Part A: Primary Healthcare (10 minutes)
You have a maximum of ten minutes to role-play the following scenario with your tutor.
The aim is to determine the most appropriate course of action when presented with a symptom and/or product-based request.
You will need to:
 recommend a product (brand/ingredient) and provide instructions for safe and effective use, OR
 refer with/without product
 provide non-pharmacological advice
If you recommend an OTC product by brand, you must be able to name the active ingredient/s in the product.

Scenario
Mikayla (17-years-old) presents to the pharmacy and says:

“I would like something to help with my dandruff please.”

What advice can you give her and what product recommendation (if any) would you make?

Part A: Primary Healthcare (10 minutes)

Please review your colleague’s answers against the answer sheet, ticking off points as they are discussed. Remember also to document recommendations and any advice given (correct or incorrect). If you feel that your colleague has done harm, please document this and explain why.
At the end of the interaction you can give this sheet to your colleague to Help them with their reflections.
Explanation of condition/symptoms:
• Mikayla has symptoms indicative of dandruff (symptoms confined to the scalp and there is no redness or hair loss)
Treatment options for dandruff:
• Options for treatment include the daily use of a standard shampoo, or an anti-yeast product if the dandruff is severe or unresponsive to first-line treatment
• Combining the anti-yeast shampoo with a tar product may be needed to treat symptoms (e.g. itch) and scale
• Instruct Mikayla on how to use the selected product (if any), including frequency of treatment
• Provide non-pharmacological advice

Shampoo type
Hypoallergenic shampoo, some examples include:
• Dermaveen® oatmeal shampoo
(doesn’t contain parabens, lanolin, fragrance, alcohol or artificial dyes)
• Johnson’s® Baby conditioning shampoo – (doesn’t contain dyes, sulfates, parabens or phthalates)
Regular shampoo
Shampoo containing coal tar, some examples include:
• Ionil T® scalp cleanser contains coal tar solution 5% & salicylic acid 2%
• Polytar® Liquid contains tar 1% (tar 0.3%, coal tar solution 0.1%, cade oil 0.3%, arachis oil extract of coal tar 0.3%)
• Neutrogena T/gel® therapeutic shampoo contains 0.5% coal tar
• Neutrogena T/gel® Plus dual action shampoo contains coal tar 0.5% & salicylic acid 2%
• Sebitar® shampoo contains pine tar 1%, coal tar solution 1% & salicylic acid 2%
Shampoo containing selenium sulphide, some examples include:
• Selsun® Shampoo
• Selsun® Blue Dual Action
• Selsun® Blue Replenishing
• Selsun® Blue Deep Cleansing shampoo
Shampoo containing zinc pyrithione, some examples include:
• Cedel® Anti dandruff medicated shampoo
• Neutrogena T/gel® daily control 2 in 1 Anti-Dandruff Shampoo Plus
• Head & shoulders® range

Shampoo type
Shampoo containing piroctone olamine, some examples include:
• Sebamed® anti-dandruff shampoo
• Moo Goo® Natural milk shampoo
Shampoo containing cicloprox olamine, some examples include:
• Stieprox®
Shampoo containing ketoconazole, some examples include:
• Nizoral® anti-dandruff shampoo (ketoconazole 1% and 2%)
• Sebizole® shampoo (ketoconazole 2%)
Shampoo containing miconazole, some examples include:
• HairScience for Dandruff Shampoo (miconazole 2%)
Non-pharmacological advice
• All antidandruff shampoos can cause local scalp irritation (discontinue use if severe)
• Shampoo often. If you tend to have an oily scalp, daily shampooing may help prevent dandruff. Gently massage your scalp to loosen flakes. Rinse thoroughly.
• Regular brushing of the hair helps to remove old skin flakes
• Limit hair styling products. Hair styling products can build up on your hair and scalp, making them oilier.
• Oatmeal based products – anecdotally, use of oatmeal-based shampoos (Dermaveen®, etc.) in between using a medicated shampoo, can help keep symptoms under control
• There is a link with stress as stress weakens the immune system allowing the causative yeast to flourish, so relaxation techniques

Part B: Legal and Ethical practice (5 minutes)
You have five minutes to discuss the legal and ethical issues associated with the following scenario and discuss what you would do if faced with this situation.

Scenario
Bill Jeffs asks to purchase two boxes of pseudoephedrine tablets (12 tablets of 60 mg pseudoephedrine in each box).
Discuss the ethical and/or legal issues you can identify in this scenario
What actions would you take?

Part B: Legal and Ethical practice (5 minutes)
Answer guide

Please review your colleague’s answers against the answer sheet, ticking off points as they are discussed.
At the end of the interaction you can give this sheet to your colleague to Help them with their reflections.
What legal and ethical issues can you identify?
Legal issues
• The latest version of the Poisons Standard (June 2022), lists pseudoephedrine as Schedule 3 as follows:
PSEUDOEPHEDRINE (other than preparations for stimulant, appetite suppression or weight-control purposes) when supplied in a primary pack:
– in liquid preparations containing 800 mg or less of pseudoephedrine hydrochloride (or its equivalent); or
– in other preparations containing 720 mg or less of pseudoephedrine hydrochloride (or its equivalent).
• Pharmacy Board of Australia (PharmBA) guidelines on practice specific issues (September 2015, http://www.pharmacyboard.gov.au/Codes-Guidelines.aspx) Item 3: Pseudoephedrine, main points:
o “Requests for pseudoephedrine are to be treated cautiously to limit the risk of the product being diverted for illicit use/manufacture. A genuine therapeutic need is to be established by careful questioning, including when requested on prescription.”
o “Only one proprietary pack is to be supplied at a time unless there are exceptional circumstances, clearly demonstrated by the customer or communicated by the prescriber, additional documentation of which should be kept.”
o “The sale of multiple packs of pseudoephedrine-containing products (other than in exceptional circumstances and when appropriately prescribed by an authorised prescriber) and failure to comply with the local regulations applying to S3 poisons (Pharmacist Only Medicines) and these guidelines may be considered as unprofessional conduct.”
o “The Board endorses the use of a real-time online monitoring system (e.g. Project STOP) as a means of Helping the pharmacist in determining whether pseudoephedrine should be supplied when a person requests it, noting that this may also involve communicating suspicious requests to the section of the police that deals with drug crimes. All purchases, including those on prescription, should be entered on this system.”

Part B: Legal and Ethical practice (5 minutes)
Answer guide
Ethical issues
Pharmacists have an ethical obligation to:
• practice lawfully, be ethical and trustworthy, demonstrating accepted standards of professional and culturally appropriate personal and professional behaviour
o if you supply excessive amounts of pseudoephedrine (or any S3 product) you are not practising according to accepted standards (e.g. Professional Practice Standards, PharmBA standards)
• uphold the reputation and public trust of the profession
o if the public are aware that you are exploiting the privilege of S3 supply they will lose trust
• behave in a manner that clearly demonstrates responsibility and accountability for all decisions made and actions taken in their professional practice
• avoid conflicts of interests at all times
o supply of excessive quantities for financial gain is unethical and unprofessional
• contribute to the achievement of the objectives of Australia’s National Medicines Policy, including quality use of medicines
• exercise a duty to make the care of patients or clients their first concern and to practise safely and effectively to prevent harm
o supply of excessive quantities, particularly if the patient takes them incorrectly will increase risk of harm
• promote the safe, judicious and efficacious use of medicines, and prevent the supply of unnecessary and/or excessive quantities of medicines, or any product which may cause harm
• protect and promote the health of individuals and the community

Part C: Prescription problem solving and communication (20 minutes)
You have up to twenty minutes to role-play the following scenario with your tutor. The aim is to identify the prescription ‘problem’ and provide adequate counselling if required.

This prescription is presented by Mr Ken White
Assume the prescription is valid and meets all legal requirements.

Dispensing History for Mrs Joan White
Date Drug Rpts Doctor
Three weeks ago Verapamil CR 180 mg/trandolapril 2 mg 3 J. Shannon

Part C: Prescription problem-solving and communication (20 minutes)
Answer guide

Please review your colleague’s answers against the answer sheet, ticking off points as they are discussed. Remember also to document recommendations and any advice given (correct or incorrect). If you feel that your colleague has done harm, please document this and explain why.
At the end of the interaction you can give this sheet to your colleague to Help them with their reflections.
Ascertained from the person (or agent) that:
o they have been prescribed dabigatran for VTE prophylaxis post knee replacement surgery
o are taking verapamil for hypertension
Determined that:
o The protocol for VTE prophylaxis is different for people also taking verapamil.
o With amiodarone or verapamil, give 75 mg 1–4 hours after surgery, then 150 mg once daily. If dabigatran cannot be started on the day of surgery, give 150 mg once daily.
o VTE prophylaxis should be continued for 10 days post knee replacement surgery
Communicated to the person (or agent):
o Explain the possible medication interaction
o Clarified dose of dabigatran with prescriber and a new prescription will be sent to the pharmacy
o The doctor has confirmed that this medicine should be taken for 7 more days only
Counselling points – dabigatran:

o Swallow capsules whole with a glass of water and take some food too; do not chew, crush or open capsules or empty pellets from capsules as this will increase your risk of bleeding.
o Take at about the same time(s) every day; use a calendar to keep a record and to mark off the date after taking a dose.
o Tell your doctor immediately if you have any unexplained bruising, bleeding, pink, red or dark brown urine, or red or black faeces
o This medicine can cause nausea and diarrhoea
o Can include a discussion of pain management if there is time
_________________________________________________________________________
Comment on communication with prescriber
Mark out of 5 (1 = very poor, 2 = poor, 3 = satisfactory, 4 = good, 5 = excellent)
Comment on communication with patient
Mark out of 5 (1 = very poor, 2 = poor, 3 = satisfactory, 4 = good, 5 = excellent)
Satisfactory patient outcome achieved? (Yes/No)

—
Part A: Primary Healthcare (10 minutes)
You have a maximum of ten minutes to role-play the following scenario with your tutor.
The aim is to determine the most appropriate course of action when presented with a symptom and/or product-based request.
You will need to:
 recommend a product (brand/ingredient) and provide instructions for safe and effective use, OR
 refer with/without product
 provide non-pharmacological advice
If you recommend an OTC product by brand, you must be able to name the active ingredient/s in the product.

Scenario
Edward, a 45-year old butcher requests some Voltaren® tablets to treat a sore back
What advice can you give and what product recommendation (if any) would you make?

Part A: Primary Healthcare (10 minutes)
Answer guide
Please review your colleague’s answers against the answer sheet, ticking off points as they are discussed. Remember also to document recommendations and any advice given (correct or incorrect). If you feel that your colleague has done harm, please document this and explain why. At the end of the interaction you can give this sheet to your colleague to Help them with their reflections.
Explanation of condition/symptoms:
• The person has lower back pain most likely related to a muscle strain from moving heavy boxes
Treatment options for back pain
• Short-term use of topical NSAID
• Short-term use of oral NSAID, e.g. ibuprofen 200-400 mg three or four doses per day (maximum 2400 mg)
o Note: the patient is taking sertraline  SSRIs can affect platelet aggregation and might increase the risk of GI bleeding, especially upper GI bleeding.
 Combinations with other drugs that affect the clotting process (e.g. NSAIDs) may increase the risk of bleeding.
 Alternatives such as paracetamol or less gastro toxic NSAIDs, such as ibuprofen, should be considered (Stockley’s Drug Interactions; monograph last modified 19/04/2017 [accessed September 2022])
o Use the minimum effective dose of the NSAID for the shortest possible time (eTG Rheumatology [amended August 2022; accessed September 2022])
Evidence suggests that paracetamol is ineffective for non-specific low back pain, however individual patients may experience a benefit. May be considered if NSAIDs are contraindicated or not tolerated (eTG Rheumatology [published March 2017; accessed September 2022]).
• paracetamol 1 g orally, 4- to 6-hourly as necessary, up to a maximum dose of 4 g daily
or paracetamol modified-release 1.33 g orally, 8-hourly as necessary
Paracetamol may be used to reduce the overall daily doses of NSAIDs required, and thus the risk of their adverse effects.
Product instructions and advice

Non-pharmacological/lifestyle counselling
• Education about nature of lower back pain and reassurance of positive outcomes
• Advice on appropriate lifting technique
• Advice to stay active, including encouragement for combining rest and physical activity (avoid prolonged bed rest). Patients should be reassured that some pain with exercise can be expected and that this does not imply continuing damage.
• Encouragement to continue to work or return to work as soon as possible
• Application of heat or cold might be helpful
• Massage may be helpful
• Reassurance that recovery is likely. Should the pain not resolve then seek advice from your doctor or physiotherapist.
• Advice about the potential for increased risk of bleeding, and signs and symptoms of bleeding
Part B: Legal and Ethical practice (5 minutes)
You have five minutes to discuss the legal and ethical issues associated with the following scenario and discuss what you would do if faced with this situation.

Scenario
You are working in a busy late 9 am to 9 pm 7-day-a-week pharmacy that has many pharmacists employed to cover all the shifts. When finalising the Drugs of Dependence return you count all the stock in the safe and discover there is a discrepancy in the number of Oxycontin® 10 mg tablets. There is 40 less than the stated amount recorded in the register. This is not the first time this has occurred.

What are the legal and ethical issues?
What do you do?

Part B: Legal and Ethical practice (5 minutes)
Answer guide
Please review your colleague’s answers against the answer sheet, ticking off points as they are discussed.
At the end of the interaction you can give this sheet to your colleague to Help them with their reflections.
What legal and ethical issues can you identify?
Legal issues
1. Pharmacists are legally required to keep an accurate balance of S8 drugs in stock on the premises
• Immediately after dispensing the drug the pharmacist must record the details of supply including all of the following:
o his or her name and business address;
o the name and address of the person to whom the drug was sold or supplied;
o the date on which the drug was sold or supplied;
o the trade or approved name of the drug or, if the drug does not have either a trade or approved name, the ingredients in the drug;
o the amount and, if applicable, the strength of the drug;
o if the drug was sold or supplied on order—the invoice number (if any) for the sale or supply of the drug.
• This includes making a record of the total amount of the drug now in stock
• In this situation the balance doesn’t match the record – there may be a number of explanations:
o The pharmacy may be careless in its approach to record keeping (including correct entry of information about receipt, dispensing and/or returned/expired stock)
o Unauthorised access to the drug safe
o Theft is occurring – Is there a drug problem? (e.g. pharmacist or staff) – referral/support may be required
2. Unauthorised access
As noted by the Code of Practice for the Storage and Transport of Drugs of Dependence Nov 2012 (a legal document referenced in the Controlled Substances Regulations):
“[4.1] No person is permitted access to a drug cabinet, safe, or strongroom key other than a registered health practitioner, veterinary surgeon, permit holder, or a licence holder who is permitted under the Act to possess drugs of dependence, and is working at the premises on which a drug cabinet, safe, or strongroom is located.”
3. Mandatory reporting may be applicable?
If there is suspicion that a pharmacist may be stealing Schedule 8 medications:
o You are obliged to contact SA Health and the police
o There are additional issues in relation to such behaviour by pharmacists. Dimensions include:
 Unsatisfactory professional conduct
 Contravention of Code of Conduct/Ethics
 Impairment

Part B: Legal and Ethical practice (5 minutes)
Pharmacists have an ethical obligation to:
1. Practise lawfully – pharmacists are required to fulfil all legal obligations. If any of the explanations above hold true, the pharmacist is not behaving legally, and therefore not behaving ethically.
2. Requirement to maintain effective control of therapeutic goods – the pharmacist has an ethical obligation to responsibly and effectively control the management of S8 medications.
3. Requirement to act with honesty and integrity – if a pharmacist is careless in their approach to the management of S8s, then they are not acting with professional integrity and therefore not upholding the profession’s reputation. In the situation that S8s are being stolen, pharmacists are dishonest and breaking the law.
4. Demonstrate a commitment to continuing professional development and self-care – a pharmacist must manage their own health and wellbeing to ensure there is no negative impact on professional practice. This is relevant if theft is occurring to support drug abuse of a health practitioner.

What should you do?
• This situation needs to be taken very seriously
• Any discrepancies found in the transaction records must be investigated without delay
• Do a recount of the safe and try to balance again
• Check the register thoroughly for any arithmetical errors
• Check the entries in the register against the original prescriptions processed and invoices for the particular S8 item
• It is not acceptable to simply “correct” the balance without resolving the discrepancy or without clearly recording how the discrepancy was resolved.
• Controlled Substances Licensing (SA Health) should be notified if the discrepancy is not resolved after investigation

Part C: Prescription problem solving and communication (20 minutes)
You have up to twenty minutes to role-play the following scenario with your tutor. The aim is to identify the prescription ‘problem’ and provide adequate counselling if required.

Mr Matt Grigg presents a prescription.

Dispensing History for Mrs Sarah Grigg

Date Drug Rpts Doctor
6 months ago Nitrofurantoin 100 mg 1 bd for 5 days Nil rpt D. Sampson
12 months ago Levlen ED 1 daily 1 rpt D. Sampson

Part C: Prescription problem solving and communication (20 minutes)
Answer guide

Please review your colleague’s answers against the answer sheet, ticking off points as they are discussed. Remember also to document recommendations and any advice given (correct or incorrect). If you feel that your colleague has done harm, please document this and explain why.
At the end of the interaction you can give this sheet to your colleague to Help them with their reflections.
Ascertained from the patient that:
• The prescription is for the wife of the person who is dropping it in (Matt)
• The patient (Sarah) is pregnant, and it is late in the pregnancy
Determined that:
• Nitrofurantoin is not recommended for use at or near term or delivery
o “Nitrofurantoin: Pregnancy Safe to use. Do not use in women at or near term or delivery because of the risk of haemolytic anaemia in the neonate.” (AMH 2022)
o “Avoid using nitrofurantoin close to delivery (after 37 weeks’ gestation, or sooner if early delivery is planned) because of the possible increased risk of neonatal jaundice and haemolytic anaemia.” Therapeutic Guidelines: Antibiotic (Urinary tract infection and bacteriuria in pregnancy; acute cystitis in pregnancy [amended March 2022, accessed September 2022])
Contacted the GP Dr Sampson to discuss:
• An alternative UTI treatment, e.g. cefalexin – the prescription presented is not appropriate for the woman due to the late stage of her pregnancy
• Confirm the doctor will write new prescription that represents an appropriate antibiotic
What regimen did the pharmacist recommend for the patient?

How do you rate the pharmacist’s communication with the prescriber?
Mark out of 5 (1 = very poor, 2 = poor, 3 = satisfactory, 4 = good, 5 = excellent)
Communicated to the husband:
• That the medicine is not suitable for his wife so close to giving birth and why
• Reassure him that is was safe to use earlier in the pregnancy
• To take his wife back to the GP or obstetrician to have the UTI reviewed, there are other medicine that they can use, but they may want to do a sensitivity test
• To always discuss use of medicines in pregnancy and breastfeeding prior to their use

How do you rate the pharmacist’s communication with the patient?
Mark out of 5 (1 = very poor, 2 = poor, 3 = satisfactory, 4 = good, 5 = excellent)

—
Part A: Primary Healthcare (10 minutes)
You have a maximum of 10 minutes to role-play the following scenario with your tutor.
The aim is to determine the most appropriate course of action when presented with a symptom and/or product-based request.
You will need to:
 recommend a product (brand/ingredient) and provide instructions for safe and effective use, OR
 refer with/without product
 provide non-pharmacological advice
If you recommend an OTC product by brand, you must be able to name the active ingredient/s in the product.

Scenario
Amanda Preston (26-years-old; female) comes into your pharmacy requesting treatment for a sore mouth.
What advice can you give her and what product recommendation (if any) would you make?

Part A: Primary Healthcare (10 minutes)
Answer guide

Please review your colleague’s answers against the answer sheet, ticking off points as they are discussed. Remember also to document recommendations and any advice given (correct or incorrect). If you feel that your colleague has done harm, please document this and explain why.
At the end of the interaction you can give this sheet to your colleague to Help them with their reflections.
Explanation of condition/symptoms:
• The person is suffering from oral thrush, probably secondary to inhaled corticosteroids
• There are no symptoms that warrant immediate referral
• A treatment for oral thrush can be recommended, with counselling that includes when to see the doctor
• The person should also be encouraged to use a spacer and wash their mouth out after inhaler use to minimise the problem
Treatment options for oral thrush:
• miconazole oral gel (Daktarin®): ½ measuring spoon four times a day
• nystatin drops (Nilstat®): 1mL four times a day
Product instructions and advice
Product recommendation:

Miconazole 2% oral gel:

• Adult, ½ measuring spoon provided (2.5 mL) topically (then swallowed) four times a day after food (for 7-14 days). Place directly in the mouth and on the tongue.
• Apply directly to the area with a clean finger/drop the dose onto the tongue and hold in the mouth for as long as comfortable before swallowing
• Best to use the gel after (rather than before) a meal or drink; keep it in your mouth for as long as possible before swallowing.
• Can occasionally cause nausea and vomiting, but rare. Mild GI disturbances are common.
• Continue treatment for 7 to 14 days to prevent relapse and reinfection (continue using the gel for several days after symptoms disappear)

Nystatin drops:

• Adult, 1 mL (100 000 Units; using the measuring syringe provided) topically (then swallowed) four times a day after food (for 7-14 days)
• Best to use after (rather than before) a meal or drink; swish the liquid around the mouth for as long as comfortable before swallowing
• Nausea, vomiting, diarrhoea are common side effects
• Continue treatment for 7-14 days (continue using the drops for several days after symptoms disappear [eTG Oral and Dental, amended May 2022 says 2-3 days after symptoms resolve])

Non-pharmacological/lifestyle counselling
• Hold product in the mouth for as long as possible before swallowing
• Use after a meal or drink; avoid eating or drinking for 1 hour after the dose
• After using your new puffer medicine rinse your mouth with water, gargle and spit out this will reduce the likelihood of future infections

Part B: Legal and Ethical practice (5 minutes)
You have five minutes to discuss the legal and ethical issues associated with the following scenario and discuss what you would do if faced with this situation.

Scenario
Rasheed, 31-years-old has recently started work at the district attorney’s office. He has many legal cases to work on and his wife is also pregnant with their fourth child.
Today he comes to the pharmacy to request a packet of Circadin® (melatonin) tablets to help him sleep.

Discuss the ethical and/or legal issues you can identify in this scenario
What actions would you take?

Part B: Legal and Ethical practice (5 minutes)
Answer guide

Please review your colleague’s answers against the answer sheet, ticking off points as they are discussed.
At the end of the interaction you can give this sheet to your colleague to Help them with their reflections.
What legal and ethical issues can you identify?
Legal issues
• The latest version of the Poisons Standard (June 2022), lists melatonin as Schedule 3 (S3) as follows:
“MELATONIN in modified release tablets containing 2 mg or less of melatonin for monotherapy for the short-term treatment of primary insomnia characterised by poor quality of sleep for adults aged 55 or over, in packs containing not more than 30 tablets”
o It is only legal to supply melatonin S3 within these parameters – any other supply is considered Schedule 4 (prescription) and/or off-label
• The TGA-approved therapeutic indication for melatonin (as given by the Circadin® approved PI [last updated 11 Nov 2020] states: “Monotherapy for the short-term treatment of primary insomnia characterised by poor quality of sleep, in patients who are aged 55 or over.”
o Use of a product outside of its TGA-approved product information is considered “off-label”
Ethical issues
Pharmacists have an ethical obligation to:
• Practise lawfully – pharmacists are required to fulfil all legal obligations for the supply of medicines. This includes following all Codes, Standards and Guidelines. If the pharmacist is not behaving legally, they are therefore not behaving ethically.
• Maintain effective control of therapeutic goods – the pharmacist has an ethical obligation to responsibly and effectively control the management and supply of medications.
• Ensure the health and wellbeing of their patients as their first priority and to prevent harm. They must at all times act in a manner which promotes and safeguards the interests and welfare of clients and the community.
o Supplying melatonin outside of its approved therapeutic indication may not be in the best interests of the patient; may cause harm to the patient if the medication is not therapeutically or clinically appropriate.
o Must ensure that the duty of care to the patient is not compromised by conflicts of interest, i.e. a temptation to provide melatonin products for financial gain without considering the risk of harm to the patient.
• Promote the safe, judicious and efficacious use of medicines – Pharmacists must exercise professional judgement to prevent the supply of unnecessary and/or excessive quantities of medicines or products, particularly those which have a potential for abuse or dependence, or to cause harm.

Part B: Legal and Ethical practice (5 minutes)
Answer guide (continued)
• Maintain the public’s trust and the profession’s reputation – If a pharmacy is careless in their approach to the safe, judicious and efficacious use of medicines, then they are not acting with professional integrity and therefore not upholding the profession’s reputation.
• Minimising risk to patients or clients is an important component of practice. The pharmacist needs to ensure that medications are supplied appropriately.
• Exercises professional autonomy to make objective and independent decisions in the best interest of the patient. The pharmacist should not be unduly influence/bullied by another health professional into doing something they disagree with.
• Exercise professional judgement in the interests of the patient and wider community – the pharmacist has an ethical obligation to responsibly and effectively participate in the overall health system and contribute to the achievement of the objectives of Australia’s National Medicines Policy.
• Work with patients or clients to provide good care, including shared decision making and promotes continuity of care for patients across health sectors and providers, through appropriate referral and appropriate sharing of information
• Provide care in a compassionate, professional, timely, and culturally safe and responsive manner in a manner that respects the dignity and autonomy of the patient
• Establish good working relationships with health professionals and others to allow consultation, communication and cooperation in order to optimise health outcomes for the patient
• Keep their knowledge and skills up to date, and to practice competently to provide safe and effective care, always aiming to provide the highest possible standards of care

What should you do?
• Explain the legal obligations to Rasheed
• Refuse supply, discuss other management options for sleep difficulties
• Appropriate referral to medical practitioner for management of sleep difficulties

Part C: Prescription problem solving and communication (20 minutes)
You have up to twenty minutes to role-play the following scenario with your tutor. The aim is to identify the prescription ‘problem’ and provide adequate counselling if required.

This prescription is presented by Kerry Simon.
Kerry has not been to your pharmacy before so there is no dispensing history on file.

Part C: Prescription problem-solving and communication (20 minutes)
Answer guide

Please review your colleague’s answers against the answer sheet, ticking off points as they are discussed. Remember also to document recommendations and any advice given (correct or incorrect). If you feel that your colleague has done harm, please document this and explain why.
At the end of the interaction you can give this sheet to your colleague to Help them with their reflections.

Ascertained from the patient that:
• The prescription is for the person who is dropping it in (Kerry)
• Kerry has been diagnosed with trigeminal neuralgia
• The carbamazepine prescription was written by the GP, and the GP has also referred the patient to a neurologist

Determined that:
• The dose of carbamazepine prescribed by the GP is high for a starting dose
• A low dose of carbamazepine that gradually increases according to symptom control and side effects is an appropriate suggestion
Contacted the GP Dr Sampson to discuss:
• Clarification of the dose for Kerry Simon
• The usual starting dose for trigeminal neuralgia is carbamazepine, 50-100 mg bd, gradually increasing the dose according to symptom control and side effects (AMH 2022)
• Confirm the doctor will write new prescription for carbamazepine that represents an appropriate dose

What regimen did the pharmacist recommend for the patient?

How do you rate the pharmacist’s communication with the prescriber?
Mark out of 5 (1 = very poor, 2 = poor, 3 = satisfactory, 4 = good, 5 = excellent)

Communicated to patient:
• The prescription has been clarified with the doctor – some of the details of the prescription have been altered, but the treatment strategy will remain the same
• Counsel the patient on the regimen recommended
• The doctor would like to see Kerry for a follow up appointment in 2 weeks if she has not seen the neurologist

Carbamazepine counselling points:
• Cautionary advisory labels 5, 9, 12†, 13, 18, 21, A, B († initiation of therapy and/or when dose is increased)

• Take tablets with or after food to prevent stomach upset
• The dose is increased slowly to minimise drowsiness until tolerance develops
• May cause drowsiness, dizziness or blurred vision when starting treatment or increasing in dose; if affected do not drive or operate machinery
• This drug may increase the effects of alcohol
• Common side effects include: headache, dry mouth, abdominal pain, nausea, vomiting, loss of appetite, diarrhoea, constipation
• If you experience a rash or skin reactions, sore throat, fever, mouth ulcers, bruising or bleeding contact your doctor immediately
• Ensure you attend regular blood tests as prescribed by the doctor
• Doctor may alter the dose in time depending upon your response to the drug, it is important that you always follow the dosing instructions carefully
• This medicine requires special handling (Label 21; Pregnancy Category D)

How do you rate the pharmacist’s communication with the patient?
Mark out of 5 (1 = very poor, 2 = poor, 3 = satisfactory, 4 = good, 5 = excellent)

Hi there,

You need to write a Pharmacy Practice Benchmarking Activity Report, by following these steps:

1- Read My Confidence scale – which was written before the test.
2- Read the test questions and answers to understand the cases (It includes 3 papers, and each paper includes 3 cases (Over-the-counter medicine (OTC) + Prescription medicines + Ethical issues).
3- Read My Performance Scale – which was written after the test.
4- Read the example file to make what you need to write very clear.
5- Start writing 2000 words Pharmacy Practice Benchmarking Activity Report, according to the following instructions:

Description
Review of performance in benchmarking assessment and plan for professional development for the internship year.

About this assessment
In the first week of this course you will undertake a mock ‘exam’ to benchmark your current level of knowledge and skills in the areas of primary healthcare, legal and ethical practice, and prescription problems.

You will also be required to provide feedback to your peers on their performance in the exam.

Through this process you will:
– Become familiar you with oral exams, emphasising that the oral exam is a good reflection of what is required of practising pharmacists.
– Practise and reflect upon the history-taking process.
– Have an opportunity to benchmark your own performance utilising feedback from experienced pharmacists and other students.
– Reflect on the oral exam process and self-assessment of your own performance to plan for ongoing professional development in the internship year

The assessment linked to this activity consists of several components all related to your critical review of performance in the benchmarking activity

Part 1: Reflections (see notes on reflection below).
Part 2: Gap Analysis.
Part 3: Plan to address gaps.

Each of the criteria are described in more detail below.

For each of the parts below, at a minimum, you need to address each part of the mock exam that you undertook
You are also encouraged to include any reflections, gaps and development opportunities that you identified from observing your colleagues undertake different parts of the exam/s.

Part 1: Reflections (approximately 750 words)
Good reflective writing includes reference to your feelings and emotions as they can indicate areas where you may need to make changes or develop better strategies.
Please answer the following questions:
1- What did I find most valuable about this activity?
2- What has been the most significant thing I learnt from this learning activity?
3- How will my behaviour, judgement or actions change tomorrow, next week or next month?

Part 2: Gap analysis (approximately 1000 words)

In this part of the assessment, you need to identify specific gaps in your knowledge and skills from each part of the learning activity, i.e.
– Part A: Primary healthcare.
– Part B: Legal and ethical practice.
– Part C: Prescription problem-solving and communication.

It is expected that you identify gaps from:
a- Your own perception of your performance in the activity and
b- Feedback from your peers, and
c- Feedback from your pharmacist tutors

Part 3 of the assessment (below) will focus on how you will address these gaps before and during your internship year.

Part 3: Plan for professional development (approximately 250 words)

In this part of the assessment, you will document what actions you will take based on what you experienced/observed/received feedback on.
You need to be specific about available sources of continuing education (CE) and comment on their relevance to your professional development.

What CE activities will Help you to bridge the gaps in your knowledge and skills?

Language
Because you are writing about your own experiences and thoughts you need to write in the first person (“I”), and you will find that you need to move between the past tense (to describe an event that took place), the present tense (your current learning), and the future tense (development plans for the future based on your reflections).

Word count
Minimum 2000 words (no maximum word count) These are included in the word count:
– Headings
– Direct quotes (you will gain more marks by writing using your own words than using lots of direct quotes)
– Summary/Executive Summary (if you chose to include one)
– In-text references

These are excluded:
– Title page
– Table of contents
– Bibliography (reference list)
– Footnotes
– Diagram headings and captions
– Text within diagrams

References
Because this is a reflective piece of work the requirement for references is minimal. However, in the gap analysis section (Part 2) you will need to refer to benchmark references to add the required depth to your work. These include:
a- Answer sheets provided on the day – how did your performance compare with the guidance given on the answer sheets?
b- Therapeutics – was there anything you missed, or got wrong (e.g. AMH, eTGs, approved Product Information, Rutter & Newby, etc.)
c- Legal and Ethical Practice – did my intended course of action match the requirements of the profession?
– Pharmaceutical Society of Australia. Professional Practice Standards. Version5, 2017.
– Pharmacy Board of Australia Codes and Guidelines (e.g. Code of Conduct, Continuing Professional Development, Dispensing of Medicines, and Practice-specific issues)
– SHPA Code of Ethics (2016)
– Pharmaceutical Society of Australia. Code of Ethics. 2017.)

Information, data, visual representations, graphics, etc. that are not of your own creation needs to be referenced/acknowledged. (for academic integrity purposed but also to add credibility to your work).

Please use the Harvard style of referencing in-text citations (refer to the section on ‘Harvard Rules’ and ‘Harvard Guide’ here www.unisa.edu.au/referencing).

Assessment | Portfolio Activity 3 Guide
Pharmacy Practice
Page 1
This is a written piece associated with the Pharmacy Practice
Benchmarking Activity on Friday of Week 1 of the course
Description
Review of performance in benchmarking assessment and plan for professional
development for internship year
About this assessment
In the first week of this course you will undertake a mock ‘exam’ to benchmark your current
level of knowledge and skills in the areas of primary healthcare, legal and ethical practice,
and prescription problems.
You will also be required to provide feedback to your peers on their performance in the
exam.
Through this process you will:
• become familiar you with oral exams, emphasising that the oral exam is a good reflection
of what is required of practising pharmacists
• practise and reflect upon the history-taking process
• have an opportunity to benchmark your own performance utilising feedback from
experienced pharmacists and other students
• reflect on the oral exam process and self-assessment of your own performance to plan
for ongoing professional development in the internship year
The assessment linked to this activity consists of several components all related
to your critical review of performance in the benchmarking activity
Part 1: Reflections (see notes on reflection below)
Part 2: Gap Analysis
Part 3: Plan to address gaps
Each of the criteria are described in more detail below.
Assessment | Portfolio Activity 3 Guide
Pharmacy Practice
Assessment | Portfolio Activity 3 Guide
Pharmacy Practice
Page 2
For each of the parts below, at a minimum, you need to address
each part of the mock exam that you undertook
You are also encouraged to include any reflections, gaps and development
opportunities that you identified from observing your colleagues undertake
different parts of the exam/s
Part 1: Reflections (approximately 750 words)
Good reflective writing includes reference to your feelings and emotions as they can indicate
areas where you may need to make changes or develop better strategies.
Please answer the following questions:
1. What did I find most valuable about this activity?
2. What has been the most significant thing I learnt from this learning activity?
3. How will my behaviour, judgement or actions change tomorrow, next week or next
month?
Part 2: Gap analysis (approximately 1000 words)
In this part of the assessment you need to identify specific gaps in your knowledge and skills
from each part of the learning activity, i.e.
• Part A: Primary healthcare
• Part B: Legal and ethical practice
• Part C: Prescription problem solving and
communication
It is expected that you identify gaps from:
a) Your own perception of your performance in the
activity, and
b) Feedback from your peers, and
c) Feedback from your pharmacist tutors
Part 3 of the assessment (below) will focus on how you will address these gaps before and
during your internship year.
Part 3: Plan for professional development (approximately 250 words)
In this part of the assessment you will document what actions you will take based on what you
experienced/observed/received feedback on.
You need to be specific about available sources of continuing education (CE) and comment
on their relevance to your professional development.
What CE activities will Help you to bridge the gaps in your knowledge and
skills?
Page 3
Assessment | Portfolio Activity 3 Guide
Pharmacy Practice
Language
Because you are writing about your own experiences and thoughts you need to write in the
first person (“I”), and you will find that you need to move between the past tense (to describe
an event that took place), the present tense (your current learning), and the future tense
(development plans for the future based on your reflections).
Word count
Minimum 2000 words (no maximum word count)
These are included in the word count:
• Headings
• Direct quotes (you will gain more
marks by writing using your own words
than using lots of direct quotes)
• Summary/Executive Summary (if you
chose to include one)
• In-text references
These are excluded:
• Title page
• Table of contents
• Bibliography (reference list)
• Footnotes
• Diagram headings and captions
• Text within diagrams
References
Because this is a reflective piece of work the requirement for references is minimal. However,
in the gap analysis section (Part 2) you will need to refer to benchmark references to add the
required depth to your work. These include:
• Answer sheets provided on the day – how did your performance compare with the
guidance given on the answer sheets?
• Therapeutics – was there anything you missed, or got wrong (e.g. AMH, eTGs,
approved Product Information, Rutter & Newby, etc.)
• Legal and Ethical Practice – did my intended course of action match the requirements
of the profession?
o Pharmaceutical Society of Australia. Professional Practice Standards. Version
5, 2017.
o Pharmacy Board of Australia Codes and Guidelines (e.g. Code of Conduct,
Continuing Professional Development, Dispensing of Medicines, and Practice specific issues)
o SHPA Code of Ethics (2016)
o Pharmaceutical Society of Australia. Code of Ethics. 2017.)
Information, data, visual representations, graphics, etc. that are not of your own creation needs
to be referenced/acknowledged. (for academic integrity purposed but also to add credibility to
your work).
Please use the Harvard style of referencing in-text citations (refer to section on ‘Harvard Rules’
and ‘Harvard Guide’ here www.unisa.edu.au/referencing)

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