Journal of Pharmacy Practice and Research最新文献

Medication-related harm can occur during transitions of care. Revised Home Medicines Review (HMR) and Residential Medication Management Review (RMMR) program rules were published in April 2020 which allowed provision for some hospital medical practitioners to refer at-risk patients for medication review. In turn, the Society of Hospital Pharmacists of Australia's (SHPA's) Transitions of Care and Primary Care Leadership Committee developed a framework to support hospitals facilitating Hospital-Initiated Medication Reviews (HIMRs) via three pathways: HMR, RMMR, and Hospital Outreach Medication Review. Following the compilation of draft barriers and enablers to implementation of the SHPA HIMR framework, refinement occurred after broad consultation with hospital- and primary care-based pharmacists with transitions of care experience. The finalised list of barriers and enablers can inform broadscale implementation of the SHPA HIMR framework to reduce medication-related harm when high-risk patients transition from hospital to primary care and aged care.

The average age of surgical candidates is increasing with the ageing population worldwide. Major surgery in older patients is associated with a significant risk of complications due to physiologic changes occurring with ageing and individual patient factors such as frailty, polypharmacy, and multimorbidity. Periodic medication review should be part of the routine management of all older patients, with the perioperative period presenting an opportune time for this review. Regular medications may need short-term modification during the surgical period. Medications implicated in increasing risk of inducing or worsening delirium should be identified and withdrawal considered ahead of time. Perioperative commencement of medication aimed at reducing risk of other complications, including cardiovascular events, should be considered on an individual basis, analysing risks and benefits. Comprehensive medication review and careful planning through the perioperative period may enhance the prospects of recovery and reduce morbidity and mortality for older surgical patients.

To the Editor,

We thank Elliott et al.¹ and Misko et al.² for their feedback on our recent scoping review.³ They both provided valuable feedback for future benchmarking studies. We acknowledge that these limitations may impact state or territory-based benchmarking but reinforce that the national benchmarking offered by our paper appears useful for such sites to compare against.

Amy Page is an Editorial Board member of the Journal of Pharmacy Practice and Research and a co-author of this article. To minimise bias, she was excluded from all editorial decision-making related to the acceptance of this article for publication.

All listed authors comply with the Journal's authorship policy.

No ethics approval was required for this letter to the editor.

The handover of medication-related information at the point of discharge often occurs via the discharge summary (DS), although these frequently contain errors. We aimed to investigate whether an intern pharmacist reviewing the medication details in discharge summaries (DSs), reconciling them with the discharge prescription and pointing out any discrepancies with the medical staff would reduce the rate of medication errors. The intervention was retrospectively reviewed by comparing medication information on the DS with the discharge prescription (considered the ‘source of truth’). Error rates on the DS were compared to a control group of patients discharged over a different 2-week period from the same ward. A modified APINCH (Antimicrobials, Potassium and other electrolytes, Insulin, Narcotics and other sedatives, Chemotherapeutic agents, Heparin and other anticoagulants, Systems) classification system was used to identify high-risk errors. The time taken to perform the intervention was measured and details of any recommendations collected. The study included 22 intervention patients and 31 control patients. Patients who received the intervention were less likely to have one or more medication errors on their DS (any: 4% vs 84%, p < 0.01; high-risk: 0% vs 29%, p < 0.01). The intern pharmacist made a total of 77 recommendations during the intervention. Six recommendations (8%) related to high-risk medications. The median time required to undertake the first review was 4 min, and the second review took 1 min. In conclusion, we found a reconciliation-based intervention involving an intern pharmacist could reduce the rate of medication errors on DSs.

Surgical antibiotic prophylaxis (SAP) reduces the risk of surgical site infections following open reduction internal fixation (ORIF) procedures. Current guidelines recommend the use of single-dose prophylaxis for ORIF procedures. It is known that adherence to SAP guidelines is suboptimal across multiple surgical disciplines, including orthopaedic surgery. The aim of this study was to identify how Australian orthopaedic surgeons self-report prescribing of SAP for ORIF of closed fractures and whether practice adheres to recommendations in the Therapeutic Guidelines: Antibiotic version 16. An online survey was distributed to Australian orthopaedic surgeons between August 2020 and February 2021. The survey consisted of 10 questions relating to SAP prescribing practice for ORIF of closed fractures, guideline awareness, and factors that influence prescribing. Twenty-two surgeons participated in the survey. All 22 surgeons reported prescribing the guideline-adherent agent cefazolin for ORIF procedures, with 68.2% (n = 15) prescribing the non-adherent agent clindamycin for patients with a severe penicillin allergy. Almost two-thirds of the surgeons (63.6%) prescribe postoperative antibiotics, with two postoperative doses the most common regimen (57.1%). Although 63.6% of surgeons were aware of guideline content, adherence to guidelines varied. Surgeons noted that multiple factors influence their prescribing practice, including knowledge gained from personal readings (77.3%), habits developed during training (68.2%), and discussion with colleagues (63.6%). Factors that influence SAP decision making for ORIF procedures are multifactorial, with variable levels of guideline adherence. This small cohort of surgeons commonly reported prescribing postoperative antibiotics. Further research is required to understand what influences SAP decision-making.