bluuebunny/crossref_metadata_2025 huggingface dataset:
Lipophilicity of Beta‐Adrenocepter Antagonists: A New Classification Scheme for Clinical Use
Authors: Northfield Susan E , Manallack David T
Published: April 2015

Background

The lipophilic nature of beta‐adrenoceptor antagonists (beta‐blockers) has clinical importance as it influences pharmacokinetics, pharmacodynamics, cardioprotective actions, and adverse effects.

Aim

To explore the lipophilicity of a series of beta‐blockers at physiological pH (logD7.4) and to compare their characteristics.

Method

The lipophilicity of each compound at physiological pH (logD7.4) was predicted and compared to available experimental data.

Results

An initial comparison undertaken of logP values for 30 selected beta‐blockers against calculated logD7.4 estimates gave a good correlation (r2 = 0.92; s = 0.37) indicating that the rank order of lipophilicities differs little between the neutral species and appropriate charge state at pH 7.4. Similarly, for a set of 21 beta‐blockers with measured logD7.4 values, a good correlation was observed against calculated logD7.4 estimates (r2 = 0.95; s = 0.25). Of interest was a subset of ten beta‐blockers in clinical use which have an associated lipophilicity classification listed in the Therapeutic Guidelines: Cardiovascular. Amendments may be required to this three‐class scheme in the light of the present results.

Conclusion

A new classification scheme is proposed comprising four lipophilic beta‐blocker classes. This new proposal could be applied clinically to make appropriate choices for patients with regard to cardioprotective effects and reducing adverse effects.
New South Wales Private Hospitals and Their Pharmacy Services
Authors: Moles Rebekah J , Brien Jo‐anne E , Benrimoj Shalom I
Published: April 2015

Aim

To explore the relationship pharmacy has with private hospitals and identify areas that can be targeted for improvement.

Method

Information about each hospital's characteristics, e.g. bed size, location, specialty services, were gathered and semi‐structured, in‐depth interviews were conducted with pharmacists servicing private hospitals. Information was gathered about the types of pharmaceutical services provided to the hospitals and the models of service provision. 82 private hospitals were identified in NSW during the study period. Data for 72 (88%) hospitals were gathered. 51 pharmacies were involved, demonstrating that some pharmacies serviced more than one hospital. 53 interviews were conducted, involving these 51 pharmacies across the state.

Results

The majority of pharmacies were off‐site community pharmacies (80%). 10 hospitals (14%) had an on‐site pharmacy and 6% of hospitals had a mixed pharmacy model. The range of pharmacy services provided to each hospital varied greatly. Overall, clinical services appeared to be underdeveloped with only a third of hospitals having pharmacists review drug charts or provide patient counselling; however, some pharmacists appeared to provide a comprehensive service.

Conclusion

This study provided insight into the relationships private hospitals have with pharmacy. It also identified areas within the private hospital sector that may need improvement with respect to pharmacy services. It provided background to research on the development, implementation and evaluation of professional pharmacy services for private hospital patients.
Drug Use Evaluation of Ondansetron in Postoperative Nausea and Vomiting
Authors: Zolezzi Monica , Forbes Alison , Bradshaw‐Leung Hilary , Aprea Sara , Barnes Monique , Clunie Laura , Fusha Bekim , Tawadrous John
Published: April 2015

Background

Postoperative nausea and vomiting (PONV) may prolong patient recovery time and increase the cost of their care. Ondansetron is an effective treatment for PONV, but is more expensive than other antiemetics. The Auckland District Health Board (ADHB) PONV guidelines are a stepwise approach to anti‐emetic prescribing in which ondansetron is the last choice.

Aim

To investigate the patterns of ondansetron prescribing in the management of PONV at Auckland City Hospital and whether its use was in accordance with the ADHB PONV guidelines.

Method

A retrospective drug use evaluation of patients for whom ondansetron was prescribed, and who were admitted postoperatively to 20 adult medical and surgical wards.

Results

303 patients were recruited over a 4‐week period, of whom 256 surgical patients were considered. Adherence with the ADHB PONV guidelines was higher when a reminder (an antiemetic sticker) was used than when it was not used (84% vs 76%). Use of the sticker increased the proportion of patients for whom other anti‐emetics were prescribed. There was poor identification of patients at risk of PONV and consequently limited use of prophylactic antiemetics in this group.

Conclusion

Although the use of antiemetic stickers was low, overall adherence to the ADHB PONV guidelines was encouraging. A number of steps were often omitted when an antiemetic sticker was not used and a significant proportion of patients received ondansetron first‐line.
Identification of Potential and Actual Breaches in the Cold‐Chain within a Tertiary Hospital
Authors: Dubrava Suzanne , Tait Paul A , Humphris Mary‐Ann
Published: April 2015

Background

Vaccines are biologicals that need a strict storage environment from the time of manufacture to ensure that they are potent at the time of administration. The National Vaccine Storage Guidelines (NVSG) provide clear directives for appropriate vaccine storage within healthcare institutions.

Aim

To compare current hospital vaccine storage and transport practices to NVSG.

Method

Areas within the hospital where vaccines were stored were identified. A senior staff member from each area was asked a series of questions about their cold‐chain management. A temperature logging device recorded the temperature for 24 hours on different shelves within each refrigerator and a visual inspection was made of each refrigerator and its environs. The temperature of vaccines transported from pharmacy stores to a ward was also monitored.

Results

4 of the 12 refrigerators examined failed to meet the temperature requirements and only 1 refrigerator fully met the NVSG criteria. Temperatures recorded in purpose‐built vaccine refrigerators were outside the required range for 4.5% of the period monitored and domestic refrigerators were outside the range for 34% of the period. Temperatures varied more between shelves in domestic refrigerators than in purpose‐built refrigerators.

Conclusion

Potential breaks in the cold‐chain were identified. The issues were addressed through the promotion of the NVSG throughout the hospital and the introduction of purpose‐built refrigerators in areas with a high level of vaccine use.
Developing Clinical Practice Guidelines for the Medication Management of Acute Behavioural Disturbance
Authors: Wheeler Amanda J , Sheridan Janie , Robinson Gail , Branford David , Holmes Nicola J
Published: April 2015

This paper describes the development process of a concise, portable clinical practice guideline for the medication management of acute behavioural disturbance in adult psychiatric inpatients in Auckland, New Zealand. It was developed to aid psychiatry registrars and is a decision aid only. A literature search identified evidence‐based reviews and guidelines implemented elsewhere. This formed the basis for development of a locally relevant tool, finalised for implementation by a process of consensus agreement. This clinical practice guideline was developed collaboratively over 2 years in response to local need. Development was requested by junior medical staff and actively supported by clinical leaders. The guideline resulted from a review of the evidence for medication management of acute behavioural disturbance and adaptation of the UK National Institute for Clinical Excellence guidance in combination with local consensus agreement.
Regulation of the Pharmacy Profession throughout Australia
Authors: Hattingh H Laetitia , Smith Nerida A , Searle Judith , King Michelle A , Forrester Kim
Published: April 2015

Background

Pharmacy state and territory legislation provides for the regulation of the profession throughout Australia by the pharmacy registering authorities. The Council of Pharmacy Registering Authorities (COPRA) was formed to harmonise these regulatory requirements and facilitate communication among pharmacy registering authorities. COPRA was recently renamed the Australian Pharmacy Council. The Council of Australian Governments (COAG) has made recommendations that will impact on the regulation of all health professionals in Australia.

Aim

To compare the regulatory requirements and identify regulatory consistencies and differences between jurisdictions.

Method

A qualitative approach encompassing a survey and interview was used. All 8 pharmacy registering authorities were approached to participate via an invitation through the Australian Pharmacy Council in September 2006.

Results

Pharmacy registering authorities operate under diverse legislative frameworks and requirements. There are different definitions for disciplinary processes and the extent to which the registering authorities are able to sanction practitioners. The jurisdictions have different requirements for pharmacy premises registration, the inspection of premises and the required equipment and resources to practise. Differences in pre‐registration programs, the assessment of pre‐registration pharmacists and initial and ongoing registration specifications were also identified.

Conclusion

The Australian Pharmacy Council and the pharmacy registering authorities have made significant progress towards the harmonisation of pharmacy regulation. However, the regulation of the profession throughout Australia remains varied. COAG needs to focus on early reforms such as a national pharmacy register before addressing the complex issues of consistency in disciplinary outcomes, pre‐registration programs and annual pharmacist registration requirements.
Burnout among Australian Hospital Pharmacists
Authors: Muir Paul R , Bortoletto Diana A
Published: April 2015

Aim

To assess the level of burnout among Australian hospital pharmacists.

Method

In May 2005 questionnaires were mailed to a sample of 528 Australian hospital pharmacists. The questionnaire gathered demographic data, and used the validated Maslach Burnout Inventory (3 subscales: emotional exhaustion, depersonalisation, personal accomplishment) to assess burnout.

Results

266 hospital pharmacists responded to the survey. There were high levels of burnout based on emotional exhaustion (39%) and personal accomplishment (49%), while the majority of pharmacists felt low levels of burnout based on depersonalisation (60%). There were no significant associations between burnout and demographic data (e.g. age, sex, practice type). Recent graduates demonstrated a low level of personal accomplishment (p = 0.011), indicating greater burnout within this subscale. Pharmacists involved with the introduction of the Pharmaceutical Benefits Scheme to hospitals had a significantly high level of personal accomplishment (p = 0.011) indicating a low level of burnout within this subscale. Around 1 in 20 pharmacists displayed a high level of burnout in all 3 subscales of the Maslach Burnout Inventory.

Conclusion

Severe burnout in hospital pharmacists was evident in this study. Young hospital pharmacists appear to be vulnerable to burnout. Strategies that decrease burnout must be instituted and there should be specific consideration to support young pharmacists within the workforce.
Vitamin D Deficiency in Aged‐Care Facilities: Prescribing Support through Residential Medication Management Reviews
Authors: Gebauer Markus
Published: April 2015

Background

Vitamin D deficiency is common in residents in aged‐care facilities, contributing to muscle and bone weakness, falls and fractures. Although supplementation is recommended by guidelines for the treatment and prevention of vitamin D deficiency, implementation remains a challenge.

Aim

To improve vitamin D supplementation in an aged‐care facility in a rural Australian town.

Method

An audit of vitamin D supplementation and serum 25‐hydroxyvitamin D (25‐OHD) levels was conducted by the pharmacist providing residential medication management review services and the results were reported to attending general practitioners (GPs).

Results

21% of residents were prescribed vitamin D. Serum 25‐OHD levels were available for 8 residents and indicated deficiency/insufficiency for 7. This information was reported to attending GPs with an offer to identify other residents who would benefit from vitamin D supplementation. 41 residents were identified solely on clinical criteria such as falls risk, malabsorption, malnutrition, osteoporosis and fracture risk, inadequate exposure to sunlight and medication use. These residents were referred to the GPs for assessment without an expressed recommendation to measure 25‐OHD levels. Within 40 days of the dissemination of the audit results, 33 residents were started on vitamin D supplements, increasing the level of supplementation at the facility from 21% to 65%. This level of supplementation was maintained without further pharmacist intervention for 9 months.

Conclusion

An audit of vitamin D prescribing and subsequent GP‐pharmacist collaboration is an effective way of increasing vitamin D supplementation in aged‐care facilities.
Using the Medical Emergency Team to Supplement an Existing Adverse Drug Event Reporting Framework
Authors: Van De Vreede Melita , Leong Tim
Published: April 2015

Background

The medical emergency team (MET) provides early intervention when a patient deteriorates. The cause of the deterioration is subsequently documented. There is no specific documentation if the cause is related to a medication error.

Aim

To introduce a process to ensure medication errors identified via MET calls are notified to the quality use of medicines (QUM) manager so they can be included in the continuous quality improvement program.

Method

A retrospective medical record review of MET calls over one month was undertaken to detect calls related to medication errors. The MET data management process was then modified to include medication as a contributing factor for reporting such events. Reports of MET calls due to medication errors were sent monthly to the QUM manager and these patients' medical records were reviewed to confirm if a medication error occurred. If so, the details of this error and whether it has been reported on the hospital reporting system were determined.

Results

The baseline review in July 2005 identified 108 confirmed MET calls, 4 of which were definitely and 5 possibly related to medication errors. 2 of the confirmed medication errors were precipitated by omitted doses. In March 2006, the improved system started and in the first 4 months, review of the 12 calls notified by the MET identified that 4 were due to medication errors. 2 of these had not been reported on Riskman. The medical record review also identified one adverse drug reaction which had not been reported and a near‐miss involving IV potassium chloride that would otherwise not have been detected.

Conclusion

The introduced process identified MET calls due to medication errors that would otherwise have been missed.
Continuity of Medication Supply and Provision of Patient Information on Discharge: Development of a Survey Tool
Authors: Couch Gabrielle , Quah Sean Minn , Ng Yee Ching , McKellar Alice
Published: April 2015

Background

As described in the national guidelines to achieve continuum of quality use of medicines between hospital and community, hospitals must ensure that continuity of care is not interrupted by the inability of patients to obtain medication on discharge.

Aims

To develop a survey tool to assess continuity of medication supply and provision of medicines information on discharge. To evaluate these parameters in patients discharged with either discharge medication or prescriptions for dispensing by a community pharmacy.

Method

Non‐surgical patients aged over 65 years or their carers from one metropolitan teaching hospital and 2 rural hospitals were interviewed by phone 5 to 7 days post‐discharge. 2 interview phases (n = 229) using different interviewers and the same survey tool were conducted in 2005 and 2006.

Results

8/227 patients (3%) ran out and missed doses of medication (7 patients 1 day, 1 patient 4 days), with no differences detected between patients receiving discharge prescriptions or discharge medication. Providing medication or prescriptions appeared to influence the timing of doctor visits (average 3 days for metropolitan, 7 to 11 days for rural). 53% of metropolitan doctor visits were for prescriptions only. 90% of rural patients obtained medication on the day of discharge or the day after. 53% of respondents recalled receiving a medication list. 4% did not know the names of their medication nor when to take them; 17% knew some details but not all.

Conclusion

The survey tool appears to provide consistent data over multiple sites and multiple interviewers. The risk of running out of medication in rural areas would be higher if discharge medications replaced prescriptions due to difficulties accessing doctors. Strategies identified to improve discharge processes include clinical pharmacy checks of discharge prescriptions and more flexibility in supply quantities.
An Intervention to Reduce the Use of Error‐Prone Prescribing Abbreviations in the Emergency Department
Authors: Taylor Simone E , Chu Mimi Tak‐Yan , Haack Louise A , McGrath Anne , To The‐Phung
Published: April 2015

Background

Numerous national and international authorities have advised against the use of certain prescribing abbreviations due to their risk of misinterpretation.

Aim

To evaluate an intervention to reduce the use of error‐prone prescribing abbreviations in the emergency department (ED).

Method

The intervention consisted of education sessions as part of ED medical and nursing orientation programs, distribution of name badge sized cards summarising the information and placement of posters in the ED. All medication and fluid charts present in the ED at one randomly selected time each day were screened over consecutive days. Patients with at least one medication or fluid prescribed were included. Error‐prone abbreviations were classified as of major, moderate or minor significance. Pre‐intervention data on abbreviation usage guided the content of the intervention.

Results

166 patients were included pre‐intervention and a further 166 patients post‐intervention. The overall rate of error‐prone abbreviation use per 100 prescriptions declined from 31.8 pre‐intervention to 18.7 post‐intervention (difference in rates 13.1; 95%CI 8.8–17.4; p < 0.001). The rate of use of major significance error‐prone abbreviations per 100 prescriptions decreased from 5.8 pre‐intervention to 2.3 post‐intervention (difference in rates 3.5; 95%CI 1.8–5.2; p < 0.001).

Conclusion

The intervention resulted in a significant reduction in the use of error‐prone abbreviations in the ED. Implementing this intervention hospital‐wide should have a further impact as ward‐based doctors also prescribe medications in the ED.
Australian Hospital Pharmacists' Attitudes, Perceptions, Knowledge and Practices of CAMs
Authors: Braun Lesley A , Cohen Marc M
Published: April 2015

Background

Although evidence suggests that some complementary and alternative medicines (CAMs) are beneficial they can also cause adverse effects. Hospital pharmacists are responsible for ensuring patient safety and wellbeing yet little is known about their perceptions, knowledge and practices of CAMs.

Aim

To explore hospital pharmacists' attitudes, perceptions, knowledge and practices of CAMs.

Method

An anonymous, self‐administered questionnaire was distributed to pharmacists at four hospitals in Melbourne.

Results

107 completed surveys were received (76% response). 87% of pharmacists thought CAMs were unsafe and required monitoring yet 45% did not routinely ask patients about CAM use. 74% thought they had insufficient knowledge to identify when CAMs could affect patient safety and 88% thought CAMs needed more hospital‐based research. Pharmacists were cautious about CAMs and concerned about safety, efficacy, cost and regulatory issues. 62% had received training about CAMs, and 83% were interested in further training. A mean score of 39.9% (SD 19.9) was obtained in the knowledge section. Several complementary therapies were considered useful, notably acupuncture.

Conclusion

Hospital pharmacists are responsible for the safe and appropriate use of medicines however this does not routinely extend to the use of CAMs. Despite receiving some education about CAMs, a lack of confidence and knowledge was identified. Clear guidelines and education is needed to improve communication about CAMs and optimise patient care. Hospital pharmacists have concerns about CAMs and would support further hospital‐based research.
Managing Insomnia in Older People
Authors: Woodward Michael C
Published: April 2015

Although insomnia is a common problem in older people, there have been few therapeutic advances in the last decade. Benzodiazepines continue to be overused and the newer benzodiazepine‐like drugs (e.g. zopiclone) are proving to be no more effective and have their own risk of adverse effects. Non‐pharmacological management remains the preferred option, but is poorly taught and infrequently adhered to, especially in hospital and residential care settings. Older people themselves often request drugs. Progress towards improved management of insomnia will require a significant shift in knowledge and attitudes in both health professionals and the community.
Eutectic Mixture of Local Anaesthetics vs Nitrous Oxide for Cannulation of Children in the Emergency Department
Authors: Mann Timothy , Taylor David McD , Smit Pieter De Villiers
Published: April 2015

Aim

To compare the effectiveness of eutectic mixture of local anaesthetics (EMLA) and nitrous oxide (N2O) in reducing the pain of IV cannulation/venipuncture in children in the ED.

Method

A randomised, non‐blinded clinical trial undertaken in a large metropolitan ED. Eligible patients were aged 3 to 15 years and needed IV cannulation/venipuncture. The Wong‐Baker FACES pain rating scale was used to measure the child's pain. A 5‐point ordinal scale (very unsatisfied to very satisfied) was used to measure parental satisfaction with the method used.

Results

56 patients received N2O and 45 received EMLA. The groups had similar gender and age profiles. The median pain score was 1 (interquartile range 0–2) for the N2O group and 1 (interquartile range 1–2) for the EMLA group (p = 0.85). The median parental satisfaction scores were 5 (interquartile range 4–5) for both methods (p = 0.29). 8 (14.3%; 95% CI 6.8–26.8) patients in the N2O group experienced minor adverse events—drowsiness (3), carpopedal spasm/paraesthesia (2), agitation (1), vomiting (1), dizziness (1). One (2.2%; 95%CI 0.1–13.2) EMLA group patient experienced post‐procedure emesis.

Conclusion

There is no significant difference between EMLA and N2O in reducing the pain associated with IV cannulation/venipuncture in children in the ED. Both methods are associated with high levels of parental satisfaction. Prolonged EMLA onset time and N2O adverse events may influence the choice of method.
Impact of an Emergency Department Pharmacist on Prescribing Errors in an Australian Hospital
Authors: deClifford Jan‐Marie , Caplygin Frances M , Lam Skip S , Leung Benjamin K
Published: April 2015

Aim

To evaluate the impact of an emergency department (ED) pharmacist on prescribing errors 24 hours post‐admission.

Method

A prospective controlled sequential study was conducted in the ED of a metropolitan teaching hospital. In the control period, ED patients admitted were followed‐up by ward pharmacists (standard practice). In the active period, they were seen first by the ED pharmacist. Targets of 50 patients were recruited into each study period. All medication charts were reviewed by a senior clinical pharmacist (reviewing pharmacist) at 24 hours post‐admission. Errors were risk‐assessed by a blinded independent physician. The number and type of errors were compared.

Results

The profile, type and complexity of patients and number of medications ordered per patient were similar in both periods. There was a 71% relative reduction in errors per patient (p < 0.0001) and a 76% relative reduction in errors per drug order (p < 0.0001) between the control and active periods. The number of errors rated as high‐extreme, moderate or minor, decreased by 64%, 71% and 90% respectively. Overall, the most common types of error were drug omissions (63%); and the most common drugs involved were cardiovascular (31.5%), central nervous system (18%), respiratory (12.6%) and endocrine (10.8%).

Conclusion

An ED pharmacist providing timely medication histories resulted in admitted patients significantly more likely to receive an accurate medication chart early in their hospital stay.
Do Pharmacists Adhere to Brand Substitution Guidelines? The Example of Simvastatin
Authors: Kalisch Lisa M , Roughead Elizabeth E , Gilbert Andrew L
Published: April 2015

Background

Although pharmacists have been criticised for not following brand substitution guidelines, evidence is lacking. Brand substitution of simvastatin has been possible since November 2004 when the first generic became available; prior to this 2 non‐substitutable products were available.

Aim

To identify the rate of switching between brand and generic products of simvastatin.

Method

Analyses were conducted using Repatriation Pharmaceutical Benefits Scheme prescription claims data from 1 November 2002 to 28 February 2006. Switches were identified if different brand or generic products were dispensed consecutively. The change in the rate of switching post‐generics was compared to the pre‐generics baseline.

Results

Following introduction of generics the switching rate increased to 78.2 switches per 1000 dispensings. Switching was 22 times more likely post‐generics compared to pre‐generics (rate ratio 21.91 (20.01, 24.00), p < 0.001). The rate of switching did not change when 10 products were available for substitution compared to when there were only 4 (RR 1.02 (0.998, 1.041); p = 0.0664). Post‐generics, 64% of switches occurred when different prescriptions were dispensed consecutively.

Conclusion

Switching between simvastatin products was low prior to generic availability, even though 2 products were available. The switching rate increased when bioequivalent products were available, suggesting that pharmacists practice in accordance with brand substitution legislation. Consumers were most vulnerable to switching when different prescriptions were dispensed consecutively. Pharmacists should be aware of this and take steps to ensure that switches do not occur unnecessarily.
Improving Clinical Outcomes for Hospital Patients Initiated on Warfarin
Authors: Bereznicki Luke R , Jackson Shane L , Morgan Steven M , Boland Camille , Marsden Katherine A , Jupe David M , Vial Janet H , Peterson Gregory M
Published: April 2015

Background

Studies have demonstrated that the risk of warfarin‐related complications is highest in the first 90 days of treatment, while quality audits suggest that warfarin initiation protocols are not always adhered to.

Aim

To improve the quality of anticoagulation for hospital patients initiated on warfarin.

Method

A warfarin drug chart, incorporating the hospital's warfarin initiation protocol, was implemented on four target medical and cardiothoracic wards. The chart was used to record international normalised ratios (INRs) and prescribe warfarin, and was faxed to the patient's GP on discharge. Warfarin initiations on the target wards immediately post‐introduction of the warfarin drug chart were reviewed and compared to the pre‐intervention data collected over a 17‐month period.

Results

The pre‐intervention and post‐intervention groups included 271 and 183 patients initiated on warfarin, respectively. The intervention was associated with fewer warfarin‐related complications (thromboembolism, major bleeding) occurring within a 90‐day follow‐up period (2.1% vs 11%; adjusted OR 0.24; 95%CI 0.07–0.85; p = 0.03), largely driven by a reduction in the incidence of major bleeding (0.7% vs 7.1%; adjusted OR 0.17; 95%CI 0.02–1.45; p = 0.05). Adherence to the warfarin initiation protocol improved significantly from 36% to 71% (p < 0.01) in the pre‐ and post‐intervention data collection periods, respectively. Post‐intervention, the proportion of patients with an INR > 4 and the proportion of patients who required a warfarin dose to be withheld was reduced from 8.5% and 13%, to 3.8% (p < 0.05) and 6.6% (p = 0.02), respectively.

Conclusion

Adherence to an age and disease based warfarin initiation protocol, and improving the quality of discharge information for patients initiated on warfarin, significantly improved patient outcomes.
Audit of Nausea and Vomiting Management in Palliative Care Hospital Patients
Authors: Burgess Christel L , Tuffin Penelope HR , Clifford Rhonda M
Published: April 2015

Aim

To investigate prescribing patterns of antiemetics for palliative care hospital patients and to compare them with best practice guidelines.

Method

A retrospective audit of nausea and vomiting management was undertaken for 70 patients referred to the hospital Palliative Care Service.

Results

19 patients presented with uncontrolled nausea and/or vomiting. An antiemetic was prescribed for 43 (61%) patients, with dopamine antagonists the most commonly prescribed. Patients taking regular antiemetics had better symptom control compared to patients taking prn (when required) doses. The 5‐hydroxytryptamine type 3 receptor antagonists were prescribed in accordance with best practice guidelines in only one‐quarter of cases.

Conclusion

In the majority of cases, antiemetics were prescribed according to best practice guidelines. Regular antiemetics (rather than prn) provide better symptom management.
Role of Adjuvant Therapy in Older People with Breast Cancer
Authors: White Shane , Stewart Josephine M
Published: April 2015

The expanding population of older people with breast cancer is challenging for the clinician. While a wealth of data on younger women assists doctors in the discussion of adjuvant therapeutic options, these are not necessarily applicable to older women. This issue is discussed in this article in relation to the efficacy and toxicity of adjuvant chemotherapy, hormone therapy and biological therapy in the older population. The differing stage and biology of breast cancer in the elderly is also highlighted. The development of using the Comprehensive Geriatric Assessment tool in the clinical assessment of older patients is also outlined.
Adverse Drug Reactions Associated with Home Parenteral Therapy
Authors: Cheong Elizabeth A , Katelaris Constance H , Sisson Colleen M , Anderson Elizabeth A , Byth Karen
Published: April 2015

Background

Few studies have investigated the incidence and management of adverse drug reactions that occur during home parenteral therapy.

Aim

To determine the incidence, characteristics and risk factors for adverse drug reactions associated with home parenteral therapy; to evaluate the management of these reactions; and to determine the ideal contents of an anaphylaxis kit.

Method

673 consecutive patients starting home parenteral therapy were recruited from the Sydney West Area Health Service (June 2002 to November 2004). Data were collected on patient characteristics; diagnosis; known drug allergies; concurrent medications; drug dose and frequency; duration of treatment; and adverse drug reactions, their management and outcomes.

Results

714 treatment courses were administered to 673 patients. Commonly treated conditions were cellulitis (313 courses; 44%), orthopaedic infections (73 courses; 10%) and wound infections (63 courses; 8.8%). Frequently prescribed drugs were cephazolin (376 courses; 50%), ceftriaxone (149 courses; 20%) and vancomycin (52 courses; 7.1%). Adverse drug reactions occurred in 38 (5.3%) courses, of which 5 were ranked as serious or life‐threatening. Adverse drug reactions included skin reactions in 18 (2.5%) courses, abdominal symptoms in 8 (1.1%) courses, and vascular symptoms in 5 (0.7%) courses. Risk factors included concurrent beta‐blocker use, which was associated with an adverse drug reaction in 9 out of 54 courses (OR 4.4; 95%CI 1.9–9.7; p = 0.0003).

Conclusion

There was a low incidence of adverse drug reactions with home parenteral therapy, with a small risk of serious reactions. Patients taking concurrent beta‐blockers may be at greater risk of adverse drug reactions when treated with parenteral drugs. Patients need to be screened for documented allergies, regularly monitored, and an anaphylaxis kit containing adrenaline and glucagon made available.
Collaborative Prescribing: Views of SHPA Pharmacist Members
Authors: Weeks Greg R , Marriott Jennifer L
Published: April 2015

Aim

To explore the views of SHPA pharmacist members on collaborative prescribing and the extent of de facto prescribing at their institutions.

Method

1367 SHPA pharmacist members were invited by mail to complete a 4–page questionnaire on current and future issues pertaining to collaborative prescribing.

Results

551 pharmacist members responded (40% response rate) to the survey. 509 (95%) respondents observed that a collaborative prescribing role could circumvent hospital delays with timely service delivery during the admission, inpatient, discharge and outpatient process. De facto prescribing was undertaken by 141 (37%) pharmacists across the range of drug schedules and practice settings. If a legal and credentialling framework existed, 406 (75%) pharmacists would consider becoming a ‘prescribing pharmacist’ in a specialised clinical area, while 81 (15%) were undecided and 57 (11%) would not consider the option.

Conclusion

SHPA pharmacist members strongly supported the development of collaborative prescribing as a means to improve patient outcomes, professional activities and standing, and hospital systems. Hospital pharmacists are undertaking a range of de facto prescribing activities.
Stability of Omeprazole Mixtures: Implications for Paediatric Prescribing
Authors: Graudins Linda V , Kivi Naghmeh J , Tattam Bruce N
Published: April 2015

Background

Commercial omeprazole paediatric mixtures are not available. The stability of omeprazole mixtures prepared from Probitor capsules or omeprazole powder has not been established.

Aim

To determine the physicochemical stability of two omeprazole mixtures, prepared from Probitor capsules or omeprazole powder BP, over a 45–day period under refrigeration or at room temperature, shaken or unshaken.

Method

Omeprazole 2 mg/mL mixtures were prepared using standard procedures by either emptying the contents of Probitor capsules or by adding omeprazole powder to preserved sodium bicarbonate 8.4% solution. Each formulation was stored in 100 mL amber glass bottles under refrigeration (2–8°C) or at room temperature (21 ± 2°C). One bottle of each formulation was shaken and the other not shaken, pH was measured and colour change determined using a visual scale. Omeprazole concentrations were measured using liquid chromatograph tandem mass spectrometry on Days 1, 7, 14, 28 and 46.

Results

Omeprazole 2 mg/mL mixture prepared from Probitor capsules was stable over 45 days when refrigerated and regularly shaken. When unshaken, the omeprazole concentration decreased rapidly over 7 days. Mixtures prepared from omeprazole powder had lower concentrations compared to the mixtures prepared from Probitor capsules, but tended to be more stable when stored at room temperature. Observed colour changes did not correlate with measured omeprazole concentrations and pH remained constant.

Conclusion

Omeprazole mixture prepared from Probitor capsules was stable over 45 days, when refrigerated and regularly shaken. Omeprazole concentration markedly decreased in the mixture prepared from omeprazole powder when refrigerated.
Prescribing in Teaching Hospitals: a Qualitative Study of Social and Cultural Dynamics
Authors: Page Meredith A , Bajorek Beata V , Brien Jo‐anne E
Published: April 2015

Background

General practitioners integrate an array of social and environmental factors into their prescribing decisions. In teaching hospitals, despite the involvement of multiple practitioners in making and acting on prescribing decisions, little is known about the influence of roles, relationships, professional subcultures and underlying beliefs, on prescribing practices.

Aim

To explore the social and cultural dynamics of prescribing in teaching hospitals.

Method

Consultants, registrars, junior doctors, nurses and pharmacists from 2 large Sydney teaching hospitals were sampled purposively and invited to participate in a qualitative study involving semi‐structured interviews. The interview topics explored included: attitudes about prescribing, roles and responsibilities, communication of decisions, influences on prescribing and factors contributing to prescribing errors. Interviews were transcribed verbatim and the content analysed thematically.

Results

Participants included 8 consultants, 8 registrars, 9 junior doctors, 7 nurses and 11 pharmacists. 5 distinct sets of social and cultural influences on prescribing behaviours were identified. The dominant set of influences related to the structure of how prescribing took place and chief among these were the strong intra‐professional relationships of medical teams. Other social and cultural influences related to how prescribing decisions were communicated, underlying assumptions within medical teams, knowledge acquisition and the hospital environment.

Conclusion

Prescribing in teaching hospitals is shaped by a complex web of social and cultural dynamics. An appreciation of these influences may be vital to the success of strategies to improve use of medicines in teaching hospitals.
Anticoagulation Control in Hospitalised Patients on Warfarin
Authors: Su Elaine Y , Naganathan Vasi , Fallah Haady , Bajorek Beata V , McLachlan Andrew J
Published: April 2015

Background

Anticoagulation control is a strong predictor of clinical outcomes for patients on warfarin.

Aim

To identify instances of excessive anticoagulation in hospitalised patients on warfarin and to determine the causes of international normalised ratios (INRs) of 5 and above and the management strategies used to correct it.

Method

An observational descriptive study undertaken at a teaching hospital over a 3–month period. Data were reviewed prospectively and retrospectively to measure the percentage of time patients were maintained within their target INR range while in hospital and to identify cases of excessive anticoagulation. Patients were divided into a control group (INR < 5) and a high INR group (INR = 5). Possible causes of INRs of 5 and above and its management strategies were recorded.

Results

Out of a total of 208 patients on warfarin identified in the geriatric, orthopaedic and cardiology wards, 144 patients met the study criteria. The mean percentage of time spent within, above and below the target INR range by the control group was 60%, 0% and 15%, and by the high INR group was 41%, 33% and 16%, respectively. In the high INR group, 26 possible causes of INRs of 5 and above were identified and the co‐administration of roxithromycin and warfarin were implicated in 7 cases. Management strategies for INRs of 5 and above were compared between two stratified groups (INR 5–9 and INR = 9). The management strategies adopted included warfarin dose reduction (83%; 86%), temporary withholding of warfarin (100%; 100%), administration of vitamin K (58%; 100%), fresh frozen plasma (13%; 43%) and prothrombin complex concentrate (8%; 29%). The time to return to the upper limit of the target INR range was INR 5–9 (1.6 SD 1.5 days) and INR = 9 (0.5 SD 0.4 days).

Conclusion

Anticoagulation control is difficult for hospital patients and drug interactions are an important contributing factor. The management strategies adopted to correct excessive anticoagulation followed the relevant guidelines.
Exploring Point‐of‐Care Testing of Capillary Blood in Warfarin Management
Authors: Glover Sharna , Bajorek Beata V
Published: April 2015

Background

Long‐term warfarin therapy requires intensive laboratory monitoring of venous blood. Reliable and efficient point‐of‐care testing (POCT) of capillary blood offers an alternative to laboratory monitoring.

Aim

To explore the perceptions of health professionals to POCT in warfarin management and to identify the models of monitoring warfarinised patients preferred by health professionals.

Method

An exploratory descriptive study that purposively sampled health professionals (hospital pharmacists, specialists, nurses, general practitioners) involved in the management of anticoagulated patients and practising within an area health service. Health professionals were invited to participate in a group discussion on POCT and to then complete a brief survey ranking proposed monitoring models incorporating POCT.

Results

4 group discussions and/or individual interviews with 33 health professionals elucidated several themes, such as lack of knowledge or confidence in POCT, operator accreditation and careful patient selection. An acute post‐acute care model and general practice surgery model incorporating POCT was preferred by health professionals in terms of perceived benefits to patients, cost‐effectiveness and time efficiency.

Conclusion

POCT will be a component in the monitoring and management of warfarinised patients in the future. A drawback to POCT is the perceived inaccuracy of the devices used. Operator training and maintenance of a controlled practice environment were suggested strategies to overcome variability.
Management of Cardiac Rhythm Disturbances in the Ageing Heart
Authors: Chase David , O'Donnell David , Farouque Omar
Published: April 2015

The elderly experience a high proportion of chronic diseases, of which cardiac rhythm disturbances comprise a significant portion. Due to ageing‐related metabolic and physiological changes, the management of cardiac rhythm disturbances will need to be modified and it is essential to be aware of the pharmacodynamics and pharmacokinetics of the drugs used. Non‐drug treatment modalities, such as implantable cardioverter‐defibrillators or radiofrequency ablation, which are increasingly available for use in the elderly, need to be considered periodically. The critical applications of drug and non‐drug therapy of cardiac arrhythmias in the elderly are discussed in this article.
Properties of a Formulated Paediatric Phenobarbitone Oral Liquid
Authors: Garg Sanjay , Svirskis Darren , Myftiu Joana , Behayaa Maryam , Shahin Dina , Thrimawithana Thilini , Vidicki Adela , Kairuz Therese
Published: April 2015

Aim

To formulate a stable and palatable paediatric phenobarbitone 10 mg/mL oral liquid and compare its physicochemical stability to the existing formulation compounded in some New Zealand hospitals.

Method

Formulations were compounded from pharmaceutical standard ingredients according to good manufacturing practices and stored in glass bottles at different storage conditions. The physical stability of the formulations was determined by pH, appearance, viscosity and microbial studies; chemical stability was assessed using high performance liquid chromatography.

Results

The new formulation and the existing hospital formulation remained physically stable for 28 days in terms of pH, appearance, viscosity and microbial stability. The phenobarbitone sodium concentration remained within an acceptable range (above 95% of the original concentration) after 28 days of storage at different conditions. The viscosity of the new formulation facilitated in masking phenobarbitone sodium's bitter taste, thus improving palatability. The palatability of the new formulation was superior to the hospital formulation.

Conclusion

A palatable paediatric phenobarbitone oral liquid formulation with improved rheological properties was developed.
Pharmacist Prescribing in Warfarin Therapy: Exploring Clinical Utility in the Hospital Setting
Authors: Nguyen Nam‐Anh , Bajorek Beata V
Published: April 2015

Background

Managing warfarin therapy can be challenging and a multidisciplinary approach to achieve optimal outcomes can be beneficial. Internationally, extended roles for pharmacists have involved collaborative prescribing privileges.

Aim

To explore the clinical utility and capacity of pharmacists to undertake prescribing functions in anticoagulation management in the hospital setting.

Methods

Pharmacists were recruited from a large Sydney teaching hospital. A questionnaire was used to simulate a pharmacist prescribing function and to explore their opinion of the usefulness of prescribing and their confidence to undertake such roles. The appropriateness of pharmacists' prescribing decisions was evaluated.

Results

Prescribing authority was generally considered useful for pharmacists in the management of warfarin therapy. Pharmacist prescribing in the inpatient setting was thought to enable enhanced pharmacovigilance and be useful when medical staff are unavailable. However, outpatient settings were considered more appropriate. Dependent or collaborative models of prescribing were considered more appropriate than independent models. Despite expressing confidence in their ability to prescribe, the majority of participants' responses (58%) were deemed clinically inappropriate. Lack of training and experience and opposition from the medical team were identified as potential barriers toward pharmacist prescribing.

Conclusion

Extended prescribing roles for pharmacists in anticoagulation management may be useful, particularly in the outpatient setting. Training and experience is needed to ensure safe prescribing practices are maintained.
Implementing a Hospital Vendor‐Managed Inventory System
Authors: Tsui Michael , Wilson David I , Merry Helen , Phulwani Kam , Dooley Michael J
Published: April 2015

Background

Traditional pharmacy imprest services require deployment of pharmacy technicians and substantial stock holding. These costly requirements could be reduced by a vendor‐managed inventory system.

Aim

To reduce the number of staff required to provide imprest services, reduce stock holding, improve customer service and maintain fill rates.

Method

Vendor‐managed inventory was implemented at a major teaching hospital in December 2005 with all imprest sites checked and restocked by vendor staff. An analysis of pharmacy stock holding was conducted over a 15 month period (9 months pre‐implementation and 5 months post‐implementation). Customer satisfaction surveys were performed in July 2006 and January 2007. Random audits were conducted from January to August 2006 to measure fill rates.

Results

3.5 full‐time equivalent imprest staff were redeployed to clinical pharmacy support duties and stock holding decreased by $352 000. The initial customer satisfaction survey in July 2006 demonstrated an average score of 5 (0 = very poor, 10 = excellent) and subsequently a number of improvements were implemented. A second customer satisfaction survey in January 2007, showed a significant increase in customer satisfaction. Initial fill rates were lower than the target of 97%, but increased to above 98% after 4 months.

Conclusion

A hospital vendor‐managed inventory system was successfully implemented and subsequently rolled out to two other hospitals in the network. All key objectives were met and an ongoing quality audit program is in place.