Part 1

Question 1

What does part 1 consist of?

Answer 1

Consist of a two-part ethical/legal scenario requiring a persusasive argment response

> Part 1A: case related to advanced services, harm minimisation or mental health

> Part 1B: case related to immunisation (including myths and realities, and the implementation of immunisation service)

What legal issues and ethical dilemmas can you identify from this scenario?

What actions would you take to address the current situation. Provide a persuasive argument to support intended actions.

Question 2

Code of Ethics: PSA

A) What is care principle 1

B) What is care principle 2

C) What is care principle 3

Answer 2

A)

A pharmacist makes the health and wellbeing of the patient their first priority

B)

A pharmacist promotes patient-centred care

C)

A pharmacist exercises professional judgement in the interests of the patient and the wider community

Question 3

Code of Ethics: PSA

A) What is integrity principle 1

B) What is intergrity principle 2

Answer 3

A)

A pharmacist acts with honesty and integrity to maintain public trust and confidence in the profession.

B)

A pharmacist only practises under conditions which uphold the professional independence, judgement and integrity of themselves and others.

Question 4

Code of Ethics: PSA

A) What is competency principle 1

B) What is competency principle 2

Answer 4

A)

A pharmacist demonstrates a commitment to the continual development of self and the profession to enhance pharmacy practice

B)

A pharmacist works collaboratively with others to deliver patient-centred care and optimise health outcomes.

Question 5

What is the privacy act 1988

Answer 5

The Privacy Act 1988 (Privacy Act) provides protection to individuals against the mishandling of personal information and applies to organisations which include individuals, partnerships, corporations and unincorporated associations

Question 6

What does confidentiality consist of?

Answer 6

Information obtained by pharmacists should only be shared with healthcare professionals involved with patient’s care

• Access to written and electronic records e.g. medication history
• Discussions about patients
• Discussions with patients

Privacy Act: regulates how personal information is handled

Question 7

What additional training to do for confidentiality and privacy that a pharmacist should do?

Answer 7

Additional training: Record Keeping and Awareness and Accountable and Ethical Decision-making

Question 8

For ethics, what is autonomy?

Answer 8

• Free will: ability of patients to make their own decisions and pursue their own actions in line with their ability to be open to reason and consider the consequences
• Contributes to the other 3 principles
• In reality, our rights and abilities to decide are impacted by the law and circumstances

Question 9

For ethics, what is beneficence?

Answer 9

Obligation to help patients

Question 10

For ethics, what is non-maleficence?

Answer 10

• Do not harm
• Ensuring that potential benefits outweight potential risks

Question 11

For ethics, what is justice (dsitrbutive justice)?

Answer 11

• People in similar situiations should be treated equally
• Fairness and freedom from discrimination
• Often relates to access to healh care

Question 12

What is supplying the wrong medicine a breach of?

> criminal law

Answer 12

A breach of the Medicines and Poisons Act and a criminal offence

> If errors resulted from reckless/irreponsible behaviour (rather than human error) –> prosecution may be more likely and if the error resulted in patient death, the pharmacist could be charged with manslaughter

Question 13

What health service laws apply or protocols apply?

Answer 13

Terms of service of the pharmacy

Employment law provides power to enforce service provisions; employees can be performance managed and disciplinary action taken

Question 14

What common laws apply?

Answer 14

You have a duty of care to your patients / customers: any dereliction of that duty that results in harm to patients will make a pharmacist liable for damages/compensation

Question 15

Guidance from Code of Ethics (PBA)? What are some points?

Answer 15

• Responsibility to avoid any activity that would impair confidence in the profession or bring it into disrepute
• Obligation to help a colleague to cope with a possible serious problem

Question 16

What must be the first concern to pharmacists?

Answer 16

Protecting the public

Question 17

Who to report to if someone not adhering to being a good pharmacist?

Answer 17

PBA

> other options is the pharmacists’ support service

Question 18

When is exemption to privacy act allowable?

Answer 18

Exemptions to the Act apply where disclosure is needed for clinical management purposes and is to a healthcare professional directly involved with her care, and is bound by a duty of confidentiality

> exemption does not apply to relatives or friends

Question 19

What health service laws or protocols apply in a hospital?

Answer 19

Hospitals and contractors providing health services are expected to maintain confidentiality.

Question 20

What could non-consesnual desire result in?

Answer 20

Anxiety or distress caused by careless disclosure of patients’ details could be deemed negligent

The non-consensual disclosure could jeopardise a patient’s progress or treatment and could result in a measureable injury

Damage could include financial loss

Question 21

Code of ethics regarding confidentiality?

Answer 21

Your responsibilities as a pharmacist include respecting patient’s confidentiality and patients decisions to participate in decisions about their care

Question 22

What does breach of confidentiality result in?

Answer 22

Loss of trust, emotional upset, damage to reputation, increased scruitny into professional and business conduct, loss of earnings/business loss

Question 23

For confidentiality and common law:

A) What is obligation maintained through?

B) What are exceptions?

Answer 23

A)

• Negligence: part of duty or care
• Contract: provider receives a fee
• Defamation: lowers reputation of patient

B)

• Express consent –> implied consent when under care of range of health professionals
• Legal duty of disclosure
• Public interest of dislosure

Question 24

Give examples where exceptions of legal duty of disclosure happens

Answer 24

• nominated health professionals to report child abuse –> different legislation in various jurisdictions
• communicable diseases
• as part of court process
• unlawful activity

Question 25

Why is privacy important?

Answer 25

Patients only likely to disclose information if understood it will be kept private and confidential and used for relevant purposes

Question 26

What is the national imunisation strategy 2019-2024? What are some objectives?

Answer 26

Key objective to increase vaccination storage

Question 27

‘Vaccines are unsafe’

Answer 27

Vaccines may produce some undesirable side effects, such as pain and redness at the injection site or fever, but most reactions are mild and resolve quickly. It is usually not possible to predict who may have a mild reaction and who may have a rarer, serious reaction to a vaccine. However, the risk of adverse effects can be minimised by following guidelines regarding when vaccines should and shouldn’t be used

Question 28

‘Vaccines contain foreign proteins’. In relation to influenza, what does this mean?

Answer 28

The majority of influenza vaccines in use in Australia have only trace amounts of ovalbumin (less than 1 microgram) per dose and can be safely given to most people with an egg allergy

Question 29

Specific immunity is not important for protection from disease

Answer 29

Importantly, for certain diseases, such as influenza, vaccination of a woman during her pregnancy protects her against this disease, as well as protecting her baby in the baby’s first few months of life (due to the passage of high levels of maternal antibodies across the placenta prior to birth).

Question 30

‘Vaccines cause or worsen asthma and allergies’

Answer 30

Iinfluenza can worsen asthma. In Australia, influenza vaccination is particularly recommended for children with asthma because of this risk.

Question 31

Influenza is sometimes dismissed as not being a serious illness

Answer 31

Many people will refer to the common cold as ‘the flu’. However, influenza is not the same as the common cold and is a serious infection, particularly in the elderly. In Australia, there are dozens of deaths every year where influenza is officially reported as the cause of death

Question 32

‘Vaccines can cause diabetes’

Answer 32

The influenza vaccine is currently recommended annually for people with diabetes.

Question 33

‘Flu vaccines cause the flu’

key one

Answer 33

• It is impossible for the influenza vaccine to cause ‘the flu’ (influenza disease). The vaccines registered for use in Australia are all inactivated, which means they do not contain live virus. The vaccines used are either ‘split-virion’ or ‘sub-unit’ vaccines which only contain the surface structures of the virus, not infectious particles.
• The belief that the vaccine causes the flu could result from misinterpretation of either mild vaccine side effects or coincidental infection from other respiratory viruses, both of which can cause ‘flu-like’ symptoms. The incubation period for influenza is between 24 and 72 hours, and the vaccine takes 7 to 14 days to produce protection, so occasionally a vaccinated person may contract the influenza virus during this period.
• All vaccines elicit an immune response. Some of these responses can include a mild fever and headache, amounting to flu-like symptoms. This could result in the mistaken belief that the vaccine has given someone the flu. These side effects may occur with many different types of vaccines.

Question 34

Vaccination of young children can cause seizures

Answer 34

it is not unexpected that febrile convulsions may occur following vaccination, although it is still very rare. The risk is higher following administration of certain vaccines, such as influenza, MMR and MMRV vaccines.

Question 35

‘The flu vaccine causes febrile convulsions in young children’

Answer 35

Overall, seasonal influenza (flu) vaccines are generally safe in children from six months of age and febrile convulsions following vaccination are rare.

Question 36

Symptoms of influenza?

Answer 36

Influenza (‘the flu’) is an infectious disease caused by the influenza virus. The symptoms of influenza include sudden fever, headache, muscle aches and pains, fatigue, cough, sore throat, and stuffy or runny nose. The virus can cause a mild or severe illness depending on the type of influenza virus and general health of the affected person.

• The greatest number of hospitalisations due to influenza occurs in children younger than four years of age
• People of all ages can become severely ill with influenza and complications following influenza can be fatal, particularly in the elderly and people with an underlying medical condition.

Question 37

Privacy act may be breached if patient safety is at risk so up to pharmacist discretion.

True or False

Answer 37

True

> Pharmacists need to use their professional judgement and be able to justify their concerns