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Vol.14 number 1

february 2013Professional develoPment and Practice suPPort for self care subscribers

Pharmacy and Pharmacist‑only medicines Counter

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2 inPHARMation February 2013 I © Pharmaceutical Society of Australia Ltd.

John bell says

Self care is not only undertaken for minor illness but is often used when managing chronic conditions.

See page 04, Facts Behind the Fact Card: Pharmacy and Pharmacist only medicines

Vol.14 number 1

february 2013

Pharmacist cPd 04 facts behind the fact Card: Pharmacy and Pharmacist Only medicines

Pharmacy assistants’ education12 Counter Connection: Pharmacy and Pharmacist Only medicines

regulars

03 John bell says

16 Members’ noticeboard

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Contents

3inPHARMation February 2013 I © Pharmaceutical Society of Australia Ltd.

self care – a not so secret success strategy by John bell, self care Principal adviser

self care is a major pillar of the established health care system in australia. the concept recognises not only the cost benefit to both the individual and the community, but also the benefits of providing consumers with a sense of ownership, independence and control over their own health.

most commonly self care is applied to treating minor ailments or self-limiting conditions. However, increasingly the management of chronic conditions involves a component of self care. treating gastro-oesophageal reflux or heartburn is an example, described in this issue of InPHARMation, where therapy may be short or long term and might include both medication and lifestyle advice.

Pharmacists and pharmacy assistants play an important role in ensuring that self care strategies are appropriate. Given that self care in the pharmacy environment often involves the supply of non-prescription medicines, we have a responsibility to ensure the products recommended are likely to lead to improved health outcomes.

of course, many non-prescription medicines are available in non pharmacy outlets; but generally the most effective are classified as Pharmacy medicines or Pharmacist Only medicines. this classification system (one which is almost exclusive to australia) takes account of the benefit/risk ratio and of

the level of advice which may be required for optimum use.

no reasonable doctor would make a diagnosis without taking a medical history. similarly, determination as to whether a requested non-prescription product is suitable for a customer will require appropriate questions to be asked. the mnemonic protocols such as WHat, stoP, Go and carer are quite useful but the questions should never be recited by rote. listen closely to the answers customers give and adjust your questions accordingly. Practice Point 1 on page 5 gives tips on how to respond to both product-based and symptom-based requests.

our heartburn case study situation is not uncommon. depending on the location, severity, frequency and duration symptoms and whether any other medicines are being taken, an antacid/alginate (such as Gaviscon or Mylanta), an H2 blocker (such as Gavilast or Zantac) or a PPi (such as Salpraz or Somac) might be suitable. occasionally an antacid /alginate combination may be useful for breakthrough symptoms for a patient on long term or step-down dosing with prescription PPi; it’s something the pharmacist can discuss with the patient.

by definition, Pharmacist Only medicines (the PPis for example) can be supplied only by pharmacists; but the pharmacy assistant needs to know what products are in this category and when to refer. the procedures and protocols are important, but education and specific product

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Self Care is a program of the Pharmaceutical Society of Australia. Self Care is committed to providing current and reliable health information.

Indigestion Indigestion is a general term for uncomfortable symptoms in the upper abdomen (belly). Indigestion is often related to eating or drinking.

Indigestion includes:

•Upperabdominal(belly)discomfort or pain

•Burping

•Nausea,lossofappetite

•Abloatedorfullstomachfeeling.

Indigestion is sometimes caused by a medical condition or by medicines. Sometimes no cause can be found.

Indigestion is an uncomfortable feeling in the upper abdomen. Heartburn is a painful, burning feeling rising up from the stomach or lower chest towards the throat. Medicines, and in some cases simple lifestyle changes, can relieve and

prevent heartburn and indigestion.

Heartburn and Indigestion

Gastrointestinal 0099 2011

oesophagus

stomach

liver

large intestine

small intestine

The Digestive System

knowledge is also essential. for instance the september 2012 issue of InPHARMation gave a comprehensive overview of the management of heartburn.

in any event, always look to add value to your advice with the provision of a self care fact card. case study Ken is the perfect recipient for the information on the Heartburn and Indigestion card (but make sure you know the contents as well); and you can tell your customers the difference between this and search engine information is that the information on the self care cards is up-to-date, accurate and evidence based.

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John bell says


John bell says

Pharmacy and Pharmacist Only medicinesby anna ezzy

learning objectivesafter reading this article, pharmacists should be able to:

• identify the advantages and disadvantages of self-medication

• differentiate between product and symptom-based requests

• discuss the pharmacist’s role in the provision of non-prescription medicines applying the relevant professional practice standard

• contrast the different role of pharmacists and pharmacy assistants in responding to medicine requests

• describe the QcPP training requirement for pharmacy assistants involved in the sale of Pharmacy and Pharmacist Only medicines.

Competencies addressed (2010): 1.1, 1.2, 1.3, 2.3, 2.3, 6.1, 6.2, 6.3,7.1

The exchange of information between consumers and pharmacy staff may be easier in symptom-based requests, as there is greater opportunity to discuss treatment options in response to a clear request for advice.

This education module is independently researched and compiled by PSA-commissioned authors and peer reviewed.

Ken, 45 years-old, presents to the pharmacy requesting over-the-counter (OTC) Somac. He tells you that he experiences a burning sensation in his chest which rises up into his throat. Most commonly he experiences reflux at night after going to bed, usually several nights a week. He has used antacids in the past, which he usually purchases from the supermarket; however his symptoms have been worse than normal in the past few weeks. His sister takes Somac to manage heartburn, and suggested that Ken try it.

Self care including self medicationself care occurs when a person takes ownership of health care decisions for themselves, their family or their friends with regard to preventing, diagnosing and treating health conditions.1 self care is undertaken for managing both minor illness and chronic conditions. self medication is one of the most frequent methods of self care, and involves using non-prescription medicines and devices to manage a health condition. the advantages and disadvantages of self medication are listed in table 1.

symptoms of gastro-oesophageal reflux disease (Gord), described by many consumers as heartburn, are usually mild and intermittent. often symptoms are associated with diet and lifestyle.2 episodic Gord occurs in >30% of individuals3; many consumers manage symptoms with self care, including self medicating with antacids, H2-inhibitor or proton pump inhibitor medicines either independently, or in collaboration with a healthcare professional.

self care in the pharmacy often involves supplying non-prescription medicines. Pharmacists and pharmacy staff have a responsibility to act as gate keepers to assist consumers with self medication.4

requests for non-prescription medicines can be symptom-based, occurring when a consumer asks for advice to treat specific symptoms they are experiencing, or product-based, when the consumer asks for a specific product by name. both present specific challenges for pharmacy staff in ensuring an appropriate response. research has indicated that product-based requests can be more challenging, and that symptom-based requests are more likely to result in an appropriate patient outcome. the exchange of information between consumers and pharmacy staff is often easier for symptom-based requests, as there is greater opportunity to discuss treatment options in response to a clear request for advice.5

in the above scenario, Ken has asked specifically for pantoprazole. the challenge is to determine if pantoprazole will be safe and effective for Ken without making him

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facts behind the fact Card Pharmacy and Pharmacist Only medicines Pharmacist cPd module number 234


feel unnecessarily interrogated. However, consider how the response would need to differ if instead Ken has presented looking for advice about treating his symptoms. to recommend a safe and appropriate treatment, staff need to ask the right questions to understand the type of heartburn symptoms Ken is experiencing and other issues such as any concurrent medicines and medical conditions. strategies for responding to symptom- and product-based requests are discussed in Practice point 1 and 2.

self care and self medication for symptoms of Gord is appropriate for many consumers, however for some, further investigation and management by a medical professional is necessary.2 more information is required from Ken to determine if otc pantoprazole is appropriate for him.

Pharmacists’ responsibilitiesthe pharmacist is responsible for the safe and judicious provision of non-prescription medicines and therapeutic devices appropriate to the needs of the consumer.7 Professional practice standard 12: Provision of non-prescription medicines and therapeutic devices details the responsibilities of the pharmacist when supplying non-prescription products.

Ken has requested pantoprazole, a Pharmacist Only (s3) medicine, to treat his symptoms of Gord. as such, the Professional Practice Standards requires the pharmacist to be directly involved in the sale. medicines in australia are scheduled to control the level of access and availability to protect public health and safety.8 as a Pharmacist Only medicine, pantoprazole is considered to require professional advice to promote safe and appropriate use, but is available without

a prescription. in contrast, Pharmacy Only medicines (s2), such as higher doses of ranitidine also used to treat symptoms of Gord, are considered safe for use and are sold in a pharmacy where professional advice is available if required, or where a pharmacy service is not available from a licenced person. unscheduled medicines, such as antacids previously used by Ken to treat symptoms of heartburn, are considered safe for use without professional advice, and as such are widely available.9

direct involvement does not mean simply acknowledging the sale of a Pharmacist Only medicine. the pharmacist is required to follow a systematic procedure when supplying these medicines, and support and educate pharmacy staff to follow this procedure. this procedure should allow the pharmacist to assess therapeutic need for the product including risks involved with use, monitor for inappropriate use, and provide information and advice on using the product that is relevant to the consumer’s needs. due to the need for the pharmacist’s direct involvement, Pharmacist Only medicines should be stored in an area under the pharmacist’s supervision.7

Practice point 3 provides an overview of the considerations when supplying Pharmacy and Pharmacist Only medicines.

returning to Ken’s request for otc pantoprazole – to assess Ken’s needs, the pharmacist should consider his presenting symptoms, the frequency of symptoms, his age, any previous treatment, and his lifestyle and medical history. Ken’s symptoms of heartburn and regurgitation appear typical of Gord, and symptoms are frequent (>2 times per week, but less than daily). this would indicate that a trial of a proton pump inhibitor, such as pantoprazole is indicated. However consider the following information that the pharmacist obtained when responding to the request.

Table 1. advantages and disadvantages of self medication6

advantages of self medication disadvantages of self medication

Safe and effective when used according to directions Can cause harm if used incorrectly or inappropriately

Reduces time and cost of visiting GP Can worsen some medical conditions

Allows consumers to maintain independence and gain confidence in managing their own health care

Can mask serious medical conditions giving rise to significant consequences

Can be less expensive than some prescribed medicines Can be more expensive than some prescribed medicines

Can reduce the burden on the healthcare system if used appropriately

Can increase the burden on the healthcare system if used incorrectly or inappropriately

Practice point 1

Strategies for responding to product-based requests

research has shown that while many consumers are happy to answer questions in the pharmacy, they prefer not to but asked the same thing every time they request a product.21 often fewer questions are required when a consumer requests a product they have used before, therefore asking about prior use is a helpful opening question. other tips for responding to product requests:

1. explain why you need to ask questions.

Highlight the fact that things may have changed since they last took the medicine, i.e. new medicines or conditions, new symptoms etc.

2. ask how the product worked for them previously.

this open ended question will allow you to prompt them about the efficacy or any side effects they may have experienced.

3. Have them tell you about the product.

rather than asking a whole lot of questions, ask the consumer to summarise how and why they have been using the product, i.e. can you tell me a bit about how you’ve used the product in the past?

4. acknowledge their experience with using the product.

instead of telling the consumer that the medicine needs to be taken with food, remind them, i.e. remember to take it [the medicine] with food.

facts behind the fact CardPharmacy and Pharmacist Only medicines Pharmacist cPd module number 234


John bell says

Practice point 2

Strategies for responding to symptom-based requests

1. Gather information by active listening and reflecting on the consumer’s comments.

there are many protocols that can be used to gather patient information, including WHat-stoP-Go and carer. However, it is still important to actively listen, and reflect on comments the consumer makes to obtain a complete picture of the problem.21 for example, a consumer might state off hand that “they have had the problem for ages”, exploring this more by reflecting on the statement will provide more information about the condition and show the consumer you are listening to what they say.

2. ask about the consumer’s experience with the condition, including past treatment.

asking about the consumer experience with the condition in the past will elicit a wide range of useful information, including duration or recurrence of the condition, how they are affected by the condition, and their response to treatment in the past.

3. Support the consumer to make an informed decision on treatment.

many consumers requesting advice in the pharmacy will want to participate in their own healthcare decisions.21 rather than simply telling the consumer what to do, by instead providing consumers with information, including the advantages and disadvantages of various treatment options, and giving them the chance to elicit their views and preference, they are supported to make an informed decision about their health care.

Ken tells you that he experiences heartburn several times a week, which is considerably more than in the past. Apart from the burning sensation and some regurgitation, he has not noticed any other symptoms or pain. Ken does not have any medical conditions, but has recently stopped smoking. He began using nicotine replacement therapy (NRT) gum a few weeks ago. Apart from antacids and the nicotine gum, he does not take any other medicines.

While Ken’s symptoms are frequent, the pattern of symptoms has changed dramatically in recent weeks so an underlying cause should be suspected. He does not present with any atypical or alarm symptoms, and is not <18 or >55 years of age, which reduces the risk the symptoms relate to an underlying disease. However he has recently started nrt, which is known to precipitate or aggravate symptoms of Gord particularly when an oral preparation such as gum is used.2,10

Ken’s situation highlights the importance of comprehensive information gathering when determining therapeutic need. How does this new information impact upon his therapeutic needs, and the decision to supply pantoprazole? consider how the decision to supply would be affected if Ken had instead reported nausea, cardiac or abdominal pain, belching, cough, bleeding or difficulty swallowing. Whilst Gord is often a mild condition that can be managed by appropriate self care, symptoms can indicate a serious underlying disease. self medication may mask the symptoms and prevent consumers seeking appropriate care.6 this is typical of many conditions treated by Pharmacist Only medicines, and is a key reason why the direct involvement of a pharmacist is essential.

When responding to a request for a non-prescription product, a holistic approach to consumer care is important. this involves formulating therapeutic solutions that address not only the presenting complaint, but any underlying causes or associated symptoms as well. While Ken has presented with symptoms of Gord and provision of a short course of pantoprazole may be appropriate, the pharmacist should address the precipitating factor of the nicotine gum. as well as supplying pantoprazole, the pharmacist could also recommend that Ken consider switching to a transdermal nicotine patch to assess whether this resolved the exacerbation of his symptoms.

Providing advice and information on using medicines is an essential responsibility for pharmacists. medicines information is widely available in the public domain and consumers increasingly obtain information from sources other than healthcare professionals such as from the internet, package inserts, advertisements, from family and friends.11 there is no guarantee regarding the quality of this information, or the consumer’s capacity to interpret it appropriately. a survey of australian adults has suggested that many consumers are not able to correctly answer questions about otc medicines after reading package instructions.12

consider again Ken’s request for otc pantoprazole. this product has been recommended by a family member, Ken has not used it before and may not be capable of determining its appropriateness or safety for his individual circumstances, which are likely to be different to those of his sister. it cannot be assumed that a consumer requesting a particular medicine has used it before, is using it correctly or has determined that it is safe and appropriate for their condition.

related fact cards Heartburn and Indigestion

Table 2. Pharmacy assistant and pharmacist roles in medicines requests

Pharmacy assistant Pharmacist

Asking questions to determine if a medicine is appropriate

Asking additional questions to determine whether referral to another healthcare professional is required

Determining appropriateness of direct product requests and uncomplicated symptom-based requests for Pharmacy medicines. Responding to triggers for referral

Determining appropriateness of more complex symptom-based requests for Pharmacy medicines and direct product requests for Pharmacist Only medicines

Referral to the pharmacist if the person is taking other medicines, has any special needs or circumstances or if the medicine requested is inappropriate

Referral to a general practitioner or other appropriate healthcare professional if the consumer meets the referral criteria

Providing advice on dosage, treatment expectations and adverse events of Pharmacy medicines

Providing advice on dosage, treatment expectations and adverse events of Pharmacist Only medicines



Practice point 3

Considerations when supplying Pharmacy and Pharmacist Only medicines

When recommending or supplying a Pharmacy or Pharmacist Only medicine, important considerations include2:

• the needs of the consumer: - symptoms – What is the likely cause

of the consumer’s symptoms? - medical history – Does the consumer

have any other medical conditions or take any medicines? Could these be contributing to the current condition?

- lifestyle and other factors – Could the consumer’s lifestyle, i.e. smoking, alcohol, exercise levels be impacting on their current condition?

- age – Could the consumer’s age influence the current condition?

• the appropriateness of the medicine: - contraindications – Is the

recommended treatment contraindicated due to the consumer’s medical history?

- drug interactions – Does the recommended treatment interact with any medicine the consumer is taking?

- efficacy of treatment options –Is the treatment effective for the consumer’s condition? Are there any other treatments that should be considered?

• referral points: - does the consumer have any signs

or symptoms that indicate self care is not appropriate?

• counselling and advice: - dose – What is the recommended

dose for the consumer? - how to administer – When and

how should the consumer take the medicine?

- treatment expectations – When should the consumer expect to feel better? When should they seek further medical advice?

- adverse effects – Are they any common or serious adverse effects associated with the treatment?

- other advice – Are there any other things the consumer can do or take to manage the condition?

this is why medicines are scheduled, to promote safe and effective use, and it is why Pharmacy and Pharmacist Only medicines are sold only in pharmacies, where professional healthcare advice is available. Pharmacists should not overlook the need to provide such advice.

resources to support Pharmacist Only medicine provisioncontinual changes to medicines scheduling has meant that there is an increasing number of Pharmacist Only medicines available in pharmacies. some pharmacists may be unsure how to best deal with product- and symptom-based requests, particularly when, like pantoprazole, a medicine is down-scheduled from a prescription only product to a Pharmacist Only product.

the Pharmaceutical society of australia (Psa) produces guidance documents to support the provision of Pharmacist Only medicines. these guides provide a decision-making framework for responding to requests for advice and treating minor ailments. the pharmacist responding to Ken’s request for pantoprazole, could refer to the Guidance for the Provision of a Pharmacist only medicine; Proton pump inhibitors (see table 3) to support the information gathering and the decision to supply. alternatively, if Ken had presented

with a symptom-based request, reference to the Gastro-oesophageal reflex disease counselling guide in the aPf22 (see table 4) may have helped to inform the recommendation of an appropriate management solution. Guidance documents and counselling guides are available in the Australian Pharmaceutical Formulary and Handbook 22nd edition2, or to Psa members at www.psa.org.au

the role of pharmacy support staff Pharmacy assistants are usually the consumer’s first point of contact in the pharmacy, and as such they are going to be involved in the majority of consumer interactions in the pharmacy. there are many areas where, with appropriate training including the use of protocols such as WHat-stoP-Go13 and carer14 (see Practice point 3), pharmacy assistants should be well equipped to provide advice. However, there are some areas such as complex symptom-based requests and providing Pharmacist Only medicines where pharmacist involvement is necessary. Perhaps one of the pharmacy assistant’s most important roles is being able to make this distinction, and recognising when referral to the pharmacist is required.

the pharmacy assistant’s role is particularly important in managing pharmacy workflow.

Table 3. Guidance for provision of a Pharmacist Only medicine – Proton pump inhibitors (PPIs)

Australian Pharmaceutical Formulary and Handbook, 22nd Edition.

Consider professional obligations A Professional standards B Privacy C Documentation

Assess patient’s needsConsider: D Presenting signs and symptoms E Symptom frequency F Age G Any prior treatment H Lifestyle and medical history

Confirm therapy is appropriateConsider: I Treatment options J Contraindications and precautions K Use in pregnancy and lactation L Drug interactions

Provide counselling (supported by written information)

M Dosage N Treatment expectations O Adverse effects P Lifestyle modifications Q Follow up advice

Refer if necessary• Atypical or alarm symptoms are present• Symptoms occurring daily • Aged >55 years with recent onset symptoms• Aged <18 years• Inadequate symptom control after two weeks of continuous

PPI therapy• Prolonged or recurrent use of a PPI without medical investigation • Family history of gastrointestinal cancer• Taking long-term NSAID therapy • Taking medications suspected of aggravating reflux symptoms

Refer if necessary• Contraindications and precautions• Concurrent medications



John bell says

scheduled medicines and scheduling changes can have a direct impact on workflow in the pharmacy. the requirement for direct involvement by the pharmacist in the sale of Pharmacist Only medicines can interrupt dispensary and other professional activities. this direct involvement does not require the pharmacist to complete all aspects of the sale. as part of a systematic procedure for dealing with a Pharmacist Only medicine request, pharmacy assistants are able to gather relevant information and pass this information to the pharmacist, allowing them to respond appropriately. by training and supporting pharmacy staff to follow a systematic procedure, the pharmacist can be confident that the pharmacy assistant has obtained all the relevant information from the consumer. When pharmacy assistants are capable and confident in performing this role the pharmacist has more time to complete the tasks that pharmacy assistants cannot perform.

it is likely that Ken’s first point of contact will be a pharmacy assistant. With appropriate training, there is no reason that this person could not gather the relevant information to assist the pharmacist to appropriately manage the request for pantoprazole. in this scenario, the precipitating factor of the nicotine gum would be uncovered by questioning and appropriate use of protocols; T: Treatment for this or any other condition in WHat-stoP-Go or C: Check other medications in the carer protocol. this information should be relayed to the pharmacist who can then provide further

advice and appropriate treatment.

Staff training Having well-trained and confident pharmacy support staff is integral to enabling them to work safely and effectively, maximising their roles in the pharmacy and allowing pharmacists to concentrate on their professional activities.

Practice point 4

WHaT-STOP-GO protocol

WHAT‑STOP‑GO13

Determine WHAT is wrong – assess the patient’s current medicines and health status.

W – Who is the patient?

h – How long have symptoms been present?

a – actual symptoms -What are they?

t – treatment for this or any other condition?

STOP and assess the situation.

S – symptoms or side effects caused by other conditions and/or medicines?

t – totally sure? any special patient needs or circumstances?

o – overuse/abuse – how long has the patient been taking the medicine or self-treating the condition?

P – Pharmacist Only – always refer to the pharmacist. check whether the patient would like to speak to the pharmacist.

GO – Supply the medicine if appropriate and provide advice.

ask the patient if they have any further questions. Would the patient like a cmi for the Pharmacist Only medicine? Provide advice on how to use the medicine.



in collaboration with the pharmacist, pharmacy assistants are involved in ensuring the health and well-being of consumers. the sale of Pharmacy and Pharmacist Only medicines is a pharmacy assistant’s key role and they need to be empowered to provide professional advice to consumers requesting otc medicines.

the importance of appropriate training is highlighted in the following scenario:

Kristy is a pharmacy assistant who has been working in the pharmacy for several months. She has no formal pharmacy assistant training, and although she is keen to learn it is hard to find the time to teach her. Kristy has excellent communication skills and is great with customers. However she lacks confidence when it comes to the sale of Pharmacy and Pharmacist only medicines.

Kristy is working when Ken comes in to the pharmacy for pantoprazole. Kristy has not sold pantoprazole before, but she knows it is kept in the dispensary. Kristy is not confident in asking Ken any questions about his condition, but she does not want to bother the pharmacist as she can see he is busy dispensing prescriptions. She assumes that since Ken has asked for pantoprazole, he must have used it before or had it recommended to him by his GP, so she sells it to him along with some nicotine gum.

Whilst in this scenario it is unlikely that Ken would suffer serious harm, consider how this would be different if he had experienced an alarm sign associated with his heartburn symptoms, for example gastro-intestinal bleeding or difficulty swallowing. the supply of pantoprazole could delay diagnosis of a serious underlying condition. the potential consequences for Ken could have been disastrous. although the pharmacist was not aware of Kristy’s actions, while they are on duty, the pharmacist is responsible for the sale of all medicines in the pharmacy. as a result the pharmacist would have been responsible for any adverse consequences Ken suffered as a result of the inappropriate use of pantoprazole.

Quality care Pharmacy Program (QcPP) accreditation requires that all pharmacy assistants involved in the sale of Pharmacy and Pharmacist Only medicines complete the accredited training unit Support the sale of Pharmacy and Pharmacist only medicines.15 this unit forms part of the certificate ii in community Pharmacy,

a nationally recognised training course providing entry level education for pharmacy assistants new to working in pharmacy. the course also covers health product knowledge, administration, sales and marketing, service delivery and dispensary operations.16 However, the unit Support the sale of Pharmacy and Pharmacist only medicines can also be delivered on its own.17

in addition to compulsory training on the sale of Pharmacy and Pharmacist Only medicines, pharmacy assistants should be encouraged to complete regular education activities to improve and update their knowledge of healthcare products and conditions. QccP accreditation requires that pharmacy assistants complete three hours of refresher training on Pharmacy and Pharmacist Only medicines per year after initial accredited training is completed.15 Pharmacists can work with staff to help them identify knowledge gaps where additional training and education would be beneficial, and to formulate a training plan to meet these needs. the self care Counter Connection modules are designed specifically for pharmacy assistants, and provide training and education in disease states and treatment options on many conditions that are commonly treated in pharmacy, not just Pharmacy and Pharmacist Only medicines.

the modules assist pharmacy assistants identify their role in managing specific healthcare conditions; modules focus on the appropriate use and counselling points for otc products, and outline circumstances in which consumers should be referred to the pharmacist. the september 2012 issue of InPHARMATION18 focused on symptoms and treatment of Gord, and may have provided Kristy with the knowledge and confidence to better handle the scenario outlined above.

applying knowledge is an important aspect of education and training. it is important that pharmacy assistants have the opportunity to regularly practice and receive feedback on the skills and knowledge they have acquired.19,20 Pharmacists can work with pharmacy assistants to reinforce the knowledge they acquire through education activities, and apply it in the context of the every-day practice in the pharmacy.

Practice point 5

Carer pxrotocol

CARER14

C- Check

• WHo is the patient?

• WHat are the symptoms?

• WHat has been tried?

• HoW lonG have the symptoms been present?

• other medication?

• other conditions?

a-assess

• diagnosis clear?

• medication therapy most aPProPiate?

• Possible interactions?

• trained and confident?

r-respond

• recommend appropriate therapy?

• refer if uncertain

• reconsider if medication inappropriate

e-explain

• verbal directions

• Written support

• WHat to do if not improved

• reasons for referral

r-record

• if leGallY reQuired

• Provide onGoinG care

• if referred

• if misuse/abuse suspected



John bell says

Table 4. Treatment of gastro-oesophageal reflux disease: a summary

for Kristy, this may involve asking her about the information in the Gord Counter Connection, and have her relay it back to you in the context of a consumer request and interaction. supervising Kristy when she is supplying Pharmacy Only medicines may also provide the opportunity for the pharmacist to provide feedback to reinforce her learning and improve her performance.

Self care and the pharmacy facilitating self care through the provision of Pharmacy and Pharmacist Only medicines is an important role of pharmacies. supplying Pharmacy and Pharmacist Only medicines not only has the potential to impact on consumer health and well-being, but is also an important aspect of pharmacy business and profitability. ensuring that the sales of Pharmacy and Pharmacist Only medicines is managed appropriately through staff training, use of resources and adherence to professional standards is essential for the ongoing success of any pharmacy.

references1. Harris P, Nagy S, Vardaxis N (eds). Mosby’s dictionary of

medicine, nursing and health professions. 2nd edn. Sydney: Elsevier; 2010. p. 1562.

2. Pharmaceutical Society of Australia. Australian pharmaceutical formulary and handbook. 22nd edn. Canberra: The Pharmaceutical Society of Australia; 2012.

3. Ciociola A, Sirgo M, Pappa K, et al. A study of the non-prescription drug consumers understanding of the ranitidine product label and actual product usage patterns in the treatment of episodic heartburn. American Journal of Therapeutics. 2001;8:387–98.

4. Covington T. Non-prescription medication and self-care- Non-prescription drug therapy: Issues and Opportunities. American Journal of Pharmaceutical Education. 2006;70(60): article 137.

5. Watson M, Bond C, Grimshaw J, Johnston M. Factors predicting the guideline complaint supply (or non-supply) of non-prescription medicines in the community pharmacy setting. Qual Saf Health Care. 2006;15:53–7.

6. Repchinsky C (ed). Patient self-care: helping your patients make therapeutic choices. 2nd edn. Ottawa: Canadian Pharmacists Association: 2010.

7. Pharmaceutical Society of Australia. Professional Practice Standards. Version 4. Canberra: Pharmaceutical Society of Australia. 2010.

8. Australian Government Therapeutic Goods Administration. Scheduling basics. 2012; At: www.tga.gov.au/industry/scheduling-basics.htm

9. Australian Government Department of Health and Ageing and Therapeutic Goods Administration. Poisons Standard 2012.Canberra; Commonwealth of Australia: 2012.

10. Rossi S (ed). The Australian Medicines Handbook. Adelaide: Australian Medicines Handbook; 2012.

11. Morgan T, Williamson M, Stewart K, et al. Medicines information seeking behavior: data for the National Census of Medicines Use. Melbourne: National Prescribing Service; 2010.

12. Communication Research Institute of Australia. How over the counter (OTC) medicines labels performed in Australia before 2005. 2011; At: www.communication.org.au/g_info/labelling_in_oz.htm

13. Pharmacy Guild of Australia and Pharmaceutical Society of

Australia. WHAT-STOP-GO protocol for providing pharmacy medicines and pharmacist-only medicines. At: http://beta.guild.org.au/uploadedfiles/Quality_Care_Pharmacy_Program/Accreditation/standardsprotocols.pdf

14. Pharmacy Guild of Australia and Pharmaceutical Society of Australia. CARER protocol for providing pharmacy medicines and pharmacist-only medicines. At: http://beta.guild.org.au/uploadedfiles/Quality_Care_Pharmacy_Program/Accreditation/standardsprotocols.pdf

15. Pharmacy Guild of Australia. Quality Care Pharmacy Program implementation information and rulings. 2012; At: www.qcpp.com/iwov-resources/documents/QCPP/QCPP/Standards/Implementation%20and%20Rulings/ImplementationandRulings.pdf

16. Pharmaceutical Society of Australia. Certificate II in community pharmacy. 2012; At: www.psa.org.au/education/certificates-and-diplomas/certificate-ii-in-community-pharmacy

17. Pharmaceutical Society of Australia. Pharmacy and pharmacist-only medicines (S2/S3) competency unit. 2012; At: www.psa.org.au/education/certificates-and-diplomas/s2s3-unit-sirppks001a

18. Thompson M. Gastro-oesophageal reflux disease; In InPHARMATION Sep 2012. Canberra: Pharmaceutical Society of Australia. 2012.

19. Egle C. A guide to facilitating adult learning, Canberra: Rural Health Education Foundation. 2009.

20. Pharmaceutical Society of Australia. National competency standards framework for pharmacist in Australia. Canberra: Pharmaceutical Society of Australia. 2010.

21. Blenkinsopp A, Paxton P, Blenkinsopp J. Symptoms in the pharmacy: A guide to the management of common illness. 6th edn. West Sussex: Blackwell Publishing. 2009.

Australian Pharmaceutical Formulary and Handbook, 22nd Edition.

Gather patient informationConsider: Symptoms Symptom frequency Patient characteristics Prior treatment Medical and lifestyle history

Assess patient needsConsider: The need to refer

Recommend treatmentConsider: Goals of therapy Treatment options

Provide counselling supported by written information

Consider: How to use the medicine Adverse effects Follow-up advice

Refer if necessary• Dysphagia (difficulty swallowing)• Odynophagia (painful swallowing)• Nocturnal choking• Suspected gastrointestinal bleeding • Persistent nausea and vomiting • Unintentional weight loss• Cardiac-type chest pain • Symptoms occurring daily • Family history of gastrointestinal cancer • Long-term NSAID therapy• Symptoms not adequately controlled after a 2-week

trial of initial therapy • First-time symptoms in people >55 years of age• People <18 years of age



assessment questions for the pharmacistSelect one correct answer from each of the following questions. answers due 31 March 2013.

before undertaking this assessment, you need to have read the facts behind the fact card article and the associated fact cards.this activity has been accredited by Psa as a Group 2 activity. two cPd credits (Group 2) will be awarded to pharmacists with four out of

five questions correct. Psa is authorised by the australian Pharmacy council to accredit providers of cPd activities for pharmacists that may be used as supporting evidence of continuing competence.

Submit answers onlineto submit your response to these questions online, go to the Psa website www.psa.org.au

accreditation number: cs13001

this activity has been accredited for Group 2 cPd (or 2 cPd credits) suitable for inclusion in an individual pharmacist’s cPd plan.

2GrouP 2

uP

TO

cPd creditS

1. Which of the following is True with regard to self care?

a. self care involves only the treatment of health conditions.

b. self care occurs when a health professional takes ownership of healthcare decisions for themselves, their family or their friends.

c. self care is only appropriate to treat minor illness.

d. self medication is a form of self care.

2. Which of the following is NOT a role of a pharmacy assistant?

a. asking questions to determine if a medicine is appropriate.

b. Providing advice on dosage, treatment expectations and adverse events for Pharmacy medicines.

c. determining if referral to a general practitioner is required.

d. Handling uncomplicated symptom-based requests.

3. Quality Care Pharmacy Program (QCPP) accreditation requires that all pharmacist assistants:

a. be enrolled in the certificate ii in community pharmacy.

b. involved in the sale of Pharmacy and Pharmacist Only medicines complete the accredited training unit Support the sale of Pharmacy and Pharmacist only medicines.

c. complete three hours of refresher training on Pharmacy and Pharmacist Only medicines per year after initial accredited training is completed.

d. b) and c).

4 . What does Carer in the Carer protocol for providing Pharmacy and Pharmacist Only medicines stand for?

a. check, assess, respond, explain, refer.

b. check, ask, respond, explain, review.

c. check, assess, respond, explain, record.

d. check, assess, review, explain, record.

5. Consider the case of Kristy explained in the article, which of the following is MOST correct?

a. Kristy is not responsible for the sale of an inappropriate product because she has no formal pharmacy qualification.

b. Kristy is responsible because she didn’t tell the pharmacist what she was doing.

c. Kristy would have been responsible for the sale of an inappropriate medicine if it had been a Pharmacy medicine instead of a Pharmacist Only product.

d. the pharmacist is ultimately responsible for the sale of all medicines in the pharmacy whilst they are working.



John bell says

Ken, 45 years-old, presents to the pharmacy requesting something to help his heartburn. He tells you that he experiences a burning sensation in his chest that rises up into his throat. He experiences reflux after going to bed, usually several nights a week. He has used antacids in the past, however he mentions his sister takes Rani 300 (ranitidine) to manage heartburn, and she suggested it may help him too.

Pharmacy and Pharmacist‑only medicinesby anna ezzy

Many people visit the pharmacy for advice and to purchase Pharmacy and pharmacist-only medicines.

This education module is independently researched and compiled by PSA-commissioned authors and peer reviewed.

Self care and self medicationself care occurs when a customer takes responsibility for the prevention, diagnosis or treatment of a health condition. self care commonly occurs when customers treat minor illness; however the management of chronic conditions can also involve a component of self care. self medication is one of the most frequent methods of self care, and involves the use of non-prescription medicines and devices to treat a health condition. many people visit the pharmacy for advice and to purchase Pharmacy and Pharmacist Only medicines.

the symptoms of heartburn that Ken is describing are known medically as gastro-oesophageal reflux disease (Gord). Gord is often mild and intermittent and can be caused by diet and lifestyle factors.

it occurs in >30% of people and many manage symptoms with self care. there are various medicines available in the pharmacy to help manage the symptoms of Gord.

Scheduling of non-prescription medicines

medicines in australia are scheduled according to the need for professional advice to enable customers to use the medicines appropriately. as a Pharmacy medicine, ranitidine is considered safe for use but is sold in a pharmacy where professional advice is available if required. not all customers using Pharmacy medicines will need advice from the pharmacist, but pharmacy assistants need to be aware of circumstance where referral is required. in contrast the sale of all Pharmacist Only medicines, including proton pump inhibitors such as pantoprazole, omeprazole and rabeprazole also used to treat symptoms of Gord, require the professional advice of the pharmacist to promote safe and appropriate use. they must be stored in an area under the supervision of the pharmacist. as a pharmacy assistant, it is important to be aware of how to handle customer requests for these products. unscheduled medicines, such as antacids previously used by Ken to treat symptoms

Self Care is a program of the Pharmaceutical Society of Australia. Self Care is committed to providing current and reliable health information.

Indigestion Indigestion is a general term for uncomfortable symptoms in the upper abdomen (belly). Indigestion is often related to eating or drinking.

Indigestion includes:

•Upperabdominal(belly)discomfort or pain

•Burping

•Nausea,lossofappetite

•Abloatedorfullstomachfeeling.

Indigestion is sometimes caused by a medical condition or by medicines. Sometimes no cause can be found.

Indigestion is an uncomfortable feeling in the upper abdomen. Heartburn is a painful, burning feeling rising up from the stomach or lower chest towards the throat. Medicines, and in some cases simple lifestyle changes, can relieve and

prevent heartburn and indigestion.

Heartburn and Indigestion

Gastrointestinal 0099 2011

oesophagus

stomach

liver

large intestine

small intestine

The Digestive System

related fact cards Heartburn and Indigestion

Counter Connection Pharmacy and Pharmacist Only medicines Pharmacy assistant’s education module 234


Many people visit the pharmacy for advice and to purchase Pharmacy and pharmacist-only medicines.

of heartburn, are considered safe for use without professional advice, and as such are widely available outside the pharmacy including from supermarkets, convenience stores and petrol stations.

Symptom-based and product-based requests

Pharmacists and pharmacy staff have a responsibility as gate keepers to the sale of Pharmacy and Pharmacist Only medicines to ensure these products are used safely and effectively. requests for non-prescription medicines can be symptom-based, occurring when a customer asks for advice to treat specific symptoms they are experiencing or product-based when the customer asks for a specific product by name. both types of request present specific challenges for pharmacy staff.

in the scenario above, Ken has asked specifically for ranitidine. the challenge is to determine if ranitidine will be safe and effective for Ken without making him feel unnecessarily interrogated. the response will however need to differ if Ken has presented looking for advice about treating his symptoms. to provide advice and recommend a safe and appropriate treatment, Ken needs to be asked the right questions for you to gain an understanding of the heartburn symptoms Ken is experiencing, and other circumstances such as concurrent medicines and medical conditions. self care and self medication for symptoms of Gord is appropriate for many customers; however more information is required to determine if ranitidine is appropriate for Ken.

role of the pharmacy assistant in medicines requestsas a pharmacy assistant you are probably the customer’s first point of contact in the pharmacy, and will be involved in the majority of medicine requests. there are many areas where, with appropriate training, pharmacy assistants should be well equipped to gather relevant information and provide advice on suitable treatment. However there are some areas such as complex symptom-based requests and the provision of Pharmacist Only medicines where pharmacist involvement is necessary. it is important to be able to make this distinction, and recognise when referral to the pharmacist is required. the role of the pharmacist and pharmacy assistant in responding to medicines requests are contrasted in table 1.

information gatheringlike many customers, Ken’s first point of contact will probably be a pharmacy assistant. the first step in responding to Ken is to gather the relevant information to determine if ranitidine will be safe and effective to treat his symptoms. to ensure that you obtain all relevant information, it can be helpful to use a structured approach, such as the WHat-stoP-Go or carer protocols (see Facts Behind the Fact Card Practice points).

Ken has had heartburn on and off for several years. apart from the burning sensation and some regurgitation, he has not noticed any other symptoms or pain. Ken does not have any medical conditions and apart from antacids he does not take any other medicines. He admits that he has started smoking again after quitting for several years. You notice that Ken is also overweight.

Ken has not reported any atypical or alarm symptoms such as difficulty swallowing, persistent vomiting, bleeding, or unintentional weight loss. He is not <18 or >55 years of age, which also reduces the risk of the symptoms being caused by underlying disease. However smoking and being overweight can precipitate symptoms of Gord and may be contributing to his heartburn. it would be reasonable to sell Ken ranitidine, with advice that quitting smoking and trying to lose weight may help him manage his symptoms.

However, consider if Ken had told you that he had noticed blood in his stools or was taking another medicine? How would this new information affect your the decision to supply ranitidine? alarm symptoms, such as gastrointestinal bleeding, or the use of other medicines are triggers that require referral to the pharmacist. While Gord is often a mild condition that can be managed by appropriate self care, some symptoms can indicate a serious underlying disease. self medication may mask the symptoms and prevent customers seeking appropriate care. certain medicines and nicotine replacement therapy can precipitate symptoms of Gord. these issues are typical of many conditions treated by Pharmacy and Pharmacist Only medicines, and are a key reason why it is essential that you obtain all relevant information before selling a Pharmacy medicine.

Providing information and advice Providing information and advice to customers on the use of Pharmacy medicines is an important role of the pharmacy assistant. information about different medicines is widely available to the public; customers can obtain information not only from healthcare professionals but from the internet, package inserts, advertisements, and like Ken from family and friends. there is no guarantee that this information is accurate and correct, or that the customer will interpret it appropriately. a survey of australian adults has suggested that many customers may not be able to correctly answer questions about non-prescription medicines after reading package instructions.

consider again Ken’s request for ranitidine. this product has been recommended by a

role of the pharmacy assistant role of the pharmacist

Asking questions to determine if a medicine is appropriate

Asking additional questions to determine whether referral to another healthcare professional is required

Determining appropriateness of direct product requests and uncomplicated symptom-based requests for Pharmacy medicines.

Determining appropriateness of more complex symptom-based requests for Pharmacy medicines and direct product requests for Pharmacist Only medicines

Referral to the pharmacist if the person is taking other medicines, has any special needs or circumstances or if the medicine requested is inappropriate

Referral to a general practitioner or another appropriate healthcare professional if the customer meets the referral criteria

Providing advice on dosage, treatment expectations and adverse events of Pharmacy medicines

Providing advice on dosage, treatment expectations and adverse events of Pharmacist Only medicines

Table 1. Pharmacy assistant and pharmacist roles in medicines requests.

Counter ConnectionPharmacy and Pharmacist Only medicines Pharmacy assistant’s education module 234


John bell says

family member; Ken has not used it before and may not be capable of determining if it is appropriate for his condition. in addition, his symptoms and circumstances may be different to those of his sister. You should not assume that a customer that directly requests a Pharmacy or Pharmacist Only medicine has used it before, is using it correctly or has determined that it is safe and appropriate for their condition. Pharmacy and Pharmacist Only medicines are sold only through pharmacies specifically so healthcare advice is available. You should not overlook the need to provide such advice.

referring to the pharmacistalthough pharmacy assistants can provide customers with information and advice on non-prescription medicines, there are some situations that require referral to the pharmacist. While the sale of all Pharmacist Only medicines need to be referred, some requests for Pharmacy medicines or complex symptom based requests may also need the advice of the pharmacist. through comprehensive information gathering, pharmacy assistants can determine when referral to the pharmacist is needed. the triggers for referral are different for every medicine and condition; however common situations that require referral are listed in table 2.

Workflow in the pharmacyPharmacy assistants can assist with managing workflow in the pharmacy. the pharmacist does not need to complete all aspects of a Pharmacist Only medicine sale. Pharmacy assistants can gather relevant information from the customer to help the pharmacist to respond appropriately. by following set protocols for gathering information, the pharmacist can have confidence that you have

gathered all relevant information from the customer. Pharmacy assistants who are capable and confident to perform this role allow the pharmacist to complete other professional duties.

assume that Ken had requested a Pharmacist Only medicine such as Somac (pantoprazole) to treat his symptoms. as a Pharmacist Only medicine, the pharmacist would need to be directly involved in the sale. However, as a trained and experienced pharmacy assistant, there is no reason that you could not gather the relevant information from Ken, and relay this to the pharmacist. With the information you provide, the pharmacist may proceed with the sale of pantoprazole or decide to discuss Ken’s condition further with him. either way, the involvement of the pharmacy assistant has improved workflow efficiency.

education and training

education and training in your role as a pharmacy assistant will improve your knowledge and confidence. this enables you to work safely and effectively with more responsibilities, allowing the pharmacist to concentrate on their professional activities. the sale of Pharmacy and Pharmacist Only medicines is a key role of the pharmacy assistant.

consider the scenario below.

Kristy has been working in your pharmacy for several months. She has no formal pharmacy assistant training, and although she is keen to learn it is hard to find the time to teach her. Kristy is great with customers; however she lacks confidence when it comes to handling medicine requests.

Kristy is working when Ken comes in to the pharmacy for rani 300. Kristy knows that it is a Pharmacy medicine so she doesn’t need to bother the pharmacist. However Kristy is not confident in asking Ken any questions about his condition as she does not know anything about heartburn. She assumes that since Ken has asked for rani 300, he must have used it before or had it recommended to him by his GP.

Without asking any questions, Kristy could not determine if ranitidine is appropriate for Ken, or whether he should be referred to the pharmacist. in this case it is likely that Ken is experiencing uncomplicated Gord and ranitidine is appropriate to treat his symptoms. However consider if for example, Ken been experiencing signs of bleeding. selling Ken ranitidine may delay the diagnosis of a serious underlying condition.

the Quality care Pharmacy Program (QcPP) accreditation requires that all pharmacy assistants involved in the sale of Pharmacy and Pharmacist Only medicines complete the accredited training unit Support the sale of Pharmacy and Pharmacist Only medicines. in addition, it is important to complete regular education activities to improve and update your knowledge of healthcare products and conditions. QcPP accreditation also requires pharmacy assistants to complete three hours of refresher training on Pharmacy and Pharmacist Only medicines per year after initial accredited training is completed.the self care Counter Connection modules are designed specifically for pharmacy assistants, and relevant ones are approved QcPP refresher training. the september 2012 issue of InPHARMation focused on symptoms and treatment of Gord, and may have provided Kristy with the knowledge and confidence to better handle Ken’s request.

Self care and the pharmacy the sale of Pharmacy and Pharmacist Only medicines is an important role of pharmacies. supply of these medicines can impact customer health and well-being, and is also an important aspect of pharmacy business and profitability. confident and capable pharmacy assistants can help ensure that customers use Pharmacy and Pharmacist Only medicines appropriately.

Counter Connection

Customer has requested a product that is not appropriate to treat their symptoms

Symptoms are recurring, persistent, or have worsened

Young or elderly customers Customer has atypical/alarm symptoms

Customers with other medical conditions Pregnant or breastfeeding customers

Customers taking other medicines Customers with allergies

Treatment requested has not worked or has caused side effects

You are unsure or suspect misuse or abuse

Table 2. Situations that may require referral to the pharmacist

Pharmacy and Pharmacist Only medicines Pharmacy assistant’s education module 234


1. a symptom-based request:

a. occurs when a consumer asks for advice on treating specific symptoms they are experiencing.

b. must always be handled by a pharmacist.

c. involves the provision of advice, but never a product sale.

d. a) and b).

2. Substances, the safe use of which May require advice from a pharmacist and which should be available from a pharmacy, are beST described as a;

a. Prescription medicine.b. Pharmacist Only medicine.c. Pharmacy medicine.d. unscheduled medicine.

3. Which of the following is not a role of a pharmacy assistant?

a. asking questions to determine if a medicine is appropriate.

b. Providing advice on dosage, treatment expectations and adverse events for Pharmacy medicines.

c. determining if referral to a general practitioner is required.

d. Handling uncomplicated symptom-based requests.

4. Quality Care Pharmacy Program (QCPP) accreditation requires that all pharmacy assistants involved in the sale of Pharmacy and Pharmacist Only medicines complete the following training?

a. the accredited training unit support the sale of Pharmacy and Pharmacist Only medicines.

b. three hours of refresher training on Pharmacy and Pharmacist Only medicines per year after initial accredited training is completed.

c. no specific training is required.d. a) and b).

5. What does Carer in the Carer protocol for providing Pharmacy and Pharmacist Only medicines stand for?

a. check, assess, respond, explain, refer.

b. check, ask, respond, explain, review.

c. check, assess, respond, explain, record.

d. check, assess, review, explain, record.

6. Which of the following situations may require referral to the pharmacist?

a. the customer has any other medical conditions and/or is taking other medicines.

b. the customer is experiencing side effects from the medicine.

c. symptoms are not typical of the condition which the customer has self-diagnosed.

d. all of the above.

assessment questions for the pharmacy assistantSelect one correct answer from each of the following questions. answers due 31 March 2013.before undertaking this assessment, you need to have read the counter connection article and the associated fact cards. Photocopy and/or use the answer sheet provided. make sure to include your id number.

the pass mark for each module is five correct answers. Participants receive one credit for each successfully completed module. on completion of 10 correct modules participants receive an achievement certificate.

Submit answers onlineto submit your response to these questions online, go to the Psa website: www.psa.org.au

Counter ConnectionPharmacy and Pharmacist Only medicines Pharmacy assistant’s education module 234


John bell says

conferences15th Annual Health Congress 27 – 28 February and 1 MarchRadisson Blu Plaza Sydney NSWww.informa.com.au/healthcongress

2013 Annual Therapeutic Update – March Weekend1 – 3 MarchCrowne Plaza, Terrigal NSWwww.psa.org.au

The Australian Pharmacy Professional Conference 201321 – 24 MarchGold Coast Convention and Exhibition Centre, QLDwww.appconference.com

10th Annual Future of the Pharmaceutical Benefits Scheme Summit 29 – 30 April Sydney Harbour Marriott Hotelwww.informa.com.au/pbs

The 38th PSA Offshore Refresher Course 20132 – 9 May plus pre and post toursLondon, Englandwww.psa.org.au

National health calendar datesFebruary 2013

1 – 28 Heart Research Month Heart Research Australia

www.redfeb.com.au

1 – 28 Ovarian Cancer Awareness MonthOvarian Cancer Australia

www.ovariancancer.net.au

4 World Cancer DayCancer Council Queensland

14 Heart Research DayHeart Research Australia

www.redfeb.com.au

24 Feb –

3 March

Donate Life WeekOrgan and Tissue Authority

www.donatelife.gov.au

27 Teal Ribbon DayOvarian Cancer Australia

www.ovariancancer.net.au

28 International Rare Disease DayRare Voices Australia Ltd

www.rarevoices.org.au

conferences and calendar dates

Members notice board

What’s coming up in inPHARMationNext month’s inPHarMation will cover the topic of immunisation. In this issue immunisation and vaccines are defined, their role in managing the worldwide threat of disease, outline of commonly used vaccines and the important role of pharmacists and pharmacy staff in promoting immunisation in the community is discussed.

The issue will also look at who should receive vaccines, practical information on how to answer frequently asked questions about vaccines and immunisation and how to address any adverse effects of vaccines.

You only dispense medicines

before their expiry date,

so how do you feel about

using reference texts that

have passed theirs?

Every pharmacy needs an APF22.Is there an APF22 in your pharmacy?

Order now at www.psa.org.au/shop

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