bluuebunny/crossref_metadata_2025 huggingface dataset:
Urinary Alkalinisation with Oral Sodium Bicarbonate for Patients at Risk of Contrast‐Induced Nephropathy
Authors: To The‐Phung , Chahadi Fahd , Freeman Melanie , Pan Mary , Farouque Omar , Mount Peter
Published: April 2015

Background

Intravenous sodium bicarbonate is used to reduce the risk of contrast‐induced nephropathy (CIN). Intravenous sodium bicarbonate is inconvenient and requires inpatient hospital resources, while oral sodium bicarbonate is less costly and easy‐to‐use.

Aim

To determine whether oral sodium bicarbonate has a similar effect on urinary pH as intravenous sodium bicarbonate in patients at risk of CIN.

Method

This sequential crossover study was conducted in patients from the cardiology and renal units scheduled for a non‐emergency contrast‐enhanced procedure. Participants received intravenous sodium bicarbonate 150 mmol/L at 3 mL/kg/h, 1 hour prior, then 1 mL/kg/h during and for 6 hours after the procedure. Participants returned to the hospital 2 to 3 weeks after their procedure to receive oral sodium bicarbonate capsules (16 times 840 mg, 160 mmol) over 7 hours with 1 L of water. Urinary pH was measured before and after the administration of intravenous and oral sodium bicarbonate.

Results

9 participants completed the study. Mean urinary pH after oral sodium bicarbonate was 6.6 (SD 0.6) versus 6.9 (SD 0.5) for intravenous sodium bicarbonate. The mean change in urinary pH was 0.9 (SD 0.7) with oral sodium bicarbonate versus 0.8 (SD 0.5) for intravenous sodium bicarbonate. The difference in change in urinary pH was not statistically significant (p = 0.5).

Conclusion

Oral sodium bicarbonate has a similar effect on urinary pH as intravenous sodium bicarbonate in patients at risk of CIN.
Documentation of Warfarin Education provided to Hospital Patients: A Clinical Audit
Authors: Nasser Sayeed , Cecchele Romana , Touma Simone , Han Priscilla , Nair Kim , Vizgoft Jason , Murdoch Veronica , Mullan Judy , Bajorek Beata
Published: April 2015

Background

Effective management of warfarin therapy is often challenged by its complex pharmacology and preventable adverse events. One strategy to ensure safe warfarin use is provision of comprehensive warfarin education to patients.

Aim

To review the provision of warfarin education to hospital patients prescribed warfarin and to describe patient characteristics that may impact on warfarin education.

Method

A prospective study was undertaken at 2 large Australian metropolitan hospitals. Provision of warfarin education was identified by auditing the medication charts and clinical notes of hospitalised older patients (≥ 65 years). Patients were also interviewed to confirm whether they recalled receiving warfarin education during their hospital stay.

Results

Data were collected for 96 patients with a mean age of 74 (SD 13) years. Most patients (78%) were admitted to medical wards, were taking warfarin for atrial fibrillation (56%), and had started warfarin prior to admission (54%). 36% of patients had provision of warfarin education documented in medication charts and clinical notes, and in most cases warfarin education was provided by a pharmacist. Of the 68 patients available for interview, only 47% recalled receiving warfarin education; in the majority of cases they cited pharmacists as providers of the education.

Conclusion

There is a need to improve documentation and provision of warfarin education to hospital patients.
How do Clinical Pharmacists spend their Working Day? A Time‐and‐Motion Study
Authors: de Clifford Jan‐Marie , Blewitt Peter , Lam Skip S , Leung Benjamin K
Published: April 2015

Background

Our health service is introducing an electronic medication management system (eMMs). Obtaining baseline data on the work patterns of pharmacists will allow assessment of the impact of the eMMs on pharmacists' work patterns.

Aim

To quantify the time clinical pharmacists spend on various activities over their working day prior to the implementation of an eMMs.

Method

During this continuous observational time‐and‐motion study (23 November to 17 December 2009), clinical pharmacists assigned to general medical and surgical wards were shadowed by two independent observers over their entire working days. A customised Access application was used to log times and calculate average times spent on each activity. Other data collected included time from admission to interview and opportunities for medication chart review.

Results

9 pharmacists were observed for 265.3 hours over 30 separate pharmacist observation days. Clinical activities (56% of total time) included professional communication (20%), medication chart review (9.6%), medication history interview (9.5%), clinical review (9.1%), providing information to patients/carers (5.5%), ascertaining discharge drugs required (1.6%), and obtaining drug information (0.5%). Non‐clinical activities (44% of total time) included social activities/breaks (13%), meetings (6.9%), ordering/distribution (6.6%), discharge dispensing (6.3%), walking between wards/pharmacy (5.2%), looking for something (3.1%), and other activities (2.8%). On an average day, each pharmacist reviewed 21 of a possible 38 medication charts (55%), spent 20 minutes on clinical interventions and completed 4.5 medication history interviews. Average time from admission to interview was 67 hours. 18% of pharmacists' time was taken up with discharge/transfer of patients. Most patients 130/141 (93%) at discharge did not require further medication history clarification.

Conclusion

This study provides baseline data for comparison of the impact of the eMMs on pharmacist workflow.
Standards of Practice for Mental Health Pharmacy
Authors:   SHPA Committee of Specialty Practice in Mental Health Pharmacy
Published: April 2015

These are standards of professional practice and not standards prepared or endorsed by the Standards Association of Australia. These are not legally binding.
Pharmacotherapy for Skin Disorders in Older People
Authors: Shen Sarah , Kelly Robert I
Published: April 2015

Human skin is a visible indicator of age. Structural and physiological changes that occur intrinsically with ageing skin combined with the effects of cumulative extrinsic damage can result in a marked susceptibility to cutaneous disorders in older patients. The progressive degeneration of ageing skin results in atrophy of the vasculature, deterioration of supporting dermis and erosion of normal immune function. Changes from the intrinsic and extrinsic effects of ageing skin have a wide clinical expression, e.g. xerosis, eczema, seborrheic dermatitis and contact dermatitis. Although rarely fatal, these cutaneous disorders can cause morbidity and reduce quality of life. Primary skin malignancies resulting from cumulative solar damage also carry considerable mortality. There have been exciting advances in the diagnosis and treatment of skin diseases in older people. However, comorbidities, polypharmacy and altered pharmacokinetics seen in older people pose significant challenges to effective treatment. Managing skin disorders in older people is often less than optimal because their special needs and limitations are not adequately addressed. This review provides an overview of treatments available for managing skin conditions commonly encountered in older people.
Stability of Dispersible Aspirin Tablets Repacked into Dosette Boxes
Authors: Mylrea Martina , Robertson Sherryl , Haywood Alison , Glass Beverley
Published: April 2015

Background

Although guidelines indicate that dispersible aspirin tablets should not be repacked into dose administration aids, it is common practice especially among older people.

Aim

To determine the stability of acetylsalicylic acid (ASA) in aspirin tablets repacked into Dosette boxes.

Method

Dispersible aspirin 300 mg tablets were removed from their primary (foil) packaging, and repacked as whole and split (halved) tablets into Dosette boxes under 4 storage conditions: refrigeration (2–8 °C), controlled room temperature (25 °C; 60% relative humidity [RH]), accelerated (40 °C; 75% RH), and ‘in‐use’ with natural variations in daylight exposure and internal temperature fluctuations (23–26 °C; 45–60% RH) for 1 week. The high performance liquid chromatography method developed was validated for accuracy, precision, linearity and range, sensitivity, robustness and specificity, and the suitability of extraction media evaluated.

Results

Linearity (r2 > 0.999), precision (relative standard deviation < 2%) accuracy (recovery: 95–102%) and selectivity for the high performance liquid chromatography method were confirmed. The ASA content remained within specifications (95–105% of labelled amount) for all except the accelerated storage condition, with 93% of the ASA remaining. The split tablets did not display any additional ASA degradation when compared to the whole tablets under the same conditions.

Conclusion

While the ASA content of the dispersible aspirin tablets remained within specifications at room temperature, there were changes in the physical appearance under accelerated storage conditions.
Stability of Amoxycillin, Clindamycin and Meropenem in Peritoneal Dialysis Solution
Authors: Tran Minh D , Sharley Nicholas , Ward Michael
Published: April 2015

Aim

To determine the stability of amoxycillin, clindamycin and meropenem in peritoneal dialysis solution containing glucose 2.5% at 37 °C over 6 hours.

Method

A stability‐indicating high‐performance liquid chromatography assay was used to determine the concentration of amoxycillin, clindamycin and meropenem in peritoneal dialysis solution (Dianeal PD‐4). Antibiotic solutions (amoxycillin 1 g, clindamycin 300 mg, meropenem 1 g) were prepared in 2 L peritoneal dialysis bags and stored at 37 °C. These were analysed at 0, 3 and 6 hours. A degradation profile was constructed for each antibiotic using linear regression and concentration remaining at 6 hours was calculated.

Results

Clindamycin and meropenem retained at least 90% or greater of the original concentration in the peritoneal dialysis solution over 6 hours, while amoxycillin displayed marginal stability.

Conclusion

Clindamycin and meropenem are stable for 6 hours in peritoneal dialysis solution containing 2.5% glucose. Amoxycillin's stability was marginal, which could be improved with a modified formulation.
Clinical Pathway for Monthly Pulse Intravenous Cyclophosphamide Therapy for Lupus Nephritis
Authors: Mirkov Sanja , Thein Hla
Published: April 2015

Aim

To assess the outcomes of monthly pulse intravenous cyclophosphamide (IV CYC) therapy for lupus nephritis and to identify factors contributing to suboptimal outcomes.

Method

Historical study of clinical and laboratory data. Statistical analysis consisted of one sample paired 2‐tailed t‐test and qualitative analysis of textual data.

Results

16 patients received 17 courses of monthly pulse IV CYC from April 2004 to January 2008 (118 doses, median dose 1025 mg or 563 mg/m2, median cumulative dose 6960 mg or 3824 mg/m2). Mean urinary protein decreased from 7.35 g/24 h pre therapy to 1.17 g/24 h (p = 0.01) after completion. Mean serum albumin increased from 25 to 35 g/L (p = 0.006). Mean serum creatinine was 105 μmol/L pre‐therapy and 122 μmol/L after treatment (p = 0.3). 9 patients achieved complete remission, 4 patients achieved partial remission, 2 patients progressed to end‐stage renal failure and 1 patient did not respond to treatment. 1 patient was lost to follow‐up. 9 out of 118 (8%) nadir white blood cell counts were below 3×109/L and neutrophils were below 2×109/L. 24 hospital admissions were due to the adverse effects of IV CYC. System deficiencies were identified relating to clinical documentation, monitoring laboratory data, patient support and coordinated care.

Conclusion

Although pulse IV CYC was effective, it was associated with serious adverse effects resulting in hospital admissions. The clinical pathway designed aims to improve efficiency and safety of pulse IV CYC for lupus nephritis.
Medication Management of Adult Patients Admitted to Hospital with Epilepsy, Seizure or Convulsion
Authors: Walker Monique P , McGovern Trudy L , Hattingh Laetitia H , Hall Tony D
Published: April 2015

Background

An inpatient medication chart review at the Gold Coast Hospital identified shortcomings with the prescribing and monitoring of antiepileptic medications.

Aim

To evaluate medication management of patients with epilepsy, seizure or convulsion; to map their transition through the health system; and to identify lifestyle behaviours that may lead to overt risks for seizure occurrence.

Method

A retrospective observational audit of adult patients (16 years and over) admitted to hospital with a diagnosis of epilepsy, seizure or convulsion from 1 to 31 January 2012.

Results

Majority of the 62 episodes of care investigated involved patients who were discharged directly from the ED (68%). Only 30% of all patients discharged from an inpatient unit received a discharge medication record from a pharmacist. Non‐adherence with antiepileptic medications, alcohol and/or recreational drug use and prescription medication misuse were identified as overt risks for seizure occurrence.

Conclusion

Valuable insights were gained into the management of seizure patients. The role of the ED pharmacist was reviewed to focus on high‐risk seizure patients. An increase in the provision of discharge medication records and patient education on the overt risks for seizure occurrence is needed.
Immunisation of Older People
Authors: Woodward Michael
Published: April 2015

Older people are more prone to infections than younger people and prevention via effective vaccines is an important approach to reduce the burden of infections in this age group, especially as microorganisms are often resistant to antibiotics. While there is an emphasis on childhood vaccination, adult vaccination is also important as part of a whole‐of‐life approach. Influenza, pneumococcal, herpes zoster and tetanus vaccines are effective in older people as are other vaccines for those at high risk. Pertussis vaccination is recommended in older people to reduce the spread of infection to children. The Australian and New Zealand Society for Geriatric Medicine has revised their position statement on vaccination of older people. These recommendations, along fsupport these, are presented in this review.
Evaluation of Consumer Medicine Information Provision from an Outpatient Dispensary
Authors: Winter Samantha J , Harlow Margaret A , Abarno Anita C , Alderman Christopher P
Published: April 2015

Background

Consumer medicine information (CMI) has been available for prescription medications since 1993. Although provision is not mandated by legislation, CMI use can meet the professional obligations of pharmacy practice.

Aim

To identify obstacles to provision of CMI from an outpatient dispensary and to gain insight into the decision‐making processes used by pharmacists when supplying CMI.

Method

Data were collected from patients presenting prescriptions at an outpatient dispensary during a 2‐month capture period. CMI provision was self‐reported by pharmacists using a structured questionnaire and analysed to investigate the influence of therapeutic subgroups and dose intensity on CMI provision.

Results

165 patient interactions were assessed. In 100 cases (61%), patients were provided with CMI with their medicines. Concerns regarding patients' interpretation of CMI content (43%) and off‐label use of medicines (22%) were the main reasons cited by pharmacists for not supplying CMI. Older patients and those from culturally and linguistically diverse backgrounds were significantly less likely to receive CMI. Therapeutic subgroup analysis and medication dose intensities also influenced provision of CMI.

Conclusion

Obstacles to provision of CMI from an outpatient dispensary included off‐label use of medicines and patients' interpretation of the CMI. Pharmacists' professional judgement was a key factor influencing provision of CMI.
Future Pharmacy‐Based Chlamydia Screening: Consumer Preference
Authors: Gudka Sajni , Misaghian Jila , Clifford Rhonda M
Published: April 2015

Background

Chlamydia trachomatis is the most prevalent sexually transmitted infection in Australia and a serious public health concern. Barriers to screening for C. trachomatis include high costs, clinic waiting times, inconvenience, fear of medical procedures, stigma and lack of privacy. Advances in nucleic acid amplification techniques have enabled the choice of 2 self‐collected and non‐invasive sampling methods for detecting C. trachomatis: first‐void urine and low vaginal swab.

Aim

To determine whether women prefer first‐void urine or low vaginal swab for detecting C. trachomatis.

Method

A self‐administered survey was piloted and refined. Women from a university and a shopping centre were invited to participate in the survey. The survey gathered data on demographics, previous experiences with sample collection and preference for a future pharmacy‐based chlamydia screening intervention. Participants completed the survey independently and sealed it in the envelope provided.

Results

Median age of the 100 female participants was 22 (range 20–23) years. 58% preferred to collect first‐void urine and 42% preferred a low vaginal swab. Almost half of the women noted it would be easy to collect both samples. Of the 40 women with previous experience of collecting a first‐void urine sample, significantly more would prefer low vaginal swabs in the future (p = 0.02).

Conclusion

Women did not prefer one method of sample collection over the other. Both sampling methods were either ‘very easy’ or ‘easy‘.
Compounding Practices in Queensland: Experiences and Perceptions of Pharmacists and Pharmacy Students
Authors: Lau Esther TL , Jones Anthea L , Kairuz Therése , Nissen Lisa M , Steadman Kathryn J
Published: April 2015

Background

Changes in the roles of the contemporary pharmacist has seen a decline in the number and variety of extemporaneously compounded dosage forms. Pharmacy curricula reflect this change with a reduction in the emphasis on extemporaneous compounding practice.

Aim

To elicit information about extemporaneously compounded dosage forms and perceptions of compounding practice from pharmacists and pharmacy students.

Method

Self‐administered surveys were mailed to 1063 pharmacists and offered online to 896 pharmacy undergraduates across the 4 years of a Bachelor of Pharmacy program in Queensland.

Results

382 (36%) pharmacists and 455 (51%) students completed the survey. Most pharmacists (96%) reported compounding a product in the 12 months prior to the survey, particularly semi‐solids (89%) and liquids (64%) for external use. Most pharmacies (> 96%) owned basic compounding equipment, such as a slab and spatula, mortar and pestle, and cylindrical/conical measures. Half of the pharmacies used mechanical rather than electronic balances. Students expressed greater confidence in their ability to use basic compounding equipment and to perform basic compounding tasks as they progressed through the 4‐year degree course. Pharmacists' views on students' ability to compound basic products at the end of their degree were generally similar to the proportion of final‐year students who reported they could confidently complete the task.

Conclusion

Despite a decline in extemporaneously compounded products in community pharmacy, pharmacy graduates need to be competent in compounding techniques.
Understanding Compliance to an Antibiotic Prescribing Policy: Perspectives of Policymakers and Prescribers
Authors: Teo Chee Kong , Baysari Melissa T , Day Richard O
Published: April 2015

Background

Antibiotic stewardship programs have been shown to reduce inappropriate institutional antibiotic use. There is no consensus on the strategies, e.g. formulary restrictions, that best improve appropriate use and reduce misuse of antibiotics.

Aim

To identify facilitators and barriers to compliance with an institutional antibiotic prescribing policy and to compare policymakers' perceptions about the facilitators and barriers that influence compliance with those held by prescribers.

Method

5 antimicrobial stewardship committee members (policymakers) and 15 prescribers from a large Sydney hospital participated in a semi‐structured interview. To gauge prescribers' knowledge of the institutional antibiotic policy, case scenarios were included in the interviews with prescribers. Interviews were continued until data saturation was reached. Recurrent themes were analysed and interpreted in terms of a well‐known conceptual framework of barriers to physician adherence to guidelines.

Results

Antimicrobial stewardship committee members identified lack of knowledge as the main barrier to compliance with the antibiotic prescribing policy. Despite reporting that they were aware of and agreed with the antibiotic prescribing policy, most prescribers did not comply with the policy and referred to clinical information sources when completing the case scenarios. Organisational hierarchies were frequently reported as a barrier by both participant groups. While prescribers considered inapplicability of the antibiotic prescribing policy as an important barrier, antimicrobial stewardship committee members attributed non‐compliance to the policy to prescriber autonomy and personal experience.

Conclusion

We identified several barriers to compliance with the antibiotic prescribing policy, such as poor knowledge of policy specifics and medical hierarchies. Involving prescribers in policy development, giving them feedback about their prescribing, and improving existing collaboration and decision support platforms may further improve judicious antibiotic use.
Cetuximab Extravasation
Authors: Moloney Michael J , Kirsa Suzanne W , Thakerar Arti
Published: April 2015

Background

Extravasation of some cytotoxic drugs can cause pain, erythema, inflammation and tissue damage. There are proven procedures for managing extravasation of older cytotoxic drugs, such as doxorubicin. However, there are limited data for the newer cytotoxic drugs, such as cetuximab.

Aim

To describe a case of suspected cetuximab extravasation.

Clinical details

The IV cannula of a 75‐year‐old male receiving cetuximab was partially dislodged. The patient reported pain and swelling at the administration site. It was established that approximately 1 mL of drug solution (equivalent to cetuximab 5 mg) had leaked into the perivascular tissue. Attempts to aspirate the leaked drug from the perivascular tissue was unsuccessful. Pain and swelling resolved within 30 minutes of the incident. Subsequent reviews confirmed no adverse effects at the extravasation site.

Outcomes

No discernible amount of cetuximab could be aspirated, which suggests that the perivascular tissue was exposed to the drug without significant adverse effects. The short duration of reported pain and minimal adverse effects suggest cetuximab is not a vesicant or irritant.

Conclusion

This case of suspected cetuximab extravasation resulted in a rapid resolution of symptoms, suggesting cetuximab is a neutral drug and not a vesicant or irritant.
Severe Infusion‐Related Reaction to Liposomal Amphotericin B
Authors: Wilson Rachael K , Connolly Michael J , Harrup Rosemary A
Published: April 2015

Aim

To describe a case of severe infusion‐related reaction to liposomal amphotericin B (LAB).

Clinical details

A severely immunocompromised 58‐year‐old male with acute myeloid leukaemia experienced 2 infusion‐related adverse events when treated with LAB for a localised Fusarium solani fungal infection of the right forefoot. The initial adverse reaction to LAB was not serious. However, the second adverse reaction following a re‐challenge was serious. The patient had a poor prognosis because of the likelihood of further chemotherapy‐induced neutropenia and a potentially untreated disseminated fungal infection in light of planned chemotherapy.

Outcomes

LAB was successfully substituted with conventional amphotericin B to treat Fusarium solani infection. No adverse events were observed with conventional amphotericin B.

Conclusion

The patient is suspected to have had a reaction to the lipid carrier of LAB.
Audit of General Practitioner Medication Lists for Older Patients at a Regional Hospital
Authors: Boyce Laura E , Knight Anne T
Published: April 2015

Background

Complete medication reconciliation is often difficult to achieve, particularly in the emergency department (ED). General practitioner (GP) medication lists may be used by some doctors for charting medications.

Aim

To determine the discrepancies in the medication history information between GP medication lists and the actual medication usage of older patients admitted via a regional ED.

Method

A clinical audit was conducted over a 2‐week period at a small regional hospital. Patients 65 years and over, taking 3 or more medications prior to admission, admitted via the ED and with a national inpatient medication chart (NIMC) prepared by a medical officer were identified. Eligible patients were provided with medication reconciliation by a pharmacist. Discrepancies between the medication history obtained by the pharmacist, the GP medication list and the NIMC were assessed. The clinical significance of the discrepancies were classified using a severity assessment code matrix.

Results

48 patients were eligible and 75% had 1 or more discrepancy in their GP medication list. Almost half of the discrepancies were related to non‐current medications being recorded. Potential clinical significance of the discrepancies in 19% of patients was ‘moderate’ or ‘major‘.

Conclusion

While a GP medication list is a useful tool in the medication reconciliation process, it is not a complete representation of the patient's medications prior to admission.
Safe Prescribing and Preparation of Continuous Subcutaneous Infusions in a Regional Palliative Care Unit
Authors: Murnane Julie M , Passlow Claire A , Arnold Mark , McCormick Christopher P
Published: April 2015

Aim

To design a safe process for prescribing and preparing medications for continuous subcutaneous infusion (CSCI) in a regional palliative care unit.

Method

Following a literature review and finding little evidence of best prescribing practice for CSCI, a working party comprising medical, nursing and pharmacy staff was established to review existing practice. Dedicated CSCI medication chart labels (MCLs) were designed to be applied to the inpatient medication chart to improve safety and clarity. These labels were trialled for 3 months. Staff surveys were conducted before and after the trial to gauge their experiences with changed practice.

Results

Surveys were completed by 27 staff before and 25 staff after the trial. Staff reported the MCLs decreased confusion, decreased the potential for error when prescribing and preparing medications, and decreased wastage of time, medication and consumables. 22 of 25 staff were moderately or highly satisfied with the new CSCI MCL.

Conclusion

The introduction of MCLs to optimise prescribing and preparation of CSCI was successfully implemented and accepted by medical, pharmacy and nursing staff.
Stability of Diluted Iron Polymaltose in PVC Infusion Bags
Authors: Patel Rahul P , Wanandy Troy , Loring Serena , Johns Cameron , Hutchinson Joseph , Shastri Madhur
Published: April 2015

Background

In Australia, iron polymaltose (IPM) is the most commonly used parenteral iron therapy for iron deficiency anaemia. Intravenous IPM is prepared by diluting IPM injection with 0.9% sodium chloride. The stability of diluted IPM is not known beyond 24 hours. Therefore, diluted IPM must be prepared on a daily basis, resulting in substantial limitations and problems.

Aim

To determine the stability of diluted IPM in polyvinyl chloride (PVC) infusion bags at different storage conditions for up to 28 days.

Method

IPM 2 mg/mL samples were prepared in 0.9% sodium chloride 500 mL PVC infusion bags. Infusion bags were kept in light protective bags or exposed to artificial light and stored at either 4 °C or 25 °C for up to 28 days. Aliquots were withdrawn immediately after preparation (Day 0) or after Days 1, 2, 3, 6, 7, 14, 21 and 28. Samples were analysed by high‐performance size‐exclusion chromatography to measure the changes in concentration or molecular weight profile of IPM before and after storage. Samples were also investigated for particle size distribution by dynamic light scattering and for the free iron content by ion chromatography.

Results

Diluted IPM remained physicochemically stable (with or without light protection) at room temperature or in the refrigerator for at least 28 days.

Conclusion

Aseptically prepared IPM 2 mg/mL intravenous solution in 0.9% sodium chloride PVC infusion bags was stable for 28 days at room temperature or in a refrigerator.
WHO High 5s Project: Medication Reconciliation International Meeting
Authors: Graudins Linda V
Published: April 2015

Medication reconciliation is in the forefront of medication safety programs, both in Australia due in part to updated accreditation standards, and globally. The first international meeting for hospitals participating in the WHO's High 5s Project was convened in Geneva in October 2012. The meeting was attended by delegates from hospitals in 6 countries participating in 2 of the WHO patient safety initiatives: medication reconciliation and correct site surgery. Networking with European colleagues provided an opportunity to exchange ideas and collaborate to address common medication safety issues.
Oral Medication Administration in Patients with Restrictions on Oral Intake—A Snapshot Survey
Authors: To The‐Phung , Story David A , Booth Jane , Nielsen Fiona , Heland Melodie , Hardidge Andrew
Published: April 2015

Aim

To determine clinical staff's understanding of managing oral medications in patients with restrictions on oral intake.

Method

An online survey was designed consisting of 4 scenarios featuring a patient who was fasting pre‐surgery, day 1 post‐surgery, nil‐by‐mouth after stroke or had a nasogastric feeding tube in situ. The target population was clinical staff (nursing, medical, pharmacy, dietetics, speech pathology) involved in the management of oral medications and/or patients' oral intake. Medications studied were: aspirin (Cartia) 100 mg mane; gliclazide (Diamicron MR) 60 mg mane; atorvastatin (Lipitor) 40 mg mane; metoprolol (Betaloc) 50 mg bd; levodopa/carbidopa (Sinemet CR) 200/50 tds; ginkgo 7500 complex mane. Respondents could choose to give, withhold, cease, contact someone for advice, change the formulation before giving or choose ‘other’ and make a comment.

Results

622 responses were received from clinical staff. When fasting, respondents would give metoprolol (65%) and levodopa (68%) but not aspirin (70%), gliclazide (63%), atorvastatin (50%) and ginkgo (65%). Approximately 10% of respondents would give oral medications to the nil‐by‐mouth patient. The consensus for the nasogastric feeding tube was to give all the medications via the tube, including modified‐ or controlled‐release medications.

Conclusion

There appeared to be varying understanding of managing oral medications when patients have restrictions on oral intake. This is concerning as it has the potential to result in adverse patient outcomes.
Home Medicines Reviews: Extent of Uptake by High‐Risk Veterans
Authors: Ellett Lisa M Kalisch , Ramsay Emmae N , Barratt John D , Gilbert Andrew L , Roughead Elizabeth E
Published: April 2015

Aim

To identify the characteristics of patients who receive home medicines reviews (HMRs).

Method

A retrospective analysis was conducted of the Department of Veterans' Affairs administrative claims data. Veterans living in the community on 30 June 2009 were included if they had ≥ 1 medicines dispensed in the previous 12 months. The main outcome measure was the number of veterans who received an HMR. Log binomial regression analysis compared characteristics of HMR recipients and non‐recipients – age and gender; number of medicines, prescribers, dispensing pharmacies and hospitalisations in the previous year; and conditions where medicine use is potentially problematic, e.g. dementia.

Results

Of the 175 572 veterans included in the study, 6236 (3.6%) had received an HMR. The likelihood of having an HMR increased with age, number of medicines and number of GP visits. Women were 12% more likely to receive an HMR than men. Veterans who had received an HMR previously were 4 times more likely to have another HMR. Veterans with 1 to 4 hospitalisations were 10% more likely to receive an HMR than those who had not been hospitalised. The likelihood of having an HMR decreased with the number of dispensing pharmacies and specialist visits.

Conclusion

Patients who received HMRs had characteristics that placed them at risk of medication‐related problems. The uptake of HMRs was appropriate in our study population.
Prescribing Antipsychotics for Young People and Monitoring Physical Health and Adverse Effects
Authors: Ellis David , Angley Manya
Published: April 2015

Background

Antipsychotics are increasingly prescribed in young people for psychiatric and behavioural disorders.

Aim

To determine the appropriateness of antipsychotic prescribing in young people; to ascertain the usage of an antipsychotic monitoring program; and to determine congruence with the antipsychotic monitoring program.

Method

A prospective 3‐month audit was conducted of patients aged < 18 years prescribed antipsychotics. Prescribing was deemed ‘appropriate’ if the diagnosis was listed as an indication for the antipsychotic in the Therapeutic Guidelines: Psychotropic and/or the Australian Medicines Handbook and within the recommended dose. For patients on an antipsychotic long term (>1 month), case notes were examined to determine if patients had a monitoring chart and if it was being used as recommended.

Results

Medical records of 60 young patients prescribed antipsychotics were reviewed. 41/70 (59%) antipsychotic prescriptions were congruent with Australian guidelines. Intellectual disability with comorbid psychiatric disorder/behavioural disturbance (20/70; 29%) was the most common indication followed by autism spectrum disorder with behavioural disturbance (13/70; 19%), and schizophrenia and related psychoses (10/70; 14%). Risperidone (36/70; 51%) was the most commonly prescribed antipsychotic. 54/60 patients were prescribed antipsychotics long term (>1 month) and it was deemed necessary they have a monitoring chart. Only 10/54 (19%) patients had an antipsychotic monitoring chart and only 4/54 (7.4%) patients were optimally monitored.

Conclusion

Most antipsychotics prescribed for the young people were congruent with Australian guidelines. In most instances of ‘inappropriate’ prescribing, there was evidence that ‘appropriate’ antipsychotics and doses were trialled and had been unsuccessful. Use of the antipsychotic monitoring program was low; strategies are needed to ensure monitoring occurs in this vulnerable population.
Insulin Dosage Preparation and Administration: Prefilled Pens versus Syringes
Authors: Rollins Brett M , Lee Diana C , Silva Matthew A
Published: April 2015

Background

Insulin delivery systems are continually evolving and today syringes or prefilled pens predominate. An efficient insulin delivery system may recover time, improve safety and reduce healthcare costs.

Aim

To quantify the time required to prepare and administer insulin doses using prefilled pens or syringes.

Method

An insulin delivery simulating protocol was followed. Insulin preparation and administration was timed from the receipt of the medication order until the end of administration. A 2:1 syringe to pen allocation ratio was used; syringes were the control. Two operators were each assigned 58 pen and 116 syringe doses; total of 348 insulin doses.

Results

Randomisation distributed doses uniformly by device and operator. The mean (SD) dose delivered by syringe was 30.4 ± 17 units and 30.3 ± 17.7 units by pen (p = 1.0). Mean dose (p = 0.3) and administration time (p = 0.6) between operators were also similar. Mean administration time for doses delivered by syringe was 71 ± 10.9 seconds and 52.1 ± 9 seconds by pen. Mean time difference between devices was 18.9 seconds (95%CI 17–21; p ≤ 0.0001). Operators prepared and administered doses more quickly over time.

Conclusion

There was a 27% reduction in preparation and administration time when prefilled insulin pens were used. A consistent training effect occurred, which was similar between operators and independent of volume. As product features and operator training influence insulin delivery efficiency, institutions should consider these factors along with efficacy, safety and acquisition costs when selecting prefilled pens or syringes.
Australian Pharmacists' understanding of their Continuing Professional Development Obligations
Authors: Thompson Wendy , Nissen Lisa M
Published: April 2015

Background

Adoption of mandatory continuing professional development (CPD) for pharmacists in Australia is relatively new. Difficulties have been reported with the introduction of CPD frameworks in other countries. There is limited information on how Australian pharmacists have engaged with the CPD requirements for registration.

Aim

To explore Australian pharmacists' understanding and engagement with the CPD requirements for renewal of registration.

Method

The Pharmacy Board of Australia's CPD requirements for registration was used to design an online survey to explore the level of understanding and engagement Australian pharmacists have with the CPD framework.

Results

278 pharmacists responded to the survey − 66% were female, 30% were male and 4% did not disclose their gender. 63% of respondents noted that it would not be difficult to acquire 40 CPD credits annually. Respondents identified that Group 1 activities were a preferred way of acquiring CPD credits. Majority of pharmacists (91%) believed that they knew the CPD requirements for registration and 77% noted that there had been sufficient guidance provided. Despite this, 26% of participants had never used self‐directed learning plans and 38% did not know how to undertake self‐directed learning. 76% of participants were under the common misconception that CPD is synonymous with continuing education.

Conclusion

The majority of pharmacists believe they understand and can engage in the acquisition of CPD credits for renewal of registration. Some aspects of the CPD framework was not understood, such as how it aims to develop a pharmacist's practice. This aspect of the CPD framework will need to be further developed.
Mitomycin‐C‐Induced Thrombotic Thrombocytopenic Purpura
Authors: Crosara Sandra LR , Qumari Sunita , Wall Geoffrey C , Belz Mark M
Published: April 2015

Background

Although mitomycin‐C has been supplanted by other chemotherapeutic drugs, it is still the drug of choice for anus squamous cell carcinoma. Mitomycin‐C has rarely been reported to cause thrombotic thrombocytopenic purpura with or without haemolytic uraemic syndrome (TTP/HUS).

Aim

To report a case of probable mitomycin‐C‐induced TTP with associated acute renal failure and severe hypertension.

Clinical details

A 60‐year‐old Caucasian female was diagnosed with anus squamous cell carcinoma and started on mitomycin‐C, fluorouracil and targeted radiation therapy. After completing this regimen, the patient developed acute kidney injury, thrombocytopenia and hypertension. Kidney biopsy revealed diffuse endocapillary cell proliferation and one glomerulus contained multiple hyaline thrombi with basement membrane double contours. Focal subendothelial and intramural fragmented erythrocytes were present; all of which suggested TTP. The patient was started on high‐dose corticosteroids followed by plasmapheresis.

Outcomes

The patient's blood pressure, and platelets returned to baseline levels, while her renal function improved partially.

Conclusion

TTP is a rare but serious adverse effect associated with mitomycin‐C. Discontinuing mitomycin‐C does not resolve TTP; a variety of treatments are required, such as corticosteroids, plasmapheresis, chemotherapeutic drugs and rituximab.
Non‐Medical Use of Prescription Drugs among Clients Admitted to an Acute Psychiatric Unit
Authors: Chan Thong Wing , Alderman Christopher P , Bell J Simon , Ilomäki Jenni
Published: April 2015

Background

Non‐medical use of prescription drugs (NMPD) is when prescription drugs are used in a manner other than for the reason or duration prescribed.

Aim

To explore NMPD among clients admitted to an acute psychiatric unit.

Method

A prospective observational study was conducted of all clients aged ≥ 18 years admitted to an acute psychiatric unit from 2 July to 2 September 2012. NMPD definition was based on the United Nations Office on Drugs and Crime criteria. Clinical and demographic data were extracted from medical records. Descriptive statistics were used to compare the characteristics of clients with and without NMPD.

Results

Of the 76 eligible clients, 19 (25%) had evidence of NMPD. NMPD was associated with age < 65 years (p = 0.03), consumption of > 4 standard alcoholic drinks per day (p = 0.02), smoker (p = 0.02) and admission for a psychological reason with suicidal ideation (p = 0.03). There was no significant association between NMPD and gender or illicit drug use. Clients with NMPD had higher symptom severity scores at discharge (p = 0.01) and shorter durations of hospital stay than clients without NMPD (p < 0.001).

Conclusion

NMPD was prevalent among clients admitted to an acute psychiatric unit. Clients with NMPD had a shorter hospital stay than those without NMPD. Clinicians and policy makers need to implement strategies to minimise NMPD.
Over‐Anticoagulation in Elderly Warfarinised Patients
Authors: Tran Winnie , Alderman Christopher P
Published: April 2015

Aim

To identify factors that contribute to over‐anticoagulation in elderly warfarinised patients and to review the management of over‐anticoagulation.

Method

A prospective cohort audit was conducted over 6 months (1 February to 31 July 2011) at a teaching hospital. Inpatients with an international normalised ratio (INR) > 4 were identified via a daily automated pathology screening report. Medical notes and drug charts of eligible patients were reviewed and data (medical history, drug history, warfarin regimen, INR results, clinical events, management of over‐anticoagulation) were compiled.

Results

62 patients prescribed warfarin were identified as experiencing over‐anticoagulation. 32 (52%) patients had INRs > 4 and 12/32 (38%) patients had documented bleeding of clinical significance. Most patients had 2, 3 or 4 risk factors for over‐anticoagulation. Prevalent risk factors were: age > 65 years (92%), co‐prescribing warfarin with interacting medications (76%) and renal insufficiency (21%). Co‐prescribed medications that interact or potentiate the effects of warfarin included antibiotics (47%) and non‐steroidal anti‐inflammatory drugs (21%). Most patients with INRs > 4 were managed by withholding warfarin and administering a small dose of vitamin K.

Conclusion

Warfarin over‐anticoagulation was prevalent among elderly patients and those prescribed interacting medications. A conservative approach to the management of over‐anticoagulation was appropriate for most cases.
USING VOLUNTEER MENTORS TO IMPROVE THE ACADEMIC OUTCOMES OF UNDERSERVED STUDENTS: THE ROLE OF RELATIONSHIPS
Authors: Bayer Amanda , Grossman Jean Baldwin , DuBois David L.
Published: April 2015

Schools can benefit from understanding how to use community volunteers to achieve academic goals. A randomized control evaluation, involving 1,139 students from 71 schools, of the school‐based mentoring program of Big Brothers Big Sisters of America found modest but statistically significant improvements in the teacher‐rated academic performance and self‐reported scholastic efficacy of mentored students. The present study explores the causal mechanism behind these effects. We find that a close relationship between mentor and protégé appears key to better academic outcomes. Because relationship closeness is not randomly assigned, we use two‐stage least squares and other methods to control for potential selection bias. The role of emotional closeness as a mediator of program effects is evident across mentoring relationships of various lengths and statuses. Students were more likely to feel close to their mentors in programs that included weekly meetings and opportunities for mentor–protégé pairs to interact outside of a large‐group setting.
USING PSYCHOLOGICAL THEORY TO PREDICT VOTING INTENTIONS
Authors: Hennessy Michael , Delli Carpini Michael X. , Blank Michael B. , Winneg Kenneth , Jamieson Kathleen Hall
Published: April 2015

Voting is an essential component of civic engagement. To demonstrate the utility of a reasoned action approach to predict voting, we created an instrument that measured non‐normative political beliefs and voting intentions. We identified political beliefs and attitudes of the Republican Party, Democratic Party, Libertarian Party, Tea Party, and Occupy Wall Street Movement. A total of 2,637 participants from Mechanical Turk completed the survey using Survey Monkey. We identified the three political belief items best characterizing each political ideology and associated attitudes and beliefs. Regression analysis confirmed the utility of our approach to predict intentions to vote for candidates who were concordant with participants’ attitudes, beliefs, and norms. The reasoned action analyses accounted for a majority of the variance in intention to vote for candidates sharing respondent favored political beliefs and specific political positions. The study is the first to demonstrate that reasoned action approach is an effective tool for predicting civic engagement.
A PRACTICAL IMPLEMENTATION SCIENCE HEURISTIC FOR ORGANIZATIONAL READINESS: R = MC2
Authors: Scaccia Jonathan P. , Cook Brittany S. , Lamont Andrea , Wandersman Abraham , Castellow Jennifer , Katz Jason , Beidas Rinad S.
Published: April 2015

There are many challenges when an innovation (i.e., a program, process, or policy that is new to an organization) is actively introduced into an organization. One critical component for successful implementation is the organization's readiness for the innovation. In this article, we propose a practical implementation science heuristic, abbreviated as R = MC2. We propose that organizational readiness involves (a) the motivation to implement an innovation, (b) the general capacities of an organization, and (c) the innovation‐specific capacities needed for a particular innovation. Each of these components can be assessed independently and be used formatively. The heuristic can be used by organizations to assess readiness to implement and by training and technical assistance providers to help build organizational readiness. We present an illustration of the heuristic by showing how behavioral health organizations differ in readiness to implement a peer specialist initiative. Implications for research and practice of organizational readiness are discussed.