Journal of Pharmacy Practice and Research最新文献

Background

Antibiotic-impregnated bone cement (AIBC) is frequently used in arthroplasty surgery to minimise the risk of infection in the prosthetic knee or hip joint.

Aim

To gain greater insight into the use, documentation, and stock-management of AIBC in Australian hospitals.

Method

A mixed-methods study was conducted. Antimicrobial surveillance data were analysed to identify Australian hospitals including AIBC in their monthly pharmacy data submissions. An online survey was distributed to pharmacists registered with the National Antimicrobial Utilisation Surveillance Program to investigate knowledge of the use, documentation, and stock-management of bone cement.

Results

Surveillance data from January to June 2021 showed 13% (n = 28) of the 222 participating hospitals included bone cement in their antimicrobial usage data. All reported AIBC usage data contained an aminoglycoside antibiotic. Fifty-two pharmacists responded (17% response rate) to the online survey. When asked about inventory, 35% of participants stated that their hospital pharmacies manage bone cements. Of 82 responses, 6% (n = 5) had knowledge of additional antibiotics or antifungals loaded into bone cements intraoperatively. More than half of the respondents reported that documentation of AIBC use was unclear, while others knew to search for it in prosthesis or theatre notes.

Conclusion

This study has illustrated a gap in pharmacists' knowledge in the perioperative setting regarding the use and documentation of bone cement, and highlights a possible focus for future education to assist with antimicrobial stewardship in this setting. Consistency in the management and documentation of AIBC would assist in surveillance of usage, help identify variations in practice and provide opportunities for quality improvement.

Background

Older people with frailty and multimorbidity are at high risk of problematic polypharmacy. Community pharmacists have a key role in medication safety for older people.

Aim

The aim of this study was to investigate the perspectives of older people with frailty, multimorbidity, and polypharmacy, and their family caregivers or whānau on the role of community pharmacists, including in situ pharmacist care practices.

Method

This study was part of a larger video reflexive ethnography (VRE) study to explore medication safety and wellbeing for older people with frailty across care transitions including hospital, home, aged residential care, primary care, and outpatient care. This paper reports data from the interview, participant observation, and filming phases of the study.

Results

Community pharmacists play a significant role in the medication safety of older people with frailty and polypharmacy. Analysis resulted in three main themes: (1) the older person–determined role of the pharmacist, (2) the ‘taken for granted’ safety work of the pharmacist, and (3) collective agency and medication safety.

Conclusion

In circumstances where older people and their family caregivers or whānau had a trusted relationship with a community pharmacist, the pharmacist played a key role as mediator of medication safety and was central to older people's care. This key role as a member of the multidisciplinary team in the care of older people with frailty and multimorbidity should be better recognised and legitimised by clinicians and policy makers and resourced accordingly.

Background

Compliance with psychotropic dosage guidelines has been shown to improve mental health status, reduce severity of symptoms, and decrease adverse effects. However, guideline recommendations are not always implemented. While deviation from dosage recommendations may be clinically appropriate in some patients, variation can cause a lack of efficacy or patient harm.

Aim

To evaluate the incidence of antidepressant and antipsychotic prescribing at doses outside the recommended range provided by local guidelines, Therapeutic Guidelines: Psychotropic.

Method

This study is a retrospective clinical audit of 793 patients admitted to hospital between August 2018 and July 2019. Data were collected through extensive file and chart reviews of patients treated with any of the antidepressant and antipsychotic medications listed in the Psychotropic Dosage Guidelines. Descriptive statistical analyses were performed to determine frequencies and proportions.

Results

The audit identified that 38.0% of patients received doses of antidepressants or antipsychotics outside the recommended range. Most antidepressants were prescribed within recommended doses (83.0%), with 10.5% above the recommended dose, and 6.2% below. Fewer antipsychotics were prescribed within the recommended range (56.8%), 2.8% were prescribed at doses above the recommended range, and 40.3% were prescribed at doses below the recommendation range. Quetiapine was frequently prescribed at doses lower than recommended.

Conclusion

The audit revealed a substantial amount of prescribing outside the recommended dosage ranges. It also highlighted the necessity of reviewing policies to limit the use of off-label, low-dose quetiapine. Audit and feedback could target psychiatrists who seem to have the highest propensity to prescribe outside the recommended dosage ranges.

Background

Increasing life expectancy has seen a continual rise in older patients who present to hospital with acute decompensation. Pharmacists are well equipped to make medication recommendations in these settings to meet patient care needs, promote harm minimisation, and improve workflow efficiency. The Partnered Pharmacist Medication Charting (PPMC) model enables pharmacists to chart regular medications for patients admitted to the General Medicine Unit (GMU) in collaboration with treating clinicians. The model was expanded to assess the safety of pharmacists additionally charting newly initiated medications.

Aim

The aim of this study was to assess the safety of the expanded PPMC model through the number of medication errors.

Method

This prospective observational study was conducted at a tertiary hospital. Patients admitted to the GMU and received PPMC were included. Pharmacists were able to chart any new medications as well as the patients' pre-admission medications. The primary outcome was the number of medication errors charted on admission. Medication errors were defined as medications charted outside of the specific recommendations documented in the medication management plan written by the PPMC pharmacist and co-signed by the admitting medical officer.

Results

A total of 8093 medications were charted by a credentialed pharmacist, with 10% (n = 816) planned newly initiated medications. Eight (0.98%) medication charting errors were identified in the PPMC model, which included five planned medications omitted. Of the 811 newly charted medications, 87 (10.7%) were amended within 24 h, with the majority being due to change in diagnosis or driven by changes in clinical status or investigative results becoming available.

Conclusion

The expansion of the PPMC model of care to enable pharmacist charting of new medications was found to be safe. The adoption of the model may aid in reducing medication errors, thereby improving patient care and safety.

Background

Approximately half of people with cancer are using complementary and alternative medicine (CAM), presenting safety concerns due to potential interactions with conventional cancer treatment. Oncology staff have a role to play in ensuring the safe use of CAMs and so, this study examined their knowledge, attitudes, and practices regarding CAMs.

Aim

This study aimed to assess the knowledge, attitudes, and practices of Australian doctors, nurses, and pharmacists regarding CAM use in oncology.

Method

Members of three national oncology professional associations took part in an online questionnaire, which determined their knowledge, attitudes, and practices regarding CAM.

Results

Ninety-nine completed surveys were obtained from nine doctors, 70 nurses, and 20 pharmacists. Most respondents (68.4%) felt that they did not have adequate knowledge of CAMs to respond to patients' questions. Assessment of attitudes found respondents generally believed that CAMs have a complementary role in oncology but indicated their concerns for the safety of patients. Respondents indicated in practice they would discuss CAMs with less than half of patients (40.6%), with a lack of scientific data and guidelines for CAM use presenting significant barriers to these discussions.

Conclusion

Our study suggests that oncology health professionals' knowledge of CAMs potentially leads to a lack of confidence in providing advice to patients and concerns for patient safety. This impacts their discussion of CAMs and lack of disclosure from patients about their use of CAMs. Education on CAMs in oncology would assist in increasing professionals' confidence in discussing these therapies, leading to increased patient disclosure of CAMs and safer treatment decision making for people with cancer.

In Australia, clinical reports are written by an accredited pharmacist following in-home patient consultations as part of a home medicines review (HMR). These reports communicate clinical findings and recommendations to the patient's general practitioner to optimise medicines and improve patient health. However, it is unknown if clinical HMR reports adhere to practice guidelines. This study aimed to develop an instrument from Australian practice guidelines, and then test the instrument by evaluating a small sample of clinical HMR reports written by accredited pharmacists. An instrument was developed from a consolidation of HMR practice guidelines and then applied to a small sample of de-identified clinical HMR reports provided by accredited pharmacists. The instrument developed contained 30 criteria for clinical HMR report writing, and 20 HMR reports were evaluated from 12 accredited pharmacists. Seven of the 30 criteria were met by all clinical HMR reports evaluated (were consumer-focused, documented a medicines list, medicines strengths, medicines directions, medication-related problems, and included both evidence-based and clinical recommendations for optimising medicines management). However, of the 20 HMR reports evaluated only 30% (n = 6) documented the general practitioner's reason for HMR referral, 60% (n = 12) detailed allergies/adverse drug reactions, 50% (n = 10) documented an adherence statement, and 20% (n = 4) documented vaccination status. Clinical HMR reports evaluated in this small study were aligned with practice guidelines for some criteria. Future research is warranted in a larger study to further investigate clinical HMR report writing adherence to practice guidelines in Australia.