Home' Australian Pharmacist : Australian Pharmacist August 2012 Contents 644 Australian Pharmacist August 2012 I ©Pharmaceutical Society of Australia Ltd.
Continuing Professional Development
The articles in this series are independently researched and compiled by PSA commissioned authors and peer reviewed.
SUPPORTING PHARMACY PRACTICE
what the pharmacist has said can
help to ensure the correct message
has been received. Pharmacists may
prompt using the starting phase:
'From what I have just said; what is your
understanding?'8--12 Finally it is important
to record and document a patient's
consent where applicable, obtain written
consent if required, and document any
Bridget and Georgia -- A better
way of doing things
Revisiting Bridget and Georgia;
how could this situation have been
handled di erently? Whilst Bridget's
communication was empathetic and
supportive and she ascertained the
appropriateness for treatment, she failed
to give Georgia su cient information
required to make an informed decision.
Let's revisit the scenario. This time
after deciding Postinor is appropriate,
the conversation they have is as follows:
Bridget: 'Now Georgia, one of your
options to prevent pregnancy from this
single event of unprotected intercourse
is to take an emergency contraceptive
pill called Postinor which contains
levonorgestrel. It is not 100% e ective
and some women may become pregnant
even after taking the emergency
contraceptive. However, given you had
intercourse less than 24 hours ago it will
be 95% e ective. So the chances of it not
working are slim.13,14
'If you decide to take this medicine you
need to take a single dose straight away
and it works in one of two ways. If you
haven't yet ovulated (that's when you
release an egg from your ovary) it may
delay ovulation. If you take it after you
ovulate it can interfere with the transport
of eggs and sperm in your body.14
'I do need to let you know there are some
side e ects. You may feel nauseous or
have an upset stomach, however this
isn't common and if you are a ected it
doesn't usually last longer than 12 hours.
If, however, you do vomit, for whatever
reason, its important you come back to
see me or other another pharmacist or
your doctor.14 You may experience breast
tenderness and headaches in the next
48 hours and a little bit of light bleeding
over the next few days. Just note though
that this won't be a normal period, it is
simply a side e ect of the medication.
'Now I don't want to scare you but I do
need to warn you that a rare complication
of using emergency contraception is
ectopic pregnancy. I don't need to go
into detail, unless of course you would
like to know more, as it is rare. However
all you do need to know is that if you get
any unusual pain in the low abdomen in
the next month you need to be examined
straight away by your doctor or someone
at the family planning clinic.
'Finally, your next period could be early,
late or on time, however; if you haven't
got it in three weeks' time you will need to
do a pregnancy test.14
'Georgia, I know there is a lot of
information to take in there, so do you
want me to repeat anything or expand on
Georgia summarises what she
understands and it is clear she is correctly
and comprehensively informed in order
to make a decision.
Bridget: 'So Georgia, what do you think
you might like to do?'
Georgia: 'Well although there are some
risks, I think the bene ts de nitely
outweigh the risks. Harry and I are
de nitely not ready to start a family
despite the fact we have been together
for four years. I would like to take the
Postinor please and I will keep you posted
if I have any further questions.'
Bridget: 'Ok, and I'm going to record
our conversation in your le if we need
to refer back to it, however know that
everything we have discussed today
stays between us. By the way, drop
in tomorrow when you are not so full
of information and we can talk about
In this version of the case it is clear that
after deciding Postinor is appropriate,
Bridget comprehensively informs Georgia
and supports autonomous decision making.
Georgia's consent is backed by knowledge,
optimal treatment plans are created and
Bridget has acted professionally and
ethically and protected herself from any
potential legal action involving negligence
and/or duty of care.
A nal message
Pharmacists play a major role in assisting
patients to make informed decisions
about services taken up, their treatment
and other health activities, and about
how their medical information is used.1
Central to good decision making is the
exchange of information and a supportive
environment.1 To provide informed
consent a patient needs to know:
• what options are available
• what the expected outcomes are for
each option, and
• what the pros and cons are for
In providing such information,
pharmacists must consider a patient's
needs, wishes, priorities and other
personal attributes.1,2 Further to providing
patients with required information,
pharmacists should participate in shared
Pharmacists play an important role in
informed patient consent.2 Providing
information, encouraging autonomy,
respecting rights and participating in
decision making facilitates best practice
as health professionals and optimal
health outcomes for patients.
1. McILwain JC. Consent: Practical principles for clinicians. UK:
Bentham Books; 2011.
2. Pharmaceutical Society of Australia. Code of Ethics for
pharmacists. Canberra: PSA; 2011.
3. Health Department of Western Australia. Office of Safety and
Quality in Healthcare -- Informed consent. Perth; 2012. At:
4. Low J, Hattingh L, Forrester K. Australian pharmacy law and
5. Gettman DA. Pharmacoethics -- a problem based approach.
New York: CRC Press; 2003.
6. Freegard H. Ethical practice for health professionals. 1st ed.
Melbourne: Cengage Learning Australia; 2006.
7. Pharmacy Board of Australia. Code of conduct for registered
health practitioners. Pharmacy Board of Australia; 2012.
8. Robbins S, Millett B, Cacioppe RT. Organisational behaviour. 3rd
ed. Sydney: Prentice Hall; 2001.
9. Williams D. Communication skills in practice: A practical guide
for health professionals. Bristol: Jessica Kingsley; 1997.
10. Quinn R. Becoming a master manager. 3rd ed. New York: Wiley
& Sons; 2003.
11. Davis M, Paleg K, Fanning P. The messages workbook. Oakland,
CA: New Harbinger Publications; 2004.
12. Flanagan N, Finger J. The management bible. Toowong QLD:
Plum Press; 2003.
13. Pharmaceutical Society of Australia. Guidance for provision
of a Pharmacist Only medicine: Levonorgestrel. Canberra:
14. Pharmaceutical Society of Australia. Emergency Contraception.
Canberra: . PSA; 2010.
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