Vaccines are temperature-sensitive, and they may lose effectiveness without correct storage. Research in remote Australia raised questions regarding the integrity of the vaccine cold chain to Aboriginal communities and prompted the development of a video resource, Vaccine Story, to raise awareness of maintaining the cold chain. This study describes the development and evaluation of the Vaccine Story video. Local engagement helped to refine and produce the video. Ethics approval was gained from the Menzies School of Health Research Human Ethics Committee (20–3807) and the Central Australian Human Ethics Committee (17–2869) in 2020. The evaluation was considered low risk to all participants. An online anonymous survey tested the appropriateness and effectiveness of the Vaccine Story video to enhance knowledge and awareness of risks to the vaccine cold chain and the potential implementation of the Vaccine Story video. Diverse health professionals and other staff (n = 83) completed the survey. Responses highlighted a lack of training around the packing and transport of vaccines, particularly for non-clinical support staff. Respondents stated the health messaging in the Vaccine Story video was effective. Over half of respondents (52%) recommend the use of the video as a training tool. The Vaccine Story video addresses some concerns regarding vaccine transportation and storage in remote Aboriginal communities through strengthening understanding of the importance of cold chain.
{"title":"Vaccine cold chain in remote environments: culturally appropriate training opportunities, an evaluation","authors":"Suzanne Belton PhD, Rosalie Schultz PhD, Tobias Speare MPH","doi":"10.1002/jppr.1862","DOIUrl":"10.1002/jppr.1862","url":null,"abstract":"<p>Vaccines are temperature-sensitive, and they may lose effectiveness without correct storage. Research in remote Australia raised questions regarding the integrity of the vaccine cold chain to Aboriginal communities and prompted the development of a video resource, Vaccine Story, to raise awareness of maintaining the cold chain. This study describes the development and evaluation of the Vaccine Story video. Local engagement helped to refine and produce the video. Ethics approval was gained from the Menzies School of Health Research Human Ethics Committee (20–3807) and the Central Australian Human Ethics Committee (17–2869) in 2020. The evaluation was considered low risk to all participants. An online anonymous survey tested the appropriateness and effectiveness of the Vaccine Story video to enhance knowledge and awareness of risks to the vaccine cold chain and the potential implementation of the Vaccine Story video. Diverse health professionals and other staff (<i>n</i> = 83) completed the survey. Responses highlighted a lack of training around the packing and transport of vaccines, particularly for non-clinical support staff. Respondents stated the health messaging in the Vaccine Story video was effective. Over half of respondents (52%) recommend the use of the video as a training tool. The Vaccine Story video addresses some concerns regarding vaccine transportation and storage in remote Aboriginal communities through strengthening understanding of the importance of cold chain.</p>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1862","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43755094","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}
Nur Fazlini Ismail BPharm, Centaine Snoswell PhD MPH BPharm, Vivien Banks BPharm, Nazanin Falconer PhD DipGrad BPharm
Background
The implementation of digital healthcare systems in hospitals globally and in Australia has led to the introduction of the informatics pharmacist as a career in the healthcare system. However, informatics pharmacists are not yet part of routine clinical services in Australia, so their perspective and roles are not well understood.
Aim
To explore pharmacists' and other health professionals' perspectives of the roles of informatics pharmacists within interprofessional teams in Australian health care.
Method
This study used semi-structured interviews with experts in pharmacy and/or informatics. They were recruited using convenience sampling and snowballing. The interviews were audio-recorded and transcribed and analysed using inductive thematic techniques to identify major themes. Ethical approval was received from the local institutional Human Research Ethics Committee (Approval No: 2020000069).
Results
The process of inductive thematic analysis was used to analyse the interview transcriptions of 11 participants. Six themes were identified: (1) a promising future for the informatics pharmacists, (2) education, (3) specific skills, (4) scope of informatics role, (5) impacts, and (6) barriers. Participants described the career of informatics pharmacists as an emerging specialty in today's healthcare systems. The roles of informatics pharmacists in Australian health care are described together with the skills and knowledge required for these roles.
Conclusion
A key role of informatics pharmacists is to facilitate the appropriate use of digital systems to prevent medication errors and improve patients' safety. While international experience has shown the potential scope for an informatics pharmacist, this research shows the use of informatics pharmacists in Australia is in its infancy.
{"title":"The roles and perspectives of an informatics pharmacist practicing in the Australian healthcare setting: a qualitative study","authors":"Nur Fazlini Ismail BPharm, Centaine Snoswell PhD MPH BPharm, Vivien Banks BPharm, Nazanin Falconer PhD DipGrad BPharm","doi":"10.1002/jppr.1860","DOIUrl":"10.1002/jppr.1860","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The implementation of digital healthcare systems in hospitals globally and in Australia has led to the introduction of the informatics pharmacist as a career in the healthcare system. However, informatics pharmacists are not yet part of routine clinical services in Australia, so their perspective and roles are not well understood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To explore pharmacists' and other health professionals' perspectives of the roles of informatics pharmacists within interprofessional teams in Australian health care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>This study used semi-structured interviews with experts in pharmacy and/or informatics. They were recruited using convenience sampling and snowballing. The interviews were audio-recorded and transcribed and analysed using inductive thematic techniques to identify major themes. Ethical approval was received from the local institutional Human Research Ethics Committee (Approval No: 2020000069).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The process of inductive thematic analysis was used to analyse the interview transcriptions of 11 participants. Six themes were identified: (1) a promising future for the informatics pharmacists, (2) education, (3) specific skills, (4) scope of informatics role, (5) impacts, and (6) barriers. Participants described the career of informatics pharmacists as an emerging specialty in today's healthcare systems. The roles of informatics pharmacists in Australian health care are described together with the skills and knowledge required for these roles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A key role of informatics pharmacists is to facilitate the appropriate use of digital systems to prevent medication errors and improve patients' safety. While international experience has shown the potential scope for an informatics pharmacist, this research shows the use of informatics pharmacists in Australia is in its infancy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1860","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45259629","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}
Lewis Bint BPharm, MBA, Matthew Rawlins BPharm, MBA, Ashleigh Lawrence BPharm, Hons, Ken Tam BPharm, Barry Jenkins BPharm
Background
Liquid opioids (controlled drugs) in multidose bottles (MDBs) are associated with measurement losses, overfill variance, gradual contamination, and potential theft. Western Australian state poisons regulations and policies require rigorous accountability and previous reports have highlighted shortcomings in historical arrangements.
Aim
To describe the process and outcomes of a transition to unit dose pod (UDP) formulations for oral liquid opioids at our institution.
Method
A UDP of oral oxycodone liquid was developed in partnership with a third-party compounder and piloted on a paediatric ward. Additional UDP opioid formulations were developed and gradually replaced MDBs across our institution. Reportable discrepancies and staff satisfaction were compared between MDBs and UDPs. This project was registered as a quality improvement project (GEKO 27758) and considered exempt from human research and ethics approval by the South Metropolitan Health Service Human Research Ethics Committee.
Results
Between May 2017 and May 2018, 3062 UDPs were distributed with nil discrepancies, and 133 MDBs were distributed with 16 discrepancies (0% vs 12%). Most staff (92%) reported more efficient inventory counts and improved confidence in product integrity for UDPs. Staff administrative overhead required to manage reportable discrepancies from volume errors was essentially eliminated. Five UDP opioid formulations were implemented in 27 inpatient wards including methadone-maintenance UDPs for inpatient use. By late 2020, UDPs were in use across 19 hospitals in Western Australia (WA), with annual use exceeding 33 000 units.
Conclusion
The UDP simplifies the management of controlled drug liquids by eliminating discrepancies associated with MDBs inventory management and increasing staff confidence in product quality, leading to significant uptake across WA.
{"title":"Developing a unit dose approach to managing oral opioid liquids in an Australian hospital","authors":"Lewis Bint BPharm, MBA, Matthew Rawlins BPharm, MBA, Ashleigh Lawrence BPharm, Hons, Ken Tam BPharm, Barry Jenkins BPharm","doi":"10.1002/jppr.1861","DOIUrl":"10.1002/jppr.1861","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Liquid opioids (controlled drugs) in multidose bottles (MDBs) are associated with measurement losses, overfill variance, gradual contamination, and potential theft. Western Australian state poisons regulations and policies require rigorous accountability and previous reports have highlighted shortcomings in historical arrangements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To describe the process and outcomes of a transition to unit dose pod (UDP) formulations for oral liquid opioids at our institution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A UDP of oral oxycodone liquid was developed in partnership with a third-party compounder and piloted on a paediatric ward. Additional UDP opioid formulations were developed and gradually replaced MDBs across our institution. Reportable discrepancies and staff satisfaction were compared between MDBs and UDPs. This project was registered as a quality improvement project (GEKO 27758) and considered exempt from human research and ethics approval by the South Metropolitan Health Service Human Research Ethics Committee.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between May 2017 and May 2018, 3062 UDPs were distributed with nil discrepancies, and 133 MDBs were distributed with 16 discrepancies (0% vs 12%). Most staff (92%) reported more efficient inventory counts and improved confidence in product integrity for UDPs. Staff administrative overhead required to manage reportable discrepancies from volume errors was essentially eliminated. Five UDP opioid formulations were implemented in 27 inpatient wards including methadone-maintenance UDPs for inpatient use. By late 2020, UDPs were in use across 19 hospitals in Western Australia (WA), with annual use exceeding 33 000 units.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The UDP simplifies the management of controlled drug liquids by eliminating discrepancies associated with MDBs inventory management and increasing staff confidence in product quality, leading to significant uptake across WA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49218558","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}
Michael J. Dooley BPharm, GradDipHospPharm, PhD, FSHP Adv Prac Pharm
{"title":"Fred J Boyd 2022 oration","authors":"Michael J. Dooley BPharm, GradDipHospPharm, PhD, FSHP Adv Prac Pharm","doi":"10.1002/jppr.1857","DOIUrl":"10.1002/jppr.1857","url":null,"abstract":"","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46995386","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}
Courtney Ierano BPharm(Hons), GradCertPharmPrac, PhD, Mia Percival BBiomedSc, BHlth, MedSc(Hons), Susan Poole BPharm, GradDip Epidem Biostat, Kathryn Mackie BPharm, GradDipClinPharm, BCGP, Zohal Rashidzada BPharm, MClinPharm, Carmela Corallo BPharm, GradDipHospPharm, James. H. Mcmahon MBBS, FRACP, MPH, PhD, Catherine Orla Morrissey MB, BCh, FRACP, Grad Dip (Clin Epi), PhD, AFRACMA, Alison Duncan BPharm, GradDipClinPharm
Background
Invasive candidiasis (IC) surveillance demonstrates an increasing incidence of resistance to azole-based therapy. Consequently, echinocandins are often considered first-line treatment for IC in critically ill patients. To better understand the complexities of decision-making around echinocandin initiation, an evidence-based audit tool was developed.
Aim
To describe echinocandin initiation and compliance with current guidelines.
Method
A retrospective audit of echinocandin initiation was conducted between 1 January 2020 and 31 December 2020 at a quaternary referral hospital. An audit tool was developed by infectious diseases physicians and antimicrobial stewardship pharmacists, capturing patient demographics, microbiological results, indication for therapy, and risk factors for invasive fungal disease (IFD). Local guideline compliance was determined. This project was determined to be a quality improvement project and was not required to undergo ethical review according to the Alfred Hospital Ethics Committee procedures.
Results
One hundred sixty-seven patients were initiated on 214 courses of echinocandin therapy. Caspofungin was most commonly prescribed (n = 172, 80%). Of the 167 patients, most (n = 119, 71%) were in the intensive care unit at the time of initiation. Empiric therapy for sepsis or infection of unclear source was the most commonly documented indication (n = 117, 55%); 71% (n = 153) of all courses were deemed empiric therapy, followed by directed therapy (n = 55, 26%). The most common risk factors for IFD were recent exposure to broad-spectrum antimicrobial therapy (n = 165, 99%) and the presence of a urinary catheter (n = 141, 84%). Most first doses were compliant with local guidelines (n = 144, 67%).
Conclusions
Echinocandin therapy was commonly prescribed in critically ill patients with risk factors for IFD. Although the majority of prescriptions were empiric and compliant with local guidelines, improved guidelines incorporating additional patient factors should be included in future antifungal stewardship initiatives.
{"title":"Echinocandin use in an Australian tertiary hospital: implications for antifungal stewardship","authors":"Courtney Ierano BPharm(Hons), GradCertPharmPrac, PhD, Mia Percival BBiomedSc, BHlth, MedSc(Hons), Susan Poole BPharm, GradDip Epidem Biostat, Kathryn Mackie BPharm, GradDipClinPharm, BCGP, Zohal Rashidzada BPharm, MClinPharm, Carmela Corallo BPharm, GradDipHospPharm, James. H. Mcmahon MBBS, FRACP, MPH, PhD, Catherine Orla Morrissey MB, BCh, FRACP, Grad Dip (Clin Epi), PhD, AFRACMA, Alison Duncan BPharm, GradDipClinPharm","doi":"10.1002/jppr.1859","DOIUrl":"10.1002/jppr.1859","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Invasive candidiasis (IC) surveillance demonstrates an increasing incidence of resistance to azole-based therapy. Consequently, echinocandins are often considered first-line treatment for IC in critically ill patients. To better understand the complexities of decision-making around echinocandin initiation, an evidence-based audit tool was developed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To describe echinocandin initiation and compliance with current guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A retrospective audit of echinocandin initiation was conducted between 1 January 2020 and 31 December 2020 at a quaternary referral hospital. An audit tool was developed by infectious diseases physicians and antimicrobial stewardship pharmacists, capturing patient demographics, microbiological results, indication for therapy, and risk factors for invasive fungal disease (IFD). Local guideline compliance was determined. This project was determined to be a quality improvement project and was not required to undergo ethical review according to the Alfred Hospital Ethics Committee procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred sixty-seven patients were initiated on 214 courses of echinocandin therapy. Caspofungin was most commonly prescribed (<i>n</i> = 172, 80%). Of the 167 patients, most (<i>n</i> = 119, 71%) were in the intensive care unit at the time of initiation. Empiric therapy for sepsis or infection of unclear source was the most commonly documented indication (<i>n</i> = 117, 55%); 71% (<i>n</i> = 153) of all courses were deemed empiric therapy, followed by directed therapy (<i>n</i> = 55, 26%). The most common risk factors for IFD were recent exposure to broad-spectrum antimicrobial therapy (<i>n</i> = 165, 99%) and the presence of a urinary catheter (<i>n</i> = 141, 84%). Most first doses were compliant with local guidelines (<i>n</i> = 144, 67%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Echinocandin therapy was commonly prescribed in critically ill patients with risk factors for IFD. Although the majority of prescriptions were empiric and compliant with local guidelines, improved guidelines incorporating additional patient factors should be included in future antifungal stewardship initiatives.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46289988","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}
Kimberly J. Ong BPharm (Hons), GradCertPharmPrac, Gillian Oates BScPharm, MPSI, MSc ClinPharm, AdvPP(II), Iouri Banakh BPharm, MClinPharm
Background
A gap in vancomycin therapeutic drug monitoring (TDM) electronic documentation, management, and related clinical pharmacist activities was identified by our clinical pharmacy team. In response, an electronic TDM (eTDM) template was planned, designed, and implemented by the pharmacy department team in collaboration with the electronic medical records team (EMR) and documentation committee.
Aim
To assess the impact of an electronic therapeutic drug monitoring (eTDM) template to measure the impact of adherence to vancomycin guidelines. Guideline adherence indicators include the number of vancomycin levels within the therapeutic range and the number of appropriate concentrations taken.
Method
An interventional, single-centre study of vancomycin therapy in adult patients was performed from 2019–2021. Data were extracted from the electronic medical records and TDM paper-based forms completed by clinical pharmacists. The number of concentrations within the therapeutic range and the number of appropriately taken levels were analysed by the chi-square test. This study received an exemption from the Peninsula Health Human Research Ethics Commitee (QA/60523/PH-2019/197291).
Results
There was a total of 198 concentrations collected in the ‘before’ period and 125 concentrations collected in the ‘after’ period. The number of concentrations in therapeutic range increased from 34.8% to 43.2% (p = 0.132), not statistically significant. The number of concentrations taken appropriately increased from 33.8% to 55.2% (p < 0.001). The proportion of patients with pharmacist involvement increased from 43.0% to 57.0% (p = 0.868).
Conclusion
The study shows that implementation of an electronic vancomycin monitoring template improved the proportion of appropriate levels taken and is the preferred method of documentation by clinical pharmacists. Future projects may benefit from analysing the cost associated with unnecessary vancomycin serum levels ordered or inclusion of pharmacists in the TDM of other narrow therapeutic medications.
{"title":"Assessing the impact of an electronic therapeutic drug monitoring record in the management of vancomycin through pharmacist intervention: a single-centre study","authors":"Kimberly J. Ong BPharm (Hons), GradCertPharmPrac, Gillian Oates BScPharm, MPSI, MSc ClinPharm, AdvPP(II), Iouri Banakh BPharm, MClinPharm","doi":"10.1002/jppr.1855","DOIUrl":"10.1002/jppr.1855","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>A gap in vancomycin therapeutic drug monitoring (TDM) electronic documentation, management, and related clinical pharmacist activities was identified by our clinical pharmacy team. In response, an electronic TDM (eTDM) template was planned, designed, and implemented by the pharmacy department team in collaboration with the electronic medical records team (EMR) and documentation committee.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To assess the impact of an electronic therapeutic drug monitoring (eTDM) template to measure the impact of adherence to vancomycin guidelines. Guideline adherence indicators include the number of vancomycin levels within the therapeutic range and the number of appropriate concentrations taken.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>An interventional, single-centre study of vancomycin therapy in adult patients was performed from 2019–2021. Data were extracted from the electronic medical records and TDM paper-based forms completed by clinical pharmacists. The number of concentrations within the therapeutic range and the number of appropriately taken levels were analysed by the chi-square test. This study received an exemption from the Peninsula Health Human Research Ethics Commitee (QA/60523/PH-2019/197291).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There was a total of 198 concentrations collected in the ‘before’ period and 125 concentrations collected in the ‘after’ period. The number of concentrations in therapeutic range increased from 34.8% to 43.2% (p = 0.132), not statistically significant. The number of concentrations taken appropriately increased from 33.8% to 55.2% (p < 0.001). The proportion of patients with pharmacist involvement increased from 43.0% to 57.0% (p = 0.868).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study shows that implementation of an electronic vancomycin monitoring template improved the proportion of appropriate levels taken and is the preferred method of documentation by clinical pharmacists. Future projects may benefit from analysing the cost associated with unnecessary vancomycin serum levels ordered or inclusion of pharmacists in the TDM of other narrow therapeutic medications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41716500","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}
Katharyn L. Smith PharmD, MPH, BCCCP, BCCP, Kimberly J. Bolton PharmD, BCPS, Natalie S. Weger DO, Ryan A. Hobbs BS Pharm, BCPS
Background
Combination hormonal contraceptives are widely used and are available in various dosage forms. Thromboembolism is an established risk factor associated with the use of these agents, with increased rates of arterial thrombosis and venous thromboembolism reported. Arterial thromboembolism occurs much less frequently and is associated with more serious short-term and long-term consequences.
Aim
We report a case of aortic thrombus occurring secondary to NuvaRing use with concomitant smoking. There are no other reports of aortic thrombus resulting from contraceptive vaginal ring (CVR) use reported in the literature.
Clinical Details
This case describes a 35-year-old female patient with disabling claudication, severe aortoiliac stenosis, and end organ damage resulting from a nearly occlusive aortic thrombus with no identifiable source of emboli. The patient's past medical history was significant for tachycardia and tobacco use disorder. Her scheduled medicines most notably included NuvaRing for contraception. Oral anticoagulation was initiated, and the patient agreed to pursue tobacco cessation. Haematology consultation and workup was negative. Months later, an open infrarenal abdominal aorta thromboendarterectomy and bovine patch angioplasty were completed. The clinical pharmacist conducting intensive care unit admission medication reconciliation postoperatively identified continued NuvaRing use, in addition to smoking. NuvaRing was promptly discontinued. Repeat hypercoagulable workup has remained negative.
Outcome
Following NuvaRing and smoking cessation, no thrombotic symptoms have recurred.
Conclusion
NuvaRing should be considered as potential aetiology for venous and arterial thromboembolism.
{"title":"Aortic thrombus with contraceptive vaginal ring use","authors":"Katharyn L. Smith PharmD, MPH, BCCCP, BCCP, Kimberly J. Bolton PharmD, BCPS, Natalie S. Weger DO, Ryan A. Hobbs BS Pharm, BCPS","doi":"10.1002/jppr.1856","DOIUrl":"10.1002/jppr.1856","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Combination hormonal contraceptives are widely used and are available in various dosage forms. Thromboembolism is an established risk factor associated with the use of these agents, with increased rates of arterial thrombosis and venous thromboembolism reported. Arterial thromboembolism occurs much less frequently and is associated with more serious short-term and long-term consequences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>We report a case of aortic thrombus occurring secondary to NuvaRing use with concomitant smoking. There are no other reports of aortic thrombus resulting from contraceptive vaginal ring (CVR) use reported in the literature.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Details</h3>\u0000 \u0000 <p>This case describes a 35-year-old female patient with disabling claudication, severe aortoiliac stenosis, and end organ damage resulting from a nearly occlusive aortic thrombus with no identifiable source of emboli. The patient's past medical history was significant for tachycardia and tobacco use disorder. Her scheduled medicines most notably included NuvaRing for contraception. Oral anticoagulation was initiated, and the patient agreed to pursue tobacco cessation. Haematology consultation and workup was negative. Months later, an open infrarenal abdominal aorta thromboendarterectomy and bovine patch angioplasty were completed. The clinical pharmacist conducting intensive care unit admission medication reconciliation postoperatively identified continued NuvaRing use, in addition to smoking. NuvaRing was promptly discontinued. Repeat hypercoagulable workup has remained negative.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Outcome</h3>\u0000 \u0000 <p>Following NuvaRing and smoking cessation, no thrombotic symptoms have recurred.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>NuvaRing should be considered as potential aetiology for venous and arterial thromboembolism.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1856","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45983449","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}
Brett Chambers BSc, MPharm, Julaine Allan BSocWk, MSocSc (Crim), PhD (SocWk), Emma Webster BSc (Hons), DrPH, Anna Packer BPharm, GradCertPharmPrac, Shannon Nott MBBS, MHM, MPH
Background
Virtual healthcare services are usually provided from urban centres to outpatient clinics or underserved rural areas. This study utilises virtual pharmacy as an innovative model to provide services to a metropolitan hospital from a rural area.
Aim
This study assesses the feasibility, and patient and staff acceptability of a Virtual Clinical Pharmacy Service (VCPS) in a tertiary metropolitan hospital ward with limited on-site clinical pharmacy services.
Method
Pharmacists from a rural health district provided telepharmacy services for nine weeks. Data on service provision and detection of medication-related issues were captured in the electronic health record. Service acceptability was assessed through a staff focus group and patient acceptability by a patient-reported experience measures (PREM) survey. Ethical approval was granted by the Greater Western Human Research Ethics Committee (Reference no: 2021/ETH00097).
Results
The VCPS demonstrated high utilisation, with 535 clinical and medication reviews provided for 225 patients. Virtual medication reviews identified 151 medication-related issues or recommendations. PREM surveys (n = 22) were supportive of the VCPS model. Staff valued the service and reported ease of access to specialist medication advice and confidence that patient medications were correct. Staff raised patient confidentiality in open wards and lack of experience using virtual healthcare as barriers to the implementation.
Conclusion
Feasibility was demonstrated by high service utilisation, detection of medication-related issues, and measures of acceptability from patients and staff. The VCPS offers a solution to enhance sustainability and service agility by delivery of clinical services when face-to-face is not practicable or available. Further research is required to demonstrate efficacy and to confirm patient acceptability.
{"title":"Feasibility and acceptability of a virtual clinical pharmacy service for elective orthopaedic inpatients in an Australian metropolitan hospital","authors":"Brett Chambers BSc, MPharm, Julaine Allan BSocWk, MSocSc (Crim), PhD (SocWk), Emma Webster BSc (Hons), DrPH, Anna Packer BPharm, GradCertPharmPrac, Shannon Nott MBBS, MHM, MPH","doi":"10.1002/jppr.1853","DOIUrl":"10.1002/jppr.1853","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Virtual healthcare services are usually provided from urban centres to outpatient clinics or underserved rural areas. This study utilises virtual pharmacy as an innovative model to provide services to a metropolitan hospital from a rural area.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study assesses the feasibility, and patient and staff acceptability of a Virtual Clinical Pharmacy Service (VCPS) in a tertiary metropolitan hospital ward with limited on-site clinical pharmacy services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Pharmacists from a rural health district provided telepharmacy services for nine weeks. Data on service provision and detection of medication-related issues were captured in the electronic health record. Service acceptability was assessed through a staff focus group and patient acceptability by a patient-reported experience measures (PREM) survey. Ethical approval was granted by the Greater Western Human Research Ethics Committee (Reference no: 2021/ETH00097).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The VCPS demonstrated high utilisation, with 535 clinical and medication reviews provided for 225 patients. Virtual medication reviews identified 151 medication-related issues or recommendations. PREM surveys (<i>n</i> = 22) were supportive of the VCPS model. Staff valued the service and reported ease of access to specialist medication advice and confidence that patient medications were correct. Staff raised patient confidentiality in open wards and lack of experience using virtual healthcare as barriers to the implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Feasibility was demonstrated by high service utilisation, detection of medication-related issues, and measures of acceptability from patients and staff. The VCPS offers a solution to enhance sustainability and service agility by delivery of clinical services when face-to-face is not practicable or available. Further research is required to demonstrate efficacy and to confirm patient acceptability.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1853","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42920243","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}
Judith A. Singleton B.Pharm, PhD, Esther T.-L. Lau B.Pharm (Hons), PhD, Lisa M. Nissen B.Pharm, PhD
Background
In Queensland, each hospital and health service (local hospital network) has its own waste reduction and recycling plan to comply with the Queensland Government's Waste Reduction and Recycling Act 2011 (Qld). The aim is to reduce both the hospital's carbon footprint and waste handling costs. Hospital environmental waste services staff do not audit pharmaceutical waste bins as this requires the presence of a registered pharmacist.
Aim
Since previous published studies of healthcare waste disposal practices have not included pharmacy waste bin audits, this study aimed to investigate waste disposal behaviours in a hospital pharmacy department.
Method
This sequential, two-phase mixed methods study was conducted in a metropolitan, tertiary public hospital's pharmacy department in Queensland. Phase I involved semi-structured interviews of hospital pharmacists and pharmacy technicians while Phase II comprised bin audits of the pharmacy department's waste streams.
Results
The bin audits revealed 36.1%, 23.8%, and 4.9% of recyclable waste in the clinical waste stream for each of the three bin audits respectively. In the general waste stream, the two bin audits of this stream revealed 14.3% and 44.4%, respectively. The reasons were identified in the interviews: there were no recycling bins in the main dispensing areas and there was confusion surrounding correct disposal of original containers and non-contaminated packaging waste. Non-paper waste was found in the confidential (shredded) waste stream in the two bin audits of this stream (10.1% and 16.7%, respectively).
Conclusion
Provision of commingled recycling bins and clean office paper waste bins in dispensing areas and education of staff on correct waste segregation processes will improve waste segregation in hospital pharmacy departments with both financial and environmental benefits for the hospital and the general population.
{"title":"Pharmaceutical waste disposal practices: a case study of an Australian public hospital pharmacy department","authors":"Judith A. Singleton B.Pharm, PhD, Esther T.-L. Lau B.Pharm (Hons), PhD, Lisa M. Nissen B.Pharm, PhD","doi":"10.1002/jppr.1850","DOIUrl":"10.1002/jppr.1850","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In Queensland, each hospital and health service (local hospital network) has its own waste reduction and recycling plan to comply with the Queensland Government's <i>Waste Reduction and Recycling Act 2011</i> (Qld). The aim is to reduce both the hospital's carbon footprint and waste handling costs. Hospital environmental waste services staff do not audit pharmaceutical waste bins as this requires the presence of a registered pharmacist.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Since previous published studies of healthcare waste disposal practices have not included pharmacy waste bin audits, this study aimed to investigate waste disposal behaviours in a hospital pharmacy department.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>This sequential, two-phase mixed methods study was conducted in a metropolitan, tertiary public hospital's pharmacy department in Queensland. Phase I involved semi-structured interviews of hospital pharmacists and pharmacy technicians while Phase II comprised bin audits of the pharmacy department's waste streams.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The bin audits revealed 36.1%, 23.8%, and 4.9% of recyclable waste in the clinical waste stream for each of the three bin audits respectively. In the general waste stream, the two bin audits of this stream revealed 14.3% and 44.4%, respectively. The reasons were identified in the interviews: there were no recycling bins in the main dispensing areas and there was confusion surrounding correct disposal of original containers and non-contaminated packaging waste. Non-paper waste was found in the confidential (shredded) waste stream in the two bin audits of this stream (10.1% and 16.7%, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Provision of commingled recycling bins and clean office paper waste bins in dispensing areas and education of staff on correct waste segregation processes will improve waste segregation in hospital pharmacy departments with both financial and environmental benefits for the hospital and the general population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1850","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41918490","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}
Katie Magee BPharm(Hons), Molly Fromont BPharm(Hons), Eloise Ihle BBiomed, BPharm(Hons), MPharm, Michael Cheung BPharm(AppHons), GradCertPharmPrac, Mia Percival BBiomedSc, BHealth & MedSc(Hons), Susan G. Poole BPharm, GradDipEpidemBiostat, Chloe Bell BPharm, GradCertPharmPrac, Belinda Theobald BSci, BPharm, MPharmPrac, GradDipHlthServMt, Michael J. Dooley BPharm, GradDipHospPharm, PhD, FSHP, FISOPP, FAAQHC, Catherine Brown BPharm, MPH, MHM, MBA
Background
Hospital pharmacy dispensaries are busy work environments where staff are involved in a variety of work-related tasks. The proportion of time spent on daily tasks, task prioritisation, multitasking, and interruptions remains largely unknown.
Aim
To examine the tasks performed and proportion of time pharmacists and pharmacy technicians in a hospital pharmacy inpatient dispensary spend on various work-related activities.
Method
Pharmacists and technicians working in the inpatient dispensary of a large metropolitan health service were directly observed by trained researchers. Tasks were recorded using Work Observation Method By Activity Timing (WOMBAT), a validated technique developed for direct observation studies of health professionals. Timed tasks were allocated to domains detailing the task performed, who performed it, who they interacted with, and where the task was performed. Data were analysed descriptively with independence of 95% confidence intervals (CI) demonstrating statistical significance.
Results
Twelve pharmacists and 13 technicians were observed for 107.4 h. Tasks that contributed the greatest proportion of time were: the preparation of discharge prescriptions: pharmacists 32.1% (95% CI 29.9–34.3%) and technicians 21.0% (95% CI 18.3–23.7%); inpatient medication supply 22.5% (95% CI 21.5–23.5%) and 49.3% (95% CI 47.3–51.3%) and; inter-professional communication 13.6% and 14.7% (non-significant [NS]). Tasks were completed independently 89.6% (pharmacists) and 88.9% (technicians) of the time. Pharmacists and technicians were interrupted 6.7 and 5.1 times per hour (p < 0.05), respectively; 8.6% and 9.5% (NS) of the time was spent undertaking at least two tasks simultaneously.
Conclusion
This is the first study to examine task time distribution within a hospital inpatient dispensary. Pharmacists and technicians spend the greatest proportion of time on direct medication dispensing-related activities. This study demonstrates a high frequency of multitasking and interruptions, both of which are known risks for dispensing errors.
{"title":"Direct observational time and motion study of the daily activities of hospital dispensary pharmacists and technicians","authors":"Katie Magee BPharm(Hons), Molly Fromont BPharm(Hons), Eloise Ihle BBiomed, BPharm(Hons), MPharm, Michael Cheung BPharm(AppHons), GradCertPharmPrac, Mia Percival BBiomedSc, BHealth & MedSc(Hons), Susan G. Poole BPharm, GradDipEpidemBiostat, Chloe Bell BPharm, GradCertPharmPrac, Belinda Theobald BSci, BPharm, MPharmPrac, GradDipHlthServMt, Michael J. Dooley BPharm, GradDipHospPharm, PhD, FSHP, FISOPP, FAAQHC, Catherine Brown BPharm, MPH, MHM, MBA","doi":"10.1002/jppr.1852","DOIUrl":"10.1002/jppr.1852","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hospital pharmacy dispensaries are busy work environments where staff are involved in a variety of work-related tasks. The proportion of time spent on daily tasks, task prioritisation, multitasking, and interruptions remains largely unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To examine the tasks performed and proportion of time pharmacists and pharmacy technicians in a hospital pharmacy inpatient dispensary spend on various work-related activities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Pharmacists and technicians working in the inpatient dispensary of a large metropolitan health service were directly observed by trained researchers. Tasks were recorded using Work Observation Method By Activity Timing (WOMBAT), a validated technique developed for direct observation studies of health professionals. Timed tasks were allocated to domains detailing the task performed, who performed it, who they interacted with, and where the task was performed. Data were analysed descriptively with independence of 95% confidence intervals (CI) demonstrating statistical significance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twelve pharmacists and 13 technicians were observed for 107.4 h. Tasks that contributed the greatest proportion of time were: the preparation of discharge prescriptions: pharmacists 32.1% (95% CI 29.9–34.3%) and technicians 21.0% (95% CI 18.3–23.7%); inpatient medication supply 22.5% (95% CI 21.5–23.5%) and 49.3% (95% CI 47.3–51.3%) and; inter-professional communication 13.6% and 14.7% (non-significant [NS]). Tasks were completed independently 89.6% (pharmacists) and 88.9% (technicians) of the time. Pharmacists and technicians were interrupted 6.7 and 5.1 times per hour (p < 0.05), respectively; 8.6% and 9.5% (NS) of the time was spent undertaking at least two tasks simultaneously.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This is the first study to examine task time distribution within a hospital inpatient dispensary. Pharmacists and technicians spend the greatest proportion of time on direct medication dispensing-related activities. This study demonstrates a high frequency of multitasking and interruptions, both of which are known risks for dispensing errors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1852","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43538340","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号