bluuebunny/crossref_metadata_2025 huggingface dataset:
Improvement in Pharmacist's Performance Facilitated by an Adapted Competency‐Based General Level Framework
Authors: Coombes Ian , Avent Minyon , Cardiff Lynda , Bettenay Karen , Coombes Judith , Whitfield Karen , Stokes Julie , Davies Graham , Bates Ian
Published: April 2015

Background

The General Level Framework (GLF) is a tool for evaluating pharmacists' performance, providing tailored feedback and training, and guiding professional development.

Aim

To ascertain the changes in pharmacists' workplace performance over time using the GLF and to describe pharmacists' views on the baseline evaluation process.

Method

The UK GLF was mapped against Australian pharmacy competency standards and practice guidelines. 61 of the 92 competencies from the Queensland Health version of the GLF representing core professional activities of Australian pharmacists were analysed. Trained evaluators used the adapted GLF to observe pharmacists from 18 Queensland public hospitals in their workplace (baseline and repeat) and rate the frequency with which competencies were completed to a defined standard. The evaluators then provided pharmacists with tailored feedback, encouraged self‐problem solving, and identified and addressed their training needs. Pharmacists' views of the baseline evaluation process was assessed using a 7‐point rating scale.

Results

66 pharmacists from 18 Queensland hospitals underwent the evaluation. At baseline, pharmacists had a median of 3 (1 to 10) years hospital experience. A median of 14 (5 to 22) months lapsed between baseline and repeat observations. Of the 61 competencies analysed, 35 (57%) competencies showed a significant improvement from baseline to repeat observations (p = 0.05). Competencies that improved significantly from baseline included: aspects of medication history taking; medication management; identification, documentation and resolution of drug‐related problems; appraisal of therapeutic options; and communication with doctors and nurses. For 9 (15%) competencies, pharmacists were already performing at the maximum level (median score 4) at baseline and no change was recorded between observations. No competency demonstrated a decrease in performance between observations. When the mean scores with 95% confidence intervals for the clusters of competencies were compared over time all the mean scores except for discharge facilitation and medicines information/patient education/liaison showed a significant improvement. 52 pharmacists provided feedback on the baseline evaluation process and the majority found it a useful professional development tool. They considered the evaluation process fair and constructive but taxing.

Conclusion

The GLF tool assisted with the identification of pharmacists' training needs, which are integral to their professional development.
Evaluation of Antifungal Treatment Guidelines for Immunosuppressed Patients
Authors: Chu Kwok‐Pui Jody , Avent Minyon , Shaw David R
Published: April 2015

Background

The antifungal treatment guidelines for immunosuppressed patients at the Royal Adelaide Hospital were revised (based on a 2004 retrospective drug use evaluation) and implemented in June 2006.

Aim

To evaluate clinical practicality and compliance associated with the revised antifungal treatment guidelines for immunosuppressed patients.

Method

A prospective drug use evaluation was conducted at the hospital from January to December 2007. Patients admitted to the cancer service who received any of the following antifungals: conventional amphotericin, liposomal amphotericin, voriconazole, caspofungin and posaconazole, were reviewed prospectively according to established criteria.

Results

53 patients who received 112 antifungal courses were evaluated. The majority of antifungals were used for empirical or possible fungal infections. The most common reason for changing antifungals during a treatment course was occurrence of toxicity or adverse effects. Compliance with the guidelines was approximately 70%; the majority of cases of non‐compliance were associated with liposomal amphotericin use.

Conclusion

The revised guidelines were well accepted and enabled early exclusion of patients who were at high risk of developing nephrotoxicity with conventional amphotericin.
SHPA Guidelines for Medicines Prepared in Australian Hospital Pharmacy Departments
Authors:   SHPA Manufacturing Working Party
Published: April 2015

These are guidelines of professional practice and not standards prepared or endorsed by Standards Australia. They are not legally binding.
Evidence, Ethics and Medication Management in Older People
Authors: Couteur David G Le , Ford Gary A , McLachlan Andrew J
Published: April 2015

Prescribing in frail older people may be improved by application of the four tenets of medical ethics – beneficence, non‐maleficence, autonomy, justice – rather than solely those of evidence‐based medicine. Evidence‐based medicine provides data primarily on the efficacy of interventions. In younger adults, this is often sufficient to make a decision to prescribe medications. In frail older people, there are additional issues that need to be considered, such as individualisation of efficacy data, increased risk of adverse drug reactions, patients' views on risk and benefit, difficulties in assessing capacity to understand risk and benefit, consent to treatment, and concerns about the cost‐effectiveness of interventions in the very old. In such situations, evidence‐based medicine can be useful in informing the prescriber about the ethical principle of beneficence. However, the decision to prescribe or withdraw medications is also influenced by the other three tenets of medical ethics: non‐maleficence (adverse drug reactions, polypharmacy), autonomy (consent, competency) and justice (appropriate allocation of healthcare resources).
DrugScan Series
Authors: Eaton Vaughn
Published: April 2015

This review brings you up‐to‐date with the international literature on therapeutics. Leading pharmacy practitioners scan major peer‐reviewed journals in areas relevant to Australian pharmacy practice and present precis on major clinical trials, important pharmacoepidemiology studies, and pharmacoeconomic research. Interested readers are encouraged to explore the original publications in greater detail.
Plasma Potassium Concentration Changes Associated with Trimethoprim used for Urinary Tract Infections
Authors: Kowalski Stefan R , Tan Mei Fong
Published: April 2015

Background

Hyperkalaemia has been reported with high‐dose trimethoprim (20 mg/kg/day) and standard‐dose trimethoprim (6 mg/kg/day) plus sulfamethoxazole use.

Aim

To investigate changes in plasma potassium concentrations in patients prescribed standard‐dose trimethoprim 300 mg daily for urinary tract infections.

Method

A retrospective cohort study of hospital patients with urinary tract infections treated with trimethoprim or other antibacterials (control group) for more than 5 days. Plasma potassium concentration, creatinine and urea were compared at baseline and at the completion of treatment.

Results

There were 31 patients in the trimethoprim group and 65 patients in the control group. End–of–therapy mean plasma potassium concentrations increased significantly from baseline in the trimethoprim group (4.2 ± 0.4 mmol/L to 4.5 ± 0.5 mmol/L; p = 0.002) but not in the control group. End–of–therapy mean plasma potassium concentrations were also higher in the trimethoprim group (4.5 ± 0.5 mmol/L vs 4.2 ± 0.5 mmol/L; p = 0.007). 65% of the trimethoprim group developed end–of–therapy hyperkalaemia versus 39% of the control group. Mean creatinine concentration in the trimethoprim group increased by an average of 21% from baseline but did not change in the control group. The trimethoprim group showed no change in mean urea concentration but a decrease was noted in the control group.

Conclusion

Treating urinary tract infections with trimethoprim 300 mg daily for more than 5 days was associated with an increase in plasma potassium concentration.
Australian Hospital Pharmacists' Experiences of a UK Non‐Medical Prescribing Course
Authors: Weeks Greg R , Marriott Jennifer , George Johnson
Published: April 2015

Background

Legislative change and a university course to credential pharmacist prescribers are needed to move the pharmacist prescribing agenda forward in Australia. Non‐medical prescribing courses in the UK aim to produce safe and competent prescribers who understand the prescribing process, know their limitations and practice within their area of competence. As no equivalent course exists in Australia there was interest in exploring whether a UK non‐medical prescribing course could be adopted for the Australian environment.

Aim

To pilot a UK non‐medical prescribing course for Australian hospital pharmacists and to elicit participants' views on non‐medical prescribing and experiences of the training.

Method

The Department of Pharmacy Practice, Monash University hosted a non‐medical prescribing course accredited by the Royal Pharmaceutical Society of Great Britain to credential pharmacists as supplementary and independent prescribers. 15 hospital pharmacists undertook the course over 9 months from September 2008. Participating pharmacists were either undertaking or planning to undertake advanced practitioner roles. Pharmacists' views on prescribing and credentialling were explored in 3 focus groups. Focus group discussions were audio‐recorded and transcribed verbatim and thematically analysed using NVivo 8.

Results

Participants identified positive themes of their understanding of non‐medical prescribing and where it could lead, i.e. growth in self‐confidence to undertake a new role and improved competency in communication and consultation skills. Negative themes related to legislative constraints, acceptance by other health professionals, assessment requirements for the Period of Learning in Practice and university documentation. Participants also stressed the need for the course to be customised to the Australian setting.

Conclusion

This first experience of a course to develop pharmacist prescribing was positive but challenging and can assist the future development of an accredited Australian course for pharmacist prescribers.
Helicobacter pylori Eradication Regimens: Is there a Difference?
Authors: Khu Jia Vui , Lim Li Lin
Published: April 2015

Background

The Singapore Ministry of Health's guidelines for Helicobacter pylori eradication recommend several regimens as first‐line treatment.

Aim

To evaluate the eradication rates of H. pylori at the National University Hospital with the regimens recommended by the Singapore Ministry of Health's guidelines.

Method

Single centre retrospective study of patients with H. pylori infection. Patients who had an urea breath test from August 2007 to August 2008 were identified from the hospital's database. Patients were included in the analysis if they were also identified to have had histology and urease tests before and after the H. pylori eradication regimens. Patients' H. pylori eradication regimens were identified and verified from the computerised patient support system and iPharm.

Results

802 patients who had an urea breath test during the study period were identified and 337 patients were excluded from the analysis as they did not meet the inclusion criteria. 465 patients were included in the final analysis. Standard triple therapy (amoxycillin, clarithromycin, proton pump inhibitor) yielded an eradication rate of 83% (n = 385), 100% (n = 10) and 78% (n = 18) when given for 7, 10 and 14 days, respectively. Metronidazole‐based triple therapy had a low eradication rate of 48% (n = 29). Quadruple therapy (proton pump inhibitor, bismuth, metronidazole, tetracycline) had an eradication rate of 100% (n = 6) and 75% (n = 8) when used as first‐line and second‐line therapy, respectively.

Conclusion

Standard triple therapy (clarithromycin, amoxycillin, omeprazole) for 7 days should be considered first‐line. Quadruple therapy (metronidazole, bismuth, tetracycline, omeprazole) should be considered for patients with penicillin and/or clarithromycin allergy and those who fail to eradicate H. pylori with standard triple therapy.
Quality of Discharge Summaries sent by a Regional Hospital to General Practitioners
Authors: Karaksha Abdullah A , Hattingh H Laetitia , Hall Tony
Published: April 2015

Background

A comprehensive hospital discharge summary sent to the patient's general practitioner (GP) in a timely manner can ease patient transition between care settings.

Aim

To investigate the quality of discharge summaries sent by a regional hospital to GPs; and to evaluate GPs' satisfaction with the medication list contained in the discharge summary.

Method

A questionnaire was mailed to a sample of 80 Gold Coast GPs who had made more than five referrals to the Gold Coast Hospital during June 2009.

Results

18 responses (23% response rate) were received from September to October 2009. The majority (67%) of GPs received discharge summaries from the hospital and they were mostly in an electronic format with attached medication lists. The reasons for changing medications were not well explained and the timeframe for receiving summaries was considered unsatisfactory. Overall, the majority of GPs were satisfied with the quality of the discharge summaries.

Conclusion

GPs mostly received the discharge summaries and the majority received them electronically. The majority of GPs indicated that the medication lists were often attached to the discharge summaries and changes to medications recorded.
Do Health Professionals on Respiratory Wards Know How to Use Inhalers?
Authors: Nguyen Yvonne BN , Wainwright Craig , Basheti Iman A , Willis Margaret , Bosnic‐Anticevich Sinthia Z
Published: April 2015

Background

Correct inhaler technique is crucial in the management of asthma and chronic obstructive pulmonary disease. Little is known about the feasibility of training hospital health professionals and respiratory inpatients in the correct use of inhalers.

Aim

To evaluate health professionals' baseline inhaler techniques on a respiratory ward; to assess the impact of training on their inhaler techniques; and to evaluate the impact of the training on service delivery to respiratory inpatients.

Method

Study conducted on the respiratory ward of a major New South Wales metropolitan hospital with a focus on training health professionals on correct inhaler techniques in four phases over 6 months.

Results

Prior to training, none of the pharmacists (n = 11) or nurses (n = 16) demonstrated correct inhaler techniques. Post training, significantly more pharmacists and nurses demonstrated correct inhaler techniques. Post training, there was a statistically significant increase in the number of respiratory inpatients who had their inhaler techniques assessed. This increase was sustained over 6 months.

Conclusion

Hospital pharmacists and respiratory nurses require training in the correct use of inhalers. Post training, more respiratory inpatients had their inhaler techniques checked by pharmacists and nurses.
Engaging Pharmacists in Adverse Medication Incident Reporting: Pilot of a Streamlined Reporting Application
Authors: Garrett Tim , Reeves Diane , Went David
Published: April 2015

Background

Medication‐related harm is a major cause of morbidity in hospitalised patients. Incident reporting is a core initiative in improving this safety risk.

Aim

To describe the impact of a purpose‐built incident reporting application; and to investigate the influence of clinical duties/pharmacists' characteristics on incident reporting at an area health service.

Method

Following implementation of the incident reporting application at the area health service, data (volume and severity on incidents by therapeutic group, error type, medication) were extracted for a 12‐month period. Pharmacists concurrently completed a data collection form to record ‘time in clinical areas’ and profile their clinical activities.

Results

Post‐implementation, 2887 incident reports were recorded by 29 pharmacists; a 20‐fold increase from baseline. The 2887 incident reports included 4106 error types for 43 therapeutic groups comprising 388 different medications. ‘Prescribing errors on admission’ (n = 562), incidents relating to ‘anticoagulants, antithrombotics’ (n = 457) and 23 medications were most commonly reported (p , 0.05). No significant differences emerged for the severity of incident by error type, therapeutic group or medication. There was no difference between ‘high’ and ‘low’ reporting pharmacists for most characteristics, such as time in clinical areas, profile of clinical activities, grade and years of experience.

Conclusion

Streamlining incident reporting and actively engaging pharmacists can reduce safety risk as well as highlight the professional role of pharmacists in improving patient safety. Workplace safety culture and individual beliefs in the reporting process need to be explored further.
Frequency and Nature of Medication‐Related Problems in Elderly Indian Inpatients
Authors: Joseph Jinta , Ramesh Madhan , Harugeri Anand , Parthasarathi Gurumurthy , Basavanagowdappa Hathur
Published: April 2015

Background

Geriatrics is an emerging clinical specialty in India. Although studies on medication use in the elderly have been conducted in India, data on medication‐related problems (MRP) in the hospitalised elderly population are limited.

Aim

To determine the prevalence, nature and predictors of MRP, and the significance of pharmacists' interventions following identification of MRP in elderly inpatients.

Method

A prospective active surveillance study conducted over 9 months (July 2008 to March 2009) on the medical wards of JSS Hospital, Mysore, India. Patients 60 years and over that were admitted to the medical wards were evaluated. Pharmacists' interventions following identification of MRP were recorded and their potential clinical significance assessed. The organ systems affected and the management of MRP were investigated. Predictors of MRP were identified using bivariate analysis and subsequent multivariate logistic regression.

Results

411 patients were evaluated and 352 MRP were identified in 230 (56%) patients. Adverse drug reactions were the major (53%) MRP. Cardiovascular drugs accounted for 37% of MRP. Insulin (9.4%) was the most frequently implicated drug. MRP commonly involved the nervous system (19%). In 47% of cases, the drug was discontinued as a management strategy. The majority of pharmacists' interventions (314; 90%) were moderate or major in their level of clinical significance. Age was an influential predictor of MRP (OR 2.1; 95%CI 1.1–4.2; p = 0.03).

Conclusion

Around half of the hospitalised elderly experienced an MRP. Pharmacists can contribute to geriatric inpatient care by reducing adverse consequences of MRP through early detection and providing advice in managing MRP.
Drug Use Evaluation Services in Australia and New Zealand: a Neglected Area of Research?
Authors: Avent Minyon L , Pattullo Champika , Dines Amanda , Martin Jennifer , Kubler Paul
Published: April 2015

Aim

To describe the drug use evaluation (DUE) models used in hospitals in Australia and New Zealand.

Method

18 hospitals in Australia and New Zealand were identified as having DUE pharmacist positions and 15 were willing to participate in the survey. DUE pharmacists were surveyed about the DUE process, structure, service implementation and their job descriptions.

Results

47% (7/15) of DUE pharmacists reported to the Director of Pharmacy, 33% (5/15) to the Drug and Therapeutics Committee and 20% (3/15) to the Director of Clinical Pharmacology. 73% (11/15) of DUE pharmacists were located in the hospital's pharmacy department. On average, a 0.8 full‐time equivalent (range 0.2 to 2.5) pharmacist was dedicated to DUE activities per hospital with an average of 0.2 full‐time equivalent (range 0 to 0.8) assigned to clinical activities. 79% (12/15) of hospitals only funded DUE pharmacist positions; 7% (1/15) funded combined pharmacist and pharmacy technician positions; 7% (1/15) funded combined pharmacist and rotating pharmacy intern positions; and 7% (1/15) funded clinical pharmacologist, nurse and pharmacist positions. 20% (3/15) of hospitals had a DUE subcommittee to coordinate DUE activities. All of the hospitals reported their DUE results to the Drug and Therapeutics Committees.

Conclusion

A variety of DUE models exist in hospitals in Australia and New Zealand. Successful DUE services had a multidisciplinary approach with support and collaboration from medical, pharmacy, nursing and administrative staff.
Barriers to Medication Adherence in Chronic Heart Failure Patients during Home Visits
Authors: Toh Cjeng T , Jackson Bruce , Gascard Debra J , Manning Alison R , Tuck Emily J
Published: April 2015

Aim

To identify barriers to medication adherence in chronic heart failure patients during home visits; and to find solutions to address medication non‐adherence.

Method

This was an observational study of home visits by the chronic heart failure pharmacist that was made after referral from a multidisciplinary chronic heart failure service. The reasons for medication non‐adherence and solutions to overcome them were recorded in 66 consecutive chronic heart failure patients. Barriers to medication adherence and subsequent interventions (education, counselling, motivational interviews), hospital readmissions, length of stay, mortality and cause of death were analysed 3 months after the first home visit.

Results

Main reasons for medication non‐adherence were poor and/or complex medication instructions (71%), running out of medications (33%) and adverse drug reactions (20%). Interventions included education and counselling (100%), reducing dosing frequency (64%) and introducing dose administration aids (32%). 10 complex chronic heart failure patients (15%) required multiple home visits, motivational interviews and telephone coaching. Hospital readmissions, average length of stay for readmissions and deaths due to chronic heart failure 3 months after the first home visit were 4.5%, 6.3 days and 3%, respectively.

Conclusion

Multiple strategies were necessary to overcome barriers to medication adherence in chronic heart failure patients. Home visits by the pharmacist optimised medication adherence, thus potentially minimising unplanned hospital admissions.
Creation of a Temperature Stability Database for Refrigerated Medications
Authors: Davis Sharon R , Anderson Elizabeth A
Published: April 2015

Aim

To create a database of refrigerated medications along with comprehensive data on their stability when stored outside the recommended conditions; and to develop an educational tool for managing cold chain emergencies at the hospital.

Method

Phase 1: a searchable database was created with fields on product stability, stored temperatures and storage conditions. Phase 2: the database was populated with the products' stability data from various sources, such as literature searches, approved product information and pharmaceutical companies. Phase 3: focus groups were held with the hospital's stakeholders (nurses, pharmacists, pharmacy technicians) to develop an educational tool for managing cold chain emergencies.

Results

Of the 36 pharmaceutical companies contacted, 29 responded (response rate 81%) and provided ‘extra’ stability data for 28 products (n = 150; 19%). Pursuant to issues raised by the pharmaceutical companies about concerns of breaching the registration conditions of their products and misinterpretation of the provided in‐house stability data, a stakeholder meeting was held with the Therapeutic Goods Administration. At the meeting, the need for short‐term ‘end of shelf life’ real‐time stability studies for refrigerated products was discussed. An educational tool was designed based on a survey of local practices at the hospital pertaining to monitoring refrigerators used to store medications.

Conclusion

Creation of the database has resulted in a critical analysis of the existing stability data on refrigerated medications. Hospital staff lack guidance on the selection, monitoring and maintenance of refrigerators used to store medications, and to manage cold chain emergencies. There is an opportunity for professional pharmacy organisations to provide this guidance.
Hospital Pharmacists and Behavioural Change Theory: Who, Why and How?
Authors: Mutavdzic André
Published: April 2015

Endeavouring to change the practice of doctors, colleagues and patients is common practice for pharmacists. Pharmacists are not trained in the humanities and the approaches used by them to change practice, such as educational campaigns, are often intuitive and not always successful. Approaches that are based on behavioural theory and tested models of behavioural change may have a greater probability of success. In this article the theory of planned behaviour, social cognitive theory and the transtheoretical model of behavioural change and their application to these efforts are discussed. Although this article focuses mainly on attempting to change doctors' behaviours, the principles can be applied to other groups.
Conception and Beyond: Using Population‐Based Record Linkage to Monitor Long‐Term Effects of Medications Used During Pregnancy
Authors: Grzeskowiak Luke E , Gilbert Andrew L , Morrison Janna L
Published: April 2015

One of the biggest challenges health professionals face when counselling patients about medication use in pregnancy is accessibility to evidence‐based information on the risks or benefits associated with treatment. There is inadequate information available regarding the immediate and long‐term effects of medications used by pregnant women on the mother and the fetus. Novel surveillance techniques using population‐based record linkage could enable better identification, quantification and understanding of long‐term risks or benefits of medications used during pregnancy. The technology, data and expertise are available to make it happen.
Contemporary Therapies for Depression in Older People
Authors: Mock Phoebe , Norman Trevor R , Olver James S
Published: April 2015

Major depressive disorder is common in the elderly and is associated with significant morbidity and disability, as well as increased risk of mortality. Extensive literature is extant examining the efficacy and tolerability of the earlier antidepressants but there are comparatively fewer trials examining the newer antidepressants, the so‐called ‘third generation’ antidepressants with a variable mode of action. This article reviews the literature published in the past 10 years on the efficacy and tolerability of the new antidepressants – escitalopram, venlafaxine, duloxetine and mirtazapine – used in treating depression of old age. There are no published data for the newly released desvenlafaxine in the elderly population. Due to the limited number of published trials and their highly heterogeneous nature, specific treatment recommendations for depression in older people are not supported by solid empirical evidence. Clearly, further studies on the management of depression in older people are needed in order to develop reliable and practical guidelines.
Low‐Dose Nebulised Epoprostenol in the Management of Acute Respiratory Distress Syndrome
Authors: Somasundaram Radhika , Ghelani Dhaval
Published: April 2015

Aim

To report a case of acute respiratory distress syndrome (ARDS) caused by Escherichia coli urosepsis with shock that resulted in multiple organ failure and refractory hypoxaemia successfully treated with low‐dose nebulised epoprostenol.

Clinical details

A 64‐year‐old female with a history of hypertension and dyslipidaemia underwent elective cystoscopy for the removal of an ureteric stent and subsequently developed hypotension followed by fever. This was attributed to E. coli urosepsis with shock and resulted in multiple organ failure and refractory hypoxaemia with the development of bilateral pulmonary infiltrates, suggestive of ARDS. Hypoxia and pulmonary infiltrates progressed despite administration of non‐invasive ventilation followed by intermittent positive pressure ventilation. The patient was subsequently started on continuous nebulised low doses of epoprostenol 2 to 4 ng/kg/min. The nebulised epoprostenol was continued for approximately 48 hours with significant improvement in oxygenation.

Conclusion

Nebulised epoprostenol, as a rescue therapy for refractory hypoxaemia caused by ARDS may be a reasonable therapeutic strategy, although further evidence to support its impact on outcomes is required.
Complementary and Alternative Medicines Use in Patients on Warfarin and Matched Controls: A Retrospective Cohort Study
Authors: Khan Munad , Taylor David McD , Taylor Simone E , Jao Kathy , Chae John , Harding Andrew M , Mitchell Elise
Published: April 2015

Aim

To investigate complementary and alternative medicines (CAM) knowledge and use in patients on warfarin and matched controls, and the association between CAM use and adverse events (bleeding or clotting).

Method

A retrospective cohort study was undertaken in the emergency department of a Melbourne hospital. Patients in the warfarin and control groups were those taking/not taking warfarin, respectively (groups matched for age and gender). An investigator‐administered questionnaire was used to collect data on CAM knowledge and use, and bleeding/clotting events during the previous 6 months. The international normalised ratio (INR) data during the previous 6 months were obtained from medical and pathology records.

Results

246 warfarin and 246 control group patients were enrolled. Approximately 50% in each group indicated that they knew of the potential for CAM–drug interactions. Only 60 (24%) patients in the warfarin group reported having been advised about CAM use. Compared to controls, a similar proportion of warfarin patients reported CAM use (29% vs 37%; p = 0.07) and significantly fewer used a CAM known to interact with warfarin (‘interacting CAM‘) (11% vs 19%; p = 0.03). In the warfarin group, CAM users and non‐users reported a similar number of events below and above their therapeutic INR range and when the INR exceeded 5. CAM users in the warfarin group tended to have more abnormal bleeding events (42% vs 30%; p = 0.06) but a similar number of clotting events (9% vs 10%; p = 0.8) than CAM non‐users. Warfarin patients who used ‘interacting CAM’ had significantly more clotting events than those who used CAM not known to interact with warfarin (18% vs 2%; p = 0.02).

Conclusion

CAM knowledge in people on warfarin was poor. ‘Interacting CAM' used concomitantly with warfarin may be associated with increased rates of clotting events.
Unanswered Health‐Related Questions in Community Pharmacy: Frequency, Nature and Consequences
Authors: Gordon Jennifer , Calabretto Jean‐Pierre , Sorich Michael J
Published: April 2015

Background

Medical practice research suggests that deficits in information exchange can have implications, such as misunderstandings and non‐adherence to treatment. There has been little investigation into the implications of unanswered health‐related questions in community pharmacy, especially for professional pharmacy practice and quality use of medicines.

Aim

To investigate the frequency of consumers leaving community pharmacies with unanswered health‐related questions, the nature of the unanswered questions and the impact on consumers.

Method

Consumers exiting participating community pharmacies (convenience sample) were interviewed using a semi‐structured tool to capture information on the frequency, nature and consequences of unanswered health‐related questions. Data recorded from the interviews were thematically analysed.

Results

Over the 5 week study period, of the 87 participants interviewed, 18 (20%) had come into the pharmacy with a health‐related question and 6 (33%) left with their question unanswered. Of the 47 participants who were asked about past instances of unanswered questions, 7 (15%) reported incidents they could recall. The nature of the unanswered questions mainly focused on potential or perceived medication‐related adverse effects, and information on which to select medicines or treatment. A number of unanswered questions were considered to have potential for negative health consequences if not followed up.

Conclusion

On occasion, consumers leave community pharmacies with unanswered questions, which could have consequences for the quality use of medicines. Further research is needed to establish the prevalence and significance of unanswered health‐related questions in community pharmacy.
‘You Look Like a 240 mg’: Gentamicin Dosing at a Sydney Hospital
Authors: Johnston Claire F , Carroll Peter R , Matthews Slade T , Mitchell Sarah J , Hilmer Sarah N
Published: April 2015

Background

Gentamicin, an aminoglycoside antibiotic, is used to treat gram‐negative bacterial infections. In the current Therapeutic Guidelines: Antibiotic, the recommendations for gentamicin have changed, i.e. the initial dose for empirical treatment, subsequent dose calculations and maximum duration of therapy.

Aim

To investigate the pattern of gentamicin utilisation and adherence to local gentamicin dosing guidelines.

Method

A cross‐sectional audit was conducted of available medication charts for inpatients (n = 51) administered gentamicin at a Sydney hospital over a 2 month period. For comparison, patients were stratified according to age into younger (18 to 59 years) or older (≥60 years) groups.

Results

Of the 51 patients evaluated, only 11 (8 younger, 3 older) had their weight recorded and they received significantly lower gentamicin doses than the recommended dose based on their age and weight. 11 patients received multiple doses of gentamicin with an average of 2.6 (range 2 to 4) days of therapy. The most common dose was gentamicin 240 mg.

Conclusion

There was significant under‐dosing of gentamicin in patients of all ages who had their weight recorded. Future studies are needed to investigate the impact of gentamicin underdosing on clinical outcomes.
Low Adherence to Vancomycin Guidelines at an Australian Paediatric Hospital
Authors: Lie Katherine , Mees Alison , Ford Violet , McCauley Louise , Roberts Malcolm , Clifford Rhonda M
Published: April 2015

Background

With increasing bacterial resistance, and the emergence of vancomycin‐resistant methicillin‐resistant Staphylococcus aureus, it is imperative that vancomycin is used appropriately in hospitals.

Aim

To investigate adherence to hospital guidelines for vancomycin dosing and therapeutic drug monitoring.

Method

A retrospective audit of vancomycin use was conducted for all inpatients (1 month to 18 years) at a paediatric hospital over an 8 month period. Data from medical records were compared with the hospital guidelines to ascertain adherence to vancomycin dosing and therapeutic drug monitoring.

Results

167 patients received vancomycin and 173 courses of vancomycin prescribed to 124 eligible patients were reviewed. 28% of vancomycin courses adhered to all aspects of the guidelines. Oncology clinicians prescribed 50% of vancomycin courses and adhered to audit criteria in 43% of cases. The most common deviation from the guidelines was under‐dosing of vancomycin.

Conclusion

Adherence to hospital vancomycin guidelines was poor. Under‐dosing was the most significant deviation and is of concern, as subtherapeutic vancomycin dosing has the potential to extend the duration of illness, contribute to adverse health outcomes and increase selection of resistant bacteria.
Exploring Medication Risk among Older Residents in Supported Residential Services: A Cross‐Sectional Study
Authors: Lee Cik Yin , George Johnson , Elliott Rohan A , Chapman Colin B , Stewart Kay
Published: April 2015

Background

Older residents in supported residential services (SRS) are often on multiple medications and may be at risk of medication misadventure. Their medication risk and uptake of medication reviews by pharmacists has not been investigated.

Aim

To investigate medication use, risk factors for medication misadventure and uptake of home medicines review (HMR) among older residents in SRS.

Method

A pre‐piloted postal survey was distributed to 361 residents from 14 SRS in Victoria. The questionnaire included validated items on medication risk, medication use, health information and uptake of HMR. The questionnaire was completed by residents, SRS care staff or family members.

Results

Of the 77 respondents (21% response rate) aged 53 to 98 years, 73 (95%, 95%CI 90–100) reported taking prescribed medications. Risk factors for medication‐related problems were present in 56 respondents (73%; 95%CI 63–83) and included: ≥ 5 regular medications (n = 41; 53%; 95%CI 42–64), ≥ 3 comorbidities (n = 31; 40%; 95%CI 29–51), medications with low therapeutic index (n = 15; 20%; 95%CI 11–28), recent hospitalisations (n = 12; 16%; 95%CI 7.5–24), recent changes to medication regimens (n = 10; 13%; 95%CI 5.5–21) and ≥ 12 tablets/capsules a day (n = 9; 12%; 95%CI 4.5–19). Of these at‐risk respondents, only 3 (5.4%; 95%CI 0.4–11) reported receiving an HMR in the previous 12 months.

Conclusion

High prevalence of medication use and medication‐related risk factors, but low awareness and uptake of HMR were identified among SRS residents.
Implementing a Pharmacist Charting Service in the PreAdmission Clinic
Authors: Cao Bei Yin , Chow Clara , Elliott Phillip , MacPherson Ross D , Crane Jenny , Bajorek Beata V
Published: April 2015

Aim

To implement a pharmacist charting service in the preadmission clinic (PAC) and describe a preparatory process for the initiation of this service.

Method

Stage 1: a proposal for a pharmacist charting service in the PA C was devised via an iterative process with an advisory panel. Stage 2: feedback on the proposal was obtained from key staff via a survey comprising 15 linear scale statements (0 = strongly disagree to 10 = strongly agree) and open–ended questions. Stage 3: baseline data were collected on existing PAC service outcomes, e.g. consultation times, accuracy of medication charts.

Results

Stage 1: a service protocol was developed following positive feedback. Stage 2: most staff strongly agreed that a pharmacist charting service would improve the efficiency and workflow in the PAC (median 8; n = 19) and that PAC pharmacists were competent and skilled to chart medications (median 9). Pharmacists perceived that the proposed service would increase their workload (median 10), consultation times (median 9) and medicolegal responsibilities (median 7) while the opposite was reported by the doctors (median 2, 2, and 3, respectively). Stage 3: mean baseline consultation times for pharmacists and doctors were 18.6 and 25 minutes, respectively. Most (95%) of the 56 analysed medication charts were incomplete (at least 1 piece of information missing) while 41% had at least one or more inaccuracies.

Conclusion

There are benefits of a pharmacist charting service. This is the first step toward exploring models for pharmacist prescribing.
Facilitating Medication Misadventure Risk Assessment in the Emergency Medical Unit
Authors: Kumar Nitesh , Knowler Christopher B , Strumpman Dana , Bajorek Beata V
Published: April 2015

Background

The risk of medication misadventure is heightened in emergency settings. Identifying at‐risk patients is integral to minimising medication‐related adverse events.

Aim

To pilot a medication misadventure risk assessment tool to identify at‐risk patients most likely to benefit from targeted intervention by an emergency department pharmacist.

Method

A prospective descriptive study was undertaken in an emergency medical unit over 2 weeks (June to July 2009). Patients were included if they were over 70 years of age, took 3 5 regular medications, had 3 3 comorbidities, and/or were newly started on warfarin or had been admitted to the emergency department as a result of a medication‐related adverse event. Nurses were encouraged to use the medication misadventure risk assessment tool for all patients admitted to the emergency medical unit. The pharmacist provided targeted interventions to all patients who were identified as being at‐risk by the nurses. The pharmacist also verified the accuracy of the risk assessments undertaken by the nurses using this tool. Main outcome measures were the sensitivity and specificity of the tool and the reliability of the nurses' risk assessment.

Results

Nurses completed 115 medication risk assessments for 194 patients. The risk assessments were accurately completed in all but 10 patients. Of the 36 (31%) patients assessed as high risk, 18 required pharmacist intervention. Of the 79 patients assessed as low risk, 3 required pharmacist intervention. The tool was useful in identifying at‐risk patients (specificity 78%, 95%CI 69–85; sensitivity 83%, 95%CI 60–94).

Conclusion

Nurses in the emergency department used the risk assessment tool to identify patients at risk of medication misadventure and facilitate targeted interventions by pharmacists.
Prevalence of Potentially Inappropriate Medication Use in Elderly Hospitalised Patients
Authors: Widagdo Imaina S , Nyfort‐Hansen Karin , Kowalski Stefan R
Published: April 2015

Background

The Beers criteria are used to identify potentially inappropriate medications (PIMs) in the elderly. Few studies have examined the Beers criteria in elderly hospitalised patients in Australia.

Aim

To identify the prevalence of PIM use in elderly patients admitted to an Australian hospital using the 2003 Beers criteria.

Method

A prospective cross‐sectional study of 100 elderly inpatients was undertaken using the Beers criteria to identify and compare PIM on admission and discharge. Logistic regression analysis examined the risk factors for PIM use.

Results

42% of patients had at least one PIM on admission compared to 39% at discharge. The most common PIMs were amitriptyline, senna, amiodarone and benzodiazepines (nitrazepam and diazepam). Excluding senna, the prevalence decreased to 36% at admission and 24% at discharge. At admission (including and excluding senna), PIM was not significantly associated with age, gender, living arrangements, number of comorbidities and number of medications. At discharge, PIM (including senna) was significantly associated with age (OR 1.1; 95%CI 1.02–1.3; p = 0.02), female gender (OR 3.6; 95%CI 1.3–10; p = 0.01) and number of medications (OR 1.2; 95%CI 1.0–1.3; p = 0.02). When senna was excluded PIM at discharge was only significantly higher in female patients (OR 5.4; 95%CI 1.7–16.9; p = 0.004).

Conclusion

The Beers criteria detected a high prevalence of PIM use in elderly hospitalised patients.
Intravenous Olanzapine for Acute Agitation in the Emergency Department
Authors: Chan Esther W , Knott Jonathan C , Taylor David McD , Kong David CM
Published: April 2015

Background

Despite the lack of supporting evidence, olanzapine intramuscular (IM) injection continues to be used via the unapproved intravenous (IV) route for the management of acute agitation in the emergency setting.

Aim

To report the management of acute agitation using IV olanzapine via 4 representative cases in the emergency department (ED).

Clinical details and outcome

IV olanzapine was used in 4 adult patients. Hospital security alerts were called in each case, mobilising security and ED staff. De‐escalation strategies were employed and chemical restraints were administered as a last resort. IV olanzapine was used as the initial, second or last drug to chemically manage the agitation. Olanzapine was used alone or in combination with benzodiazepines and/or other antipsychotics. No adverse events were observed and vital signs remained within normal ranges. Sedation was noted from 30 minutes post olanzapine administration. There were relapses of agitation which required further sedation. No clinical trials have reported on the safety of IV olanzapine for the management of acute agitation specifically in the ED.

Conclusion

There is little evidence of efficacy or safety to support the use of IV olanzapine in the ED.
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 US experience, including (with permission) material from ISMP Medication Safety Alert! a bulletin published by the US Institute for Safe Medication Practices >www.ismp.org>. This series is coordinated via 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 (Medication Safety Consultant; >www.QuAMS.com.au>).
Bayesian Optimisation of Tobramycin Dosing in Paediatric Patients with Cystic Fibrosis
Authors: Barras Michael , Alraman Hana , Kirkpatrick Carl MJ , Harris Margaret , Dakin Carolyn , Jess Katrina , Pilbeam Melissa , Norris Ross LG
Published: April 2015

Background

In children with cystic fibrosis (CF), tobramycin concentrations are monitored via the area under the plasma concentration time curve (AUC) approach. Currently, a minimum of 2 plasma concentrations of tobramycin within one dosing interval are required to estimate the AUC, which is costly, painful and blood collection is often difficult to coordinate.

Aim

To evaluate the accuracy of tobramycin AUC estimated using 1 plasma concentration compared to AUC based on 2 plasma concentrations calculated using Bayesian software.

Method

Data were collected from paediatric patients with CF prescribed once daily intravenous tobramycin. Each patient had 2 blood samples taken within a dosing interval (according to usual practice at the hospital) on 2 separate occasions during their admission. Data on tobramycin dosing and concentration, and patient demographics from the first occasion were entered into the Bayesian software, TCIWorks, to establish an individual patient's pharmacokinetic model. Data from the second occasion were then also entered into TCIWorks to estimate 2 AUCs – from 1 (AUC1) and 2 (AUC2) plasma concentrations. The accuracy of each patient's AUCs (AUC1 and AUC2) were then evaluated using a Bland‐Altman analysis to describe bias relative to the mean of the two values. To show the benefits of good quality data when using TCIWorks, data were obtained and analysed from 2 patient groups. For group A patients, accurate sampling and administration times of the tobramycin infusion were obtained prospectively. Group B consisted of patients from group A plus additional patients who had data collected from a retrospective medical chart review.

Results

Data were collected for 30 paediatric patients with CF − 14 in group A and 16 additional patients in group B. In group A, there was no significant bias relative to the mean of the values for AUC1 and AUC2 (mean bias 1; 95%CI −4.9–6.9). A similar result was seen in group B (mean bias −0.7; 95%CI −10–8.6) indicating that the 2 estimates of tobramycin AUC (using 1 and 2 blood samples) are not significantly different. Conclusion: Once an individual paediatric patient's tobramycin pharmacokinetic model is determined with two blood samples using TCIWorks, only one blood sample is required to estimate an AUC for tobramycin.