bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unplanned Medication‐Related Hospital Readmission following Transfer to a Residential Care Facility
Authors: Elliott Rohan A , Taylor Simone , Harvey Penelope A , Tran Tim , Belfrage Mary K 
Published: April 2015

ABSTRACTBackgroundAnecdotal evidence suggests that current medication arrangements following discharge from hospital to residential care facilities sometimes lead to medication delays and errors, which may result in adverse outcomes.AimTo describe a case where delays in initiating a revised antiepileptic medication regimen may have contributed to adverse clinical outcomes for a patient requiring unplanned hospital readmission.Clinical detailsA 41‐year‐old man was admitted to hospital from a residential care facility with seizures and hyponatraemia. Multiple changes were made to the patient's antiepileptic medication regimen and he was discharged on Day 11 (a Sunday). Following discussion with the residential care facility and their designated community pharmacy, it was agreed that the community pharmacy would dispense his medications and pack them into a dose administration aid, and the residential care facility would organise for a new medication chart to be written by a general practitioner. The hospital doctor prepared a discharge summary and a copy of the discharge prescription was faxed to the community pharmacy. The patient was discharged from hospital with no medications. 3 days later he was readmitted to hospital with seizures, falls and a subdural haemorrhage. On review, the revised antiepileptic regimen had not been implemented at the residential care facility. The patient spent a further 11 days in hospital before returning to the residential care facility.ConclusionTransferring patients from hospital to residential care poses challenges to continuity of care. Improved discharge planning processes to ensure continuity of medication administration on discharge to a residential care facility are urgently needed.
Tissue Distribution of Beta‐Lactam Antibiotics: Continuous versus Bolus Dosing
Authors: Roberts Jason A , Lipman Jeffrey 
Published: April 2015

ABSTRACTBackgroundIn vitro studies suggest that administering beta‐lactam antibiotics by continuous infusion may maximise efficacy. Several pharmacokinetic studies have compared the distribution of beta‐lactam antibiotics administered by continuous and bolus dosing in plasma and tissues. Knowledge of pharmacokinetic exposure to tissues is essential, as tissue sites are most commonly the ‘target site’ for antibiotic therapy.AimTo identify published studies that measure the serum and tissue concentrations of beta‐lactam antibiotics administered by continuous and bolus dosing. Data sources: A number of studies in animals, healthy volunteers and hospitalised patients were identified.ResultsMore prospective clinical trials are required to validate that the continuous infusion of beta‐lactam antibiotics attain better tissue distribution at the target site.ConclusionBeta‐lactam antibiotics administered by continuous infusion maintain higher concentrations in serum and tissue. There is also compelling evidence that tissue distribution of antibiotics is impaired with increased sickness severity, therefore, larger doses of beta‐lactam antibiotics may be required in severely sick patients to optimise antibiotic exposure at the target site.
Clopidogrel Prescribing and Concordance with the Pharmaceutical Benefits Scheme in Hospital Patients
Authors: Luinstra Marianne , Naunton Mark , Peterson Gregory M , Bereznicki Luke R 
Published: April 2015

ABSTRACTBackgroundClopidogrel is used for the secondary prevention of cerebrovascular and cardiovascular events. Clopidogrel has a similar safety profile to low‐dose aspirin but is considerably more expensive. Clopidogrel is subsidised for restricted indications via the Pharmaceutical Benefits Scheme (PBS).AimTo examine clopidogrel prescribing in hospital; and to identify patients discharged on clopidogrel according to PBS criteria.MethodCross‐sectional evaluation of patients started on clopidogrel (July 2006 to June 2007) at the Royal Darwin and Royal Hobart Hospitals. Clopidogrel prescribing was examined and the indication for discharge on clopidogrel was documented. The primary outcome was concordance between clopidogrel use and PBS criteria.ResultsData were collected for 385 patients. 54% of patients from the Royal Darwin Hospital and 39% of patients from the Royal Hobart Hospital discharged on clopidogrel met PBS criteria. The main reason for noncompliance with the PBS was absence of a history of cardiovascular or cerebrovascular events while on low‐dose aspirin and an absence of contraindications to aspirin at the time of clopidogrel prescribing.ConclusionAlthough clopidogrel prescribing at the hospitals was often not in accordance with PBS criteria, in most cases prescribing was based on the available evidence.
Individualised Foreign Language Medication Lists for Non‐English Speaking Hospital Patients
Authors: Larizza Maria A , Wilson Rita , Dooley Michael J 
Published: April 2015

ABSTRACTBackgroundLanguage barriers can significantly impact on medication adherence and health outcomes.AimTo assess the impact on medication adherence of individualised foreign language medication lists for non‐English speaking hospital patients.MethodPatients using foreign language medication lists at The Alfred hospital were invited to participate in the study (June to September 2007). A quantitative questionnaire incorporating modified validated assessment tools was used to collect data on patient demographics, motivations and perceptions. Data were also collected on the impact of the foreign language medication list and the patient's cultural environment on medication adherence. These factors were assessed for association with self‐reported medication adherence and estimated using the Morisky score.ResultsTwo‐thirds (n = 43) of respondents reported moderate to high medication adherent behaviour. Factors with a positive influence on medication adherence were female gender (Wilcoxon rank sum test = 2.7; p = 0.007), patients' understanding of their medications (Spearman's rho = +0.36; p = 0.02) and services provided by the hospital (p = 0.04). Factors with a negative influence on medication adherence were patients' dissatisfaction with medication counselling undertaken by pharmacists using a foreign language medication list without a translator (Spearman's rho = −0.35; p = 0.02).ConclusionThe availability of translators working alongside pharmacists using foreign language medication lists could improve medication adherence.
Implementation and Acceptance of a Pharmacist‐Initiated E‐Script Transcription Service for Discharge Prescriptions
Authors: deClifford Jan‐Marie , Lam Skip S , Leung Benjamin K 
Published: April 2015

ABSTRACTAimTo describe the implementation of pharmacist‐initiated e‐script transcription service (PETS) in a teaching hospital; to validate the service through process indicators; and to explore the views of stakeholders.MethodFollowing an initial trial, PETS was implemented in 7 medical and surgical units at Frankston Hospital. Data were collected on activities and discharge prescription errors. Stakeholders' satisfaction was measured using a Likert scale based survey and group interviews. Transcripts of group interviews were analysed by informal word‐based techniques, noting words or synonyms used repeatedly to discover themes.ResultsDuring the implementation phase (8 to 29 February 2008), a daily average of 15 prescriptions (112 items) were prepared by the PETS pharmacist, i.e 30 to 60% of weekday discharge prescriptions. The discharge prescription error/amendment rate was 0.06 per patient. 163 respondents (92%) were satisfied or very satisfied with PETS. As a result of 3 group interviews of 10 doctors, 10 nurses and 10 pharmacists, several areas for enhancement were identified and implemented.ConclusionPETS has transitioned from trial to mainstream service, facilitating the discharge process and improving continuity of care.
Effect of Nebulised Acetylcysteine on Sputum Quality and Diagnostic Yield
Authors: Taylor David McD , Taylor Simone , Ho Jiong , Cabalag Miguel , Hijazi Ramzi , Howden Benjamin P , Charles Patrick GP 
Published: April 2015

ABSTRACTBackgroundAcetylcysteine acts as a mucolytic by cleaving disulfide bonds in mucoprotein and decreasing sputum viscosity. Mucolysis should lead to easier expectoration and improved sputum sample quality for microbiological analysis.AimTo compare an effect size for the efficacy of nebulised acetylcysteine and sodium chloride 0.9% in the procurement of good quality sputum samples.MethodA double‐blind, randomised, placebo‐controlled pilot study in the emergency department. Adults with probable lower respiratory tract infection requiring sputum sampling were enrolled. Patients were randomised to receive acetylcysteine 1 g or sodium chloride 0.9% (placebo) via nebuliser. Patients, emergency department and microbiology staff were blinded to the treatment allocation. The study endpoints were good quality sputum samples (< 10 squamous cells per high‐powered field and < 10 squamous cells plus > 25 polymorphs per high‐powered field), sputum samples where a predominant pathogen was isolated and adverse effects of acetylcysteine and sodium chloride 0.9%.Results28 patients were randomised to the acetylcysteine (n = 14) and sodium chloride 0.9% (n = 14) groups. Four (29%) patients in each group produced good quality sputum samples based on squamous cells alone. 2 (14%) and 3 (21%) patients in the acetylcysteine and sodium chloride 0.9% groups, respectively, produced good quality samples based on squamous cells and polymorph counts. Predominant pathogens were isolated in 2 (14%) patients in each group. 2 (14%) and 5 (36%) patients in the acetylcysteine and sodium chloride 0.9% groups, respectively, reported bronchospasm and/or coughing.ConclusionThere was no detectable trend towards acetylcysteine improving sputum sample quality. A large scale trial is not warranted.
Insulin e‐Learning Module an Effective Means of Education Delivery to Hospital Health Professionals?
Authors: Ho Lisa , To The‐Phung , MacIsaac Richard 
Published: April 2015

ABSTRACTBackgroundInsulin is a high‐risk medication that is available in a range of products with potential for harm if administration errors occur. Anecdotally, insulin product knowledge among hospital health professionals is poor.AimTo develop and evaluate an insulin e‐learning module to improve the knowledge of hospital health professionals of insulin products and their appropriate use.MethodAn Internet‐based module was developed using Microsoft ASP.NET. Participants (doctors, nurses, pharmacists) undertook an initial knowledge test (pre‐test) on insulin products. After viewing an educational slide show, participants then undertook another evaluation (post‐test). Both tests contained 12 identical multiple choice questions. To pass the module successfully participants were required to score full marks on the post‐test. On completion, participants were asked to complete a brief survey on the usefulness of the module. The module was evaluated by comparing test scores and reviewing the responses to the survey. Knowledge retention was assessed by inviting participants who had passed to repeat the test after 3 months.Results324 participants undertook the pre‐test (7.4% doctors, 79% nurses, 7.1% pharmacists). 13 (4%) participants scored full marks on the pre‐test and did not proceed to the slide show. 200 (85%) of the 235 participants who viewed the slide show and undertook the post‐test, scored full marks. At 3 months, only 44 of the 213 participants who scored full marks in the pre‐test and post‐test agreed to the re‐test with 10 (23%) participants achieving full marks.ConclusionThe e‐learning module was effective in delivering information on insulin products to hospital health professionals. Incorporating this e‐learning module into a mandatory formal education session with a revision strategy might improve participation and knowledge retention rates.
Cytochrome P450 Part 3: Impact of Drug‐Drug Interactions
Authors: Ward Michael B , Sorich Michael J , Evans Allan M , McKinnon Ross A 
Published: April 2015

ABSTRACTThe role of individual hepatic cytochrome P450 (CYP) enzymes in drug metabolism and the factors that modulate CYP activity are becoming increasingly well understood. These advances have resulted in a better understanding of drug‐drug and drug‐ food interactions and an enhanced capacity to predict drug interactions that may occur with new drugs. This final article in the series describes the issues and principles that are important in identifying and assessing drug interactions that involve CYP enzymes.
Stability of Intravenous Flucloxacillin Solutions used for Hospital‐in‐the‐Home
Authors: To The‐Phung , Ching Michael S , Ellis Andrew G , Williams Louise , Garrett M Kent 
Published: April 2015

ABSTRACTBackgroundDespite the uncertainty regarding flucloxacillin's stability, flucloxacillin solutions are routinely used as 24‐hour ambulatory infusions for hospital‐in‐the‐home patients.AimTo determine the stability of flucloxacillin solutions in a simulated hospital‐in‐the‐home environment and to assess whether flucloxacillin loss can be minimised via pH control.MethodSamples of flucloxacillin 5% and 12% solutions were prepared with either sodium chloride 0.9% or water for injection and with or without 5 mL phosphate buffer (0.384 M; pH 7). Flucloxacillin 5% solutions were tested in elastomeric infusion devices and the 12% solutions in polyvinyl chloride bags. All of the solutions were refrigerated for 6 days and then half of them were incubated at 37 °C for 24 hours. The remainder of the refrigerated solutions acted as controls. Incubated solutions were sampled for pH and high performance liquid chromatography analysis on Day 0, and Day 6 at 0, 12, 18 and 24 hours. Controls were sampled on Days 0, 6 and 14. Acceptable shelf life was ± 7.5% of initial flucloxacillin content.ResultsRefrigerated buffered controls remained stable for 14 days while the unbuffered controls were stable for 6 days. All of the buffered solutions were stable at 37 °C after 24 hours, except for flucloxacillin 12% in water for injection. Incubated unbuffered flucloxacillin 5% in water for injection lost approximately 27% flucloxacillin and all of the other incubated unbuffered solutions lost up to 60%. Incubated unbuffered solutions displayed significant yellowing and cloudiness. The pH of all solutions fell by approximately 1 unit, except for refrigerated buffered controls (fell by 0.5 units).ConclusionUnbuffered flucloxacillin 5% and 12% solutions lost up to 60% of flucloxacillin content when stored at 37 °C for 24 hours. Adjusting pH with phosphate buffer kept the incubated solutions stable for at least 24 hours (except flucloxacillin 12% in water for injection).
Electronic Medication Management Systems' Influence on Hospital Pharmacists' Work Patterns
Authors: Lo Connie , Burke Rosemary , Westbrook Johanna I 
Published: April 2015

ABSTRACTBackgroundImplementation of electronic medication management systems (eMMS) are advocated to reduce medication errors, improve patient safety and impact on hospital pharmacists' work patterns.AimsTo quantify hospital pharmacists' distribution of their time and to identify differences in work patterns on wards with and without eMMS.MethodAn observational time and motion study was conducted at a major Sydney teaching hospital. 8 pharmacists (3 on wards with eMMS, 5 on wards without eMMS) were observed on their wards for 37 hours. Distribution of tasks across work categories, mean task times, tasks performed with others and tasks using information tools, were calculated and compared between wards with and without eMMS.ResultsMedication chart review was the most frequently performed task on both ward types. Pharmacists on eMMS wards had lower rates of interruptions (1/19.2 min vs 1/13.7 min) and multi‐tasking (2.4% vs 8.7%) than non‐eMMS wards. On eMMS wards, review activities were more frequent and faster, fewer ‘in‐transit’ tasks occurred and more work was completed alone compared to non‐eMMS wards. Patient care tasks took longer but occurred less often on eMMS wards. Pharmacists on eMMS wards spent more time clarifying medication orders but did it less often than pharmacists on non‐eMMS wards.ConclusionPharmacists' work patterns in terms of task frequency, duration and location was different on the two ward types. Differences may be attributable to eMMS allowing easy and speedy access to information for reviews; shift away from the bedside to a computer terminal reducing tasks in‐transit, interruptions and contact with patients and others; and improved clarity of medication orders reducing queries.
Improvement in Pharmacist's Performance Facilitated by an Adapted Competency‐Based General Level Framework
Authors: Coombes Ian , Avent Minyon , Cardiff Lynda , Bettenay Karen , Coombes Judith , Whitfield Karen , Stokes Julie , Davies Graham , Bates Ian 
Published: April 2015

ABSTRACTBackgroundThe General Level Framework (GLF) is a tool for evaluating pharmacists' performance, providing tailored feedback and training, and guiding professional development.AimTo ascertain the changes in pharmacists' workplace performance over time using the GLF and to describe pharmacists' views on the baseline evaluation process.MethodThe UK GLF was mapped against Australian pharmacy competency standards and practice guidelines. 61 of the 92 competencies from the Queensland Health version of the GLF representing core professional activities of Australian pharmacists were analysed. Trained evaluators used the adapted GLF to observe pharmacists from 18 Queensland public hospitals in their workplace (baseline and repeat) and rate the frequency with which competencies were completed to a defined standard. The evaluators then provided pharmacists with tailored feedback, encouraged self‐problem solving, and identified and addressed their training needs. Pharmacists' views of the baseline evaluation process was assessed using a 7‐point rating scale.Results66 pharmacists from 18 Queensland hospitals underwent the evaluation. At baseline, pharmacists had a median of 3 (1 to 10) years hospital experience. A median of 14 (5 to 22) months lapsed between baseline and repeat observations. Of the 61 competencies analysed, 35 (57%) competencies showed a significant improvement from baseline to repeat observations (p = 0.05). Competencies that improved significantly from baseline included: aspects of medication history taking; medication management; identification, documentation and resolution of drug‐related problems; appraisal of therapeutic options; and communication with doctors and nurses. For 9 (15%) competencies, pharmacists were already performing at the maximum level (median score 4) at baseline and no change was recorded between observations. No competency demonstrated a decrease in performance between observations. When the mean scores with 95% confidence intervals for the clusters of competencies were compared over time all the mean scores except for discharge facilitation and medicines information/patient education/liaison showed a significant improvement. 52 pharmacists provided feedback on the baseline evaluation process and the majority found it a useful professional development tool. They considered the evaluation process fair and constructive but taxing.ConclusionThe GLF tool assisted with the identification of pharmacists' training needs, which are integral to their professional development.
Evaluation of Antifungal Treatment Guidelines for Immunosuppressed Patients
Authors: Chu Kwok‐Pui Jody , Avent Minyon , Shaw David R 
Published: April 2015

ABSTRACTBackgroundThe antifungal treatment guidelines for immunosuppressed patients at the Royal Adelaide Hospital were revised (based on a 2004 retrospective drug use evaluation) and implemented in June 2006.AimTo evaluate clinical practicality and compliance associated with the revised antifungal treatment guidelines for immunosuppressed patients.MethodA prospective drug use evaluation was conducted at the hospital from January to December 2007. Patients admitted to the cancer service who received any of the following antifungals: conventional amphotericin, liposomal amphotericin, voriconazole, caspofungin and posaconazole, were reviewed prospectively according to established criteria.Results53 patients who received 112 antifungal courses were evaluated. The majority of antifungals were used for empirical or possible fungal infections. The most common reason for changing antifungals during a treatment course was occurrence of toxicity or adverse effects. Compliance with the guidelines was approximately 70%; the majority of cases of non‐compliance were associated with liposomal amphotericin use.ConclusionThe revised guidelines were well accepted and enabled early exclusion of patients who were at high risk of developing nephrotoxicity with conventional amphotericin.
Evidence, Ethics and Medication Management in Older People
Authors: Couteur David G Le , Ford Gary A , McLachlan Andrew J 
Published: April 2015

ABSTRACTPrescribing in frail older people may be improved by application of the four tenets of medical ethics – beneficence, non‐maleficence, autonomy, justice – rather than solely those of evidence‐based medicine. Evidence‐based medicine provides data primarily on the efficacy of interventions. In younger adults, this is often sufficient to make a decision to prescribe medications. In frail older people, there are additional issues that need to be considered, such as individualisation of efficacy data, increased risk of adverse drug reactions, patients' views on risk and benefit, difficulties in assessing capacity to understand risk and benefit, consent to treatment, and concerns about the cost‐effectiveness of interventions in the very old. In such situations, evidence‐based medicine can be useful in informing the prescriber about the ethical principle of beneficence. However, the decision to prescribe or withdraw medications is also influenced by the other three tenets of medical ethics: non‐maleficence (adverse drug reactions, polypharmacy), autonomy (consent, competency) and justice (appropriate allocation of healthcare resources).
Plasma Potassium Concentration Changes Associated with Trimethoprim used for Urinary Tract Infections
Authors: Kowalski Stefan R , Tan Mei Fong 
Published: April 2015

ABSTRACTBackgroundHyperkalaemia has been reported with high‐dose trimethoprim (20 mg/kg/day) and standard‐dose trimethoprim (6 mg/kg/day) plus sulfamethoxazole use.AimTo investigate changes in plasma potassium concentrations in patients prescribed standard‐dose trimethoprim 300 mg daily for urinary tract infections.MethodA retrospective cohort study of hospital patients with urinary tract infections treated with trimethoprim or other antibacterials (control group) for more than 5 days. Plasma potassium concentration, creatinine and urea were compared at baseline and at the completion of treatment.ResultsThere were 31 patients in the trimethoprim group and 65 patients in the control group. End–of–therapy mean plasma potassium concentrations increased significantly from baseline in the trimethoprim group (4.2 ± 0.4 mmol/L to 4.5 ± 0.5 mmol/L; p = 0.002) but not in the control group. End–of–therapy mean plasma potassium concentrations were also higher in the trimethoprim group (4.5 ± 0.5 mmol/L vs 4.2 ± 0.5 mmol/L; p = 0.007). 65% of the trimethoprim group developed end–of–therapy hyperkalaemia versus 39% of the control group. Mean creatinine concentration in the trimethoprim group increased by an average of 21% from baseline but did not change in the control group. The trimethoprim group showed no change in mean urea concentration but a decrease was noted in the control group.ConclusionTreating urinary tract infections with trimethoprim 300 mg daily for more than 5 days was associated with an increase in plasma potassium concentration.