6.13: Professional Practice, Ethics, & Communication

Professional Practice, Ethics, & Communication

Professional practice in Australia requires a thorough understanding of federal and state legislation, adherence to ethical codes, effective communication, and participation in quality improvement and safety initiatives like the Return Unwanted Medicines (RUM) scheme.

Pharmacy Legislation & Regulation in Australia

Pharmacy practice is regulated through a co-regulatory model involving national and state bodies:

1. National Law & AHPRA: The Health Practitioner Regulation National Law establishes the National Registration and Accreditation Scheme. The Australian Health Practitioner Regulation Agency (AHPRA) supports the national boards.
2. Pharmacy Board of Australia (PBA): The PBA is responsible for registering pharmacists, developing registration standards (e.g., continuing professional development, professional indemnity insurance), and publishing clinical guidelines (e.g., Guidelines for dispensing of medicines, Guidelines on compounding of medicines). The PBA's Code of Conduct outlines the professional and ethical standards expected of all registered pharmacists.
3. Dispensing Requirements & Guidelines: Dispensing must be performed in accordance with the PBA guidelines and the Pharmaceutical Society of Australia (PSA) Professional Practice Standards (PPS).
   • Labelling: Labels must contain clear instructions, active ingredient names, strength, quantity, date, patient name, and dispenser details. Pharmacists must apply appropriate Cautionary Advisory Labels (CALs) as specified in the Australian Pharmaceutical Formulary and Handbook (APF) (e.g., CAL 1 for sedation, CAL 12 for avoiding alcohol with metronidazole).
   • Dispensing Records: All dispensed medicines must be recorded in the pharmacy's dispensing software. Schedule 8 records must be duplicated in the S8 Drug Register, tracking all receipts, supplies, and current balances.

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Professional Ethics & Patient Confidentiality

1. PSA Code of Ethics: The code is structured around core values that guide professional relationships and decision-making:
   • Care: Prioritise the health and well-being of the patient and public.
   • Integrity: Practice honestly, transparently, and maintain professional independence.
   • Respect & Competence: Respect patient autonomy, diversity, and commit to lifelong learning.
2. Patient Confidentiality: Pharmacists must comply with the Privacy Act 1988 (Cth) and the Australian Privacy Principles (APPs) regarding the collection, storage, use, and disclosure of personal health information. Patient information must not be disclosed to third parties (including spouses or family members) without the patient's explicit consent, except in the following circumstances:
   • When required by law (e.g., a court subpoena, statutory notification of certain infectious diseases).
   • When there is an imminent threat to the life or safety of the patient or the public (e.g., reporting a patient who threatens immediate self-harm or violence against others).
   • Under provisions of the National Law (e.g., mandatory reporting of 'impairment' or 'unprofessional conduct' of another practitioner).

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Effective Patient Communication & Cultural Safety

Clear, empathetic, and culturally appropriate communication is essential to prevent medication errors and improve adherence.

1. Assessment Protocols: Pharmacists use structured questions to assess patient needs for minor ailments:
   • WWHAM: Who is the patient?, What are the symptoms?, How long have they been present?, Action taken already?, Medications taken regularly?
   • ASMETHOD: Age, Self or someone else?, Medicines currently taken?, Exact symptoms?, Timeframe/duration?, History of other conditions?, Other symptoms?, Danger/Red Flags?
2. Cultural Safety: Pharmacists have a responsibility to provide culturally safe care, particularly to Aboriginal and Torres Strait Islander peoples. This involves reflecting on one's own biases, respecting cultural values, and adapting communication styles to build trust. For patients with limited English proficiency, pharmacists should utilise the Translating and Interpreting Service (TIS National), a free service funded by the Australian Government for eligible encounters.
3. Special Communication Needs: When communicating with patients who have cognitive impairment (e.g., dementia), sensory deficits (e.g., hearing or visual impairment), or low health literacy, pharmacists should use visual aids, written consumer medicines information (CMI), and simplify language (avoiding medical jargon).

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Clinical Referrals and 'Red Flags'

A critical role of the pharmacist is to identify 'red flag' symptoms during patient consultations that require immediate medical referral to a general practitioner (GP) or emergency department.

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Quality Use of Medicines (QUM) & Safe Disposal

The Return Unwanted Medicines (RUM) scheme is a national Australian government-funded program that provides a free and safe way for consumers to dispose of expired or unwanted medicines.

Rules and Protocols for RUM Bin Disposal:

1. General Medicines: Tablets, liquids, creams, and inhalers can be placed directly into the RUM bin. Packaging should be recycled where possible, but the primary container containing the drug is placed in the bin.
2. Schedule 8 (Controlled Drugs) Disposal: S8 medicines must never be placed directly into a RUM bin in their original form. Pharmacists must first destroy (denature) the S8 medicines using a chemical destruction kit (such as a denaturing jar containing active agents that turn the drugs into an unusable gel). Once the S8 medicine is rendered unusable, the denatured mixture can be placed in the RUM bin. The destruction must be recorded in the S8 Drug Register, noting the date, drug name, quantity, and must be signed by the pharmacist and a witness (requirements for the witness's credentials vary by state, but typically another registered healthcare professional is required).
3. Cytotoxic Medicines: Cytotoxic waste (e.g., methotrexate, oral chemotherapy agents) must never be placed in a standard RUM bin due to the risk of hazardous exposure to disposal workers. Cytotoxic medicines must be disposed of in dedicated purple cytotoxic waste bins and incinerated at high temperatures.
4. Sharps and Needles: Sharps must never be placed in a RUM bin. Consumers must be directed to place sharps in approved yellow sharps containers, which are disposed of through dedicated public health or local council needle exchange programs.