Journal of Pharmacy Practice and Research最新文献

Doctors are perceived as the primary decision makers in antimicrobial therapy, but prescribing decisions are influenced by the multidisciplinary team. Antimicrobial stewardship (AMS) programs formalise interprofessional advice-giving. No studies capture the advice provided by pharmacists. This study aimed to describe the volume and nature of antimicrobial prescribing advice that healthcare professionals seek from hospital pharmacists. A prospective audit of antimicrobial-related advice requests received by pharmacists (n = 18) at an Australian public hospital was undertaken in July 2020. Antimicrobial advice was sought from 11 pharmacists on 300 occasions. Most requests (80%) were received by the AMS pharmacist. A mean (range) of 30 (17–40) requests per day was recorded and the AMS pharmacist received 24 (16–31) requests daily. Most requests came from the intensive care unit (22.1%), pharmacy (21.4%), and infectious diseases (17.1%). The AMS pharmacist was mostly contacted by consultants and pharmacists, and other pharmacists were contacted by registrars and junior medical officers. Despite COVID-19 adaptations, face-to-face interaction was most common. This audit demonstrates the value of an AMS pharmacist, and indicates the importance of face-to-face interactions and the formalisation of pharmacists' role in prescribing decision-making. Pharmacists provided antimicrobial advice daily to other healthcare professionals. Further research is required to provide insights into the barriers and enablers to effective advice-giving interactions.

The United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) remains the most comprehensive international instrument on the rights of First Nations peoples around the world, setting standards for survival, dignity, and wellbeing. Under the UNDRIP, the Aboriginal and Torres Strait Islander Peoples of Australia “have an equal right to the enjoyment of the highest attainable standard of physical and mental health”.¹ In 2017, when the UNDRIP was first adopted by the United Nations General Assembly, Australia was one of four countries who did not vote in support. Whilst Australia and its three counterparts later reversed their positions and now support the UN declaration, this chapter in history illustrates the challenges that face those seeking to address discriminatory attitudes within the Australian community.

Throughout Australia, freedom from racism at work is protected by legislation, the Fair Work Act 2009.² When bias, discrimination, and racism occur in the workplace “the psychological and cultural safety of staff” is threatened, “feelings of acceptance and respect at work” are weakened, and the burnout of staff may result.³ It is important that leaders and managers understand the effects of structural racism on workplace dynamics, and that they identify and act on incidences of racism in the workplace.

This understanding is crucial, not only to fostering a workplace that is free from racism, but for ensuring all pharmacists have access to training and education to further develop their own cultural capacity, communication skills, and ability to connect with First Nations Peoples. These competencies are described within the National Competency Standards Framework for Pharmacists in Australia,⁴ the Pharmacy Council of New Zealand's Competence Standards for the Pharmacy Profession,⁵ and internationally.

A pharmacists' development of cultural competency can be accelerated by undertaking cultural responsiveness training and focusing on developing appropriate communication skills that enable the delivery of care to First Nations Peoples in a culturally safe manner. Undergraduate pharmacy programs and pharmacy intern training programs in Australia are including these elements of pharmacy practice within their curriculums, so Australia's newly registered pharmacists are arguably the most culturally responsive we have ever had.

But what of their leaders and managers?

Successful leaders can often point to mentors who have guided elements of their career. ‘Mentors’ are defined within the Australian Competency Standards Framework as “those who share their knowledge, expertise and experience on career, technical, professional and cultural issues with another individual”.⁴ Amongst those you consider your mentors, is there someone fro

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.