bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating New Medicines for Use in Australian Hospitals: Lessons from North America
Authors: Duguid Margaret J 
Published: April 2015

ABSTRACTSeveral centres were visited in North America to identify strategies that could improve the processes used by Australian hospitals when evaluating new medicines for clinical and economic benefits. The centres visited included hospitals, a managed care organisation and the Canadian Agency for Drugs and Technologies in Health. All of the hospitals visited used a formulary to manage medicines and took a similar approach to evaluating new medicines for formulary listing and monitoring decisions. The institutional pharmacy and therapeutics committees were responsible for decision‐making and were guided by detailed drug monographs prepared by pharmacy staff. There was limited use of pharmacoeconomic data in decision‐making. Resources used to guide decision‐making included standard guidelines for formulary submission, comparative effectiveness reviews and a checklist. A more consistent and rigorous approach to assessing medicines and determining cost‐effectiveness could be achieved in Australian hospitals by using a standard format for submissions. Australian drug and therapeutics committees' members need to be educated about the utility of pharmacoeconomic studies in the evaluation of new medicines.
Outcomes of Pharmacological Management of Violent Behavioural Disturbances in Older Hospital Patients
Authors: Cheh Rachael M , Selby Philip R , Abarno Anita C , Alderman Christopher P 
Published: April 2015

ABSTRACTBackgroundViolent behaviour displayed by hospital patients that are a physical and personal threat to patients, visitors and staff is an emergency situation.AimTo evaluate medications used to manage violent behavioural disturbances; to explore patients' antecedent characteristics; and to assess concordance with hospital guidelines.MethodRetrospective analysis (March 2008 to August 2009) of a convenience sample of hospital patients who displayed violent behaviour requiring an emergency response. Patient data were extracted from case notes and the Australian Incident Monitoring System, and included baseline demographics, medication used during admission, details of the behavioural disturbance and outcomes of the emergency response.ResultsOf the 28 patients analysed, 23 (82%) were male. Mean age was 81.5 years and 50% were aged 80 to 89 years. 17 (61%) patients were admitted for cognitive decline and 24 (86%) had a history of neuropsychiatric disorders. Clonazepam was the most frequently used drug and the intramuscular route was the most popular mode. Patients with poorly controlled pain were more likely to display violent behaviour (p < 0.01). Initiating antipsychotics or dose increases during admission was significantly associated with multiple violent episodes (p < 0.001). Opioids were most likely to be charted before a violent episode (n = 10; 36%) and ceased after an episode (n = 5; 18%). Concordance with hospital guidelines was observed in 18 (64%) cases. Non‐concordance with hospital guidelines was not predictive of multiple violent episodes.ConclusionBetter assessment of at‐risk patients and early intervention are required. Concordance with hospital guidelines was low. Effective implementation, monitoring and adjustment of protocols used in emergency responses require interdisciplinary collaboration.
Impact of a Hospital Pharmacy Technician Facilitated Medication Delivery System
Authors: Seaton Suzette M , Adams Rodney C 
Published: April 2015

ABSTRACTAimTo evaluate a hospital pharmacy technician facilitated patient medication delivery system in a rural/regional hospital.MethodPre‐implementation, the medication distribution system on the study medical ward consisted of imprest and individual dispensing with medications administered to patients from medication trolleys. Post‐implementation, the pharmacy technician serviced the medical ward's imprest and individual dispensing and stored in individual bedside drawers. Two missed doses audits were conducted pre‐implementation and two drawer audits conducted post‐implementation.ResultsThe ward pharmacy technician facilitated medication delivery on the medical ward and resulted in a reduction in missed doses, improvement in monitoring medication discrepancies and cost savings.ConclusionA ward pharmacy technician service had a positive impact on medication safety (reduction in missed doses) and cost savings (by avoiding medication wastage).
Do High‐Risk Medicines Alerts Influence Practice?
Authors: Dunning Trisha L , Leach Helen , Van De Vreede Melita , Williams Allison F , Buckley John , Jackson John , Leversha Anne , Nation Roger L , Rokahr Catherine , O'Reilly Mary , Kirsa Suzanne W 
Published: April 2015

ABSTRACTBackgroundMedicine‐related adverse events are prevalent, costly and mostly preventable. The High Risk Medicines Working Party (Victoria) developed and distributed three high‐risk medicines alerts – wrong route of administration of oral medicines, subcutaneous insulin and unfractionated heparin – and accompanying audit tools in 2008 and 2009.AimsTo determine the impact of the three high‐risk medicines alerts on Victorian health services; to assess the clinical relevance and utility of the audit tools; to identify barriers to implementing recommendations; and to obtain feedback and suggestions for future alert topics.MethodA cross‐sectional survey was undertaken from 6 to 31 July 2009 using an online questionnaire. The questionnaire was distributed to 90 metropolitan, regional and rural public health services in Victoria and approximately 200 members of the Quality Use of Medicines Network (Victoria).ResultsMost of the 90 respondents were pharmacists (53%) and nurses (31%). 53 (59%) respondents reported making changes as a result of receiving the high‐risk medicines alerts – 21 (40%) concerned the wrong route of administration, 12 (23%) subcutaneous insulin and 7 (13%) unfractionated heparin. Barriers to implementation included time constraints, inadequate staff and resources, excessive paperwork and competing priorities. A minority of respondents indicated some alerts were not relevant to small rural services. Suggestions for improving the audit tools included making them less labour intensive, enabling electronic responses and ensuring their distribution is coordinated with other medicine‐related tools.ConclusionHigh‐risk medicines alerts and the accompanying audit tools facilitated change but there were some barriers to their implementation, such as time and resource constraints. Not all alerts and audit tools were relevant to all health services.
Clinical Pharmacist Staffing Levels Needed to Deliver Clinical Services in Australian Hospitals
Authors: O'Leary Karen M , Stuchbery Peter , Taylor George 
Published: April 2015

ABSTRACTBackgroundThe Society of Hospital Pharmacists of Australia's (SHPA) Standards of practice for clinical pharmacy list 10 activities pharmacists undertake to provide a comprehensive clinical service to inpatients and the staffing level needed to deliver this service (based on bed type). Time motion data from a recent Australian study could be used to elucidate the number of beds for which a pharmacist can provide clinical services (based on time taken for individual clinical activities).AimTo calculate the number of patients/inpatient beds for which a pharmacist can provide clinical services.MethodA profile of clinical pharmacy activities and how often they need to be delivered to meet the SHPA Standards was developed for different patient types. Formulae were developed and populated with the time motion data to calculate clinical pharmacist staffing levels.ResultsStaffing levels for 7 categories of patients/inpatient beds were elucidated. These calculations suggest the clinical pharmacist to bed type ratios described in the SHPA Standards considerably underestimate the time required to deliver a comprehensive clinical pharmacy service.ConclusionTimes per activity used in this exercise are conservative and provide the maximum number of patients for which a pharmacist can provide clinical services. These staffing levels could be used to allocate resources to achieve agreed clinical pharmacy service delivery in Australian hospitals.
Not Seeing the Light?
Authors: Behan Kieran P , McGovern Trudy L , Dahms Karyn 
Published: April 2015

ABSTRACTBackgroundAseptic preparation of pharmaceuticals is regularly undertaken by pharmacists and technicians in hospital pharmacy departments. Despite the existence of practice standards and personnel experienced in aseptic preparation, errors can occur which can jeopardise staff safety.AimTo describe three cases of photokeratitis from inadvertent exposure to ultraviolet light during aseptic preparation.Clinical Details3 clinical pharmacists preparing aseptic products were exposed to ultraviolet light for approximately 2 hours. They developed photokeratitis with diffuse punctate epithelial erosions and burns to the corneas. They also experienced a reduction in their visual acuity. The pharmacists were reviewed by ophthalmologists and treated conservatively. They all made uneventful recoveries.ConclusionThis report reinforces the hazards of ultraviolet lights used in sterile rooms. It is essential that training of aseptic preparation starts with switching off of the ultraviolet lights.
Management of Osteoporosis in Older People
Authors: Inderjeeth Charles A , Poland Kate E 
Published: April 2015

ABSTRACTOsteoporosis is characterised by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. Osteoporosis and fracture risk increase exponentially in postmenopausal women. Osteoporosis is under‐diagnosed and under‐treated and advancing age is a risk factor for under‐management. Osteoporosis management in older people (75 years and over) must focus on non‐pharmacological and pharmacological interventions. The aim of treatment is to reduce morbidity and mortality associated with the first fracture and prevent subsequent fractures. Successful non‐pharmacological measures include falls risk assessment and management, participation in exercise programs and the use of hip protectors. Pharmacotherapies such as calcium, vitamin D, alendronate, risedronate, zoledronic acid, teriparatide and strontium ranelate are safe in older people and significantly reduce fractures, especially vertebral fractures. There is less evidence for risk reduction in non‐vertebral and hip fractures, which are more relevant in older people. The body of evidence in this cohort is small and further studies are needed to provide more evidence.
Rurally Focused BPharm Course: Perceptions of Graduates
Authors: Kemp Sarah M , Spark M Joy 
Published: April 2015

ABSTRACTBackgroundThe Bachelor of Pharmacy (BPharm) course at La Trobe University, Bendigo campus is rurally focused and aims to address the shortage of pharmacists in rural areas.AimTo ascertain pharmacy graduates' perceptions of the pharmacy indicative curriculum and to explore whether the rural focus of the course influenced their location of employment.MethodCross‐sectional survey of the first 4 cohorts of BPharm graduates from La Trobe University, Bendigo campus.ResultsMost of the indicative curriculum was perceived to be well covered, with wound management the only topic identified as poorly covered. Graduates from rural backgrounds tended to undertake rural employment. The rural focus of the course did not result in graduates from metropolitan backgrounds undertaking rural employment.ConclusionLa Trobe University's BPharm course was perceived by students to prepare them well for practice as a pharmacist. For La Trobe University, Bendigo campus graduates a rural background was a stronge indicator of future rural practice.
Risk Factors for Adverse Drug Events and Medication Errors in Paediatric Inpatients: Analysis by Admission Characteristics
Authors: Kunac Desireé L , Kennedy Julia , Austin Nicola C , Reith David M 
Published: April 2015

ABSTRACTBackgroundThere are few published data analysing risk factors for adverse drug events and medication errors in children.AimTo evaluate the factors that influence the risk of adverse drug events and medication errors occurring during a hospital admission for a child.MethodProspective cohort study of all paediatric admissions of at least 24 hours duration at Dunedin Hospital over a 12‐week period. Suspected events were identified via chart review, multidisciplinary ward meetings, parent interview and voluntary staff reporting. Hypothesis tests were performed using hazard ratios and 95% confidence intervals.Results495 patients were included who in total had 520 admissions. There were 67 adverse drug events, of which 38 (57%) were classified as preventable, 77 potential adverse drug events and 255 ‘no‐harm’ medication errors. On multivariate analysis, the major independent risk factors for adverse drug events were increasing age (HR 1.2; 95%CI 1.1–1.3) and a greater number of regular medications (HR 6; 95%CI 1.9–19.3). For potential adverse drug events, intravenous infusions conferred the highest risk (HR 32.4; 95%CI 10.9–95.5). For ‘no‐harm’ medication errors, greater duration of hospital admission (HR 1.2; 95%CI 1.1–1.3) and a greater number of regular medications (HR 14.6; 95%CI 6.4–33.2), particularly IV infusions (HR 13; 95%CI 2.9–56.9), were the main predictors of occurrence. Sex and weight were not found to be related to adverse drug events or medication errors in this cohort of hospitalised children.ConclusionA greater number of regular medications and intravenous infusions were important risk factors for adverse drug events and medication errors occurring during hospital admission for a child. Increasing age also influenced the risk of an adverse drug event, whereas for ‘no harm’ medication errors, a greater duration of hospital admission was important.
Factors Influencing Concomitant Use of Complementary and Alternative Medicines with Warfarin
Authors: Hasan Shahzad S , Feng Siow R , Ahmadi Keivan , Ahmad Kamarunnesa M , Chong David WK , Anwar Mudassir , Badarudin Nurul Z 
Published: April 2015

ABSTRACTAimTo investigate factors influencing complementary and alternative medicines (CAM) use among patients on warfarin.MethodCross‐sectional study of randomly selected patients at a hospital‐based anticoagulation clinic in Malaysia. A 38‐item validated data collection form was used to interview patients and investigate the reasons, perceived efficacy and adverse drug events experienced. Data were also collected on potential drug interactions and the international normalised ratio (INR).ResultsOf the 138 randomly selected patients, 76 (55%) reported using CAM – 46 (61%) used biologically based practices such as herbal products, vitamins and supplements. Monthly household income (p = 0.05, rs = 0.13) and family history of CAM use (p = 0.001, rs = 0.32) were significantly associated and positively correlated with CAM use. 19 patients reported adverse events with warfarin use while none reported adverse events with CAM use. 19 and 58 patients, respectively, were identified as being at risk of potential interactions between warfarin‐CAM and warfarin‐conventional medicines. No significant difference in the mean INR was found between CAM and non‐CAM users.ConclusionA large number of patients attending the anticoagulation clinic reported using CAM. Socioeconomic factors such as monthly household income, education level and family history of CAM use were significantly related with CAM use. Routine medication interviews should include questions about concomitant CAM use.
Review of Instruments used in Clinical Practice to Assess Patients' Ability to Manage Medications
Authors: Elliott Rohan A , Marriott Jennifer L 
Published: April 2015

ABSTRACTBackgroundManaging medications can be challenging, especially in the presence of cognitive and physical impairments that are common in older age.AimTo identify instruments used in clinical practice to assess patients' ability to manage medications; to determine whether they have been tested for reliability and validity; and to compare unvalidated and validated instruments.MethodA sample of health professionals involved in geriatric practice or research in Australia, the UK and USA were asked to provide copies of medication management assessment instruments that they had developed or used. A literature search was conducted to identify published instruments. The instruments were then categorised into 2 groups based on whether or not they had been tested for reliability and validity. The medication management skills assessed by each instrument were also categorised.ResultsOf the 69 (33 published, 36 unpublished) instruments located, 44 (26 unvalidated, 18 validated) instruments met the inclusion criteria and were reviewed. None of the instruments used in clinical practice had been validated. Skills assessed, and methods for assessment, were highly variable. Skills most commonly assessed were: ability to open at least one type of medication packaging (96%), ability to read a standard medication label without interpreting meaning (75%), ability to remove medication from at least one type of packaging (73%), and ability to either comprehend and explain medication instructions or demonstrate setting out a medication regimen (52%). Most validated instruments used a standardised, simulated medication regimen, whereas unvalidated instruments mostly used patients' own medications with inadequate detail or instructions to enable standardised administration.ConclusionNumerous instruments have been developed to assess patients' ability to manage medications. Instruments used in clinical practice have not been validated and are generally not standardised, leading to potential for poor reliability.
Optimisation of Digoxin Maintenance Dose in Toxicity
Authors: Bhindi Arun K 
Published: April 2015

ABSTRACTBackgroundDigoxin pharmacokinetics can be altered by disease states, age‐related decline in renal function, decreased skeletal muscle mass and drug interactions.AimTo report a case of digoxin toxicity in a patient with advanced congestive heart failure in atrial fibrillation and worsening renal failure; and to describe the application of pharmacokinetic principles in the optimisation of digoxin dosing.Clinical detailsA 59‐year‐old Caucasian male presented with a week long history of abdominal pain, increased dyspnoea and lethargy. His medical history included heart failure, atrial fibrillation, hypertension, ischaemic heart disease, type 2 diabetes, acute on chronic renal failure, dyslipidaemia, anaemia and morbid obesity. His serum biochemistry revealed hyperkalaemia of 6.9 mmol/L, elevated creatinine of 407 μmol/L (prior baseline 247 μmol/L) and a trough serum digoxin concentration of 3.4 nmol/L at steady state on an oral maintenance digoxin dose of 125 microgram daily. His calcium and magnesium levels were in the normal range.OutcomesHyperkalaemia was corrected and the potassium‐sparing medications, spironolactone and perindopril, were withheld. Digoxin was withheld until digoxin's serum concentration returned to the therapeutic range. A reduced maintenance dose of digoxin 62.5 microgram on alternate days was calculated and recommended by the clinical pharmacist. At discharge, the patient felt significantly better and was able to engage with activities of daily living. Perindopril and spironolactone were recommenced once the potassium had returned to normal levels. The patient was unaware of signs and symptoms of digoxin toxicity and the clinical pharmacist provided counselling prior to discharge. The patient's local doctor was requested to closely monitor his renal function and potassium levels and to check his trough serum digoxin concentration if toxicity was suspected.ConclusionPharmacists and clinicians need to understand digoxin's pharmacokinetics in various clinical settings to be able to make appropriate dose adjustments.
Impact of Hospitalisation on the Complexity of Older Patients' Medication Regimens and Potential for Regimen Simplification
Authors: Elliott Rohan A , O'Callaghan Christopher J 
Published: April 2015

ABSTRACTAimTo investigate the impact of hospitalisation on the complexity of older patients' medication regimens; and to determine whether discharge medication regimens could be simplified.MethodMedication Regimen Complexity Index (MRCI) scores were calculated on admission and discharge for 186 consecutive patients (mean age 80 years) discharged from 2 acute general medicine and 2 subacute aged care wards. A random sample of 40 discharge medication regimens were retrospectively simplified by clinical pharmacists and proposed changes reviewed by a clinical pharmacologist to determine feasibility of the changes and likelihood of equivalent therapeutic outcomes.ResultsOn average, 1.2 regularly scheduled long‐term medications/patient were ceased in hospital and 2.5 added. 0.6 regularly scheduled short‐term (defined duration) medications were commenced. MRCI scores increased by 22% (18 to 22; p < 0.0001) for regularly scheduled long‐term medications and 32% (21 to 27; p < 0.0001) for all medications. In multivariate analysis, using fewer medications prior to admission and being discharged from a subacute aged care ward were associated with increased regimen complexity. For the 40 discharge medication regimens reviewed, 90 simplifications to regularly scheduled long‐term medications were proposed, and 84 (93%) were rated by the clinical pharmacologist as feasible and likely to have the same or similar therapeutic outcomes to the complex regimens. These changes, if implemented, could have reduced medication regimen complexity at discharge by an average of 14%.ConclusionHospitalisation resulted in multiple medication changes and increased regimen complexity. Most medication regimens had the potential to be simplified.
Feasibility and Timeliness of Alternatives to Post‐Discharge Home Medicines Reviews for High‐Risk Patients
Authors: Angley Manya , Ponniah Anne P , Spurling Lisa K , Sheridan Louise , Colley Des , Nooney Vivek B , Bong Xin Jou , Padhye Vaishali , Shakib Sepehr 
Published: April 2015

ABSTRACTBackgroundThe period 7 to 10 days following hospital discharge is associated with a significant risk of medication misadventure, especially in high‐risk patients.AimTo investigate whether post‐discharge hospital‐initiated medication review (HIMR) pathways are more timely than the post‐discharge home medicines review (HMR) pathway.MethodAn implementation study conducted over 9 months in 2008/2009 of patients from 3 South Australian hospitals. A risk stratification instrument was used to identify patients at “high” risk of medication misadventure. Feasibility was assessed and time to conduct the post‐discharge medication reviews was determined for the HMR and HIMR pathways.ResultsOf the 97 consenting patients, 92 were stratified as “high” risk. HIMR were organised for 59 patients − 52 patients completed the HIMR process. Of the 22 HMRs organised via the patient's general practitioner, 18 patients completed the HMR process. The time from request to conducting the HIMR and HMR were statistically significantly different – HIMR and HMR took 6.5 ± 4.7 days and 11 ± 7.4 days, respectively (p = 0.02).ConclusionThis study has demonstrated the feasability of alternative pathways to post‐discharge medication reviews. The HIMRs were conducted sooner than HMRs organised via existing community processes. If post‐discharge medication reviews are organised via the HIMR pathway, there is potential to reduce medication misadventure in high risk patients in a more timely manner than when post‐discharge HMRs are organised.