bluuebunny/crossref_metadata_2025 huggingface dataset:
Direct–to–Consumer Advertising of Prescription Medicines on the Internet: An Australian Consumer Perspective
Authors: Gu Phoebe , Williams Kylie A , Aslani Parisa , Chaar Betty B
Published: April 2015

Background

In Australia there are strict regulations in place to protect the consumer from direct–to–consumer advertising (DTCA) of prescription medicines. However, the degree of infallibility of these restrictions is unclear.

Aim

To investigate the DTCA encountered by Australian consumers when searching the Internet for common health‐ or medicine‐related questions.

Method

2 health topics, weight loss and impotence, were chosen and explored from 2 perspectives – the health condition and a commonly used medicine (brand name). Key words were chosen to simulate the language and search style of a consumer. The first 10 hits from each search were evaluated using the validated DISCERN scale, and a descriptive report of each web site was conducted with a specific focus on evidence for DTCA.

Results

Of the 70 web sites visited, 10 sites originating from the USA or New Zealand exhibited DTCA. The scale and intensity of DTCA varied between search topics and strategies and ranged in appearance from simple, pictorial advertising to subtle forms of persuasive language. DTCA of some pharmaceuticals was often hidden within disease awareness campaigns, ePharmacy web pages and online communities.

Conclusion

Australian consumers are exposed to DTCA of prescription medicines on the Internet. Clearly, DTCA restrictions in Australia are not infallible. Australian policy makers in the interests of public health must take measures to address the gaps.
Post‐Registration Learning Trends of Community Pharmacists
Authors: Clifford Rhonda M , Ram Pretisha L , Lakos Anneika , Gudka Sajni , Seubert Liza J , Schneider Carl R , Gregory Lesley AH
Published: April 2015

Background

Some Australian pharmacists use continuing education to maintain knowledge and acquire new information. There has been a progression from continuing education to continuing professional development (CPD) – a mandatory requirement for pharmacists in all jurisdictions of Australia.

Aim

To identify post‐registration learning trends of community pharmacists in Western Australia.

Method

A questionnaire was developed and administered by face–to–face interviews with community pharmacists in metropolitan Perth. Pharmacists registered for less than 12 months and pharmacists working in hospitals were excluded.

Results

103 pharmacists were approached with a response rate of 95%. Journals (41%), reference books (23%) and the Internet (18%) were the most commonly used educational resources cited by pharmacists. Keeping scientific information up‐to‐date (39%) and gathering practical knowledge (22%) were the leading motivators for pharmacists to participate in continuing education. Factors that hindered participation in continuing education included lack of time (34%), family commitments (21%) and business commitments (21%). 79% of pharmacists agreed with the concept of mandatory CPD. 47% of pharmacists suggested that the primary sanction for not complying with mandatory CPD should be counselling to determine reasons for non‐compliance.

Conclusion

Community pharmacists preferred educational resources that were easily accessible at convenient times. Most pharmacists were able to fulfil the requirements of CPD, however, further educational support and promotion would ensure the successful uptake of CPD by community pharmacists in Western Australia.
Revisiting Guidelines and Inappropriate use of Ticarcillin/ Clavulanate at an Australian Teaching Hospital
Authors: Patterson Tina H , Unwin Sean , Looke David FM , Pillans Peter I , Loy Lynette M
Published: April 2015

Aim

To assess adherence to local ticarcillin/clavulanate prescribing guidelines; to examine the appropriateness of non‐compliant prescribing; and to identify patterns of prescribing that could be improved.

Method

A convenience sample of patients prescribed ticarcillin/clavulanate was prospectively identified by ward pharmacists over a 9‐week period. Their medication charts were retrospectively reviewed by the drug use evaluation pharmacist and data collected on patient demographics, diagnosis, previous penicillin allergy, microbiology, treatment type and compliance with local guidelines. Ticarcillin/clavulanate use that was considered inappropriate was analysed for costs.

Results

Of the 100 patients included in the audit, half were prescribed ticarcillin/clavulanate outside of local guidelines. In this non‐compliant group, approximately two thirds (65%) of patients were considered to have been treated appropriately. The majority of these patients were being managed for diabetic foot infections. Prescribing in only 18% of cases was considered to be neither compliant with the guidelines or appropriate. Pharmacoeconomic analysis suggests that efforts to improve prescribing may result in cost savings.

Conclusion

There was widespread use of ticarcillin/ clavulanate outside of the local guidelines. In many cases, non‐compliant prescribing was considered appropriate.
Drugs, Delirium and Older People
Authors: Britton Mary E
Published: April 2015

Risk factors for delirium are common in older people, and they experience delirium more frequently than younger people. Delirium is associated with poor outcomes. This review explores the relationship between drugs and delirium based on our understanding of the neuropathology and neurotransmitter hypothesis of delirium. Also discussed, are the limitations of the evidence that certain drugs are causative or useful in the treatment and prevention of delirium. Since older people are the biggest users of drugs, the inextricable links between drugs and delirium make this subject pertinent in older people.
Impact of Pharmaceutical Reforms on Non‐Prescription Medication Management in Post‐Natal Women Following Discharge from Hospital
Authors: Whennan Lisa D , Grzeskowiak Luke E
Published: April 2015

Background

Pharmaceutical reforms were introduced to South Australia in 2007 and resulted in significant changes to the provision of medications on discharge for postnatal women. Women are required to pay for each medication provided on discharge, where previously these were free of charge.

Aim

To determine whether postnatal women discharged from the Women's and Children's Hospital purchased recommended non‐prescription medications.

Method

Postnatal women who delivered over a 3‐week period (May to June 2010) completed a short questionnaire during a home visit by a midwife in the days following discharge. The questionnaire collected data on demographics, as well as on medications supplied on discharge, whether non‐prescription medications were recommended to be purchased post‐discharge and whether these medications were purchased.

Results

70 questionnaires were returned and analysed (response rate 30%). 110 non‐prescription medications were recommended for purchase post‐discharge; 42 were not purchased because they were present at home. Of the remainder, 42 (62%) were purchased and 26 (38%) were not purchased. The most common reason for medications not being purchased was that it was no longer required (59%). Medications purchased most often included iron (83%) and vitamin D (100%), while those purchased least often included urinary alkalinisers (33%) and fibre supplements (44%).

Conclusion

Pharmaceutical reforms do not appear to have had an adverse impact on non‐prescription medication management in postnatal women. The majority of non‐prescription medications were purchased as recommended post‐discharge.
Comparative Analysis of Rural Community Pharmacy Practice in Western Australia in 2002 and 2006
Authors: Wibowo Yosi , Berbatis Constantine G , Joyce Andrew , Sunderland V Bruce
Published: April 2015

Background

Data are lacking on the characteristics of rural and remote community pharmacies in Western Australia (WA).

Aim

To analyse characteristics of community pharmacies and pharmacists in rural WA in 2006 and to compare these with the results of a national survey conducted in 2002.

Method

A survey was conducted in 2006 using a questionnaire similar to that used in a national survey conducted in 2002. The questionnaires were mailed to all 103 rural pharmacies in WA, of which 51 were returned (response rate 50%). Chi2 tests were used to compare the 2002 (rural WA) and 2006 data.

Results

Pharmacist demographic characteristics were mostly unchanged. A trend towards increased employment of younger female pharmacists was found in 2006. 60% of respondents devoted less than 5 hours per month to continuing pharmacy education in both surveys. There were no significant differences in the characteristics of pharmacies in terms of PhARIA location, setting, banner group membership, inclusion of counselling areas, operations, trading hours and annual turnover. Pharmacies accredited by the Quality Care Pharmacy Program (QCCP) increased from 42% in 2002 to 86% in 2006.

Conclusion

Many characteristics of rural WA pharmacies and pharmacists in 2006 were similar to 2002. Increased QCCP accreditations indicated higher quality assurance of rural pharmacy practice. The low uptake of ‘forward pharmacy’ in rural pharmacies warrants further evaluation.
Chiral Stability Study of Oral Liquid Clopidogrel Formulations for Infants
Authors: Mihaila Bianca , Ellis David , Rozek Thomas , Milne Robert
Published: April 2015

Background

Clopidogrel is used in at‐risk infants to prevent thrombotic complications. There is no commercially available liquid preparation and existing formulations have not been evaluated for the chiral stability of clopidogrel.

Aim

To determine the stability of clopidogrel 1 mg/mL liquid formulations using chiral chromatography.

Method

Clopidogrel 1 mg/mL suspension was formulated using Plavix (clopidogrel) tablets and Ora‐Plus:Ora‐Sweet 1:1, and stored at room temperature and under refrigeration. Samples were also prepared using a variety of co‐solvents and stored at room temperature. Samples were taken for up to 49 days and assayed for S‐clopidogrel, R‐clopidogrel and S‐acid using high‐performance chiral liquid chromatography. Percentage of S‐clopidogrel remaining (at least 90% of nominal content) and percentage of degradation product formation were used to estimate shelf‐life.

Results

Only the refrigerated Ora‐Plus:Ora‐Sweet mixture did not have degradation products that exceeded USP limits for clopidogrel impurities for at least 30 days. The estimated shelf‐lives of the Ora‐Plus:Ora‐Sweet mixtures at room temperature (25 °C) and under refrigeration (4 °C) were 19 and 37.5 days, respectively. There was no improvement in stability when mixtures were prepared using a variety of co‐solvents.

Conclusion

Clopidogrel 1 mg/mL suspension made with Ora‐Plus:Ora‐Sweet and stored in amber glass bottles was stable for 1 month under refrigeration and 2 weeks at room temperature.
Two Examples of Student Placement Tasks: Drug Use Evaluations
Authors: Flavel Daniel , Grey Luka , Morrissey Hana , Ball Patrick
Published: April 2015

Background

Experiential clinical placement is a compulsory component of the pharmacy course at Charles Sturt University. The Rural Pharmacy Practice subject, in addition to addressing the National Competency Standards, tasks students to undertake a number of projects during their clinical placements.

Aim

To present 2 examples of student conducted drug use evaluations where the outcomes of the activities were perceived to have benefited the placement site.

Method

This was an observational study involving 2 student projects considered to be of benefit by the placement sites. Both studies investigated adherence to local guidelines to inform optimal patient care.

Results

Project 1 evaluated intravenous versus oral paracetamol use and concluded that the prescribing guidelines for intravenous paracetamol were adhered to in around 50% of cases. Project 2 evaluated OxyContin (oxycodone) use and concluded that oxycodone dosages prescribed complied with guidelines. However, the treatment regimens of around 35% of patients assessed could be improved by using non‐opioid analgesics, such as paracetamol.

Conclusion

Student placement projects, such as drug use evaluations, represent an excellent way for students to benefit the clinical placement site.
National Survey of Clinical Pharmacy Services and Pharmacy Technician Roles for Subacute Aged‐Care Inpatients
Authors: Elliott Rohan A , Perera Dhineli , O'Leary Karen
Published: April 2015

Background

Subacute aged‐care inpatients usually have multiple risk factors for adverse medication events. There is evidence that clinical pharmacy services can improve their medication management.

Aim

To describe clinical pharmacy services, pharmacist and pharmacy technician staffing levels, and pharmacy technician roles in the subacute aged‐care inpatient setting.

Method

A pre‐piloted online survey was e‐mailed to directors of pharmacy listed in the Society of Hospital Pharmacists of Australia Directory of Hospital Pharmacy Services 2011. The survey included items about the hospital, number of full‐time equivalent (FTE) pharmacists and pharmacy technicians providing clinical and medication distribution services to subacute aged‐care beds, clinical pharmacy services provided, and tasks undertaken by pharmacy technicians.

Results

31 evaluable responses were received (estimated response rate 25%). 11 (36%) respondents provided a comprehensive clinical pharmacy service to most subacute aged‐care inpatients at least 5 days/week; 8 (26%) respondents were unable to provide a basic clinical pharmacy service. The number of subacute aged‐care beds per 1 FTE pharmacist (20–128 beds) and pharmacy technician (15–630 beds) was highly variable. Pharmacy technicians predominantly assisted with distribution of medicines (restocking ward imprest and individual patient supply) and infrequently assisted with clinical pharmacy tasks.

Conclusion

Clinical pharmacy service provision to subacute aged‐care inpatients was suboptimal at most participating hospitals. Increased FTE pharmacists would be needed to consistently deliver comprehensive clinical pharmacy services. Expanding pharmacy technicians' roles could support the provision of clinical pharmacy services.
Vanishing Valproate: Significant Reductions in Serum Levels of Valproate with Meropenem Coadministration
Authors: Tong Erica Y , Ooi Sheue‐Ching , Choo Shin , Dooley Michael J , Skinner Matthew J
Published: April 2015

Background

The first report of a valproate–meropenem interaction was published in 1998 and a warning was issued by the US Food and Drug Administration in 2001. Despite the documentation of this clinically significant drug interaction, there may be limited awareness among clinicians in Australia.

Clinical Details: We report a case of a patient stabilised on valproate and topiramate for epilepsy who was started on intravenous meropenem for neutropenic sepsis. Within 48 hours of starting meropenem, the patient experienced multiple tonic–clonic seizures and the trough serum valproate concentration was 161 micromol/L. 2 weeks prior to meropenem initiation, a trough serum valproate concentration was 672 micromol/L. Our patient experienced a 75% reduction in serum valproate concentration within 48 hours of starting meropenem.

Conclusion

Co‐administration of valproate and meropenem should be avoided due to the rapid onset and extent of the interaction.
Complementary and Alternative Medicines Use by Cancer Patients and the Role of the Drug Information Pharmacist
Authors: Mellor James D , Sanders Julie , Thakerar Arti
Published: April 2015

Background

Cancer patients are increasingly using complementary and alternative medicines (CAM). Oncology pharmacists need to be able to discuss CAM use with patients, and identify potential interactions with conventional cancer therapies. At the study oncology hospital, the Drug Information (DI) centre responds to around 25 complex inquiries on CAM each month.

Aim

To highlight the role of DI pharmacists in advising cancer patients and health professionals on the safe use of CAM with conventional cancer therapies.

Method

3 case studies on CAM researched by the DI centre are presented.

Conclusion

DI pharmacists provide safe and informed advice to health professionals and patients on CAM use with conventional cancer therapies.
Pharmacists', General Practitioners' and Consumers' Views on Integrating Pharmacists into General Practice
Authors: Freeman Christopher , Cottrell W Neil , Kyle Greg , Williams Ian D , Nissen Lisa
Published: April 2015

Background

Integrating pharmacists into general practice is not a novel concept. However, it is new to Australia and evidence supporting this role is limited.

Aim

To seek the views of pharmacists, general practitioners and consumers on integrating pharmacists into general practice.

Method

Questionnaires were used to elicit the opinions of pharmacists, general practitioners and consumers on integrating pharmacists into general practice.

Results

1038 participants (829 pharmacists, 167 consumers, 42 general practitioners) completed the survey. Commonly agreed roles for pharmacists in general practice included drug information and medication review. Perceived barriers to service provision included the pharmacist's clinical ability and turf protection. Remuneration was viewed as a facilitator and a barrier. Perceived facilitators included additional training for pharmacists and an existing rapport with the general practitioners.

Conclusion

There was support for integrating pharmacists' professional activities into general practice. These findings will guide the development of a new model of integrated primary care with practice pharmacists.
Combined Neem Oil 6% w/w and Eucalyptus Oil 16% w/w Lotion for Treating Head Lice: In Vitro and In Vivo Efficacy Studies
Authors: Thawornchaisit Prasutr , Amornsak Weerawan , Mahannop Pakpimol , Buddhirakkul Prayute , Pandii Wongdyan , Connellan Paul , Thompson Dion , Brushett Don , Morris Carol
Published: April 2015

Aim

To test a combined neem oil 6% w/w and eucalyptus oil 16% w/w lotion for the whole‐of‐life cycle treatment of human head lice (Pediculus humanus var. capitis) infestation.

Method

Preliminary formulations of dilutions of neem and eucalyptus oils in isopropanol were tested for pediculicidal and ovicidal efficacies against Pediculus humanus var. capitis. This trial informed the development of a stable formulation consisting of neem oil 6% w/w and eucalyptus oil 16% w/w in a hydrophobic carrier (mixture of lanolin and silicones), which was also tested in vitro for pediculicidal and ovicidal efficacies against Pediculus humanus var. capitis. The lotion was then tested in vivo (clinical study) in volunteer Thai female students. At the conclusion of the in vivo study, participants and their parents/guardians completed a questionnaire pertaining to their perceptions and acceptance of the treatment.

Results

Initial in vitro testing demonstrated pediculicidal and ovicidal efficacies of 96% and 100%, respectively. The clinical study involving 45 volunteer Thai female students aged 7 to 12 years, with 2 applications of the lotion on the scalp and hair 1 week apart, showed significant in vivo activity. Pediculicidal efficacies of 93% and 97% and ovicidal efficacies of 80% and 100% were measured 2 days after the first and second application of the lotion. Participants and their parents/guardians indicated strong acceptance of the formulation.

Conclusion

The combined neem oil 6% w/w and eucalyptus oil 16% w/w lotion demonstrated high pediculicidal and ovicidal efficacy for Pediculus humanus var. capitis infestation.
Complexity and Workload of Cytotoxic Manufacturing at a Regional Hospital: A Comparative Study
Authors: Robertson Kelvin , Roberts Lynden , Plummer David , Ede Judy
Published: April 2015

Background

At The Townsville Hospital, the largest tertiary facility in northern Australia, cytotoxic workload statistics are only recorded as a single quantitative measure – the number of items. Complexity of the cytotoxic products manufactured are not known.

Aim

To determine the complexity of cytotoxic products manufactured at the hospital; to compare the cytotoxic preparation workload to another Australian hospital; and to ascertain the resources needed to manufacture cytotoxic products at a regional hospital.

Method

The pharmacy department's medication database was searched to identify retrospectively all locally manufactured cytotoxic products for 4 years from 2008. The complexity score (CS) was applied to each identified cytotoxic product. The CSs were collated and compared to the number of items manufactured per year. Data from Austin Health, Melbourne were used as a comparator.

Results

Over 4 years, the number of products manufactured dramatically increased by 800% while the CSs decreased by 28%. There was an average increase per year of 266% in the number of items manufactured while the CS per item decreased an average of 9%. Compared to Austin Health, The Townsville Hospital manufactured fewer cytotoxic products of low complexity.

Conclusion

These workload statistics provide useful data to inform staffing levels and resources required for expansion of oncology services in regional hospitals.
Pain Severity Cut‐Points and Analgesic Use by Community‐Dwelling People for Chronic Pain
Authors: Brown Kathryn E , Swift Ian , Spark M Joy
Published: April 2015

Aim

To define a descriptive scale for mild, moderate and severe chronic pain experienced by community‐dwelling people; and to use this scale to investigate chronic pain management in community‐dwelling people.

Method

People with chronic pain were recruited through 20 randomly selected rural and urban community pharmacies in Victoria, Australia. Participants received a survey pack with their prescription medication and chose to participate in the study by returning the completed anonymous questionnaire. Multivariate analysis of variance was used to determine cut‐points on the 0 to 10 average pain intensity scale of the Brief Pain Inventory (short form) from participants' reports of pain interference in daily activities during the previous week.

Results

Questionnaires were returned by 219 people (response rate 31%). Cut‐points on the average pain intensity scale of 3 and 6 were found to categorise chronic pain. Therefore, an average pain intensity of 1 to 3 can be considered mild, 3 to 6 moderate and 6 to 10 severe, with each increase in category indicating a significant increase in pain interference in daily activities. Gender, age and locality did not influence reported pain intensity. 191 participants (91%) reported experiencing moderate or severe pain during the previous week.

Conclusion

Cut‐points on the average pain intensity scale of the Brief Pain Inventory (short form) for mild, moderate and severe pain are 3 and 6. Pain management of community‐dwelling people with chronic pain can be improved.
Medicines Management by the Older‐Aged Living Independently in Different Types of Retirement Villages
Authors: Doggrell Sheila A , Kairuz Therése
Published: April 2015

Background

Resources to assist the older‐aged manage their medicines should target those in greatest need. Little is known about whether socioeconomic status (SES) influences medicines management by the older‐aged.

Aim

To explore whether there is a difference in medicines management by the older‐aged living independently in different types of retirement villages.

Method

Semi‐structured interviews were conducted with 56 older‐aged residents living in 5 different types of retirement villages. A purposefully designed instrument was used to inform the researchers' perceptions of medication adherence.

Results

92% of residents from the freehold retirement village (metropolitan city, high SES) were perceived to be adherent to their medicines and not likely to have problems with adherence within the next 6 to 12 months. While in the 2 rental retirement villages (low SES), 50% or fewer residents were in this category. Participants from the freehold retirement village had a good understanding of about 80% of their illnesses, which was significantly lower in the 2 rental villages (10% to 20%). More medicines per person were prescribed in the 2 rental retirement villages than in the freehold village. Cardiovascular drugs were the most commonly prescribed in all of the retirement villages, but prescribing of psychotropic drugs was greater in rental than freehold villages. Pooled data showed that lack of knowledge about medicines and illness was associated with a medication organiser dispensed by a pharmacy.

Conclusion

The older‐aged living in low SES rental retirement villages may need assistance and resources to manage their medicines.
Stability of Oral Cholecalciferol (Vitamin D3) Liquid Formulations in Olive Oil
Authors: Joseph Pathma D , Hemmens Violet J , Munns Craig F
Published: April 2015

Background

Vitamin D deficiency states in children are treated with extemporaneously prepared oral cholecalciferol liquid in olive oil at The Children's Hospital at Westmead. No formal stability data are available for these cholecalciferol dose forms.

Aim

To investigate the stability of extemporaneously prepared oral cholecalciferol liquid formulations in olive oil.

Method

Three different concentrations of cholecalciferol formulations were prepared extemporaneously. Cholecalciferol contents were assayed using ultra‐performance liquid chromatography. Determinations of the specific gravity and cholecalciferol concentrations were made over 9 months. Formulations were tested for microbial contamination at the beginning and end of the study.

Results

The initial concentrations of cholecalciferol in the formulations were assayed at 60 178 IU/mL, 5680 IU/mL and 400 IU/mL. Over the 9‐month study period, specific gravity determinations indicated that no major changes had occurred in the physical nature of the formulations. Linear regression analysis showed that all data points fell within the 95% confidence interval of the starting concentrations. The negative trend over time indicated that the cholecalciferol concentration decreased slowly, but remained within the British Pharmacopoeia limits for solid dose forms of 90% to 125%. The formulations passed microbial testing after 9 months.

Conclusion

These stability data support the current 3‐month expiry date for cholecalciferol liquid formulations in olive oil. The limitations of extemporaneous manufacture support the use of commercial products when possible.
Measuring and Describing Dose Omissions using an Electronic Medication Management System
Authors: Munzner Eyra E , Welch Susan A , Richardson Katrina L
Published: April 2015

Background

Omitted doses are the most common cause of medication errors in hospital. The impact of an electronic medication management system (eMMS) on rates of omitted doses is unclear.

Aim

To determine the rate of omitted doses in inpatients using MedChart and to identify non‐valid omissions involving high‐risk medications.

Method

Retrospective reports were generated using eMMS and omitted doses were identified across inpatient wards (except the ED) at a tertiary hospital over a 2‐week period in 2011. Omissions were classified to highlight non‐valid omissions and the prevalence of high‐risk medications. Results were compared to voluntary incident reports for the same period and institutional data from 2001.

Results

7.5% (5308//70 774) of doses were recorded as omitted, mirroring 2001 results (7.6%). Non‐valid omissions accounted for 11% (571/5308) of total omissions. ‘Medication unavailable’ was the reason for omission in 19% (111/571) of non‐valid omissions. 24% (137/571) involved high‐risk medications, with anti‐infectives the most commonly missed group (52%, 71/137). Only 2 omitted doses were reported in the voluntary system.

Conclusion

Although eMMS did not reduce the rate of omitted doses, there was a decrease in ‘missed’ doses. High‐risk medications were prevalent in non‐valid dose omissions. Omitted doses were significantly under‐reported via the voluntary system.
Validated Competency Framework for Delivery of Pharmacy Services in Pacific‐Island Countries
Authors: Brown Andrew N , Gilbert Ben J , Bruno Andreia F , BPharm Gabrielle M Cooper
Published: April 2015

Background

Scarcity of health personnel with relevant competence is an impediment to achieving the UN health‐related Millennium Development Goals in many Pacific‐Island Countries (PICs). A systematic approach to improving essential medicines supply management and workforce competence has begun in the region. The development of a pharmacy competency framework has been identified as a priority.

Aim

To develop a validated pharmacy competency framework for PICs.

Method

Academics, Ministry of Health officials and health personnel collaborated to articulate a competency framework using participatory action research. The draft framework was revised via a process of workplace interviews and focus groups in Vanuatu and Papua New Guinea with wider regional validation undertaken using an online survey tool.

Results

A validated pharmacy competency framework was developed for PICs. 113 competencies required for delivery of pharmacy services, organised into four clusters: organisation and management (n = 24), professional/personal (n = 24), pharmaceutical public health (n = 24) and pharmaceutical care (n = 24) were identified.

Conclusion

The pharmacy competency framework for PICs is service‐based and not cadre‐specific, allowing wide application to the Pacific region where a myriad of personnel provide pharmacy services. Pharmacy service personnel in PICs are encouraged to use this tool when training staff and monitoring their effectiveness in local environments.
SHPA Standards of Practice for Medication Safety
Authors:   SHPA Committee of Specialty Practice in Medication Safety
Published: April 2015

These are standards of professional practice and not standards prepared or endorsed by Standards Australia. These are not legally binding.
Medication Reconciliation Challenges at Discharge from Hospital using an Electronic Medication Management System and Electronic Discharge Summaries
Authors: Ng Carmen , Welch Susan A , Luddington Jane , Bui Diana , Glasson Elizabeth , Richardson Katrina L
Published: April 2015

Background

Continuity of care can be facilitated by reconciling changes made to electronic discharge medicines profiles (eDPs) in the electronic medication management system (eMMS) and electronic discharge summaries (eDSs).

Aim

To review eDPs containing discrepancies and to discern the proportion of discrepancies reconciled in the eMMS and eDSs.

Method

All eDPs presented to the pharmacy during 4 one‐week periods: September/October 2009, March 2011, January 2012, February/March 2012 were reviewed retrospectively. eDPs with changes were identified and the number, type of changes and potential severity assessment were recorded. An eDS was introduced in January 2012, with discharge medicines listed in the eMMS populating the eDSs. eDPs identified by the pharmacist as requiring edits by the prescriber were cross checked with the final version in the eMMS and eDSs.

Results

Number of eDPs reviewed were: 67 (2009), 150 (2011) and 382 (2012). Percentage of eDPs with changes made were: 40% (2009), 33% (2011) and 20% (2012). Percentage of items on eDPs with changes not reconciled in the eMMS were: 100% (2009), 81% (2011) and 31% (2012) (p < 0.0001). Of the eDPs that had changes made, 59% (34) had accurate eDSs in 2012 compared with 11% of handwritten discharge summaries in 2009.

Conclusion

While there has been a substantial improvement in the reconciliation of discharge medicines in the eMMS, further work is required to ensure these are imported into the eDSs so that an accurate list is maintained in both systems.
Australian Hospital Pharmacists Reflect on Career Success
Authors: Jepsen Denise M , O'Neill Marjorie Spooner
Published: April 2015

Background

As not all professionals have a linear, upward career trajectory, intrinsic career success is important. This study supplements job satisfaction and retention surveys by exploring the subjective notion of career success.

Aim

To determine Australian hospital pharmacists' views on their intrinsic career success.

Method

Interviews were conducted with experienced pharmacists from regional and metropolitan areas in central Victoria through to northern Queensland. 1 hour semi‐structured interviews were recorded and transcribed verbatim. NVivo9 was used to code broadly before interpretive coding.

Results

3 themes on career success emerged from the interviews. Hospital pharmacists felt successful in their careers when they received acknowledgement from others, from self‐confidence in their ability to do the work well and from determining their work methods.

Conclusion

Hospital pharmacists valued acknowledgment for a job well done, self‐confidence in their ability and increasing autonomy.
Development and Implementation of a Ward‐Based Pharmacy Intervention for Dutch Surgical Patients
Authors: Boeker Eveline B , de Boer Monica , Ramrattan Maya A , van Lent‐Evers Nicolette , Gombert‐Handoko Kim B , Lie‐A‐Huen Loraine , Boermeester Marja A , Kuks Paul FM
Published: April 2015

Medication errors can result in patient harm and additional hospital costs. Surgical patients are at risk of experiencing medication errors mainly due to multiple transfers between care providers at different locations in the hospital with associated medication changes, comorbidities and use of high‐risk medicines. We evaluated a ward‐based pharmacy intervention to overcome these risks. A strategy tailored to the surgical pathway and associated risks was developed from admission to discharge and implemented in 3 Dutch hospitals. A total of 547 surgical patients were assessed. 93% of patients had their medications reconciled on admission, 95% of patients had at least 1 medication review by the hospital pharmacist during their stay and 89% of patients had both. An intervention was recommended 880 times, mostly stopping, starting or altering medicines. The advice was accepted and actioned by the physician in 83% of cases. This pharmacy intervention provides a practical approach for ward‐based medication reviews in surgical patients. Its cost‐effectiveness remains to be proven.
SHPA Standards of Practice for Medicines Information Services
Authors:   SHPA Committee of Specialty Practice in Medicines
Published: April 2015

These are standards of professional practice and not standards prepared or endorsed by Standards Australia. They are not legally binding.
Prophylactic Antibiotic Use in Breast Cancer Surgery Patients
Authors: Habak Jawad E , Varma Sheena , Kiani Mona , Twaddle Andrew , Emmerton Lynne M
Published: April 2015

Background

Despite the risks of contributing to antibiotic resistance, guidelines recommend antibiotic prophylaxis for plastic surgery,.

Aim

To evaluate institutional antibiotic prescribing patterns for breast cancer surgery.

Method

As there are no national antibiotic prophylaxis guidelines for breast cancer surgery, the Therapeutic Guidelines: Antibiotic for head, neck and thoracic surgery were the most appropriate reference point. Data were reviewed for 95 patients from 1 hospital who underwent 134 breast cancer operations performed by 12 surgeons over a 6‐month period in 2012. A bivariate scoring system (in agreement/not in agreement) assessed each surgical record against 4 criteria: antibiotic, route, timing of administration, dosage. A conservative assumption, that all surgical cases would require single‐dose antibiotic prophylaxis, was applied.

Results

Of the 134 operations (comprising 241 surgical procedures), 71 (53%) involved prophylactic administration of antibiotics, mainly IV cefazolin. 38 of the 71 operations also used postoperative antibiotics. There were no trends between surgeons. None of the cases was in complete agreement with the Therapeutic Guidelines: Antibiotic.

Conclusion

The lack of specificity of the Therapeutic Guidelines: Antibiotic may account for the observed divergence in antibiotic prescribing patterns. Guidelines for breast cancer surgery are needed that are based on consultation with surgeons and balance specificity with flexibility for the surgeon's judgement of infection risk.
History of Extemporaneous Compounding in Australia: Changes and Developments in the Australian Pharmaceutical Formulary
Authors: Kairuz Therése E , Laksmana Ihsan , Steadman Kathryn J
Published: April 2015

Background

The Australian Pharmaceutical Formulary (APF) has diversified in content and grown in size. Change can be indicative of progress within, and influences on, a profession.

Aim

To determine variations to the formulary sections of the 22 editions of the APF (1902 to 2012) with respect to dosage forms, ingredients and compounding methods.

Method

Each formula in the APF was entered into a customised Excel spreadsheet with descriptors including formula type, dosage form, active ingredient and route of administration. Data were analysed using features in Excel.

Results

A total of 1197 different formulae were identified in the 22 editions of the APF. The first edition consisted almost entirely of formulae (81% of the total number of pages) and this percentage decreased considerably to 3% to 5% in APFs published since 2002. The greatest number of formulae (n = 496) were included in 1934 (APF6), the edition which also had the greatest number of new formulae (n = 307). Most new formulae appeared for the first time between 1930 and 1964 (APF 5 to 9). A total of 47 different dosage forms were identified and the top 5 in descending order were mixtures (17%), solutions (8%), ointments (7%), eye drops (6%) and creams (5%). Most of the formulae contained in APF22 originated from APF9.

Conclusion

The number of formulae has decreased in the APF over time, with recent deletions based on lack of safety and efficacy data or due to the availability of commercial products. There have been comparatively few alterations to the formulary section in the last decade.
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 . 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 (Consultant, Quality Assurance in Medication Safety; ).
Dispensing Practices of General Practitioners and Community Pharmacists in Malaysia–A Pilot Study
Authors: Alabid Alamin Hassan MA , Ibrahim Mohamed Izham M , Hassali Mohamed Azmi A
Published: April 2015

Background

In Malaysia, general practitioners (GPs) in private clinics are legally permitted to dispense medicines.

Aim

To compare the dispensing practices of community pharmacists and GPs in private clinics.

Method

Simulated patients trained in common cold symptoms presented to GPs and community pharmacists in Penang, Malaysia. They observed their dispensing practices and recorded the number, category and cost of medicines dispensed and whether generic or brand name medicines were selected.

Results

Based on descriptive and inferential analyses, GPs dispensed more medicines (p < 0.001), more antibiotics (p = 0.001) and charged more than pharmacists (p < 0.001). From the 40 GP and 100 community pharmacist encounters, the mean number of medicines per encounter were 3.3 (± 0.9) and 2.6 (± 1.1) from clinics and pharmacies, respectively. Average medical costs were RM19.02 (± 5.70) at clinics versus RM14.35 (± 2.76) at pharmacies. Pharmacists (n = 11,11%) were more likely to promote brand name medicines than GPs (p = 0.014).

Conclusion

Community pharmacists dispensed fewer medicines and antibiotics and charged less than GPs to simulated patients presenting with common cold symptoms.
Management of Controlled Drug (Schedule 8) Liquid Discrepancies to Achieve Best Practice
Authors: Santoro Veronica A , Hilmi Samantha C , Hort Adam L , Jenkins Barry G
Published: April 2015

Aim

To determine volume loss when Schedule 8 (S8) liquid medicines are measured during routine dispensing and checking processes.

Method

A literature review and policy review of local, state and territory practices pertaining to S8 liquid medicines discrepancies was conducted, including measuring techniques, monitoring and reporting requirements. Hospital staff and manufacturers were surveyed to identify commonly used measuring techniques relevant to S8 liquid medicines. Subsequently, an experiment was conducted with 3 measuring techniques (bung, needle, cannula) to identify if measuring technique, S8 liquid viscosity, frequency of dispensing and duration of storage influence volume loss.

Results

Policy review did not uncover substantial guidelines to inform practice. Survey findings demonstrated a lack of uniformity with the 3 commonly used measuring techniques. These 3 techniques were investigated. A bung with an oral syringe resulted in the least amount of loss independent of the frequency of dispensing or viscosity of the liquid measured; less than 1% of the liquid remained in the syringe after a dose was removed. Average discrepancy associated with this technique was 3.4% when the volume recorded in the S8 register was compared to the actual volume measured at each dispensing.

Conclusion

Under laboratory conditions, volume loss through routine measurement and dosing of S8 liquid medicines was on average 3.4%. We recommend that a 4% discrepancy for S8 liquid medicines be included in institutional policies when utilising the bung and oral syringe technique.
Anticholinergic Burden Assessed Using General Practice Electronic Records
Authors: Ball Patrick A , Morrissey Hana , Pilotto Louis SJ
Published: April 2015

Aim

To determine the anticholinergic burden (ACB) of an Australian primary care population.

Method

A cross‐sectional study was undertaken of medication data from 11 general practices. Participants were active patients aged 65 years and over seen at least 3 times in the last 2 years (n = 4853). The ACB score was calculated based on a UK peer‐reviewed scoring system (Fox) and a modified scale (Fox‐plus) that included medications not present in the Fox scale. The main outcome measure was total ACB from prescribed medications.

Results

A Fox ACB score ≥ 4 is associated with increased risk of morbidity and mortality, 249 (9%) females, 130 (6%) males and 379 (8%) overall fell in this category. Applying the Fox‐plus ACB scale, 983 (36%) females, 630 (30%) males and 1613 (33%) overall fell in this category.

Conclusion

A large proportion of the elderly population may have cognitive impairment because of their therapy. Alternative medications or strategies are needed to maintain therapeutic benefits with a low ACB.
Presentations of Eating Disorders Later in Life
Authors: Newton J Richard
Published: April 2015

Although eating disorders typically present early in life, the literature contains numerous examples of eating disorders presenting later in life. This review will discuss the available literature on eating disorder presentations later in life; present data from a specialist community‐based eating disorder clinic; and consider special issues in the assessment and management of eating disorders in older people.
Medicine Use among Older Australians Before and After Hip Fracture
Authors: Leach Michael J , Pratt Nicole L , Roughead Elizabeth E
Published: April 2015

Background

Hip fracture impacts on quality of life and may lead to premature death. In Australia, the extent of use of medicines that increase risk of falls or hip fracture in at‐risk older people is not known.

Aim

To determine the use of medicines associated with falls or hip fracture before hip fracture and whether medicine use changed after hip fracture.

Method

Data from the Australian Department of Veterans' Affairs healthcare claims database were used. The cohort included patients aged > 65 years who were hospitalised for hip fracture in 2009. Percentages of patients using medicines associated with falls or hip fracture were calculated in the 6 weeks before hospitalisation for hip fracture. McNemar's test was used to assess changes in medicines used before admission and after discharge from hospital.

Results

2235 patients with a median age of 87 years had hip fractures in 2009. At least 1 medicine that increases risk of falls or hip fracture was used by 84% of patients before admission. Of the drug classes that increase risk of falls or hip fracture, the 4 most commonly dispensed before admission were antihypertensives (63%), antidepressants (29%), benzodiazepines (26%) and opioids (19%). After discharge, the use of antipsychotics (p < 0.0001), opioids (p < 0.0001), benzodiazepines (p = 0.0009) and antidepressants (p = 0.01) increased significantly.

Conclusion

Most older patients used at least 1 medicine that increases the risk of falls or hip fracture before and after hip fracture. Antipsychotic, opioid, benzodiazepine and antidepressant use increased significantly after hospital discharge.
Octreotide Use in Gastric Antral Vascular Ectasia
Authors: Lam Alice , Lam Skip SH , Chang Denis WH , Badov David
Published: April 2015

Background

Gastric antral vascular ectasia (GAVE) accounts for 4% of non‐variceal gastrointestinal bleeding. Argon Plasma Coagulation, an endoscopic therapy, is the treatment of choice, followed by medications and surgery. There is limited evidence for drug therapies, such as corticosteroids, hormones, tranexamic acid, thalidomide and octreotide, to treat GAVE.

Aim

To describe a case of octreotide use in GAVE.

Clinical details

A 78‐year‐old female with repeat gastrointestinal bleeds required frequent hospitalisation for investigations and blood and iron transfusions. She was eventually diagnosed with GAVE but multiple endoscopic treatments were ineffective. She was unsuitable for surgery because of her advanced age and comorbidities. She was initiated on octreotide 200 micrograms 3 times daily with ongoing maintenance on 100 micrograms 3 times daily.

Outcome

Prior to initiation of octreotide (June 2011 to May 2012), the patient was transfused with 53 units of blood, 5.9 g of iron and spent 151 days in hospital. Post initiation of octreotide (June 2012 to April 2013), she only required 13 units of blood, 1.9 g of iron and spent 38 days in hospital.

Conclusion

Successful use of octreotide in this patient with GAVE contributes to the limited available evidence.
Identifying Inappropriate Prescribing for Older People
Authors: Elliott Rohan A , Stehlik Paulina
Published: April 2015

Older people are at risk of polypharmacy, inappropriate prescribing and adverse drug reactions. Reasons include comorbidities, altered pharmacodynamics and pharmacokinetics, and limited evidence to guide drug therapy decisions, especially for people aged > 75 years. Tools to assist with identifying inappropriate prescribing for older people have been developed. The most well known is the Beers criteria, a list of medications that an expert panel agreed should usually be avoided. Criticism of the Beers criteria and limited applicability outside of North America, led to the development of other tools and a major revision of the Beers criteria in 2012. Since 2008, the Screening Tool of Older Persons' Prescriptions and the Screening Tool to Alert doctors to Right Treatment have gained popularity. Australian indicators and electronic decision support systems have also been developed. This article provides an overview of the tools for identifying (and avoiding) inappropriate prescribing and their application in clinical practice and research.
DrugScan Series
Authors: Eaton Vaughn
Published: April 2015

This review updates you on the international literature on therapeutics. Specialist 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.