bluuebunny/crossref_metadata_2025_split huggingface dataset:
Regulation of the Pharmacy Profession throughout Australia
Authors: Hattingh H Laetitia , Smith Nerida A , Searle Judith , King Michelle A , Forrester Kim 
Published: April 2015

ABSTRACTBackgroundPharmacy state and territory legislation provides for the regulation of the profession throughout Australia by the pharmacy registering authorities. The Council of Pharmacy Registering Authorities (COPRA) was formed to harmonise these regulatory requirements and facilitate communication among pharmacy registering authorities. COPRA was recently renamed the Australian Pharmacy Council. The Council of Australian Governments (COAG) has made recommendations that will impact on the regulation of all health professionals in Australia.AimTo compare the regulatory requirements and identify regulatory consistencies and differences between jurisdictions.MethodA qualitative approach encompassing a survey and interview was used. All 8 pharmacy registering authorities were approached to participate via an invitation through the Australian Pharmacy Council in September 2006.ResultsPharmacy registering authorities operate under diverse legislative frameworks and requirements. There are different definitions for disciplinary processes and the extent to which the registering authorities are able to sanction practitioners. The jurisdictions have different requirements for pharmacy premises registration, the inspection of premises and the required equipment and resources to practise. Differences in pre‐registration programs, the assessment of pre‐registration pharmacists and initial and ongoing registration specifications were also identified.ConclusionThe Australian Pharmacy Council and the pharmacy registering authorities have made significant progress towards the harmonisation of pharmacy regulation. However, the regulation of the profession throughout Australia remains varied. COAG needs to focus on early reforms such as a national pharmacy register before addressing the complex issues of consistency in disciplinary outcomes, pre‐registration programs and annual pharmacist registration requirements.
Burnout among Australian Hospital Pharmacists
Authors: Muir Paul R , Bortoletto Diana A 
Published: April 2015

ABSTRACTAimTo assess the level of burnout among Australian hospital pharmacists.MethodIn May 2005 questionnaires were mailed to a sample of 528 Australian hospital pharmacists. The questionnaire gathered demographic data, and used the validated Maslach Burnout Inventory (3 subscales: emotional exhaustion, depersonalisation, personal accomplishment) to assess burnout.Results266 hospital pharmacists responded to the survey. There were high levels of burnout based on emotional exhaustion (39%) and personal accomplishment (49%), while the majority of pharmacists felt low levels of burnout based on depersonalisation (60%). There were no significant associations between burnout and demographic data (e.g. age, sex, practice type). Recent graduates demonstrated a low level of personal accomplishment (p = 0.011), indicating greater burnout within this subscale. Pharmacists involved with the introduction of the Pharmaceutical Benefits Scheme to hospitals had a significantly high level of personal accomplishment (p = 0.011) indicating a low level of burnout within this subscale. Around 1 in 20 pharmacists displayed a high level of burnout in all 3 subscales of the Maslach Burnout Inventory.ConclusionSevere burnout in hospital pharmacists was evident in this study. Young hospital pharmacists appear to be vulnerable to burnout. Strategies that decrease burnout must be instituted and there should be specific consideration to support young pharmacists within the workforce.
Vitamin D Deficiency in Aged‐Care Facilities: Prescribing Support through Residential Medication Management Reviews
Authors: Gebauer Markus 
Published: April 2015

ABSTRACTBackgroundVitamin D deficiency is common in residents in aged‐care facilities, contributing to muscle and bone weakness, falls and fractures. Although supplementation is recommended by guidelines for the treatment and prevention of vitamin D deficiency, implementation remains a challenge.AimTo improve vitamin D supplementation in an aged‐care facility in a rural Australian town.MethodAn audit of vitamin D supplementation and serum 25‐hydroxyvitamin D (25‐OHD) levels was conducted by the pharmacist providing residential medication management review services and the results were reported to attending general practitioners (GPs).Results21% of residents were prescribed vitamin D. Serum 25‐OHD levels were available for 8 residents and indicated deficiency/insufficiency for 7. This information was reported to attending GPs with an offer to identify other residents who would benefit from vitamin D supplementation. 41 residents were identified solely on clinical criteria such as falls risk, malabsorption, malnutrition, osteoporosis and fracture risk, inadequate exposure to sunlight and medication use. These residents were referred to the GPs for assessment without an expressed recommendation to measure 25‐OHD levels. Within 40 days of the dissemination of the audit results, 33 residents were started on vitamin D supplements, increasing the level of supplementation at the facility from 21% to 65%. This level of supplementation was maintained without further pharmacist intervention for 9 months.ConclusionAn audit of vitamin D prescribing and subsequent GP‐pharmacist collaboration is an effective way of increasing vitamin D supplementation in aged‐care facilities.
Using the Medical Emergency Team to Supplement an Existing Adverse Drug Event Reporting Framework
Authors: Van De Vreede Melita , Leong Tim 
Published: April 2015

ABSTRACTBackgroundThe medical emergency team (MET) provides early intervention when a patient deteriorates. The cause of the deterioration is subsequently documented. There is no specific documentation if the cause is related to a medication error.AimTo introduce a process to ensure medication errors identified via MET calls are notified to the quality use of medicines (QUM) manager so they can be included in the continuous quality improvement program.MethodA retrospective medical record review of MET calls over one month was undertaken to detect calls related to medication errors. The MET data management process was then modified to include medication as a contributing factor for reporting such events. Reports of MET calls due to medication errors were sent monthly to the QUM manager and these patients' medical records were reviewed to confirm if a medication error occurred. If so, the details of this error and whether it has been reported on the hospital reporting system were determined.ResultsThe baseline review in July 2005 identified 108 confirmed MET calls, 4 of which were definitely and 5 possibly related to medication errors. 2 of the confirmed medication errors were precipitated by omitted doses. In March 2006, the improved system started and in the first 4 months, review of the 12 calls notified by the MET identified that 4 were due to medication errors. 2 of these had not been reported on Riskman. The medical record review also identified one adverse drug reaction which had not been reported and a near‐miss involving IV potassium chloride that would otherwise not have been detected.ConclusionThe introduced process identified MET calls due to medication errors that would otherwise have been missed.
Continuity of Medication Supply and Provision of Patient Information on Discharge: Development of a Survey Tool
Authors: Couch Gabrielle , Quah Sean Minn , Ng Yee Ching , McKellar Alice 
Published: April 2015

ABSTRACTBackgroundAs described in the national guidelines to achieve continuum of quality use of medicines between hospital and community, hospitals must ensure that continuity of care is not interrupted by the inability of patients to obtain medication on discharge.AimsTo develop a survey tool to assess continuity of medication supply and provision of medicines information on discharge. To evaluate these parameters in patients discharged with either discharge medication or prescriptions for dispensing by a community pharmacy.MethodNon‐surgical patients aged over 65 years or their carers from one metropolitan teaching hospital and 2 rural hospitals were interviewed by phone 5 to 7 days post‐discharge. 2 interview phases (n = 229) using different interviewers and the same survey tool were conducted in 2005 and 2006.Results8/227 patients (3%) ran out and missed doses of medication (7 patients 1 day, 1 patient 4 days), with no differences detected between patients receiving discharge prescriptions or discharge medication. Providing medication or prescriptions appeared to influence the timing of doctor visits (average 3 days for metropolitan, 7 to 11 days for rural). 53% of metropolitan doctor visits were for prescriptions only. 90% of rural patients obtained medication on the day of discharge or the day after. 53% of respondents recalled receiving a medication list. 4% did not know the names of their medication nor when to take them; 17% knew some details but not all.ConclusionThe survey tool appears to provide consistent data over multiple sites and multiple interviewers. The risk of running out of medication in rural areas would be higher if discharge medications replaced prescriptions due to difficulties accessing doctors. Strategies identified to improve discharge processes include clinical pharmacy checks of discharge prescriptions and more flexibility in supply quantities.
An Intervention to Reduce the Use of Error‐Prone Prescribing Abbreviations in the Emergency Department
Authors: Taylor Simone E , Chu Mimi Tak‐Yan , Haack Louise A , McGrath Anne , To The‐Phung 
Published: April 2015

ABSTRACTBackgroundNumerous national and international authorities have advised against the use of certain prescribing abbreviations due to their risk of misinterpretation.AimTo evaluate an intervention to reduce the use of error‐prone prescribing abbreviations in the emergency department (ED).MethodThe intervention consisted of education sessions as part of ED medical and nursing orientation programs, distribution of name badge sized cards summarising the information and placement of posters in the ED. All medication and fluid charts present in the ED at one randomly selected time each day were screened over consecutive days. Patients with at least one medication or fluid prescribed were included. Error‐prone abbreviations were classified as of major, moderate or minor significance. Pre‐intervention data on abbreviation usage guided the content of the intervention.Results166 patients were included pre‐intervention and a further 166 patients post‐intervention. The overall rate of error‐prone abbreviation use per 100 prescriptions declined from 31.8 pre‐intervention to 18.7 post‐intervention (difference in rates 13.1; 95%CI 8.8–17.4; p < 0.001). The rate of use of major significance error‐prone abbreviations per 100 prescriptions decreased from 5.8 pre‐intervention to 2.3 post‐intervention (difference in rates 3.5; 95%CI 1.8–5.2; p < 0.001).ConclusionThe intervention resulted in a significant reduction in the use of error‐prone abbreviations in the ED. Implementing this intervention hospital‐wide should have a further impact as ward‐based doctors also prescribe medications in the ED.
Australian Hospital Pharmacists' Attitudes, Perceptions, Knowledge and Practices of CAMs
Authors: Braun Lesley A , Cohen Marc M 
Published: April 2015

ABSTRACTBackgroundAlthough evidence suggests that some complementary and alternative medicines (CAMs) are beneficial they can also cause adverse effects. Hospital pharmacists are responsible for ensuring patient safety and wellbeing yet little is known about their perceptions, knowledge and practices of CAMs.AimTo explore hospital pharmacists' attitudes, perceptions, knowledge and practices of CAMs.MethodAn anonymous, self‐administered questionnaire was distributed to pharmacists at four hospitals in Melbourne.Results107 completed surveys were received (76% response). 87% of pharmacists thought CAMs were unsafe and required monitoring yet 45% did not routinely ask patients about CAM use. 74% thought they had insufficient knowledge to identify when CAMs could affect patient safety and 88% thought CAMs needed more hospital‐based research. Pharmacists were cautious about CAMs and concerned about safety, efficacy, cost and regulatory issues. 62% had received training about CAMs, and 83% were interested in further training. A mean score of 39.9% (SD 19.9) was obtained in the knowledge section. Several complementary therapies were considered useful, notably acupuncture.ConclusionHospital pharmacists are responsible for the safe and appropriate use of medicines however this does not routinely extend to the use of CAMs. Despite receiving some education about CAMs, a lack of confidence and knowledge was identified. Clear guidelines and education is needed to improve communication about CAMs and optimise patient care. Hospital pharmacists have concerns about CAMs and would support further hospital‐based research.
Managing Insomnia in Older People
Authors: Woodward Michael C 
Published: April 2015

ABSTRACTAlthough insomnia is a common problem in older people, there have been few therapeutic advances in the last decade. Benzodiazepines continue to be overused and the newer benzodiazepine‐like drugs (e.g. zopiclone) are proving to be no more effective and have their own risk of adverse effects. Non‐pharmacological management remains the preferred option, but is poorly taught and infrequently adhered to, especially in hospital and residential care settings. Older people themselves often request drugs. Progress towards improved management of insomnia will require a significant shift in knowledge and attitudes in both health professionals and the community.
Eutectic Mixture of Local Anaesthetics vs Nitrous Oxide for Cannulation of Children in the Emergency Department
Authors: Mann Timothy , Taylor David McD , Smit Pieter De Villiers 
Published: April 2015

ABSTRACTAimTo compare the effectiveness of eutectic mixture of local anaesthetics (EMLA) and nitrous oxide (N2O) in reducing the pain of IV cannulation/venipuncture in children in the ED.MethodA randomised, non‐blinded clinical trial undertaken in a large metropolitan ED. Eligible patients were aged 3 to 15 years and needed IV cannulation/venipuncture. The Wong‐Baker FACES pain rating scale was used to measure the child's pain. A 5‐point ordinal scale (very unsatisfied to very satisfied) was used to measure parental satisfaction with the method used.Results56 patients received N2O and 45 received EMLA. The groups had similar gender and age profiles. The median pain score was 1 (interquartile range 0–2) for the N2O group and 1 (interquartile range 1–2) for the EMLA group (p = 0.85). The median parental satisfaction scores were 5 (interquartile range 4–5) for both methods (p = 0.29). 8 (14.3%; 95% CI 6.8–26.8) patients in the N2O group experienced minor adverse events—drowsiness (3), carpopedal spasm/paraesthesia (2), agitation (1), vomiting (1), dizziness (1). One (2.2%; 95%CI 0.1–13.2) EMLA group patient experienced post‐procedure emesis.ConclusionThere is no significant difference between EMLA and N2O in reducing the pain associated with IV cannulation/venipuncture in children in the ED. Both methods are associated with high levels of parental satisfaction. Prolonged EMLA onset time and N2O adverse events may influence the choice of method.
Impact of an Emergency Department Pharmacist on Prescribing Errors in an Australian Hospital
Authors: deClifford Jan‐Marie , Caplygin Frances M , Lam Skip S , Leung Benjamin K 
Published: April 2015

ABSTRACTAimTo evaluate the impact of an emergency department (ED) pharmacist on prescribing errors 24 hours post‐admission.MethodA prospective controlled sequential study was conducted in the ED of a metropolitan teaching hospital. In the control period, ED patients admitted were followed‐up by ward pharmacists (standard practice). In the active period, they were seen first by the ED pharmacist. Targets of 50 patients were recruited into each study period. All medication charts were reviewed by a senior clinical pharmacist (reviewing pharmacist) at 24 hours post‐admission. Errors were risk‐assessed by a blinded independent physician. The number and type of errors were compared.ResultsThe profile, type and complexity of patients and number of medications ordered per patient were similar in both periods. There was a 71% relative reduction in errors per patient (p < 0.0001) and a 76% relative reduction in errors per drug order (p < 0.0001) between the control and active periods. The number of errors rated as high‐extreme, moderate or minor, decreased by 64%, 71% and 90% respectively. Overall, the most common types of error were drug omissions (63%); and the most common drugs involved were cardiovascular (31.5%), central nervous system (18%), respiratory (12.6%) and endocrine (10.8%).ConclusionAn ED pharmacist providing timely medication histories resulted in admitted patients significantly more likely to receive an accurate medication chart early in their hospital stay.
Do Pharmacists Adhere to Brand Substitution Guidelines? The Example of Simvastatin
Authors: Kalisch Lisa M , Roughead Elizabeth E , Gilbert Andrew L 
Published: April 2015

ABSTRACTBackgroundAlthough pharmacists have been criticised for not following brand substitution guidelines, evidence is lacking. Brand substitution of simvastatin has been possible since November 2004 when the first generic became available; prior to this 2 non‐substitutable products were available.AimTo identify the rate of switching between brand and generic products of simvastatin.MethodAnalyses were conducted using Repatriation Pharmaceutical Benefits Scheme prescription claims data from 1 November 2002 to 28 February 2006. Switches were identified if different brand or generic products were dispensed consecutively. The change in the rate of switching post‐generics was compared to the pre‐generics baseline.ResultsFollowing introduction of generics the switching rate increased to 78.2 switches per 1000 dispensings. Switching was 22 times more likely post‐generics compared to pre‐generics (rate ratio 21.91 (20.01, 24.00), p < 0.001). The rate of switching did not change when 10 products were available for substitution compared to when there were only 4 (RR 1.02 (0.998, 1.041); p = 0.0664). Post‐generics, 64% of switches occurred when different prescriptions were dispensed consecutively.ConclusionSwitching between simvastatin products was low prior to generic availability, even though 2 products were available. The switching rate increased when bioequivalent products were available, suggesting that pharmacists practice in accordance with brand substitution legislation. Consumers were most vulnerable to switching when different prescriptions were dispensed consecutively. Pharmacists should be aware of this and take steps to ensure that switches do not occur unnecessarily.
Improving Clinical Outcomes for Hospital Patients Initiated on Warfarin
Authors: Bereznicki Luke R , Jackson Shane L , Morgan Steven M , Boland Camille , Marsden Katherine A , Jupe David M , Vial Janet H , Peterson Gregory M 
Published: April 2015

ABSTRACTBackgroundStudies have demonstrated that the risk of warfarin‐related complications is highest in the first 90 days of treatment, while quality audits suggest that warfarin initiation protocols are not always adhered to.AimTo improve the quality of anticoagulation for hospital patients initiated on warfarin.MethodA warfarin drug chart, incorporating the hospital's warfarin initiation protocol, was implemented on four target medical and cardiothoracic wards. The chart was used to record international normalised ratios (INRs) and prescribe warfarin, and was faxed to the patient's GP on discharge. Warfarin initiations on the target wards immediately post‐introduction of the warfarin drug chart were reviewed and compared to the pre‐intervention data collected over a 17‐month period.ResultsThe pre‐intervention and post‐intervention groups included 271 and 183 patients initiated on warfarin, respectively. The intervention was associated with fewer warfarin‐related complications (thromboembolism, major bleeding) occurring within a 90‐day follow‐up period (2.1% vs 11%; adjusted OR 0.24; 95%CI 0.07–0.85; p = 0.03), largely driven by a reduction in the incidence of major bleeding (0.7% vs 7.1%; adjusted OR 0.17; 95%CI 0.02–1.45; p = 0.05). Adherence to the warfarin initiation protocol improved significantly from 36% to 71% (p < 0.01) in the pre‐ and post‐intervention data collection periods, respectively. Post‐intervention, the proportion of patients with an INR > 4 and the proportion of patients who required a warfarin dose to be withheld was reduced from 8.5% and 13%, to 3.8% (p < 0.05) and 6.6% (p = 0.02), respectively.ConclusionAdherence to an age and disease based warfarin initiation protocol, and improving the quality of discharge information for patients initiated on warfarin, significantly improved patient outcomes.
Audit of Nausea and Vomiting Management in Palliative Care Hospital Patients
Authors: Burgess Christel L , Tuffin Penelope HR , Clifford Rhonda M 
Published: April 2015

ABSTRACTAimTo investigate prescribing patterns of antiemetics for palliative care hospital patients and to compare them with best practice guidelines.MethodA retrospective audit of nausea and vomiting management was undertaken for 70 patients referred to the hospital Palliative Care Service.Results19 patients presented with uncontrolled nausea and/or vomiting. An antiemetic was prescribed for 43 (61%) patients, with dopamine antagonists the most commonly prescribed. Patients taking regular antiemetics had better symptom control compared to patients taking prn (when required) doses. The 5‐hydroxytryptamine type 3 receptor antagonists were prescribed in accordance with best practice guidelines in only one‐quarter of cases.ConclusionIn the majority of cases, antiemetics were prescribed according to best practice guidelines. Regular antiemetics (rather than prn) provide better symptom management.
Role of Adjuvant Therapy in Older People with Breast Cancer
Authors: White Shane , Stewart Josephine M 
Published: April 2015

ABSTRACTThe expanding population of older people with breast cancer is challenging for the clinician. While a wealth of data on younger women assists doctors in the discussion of adjuvant therapeutic options, these are not necessarily applicable to older women. This issue is discussed in this article in relation to the efficacy and toxicity of adjuvant chemotherapy, hormone therapy and biological therapy in the older population. The differing stage and biology of breast cancer in the elderly is also highlighted. The development of using the Comprehensive Geriatric Assessment tool in the clinical assessment of older patients is also outlined.