bluuebunny/crossref_metadata_2025_split huggingface dataset:
Compatibility of Paclitaxel in 5% Glucose and 0.9% Sodium Chloride Injections with EVA Minibags
Authors: Xu Quanyun A , Trissel Lawrence A , Davis Melvyn R 
Published: March 2016

Aim: To evaluate the compatibility of a paclitaxel formulation (Anzatax, Paulding) at concentrations of 0.3 and 1.2 mg/mL in 5% glucose injection and 0.9% sodium chloride injection with Baxter ethylene vinyl acetate (EVA) solution containers. We evaluated the potential for leachable materials to be extacted from the EVA bag by the paclitaxel formulation and the potential for paclitaxelloss due to sorption to the plastic.Method: The paclitaxel admixtures at both concentrations were prepared and stored at 25 and 32°C, protected from light, for 72 hours. All admixtures were prepared in triplicate in the EVA minibags; samples were drawn from the containers initially upon preparation and after 24 and 72 hours of storage. The paclitaxel concentrations of the samples and the extractable content from the container were determined using separate high performance liquid chromatographic methods. Leached material was analysed by mass spectrometer.Results: Paclitaxel was chemically stable throughout the 72‐hour study period exhibiting no loss due to decomposition or sorption in any of the admixtures. However,
an unknown material was leached from the EVA containers, appearing in both the 24‐ and 72‐hour samples. The unknown material chromatographed very similarly to an unknown that was extracted by contact of the plastic with pure acetonitrile. The unknown primarily consisted of three entities having masses of 888.69, 932.68, and 976.73 daltons and may be leached polymeric material varying in the number of associated acetate groups.Conclusion: Paclitaxel is chemically stable at 0.3 and 1.2 mg/mL in 5% glucose injection and in 0.9% sodium chloride injection in EVA containers for up to 72 hours at 25 and 32°C. However, some material of unknown identity was leached into the drug admixture from the container within 24 hours.
Perhexiline‐Paroxetine Drug Interaction
Authors: Alderman Christopher P 
Published: March 2016

Objective: To document a case of perhexiline toxicity associated with concurrent treatment with paroxetine.Clinical Features: An 86‐year‐old woman was admitted to hospital when she was unable to cope at home and because of ataxia, falls, lethargy and nausea. She had started on paroxetine 20 mg daily five weeks before presentation. Investigations revealed elevations in both liver function and serum perhexiline concentration (2.02 mg/L, range 0.15‐0.6 mg/L).Conclusion: Perhexiline toxicity may occur as a result of concurrent treatment with a selective serotonin reuptake inhibitor.
Strategies to Attract Locum Pharmaciststo Hospital Practice
Authors: Linsley Ross F , Gregory Debbie 
Published: March 2016

Uncompetitive wages, inflexible work conditions, and scarce graduate positions in hospital each year have contributed to a shortage of locum hospital pharmacists in New South Wales (NSW). Therefore, the NSW Branch of SHPA introduced a self‐funding, fee‐paying placement service coordinated by a locum pharmacist. Twenty‐two known locums were surveyed to identify their needs, motivation, and the barriers to working in hospital.Most locums were newly registered pharmacists or were returning to hospital pharmacy after an extended absence. Hospital pharmacy was attractive because of a clinical and supportive environment, plus contact with patients and physicians. The barriers were locums' perceived gap in clinical knowledge, the absence of entry level clinical courses, inflexible work hours, illogical procedures, and a bureaucratic mentality.Consequently, an Introduction to Hospital Pharmacy course is being offered by SHPA (NSW), with an emphasis on mentoring locums back into the workforce through entry‐level clinical teaching and an explanation of policies and procedures. Since this initiative, two pharmacists who had been out of work for many years are now keenly sought as locums,some locums have worked in other hospitals and are enjoying the variety, UK pharmacists have telephoned in advance for placement, and the locums have appreciated information about a job from an independent source.
Surgical Antibiotic Prophylaxis in a Private Hospital Compliance with Guidelines
Authors: McConachy Kerri A , Cuell Sylvia , Kent Paschal J , McDonald Malcolm I 
Published: March 2016

Objective: To prospectively evaluate the appropriateness of prophylactic surgical antibiotic use and the cost of inappropriate surgical antibiotic prophylaxis in a 115‐bed private hospital.Method: Details of prophylactic antibiotic administration were recorded by operating theatre nursing staff and the clinical pharmacists assessed the appropriateness of the indication, antibiotic choice and dose. Surgical antibiotic prophylaxis was considered appropriate if it met either the in‐house Surgical Antimicrobial Protocol or the Antibiotic Guidelines 96/97 9th edition. We assessed the timing of administration and analysed the cost of inappropriate drug use and laboratory monitoring.Results: Surgical antibiotic prophylaxis was indicated in 92% of procedures (230/251) and used, or not used, appropriately in 86% of procedures (215/251). In the 197 cases in which antibiotics were indicated and used: only 62% of doses (122/197) were administered at or less than two hours before induction; and the correct antibiotic was chosen in 90% of cases (178/197). Dosage was correct in 77% of cases overall (192/251), but in 98% of cases when the appropriate antibiotic was chosen (174/178). Single doses were employed in only 68% of procedures (133/197). There was compliance with all five criteria in only 35% of cases. The annual cost to this hospital of inappropriate antibiotic prophylaxis was estimated at over $40 000.Conclusion: This study demonstrated modest compliance with current recommendations for surgical antimicrobial prophylaxis. As a result, the in‐house protocol is being revised to include ENT procedures and a new anaesthetic record form is being developed. Further education is being targeted to anaesthetists, urologists, orthopaedic, colorectal and ENT surgeons.
Evaluation of an Automated Drug Distribution System in an Australian Teaching Hospital
Authors: Martin E Dean , Burgess Naomi G , Doeck Christopher J 
Published: March 2016

Aim: To assess an automated drug distribution system implemented on four wards of a large teaching hospital.Method: Pyxis Medstation System 2000 Rx was configured and installed in four inpatient care areas at Royal Adelaide Hospital. These consisted of a medical ward, a surgical ward and two intensive care areas. The system was assessed over the seven weeks immediately following implementation and was compared to the previous systems of individual patient dispensing and imprest drug supplies. The process was assessed in terms of drug inventory, drug distribution, pharmacy staff requirements, missed doses, clinical interventions and nurse satisfaction.Results: The number of pharmaceutical line items available in patient care areas was increased by 324% using the controlled storage and delivery of the automated system. Over 95% of required items were available at ward level during the trial. Pharmacists' time was reduced by 46% and technicians' time was increased by 36%. The overall staff costs increased by 2.5%. Missed doses declined from 29% to 24%. The prescription turnaround time for items in Medstations was decreased by 88% compared to pharmacy‐based dispensing. Dispensing interventions by pharmacists increased by 16%. Most nurses (91 % ) in the wards preferred the automated system and 54% of nurses in the intensive care areas thought the system should be adopted.Conclusion: Automated drug distribution was successfully implemented and demonstrated increased efficiency of drug supply and improved accountability. If implemented more widely, the system could allow pharmacists to focus on improving pharmaceutical care through increased clinical activities.
Multicentre Pilot Study of a Standard Approach to Document Clinical Pharmacy Activity
Authors: Dooley Michael J , McLennan Danielle N , Galbraith Kirsten J , Burgess Naomi G 
Published: March 2016

Aim: To describe the pilot implementation of guidelines for the standard documentation of clinical pharmacy activities in clinical practice settings in a range of Australian hospitals.Methods: Twenty‐eight hospital pharmacies participated in the study conducted over a 5‐day period in June 1999. Pharmacists recorded patient‐specific clinical activities as defined in the set of documentation guidelines, documented their experience and provided feedback during and at the end of the study period. Participants were also asked to provide suggestions on potential performance indicators for clinical pharmacy and to comment on four proposed indicators.Results: 18 402 clinical activities were documented by 85 pharmacists. The most frequent clinical activities performed (% of total activities) were medication order review (53%), clinical review (21 % ), medication history interview (8%) and patient medication counselling (7%). The definitions were deemed to be suitable for most activities. With the exception of clinical review, there was general agreement that the proposed methods of quantifying the activities were suitable. Respondents provided qualitative feedback regarding the definitions and quantification methods. Most respondents thought it would be possible to collect data for the four indicators proposed.Conclusion: A set of guidelines developed for defining and quantifying patient‐specific clinical pharmacist activities was successfully implemented and utilised in a range of Australian hospitals. The guidelines will be further refined and submitted for consideration and ratification by The Society of Hospital Pharmacists of Australia.
The Role of the Clinical Pharmacist in Poison‐Related Admissions in a Secondary Care Hospital
Authors: Kaleemuddin Mohammed , Sankham Rajendran D , Bhojraj Suresh 
Published: March 2016

Objective: To assess the value of a clinical pharmacy program to optimise the management of poison‐related admissions to a secondary care hospital in Ootacamund, India.Methods: A baseline study was carried out to determine the types of poisoning encountered at the hospital. Agrochemicals and other locally available chemicals were surveyed and a simple method for identification of poisons developed. Protocols for the management of poisoning were developed and physicians and nurses were educated on the use of protocols and identification methods. Outcome measures were assessed.Results: During the 13‐month program, there were 292 poisoning cases. Poisoning due to agrochemicals caused the majority of admissions ( 178 cases). All but four cases were found to be of poisoning with homicidal intent. Clinical pharmacist intervention reduced the number of unidentified poisons from 24% to 7.1 %. The overall death rates in the three periods were 10%, 13% and 9.7%. None of three patients admitted with paraquat poisoning survived in the pre‐intervention period; however, eight patients survived this condition in the postintervention period. The mean number of drugs used per patient declined from 5.5 to 4.1 and the mean length of patient stay at the hospital decreased from 6.2 to 4.1 days.Conclusion: Clinical pharmacist involvement improved the identification of poisons and treatment protocols for poisoning. The program could have contributed to reduced fatalities and improved therapeutic outcomes for survivors.
Clinical Pharmacy in 2020: an Alternative Future for Clinical Pharmacy in a Rural Setting
Authors: Lum Elaine PM 
Published: March 2016

This paper paints one of many possible futures for clinical pharmacy in the year 2020, the role of the pharmacist in that scenario, and the steps required to achieve that reality. In particular, the future of clinical pharmacy in the rural setting will be offered.An emerging issues analysis of global and national trends that are driving change will be used to critique the present. This is complemented by a causal layered analysis (CLA) of problems and issues that arise in rural pharmacy practice. CLA is a tool developed by futurists to explore current issues and paradigms at several different levels of knowing. A vision of rural clinical pharmacy will be offered, using the CLA as a template. Broad strategies to guide the move from current reality to the preferred future are briefly outlined.
Vancomycin Continuous Infusion: a Cohort of 23 Intensive Care Unit Patients
Authors: Matthews Zachariah 
Published: March 2016

Objective: To observe the phannacokinetic impact of administering vancomycin by continuous infusion in selected patients in the Royal Prince Alfred Hospital (RPAH) General Intensive Care Unit.Method: A retrospective review was performed of patients given vancomycin by continuous infusion in the General Intensive Care Unit over a four‐year period from June 1996 to May 2000.Results: Twenty‐six critically ill patients treated with continuous infusion vancomycin were identified. Twenty‐three of the 26 patients also received a regimen of vancomycin by intermittent dosing during the same admission to the unit. The pharmacokinetic data for these 23 patients are presented. The results of this review support the findings of previous studies that vancomycin given by continuous infusion achieves a better phannacokinetic profile than intermittent dosing.
Review of a Drug Information Service in an Indian Teaching Hospital
Authors: Nibu P , Ramesh M , Parthasarathi G 
Published: March 2016

Aim: To describe a review of drug information activities in a teaching hospital in Mysore, India.Method: Drug information enquiry forms were reviewed for a 6‐month period. Randomly selected enquiries were audited by experienced clinical pharmacists.Results: 370 enquiries were handled at an average of 62 per month. Most enquiries were from doctors (52%) and postgraduate medical students (30% ). Questions most frequently related to administration/dosage (30%) and adverse drug reactions (27% ). Standard textbooks were used for 64% of enquiries. Of the 16 enquiries directly audited, 15 were rated as good or excellent and 1 as ‘can improve’.Conclusions: The service was well used. In developing countries, it is important to establish independent drug information centres beginning with basic resources. Output should be monitored with quality assurance programs.
The Medication Chart as an Integral Tool in the Pharmaceutical Care Plan
Authors: Wilcox Carole , Duguid Margaret J 
Published: March 2016

Aim: To develop a practical guide for pharmacists for the provision of clinical pharmacy services that would: 1. facilitate the delivery of a uniform standard of care; and 2. enhance communication between pharmacists and other members of the medication team.Method: A generic pharmaceutical care plan based on the ‘SHPA Standards of Practice for Clinical Pharmacy’ was developed as an appropriate framework for the model. The plan is outcome oriented. It uses the patient's medication chart to document clinical information and activities and follows the patient from admission to discharge. The medication chart was chosen as the medium for documenting pharmaceutical care following a survey of the medical staff. Previously this information was recorded in patient profiles in individual pharmacists' ward folders.Results: Major outcomes included a change in clinical practice, improved discharge planning, visibility of the pharmacists' contribution to patient care, and an increase in the pharmacists' profile within the hospital. The plan also proved to be a useful tool for performance management and education purposes, and was well accepted by pharmacists.Conclusion: A formalised pharmaceutical care plan is a practical and efficient model for providing and documenting clinical pharmacy services. Using the medication chart as the medium for documenting clinical services supports continuity of care in the hospital, improves productivity and streamlines the discharge process.
Stability and Compatibility of Morphine, Midazolam and Bupivacaine Combinations for Intravenous Infusion
Authors: La Forgia Simon P , Sharley Nicholas A , Burgess Naomi G , Doeck Christopher J 
Published: March 2016

Aim: To establish the stability and compatibility of morphine and midazolam, and morphine, midazolam and bupivacaine infusions prepared at the Royal Adelaide Hospital.Method: A validated stability indicating high performance liquid chromatography (HPLC) method was developed to measure the concentrations of each compound in the infusions over a 42‐day study period. Visual inspection and pH measurement were also carried out on each study day.Results: Midazolam concentration decreased to 86.0% of initial concentration in the morphine and midazolam infusion bags and to 86.3% of the initial concentration in the morphine, midazolam and bupivacaine infusion bags by day 42 of the study. The concentration of midazolam was reduced in both combinations to the 90% acceptable level for stability at day 28. There was no significant decrease in morphine or bupivacaine concentration in either solution during the study period.The drug combinations were compatible to visual inspection over the 42‐day study period showing no change in colour and clarity or any precipitation.Conclusion: Based on these results the infusions tested in this study are chemically stable for up to 28 days. Therefore when protected from light and stored at 22 ± 2°C the expiry date for these products can be set at 28 days.
Snapshot of Hospital Pharmacy Workforce in Australia
Authors: Leary Karen M O' , Allinson Yvonne M , Kirsa Sue W , Jackson John K , Burgess Naomi G 
Published: March 2016

To provide a snapshot of current staff utilisation, a questionnaire was sent to 248 Australian hospitals with an identified hospital pharmacy service. The data returned from 101 hospital pharmacy services provided a snapshot of where hospital pharmacists are currently working, what they spend their time doing, and the role of pre‐registration pharmacists and pharmacy support staff in providing hospital pharmacy services.Key findings of the responses from these 101 hospital pharmacy services showed that in 2000‐2001:
1. 129.16 of the 929.46 pharmacists establishment full‐time equivalent positions (14%) were vacant;
2. one in three hospital pharmacists worked part time;
3. one in three hospital pharmacists had a postgraduate qualification; and
4. on average 41 % of pharmacists' time was devoted to clinical services, 39% to distribution services and 16% to management activities.The full report is available at: http://www.shpa.org.au/documents/snapshotworkforce.pdf
A Randomised Controlled Trial of Medication Liaison Services—Patient Outcomes
Authors: Stowasser Danielle A , Collins David M , Stowasser Michael 
Published: March 2016

Objectives: To evaluate the effects of a Medication Liaison Service (MLS) on quality of medication‐related information associated with hospital admission, risk of drug misadventure and other patient outcomes, and health resource utilisation.Method: Patients were randomly selected from eight acute wards (servicing 12 medical and five surgical units) and an orthopaedic pre‐admission clinic at two major hospitals. Subjects were randomly assigned to an intervention (MLS) or control group. For each patient in the MLS group a clinical pharmacist attached to the MLS contacted the general practitioner and community pharmacist in order to prepare a comprehensive medication history. Prior to discharge, the MLS clinical pharmacist, in consultation with the hospital medical staff, prepared a discharge communication which included a list of medications on admission and discharge, corresponding therapy changes, intended duration of therapy, sources of supply, allergies and adverse drug reactions, new therapeutic devices, medication‐related problems and actions required by the general practitioner. This information was forwarded to the patient's general practitioner and community pharmacist within 24 hours of discharge. Patient outcomes were evaluated 30 days after discharge using a mailed questionnaire and review of medical files.Results: Of 240 patients recruited, 113 were randomised to the MLS group and 127 to the control group. During hospital admission a significantly greater proportion of MLS subjects experienced a clinical pharmacist intervention (MLS 68% vs control 44%) and more subjects had at least one change to their therapy (MLS 97% vs control 90%), with more interventions (mean MLS 1.43 [SD 1.5] vs control 0.77 [SD 1.1]) and more medication changes per subject (mean MLS 3.75 [SD 2.6] vs control 3.10 [SD 2.3]). There was no significant effect on length of stay or mortality. In the 30 days following discharge there were fewer réadmissions per subject in the MLS group (mean 0.12 [SD 0.4] vs 0.46 [SD 1.9]) but this difference did not quite reach statistical significance (p = 0.055). The MLS group had significantly fewer healthcare professional visits per subject (mean MLS 7.54 [SD 7.4] vs control 9.94 [SD 10]). In an assessment of functional health status, MLS subjects improved for 7 of 8 factors (significantly so for two), and tended to improve more than controls in all factors except vitality.Conclusion: MLS was associated with improved patient outcomes and a greater number of inpatient clinical pharmacy interventions and medication changes intended to optimise therapy. There was also a tendency for reduced readmissions, a significant decrease in community healthcare professional visits, and significant improvements in functional health status score.
A Randomised Controlled Trial of Medication Liaison Services—Acceptance and Use by Health Professionals
Authors: Stowasser Danielle A , Collins David M , Stowasser Michael 
Published: March 2016

Objectives: To determine the acceptance and utility of a Medication Liaison Service (MLS) by hospital and community healthcare professionals. The MLS aimed to improve the quality and transfer of medication‐related information associated with hospital admission.Method: 240 patients were randomly selected from acute wards and a pre‐admission clinic (PAC) at two major hospitals and randomly assigned to MLS (n = 113) or control (n = 127) groups. General practitioners (GPs) and community pharmacists attending each intervention patient were asked to anonymously complete a survey to assess acceptance and utility of the MLS 30 days post‐discharge. Hospital resident medical officers (RMOs, n = 12) exposed to the MLS while working in the PAC were also surveyed.Results: Surveys were returned from 76% of GPs, 84% of community pharmacists and 83% of RMOs. The comprehensiveness of medication information was rated as ‘good’ or ‘excellent’ by 100% of RMOs, 92% of GPs and 89% of community pharmacists. Timeliness was rated as at least ‘adequate’ by all but one GP and one community pharmacist. Over 70% of GPs utilised the information provided in patient care and GPs reported making 52 interventions to drug therapy as a result of MLS information. While only 11 interventions were made by community pharmacists, 70% requested routine access to the MLS information. Problems with storage and retrieval of information were factors limiting the utility of MLS information provided on discharge.Conclusion: MLS information was rated highly by RMOs, GPs and community pharmacists in terms of comprehensiveness and timeliness. The MLS facilitated medication management decisions and the majority of users requested routine access to the service in the future.