Clinical practice after hours and attendance at medical emergency team (MET) calls are two novel and emerging areas of pharmacy practice. During the COVID-19 pandemic, our institution's pharmacy services expanded from 8 am–5 pm to 24 h daily, including MET call attendance.
This study aimed to describe pharmacist roles, including medications charted by the general medicine and intensive care unit pharmacists during the period of extended-hours pharmacy practice and the characteristics of MET calls attended.
This descriptive, cross-sectional study included patients admitted to the Alfred Hospital, Victoria, Australia between 3 April 2020–28 February 2021, when a MET was called between 5 pm–8 am, a pharmacist attended, and medication changes occurred. Data collected included whether the MET call was medication related and a description of medication changes. Ethics approval was granted by the Alfred Hospital Human Research Ethics Committee (Reference no: 297/21).
One thousand six hundred and forty-four MET calls (average 5.4 calls per night) were attended by pharmacists during extended hours. Medication changes were made in response to clinical deterioration at 627 (38%) calls. The most frequent change was the initiation of cardiovascular medications (n = 206). Partnered pharmacist medication charting, including commencing, ceasing, or changing medications, occurred at 39% of MET calls with therapy changes.
Pharmacists can play a key role in managing deteriorating patients as part of a MET team. Medications may be implicated in clinical deterioration of patients and are frequently administered at MET calls. The expansion of pharmacy services provided the opportunity for pharmacists to contribute to MET calls across the 24-h period.
It is with great pleasure and pride that I introduce this reprint of Rohan Elliott and Michael Woodward's article, ‘Thirty years of Geriatric Therapeutics’, originally published in 2016.1 As a founding member of the Geriatric Therapeutics Editorial Committee in 1986, reading this article feels like a nostalgic stroll down memory lane, to a time where knowledge of the impact of ageing on medication safety was limited, and we were innocently oblivious to the impending explosion of information and therapeutic advances that lay ahead.
Driven by altruistic ambition, in 1986 the pharmacy department at Melbourne's Heidelberg Repatriation Hospital (‘the Repat’) embarked on an educational mission to improve prescribing for our ageing war veteran population. Our aim was to raise prescribers' awareness of the fact that older individuals handle medications differently, and respond differently, compared to their younger counterparts. To achieve this aim, we approached consultant physicians at the Repat, requesting them to write an article within their specialty, with a focus on treating older people. By doing so, we aimed to deepen their understanding of the complexities associated with elderly patients. We hoped that this subtle approach would enhance the consultant's knowledge, while also educating a broader clinical readership.
Fortunately, the newly appointed director of geriatrics at the Repat, Dr David Fonda, enthusiastically agreed to join our small editorial team. It was his task to approach the consultants and encourage their contributions to the newsletter. We had no reservations about leveraging our greatest asset: it was indeed challenging for authors to decline David's requests. Each Geriatric Therapeutics article was published in the pharmacy's monthly newsletter, which was distributed across all clinical areas within the hospital.
The enduring interest in our articles persisted over the ensuing years and was further bolstered by the addition of geriatrician Dr Michael Woodward to the editorial team. The column's professionalism received a significant boost when this Journal agreed to publish our articles from 1991, leading to an expanded distribution. With Michael at the helm of the editorial committee, and articles published in the Journal, authors were able to be recruited beyond the initial primary targets at the Repat hospital, and over the years leading physicians from throughout Australia contributed articles. As clinical pharmacy practice developed and matured, pharmacists with expertise in the care of older people were also invited to contribute articles.
The Geriatric Therapeutics series (more recently known as Geriatric Therapeutics Review) also owes much to the dedication and unparalleled commitment of Rohan Elliott, who joined the editorial committee in 1999 and became the editor in 2014. Without his input, Geriatric Therapeutics Review would not have achieved a remark
Clofazimine is recommended as a treatment for tuberculosis in infants. Extemporaneously prepared clofazimine oral suspensions are more appropriate dosage forms for infants than tablets, however no data exist to inform appropriate storage conditions.
To examine the physical and chemical stability of extemporaneously prepared clofazimine oral suspensions and determine appropriate storage conditions.
An oral suspension of clofazimine 10 mg/mL was prepared by grinding six 100 mg clofazimine tablets to produce a fine powder. Ora-Blend SF (sugar free) was added to make a final volume of 60 mL. Six 10 mL aliquots were placed in amber plastic bottles with plastic bottle caps. Three bottles were stored at room temperature, and three bottles were refrigerated at 4°C. Following shaking, a 1 mL sample was taken from each bottle on days 0, 7, 14, 28, and 60. Samples were assayed using the high-performance liquid chromatography method. The samples were visually examined for colour change and separation at each time point. Stability was defined as the retention of at least 90% of the initial concentration. Ethics approval was not required for this research article as it was a stability study that did not involve human subjects.
The clofazimine content remained >94% of the initial concentration throughout the 60-day period for samples that were kept at room temperature, and slightly <90% (87.4%) for samples that were kept refrigerated at 4°C. No separation or colour change was noted throughout the 60-day period for both preparations.
Extemporaneously prepared suspensions of clofazimine in Ora-Blend SF were chemically stable for at least 60 days when stored at room temperature. Clofazimine degraded slightly more rapidly at 4°C compared to room temperature.
The Geriatric Therapeutics Review series (originally Geriatric Therapeutics) began as a local publication at the Heidelberg Repatriation Hospital in Melbourne in 1986. Its aim was to raise awareness and educate physicians about the special considerations needed when prescribing for ‘geriatric’ patients, at a time when there were few guidelines and reference texts to guide prescribing for older people. Geriatric Therapeutics Review articles have been published in the Journal since 1991, expanding its audience to pharmacists and other readers. For many years, reprints were distributed to members of the Australian and New Zealand Society for Geriatric Medicine.
Nearly 40 years later, the landscape has changed. Geriatric medicine has become one of the largest medical specialties in Australia, and an area of specialisation for many Australian pharmacists working in hospitals, residential care, and primary care. Information, guidelines, and professional development related to prescribing and medication management for older people are readily accessible.
The Geriatric Therapeutics Review series, comprising 146 peer-reviewed articles covering many areas of therapeutics and medication management (Table 1), has made a significant contribution to increased awareness and knowledge, thus achieving its aim. And so, the time has come to draw the series to a close.
This issue of the Journal celebrates the Geriatric Therapeutics Review series by looking back at a selection of vintage and seminal articles. Each article is accompanied by an introduction and commentary from a past author or guest commentator. There are also two new articles to round out the series.
We start with a reprint of the first Geriatric Therapeutics article published in the Journal, in 1991, titled ‘Problems associated with drug use in the elderly’.1 This article was written by Dr David Fonda, the first geriatrician appointed at the Heidelberg Repatriation Hospital (in 1983). David has also written the accompanying introduction and commentary, in which he reflects on the state of geriatric medicine in the 1980s, the origins of the Geriatric Therapeutics series, and how medication use has changed since he wrote his original article more than 30 years ago. Although much has changed, many of the problems addressed in David's original article remain relevant today.
Next is a reprint of an article on diabetes from 1991, written by the late Dr Mario De Luise.2 The introduction and commentary are written by Dr Tilenka Thynne, clinical pharmacologist and endocrinologist. Tilenka's commentary reflects on the limited treatment options that were available in the 1990s and the huge advances in diabetes therapeutics that have occurred since. As therapeutic options for diabetes evolved over the years, the Geriatric Therapeutics Review series published additional articles on this topic, including one co-au
Vitamin B12 deficiency is common in older people and is linked to anaemia, cognitive decline, and dementia. Clinical presentation is variable, ranging from no symptoms or subtle, non-specific symptoms, through to serious, irreversible neurological symptoms if left untreated. Although common, it is often under-recognised, with diagnosis usually occurring on incidental blood test screening. Older people are at increased risk of vitamin B12 deficiency due to insufficient dietary intake, malabsorption associated with aged-related changes in gastrointestinal function, higher incidence of pernicious anaemia, and chronic use of interfering medications such as metformin and proton-pump inhibitors. Early detection and treatment in symptomatic deficiency are crucial to prevent irreversible damage. Vitamin B12 intramuscular injection bypasses potential absorption issues and is traditionally the first-line treatment in older people. However, emerging evidence suggests that high-dose oral replacement may be as effective. Older people often require lifelong therapy due to the irreversible nature of the underlying cause of deficiency. This review provides an overview of vitamin B12 deficiency and its management in older people.
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