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ISSUE #38 : OCTOBER / NOVember 2014
P r a c t i c a l I n f o r m at i o n f o r T o d a y ’ s C o m m u n i t y P h a r m a c i s t
• Building Efficiencies • CPD – Dose Administration
and Services Aids
• Business Profiles • The Power of the Gold Cross
IN THE KNOW • Patient Engagement • Training and Education
What can
Tony Ferguson
do for your TOTALLY
NEW!
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✓ Renewed focus on Consulting
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To see if your independent pharmacy
qualifies for a Tony Ferguson Clinic,
contact Julie-Ann Wharley on 0410 417 135.
For more information about the new Tony Ferguson Program go to tonyferguson.com
2 CONTENTS
THE VALUE Special Feature
OF A BRAND Centre: MPS Australia – Your key
to better health outcomes
10 CPD – Dose Administration Aids
BY SEAN TUNNY
7
Editor, Gold Cross Products
& Services Pty Ltd Training and Education
As this edition of ITK is distributed to 38 Coco – Scalp
Pharmacies, we are excited to announce the
endorsement by Gold Cross of MPS Australia. 39 Optifresh
As we put together key elements of the
publication, including our featured Gold 30 Hydralyte
Cross booklet, one of the key underpinnings
in business is brand value or equity. 41 Murine 10
Who do you think has the most powerful
and valuable brand in the World? Well, if you
answered Apple then you were correct. Business Profile
This brand is worth $104.3 billion, with brand
revenue of $156.5 billion, which is astonishing.
6 MPS Australia
So what is brand value? A brand includes the
name, logo, image, and overall perceptions
18 Tony Ferguson
that identify the product, service and owner
of the brand in the minds of customers.
32 PARA’KITOTM
This takes the shape of advertising, 22
packaging, and other marketing
communications, and becomes a focus of
the relationship with consumers. In time, Down to Business
this brand comes to encapsulate a promise
about the goods it identifies—a promise about 22 Building Efficiencies and Services
quality, performance, or other dimensions
of value, which can influence consumers’ 28 Patient Engagement
choices among competing products. In dealing
with dozens of direct and indirect partners 36 Using Personal Selling Skills
in our profession each week through ITK,
we strive together to ensure that the brand
24
and the value attached to it is accurate After Hours
and promoted.
MPS, founded in 1997 is a company who 50 Melbourne Cup Day
has strived tirelessly to build and represent
a brand that delivers high quality solutions
that create efficiencies and market leading
Regulars
incident-free rates of dose administration.
Fittingly, this edition has a key focus 44 Product Spotlight
on dose administration aids extending
to continuing professional development along
29
with a host of independent editorials. We also
feature informative Business Profiles, including PLEASE USE THIS PUBLICATION TO KEEP YOUR PHARMACY IN THE KNOW.
the pharmacy exclusive Tony Ferguson weight
loss program. Thank you to all the contributors, EDITOR: Sean Tunny
partners and supporters of ITK, wishing you 0457 029 052
an enjoyable read of this edition. sean.tunny@goldx.com.au
Best of Health. DESIGN: Megan Hibberd
0408 452 133
Sean Tunny www.artbymegan.com.au
Editor
PRINT & DISTRIBUTION: APN Print
1300 134 628
www.apnprint.com.au
BROUGHT TO YOU BY:
PUBLISHED BY: Gold Cross Products & Services. PO Box 505 Spring Hill Qld 4004.
Contact Jessica O’Connor – Email: jessica.oconnor@goldx.com.au. In The Know is
produced for the information of Australian Pharmacists. The presence of the logo of
the Pharmacy Guild does not constitute endorsement of a product. The Pharmacy
Guild of Australia accepts no responsibility for claims made by advertisers. Opinions
and views expressed in articles do not necessarily reflect those of Gold Cross.
DOWN TO BUSINESS 3
Are you hiring the
best employees?
Graham Howard
Agency Owner, Frontline Health
It all starts at the interview •• Give me an example of a time when you
Behavioural interviewing is a style had to make a split-second decision.
of interviewing that was developed •• What is your typical way of dealing with
in the 1970s by industrial psychologists. conflict? Give me an example.
Behavioural interviewing asserts, “the most •• Tell me about a difficult decision you have
accurate predictor of future performance made in the last year.
is past performance in a similar situation”.
Behavioural interviewing, in fact, is said
The ‘Performance-based’
to be 55 percent predictive of future on-the-job
Interview
While the behavioural interview is able to
behaviour, while traditional interviewing
focus on the way in which the candidate dealt
is only 10 percent predictive.
with situations in the past, indicating how
Unlike traditional interviews, which they would deal with similar situations in the
include such questions as: future; there still needs to be a way for the
•• Tell me about yourself? interviewer to determine how the candidate
•• What are your strengths and weaknesses? will react in a future situation. This is where the
•• Why are you interested in working for us? ‘performance-based’ interview comes in.
behavioural interviewing emphasises past Rather than focusing purely on questions
performance and behaviours where candidates that guide the candidate through a review
must rely on past experiences as opposed of their skills and experience, the performance-
to predicting how they would behave. based interview asks the candidate to describe
Typical behavioural-based interview two or three of their accomplishments,
questions include: and, with the aid of the interviewer, discuss
these accomplishments in detail. By allowing
•• Describe a situation in which you were
the candidate to choose the accomplishments
able to use persuasion to successfully
to discuss, the interviewer is effectively asking
convince someone to see things your way.
the candidate to discuss those aspects of their
•• Describe a time when you were faced with
working lives that they feel they achieved the
a stressful situation that demonstrated
most, and have the greatest pride.
your coping skills.
•• Give me a specific example of a time This discussion, however, should not
when you used good judgement and be brief. While the candidate will be able
logic in solving a problem. to give an indication of their performance
•• Give me an example of a time when within their accomplishment, it is up to the
you set a goal and were able to meet interviewer to actively listen to what is being
or achieve it. said, and delve into those areas where more
•• Give me a specific example of a time when information is needed. Deep questioning
you had to conform to a policy with which should allow the interviewer to uncover
you did not agree. indications of candidate commitment,
•• Tell me about a time when you had motivation, cultural fit, interest, motivation,
to go beyond the call of duty in order experience, and willingness to learn; and allow
to get a job done. the interviewer to evaluate how the candidate
•• Tell me about a time when you had too will work in a similar environment.
many things to do and you were required Further depth can be gained by asking the
to prioritise your tasks. candidate to describe their accomplishments
GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 38 : OCTOBER / NOVEMBER 2014
4 DOWN TO BUSINESS
in chronological order. Again, through in-depth is best for the business, rather than by how The interview is one of the most
questioning, the interviewer should be able well the candidate was able to perform powerful tools that you have to ensure
to extract an understanding of the candidate’s at the interview; a key factor in an increasingly that the person you hire is suitable for the
progression and improvement over time. competitive industry. “In the competitive role and for your business. While it is not
candidate market, it is crucial that employers possible to gain the full measure of the
By allowing the candidate to discuss
are able to make the best recruitment
specific accomplishments or failures, candidate’s ability as a result of the interview,
decisions for the organisation, particularly
and by developing questions from these it is critical that the interviewer is able to
as a ‘bad’ hire can result in more than just
examples, the interview is less likely to ensure that the interview process is as
the lost time spent in selection and training.
follow a pre-determined format, removing Matching the needs of the job to the skills and vigorous as possible. By using an interview
the smokescreen that can be thrown up by behaviours of the candidate is clearly vital technique that draws on both behavioural
a well pre-prepared candidate. This sort of so that your business can gain and maintain and performance-based methodologies,
questioning will allow the interviewer to make a competitive edge,” says Peter Davis, Managing you will have a better chance of securing
the recruitment decision in light of what Director, Frontline Recruitment Group. the right person for your organisation.
NEWS FROM THE GUILD PRESIDENT 5
The Power of
the Gold Cross
George Tambassis
National President of
The Pharmacy Guild of Australia
I am very pleased that the ‘Discover more. Ask your pharmacist.’ advertising campaign has such
a strong focus on the Gold Cross symbol. I believe – and significant research confirms – that
most Australians identify the Gold Cross with their local pharmacy, and therefore with trust
and professional care. We are building on a strength.
When the Guild decided to embark on a new so we were starting from a point of strength plays in health care, providing advice and
consumer advertising campaign, we were in terms of public perceptions and familiarity. guidance regarding medications. Yet many
shown a wide range of creative concepts – The Guild worked with the creative Australians are surprised when they discover
all of them focused on telling people that Sydney agency, Jack Watts Currie, to build what just how much their local pharmacy can do.
there is a lot more available to them at their I believe is an engaging awareness campaign. Now it is time to let everybody know how
local pharmacy beyond the dispensing It is comprised of television and online much more we can do.
of medicines. We were looking for a way advertisements supported by a new website A comprehensive suite of materials
to reinforce the already high perception and Facebook page. Pharmacies around for display in pharmacies, amplifying the
of the value of community pharmacy. Australia have an opportunity to be involved, campaign message, has been created and
And the winning pitch focused very heavily further informing their customers of what is available to order and customise online.
on the power of the Gold Cross. is on offer. The Gold Cross features prominently in the
This is a symbol which has previously It is well known that Australians appreciate television commercial and other materials.
been the subject of branding campaigns, the important role that community pharmacy The Guild has been in regular contact
with pharmacy banner groups, management
groups and wholesalers about this campaign
and is hoping for a strong level of support
from across pharmacy.
As part of the campaign, Guild Member
“Many Australians are surprised when they pharmacies were sent a new ‘tile’ version
discover just how much their local pharmacy of the Gold Cross for display in their pharmacy.
I certainly hope it is being displayed with
can do. Now it is time to let everybody know pride, tying all participating pharmacies
in with the national advertising campaign.
how much more we can do.”
As we are now well into the final year
of the Fifth Community Pharmacy Agreement,
it is an important time to be spreading the
word about the value of community pharmacy.
GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 38 : OCTOBER / NOVEMBER 2014
6 Business Profile
Better
Medication
Management
BY SEAN TUNNY
Editor, Gold Cross Products
& Services Pty Ltd
Founded in 1997 by pharmacists, MPS (Medication Packaging
Systems Australia Pty Ltd) provides Medication Management
Solutions to pharmacists enabling them to better serve both
their community patients and Aged Care Facility residents.
MPS operates three, TGA licensed, Dose the manual nature of the business meant it
Manufacturing Facilities nationally and is was becoming ever harder, and we knew what
Australia’s leading provider of automated Dose we were doing was not ultimately sustainable.
Administration Aid solutions. MPS has recently We simply had to find another way, and after
received endorsement by the Pharmacy Guild seeing some of machinery available, we knew
of Australia for its Community Medication automation was the way to go.
Management System. In this edition of ITK,
we had the opportunity to speak with Chairman The next significant consideration however
and Founder, George Castrisos, to outline a little was how to get ‘clean’ information as with
about the company and its history, its interface any automation clean data is absolutely
with the pharmacy profession and to also share imperative, otherwise what is packed is not
some insights about the future of Medication going to be accurate. We therefore identified
“In 2008, we were Management in Australia. a need for an IT solution and began coding for
the first to recognise what became HealthstreamTM in 1997.
that pharmacy needed Editor: MPS is Australia’s leading
Editor: Can you highlight some of the
provider of automated Dose
software to allow it to Administration Aids (DAAs). Can you key milestones to date for MPS and what
lockdown its workflow outline a little of the MPS background? do you believe are the key underpinnings
for MPS that allows it to continue to
George: Prior to founding MPS, I had the
processes to keep opportunity to go to the States in 1993 on better serve community pharmacy?
up with the demand a home health discovery tour with a number George: In 2000, we opened our first
3rd party packaging facility, the first ever
of patients and of pharmacists from various specialist areas.
The Aged Care Facilities that we were servicing in Australia. Up until this point, DAA
customers.” at the time were extremely happy with us but preparation was generally conducted in the
GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 38 : OCTOBER / NOVEMBER 2014
Business Profile 7
“It’s in our DNA that a process of constant
improvement increases efficiency and
back of pharmacy. That year we were also helps decrease medication incidents.”
the first to provide hard copy signing sheets
and charts that were from exactly the same
data set as our software. Until this point,
and often still to this day, most solutions
don’t use pharmacy controlled data and /
or are reliant on sending and receiving data
between different systems.
In 2002, we voluntarily elected to seek TGA Editor: MPS Australia is the only Editor: MPS has enjoyed a privileged
approval for our facility as we required a set provider with 12 consecutive years and professional relationship with
of standards that would set us apart and also of Therapeutic Goods Administration Pharmacy. The Pharmacy Guild of
drive continuous quality improvement. licensing. How significant is this to your Australia recently announced that they
business and community pharmacy? have endorsed the MPS Community
In 2006, we were the first to introduce Medication Management Aystem.
George: It’s hugely significant as you always
automated checking technology. This is Appreciating the infancy of the
want your team to strive to be innovative,
where a machine, following packing, takes endorsement, how does this strengthen
to become more efficient and to progressively
a photograph of each and every Packette™, your relationship with Guild members?
decrease the number of potential medication
compares what it ‘sees’ versus the medication George: As a pharmacist I am extremely
incidents. In striving for good manufacturing
record, and then confirms that it is correct. proud of the endorsement. More so, I am
practice through the TGA, the annual audits
In 2008, we recognised that every pharmacy just make sure it happens. You know you are thrilled for the wider MPS team as they are
dealing with Aged Care needed software going to get a visit and that you must be able now being recognised for a system that we
to allow it to lockdown its workflow processes to to demonstrate improvement on the know improves the lives of tens of thousands
keep up with paperwork associated with patient previous audit. of Australians. It is the result of 15 years
administration and script management. of hard work and continued investment in
We also follow the Code of Good people, process and technology. We have
2013 saw the introduction of our Electronic Manufacturing Practice, use a number been through an exhaustive review process
Administration Interface called Dosedge™. of lean Six Sigma principles and have and we hope the Guild endorsement provides
What’s most unique about this product is benefited from over 12 years of continued confidence to Guild members that the product
that it still continues to use the one pharmacy workflow improvements in all aspects and service they receive from MPS is first class.
controlled data set, and loops back to that of our production processes. It’s in our DNA MPS is a proven and uniquely automated
single point of truth. Our philosophy has, that a process of constant improvement medication management solution and one
and continues to be, about striving for the increases efficiency and helps decrease that we believe pharmacy can embrace with
highest possible levels of compliance. medication incidents. complete confidence.
GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 38 : OCTOBER / NOVEMBER 2014
8 Business Profile
Editor: George what are some of the
goals and objectives for MPS as it
“MPS is a proven and uniquely automated continues to strengthen its relationship
medication management solution, with the profession in the future?
George: Our primary objective is to work
and one that we believe pharmacy can with the industry to meet the challenges
embrace with complete confidence.” ahead. To continue to add value and
develop our proprietary software solutions
– Healthstream™, Quantum and DosEdge™
- to help lock down workflow improvements.
MPS long ago ceased to be just a “packing”
solution for pharmacy and the fact we have
Editor: At APP this year, you delivered they do best. To do this, they need both the
this technology means we are able to tailor
a key note address titled “The future experience and expertise to be able to provide
our offer to key customers. This has provided
of medication management – how it will professional services but also the time and
us with great traction in the market and
impact your pharmacy and what you freedom to be able to provide the service. allowed us to partner with a number of
can do about it?” If there was just one MPS automates, and allows the pharmacist to key groups and deliver our medication
key take home message from the many delegate, unproductive administrative activity management solution to their members.
outlined that you would like to reinforce, which in turn increases patient contact time. If we can remove 70% of “unproductive”
what would that be? In conjunction with the work being done by administrative time in pharmacy and help
George: I guess the headline would be – the Guild, this allows community pharmacists the pharmacists to spend that time improving
let’s try and remove wasteful processes to fulfil their primary role of providing the lives of their patients, than that makes
in the back of pharmacy. Ultimately, this would professional services to the community. it all worthwhile.
enable the pharmacist to increase patient
contact time which has to be the primary
goal. If we look at the statistics we know that
we are going to be asked to dispense more 8 Clunies Ross Court
prescriptions, albeit for less return.
Eight Mile Plains QLD 4113
That’s going to be a challenge for all of us.
As a pharmacy owner I know that I need
Tel: 1800 003 938
to be continually reviewing my business
to be as efficient as possible but also to mps-aust.com.au Email: customer-service@mps-aust.com.au
focus my key staff, my pharmacists, on whatCUSTOM DISPENSARY SOLUTIONS New Flowsell ® Dispensa™ Solutions make it easy to design the All Dispensa™ dispensary products are manufactured to ISO most optimal and efficient layouts for small to large pharmacies. standard 9001 and are backed by a five year warranty. Ask about The flexible Dispensa™ systems — Rear Load Cabinet, free our full service program that includes consultation, store plans, standing and wall mounted PullOut Shelves and Drawer Cabinets supply and national installation. — allow for cost effective customised dispensary solutions. Flowsell ® Factory 1/13 Network Drive, Carrum Downs, Victoria 3201 T: (03) 9708 2276 F: (03) 9708 2279 E: john@flowsell.com.au flowsellpharmacysolutions.com.au
10 CONTINUING PROFESSIONAL DEVELOPMENT
Dose
Administration
Aids:
The Right Dose, at the Right Time
Introduction
In addition to providing patients with professional advice about their
Tim Roberts medications, one of the core tenants of the pharmacists’ role is to ensure
B.Pharm (Hons), AACPA, DipBusMgt that all patients are taking their medications safely and appropriately to
achieve optimal health outcomes – the right dose, at the right time with
Professional Development Manager; the right advice. As we know, many of our patients are taking a number
Pharmacy Guild of Australia QLD
of medications at once, with the complexity of medication regimes often
increasing as disease states progress. Dose Administration Aids (DAA’s)
are one of the most widely used tools in the professional services arsenal
of many pharmacies, both in Australia and abroad.
Learning Objectives A systematic review of DAA’s published in the Bulletin of the World
After reading this article, the learner should be able to: Health Organization in 2004 concluded that ‘DAA’s significantly improve
medication compliance and management of hypertension and diabetes1’.
•• quantify the cost-benefits in optimising medication
While this review was only focused on two chronic disease states, the
management and reducing medication related
published national and international evidence supports the use of DAA’s
hospitalisations
in elderly patients and those on long-term therapy for several chronic
•• describe the different types of Dose Administration Aids
conditions, as well as patients with unintentional poor compliance.2
available, including the differences in properties between
It is this wealth of favourable evidence which led to the consideration for
them
community pharmacy funding for the provision of DAA’s across both the
•• recognise and understand the eligibility requirements for
4th and 5th Community Pharmacy Agreements, recognising the valuable
participation in the Pharmacy Practice Incentives for Dose
role that DAA’s may play in reducing medication-related hospitalisations
Administration Aids
and adverse effects through improving medication management.
•• identify the types of medications which may not be
suitable for Dose Administration Aid packing due to In 2002, an Australian Commission on Safety and Quality in
physical stability issues. Healthcare report estimated that between 2 and 3 per cent of all hospital
admissions are related to problems with medicines which may originate
Competencies Addressed in the community or in hospital – this includes over-use, under-use and
1.1, 1.2, 1.3, 1.4, 2.3, 3.4, 4.1, 4.2, 4.3, 7.1, 7.2 medication adverse effects.3 The cost impact of these medicine-related
hospitalisations in Australia is believed to be $660 million per year
in the public hospital system alone (from hospital admissions data)4,
representing a significant opportunity for healthcare-savings through
better management of medications in the community. On a global scale,
a Responsible use of Medicines report from IMS Health describes that
research estimates approximately 8% of total health expenditure
(or around US$500 billion) per year worldwide, can be avoided through
optimised use of medications.4 IMS Health identified a number of levers
by which these healthcare savings could potentially be made, specifically
including: non-adherence to medication, untimely medication use,
medication errors and mismanaged polypharmacy.4
Linking our patients into medication management initiatives such
as DAA’s is not just good for their health, but it can also contribute
to a more sustainable healthcare system in Australia – so let’s explore
our options and ensure our patients get the right dose, at the right time…
GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 38 : OCTOBER / NOVEMBER 2014CONTINUING PROFESSIONAL DEVELOPMENT 11
DAA Basics – Options for
Medication Packaging
Compartmentalised plastic boxes
(e.g. Dosette boxes)5
Dosette boxes are re-usable stand-alone
units which allow the packing of medications,
often packed by the user (or sometimes
by a pharmacy). There are multiple
varieties available – some comprise of one
compartment, others spilt into AM–PM doses
and some have upwards of four compartments
for each day of the week. Some brands come
with additional features such as braille writing
for the vision impaired. These types of packing
options are typically not tamper-evident.
Blister or bubble packs
(e.g. Webster-Pak, MedicoPak)5
dispense pre-filled medications. Some devices Identifying patients who might benefit
Blister packs are held within a plastic or have additional functionality such as sms-text from a DAA service can also be linked into
disposable cardboard device with four
or email notification messages to a designated a number of opportunities which pharmacies
compartments for each day of the week.
person if the user does not respond to the already participate in; the first and foremost
These are hermetically sealed packs (either
alarm reminder within a certain time period. opportunity being the patient engagement
cold-seal or thermal seal foils), which are
at the point of sale whilst counselling on
tamper-evident upon sealing. Typically, these
Getting started – Identifying medications. Making sure that pharmacy staff
are prepared by the pharmacy for use by the
Patients and Pharmacy are well educated on the benefits of a DAA
patient. Medication information (e.g. name/
Eligibility for Incentives service and having appropriate informative
active ingredient, strength, dose frequency,
tablet descriptions etc.) is typically printed Who will benefit from DAA’s? collateral available are tried and tested
either on a header card for the pack or directly mechanisms of increasing awareness about
There are no specific criteria for who will
on to the foil (or both). Some variances in the service. Other opportunities to promote
‘benefit the most’ from utilising a DAA service;
types may include options for patients with a DAA service may include:
some patients on a single prescribed medicine
low vision or multi-lingual varieties for those may derive benefit from the service whilst •• identifying patient need through existing
who don’t read English. other patients who are prescribed multiple Medication Management Review (MMR)
medications may be able to handle them services, such as: MedsCheck/Diabetes,
Sachet Systems (e.g. MPS packettes, MedsCheck and Home Medicines Reviews
quite effectively without a DAA!
APHS ‘My Sachets’)5
However, some studies that assessed •• linking in to Pharmacy Practice Incentives
Sachet systems are typically small, tamper- such as Primary Health Care, and
the patient viewpoint on DAA’s report that
evident plastic packs which hold the promoting good medication management
users often like the fact that the devices
medications required for a particular date through Health Promotion activities and
simplify their medication-taking routine, and
and dosing time. These sachets can hold also identifying DAA service candidates
reduce the stress associated with managing
multiple medications in the one sachet and through Disease State Management
multiple medications. They generally improved
the medicine information (e.g. name/active
medication adherence in patients with initiatives for patients with major chronic
ingredient, strength, dose time/date, tablet
unintentionally poor compliance.2,6 disease states (Respiratory, Mental Health,
descriptions) is printed on the front of the
With those patient perspectives in mind, Diabetes and Cardiovascular)
sachet. These sachets come to the patient
pharmacists can take a proactive approach •• patients who identify as recently
as a roll (in chronological date and time order)
in identifying patients who may derive the discharged from hospital – often multiple
and are often provided in a container for
most benefit from participating in a DAA medication changes occur, including the
storage and easy access. Sachets are prepared
service. Some patient characteristics which prescribing of new medicines and the
using automated packing technologies, thus
usually these services are outsourced to large- pharmacists may try to identify include:7 changing of medication regimes
scale packing facilities and then delivered •• patients taking 5 (or more) medications •• promotion of the DAA service to
to patients through the community pharmacy. daily (including non-prescriptions family members or carers who pick up
medications) prescriptions. Also, ensure that all local
Automated dispensing devices •• patients with a medical history prescribers are aware of your DAA service
(e.g. Medido, TabTimer)5 suggesting problems managing so that they may recommend it to patients
These devices dispense medications for medications (e.g. prior hospitalisation •• target local seniors support groups,
a particular (user-nominated) dose-time, due to poor adherence) Rotary/Probus clubs, RSLs and other
typically with a built-in alarm functionality •• patients with complex medication regimes relevant community organisations to
to alert users to when a dose is required •• patients with signs of cognitive or physical spread the word to your customers about
(or if a dose has been missed). Devices impairment which may affect their ability the medication management services
may need to be manually filled or they may to manage medications. on offer in the pharmacy.
GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 38 : OCTOBER / NOVEMBER 201412 CONTINUING PROFESSIONAL DEVELOPMENT
Pharmacy Practice Incentives:
Dose Administration Aids
The Pharmacy Practice Incentives (PPI), under
the 5th Community Pharmacy Agreement,
commenced in 2011 and recognised 6 priority
areas of practice with incentives for community
pharmacy participation. The DAA priority area
allows for an incentive payment for eligible
pharmacies to be paid four times per year, and
for the provision of DAA services to patients
residing in the community. For a pharmacy
to be eligible for these incentive payments,
they would need to meet the program
requirements and the Quality Care Pharmacy
Program (QCPP) accreditation requirements
for providing a DAA service (see QCPP Dose
Administration Aids Checklist – T3B).
For the purposes of the PPI programme
the PPI Program Specific Guidelines defines
a DAA as: a sealed, tamper-evident device
that allows medicine doses to be organised
according to the prescribed dose schedule.8
As such, there are a number of suitable
packing options available commercially,
however, devices that are not ‘tamper-evident’
as described by the program guidelines
are not eligible for incentive claiming (e.g.
compartmentalised plastic boxes or ‘dosette’
boxes). The PPI program definition states
that DAAs are a Sheet of hermetically sealed
blisters or medicines set out in a calendar pack
which must be tamper-proof once packed.
Should a pharmacist choose to provide
a non-tamper-evident DAA, the service
provided must still meet the criteria in the
PSA Professional Practice Standards –
Standard 7: Dose Administration Aids Service.
To claim incentive payments for the DAA
priority area under the PPI program, DAA’s
provided must meet the following criteria:8
•• The patient’s medicine/s in the DAA
are dispensed and packed by the claiming
Eligible Community Pharmacy
in accordance with the quality Standard
General Eligibility for Participation in the PPI in the pharmacy; or
Programs requires a pharmacy to:8 •• The patient’s medicine/s in the DAA
are dispensed by the claiming Eligible
•• be a Section 90 Pharmacy
Community Pharmacy but are packed
•• be accredited by an approved Pharmacy Accreditation Program such as the QCPP
at another site (DAA packing warehouse,
•• agree to publicly display and comply with the Community Pharmacy Service another pharmacy, etc.) which meets the
Charter and Customer Service Statement pharmacy approval authority requirements
•• register for one or more of the PPI priority areas via the 5CPA Registration and in the relevant state or territory as well
Claiming portal as the relevant quality Standard; and
•• continue to meet the above eligibility criteria while participating in any priority •• The DAA patient is not living in a
areas of the PPI Programme Government funded Residential Aged Care
•• deliver the PPI priority area services in accordance with the PPI Programme Facility (RACF) or a correctional facility.
Specific Guidelines.
Further information about the eligible
For more information about the PPIs and to register online for priority areas, claiming periods and the procedures for
please visit www.5cpa.com.au. For QCPP support please visit www.qcpp.com claiming for payment can be accessed
or contact your local state Guild branch. through www.5cpa.com.au
GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 38 : OCTOBER / NOVEMBER 2014CONTINUING PROFESSIONAL DEVELOPMENT 13
Department of Veterans’
Affairs DAA service
The Department of Veterans’ Affairs (DVA) DAA
service provides veterans, war windows and
other eligible DVA patients a DAA at no cost “The PPI program definition states that DAAs
to the patient along with ongoing support and
care from both their pharmacist and doctor. For a are a Sheet of hermetically sealed blisters or
veteran to be eligible for this service, they must:9 medicines set out in a calendar pack which
•• hold a Gold, White or Orange card
•• live in the community and not in a
must be tamper-proof once packed.”
residential care facility
•• be likely to benefit from the DAA service.
As part of this service, GPs are able to prescribe
(on authority from VAPAC) a six month
prescription for one weekly DAA Service (written
as an original with 25 repeats). Pharmacists are
also eligible to receive a payment for a Veteran Additionally, State and Territory pharmacy DAA Dilemmas – Ensuring
Six Month Review (VSMR) after 20 weeks of authority guidelines may require that Best-Practice Protocols
DAA use, to assess whether the service is still a pharmacy have a designated area Whilst the benefits for both patients
of benefit and identify if any further information (or minimum space) to pack DAA’s and store and pharmacies in instituting a DAA service
or assistance is needed. VSMR interviews may patient medications in an assigned space are quite evident, in order to ensure that
take place either in the pharmacy or in the which is free from interruption and ensure the service runs smoothly and meets the
patient’s home.9 that only suitably trained personnel (under QCPP accreditation standards, it is imperative
the direct supervision of a pharmacist) be able that robust protocols and procedures are
The DVA DAA service is separate to the
to pack the DAA. considered.
practice incentive payments available under
the 5CPA, so participation in this service QCPP Dose Administration Aids Checklist
Third-Party Packaging
won’t preclude patients from being eligible (T3B) is a great starting point for developing
For pharmacies that feel they do not have
in PPI claims. store procedures that meet the quality
adequate space, staff or time to package
standard and considering the personnel,
Pharmacy Considerations: medications for a DAA service, engaging with
resource, space and time requirements that
Getting Set-up to provide DAA’s a third-party automated dose packing provider
will be needed to run the service. Some major
may be a viable option. The Pharmacy
Alongside the PPI Program Specific Guidelines considerations to take into account while
Board Guidelines on Specialised Supply
and the QCPP accreditation standards for putting together DAA procedures should
Arrangements state that pharmacists who use
DAA service provision, pharmacies should include (but are not limited to) the following:7,10
an automated dose packaging system (packing
also refer to the Pharmaceutical Society of
pharmacist) to pack sachets on behalf of •• Hygiene: Ensure that handwashing
Australia’s Dose Administration Aid Service
another pharmacist (supply pharmacist) facilities are accessible and that
– Guidelines and Standard July 2007 and the
may need licencing by the therapeutic goods equipment such as gloves, tweezers
Professional Practice Standards – Standard 7:
administration in jurisdictions that have and tablet counters are made available
Dose Administration Aids (available for
laws to complement the Therapeutic Goods to ensure hygienic contact with packed
download from www.5cpa.com.au).
Act 1989 (cwth).10 Some considerations that medicines. Components of a DAA which
Prior to establishing a DAA service, the should be addressed prior to engaging a third- are re-usable should be regularly cleaned
following considerations are recommended party packaging provider include:7 and maintained.
for pharmacists providing the service to take •• Storage: Ensure that procedures
•• an agreement between both parties
into account:7 and mechanisms are in place for the
(packaging and supply) describing
•• Understand the full extent of what is aspects such as dispensing, packing,
appropriate storage of dispensed original
required in a DAA service, including the packs of medicines used for patient DAA’s
and compliance with relevant legislation
consumer expectations. •• the right of the consumer to privacy is and the storage of completed DAA’s
•• Determine if there are consumers for understood by each party awaiting receipt. After packing, DAA’s
whom the provision of a DAA service •• consent is obtained from the consumer should be stored in a cool, dry place and
would provide benefits over existing for this arrangement. protected from light
methods of supplying medications. •• Labelling: The label on a DAA should
•• Estimate the number and type of The ultimate responsibility and liability for maximise compliance, promote usability
consumers for who the DAA service may the integrity of the DAA process, however, and minimise error. It should clearly
be provided and plan appropriately for will rest with the pharmacist who accepts identify the name of the patient,
packing facilities and requirements. the prescription from the consumer.7 As per pharmacy name/address and the name,
•• Anticipate (as far as practicable) the the eligibility criteria for the PPI incentive strength and dose form of the medicines.
demand a DAA service will have on payments for the DAA service, a third-party Best practice is to include both the
pharmacy resources and the expected packaging service does not preclude a active ingredient and brand name of
number of DAA’s likely to be supplied. pharmacy for claiming the incentive payments medications, but when space is limited
•• Ensure that adequate time and resources for DAA’s provided that the other patient the active ingredient/Australian approved
are allocated for the packing of DAA’s. eligibility criteria are met. name should be used.10
GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 38 : OCTOBER / NOVEMBER 201414 CONTINUING PROFESSIONAL DEVELOPMENT
effervescent, dispersible, buccal and
sublingual preparations
•• hygroscopic medications which absorb
moisture from the air when removed
“A Medication Management Review (such as from packaging
•• medicines that degrade when exposed
a MedsCheck, Diabetes MedsCheck or Home to light or require significant protection
Medicines Review) may be a valuable undertaking from light
•• medications taken ‘when required’
for eligible patients, to make a suitable or in variable doses.
determination of the patient’s suitability for a DAA.”
Ideally, a DAA should be used within as short
a time frame as possible, as the manufacturer
cannot guarantee quality and safety after
removal from the original packaging. As an
example, some medications such as frusemide
and prochlorperazine can be light-sensitive
and may discolour if removed from the original
•• Record Keeping: Records should be orderly and well lit, and providing freedom packaging and placed in packaging exposed
maintained of each DAA packing, including from interruption, are necessary for safely to light for a long period of time (e.g. longer
the consumer’s name and date of packing, performing the task and minimising the risks than 4 weeks).11 This does not necessarily
date of provision, details of the medication of medication packing errors.10 preclude the packing of these tablets into a
provided (with cross reference to Maintaining effective collaboration and DAA, however, consideration needs to be given
prescription numbers where appropriate) communication between the GP, Pharmacist, for the time frames in which the medicines
and some form of identification of the patient and carer(s) is imperative in the will be administered. A hygroscopic tablet,
pharmacist involved. delivery of a safe and efficient DAA service.7 however, such as chewable sodium valproate,
•• Staff Training: Staff involved in the packing Putting in place a system which ensures good undergoes significant changes to physical
of DAA’s should have the necessary communication between these parties may help stability (weight variation and change in
training and practical experience. minimise the need for re-working DAA’s and also dissolution profile) and could pose an issue
Procedures for the service should also reduce the chance of medication errors arising when packed in a DAA11 – in this case an
assist staff involved with understanding through a DAA service. Providing regular patient alternative dose form would ideally be used.
DAA requirements. Pharmacists should follow up is also imperative to ensure that any For pharmacies utilising a heat seal
have an understanding of the legal and issues identified by the user of a DAA service system from DAA packs, consideration should
professional requirements of a DAA service can be addressed and rectified if necessary. also be given to the amount of heat (and time
whilst all dispensary staff should have a
applied) when sealing packs, so as to not
general understanding of the overall DAA Problematic Pills– The Suitability compromise the quality of packed medicines
service offered by the pharmacy. of Medications for Packaging due to exposure to heat. Special consideration
When considering commencing a patient on should be given to medications which may not
For a more comprehensive list of QCPP
a DAA, it is prudent for a pharmacist to review be suitable in a heat seal system, such as soft-
considerations, consult QCPP Dose
the patient’s most current list of medications, gel capsule-type medications.
Administration Aids Checklist (T3B) and
medication history and their current
the PSA Dose Administration Aid Service – Ultimately, a pharmacist engaging in a DAA
medication management in order to ascertain
Guidelines and Standards July 2007. service should make informed judgements as
the benefits of a patient taking part in a DAA
to the suitability of patient’s medications to
Eternal Vigilance: service. A Medication Management Review
be included into a DAA pack, adopting a ‘risk-
Reducing Medication Packing Errors (such as a MedsCheck, Diabetes MedsCheck
assessment’ policy and weighing the risks of
or Home Medicines Review) may be a valuable
Recent media attention placed a spotlight on poor compliance against the potential issues
undertaking for eligible patients, to make
DAA services and dispensing errors (Medicine of medication instability.
a suitable determination of the patient’s
Mix-Up, A Current Affair; Air date – Friday 20 Cytotoxic Medicines in DAA’s:
suitability for a DAA. Additionally, there are
June 2014), describing a pharmacy error in the If a cytotoxic medication is to be included
a number of considerations that a pharmacist
DAA packaging of methotrexate. The report in a DAA pack the medication should be
may take into account in regards to the
highlighted the need for robust protocols handled in a manner which avoids skin
medications which are packed into a DAA.
in pharmacy to minimise packaging errors contact and the contamination of other
and also prompted a re-issuing of guidance Stability of Medications in DAA’s:
drugs (e.g. all equipment used in handling
from the Pharmacy Board of Australia (PBA) Because the transfer of medicines into
should be labelled and used solely for that
surrounding the dispensing of medicines a DAA pack is outside the individual product
purpose).7 Ideally, cytotoxic medications
with a narrow therapeutic index, such as licence registration terms from medicine
should be packed in a separate unit dose pack
methotrexate. manufacturers, pharmacists must consider
(and labelled appropriately), unless there
the drug stability impacts of medicines in
The task of filling DAA’s is repetitive, yet it is significant enough compliance concern,
a DAA.7 Typically, non-solid dosage forms
requires significant and focused concentration warranting inclusion in a multi-dose pack.
would not be packable in a DAA; other
to minimise error. The role may be delegated Relevant state occupational health and safety
commonly used medications that may not be
to suitably trained pharmacy students, interns standards should be observed when cytotoxic
suitable for inclusion in a DAA could include:
and dispensary assistants – with the work substances are handled.
subjected to checking by a pharmacist.10 •• medicines that deteriorate when
Controlled Drugs in DAA’s: The dispensing
Ensuring that the DAA packing area is tidy, removed from manufacturer packaging;
and packing of Controlled Drugs (Schedule 8
GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 38 : OCTOBER / NOVEMBER 2014CONTINUING PROFESSIONAL DEVELOPMENT 15
medicines) and the storage of DAA containing
Controlled Drugs must be in compliance ASSESSMENT
with relevant State/Territory legislation.
The pharmacy conditions in which DAA’s QUESTIONS
containing Controlled Drugs are stored must
meet relevant legislative requirements and
should accommodate the packed DAA without
physical damage.7
QUESTION 1
Taking the plunge: What is the estimated annual cost of medicine-related hospitalisations
Implementing a DAA Service in Australian public hospitals?
While DAA’s are a commonplace service in
a. $60 million
many community pharmacies, their benefits
to our patients in effectively managing their b. $660 million
medications cannot be underestimated! By c. 3% of total health expenditure
proactively identifying the patients who will d. 8% of total health expenditure
derive the most benefit from medication
management services such as DAA’s,
community pharmacy can continue to QUESTION 2
contribute to the betterment of patient health a. Which one of the following types of Dose Administration Aids is NOT considered
and the optimisation of medication taking. to be ‘tamper-evident’ once packed?
So, take the plunge, offer your patients b. Hot-Seal Blister Pack
a medication management solution that is not
c. Disposable Blister Pack
only good for their health, but can also grow
goodwill and loyalty in your pharmacy. d. Dosette Box
Give your patients the right dose, at the e. Plastic Sachet
right time…
QUESTION 3
a. Which one of the following patients would be eligible for payment, claiming under
Dose Administration Aids priority area of the Pharmacy Practice Incentives?
REFERENCES
b. A patient on a cold-seal blister pack, living in an aged care facility.
1 Connor, J., N. Rafter, et al.”Do fixed dose
combination pills or unit-of-use packaging improve c. A patient who receives a roll of sachet packs, in a correctional facility.
adherence? A systematic review.” Bulletin of the
World Health Organisation. 2004. 82: 935-939. d. A patient who lives at home (community) and is delivered a weekly dosette box that
2 Quality Medication Care Pty Ltd and Therapeutics
is prepared by the pharmacy (using their prescriptions on file).
Research Unit. Effectiveness and cost effectiveness c. A patient who receives a roll of sachet packs, picked up from their local pharmacy,
of dose administration aids (DAA’s). Final Report.
2004. Brisbane, University of Queensland and who dispenses the prescriptions but utilises a third-party packaging provider.
Princess Alexandra Hospital.
3 Australian Council for Safety and Quality in QUESTION 4
Healthcare. Second National Report on Patient
Safety-Improving Medication Safety. July 2002 a. Which of the following statements about Dose Administration Aids is CORRECT?
4 IMS Institute for Healthcare Informatics. Advancing b. Dose Administration Aids guarantee an improvement in compliance in all patients using
the Responsible Use of Medicines: Applying Levers
for Change. October 2012
more than 5 medications.
5 Elliott R. Appropriate use of Dose Administration c. When space on a Dose Administration Aid label is limited, it is preferable to use the active
Aids. Australian Prescriber. 2014; 37:2 ingredient name of the medications in the pack.
6 Nunney J, Raynor DK, Knapp P, Closs SJ. How d. Dispensary technicians and Intern Pharmacists can be delegated to check Dose
do the attitudes and beliefs of older people and
healthcare professionals impact on the use of Administration Aids, provided they have undertaken appropriate training.
multi-compartment compliance aids?: a qualitative
e. Patients who hold an orange, white or gold repatriation card are not eligible to be included
study using grounded theory. Drugs Aging
2011;28:403-14. in claiming for Dose Administration Aid PPI payments.
7 Pharmaceutical Society of Australia – Dose
Administration Aid Service, Guidelines for
Pharmacists July 2007
QUESTION 5
8 Program Specific Guidelines – Pharmacy Practice a. Which one of the following tablet properties makes chewable sodium valproate
Incentives – February 2014 physically unstable in a Dose Administration Aid?
9 Dose Administration Aid Service – the right dose: b. Tablet discoloration when exposed to light
Pharmacist information booklet. Accessed from
www.dva.gov.au (20/8/2014) c. Tablet degradation when exposed to light
10 Pharmacy Board of Australia. Guidelines on d. Tablet degradation when exposed to heat
Specialised Supply Arrangements. 2012
e. Tablet degradation when exposed to moisture in air
11 Haywood A, Llewelyn V, Robertson S, Mylrea M,
Glass BD. Dose Administration Aids: Pharmacists’
Role in Improving Patient Care. AMJ 2011, 4, 4, 186-
192 http//dx.doi.org/10.4066/AMJ.2011.693 ANSWERS: Question 1 – b / Question 2 – c / Question 3 – d / Question 4 – b / Question 5 – d
GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 38 : OCTOBER / NOVEMBER 201416 GUILDCARE
Pharmacy
Software Solutions
BY ROMA CECERE
General Manager –
Strategic Business
Performance, GuildCare
It is apparent that most community pharmacies in Australia are feeling the financial effects
of the PBS reforms. Aligning with one of GuildLink’s core strategies, enhancing sustainability
of pharmacy, GuildLink provides pharmacy with business tools and software solutions
designed to optimise their front of shop and professional services by identifying opportunities
with real-time insights.
GuildCare programs is a purpose-built software address patient compliance issues. GuildCare 5CPA Medication Management which
solution assisting Australian community works with the pharmacy’s dispensing software covers MedsChecks/Diabetes MedsChecks
pharmacies in identifying, recording, and and triggers a prompt at dispense for patients (also available on iPad) and Home
reporting of professional services. GuildCare that may meet the program criteria. This feature Medication Reviews.
was originally designed to support pharmacies ensures busy pharmacists are spending less GuildLink’s technology is aligned with
in meeting the requirements of the 5th time analysing a patient’s potential fit and the future needs of pharmacy, including
Community Pharmacy Agreement (5CPA) focusing on delivering the service. development of new 6CPA programs that may
Pharmacy Practice Incentive and Medication require technology for recording the service.
Management Programs. GuildCare has As always we will enhance the GuildCare
Program Streams
expanded its offering profoundly since its platform to accommodate any new initiatives
5CPA Pharmacy Practice Incentives –
humble beginnings in July 2011, with many new that arise.
Programs designed to unlock funding under
programs developed since launch. During this
the 5CPA. GuildCare programs cover five out Patient Services are also a perfect way
time, GuildCare pharmacies have accumulated
of the six categories offered by 5CPA PPIs: to gain patient loyalty to your pharmacy.
over 6 million recorded pharmacy-led
GuildCare offers pharmacies an easier way
interactions through the software. •• Clinical Interventions – also available
of recording patient services which they have
Through GuildCare, pharmacists can on iPad been delivering for many years such as blood
identify patients who may be eligible for a •• Dose Administration Aids Patient Detect pressure, lipid and blood glucose monitoring,
professional service, whether it is a 5CPA •• Staged Supply baby weight recording, and vaccinations.
program such as MedsChecks, or a patient •• Inter-Professional Collaboration
Patient Adherence Programs are tailored
adherence program which is designed to •• MedScreens (Primary Health Care) to the needs of the molecule to ensure that
patients are provided specific information
about their medication/condition that will help
to improve their knowledge and adherence
to treatment. Our figures show that when a
patient has been enrolled in one of GuildCare’s
“GuildSmart allows managers to set profit generating adherence programs, their adherence
goals for their pharmacy, track progress in real-time increases by 1.5 to 2 additional scripts per
year. Most of these programs are sponsored
and maximise the pharmacy’s’ profitability by utilising which means the pharmacy will be reimbursed
opportunities as they happen.” for the additional time spent on counselling
the patient.
Admin Module is a new section available
in GuildCare. Patient Plan is designed to help
GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 38 : OCTOBER / NOVEMBER 2014You can also read
