists make to PSA and the broader pharmacy profession. ‘On behalf of PSA, I extend my congratulations to each of these remarkable pharmacists, and thank them for their enduring service and dedication to driving our profession forward.’ In addition to 38 Fellows, PSA has also recognised Rhonda White AO and Terry White AO as PSA Life Fellows. ‘In particular I’d like to acknowledge and congratulate Rhonda and Terry White, two stalwarts of Australian pharmacy who we are proud to recognise as Life Fellows of the PSA. ‘Together, Terry and Rhonda have changed the course of Australian pharmacy, championing accessible, patient-centred care and inspiring generations of pharmacists through their leadership. ‘PSA is proud to honour their lifelong dedication to community pharmacy.’ Among the 2025 cohort are a number of PSA staff who have had a significant impact on the pharmacy profession. ‘The PSA team are the backbone of our organisation, working unbelievably hard to support pharmacists across the country. For these members of our team, who are also pharmacists themselves, the drive to make an impact on their profession is particularly strong. ‘Congratulations to Caroyln, Claire, Chris, Quyen, Peter, Jarrod, Kay, Helen and Ella, these recognitions are very well deserved,’ A/Prof Sim said. Full list of PSA Fellows inducted in 2025:
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30101 [post_author] => 3410 [post_date] => 2025-08-04 14:19:38 [post_date_gmt] => 2025-08-04 04:19:38 [post_content] => PSA’s biggest ever national conference wrapped on Sunday 3 August after 3 full days of learning and networking. The rainy weather didn’t stop more than 1,200 pharmacists from all areas of practice and corners of the country coming together at Sydney’s International Convention Centre (ICC) to further their knowledge and practice with Australia’s leading pharmacy voices. [gallery type="flexslider" size="full" ids="30118,30113,30115,30116,30117,30119"] If you weren't able to make it down to the conference, Australian Pharmacist has captured some of the best moments.WA student clinches 2025 Pharmacy Student of the Year
Curtin University student Maxime Watts took out the 2025 PSA Viatris Pharmacy Student of the Year (PSOTY) award, as well as the People’s Choice award – as voted by PSA25 delegates. [gallery type="flexslider" size="full" ids="30105,30106"] ‘I feel incredibly grateful to receive this recognition,’ Ms Waters told AP. ‘Pharmacy has become something I’m genuinely passionate about, and to have my work acknowledged in this way means so much. I’m looking forward to starting my career and continuing to learn within such a supportive profession.’ Seeing the next generation of pharmacists showcase their skills is a highlight of the PSA national conference, said PSA National President Associate Professor Fei Sim FPS. ‘These are our future pharmacists, our future leaders, and I must say I’m very confident our profession is in good hands,’ she said. ‘Each of the students who participated in the PSOTY competition has demonstrated impressive professionalism, skill, and dedication. On behalf of PSA, I wish them all the best in what I’m sure will be successful and rewarding careers as pharmacists.’Pharmacist glitterati dazzle at the Gala Dinner
Pharmacists donned sequins, sparkles and feathers at Saturday night’s gala dinner, themed carnivàle. [gallery type="flexslider" size="full" ids="30103,30104,30107,30108,30109,30110,30111"] Delegates were transported to downtown Rio, with professional dancers putting on a colorful and acrobatic display – before hitting the dance floor to show off their own moves. See if you can spot your friends and colleagues in the crowd.Closing out PSA’s biggest conference ever
To cap off the weekend, PSA and the Australasian Pharmaceutical Science Association (APSA) presented the Outstanding Poster Presentation to Jade Swarbrick for her presentation ADHD in GP settings. The Outstanding Oral Presentation went to Kym Ramsey for his presentation Utilising rural community pharmacists to screen for chronic diseases. PSA and PDL once again joined forces to present the 2025 Volunteer of the Year Award to Madeline Scarlett, as voted by PSA25 delegates, in recognition of her positivity and helpfulness across the weekend. Closing the event, PSA National President Associate Professor Fei Sim FPS highlighted the significance of PSA membership reaching 20,000 for the first time – reflecting the growing confidence pharmacists have in PSA as their professional home. ‘Every year I leave this conference feeling a renewed sense of belonging and passion for this profession,’ she said. ‘Thank you to everyone who made PSA25 a success – our delegates, volunteers, branch committees, staff, speakers and partners – I’m truly inspired by every single one of you. ‘Whether you’re a student, early career pharmacist, or seasoned practitioner, PSA is proud to be your professional home, giving you the tools and the support you need to build the pharmacy career you want.’ See you all again next year at PSA26, held in Sydney at the ICC from Friday 31 July to Sunday 2 August. [post_title] => Rain fails to dampen PSA’s most successful conference yet [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => rain-fails-to-dampen-psas-most-successful-conference-yet [to_ping] => [pinged] => [post_modified] => 2025-08-06 15:50:45 [post_modified_gmt] => 2025-08-06 05:50:45 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30101 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Rain fails to dampen PSA’s most successful conference yet [title] => Rain fails to dampen PSA’s most successful conference yet [href] => https://www.australianpharmacist.com.au/rain-fails-to-dampen-psas-most-successful-conference-yet/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30121 [authorType] => )
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30283 [post_author] => 3410 [post_date] => 2025-08-11 12:10:58 [post_date_gmt] => 2025-08-11 02:10:58 [post_content] => The Australian Technical Advisory Group on Immunisation (ATAGI) has made an unusual move by issuing a statement on RSV vaccination errors. There have been numerous reports to the Therapeutic Goods Administration (TGA) of RSV vaccines being administered to the wrong patient. As of 13 June 2025, there have been:
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 29863 [post_author] => 1925 [post_date] => 2025-08-08 10:00:48 [post_date_gmt] => 2025-08-08 00:00:48 [post_content] =>How pharmacists are trained to deal with life-threatening calls – from medicine misadventure to ingestion of pesticides.
An average of more than 550 calls a day are taken – largely by pharmacists – at Australia’s four Poisons Information Centres (PICs). That’s more than 200,000 calls a year.
Exposures to medicine, chemicals, household products, bites, stings and plants account for the majority of calls to PICs – about 80%. The remaining 20% are largely medicine-related queries. Over the past 2 years, seven of the top 10 most common substance exposures have been medicines.
The PICs are separate state organisations that work together to support the 24-hour Poisons Hotline (131126). One quarter of the PIC calls received overall are from health professionals. These include paramedics, nurses, emergency department (ED) and intensive care unit (ICU) doctors, general practitioners (GPs), mental health professionals and pharmacists. Operating with extended opening hours, the NSW PIC is the largest. It takes half the national calls. In 2024 that was over 117,000.
According to its Senior Pharmacist Poisons Information, Genevieve Adamo MPS, most poisonings are accidental.
‘However, 17% of our calls relate to deliberate self-poisoning,’ she says.
‘These are usually our most serious cases because of the large amount and the combinations taken. We also advise on therapeutic errors, recreational and occupational exposures. We encourage pharmacists to call the PIC about any exposure, particularly deliberate ingestions. If a patient has collapsed or is not breathing, we advise them to call 000 and start cardiopulmonary resuscitation. The PIC will transfer calls to 000 if necessary.’
Most Specialists in Poisons Information (SPIs) in Australia are pharmacists. SPIs perform an individual risk assessment for each case – taking a detailed history, including patient details, the substance exposure, dose/amount, time and type of exposure, symptoms and signs.
For cases already assessed by a health professional, the clinical assessment including any investigations or treatments already carried out, is also considered. All of these factors influence the risk assessment and management plan.
The PIC has access to several specific toxicology resources. These include Therapeutic Guidelines, the National Poisons Register, POISINDEX and Toxinz.
As many exposures involve medicines, resources such as the Australian Medicines Handbook (AMH) and the Monthly Index of Medical Specialities (MIMS) are also used.
‘Information on the risk of toxicity from various exposures relies on publication from actual poisonings – not clinical trials – so there may not be published answers for all clinical scenarios,’ says Ms Adamo. ‘We must consider available evidence, first principles and theoretical risks when formulating an individual management plan for each case.’
Finding the required information, and quickly collating it into an individualised risk assessment and management plan, requires training and practice, she says.
‘We look for pharmacists with a sound knowledge of pharmacology and pharmacokinetics, relevant clinical experience and excellent communication skills. In NSW the PIC internal training program consists of 12 bespoke modules, including toxidromes (toxic syndromes), communication, pesticides, household chemicals, toxicology of specific drugs and drug classes, toxinology and plant toxicology.
‘Along with the theory, trainee SPIs will listen to real-time calls and then progress to supervised call-taking after completing the bulk of the training. The trainee will complete a written exam before they can be rostered to take calls with a “buddy”.
‘Each SPI is required to pass a second exam before they are eligible to work independently and be rostered to the more complex and busy overnight shifts. This whole process usually takes 6 months.
‘The demands of the role,’ says Ms Adamo, ‘require a degree of resilience to cope with the prevalence of self-harm, along with patience to deal with often distressed and sometimes argumentative callers. Most SPIs agree these demands are outweighed by the professional rewards of working in such a clinically interesting and challenging area.’
SPIs are supported by a team of clinical toxicologists, medical specialists who consult on serious life-threatening poisonings, and provide ongoing education and research opportunities for SPIs.
AP spoke to two PIC pharmacists.
Case 1
Kristy Carter (she/her)
Specialist in Poisons Information, NSW Poisons Information Centre
Around midday, I answered the phone to an emergency doctor who was managing a toddler inadvertently given a 10-fold dose of risperidone liquid earlier that morning and the previous morning.
The child was noticeably drowsy the day before, had slept longer than normal overnight and, after another dose that morning, had become agitated, restless and experienced a dystonic episode with abnormal head posturing and eyes deviating upwards. My colleague mentioned speaking to paramedics earlier that day about the child and promptly referred the child to hospital.
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Once in hospital, the child appeared more alert, and the dystonic reaction settled. The doctor on the phone to me requested advice on management and monitoring. I advised the doctor about the clinical effects anticipated with the dosing error and when benzatropine was appropriate. This was a particularly concerning overdose in a child. Clinical effects included central nervous system (CNS) depression, dystonic reactions and anticholinergic effects such as tachycardia, agitation, restlessness and urinary retention.
Uncommon abnormalities included QT prolongation, hypotension and seizures. We discussed monitoring periods and what other investigations were needed. I encouraged them to call back if there was any deterioration or changes, particularly if there were further dystonic reactions.
Within an hour, the emergency doctor called back to report the cervical and ocular dystonias had returned – as well as new opisthotonos. The child was becoming very distressed. We discussed benzatropine dosage and when to use pro re nata (PRN) dosing overnight. The toddler had a good response to the initial dose and was discharged the next day with extra education around dosing provided to the caregivers.
The NSW Poisons Information Centre (PIC) has received many calls regarding 10-fold risperidone errors. Between September 2023 and September 2024, there were 25 cases of at least 10-fold risperidone liquid dosing errors in children aged 3–14 years.
This was particularly alarming, given paediatric patients are more susceptible to the adverse effects of risperidone. Even the smallest overdose can cause serious symptoms. We identified these errors as being mainly due to misunderstanding of dosing instructions and incorrect use of the provided dosing syringe. We knew that increasing awareness and reporting was needed to prevent further poisonings.
The NSW PIC reported these cases to the Therapeutic Goods Administration (TGA). As a result, there have since been mandatory updates to the Product Information and Consumer Medicines Information for risperidone liquid products. The revision includes clearer dosing instructions and illustrations to help ensure correct dosing.
A public safety alert and medicines safety update were both published by the TGA in May 2025. This case is a reminder of one of the roles that pharmacists can play in medication safety and the role of PICs in identifying and preventing medicine errors.
Case 2
Louise Edwards (she/her)
Specialist in Poisons Information, WA Poisons Information Centre
I received a call about an adult family member, who had been discovered drowsy with evidence he’d had one large vomit with a strong smell. He would not reveal what he had ingested.
The caller reported that the man had drunk a large amount of alcohol earlier in the day.
In his room, the family found empty packets of paracetamol, quetiapine, ibuprofen, and a bottle of a pesticide containing chlorpyrifos, suggesting a deliberate self-poisoning.
To help identify the ingredient in the pesticide (chlorpyrifos), I referred to the National Poisons Register. For the other substances, I referred to the Toxicology Handbook, Micromedex and Toxinz, which allowed me to understand the time of onset to symptoms, time required to monitor, possible clinical outcomes (given the unknown number of tablets in each case), and details of antidotes used in organophosphate poisoning. I also referred to the WAPIC Medical Assessment Guidelines to remind myself of local protocols.
Because the patient was still conscious and breathing, I advised the caller to get him to hospital by ambulance. I also advised them to take the tablet packets so the doctors there could work out how many might have been ingested. I also managed a call from ambulance personnel once they arrived to assist the patient. The ambulance journey to the hospital was only 10 minutes, and with no further signs of significant toxicity, there was no requirement for the patient to be transferred to a clinical toxicologist.
First responders/health professionals often experience concern about their own exposure when there are strange chemicals involved. I advised that in this case, the smell from hydrocarbons in the vomit, and potential future vomits, was not a significant risk, as long as they followed appropriate protocols to reduce the possibility of minor symptoms.
A call from the hospital before the patient’s arrival included similar concerns about “off-gassing”. I repeated the advice I had given the ambulance staff. I also advised them to call us back to be transferred to our on-call clinical toxicologist (local WAPIC protocol guidelines) once the patient had been assessed.
Usually, if it had been only the ingested pharmaceuticals, I would have advised on the assessment of paracetamol blood levels and liver function test results for considering N-acetyl cysteine (NAC), advised on potential symptoms, time required to monitor, important screening and other tests regarding quetiapine and ibuprofen, including the risk of seizures and coma with quetiapine, and the additive risk of CNS depression with alcohol and quetiapine.
In this case, the clinical toxicologist would have covered these points in their own advice, given they needed to also assess and advise the doctor about the chlorpyrifos exposure.
The hospital later called me to speak with the clinical toxicologist. I took initial details, such as that the patient was GCS 14, chest clear, managing airways, no further gastrointestinal symptoms or evidence of further bodily secretions, or other features of cholinergic toxidrome.
The patient received NAC for paracetamol and assumed small chlorpyrifos ingestion.
Among other lessons learned in this incident was the importance of providing information about off-gassing risk to ensure a potential patient receives timely support.
[post_title] => On the ground with poisons information specialists [post_excerpt] => How pharmacists are trained to deal with life-threatening calls – from medicine misadventure to ingestion of pesticides. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => life-as-a-poisons-information-specialist [to_ping] => [pinged] => [post_modified] => 2025-08-11 14:58:42 [post_modified_gmt] => 2025-08-11 04:58:42 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=29863 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => On the ground with poisons information specialists [title] => On the ground with poisons information specialists [href] => https://www.australianpharmacist.com.au/life-as-a-poisons-information-specialist/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30280 [authorType] => )
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30197 [post_author] => 3410 [post_date] => 2025-08-06 14:21:58 [post_date_gmt] => 2025-08-06 04:21:58 [post_content] => Vaccination is one of the most cost-effective and life-saving health interventions, saving over 150 million lives worldwide in the last half century. In Australia, we’re lucky enough to have enhanced vaccination access via the National Immunisation Program (NIP). Between 2005 and 2015, the overall burden of illness, disability and premature death from the 17 vaccine-preventable diseases covered under the NIP fell by 30%. Yet since the COVID-19 pandemic, vaccination rates have continued to drop – particularly in vulnerable groups. Pharmacist immunisers, who have recently become significant contributors to Australia’s vaccination effort, now have a unique opportunity to build on this success and turn things around, David Laffan – Assistant Secretary, Immunisation Access and Engagement at the federal Department of Health, Disability and Ageing – told delegates at PSA25 last week. ‘Pharmacies in Australia have provided over 13% of all vaccinations administered in 2024–25 – and a double-digit share of many of them,’ he said. Here, Australian Pharmacist highlights the impact pharmacists have had on vaccination rates, and where we can grow even further.Record number of COVID-19 vaccinations administered by pharmacists
The two largest vaccinations by volume provided by pharmacies are influenza and COVID-19, Mr Laffan said. While COVID-19 vaccination rates in the general population remain low – with only 9% coverage over the past 12 months – pharmacists have administered a substantial proportion of those doses. ‘Vaccination rates in June 2025 for the COVID-19 Vaccination in Community Pharmacy (CVCP) Program were the highest they've been since the first half of 2023,’ he said.Pharmacists overtake GPs as aged care vaccinators
Pharmacists have played a significant role in increasing vaccination rates for aged care residents, who are particularly vulnerable to severe complications, hospitalisation and death. ‘This year, 59% of residents over the age of 75 received a COVID-19 dose in the last 6 months, a big increase from less than 40% a year ago,’ Mr Laffan said. In May this year, pharmacists delivered over 41% of COVID-19 vaccinations in residential aged care homes, compared to 38% administered by GPs. ‘So for the first time, pharmacists have provided more COVID-19 vaccines in residential aged care than general practitioners,’ he said. While co-administration of COVID-19 and influenza vaccines has been encouraged, it has not been enthusiastically embraced by the public. ‘This winter, only about one in four COVID-19 and flu vaccines were co-administered,’ Mr Laffan said. ‘So there's also an opportunity there.’ Come November, when the new Aged Care Act will commence, offering COVID-19 and influenza vaccines will become a registration requirement. ‘Aged care providers will also be required to offer their residents shingles and pneumococcal vaccines if they're eligible under the NIP.’RSV vaccination program heralded a success
The new maternal RSV program, launched in February 2025, has had strong uptake – significantly reducing the burden of disease. ‘Early data indicates about 60% of pregnant women are accessing the maternal vaccine and about a further 20% accessing the monoclonal antibody offered by the states and territories after birth,’ Mr Laffan said. Maternal immunisation reduces the risk of severe RSV disease in infants under 6 months of age by around 70%. ‘These immunisations being made available through the RSV program are estimated to keep 10,000 infants out of hospital each year, and we've already seen a 40% reduction in RSV notifications for young children since the introduction of the [the program],’ he said. ‘That's an incredible success.’Concerning fall in vaccination rates across age groups
Despite these recent successes, immunisation rates for many vaccines are low or falling. In fact, every childhood vaccine on the NIP schedule has lower uptake in 2024 than 2020. ‘This decline means that this year, there will be an additional 15,000 babies unvaccinated compared to pre-COVID immunisation rates,’ Mr Laffan said. Mistrust, fuelled by misinformation and disinformation, has contributed significantly to vaccine hesitancy. And it’s not childhood vaccination rates that are in decline. The preliminary findings from the National Centre for Immunisation Research and Surveillance’s annual immunisation coverage report found that adolescent vaccination rates are also particularly low. ‘For example, only 70% of children turning 17 have received a meningococcal vaccination in 2024,’ he said. ‘Older people are at high risk of infection and serious illness, yet only a third are vaccinated for shingles and less than half are vaccinated for pneumococcal.’ The rates of vaccination in First Nations’ children are even lower in the 1 year and 2 year old cohorts. Similarly, human papillomavirus coverage rates are declining – except for a spike in 2022–23 caused by the move to a single-dose schedule. ‘There is a significant opportunity for community pharmacy to assist in lifting these rates,’ Mr Laffan added.NIPVIP could be the saving grace
The NCIRS interim report highlighted that key barriers to vaccination uptake in children include difficulty of access and cost. Since its inception on 1 January 2024, the National Immunisation Program Vaccinations in Pharmacy is helping to break down these barriers. ‘Opening up NIP vaccines to community pharmacies has been a really important step in improving equity,’ Mr Laffan said. ‘The NIPVIP program has improved access by enabling community pharmacies to significantly increase the number of sites that can vaccinate. In turn, consumers benefit from the convenience of your locations. This also further represents an area of significant growth potential.’ NIPVIP vaccinations are up almost 50% from 2024, demonstrating the capacity for growth for pharmacy vaccinations. ‘[In] NIPVIP’s first month of operation, pharmacies claimed 1,400 vaccination services,’ he said. ‘Since then, nearly 34 million vaccinations have been provided and over 4,750 pharmacies have registered for NIPVIP.’And the NIPVIP program is only set to expand
The increase in this year's winter vaccinations are in part attributable to the uptick in NIPVIP participation – and pharmacies becoming more recognised and accepted as trusted NIP vaccination providers. Federal Minister for Health, Disability and Ageing Mark Butler hinted that the program is set to expand when launching the National Immunisation Strategy for Australia 2025–2030 in June this year. ‘One of the goals within the strategy is to harmonise relevant workforce policies, training and accreditation across all states and territories, Mr Laffan said. ‘And part of this priority involves developing strategies to safely enable health professionals, including community pharmacists, to work to their full scope of practice, which the NIP helps to facilitate.’ The department is also working to harmonise NIPVIP and CVCP to ensure vaccination is embedded into routine primary care service delivery following Australia exiting the emergency stage of the pandemic – including aligning payment rates. ‘I know from many of my conversations with you that you are looking forward to having one less ordering system to deal with when it comes to COVID-19 vaccines, so we'll continue to harmonise the programs and look at ways to streamline systems and reduce barriers,’ he said. Community pharmacies are recognised as providing a vital channel of access to vaccinations, with work underway to operationalise the National Immunisation strategy through a National implementation plan. ‘This plan is about collaboration across governments, sectors and communities to drive improved vaccination outcomes … to ensure that every Australian has equitable access to life-saving vaccines,’ Mr Laffan said. ‘To this end, I've invited the PSA to engage with the department about future vaccination priorities … to ensure that the profession has a say in future government considerations.’ [post_title] => Pharmacists are driving an increase in vaccination rates, says vaccine expert [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => pharmacists-are-driving-an-increase-in-vaccination-rates-says-vaccine-expert [to_ping] => [pinged] => [post_modified] => 2025-08-06 16:45:20 [post_modified_gmt] => 2025-08-06 06:45:20 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30197 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Pharmacists are driving an increase in vaccination rates, says vaccine expert [title] => Pharmacists are driving an increase in vaccination rates, says vaccine expert [href] => https://www.australianpharmacist.com.au/pharmacists-are-driving-an-increase-in-vaccination-rates-says-vaccine-expert/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30215 [authorType] => )
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30123 [post_author] => 7479 [post_date] => 2025-08-04 14:47:08 [post_date_gmt] => 2025-08-04 04:47:08 [post_content] => A record 38 pharmacists have been inducted as Fellows of the PSA at the annual Fellows Dinner, recognising leadership, advocacy, and service to the profession over an extended period. PSA National President Associate Professor Fei Sim FPS congratulated the 2025 cohort, saying: ‘This year’s Fellows showcase the passion, leadership and drive for excellence that define our profession’. ‘Being awarded Fellowship is a recognition of the sustained and outstanding contributions many pharmacists make to PSA and the broader pharmacy profession. ‘On behalf of PSA, I extend my congratulations to each of these remarkable pharmacists, and thank them for their enduring service and dedication to driving our profession forward.’ In addition to 38 Fellows, PSA has also recognised Rhonda White AO and Terry White AO as PSA Life Fellows. ‘In particular I’d like to acknowledge and congratulate Rhonda and Terry White, two stalwarts of Australian pharmacy who we are proud to recognise as Life Fellows of the PSA. ‘Together, Terry and Rhonda have changed the course of Australian pharmacy, championing accessible, patient-centred care and inspiring generations of pharmacists through their leadership. ‘PSA is proud to honour their lifelong dedication to community pharmacy.’ Among the 2025 cohort are a number of PSA staff who have had a significant impact on the pharmacy profession. ‘The PSA team are the backbone of our organisation, working unbelievably hard to support pharmacists across the country. For these members of our team, who are also pharmacists themselves, the drive to make an impact on their profession is particularly strong. ‘Congratulations to Caroyln, Claire, Chris, Quyen, Peter, Jarrod, Kay, Helen and Ella, these recognitions are very well deserved,’ A/Prof Sim said. Full list of PSA Fellows inducted in 2025:
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30101 [post_author] => 3410 [post_date] => 2025-08-04 14:19:38 [post_date_gmt] => 2025-08-04 04:19:38 [post_content] => PSA’s biggest ever national conference wrapped on Sunday 3 August after 3 full days of learning and networking. The rainy weather didn’t stop more than 1,200 pharmacists from all areas of practice and corners of the country coming together at Sydney’s International Convention Centre (ICC) to further their knowledge and practice with Australia’s leading pharmacy voices. [gallery type="flexslider" size="full" ids="30118,30113,30115,30116,30117,30119"] If you weren't able to make it down to the conference, Australian Pharmacist has captured some of the best moments.WA student clinches 2025 Pharmacy Student of the Year
Curtin University student Maxime Watts took out the 2025 PSA Viatris Pharmacy Student of the Year (PSOTY) award, as well as the People’s Choice award – as voted by PSA25 delegates. [gallery type="flexslider" size="full" ids="30105,30106"] ‘I feel incredibly grateful to receive this recognition,’ Ms Waters told AP. ‘Pharmacy has become something I’m genuinely passionate about, and to have my work acknowledged in this way means so much. I’m looking forward to starting my career and continuing to learn within such a supportive profession.’ Seeing the next generation of pharmacists showcase their skills is a highlight of the PSA national conference, said PSA National President Associate Professor Fei Sim FPS. ‘These are our future pharmacists, our future leaders, and I must say I’m very confident our profession is in good hands,’ she said. ‘Each of the students who participated in the PSOTY competition has demonstrated impressive professionalism, skill, and dedication. On behalf of PSA, I wish them all the best in what I’m sure will be successful and rewarding careers as pharmacists.’Pharmacist glitterati dazzle at the Gala Dinner
Pharmacists donned sequins, sparkles and feathers at Saturday night’s gala dinner, themed carnivàle. [gallery type="flexslider" size="full" ids="30103,30104,30107,30108,30109,30110,30111"] Delegates were transported to downtown Rio, with professional dancers putting on a colorful and acrobatic display – before hitting the dance floor to show off their own moves. See if you can spot your friends and colleagues in the crowd.Closing out PSA’s biggest conference ever
To cap off the weekend, PSA and the Australasian Pharmaceutical Science Association (APSA) presented the Outstanding Poster Presentation to Jade Swarbrick for her presentation ADHD in GP settings. The Outstanding Oral Presentation went to Kym Ramsey for his presentation Utilising rural community pharmacists to screen for chronic diseases. PSA and PDL once again joined forces to present the 2025 Volunteer of the Year Award to Madeline Scarlett, as voted by PSA25 delegates, in recognition of her positivity and helpfulness across the weekend. Closing the event, PSA National President Associate Professor Fei Sim FPS highlighted the significance of PSA membership reaching 20,000 for the first time – reflecting the growing confidence pharmacists have in PSA as their professional home. ‘Every year I leave this conference feeling a renewed sense of belonging and passion for this profession,’ she said. ‘Thank you to everyone who made PSA25 a success – our delegates, volunteers, branch committees, staff, speakers and partners – I’m truly inspired by every single one of you. ‘Whether you’re a student, early career pharmacist, or seasoned practitioner, PSA is proud to be your professional home, giving you the tools and the support you need to build the pharmacy career you want.’ See you all again next year at PSA26, held in Sydney at the ICC from Friday 31 July to Sunday 2 August. [post_title] => Rain fails to dampen PSA’s most successful conference yet [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => rain-fails-to-dampen-psas-most-successful-conference-yet [to_ping] => [pinged] => [post_modified] => 2025-08-06 15:50:45 [post_modified_gmt] => 2025-08-06 05:50:45 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30101 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Rain fails to dampen PSA’s most successful conference yet [title] => Rain fails to dampen PSA’s most successful conference yet [href] => https://www.australianpharmacist.com.au/rain-fails-to-dampen-psas-most-successful-conference-yet/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30121 [authorType] => )
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.