Pharmacy Consultations during COVID-19 - Pharmacy and singleuse plastic - Irish Pharmacy Union
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IRELAND’S OFFICIAL PHARMACY PUBLICATION
OCTOBER 2020
Statutory
entitlements
Pharmacy
and single-
use plastic
Pharmacy
Consultations
during COVID-19
MY FERTILITY JOURNEY | ANTIMICROBIAL STEWARDSHIP PROGRAMME
DON’T LET PAIN
HOLD YOU BACK
ESSENTIAL
INFORMATION
Solpa-Extra 500mg/65mg Soluble Tablets contain paracetamol and caffeine. For the treatment of mild to moderate pain. Adults and children over 16 years: 1-2 tablets
dissolved in water every 4-6 hours. Max 8 tablets a day. Children 12-15 years: 1 tablet disolved in water every 4-6 hours. Max 4 tablets a day. Not suitable for children under 12
years. Contraindications: Hypersensitivity to the ingredients. Precautions: Particular caution needed under certain circumstances, such as renal or hepatic impairment, chronic
alcoholism and malnutrition or dehydration. Precautions needed in asthmatic patients sensitive to acetylsalicylic acid, patients on a controlled sodium diet and with rare hereditary
problems of fructose intolerance. Patients should be advised not to take other paracetamol containing products concurrently. Pregnancy and lactation: Not recommended during
pregnancy and breastfeeding. Side effects: Rare: allergies. Very rare: thrombocytopenia, anaphylaxis, bronchospasm, hepatic dysfunction, cutaneous hypersentitivity reactions.
Unknown: nervousness, dizziness. Further information is available in the SmPC. PA 1186/017/001. P. MAH: Chefaro Ireland DAC, Treasury Building, Lower Grand Canal Street,
Dublin 2, Ireland. Date of preparation: April 2017. IRE/NHPT/SOL1/2019-003.
OCTOBER 2020
7 A Note from the Editor
IPU News
The latest news and events
20
from Butterfield House
8 Dates for your Diary
8 Pharmacy in the Media
10 IPU AGM on 8 October
The IPU Review is published
monthly and circulated to Irish 10 Annual Report
pharmacists. The views expressed 10 Flu Vaccination Service 2020 –
by contributors are not those Promotional Materials
of the IPU nor is responsibility
accepted for claims in articles 10 Vaccination Module available on IPUnet
or advertisements.
11 Pharmacists welcome expansion of
Subscription: Flu Vaccination programme
€100 (Ireland North & South) and 12 Submission on Budget 2021
€150 (including postage overseas).
12 Pharmacists urge Rethink on Healthcare Spending
Publisher: 14 World Pharmacists Day 2020
Irish Pharmacy Union
(IPU Services Ltd), 15 Examinership of Pharmacy Group shows
Butterfield House, Sector in Crisis
16
Butterfield Avenue,
Rathfarnham, Dublin 14,
D14 E126
Tel: (01) 493 6401
Fax: (01) 493 6626
Email: ipureview@ipu.ie
Website: www.ipu.ie
Editor: Jack Shanahan MPSI
Editorial Associates:
Siobhán Kane, Ciara Browne
and Jim Curran
Advertising: Siobhán Kane
Email: ipureview@ipu.ie
Tel: (01) 493 6401
©2020
Features
Copyright: All Rights Reserved,
Irish Pharmacy Union.
Printed by Rymar Print.
16 Five STEPS to successful
IPU Review is a Registered Trademark
of the Irish Pharmacy Union.
Pharmacist Consultations during
COVID-19 (and beyond)
20 Antimicrobial Stewardship
Programme in the Community
24
24 Statutory Entitlements in the
Context of COVID-19
IPUREVIEW OCTOBER 2020 3
29 Pharmacies must adopt more
sustainable practices
36
32 My Fertility Journey, and what
it taught me as a Pharmacist
34 Providing information to a person
with vision impairment
36 Why all pharmacies should have
cash technology
37 Living Well: A programme for adults
with long-term health conditions
Other News
40 CPD: Symptom Management in
57 Emergency card for carers launched
Palliative Care: Nausea and Vomiting
57 IFA says new vet medicine regulations
49 Clinical Tips: Corticosteroids must maintain competition
for COVID-19 58 Boots Ireland roll out dementia
awareness training to all staff
50
50 ‘Doctor Google’ and 59 New information website launched on
Mouth Cancer Awareness Day
‘Consultant WhatsApp’
59 Asthma Society calls for subsidisation
are a dangerous team of asthma medications
60 COVID-19 community response
52 Studies projects awarded €3 million
53 Political Report
61 Crossword
55 Letter to the Editor 62 Wine column
56 International News 64 The Village Bookshelf
66 Product Information
67 Classifieds
40
29 37
IPUREVIEW OCTOBER 2020 5
The journey to triple
protection in T2D
starts at the kidneys
LICENCE EXTENSION
Choose INVOKANA – the only SGLT2i INVOKANA now includes
licensed to offer your T2D patients evidence for the treatment
of diabetic kidney disease1
triple protection against renal events,
CV events and elevated HbA1c1–4
INVOKANA® (canagliflozin) 100 mg & 300 mg film-coated Renal impairment: regardless of pretreatment, patients on exposure; take canagliflozin at least 1 hour before or 4-6 hours after
tablets. PRESCRIBING INFORMATION. REPUBLIC OF IRELAND. canagliflozin had an initial fall in eGFR that attenuated over time. a bile acid sequestrant. Effects of Invokana on other medicines:
Please refer to the Summary of Product Characteristics (SmPC) eGFR < 60 mL/min/1.73 m2: higher incidence of adverse reactions Monitor patients on digoxin, other cardiac glycosides, dabigatran.
before prescribing. INDICATIONS: The treatment of adults associated with volume depletion particularly with 300 mg dose; Inhibition of Breast Cancer Resistance Protein cannot be excluded;
with insufficiently controlled type 2 diabetes mellitus as an more events of elevated potassium; greater increases in serum possible increased exposure of drugs transported by BCRP
adjunct to diet and exercise as monotherapy when metformin is creatinine and blood urea nitrogen (BUN); limit dose to 100 mg (e.g. rosuvastatin and some anti-cancer agents). PREGNANCY:
considered inappropriate due to intolerance or contraindications, once daily. Not studied in severe renal impairment. Monitor renal No human data. Not recommended. LACTATION: Unknown if
or in addition to other medicinal products for the treatment of function prior to initiation and at least annually. Volume depletion: excreted in human milk. Should not be used during breast-feeding.
diabetes. DOSAGE & ADMINISTRATION: Adults: recommended caution in patients for whom a canagliflozin- induced drop in SIDE EFFECTS: Very common (≥1/10): vulvovaginal candidiasis,
starting dose: 100 mg once daily. In patients tolerating this dose blood pressure is a risk (e.g. known cardiovascular disease, eGFR hypoglycaemia in combination with insulin or sulphonylurea.
and with eGFR ≥ 60 mL/min/1.73 m2 needing tighter glycaemic < 60 mL/min/1.73 m2, anti-hypertensive therapy with history of Common (≥1/100 to
A NOTE FROM THE EDITOR Jack Shanahan MPSI
Getting the Balance Right
on Drug Interactions
Luxuriating, for want of a better word, in Kerry, where we
currently have the second lowest rate of diagnosed COVID-19
infection in Ireland, it feels more like Warsaw on the 31 August
1939. There is an air of unreality.
W
e all feel that already contains a member of dilemma, particularly if the challenging during COVID.
something this group of drugs, you will prescriber is uncontactable. A more sinister interaction
bad is about typically be warned that one Often, in these cases, the best can be with trimethoprim.
to happen, drug potentiates the effect of advice is to wait until you Typically regarded as a fairly
yet life must the other. This is a desirable have spoken to the prescriber. innocuous drug, trimethoprim
go on. As we see elsewhere, interaction, which you will file The issue then arises if there has been widely used as a first
low infection rates can under ‘F’ for forget. Of course, is an overwhelming need to choice for uncomplicated UTIs.
spiral upwards in the virtual there is the occasional issue dispense, and professional Yet, combined with MTX, it
blink of an eye. There is a where duplicate drug classes, judgment becomes critical. has the potential of producing
low-level stress pervading two ACE inhibitors or similar, Perhaps you dispense, with a fatal blood disorder. This is
all our actions, all of the where the alert is important. the clear requirement that the rare, but well documented;
time. Having to be aware of You need to act. As you move patient gets their INR checked indeed many authorities
potential infection constantly up the scale of importance, a consistently over the duration specifically contraindicate
erodes concentration. While whole series of confounding of risk. Perhaps you refuse their use together. Typically,
pharmacists, and the people variables arise. to dispense, referring back a phone call to the prescriber
who work with them, are no Frequently the interaction to a doctor. Perhaps you take would elicit a grateful
different to anyone else at is dose related, perhaps another avenue. response. What do you do if it
the moment, it is important where one affects the While warfarin use is now doesn’t? This poses one of the
to recognise this. We need to pharmacokinetics of the other, waning, and these specific great challenges, managing
mind ourselves. Nobody can through metabolism, excretion issues are fading, another interprofessional relationships.
do it for us. or whatever. These can be drug is rapidly taking It can be extremely difficult to
Drug interactions are one of nuanced, where you look at its place in prominence. get the balance right. Yet, as
the more challenging issues to the doses involved and decide Methotrexate (MTX) is now we well know, this is merely all
face the working pharmacist that the interaction can be widely used in many auto- in a day’s work.
on a routine basis. While managed. A typical situation immune conditions. From
Stockley’s remains the bible, would be where, sometimes being a relative rarity in the
it is not always the first port we might stop a statin while a dispensary, it is now something
of call. Almost all pharmacies patient is on clarithromycin. that most pharmacies are
have an interaction package Some drugs are scary, where dispensing almost every day.
built into their dispensary all interactions are potentially When used correctly, it is a
system. It will usually alert serious. These are problem great medicine, bringing relief
the common issues, which drugs, for a number of and solace to many individuals
is really as much as can be reasons. The first is familiarity. and their families. By its very
expected. The nature of many For instance, warfarin is a nature, it is an extremely
interactions is that they are drug where I have heard toxic molecule, potentially
specific to the individual quoted ‘everything interacts producing disastrous
involved. An alert is merely with it except water, and outcomes when things go
a flag to the pharmacist that even that is questionable’. wrong. So, whenever we see
something can potentially An additional issue with a methotrexate interaction,
go wrong. It does not, by warfarin is that it is not we sit up and take notice.
definition, give a direction always consistent. One person One of the most common is
to the pharmacist. It is up to can take diclofenac without the co-administration of an
the pharmacist to act on the apparent issue and another NSAID, a class of drugs that
information presented. Typical may face a haemorrhagic can affect MTX clearance. In
interactions are often of the emergency. Prescribers know these situations, the solution
‘Doh’ variety. For instance, this and are often willing to is that patients’ bloods need to
where an anti-hypertensive take a chance. This can often be more carefully monitored,
is added to a regimen that place the pharmacist in a although this is more
If you have any comments, queries or issues to raise, send
your “Letters to the Editor” by email to ipureview@ipu.ie.
IPUREVIEW OCTOBER 2020 7
Pharmacy in
the Media
Pharmacy Contractors’ Committee member and
former IPU President Kathy Maher was interviewed
on LMFM to discuss both the Sunday Independent
article on mental health issues during COVID-19,
and our press release on the risks of purchasing
medicines online.
We issued a press release to welcome the
expansion of the flu vaccination programme. There
was coverage in the Irish Daily Mirror and on Buzz.ie
and IrishHealth.com. IPU member Feidhlim Hillery
was interviewed on Clare FM on the topic. This was
also covered in Woman’s Way magazine.
Our sexual health campaign, which we launched
Dates forry
in early August with the HSE, gained more coverage
on RTÉ Radio 1’s Liveline. This segment also gained
your Dia
coverage in online media such as IrishPost.com and
Extra.ie, and in the Irish Sunday Mirror.
We issued a statement following the
announcement that the Cara Pharmacy Group
has entered examinership stating that this and
20
OCTOBER 20 previous similar situations are symptomatic of
loma the unsustainable financial pressures on the
IPU/ILM Dip
7 October Le ad er sh ip and community pharmacy sector. There was coverage
in
en t 20 20 in The Sunday Times.
Managem
ts, w w w .ip u.ie The IPU Secretary General wrote an article for
star
the Irish Independent’s Vaccine Supplement on the
,
IPU AGM 2020 importance of getting the flu vaccination this year,
8 October
www.ipu.ie particularly all at-risk patients.
Health The IPU Secretary General, along with
IPU Basics in
15 October ri ti on course pharmacists Gráinne O’Leary and Eamonn Brady,
and Nut
u.ie was interviewed on Newstalk’s Down to Business
starts, www.ip
with Bobby Kerr in relation to the impact COVID-19
ory
IPU Supervis has had on pharmacy businesses. You can
22 October en t course
Developm listen to the segment on our YouTube channel,
, w w w.ip u.ie
starts IrishPharmacyUnion.
h
Smart Healt
22 October m m it , w w w.smart
Su
m m it.ie
healthsu
2020
N OV E M B E R
ancer.ie
onth, www.c
Movember m
betes Day,
r World Dia
14 Novembe .d ia be tes.ie
www
Antibiotic
r European
18 Novembe ay,
Awareness D
er theweather.ie
www.und
8 IPUREVIEW OCTOBER 2020
Help them
face life’s
adventures
GMS
reimbursed
GMS
reimbursed
with
2’-FL*
EleCare and Alimentum are
the first hypoallergenic
formulas to contain 2’-FL* Extensively Hydrolysed Amino Acid-Based
Formula Formula
GMS code 85072 GMS code 83249
Helps support the immune system in the gut and beyond1–3
Contains 2’-FL* which has proven benefits on the gut and systemic immune responses**
Supports healthy growth and symptom resolution†‡4–10
Trusted by mums and healthcare professionals8,11-13
To live chat with a dietitian visit www.abbottnutrition.ie
IMPORTANT NOTICE: Breastfeeding is best for infants and is recommended for as long as possible during infancy.
FOR HEALTHCARE PROFESSIONAL USE ONLY
* 2’-FL: 2’-fucosyllactose. Structurally identical to that found in breast milk (not sourced from human milk). ** Study conducted in healthy-term infants
consuming standard infant formula (Similac) with 2’-FL, compared to control formula without 2’-FL. † Data collected from infants fed standard EleCare
formula without 2’-FL. ‡ Parent reports from a single-arm study, where all infants were consuming an extensively hydrolysed formula before being
switched to Alimentum with 2’-FL for 60 days. After 7 days of switching to Alimentum with 2’-FL, the majority of parents reported that the following
symptoms had improved or resolved: 84% of infants with constipation, 71% of infants with eczema, 100% of infants with vomiting.
References. 1. Reverri EJ, et al. Nutrients. 2018;10(10):1346. 2. Marriage BJ, et al. J Pediatr Gastroenterol Nutr. 2015;61(6):649–658. 3. Goehring KC, et al. J
Nutr. 2016;146(12):2559–2566. 4. Borschel MW, et al. Clin Pediatr (Phila). 2013;52(10):910–917. 5. Borschel MW, et al. BMC Pediatr. 2014;14:136. 6. Sicherer
SH, et al. J Pediatr. 2001;138:688–693. 7. Borschel MW, et al. SAGE Open Med. 2014;2:2050312114551857 8. Abbott Nutrition. Data on File (AL32). April
2020. 9. Borschel M. Allergy. 2014; 69(Suppl. 99):454–572. 10. Sampson HA, et al. J Pediatr. 1991;118(4 Pt 1):520–525. 11. RTI research. Abbott Elecare No.1
Dr Recommended. Final Results. 2019. 12. Abbott. EleCare Promotional Claims Parent Survey. 2019. 13. Abbott. Alimentum Market Research, UK 2018.
Abbott Laboratories Ltd., Block B, Liffey Valley Office Campus, Quarryvale, Dublin 22, D22 X0Y3
(01) 4691500 | abbott_nutrition_irl@abbott.com | www.abbottnutrition.ie Date of Preparation: September 2020 | IE--2000016
IPU NEWS
IPU AGM on Flu Vaccination
8 October Service 2020
– Promotional
Materials
The Annual General Meeting of
the IPU will take place at 7.00pm
on Thursday 8 October and will
conclude before 9.00pm. Due to
COVID-19 public health restrictions,
this year’s AGM cannot take place in its
normal format and will instead be conducted virtually. We have produced posters and leaflets to
Registration for the AGM is open; please check your help you advertise your vaccination service.
email for the registration link along with a GoToWebinar You can download and print the materials
Attendee Guide. from www.ipu.ie > Professional > Vaccination
Please remember that the AGM can only be attended by > Promotional Materials. You will also find a
IPU members who have paid their Annual Subscription. Media Kit that contains tweets/posts which you
You can email any topics or questions that you would like can use on Twitter, Facebook, and other social
discussed or clarified during the meeting up to 48 hours in media channels, as well as videos to download
advance of the meeting to jim.curran@ipu.ie. and play on your pharmacy TV if you have one.
The HSE flu vaccination advertising campaign
will start on 7 October in two phases. Phase 1 is
aimed at those at-risk and healthcare workers
and will include radio advertising and social
Annual
media; this campaign will run for two weeks.
Phase 2 will begin on 19 October and is aimed
at children’s flu vaccination which will run for
Report
three to four weeks. This phase will include
radio, TV and social media.
The 2020 Annual Report of the IPU
Executive Committee has been published.
It is available if you log on to www.ipu.ie > Communications >
Publications > Reports. There is also a link to the Report on the
members’ homepage. If any member would like a hard copy of
the report, please send a request to communications@ipu.ie.
Vaccination
Module available
on IPUnet
The IPUnet Vaccination Module has been updated to record both types
of influenza vaccination being provided by pharmacy this year. The
anonymised, aggregated, national IPUnet data was successfully used to
demonstrate the effectiveness of delivering patient services in community
pharmacies, such as the supply of EHC to GMS patients. We encourage
you to record vaccinations in IPUnet, which will provide useful statistics
to the IPU to help us advocate for more remunerated pharmacy services.
10 IPUREVIEW OCTOBER 2020IPU NEWS
Pharmacists welcome
expansion of Flu
Vaccination programme
Pharmacists have welcomed the announcement by Minister for Health Stephen
Donnelly TD that the flu vaccination programme will be expanded this year. The
IPU said the announcement shows the important role flu vaccination will play in
protecting our health as we enter our first flu season while living with COVID-19.
IPU Secretary General Darragh O’Loughlin said, “The flu led to the hospitalisation
of over 4,000 people in Ireland during the last flu season. That is more than were
hospitalised with COVID-19, which should be a reminder of the serious nature of the
illness. Since the start of the COVID-19 crisis, we have consistently called for a significant
investment in this year’s national flu vaccination campaign, to keep people safe from flu and
protect our health system from its impact, so we can deal with the continuing impact of COVID-19.
“There is no doubt that expanding the programme and making the vaccine free to children, as well
as everyone in an at-risk group, will save lives. Pharmacists are committed to playing our part and ensuring this expanded
availability means expanded uptake nationwide. Last year, there were over 1.1 million flu vaccines delivered in Ireland, which is
up 60% since pharmacies were first permitted to administer the vaccine a decade ago.”
Mr O’Loughlin encouraged everyone to get vaccinated early, “The earlier we all get vaccinated the earlier we are protecting
ourselves, our families and our entire communities. We can’t yet stop COVID-19, but we have a vaccine to stop the flu, and that is
everyone’s responsibility.”
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IPUREVIEW OCTOBER 2020 11IPU NEWS
Pharmacists urge Rethink
on Healthcare Spending
The IPU has said next month’s budget represents an opportunity and experience around the world shows how effective it can
for an innovative rethink of healthcare spending, saying that be,” according to Mr O’Loughlin. “One example would be
while there is very little low-hanging fruit in terms of savings introducing pharmacy-based screening for atrial fibrillation. A
available in the health budget , what’s there needs to be study commissioned by the IPU found this could prevent over
picked. IPU Secretary General Darragh O’Loughlin said, “there 2,300 cardiac events per year with an associated cost saving of
are sensible cost savings available which could be reinvested €45 million. As well as saving lives it would avoid €1.36 billion in
in community-based care if we allow pharmacies to expand additional health spending over the next 30 years.”
the care they provide, which would result in better patient “It is clear that we can’t afford cutbacks in our health service,
outcomes and increased capacity and would be cost-effective but equally we can’t afford to ignore opportunities. Expanding
for the State”. the role of pharmacists is a cost-effective way of immediately
Speaking about the IPU’s Pre-Budget Submission Mr increasing the capacity of our health service. At a time of crisis,
O’Loughlin said, “The health service has suffered from budget and when we consistently hear of the capacity issues felt by our
constraints for decades. Now in the midst of the Covid-19 GPs, pharmacists are saying loud and clear we can do more.
pandemic it is recognised that we need to do things differently. “Why have we not yet implemented the kind of accessible
The Government must think innovatively and realise the cost healthcare for common ailments that the Minor Ailments
savings that are available — we have been shouting about Service in Northern Ireland and its equivalent in Scotland,
these opportunities for years, and it is more urgent now than the Pharmacy First service, both provide? GPs are going to be
ever before to embrace innovation and change our health exceptionally busy this winter dealing with Covid-19 on top
service for the better.” of their normal heavy workload, and we need to provide other
Biosimilars represent one of the most effective cost savings pathways for people who don’t necessarily need a doctor. As
the Government can implement according to Mr O’Loughlin: Sláintecare says – Right Care, Right Place, Right Time.”
“These are medicines, many manufactured in Ireland, which Mr O’Loughlin concluded by saying, “In order to realise
clinically have no meaningful difference with the more this potential, there is an urgent need to review the current
expensive alternative. Three years ago, a national biosimilars pharmacy contract. Developed in 1996 it predates the internet
policy was promised but has not been implemented. Since 2017 and the current laws governing pharmacies — it is hopelessly
this has led to an estimated €370 million in needless additional out of date. Budget 2021 should provide a new impetus on
spending – up to €125 million that could be reinvested in innovative thinking, which this new contract can deliver to
community healthcare every year.” ensure that community pharmacies are adequately resourced
Similar savings could be realised, while also improving so they can provide the continuum of care which is urgently
the nation’s health, by introducing pharmacy-based chronic required in our communities and demanded by the public. We
disease management programmes: “This is a broad concept are ready and waiting to help.”
Submission on Budget 2021
The IPU’s Submission on Budget 2021 was Pharmacy Contract was negotiated in
presented to the Minister for Finance; the 1996. The commitment to commence
Minister for Public Expenditure and Reform; talks on a new contract, outlined in the
the Minister for Health; and the Tánaiste and Programme for Government, must be
Minister for Enterprise, Trade and Employment. fulfilled in 2020; and IRISH PHAR
MA CY UNION
The Submission was also sent in hard copy SUBMISSIO
n Expanding the Scope of Pharmacy N ON
BUDGET 20
format to all TDs and Senators. Services: Pharmacists can do so much 21
The IPU’s Submission sets out three core areas more. We urge Government to bring
affecting pharmacists as we look towards 2021, Ireland up to international norms and
namely: let pharmacies provide the additional
n Pharmacy Fees: Pharmacy payments services patients need.
have declined continually since the
FEMPI legislation of 2009 slashed fees and We look forward to engaging with Ministers
margins, undermining the sustainability and Oireachtas Members over the coming
of the service. This needs to be addressed weeks to discuss the issues we have outlined
as a matter of urgency; in the Submission. Read the Submission in full at
n Introduction of a new Community www.ipu.ie > Communications > Publications >
Pharmacy Contract: The current Submissions.
12 IPUREVIEW OCTOBER 2020Think Hi Techs, Think Accord
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Linezolid Filgrastim
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Posaconazole Accord / Infusion in Pre-Filled Syringe x 5
Posaconazole
Pelgraz ▼
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Voriconazole Accord 6 mg Solution for Injection
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Voriconazole
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50 mg x 28 Film Coated Tablets in Pre-Filled injector x1
200 mg x 28 Film Coated Tablets
ONCOLOGY AGENT
ANTI-VIRAL AGENT
Bicalutamide
Valganciclovir Bicalutamide
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Capecitabine Accord
IMMUNOSUPPRESSANT Capecitabine
Mycophenolate 150 mg x 60 Film Coated Tablets
Mofetil Accord 300 mg x 60 Film Coated Tablets
Mycophenolate Mofetil 500 mg x 120 Film Coated Tablets
250 mg x 100 Capsules Imatinib Accord
500 mg x 50 Film Coated Tablets Imatinib
HIV-1 INFECTION AND HEPATITIS B INFECTION 100 mg x 60 Film Coated Tablets
400 mg x 30 Film Coated Tablets
Tenofovir disoproxil
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245 mg x 30 Film Coated Tablets
5 mg x 5 Hard Capsules
20 mg x 5 Hard Capsules
HEPATITIS B INFECTION 100 mg x 5 Hard Capsules
140 mg x 5 Hard Capsules
Entecavir Accord 180 mg x 5 Hard Capsules
Entecavir 250 mg x 5 Hard Capsules
0.5 mg x 30 Film Coated Tablets
SYSTEMIC HORMONAL PREPARATIONS
PULMONARY ARTERIAL HYPERTENSION
Cinacalcet Accord
Granpidam Cinacalcet
Sildenafil 30 mg x 28 Film Coated Tablets
20 mg x 90 Film Coated Tablets 60 mg x 28 Film Coated Tablets
90 mg x 28 Film coated Tablets
Further information is available on request from Accord Healthcare Ireland Ltd, Euro House |
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Products subject to prescription. Supply through pharmacies only. Accord Healthcare Ireland Limited, Euro House, Euro Business Park, Little Island, Cork T45 K857, Ireland
and Accord Healthcare S.L.U. World Trade Center, Moll de Barcelona, s/n, Edifici Est 6ª planta, 08039 Barcelona, Spain.
*Pack sizes do not represent actual size. Date of Preparation: April 2020. IE-01435IPU NEWS
World Pharmacists Day 2020:
Pharmacists nationwide answered
the call in 2020, it’s now time to
make good on promises
The IPU paid tribute to “Throughout the pandemic, visits; this makes the sector in the home or close to home,
the dedication shown by we have witnessed countless more accessed than hospitals, rather than in our hospitals.
the country’s pharmacists acts of pharmacists and their than GPs or any other aspect Actions not words are now
throughout the COVID-19 staff going above and beyond of our healthcare system. required to deliver on these
pandemic on World for their patients. Pharmacies Unfortunately, the sector has promises.”
Pharmacists Day on 25 remained open, even during been consistently undervalued “We will soon reach the
September. The IPU has called the most challenging days and underutilised by first anniversary of the
on the Government to repay of the lockdown. To ensure successive governments. Department of Health’s formal
this commitment by helping Ireland had a continuous “Earlier this year, we commitment to commence
the sector and implementing supply of all medicines, they welcomed commitments talks with pharmacists on
promises contained in the introduced delivery services towards expanding the role a new contract. This should
Programme for Government. and were among the first to of community pharmacies, include examining ways
Commending the work install protective measures contained within the to enhance our role in the
of pharmacists, IPU Vice- in their shops. Asked by Programme for Government. delivery of healthcare in the
President Eoghan Hanly said, Government to do more, Today we want to know when community. We are still no
“2020 has been the most issuing repeat prescriptions these will be implemented. clearer on when this will start.”
challenging year in living and quickly adopting to a new “The Government has Mr Hanly concluded by
memory for healthcare e-prescribing system, they also promised to include once again paying tribute
professionals. Across the responded. Now we want the pharmacies as part of their to pharmacists stating, “In
length and breadth of the Government to repay this faith commitment to expand pharmacists, Ireland has
country, pharmacies have and keep their promises. primary and community care, a highly committed and
responded to the challenge “Every year, Ireland’s making the vast majority of expert group of healthcare
and played a pivotal role in pharmacies receive 78 million healthcare services available professionals. They are ready,
supporting the willing, and waiting
health of their to do more for their
communities. patients. As well
I have never as thanking each
been prouder of of them for their
the role played service, we must
by community quickly take them
pharmacies up on this offer
throughout the as it will improve
country.” the health service
overall.”
14 IPUREVIEW OCTOBER 2020IPU NEWS
Examinership of Pharmacy
Group shows Sector in Crisis
The announcement that across the country. However, Mr O’Loughlin continued, Government for remaining
the Cara Pharmacy Group staying open has come at “Ongoing deep cuts in open and accessible to
has entered examinership a significant cost to those funding over the last decade, patients and the public.”
highlights the unsustainable pharmacies. All of them together with the impact In conclusion, Mr O’
financial pressures on the had to invest significantly of COVID-19, have taken a Loughlin said, “This should
community pharmacy sector, to put in place measures heavy toll and pharmacy act as a warning call to the
according to the IPU. The to keep staff and patients finances are now in critical Government that, unless
pharmacy sector suffered safe, putting huge pressure condition, with the pressure previous cuts are reversed
deep cuts in funding imposed on pharmacy businesses. on the sector becoming and adequate resources
during the financial crisis It is a worrying time for increasingly intolerable. This are invested in pharmacy
a decade ago and which, the staff of Cara Pharmacy is compounded by the fact services, other cases similar
despite repeated Government Group and those across the that, despite huge additional to what happened with the
commitments, have not been sector. Unfortunately, many investment in health services Cara Pharmacy Group will
reversed. The increasing pharmacies have laid staff off, and substantial additional become inevitable, potentially
financial pressure has and many more may be forced resources for other health depriving local communities
already resulted in a number to do so.” professions, pharmacists have of their last truly accessible
of prominent pharmacy Recent research by the IPU received little or no direct healthcare service provider.”
insolvencies, with several found that it is costing the financial support from the
pharmacy businesses entering pharmacy sector over €10
examinership or being taken million a month to remain
over by their creditors or open and to provide safe care.
suppliers. In addition, pharmacies have
According to IPU Secretary reported retail sales falling
General Darragh O’Loughlin, by an average of 36% since
“Throughout the COVID-19 the start of the crisis. One in
pandemic, pharmacies have five pharmacies has laid off
kept their doors open to staff, while another two in five
ensure the supply of medicine, (38%) indicated they would
and healthcare services have have to do so over the next few
continued in every community months.
Part-Time
Lecturer
Required
Bray Institute of Further Education seeks a part-
time lecturer to commence in October 2020.
For further information please email
bifeenquiries@kwetb.ie or phone 01 282 9668.
BIFE Half-Page Ad ART.indd 1 30/09/2020 12:30
IPUREVIEW OCTOBER 2020 15PROFESSIONAL Rachel Dungan MPSI
Five STEPS
to successful
Pharmacist
Consultations
during COVID-19
(and beyond)
COVID-19 has required both patients and pharmacy
teams to radically change how pharmacists
communicate and fulfil their professional duties.
This article aims to provide useful communication
tips and tools to use during COVID-19 (and beyond).
W
e have phone consultations has
seen a escalated, and there has
dramatic been a significant increase
shift from in dispensing where the only
in-person contact with the patient is
consultations towards remote remote.
consultations. Many patients With this trend likely to
are no longer attending continue, pharmacists and
their GP or collecting their their teams need to adapt and
prescription in-person. In develop skills and strategies
addition, for those who attend to ensure that remote
the pharmacy in person, consultations and masked
communication from behind in-person consultations are
masks changes the dynamic. effective and person-centred.
Prior to 2020, few of How can we adapt our
us had any experience communication to better meet
of communicating while patient needs, and safeguard
wearing masks or conducting their health and wellbeing in
video consultations. In the current circumstances?
addition, the volume of
16 IPUREVIEW OCTOBER 2020The aim of this article is to ‘People don’t care how
provide useful communication Best practice tips Best practice tips much you know until they
tips and tools to use during know how much you care’
Seek to understand Then be understood
COVID-19 (and beyond). At the Theodore Roosevelt
end of this article you will be
1. Confirm the identity 1. Assess the patient’s
able to:
of the person you are starting point, by
Best practice tips
n Identify five key pitfalls talking to and their asking them what
to avoid; and relationship with the they already know, Demonstrate
n Apply a 5-STEP
patient (in the case of a for example, ‘what empathy
patient representative); do you already know
framework to mitigate about this’? This saves 1. Reduce distractions:
the risks associated 2. Manage expectations time and evaluates Don’t multi-task.
with these pitfalls and by explaining the the accuracy of the Listening requires your
optimise outcomes. consultation process patient’s current full attention. People
and its purpose at understanding; can sense when you
the beginning of the
Pitfall 1: Making consultation; and 2. Provide information in
are only half-listening,
assumptions even on the phone;
small chunks; and
Gathering information is a 3. Seek to understand 2. Verbally convey
core consultation skill. Given the patient’s agenda, 3. Check for feedback, for respect: Introduce
the radical changes to our by asking an open example, ‘As I share yourself and your role.
way of life and methods question, for example, that, what’s coming Use the person’s name.
of communication since what would you like up for you?’ Or ‘What Seek permission
March 2020, it is vital that we to discuss today? questions do you have to consult with the
avoid making assumptions Listen attentively to about what I’ve just patient, for example
by explicitly seeking to the patient’s response, shared’? This enables ‘Is now a good time to
understand the patient and without interrupting. you to check if the speak’?
their needs. This is important message intended is
because masks and remote in fact received and 3. Actively listen: One
consultations reduce our allows you to correct effective skill is to
ability to read body language,
Pitfall 2: Giving too any misconceptions. reflect the emotion
facial expressions and visual much information you are hearing back
identity cues. This risk is Giving too much information to the person using the
further increased if either you phrase ‘sounds like’,
or the patient does not speak
before checking if the message Pitfall 3: Ignore emotions
intended is indeed the for example, ‘It sounds
English as a first language, or message received, can risk The COVID-19 pandemic like you are worried’.
if either of you has hearing miscommunication, especially is fraught with stress and
difficulties. in the absence of facial difficult emotions such as
expression cues. fear, loneliness, anxiety and
worry. Given the context, it is Pitfall 4: Technology
more challenging (yet even problems
more important), to recognise Technology problems can
and acknowledge emotions, be divided into technology
and convey care in our failures, and user challenges.
consultations. In the absence It is important to mitigate the
of visual cues, we rely on other risk of these problems arising,
senses, such as hearing, to as they make communication
convey care. more difficult and create a
negative experience for
both parties.
”With this trend likely to continue,
pharmacists and their teams need to
adapt and develop skills and strategies
to ensure that remote consultations and
masked in-person consultations are
effective and person-centred.”
IPUREVIEW OCTOBER 2020 17Pitfall 5: No clear For a deeper dive into this
Best practice tips Technology user tips
follow-up content, go to www.ipu
academy.ie for the webinar
Problem solve 1. Check the
To prevent misunderstanding,
environment: Are both entitled Five STEPS to
before closing the consultation, Successful Pharmacist
Mitigating you and the patient in
remember to explicitly confirm Consultations during COVID19
technology risks a confidential space?
that both you and the patient (and Beyond), presented by
Is there background
1. Check the connection have a shared understanding Rachel Dungan MPSI, IPU
noise;
in advance, for both of the next steps. Academy Tutor and founder
you and the patient, 2. Check the equipment: of www.4FrontPharmacy.ie.
for example, mobile If using a camera, You can also refer to the IIOP
phone signal, mobile Best practice tips Online Course Consultation
check the quality and
internet, broadband angle of the camera so Safety net Skills in Pharmacy Practice.
etc; that you appear to be
looking directly at the 1. Check shared
2. Agree a back-up patient; and understanding: Ask the
plan in advance, for patient to tell you the
example a mobile/ 3. Sound and lighting: most important things
landline telephone Your posture, breathing they will take from the
number; and and facial expressions consultation;
affect the tone of
3. Check equipment in your voice. Before 2. Forward plan: Explain
advance, for example phone and video what will happen next
camera, headphones. consultations, take and agree the next
a deep breath, smile, steps for you and the
and sit or stand with patient. Document
a straight back and the call and follow-up
shoulders back. For plan; and
video consultations, sit
with the light towards 3. Safety net: Tell the
your face to ensure the patient what you
patient can see you. would expect to
happen if all goes
well, and what to do if
symptoms worsen.
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Permit No. : NWCPO-10-04744-02 Ocon is a fully certified company.PROFESSIONAL Bernie Love, Chief II Antimicrobial Pharmacist, HSE Community Operations
Antimicrobial
Stewardship
Programme in
the Community
Ireland’s National Action Plan on
Antimicrobial Resistance (iNAP) 2017-
2020 recognises the urgent and
growing problem of antimicrobial
resistance for human health
worldwide and outlines strategic
objectives to address the issue
in Ireland. In this article, Bernie
Love, Chief II Antimicrobial
Pharmacist, HSE Community
Operations, outlines the plan and
provides an overview of the role of
the senior antimicrobial pharmacist
at Community Healthcare
Organisation level in the HSE.
A
ntimicrobial microorganisms to either for prophylaxis of
resistance is adapt or die. infection. Infections
the ability of a Antibiotics have been used which in the past may
microorganism since the mid-20th century have been deadly are
(e.g. a bacterium, to treat bacterial infections, now often easily treated,
a virus, or a parasite, such as and great strides have been and the use of antibiotics
the malaria parasite) to resist made in health care and has made modern medical
the action of an antimicrobial public health due to their procedures such as surgeries
agent. It is an adaptation use. Modern medicine relies and chemotherapy possible.
of the microorganism to on availability of effective However human antibiotic
its environment. Any use antibiotics in the case an use is a known driver of
of an antimicrobial forces infectious complication or antibiotic resistance.
20 IPUREVIEW OCTOBER 2020Antibiotic resistance is Healthcare: Quality and
a global concern. If not Patient Safety (QPS) Infection
managed, it has the potential Prevention and Control (IPC)
to undo many of the gains Team at National level. The
made in global health over National Community QPS
the past century. Without IPC team which includes
effective antibiotics, intensive antimicrobial stewardship is
care, organ transplants, cancer led by Aileen O’Brien, Head
chemotherapy, care of preterm of IPC. Bernie Love, Chief II
babies, or even common Antimicrobial Pharmacist,
surgical procedures, such joined the team in June
as hip or knee replacement, 2020. Bernie will lead and
would not be possible. support the development of
Although antibiotic a community antimicrobial
resistance is a naturally stewardship programme; a Overview of the role of the senior
occurring biological Director of Nursing, Infection
phenomenon, it has been Prevention and Control is also
antimicrobial pharmacist in a CHO
exacerbated by the overuse to be appointed. Recruitment of a Senior accounts for approximately
and misuse of antibiotics. A At Community Healthcare AMP in each CHO in Ireland 80% of total antimicrobial
concerted effort is needed Organisation (CHO) level, aims to provide a key clinical use in Ireland. These new
to strategically reduce any funding has been provided leadership role that is positions are a very welcome
overuse and misuse of for a Senior Antimicrobial central to the delivery of an development as it is the
antibiotics at the individual Pharmacist (AMP) and an antimicrobial stewardship first time that AMPs will be
and population level. Assistant Director of Nursing service at the front line in dedicated to antimicrobial
Combined, these efforts not (ADON) in IPC in each of community services. Newly stewardship activities in
only have the potential to the HSE’s nine Community appointed antimicrobial the community in Ireland,
arrest and possibly reverse Healthcare Organisations. pharmacists will proactively having supported stewardship
the current upward trends The National Community engage with those involved in activities in the acute
in resistance, but also have QPS IPC Team will work prescribing, dispensing and setting for 10-15 years. We
the potential to alleviate the closely with the National administering antimicrobials are privileged to have a
burden placed on individuals AMRIC Implementation in community health team assembling with such
and the health care system Team to develop and support and social care settings extensive experience in a
associated with antimicrobial the implementation of to ensure their best use. variety of settings. These
resistant infections. a standardised national Engagement may take the pharmacists are now available
The Department of Health approach to antimicrobial form of provision of education to support antimicrobial
has provided significant stewardship in the community. across multidisciplinary stewardship activities in
funding to support the The purpose of antimicrobial fields, provision of evidence- community settings and their
implementation of iNAP and stewardship is to promote based guidance (www. contact details are below.
this funding has enabled the the prudent use of antibiotics antibioticprescribing.ie), audit Antimicrobial stewardship
appointment of key positions in order to optimise patient and prescriber feedback, in the community is a
to implement a standardised outcomes while at the promoting patient and necessary step in the battle
national approach to same time minimising the public awareness (www. against antimicrobial
managing healthcare- probability of adverse effects, undertheweather.ie ) and resistance, and is strongly
associated infection (HCAI) including toxicity and the support and implementation advocated by global health
and antimicrobial resistance selection of pathogenic of nationally standardised agencies. As evident
(AMR) in the community. In organisms, and the emergence quality improvements to from community-based
the human health sector in and spread of antibiotic ensure effectiveness and antimicrobial stewardship
Ireland, the antimicrobial resistance. Key evidence-based sustainability in the long-term. activities in other countries, it
consumption in the stewardship interventions have These appointments will is hoped that the initiative in
community is higher than the demonstrated benefits in terms expand and strengthen Ireland will curb the alarming
European average. of clinical outcome, adverse existing efforts to optimise rate that antimicrobial
Funding has enabled the events, treatment costs, and use of antimicrobials in resistance is rising globally
recruitment of a Community antibiotic resistance rates. community settings which and nationally.
”A concerted effort is needed to
strategically reduce any overuse
and misuse of antibiotics at the
individual and population level.”
IPUREVIEW OCTOBER 2020 21Meet your new CHO antimicrobial pharmacists:
Aisling Clancy
aislingn.clancy@hse.ie
CHO 1 (Donegal, Sligo, Leitrim, Cavan, Monaghan)
Aisling has over 20 years’ pharmacy experience working in community, hospital
and industry settings. She has an MSc in Clinical Pharmacy and a Diploma in
Health Economics. She has had the opportunity to work abroad at The Hospital
For Sick Kids in Toronto and later with Sanofi Genzyme at their Boston HQ.
For the past 13 years, Aisling has worked as the Antimicrobial Pharmacist at
Letterkenny University Hospital (LUH).
Shirley Armitage
shirley.armitage@hse.ie
CHO 3 (Clare, Limerick, North Tipperary)
Shirley has an MSc in Clinical Pharmacy and over 15 years' experience in hospital
pharmacy. She spent 5 years in London working in the Royal Marsden Hospital and
Great Ormond Street Hospital and has worked for the past 10 years as a Clinical
and Antimicrobial Pharmacist at Midlands Regional Hospital Tullamore.
Catherine Mannion
catherine.mannion@hse.ie
CHO 5 (South Tipperary, Carlow, Kilkenny, Waterford, Wexford)
Catherine has an MSc in Clinical Pharmacy and has worked as the Antimicrobial
Pharmacist at St. Luke’s General Hospital Carlow/Kilkenny for over 10 years.
She also has experience of providing a clinical pharmacy service to ICU,
pharmacy management and oncology.
Mala Shah
mala.shah@hse.ie
CHO 4 (Cork, Kerry)
Mala has over 20years’ hospital pharmacy experience. She has an MSc in Clinical
Pharmacy, and is an adjunct senior lecturer for UCC. She started her career as HIV
Pharmacist in London and has worked as an Antimicrobial Pharmacist in Cork
University Hospital for the last 13 years.
Sarah Fagan
sarah.fagan@hse.ie
CHO 8 (Laois, Offaly, Longford, Westmeath, Louth, Meath)
Sarah has over 20 years’pharmacy experience (17 in hospital and 5 years in
community). Sarah has a Diploma in Clinical Pharmacy and an MSc in Healthcare
Management. Sarah has worked in Louth County, Hospital, Our Lady's Hospital,
Navan and Our Lady of Lourdes Hospital, Drogheda as well as community
pharmacy settings in Ireland, UK, Australia and New Zealand.
*Recruitment for the remaining
CHO’s are in progress
22 IPUREVIEW OCTOBER 2020BUSINESS John Barry, Managing Director, MSS the HR people
Statutory
Entitlements in
the Context of
COVID-19
I
With all of the public statements being have gathered together
some frequently asked
made by the Government, opposition questions in this area,
which have been posed
spokespeople, professionals, doctors and regularly over recent
weeks. However, before looking
everybody else, it is totally understandable at potential scenarios within
the workplace, it is important
why many people, including employers and that you understand the
employees, are confused as to what they different terminology used, for
example, self-isolation versus
can do in relation to the COVID-19 situation restricted movements, as this
has a bearing on the different
at this time. In this article, John Barry, scenarios that you will
encounter and may influence
Managing Director at Management Support which statutory entitlements
are most applicable to that
Services (MSS), provides advice on statutory scenario.
entitlements in the context of COVID-19.
24 IPUREVIEW OCTOBER 2020Contains nicotine
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NiQuitin CLEAR 24 hrs transdermal patches are indicated for the relief of nicotine withdrawal symptoms including cravings as an aid to smoking cessation. Indicated in adults and adolescents aged 12 years
and over. NiQuitin patches should be applied once a day, at the same time each day and preferably soon after waking and worn continuously for 24 hours. Apply a patch to non-hairy clean dry skin surface,
a new skin site should be used every day. Therapy should usually begin with NiQuitin 21 mg/24 hrs and reduced according to the following dosing schedule: Step 1 NiQuitin Clear 21 mg/24 hrs transdermal
patches first 6 weeks. Step 2 NiQuitin Clear 14 mg/24 hrs transdermal patches next 2 weeks. Step 3 NiQuitin Clear 7 mg/24 hrs transdermal patches last 2 weeks. Light smokers (e.g. those who smoke less
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ie/medicine/12136/SPC/NiQuitin+CLEAR+7+mg+24+hours++transdermal+patch/ http://www.medicines.ie/medicine/12137/SPC/NiQuitin+CLEAR+14+mg+24+hours+transdermal+patch/ http://www.
medicines.ie/medicine/12138/SPC/NiQuitin+CLEAR+21+mg+24+hours+transdermal+patch/ NiQuitin Mini 1.5mg/4mg Mint Lozenges are used for the treatment of tobacco dependence by relief of
nicotine withdrawal symptoms and cravings. Indicated in adults and adolescents aged 12 years and over. NiQuitin Mini 1.5 mg are suitable for those who smoke who smoke 20 cigarettes or less a day.
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whenever there is an urge to smoke in order to reduce the number of cigarettes smoked for up to 6 weeks, followed by abrupt cessation. Adolescents (12-17 years): Only with advice from a healthcare
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myocardial infarction, unstable or worsening angina pectoris including Prinzmetal’s angina, severe cardiac arrhythmias, uncontrolled hypertensions or recent cerebrovascular accident. Use with caution in
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http://www.medicines.ie/medicine/14492/SPC/NiQuitin+Mini+4mg+mint+lozenges/ Legal classification: GSL: PA 1186/18/11 & PA 1186/18/12. MAH: Chefaro Ireland DAC, The Sharp Building, Hogan
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