Instilling quality and safety into conversations around the provision of Pharmacist Only medicines.

Effective provision of Pharmacist Only medicines requires a thorough understanding of a patient’s needs in order to ensure the medicine is safe and therapeutically appropriate.

This can only be achieved through quality conversations in which pharmacists can gather all the necessary information, such as a patient’s symptoms and whether they are taking any other medicines. The importance of these conversations is highlighted in the Pharmacy Board’s Guidelines on practice-specific issues, which states that pharmacy staff members ‘need to be trained to ask specific questions’ when dealing with Pharmacist Only medicines.¹

The PSA’s new Professional Practice Standards also emphasise the need for effective communication, particularly the first standard: patient-centred care.² 

This applies to all registered pharmacists, regardless of the practice setting, and requires pharmacists to communicate effectively and provide current, relevant and evidence-based advice. This means pharmacists need to stay updated on the latest research, guidelines and regulations. 

Consulting the Australian Pharmaceutical Formulary and Handbook should be second nature – it is expected practice rather than a ‘nice to have’, and will ensure pharmacists can provide the best possible advice to patients. 

‘When prescribing Pharmacist Only medicines, pharmacists are responsible for gathering the necessary information to be able to assess the patient’s needs, agreeing on a management plan with the patient (including addressing any concerns the patient might have), discussing the agreed management plan (providing health information and information about the treatment) and documenting the interaction with the patient,’ says Claire Antrobus MPS, PSA’ Manager – Practice Support. 

Inadequate communication can have a negative effect on patients, as shown in a 2016 simulated patient study, where 4 ‘patients’ visited 75 community pharmacies across Victoria in search of non-prescription combination analgesics containing codeine.³ Of the 145 visits completed, researchers found adequate questioning to establish therapeutic need occurred in 50%, safety was established in 17%, and adequate patient education was provided in 17%. This example is complicated by the fact that pain is subjective, making it even more vital that pharmacists find ways to have meaningful conversations in order to gather the details they need to make an informed prescribing decision.

AP spoke with two pharmacists about how they approach conversations around the provision of Pharmacist Only medicines.

Case 1

KARLA WRIGHT MPS Clinical consultant pharmacist, Australian Pain Society Relationship Committee Member and Queensland PSA Branch Vice President

A 35-year-old woman came into the pharmacy asking for paracetamol and ibuprofen. I asked what kind of pain she needed to treat and she said ‘I just need the tablets’. I retrieved the items and queried whether she really was alright, as she didn’t look well. 

She said she had a migraine coming on but her sumatriptan script had expired more than 12 months earlier. She needed something for this attack. 

I confirmed her details. She had no allergies, her migraines were pretty well controlled and she was only taking citalopram. I told her I could supply a non-prescription triptan. The relief on her face was evident. She couldn’t see her GP for a few weeks and was extremely grateful we could help when she needed it most.

We discussed a management plan. I advised her there were other options available she may be eligible for, such as preventive therapy and even injections, as treatments for migraine have changed drastically in the last few years. This made her realise the importance of reviewing the situation with her GP sooner rather than later. 

I suggested keeping a migraine diary, so she could accurately record not just how often the migraines were happening, but also details of severity and possible triggers. 

This would help, when a review is done, to gather a better overall picture. There is a phone app for those who prefer more modern tech: Migraine Buddy. I also brought up overuse headaches, which some patients and pharmacists might not know about. Opioids are renowned for it, however any combination of simple analgesics with opioids and triptans can cause them. 

Often, patients can seem aggressive when in pain, distressed or frustrated. By making it clear we want to help, we can evolve the conversation into more than a transactional request. 

It can pay off to go beyond the usual, ‘Have you had this before? Make sure you take no more than six or eight per day [depending on medicine]’.

Simply asking what kind of pain someone is in, or how often they are using pain medicines, can open up so many options where we as pharmacists can make a bigger difference.

Case 2

SHERRI BARDEN MPS Pharmacist and asthma educator, Moama Village Pharmacy, NSW

A man in his late 40s presents to the pharmacy with asthma. He had a telehealth prescription for his preventer medicine, as he could not see his regular GP for 6 weeks. He now requests salbutamol. 

I assess his asthma control – always an important question to ask as asthma is a chronic condition that is both reversible and variable. Asthma control can change quickly over minutes, hours or days. 

He says he still has symptoms of wheeze and cough despite preventer use, and has needed salbutamol up to four times a week over the past month. 

There have been no night-time symptoms, no hay fever, no limitation on activity, no signs of infection and he does not smoke. It is now important to establish this: is he using his preventer as prescribed and with correct technique? 

The patient takes his preventer twice a day each day as prescribed and uses a spacer, as I had previously recommended. And his technique is perfect! 

During discussion about what may be triggering his asthma, he thinks it might be his new work environment. He agrees to check what cleaning products are used by his employer as this could be the cause of his symptoms that are occurring only on work days. Given the ongoing symptoms we discuss him keeping his 6-week appointment with his GP for a full review as he may need to step up his preventer treatment if the trigger cannot be avoided. 

At this point, I like to show patients the National Asthma Council’s Asthma and COPD Medications Chart⁵ on my counter to visually demonstrate the different types of asthma medicines available. The patient is thankful for the discussion and eager to see the different devices and new inhalers. 

Lastly, when taking the patient to the till to pay, we finish with the dosing guidelines for salbutamol and check to see if he knows Asthma First Aid.⁶

Asthma First Aid is taught in all first aid courses around Australia. If it is not you who might need it one day, you may need to give Asthma First Aid to one of the 1 in 9 Australians who suffer from asthma.⁷ 

Our staff members hearing this conversation over time, become well educated in Asthma First Aid and asthma management. In particular they learn the recommendation that a spacer be used every time with MDIs – an added bonus!

References

1. Pharmacy Board of Australia. Guidelines on practice-specific issues. 2015.
2. PSA. Professional Practice Standards 2023. 2023. At: www.psa.org.au/wp-content/uploads/2023/07/5933-Professional-Practice-Standards_FINAL-1.pdf
3. Byrne GA, Wood PJ, Spark MJ. Non-prescription supply of combination analgesics containing codeine in community pharmacy: a simulated patient study. Res Social Adm Pharm 2018;14(1):96–105.
4. Sansom LN, ed. Australian pharmaceutical formulary and handbook [online]. Headache and Migraine. Gather patient information. Canberra: Pharmaceutical Society of Australia; 2024. At: https://apf.psa.org.au/home
5. National Asthma Council Australia. Asthma & COPD Medications Chart. 2024. At: www.nationalasthma.org.au/living-with-asthma/resources/health-professionals/charts/asthma-copd-medications-chart
6. National Asthma Council Australia. Asthma first aid. 2024. At: www.nationalasthma.org.au/asthma-first-aid
7. Asthma Australia. Asthma in Australia. 2023. At: https://asthma.org.au/wp-content/uploads/2022/02/AA2023_Asthma-In-Australia-Infographic-A4_v6_web.pdf