The Active Ingredient Prescribing (AIP) mandate was introduced Australia-wide on 1 February 2021. The AIP legislation makes the pharmacist a stakeholder who can provide valuable information to customers and patients.
Aim
To explore the experiences of community pharmacists with AIP legislation with a focus on attitude, health literacy, and medication safety.
Method
Semi-structured, in-depth interviews were conducted and guided by the Theoretical Domains Framework (TDF). Transcripts were analysed using a deductive approach to categorise data and inductive thematic analysis to identify concepts and themes. Ethical approval was granted by the Griffith University Human Research Ethics Committee (Reference no: 2021/878) and the study conforms to the Australian National Statement on Ethical Conduct in Human Research. Informed consent from all participants was obtained via a study information sheet distributed to all potential participants and completion of written consent forms prior to participation in the study. Participants received gift cards as compensation for their time.
Results
Six pharmacists participated, and thematic analysis of collected data revealed three main themes. These included education, integration, and trust. Insights on patients' acceptance of their prescriptions and the expanded patient-facing opportunities were highlighted. Participants' opinions leaned towards enhancing the smooth integration into the AIP process of other stakeholders like prescribers and regulatory bodies. Establishing multilevel communication between stakeholders and customers was pivotal to improving health literacy and medication safety. Pharmacists' views on process integration provided unique insight into the practical challenges with the AIP mandate. In addition, ‘trust’ in the prescriber enhanced patient acceptance of generic medicines.
Conclusion
The study provided baseline evidence to show that the AIP mandate enhances health literacy and empowers patients to know the active ingredients in their medicines, which in turn supports medication safety. Examining the implementation of the AIP legislation facilitated a nuanced understanding of the effect that these AIP changes have on patients.
{"title":"Active Ingredient Prescribing in Australia: exploring pharmacists' experiences","authors":"Taylah Swifte BPharm, MPharm, Michelle Bowden BPharm, GradDipClinPharm, Henry Ndukwe BPharm, MSc, PhD","doi":"10.1002/jppr.1935","DOIUrl":"https://doi.org/10.1002/jppr.1935","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Active Ingredient Prescribing (AIP) mandate was introduced Australia-wide on 1 February 2021. The AIP legislation makes the pharmacist a stakeholder who can provide valuable information to customers and patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To explore the experiences of community pharmacists with AIP legislation with a focus on attitude, health literacy, and medication safety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Semi-structured, in-depth interviews were conducted and guided by the Theoretical Domains Framework (TDF). Transcripts were analysed using a deductive approach to categorise data and inductive thematic analysis to identify concepts and themes. Ethical approval was granted by the Griffith University Human Research Ethics Committee (Reference no: 2021/878) and the study conforms to the <i>Australian National Statement on Ethical Conduct in Human Research</i>. Informed consent from all participants was obtained via a study information sheet distributed to all potential participants and completion of written consent forms prior to participation in the study. Participants received gift cards as compensation for their time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six pharmacists participated, and thematic analysis of collected data revealed three main themes. These included education, integration, and trust. Insights on patients' acceptance of their prescriptions and the expanded patient-facing opportunities were highlighted. Participants' opinions leaned towards enhancing the smooth integration into the AIP process of other stakeholders like prescribers and regulatory bodies. Establishing multilevel communication between stakeholders and customers was pivotal to improving health literacy and medication safety. Pharmacists' views on process integration provided unique insight into the practical challenges with the AIP mandate. In addition, ‘trust’ in the prescriber enhanced patient acceptance of generic medicines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study provided baseline evidence to show that the AIP mandate enhances health literacy and empowers patients to know the active ingredients in their medicines, which in turn supports medication safety. Examining the implementation of the AIP legislation facilitated a nuanced understanding of the effect that these AIP changes have on patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 5","pages":"402-411"},"PeriodicalIF":1.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1935","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142664658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pharmacist surgical preadmission review is common in adult healthcare settings, however there is little evidence of this practice in the paediatric setting. This research describes a pilot surgical preadmission pharmacist service in a paediatric hospital.
Aim
To evaluate the impact of a surgical preadmission pharmacist service on patient flow and the quality of medication management.
Method
A retrospective review (2 months) was conducted to compare an intervention group (1 May 2019–30 June 2019) to historical baseline (1 October 2018–30 November 2018). Children and adolescents (aged 0–18 years) presenting for elective surgery and overnight admission were included. Relevant clinical data and timestamps were extracted from the electronic medical record. Multiple linear regression models were built to examine the difference in outcomes between the control and intervention groups. This project was exempt due to the local policy requirements that constitute research by the Queensland Children's Hospital Human Research Ethics Committee (Reference no: LNR/19/QCHQ/53406). The justification for this exemption was as follows: the study presented no foreseeable risk of patient harm as it involved evaluation of an established standard of clinical care and involved the use of existing collections of records that contain only non-identifiable patient data.
Results
In total, 135 patients were included in the baseline and 96 patients were included in the intervention group. The intervention group had statistically significant lower time to best possible medication history (BPMH) by 47.57 h (95% confidence interval [CI] −53.25 to −41.89, p < 0.001). Time to prescription of home medications was significantly reduced in the intervention group by 5.26 h (95% CI −10.45 to −0.08, p = 0.05). There was no difference in proportion of patients with home medications omitted (71–62%, p = 0.38) or requiring modification (14–12%, p = 0.58) between the two groups.
Conclusion
Implementation of a surgical preadmission pharmacist service in our paediatric hospital demonstrated earlier BPMH documentation and prescription of home medications, without negative effects on perioperative patient flow.
{"title":"A surgical preadmission pharmacist service in a tertiary paediatric hospital: a pilot study","authors":"Bruce Chio BPharm, GDipClinPharm, Syeda Farah Zahir PhD, MSc(HM), MBBS, Jenny Lee-Peters BPharm, GDipClinPharm, CHIA, Emily Elliott BPharm, BPharm(Hons), Lana Steward-Harrison BPharm, GDipClinPharm, MHLM, MSHP, Gemma Burns BPharmSci, MPharm, Sonya Stacey BPharm, PhD, FANZCAP","doi":"10.1002/jppr.1933","DOIUrl":"https://doi.org/10.1002/jppr.1933","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pharmacist surgical preadmission review is common in adult healthcare settings, however there is little evidence of this practice in the paediatric setting. This research describes a pilot surgical preadmission pharmacist service in a paediatric hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate the impact of a surgical preadmission pharmacist service on patient flow and the quality of medication management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A retrospective review (2 months) was conducted to compare an intervention group (1 May 2019–30 June 2019) to historical baseline (1 October 2018–30 November 2018). Children and adolescents (aged 0–18 years) presenting for elective surgery and overnight admission were included. Relevant clinical data and timestamps were extracted from the electronic medical record. Multiple linear regression models were built to examine the difference in outcomes between the control and intervention groups. This project was exempt due to the local policy requirements that constitute research by the Queensland Children's Hospital Human Research Ethics Committee (Reference no: LNR/19/QCHQ/53406). The justification for this exemption was as follows: the study presented no foreseeable risk of patient harm as it involved evaluation of an established standard of clinical care and involved the use of existing collections of records that contain only non-identifiable patient data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 135 patients were included in the baseline and 96 patients were included in the intervention group. The intervention group had statistically significant lower time to best possible medication history (BPMH) by 47.57 h (95% confidence interval [CI] −53.25 to −41.89, p < 0.001). Time to prescription of home medications was significantly reduced in the intervention group by 5.26 h (95% CI −10.45 to −0.08, p = 0.05). There was no difference in proportion of patients with home medications omitted (71–62%, p = 0.38) or requiring modification (14–12%, p = 0.58) between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Implementation of a surgical preadmission pharmacist service in our paediatric hospital demonstrated earlier BPMH documentation and prescription of home medications, without negative effects on perioperative patient flow.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 5","pages":"393-401"},"PeriodicalIF":1.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142664788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emily M. Laswell PharmD, BCPS, David Peters Jr PharmD, BCCCP, Jordan Orchard PharmD
Background
Status epilepticus (SE) is defined as 5 min or more of seizure activity or two recurrent seizures without a return to baseline. Healthcare providers encounter a challenge when a patient with SE is pregnant. SE is not only detrimental to the mother but can also put the baby at risk of severe harm. SE must be treated rapidly and therefore healthcare providers have very little time to thoroughly review the risk and benefits of available antiseizure medication in this population.
Aim
To evaluate the current available evidence related to the management of SE in pregnancy.
Design
A literature search of PubMed, CINAHL, ProQuest Nursing & Allied Health Source, and Web of Science databases was conducted (2012–2022) using the following search terms: ‘pregnancy’, ‘pregnant women’ OR ‘gestation’ AND ‘status epilepticus’, ‘generalized status epilepticus’, ‘generalized convulsive status epilepticus’, ‘non convulsive status epilepticus’ OR ‘non-convulsive status epilepticus’. Full-text randomised controlled trials, clinical trials, observational studies, and case reports published in English were included. Data were extracted and the quality of the studies was evaluated using the Mixed Methods Appraisal Tool.
Results
The literature described 29 pregnancies and 30 total foetuses. Intravenous benzodiazepine use for emergent control was reported in 45% of patients. Phenytoin and levetiracetam were primarily utilised for urgent control, with a variety of agents used for refractory SE. Ninety-seven percent of maternal outcomes were reported as positive. The most common outcome was the birth of a healthy term infant. There were seven cases of pregnancy loss.
Conclusion
Publications pertaining to the treatment of SE in pregnancy are limited to case reports and small observational studies. Use of a benzodiazepine followed by levetiracetam or phenytoin is appropriate, whereas valproic acid should be utilised only when necessary due to the risk of major congenital malformation.
背景 癫痫状态（SE）的定义是发作活动持续 5 分钟或更长时间，或两次反复发作且未恢复到基线。当 SE 患者怀孕时，医疗服务提供者会遇到一个难题。SE 不仅对母亲有害，还可能使婴儿面临严重伤害的风险。SE 必须得到快速治疗，因此医疗服务提供者几乎没有时间来彻底审查抗癫痫药物在这一人群中的风险和益处。 目的 评估与妊娠期 SE 的治疗相关的现有证据。 设计 使用以下检索词对 PubMed、CINAHL、ProQuest Nursing & Allied Health Source 和 Web of Science 数据库进行文献检索（2012-2022 年）：妊娠"、"孕妇 "或 "妊娠 "和 "癫痫状态"、"全身性癫痫状态"、"全身性惊厥性癫痫状态"、"非惊厥性癫痫状态 "或 "非惊厥性癫痫状态"。研究对象包括用英语发表的全文随机对照试验、临床试验、观察性研究和病例报告。采用混合方法评估工具（Mixed Methods Appraisal Tool）提取数据并评估研究质量。 结果 文献中描述了 29 例妊娠和 30 个胎儿。据报道，45%的患者使用静脉注射苯二氮卓类药物进行紧急控制。苯妥英和左乙拉西坦主要用于紧急控制，各种药物用于难治性 SE。据报告，97%的孕产妇结果为阳性。最常见的结果是产下健康足月婴儿。有 7 例妊娠失败。 结论 有关治疗妊娠期 SE 的文献仅限于病例报告和小型观察性研究。在使用苯二氮卓类药物后再使用左乙拉西坦或苯妥英是合适的，而丙戊酸由于有导致重大先天性畸形的风险，只有在必要时才能使用。
{"title":"The pharmacologic management of status epilepticus in pregnant patients: a scoping review","authors":"Emily M. Laswell PharmD, BCPS, David Peters Jr PharmD, BCCCP, Jordan Orchard PharmD","doi":"10.1002/jppr.1934","DOIUrl":"https://doi.org/10.1002/jppr.1934","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Status epilepticus (SE) is defined as 5 min or more of seizure activity or two recurrent seizures without a return to baseline. Healthcare providers encounter a challenge when a patient with SE is pregnant. SE is not only detrimental to the mother but can also put the baby at risk of severe harm. SE must be treated rapidly and therefore healthcare providers have very little time to thoroughly review the risk and benefits of available antiseizure medication in this population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate the current available evidence related to the management of SE in pregnancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A literature search of PubMed, CINAHL, ProQuest Nursing & Allied Health Source, and Web of Science databases was conducted (2012–2022) using the following search terms: ‘pregnancy’, ‘pregnant women’ OR ‘gestation’ AND ‘status epilepticus’, ‘generalized status epilepticus’, ‘generalized convulsive status epilepticus’, ‘non convulsive status epilepticus’ OR ‘non-convulsive status epilepticus’. Full-text randomised controlled trials, clinical trials, observational studies, and case reports published in English were included. Data were extracted and the quality of the studies was evaluated using the Mixed Methods Appraisal Tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The literature described 29 pregnancies and 30 total foetuses. Intravenous benzodiazepine use for emergent control was reported in 45% of patients. Phenytoin and levetiracetam were primarily utilised for urgent control, with a variety of agents used for refractory SE. Ninety-seven percent of maternal outcomes were reported as positive. The most common outcome was the birth of a healthy term infant. There were seven cases of pregnancy loss.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Publications pertaining to the treatment of SE in pregnancy are limited to case reports and small observational studies. Use of a benzodiazepine followed by levetiracetam or phenytoin is appropriate, whereas valproic acid should be utilised only when necessary due to the risk of major congenital malformation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 5","pages":"353-367"},"PeriodicalIF":1.0,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1934","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142664587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael J. Dooley BPharm, GradDipHospPharm, PhD, FSHP, AdvPracPharm
<p>In the previous issue of the <i>Journal of Pharmacy Practice and Research</i>, the Society of Hospital Pharmacists of Australia (SHPA) Standard of practice in palliative care for pharmacy services was published.<span><sup>1</sup></span> This Standard describes current best practice for the provision of palliative care pharmacy services and demonstrates the depth and breadth of these services that have continued to evolve over the recent decade. This includes describing essential and emerging services and challenges the profession to strive to provide emerging services, in addition to essential services wherever possible. This is indeed a challenge when these services are provided in non-specialist and specialist palliative care settings by individual practitioners with varying degrees of experience and expertise. This professional Practice Standard sets the scene and provides guidance to pharmacists within palliative care interdisciplinary teams, through to those working in more generalist roles in settings with clinicians without palliative expertise and, most importantly, entrenches the essence of the palliative care approach in the profession.</p><p>Fundamental to this approach is the description within the Standard that everyone shares a fundamental right to safe and high-quality health care, including palliative care services, as is clearly prioritised in the <i>Australian Charter of Healthcare Rights</i>.<span><sup>2</sup></span> However, there is clear evidence both internationally and within Australia that many patients who would benefit from palliative care service unfortunately do not have access to these.<span><sup>3, 4</sup></span> This includes the continued lack of awareness within the healthcare sector and the wider community that palliative care services can be complementary to active treatment and not reserved for end-of-life care.<span><sup>5</sup></span> Continued effort must be made to reduce these barriers to care and integrate palliative care services as early as possible, from when curative or life-prolonging (disease-modifying) treatment is occurring through to when death may be imminent. This is addressed within the Standard where the benefits of palliative care are highlighted for patients first diagnosed with a life-limiting condition receiving active interventions through to patients with progressive, advanced disease with little to no prospect of cure.</p><p>A conceptual framework to underpin access to palliative care services has also been developed to help guide health professionals.<span><sup>6</sup></span> This, along with key messaging to facilitate engagement with and promotion of palliative care services, has been advocated as an approach to improve the care of individuals with serious illness. There remain significant challenges to adopting these concepts into routine clinical practice. Unfortunately, palliative care, for many healthcare professionals and patients, is perceived to be only for end-of-life ca
这篇社论没有得到任何公共、商业或非营利部门资助机构的具体资助。
{"title":"Person- and carer-centred palliative care: consensus for the pharmacy profession","authors":"Michael J. Dooley BPharm, GradDipHospPharm, PhD, FSHP, AdvPracPharm","doi":"10.1002/jppr.1944","DOIUrl":"https://doi.org/10.1002/jppr.1944","url":null,"abstract":"<p>In the previous issue of the <i>Journal of Pharmacy Practice and Research</i>, the Society of Hospital Pharmacists of Australia (SHPA) Standard of practice in palliative care for pharmacy services was published.<span><sup>1</sup></span> This Standard describes current best practice for the provision of palliative care pharmacy services and demonstrates the depth and breadth of these services that have continued to evolve over the recent decade. This includes describing essential and emerging services and challenges the profession to strive to provide emerging services, in addition to essential services wherever possible. This is indeed a challenge when these services are provided in non-specialist and specialist palliative care settings by individual practitioners with varying degrees of experience and expertise. This professional Practice Standard sets the scene and provides guidance to pharmacists within palliative care interdisciplinary teams, through to those working in more generalist roles in settings with clinicians without palliative expertise and, most importantly, entrenches the essence of the palliative care approach in the profession.</p><p>Fundamental to this approach is the description within the Standard that everyone shares a fundamental right to safe and high-quality health care, including palliative care services, as is clearly prioritised in the <i>Australian Charter of Healthcare Rights</i>.<span><sup>2</sup></span> However, there is clear evidence both internationally and within Australia that many patients who would benefit from palliative care service unfortunately do not have access to these.<span><sup>3, 4</sup></span> This includes the continued lack of awareness within the healthcare sector and the wider community that palliative care services can be complementary to active treatment and not reserved for end-of-life care.<span><sup>5</sup></span> Continued effort must be made to reduce these barriers to care and integrate palliative care services as early as possible, from when curative or life-prolonging (disease-modifying) treatment is occurring through to when death may be imminent. This is addressed within the Standard where the benefits of palliative care are highlighted for patients first diagnosed with a life-limiting condition receiving active interventions through to patients with progressive, advanced disease with little to no prospect of cure.</p><p>A conceptual framework to underpin access to palliative care services has also been developed to help guide health professionals.<span><sup>6</sup></span> This, along with key messaging to facilitate engagement with and promotion of palliative care services, has been advocated as an approach to improve the care of individuals with serious illness. There remain significant challenges to adopting these concepts into routine clinical practice. Unfortunately, palliative care, for many healthcare professionals and patients, is perceived to be only for end-of-life ca","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 4","pages":"271-272"},"PeriodicalIF":1.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1944","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142099970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Flucytosine is an antifungal agent used in combination with other medicines for the treatment of fungal infections. It was available as intravenous (IV), oral tablet, and capsule formulations up until October 2021, when the IV product, Ancotil, was discontinued with no alternative brands available.
Aim
This study aimed to formulate a suitable formulation with appropriate stability data for medium to long-term nasogastric (NG) administration use.
Method
Flucytosine 500 mg tablets (Ancotil) were crushed and suspended in (1) Ora-Plus (OP) + Ora-Sweet (OS) and (2) Ora-Blend (OB) to produce 100 mg/mL suspensions (n = 3 for each suspending base) that were stored at 2–8°C in amber glass bottles until assayed. Appearance, odour and pH, and the concentrations of flucytosine in the suspensions were determined by high-performance liquid chromatography on days 1, 8, and 15. A subjective assessment of the ease of suspension for NG administration via a size 10fr nasogastric tube (NGT) was also tested. Ethics approval was not required for this research article as it was a stability study and did not contain human participants or human data.
Results
One of the three OB suspension bottles demonstrated significant suspension clumping resulting in all OB suspensions being excluded from further analysis. There was no change in appearance, odour or pH with the OP + OS based flucytosine suspensions and they extruded easily through a size 10fr NGT with minimal force. The three OP + OS bottles of flucytosine suspension were stable (>98% at all timepoints assessed) for 15 days at 2–8°C when stored in amber glass bottles.
Conclusions
The OP + OS suspensions showed chemical stability for up to 15 days when stored under refrigerated conditions and protected from light, making this a suitable multidose enteral alternative to IV flucytosine.
背景氟尿嘧啶是一种抗真菌药物，可与其他药物联合用于治疗真菌感染。该药有静脉注射剂、口服片剂和胶囊剂，直到 2021 年 10 月，静脉注射剂产品 Ancotil 停产，没有替代品牌。 目的 本研究旨在为中长期鼻胃（NG）给药配制一种具有适当稳定性数据的合适制剂。 方法 将氟尿嘧啶 500 毫克片剂（Ancotil）碾碎并悬浮于 (1) Ora-Plus (OP) + Ora-Sweet (OS) 和 (2) Ora-Blend (OB) 中，制成 100 毫克/毫升的悬浮液（每种悬浮基质 n = 3），在 2-8°C下贮存于琥珀色玻璃瓶中，直至化验。在第 1、8 和 15 天，用高效液相色谱法测定悬浮液的外观、气味和 pH 值以及氟西多辛的浓度。此外，还测试了悬浮液是否易于通过 10fr 大小的鼻胃管（NGT）进行 NG 给药的主观评估。由于这是一项稳定性研究，不涉及人类参与或人类数据，因此本研究文章无需获得伦理批准。 结果 三瓶转瓶混悬液中有一瓶出现了明显的混悬液结块现象，因此所有转瓶混悬液都被排除在进一步分析之外。基于 OP + OS 的氟尿嘧啶混悬液在外观、气味或 pH 值方面均无变化，而且它们很容易通过 10fr 的 NGT 管挤出，挤出力很小。三瓶 OP + OS 氟尿嘧啶混悬液在 2-8°C琥珀色玻璃瓶中储存 15 天后保持稳定（在所有评估的时间点均为 98%）。 结论 OP + OS 悬浮液在冷藏避光条件下保存 15 天后显示出化学稳定性，使其成为静脉注射氟尿嘧啶的合适多剂量肠内替代品。
{"title":"Stability of flucytosine 100 mg/mL suspension as an alternative to intravenous administration","authors":"Pamela Huang BPharm, Carmela Corallo BPharm, Cherie Chiang MBBS (Hons), FRACP, FRCPA, MAACB, MD, FFSc, Yoke Chee Leong BSc, MAACB, Bianca Tong BPharm (Hons)","doi":"10.1002/jppr.1924","DOIUrl":"https://doi.org/10.1002/jppr.1924","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Flucytosine is an antifungal agent used in combination with other medicines for the treatment of fungal infections. It was available as intravenous (IV), oral tablet, and capsule formulations up until October 2021, when the IV product, Ancotil, was discontinued with no alternative brands available.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aimed to formulate a suitable formulation with appropriate stability data for medium to long-term nasogastric (NG) administration use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Flucytosine 500 mg tablets (Ancotil) were crushed and suspended in (1) Ora-Plus (OP) + Ora-Sweet (OS) and (2) Ora-Blend (OB) to produce 100 mg/mL suspensions (<i>n</i> = 3 for each suspending base) that were stored at 2–8°C in amber glass bottles until assayed. Appearance, odour and pH, and the concentrations of flucytosine in the suspensions were determined by high-performance liquid chromatography on days 1, 8, and 15. A subjective assessment of the ease of suspension for NG administration via a size 10fr nasogastric tube (NGT) was also tested. Ethics approval was not required for this research article as it was a stability study and did not contain human participants or human data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One of the three OB suspension bottles demonstrated significant suspension clumping resulting in all OB suspensions being excluded from further analysis. There was no change in appearance, odour or pH with the OP + OS based flucytosine suspensions and they extruded easily through a size 10fr NGT with minimal force. The three OP + OS bottles of flucytosine suspension were stable (>98% at all timepoints assessed) for 15 days at 2–8°C when stored in amber glass bottles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The OP + OS suspensions showed chemical stability for up to 15 days when stored under refrigerated conditions and protected from light, making this a suitable multidose enteral alternative to IV flucytosine.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 4","pages":"323-327"},"PeriodicalIF":1.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Treatment guidelines for COVID-19 recommend basic analgesics/antipyretics such as paracetamol.<span><sup>1</sup></span> Paracetamol therapeutic errors are associated with morbidity and mortality.<span><sup>2</sup></span> The Victorian Poisons Information Centre (VPIC), the statewide poisons centre for Victoria, Australia, receives calls from members of the public for advice regarding errors made with medicines. Paracetamol therapeutic errors are usually accidental overdoses (e.g. double-dose, maximum daily dose exceeded, incorrectly measured liquid paracetamol, or use of two paracetamol-containing medicines). The aim of this research was to explore the impact of the COVID-19 pandemic on the number of paracetamol therapeutic error cases in the community (outside of hospitals) that were reported to VPIC.</p><p>Call records were extracted from the VPIC database from 1 July 2017 to 30 June 2022 (approximately 2.5 years before and after the first cases of COVID-19 in Victoria). Retrospectively, records were reviewed where callers reported a therapeutic error with any form of paracetamol that occurred in an adult or child in the home or community.</p><p>In the 2.5 years prior to the pandemic there was an average of 120 (standard deviation [SD] 21) paracetamol therapeutic error cases per month. In the 2.5 years from January 2020 there was an average of 116 (SD 33) cases per month, but case numbers varied as the Victorian population went into and out of lockdown (lockdowns were a stay-at-home order to reduce the spread of COVID-19). During the first two Melbourne lockdowns, which occurred between 31 March 2020–12 May 2020 and 9 July 2020–27 October 2020,<span><sup>3</sup></span> the average number of paracetamol therapeutic error cases per month fell to 60 (SD 19) and 80 (SD 5) per month, respectively. During this time, COVID-19 cases remained low (Figure 1).<span><sup>4</sup></span> When the number of COVID-19 cases rose in the second half of 2021, the average number of paracetamol therapeutic error cases per month increased.<span><sup>4</sup></span> The mean number of cases after lockdowns ended (22 October 2021–30 June 2022) was 145 per month compared to 120 per month pre-pandemic (p < 0.001).</p><p>In reviewing cases related to paediatrics and adolescents (defined in the database as people ≤19 years of age) prior to COVID-19, the average number of therapeutic error cases was 62.66 (SD 13) per month. After the COVID-19 lockdown periods, the average number of therapeutic error cases per month increased to 80 (SD 26, p < 0.001).</p><p>The lower number of paracetamol therapeutic error cases reported to VPIC during the first two lockdowns could be explained by an overall reduction in viral illness due to prolonged lockdowns and improved infection control (e.g. social distancing, face masks, improved hand hygiene).<span><sup>5</sup></span> The statistically significant increase in paracetamol therapeutic errors in the post-lockdown period, compare
{"title":"Rise in paracetamol therapeutic errors in the community during the COVID-19 pandemic","authors":"Nicole O'Shea BPharm, MClinPharm, MSHP, GradCertPharmPrac, GradCertHlthMgmt, FANZCAP (Tox, MedSafety), Rohan A. Elliott BPharm, BpharmSc(Hons), MClinPharm, PhD, FSHP, FANZCAP (GeriMed, Research), Anselm Wong MBBS, DipTox, PhD, FACEM, FACMT, FAACT, FEAPCCT","doi":"10.1002/jppr.1936","DOIUrl":"10.1002/jppr.1936","url":null,"abstract":"<p>Treatment guidelines for COVID-19 recommend basic analgesics/antipyretics such as paracetamol.<span><sup>1</sup></span> Paracetamol therapeutic errors are associated with morbidity and mortality.<span><sup>2</sup></span> The Victorian Poisons Information Centre (VPIC), the statewide poisons centre for Victoria, Australia, receives calls from members of the public for advice regarding errors made with medicines. Paracetamol therapeutic errors are usually accidental overdoses (e.g. double-dose, maximum daily dose exceeded, incorrectly measured liquid paracetamol, or use of two paracetamol-containing medicines). The aim of this research was to explore the impact of the COVID-19 pandemic on the number of paracetamol therapeutic error cases in the community (outside of hospitals) that were reported to VPIC.</p><p>Call records were extracted from the VPIC database from 1 July 2017 to 30 June 2022 (approximately 2.5 years before and after the first cases of COVID-19 in Victoria). Retrospectively, records were reviewed where callers reported a therapeutic error with any form of paracetamol that occurred in an adult or child in the home or community.</p><p>In the 2.5 years prior to the pandemic there was an average of 120 (standard deviation [SD] 21) paracetamol therapeutic error cases per month. In the 2.5 years from January 2020 there was an average of 116 (SD 33) cases per month, but case numbers varied as the Victorian population went into and out of lockdown (lockdowns were a stay-at-home order to reduce the spread of COVID-19). During the first two Melbourne lockdowns, which occurred between 31 March 2020–12 May 2020 and 9 July 2020–27 October 2020,<span><sup>3</sup></span> the average number of paracetamol therapeutic error cases per month fell to 60 (SD 19) and 80 (SD 5) per month, respectively. During this time, COVID-19 cases remained low (Figure 1).<span><sup>4</sup></span> When the number of COVID-19 cases rose in the second half of 2021, the average number of paracetamol therapeutic error cases per month increased.<span><sup>4</sup></span> The mean number of cases after lockdowns ended (22 October 2021–30 June 2022) was 145 per month compared to 120 per month pre-pandemic (p < 0.001).</p><p>In reviewing cases related to paediatrics and adolescents (defined in the database as people ≤19 years of age) prior to COVID-19, the average number of therapeutic error cases was 62.66 (SD 13) per month. After the COVID-19 lockdown periods, the average number of therapeutic error cases per month increased to 80 (SD 26, p < 0.001).</p><p>The lower number of paracetamol therapeutic error cases reported to VPIC during the first two lockdowns could be explained by an overall reduction in viral illness due to prolonged lockdowns and improved infection control (e.g. social distancing, face masks, improved hand hygiene).<span><sup>5</sup></span> The statistically significant increase in paracetamol therapeutic errors in the post-lockdown period, compare","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 5","pages":"436-438"},"PeriodicalIF":1.0,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1936","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141797046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andre Wang BPharm, Jonathan Yong Jie Lam BPharm, Nazanin Falconer BPharm, PhD, Michael Barras BPharm, GradDipClinPharm, PhD
Background
Medication harm (MH) causes patient morbidity and is a major healthcare burden. Research into MH is growing, but effective methods to identify MH are debated. The prevalence of MH is often based on an incomplete, retrospective chart review or spontaneous reporting, reliant on busy clinicians. A practical and clinically relevant method to detect MH is required. A trigger tool (TT) offers a solution.
Aim
To evaluate a modified TT to prospectively detect MH and determine the prevalence and severity of MH in a geriatric population.
Method
An international TT was peer evaluated and modified for use in a geriatric ward of a quaternary hospital. Patients were recruited over a 6-month period. The TT was applied to prospectively help identify MH, which was assessed for causality and severity. Positive predictive values (PPV) were estimated for each trigger to determine its sensitivity in identifying MH. Ethics approval was granted by the Metro South Human Research Ethics Committee (Reference no: HREC/2022/QMS/80654) and the study conforms to the Australian National Statement on Ethical Conduct in Human Research. Informed consent was obtained from all participants through completion of a written consent form, after a full explanation of the protocol design.
Results
Fifty patients consented, of which 16 (32%) patients experienced one or more MH events. A total of 257 triggers were activated (mean of 5.14 per patient) and 31 (12%) predicted an event. Of the 31 events, 19 (61.3%) events were rated as mild and 12 (38.7%) events were rated as moderate to severe. The most common events were bleeding/large bruising, major constipation, diarrhoea, and vomiting. The triggers with the highest PPV included triggers T5 (bleeding/bruising), T9 (gastrointestinal disorders), and T11 (major constipation) with PPVs of 0.455, 0.238, and 0.286, respectively.
Conclusion
A modified TT helped to detect MH in a geriatric population and will aid in identifying events in future studies.
{"title":"Prospective identification of medication harm in geriatric inpatients using a modified trigger tool","authors":"Andre Wang BPharm, Jonathan Yong Jie Lam BPharm, Nazanin Falconer BPharm, PhD, Michael Barras BPharm, GradDipClinPharm, PhD","doi":"10.1002/jppr.1929","DOIUrl":"10.1002/jppr.1929","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Medication harm (MH) causes patient morbidity and is a major healthcare burden. Research into MH is growing, but effective methods to identify MH are debated. The prevalence of MH is often based on an incomplete, retrospective chart review or spontaneous reporting, reliant on busy clinicians. A practical and clinically relevant method to detect MH is required. A trigger tool (TT) offers a solution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate a modified TT to prospectively detect MH and determine the prevalence and severity of MH in a geriatric population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>An international TT was peer evaluated and modified for use in a geriatric ward of a quaternary hospital. Patients were recruited over a 6-month period. The TT was applied to prospectively help identify MH, which was assessed for causality and severity. Positive predictive values (PPV) were estimated for each trigger to determine its sensitivity in identifying MH. Ethics approval was granted by the Metro South Human Research Ethics Committee (Reference no: HREC/2022/QMS/80654) and the study conforms to the <i>Australian National Statement on Ethical Conduct in Human Research</i>. Informed consent was obtained from all participants through completion of a written consent form, after a full explanation of the protocol design.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty patients consented, of which 16 (32%) patients experienced one or more MH events. A total of 257 triggers were activated (mean of 5.14 per patient) and 31 (12%) predicted an event. Of the 31 events, 19 (61.3%) events were rated as mild and 12 (38.7%) events were rated as moderate to severe. The most common events were bleeding/large bruising, major constipation, diarrhoea, and vomiting. The triggers with the highest PPV included triggers T5 (bleeding/bruising), T9 (gastrointestinal disorders), and T11 (major constipation) with PPVs of 0.455, 0.238, and 0.286, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A modified TT helped to detect MH in a geriatric population and will aid in identifying events in future studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 5","pages":"376-383"},"PeriodicalIF":1.0,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1929","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141802218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Iouri Banakh BPharm, MClinPharm, Stephen Louey BPharm, MClinPharm, Graham Rivers BSc, PgD Pharm Practice, Tavan Hem BPharm, Lili Israelian BPharm, Junwon Kang BPharm, Vivienne Luu BPharm, Firuz Tanyeri MBChB, Rachel Rosler MBChB, FACEM
Background
Sepsis and septic shock are common emergency department (ED) presentations, with current guidelines recommending early administration of antibiotics to reduce mortality.
Aim
Sepsis calls with pharmacist attendance have been introduced at two EDs, and the aim of this study was to evaluate the impact of this service on outcomes of all septic patients.
Method
At a multisite, single healthcare network, located in Victoria, Australia, emergency medicine pharmacists were trained in assisting medical staff in antibiotic selection, dosing, and delivering antibiotics directly to nursing staff. The sepsis call service was introduced in May 2022 at one site and in March 2023 at another site, with time to first antibiotic administration, morbidity, and mortality being compared to the outcomes of patients from the same EDs from January–April 2022 (group 1). Post the sepsis call introduction, two cohorts were compared: sepsis call attended patients without a pharmacist (group 2) and with a pharmacist (group 3). This project was exempt due to the local policy requirements that constitute research by the Monash Health Human Research Ethics Committee (Reference no: RES-23-0000-237Q). The justification for this ethics exemption was as follows: the study was retrospective, included privacy protections for patients' data, and presented no increased risk to patient care.
Results
The study included 201 patients, with time to first antibiotic administration on average 302.0 min in group 1, 201.3 min (p = 0.007) in group 2, and 89.8 min (p < 0.001) in group 3. Mortality (p = 0.306), rates of acute kidney injury (p = 0.111), intensive care unit (ICU) admission (p = 0.002), and need for dialysis (p = 0.497) were all reduced in group 3. Adherence to antibiotic guidelines was increased in group 3 (p < 0.001).
Conclusion
Emergency medicine pharmacist contribution led to reduced time to first antibiotic, an improved adherence to antibiotic guidelines, and positive trends in secondary clinical outcomes. Further research is required to determine the significance of improvements in mortality, intensive care unit admissions, and renal impairment.
{"title":"Sepsis call emergency department pharmacist service: a single healthcare network cohort study","authors":"Iouri Banakh BPharm, MClinPharm, Stephen Louey BPharm, MClinPharm, Graham Rivers BSc, PgD Pharm Practice, Tavan Hem BPharm, Lili Israelian BPharm, Junwon Kang BPharm, Vivienne Luu BPharm, Firuz Tanyeri MBChB, Rachel Rosler MBChB, FACEM","doi":"10.1002/jppr.1931","DOIUrl":"10.1002/jppr.1931","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sepsis and septic shock are common emergency department (ED) presentations, with current guidelines recommending early administration of antibiotics to reduce mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Sepsis calls with pharmacist attendance have been introduced at two EDs, and the aim of this study was to evaluate the impact of this service on outcomes of all septic patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>At a multisite, single healthcare network, located in Victoria, Australia, emergency medicine pharmacists were trained in assisting medical staff in antibiotic selection, dosing, and delivering antibiotics directly to nursing staff. The sepsis call service was introduced in May 2022 at one site and in March 2023 at another site, with time to first antibiotic administration, morbidity, and mortality being compared to the outcomes of patients from the same EDs from January–April 2022 (group 1). Post the sepsis call introduction, two cohorts were compared: sepsis call attended patients without a pharmacist (group 2) and with a pharmacist (group 3). This project was exempt due to the local policy requirements that constitute research by the Monash Health Human Research Ethics Committee (Reference no: RES-23-0000-237Q). The justification for this ethics exemption was as follows: the study was retrospective, included privacy protections for patients' data, and presented no increased risk to patient care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 201 patients, with time to first antibiotic administration on average 302.0 min in group 1, 201.3 min (p = 0.007) in group 2, and 89.8 min (p < 0.001) in group 3. Mortality (p = 0.306), rates of acute kidney injury (p = 0.111), intensive care unit (ICU) admission (p = 0.002), and need for dialysis (p = 0.497) were all reduced in group 3. Adherence to antibiotic guidelines was increased in group 3 (p < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Emergency medicine pharmacist contribution led to reduced time to first antibiotic, an improved adherence to antibiotic guidelines, and positive trends in secondary clinical outcomes. Further research is required to determine the significance of improvements in mortality, intensive care unit admissions, and renal impairment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 5","pages":"368-375"},"PeriodicalIF":1.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141650207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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