Journal of Pharmacy Practice and Research最新文献

Older adults are at high risk of drug-related problems during hospitalisation for surgery. Pharmacists play a key role in the multidisciplinary health care team to improve the safety and quality use of medicines in hospitals. The aims of this prospective study were to examine the frequency, type, associated factors, and acceptance rates of pharmacist consultations in a cohort of 302 consecutive patients aged ≥65 years admitted to a tertiary vascular surgery unit. Data collected included frequency and type of pharmacist consultations, patient and clinical characteristics, and the rate of acceptance of pharmacist recommendations. There was a total of 299 pharmacist consultations, with 159 (52.6%) patients being reviewed at least once by a pharmacist. Of the 299 pharmacist consultations, the most common reason for consultation was a medication order review (38.8%). Pharmacist consultation was more likely if the patient had an emergency admission (p = 0.045), had admission to intensive care unit during the hospitalisation (p < 0.001), or had a long-stay admission defined as >14 days (p < 0.001). Older age, frailty status, cognitive impairment, polypharmacy, and operative management were not associated with having a pharmacist review. Of these pharmacist consultations, 190 (63.5%) included recommendations for the care team to implement, and 166 (87.4%) of the 190 recommendations were addressed. These findings provide insight into the roles played by hospital pharmacists and suggest an unmet need for proactive pharmacist consultation for older surgical patients with polypharmacy, frailty, and cognitive impairment. Ethical approval was granted by the Sydney Local Health District Human Research Ethics Committee — Concord Hospital (Reference no: CH62/6/2018–170) and the study conforms to the Australian National statement on ethical conduct in human research.

At our quaternary teaching hospital in Queensland, Australia, there has been a rapid increase from 2019 to 2022 in the usage of fibrinogen concentrate (FC) in preference to cryoprecipitate for cardiac surgery. FC is indicated for patients having major trauma requiring haemostatic resuscitation, major intraoperative haemorrhage, or liver transplant patients with major intraoperative haemorrhage. These patients must exhibit severe hypofibrinogenaemia, which is assessed using assay cut-offs of thromboelastogram (TEG) (citrated functional fibrinogen [CFF] ≤ 10 mm) or rotational thromboelastometry (ROTEM) (FIBTEM A5 ≤ 8 mm). FC usage over cryoprecipitate for cardiac surgery is an ongoing debate due to advantages such as dose predictability, rapid reconstitution, viral inactivation, and minimal transfusion-related adverse events; however, it is expensive. The aim of this study was to capture prescribing patterns of FC and appropriateness against local guidelines. Retrospective data were analysed, and the practice was compared to hospital guidelines. Data from 52 patients over a 4-year period (2019–2022) showed intraoperative haemorrhage was the leading indication for FC use (65%, n = 34), followed by liver transplantation (27%, n = 14), and major trauma (8%, n = 4). When breaking down the cause of intraoperative haemorrhage, cardiothoracic surgery, both elective (50%, n = 17) and emergency procedures (41%, n = 14), accounted for 91% of all operative bleeding requiring FC. There were 34 (65%) of 52 patients who received a differing dose of FC compared to what was recommended in the hospital guideline, with 50% (n = 17) receiving a higher than recommended dose and 50% (n = 17) receiving lower than recommended doses. This project was exempt due to the local policy requirements that constitute research by the Metro South Human Research Ethics Committee (Reference no: CM2305202303). The justification for this exemption was as follows: the study presented no foreseeable risk of patient harm as it involved evaluation of standard care involved the use of existing non-identifiable patient records.

Within our hospital network, the PINCH acronym (Potassium, Insulin, Narcotics, Chemotherapeutics, Heparin) designates high-risk medications. As per local guidelines, double-checking is mandated at the point of administration. This retrospective audit aimed to assess nursing and midwifery staff's ability to recognise PINCH medications by examining their adherence to double-signing protocols, serving as an indicator of double-checking. The analysis included overall compliance proportions, categorised by PINCH class and further stratified based on location, specialty, and staffs' level of training. An analysis of the first thousand PINCH medication administrations from 1 January 2023 was conducted, spanning four sites within our hospital network. Data sourced from the Electronic Medication Record system were refined to include one medication per patient per day, totalling 200 administrations per PINCH category. The results revealed that 896 (89.6%) out of 1000 medication administrations were co-signed, with narcotics showing a co-signature rate of 100%, followed by potassium at 99%, heparin at 98%, insulin at 97.5%, and chemotherapeutics at 53.5%. Among the orders lacking co-signature, 90% pertained to chemotherapeutics and the remaining 10% were distributed across other categories. Stratifying by location showed 28 (17.6%) out of 159 administrations in a subacute setting lack co-signature, compared to 76 (6%) from 841 in an acute setting. Compliance rates were highest in specialty medicine at 94.3%, followed by surgical at 86.2%, general medicine 84.5%, women and children's and mental health units at 83.3% each, and continuing care at 82.2%. Notably, enrolled nurses exhibited the highest level of compliance with co-signatures. Future research could explore the impact of educational strategies on the administration of high-risk medications. Ethical approval was granted by the Eastern Health Office of Research and Ethics (Reference no: QA23-075-101 386) and the study conforms to the National Statement on Ethical Conduct in Human Research.

Recent medicine shortages in Australia have significantly impacted pharmacists' professional practice. The inability to provide essential medicines to consumers in a timely manner has increased pharmacist workload whilst attempting to maintain quality patient care during and after the COVID-19 pandemic. This study aimed to investigate the impact of medicine shortages on the operational responsibilities of community pharmacists, their ability to deliver health care, and the personal impact on community pharmacists. A nationwide anonymous survey was distributed to Australian community pharmacists via the Qualtrics survey platform between April – September 2023. Of the 142 pharmacists who responded to this survey, 89.5% (n = 127) reported having to purchase medicines from sources other than their regular wholesaler on at least a weekly basis in the last 3 months. The same number reported that they frequently needed to substitute medicines because of ongoing shortages. Most pharmacists (n = 128, 90.1%) reported that their workload had been affected by medicine shortages and that their motivation and engagement with work were frequently affected (n = 79, 55.7%). Pharmacists reported taking on additional administrative responsibilities to ensure access to treatment and health care. Current regulatory restrictions regarding the substitution of medicine dosage forms are often implemented only after community pharmacists are affected by medicine shortages. This survey highlights the need for improved awareness of medicine shortages and timely actions to be taken to ensure pharmacist wellbeing and patient access to health care in the face of medicine shortages. Ethics approval was granted by the University of South Australia Human Research Ethics Committee (Reference no.: 205399) and the study conforms with the Australian National Statement on Ethical Conduct in Human Research. Informed consent was obtained from all participants.