Infographic: Here’s how many people pharmacists have vaccinated
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[post_content] => As pharmacy practice evolves, professional, ethical and legal expectations become more complex.
From blurred relationship boundaries to compounding compliance and medicinal cannabis oversight, regulators reflect on five situations where pharmacists must exercise sound judgement, integrity and professional autonomy.
Flag 1. A carer blurs professional boundaries
Relationships with carers can shift over time, especially when familiarity leads to interactions that feel more personal. For example, a carer who regularly collects medicines may begin asking a pharmacist personal questions or even hint at romantic interest.
Should this happen, pharmacists must recognise the emerging risk and reinforce clear professional boundaries to prevent blurred lines from escalating, said Dennis Leung, clinical advisor (pharmacy) at the Australian Health Practitioner and Regulatory Agency (Ahpra) at the recent PSA webinar Navigating Legal Boundaries in Evolving Pharmacy Practice.
‘Supplying a medicine is a form of therapeutic relationship, because clinical and professional responsibilities apply to ensure duty of care to the patient’ he said. ‘There is always a potential power imbalance between you as the health practitioner and the patient or carer.’
If the relationship becomes overfamiliar, misunderstandings may open the door to professional conduct complaints.
‘When relationships move into a personal nature – whether sexual, psychological, financial or social – these are what we call boundary issues,’ Mr Leung said. ‘This is why it’s prudent for a workplace to develop a policy that gives guidance to employees.’
If continuing to act as both pharmacist and personal acquaintance feels conflicted, stepping back or transferring care may be necessary to protect the patient’s interests.
‘You have to be mindful of how objective you can remain if you enter into a relationship with the carer,’ he said. ‘You may decide early on that the best thing is to change who provides care to the patient.’
Timely communication helps to maintain mutual respect and reduces risk.
‘People often forget to reflect, and before they realise it, the situation has progressed beyond where they’re comfortable,’ Mr Leung said. ‘Professional boundaries allow all parties to engage safely and effectively.’
Flag 2. An unsafe or non-compliant compounding request
Compounding often puts pharmacists at the crossroads between clinical judgement, legal requirements and business expectations. Consider if a cosmetic clinic requests a compounded topical anaesthetic with high-strength active ingredients that appear to breach Schedule 3 limits. Even if the pharmacy has dispensed the formulation previously, the pharmacist must assess current standards and patient risk, Kylie Neville, professional officer with PDL, told webinar participants.
‘Compounding is definitely an area where PDL receives frequent questions about risk,’ she said. ‘Unfortunately, it’s also an area where pharmacists may be unsure of their legal and professional obligations.’
This type of request carries potential regulatory breaches and professional liability if harm occurs.
‘There is a regulatory risk if you supply a compounded item that exceeds Schedule 3 limits,’ Ms Neville said. ‘And of course, there is the risk to the patient – if they experience toxicity or an adverse effect … they may not have access to medical care at that time.’
Competence must extend beyond technical compounding skills to include risk awareness, indication, appropriateness and safe use. If those elements can’t be safely assessed, the product shouldn’t be compounded.
‘You also need to consider whether this activity is truly within your scope,’ she said. ‘Individual pharmacists are responsible for the safety and wellbeing of the patient and … any consequences of providing the compounded product.’
Using a two-stage risk assessment can help to catch issues early.
‘A risk assessment can actually happen twice: once before you supply, and once again at the end,’ Ms Neville said. ‘You confirm formulation, stability, expiry, and double-check your calculations to ensure the product you think you’re supplying is actually what you’re supplying.’
Flag 3. Cultural safety blindspots
Cultural safety is increasingly recognised as central to pharmacy practice. Let’s say a patient attends a GLP1-RA injection education session expecting it to be run by a pharmacist they are familiar with, or someone of the same gender or cultural background. If another pharmacist steps in without clarification, the patient may feel uncomfortable.
‘Cultural safety is probably a concept that wasn’t always considered in the past … and it’s now a very important aspect of practice,’ Mr Leung said. ‘Despite your good intentions, the patient might have been expecting a different staff member.’
If the patient feels uncomfortable due to a perceived power imbalance, differences in cultural norms or unmet privacy expectations – learning and treatment adherence can be disrupted.
‘The patient may feel less receptive to the education you’re trying to provide,’ he said. ‘They may even refuse to proceed with the consult entirely.’
Culturally safe care involves awareness of personal assumptions and actively creating an inclusive environment.
‘Cultural safety involves acknowledging the social, economic, cultural, historical, generational and behavioural factors that influence health,’ Mr Leung said. ‘It requires adopting practices that respect diversity and avoiding biases or discrimination, including racism.’
Clarifying expectations ahead of time allows patients to express preferences and increases the likelihood of a respectful, effective consultation.
‘Ideally, you ask the patient for their preferences and expectations,’ he said. ‘Initial consent isn’t blanket consent for changes to who provides the care.’
Flag 4. Medicinal cannabis scripts where products, dosing and evidence
Medicinal cannabis has created numerous challenges for pharmacists, including the availability of a wide range of products, inconsistency in strengths and formulations, and varying legal requirements.
For example, patients may present with multiple prescriptions, unclear dosing sequences or expectations of early supply.
‘Many pharmacists have experienced quite a sharp increase in the number of medicinal cannabis prescriptions,’ Ms Neville said. ‘There are so many non-approved products … it’s incredibly challenging for pharmacists to keep track.’
Many of these products are Controlled Drugs (Schedule 8 medicines). So the same level of clinical judgement must be applied to medicinal cannabis as any other Controlled Drug.
Real-time prescription monitoring is essential for ensuring patients are not receiving unsafe or overlapping supply from multiple providers.
‘There is a total monthly THC quantity that must be monitored carefully,’ Ms Neville said. ‘This is where real-time prescription monitoring becomes vital.’
If you’re not sure how and why patients are using it, it’s ‘absolutely appropriate to ask’.
‘[And] if you have a good relationship with the prescriber, talk to them – ask for guidance,’ she added.
Flag 5. Unusual doses of high-risk medicines
Professional autonomy becomes critical when prescriptions seem unsafe – especially when high-risk medicines such as methotrexate are involved. For example, a script instructing ‘10 mg daily for 5 days’ should raise immediate concern. Even if the patient insists it’s correct and the prescriber is unreachable, the pharmacist can’t proceed without clarity.
‘The Pharmacy Board has highlighted issues around this, particularly regarding methotrexate,’ Mr Leung said. ‘In 2019, they commissioned research covering notifications from mid-2010 to mid-2019. There were 28 notifications – seven deaths and nine hospitalisations. All seven deaths were considered preventable.’
Unclear labels or directions are unacceptable for a medicine with a well-documented history of fatal dosing errors.
‘Labels must include clear directions for use – “take as directed” is not acceptable,’ he said. ‘Methotrexate has a narrow therapeutic index, and ambiguous directions are dangerous.’
Sometimes the safest course is simply to pause supply and direct the patient back to the prescriber.
‘Pharmacists must exercise independent judgement to ensure a medicine is appropriate and safe,’ Mr Leung said. If you cannot clarify the dose … you must decline to dispense.’
Coronial findings across multiple cases reinforce that pharmacists are expected to uphold safety – even when it requires uncomfortable or assertive decision-making.
‘Professional autonomy means centering your decisions around patient safety,’ he added.
Learn more about developing your pharmacy career while remaining compliant by attending the upcoming Voices of Pharmacy – Passion, Purpose, and Possibility webinar.
[post_title] => Navigating legal red flags in the changing pharmacy landscape
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[post_content] => Pharmacists are helping detect CKD sooner through point-of-care testing and risk assessment that connect at-risk patients with their GP.
Chronic kidney disease (CKD) is a common but often ‘silent’ condition. One in three Australians are at risk of developing progressive CKD resulting from comorbidities such as hypertension, diabetes and cardiovascular disease. And most people are asymptomatic until significant kidney damage has occurred.
Familiarity with patients’ medical history equips pharmacists to act as first identifiers of potential CKD and to suggest Kidney Health Checks – which can find CKD in time to better manage the condition. People with diabetes, hypertension, family history of kidney disease, or those who are over 18 and from an Aboriginal and Torres Strait Islander family should have annual Kidney Health Checks. Current smokers and people with other risk factors, such as cardiovascular disease or obesity, should have Kidney Health Checks every 2 years.
Screening for CKD
A trial of CKD screening by pharmacists is currently underway across Australia, covering nearly 1,500 patients in 192 community pharmacies.
According to the University of Sydney’s Associate Professor Ron Castelino, a practising renal pharmacist at Blacktown Hospital, the trial was inspired by the discrepancy between the routine kidney function test results available to hospital pharmacists – who can then adjust doses of medicines cleared by the kidneys – and the lack of information available to community pharmacists.
The pilot first required pharmacists to assess patients’ likelihood of developing CKD using a series of questions about their risk factors. Around 30% of the patients in the recruitment pool were assessed as having a moderate to severe risk of developing CKD within 5 years. They were offered a point-of-care kidney function test, which is essentially a finger-prick test similar to the glucometer test used to manage diabetes, A/Prof Castelino said.
The point-of-care test provides an immediate reading of the patient’s estimated glomerular filtration rate (eGFR) and levels of serum creatinine to measure how well the kidneys are filtering waste from the blood. Patients identified as having impaired kidney function are referred to their general practitioner (GP) for more comprehensive blood and urine tests, spaced over at least 3 months, to diagnose CKD, he added.
‘There are two or three benefits that I see straight away with the point-of-care device screening, particularly in rural and remote areas where pharmacy is more accessible,’ A/Prof Castelino said.
‘Patients can walk in and get the finger-prick test as the initial screening. Those who do come up with a decline in kidney function can be referred to the doctor straightaway, so that’s a massive positive. It’s also a good opportunity for pharmacists to see whether the dosage of medicines cleared by the kidneys may need to be adjusted.’
Management in pharmacy
Pharmacists’ therapeutic knowledge puts them in a unique position to help people manage CKD. A recent systematic review and meta-analysis of randomised controlled trials – including adults with a diagnosis of CKD and those with and without kidney replacement therapy – found pharmacist interventions resulted in statistically significant improvements in systolic blood pressure and haemoglobin levels.5
But the findings showed pharmacist interventions had mixed results for various outcomes, according to the scientists. ‘Future studies should be more robustly designed and take into consideration the role of the pharmacist in prescribing and deprescribing, the findings of which will help inform research and clinical practice,’ they concluded.
This is part one of the AP November 2025 issue on chronic kidney disease.For more information, complete AP’s Chronic kidney disease: when the filters fail CPD.
[post_title] => Screening for kidney disease starts in pharmacy
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[post_content] => ADHD medicine poisonings have quadrupled in the last decade, new research has found.
In 2023, there were 3,242 reported poisoning cases involving ADHD medicines, more than four times the 795 cases recorded in 2014.
Drawing on national data from the NSW Poisons Information Centre (NSWPIC), researchers from the University of Sydney found that over half of the 17,000 self-reported cases during the study period led to hospitalisation, with more than 9,000 involving children under 15 years of age.
These numbers are also likely underreported, said lead researcher Amy Thomson.
‘While our study captured over 17,000 cases over 10 years, that only includes calls to the Poisons Information Centre – which means someone had to actually pick up the phone for advice,’ she said. ‘It doesn’t include cases where someone went straight to their doctor or called an ambulance without contacting the centre.’
Prescription trends linked to growing poisoning rates
There has been a significant uptick in ADHD diagnoses, with the number of Australians diagnosed with ADHD more than doubling between 2013–2020.
One of the main drivers behind the rise in ADHD medicine poisonings is the growing number of prescriptions being issued, Ms Thomson said.
‘The majority of agents we studied have shown increased poisoning incidents, but largely in proportion to the number of prescriptions being written,’ she said.
‘The exception is clonidine, where we’re seeing a much greater increase in poisonings compared with the number of prescriptions issued.’
Originally indicated for hypertension, clonidine has been found to be useful for some patients with ADHD when stimulants don't adequately manage symptoms.
‘Around 35% of the poisoning cases were from clonidine, and another 35% were from methylphenidate (Ritalin), which is much more commonly prescribed,’ Ms Thomson said.
Unintentional overdoses most common in children
Unintentional poisoning from ADHD medicines are more likely to occur in children due to the high volume of prescribing in this age cohort, Ms Thomson said.
‘About 60% of [the reported] cases were unintentional – for example, where a parent doses a child, then the other parent, unaware, gives another dose. That kind of miscommunication can lead to hospitalisation, especially with clonidine,’ she said.
‘There are also cases of children being curious and getting into a sibling’s medication.’
Because clonidine is formulated for adults, dosing children often requires quarter or half tablets. ‘These are small white tablets that need to be cut manually, which increases the risk of dosing errors – for instance, giving a whole tablet instead of the intended half or quarter,’ she said.
Intentional poisonings, on the other hand, were more likely to occur among adolescents.
‘Concerningly, adolescent females are showing an increased risk of intentional poisoning with these medicines,’ Ms Thomson added.
Don’t call them lollies!
Awareness of ADHD has grown significantly, so it’s crucial for pharmacists to provide medicine safety counselling. This includes ensuring families know to store medicines safely and well out of reach of children, Ms Thomson advised.
‘Parents should be advised to avoid referring to medicines as “lollies” – if a parent convinces a child to take medicine by calling it a lolly, the child may later take more on their own,’ she said.
Pharmacists can also help parents establish clear communication strategies at home to avoid accidental double doses.
‘Life can be chaotic when you're trying to get everyone ready for the school run, and it's very easy for both parents to dose one child or to dose the incorrect child,’ Ms Thomson said.
Encouraging families to document each dose or use a shared communication system could help.
‘Pharmacists know their patients and are best placed to help them find a system that works,’ she said.
For clonidine use in children, there should ideally be a change at a national level, with the development of a suitable paediatric formulation, Ms Thomson thinks.
But in the interim, there are some ways pharmacists could help to prevent dosing errors.
‘At a pharmacy level, it may be appropriate in some cases for pharmacists to divide tablets ahead of time and supply them in dose administration aids, which could help some families,’ she said.
Pharmacists also play an important role in harm minimisation for adolescent patients, particularly when the adolescent is old enough to collect their own prescription – generally those aged 16 years and over in NSW.
‘The pharmacist can have a conversation about maturity, the level of supervision required, and what’s appropriate for that patient,’ Ms Thomson said.
Pharmacists have an important role in triage if double dosing or poisoning is suspected.
‘If the child is not breathing, has collapsed, or is unconscious, direct the parent to call 000 immediately,’ she said.
‘Otherwise, the pharmacist should refer them to call the Poisons Information Centre on 13 11 26, which is a 24/7 national hotline operating every day of the year. It’s staffed by pharmacists who specialise in poisoning management, who can triage and provide advice.’
Ms Thomson emphasised that there is no wrong referral. ‘If a parent calls and the child turns out to be fine, that’s a good outcome.’
[post_title] => ADHD poisonings highlight growing safety risk
[post_excerpt] => In 2023, there were 3,242 reported poisoning cases involving ADHD medicines, more than four times the 795 cases recorded in 2014.
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[post_content] => The PSA released its 2025 Strategic Projects Impact Report last week (6 November), showcasing its leadership in advancing pharmacist practice and promoting medicines safety nationally.
The report highlights how PSA drives the safe use of medicines forward through projects in palliative care, mental health, and vaping reform that demonstrate collaborative, evidence-based initiatives.
In 2025, PSA’s projects team delivered more than 40 initiatives in collaboration with over 30 partners, cementing its role as the national peak body driving the Quality Use of Medicines (QUM) agenda.
The PSA’s commitment to supporting pharmacists through change is demonstrated in the report with key education projects including:
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[post_content] => This year, the Australian Health Practitioner Regulation Agency (Ahpra) debuted a new platform that many pharmacists have found less than user friendly.
With the re-registration date fast approaching (30 November), AP looks at the troubles pharmacists have faced and why you should initiate your renewal sooner rather than later.
Multifactor authentication fails
To improve user security, the new Ahpra portal requires two-step verification, with the Google Authenticator app recommended by the regulator.
Seems simple enough, but the process has been far from straightforward for many.
‘I had trouble logging in to the new Ahpra portal as the initial authenticator sign up didn’t work,’ said Gold Coast–based pharmacist Samantha Arche.
‘I looked on the Ahpra website for how to troubleshoot but there wasn’t anything listed. I then tried resetting my password which also didn’t work.’
Unable to reach Ahpra by phone, Ms Arche lodged an online complaint which took some time to resolve.
‘After 2 business days they got back to me with instructions, and said they would send me a new link which never came through,’ she said.
‘I couldn’t reply to the email and I had to lodge a new complaint which took another 2 business days to be answered. [But] my login has been rectified now and I was able to renew my registration.’
Authentication only works with one app
Some pharmacists who set up authentication early – and/or used a different app – have found themselves locked out of the new Ahpra portal.
‘When they updated the portal, I set up new login details and a two-factor authentication app and left it there. This was a few months ago,’ said Melbourne-based pharmacist Heem Yesjusthim.
After logging in again to renew his registration, Mr Yesjusthim was unable to recall what authenticator app he used at the time. But the Google app is now the only one accepted, he said.
‘I looked through my phone and couldn’t find it. Then I looked at the other authentication apps I have (Apple and Microsoft). And none of them showed the Ahpra portal.’
After downloading the Google Authenticator app and attempting to sign up again, Mr Yesjusthim was unable to log in.
‘Once you set up the authentication app the first time, you’re not able to make any changes or log in using other methods,’ he said.
‘If you attempt to log in with another app and you’re at the authentication stage, you’ll notice you can’t go further than that step without a code.
‘Multi-factor authentication is pretty important to prevent hacks and scams but when you implement it, you need to have a system in place to be able to recover your account without the need to call that agency every single time you have an issue logging in.
‘Other ways could be a recovery key that you save somewhere safe, sending a code via message, an automated call back, or you can set up a recovery email or security questions.’
Other pharmacists have also lamented that they’ve submitted multiple contact forms and requested password reset links that never came. While most issues appear to resolve, it takes time.
‘[When I got through on the phone] the lady on the phone was kind and responsive and helped with setting up and logging in quickly from there,’ Yesjusthim said.
AP reached out to Ahpra for comment, and was advised that pharmacists experiencing technical difficulties should visit the advice and information page on Ahpra’s website. Pharmacists can also call the regulator on 1300 419 495 Monday to Friday, 9.00 am – 5.00 pm AEDT.
[post_title] => Ahpra’s new login system leaves some pharmacists locked out
[post_excerpt] => The Australian Health Practitioner Regulation Agency has debuted a new platform that many pharmacists have found less than user friendly.
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[post_content] => As pharmacy practice evolves, professional, ethical and legal expectations become more complex.
From blurred relationship boundaries to compounding compliance and medicinal cannabis oversight, regulators reflect on five situations where pharmacists must exercise sound judgement, integrity and professional autonomy.
Flag 1. A carer blurs professional boundaries
Relationships with carers can shift over time, especially when familiarity leads to interactions that feel more personal. For example, a carer who regularly collects medicines may begin asking a pharmacist personal questions or even hint at romantic interest.
Should this happen, pharmacists must recognise the emerging risk and reinforce clear professional boundaries to prevent blurred lines from escalating, said Dennis Leung, clinical advisor (pharmacy) at the Australian Health Practitioner and Regulatory Agency (Ahpra) at the recent PSA webinar Navigating Legal Boundaries in Evolving Pharmacy Practice.
‘Supplying a medicine is a form of therapeutic relationship, because clinical and professional responsibilities apply to ensure duty of care to the patient’ he said. ‘There is always a potential power imbalance between you as the health practitioner and the patient or carer.’
If the relationship becomes overfamiliar, misunderstandings may open the door to professional conduct complaints.
‘When relationships move into a personal nature – whether sexual, psychological, financial or social – these are what we call boundary issues,’ Mr Leung said. ‘This is why it’s prudent for a workplace to develop a policy that gives guidance to employees.’
If continuing to act as both pharmacist and personal acquaintance feels conflicted, stepping back or transferring care may be necessary to protect the patient’s interests.
‘You have to be mindful of how objective you can remain if you enter into a relationship with the carer,’ he said. ‘You may decide early on that the best thing is to change who provides care to the patient.’
Timely communication helps to maintain mutual respect and reduces risk.
‘People often forget to reflect, and before they realise it, the situation has progressed beyond where they’re comfortable,’ Mr Leung said. ‘Professional boundaries allow all parties to engage safely and effectively.’
Flag 2. An unsafe or non-compliant compounding request
Compounding often puts pharmacists at the crossroads between clinical judgement, legal requirements and business expectations. Consider if a cosmetic clinic requests a compounded topical anaesthetic with high-strength active ingredients that appear to breach Schedule 3 limits. Even if the pharmacy has dispensed the formulation previously, the pharmacist must assess current standards and patient risk, Kylie Neville, professional officer with PDL, told webinar participants.
‘Compounding is definitely an area where PDL receives frequent questions about risk,’ she said. ‘Unfortunately, it’s also an area where pharmacists may be unsure of their legal and professional obligations.’
This type of request carries potential regulatory breaches and professional liability if harm occurs.
‘There is a regulatory risk if you supply a compounded item that exceeds Schedule 3 limits,’ Ms Neville said. ‘And of course, there is the risk to the patient – if they experience toxicity or an adverse effect … they may not have access to medical care at that time.’
Competence must extend beyond technical compounding skills to include risk awareness, indication, appropriateness and safe use. If those elements can’t be safely assessed, the product shouldn’t be compounded.
‘You also need to consider whether this activity is truly within your scope,’ she said. ‘Individual pharmacists are responsible for the safety and wellbeing of the patient and … any consequences of providing the compounded product.’
Using a two-stage risk assessment can help to catch issues early.
‘A risk assessment can actually happen twice: once before you supply, and once again at the end,’ Ms Neville said. ‘You confirm formulation, stability, expiry, and double-check your calculations to ensure the product you think you’re supplying is actually what you’re supplying.’
Flag 3. Cultural safety blindspots
Cultural safety is increasingly recognised as central to pharmacy practice. Let’s say a patient attends a GLP1-RA injection education session expecting it to be run by a pharmacist they are familiar with, or someone of the same gender or cultural background. If another pharmacist steps in without clarification, the patient may feel uncomfortable.
‘Cultural safety is probably a concept that wasn’t always considered in the past … and it’s now a very important aspect of practice,’ Mr Leung said. ‘Despite your good intentions, the patient might have been expecting a different staff member.’
If the patient feels uncomfortable due to a perceived power imbalance, differences in cultural norms or unmet privacy expectations – learning and treatment adherence can be disrupted.
‘The patient may feel less receptive to the education you’re trying to provide,’ he said. ‘They may even refuse to proceed with the consult entirely.’
Culturally safe care involves awareness of personal assumptions and actively creating an inclusive environment.
‘Cultural safety involves acknowledging the social, economic, cultural, historical, generational and behavioural factors that influence health,’ Mr Leung said. ‘It requires adopting practices that respect diversity and avoiding biases or discrimination, including racism.’
Clarifying expectations ahead of time allows patients to express preferences and increases the likelihood of a respectful, effective consultation.
‘Ideally, you ask the patient for their preferences and expectations,’ he said. ‘Initial consent isn’t blanket consent for changes to who provides the care.’
Flag 4. Medicinal cannabis scripts where products, dosing and evidence
Medicinal cannabis has created numerous challenges for pharmacists, including the availability of a wide range of products, inconsistency in strengths and formulations, and varying legal requirements.
For example, patients may present with multiple prescriptions, unclear dosing sequences or expectations of early supply.
‘Many pharmacists have experienced quite a sharp increase in the number of medicinal cannabis prescriptions,’ Ms Neville said. ‘There are so many non-approved products … it’s incredibly challenging for pharmacists to keep track.’
Many of these products are Controlled Drugs (Schedule 8 medicines). So the same level of clinical judgement must be applied to medicinal cannabis as any other Controlled Drug.
Real-time prescription monitoring is essential for ensuring patients are not receiving unsafe or overlapping supply from multiple providers.
‘There is a total monthly THC quantity that must be monitored carefully,’ Ms Neville said. ‘This is where real-time prescription monitoring becomes vital.’
If you’re not sure how and why patients are using it, it’s ‘absolutely appropriate to ask’.
‘[And] if you have a good relationship with the prescriber, talk to them – ask for guidance,’ she added.
Flag 5. Unusual doses of high-risk medicines
Professional autonomy becomes critical when prescriptions seem unsafe – especially when high-risk medicines such as methotrexate are involved. For example, a script instructing ‘10 mg daily for 5 days’ should raise immediate concern. Even if the patient insists it’s correct and the prescriber is unreachable, the pharmacist can’t proceed without clarity.
‘The Pharmacy Board has highlighted issues around this, particularly regarding methotrexate,’ Mr Leung said. ‘In 2019, they commissioned research covering notifications from mid-2010 to mid-2019. There were 28 notifications – seven deaths and nine hospitalisations. All seven deaths were considered preventable.’
Unclear labels or directions are unacceptable for a medicine with a well-documented history of fatal dosing errors.
‘Labels must include clear directions for use – “take as directed” is not acceptable,’ he said. ‘Methotrexate has a narrow therapeutic index, and ambiguous directions are dangerous.’
Sometimes the safest course is simply to pause supply and direct the patient back to the prescriber.
‘Pharmacists must exercise independent judgement to ensure a medicine is appropriate and safe,’ Mr Leung said. If you cannot clarify the dose … you must decline to dispense.’
Coronial findings across multiple cases reinforce that pharmacists are expected to uphold safety – even when it requires uncomfortable or assertive decision-making.
‘Professional autonomy means centering your decisions around patient safety,’ he added.
Learn more about developing your pharmacy career while remaining compliant by attending the upcoming Voices of Pharmacy – Passion, Purpose, and Possibility webinar.
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[post_content] => Pharmacists are helping detect CKD sooner through point-of-care testing and risk assessment that connect at-risk patients with their GP.
Chronic kidney disease (CKD) is a common but often ‘silent’ condition. One in three Australians are at risk of developing progressive CKD resulting from comorbidities such as hypertension, diabetes and cardiovascular disease. And most people are asymptomatic until significant kidney damage has occurred.
Familiarity with patients’ medical history equips pharmacists to act as first identifiers of potential CKD and to suggest Kidney Health Checks – which can find CKD in time to better manage the condition. People with diabetes, hypertension, family history of kidney disease, or those who are over 18 and from an Aboriginal and Torres Strait Islander family should have annual Kidney Health Checks. Current smokers and people with other risk factors, such as cardiovascular disease or obesity, should have Kidney Health Checks every 2 years.
Screening for CKD
A trial of CKD screening by pharmacists is currently underway across Australia, covering nearly 1,500 patients in 192 community pharmacies.
According to the University of Sydney’s Associate Professor Ron Castelino, a practising renal pharmacist at Blacktown Hospital, the trial was inspired by the discrepancy between the routine kidney function test results available to hospital pharmacists – who can then adjust doses of medicines cleared by the kidneys – and the lack of information available to community pharmacists.
The pilot first required pharmacists to assess patients’ likelihood of developing CKD using a series of questions about their risk factors. Around 30% of the patients in the recruitment pool were assessed as having a moderate to severe risk of developing CKD within 5 years. They were offered a point-of-care kidney function test, which is essentially a finger-prick test similar to the glucometer test used to manage diabetes, A/Prof Castelino said.
The point-of-care test provides an immediate reading of the patient’s estimated glomerular filtration rate (eGFR) and levels of serum creatinine to measure how well the kidneys are filtering waste from the blood. Patients identified as having impaired kidney function are referred to their general practitioner (GP) for more comprehensive blood and urine tests, spaced over at least 3 months, to diagnose CKD, he added.
‘There are two or three benefits that I see straight away with the point-of-care device screening, particularly in rural and remote areas where pharmacy is more accessible,’ A/Prof Castelino said.
‘Patients can walk in and get the finger-prick test as the initial screening. Those who do come up with a decline in kidney function can be referred to the doctor straightaway, so that’s a massive positive. It’s also a good opportunity for pharmacists to see whether the dosage of medicines cleared by the kidneys may need to be adjusted.’
Management in pharmacy
Pharmacists’ therapeutic knowledge puts them in a unique position to help people manage CKD. A recent systematic review and meta-analysis of randomised controlled trials – including adults with a diagnosis of CKD and those with and without kidney replacement therapy – found pharmacist interventions resulted in statistically significant improvements in systolic blood pressure and haemoglobin levels.5
But the findings showed pharmacist interventions had mixed results for various outcomes, according to the scientists. ‘Future studies should be more robustly designed and take into consideration the role of the pharmacist in prescribing and deprescribing, the findings of which will help inform research and clinical practice,’ they concluded.
This is part one of the AP November 2025 issue on chronic kidney disease.For more information, complete AP’s Chronic kidney disease: when the filters fail CPD.
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[post_content] => ADHD medicine poisonings have quadrupled in the last decade, new research has found.
In 2023, there were 3,242 reported poisoning cases involving ADHD medicines, more than four times the 795 cases recorded in 2014.
Drawing on national data from the NSW Poisons Information Centre (NSWPIC), researchers from the University of Sydney found that over half of the 17,000 self-reported cases during the study period led to hospitalisation, with more than 9,000 involving children under 15 years of age.
These numbers are also likely underreported, said lead researcher Amy Thomson.
‘While our study captured over 17,000 cases over 10 years, that only includes calls to the Poisons Information Centre – which means someone had to actually pick up the phone for advice,’ she said. ‘It doesn’t include cases where someone went straight to their doctor or called an ambulance without contacting the centre.’
Prescription trends linked to growing poisoning rates
There has been a significant uptick in ADHD diagnoses, with the number of Australians diagnosed with ADHD more than doubling between 2013–2020.
One of the main drivers behind the rise in ADHD medicine poisonings is the growing number of prescriptions being issued, Ms Thomson said.
‘The majority of agents we studied have shown increased poisoning incidents, but largely in proportion to the number of prescriptions being written,’ she said.
‘The exception is clonidine, where we’re seeing a much greater increase in poisonings compared with the number of prescriptions issued.’
Originally indicated for hypertension, clonidine has been found to be useful for some patients with ADHD when stimulants don't adequately manage symptoms.
‘Around 35% of the poisoning cases were from clonidine, and another 35% were from methylphenidate (Ritalin), which is much more commonly prescribed,’ Ms Thomson said.
Unintentional overdoses most common in children
Unintentional poisoning from ADHD medicines are more likely to occur in children due to the high volume of prescribing in this age cohort, Ms Thomson said.
‘About 60% of [the reported] cases were unintentional – for example, where a parent doses a child, then the other parent, unaware, gives another dose. That kind of miscommunication can lead to hospitalisation, especially with clonidine,’ she said.
‘There are also cases of children being curious and getting into a sibling’s medication.’
Because clonidine is formulated for adults, dosing children often requires quarter or half tablets. ‘These are small white tablets that need to be cut manually, which increases the risk of dosing errors – for instance, giving a whole tablet instead of the intended half or quarter,’ she said.
Intentional poisonings, on the other hand, were more likely to occur among adolescents.
‘Concerningly, adolescent females are showing an increased risk of intentional poisoning with these medicines,’ Ms Thomson added.
Don’t call them lollies!
Awareness of ADHD has grown significantly, so it’s crucial for pharmacists to provide medicine safety counselling. This includes ensuring families know to store medicines safely and well out of reach of children, Ms Thomson advised.
‘Parents should be advised to avoid referring to medicines as “lollies” – if a parent convinces a child to take medicine by calling it a lolly, the child may later take more on their own,’ she said.
Pharmacists can also help parents establish clear communication strategies at home to avoid accidental double doses.
‘Life can be chaotic when you're trying to get everyone ready for the school run, and it's very easy for both parents to dose one child or to dose the incorrect child,’ Ms Thomson said.
Encouraging families to document each dose or use a shared communication system could help.
‘Pharmacists know their patients and are best placed to help them find a system that works,’ she said.
For clonidine use in children, there should ideally be a change at a national level, with the development of a suitable paediatric formulation, Ms Thomson thinks.
But in the interim, there are some ways pharmacists could help to prevent dosing errors.
‘At a pharmacy level, it may be appropriate in some cases for pharmacists to divide tablets ahead of time and supply them in dose administration aids, which could help some families,’ she said.
Pharmacists also play an important role in harm minimisation for adolescent patients, particularly when the adolescent is old enough to collect their own prescription – generally those aged 16 years and over in NSW.
‘The pharmacist can have a conversation about maturity, the level of supervision required, and what’s appropriate for that patient,’ Ms Thomson said.
Pharmacists have an important role in triage if double dosing or poisoning is suspected.
‘If the child is not breathing, has collapsed, or is unconscious, direct the parent to call 000 immediately,’ she said.
‘Otherwise, the pharmacist should refer them to call the Poisons Information Centre on 13 11 26, which is a 24/7 national hotline operating every day of the year. It’s staffed by pharmacists who specialise in poisoning management, who can triage and provide advice.’
Ms Thomson emphasised that there is no wrong referral. ‘If a parent calls and the child turns out to be fine, that’s a good outcome.’
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[post_content] => The PSA released its 2025 Strategic Projects Impact Report last week (6 November), showcasing its leadership in advancing pharmacist practice and promoting medicines safety nationally.
The report highlights how PSA drives the safe use of medicines forward through projects in palliative care, mental health, and vaping reform that demonstrate collaborative, evidence-based initiatives.
In 2025, PSA’s projects team delivered more than 40 initiatives in collaboration with over 30 partners, cementing its role as the national peak body driving the Quality Use of Medicines (QUM) agenda.
The PSA’s commitment to supporting pharmacists through change is demonstrated in the report with key education projects including:
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[post_content] => This year, the Australian Health Practitioner Regulation Agency (Ahpra) debuted a new platform that many pharmacists have found less than user friendly.
With the re-registration date fast approaching (30 November), AP looks at the troubles pharmacists have faced and why you should initiate your renewal sooner rather than later.
Multifactor authentication fails
To improve user security, the new Ahpra portal requires two-step verification, with the Google Authenticator app recommended by the regulator.
Seems simple enough, but the process has been far from straightforward for many.
‘I had trouble logging in to the new Ahpra portal as the initial authenticator sign up didn’t work,’ said Gold Coast–based pharmacist Samantha Arche.
‘I looked on the Ahpra website for how to troubleshoot but there wasn’t anything listed. I then tried resetting my password which also didn’t work.’
Unable to reach Ahpra by phone, Ms Arche lodged an online complaint which took some time to resolve.
‘After 2 business days they got back to me with instructions, and said they would send me a new link which never came through,’ she said.
‘I couldn’t reply to the email and I had to lodge a new complaint which took another 2 business days to be answered. [But] my login has been rectified now and I was able to renew my registration.’
Authentication only works with one app
Some pharmacists who set up authentication early – and/or used a different app – have found themselves locked out of the new Ahpra portal.
‘When they updated the portal, I set up new login details and a two-factor authentication app and left it there. This was a few months ago,’ said Melbourne-based pharmacist Heem Yesjusthim.
After logging in again to renew his registration, Mr Yesjusthim was unable to recall what authenticator app he used at the time. But the Google app is now the only one accepted, he said.
‘I looked through my phone and couldn’t find it. Then I looked at the other authentication apps I have (Apple and Microsoft). And none of them showed the Ahpra portal.’
After downloading the Google Authenticator app and attempting to sign up again, Mr Yesjusthim was unable to log in.
‘Once you set up the authentication app the first time, you’re not able to make any changes or log in using other methods,’ he said.
‘If you attempt to log in with another app and you’re at the authentication stage, you’ll notice you can’t go further than that step without a code.
‘Multi-factor authentication is pretty important to prevent hacks and scams but when you implement it, you need to have a system in place to be able to recover your account without the need to call that agency every single time you have an issue logging in.
‘Other ways could be a recovery key that you save somewhere safe, sending a code via message, an automated call back, or you can set up a recovery email or security questions.’
Other pharmacists have also lamented that they’ve submitted multiple contact forms and requested password reset links that never came. While most issues appear to resolve, it takes time.
‘[When I got through on the phone] the lady on the phone was kind and responsive and helped with setting up and logging in quickly from there,’ Yesjusthim said.
AP reached out to Ahpra for comment, and was advised that pharmacists experiencing technical difficulties should visit the advice and information page on Ahpra’s website. Pharmacists can also call the regulator on 1300 419 495 Monday to Friday, 9.00 am – 5.00 pm AEDT.
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[post_content] => As pharmacy practice evolves, professional, ethical and legal expectations become more complex.
From blurred relationship boundaries to compounding compliance and medicinal cannabis oversight, regulators reflect on five situations where pharmacists must exercise sound judgement, integrity and professional autonomy.
Flag 1. A carer blurs professional boundaries
Relationships with carers can shift over time, especially when familiarity leads to interactions that feel more personal. For example, a carer who regularly collects medicines may begin asking a pharmacist personal questions or even hint at romantic interest.
Should this happen, pharmacists must recognise the emerging risk and reinforce clear professional boundaries to prevent blurred lines from escalating, said Dennis Leung, clinical advisor (pharmacy) at the Australian Health Practitioner and Regulatory Agency (Ahpra) at the recent PSA webinar Navigating Legal Boundaries in Evolving Pharmacy Practice.
‘Supplying a medicine is a form of therapeutic relationship, because clinical and professional responsibilities apply to ensure duty of care to the patient’ he said. ‘There is always a potential power imbalance between you as the health practitioner and the patient or carer.’
If the relationship becomes overfamiliar, misunderstandings may open the door to professional conduct complaints.
‘When relationships move into a personal nature – whether sexual, psychological, financial or social – these are what we call boundary issues,’ Mr Leung said. ‘This is why it’s prudent for a workplace to develop a policy that gives guidance to employees.’
If continuing to act as both pharmacist and personal acquaintance feels conflicted, stepping back or transferring care may be necessary to protect the patient’s interests.
‘You have to be mindful of how objective you can remain if you enter into a relationship with the carer,’ he said. ‘You may decide early on that the best thing is to change who provides care to the patient.’
Timely communication helps to maintain mutual respect and reduces risk.
‘People often forget to reflect, and before they realise it, the situation has progressed beyond where they’re comfortable,’ Mr Leung said. ‘Professional boundaries allow all parties to engage safely and effectively.’
Flag 2. An unsafe or non-compliant compounding request
Compounding often puts pharmacists at the crossroads between clinical judgement, legal requirements and business expectations. Consider if a cosmetic clinic requests a compounded topical anaesthetic with high-strength active ingredients that appear to breach Schedule 3 limits. Even if the pharmacy has dispensed the formulation previously, the pharmacist must assess current standards and patient risk, Kylie Neville, professional officer with PDL, told webinar participants.
‘Compounding is definitely an area where PDL receives frequent questions about risk,’ she said. ‘Unfortunately, it’s also an area where pharmacists may be unsure of their legal and professional obligations.’
This type of request carries potential regulatory breaches and professional liability if harm occurs.
‘There is a regulatory risk if you supply a compounded item that exceeds Schedule 3 limits,’ Ms Neville said. ‘And of course, there is the risk to the patient – if they experience toxicity or an adverse effect … they may not have access to medical care at that time.’
Competence must extend beyond technical compounding skills to include risk awareness, indication, appropriateness and safe use. If those elements can’t be safely assessed, the product shouldn’t be compounded.
‘You also need to consider whether this activity is truly within your scope,’ she said. ‘Individual pharmacists are responsible for the safety and wellbeing of the patient and … any consequences of providing the compounded product.’
Using a two-stage risk assessment can help to catch issues early.
‘A risk assessment can actually happen twice: once before you supply, and once again at the end,’ Ms Neville said. ‘You confirm formulation, stability, expiry, and double-check your calculations to ensure the product you think you’re supplying is actually what you’re supplying.’
Flag 3. Cultural safety blindspots
Cultural safety is increasingly recognised as central to pharmacy practice. Let’s say a patient attends a GLP1-RA injection education session expecting it to be run by a pharmacist they are familiar with, or someone of the same gender or cultural background. If another pharmacist steps in without clarification, the patient may feel uncomfortable.
‘Cultural safety is probably a concept that wasn’t always considered in the past … and it’s now a very important aspect of practice,’ Mr Leung said. ‘Despite your good intentions, the patient might have been expecting a different staff member.’
If the patient feels uncomfortable due to a perceived power imbalance, differences in cultural norms or unmet privacy expectations – learning and treatment adherence can be disrupted.
‘The patient may feel less receptive to the education you’re trying to provide,’ he said. ‘They may even refuse to proceed with the consult entirely.’
Culturally safe care involves awareness of personal assumptions and actively creating an inclusive environment.
‘Cultural safety involves acknowledging the social, economic, cultural, historical, generational and behavioural factors that influence health,’ Mr Leung said. ‘It requires adopting practices that respect diversity and avoiding biases or discrimination, including racism.’
Clarifying expectations ahead of time allows patients to express preferences and increases the likelihood of a respectful, effective consultation.
‘Ideally, you ask the patient for their preferences and expectations,’ he said. ‘Initial consent isn’t blanket consent for changes to who provides the care.’
Flag 4. Medicinal cannabis scripts where products, dosing and evidence
Medicinal cannabis has created numerous challenges for pharmacists, including the availability of a wide range of products, inconsistency in strengths and formulations, and varying legal requirements.
For example, patients may present with multiple prescriptions, unclear dosing sequences or expectations of early supply.
‘Many pharmacists have experienced quite a sharp increase in the number of medicinal cannabis prescriptions,’ Ms Neville said. ‘There are so many non-approved products … it’s incredibly challenging for pharmacists to keep track.’
Many of these products are Controlled Drugs (Schedule 8 medicines). So the same level of clinical judgement must be applied to medicinal cannabis as any other Controlled Drug.
Real-time prescription monitoring is essential for ensuring patients are not receiving unsafe or overlapping supply from multiple providers.
‘There is a total monthly THC quantity that must be monitored carefully,’ Ms Neville said. ‘This is where real-time prescription monitoring becomes vital.’
If you’re not sure how and why patients are using it, it’s ‘absolutely appropriate to ask’.
‘[And] if you have a good relationship with the prescriber, talk to them – ask for guidance,’ she added.
Flag 5. Unusual doses of high-risk medicines
Professional autonomy becomes critical when prescriptions seem unsafe – especially when high-risk medicines such as methotrexate are involved. For example, a script instructing ‘10 mg daily for 5 days’ should raise immediate concern. Even if the patient insists it’s correct and the prescriber is unreachable, the pharmacist can’t proceed without clarity.
‘The Pharmacy Board has highlighted issues around this, particularly regarding methotrexate,’ Mr Leung said. ‘In 2019, they commissioned research covering notifications from mid-2010 to mid-2019. There were 28 notifications – seven deaths and nine hospitalisations. All seven deaths were considered preventable.’
Unclear labels or directions are unacceptable for a medicine with a well-documented history of fatal dosing errors.
‘Labels must include clear directions for use – “take as directed” is not acceptable,’ he said. ‘Methotrexate has a narrow therapeutic index, and ambiguous directions are dangerous.’
Sometimes the safest course is simply to pause supply and direct the patient back to the prescriber.
‘Pharmacists must exercise independent judgement to ensure a medicine is appropriate and safe,’ Mr Leung said. If you cannot clarify the dose … you must decline to dispense.’
Coronial findings across multiple cases reinforce that pharmacists are expected to uphold safety – even when it requires uncomfortable or assertive decision-making.
‘Professional autonomy means centering your decisions around patient safety,’ he added.
Learn more about developing your pharmacy career while remaining compliant by attending the upcoming Voices of Pharmacy – Passion, Purpose, and Possibility webinar.
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[post_content] => Pharmacists are helping detect CKD sooner through point-of-care testing and risk assessment that connect at-risk patients with their GP.
Chronic kidney disease (CKD) is a common but often ‘silent’ condition. One in three Australians are at risk of developing progressive CKD resulting from comorbidities such as hypertension, diabetes and cardiovascular disease. And most people are asymptomatic until significant kidney damage has occurred.
Familiarity with patients’ medical history equips pharmacists to act as first identifiers of potential CKD and to suggest Kidney Health Checks – which can find CKD in time to better manage the condition. People with diabetes, hypertension, family history of kidney disease, or those who are over 18 and from an Aboriginal and Torres Strait Islander family should have annual Kidney Health Checks. Current smokers and people with other risk factors, such as cardiovascular disease or obesity, should have Kidney Health Checks every 2 years.
Screening for CKD
A trial of CKD screening by pharmacists is currently underway across Australia, covering nearly 1,500 patients in 192 community pharmacies.
According to the University of Sydney’s Associate Professor Ron Castelino, a practising renal pharmacist at Blacktown Hospital, the trial was inspired by the discrepancy between the routine kidney function test results available to hospital pharmacists – who can then adjust doses of medicines cleared by the kidneys – and the lack of information available to community pharmacists.
The pilot first required pharmacists to assess patients’ likelihood of developing CKD using a series of questions about their risk factors. Around 30% of the patients in the recruitment pool were assessed as having a moderate to severe risk of developing CKD within 5 years. They were offered a point-of-care kidney function test, which is essentially a finger-prick test similar to the glucometer test used to manage diabetes, A/Prof Castelino said.
The point-of-care test provides an immediate reading of the patient’s estimated glomerular filtration rate (eGFR) and levels of serum creatinine to measure how well the kidneys are filtering waste from the blood. Patients identified as having impaired kidney function are referred to their general practitioner (GP) for more comprehensive blood and urine tests, spaced over at least 3 months, to diagnose CKD, he added.
‘There are two or three benefits that I see straight away with the point-of-care device screening, particularly in rural and remote areas where pharmacy is more accessible,’ A/Prof Castelino said.
‘Patients can walk in and get the finger-prick test as the initial screening. Those who do come up with a decline in kidney function can be referred to the doctor straightaway, so that’s a massive positive. It’s also a good opportunity for pharmacists to see whether the dosage of medicines cleared by the kidneys may need to be adjusted.’
Management in pharmacy
Pharmacists’ therapeutic knowledge puts them in a unique position to help people manage CKD. A recent systematic review and meta-analysis of randomised controlled trials – including adults with a diagnosis of CKD and those with and without kidney replacement therapy – found pharmacist interventions resulted in statistically significant improvements in systolic blood pressure and haemoglobin levels.5
But the findings showed pharmacist interventions had mixed results for various outcomes, according to the scientists. ‘Future studies should be more robustly designed and take into consideration the role of the pharmacist in prescribing and deprescribing, the findings of which will help inform research and clinical practice,’ they concluded.
This is part one of the AP November 2025 issue on chronic kidney disease.For more information, complete AP’s Chronic kidney disease: when the filters fail CPD.
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[post_content] => ADHD medicine poisonings have quadrupled in the last decade, new research has found.
In 2023, there were 3,242 reported poisoning cases involving ADHD medicines, more than four times the 795 cases recorded in 2014.
Drawing on national data from the NSW Poisons Information Centre (NSWPIC), researchers from the University of Sydney found that over half of the 17,000 self-reported cases during the study period led to hospitalisation, with more than 9,000 involving children under 15 years of age.
These numbers are also likely underreported, said lead researcher Amy Thomson.
‘While our study captured over 17,000 cases over 10 years, that only includes calls to the Poisons Information Centre – which means someone had to actually pick up the phone for advice,’ she said. ‘It doesn’t include cases where someone went straight to their doctor or called an ambulance without contacting the centre.’
Prescription trends linked to growing poisoning rates
There has been a significant uptick in ADHD diagnoses, with the number of Australians diagnosed with ADHD more than doubling between 2013–2020.
One of the main drivers behind the rise in ADHD medicine poisonings is the growing number of prescriptions being issued, Ms Thomson said.
‘The majority of agents we studied have shown increased poisoning incidents, but largely in proportion to the number of prescriptions being written,’ she said.
‘The exception is clonidine, where we’re seeing a much greater increase in poisonings compared with the number of prescriptions issued.’
Originally indicated for hypertension, clonidine has been found to be useful for some patients with ADHD when stimulants don't adequately manage symptoms.
‘Around 35% of the poisoning cases were from clonidine, and another 35% were from methylphenidate (Ritalin), which is much more commonly prescribed,’ Ms Thomson said.
Unintentional overdoses most common in children
Unintentional poisoning from ADHD medicines are more likely to occur in children due to the high volume of prescribing in this age cohort, Ms Thomson said.
‘About 60% of [the reported] cases were unintentional – for example, where a parent doses a child, then the other parent, unaware, gives another dose. That kind of miscommunication can lead to hospitalisation, especially with clonidine,’ she said.
‘There are also cases of children being curious and getting into a sibling’s medication.’
Because clonidine is formulated for adults, dosing children often requires quarter or half tablets. ‘These are small white tablets that need to be cut manually, which increases the risk of dosing errors – for instance, giving a whole tablet instead of the intended half or quarter,’ she said.
Intentional poisonings, on the other hand, were more likely to occur among adolescents.
‘Concerningly, adolescent females are showing an increased risk of intentional poisoning with these medicines,’ Ms Thomson added.
Don’t call them lollies!
Awareness of ADHD has grown significantly, so it’s crucial for pharmacists to provide medicine safety counselling. This includes ensuring families know to store medicines safely and well out of reach of children, Ms Thomson advised.
‘Parents should be advised to avoid referring to medicines as “lollies” – if a parent convinces a child to take medicine by calling it a lolly, the child may later take more on their own,’ she said.
Pharmacists can also help parents establish clear communication strategies at home to avoid accidental double doses.
‘Life can be chaotic when you're trying to get everyone ready for the school run, and it's very easy for both parents to dose one child or to dose the incorrect child,’ Ms Thomson said.
Encouraging families to document each dose or use a shared communication system could help.
‘Pharmacists know their patients and are best placed to help them find a system that works,’ she said.
For clonidine use in children, there should ideally be a change at a national level, with the development of a suitable paediatric formulation, Ms Thomson thinks.
But in the interim, there are some ways pharmacists could help to prevent dosing errors.
‘At a pharmacy level, it may be appropriate in some cases for pharmacists to divide tablets ahead of time and supply them in dose administration aids, which could help some families,’ she said.
Pharmacists also play an important role in harm minimisation for adolescent patients, particularly when the adolescent is old enough to collect their own prescription – generally those aged 16 years and over in NSW.
‘The pharmacist can have a conversation about maturity, the level of supervision required, and what’s appropriate for that patient,’ Ms Thomson said.
Pharmacists have an important role in triage if double dosing or poisoning is suspected.
‘If the child is not breathing, has collapsed, or is unconscious, direct the parent to call 000 immediately,’ she said.
‘Otherwise, the pharmacist should refer them to call the Poisons Information Centre on 13 11 26, which is a 24/7 national hotline operating every day of the year. It’s staffed by pharmacists who specialise in poisoning management, who can triage and provide advice.’
Ms Thomson emphasised that there is no wrong referral. ‘If a parent calls and the child turns out to be fine, that’s a good outcome.’
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[post_excerpt] => In 2023, there were 3,242 reported poisoning cases involving ADHD medicines, more than four times the 795 cases recorded in 2014.
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[post_content] => The PSA released its 2025 Strategic Projects Impact Report last week (6 November), showcasing its leadership in advancing pharmacist practice and promoting medicines safety nationally.
The report highlights how PSA drives the safe use of medicines forward through projects in palliative care, mental health, and vaping reform that demonstrate collaborative, evidence-based initiatives.
In 2025, PSA’s projects team delivered more than 40 initiatives in collaboration with over 30 partners, cementing its role as the national peak body driving the Quality Use of Medicines (QUM) agenda.
The PSA’s commitment to supporting pharmacists through change is demonstrated in the report with key education projects including:
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[post_content] => This year, the Australian Health Practitioner Regulation Agency (Ahpra) debuted a new platform that many pharmacists have found less than user friendly.
With the re-registration date fast approaching (30 November), AP looks at the troubles pharmacists have faced and why you should initiate your renewal sooner rather than later.
Multifactor authentication fails
To improve user security, the new Ahpra portal requires two-step verification, with the Google Authenticator app recommended by the regulator.
Seems simple enough, but the process has been far from straightforward for many.
‘I had trouble logging in to the new Ahpra portal as the initial authenticator sign up didn’t work,’ said Gold Coast–based pharmacist Samantha Arche.
‘I looked on the Ahpra website for how to troubleshoot but there wasn’t anything listed. I then tried resetting my password which also didn’t work.’
Unable to reach Ahpra by phone, Ms Arche lodged an online complaint which took some time to resolve.
‘After 2 business days they got back to me with instructions, and said they would send me a new link which never came through,’ she said.
‘I couldn’t reply to the email and I had to lodge a new complaint which took another 2 business days to be answered. [But] my login has been rectified now and I was able to renew my registration.’
Authentication only works with one app
Some pharmacists who set up authentication early – and/or used a different app – have found themselves locked out of the new Ahpra portal.
‘When they updated the portal, I set up new login details and a two-factor authentication app and left it there. This was a few months ago,’ said Melbourne-based pharmacist Heem Yesjusthim.
After logging in again to renew his registration, Mr Yesjusthim was unable to recall what authenticator app he used at the time. But the Google app is now the only one accepted, he said.
‘I looked through my phone and couldn’t find it. Then I looked at the other authentication apps I have (Apple and Microsoft). And none of them showed the Ahpra portal.’
After downloading the Google Authenticator app and attempting to sign up again, Mr Yesjusthim was unable to log in.
‘Once you set up the authentication app the first time, you’re not able to make any changes or log in using other methods,’ he said.
‘If you attempt to log in with another app and you’re at the authentication stage, you’ll notice you can’t go further than that step without a code.
‘Multi-factor authentication is pretty important to prevent hacks and scams but when you implement it, you need to have a system in place to be able to recover your account without the need to call that agency every single time you have an issue logging in.
‘Other ways could be a recovery key that you save somewhere safe, sending a code via message, an automated call back, or you can set up a recovery email or security questions.’
Other pharmacists have also lamented that they’ve submitted multiple contact forms and requested password reset links that never came. While most issues appear to resolve, it takes time.
‘[When I got through on the phone] the lady on the phone was kind and responsive and helped with setting up and logging in quickly from there,’ Yesjusthim said.
AP reached out to Ahpra for comment, and was advised that pharmacists experiencing technical difficulties should visit the advice and information page on Ahpra’s website. Pharmacists can also call the regulator on 1300 419 495 Monday to Friday, 9.00 am – 5.00 pm AEDT.
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[post_excerpt] => The Australian Health Practitioner Regulation Agency has debuted a new platform that many pharmacists have found less than user friendly.
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[post_content] => As pharmacy practice evolves, professional, ethical and legal expectations become more complex.
From blurred relationship boundaries to compounding compliance and medicinal cannabis oversight, regulators reflect on five situations where pharmacists must exercise sound judgement, integrity and professional autonomy.
Flag 1. A carer blurs professional boundaries
Relationships with carers can shift over time, especially when familiarity leads to interactions that feel more personal. For example, a carer who regularly collects medicines may begin asking a pharmacist personal questions or even hint at romantic interest.
Should this happen, pharmacists must recognise the emerging risk and reinforce clear professional boundaries to prevent blurred lines from escalating, said Dennis Leung, clinical advisor (pharmacy) at the Australian Health Practitioner and Regulatory Agency (Ahpra) at the recent PSA webinar Navigating Legal Boundaries in Evolving Pharmacy Practice.
‘Supplying a medicine is a form of therapeutic relationship, because clinical and professional responsibilities apply to ensure duty of care to the patient’ he said. ‘There is always a potential power imbalance between you as the health practitioner and the patient or carer.’
If the relationship becomes overfamiliar, misunderstandings may open the door to professional conduct complaints.
‘When relationships move into a personal nature – whether sexual, psychological, financial or social – these are what we call boundary issues,’ Mr Leung said. ‘This is why it’s prudent for a workplace to develop a policy that gives guidance to employees.’
If continuing to act as both pharmacist and personal acquaintance feels conflicted, stepping back or transferring care may be necessary to protect the patient’s interests.
‘You have to be mindful of how objective you can remain if you enter into a relationship with the carer,’ he said. ‘You may decide early on that the best thing is to change who provides care to the patient.’
Timely communication helps to maintain mutual respect and reduces risk.
‘People often forget to reflect, and before they realise it, the situation has progressed beyond where they’re comfortable,’ Mr Leung said. ‘Professional boundaries allow all parties to engage safely and effectively.’
Flag 2. An unsafe or non-compliant compounding request
Compounding often puts pharmacists at the crossroads between clinical judgement, legal requirements and business expectations. Consider if a cosmetic clinic requests a compounded topical anaesthetic with high-strength active ingredients that appear to breach Schedule 3 limits. Even if the pharmacy has dispensed the formulation previously, the pharmacist must assess current standards and patient risk, Kylie Neville, professional officer with PDL, told webinar participants.
‘Compounding is definitely an area where PDL receives frequent questions about risk,’ she said. ‘Unfortunately, it’s also an area where pharmacists may be unsure of their legal and professional obligations.’
This type of request carries potential regulatory breaches and professional liability if harm occurs.
‘There is a regulatory risk if you supply a compounded item that exceeds Schedule 3 limits,’ Ms Neville said. ‘And of course, there is the risk to the patient – if they experience toxicity or an adverse effect … they may not have access to medical care at that time.’
Competence must extend beyond technical compounding skills to include risk awareness, indication, appropriateness and safe use. If those elements can’t be safely assessed, the product shouldn’t be compounded.
‘You also need to consider whether this activity is truly within your scope,’ she said. ‘Individual pharmacists are responsible for the safety and wellbeing of the patient and … any consequences of providing the compounded product.’
Using a two-stage risk assessment can help to catch issues early.
‘A risk assessment can actually happen twice: once before you supply, and once again at the end,’ Ms Neville said. ‘You confirm formulation, stability, expiry, and double-check your calculations to ensure the product you think you’re supplying is actually what you’re supplying.’
Flag 3. Cultural safety blindspots
Cultural safety is increasingly recognised as central to pharmacy practice. Let’s say a patient attends a GLP1-RA injection education session expecting it to be run by a pharmacist they are familiar with, or someone of the same gender or cultural background. If another pharmacist steps in without clarification, the patient may feel uncomfortable.
‘Cultural safety is probably a concept that wasn’t always considered in the past … and it’s now a very important aspect of practice,’ Mr Leung said. ‘Despite your good intentions, the patient might have been expecting a different staff member.’
If the patient feels uncomfortable due to a perceived power imbalance, differences in cultural norms or unmet privacy expectations – learning and treatment adherence can be disrupted.
‘The patient may feel less receptive to the education you’re trying to provide,’ he said. ‘They may even refuse to proceed with the consult entirely.’
Culturally safe care involves awareness of personal assumptions and actively creating an inclusive environment.
‘Cultural safety involves acknowledging the social, economic, cultural, historical, generational and behavioural factors that influence health,’ Mr Leung said. ‘It requires adopting practices that respect diversity and avoiding biases or discrimination, including racism.’
Clarifying expectations ahead of time allows patients to express preferences and increases the likelihood of a respectful, effective consultation.
‘Ideally, you ask the patient for their preferences and expectations,’ he said. ‘Initial consent isn’t blanket consent for changes to who provides the care.’
Flag 4. Medicinal cannabis scripts where products, dosing and evidence
Medicinal cannabis has created numerous challenges for pharmacists, including the availability of a wide range of products, inconsistency in strengths and formulations, and varying legal requirements.
For example, patients may present with multiple prescriptions, unclear dosing sequences or expectations of early supply.
‘Many pharmacists have experienced quite a sharp increase in the number of medicinal cannabis prescriptions,’ Ms Neville said. ‘There are so many non-approved products … it’s incredibly challenging for pharmacists to keep track.’
Many of these products are Controlled Drugs (Schedule 8 medicines). So the same level of clinical judgement must be applied to medicinal cannabis as any other Controlled Drug.
Real-time prescription monitoring is essential for ensuring patients are not receiving unsafe or overlapping supply from multiple providers.
‘There is a total monthly THC quantity that must be monitored carefully,’ Ms Neville said. ‘This is where real-time prescription monitoring becomes vital.’
If you’re not sure how and why patients are using it, it’s ‘absolutely appropriate to ask’.
‘[And] if you have a good relationship with the prescriber, talk to them – ask for guidance,’ she added.
Flag 5. Unusual doses of high-risk medicines
Professional autonomy becomes critical when prescriptions seem unsafe – especially when high-risk medicines such as methotrexate are involved. For example, a script instructing ‘10 mg daily for 5 days’ should raise immediate concern. Even if the patient insists it’s correct and the prescriber is unreachable, the pharmacist can’t proceed without clarity.
‘The Pharmacy Board has highlighted issues around this, particularly regarding methotrexate,’ Mr Leung said. ‘In 2019, they commissioned research covering notifications from mid-2010 to mid-2019. There were 28 notifications – seven deaths and nine hospitalisations. All seven deaths were considered preventable.’
Unclear labels or directions are unacceptable for a medicine with a well-documented history of fatal dosing errors.
‘Labels must include clear directions for use – “take as directed” is not acceptable,’ he said. ‘Methotrexate has a narrow therapeutic index, and ambiguous directions are dangerous.’
Sometimes the safest course is simply to pause supply and direct the patient back to the prescriber.
‘Pharmacists must exercise independent judgement to ensure a medicine is appropriate and safe,’ Mr Leung said. If you cannot clarify the dose … you must decline to dispense.’
Coronial findings across multiple cases reinforce that pharmacists are expected to uphold safety – even when it requires uncomfortable or assertive decision-making.
‘Professional autonomy means centering your decisions around patient safety,’ he added.
Learn more about developing your pharmacy career while remaining compliant by attending the upcoming Voices of Pharmacy – Passion, Purpose, and Possibility webinar.
[post_title] => Navigating legal red flags in the changing pharmacy landscape
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[post_content] => Pharmacists are helping detect CKD sooner through point-of-care testing and risk assessment that connect at-risk patients with their GP.
Chronic kidney disease (CKD) is a common but often ‘silent’ condition. One in three Australians are at risk of developing progressive CKD resulting from comorbidities such as hypertension, diabetes and cardiovascular disease. And most people are asymptomatic until significant kidney damage has occurred.
Familiarity with patients’ medical history equips pharmacists to act as first identifiers of potential CKD and to suggest Kidney Health Checks – which can find CKD in time to better manage the condition. People with diabetes, hypertension, family history of kidney disease, or those who are over 18 and from an Aboriginal and Torres Strait Islander family should have annual Kidney Health Checks. Current smokers and people with other risk factors, such as cardiovascular disease or obesity, should have Kidney Health Checks every 2 years.
Screening for CKD
A trial of CKD screening by pharmacists is currently underway across Australia, covering nearly 1,500 patients in 192 community pharmacies.
According to the University of Sydney’s Associate Professor Ron Castelino, a practising renal pharmacist at Blacktown Hospital, the trial was inspired by the discrepancy between the routine kidney function test results available to hospital pharmacists – who can then adjust doses of medicines cleared by the kidneys – and the lack of information available to community pharmacists.
The pilot first required pharmacists to assess patients’ likelihood of developing CKD using a series of questions about their risk factors. Around 30% of the patients in the recruitment pool were assessed as having a moderate to severe risk of developing CKD within 5 years. They were offered a point-of-care kidney function test, which is essentially a finger-prick test similar to the glucometer test used to manage diabetes, A/Prof Castelino said.
The point-of-care test provides an immediate reading of the patient’s estimated glomerular filtration rate (eGFR) and levels of serum creatinine to measure how well the kidneys are filtering waste from the blood. Patients identified as having impaired kidney function are referred to their general practitioner (GP) for more comprehensive blood and urine tests, spaced over at least 3 months, to diagnose CKD, he added.
‘There are two or three benefits that I see straight away with the point-of-care device screening, particularly in rural and remote areas where pharmacy is more accessible,’ A/Prof Castelino said.
‘Patients can walk in and get the finger-prick test as the initial screening. Those who do come up with a decline in kidney function can be referred to the doctor straightaway, so that’s a massive positive. It’s also a good opportunity for pharmacists to see whether the dosage of medicines cleared by the kidneys may need to be adjusted.’
Management in pharmacy
Pharmacists’ therapeutic knowledge puts them in a unique position to help people manage CKD. A recent systematic review and meta-analysis of randomised controlled trials – including adults with a diagnosis of CKD and those with and without kidney replacement therapy – found pharmacist interventions resulted in statistically significant improvements in systolic blood pressure and haemoglobin levels.5
But the findings showed pharmacist interventions had mixed results for various outcomes, according to the scientists. ‘Future studies should be more robustly designed and take into consideration the role of the pharmacist in prescribing and deprescribing, the findings of which will help inform research and clinical practice,’ they concluded.
This is part one of the AP November 2025 issue on chronic kidney disease.For more information, complete AP’s Chronic kidney disease: when the filters fail CPD.
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[post_content] => ADHD medicine poisonings have quadrupled in the last decade, new research has found.
In 2023, there were 3,242 reported poisoning cases involving ADHD medicines, more than four times the 795 cases recorded in 2014.
Drawing on national data from the NSW Poisons Information Centre (NSWPIC), researchers from the University of Sydney found that over half of the 17,000 self-reported cases during the study period led to hospitalisation, with more than 9,000 involving children under 15 years of age.
These numbers are also likely underreported, said lead researcher Amy Thomson.
‘While our study captured over 17,000 cases over 10 years, that only includes calls to the Poisons Information Centre – which means someone had to actually pick up the phone for advice,’ she said. ‘It doesn’t include cases where someone went straight to their doctor or called an ambulance without contacting the centre.’
Prescription trends linked to growing poisoning rates
There has been a significant uptick in ADHD diagnoses, with the number of Australians diagnosed with ADHD more than doubling between 2013–2020.
One of the main drivers behind the rise in ADHD medicine poisonings is the growing number of prescriptions being issued, Ms Thomson said.
‘The majority of agents we studied have shown increased poisoning incidents, but largely in proportion to the number of prescriptions being written,’ she said.
‘The exception is clonidine, where we’re seeing a much greater increase in poisonings compared with the number of prescriptions issued.’
Originally indicated for hypertension, clonidine has been found to be useful for some patients with ADHD when stimulants don't adequately manage symptoms.
‘Around 35% of the poisoning cases were from clonidine, and another 35% were from methylphenidate (Ritalin), which is much more commonly prescribed,’ Ms Thomson said.
Unintentional overdoses most common in children
Unintentional poisoning from ADHD medicines are more likely to occur in children due to the high volume of prescribing in this age cohort, Ms Thomson said.
‘About 60% of [the reported] cases were unintentional – for example, where a parent doses a child, then the other parent, unaware, gives another dose. That kind of miscommunication can lead to hospitalisation, especially with clonidine,’ she said.
‘There are also cases of children being curious and getting into a sibling’s medication.’
Because clonidine is formulated for adults, dosing children often requires quarter or half tablets. ‘These are small white tablets that need to be cut manually, which increases the risk of dosing errors – for instance, giving a whole tablet instead of the intended half or quarter,’ she said.
Intentional poisonings, on the other hand, were more likely to occur among adolescents.
‘Concerningly, adolescent females are showing an increased risk of intentional poisoning with these medicines,’ Ms Thomson added.
Don’t call them lollies!
Awareness of ADHD has grown significantly, so it’s crucial for pharmacists to provide medicine safety counselling. This includes ensuring families know to store medicines safely and well out of reach of children, Ms Thomson advised.
‘Parents should be advised to avoid referring to medicines as “lollies” – if a parent convinces a child to take medicine by calling it a lolly, the child may later take more on their own,’ she said.
Pharmacists can also help parents establish clear communication strategies at home to avoid accidental double doses.
‘Life can be chaotic when you're trying to get everyone ready for the school run, and it's very easy for both parents to dose one child or to dose the incorrect child,’ Ms Thomson said.
Encouraging families to document each dose or use a shared communication system could help.
‘Pharmacists know their patients and are best placed to help them find a system that works,’ she said.
For clonidine use in children, there should ideally be a change at a national level, with the development of a suitable paediatric formulation, Ms Thomson thinks.
But in the interim, there are some ways pharmacists could help to prevent dosing errors.
‘At a pharmacy level, it may be appropriate in some cases for pharmacists to divide tablets ahead of time and supply them in dose administration aids, which could help some families,’ she said.
Pharmacists also play an important role in harm minimisation for adolescent patients, particularly when the adolescent is old enough to collect their own prescription – generally those aged 16 years and over in NSW.
‘The pharmacist can have a conversation about maturity, the level of supervision required, and what’s appropriate for that patient,’ Ms Thomson said.
Pharmacists have an important role in triage if double dosing or poisoning is suspected.
‘If the child is not breathing, has collapsed, or is unconscious, direct the parent to call 000 immediately,’ she said.
‘Otherwise, the pharmacist should refer them to call the Poisons Information Centre on 13 11 26, which is a 24/7 national hotline operating every day of the year. It’s staffed by pharmacists who specialise in poisoning management, who can triage and provide advice.’
Ms Thomson emphasised that there is no wrong referral. ‘If a parent calls and the child turns out to be fine, that’s a good outcome.’
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[post_excerpt] => In 2023, there were 3,242 reported poisoning cases involving ADHD medicines, more than four times the 795 cases recorded in 2014.
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[post_content] => The PSA released its 2025 Strategic Projects Impact Report last week (6 November), showcasing its leadership in advancing pharmacist practice and promoting medicines safety nationally.
The report highlights how PSA drives the safe use of medicines forward through projects in palliative care, mental health, and vaping reform that demonstrate collaborative, evidence-based initiatives.
In 2025, PSA’s projects team delivered more than 40 initiatives in collaboration with over 30 partners, cementing its role as the national peak body driving the Quality Use of Medicines (QUM) agenda.
The PSA’s commitment to supporting pharmacists through change is demonstrated in the report with key education projects including:
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[post_content] => This year, the Australian Health Practitioner Regulation Agency (Ahpra) debuted a new platform that many pharmacists have found less than user friendly.
With the re-registration date fast approaching (30 November), AP looks at the troubles pharmacists have faced and why you should initiate your renewal sooner rather than later.
Multifactor authentication fails
To improve user security, the new Ahpra portal requires two-step verification, with the Google Authenticator app recommended by the regulator.
Seems simple enough, but the process has been far from straightforward for many.
‘I had trouble logging in to the new Ahpra portal as the initial authenticator sign up didn’t work,’ said Gold Coast–based pharmacist Samantha Arche.
‘I looked on the Ahpra website for how to troubleshoot but there wasn’t anything listed. I then tried resetting my password which also didn’t work.’
Unable to reach Ahpra by phone, Ms Arche lodged an online complaint which took some time to resolve.
‘After 2 business days they got back to me with instructions, and said they would send me a new link which never came through,’ she said.
‘I couldn’t reply to the email and I had to lodge a new complaint which took another 2 business days to be answered. [But] my login has been rectified now and I was able to renew my registration.’
Authentication only works with one app
Some pharmacists who set up authentication early – and/or used a different app – have found themselves locked out of the new Ahpra portal.
‘When they updated the portal, I set up new login details and a two-factor authentication app and left it there. This was a few months ago,’ said Melbourne-based pharmacist Heem Yesjusthim.
After logging in again to renew his registration, Mr Yesjusthim was unable to recall what authenticator app he used at the time. But the Google app is now the only one accepted, he said.
‘I looked through my phone and couldn’t find it. Then I looked at the other authentication apps I have (Apple and Microsoft). And none of them showed the Ahpra portal.’
After downloading the Google Authenticator app and attempting to sign up again, Mr Yesjusthim was unable to log in.
‘Once you set up the authentication app the first time, you’re not able to make any changes or log in using other methods,’ he said.
‘If you attempt to log in with another app and you’re at the authentication stage, you’ll notice you can’t go further than that step without a code.
‘Multi-factor authentication is pretty important to prevent hacks and scams but when you implement it, you need to have a system in place to be able to recover your account without the need to call that agency every single time you have an issue logging in.
‘Other ways could be a recovery key that you save somewhere safe, sending a code via message, an automated call back, or you can set up a recovery email or security questions.’
Other pharmacists have also lamented that they’ve submitted multiple contact forms and requested password reset links that never came. While most issues appear to resolve, it takes time.
‘[When I got through on the phone] the lady on the phone was kind and responsive and helped with setting up and logging in quickly from there,’ Yesjusthim said.
AP reached out to Ahpra for comment, and was advised that pharmacists experiencing technical difficulties should visit the advice and information page on Ahpra’s website. Pharmacists can also call the regulator on 1300 419 495 Monday to Friday, 9.00 am – 5.00 pm AEDT.
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[post_excerpt] => The Australian Health Practitioner Regulation Agency has debuted a new platform that many pharmacists have found less than user friendly.
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.
