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":"53 3","pages":"110-115"},"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":"53 2","pages":"87-90"},"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":"53 2","pages":"79-86"},"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":"53 2","pages":"56-63"},"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":"53 2","pages":"64-72"},"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}
<p><i>Pharmacy Forecast Australia</i> is an annual, strategic thought leadership piece on the emerging trends and phenomena projected to impact pharmacy practice and the health of Australian patients over the next 5 years (2022–2027). The purpose of <i>Pharmacy Forecast Australia 2022</i> is to encourage and support active and deliberate strategic planning in hospitals and health systems. It is intended to stimulate thinking and discussion, providing a starting point for individuals and teams who wish to proactively position themselves for potential future events and trends rather than be reactive when they occur. This special report presents an abridged version of <i>Pharmacy Forecast Australia 2022</i>, focusing on the key findings and recommendations within each of the six themes, to assist pharmacy and health system leaders among the <i>Journal of Pharmacy Practice and Research</i>'s readership in this effort.</p><p>The 2022 report is divided into six themes: environmental sustainability; future workforce; patient-centred care; technology; funding models; and workforce wellbeing. Through analysis and recommendations, the theme leads provide advice and guidance on how to approach issues pertinent to our times such as sustainably reducing our carbon footprint; fostering an effective, diverse, engaged and expert pharmacy workforce into the future; reorienting strategy to fortify research, embed pharmacogenetics and put the patient at the centre of care; harnessing secure technology to improve access to medicines; ensuring funding reforms prioritise safe and timely patient care; and supporting workforce wellbeing through structured training and appreciation of individual and team needs.</p><p>In its second year in Australia, the method used to develop <i>Pharmacy Forecast Australia 2022</i> continued to draw on concepts described in James Surowiecki's book <i>The Wisdom of Crowds</i>.<span><sup>1</sup></span> According to Surowiecki, the collective opinions of ‘wise crowds’ — groups of diverse individuals in which each participant's input is provided independently, drawing from their own locally informed points of view — can be more informative than the opinion of any individual participant.</p><p>The Pharmacy Forecast Advisory Committee (see the full membership list in the Acknowledgements) began developing the survey by engaging in a series of workshops to identify and interrogate key issues and concerns they believed would influence health-system pharmacy in the coming 5 years, further informed by insight from the policy and advocacy activities of the Society of Hospital Pharmacists of Australia (SHPA). That list was then expanded and refined through an iterative process, resulting in a final set of six themes, each with seven focused topics on which the survey was built. Each of the 42 survey items was written to explore the selected themes in greater detail.</p><p>Survey respondents — Forecast Panellists (FPs) — were nominated and selected b
{"title":"Pharmacy Forecast Australia 2022: key findings","authors":"Russell Levy BPharm, MClinPharm, FSHPA","doi":"10.1002/jppr.1849","DOIUrl":"10.1002/jppr.1849","url":null,"abstract":"<p><i>Pharmacy Forecast Australia</i> is an annual, strategic thought leadership piece on the emerging trends and phenomena projected to impact pharmacy practice and the health of Australian patients over the next 5 years (2022–2027). The purpose of <i>Pharmacy Forecast Australia 2022</i> is to encourage and support active and deliberate strategic planning in hospitals and health systems. It is intended to stimulate thinking and discussion, providing a starting point for individuals and teams who wish to proactively position themselves for potential future events and trends rather than be reactive when they occur. This special report presents an abridged version of <i>Pharmacy Forecast Australia 2022</i>, focusing on the key findings and recommendations within each of the six themes, to assist pharmacy and health system leaders among the <i>Journal of Pharmacy Practice and Research</i>'s readership in this effort.</p><p>The 2022 report is divided into six themes: environmental sustainability; future workforce; patient-centred care; technology; funding models; and workforce wellbeing. Through analysis and recommendations, the theme leads provide advice and guidance on how to approach issues pertinent to our times such as sustainably reducing our carbon footprint; fostering an effective, diverse, engaged and expert pharmacy workforce into the future; reorienting strategy to fortify research, embed pharmacogenetics and put the patient at the centre of care; harnessing secure technology to improve access to medicines; ensuring funding reforms prioritise safe and timely patient care; and supporting workforce wellbeing through structured training and appreciation of individual and team needs.</p><p>In its second year in Australia, the method used to develop <i>Pharmacy Forecast Australia 2022</i> continued to draw on concepts described in James Surowiecki's book <i>The Wisdom of Crowds</i>.<span><sup>1</sup></span> According to Surowiecki, the collective opinions of ‘wise crowds’ — groups of diverse individuals in which each participant's input is provided independently, drawing from their own locally informed points of view — can be more informative than the opinion of any individual participant.</p><p>The Pharmacy Forecast Advisory Committee (see the full membership list in the Acknowledgements) began developing the survey by engaging in a series of workshops to identify and interrogate key issues and concerns they believed would influence health-system pharmacy in the coming 5 years, further informed by insight from the policy and advocacy activities of the Society of Hospital Pharmacists of Australia (SHPA). That list was then expanded and refined through an iterative process, resulting in a final set of six themes, each with seven focused topics on which the survey was built. Each of the 42 survey items was written to explore the selected themes in greater detail.</p><p>Survey respondents — Forecast Panellists (FPs) — were nominated and selected b","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"52 6","pages":"458-481"},"PeriodicalIF":2.1,"publicationDate":"2023-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1849","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51329944","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}
Human immunodeficiency virus (HIV) infection and certain retroviral therapies are associated with an increased risk of atherosclerosis with plaque rupture resulting in acute coronary syndromes. Therefore, there is often a need to co-prescribe antiretroviral and cardiovascular therapies, including antiplatelet agents. Antiplatelet agents, such as the P2Y12 receptor antagonists clopidogrel and prasugrel, require activation by cytochrome P450 3A4 (CYP3A4). The P2Y12 receptor antagonist ticagrelor is also metabolised by CYP3A4. Pharmacokinetic enhancers, such as ritonavir and cobicistat, are utilised to increase the systemic exposure of certain agents within multidrug HIV regimens and are potent CYP3A4 inhibitors. Using these drugs together can result in unintended and undesirable drug–drug interactions. A 55-year-old male with a history of HIV presented to the emergency department with central chest pain. He was found to have had a non-ST-elevation myocardial infarction and was commenced on dual antiplatelet therapy including ticagrelor, anticoagulation and statin therapy, in addition to his usual HIV therapy, Genvoya (elvitegravir, cobicistat, emtricitabine, tenofovir alafenamide). A drug–drug interaction between Genvoya and ticagrelor was identified by the pharmacist, and the patient was switched to prasugrel on the pharmacist's recommendation. Although prasugrel was delisted from the Pharmaceutical Benefits Scheme (PBS) in July 2020, it remains accessible as a non-PBS medicine. Prasugrel should be considered the P2Y12 antagonist of choice for patients who are on HIV regimens containing a pharmacokinetic enhancer such as ritonavir or cobicistat.
{"title":"Prasugrel — gone, but not forgotten","authors":"Samuel R. Ford","doi":"10.1002/jppr.1847","DOIUrl":"10.1002/jppr.1847","url":null,"abstract":"<p>Human immunodeficiency virus (HIV) infection and certain retroviral therapies are associated with an increased risk of atherosclerosis with plaque rupture resulting in acute coronary syndromes. Therefore, there is often a need to co-prescribe antiretroviral and cardiovascular therapies, including antiplatelet agents. Antiplatelet agents, such as the P2Y12 receptor antagonists clopidogrel and prasugrel, require activation by cytochrome P450 3A4 (CYP3A4). The P2Y12 receptor antagonist ticagrelor is also metabolised by CYP3A4. Pharmacokinetic enhancers, such as ritonavir and cobicistat, are utilised to increase the systemic exposure of certain agents within multidrug HIV regimens and are potent CYP3A4 inhibitors. Using these drugs together can result in unintended and undesirable drug–drug interactions. A 55-year-old male with a history of HIV presented to the emergency department with central chest pain. He was found to have had a non-ST-elevation myocardial infarction and was commenced on dual antiplatelet therapy including ticagrelor, anticoagulation and statin therapy, in addition to his usual HIV therapy, Genvoya (elvitegravir, cobicistat, emtricitabine, tenofovir alafenamide). A drug–drug interaction between Genvoya and ticagrelor was identified by the pharmacist, and the patient was switched to prasugrel on the pharmacist's recommendation. Although prasugrel was delisted from the Pharmaceutical Benefits Scheme (PBS) in July 2020, it remains accessible as a non-PBS medicine. Prasugrel should be considered the P2Y12 antagonist of choice for patients who are on HIV regimens containing a pharmacokinetic enhancer such as ritonavir or cobicistat.</p>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"53 1","pages":"44-46"},"PeriodicalIF":2.1,"publicationDate":"2023-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1847","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46324268","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}
Jason A Roberts PhD, B Pharm (Hons), B App Sc, FSHP, FISAC, FAHMS
<p>Mr. President, Peter Fowler, Mr. Jahrmarley Dawson, Distinguished Guests, and my Pharmacy Colleagues.</p><p>It is an honour to stand before you and accept the 2021 Fred J Boyd Award from the Society of Hospital Pharmacists of Australia (SHPA).</p><p>I am a student of history, and I believe history still has much to teach us, just as science is our best guide into the future. Indeed, the history of this award is poignant for me, as it is for all SHPA members and fellows. Mr. Frederick John Boyd, who made his mark a hundred years ago, was a pioneer in every sense. A hospital pharmacist, he ascended to Chief Pharmacist of Mont Park Mental Hospital. His commitment to the pharmacy profession became clear in subsequent years when he took on numerous service roles with the Pharmaceutical Society of Victoria. Recognising that hospital pharmacists would benefit from a professional society that served their specific needs, in 1941 Boyd formed the Society of Hospital Pharmaceutical Chemists with support from Mr. Charles B Macgibbon. His leadership role among hospital pharmacists was then cemented when he became the first national president of SHPA. Mr. Boyd then went on to become the first editor of what is now SHPA's flagship journal, the <i>Journal of Pharmacy Practice and Research</i> (<i>JPPR</i>). Mr. Boyd served in many community-facing volunteer roles and held lifetime memberships in at least two sporting clubs.</p><p>What can we learn about Mr. Boyd and his legacy? Many things, in my view. I'd like to highlight here a couple that I feel are worth reflecting on.</p><p>Firstly, Mr. Boyd taught us that service to your community creates a better community — this is clear when you see Mr. Boyd's legacy that is SHPA, a professional society that now guides a community of fundamental importance to the Australian healthcare system and a profession whose research and advocacy influence global health care.</p><p>Secondly, Mr. Boyd taught us about being creative and cultivating a pioneering mindset to create new entities and opportunities. Mr. Boyd established himself within pharmacy and then created meaningful institutions. I believe he did this through an understanding of the organisational and political opportunities available to him and then made wise decisions that dynamic and influential managers would support.</p><p>Thirdly, Mr. Boyd was committed to the long-term success of his initiatives with professional societies (as well as cricket and football clubs) and spent years of his life to ensure his vision would translate into a sustained and successful endeavour. As we reflect on SHPA, I'm sure we are all grateful for his unparalleled commitment and impact.</p><p>Of course, while this is not an award for Fred J Boyd, it is an award in his name and, as he clearly did, I believe in the power of both history and science.</p><p>As I hope I was able to convey, Mr. Boyd possessed key traits that led to his success. Reflecting on my own career, I feel that a
这项在三个国家进行的双盲、双虚拟随机对照试验完成得非常好，证实了我们的研究设计是稳健的，可以在多中心形式下进行。我们将该研究命名为BLING 1，其中BLING代表β -内酰胺输注组。8接下来，我们在26个icu中的420名败血症患者中进行了BLING 2，采用相同的研究设计，由NHMRC和新西兰同等资助机构资助。这也是成功完成的，并展示了一些有趣的临床结果，这有助于我们更多地了解干预，使我们能够丰富最终的BLING 3研究的设计BLING 3正在评估随机接受连续或短期输注美罗培南或哌拉西林/他唑巴坦的败血症患者的90天死亡率。由于主要终点的性质，它不再是双盲或双哑。10,11我们现在已经在三大洲的100个icu中招募了7000名患者，到明年年中应该会有结果，这将以某种方式改变全球实践。这个研究项目强调，培养小事情可以让它们成为大事情，杰夫·利普曼和我的团队已经发展成为一个更大的团队，其中包括当地的关键人物，如乔尔·杜尔亨特、奥斯·科塔、约翰·麦伯格和多里琳·拉杰班达里。这个团队让这么大的事业取得了成功，我很荣幸能成为其中的一员，就像我很荣幸能得到Metro North Health、RBWH以及昆士兰大学的支持一样。这对所有人来说都是一个重要的信息——从小而可实现的目标开始，随之而来的是更大的影响。我说过我会更多地评论我的家庭，我想以感谢他们所有人来结束我的演讲。我的兄弟姐妹都是我人生旅程的一部分，每个人都在我的生活中发挥了关键的支持作用。我母亲对我的支持从未动摇过，我父亲也从未不愿意挤出时间来分享一些科学、专业或个人的指导。然而，我的妻子艾莉森值得特别提及。她为我做出了很多牺牲，让我能够利用所有的机会。在我所有的职业成就中，她都是我的伙伴，就像她在我的生活中一样。我们的三个可爱的女儿，伊维，露西和伊莎贝尔，给我带来快乐，提醒我为什么我们都做我们所做的事情。我感谢SHPA给我的这份殊荣。我向博伊德先生的遗产表示敬意，我希望有一天我能自豪地回顾自己的遗产，对于所有帮助我取得成就的人，我希望他们也会为他们的善意和支持所产生的成果感到自豪。我还要感谢所有为我的研究提供资助的机构。
{"title":"Fred J Boyd Oration 2021","authors":"Jason A Roberts PhD, B Pharm (Hons), B App Sc, FSHP, FISAC, FAHMS","doi":"10.1002/jppr.1851","DOIUrl":"10.1002/jppr.1851","url":null,"abstract":"<p>Mr. President, Peter Fowler, Mr. Jahrmarley Dawson, Distinguished Guests, and my Pharmacy Colleagues.</p><p>It is an honour to stand before you and accept the 2021 Fred J Boyd Award from the Society of Hospital Pharmacists of Australia (SHPA).</p><p>I am a student of history, and I believe history still has much to teach us, just as science is our best guide into the future. Indeed, the history of this award is poignant for me, as it is for all SHPA members and fellows. Mr. Frederick John Boyd, who made his mark a hundred years ago, was a pioneer in every sense. A hospital pharmacist, he ascended to Chief Pharmacist of Mont Park Mental Hospital. His commitment to the pharmacy profession became clear in subsequent years when he took on numerous service roles with the Pharmaceutical Society of Victoria. Recognising that hospital pharmacists would benefit from a professional society that served their specific needs, in 1941 Boyd formed the Society of Hospital Pharmaceutical Chemists with support from Mr. Charles B Macgibbon. His leadership role among hospital pharmacists was then cemented when he became the first national president of SHPA. Mr. Boyd then went on to become the first editor of what is now SHPA's flagship journal, the <i>Journal of Pharmacy Practice and Research</i> (<i>JPPR</i>). Mr. Boyd served in many community-facing volunteer roles and held lifetime memberships in at least two sporting clubs.</p><p>What can we learn about Mr. Boyd and his legacy? Many things, in my view. I'd like to highlight here a couple that I feel are worth reflecting on.</p><p>Firstly, Mr. Boyd taught us that service to your community creates a better community — this is clear when you see Mr. Boyd's legacy that is SHPA, a professional society that now guides a community of fundamental importance to the Australian healthcare system and a profession whose research and advocacy influence global health care.</p><p>Secondly, Mr. Boyd taught us about being creative and cultivating a pioneering mindset to create new entities and opportunities. Mr. Boyd established himself within pharmacy and then created meaningful institutions. I believe he did this through an understanding of the organisational and political opportunities available to him and then made wise decisions that dynamic and influential managers would support.</p><p>Thirdly, Mr. Boyd was committed to the long-term success of his initiatives with professional societies (as well as cricket and football clubs) and spent years of his life to ensure his vision would translate into a sustained and successful endeavour. As we reflect on SHPA, I'm sure we are all grateful for his unparalleled commitment and impact.</p><p>Of course, while this is not an award for Fred J Boyd, it is an award in his name and, as he clearly did, I believe in the power of both history and science.</p><p>As I hope I was able to convey, Mr. Boyd possessed key traits that led to his success. Reflecting on my own career, I feel that a","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"52 6","pages":"482-484"},"PeriodicalIF":2.1,"publicationDate":"2023-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1851","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43891036","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}
Kanika Chaudhri BMedSci (Hons), MD, Madeleine Kearney BMedSci, Gian Luca Di Tanna PhD, Sonali R. Gnanenthiran MBBS, PhD, Richard O. Day MBBS, PhD, Anthony Rodgers MBBS, PhD, Emily R. Atkins PhD
Background
Tablet splitting is a widely prevalent practice resulting from the need to alter doses into two or more parts and optimise medicine in individual patients. If a tablet is split unequally problems may arise.
Aim
The aim of the study was to summarise the literature measuring the effect of tablet splitting on dose accuracy.
Method
MEDLINE, EMBASE, CINAHL and Cochrane were searched and studies published prior to January 2020 investigating the effect of splitting tablets on dose accuracy were included. Studies investigating any drug, where the tablet was split, were potentially eligible. Two independent reviewers conducted the screening and extracted the data. Meta-analyses assessing the effect of tablet splitting on dose accuracy were performed. (Study registration: PROSPERO CRD42018106252).
Results
Of 25 included studies, 16 examined the effect of tablet splitting on weight of the tablet, one on drug concentration and eight examined both. Meta-analysis found small variation between split tablets (0.87% weight variation, 95% confidence interval 0.63%–1.11% and 0.24% drug content variation, 95% confidence interval 0.06%–0.43%). There was some inconsistency across trial results for weight but not for drug content variation (I2 50% and I2 1%, respectively). Splitting method and tablet characteristics were predictors of accuracy.
Conclusion
Although tablet splitting may influence dose accuracy, this analysis suggests that the weight and drug content variation is minimal, regardless of method and tablet characteristics. Additional studies, such as those examining drug plasma concentrations and effect on patient health outcomes for example blood pressure and cholesterol levels, are needed to better understand the role of tablet splitting on dose accuracy.
{"title":"Does splitting a tablet obtain an accurate dose? A systematic review and meta- analysis","authors":"Kanika Chaudhri BMedSci (Hons), MD, Madeleine Kearney BMedSci, Gian Luca Di Tanna PhD, Sonali R. Gnanenthiran MBBS, PhD, Richard O. Day MBBS, PhD, Anthony Rodgers MBBS, PhD, Emily R. Atkins PhD","doi":"10.1002/jppr.1843","DOIUrl":"10.1002/jppr.1843","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Tablet splitting is a widely prevalent practice resulting from the need to alter doses into two or more parts and optimise medicine in individual patients. If a tablet is split unequally problems may arise.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The aim of the study was to summarise the literature measuring the effect of tablet splitting on dose accuracy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>MEDLINE, EMBASE, CINAHL and Cochrane were searched and studies published prior to January 2020 investigating the effect of splitting tablets on dose accuracy were included. Studies investigating any drug, where the tablet was split, were potentially eligible. Two independent reviewers conducted the screening and extracted the data. Meta-analyses assessing the effect of tablet splitting on dose accuracy were performed. (Study registration: PROSPERO CRD42018106252).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 25 included studies, 16 examined the effect of tablet splitting on weight of the tablet, one on drug concentration and eight examined both. Meta-analysis found small variation between split tablets (0.87% weight variation, 95% confidence interval 0.63%–1.11% and 0.24% drug content variation, 95% confidence interval 0.06%–0.43%). There was some inconsistency across trial results for weight but not for drug content variation (<i>I</i><sup>2</sup> 50% and <i>I</i><sup>2</sup> 1%, respectively). Splitting method and tablet characteristics were predictors of accuracy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although tablet splitting may influence dose accuracy, this analysis suggests that the weight and drug content variation is minimal, regardless of method and tablet characteristics. Additional studies, such as those examining drug plasma concentrations and effect on patient health outcomes for example blood pressure and cholesterol levels, are needed to better understand the role of tablet splitting on dose accuracy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"52 6","pages":"411-421"},"PeriodicalIF":2.1,"publicationDate":"2023-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1843","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42555714","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}
Jaidyn Muhandiramge MD, BMedSc(Hons), Tara Dev MD, BMedSc(Hons), Jason Kong MBBS(Hons), BMedSc(Hons), Kylie Hall BN, Vikas Wadhwa MBBS, MBA, MPH
Background
A lack of clear guidelines for medication cessation has contributed to the proliferation of polypharmacy. Hospitalisation provides a unique opportunity for initiating deprescribing. Deprescribing interventions are usually pharmacist- or multidisciplinary team-led and are typically safe and beneficial for patients. However, few studies have explored interventions that are implementable by clinicians at the bedside.
Aim
To explore the efficacy and feasibility of a clinician-led deprescribing intervention on an acute general medicine ward.
Method
A multifaceted intervention was implemented comprising (a) education sessions on deprescribing and (b) a deprescribing alert in the bedside folders of patients with hyperpolypharmacy (>10 medications). Using a historical cohort study design, data from the intervention cohort were compared to a historical control group. A subset of the intervention cohort was surveyed after discharge regarding attitudes toward deprescribing.
Results
We recruited 1333 patients and had complete data for 1169 (nintervention = 888, ncontrol = 281). The prevalence of hyperpolypharmacy decreased from 28% to 26% in the intervention cohort, but this reduction was not statistically significant (net change = −1, interquartile range [IQR] = −2–0; p = 0.26). There was similarly no statistically significant change in medication numbers due to the intervention across other subgroups. Most patients agreed they were taking too many medications and supported deprescribing.
Conclusions
Despite observing no statistically significant effect of the intervention, we demonstrated the feasibility of introducing clinician-led deprescribing interventions in resource-poor, busy inpatient units. Simple, innovative deprescribing interventions in hospital settings, along with the measurement of long-term patient outcomes and medication adverse effects, should be investigated further in large inpatient cohorts.
{"title":"In-hospital deprescribing in the real world – a clinician-led approach to hyperpolypharmacy","authors":"Jaidyn Muhandiramge MD, BMedSc(Hons), Tara Dev MD, BMedSc(Hons), Jason Kong MBBS(Hons), BMedSc(Hons), Kylie Hall BN, Vikas Wadhwa MBBS, MBA, MPH","doi":"10.1002/jppr.1844","DOIUrl":"10.1002/jppr.1844","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>A lack of clear guidelines for medication cessation has contributed to the proliferation of polypharmacy. Hospitalisation provides a unique opportunity for initiating deprescribing. Deprescribing interventions are usually pharmacist- or multidisciplinary team-led and are typically safe and beneficial for patients. However, few studies have explored interventions that are implementable by clinicians at the bedside.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To explore the efficacy and feasibility of a clinician-led deprescribing intervention on an acute general medicine ward.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A multifaceted intervention was implemented comprising (a) education sessions on deprescribing and (b) a deprescribing alert in the bedside folders of patients with hyperpolypharmacy (>10 medications). Using a historical cohort study design, data from the intervention cohort were compared to a historical control group. A subset of the intervention cohort was surveyed after discharge regarding attitudes toward deprescribing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We recruited 1333 patients and had complete data for 1169 (<i>n</i><sub>intervention</sub> = 888, <i>n</i><sub>control</sub> = 281). The prevalence of hyperpolypharmacy decreased from 28% to 26% in the intervention cohort, but this reduction was not statistically significant (net change = −1, interquartile range [IQR] = −2–0; p = 0.26). There was similarly no statistically significant change in medication numbers due to the intervention across other subgroups. Most patients agreed they were taking too many medications and supported deprescribing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite observing no statistically significant effect of the intervention, we demonstrated the feasibility of introducing clinician-led deprescribing interventions in resource-poor, busy inpatient units. Simple, innovative deprescribing interventions in hospital settings, along with the measurement of long-term patient outcomes and medication adverse effects, should be investigated further in large inpatient cohorts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"53 2","pages":"47-55"},"PeriodicalIF":2.1,"publicationDate":"2023-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1844","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48717016","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}
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