From: "Bill Arnold" farmacia@bigpond.net.au

http://transform-drugs.blogspot.com/2007/06/ parliamentarians-dont-support.html

Below is copied a press release issued jointly by two all party parliamentary groups (drug misuse and primary care and public health) this week calling for the MRHA not to reclassify over the counter medicines containing ephedrine and pseudo ephedrine as prescription only.

This follows on from the recent kerfuffle about the dangers of cold remedies, such as Lemsip and Sudafed which contain the drugs in question (albeit in relatively tiny doses), being used in the illicit manufacture of meth amphetamine. As discussed here the recent War on Lemsip blog such a move would be largely gesture politics, and have no discernible impact on the production supply and use of meth amphetamine. As we have seen over the past century's experience of trying to prohibit drugs that are in demand, such moves will always fail. If there is profit to be made then illicit markets will always find a way to produce and supply.

From: "John Sobkowiak" aquabuggy@hotmail.com

Can anybody tell me some of the pros and cons of using "Packman" with LOTS?.

From: "Peter Ryan" robinaparkway.mcp@nunet.com.au

Does anybody know why there is no CMI available for Ferro Liquid ? It has been on the PBS for some time now, yet no CMI is available. As far as I am concerned, this is not acceptable.

From: "Amanda Galbraith" amandag@capitalchemist.com.au

Just wondering whether the sudden influx of pharmacies trying to go online before June 30 is responsible for some of these issues. Does MA think the system will be able to cope with the volume of scripts processed through PBS online?

Amanda Galbraith
Capital Chemist Chisholm

From: "Vicki Dyson" vickidyson@optusnet.com.au

In performing nursing home reviews, I come across Ural being ordered prn on charts and nursing staff giving it to patients tds regularly for years on end.

The residents still get their UTIs from time to time. I have pointed out its potential to raise blood pressure, worsen CCF and reduce some anitbiotic efficacy. Does anyone have any source of evidence that changing pH of urine either up or down alters the frequency of UTIs?

I would like to be able to quote an article which I can use to back up my recommendation to cease regular use?

Vicki Dyson

From: "anderson leong" andersonleong@hotmail.com

Has anyone had problems with Xeloda 500mg 120 tab's from API price $677 ex gst, while Winifred is $662.26?

I asked API but they said that is the price, go and order it direct from Roche.

From: "Andrew Roberts" stuff@bitethedust.com.au

Terry Irvine wrote:

"Yesterday, a doctor told me I should not have sent him an email that was not encrypted. All communications between doctors is now encrypted, he said. How do we become part of this privacy preserving protocol"

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I'd say the doc's having a bit of a lend. Many don't know how to use the encryption process. Didn't a Melbourne hospital (Austin?) feature in the news a few months back when a GP went public about emails that weren't encrypted? From memory their privacy committee had looked at this before starting sending emails and decided that the importance of getting the info to the GPs was more important than the risk of an unencrypted email being intercepted. Part of the decision making was looking at how few doctors could use the encryption technology.

Our patient care would be reduced without email.

Robbo

From: "Andrew Roberts" stuff@bitethedust.com.au

Philip Smith wrote:

"I had a young gentleman (under 30) present to the pharmacy with a few areas on his face that have stopped growing hair. The skin looked completely normal and the same as the skin with hair, no redness, sign of infection, nothing. Could it be Alopecia Areata from my google search?"

--------------

Any hair loss on the outer third of the eyebrows or perhaps blisters/rash on the soles of his feet? We see patchy alopecia (not necessarily on top of the head) out here and think secondary syphilis.

Robbo

From: "irwin lowe" irwin@heidelbergcentralpharmacy.com.au

Adam Hay wrote:

"A cardholder's entitlement may end for any number of reasons. Andrew Topp rightly noted that these are irrelevant for the purposes of the pharmacist. You are either entitled or not entitled to concessional benefits at a given time.

It is the patient's own responsibility to ensure they are using a valid card.

If you are presented with a card which has an expiry date beyond today's date but PBS online says it is invalid today, that is the end of the matter. It is a general copayment, a S87A receipt and a trip to the Medicare office.

Why would you check the '01' box if PBS online says it is invalid?"

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So my father walks into your pharmacy for his BP, cholesterol & CV drugs, after his quadruple bypass. He has a concession card with a long expiry. Lo and behold, PBS online reports that the concession is CANCELLED. You tell him that he is a vicious bastard for rorting the system, and further (assuming he hasn't demanded his rxs back and stormed out) charge him $100 for what should have been $15 worth of scripts.

Here's my dad's email from today:

"More funny is Centrelink. I opened my mail yesterday at 4.30pm, Centrelink wrote that I havnt provided them with current address, therefore my cwlth hlth card was cancelled on 16 June. I dashed to westfield centrlk, running and panting to their office which closes 5.00pm. I told the lady that I have not moved for 25yrs and I received Centrlink letter addressed correctly, what's really happening? The lady suggested that somebody has informed centrlink something, or I have gone overseas without proper notification. I said none of these things haven ever happened and my income now is much lower that last fiscal year which I have already provided with a copy. She reinstated my entitlement right away. I don't know whats going on there, apparently something is happening, I am waiting for their explanation."

OBVIOUSLY, the chemists & the public are rorting the system.

Irwin the evil chemist.

From: "Andrew Roberts" stuff@bitethedust.com.au

Peter Bayly wrote:

"Then I spoke to some prescribers who put i tds ac or pc and their motivation was to improve compliance by taking the drug at meal times.... So my standard advice is to take amoxycillin at meal times to help the patient remember"

----------------

Aren't you better to discuss and adjust the dosing schedule with the individual receiving the medication? Perhaps I have been out bush too long where meals aren’t necessarily a certainty with my mob. They might only take one capsule a day following this recommendation. I tend to use the position of the sun and reinforce the times in their language.

Robbo

From: "Peter Crothers" peter.crothers@stratman.com.au

Peter Bayly wrote:

"A recording system is needed for ALL S3 drugs and some S2 drugs to effectively monitor abuse or inappropriate use...."

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I agree. I used to be sceptical about this, but now I'm so convinced, I reckon its a 'no brainer'. If S3 is for medicines that require pharmacist recommendation and/or monitored supply, then it follows like night follows day that supply should be recorded. With scanners etc., this is so easy to do nowadays that it is no imposition at all, especially with a dispensing station nearby to the S3s, which most of us increasingly need anyway, in order to assist script counselling, answer questions from 'regulars' (remember the regulars? the patients that probably account for most of our profitability?), etc.

Across the board S3R would also help patients understand that there is a material difference between S3 and "OTC"; help them understand and appreciate the role of pharmacists; and encourage a 'local service/ regular customer model' of pharmacy practice that would assist the profession in meeting Guild/PSA, government and consumer organisation expectations (have I said something controversial?)

If all S3s required recording, the argument about large packs of Panafen Plus would be simple: whack it in S3. We had a serious local abuse problem with 48 packs of Nurofen+ and Panafen+ (we won't stock the 72s) which we 'solved' overnight by 'voluntarily' making them S3R. So simple. And guess what? The people who aren't deliberate abusers really appreciate that we are interested in their wellbeing. So, it's good for business as well.

What do others think?

Peter C

From: "Bruce Moffat" chemco@optushome.com.au

Philip Smith asked

"Just wondering other pharmacist thoughts, or history on the situation as to why they are not funded, the oral contraceptive pill is this sexist"

----------------------------

Any historically under or unfunded device, medication, or procedure related to control of conception in Oz in the last 15 years probably has a 2 word cause. Brian and Harradine. Fortunately, the burden of carrying the responsibility of forcing his moral perspective on the rest of the country became too much for him and he is now retired.

Upon his unlamented passing the first wave of erosion was RU-486, and also Emergency Hormonal Contraception (going off S4). Hells bells, if this continues apace we may get decent universal sex education instead of flagpoles in all our primary schools.

Cheers,

Bruce

From: "Ben Wishaw" auspharm@buz81.cjb.net

Peter Bayly wrote:

"....a complaint from a patient that the word Zoloft appeared on the screen at the checkout of her pharmacy and she was upset that those in the queue behind her could also read it."

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The pharmacy I work in shows the patient name and the medications. The screens are angled away from the customers. I know that I use the information to check that the patient has the correct items and I have picked up errors a few times at the counter.

I believe that as long as steps are taken to keep this information to the "checkout" staff it can be used effectively to prevent dispensing errors.

From: "Ian Bodycote" jjulihol@bigpond.net.au

Peter Bayly wrote:

"....a complaint from a patient that the word Zoloft appeared on the screen at the checkout of her pharmacy and she was upset that those in the queue behind her could also read it."

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To even complicate matters more , it is my understanding that these electronic display poles on registers are compulsory for retailers: if we display we are in breach of privacy if we don't we are in breach of some retailing law: so what is the answer ?

From: "Harriet Wright" gulgongdispensary@bigpond.com

Peter Bayly wrote:

"....a complaint from a patient that the word Zoloft appeared on the screen at the checkout of her pharmacy and she was upset that those in the queue behind her could also read it."

----------

Dear Peter

We have a display which shows product names for OTCs but scripts are displayed as "script". It can also be turned off at customer request and we have a sign stating this fact on the display. We place all script items in a paper bag in the dispensary and store them in that bag until handed to the customer.

Cheers
Harriet Wright
Gulgong Dispensary

From: "Geoff Timbs" warnersbay@amcal.net.au

Peter Bayly wrote:

"....a complaint from a patient that the word Zoloft appeared on the screen at the checkout of her pharmacy and she was upset that those in the queue behind her could also read it."

----------

Perhaps QCPP could come up with a sign near the entrances to advise that pharmacies are a privacy free zone, that you will be videotaped and conversations recorded for training purposes. Those unwilling to partake should feign a husky voice & wear a disguise - perhaps a bin of wigs & dark glasses at the door to assist - traffic flow would probably increase!

I recall when feminine hygiene products were pre-wrapped in brown paper and condoms were sold on veiled request from the 'indoor sports' drawer behind the counter and total strangers did not talk on mobiles about everything just about everywhere- but that just highlights my age rather than any relevance to privacy being relative....we seem to have accepted more intrusion into our everyday lives but believe our illusory privacy is sacred.

Geoff Timbs - Friday night rant.

From: "Penny Kraemer" penny_kraemer@optusnet.com.au

peter howard wrote:

"After completing Medication Reviews in a Nursing Home yesterday, I phoned the Medicare Hotline to check Medicare numbers for some residents (these must now be included on the new RMMR claim forms). I was told by two separate operators and a supervisor at Medicare that they are allowed to give these numbers ONLY to pharmacists who are dispensing a script. Furthermore, I was told that I should only include 6 names on the claim form, and not 8 as indicated, as the forms were printed before Medicare realised that their computer system could only handle 6 names at a time!... What a farcical situation!"

----------

Peter,

I have emailed Glenys Fitzpatrick at the Medicare Incentives Department in SA twice this month regarding the same issue as you described. On both occasions she told me that she had referred the query to National Office and that either she or they would get back to me.

Still waiting.....

Interesting re the number of reviews on the form, didn't know that one!!!

The alternative at the moment is to get the number from the pharmacy who is supplying the medications to the facility.

Penny Kraemer

From: "Damien Louttit" louttit@dodo.com.au

peter howard wrote:

"After completing Medication Reviews in a Nursing Home yesterday, I phoned the Medicare Hotline to check Medicare numbers for some residents (these must now be included on the new RMMR claim forms). I was told by two separate operators and a supervisor at Medicare that they are allowed to give these numbers ONLY to pharmacists who are dispensing a script. Furthermore, I was told that I should only include 6 names on the claim form, and not 8 as indicated, as the forms were printed before Medicare realised that their computer system could only handle 6 names at a time!... What a farcical situation!"

----------

Welcome to a day in the life of a Community pharmacist !!

Damien Louttit
Community Pharmacist
Sth Coast NSW

From: "Edgar SMALL" edgarsmall@bigpond.com

peter howard wrote:

"After completing Medication Reviews in a Nursing Home yesterday, I phoned the Medicare Hotline to check Medicare numbers for some residents (these must now be included on the new RMMR claim forms). I was told by two separate operators and a supervisor at Medicare that they are allowed to give these numbers ONLY to pharmacists who are dispensing a script. Furthermore, I was told that I should only include 6 names on the claim form, and not 8 as indicated, as the forms were printed before Medicare realised that their computer system could only handle 6 names at a time!... What a farcical situation!"

----------

Surely the Pharmacy where these patients had their prescriptions dispensed would have their medicare numbers on file. Apart from having to make another phone call I don't see where there is a problem!!

Edgar Small
Community Pharmacist
WINDSOR NSW

From: "Geoff Timbs" warnersbay@amcal.net.au

Andrew Topp wrote:

"Does anyone know if there will be any extra processing requirements for pharmacists using the streamlined authority system? Or is the whole process in the prescriber's domain?"

----------

Curiously no one has bothered to tell us so I called MA: at first I was told all changes were embargoed until 7 days before the change but eventually I was put onto a pharmacist whistle-blower (name withheld in case ASIO is reading this).

I was told.....streamlined authorities will be in the same format as phone authorities except instead of the "Z" approval No the Dr will now enter the 4 digit code supplied in the PBS shedule but more likely from the software. Pharmacist checks is 4 digits, not 3, not 5, no letters, etc and processes as previously for a phone approval. We do not have to check the 4 digits match the code in the shedule (...yet, but I imagine MA will make us responsible so they can have the usual run of trivial rejections). So essentially it is like the old days when we had to check the DR wrote "SP" specified purpose on some scripts ( but naturally more complicated).. the more things change....

Geoff Timbs B.Pharm

From: "Peter Bayly" pdlsa@bigpond.com

Christopher Morris wrote:

"I know some pharmacists who would make mistakes doing 10 scripts a day. Meanwhile i regularly do 300+ in a day and haven't made a mistake for years. I honestly can't see how any form of regulation is feasible whatsoever."

----------

How do you know you haven't made a mistake? And at 300 a day your first mistake is to leave inadequate time to add professional services to the supply function.

With that in mind, there obviously IS a need for regulation and it IS possible to factor in those variables.

From: "Ron Batagol" rbatagol@optusnet.com.au

Christopher Morris wrote:

"I know some pharmacists who would make mistakes doing 10 scripts a day. Meanwhile i regularly do 300+ in a day and haven't made a mistake for years." (my italics and bold print)

------------------------

Oh, my G*d, Christopher! It seems that you have found the dispensing "Holy Grail! And, it appears that I've got it wrong, when, after all these years of supervising large numbers of pharmacists and pharmacy interns, on a daily basis, I routinely give them the advice that "the pharmacist who says that they have never made a mistake in dispensing a script is either a liar or is just kidding themselves"!

Let me just remind Christopher and others who say that they can dispense 300 scripts a day, (faultlessly or otherwise) that there are certain defined steps in the dispensing process, that a pharmacist, and ONLY A PHARMACIST, must carry out for each and every script, including repeats! These steps are, of course, "set in stone", as absolute, not discretionary, requirements, not just by Pharmacy Boards, (whose Guidelines, after all, simply reflect the accepted prevailing professional standards), but by our professional organisations themselves, which developed those standards, as well as by professional indemnity insurers. Indeed, it is a pharmacist, and only a pharmacist, who is obliged to "sign off" on interpreting the prescriber's intentions and contact where appropriate, review of the medication history, (including special requirements and considerations such a pregnancy, breast-feeding paediatric doses/ dose form/calibrated measures), checking of potential script interactions, and, of course, as specified in all of the above professional and Board standards, counselling of each and every script including repeats,( and as you've all heard before, for repeats, the need to ensure that what you are dispensing reflects the latest medication regimen- remember my recent article, "no squirrelling"). Now, for repeats, of course, the end-point patient counselling may be as simple as- "how are this med going- any problems, any new med issues- herbals or other self-meds" etc.etc.etc.) - Ok it doesn't take long for repeats, but it has to be done! But, of course, for new meds, counselling must include emphasising instructions and highlighting the key points of a CMI .

Of course, I admit that there are existing and potential smart and innovative ways of streamlining the dispensing processes. For instance, optimal use of technicians/trained pharmacy assistants, And I, for one, have expressed openly, that, in this day and age when we have scanners and hopefully, smarter work station arrangements, I have no problem with one pharmacist supervising more than the current statutory, one only, trained technician/pharmacy assistant, to make the dispensing process more efficient (since this can already occur legally for the far more complex and error-prone operations of dose administration packing/dispensing.) We all hope that this legal change may come about sometimes soon!.

And, as we've read, there's the emerging robotics option. However, on that score, as noted during the current is discussion by Peter Bayly, on the topic of the consideration of dispensing robots..."the machine referred to saves a few seconds in product selection which is still subjects errors in keying, interpretation etc. It was described by one writer as a piece of theatre displayed in a shop window to attract extra prescriptions and produce a peak of 161 prescriptions in an hour. This then is counter-productive in allow ing more time for counselling unless 4 pharmacists are on hand to deliver professional services."

And, at the end of the day, that's the critical point, isn't it - As I pointed out above, a pharmacist and only a pharmacist, can "sign off" on the professional aspects of a script, and a pharmacist, and only a pharmacist must, and should, by agreed legal and professional standards, counsel each and every patient receiving their scripts.

So, in the end, it's quite simple really and boils down to the question that I would ask Christopher -, namely": Are you really saying that you can do all of these things at the rate of 300 scripts a day, and as a special bonus, never make a mistake! Well, if so, you are not only a very fast, and super-gold- standard dispensing pharmacist, but also, to fit all that mandatory patient counselling in as well- hey, you must be a very fast talker.!"

But, for the rest of us lesser mere mortal souls, for the sake of industry uniformity, and most importantly of all, guaranteed patient safety, as a majority of AusPharmListers have agreed in the most recent poll, we desperately need, at least an accepted professional and statutory guideline, to the safe upper limit of our basic dispensing operations, in line with basic operational standards in just about every other industry and profession!

Ron Batagol

p.s. When Christopher says" I regularly do 300+ in a day and haven't made a mistake for years" I would suggest that what he is really saying is "I'm not aware of any mistake that I have made in that time" And - there is a difference!

From: "Ian Bodycote" jjulihol@bigpond.net.au

Suhail Mir Mohamed wrote:

"Anyone else finding the old system a lot easier to reconcile? This is just far too complicated? Perhaps with all the money saved with PBS online, these might be room in the budget for having someone come out and explain to us how to reconcile our statements properly."

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Well we are dealing with multiple part payment of claims in one hit with PBS online: personally I find the time lag receiving payment advices frustrating but the worst aspect is that you never actually know what amount you will receive on payment day

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