Challenges during the holiday season

As the year nears its end, it is even more important for practitioners to be aware of additional time constraints and challenges faced in community pharmacy practice during the holiday season.

When the volume of work increases so, too, does the risk of error. It is critical that practitioners are vigilant and adhere to best practice dispensing guidelines.

Regular communication is a critical component of the relationship between practitioners and their non-professional staff. It is prudent to conduct staff meetings to review Standard Operating Procedures, ensure staff are aware of all policies and procedures, and confirm that there is agreement by staff on workplace policies.

Often, there is pressure during this time from patients to supply medication as an ‘emergency supply’. Please ensure you are aware of the policies and protocols to which all staff must adhere and ensure practitioners and staff abide by all legislative requirements.

During the holiday period, many patients are likely to seek early dispensing because of their travel arrangements. It is critical to abide by the legislation and guidelines applicable to dispensing prescriptions earlier than normal.

The Ahpra shared code of conduct refers to patient care is a pharmacist’s primary concern in clinical practice. Providing good care includes that pharmacists facilitate coordination and continuity of care.

A case study in relation to ‘Emergency supply and Continued Dispensing’

You are working in a small seaside town that gets very busy during the holidays with travellers from the city. A person presents to the pharmacy. They explain that they have been travelling, have had their car break down and that it requires servicing, resulting in them running out of their regular medications. They have not been able to get in contact with their usual GP to get another script, and they don’t leave their scripts on file with their usual pharmacy. You know the local GP surgery is closed this week, as the doctor is on holidays, and the nearest emergency hospital is two hours away.

The medications the patient is taking are metformin 1000mg MR, irbesartan 300mg, apixaban 5mg and Flutiform 250/10 inhaler. What do you do?

In NSW, a pharmacist may supply certain PBS medicines under the Continued Dispensing arrangements. In order to supply under this arrangement, you should ensure that:

  • the person has an immediate need for the medicine before a prescription can be obtained
  • the usual prescriber is unable to be contacted and/or is unable to provide an e-prescription or owing prescription
  • the medicine is eligible for supply under the arrangements (including under relevant state/territory legislation)
  • the person has been supplied the medicine in the last three months and their condition is stable
  • the medicine has not been supplied under Continued Dispensing arrangements to the person by any pharmacy within the 12 months before the requested supply, and
  • it is safe and appropriate for the person to obtain the medicine.

The Pharmaceutical Society of Australia (PSA) has developed a set of guidelines for supply via continued dispensing.

Medicines currently available under the Continued Dispensing arrangements are predominantly for the management of chronic disease such as asthma and other lung conditions, diabetes, high cholesterol and heart disease. Oral contraceptives and medicines for the treatment of human immunodeficiency virus (HIV) may also be supplied. For a list of all the medicines available under Continued Dispensing, please refer to Schedule 1 of the current Commonwealth legislation.

For those medications not available under continued dispensing, an emergency supply may be deemed appropriate. Under Clause 45 of the Poison and Therapeutic Goods Regulation 2008, a pharmacist may supply up to 7 days’ treatment, or the smallest standard pack of any liquid, inhaler, cream or ointment of a prescription medication (other than S4D and S8 medications). The medication may be supplied if the pharmacist is satisfied that:

  • that the person is undergoing treatment essential to the person’s well-being, and
  • that the substance has previously been prescribed for the treatment, and
  • that the person is in immediate need of the substance for continuation of the treatment, and
  • that, in the circumstances, it is not practicable for the person to obtain a prescription for the substance from an authorised practitioner.

In the case of emergency supply, the item is supplied as non-PBS, there is not a requirement for a script to be obtained, and the medication label must contain the words “Emergency Supply”.

The person requesting a supply of medications without a script tells you that they have not ever had this situation before, and they always have a script for their medications. They have brought their old boxes of medication, and you can see on their My Health Record that these are their regular medications that they get every month.

The patient is using metformin 1000mg MR, which is a medication that is listed in schedule 1 of the Commonwealth legislation for supply under continued dispensing. However, their apixaban 5mg and Flutiform 250/10 inhaler are not covered.

You supply the patient a full box of the metformin under the continued dispensing supply. As the apixaban 5mg is not covered, you explain to the patient that you can supply up to 7 days’ worth of medications to them at a private price. You also explain that the same regulation also applies to the Flutiform, but in the case of an inhaler, they will receive 1 inhaler, which may be more than 7 days, but again at the private price. The medications are dispensed and labelled, with those supplied under emergency supply clearly identified on the dispensing label. You explain to the patient that they do not have to supply a prescription to you for supply of the products.