April 2024

Issue 40 - April 2024

• From the Chair
• Board news
  • Pharmacist prescribing position statement update
  • New accreditation standards for pharmacist prescriber education programs
  • Supervised practice requirements for interns
• Practice advice
  • Dispensing errors
• Students and graduates
  • Beware of identity theft – don’t post your registration certificate online
  • Are you aware of the Board’s Code of conduct and guidelines?
• Registration news
  • Latest workforce data released
• Regulation at work
  • Latest court and tribunal cases
• What’s new?
  • Regulators come together as one million Australians turn to medicinal cannabis treatments
  • Have your say on the role of consumers in accreditation
  • Interprofessional Collaborative Practice Statement of Intent
  • Ahpra partnership with Weenthunga Health Network guiding critical reform work to eliminate racism in healthcare
• Stay in touch with the Board

From the Chair

Welcome to our first newsletter for 2024. In this issue we highlight a recent update to the Board’s prescribing position statement, the publication of the accreditation standards for pharmacist prescriber education programs and share some important advice for practice.

The Board is continuing with its review of registration standards and guidelines this year and looks forward to hearing your views once public consultation begins.

Board news

Pharmacist prescribing position statement update

In December 2023, the Board published an update to its position statement on pharmacist prescribing and reconfirmed it has no regulatory barriers in place for pharmacists to participate in public health initiatives approved by states and territories.

Since we issued the previous position statement in October 2019, there have been numerous changes to state and territory medicines and poisons legislation resulting in increased public access to health services delivered by pharmacists, including administering a wider range of vaccines and supplying medications that do not require prescriptions.

In forming its position, the Board has monitored state and territory legislated pilots, trials, and health programs involving pharmacists and engaged extensively with state and territory health departments.

Pharmacists participating in the pilots, trials and health programs authorised by states and territories are not required by the Board to complete any additional prescribing qualifications or other requirements to maintain their registration.

Read more in the news item.

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New accreditation standards for pharmacist prescriber education programs

Late last year, the Board announced the publication of the Accreditation standards for pharmacist prescriber education programs.

In October 2022, we announced funding for the Australian Pharmacy Council, the accrediting authority for the pharmacy profession, to develop the accreditation standards. This followed our extensive work exploring the capacity for competent and safe prescribing by pharmacists.

The Accreditation standards for pharmacist prescriber education programs will ensure that graduates of an accredited education program meet the competencies in the NPS MedicineWise Prescribing competency framework (2nd Edition) which describes the practice expectations of Australian prescribers regardless of profession.

The Board makes the accreditation standards available as a resource to potential education providers to use to inform the development of future prescribing education programs. Stakeholders can contact the Australian Pharmacy Council for further information about accessing its accreditation services.

Read more in the news item.

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Supervised practice requirements for interns

On 30 April 2020, in response to the COVID-19 pandemic, the Board decided to vary the requirements for supervised practice for interns. Issues such as self-isolation, illness or pharmacy closure may mean that interns may be unable to complete the required number of supervised practice hours within the usual 12-month timeframe. The following modifications to internships applied:

• the number of supervised practice hours required for general registration was reduced from 1,824 hours to 1,575 hours
• the requirement for interns to complete a minimum of 152 hours of supervised practice under the supervision of an individual preceptor for those hours to count towards the period of supervised practice was waived, and
• the requirement for interns to complete a minimum of 80 hours of supervised practice during any four consecutive calendar weeks was waived.

The Australian Government Department of Health and Aged Care website states that although the WHO Director-General has announced that WHO no longer considers COVID-19 to be a Public Health Emergency of International Concern (PHEIC), the COVID-19 pandemic declaration is still active.

The Board has carefully considered the impacts of the modified requirements for supervised practice, informed by the views of stakeholders. We have agreed to maintain these requirements until a revised registration standard setting out supervised practice arrangements, approved by health ministers, is implemented.

We are satisfied that the modified requirements continue to support interns to meet all eligibility requirements to gain general registration and practise safely, and provide adequate protection of the public, as:

• during their 12-month provisional registration period, interns can complete the minimum 1,575 hours or longer period if additional practice experience is needed
• the registration standard still requires interns to satisfactorily complete an accredited intern training program including all assessment assigned by the program provider, and
• a final assessment of competence is required by the Board in the form of a written examination and an oral examination which all interns must satisfactorily complete.

Practice advice

Dispensing errors

Periodically, dispensing errors come to the attention of the Board, and below are some recent examples. It is important we learn from these errors. System-based strategies may help reduce the risk of potential harm and should be considered for implementation in the workplace.

Atropine eye drops

A recent case involved the dispensing of an incorrect strength of atropine eye drops to a paediatric patient. The patient was prescribed atropine sulphate monohydrate 0.01% eye drops by their optometrist, however atropine 1% eye drops were dispensed and supplied. These eye drops were used on two occasions and the patient experienced adverse effects including partial blindness, sensitivity to light, pain and dry mouth.

There is a preparation of atropine 0.01% eye drops (Eikance), available by private prescription, that has been commercially available since September 2021. Before that, the 0.01% drops had to be compounded as no proprietary product was available. Some pharmacists may be unaware of the lower strength’s existence and assume that atropine 1% (Atropt) is being prescribed. Administering the higher strength eye drops, usually to a child, may elicit extreme pupil dilation and associated discomfort and blurred vision. We remind you to consider the appropriateness of the medication for the patient and not assume a particular strength based on commercially available medicines available on the PBS.

Sound-alike medications

A prescription for carbamazepine was presented by a patient, however, carbimazole was incorrectly dispensed instead. The patient took the carbimazole for a week before the error was detected.

Sound-alike medications such as carbamazepine and carbimazole can be a source of dispensing errors. Dispensing errors like this highlight the importance of patient counselling as the final step before giving the medication to the patient.

Lessons to be learned

The Code of conduct outlines that good practice for risk management involves several steps. This includes working in practice and within systems to reduce errors and improve patient safety, and taking all reasonable steps to address the issue if there is reason to think that the safety of patients may be compromised.

Standard 7 of the Professional Practice Standards highlights determining if the medicine is safe and therapeutically appropriate for the patient and accurately dispensing the medicine using an appropriate system and quality assurance measures. It is crucial to implement system-based strategies to minimise the risk of errors.

Standard 15 outlines the importance of providing appropriate information to the patient to meet their needs. The Board’s Guidelines for dispensing of medicines reiterate the importance of carefully checking and re-checking all dispensing for accuracy and completeness as well as counselling patients as the final step.

Patient counselling is a critical step. This is usually the last point of contact between the patient and pharmacist in the dispensing process and is an important strategy to minimise dispensing errors.

In addition, reporting errors as and when they occur will help in learning from the mistakes and ultimately, reduce the risk of such errors in the future.

Students and graduates

Beware of identity theft – don’t post your registration certificate online

Successfully registering with the Australian Health Practitioner Regulation Agency (Ahpra) is the last green light for new graduates starting their career in their chosen profession. It’s an exciting step and one to feel immensely proud of. The temptation might be strong to celebrate by sharing your first registration certificate with the world – but think twice before posting.

Identity theft is rife. Every day, websites pop up selling fake Ahpra certificates of registration based on real ones that graduating practitioners have posted on their social media. Never post your identity documents online. You’ve worked hard to earn your registration; don’t let somebody steal it.

Are you aware of the Board’s Code of conduct and guidelines?

The Code of conduct (the code) sets out the Board’s expectations of professional behaviour and conduct for pharmacists. The code supports good patient care within an ethical framework, helping to keep the public safe. You have a professional responsibility to be familiar with and to apply the code.

The code contains important principles that set out the Board’s expectations of pharmacists including:

• safe, effective and collaborative practice
• Aboriginal and Torres Strait Islander health and cultural safety
• respectful and culturally safe practice for all
• working with patients
• working with other practitioners
• working within the healthcare system
• minimising risk to patients
• professional behaviour
• maintaining practitioner health and wellbeing
• teaching, supervising and assessing, and
• ethical research.

We have also developed several guidelines to help you and to clarify our views and expectations on a range of issues. Our Quick reference guide will help you identify the appropriate guidelines to read.

Registration news

Latest workforce data released

The Board’s latest quarterly registration data report covers the period to 31 December 2023. At this date there were 37,393 registered pharmacists, including: 33,313 with general registration, 2,344 with provisional registration, 31 with limited registration and 1,705 with non-practising registration.

For further data broken down by division, age, gender and principal place of practice, visit the Board’s Statistics page.

Regulation at work

Latest court and tribunal cases

We publish summaries of court and tribunal cases for their educational value to the profession.

Pharmacist suspended for inappropriately dispensing restricted medications

A Victorian pharmacist has been reprimanded and had his registration suspended for two months for inappropriately supplying scheduled medications, failing to maintain associated drug registers and failing to comply with registration conditions.

Read more in the news item.

WA pharmacist suspended for two months, reprimanded, and fined $10,000 for non-therapeutic steroid dispensing

A Western Australian pharmacist has been reprimanded, suspended for two months, and fined $10,000 for professional misconduct after inappropriate dispensing of anabolic androgenic steroids.

Read more in the news item.

Man sentenced for working as a pharmacist without registration

Ahpra has prosecuted a man for holding himself out as a registered pharmacist after his registration lapsed, in contravention of section 116 of the Health Practitioner Regulation National Law 2009.

Read more in the news item.

Pharmacist’s registration cancelled with a 12-month disqualification for inappropriate behaviour and dispensing

A Victorian pharmacist has had his registration cancelled and been disqualified from applying for registration for 12 months for inappropriate behaviour with three female clients and inappropriate dispensing.

Read more in the news item.

Perth pharmacist disqualified for 18 months for dispensing medications to herself and others without prescriptions

A Perth pharmacist has had her registration cancelled and has been disqualified from re-applying for 18 months for dispensing medications to herself and others without valid prescriptions over a six-month period.

Read more in the news item.

What’s new?

Regulators come together as one million Australians turn to medicinal cannabis treatments

Maintaining a balance between access to medicinal cannabis and its safety is a priority for health regulators across Australia amid a growing number of prescriptions and the emergence of telehealth, online prescribing and direct-to-consumer health services. Australia’s medicine regulation system is complex, with different agencies responsible for overseeing the medicines themselves, the health professionals who prescribe and provide them, and the premises where they are stored and dispensed

In February, Ahpra and several of the National Boards, including the Pharmacy Board, convened a forum in Melbourne that brought together health regulators to share information and regulatory intelligence, discuss any current risks to the public, and determine how all regulators can best work together.

The use of unregistered medicinal cannabis products has spiralled in recent years, from around 18,000 Australians in 2019 to more than one million in January 2024. The number of prescribers accessing the Authorised Prescriber and the Special Access Scheme has also risen sharply to more than 5,700 medical and nurse practitioners prescribing and dispensing medicinal cannabis products that have not been evaluated by the Therapeutic Goods Administration for safety, quality, or efficacy.

The forum attendees agreed to continue discussions with the aim to monitor issues and identify any gaps in the regulatory and wider health response to this rapidly growing industry. In particular:

• improving data and information sharing among Australia’s regulatory agencies
• gaining a better understanding of the drivers of the recent rapid rise in access to these products
• enhancing communication to prescribers, including clinical guidance, on the safe and effective use of medical cannabis products
• examining ways of better educating consumers about medicinal cannabis medications, and
• encouraging more research to drive the production of clinical guidelines for medicinal cannabis.

Read more in the communiqué on Ahpra’s website.

Have your say on the role of consumers in accreditation

The Ahpra Accreditation Committee invites you to give feedback on its draft proposed principles to strengthen the involvement of consumers in accreditation.

The committee is developing the principles to ensure meaningful involvement of consumers in accreditation activities in the National Registration and Accreditation Scheme. This will support diversity of input into accreditation functions and enable responsive and person-centred processes that value and respect the views of consumers.

The consultation is open until 18 April 2024. Find out more about this consultation and provide feedback at the Accreditation Committee’s Current consultations page.

Interprofessional Collaborative Practice Statement of Intent

The Ahpra Accreditation Committee has published its Interprofessional Collaborative Practice Statement of Intent. The statement of intent aims to embed interprofessional collaborative practice across the continuum of healthcare settings.

The statement is a fundamental step towards achieving effective team-based and coordinated care across Australia. It is a commitment to improving the outcomes for patients and consumers by reducing the risk of fragmented and uncoordinated care.

Interprofessional collaborative practice is healthcare practice where multiple health workers from different professional backgrounds work together and with patients, families, carers and communities to deliver the highest quality of care that is free of racism and other forms of discrimination.

The statement represents a joint commitment from 53 stakeholders across the health and education sectors to take action.

Read more in the news item.

Ahpra partnership with Weenthunga Health Network guiding critical reform work to eliminate racism in healthcare

Aboriginal and Torres Strait Islander Peoples have the right to access and work in healthcare that is culturally safe and free from racism. The health practitioner regulator’s Aboriginal and Torres Strait Islander Health Strategy Unit is supporting the Cultural Safety Accreditation and Continuing Professional Development Working Group and Weenthunga Health Network, an Aboriginal and Torres Strait Islander consultancy, to co-design and develop nationally consistent standards, codes and guidelines on cultural safety for registered practitioners.

The Cultural Safety Accreditation and Continuing Professional Development Framework and Strategy is a multi-year project, grounded by Aboriginal and Torres Strait Islander ways of being, knowing and doing. By embedding cultural safety in accreditation and continuing professional development requirements for all 16 regulated health professions in the National Scheme, we will ensure consistency and accountability to protect Aboriginal and Torres Strait Islander patients and health workers.

Cultural safety is patient safety. Racist and culturally unsafe practice and behaviour towards Aboriginal and Torres Strait Islander Peoples will not be tolerated, as seen in the landmark ruling of a doctor banned for discriminatory and offensive behaviour.

Stay in touch with the Board

• Visit the Pharmacy Board website for news about the profession, information on the National Scheme and for registration standards, codes, guidelines, policies and fact sheets.
• Lodge an online enquiry.
• For registration enquiries call 1300 419 495 (from within Australia) or +61 3 9125 3010 (for overseas callers).
• Address mail correspondence to the Chair, Pharmacy Board of Australia, GPO Box 9958, Melbourne VIC 3000.