bluuebunny/crossref_metadata_2025 huggingface dataset:
Role for Aspirin after Total Hip Replacement?
Authors: Chan Esther W
Published: April 2015

Background

Deep vein thrombosis can occur in up to 60% of patients following major orthopaedic surgery. Routine prophylaxis against thromobembolic complications is now the standard of care in this setting. Pharmacological agents used include unfractionated heparin, low molecular weight heparin, factor Xa inhibitors (fondaparinux), vitamin K antagonists and aspirin.

Aim

To review the evidence and discuss the use of aspirin as thromboprophylaxis following elective total hip replacement, and consider its use in adult patients who refuse low molecular weight heparin.

Method

A literature search was conducted to identify clinical studies, meta‐analyses and clinical practice guidelines evaluating the use of aspirin as thromboprophylaxis following elective total hip replacement.

Results

No large trials of acceptable quality which specifically compared aspirin with placebo following total hip replacement were identified. Clinical practice guidelines, meta‐analyses and one clinical trial assessed aspirin against placebo or other agents used in thromboprophylaxis in major orthopaedic surgery, including elective total hip replacement.

Conclusion

There is insufficient evidence to support the use of aspirin alone as thromboprophylaxis following elective total hip replacement.
Modelling Drug Loss during Intravenous Infusion to Premature Neonates
Authors: Anh Andrew VQ , Norris Ross LG , Charles Bruce G
Published: April 2015

Background

Our experience has suggested that not all the drug dose put into an IV infusion reached the bloodstream of neonates.

Aim

To use sparse‐data modelling to estimate how much of a continuously infused dose of caffeine, gentamicin, phenobarbitone and vancomycin was delivered. To use the results to develop a modified infusion protocol to minimise drug losses.

Method

Various drug infusions were prepared in duplicate (test, control). The test set was delivered through an in vitro infusion system identical to that used in the neonatal intensive care nursery. Samples were collected after flushing the system twice with 1.5 mL of normal saline. Each experiment was replicated 4 times for each drug. Drug concentrations were measured by enzyme immunoassay. Recovery and variability during flushing was described as a function of the normal saline flushing volume using an asymptotic mono‐exponential accumulation model.

Results

53% of phenobarbitone, 60% of caffeine, 92% of gentamicin, and 99% of vancomycin doses were recovered. There was considerable variability in the recovery of phenobarbitone.

Conclusion

Current infusion protocols appear inadequate for delivery of drugs to neonates and may result in suboptimal therapy. It is recommended that the administration set be completely primed with the drug and any additional volume of normal saline required, then flushed with a further 2 mL of normal saline to obtain a minimum 90% recovery of these drugs.
Potential Interactions between Drugs Taken by Emergency Department Patients of an Australian Hospital
Authors: Hassan Fariza Abu , Taylor David McD , Leow Fiona HP , Doolan Gabrielle , Knott Jonathan C
Published: April 2015

Background

While drug interactions are reported to be common, there are no published reports of the prevalence of such interactions among Australian emergency department (ED) patients.

Aim

To determine the prevalence and characteristics of potential drug interactions among Australian ED patients, the drugs most frequently involved and identify high‐risk patient groups.

Method

An analytical cross‐sectional survey of 409 patients who were taking at least two drugs. Drug lists were compiled from a range of resources. Analyses of potential interactions were made using Micromedex Drug‐Reax software. Multivariate analysis was used to determine factors associated with potential drug interactions.

Results

855 potential drug interactions were identified among 254 (62.1%, 95%CI 57.2–66.8) patients. The mean number of potential interactions among all patients was 2.1 ± 2.7 per patient. The most common potential interactions were between angiotensin converting enzyme inhibitors and loop diuretics (11.3% of patients at risk), beta‐blockers and antidiabetics (7.3%) and frusemide and aspirin (9.1%). Drugs most commonly involved were aspirin (27.7% of potential interactions), beta‐blockers (11.1%) and warfarin (9.9%). Only the number of drugs taken correlated significantly with the number of potential interactions (p < 0.001).

Conclusion

The possibility of potential drug interactions should be considered when prescribing and ED pharmacists should target patients on multidrug regimens for specific evaluation.
Wound Dressings Update
Authors: Weller Carolina , Sussman Geoff
Published: April 2015

The availability of different types of wound dressings has increased in the last decade. Wound care practitioners have at their disposal an extensive range of dressings. Emerging dressing types include interactive/bioactive dressings and tissue‐engineered skin substitutes. There is no one dressing that is suitable for the management of all types of chronic wounds and few are suited for the treatment of a single wound during all stages of the healing cycle. Successful wound management depends on an understanding of the healing process combined with knowledge of the properties of the various dressings available. Without such knowledge and careful assessment of all the factors that effect healing, dressing selection is likely to be arbitrary and ineffective, wasteful both in terms of time and physical resources. This article is an overview of some of the first‐line and second‐line interactive/bioactive dressings available. A synopsis of wound assessment and wound bed preparation will aid in choosing the appropriate dressings. It will also touch on advanced technologies including tissue‐engineered skin substitutes.
Unnecessary Medicines Stored in Homes of Patients at Risk of Medication Misadventure
Authors: Vuong Tam , Marriott Jennifer L
Published: April 2015

Background

The storage of unnecessary medicines poses safety concerns including patient confusion, inappropriate medication use and unintentional ingestion by children. Consumer storage and wastage of medicines is of concern to health practitioners and the Australian government.

Aim

To describe, quantify, establish safety concerns, and estimate the cost of unnecessary medicines stored in patients' homes.

Method

Patients discharged from two hospitals in 2002 who were part of a study of a community liaison pharmacy service, had their unnecessary medicines removed (with permission) during the home visit. Details of removed medicines, including costs, were recorded and analysed.

Results

A mean of 4.6 medicines/patient (range 1–21) that had expired or no longer required were removed from the homes of 85 patients. A quarter of the items had expired at the time of collection. There were significant alterations to, or deficiencies in, the removed medicines. The mean cost of medicines removed was $65/patient.

Conclusion

Patients place themselves at increased risk of medication misadventure by storing unnecessary medicines in their homes. As well as creating risks to the safety of patients and children, this practice results in wastage of health resources.
Risk Analysis of Errors in Prescribing, Dispensing and Administering Medications within a District Hospital
Authors: Parke John
Published: April 2015

Aim

To investigate errors in prescribing, dispensing and administering medications, determine the origin of the error and analyse the risks according to established risk‐rating matrices.

Method

Errors detected by pharmacists were recorded and combined with errors recorded by nurses and doctors. Errors were classified by type of event, source of report and professional group responsible for the occurrence. Errors were evaluated against two risk‐rating matrices developed by Queensland Health and Standards Australia.

Results

Reported errors occurred at the rate of 1.8% of drugs prescribed over the period from admission to discharge. There were no dispensing errors reported during the study period. Nurses reported 150 incidents and pharmacists detected 275. In the majority of cases it was possible to identify the node in the medication‐use process that was associated with the error (35% administering and 53% prescribing) but this was not possible in 12% of cases. The two largest categories of errors were incorrect dose prescribed (29%) and dose not recorded as given (28%). There was a marked difference in risk profile between the two risk‐rating matrices.

Conclusion

The majority of errors were due to performance lapses or lack of knowledge. The difference in risk profiles suggests that hospitals should adopt a uniform risk‐rating matrix for benchmarking purposes. To avoid underestimates of hospital error rates, a reporting system that can interface with pharmacy information‐management systems needs to be developed.
Are Patients on Long‐Term Corticosteroids Receiving Bone Loss Therapy?
Authors: Rofail Serena , Barras Michael A
Published: April 2015

Aim

To evaluate the quality of medicine use in the primary prevention, secondary prevention and treatment, of osteoporosis in patients who require prolonged oral corticosteroids.

Method

A prospective evaluation of inpatients, who were receiving corticosteroids, during a 7‐week period at a tertiary referral hospital was undertaken. Patients receiving at least prednisolone 5 mg for greater than 3 months were examined via a detailed patient interview and investigation of medical records. The type of treatment, indication and presence of other risk factors for osteoporosis were documented.

Results

51 patients were identified: 32 (63%) were being treated for the prevention or treatment of corticosteroid‐induced osteoporosis; 4 (8%) for primary prevention and 28 (55%) for secondary prevention and treatment. The remaining 19 (37%) were not on any treatment. Only 15 (29%) patients were receiving optimal therapy, as described by Australian standards.

Conclusion

A significant proportion of patients taking prolonged oral corticosteroids were not receiving adequate therapy for the prevention and treatment of corticosteroid‐induced osteoporosis.
Victorian Hospital Pharmacy Technician Workforce Survey
Authors: O'Leary Karen M , Harding Andrew , Rocca Joanne
Published: April 2015

Aim

To collect data to assist in the preparation of a revised enterprise bargaining agreement and award for Victorian hospital pharmacy technicians.

Method

An electronic questionnaire was sent to a representative at each hospital pharmacy service in Victoria who then circulated the questionnaire within their department for completion by every person employed as a hospital pharmacy technician.

Results

The survey confirmed that Victorian hospital pharmacy technicians undertake an extensive range of activities. Findings of note included: 28% had more than 10 years experience as a hospital pharmacy technician; 24% had less than 2 years experience; 32% had, or were undertaking Certificate III or IV in Health Service Assistance qualifications. Respondents working in hospitals with less than 200 beds were more likely to have Certificate III in Health Service Assistance qualifications. 47% of the 126 respondents indicated that they support clinical pharmacy activities as part of their day‐to‐day activities. 76% were paid award rates. Technicians paid above award rates had the following characteristics: more than 5 years experience; Certificate III or IV in Health Service Assistance qualifications; employed as grade 2 technicians; work in metropolitan hospitals and work in hospitals with less than 200 beds. 40% were involved in supporting clinical pharmacy and 40% undertook management activities. Respondents estimated that in total they spent 80% of their time on distribution services; 9% of their time on management services and 10% supporting clinical pharmacy services.

Conclusion

This survey demonstrated that in Victoria there is a disconnection between the work performed by hospital pharmacy technicians, their qualifications and their remuneration. It is hoped that a revised enterprise bargaining agreement and award will provide incentives and a career structure that encourages many to pursue formal qualifications.
Problems with Medication Use in the Elderly: An Australian Perspective
Authors: Elliott Rohan A
Published: April 2015

Pharmacotherapy is an essential component of medical care for older patients, and around two‐thirds of Australians over the age of 60 years use 4 or more drugs. Although polypharmacy is a well‐known risk factor for adverse drug events, use of multiple drugs may be unavoidable in the elderly with multiple comorbidities. While there have been concerns about inappropriate prescribing, polypharmacy and non‐adherence, it is now recognised that there are a broader range of drug‐related problems that need to be addressed. These include suboptimal monitoring of drugs, poor medication management in patients' homes, under‐prescribing and poor communication between health professionals. This is a review of the Australian literature on problems with medication use in the elderly, with guidelines for improving the quality of medicine use in this population.
Book Review
Authors: Eu Peter
Published: April 2015

Radiopharmaceuticals in Nuclear Pharmacy and Nuclear Medicine, 2nd edition Richard J Kowalsky, Steven W Falen, authors Washington DC: American Pharmacists Association, 2004, xiii + 825 pages, ISBN 1‐58212‐031‐5. Available from: American Pharmacists Association  $US129.95 plus postage and handling
Stability of Mixtures Formulated from Warfarin Tablets or Powder
Authors: Sharley Nicholas A , Yu Annie MC , Williams Desmond B
Published: April 2015

Background

Although warfarin is a commonly prescribed oral anticoagulant, published data on the stability of mixtures prepared from warfarin tablets are limited.

Aim

To investigate the stability of mixtures formulated using Coumadin tablets, Marevan tablets or warfarin sodium clathrate.

Method

A stability indicating high performance liquid chromatography (HPLC) method was developed to determine the concentration of warfarin. Warfarin sodium clathrate was forcibly degraded and injected into the HPLC system to ascertain lack of interference from degradation product peaks from the warfarin peak. Warfarin mixtures (1 mg/mL) were prepared in triplicate from Coumadin tablets, Marevan tablets and warfarin sodium clathrate using compound hydroxybenzoate solution APF as a preservative. A four‐level calibration was used. On each study day each sample was injected into the HPLC system in duplicate together with quality control standards and blanks. Warfarin concentrations were calculated from the linear regression equation derived from the calibration curve.

Results

The method was stability indicating as the degradation peaks did not interfere with the principal peak and UV spectral confirmation was used to identify the warfarin peak. All mixtures retained at least 98% of their original concentration over the 28‐day study period.

Conclusion

Warfarin mixtures can be formulated by either suspending crushed tablets or preparing a solution from warfarin sodium clathrate. Compound hydroxybenzoate solution APF can be used as the preservative. A 28‐day shelf‐life can be assigned to the products.
Measuring the Time Required to Provide Components of Clinical Pharmacy Services
Authors: Stuchbery Peter , Kong David CM , DeSantis Giovanna N , Lo SK
Published: April 2015

Aim

To determine the time spent by pharmacists on components of clinical pharmacy services using chosen recording tools.

Method

A 4‐week study was conducted at an acute general hospital in early 2006. Pharmacists completed Pharmaceutical Clinical Pathway (PCP) forms and recorded the time needed for its completion. Other activities not associated with completing PCP forms (e.g. medication chart review, clinical review, adverse drug reaction monitoring, therapeutic drug monitoring, provision of drug information) and the time needed to complete these were recorded on Clinical Activity Data Sheets (CADS). Finally, pharmacists recorded their interventions (and the time involved) directly into the Riskman database.

Results

204 PCP forms were completed. Pharmacists completed the medication history component of the PCP form and recorded the time in 92% of completed forms. The most commonly recorded time for this component of the PCP form was 6 to 10 minutes. There were 418 CADS completed with the most recorded activities being clinical review (355 occasions) and medication chart review (351 occasions). The least recorded activity was adverse drug reaction monitoring (20 occasions). The time for these activities was recorded on more than 97% of CADS completed with mean times ranging from 4.9 minutes (therapeutic drug monitoring) to 6.9 minutes (provision of drug information). 202 interventions were entered into the Riskman database and the time was recorded for 98% of these (mean time 8.8 minutes).

Conclusion

The chosen recording tools measured the times required for the provision of a range of activities provided by a clinical pharmacy service.
Psychotropic Medication Use in Older People
Authors: Hopwood Malcolm J
Published: April 2015

Older people have high rates of mental health disorders such as mood and anxiety disorders, bipolar affective disorder, psychotic disorders, and dementia. All of these disorders are associated with significant morbidity and mortality and have been historically under‐recognised and under‐treated. Recent advances in psychopharmacology have brought great benefit to many young patients with these conditions where they are supported by a clear evidence base. To date, this evidence base has been incompletely developed for older people leaving the prescriber with many difficult decisions. There is moderate and growing evidence supporting the use of antidepressants in this population. The use of mood stabilisers and antipsychotics for indications other than the behavioural and psychological symptoms of dementia currently occurs in the absence of effective evidence.
Reporting Purchasers of Pseudoephedrine Products to Police: New Zealand Community Pharmacists' Experiences
Authors: Sheridan Janie , Kairuz Therese , Butler Rachael
Published: April 2015

Background

Pseudoephedrine is the precursor of choice for the illicit manufacture of methamphetamine, much of which is obtained through purchases of pseudoephedrine products from community pharmacies.

Aim

To investigate issues surrounding data collection by community pharmacists in New Zealand on purchasers of pseudoephedrine products and its provision to police.

Method

Questionnaires were mailed to a random sample of 50% of community pharmacies in New Zealand, with a second mailing to non‐responders.

Results

There was a response rate of 63%. 95% of pharmacists limited the quantity of pseudoephedrine products sold on each occasion. 45% asked for identification from all purchasers. Requesting/collecting identification resulted in various problems such as dealing with aggressive customers, and requiring time to attend court cases as a result of data provided to police. A major issue identified was the lack of feedback from police on information that had been provided. Nonetheless, there was support amongst pharmacists to continue to collect this information.

Conclusion

Although there were a number of problems encountered by pharmacists, many of these can be overcome.
Using Personal Digital Assistants for a Pharmacist Intervention Monitoring Database: Cost Analysis
Authors: To Timothy HM , Spurling Lisa K , Mangoni Arduino A , Eaton Vaughn S
Published: April 2015

Background

Clinical pharmacists play an important role in inpatient care; however, their contribution and resultant cost savings are often difficult to define and quantify.

Aim

To evaluate the use of the pharmacist intervention monitoring (PIM) tool on personnel digital assistants (PDAs) in documenting pharmacy interventions, quantify pharmacy interventions in cost savings, and demonstrate their contribution to inpatient care.

Method

The study was undertaken on 3 hospital wards over 4 weeks. 2 clinical pharmacists prospectively recorded all interventions, defined as any action that directly resulted in a change to patient management, monitoring or therapy. The interventions likely to affect length‐of‐stay were reviewed by a panel who estimated the likely change in length‐of‐stay, and thus savings in bed‐days and potential cost.

Results

179 interventions were documented from a review of 204 drug charts. 22 interventions (12%) prevented major harm, 86 (49%) moderate harm, 65 (36%) minor harm and 6 (3%) were of no clinical significance. 63 interventions were likely to have affected length‐of‐stay, with an estimated 40.3 bed‐days saved, and calculated savings of $13 685.

Conclusion

This pilot demonstrated the usability of the PIM tool to document clinical interventions by pharmacists on PDA, and provided evidence of the cost‐effectiveness of a clinical pharmacy service.
Australian Electronic Medication Management Policy and Systems
Authors: Ryan Michael J
Published: April 2015

Aim

To investigate and describe the policies and activities of Commonwealth and state/territory health departments in regard to electronic medication management (EMM); and to evaluate the EMM systems available to Australian hospitals for usability, functional capabilities and system readiness.

Method

A literature review of EMM systems was conducted, governments were contacted to gather data on policy and initiatives related to EMM systems, and vendor EMM systems were evaluated using ‘key principles' and ‘core features' criteria related to knowledge base, database, functionality and usability, and organisational aspects.

Results

There is an abundance of data demonstrating the benefits of EMM systems but also an increasing number of reports of lessons learnt from their implementation. The Commonwealth sees its role as encouraging the adoption of electronic records and standardised ways of describing health products and terminology. The states and territories have approached EMM systems in various ways, from considering EMM as part of a state‐wide e‐Health strategy (Vic., SA, Qld, NSW), to trialling EMM or part EMM systems (SA, NT), to developing business cases or watching developments in other states (Tas., WA, ACT). 11 vendor EMM systems were evaluated using a continuous scale.

Conclusion

There is good evidence of benefits with EMM systems, but there are many change management issues which need to be addressed. The Commonwealth appears focused on standards and interoperability. There is slow progress in a number of states towards EMM systems. There are a number of developed and proved vendor EMM systems available to Australian hospitals.
Pharmacological Management of Pain in Older People
Authors: Katz Benny
Published: April 2015

The prevalence of pain increases with advancing age. Pain is often undiagnosed or under‐treated in older patients, particularly those with cognitive impairment, communication problems or residents of aged‐care facilities. The most definitive approach to the management of pain is to treat the underlying cause. As this is often not feasible in the elderly, the emphasis then shifts to symptom control. Pharmacological approaches form the mainstay of therapy. They are convenient and often cost‐effective, and may be used alone, or in combination with physical and psychological therapies.
Stability of Frusemide Tablets Repackaged in Dose Administration Aids
Authors: Bowen Luke , Mangan Martina , Haywood Alison , Glass Beverley
Published: April 2015

Background

Repackaging tablets into a dose administration aid (DAA) requires that the pharmacist consider the stability of the active pharmaceutical ingredient and the excipients of the drug product. Frusemide is susceptible to photodegradation and is commonly repackaged into DAAs.

Aim

To evaluate the stability (chemical and physical) of frusemide tablets repackaged into DAAs.

Method

Frusemide tablets repackaged into DAAs were evaluated for physicochemical stability over a period of 8 weeks at a controlled room temperature (25 ±2 °C) and other relevant in‐use conditions. In addition, photostability studies were performed according to the International Committee on Harmonisation (ICH) guidelines.

Results

Chemical stability was confirmed for all storage conditions, including the ICH light conditions, with the frusemide content within the British Pharmacopoeial range of 95 to 105%. Although the physical stability was confirmed by all tests (weight uniformity, hardness, friability, disintegration, dissolution), storage in a simulated pharmacy environment after one week and exposure to ICH light conditions resulted in a yellow colouration of the tablets.

Conclusion

Although the chemical and physical stability of frusemide was within acceptable limits during the study, the discolouration of the tablets from light exposure is unacceptable. It is recommended that DAAs are stored protected from light immediately after repackaging with frusemide tablets, and that patients are counselled to store the DAA in a cool dark place.
General Practitioner Perceptions of Extended Pharmacy Services and Modes of Collaboration with Pharmacists
Authors: Van Connie , Krass Ines , Mitchell Bernadette
Published: April 2015

Aims

To explore the perceptions of Australian general practitioners (GPs) towards extended pharmacy services, and to investigate the modes and extent of collaboration between community pharmacists and GPs.

Method

Semi‐structured face‐to‐face and telephone interviews were conducted on a purposive sample of GPs from Sydney and surrounding areas. The data were thematically analysed, using qualitative data analysis software.

Results

23/68 (34%) GPs approached, agreed to participate in the interviews. The respondents practised in different settings (private/medical centre/specialised settings, rural/suburban/city areas), had been in professional practice for periods ranging from 6 months to several decades and included both female and male practitioners. Support for pharmacist provision of services varied. GP perceptions were mostly positive for home medicines review (HMR), information provision and monitoring. However, most GPs did not favour pharmacists' provision of screening and immunisation services. Most respondents believed that GP‐pharmacist collaboration would be beneficial to both the patient and the GP. However, despite this, collaboration was minimal in all extended pharmacy services discussed except HMR.

Conclusion

HMR is the extended pharmacy service most widely accepted by GPs and has proved to be an effective platform for inter‐professional collaboration. Considering the factors that promote effective collaboration in HMR will position us better to improve the GP‐pharmacist collaboration crucial for expanding other extended pharmacy services.
Extemporaneous Compounding in Queensland Hospitals
Authors: Cook Graham K , Ling Joanna WH , Lee Robin
Published: April 2015

Background

Extemporaneous compounding is common pharmacy practice when commercially‐available registered products do not exist. While extemporaneously compounded preparations provide access to medication, there are concerns about the quality, safety and efficacy of these products.

Aim

To examine the extent and quality of extemporaneous compounding within Queensland public hospital pharmacy departments from an organisational perspective.

Method

An e‐mail questionnaire was sent to all Queensland public hospital pharmacy departments staffed by pharmacists requesting details of their extemporaneous dispensing activities. A computer search of manufactured formulations on the Queensland Health pharmacy information management system was used to supplement data obtained from the questionnaire.

Results

95 formulations were prepared by 28 hospital pharmacies. Different formulations of the same active ingredient were recorded in 7 instances. Stability data supporting assigned expiry dates was available for 74 (78%) preparations. Other issues with potential to impact on patient safety included extrapolation of stability data from other formulations and product type, multiple presentations and strengths of the same formulation, and the use of alternative dosage forms as a source for active ingredient in 70% of preparations (90% of mixtures and suspensions).

Conclusions

The results identified areas for improvement to the quality of extemporaneous compounding. These include use of stability data to assign expiry dates, standardisation of formulation, and use of raw material as a source of active ingredient. Utilisation by hospital pharmacies of a resourced, central manufacturing facility is identified as a potential vehicle to achieve these improvements.
Recombinant Erythropoietin for Anaemia of Prematurity—When Should Treatment Start?
Authors: Meyer Michael P
Published: April 2015

Background

Recombinant erythropoietin reduces blood transfusion requirements in preterm neonates weighing under 1000 g 30 days postpartum. The optimal timing of starting erythropoietin therapy to achieve this effect is unclear.

Aim

To ascertain the number of neonates receiving blood transfusions 30 days postpartum at an Auckland hospital.

Method

In this retrospective study, blood transfusion and donor requirements of a cohort of neonates starting treatment at 30 days of age were compared with a cohort treated at 14 days of age. Blood transfusion guidelines and treatment practices were the same for the two groups.

Results

The two groups were comparable with regard to demographic characteristics. 16/26 (62%) neonates treated from 30 days and 14/35 (40%) neonates treated from 14 days received a blood transfusion 30 days postpartum. This 22% difference was not statistically significant. The number of neonates exposed to at least one new donor 30 days postpartum was reduced from 11/26 (42%) to 11/35 (31%) with earlier commencement of treatment (not statistically significant).

Conclusion

There were trends suggesting that starting erythropoietin treatment from 14 days of age was beneficial in reducing blood transfusion and donor exposure compared to starting at 30 days. However, the differences were not statistically significant and definite conclusions cannot be reached.
DrugScan Series
Authors: Keen Neil
Published: April 2015

DrugScan is a review of the international literature on therapeutics. Leading pharmacy practitioners scan the literature and present information on major clinical trials, important pharmacoepidemiology studies, and pharmacoeconomic research in a succinct format. Interested readers are encouraged to explore the original publications in greater detail.
Successful Introduction of Tallman Letters to Reduce Medication Selection Errors in a Hospital Network
Authors: Van de Vreede Melita , McRae Amy , Wiseman Meredith , Dooley Michael J
Published: April 2015

Aim

To implement Tallman letters into the medication selection process at a hospital network, including dispensing and drug administration, to reduce errors associated with look‐alike sound‐alike (LASA) drugs.

Method

The 3 phases of the study were overseen by a working party consisting of pharmacists at the Alfred Hospital (May 2006 to May 2008). The 3 phases consisted of piloting Tallman letters in the pharmacy department, developing a LASA drug list appropriate to the hospital network, and implementing Tallman letters into the hospital network's medication selection process.

Results

A short LASA drug list was piloted in the inpatient dispensary for 6 months. When this was considered successful, a comprehensive LASA drug list was developed that consisted of 51 items to distinguish between generic names (n = 41), brand names (n = 6) and generic and brand name combinations (n = 4). Tallman letters were included into the pharmacy dispensing software. Finally, Tallman letters were implemented across the 3 hospitals in the network, i.e. 7 dispensaries and 40 ward medication storage areas.

Conclusion

Tallman letters were successfully introduced and implemented into a hospital network. This was achieved with the expenditure of minimal resources and has improved safety by minimising the risk of selecting the wrong medication.
Daily Intravenous Chloride Load and the Acid‐Base and Biochemical Status of Intensive Care Unit Patients
Authors: Klemz Katja , Ho Lisa , Bellomo Rinaldo
Published: April 2015

Background

Studies have described the development of metabolic acidosis after the rapid intravenous administration of large amounts of chloride‐rich solutions. There are little data on the effect of daily intravenous fluid therapy within the intensive care unit.

Aim

To test the correlation between daily intravenous chloride load and the acid‐base and biochemical status of intensive care unit patients.

Method

Data were prospectively collected on the type and volume of intravenous fluids administered to intensive care unit patients over 24–hour cycles. Correlation was then tested between daily chloride load and the acid‐base and biochemical variables obtained from the first morning measurement of arterial blood gases on the following day.

Results

49 patients were audited. 30 (61%) patients had hyperchloraemia on intensive care unit admission with a median serum chloride level of 108 mmol/L (range 87–123); 32 (65%) patients had a negative base excess above −2 mEq/L and 11 (23%) patients had a bicarbonate level below 22 mmol/L. The median daily amount of chloride administered was 88.5 mmol (range 0–732). There was a statistically significant negative correlation between total chloride intake and serum bicarbonate (p < 0.0002), base excess (p < 0.0002), pH (p < 0.006), sodium chloride difference (p < 0.0001) and a positive correlation with serum chloride concentration (p < 0.006).

Conclusion

The daily chloride load significantly influenced the acid‐base and biochemical status of intensive care unit patients. The higher the chloride load, patients are more likely to develop metabolic acidosis, hyperchloraemia and decreased sodium chloride difference.
Medication Safety Series
Authors: Thornton Penny
Published: April 2015

This series brings you up‐to‐date information about medication safety and strategies to prevent medication errors. It draws on Australian incidents and US experience, including (with permission) material from ISMP Medication Safety Alert! a bulletin published by the Institute for Safe Medication Practices . 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 (Pharmacy Services Manager, The Children's Hospital, NSW; ).
Monitoring Physical Health and Adverse Effects in Children and Adolescents Prescribed Antipsychotics
Authors: Grzeskowiak Luke E , Ellis David P , Phillips Adam J , Angley Manya T
Published: April 2015

Background

The adverse effects and long‐term health risks associated with antipsychotic use means that monitoring children and adolescents prescribed these medications is important.

Aim

To implement an evidence‐based chart and guideline to monitor physical health and adverse effects in children and adolescents prescribed antipsychotics in a range of practice settings; and to identify the barriers and benefits of implementation.

Method

Using an action research approach a pilot trial was undertaken to implement a chart and guideline in a range of practice settings. Patient and health professional resource kits and an information compact disc were produced to facilitate implementation. Barriers identified during implementation were doctor/health professional, patient‐related and environmental. Carer and doctor satisfaction questionnaires were administered to assess the implementation process and evaluate the quality and usefulness of the monitoring chart and guideline.

Results

10 doctors were recruited to participate in the implementation trial and 21 patients prescribed antipsychotics were enrolled. Monitoring data collected retrospectively from patients' case notes, such as weight/height measurements and haematological monitoring were congruent with the guideline in 41% and 29% of patients respectively. Carer and doctor satisfaction questionnaires indicated that the monitoring package was well received and raised awareness of potential adverse effects and the importance of monitoring.

Conclusion

The monitoring package can bridge the evidence to practice gap regarding monitoring physical health and adverse effects in children and adolescents prescribed antipsychotics.
Medication Use by Australian War Veterans in Residential Aged‐Care Facilities
Authors: Roughead Elizabeth E , Gilbert Andrew L , Woodward Michael C
Published: April 2015

Background

There has been concerns about the appropriateness of medication use in Australian residential aged‐care facilities. Data on overall medication use in aged‐care has been unavailable.

Aim

To examine medication use for Australian war veterans in residential aged‐care facilities.

Method

An observational study using the Department of Veterans' Affairs' pharmacy claims database was undertaken. Veterans resident in aged‐care facilities between April and June 2005 were included. Veterans using gastrointestinal, analgesic, psychotropic, antiinfective and cardiac drugs were assessed.

Results

All 16 126 veterans (5% of the veteran population) identified as residing continuously in aged‐care facilities were included (average age 86 years). Those with low‐care needs (44%) were dispensed on average 9 (SD 5) different medicines, while those with high‐care needs (56%) were dispensed 8 (SD 5) different medicines. More than 50% of veterans were dispensed analgesics, predominantly paracetamol, and over 60% psychotropic drugs. In all, 35% were receiving antidepressants, proton pump inhibitors and antibacterials.

Conclusion

Veterans residing in aged‐care facilities are taking high levels of medications, particularly analgesics, psychotropics, antibacterials, laxatives and proton pump inhibitors, for which studies have demonstrated concerns about their appropriateness.
Intravenous Potassium Chloride Use in Hospitals: Current Practice
Authors: Van De Vreede Melita A , Wilson Sally G , Dooley Michael J
Published: April 2015

Aim

To assess if current hospital practice reflected the Australian Council for Safety and Quality in Health Care's 2003 recommendation to remove potassium chloride ampoules from general wards; to identify where premixed potassium chloride infusions and ampoules are used; and if the lessons learnt and safety improvements introduced in 2003 had been sustained.

Method

25 hospitals in Victoria were surveyed by telephone interview in May/June 2006 regarding their use of intravenous potassium chloride. Hospitals surveyed included city and country, large and small.

Results

All of the hospitals surveyed, apart from 2, had removed potassium chloride ampoules from their general wards at the time of the survey and 6 no longer stocked any potassium chloride ampoules. Potassium chloride ampoules tended to be used in specialty areas such as intensive care, cardiac and haematology/oncology, although this varied among hospitals. All of the hospitals were using premixed potassium chloride infusions. 23 hospitals had a potassium chloride administration policy.

Conclusion

There was awareness in hospitals about the risks of intravenous potassium chloride but there was concern that staff would forget over time and hence the need for ongoing education. Further investigation into barriers to the use of premixed infusions needs to focus on specialist areas, which tend to be where potassium chloride ampoules are still used.
Co‐Dispensing of Contraindicated Drugs with Cisapride
Authors: Boyd Ian W , McEwen John , Calcino Lisa J , Zhang Judy Y , Walsh Robert L
Published: April 2015

Aim

To measure the rate of co‐dispensing of contraindicated drugs with cisapride 12 months prior to and 12 months after a period of publicity; and to assess the impact of the publicity, the ‘Dear Healthcare Professional letters‘, changes to the product information and pharmaceutical benefits subsidy restrictions.

Method

Medicare Australia's Pharmaceutical Benefits Scheme database was searched to identify a cohort of patients who had been dispensed both cisapride and a contraindicated drug in a 12‐month period before and after a period of publicity.

Results

The number of patients dispensed cisapride fell from 42 319 in 1998 to 2849 in 2001 after the publicity, and significantly after the restriction was placed on cisapride as a pharmaceutical benefit in 2000. In 1998, 11% of patients were dispensed a contraindicated drug 30 days after cisapride dispensing and this figure fell to 9.7% in the 2001 cohort. When the analysis was restricted to the dispensing of the specific drugs that had been named in the publicity letters (‘named’ drugs), a contraindicated drug was dispensed to 3.3% in 1998 and 2.7% in 2001.

Conclusion

The large fall in the use of cisapride from 1998 to 2001 was more likely due to the pharmaceutical benefits subsidy restrictions rather than the publicity or regulatory actions during 2000. While the proportion of patients who were dispensed a contraindicated drug showed a small fall, it was unlikely to be clinically significant. When the analysis was restricted to patients who were dispensed only a ‘named’ drug, the reduction from 1998 to 2001 was small and statistically insignificant. Sponsor‐initiated communication failed to ensure optimal prescribing and dispensing of drugs.
Australian Reports of Bleeding Complications Associated with Antithrombotic Drug Combinations
Authors: Ghiculescu Razvan A , Pillans Peter
Published: April 2015

Background

The Australian Adverse Drug Reactions Advisory Committee (ADRAC) has received numerous reports of bleeding complications associated with the combined use of antithrombotic drugs (anticoagulants and/or antiplatelet drugs).

Aim

To review the ADRAC reports of major bleeding complications and determine the antithrombotic drug combinations implicated; and to establish the relevance of the voluntary ADRAC reporting data by comparing with published reports.

Method

ADRAC reports over a 6 year period from 1 January 2000 to 31 December 2006 were reviewed on the antithrombotic drugs involved, and the severity and nature of bleeding complications. Data were collated on patient demographics, and comorbidities.

Results

Bleeding complications related to the combined use of antithrombotic drugs were described in 188 ADRAC reports over the 6 year period. 17.5% of the reports had a fatal outcome. The median age of patients was 76 years, 47% were men and the principal comorbid condition was renal impairment (8.5%). The antithrombotic drug combinations associated with the risk of mortality included aspirin and/or clopidogrel and heparins; aspirin and/or clopidogrel and warfarin; aspirin and/or clopidogrel co‐prescribed with heparins and glycoprotein IIb/IIIa inhibitors; aspirin and heparins co‐prescribed with tissue plasminogen activator drugs. Bleeding was reported to occur in the upper gastrointestinal tract (26%), central nervous system (21%) and retroperitoneal space (16%). Of the reports of cerebral haemorrhage, 14 reports (35%) were associated with mortality.

Conclusion

ADRAC reports of major bleeding complications involving vital organs were associated with the combined use of anticoagulant and/or antiplatelet drugs and were frequently reported in older patients. These observations were supported by similar findings in published reports. These data highlight the risk associated with the use of antithrombotic drug combinations and the need for care in the clinical monitoring of patients.
Patient's Own Drugs and One‐Stop Dispensing: Improving Continuity of Care and Reducing Drug Expenditure
Authors: James C Robert , Leong Cherrie KY , Martin Robyn C , Plumridge Richard J
Published: April 2015

Background

The use of patient's own drugs and one‐stop dispensing can reduce the risk of medication misadventure by refocusing pharmacy services from distributive functions to improving patient clinical review from admission to discharge. Changing practice to adopt these programs will contribute towards greater compliance with accepted standards of practice for appropriate, safe and effective use of medicines.

Aim

To estimate the cost savings associated with patient's own drugs and one‐stop dispensing using the Pharmaceutical Benefits Scheme.

Method

Patient's own drugs use and hospital‐initiated drugs were recorded on 4 wards over a 26 day period and the costs determined.

Results

Use of patient's own drugs on the 4 wards resulted in estimated annual savings of 9.92% (percentage of total hospital drug expenditure).

Conclusion

Patient's own drugs and one‐stop dispensing can improve the continuity of care, quality use of medicines, and result in significant cost savings.
SHPA Standards of Practice for Critical Care Pharmacy Practice
Authors:   SHPA Committee of Specialty Practice in Critical Care
Published: April 2015

These are standards of professional practice and not standards prepared or endorsed by Standards Australia. They are not legally binding.
Developing an Outpatient Heart Failure Pharmacy Service
Authors: Hargraves Tracey‐Lea , Bennett Alexandra A , Brien Jo‐anne E
Published: April 2015

Background

Heart failure is a progressive disease with a high mortality rate and significant cost burden. Various roles have been proposed for pharmacists in the multidisciplinary outpatient care of heart failure patients. In 2002, an outpatient heart failure pharmacy service was established in the Heart Lung Clinic, St Vincent's Hospital, Sydney.

Aim

To describe the patients attending the Heart Lung Clinic on the days that the outpatient heart failure pharmacy service was available, including patients using the service; the pharmacy activities delivered to patients; and to measure patient satisfaction with the service.

Method

Data were collected prospectively over 4 weeks. Patient medical records were manually reviewed. Documented pharmacy activities were classified using the ICD‐10‐AM codes for pharmacy‐specific activities. A self‐administered patient satisfaction survey was used.

Results

Of the 46 patients included in the study (mean age 56 SD 16 years), 36 patients had heart failure as the primary diagnosis for referral. 11/36 patients had preserved left ventricular ejection fraction, 28 patients were prescribed angiotensin converting enzyme inhibitors, and 28 patients were prescribed beta‐blockers. 17 patients used the outpatient heart failure pharmacy service. Medication order review, clinical review and medication counselling were the most frequently documented pharmacy activities. 15/16 patient satisfaction surveys were returned. Mean satisfaction score was 4.64 (maximum score = 5).

Conclusion

Data obtained were used to streamline the outpatient heart failure pharmacy service at the Heart Lung Clinic.