bluuebunny/crossref_metadata_2025_split huggingface dataset:
Snapshot of Barriers to and Indicators for Antimicrobial Stewardship in Australian Hospitals
Authors: Chen Alex WJ , Khumra Sharmila , Eaton Vaughn , Kong David CM 
Published: April 2015

ABSTRACTBackgroundEffective antimicrobial stewardship programs are vital in an environment of emerging resistance to existing antimicrobials and the limited availability of new antimicrobials. There are institutional barriers to successful implementation of these programs. Key performance indicators (KPI) are useful for determining the success of antimicrobial stewardship programs and for benchmarking purposes.AimTo identify barriers to implementation of antimicrobial stewardship programs, KPI used to measure program outcomes and the perceived usefulness of these KPI in Australian hospitals.MethodAustralian Directors of Pharmacy in private and public hospitals or their nominees (n = 281) were surveyed by mail to identify barriers to, and KPI used for antimicrobial stewardship programs at their hospitals. Hospital pharmacists, infectious diseases clinicians and infection control nurses were interviewed until saturation of themes was reached.ResultsResponse rate for the postal survey was 29% (n = 80). Main barriers to implementing antimicrobial stewardship programs encountered by respondents included: lack of education and training related to antimicrobial usage; prescribing culture at the hospital which was resistant to change; lack of resources to conduct stewardship activities; and lack of feedback to doctors, nurses and pharmacists on institutional antimicrobial use. Only 14 respondents used KPI to measure program outcomes. The KPI used between institutions were variable.ConclusionAustralian hospitals encounter many barriers to implementing antimicrobial stewardship programs. There were no standard national KPI to measure program outcomes. Most participants agreed that the KPI at their hospitals were useful.
Drug Interactions Between Anti‐Epileptics and Chemotherapeutic Drugs: Value of a Pre‐Treatment Pharmaceutical Review
Authors: Mellor James D , Jayasinghe Charini 
Published: April 2015

ABSTRACTBackgroundMany cancer patients take medications for preexisting comorbidities that are unrelated to their malignancy. Eliciting an accurate medication history prior to cancer chemotherapy is important to ensure that any drug‐drug interactions are detected, assessed and avoided.AimTo report a potential case of an interaction between antiepileptics and chemotherapeutic drugs.Clinical detailsA 24‐year‐old female with rapidly progressing metastatic rhabdomyosarcoma of the right maxillary sinus was treated with the Children's Oncology Group ARST0431 protocol for high‐risk rhabdomyosarcoma. This intensive regimen combines radiation therapy with 7 chemotherapeutic drugs: vincristine, irinotecan, cyclophosphamide, ifosfamide, doxorubicin, etoposide and actinomycin‐D. During routine pre‐treatment medication reconciliation, the pharmacist identified that the patient was also taking carbamazepine, a potent inducer of cytochrome P450 (CYP) enzymes, for left‐sided focal epilepsy.OutcomeThere was potential for clinically relevant drug interactions because CYP enzymes were responsible for metabolising some of the chemotherapy drugs planned for her treatment. The pharmacist's intervention resulted in carbamazepine switched to levetiracetam, a non‐enzyme inducing antiepileptic, and avoiding the potential interaction.ConclusionThis case highlights the value of clinical pharmacists undertaking medication reconciliation prior to the start of cancer chemotherapy.
Possible Metformin‐Induced Otorrhoea: A Rare Case
Authors: Maarup Norlela , Palaian Subish , Ibrahim Mohamed Izham M , Khanal Saval , Alshakka Mohammed 
Published: April 2015

ABSTRACTBackgroundEar problems attributed to metformin use are not documented in the literature.AimTo report a possible case of otorrhoea from metformin therapy.Clinical detailsA 50‐year‐old male developed an ear discharge during metformin therapy.OutcomesHis ear discharge reappeared when metformin was reintroduced and disappeared when it was discontinued, suggesting a possible association between metformin and otorrhoea. The causality assessment revealed a “probable” (Naranjo algorithm score 8) association and the severity was ‘moderate’ (Level 3).ConclusionFirst case of possible otorrhoea from metformin therapy to be reported in the literature.
Peptic Ulcer Disease in Older People
Authors: Lockrey Gregory , Lim Lucy 
Published: April 2015

ABSTRACTPeptic ulcer disease is a common disorder that affects millions of people worldwide. Peptic ulcer disease has a major impact on quality of life and on the utilisation of the health system when complications occur. Understanding the causative roles of Helicobacter pylori and non‐steroidal anti‐inflammatory drugs has led to changes in management of the disease. Comorbidities in older people add further complexity to treatment. This article summarises the clinical aspects of peptic ulcer disease and outlines principles which enable effective treatment.
Restricted Antimicrobial Use at Transitions of Care at an Australian Hospital
Authors: Lee Yi JF , Levy Russell , Bajorek Beata V 
Published: April 2015

ABSTRACTBackgroundThe emergence of antimicrobial resistance reinforces the need for antimicrobial stewardship to promote the appropriate and judicious use of antimicrobials.AimTo quantify restricted antimicrobial use among intensive care unit (ICU) discharges to general wards, and to review appropriateness of antimicrobial use.MethodA prospective clinical audit was conducted over a 2‐week period. Medical records for ICU discharges were reviewed, with relevant data extracted (patient characteristics, antimicrobial therapy prescribed, treatment instructions). Appropriateness of restricted antimicrobials used was gauged in accordance with hospital policies and the Therapeutic Guidelines: Antibiotic.Results98 patients were discharged from the ICU – 74 (76%) discharged to general wards were on antimicrobials, 15 discharged to general wards were not on antimicrobials and 9 discharged out of the hospital. Of these 74 patients, 31 (42%) were prescribed a total of 57 restricted antimicrobials; only 11 of these 31 (36%) patients had documented approval (from microbiology/infectious diseases teams) for use of restricted antimicrobials. 46 restricted antimicrobials (n = 57; 81%) were deemed clinically appropriate and the remaining 11 were prescribed outside guideline‐recommended indications.ConclusionWhile most restricted antimicrobials were prescribed according to national guidelines, in only one‐third of patients were the restricted antimicrobials ‘approved’ for use according to hospital policies. Better clinical documentation on treatment plans and review processes for restricted antimicrobial use is needed during the transition from ICU to general wards.
Prescriber Feedback to Improve Quality Use of Medicines among Older People: the Veterans' MATES Program
Authors: Bell J Simon , Kalisch Lisa M , Ramsay Emmae N , Pratt Nicole L , Barratt John D , LeBlanc Tammy , Roughead Elizabeth E , Gilbert Andrew L 
Published: April 2015

ABSTRACTSince 2004, the Department of Veterans' Affairs (DVA) has funded the Veterans' Medicines Advice and Therapeutics Education Services (MATES) program. The main intervention of the program is quarterly targeted patient‐specific prescriber feedback. The feedback comprises a list of relevant medications dispensed to each patient and notes about potential medication‐related problems specific to the intervention. Supportive educational material is provided to assist general practitioners (GPs) resolve these medication‐related problems. Veterans identified in the GP mailing are sent an educational brochure highlighting medication issues and encouraging them to speak with their doctor. To enable pharmacists to support this practice change, educational material is also provided to all pharmacies and accredited pharmacists. The most recent of the 28 interventions implemented to date have addressed osteoporosis, opioid‐induced constipation and urinary incontinence. Overall, program materials have been mailed to 249 454 veterans, 34 527 GPs and around 8000 pharmacies and accredited pharmacists. Evaluation has demonstrated a doubling of home medicines review (HMR) rates in the veteran population. Analyses of the DVA data have reported a 45% reduction in hospitalisation for heart failure following HMR among veterans with heart failure (adjusted hazard ratio [HR] 0.6; 95% confidence interval [CI] 0.4–0.8), and a 79% reduction in hospitalisation for haemorrhage (HR 0.2; 95%CI 0.05–0.9) 2 to 6 months after an HMR in veterans dispensed warfarin. Veterans' MATES has resulted in clinically significant improvements in medication and health service use.
Medication Prescribing, Surveillance and Safety in Australasian Emergency Departments
Authors: Marmor Gerrard O , Braitberg George , Nicolas Caroline M 
Published: April 2015

ABSTRACTBackgroundThe prescribing practices of the Fellows of the Australasian College of Emergency Medicine (FACEM) in Australasian emergency departments (EDs) are unknown.AimTo describe the FACEM's prescribing practices in relation to charting and monitoring medications in the ED; and to investigate the differences in the prescribing practices between the users and non‐users of the National Inpatient Medication Chart (NIMC) in EDs.MethodAnalysis of a multimodal survey sent to FACEM across Australasia.ResultsResponses were received from 122 (n = 940) FACEM (13% response rate). 91% of FACEM considered medication safety to be a quality issue. Most FACEM (56%) prescribed on 2 to 3 different documents in the ED and only 39 (32%) prescribed on 1 document. Time pressure was the main barrier to safe prescribing in the ED. Prescribing guidelines for analgesics and antibiotics were often in situ but times to administration were not monitored. 65% of FACEM who used the NIMC tended to prescribe on only 1 document and came from larger EDs that employed an ED pharmacist. Strategies cited to decrease the rate of prescribing errors included educational interventions, ED pharmacists and use of the NIMC.ConclusionThere are a wide range of prescribing and medication safety practices and a lack of conformity among Australian emergency physicians. Despite the introduction of the NIMC, most FACEM prescribed on multiple documents in the ED. The differences between users and non‐users of the NIMC identified may aid future initiatives to increase its use.
Managing Patients on Antiplatelet Drugs Requiring Emergency Non‐Cardiac Surgery
Authors: Seleem Mostafa , Ratnapala Dinesh N , Stride Peter JO , Wood Peter , Lambrianides Andreas L , Gupta Shravani 
Published: April 2015

ABSTRACTBackgroundThe antiplatelet drugs, aspirin and clopidogrel, are widely prescribed for cardiovascular and neurovascular diseases. It is recommended that these drugs should be ceased 5 days prior to elective surgery. If patients on these drugs require emergency non‐cardiac surgery, the peri‐operative risk of haemorrhage and thrombosis causes management dilemmas. Current guidelines are limited to the management of patients with coronary stents who are on antiplatelet drugs and require elective surgery. There is no universal evidence‐based consensus, for the indications, method, timing or endpoints of treatment to reverse the antiplatelet action of clopidogrel in patients requiring emergency non‐cardiac surgery.AimTo report two cases where emergency abdominal surgery was required in patients on concomitant clopidogrel and aspirin.Clinical details and outcomeTwo patients who were on concomitant aspirin and clopidogrel required urgent abdominal surgery. The two cases were managed differently. In the first case, no pre‐operative platelets or fresh frozen plasma were administered and surgery was complicated by major bleeding. The second patient received pre‐operative platelet transfusion and encountered no significant bleeding or thrombotic complications.ConclusionThere is an urgent need for the development of guidelines to manage patients receiving antiplatelet drugs requiring emergency non‐cardiac surgery.
Deprescribing in the Last Year of Life
Authors: Hardy James E , Hilmer Sarah N 
Published: April 2015

ABSTRACTPolypharmacy and adverse drug reactions are common with ageing. Deprescribing or ceasing unnecessary or harmful medications is an important component of aged care practice, especially in the final year of life. Changes in pharmacokinetics and pharmacodynamics with ageing can affect decisions about deprescribing. Similarly, the balance between risk and benefit for medications is often altered in patients in their final year of life and needs to be taken into account. There is evidence for medicines that can be safely ceased abruptly and medicines that need to be weaned. An individualised approach is required to assess prognosis, trajectory of decline and therapeutic goals for each patient. An algorithm is provided in this review to guide safe, rational deprescribing for patients who are believed to be in their last year of life.
External Surface Contamination of Cytotoxic Admixtures: Caveat Emptor
Authors: Siderov Jim , Kirsa Sue , McLauchlan Robert 
Published: April 2015

ABSTRACTBackgroundPublished studies suggest that cytotoxic contamination in the workplace may originate from the external surface of commercially available vials. No published studies were found describing the testing of surface contamination of cytotoxic products purchased from commercial compounders.AimTo determine if cytotoxic admixtures purchased from a commercial compounder would test positive for surface contamination with cyclophosphamide.MethodSurface wipe sampling was performed to detect cyclophosphamide surface contamination on products sourced from a commercial compounder. Surface wipe sampling was performed using previously published methods.ResultsSurface contamination was detected on all of the samples taken.ConclusionCytotoxic products purchased from commercial compounders may have external surface cytotoxic contamination. Safe handling procedures should be instituted for these products.
Non‐Therapeutic Medication Omissions: Incidence and Predictors at an Australian Hospital
Authors: Latimer Sharon L , Chaboyer Wendy , Hall Tony 
Published: April 2015

ABSTRACTBackgroundThe inconsistent definition of non‐therapeutic medication omissions, under‐reporting, and a poor understanding of their associated factors hamper efforts to improve medication administration practices.AimTo examine the incidence of non‐therapeutic medication omissions among acutely ill medical and surgical adult patients; and to identify the patient‐, drug‐ and system‐related predictors of these omissions.MethodA medication chart audit of 288 acutely ill adult medical and surgical patients admitted to 4 target wards (2 surgical and 2 medical) at an Australian hospital. Patients admitted to these wards from December 2008 to November 2009, with at least one regularly prescribed medication, were eligible. The sample was stratified according to gender, season and ward. A medication chart audit identified medication omissions, and data were collected on gender, age, length of stay, comorbidities, medication history and clinical pharmacy review.ResultsOf the 288 medication charts audited, 220 (75%) had one or more medication omissions. Of the 15 020 medication administration episodes, there were 1687 omissions, resulting in an omission rate per medication administration episode of 11%. Analgesics and aperients were the most frequently omitted medications, with failure to sign the medication record and patient refusal, the main reasons for omission. Female gender (p < 0.001) and the number of medication administration episodes (p < 0.001) were statistically significant predictors of non‐therapeutic medication omissions.ConclusionThe high incidence of medication omissions suggests there is need for an agreed definition of medication omission and its inclusion as a reportable incident. Increasing medication reconciliation via implementation of the Medication Management Plan may also reduce the opportunity for error.
Smart Infusion Pumps Reduce Intravenous Medication Administration Errors at an Australian Teaching Hospital
Authors: Pang Rebecca KY , Kong David CM , de Clifford Jan‐Marie , Lam Skip S , Leung Benjamin K 
Published: April 2015

ABSTRACTBackgroundSerious and life‐threatening adverse drug events are often attributed to intravenous medication administration errors. Although smart infusion pumps are increasingly being adopted by hospitals to prevent such errors, data are lacking on their effectiveness in clinical practice.AimTo measure and characterise intravenous medication administration errors and their clinical significance before and after the implementation of smart infusion pumps.MethodIn the pre‐intervention period, an independent observer over 41 working days recorded the prescribing and administration details of infusions administered via the IMED Gemini Volumetric Infusion Pumps. 20 months after the introduction of the smart pumps – Alaris GP Volumetric Pump with Guardrails software – a repeat audit was conducted over 27 working days. Only infusions containing drugs that were to be incorporated into Guardrails (the medication–error–prevention software of the Alaris GP pump) were evaluated. The clinical significance of the identified errors was evaluated by 2 independent assessors (pharmacist and doctor) and rated as ‘low’, ‘moderate’, ‘high’ or ‘extreme’.ResultsIn the pre‐intervention period, 76 infusions (n = 432, 18%) had one or more errors compared to 25 infusions (n = 266, 9.4%) following the introduction of the smart pumps. Of the 165 infusions administered using Guardrails, only 6 infusions with errors (3.6%) were identified. When drugs were infused with the Alaris GP pumps without Guardrails, the number of errors post‐intervention when compared with errors in the pre‐intervention period were not statistically significant (p = 0.8). When Alaris GP pumps with Guardrails were used there were no errors of ‘extreme’ clinical significance and only 1 error of ‘high’ clinical significance compared to the pre‐intervention period where 1 ‘extreme’ and 30 errors with ‘high’ clinical significance were identified.ConclusionAlaris GP pumps with Guardrails resulted in significant reductions in the number and clinical significance of intravenous medication administration errors.
Successful Implementation of a Pharmacist Anticoagulant Dosing Service in Ambulatory Care
Authors: Dooley Michael J , McGuiness Josephine V , Choo Shin , Ngo‐Thai Lam‐Lan , Tong Erica , Neave Katrina , Poole Susan , Street Alison 
Published: April 2015

ABSTRACTAimTo assess the effectiveness of a pharmacist anticoagulant dosing service in an ambulatory care program at an Australian hospital.MethodA pre‐ and post‐intervention study method was used. The pre‐intervention group consisted of patients admitted for anticoagulation to the Hospital‐in‐the‐Home program from September 2009 to January 2010, where warfarin was managed by doctors from the treating unit. The post‐intervention group consisted of patients enrolled in the pharmacist dosing service from February 2010 to October 2010. Eligibility criteria for enrolment in the pharmacy dosing service included: admission to the Hospital‐in‐the‐Home program for anticoagulation; warfarin dosing initiated in line with the existing hospital anticoagulation guidelines (modified to accommodate a pharmacist dosing service); medical unit consent for patient inclusion; and patients able to undergo daily INR blood tests.ResultsThe mean number of days for a patient to achieve 2 consecutive therapeutic international normalised ratios was 8.8 days for the pharmacist dosing service (n = 35) and 11.8 days for the pre‐intervention group (n = 53) (p = 0.002). There was no difference in the mean number of international normalised ratios measured between the two groups.ConclusionA pharmacist anticoagulant dosing service effectively managed warfarin dosing in patients admitted to an ambulatory care program.
Impact of a Surgical Preadmission Clinic Pharmacist on the Quality of Medication Management from Preadmission to Discharge: a Randomised Controlled Study
Authors: George Lewis JW , Senturk‐Raif Reyhan , Hodgkinson Marisa R , Emmerton Maggie , Larmour Ian 
Published: April 2015

ABSTRACTBackgroundStudies evaluating the impact of surgical preadmission clinic (PAC) pharmacists have reported significant improvements in medication management. However, despite the increased uptake of pharmacy services in this area, randomised controlled studies are limited.AimTo investigate the impact of a surgical PAC pharmacist on the quality of medication management from preadmission to discharge.MethodA prospective, randomised, controlled design was used to assign patients to either the intervention or control groups. The intervention group received standard PAC care plus assessment by a PAC pharmacist. The control group received standard PAC care only. Both groups also received standard inpatient care, and were followed from PAC to discharge, and data collected on pharmacist interventions, medication reconciliation and medication history documentation.Results171 patients were randomised to the intervention group and 184 to the control group. The intervention group had significantly more regular and as required prescription medicines, and complementary and alternative medicines documented per patient than the control group; and significantly more pharmacist interventions (31%) than the control group. The PAC pharmacist made 27% of interventions in the intervention group. Medication reconciliation at admission was 81% for the intervention group and 75% for the control group. Medication reconciliation for both groups was 90% at discharge.ConclusionA surgical PAC pharmacist had a positive impact on medication management through improved quality of medication histories and documentation, interventions and medication reconciliation.
Dexamethasone Use in Inpatient Palliative Care
Authors: Kiani Mona , Yip Anna YM , Tuffin Penelope HR , Roberts Malcolm , Clifford Rhonda M 
Published: April 2015

ABSTRACTAimTo describe the prescribing patterns of dexamethasone in a cohort of palliative care inpatients.MethodData were collected from a consecutive sample of patients admitted to 2 palliative care units over an 8 week period. Data on dexamethasone use was also collected, i.e. indication for use, dosages, concurrent medications, adverse effects, blood glucose levels and reasons for changes in dose.Results359 patients were admitted during the recruitment period and 185 (52%) were prescribed dexamethasone. 37 (20%) patients were prescribed dexamethasone for specific indications, such as cerebral disease, spinal cord compression and bowel obstruction. The majority of dexamethasone was prescribed for non‐specific indications: poor appetite, nausea, and poor wellbeing. A range of doses was prescribed for each indication and during their inpatient stay most patients (65%) had their dose reduced. Adverse effects were commonly reported; 117 (63%) patients experienced adverse effects attributable to dexamethasone.ConclusionDexamethasone use is widespread in palliative care for a myriad of indications.