Advice in relation to dose administration aids and staged supply of dispensed medicines, including re-use of medicines

The Pharmacy Board of Australia Guidelines on dose administration aids and staged supply of dispensed medicines were developed in recognition of the increased demand for dose administration aids (DAAs) and, where used in association with them, automated dose packaging systems. Also addressed is advice on dealing with the supply of medicines to be issued periodically.

Pharmacists may provide DAAs for selected patients to assist in the safe and effective administration of a patient’s medicines and to enhance adherence. In addition to the Board’s Guidelines for dispensing of medicines, the Board has regard to established practice and quality assurance standards, including the DAA service standards and guidelines issued by the Pharmaceutical Society of Australia (PSA). These standards should be considered as part of the process of determining whether the provision of a DAA to a patient is appropriate.

The PSA Professional Practice Standards refer to DAAs in Standard 2 (Responsibility and accountability), Standard 4 (Service delivery), Standard 9 (Medicine packing), and Standard 12 (Medication review). The PSA Guidelines for pharmacists providing dose administration aid services state that the provision of a DAA is a clinical service, and not simply a supply function. Patient safety is paramount; pharmacists providing DAA services must follow robust processes that meet relevant professional practice standards. Particular reference is made to the re-use of medicines. Pharmacists should use professional judgment to determine whether medicines supplied by the patient, hospital or other facility, should be packed into a DAA, with consideration of storage and stability, urgency of supply, patient safety, and other relevant patient factors. Medicines not in original containers or that have illegible or missing expiry dates should not be packed.

In October 2020, Pharmaceutical Defence Limited (PDL) released a national Practice Alert titled “Dosage administration aids”. Despite their purpose to enhance compliance and minimise dosage errors, PDL still receives many reports involving incidents and errors relating to the supply of DAAs. Pharmacy owners and employed pharmacists need to be cognisant that this can be an area of high risk and therefore it is important to have well documented procedures that are adhered to. Consistently accurate packing and checking is imperative to ensure patients are not harmed. In November 2023, PDL released a further national Practice Alert titled “Delaying or declining supply of medication”. PDL would always encourage a pharmacist to be mindful of their obligations and professional expectations before declining to supply a medicine. PDL believes that such a serious action should only be contemplated when the pharmacist has a concern for the patient’s safety. Explanations to the patient should reinforce that all actions are being taken out of concern for the patient’s health and wellbeing. It’s PDL’s understanding that if supply is delayed or declined based on a pharmacist’s clinical decision with a focus on patient safety, then the concern of a regulatory agency is likely to be low.

Under section 41 of the National Law, these guidelines can be used in disciplinary proceedings under the National Law or law of a co-regulatory jurisdiction as evidence of what constitutes appropriate professional conduct or practice for pharmacists.