bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adverse Drug Reactions Associated with Home Parenteral Therapy
Authors: Cheong Elizabeth A , Katelaris Constance H , Sisson Colleen M , Anderson Elizabeth A , Byth Karen 
Published: April 2015

ABSTRACTBackgroundFew studies have investigated the incidence and management of adverse drug reactions that occur during home parenteral therapy.AimTo determine the incidence, characteristics and risk factors for adverse drug reactions associated with home parenteral therapy; to evaluate the management of these reactions; and to determine the ideal contents of an anaphylaxis kit.Method673 consecutive patients starting home parenteral therapy were recruited from the Sydney West Area Health Service (June 2002 to November 2004). Data were collected on patient characteristics; diagnosis; known drug allergies; concurrent medications; drug dose and frequency; duration of treatment; and adverse drug reactions, their management and outcomes.Results714 treatment courses were administered to 673 patients. Commonly treated conditions were cellulitis (313 courses; 44%), orthopaedic infections (73 courses; 10%) and wound infections (63 courses; 8.8%). Frequently prescribed drugs were cephazolin (376 courses; 50%), ceftriaxone (149 courses; 20%) and vancomycin (52 courses; 7.1%). Adverse drug reactions occurred in 38 (5.3%) courses, of which 5 were ranked as serious or life‐threatening. Adverse drug reactions included skin reactions in 18 (2.5%) courses, abdominal symptoms in 8 (1.1%) courses, and vascular symptoms in 5 (0.7%) courses. Risk factors included concurrent beta‐blocker use, which was associated with an adverse drug reaction in 9 out of 54 courses (OR 4.4; 95%CI 1.9–9.7; p = 0.0003).ConclusionThere was a low incidence of adverse drug reactions with home parenteral therapy, with a small risk of serious reactions. Patients taking concurrent beta‐blockers may be at greater risk of adverse drug reactions when treated with parenteral drugs. Patients need to be screened for documented allergies, regularly monitored, and an anaphylaxis kit containing adrenaline and glucagon made available.
Collaborative Prescribing: Views of SHPA Pharmacist Members
Authors: Weeks Greg R , Marriott Jennifer L 
Published: April 2015

ABSTRACTAimTo explore the views of SHPA pharmacist members on collaborative prescribing and the extent of de facto prescribing at their institutions.Method1367 SHPA pharmacist members were invited by mail to complete a 4–page questionnaire on current and future issues pertaining to collaborative prescribing.Results551 pharmacist members responded (40% response rate) to the survey. 509 (95%) respondents observed that a collaborative prescribing role could circumvent hospital delays with timely service delivery during the admission, inpatient, discharge and outpatient process. De facto prescribing was undertaken by 141 (37%) pharmacists across the range of drug schedules and practice settings. If a legal and credentialling framework existed, 406 (75%) pharmacists would consider becoming a ‘prescribing pharmacist’ in a specialised clinical area, while 81 (15%) were undecided and 57 (11%) would not consider the option.ConclusionSHPA pharmacist members strongly supported the development of collaborative prescribing as a means to improve patient outcomes, professional activities and standing, and hospital systems. Hospital pharmacists are undertaking a range of de facto prescribing activities.
Stability of Omeprazole Mixtures: Implications for Paediatric Prescribing
Authors: Graudins Linda V , Kivi Naghmeh J , Tattam Bruce N 
Published: April 2015

ABSTRACTBackgroundCommercial omeprazole paediatric mixtures are not available. The stability of omeprazole mixtures prepared from Probitor capsules or omeprazole powder has not been established.AimTo determine the physicochemical stability of two omeprazole mixtures, prepared from Probitor capsules or omeprazole powder BP, over a 45–day period under refrigeration or at room temperature, shaken or unshaken.MethodOmeprazole 2 mg/mL mixtures were prepared using standard procedures by either emptying the contents of Probitor capsules or by adding omeprazole powder to preserved sodium bicarbonate 8.4% solution. Each formulation was stored in 100 mL amber glass bottles under refrigeration (2–8°C) or at room temperature (21 ± 2°C). One bottle of each formulation was shaken and the other not shaken, pH was measured and colour change determined using a visual scale. Omeprazole concentrations were measured using liquid chromatograph tandem mass spectrometry on Days 1, 7, 14, 28 and 46.ResultsOmeprazole 2 mg/mL mixture prepared from Probitor capsules was stable over 45 days when refrigerated and regularly shaken. When unshaken, the omeprazole concentration decreased rapidly over 7 days. Mixtures prepared from omeprazole powder had lower concentrations compared to the mixtures prepared from Probitor capsules, but tended to be more stable when stored at room temperature. Observed colour changes did not correlate with measured omeprazole concentrations and pH remained constant.ConclusionOmeprazole mixture prepared from Probitor capsules was stable over 45 days, when refrigerated and regularly shaken. Omeprazole concentration markedly decreased in the mixture prepared from omeprazole powder when refrigerated.
Prescribing in Teaching Hospitals: a Qualitative Study of Social and Cultural Dynamics
Authors: Page Meredith A , Bajorek Beata V , Brien Jo‐anne E 
Published: April 2015

ABSTRACTBackgroundGeneral practitioners integrate an array of social and environmental factors into their prescribing decisions. In teaching hospitals, despite the involvement of multiple practitioners in making and acting on prescribing decisions, little is known about the influence of roles, relationships, professional subcultures and underlying beliefs, on prescribing practices.AimTo explore the social and cultural dynamics of prescribing in teaching hospitals.MethodConsultants, registrars, junior doctors, nurses and pharmacists from 2 large Sydney teaching hospitals were sampled purposively and invited to participate in a qualitative study involving semi‐structured interviews. The interview topics explored included: attitudes about prescribing, roles and responsibilities, communication of decisions, influences on prescribing and factors contributing to prescribing errors. Interviews were transcribed verbatim and the content analysed thematically.ResultsParticipants included 8 consultants, 8 registrars, 9 junior doctors, 7 nurses and 11 pharmacists. 5 distinct sets of social and cultural influences on prescribing behaviours were identified. The dominant set of influences related to the structure of how prescribing took place and chief among these were the strong intra‐professional relationships of medical teams. Other social and cultural influences related to how prescribing decisions were communicated, underlying assumptions within medical teams, knowledge acquisition and the hospital environment.ConclusionPrescribing in teaching hospitals is shaped by a complex web of social and cultural dynamics. An appreciation of these influences may be vital to the success of strategies to improve use of medicines in teaching hospitals.
Anticoagulation Control in Hospitalised Patients on Warfarin
Authors: Su Elaine Y , Naganathan Vasi , Fallah Haady , Bajorek Beata V , McLachlan Andrew J 
Published: April 2015

ABSTRACTBackgroundAnticoagulation control is a strong predictor of clinical outcomes for patients on warfarin.AimTo identify instances of excessive anticoagulation in hospitalised patients on warfarin and to determine the causes of international normalised ratios (INRs) of 5 and above and the management strategies used to correct it.MethodAn observational descriptive study undertaken at a teaching hospital over a 3–month period. Data were reviewed prospectively and retrospectively to measure the percentage of time patients were maintained within their target INR range while in hospital and to identify cases of excessive anticoagulation. Patients were divided into a control group (INR < 5) and a high INR group (INR = 5). Possible causes of INRs of 5 and above and its management strategies were recorded.ResultsOut of a total of 208 patients on warfarin identified in the geriatric, orthopaedic and cardiology wards, 144 patients met the study criteria. The mean percentage of time spent within, above and below the target INR range by the control group was 60%, 0% and 15%, and by the high INR group was 41%, 33% and 16%, respectively. In the high INR group, 26 possible causes of INRs of 5 and above were identified and the co‐administration of roxithromycin and warfarin were implicated in 7 cases. Management strategies for INRs of 5 and above were compared between two stratified groups (INR 5–9 and INR = 9). The management strategies adopted included warfarin dose reduction (83%; 86%), temporary withholding of warfarin (100%; 100%), administration of vitamin K (58%; 100%), fresh frozen plasma (13%; 43%) and prothrombin complex concentrate (8%; 29%). The time to return to the upper limit of the target INR range was INR 5–9 (1.6 SD 1.5 days) and INR = 9 (0.5 SD 0.4 days).ConclusionAnticoagulation control is difficult for hospital patients and drug interactions are an important contributing factor. The management strategies adopted to correct excessive anticoagulation followed the relevant guidelines.
Exploring Point‐of‐Care Testing of Capillary Blood in Warfarin Management
Authors: Glover Sharna , Bajorek Beata V 
Published: April 2015

ABSTRACTBackgroundLong‐term warfarin therapy requires intensive laboratory monitoring of venous blood. Reliable and efficient point‐of‐care testing (POCT) of capillary blood offers an alternative to laboratory monitoring.AimTo explore the perceptions of health professionals to POCT in warfarin management and to identify the models of monitoring warfarinised patients preferred by health professionals.MethodAn exploratory descriptive study that purposively sampled health professionals (hospital pharmacists, specialists, nurses, general practitioners) involved in the management of anticoagulated patients and practising within an area health service. Health professionals were invited to participate in a group discussion on POCT and to then complete a brief survey ranking proposed monitoring models incorporating POCT.Results4 group discussions and/or individual interviews with 33 health professionals elucidated several themes, such as lack of knowledge or confidence in POCT, operator accreditation and careful patient selection. An acute post‐acute care model and general practice surgery model incorporating POCT was preferred by health professionals in terms of perceived benefits to patients, cost‐effectiveness and time efficiency.ConclusionPOCT will be a component in the monitoring and management of warfarinised patients in the future. A drawback to POCT is the perceived inaccuracy of the devices used. Operator training and maintenance of a controlled practice environment were suggested strategies to overcome variability.
Management of Cardiac Rhythm Disturbances in the Ageing Heart
Authors: Chase David , O'Donnell David , Farouque Omar 
Published: April 2015

ABSTRACTThe elderly experience a high proportion of chronic diseases, of which cardiac rhythm disturbances comprise a significant portion. Due to ageing‐related metabolic and physiological changes, the management of cardiac rhythm disturbances will need to be modified and it is essential to be aware of the pharmacodynamics and pharmacokinetics of the drugs used. Non‐drug treatment modalities, such as implantable cardioverter‐defibrillators or radiofrequency ablation, which are increasingly available for use in the elderly, need to be considered periodically. The critical applications of drug and non‐drug therapy of cardiac arrhythmias in the elderly are discussed in this article.
Properties of a Formulated Paediatric Phenobarbitone Oral Liquid
Authors: Garg Sanjay , Svirskis Darren , Myftiu Joana , Behayaa Maryam , Shahin Dina , Thrimawithana Thilini , Vidicki Adela , Kairuz Therese 
Published: April 2015

ABSTRACTAimTo formulate a stable and palatable paediatric phenobarbitone 10 mg/mL oral liquid and compare its physicochemical stability to the existing formulation compounded in some New Zealand hospitals.MethodFormulations were compounded from pharmaceutical standard ingredients according to good manufacturing practices and stored in glass bottles at different storage conditions. The physical stability of the formulations was determined by pH, appearance, viscosity and microbial studies; chemical stability was assessed using high performance liquid chromatography.ResultsThe new formulation and the existing hospital formulation remained physically stable for 28 days in terms of pH, appearance, viscosity and microbial stability. The phenobarbitone sodium concentration remained within an acceptable range (above 95% of the original concentration) after 28 days of storage at different conditions. The viscosity of the new formulation facilitated in masking phenobarbitone sodium's bitter taste, thus improving palatability. The palatability of the new formulation was superior to the hospital formulation.ConclusionA palatable paediatric phenobarbitone oral liquid formulation with improved rheological properties was developed.
Pharmacist Prescribing in Warfarin Therapy: Exploring Clinical Utility in the Hospital Setting
Authors: Nguyen Nam‐Anh , Bajorek Beata V 
Published: April 2015

ABSTRACTBackgroundManaging warfarin therapy can be challenging and a multidisciplinary approach to achieve optimal outcomes can be beneficial. Internationally, extended roles for pharmacists have involved collaborative prescribing privileges.AimTo explore the clinical utility and capacity of pharmacists to undertake prescribing functions in anticoagulation management in the hospital setting.MethodsPharmacists were recruited from a large Sydney teaching hospital. A questionnaire was used to simulate a pharmacist prescribing function and to explore their opinion of the usefulness of prescribing and their confidence to undertake such roles. The appropriateness of pharmacists' prescribing decisions was evaluated.ResultsPrescribing authority was generally considered useful for pharmacists in the management of warfarin therapy. Pharmacist prescribing in the inpatient setting was thought to enable enhanced pharmacovigilance and be useful when medical staff are unavailable. However, outpatient settings were considered more appropriate. Dependent or collaborative models of prescribing were considered more appropriate than independent models. Despite expressing confidence in their ability to prescribe, the majority of participants' responses (58%) were deemed clinically inappropriate. Lack of training and experience and opposition from the medical team were identified as potential barriers toward pharmacist prescribing.ConclusionExtended prescribing roles for pharmacists in anticoagulation management may be useful, particularly in the outpatient setting. Training and experience is needed to ensure safe prescribing practices are maintained.
Implementing a Hospital Vendor‐Managed Inventory System
Authors: Tsui Michael , Wilson David I , Merry Helen , Phulwani Kam , Dooley Michael J 
Published: April 2015

ABSTRACTBackgroundTraditional pharmacy imprest services require deployment of pharmacy technicians and substantial stock holding. These costly requirements could be reduced by a vendor‐managed inventory system.AimTo reduce the number of staff required to provide imprest services, reduce stock holding, improve customer service and maintain fill rates.MethodVendor‐managed inventory was implemented at a major teaching hospital in December 2005 with all imprest sites checked and restocked by vendor staff. An analysis of pharmacy stock holding was conducted over a 15 month period (9 months pre‐implementation and 5 months post‐implementation). Customer satisfaction surveys were performed in July 2006 and January 2007. Random audits were conducted from January to August 2006 to measure fill rates.Results3.5 full‐time equivalent imprest staff were redeployed to clinical pharmacy support duties and stock holding decreased by $352 000. The initial customer satisfaction survey in July 2006 demonstrated an average score of 5 (0 = very poor, 10 = excellent) and subsequently a number of improvements were implemented. A second customer satisfaction survey in January 2007, showed a significant increase in customer satisfaction. Initial fill rates were lower than the target of 97%, but increased to above 98% after 4 months.ConclusionA hospital vendor‐managed inventory system was successfully implemented and subsequently rolled out to two other hospitals in the network. All key objectives were met and an ongoing quality audit program is in place.
Grow Clinical Pharmacists on Supervised Pre‐Registrant Wards
Authors: McLachlan Gina B , Tanner Francine E , Carroll Margaret E 
Published: April 2015

ABSTRACTPre‐registrant pharmacists at Austin Health have traditionally learned clinical pharmacy skills, through rotations under the supervision of clinical pharmacists. Although this process resulted in conscientious clinical pharmacists, they were accustomed to looking after only 6 patients at a time. In 2006, a new rotation was introduced that involved supervised, semi‐independent work on a dedicated pre‐registrant ward. The semi‐independent experience relied on a clinical training and competency assessment prior to rotation on the pre‐registrant ward. The pre‐registrant ward experience was well received by all involved (pre‐registrant pharmacists, supervising pharmacists, nurses, doctors) and will be repeated in future years. The experience allowed the pre‐registrant pharmacists to learn skills, such as time management, organisation, customer service and communication. They also required less time post‐registration to adjust to a full clinical workload.
Ethical and Practical Dimensions of Prescribing for Older People as Quality of Life Decreases
Authors: Darzins Peteris , Marriott Jennifer 
Published: April 2015

ABSTRACTPrescribing medicines for older people always presents difficulties, never more so than when quality of life decreases or the process of dying begins. The problem confronting doctors, and others caring for older patients, is the option of intervening or not intervening. The principles of bioethics can be used to assist those making decisions regarding the medical management of older people. Decisions that are made must consider the likely benefit and associated harms that may accrue from continuing or commencing treatment. Respect for individuals and their wishes must be maintained even when the patient's decision‐making capacity is impaired and others need to make decisions for them. Management dilemmas include when to stop or reduce prescribing as the end‐of‐life approaches, the use of medication to manage behavioural disturbance, multiple medication use increasing the risk for harm and the use of drugs for which the evidence of benefit is not available for older patients or for which there is evidence of increased adverse effects that may impair quality of life. Those caring for older people must consider a wide range of options and can be assisted by asking key questions to help guide appropriate decision making.
Investigating the Hospital Discharge Medication Process
Authors: Marriott Jennifer L , Bessell Tracey L 
Published: April 2015

ABSTRACTAimTo investigate the hospital discharge medication process from the perspective of the staff involved in the process.MethodQuestionnaires were sent to participating hospitals with pharmacy departments for completion by doctors, pharmacists, nurses and administrative personnel involved in the discharge process. A subset of participants was followed up with focus groups to further explore issues raised in the questionnaire.ResultsThe questionnaire and the focus groups confirmed that the main problem in the discharge medication process, is the time lag between making the decision to discharge patients and junior doctors writing the discharge prescription. Emerging medication management system reforms were perceived to improve patient safety, but unlikely to overcome delays in the discharge medication process.ConclusionThe problems with the discharge process were mainly due to delays in writing accurate discharge prescriptions.
Chemical Stability of Voriconazole 1% Eye Drops
Authors: Lau David , Leung Lok , Fullinfaw Robert , Davies Geoffrey E 
Published: April 2015

ABSTRACTBackgroundCase reports suggest that voriconazole 1% eye drops are effective in treating refractory fungal keratitis. There are no data available on the stability and shelf‐life of extemporaneously prepared voriconazole 1% eye drops.AimTo determine the stability and shelf‐life of extemporaneous voriconazole 1% eye drops when stored at 2 to 8 °C.MethodVoriconazole 1% solution was manufactured using voriconazole injection and preserved with 0.01% benzalkonium chloride. Aliquots (2.5 mL) were dispensed into pre‐sterilised plastic eye dropper bottles. Samples from 3 different batches were stored at 2 to 8 °C and analysed using high performance liquid chromatography to measure voriconazole concentrations on Days 0, 15, 30, 45, 60 and 75 after manufacture.ResultsAfter 75 days at 2 to 8 °C there was minimal reduction in the potency of the voriconazole 1% solution. Extrapolating the stability data beyond 75 days using linear regression suggest that it may take up to 4 months for voriconazole concentrations to drop below 90% of the nominal content.ConclusionVoriconazole 1% eye drops stored at 2 to 8 °C display negligible chemical degradation after 75 days.
Pharmacy Workforce Recruitment and Retention: an Australian Area Health Service Perspective
Authors: Garrett Tim 
Published: April 2015

ABSTRACTAimTo investigate factors influencing recruitment and retention of the pharmacy workforce within an Area Health Service.MethodAn online survey was used to collect data from pharmacy staff and responses were analysed with a focus on recruitment, retention and factors influencing job satisfaction.ResultsThe response rate was 50%. The Area Health Service pharmacy service is comprised of full‐time (70%), permanent (93%) employees aged 25 to 34 years (38%) or over 45 years (39%). Location was found to be the primary motivator when applying for positions, followed by work hours, type of position and professional development opportunities. Most staff achieved their employment expectations (67%) and received regular supervision/support (72%). However, 31% indicated an intention to leave within 2 years. The main drivers of job satisfaction were relationship with peers, job security and staff support. In those intending to leave, there were significant differences for flexibility of work hours, support, communication, access to professional development and ability to influence decisions/success (p < 0.05).ConclusionAn insight was gained into motivators for employment and influencers of work place satisfaction. Further research is needed to explore how these variables are influenced by recruitment and retention strategies and how they compare with other public sector settings.