Escolar Documentos
Profissional Documentos
Cultura Documentos
Pharmacy and
Pharmacistonly medicines
V ol .14
Number 1
february 2013
Counter
Connection
approved QCPP
refresher
training
february 2013
V ol .14
Number 1
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
Pharmacist CPD
04 Facts Behind the Fact Card: Pharmacy and Pharmacist Only medicines
Regulars
03
16
Subscribe to inPHARMation
Pharmaceutical Society of
Australia Ltd. ABN 49 008 532 072
Pharmacy House
PO Box 42, Deakin West ACT 2600
P: 02 6283 4777 F: 02 6285 2869
E: psa.nat@psa.org.au
www.psa.org.au/selfcare
Sponsorship
For sponsorship and advertising enquiries contact
the Sponsorship Manager, Tony Craig on
(02) 9547 3001 or tony.craig@tremedia.com.au
Display units
Email: sales@plasticsfactory.com.au
1800-OZPLASTICS (1800-697-527)
Fax:
1300-OZPLASTICS (1300-697-527)
Web:
www.plasticsfactory.com.au/psa/psa.htm
Gastrointestinal 0099
Indigestion
stomach
Burping
Nausea, loss of appetite
A bloated or full stomach feeling.
liver
large intestine
small intestine
Electronic delivery
The John Bell Health Column is available
weekly by email. If your pharmacy would
like to receive the column, please send
your email details to psc.nat@psa.org.au
170
CPD CReDits
GROUP 2
Visit www.psa.org.au/education/online-learning
PSA3172
2011
Heartburn and
Indigestion
uP to
Pharmacy and Pharmacist Only medicines Pharmacist CPD Module number 234
CPD Credits
GROUP2
This education module is independently researched and compiled by PSA-commissioned authors and peer reviewed.
Theexchange 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.
up to
John Facts
Bell says
Behind the Fact Card
Pharmacy and Pharmacist Only medicines Pharmacist CPD Module number 234
Pharmacists
responsibilities
The pharmacist is responsible for the
safe and judicious provision of nonprescription 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 nonprescription products.
Ken has requested pantoprazole,
aPharmacist Only (S3) medicine,
totreat his symptoms of GORD. Assuch,
theProfessional 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 PharmacistOnly medicine,
pantoprazole is considered to require
professional advice to promote safe and
appropriate use, but is available without
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,
thereforeasking 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 youve 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.
John Facts
Bell says
Behind the Fact Card
Practice point 2
Strategies for responding to
symptom-based requests
1. Gather information by active listening
and reflecting on the consumers
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,
aconsumer 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
theysay.
2. Ask about the consumers 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 Ratherthan
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.
Pharmacy and Pharmacist Only medicines Pharmacist CPD Module number 234
Pharmacist
Pharmacy and Pharmacist Only medicines Pharmacist CPD Module number 234
Resources to support
Pharmacist Only medicine
provision
Continual 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. Thepharmacist responding
to Kens request for pantoprazole, could
refer to the Guidance for the Provision of
a Pharmacist Only medicine; Proton pump
inhibitors (seetable 3) to support the
information gathering and the decision to
supply. Alternatively, if Ken had presented
Table 3. Guidance for provision of a Pharmacist Only medicine Proton pump inhibitors
(PPIs)
Consider professional obligations
A
Professional standards
B Privacy
C Documentation
Refer if necessary
Treatment options
Contraindications and precautions
Use in pregnancy and lactation
Drug interactions
Refer if necessary
Contraindications and precautions
Concurrent medications
Provide counselling
(supported by written information)
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 consumers 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 consumers lifestyle, i.e. smoking,
alcohol, exercise levels be impacting
on their current condition?
-- age Could the consumers age
influence the current condition?
The appropriateness of the medicine:
-- contraindications Is the
recommended treatment
contraindicated due to the
consumers 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 consumers
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?
M Dosage
N
Treatment expectations
O Adverse effects
P
Lifestyle modifications
Q Follow up advice
John Facts
Bell says
Behind the Fact Card
Pharmacy and Pharmacist Only medicines Pharmacist CPD Module number 234
Practice point 4
WHAT-STOP-GO protocol
WHAT-STOP-GO13
Determine WHAT is wrong assess the
patients 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
selftreating 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?
Provideadvice on how to use the
medicine.
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.
Pharmacy and Pharmacist Only medicines Pharmacist CPD Module number 234
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 Facts
Bell says
Behind the Fact Card
Pharmacy and Pharmacist Only medicines Pharmacist CPD Module number 234
Refer if necessary
Recommend treatment
Consider:
Goals of therapy
Treatment options
10
References
1. Harris P, Nagy S, Vardaxis N (eds). Mosbys 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 nonprescription drug consumers understanding of the ranitidine
product label and actual product usage patterns in the
treatment of episodic heartburn. American Journal of
Therapeutics. 2001;8:38798.
4. Covington T. Non-prescription medication and self-careNon-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;15:537.
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
Pharmacy and Pharmacist Only medicines Pharmacist CPD Module number 234
up to
CPD Credits
GROUP2
11
John BellCounter
says Connection
Pharmacy and Pharmacist Only medicines Pharmacy assistants education Module 234
This education module is independently researched and compiled by PSA-commissioned authors and peer reviewed.
Many people visit the pharmacy for advice and to purchase Pharmacy and pharmacist-only medicines.
Gastrointestinal 0099
2011
Heartburn and
Indigestion
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.
Indigestion
oesophagus
stomach
liver
large intestine
small intestine
12
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 PharmacistOnly 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, suchas antacids
previously used by Ken to treat symptoms
Pharmacy and Pharmacist Only medicines Pharmacy assistants education Module 234
Information gathering
Like many customers, Kens 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,
itcan be helpful to use a structured
approach, such as the WHAT-STOP-GO
or CARER protocols (see Facts Behind the
FactCard 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.
Counter Connection
13
John BellCounter
says Connection
Pharmacy and Pharmacist Only medicines Pharmacy assistants education Module 234
14
Pharmacy and Pharmacist Only medicines Pharmacy assistants education Module 234
Counter Connection
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.
15
John Bell
says notice board
Members
February 2013
1 28 Heart Research Month
14
24 Feb
3 March
27
www.ovariancancer.net.au
28
16
Whats coming up
in inPHARMation
Next months 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.