bluuebunny/crossref_metadata_2025 huggingface dataset:
Adherence to Disease Management Interventions for COPD Patients: Patients' Perspectives
Authors: George Johnson , Kong David CM , Santamaria Nick M , Ioannides‐Demos Lisa L , Stewart Kay
Published: April 2015

Background

The management of chronic obstructive pulmonary disease (COPD) requires a disease management approach—a combination of pharmacotherapy, pulmonary rehabilitation and behavioural changes. Patient adherence to therapy has been found to be poor, with a negative influence on outcomes.

Aim

To explore factors associated with adherence to disease management interventions from COPD patients' perspectives.

Method

A subset of 28 patients with moderate to severe COPD participating in a community‐based randomised controlled trial were interviewed in depth about their health beliefs, attitudes to and experiences with their disease and its management, and their relationships with health professionals. The interviews were transcribed verbatim and analysed thematically.

Results

Patients with a range of sociodemographic backgrounds and varying disease severity were interviewed. Adherence to disease management programs in COPD was found to be a complex process driven by health beliefs and experiences related to patient, treatment, disease, and health professionals. 15 major themes related to adherent behaviour were identified. The balance between reservations in following treatment recommendations and motivating factors for following those recommendations was likely to determine decisions to adhere to disease management programs.

Conclusion

The study highlighted the importance of consultation with the patient in the management of COPD. Treatment recommendations that fitted into patients' existing routines were more likely to be successful. Health professionals could enhance adherence by being empathic, by improving patient knowledge about the disease and faith in the treatment, and by reducing their concerns about the treatment.
Influence of Penicillin Allergy on Antibiotic Prescribing Patterns and Costs
Authors: Irawati Lyna , Hughes Jeffery D , Keen Neil J , Golledge Clayton L , Joyce Andrew W
Published: April 2015

Background

Antibiotic treatment for patients with community‐acquired pneumonia (CAP) and previous history of penicillin allergy varies widely and can be more costly than for those with no history of penicillin allergy.

Aim

To assess the influence of documented penicillin allergy on antibiotic prescribing for patients with CAP in an Australian hospital, and the clinical and financial consequences arising from changes to prescribing patterns.

Method

The medical records of all patients 18 years and older admitted with CAP over a 15‐week period were reviewed. The severity of patients' penicillin allergies was assessed through interview using a structured questionnaire and two groups formed: those with and without penicillin allergy. The antibiotic selections and treatment costs (drug plus accommodation costs) were then compared for the two groups.

Results

155 patients were reviewed (84 females, 71 males) with a mean age of 68 years (SD 18). Of these, 27 (17%) had documented penicillin allergies, of which 12 were classified as Severity 1 (anaphylaxis, urticaria), 12 as Severity 2 (rash, itch) and 3 as intolerance (gastrointestinal upset). Patients with a penicillin allergy were more likely to receive a cephalosporin, a macrolide and/or an aminoglycoside. This approach was in accordance with the recommendations of the Therapeutic Guidelines: Antibiotic (published in 2000), however the choice of cephalosporin in all cases was not. A history of penicillin allergy increased length of stay (p = 0.054) and total cost of admission (p = 0.051).

Conclusion

Adherence of antibiotic prescribing to the Therapeutic Guidelines: Antibiotic for patients with penicillin allergies is variable. Patients labelled with penicillin allergy had greater drug costs and total admission costs. Thorough history taking to identify patients with true allergy versus intolerance may increase appropriate use of penicillins and reduce the use of more costly and potentially toxic alternative antibiotics.
Pharmaceutical Review: Resource Implications for the Pharmacy Component in Australian Public Hospitals
Authors: O'Leary Karen M , Allinson Yvonne M
Published: April 2015

Background

Pharmaceutical review requires a facility‐wide approach and multidisciplinary collaboration between all involved in the use of medicines. Standards of practice for clinical pharmacy services and distribution of medicines, provide a blueprint for two activity groups provided by pharmacy services that contribute to pharmaceutical review.

Aim

To explore the pharmacy components required to deliver pharmaceutical review in Australian public hospitals and examine the resource implications to meet these objectives.

Method

Workforce data were collected from a questionnaire sent to hospital pharmacy managers in 2005. Respondents were asked to detail the pharmacist full‐time equivalents (FTEs) devoted to clinical, distribution and management activities. They were also asked to detail clinical service delivery models and the number of beds at their facility according to clinical pharmacy categories. Ratios of the number of pharmacists to clinical pharmacy bed type were used to calculate the national workforce requirements estimated after extrapolation.

Results

Approximately 768 pharmacist FTEs would be required to provide a basic clinical pharmacy service (3 clinical pharmacy activities: accurate medication history, assessment of current medication management, provision of medicines information to patients) for all patients in Australian public hospitals; approximately 1300 pharmacist FTEs would be required for a comprehensive clinical pharmacy service. This equates to 58 minutes of pharmacist time during an inpatient stay, for each overnight admission. At least 40% of clinical pharmacy services are required for general medical type beds and this should be considered when identifying the skills base required in the hospital pharmacy workforce.

Conclusion

Retaining the current highly skilled pharmacist workforce and attracting pharmacists into the hospital sector to fill vacant establishment positions is the first step. The number of establishment positions will then need to be increased nationally to fully deliver pharmaceutical review in Australia's public hospitals.
Promoting Safe Use of Paracetamol in Children
Authors: Graudins Linda V , Gazarian Madlen
Published: April 2015

Paracetamol is one of the most widely used analgesics and the most common medicine given to children in Australia. Its safety and efficacy when appropriately used is well established and its effects in acute overdose are well known to health professionals. However, gaps in knowledge of parents/carers of young children about its safe use are less recognised and may lead to unintentional misuse and harm. This paper aims to help bridge this knowledge gap and promote safe use of paracetamol in children. By using illustrative cases to highlight this problem, discussing the relevant literature, providing a parent/carer counselling checklist and resources for health professionals.
Angioedema Possibly Associated with Ezetimibe
Authors: Shah Krupa , Taylor Simone E , Cranswick Miriam , Chan Robert K
Published: April 2015

Background

Angioedema has been reported during ezetimibe post‐marketing surveillance; no causality has been established.

Aim

To describe a case of delayed angioedema possibly associated with ezetimibe therapy.

Clinical details

A 64‐year‐old female presented with angioedema and urticaria developing progressively over 2 days, 3 months after starting ezetimibe. She had no respiratory compromise, infectious symptoms or swelling of the tongue or pharynx. She was moderately distressed, and vital signs were normal. She was not taking an ACE inhibitor, angiotensin II antagonist, aspirin or NSAID. She denied complementary medicine use or change in diet. She had no previous drug, food, or food additive allergies and no family history of angioedema. Standard laboratory tests were within normal limits.

Outcome

Swelling responded to prednisolone and promethazine. Ezetimibe, the suspected precipitant was discontinued. Swelling resolved 4 days after presentation. 10 months after ceasing ezetimibe, she had no further episodes of angioedema or urticaria.

Conclusion

Close monitoring and reporting of future cases of ezetimibe‐associated angioedema will be required to fully characterise the nature of this potential adverse drug reaction.
SHPA Standards of Practice for the Provision of Palliative Care Pharmacy Services
Authors: Gilbar Peter
Published: April 2015

These are standards of professional practice and not standards prepared or endorsed by Standards Australia. They are not legally binding.
Possible Role for Clinical Pharmacists in Identifying Pharmacogenomic Interventions
Authors: Toy Alana C , Anderson Barbara A , McKinnon Ross A , Gilbert Andrew L
Published: April 2015

Background

Individualised drug therapy is important in contemporary pharmacy practice. Pharmacogenomics is one way of individualising therapy to maximise efficacy and minimise toxicity, based on patients' genetic data.

Aim

To assess clinical pharmacists' understanding of pharmacogenomics and their ability to identify interventions.

Method

Structured interviews were conducted with 9 clinical pharmacists, practising in a private hospital setting, to identify: level of understanding of pharmacogenomics; drugs encountered that display significant inter‐patient variability; and whether a literature review could confirm that dugs identified are likely to have a genetic basis for their variability.

Results

Findings of this pilot study show that although pharmacists had a negligible understanding of pharmacogenomics, they acknowledged the importance of its integration into clinical practice and the need for education. Pharmacists identified a number of drugs which displayed inter‐patient variability—the drugs were subsequently confirmed by a literature search to be affected by genetic polymorphisms.

Conclusion

For pharmacogenomics to be successfully implemented in practice, there is a need for education of pharmacists. Pharmacists saw pharmacogenomics as a beneficial technology that could improve patient outcomes.
Literature summaries of the latest developments in pharmacy practice and therapeutics
Authors: Keen Neil
Published: April 2015

DrugScan is a review of the international literature on therapeutics. Leading pharmacy practitioners scan the literature and present information on major clinical trials, important pharmacoepidemiology studies, pharmacoeconomic research and other related materials in a succinct format. Interested readers are encouraged to explore the original publications in greater detail.
Prolonged Antibiotic Therapy for Recurrent Urinary Tract Infections in Aged‐Care Residents: Time to Change the Dogma?
Authors: Wee Jayne S , Hughes Jeffery D , Lee Andy H , Joyce Andrew W
Published: April 2015

Aim

To determine whether the duration of therapy and antibiotic dosage prescribed affected the recurrence rates and times between recurrent urinary tract infection (UTI) episodes among elderly women in residential aged‐care facilities.

Method

A 2‐year retrospective cohort study was conducted in 6 aged‐care facilities. Eligibility criteria were females aged ≥ 60 years in residential aged‐care for at least 6 months. Poisson regression and survival frailty modelling were used to analyse the recurrence rates and times between successive UTI episodes.

Results

Of the 200 eligible subjects, 35 (18%) had 1 UTI episode and 57 (29%) had recurrent UTI episodes during the follow‐up period. The majority (72%) of the total 269 UTI episodes were either diagnosed by midstream urine culture plus dipstick analysis, or midstream urine culture only. On average, 5 antibiotics courses with a duration of 13.5 doses were prescribed. Apart from prior history of UTI and residential status, the incidence of recurrent UTI was positively associated with the duration of antibiotic treatment (adjusted RR = 1.05; 95%CI 1.02–1.09) and antibiotic courses prescribed (adjusted RR = 1.14, 95%CI 1.09–1.20). The median time between successive UTI episodes was 125 days (95%CI 90–160). Treatment duration and antibiotic exposure did not significantly affect the recurrence times.

Conclusion

Prolonging antibiotic therapy neither reduced the incidence of recurrent UTI nor increased the time between recurrent UTI episodes. The findings do not support antibiotic treatment guidelines currently adopted in practice and suggest the need for a prospective randomised trial.
Classification of Findings in the Home Medicines Reviews of Post‐Discharge Patients at Risk of Medication Misadventure
Authors: Nguyen Andrew , Yu Kevin , Shakib Sepehr , Doecke Christopher J , Boyce Merelyn , March Geoff , Anderson Barbara A , Gilbert Andrew L , Angley Manya T
Published: April 2015

Background

The risk of medication misadventure for patients is greatest during times of change, particularly on discharge from hospital. Patients at high risk of medication misadventure post‐discharge should be identified and provided with interventions to ensure the quality use of medicines and positive health outcomes. Home medicines reviews (HMRs) can be used to improve patient health outcomes and reduce the risk of medication misadventure.

Aim

To describe the impact of issues raised in post‐discharge HMRs, organised via a hospital medication liaison service.

Method

HMR reports of participants were evaluated. Issues identified by the accredited pharmacist in each HMR report were classified as either a ‘pharmacist intervention’ delivered during the HMR or ‘information given’ that was previously unknown to the medical team. A potential clinical impact of these issues was assigned and the overall clinical significance of all the issues identified in each HMR report was ranked.

Results

In 21 HMR reports, 98 issues were identified, with the mean per HMR report of 4.7 ±2.2. Of the 98 issues, 25 were classified as ‘pharmacist intervention’ and 73 were classified as ‘information given‘. On 2 occasions, a potential clinical impact of 4 (potentially life‐saving) was allocated to an issue identified in the HMR report. 90% of issues identified in the HMR reports were ranked as clinically significant.

Conclusion

This pilot demonstrated that a liaison pharmacist was able to implement a hospital medication liaison model for patients at risk of medication misadventure. Evidence suggests that an HMR conducted post‐discharge can identify clinically significant medication‐related issues.
Retention and Recruitment of Oncology Pharmacists
Authors: Gilbar Peter , Davis Jill , McLauchlan Robert , O'Leary Karen M
Published: April 2015

Background

A noticeable turnover of staff through the specialty of oncology pharmacy has been observed nationally. Literature searches failed to identify research directly relating to oncology pharmacist retention. Studies in pharmacists and non‐pharmacist oncology staff have determined that, while patient care and contact, personal accomplishment and satisfaction are important, stress levels and lack of professional support were factors considered when leaving the profession.

Aim

To explore why pharmacists choose to remain in or leave the specialty of oncology pharmacy and identify strategies to ensure retention of current staff and aid recruitment of new oncology pharmacists.

Method

Electronic surveys designed to obtain retrospective quantitative and qualitative data were sent to: current oncology pharmacists; former oncology pharmacists; and directors of pharmacy at institutions with oncology services. Participants were identified through databases of the Society of Hospital Pharmacists of Australia, Clinical Oncological Society of Australia, and International Society of Oncology Pharmacy Practice.

Results

Reasons for pharmacists remaining in oncology generally related to job satisfaction issues (closely associated with clinical involvement). Reasons for leaving included stress levels, staffing issues, lack of recognition from hospital management and remuneration. Strategies for retaining staff should include improved pay structure, opportunities for professional development and continuing education, peer support, availability of suitably trained staff to cover periods of leave, positive feedback and support from hospital management, and devising methods for reducing work‐related stress.

Conclusion

Implementation of information gained from this study will facilitate recruitment and retention of experienced, well‐trained oncology staff.
Incidence of Vancomycin‐Induced Red Man Syndrome in a Women's and Children's Hospital
Authors: Chui Sin Yan , Onishko Christine , Turner Sean , Coulthard Kingsley , McKinnon Ross
Published: April 2015

Background

Red man syndrome (RMS) is an adverse reaction to vancomycin. Symptoms include rash, itch, hypotension, hypothermia, angioedema and respiratory distress. The incidence of RMS in the paediatric population is unclear.

Aim

To estimate the incidence of RMS in a women's and children's hospital, focusing on the paediatric population, and to identify risk factors.

Method

Patients at a women's and children's hospital receiving IV vancomycin were identified during a 2‐month period and their case notes were reviewed for documented RMS symptoms.

Results

21 patients (5 days to 24 years of age) were identified, and 37 vancomycin courses were investigated. RMS symptoms occurred in 8/21 (38%) patients and in 8/37 (22%) vancomycin courses. 4 patients experienced a rash only, mostly an itchy, urticarial rash on the face and/or limbs. 4 patients experienced RMS without a rash: 2 had hypotension; 1 had bradycardia; and 1 had hypothermia, hypotension and bradycardia. None of the reactions were life‐threatening, and none resulted in cessation of vancomycin. 3/4 patients who experienced a rash received antihistamines, whereas none of the 4 patients who experienced RMS without a rash received antihistamines.

Conclusion

RMS is common and unpredictable. Cardiovascular symptoms can occur without accompanying dermatological symptoms. There may be potential for greater use of antihistamine prophylaxis and treatment for RMS.
Managing Extemporaneous Oral Liquids in Practice
Authors: Haywood Alison , Glass Beverley
Published: April 2015

Oral liquid preparations are often the dosage form of choice in paediatric and geriatric populations. Many drugs are not available in oral liquid dosage forms because of the complexity of formulating liquids and the small market size. Pharmacists are often challenged with the extemporaneous preparation of oral liquids from commercially available products. Most problems associated with the stability of these preparations have been attributed to interactions between the drug substance and excipients (tablet and formulation) rather than the degradation of the drug substance by standard routes. However, a review of 83 such dosage forms revealed that only 7.2% exhibited stability concerns. To address these challenges pharmacists may consider the management plan for oral liquid dosage forms presented in this paper to ensure the provision of safe, effective and quality drug products to patients.
Reporting the Real Value of a Hospital Pharmacy Service
Authors: Thornton Penny
Published: April 2015

Background

Hospital pharmacy managers have to account for the expenditure of millions of dollars of public funds for drugs provided in healthcare delivery. There appeared to be variation in the method of reporting drug expenditure data in Australian hospitals.

Aim

To investigate the reporting practices used by hospital pharmacy departments to account for their drug expenditure.

Method

Pharmacy managers of Australia's major metropolitan and rural hospitals were surveyed for their financial reporting practices. These baseline data were then compared to the financial reporting methods used by UK hospital pharmacy managers (a comparable public health provider). Hospital administrators were also interviewed to determine their ideal drug expenditure report.

Results

The baseline survey consisted of 93 responses and demonstrated that varying types of financial reporting are used with a primary focus on gross expenditure and high‐cost drug use with variable definition. Few drug expenditure reports considered cost per patient treated. Other pharmacy services delivered adjacent to this expenditure were separately reported.

Conclusion

Significant variation was identified in reporting hospital drug expenditure data. The disparate models of financial reporting in Australia are in contrast with the unified UK model. A reporting template is proposed that will provide a means of identifying key variation in expenditure alongside service delivery.
SHPA Standards of Practice for the Provision of Oral Chemotherapy for the Treatment of Cancer
Authors:   SHPA Committee of Specialty Practice in Cancer Services
Published: April 2015

These guidelines are standards of professional practice and not standards prepared by Standards Australia. They are not legally binding.
Scope of Pharmacy Services to the Emergency Department
Authors: Welch Susan A , Graudins Linda V
Published: April 2015

Aim

To determine the scope of pharmacy services offered by Australian emergency medicine (EM) pharmacists, and to use the data to develop the SHPA Practice Standards for EM.

Method

Qualitative data were obtained from a survey that was e‐mailed to EM pharmacists and state‐based quality use of medicine groups about the type and extent of pharmacy services to the emergency department (ED).

Results

The survey was distributed to 22 hospitals known to have an EM pharmacist, with a response rate of 82% (18/22) and 92 hospitals via the quality use of medicine groups. No further EM pharmacists were identified via the quality use of medicine groups. The majority (94%) of EM pharmacists took medication histories on admission and 89% reported adverse drug reactions. 78% (14/18) regularly contacted community health professionals about patients admitted to the ED. 39% (7/18) had conducted ED‐related research. Other services included: patient counselling, preventing medication‐related problems on discharge, protocol development, provision of drug information, stock control, and staff and student education.

Conclusion

Working in the ED is a relatively new professional activity for pharmacists. EM pharmacists are involved in the quality and safe use of medicines, by providing continuity of pharmaceutical care from community to the ED and to the wards with regards to medicines management, as well as a wide range of services to patients and staff in the ED. The survey responses were incorporated into the SHPA Practice Standards for EM.
Community Pharmacy's Role in Promoting Healthy Behaviours
Authors: Joyce Andrew W , Sunderland V Bruce , Burrows Suzanne , McManus Alexandra , Howat Peter , Maycock Bruce
Published: April 2015

Many have commented on the potential of community pharmacy as a health promotion setting, due to accessibility, high level of use, and the respect afforded to pharmacists. Community pharmacy could be a setting through which to address risk and protective health behaviours relevant to Australia's National Health Priority Areas. However, apart from some studies on smoking cessation, there is scant evidence on its involvement in other healthy behaviours. This paper discusses how to increase research and interventions on healthy behaviours in community pharmacy. This includes placing community pharmacy's role within a broader health promotion context, expanding community expectations of pharmacists, and addressing barriers to performing a health promotion role.
Medication Safety Series
Authors: Thornton Penny
Published: April 2015

This series brings you up‐to‐date information about medication safety and strategies to prevent medication errors. It draws on Australian incidents and US experience, including (with permission) material from ISMP Medication Safety Alert! a bulletin published by the Institute for Safe Medication Practices, USA . This series is coordinated through the Committee of Specialty Practice in Medication Safety (Chair, Rosemary Burke, Director of Pharmacy, Concord Hospital, NSW). Australian incidents are collated and recommendations made by Penny Thornton (Federal Councillor, SHPA, and Pharmacy Services Manager, The Children's Hospital, NSW; e‐mail: pennyt2@chw.edu.au).
Serial Point‐Prevalence Studies to Investigate Hospital Antimicrobial Prescribing
Authors: Ho Lisa , Melvani Sharmila
Published: April 2015

Aim

To investigate antimicrobial prescribing patterns using a validated point‐prevalence approach and to identify intervention targets to optimise antimicrobial use.

Method

3 prospective point‐prevalence studies were conducted over 4‐day periods in April 2005, September 2005 and April 2006 at a tertiary hospital using a previously published method. Clinical pharmacists used a standardised data collection form on an allocated day to record details of all patients who were prescribed systemic antimicrobials (antivirals, antifungals, antibacterials) and the total number of patients seen. The appropriateness of the IV route was assessed using pre‐defined criteria.

Results

Over the 3 study periods 1515 drug charts were reviewed. Of these, 508 (34%) patients were prescribed 832 antimicrobial courses. The mean patient age was 67.5 (SD 32.3) years and 55% were males. Treatment accounted for 730 (88%) courses and prophylaxis for 102 (12%). The most frequently prescribed antimicrobials were ceftriaxone (9.7%) and amoxycillin/clavulanate (7.5%). The most commonly prescribed antimicrobial classes were penicillins (26%) and cephalosporins (20%). 342 (41%) courses were restricted antimicrobials and 85% of these had appropriate approval. 478 (58%) courses were given IV with clinical pharmacists identifying that 2.9% of these could have been given orally.

Conclusion

Serial point‐prevalence studies proved to be an effective tool for examining baseline patterns of antimicrobial use. This efficient and reproducible tool would be appropriate for other hospitals to use as a component of their antimicrobial usage monitoring.
Pharmacists Investigating Adverse Penicillin Responses—Pilot Study
Authors: Roberts Jason A , Hsu Millie , Allen Karen , Willis Jennifer , Barras Michael
Published: April 2015

Background

Penicillins are used first‐line for many infections and are commonly associated with adverse drug responses. Pharmacists can take a detailed adverse drug response history and provide such information to prescribers.

Aim

To investigate and quantify the nature of adverse penicillin responses of hospital inpatients and to develop a tool to enable pharmacists to provide recommendations on potential rechallenge of patients with a history of adverse response to penicillin.

Method

Patients were administered a structured interview to classify the true nature of their documented adverse penicillin responses. A literature review was undertaken to develop a flowchart to enable pharmacists to advise on penicillin rechallenge in patients with a history of adverse response to penicillin.

Results

84 patients were identified and 49 (58%) met the inclusion criteria. Of these 18% had either a true penicillin allergy or were not able to recall the nature of their reaction. Of the 49 patients interviewed, 82% could be rechallenged with a penicillin. The literature review identified publications that allowed the development of a flowchart to assist pharmacists in evaluating reactions and recommending future therapy for these patients.

Conclusion

In this small cohort, a significant proportion of patients were considered appropriate for rechallenge with penicillins. Knowledge of the sequelae of previous exposure to penicillins can inform decisions should a penicillin be indicated for treatment. The flowchart will allow pharmacists to make recommendations to the patient's medical team.
Investigation of Trigger Tools for Detecting Adverse Drug Reactions
Authors: Zolezzi Monica , Forbes Alison , Parsotam Nirasha , Asamoah Philomina , Cheng Grace , Ngieng May LL , Oldfield Benjamin , Park Sarah SH
Published: April 2015

Background

Despite the high morbidity and mortality associated with adverse drug events (ADEs) and adverse drug reactions (ADRs) the ability to detect and report them systematically remains inefficient.

Aim

To investigate if the use of a modified ADE trigger tool could improve the identification of ADRs in hospitals.

Method

Retrospective review of patients' discharge summaries was conducted at a tertiary care facility over a 5‐week period. A modified ADE trigger tool (based on a previous model) was used to assess four high‐risk medicines (warfarin, heparin, morphine, benzodiazepines). ADEs identified were classified using both the Naranjo probability scale and the WHO ADR classification.

Results

Data from 528 patients were reviewed, of which 286 (54%) received at least 1 of the 4 high‐risk medicines. 45 patients (8.5%) were identified using the modified trigger tool as having had an ADE during their hospital stay. The modified ADE trigger tool improved the identification of ADRs compared with the spontaneous reporting system, regardless of the classification method used. Both the WHO and Naranjo classification scales yielded higher rates than the spontaneous reporting rate of 0.07% recorded by the New Zealand Centre for ADR Monitoring.

Conclusion

The modified ADE trigger tool appears to be a sensitive method for identifying ADRs. The results indicate that using the modified trigger tool yields significantly higher ADR reporting rates than the traditional spontaneous reporting system.
Medication Safety Series
Authors: Thornton Penny
Published: April 2015

This series brings you up‐to‐date information about medication safety issues and strategies to prevent medication errors. It draws on Australian incidents and also US experience, including (with permission) material from ISMP Medication Safety Alert! a bulletin published by the Institute for Safe Medication Practices, USA . This series is coordinated through the Committee of Specialty Practice in Medication Safety (Chair, Rosemary Burke, Director of Pharmacy, Concord Hospital, NSW). Australian incidents are collated and editorial recommendations made by Penny Thornton (Federal Councillor, SHPA, and Pharmacy Services Manager, The Children's Hospital, NSW; e‐mail: pennyt2@chw.edu.au).
SHPA Standards of Practice for the Transportation of Cytotoxic Drugs from Pharmacy Departments
Authors:   SHPA Committee of Specialty Practice in Cancer Services
Published: April 2015

These are standards of professional practice and not standards prepared or endorsed by Standards Australia. They are not legally binding.
Specialised Compounding—Practices and Opinions of Australian Community Pharmacists
Authors: Giam Jennifer A , McLachlan Andrew J , Krass Ines
Published: April 2015

Background

Anecdotal reports of the increase in dispensing of compounded products have resulted in a review of pharmacy compounding by regulatory authorities. However, little is known about the compounding practices of community pharmacists.

Aim

To investigate the extent and nature of compounding in community pharmacies, to assess the differences between specialised and non‐specialised compounding practices and to evaluate pharmacists' attitudes to compounding as a specialty.

Method

A 42‐item self‐completion questionnaire was sent to 500 randomly selected Australian community pharmacies. This was followed by 3 additional mailings to non‐responders. A final non‐respondent telephone survey was also conducted.

Results

Inclusion criteria were met by 465 pharmacies. Surveys were completed by 271 pharmacists (58% response rate). Although the extent of compounding is unchanged (less than 1% of prescriptions) some pharmacists have adopted compounding as a specialty practice. Specialised compounding was provided by 9.6% of pharmacies dispensing an average of 25 compounded products weekly compared to 3 products by non‐specialised pharmacies. Specialised pharmacies have different equipment and training, and dispensed a variety of dosage forms for a wide range of therapeutic areas.

Conclusion

Specialised compounding service is being increasingly offered by community pharmacies. Pharmacists felt strongly that compounding should be provided by all pharmacies but accepted that there should be accreditation of specialised practices. More research is needed to enable the development of appropriate standards and guidelines.
Young Pharmacists as Mentors to Pharmacy Students: Partnerships for the Future of the Profession
Authors: Moles Rebekah J , Roberts Alison S , Diamandis Simone , Bell J Simon , Nichols Cecily
Published: April 2015

Background

There is a well‐documented shortage of pharmacists in Australia and overseas. Mentoring has been proposed as a strategy to help bridge the gap between university and the workforce, and to maintain enthusiasm in young pharmacists and students for their profession.

Aim

To develop, implement and evaluate a mentoring program, matching young pharmacists working in a range of pharmacy practice settings with pharmacy students.

Method

The mentoring program was divided into 3 phases: Phase 1—literature review and feasibility study; Phase 2—recruitment of young pharmacists (mentors) and pharmacy students (mentees), matching mentors and mentees by areas of pharmacy interest and encouraging them to discuss their individual needs, desires and work goals; Phase 3—program evaluation.

Results

151 mentees and 56 mentors (n = 207) were recruited (April 2003 to October 2004). Of the 56 mentors, 13 were from a hospital pharmacy background. 42% of students selected hospital pharmacy as their first preference and 21% selected hospital pharmacy as their second preference. 58 students were recorded as having a hospital mentor. Due to poor response rates to the program evaluation survey, the data reported for phase 3 is for all participants and is not specific to hospital. No differences in qualitative results could be seen between the sectors.

Conclusion

The mentoring program was flexible and appears transportable. Further studies are needed to determine whether mentoring impacts on the retention of young pharmacists and pharmacy students within the profession. We recommend that the profession support a national mentoring program where further outcomes of this model could be evaluated.
Surface Contamination from Cytotoxic Chemotherapy Following Preparation and Administration
Authors: Lee Su‐Gil , Tkaczuk Michael , Jankewicz Ganyk , Ambados Fotios
Published: April 2015

Background

Surface contamination with cytotoxic drug residue is a potential occupational health hazard to staff working in cytotoxic compounding areas and oncology wards.

Aim

To identify surfaces contaminated with cytotoxic drug residue and to indicate the risk of exposure to health workers handling cytotoxic drug residue.

Method

Wipe sampling was used to investigate surface contamination and occupational skin exposure to the marker cytotoxic drugs, fluorouracil (5‐FU) and gemcitabine (GEM), in the pharmacy cytotoxic compounding section and oncology wards. Drug packaging, primary containers and gowns were also examined. Samples were analysed using a validated HPLC method. Repeat sampling was performed on selected surfaces to monitor any impact after implementing changes in practice.

Results

The majority of surfaces tested were contaminated. The cytotoxic work room (5‐FU 56.7–320 μg/m2; GEM 75–370 μg/m2) and oncology wards had similar levels of contamination. Cytotoxic drug residue was detected on original containers and drug vials (5‐FU < 3–6 μg; GEM 7.8–7.9 μg/wipe sample) stored in the cytotoxic work room but not on containers delivered directly from the distributor, suggesting that accidental contamination by pharmacy personnel does occur. Contamination was also detected on sections of the gowns (GEM around 0.9 mg/m2) worn by nurses in the oncology wards.

Conclusion

There is a risk of dermal contamination and accidental ingestion from inappropriate use of gloves, hand washing and cleaning, during and after preparation and administration of cytotoxic drugs. Implementing effective cleaning practices to decontaminate work surfaces is recommended in all cytotoxic drug compounding and administration areas. Regular environmental monitoring is warranted in these areas to ensure that background contamination is kept to a minimum and that decontamination protocols are adhered to.
Trans‐Tasman Comparison of Non‐Prescription Medicine Purchasing Behaviour
Authors: Bialy Leisa H , Emmerton Lynne M
Published: April 2015

Background

The non‐prescription medicine market is subject to professional practice policy and legislative influences, including trans‐Tasman harmonisation initiatives.

Aim

To establish a baseline comparison of purchasing behaviour for non‐prescription medicines in community pharmacies in Australia and New Zealand.

Method

2 comparable survey databases were merged and analysed. The Australian survey was conducted in 15 pharmacies in August 2004 (n = 3017) and the New Zealand survey was conducted in 6 pharmacies in July 2005 (n = 1092). Both used the same questionnaire, completed via observation of the sale and interview with all available customers. Data included customer demographics, purchasing behaviour and the observed incidence of staff‐customer consultation during the sale.

Results

General descriptors of the 2 cohorts were similar. Analysis of purchasing behaviour variables revealed significantly higher incidence of pharmacy staff involvement in product selection and customers' predetermined brand choices in Queensland compared to New Zealand. However, there was a significantly higher rate of observed questioning and advice by pharmacy staff in New Zealand across all schedules of medicines, with greater involvement of pharmacists alone in Queensland.

Conclusion

A number of trans‐Tasman differences were identified in non‐prescription medicine purchasing behaviour from two limited samples of pharmacies. Future concurrent and national‐scale research is recommended to explore and monitor these findings with respect to trans‐Tasman medicines regulatory harmonisation and professional pharmacy initiatives.
Measuring Pharmacy Workload Associated with Clinical Trials
Authors: Rice Carol A , Dooley Michael J , Kirsa Suzanne W
Published: April 2015

Aim

To develop and evaluate a method to quantify hospital pharmacy workload associated with clinical trials.

Method

Workload measures were developed and then applied to quantify workload associated with clinical trials within the pharmacy department at Peter MacCallum Cancer Centre.

Results

4 workload measures were developed and included a setup score for trial establishment and 3 complexity indices for the specific activities associated with patients accrued to clinical trials. The setup score was assigned to each trial based on the initial workload required to set up the trial in preparation for patient recruitment and dispensing. The complexity indices were assigned to the activities associated with the preparation of study medication, dispensing of individual patient treatments and documentation requirements. Application of these measures to all clinical trials open for patient accrual for the calendar years, 2000 and 2004 showed a 33% increase in dispensing (1299 compared to 1726 clinical medicine supplies) with a total complexity increase of 51% and an average setup score increase of 6%. The data collected were successfully used to support an application for increased funding for the clinical trials service within the pharmacy department.

Conclusion

The complexity index and setup score are valuable tools to quantify workload within a hospital pharmacy clinical trials service and identifies the key aspects of a clinical trial that require pharmacy resources.
Acute Renal Failure in Patients on Diuretics and/or NSAID, COX‐2 inhibitors, ACEI, ARA
Authors: Ng Chin Soon , Pillans Peter I , Johnson David W , Sturtevant Joanna M
Published: April 2015

Aim

To review acute renal failure in patients on one or more target drugs – diuretics, non‐steroidal anti‐inflammatory drugs (NSAID), cyclo‐oxygenase‐2 (COX‐2) inhibitors, angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor antagonists (ARA).

Method

Retrospective review of drug charts of patients admitted to hospital with acute renal failure from 2003 to 2005. Patients taking one or more of the target drugs prior to admission were identified. Data were collected on patient demographics, target drugs, other factors contributing to acute renal failure, medical history, baseline and peak creatinine concentration, and clinical outcome. The baseline and lowest estimated glomerular filtration rate (eGFR) were calculated.

Results

Of the 289 patients admitted with acute renal failure, 108 (37%) were taking one or more of the target drugs. The mean age was 73 years and 84 patients (79%) had a baseline eGFR of = 60 mL/min. There was a marked decline in kidney function from a mean baseline eGFR of 50 mL/min to 17 mL/min (60% decline). 44% of patients were dehydrated, 12% were septic and 60% had more than 4 comorbid diseases. Only 6 patients were on more than 3 target drugs. The decline in eGFR exceeded 50% with each drug/drug combination and except for ACEI and ARA (withheld in 50% of cases) other drugs/drug combinations were withheld in most patients. Acute renal failure was reversible after treatment of the underlying illness and withdrawal of the target drugs in the majority of patients.

Conclusion

Over a third of patients with acute renal failure were taking diuretics, NSAID/COX‐2 inhibitors, ACEI/ARA, which may have played a causal or contributory role in the decline in their renal function. Other risk factors for developing acute renal failure included dehydration, sepsis, multiple comorbidities and older age.
Variation in Paediatric Omeprazole Dosing
Authors: Graudins Linda V
Published: April 2015

Aim

To characterise enteral omeprazole prescribing for paediatric inpatients; to compare doses prescribed for tablets and mixtures; and to compare doses prescribed to a nationally recognised paediatric dosing guideline.

Method

A cross‐sectional study conducted at a paediatric hospital where pharmacists prospectively collected dose and formulation data for all paediatric inpatients prescribed enteral omeprazole over a 2–week period.

Result

35 children (8.6% inpatients) were prescribed enteral omeprazole. Omeprazole doses varied from 0.5 to 3.7 mg/kg/day (median 1.2), higher doses were prescribed for infants and for the mixture formulation. Less than half of the prescriptions followed the nationally recognised paediatric dosing guideline.

Conclusion

There was a wide variation in omeprazole dosing in children. Studies of the stability and bioavailability of omeprazole along with clinical outcomes are needed to establish optimal dosing, especially in younger children.
DrugScan Series
Authors: Eaton Vaughn
Published: April 2015

DrugScan is a review of the international literature on therapeutics. Leading pharmacy practitioners scan the literature, and then summarise and comment on major clinical trials, pharmacoepidemiology studies, and pharmacoeconomic research. Readers are encouraged to explore the original publications in greater detail.
Cytochrome P450 Part 1: Multiplicity and Function
Authors: McKinnon Ross A , Sorich Michael J , Ward Michael B
Published: April 2015

While new cytochrome P450 (CYP450) enzymes continue to be identified, it is now possible to predict with some confidence the total number of human CYP450 enzymes. This review is an update of the CYP450 superfamily of drug metabolising enzymes. It comprises a brief history of CYP450 research, outlines the standard P450 nomenclature system, and describes CYP450 multiplicity, structure and function.
Prevalence and Validity of Self‐Reported Antibiotic Allergy in Emergency Department Patients
Authors: Wong Jeremy , Knott Jonathan C , Taylor David McD , MacBean Catherine E
Published: April 2015

Aim

To determine the prevalence of self‐reported antibiotic allergy and the likelihood of true antibiotic hypersensitivity in emergency department patients.

Method

A convenience sample of emergency department patients were reviewed for antibiotic allergy. Patients with self‐reported allergy were invited to participate in a structured interview to obtain a detailed allergy history. The interview findings were reviewed to determine the likelihood of the self‐reported reaction being an allergy.

Results

141/1087 (13%; 95%CI 11.1–15.2) patients reported an antibiotic allergy. 18 antibiotics were reported as allergens, with penicillin reported 107 times (prevalence 9.8%; 95%CI 8.2–11.8). 41 patients underwent a structured interview. More than 20 different allergy symptoms were reported, especially rash, redness and itchiness. 9 (19%; 95%CI 0.7–15.7) patients were classified as unlikely to have a true antibiotic hypersensitivity.

Conclusion

Although, self‐reported antibiotic allergy is common, a considerable proportion are unlikely to be true hypersensitivities. Further education, referral and skin‐prick testing of patients is needed.
Australian General Practitioners' Views on Pharmacist Prescribing
Authors: Vracar Dijana , Bajorek Beata V
Published: April 2015

Aim

To explore Australian general practitioners' views on extending prescribing rights to pharmacists, the appropriateness of pharmacist prescribing models, and the influence of general practitioners' characteristics on their preference for a particular pharmacist prescribing model.

Method

The study consisted of two parts. Part A was a scenario‐based questionnaire using Likert‐scale responses and Part B was a semi‐structured interview. General practitioners were randomly recruited from two Sydney divisions of general practice. Data were analysed using descriptive statistics and qualitative responses were thematically analysed.

Results

Completed questionnaires were received from 22/150 general practitioners (response rate 15%), with 10 general practitioners providing additional comments. 10/12 (83%) general practitioners participated in the interviews. Repeat prescribing and prescribing by referral were the most favoured models; 53% of general practitioners rated them as appropriate or somewhat appropriate models of pharmacist prescribing. 6 major themes emerged: focus on safety issues, lack of awareness of pharmacist training and capabilities, division of professional/clinical responsibility, conflict in definition of prescribing versus treating, interference with the general practitioner‐patient relationship and remuneration.

Conclusion

General practitioners favoured the dependent pharmacist prescribing approach, which is the most widespread practice overseas. The issues raised by the general practitioners need to be addressed before pharmacist prescribing can be pursued in Australia.