Inpharmation February 2013

Professional development and practice support for self care SUBSCRIBERS
Pharmacy and
Pharmacistonly medicines
V ol .14
Number 1
Print Post approved

PP255003/05274
february 2013
Counter
Connection
approved QCPP
refresher
training
John Bell says Contents
february 2013
V ol .14
Number 1
Managing editor Andrew Daniels

Production coordinator Kylie Davis
Contributor Anna Ezzy
Peer Review Simon Carroll
Layout Caroline Mackay
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Views expressed by authors of articles in
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The information contained in this material is
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Self care is not only undertaken for minor illness but is often
used when managing chronic conditions.
See page 04, Facts Behind the Fact Card: Pharmacy and Pharmacist Only medicines
Pharmacist CPD
04 Facts Behind the Fact Card: Pharmacy and Pharmacist Only medicines
Pharmacy assistants education

12
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John Bell says

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inPHARMation February 2013 I Pharmaceutical Society of Australia Ltd.
John Bell says
Self care a not so secret success strategy

By John Bell, Self Care Principal Adviser
Most commonly self care is applied to

treating minor ailments or self-limiting
conditions. However, increasingly the
management of chronic conditions
involves a component of self care.
Treatinggastrooesophageal reflux or
heartburn is an example, described in this
issue of InPHARMation, where therapy may
be short or long term and might include
both medication and lifestyle advice.
the level of advice which may be required for

optimum use.
No reasonable doctor would make
adiagnosis without taking a medicalhistory.
Similarly, determination as to
whethera requested non-prescription
productis suitable for a customer will
requireappropriate questions to be
asked. Themnemonic protocols such as
WHAT,STOP, GO and CARER are quite useful
but the questions should never be recited by
rote. Listen closely to the answers customers
give and adjust your questions accordingly.
Practice Point 1 on page 5 gives tips on
how to respond to both product-based and
symptom-based requests.
Pharmacists and pharmacy assistants play

an important role in ensuring that self care
strategies are appropriate. Given that self
care in the pharmacy environment often
involves the supply of non-prescription
medicines, we have a responsibility to ensure
the products recommended are likely to lead
to improved health outcomes.
Our heartburn case study situation is not

uncommon. Depending on the location,
severity, frequency and duration symptoms
and whether any other medicines are
being taken, an antacid/alginate (such as
Gaviscon or Mylanta), an H2 blocker (such as
Gavilast or Zantac) or a PPI (such as Salpraz
or Somac) might be suitable. Occasionally
an antacid /alginate combination may be
useful for breakthrough symptoms for a
patient on long term or step-down dosing
with prescription PPI; its something the
pharmacist can discuss with the patient.
Of course, many non-prescription medicines

are available in non pharmacy outlets;
butgenerally the most effective are classified
as Pharmacy medicines or PharmacistOnly
medicines. This classification system
(onewhich is almost exclusive to Australia)
takes account of the benefit/risk ratio and of
By definition, Pharmacist Only medicines

(the PPIs for example) can be supplied
only by pharmacists; but the pharmacy
assistant needs to know what products
are in this category and when to refer.
Theprocedures and protocols are important,
but education and specific product
knowledge is also essential. For instance

the September 2012 issue of InPHARMation
gave a comprehensive overview of the
management of heartburn.
In any event, always look to add value
to your advice with the provision of a
SelfCare Fact Card. Case study Ken is
the perfect recipient for the information
on the Heartburn and Indigestion card
(butmake sure you know the contents as
well); andyou can tell your customers the
difference between this and search engine
information is that the information on the
Self Care cards is up-to-date, accurate and
evidence based.
Gastrointestinal 0099
Indigestion is an uncomfortable feeling in the upper abdomen. Heartburn is a

painful, burning feeling rising up from the stomach or lower chest towards the
throat. Medicines, and in some cases simple lifestyle changes, can relieve and
prevent heartburn and indigestion.
Indigestion
The Digestive System
Indigestion is a general term for

uncomfortable symptoms in the upper
abdomen (belly). Indigestion is often
related to eating or drinking.
Indigestion includes:
oesophagus
Upper abdominal(belly) discomfort

or pain
stomach
Burping
Nausea, loss of appetite
A bloated or full stomach feeling.
liver
Indigestion is sometimes caused by

a medical condition or by medicines.
Sometimes no cause can be found.
large intestine
small intestine
Self Care is a program of the Pharmaceutical Society of Australia.

Self Care is committed to providing current and reliable health information.
Electronic delivery
The John Bell Health Column is available
weekly by email. If your pharmacy would
like to receive the column, please send
your email details to psc.nat@psa.org.au
CPD that comes to you...

Quality CPD, anytime, anywhere
Automatic recording of your CPD credits
Choose from over 80 activities
170
CPD CReDits
GROUP 2
Visit www.psa.org.au/education/online-learning
PSA3172
PSA online CPD
2011
Heartburn and
Indigestion
uP to
Self care is a major pillar

of the established health
care system in Australia.
The concept recognises
not only the cost benefit
to both the individual and
the community, but also
the benefits of providing
consumers with a sense of ownership,
independence and control over their
ownhealth.
PSA All you need for your CPD.
Pharmacy and Pharmacist Only medicines Pharmacist CPD Module number 234
Pharmacy and Pharmacist Only medicines

By Anna Ezzy
Ken, 45 years-old, presents
to the pharmacy requesting
overthe-counter (OTC) Somac.
He tells you that he experiences
a burning sensation in his chest
which rises up into his throat.
Most commonly he experiences
reflux at night after going to bed,
usually several nights a week.
He has used antacids in the past,
which he usually purchases from
the supermarket; however his
symptoms have been worse than
normal in the past few weeks.
Hissister takes Somac to manage
heartburn, and suggested that
Ken try it.
After reading this article,

pharmacists should be able to:
Identify the advantages and
disadvantages of self-medication
Differentiate between product
and symptom-based requests
Discuss the pharmacists role in
the provision of non-prescription
medicines applying the relevant
professional practice standard
Contrast the different role of
pharmacists and pharmacy
assistants in responding to
medicine requests
Describe the QCPP training
requirement for pharmacy
assistants involved in the sale of
Pharmacy and Pharmacist Only
medicines.
Competencies addressed (2010):
1.1, 1.2, 1.3, 2.3, 2.3, 6.1, 6.2, 6.3,7.1
CPD Credits
GROUP2
This education module is independently researched and compiled by PSA-commissioned authors and peer reviewed.
Theexchange of information between consumers and pharmacy staff may be easier in symptom-based requests,
as there is greater opportunity to discuss treatment options in response to a clear request for advice.
Self care including self

medication
Learning objectives
up to
John Facts
Bell says
Behind the Fact Card
Self care occurs when a person takes

ownership of health care decisions for
themselves, their family or their friends
with regard to preventing, diagnosing
and treating health conditions.1 Self care is
undertaken for managing both minor illness
and chronic conditions. Self medication is
one of the most frequent methods of self
care, andinvolves using non-prescription
medicines and devices to manage a
health condition. The advantages and
disadvantages of self medication are listed
in table 1.
Symptoms of gastro-oesophageal reflux
disease (GORD), described by many
consumers as heartburn, are usually mild and
intermittent. Often symptoms are associated
with diet and lifestyle.2 Episodic GORD occurs
in >30% of individuals3; many consumers
manage symptoms with self care, including
self medicating with antacids, H2-inhibitor
or proton pump inhibitor medicines either
independently, or in collaboration with a
healthcare professional.
Self care in the pharmacy often involves

supplying non-prescription medicines.
Pharmacists and pharmacy staff have a
responsibility to act as gate keepers to
assist consumers with self medication.4
Requestsfor non-prescription medicines
can be symptombased, occurring when
a consumer asks for advice to treat
specific symptoms they are experiencing,
or product-based, when the consumer
asks for a specific product by name. Both
present specific challenges for pharmacy
staff in ensuring an appropriate response.
Research has indicated that product-based
requests can be more challenging, and that
symptom-based requests are more likely to
result in an appropriate patient outcome.
Theexchange of information between
consumers and pharmacy staff is often
easier for symptom-based requests, as there
is greater opportunity to discuss treatment
options in response to a clear request
foradvice.5
In the above scenario, Ken has asked
specifically for pantoprazole. The challenge
is to determine if pantoprazole will be safe
and effective for Ken without making him
feel unnecessarily interrogated. However,

consider how the response would need to
differ if instead Ken has presented looking
for advice about treating his symptoms.
To recommend a safe and appropriate
treatment, staff need to ask the right
questions to understand the type of
heartburn symptoms Ken is experiencing
and other issues such as any concurrent
medicines and medical conditions.
Strategies for responding to symptom- and
product-based requests are discussed in
Practice point 1 and 2.
a prescription. Incontrast, PharmacyOnly

medicines (S2), such as higher doses of
ranitidine also used to treat symptoms of
GORD, areconsidered safe for use and are
sold in a pharmacy where professional
advice is available if required, or where a
pharmacy service is not available from a
licenced person. Unscheduled medicines,
such as antacids previously used by
Ken to treat symptoms of heartburn,
are considered safe for use without
professional advice, and as such are widely
available.9
Self care and self medication for

symptoms of GORD is appropriate for
many consumers, however for some,
further investigation and management
by a medical professional is necessary.2
Moreinformation is required from Ken
to determine if OTC pantoprazole is
appropriate for him.
Direct involvement does not mean simply

acknowledging the sale of a Pharmacist
Only medicine. The pharmacist is required
to follow a systematic procedure when
supplying these medicines, andsupport
and educate pharmacy staff to follow this
procedure. This procedure should allow
the pharmacist to assess therapeutic need
for the product including risks involved
with use, monitor for inappropriate use,
and provide information and advice on
using the product that is relevant to the
consumers needs. Due to the need for the
pharmacists direct involvement, Pharmacist
Only medicines should be stored in an
area under the pharmacists supervision.7
Practice point 3 provides an overview of the
considerations when supplying Pharmacy
and Pharmacist Only medicines.
Pharmacists
responsibilities
The pharmacist is responsible for the
safe and judicious provision of nonprescription medicines and therapeutic
devices appropriate to the needs of the
consumer.7 Professional practice standard
12: Provision of non-prescription medicines
and therapeutic devices details the
responsibilities of the pharmacist when
supplying nonprescription products.
Ken has requested pantoprazole,
aPharmacist Only (S3) medicine,
totreat his symptoms of GORD. Assuch,
theProfessional Practice Standards requires
the pharmacist to be directly involved
in the sale. Medicines in Australia are
scheduled to control the level of access
and availability to protect public health
and safety.8 As a PharmacistOnly medicine,
pantoprazole is considered to require
professional advice to promote safe and
appropriate use, but is available without
Returning to Kens request for OTC

pantoprazole to assess Kens needs,
thepharmacist should consider his
presenting symptoms, the frequency
of symptoms, hisage, any previous
treatment, and his lifestyle and medical
history. Kenssymptoms of heartburn and
regurgitation appear typical of GORD, and
symptoms are frequent (>2 times per week,
but less than daily). This would indicate
that a trial of a proton pump inhibitor,
such as pantoprazole is indicated. However
consider the following information that the
pharmacist obtained when responding to
the request.
Facts Behind the Fact Card
Practice point 1
Strategies for responding to
product-based requests
Research has shown that while many
consumers are happy to answer questions
in the pharmacy, they prefer not to
but asked the same thing every time
they request a product.21 Often fewer
questions are required when a consumer
requests a product they have used before,
thereforeasking about prior use is a
helpful opening question. Other tips for
responding to product requests:
1. Explain why you need to ask
questions.
Highlight the fact that things may
have changed since they last took
the medicine, i.e. new medicines or
conditions, new symptoms etc.
2. Ask how the product worked for
them previously.
This open ended question will allow you
to prompt them about the efficacy or any
side effects they may have experienced.
3. Have them tell you about the
product.
Rather than asking a whole lot of
questions, ask the consumer to
summarise how and why they have been
using the product, i.e. can you tell me a
bit about how youve used the product
in the past?
4. Acknowledge their experience with
using the product.
Instead of telling the consumer that the
medicine needs to be taken with food,
remind them, i.e. remember to take it
[the medicine] with food.
Table 1. Advantages and disadvantages of self medication6

Advantages of self medication
Disadvantages of self medication
Safe and effective when used according to directions
Can cause harm if used incorrectly or inappropriately
Reduces time and cost of visiting GP
Can worsen some medical conditions
Allows consumers to maintain independence and gain

confidence in managing their own health care
Can mask serious medical conditions giving rise to

significant consequences
Can be less expensive than some prescribed medicines
Can be more expensive than some prescribed

medicines
Can reduce the burden on the healthcare system if used

appropriately
Can increase the burden on the healthcare system if

used incorrectly or inappropriately
John Facts
Bell says
Practice point 2
Strategies for responding to
symptom-based requests
1. Gather information by active listening
and reflecting on the consumers
comments.
There are many protocols that can be
used to gather patient information,
including WHAT-STOP-GO and CARER.
However, it is still important to actively
listen, and reflect on comments the
consumer makes to obtain a complete
picture of the problem.21 For example,
aconsumer might state off hand that
they have had the problem for ages,
exploring this more by reflecting on the
statement will provide more information
about the condition and show the
consumer you are listening to what
theysay.
2. Ask about the consumers experience
with the condition, including past
treatment.
Asking about the consumer experience
with the condition in the past will elicit
a wide range of useful information,
including duration or recurrence of the
condition, how they are affected by
the condition, and their response to
treatment in the past.
3. Support the consumer to make an
informed decision on treatment.
Many consumers requesting advice in the
pharmacy will want to participate in their
own healthcare decisions.21 Ratherthan
simply telling the consumer what to do,
by instead providing consumers with
information, including the advantages
and disadvantages of various treatment
options, and giving them the chance to
elicit their views and preference, they are
supported to make an informed decision
about their health care.
Related Fact Cards

Heartburn and Indigestion
Ken tells you that he experiences heartburn

several times a week, which is considerably
more than in the past. Apart from the
burning sensation and some regurgitation,
he has not noticed any other symptoms
or pain. Ken does not have any medical
conditions, but has recently stopped
smoking. He began using nicotine
replacement therapy (NRT) gum a few weeks
ago. Apartfrom antacids and the nicotine
gum, he does not take any other medicines.
While Kens symptoms are frequent,
the pattern of symptoms has changed
dramatically in recent weeks so an
underlying cause should be suspected.
Hedoes not present with any atypical or
alarm symptoms, and is not <18 or >55
years of age, which reduces the risk the
symptoms relate to an underlying disease.
However he has recently started NRT,
which is known to precipitate or aggravate
symptoms of GORD particularly when an
oral preparation such as gum is used.2,10
Kens situation highlights the importance
of comprehensive information gathering
when determining therapeutic need.
Howdoes this new information impact
upon his therapeutic needs, and the
decision to supply pantoprazole?
Considerhow the decision to supply
would be affected if Ken had instead
reported nausea, cardiac or abdominal
pain, belching, cough, bleeding or
difficulty swallowing. Whilst GORD is often
a mild condition that can be managed
by appropriate self care, symptoms can
indicate a serious underlying disease.
Selfmedication may mask the symptoms
and prevent consumers seeking
appropriate care.6 This is typical of many
conditions treated by Pharmacist Only
medicines, and is a key reason why the
direct involvement of a pharmacist
isessential.
When responding to a request for a

nonprescription product, a holistic
approach to consumer care is important.
This involves formulating therapeutic
solutions that address not only the
presenting complaint, but any underlying
causes or associated symptoms as well.
While Ken has presented with symptoms
of GORD and provision of a short course
of pantoprazole may be appropriate,
thepharmacist should address the
precipitating factor of the nicotine gum.
As well as supplying pantoprazole,
thepharmacist could also recommend that
Ken consider switching to a transdermal
nicotine patch to assess whether this
resolved the exacerbation of his symptoms.
Providing advice and information on using
medicines is an essential responsibility
for pharmacists. Medicines information
is widely available in the public domain
and consumers increasingly obtain
information from sources other than
healthcare professionals such as from the
internet, package inserts, advertisements,
fromfamily and friends.11 There is no
guarantee regarding the quality of this
information, or the consumers capacity
to interpret it appropriately. A survey of
Australian adults has suggested that many
consumers are not able to correctly answer
questions about OTC medicines after
reading package instructions.12
Consider again Kens request for OTC
pantoprazole. This product has been
recommended by a family member,
Kenhas not used it before and may not be
capable of determining its appropriateness
or safety for his individual circumstances,
which are likely to be different to those
of his sister. It cannot be assumed that a
consumer requesting a particular medicine
has used it before, is using it correctly
or has determined that it is safe and
appropriate for their condition.
Table 2. Pharmacy assistant and pharmacist roles in medicines requests

Pharmacy assistant
Pharmacist
Asking questions to determine if a medicine is

appropriate
Asking additional questions to determine whether

referral to another healthcare professional is required
Determining appropriateness of direct product requests

and uncomplicated symptom-based requests for
Pharmacy medicines. Responding to triggers for referral
Determining appropriateness of more complex

symptom-based requests for Pharmacy medicines and
direct product requests for Pharmacist Only medicines
Referral to the pharmacist if the person is taking other

medicines, has any special needs or circumstances or if
the medicine requested is inappropriate
Referral to a general practitioner or other appropriate

healthcare professional if the consumer meets the
referral criteria
Providing advice on dosage, treatment expectations

and adverse events of Pharmacy medicines

and adverse events of Pharmacist Only medicines
This is why medicines are scheduled, to

promote safe and effective use, and it
is why Pharmacy and Pharmacist Only
medicines are sold only in pharmacies,
where professional healthcare advice is
available. Pharmacists should not overlook
the need to provide such advice.
Resources to support
Pharmacist Only medicine
provision
Continual changes to medicines
scheduling has meant that there is an
increasing number of Pharmacist Only
medicines available in pharmacies.
Some pharmacists may be unsure
how to best deal with product- and
symptom-based requests, particularly
when, like pantoprazole, a medicine is
down-scheduled from a prescription only
product to a Pharmacist Only product.
The Pharmaceutical Society of Australia
(PSA) produces guidance documents
to support the provision of Pharmacist
Only medicines. These guides provide a
decision-making framework for responding
to requests for advice and treating minor
ailments. Thepharmacist responding
to Kens request for pantoprazole, could
refer to the Guidance for the Provision of
a Pharmacist Only medicine; Proton pump
inhibitors (seetable 3) to support the
information gathering and the decision to
supply. Alternatively, if Ken had presented
with a symptom-based request, reference

to the Gastrooesophageal reflexdisease
counselling guide in the APF22
(seetable4) mayhave helped to inform
the recommendation of an appropriate
management solution. Guidance
documents and counselling guides are
available in the Australian Pharmaceutical
Formulary and Handbook 22nd Edition2,
orto PSA members at www.psa.org.au
The role of pharmacy

support staff
Pharmacy assistants are usually the
consumers first point of contact in the
pharmacy, and as such they are going to
be involved in the majority of consumer
interactions in the pharmacy. There are
many areas where, with appropriate
training including the use of protocols
such as WHAT-STOP-GO13 and CARER14
(see Practice point 3), pharmacy assistants
should be well equipped to provide
advice. However, there are some areas
such as complex symptombased
requests and providing Pharmacist
Only medicines where pharmacist
involvement is necessary. Perhapsone
of the pharmacy assistants most
important roles is being able to make this
distinction, and recognising when referral
to the pharmacist is required.
The pharmacy assistants role is
particularly important in managing
pharmacy workflow.
Table 3. Guidance for provision of a Pharmacist Only medicine Proton pump inhibitors
(PPIs)
Consider professional obligations

A
Professional standards
B Privacy
C Documentation
Assess patients needs

Consider: D
Presenting signs and symptoms

E
Symptom frequency

F Age

G Any prior treatment

H
Lifestyle and medical history
Refer if necessary

Confirm therapy is appropriate

Consider: I

J

K

L
Treatment options
Contraindications and precautions
Use in pregnancy and lactation
Drug interactions
Atypical or alarm symptoms are present

Symptoms occurring daily
Aged >55 years with recent onset symptoms
Aged <18 years
Inadequate symptom control after two weeks of continuous
PPI therapy
Prolonged or recurrent use of a PPI without medical investigation
Family history of gastrointestinal cancer
Taking long-term NSAID therapy
Taking medications suspected of aggravating reflux symptoms
Refer if necessary
Contraindications and precautions
Concurrent medications
Provide counselling
(supported by written information)

Practice point 3
Considerations when supplying
Pharmacy and Pharmacist Only
medicines
When recommending or supplying a
Pharmacy or Pharmacist Only medicine,
important considerations include2:
The needs of the consumer:
-- symptoms What is the likely cause
of the consumers symptoms?
-- medical history Does the consumer
have any other medical conditions or
take any medicines? Could these be
contributing to the current condition?
-- lifestyle and other factors Could
the consumers lifestyle, i.e. smoking,
alcohol, exercise levels be impacting
on their current condition?
-- age Could the consumers age
influence the current condition?
The appropriateness of the medicine:
-- contraindications Is the
recommended treatment
contraindicated due to the
consumers medical history?
-- drug interactions Does the
recommended treatment interact with
any medicine the consumer is taking?
-- efficacy of treatment options Is the
treatment effective for the consumers
condition? Are there any other
treatments that should be considered?
Referral points:
-- does the consumer have any signs
or symptoms that indicate self care
is not appropriate?
Counselling and advice:
-- dose What is the recommended
dose for the consumer?
-- how to administer When and
how should the consumer take the
medicine?
-- treatment expectations When
should the consumer expect to feel
better? When should they seek further
medical advice?
-- adverse effects Are they any
common or serious adverse effects
associated with the treatment?
-- other advice Are there any other
things the consumer can do or take to
manage the condition?
M Dosage
N
Treatment expectations
O Adverse effects
P
Lifestyle modifications
Q Follow up advice
Australian Pharmaceutical Formulary and Handbook, 22nd Edition.

John Facts
Bell says
Practice point 4
WHAT-STOP-GO protocol
WHAT-STOP-GO13
Determine WHAT is wrong assess the
patients current medicines and health
status.
W Who is the patient?
H How long have symptoms been
present?
A Actual symptoms -What are they?
T Treatment for this or any other
condition?
STOP and assess the situation.
S Symptoms or side effects caused by
other conditions and/or medicines?
T Totally sure? Any special patient needs
or circumstances?
O Overuse/abuse how long has the
patient been taking the medicine or
selftreating the condition?
P Pharmacist Only always refer to the
pharmacist. Check whether the patient
would like to speak to the pharmacist.
GO Supply the medicine if appropriate
and provide advice.
Ask the patient if they have any further
questions. Would the patient like a
CMI for the Pharmacist Only medicine?
Provideadvice on how to use the
medicine.
Scheduled medicines and scheduling

changes can have a direct impact on
workflow in the pharmacy. Therequirement
for direct involvement by the pharmacist in
the sale of Pharmacist Only medicines can
interrupt dispensary and other professional
activities. Thisdirect involvement does
not require the pharmacist to complete all
aspects of the sale. As part of a systematic
procedure for dealing with a PharmacistOnly
medicine request, pharmacy assistants are
able to gather relevant information and
pass this information to the pharmacist,
allowingthem to respond appropriately.
By training and supporting pharmacy
staff to follow a systematic procedure,
thepharmacist can be confident that the
pharmacy assistant has obtained all the
relevant information from the consumer.
When pharmacy assistants are capable
and confident in performing this role the
pharmacist has more time to complete
the tasks that pharmacy assistants
cannotperform.
It is likely that Kens first point of contact will

be a pharmacy assistant. Withappropriate
training, there is no reason that this person
could not gather the relevant information
to assist the pharmacist to appropriately
manage the request for pantoprazole.
Inthis scenario, theprecipitating factor
of the nicotine gum would be uncovered
by questioning and appropriate use of
protocols; T: Treatment for this or any other
condition in WHAT-STOP-GO or C: Check
other medications in the CARER protocol.
This information should be relayed to the
pharmacist who can then provide further
advice and appropriate treatment.
Staff training
Having well-trained and confident
pharmacy support staff is integral
to enabling them to work safely and
effectively, maximising their roles in the
pharmacy and allowing pharmacists to
concentrate on their professional activities.
In collaboration with the pharmacist,

pharmacy assistants are involved in
ensuring the health and well-being of
consumers. The sale of Pharmacy and
Pharmacist Only medicines is a pharmacy
assistants key role and they need to be
empowered to provide professional advice
to consumers requesting OTC medicines.
The importance of appropriate training is
highlighted in the following scenario:
Kristy is a pharmacy assistant who has
been working in the pharmacy for several
months. She has no formal pharmacy
assistant training, and although she is keen
to learn it is hard to find the time to teach
her. Kristyhas excellent communication skills
and is great with customers. However she
lacks confidence when it comes to the sale of
Pharmacy and Pharmacist Only medicines.
Kristy is working when Ken comes in to the
pharmacy for pantoprazole. Kristy has not
sold pantoprazole before, but she knows
it is kept in the dispensary. Kristy is not
confident in asking Ken any questions about
his condition, but she does not want to
bother the pharmacist as she can see he is
busy dispensing prescriptions. She assumes
that since Ken has asked for pantoprazole,
he must have used it before or had it
recommended to him by his GP, so she sells it
to him along with some nicotine gum.
Whilst in this scenario it is unlikely that
Ken would suffer serious harm, consider
how this would be different if he had
experienced an alarm sign associated with
his heartburn symptoms, for example
gastro-intestinal bleeding or difficulty
swallowing. Thesupply of pantoprazole
could delay diagnosis of a serious
underlying condition. The potential
consequences for Ken could have been
disastrous. Although the pharmacist was
not aware of Kristys actions, while they are
on duty, the pharmacist is responsible for
the sale of all medicines in the pharmacy.
As a result the pharmacist would have
been responsible for any adverse
consequences Ken suffered as a result of
the inappropriate use of pantoprazole.
Quality Care Pharmacy Program (QCPP)
accreditation requires that all pharmacy
assistants involved in the sale of Pharmacy
and Pharmacist Only medicines complete
the accredited training unit Support the
sale of Pharmacy and Pharmacist Only
medicines.15 Thisunit forms part of the
Certificate II in Community Pharmacy,
a nationally recognised training course

providing entry level education for
pharmacy assistants new to working in
pharmacy. The course also covers health
product knowledge, administration,
sales and marketing, service delivery
and dispensary operations.16 However,
theunit Support the sale of Pharmacy and
Pharmacist Only medicines can also be
delivered on itsown.17
In addition to compulsory training on
the sale of Pharmacy and Pharmacist Only
medicines, pharmacy assistants should be
encouraged to complete regular education
activities to improve and update their
knowledge of healthcare products and
conditions. QCCP accreditation requires
that pharmacy assistants complete three
hours of refresher training on Pharmacy
and Pharmacist Only medicines per
year after initial accredited training is
completed.15 Pharmacists can work with
staff to help them identify knowledge gaps
where additional training and education
would be beneficial, and to formulate
a training plan to meet these needs.
TheSelf Care Counter Connection modules
are designed specifically for pharmacy
assistants, andprovide training and
education in disease states and treatment
options on many conditions that are
commonly treated in pharmacy, not just
Pharmacy and Pharmacist Only medicines.
Themodules assist pharmacy assistants
identify their role in managing specific
healthcare conditions; modules
focus on the appropriate use and
counselling points for OTC products,
and outline circumstances in which
consumers should be referred to the
pharmacist. TheSeptember 2012 issue of
InPHARMATION18 focused on symptoms
and treatment of GORD, and may have
provided Kristy with the knowledge and
confidence to better handle the scenario
outlined above.
Practice point 5
CARER pxrotocol
CARER14
C- Check
WHO is the patient?
WHAT are the symptoms?
WHAT has been tried?
HOW LONG have the symptoms been
present?
Other MEDICATION?
Other CONDITIONS?
A-Assess
Diagnosis CLEAR?
Medication therapy MOST
APPROPIATE?
Possible INTERACTIONS?
TRAINED and CONFIDENT?
R-Respond
RECOMMEND appropriate therapy?
REFER if uncertain
RECONSIDER if medication
inappropriate
E-Explain
VERBAL directions
WRITTEN support
WHAT TO DO if not improved
REASONS for referral
R-Record
IF LEGALLY REQUIRED
Provide ONGOING CARE
If REFERRED
If MISUSE/ABUSE suspected
Applying knowledge is an important

aspect of education and training. It is
important that pharmacy assistants have
the opportunity to regularly practice
and receive feedback on the skills and
knowledge they have acquired.19,20
Pharmacists can work with pharmacy
assistants to reinforce the knowledge
they acquire through education activities,
andapply it in the context of the everyday
practice in the pharmacy.
John Facts
Bell says
Table 4. Treatment of gastro-oesophageal reflux disease: a summary
Gather patient information

Consider: Symptoms

Symptom frequency

Patient characteristics

Prior treatment

Medical and lifestyle history
Assess patient needs

Consider:
Refer if necessary
The need to refer
Dysphagia (difficulty swallowing)

Odynophagia (painful swallowing)
Nocturnal choking
Suspected gastrointestinal bleeding
Persistent nausea and vomiting
Unintentional weight loss
Cardiac-type chest pain
Symptoms occurring daily
Family history of gastrointestinal cancer
Long-term NSAID therapy
Symptoms not adequately controlled after a 2-week
trial of initial therapy
First-time symptoms in people >55years of age
People <18 years of age
Recommend treatment
Consider:

Goals of therapy
Treatment options
Provide counselling supported

by written information
Consider:

How to use the medicine

Adverse effects
Follow-up advice
Australian Pharmaceutical Formulary and Handbook, 22nd Edition.
ForKristy, this may involve asking her

about the information in the GORD
Counter Connection, and have her relay it
back to you in the context of a consumer
request and interaction. Supervising
Kristy when she is supplying Pharmacy
Only medicines may also provide the
opportunity for the pharmacist to provide
feedback to reinforce her learning and
improve her performance.
Self care and the pharmacy

Facilitating self care through the
provision of Pharmacy and Pharmacist
Only medicines is an important role of
pharmacies. Supplying Pharmacy and
Pharmacist Only medicines not only has
the potential to impact on consumer
health and well-being, but is also an
important aspect of pharmacy business
and profitability. Ensuring that the sales of
is managed appropriately through staff
training, use of resources and adherence to
professional standards is essential for the
ongoing success of any pharmacy.
10
References
1. Harris P, Nagy S, Vardaxis N (eds). Mosbys dictionary of
medicine, nursing and health professions. 2nd edn. Sydney:
Elsevier; 2010. p. 1562.
2. Pharmaceutical Society of Australia. Australian
pharmaceutical formulary and handbook. 22nd edn.
Canberra: The Pharmaceutical Society of Australia; 2012.
3. Ciociola A, Sirgo M, Pappa K, et al. A study of the nonprescription drug consumers understanding of the ranitidine
product label and actual product usage patterns in the
treatment of episodic heartburn. American Journal of
Therapeutics. 2001;8:38798.
4. Covington T. Non-prescription medication and self-careNon-prescription drug therapy: Issues and Opportunities.
American Journal of Pharmaceutical Education. 2006;70(60):
article 137.
5. Watson M, Bond C, Grimshaw J, Johnston M. Factors
predicting the guideline complaint supply (or non-supply)
of non-prescription medicines in the community pharmacy
setting. Qual Saf Health Care. 2006;15:537.
6. Repchinsky C (ed). Patient self-care: helping your patients
make therapeutic choices. 2nd edn. Ottawa: Canadian
Pharmacists Association: 2010.
7. Pharmaceutical Society of Australia. Professional Practice
Standards. Version 4. Canberra: Pharmaceutical Society of
Australia. 2010.
8. Australian Government Therapeutic Goods Administration.
Scheduling basics. 2012; At: www.tga.gov.au/industry/
scheduling-basics.htm
9. Australian Government Department of Health and Ageing
and Therapeutic Goods Administration. Poisons Standard
2012.Canberra; Commonwealth of Australia: 2012.
10. Rossi S (ed). The Australian Medicines Handbook. Adelaide:
Australian Medicines Handbook; 2012.
11. Morgan T, Williamson M, Stewart K, et al. Medicines
information seeking behavior: data for the National Census
of Medicines Use. Melbourne: National Prescribing Service;
2010.
12. Communication Research Institute of Australia. How over
the counter (OTC) medicines labels performed in Australia
before 2005. 2011; At: www.communication.org.au/g_info/
labelling_in_oz.htm
13. Pharmacy Guild of Australia and Pharmaceutical Society of
Australia. WHAT-STOP-GO protocol for providing pharmacy

medicines and pharmacist-only medicines. At: http://
beta.guild.org.au/uploadedfiles/Quality_Care_Pharmacy_
Program/Accreditation/standardsprotocols.pdf
14. Pharmacy Guild of Australia and Pharmaceutical Society of
Australia. CARER protocol for providing pharmacy medicines
and pharmacist-only medicines. At: http://beta.guild.
org.au/uploadedfiles/Quality_Care_Pharmacy_Program/
Accreditation/standardsprotocols.pdf
15. Pharmacy Guild of Australia. Quality Care Pharmacy
Program implementation information and rulings. 2012;
At: www.qcpp.com/iwov-resources/documents/QCPP/
QCPP/Standards/Implementation%20and%20Rulings/
ImplementationandRulings.pdf
16. Pharmaceutical Society of Australia. Certificate II in
community pharmacy. 2012; At: www.psa.org.au/education/
certificates-and-diplomas/certificate-ii-in-communitypharmacy
17. Pharmaceutical Society of Australia. Pharmacy and
pharmacist-only medicines (S2/S3) competency unit. 2012;
At: www.psa.org.au/education/certificates-and-diplomas/
s2s3-unit-sirppks001a
18. Thompson M. Gastro-oesophageal reflux disease; In
InPHARMATION Sep 2012. Canberra: Pharmaceutical Society
of Australia. 2012.
19. Egle C. A guide to facilitating adult learning, Canberra: Rural
Health Education Foundation. 2009.
20. Pharmaceutical Society of Australia. National competency
standards framework for pharmacist in Australia. Canberra:
Pharmaceutical Society of Australia. 2010.
21. Blenkinsopp A, Paxton P, Blenkinsopp J. Symptoms in the
pharmacy: A guide to the management of common illness.
6th edn. West Sussex: Blackwell Publishing. 2009.
Assessment questions for the pharmacist

Before undertaking this assessment, you
need to have read the Facts Behind the Fact
Card article and the associated Fact Cards.
This activity has been accredited by PSA as a
Group 2 activity.
Two CPD credits (Group2) will be
awarded to pharmacists with four out of
1. Which of the following is TRUE with

regard to self care?
a. Self care involves only the
treatment of health conditions.
b. Self care occurs when a health
professional takes ownership
of healthcare decisions for
themselves, their family or
theirfriends.
c. Self care is only appropriate to
treat minor illness.
d. Self medication is a form of
selfcare.
2. Which of the following is NOT a role
of a pharmacy assistant?
a. Asking questions to determine if a
medicine is appropriate.
b. Providing advice on dosage,
treatment expectations and
adverse events for Pharmacy
medicines.
c. Determining if referral to a general
practitioner is required.
d. Handling uncomplicated
fivequestions correct. PSA is authorised by

the Australian Pharmacy Council to accredit
providers of CPD activities for pharmacists
that may be used as supporting evidence of
continuing competence.
Accreditation number: CS13001
Submit answers online
This activity has been accredited for Group 2 CPD

(or 2 CPD credits) suitable for inclusion in an individual
pharmacists CPD plan.
up to
Select one correct answer from each

of the following questions.
Answers due 31 March 2013.
CPD Credits
GROUP2
To submit your response to these

questions online, go to the PSA website
www.psa.org.au
3. Quality Care Pharmacy Program

(QCPP) accreditation requires that all
pharmacist assistants:
5. Consider the case of Kristy explained

in the article, which of the following
is MOST correct?
a. be enrolled in the Certificate II in

community pharmacy.
b. involved in the sale of Pharmacy
and Pharmacist Only medicines
complete the accredited training
unit Support the sale of Pharmacy
and Pharmacist Only medicines.
c. complete three hours of
refresher training on Pharmacy
and Pharmacist Only medicines
per year after initial accredited
training is completed.
d. b) and c).
a. Kristy is not responsible for the

sale of an inappropriate product
because she has no formal
pharmacy qualification.
b. Kristy is responsible because she
didnt tell the pharmacist what
she was doing.
c. Kristy would have been
responsible for the sale of an
inappropriate medicine if it
had been a Pharmacy medicine
instead of a Pharmacist Only
product.
d. The pharmacist is ultimately
responsible for the sale of all
medicines in the pharmacy whilst
they are working.
4 . What does CARER in the CARER

protocol for providing Pharmacy and
Pharmacist Only medicines stand for?
a. Check, Assess, Respond,
Explain, Refer.
b. Check, Ask, Respond,
Explain, Review.
c. Check, Assess, Respond,
Explain, Record.
d. Check, Assess, Review,
Explain, Record.
11
John BellCounter
says Connection
Pharmacy and Pharmacist Only medicines Pharmacy assistants education Module 234
Pharmacy and Pharmacist-only medicines

By Anna Ezzy
This education module is independently researched and compiled by PSA-commissioned authors and peer reviewed.
Ken, 45 years-old, presentsto

the pharmacy requesting
something to help his heartburn.
He tells you that he experiences
a burning sensation in his chest
that rises up into his throat.
Heexperiences reflux after going
to bed, usually several nights a
week. He has used antacids in the
past, however he mentions his
sister takes Rani 300 (ranitidine)
to manage heartburn, and she
suggested it may help him too.
Many people visit the pharmacy for advice and to purchase Pharmacy and pharmacist-only medicines.
Self care and self

medication
Gastrointestinal 0099
2011
Heartburn and
Indigestion
Indigestion is an uncomfortable feeling in the upper abdomen. Heartburn is a
painful, burning feeling rising up from the stomach or lower chest towards the
throat. Medicines, and in some cases simple lifestyle changes, can relieve and
prevent heartburn and indigestion.
Indigestion
The Digestive System
Indigestion is a general term for

uncomfortable symptoms in the upper
abdomen (belly). Indigestion is often
related to eating or drinking.
Indigestion includes:
Upper abdominal(belly) discomfort
or pain
Burping
oesophagus
stomach
Nausea, loss of appetite

A bloated or full stomach feeling.
Indigestion is sometimes caused by
a medical condition or by medicines.
Sometimes no cause can be found.
liver
large intestine
small intestine
Self Care is a program of the Pharmaceutical Society of Australia.

Self Care is committed to providing current and reliable health information.
Related Fact Cards

Heartburn and Indigestion
12
Self care occurs when a customer

takes responsibility for the prevention,
diagnosis or treatment of a health
condition. Self care commonly occurs
when customers treat minor illness;
however the management of chronic
conditions can also involve a component of
self care. Selfmedication is one of the most
frequent methods of self care, and involves
the use of non-prescription medicines and
devices to treat a health condition. Many
people visit the pharmacy for advice and
to purchase Pharmacy and Pharmacist Only
medicines.
The symptoms of heartburn that Ken
is describing are known medically as
gastrooesophageal reflux disease (GORD).
GORD is often mild and intermittent and
can be caused by diet and lifestyle factors.
It occurs in >30% of people and many
manage symptoms with self care. There
are various medicines available in the
pharmacy to help manage the symptoms
of GORD.
Scheduling of non-prescription
medicines
Medicines in Australia are scheduled
according to the need for professional
advice to enable customers to use the
medicines appropriately. As a Pharmacy
medicine, ranitidine is considered safe
for use but is sold in a pharmacy where
professional advice is available if required.
Not all customers using Pharmacy
medicines will need advice from the
pharmacist, but pharmacy assistants
need to be aware of circumstance where
referral is required. In contrast the
sale of all PharmacistOnly medicines,
including proton pump inhibitors
such as pantoprazole, omeprazole and
rabeprazole also used to treat symptoms
of GORD, require the professional advice
of the pharmacist to promote safe and
appropriate use. They must be stored
in an area under the supervision of the
pharmacist. As a pharmacy assistant, it is
important to be aware of how to handle
customer requests for these products.
Unscheduled medicines, suchas antacids
previously used by Ken to treat symptoms
of heartburn, are considered safe for use

without professional advice, and as such
are widely available outside the pharmacy
including from supermarkets, convenience
stores and petrol stations.
Symptom-based and product-based

requests
Pharmacists and pharmacy staff have
a responsibility as gate keepers to the
medicines to ensure these products are
used safely and effectively. Requests
for nonprescription medicines can
be symptom-based, occurring when a
customer asks for advice to treat specific
symptoms they are experiencing or
product-based when the customer asks
for a specific product by name. Both types
of request present specific challenges for
pharmacy staff.
In the scenario above, Ken has asked
specifically for ranitidine. The challenge
is to determine if ranitidine will be safe
and effective for Ken without making
him feel unnecessarily interrogated.
Theresponse will however need to differ if
Ken has presented looking for advice about
treating his symptoms. To provide advice
and recommend a safe and appropriate
treatment, Ken needs to be asked the right
questions for you to gain an understanding
of the heartburn symptoms Ken is
experiencing, and other circumstances
such as concurrent medicines and medical
conditions. Selfcare and self medication for
symptoms of GORD is appropriate for many
customers; howevermore information
is required to determine if ranitidine is
appropriate forKen.
Role of the pharmacy

assistant in medicines
requests
As a pharmacy assistant you are probably
the customers first point of contact in
the pharmacy, and will be involved in the
majority of medicine requests. Thereare
many areas where, with appropriate
training, pharmacy assistants should be well
equipped to gather relevant information
and provide advice on suitable treatment.
However there are some areas such as
complex symptom-based requests and the
provision of Pharmacist Only medicines
where pharmacist involvement is necessary.
It is important to be able to make this
distinction, and recognise when referral
to the pharmacist is required. The role of
the pharmacist and pharmacy assistant
in responding to medicines requests are
contrasted in table 1.
Information gathering
Like many customers, Kens first point
of contact will probably be a pharmacy
assistant. The first step in responding to
Ken is to gather the relevant information
to determine if ranitidine will be safe and
effective to treat his symptoms. To ensure
that you obtain all relevant information,
itcan be helpful to use a structured
approach, such as the WHAT-STOP-GO
or CARER protocols (see Facts Behind the
FactCard Practice points).
Ken has had heartburn on and off for several
years. Apart from the burning sensation
and some regurgitation, he has not noticed
any other symptoms or pain. Ken does not
have any medical conditions and apart
from antacids he does not take any other
medicines. He admits that he has started
smoking again after quitting for several
years. You notice that Ken is also overweight.
Table 1. Pharmacy assistant and pharmacist roles in medicines requests.

Role of the pharmacy assistant
Role of the pharmacist
Asking questions to determine if a medicine is

appropriate
Asking additional questions to determine whether

referral to another healthcare professional is required
Determining appropriateness of direct product requests

and uncomplicated symptom-based requests for
Pharmacy medicines.
Determining appropriateness of more complex

symptom-based requests for Pharmacy medicines and
direct product requests for Pharmacist Only medicines
Referral to the pharmacist if the person is taking other

medicines, has any special needs or circumstances or if
the medicine requested is inappropriate
Referral to a general practitioner or another appropriate

healthcare professional if the customer meets the
referral criteria

and adverse events of Pharmacy medicines

and adverse events of Pharmacist Only medicines
Counter Connection
Ken has not reported any atypical or

alarm symptoms such as difficulty
swallowing, persistent vomiting,
bleeding,orunintentional weight loss.
Heis not <18 or >55 years of age,
whichalso reduces the risk of the symptoms
being caused by underlying disease.
Howeversmoking and being overweight
can precipitate symptoms of GORD andmay
be contributing to his heartburn. Itwould
be reasonable to sell Ken ranitidine, with
advice that quitting smoking and trying
to lose weight may help him manage
hissymptoms.
However, consider if Ken had told you that
he had noticed blood in his stools or was
taking another medicine? How would this
new information affect your the decision
to supply ranitidine? Alarm symptoms,
suchas gastrointestinal bleeding, or the
use of other medicines are triggers that
require referral to the pharmacist. While
GORD is often a mild condition that can
be managed by appropriate self care,
some symptoms can indicate a serious
underlying disease. Self medication may
mask the symptoms and prevent customers
seeking appropriate care. Certain medicines
and nicotine replacement therapy can
precipitate symptoms of GORD. These issues
are typical of many conditions treated by
Pharmacy and Pharmacist Only medicines,
and are a key reason why it is essential that
you obtain all relevant information before
selling a Pharmacy medicine.
Providing information and

advice
Providing information and advice to
customers on the use of Pharmacy
medicines is an important role of the
pharmacy assistant. Information about
different medicines is widely available to the
public; customers can obtain information
not only from healthcare professionals
but from the internet, package inserts,
advertisements, and like Ken from family
and friends. There is no guarantee that this
information is accurate and correct, or that
the customer will interpret it appropriately.
A survey of Australian adults has suggested
that many customers may not be able
to correctly answer questions about
nonprescription medicines after reading
package instructions.
Consider again Kens request for ranitidine.
This product has been recommended by a
13
John BellCounter
says Connection
Table 2. Situations that may require referral to the pharmacist

Customer has requested a product that is not
appropriate to treat their symptoms
Symptoms are recurring, persistent, or have worsened
Young or elderly customers
Customer has atypical/alarm symptoms
Customers with other medical conditions
Pregnant or breastfeeding customers
Customers taking other medicines
Customers with allergies
Treatment requested has not worked or has caused

side effects
You are unsure or suspect misuse or abuse
family member; Ken has not used it before

and may not be capable of determining if it
is appropriate for his condition. Inaddition,
his symptoms and circumstances may be
different to those of his sister. Youshould
not assume that a customer that directly
requests a Pharmacy or Pharmacist Only
medicine has used it before, is using it
correctly or has determined that it is
safe and appropriate for their condition.
are sold only through pharmacies
specifically so healthcare advice is available.
You should not overlook the need to
provide such advice.
Referring to the pharmacist

Although pharmacy assistants can provide
customers with information and advice
on non-prescription medicines, there
are some situations that require referral
to the pharmacist. While the sale of all
PharmacistOnly medicines need to be
referred, somerequests for Pharmacy
medicines or complex symptom based
requests may also need the advice of
the pharmacist. Throughcomprehensive
information gathering, pharmacy assistants
can determine when referral to the
pharmacist is needed. The triggers for
referral are different for every medicine and
condition; however common situations that
require referral are listed in table 2.
Workflow in the pharmacy

Pharmacy assistants can assist with
managing workflow in the pharmacy.
Thepharmacist does not need to complete
all aspects of a Pharmacist Only medicine
sale. Pharmacy assistants can gather
relevant information from the customer
to help the pharmacist to respond
appropriately. By following set protocols for
gathering information, the pharmacist can
have confidence that you have
14
gathered all relevant information from the

customer. Pharmacy assistants who are
capable and confident to perform this role
allow the pharmacist to complete other
professionalduties.
Assume that Ken had requested a
Pharmacist Only medicine such as Somac
(pantoprazole) to treat his symptoms. As a
Pharmacist Only medicine, the pharmacist
would need to be directly involved
in the sale. However, as a trained and
experienced pharmacy assistant, there
is no reason that you could not gather
the relevant information from Ken, and
relay this to the pharmacist. With the
information you provide, the pharmacist
may proceed with the sale of pantoprazole
or decide to discuss Kens condition further
with him. Either way, the involvement
of the pharmacy assistant has improved
workflowefficiency.
Education and training

Education and training in your role as
a pharmacy assistant will improve your
knowledge and confidence. This enables
you to work safely and effectively with
more responsibilities, allowing the
pharmacist to concentrate on their
professional activities. The sale of Pharmacy
and Pharmacist Only medicines is a key role
of the pharmacy assistant.
Consider the scenario below.
Kristy has been working in your pharmacy for
several months. She has no formal pharmacy
assistant training, andalthough she is keen
to learn it is hard to find the time to teach her.
Kristy is great with customers; however she
lacks confidence when it comes to handling
medicinerequests.
Kristy is working when Ken comes in to the

pharmacy for Rani 300. Kristy knows that it is
a Pharmacy medicine so she doesnt need to
bother the pharmacist. However Kristy is not
confident in asking Ken any questions about
his condition as she does not know anything
about heartburn. She assumes that since Ken
has asked for Rani 300, he must have used
it before or had it recommended to him by
hisGP.
Without asking any questions, Kristy could
not determine if ranitidine is appropriate
for Ken, or whether he should be referred
to the pharmacist. In this case it is likely
that Ken is experiencing uncomplicated
GORD and ranitidine is appropriate to
treat his symptoms. However consider if
for example, Ken been experiencing signs
of bleeding. Selling Ken ranitidine may
delay the diagnosis of a serious underlying
condition.
The Quality Care Pharmacy Program (QCPP)
accreditation requires that all pharmacy
assistants involved in the sale of Pharmacy
and Pharmacist Only medicines complete
the accredited training unit Support the
medicines. In addition, it is important to
complete regular education activities
to improve and update your knowledge
of healthcare products and conditions.
QCPPaccreditation also requires pharmacy
assistants to complete three hours of
refresher training on Pharmacy and
Pharmacist Only medicines per year after
initial accredited training is completed.
The Self Care Counter Connection modules
are designed specifically for pharmacy
assistants, and relevant ones are approved
QCPP refresher training. The September
2012 issue of InPHARMation focused
on symptoms and treatment of GORD,
and may have provided Kristy with the
knowledge and confidence to better
handle Kens request.
Self care and the pharmacy

The sale of Pharmacy and PharmacistOnly
medicines is an important role of
pharmacies. Supply of these medicines can
impact customer health and wellbeing,
and is also an important aspect of
pharmacy business and profitability.
Confident and capable pharmacy assistants
can help ensure that customers use
appropriately.
Counter Connection
Assessment questions for the pharmacy assistant

Select one correct answer from each
of the following questions.
Answers due 31 March 2013.
Before undertaking this assessment, you
need to have read the Counter Connection
article and the associated Fact Cards.
Photocopy and/or use the answer sheet
provided. Make sure to include your
IDnumber.
1. A symptom-based request:
a. Occurs when a consumer asks
for advice on treating specific
symptoms they are experiencing.
b. Must always be handled by a
pharmacist.
c. Involves the provision of advice,
but never a product sale.
d. a) and b).
2. Substances, the safe use of which
MAY require advice from a pharmacist
and which should be available from a
pharmacy, are BEST described as a;
a. Prescription medicine.
b. Pharmacist Only medicine.
c. Pharmacy medicine.
d. Unscheduled medicine.
The pass mark for each module is five

correct answers. Participants receive one
credit for each successfully completed
module. On completion of 10 correct
modules participants receive an
Achievement Certificate.
Submit answers online
3. Which of the following is not a role of

a pharmacy assistant?
5. What does CARER in the CARER

protocol for providing Pharmacy and
Pharmacist Only medicines stand for?
a. Asking questions to determine if a

medicine is appropriate.
b. Providing advice on dosage,
treatment expectations and
adverse events for Pharmacy
medicines.
c. Determining if referral to a
general practitioner is required.
d. Handling uncomplicated
4. Quality Care Pharmacy Program
(QCPP) accreditation requires that all
pharmacy assistants involved in the
medicines complete the following
training?
a. The accredited training unit
Support the sale of Pharmacy and
Pharmacist Only medicines.
b. Three hours of refresher training
on Pharmacy and Pharmacist Only
medicines per year after initial
accredited training is completed.
c. No specific training is required.
d. a) and b).
To submit your response to these

questions online, go to the PSA website:
www.psa.org.au
a. Check, Assess, Respond,

Explain, Refer.
b. Check, Ask, Respond,
Explain, Review.
c. Check, Assess, Respond,
Explain, Record.
d. Check, Assess, Review,
Explain, Record.
6. Which of the following situations may
require referral to the pharmacist?
a. The customer has any other
medical conditions and/or is
taking other medicines.
b. The customer is experiencing side
effects from the medicine.
c. Symptoms are not typical of the
condition which the customer has
self-diagnosed.
d. All of the above.
15
John Bell
says notice board
Members
Conferences and calendar dates

Conferences
National health calendar dates
15th Annual Health Congress
February 2013
1 28 Heart Research Month
27 28 February and 1 March

Radisson Blu Plaza Sydney NSW
ww.informa.com.au/healthcongress
2013 Annual Therapeutic Update

March Weekend
1 3 March
Crowne Plaza, Terrigal NSW
www.psa.org.au
The Australian Pharmacy Professional

Conference 2013
21 24 March
Gold Coast Convention and Exhibition Centre, QLD
www.appconference.com
10th Annual Future of the Pharmaceutical

Benefits Scheme Summit
29 30 April
Sydney Harbour Marriott Hotel
www.informa.com.au/pbs
Heart Research Australia

www.redfeb.com.au
1 28
Ovarian Cancer Australia

www.ovariancancer.net.au
4
World Cancer Day

Cancer Council Queensland
14
Heart Research Day

Heart Research Australia
www.redfeb.com.au
24 Feb
3 March
27
Donate Life Week

Organ and Tissue Authority
www.donatelife.gov.au
Teal Ribbon Day

Ovarian Cancer Australia
The 38th PSA Offshore Refresher Course

2013
2 9 May plus pre and post tours
London, England
www.psa.org.au
Ovarian Cancer Awareness Month
www.ovariancancer.net.au
28
International Rare Disease Day

Rare Voices Australia Ltd
www.rarevoices.org.au
You only dispense medicines

before their expiry date,
so how do you feelabout
using reference texts that
have passedtheirs?
Every pharmacy needs an APF22.
Is there an APF22 in your pharmacy?
Order now at www.psa.org.au/shop
16
Whats coming up
in inPHARMation
Next months inPHARMation will
cover the topic of immunisation.
In this issue immunisation and
vaccines are defined, their role
in managing the worldwide
threat of disease, outline of
commonly used vaccines and the
important role of pharmacists
and pharmacy staff in promoting
immunisation in the community
is discussed.
The issue will also look at who
should receive vaccines, practical
information on how to answer
frequently asked questions about
vaccines and immunisation and
how to address any adverse
effects of vaccines.

Inpharmation February 2013

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Professional development and practice support for self care SUBSCRIBERS

Print Post approved

John Bell says Contents

Managing editor Andrew Daniels

Pharmacy assistants education

Counter Connection: Pharmacy and Pharmacist Only medicines

John Bell says

Self Care contacts

Your staff can have their own copy mailed directly to

To contact your local branch phone 1300 369 772

Additional inPHARMation 12-month subscription $50.00

Self Care Fact Cards

Please make sure that you keep your Fact Cards

Fact Cards are included in your subscription.

The Plastics Factory Pty Ltd (ABN: 62-128-887-767)

Pharmaceutical Society of Australia Ltd., 2013

inPHARMation February 2013 I Pharmaceutical Society of Australia Ltd.

John Bell says

Self care a not so secret success strategy

Most commonly self care is applied to

the level of advice which may be required for

Pharmacists and pharmacy assistants play

Our heartburn case study situation is not

Of course, many non-prescription medicines

By definition, Pharmacist Only medicines

knowledge is also essential. For instance

Indigestion is an uncomfortable feeling in the upper abdomen. Heartburn is a

The Digestive System

Indigestion is a general term for

Upper abdominal(belly) discomfort

Indigestion is sometimes caused by

Self Care is a program of the Pharmaceutical Society of Australia.

CPD that comes to you...

PSA online CPD

Self care is a major pillar

PSA All you need for your CPD.

inPHARMation February 2013 I Pharmaceutical Society of Australia Ltd.

Pharmacy and Pharmacist Only medicines

After reading this article,

Self care including self

Self care occurs when a person takes

inPHARMation February 2013 I Pharmaceutical Society of Australia Ltd.

Self care in the pharmacy often involves

feel unnecessarily interrogated. However,

a prescription. Incontrast, PharmacyOnly

Self care and self medication for

Direct involvement does not mean simply

Returning to Kens request for OTC

Facts Behind the Fact Card

Table 1. Advantages and disadvantages of self medication6

Disadvantages of self medication

Safe and effective when used according to directions

Can cause harm if used incorrectly or inappropriately

Reduces time and cost of visiting GP

Can worsen some medical conditions

Allows consumers to maintain independence and gain

Can mask serious medical conditions giving rise to

Can be less expensive than some prescribed medicines

Can be more expensive than some prescribed

Can reduce the burden on the healthcare system if used

Can increase the burden on the healthcare system if

inPHARMation February 2013 I Pharmaceutical Society of Australia Ltd.

Related Fact Cards

Ken tells you that he experiences heartburn