Safety alert – check route of administration carefully. RGH Pharmacy E-Bulletin

Interaction

A recent incident at one of the campuses of the Southern Adelaide Local Health Network has once again drawn attention to the potential for significant adverse consequences if a medication is administered to a patient via a route other than that which was intended. If a drug intended for oral administration via a nasogastric tube is inadvertently administered via an IV line, this can cause a serious adverse reaction or even death.

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Medication Safety in Pregnancy: RGH E-Bulletin

Interaction

In pregnancy, the use of medications (both prescription & over-the-counter) is often managed with great caution. The issue can be compounded by an increased need for medications, as pregnant women can be affected by ailments such as constipation, haemorrhoids, nausea, nasal congestion, heartburn, hypertension, oedema, and an amplification in general aches and pains.

An increased risk of birth defects or miscarriage caused by drugs is a common concern for both parentsto-be and practitioners involved in their care. As such, information surrounding safety of drugs is paramount in minimising potential drug-induced harm to a pregnancy.

Read the complete bulletin:

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A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.

Australia Post and Supply of Medications

If you live out bush one of the few regular personal contacts you have is with the contractor providing a regular Australia Post particularly if they arrive at your property by air. The Royal Flying Doctor Service may land regularly for a clinic or perhaps only visit when you are ill.

I want you to imagine that you or a loved one live out bush hundreds of kilometres from the nearest health service or hospital. Perhaps you are dying but want to do it pain free and with dignity at home in your remote community/station. Perhaps you are suffering from severe pain from an injury but you no longer need to be in hospital. Perhaps you have a child with behavioural problems and need a supply of dexamphetamine sent out regularly.

Well according to Australia Post it is just bad luck. They won’t send them to you.

This concern recently raised it’s head over on the Auspharm List:

What is the legislation with posting medicines in particular scheduled medicines and schedule 8’s. Am getting conflicting information from drugs of dependence unit and Australia Post.

Personally I’d trust the advice of the Drug of Dependence Unit. That’s what they are good at. Legislation on narcotic and other Schedule 8 medications.

For those not familiar with Australia’s Poison schedules here is a definition:

Schedule 8. Controlled Drug – Substances which should be available for use but require restriction of manufacture, supply, distribution, possession and use to reduce abuse, misuse and physical or psychological dependence.

Apparently Australia Post think it is against the law, specifically their controlling legislation “Australian Postal Corporation Act 1989“.

Also, and this is third hand, the Pharmaceutical Society of Australia looked at this in the past and decided that though State laws allow postage of S8 items, the federal statutes overrode them.

So what is the law.

Australia Post Terms and Conditions states:

63.1 A poison, drug or medicine which is a narcotic substance shall not be lodged for carriage by post nor carried by post.

Clicking on narcotic substance links through on the Australia Post site to its definition.

narcotic substance has the same meaning as in the Customs Act 1901.

The Customs Act 1901 defines a “narcotic substance” as:

“narcotic substance” means a border controlled drug or a border controlled plant.

and further describes a

“border controlled drug” has the same meaning as in Part 9.1 of the Criminal Code .

The Criminal Code defines a border controlled drug as (from the Victorian Law Book)

Narcotic drugs in Australian law are Border Controlled Drugs

Not a legal drug listed.

Australia Post has it wrong. It is legal to send prescription Schedule 8 items through the mail. I’d say someone has had a look at the term “narcotic” but didn’t bother to see what it meant in a legal sense. If the Pharmaceutical Society did look at this issue in the past then they have ballsed it up. I will be writing to both to try and have this corrected.

Australia is one of the most urbanised countries in the world. I have heard it said 0.1% of us live in 50% of the country. The more remote you get the worse the health outcomes. I’d hate to see a misunderstanding of a legal term denying people in the bush.

For those of you wondering what a Drug of Dependence Unit does go have a look.

Remote Pharmacy – A Review from a Remote Nurse

This was written for me some time ago by Melissa, a Remote Area Nurse I worked with in 2008.

Working in a remote area as a health professional is a very challenging role. Unlike working in an urban or rural hospital situation, where there are a multitude of doctors, nurses, allied health professionals and pharmacists available 24 hours a day, remote health clinics rarely have a variety of health professionals, let alone the ones which are essential. Having a pharmacist located within the region is not only rare, but is highly valuable and appreciated.

There are many times when having a pharmacist nearby is a definite advantage. Questions over medication interactions, brand names, etc can easily be sorted by pharmacist who is only a phone call away and is well familiar with the medications commonly utilised in the area. Pharmacists are a fount of knowledge about medications, drug interactions, and side effects. This is not only helpful for doctors, so that they do not prescribe medications which interact, but also for nurses who may need help with understanding certain medications, interactions and side effects.

Having a pharmacist as a part of the remote health team helped immensely in streamlining patients medications when they have been discharged from hospital. Commonly, patients are discharged from hospital without any consultation with Medical and/or Nursing staff, with patients discharged on new or altered medications, which may not be readily available in the remote clinic. Having a pharmacist who is actively involved in helping with patient discharges means that any new or altered dose medications a patient may require can be ordered and, hopefully, arrive prior to the patient returning to the community. The pharmacist can also help to organise new remote scripts when patients’ medications have been changed by a hospital or specialist.

Transportation of medical supplies and medications in remote areas is not merely a matter of placing an order and it arriving in a day or two. It takes time to get medications and medical supplies transported out, mostly by airplane, and having a remote health pharmacist has certainly helped with this. Whilst it is impossible to know exactly how much medication a clinic will use in a given month, the pharmacist can be instrumental in helping to calculate average usage and to assess what minimum level of medication stock should be kept in a clinic.

When a medication inadvertently does run out before the next order is due/arrives, having a pharmacist nearby is handy. By calling the pharmacist who has a general idea of what clinics have what medications and the levels of medication in each clinic, the pharmacist can organise to have emergency supplies transferred from another clinic to the clinic in need. This can also be useful for medications whose expiration date is coming up. Because the pharmacist has knowledge about which clinics and patients use certain medications, close to expiration date medications and vaccines can be transferred to where they are most likely to be used in order to help prevent wastage.

A remote health pharmacist can also spend time with individual patients and explain their individual medications, changes to their medications, and how to use medication devices such as dosette boxes and insulin pens. Whilst nursing and medical staff aim to explain the medication prescribed to the individual, often they do not have the time or the expertise of knowledge which a pharmacist has. Having a pharmacist travel from remote clinic to remote clinic means that patients who require extra explanations can have a visit booked with the pharmacist for that express purpose.

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