bluuebunny/crossref_metadata_2025 huggingface dataset:
Grow Clinical Pharmacists on Supervised Pre‐Registrant Wards
Authors: McLachlan Gina B , Tanner Francine E , Carroll Margaret E
Published: April 2015

Pre‐registrant pharmacists at Austin Health have traditionally learned clinical pharmacy skills, through rotations under the supervision of clinical pharmacists. Although this process resulted in conscientious clinical pharmacists, they were accustomed to looking after only 6 patients at a time. In 2006, a new rotation was introduced that involved supervised, semi‐independent work on a dedicated pre‐registrant ward. The semi‐independent experience relied on a clinical training and competency assessment prior to rotation on the pre‐registrant ward. The pre‐registrant ward experience was well received by all involved (pre‐registrant pharmacists, supervising pharmacists, nurses, doctors) and will be repeated in future years. The experience allowed the pre‐registrant pharmacists to learn skills, such as time management, organisation, customer service and communication. They also required less time post‐registration to adjust to a full clinical workload.
Ethical and Practical Dimensions of Prescribing for Older People as Quality of Life Decreases
Authors: Darzins Peteris , Marriott Jennifer
Published: April 2015

Prescribing medicines for older people always presents difficulties, never more so than when quality of life decreases or the process of dying begins. The problem confronting doctors, and others caring for older patients, is the option of intervening or not intervening. The principles of bioethics can be used to assist those making decisions regarding the medical management of older people. Decisions that are made must consider the likely benefit and associated harms that may accrue from continuing or commencing treatment. Respect for individuals and their wishes must be maintained even when the patient's decision‐making capacity is impaired and others need to make decisions for them. Management dilemmas include when to stop or reduce prescribing as the end‐of‐life approaches, the use of medication to manage behavioural disturbance, multiple medication use increasing the risk for harm and the use of drugs for which the evidence of benefit is not available for older patients or for which there is evidence of increased adverse effects that may impair quality of life. Those caring for older people must consider a wide range of options and can be assisted by asking key questions to help guide appropriate decision making.
Investigating the Hospital Discharge Medication Process
Authors: Marriott Jennifer L , Bessell Tracey L
Published: April 2015

Aim

To investigate the hospital discharge medication process from the perspective of the staff involved in the process.

Method

Questionnaires were sent to participating hospitals with pharmacy departments for completion by doctors, pharmacists, nurses and administrative personnel involved in the discharge process. A subset of participants was followed up with focus groups to further explore issues raised in the questionnaire.

Results

The questionnaire and the focus groups confirmed that the main problem in the discharge medication process, is the time lag between making the decision to discharge patients and junior doctors writing the discharge prescription. Emerging medication management system reforms were perceived to improve patient safety, but unlikely to overcome delays in the discharge medication process.

Conclusion

The problems with the discharge process were mainly due to delays in writing accurate discharge prescriptions.
Chemical Stability of Voriconazole 1% Eye Drops
Authors: Lau David , Leung Lok , Fullinfaw Robert , Davies Geoffrey E
Published: April 2015

Background

Case reports suggest that voriconazole 1% eye drops are effective in treating refractory fungal keratitis. There are no data available on the stability and shelf‐life of extemporaneously prepared voriconazole 1% eye drops.

Aim

To determine the stability and shelf‐life of extemporaneous voriconazole 1% eye drops when stored at 2 to 8 °C.

Method

Voriconazole 1% solution was manufactured using voriconazole injection and preserved with 0.01% benzalkonium chloride. Aliquots (2.5 mL) were dispensed into pre‐sterilised plastic eye dropper bottles. Samples from 3 different batches were stored at 2 to 8 °C and analysed using high performance liquid chromatography to measure voriconazole concentrations on Days 0, 15, 30, 45, 60 and 75 after manufacture.

Results

After 75 days at 2 to 8 °C there was minimal reduction in the potency of the voriconazole 1% solution. Extrapolating the stability data beyond 75 days using linear regression suggest that it may take up to 4 months for voriconazole concentrations to drop below 90% of the nominal content.

Conclusion

Voriconazole 1% eye drops stored at 2 to 8 °C display negligible chemical degradation after 75 days.
Pharmacy Workforce Recruitment and Retention: an Australian Area Health Service Perspective
Authors: Garrett Tim
Published: April 2015

Aim

To investigate factors influencing recruitment and retention of the pharmacy workforce within an Area Health Service.

Method

An online survey was used to collect data from pharmacy staff and responses were analysed with a focus on recruitment, retention and factors influencing job satisfaction.

Results

The response rate was 50%. The Area Health Service pharmacy service is comprised of full‐time (70%), permanent (93%) employees aged 25 to 34 years (38%) or over 45 years (39%). Location was found to be the primary motivator when applying for positions, followed by work hours, type of position and professional development opportunities. Most staff achieved their employment expectations (67%) and received regular supervision/support (72%). However, 31% indicated an intention to leave within 2 years. The main drivers of job satisfaction were relationship with peers, job security and staff support. In those intending to leave, there were significant differences for flexibility of work hours, support, communication, access to professional development and ability to influence decisions/success (p < 0.05).

Conclusion

An insight was gained into motivators for employment and influencers of work place satisfaction. Further research is needed to explore how these variables are influenced by recruitment and retention strategies and how they compare with other public sector settings.
Phenotyping for Thiopurine Therapy in Clinical Practice
Authors: Dooley Michael J , Dixon Barbara , Poole Susan G , Chiang Cherie , Whitlock Alison , Schneider Hans
Published: April 2015

Aim

To quantify the uptake of thiopurine methyltransferase (TPMT) phenotyping in patients on thiopurines.

Method

A retrospective audit was undertaken to identify all patients initiated on thiopurines from 1 August 2003 to 31 May 2006 at a tertiary referral hospital. All patients dispensed azathioprine, mercaptopurine and thioguanine were identified from computerised dispensing records. TPMT phenotype test results were obtained from the hospital's pathology service for the period 1 July 2003 to 30 June 2006.

Results

Of the 287 patients initiated on thiopurines, 21 (8.8%) had TPMT activity measured. Thiopurines were widely prescribed across a number of medical disciplines with the largest usage in the transplant units − 88 lung transplant recipients and 3 dual heart and lung transplant recipients. Only one transplant recipient had TPMT activity measured. In the dermatology unit, 47% of patients receiving thiopurines underwent TPMT phenotyping.

Conclusion

The uptake of TPMT phenotyping in patients on thiopurines was low and variable depending on the clinical unit. Further efforts to increase the uptake of TPMT phenotyping before initiation of thiopurine therapy are warranted.
Pharmacokinetics and Bioavailability of Hydromorphone Nasal Spray
Authors: Lim Stephen CB , Paech Michael J , Goy Raymond , Liu Yandi , Zhang Guicheng , Yao Meicun , Doherty Dorota A
Published: April 2015

Aim

To evaluate the pharmacokinetics and bioavailability of two formulations of intranasal hydromorphone hydrochloride in adult postoperative patients.

Method

In an open‐label, randomised, crossover study a convenience sample of adult postoperative patients received intravenous hydromorphone 1 mg and intranasal hydromorphone 2 mg (with and without chitosan).

Results

Pharmacokinetic data sets from 19 patients showed intranasal hydromorphone produced detectable serum levels within 2 minutes of administration, with mean bioavailability of 49.5% (without chitosan) and 67.5% (with chitosan). Mean peak serum concentrations were 0.92 ng/mL (without chitosan) and 1.16 ng/mL (with chitosan). Summed pain intensity differences suggest that intravenous hydromorphone produced a better clinical response.

Conclusion

The bioavailability of intranasal hydromorphone is approximately 0.6 of intravenous hydromorphone. Adding chitosan to the intranasal solution did not significantly increase the bioavailability of hydromorphone.
Value of Medication Reconciliation in Reducing Medication Errors on Admission to Hospital
Authors: McLeod Susan E , Lum Elaine , Mitchell Charles
Published: April 2015

Aim

To review the literature and report on the prevalence of medication history taking errors occurring on admission to hospital when medications are prescribed or reordered, and the value of medication reconciliation in detecting these errors.

Method

Ovid Medline and PubMed databases were searched for articles published from 1966 to March 2008 that related to: medication errors on or during hospital admission; value of medication history taking and reconciliation on admission; and systems for reducing medication errors and adverse drug events. The Ovid Medline search identified 461 articles of which 20 were used. The PubMed search identified 119 articles, of these, 7 not found in the Ovid Medline search were used. References from the identified papers revealed a further 6 articles. Web sites of patient safety organisations were also searched and generated 8 articles. A total of 41 articles were used in the review.

Results

Medication history taking errors occur during transition points such as admission, transfer and discharge to hospital. The cited studies reviewing medication history errors are qualitative, study different population groups, use different methods to obtain medication history and do not always rate the clinical importance of the error. These limitations account for the range of medication history errors found in the cited studies (27–65%). Medication errors and subsequent adverse drug events are detected and reduced by a standardised process of reconciliation. Numerous large scale hospital initiatives in the US have outlined the implementation of a reconciliation process and the subsequent reduction in medication errors, adverse drug events and resultant economic benefits. Strategies for improving the medication reconciliation process include the use of a standardised form, improved communication, multidisciplinary approach, use of computerised physician or prescriber order entry with decision support and home medication lists.

Conclusion

Obtaining a detailed medication history and performing medication reconciliation reduces the incidence of medication errors and subsequent adverse drug events.
Medications in Pregnancy: Impact on Time to Lactogenesis after Parturition
Authors: Kong Ming‐Shu , Bajorek Beata
Published: April 2015

Background

Although the many factors that affect the initiation of lactation have been identified, the impact of medications on lactogenesis remains largely unknown.

Aim

To explore the impact of medications used during pregnancy on time to lactogenesis after parturition.

Method

Data were collected prospectively from women admitted to a metropolitan Sydney hospital for parturition. Information was obtained via a short interview with each patient, as well as from medical notes, drug charts and infant feeding charts.

Results

The average time to lactogenesis was 68.9 hours (range 22.5–126). 39% of women experienced delayed lactogenesis. Observational results showed that the use of some medications during pregnancy may impact on the time to lactogenesis. Cigarette smoking during pregnancy and prolonged stage II vaginal delivery may also increase the time to lactogenesis.

Conclusion

Several medications used during pregnancy may impact on time to lactogenesis but the biological plausibility is unknown.
Stability of a Formulated N‐acetylcysteine Capsule for Prevention of Contrast‐Induced Nephropathy
Authors: To The‐Phung , Ellis Andrew G , Ching Michael S , Shilson Alan D , Kong David CM , Garrett Kent
Published: April 2015

Background

N‐acetylcysteine is used as prophylaxis to prevent contrast‐induced nephropathy.

Aim

To investigate the stability of a formulated N‐acetylcysteine capsule for prevention of contrast‐induced nephropathy.

Method

Gelatine capsules containing N‐acetylcysteine and lactose were stored at 2–8 °C, 18–25 °C and 40 °C, with and without desiccant, at ambient and high humidity (~75%). Capsule stability was assessed using high performance liquid chromatography to measure N‐acetylcysteine and N,N‐diacetylcystine (breakdown product) on Days 0, 3, 7, 14, 28, 84, 168, 252, 336 and 420 of storage.

Results

At 40 °C and high humidity the capsules showed severe physical degradation and hydrogen sulphide odour, and loss of N‐acetylcysteine was around 30–40% by 420 days. Under all other storage conditions, the N‐acetylcysteine content was stable up to 420 days (± 2% change from initial content), irrespective of humidity. The presence of desiccant did not significantly affect stability and the presence of N,N‐diacetylcystine barely exceeded the European Pharmacopoeia limit of 0.5%.

Conclusion

The formulated N‐acetylcysteine capsule was stable for 420 days when stored at 2–8 °C, 18–25 °C and 40 °C.
Inflammatory Bowel Disease in Older People
Authors: Grimpen Florian , Pavli Paul
Published: April 2015

Inflammatory bowel disease (IBD) can affect patients of all ages. The majority of patients are diagnosed in the second or third decade of life, but a minority develop the disease at an advanced age. Diagnosis can be delayed due to the preconception that IBD mainly affects young people, and the broader spectrum of differential diagnoses in the elderly. Management and treatment options are similar to those in younger patients but adverse reactions and drug interactions may be of greater significance in the elderly. Precluding treatment with anti‐tumour necrosis factor drugs on grounds of previous infection with tuberculosis or viral hepatitis, comorbidities or previous malignancy – factors often found with advanced age – can make treatment challenging. The increased risk of bowel cancer in IBD warrants regular screening, especially in the elderly as their absolute risk of cancer is higher.
Oxycodone as a Component of Multimodal Analgesia Post‐Caesarean Section in Australia and New Zealand
Authors: Seaton Suzette M , Reeves Mark
Published: April 2015

Background

There is a perception that oral oxycodone is becoming a popular choice for post‐caesarean section analgesia. There are a lack of published data quantifying the use of oxycodone and other drugs for post‐caesarean section analgesia in Australasian practice.

Aim

To determine the use of oxycodone and other drugs for multimodal analgesia post‐caesarean section and to evaluate the compatibility of these drugs with breastfeeding.

Method

Fellows of the Australian and New Zealand College of Anaesthetists from 41 Australian and New Zealand obstetric units were invited to participate in an online survey on analgesic preference (drug, route of administration, dosing schedule) post‐caesarean section and whether breastfeeding considerations influenced their choice of analgesics.

Results

25 participants (response rate 61%) completed the survey. All of the responding obstetric units used multimodal analgesic protocols, which included oral and rectal paracetamol and non‐steroidal anti‐inflammatory drugs. Survey responses indicated that 50% of women in metropolitan hospitals and 95% of women in rural and regional hospitals would receive oral or rectal oxycodone post‐caesarean section. Approximately, 15% of women would be asked about their intention to breastfeed. 6% of anaesthetists would modify their choice of analgesic if the patient was breastfeeding.

Conclusion

The obstetric units preferred oral and rectal analgesics over parenteral opioids and non‐steroidal anti‐inflammatory drugs. There was a high use of oxycodone for post‐caesarean section analgesia. The analgesics chosen were largely compatible with breastfeeding.
Surface Contamination of Cytotoxic Chemotherapy Preparation Areas in Australian Hospital Pharmacy Departments
Authors: Siderov Jim , Kirsa Sue , McLauchlan Robert
Published: April 2015

Background

Studies from Europe, the US and Australia have shown measurable levels of cytotoxic contamination in health facilities. Cytotoxic drug residue has been detected in the air and on surfaces in preparation areas even though work was undertaken in biological safety cabinets. Several studies have found substantial levels of surface contamination in pharmacy drug preparation and administration areas. At the time this study was conducted there were no published Australian studies investigating surface contamination when cytotoxic drug safety cabinets are in use.

Aim

To determine if surface contamination with cytotoxic drugs occurs when cytotoxic drug safety cabinets are used by pharmacy personnel to prepare cytotoxic chemotherapy.

Method

A multicentre study conducted at 10 hospital pharmacy departments in metropolitan Melbourne. All sites were tested to measure the amount of cytotoxic contamination present using cyclophosphamide as a surrogate marker for all cytotoxic drugs. Surface wipe sampling was performed at specified locations within the cytotoxic suites.

Results

Cyclophosphamide contamination was detected in 78% of samples taken within the cytotoxic drug safety cabinet, with 100% contamination detected in the sump. Positive results were also found in 89% of floor samples (cleanroom and anteroom) and 67% of checking benches.

Conclusion

Cytotoxic drug contamination was detected on a variety of surfaces in the cytotoxic drug preparation areas that used cytotoxic drug safety cabinets. The potential risk of exposure to cytotoxic drugs exists in the workplace despite adherence to the recommended safe handling guidelines.
Solid Medication Dosage Form Modification at the Bedside and in the Pharmacy of Queensland Hospitals
Authors: Nissen Lisa M , Haywood Alison , Steadman Kathryn J
Published: April 2015

Background

Solid medication dosage forms are regularly modified to aid medication delivery to patients that are unable to swallow them.

Aim

To identify medications that are commonly modified in Queensland hospitals at the bedside and in the pharmacy and to identify how these modifications are made.

Method

A self‐report survey was sent to 97 hospitals of varying sizes in metropolitan and rural areas across Queensland.

Results

Most (n = 31; 79%) of the responding hospitals reported that medications were modified at the bedside. 73 different medications were modified at the bedside. Most of the tablets or capsules had standard‐release characteristics. 8 hospitals crushed modified‐release dosage forms and 11 hospitals crushed medications with a narrow therapeutic index. At the bedside, 88% of medications were modified for adult use, mostly by crushing multiple tablets together (84% of hospitals) using a pestle and mortar (87%) and mixing into jam (72%) or water (64%). Only 7 hospitals reported modifications in the pharmacy (many small hospitals do not employ a pharmacist). 17 medications modified in the pharmacy were all modified for children because of the lack of commercial preparations.

Conclusion

Commercial medication dosage forms are altered in Queensland hospitals, including medications for which serious adverse effects may arise from the delivery of toxic or subtherapeutic doses. Pharmacists can contribute to the education of nurses to raise awareness of problems resulting from altering medication dosage forms. Education of doctors is also needed to raise awareness of prescribing alternative dosage forms that may either be commercially available or prepared by the pharmacy as an extemporaneous preparation.
Management of Medicines in Chronic Illness: Views of Community Pharmacists in New South Wales
Authors: Lehnbom Elin C , Boxall Anne‐marie , Russell Lesley M , Brien Jo‐anne E
Published: April 2015

Background

Healthcare reforms are needed to meet the predicted increase in the chronic disease burden. A multidisciplinary team approach has been extensively evaluated and shown to improve health outcomes. There is also support for including pharmacists in these teams. Pharmacists have valuable insight, from a medication perspective, to improve the management of patients with chronic illness.

Aim

To explore the perceptions of community pharmacists regarding the incentives, barriers and solutions in managing the medication regimens of patients with chronic illness.

Method

Semi‐structured group discussions and individual interviews were conducted in October and November 2008 with community pharmacists working in Western Sydney and the Blue Mountains.

Results

Community pharmacists struggle to provide optimal care for patients with chronic illness. Identified reasons include poor communication with patients and health professionals, lack of care coordination and continuity of care. Many patients were thought to struggle financially when managing a chronic illness, which negatively influenced their adherence to medication regimens and recommendations on lifestyle changes. Better teamwork and communication, possibly through co‐locating health professionals under one roof were suggested by pharmacists as possible solutions.

Conclusion

Pharmacists have a good understanding of patients' social circumstances but lack relevant clinical data. Community pharmacists are willing to take a greater role in the management of patients with chronic illness.
Stability of Methoxyflurane Loaded Penthrox Inhaler
Authors: Crankshaw David P
Published: April 2015

Background

Methoxyflurane (MEOF), a non‐narcotic inhalational anaesthetic, administered with the Penthrox Inhaler is effective in managing acute pain. Despite widespread use by ambulance services, its use in emergency departments and hospital wards has been limited. MEOF storage to minimise evaporation would facilitate pre‐filling inhalers for multiple treatment use.

Aim

To ascertain if Penthrox Inhalers loaded with MEOF can be stored for extended periods without appreciable loss of MEOF.

Method

18 Penthrox Inhalers were loaded with MEOF 3 mL and weighed over 87 hours. 6 inhalers were left in the open, 6 inhalers stored in the packing boxes and 6 inhalers sealed in low‐density polyethylene bags inside the packing boxes.

Results

Penthrox Inhalers in the polyethylene bags retained over 95% of the MEOF after 25 hours and over 80% after 87 hours. Inhalers stored in the packing boxes retained 15% of the MEOF after 25 hours while inhalers left in the open lost 50% of the MEOF after 5 hours with less than 1% remaining after 25 hours.

Conclusion

Penthrox Inhalers loaded with MEOF and stored in low‐density polyethylene bags inside the packing boxes can be effective for over 3 days without appreciable loss of MEOF.
Coordinated Strategies to Attract Pharmacists to the Public Hospital Sector in Victoria
Authors: O'Leary Karen , Newman Suzanne , Yeung Sally , Wright Sue
Published: April 2015

A 2001 census of Victoria's public hospitals reported that 8% of the 443.5 pharmacist full‐time equivalent positions were vacant. The funding of a pharmacist project officer by the Victorian Department of Human Services enabled the identification and implementation of recruitment strategies. Subsequent workforce analyses highlighted links between high vacancy rates and reduced job satisfaction with staff retention. Also identified was the importance of hospital‐based training in recruiting newly qualified pharmacists to the public hospital sector. Since 2001, there has been an estimated increase of 185 to 200 full‐time equivalent pharmacist positions in Victoria's public hospitals and the vacancy rate has also improved (8% to 3%). Hospital‐based training is a successful strategy to recruit newly qualified pharmacists and pro‐actively addressing the vacancy rate is an effective retention strategy.
Management of Older People with Chronic Obstructive Pulmonary Disease
Authors: Malipatil Vivek , McDonald Christine F
Published: April 2015

Worldwide, chronic obstructive pulmonary disease ranks among the most common chronic diseases and with the population ageing, its prevalence is predicted to increase. Established interventions that improve mortality include smoking cessation, and oxygen therapy in patients with significant hypoxaemia. Pharmacotherapy aims to alleviate symptoms, improve exercise tolerance and quality of life, and prevent and manage exacerbations. Although most medications are delivered via the inhaled route, adverse effects can manifest systemically. The likelihood of systemic adverse effects increases in the elderly and caution should be exercised in patients with comorbidities, such as cardiovascular disease. When indicated, combination therapies can offer superior efficacy over monotherapy. Assessment and education to ensure appropriate delivery device selection and use are integral to optimal care.
Management of Over‐Anticoagulation in Warfarinised Hospital Patients
Authors: Bajorek Beata V , Yau Leanne , Lee Kevin , Zulueta Wayne
Published: April 2015

Aim

To determine the number of warfarinised hospital patients experiencing over‐anticoagulation; to identify how over‐anticoagulation is managed and whether local guidelines are adhered to.

Method

2 prospective one‐week clinical audits were conducted in 2005 (Audit 1) and 2008 (Audit 2). The medical notes, drug charts and anticoagulation charts of warfarinised patients admitted to hospital were reviewed. The following data were collected: medical histories, warfarin regimen, international normalised ratio results, clinical events and over‐anticoagulation clinical management and treatment options.

Results

Data were collected for 58 patients (Audit 1: n = 30; Audit 2: n = 28). At least one‐third of all patients experienced over‐anticoagulation (Audit 1: 53%; Audit 2: 36%). Haemorrhagic events occurred in 40% of patients in Audit 1 and 18% in Audit 2 (p = 0.06) – not all were associated with elevated international normalised ratios. Most cases of over‐anticoagulation were managed by withholding warfarin doses and one case (Audit 2) required Prothrombinex. Drug interactions were the most common risk factor (> 50% of patients) for over‐anticoagulation in both audits. Problems with documentation were more prevalent in Audit 1 than in Audit 2.

Conclusion

Over‐anticoagulation is a common occurrence in warfarinised hospital patients. Hospital over‐anticoagulation management practices need to be reviewed to ensure safe and efficacious anticoagulation.
Identification of Adverse Drug Reactions Using the ICD‐10 Australian Modification Clinical Coding Surveillance
Authors: Hodgkinson Marisa R , Dirnbauer Nicole J , Larmour Ian
Published: April 2015

Background

Adverse drug reactions (ADRs) pose a significant burden on patients and the health system. ADR reporting contributes to data that guide patient safety strategies. Despite numerous strategies aimed to improve ADR reporting rates, ADRs continue to be under‐reported.

Aim

To compare the effectiveness and efficiency of identifying institutional ADRs using the International Classification of Diseases 10th Revision Australian Modification (ICD‐10‐AM) clinical coding surveillance and spontaneous reporting.

Method

Medical records of multi‐day (staying overnight or longer) inpatient separations (single patient encounter resulting in discharge) assigned an ADR‐related ICD‐10‐AM code were retrospectively reviewed to verify if an ADR had occurred and whether the codes assigned were appropriate. ADR reports received via the spontaneous reporting system were also reviewed. ADRs were assessed for causality, seriousness and type of reaction. The drugs, type of adverse reactions involved and the resource implications of this reporting method were also investigated.

Results

ICD‐10‐AM coding surveillance and spontaneous reporting resulted in an ADR reporting rate of 3.3% and 0.4% of inpatient separations, respectively. ICD‐10‐AM coding surveillance was more likely to identify type A ADRs than spontaneous reports although there were no significant differences in seriousness or causality. The ICD‐10‐AM codes assigned were appropriate in 94% of cases, with the omission of drugs being the most common discrepancy.

Conclusion

The ICD‐10‐AM coding surveillance is an effective and efficient method of improving ADR reporting by utilising data collected for administrative purposes.
Snapshot of the Australian Public Hospital Pharmacy Workforce in 2007
Authors: O'Leary Karen M , Allinson Yvonne M
Published: April 2015

In 2007, a workforce questionnaire was sent to 236 Australian public hospitals with more than 50 beds. This report details the data received from 108 public hospital pharmacy services and compares the results to the earlier surveys performed at the same time of year in 2001, 2003 and 2005. Key findings of the 2007 snapshot of the Australian public hospital pharmacy workforce are that:

overall, 84 of the 1256 (7%) establishment pharmacist full‐time equivalent positions were vacant (similar to 2005);

there has been a considerable increase in establishment pharmacist full‐time equivalent positions in public hospitals in the past 2 years. 35 respondents indicated the need for additional 133 pharmacist full‐time equivalent positions (or an increase of 11%) in the next 2 years. The majority of these positions were needed because of the expansion of clinical services, improving pharmaceutical review initiatives and the introduction of the Pharmaceutical Benefits Scheme.

30 of the 84 vacancies are in New South Wales (vacancy rate 11%). New South Wales also has a substantial gap between the actual and required number of pharmacist full‐time equivalent positions and a relatively low number of establishment pharmacist full‐time equivalent positions;

on average pharmacists spent (similar to 2005) 47% of their time providing clinical services, drug information services, and training and education; 38% of their time acquiring, manufacturing and dispensing medicines; and 15% of their time managing the medicine and personnel resources of the pharmacy service and hospital‐wide activities, such as institutional drug policy management;

the number of available pharmacy intern positions has only increased slightly despite a large increase in the number of pharmacy graduates; and

the percentage of hospital pharmacy technicians with formal qualifications as a pharmacy technician or overseas pharmacist has increased to over 50% (26% Certificate 111, 11% Certificate 1V, 13% with other qualifications).
Evaluation of a Pharmacist‐Initiated E‐Script Transcription Service for Discharged Patients
Authors: deClifford Jan‐Marie , Lam Skip S , Leung Benjamin K
Published: April 2015

Aim

To evaluate a pharmacist‐initiated e‐script transcription service for discharged patients.

Method

A sequential prospective study of 2 groups of 40 eligible medical patients recruited from the neurology and respiratory wards. Pre‐implementation of the service, baseline data were collected from 40 consecutive medical patients. After the new service was implemented and allowing for a 2 week run‐in period, data were collected from a further 40 consecutive medical patients. The outcome indicators were the time taken to discharge patients and the number of prescribing errors.

Results

The pharmacist‐initiated e‐script transcription service was successfully implemented. The discharge process was faster with the time taken from decision to discharge to actual discharge decreased by 34% (p = 0.02). The time spent by dispensing pharmacists in clarifying and amending discharge prescriptions decreased from 9.5 to 1.5 minutes per patient. The time spent by doctors in preparing discharge prescriptions fell from 15 to 2 minutes per patient. There were also fewer prescribing errors – number of errors decreased from 0.83 to 0.1 per patient (p = 0.0005) and from 0.0962 to 0.0137 per item (p = 0.011).

Conclusion

Combining a prescribing role with the medication safety elements of electronic prescribing and medication reconciliation has resulted in significant improvements in the quality, accuracy and timeliness of discharge prescriptions. The centralised discharge transcription service is transferable to a wide variety of health settings. The principles of workforce substitution and process change is important as the health system struggles to meet ever increasing demands.
Pattern of High‐Dose Prednisolone‐Induced Hyperglycaemia in COPD Exacerbations
Authors: Roberts Gregory W , Monteiro Vinia E
Published: April 2015

Background

High‐dose prednisolone is the mainstay of treatment for acute exacerbations of chronic obstructive pulmonary disease (COPD). Hyperglycaemia is a dose‐related adverse effect of prednisolone. Recent evidence suggests that the presence of hyperglycaemia during COPD exacerbations may impair recovery. To develop a successful management strategy, more information is needed on the nature of prednisolone‐induced hyperglycaemia in COPD exacerbations.

Aim

To determine the characteristics of prednisolone‐induced hyperglycaemia in patients experiencing COPD exacerbations and receiving high‐dose prednisolone (20 mg or more daily).

Method

A prospective study of patients hospitalised for COPD exacerbations and receiving high‐dose prednisolone. Eligible patients with COPD exacerbations and receiving highdose prednisolone were divided into 3 groups – diabetic, non‐diabetic and pre‐diabetic. The capillary blood glucose levels for the 3 groups were measured daily at 7 am, noon, 5 pm and 9 pm for up to 4 days of treatment. These blood glucose levels were compared with the retrospective blood glucose levels of diabetic patients hospitalised for reasons other than COPD exacerbations and not receiving prednisolone (control).

Results

Compared to the diabetic control group (n = 117), the mean daily blood glucose levels were 2 mmol/L higher in diabetic COPD patients receiving prednisolone (n = 7; p < 0.05). Pre‐diabetic COPD patients receiving prednisolone (n = 6), experienced a mean daily blood glucose level similar to that of the diabetic control group, while the non‐diabetic COPD patients (n = 6) were largely unaffected. In both diabetic and pre‐diabetic COPD patients there was a delayed blood glucose level peak at 5 pm that was 4 mmol/L higher than the 7 am blood glucose level (p < 0.05 for both). This pattern was not evident in the diabetic control group. In both the diabetic and pre‐diabetic COPD patients the recovery of blood glucose levels to baseline occurred within 24 hours.

Conclusion

Prednisolone‐induced hyperglycaemia influenced blood glucose levels in pre‐diabetic COPD patients to the same extent as diabetic COPD patients, while the non‐diabetic COPD patients were largely unaffected. The hyperglycaemic effect was transient, lasted for less than 24 hours and followed a distinct daily pattern.
Rapid Desensitisation of an Immunocompetent Patient with Cotrimoxazole Hypersensitivity
Authors: Walton Natalie , Krumins Daila
Published: April 2015

Background

Hypersensitivity reactions to cotrimoxazole (trimethoprim+sulfamethoxazole) are common. Limited and varied data are available on desensitisation protocols for patients with cotrimoxazole hypersensitivity.

Aim

To report the successful rapid desensitisation of an immunocompetent patient with cotrimoxazole hypersensitivity.

Clinical Details

A 58‐year‐old male presented with multiple brain abscesses of unknown origin on a background of actinomycotic lung lesions. He was admitted to the intensive care unit in a critical state and started on multiple antibiotics. After limited clinical improvement intravenous cotrimoxazole was initiated. Although the patient's clinical signs improved, he developed a rash. Cotrimoxazole was ceased and the rash cleared. Once the patient was clinically stable, cotrimoxazole desensitisation was attempted over 6 hours using the protocol from Therapeutic Guidelines: Antibiotic.

Outcomes

The patient was successfully desensitised and subsequently completed a 6‐month course of cotrimoxazole therapy. No further adverse reactions were reported.

Conclusion

Cotrimoxazole desensitisation using the protocol from Therapeutic Guidelines: Antibiotic can allow treatment of patients with sulfamethoxazole hypersensitivity.
Medication Safety Series
Authors: Thornton Penny
Published: April 2015

This series brings you information about medication safety issues and strategies to prevent medication errors. It draws on Australian incidents and US experience (with permission) from ISMP Medication Safety Alert! a bulletin published by the Institute for Safe Medication Practices . This series is coordinated by 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 (Principal Advisor, Medication Safety, NSW Health; >medsafety@shpa.org.au<).
Hospital Pharmacy Dispensing Records for Pharmacoepidemiology Research into Late Gestation Exposure to Antidepressants
Authors: Grzeskowiak Luke E , Gilbert Andrew L , Morrison Janna L
Published: April 2015

Aim

To determine the validity of electronic hospital pharmacy dispensing records as an indicator of late gestation exposure to antidepressants using medical records as the gold standard.

Method

Medical records (gold standard) were reviewed for a consecutive sample of 400 women who delivered at a large maternity hospital during 2005. Data on antidepressants used in pregnancy from the medical records were compared with the electronic pharmacy dispensing records to ascertain sensitivity and specificity.

Results

According to the medical records, 12 (3%) women were identified as taking antidepressants during late gestation. The electronic pharmacy dispensing records correctly identified 9 women as exposed to antidepressants (sensitivity score 75%; 95%CI 43–95). No women were classified as exposed according to pharmacy dispensing records and classified as not exposed according to the medical records (specificity score 100%; 95%CI 99–100). 7 (1.8%) women were identified in the medical records as taking antidepressants but had either stopped prior to pregnancy or on finding out that they were pregnant. These patients were not identified in the pharmacy dispensing records.

Conclusion

Electronic hospital pharmacy dispensing records may provide an efficient alternative to paper records for identifying late gestation exposure to antidepressants, but will underestimate the exposure by 25%.
Identifying Temporal Changes to the Prescribing of Anti‐Arrhythmics for Atrial Fibrillation
Authors: Yip Annie , Bajorek Beata V
Published: April 2015

Background

There are a paucity of data on the use of anti‐arrhythmics for atrial fibrillation (AF), particularly in view of new treatment guidelines recommending rate control over rhythm control.

Aim

To investigate the use of anti‐arrhythmics for AF in the local clinical setting.

Method

A retrospective clinical audit of the medical records of 174 adult patients with primary or secondary AF was conducted at a large Sydney teaching hospital. Data were collected on patients' characteristics, medical history, factors affecting treatment choice and clinical outcomes.

Results

For acute treatment of AF, 38 (22%) patients received rhythm control only, 30 (17%) received rate control only, and 42 (24%) received rate control plus rhythm control. For long‐term management of AF, 24 (14%) patients received rhythm control only, 42 (24%) received rate control only, and 28 (16%) received rate control plus rhythm control. The number of patients who attained sinus rhythm was higher in those receiving rhythm control drugs versus rate control drugs (84% vs 31%; p < 0.05). A decrease was observed in the number of patients on digoxin (41% vs 6%; p < 0.01) and amiodarone (26% vs 6%; p < 0.001). Factors identified as influencing treatment choice were age, heart rate, AF characteristics and comorbidities.

Conclusion

There has been a temporal change in the use of anti‐arrhythmics for AF, reflecting changes to recommendations on the use of rhythm versus rate control drugs. These changes in prescribing patterns are reflective of current guidelines and evidence‐based practice.
Provision of Hospital Pharmacy Services for Clinical Drug Trials
Authors: Hynes Kay I , Rice Carol A
Published: April 2015

Aim

To explore Australian hospital pharmacy services provided to clinical drug trials in 2007; and to compare the results with data from similar surveys conducted in 1989 and 1994.

Method

Questionnaires were sent to pharmacy managers of 301 public and private Australian hospitals.

Results

164 hospitals responded to the survey. The response rate (55%), demographics and number of hospitals conducting clinical drug trials (75%) did not differ significantly in 1989, 1994 and 2007. However, the number of hospital pharmacies reporting 30 or more clinical drug trials had more than tripled between 1989 (n = 11) and 2007 (n = 38). From 1994 to 2007 there was a 300% increase in the number of pharmacy departments who reported spending 20 hours/week or more on clinical trials. In 1994 and 2007, pharmacy departments with 30 or more clinical trials reported that they had a dedicated clinical trials pharmacist. By 2007, most hospital pharmacies (70%) were funded for over 50% of their clinical trials; a significant increase from 5% in 1989 and 32% in 1994. Most hospital pharmacies (78%) dispensed more than 75% of the investigational drugs within their hospitals. Pharmacist involvement in the review of trial protocols by membership of institutional human research ethics committees had tripled between 1989 (n = 14) and 2007 (n = 43).

Conclusion

Specialisation and expertise to conduct clinical drug trials by hospital pharmacists is recognised by their increased involvement with human research ethics committees, increased funding to pharmacies, more specialist clinical trial pharmacists, and pharmacists dispensing drugs for clinical trials conducted in hospitals.
Treatment of Venous Thromboembolism in Older People
Authors: Ho Wai Khoon
Published: April 2015

The incidence of venous thromboembolism increases markedly with age. Anticoagulation is effective in secondary prevention of venous thromboembolism but in older people, anticoagulation may be associated with increased risk of haemorrhage. Furthermore, given the high prevalence of renal impairment, there is risk of accumulation of renally cleared drugs (e.g. low molecular weight heparins, fondaparinux, some of the new anticoagulants). Older people tend to have more comorbidities and are on more medications which can potentially interact with anticoagulants. Older people are generally more sensitive to warfarin and require lower doses to maintain therapeutic anticoagulation. With the discovery of genetic polymorphisms that influence warfarin metabolism, dosing algorithms based on pharmacogenomics have been devised and are being evaluated to help improve the safety of anticoagulation.
Snapshot of Antimicrobial Stewardship in Australian Hospitals
Authors: Chen Alex WJ , Khumra Sharmila , Eaton Vaughn , Kong David CM
Published: April 2015

Background

The diminishing investment into the development of new antimicrobials is of significant global concern. This, coupled with the emergence of anti‐infective drug resistance, highlights the need to both prolong and optimise the use of existing antimicrobials. Strategies or programs to optimise antimicrobial use fall under the broad heading of antimicrobial stewardship.

Aim

To identify the types of antimicrobial stewardship programs in existence in Australian hospitals and their perceived success.

Method

Directors of Pharmacy or their nominees (n = 281) working in Australian hospitals were surveyed to identify their institutional antimicrobial stewardship programs. Infectious disease clinicians, infection control nurses and hospital pharmacists were recruited for the qualitative interviews. They were interviewed until saturation of themes was identified. All of the interviews were transcribed verbatim and analysed for common themes.

Results

Responses were received from 80 Directors of Pharmacy or their nominees (29% response rate). The types of antimicrobial stewardship programs identified can be broadly grouped into: administration‐related; antimicrobial use and prescribing‐related; education and training‐related; and infection control and surveillance‐related. A variety of strategies are used to promote appropriate prescribing of antimicrobials, resulting in varying levels of perceived success, for example the use of Drug and Therapeutics Committees, formulary restrictions, locally developed antimicrobial guidelines and streamlining or de‐escalation of therapy. Clinical leadership, a multidisciplinary approach and the availability of enthusiastic and motivated individuals are critical to the success of antimicrobial stewardship programs.

Conclusion

Australian hospitals have implemented a variety of antimicrobial stewardship programs with varying degrees of perceived success.
Medicine Management in Older People from Non‐English Speaking Backgrounds
Authors: Blennerhassett Jenny , Hilbers Julieanne
Published: April 2015

Aim

To examine medicine management in older people from non‐English speaking backgrounds (NESB) after discharge from hospital.

Method

A literature review, followed by focus group discussions with hospital clinicians. Patients 70 years and over from Greek, Chinese, Russian and English speaking backgrounds were interviewed. Case histories were developed based on the interviews and a review of the patients' medical records. Data were clustered and themes extracted. Educational resources were produced for clinicians comprising an action guide and a composite audiovisual case study. These resources were used in further focus group discussions with hospital clinicians to determine current practice for identifying and managing medication management risks for patients from NESB.

Results

Major themes identified included: patients' lack of knowledge about medications and medication changes; interpreter services not used routinely; and inadequate communication between health professionals. There was little evidence of systematic, standardised processes for identifying people at risk of medicine mismanagement or for the implementation of actions to minimise risks.

Conclusion

There is a need for effective communication about medications, particularly when patients are transferred from hospital to the community. For people from NESB, this also includes the use of interpreters and translated educational material. A patient journey map and medicine management action guide provides a framework for clinicians to optimise safe medicine management and continuity of care.