bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimal Level of Liaison Pharmacist Intervention to Facilitate a Post‐Discharge Home Medicines Review
Authors: Bollella Giuseppe , Angley Manya T , Pink Jennifer A , Caird Cathy J , Goldsworthy Sharon J
Published: April 2015

Background

Interventions by hospital liaison pharmacists make general practitioners aware that the hospital deems it appropriate for their patient to have a post‐discharge home medicines review.

Aim

To determine the frequency of patient referrals for a post‐discharge home medicines review by general practitioners using two less resource intensive models than that previously developed at the Royal Adelaide Hospital.

Method

Patients were randomly assigned to either Group A or Group B. Group A patients were counselled about the benefits of an home medicines review and their general practitioner and community pharmacist were sent a medication discharge summary highlighting the hospital's suggestion for a postdischarge home medicines review (standard care). Group B patients received standard care plus their medication discharge summaries included reasons for why an home medicines review was recommended, the community pharmacist's contact details were provided, and a general practitioner appointment was also made via a practice nurse/receptionist.

Results

The lower level of intervention in Group A patients resulted in a 7% home medicines review referral rate while a higher level of intervention in Group B patients resulted in a 53% home medicines review referral rate (p = 0.0052).

Conclusion

The Group B model resulted in a significantly higher general practitioner referral rate when compared to ‘standard care'. A compromise in referral rates occurs if a less resource intensive model is used compared to the previously developed resource intensive model involving the liaison pharmacist.
Pharmacist's Role in the Hospital Discharge Process
Authors: Marriott Jennifer L , Bessell Tracey L
Published: April 2015

Aim

To determine pharmacist involvement in the hospital discharge process and to explore the potential for further involvement.

Method

Questionnaires were distributed to staff at participating hospitals with pharmacy departments and followed‐up with focus groups to further explore relevant issues. Qualitative data were explored thematically.

Results

163 questionnaires were completed by pharmacists, nurses, doctors and administrators from 53 hospitals. Writing of discharge prescriptions was the problematic component of the discharge process and the pressure to discharge the patient contributed to errors. A range of solutions was discussed and it was generally noted that increased pharmacist involvement in the discharge process would improve efficiency.

Conclusion

The increased involvement of pharmacists in the hospital discharge process by writing discharge prescriptions would benefit the health system, notwithstanding the need for legislative change and a commitment to systems and workforce reform.
Experiential Placements: Nurturing Interactive Pharmacists By Planning and Scaffolding for Improved Communication
Authors: Owen Susanne M , March Geoff
Published: April 2015

Background

Universities' pharmacy experiential placements are important in bridging the theory‐practice connection, with learning ‘just happening' from being in the actual environment with patients and practitioners and reflecting on events with students. There is an expectation that preceptors will support and accelerate this process by coaching for specific skills and giving explicit feedback. The university's role involves using comprehensive planning and aligning learning with outcomes including graduate attributes and professional competencies. The development of communication skills requires scaffolding and nurturing to ensure students develop into interactive professionals.

Aim

To map pharmacy experiential placement programs (objectives, learning and assessment, evaluation strategies) across Australian universities; to highlight successful practices; and to identify areas for improvement and quality indicators.

Method

This qualitative study used semi‐structured interviews with staff from pharmacy schools to map experiential placement programs and identify practices and issues, as well as, focus group consultations with professional/registration organisations, student representatives and preceptors. University experiential placement handbooks were analysed, with key categories and issues emerging through thematic data analysis.

Results

Consultations with over 250 participants and handbooks' analyses indicated a range of structures and approaches for pharmacy experiential placements. To develop communication and patient counselling skills some universities use elements of a planning process but consistent use of comprehensive planning and scaffolding was not evident.

Conclusion

The need for planning and scaffolding of learning was highlighted, including university‐based role play practices at the pre‐placement stage, linked closely with demonstrations and explicit feedback from preceptors during placements and feedback and discussion at the debriefing stage.
Determining Clinical Pharmacy Workload by Patient Disease Classification in Medical and Surgical Patients
Authors: Stuchbery Peter , Kong David CM , DeSantis Giovanna N , Lo Sing Kai
Published: April 2015

Aim

To determine the time needed to provide clinical pharmacy services to individual patient episodes for medical and surgical patients and the effect of patient presentation and complexity on the clinical pharmacy workload.

Method

During a 5‐month period in 2006 at two general hospitals, pharmacists recorded a defined range of activities that they provided for patients, including the actual times required for these tasks. A customised database linked to the two hospitals' patient administration systems stored the data according to the specific patient episode number. The influence of patient presentation and complexity on the clinical pharmacy activities provided was also examined.

Results

The average time required by pharmacists to undertake a medication history interview and medication reconciliation was 9.6 (SD 4.9) minutes. Interventions required 5.7 (SD 4.6) minutes, clinical review of the medical record 5.5 (SD 4.0) minutes and medication order review 3.5 (SD 2.0) minutes. For all of these activities, the time required for medical patients was greater than for surgical patients and greater for ‘complicated' patients. The average time required to perform all clinical pharmacy activities for 1071 completed patient episodes was 14.4 (SD 10.9) minutes and was greater for medical and ‘complicated' patients.

Conclusion

The time needed to provide clinical pharmacy services was affected by whether the patients were medical or surgical. The existence of comorbidities or complications affected these times. The times required to perform clinical pharmacy activities may not be consistent with recently proposed staff ratios for the provision of a basic clinical pharmacy service.
Medications and Falls in Older People
Authors: Zeimer Henry
Published: April 2015

Falls are a major cause of morbidity in older people. Although in most cases falls are multifactorial in aetiology, medications are one of the most easily reversible risk factors that need to be considered in the falls assessment process. There is strong evidence that sedatives, particularly benzodiazepines (short‐acting and long‐acting), are associated with falls with odds ratios in the range of 1.3 to 1.5. Although antipsychotics (typical and atypical) are associated with a similar falls risk, most of the data are from nursing home studies. Antidepressants consistently increase falls risk, with a similar risk from the selective serotonin reuptake inhibitors compared to tricyclic antidepressants. The evidence for an association with falls risk and anticonvulsants, narcotic analgesics, and cardiovascular medications is less strong due to fewer studies published on these drug classes. Medication review is an integral component of the comprehensive falls assessment process in older people.
Incidence of Venous Thromboembolism and Thromboprophylaxis after Total Hip or Knee Arthroplasty
Authors: Buchan Dona S , Bajorek Beata
Published: April 2015

Background

Despite numerous guidelines and consensus statements on venous thromboembolism (VTE) prophylaxis, there appears to be a large gap between evidence and practice.

Aim

To identify the incidence of VTE, thromboprophylaxis practice, VTE risk factors, and bleeding complications in patients undergoing elective total hip or knee arthroplasty.

Method

Patients who underwent elective total hip or knee arthroplasty from 1 January 2004 to 31 December 2005 were identified retrospectively from medical records at two hospitals. A clinical case audit was performed and data collected on the 3‐month incidence of VTE, thromboprophylaxis practice, VTE risk factors and bleeding episodes.

Results

VTE incidence was 13% (in‐hospital incidence 9.3% and 3‐month readmission incidence 3.3%) and was significantly higher at Hospital 1 for unilateral total knee arthroplasty (p = 0.02) and unilateral total hip arthroplasty (p = 0.02). At both hospitals the 3‐month incidence of VTE was 16% post unilateral total knee arthroplasty compared to 7.7% post unilateral total hip arthroplasty (p = 0.06). 99% of patients received appropriate pharmacological prophylaxis and of these 87% received an appropriate dose. 17 patients (55%) that developed VTE had one or more risk factors. There were 23 cases (9.3%) of minor bleeding and 4 cases (1.6%) of major bleeding.

Conclusion

VTE incidence was higher than that quoted in the literature, which may reflect high usage of pre‐discharge deep vein thrombosis screening in the study population. There is a need to develop and disseminate management algorithms for elective total hip or knee arthroplasty in the local setting.
Liposomal Amphotericin and Caspofungin: Salvage Therapy for Invasive Aspergillosis in Hepatic Failure
Authors: Ho Lisa
Published: April 2015

Background

Invasive aspergillosis is a life‐threatening condition associated with severe morbidity and mortality. There are limited data on the treatment of invasive aspergillosis in solid organ transplant recipients.

Aim

To describe a case of invasive pulmonary aspergillosis in a patient with hepatic failure secondary to paracetamol overdose who subsequently underwent liver transplantation.

Clinical Details

A 33‐year‐old female was admitted with fulminant hepatic failure secondary to paracetamol overdose who subsequently underwent liver transplantation. She developed invasive pulmonary aspergillosis prior to transplantation. Her infection progressed despite initial treatment with liposomal amphotericin. Caspofungin was added to her therapy and she improved. Her antifungal was later changed to oral voriconazole.

Outcomes

Invasive pulmonary aspergillosis responded to the combination therapy of liposomal amphotericin and caspofungin.

Conclusion

Antifungal therapy of invasive aspergillosis in solid organ transplant recipients is complex and challenging. Treatment with liposomal amphotericin and caspofungin may be considered as salvage therapy for liver transplant recipients with invasive Aspergillus fumigatus and renal failure.
Cytochrome P450 Part 2: Genetics of Inter‐Individual Variability
Authors: Ward Michael B , Sorich Michael J , McKinnon Ross A
Published: April 2015

Inter‐individual variability in drug metabolism results from the influence of a myriad of factors, such as concomitant drug therapy and genetic factors. Advances in recombinant DNA technology have enhanced our understanding of the extent of genetic variation in the cytochrome P450 (CYP) enzyme super family, thus clarifying the molecular basis of many clinically observed variations in drug response. This second article in the CYP series describes current understanding of genetic variability in the major drug metabolising CYP enzymes, nomenclature used to describe variant CYP genes, and the clinical significance of such variability.
Beliefs and Attitudes that Influence Reporting of Clinical Interventions by Pharmacists
Authors: Garrett Tim , Reeves Diane
Published: April 2015

Background

Pharmacist interventions improve patient outcomes and highlight the profession's contribution to the healthcare team. Under‐reporting of interventions is common and result from a variety of interrelated workplace barriers and individual beliefs and attitudes.

Aim

To investigate the barriers to pharmacists' recording clinical interventions via the Incident Information Management System within an area health service.

Method

All pharmacists within the area health service were surveyed to explore their opinions about intervention reporting and to identify potential barriers and incentives to reporting. Responses were also analysed for aspects relating to the type/severity and frequency of clinical interventions reported.

Results

Pharmacists are most likely to report actual interventions and those of a greater clinical severity than near‐misses or those of lesser significance. Approximately, only 20% of serious interventions were reported into the Incident Information Management System. Significant barriers to reporting interventions were time constraints, lack of feedback, difficulties with the reporting software and poor computer access. Respondents had a strong belief that interventions were an important part of a pharmacist's role (98%) and that they improve patient outcomes (92%). However, the pharmacists had a lesser belief in the value of reporting these activities (p < 0.005).

Conclusion

Despite pharmacists attributing importance to clinical interventions, this activity was not well reported. The most important barriers were time constraints and technological limitations. An awareness of these barriers can assist in the development of work practices and technological solutions to improve clinical intervention reporting.
Compliance with Paracetamol Prescribing Policies at a Sydney Hospital
Authors: Mitchell Sarah J , Murnion Bridin P , Matthews Slade T , Hilmer Sarah N
Published: April 2015

Background

Despite being marketed as a safe non‐opioid analgesic there are concerns about paracetamol's potential to cause hepatotoxicity. The NSW Health paracetamol policy mandates review of all hospital inpatient orders 48 hours after starting paracetamol and dose reduction for older patients.

Aim

To assess hospital staff's knowledge and attitude of and their compliance with the NSW Health paracetamol policy and the complementary hospital paracetamol guideline.

Methods

A cross‐sectional audit of 14 wards at a 560‐bed hospital was conducted over one week to evaluate compliance with the NSW Health and the hospital paracetamol guidelines. An anonymous questionnaire was used to assess the hospital staff's awareness of these guidelines.

Results

274 patients were eligible to participate in the audit. Most patients (n = 196; 75%) were prescribed paracetamol with regular paracetamol the most common prescription. Patients prescribed paracetamol were less likely to have their liver function tests measured than patients not prescribed paracetamol. Most (73%) patients aged 65 years and over were prescribed reduced doses of paracetamol (less than 4 g/day) in accordance with the NSW Health and the hospital guidelines. Hospital staff's awareness of these guidelines was low and was highest among pharmacy staff.

Conclusion

Compliance with and knowledge of the NSW Health and hospital paracetamol guidelines were limited and varied between hospital staff. Innovative methods for dissemination of information crucial for safe and efficacious use of medicines are required.
Hospital Supply of Off‐label Immunomodulatory Drugs
Authors: O'Connor Kate , Burke Rosemary , Riminton Sean
Published: April 2015

Background

There has been an increase in the demand for new immunomodulatory drugs for the treatment of immune‐mediated inflammatory diseases. Many of these indications represent the off‐label use of immunomodulatory drugs.

Aim

To evaluate the spectrum of requests, clinical outcomes and costs for the hospital‐approved, off‐label use of immunomodulatory drugs.

Method

A list of all new individual patient use approvals at a Sydney teaching hospital (February 2005 to June 2006) was obtained and the approved immunomodulatory drugs were selected for audit. A literature review was conducted to determine the level of evidence available for the approved immunomodulatory drugs.

Results

61 individual patient use approvals for off‐label immunomodulatory drugs were analysed. The most commonly requested drugs were infliximab (n = 22), mycophenolate (n = 13), rituximab (n = 10) and cyclosporin (n = 7). These drugs were initiated for treatment of a heterogeneous group of serious medical disorders. 10 hospital departments initiated the requests. The cost of new approvals was $458 301, accounting for 61% of the total cost of $749 236 for off‐label immunomodulatory drugs within the study period. The most expensive drugs were rituximab, infliximab and mycophenolate. Efficacy reports were available for 64% of approvals and a favourable therapeutic response was observed in 74% of cases. 4 deaths occurred and significant treatment‐related adverse events were noted in 24% of cases. High‐level evidence supported the use of immunomodulatory drugs for 41 individual patient use approvals.

Conclusion

Off‐label use of immunomodulatory drugs was diverse and supported by good evidence in over 50% of cases. Methods used to assess the response to immunomodulatory drugs were suboptimal and non‐standardised. Formalising the supply of immunomodulatory drugs may enable aggregation of data to inform future decisions and resource allocation.
Midazolam Metabolism: Implications for Individualised Dosing?
Authors: Roberts Jason A , Coulthard Mark G , Addison Russell S , Foot Carole , Lipman Jeffrey
Published: April 2015

Aim

To compare the clearance of midazolam and its metabolites in critically ill paediatric and adult patients.

Method

A prospective study conducted in paediatric and adult intensive care units. Patients over 2 years of age receiving midazolam for therapeutic sedation were eligible for enrolment. Midazolam and its metabolite concentrations were determined in plasma and urine.

Results

The median (interquartile range) steady‐state concentrations observed in the paediatric and adult groups were 90 mg/L (48–135) and 253 mg/L (148–404), respectively (p = 0.90). The median daily doses were 1.8 mg/kg (0.6–2.2) and 1.9 mg/kg (0.6–2.7), respectively (p = 0.84). Midazolam clearance in paediatric and adult patients was 1.1 mL/kg/min (0.9–3.8) and 2.9 mL/kg/min (0.9–3.8), respectively. Analysis of clearances by age identified two peaks in midazolam and its metabolites occurring around 12 years of age and at 45 years of age. Neither midazolam nor its metabolites appeared to accumulate in blood after long courses of treatment (> 3 days).

Conclusion

A conclusion that could be drawn from this study is that some of midazolam's pharmacokinetic variability may be explained by age‐related changes in metabolism. These findings require validation in a larger study.
Winning of Australian Pharmacy Degrees – A Retrospect
Authors: Newgreen David B
Published: April 2015

The 1960s and 70s were testing times for Australian pharmacy schools and were characterised by poor resources and infrastructure, and political and academic intransigence, which varied in intensity across the country. The South Australian and Victorian stories were the most complicated, followed by Tasmania and Western Australia. In New South Wales, the pharmacy school was in the university while in Queensland, the upgrading and transfer of the course from a technical college to the University of Queensland was at the university's behest. This paper chronicles the events leading up to the granting of pharmacy degrees in Australia.
Paracetamol and Ibuprofen for Paediatric Pain and Fever
Authors: Tucci Joe , Bandiera Emily , Darwiche Rima , Medos Zeljko , Nashed Robert , Trinh David
Published: April 2015

Aim

To review the literature on the pharmacology and pharmacokinetics of paracetamol and ibuprofen pertaining to their use for paediatric pain and fever.

Data sources

A literature search was conducted using the PubMed database service on the National Centre for Biotechnology Information web page.

Study selection

Data from original studies on paediatric pharmacogenomics, pharmacokinetics and pharmacology of paracetamol and ibuprofen were included in the analysis.

Results

More published studies are required to comprehensively define the pharmacology and phamacokinetics of paracetamol and ibuprofen in paediatrics.

Conclusion

An understanding of drug metabolic processes during ontogeny may enable predictions about the capacity of children to cope with medications. Pharmacogenomic screening may help elucidate the inter‐individual variation in drug metabolism and pharmacokinetics.
Timeliness and Clinical Impact of Hospital‐Initiated Medication Reviews
Authors: Lövgren Suzanna , Clark Robyn A , Angley Manya , Ponniah Anne P , Colley Desmond , Shakib Sepehr
Published: April 2015

Background

Medication‐related problems often occur in the immediate post‐discharge period. To reduce medication misadventure the Commonwealth Government funds home medicines reviews (HMRs). HMRs are initiated when general practitioners refer consenting patients to their community pharmacists, who then engage accredited pharmacists to review patients' medicines in their homes.

Aim

To determine if hospital‐initiated medication reviews (HIMRs) can be implemented in a more timely manner than HMRs; and to assess the impact of a bespoke referral form with comorbidity‐specific questions on the quality of reports.

Method

Eligible medical inpatients at risk of medication misadventure were referred by the hospital liaison pharmacist to participating accredited pharmacists post‐discharge from hospital. Social, demographic and laboratory data were collected from medical records and during interviews with consenting patients. Issues raised in the HIMR reports were categorised: intervention/action, information given or recommendation, and assigned a rank of clinical significance.

Results

HIMRs were conducted within 11.6 ± 6.6 days post‐discharge. 36 HIMR reports were evaluated and 1442 issues identified – information given (n = 1204), recommendations made (n = 88) and actions taken (n = 150). The majority of issues raised (89%) had a minor clinical impact. The bespoke referral form prompted approximately half of the issues raised.

Conclusion

HIMRs can be facilitated in a more timely manner than post‐discharge HMRs. There was an associated positive clinical impact of issues raised in the HIMR reports.
Complementary Medicines: Hospital Pharmacists' Attitude, Knowledge and Information Seeking Behaviour
Authors: Brown Jared A , Roufogalis Basil D , Williamson Margaret
Published: April 2015

Background

The use of complementary medicines (CM) is increasing in the community. Hospital pharmacists need to expand their knowledge of CM and have access to and become familiar with reliable information sources.

Aim

To ascertain hospital pharmacists' knowledge on adverse effects of CM; and to investigate their information seeking practices and preferred sources of reliable information on CM.

Method

Anonymous self‐administered surveys were sent to a stratified random sample of pharmacists across Australia. The questionnaire was designed to address five areas on CM: experience and attitude, knowledge, information use, preference for information sources and demographics.

Results

388 eligible responses were received (23% response rate). 81 respondents were hospital pharmacists. Around half of the hospital pharmacists sought information on CM at least monthly. The most frequently sought information was drug interactions, contraindications and adverse effects. A variety of sources were used to find the information, with the most popular being the Internet and MIMS, however, the most useful were specific web sites and drug information phone services. Only 36% of hospital pharmacists knew that hepatotoxicity is a potential adverse effect of black cohosh and 38% knew that glucosamine can interact with warfarin.

Conclusion

Many Australian hospital pharmacists had a limited knowledge on the adverse effects of common CM. Although hospital pharmacists often seek information on CM, many were unable to or unaware of where to access reliable information.
Paedpharm: Paediatric Pharmacy Network
Authors: Graudins Linda V , Turner Sean , Kunac Desiree
Published: April 2015

Background

Up‐to‐date data on paediatric therapeutics, such as off‐label use of medicines, availability of unlicensed formulations and medication protocols are often not available. The paediatric pharmacy network (Paedpharm) was launched in 1999 to support paediatric pharmacists and provide a network for the exchange of information.

Aim

To describe Paedpharm subscribers; to assess utility and activity of the network; and to identify improvements to be made.

Method

A 7‐question survey was e‐mailed to Paedpharm subscribers. Data on Paedpharm posts (2000 to 2008) were obtained from the University of Otago. The posts for a 18‐month period (January 2007 to July 2008) were retrospectively reviewed to characterise the utility and activity of the network.

Results

Of the 168 Paedpharm subscribers, 100 subscribers replied to the survey (60% response rate). 89% of subscribers worked in public hospitals and 77% specialised in paediatrics. 70% of subscribers had used Paedpharm to help inform a treatment decision. There were 9107 posts from August 2000 to December 2008 and 987 posts for the 18‐month period (January 2007 to July 2008), of which 415 were new topics. The most popular topics were availability of products (21%) and protocols/guidelines (20%). The most popular therapeutic categories were nutrition/blood (16%) and antimicrobials (13%).

Conclusion

Paedpharm continues to be a valued service for pharmacists from a variety of paediatric specialties. Subscribers use the network for queries, formulating therapeutic guidelines and sharing information.
Impact of a New Insulin Chart on Hospitalised Patients with Diabetes
Authors: Lehnbom Elin C , Welch Susan A , Ludington Jane E , Bryant Wendy , Brien Jo‐anne E
Published: April 2015

Background

Hospitalised patients with diabetes often have poor glycaemic control. To improve the management of hospitalised patients with diabetes, a new insulin chart incorporating documentation of blood glucose levels was developed and introduced at St Vincent's Hospital, Sydney.

Aim

To evaluate the impact of a new insulin chart on the management of hospitalised patients with diabetes.

Method

A retrospective study comparing the management of three groups of hospitalised diabetic patients. The use of insulin and management of hypoglycaemic events before and after the introduction of the new insulin chart were compared. Clinical data were collected from medical records from April 2004 to April 2005. Chi‐square tests were performed to analyse the data for significant differences.

Results

Post‐implementation of the new insulin chart, patients seen by the endocrine team were more frequently ordered regular insulin (p < 0.017) than patients not managed by the endocrinologists. The number of omitted doses of regular insulin remained unchanged. Poor cross‐referencing of the insulin and standard medication charts may have been a contributing factor. Post‐implementation, significantly more hypoglycaemic events were treated according to the hospital's protocol (p < 0.001). Staff satisfaction with the new insulin chart was high except for some doctors' dissatisfaction with the chart when ordering regular insulin.

Conclusion

Introduction of the new insulin chart had a positive impact on the management of hypoglycaemic events. Other aspects of diabetes management, such as the number of patients on regular insulin and insulin dose omissions were suboptimal.
Advances in Diabetes Therapy in the Elderly
Authors: Lee Fiona TH
Published: April 2015

Diabetes is increasing in prevalence and the choice of medication is expanding with the recent introduction of a new class of oral hypoglycaemics. Emerging data on the older oral hypoglycaemics is adding to the complexity of diabetes management, particularly in the elderly for whom special consideration of adverse effects and dosing are required. As diabetes progresses the inevitable decline in pancreatic β‐cell function diminishes the efficacy of the oral hypoglycaemics and insulin is required. The new synthetic long‐acting insulin analogues are useful in the elderly both for ease of administration and to minimise hypoglycaemia. Exogenous insulin often does not provide optimal control of diabetes and it is envisioned that in the future, therapy may target preservation of pancreatic β‐cell function to produce long‐term glycaemic control with endogenous insulin.
Visual Thematic Analysis of Children's Illustrations to Improve Receptiveness to Pictorial Asthma Action Plans
Authors: Pascuet Elena , Vaillancourt Régis , Collins Michael A , Moore Anne‐Marie , Scoular Douglas , Gaboury Isabelle , Ullyot Nora , Stewart Carolyn
Published: April 2015

Background

Written asthma action plans are an important component of asthma self‐management. However, these action plans may be difficult for patients with low health literacy, especially children, to understand. The addition of illustrations to health information can improve comprehension, recall and treatment adherence, which can lead to improved disease management.

Aim

To discern the perceptions of the somatic symptoms of paediatric patients with chronic asthma and aspects of their asthma management.

Method

Paediatric patients with chronic asthma aged 5 to 13 years who were either inpatients or outpatients of a Canadian paediatric hospital were asked to draw 2 pictures relating to how they felt when their asthma was well‐controlled and how they felt during an asthma attack. The illustrations were evaluated using established visual theme categories. Following theme development, study team members individually analysed the pictures.

Results

104 pictures drawn by 53 paediatric participants were analysed. Well‐controlled asthma was commonly depicted by smiling faces (53%), sunshine (33%) and children playing sports outdoors (25%). During an asthma attack, images of sad expressions (60%), children unable to play or confined (28%), children coughing (22%), and lung pain or tightness (19%) were common.

Conclusion

Paediatric patients' perceptions of their asthma was highly emotional. To improve comprehension and be effective, illustrations added to health information must be specific to the audience.
Support Needed by Pharmacy Students in Experiential Placements: Stakeholders' Expectations
Authors: Owen Susanne M , Stupans Ieva , Ryan Greg , McKauge Leigh M , Woulfe Jim
Published: April 2015

Background

From July 2010, Australian state and territory pharmacy registration boards will be replaced by a national body that will register health professionals and also accredit university pharmacy programs. Traditionally, assessment during the pharmacy internship year and national examination provide consistency at the post‐graduation stages, but the endpoints of university programs have been derived within state and territory contexts.

Aim

To determine the skills needed to gain competence within university pharmacy programs; and to identify the levels of support required by early and late placement students.

Method

Students, academics and professional/registration/preceptors were involved in state and territory focus groups. 140 participants completed a chart about their expectations regarding levels of supervising preceptor support required by students during experiential placements. Manual collation and comparative analysis was undertaken for early and late placement students.

Results

Early placement students were consistently viewed by all stakeholder groups as needing assistance or minimal assistance. For late placement students, there were wide variations in responses in regard to levels of support expectations for competency functional areas and within and across state and territory groups, especially among academics from various institutions.

Conclusion

There is variability across states and territories with respect to competency development in academic programs. This may present challenges within a national accreditation and registration context.
Evaluating New Medicines for Use in Australian Hospitals: Lessons from North America
Authors: Duguid Margaret J
Published: April 2015

Several centres were visited in North America to identify strategies that could improve the processes used by Australian hospitals when evaluating new medicines for clinical and economic benefits. The centres visited included hospitals, a managed care organisation and the Canadian Agency for Drugs and Technologies in Health. All of the hospitals visited used a formulary to manage medicines and took a similar approach to evaluating new medicines for formulary listing and monitoring decisions. The institutional pharmacy and therapeutics committees were responsible for decision‐making and were guided by detailed drug monographs prepared by pharmacy staff. There was limited use of pharmacoeconomic data in decision‐making. Resources used to guide decision‐making included standard guidelines for formulary submission, comparative effectiveness reviews and a checklist. A more consistent and rigorous approach to assessing medicines and determining cost‐effectiveness could be achieved in Australian hospitals by using a standard format for submissions. Australian drug and therapeutics committees' members need to be educated about the utility of pharmacoeconomic studies in the evaluation of new medicines.
Outcomes of Pharmacological Management of Violent Behavioural Disturbances in Older Hospital Patients
Authors: Cheh Rachael M , Selby Philip R , Abarno Anita C , Alderman Christopher P
Published: April 2015

Background

Violent behaviour displayed by hospital patients that are a physical and personal threat to patients, visitors and staff is an emergency situation.

Aim

To evaluate medications used to manage violent behavioural disturbances; to explore patients' antecedent characteristics; and to assess concordance with hospital guidelines.

Method

Retrospective analysis (March 2008 to August 2009) of a convenience sample of hospital patients who displayed violent behaviour requiring an emergency response. Patient data were extracted from case notes and the Australian Incident Monitoring System, and included baseline demographics, medication used during admission, details of the behavioural disturbance and outcomes of the emergency response.

Results

Of the 28 patients analysed, 23 (82%) were male. Mean age was 81.5 years and 50% were aged 80 to 89 years. 17 (61%) patients were admitted for cognitive decline and 24 (86%) had a history of neuropsychiatric disorders. Clonazepam was the most frequently used drug and the intramuscular route was the most popular mode. Patients with poorly controlled pain were more likely to display violent behaviour (p < 0.01). Initiating antipsychotics or dose increases during admission was significantly associated with multiple violent episodes (p < 0.001). Opioids were most likely to be charted before a violent episode (n = 10; 36%) and ceased after an episode (n = 5; 18%). Concordance with hospital guidelines was observed in 18 (64%) cases. Non‐concordance with hospital guidelines was not predictive of multiple violent episodes.

Conclusion

Better assessment of at‐risk patients and early intervention are required. Concordance with hospital guidelines was low. Effective implementation, monitoring and adjustment of protocols used in emergency responses require interdisciplinary collaboration.
Impact of a Hospital Pharmacy Technician Facilitated Medication Delivery System
Authors: Seaton Suzette M , Adams Rodney C
Published: April 2015

Aim

To evaluate a hospital pharmacy technician facilitated patient medication delivery system in a rural/regional hospital.

Method

Pre‐implementation, the medication distribution system on the study medical ward consisted of imprest and individual dispensing with medications administered to patients from medication trolleys. Post‐implementation, the pharmacy technician serviced the medical ward's imprest and individual dispensing and stored in individual bedside drawers. Two missed doses audits were conducted pre‐implementation and two drawer audits conducted post‐implementation.

Results

The ward pharmacy technician facilitated medication delivery on the medical ward and resulted in a reduction in missed doses, improvement in monitoring medication discrepancies and cost savings.

Conclusion

A ward pharmacy technician service had a positive impact on medication safety (reduction in missed doses) and cost savings (by avoiding medication wastage).
Do High‐Risk Medicines Alerts Influence Practice?
Authors: Dunning Trisha L , Leach Helen , Van De Vreede Melita , Williams Allison F , Buckley John , Jackson John , Leversha Anne , Nation Roger L , Rokahr Catherine , O'Reilly Mary , Kirsa Suzanne W
Published: April 2015

Background

Medicine‐related adverse events are prevalent, costly and mostly preventable. The High Risk Medicines Working Party (Victoria) developed and distributed three high‐risk medicines alerts – wrong route of administration of oral medicines, subcutaneous insulin and unfractionated heparin – and accompanying audit tools in 2008 and 2009.

Aims

To determine the impact of the three high‐risk medicines alerts on Victorian health services; to assess the clinical relevance and utility of the audit tools; to identify barriers to implementing recommendations; and to obtain feedback and suggestions for future alert topics.

Method

A cross‐sectional survey was undertaken from 6 to 31 July 2009 using an online questionnaire. The questionnaire was distributed to 90 metropolitan, regional and rural public health services in Victoria and approximately 200 members of the Quality Use of Medicines Network (Victoria).

Results

Most of the 90 respondents were pharmacists (53%) and nurses (31%). 53 (59%) respondents reported making changes as a result of receiving the high‐risk medicines alerts – 21 (40%) concerned the wrong route of administration, 12 (23%) subcutaneous insulin and 7 (13%) unfractionated heparin. Barriers to implementation included time constraints, inadequate staff and resources, excessive paperwork and competing priorities. A minority of respondents indicated some alerts were not relevant to small rural services. Suggestions for improving the audit tools included making them less labour intensive, enabling electronic responses and ensuring their distribution is coordinated with other medicine‐related tools.

Conclusion

High‐risk medicines alerts and the accompanying audit tools facilitated change but there were some barriers to their implementation, such as time and resource constraints. Not all alerts and audit tools were relevant to all health services.
Clinical Pharmacist Staffing Levels Needed to Deliver Clinical Services in Australian Hospitals
Authors: O'Leary Karen M , Stuchbery Peter , Taylor George
Published: April 2015

Background

The Society of Hospital Pharmacists of Australia's (SHPA) Standards of practice for clinical pharmacy list 10 activities pharmacists undertake to provide a comprehensive clinical service to inpatients and the staffing level needed to deliver this service (based on bed type). Time motion data from a recent Australian study could be used to elucidate the number of beds for which a pharmacist can provide clinical services (based on time taken for individual clinical activities).

Aim

To calculate the number of patients/inpatient beds for which a pharmacist can provide clinical services.

Method

A profile of clinical pharmacy activities and how often they need to be delivered to meet the SHPA Standards was developed for different patient types. Formulae were developed and populated with the time motion data to calculate clinical pharmacist staffing levels.

Results

Staffing levels for 7 categories of patients/inpatient beds were elucidated. These calculations suggest the clinical pharmacist to bed type ratios described in the SHPA Standards considerably underestimate the time required to deliver a comprehensive clinical pharmacy service.

Conclusion

Times per activity used in this exercise are conservative and provide the maximum number of patients for which a pharmacist can provide clinical services. These staffing levels could be used to allocate resources to achieve agreed clinical pharmacy service delivery in Australian hospitals.
Not Seeing the Light?
Authors: Behan Kieran P , McGovern Trudy L , Dahms Karyn
Published: April 2015

Background

Aseptic preparation of pharmaceuticals is regularly undertaken by pharmacists and technicians in hospital pharmacy departments. Despite the existence of practice standards and personnel experienced in aseptic preparation, errors can occur which can jeopardise staff safety.

Aim

To describe three cases of photokeratitis from inadvertent exposure to ultraviolet light during aseptic preparation.

Clinical Details

3 clinical pharmacists preparing aseptic products were exposed to ultraviolet light for approximately 2 hours. They developed photokeratitis with diffuse punctate epithelial erosions and burns to the corneas. They also experienced a reduction in their visual acuity. The pharmacists were reviewed by ophthalmologists and treated conservatively. They all made uneventful recoveries.

Conclusion

This report reinforces the hazards of ultraviolet lights used in sterile rooms. It is essential that training of aseptic preparation starts with switching off of the ultraviolet lights.
Management of Osteoporosis in Older People
Authors: Inderjeeth Charles A , Poland Kate E
Published: April 2015

Osteoporosis is characterised by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. Osteoporosis and fracture risk increase exponentially in postmenopausal women. Osteoporosis is under‐diagnosed and under‐treated and advancing age is a risk factor for under‐management. Osteoporosis management in older people (75 years and over) must focus on non‐pharmacological and pharmacological interventions. The aim of treatment is to reduce morbidity and mortality associated with the first fracture and prevent subsequent fractures. Successful non‐pharmacological measures include falls risk assessment and management, participation in exercise programs and the use of hip protectors. Pharmacotherapies such as calcium, vitamin D, alendronate, risedronate, zoledronic acid, teriparatide and strontium ranelate are safe in older people and significantly reduce fractures, especially vertebral fractures. There is less evidence for risk reduction in non‐vertebral and hip fractures, which are more relevant in older people. The body of evidence in this cohort is small and further studies are needed to provide more evidence.
DrugScan Series
Authors: Eato Vaughn
Published: April 2015

This section brings you summaries of the current international literature on therapeutics in areas relevant to Australian pharmacy practice. Specialist pharmacy practitioners scan peer‐reviewed journals and present succinct summaries on major clinical trials, important pharmacoepidemiology studies and pharmacoeconomic research. Interested readers are encouraged to explore the original publications in more detail.
Rurally Focused BPharm Course: Perceptions of Graduates
Authors: Kemp Sarah M , Spark M Joy
Published: April 2015

Background

The Bachelor of Pharmacy (BPharm) course at La Trobe University, Bendigo campus is rurally focused and aims to address the shortage of pharmacists in rural areas.

Aim

To ascertain pharmacy graduates' perceptions of the pharmacy indicative curriculum and to explore whether the rural focus of the course influenced their location of employment.

Method

Cross‐sectional survey of the first 4 cohorts of BPharm graduates from La Trobe University, Bendigo campus.

Results

Most of the indicative curriculum was perceived to be well covered, with wound management the only topic identified as poorly covered. Graduates from rural backgrounds tended to undertake rural employment. The rural focus of the course did not result in graduates from metropolitan backgrounds undertaking rural employment.

Conclusion

La Trobe University's BPharm course was perceived by students to prepare them well for practice as a pharmacist. For La Trobe University, Bendigo campus graduates a rural background was a stronge indicator of future rural practice.
Risk Factors for Adverse Drug Events and Medication Errors in Paediatric Inpatients: Analysis by Admission Characteristics
Authors: Kunac Desireé L , Kennedy Julia , Austin Nicola C , Reith David M
Published: April 2015

Background

There are few published data analysing risk factors for adverse drug events and medication errors in children.

Aim

To evaluate the factors that influence the risk of adverse drug events and medication errors occurring during a hospital admission for a child.

Method

Prospective cohort study of all paediatric admissions of at least 24 hours duration at Dunedin Hospital over a 12‐week period. Suspected events were identified via chart review, multidisciplinary ward meetings, parent interview and voluntary staff reporting. Hypothesis tests were performed using hazard ratios and 95% confidence intervals.

Results

495 patients were included who in total had 520 admissions. There were 67 adverse drug events, of which 38 (57%) were classified as preventable, 77 potential adverse drug events and 255 ‘no‐harm’ medication errors. On multivariate analysis, the major independent risk factors for adverse drug events were increasing age (HR 1.2; 95%CI 1.1–1.3) and a greater number of regular medications (HR 6; 95%CI 1.9–19.3). For potential adverse drug events, intravenous infusions conferred the highest risk (HR 32.4; 95%CI 10.9–95.5). For ‘no‐harm’ medication errors, greater duration of hospital admission (HR 1.2; 95%CI 1.1–1.3) and a greater number of regular medications (HR 14.6; 95%CI 6.4–33.2), particularly IV infusions (HR 13; 95%CI 2.9–56.9), were the main predictors of occurrence. Sex and weight were not found to be related to adverse drug events or medication errors in this cohort of hospitalised children.

Conclusion

A greater number of regular medications and intravenous infusions were important risk factors for adverse drug events and medication errors occurring during hospital admission for a child. Increasing age also influenced the risk of an adverse drug event, whereas for ‘no harm’ medication errors, a greater duration of hospital admission was important.