KARALYN
HUXHAGEN
PSA
Councilor Perspective
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Paracetamol
and Supermarkets
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The
recent case of a teenage boy dying from complications of acute
paracetamol toxicity has brought questions from the coroner on
how easy it is to die from a simple pain relieving medication
"A coroner is expected to recommend that paracetamol be removed
from supermarket shelves and sold only in pharmacies, after a
teenage boy died from an overdose of the drug.
Wade Dunn, 13, was administered 31 grams of paracetamol over 14
days in two NSW hospitals while convalescing from a routine procedure.
Draft recommendations circulated by the coroner Jan Stevenson
to lawyers involved in Wade's inquest ask the NSW Department of
Health to consider restricting the availability of paracetamol
products to pharmacies.
The recommendations, referred to in written submissions made to
Orange Local Court yesterday, also call for a committee of experts
to review the current "use and abuse of paracetamol, to establish
realistic guidelines in order to prevent the potential for liver
failure in children".
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Don
Robertson, president of the paediatrics and child health division
of the Royal Australasian College of Physicians, said that rather
than restricting the drug's sale, he would support more safety information
to be made available where it was sold.
"Under almost all circumstances [paracetamol] is helpful and
safe," Dr Robertson said. "But we do need to recognise
that when it is taken in high doses it can have adverse effects."
In earlier evidence, a gastroenterologist, Dr Edward O'Loughlin,
called for stronger warnings on packets of the drug, recommending
patients were reviewed after 48 hours' treatment."
Even though this case looks like a hospital based drug misadventure,
the coroner has made several recommendations including restricting
the sale of Paracetamol products to Pharmacies.
This then begs the question- is Pharmacy any better situated in
offering advice and counselling with the sale of Paracetamol products
than the 'checkout' chick at Coles?
How many OTC sales of Paracetamol 24 tablets does the Pharmacist
personally supervise?
How many times does the Pharmacist/ senior pharmacy assistant counsel
the patient on the potential for additive effects if this product
is taken with several of the cough and cold or headache medications?
In some States, the consumers can access the Paracetamol easily
and there is no staff intervention-where is the point of difference
occurring that would make it better for these products to be sold
only in Pharmacies?
I do not think restricting the sale only to Pharmacies is the complete
answer.
There also needs to be a major consumer awareness campaign on the
dangers of long term and large dose usage of Paracetamol as well
as a campaign on the dangers of mixing medications.
This may be an area that organizations such as NPS can play a part
when developing their 'key message' strategies for public health
campaigns such as the Cough and Cold campaign.
With many proprietary cough and cold medications already containing
paracetamol there is potential for toxic doses to be ingested.
Cough and cold season is when this is more likely to occur and maybe
this needs to be a key message when training our Pharmacy staff
on professional counselling in S2/S3 sales. Manufacturers need to
place warnings on the boxes about the recommended daily dosing of
ALL paracetamol and the warning should extend to how long to use
the product before seeking medical advice.
Pharmacy is an excellent source of health information and we are
able to retain our customers by delivering good service backed by
good evidence based information.
It is vital that we do not lose sight of the fact that some of the
more common and older medications we sell can cause harm.
When developing your protocols for your staff on the counselling
and sales for products in the S2/S3 section, it is prudent to remind
them it is not only the large pack size users who are at risk consumers.
All consumers have the potential to 'mix' products and to take three
tablets four times a day as a 'little bit more' is always better.
The point of difference between Pharmacy and the supermarket is
the specialised training of the pharmacy staff and the time taken
to deliver the important messages to the consumer.
Pharmacy staff should also be aware that consumers rarely read all
of the messages printed on a product box or in the leaflet so it
is vital to reiterate the important messages at the point of sale.
The PSA document'Standards for the Provision of Pharmacist Only
and Pharmacy Medicines in Community Pharmacy' (see www.psa.org.au)
was developed in response to the emerging awareness of the need
for community Pharmacy to protect their unique position as being
the major provider of these products. Community Pharmacies employ
professional Pharmacists supported by well trained assistants and
they operate in an environment that is conducive to providing accurate
information to the consumers.
It is absolutely important that all Pharmacists read this document
and implement its guidelines if we are going to provide the point
of difference to the consumers.
This document is a vital part of the QCPP process and adherence
to the standards of the Quality Care Pharmacy Program is one sure
way that Pharmacy can show that it is a certainly a better place
to sell Paracetamol products than supermarkets will ever be.
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