Conference_Handbook_and_Book_of_Abstracts by Conference Logistics

The 36th SHPA National Conference

medicines management

conference handbook & book of abstracts Melbourne 11-14 November 2010 Melbourne Convention Exhibition Centre

KEY PARTNER

EDUCATION PARTNERS

conference handbook & book of abstracts

CONTENTS WELCOME

HOST ORGANISATION

ACKNOWLEDGEMENTS

GRANTS AND AWARDS FOR 2009-2010

GENERAL INFORMATION

KEYNOTE SPEAKERS

INVITED SPEAKERS

PHARMACIST LEADERSHIP IN ACTION SPEAKERS

SOCIAL PROGRAM

EXHIBITORS

KEY PARTNER

EDUCATION PARTNERS

MAJOR SPONSORS

STANDARD SPONSORS

PROGRAM

SHPA CPD

SHPA CPD ACTIVITY RECORD FORM

ABSTRACTS - FRIDAY

ABSTRACTS - SATURDAY

ABSTRACTS - POSTERS

121

INDEX

225

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WELCOME ON BEHALF OF THE MEDICINES MANAGEMENT 2010 ORGANISING COMMITTEE, WELCOME TO MELBOURNE! This year’s diverse conference programme highlights many ways in which hospital pharmacy practice continues to evolve. We trust you will take the opportunity to share ideas with colleagues from around the country and find new ideas to challenge yourself.

The content of this year’s conference has been CPD accredited. Remember to keep a record of the sessions attended for inclusion in your CPD Activity Record. This is especially important in light of the new Pharmacy Board of Australia requirements.

We were delighted with the record number of submitted abstracts for this year’s conference and as a result, the quality of presented work is very high. We hope you all take the opportunity to reflect on the presented research and practice updates and find inspiration to further develop your own practice or that of your workplace. To those presenting a paper or poster, we strongly encourage you to submit your work to the Journal of Pharmacy Practice and Research.

Thank you for attending this year’s conference. We hope it keeps your passion for your profession alive!

KEY PARTNER

EDUCATION PARTNERS

MAJOR SPONSORS

Alice Kochman Conference Convenor

Andrew Harding Conference Program Manager

conference handbook & book of abstracts

HOST ORGANISATION THE SOCIETY OF HOSPITAL PHARMACISTS OF AUSTRALIA (SHPA) IS THE PROFESSIONAL BODY WHICH REPRESENTS 2,500 PHARMACISTS, PHARMACY TECHNICIANS AND ASSOCIATES PRACTISING IN ALL PARTS OF THE AUSTRALIAN HEALTH SYSTEM. SHPA was established in 1941 following the pioneering efforts of 25 public hospital pharmacists in Victoria. From 1947 to 1964 other branches were developed. The inaugural meeting of the SHPA Federal Council and the first SHPA federal conference were held in Adelaide in 1961. SHPA has a long-standing commitment to the provision of pharmacy services in hospitals and to the profession’s role in ensuring optimal health outcomes for Australian consumers by the safe and effective use of medicines. Safe and effective medication use is the core business of pharmacists, especially in hospitals. SHPA is the only professional pharmacy organisation with an especially strong base of members practising in hospitals and other facilities. SHPA supports hospital pharmacy services to provide safe and effective medication use for consumers and advocacy to support members in delivering better health care and outcomes for consumers across the entire health system. What were once “hospital services” are now being delivered in a range of other settings and the changing nature of healthcare delivery is now also reflected in the diversity of SHPA membership. Whilst maintaining a strong public hospital base, SHPA draws members from a diverse range of pharmacy and health practice settings including public and private hospitals, community pharmacy, academia, research, industry, government, consultant pharmacy and a range of quality use of medicines projects, clinical governance and medicines management programs.

Pharmacists working in hospitals have an established role at all steps of the medicines management pathway. With more professional services being offered via community pharmacy and other pharmacy settings, the medicines management pathway with its central focus of consumer outcomes will play an increasingly greater role across the continuum of care.

THE SHPA VISION IS: Excellence in medicines management through leading edge pharmacy practice and research

SPONSORSHIP AND CONFERENCE MANAGER SHPA Sally Ridgers PO Box 1774 Collingwood, VIC 3066 T F M E

03 9486 0177 03 9486 0311 0438 074 348 sridgers@shpa.org.au

www.shpa.org.au

CONFERENCE OFFICE

THE SHPA MISSION IS: • Supporting the continuing professional development of our members • Having strong membership within hospitals and all other quality use of medicines settings • Partnering with key medicines stakeholders • Advocating the safe and effective use of medicines across the continuum of care

PO Box 6150 Kingston, ACT 2604 T 02 6281 6624 F 02 6285 1336 E conference@conlog.com.au www.conlog.com.au

THE SHPA VALUES ARE: • • • • •

Teamwork Integrity Recognition Respect Innovation

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ACKNOWLEDGEMENTS CONFERENCE COMMITTEE

CONFERENCE CHAIR Alice Kochman Alfred Health

PROGRAM MANAGER Andrew Harding Austin Health

COMMITTEE MEMBERS Gedal Basman St Vincent’s Melbourne Kerryn Barned Southern Health Mimi Chu Western Hospital Kate Deale Melbourne Health Michael Frank Melbourne Health Megan Middleton Eastern Health Veronica Saenz St Vincent’s Melbourne Sonia Shen Eastern Health Jennifer Tio Royal Victorian Eye and Ear Hospital Lavinia Verduci St Vincent’s Melbourne To-Hao Vo-Tran Royal Women’s Hospital in Victoria

FURTHER ACKNOWLEDGEMENTS The Conference Committee wish to acknowledge the work done by the Abstract Reviewers, Session Chairs and Paper & Poster Judges. We thank them for their contribution to the success of Medicines Management 2010, the 36th SHPA National Conference. Jacqueline Abercrombie Manya Angley Megan Arnold Julie Beechey Sasha Bennett Camille Boland Nicki Burridge Paula Caird Katherine Chandler Lisa Ciabotti Andrew Cording Osbert Cotta Geoff Davies Nicole Dirnbauer Trish Downes Catherine Drake Joanna Edwards Wendy Ewing Rowena Fary Shannon Ferguson Kirstie Galbraith Angela Given Sharon Goldsworthy Linda Graudins Kylee Hayward Lisa Ho Marisa Hodgkinson Catherine Hughes Vicki Ibrahim Natalie Jenkins Ceridwen Jones Nick Jones Benafsha Khariwala

Sue Kirsa Beverley Lamb Dennis Leung Anne Leversha Julie Lord Helen Lovitt Elaine Lum Angela Madden Erini Mathiopoulos Helen Matthews Gina McLachlan Laura Murray Li-Ling Ng Cathy Ngo Karen O’Leary Silvana Pignataro Susan Poole Diana Rainbird Cameron Randall Olivia Rofe Joan Semmler Tom Simpson Leanne Stafford Angela Stathopoulos Adam Stormont Christopher Thompson Michael Tsui Tim Tran Glenn Valoppi Melita Van de Vreede Graeme Vernon Michelle Vienet Diane Walters Cynthia Walton Meredith Wiseman Kate Witney Swee Wong Vincent Wong Mary Wood Jennifer Woodgate Sally Yeung Golriz Zarei

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GRANTS AND AWARDS FOR 2009-2010 Baxter NW Naismith Management Grant 2010 Sharon Goldsworthy

Healthcare Leadership Study Tour “What’s right in healthcare” Conference and Coaching

$10,000

Celgene Information Technology in Hospital Pharmacy Grant 2010 Inaugural grant to be announced at the Medicines Management 2010, the 36th SHPA National Conference

$10,000

EBEWE Pharma 2010 Oncology Pharmacy Grant John Coutsouvelis

Evaluation of the physicochemical compatibility of parenteral cyclosporine and total parenteral nutrition when intravenously administered via the same central line lumen

$7,500

Geeta Sandhu

To attend the 12th Symposium of the International Society of Oncology pharmacy Practitioners (ISOPP) in Prague, Czech Republic

$2,500

Fresenius Kabi Cancer Services Grant 2010 James Mellor

To attend the British Oncology Pharmacy Association (BOPA) 13th Annual Symposium in Manchester, UK

$4,300

Anna Shi

Preceptorship at the Peter MacCallum Cancer Centre in Melbourne: “What do we do well, what can we do better?”

$5,700

Hospira DBL Development Fund 2009 – 2010 Kamaleswary Arumugam

To attend the ANZSGM (Australia & New Zealand Society of Geriatric Medicine) 2010 Annual Scientific Meeting in Queensland, AUS

$1,640

Alison Duncan

To attend the International AIDS Conference 2010 in Vienna and study tour to Toronto Immunodeficiency Clinic

$2,500

Natasa Gisev

Predictors and Outcomes of Antipsychotic Polypharmacy

$3,500

Rebekah Moles

To attend the 70th International Congress of FIP at the University of Lisbon, Portugal

$2,500

Jonathan Penm

To attend the 23rd Federation of Asian Pharmaceutical Associations (FAPA) Congress

$2,500

Verna Wallroth

To attend the 50th American Society for Microbiology ICAAC Symposium in Boston, USA

$2,500

Susan Welch

Pharmacokinetics of broad spectrum antibiotics in extracorporeal membrane oxygenation (ECMO) – using plasma concentrations to optimize antibiotic therapy

$8,000

Hospira DBL Development Fund Travel Assistance to attend Medicines Management 2010, the 36th SHPA National Conference in Melbourne November 2010 SHPA Members (59)

$10,000

Hospira DBL Young Pharmacist Award 2010 Catherine Hughes

Observational review of rural and remote pharmacy services in Canada to optimise patient outcomes in pharmaceutical reforms for country South Australia

$10,000

Janssen-Cilag Specialist Renal Pharmacists Grant 2009 Angela Young

Preceptorship in Renal Pharmacy at The Royal Adelaide Hospital in South Australia

$5,000

Merck Sharp & Dohme Pharmacy Postgraduate Study Grants 2009 Amy Allen

Oncology and Palliative Care MSc, PGDip, Cancer Studies PGCert Newcastle University, UK

$3,000

Chastina Anderson

Graduate Diploma in Clinical Pharmacy at the University of Queensland, AUS

$3,000

Jared Brown

Graduate Diploma in Clinical Epidemiology (Clinical Toxicology) at the University of Newcastle, AUS

$5,000

Lisa Ho

Graduate Certificate of Pharmacoeconomics at Monash University, AUS

$5,000

Merck Sharp & Dohme Pharmacy Postgraduate Study Grants 2010 To be announced at the Medicines Management 2010, the 36th SHPA National Conference

$20,000

Pfizer Australia Pharmacy Grant 2009 Kathryn Mackie

To attend the 11th International Workshop on Adverse Drug Reactions and Co-morbidities in HIV in Philadelphia, USA

$5,000

Felicity Wright

To attend the 12th Symposium for the International Society of Oncology Pharmacy Practitioners (ISOPP) in Prague, Czech Republic

$5,000

Pfizer Australia Pharmacy Grant 2010 To be announced at Medicines Management 2010, the 36th SHPA National Conference

$20,000

Roche Research Grant on Quality and Safety 2010 The-Phung To

Stability, safety and suitability of prefilled metaraminol syringes

$10,000

sanofi-aventis Pamela Nieman Continuum of Care Research Grant 2010 Alexandra Bennett

Mapping pharmacist outreach services in Australia: What is the current involvement of pharmacists in programs addressing continuity of care gaps in the quality use of medicines? $10,000

National Alliance for Pharmacy Education The National Alliance for Pharmacy Education (NAPE) is a partnership between four of Australiaâ&#x20AC;&#x2122;s leading pharmacy schools (Monash University, The University of Queensland, University of South Australia, The University of Sydney). NAPEâ&#x20AC;&#x2122;s vision is to provide leadership in pharmacy education and to support the DGYDQFHPHQW RI WKH SKDUPDF\ SURIHVVLRQ YLD KLJK TXDOLW\ Ă&#x20AC;H[LEO\ GHOLYHUHG DZDUG courses. Three universities (Monash University, The University of South Australia and The University of Sydney) will offer the NAPE Intern Training Program in 2011. This SURJUDP OHDGV LQWR D *UDGXDWH &HUWLÂżFDWH LQ 3KDUPDF\ 3UDFWLFH D KLJKO\ UHJDUGHG SRVWJUDGXDWH TXDOLÂżFDWLRQ NAPEâ&#x20AC;&#x2122;s University members offer a range of postgraduate coursework programs IRU SKDUPDFLVWV GHVLJQHG WR GHYHORS VSHFLDOLVW FOLQLFDO H[SHUWLVH WR HQKDQFH FDUHHU SURVSHFWV DQG LPSURYH SDWLHQW FDUH &RXUVHV DUH DYDLODEOH YLD Ă&#x20AC;H[LEOH GHOLYHU\ PRGHV which accommodate students working full-time and/or in remote or regional locations.

Baxter Pharmacy Services TAILORED PARTNERSHIPS, TOTAL SOLUTIONS

Proud supporters of the 2010 Medicines Management Conference

conference handbook & book of abstracts

GENERAL INFORMATION VENUE Melbourne Convention Exhibition Centre 1 Convention Centre Place South Wharf, Melbourne VIC 3006 www.mcec.com.au

CITY OF MELBOURNE INFORMATION

REGISTRATION LOCATION AND HOURS

There is a lot to love about Melbourne - just ask the locals. This sophisticated world city in the south-east corner of mainland Australia inspires a deep passion in those who live there.

The Conference Registration and Information Desk will be located in Main Foyer 3 of the Melbourne Convention Exhibition Centre, next to the glass doors in between the Exhibition and Convention Centres, and will be open at the following times:

Melbourne is very much about lifestyle. It is no huge surprise to residents that their city has been ranked as one of the world’s most liveable cities. Melburnians love the city’s vibrant energy, restaurants, fashion boutiques, café-filled laneways, cool bars, unbeatable galleries, spacious parks and village-like inner suburbs, each with its own special character. Melbourne is less than 200 years old and never sits still. Modern, cutting-edge designs add to the fascinating mix of heritage architecture and ensure the skyline is constantly changing.

Thursday 11 November 0800–1900 Friday 12 November

0730–1930

Saturday 13 November 0700–1800 Conference Logistics staff will be happy to assist you in any way they can.

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ACCOMMODATION HILTON MELBOURNE SOUTH WHARF 2 Convention Centre Place Melbourne, VIC 3006 T 03 9027 2000 www.hiltonmelbourne.com.au CROWN PROMENADE HOTEL 8 Whiteman Street Melbourne, VIC 3006 T 03 9292 6688 www.crownpromenade.com.au QUEST APARTMENTS SOUTHBANK 16 Kavanagh Street Melbourne, VIC 3006 T 03 9694 5600 www.questsouthbank.com.au NOVOTEL MELBOURNE on COLLINS 270 Collins Street Melbourne, VIC 3000 T 03 9667 5800 www.novotelmelbourne.com.au VIBE SAVOY HOTEL MELBOURNE 630 Little Collins Street Melbourne, VIC 3000 T 03 9622 8888 www.vibehotels.com.au RENDEZVOUS HOTEL 328 Flinders Street Melbourne, VIC 3000 T 03 9250 1888 www.rendezvoushotels.com QUALITY HOTEL BATMAN’S HILL 623 Collins Street Melbourne, VIC 3000 T 03 9614 6344 www.batmanshill.com.au TRAVELODGE SOUTHBANK 9 Riverside Quay Melbourne, VIC 3006 T 03 8696 9600 www.travelodge.com.au HOTEL ENTERPRIZE 44 Spencer Street Melbourne, VIC 3000 T 03 9629 6991 www.hotelenterprize.com.au

CATERING AND DIETARY REQUIREMENTS Lunches, morning and afternoon teas on Friday and Saturday will be held in the Industry Exhibition (Halls 13 and 14). Lunches will be served as an informal stand-up buffet. Dietary requirements noted on your registration form have been passed on to the catering staff. There will be a table dedicated for special dietary requirements in the Industry Exhibition which will include vegetarian options. Please ask the MCEC staff to assist if needed. At the Gala Dinner, vegetarian meals will only be available for those who have previously advised of this requirement.

CHILD MINDING Please note that no official arrangements have been made for child care during the Conference. Please check with your hotel as they should be able to assist you with child minding services.

SHPA CPD

EXHIBITION HOURS The exhibition will be open at the following times: Friday 12 November

1045–1930

Saturday 13 November 1030–1545

EVALUATION SURVEY An online evaluation survey will be emailed to all delegates after the conference. Delegates are encouraged to complete the conference evaluation as it assists us to plan future conferences.

INTERNET ACCESS Internet booth Complimentary internet access is available in the Exhibition Hall at the two internet booths. Please limit your time at the internet booths so the facilities can be shared by as many delegates as possible.

Wireless internet Melbourne Convention Exhibition Centre wireless internet can be purchased by credit card via the Melbourne Convention Exhibition Centre Wireless Portal. Plan 1 – 1 hour access or 75MB download – $10 (including GST)

The content of this year’s conference has been accredited by SHPA. Please refer to page 55 for full details.

DELEGATE LIST A delegate list with name, organisation and state will be supplied to delegates and exhibitors at the Conference. Anyone who indicated on their registration form that they did not want their name and organisation to appear on the list has not been included.

DRESS The conference dress is smart casual for sessions, Wine and Nibbles on Thursday evening and the Welcome Reception on Friday evening. The Gala Dinner on Saturday evening is optional 1970s theme dress up or formal attire with a touch of 70s. Prizes will be awarded for the grooviest gals and guys.

Plan 2 – 8 hours access or 250 MB download – $20 (including GST)

LOST AND FOUND Please report any lost or found property to the Melbourne Convention Exhibition Centre Information desk located on Level 1.

MESSAGES Messages can be left at the Registration Desk (Main Foyer 3). The messages will be posted on the message board situated near the desk. Please check the board on passing. The registration desk can be contacted on 0488 576 105.

MOBILE PHONES AND PAGERS As a courtesy to other delegates and speakers, please ensure that all mobile telephones and pagers are turned off or in “silent” mode during all sessions and social functions.

conference handbook & book of abstracts

NAME BADGES Your official conference name badge must be worn at all times, as it is your entry to all sessions, the exhibition hall and social functions. Security staff will be asked to refuse entry to anyone not wearing their allocated name badge.

POSTERS Posters are located in the Exhibition Hall and will be available for viewing on Friday 12 and Saturday 13 November during the exhibition opening hours. Delegates are encouraged to view the posters which have been grouped according to the conference themes. Delegates can see a preview of each poster on the screens located at the registration desk and booth 15. We ask poster presenters of odd numbered posters to be by their posters and available to talk to delegates between 1300-1330, Saturday 13 November and poster presenters of even numbered posters to be by their posters between 1330-1400, Saturday 13 November. Delegates are welcome to talk to poster presenters about their work during this time. All poster presenters need to remove any poster tubes or other packaging from the Exhibition Hall for the duration of the conference. Any poster packaging left next to poster boards will be disposed of.

PRESENTERSâ&#x20AC;&#x2122; AWARDS Prizes will be awarded for:

Papers Best Paper Best Technician Paper Best First Time Presenter Best First Time Technician Presenter

Posters Best First Time Poster Presenter kindly donated by MIMS Australia Best Technician Poster Peopleâ&#x20AC;&#x2122;s Choice Award for the Best Poster Awards will be announced at the Gala Dinner. If a winner is not present the prize will be sent to them.

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SPEAKERS’ PREPARATION ROOM Speakers are required to submit and preview their presentations prior to their session. If you have not previously emailed or uploaded your presentation, please deliver it as soon as possible to the Speakers’ Preparation Room. An Audio Visual Technician will be available to assist. Presenters may run through their presentations in the Speakers’ Preparation Room at any time the room is open prior to their presentation. The Speakers’ Preparation Room is located in Meeting Room 215 on level 2 and will be open as follows:

Car Parking There are three car parks available for visitors to the Melbourne Convention Exhibition Centre (MCEC). Costs for these vary as to the day and the time of day. (Prices correct at time of printing).

Melbourne Exhibition Centre

Saturday 13 November 0700 - 1530

Entrance off Normanby Road (Open 24 hours, 7 days a week) 1060 undercover parking spaces managed by Wilson Parking. The most convenient doors to enter the Exhibition Centre are doors 6 and 7.

SPECIAL REQUIREMENTS

Fees:

Every effort has been made to ensure people with special requirements are catered for. Should you require any assistance, please contact the registration desk to enable us to make your attendance at the Conference a pleasant and comfortable experience.

0.0 - 1.0 hour 1.0 - 2.0 hours 2.0 - 3.0 hours 3.0 - 4.0 hours 4.0 + hours

Thursday 11 November 0800 - 1900 Friday 12 November

0730 - 1900

TRANSPORT INFORMATION The Melbourne Convention and Exhibition Centre is easily accessed by the city’s roadways, freeways, public transport and on foot. The City Link automated tollway connects the MCEC to the airport in just 20 minutes. The Centre is also serviced by several paid parking areas within walking distance of the Centre.

Trams The following tramlines will bring you to MCEC • Route 96 - St Kilda to East Brunswick • Route 109 - Port Melbourne to Box Hill • Route 112 - West Preston to St Kilda

Trains • Southern Cross and Flinders Street stations are both a short stroll from MCEC.

Bus Services Melbourne’s bus network is made up of over 300 routes and buses run frequently to major hubs. For more information please visit www.metlinkmelbourne.com.au

$8 $16 $24 $32 $32 max.

WEATHER Melbourne has a reputation for its changeable weather. A tip for any visitor is be prepared for anything – take an umbrella and wear layers that can be worn and removed as needed! Average temperatures for November range from an overnight minimum of 11°C to a daytime maximum of 22°C.

2011 CONFERENCE Medicines Management 2011, the 37th SHPA National Conference, will be held at the Hotel Grand Chancellor, Hobart Tasmania, 10 – 13 November 2011. For further information, and to register your interest, please visit the conference website at www.mm2011shpa.com or the SHPA website at www.shpa.org.au. Visit the team from Business Events Tasmania at their display located on the concourse of the Melbourne Convention and Exhibition Centre during the conference.

Evening rate - $10, Monday to Thursday, entry from 6pm and exit before 6am Weekend rate - $12, per exit, per day Earlybird rate - $11, enter between 6am - 9am and exit between 3pm - midnight

DISCLAIMER

myki is Victoria’s new smart card ticketing system for trains, trams and buses, and replaces Metcard. myki is a reusable plastic smart card that you store value on to pay for your fare on public transport.

Medicines Management 2010, the 36th SHPA National Conference including the Conference Organisers will not accept liability for the damages of any nature sustained by participants or their accompanying persons for the loss or damage to their personal property as a result of Medicines Management 2010, the 36th SHPA National Conference and exhibition or related events. All details contained in this Conference Handbook are correct at time of printing.

Taxis

PRIVACY

Melbourne taxis are numerous and easy to spot – they are all uniformly yellow. Melbourne’s major taxi companies include:

Information provided on the registration form will be used to administer the Conference including accommodation, catering, transport, sponsorship and exhibition.

13 CABS Arrow Embassy Taxis Silver Top Taxis

Data obtained will remain the property of Conference Logistics and the Society of Hospital Pharmacists of Australia.

Alternative car parking is available at the World Trade Centre and South Wharf Retail Car Park.

myki

13 22 27 13 22 11 13 17 55 13 10 08

conference handbook & book of abstracts

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Local representatives and customer service teams in each state.

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CH2 Direct is our web based online ordering system, providing a simple and intuitive ordering interface allowing you to place orders directly into CH2 using your internet browser.

1300 720 274 www.ch2.net.au Your Partner Delivering Excellence in Healthcare Supply Solutions 11

staying alive 2010

Introducing the new THALOMIDÂŽ 100 mg capsule +DOI WKH FDSVXOHV GRXEOH WKH FRQYHQLHQFH

*Pack still includes 28 capsules

PBS Information: multiple myeloma. Authority required. Refer to PBS schedule for full authority information.

Before prescribing Thalomid please refer to the full Product Information which is available from Celgene Pty Ltd. Thalomid 50mg Hard Capsules (containing 50mg thalidomide). Thalomid 100mg Hard Capsules (containing 100mg thalidomide). Teratogenic effects: Thalidomide has caused severe birth defects when taken during pregnancy. Thalidomide should never be used by women who are pregnant or who could become pregnant whilst taking the drug or could become pregnant within 4 weeks after stopping the drug. Even a single dose can cause birth defects. Indications:- patients with untreated multiple myeloma â&#x20AC;&#x201C; in combination with (a) melphalan and prednisone for the treatment of patients aged â&#x2030;Ľ65 years or ineligible for high-dose chemotherapy or (b) dexamethasone for induction therapy prior to high-dose chemotherapy with autologous stem cell rescue; after failure of standard therapies in multiple myeloma, as monotherapy; cutaneous manifestations of moderate to severe erythema nodosum leprosum (ENL). Contraindications:- hypersensitivity to thalidomide or ingredients; patients aged <12 years; pregnancy, lactation, women of child-bearing potential who are not using adequate contraceptive measures; women of child-bearing potential where there is an alternative treatment of non-inferior efďŹ cacy available; males unable to comply with adequate contraceptive measures. Precautions:- treatment initiated and monitored under the supervision of specialists only; individual, written, fully informed consent for use; teratogenicity (see boxed warning â&#x20AC;&#x201C; refer to full PI for requirements concerning pregnancy testing, contraception and condom use in male patients); supply only to prescribers, pharmacists and patients registered with the i-accessÂŽ risk management program; drowsiness, somnolence and sedation; peripheral neuropathy; thrombogenicity, seizures; dizziness and orthostatic hypotension; syncope and bradycardia, neutropenia; dermatological reactions; impaired wound healing; hypothyroidism; do not donate blood or semen while receiving thalidomide; impaired renal or hepatic function. Drug interactions: enhanced effect of sedative drugs, medicines associated with peripheral neuropathy, cytotoxics, drugs which interact with hormonal contraceptives. Adverse events:- Combination therapy and/or monotherapy: Very common: deep vein thrombosis, peripheral neuropathy, tremor, dizziness, drowsiness, somnolence, paraesthesia, dysaesthesia, constipation, peripheral oedema, fatigue, neutropenia, leukopenia. Common: pneumonia, depression, anxiety, confusional state, mood changes, bradycardia, syncope, pulmonary embolism, dyspnoea, vomiting, nausea, dry mouth, dyspepsia, headache, hypotension, rash, urticaria, dry skin, toxic skin eruption, muscle cramps, asthenia, pyrexia, malaise, ataxia, lethargy, blurred vision, vertigo. The most serious toxicity associated with thalidomide is teratogenicity. This is not a full list â&#x20AC;&#x201C; see full PI for all adverse events including uncommon/rare events. Dosage and administration:- Multiple myeloma (adult dosage): Untreated multiple myeloma as combination therapy: 200mg daily in combination with melphalan and prednisone (maximum of 12 cycles of 6 weeks) or dexamethasone (4 cycles of 4 weeks); after failure of standard therapies as monotherapy: 200mg, increased by 100mg at weekly intervals to a maximum dose of 400mg daily according to tolerance and toxicity. Erythema Nodosum Leprosum (adult dosage): 100mg daily, increased by 100mg at weekly intervals to a maximum dose of 400mg daily according to tolerance and toxicity. Lower maintenance doses can be used. Titrate dose in renal or hepatic disease (see full PI for further information). Capsules taken orally as a single dose in the evening, at least one hour after food. PBS dispensed price:- $1680 (public hospital), $1726.42 (private hospital).

Celgene Pty Ltd ABN 42 118 998 771 Level 7, 607 St Kilda Rd, Melbourne VIC 3004, Australia Tel 03 9539 5500 Fax 03 9539 5566 www.celgene.com.au

WMP CEL21677 10/10

conference handbook & book of abstracts

KEYNOTE SPEAKERS Dr Luke Bereznicki Dr Luke Bereznicki is a Senior Research Fellow in the Unit for Medication Outcomes Research and Education (UMORE), at the School of Pharmacy, University of Tasmania. He is also a Senior Lecturer at the Tasmanian School of Pharmacy. He writes for a range of pharmacy industry publications. Luke is a practicing pharmacist and regularly works in retail pharmacy and performs medication reviews. Luke was the PSA Young Pharmacist of the Year in 2008. His major research focus has been on improving the use of antithrombotic medications. Dr Malcolm Dobbin Dr Malcolm Dobbin is a Public Health Physician working as the Senior Medical Advisor on Alcohol and Drugs to the Mental Health, Drugs and Regions Division of the Victorian Department of Health. He has done postgraduate research in preventive medicine (Aboriginal child health and nutrition), and has a background in emergency medicine, general practice, drug and alcohol treatment, public health, as well as working for Aboriginal community controlled health services in inner city and remote area practices. His areas of interest include addressing the misuse of pharmaceutical drugs (prescription and overthe-counter), engagement of general practitioners in the identification and management of alcohol and other drug problems in their practice, and prevention of methadonerelated deaths. Rosie Forster Rosie Forster is Acting Executive Director of the National Health and Medical Research Councilâ&#x20AC;&#x2122;s (NHMRC) National Institute of Clinical Studies (NICS), leading a team responsible for improving the translation of research findings into clinical practice. Prior to working with NHMRC and NICS, she held positions in the Department of Health and Ageing, and a Division of General Practice.

Dr Michael McDonough Dr Michael McDonough is currently employed as Medical Director, Addiction Medicine Service at Western Hospital. The latter position involves the provision of treatment for both inpatients and outpatients referred with tertiary problems related to Substance Abuse/ Addiction. This also includes managing a special clinic for patients who have Chronic Pain and Drug Dependence problems. At Western Hospital, Dr McDonough is also involved in teaching of both undergraduate and postgraduate medical trainees, engaged in a variety of research projects (having a special interest in the Toxicology of Drugs of Abuse) and is the Chairman of the Adverse Drug Events Committee, Chairman of the Western Health Institutional Ethics management Committee. In 2010, Dr McDonough was appointed as Chief Adviser in Addiction Medicine, Department of Health & Human Services, Victorian State Government. Dr McDonough graduated from Monash University in 1982, trained in general internal medicine for four years then two years of advanced training in Addiction Medicine at the Addiction Research Foundation (Toronto, Canada), an organisation affiliated with Toronto University and the World Health Organisation. On return to Australia, he took up the position of full-time staff specialist in the Drug and Alcohol Unit at Box Hill Hospital and also served as a Consultant to Drug Services Victoria. Dr McDonough is a Foundation Fellow in the Australasian Chapter of Addiction Medicine (FAChAM) within the RACP and has completed a Masters in Addiction Studies (MAS) and a postgraduate Diploma in Clinical Toxicology. He is a consultant for the Victorian Drug and Alcohol Clinical Advisory Service and a member of the Drugs of Dependence Advisory Committee and the Poisons Advisory Committee, of the Department of Human Services. He is also a member of the Australian Pain Society, the Australian Professional Society on Alcohol and other Drugs, the European Society of Poisons Centres & Clinical Toxicologists and the International Association of Forensic Toxicologists; Dr McDonough occasionally acts as a peer reviewer for the Medical Journal of Australia, Addiction and the Drug and Alcohol Review.

Rosie has a Masterâ&#x20AC;&#x2122;s Degree of Business from the Queensland University of Technology. Her undergraduate degree is in Physiotherapy and she gained clinical experience in acute and ambulatory settings, before taking on postgraduate studies and other roles in the health care system.

staying alive 2010

Irvine Newton Irvine Newton, a community pharmacist and pharmacy owner, has been Chair of the PSA (Vic) Harm Minimisation Committee and is a member of the Department of Human Services (Vic) Drug of Dependence Advisory Committee. He was spokesman of the National Pharmacy Illicit Drug Training Project and was awarded the coveted Professional of the Year 2003 by Professions Australia. He was a Pharmaceutical Society of Australia (Victorian Branch) councillor for many years and served as President in 1998-99. He is also a Fellow of the Pharmaceutical Society of Australia and a Fellow of the Australian Institute of Pharmacy Management. He won an Alcohol and Other Drug Council of Australia (ADCA) Australia Day Award in 2002. According to ADCA, Irvine has ‘devoted much of his professional career as a pharmacist to implementing services for illicit drug users. He has been instrumental in creating a culture of change within pharmacy and he has unstintingly worked to eliminate prejudice towards drug users’. He was also awarded the Medal of the Order of Australia (OAM) in 2005 for service to the pharmacy profession and to the community, particularly through promoting harm minimisation programs. Rodney Adams Rodney Adams has been employed as the only Ward based Pharmacy Technician for the last 2 Years at the North West Regional Hospital in Burnie, Tasmania. He has worked in the Health department since 1981, apart from a 5 year break in the early 2000s. He is also an Employee Safety Representative for this hospital and relates these two areas to this conference’s theme “Staying alive”. All this is fitted in around his passion for fishing and Tasmania. Yvonne Allinson Yvonne Allinson is CEO of The Society of Hospital Pharmacists of Australia (SHPA), the peak professional membership organisation for continuing professional development and practice standards for Australian hospital pharmacists. Yvonne works at both national and state/territory levels to support efforts to improve health care and pharmacy services for individual consumers. She is a hospital pharmacist with extensive clinical pharmacy experience. Yvonne has undertaken post graduate studies in hospital pharmacy, health education and health administration and she has worked at several Australian public hospitals and overseas in clinical pharmacy and management positions. Prior to joining SHPA, she worked in the Victorian Health Department on the change management aspects of the information technology and telecommunications strategy for public hospitals.

Yvonne’s current professional interests include: • Continuity in medication management to bridge the gap between hospital and community, both before admission and at discharge. • Facilitating consumer empowerment and partnership as part of e-health developments via a shared current medication list that both consumers and health professionals can use to improve the use of medicines. • The role of pharmacists, working in multidisciplinary teams, to improve the safe and effective use of medicines. • Using the medicines management pathway and an understanding of the interdependency of the nine key steps and three background processes to improve medicines use and the design of e-health systems. • Facilitating change in health care so as to maximise the efficiency, effectiveness, safety and quality of the medicines used in health care delivery. Dr Kirsty Buising Kirsty Buising is an infectious diseases physician at St Vincent’s Hospital in Melbourne, and a clinical research physician at the Victorian Infectious Diseases Service based at the Royal Melbourne Hospital. She chairs the Antimicrobial Stewardship committees at both of these hospitals. Kirsty has a Doctorate of Medicine through the University of Melbourne, which focused on the use of computersied decision support for antimicrobial stewardship. She has been a core member of the guidance team at the Royal Melbourne Hospital, a not for profit organisation that has developed and implemented computersied drug stewardship systems in many Australian hospitals. Natalie Bula Natalie Bula is the Deputy Director of Pharmacy Operations at The Canberra Hospital. A graduate of the University of Queensland in 1997, Natalie has worked in hospitals in Queensland and the ACT in a variety of roles including clinical pharmacist, drug and poisons information, medication safety, cytotoxic cancer and sterile manufacture before embarking on a management and leadership pathway. Natalie was the recipient of the 2008 SHPA Baxter NW Naismith Leadership Grant, which facilitated a study tour throughout the UK and Europe investigating IT and Automation solutions for medicines management.

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INVITED SPEAKERS Paula Caird Paula has been working at Fremantle Hospital for the past eleven years in varying roles, predominantly as a pharmacy technician, but also had the opportunity to work as a Research Assistant for the Discharge Liaison Pharmacy project. From this project Paula was actively encouraged to create a role in the Emergency Department for a technician, which has presented many opportunities to extend her role as a pharmacy technician. She has been fortunate to present her work at local and national forums. Paula is passionate about developing a career structure for technicians, progressing forward from some of the more traditionally recognised roles, and is currently involved with the National Technician Network to achieve this. Prior to emigrating to Australia she had fifteen years technician experience in the UK. Ruth Chieng Ruth is a clinical pharmacist at the Alfred Hospital, Victoria where she’s worked since 2001. She has clinical experience in various units including cardiology, heart failure, renal transplant, burns and intensive care. The past three years has seen Ruth specialising in Haematology/ Oncology – in particular, working in the Bone Marrow Transplant unit. Ruth has developed a keen interest in this group of patients and is working on a research project looking at improving their medication management in an outpatient setting. Dr Julie Cichero Dr Julie Cichero is currently employed as a senior research fellow with the Children’s Nutrition Research Centre, School of Medicine (The University of Queensland). She is both a deglutitionist (feeding swallowing) and a speech pathologist, with 18 years of clinical experience. Julie has research collaborations with a number of schools at the University of Queensland (Chemical Engineering, Pharmacy, Food Science, Biochemistry) and the Toronto Rehabilitation Institute, Canada. Julie is an internationally recognised author, educator and researcher. She published her first textbook in 2006 together with co-editor Prof. B. Murdoch, titled: Dysphagia: Foundation, Theory and Practice (Wiley & Sons Inc.). In 2009, together with dietitian Kate Di Prima her first popular press book was published, titled: More Peas Please: Solutions for Feeding Fussy Eaters (Allen & Unwin). Julie is a reviewer for a number of international medical, nursing and allied health journals. She has served as a consultant on dysphagia for the National Stroke Foundation (Australia), Speech Pathology Australia, the Dietitians Association of Australia, American Speech and Hearing Association (Division 13–Dysphagia), Wyeth (Australia) and Nestlé Health Care Nutrition (Global).

Dr Sally Cockburn Dr Sally Cockburn is a GP with over 25 years clinical experience, but she is probably better known for her 18 year media career as Dr Feelgood, host of the highly successful late night radio program Pillowtalk, which aired in the 1990s and her regular TV presentations. These days, she has her own weekly radio program, Talking Health, on Melbourne’s 3AW and appears on The Morning Show on Channel 7. Behind the scenes, Sally is passionate about patient and community issues and is active in health policy and education at many levels. She sits on the Board of Vic Health and Monash Medical Foundation and is deputy Chair of Family Planning Victoria. She is also a patron or ambassador for many health support agencies including RDNS, Melbourne Osteoporosis Support Group and Lort Smith Animal Hospital. Sally is renowned for bringing sensitive issues out of the closet with humour and sensitivity and leaving her audiences feeling good! Neil Cottrell Neil Cottrell has extensive experience as a clinical pharmacist practitioner and manager of clinical pharmacy services in teaching hospitals in the United Kingdom. During that time he provided clinical pharmacy services to general medical, renal, care of the elderly, cardiac, endocrinology and intensive care wards and had joint appointments with Aston and Manchester Universities. In 1998 he moved to Australia to take up the position of Assistant Director of Pharmacy at the Royal Brisbane Hospital where he was responsible for the clinical pharmacy services. At that time Neil was also appointed as a Clinical Senior Lecturer in the School of Pharmacy, The University of Queensland. In 2001 Neil became a full time Senior Lecturer in the School of Pharmacy, The University of Queensland. In this position he teaches therapeutics to 3rd year students and has developed and delivered integrated case tutorials with 4th year and Postgraduate students. In July 2010, Neil was seconded to a project as the Deputy Head of the UQ-Greenslopes Private Hospital Clinical School, to lead a team to develop an interprofessional education curriculum. Neil’s current research interests include investigation of consumer perceptions and beliefs towards the use of medicines in patients with heart disease and their relationship to adherence. Neil is an associate editor for the Journal of Pharmacy Practice and Research. In 2007, Neil was the recipient of the Society of Hospital Pharmacists of Australia Clinical Pharmacy award.

staying alive 2010

Dr Ian Coombes Dr Ian Coombes is currently Acting Director of Safe Medication Practice Unit, Queensland Health and is responsible for a state wide program of practitioner development utilising competency based performance assessment and training of all pharmacy staff. Ian graduated from the University of London and worked as a clinical pharmacist at the Royal London Hospital UK. He came to Australia in 1989 returning to the UK with his wife and worked as a Clinical Services Manager developing clinical pharmacy services at Royal Sussex County Hospital. He completed his Masters in Clinical Pharmacy in Brighton. Ian Coombes returned to Australia in 1995 as Assistant Director, Clinical Services, Princess Alexandra Hospital leading medication safety and team based clinical pharmacy services. In 2002 he moved to the Safe Medication Practice Unit developing state wide medication systems and safe prescribing programs. He completed his PhD in 2007 having investigated interventions to reduce doctor prescribing errors. Ian has published widely and has been an invited speaker at many National and international meetings. He is a founding member of the Australian Pharmacy Council and a member of the Editorial Executive committee of Australian Prescriber, a Clinical Senior Lecturer at the Schools of Pharmacy and Medicine University of Queensland and the University of Peradeniya, Sri Lanka. Margaret Duguid Margaret Duguid joined the Australian Commission on Safety and Quality in Health Care as their Pharmaceutical Advisor in January 2008 after a long career in hospital pharmacy, most recently as Director of Royal North Shore Hospital. A graduate of Otago University in New Zealand, Margaret commenced her career in hospital pharmacy in New Zealand before moving to Australia to work in the pharmaceutical industry. She then spent some time in community pharmacy in Australia and Scotland before returning to Australia and hospital practice, firstly as a clinical pharmacist at the Royal Canberra Hospital, then as Director of Pharmacy at Wollongong Hospital before moving to Royal North Shore Hospital, Sydney in 1993. Margaret has been an active member of the SHPA for over 30 years. She served as a Federal Councillor for 8 years, as Federal President (1993 â&#x20AC;&#x201C; 1995) and as Chair of the SHPA Research and Development Grants Advisory Committee (2000-2005). Margaret is an examiner for the NSW Pharmacy Board and has served on the Australian Pharmaceutical Advisory Council. Margaret has a keen interest in the quality and safe use of medicines and has undertaken research in this area. In 1995 Margaret was awarded the Merck Sharp Dohme (Australia) Medal for Pharmacy Practice and in 2005 received the Fred J Boyd award from the Society of Hospital Pharmacists of Australia. 18

Rohan Elliott Rohan Elliott is a senior pharmacist at Austin Health and clinical senior lecturer at Monash University. He obtained his BPharm in 1991, and subsequently completed an Honours degree and Master of Clinical Pharmacy. He is a Certified Geriatric Pharmacist and a Fellow of the SHPA and the American Society of Consultant Pharmacists. Rohan has practiced as an aged care pharmacist in hospital, residential care and community settings for more than 10 years, and has led several major research projects. He has published more than 20 peer reviewed papers and a book chapter on geriatric pharmacy practice and is an editor and contributor to the Geriatric Therapeutics and DrugScan (Geriatrics) sections of the Journal of Pharmacy Practice & Research. Rohan has also developed and coordinates two postgraduate units in geriatric pharmacy practice at Monash University. Recently, he was principal investigator on a multicentre study that sought to identify and address problems with continuity of medication management at the hospitalresidential care interface. Jane Evans Jane Evans is the Clinical Trials Administrator at Alfred Health. After completing a Certificate II in Retail -Pharmacy Services in Queensland, Jane moved to Melbourne and started working as a pharmacy technician at the Alfred Hospital where she completed her Certificate III in Health Services - Hospital Pharmacy. Jane has worked in many areas of the pharmacy, including sterile manufacturing and as a Clinical Technician, before accepting her current role in the Clinical Trials Pharmacy, where she has been working for the past three years. Michael Frank Michael Frank is a clinical pharmacist from the Royal Melbourne Hospital. He has been working in the area of smoking cessation and the management of smoker withdrawal whilst in hospital over a number of years. In 2009, Michael received the NHMRC NICS-Melbourne Health Fellowship to conduct an evidence based implementation of a guideline for the management of nicotine withdrawal in hospitalised patients at The Royal Melbourne Hospital. This program is unique in its emphasis on the science of knowledge translation to reduce the time taken for evidence to reach common practice.

conference handbook & book of abstracts

Dr Andrew Fuller Andrew is an Infectious Diseases Physician and microbiologist and has been at the Alfred as a fulltime staff specialist for almost twenty years. Andrew began the ‘Hospital in the Home’ program in 1995 and has been managing the program as medical head since that time. Andrew’s interests are in a wide range of Infectious Diseases ranging from transplant infections through to orthopaedic infections. The Alfred Hospital program is currently the largest ‘Hospital in the Home’ program in Victoria managing a wide range of complicated patients and conditions. Kirstie Galbraith Kirstie Galbraith is the Director of the Postgraduate Studies & Professional Development Unit at the Faculty of Pharmacy and Pharmaceutical Sciences, Monash University. This unit has responsibility for the delivery of a suite of postgraduate programs including Master of Clinical Pharmacy, Master of Pharmacy Practice, and Master of Wound Care. Kirstie has many years of experience as a hospital and community pharmacist and has been the Course Director of the Master of Clinical Pharmacy program since its inception in 2003. Kirstie is the coordinator of activities being undertaken by a new group of leading pharmacy schools entitled the National Alliance for Pharmacy Education (NAPE). The Alliance’s vision is to support the on-going advancement of the pharmacy profession through provision of high quality, flexibly delivered award courses by leveraging the resources, experience and expertise from its university members. It will provide leadership and a national voice in pharmacy education, with a focus on advancement of the pharmacy profession. Paul Gysslink Paul Gysslink is both a registered pharmacist and a registered teacher in Victoria. He works part-time in pharmacy as well as coordinating and teaching in the Certificate III and IV courses in Hospital/Health Services Pharmacy Support at Box Hill Institute of TAFE. Paul is a member of the Pharmacy Clinical Panel of Worksafe Victoria.

Dr Malcolm Hogg Dr Malcolm Hogg is Staff Specialist, Anaesthesia and Pain Management and Head of Pain Services, Melbourne Health and supervises a co-ordinated service from acute to chronic pain, linking the acute services at the City Campus with the persistent pain services at the Royal Park Campus. Therapies offered include interventional procedures for cancer and non-cancer pain, and allied health based pain management programs. Research programs include studies investigating the peri-operative pharmacokinetics of Paracetamol, functional brain imaging in clinical pain, and different models on pain service delivery. Dr Hogg is the Victorian Councillor on the executive of the Australian Pain Society, and is leading the Waiting in Pain project, a systematic investigation into the provision of persistent pain services in Australia. Dr Benjamin Howden Dr Ben Howden is an Infectious Diseases Physician and Medical Microbiologist at Austin Health. His research interests include understanding pathogenic mechanisms and antibiotic resistance in gram positive pathogens such as Staphylococcus aureus and Enterococcus faecium. He is also interested in the appropriate use of antimicrobials and prevention of antibiotic resistance. Professor Jeff Hughes Jeff Hughes is the Head of the School of Pharmacy, Curtin University of Technology. He is recognised as a leader in clinical pharmacy education and practice in Australia. The focus of his research is drug safety, pharmacy practice and pharmacy education. He has won a number of state and national pharmacy awards, including the SPHA’s Clinical Pharmacy Award in 2001, the Pharmaceutical Society of Australia’s Pharmacist of the Year Award in 2004, and the AACPPfizer Consultant Pharmacist Award in 2009. Jeff is a community pharmacy proprietor and a practising accredited pharmacist.

He has a passion for the education and role development of hospital pharmacy technicians. He wrote the content of the flexible delivery courses and feels he is fortunate to be able to combine the professions of pharmacy and education. Paul has experience on various pharmacy organisations including Pharmaceutical Society of Australia committees and the Pharmacists Division of APESMA.

staying alive 2010

Professor Ross McKinnon Professor Ross McKinnon is a Professor of Pharmaceutical Biotechnology at University of South Australia. He was previously the inaugural Director of the Sansom Institute (2005-2009). His research interests are predominantly in the molecular pharmacology/ toxicology area including pharmacogenomics and molecular oncology. He also has a research interest in cancer chemoprevention, particularly related to skin cancers. This work has led to the founding of a new company, PharmaQest.

Sue has a graduate diploma in hospital pharmacy and is a Fellow of the SHPA. Sue has published in a variety of areas including Hand Hygiene, use of bisphosphonates, PBS reform and safe dispensing of oral chemotherapies.

His current roles include Chair of the SA Tall Poppy Campaign, Member of the TGA Pharmaceutical Science Subcommittee, Member of the Australian Institute of Policy and Science (AIPS) Board and Member of the Federation of International Pharmacists Council. He also currently serves on both the CSIRO Health Sector and Preventative Health Flagship Advisory Boards. Past roles include President of the Australasian Pharmaceutical Science Association (2 terms) and Chair of the Adelaide Women’s and Children’s Hospital, Clinical Trials Review Committee. Awards and honours include an AIPS Tall Poppy Award, a Leaders Institute of South Australia Fellowship, a CSIRO Flagship Fellowship and NHMRC Academy membership. Prof. McKinnon was recently appointed National Facilitator for the Federal Government’s Translating Health Discovery Super Science Project. He has published over 125 research and education manuscripts since 1991.

Helen Lovitt Helen started her career as an intern at Royal Perth Hospital and then worked as a clinical pharmacist at Repatriation General Hospital Hollywood. She set up the state wide advisory position for the Repatriation Pharmaceutical Benefits Scheme in WA and then went to Swan Districts/ Kalamunda District Community Hospitals as a Senior Clinical Pharmacist. Helen’s substantive position is as manager of the Dispensary Service at Fremantle Hospital and Health Service (FHHS) but she has been working with other business representatives in the implementation of i.Pharmacy across public hospitals in WA. She is now working on the Pharmaceutical Benefits Scheme implementation for FHHS. Helen has long been a member of the Society of Hospital Pharmacists of Australia (SHPA) and previously participated on the State Branch Committee as Chairman and Vice Chairman. She chaired the SHPA State Branch Conference committees for 2004, 2006 and 2008. She was a member of the Conference Committee for Medicines Management 2009, the 35th SHPA National Conference. She has been the Federal Representative from WA on the SHPA council since 2007. Helen has lectured for Curtin University postgraduate and undergraduate students as well as TAFE students. She has presented at conferences for RACGP, PSANZ and at several SHPA Federal and State Branch Conferences. She coauthored Mosby’s medication guide for nurses published in December 1999. Helen’s interests in medication safety mean she has been involved with the WA Medication Safety Group since its inception and she is the current chair of the Group as well as WA representative on the SHPA Committee of Specialty Practice. She also has interests in the e-Health agenda Australia-wide and in Pharmacy workforce issues.

Kevin McNamara Kevin McNamara is a Lecturer in Pharmacy Practice at Monash University and a Research Fellow in Rural Pharmacy at the Greater Green Triangle University Department of Rural Health, a collaboration between Flinders University and Deakin University. For several years Kevin has been part of a multidisciplinary team involved in epidemiological and clinical studies involving cardiovascular disease risk factors. His major focus has been the identification of evidence treatment gaps in risk factor management and developing primary care responses in keeping with public health priorities. Kevin was a NHMRC National Institute of Clinical Studies – National Prescribing Service Quality Use of Medicines Fellow 2008-2010. As part of this Fellowship he conducted a randomised controlled trial to examine the influence of professional development and other clinical supports on the nature and extent of community pharmacist interventions in blood pressure management. This was one of several clinical trials based in primary care where Kevin has examined in detail how general practitioners, community pharmacists and other health professionals might be engaged to improve the quality of patient management.

conference handbook & book of abstracts

Maryanne Molenaar Maryanne is a Project Pharmacist implementing an electronic clinical record (HealthSMART) into Eastern Health, and ultimately across the state of Victoria, using her variety of skills, acquired from working as a hospital pharmacist. Previously, Maryanne held the position of Deputy Director of Pharmacy at Western Hospital where her areas of interest were medication safety and adverse drug reaction management. Prior to this appointment, Maryanne was the Director of Pharmacy, Bendigo Health Care Group. Bhavini Patel Bhavini Patel is the Director of Pharmacy at the Royal Darwin Hospital (RDH) and has been instrumental in the setting up of clinical pharmacy services in the NT public hospitals. Her clinical expertise is in renal and cardiovascular medicine and she has a special interest in how clinical pharmacists can improve the safety of and optimise outcomes of the medication use process. Bhavini’s research interests include organisational change and how to translate evidence into practice, specifically in relation to redesigning systems of care to improve equity and access and how information technology can assist in this process. She has been involved in a number of projects including the implementation of a paperless medication management system in the NT, the National VTE collaborative and was recently awarded a fellowship through the National Institute of Clinical Studies to improve the management of modifiable risk factors in patients with chronic kidney disease. Bhavini also holds a senior lecturer position at the Charles Darwin University where she has facilitated the development of an undergraduate pharmacy degree programme and is also a member of the Pharmacy Board of Australia. Bhavini graduated from Portsmouth University (UK) in 1992 and completed a residency and a Masters in Clinical Pharmacy in 1995 in Derby (UK). She now lives and works in the NT and finds the relaxed outdoor lifestyle a good balance to the demands of her work.

Angelo Pricolo Angelo Pricolo is a partner in three pharmacies, including the only 24 hour Victorian pharmacy – in the inner Melbourne suburb of Brunswick. He has acted as a mentor and preceptor for many pharmacy students and trainees. Angelo also regularly conducts tutorials and lectures at Victorian College of Pharmacy Monash University. After completing his Bachelor of Pharmacy degree at Victorian College of Pharmacy, Angelo went on to complete a traineeship at St Vincent’s Hospital in Melbourne after which he moved onto community pharmacy as a manager of various pharmacy businesses. He has worked as a pharmacist in Italy which included a short period of time at the Vatican Pharmacy where he dispensed a script for Pope John Paul II. In 2008 Angelo completed his documentary Fighting the Dragon with Luck–the story of heroin abuse seen through the eyes of six people on ORT, their treating physician and pharmacist–which has screened in Barcelona at the IHRA Harm Reduction Film Festival prompting interest from Canada, India and the UK for entry into various conferences. In 2009 it was featured at CPDD in America, the main addiction medicine conference in the USA, with over 1000 delegates. The documentary has further screenings planned around Australia and Angelo has been invited to present at upcoming NAPSA (National Australian Pharmacy Students’ Association) and APSAD (Australian Professional Society of Alcohol and other Drugs) congresses. The film aims to educate the naïve audience as well as encouraging more doctors and pharmacists to practise in this area. Angelo continues to be actively involved with opioid replacement pharmacotherapy programs, is on the PSA Harm Minimisation Committee and is also completing his Masters in Pharmaceutical Science at Monash University. He was awarded the Pharmaceutical Society of Australia Pharmacist of the Year 2008. Gregory Roberts Greg Roberts has over 20 years of clinical experience that commenced in paediatrics and progressed to adult medicine. His last five years have been involved in clinically based research with a view to improving clinical practice and patient outcomes, largely through the development of clinical decision support programs. Current interests include a number of aspects of anticoagulation practice, inpatient blood glucose control, dosing of renally cleared drugs, and development of ITbased clinical decision support with a view to enabling sustainable clinical change.

staying alive 2010

Sandy Scholes Sandy Scholes is a Clinical Pharmacist at Calvary Health Care Bethlehem, Victoria. She has a Bachelor of Pharmacy (1976) and a Graduate Certificate in Health (Palliative Care), and has worked in community pharmacy as well as private and public hospital pharmacy in rural, remote and city Australia. Sandy has gained practical experience in palliative care at Peter MacCallum Cancer Centre and Calvary Health Care Bethlehem. In 2009/2010, she has undertaken a Victorian Department of Health project to develop the role of the pharmacist as a member of the community palliative care multidisciplinary team. Sandy has had input into two projects funded by the Australian Government Department of Health and Ageing which are aimed at improving the medication management of palliative care patients by educating community pharmacists. She was also a member of the expert group to update Therapeutic Guidelines Palliative Care version 3 which was released in early 2010. Dr Thomas Schulz Dr Thomas Schulz is an Infectious Diseases and General Physician at the Royal Melbourne Hospital. One of his main areas of interest is the health of immigrants to Australia, in particular those who arrive as refugees. This includes infectious diseases that are particularly relevant to the refugee cohort, including Tuberculosis, Viral Hepatitis B and C, and Helminthic infections including Schistosomiasis and Strongyloides. Dr Schulz has previously been engaged in clinical and research in a number of international locations including Sudan, India and Papua New Guinea. Joan Semmler Joan is the Senior Technician in the Pharmacy Sterile Production Centre at the Princess Alexandra Hospital in Brisbane. She has 15 years experience including 4 years at Peter MacCallum Cancer Centre before moving to Queensland. Her role has expanded over several years to include staff training and development, and review and development of policies and procedures to ensure best practice standards. As a member of the SHPA Cancer Services COSP, she developed a greater awareness of the potential for pharmacy staff to be exposed to cytotoxic substances in the workplace. She has recently been involved in designing and implementing a project to determine levels of cytotoxic contamination in the Sterile Production Centre and levels of uptake by staff.

Mary Simic Mary Simic is the Product and Systems Manager for Slade Pharmacy, one of the leading providers of pharmacy services to the private hospital sector. She has over 12 years of industry experience, with a specialty focus on product supply and supply operations. Initially starting as a hospital pharmacy technician with Southern Health Monash Medical Centre (Clayton) in 1996, Mary moved into the private hospital sector with Slade Pharmacy in 1997 and then with John Jackson Pharmacy in 2000. In 2003 Mary returned to Slade Pharmacy in the role of Senior Purchasing Officer, moving on to become the Products and Systems Manager in 2005. Her role quickly evolved to encompass product supply negotiation, imprest and in-house operations and other facets of product supply to ensure effective continuity of business. In 2008 Slade Pharmacy entered a new era of patientfocused pharmacy service with the introduction of the largest ConSis B3 original pack Automated Dispensing System. Mary played a key role in implementation of the machine into dispensary workflow and supply, embracing advancing technology for improved patient outcomes. Dr Natalie Soulsby Dr Natalie Soulsby is currently working in the Multi-Disciplinary Ambulatory Consulting Service at the Royal Adelaide Hospital and has recently started a private consultancy company called “NatSoul”. She graduated from John Moores University in Liverpool in 1987 and started her clinical pharmacy career working at Fazakerley Hospital, Liverpool UK where she helped develop the service and completed her MSc in Clinical Pharmacy in 1992. Next she spent a year working at the Royal Perth Hospital before pursuing a role as a senior clinical pharmacist and “teacher/ practitioner” at Wirral Hospitals NHS Trust and Liverpool John Moores University. On arriving in Adelaide 10 years ago, she worked as a specialist pharmacist in the thoracic unit at the Royal Adelaide Hospital where her interest in medication management of patients with Cystic Fibrosis first developed. She also worked at the University of SA where her main role was in curriculum development in relation to the “Experiential learning program and Applied Pharmacokinetics courses”. She has also taught on both the introductory and advanced clinical pharmacy seminars run by SHPA as well as on the laboratory test course. She is a contributor to the textbook “Case Studies in Clinical Practice Use of Laboratory Test Data: Process Guide and Reference for Health Care Professionals” as well as writing the Pathology Test series in the Australian Pharmacist. She has just been awarded her PhD entitled “Renal dysfunction in patients with Cystic Fibrosis” from which she produced three publications. She is also the recipient of two SHPA research and development grants from DBL Development Fund and Pfizer Contemporary Therapeutics Grant and a Solvay Pharmaceuticals Cystic Fibrosis Travel Scholarship. She also received an Australian Cystic Fibrosis Research Trust funded PhD Student Fellowship.

conference handbook & book of abstracts

Joel Symons Dr Joel Symons is a Staff Specialist Anaesthetist at The Alfred Hospital in Melbourne. He is the recent past acting head of The Alfred Acute Pain Service and is an Adjunct Senior Lecturer at Monash University for the Academic Board of Anaesthesia and Perioperative Medicine. He has a keen interest in burns anaesthesia and analgesia and was extensively involved in anaesthesia and pain management of the Black Saturday fire victims who came to The Alfred. His interests also extend to perioperative medicine where he is the course convenor of the Short Course in Perioperative Medicine which is being run through The Alfred and Monash University. Simone Taylor Simone Taylor is a Senior Pharmacist in the Emergency Department at the Austin Hospital and is also involved in developing the pharmacyâ&#x20AC;&#x2122;s research program. After completing her Bachelor of Pharmacy degree at Monash University in Melbourne, Simone worked in a variety of hospital pharmacy positions. She developed an interest in critical care at Geelong Hospital, then undertook a Doctor of Pharmacy degree at University of Pittsburgh and a Specialty Critical Care Residency at University of Pittsburgh Medical Center. Since 2001, she has developed the clinical pharmacy service in the Emergency Department at the Austin Hospital. In 2005, she was awarded the Australian Clinical Pharmacy Award by SHPA. Simone is also involved in developing the research program in the pharmacy department at Austin Health and is a visiting lecturer at Monash University. She is an active member of the Emergency Medicine COSP and the pharmacist representative on the National Institutes of Clinical Studies Emergency Care Pain Management Initiative. Arti Thakerar Arti Thakerar is currently working as the Education / Pain and Palliative Care pharmacist at the Peter MacCallum Cancer Centre in Melbourne. Arti completed her pharmacy training in the UK and worked there as a pharmacist at a London tertiary hospital. Since she moved to Australia in 2005 she has been with Peter Mac where she is currently involved with the pain and CAMs working committees. Arti holds a Post Graduate Diploma in Clinical Pharmacy (Monash University).

Associate Professor Joseph Torresi Associate Professor Torresi is an infectious diseases physician at the Austin Hospital and Fellow of the Department of Medicine, Austin Health, University of Melbourne. He currently heads the Travel Medicine clinic at the Austin Hospital and is the Australian co-director for the international GeoSentinel Surveillance network. He has directed numerous international clinical research projects on infectious diseases in travellers and immigrants through the GeoSentinel Global Surveillance Network. The results of these studies have been cited in both the WHO International Travel and Health and the CDC Health Information for International Travel books. Associate Professor Torresi also heads the Hepatitis Molecular Biology Research laboratory at Austin Hospital and has published numerous papers on hepatitis B, C and E viruses, including seminal work on HBV vaccine escape mutants and compensatory HBV polymerase protein mutations and viral replication fitness. His hepatitis C research is directed towards the development of vaccine candidates against HCV and is funded through the National Health and Medical Research Council of Australia, the Australian Centre of Hepatitis and HIV Virology (Population Health Division of the Commonwealth Department of Health and Ageing) and the Australia-India Biotechnology Research Fund. Emeritus Professor Ian Webster Ian Webster is a physician and Emeritus Professor of Public Health and Community Medicine of the University of New South Wales. He has held appointments at Monash, Sheffield and Sydney Universities and in public hospitals in New South Wales. He is Patron of the Alcohol and other Drugs Council of Australia and is past Chairman of the Alcohol Education and Rehabilitation Foundation. He is Chairman of the Australian Suicide Prevention Advisory Council, the NSW Expert Advisory Group on Drugs and Alcohol, the Governing Council of the Ted Noffs Foundation and the Centres for Primary Health Care and Equity at the University of New South Wales. He was a member of the Australian National Council on Drugs. From 1976 to 2007 he was honorary visiting physician to the Matthew Talbot Hostel for the Homeless in Woolloomooloo, Sydney and now visits a clinic for the homeless at the Exodus Foundation, Ashfield, Sydney. He is Consultant Physician in the South Western Sydney and Shoalhaven Areas. He was made an Officer in the Order of Australia in 1995 and received the Prime Ministerâ&#x20AC;&#x2122;s Award in 2009 for outstanding work in the field of drugs and alcohol.

staying alive 2010

PHARMACIST LEADERSHIP IN ACTION SPEAKERS Naomi Burgess Naomi Burgess currently holds positions as Pharmacy Consultant, SA Health, Deputy Director of Pharmacy Services at the Royal Adelaide Hospital and is a Senior lecturer within the School of Pharmacy and Medical Sciences, University of South Australia. She has many years experience in a wide range of pharmacy practice areas including management roles within the public hospital, government and university settings. She has significant experience at both state and national level in management of major projects particularly in her key interest area, the safety and quality use of medicines. In recent years, Naomi has been instrumental in the recognition and acceptance of medication safety by Government as an imperative to excellence in patient care. Her role within SA Health has enabled her to advocate for the important contribution of hospital pharmacists to patient safety and safer use of medicines. Current activities include working with the senior advisory teams in SA Health leading and implementing safe medicines management policy and evaluation, workforce review and development, incident reporting, pharmacy automation, electronic support systems and research in quality medication management. Professor Michael Dooley Professor Michael Dooley holds a joint appointment as Director of Pharmacy at Alfred Health and Professor of Clinical Pharmacy in the Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences at Monash University. He is also Co-Director of the Centre for Medication Use and Safety of Monash University. He manages the pharmacy services to The Alfred, Caulfield and also the Sandringham Hospitals and the Melbourne Sexual Health Service. The Pharmacy Service is one of the nine clinical programs of Alfred Health. The pharmacy services include comprehensive unit based clinical pharmacy services including inpatient, outpatient clinic and outreach services across a range of specialized clinical programs. His contribution to pharmacy and improvements in medication use have been recognized by receiving the Australia Council of Health Standard (ACHS) 2005 Gold Medal and the SHPA Clinical Pharmacy Award and the 2003 Medal of Merit. Michael contributes to many national and local professional committees and working parties related to improving the delivery of quality heath care services and medication usage. He has been actively involved in a range of research activities from practice based undergraduate projects through to competitively funded NHMRC and ARC collaborative initiatives and post graduate programs. He has presented and published both locally and internationally on a wide range of topics.

Toni Howell Toni has been the QUM Pharmacist for Melbourne Health since 2007. She won the 2009 Melbourne Health Celebrating Excellence Award for Quality and Safety for her work in Medication Safety.

Sue Kirsa Sue Kirsa is the Director of Pharmacy at the Peter MacCallum Cancer Centre and is currently an SHPA Federal Councillor holding the Executive position of Treasurer. Sue sits on a number of State Government and Professional Committees including the Australian Pharmacy Councilâ&#x20AC;&#x2122;s Accreditation Committee, the Victorian Quality Council, the Victorian Medicines Advisory Committee and VicTAG. Sue has an active interest in Oncology Pharmacy Practice, Infectious Diseases, Quality Use of and Access to Medicines. Sue has a graduate diploma in hospital pharmacy and is a Fellow of the SHPA. Sue has published in a variety of areas including Hand Hygiene, use of bisphosphonates, PBS reform and safe dispensing of oral chemotherapies. Lynette Loy Lynette Loy is the Director of Pharmacy at Princess Alexandra Hospital where she has overseen the expansion of pharmacy services including a pharmacist prescribing pilot, and clinical development of technician roles. Also, Lynette and her team have secured over $1.5 million in grants for projects such as implementation of a robotic dispensing system. Lynette graduated from the University of Queensland in 1977. Since then she has had a diverse career including roles within both rural and metropolitan hospitals including Director of Pharmacy for Wynnum, Gladstone, Nambour, Redlands, and more recently the Princess Alexandra (PA) Hospital. Lynette is an adjunct Associate Professor at Griffith University and an Adjunct Senior Lecturer at the University of Queensland. She is also an AACP accredited pharmacist. In her current role she is an active member of local, statewide and national advisory and focus groups. Alongside this Lynette still likes to keep a clinical aspect to her work, and can be seen working on the wards and performing home medication reviews. Amber Roberts Amber Roberts is the State-wide Medication Coordinator in the Department of Health and Human Services in Tasmania. She is currently undertaking work on the major project of implementing Pharmaceutical Reform into the Tasmanian public hospitals. She is SHPAâ&#x20AC;&#x2122;s Federal Vice-President and has been a SHPA Federal Councillor since 2005.

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SOCIAL PROGRAM Thursday 11 November 2010

SHPA ANNUAL GENERAL MEETING

1730–1830

Thursday 11 November 2010

Main Foyer 3, MCEC

1830–1915

Dress: Neat casual

Meeting Room 220, level 2, MCEC

Come along, register and enjoy a drink and catch up with colleagues, friends, and attend the SHPA AGM from 1830.

WELCOME RECEPTION

The cost for this function is included in the full registration fees. Additional tickets can be purchased from the registration desk for $45 (incl GST) per person.

Exhibition Halls 13 and 14, MCEC

WINE AND NIBBLES

Friday 12 November 2010 1730–1930 Dress: Conference attire / Smart casual Welcome to the 2010 Conference. Take the opportunity to meet up with old and new friends and colleagues,

meet the sponsors and view the posters. Come along and enjoy the canapés and beverages on offer. The cost for this function is included in full registration fees, and Friday day registration fees. If you have not already indicated your intention to attend this function on your registration form, please see the staff at the registration desk. Additional tickets for accompanying persons and other registration types can be purchased from the registration desk for $65 (inc. GST) per person.

GALA DINNER – SATURDAY NIGHT FEVER Saturday 13 November 2010 1900–0100 Banquet Rooms 201/202 (level 2), MCEC Dress: Optional 70s theme dress up or formal attire, with a touch of 70s. Put on your funky gear and get ready to boogie! This will be an awesome night with fab food, wine and music. There will be great prizes for the grooviest gals and guys and table and those with the best disco moves. Be there or be square! The cost for this function is included in full registration fees. If you have not already indicated your intention to attend this function on your registration form, please see the staff at the registration desk. Additional tickets for accompanying persons and other registration types can be purchased from the registration desk for $150 (inc. GST) per person.

The Gala Dinner is proudly sponsored by our Key Partner

Hospira has an expanding portfolio of specialty pharmaceuticals to meet your healthcare needs. For over 70 years, the DBL range has provided healthcare professionals with a broad portfolio that meets your expectations of quality and safety. Itâ&#x20AC;&#x2122;s a name you trust. TM

Hospira Pty Ltd, ABN 13 107 058 328 Level 3/390 St Kilda Road Melbourne Vic 3004 Tel: 1300 046 774 www.hospira.com.au 101013DBL

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EXHIBITORS Exhibitor

Stand

Health Communication Network

Mundipharma

iSOFT

sanofi-aventis

Meditec

Symbion

Novartis Pharmaceuticals Australia

Amgen Australia

Aspen Pharmacare

Willach

Abbott Australasia

Sandoz

Pfizer Australia

Eli Lilly

Poster Preview National E-Health Transition

Authority (NEHTA)

PhaSeal速

GlaxoSmithKline

PHARMHOS Software

Device Technologies CH2 Clifford Hallam Healthcare

20 21 & 22

Orion Laboratories

Generic Health / Max Pharma

Bioceuticals

MIMS 100% Pure Knowledge

REM Systems

Obagi International

B. Braun Australia

Charm Health

Baxter Pharmacy Services

Celgene

Fresenius Kabi Australia

Self Care

Willow Pharmaceuticals

Phebra

HealthCare Software

Hospira

AFT Pharmaceuticlas

Nycomed

Janssen National Alliance for

Pharmacy Education

Pharmashelve Asia Pacific

EBEWE Oncology

CareFusion The Society of Hospital Pharmacists of Australia

46 Concourse

staying alive 2010

KEY PARTNER Stand 21 & 22 Clifford Hallam Healthcare (CH2) is today Australia’s largest national pharmaceutical and medical healthcare service provider utilising local knowledge and local people to provide pharmaceuticals, medical consumables and equipment products to the healthcare market. Our customers have long enjoyed the benefits of our Simple Ordering System (SOS) that provides direct access to CH2’s inventory of over 15,000 products to check price and availability. CH2 have also developed CH2 Direct, our web based online ordering system, providing a simple and intuitive ordering interface.

CH2 also offer value added services such as: • B2B – E Commerce functionality based on GS1 standards. CH2 can connect any Healthcare facility to CH2’s systems. • WardBox® that is unique to CH2. It is designed to reduce stock holdings and offers a range of service • model options that assist in achieving operational efficiencies. • CH2 Link – real time online invoice and credits download. • Local Customer Service and Representatives in each state.

EDUCATION PARTNERS

Stand 33 Celgene is a multinational biopharmaceutical company committed to improving the lives of patients. At Celgene, we seek to deliver truly innovative and life-changing drugs for our patients. Our mission as a company is to build a major global biopharmaceutical corporation while focusing on the discovery, the development, and the commercialization of products for the treatment of cancer and other severe, immune, inflammatory conditions. Investigational compounds are being studied for patients with incurable hematological and solid tumor cancers, including multiple myeloma, myelodysplastic syndromes, chronic lymphocyte leukemia (CLL), non-Hodgkin’s lymphoma (NHL), glioblastoma, and ovarian, pancreatic and prostate cancer. As committed as we are to clinical accomplishment, we are equally committed to patient and healthcare professional support, which is a guiding principle at Celgene.

Stand 39 Hospira is a global specialty pharmaceutical and medication delivery company dedicated to Advancing Wellness™. As the world leader in specialty generic injectable pharmaceuticals, Hospira offers one of the broadest portfolios of generic acute-care and oncology injectables, as well as integrated infusion therapy and medication management solutions. Through its products, Hospira helps improve safety, cost and productivity of patient care. The company is headquartered in Lake Forest, Ill., and has more than 14,000 employees. Learn more at www.hospira.com.au

Stand 15 Headquartered in Basel, Switzerland, Roche is a leader in research-focused healthcare with combined strengths in pharmaceuticals and diagnostics. Roche is the world’s largest biotech company with truly differentiated medicines in oncology, virology, inflammatory and autoimmune diseases, metabolism and CNS (central nervous system). Roche is also the world leader in in-vitro diagnostics, tissue-based cancer diagnostics and a pioneer in diabetes management. Roche’s personalised healthcare strategy aims at providing medicines and diagnostic tools that enable tangible improvements in the health, quality of life and survival of patients. In 2009, Roche invested almost 10 billion Swiss francs in research and development worldwide, including approximately $36 million (AUD) in pharmaceuticals in Australia. Genentech, United States, is a wholly owned member of the Roche Group. Roche has a majority stake in Chugai Pharmaceutical, Japan. For more information: www.roche-australia.com.

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MAJOR SPONSORS

Stand 32 Baxter has a proud history of over 25 years in the supply of aseptically compounded pharmaceuticals, Intravenous Solutions and nutrition preparations to health care providers & patients across Australia and New Zealand.

Stand 2 Mundipharma focuses on the therapeutic area of moderate to severe pain. We provide the broadest range of short- and long-acting strong analgesic medicines to accommodate the wide-ranging needs of Australian and New Zealand patients.

As the largest commercial compounding operation within the region, Baxter Pharmacy Services is the only provider able to manufacture and supply a complete range of ready-to-use, compounded solutions including cytotoxic, nutrition, antibiotic and analgesic preparations.

Our analgesic products include OxyContin® tablets, OxyNorm® capsules, liquid and injection, and NORSPAN® patches.

Whether it is a bulk order of analgesics for a busy hospital pharmacy, or a patient-specific dose of chemotherapy or antibiotics, we provide an individual service tailored to meet the specific needs of your hospital pharmacy or clinic, providing a total solution for all of your aseptic compounding requirements. Contact: Simon Venville Email: Simon_Venville@baxter.com

Stand 13 Pfizer Australia is the nation’s leading provider of prescription medicines and animal health products. For more than 50 years, Pfizer Australia has partnered with Government, healthcare providers and communities to expand access to our medicines and provide better quality health care. Pfizer Injectables has been formed to bring the same range, quality, innovation, reliable supply and customer focused flexibility that customers and patients have come to expect from Pfizer. In the offpatent marketplace, Pfizer Injectables now provides hospitals with high quality treatment options at a competitive price.

Please refer to Product Information and state and federal regulations before prescribing or call Mundipharma on 1800 188 009.

Stand 4 The ambition of sanofi-aventis is to become a diversified global healthcare leader, focused on patients’ needs. The largest pharmaceutical company in Europe and in emerging markets, sanofi-aventis is the fourth largest worldwide. The Group’s vaccine division, sanofi pasteur, is the world leader for human vaccine production and commercialisation. With the recent acquisition of Australia’s leading nutraceutical brands including Nature’s Own and Cenovis, sanofi-aventis ANZ is now a horizontally integrated health care provider from complementary medicines, through to patented medicines, generics, over the counter medicines, and vaccines. Sanofi-aventis has a strong commitment to R&D and we currently have 48 compounds in development. At sanofi-aventis we are committed to our customers, our employees, and even more importantly to the people who rely daily on our medicines.

Stand 41 Nycomed as a pioneering pharmaceutical organization in Australia and New Zealand is committed to an investment in the countries’ healthcare systems. With our innovative products and support activities including Research we add value to patients lives. We strive for a leadership position in the fields of our expertise, by engaging in constant value innovation and delivering the highest standard in customer service. Nycomed operates in both the prescription and consumer health sectors and brings medicines that matter to the market through a combination of our own research pipeline as well as partnerships with other companies in the areas of gastrointestinal, respiratory diseases, pain and wound care.

Stand 6 Symbion Hospital Services is the culmination of over 160 years of expertise in pharmaceutical distribution. With the combination of our IT solutions, a comprehensive customer service package and the skills of our operational infrastructure we can provide you with one of Australia’s most innovative hospital supply chain networks. Symbion Hospital Services is the key link between your suppliers of pharmaceuticals and the demanding needs of your hospital. From supply dock delivery through to total imprest management, our systems can provide you with an efficient and effective way to manage your pharmaceutical supply chain.

Pfizer Australia Pty Limited ABN 50 008 422 348 38 – 42 Wharf Rd West Ryde NSW 2114 Australia

staying alive 2010

STANDARD SPONSORS Abbott Australasia

Aspen Pharmacare

CareFusion

Stand 11 Abbott is a global, broad-based health care company devoted to discovering new medicines, new technologies and new ways to manage health. Our businesses span the continuum of care, offering nutritional, pharmaceutical and diabetes care products, as well as vascular devices and laboratory diagnostics.

Stand 9 Aspen Pharmacare Australia commenced operations in May 2001. Current annual sales are over $180 million and growing.

Stand 46 CareFusion delivers clinically proven products and services that measurably improve the productivity and safety of healthcare globally. We help our customers improve patient care by focusing on two of the biggest issues affecting healthcare, medication errors and infection prevention.

In anaesthesia, SEVOrane has been registered in Australia for over a decade. Abbott also provides anaesthetists with the additional products Forthane and Chirocaine.

We have a pipeline of products which we plan to launch in Australia. Our partners and licensors include the biggest names in the pharmaceutical industry, including CSL, SanofiAventis, GlaxoSmithKline, Novartis, Eli Lilly, Abbott, Teva, MSD.

AFT Pharmaceuticals

B. Braun Australia

Charm Health

Stand 40 AFT Pharmaceuticals is a privately owned company with operations in both Australia and New Zealand. AFT is involved in the development, distribution and marketing of branded and generic products in all the key market areas OTC, Prescription (PBS/ Health Subsidy) and hospital markets. We look forward to welcoming you to our stand no. 40 where we will be showcasing a range of products including PBS Listed Ferro-F-Tabs, Ferro Liquid, Calci-Tab, Cromolux, Vistil Eye Drops & Micolette.

Stand 29 B. Braun Australia is a full subsidiary of B. Braun Melsungen AG, a family owned company that today is the largest privately owned global healthcare company in the world. Our innovative range of quality products and services sets standards in medical technology and establishes B. Braun as the competent partner to the health industry. B. Braun provides a range of pharmaceutical and medical products for Intravenous Therapy, Regional Anaesthesia, Surgery/Orthopaedics and education through the Aesculap Academy.

Stand 30 Charm Health develops innovative clinical information solutions that assist the pharmacy and improve patient care and safety. CHARM provides Oncology and Renal Information Management modules that can be used as stand-alone responses in these specific specialities or deployed as part of an overarching solution. Scheduling, e-prescribing, e-med admin, pharmacy and charting support the clinical work processes involved in the treatment of the patient. Incorporating an electronic patient medical record and reporting module, Charm reduces inefficiencies and errors in service delivery.

Amgen Australia

BioCeuticals

Stand 8 Amgen (NASDAQ:AMGN), a biotechnology pioneer, discovers, develops, and delivers innovative human therapeutics. Our medicines help millions of patients in the fight against cancer, kidney disease, rheumatoid arthritis, bone disease, and other serious illnesses. With a deep and broad pipeline of potential new medicines, we continue to advance science to serve patients.

Besides marketing and distributing products owned by the Aspen Group, we also license in products from other companies, and are focused on meeting the needs of our licensors.

Stand 25 BioCeuticals is a family-owned company committed to empowering people to embrace and enjoy the benefits of a strong and healthy body and mind. We firmly believe that effective nutritional supplementation relies on the science behind the product and our range of professional formulae represent the pinnacle of science, technology and tradition in line with time-tested micronutrients, medical foods and nutraceuticals. We are committed to providing you and your patients with only the highest quality products and see this as a reflection of the integrity of our company.

info@charmhealth.com.au www.charmhealth.com.au

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Device Technologies

Eli Lilly

Stand 20 Founded in 1992, Device Technologies is an established distributor of quality and technologically-advanced, capital equipment and consumables. The company is Australian-owned and employs more than 350 healthcare specialists and support staff.

Stand 14 Eli Lilly and Company is a leading, innovation–driven corporation committed to developing a growing portfolio of best–in–class and first–in–class pharmaceutical products that help people live longer, healthier and more active lives. Lilly products provide clinicians and patients with treatment options in neuroscience, oncology, cardiology, diabetes and osteoporosis.

Our products are professionally supported by Product Managers and Specialist Representatives, trained to work in surgical and OR environments. Other services provided by our qualified personnel include: • Clinical education and |in-servicing • Technical service and equipment maintenance • Customer service for all product information, orders and delivery • Quality assurance and TGA listing of all products

As one of the top 10 Lilly affiliates (sales) globally, Lilly Australia is committed to providing answers that matter – through medicines and information – for some of the world’s most urgent medical needs.

Generic Health / Max Pharma Stand 24 Generic Health is an Australian based supplier of key generic medicines directly to hospitals and pharmacies. Since our formation in September 2004, Generic Health has worked to sourced quality generic pharmaceuticals at low, sustainable prices from the world’s top manufacturers. Generic Health’s 2009 acquisition of Max Pharma and partnership with Actavis has expanded our specialty hospital generics product portfolio and is part of our growth strategy to become one of the leading players in the Australian hospital generics industry.

EBEWE Oncology

Fresenius Kabi Australia

GlaxoSmithKline

Stand 45 EBEWE Pharma is one of the world’s leading manufacturers of highly active compounds for parenteral administration. EBEWE specialises in developing and manufacturing pharmacy preferred presentations which are exported to over 90 countries worldwide. EBEWE Oncology was launched in Australia in April 2005 and has since become a major supplier to both the Australian and New Zealand markets. Part of the EBEWE philosophy is to actively support Oncology Pharmacy. This commitment is demonstrated with EBEWE’s support of the both the annual SHPA conference and the Ebewe Oncology SHPA Pharmacy Grant.

Stand 34 Fresenius Kabi Australia Pty Limited is one of Australia’s fastest growing and innovative pharmaceutical companies, which is dedicated to improving the quality of life of patients in Australian hospitals by creating a new level of expertise and care.

Stand 18 GlaxoSmithKline (GSK) Australia is one of the largest research based pharmaceutical companies in Australia. GSK’s vision is to help Australians do more, feel better and live longer. GSK’s product portfolio is closely aligned with Australian key health priorities of asthma, immunisation, depression, diabetes, oncology, indigenous health and infectious diseases. GSK invests more than $35 million a year in Australian R&D, and contribute to export revenue through pharmaceutical and consumer healthcare exports.

Fresenius Kabi Australia specialises in these key areas: • • • • • • •

Oncology Compounding Infusion Technology Transfusion Technology IV Drugs Volume Therapy Parenteral Nutrition Gastroenterology

www.fresenius-kabi.com.au

staying alive 2010

HealthCare Software Stand 38 HealthCare Software (HCS) is Australia’s premier provider of integrated medication management solutions. The HCS Clinical Suite promotes safer and more effective clinical practice by providing applications that range from medication reconciliation to inpatient reviews and PBS prescribing. These support your team across the whole patient episode, from admission interview to discharge summary. Developed specifically to support clinicians, HCS solutions assist you to meet national clinical and statutory guidelines. For improving medication safety, HCS is the only option.

iSOFT Stand 3 iSOFT designs, develops and implements advanced software solutions which are focused on enabling all healthcare participants to connect, communicate and collaborate to improve the quality, timeliness and experience of care for providers and consumers. We provide flexible and interoperable solutions to the whole spectrum of providers, from single physician practices through to integrated national solutions supporting thousands of concurrent users. Today more than 13,000 provider organisations in 40 countries, across five continents, use iSOFT’s solutions to manage patient information and drive improvements in their core processes.

Meditec Stand 5 The largest supplier of automated sachet packing technology for medication in the southern hemisphere, Meditec has joined with Omnicell to bring their solutions to Australian and New Zealand. A globally recognised provider, Omnicell supplies technologically advanced hardware/software solutions to allow Pharmacy and Supply challenges to be better managed in a healthcare facility. In addressing these challenges, Omnicell has helped reduce medication errors, improve efficiency and decrease costs in >1,600 hospitals across the world. We look forward to discussing the possibilities.

Health Communication Network

Janssen

MIMS 100% Pure Knowledge

Stand 1 Knowledge Solutions is a division of HCN dedicated to delivering a broad range of innovative solutions that assist clinicians at the point of care and, thereby, improve the quality and efficiency of health care service delivery. With committed investment in research and development, in-house technological expertise and robust project management, Knowledge Solutions is the national leader in the provision of decision support tools and clinical information resources to support evidencebased practice. Developed in close collaboration with healthcare customers, Knowledge Solutions offers a premium service underpinned by technology, a strong customer service ethic, and a dedication to making clinicians’ lives easier and patients’ lives safer.

Stand 42 Janssen is a leading research-based pharmaceutical company, dedicated to improving the health and wellbeing of all Australians. By embracing innovation, developing our people and celebrating success, we will inspire our customers with patient focused healthcare solutions.

Stand 26 MIMS is Australia’s most widely used medicines information and clinical decision support product. MIMS is available in print (MIMS Annual and BiMonthly), on CD (eMIMS), PDA (MIMS on PDA) and integrated into clinical and medication management software (MIMS Integrated). MIMS is highly regarded as the most reliable and comprehensive medicine information source. Independently edited by a team of healthcare specialists, the MIMS product range is continually evolving to meet the changing needs of Australian healthcare professionals.

Janssen is the seventh largest pharmaceutical company in the world. We research and develop prescription medicines for some of the world’s most serious and prevalent diseases, ranging from cancer and rheumatoid arthritis, to life-threatening bacterial infections and HIV/AIDS. www.janssen-cilag.com.au

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National Alliance for Pharmacy Education Stand 43 The National Alliance for Pharmacy Education (NAPE) is a partnership between four of Australia’s leading pharmacy schools (Monash University, The University of Queensland, University of South Australia, The University of Sydney). NAPE’s vision is to provide leadership in pharmacy education and support advancement of the pharmacy profession via high quality, flexibly delivered award courses. Three universities will offer the NAPE Intern Training Program in 2011. This program leads into a Graduate Certificate in Pharmacy Practice, a highly regarded postgraduate qualification.

National E-Health Transition Authority (NEHTA) Stand 16 The National E-Health Transition Authority Limited (NEHTA) is the lead organisation supporting the national vision for e-health in Australia; working openly, constructively and collaboratively with consumers, providers, funders, policy makers and the broader healthcare industry; to enable safer, higher quality, accessible, equitable, efficient and sustainable healthcare. NEHTA was established by the Australian Commonwealth, State and Territory governments in 2005. It aims to develop better ways of electronically collecting and securely exchanging health information.

Novartis Pharmaceuticals Australia Stand 7 Novartis is a world leader in the research, development and supply of products to protect and improve health and well-being. In Australia the company now employs more than 700 people, and invests over $27million AUD annually in local research. The Novartis group of companies offers a portfolio of products that benefit patients, healthcare professionals and the community, including innovative medicines to treat some of the most debilitating and life threatening conditions, including in oncology, cardiovascular disease, osteoporosis, ophthalmic and transplantation.

Orion Laboratories Stand 23 ORION is an Australian Pharmaceutical Manufacturer, with a TGA Registered manufacturing facility based in Western Australia. Orion is committed to providing and manufacturing essentials for everyday health care in hospitals. Orion’s product range is extensive and includes antiseptics and disinfectants, hand hygiene products, oral care and skin care products. Orion contract manufacture specialty products for major health care facilities nationally and internationally plus a diverse range of quality products for the healthcare market. The Orion team look forward to seeing you during the SHPA. For more information on Orion products see www.orion.net.au or contact Orion Customer Service on 1800 805 546.

Obagi International

Pharmashelve Asia Pacific

Stand 28 Obagi Australasia introduced Obagi cosmetic products into the Australian and New Zealand markets in early 2009. This same client group was the reason that LMX4 was introduced by Ferndale to Obagi, then evolving into Obagi International, the distributors for LMX4 into the Australian market.

Stand 44 Pharmashelve is the latest storage solution developed specifically for pharmacists who are faced with the problem of freeing up enough internal space for storing the increasing number of products available on the market that they are expected to stock. It has up to 4 times more stock holding than traditional shelves, Easier to fill & retrieve product, automatically rotates stock when back filled and ultimately saves time and money. Pharmaflo, is a semi-automatic dispensing batch Flow System which is designed to work alongside existing systems and skilled personnel. By using in conjunction with Pharmashelve equipment and utilising current staff, significant improvements can be made in the accuracy, safety and efficiency of the prescription ordering and picking process in a hospital. Enquiries 1300 618 100 and www.pharmashelve.com

LMX4 is a topical local anaesthetic that offers a number of differences over currently available topical preparations. LMX4 has been available in the USA since 1999 and Canada and the UK since 2003, and has extensive published clinical data. Obagi International with LMX4, had its original start in the cosmetic market, and now with a new indication is available to all hospitals nationally. Come and visit Obagi at stand 28 to talk about LMX4 and how it can benefit your hospital today.

staying alive 2010

PhaSeal®

PHARMHOS Software Stand 19 The Merlin Pharmacy Information System provides a comprehensive integrated business and clinical solution to meet the requirements of complex pharmacy management.

Stand 17 Carmel Pharma is the manufacturer of the PhaSeal® System, a scientifically proven closed-system drug transfer device (CSTD) for the safe handling of hazardous drugs.

Merlin has the experience and functionality for the issues facing Hospital Pharmacy practice –

Product: PhaSeal has been validated by more than 15 independent, peer-reviewed, published clinical studies. PhaSeal’s unique airtight expansion chamber and dry, leakproof connections prevent exposure to hazardous drugs, including aerosols and vapors. Its streamlined design and universallycompatible components make the system easy to use from preparation and administration to waste disposal.

• PBS Dispensing for Public and Private Hospital practice • PBS Section 100 HSD claims processing • Patient Billing and Debtor tracking, integrated with Point of Sale • ePrescribing script processing • Script-Scan checking and tracking • Point of Administration interface Pyxis® Medstation • Sophisticated multi-store Inventory management • Electronic Purchase Orders via EDI, eCommerce and Ward Box • Strong support for your day-today running

The PhaSeal System is trusted by and implemented in more than 2000 cancer facilities, infusion centers and private practices across 30+ countries. www.phaseal.com Customer Service 1800 110 511

Phebra Stand 37 Phebra is an Australian pharmaceutical company that is focussed on the development and commercialisation of specialty pharmaceuticals. The team at Phebra has the mission to develop innovative and critical medicines that save and improve lives. The company’s therapeutic focus is cystic fibrosis, pain, oncology and hospital injectables. Phebra’s headquarters and manufacturing operations are located in Sydney, Australia. Phebra is supported by a regional office in Melbourne, Australia and a network of distributors in New Zealand, Asia, Europe and Canada. Phebra is a fully integrated pharmaceutical company and employs more than 60 people worldwide in research, development, manufacturing, regulatory affairs, quality assurance, marketing and sales.

Australia’s largest pharmaceutical wholesaler to the healthcare industry

1300 773 000 nnn%jpdY`feg_XidXZp%Zfd

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REM Systems Stand 27 REM SYSTEMS offers you products for the following clinical markets: • Pharmacy automated filling, compounding equipment and accessories • Products for Sterile manufacturing, connectors, filters, TPN administration • Cytotoxic drug preparation consumables, spikes, closed IV systems • Oral dispensers & Specialist Syringes • Protective Apparel, “Chemo” gloves, gowns, mats • Special purpose IV administration sets, non DEHP, low sorbing REM SYSTEMS currently represents the following companies : • • • • •

Self Care Stand 35 Self Care is Australia’s leading health information and education program for pharmacy. It creates an essential information and education link between the consumer, the pharmacist and the pharmacy assistant. All resources are aligned with S2 and S3 Standards and PSA’s Professional Practice Standards. Self Care is a program of the Pharmaceutical Society of Australia and consists of health information for consumers and monthly education modules for both the pharmacist and pharmacy assistant.

Willow Pharmaceuticals Stand 36 What makes our company unique in the sea of sameness? At Willow we care about quality – both in the product and the service we offer, we care about making a difference to our customers and ultimately to the patients whose lives are made better because of the care they receive. We care about the way we do business and how we work in the Australian hospital market. We proudly support The Society of Hospital Pharmacists Australia. Come visit us at our stand.

For more information contact 1300 369 772.

BAXA MEDLINE CODAN METRIX ARGUS

Call us on Freecall 1800-737 222

Sandoz Stand 12 The Sandoz Hospital Business Division was launched in January 2009, with a strong focus on delivering cost-effective pharmaceutical products to the hospital market. Speed and simplicity, quality and customer focus, as well as trust and mutual respect are our core values. They guide our entrepreneurial thoughts and actions and form the basis of the trust placed in us by our customers and their patients. We seek to build lasting business partnerships that are founded on credible and transparent dialogue. Phone: 1800 SANDOZ Fax: 1800 040 644 www.sandoz.com.au

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quality

cytopod

safety

we care

W ILLOW PHAR MACEUTICA LS

What makes our company unique in the sea of sameness? At Willow we care about quality â&#x20AC;&#x201C; both in the product and the service we offer. We care about making a difference to our customers, and ultimately, to the patients whose lives are made better because of the care they receive. The latest exciting addition to our product portfolio is Esmeron (rocuronium) and Norcuron (vecuronium). We proudly support The Society of Hospital Pharmacists Australia. Come visit us at our stand.

OUR PROD U CTS Blenamax (bleomycin) Ceftazidime SXP (ceftazidime) Esmeron (rocuronium) Farine (fludarabine) Gemcite (gemcitabine) Lodam (tramadol) Momex (morphine sulphate) Norcuron (vecuronium) Onsetron (ondansetron) Oxalatin (oxaliplatin) Plaxel (paclitaxel) Tecan (irinotecan) Simvastatin Spirit (simvastatin)

Esmeron and Norcuron are registered trademarks of N.V Organon Kloosterstraat 6, 5349 AB Oss, The Netherlands. Willow Pharmaceuticals Pty Limited Level 31 ABN AMRO Tower 88 Phillip St Sydney NSW 2000

conference handbook & book of abstracts

SCIENTIFIC PROGRAM Friday 12 November 2010 0730-1900

Registration desk open – Main Foyer 3

0815-0855

OPENING CEREMONY

ROOM

Plenary 3 Welcome to Country Welcome and Introduction to Conference, Alice Kochman, Conference Convenor Conference Opening & Welcome, Neil Keen, SHPA Federal President

0855-0915

GSK Medal of Merit – Presentation & oration

0915-1045

PLENARY SESSION 1: MISUSE OF PRESCRIPTION PAIN MANAGEMENT AGENTS

CHAIR

Alice Kochman

ROOM

Plenary 3 Analgesic abuse problems Dr Mike McDonough, Director, Department of Addiction Medicine and Toxicology, Western Hospital, VIC Pharmaceutical drug misuse in Australia - issues for pharmacy Dr Malcom Dobbin, Senior Medical Advisor on Alcohol and Drugs to the Mental Health, Drugs and Regions Division, Department of Health, VIC Opiates, benzos and pharmacy - meeting the challenge Irvine Newton, Chairman, Harm Minimisation Committee, Pharmaceutical Society of Australia (VIC), VIC

1045-1115

MORNING TEA – Exhibition Halls 13 & 14

1115-1230

Contributed papers sessions C1

Bugs and drugs

Life goes on

Painful situations

Broadening the profession

1970s to now – changes in technician training and roles

CHAIR

Nick Jones

Marisa Hodgkinson

Leanne Stafford

Anne Leversha

Cynthia Walton

ROOM

Plenary 3

Meeting Room 219

Meeting Room 220

Meeting Room 212

Meeting Room 213

1115-1130

Calcium channel blocker - induced LUTS in males - an Australian observational study Professor Jeff Hughes Head, School of Pharmacy, Curtin University, WA

Impact of a hospital pharmacist prepared interim residential care medication administration chart on medication administration errors after discharge from hospital to residential care (MedGap Project) Dr Simone Taylor Senior Pharmacist, Emergency Medicine and Research, Pharmacy Department, Austin Hospital, VIC

Improving outcomes for opioid pain management balancing the needs versus the risks Anna Gelavis Manager Drugs of Dependence Unit, Department of Health, WA

Are transcribing or prescribing roles for emergency pharmacists supported? Views of clinical staff following a pilot in three Victorian hospitals Greg Weeks Director of Pharmacy, Barwon Health, VIC

Current experiences in pharmacy technician training informing future training opportunities Professor Gabrielle Cooper Head of Discipline, University of Canberra, ACT

staying alive 2010

Contributed papers sessions (continued)

Bugs and drugs

Life goes on

Painful situations

Broadening the profession

1970s to now – changes in technician training and roles

CHAIR

Nick Jones

Marisa Hodgkinson

Leanne Stafford

Anne Leversha

Cynthia Walton

ROOM

Plenary 3

Meeting Room 219

Meeting Room 220

Meeting Room 212

Meeting Room 213

1130-1145

Intra - pleural alteplase for complicated pleural effusion - a case report Lauren Cortis Pharmacist, Women’s and Children’s Hospital, SA

General practitioner and residential care staff satisfaction with a hospital pharmacist prepared interim residential care medication administration chart, MedGap Project Tim Tran Pharmacist, Austin Health, VIC

Medication safety – embracing the TALLman Toni Howell Quality Use of Medicines Pharmacist, Melbourne Health, VIC

A culture of research and appointment of a pharmacy research coordinator promotes research output Susan Welch Senior Pharmacist, St Vincent’s, NSW

A stability study of extemporaneously prepared oral cholecalciferol liquid formulations in olive oil Pathma Joseph Senior Pharmacist, The Children’s Hospital at Westmead, NSW

1145-1200

Implementation of a multifaceted, hospital wide antimicrobial stewardship program at an Australian tertiary teaching hospital Duncan McKenzie Infectious Diseases Pharmacist, Royal Hobart Hospital, TAS

Are there any differences in the outreach pharmacist’s activities and outcomes of patients referred by clinical pharmacists and the Complex Care Program? Rebecca Kwok - Yee Pang Clinical Pharmacist, Frankston Hospital, Peninsula Health, VIC

Failure mode effect analysis - the other side of the safety coin Diane Reeves Area Medication Safety Pharmacist, Northern Sydney Central Coast Area Health Service, NSW

Making medicines information child size development of the first WHO Model Formulary for Children Christine Plover Senior Pharmacist, The Royal Children’s Hospital, VIC

Two paths well travelled Belinda McLachlan Pharmacy Technician, John Hunter Hospital, NSW

1200-1215

Successful treatment of scedosporium prolificans osteomyelitis with voriconazole, terbinafine and 0.2% polyhexamethylene biguanide wound washouts in a 9 year old boy Maria Chan Senior Clinical Pharmacist, The Royal Children’s Hospital Melbourne, VIC

Evaluation of a self administration of medications program for hospitalised aged patients Tim O’Shea Senior Pharmacist, Alfred Health, VIC

Staying alive - new ways to educate prescribers Dianne Rozynski Clinical Pharmacist, Toowoomba Health Service, QLD

Advanced level framework for the development of cardiology pharmacists Sally Porter Senior Pharmacist, Queensland Health, QLD

The expanding role of the DUE technician Carolyn Young Pharmacy Technician, John Hunter Hospital, NSW

1215-1230

Oseltamivir use in pregnant women - the 2009 experience Leah Brearley Pharmacist, King Edward Memorial Hospital, WA

Pharmacist medication review for patients referred to an aged care assessment service Rohan Elliott Senior Pharmacist, Aged Care, Austin Health; Clinical Senior Lecturer, Monash University, VIC

A stepwise approach to safer analgesic medication management Michelle Sweeney Intern Pharmacist, Fremantle Hospital and Health Service, WA

Integration of paediatric pharmacy training from undergraduate to advanced practice implementation of a paediatric advanced level competency framework Sonya Stacey Assistant Director of Pharmacy, Children’s Health Services, QLD

Clinical support pharmacy technicians and the patient journey - a twist on Garling Tanya Foyle Clinical Pharmacist Emergency Department, Hunter New England Area Health Service, NSW

1230-1330

LUNCH – Exhibition Halls 13 & 14

conference handbook & book of abstracts

1330-1500

Invited speakers sessions S1

Bugs and drugs

Life goes on

Painful situations

Broadening the profession

1970s to now – changes in technician training and roles

CHAIR

Nicole Dirnbauer

Jenny Woodgate

Sue Kirsa

Sharon Goldsworthy

Jacqueline Abercrombie

ROOM

Plenary 3

Meeting Room 219

Meeting Room 220

Meeting Room 212

Meeting Room 213

Infectious diseases in newly arrived refugees Dr Thomas Schulz Victorian Infectious Diseases Service, Refugee Health Fellow, The Royal Melbourne Hospital, VIC

Expanding roles, the future of ‘Hospital in the Home’ - the Alfred experience Dr Andrew Fuller Infectious Diseases Physician, The Alfred Hospital, VIC

Multidisciplinary pain clinic Arti Thakerar Education/Pain and Palliative Care Pharmacist, Pharmacy Department, Peter MacCallum Cancer Centre, VIC

The first three speakers are recipients of RDGAC funding and are invited to present their research results.

Education - 70s and now Paul Gysslink Course Coordinator of Certificates III and IV in Hospital/Health Services Pharmacy Support, Box Hill Institute of TAFE, VIC

Increasing resistance in Staphylococci and Enterococci in Australia - implications for management Dr Benjamin Howden Infectious Diseases Physician and Clinical Microbiologist, Infections Diseases Department, Austin Hospital, VIC

Pharmacogenomics demystified Professor Ross McKinnon Professor, Division of Health Services, University of South Australia, SA

Role of the pharmacist in palliative care Sandy Scholes Clinical Pharmacist, Calvary Health Care Bethlehem, VIC

Inhaled tobramycin as a treatment for hospitalised patients with CF Dr Natalie Soulsby Royal Adelaide Hospital, SA

Rural ward technician Rodney Adams Pharmacy Technician, Pharmacy Department, North West Regional Hospital, TAS

Advances in the treatment of hepatitis C virus infection Associate Professor Joe Torresi Infectious Diseases Physician, Department of Infectious Diseases, Austin Hospital, University of Melbourne, VIC

Medication management during transition from hospital to residential care Rohan Elliott Senior Pharmacist, Aged Care, Austin Health; Clinical Senior Lecturer, Monash University, VIC

Pain management in the emergency department Dr Simone Taylor Senior Pharmacist, Emergency Medicine and Research, Pharmacy Department, Austin Hospital, VIC

Improving the transition of highly complex patients into the community impact of a pharmacist in an allogenic stem cell transplant outpatients clinic Ruth Chieng Pharmacy Department, Alfred Hospital, VIC

Introduction of an emergency department technician Paula Caird Pharmacy Technician, Fremantle Hospital and Health Service, WA

Fighting the dragon with luck Angelo Pricolo Community Pharmacist, Tambassis Pharmacy, VIC

Developing technician roles through the expansion of clinical trials pharmacy services Jane Evans Clinical Trials Administrator, Pharmacy Department - Clinical Trials, The Alfred Hospital, VIC

1500-1530

Measurement of prednisolone induced hyperglycaemia using continuous glucose monitoring Greg Roberts Clinical Research Pharmacist, Pharmacy Department, Repatriation General Hospital, SA

AFTERNOON TEA – Exhibition Halls 13 & 14

staying alive 2010

1530-1540

SHPA Grants and Awards Presentation, Anna McClure, RDGAC Chair

ROOM

Plenary 3

1540-1600

Clinical Pharmacy Award Presentation & oration

ROOM

Plenary 3

1600-1730

PLENARY SESSION 2: STAYING ALIVE THROUGH IMPLEMENTING CHANGE

CHAIR

Michael Frank

ROOM

Plenary 3 Staying alive through implementing change - knowledge to action Rosie Forster, Executive Director, National Institute of Clinical Studies, National Health and Medical Research Council, VIC Attempting to change practice - challenges and rewards Dr Luke Bereznicki, Senior Research Fellow, UMORE; Lecturer in Pharmacy Practice, School of Pharmacy, University of Tasmania, TAS

1730-1930

WELCOME RECEPTION Exhibition Halls 13 & 14

conference handbook & book of abstracts

Saturday 13 November 2010 0715-1800

Registration desk open

0715-0845

BREAKFAST WITH THE BGs

ROOM

Banquet Room 201 Join Mr and Mrs BG for breakfast to discuss their health issues in a case based interactive session. Apply your recent found knowledge on pain management, infectious diseases and chronic disease management to show how life really does go on! Your Mr and Mrs BG will be Professor Jeff Hughes, Head, School of Pharmacy, Curtin University, WA and Helen Lovitt, Federal Councillor, The Society of Hospital Pharmacists of Australia, WA with Associate Professor Neil Cottrell, Senior Lecturer, University of Queensland, QLD as the facilitator of the session. You have been invited to be part of the audience in a reality TV show “Staying Alive”. This show has broken all ratings knocking a cooking show off the top spot; an event described as a ‘Tragedy’ by the popular press. “Staying Alive” has become so popular because it puts a humorous slant on real people talking about their medicines and the difficulties they have, but still achieves the delivery of important messages about the Quality Use of medicines. Episode Three: You should be dancing In this episode we get to meet Mr and Mrs BG, Maurice and Robyn, an elderly couple who have opened their house to one and all. Maurice and Robyn emigrated to Queensland sometime during the late 1960s and Barry has come to visit them for the first time in 5 years. As the episode opens Maurice and Robyn are at breakfast having a discussion with their eldest son Barry who is enquiring after their health and the array of tablets on the table in front of them...... This session is designed to make you think what is important. Is it best practice where all decisions are guided by evidence, or is it practice which is guided by the wishes of the patient and/or carer? The new paradigm of patientcentred care involves the health care provider and patient working in collaboration to decide upon the best course of management, but how much emphasis should be placed on the patient’s preference when managing complex and potential life threatening chronic conditions? Come along and put your clinical judgement to the test as two complex cases are discussed and potential options explored. Can you make “staying alive” a reality for Mr and Mrs BG?

We thank The National Alliance for Pharmacy Education for their support:

staying alive 2010

0900-1030

Invited speakers sessions S6

S10

Bugs and drugs

Life goes on

Painful situations

Broadening the profession

1970s to now – changes in technician training and roles

CHAIR

Catherine Hughes

Karen O’Leary

Angela Stathopoulos

Michael Frank

Helen Matthews

ROOM

Plenary 3

Meeting Room 219

Meeting Room 220

Meeting Room 212

Meeting Room 213

Antimicrobial stewardship Dr Kirsty Buising Infectious Diseases Physician; Clinical Research Physician, The Royal Melbourne Hospital, VIC Margaret Duguid Pharmaceutical Advisor, Australian Commission on Safety and Quality in Health Care, NSW

The management of chronic disease in homeless people Emeritus Professor Ian Webster Physician and Emeritus Professor of Public Health and Community Medicine, The University of New South Wales, NSW

Painful situations management relating to the progression of acute to chronic pain Dr Malcolm Hogg Acute Pain Service Co - Coordinator; Consultant Anaesthetist, The Royal Melbourne Hospital, VIC

Knowledge translation workshop - change management and implementing change Michael Frank NICS - Melbourne Health Fellow 2009; Pharmacist, The Royal Melbourne Hospital, Melbourne Health, VIC Bhavini Patel NICS - HCF Foundation Fellow 2007; Director of Pharmacy, Royal Darwin Hospital, NT Kevin McNamara NICS – NPS; QUM Fellow 2008; Lecturer in Pharmacy Practice, Monash University, VIC; Research Fellow in Rural Pharmacy, Flinders University, SA

Hospital pharmacy automation - will robots replace technicians? Natalie Bula Deputy Director Pharmacy, Operations, Pharmacy Services, The Canberra Hospital, ACT

A difficult pill to swallow understanding dysphagia Dr Julie Cichero Honorary Research Consultant, School of Pharmacy, The University of Queensland, QLD

Burns pain management Dr Joel Symons Specialist Anaesthetist, Department of Anaesthesia and Perioperative Medicine, The Alfred Hospital, VIC

Developing multidisciplinary collaborative team and leading them as a pharmacist Bhavini Patel As above

Automated dispensing the Slade experience Mary Simic Product and Systems Manager, Slade Pharmacy Services, VIC

Occupational exposure - cytotoxic contamination in the workplace Joan Semmler Pharmacy Technician, Sterile Production Centre, Princess Alexandra Hospital, QLD

1030-1100

MORNING TEA – Exhibition Halls 13 & 14

conference handbook & book of abstracts

1100-1230

Contributed papers sessions C6

C10

Bugs and drugs

Life goes on

Painful situations

Broadening the profession

1970s to now – changes in technician training and roles

CHAIR

Tom Simpson

Wendy Ewing

Glenn Valoppi

Megan Middleton

Veronica Saenz

ROOM

Plenary 3

Meeting Room 219

Meeting Room 220

Meeting Room 212

Meeting Room 213

1100-1115

Antimicrobial pilot study in an intensive care unit - the impact on antimicrobial use by an antimicrobial stewardship team Stav Mantas Pharmacist, Southern Health, Monash Medical Centre, VIC

Basal - bolus insulin verses sliding scale insulin for inpatient glycaemic management - a clinical practice -based assessment Greg Roberts Clinical Research Pharmacist, Pharmacy Department, Repatriation General Hospital, SA

Pain and oxycodone use in frail older patients in hospital Dr Alexandra Bennett Pharmacy Researcher, The University of Sydney, NSW

Comparison of one versus two blood samples for determination of tobramycin AUC in cystic fibrosis Dr Michael Barras Coordinator, Medication Safety and Quality Unit, Mater Health Services, QLD

Computerising expiry date checking process, Stage 1 Debbie Parker Pharmacy Technician, Southern Health, VIC

1115-1130

The role of formative evaluation in successful implementation of an antibiotic decision support system at a teaching hospital Dr Syed Tabish Razi Zaidi Senior Clinical Pharmacist, Box Hill Hospital, VIC

The incidence of dosing administration errors with basal bolus insulin compared to sliding scale insulin in a hospital setting Gauri Godbole Pharmacist, University of South Australia, SA

TAP catheters introduction of a novel post - operative analgesia technique and its medication safety implications Julie Murnane Clinical Pharmacist, Barwon Health, VIC

Successful carboplatin desensitisation and subsequent full dose rechallenge Jim Siderov Senior Pharmacist, Austin Health, VIC

Medication recycling accounting for time Heather Casey Technical Officer, The Canberra Hospital, ACT Carolyn Lane Technical Officer, The Canberra Hospital, ACT

1130-1145

Is azithromycin maintenance in cystic fibrosis patients associated with antibiotic resistance? Rachael Worthington Senior Pharmacist, Medication Safety, The Children’s Hospital at Westmead, NSW

Factors influencing chronic medication management in ambulatory care - case controlled study of 449 patients on chronic warfarin therapy Professor Michael Dooley Director of Pharmacy, Alfred Health, VIC

‘The K factor’ understanding the dose conversion ratio between subcutaneous and oral ketamine Claire McCormack Senior Pharmacist, Production and Clinical Trials, Gosford Hospital, NSW

Current dosing of low molecular weight heparins does not reflect licensed product labels - an international survey Dr Michael Barras Coordinator, Medication Safety and Quality Unit, Mater Health Services, QLD

Forty years of pharmacy technicians 1970–2010 - staying alive Cynthia Walton Pharmacy Technician, Peter MacCallum Cancer Centre, VIC

1145-1200

Molybdenum cofactor deficiency - the special story of Baby Z Connie Yin Senoir Pharmacist, Southern Health, VIC

Medication regimen adherence risk assessment in an elderly inpatient population Gail Price Clinical Pharmacist, Box Hill Hospital, Eastern Health, VIC

Ketamine lozenges too much of a good thing? Penelope Tuffin Senior Clinical Pharmacist, Royal Perth Hospital, WA

Desvenlafaxine transfer into milk and infant exposure during its use in lactating women with postnatal depression Wai Khuan Stephanie Teoh Senior Pharmacist, King Edward Memorial Hospital, WA

Managing non - imprest returns back into pharmacy Debbie Parker Pharmacy Technician, Southern Health, VIC

1200-1215

The penetration of topically administered 0.5% caspofungin eye drops into human aqueous humour Dr David Kong Lecturer/Pharmacist, Monash University, VIC

The snap before the fall Richard Grygiel Pharmacist, Alfred Health, VIC

Better than a poke in the eye with an antipsychotic Sally Taylor Pharmacist, Princess Alexandra Hospital, QLD

Launch success of a new mission broadening our horizons Kerry Fitzsimons Senior Audit Pharmacist, Fremantle Hospital and Health Service, WA

From stress to success in the dispensary Belinda Lyons Technical Officer, The Canberra Hospital, ACT

staying alive 2010

Contributed papers sessions (continued) C6

Bugs and drugs

Life goes on

Painful situations

Broadening the profession

C10 1970s to now – changes in technician training and roles

CHAIR

Tom Simpson

Wendy Ewing

Glenn Valoppi

Megan Middleton

Veronica Saenz

ROOM

Plenary 3

Meeting Room 219

Meeting Room 220

Meeting Room 212

Meeting Room 213

1215-1230

Controversial choices a snapshot of treatment variability in cellulitis patients Jessica Hagan

Development of an assessment tool for falls risk related to medications amongst older inpatients Claire Jones Intern Pharmacist, Repatriation General Hospital, SA

Inpatient management of transdermal fentanyl and buprenorphine patches Ka - Yee Chen Chief Pharmacist, Calvary Health Care Bethlehem, VIC

Management of medications in a public nurse led walk - in centre Miriam Lawrence Deputy Director, Clinical, The Canberra Hospital, ACT

Horses for courses making better use of staff resources in an outpatient dispensary Larissa Clifford Pharmacy Assistant, Princess Alexandra Hospital, QLD

C15 1970s to now – changes in technician training and roles

Intern Pharmacist, Central Coast Health Service, NSW

Katherine Callaghan Intern Pharmacist, Central Coast Health Service, NSW

1230-1400

LUNCH – Exhibition Halls 13 & 14

1400-1515

Contributed papers sessions C11

C12

C13

C14

Bugs and drugs

Life goes on

Painful situations

Broadening the profession

CHAIR

Melita Van de Vreede

Mimi Chu

To-Hao Vo-Tran

Geoff Davies

Joan Semmler

ROOM

Plenary 3

Meeting Room 219

Meeting Room 220

Meeting Room 212

Meeting Room 213

1400-1415

An educational intervention to improve vancomycin dosing in critically ill patients Janice Li School of Pharmacy, The University of Queensland, QLD

Complementary medicines and chemotherapy do they mix?

Oral analgesic use post caesarean section David Plevin Intern Pharmacist, Flinders Medical Centre, SA

Evaluation of a pharmacist led anticoagulant dosing service in ‘Hospital in the Home’ Shin Choo Lead Clinical Pharmacist, Alfred Health, VIC

Evolving the role of pharmacy technician led training and education Laren McConnel Pharmacy Technician Grade 2, Prince of Wales Hospital, NSW

A painful problem opioid - induced hyperalgesia in a neonate Stephanie Brumby Clinical Pharmacist, The Royal Children’s Hospital, VIC

Delivering national messages regarding safe and effective use of medicines in Australian hospitals and across the continuum Lisa Pulver Senior Research Officer, University of Queensland, QLD

The expanding role of pharmacy assistants within inpatient units Trudy McGovern Pharmacist–Deputy Director, Gold Coast Health Service District, QLD

Paediatric procedural pain management can we do it better? Michele Cree Senior Clinical Pharmacist, Royal Children’s Hospital, QLD

Can quality improvement interventions optimise practice? The Discharge Management of Acute Coronary Syndromes initiative Lisa Pulver Senior Research Officer, University of Queensland, QLD

Smokin’ new role for pharmacy technicians Sonya Dillon Technical Officer Level 2, The Canberra Hospital, ACT

1415-1430

1430-1445

Does one dose fit all? Determinants of therapeutic vancomycin concentrations in adult patients Dr Syed Tabish Razi Zaidi Senior Clinical Pharmacist, Box Hill Hospital, VIC

Medical versus surgical showdown - who wins our time? Dr Ian Coombes

Plasma and tissue concentrations of cefazolin during abdominal aortic aneurysm repair surgery–are standard doses sufficient? Dr Jason Roberts

Determination of medication storage temperatures in hospital in the home Louise Williams Pharmacist, Austin Health, VIC

Senior Clinical Pharmacist, Royal Brisbane and Women’s Hospital; The University of Queensland, QLD

Berenice Sheridan Clinical Pharmacist, Southern Health, VIC Obaid Fazil Pharmacist, Southern Health, VIC

Team Leader Practitioner Development, Medicines Services Queensland, Queensland Health; Clinical Lecturer, School of Pharmacy, University of Queensland, QLD

conference handbook & book of abstracts

Contributed papers sessions (continued) C11

C12

C13

C14

Bugs and drugs

Life goes on

Painful situations

Broadening the profession

C15 1970s to now – changes in technician training and roles

CHAIR

Melita Van de Vreede

Mimi Chu

To-Hao Vo-Tran

Geoff Davies

Joan Semmler

ROOM

Plenary 3

Meeting Room 219

Meeting Room 220

Meeting Room 212

Meeting Room 213

1445-1500

Subtherapeutic trough beta - lactam levels in critically ill patients are associated with high creatinine clearance Julie Varghese PhD candidate, University of Queensland, QLD

Identification and prevention of medication errors associated with product changes from a state - based tender Rowena Fary

Pain management in the home - are over the counter analgesics appropriately used? Vincent Wong

The impact of a multidisciplinary Medication Safety and Quality Unit Dr Michael Barras Coordinator, Medication Safety and Quality Unit, Mater Health Services, QLD

A pharmacy technician in the renal unit Sarah Crossing Pharmacy Assistant, Flinders Medical Centre, SA

1500-1515

Pharmacokinetics of intraperitoneal gentamicin in peritoneal dialysis patients with peritonitis, GIPD Study Julie Varghese PhD candidate, University of Queensland, QLD

The ‘SA Health smokefree policy’ assessment of the demand for nicotine replacement therapy to decrease cravings and make inpatient stay more comfortable for smokers Jennifer Gordon Intern Pharmacist, The Queen Elizabeth Hospital, SA

How clinical pharmacists spend their day - a time and motion study Jan - Marie deClifford Medication Safety Officer/Senior Clinical Pharmacist, Peninsula Health, Frankston Hospital, VIC

Breaking out! Increasing scope of practice for pharmacy technicians in a correctional environment Clare Harris Pharmacy Technician, Justice Health, NSW

1515-1545

AFTERNOON TEA – Exhibition Halls 13 & 14

1545-1700

PLENARY SESSION 3: STATE OF THE NATION

ROOM

Plenary 3

Senior Pharmacist, Medication Safety, Alfred Health, VIC

Pharmacist Intern, Pharmacy 777; Armadale Health Service, WA

Painful painkillers - the sharp end of S8 administration Katrina Harman Intern Pharmacist, Children’s Hospital at Westmead, NSW Alex Holmes Intern Pharmacist, Children’s Hospital at Westmead, NSW

MC: Dr Sally Cockburn (‘Dr Feelgood’): GP, Health Advocate and Media Health Commentator, VIC Competency standards Dr Ian Coombes, Team Leader Practitioner Development, Medicines Services Queensland, Queensland Health; Clinical Lecturer, School of Pharmacy, University of Queensland, QLD Healthsmart Maryanne Molenaar, Project Pharmacist, HealthSMART Clinical Systems Project, VIC SHPA advocacy Yvonne Allinson, Chief Executive Officer, Society of Hospital Pharmacists of Australia, VIC Robots in pharmacy Sue Kirsa, Director of Pharmacy, Peter MacCallum Cancer Centre, VIC When is enough, enough? Kirstie Galbraith, Director, Postgraduate Studies and Professional Development Unit, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, VIC National pharmacy registration Bhavini Patel, NICS - HCF Foundation Fellow 2007; Director of Pharmacy, Pharmacy Department, Royal Darwin Hospital, NT 1700-1715

Official Close and Launch of Medicines Management 2011, the 37th SHPA National Conference

1900-0100

GALA DINNER - Saturday Night Fever Banquet Rooms 201/202

staying alive 2010

Sunday 14 November 2010 PHARMACIST LEADERSHIP IN ACTION Registration is open to SHPA members only. ROOM

Meeting Room 220

0900-0930

BREAKFAST AVAILABLE ON ARRIVAL

0930-1100

Session 1: Leadership at a hospital level Tips and tools for moving the pharmacy agenda forward at a hospital level Professor Michael Dooley, Director of Pharmacy, The Alfred Hospital, Melbourne, VIC Tips and tools for communicating the issues to the people who ‘need to know’ at a hospital level Toni Howell, Quality Use of Medicines Pharmacist, The Royal Melbourne Hospital, Melbourne, VIC Group discussion

1100-1130

MORNING TEA

1130-1300

Session 2: Leadership at a health department level Tips and tools for moving the pharmacy agenda forward at a government level Putting a case for the pharmacy services and continuity of medication management services – what can be learned from Tasmania? Amber Roberts, State-wide Medication Coordinator, Care Reform, Department of Health & Human Services, TAS After success, follow-up means delivery! What can be learned from South Australia Naomi Burgess, Pharmacy Consultant , SA Health, SA Group discussion

1300-1330

LUNCH

1330-1430

Session 3: Leadership in a business case for pharmacy robotics Tips and tools for a successful business case Robotics for chemotherapy – the case, the reality, the learnings Sue Kirsa, Director of Pharmacy, Peter MacCallum Cancer Centre, Melbourne, VIC Robotics in a hospital dispensary – the why, what and how Lynette Loy, Director of Pharmacy, Princess Alexandra Hospital, Brisbane, QLD

1430-1500

Session 4: Wrap-Up Reflection on key points Craft ‘take home’ messages (for next SHPA bulletin)

1500

conference handbook & book of abstracts

COMMITTEES OF SPECIALTY PRACTICE AND SPECIAL INTEREST GROUPS Thursday 11 November 2010 PAEDIATRIC COSP Paediatric renal and infectious diseases

ROOM

Meeting Room 219

0900-1000

Registration Arrival Tea and Coffee

1000-1010

Introduction Sean Turner Director of Pharmacy, Adelaide Women’s and Children’s Hospital, Adelaide, SA (Chair, SHPA Paediatric COSP)

RENAL Chronic renal failure 1010-1040

Renal replacement therapy – What are all these machines and bags and tubes? Brendan Cusack Haemodialysis Coordinator, Royal Children’s Hospital, Melbourne, VIC

1040-1100

Chronic renal failure in children – Chemistry, physics and tips and tricks for pharmacists Peter Barclay Director of Pharmacy, Children’s Hospital at Westmead, NSW

1100-1115

Case Report – Aminoglycoside therapy and RRT Peter Barclay Director of Pharmacy, Children’s Hospital at Westmead, NSW

1115-1130

MORNING TEA

Acute renal failure 1130-1140

Vignette 1- Renal failure case in PICU Rachael Worthington Medication Safety Pharmacist, Children’s Hospital at Westmead, NSW

1140-1150

Vignette 2 – Triple whammy – it can happen in children Clinical Educator and Acting Clinical Team Leader Royal Children’s Hospital, QLD

1150-1200

Vignette 3 – Polycystic kidney disease Senior Paediatric Pharmacist and Education and Training Pharmacist Christchurch Hospital, NZ

1200-1215

Discussion – Acute renal failure in children Peter Barclay/All

Nephrotic syndrome 1215-1225

Vignette 4 – Nephrotic syndrome Shelley Pember Clinical Pharmacist, Cairns Base Hospital, QLD

1225-1235

Vignette 5 – Steroid resistant nephrotic syndrome Dianne Rozsynski Clinical Pharmacist, Education and Training, Toowoomba Base Hospital, QLD

1235-1245

Vignette 6 – Congenital nephrotic syndrome Heidi Wong Clinical Educator and Acting Clinical Team Leader, Royal Children’s Hospital, QLD

1245-1300

Discussion – Nephrotic Syndrome Peter Barclay/All

staying alive 2010

1300-1330

LUNCH

INFECTIOUS DISEASES Clinical governance in bugs and drugs in kids 1330-1400

Role of the antimicrobial steward in paediatrics Lucy Holt Antimicrobial Stewardship Pharmacist, Children’s Hospital at Westmead, NSW

1400-1415

VRE in paediatrics – the story from Brisbane Courtney Emerson Clinical Pharmacist, Royal Children’s Hospital, Brisbane, QLD

1415-1430

Group B Streptococcal infection in neonates – Qld Health guidelines and case report Katri Lyddiard Neonatology Pharmacist, Townsville General Hospital, QLD

1430-1500

Tuberculosis in children–Changing epidemiology and treatments Dr Nicole Ritz Research Fellow in Infectious Diseases, Royal Children’s Hospital, VIC

1500-1520

Atypical mycobacterium infections in CF Case Report on use of gamma interferon Discussion Carol Smith Senior Clinical Pharmacist, Womens and Children’s Hospital, SA Sonya Stacey Assistant Director of Pharmacy, Royal Children’s Hospital, QLD

1520-1530

AFTERNOON TEA

Complex cases to share

1530-1545

Case Report – Melioidosis Shelley Pember Clinical Pharmacist, Cairns Base Hospital, QLD

1545-1600

Case Report – Sepsis Stephanie Brumby Clinical Pharmacist, Royal Children’s Hospital, VIC

1600-1615

Case Report – Paediatric HIV Louise Bordun Specialist Paediatric HIV Pharmacist, Royal Children’s Hospital, VIC

1615-1630

Case Report – Infectious gastroenteritis Sophie Higgins Paediatric Pharmacist, Alice Springs Hospital, NT

1630-1645

Case Report – Culture negative meningitis Joyce Liew Clinical Pharmacist, Children’s Hospital at Westmead, NSW

1645-1700

Wrap-Up Sean Turner Director of Pharmacy, Adelaide Women’s and Children’s Hospital, Adelaide, SA (Chair, SHPA Paediatric COSP)

conference handbook & book of abstracts

MEDICATION SAFETY COSP

ROOM

Meeting Room 220

0830-0930

Registration Arrival Tea and Coffee

Medication safety at the coal face: Skills 0930-1100

Have you always been interested in medication safety but donâ&#x20AC;&#x2122;t know where to start? This session will focus on basic skills, terminology, gathering information, analysis and making changes. Engaging medical staff in medication safety ie detailing, medical intern medication safety ambassadors Jan de Clifford Medication Safety Officer; Senior Clinical Pharmacist, Peninsula Health, VIC Change management and sustainable change Melita Van De Vreede Deputy Director - QUM, Eastern Health, VIC Medication safety plans and strategies Wendy Ewing Quality use of Medicines Pharmacist, Southern Health, Monash Medical Centre, VIC Engaging nurses in medication safety - insulin syringes Anne McGrath Medication Safety Pharmacist, Austin Hospital, VIC Questions

1100-1130

MORNING TEA

Cases from the coal face: Risk management focusing on high risk medicines 1130-1300

Diane Reeves Medication Safety Pharmacist, North Sydney Central Coast Area Health Service, NSW Rosemary Burke Concord Director of Pharmacy, Concord Hospital, NSW Rachael Worthington Medication Safety Pharmacist, Childrens Hospital at Westmead, NSW Questions Panel Discussion Medication Safety Pharmacists. What do they do? What should they do?

1300-1345

LUNCH

Medication safety: New technologies & new horizons 1345-1530

This session will focus on new technologies such as electronic medication management, smart pumps and the importance of embedding safety in technology. Smart pumps Rebecca Pang Clinical Pharmacist, Peninsula Health, Frankston Hospital, VIC Electronic medication management Bhavini Patel NICS-HCF Foundation Fellow 2007; Director of Pharmacy, Royal Darwin Hospital, NT New technology and human factors engineering Rosemary Burke Director of Pharmacy, Concord Hospital, NSW Questions

staying alive 2010

Medication safety: State & national agenda What is on the national agenda? Margaret Duguid Pharmaceutical Advisor, Australian Commission on Safety & Quality in Health Care, NSW Discussion forum: Recording of incidents State Based Charts Safety Alerts Medication Safety Groups SHPA representative Moderator: Rosemary Burke Director of Pharmacy, Concord Hospital, NSW

ACADEMIC DETAILING COSP Advanced practice roles and specialisation: Current and future opportunities for expanding the role of academic detailing in the hospital setting SHPA Academic Detailing COSP presents an update of academic detailing acknowledging the changes in practice and the practice environment arising from the PBS reforms in hospital and the broader health reforms including the National Registration and Accreditation Scheme. The importance of specialist roles in medicines and therapeutic decision making as part of collaborative teams will be the focus of the workshop. ROOM

Meeting Room 206

1230-1300

Registration Arrival Tea and Coffee

1300-1315

Welcome and Overview

The policy 1315-1345

Medicines experts – Advocacy, collaboration, communication New national registration standards for continuing professional development – AD meets CPD!

The practice 1345-1430

Updates from program currently being provided across Australia hospital and residential aged care

1430-1500

AFTERNOON TEA

The opportunity

1500-1600

Designing an AD program Gathering the evidence – DUE, critical appraisal Developing ‘key messages’ Developing materials Training

1600-1700

Designing an AD program (continued) Competency standards Evaluation and close

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CLINICAL PHARMACY COSP Members of the COSP will provide information, and conduct workshop style activities. ROOM

Meeting Room 108

1300-1400

Registration Arrival Tea and Coffee

Session 1: How to deliver the key components of a clinical pharmacy service 1400-1530

This interactive session is intended to provide the ground work for pharmacists undertaking clinical pharmacy activities. How will you prioritise your services, perform a medication history and reconciliation, perform a medication chart review, provide discharge medication information, and measure your contribution?

1530-1550

AFTERNOON TEA

Session 2: What is the most appropriate beds to pharmacist staffing level for your department/service? 1550-1700

COSP members will provide information on newly recommended beds to pharmacist staffing levels based on Australian data. How were these derived? How applicable are they? Can these be applied to your hospital/service? The COSP will seek feedback for clinical pharmacists and pharmacy managers that will assist in fine tuning the beds to pharmacist staffing levels. Panel speakers: George Taylor Clinical Tutor, Royal Hobart Hospital/School of Pharmacy, UTas, TAS Professor Michael Dooley Director of Pharmacy, Alfred Hospital, VIC Cameron Randall Director of Pharmacy, Royal Hobart Hospital, TAS Duncan McKenzie ID Pharmacist, Royal Hobart Hospital, TAS Karen Oâ&#x20AC;&#x2122;Leary Project Pharmacist, SHPA Federal Office Olimpia Nigro Clinical Pharmacy Co-Ordinator, Royal Adelaide Hospital, SA Camille Boland Senior Clinical Pharmacist, Royal Hobart Hospital, TAS Sally Marotti Clinical Pharmacist, Queen Elizabeth Hospital, SA

ONCOLOGY COSP

ROOM

Meeting Room 214

1200-1245

Registration Arrival Tea and Coffee

1245-1300

Introduction Julie Wilkes Clinical Haematology Pharmacist & Coordinator Home Cancer Care Service, Royal Perth Hospital, WA

1300-1400

Integrative oncology- Complementary medicines Lesley Braun Research Pharmacist, Alfred Health, Monash University, VIC

Challenges facing haematology patients 1400-1500

Challenges facing haematology patients in ICU Bianca Levkovich Senior Clinical Pharmacist, Alfred Health, VIC

1500-1600

Infectious disease relating to haematology/case presentations John Coutsouvelis Senior Haematology Clinical Pharmacist, Alfred Health, VIC

sstaying alive 2010

1600-1615

AFTERNOON TEA

Medical oncology - An update 1615-1700

Current practices in medical oncology - Part I Maggie Chau Clinical Pharmacist, Southern Health, VIC Melanie Poorun Clinical Pharmacist, Alfred Health, VIC

1700-1745

Current practices in medical oncology - Part II Melanie Poorun Clinical Pharmacist, Alfred Health, VIC Maggie Chau Clinical Pharmacist, Southern Health, VIC

Saturday 13 November 2010 BREAKFAST SESSIONS

0715-0845

Critical Care COSP Breakfast A “meet and greet” for critical care pharmacists and other interested parties with discussion of “Continuity of care – an intensive care perspective” and “Research in the ICU – the how, what and why of getting started”

ROOM

Meeting Room 219

0715-0845

Medicines Information COSP Breakfast Staying Alive – The Essential Role of Medicines Information in Patient Care’ This breakfast session will consider aspects of past and present Medicines Information (MI) practice in Australia, the contribution of MI to better patient outcomes and possible future directions.

ROOM

Meeting Room 212

0715-0845

Rural Network Breakfast Sharing our successes and challenges

ROOM

Meeting Room 220

0715-0845

Technician Network Breakfast

ROOM

Meeting Room 213

Our most important ingredient is integrity

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PB N S OW LI S TE D

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Mezavant® - The high dose mesalazine (1.2g) tablet for once daily dosing1

PBS Information: Authority required (STREAMLINED). Ulcerative colitis where hypersensitivity to sulfonamides exists. Ulcerative colitis where intolerance to sulfasalazine exists

TANDEM 14352 09/10

BEFORE PRESCRIBING PLEASE REVIEW FULL PRODUCT INFORMATION MINIMUM PRODUCT INFORMATION. MEZAVANT® References: 1. Mezavant Product Information, Sept 2009. Indications: Induction and maintenance of remission in patients with mild to moderate, active ulcerative colitis. Dosage and Administration: For induction of remission: 2.4 to 4.8g (2-4 tablets) taken once daily. For maintenance of remission: 2.4g (2 tablets) taken once daily. The tablets must not be crushed or chewed and should be swallowed whole with food. Contraindications: Hypersensitivity to mesalazine and other salicylates. Precautions: Caution in patients allergic to sulphasalazine, although cross-sensitivity is uncommon. Blood dyscrasias, acute intolerance syndrome, cardiac hypersensitivity reactions (myo- and pericarditis) have been reported. Caution in renal and hepatic impairment. Pregnancy Category C. Caution in breast feeding women. Not studied in children <18 years. Interactions: May exacerbate nephrotoxic agents, may increase levels of azathioprine and mercaptopurine and reduce activity of coumarin anticoagulants. Adverse Events: Common reactions include headache, abdominal distension/pain, diarrhoea, dyspepsia, ﬂatulence, nausea, vomiting, pruritis, rash, hypertension, liver function test abnormalities, asthenia, pyrexia, arthralgia associated with myalgia, back pain. PBS dispensed price for maximum quantity: 60 x 1.2g tablets $220.99. SM210005

Shire Australia Pty Ltd. ABN 29 128 941 819. ® is a Registered Trademark of Shire Australia Pty Ltd. Level 3, 78 Waterloo Road, North Ryde, NSW 2113, Australia.Tel: 1800 012 612. Fax: (02) 8864 0161. Further information is available on request from Shire Australia Pty Ltd. medical information Tel: 1800 012 612 All sales and marketing requests refer to Nycomed Pty Ltd, ABN 71095 610 870, 2-4 Lyonpark Road, North Ryde NSW 2113. Tel: 1800 675 957.

conference handbook & book of abstracts

SHPA CPD shpacpd is designed to meet the Pharmacy Board of Australia requirements for re-registration so that every pharmacist can remain current, informed and connected to the profession. SHPA offers a range of education services to support every member’s professional development plan.

The wide range of activities offered at Medicines Management 2010, the 36th SHPA National Conference ensures that delegates will find many opportunities for unplanned learning as well as activities they have identified as part of their own personal CPD plan. The content of this year’s conference has been accredited by SHPA as a Group 1 activity (information accessed without assessment) for 11 CPD credits¥. Remember to keep a record of the sessions attended with any notes/reflections so that they can be included in your SHPA online CPD summary. This is especially important in light of the new Pharmacy Board of Australia requirements to maintain records.

Session

Remember that if you are presenting a paper/poster, then you can also record this as a Group 3 activity (quality or practice improvement facilitated). Generally Group 3 activities involve some assessment of an existing situation, the needs/ barriers to change and the development of an activity/action. As a result the activity addresses identified needs with a reflection post activity to evaluate the outcome. Such activity may extend over many weeks. When making the record in your SHPA online CPD summary, you should reflect on the activity and how it has facilitated quality or practice improvement.

Duration

CPD Credits Allocated

Competency Units Approved

1 hr

1 (Group 1)

1.3, 3.1, 3.2, 3.3

1 hr

1 (Group 1)

1.5 hr

1.5 (Group 1)

1.3, 3.1, 3.2, 3.3, 6.2, 6.3, 7.3, 8.3, 8.4, 8.5, 8.6 1.3, 3.1, 3.2, 3.3, 6.2, 6.3 1.3, 3.1, 3.2, 3.3, 6.2, 6.3 1.3, 3.1, 3.2, 3.3, 6.2, 6.3 1.3, 3.1, 3.3, 6.2, 6.3, 8.4 1.3, 8.3

1.5 hr

1.5 (Group 1)

1.3, 3.3, 6.3, 7.3, 8.3, 8.4, 8.5, 8.6

Breakfast with the BGs (case-based interactive session) Bugs and drugs Life goes on Painful situations Broadening the profession 1970s to now – changes in technicians training and roles Contributed papers

1.25 hr

2.5 (Group 2)

1.3, 3.1, 3.2, 3.3, 6.2, 6.3

Plenary session 3: The state of the nation

Friday, 12th November 2010

Concurrent

Plenary Session 1: Misuse of prescription pain management agents Contributed papers Bugs and drugs Life goes on Painful situations Broadening the profession 1970s to now – changes in technicians training and roles Plenary session 2: Staying alive through implementing change Saturday 13th November 2010

1.5 hr

1.5 (Group 1)

2.25 hr

2.25 (Group 1)

1 hr

1 (Group 1)

1.3, 3.1, 3.2, 3.3, 6.2, 6.3 1.3, 3.1, 3.2, 3.3, 6.2, 6.3 1.3, 3.1, 3.2, 3.3, 6.2, 6.3 1.3, 3.1, 3.2, 3.3, 6.2, 6.3, 8.4 1.3, 8.3 1.3, 3.1, 3.2, 3.3, 6.2, 6.3, 7.3, 8.3, 8.4, 8.5, 8.6 1.3, 3.3, 6.3, 8.4, 8.5, 8.6

¥ The CPD hours approved are: 11 hours of content as Group-1 activity if no assessments are undertaken in the breakfast session. Up to 1.25 hours of this Group - 1 activity can be converted to Group-2 activity if assessments are undertaken in the Saturday breakfast session.

Date

Record No.

Reflection (R) Audit (A) Other

• •

Critical Incident (CI) Unscheduled (U)

Description of activity/ies:

Time for each # activity type (hours) 1 2

Step 3 – What actions did you take? AND document your actions

My plan

Step 2 – Planning to fulfil your CPD needs

For detail see Activity Groups Chart for shpacpd: 1. Information Accessed Without Assessment 2. Knowledge or Skills Improved with Assessment 3 Quality or Practice Improvement Facilitated

What additional learning has it identified?

What difference has it made to your practice?

Description of outcome

Step 4 - Evaluation of the outcome (required for Cat 3 activities)

What area of competency does it cover?

• • •

How was it identified?

Describe the area that needs improvement

Step 1 – Identifying your CPD needs

SHPA CPD Activity Record (Master Copy – photocopy for folio record)

Number of CPD Credits

ABSTRACTS—FRIDAY PLENARY SESSION Plenary session 1—Misuse of prescription pain management agents....................... 59 CONTRIBUTED PAPERS SESSIONS Contributed papers stream C1—Bugs and drugs..................................................... 60 Contributed papers stream C2—Life goes on .......................................................... 63 Contributed papers stream C3—Painful situations ................................................... 65 Contributed papers stream C4—Broadening the profession .................................... 68 Contributed papers stream C5—1970s to now—changes in technician training and roles ...................................................................................................... 70 INVITED SPEAKER SESSIONS Invited speaker session S1—Bugs and drugs........................................................... 73 Invited speaker session S2—Life goes on ................................................................ 74 Invited speaker session S3—Painful situations ......................................................... 76 Invited speaker session S4—Broadening the profession .......................................... 77 Invited speaker session S5—1970s to now—changes in technician training and roles .................................................................................................................. 80 PLENARY SESSION Plenary session 2—Staying alive through implementing change ............................... 82

conference handbook

Friday abstracts Plenary session 1—Misuse of prescription pain management agents 0915–0945, PLENARY ROOM 3

Analgesic abuse problems Mike McDonough1 1 Department of Addiction Medicine and Toxicology, Western Hospital, VIC

Objectives: To describe the current opioid analgesic epidemic in Australia. Methods: Literature review with clinical case descriptions. Results: An ageing population increases the prevalence of degenerative disorders (musculo-skeletal and rheumatological) together with malignancies. This is likely to have been a key factor leading to an escalation in opioid analgesic prescribing; other likely factors include analgesic availability and marketing. In Australia, like has been described in some other countries, some people abuse analgesics and related to this, some specific pathologies have been identified e.g. medication overuse headache, analgesic nephropathy etc. Following the increased availability of opioid analgesics, it now appears that more related problems are being identified. There is evidence of an epidemic of opioid analgesic related deaths in the USA and now in Australia, rates of opioid analgesic related problems including addiction, overdose and death are increasing. Conclusion: A ‘drug epidemic’ is identified which requires both a clinical management and public health response.

0945–1015, PLENARY ROOM 3

Pharmaceutical drug misuse in Australia: issues for pharmacy Malcom Dobbin1 1 Mental Health, Drugs and Regions Division, Department of Health, VIC

Pharmaceutical drug misuse is emerging as a major problem from both the health and law enforcement perspectives. The USA is experiencing a drug death epidemic involving prescription opioids where deaths now exceed the combined number of deaths due the illicit drugs cocaine and heroin. There is also crime involving procurement and trafficking, or resulting from impairment due to intoxication. Australian indicators demonstrate that a similar problem is emerging here. This session will describe pharmaceutical drug misuse in the high income countries USA, Canada and Australia: diversion, misuse, trafficking and health outcomes. It will include trends in supply of opioids, harm from misuse, and characteristics of pharmaceutical opioid misusers so far identified. It will also include information about diversion of pharmaceutical opioids from licit to illicit use, and potential countermeasures to prevent diversion, and decrease demand. The potential role of hospital pharmacists to contribute to containment of the problem will also be raised.

conference handbook

Friday abstracts 1015–1045, PLENARY ROOM 3

Opiates, benzos and pharmacy: meeting the challenge Irvine Newton1 1 Harm Minimisation Committee, Pharmaceutical Society of Australia (VIC), VIC

The problems surrounding pseudoephedrine and codeine-containing medicines are common and have received lots of pharmacy attention. But what about the long term use of benzodiazepines, the huge growth in the use of prescription opiates and the inappropriate use of non steroidal anti-inflammatories? These are just a few examples of drug misuse. Many pharmacists are now supplying morphine and oxycodone on a periodic basis. There have been massive increases in the quantities being prescribed and many clients are obviously drug dependent and/or mentally ill people. Are these being prescribed appropriately and how do the various health departments allow continued supply for drug dependent patients? The regulations relating to the supply of codeine-containing medicines have been tightened recently but what effect has this had on the way we deal with OTC sales? Benzodiazepines have long been used inappropriately. Regular use, often over extended periods is surely outside the approved use for Diazepam, Temazepam etc. Are all those Alprazolam scripts we see in the best interests of the patients? Doctors continue to prescribe and we continue to supply. Do we have any choice? Can we/should we intervene? Are there protocols to help pharmacists perform better? Recent experience has revealed numerous morbidities and even mortalities, associated with the use of codeine-containing analgesics, especially those with NSAIDS and codeine combinations (Nurofen Plus, etc) opiate dependence is driving patients to further misuse these products. There is now a completely new cohort of drug dependent people. Are we responding well to the challenges this presents? Are we doing well as a profession or do we need to make some changes to how we operate? We use the term ‘use it or lose it’ for S2 and S3 medicines. Is it now time we applied the same principals to some of these issues? In this session we’ll discuss all these issues and some possible strategies to help us ‘move forward’.

Contributed papers stream C1—Bugs and drugs 1115–1130, PLENARY ROOM 3

Calcium channel blocker-induced LUTS in males: an Australian observational study Jeff Hughes1, Mark Coles1, Andrew Joyce2 1 Curtin University, WA, 2Monash University, VIC Correspondence: J.D.Hughes@curtin.edu.au

Objective: To determine whether calcium channel blockers (CCB) worsened, improved or did not alter symptoms of urinary obstruction in males aged 45 years and above with medical conditions associated with urinary obstruction. Patients and methods: A cohort observational study with both prospective and retrospective groups was undertaken to identify the effect of the use of CCB on lower urinary tract symptoms (LUTS) in males over 45 years of age. Participants were recruited from four community pharmacies and a general practitioners’ surgery. Eligible patients provided informed consent and were administered a standardised questionnaire (IPSS) to obtain information on LUTS and quality of life (QOL) prior to and after commencement of CCB therapy. Results: Forty males (prospective cohort 2, retrospective cohort 38) were enrolled in the study, and their mean age was 67 years (46– 89 years). After adjustment was made for natural progression of LUTS which occurs with ageing in men with benign prostatic hyperplasia (BPH), a highly significant worsening of LUTS in the retrospective cohort after commencement of CCB therapy (p< 0.001), which was accompanied by a significant worsening of QOL. The results of the two patients in the prospective cohort also showed worsening of LUTS and QOL, although due to the small sample size data were not analysed using descriptive statistics. Conclusion: This study clearly demonstrated that in middle aged males the introduction of a CCB may be associated with worsening of LUTS, and an associated decline in QOL. Given the common use of these agents in males to treat a range of cardiovascular conditions we would suggest men commenced on CCB should be questioned about urinary symptoms before and after commencing treatment.

staying alive 2010

Friday abstracts 1130–1145, PLENARY ROOM 3

Intra-pleural alteplase for complicated pleural effusion: a case report Lauren Cortis1 1 Women’s and Children’s Hospital, SA

Correspondence: lauren.cortis@health.sa.gov.au

Background: Despite the introduction of the 7-valent pneumococcal conjugate vaccine (PCV-7) and overall decrease in incidence of bacterial pneumonia, the rate of empyema in children continues to increase. These infections are often associated with more aggressive pathogens such as Panton-Valentine leucocidin - positive methicillin resistant Staphylococcus aureus. Treatment of complicated pleural effusion (CPE) remains empiric and the role of intra-pleural fibrinolytics is unclear. Most experience is with urokinase, only available in Australia via the Special Access Scheme. There is little evidence surrounding the use of intra-pleural alteplase in paediatrics. Objective: To report the use of intra-pleural alteplase in a paediatric patient with CPE. Clinical features: A fully immunised four-year-old Caucasian boy with history of asthma was diagnosed with lower left lobe pneumonia and moderate pleural effusion (causative organism streptococcal pneumonia). Case progress: Treatment with parenteral antibiotics together with the insertion of a pig tail chest drain saw symptomatic improvement by day four. Further investigation prompted by clinical deterioration on day five revealed incomplete drainage and a multiloculated pleural effusion for which intra-pleural alteplase was initiated. Intervention: 3mg of alteplase (0.1mg/kg) in 40mL normal saline was injected into the pig tail drain and clamped for one hour. This resulted in drainage of 450mL purulent fluid. When staphylococcal aureus was confirmed in the pleural fluid on day seven and significant effusion persisted, the dose was repeated. This resulted in a further 290mL of fluid drainage. Outcome: From day nine onward the patient showed significant clinical improvement. The pig tail drain was removed on day ten. He was discharged on day thirteen with two weeks of oral antibiotics (amoxicillin with clavulanic acid). Conclusions: Alteplase 0.1mg/kg administered intra-pleurally was an effective method for treating a multiloculated pleural effusion in a paediatric patient.

1145–1200, PLENARY ROOM 3

Implementation of a multifaceted, hospital-wide antimicrobial stewardship program at an Australian tertiary teaching hospital Duncan McKenzie1 1 Pharmacy Department, Royal Hobart Hospital, TAS Correspondence: duncan.mckenzie@dhhs.tas.gov.au

Aim: To develop a hospital wide antimicrobial stewardship program aimed at improved institutional antimicrobial use. Method: Following a Hospital wide outbreak of Vancomycin Resistant Enterococcus (VRE) in April 2008 the Pharmacy and Infectious Diseases (ID) Departments collaborated to develop a business case for an Antimicrobial Stewardship Project. Hospital Executive awarded funding and a permanent, full time pharmacist position was created to drive the project. The approach to improved antimicrobial use was multifaceted and included:

x x x x

formal liaison ward rounds between ID, Pharmacy and high use areas of the hospital (Adult and Paediatric ICU and Haematology/Oncology) stratification of a formal antimicrobial restriction policy implementation of Guidance® software for antimicrobial decision support and approvals (May 2009) initiation of a daily hospital-wide multidisciplinary Antimicrobial Stewardship ward round to review antimicrobial prescribing (May 2009).

Results: Uptake of the Guidance system to gain antimicrobial approvals was rapid and sustained with a mean of 561 approvals per month entered into the system to March 2010, this has become a regular part of medical practice in our institution. Total antimicrobial usage trends and costs have been dramatically reduced since the implementation of the program. Analysis continues, it is important to note that this has been confounded by a change of the pharmacy dispensing program (and hence reporting) during the intervention period. Consumption trends for targeted individual antibiotic agents e.g. meropenem and ceftriaxone have decreased as shown in data contributed to the National Antimicrobial Utilisation Surveillance Program NAUSP. Conclusion: This antimicrobial stewardship program has been successfully implemented hospital-wide at a large Australian tertiary teaching centre. Within 12 months of implementation the program has been widely accepted and significant cost savings have been shown.

conference handbook

Friday abstracts 1200–1215, PLENARY ROOM 3

Successful treatment of Scedosporium prolificans osteomyelitis with voriconazole, terbinafine and 0.2% polyhexamethylene biguanide wound washouts in a 9-year-old boy Maria Chan1 1 Royal Children’s Hospital (Melbourne), VIC Correspondence: maria.chan@rch.org.au

Objective: To describe the successful use of voriconazole, terbinafine and 0.2% polyhexamethylene biguanide (PHMB) wound irrigation in the treatment of Scedosporium prolificans osteomyelitis in a paediatric patient. Clinical features: A 9-year-old boy previously well presented to the emergency department with a penetrating right knee injury. He was initially treated for bacterial osteomyelitis with an arthroscopic knee washout, intravenous and oral flucloxacillin. Ten days after discharge he was referred back to the hospital because Scedosporium prolificans was cultured from his knee aspiration. Open wound washouts showed extensive purulent exudates surrounding the knee and proximal tibia. Interventions, case progress and outcome: He was diagnosed with Scedosporium prolificans osteomyelitis which is an aggressive infection. Infectious Disease Team was involved throughout his admission, prescribing high doses of intravenous voriconazole and oral terbinafine. He tolerated the antifungals well with no adverse drug reaction noted. Voriconazole levels were measured to monitor efficacy and toxicity. A novel agent polyhexamethylene biguanide (PHMB) as a wound irrigation was requested by our consultant orthopaedic surgeon, based on a case report from Sydney. The pharmacy department was involved in sourcing, researching and finally manufacturing the 0.2% PHMB solution in the pharmacy sterile department. The patient required four wound irrigation sessions and samples from each washout were sent for culture. Multiple disciplinary teams were involved in managing his pain and occupational health issues. Three weeks after admission he was discharged with oral voriconazole and terbinafine for at least six months. Conclusions: This case demonstrate the successful use of 0.2% PHMB wound washouts as a powerful adjunct to systemic voriconazole and terbinafine in the treatment of Scedosporium prolificans osteomyelitis. The pharmacy department was involved in determining an appropriate dose of voriconazole and terbinafine, and sourcing and manufacturing of the 0.2% PHMB wound washout solution.

1215–1230, PLENARY ROOM 3

Oseltamivir use in pregnant women: the 2009 experience Leah Brearley1, Judith Kristensen1 1 King Edward Memorial Hospital, WA

Correspondence: LeahJayne.Brearley@health.wa.gov.au

Aim: To document and audit the use of oseltamivir in a tertiary maternity hospital during the influenza pandemic associated with the influenza A (H1N1) virus outbreak between July and November 2009. Method: Prescriptions of oseltamivir were identified from the Pharmacy dispensing records, and demographic and pregnancy outcome data was extracted from the mothers’ and infants’ medical records. Results: Forty-seven pregnant women and eight women post partum were prescribed oseltamivir during the six month study period. 35 women were treated in the third trimester, eleven in the second trimester and one in the first trimester of their pregnancies. Of the 41 patients available for follow-up, there were thirty-eight singleton births, two sets of twins and one still-birth. Eleven of the infants, including both sets of twins, and the still born infant were born at less than 37 weeks gestation. No birth defects were documented for the infants in the study. Fourteen women were lost to follow up as their infants were born at peripheral hospitals. Conclusion: There is a paucity of information on the safety of oseltamivir in human pregnancy. However it is recommended that oseltamivir therapy is prescribed to pregnant women, particularly in the second and third trimesters, with suspected or proven H1N1 infection, as they are a vulnerable group for complications of the disease. Although the data is not of a magnitude to illustrate absolute safety of oseltamivir in pregnancy, it does provide some reassurance for Doctors who prescribe the drug and their patients who are concerned about the effects of oseltamivir on their unborn infants.

staying alive 2010

Friday abstracts Contributed papers stream C2—Life goes on 1115–1130, MEETING ROOM 219

Impact of a hospital pharmacist prepared interim residential care medication administration chart on medication administration errors after discharge from hospital to residential care (MedGap Project) Rohan Elliott1,2, Tim Tran1, Simone Taylor1, Penelope Harvey3, Mary Belfrage4, Rhonda Jennings3, Liam Carter3, Jennifer Marriott2 1 Pharmacy Department, Austin Health, VIC, 2Centre for Medicine Use and Safety, Monash University, VIC, 3Bundoora Extended Care Centre, Northern Health, VIC, 4North East Valley Division of General Practice, VIC

Background: Medication delays and errors are common when patients are transferred from hospital to residential care facilities (RCF). The RCFs’ need for a general practitioner or locum medical officer to prepare or update the RCF medication chart is a major contributing factor. Aim: To test the impact of a hospital pharmacy-provided interim residential care medication administration chart (IRCMAC) on medication errors and use of locum medical services. Methods: Patients discharged from inpatient wards of a major public health service to an RCF over a 3-month period were studied. Data were collected from hospital records and structured telephone interviews with RCF staff approximately 24 hours after discharge. This was followed by extensive stakeholder consultation and development of an electronically-generated IRCMAC and associated policies and procedures for RCFs and hospitals. Following implementation of the IRCMAC, data collection was repeated over another 3-month period. The primary endpoint was: proportion of patients experiencing a medication administration error, defined as a missed dose, significantly delayed dose (more than 50% of prescribed dose-interval), or wrong drug/dose. A secondary endpoint was: proportion of patients who required locum medical attendance at the RCF. Results: The number of patients who experienced one or more medication administration errors fell from 41/202 (20%) in the preinteventrion period to 5/226 (2%) following introduction of the IRCMAC (difference in percentages 18%, 95%CI 12–24%, p<0.001). The majority of medication errors in both groups were missed doses (80%). The number of patients who received a locum medical attendance fell from 66/202 (33%) to 25/226 (11%) patients (difference in percentages 22%, 95% CI 13–30%, p<0.001). Conclusion: Lack of an updated medication chart at RCFs was a barrier to continuity of care and source of unnecessary use of locum medical services. A hospital pharmacy-provided IRCMAC significantly reduced errors and locum attendances.

1130–1145, MEETING ROOM 219

General practitioner and residential care staff satisfaction with a hospital pharmacist prepared interim residential care medication administration chart (MedGap Project) Tim Tran1, Rohan Elliott1,2, Penny Harvey3, Simone Taylor1, Rhonda Jennings3, Mary Belfrage4 1 Austin Health, VIC, 2Monash University, VIC, 3Northern Health, VIC, 4North East Valley Division of General Practice, VIC Correspondence: tim.tran@austin.org.au

Background: Residential care facility (RCF) staff and general practitioners (GPs) are often dissatisfied with the handover of medication information when patients are discharged from hospital. Poor handover, including lack of an up-to-date medication administration chart, increases the risk of medication errors and places unnecessary burden on RCF staff and GPs. Objectives: To evaluate RCF staff and GP satisfaction with a hospital pharmacist prepared 7-day interim residential care medication administration chart (IRCMAC) provided for patients discharged from hospital to a RCF. Methods: An IRCMAC was provided to 226 patients discharged from inpatient wards of a major public health service over a 3-month period. RCF staff satisfaction with the IRCMAC was evaluated via a structured telephone interview approximately 24 hours after discharge. GP satisfaction was evaluated via a questionnaire mailed to GPs of patients who were discharged in the final 4 weeks of the study (n = 84). Results: An IRCMAC was received by the RCF for 214/226 (95%) patients, and used to record medication administration in 147/214 (69%) cases. 189/214 (88%) RCF staff reported that the IRCMAC improved patient transfer. Qualitative data suggested that the IRCMAC provided a clear source of information, reduced time spent organising urgent medical practitioner attendance, and enabled RCF staff to administer medications in a timely, safe and legal way. GPs completed the questionnaire for 35 patients (response rate 42%). 31 (89%) GPs reported the IRCMAC reduced the urgency to attend the RCF, 35 (100%) were comfortable with the RCF using the chart in the interim period, 34 (97%) found the communication of medication changes on the IRCMAC useful and 35 (100%) thought the IRCMAC should be standard practice for all patients discharged to a RCF. Conclusions: RCF staff and GPs were highly satisfied with the provision of a hospital pharmacist prepared IRCMAC.

conference handbook

Friday abstracts 1145–1200, MEETING ROOM 219

Are there any differences in the outreach pharmacist’s activities and outcomes of patients referred by clinical pharmacists and the Complex Care Program? Rebecca Kwok-Yee Pang1, Sin Hoon (Skip) Lam1, Benjamin K Leung1 1 Frankston Hospital, Peninsula Health, VIC Correspondence: rpang@phcn.vic.gov.au

Aim: To compare and evaluate the outreach pharmacist’s activities and resulting outcomes of patients at risk of medication misadventures referred by clinical pharmacists and patients from the Complex Care Program. Methods: The Peninsula Complex Care Program (PCCP) outreach pharmacist receives patients from clinical pharmacists (primary referrals) and PCCP (secondary referrals). Medication review activities can occur over the phone (PH), by home visit (HV), liaison with other health professionals or chart review. Pharmacy interventions were documented and classified into clinical, compliance, education and psychosocial categories. Results: Between June 2009 and April 2010, 271 patients (148 primary versus 128 secondary) were recruited; 5 patients referred by the clinical pharmacist were subsequently recruited into the PCCP. There were 389 interventions for primary referrals and 406 for secondary referrals. The average number of interventions per patient was 2.63 and 3.17 for primary and secondary respectively i.e. 17% more interventions were recorded for secondary referrals. Home visits resulted in the highest rate of interventions (3.2 interventions per patient) in both primary and secondary referrals. Primary referrals were followed up mainly by phone (58%) and resulted in 46% of interventions. In secondary referrals, PH and HV contributed to 41% and 34% of activities respectively. Liaison with doctor occurred frequently in secondary referrals as they might be at higher risk of medication misadventures. The most common types of interventions were related to clinical issues with at least 50% of pharmacy interventions resulting in medication or treatment changes. Conclusion: Medication reviews by the outreach pharmacist significantly improved medication management for primary and secondary referrals. Importantly, there were a large number of primary referrals who did not require PCCP services who benefited from the medication reviews. Tighter selection criteria will ensure a sustainable and prompt pharmacy service to all patients at high risk of medication misadventures.

1200–1215, MEETING ROOM 219

Evaluation of a self-administration of medications program for hospitalised aged patients Tim O’Shea1,2, Kim Bjallgren1, Jan Gooding2, Susan Poole1,3, Peter Hunter2, Louise Dillon2, Renata Lemke2, Lorraine McGrath2, Rohan Elliott3,4, Michael Dooley1,3 1 Pharmacy Department, Alfred Health, VIC, 2Aged Care Unit, Caulfield Hospital, Alfred Health, VIC, 3Faculty of Pharmacy, Monash University, VIC, 4Pharmacy Department, Austin Health, VIC Correspondence: T.OShea@alfred.org.au

Aims: The primary aim was to pilot a self-administration of medications (SAM) program in hospitalised subacute aged care patients. Secondary aims were to determine the nursing and pharmacy resource requirements for implementation of a SAM program and identify factors that might predict patients’ performance in the program. Methods: Eligible consenting patients were recruited during their inpatient stay. They were 60yrs of age, on a stable regimen of 4 medications and planned to be primarily responsible for self-medicating at home after discharge. The program consisted of two phases: Stage 1: Patient initiated, supervised medication administration and Stage 2: Independent medication administration with daily compliance monitoring. Judgements about patients’ performance were made by the pharmacist and nurses. After discharge patients were visited by an out-reach pharmacist to identify any medication related problems. Results: Forty-three patients were recruited into the program over 6 months. The average age was 82.1yrs; the average number of medications was 12.8 per patient. Twenty-four patients (55.8%) passed the program, 3 (7.0%) passed with intervention (usually the introduction of a dose administration aid), 1 (2.3%) passed after having difficulty with original containers, but refused a Dosette, 7 (16.3%) failed and were unable to independently self-medicate. 4 (9.3%) withdrew and 4 (9.3%) did not complete the program and were not included. A significant difference was observed between those who passed and failed for Mini-Mental State Examination (MMSE), Medication Regimen Complexity Index (MRCI) and Self-Efficacy for Appropriate Medication Use Scale (SEAMS). The average staff time involvement in the program was 5 hours and 40 minutes per participant. Conclusion: The SAM program was found to be feasible in the subacute setting and staff resource requirements were quantified. The program was effective in the detection and addressing of barriers to compliance in older patients.

staying alive 2010

Friday abstracts 1215–1230, MEETING ROOM 219

Pharmacist medication review for patients referred to an aged care assessment service Rohan Elliott1,2, Georgia Martinac1, Stephen Campbell3, Juliet Thorn3, Michael Woodward3 1 Pharmacy Department, Austin Health, VIC, 2Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, VIC, 3 Heidelberg Aged Care Assessment Service, Aged and Residential Care Services, Austin Health, VIC Correspondence: rohan.elliott@austin.org.au

Background: Aged care assessment services or teams (ACAS/ACATs) assess older people in need of support with activities of daily living. Assessment does not normally include a formal medication review. Aim: To compare methods for providing a pharmacist medication review for community-dwelling people referred to an ACAS. Methods: Consenting ACAS clients were randomised to receive either referral to a hospital outreach medication review (HOMR) pharmacist associated with the ACAS or referral to their general practitioner (GP) for a Home Medicines Review (HMR) plus verbal and written information about HMR. Clients were followed up 4–6 weeks after referral to determine whether a medication review had occurred. A survey was sent to each client’s GP. The primary endpoint was the proportion of clients who received a HOMR or HMR within 4 weeks of referral. Results: 80 clients (mean age 84 years) were recruited. Only 4/80 (5%) had received a HMR or HOMR in the 12 months prior to recruitment. 36/40 (90%) clients referred by ACAS to a HOMR pharmacist received a home medication review within 28 days, compared with 7/40 (17.5%) clients referred to their GP (p < 0.0001). 60/80 (75%) GPs responded to the fax-back survey; 8 (13.3%) indicated a preference for an ACAS-organised HOMR, 16 (26.6%) indicated a preference for HMR, 32 (53.3%) indicated no preference, and 4 (6.7%) indicated they preferred no pharmacist medication review. Of the GPs whose patient had a HOMR, 41% found the review ‘very useful’; 52% ‘somewhat useful’, and 7% ‘not useful’. Conclusion: Providing ACAS clients with information about HMR and making a referral to their GP results in a small increase in uptake of HMR. Having a pharmacist associated with the ACAS is a more effective way of providing a timely medication review for this group of clients who are at high-risk for medication-related problems.

Contributed papers stream C3—Painful situations 1115–1130, MEETING ROOM 220

Improving outcomes for opioid pain management—balancing the needs versus the risks Anna Gelavis1, Samantha Poke2 1 Pharmaceutical Services Branch, Department of Health, WA, 2Disaster Management, Regulation and Planning Directorate, Department of Health, WA Correspondence: anna.gelavis@health.wa.gov.au

The State health organisation is responsible for administering the Poisons Act 1964 and its subsidiary legislation. This legislation aims to reduce the diversion and abuse of Schedule 8 medicines (S8s) without impeding access to these drugs for patients suffering genuine pain. In the past decade, there has been a dramatic increase in the use of S8s, particularly oxycodone, both nationally and in this state. The total number of PBS opioid prescriptions increased from 2 397 006 in 1992 to 6 998 556 in 2007. Concurrent with this increase is the emergence of a number of public health issues relating to the S8s including:

x x x x

an increasing number of patients (under 60 years) on high doses (greater than 200 morphine equivalents per day) of S8s the misuse and abuse of opiates, including doctor-shopping and diversion significant delays (up to twelve months in some cases) in accessing the metropolitan public pain clinics for consultant review transition of hospital inpatients on opioids into the community.

A review of the current regulatory requirements for the S8s is being undertaken, in consultation with stakeholders, including pain specialists, medical practitioners and consumer representatives. The aim of the review is to seek a risk-based approach to opioid regulation, which acknowledges the legitimate medical need for opioids in patients with chronic pain, while recognising the public health issues of abuse, addiction and diversion. Based on comments from stakeholders, the revised S8 regulatory system will include:

x x x x

ready access to appropriate evidence-based treatment with S8s when medical practitioners are prescribing within guidelines a monitoring system that minimises the risk of diversion of S8 medicines for non-therapeutic purposes early detection of people exhibiting drug-seeking behaviour in order to encourage appropriate management of their condition education of medical practitioners on the revised statutory obligations.

conference handbook

Friday abstracts 1130–1145, MEETING ROOM 220

Medication safety—embracing the TALLman Toni Howell1, Hayley Zarth1, Daniel Gilbertson1, Janelle Penno1, Caroline Chen1, Katie Phillips1, Justine Hong1 1 Melbourne Health, VIC Correspondence: toni.howell@mh.org.au

Aim: To reduce the risk of opioid selection errors in hospital wards by providing adhesive labels with TALLman letters for ward drug of dependence administration books. Method: An audit of drug of dependence administration books used on each of the wards in the hospital indicated that handwritten details of stock kept in ward safes was often illegible and inadequately described the drug name, dose and form. This was considered a significant risk due to the high rate of look-alike/sound-alike names of opioids. An excel document was designed which could utilise existing adhesive labels used to print patient identification labels. It included each of the medication names in a suitable size and format to fit with the existing drug of dependence administration book. A template was developed for each ward based on case mix and prescribing practices in liaison with the ward pharmacist. TALLman letters and bold font were used to highlight the difference between look-alike/sound-alike medications, e.g. oxyNORM and oxyCONTIN. Results: In the four consecutive 6-month periods prior to implementation, there were 8, 3, 3 and 7 reported incidents respectively where a similar sounding opioid was accidentally selected. In the 6-month period after implementation, no opioid selection errors were reported indicating that the use of adhesive labels was aiding the prevention of selection errors. Conclusions: The use of adhesive labels with TALLman lettering is a simple and successful strategy to reduce the risk of selection errors in opioids, which have a high rate of look alike sound alike names. The use of TALLman letters has also been applied to other areas of the hospital, including Pyxis, and is being considered for wider applications.

1145–1200, MEETING ROOM 220

Failure mode effect analysis—the other side of the safety coin Diane Reeves1,2, Helen Ganley1 1 Clinical Governance Unit, Northern Sydney Central Coast Area Health Service, NSW, 2Pharmacy Department, Central Coast Health, NSCCH, NSW Correspondence: dreeves@nsccahs.health.nsw.gov.au

Aim: To implement a prospective risk management tool in order to evaluate processes and products for possible failures before an event occurs. Method: Failure modes and effects analysis (FMEA) is a prospective risk management tool. FMEA is a systematic, proactive, teambased method evaluation, identifying opportunities for failure, or ‘failure modes’, (FM) in each process step. Each FM gets a numeric score that quantifies (a) likelihood of failure occurring, (b) likelihood of detecting failure, and (c) the potential for harm/damage. The product of these three scores is the Risk Priority Number (RPN). This work will demonstrate medication related work conducted for the State Government and a large metropolitan AHS. Results: Pilot projects demonstrated potential reductions in the RPN: parenteral administration—neonates—11%; care of high-risk emergency patient—53%; intrathecal chemotherapy—62%. Additional monitoring of process and outcome indicators demonstrate sustained success. Patient identification process evaluation showed a statistically significant increase in patients with ID bands and no change in related adverse events despite incident reporting increasing. Conclusion: FMEA participants were highly satisfied with the process, time involved, increased skills and outcomes. They stated improvements were effected in safety, effectiveness, appropriateness, consumer participation, continuity of care, access, efficiency, competence/training and information management Lessons learnt when piloting an innovation is to work with clinical leaders and early adopters; this is the key to success. A skilled facilitator is essential, building in ‘train the trainer’ strategies increasing the pool of facilitators. Message for others: Where possible, organisations should move from focusing on special cause variation, to systems exhibiting common cause variation, reducing harm to a much larger number of consumers, patients, visitors, staff, equipment and the facility. Prospective risk reduction wins hands down over retrospective processes like root cause analysis, audits and peer review.

staying alive 2010

Friday abstracts 1200–1215, MEETING ROOM 220

Staying alive: new ways to educate prescribers Dianne Rozynski1 1 Toowoomba Health Service, QLD

Pharmacy has contributed to formal MO and Intern education during the Orientation and Induction process for many years. Participants are bombarded with information and processes during the Orientation week and overload may result. Quality and legality of subsequent prescription writing is often amiss. Toowoomba Health Services has developed a computer based education tool which is distributed to new graduates on a USB stick during their initial contact with the hospital. Pharmacy and a number of other clinical areas have contributed a short video as part of this tool. Pharmacy’s video is entitled ‘Script writing for Junior Doctors’ and is intended for use by Interns, Resident Medical Officers and Medical Students on rotation at Toowoomba Base Hospital. The video opens with the Director of Pharmacy emphasising the importance of an accurate prescription particularly in relation to patient safety, patient flow and continuity of care at discharge. The Assistant Director of Pharmacy then details the requirements of a legal prescription and the many nuances unique to prescribing in the Queensland Health system and at Toowoomba Hospital. The verbal commentary is accompanied by a variety of visual examples highlighting the point being made. Throughout the video, the importance and benefits of working with the hospital’s ward pharmacists is stressed. The recipient is able to view the presentation at their leisure and review the information as required. This video was produced in collaboration with the Medical Education Unit at Toowoomba Hospital and will be played during my presentation.

1215–1230, MEETING ROOM 220

A stepwise approach to safer analgesic medication management Michelle Sweeney1 1 Fremantle Hospital and Health Service, WA Correspondence: michelle.sweeney@live.com.au

Background: A lack of patients’ understanding of analgesic medications was identified as a barrier to optimal pain management postdischarge from hospital. A patient information leaflet was developed by the pharmacy department to assist patients in effectively stepping down their use of analgesic medications following surgery. Aim: To assess the effectiveness of a patient information leaflet developed to assist patients in stepping down their use of analgesic medications following surgical procedures. Methods: Forty-eight patients were recruited into the pilot study over a six-week period. Thirty-seven patients located on the orthopaedic ward were eligible for the study, having undergone a surgical procedure and provided with analgesic medications at discharge. Patients were provided with pharmacist counselling and an explanation of the information leaflet prior to discharge. These patients were contacted within twenty-eight days post-discharge from hospital to complete a phone interview that involved an assessment of their understanding of the content and their opinion regarding the usefulness of the leaflet. Patient feedback was requested to determine further improvements to the content and presentation of the leaflet. Results: Twenty-nine patients (78.4%) were available for follow up. Of those interviewed, 100% assessed the leaflet as easy to understand and 89.7% assessed the leaflet a useful information tool in assisting their analgesic medication management. The medication administration table provided with the leaflet was utilised by 24.1% of patients, with 37.9% assessing the table as a useful tool. Feedback regarding aesthetics and usability was positive. Conclusion: The patient information leaflet was assessed by this cohort of patients to be a useful intervention, in providing an understanding of the stepwise approach to pain management. The suggestions provided by this cohort of patients will be taken into consideration when a revised edition of the leaflet is produced.

conference handbook

Friday abstracts Contributed papers stream C4—Broadening the profession 1115–1130, MEETING ROOM 212

Are transcribing or prescribing roles for emergency pharmacists supported? Views of clinical staff following a pilot in three Victorian hospitals Greg Weeks1, Johnson George1, Jennifer Marriott1 1 Barwon Health, VIC Correspondence: greg@barwonhealth.org.au

Aim: To explore the views of clinical staff on ED pharmacist roles at the conclusion of a pilot project in which ED pharmacists directly prepared medication charts. Method: At the conclusion of the pilot project, focus groups were held comprising emergency and general medical staff, emergency nurses, and pharmacists (n=14) at three Victorian teaching hospitals. An independent researcher led the focus groups and recordings were transcribed verbatim. Thematic analysis was undertaken using NVivo 8. Ethics approval for the study was obtained from the relevant ethics committees. Results: The ED pharmacist’s contribution in the areas of education, medicines information and organising supply was highly valued. Pharmacist-prepared drug charts within the processes established were deemed safe, timely, accurate, complete, and legible. A service consensus ranking of 4 or 5 on a scale of 1 to 5 was given. (5 equating to an essential part of the pharmacy service). Time pressures often prevented medical staff taking an accurate medication history from multiple sources. Individual ED pharmacist excellence and teamwork led to trust in the pharmacist-prepared chart. However medical staff generally held that it should remain their role to sign the medication chart. For a pharmacist to sign off the chart, evidence of a consultation with medical staff would be required. Restricted pharmacy hours were seen as a limitation. Views on extended prescribing varied from negative to support for limited prescribing via protocol, Schedule 3 drugs, regular medications or as part of a response team. The chart preparation role has continued in the three hospitals. Conclusion: ED pharmacist-prepared drug charts are supported, being viewed as safe, saving clinical staff time, enhancing teamwork and the pharmacist’s profile. A further extension of prescribing roles remains challenging.

1130–1145, MEETING ROOM 212

A culture of research and appointment of a pharmacy research coordinator promotes research output Susan Welch1 1 St Vincent’s Hospital, NSW

Correspondence: swelch@stvincents.com.au

Aim: To illustrate the role of a pharmacy research coordinator (PRC) Method: Since the early 1990s a grade 3 pharmacist responsible for the coordination of the Pharmacy Department’s research has been employed. The PRC: coordinates and overseas the research and development program (RDP); and liaises with the Chair of Clinical Pharmacy regarding research undertaken by external persons working with the Pharmacy Department. The PRC helps identify possible research topics, publicises grants, provides editorial review and maintains a record of all projects and output using an Access® database. They lead by example in the presentation/publication of projects. The RDP involves regular departmental meetings which aim to develop and support research projects via target setting, provide a supportive forum for discussion, facilitate protocol development and provide advice on experimental design, methods, presentation and publication. Research is a departmental priority. All pharmacy interns conduct a project, all pharmacists and technicians are encouraged to participate while senior pharmacists are expected to be involved. Staff are encouraged to seek funding from both internal and external funding sources. Results: Over the past 10 years the department has had an average output of 16 presentations (range: 10–25) and 4 publications (peer reviewed articles, editorials, clinical cases and published abstracts; range: 1–10) per year. Technicians have also been involved with 6 conference presentations and 1 publication over that time. All projects are reviewed by the Research Ethics Committee as low or high risk projects. The majority of projects are conducted without funding. The clinical nature of projects and increased involvement of students allows this. External funding has been sought on an increasing basis and has been gained recently for 3 studies currently under way. Conclusion: A prioritised, structured research program coordinated by a PRC provides job satisfaction for all staff and a sustained level of research output.

staying alive 2010

Friday abstracts 1145–1200, MEETING ROOM 212

Making medicines information child size: development of the first WHO Model Formulary for Children Christine Plover1, Leith Lilley1 1 Royal Children’s Hospital, VIC

Correspondence: christine.plover@rch.org.au

Background: In 2007, the World Health Assembly passed a resolution titled ‘Better Medicines for Children’. An integral part of this resolution was to develop a list of essential medicines for children and an accompanying paediatric medicines information reference. The Model List of Essential Medicines for Children (EMLC) presents a list of essential medicine needs for use in children up to 12 years of age. The EMLC includes the minimum medicines required for a basic health care system, listing the most efficacious, safe and costeffective medicines for priority conditions. Aim: Develop the first Model Formulary for Children based on the second EMLC for the World Health Organization (WHO). Method: A multidisciplinary project team was formed to develop the formulary using the predominantly adult based WHO Model Formulary as a starting point. Paediatric clinical pharmacists reviewed medicines information references, clinical guidelines and the current literature to write a monograph for each drug on the EMLC. Monographs were designed to enable a health care professional with limited experience to prescribe and administer the medicine to a child. An extensive review process was established involving the internal project team and local and international experts. Editing and formatting was done by an external company. Results: Paediatric clinical pharmacists challenged the boundaries of their profession to work as clinical editors and prepare monographs for each of the 310 medicines listed on the EMLC utilising their experience and the best global evidence available. The formulary provides medical practitioners around the world with standardised medicines information on the recommended use, dosage, adverse effects, interactions and administration for children in an easily accessible format. Conclusions: The WHO Model Formulary for Children is a comprehensive and easy to read information source that ensures access to paediatric essential medicines information for health care professionals working with children across the world including resourcelimited settings.

1200–1215, MEETING ROOM 212

Advanced level framework for the development of cardiology pharmacists Sally Porter1 1 Queensland Health, QLD

Aim: To develop a framework for advanced pharmacist practitioners in the area cardiology. The main objective being to improve medicines management for patients through the provision of pharmaceutical care by adequately trained pharmacists. Background: Pharmacy practice has changed substantially in recent years as medication use in hospital increases in complexity and cost. It has been identified that there is a need for pharmacists with a more advanced level of knowledge and skills in order to offer improved, consistent and equitable patient care in specialist areas. Development of competency frameworks for health professionals is an important strategy in ensuring high quality health care. There has been a great deal of work undertaken in Queensland, interstate and internationally on competency assessments in pharmacists. There are currently pharmacists practicing within specialist posts (including cardiology) who have not undergone any formalised specialist training, many of whom require ‘up skilling’ and consequently standards of practice are variable intra-state. Methods: To develop a draft framework by adapting existing frameworks to the cardiology specialty. Competency clusters were identified and developed by input and feedback from a cardiology expert reference group including pharmacists, nurses and doctors. The framework was then piloted in various sites with cardiology pharmacists to determine the functionality and usefulness of the tool. Results: The draft framework was developed and then updated following feedback from the expert reference group. Three pilots were conducted and qualitative feedback indicated that the framework would be useful for aiding in identifying evidence, demonstrating experience and also for identifying gaps in knowledge. Conclusion: The developed framework will assist in guiding training and development needs of pharmacists working in cardiology and wishing to specialise. Development of frameworks in other specialty areas would be of benefit in guiding training and development of specialist pharmacists.

conference handbook

Friday abstracts 1215–1230, MEETING ROOM 212

Integration of paediatric pharmacy training from undergraduate to advanced practice— implementation of a paediatric advanced level competency framework Sonya Stacey1,2, Judith Coombes2,3 1 Children’s Health Services, Queensland Health, QLD, 2Allied Health Clinical Education and Training Unit, Queensland Health, QLD, 3Princess Alexandra Hospital, Queensland Health, QLD Correspondence: sonya_stacey@health.qld.gov.au

Aim: The aim of the project was to implement an existing advanced level competency framework (ALF) for paediatrics into practice Methods: Methods included identification of a paediatric pharmacy reference group, updating of the paediatric ALF from 2008, adapting for paediatrics an existing clinical pharmacy observational tool, a workshop for specialist paediatric pharmacists, and on-site mentoring and feedback (via structured observation using the paediatric observation tool, and portfolio review using the ALF) at various sites. The competencies defined in the ALF and the learning needs identified during the site visits were used to develop targeted workshops, and educational resources in a range of electronic and written formats. Results: In the six months of the project, there were 10 presentations and 8 mentoring sessions given to approximately 180 pharmacists across 12 sites. There were an additional 10 lectures and tutorials given to approximately 350 undergraduate and postgraduate medical and pharmacy students. There were 12 reviews (combination of observational and portfolio reviews) for 10 pharmacists across 5 sites. Feedback has been positive regarding the use of the tools and the mentoring support provided, particularly from the less experienced paediatric pharmacists and those in regional areas. Educational resources were developed based on the competencies articulated in the ALF, for 5 topics in a range of flexible formats, to be available via an e-learning platform which will allow assessment of learning and certificates of completion. Conclusion: Articulation of expected competencies in paediatric pharmacy has allowed an integrated training program to be developed from undergraduate level to advanced practice; providing mentoring, professional support and learning opportunities to pharmacists in metropolitan and rural areas.

Contributed papers stream C5—1970s to now—changes in technician training and roles 1115–1130, MEETING ROOM 213

Current experiences in pharmacy technician training informing future training opportunities Andrew Brown1, Katie Doherty1, Gabrielle Cooper1 1 University of Canberra, ACT

Aim: In the current climate of health and education reform there are a number of drivers that are prompting a closer look at the training and career structure of pharmacy technicians. The aim of this research was to look at the satisfaction with current technician training over the previous 12 months, exploring the types of training conducted investigating barriers and enablers that may affect pharmacy technician training in hospitals. Method: A triangulation method of data collection was undertaken using written survey, face to face interview and focus groups to investigate issues around pharmacy technician training over the last 12 months in seven hospitals in the Canberra region. 20 surveys were completed, 15 interviews conducted and 3 focus groups facilitated. Results: The results from the research were then analysed using ‘survey monkey’ and qualitative thematic analysis. With the following themes documented:

x x x

a lack of time is the greatest barrier to technician training

x x

a variety of approaches to technician training are used

a certificate to Masters pathway for pharmacy technicians to progress to pharmacists, is seen as very positive the most prominent incentive for all stakeholders to increase the level of training was not fiscal but related to improved job satisfaction for pharmacy technicians the size of the hospital determines the roles and subsequent training requirements for technicians.

Conclusion: This research documents the difficulties faced in meeting the training needs of pharmacy technicians and provides some insights which can be used to inform the development of future certificate training and CE for pharmacy technicians.

staying alive 2010

Friday abstracts 1130–1145, MEETING ROOM 213

A stability study of extemporaneously prepared oral cholecalciferol liquid formulations in olive oil Pathma D Joseph1, Violet Hemmens1, Philip Neilson2, Craig Munns1 1 The Children’s Hospital at Westmead, NSW, 2Lipa Pharmaceuticals Limited Correspondence: pathmam@chw.edu.au

Aim: To determine the stability of various concentrations of extemporaneously prepared solutions of olive oil-based cholecalciferol. Methods: No formal stability or microbiological data has been available to support the shelf-life of oral solutions of cholecalciferol. The stability of various concentrations of cholecalciferol in olive oil was investigated to validate the currently assigned shelf-life of 90 days. Cholecalciferol solutions of three different concentrations were manufactured extemporaneously from a PCCA cholecalciferol assayed concentrate of 1.03 million IU/g. The solutions were then assayed by a pharmaceutical company specialising in stability determinations using an Ultra-Performance Liquid Chromatography assay validated for use in cholecalciferol. Determinations of the specific gravity and concentrations were made at 5 different test points (0, 1, 2, 3, 6, 9 months) over a 9-month period. Microbiological testing was carried out at test point 0 and 9 months. Results: The assayed initial concentrations of the cholecalciferol solutions were found to be 60178IU/mL, 5680IU/mL and 400IU/mL. All three solutions conformed to the test specifications for specific gravity, indicating no major change in the physical nature of cholecalciferol liquid over the 9-month period. Using the linear regression analysis, all data points fall within the upper and lower 95% confidence levels indicating that any variations in concentration away from the trend line are due to differences between analysts or bottles. The negative trend line showed that the concentration of cholecalciferol was decreasing with time but all data points are above the lower specification limit. The solutions also passed microbial testing after 9 months. Conclusions: The study supports a nine month shelf-life of olive oil-based cholecalciferol solutions without compromising the quality of the product. At the same time, the study indicates that large scale manufacture in the hospital setting is limited by the manufacturing procedures and supports the use of commercial products where available.

1145–1200, MEETING ROOM 213

Two paths well travelled Carolyn Young1, Belinda McLachlan1 1 John Hunter Hospital, NSW

Correspondence: belinda.mclachlan@hnehealth.nsw.gov.au

Aim: To highlight the paths two pharmacy technicians have travelled to reach a common destination. Method: Compare and contrast how different training and experiences can be used to build a fulfilling career. Result: In the same recruitment pool in November 1990, two ‘strangers’ were successful and began their journey as hospital pharmacy assistants. One assistant began in a small community hospital and the second assistant started in a larger teaching hospital. Throughout the intervening years each technician has followed their own varied career path. Both completed education and training courses within the pharmacy department, staff development unit and external institutions. One technician concentrated on traditional technician training whilst the other technician acquired skills through a tertiary establishment and adapted them to suit her role. Moreover the two technicians have been proactive within the pharmacy department and have actively sought additional challenges. This has led them to the distinctive role of Pharmacy Technicians within the Drug Usage Evaluation (DUE) section of a large tertiary teaching hospital. Their major duties comprise data management, consisting of monthly and quarterly reporting of drug usage data and the collection and collation of data for internal and external medication audits. Conclusion: This demonstrates that there are many paths to travel to reach a destination, and it is dependant upon the willingness to embrace all opportunities offered throughout the journey. Both technicians have had the initiative to look outside the main stream duties of a pharmacy technician and this has created a fulfilling career path. Their enthusiasm and motivation continues and they cannot wait to see what the future holds.

conference handbook

Friday abstracts 1200–1215, MEETING ROOM 213

The expanding role of the DUE technician Carolyn Young1, Belinda McLachlan1 1 John Hunter Hospital, NSW

Correspondence: carolyn.young@hnehealth.nsw.gov.au

The Drug Usage Evaluation (DUE) section has been available since 1999 offering a specialised service in quality assurance and management activities. In 2000 it became apparent that a pharmacy technician would be a valuable resource to assist the DUE pharmacist with data management. In 2003 the department expanded to an Area wide service. This resulted in the employment of another pharmacy technician to meet the growing demand. The purpose of the positions is to provide technical assistance for the scope of work conducted by the Quality Use of Medicines (QUM) Unit. The key accountabilities for the DUE technicians are to assist in: x preparation of documents and presentations x preparation of Quality Use of Medicines (QUM) Programs—antibiotic stewardship and medication safety x conduct, rollout, and implementation of medication safety initiatives x all aspects of QUM audits x development of database files and spreadsheets for entry and evaluation of audit data x maintain existing QUM audit databases x format drug usage reports x final presentation of QUM reports x preparation of educational interventional material x production of regular QUM monthly reporting x maintain accurate documentation and statistical information for various QUM projects x provision of drug usage information to the Director and Area Director of Pharmacy. The pharmacy technician’s contribution in the Drug Usage Evaluation role as a specialised pharmacy technician has become an integral part of the multi disciplinary health care team. These positions place the department in a unique situation of being able to provide impartial drug usage information, and therefore has become an invaluable service to the Area. Additionally this is an exciting opportunity for pharmacy technicians to enhance there skill base and develop another career path within the department.

1215–1230, MEETING ROOM 213

Clinical support pharmacy technicians and the patient journey—a twist on Garling Tanya Foyle1 1 Hunter New England Area Health Service, NSW Correspondence: Tanya.Foyle@hnehealth.nsw.gov.au

Aim: To improve cohesiveness of patient journey through hospital via implementation of a clinical support pharmacy technician in the Emergency Department. To underline the importance of ward pharmacy technicians as part of the pharmacy team on wards; help to ensure Garling outcomes by supporting pharmacist (continuum of care). In light of Garling recommendations, highlight that pharmacy technicians are a group to invest time and training in, in addition to other groups identified in report. Methods: A competency based clinical support pharmacy technician manual was developed based on SHPA Standard of Practice for Clinical Pharmacy. A pharmacy technician was trained to commence work in Emergency Department and assist Clinical Pharmacist. Qualitative measures (survey) taken of ED staff and patients to determine increase (if any) of satisfaction with pharmacy service. Measured reduction in drug wastage (drugs following patient to ward, particularly puffers, and insulin). Measured ‘missed doses’ due to problems with medication supply and handover. Results: Satisfaction with pharmacy services in ED increased (from essentially no service prior to this project). Quality of pharmacy service improved for ED discharges—early data indicates counselling rate of over 70% for those provided with medication. Reduction in ‘lost’ medications—puffer distribution reduced, insulin disposal reduced, patient’s own medications staying with patient (figures available after stocktake). Missed doses reduced as medication continuity ensured by pharmacy technician (snapshots pre and post intervention indicates reduction of missed doses in ED by 23%). Conclusion: The implementation of this project has had many practical qualities:

better handover to the next ward pharmacist to ensure pharmaceutical supply and prescribing issues are followed up and not ‘lost in the system’, (resulting in reduction of missed doses, loss of medication)

better supply of inpatient and discharge medications facilitating a ‘faster’ journey for some patients through the Emergency Department.

staying alive 2010

Friday abstracts Invited speaker session S1—Bugs and drugs 1330–1400, PLENARY ROOM 3

Infectious diseases in newly arrived refugees Thomas Schulz1 1 Victorian Infectious Diseases Service, The Royal Melbourne Hospital, VIC

Australia accepts 13 700 refugees annually through humanitarian intake, both via the United Nations and acceptance of a varying number of asylum seekers. These people have often arrived from countries of great poverty and have usually lived in very basic conditions for most of their lives. Limited health screening occurs before refugees arrive in Australia and a full health assessment is recommended after arrival. It is important to determine if new arrivals have specific infectious diseases as prompt recognition can improve outcomes and avoid long-term disease consequences. These conditions include tuberculosis, viral hepatitis, parasitic infections and other conditions. The presence of conditions such as hepatitis B also requires lifelong follow-up and potentially screening to exclude the development of liver cancer. Many of the conditions are unfamiliar to Australian health professionals and need to be considered in this specific patient group. This session will include a brief outline of the process for refugee arrivals in Australia and the health screening involved. This will be followed by a short discussion of the diagnosis and management of common conditions that may be encountered.

1400–1430, PLENARY ROOM 3

Increasing resistance in Staphylococci and Enterococci in Australia—implications for management Benjamin P Howden! ! Austin Hospital, VIC

Staphylococci and enterococci remain important causes of serious infections in humans, including skin and soft tissue infections, post surgical wound infections, bone and joint infections and bacteraemia. While traditionally infections caused by these organisms arising in the community have been susceptible to multiple antibiotics, increasingly resistant strains are being found. This is most evident in the case of community acquired methicillin-resistant S. aureus (CA-MRSA) infections, which are on the rise in Australia, and may be associated with severe skin infections or necrotising pneumonia. In Australian hospitals resistance continues to evolve in S. aureus and enterococci. Hospital acquired S. aureus are often MRSA, and are usually multiply resistant to other antibiotics. In addition, hospital MRSA has now demonstrated low level resistance to vancomycin (called hVISA and VISA), a key antibiotic for treatment of these infections. Vancomycin resistance in enterococci, especially E. faecium, is increasingly reported, and has significant impact on the outcome of immunocompromised patients. These changes in epidemiology of resistance has major implications for the empiric and directed therapy of patients infected with these strains, and requires a detailed understanding of the role of new agents such as daptomycin, linezolid and tigecycline.

conference handbook

Friday abstracts 1430–1500, PLENARY ROOM 3

Advances in the treatment of hepatitis C virus infection Joe Torresi1 1 Department of Infectious Diseases, Austin Centre for Infection Research, Austin Hospital, University of Melbourne, VIC

HCV is estimated to chronically infect 3% of the worlds’ population and is associated with the development of liver cirrhosis, hepatic failure and hepatocellular carcinoma. Six major genotypes of HCV have now been described although the most common genotypes in Australia, Europe and the United States are 1a, 1b followed by genotypes 2 and 3. The current standard of care consists of using a combination of pegylated interferon-D and ribavirin (PEG-IFN/RBV) or 24 to 48 weeks. Overall, treatment achieves a sustained virological response (SVR) in 40%–50% of patients with genotype 1 infection and up to 85% for genotype 2 and 3 infections. Significant improvements in treatment outcomes with PEG-IFN/RBV have now been made by individualising treatment durations according to viral kinetics and antiviral responses at key time points through the treatment course. For patients achieving a negative HCV RCR at week 4 of treatment (rapid virological response, RVR), the SVR may be as high as 80% for genotype 1 and 95% for genotypes 2 and 3. A large number of ‘Direct Acting Antiviral’ (DAA) agents for HCV have recently been developed and are now under evaluation in clinical trials. These molecules include nucleoside and non-nucleoside inhibitors of the viral NS5B polymerase, NS3 viral protease inhibitors and NS4A, NS5A and Cyclophyllin inhibitors. Although demonstrating potent antiviral activity both in vitro and in vivo, the rapid emergence of resistance to DAAs has necessitated the use of these agents in clinical trials in combination with PEG-IFN/RBV. Combination DAA/PEG-IFN/RBV therapy has resulted in significantly higher SVRs in patients infected with HCV genotype 1 when compared with PEG-IFN/RBV alone. To date only two NS3 protease inhibitors have progressed to phase III clinical trials—Telaprevir and Boceprevir. Telaprevir is synergistic with PEG-IFN/RBV and when used in combination the rate of telaprevir resistance is reduced. In two phase II trials the combination of telaprevir with PEG-IFN/RBV resulted in an SVR of 69% compared with 36% with PEG-IFN/RBV alone. In Phase II studies, Boceprevir in combination with PEG-IFN/RBV resulted in a significant improvement in the SVR rate from 38% in the standard therapy arms to 75% in the boceprevir/PEG-IFN/RBV arm. Studies of the combination of a protease and polymerase inhibitors together with PEG-IFN/RBV in a phase 1 trial (INFORM-1) have also commenced and shown potent antiviral activity in vivo. It is now possible to achieve high cure rates with PEG-IFN/RBV. Combination antiviral therapy has already become the standard of care for patients with chronic hepatitis C however, with the advent of DAAs and various immunotherapeutic approaches it should soon become possible to achieve a cure in almost all patients infected with HCV.

Invited speaker session S2—Life goes on 1330–1400, MEETING ROOM 219

Expanding roles, the future of ‘Hospital in the Home’—the Alfred experience Andrew Fuller1 1 Hospital in the Home Program, The Alfred Hospital, VIC

Background: ‘Hospital in the Home’ at The Alfred started in 1995. Initially the program was for antibiotics for cystic fibrosis patients and osteomyelitis, and the Royal District Nursing Service visited patients at home. Over the years at The Alfred we have built up our nurse bank, we have our own cars and we now visit patients up to forty kilometres away. Other than antibiotics the service has taken complicated dressings, burns, drain tube management, clexane/warfarin crossover, chemotherapy and even physiotherapy at home. Without these services the patient would otherwise need to be in hospital: which is the definition of ‘Hospital in the Home’. Discussion: Patients have become more complicated. They include transplant patients, HIV patients, cystic fibrosis, orthopaedic, burns, general medical and surgical patients. Patients are now sent home much earlier than they were in the past. With the reduction in total hospital beds and increased bed pressures, ‘Hospital in the Home’ has steadily increased. The wide range of medications now used at home ranging from dobutamine, frusemide, methylprednisolone to virtually every IV antibiotic, from ambisome and caspofungin through to tigecycline and even intravenous penicillin for neurosyphilis. The commonest infections are staph aureus, where cephazolin 2 grams twice a day is used and MRSA where Vancomycin is used, Pseudomonas is the next most common pathogen usually treated with cefepime together with oral ciprofloxacin. With the development of resistant organisms new antibiotics such as ertapenem, teicoplanin and daptomycin have been used. Baxter infusions and gemstar pumps are used for drugs that require more than two doses a day. In the future there is no doubt that number will increase, complexities of patients and treatment will increase and that new therapies such as chemotherapy will occur at home. Safety and patient preferences are overriding factors and need to be addressed so that home treatment remains a safe and effective option.

staying alive 2010

Friday abstracts 1400â&#x20AC;&#x201C;1430, MEETING ROOM 219

Pharmacogenomics demystified RA McKinnon1, WB Ward, MJ Sorich 1 University of South Australia, SA

The central principle of the personalised medicine approach is use diagnostic technologies to stratify populations in order to optimise drug based treatments. Personalise medicine approaches, incorporating pharmacogenomics, are widely touted as a major advance in therapeutics. While drug therapy has always been cognisant of individual patient characteristics, recent technological innovation has greatly increased our capacity to interrogate the biological characteristics of individual patients. These strategies utilise a complex array of testing approaches including DNA, RNA and protein based technologies and have yielded many potential markers (biomarkers) that have the potential to improve drug treatments. To date, the clinical uptake of personalised medicine has been sluggish due to a complex set of factors including clinical, economic and regulatory issues. Attention to these factors has recently become much more focused and as a result, a general consensus is emerging on facilitated pathways of adoption. Personalised medicine advances are most notable in the area of oncology where the need for more rational treatment strategies is paramount. A number of biomarkers have emerged as useful in optimising drug treatments and the development of many more is continuing. Combined with the introduction of targeted therapies, drug based cancer treatment is currently undergoing an unprecedented transformation. This presentation will provide a general overview of the area of personalised medicine and pharmacogenomics, focusing on strategies to ensure clinical uptake.

1430â&#x20AC;&#x201C;1500, MEETING ROOM 219

Medication management during transition from hospital to residential care Rohan A Elliott1,2 1 Pharmacy Department, Austin Health, VIC, 2Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, VIC Correspondence: rohan.elliott@austin.org.au

Almost 10% of hospital inpatients aged 65 years and over are discharged to a residential care facility (RCF), and medication-related problems frequently arise during this handover of care. In an Australia-wide survey of RCF staff it was reported that issues with medications occur for around two thirds of patients transferred from hospital. A recent study of discharges from four Victorian hospitals (the MedGap project) found that medication administration errors occurred in around 20% of patients in the first 24 hours after discharge. Problems maintaining continuity of medication management may result from:

x x x

suboptimal communication between hospital and community health care providers; absence of an up-to-date medication administration chart at the RCF for use immediately after patient transfer; and medication supply and packaging issues.

These problems lead to disruptions in continuity of care and, sometimes, adverse outcomes including suboptimal symptom control and unplanned hospital readmissions. They also result in inefficient use of the health care workforce, and create unnecessary pressure and stress for all health care workers involved in the handover of care. Recent Australian studies have highlighted strategies that can be used to improve continuity of care, including provision of an interim residential care medication administration chart and use of a pharmacist transition coordinator. This presentation will include case studies that illustrate medication management problems that occur when patients are discharged to a RCF, and discuss the reasons why these problems occur. Strategies that pharmacists and other hospital staff can use to improve continuity of care will be described.

conference handbook

Friday abstracts Invited speaker session S3—Painful situations 1330–1400, MEETING ROOM 220

Multidisciplinary pain clinic Arti Thakerar1 1 Pharmacy Department, Peter MacCallum Cancer Centre, VIC Correspondence: arti.thakerar@petermac.org

Complex pain often involves a variety of factors including physiological, pathological, emotional, psychological, cognitive, environmental, social and physical causes. This type of pain can differs from pain associated with acute injury which can often be self limiting. It has been established that persistent or prolonged pain managed at a pain clinic involving a multidisciplinary team improves patient outcomes. The aims of this presentation are:

x x

to highlight the vital role of pharmacists within a multidisciplinary pain clinic to review actual and potential barriers encountered in establishing this role.

A variety of complex case studies will be presented, highlighting specialist pharmacy involvement within a multidisciplinary pain team. These will also demonstrate:

x x x

the role of the pharmacist in identifying patients with complex pain the use of off-licence medications by the pain and palliative care team recommendations made by a pharmacist on safety, dosing, drug interactions and counselling.

Pharmacy involvement within multidisciplinary teams is an expanding area and at Peter Mac the pharmacist is an integral part of the pain team. With the pharmacist’s ability to use appropriate resources along with specialised knowledge of medications, a multidisciplinary clinic is the ideal environment for a pharmacist to provide advice to both health care professional and patients and also ensure medication safety and adherence.

1400–1430, MEETING ROOM 220

The role of the pharmacist in palliative care Sandy Scholes1 1 Calvary Health Care Bethlehem, VIC

The pharmacist is involved with the palliative care patient in the practice areas of community and hospital pharmacy. The community pharmacist can provide the following services to the palliative care patient: prescription dispensing, written information, counselling, compounding, timely access to medications, disposal of medications, patient and family support. Clinical pharmacy services in hospitals are well established, with the palliative care pharmacist involved in the following activities x obtaining a drug history x developing a medication action plan x counselling and provision of written information x liaison with the patient’s health care professionals on discharge x attending palliative care rounds and team meetings x policy and protocol development. Community palliative care services facilitate the patient’s choice to die at home. In 2009, Victorian statistics indicate that there were 13000 admissions to a community palliative care service, with the average age at referral being 74, and average length of stay 100 days. Sixty per cent of referrals to the services came from hospitals. Palliative care patients have been identified as one group of patients at high risk of medications misadventure. However, they are also one of the groups of patients least likely to receive a Home Medicine Review (HMR). Changes to the HMR service under the Fifth Community Pharmacy Agreement of a direct referral model and access to HMR for patients soon after hospital discharge are expected. These changes present opportunities for the accredited pharmacist in palliative care. Up skilling of community and accredited pharmacists in palliative care will need to be addressed to improve the management of patients wishing to die at home. The expanding role of the pharmacist in palliative care will be discussed.

staying alive 2010

Friday abstracts 1430–1500, MEETING ROOM 220

Pain management in the emergency department Simone Taylor1 1 Pharmacy Department, Austin Hospital, VIC

According to national and international studies, pain is the major complaint in about three-quarters of emergency department (ED) presentations. Despite this, there is extensive literature that indicates that pain is poorly managed in the ED setting. There are a number of challenges to optimal pain management that are unique to the ED environment:

x x x x

frequently, pain needs to be treated before you have a diagnosis often you don’t know what medications a patient regularly takes, including whether they are opioid tolerant legal issues sometimes preclude the optimal analgesic being used the diversity of patient presentations and rapidity of patient turn-over.

There is a range of ways in which a pharmacist can positively impact upon acute pain management in the ED. Many patients benefit from simple pain management techniques and simply need pain to be included on the problem-list. Pharmacists practising in the ED environment need to have a working knowledge of techniques such as nerve blocks, procedural sedation and analgesia and unique delivery approaches such as intranasal fentanyl and inhaled methoxyflurane. It is also important for pharmacists to be aware of the role of non-drug modalities such as splinting, positioning for comfort or oxygen over pharmacological approaches. Given that one pharmacist cannot be involved in the care of all patients presenting to the ED, they can play key roles in developing quality guidelines and policies related to pain management. ED pharmacists have played key roles in the National Institutes of Clinical Studies Pain Management Initiative and developing nurse initiated analgesia policies and competency assessments. These roles will be discussed.

Invited speaker session S4—Broadening the profession 1330–1345, MEETING ROOM 212

Measurement of prednisolone-induced hyperglycaemia using continuous glucose monitoring Greg Roberts1 1 Pharmacy Department, Repatriation General Hospital, SA Correspondence: greg.roberts2@health.sa.gov.au

Aim: Patients experiencing acute exacerbations of chronic obstructive airways disease (COPD) receive large doses of prednisolone as the mainstay of treatment. Prednisolone is well known for its ability to cause hyperglycaemia, which has been strongly associated with poor outcomes in this patient group. Our aim was to determine the precise pattern of prednisolone-induced hyperglycaemia in order to develop a blood glucose management approach. Method: Patients experiencing acute exacerbations of COPD and receiving high-dose prednisolone were monitored for up to 3 days using continuous glucose monitoring (CGMS). Control patients consisted of patients with COPD admitted to hospital for reasons other than an exacerbation in their COPD and not receiving prednisolone. Results: There were 40 non-diabetic patients with exacerbations of COPD (77±14 yrs, 72±17 kg, prednisolone = 30±6 mg/day), 7 diabetic patients with exacerbations of COPD (84±9 yrs, 87±23 kg, prednisolone = 26±9 mg/day), and 9 control group patients (75±11 yrs, 65±13 kg, no prednisolone).

conference handbook

Friday abstracts 14

Diabetic, prednisolone Non-diabetic, prednisolone

glucose (mmol/L)

Controls, no prednisolone

4 1

9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Time of day The impact of prednisolone in non-diabetic patients was delayed, commencing 4–5 hours after dose administration, with significant increase in glucose only seen during the afternoon and evening. The affect lasted less than 24 hours, with glucose levels gradually declining overnight, returning to normal by the morning. A similar pattern was observed in the diabetic group receiving prednisolone, but as expected, the hyperglycaemia was more marked. 50% of non-diabetic patients receiving prednisolone recorded a blood glucose >11.1mmol/L compared to 11% of controls (p=0.03). Conclusion: The onset of prednisolone-induced hyperglycaemia was delayed and lasted approximately 12–14 hours in non-diabetic patients, with marked post-prandial effects seen at the midday and evening meals after an 0800 prednisolone dose. Strategies targeting blood glucose control in this group need to be targeted at the second half of the day, and at the midday and evening meals.

1345–1400, MEETING ROOM 212

Inhaled tobramycin as a treatment for hospitalised patients with CF Natalie Soulsby1 1 Royal Adelaide Hospital, SA

Aim: The aim of the study was to determine the feasibility as to whether tobramycin given via inhalation was as effective at treating exacerbations of lung infections in patients with CF as treatment with IV tobramycin. It was hoped that this pilot study would provide data to allow for a sample size to be calculated in order for a larger more definitive study to take place. Method: Ethics approval was received from both the Royal Adelaide and Women’s and Children’s Hospitals. All patients over the age of 6 were eligible for inclusion. Patients identified as being chronically infected with Pseudomonas aeruginosa were approached in clinic and consent obtained. On the first admission patients were randomised to receive either IV or inhaled tobramycin as well as their usual second antibiotic. Treatment was the same irrespective of the route of administration of their tobramycin i.e. blood samples were taken for TDM and complete blood examination, sputum was taken for culture and sensitivities and for colony forming unit counts. Information on weight, spirometry, audiology, urine for b2 microglobulin was also collected. Patients were also given a quality of life questionnaire to complete on day 1 and last day of admission. On their second admission they received the other form of tobramycin. Information was compared for differences between admissions with FEV1 being the primary outcome measure. Results: In the 12 months of this pilot study 24 patients were recruited but only 7 patients completed both arms.

staying alive 2010

Friday abstracts Intravenous tobramycin Patient

Day 1

Last day of *tx

% Change

1 2 3 4 5 6 7

92 26 37 54 77 37 74

112 29 30 58 77 44 74

+22 +11.5 –20 +7 0 +19 0

Inhaled tobramycin † Clinic 84 31 38 60 DNA 50 69

Day 1

Last day of *tx

% Change

Clinic

89 26 31 63 82 36 48

108 27 50 61 87.5 49 57

+21 +4 +61 –3 +7 +36 +19

80 Re-admit 39 68 77 37 N/A

* tx = treatment † clinic = their 6 week post treatment clinic appointment

Conclusion: Due to the small numbers recruited it is difficult to draw any formal conclusions from this pilot study. In the 7 patients who completed the study no-one required an admission earlier than usual due to treatment failure. In most cases FEV1% predicted increased regardless of treatment received. Successful treatment was achieved irrespective of the sensitivities of the Pseudomonas strains that were cultured. It is possible that for some patients inhaled tobramycin may be a therapeutic option for treating exacerbations.

1400–1415, MEETING ROOM 212

Improving the transition of highly complex patients into the community: impact of a pharmacists in an allogenic stem cell transplant outpatients clinic Ruth Chieng1, J Coutsouvelis,1,2, S Poole,1,2, A Wei3 1 Pharmacy Department, Alfred Health, VIC, 2Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, VIC, 3Malignant Haematology and Stem Cell Transplant Service, Alfred Health, VIC

Aims: To evaluate the benefit of a specialist clinical pharmacy service in the stem cell transplant (SCT) outpatient clinic in assisting the safe and effective transition of these patients from the inpatient to ambulatory setting. The objective of the project is to determine the impact of the clinical pharmacist on patient adherence and medication-related problems. Methods: Allogeneic SCT patients discharged from the acute ward and presenting for review in the outpatient clinic received a weekly 20 minute consultation with the clinical pharmacist. During each visit, a medication reconciliation interview, dosette box assessment and Morisky score questionnaire was performed to identify any drug related problems and evaluate patient adherence. Drug related problems were recorded as interventions under categories as defined by SHPA standards and ‘risk’ assessment of these interventions were determined using the ‘risk matrix’ from the SHPA Standards of Practice for Clinical Pharmacy. Results: At the time of presentation we aim to have recruited a total of 20 patients. From this pool approximately 15 patients would have completed the study and are eligible for analysis. Data presented will be demographic information, details of interventions performed by the clinical pharmacist and quantitative effect on the adherence of these patients based on Morisky score. A sample of interventions performed will also have a risk rating assigned to them. Conclusions: The presence of the clinical pharmacist in the outpatient SCT clinic will impact on prescribing, medication safety and patient adherence. By assigning a risk rating to the interventions recording we can determine the importance of the clinical pharmacy service in this setting.

conference handbook

Friday abstracts 1415–1500, MEETING ROOM 212

Fighting the dragon with luck Angelo Pricolo1 1 Tambassis Pharmacy, VIC

Some of my friends have told me over the years that getting a pharmacy degree limited their job prospects and creative opportunities and flare. I’ve heard the same said about engineering, law and economics. Truth is, I think opportunities are created and most tertiary qualifications should give you the chance to develop as a person and break new ground. That’s not to say there is a job out there that has all the tedious stuff eliminated and you just turn up and do the good stuff. I think there is a mundane aspect to the most glamorous occupations. Trick is to outweigh the tedious with the exciting. When I first dispensed methadone it was not a fun experience. In fact I hated it. But I wanted the part time job for various reasons so there was no choice. Many years later I seemed to have acquired a real taste for it, not the drink but the patients and the program. With that came a desire to improve my program and so I circulated a crude first attempt at research in the way of a survey. The results, or should I say the individual accounts made me eager to learn more and respond to the information I had gathered. I wanted to tell people what I read and heard from patients and film appealed to me as a perfect format. Two major obstacles surfaced. No one seemed to share my passion and I was not a filmmaker. Many years of frustration followed until my project finally became a reality, the culmination of work and life experience came together and a producer was born. When I rang the manufacturer 2 years ago to order 20 000 copies of the DVD they thought it was a prank call and hung up on me. I hope to have the same experience with the next project …

Invited speaker session S5—1970s to now—changes in technician training and roles 1330–1350, MEETING ROOM 213

Education: 70s and now Paul Gysslink1 1 Box Hill Institute of TAFE, VIC

Students of history might say the 1970s were a time of great social change in Australia. The Vietnam War ended in 1971, the public became aware of aboriginal land rights and the Women’s Electoral Lobby was formed to promote feminist issues. When we examine the changes in pharmacy practice since the 1970s and observe the evolving and expanding roles of hospital pharmacy technicians, we also become aware of the developments in the education of technicians. From working in the basement of a hospital with no windows or natural light, to working in a pharmacy department located near the entrance of the hospital and gaining public prominence. From handling medicines for preparing imprest orders for the wards to assisting the pharmacists dispense prescriptions and helping pharmacists on the wards, are some examples of the change in the role of technicians. With changing roles that give more responsibility to technicians, comes the need for more rigorous and formal education and training of technicians. This presentation will explore the role development and focus on the changes in the educational needs and requirements of hospital pharmacy technicians. The important role which technology has played in this role expansion of technicians, as well as assisting technicians undertake their education will be discussed. Australian society started to come of age in the 1970s. At the same time, pharmacy technicians experienced a coming of age in the hospitals of Australia.

staying alive 2010

Friday abstracts 1350–1410, MEETING ROOM 213

Rural ward technician Rodney Adams1 1 Pharmacy Department, North West Regional Hospital, TAS

In 2005 the Society of Hospital Pharmacists of Australia published the revised SHPA Standards of Practice for Clinical Pharmacy, which included recommended roles for clinical support technicians. Funding for a ward-based technician in a rural/regional hospital enabled pharmacy management to implement a technician facilitated individual patient medication delivery system. The system was evaluated to determine i) the impact on the safety of medication supply and administration; and ii) any cost efficiencies generated through reduced wastage of medicines. The implementation of the system and the technician service resulted in a substantial reduction in the incidence of missed medication doses, improved ability to monitor medication discrepancies and significant cost savings. The personal rewards for a ward based technician are many; the technician plays an integral role with all staff in the care of the patient during their stay, and interacts directly with the patients during their hospitalisation.

1410–1430, MEETING ROOM 213

Introduction of an emergency department technician Paula Caird1 1 Fremantle Hospital and Health Service, WA

The role of an emergency department (ED) technician is constantly changing, developing and evolving. Following the initiation of the SQuIRe Medication Reconciliation Project at Fremantle Hospital in 2007, it was decided that an ED technician was needed to assist pharmacists in the medication reconciliation process by collecting medication histories from the patient and requesting the patient’s medication information from the GP and community pharmacy for confirmation purposes. While studies have demonstrated the positive effect pharmacists have had on the medication reconciliation process, the costs and time involved can be problematic. Given their familiarity with medications, pharmacy technicians offer a reasonable solution. There have been published reports describing the use of pharmacy technicians to obtain medication histories in the emergency and pre-admission clinic settings. A pilot study in June 2006 provided supportive evidence that the position was warranted. This position was funded by the Medicines Management Reference Group (MMRG). Initially there were many challenges that we had to overcome. Interview procedures, reading medical notes and interaction with other staff members such as doctors and nurses were all new to the technician’s normal role, therefore appropriate training and support was provided. The role of the ED technician has changed over the ensuing years due to the changing structure of our Emergency Department and the increased availability of pharmacists to cover this area. In this presentation, I will discuss the initial project that highlighted the need for a technician to take medication histories and the daily duties/role of the technician; addressing how we have developed this role to fit the changing needs of the emergency and pharmacy departments and how this role will hopefully evolve in the future.

conference handbook

Friday abstracts 1430-1450, MEETING ROOM 213

Developing technician roles through the expansion of clinical trials pharmacy services Jane Evans1 1 Pharmacy Department—Clinical Trials, The Alfred Hospital, VIC

The Clinical Trial (CT) Pharmacy Services at Alfred Health is a centralised service provided from a purpose built facility and managed by a dedicated Clinical Trial Pharmacy team. Currently, there are over 240 active trials with pharmacy involvement ranging from Phase 1 (first in man studies) to Phase 4 (post marketing studies). In the past, the CT services were run by pharmacists with little to no involvement of technicians. Over time, the number of trials as well as the complexity in study design has increased. It was identified that it was imperative to create a full time technician role to not only cover non-clinical activities to free up pharmacists but to also assist in service design and improvement. Initially, the role included drug accountability tasks such as dispensing and stock receipt, temperature monitoring, basic account management in the raising of invoices and administrative tasks such as filing and reception duties. Opportunity for expansion of the role became apparent as the level of pharmacy involvement especially in investigator initiated studies increased. This meant moving away from traditional technician roles and the creation of the position of Clinical Trial Administrator. This role included the opportunity to act as the distribution coordinator for a multi-site international study including design of drug accountability records, developing procedures for non-sterile manufacturing/repacking for double blinded studies and providing training for the trial coordinators to ensure their competency in following the procedures. The future holds more opportunities for role development of the Clinical Trial Administrator as demand leads to further expansion of services offered by Clinical Trials Pharmacy. This will include larger scale manufacturing capabilities due to the development of a TGA GMP compliant non-sterile manufacturing facility primarily for clinical trial use and employment of an extra technician to assist in nonclinical activities freeing up time for more project management duties.

Plenary session 2—Staying alive through implementing change 1600–1645, PLENARY ROOM 3

Staying alive through implementing change: knowledge to action Rosie Forster1 1 National Institute of Clinical Studies, National Health and Medical Research Council, VIC

Health and medical research constantly produces important new findings to improve patient care. However, despite advances in technologies, procedures and other new insights, there is often a gap between what is known from the best available evidence, and what actually happens in practice. Even the results of landmark studies can take up to 17 years to be implemented into routine care. This problem—the gap between best available evidence and patient care—is increasingly a field of research in its own right, known as ‘implementation science’ or ‘knowledge translation’. This area of research recognises that the adoption of new evidence often requires individuals, teams and systems to work in different and new ways. The dissemination of new knowledge is necessary, but not sufficient, in addressing the complex changes needed in clinical practice, behaviours and systems to improve the timely and consistent uptake of evidence. Implementing change often involves significant effort and commitment from dedicated heath care professionals, as well as time and money. Research findings from the field of knowledge translation can be used to better inform these efforts and resources. This presentation will provide frameworks and strategies from the knowledge translation research to assist hospital pharmacists to guide, develop and implement methods to improve the uptake of evidence into practice.

staying alive 2010

Friday abstracts 1645–1730, PLENARY ROOM 3

Attempting to change practice: challenges and rewards Luke Bereznicki1 1 School of Pharmacy, University of Tasmania, TAS

It is a general observation that the health care setting is often one of ‘under-use, over-use and mis-use of care’. Patients can be deprived of effective care or receive unnecessary, outdated or even harmful care despite our best efforts. One of the most consistent findings of research of health services is the gap between evidence and practice. Studies conducted overseas imply that approximately 30–40% of patients do not receive care according to scientific evidence, and approximately one-quarter of care provided is not needed or is potentially harmful. In Australia, we became aware that about 17% of hospital admissions were associated with an adverse event, of which over half were preventable, based on the findings of the Quality in Australian Health Care Study. In addition, we are aware that between 2 and 4% of all hospital admissions to Australian hospitals are medication related, with around three-quarters of these preventable. Alarmingly, reports based on Western Australian data in older Australians found that increases in hospital admissions or extended length of stay due to adverse drug reactions have continued despite programs to promote rational and safer use of medications. The importance of clinical pharmacy services was highlighted in the 2002 Second National Report on Patient Safety as a means of reducing medication incidents through patient and staff education, monitoring and medication review. Pharmacists often lead, or at are least involved in the implementation of strategies to improve the quality use of medicines in hospitals. The evidence suggests that this implementing change is often difficult, potentially involving changes to professional practice, patient care, the organisation of care processes, resources, leadership and the political environment. This presentation will provide insight into the challenges that we face in implementing research findings, as well as the rewards and benefits associated with quality improvement activities.

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ABSTRACTS—SATURDAY INVITED SPEAKER SESSIONS Invited speaker session S6—Bugs and drugs........................................................... 87 Invited speaker session S7—Life goes on ................................................................ 87 Invited speaker session S8—Painful situations ......................................................... 88 Invited speaker session S9—Broadening the profession .......................................... 89 Invited speaker session S10—1970s to now—changes in technician training and roles .................................................................................................................. 90 CONTRIBUTED PAPERS SESSIONS Contributed papers stream C6—Bugs and drugs..................................................... 92 Contributed papers stream C7—Life goes on .......................................................... 95 Contributed papers stream C8—Painful situations ................................................... 98 Contributed papers stream C9—Broadening the profession .................................. 101 Contributed papers stream C10—1970s to now—changes in technician training and roles .................................................................................................... 104 Contributed papers stream C11—Bugs and drugs................................................. 107 Contributed papers stream C12—Life goes on ...................................................... 110 Contributed papers stream C13—Painful situations ............................................... 112 Contributed papers stream C14—Broadening the profession ................................ 115 Contributed papers stream C15—1970s to now—changes in technician training and roles .................................................................................................... 118

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Saturday abstracts Invited speaker session S6—Bugs and drugs 0900–1030, PLENARY ROOM 3

Antimicrobial stewardship K Buising1, MJ Duguid2 1 St Vincent’s Hospital Melbourne and Royal Melbourne Hospital, VIC, 2Australian Commission on Safety and Quality in Health Care, NSW

Antimicrobial resistance is one of the major threats to the great advances in treatment of infectious diseases over the past 40 years. There is good evidence that the overuse and inappropriate use of antimicrobials leads to the emergence and dissemination of resistant organisms. Patients with infections due to resistant bacteria have poorer outcomes, experience delayed recovery, treatment failure and even death. Inappropriate use of antimicrobials also increases the risk of patient harm from adverse effects such as Clostridium difficile infection, and increases costs both to health care and society. Antimicrobial stewardship is a systematic approach to optimising the use of antimicrobials. Successful hospital antimicrobial stewardship (AMS) programs have been shown to improve the appropriateness of antimicrobial use, effect cost savings, and reduce institutional resistance rates and contribute to reduced patient morbidity and mortality. The Australian Commission on Safety and Quality in Health Care (ASCHC) promotes AMS as a major strategy to reduce patient harm from health care acquired infection. The ACHQC publication Antimicrobial Stewardship in Australian Hospital outlines the requirements for effective AMS programs, outlining the importance of governance and executive support, and describing the essential and complementary strategies. These requirements, along with the evidence for AMS and recommendations for establishing an AMS program for the different strategies for influencing prescribing behaviour, will be discussed. These include:

x x x x x x

the role of the AMS team restrictive formularies and approval systems review and prescriber feedback measuring performance education, guidelines resources required (microbiology, pharmacy, infectious diseases and information technology)

Guidance on establishing AMS programs will be provided along with examples of successful initiatives from small, large, city, rural and paediatric hospitals will be provided. Opportunities for pharmacists in AMS will be discussed.

Invited speaker session S7—Life goes on 0900–0945, MEETING ROOM 219

The management of chronic disease in homeless people Ian Webster1 1 The University of New South Wales, NSW

Key elements in the management of chronic disease are: self-care, involvement with the health care team, anticipatory care and the ‘chain of care’. At each level there are major obstacles to the effective management of chronic disease and disabilities in homeless people. This difficult but important task will be presented against the backdrop of the epidemiology of disease in homeless populations, with special reference to mental health and coexisting substance use problems. A new paradigm is needed to deliver health care and to meet the needs of the long-term mentally ill who are homeless.

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Saturday abstracts 0945–1030, MEETING ROOM 219

A difficult pill to swallow—understanding dysphagia Julie Cichero1 1 Deglutitionist and speech pathologist, QLD

The ability to eat a roast dinner with vegetables, indulge in a chocolate cake or enjoy a glass of water is something many of us take for granted. Following a stroke, with late onset dementia, treatment for oral cancer, and many other conditions, the ability to swallow regular foods and liquids is a luxury. Daily doses of pureed meat and vegetables and the consumption of thickened liquids becomes the mainstay for survival. Approximately 25% of all hospital admissions have a diagnosis of swallowing difficulty (dysphagia). This figure rises to 30–60% for residents in aged care. Half of all stroke patients have dysphagia. The consequences of dysphagia are sobering. At its most basic level, patients must be identified and treated to prevent dehydration and malnutrition. The most serious complication of dysphagia is death due to aspiration pneumonia. Food and liquids are not the only things that travel from mouth to stomach, cleverly bypassing the lungs. Prescription medications have become the mainstay of medical ‘treatment’. The side effects of many medications, such as dry mouth and reduced level of consciousness pose significant safety issues for patients with swallowing difficulties. In addition, approximately 18% of the healthy people simply find it difficult to swallow their daily medications. There is little awareness that as many as 83% of solid dose medications in acute care and 34% in aged care, are modified at bed-side because patients find them hard to swallow. Alterations to tablets or capsules may lead to toxicity, or a decrease in medication efficacy. Many pharmaceutical companies will not warrant their medications if they are not administered in the form prescribed. This presentation will provide a background to normal and disordered swallowing of foods, liquids and medications. It will also address the impact of dysphagia on medication administration, efficacy and patient compliance.

Invited speaker session S8—Painful situations 0900–0945, MEETING ROOM 220

Painful situations: management relating to the progression of acute to chronic pain Malcolm Hogg1 1 Royal Melbourne Hospital, VIC

No one strategy is recommended to prevent the transition from acute to chronic pain given the complexities of influencing factors (e.g. genetic, surgical, post-operative issues, psychosocial). From the available literature and current expert opinion, the recommendation would be a process of:

x x x x

identifying patients at risk optimising post-injury/operative pain management provision of sub acute pain management plan with early follow-up multidisciplinary approach to any physiological, psychological and social factors contributing to pain maintenance.

The acute care teams can contribute to pain prevention by early identification of patients at risk and implementing a multi-modal analgesic regime, utilising traditional analgesics with anti-hyperalgesic strategies. Interestingly, some authors suggest the use of Paracetamol and NSAIDS act by an anti-hyperalgesia mechanism, so are optimal when used in conjunction with opioids and local anaesthetic based techniques. More specifically, Ketamine, Calcitonin, Tricyclic and SNRI antidepressants and atypical anti-convulsants may have a role in a chronicity prevention strategy. The sparse literature regarding these techniques will be examined. The consequence of excessive reliance on opioid analgesia in the acute setting includes the development of opioid induced hyperalgesia and the potential for ongoing opioid use. Recent efforts in examining for risk factors for aberrant opioid use will be discussed. Professional issues regarding team development/contribution and ‘giving the right message’ will be introduced, although the ability to influence and measure any effects appear limited.

staying alive 2010

Saturday abstracts 0945–1030, MEETING ROOM 220

Burns pain management Joel Symons1 1 The Alfred Hospital, VIC

Introduction: Pain in burns patients presents many challenges to the clinician because these patients experience both nociceptive and neuropathic pain which may be constant (background), procedure-related or intermittent. Adequate and effective management of analgesia in this population is essential in order to prevent chronic pain and the psychological stress that may accompany poorly managed analgesia. Scope of presentation: Background analgesia is provided by a multimodal regime consisting of opioids (intravenous or oral), paracetamol and non-steroidal anti-inflammatory agents. Clonidine may be used as an opioid sparing agent and ketamine is used as both an acute an anti-neuropathic agent in the acute phase. In our institution, neuropathic pain is treated aggressively using amitriptyline, pregabalin or gabapentin. Procedural pain is often undertreated with a large percentage of burns patients reporting severe pain during the procedure. Effective analgesia is required to facilitate burns dressings changes, staple removal, physiotherapy and occupational therapy as well as to reduce anxiety during the procedure. This should be achieved without producing excessive respiratory depression. Analgesia should be administered by a practitioner who is skilled in dealing with the consequences which can occur (eg airway obstruction) after administration of these drugs. Analgesia should also cover the post procedure period. Maintaining continuity of a successful procedural analgesic plan amongst anaesthetists and nursing staff is essential. Our pain service has well established protocols for management of background, breakthrough and procedural analgesia for burns patients. These will be discussed in more detail during the presentation. The evidence for the use of analgesic agents as well as alternative methods of administration (PCA, intranasal, topical routes), will be reviewed. The use of other agents such as nitrous oxide, dexmedetomidine and regional anaesthesia will also be covered. Conclusions: Effective management of procedural pain analgesia requires a multimodal and multidisciplinary approach in order to obtain the best patient outcomes.

Invited speaker session S9—Broadening the profession 0900–1000, MEETING ROOM 212

Knowledge translation workshop: change management and implementing change Michael Frank1, Bhavini Patel2, Kevin McNamara3 1 The Royal Melbourne Hospital, Melbourne Health, VIC, 2Pharmacy Department, Royal Darwin Hospital, NT, 3Monash University, VIC and Flinders University, SA

There are large gaps between evidence (what we know works) and clinical practice (what we do) for many aspects of everyday patient care. Assisting health professionals to close such ‘evidence-practice gaps’ is a key function of The National Institute of Clinical Studies (NICS), an institute of the National Health and Medicine Research Council. This workshop will be run by three pharmacists who have benefited from training and support provided through NICS’ Translating Research Into Practice (TRIP) Fellowships program (formerly NICS Fellowships). These fellowships provide early career health professionals with the skills and support to implement effective strategies for promoting the use of evidence-based care in the health care sector. This workshop will be run by three recent pharmacist Fellow’s and will explore a number of tools available from NHMRC NICS to identify barriers to the implementation of evidence into practice, the development of evidence based strategies for overcoming these barriers, increasing the likelihood of successful changes in practice and the importance of identifying and utilising stakeholders. Using examples of implementation projects provided by delegates and the Fellowship projects of the facilitators, this session will demonstrate the benefits of a structured approach to managing organisation change.

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Saturday abstracts 1000–1030, MEETING ROOM 212

Developing a multidisciplinary collaborate team and leading them as a pharmacist Bhavini Patel1 1 Pharmacy Department, Royal Darwin Hospital, NT

Greater numbers of the Australian community are living with complex chronic conditions, which require continuing care via a variety of health care professionals. It is becoming apparent that there needs to be effective inter-professional collaboration to meet the increasingly complex patients needs that is radically different to the current model, where a number of health care professionals review the patient in series and make recommendations in isolation of each other. This often leaves the patient confused and unsatisfied and results in the waste of scare health care resources. Today’s pharmacists need to know and understand the importance, functions and roles of other health care professional groups before they can participate in a truly collaborative approach. Strong leadership is required to create a clear vision for future health care delivery models. This session will use the I’m OK project (Improving modifiable Outcomes for Kidneys) as a case study to demonstrate how pharmacists can foster new models of inter-professional collaboration and provide leadership to change systems of health care delivery to provide improved patient-focused care.

Invited speaker session S10—1970s to now—changes in technician training and roles 0900–0930, MEETING ROOM 213

Hospital pharmacy automation: will robots replace technicians? Natalie Bula1 1 Pharmacy Department, The Canberra Hospital, ACT

Technology is leading change in many areas of our lives, and medicines management is no different. IT and automated technologies are becoming sufficiently sophisticated to improve medication safety and processes and reduce medication errors and adverse events. The automation technologies available today are already being used in leading public hospitals in the US, UK and Europe to improve processes and safety. They include:

x x x

pharmacy-based systems for medication storage and distribution and sterile and non-sterile compounding ward-based systems for electronic prescribing and administration of medications non-clinical technologies such as bar-coding and radiofrequency tagging, and automatic guided vehicles.

These technologies have the ability to:

x x

reduce dispensing and imprest picking errors, expired stock, and total pharmacy and imprest stock holdings increase efficiency though faster dispensing, stock selection, medicines delivery, imprest picking, and manufacture.

So where does this leave the hospital pharmacy technician? Will they be replaced by faster, more accurate robots? The good news is that these technologies will all still require a human element, opening up new roles for technicians as robot operators and trainers, robot troubleshooters. These technologies will also enable us to reengineer our pharmacy services and redeploy technicians to more ward and patient focused activities. The role of the Australian hospital pharmacy technician will change with technological changes. There will be new challenges and opportunities as new roles, duties, and procedures emerge and require a new set of knowledge and skills. The hospital pharmacy technician will need to focus on professional development in the coming years to gain these new skills and ensure they aren’t left behind in the automation revolution.

staying alive 2010

Saturday abstracts 0930–1000, MEETING ROOM 213

Automated dispensing—the Slade experience Mary Simic1 1 Slade Pharmacy Services, VIC

The business of pharmacy, as distinct to the pharmaceutical industry, has traditionally been slow in taking up new technologies, primarily due to financial cost benefit shortfalls. Dispensing automation however, presents a new scope of opportunity for the forwardthinking, progressive and expanding business model. Slade Pharmacy’s ambition to become one of the first hospital pharmacies to automate its dispensing practice via the ConSis (manufactured by Willach) became a reality in 2008 at their Richmond site, after having already installed a smaller version at their Box Hill site, Epworth Eastern Hospital in 2005. There were multiple reasons why automated dispensing was appealing for the Slade Pharmacy business. On site it would create improved work flow, inventory management, maximise space, to streamline dispensing and create overall greater efficiency. The growing need to reduce the costs in pharmacy due to PBS margin pressure was also a driving force towards improved efficiencies. Beyond the pharmacy site, the flow on effect is significant. The discharge process within the hospital is becoming more fine-tuned to cater for an increasing number of patients, so prompt medication delivery is an important step in this process. The call for automation at the Richmond site was complex due to the mixed business practice; that is retail and hospital pharmacies operating out of the one site. The challenging environment meant that ConSis was the most suitable machine for the location. Automated dispensing provided Slade Pharmacy staff with better job satisfaction, improved efficiencies and reduced dispensing errors by up to 58%, however, ordering processes require further refinement. Overall, dispensing automation offers a better service in a highly competitive service industry, enabling pharmacy to keep up with the increasing work load as well as maximising safety to patients by reducing medication selection errors.

1000–1030, MEETING ROOM 213

Occupational exposure: cytotoxic contamination in the workplace Joan Semmler1 1 Sterile Production Centre, Princess Alexandra Hospital, QLD

Published reports from overseas and within Australia have documented cytotoxic contamination in hospital pharmacy compounding areas, despite current best practice standards. It has also been demonstrated that using closed systems for preparation of cytotoxic doses may reduce levels of measurable contamination, and therefore potentially reduce occupational exposure risks for staff associated with cytotoxic preparation and administration. Background surface contamination levels of cyclophosphamide, ifosfamide and 5-fluorouracil were assessed by analysis of wipe samples taken prior to implementation of closed system devices (PhaSeal) for preparation of all cytotoxic doses. Samples were taken from drug preparation areas in the Pharmacy Sterile Production Centre and from drug administration and storage areas in the Oncology Day Care Unit. During the same period, urine samples were collected over a 24-hour period from seven consenting pharmacy and nursing staff, and analysed for cyclophosphamide and ifosfamide. The results showed measurable levels of contamination on surfaces in both the Pharmacy Sterile Production Centre and in the Day Care Unit where chemotherapy is administered. The highest levels of contamination were found in the pharmacy SPC on the isolator work surface, followed by the isolator sump and the Cytogard sump. On the other surfaces very low levels of contamination were detected. Small amounts of cyclophosphamide and ifosfamide were detected on the seat and armrests of a treatment chair in the Day Care Unit. Cyclophosphamide was also detected in urine samples from two nurses, but none of the pharmacy staff. The results indicate that surface contamination in the Pharmacy SPC is largely confined to the inside of the cytotoxic drug safety cabinets. Contamination in this area indicates spillage during drug preparation. Contamination on the treatment chair indicates spillage during drug administration. The detection of cyclophosphamide in the urine of two nurses demonstrates that staff exposure does occur. All practicable measures should be taken to prevent spillage and the consequent spread of contamination. PhaSeal devices were used exclusively to prepare cytotoxic drugs for a period of six months following initial sample collection. At the end of the trial period surface wipe samples and urine sample collection were repeated, and the samples are currently being tested to compare results.

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Saturday abstracts Contributed papers stream C6—Bugs and drugs 1100–1115, PLENARY ROOM 3

Antimicrobial pilot study in an intensive care unit: the impact on antimicrobial use by an antimicrobial stewardship team Stav Mantas1, Alexander Padiglione1, Bunmi Adebayo2 1 Southern Health—Monash Medical Centre, VIC, 2Southern Health—Dandenong Hospital, VIC Correspondence: stav.mantas@southernhealth.org.au

Aim: To describe the interventions initiated by an antimicrobial stewardship team in an intensive care unit (ICU) and to examine their effect on the average monthly use of high cost or high risk of resistance antimicrobials. Method: Over a four-week period, the prescribing of antimicrobials in the ICU was overseen by an antimicrobial stewardship team that included a pharmacist and an infectious diseases physician with experience in the ICU setting. Education sessions focusing on appropriate antibiotic use and on improved diagnosis of infection in the ICU setting were presented. Changes to therapy were made in consultation with ICU medical officers. A pre- and post-intervention stock take of selected antimicrobials was undertaken to compare the use of specific agents during the audit period to pre audit data. All interventions made by the stewardship team were recorded. Results: A total of 60% of antimicrobial orders required intervention (89 orders for antimicrobials reviewed, 54 interventions made). The use and cost of the selected antimicrobials was lower during the intervention period despite escalation in antimicrobial therapy being the most common intervention made by the antimicrobial stewardship team. Meropenem use decreased by approximately 80% and vancomycin by 40%, whilst use of narrow spectrum agents increased (ampicillin by 80%, gentamicin by 34%). This indicates that the presence of an antimicrobial stewardship team encourages a more targeted approach to antimicrobial therapy. Conclusion: The antimicrobial stewardship team demonstrated a reduction in broad spectrum antimicrobial use, despite escalation in antimicrobial therapy being the most common intervention. Funding a formal stewardship program within the organisation offers the opportunity to provide more directed therapy and could achieve considerable financial savings.

1115–1130, PLENARY ROOM 3

The role of formative evaluation in successful implementation of an antibiotic decisionsupport system at a teaching hospital Syed Tabish Razi Zaidi1, Jennifer L Marriott2, Roger L Nation2 1 Box Hill Hospital, VIC, 2Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, VIC Correspondence: tabish.zaidi@easternhealth.org.au

Aims: To identify potential barriers surrounding the implementation of an antibiotic decision-support system (DSS) and to evaluate the impact of addressing such barriers using a formative evaluation design. Methods: Semi-structured interviews were conducted with 18 junior doctors, 12 consultants and 12 pharmacists. Thematic analyses were performed on the transcripts of the interviews to identify potential barriers surrounding the implementation of DSS at the study hospital and were conveyed to the developers. Usage of the system was studied pre and post formative evaluation. Results: Various issues were identified and can be categorised into three categories: implementation strategy, knowledge base and information technology related issues. Lack of adequate advertisement, lack of one-on-one training and lack of local champions from various clinical disciplines were identified as barriers related to the implementation strategy. Most of the users were unaware of the knowledge base of the studied system and were worried that it is not comprehensive enough to include all clinical indications. Information technology related issues were mainly based on the numbers of computer terminals and login difficulties. A number of recommendations were made to address the advertisement strategy, education and training, review of knowledge base, presentations at the various clinical forums and improving technical support. The revised version of the system along with the enhanced strategy was then introduced. The average use of the antibiotic DSS was subsequently raised to 215% compared to pre-formative evaluation levels. Conclusion: Implementation of commercial DSS without any genuine discussions with clinicians in teaching hospitals is not an uncommon phenomenon. The present study provides a successful alternative, in the form of formative evaluation, to the development and implementation of antibiotic DSS at a teaching hospital.

staying alive 2010

Saturday abstracts 1130–1145, PLENARY ROOM 3

Is azithromycin maintenance in cystic fibrosis patients associated with antibiotic resistance? Rachael Worthington1, Ulrike Schmidt1, Peter Van Asperen1, David Andresen1 1 The Children’s Hospital at Westmead, NSW Correspondence: rachaelw@chw.edu.au

Background/introduction: Azithromycin (AZM) therapy has been shown to improve lung function in patients with cystic fibrosis (CF). Two potential drawbacks are the development of antibiotic resistance in existing bacterial airway flora, and pressure for subsequent colonisation with Methicillin resistant Staphylococcus aureus (MRSA). Objectives: We investigated whether prolonged azithromycin use in CF patients changed the incidence of Methicillin-sensitive and resistant Staphylococcus aureus isolation. In addition, we studied the emergence of macrolide resistance in airway isolates of S. aureus as well as pulmonary function decline in paediatric CF patients on azithromycin therapy. Methods: Clinical data on paediatric CF patients treated with azithromycin were obtained from medical records, the CF data registry and iPharmacy between January 2003 and December 2008. The oral AZM dose was based on body weight (250 mg <40kg or 500 mg >40 kg) and administered 3 times a week for at least 6 months. Sputum samples were regularly collected. Clinical outcomes, principally FEV1 and BMI, as well as-vitro susceptibility data were examined, and compared to each patient’s pre-azithromycin period. Main Results: 52 CF patients were treated with azithromycin for a median of 1.4 years (range 0.7–3.5 years). Exposure to AZM resulted in significantly reduced susceptibility to erythromycin in airway S. aureus isolates (p=0.043) but sensitivity to clindamycin did not change significantly (p=0.633). FEV1 improved with a mean increase in FEV1 at 3 months was 6.2% and at 12 months 6.8% predicted (p=0.059 and p=0.023). The BMI and weight increased significantly for the first 9 months of treatment (p=0.01). There was no difference in hospitalisation rates or hospital bed days. Conclusion: Prolonged treatment with azithromycin in CF patients does not significantly alter S. aureus or MRSA isolation but increases macrolide resistance in S. aureus isolates. Azithromycin therapy improves nutrition and lung-function for up to 9 months.

1145–1200, PLENARY ROOM 3

Molybdenum cofactor deficiency—the special story of Baby Z Connie Yin1, Ian Larmour1, Hui Kong1, Sandra Lee1, Robert Ponsford1 1 Southern Health, VIC Correspondence: pochy148@hotmail.com

Objective: To report on the medical breakthrough that saved a baby with molybdenum cofactor deficiency (MCD). Clinical features and early interventions: Baby Z, born prematurely at 37 weeks gestation, developed intermittent tonic-clonic seizures and cycling movement at 60 hours of age. Magnetic resonance imaging showed severe global hypoxic ischaemic injury and a cranial ultrasound showed cerebral atrophy and choroid plexus cysts. A metabolic workup revealed elevated levels of xanthine, sulphite and its toxic metabolite s-sulphocysteine in the urine. MCD was suspected and later confirmed by genetic testing. Treatment: MCD is a rare autosomal recessive disorder that leads to the deficiency of molybdenum dependent enzymes, including sulphite oxidase. Neurological damage is severe and rapidly progressive because of sulphite accumulation in the cerebrum. Only a handful of cases have been reported in the literature and all have resulted in death in the neonatal period. An experimental treatment, cyclic pyranopterin monophosphate (cPMP), was found in Germany which had only been tested in mice. cPMP, which is a precursor to molybdenum cofactor, was fortunately approved for use by the hospital’s bioethics panel and the Family Court of Australia. Treatment commenced at 80mcg per kg intravenously daily with baseline and ongoing tests. cPMP was prepared daily in the pharmacy department with the assistance of the researching biochemist. The preparation process involved thawing the drug, adjusting the pH and sterilising the solution before use. Case progress and outcomes: Within hours of the first dose, urine levels of s-sulphocysteine decreased. Other biomarkers also improved with time and Baby Z was feeding better and improving neurologically. After two months of therapy in hospital, Baby Z was discharged home with the plan to continue cPMP lifelong. Conclusion: Baby Z is now the first person to survive MCD. While cPMP is still unregistered, it has been used to save a number of newly diagnosed babies worldwide under emergency access schemes.

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Saturday abstracts 1200–1215, PLENARY ROOM 3

The penetration of topically administered 0.5% caspofungin eye drops into human aqueous humour David Kong1,2, Chin Fen Neoh1,2, Lok Leung3, Anant Misra4, Rasik Vajpayee4,5, Geoffrey Davies6, Robert Fullinfaw7, Kay Stewart1 1 Department of Pharmacy Practice, Centre for Medicine Use and Safety, Monash University, VIC, 2Facility for Anti-infective Drug Development and Innovation, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, VIC, 3Department of Pharmacy, Royal Victorian Eye and Ear Hospital, VIC, 4Corneal and Cataract Surgery Unit, Royal Victorian Eye and Ear Hospital, VIC, 5Centre for Eye Research Australia, University of Melbourne, VIC, 6Health Systems Program Office, Land Systems Division, Defence Materiel Organisation, VIC, 7Special Chemistry, Melbourne Health Pathology, The Royal Melbourne Hospital, VIC Correspondence: david.kong@monash.edu

Aim: To investigate the ocular penetration of 0.5% caspofungin eye drops into human aqueous humour. Methods: Caspofungin 0.5% eye drops were aseptically prepared by reconstituting a 50 mg vial of caspofungin (Cancidas™) as per manufacturer’s instruction. Ten participants attending elective anterior segment eye surgery were consented into the study. Participants received 0.5% caspofungin eye drops either one drop hourly for four hours (Arm 1) or a single drop one hour before surgery (Arm 2). Participants were monitored for side effects after each administration. Aqueous humour samples were collected during surgery, stored at -80ºC and analysed using a validated liquid chromatography/mass spectrometry method. Results: The mean caspofungin concentration in the aqueous humour of participants for Arm 1 was 56.3 ± 25.9 ng/mL and the mean sampling time was 1.15 ± 0.38 hour. For Arm 2 participants, the mean caspofungin concentration in aqueous humour was 32.1 ± 1.67 ng/mL, with a mean sampling time of 1.33 ± 0.45 hour. Negligible side effects were reported. Conclusions: This study has shown for the first time that 0.5% caspofungin eye drops are well tolerated and caspofungin is able to penetrate into human aqueous humour after topical administration, thus, it has potential as an alternative antifungal eye drop.

1215–1230, PLENARY ROOM 3

Controversial choices: a snapshot of treatment variability in cellulitis patients Jessica Hagan1, Katherine Callaghan1, Tim Garrett1, Amanda Mari1 1 Central Coast Health Service, NSW

Objective: To profile the inpatient management of cellulitis and identify relationships between patient risk factors, antibiotic appropriateness and therapeutic outcomes. Method: A total of 49 consecutive patients presenting to a large metropolitan health service with a diagnosis of cellulitis were prospectively reviewed for a number of variables including duration of stay, antibiotic regimen, response to treatment and risk factors for cellulitis. A structured audit tool was used to determine time to disease non-progression. Pathology results, clinical notes and discharge summaries were reviewed by a clinical pharmacist to assess the appropriateness of prescribed antibiotic regimens as per the Australian therapeutic guidelines and/or microbiologist advice. Results: A total of 18 different antibiotic regimens were used, the most common of which included IV flucloxacillin (22%), IV cephazolin (18%) and combined IV flucloxacillin with IV benzylpenicillin (14%). Only 57% of patients were deemed to be on appropriate antibiotics, however all therapeutic combinations proved to have eventual efficacy. Trends towards an increased duration of stay and decreasing appropriateness of antibiotics were observed for patients with one or more predisposing co-morbidities and for those on long term corticosteroid therapy. After improvement on IV antibiotics, 90% of patients received oral antibiotics either as inpatients or at discharge, while 8% of patients were discharged with IV antibiotics through the Acute Post-Acute Care program and the remaining 2% were transferred to private health care facilities. Conclusion: Cellulitis is a common cause of hospitalisation with reliable evidence-based treatment guidelines, however therapeutic management is highly variable. Levels of impractical antibiotic prescribing are significant, providing considerable opportunity for pharmacists to make cost-effective interventions, provide prescriber education, improve the quality use of medicines and potentially decrease the average duration of stay for this diagnostic-related group.

staying alive 2010

Saturday abstracts Contributed papers stream C7—Life goes on 1100–1115, MEETING ROOM 219

Basal-bolus insulin verses sliding scale insulin for inpatient glycaemic management—a clinical practice-based assessment Greg Roberts1, Norma Aguilar-Loza1, Morton Burt1, Steve Stranks1 1 Repatriation General Hospital, SA Correspondence: greg.roberts2@health.sa.gov.au

Aim: Compare the efficacy of a basal-bolus insulin (BBI) approach against traditional sliding scale insulin (SSI) for glycaemic control of hospitalised patients. Methods: Four times daily blood glucose levels (BGL) were prospectively collected for up to 8 days, along with patient demographics, for BBI data (n=126) and compared to retrospective SSI data (n=102) in a before-and-after observational format. Results: Admission BGLs were similar for both groups (BBI 11.3+4.1mmol/L, SSI 10.9+4.5mmol/L, p=0.48). By Day 2 the mean daily BGL for BBI was lowered by 1.7mmol/L, compared to 0.2mmol/L for SSI (p<0.0001) and remained significantly lower for BBI each day thereafter (p<0.05 for all) apart from day 6 (p=0.096). The superiority of BBI over SSI remained intact for separate analyses of patients who were insulin-naïve prior to the study, insulin users prior to the study, patients undergoing surgical procedures, and medical patients. Rates of hypoglycaemia (<4mmol/L) were elevated in the BBI group (3.4% verses 1.7%, p<0.05), but not for more severe hypoglycaemia (<3.0mmol/L) (0.6% verses 0.6%, p=0.8). The incidence of hyperglycaemia (>10mmol/L) for BBI decreased from 54.7% at admission to 41.3%% by day 2 (p<0.001) and remained at 36.4% to 41.1% for the remainder of the study. SSI reduced hyperglycaemia from 52.9% to 52.4% on day 2 (p=NS) and ranged from 45.3% to 47.7% thereafter. Conclusion: Under routine, clinical, non-study conditions, BBI offered an improvement in mean daily BGLs compared to SSI, a decrease in the incidence of hyperglycaemia, offset against a small increase in hypoglycaemic episodes in the 3–4mmol/L range. BBI was effective and sustainable in the clinical setting across a wide range of patients, superior to the use of SSI, and the improved glycaemic control is expected to translate to improved patient outcomes.

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The incidence of dosing administration errors with basal-bolus insulin compared to sliding scale insulin in a hospital setting Gauri Godbole1, Greg Roberts2, Stefan Kowalski1 1 University of South Australia, SA, 2Repatriation General Hospital, SA Correspondence: Gauri.Godbole@health.sa.gov.au

Background: Insulin is consistently among the top five medications associated with administration errors in the hospital setting. Among the subcutaneous insulin administration methods, sliding scale insulin (SSI) therapy is known to be largely ineffective in controlling blood glucose levels, and guidelines now advocate the use of basal bolus insulin (BBI) therapy. Despite this, SSI is still used extensively in hospitals worldwide. There is little published literature evaluating issues surrounding the administration accuracy using a BBI approach compared to SSI. Aims: To assess the frequency of omitted, high or low doses in patients undergoing management with SSI versus BBI regimens in a tertiary teaching hospital. Methods: Data was collected prospectively for the BBI arm and retrospectively for the SSI arm in hospitalised patients requiring glycaemic management. Records were assessed for the incidence of omitted doses (not signed for by nursing staff and no indication in the case-notes that the dose needed to be held or the patient was fasting), and for high or low doses. Results: For the SSI regimen (n=25), 41 out of 251 doses (16.3%) were missed and for BBI, 12 out of 467 doses (2.6%) were missed (p<0.001). The incidence of low doses for SSI and BBI was 8.7% and 8.8% respectively (p=0.96), while the incidence of high doses was 2.3% and 0% respectively (p=0.004). Only one omitted dose incident for SSI and two incidents for BBI were formally reported. For either group, when a dose was omitted or a low dose administered, the following blood glucose level was significantly higher. Conclusion: BBI management resulted in more accurate dosing administration, which in turn is more likely to result in better inpatient glycaemic control.

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Saturday abstracts 1130–1145, MEETING ROOM 219

Factors influencing chronic medication management in ambulatory care: case controlled study of 449 patients on chronic warfarin therapy Michael Dooley1,2, Basia Diug3, Judy Lowthian3, Sue Evans3, Ellen Maxwell4, Alison Street5, Peter Cameron3, John McNeil3 1 Alfred Health, VIC, 2Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, VIC, 3Department of Epidemiology and Preventive Medicine, Monash University, VIC, 4Melbourne Pathology, VIC, 5Haemothrombosis Unit, Alfred Health, VIC Correspondence: m.dooley@alfred.org.au

Aim: Warfarin, as the mainstay of prophylaxis against stroke in atrial fibrillation (AF) and valve replacement, has a low safety margin, requiring an effective system of care to underpin its use. Therefore, the purpose of this study was to examine risk factors that contribute to elevated International Normalised Ratio (INRs). Methods: A case control study comprised of cases with an elevated INR ( 6.0) and controls with an INR persistently within their therapeutic range. Patients were recruited from a large metropolitan pathology provider and interviewed at either a recruitment centre or at their home by a trained researcher. Results: A total of 449 patients, 149 cases (mean age 75.4 yrs, range 25–96), 300 controls (mean age 75.5 yrs, range 36–92). Mean duration of treatment was 7.3 (0.5–30) and 6.8 (0.6–30) years in cases and controls respectively with AF the most common indication (44.8%). Mild cognitive impairment was present in 78.5% cases and 56.7% controls and 42.3% cases and 19% controls showed possible signs of depression. Self-reported social isolation was found in 30.2% cases and 14.7% controls, whilst inadequate health literacy was observed in 67.1% cases and 40% controls. Respective unadjusted odds ratios for the above four factors (95% confidence intervals) were 2.79 (1.77–4.39); 3.12 (2.02–4.82); 2.52 (1.57–4.04) and 3.17 (2.09–4.81), all with p-values <0.00001. Conclusion: This study demonstrated that impaired cognitive function, depression, reported social isolation and low health literacy are strongly related to the likelihood of warfarin instability. This underlying characteristics need to be taken into account in patients receiving complex chronic medication therapy.

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Medication regimen adherence risk assessment in an elderly inpatient population Gail Price1, Rohan Elliott2,3 1 Box Hill Hospital, Eastern Health, VIC, 2Austin Health, VIC, 3Department of Pharmacy Practice, Monash University, VIC Correspondence: gail.price@easternhealth.org.au

Aim: To validate an adherence ability assessment, the ‘Medication Administration Test’ (MAT), in an inpatient population and assess the feasibility of inclusion into routine clinical pharmacy practice. Method: The quantitative instrument was used on participants intending to return to an independent living environment. The results were compared to a well validated standard, a measure of current practice and a range of attributes routinely associated with ability to manage medications. Results: Of 29 participants, 14 (48%) were considered ‘adherent’ using the MAT instrumental measure compared to 22 (88%) using current practice. Age was negatively correlated with the MAT score (rho = -0.50, p = 0.006), and positively correlated with ‘Mini Mental State Examination’ (MMSE) (rho = 0.45, p = 0.02) and discharge ‘Functional Independence Measure’ (FIM) score (rho = 0.39, p = 0.04). Two groups were identified from the MAT score—‘adherent’ and ‘non-adherent’—using two different cut-off values. The lower of the two cut-off scores demonstrated significant differences between the two groups in the attributes age (p = 0.04), MMSE (p = 0.01) and ‘Instrumental Activities of Daily Living’ (IADL) (p = 0.03). Participants responded positively to the test. The mean time taken to complete the test was 7 minutes. Conclusion: The MAT appears to be a valid instrument for assessing the ability to manage medication in an inpatient population. The test was not considered feasible for routine clinical use and it was well accepted by participants. Use in selected patients could provide the pharmacist with information to provide an individualised discharge medication plan.

staying alive 2010

Saturday abstracts 1200–1215, MEETING ROOM 219

The snap before the fall Richard Grygiel1, Ilana Gory1, Bianca Levkovich1 1 Alfred Health, VIC Correspondence: r.grygiel@alfred.org.au

Aim: To present a case involving a non-traumatic fracture of the femur, possibly secondary to alendronate treatment. Clinical details: A 75-year-old female presented to hospital with a non-traumatic fracture of her proximal femoral diaphysis on a background of six-year alendronate usage for osteoporosis. The fracture occurred as she was placing her foot up a small step. She heard a ‘snap’ and her leg gave way. She was unable to weight bear and required an ambulance to transport her to hospital. Over the preceding month the patient had been experiencing increased hip pain described as a ‘dull ache’, which had not resolved with ibuprofen, as prescribed by her general practitioner. Her medication on admission included alendronate 70mg weekly. During her admission calcium 600mg daily and cholecalciferol 1000 units daily were commenced. This patient had many differential diagnoses including cancer, hyperthyroidism, coeliac disease, osteoporosis, parathyroid dysfunction and antiphospholipid syndrome; all were excluded as causative to the fracture. During admission the patient underwent surgery for placement of an intramedullary rod, before transfer to a rehabilitation ward. Discussion: Alendronate was approved by the TGA in 1997; due to its long half life (over 10 years) side effects associated with long term usage are now emerging. Long term usage of bisphosphonates have been implicated as a risk for the development of fragility fractures due to the over-suppression of bone turn-over. The use of a ‘drug holiday’ has been considered as an option to avoid this risk.

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Development of an assessment tool for falls risk related to medications amongst older inpatients Claire Jones1, Anita Abarno1, Jenny Casanova1, Chris Alderman1,2 1 Repatriation General Hospital, SA, 2Quality Use of Medicine and Pharmacy Research Centre, University of South Australia, SA Correspondence: claire.jones@health.sa.gov.au

Background: Assessment tools have previously been developed for use in evaluation of falls risk, but few specifically assess the risk of falls associated with medications, and no specific instrument has been developed for use in a geriatric population. Aim: To develop a medication-related falls risk assessment tool for clinical pharmacists that supports rationalisation of patients’ medications and provides documentation that can be communicated to the multidisciplinary team. To analyse information gained from the initial application of the tool in a geriatric inpatient population. Methods: The assessment tool was developed with input from a team of senior clinical pharmacists, based on medication classes that have been previously identified in literature as contributing to the risk of falling. The instrument also highlighted other relevant medication-related issues, such as prophylaxis for osteoporosis, and oral anticoagulation. The assessment required clinical pharmacists to assign a level of risk for falls due to medications, and to highlight recommendations for follow-up. The tool was then used by clinical pharmacists to review a cohort of patients that had been identified or referred for being at risk of falls. Results: 139 patients (average age 83 years) were assessed by clinical pharmacists: 5.8% had no medication-related risk factors for falls, 20.9% had one risk factor, 24.5% had two risk factors, 21.6% had three risk factors, and 27.3% had four or more medicationrelated risk factors. The pharmacist-estimated overall falls risk scores were found to be positively correlated with the number of medication-related risk factors. Conclusion: This falls risk assessment tool specifically addressed medications issues in a geriatric population. The overall risk for falls was positively correlated with the number of medication-related risk factors, highlighting the value of pharmacist participation in the falls risk assessment process.

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Saturday abstracts Contributed papers stream C8—Painful situations 1100–1115, MEETING ROOM 220

Pain and oxycodone use in frail older patients in hospital Alexandra Bennett1, Kirsten Tsang1, Andrew McLachlan1,2 1 Faculty of Pharmacy, The University of Sydney, NSW, 2Centre for Research and Education on Ageing, Concord Hospital Correspondence: sasha.bennett@sydney.edu.au

Aim: To compare oxycodone usage and pain control between frail and non-frail older hospitalised patients. Methods: This prospective observational study recruited hospitalised patients aged > 70 years, prescribed regular oxycodone for nonmalignant pain and able to give consent. Pain was evaluated using the modified Brief Pain Inventory. Frailty was assessed using the Reported Edmonton Frailty Scale. Demographic and clinical data were obtained from medical records. Results: 57 patients were recruited. Average age was 84 years (range 74–95), 65% were female and 56% were classified frail. No differences in age, sex and disease burden were seen between frail and non-frail groups although frail patients were prescribed more inpatient medications, p<0.01. There was a high incidence of adverse effects attributable to oxycodone (67% of total cohort) and no association with frailty. All but 3 patients reported pain in the previous 24 hours. Mean pain scores were 4.2/10 for ‘average pain’, 7.8/10 for ‘worst pain in the previous 24 hours’ and 2.1/10 for ‘least pain in previous 24 hours’. The frail reported higher ‘average’ pain, ‘current’ pain and ‘least pain in previous 24 hours’. The effect of pain on a patient’s ‘ability to concentrate’ was greater in the frail, p=0.025 with ‘relating to other people’ also affected, p=0.06. Patients took approximately half the quantity of prescribed daily oxycodone (regular and ‘prn’). Although there was a tendency for prescribed doses to be less in frail subjects (p=0.09), there was no significant difference in the actual amount of daily oxycodone (p=0.56). A greater proportion of frail subjects (38% vs 16%, p=0.07) took ‘prn’ oxycodone. Fewer frail patients were prescribed inpatient paracetamol (84% vs 100%, p=0.06). Conclusions: Despite treatment, many older hospitalised patients experienced significant levels of pain. Frail patients reported greater pain intensity at rest and may be undertreated. Further study is warranted.

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TAP catheters—introduction of a novel post-operative analgesia technique and its medication safety implications Julie Murnane1, Sylvia Cuell1 1 Barwon Health, VIC

Correspondence: jmurna@barwonhealth.org.au

Aim: To ensure the safe administration of ropivacaine into the transversus abdominis plane (TAP) following major abdominal surgery. Methods: Intermittent injection of local anaesthetic into the transversus abdominis plane via indwelling catheters is a novel postoperative analgesia technique used as an alternative to overcome issues inherent with epidural administration and to reduce opioid consumption. This administration route poses significant medication toxicity concerns given the potential for ropivacaine 0.2% boluses to be inadvertently administered intravenously rather than via the abdominal catheters. Pharmacists and Acute Pain Service (APS) clinicians liaised closely to implement medication safety procedures to minimise this risk. Results: Strategies employed to ensure safe administration of ropivacaine via TAP catheters included:

development of a TAP catheter education package and its ongoing delivery to nursing and medical staff in Intensive Care and two specialised surgical wards by the APS liaison nurse and pharmacist

x x x

requirement for nursing staff to undergo competency assessment prior to caring for patients with TAP catheters

x x x

individual ropivacaine polyamps and outer box are labelled with precautionary bright yellow ‘Do Not Inject Intravenously’ stickers

restricting admittance of patients with TAP catheters to wards educated in their use providing supply of 20mL ropivacaine (Naropin®) 0.2% polyamps only when patients with TAP catheters are admitted to the ward. Stock is secured in the patient’s bedside medication drawer. Storage in ward imprest cupboards is not permitted additional supply of polyamps is available in the pharmacy ‘After-Hours’ cupboard redesign of regional anaesthetic charts to accommodate safe prescribing of ropivacaine via TAP catheters.

Conclusion: Negotiation, intervention and education by pharmacists has assisted in the safe introduction of this novel anaesthetic technique on specialised surgical wards. Ongoing efforts are under way to identify a unique TAP catheter connector to further lessen the risk of inadvertent intravenous administration.

staying alive 2010

Saturday abstracts 1130–1145, MEETING ROOM 220

‘The K factor’—understanding the dose conversion ratio between subcutaneous and oral ketamine Claire McCormack1 1 Gosford Hospital, Northern Sydney Central Coast Health, NSW Correspondence: cmccormack@nsccahs.health.nsw.gov.au

Objective: To describe a complex pain case requiring careful dose consideration to convert a ketamine continuous subcutaneous infusion (CSCI) to oral dosing. Clinical features: A 38-year-old female was admitted with acute-on-chronic spinal and suprapubic pain secondary to trauma. Over a period of weeks, titration of oral and injectable pain agents occurred, with greatest relief achieved through a combination of oral opioids, neuroleptics and a 10mg/mL CSCI of ketamine running at 2.5mL/hr (600mg/day). Interventions and discussion: In preparation for transfer to a rehabilitation unit, Pharmacy was asked to advise on the conversion of the CSCI to an oral dose. Ketamine has interesting pharmacodynamic properties which can make this conversion difficult. The bioavailability of ketamine is 15%. When given orally, it undergoes extensive first-pass metabolism to norketamine. Despite being only a third as potent an anaesthetic as ketamine, norketamine is an equipotent analgesic. Long-term ketamine use leads to higher levels of norketamine due to enhanced metabolism and hepatic enzyme induction. These higher levels of norketamine in chronic use are thought to be responsible for the analgesic effects. This may explain why, when switching from CSCI to oral after weeks to months, an equianalgesic oral dose may be as little as 25–50% previous parenteral dose, yet when switching from CSCI to oral after just a few days, a conversion of 1:1 is advised. Case progress: An oral dose of 50mg tds was initiated (25% previous CSCI dose). This was gradually increased and the patient was discharged to the rehabilitation unit with pain controlled on 100mg qid orally (66% previous CSCI dose). Conclusion: Dose recommendations vary when changing from subcutaneous to oral ketamine. Despite being poorly bioavailable, the oral dose is often less than the CSCI dose due to pharmacodynamic peculiarities related to secondary metabolites and duration of previous exposure to CSCI ketamine.

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Ketamine lozenges: too much of a good thing? Penelope Tuffin1, Barry Jenkins1 1 Royal Perth Hospital, WA

Correspondence: Penelope.Tuffin@health.wa.gov.au

Aim: To describe the history of ketamine oral dosage form development in WA and the challenges faced in managing a high cost, unregistered, controlled drug. Discussion: As the most potent NMDA receptor antagonist available, ketamine has potential for use as an adjuvant analgesic in acute and chronic pain conditions. Ketamine was first used in the early nineties in WA for neuropathic pain when published case reports highlighted the success in using sub-anaesthetic doses of IV ketamine. These patients were usually palliative or had extreme pain unresponsive to opioids. Parenteral ketamine became accepted practice in the subsequent years for inpatients delivered under the care of an Acute Pain or Palliative Care Service. Development of an oral solution, then a soft gelatine lozenge for oral or sublingual administration enabled the preparation to be utilised in the outpatient setting. Stability studies indicated the lozenge was stable for at least 14 weeks, and pharmacokinetic studies demonstrated a sublingual and oral bioavailability of 24%. A new formulation, and outsourcing to a local manufacturing facility led to a dramatic increase in supply and demand over a 10-year period. A significant proportion of this prescribing has been for outpatients attending the Pain Centres of the 2 tertiary hospitals. In 2010 production was capped to alleviate production capacity constraints, and a high cost drug evaluation was recommended to the State’s therapeutic advisory and drug evaluation groups. Conclusion: Over a 10-year period the story of ketamine lozenge development in WA provides some salient reminders about good governance. From local innovation and manufacturing expertise to production constraints, inappropriate prescription and alleged diversion. The balance between best–practice pain management and community safety must be considered and inform practice.

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Saturday abstracts 1200–1215, MEETING ROOM 220

Better than a poke in the eye with an antipsychotic Sally Taylor1 1 Princess Alexandra Hospital, QLD

Correspondence: sally_m_taylor@health.qld.gov.au

Background: Acanthamoeba keratitis is an uncommon infection, though its frequency has increased in line with increased use of contact lenses. The condition can lead to corneal ulceration, blindness and severe pain. Peribulbar injection of chlorpromazine has been used previously for eye pain, with a reported efficacy of over 80% at one year. Objective: To report on a case of severe eye pain treated with peribulbar injection of chlorpromazine. Clinical features: A 30-year-old Caucasian female was admitted with severe left eye pain. One year prior to admission, the patient had presented with Acanthamoeba infection, causing severe keratitis and corneal scarring requiring corneal transplant. Left eye pain had not resolved and had worsened since this time. Progress and outcome: Severe pain continued despite the use of therapeutic doses of morphine (>300mg PO daily), tramadol, amitriptyline, gabapentin, ibuprofen, prednisolone and diazepam. The patient received a peribulbar injection of triamcinolone with little improvement. A second corneal transplant was performed but severe pain persisted. Consideration was given to enucleation of the eye or immunosuppressant therapy, with no guarantee of pain relief. The patient was given a peribulbar injection of chlorpromazine. Significant, rapid improvement was noted by the patient, with less parenteral morphine required. A second injection of chlorpromazine, this time retrobulbar, was administered with a further significant reduction in pain relief. The patient was discharged on a significantly reduced analgesic regimen. No further consideration was being given to enucleation or immunosuppressant therapy at 12 weeks post chlorpromazine injection. Conclusion: Acanthaemoeba keratitis infection can have devastating outcomes, including severe pain. History suggests use of chlorpromazine administered by peribulbar injection may be efficacious in relief of eye pain. This case demonstrates a significant effect of chlorpromazine in decreasing severe eye pain, which may otherwise have resulted in enucleation of the eye.

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Inpatient management of transdermal fentanyl and buprenorphine patches Ka-Yee Chen1, Joy Mason1 1 Calvary Health Care Bethlehem, VIC

Correspondence: kayeec@bethlehem.org.au

Background: A review of medication incident reports found many incidences involving the use of either fentanyl or buprenorphine transdermal patches. Patches either were found to be missing from the patient’s body, or multiple patches were found on patients. Although the date on which patches were applied to patients were documented on the medication chart, there was a lack of evidence as to whether the medication was being correctly administered on the days between ‘change days’. Method: A new policy was introduced which stipulated that fentanyl or buprenorphine transdermal patches were to be physically sighted by nursing staff at least once during each shift, and the check was to be documented on the medication chart. Compliance to this new policy improved after the introduction of a Schedule 8 Transdermal Drug prescribing sticker. Conclusion: The consequences of poorly administered transdermal patches may be significant, with patients at risk of being over or under dosed. Often changes to medications are made on the assumption that current medications are being administered correctly. Evidence of this occurring with transdermal fentanyl or buprenorphine patches is often difficult to find. The introduction of a Schedule 8 Transdermal Drug prescribing sticker has significantly reduced the number of incident reports related to the use of transdermal fentanyl or buprenorphine patches.

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Saturday abstracts Contributed papers stream C9—Broadening the profession 1100–1115, MEETING ROOM 212

Comparison of one versus two blood samples for determination of tobramycin AUC in cystic fibrosis Michael Barras1,2, Hana Alraman1, Carl Kirkpatrick2, Margaret Harris1,3, Carolyn Dakin1,3, Katrina Jess1, Ross Norris1 1 Mater Health Services, QLD, 2School of Pharmacy, University of Queensland, QLD, 3School of Medicine, University of Queensland, QLD Correspondence: michael.barras@bigpond.com

Background: The therapeutic range for tobramycin in cystic fibrosis (CF) is an AUC between 70–100 mg l hr-1. Currently, 2 blood concentrations are required to estimate the AUC, which is costly, painful to the child and often difficult to coordinate. A model-based Bayesian predictive program (TCIWorks®) is available which requires evaluation in the clinical setting. Aim: To evaluate the accuracy of an AUC estimated using one blood concentration as compared with an AUC based on two concentrations using TCIWorks®. Methods: Data were collected from CF patients admitted to X Hospital on once daily IV tobramycin. Each patient had 2 blood samples taken according to usual clinical practice, on 2 separate occasions during admission. Dosing data, tobramycin concentrations and patient demographics from the first occasion were entered into TCIWorks® to establish an individual patient pharmacokinetic model. Using this model, data from the second occasion were used to estimate an AUC from 1 concentration (AUC1) and from 2 concentrations (AUC2). Two patient groups were analysed. Group 1 comprised 14 children where accurate sampling and administration times were obtained. Group 2 included a different group of 16 children where the sampling and dosing times were obtained from patient charts. Results: Key results are shown below. In group 1, AUC1 correlates highly with AUC2 (P<0.001), with minimal bias. Despite data being less accurate in the total population, the correlation is still high (P<0.001). Population (N) Gp 1 (14) Total (30)

Median weight (range), kg 28.5 (14–57) 30 (14–74)

Gender 7m,7f 14m,16f

Median age (range), yr 11.5 (3–17) 11 (2–17)

Correlation AUC1vs. AUC2 R2 =0.94 R2=0.84

Bias 1.00 –0.72

Bias (95%CI) –4.91 to 6.91 –10.1 to 8.7

Conclusion: TCIWorks® required only 1 blood sample to calculate an AUC, once an individual patient model was established. A prospective study is required to confirm this finding.

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Successful carboplatin desensitisation and subsequent full dose rechallenge Jim Siderov1 1 Austin Health, VIC

Correspondence: jim.siderov@austin.org.au

Objective: To describe a patient receiving multiple recurrent treatments with carboplatin undergoing a hypersensitivity reaction (HSR), rechallenged with a desensitisation protocol, and subsequently recommence on full dose carboplatin without incident. Clinical features: PP, a 57-year-old female with recurrent oligodendroglioma, was commenced on second line therapy with single agent three-weekly intravenous carboplatin infusions over 60 minutes. After 8 cycles of therapy, scans showed gradual improvement with a reduction in tumour mass and improved behaviour patterns. Therapy was to continue. Within minutes of commencement of cycle 12 PP experienced a HSR which included sudden onset rash and hypotension. The infusion was immediately stopped and the patient recovered. PP remained on her usual medications, which included low dose dexamethasone. Interventions, progress and outcome: PP remained behaviourally well and was planned to continue therapy for at least a total of 12 months. A carboplatin desensitisation protocol was commenced. The 6-hour protocol involved the infusion of 4 carboplatin solutions, each progressively more concentrated. Each infusion was administered over 90 minutes. Premedication included an antihistamine. Each infusion was administered as an inpatient. After 4 cycles on the desensitisation protocol, PP was recommenced on full dose carboplatin over 60 minutes. Premedications remained. Therapy was administered as an outpatient. Five further cycles of carboplatin were administered without incident. Conclusion: Patients with HSR to carboplatin can be successfully treated with a desensitisation protocol. Furthermore, we described the first published case were a patient who successfully completes such a program can return to a normal carboplatin dosing schedule without incident.

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Current dosing of low-molecular-weight heparins does not reflect licensed product labels—an international survey Michael Barras1,2, Carl Kirkpatrick1,2, Bruce Green1,2 1 Mater Health Services, QLD, 2School of Pharmacy, University of Queensland, QLD Correspondence: michael.barras@bigpond.com

Background: Low-molecular-weight heparins (LMWHs) are used world-wide to treat thromboembolic diseases; however there is much debate on how to effectively prescribe for patients that have renal impairment and/or obesity. These populations were generally excluded during drug development studies and little post-marketing data exists. Many clinicians recognise the risk of bleeding and introduce arbitrary dose adjustments. We are not aware of any studies that have examined the diversity of dose-individualisation strategies. Aim: To investigate the strategies used to dose-individualise LMWH therapy in four countries. Methods: An online survey of selected hospitals in Australia, New Zealand (NZ), United Kingdom (UK) and the United States (US). The outcomes measured included: the percentage of hospitals who recommend adherence to the Product Label (PL); the percentage of hospitals that dose LMWHs outside the PL based on renal function, body weight and anti-Xa activity. We then investigated specific methods used to dose-individualise therapy, in particular for subjects with renal impairment and obesity who are at a high risk of bleeding events to LMWHs. Results: A total of 257 surveys were suitable for analysis: 84 (33%) from Australia, 79 (31%) from the UK, 73 (28%) from the US and 21 (8%) from NZ. Dosing protocols were used in 207 (81%) hospitals, of which 198 (96%) recommended doses outside the PL. Of these 198 hospitals, 175 (87%) dose-individualised based on renal function, 128 (62%) on body weight and 48 (23%) using anti-Xa activity. All three of these variables were used in 29 (14%) hospitals, 98 (47%) used two variables and 71 (34%) used only one variable. Conclusions: The survey demonstrated that 96% of surveyed hospitals contravene the PL, and preferred to dose-individualise. Common individualisation methods include dose-capping, use of lean body size descriptors to calculate renal function and the starting dose, followed by post dose anti-Xa monitoring.

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Desvenlafaxine transfer into milk and infant exposure during its use in lactating women with postnatal depression Wai Khuan Stephanie Teoh1, Kenneth Ilett2,5, Jonathon Rampono3, Rolland Kohan4, Peter Hackett5 1 Pharmacy Department, King Edward Memorial Hospital, WA, 2Pharmacology and Anaesthesiology Unit, School of Medicine and Pharmacology, University of Western Australia, WA, 3Department of Psychological Medicine, King Edward Memorial Hospital, WA, 4Department of Neonatal Paediatrics, King Edward Memorial Hospital, WA, 5 Clinical Pharmacology and Toxicology Laboratory, Path West Laboratory Medicine, WA Correspondence: Stephanie.Teoh@health.wa.gov.au

Aim: To characterise the transfer of desvenlafaxine into milk, the absolute and relative infant doses via milk, to determine the plasma concentrations in mothers and infants, and to assess any untoward effects in the breastfed infant. Method: Multiple samples of blood and milk were obtained over a dose interval at steady-state from ten women who were taking desvenlafaxine. Desvenlafaxine concentrations were determined using high-performance liquid chromatography. Relative infant dose was estimated as the product of estimated milk production rate (0.151/kg/day) and average drug concentration in milk, normalised to body weight and expressed as a percentage of the weight adjusted maternal dose. Breastfed infants were examined clinically by a neonatologist. A blood sample was taken for drug analysis in nine infants. Results: The mean absolute infant dose via milk was 85 (95%CI, 53, 117) Pg/kg/day. The relative infant dose was 6.8(5.5–8.1)% of the weight-adjusted maternal dose. The mean milk: plasma distribution ratio was 2.24 (2.05–2.43). Mean infant exposure estimated as desvenlafaxine concentration in the infant’s plasma as per cent of that in mother’s plasma was 4.8(3.5–6.2)%. No adverse effects in the infants were detected by the mother or on the clinical examination. All infants had normal Denver developmental quotients. Conclusion: The relative infant dose via milk was similar to that for previous studies using venlafaxine at usual therapeutic doses. However, desvenlafaxine may be preferred over venlafaxine in postnatal depression as comparable therapeutic doses for postnatal depression were lower in this study. This is reflected in the absolute infant dose of desvenlafaxine of approximately 43% of that for venlafaxine and its metabolite desvenlafaxine in previous studies. Nevertheless, each decision to breast feed should be made as an individual risk: benefit analysis.

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Saturday abstracts 1200â&#x20AC;&#x201C;1215, MEETING ROOM 212

Launch success of a new mission: broadening our horizons Kerry Fitzsimons1, Cindy Tan1, Richard Donnelly1 1 Fremantle Hospital and Health Service, WA Correspondence: Kerry.Fitzsimons@health.wa.gov.au

Aim: To investigate the benefits and contributions of a preadmission clinic pharmacist (PACP) in optimising health outcomes, and in reducing medication-related utilisation for elective surgery patients. Method: Patients were randomly selected from the PAC Appointment List for a 10 week trial to obtain the core data pre and post intervention. Four core outcome measures; medication reconciliation processes, risk assessment, cost-benefit analysis and stakeholder feedback, were audited for control and active groups. Results: A complete and accurate medication history was reconciled and documented in 77% of patients seen by the PACP compared with 12% in the control group. Discharge liaison also improved from 26% to 68% in the intervention phase. Unintentional discrepancies were halved from 41% to 22% if the patient had seen the PACP. The PACP was directly involved in preventing at least 11 clinically significant incidents which prevented potential harm to the patient. A reduction in the number of medications dispensed at discharge per patient was demonstrated resulting in a 60% cost saving as a result of the PACP intervention. The intervention group also achieved a reduction in average length of stay of 4.8 days. Satisfaction surveys to doctors, PAC nurses and patients demonstrated a high level of satisfaction with the quality of medication-related information provided by the pharmacist; consensus such that the service improves medication safety for surgical patients and that it should be continued. Conclusion: A PACP service has demonstrated significant improvements in medication safety through the application of best practice standards. Cost-benefit analysis of this trial also demonstrates that this service produces a cost saving to the hospital. The trial has also afforded a review of current processes that contribute to medication-related problems for patients admitted for elective surgery such as development of guidelines for the safe management of medications in the peri-operative period.

1215â&#x20AC;&#x201C;1230, MEETING ROOM 212

Management of medications in a public nurse-led walk-in centre Miriam Lawrence1, Neil Keen1 1 The Canberra Hospital, ACT

Correspondence: Miriam.Lawrence@act.gov.au

Aim: to describe pharmacist involvement in medicines prescribing and supply functions in a walk-in centre (WiC) Methods: in 2010 the first Australian publicly funded nurse-led WiC opened to compliment local GPs over extended hours, providing single episodic treatments for minor, acute, uncomplicated ailments. Based on overseas WiC models a limited range of scheduled medicines were considered necessary for effective treatment. The pharmacy assisted in development of medication management systems to support nursing staff. This WiC model utilises advanced practice nurses with contrasting needs to nurse practitioners. Specific issues included: legislative requirements, integrating evidence based practice, policy, clinical decision support, supply processes, medicines history taking, counselling, training and competency assessment. Results: An expert multidisciplinary clinical group mapped a scope of practice (WiC treatable conditions) to evidence and potential medication access needs. Medications were considered for onsite treatment and single course treatments. A list of 26 agents was identified, including simple analgesics and routine antibiotics. Local legislation granted advanced practice nurses limited rights to prescription medicines under standing order directives. WiC nurses underwent detailed training and OSCE style competency evaluation on medicines management. Purpose designed software is used to safely exclude serious conditions. A confirmed diagnosis prompts entry to a treatment algorithm (clinical guideline) directing consideration of pharmacological treatment. Age, allergies, contraindications and other medications are considered. Where no exclusions exist, medication may be supplied in pre-labelled and packaged short courses. Medication selection decisions are detailed in consult notes and two nurses must check and record supply. Provision of counselling and written medicines information is mandatory. Systematic measurement of medicines management performance is planned. Conclusion: this novel service outlines one potential template for health reform and improved consumer access. It includes medicines management components. While nurse led it still relies heavily on pharmacy expertise for successful design, implementation and operation.

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Saturday abstracts Contributed papers stream C10—1970s to now—changes in technician training and roles 1100–1115, MEETING ROOM 213

Computerising expiry date checking process. Stage 1 Debbie Parker1, Robin Lee1, Christine Winter1 1 Southern Health, VIC

Correspondence: debbie.parker@southernhealth.org.au

Aim: To reduce the time spent conducting expiry date checking and to maintain an accurate record of stock expiry dates by stock location. To prepare for the eventual tracking of stock from the moment stock is received into pharmacy via barcode scanning. Method: A new spreadsheet was written for a notebook computer. The notebook and barcode scanner could then be taken to the wards to check for expiring stock. Once stock was scanned from the barcode you could enter:-

x x x x x x

who conducted the expiry date check the date and time that the check was done product code expiry date of product location of the product quantity that is expiring.

After stock has been entered into the notebook, checking expiry dates can be done in two ways:

by ward (What is expiring on a certain ward for the next three months)

by month (What is expiring in the hospital each month)

At the end of the month a printout is given to the relevant staff member to remove stock that is near to the expiry date. Results: Using the notebook and barcode scanning of the products enabled the time spent on expiry date checking to be halved and the data base was easier to access. It also enabled identification of other potential problems. Conclusion: Expiry date checking by scanning product details into the computer saved time and created an easy to use data base. Our next step is to further develop the data base information, including provisions for stock movements between wards.

1115–1130, MEETING ROOM 213

Medication recycling: accounting for time Heather Casey1, Carolyn Lane1, Jennifer Collins1, Belinda Lyons1 1 The Canberra Hospital, ACT Correspondence: heather.casey@act.gov.au

Introduction: The hospital currently provides medication supply services for corrections facilities within the area. The technician role involves dose administration packing, imprest, medication recycling and general administration. Initially the technician role was employed at a 0.5 full time equivalent. The technician has taken on the responsibility of tracking costs associated with recycling of medications. Evidence has demonstrated that medication recycling can reduce costs substantially. In January 2010 it was reported that the average cost of incarcerating a detainee within the facility was $180 000 per year. Therefore it was decided that recycling medications may assist in reducing medication related costs within the corrections facilities. Aim: The aim of the research was initially to determine the cost savings for the corrections facilities associated with recycling of medications and later to provide a case for increasing the technician FTE for corrections. Method: A literature review was carried out to determine which medications could be safely recycled, and a list collated. Medications returned from the facility were assessed against this list and recycled where safe. The quantities of medications recycled and the costs savings have been recorded since March 2009. Results: Since March 2009 the recycling of medications within the facility has resulted in approximately a 7.8% saving to the facility over all medication costs. Furthermore the total percentage of medications discarded from the facility is approximately 1.3% of the total amount spent on medication since March 2009 to May 2010. These savings allowed for an increase in technician FTE. Conclusion: These results demonstrate that recycling of medication within a corrections facility can result in a dramatic reduction in costs, and that Pharmacy Technicians can play a role in assisting to reduce medication related costs.

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staying alive 2010

Saturday abstracts 1130–1145, MEETING ROOM 213

Forty years of pharmacy technicians 1970–2010: staying alive Cynthia Walton1 1 Peter MacCallum Cancer Centre, VIC

Correspondence: Cynthia.Walton@petermac.org

Aim: To review and describe the increased roles and responsibilities for pharmacy technicians over the past 40 years and look at role development in relation to other pharmacy technician roles in the UK. Method: Investigate the role of the pharmacy technicians, if any, in 1970. Describe developments in roles and responsibilities over the last 40 years, and determine how these have evolved over time. Make comparisons with the UK in terms of roles and responsibilities and investigate how these developments were achieved. Ascertain if an increase in technician roles is related to changes in education and training. Results: In Australia in the 70s pharmacy technicians were better described as assistants who assisted pharmacists within the workplace with stock management activities. Today technician roles include ward technicians, project technicians, management technicians and operations managers. The actual role of these positions is very different to that of the roles of similar jobs in the UK, mainly due to governing bodies’ interpretation of legislation and guidelines. Today hospital technicians in Australia must complete (or be working towards completion of) Cert 3 in hospital pharmacy prior to being employed as a hospital pharmacy technician. A higher level of education is also available at Cert IV level. Roles of hospital pharmacy technicians are now varied with more responsibility attached to individual roles and further development of a diploma is being addressed within Australia with the formation of the New Technician Network. Work based training is compulsory in UK and is completed at the same time as attending college on a day release. Role development has been more progressive in the UK mainly due to an increase in pharmacist development and therefore more demand for a diverse pharmacy technician. Future opportunities exist in all areas of hospital pharmacy and we can look forward to an exciting future in which our job is a career choice we can be proud of.

1145–1200, MEETING ROOM 213

Managing non-imprest returns back into pharmacy Debbie Parker1, Christine Winter1, Pamela Fernando1 1 Southern Health, VIC Correspondence: debbie.parker@southernhealth.org.au

Aim: To reduce the volume of returns and broken packs from non-imprest supplies, whilst simultaneously ensuring that the medication is supplied in a timely manner. Method: Several options for supplying medications to inpatients were developed to address problems in the way medications were supplied. This included input from the nursing staff to streamline ward medication supply. Three systems were trialled.

x x x x

supplying enough medication to last patient 3–5 days (average stay 3.5 days) medications were dispensed directly to the patient to avoid medications from previous patients been left in bedside drawers a yellow dispensary label was used to identify the non-imprest stock from the imprest medications, making it easier for the nurses to return the imprest medications back to the shelves when the patient had gone home, any unused non-imprest medication was scanned back into pharmacy stock.

The following variation in service delivery were evaluated:

x x x

technician initiate and supply medication pharmacist initiate and technician supply pharmacist initiate and supply.

Results: Supplying less but more often, reduced the amount of stock to be returned to the pharmacy department, as well as reducing the amount of broken packs that were kept on the shelf. Technician initiate and supply and pharmacist initiate and supply both worked equally well. Having two people involved in the supply of medication increased the time taken to deliver medication to the ward. Conclusion: We found that by changing the method by which we supplied non-imprest medication to the wards, the medication could be supplied more quickly and also reduced the number of stock returns.

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Saturday abstracts 1200–1215, MEETING ROOM 213

From stress to success in the dispensary Belinda Lyons1, Jennifer Collins1 1 The Canberra Hospital, ACT

Correspondence: belinda.lyons@act.gov.au

Aim: To improve the workflow and efficiency of our dispensary and to streamline the dispensing of discharges within the pharmacy department. Method: Our busy dispensary processes approximately 1000 prescriptions per day, and is increasing by 10% annually. We recognised a need to change the current workflow of our dispensary to cope with the current and future demands. Each dispensary technician (up to 6) had their own dispensing terminal and processed the prescriptions from start to finish. Three floating pharmacists were designated to check. To improve work flow it was decided to divide our dispensary physically into two separate work sections:

x x

inpatient/outpatient prescriptions discharges/leave passes/Hospital in the Home prescriptions.

Each section now has one technician designated to dispense and two technicians to collect and pack the medications, these roles are continually rotated to maximise efficiency. One pharmacist is designated to each section and the third pharmacist floats between both sections. To help streamline the dispensing of discharges, a log was developed. When a discharge prescription arrives it is written in a daily log to track the progress of the discharge and document where it has been sent after completion, therefore minimising phone calls and confusion. Results: The dispensing efficiency has increased and anecdotally fewer errors are occurring. The alteration in the management of discharges and outpatient prescriptions has improved the process dramatically and has resulted in less confusion and greater pharmacist, patient and nurse satisfaction. Conclusion: Since implementing the new system it has streamlined the workflow of the dispensary, and small changes are still being made to refine the process. Overall the transition has been accepted well by staff and we believe it was a necessary step to take to decrease the stress levels in the dispensary and cope with the increasing workload.

1215–1230, MEETING ROOM 213

Horses for courses—making better use of staff resources in an outpatient dispensary Larissa Clifford1, Jennifer Bolivar1 1 Princess Alexandra Hospital, QLD

Correspondence: larissa_clifford@health.qld.gov.au

Aim: To free up more pharmacists’ time for essential clinical tasks, by transferring non-clinical tasks to pharmacy assistants. Method: A meeting was held with the dispensary manager and outpatient dispensary pharmacy assistants. All tasks that needed to be performed were listed and assessed for suitability to become a pharmacy assistant task. The following tasks were identified as being suitable for pharmacy assistant to undertake and the most time saving for the pharmacist:

x x x x

faxed orders—including Risperidone Consta phone requests for repeat supplies kept on file handing out repeat medication to clients—where there have been no changes procedures were written for these tasks. Training was conducted for the pharmacy outpatient dispensary assistants.

Using a faxed order for Risperidone Consta as an example, the time taken for the various steps was recorded:

receiving the fax, checking the dispensing history (date of last dispensing, strength, current repeat available)—any issues are highlighted

the hardcopy prescription(s) accessed from the file—if there are any patients that do not have a prescription or the dispensing is too early, the pharmacist is informed, to get clarification from clinic

x x

entering the patient details into ‘script tracker’ prepare the prescription.

Results: The average time saved by using the new risperidone consta procedure was 54 minutes per fax. An average of three faxes for Risperdone Consta are received per week therefore reallocating this task alone saves the pharmacist an average of 162 minutes of pharmacist time a week. This pharmacist time can be devoted to clinical screening and counselling. Conclusion: This project has created a more efficient outpatient dispensary and by reallocating these tasks to pharmacy assistants outpatient pharmacists have more time to devote to clinical tasks.

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staying alive 2010

Saturday abstracts Contributed papers stream C11—Bugs and drugs 1400–1415, PLENARY ROOM 3

An educational intervention to improve vancomycin dosing in critically ill patients Janice Li1, Andrew Udy2,3, Carl Kirkpatrick1, Jason Roberts2,3,4 1 School of Pharmacy, The University of Queensland, QLD, 2Burns, Trauma and Critical Care Research Centre, The University of Queensland, QLD, 3Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, QLD, 4Pharmacy Department, Royal Brisbane and Women’s Hospital, QLD Correspondence: xuanhui.li@uqconnect.edu.au

Aim: To improve the appropriateness of initial vancomycin dosing and early attainment of therapeutic trough concentrations within the first 24 hours of therapy in critically ill patients. Methods: A full-cycle drug use evaluation was conducted in a tertiary referral intensive care unit. A retrospective evaluation of eligible vancomycin orders from January 2009 to January 2010 led to an educational intervention comprising a vancomycin dosing protocol that advocated weight-based initial dosing (25–30 mg/kg). A subsequent re-audit was conducted from April 2010. Initial predicted vancomycin trough concentrations were obtained using TCIworks (www.tciworks.info). Vancomycin initial doses and trough concentrations were compared in the pre- and post-intervention groups using Chi-square tests and Mann-Whitney tests. Statistical analyses between the 2 groups were performed using PASW Statistics Gradpack 17.0. Results: A total of 103 vancomycin orders were analysed in the pre- (n=80) and post- (n=23) intervention groups. Patients in the postintervention group had significantly higher weight-based initial doses compared to the pre-intervention group (20.0 mg/kg vs 12.5mg/kg; p<0.01). This corresponded to significantly higher predicted vancomycin trough concentrations in the post-intervention group (11.3 mg/L vs 6.8 mg/L; p=0.01). Despite a significantly higher weight-based initial dose, majority of patients in the postintervention group (86%) had not achieved therapeutic trough concentrations ( 15 mg/L) within the first 24 hours of therapy. Conclusion: Development and dissemination of a vancomycin dosing protocol increased the appropriate prescribing of initial vancomycin doses and the proportion of patients that rapidly achieved therapeutic trough concentrations. However, the small proportion of patients achieving therapeutic trough concentrations within the first 24 hours of therapy may warrant more aggressive approaches to dosing vancomycin in this population.

1415–1430, PLENARY ROOM 3

Does one dose fit all? Determinants of therapeutic vancomycin concentrations in adult patients Syed Tabish Razi Zaidi1, Michelle Chia1, Ngoc Dang1 1 Box Hill Hospital ,VIC Correspondence: tabish.zaidi@easternhealth.org.au

Aims: To measure the cumulative dose and time required to reach therapeutic vancomycin concentration and to determine factors affecting therapeutic vancomycin concentration in hospitalised adults. Methods: Patients receiving vancomycin between 15 April to 15 May 2010 at a teaching hospital were followed until they reached trough vancomycin concentration of more than or equal to 10mg/L. Following variables were collected: age, gender, weight, eGFR, initial dose (mg/kg), level aims, vancomycin levels and their times and treating unit. Independent sample t-test was used to study the differences and Pearson correlations were used to study the relationship between the study variables. Linear regression model was used to determine the predictors of therapeutic vancomycin levels. Results: A total of 46 patients received vancomycin during the study period. Fifteen out of 46 patients were excluded; 5 patients had vancomycin prior to admission, 4 patients received less than 2 doses and levels were not measured in 6 patients. Eleven out of 31 eligible patients were female; no significant differences were observed in study variables based on the gender. The average time required to reach therapeutic vancomycin concentration was 61.8 hrs. Four patients were unable to reached therapeutic levels while only 6 patients were able to reach therapeutic levels within 24 hrs. After eliminating all the other study variables in a stepwise backward linear regression model, patients’ age and eGFR were found to be the best predictors of therapeutic vancomycin concentration (Adjusted R2= 0.929). No significant correlations were observed between body weight and either cumulative dose required or time to reach therapeutic vancomycin concentrations. Conclusion: The present study highlights the need of quality initiatives to improve vancomycin prescribing to achieve therapeutic vancomycin concentration earlier in the course of treatment.

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Saturday abstracts 1430–1445, PLENARY ROOM 3

Plasma and tissue concentrations of cefazolin during abdominal aortic aneurysm repair surgery—are standard doses sufficient? Jason Roberts1,2, Alexandra Douglas1, Paul Jarrett1, Melissa Lassig-Smith1, Janine Stuart1, Steven Wallis2, Gregory Medley2, Jeffrey Lipman1,2, Andrew Udy1,2 1 Royal Brisbane and Women’s Hospital, QLD, 2The University of Queensland, QLD Correspondence: j.roberts2@uq.edu.au

Aim: The aim of this study was to determine the perioperative plasma and subcutaneous tissue pharmacokinetics of cefazolin during abdominal aortic aneurysm (AAA) repair surgery. Methods: This was a prospective pharmacokinetic study in patients undergoing elective or semi-elective repair of AAA. All patients were administered 2g cefazolin within 30-minutes of procedure. Serial blood and urine samples were collected and subcutaneous tissue concentrations of cefazolin were determined using microdialysis. Results: Eight patients, (7 males and 1 female), median age of 72.5 years and weight 87.3 kg, were enrolled. Median duration of surgery was 3 h and the clamping of aorta was 0.9 h. The following are the peri-operative median (interquartile range) pharmacokinetic parameters of unbound cefazolin: plasma terminal elimination half-life 4.5 (3.4–5.2) h; terminal volume of distribution 0.21 (0.16–0.26) L/kg; observed peak unbound cefazolin plasma and tissue concentrations were 15.9 and 20.6 mg/L respectively; and trough concentrations were 8.0 and 11.9mg/L respectively. Tissue concentrations were consistently higher than plasma concentrations after 1 h post-dosing. No significant effect of clamping of the aorta on cefazolin pharmacokinetics was apparent. Conclusion: In elderly vascular patients undergoing AAA repair surgery, 2g cefazolin administered within 30-minutes of the procedure is highly likely to maintain effective unbound plasma and tissue concentrations against susceptible bacteria for the duration of the procedure.

Unbound plasma and subcutaneous tissue concentrations of cefazolin during AAA repair surgery Unbound cefazolin concentration (mg/L)

Unbound tissue concentration Unbound plasma concentration

100

150

200

Time (mins)

108

staying alive 2010

250

300

Saturday abstracts 1445–1500, PLENARY ROOM 3

Subtherapeutic trough beta-lactam levels in critically ill patients are associated with high creatinine clearance Julie Varghese1, Brett McWhinney2, Jacobus Ungerer2, Jeffrey Lipman1,3, Jason Roberts1,3,4 1 Burns, Trauma and Critical Care Research Centre, The University of Queensland, QLD, 2Chemical Pathology, Pathology Queensland, QLD, 3Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, QLD, 4Pharmacy Department, Royal Brisbane and Women’s Hospital, QLD Correspondence: j.varghese1@uq.edu.au

Aim: To determine if high creatinine clearance is associated with subtherapeutic trough plasma concentrations of beta-lactam antibiotics in critically ill patients Methods: Therapeutic drug monitoring was performed for piperacillin-tazobactam, meropenem, ceftriaxone, cephazolin, flucloxacillin, dicloxacillin and benzylpenicillin in critically ill patients in our intensive care unit (ICU). Trough plasma concentrations were measured using validated HPLC assay methods. Beta-lactam levels were utilised to make dose recommendations to achieve pharmacodynamic targets based on the minimum inhibitory concentration (MIC) for the targeted microorganisms. An 8-hour creatinine clearance was also measured on the same day that plasma antibiotic levels were measured. Results: Fifty-seven patients had beta-lactam trough levels and an 8-hour creatinine clearance collected on the same day. The mean age and weight of patients was 51 years and 85 kg respectively. Median 8-hour creatinine clearance was 132ml/min (interquartile range= 70–175 ml/min) while median Cockroft-Gault estimated creatinine clearance was significantly lower at 101 ml/min (interquartile range=71–155 ml/min). Twenty-five out of the 36 patients (69%) who had subtherapeutic antibiotic levels had a creatinine clearance above 120ml/min. Only 5 out of the 21 patients (24%) who did not have subtherapeutic levels exhibited creatinine clearances greater than 120ml/min. The presence of subtherapeutic antibiotic levels when high creatinine clearances were observed (above 120ml/min) was statistically significant (p=0.001). Among the patients with creatinine clearance greater than 120ml/min, piperacillin-tazobactam was the most consistently subtherapeutic antibiotic with 83% of orders for this antibiotic requiring a dose increase. Conclusion: An 8-hour creatinine clearance can be used as a useful measure to identify patients at risk of subtherapeutic beta-lactam antibiotic dosing in critically ill patients. In such cases, a higher dose than normal may be warranted to achieve concentrations that are more likely to facilitate maximal antibiotic efficacy.

1500–1515, PLENARY ROOM 3

Pharmacokinetics of intraperitoneal gentamicin in peritoneal dialysis patients with peritonitis (GIPD Study) Julie Varghese1, Dwarakanathan Ranganathan2, Jeffrey Lipman1, Jason Roberts1,3 1 Burns, Trauma and Critical Care Research Centre, The University of Queensland, QLD, 2Department of Renal Medicine, Royal Brisbane and Women’s Hospital, QLD, 3 Pharmacy Department, Royal Brisbane and Women’s Hospital, QLD Correspondence: j.varghese1@uq.edu.au

Aim: To describe the plasma pharmacokinetics of gentamicin administered by the intraperitoneal (IP) route in peritoneal dialysis (PD) patients with peritonitis Methods: This was an observational pharmacokinetic study conducted in PD patients presenting with peritonitis that were either anuric or non-anuric. Drug dosing was based on the current International Society for Peritoneal Dialysis Peritonitis Treatment Recommendations. Gentamicin doses of 0.6mg/kg added to a single peritoneal dialysis bag once daily were administered intraperitoneally and allowed to dwell for at least 6 hours. Serial blood samples were collected for analysis. Plasma gentamicin levels were measured using a validated liquid chromatography tandem-mass spectrometry assay. Results: Plasma samples were collected during the first day of IP gentamicin therapy in 14 patients. Pharmacokinetic analysis was conducted using the non-compartmental approach. Intraperitoneally administered gentamicin displayed a median Cmax of 3.1 mg/L (2.9–3.5 mg/L) in plasma with a median Tmax of 6.5 hours (3.3–7.2 hours). Plasma half life was 27.1 hours (21.9–27.5 hours) with the gentamicin plasma concentration at 24 hours post dose of 2 mg/L (1.8–2.3 mg/L). [All values presented as median with the interquartile range quoted in brackets] Conclusion: A significant amount of gentamicin administered intraperitoneally can be absorbed into the systemic circulation with peak plasma drug concentrations achieved during the IP antibiotic dwell time. The observed long half life of gentamicin in plasma is due to decreased renal clearance of gentamicin in this group of chronic kidney disease patients with impaired renal function and this can lead to accumulation of gentamicin in the systemic circulation with prolonged dosing and potential for gentamicin toxicity.

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Saturday abstracts Contributed papers stream C12—Life goes on 1400–1415, MEETING ROOM 219

Complementary medicines and chemotherapy—do they mix? Berenice Sheridan1, Obaid Fazli1 1 Pharmacy Department, Southern Health, VIC Correspondence: sheridat@bigpond.net.au

Aims: The core objectives of this educational initiative were to evaluate the knowledge of both patients and health care professionals with respect to combining complementary medicines and chemotherapy, to create reference tools, to outline the potential interactions between complementary medicines and chemotherapeutic agents and to evaluate the effectiveness of these reference tools. Method: One hundred patients currently undergoing chemotherapy were surveyed to evaluate their current knowledge about consuming complementary medicines whilst undergoing chemotherapy. Their interest in developing an information leaflet on the topic and any complementary medicines they were currently using was also evaluated. An extensive literature review was conducted to investigate the potential interactions between commonly taken complementary medicines and chemotherapeutic agents. The information gained from this review was used to construct educational tools targeted to both health professionals and patients. These educational tools were distributed and their effectiveness was then evaluated through using a survey. Results: The initial survey of 100 patients indicated that 39% of the patients were taking complementary medicines, 16% believed that they had some knowledge of the potential interactions between complementary medicines and chemotherapy and 67% were interested in information leaflets being developed. Of the 100 surveys distributed to evaluate the effectiveness of the educational tools, 100% of the 32 patients and 20 health care professionals that responded, stated that the educational tools had improved their knowledge and that the documents were clear and easy to use. Recommendations for future improvements included translating the documents into different languages. Conclusion: Many patients currently undergoing chemotherapy take complementary medicines. Patients and health care professionals admit that they do not always have a good knowledge of the potential interactions between chemotherapeutic agents and complementary medicines. The construction of educational tools, such as those developed, has improved knowledge and changed our educational practices for both patients and health care professionals.

1415–1430, MEETING ROOM 219

Medical versus surgical showdown: who wins our time? Arna Neilson1, Ian Coombes2 1 Medication Services Queensland, QLD, 2Medicines Services Queensland, Queensland Health, and School of Pharmacy, University of Queensland, QLD

Background: Conventional pharmacist:bed ratios assume that surgical patients require less clinical pharmacist time than medical patients. Medication history and reconciliation on admission (MH&R), medication counselling, medication reconciliation on discharge, and provision of a Discharge Medication Record (DMR) are clinical pharmacy services integral to safe medication management and implementation of the Australian Pharmaceutical Advisory Council (APAC) guidelines. Aim: To investigate whether provision of APAC-related clinical pharmacy services requires less clinical pharmacist time for surgical patients than for medical patients. Method: Prospective observational audits of Emergency Department (ED) and ward pharmacist duties were conducted in 2008 (medical) and 2010 (surgical) at one large tertiary referral hospital in Queensland. Ward pharmacist cover was in keeping with conventional pharmacist:bed ratios (1:30 medical; 1:56 surgical). Details of pharmacy service provision for all patients admitted to and discharged from the wards over a seventeen day period were collated. Retrospective chart review was used to classify each patient in terms of ‘medication risk’ level. Results: Two hundred and fifty-one patients were included in the analysis (medical n=82; surgical n=169). Medical patients were older than surgical patients (p<0.001). The proportion of ‘low risk’ patients in each population was similar. Median times spent per patient delivering MH&R (medical 11 minutes; surgical 5 minutes, p<0.001), medication counselling (medical 3 minutes; surgical 2 minutes, p=0.02) and DMR (medical 5 minutes; surgical 8 minutes, p=0.01) varied significantly between the two patient populations. Time spent on medication reconciliation on discharge (medical 12 minutes; surgical 16 minutes, n/s) and the overall time spent delivering all four services (medical 42 minutes; surgical 34 minutes, n/s) were similar. Conclusion: Surgical patients often require as much clinical pharmacist time as medical patients. An ageing population will see an increasing number of patients at high risk of medication misadventure undergoing surgery. Conventional pharmacist:bed ratios may require review.

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staying alive 2010

Saturday abstracts 1430–1445, MEETING ROOM 219

Determination of medication storage temperatures in hospital in the home Louise Williams1, The-Phung To1, Simone Taylor1, Kath Bowler2, Nicola Burnett2 1 Pharmacy Department, Austin Health, VIC, 2Hospital in the Home, Austin Health, VIC Correspondence: louise.williams@austin.org.au

Aim: To determine the temperatures to which medications are exposed when used in a hospital in the home (HITH) program. Methods: Patients requiring HITH services for antibiotic therapy between January-March 2010 (summer) were invited to participate. Participants placed temperature data logger(s) with their medications. The number of loggers varied depending on the type and/or where medications were stored during the HITH program e.g., fridge, bedroom, with the infusion pump. Loggers recorded the ambient temperature every 30 minutes and remained with the medications for the duration of HITH treatment or for a maximum of 6 weeks. Participants also completed a questionnaire regarding medication storage and air-conditioning in their home. Results: Twenty-four participants completed the study. Most of the logger recordings for medications stored at ‘room temperature’ or with infusion pumps were within 17–27ºC. However, for 13 participants the temperature exceeded 30ºC (on at least 1 reading), with 4 of these participants having readings above 35ºC and one logger recording as high as 41ºC. Refrigerated temperatures ranged from -10ºC to 15ºC. Questionnaires were completed by 18 participants (response rate 75%) and showed that medications were stored in a variety of locations. Twelve of these 18 participants (67%) would ‘always’ enquire about medication storage and 17 (94%) had air-conditioning in their home. Conclusion: Temperatures to which medications are exposed in the HITH situation varied greatly. Of particular concern were the readings above 30ºC for medications or infusion pumps intended for storage at ‘room temperature’, and the -10ºC and 15ºC readings for the refrigerated items. Although participants might enquire about medication storage and many have air-conditioning in their home, the results indicate that medications can be exposed to extremes of temperature in the HITH setting.

1445–1500, MEETING ROOM 219

Identification and prevention of medication errors associated with product changes from a state-based tender Rowena Fary1, Linda Graudins1, Colin Hui1 1 Pharmacy Department, Alfred Health, VIC Correspondence: r.fary@alfred.org.au

Aim: To implement a standardised process to identify and prevent medication errors associated with product changes from a state based tender. Method: The Pharmacy Drug Availability Working Group (DAWG) evaluated products resulting from the 2010 Health Purchasing Victoria (HPV) tender and implemented strategies to reduce risk of errors. New brands were evaluated and compared against existing products, specifically evaluating differences in: concentration; volume; compatibility; reconstitution recommendations; storage conditions; expiry dates; appearance; route of administration; and risk of selection errors due to similar packaging with products already purchased by the Pharmacy. Results: Three hundred new products were evaluated from the HPV tender in April 2010. There were 15 (5%) items identified with a significant potential for medication error. Of these, four were deemed to be of high risk with three replaced by safer alternate products and one not made available. Eleven products required specific tailored alerts to be prepared and distributed with the products to nursing and pharmacy staff. The notification about similar appearance between intravenous ciprofloxacin and fluconazole pre-mix bags resulted in the manufacturer planning to change the packaging. Comments and recommendations were documented and communicated to pharmacy and ward staff according to the DAWG procedure. Conclusion: The DAWG process identified several institution specific product changes not detected by the HPV tender review process. This allowed early identification of risk, evaluation of alternative products and communication of significant product changes to ensure patient safety was not compromised.

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Saturday abstracts 1500–1515, MEETING ROOM 219

The ‘SA Health Smoke-free policy’: assessment of the demand for nicotine replacement therapy to decrease cravings and make inpatient stay more comfortable for smokers Jennifer Gordon1, Sally Marotti1 1 The Queen Elizabeth Hospital, SA

Correspondence: jennifer.gordon@health.sa.gov.au

Aims: The aims of this project were to determine the prevalence of smoking in inpatients and to assess the demand for transdermal nicotine replacement therapy (NRT) prior to the implementation of the ‘SA Health Smoke-free policy’. Secondary aims included assessing patient-centred barriers to use of transdermal NRT. Method: This project was conducted from the 8 to 14 May 2010 in a metropolitan teaching hospital in Adelaide. A questionnaire was developed and all patients admitted via the ED were eligible to be interviewed. Patients were identified prospectively and interviewed within one day of admission. Results: There were 319 patients admitted over the study period. Of these, 154 (48%) were interviewed (median age = 72.5 years; females = 51%) and 165 (52%) were missed. ED short-stay (EDSS) admissions comprised 48% of those not interviewed compared to 3% of those interviewed. Only 22 of 154 patients were current smokers (14%), 55 were ex-smokers (36%) and 73 were non-smokers (47%). The majority from each group answered ‘yes’ when asked if they were in support of the smoking ban on premises (54%, 75% and 84% respectively). Ten of the 22 smokers were experiencing cravings at the time of interview but only four expressed interest in transdermal NRT. Reasons for not wanting a patch included dissatisfaction with this formulation. Discussion: Smoking prevalence in patients admitted through the ED was lower than expected and demand for transdermal NRT was low. Alternative NRT products may be beneficial for those who had negative views of this formulation. Craving levels may fluctuate over inpatient stay and thus assessing patients within 24 hours may not reflect demand for NRT throughout the admission. A broader study assessing prevalence of smoking and NRT preferences for craving control in EDSS patients (largely missed this study) and across admission is required to further inform our understanding on the subject.

Contributed papers stream C13—Painful situations 1400–1415, MEETING ROOM 220

Oral analgesic use post caesarean section David Plevin1, Lisa Robertson1 1 Flinders Medical Centre, SA

Correspondence: david.plevin@health.sa.gov.au

Aim: To investigate the use of analgesia for pain control in women post caesarean section both in hospital and post-discharge. Methods: Patients who underwent caesarean section were identified on the postnatal ward and their National Inpatient Medication Chart was audited for analgesia orders and administration. Patients were contacted by telephone at 5 to 7 days following discharge regarding use of their oral analgesics and their pain score both pre- and post-discharge. Patients receiving chronic opioid therapy were excluded from this study. Results: In hospital, all patients (n=19) received regular paracetamol (1 g qid) and oxycodone ‘prn’ (median number of doses/day = 3, range = 0–7). Most patients (84%) were also prescribed diclofenac or ibuprofen, which were given regularly in 79% of patients. Following discharge, oxycodone ‘prn’ was taken by 84% (n=16) of patients (median number of tablets taken = 7, range = 3–20). Only 31% of these patients used both paracetamol and an NSAID regularly as background analgesia.. Pain scores following discharge were lower than inpatient pain scores. Conclusion: Patients reported less pain following discharge. For inpatients, perceived pain control was not optimum. Diclofenac was often prescribed, despite recommendations to use ibuprofen due to its PBS availability. On discharge, regular paracetamol and NSAIDs may decrease the requirement for oxycodone. It is preferable not to use oxycodone in this population because of the increased risk of adverse effects to breastfeeding infants. It is recommended that a multidisciplinary approach to improve pain post caesarean section is warranted. Education is required for both nursing and medical staff; regular documentation of pain scores is also proposed. Preparation of written prescribing guidelines for analgesia and patient information sheets for discharge will also assist in appropriate oral analgesic use.

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Saturday abstracts 1415–1430, MEETING ROOM 220

A painful problem: opioid-induced hyperalgesia in a neonate Claire Moore1, Stephanie Brumby1 1 Royal Children’s Hospital, VIC

Objective: Due to the lack of safety data, the range of analgesics and sedatives used in the neonatal population is limited. This case describes the complex pharmacotherapy, including a continuous dexmedetomidine infusion, used in the management of a neonate who developed post-operative opioid-induced hyperalgesia. Clinical features: A male infant was born at 36 weeks gestation with antenatally diagnosed gastroschisis. Primary closure occurred on Day one of life. In the following five weeks, seven laparotomies were performed for bowel perforations and wound dehiscence. Despite the infant receiving moderate doses of opioids since birth, difficult pain management persisted. Interventions, case progress and outcome: On Day 38, the infant consistently scored 16 (range 0–20) on the Neonatal Pain Assessment Tool (PAT), despite receiving continuous intravenous infusions of fentanyl (6mcg/kg/hr), midazolam (3mcg/kg/min), clonidine (0.33mcg/kg/hr), and six hourly intravenous tramadol (2mg/kg). On Day 40, fentanyl was changed to morphine (100mcg/kg/hr), which was increased to 200mcg/kg/hr the next day. PAT scores of 18–20 on Day 42 prompted the substitution of morphine with hydromorphone (40mcg/kg/hr) and a Pain Management Service (PMS) consultation. The PMS suggested that opioid-induced hyperalgesia may have been partially responsible for the difficulty in achieving adequate pain relief. Clonidine and tramadol were ceased and ketamine (100mcg/kg/hr) and dexmedetomidine (0.7mcg/kg/hr) were commenced. Over the next 24 hours there were some improvements in pain scores, although scores of 16 were still observed. The next day dexmedetomidine was increased to1.6mcg/kg/hr and ketamine doubled to 200mcg/kg/hr. PAT scores of zero were finally achieved and remained under eight until analgesia was weaned. Conclusions: Continuous infusions of hydromorphone, midazolam, ketamine and dexmedetomidine were successfully used to provide adequate pain relief in a post-operative neonate with opioid-induced hyperalgesia. Further studies are required to investigate the potential roles and safety profiles of ketamine and dexmedetomidine in neonates.

1430–1445, MEETING ROOM 220

Paediatric procedural pain management—can we do it better? Michele Cree1,2, Janelle Keyser1, Julianne Richards1 1 Queensland Paediatric Pain Centre, Royal Children’s Hospital Brisbane, QLD, 2Pharmacy Department, Royal Children’s Hospital Brisbane, QLD Correspondence: michele_cree@health.qld.gov.au

Introduction: Procedures in children may be viewed as fear evoking and can be seen to cause a great deal of anxiety in hospitalised children. Aim: To develop and implement a survey and audit tool to review current practices for procedural pain management at a tertiary paediatric facility. Method: The multidisciplinary team reviewed current best evidence and benchmarked with paediatric hospitals worldwide to establish available models of care utilised to manage paediatric procedural pain. Three survey tools and an observational audit tool were developed to evaluate current practice and address staff’s, parent’s and patient’s perception in relation to current procedural pain management. Results: Parents’ viewed cuddling/holding/touch as the most useful technique for managing procedural pain, whilst patients’ rated distraction/play as the most useful technique. 64% of staff surveyed rated distraction/play as a technique they have used for the management of pain and distress in their patients. Both parents and patients rated mothers and nurses as the most helpful person in managing procedural pain whilst in hospital. 63% of staff surveyed reported they had received no training or poor training in the area of procedural pain management, with 72% of staff having never or not often used a written procedural pain management plan with patients. In the observational audit 72% of procedures took place in dedicated treatment rooms, with equipment prepared in advance in 72% of cases. Verbal consent prior to a procedure was obtained in 78% of cases, documentation occurred in 14% of the patients’ audited. Conclusion: The results of the survey demonstrate that considerable improvement needs to occur to align ourselves with the recommendations currently outlined in the literature in relation to best practice for paediatric procedural pain management. Study results will contribute to the development of a model of care that will promote effective procedural pain management in the paediatric population.

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Pain management in the home: are over-the-counter analgesics appropriately used? Vincent Wong1, Stephen Lim2 1 Pharmacy 777, Armadale Health Service, WA, 2Armadale Health Service, WA

Aim: To determine the types of over-the-counter (OTC) analgesics purchased and their appropriate used in the community. Method: Data were collected from customers attending a suburban community pharmacy in the month of May 2010. Verbal consent was given by the pharmacy owner and the customers to collect data during the counselling session for customers who have purchased OTC analgesics. Results: Data was collected from 13 male (M) and 15 female (F). Their age were categorised into 18–65 years (12M, 7F), 66–75 years (4M, 4F) and >75 years old (1M). The OTC analgesics purchased were: Ibuprofen 200mg (17.9%), Diclofenac 25mg (10.7%), Ibuprofen 200mg/codeine 12.8mg (50%), paracetamol 500mg/codeine 15.4mg (21.4), for treating headache (25%), migraine (21.4%), period pain (21.4%), neck/shoulder pain (10.7%), low back pain (7.1%), toothache (7.1%), sprain (3.6%) and rheumatoid arthritic pain (3.6%). On the question on why plain paracetamol was not used ahead of combination analgesic products and non-steroidal anti-inflammatory drugs (NSAID) the responses were: plain paracetamol was ineffective (32.1%), NSAID was for severe pain (28.6%) and not sure why (38.3%). Some of the customers who purchased NSAID were also taking antihypertensive drugs, celecoxib, meloxicam, have a history of asthma and peptic ulcer. These customers were not aware that celecoxib and meloxicam were also NSAID and NSAID could trigger an asthmatic attack or precipitate ulcer. Conclusion: All customers purchased combination analgesic products or NSAID instead of the plain paracetamol believing that paracetamol is a poor analgesic (only useful in treating fever) and pharmacists should reiterate the correct use of regular paracetamol (four times a day) for effective pain relief. Most customers believed that NSAID are potent analgesic. There is a need for pharmacist to take medication history when selling OTC analgesics because some customers are already taking celecoxib, meloxicam, antihypertensive, and asthma medications.

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Painful painkillers: the sharp end of S8 administration Katrina Harman1, Alex Holmes1, Natalie Tasker1, Natasha Haynes1, Rachael Worthington1, Peter Barclay1 1 Children’s Hospital at Westmead, NSW

Background: Incidents involving oxycodone and morphine preparations consistently appear in the top 10 drugs reported in IIMS. The literature describes medication errors in paediatrics occurring across the entire spectrum of the medication management process and across all settings of care, including within the home. Opioids are highlighted as causing or potentially causing harm to paediatric patients. Aims

x x x

To analyse/theme S8 IIMS data over one year. To liaise with the multidisciplinary pain team to identify S8 issues. To develop, deliver and evaluate an education program responding to our reported incidents

Method: We undertook a review of 12 months (2009) IIMS data. All medication/IV fluid S8 incidents were exported into a spreadsheet for classification and analysis. Focus group discussions were held with the multidisciplinary pain team around issues highlighted through IIMS, daily pain team rounds and clinical pharmacy activities. An education program was developed, targeting issues identified. Results: There were 67 S8 incidents reported in 2009. The main errors were wrong drug or dose, wrong formulation, wrong route and issues with checking of syringes. The program developed focused on oxycodone usage and formulations available. It was delivered to medical and nursing staff in faceto-face sessions by intern pharmacists. Further support was provided with tools/posters on the intranet and in ward areas. The program was evaluated by questionnaires of nursing staff, review of IIMS data and quality of prescribing audits. Conclusion: The targeted approach to addressing the reported S8 IIMS reports has been successful. Participants in the pilot education program agreed that the program addressed many gaps in their knowledge regarding the administration of S8s and felt that their workplace practices would be improved as a direct result of having attended the program. The S8 IIMS reports for 2010 will need to be reviewed to fully assess the impact of the pilot education program.

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Saturday abstracts Contributed papers stream C14—Broadening the profession 1400–1415, MEETING ROOM 212

Evaluation of a pharmacist-led anticoagulant dosing service in Hospital-in-the-Home Shin Choo1,2, Josephine McGuiness1,3, Ngo-Thai Lam-Lan1, Katrina Neave4, Alison Street5,6, Michael Dooley1,3 1 Alfred Health, VIC, 2Department of Epidemiology and Preventative Medicine, Monash University, VIC, 3Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, VIC, 4Hospital in the Home, Alfred Health, VIC, 5Haemostasis-Thrombosis, Alfred Health, VIC, 6Department of Pathology, Epidemiology and Medicine, Monash University, VIC Correspondence: s.choo@alfred.org.au

Aim: To assess the safety and effectiveness of a pharmacist-led anticoagulant dosing service in Hospital-in-the-Home (HITH). Methods: A number of warfarin-related incidents in HITH prompted the development of a pharmacist-led warfarin dosing service. It is endorsed by the Drug and Therapeutics Committee, Haemostasis-Thrombosis and medical units. Data prior to pharmacists’ involvement were collected retrospectively. An anticoagulant dosing competency program was established using local and international resources, together with nursing and medical input. Pharmacists completed two written competency tests and recommended a minimum of 20 warfarin doses. During the initial stages of the service pharmacists worked in pairs and contacted a treating doctor to confirm dose recommendations. Data was collected prospectively. Results: Data on 76 patients was collected in the pre-intervention period. Thirty-four patients (45%) were initiated on warfarin; 41 patients (55%) re-started warfarin therapy. The mean time to reach first therapeutic INR was 10 days; and to achieve two consecutive therapeutic INRs was 13 days. As of June 2010, 9 pharmacists are actively involved in the service, with 26 patients referred for pharmacist dosing and 20 successfully recruited. Thirteen patients (65%) were newly initiated; 7 patients (35%) re-starting. Of the 15 patients dosed to completion, mean time to first therapeutic INR reduced to 7.9 days (p=0.086); time to achieve two consecutive therapeutic INRs reduced to 8.9 days (p=0.061). In the pre-intervention period, 6 cases (8%) of bleeding were identified, none related to high INR. In the post-intervention period one case (5%) of bleeding was identified, unrelated to high INR. In the pre-intervention period, 3 supratherapeutic INRs (defined as INR > 4) were identified, none were identified in the post-intervention phase. Conclusion: This data suggests that a pharmacist-led warfarin dosing service is safe and effective. Subsequent phases of the service will progress to pharmacists assessed as competent providing the dosing service independently.

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Delivering national messages regarding safe and effective use of medicines in Australian hospitals and across the continuum Lisa Pulver1, David Maxwell2, Marion Robertson3, Angela Wai4 1 School of Pharmacy, University of Queensland, QLD, 2New South Wales Therapeutic Advisory Group, NSW, 3Victorian Drug Usage Evaluation Group, VIC, 4National Prescribing Service, NSW Correspondence: l.pulver@uq.edu.au

Aim: To describe a unique national framework and methodology used to promote safe and effective use of medicines in the Australian acute care setting. Methods: The national drug use evaluation (DUE) program in Australian hospitals is coordinated by a collaborative of quality use of medicines (QUM) organisations. QUM issues are identified through consultation via state-based groups. When a topic is identified, a national expert advisory group provides strategic direction and review, including identification of quality indicators/measures for improvement, key messages and educational intervention tools. Hospitals are recruited voluntarily. DUE methodology is used across participating sites to implement relevant QUM activities. Hospital teams attend a workshop in each state, where a therapeutic briefing and training in social marketing techniques are provided. All project materials, data collection tools and educational resources are developed by the national project team. Hospitals complete a baseline audit, then a targeted educational intervention including academic detailing. A follow-up audit is conducted to monitor changes in practice. Hospitals use local audit results to monitor current practice and are provided with state and national results for comparison. State-based coordinators provide guidance and support to hospitals. Results: 148 public and private hospitals in five states have been engaged across three projects: Community Acquired Pneumonia Towards Improving Outcomes Nationally (CAPTION), Acute Postoperative Pain (APOP) management and Discharge Management of Acute Coronary Syndromes (DMACS). Measurable improvements in prescribing practices and medicine management have been achieved across a number of key indicators. Conclusion: This unique national program facilitated the engagement and participation of a large number of hospitals on a broad range of QUM issues. This national coordination has ensured a consistent and standardised approach to delivering key messages to promote safe and effective use of medicines. Embedding this activity in everyday practice should be considered a priority for all committed to QUM.

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Can quality improvement interventions optimise practice? The Discharge Management of Acute Coronary Syndromes initiative Lisa Pulver1, Angela Wai2, Kathleen Mulligan2, Marion Roberston3, Kylie McIntosh3,4, Donna Taylor1, David Maxwell5, Shwu Fen Loh6, Rosie Nash7, Angus Thompson 1 School of Pharmacy, University of Queensland, QLD, 2National Prescribing Service, NSW, 3Victorian Drug Usage Evaluation Group, VIC, 4Department of Human Services, VIC, 5New South Wales Therapeutic Advisory Group, NSW, 6South Australian Therapeutic Advisory Group, SA, 7School of Pharmacy, University of Tasmania, TAS Correspondence: l.pulver@uq.edu.au

Aim: The Discharge Management of Acute Coronary Syndromes (DMACS) project aimed to optimise: prescription of guidelinerecommended medications; education on lifestyle modifications; and communication with patients and general practitioners (GP). We describe improvements in practice after a targeted intervention. Methods: Forty-nine Australian hospitals participated in a drug use evaluation cycle (audit, feedback, intervention and re-audit) from June 2008 until November 2009. Data were collected through an inpatient medical record review, a GP survey 14 days post-discharge and a patient survey 90 days post-discharge. Interventions included feedback of hospital results at educational meetings, academic detailing and point-of-care reminders. Outcome measures included guideline-recommended medications prescribed at discharge; referral to cardiac rehabilitation (CR); documentation of an ACS management plan and its communication to patients and GPs. Results: 1545 and 1589 patients were included pre- and post-intervention respectively. 3134 hospital staff participated in the educational intervention. Post-intervention, more patients received all four guideline-recommended medications (69% v 57%; p<0.0001) and short-acting nitrate (68% v 56%; p<0.0001) at discharge. At 3 months post-discharge, consecutive (comparative) audits showed significantly more patients were using all four guideline-recommended medications (52% v 48%; p=0.05), and possessed a short-acting nitrate (60% v 52%; p<0.0001) for relief of ACS symptoms. There were significant increases in documented referral to CR (68% v 57%; p<0.0001) and patient recall of referral (73% v 67%; p<0.005), documented discharge medication counselling (75% v 64%; p<0.0001), and documented smoking cessation counselling for current smokers (77% v 59%; p<0.0001). The number of patients receiving an ACS management plan increased (88% v 95%; p<0.0001), with more GPs receiving the ongoing management plans in discharge summaries (74% v 80%; p=0.0001). Conclusion: Targeted education of hospital personnel enhances adherence to guidelines1 in the discharge management of patients with ACS.

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The impact of a multidisciplinary Medication Safety and Quality Unit Michael Barras1, Stephen Parry-Jones1, Eric Lee1, Anna Olson1 1 Mater Health Services, QLD Correspondence: michael.barras@bigpond.com

Aim: To describe the progressive outcomes of a strategic approach to improving medication safety across five hospitals. Methods: Mater Health Services (MHS) is a complex organisation consisting of adult, paediatric, maternity, private and satellite hospitals. Medication Safety Self Assessment® (MSSA) surveys (Clinical Excellence Commission) were conducted across all hospitals in July 2008. The surveys identified areas of best practice that were met when referenced nationally against hospitals of similar size. For the majority of standards MHS performance was below national benchmarks. A Medication Safety and Quality Unit (MSQU) was formed consisting of a coordinator, two medication safety officers, a clinical drug information pharmacist, two pharmacy educators and a nurse educator. The primary responsibility of the unit was to design and coordinate a three year ‘Medication Safety Strategy’ to guide a phased approach to the implementation of medication safety projects. The strategy aimed at addressing short term needs of MHS whilst setting goals for long term system changes. It incorporated the necessary schedules, risks, transition and communication plans, resources, and monitoring to enable the effective management of projects. A follow-up MSSA was conducted in March 2010 and results compared to 2008 and the national benchmark. 2

Results: All hospitals achieved a statically significant improvement in scores from 2008–2010 ( , P<0.001) and increased scores from below to well above national benchmarks (Figure 1).

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Saturday abstracts Figure 1. Scores as a percentage of the maximum score for 2008 (left) and 2010 (right) with benchmarked national mean (line).

% of maximum score

100

te el it Sa t

at er ni ty

iv at e Pr

hi ld re ns C

du lt

Hospital

Conclusion: Using a strategic approach to system change, the MSQU has helped improve medication safety standards above national benchmarks, within 18 months of a three-year strategy.

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How clinical pharmacists spend their day—a time and motion study Jan-Marie deClifford1, Skip Lam1, Ben Leung1, Peter Blewitt1, Sigrid Perl2, Tamara Raggam2 1 Peninsula Health—Frankston Hospital, VIC, 2Institut für Pharmazeutische Wissenschaften, Austria Correspondence: jdeClifford@phcn.vic.gov.au

Aim: To use time and motion methods to determine how clinical pharmacists spend their time prior to the implementation of Cerner MillenniumTM, an e-prescribing and e-administration computerised system Methods: The activities of clinical pharmacists were classified into major categories and minor subcategories. A customised Access™ application, on a laptop, was used as for logging the exact time for each classified activity. Clinical pharmacists assigned to general medical and surgical wards were shadowed by two independent observers over the whole working day (except breaks) for 4 days a week, from 23.11.09 to 17.12.09. The Access™ database enabled calculations of average times spent on various activities. Other information collected were time from admission to interview and number of opportunities for drug chart review. Results: Nine pharmacists were observed for a total of 265 hours over 30 working days. Clinical activities accounted for 56% of their time. This included chart review (9.6%), clinical review (9.1%), ascertaining drugs required at discharge (1.6%), providing information to patients/carers (5.5%), taking medication histories (9.5%), professional communication (20.2%), and obtaining drug information (0.5%). Time spent on non-clinical activities (44% of total time) included ordering/distribution (6.6%), walking (5.2%), looking for something (3.1%), (social activities/breaks) (13.1%), meetings (7.0%), other activities (2.8%) and discharge dispensing (6.3%) Each pharmacist completed, on average, 23 medication histories, reviewed 21 medication charts and spent 20 minutes on clinical interventions per day. The average time from admission to interview was 67hrs. There was an average of 38 opportunities for chart review per day; 55% of these charts were reviewed. Conclusion: The study provides a useful baseline for future comparisons following the implementation of Cerner MillenniumTM. Such comparisons are important for future planning and assessment of the impact of technology on clinical workflow. There may be opportunities to increase the clinical time spent by pharmacists.

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Saturday abstracts Contributed papers stream C15—1970s to now—changes in technician training and roles 1400–1415, MEETING ROOM 213

Evolving the role of pharmacy technician led training and education Laren McConnel1, Becky Walsh1, Sue Goh1,2, Thomas Fong, Declan Gibney1,2 1 Pharmacy Department, Prince of Wales Hospital, NSW, 2Sydney Children’s Hospital, NSW Correspondence: laren.mcconnel@sesiahs.health.nsw.gov.au

This paper will discuss the role of a lead hospital pharmacy technician in the development and implementation of an aseptic dispensing education training program within an aseptic dispensing unit. Aim: To utilise a technician as the trainer to effectively and efficiently provide theory and practical training of aseptic dispensing and quality assurance (QA) activities as per code of Good Manufacturing Practice (cGMP) to pharmacists, technicians and intern pharmacists. Method: The program evolved over the past decade in consultation with senior pharmacists. Refinement over the past 2 years proved so successful it was expanded to include intern pharmacists. It is now the sole responsibility of the lead technician to perform all training and education for aseptic dispensing. Training involves one on one ‘classroom’ sessions to discuss cGMP, standard operating procedures and QA activities plus teaching the practical skills necessary to compound. Practical skills are consolidated with hands on teaching within the clean room. The program incorporates documented evidence of knowledge and skills learnt and accreditations achieved. A validation process involving three successful broth transfers is carried out once the trainee has completed the training program. Once validated, staff must carry out a monthly compounding session to maintain their validated status and complete an annual broth revalidation. Results: Since refining the program the lead technician has successfully trained and validated 15 rotational staff members, taking an average of 6–8 weeks to complete. Once completed staff have a sound understanding of QA, cGMP, clean room design and function and the necessary aseptic skills. This ensures a continuum of skilled staff competent in specialist aseptic dispensing and facilitates service provision and capacity planning. Conclusion: Traditionally pharmacists have been responsible for the aseptic training however evolving the role of the lead pharmacy technician to train staff has enabled pharmacists to spend more time on patient focused care, facilitated more thorough and efficient training and enhanced job satisfaction for all involved.

1415–1430, MEETING ROOM 213

The expanding role of pharmacy assistants within inpatient units Trudy McGovern1, Bridie Cameron1 1 Gold Coast Health Service District, QLD

Correspondence: trudy_mcgovern@health.qld.gov.au

Aim: To improve medication management within an inpatient unit, by implementing a unit based pharmacy assistant service. Method: A pharmacy assistant was allocated full time (38 hours/week) to a 28 bed neurology, cardiology and general medical inpatient unit, from 19 April 2010. Data was collected over a two-week period immediately prior to commencement of the service. The focus for improvement was on the following stages of the medication management cycle: 1.

Distribution and storage

Issue of medicine

Transfer of verified information

Data was recollected over a two-week period, between 2 and 16 May 2010.

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Saturday abstracts Results Stage of medication management cycle Distribution and Storage

Issue of Medication

Transfer of Verified Information

Measure Value of imprest medication list Value of actual imprest medication held Value of expired stock held Value of inappropriate medication in patient’s bedside drawer Number of medicines not administered due to nil stock Number of ad-hoc orders for imprest stock and controlled drugs Number of patients with medication history documented in Enterprise Liaison Medication System (eLMS) Number of patients with a pharmacist generated discharge medication record (DMR)

Number of patients with an electronic discharge summary (EDS)

Number of patients with source of discharge medicine information in EDS being a DMR

Pre implementation data $6 409 $13 911 $763 $164

Post implementation data $5 932 $6 499 $0 $0

12 23

5 12

14/55 (25%)

28/49 (57%)

Weekdays 18/31 (58%) Weekend 0/7 (0%) Weekdays 25/31 (80%) Weekend 3/7 (43%) 11/38 (29%)

10/18 (56%) 1/7 (14%) 15/18 (83%) 1/7 (14%) 6/25 (24%)

Conclusion: The main areas of improvement were the distribution, storage and issue of medicines. While significant improvements were seen in the documentation of medication histories in electronic format, ongoing discussion with other members of the health care team is required to further improve the transfer of verified information. The service is to be continued for another 12 months allowing for further development of the role. To ensure sustainability, issues relating to training, the definition of competencies, career structure, qualifications, role expansion, role definition and ongoing funding must be addressed.

1430–1445, MEETING ROOM 213

Smokin’ new role for pharmacy technicians Sonya Dillon1, Kathryn Sturgiss1, Miriam Lawrence1 1 The Canberra Hospital, ACT Correspondence: Sonya.Dillon@act.gov.au

Aim: To expand the role of pharmacy technicians to develop skills and knowledge in counselling and to implement a technician led nicotine replacement therapy (NRT) program. Method: As part of the transition to a ‘smoke free’ hospital, the pharmacy department was asked to supply NRT to staff members who were committed to smoking cessation. This was seen as an opportunity for technicians to develop their skills in patient counselling and to free up pharmacists in a busy dispensary environment. Technicians participated in a training program developed by a team of pharmacists. This involved a baseline quiz, and then a training session to standardise knowledge. Each technician was then validated using an OSCE style assessment, with observation and feedback on their first dispensing and counselling. Resources were developed, containing a dispensing and counselling guide for technicians, a staff information sheet and questionnaire (with referral points to the Pharmacist when appropriate) and a patch strength selection guide. Results: The role of pharmacy technicians has been expanded to include staff counselling on NRT. Using the tools provided the technicians are able to independently determine the needs of the staff member, recommend the appropriate nicotine patch strength and provide counselling and information resources. To date 11, (55%) of our pharmacy technicians have been validated, this includes all levels. Sharing the work load in our busy dispensary has been received positively by all staff members involved and since implementing the service we have dispensed and counselled 153 staff members on NRT. Conclusion: This training module has been a success and has developed a new role for pharmacy technicians in our department. Further application of this type of training is planned to develop other roles and skills for technicians such as handing out non-complex prescriptions for example antibiotics and pain relief medication.

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A pharmacy technician in the renal unit Sarah Crossing1, Winnie Chau1, Vaughn Eaton1 1 Flinders Medical Centre, SA

Recent introduction of pharmaceutical reforms within the South Australian public hospital system has lead to an increased demand for pharmacy services in the renal unit. Distinct from renal units in other states, our institution manages all medications for dialysis patients; including S100, PBS and non-PBS medications. In addition, our institution also manages the medications of patients who dialyse in satellite dialysis centres. Patients requiring dialysis often have multiple co-morbidities and are generally prescribed a large number of medications. Some of these medications are highly specialised and expensive, and patients are required to meet certain criteria before dispensing. Introducing a pharmacy technician into the renal unit has increased efficiency in medication dispensing, improved the rapport between pharmacy and renal unit staff and has contributed to providing a high standard of pharmacy care to renal failure patients. The extra assistance with management of renal medication dispensing has allowed the renal pharmacist to devote a greater proportion of their time to clinical activities. This presentation will outline the role and responsibilities of the renal pharmacy technician which includes:

x x x x x x x x x

liaising with renal specialists to ensure accuracy and compliance of prescriptions liaising with nursing staff on medication and supply issues coordinating supply of medications for satellite centre patients providing counselling and consumer medication information to renal patients assisting to dispense renal outpatient prescriptions coordinating medication changes and supply for dosage administration aids in the community compiling current medication profiles for dialysis patients inpatient chart review to highlight issues for the renal pharmacist assisting with data collection for pharmacy research.

In addition to providing all pharmacy staff with an example of the new and challenging roles for hospital pharmacy technicians, this presentation will introduce pharmacy technicians to the dialysis process and discuss medications commonly used on dialysis.

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Breaking out! Increasing scope of practice for pharmacy technicians in a correctional environment Clare Harris1 1 Justice Health, NSW

Correspondence: clare.harris@justicehealth.nsw.gov.au

Aim: To increase the scope of practice of pharmacy technicians thus facilitating streamlining of pharmacy procedures which will, in turn, librate time for quality activities for both pharmacy technicians and pharmacists. Method: Our pharmacy department unique due to the delivery of state-wide pharmacy service, which supports over 11 000 patients, services 51 rural, remote and metropolitan health centres, and covers an area of 809 444 km2. The self medication program is instrumental in promoting fair health care access to patients in corrections. The self medication program involves health centre staff risk assessing particular patients who fit the criteria of suitability. A review of their medications is conducted by the pharmacist to ensure that the medications are clinically appropriate. This process can be labour intensive and time consuming. Resultantly, as a practice improvement project, a pharmacy technician has absorbed the task of processing the risk assessments for patients commencing on the self medication program. It important to note that all work conducted by the pharmacy technician has a final clinical check by a registered pharmacist. This additional initiative to streamline work practices will ensure efficient, more contingent operation. This will be achieved by improving work flow within the pharmacy department and providing pharmacy service education sessions to clinical staff. The intention is for pharmacists and pharmacy technicians to visit heath centres. During this period, pharmacists will provide education, and pharmacy technicians will provide advice on tailoring imprest lists to the correctional centre patient population. Other initiatives undertaken by the pharmacy technician will include treatment sheet audits, assisting, and educating health centre staff on streamlining their ordering process. Results: This study is a practice improvement project. It is proposed to conclude in August 2010, with results to be submitted by report to the Manager of Quality Improvement Governance. Currently, 42 patients have had their medications initially reviewed by the pharmacy technician over a period of 2 months with follow on checking by the registered the pharmacist. Although it is difficult to quantify, it can be approximated that 22 hours of pharmacist time has been freed up by this process so far. Conclusion: Improving work practice is a continual process but is essential in providing an efficient pharmacy service. The role of the pharmacy technician has great importance, and it to must evolve in response to the changing demands of health. Increasing the scope of practice of pharmacy technicians to assist the pharmacist role is paramount.

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ABSTRACTS—POSTERS POSTER SESSIONS Bugs and drugs...................................................................................................... 127 Life goes on............................................................................................................ 146 Painful situations..................................................................................................... 162 Broadening the profession...................................................................................... 168 1970s to now—changes in technicians training and roles ...................................... 203 Other ...................................................................................................................... 211

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poster listing 19

Bugs and drugs 1

Switch! The impact of an antimicrobial stewardship project A case of mistaken allergy: sulfamethoxazole or trimethoprim?

Kerryn Barned

Just another chest infection? Community acquired pneumonia in Central Australia: does the Pneumonia Severity Index guide treatment in Indigenous patients? Kieran Behan

A review of surgical antibiotic prophylaxis—gastrointestinal surgery Antibiotic compounding of 24-hour infusors as a stop-gap measure in home IV therapy

Implementation of Guidance DS in an established antimicrobial stewardship service

Adherence to an AUC gentamicin dosing and monitoring system Penelope Collins

Adherence to prophylaxis guidelines in patients that develop symptomatic venous thromboembolism—where are we at? A retrospective hospital audit at Royal Darwin Hospital

Macrolides on the menu— azithromycin and delirium Drug utilisation evaluation—a natural partner in antimicrobial stewardship Fungal bone infection post hemispherectomy in a paediatric patient

Optimising posaconazole usage as antifungal prophylaxis in acute leukaemia

Aminoglycoside training program— impact on prescribing and monitoring

Pamela Fernando

Exogenous pyocyanin alters

Pseudomonas aeruginosa susceptibility to ciprofloxacin Lee Gloyne

Azithromycin eye drops for the treatment of Mycobacterium fortuitum keratitis Judith Hampson

Finding a home for insulin: a review of insulin storage and labelling across NT hospitals Stuart Brown

Reviewing the old: what is the evidence for secondary cardiovascular disease prevention in a 95-year-old patient post acute myocardial infarction? Tina Chang

Round and round the medication safety cycle—a multidisciplinary approach Emily Diprose

Amiodarone: adverse drug reaction, aftermath distress resolved and after discharge reassurance! Sue Driscoll

Development of a hospital pharmacist prepared interim residential care medication administration chart (MedGap Project) Rohan Elliott

Audit of osteoporosis prophylaxis in heart and lung transplant recipients

Development of an Ecarin clotting time test as an alternative to APTT for monitoring lepirudin

Devang Rai

Morna Falkland

The use of forgotten antibiotics in multi-resistant tuberculosis patients Bugs and drugs: what role does a clinical pharmacist play in enhancing appropriate antimicrobial use? When cleanrooms go bad— unexpected closure of a cytotoxic production unit Jim Siderov

Allergy documentation—if it’s important why aren’t we inputting it? Sophie Arthur

Interim medication charts—smoothing the transition from hospital to residential aged care facilities Pamela Fernando

Diane Reeves

Audit of warfarin initiation at an obstetric and paediatric teaching hospital Eu Queen Ang

Devang Rai

Jade Eyles

Use of a point prevalence study to assess appropriateness of antibiotic prescribing in surgical patients at a major teaching hospital Roseleen O’Doherty

Review of pharmacist-led interventions in the management of hypertension Tariq Alhawassi

Neurological toxicity from cefepime— right drug, wrong dose Kelly Mulvogue

Courtney Emerson

A drug utilisation evaluation of ceftriaxone Jade Merritt

Paula Doherty, Carolyn Young

Vicki McNeil

Emily Diprose

Life goes on

Multi-access from single use vials versus single use of single use vials: a cost comparison audit Antibiotic surveillance data and its role in antimicrobial stewardship

Systemic absorption of oral vancomycin—check the dose! Kate Witney

Patrick Mannion

Joseph De Zylva

Cryptococcal meningitis complicated by vancomycin-induced DRESS syndrome Yuet Han (Joyce) Liew

Appropriateness of restricted antibiotic use: the impact of Guidance ® DS Osbert Cotta

Prescribing and safety issues of oral molecular therapies and chemotherapies in Australian haematology oncology practice Maria Larizza

Validation of a pharmacokinetic prediction system for vancomycin dosing Carmela Corallo

Assessment of pneumococcal and influenza virus vaccination status in medically at risk patients admitted to the emergency department of a metropolitan public hospital.

Use of artesunate and leflunomide in the treatment of ganciclovir-resistant cytomegalovirus Jenny Willis, Shannon Finn

Anna Klusak

Kelly Cairns

Assessment of bolus intravenous gentamicin administration versus infusion Mona Khalessi-Rad

Kelly Cairns

Delineating drug disposition of antimicrobials in patients undergoing ECMO

Bronchiolitis obliterans organising pneumonia in a patient treated with intravenous busulfan-melphalan conditioning regimen in autologous stem cell transplantation—bug or drug? Karen Urbancic

Kristen Joyce

Stuart Benson

Improving once daily gentamicin prescribing at a tertiary teaching hospital: we need more than just education Karim Ibrahim

Kieran Behan

Sophie Higgins

Kerryn Barned

A retrospective review of the use of nitazoxanide in treating Cryptosporidium in children in Alice Springs Hospital

How can we best manage an agitated older patient? Follow-up audit Kerry Fitzsimons

Warfarin polymorphism: a potential poly-problem Leah James

The stability of various antibiotics in peritoneal dialysis solution with glucose 2.5%

To reduce or not to reduce? Investigating the appropriateness of metformin dosing in renal impairment in the general medicine population

Minh Tran

Melina Johannesen

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poster listing 52

A review of pharmacist recommendations in a rural aged care facility

Painful situations 71

Hanan Khalil

Vitamin D monitoring in mental health patients Cathy Larson

The preoperative management of the chronically anticoagulated patient admitted to a tertiary teaching hospital

Staying alive: removal of 100-unit insulin syringes Anne McGrath

A qualitative study on Australians opinions about integrated electronic health records Andrew McLachlan

Kate O’Hara, Jane Gillard

Iron infusions—a review of prescribing practices Janelle Penno

Exploring the beliefs of heart failure patients towards their medicines Matthew Percival

Positive ripple effects for patient care on an aged care and rehabilitation sub-acute hospital

A communicative tool for preoperative diabetic management—a pilot study

Exploring patients’ views surrounding cessation of medications in a multidisciplinary ambulatory consulting service

Purple glove syndrome associated with phenytoin—who is aware? Staying alive: encouraging use of IV potassium pre-mixes ‘Contin’ confusion: a multifaceted approach to a painful problem! NSAIDs—are we giving enough? Pharmacists and pain management: are we ready, willing, and able?

Lead—the blessing and the curse of a mining town

Hospital Oxycodone Utilisation Research Study (HOURS)

Broadening the profession 83

Stress less—inappropriate continuation of stress ulcer prophylaxis Rebecca Sbeghen

Facilitating medication safety risk assessment in the emergency department

Lisa Nissen

Dana Strumpman

Current prescribing trends for the treatment of osteoporosis: combination versus monotherapy

Accuracy of interim residential care medication administration charts prepared by hospital pharmacists (MedGap Project)

Are there gaps in our pharmacy service provision? A discharge medication record audit Dimity Williams

Patient awareness of the risks of zoledronic acid use in osteoporosis Louise Williams, Claire Keith

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Crossing the red line—pharmacy in the operating suite Jane Booth

Xing Xin

Provision of remote clinical pharmacy services to the bush—a new service model Susan Alexander

Evelin Tiralongo

The effect of collaborative doctorpharmacist prescribing in a multidisciplinary elective surgical preadmission clinic on the rates of venous thromboembolism risk assessment, chemical and mechanical contraindication assessments and appropriateness of VTE prescribing

A pharmacist in the lab: development of an intracoronary injectables guide Megan Booth

Pharmacy meets industry: what does it mean to be LEAN? Carl Bufe

An audit of the rates of prescribing of venous thromboembolism pharmacological prophylaxis in medical patients admitted through the hospital emergency department Rachael Cheh, Sally Marotti

Tara Wenzel, Ayesha Platis

Yograjsinh Sagar

Bisphosphonate related osteonecrosis of the jaw with alendronate Derek Weidner

The impact of a unit-based clinical pharmacy service on discharge efficiency and waiting times Katherine Chandler

Penelope Tuffin

The impact of a unit-based clinical pharmacy service on medication prescribing errors Katherine Chandler

Ljubica Trajceska

A multifaceted approach to facilitate safe cyclophosphamide administration Kelly Cairns

Lindsay Scott

The successful introduction of standardised practices for patient controlled analgesia Dean Byrnes

Dianne Rozynski

A pilot study to determine the impact and feasibility of extending pharmacy services to the point of discharge (in the Republic of Ireland): pharmacist review versus pharmacist led discharge service Eamonn Butler

Janelle Penno

Emily Reeve

Don’t condone medication errors involving oxycodone: if you don’t succeed, try and try again! Opioid prescribing: are patients taking opioid(s) receiving appropriate breakthrough doses and prophylactic laxatives?

The evidence and rationale for the integration of the General Level Framework into the Postgraduate Clinical Pharmacy Program at the University of Queensland Judith Burrows

Nina (Pei-Chia) Hsu

Michelle Phung

David Gilbert

Lynda Pham

A retrospective review of the appropriate prescribing and costs of intravenous paracetamol Karen Figueroa

A comparison of heparin infusion protocols in vascular surgery patients Life goes on—the journey home: establishing a paediatric home parenteral nutrition service

The evolving role of the pharmacist in chronic pain management

Understanding alert overrides in an electronic medication management system in a university teaching hospital Rosemary Burke

Alana Croucher

Nikki Minge

Does gabapentin have a role in children undergoing spinal surgical procedures? Michele Cree

Alice Lim

Practice evaluation and identification of CPD needs using the General Level Framework Jaclyn Costello

Preparing a case for extended hours clinical pharmacy services in the emergency department Sylvia Cuell

Improving access to medicines in Malawi Danielle Deidun

A strategy to promote individual ownership and responsibility for medication safety Paula Doherty

100 High cost individual patient usage drugs—a 2-year follow-up study James Dwyer

101 Medication prescribing competency for medical interns Wendy Ewing

102 Putting adverse drug reaction documentation into the spotlight Kerry Fitzsimons

103 Interns at triage Will Franks

104 Introduction of the cardiothoracic pharmacist into a peri-operative clinic Rachel Fyfe

poster listing 105 Epidemiology of medication error— what we ‘know’ and assume may not be true Tim Garrett

106 Factors influencing intervention reporting: it’s all about what you believe Tim Garrett

107 Building patient-centred leaders: pharmacist leaders experience of the Clinical Leadership Program in Australia Sharon Goldsworthy

108 Eight into three does work—guardrails and patient safety James Grant

109 Getting the basics WRITE—assisting medical interns with safe prescribing Kirsty Grant

110 Adverse drug reactions—is the patient in the loop? Linda Graudins

111 Addressing medication safety by stealth: raising the relevance of adverse drug reaction documentation Toni Howell

112 Dexamethasone for bronchopulmonary dysplasia—a 4year review Lisa Hughes

113 Implementation of a deterministic inventory management system using order-point order quantity (Q,R) theory Colin Hui

114 Does a medication reconciliation pharmacist reduce medication errors at the community-hospital interface? Angela James

115 The role of the pharmacist in improving evidence based health care of paediatric patients at the Australian Children’s Clinical Trials Centre Pathma D Joseph

116 Using technology to support continuous professional development Neil Keen

117 Consumer demographics and medication supply demands in a public nurse-led walk-in centre Neil Keen

118 Assessing intern doctors prescribing skills at orientation to hospital Miriam Lawrence

119 The journey of an emergency department specialist pharmacist beyond the clinical role Shu Lay

120 A review of the diabetes record and insulin medicine chart Melissa Lee

121 Clinical pharmacy services: providing access and equity for rural patients Anne Leversha

122 Introduction of a weekend clinical pharmacist service to an intensive care unit Bianca Levkovich

123 Dispensing, counselling, clinical reviews and beyond

124 Home medicine reviews in partnership: working together with an Aboriginal health worker Angela Madden, Margaret O’Brien

125 Evaluation of a clinical pharmacy service to an acute medical unit Sally Marotti

126 ‘Making acid’—the use of ammonium chloride in a urine acidification test Claire McCormack

127 Oral chemotherapy—implementation of practice guidelines for general dispensary staff Robert McLauchlan

128 Advanced pharmacy experiential hospital placements in Australia for University of Maryland students Michelle Nalder, Michelle Vienet

129 Does the consultation order in a multidisciplinary elective surgical preadmission clinic influence the frequency and quality of prescribing for inpatient medication charts? Lisa Nissen

130 Pharmacy in the Solomon Islands Samantha Nothling

131 ‘Are you being served?’ Hospital pharmacists ask community pharmacists. Tara O’Brien, Mazdak Zamani, Andrew Cording

132 Loading dosing of phenytoin in adult intensive care patients—are we even close to therapeutic concentrations? Jason Roberts

133 Implementation of the Paediatric National Inpatient Medication Chart into a neonatal intensive care and neonatal special care unit Lisa Robertson

134 An innovative eMR pharmacy consult/review sub-system as an enabling instrument for serving quality and education agenda Ahmad Sayar, Margaret Macarthur, Pushminder Saran, Kurshid Chaudhry

135 Sustained results with a closed system drug transfer device in minimising cytotoxic surface contamination Jim Siderov

136 Capacity planning—evidence-based management Peter Smart

137 A common sense approach to medicines management in Pacific island countries Beverley Snell

138 Diagnostic to therapy work up Lu Song

139 How can pharmacists improve warfarin management along the continuum of care? Leanne Stafford

140 Pharmacists team up! Re-engineering hospital pharmacy to improve patient care and better support junior pharmacists Dana Strumpman

141 The effectiveness of a standardised Echinacea preparation in preventing colds, flu and other respiratory disorders for air travellers Evelin Tiralongo

142 Medication management options for patent ductus arteriosus Mary Tredinnick

143 Becoming a ‘jack of all trades’ rural and remote pharmacy practitioner Rhonda Tulk

144 Implementing medication reconciliation on discharge in a paediatric hospital Adela Vidicki-Mastilovich

145 Eculizumab—a novel therapeutic approach for atypical haemolytic uraemic syndrome Adela Vidicki-Mastilovich

146 The Medication Error Minimisation Scheme (Mems) in an Australian tertiary intensive care unit Susan Welch

147 Medication errors at discharge— impact of clinical pharmacist reconciliation process at ward level Karen Whitfield

148 Development and implementation of a method to evaluate the skills of pharmacists involved in an aminoglycoside monitoring service Jennifer Willis, Karen Whitfield

149 Cost analysis of outsourcing parenteral cytotoxics in a major teaching hospital Mardi Wills

150 Using link analysis techniques to improve the productivity of dispensary staff Chui Yap

151 A qualitative comparison of three drug information databases in Australia Melissa Yong

152 Unit-based clinical pharmacy services—what do doctors think? Mazdak Zamani

1970s to now—changes in technicians training and roles 153 Restructure of imprest supply produced financial benefits with increased accuracy Melanie Anderson, Jennifer O’Hara

154 Adverse event/allergy documentation—a small step to utilising pharmacy technicians Sophie Arthur

155 Improving the uptake of influenza vaccination in high risk elderly patients—a pharmacy technician’s role Lisa Hansen

156 How many trees can we save? Sabine Heymann

157 Coming alive … and staying alive Janette Hodgson, Kellie Saunders

158 Oops! I nearly did it again—near-miss dispensing error reporting Joanne Kelly

Peter Ludlow

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poster listing 159 Urinary incontinence in a heart failure population Jane La

160 Vendor managed inventory within a major teaching hospital Kate Lilleyman

Noman Masood

162 Prescribing linezolid instead of vancomycin for severe MRSA infection Ian Mawbey

163 Recording of pharmacist-initiated interventions in the dispensary and clinical settings Vaishali Padhye

Sally Porter

165 Competency-based assessment and training in the procurement of pharmaceuticals for pharmacy technicians Arti Thakerar

166 2010: a NSW pharmacy technician workforce survey Becky Walsh

167 Multi-drug resistant tuberculosis in pregnancy Jenny Willis

Shu Lay, Catherine Richards

180 The use of carglumic acid in treating acute hyperammonaemia crisis in a 2year-old with propionic acidaemia Yuet Han (Joyce) Liew

181 An audit of ondansetron use in a tertiary paediatric hospital 182 An assessment of the use of ciprofloxacin at Mount Gambier Hospital Liz Mampallil

183 Drug-induced Sweet’s syndrome due to Trimethoprim/Sulfamethoxazole Amy McRae

184 Rivaroxaban and enoxaparin for venous thromboembolism prophylaxis Jemma McWiggan

185 An evaluation of parents/carers’ skills in managing fever and cough and cold in children Rebekah Moles

Other 168 Discharge Management of Acute Coronary Syndrome project Amela Korajkic, Angela Given

169 Reconciliation of changes to handwritten discharge prescriptions and those generated using an electronic medication management system Diana Bui

170 Putting risk into perspective—how many medications do we administer in a year? Wendy Ewing

171 Amiodarone and carbimazole: severe adverse effects limiting treatment options Catherine George

186 Evaluation of the effectiveness of an intravenous heparin infusion order form for acute coronary syndromes Thao Nguyen

187 Storage of refrigerated medicines in clinical areas Rosemarie Oblimar

188 Pyxis in the ‘superclinic’ setting with no pharmacy on site—does it work? Sonia Shen

189 Recombinant activated factor VII: a high cost lifesaving drug—is it used appropriately? Sarah Thomas

190 An audit of Pentavite and iron use in the neonatal setting Rita Wardan

191 Vitamin A formulation in paediatrics Rita Wardan

172 A case of desvenlafaxine induced extrapyramidal side effects Angela Given

173 The individual patient usage database—a tool for tracking, reporting and managing non formulary, off-label and high-cost medication use Karim Ibrahim ®

174 The wonderful world of Botox : an evaluation on the use of botulinum toxin type A Mona Kiani

175 Automated creation of a comprehensive consumer medication chart from iPharmacy™ Skip Lam

176 When mouth ulcers turn nasty—a case for infliximab in Behçets disease

staying alive 2010

179 The emergency department challenge—Five chaRting Events Doctors Do Omit

Yuet Han (Joyce) Liew

164 A drug use evaluation of heparin induced thrombocytopenia

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178 The Beetle challenge Shu Lay, Catherine Richards

161 Medication storage on wards: who’s looking?

Beverley Lamb

177 Exploring the benefits of the information contained in a local adverse drug reaction database

192 Rivaroxaban HITs the spot Katrina Warwicker

193 Educating medical students in drug use evaluation methods Susie Welch

194 Impact of the implementation of pharmaceutical reforms on nonprescription medication management in post-natal women discharged from hospital Lisa Whennan

195 Investigation of the extent that clinical handover is undertaken by pharmacists for patients transferred within the hospital and to explore pharmacists’ perceptions of the need for effective clinical handover Karen Whitfield

poster abstracts Bugs and drugs 1

Switch! The impact of an antimicrobial stewardship project

Kerryn Barned1, Silvana Pignataro1 1 Southern Health, VIC

Correspondence: kerryn.barned@southernhealth.org.au

Aim: To evaluate the impact of an antimicrobial stewardship campaign, promoting an early switch from intravenous (IV) to oral antibiotics, on three pilot wards. Method: In 2009 an antimicrobial stewardship program was established to review and optimise antimicrobial prescribing within the hospital network. The promotion of an early switch from IV to oral antibiotics was identified as an initial project. To ensure its success an extensive literature review was undertaken and in collaboration with the stewardship committee, a project plan and implementation tools were developed. The campaign, led by the pharmacy department, was extensively promoted during a four-week period through organisational advertising media, tutorials, education packages, eye catching stickers for medication charts and swing tags. Emphasis was placed on clinical criteria guiding an early switch and associated benefits. The impact of the campaign was evaluated by conducting a pre and post intervention audit on the pilot wards. These audits examined the prescribing patterns of IV antibiotics, with a focus on the appropriate timing of IV to oral switch. Results: The number of patients identified as being on IV antibiotics in the two audits was comparable (83 vs 73). Of these, 55 and 49 patients respectively were eligible for inclusion. There was a significant improvement in the number of treatment courses switched from IV to oral therapy at an appropriate time (22.8% vs 51.9%) following intervention. The overall total number of excess IV days of antibiotic treatment reduced by 24% (183 days vs 139 days), however the average length of excess IV therapy per treatment course remained unchanged. It was calculated that antibiotic expenditure incurred due to unnecessary IV therapy decreased by 20.5%. Conclusion: This study shows that the implementation of an antimicrobial stewardship campaign promoting an early switch to oral antibiotics can reduce unnecessary IV antibiotic days and medication costs.

A case of mistaken allergy: sulfamethoxazole or trimethoprim?

Kerryn Barned1, Alla Shvaytser1 1 Southern Health, VIC

Correspondence: kerryn.barned@southernhealth.org.au

Objective: To report a case in which a patient with a documented ‘sulphur allergy’ experienced an anaphylactic reaction to trimethoprim. Clinical features: A 53-year-old Caucasian male with progressive pulmonary silicosis, secondary to occupational exposure whilst working as a plasterer, was admitted to hospital for treatment of a lower respiratory tract infection. He had an apparent allergy to ‘sulphur medication’, having experienced a rash ten years earlier. Previous chest infections with Serratia marcescens were treated with ciprofloxacin and cephalosporins and he was on suppressive posaconazole therapy for aspergillosis. On this occasion sputum cultures revealed infection with Serratia marcescens, resistant to ciprofloxacin and sensitive to trimethoprim and gentamicin. Interventions, case progress and outcome: Despite the possible allergy, Infectious Diseases considered trimethoprim/sulfamethoxazole and ertapenem to be the most appropriate treatment option. He was observed closely for signs of an adverse reaction. After seven days of treatment, improvement of symptoms was noted, however a maculopapular rash was observed on his upper arms and trunk. Trimethoprim/sulfamethoxazole was subsequently ceased and the rash gradually resolved. Desensitisation was deemed necessary, once this acute reaction had resolved, as it was likely that further treatment and/or prophylaxis with this agent would be required. During the desensitisation process the patient developed a generalised rash, rigors, hypotension and tachycardia, which were attributed to an allergic reaction. He was admitted to the intensive care unit for haemodynamic support and remained in hospital for a further two weeks. A week after discharge the patient presented to the emergency department with shortness of breath, tachycardia and rash after taking a single trimethoprim tablet. Conclusion: This case illustrates that hypersensitivity reactions attributed to sulfonamides following exposure to trimethoprim/sulfamethoxazole may in fact be related to trimethoprim.

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poster abstracts 3

Just another chest infection?

Kieran Behan1 1 Alice Springs Hospital, NT

Correspondence: kieran_behan@nt.gov.au;ramonak@amgen.com

Objective: Pneumocystis carnii pneumonia (PCP) can occur in immunocompromised people. A case of PCP occurring in untreated systemic lupus erythematosus (SLE) is reported, due to the rarity of this association. Clinical features: Mr GR a 28-year-old English backpacker presented to Alice Springs Hospital with a history of fever and cough. On presentation, he was febrile and pale, with tachypnoea, tachycardia, bilateral axillary lymphoadenopathy and oral candidiasis. A septic screen was taken and chest x-ray revealed bilateral interstitial infiltrates. Pathology revealed a WCC of 2x109/ml, with thrombocytopenia and anaemia. The presumptive diagnosis was community acquired pneumonia (PSI 102, class IV), and the patient was commenced on timentin, gentamicin and azithromycin. Interventions, case progress and outcomes: His condition deteriorated, requiring intubation and ventilation. Given his travel history, additional pathology was ordered, showing a CD4 count 360/ml (500–1500). HIV serology was negative, however anti-nuclear antibodies were positive. A lymph node fine needle aspiration was conducted, which revealed ‘reactive hyperplasia’. GR was diagnosed with SLE. Initial sputum cultures grew Pneumocystis carnii trophozoites, suggesting PCP secondary to SLE. This can occur from immunosuppression, however GR had only been prescribed oral antibiotics. A Medline search revealed a similar case report. The PCP was believed to result from SLE causing lymphopenia, which lowered the CD4 count, which reduced GR’s cellular immunity. GR was treated with intravenous cotrimoxazole and prednisolone, and later discharged on oral cotrimoxazole, prednisolone and hydroxychloroquine. Conclusion: PCP is a rare complication of SLE that has been documented in immunosuppressed patients. However, this is possible via other pathways. Clinical pharmacists need to be aware of alternate pathways, have the ability to undertake Medline investigations, and advocate evidenced based treatments. The clinical pharmacist’s role also extends to converting to oral therapy when possible, and counselling regarding the ongoing need to be concordant with therapy.

Community acquired pneumonia in Central Australia: does the Pneumonia Severity Index guide treatment in Indigenous patients?

Kieran Behan1 1 Alice Springs Hospital, NT

Correspondence: kieran_behan@nt.gov.au;ramonak@amgen.com

Background: The Pneumonia Severity Index (PSI) is used to triage patients with community acquired pneumonia (CAP), guide antimicrobial therapy, and predict mortality. Despite this, the PSI hasn’t been validated in indigenous populations. Indigenous Australians are more likely to suffer from comorbidites including alcoholism, chronic lung disease and uncontrolled diabetes, and have poorer social determinants of health, all of which have been shown to worsen outcomes associated with sepsis. It is unknown whether these health issues endemic in Central Australia would provide a proper representation of each patient’s PSI, leading to under treatment. Aim: To compare the empiric management of CAP in indigenous patients admitted to ICU/HDU at Alice Springs Hospital to the treatment described by the PSI in the Therapeutic Guidelines (TGs). Methods: All patients admitted to ICU/HDU for CAP during 2008 were identified and their PSI calculated. Admission to ICU/HDU was based on CAP severity and bed availability. All initial antibiotics were prescribed empirically. Antibiotics were changed if required, based on microbiological or radiological results, or the patient’s clinical condition. Only patients with a PSI > 91 (class IV and V) were included. Results: 476 CAP patients presented to ED in 2008, of which 91% (436/476) were Indigenous and 12% (57/476) were transferred to ICU. Of these 57 patients, 41 were PSI class IV and 16 PSI class V. Overall concordance with TGs was 27/57 (47%). 28/30 (93%) of initial antimicrobial therapy was broader than indicated in TGs. Atypical cover was prescribed in 46/57 (80%) of all patients. Intravenous ceftriaxone was the most common antibiotic initially prescribed (n=29, 51%). Conclusion: Prescribed antimicrobial therapy for patients admitted with class IV and V CAP was broader than indicated in the TGs, based on PSI. These results may be explained by the different patient demographics associated with Indigenous patients in Central Australia.

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poster abstracts 5

A review of surgical antibiotic prophylaxis—gastrointestinal surgery

Stuart Benson1, Stephanie Wiltshire1 1 Royal Adelaide Hospital, SA

Correspondence: stuart.benson@health.sa.gov.au

Aim: To evaluate the antibiotic prophylactic regimen administered to patients undergoing gastrointestinal surgical procedures. Method: Sample size was determined according to the methodology outlined in the Indicators for Quality Use of Medicines in Australian Hospitals. Patients were then identified from the daily operating theatre list, and their medical records reviewed by the investigator on the day following surgery. The data collection period was between 24 May and 18 June 2010. The prophylactic antibiotic regimen for each patient was then evaluated for compliance with hospital guidelines. Results: Of the 32 patients selected for inclusion, 9 patients (29%) received appropriate antibiotic choice and dose according to hospital guidelines. Twenty-three (72%) patients received at least one of the recommended antibiotics. However, incorrect choice of additional antibiotic(s) was responsible for non-compliance of the overall prophylactic antibiotic regimen. Sixteen (70%) of 23 patients appropriately received the dose within the recommended 30 minutes before incision, and 23 (92%) of 25 patients were administered antibiotics for an appropriate duration. Five patients (15%) received no prophylaxis where prophylaxis was indicated. Conclusion: Prophylactic antibiotic regimen was not compliant with hospital guidelines for the majority of surgical procedures. Further education and consultation with gastrointestinal surgical teams is required to ensure the rationale for the hospital guideline recommendations is communicated effectively.

Antibiotic compounding of 24-hour infusors as a stop-gap measure in home IV therapy

Kelly Cairns1, Pauline Dobson1, Mark Loewenthal1, Narelle Orford1, Jennine Lemessurier1, Karen Roberts1, Amanda Madden1 1 John Hunter Hospital, NSW Correspondence: kelly.cairns@hnehealth.nsw.gov.au

Aim: To describe the process and outcomes of nurse-compounding of antibiotics into pre-loaded 0.9% sodium chloride infusors for 24-hour administration in home intravenous (IV) therapy. Methods: Baxter® elastomeric infusor devices are commonly used to administer 24-hour infusions of antibiotics for patients receiving hospital in the home services for a variety of infections. There may be a two to three day delay between ordering of compounded infusors and their delivery. This often leads to the need for stop-gap infusions to cover a couple of days—when there is an urgent need to discharge a patient from hospital on the day of referral, or the patient’s treatment changes due to allergy or suboptimal clinical response. Current best practice for preparation of 24-hour infusions is that compounding occurs in an aseptic suite. We describe the compounding process implemented by our home IV therapy service and related patient outcomes from our clinical database. The principles incorporated into nurse loading of intravenous antibiotics are that:

x x x x x

antibiotics must be suitable for 24-hour infusion infusions are loaded immediately prior to use aseptic technique is used infusions are loaded in a clean clinical area infusions are double-checked by a second nurse.

Results: From May 2007, over 500 infusors (average 15 infusors/month) have been compounded by nurses for 24-hour administration, as stop-gap infusions. During this period, the rate of central venous catheter infection compares favourably with the international literature (0.16 per 1000 line days). Conclusion: Our service has demonstrated high success rates after long term follow-up of patients treated for serious infections, and low complication rates, including central venous catheter infections. We believe that nurse-loading of 24-hour infusor devices as a stopgap measure is a safe practice when strict guidelines are followed and aseptic technique is used.

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poster abstracts 7

Implementation of Guidance DS® in an established antimicrobial stewardship service

Kelly Cairns1, Jennifer MacDonald1, Robert Pearce1, Paula Doherty1, John Ferguson1, Mark Loewenthal1 1 John Hunter Hospital, NSW Correspondence: kelly.cairns@hnehealth.nsw.gov.au

Aim: To implement a new electronic decision-support system (Guidance DS®) into an established antimicrobial stewardship service. Methods: Antimicrobial stewardship has been a strong component of clinical service provision in this hospital for 15 years resulting in reduced use of broad spectrum antimicrobial agents when compared with other hospitals participating in the National Antimicrobial Utilisation Surveillance Program (NAUSP) and low resistance rates. A key component of the stewardship program was the online Anti-Infective Registration system (AIR) introduced in 2005, however this has been superseded in recent years by Guidance DS®. Guidance DS® has been successfully implemented in Victorian and Tasmanian hospitals however had yet to be implemented in other states around Australia. We describe the process of Guidance DS® implementation as the pilot site for this state. This hospital has had the majority of Australian Commission on Safety and Quality in Healthcare essential strategies for antimicrobial stewardship programs in Australian hospitals in place for many years, including clinical guidelines that are consistent with the latest version of Therapeutic Guidelines: Antibiotic, formulary restrictions and approval systems for broad spectrum antimicrobial therapy and a review and audit process for antimicrobial prescribing. Implementation strategies for Guidance DS® included: review of existing clinical guidelines; notification and promotion of Guidance DS® through both internal hospital services and external media sources; introduction of daily antimicrobial stewardship rounds; promotion of the decision-support component of Guidance DS® to users; education and training of medical officers and pharmacists; retrospective assessment of effectiveness of Guidance DS® implementation. Results: Guidance DS® was successfully implemented at this hospital. Antimicrobial stewardship ward rounds were introduced at the same time and have successfully been incorporated into daily clinical practice. Conclusion: This hospital has successfully implemented a new electronic decision-support system into an established antimicrobial stewardship program.

Adherence to an AUC gentamicin dosing and monitoring system

Penelope Collins1, Miriam Lawrence1 1 The Canberra Hospital, ACT

Correspondence: pene.collins@act.gov.au

Aim: To assess adherence to an area under the curve (AUC) gentamicin dosing and monitoring system in a tertiary referral hospital. Method: A new gentamicin dosing and monitoring system was implemented at our institution at the end of 2008. The new system specified initial weight based dosing and our pathology system, using a target AUC of 100mgL-1hr recommended a subsequent gentamicin dose. Clinicians were required to send the mandatory information (patient weight, gentamicin dose and time of dose) with the blood sample to pathology. Because of the complexity of the system and the change in practice, extensive education at both ward level and intern orientation was provided. We conducted a retrospective review of patients on gentamicin to assess adherence to the new system. Data collected included appropriateness of dose, use of the AUC system and frequency of dose recommendations. Results: One hundred patients on gentamicin from February and June 2009 were reviewed. Only 25% of these patients were given the correct weight based initial dose. Seventy-five per cent of patients had a level taken after the first dose, but only 20% were taken at the appropriate time. The AUC system was used 36% of the time, however due to imperative information missing from the pathology form a dose recommendation was only made on 23% of these occasions. Conclusion: Although extensive education and training was conducted, adherence to the AUC dosing and monitoring system is still not routine. The system’s complexity has limited compliance to date. In order to optimise its use, further education and potential simplification is required.

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poster abstracts 9

Validation of a pharmacokinetic prediction system for vancomycin dosing

Carmela Corallo1, Maya Nunn1,2, Cecile Aubrun3, Susan Poole1,3, Michael Dooley1,3, Frances Ng1, Allen Cheng1,3 1 The Alfred Hospital, VIC, 2University of Nottingham, UK, 3Monash University, VIC Correspondence: c.corallo@alfred.org.au

Aim: The aim was to audit vancomycin dosing and serum levels and evaluate a pharmacokinetic simulation program by comparing predicted and observed levels, with a view to implementing a pharmacy-based pharmacokinetic service for vancomycin. Methods: Patients receiving vancomycin were identified through the therapeutic drug monitoring reports received from the pathology department. Patient information was obtained from medication charts and medical records which were located on wards. Data was entered into the MM-USC*Pack program (Jelliffe R, University of Southern California, 2008, version 12.10). The program was used to predict initial and subsequent levels of vancomycin based on patient parameters. The program was validated by comparing the predicted levels to the observed levels. Results: In a six-week period, 204 levels were measured in 77 patients. The most common dosing regimen was 1g every 12 hours and 58.4% of patients had sub-therapeutic ( 10 mg/L) initial trough levels. Overall, 159 of 204 (77.9%) predicted levels were within 5 mg/L of the observed levels. The median absolute prediction error was 2.8 mg/L, with a correlation coefficient of 0.61. Conclusion: The results of this study confirm those of previous audits and reinforce the necessity for the implementation of such a pharmacokinetic service for vancomycin. The program was able to predict vancomycin levels across a heterogeneous patient population.

10 Appropriateness of restricted antibiotic use: the impact of Guidance DS Osbert Cotta1, Jonathan Darby2, Hiu Tat Chan2, Alistair Reid2, Kirsty Buising2 1 St Vincent’s Hospital, NSW, 2Monash University, VIC Correspondence: cottamo@svhm.org.au

Aim: We aimed to evaluate the impact of Guidance DS®, an electronic antimicrobial approval system, on the appropriateness of restricted antibiotic use. Methods: The study was conducted over two 14-week periods (seasonally adjusted) on one multi-unit hospital floor pre and post Guidance DS® deployment. A research team consisting of a pharmacist, a microbiologist and a infectious diseases (ID) specialist prospectively evaluated each patient daily. They assessed each patient’s clinical state, indication for antibiotic use, microbiology results and considered available prescribing guidelines to determine whether restricted antibiotic therapy was appropriate. Prescribers were blinded to the study. A time series evaluation was used to describe the appropriateness of prescribing over time with linear regression used to assess trends. Results: 107 patients were assessed pre intervention and 86 post intervention. 33% and 44% met SIRS criteria. 26% and 25% in each group had a bacterial pathogen isolated and empiric treatment was used in 55% and 63% respectively. Post implementation, the likelihood of appropriate antibiotic therapy improved (OR 1.698, p=0.071), particularly for empiric treatment (OR 2.105, p=0.051). The ID unit was also more likely to be involved in care (OR 4.240, p<0.001). The appropriateness of prescribing was declining over time pre intervention (OR –0.428 p<0.0001). Post intervention the appropriateness over time plateaued (OR 0.186, p=0.135). The difference in the trends in prescribing behaviour between the two periods was significant (OR 3.863, p=0.013). Conclusion: This study describes a rigorous method for assessing appropriateness of antibiotic use on an individual patient level by a multidisciplinary input. Guidance DS® introduction was associated with improvement in the appropriateness of restricted antibiotic prescribing, possibly by initiating ID service to more patients.

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poster abstracts 11 Adherence to prophylaxis guidelines in patients that develop symptomatic venous

thromboembolismâ&#x20AC;&#x201D;where are we at? A retrospective hospital audit at Royal Darwin Hospital Pascale Dettwiller1, Joseph De Zylva1, Mark Naunton1, Ferenc Szabo2 1 Charles Darwin University, NT, 2Royal Darwin Hospital, NT Correspondence: joseph.dezylva@students.cdu.edu.au

Venous thromboembolism (VTE) is a significant contributor to morbidity and mortality associated with hospitalisation. Common VTE risk factors include age, pregnancy, obesity, smoking and genetic predispositions. Hospitalisation generally confers a greater risk of VTE than travelling. Surgical intervention associated with trauma, orthopaedic, neurologic, or major surgery, confer a substantial risk. Medical risk factors include coagulation disorders: history of VTE, diseases affecting venous perfusion or arterial perfusion, heart failure, inflammation, respiratory disease, diabetic ketoacidosis and nephrotic syndrome. A number of medications are also implicated, including oestrogen hormonal preparations and erythropoeitic agents. Evidence based practice is utilised when selecting the appropriate treatment or prophylaxis agent for VTE. This includes enoxaparin, dalteparin, unfractionated heparin, warfarin, Factor Xa inhibitors and mechanical devices. There is increasing evidence supporting the use of direct thrombin inhibitors but special consideration is necessary for pregnancy, renal impairment, and heparin induced thrombocytopenia. The proposed research project is aimed at assessing the adherence to current hospital guidelines for VTE prophylaxis and the use of treatment agents amongst patients in Royal Darwin Hospital (RDH). The project consists of a retrospective audit of medical records from January 2007 to June 2010, with candidates/patients being aged >18 years with a diagnosis of symptomatic VTE. The results from the research project will identify both adherence rates and the risk factors implicated in patients that develop symptomatic VTE. Data collection will occur during July 2010 and the results of the audit will be available for publication by December 2010. The audit is part of an ongoing quality assurance strategy aimed at assessing the need for dedicated VTE prophylaxis staff. Conclusions will be drawn on how to improve adherence to current guidelines, in the context of the Northern Territory, and the available resources to achieve this.

12 Macrolides on the menuâ&#x20AC;&#x201D;azithromycin and delirium Emily Diprose1 1 Calvary Health Care, ACT

Correspondence: emily.diprose@calvary-act.com.au

Objective: To discuss a case of possible azithromycin induced delirium and to improve awareness of neuropsychiatric side effects of macrolides. Clinical features: A 52-year-old male with a history of depression, reflux, hypertension and SLE, presented with severe chest pain and dizziness post a fall at home. He was a heavy smoker and drinker and lived at home with his wife. Initial differential diagnoses included ACS or PE, however these were excluded and multiple rib fractures were discovered. Interventions, case progress and outcome: He was admitted to HDU with uncontrolled pain and deteriorating lung function where he was sedated, ventilated, and treated for bilateral, lower lobe CAP. Empiric antimicrobial therapy included ceftriaxone and azithromycin, followed by a change to various penicillins for a sensitive S. aureus in sputum. Following a further decline in lung function and repeated temperature spikes a second course of azithromycin was introduced. He was difficult to sedate throughout the admission, and was easily agitated due to pain and presumed alcohol withdrawal. Post extubation he experienced alternating levels of orientation, hallucinations and paranoia and at one stage he insisted he had enjoyed a BBQ with the treating doctors. After 16 days in the HDU, all antimicrobials were ceased, he became more lucid and was discharged to the ward two days later. A search of the literature revealed two other case reports suggesting a possible link between azithromycin and delirium with visual hallucinations being a common theme. Conclusion: Clarithromycin and erythromycin are known to cause neuropsychiatric adverse effects. Only recently have these side effects been reported with the structurally different macrolide, azithromycin1. Although it is difficult to attribute the patientâ&#x20AC;&#x2122;s delirium solely to the use of azithromycin, there was a definite association between the onset and resolution of symptoms and the initiation and cessation of the drug.

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poster abstracts 13 Drug utilisation evaluation—a natural partner in antimicrobial stewardship Paula Doherty1, Belinda McLachlan1, Carolyn Young1 1 Hunter New England Health Service, NSW Correspondence: Paula.Doherty@hnehealth.nsw.gov.au

Aim: The drug utilisation evaluation (DUE) service plays a partnership role within a multidisciplinary, multi-site antimicrobial stewardship program. Method: An antimicrobial stewardship program has developed in the decade since the implementation of a DUE service. This service initially was within one tertiary referral hospital and has now expanded across multiple sites within the Area Health Service. The service consists of one 0.8 FTE pharmacist and two 0.8 FTE technicians and sits within the pharmacy department. The stewardship program is run by the Antimicrobial Working Party consisting of microbiologists, infectious diseases physicians, pharmacy management, infectious diseases pharmacist and the DUE pharmacist. Result: The DUE service has responsibility for five aspects of the antimicrobial stewardship program:

DUE program—stewardship related activities form a large proportion of the program. Current projects include reviews of surgical antibiotic prophylaxis and treatment of community acquired pneumonia across multiple sites.

Restricted anti-infective reporting—an effective restricted anti infective policy has resulted in the ongoing success in limiting over use of third generation cephalosporins. With the imminent implementation of the Guidance® program this function will expand.

Clinical practice guidelines (CPGs)—distribution of CPGs on lanyard size cards. The service coordinates the production and area wide distribution.

Antibiotic usage reports—for drug and therapeutic committees and departments.

Coordination of usage reporting to National Antimicrobial Utilisation Surveillance Program (NAUSP). Participation since the programs inception has allowed bench marking with similar institutions. From 2009 all major sites within the area within our health service contribute data. This will play a major role in the future expansion of the stewardship program.

Conclusion: The service has evolved from a project based service to an integral part of a multidisciplinary team. It has taken responsibility for much of the evaluation phase of the antimicrobial stewardship program across the area.

14 Fungal bone infection post hemispherectomy in a paediatric patient Courtney Emerson1 1 Royal Children’s Hospital, QLD

Correspondence: courtney_emerson@health.qld.gov.au

Objective: To evaluate the treatment options for an aspergillus bone infection at a surgical site, with particular focus on voriconazole, caspofungin and posaconazole. Clinical features: Patient EK is a 6-year-old female who has undergone a previous hemispherectomy for intractable seizures. Ten months following surgery EK developed an aspergillus infection in the skull bone flap at the surgical site. Interventions, case progress and outcome: EK was commenced on voriconazole and the dose was titrated to 200mg twice daily. Six weeks after commencement of voriconazole she developed rash and blistering. Voriconazole was ceased and caspofungin was commenced as IV home therapy. The patient re-presented to hospital twice in two weeks with bacterial line infections requiring IV antibiotics. Further brain scans revealed progression of infection to deeper skull bone. As a result of these two complicating factors the treating team investigated the use of posaconazole. There is limited information in the literature on the cross-sensitivity between voriconazole and posaconazole. Anecdotal experience in the institution suggested that the risk of skin reaction recurring with posaconazole following reaction with voriconazole was low. After discussing with the family, posaconazole was initiated. Terbinafine was also added for synergistic effect. EK responded well to treatment and showed no signs of cross-sensitivity. The surgical site healed well with no sign of progression of infection. Conclusion: While the use of evidence based medicine to improve patient outcomes is ideal, it is not always practical or possible. Progression of the bone infection would lead to removal of the bone flap, having a devastating impact on the physical appearance of the patient. The infection needed to be treated aggressively by the best available agent, which in this case was posaconazole. This case required careful consideration of the risk/benefit relationship by the patient’s family and treating team.

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poster abstracts 15 Optimising posaconazole usage as antifungal prophylaxis in acute leukaemia Jade Eyles1, Lisa Ho1 1 Austin Health, VIC

Background: The implementation of guidelines for antifungal prophylaxis in patients with acute myeloid leukaemia or acute lymphoblastic leukaemia pre-allogeneic stem cell transplant resulted in a greater than anticipated increase in posaconazole expenditure. Aim: To evaluate the effectiveness of a multifaceted intervention aimed at optimising cost-effective use of posaconazole. Methods: Patients who received posaconazole for antifungal prophylaxis according to the guideline were identified from pharmacy dispensing records. A pharmacist extracted data retrospectively from medical and dispensing records using an explicit data collection tool. Pre-intervention data was collected between June 2009 and February 2010. Post-intervention data was collected between March and May 2010. Pre-intervention data informed the content of the intervention. The intervention involved optimising use of the PBS scheme for eligible patients and educating pharmacy and nursing staff about the cost of posaconazole and methods to minimise wastage (e.g. storing individually dispensed in-patient stock in the pharmacy for use during the patient’s next admission). Results: 19 and 11 patients in the pre- and post-intervention periods, respectively, were commenced on posaconazole for antifungal prophylaxis according to the guidelines. Pre-intervention, 47% of posaconazole expenditure was PBS reimbursable. This increased to 70% after the introduction of the intervention (p<0.001). Monthly net expenditure has significantly declined from $17 852r3 776 preintervention to $5 254r2 010 post intervention (p=0.001). Qualitative data suggests that staff awareness of posaconazole costs and wastage minimisation has greatly improved. Conclusion: Targeted interventions have been effective in optimising posaconazole usage and minimising hospital expenditure.

16 Aminoglycoside training program—impact on prescribing and monitoring Pamela Fernando1, Lisa Ciabotti2, Wendy Ewing2, Bronwyn Allan2, Ian Larmour2, Kelly Pountney2 1 Southern Health—Casey Hospital, VIC, 2Southern Health, VIC Correspondence: pamela.fernando@southernhealth.org.au

Aim: To assess the impact of a new aminoglycoside training program on the prescribing, administration and monitoring of aminoglycosides. Methods: The results of an audit conducted in 2008 assessing use of aminoglycosides showed poor adherence to local guidelines. A Therapeutic Drug Monitoring Committee was formed to identify knowledge gaps and develop a targeted education program for pharmacists and nursing staff based upon areas for improvement identified in the audit:

x x x x

prescribing of initial doses according to patient’s age, weight and renal function duration of infusion performing aminoglycoside levels on the first dose (for area under the curve calculations) ensuring levels are reviewed prior to administration of the next dose.

Lanyard tag and revised monitoring forms were introduced together with improved access to electronic dosing decision-support tools. A training manual for pharmacist to complete prior to participation in small group tutorials was also created as well as a presentation for pharmacists to present to nursing staff at a local level. The audit was repeated in 2009 to assess the impact of the training program. Results: Prescribing of appropriate initial doses increased from 19% in 2008 to 36% in 2009 for adults and remained at 74% in 2008 and 76% in 2009 for paediatric patients. In 2009, 71% of infusions were administered over the recommended duration of 30 minutes, compared with 59% in 2008. Performing of aminoglycoside levels on the first dose remained consistent with 49% in the initial audit and 47% in the subsequent audit. In 2009, 81% of patients with a toxic or subtherapeutic aminoglycoside concentration had their doses adjusted or reviewed prior to administration of the next dose, compared to 52% in 2008. Conclusion: The aminoglycoside education program has led to increased awareness and knowledge about aminoglycosides resulting in increased concordance with local guidelines.

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poster abstracts 17 Exogenous pyocyanin alters

Pseudomonas aeruginosa susceptibility to ciprofloxacin

Lee Gloyne1, Gary Grant1,2, Tian Tian Zhang1, Milton Kiefel4, Anthony Perkins3, Shailendra Anoopkumar-Dukie1 1 School of Pharmacy, Griffith University, QLD, 2Griffith Health Institute, Griffith University, QLD, 3School of Medical Sciences, Griffith University, QLD, 4Institute for Glycomics, Griffith University, QLD Correspondence: l.gloyne@griffith.edu.au

Pseudomonas aeruginosa is the major pathogen in the cystic fibrosis (CF) lung with pyocyanin being a critical component of its virulence. Prevalence is high and, once acquired, chronic infection is difficult to eliminate. Ciprofloxacin remains a crucial oral agent effective against P. aeruginosa, but resistance is increasingly reported. Here we examined the extent to which exogenously added pyocyanin affected P. aeruginosa susceptibility to ciprofloxacin, and the contribution of altered efflux activity and biofilm production. Metabolic conversion of resazurin to resorufin was used as an index of bacterial cell growth while fluorescent measurement of acriflavine efflux and crystal violet staining was used as markers of efflux activity and biofilm production, respectively. Pyocyanin (100 M) added exogenously decreased susceptibility of two P. aeruginosa strains, PAO1 and ATCC 27853 to ciprofloxacin at 125Pg/L and 500Pg/L, respectively. Exogenously added pyocyanin decreased efflux activity in both strains while biofilm production was significantly increased. We conclude that increased biofilm production may contribute to the observed decreased susceptibility of P. aeruginosa to ciprofloxacin.

18 Azithromycin eye drops for the treatment of Mycobacterium fortuitum keratitis Judith Hampson1, Cathy Vlouhos1, Philippa McGann1 1 Sydney and Sydney Eye Hospital, NSW

Correspondence: judith.hampson@sesiahs.health.nsw.gov.au

Objective: To report a case of mycobacterium fortuitum keratitis and its treatment with azithromycin eye drops. Clinical features: An 80-year-old female was admitted to the hospital with a corneal abscess. Initial corneal scrapings identified fortuitum keratitis complex with sensitivities to ciprofloxacin, amikacin and imipenem. Case progress: On admission topical and oral ciprofloxacin as well as gentamicin eye drops were commenced but clinical features continued to deteriorate. After extensive review with infectious diseases consultants, amikacin eye drops and intravenous meropenem were commenced and oral ciprofloxacin ceased. Further corneal scrapings and biopsy identified sensitivities to clarithromycin and azithromycin as well as amikacin and ciprofloxacin and resistance to imipenem. Treatment was changed to oral azithromycin and topical azithromycin was requested. Azithromycin 1% eye drops were prepared and administered twice a day. Intrastromal, intracameral and topical amikacin were also given. Outcome: Despite intensive treatment a subclinical corneal perforation led to the decision to perform a corneal graft. Topical azithromycin was continued for two weeks and topical amikacin was continued for four months post graft to prevent recurrence of infection. Months later, no recurrence of infection was seen in the graft. Conclusion: Limited treatment options are available for ocular infections caused by organisms sensitive to macrolides. The availability of a formulation for the preparation of azithromycin 1% eye drops gives clinicians an option for topical treatment of ocular infections sensitive to macrolides.

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poster abstracts 19 A retrospective review of the use of nitazoxanide in treating Cryptosporidium in

children in Alice Springs Hospital Sophie Higgins1, Joan Yeung1, Robert Roseby1 1 Alice Springs Hospital, NT

Background: Persistent diarrhoea due to Cryptosporidium in the setting of malnutrition is a common reason for admission to hospital in Central Australia. Nitazoxanide has been shown to be effective in reducing the duration of both diarrhoea and oocyst shedding in cryptosporidiosis, especially in immunosuppressed individuals. We began using nitazoxanide at Alice Springs Hospital in 2006 for children with the combination of cryptosporidium diarrhoea and malnutrition. This study is a review of our first two yearsâ&#x20AC;&#x2122; experience of managing this condition with this drug available under the Special Access Scheme (SAS) in this country. Methods: Paediatric inpatients who were treated with nitazoxanide since 2006 were reviewed. Data was collected from hospital medical record and local community clinics. Findings: 105 children admitted to Alice Springs Hospital between November 2006 and June 2009 were diagnosed with cryptosporidium. 46 (41.9%) were treated with nitazoxanide. 29 of the 46 treated patients were considered to have failure to thrive on admission. At follow up (mean duration of 7 months), 66% of the treated group made a positive change of weight-for-age z-score. Conclusion: The majority of patients treated with nitazoxanide had a positive weight for age change. This suggests that nitazoxanide is useful in the treatment of cryptosporidium infection. Ongoing investigation of this treatment option appears warranted in Australia.

20 Improving once daily gentamicin prescribing at a tertiary teaching hospital: we need

more than just education Karim Ibrahim1, Sharna Glover1, Anmol Pasricha1 1 St Vincentâ&#x20AC;&#x2122;s Hospital, NSW Correspondence: kibrahim@stvincents.com.au

Aim: To evaluate the impact of implemented educational interventions on gentamicin use at a tertiary teaching hospital with respect to initial dose selection, therapeutic drug monitoring (TDM) and length of therapy. Methods: This audit was conducted over a five-week period in May/June 2010. Patients were identified prospectively during routine pharmacistsâ&#x20AC;&#x2122; ward rounds and their medical notes and computerised pathology resources were reviewed retrospectively. The results were compared to those of a gentamicin audit performed in 2008, prior to educational interventions implemented to promote evidencebased gentamicin prescribing and monitoring. Chi-squared test was used to compare outcomes from the pre and post interventions groups. Results: 43 patients were included in this analysis, compared to 44 patients in the previous audit. In the post-intervention group 34.9% (15/43) of patients were prescribed initial doses in accordance with hospital guidelines compared with 29.5% (13/44) in the preintervention group (p=0.6). TDM was performed in 66.7% (14/21) of gentamicin courses that required monitoring compared with 67.9% (19/28) in the pre-intervention group (p=0.93). There was a trend towards improvement in the number of appropriate blood sampling times [64.3% (9/14); 2010 vs 58% (11/19); 2008] (p=0.7), and in the number of courses fully compliant with the hospital policy in terms of TDM and subsequent dosing adjustments [23.8% (5/21); 2010 vs 14.2% (4/28); 2008] (p=0.4). Duration of therapy was considered inappropriately long in 1 patient (2.3%) post-intervention compared with 6 patients (13.6%) (p=0.052) pre-intervention. Conclusion: Although the results were not statistically significant, it appears that education has some impact on improving prescribing patterns. This audit has highlighted the need for further interventions, such as software decision-support tools to assist in gentamicin prescribing and monitoring practices, as education alone is not enough to bring about significant changes.

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poster abstracts 21 Delineating drug disposition of antimicrobials in patients undergoing ECMO Kristen Joyce1,2 1 UnitingCare Health Pharmacy, 2Critical Care Research Group Correspondence: Kristen.Joyce@uchealth.com.au

Aim: To determine the extent to which antimicrobial pharmacokinetics are altered when administered during extracorporeal membrane oxygenation (ECMO). Background: ECMO is a modified form of extracorporeal circulation allowing extended life support for patients with severe acute respiratory or cardiorespiratory failure. Patients requiring ECMO have an increased risk of serious infections due to the invasive nature of the support and prolonged exposure of blood to the circulating system. These patients often have multi-organ failure and immunosuppression, further increasing the risk of infection. Significant changes to drug pharmacokinetics occur during ECMO which can complicate provision of optimal antimicrobial therapy. Understanding and compensating for these changes are imperative for improving patient outcomes. Methods: Phase I was to conduct a literature review using EMBASE, Pubmed and Medline to identify pharmacokinetic studies of antimicrobials administered during ECMO. Phase II will be undertaken to analyse target drugs on ex vivo and in vivo models of ECMO. Results: ECMO alters pharmacokinetic parameters through:

x x x x

increased volume of distribution changes to drug elimination loss of drug through inactivation adsorption and sequestration by ECMO components.1

Antimicrobial properties such as solubility and protein binding determine the extent to which drug disposition will be affected by ECMO. Optimal antimicrobial dosing while on ECMO has been identified as a knowledge gap and further study is required before dosing recommendations can be made. To date dosing guidelines are available for gentamicin and vancomycin. Conclusion: The importance of achieving adequate antimicrobial concentrations at the site of infection, along with the narrow therapeutic windows and potentially severe toxicities common to these agents, has prompted the Critical Care Research Group to study target drugs within this class on ECMO. Phase II aims to expose the mechanism and extent pharmacokinetics are altered by ECMO and to develop appropriate dosing regimens for critical care centres.

22 Assessment of bolus intravenous gentamicin administration versus infusion Mona Khalessi-Rad1, Greg Roberts2 1 Flinders Medical Centre, SA, 2Repatriation General Hospital, SA

Aim: Determine if rapid bolus intravenous (IV) administration of high-dose gentamicin over three minutes is associated with transient rate-related side-effects compared to conventional administration of gentamicin 1mg/mL solution over 30 minutes. Background: Guidelines recommend doses up to 240mg can be administered as an IV bolus over 2â&#x20AC;&#x201C;5 minutes, but doses greater than 240mg be diluted and infused over 20â&#x20AC;&#x201C;120 minutes. Transiently high gentamicin concentrations seen after bolus doses are not linked to known adverse effects of gentamicin, including nephrotoxicity and ototoxicity. Bolus administration offers higher peak concentrations and thus efficacy, increased patient convenience, and savings in cost and time. Methods: Patients receiving at least two doses of gentamicin of 240mg or greater were randomised to receive undiluted IV bolus injection over three minutes on one occasion and 1mg/mL infusion over 30 minutes on another. Power calculations indicate 73 patients were needed to detect a 10% difference in the incidence of any side effects. Patients rated side effects from 0 (no effect) to 10 (worst effect) immediately pre-dose and at 15, 30 and 60 minutes after administration. These included pain, swelling and redness at the injection site, tinnitus, dizziness, headache and nausea. Results: The mean administration rate in the bolus arm was 88+41mg/min (range: 16mg/min to 160mg/min) and 10+3mg/min (range: 6mg/min to 16mg/min) in the infusion arm. To date (n=17) no patient has experienced discernible side effects related to an increased administration rate of up to 160mg/min. In depth statistical analysis will be performed upon recruitment of greater numbers. Conclusion: At this early stage, bolus administration of IV gentamicin appears to be a viable option that will offer a more sensible dosing approach, both logistically (time and resources), and clinically (efficacy).

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poster abstracts 23 Assessment of pneumococcal and influenza virus vaccination status in medically at

risk patients admitted to the emergency department of a metropolitan public hospital. Anna Klusak1, Sally Marotti1, Narin Bak1 1 The Queen Elizabeth Hospital, SA

Correspondence: anna.klusak@health.sa.gov.au

Aim: To determine the proportion of patients deemed medically at risk of developing invasive pneumococcal disease (IPD) or complications from influenza virus infection admitted to the emergency department (ED) with a negative or unknown vaccination status. A secondary aim was to determine the proportion of patients with negative or unknown vaccination status that were willing to consent to being immunised whilst in hospital. Methods: Patients presenting to the ED over a seven day period were interviewed by a pharmacist. Pharmacists recorded each patient’s current vaccination status and assigned risk categories for the development of IPD or complications from influenza virus infection. Patient’s willingness to consent to being vaccinated if deemed medically appropriate while an inpatient was also recorded. Vaccination status and consent was communicated to the medical team. Results: Of the 319 patients admitted, 154 (48%) had their vaccination status assessed. Of these, 87 (56%) and 48 (31%) were assessed as being medically at risk and had either not been vaccinated against pneumococcal disease and influenza virus respectively, or their vaccination status was unknown. Of these, 52 (60%) would consent to being vaccinated against pneumococcal disease and 32 (67%) against influenza virus while an inpatient if deemed appropriate. Conclusion: A significant number of patients presenting to the ED do not have current vaccinations for pneumococcal disease or influenza virus and are at risk of developing IPD or complications from influenza virus infection. A large proportion of these patients would consent to being vaccinated during their hospital admission if deemed medically appropriate. Hospital pharmacists may have a valuable role to play in preventing significant morbidity and mortality associated with these infections by identifying at risk patients in whom immunisation is indicated.

24 Prescribing and safety issues of oral molecular therapies and chemotherapies in

Australian haematology oncology practice Maria Larizza1, Michael Dooley1,2, Susan Poole1,2, Christine Carrington3 1 Alfred Health, VIC, 2Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, VIC, 3Princess Alexandra Hospital, QLD Correspondence: m.larizza@alfred.org.au

Aim: With the increasing use of oral therapies for the treatment of cancer, it is important to understand the extent to which safe prescribing practices are employed. The aim was to determine the prescribing practices of oncologists and haematologists regarding oral molecular and chemotherapy medications across various practice settings in Australia. Methods: Ethics approval was obtained. A 19-question survey was developed, based, with permission, on that of Weingart et al (BMJ 2007); examining aspects of prescribing and supply of oral chemotherapy and molecular therapies. The survey was distributed to all 203 medical oncologist and haematologist members of Medical Oncology Group of Australia (MOGA) and/or Clinical Oncology Society of Australia (COSA) in April 2008. Results: 84 surveys were returned (41% response rate). Ninety per cent of respondents agreed that oral molecular medications should be prescribed and supplied using the same procedures as oral chemotherapy. 21–45% of prescribers state that they prescribe the exact number of tablets/capsules required for each cycle for commonly used oral chemotherapies (capecitabine, temozolomide, vinorelbine, etoposide) and molecular therapies (gefitinib, imatinib, sunitinib, erlotinib). One third of respondents stated that they always assess a patient’s adherence to oral chemotherapy and molecular therapies. In the past year, 43% of prescribers reported at least one medication error relating to oral chemotherapy and 15% relating to oral molecular therapies in the ambulatory setting. The vast majority of prescribers treating patients in the public setting have oral chemotherapy and molecular therapy prescriptions checked by an oncology pharmacist. Significantly fewer of these prescriptions are checked by an oncology pharmacist in private practice. Conclusion: There is significant variability in the prescribing of oral chemotherapy and molecular therapies among oncologist/haematologists which could contribute to potential for error.

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poster abstracts 25 Cryptococcal meningitis complicated by vancomycin-induced DRESS syndrome Yuet Han (Joyce) Liew1, Briony Hazelton2 1 Department of Pharmacy, The Children’s Hospital at Westmead, NSW, 2Microbiology/Infectious Disease Department, The Children’s Hospital at Westmead, NSW Correspondence: joyceL1@chw.edu.au

Objective: To describe a case of Cryptococcus gattii meningitis complicated by vancomycin-induced DRESS syndrome. Clinical features: A 12-year-old boy presented with severe headache resulting in abnormal behaviour with a history of intermittent headache in the last two weeks. He was previously healthy with no evidence of a chronic disease, past behavioural problems or recent overseas travel. The patient also had high intracranial pressure, double vision, low-grade fever with no sudden weight loss. His cerebrospinal fluid (CSF) grew Cyptococcus gattii which was treated and subsequently discharged home on antifungal therapy. He was re-admitted after a month when he presented again with headache and fever, thought to be a relapse of cryptococcal meningitis and a suspected staphylococcal infection where he received vancomycin. The patient then developed a widespread erythematous rash, acute renal failure, hepatitis, coagulopathy, cytopenia, and pericarditis as well as raised inflammatory markers and eosinophilia. This was consistent with a syndrome known as drug reaction with eosinophilia and systemic syndrome (DRESS). Interventions, case progress and outcome: The patient was initially treated with four weeks of intravenous conventional amphotericin B and flucytosine for Cryptococcus gattii for four weeks. His symptoms resolved and he was discharged on maintenance therapy of oral fluconazole. In the re-admission, the DRESS syndrome was suspected to be caused by vancomycin. He was treated with two doses of intravenous immunoglobulin 1g/kg which resolved the fever and skin erythema. His CSF culture did not grow Cryptococcus and subsequently received high dose prednisolone (2mg/kg/day) after which he had significant clinical and biochemical improvement. He is currently maintained on weaning regimen of oral steroids and fluconazole. Conclusion: Early identification of DRESS syndrome by vancomycin is treatable and is potentially life-saving.

26 Multi-access from single use vials versus single use of single use vials: a cost

comparison audit Patrick Mannion1, Usha Ritchie1, Sean Turner1 1 Women’s and Children’s Hospital

Background: Multi-access from single use vials (MASUV) is a cost-containing practice where multiple doses are extracted from a vial intended for single use. The practice is seen in neonatal/paediatric settings where marketed vial sizes are inappropriate for small doses, resulting in waste and expense for the institution. This practice is considered low-risk if correct aseptic technique is used, however, inherent risks of infection contamination, propagation of reconstitution errors and contravention of licensed product information make the practice suboptimal when compared to using single use vials (SUV) as intended. Aim: To measure the prevalence of current, accepted MASUV practice over a 24-hour period and extrapolate the annual cost implications of implementing the optimal SUV practice throughout a specialist neonatal and paediatric hospital. Methods: Data was collected over three days during March 2010. Inpatient medication charts from specified clinical areas were reviewed for administration of certain intravenous (IV) medications over the previous 24 hours. IV medications were included if they were in vial preparations, the product information specified single use only and the hospital’s IV guidelines permitted MASUV. The numbers of vials used and associated costs with each practice were determined. Results: 784 patients’ medication charts were reviewed. Daily costs of MASUV practice were estimated at $965 (consumables alone) and $1 817 (inclusive of nursing time). Daily costs of SUV practice were estimated at $1 194 and $2 166 respectively. The increase in annual cost associated with SUV practice would be $83 585 and $127 385 respectively. The nursing resource cost difference was found to be equivalent to 0.8 full time equivalent (FTE). Conclusion: Based on extrapolation of the data collected over the three days, it is anticipated that implementing a SUV practice across the hospital would incur an additional cost of $83 585 per annum based on consumables alone, and up to $127 385 per annum inclusive of nursing time.

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poster abstracts 27 Antibiotic surveillance data and its role in antimicrobial stewardship Vicki McNeil1 1 SA Health, SA

Correspondence: vicki.mcneil@health.sa.gov.au

Background: Antimicrobial stewardship (AMS) involves a systematic approach to optimising the use of antimicrobials. Measurement of antimicrobial consumption (surveillance) is a key element of AMS. Surveillance data can be used for benchmarking, to target interventions and to monitor usage trends following AMS interventions. Method: Member hospitals of an Australian surveillance program contribute antibiotic consumption data via pharmacy dispensing records. Collated usage rates of 18 classes of antibiotic, presented as defined daily doses (DDDs) per 1000 occupied bed days (OBDs), were charted over a 24-month period between 2008 and 2010 for 26 hospitals. Trend lines were examined to determine if usage increased, decreased or remained stable. Results: Overall trends were neither up or down for many antibiotic classes. However this often resulted from increases at some hospitals being offset by decreases at others. Of the 18 classes studied it was notable that usage of third generation cephalosporins increased in 12 out of 26 hospitals and carbapenem usage increased in 11 out of 26 hospitals, despite the overall trends being only minimally upwards. Other findings included usage of first generation cephalosporins, glycopeptides, lincosamides, nitroimidazoles and anti-pseudomonal penicillin/ -lactam inhibitor combinations increased in 50 per cent of member hospitals. Fluoroquinolone usage declined overall despite upward trends in nine hospitals. Conclusion: Although surveillance data cannot be used to determine appropriateness of prescribing directly, monitoring trends of antibiotic consumption, particularly of groups of antibiotics known to be associated with emergence of multi-resistant organisms and Clostridium difficile can be used to direct AMS interventions. In this way antibiotic surveillance can play an important role in improving patient outcomes and saving health care costs.

28 A drug utilisation evaluation of ceftriaxone Jade Merritt1, Tess Cardinal1, Stephanie Wiltshire1 1 Royal Adelaide Hospital, SA Correspondence: jnmerritt@bigpond.com

Aim: To evaluate the prescribing of ceftriaxone in the general medical wards at a teaching hospital. Methods: A prospective review was performed including all patients from the general medical wards who were prescribed ceftriaxone during a four-week time period (May to June 2010). Medical records were reviewed and data was collected on patient demographics, the documented indication for therapy, dosage regimen, duration of therapy and relevant culture and sensitivity data. Treatment was deemed appropriate if ceftriaxone was prescribed in accordance with the criteria outlined in the hospitalâ&#x20AC;&#x2122;s anti-infective restriction policy. Ceftriaxone dosage regimen and duration of therapy was required to be in agreement with the hospital guidelines for each indication. Results: Thirty-three general medical patients were prescribed ceftriaxone during the study period. Twenty-three of the 33 patients received ceftriaxone for lower respiratory tract infections, 6 patients were treated for urinary tract infections, 2 received empirical treatment for bacterial meningitis and 2 patients were treated for spontaneous bacterial peritonitis. Seventeen patients (52%) were not prescribed ceftriaxone in accordance with the anti-infective restriction policy. This included 14 of the 23 patients (61%) prescribed ceftriaxone for lower respiratory tract infections and 3 of the 6 (50%) being treated for urinary tract infections. Twenty-six patients (79%) were prescribed dosage regimens appropriate for their indication and 2 patients (6%) completed the recommended duration of treatment. The mean duration of ceftriaxone therapy was 4 days and no patient exceeded the recommended treatment period. Conclusion: A significant number of patients in the general medical wards were not prescribed ceftriaxone according to the hospital guidelines. Further education of prescribers and pharmacists may be warranted to improve adherence to these guidelines.

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poster abstracts 29 Neurological toxicity from cefepime—right drug, wrong dose Kelly Mulvogue1, Shannon Finn1, Jason Roberts1 1 Royal Brisbane and Women’s Hospital, QLD Correspondence: kellpaul@tpg.com.au

Objective: Cefepime is a fourth-generation cephalosporin used for the treatment of severe infections. Exposure-related serious adverse effects are rare but include encephalopathy and seizures. We report the case of a patient with chronic kidney disease administered inappropriate doses of cefepime that responded to treatment with intermittent haemodialysis. Clinical features: An 88-year-old Caucasian male was admitted to a tertiary referral hospital for pneumonia and acute-on-chronic kidney injury. Empiric antibiotics were commenced. On day three of admission, a blood culture specimen grew a Gram negative bacilli and a urine culture grew Pseudomonas aeruginosa. The infectious diseases team suggested a two-week course of cefepime. Cefepime was commenced at a dose of 2g IV twice daily. The patient’s creatinine clearance was estimated at 13ml/min. The patient developed encephalopathy and seizures from likely cefepime toxicity. Interventions: Cefepime was ceased and the patient received three intermittent haemodialysis treatments over four days. The seizures were treated with intravenous clonazepam and midazolam. Case progress: A cefepime level was taken. It was determined that the likely half-life in this patient from endogenous cefepime clearance was 13.5 hours compared with a half-life of 2.7 hours during intermittent haemodialysis. After the intermittent haemodialysis treatments, the final cefepime concentration was 5.2mg/L suggesting that the peak concentration prior to intermittent haemodialysis exceeded 400mg/L. Target concentration for Pseudomonas aeruginosa was 8mg/L. Outcome: The patient’s seizures and encephalopathy gradually resolved after efficient cefepime clearance with intermittent haemodialysis. Conclusion: Cefepime is a valuable antibiotic that is often restricted due to concerns regarding antibiotic resistance. This case provides an example of the adverse effects that can arise from cefepime. It demonstrates that inappropriate dosing can result in toxicity and that pharmacists have a vital role in ensuring appropriate, renally adjusted, doses are prescribed.

30 Use of a point prevalence study to assess appropriateness of antibiotic prescribing in

surgical patients at a major teaching hospital Roseleen O’Doherty1, Jennifer Kieran1, Bernard Hudson1, Sally Nicolson1 1 Royal North Shore Hospital, NSW

Aim: To assess the appropriateness of antibiotic prescribing in surgical patients and to identify targets for an antibiotic stewardship program. Methods: A point prevalence study of antibiotic prescriptions for surgical inpatients was undertaken over two consecutive days in December 2009. The prescription charts of all surgical inpatients were examined. Antimicrobials were identified and patient records reviewed to assess indications for use and appropriateness of prescriptions. Data was analysed using SSPS version18. Results: 178/179 (98%) prescriptions charts were examined. Of these, 95/178 (53%) patients were receiving antimicrobials. 140 antimicrobials prescriptions were identified with 19 different antimicrobials in use. Cephazolin was the most commonly prescribed antimicrobial 32/140 (22%). Three of the five most prescribed antimicrobials were cephalosporins. The majority of antimicrobials were administered intravenously 115/140 (82%). The most common reason for an inappropriate prescription was an inappropriate duration of treatment. 35/140 (25%) of antimicrobials were prescribed for surgical prophylaxis. Of these, 15/35 (42%) were considered inappropriate, due to antibiotic surgical prophylaxis duration >1 day. A cost analysis of these prescriptions was performed including drug costs, medical time and cost of cannulation equipment and nursing time for drug administration. These prescriptions were responsible for 78 excess patient-days of therapy and represented a cost of $1 406. Conclusion: The study highlighted that prolonged duration of surgical prophylaxis is the most frequent reason for inappropriate antimicrobials. It also demonstrated good adherence to current stewardship initiatives. Strategies to improve education and adherence to guidelines should result in considerable cost savings and better patient outcomes.

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poster abstracts 31 Audit of osteoporosis prophylaxis in heart and lung transplant recipients Devang Rai1, Fay Burrows1, Diane Tran2, Paul Lee1, Alan Glanville1 1 St Vincent’s Public Hospital, NSW, 2University of Queensland, QLD Correspondence: devang_rai@hotmail.com

Background: Transplant recipients are at significant risk of osteoporosis due to multiple risk factors including long term corticosteroid use. Current lung transplant protocols have recommendations for osteoporosis prophylaxis but there are no recommendations made for heart transplant patients. Aim: To describe pre-existing osteoporosis and risk factors in recent transplant recipients. To investigate appropriateness of osteoporosis prophylaxis compared to hospital protocols and published guidelines to help identify at risk patients and develop and implement new protocols. Method: A retrospective review of all patients receiving a heart or lung transplant (2009) was performed. Data on pre-existing osteoporosis, risk factors and pre-transplant osteoporosis therapy were collected to assess pre-transplant osteoporosis risk. Data were collected on osteoporosis therapy prescribed at discharge following the transplant procedure, with the patient’s subsequent clinic visits reviewed up until February 2010 to determine if any additional osteoporosis therapy or investigations were added. Results: Of 59 patients transplanted in 2009, 49 patients were able to be evaluated (14 heart and 35 lung). Eleven patients had prior osteoporosis and at least 12 (86%) heart and 29 (83%) lung patients were on prednisolone maintenance doses greater than 7.5mg/day. Compared to current hospital protocols, only 5 (14%) lung transplant patients were receiving the recommended therapy. However more patients (14% heart and 43% lung recipients) were receiving appropriate therapy when compared to clinical guidelines. Conclusion: Prescribing adherence to hospital protocols was poor but improved in comparison to published guidelines suggesting the need for review of current protocols. The low overall adherence suggests the need for improvement in the identification and follow-up of these patients. These data will be used to develop and implement new osteoporosis prophylaxis protocols for both heart and lung recipients in line with current best practice guidelines. A reaudit is planned to assess adherence to the new protocols once implemented.

32 The use of forgotten antibiotics in multi-resistant tuberculosis patients Devang Rai1, Susie Welch1, Sylvia Bridle1, Marshall Plit1 1 St Vincent’s Public Hospital, NSW Correspondence: devang_rai@hotmail.com

Objective: To report the progress and obstacles when treating a patient presenting with multi-resistant tuberculosis (MRTB). Clinical features: A 66-year-old Indonesian man YJ referred to the thoracic medicine clinic with copious coughing and PET/CT scans suggestive of wide-spread malignant disease in the liver and lymph nodes above and below the diaphragm. Subsequent PET/CT scans reported a left hilar tumour, upper lobe bronchus narrowing and slight increase in lymph nodes over the last month. Abdominal ultrasound showed multiple liver solid foci compatible with metastases. However, further investigations suggested no evidence of a tumour. Liver fine needle aspiration showed granulomata with no acid-fast bacilli seen. Prior to treatment baseline CT chest scan showed irregular soft tissue mass in left hilar region extended to the mediastinum, minor collapse and consolidation in left lower lobe, enlarged lymph nodes in superior mediastinum and a mass noted behind the head of the pancreas. Mycobacterium tuberculosis PCR was positive with subsequent positive mycobacterium culture. Interventions and case progress: A three times weekly anti-TB regimen was initiated and administered as directly observed therapy: isoniazid 600mg, pyrazinamide 2500mg, ethambutol 2000mg and pyridoxine 25mg. Two months later, liver biopsy showed resistance to isoniazid, rifampicin and pyrazinamide. A five drug regimen based on sensitivities was initiated: amikacin 1g IM daily Monday to Friday, ethambutol 1600mg daily, cycloserine (SAS) 500mg twice daily, prothionamide (SAS) 500mg twice daily, aminosalicylic acid (SAS) 4g three times daily and pyridoxine 150mg daily. Outcome: After two months amikacin was replaced with clofazimine (SAS) 100mg daily due to deteriorating renal function and hearing. Nausea and dizziness proved problematic—nausea being treated with metoclopramide. Three months later, YJ’s cough had ceased. Repeat CT chest showed a dramatic improvement. Conclusion: This case demonstrates the importance of obtaining TB sensitivities and the role of forgotten antibiotics.

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poster abstracts 33 Bugs and drugs: what role does a clinical pharmacist play in enhancing appropriate

antimicrobial use? Diane Reeves1,2, Tim Garrett2, David Went2 1 Northern Sydney Central Coast Area Health Service, NSW, 2Central Coast Health, NSCCH, NSW Correspondence: dreeves@nsccahs.health.nsw.gov.au

Aim: To improve our understanding of antimicrobial medication issues during the inpatient journey. Method: Incidents into the nurse-lead incident information management system (IIMS) were compared with the locally constructed pharmacist database at a large metropolitan group of hospitals over a 12-month period. The types and frequency of notifications were compared for each data set. The cost savings were calculated from the pharmacist intervention database. Results: There were 730 notifications to the pharmacist database and 103 to the IIMS database over that period. The top five pharmacist categories were those of high and low doses, appropriateness of therapy and drug-drug interactions, accounting for 66% of the interventions. In contrast there were only two reports from nursing staff for these groups. Nursing reported 60% of incidents into the categories of incorrect administration plus small numbers into prescribing medication when allergic, adverse drug reactions (reported differently by pharmacists) and dispensing errors. Pharmacist optimisation of therapy and cessation of treatment showed considerable savings. Pharmacists reported 11% of technical/operational issues such as administration and the physical ordering of the medications by the medical officer and 89% clinical interventions. Nursing reported 78% and 23% respectively. Conclusion: Although voluntary incident reporting is never the sole source of information to drive medication safety and optimisation of antimicrobial therapy, it is paramount that local data represents all sectors of clinicians otherwise an incomplete understanding of issues will occur. In addition to medication safety and optimisation of therapy, these findings support the cost effectiveness of clinical pharmacy services.

34 When cleanrooms go badâ&#x20AC;&#x201D;unexpected closure of a cytotoxic production unit Jim Siderov1 1 Austin Health, VIC

Correspondence: jim.siderov@austin.org.au

Objective: To describe the problems encountered and the strategies implemented when the cytotoxic suite in a large teaching hospital was shut down by Infection Control. Clinical features: With the unexpected finding of dirt on the HEPA filter of the ante-room and in the sump of the cytotoxic cabinets, the infection control department immediately suspended all aseptic production in the cytotoxic suite. There was no warning of this disastrous event. Air pressures and other quality measures were normal. Until the problem could be resolved, on-site preparation of chemotherapy was suspended. Interventions, progress and outcome: The pharmacy department outsourced the production of over 250 aseptic preparations which included cytotoxic chemotherapy, antiviral therapy, and monoclonal antibodies. Clinical trial requirements were prepared in two other metropolitan hospitals by pharmacy staff travelling to these sites. Microbial air sampling was immediately performed for bacterial and fungal cultures. Air particle testing was also undertaken. A review of structural defects was also performed. Rooms were thoroughly cleaned and retested. Turnaround time for results was seven days, upon which the production facility was reopened. A thorough review of air flow in the ante-room revealed a return of air flow through the top of the entry door. This, coupled with excavation and construction at the hospital, resulted in the dirt particles entering the ante-room. A second HEPA filter to act as an air curtain at the entry to the ante-room was commissioned and installed three months later. Conclusion: Pharmacy departments must be vigilant in the quality assurance and quality control activities. They should also have risk strategies in place for catastrophic events such as the unexpected closure of their cleanrooms. The extra cost of outsourcing for this exercise above the medication expenses was over $7 000 for the seven day closure.

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poster abstracts 35 The stability of various antibiotics in peritoneal dialysis solution with glucose 2.5% Minh Tran1, Nicholas Sharley1, Michael Ward2 1 Royal Adelaide Hospital, SA, 2University of South Australia, SA Correspondence: dacminh@internode.on.net

Aim: To determine the chemical stability of clindamycin, amoxycillin and meropenem in Dianeal® PD-4 2 litre peritoneal dialysis solution with 2.5% glucose over 6 hours at 37°C. Method: Published stability indicating high performance liquid chromatography (HPLC) methods were adapted to determine the percentage of concentration remaining of clindamycin, amoxycillin and meropenem. Antibiotic injections were used to prepare samples. Samples were forcibly degraded and injected onto the HPLC system to ensure there were no interfering peaks from degradation products or injection excipients with the principal peak of the antibiotic. Dianeal® PD-4 2 litre peritoneal dialysis bags were preincubated at body temperature (37°C) the night prior to each study day. Samples were prepared by injecting the separate preincubated bags with clindamycin 300mg, amoxycillin 1g and meropenem 1g and re-incubating all the bags at 37°C. Study samples were prepared in triplicate for each antibiotic. A five level calibration was performed each study day. Study samples were drawn from each bag at time 0, 3 and 6-hour intervals and analysed in duplicate. A degradation profile was constructed for each antibiotic using linear regression. The percentage of concentration remaining at time 6 hour was calculated. Results: The adapted HPLC methods were stability indicating as the degradation peaks did not interfere with the principle antibiotic peak. All antibiotics analysed: clindamycin, amoxycillin and meropenem, retained at least 90% or greater of their original concentration in dialysis solution over 6 hours. Conclusion: Clindamycin, amoxycillin and meropenem are stable over 6 hours and are suitable options for the treatment of peritonitis in intraperitoneal dialysis solutions.

36 Bronchiolitis obliterans organising pneumonia in a patient treated with intravenous

busulfan-melphalan conditioning regimen in autologous stem cell transplantation— bug or drug? Karen Urbancic1 1 Austin Health, VIC

Correspondence: karen.urbancic@austin.org.au

Objective: To describe a case of bronchiolitis obliterans organising pneumonia (BOOP) in a patient after autologous stem cell transplantation and discuss the potential infectious and non-infectious causes. Clinical features: Mr X, a 57-year-old Caucasian farmer with refractory stage IV diffuse large B cell lymphoma under went intensive conditioning chemotherapy with intravenous busulfan and melphalan prior to autologous transplantation. Other medical history includes: previous dental infection with osteomyelitis; benign prostate hypertrophy. During post-autograft recovery, Mr X developed febrile neutropenia with a respiratory focus, and was diagnosed with BOOP. Interventions, case progress and outcome: On day 13 post-autograft he developed acute respiratory distress syndrome whilst neutropenic. Chest imaging suggested aspergillus pneumonitis, however, this was not in keeping with the length of neutropenia. A differential diagnosis was engraftment syndrome and high dose pulse methylprednisolone initiated. Continuing respiratory distress despite neutrophil recovery and appropriate antifungal therapy warranted further investigations. Upon specialty input from both infectious diseases and respiratory medicine, a provisional diagnosis of BOOP was made secondary to cytomegalovirus (CMV), from positive testing on bronchoscopy washings. Valganciclovir was commenced with weekly serology surveillance. Oral prednisolone was also started to treat BOOP. Apart from infectious causes in this patient, other potential causes of BOOP included high dose busulfan and stem cell transplantation. The patient responded to two weeks of valganciclovir followed by prophylaxis until negative CMV serology. Respiratory function gradually improved with prednisolone able to be weaned. Conclusion: The use of highly intensive chemotherapy conditioning in autologous stem cell transplantation has brought with it a broader set of infectious complications for patients during the recovery phase. Whilst infectious complications were identified as the most likely cause of BOOP in this patient, other non-infectious causes cannot be ruled out, including high dose busulfan.

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poster abstracts 37 Use of artesunate and leflunomide in the treatment of ganciclovir-resistant

cytomegalovirus Jenny Willis1, Shannon Finn1 1 Royal Brisbane and Women’s Hospital, QLD

Objective: To examine the role of artesunate and leflunamide in the treatment of cytomegalovirus (CMV) where standard medications are limited by toxicity, resistance or both. Cytomegalovirus infection is a major complication following solid organ transplant resulting in considerable morbidity and mortality. Five drugs, ganciclovir, valganciclovir, cidofovir, foscarnet and fomivirsen are recognised as CMV treatments. Their use is limited by toxicity, low oral bioavailability and the emergence of drug-resistant virus. All agents target the viral DNA polymerase. Recently artesunate, a safe and well tolerated antimalarial drug has been shown to possess antiviral activity against wild-type and ganciclovir-resistant CMV strains. Drug resistance is not expected to develop during artesunate therapy owing to its novel mechanism of action. Leflunomide has also been shown to be effective in ganciclovir resistant CMV infection, thought to be as a result of its inhibition of the intracellular formation of viral nucleocapsid. Case: We report the case of a 47-year-old female, recipient of a CMV positive renal allograft 12 years previously. On admission she had CMV colitis and her CMV viral load was >1.1x105 copies/ml. Her eGFR was 27ml/min. Medications on admission included valganciclovir 450mg BD. High dose ganciclovir failed to improve the viral load. Foscarnet was initially avoided due its nephrotoxicity, instead intravenous artesunate 180mg/day was commenced and increased after 7 days to 240mg/day. After 20 days of poor response to the artesunate, foscarnet was reluctantly introduced together with leflunamide reducing the viral load to <600copies/ml. Leflunomide was used at a dose of 100mg/day for 5 days and subsequently reduced to 20mg/day thereafter. Discussion: The artesunate was well tolerated but did not result in a decrease in viral load. Leflunamide, when used with foscarnet, led to a significant reduction in the patient’s viral load.

38 Systemic absorption of oral vancomycin—check the dose! Kate Witney1, John Coutsouvelis1,2, Carmela Corallo1 1 The Alfred Hospital, VIC, 2Monash University, VIC Correspondence: k.witney@alfred.org.au

Objective: To describe a case of systemic absorption of oral vancomycin. The absorption of vancomycin after oral administration is usually considered to be minimal or non-existent. However, in the presence risk factors such as renal impairment or doses 2g a day for prolonged periods, systemic absorption resulting in therapeutic levels of vancomycin can occur. This is the second case investigated and reported by the authors. Clinical details: A 69-year-old female with neutropenia and severe diarrhoea was admitted to the intensive care unit after an episode of hypotension due to hypovolemia and septic shock. Faecal cultures were positive for Clostridium difficile and the patient commenced vancomycin 500mg orally QID. Serum creatinine at this time was 161 micromol/L. Intervention: The clinical pharmacist, based on previous experience, identified the high dose of vancomycin being used and the potential problem with absorption of oral vancomycin and possible causes i.e. prolonged use at high doses. Medical staff insisted on continuing with this regimen, so the clinical pharmacist recommended a spot level. Case progress: After nine days of treatment at this dose, the last six with a normal creatinine, a spot sample indicated a systemic vancomycin level of 5.0 mg/L. Outcome: The oral vancomycin was ceased after 12 days of treatment upon the resolution of the diarrhoea. No further vancomycin levels were taken. Conclusion: Systemic absorption of vancomycin may occur following oral administration resulting in therapeutic levels. The extent of absorption is unpredictable. The literature does not support doses greater than 125mg orally QID in this setting. Adherence to recommended guidelines for dosing of oral vancomycin should decrease the potential for toxicity from the absorption of excessively high oral doses.

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poster abstracts Life goes on 39 Review of pharmacist-led interventions in the management of hypertension Tariq Alhawassi1, Beata Bajorek1, Lisa Pont1 1 The University of Sydney, NSW Correspondence: tarriq@hotmail.com

Background: Hypertension affects an estimated one billion people worldwide. Despite good evidence that appropriate management can significantly reduce cardiovascular complications, management of many patients remains sub-optimal. Quality use of medicines is a key area in the successful management of hypertension and pharmacist-led interventions focusing on medication use may play an important role in improving hypertension management. Aim: The aim of this study was to identify and critically review the published literature on pharmacist-led interventions for improving hypertension management. Method: A quasi-systematic review was undertaken via a search of the MEDLINE (1966-June 2010) and Cochrane databases for English-language studies evaluating pharmacist-led interventions to improve the management of hypertension. A manual search of relevant trials was also conducted. Results: In total 33 studies evaluating the impact of pharmacists-led interventions on the management of hypertension were identified. All studies included patients aged over 18 with only three focusing specifically on older patients (aged over 65 years). Out of these 19 studies, over half (58%) were in the hospital or clinic setting, 12 (36%) were in the community and 2 (6%) were in a mixed setting. Most trials (88%, n=29,) examined the impact of pharmacist interventions by monitoring the patients’ blood pressure (BP) control, with most (85%, n=28) showing a significant reduction in BP following pharmacists intervention. Twelve studies (36%) explored the impact of pharmacist services on patient compliance or adherence with seven of these studies (58%) showing a significant impact on improving adherence. Five studies reviewed pharmacists prescribing where four showed no significant difference in BP for patients with pharmacist prescribers. Conclusion: Pharmacist-led interventions can have a significant role in reducing BP in patients with hypertension. With an ageing population and increases risk of hypertension patients more work is needed to evaluate pharmacist interventions for improving blood pressure control in older patients.

40 Audit of warfarin initiation at an obstetric and paediatric teaching hospital Eu Queen Ang1, Paul Tait1 1 Women’s and Children’s Hospital, SA

Correspondence: euqueen.ang@health.sa.gov.au

Background: Warfarin initiation is individualised for each patient and is dependent upon various factors including liver function, intercurrent illness, concurrent drug therapy and diet. The standardisation of warfarin prescribing and management process is vital in any major health care setting. Whilst there is an established protocol at our institution for warfarin dosing and monitoring in paediatric patients, there is no formal protocol to guide prescribers with the standardised dosing of warfarin for obstetric patients. Objective: To review the current practices in place for warfarin initiation of paediatric and obstetric patients and to discover which factors could contribute to a standardised process with regards to dosing and monitoring. Method: Retrospective quantitative and qualitative review of medical records for admitted patients prescribed with warfarin between July 2008 and June 2010. Data collected included the current prescribing practices, indications, monitoring protocols and dose adjustments of warfarin which were recorded during hospital admission. Hospital ethics approval was obtained prior to commencing the audit. Results: Warfarin was prescribed most commonly for the indication of deep vein thrombosis (~60%), pulmonary embolism (~35%) or a background of coagulation deficiencies (~15%), mostly in the women’s cohort. There was generally an appropriate level of heparinisation prior to therapeutic warfarin therapy. No adverse drug reactions were reported despite a small number of International Normalised Ratio (INR) measurements being above the normal therapeutic range (INR>2.0–3.0). There was variability identified within the initiation process and prescribing teams across the paediatric and obstetric populations. Conclusion: Initial findings suggest a safe and efficient warfarin initiation process across all patient groups within the hospital despite some variability within the dose initiation and monitoring regimens. The variability provides opportunity for standardisation within warfarin prescribing and management processes; the subsequent nominated strategies to achieve standardisation will be presented with the finalised results of the study.

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poster abstracts 41 Allergy documentation—if it’s important why aren’t we inputting it? Sophie Arthur1, James Radford1, Cal Winckel1, Krishna Shah1 1 Ipswich Hospital Pharmacy, QLD

Background: Complete documentation by pharmacists of patient allergies and adverse drug reactions on inpatient medication charts and in the iPharmacy dispensing software is important to prevent patient re-exposure and potential adverse events from occurring during hospital stay and on discharge. The presence of this information in iPharmacy (Queensland Health dispensing software) aims to prevent the dispensing of drugs or drug-groups to which a patient has had a previous adverse or allergic reaction. Aim: To investigate the frequency of documentation of patient allergies and adverse drug reactions by pharmacists into dispensing software, and to investigate obstacles for data input. Method: New inpatients were interviewed regarding previous allergies and adverse drug reactions. Inpatient medication charts and iPharmacy were audited after patients had been clinically reviewed by a hospital pharmacist to assess for the presence of this information. A survey was also conducted to ascertain obstacles to data entry by pharmacists. Results: Allergy/ADR information was present in iPharmacy for 30% of patients 24-hours post-clinical review. All pharmacists believed that inputting allergy and ADR information into the dispensing software on admission was important, with the most commonly identified barriers to data input being time, failing to remember and limited access to computers. All pharmacists indicated that they believed a dedicated pharmacy technician would be beneficial to perform this task. Conclusion: Only 30% of current patient admissions have allergy/ADR information entered into dispensing software by pharmacists. Providing a pharmacy technician to perform this task may address the identified barriers to data input, ensuring timely and complete documentation of patient allergies and adverse drug reactions.

42 Finding a home for insulin: a review of insulin storage and labelling across NT

hospitals Stuart Brown1 1 Royal Darwin Hospital Pharmacy, NT

Aim: The aim of this quality improvement review was to evaluate the current practices of storage and labelling of insulin vials/pens at the four major hospitals in the Northern Territory (NT). Comparison was then made to current best practices. Methods: The review examined storage and labelling of insulin in the four major hospitals of the NT. All wards that store insulin were included in the review. The quality improvement review was conducted by a single person at each site. Results were analysed using Microsoft Excel. Ethics approval was not obtained due to it being a quality improvement review with no patient contact or use of patient records. Results: A total of 179 opened insulin vials/pens were found on the 33 wards included in the review. 70 (39%) met the requirements of ideal labelling practice, of these 30 (43%) were stored in the correct patient drawer meeting the requirements for ideal storage. Common themes identified included storage of open and closed insulin together in 21 wards (64%); recording of date of opening was also an area of focus with 78 (44%) of vials/pens not labelled with date of opening, and 23 (13%) vials/pens found to be expired. Conclusion: Differences were seen in practices between both hospitals and individual wards with some wards meeting requirements of ideal labelling practice more than others. The same issues were seen across the all the wards/hospitals. In conjunction with diabetes educators at each hospital the following interventions will be made:

x x x

labelling of individual insulin highlighting ideal storage practices formation of ‘open insulin’ box outside of the fridge in drug rooms on wards where there are no patient drawers monthly expiry checks.

Each ward will be reviewed in four months to re-assess practices after implementation of the recommendations.

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poster abstracts 43 Reviewing the old: what is the evidence for secondary cardiovascular disease

prevention in a 95-year-old patient post acute myocardial infarction? Tina Chang1 1 Princess Alexandra Hospital, QLD

Objective: To highlight the importance of pharmacist involvement in optimising health and quality of life outcomes for elderly patients. Clinical features: A 95-year-old male presented with intermittent chest pain of increasing intensity. Investigations showed raised troponin, ECG changes, diffuse subendocardial ischaemia, right bundle branch block (RBBB) and primary heart block. Investigations confirmed a diagnosis of NSTEMI. Past medical history include non-insulin dependent diabetes and nil other significant, with no other predisposing cardiovascular risk factors. Patient experienced ongoing chest pain despite heparin and glyceryl trinitrate continuous infusion and optimal medical management. Interventions, case progress and outcome: Issues faced included failure of conservative medical management of chest pain, risk versus benefit of procedural intervention, mental capabilities of patient to make an informed decision and most importantly, evidence for secondary cardiovascular disease prevention. A multidisciplinary team, including the pharmacist was involved evaluating and optimising the use of evidence-based treatments. The patient underwent angiogram, with percutaneous transluminal coronary angioplasty performed to the left anterior descending artery. Standard secondary cardiovascular disease preventative medications were commenced. At discharge, pharmacist explained the rationale for each medication and the importance of ongoing compliance to reduce the risk of future events and other complications. Conclusion: Pharmacistâ&#x20AC;&#x2122;s involvement:

x x x x x x x

simplified medication regimen to allow ease of administration and encourage adherence identification of potential non-adherence of medication regimen, especially vital post stent placement advice on administration of medications in this age group, with age-related impairments literature review and critical analysis for applicability of evidence in this patient group identification of potential drug-drug, drug-disease and drug-age interactions overcome challenges posed by this patient group, such as physical barriers (age-related impairments) and social barriers (financial, government budget, procedural and medicinal related risks, etc) counselling on new medications.

44 Round and round the medication safety cycleâ&#x20AC;&#x201D;a multidisciplinary approach Emily Diprose1, Liisa Nurmi1 1 Calvary Health Care, ACT

Correspondence: emily.diprose@calvary-act.com.au

Aim: To improve National Inpatient Medication Chart (NIMC) audit results, promote medication safety practices and ultimately reduce medication safety incidents. Methods: A multidisciplinary group with representatives from three hospital units (Pharmacy, Learning and Development, and Quality, Safety and Risk) designed a NIMC audit and education package. Results from a baseline audit were combined with relevant medication safety material and presented multiple times to each clinical area of the hospital during April. Areas identified for improvement included documentation of allergies, patient height and weight, and patient identification, as well as medication administration omissions and recording of nil stock without appropriate follow up. A second audit was completed in June. Results: One hundred and eight charts (593 medication orders and 2 626 medication administrations) were audited in March. Compliance with correct documentation was 27% for height and weight, 64% for allergies, and 31% for patient identification (24% were confirmed in handwriting). There were 2.3% administration omissions and only 7.7% of nil stock records had been resolved. During April, over 200 staff members attended 23 education sessions to 11 clinical areas for nurses as well as doctors at grand rounds. A follow up audit consisting of 133 charts (781 medication orders and 2 991 medication administrations) was completed in June. Compliance with correct documentation increased to 35% for height and weight, and 42% for patient identification (51% were confirmed in handwriting), but allergies had reduced to 42%. The rate of administration omissions had reduced to 1.8% and the percentage of nil stock records resolved had increased to 36%. Conclusion: This multidisciplinary approach resulted in a successful and well received medication safety education campaign. The audit results showed considerable improvement in five of the six areas targeted, however ongoing education and feedback is essential to maintain desired results and reduce medication incidents.

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poster abstracts 45 Amiodarone: adverse drug reaction, aftermath distress resolved and after discharge

reassurance! Sue Driscoll1, Stephanie D’ Souza2 1 St Vincent’s Hospital, NSW, 2Charles Darwin University, NT (4th year student) Correspondence: sdriscoll@stvincents.com.au

Objective: Adverse drug reactions (ADRs) are not necessarily resolved on leaving hospital. This case presents an elderly lady who nearly died from multiple reactions and her management during admission and upon returning home. Clinical features: Kate, an 85-year-old holocaust survivor, reported radiating chest-pain, cough and haemoptysis with prior history of hypertension and paroxysmal atrial fibrillation. She was admitted to a private hospital where radiology revealed ‘interstitial lung pattern indicating drug-reaction’ and pathology showed hypothyroidism, hyponatraemia and raised troponin. Interventions, case progress and outcome: Amiodarone and diuretics were stopped. Her cardiologist referred to a respiratory consultant who commenced prednisolone and an endocrinologist reviewed thyroid and electrolytes. Later she was admitted to intensive care, obtunded, requiring breathing support, with worsening hyponatraemia. Family conference discussed ‘end-of-life’ but Kate responded to treatment and went home two weeks later. On discharge her cardiologist requested follow-up in two weeks and steroid weaning by 5mg every five days. Referral was made for home-based transition care as Kate lived alone, and a pharmacist visited over the next seven weeks. Initially Kate did well with introduction of a dosette-box and clarification of thyroxine. Unfortunately, before her scheduled appointment she developed breathing difficulties, oedema and abnormal liver biochemistry. Kate’s confidence waned due to deteriorating health and imminent family overseas trip. With increased steroids and slow reintroduction (under monitoring) of diuretics she eventually improved. Visits and education gave reassurance and close collaboration with the GP allowed review of therapy and ordering of missing tests. Steroids were stopped after a year and low-dose diuretics have not caused recurrence of hyponatraemia. Amiodarone has been reported to cause many side-effects (see ADRAC table). Conclusion: Kate’s recovery from amiodarone ADR was jeopardised by poor discharge communication, multiple consultants and frequent medicine changes. Without the support of a transition care pharmacist, this would have been difficult for GP alone.

46 Development of a hospital pharmacist prepared interim residential care medication

administration chart (MedGap Project) Rohan Elliott1,2, Tim Tran1, Penelope Harvey3, Simone Taylor1, Stephen Cheung1, Liam Carter3, Rhonda Jennings3, Mary Belfrage4 1 Pharmacy Department, Austin Health, VIC, 2Centre for Medicine Use and Safety, Monash University, VIC, 3Bundoora Extended Care Centre, Northern Health, VIC, 4North East Valley Division of General Practice, VIC Correspondence: rohan.elliott@austin.org.au

Aim: The objective of the MedGap project was to address gaps in continuity of medication management during patients’ transition from hospital to residential care. The main intervention was a hospital pharmacist prepared interim residential care medication administration chart (IRCMAC). Impact of the IRCMAC on medication administration errors and locum medical attendances at residential care facilities (RCF) is reported elsewhere at this conference. This poster describes development of the IRCMAC. Methods: IRCMAC development was informed by analysis of data from a pre-intervention study of medication errors following discharge to RCFs, and extensive stakeholder consultation. Stakeholders included the Aged Care Accreditation and Standards Agency, Australian Nurses Federation, Victorian Drugs and Poisons Unit (Department of Health), RCF staff, general practitioners, hospital doctors, and community and hospital pharmacists. To ensure sustainability and maximise patient safety, a semi-automated process for producing the IRMCAC was developed, designed to:

have minimum possible impact on hospital staff workload

avoid manual transcription of discharge medication lists

ensure the IRCMAC was produced after pharmacist reconciliation and review of discharge prescriptions.

Results: Software modules were developed that could be linked or integrated with the participating hospitals’ pharmacy dispensing software, to populate the IRCMAC with the medications prescribed on discharge. The IRCMAC format was based on existing RCF medication charts and the National Inpatient Medication Chart. It was designed to last for seven days, providing time for the patient’s usual GP to attend the RCF and write a new medication chart. Sections for the hospital pharmacist to communicate medication changes were included to address identified discharge communication gaps. Conclusion: A semi-automated electronic process enabling hospital pharmacists to produce IRCMACs was successfully developed and implemented. Stakeholder consultation (and post-intervention evaluation—presented separately) indicate the IRCMAC is an efficient, highly effective method for improving continuity of medication management.

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poster abstracts 47 Development of an Ecarin clotting time test as an alternative to APTT for monitoring

lepirudin Morna Falkland1, Philip Crispin2, Jackie Pratt3, Miriam Lawrence1 1 Pharmacy Department, The Canberra Hospital, ACT, 2Haematology Department, The Canberra Hospital, ACT, 3Coagulation Laboratory, The Canberra Hospital, ACT Correspondence: morna.falkland@act.gov.au

Aim: To review the use of the Ecarin clotting time test for monitoring of the anticoagulant lepirudin. Methods: The activated partial thromboplastin time (APTT) is recommended to be used by the manufacturer to monitor lepirudin, a direct thrombin inhibitor used in patients with heparin-induced thrombotic thrombocytopenia (HITT). However the APTT ratio may have a non-linear dose relationship with lepirudin at higher concentrations with consequent risk of overdosing. The Ecarin clotting time (ECT) is a meizothrombin generation test which has a linear correlation with lepirudin. It allows quantification of direct thrombin inhibitors and has a wide range of linear correlation between clotting time and hirudin levels. We reviewed the implementation of ECT in our institution and correlated with APTT for lepirudin monitoring. Results: An ECT standard curve was constructed using known concentrations of lepirudin in normal plasma. The ECT was then incorporated into the hospital protocol for lepirudin monitoring. Issues encountered during implementation included the lack of a well established lepirudin dose adjustment protocol using ECT and laboratory staff familiarity needed for 24-hour availability. A total of six patients with HITT had 34 paired ECT/APTT testing before or after implementation. Nine paired samples produced results that would have led to different dosing decisions with APTT or ECT. There was no identifiable cause for the discrepant results. Although a marked difference occurred in one patient during initiation of warfarin, this was not seen in every case where warfarin was used. All patients had creatinine clearance within the normal range for age. Conclusion: The ECT is a viable alternative to the APTT for monitoring of lepirudin with theoretical advantages due to a linear association with lepirudin concentration, particularly at higher concentrations. Clinical studies are needed to determine whether the improved monitoring can reduce the rate of complications during lepirudin therapy for HITT.

48 Interim medication chartsâ&#x20AC;&#x201D;smoothing the transition from hospital to residential aged

care facilities Pamela Fernando1, Ian Larmour2, Robin Lee1 1 Southern Healthâ&#x20AC;&#x201D;Casey Hospital, VIC, 2Southern Health, VIC Correspondence: pamela.fernando@southernhealth.org.au

Aim: To evaluate issues regarding discharges from hospital to residential aged care facilities (RACF) and implementing a system to address any concerns. Method: As part of the Council of Australian Government, Long Stay Older Person project, methods to improve care to elderly patients and facilitate smoother transition of care from hospital to RACF were investigated. Ten RACFs were surveyed to assess current medication administration policies and concerns with patients being discharged from hospital. The delay in having a medication administration chart written was noted by 90% of facilities as being their biggest concern about patients being discharged from hospital. As an extension of the Interim Medication Chart (IMC) project, a pilot project introducing an IMC, produced by the pharmacy department was conducted. Over a ten-week period, residents of ten local RACF were discharged from the general medical and subacute wards with an IMC. The chart was valid until a medication chart was written up by the patientâ&#x20AC;&#x2122;s general practitioner (for a maximum of seven days). The directors of nursing (DON) at eight of the facilities involved were surveyed to gauge their satisfaction at the conclusion of the project. Results: During the pilot period, 27 patients were discharged to their RACF with an IMC. The average time taken to produce the chart was thirty minutes, including dispensing and annotations. All DONs surveyed found the IMC beneficial as it allowed staff to administer medications in a more timely fashion. 75% stated that the chart reduced medical locum calls outs for residents returning from hospital. All facilities reported that the provision of an IMC increased the likelihood of accepting existing residents back on weekend/public holidays; the majority of facilities (62.5%) were also more likely to accept new residents. Conclusion: Implementing the IMC enabled a smoother transition of care from hospital to RACF, by allowing the administration of medications in a timely and less stressful manner.

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poster abstracts 49 How can we best manage an agitated older patient? Follow-up audit Kerry Fitzsimons1, Deirdre Alderton1 1 Fremantle Hospital and Health Service, WA

Correspondence: Kerry.Fitzsimons@health.wa.gov.au

Objectives: A follow-up audit was undertaken two years post introduction of an agitation and arousal medication chart to review prescribing trends for management of agitation on a ‘prn’ (when required) basis in older patients (>65 years of age) compared with hospital guidelines. Methods: Patients where identified by the clinical pharmacist during the audit period (four weeks). Past medical history, presenting complaint and medications on admission were documented, as were drug choice, time administered, dose, frequency and route of each ‘prn’ medication. In each case prescribing was compared to the hospital guidelines. The case notes were reviewed to determine if any adverse drug events (ADEs) occurred due to their ‘prn’ psychotropic medications. Results: Thirty patients were audited over the two-month period. Only eight patients (36.3%) received treatment which did not follow the recommended guidelines for prescribing of ‘prn’ psychotropics for agitation and arousal for older patients. This is a significant improvement compared to the original audit where 63.3% did not adhere to guidelines. Patients were reviewed for any ADEs occurring as a result of prn psychotropic medications. A total of 13 patients (43%) were documented as having a possible ADE to the psychotropic medications. Seven of the 8 patients (87.5%) who received treatment outside of the guidelines experienced a possible ADE. Of those patients whose therapy did adhere to the recommended guidelines, only 27% (6/22) displayed possible side-effects attributable to psychotropic use. Conclusion: A significant increase was observed in patients’ treatment following the recommended guidelines since the introduction of the agitation and arousal chart (73% compared with 36.7%). Treatment which adhered to recommended guidelines was less likely to result in an ADE. This audit demonstrates that when therapy follows the recommended guidelines, in conjunction with a prescribing tool and education, the patient is less likely to experience ADEs.

50 Warfarin polymorphism: a potential poly-problem Leah James1, Margie Butnoris1, James Radford1, Cal Winkel1 1 Ipswich General Hospital Pharmacy, QLD

Objective: To describe a case of suspected warfarin polymorphism and demonstrate that awareness and management of this problem can produce a favourable outcome and reduce adverse events. Clinical features: A 73-year-old man with a history of congestive heart failure and aortic valve replacement presented to hospital with: increased shortness of breath, decreased exercise tolerance and tachycardia 2 weeks post aortic valve replacement. On examination he was found to be in atrial flutter. The initial management plan included rate control and cardioversion once warfarinised. Case progress and outcome: Warfarin was commenced as planned. An initial INR of 2.3 was achieved and this increased progressively to 6.3 despite multiple withheld doses. After an extended length of stay of 12 days, the patient was discharged home without warfarin. Although at high risk of a stroke and with New York Heart Association class III-IV heart failure symptoms, he was deemed unmanageable for warfarin therapy. The GP recognised a potential polymorphic problem and stabilised the patient on 0.5mg of warfarin daily. The patient had successful cardioversion 6 weeks later. Conclusion: Warfarin polymorphism can be a barrier to successful warfarin treatment. This case highlights the importance of recognising polymorphism even without pathological confirmation. Failing to do this may result in adverse events for the patient, extended length of stay and increased burden to the health care system.

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poster abstracts 51 To reduce or not to reduce? Investigating the appropriateness of metformin dosing in

renal impairment in the general medicine population Melina Johannesen1 1 Pharmacy Department, John Hunter Hospital, NSW

Correspondence: melina.johannesen@hnehealth.nsw.gov.au

Background: The incidence of T2DM is increasing in the community, with many elderly patients admitted to hospital taking metformin. Guidelines recommend metformin as first line therapy for type 2 diabetes mellitus (T2DM). Dose reduction or cessation is required in renal impairment or when lactic acidosis and respiratory failure is present. Aim: To identify if elderly T2DM patients prescribed metfomin were on an appropriate dose during their admission to an acute care hospital. Method: A prospective chart audit of general medicine patients admitted to two participating wards in the hospital was conducted. Creatinine clearance (CrCl) using ideal body weight was calculated to assess the appropriateness of metormin doses. Results: A total of 50 patients (15%) from 341 patients, with a median age 73 years, were admitted taking metformin on admission. Over half these patients, 29 (58%), were taking another medication for their diabetes. Nine (18%) patients were admitted with CrCl <30mL/min, of which 8 were ceased. Eight patients (16%) with reduced renal function, CrCl between 30–90mL/min were on an inappropriate dose of metformin. Conclusion: This study suggests that metfomin is ceased in patients with severe renal impairment, but dose reduction is less likely to occur in patients with mild to moderate renal impairment. Increased awareness amongst prescribers of dose reduction in renal impairment is required.

52 A review of pharmacist recommendations in a rural aged care facility Hanan Khalil1 1 Monash University, VIC

Correspondence: hanan.khalil@monash.edu

Aim: To investigate the information provided in the residential medication management reviews (RMMR), carried out by the accredited pharmacist. Method: A retrospective, cross sectional study design was used to review 56 aged care residents’ case notes over 12-month period. Main outcome measures: Types of and reasons for recommendations made by the pharmacists, classes of drugs associated with pharmacist recommendations and implementation of pharmacist recommendations by the medical practitioners. Results: A total of 196 recommendations were made by the pharmacists to the residents’ existing medications. The classification of the types and causes of recommendations was based on the PCNE classification V5.01. The main types of recommendations were alteration to patients’ monitoring (49%), discontinuation of drug treatment (19%) followed by initiation of drug treatment (17%). The main reasons for the recommendations were to reduce potential side effects (45%), symptom control (31.5%) and increasing drug efficacy (19%). Analysis of medical practitioners’ case notes estimated 70% of pharmacists’ recommendations were being implemented by the residents’ medical practitioner. Correlations between variables were calculated using Pearsons’ correlations. While there was no significant correlation between the number of regular medications the residents are taking and the number of interventions taken by the doctor, there was a statistically significant correlation (p<0.03) between the number of regular medications the residents are taking and the number of recommendations made by the pharmacist. There was also statistically significant correlation (p<0.005) between the number of recommendations made by the pharmacist and the number of interventions taken up by the medical practitioners. Conclusion: All health care professionals share a commitment to and responsibility for providing safe and effective patient care. This case notes analysis reinforces the significant contribution that pharmacists and medical practitioners make to improving health outcomes for residents in aged care facilities.

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poster abstracts 53 Vitamin D monitoring in mental health patients Mai Ta1, Praneel Chandra1, Patrick Lam1, Cathy Larson1 1 Southern Health Pharmacy Department, Casey Hospital, VIC

Aim: To evaluate the prevalence of vitamin D deficiency in mental health patients. Method: A retrospective audit of serum vitamin D levels was conducted for all patients admitted to the adult psychiatric ward at a Melbourne hospital between August 2009 and December 2009. Results: A total of 197 patients were admitted, three of whom were excluded because they were admitted for less than 24 hours. Of the 104 (53.6%) patients for whom a vitamin D level was performed, the majority were found to be vitamin D deficient: 22 (21.2%) had mild deficiency (50–74 nmol/L); 42 (40.4%) had moderate deficiency (25–49 nmol/L); and 32 (30.8%) had severe deficiency (< 25 nmol/L). The mean age and length of hospital stay (± SD) were 37 ± 12 years old (range 17–64) and 17 ± 21 days (range 1–156) respectively. Discussion: Vitamin D deficiency has been well documented in elderly people (particular those in residential care). To the best of the authors’ knowledge, the prevalence in the general psychiatric population has not been reported. Based on our study results there is reason to believe that vitamin D deficiency may be widespread in the psychiatric population. Possible explanations for this could be lack of sun exposure due to being institutionalised and/or lack of outdoor activity, medications (eg. anticonvulsants), and poor dietary intake. Of note, the majority of patients in our study were not elderly or institutionalised, and did not appear to have extended hospital stays. Conclusion: Of the proportion of patients with measured vitamin D levels, the majority (92.3%) were found to be vitamin D deficient. This indicates that vitamin D levels should be routinely tested in all mental health patients.

54 The preoperative management of the chronically anticoagulated patient admitted to a

tertiary teaching hospital Alice Lim1, Peter Samios2 1 University of Queensland, QLD, 2St Vincent’s Hospital, NSW Correspondence: lim.alice@gmail.com

Aim: To review preoperative management of warfarinised patients admitted to a tertiary teaching hospital with a secondary aim to develop and implement guidelines on the management of warfarin therapy interruptions pre- and post-operatively. Methods: All patients admitted for elective or non elective surgery from April to July 2009 were reviewed. Patients documented as taking warfarin on the theatre report were included in the study. Information was sourced from MediWEB (intranet pathology reporting system), medical records and iPharmacy (dispensing software). Appropriateness of the therapy was then determined using current evidence. Results: A total of 1 590 surgical cases were identified during the study period, of which 22 patients were eligible for inclusion, with the majority of these patients (69%) undertaking elective surgery. Indication for warfarin therapy varied with the majority of patients (68%) having atrial fibrillation. All but one patient had warfarin therapy withheld prior to surgery. On average, warfarin therapy was ceased 5.35 days prior to surgery. Ten (48%) patients were prescribed bridging therapy using a heparin infusion (50%), low dose subcutaneous heparin (20%) or therapeutic dosed enoxaparin (30%). Post operatively, 17 patients were restarted warfarin during the episode of care. Of which, 12 (70%) patients were prescribed parenteral anticoagulation. On average warfarin was re-initiated 5.6 days postoperatively. Conclusion: The study found that bridging therapy management was inconsistent with some patients receiving inappropriate therapy. Results have been fed back to the appropriate teams and a management guideline is under development to provide junior medical staff with direction on providing patients with the appropriate therapeutic regimen.

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poster abstracts 55 Staying alive: removal of 100-unit insulin syringes Anne McGrath1, Jennifer Hancock2 1 Pharmacy Department, Austin Health, VIC, 2Austin Health, VIC Correspondence: anne.mcgrath@austin.org.au

Introduction: Quality use of medicines alerts endorsed by the Victorian Medicines Advisory Committee (VMAC) are issued periodically by the Victorian Department of Health to raise awareness of potential patient harm associated with high-risk medicines. These alerts contain recommendations and strategies to minimise risk. A subcutaneous insulin alert, issued in December 2008, outlined best practice recommendations including removal of 100 unit insulin syringes. Aim: To describe the process of removing 100 unit insulin syringes from wards and departments across a multi campus major metropolitan health service. Method: A multidisciplinary working group reviewed compliance with the recommendations in the alert. Concurrently, a medication incident occurred and was investigated, that involved the wrong syringe being used to administer a ten-fold insulin overdose. Immediate action prevented patient harm, but removal of 100 unit insulin syringes and adding warnings to 1mL syringe supplies became priorities in response to this serious incident. Results: Consultation with stakeholders was broad to ensure obstacles were identified. A register was kept to track problems and their resolution. The major obstacles to change centred around the practice of using 100 unit insulin syringes to administer medicines other than insulin. Educational materials were developed and endorsed by the Medication Safety Committee. A staged removal of 100 unit insulin syringes was undertaken over a three-week period. Each ward and department was visited to explain the message to staff, distribute educational materials and remove the insulin syringes. Strategies were implemented to prevent re-ordering. A process was established at each hospital campus to permit access to 100 unit insulin syringes for administration of verified insulin doses greater than 50 units for individual patients. Conclusion: 100 unit insulin syringes were removed from patient care areas. Use of safety alerts together with local incident reports and robust multidisciplinary partnerships can be used to drive change.

56 A qualitative study on Australians opinions about integrated electronic health records Elin Lehnbom1,2, Andrew McLachlan1,3, Jo-anne Brien1,2,4 1 Faculty of Pharmacy, University of Sydney, NSW, 2Therapeutics Centre, St Vincentâ&#x20AC;&#x2122;s Hospital, NSW, 3Centre for Education and Research on Ageing, Concord Hospital, NSW, 4Faculty of Medicine, University of New South Wales, NSW Correspondence: andrew.mclachlan@sydney.edu.au

Aim: To explore the knowledge, understanding and views on Integrated Electronic Health Records (IEHRs) among Australian health care providers (HCPs) and consumers. Methods: Participants were recruited via advertisements placed in hospitals, outpatient clinics, libraries and also sent electronically to professional organisations. Consenting participants were interviewed once, over the phone or face-to-face, individually or in small groups. Interviews were audio recorded, transcribed verbatim and analysed for emerging themes. Results: Twenty consumers and 22 HCPs were interviewed. The analysis revealed poor knowledge about IEHR among consumers whereas most HCPs had heard about IEHRs. However, HCPs understanding was limited to electronic health records for hospital inpatients. All participants viewed the implementation of IEHRs as inevitable and the majority were in favour of this development. It was believed that IEHRs would be a helpful communication tool, be cost saving (minimise test duplications) and provide a holistic patient view thus improving patient care. The major concern participants had regarding IEHRs was how patient privacy would be protected. Most consumers indicated they would share their health information with their GP and specialists. However, the benefits of giving pharmacists access to the IEHR was debated. In addition, there was major controversy regarding the uptake of the system and whether it should be an opt-in, opt-out or a universal system. Conclusion: This exploratory study has provided valuable insight into the current knowledge, understanding and views of IEHRs. It has highlighted current shortfalls in the awareness of IEHR and a need for strategies to inform consumers and health care professionals about IEHR. This is critical to the successful implementation and utilisation of e-health initiatives and policies in Australia.

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staying alive 2010

poster abstracts 57 A comparison of heparin infusion protocols in vascular surgery patients Nikki Minge1, Laura Brooks1 1 Flinders Medical Hospital, SA

Background: Unfractionated heparin (UFH) infusions can be used for many indications including the treatment of venous thromboembolism, pulmonary embolism and bridging therapy for patients on warfarin for whom surgery is imminent. Infusions are monitored by activated parital thromboplastin time (APTT). The target range of APTT varies depending on the indication of use. In 2010 the vascular team developed an UFH infusion protocol specifically targeting a higher APTT than the current cardiac UFH infusion protocol. Aim: The primary aim of this study is to compare the safety of a new UFH infusion protocol against the existing protocol in vascular surgery patients. A secondary aim is to assess protocol adherence. Method: The study was conducted from February to May 2010. Patients were identified through OACIS (Open Architecture Clinical Information System) if they had an APTT test performed during a vascular admission within the study time period. The safety of the new UFH infusion protocol was assessed by measuring the incidence of bleeding as identified by a drop in haemoglobin below 80g/L, or the need for a blood transfusion while on the infusion. Time spent in the intensive care unit was not included, nor were patients with known bleeding disorders. Results: Seventeen of the 23 patients receiving the cardiac protocol achieved therapeutic APTT (74%) with a mean time of 20.9 hours, compared with 14 of the 18 patients receiving the vascular protocol (79%) with a mean time of 20 hours. There was no significant difference in the incidence of bleeding between the protocols. Conclusion: No single UFH infusion protocol will suit all indications. The new vascular UFH infusion protocol achieved therapeutic APTT in a comparable time frame to the cardiac protocol without increased risk of bleeding. It is anticipated that the vascular UFH infusion protocol will be extended hospital wide for specific indications.

58 Life goes onâ&#x20AC;&#x201D;the journey home: establishing a paediatric home parenteral nutrition

service Kate Oâ&#x20AC;&#x2122;Hara1, Jane Gillard1 1 John Hunter Hospital, NSW

Correspondence: kate.o'hara@hnehealth.nsw.gov.au

Objective: As a major teaching tertiary referral hospital, our institution possessed vast experience in neonatal and adult parenteral nutrition (PN) including many years experience with adult home parenteral nutrition. Experience of parenteral nutrition within the paediatric population was limited to short term use for oncology or post operative indications. The delivery of a child at our institution with intestinal pseudo-obstructive disorder presented us with a myriad of challenges during his admission fulminating in establishing resources and support for his discharge on home parenteral nutrition. Background: Intestinal pseudo-obstructive disorder is a form of intestinal failure independent of actual intestinal length. It can be described as loss of intestinal competence resulting in an inability to sustain life. Supplementation with parenteral nutrition is life saving and life long. Clinical features: Antenatal scans showed our patient had dilated bowel loops and investigations and multiple medications were commenced soon after birth. Significant surgeries were also undertaken. As it became clear that long term PN would be required a range of other problems arose. Interventions: The transitioning process from neonatal to paediatric PN formulations, development of monitoring guidelines, managing a long term central line, management of enteral feeding and medication administration and management of other co-morbidities presented formidable obstacles. In addition to the normal practicalities of home PN, not hindering development provides additional challenges. Conclusion: Meeting these challenges enabled the establishment of a paediatric home parenteral nutrition service within our hospital.

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poster abstracts 59 Iron infusions—a review of prescribing practices Janelle Penno1, Michelle Vienet1 1 The Royal Melbourne Hospital, VIC

Correspondence: Janelle.Penno@mh.org.au

Aim: To audit the appropriateness of prescribing of iron polymaltose infusions with respect to pathology results and to determine if an appropriate protocol was used. Method: A prospective audit, over two months, of hospital administered iron infusions was conducted. Dialysis patients and infusions given over weekends were excluded. Data collected included age, admission details, haemoglobin, iron studies, protocol used and dose. Results: Over the study period 92 infusions were administered, approximately two per day. Patients had an average age of 62 years (range 20–91 years) and 52% were outpatients admitted for an iron infusion. Of those infusions prescribed for inpatients the most common reason for hospital admission was anaemia followed by chest pain and active bleeding. 37/92 (40%) iron infusions were prescribed according to a ‘general’ protocol, which does not specify measurement of iron studies prior to prescription and uses a 500mL volume administered over five hours. The remaining 55/92 (60%) used a ‘renal’ protocol, which specifies measurement of ferritin and transferrin saturation. This protocol utilises a lower infusion volume and administration time but has a maximum dose of 1500mg. Of those infusions prescribed according to the ‘renal’ protocol 36/55 (65%) patients had documented chronic kidney disease. 75/92 (82%) patients had a documented haemoglobin available and of those 67 (89%) were anaemic (haemoglobin <120 g/L). 62/75 had documented iron studies available and 42/62 (68%) were consistent with iron deficiency (ferritin <150mCg/L and transferrin saturation <15%). 40/92 (43%) patients had a documented weight available. According to the available protocols 22/40 (55%) were administered an appropriate dose for their weight and pathology, while 15% were given a higher dose than recommended, and 30% were given a lower dose. Conclusion: Iron infusions are prescribed inconsistently and according to a variety of protocols. There is need for a single comprehensive protocol.

60 Exploring the beliefs of heart failure patients towards their medicines Matthew Percival1, Neil Cottrell2, Rohan Jayasinghe1 1 Queensland Health, QLD, 2School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, QLD Correspondence: matt_percival@health.qld.gov.au

Aim: To identify beliefs that patients with heart failure have towards their medications and self–care activities and whether these beliefs relate to adherence. Methods: Patients attending a multi–disciplinary heart failure clinic were interviewed using a questionnaire composed of fours parts: the Beliefs About Medicines questionnaire (BMQ); the repertory grid technique (compares and contrasts between patient medicines and self–care activities allowing them to generate a list of statements reflecting their understanding of their medicines); the Medicines Adherence Reporting Scale (MARS); demographic details. Patients were divided into those with good adherence (MARS score >23) and those with poor adherence (MARS score 22). The necessity beliefs scores from BMQ and the frequency of statements generated from the repertory grid portion of the questionnaire were compared between these two groups. Results: Forty-four patients were interviewed with a mean age (±SD) of 64 (±17) years and seven (16%) were female. Thirty-eight (86%) patients had good self–reported adherence (MARS > 23); the remaining six (14%) had poor self-reported adherence (MARS 22). The 44 patients generated a total of 262 statements (225 in good adherence group) about their medicines. The four most common themed statements were; related to fluid (92), benefit to the heart (89), related to weight (34), benefit to me (14). Patients with good selfreported adherence had a non-significant higher median necessity score (22 vs 19.5; p=0.056) and generated the statement ‘benefit to the heart’ more frequently (34.7% vs 29.7%) compared to those with poor adherence. Conclusion: A high necessity belief towards medicines was related to improved adherence in patients with heart failure. The necessity belief may be related to patient’s understanding that their medicines are of benefit to the heart: this may be a key term to utilise when explaining the role of medicines to patients with heart failure.

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poster abstracts 61 Positive ripple effects for patient care on an aged care and rehabilitation sub-acute

hospital Lynda Pham1 1 Royal Melbourne Hospital—Park Campus, VIC Correspondence: lyndathpham@yahoo.com.au

Aim: To improve communication at an interdepartmental, interdivisional, inter-hospital and intra-hospital level in a remote sub-acute aged care and rehabilitation hospital in relation to medication safety. To utilise a hospital wide health care team approach to medication safety through formation of a medication safety sub-committee. Method: A medication safety sub-committee that focuses on the needs of the remote campus was proposed in light of a large increase in medication incident reporting and the looming ACHS EquiP accreditation review. The sub-committee included medical, nursing, quality, safety and pharmacy representation. Results: The multidisciplinary sub-committee has served to unite the campus and improve lateral communication flow. Formalised, interactive medication safety tutorials utilising current local medication incidents from risk reporting system has resulted in a systematic approach to providing junior doctors, graduate nurses and graduate pharmacists feedback and methods of improving patient care. The sub-committee reports to the medication safety committee at the main city campus, thereby allowing clear flow of communication between the city and remote sub-acute campus. This has resulted in more efficient implementation of organisation wide initiatives. Conclusion: When all other committees on the campus are divisional based, the formation of the medication sub-committee has led to better communication in every direction and a positive ripple effect to patient care.

62 A communicative tool for preoperative diabetic management—a pilot study Michelle Phung1, Laura Leung1 1 Royal Women’s Hospital

Correspondence: michellephung10@hotmail.com

Background: Growing evidence supports the association of well controlled preoperative glucose levels and improved patient outcomes. Consequently, a preoperative communicative tool was developed with consultation from medical and nursing staff. It consists of a patient information leaflet ‘diabetes and surgery’ and a medicine management proforma outlining an individualised antidiabetic regimen used prior to surgery. Aim: The aim of this study was to evaluate the usefulness of the communicative tool in diabetic patients undergoing surgery. Method: All diabetic patients undergoing elective gynaecological surgery attending preadmission clinic between Feb-June 2010 were included in this study. The attending anaesthetist was to hand out and complete the tool for each patient during their consultation. The usefulness of the tool was quantitatively assessed by the patient and anaesthetist using self-completed Likert surveys. Results: Seventeen patients were eligible to be enrolled into the study, however, ten patients did not participate due to time constraints and language barriers. Seven patients, aged between 42 and 83, were included in the study. Seven patient and seven medical surveys were received. 86% (6/7) of patients agree that the information leaflet was easy to read, relevant and helpful with the majority willing to recommend the leaflet to others, while 43% (3/7) of patients agree that the medicine management form was easy to follow, clear and helpful. Results from the medical survey found 71% (5/7) agree that the tool was easy to follow, complete and served as an effective means of communication. However difficulties encountered included time constraints and the layout of the medicine management form. Conclusion: Although participation numbers were low, feedback from patients and anaesthetists indicate that the communicative tool is useful. Improvements include offering the tool in different languages, simplifying the medicine management form and extending the study to a larger patient population.

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poster abstracts 63 Exploring patients’ views surrounding cessation of medications in a multidisciplinary

ambulatory consulting service Emily Reeve1, Sepehr Shakib1,2, Michael Wiese1, Ivanka Hendrix1,2, Michael Roberts1 1 University of South Australia, SA, 2Royal Adelaide Hospital, SA Correspondence: emily.reeve@postgrads.unisa.edu.au

Background: Patients often complain about the number of medications that they are taking, and the possible consequences of polypharmacy are well established. In order to conduct shared decision making with patients it is important to understand how they feel about their medications. Aim: The primary aim of this study was to explore patients’ attitudes, beliefs and experiences regarding the number of medications they are taking and the cessation of regular medications. Methods: This study used a 15 question questionnaire for quantitative analysis. Additional information collected included age, country of birth, management of medications and number of current medications and co-morbidities. Results: Questionnaires were completed in a total number of 100 patients. Over 60% of patients felt that they were taking a ‘large number’ of medications. However not all of these patients were uncomfortable with the number of medications that they are taking. A majority of patients would be willing to stop one or more of their current medications if possible and also would start a new medication if needed. The question of whether or not patients feel that all of their medications are still needed or not produced the most uncertainty. Approximately half of all patients reported that they would be comfortable if a pharmacist was involved in the cessation of one or more of their regular medications. Conclusion: Patients were found to have different views about their medications. Therefore patients must be treated as individuals when performing medications reviews with focus on cessation of regular medications which are no longer indicated. The results of this study support the need for development of a ‘deprescribing’ process which allows for differences in individual patient beliefs.

64 Lead—the blessing and the curse of a mining town Yograjsinh Sagar1, Lindsay Scott1 1 Broken Hill Base Hospital, NSW

Correspondence: yograj1357@gmail.com

Background: The case outlines the importance of environmental lead monitoring in a mining town. Current lead monitoring programs involves monitoring of lead levels, remediation of public land, public education and health promotion. Voluntary annual testing is offered to all children up to the age of five as children in this age group are at higher risk of lead poisoning. All adults working in high risk occupations (eg mining) are also tested annually. Objective: To show the treatment of high lead levels in a paediatric patient. Clinical features: Pt TR is 2½-year-old boy who was seen in paediatric outpatients following routine lead level monitoring test. Lead level = 3.65 micromol/L. The child had no relevant past medical history and had no symptoms related to high lead levels. Common manifestations of high lead levels would include headache, seizures, ataxia, parasthesia irratibility, depression, abdominal pain and constipation. Interventions: TR was prescribed the chelation agent succimer which is an SAS product available from Link Pharmaceuticals. The mode of action is a heavy metal chelating agent which forms a water soluble complex with lead and is excreted in the urine. TR was given the standard dose of 10mg/kg tds for 5 days then 10mg/kg bd for 14 days. Precautions with the use of succimer include adequate hydration. TR had further lead levels taken weekly during treatment. Conclusion: Management of TR is ongoing.

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staying alive 2010

poster abstracts 65 Stress lessâ&#x20AC;&#x201D;inappropriate continuation of stress ulcer prophylaxis Rebecca Sbeghen1 1 Greenslopes Hospital Pharmacy, QLD

Correspondence: sbeghenr@ramsayhealth.com.au

Aim: To review the proportion of patients in the intensive care unit (ICU) who were initiated on stress ulcer prophylaxis (SUP) and continued on a proton pump inhibitor (PPI) inappropriately on discharge. Method: The study was a retrospective chart review of patients who received a proton pump inhibitor for SUP in ICU over one month. Discontinuation of the PPI was deemed appropriate when risk factors such as mechanical ventilation and coagulopathy were no longer present. Results: Twenty-nine patients received an IV PPI for SUP in ICU. Only one patient ceased SUP on transfer from ICU to ward. Most patients (96%) continued the PPI on transfer from ICU to ward, with 39% of these continuing on an IV PPI and 57% changed to oral PPIs before transfer. Most patients initiated on SUP had two or more risk factors with 75% of patients receiving mechanical ventilation. The PPI was discontinued in 39% of patients during their hospital admission and 61% of patients continued on a PPI on discharge. A PPI was continued inappropriately on discharge from hospital in 25% of patients. Conclusion: This DUE confirmed other recent published research which showed that SUP was regularly continued in patients when risk factors were no longer present including on discharge from hospital. Guidelines for SUP use should be instituted in the hospital as well as educational strategies aimed at pharmacists, nurses and doctors to prevent overuse of SUP and provide cost benefits.

66 Facilitating medication safety risk assessment in the emergency department Dana Strumpman1, Beata Bajorek2, Nitesh Kumar2, Christopher Brian Knowler2 1 Pharmacy Department, Prince of Wales Hospital, NSW, 2Faculty of Pharmacy, University of Sydney, NSW Correspondence: dana.strumpman@sesiahs.health.nsw.gov.au

Background: The risk of medication misadventure is heightened in acute ambulatory settings, such that identification of patients at high risk is integral to minimising medication-related adverse drug events. Aim: To pilot and evaluate a process for detecting patients at high risk of medication misadventure in the emergency department (ED) and to assess the outcome of any intervention performed by the ED pharmacist. Methods: A prospective descriptive study was undertaken over a two-week period. All patients admitted to the emergency medical unit (EMU) were assessed for their risk of medication misadventure by ED nurses, ED pharmacist and researchers using a purpose designed risk assessment form. Patients identified by the nurses as being at high risk were referred to the ED pharmacist for consultation and intervention as necessary. The nature and outcome of each intervention was recorded. Results: Of the 118 patients reviewed, 36 patients (31%) were categorised as being at high risk of medication misadventure, with 18 patients (15%) requiring clinical pharmacist intervention. Overall, 43 interventions were performed by the ED pharmacist, with all patients requiring medication counselling. Four patients identified as potentially benefiting from home medicines reviews were referred to the hospitalâ&#x20AC;&#x2122;s community liaison pharmacist. Discussion: The results of this pilot study highlight the contribution of a clinical pharmacist in the ED in reducing the risk of medication misadventure and the value of a purpose-designed risk assessment tool. Overall, this can improve health outcomes in patients as well as bridge the communication gap between hospital and community health care providers.

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poster abstracts 67 Current prescribing trends for the treatment of osteoporosis: combination versus

monotherapy Satish Maganlal1, Nicola Shapland1, Carly Clifford1, Benjamin Fretten1, Sai Tappoo1, Evelin Tiralongo1 1 Griffith University, QLD

2.2 million Australians suffer from osteoporosis placing a heavy burden on the health system with an annual cost of approximately $1.9 billion, mostly due (68%) to hospitalisations and nursing home care. Guidelines for osteoporosis advise a holistic approach, in which lifestyle changes and mineral supplementation are combined with drug therapy and monitoring. To optimise medication adherence, several combination products containing various mixtures of bisphosphonate, vitamin D and calcium are available. Aim: To compare the prescribing of combination products with single ingredient preparations for the management of osteoporosis. Methods: Participants were consenting patients filling a prescription for osteoporosis medication at five community pharmacies in South-East Queensland during the data collection period in April 2010. The survey was conducted using a standard questionnaire in face-to-face interviews. Results: Of the 68 participants surveyed, 36 (53%) used a combination product; and of these 11 (30%) used an alendronate/colecalciferol combination. Thirty-nine (57%) of all participants were not taking additional calcium or vitamin D supplements; and of these 19 (48%) on advice from their GP. Only six of these 39 participants were taking a combination product, thus a total of 33 (49%) were receiving NO calcium or vitamin D. Furthermore, 28 (41%) participants had missed doses or had trouble remembering doses. Greater adherence was observed in patients taking combination products. Finally, 49 (72%) participants had inadequate doctors’ instructions on their prescriptions, a finding that may have influenced adherence. Conclusion: While the treatment of osteoporosis has improved over the last decade, this study confirmed that even with the addition of combination therapy to the Australian market, optimal management of the disease is yet to be attained. Significant improvements in treatments, adherence and understanding of osteoporosis could be achieved by the use of combination products and greater patient, as well as, pharmacist and doctor education.

68 Accuracy of interim residential care medication administration charts prepared by

hospital pharmacists (MedGap Project) Tim Tran1, Xing Xin2, Simone Taylor1, Rohan Elliott1,2 1 Austin Health, VIC, 2Monash University, VIC

Background: A hospital-provided interim residential care medication administration chart (IRCMAC) enables medications to be administered upon patient arrival at a residential care facility (RCF). The IRCMAC may be used for up to seven days, until the patient’s GP writes a new chart, so it is vital that it is accurate (i.e. concordant with the discharge prescription). An IRCMAC that is prepared by hospital pharmacists using data extracted electronically from hospital discharge dispensing records was recently implemented at our health service. Aim: To determine the accuracy of IRCMACs prepared by hospital pharmacists. Methods: An IRCMAC was provided to 226 patients over a 3-month period. One third of IRCMACs (n=76) were randomly selected and compared retrospectively with patients’ hospital discharge prescription(s). The primary endpoint was the proportion of medications prescribed on discharge that were accurately recorded on the IRCMAC. Results: 877 items (765 regular, 112 prn) were prescribed on discharge for the 76 patients. 16/877 (1.8%) items had a discrepancy on the IRCMAC compared to the discharge prescription. Seven of these discrepancies involved nutritional drinks that were not supplied by the pharmacy department. Excluding these, there were 9/870 (1.0%) items that had a discrepancy: omissions of cholecalciferol, glucosamine, lactobacilli, prn paracetamol and prn temazepam, a dose discrepancy for salbutamol, salbutamol prescribed for both regular and prn use charted only in the prn section (2 cases), and inclusion of amoxicillin/clavulanic acid on the IRCMAC that had been ceased on the discharge prescription. Conclusion: The pharmacist-prepared IRCMAC is an accurate tool on which RCF staff can record medication administration prior to the GP attending to update the RCF medication chart.

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staying alive 2010

poster abstracts 69 Are there gaps in our pharmacy service provision? A discharge medication record

audit Dimity Williams1, James Radford1, Cal Winckel1 1 Ipswich Hospital Pharmacy, QLD Correspondence: dimity.williams@uqconnect.edu.au

Background: The provision of a discharge medication record (DMR) contributes to the continuity of care across different health care providers and settings and the quality of use of medicines. The supply of DMRs is key component of the APAC guidelines, ACHSâ&#x20AC;&#x2122; mandatory criteria and QLD Health Medicines Management. Aim: To ascertain the proportion of patients discharged from the hospital that received a DMR; to determine proportion of surgical/medical/paediatric DMRs provided; to identify potential shortfalls in service provision. Method: Data was sourced from clinical benchmarking, electronic discharge summary (EDS) and Enterprise Liaison Medication System (eLMS) databases and iPharmacy dispensing system. Baseline separation data for February 2010 was obtained. EDS services provided discharge summary data by medical staff. The eLMS application established each patientâ&#x20AC;&#x2122;s DMR status and iPharmacy determined the medications supplied to the patient at discharge. Patients were excluded due to predetermined criteria. Results: 1 340 separations were recorded for the study period, with 859 EDS were produced. 117 patients were excluded according to criteria. Of the remaining 742 patients, 336 (45%) received a DMR. 11% of paediatric, 29% of surgical and 74% of medical patients were supplied with a DMR. After-hours discharges accounted for 41% of surgical, 39% of medical and 29% of paediatric patients not receiving a DMR. Conclusion: The hospital pharmacy services are performing above the state benchmark of 15% DMR provision. This investigation highlights a significant proportion of surgical and paediatric patients not supplied with a DMR. Potential risk for these patients maybe reduced if no medications were required at discharge due to low co-morbidities or low risk procedures. However, further work must be performed to determine potential risk to these patients and if redistribution of resources to the surgical or paediatric pharmacy teams may alleviate this problem.

70 Patient awareness of the risks of zoledronic acid use in osteoporosis Louise Williams1, Claire Keith1, Simone Taylor1 1 Pharmacy Department, Austin Health, VIC Correspondence: louise.williams@austin.org.au

Background: More patients with osteoporosis are receiving zoledronic acid since it was included on the PBS schedule for secondary prevention of osteoporosis. Parenteral bisphosphonates have been associated with an increased risk of osteonecrosis of the jaw (ONJ) and a dental review is recommended prior to initiation. Aim: To evaluate patient awareness of the risks of zoledronic acid in osteoporosis, with particular focus on the issue of ONJ, before and after implementation of an education intervention. Methods: Ambulatory care centre patients administered zoledronic acid for osteoporosis were eligible for inclusion. Data was collected regarding ONJ risk factors (age >60 years, dental check within the previous 12 months, dental surgery, local trauma or infection, preexisting dental or periodontal disease, self reported poor oral hygiene, longer duration of therapy, immunosuppressive therapy, history of malignancy or diabetes, and alcohol and/or tobacco abuse). The intervention consisted of an information leaflet sent to patients prior to their treatment. Discussion of dental checks was also added to the prescribing checklist used by the Endocrinology Unit. Results: Of the 49 pre-intervention patients, 33 (67%) were Endocrinology Unit patients and 35 (71%) were >60 years of age. Only 29 (60%) had visited the dentist within the preceding 12 months and 6 (12%) had some outstanding dental work. Of the 33 post-intervention patients recruited to date, 19 (58%) received the leaflet prior to their appointment. Seventeen (89%) of these 19 patients had read the leaflet prior to attending. Twenty-two (67%) had visited the dentist within the preceding 12 months. Qualitative data suggests that patients are much more informed about what to expect with the infusion and the risks-vs-benefits. Data collection for the post intervention phase is continuing. Conclusion: The intervention to increase patient awareness of issues surrounding zoledronic acid and the risks of ONJ is showing trends towards improvement.

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poster abstracts Painful situations 71 Does gabapentin have a role in children undergoing spinal surgical procedures? Michele Cree1,2, Julianne Richards1, Catherine Kotzer1, Kathleen Cooke1 1 Queensland Paediatric Pain Centre, Royal Children’s Hospital Brisbane, QLD, 2Pharmacy Department, Royal Children’s Hospital Brisbane, QLD Correspondence: michele_cree@health.qld.gov.au

Introduction: Clinical studies have found that gabapentin has been effective in treating neuropathic pain in paediatric patients. A few trials have demonstrated that gabapentin in conjunction with morphine for pain relief has provided patients with an increased pain tolerance. Aim: To review the evidence for gabapentin and whether gabapentin reduces opioid requirements in paediatric patients undergoing spinal surgical procedures. Method: An extensive literature review was performed to establish the evidence for gabapentin in paediatric spinal surgical procedures. A protocol was developed from evidence and patients were selected on the following criteria: to be greater than 8 years; having posterior spinal surgery of 5 levels or greater; and no previous history of spinal surgery. Patients with post operative epidural analgesia were excluded. Patients were given a premedication of gabapentin at 10mg/kg and additional gabapentin 10mg/kg three times a day for 48 hours post spinal fusion surgery. Opioid consumption was reviewed in these patients. Results: Limited literature exists especially involving paediatrics. Rusy and colleagues demonstrated that gabapentin reduced opioid requirements in 29 paediatric spinal fusion patients. Data collected on our spinal fusion patients found that average opioid use in those patients who did not receive gabapentin (n=8) was 2.98mg/kg; compared with patients receiving gabapentin (n=6) was 4.17mg/kg; however one patient received 4–5 times the average opioid dose and if excluded then the average opioid use was 2.7mg/kg (n=5). Preliminary analysis suggests that gabapentin did not exhibit a significant decrease in opioid requirements. However this could be associated with complexity of pain and the multiple patient variables including pre-existing medical conditions and variations in intraoperative analgesia techniques. Conclusion: Unfortunately we found that we could not replicate Rusy and colleagues findings that gabapentin decreased opioid consumption in paediatric spinal fusion patients. More studies with greater patient numbers are needed to see whether gabapentin has a role in reducing opioid consumption in paediatric spinal surgical patients.

72 The evolving role of the pharmacist in chronic pain management Alana Croucher1, Tony Hall1,2 1 Griffith University, QLD, 2Gold Coast Hospital Chronic Pain Management Team, QLD Correspondence: alana.croucher@griffithuni.edu.au

Background: Multidisciplinary pain management programs (MDPMP) involves three or more health disciplines in the treatment of chronic pain. These teams, despite involving multiple fields of health care professionals had minor involvement of a pharmacist. Pharmacotherapeutics is the optimal therapeutic decisions based on an evaluation of the individual patient and an assessment of the evidence for efficacy and safety of the treatment. An understanding of the pharmacokinetics and pharmacodynamics of the drug should be integrated with this patient-focused information to guide implementation of therapy. Pharmacists can have an important pharmacotherapeutic role in the treatment of chronic pain through the management of medications. Aim: The aim of this study is to ensure the abilities of the pharmacist and clinical pharmacist are acknowledged, and should be integrated and utilised in the chronic pain team rehabilitation treatment. Method: Cross-sectional evaluation of current national and international pain management programs (PMP) was compiled in January 2010, specifically noting the participating health disciplines in these programs. Twenty-nine publications including 15 discussing interdisciplinary team and PMP, 7 discussing interdisciplinary treatments but no defined PMP, and 6 articles that highlight the role of the pharmacist in the management and treatment of chronic pain. Discussion: The role of a clinical pharmacist as a member of the multidisciplinary pain management program was explored. Clinical pharmacists not only to assist in the management of the chronic pain medication, but also educate patients and assess the patient’s overall health state. Recognition of pharmacists as an important feature of the health care model is particularly valuable first and foremost to the patient in ensuring a complete model of care is being applied.

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staying alive 2010

poster abstracts 73 A retrospective review of the appropriate prescribing and costs of intravenous

paracetamol Karen Figueroa1, Richard Marotti1 1 Flinders Medical Centre, SA

Correspondence: Karen.Figueroa@health.sa.gov.au

Intravenous (IV) paracetamol is indicated for the relief of mild to moderate pain and the reduction of fever where an intravenous route of administration is considered clinically necessary. Current guidelines at this centre restrict the prescribing of IV paracetamol to patients in whom oral formulations are not deemed clinically appropriate. The decision to prescribe IV paracetamol at this centre is restricted to recommendations made by the acute pain service. Aim: The primary aim of this project is to evaluate compliance of IV paracetamol 1g/100mL (Perfalgan®) prescribing in accordance with local centre guidelines. Furthermore, an assessment will be made on the comparative costs of the intravenous administration route versus oral and rectal administration. Methods: A retrospective review of IV paracetamol inpatient dispensing was undertaken over a four-week period. The review involved a pharmacist undertaking a comprehensive assessment of clinical records of all inpatient orders faxed to pharmacy over this period. Relevant clinical details were collected including whether the patient was taking any other oral medications, if the patient was fasting or whether the patient had difficulty swallowing, etc. In order to assess total use in the centre a review of the pharmacy software was completed over the preceding six months to determine the total number of doses distributed by the pharmacy service. This review included those distributions made to the imprests of designated clinical units and the dispensing of IV paracetamol to individual patients. Results: From December 2009 to May 2010 a total of 7 843 doses of Perfalgan® were used in the centre with a total cost of $51 058. These costs do not include the additional expenses associated with nursing time and administration. Conclusion: A significant proportion of IV paracetamol is continued in patients where oral or rectal routes are a more appropriate form of administration.

74 Don’t condone medication errors involving oxycodone: if you don’t succeed, try and

try again! David Gilbert1, Diane Reeves1, Jenny Burrows1, Julianne Angel1 1 Gosford and Wyong Hospitals, North Sydney Central Coast Area Health Service, NSW Correspondence: dgilbert@nsccahs.health.nsw.gov.au

Aim: The state-wide Incident Information Management System (IIMS) revealed that around 100 medications errors per year related to oxycodone were occurring at a large metropolitan teaching hospital. The aim of this project was to improve awareness and knowledge base surrounding oxycodone and minimise errors. Method: Baseline data revealed that errors were occurring in relation to prescribing, administration and dispensing of oxycodone and as such a multidisciplinary approach to the project was required. Stakeholder representatives from pharmacy, medical, nursing, education and psychology backgrounds were brought together to identify means of dealing with this problem. Strategies incorporating colour coding, separate registers, improved labelling, lanyard cards, charting specifications, educational resources and awareness programs were developed. Stakeholders took personal ownership of the problem and the strategies used to address it. Endorsement was sourced from both the Clinical Governance Unit and Executive Management to support implementation. A questionnaire assessed staff knowledge of oxycodone both pre- and post-implementation. Prescribing and IIMS data audits were undertaken and reviewed to determine if the strategies had impacted on oxycodone related errors. Results: The project was rolled out in an acute medical unit in phase1 with a 20% increase in knowledge base. Some modifications to the project occurred as a result of phase 1 prior to phase 2 implementation and subsequent roll out across the organisation. The marketing of the project and the involvement of a diverse group of stakeholders managed to maintain both enthusiasm and support for the project. Conclusion: The enthusiasm generated by the multidisciplinary approach and the endorsement of senior management provided a platform for sustainability. Clinicians in the clinical areas welcomed the strategies which supported them in clarification and accuracy regarding oxycodone administration. Ongoing audits of prescribing, administration and the profile of medication incidents are reported back to area executive and clinicians

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poster abstracts 75 Opioid prescribing: are patients taking opioid(s) receiving appropriate breakthrough

doses and prophylactic laxatives? Nina (Pei-Chia) Hsu1, Dan Mellor1, Allan Shum1, Arti Thakerar1 1 Peter MacCallum Cancer Centre, VIC

Background: As a specialist cancer centre, a significant number of our patients require pain management. A large proportion of the prescriptions coming to the pharmacy from the outpatient department comprise at least one opioid. Optimisation for control of the patientâ&#x20AC;&#x2122;s cancer pain, based on the hospital protocol, should be performed. Objective: To assess the current practice of prescribing opioid breakthrough doses and prophylactic laxatives in the outpatient setting and to compare the results with the current hospital recommendations. Method: A nine-question data capture form will be utilised. The dispensary pharmacists collected the data over a 3-week period in May 2010. Data was collected from prescriptions containing an opioid prescribed by hospital doctors from various clinics. Data collected include the outpatient clinic patient had attended; the opioids prescribed (including name, strength, dose and frequency); any laxatives patient uses or has at home. Results: Data was collected for a total of 61 prescriptions. 19 (31%) patients had breakthrough doses specified and were prescribed within the recommended range. 11 (18%) patients were prescribed with immediately release opioids only. 7 (11%) patients who were prescribed with regular slow release opioids and do not have breakthrough pain relief. 4 (7%) patients do not have laxatives at home however, 2 patients do not require laxatives, 1 patient has diarrhoeal episodes and 1 patient has laxative and opioids newly prescribed on the same prescription. Total 31 (51%) prescriptions would require pharmacy intervention based on the hospital protocol. Of those prescriptions that require interventions, 94% (n=31) would involve recommendation of the correct breakthrough dose and 6% requires clarification of a specific breakthrough dose. Discussion: The result proposes a good practice of using prophylactic laxatives from all aspects. The result also suggests improvement of prescribing opioid breakthrough doses based on the hospital protocol in hospital clinics is essential.

76 Purple glove syndrome associated with phenytoinâ&#x20AC;&#x201D;who is aware? Janelle Penno1 1 The Royal Melbourne Hospital, VIC

Correspondence: Janelle.Penno@mh.org.au

Objective: To report a case of purple glove syndrome (PGS) associated with phenytoin, its low rate of recognition, management with simple conservative measures and prevention strategies possible. Clinical features: An 88-year-old female was transferred for management of an acute on chronic sub-dural haemorrhage. Past medical history included hypertension, osteoarthritis, gastro-oesophageal reflux and stress incontinence. Interventions, case progress and outcome: For seizure prophylaxis the patient was loaded with 1g intravenous phenytoin then continued on 300mg intravenous phenytoin daily. On day two of admission, to the intensive care unit the patient developed severe hand pain after approximately 30mg of phenytoin had been administered via a peripheral line in the left arm. The hand was grossly oedematous and erythema with purple discolouration was observed. The IV cannula was removed, the arm elevated in a splint and regular vascular observations taken. A new IV line was inserted in the right arm to allow for continuing therapy with no subsequent reaction. After 12 days of elevation and hand physiotherapy most symptoms had subsided however some weakness remained. This reaction was recognised by the intensive care unit as PGS, however the parent team documented it as cellulitis, treating with antibiotics, despite no signs of infection. PGS treatment recommendations include elevation of the limb, dry heat and regular vascular observations. Factors that can prevent this rare reaction occurring include avoiding injury to blood vessels during cannulation, use of a larger vein, reduced rate of infusion, ensuring the line is well flushed before and after dose and judicious use of intravenous phenytoin in the higher risk elderly population. Conclusion: PGS is a rare adverse reaction associated with intravenous phenytoin but it can be prevented via simple measures. Increased awareness of the causes and correct identification of PGS will aid in the prevention and improved treatment of this reaction.

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staying alive 2010

poster abstracts 77 Staying alive: encouraging use of IV potassium pre-mixes Dianne Rozynski1, Vanessa Frkovic1 1 Toowoomba Health Service, QLD

Aim: To increase staff awareness of available products and increase the uptake of the use of pre-mixed parenteral potassium chloride products and reduce the excessive use of potassium chloride ampoules at Toowoomba Hospital. Method: An audit of the use of parenteral potassium chloride in all wards and units, including both imprest and non-imprest use of premixed potassium chloride fluids and concentrated potassium chloride ampoules. Survey (MOs/RNs) staff to ascertain knowledge of available products and opinions regarding pre-mixed bags and concentrated ampoules. Results: Staff are aware of the risks of using potassium ampoules and the benefits of using a pre-mix solution. However, there was a lack of awareness of which pre-mixed products were available (MOs and RNs) and the appropriateness of these alternatives. 92.3% MOs surveyed were unaware of the availability of 3% glucose, 0.3%NaCl, 40mmol KCL. 100% RNs surveyed incorrectly identified which pre-mix are available. Conclusion: Following presentation of the survey results to CME (continuing medical education) and discussion at the Medication Management Committee, posters showing the strength of all oral and parenteral potassium products available in the Toowoomba Hospital have been placed in every ward and laminated cards with the same information have been placed in the medication folders at the end of each bed. A selection of pre-mix bags have been placed on imprest in the wards and staff shown the location of them. Staff awareness of QH Fluids and Electrolytes Guidelines and the recommendation to order 3% glucose, 0.3% NaCl, with an appropriate amount of KCl has been raised. Use of ampoules when a suitable alternative is available has reduced, aided by education of pharmacists to determine need or request a change of order if suitable.

78 ‘Contin’ confusion: a multifaceted approach to a painful problem! Lindsay Scott1 1 Broken Hill Base Hospital, NSW

Correspondence: lscott@gwahs.health.nsw.gov.au

Background: Confusion and errors associated with the ‘sound-alike’ Contin medicines Oxycontin® and MS Contin® is a common problem in Australian hospitals. Aim: The aim of this study is to implement an action research approach to reduce errors associated with the ‘Contins’ and combining education and changes in hospital policy Method: The study was conducted in a number of phases using an action research methodology in a small base hospital in NSW. The first phase of the intervention was an educational campaign using NSW Health produced poster informing health professionals about the difference between the ‘Contins’. The second phase of the project was a change in hospital policy removing MS Contin from the formulary and using an alternative brand of slow release oral morphine. The third phase expanded the scope of the project to include reducing the confusion between immediate release and slow release products. All S8 tablets and capsules distributed to wards had a sticker attached to indicate if the product was slow release or immediate release. Results: Following the education campaign, two IIMs reports were received regarding errors associated with the ‘Contin’ drugs, indicating that further ‘action’ was required. Twelve months after the implementation of the hospital policy changes no incident reports relating to ‘Contin confusion’ have been received. Conclusion: The combination of educational and hospital policy interventions used in an action research setting provides an effective strategy for reducing the risk associated with ‘Contin confusion’. Expansion of the project to focus education on medication release profiles, targets administration errors associated with a high risk medication group.

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poster abstracts 79 NSAIDs—are we giving enough? Ljubica Trajceska1, Jane Booth1 1 Austin Health, VIC

Correspondence: lmitkoska@hotmail.com

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) given intra-operatively may reduce post-operative analgesia requirements. NSAIDs are also an important part of post-operative multimodal analgesia. Aim: To evaluate intra-operative and post-operative NSAID prescribing. Method: Over a five-week period, intra-operative NSAID prescribing was examined for patients undergoing low-risk orthopaedic, plastic and abdominal surgery. Patient factors relevant to NSAID use such as renal function, cardiovascular risk and age were collected. The prevalence of NSAID usage was compared with the number of patients who could have received an NSAID, based on the absence of relative contraindications. Post-operative NSAID prescribing was evaluated for 18 patients who had undergone hip or knee replacement to determine the prevalence of multimodal analgesia prescription at 48 hours after discharge from the acute pain service (APS). Multimodal analgesia was defined as concurrent paracetamol, NSAID and opioid orders. Results: Of the 83 patients included in the intra-operative study, 34 (41%) received an intra-operative NSAID. Of the 49 patients who did not receive an NSAID, only 2 (4%) had a relative contraindication. In the post-operative study, 12 (67%) patients were prescribed multi-modal analgesia at 48 hours after APS discharge; all of this NSAID use had been initiated by the APS. Of the 6 patients who were not prescribed an NSAID, 5 had a relative contraindication. The most common contraindication was a drug interaction. Conclusion: NSAIDs appear to be under utilised intra-operatively, as this therapy is not provided to all patients without relative contraindications. The APS is initiating post-operative NSAIDs for appropriate patients and the surgical units are continuing these agents after APS ceases their involvement. Further work is planned to quantify the impact that NSAID use has on opioid requirements and endpoints such as nausea and vomiting.

80 Pharmacists and pain management: are we ready, willing, and able? Penelope Tuffin1, Nyree Marr1 1 Royal Perth Hospital, WA

Correspondence: Penelope.Tuffin@health.wa.gov.au

Aim: To determine if hospital based pharmacists consider the management of pain to be within their role and expertise. Method: All pharmacists at a tertiary hospital were invited to complete a questionnaire regarding the role of pharmacists in pain management. They self-rated their skills and confidence, and indicated resources and education they accessed. Results: 61 (95%) pharmacists responded, representing all levels of experience and roles within the pharmacy. Using a scale of ‘not at all, minimal, average, very, extremely’ all pharmacists considered their role in pain management to be of at least ‘average’ importance, with 11 (18%) regarding it as ‘extremely’ important. More than 58 (95%) participants considered that the pharmacist’s role should include: provision of patient and staff information, assisting in medication dose decisions, and supply of medication. Pain assessment was least commonly 23 (38%) included within the pharmacist role. Using a scale of ‘no knowledge, minimal, adequate, good, excellent’ pharmacists most frequently considered their knowledge of pain management, medications, and opioids to be ‘adequate’. After MIMS or AMH, accessed by 53 (87%) respondents, the most common source of information was the pain specialist pharmacist by 43 (70%). Pharmacists most commonly regarded their education in pain management as ‘adequate’, however, 22 (36%) considered it less and 12 (20%) as more than adequate. Further education was requested in a median of 5 of the 9 predetermined areas, and several respondents included additional topics. The most commonly requested were: malignant pain, neuropathic pain, patients with a history of drug abuse, and opioid conversions. Other data includes frequency and confidence of intervention by pharmacists. Conclusion: Pharmacists consider certain aspects of pain management to be within their role. Although the majority feel they have received ‘adequate’ education in pain management they indicate many specific topics about which they are keen to learn more.

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poster abstracts 81 Bisphosphonate related osteonecrosis of the jaw with alendronate Derek Weidner1, Madalene Crow1, Catriona Williams1 1 Royal Melbourne Hospital, VIC Correspondence: Derek.Weidner@mh.org.au

Objective: To report a case of bisphosphonate related osteonecrosis of the jaw (BRONJ) in a patient prescribed alendronate. Clinical features: A 78-year-old man of Maltese origin was referred from the dental hospital following a seven-week history of increasing swelling and pain in the right buccal/submandibular region. Investigation revealed a submandibular abscess and two pinhole sized breaks in the right alveolus. The patient was afebrile. Risk factors for BRONJ included advanced age, Caucasian race, prolonged use of alendronate, recent dental extraction, type 2 diabetes, and tobacco use. Medications on admission were candesartan, gliclazide MR, sitagliptin, frusemide, atorvastatin, amlodipine, paracetamol, warfarin and alendronate. Cephalexin and metronidazole were started prior to admission by the GP. A CT scan suggested osteonecrosis of the jaw. Alendronate was ceased and a suspected ADR (adverse drug reaction) form was completed by pharmacy. Interventions, case progress and outcome: The patient underwent incision and drainage of his submandibular collection but the collection reaccumulated and required a repeat procedure. Microbiology confirmed gram-positive cocci and mixed anaerobes. Cefazolin IV and metronidazole IV were started then later switched to clindamycin 450mg po tds (penicillin allergy) + metronidazole 400mg po tds. After surgery a gradual reduction in facial swelling and general improvement occurred until discharged home. The discharge prescription included regular medicines (alendronate ceased) plus clindamycin 450mg tds for three months and chlorhexidine 0.2% mouthwash 10ml tds. An outreach pharmacist visited the patient due to poor compliance of his antibiotics. The patient was taking alendronate for secondary prevention of osteoporosis and is currently on no medication for this indication. Conclusion: BRONJ is a serious ADR associated with considerable morbidity. Since bisphosphonates are prescribed in large numbers, health care practitioners should be aware of the risk factors and treatment of this important ADR.

82 Hospital Oxycodone Utilisation Research Study (HOURS) Tara Wenzel1, Ayesha Platis1, Karen Macolino1, Olimpia Nigro1, Stephanie Wiltshire1, Pam MacIntyre1 1 Royal Adelaide Hospital, SA

Aim: To review the prescription and administration of oral oxycodone, as well as subsequent monitoring, in accordance with the approved hospital oral oxycodone guidelines. In addition, to review oxycodone doses upon discharge and whether oxycodone specific information was communicated in discharge summaries to general practitioners. Method: The pharmacy drugs of dependence discharge records for oxycodone 5mg tablets were used to identify patients discharged from surgical wards on oral oxycodone between September and November 2009. Of these, 100 patients were randomly selected for inclusion in the study. Study subjects who were not prescribed as required oral oxycodone as an inpatient were excluded from the study. Data was collected from inpatient medication charts, discharge summaries and the pharmacy dispensing program. Results: 594 patients were identified from pharmacy records, of which 100 were randomly selected for inclusion. Of these, eight patients were excluded leaving 92 patients as the study population. Approximately 76% of initial oral oxycodone doses were prescribed in accordance with the hospital dosing guidelines. While this suggests good adherence to the hospitalâ&#x20AC;&#x2122;s oral oxycodone protocol, only 1 in 4 patients had pain and sedation scores appropriately recorded and 1 in 2 had bowel observations recorded. With respect to doses on discharge, the majority of patients were prescribed an oxycodone dose which correlated with their usage in the 24 hours preceding discharge. On average, the quantity of oxycodone tablets provided on discharge equated to a minimum of 1.9 days worth of analgesia. Approximately one quarter of discharge summaries correctly documented the prescribed dose of oxycodone on discharge, however only 14% of all summaries contained a post discharge pain management plan. Conclusion: Adherence to the hospital dosing guidelines exceeded adherence to the monitoring guidelines for oral oxycodone. The dose of oral oxycodone upon discharge was appropriate in the majority of cases however, pain management plans, including oxycodone doses were not well communicated to general practitioners.

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poster abstracts Broadening the profession 83 The effect of collaborative doctor-pharmacist prescribing in a multidisciplinary

elective surgical pre-admission clinic on the rates of venous thromboembolism risk assessment, chemical and mechanical contraindication assessments and appropriateness of VTE prescribing Hale Andrew1,2, Renea Collins3, Julie Stokes1, Elaine Lum1,5, Lisa Nissen4,5, Danielle Stowasser4, Ian Coombes1,4,5 1 Medication Services Queensland, QLD, 2Pharmacy Department, Princess Alexandra Hospital, QLD, 3Department of Vascular Medicine, Princess Alexandra Hospital, QLD, 4Pharmacy Australia Centre of Excellence, University of Queensland, QLD, 5Centre for Safe and Effective Prescribing, University of Queensland, QLD Correspondence: l.nissen@uq.edu.au

Objectives: In Australia, venous thromboembolism (VTE) affects approximately 15 000 individuals and is responsible for over 5 000 deaths annually, yet VTE is considered to be a preventable cause of death in hospital. This study evaluated a new role for the preadmission clinic (PAC) pharmacist; assessing VTE risk and contraindications and initiating mechanical and chemical prophylaxis within a collaborative prescribing model. Methods: An open, randomised study compared pharmacist prescribing of VTE prophylaxis on the National Inpatient Medication Chart with usual care in a PAC. Usual care was peri-operative medication management planning by the pharmacist with medical officers completing the medication chart. For intervention subjects, the pharmacist completed the medication chart, including initiation of VTE prophylaxis. Rates and accuracy of VTE risk, mechanical and chemical contraindication assessments were audited. Prescribing was assessed for appropriateness of chemical and mechanical VTE prophylaxis, according to local and national guidelines. Results: Four hundred patients were recruited (93 exclusions to VTE prophylaxis prescribing; control, n=147; intervention, n=160). The safety of individual orders was significantly better in intervention patients, with medication charts containing fewer omissions and prescribing errors. VTE risk assessment was documented in 96% of intervention and 1% of control patients (p<0.005), and was correct in 95% of intervention and 100% of control patients. Mechanical and chemical contraindications were documented in 83% and 68% of intervention patients respectively, and correct in 100%; controls had no documentation for either categories. VTE prescribing in PAC was appropriate in 64% of control and 94% of intervention patients (p<0.005). VTE prescribing on admission to the ward was appropriate in 89% of control and 93% of intervention subjects. Conclusion: Overall, medication charts in the intervention arm were significantly safer and contained significantly fewer omissions and prescribing errors. VTE risk and contraindication assessments were documented significantly more in the intervention arm, and VTE prophylaxis prescribing was more appropriate.

84 Provision of remote clinical pharmacy services to the bushâ&#x20AC;&#x201D;a new service model Susan Alexander1, Helen Dowling1, Kerry Duprez1, Cindy Mortimer1 1 Hunter New England Area Health Service, NSW

Following a successful pilot of providing a remote clinical pharmacy service to a small rural hospital which did not employ a pharmacist, the Area Health Service has established three positions for remote clinical pharmacists. The pharmacists are based in the pharmacy departments of three main rural referral hospitals and provide a pharmaceutical review service to the smaller and more remote hospitals and multipurpose facilities in their region. The service was established between April and June 2010, and involved an extensive consultation process commencing September 2009, along with the development of service agreements, policies, procedures, forms and a process for receiving referrals and providing reports electronically. A nurse in each facility refers patients for pharmaceutical review based on criteria such as being on high-risk medicines, suspected non-compliance, aboriginal background and medication related admissions. A referral form, medication charts, patient details and admission notes are sent electronically to the remote clinical pharmacist. The pharmacist undertakes a pharmaceutical review including a medication history, chart review, clinical review and medication reconciliation. If necessary, the patient can be interviewed or provided with education via the phone or utilising telehealth facilities. Issues of immediate concern are discussed directly with the general practitioner (GP). A written report containing any recommendations is prepared and sent back to be added to the patientâ&#x20AC;&#x2122;s notes. Receipt of the report and any actions taken are acknowledged by the GP and nurse. A medication list and relevant information is provided for discharge if needed. The pharmacist also makes regular visits to each facility to provide feedback, education, and information and to participate in on-site quality and patient safety meetings. In the past it has been difficult to recruit and retain pharmacists in rural and remote hospitals. This initiative provides a consistent, high quality and sustainable clinical pharmacy service to small rural sites.

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poster abstracts 85 Crossing the red lineâ&#x20AC;&#x201D;pharmacy in the operating suite Jane Booth1, Ljubica Trajceska1 1 Austin Health, VIC

Correspondence: jane.booth@austin.org.au

Background: At a major Melbourne hospital, an operating suite pharmacist position was funded at the main campus on a trial basis. The operating suite at the smaller campus of the same hospital has had a pharmacist for two years. These positions are relatively uncommon in Australia. Aim: The aim of the trial was to demonstrate clinical and financial benefits by improving the interaction between the operating suite and the pharmacy department. Method: Pharmacy offices were established in both operating suites to facilitate communication and improve access to clinical pharmacy services. A review of prescribing patterns and stock usage was conducted to identify those medications for which a more cost-effective alternative existed. The processes for handling schedule 8 medications were reviewed to improve ordering processes, access and compliance with legislative requirements. Targets for medication safety and quality improvement, such as antibiotic use, were identified. Outcomes: A clinical pharmacy service has been established in both operating suites. The operating suite pharmacists are the point of contact for all pharmacy services. They provide information about medications to anaesthetic, surgical and nursing staff. Medications are now supplied in a more timely and efficient way. Any queries can be directly addressed with the prescriber at the time of ordering. It is estimated that at least $30 000 will be saved annually due to dynamic imprest review, reduced stock holdings and the rapid turnaround in supply of medications. The operating suite pharmacists are involved in responding to and preventing medication-related incidents. Antibiotic usage is closely monitored and reported to infection control. Conclusion: Having a pharmacist based within the operating suite has demonstrated both clinical and financial benefits. Good relationships between the pharmacy department and operating suite staff have developed, paving the way for more extensive projects in the future.

86 A pharmacist in the lab: development of an intracoronary injectables guide Megan Booth1 1 Greenslopes Private Hospital, QLD

Correspondence: megbooth@gmail.com

Percutaneous coronary intervention restores optimal blood flow in most cases however abnormal myocardial perfusion may still persist. Several agents have been investigated to treat coronary microvascular dysfunction. Intracoronary administration increases the local drug concentrations of these agents to over 100 times the IV administrationâ&#x20AC;&#x201D;maximising drug efficacy and minimising systemic effects. Whilst the Australian Injectable Handbook provides information on the intravenous administration of medicationâ&#x20AC;&#x201D;very little information exists on the dilution, administration and dosage of intracoronary injections for cardiac catheterisation laboratories (CCL) in Australia. A desktop guide using current clinical evidence and Australian parenteral formulations was developed for use by the CCL staff. The goal of the project was to decrease drug errors in the areas of reconstitution and administration, promote the most cost effective dilution and use of ampoules and to ensure the medications were prepared in a manner that minimised the potential for contamination.

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poster abstracts 87 Pharmacy meets industry: what does it mean to be LEAN? Carl Bufe1, Anna Shi1, Davina Lau1, Leanne Samuel1, Juanita Haslett1, William Ng1, Maggie Patterson1, Chris Giles2, Brett Dalgliesh2 1 APHS—River City Pharmacy, 2APHS—Pharmacy Practice Unit

In the fast changing health care environment that we work in, important questions arise: Where is our profession going? Where are other pharmacists taking their practice? What’s the evidence? How do we translate evidence into practice? Join in the discussions, challenge your ideas and maybe find a new career path. Aim: To assess applicability of GMP and LEAN manufacturing principles to a cytotoxic drug reconstitution pharmacy. Methods: The productivity and risk management strategies of compounding underwent review by an external GMP consultant to strengthen the pharmacy’s initiatives in the area of incident reporting, layout, workflow and documentation. The consultants applied LEAN manufacturing principles to pharmacy compounding. Results: The application of GMP and LEAN manufacturing principles resulted in:

x x x

a quality systems framework being implemented, including comprehensive reformatting of policies, procedures, work instructions and associated accountability documents to underpin a revised workflow model changes to site layout to mitigate risk of cross contamination of products throughout the production process, minimise distractions in critical functions and workflow disruption improved near miss/incident analysis and resulting systemic interventions.

Discussion: GMP and LEAN manufacturing principles incorporate systematised and streamlined arrangements that divide production into discreet steps. The extent of application of these principles to cytotoxic reconstitution was unclear, e.g. division of the production process into discrete steps may not satisfy the legislative obligations of a pharmacist needing to be accountable for the entire manufacturing and dispensing process when compounding cytotoxic drugs. In assessing GMP and LEAN manufacturing principles it was necessary to:

x x x x

address potential conflicts and barriers, real and perceived, in relation to the pharmacists’ professional conduct and autonomy maintain direct pharmacist involvement in mandatory critical processes enhance pharmacy technician skills to perform technical tasks ‘traditionally’ performed by a pharmacist clarify roles and responsibilities, supported by appropriate training.

Conclusion: LEAN thinking requires some cultural change from that of traditional aseptic compounding pharmacies yet the rewards for such change are a consistency of product quality and mitigating risk to the patient.

88 Understanding alert overrides in an electronic medication management system in a

university teaching hospital Rosemary Burke1, Kylie Williams2, Quishi Zeng2, Andrew McLachlan3 1 Pharmacy Department, Concord Repatriation Hospital, NSW, 2Faculty Pharmacy, Sydney University, NSW, 3Faculty of Pharmacy and Centre for Education and Research on Ageing, Sydney University, NSW Correspondence: rosemary.burke@sswahs.nsw.gov.au

Background: Electronic medication management (eMM) systems have the potential to improve patient safety. One of the ways they do this is via the use of active and passive decision support (eg adverse drug reaction and allergy alerts). Alerts are overridden for a variety of reasons. To avoid alert overload they can be set to fire at different levels (e.g. major, moderate). These settings can be for active alerts (i.e. it interrupts the process requiring acceptance or an override) or a passive alert (i.e. the clinician can look it up). Aims: The aims were to explore the prevalence of and reasons for overriding active alerts generated by an electronic medication management system implemented in an acute teaching hospital and to explore clinicians’ attitudes to those alerts. Methods: Following a short pilot study, an analysis of alerts from July–September 2009 was undertaken. A report was generated listing all overridden alerts, the reasons for the override and the type of clinician that overrode the alert. Clinicians’ attitudes to the alerts were investigated in focus groups conducted with pharmacists and doctors. Results: There were 14 107 alerts that fired across four severity levels. Of these, 1 671 alerts were active, consisting of 1 011 drugdrug interaction (DDI) safety alerts, and 660 drug-allergy safety alerts. Override rates were found to be 90% for drug-drug interaction alerts, and 63% for drug-allergy alerts. Both pharmacists and doctors valued alerts, however felt that improvements in sensitivity (the proportion of major interactions detected) and selectivity (the proportion of the minor interactions not detected) would enhance their value. Conclusion: The hospital is now considering whether to change the specificity level for prescribers and will continue monitoring overrides. Future studies could focus on clinical outcomes

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poster abstracts 89 The evidence and rationale for the integration of the General Level Framework into

the Postgraduate Clinical Pharmacy Program at the University of Queensland Judith Burrows1,2, Carl Kirkpatrick1, Ian Coombes2 1 School of Pharmacy, University of Queensland, QLD, 2Medication Services Queensland, Queensland Health, QLD Correspondence: j.burrows@uq.edu.au

Background: The application of learning to develop clinical practice is an aim of the Postgraduate Clinical Pharmacy Program (PGCPP) at the University of Queensland. However, learning outcomes from the program have not been formally linked to clinical competence in the workplace. Aim: To assess the need for the School of Pharmacy to partner with the workplace to develop students’ clinical performance. Results: A review of competency criteria from General Level Framework (GLF) evaluations relating to key learning objectives of the program was undertaken for Queensland Health (QH) staff. Nineteen current students who had a GLF evaluation performed in the previous 12 months and 18 recent graduates who had a GLF evaluation since graduating were identified. Students were deemed to either consistently, usually, sometimes or rarely perform the specified criteria. Current students were consistently better at comprehensive medication histories (93% vs 63%), assessment of adherence (41% vs 13%) and clear decision making (55% vs 35%). There appeared to be similar abilities for the current students and recent graduates to identify medication related problems (42% vs 56%), and prioritising actions for the drug related problems appropriately (56% vs 59%). Conclusion: These data demonstrate that the clinical performance of many current students and graduates of the PGCPP for key criteria in GLF evaluations requires further development. In 2011, the PGCPP will work jointly with QH to integrate the GLF into the curriculum in line with the vision of the National Alliance for Pharmacy Education (NAPE). This formative developmental framework will be introduced for all UQ PGCPP students across Australia with the goal of working in conjunction with workplaces to optimise the clinical performance and the professional development of their pharmacists.

90 A pilot study to determine the impact and feasibility of extending pharmacy services

to the point of discharge (in the Republic of Ireland): pharmacist review versus pharmacist led discharge service Eamonn Butler1, Suzanne McCarthy2 1 Royal Melbourne Hospital, VIC, 2University College Cork, Ireland Correspondence: eamonnbutler.ie@gmail.com

Aim: To determine the impact and feasibility of extending pharmacy services to the point of discharge in the Irish health care setting, and whether a pharmacist review or pharmacist led discharge service is the more feasible option. Methods: The study consisted of two phases. Phase 1: A pharmacist review of prescriptions written by doctors was undertaken over three weeks (ward based). Phase 2: A pharmacist-led discharge service was undertaken over five weeks (team based). As part of the pharmacist led discharge service an electronic prescription and medication report was generated and provided to the community pharmacist and general practitioner/patient, respectively. The main outcome measure used for the study was the number of medication errors on the discharge medication lists (doctor vs pharmacist) at the point of discharge. Results: Phase 1: Errors on the doctor-written medication lists affected 50% of patients and 10% of medication orders. Phase 2: The pharmacist-led discharge service significantly reduced errors—7% of patients (p<0.001) and 1% of medication orders (p=0.001) were affected. On the doctor-written medication lists omissions were the most frequently occurring errors. Of the errors, 61.5% were judged to have the potential to cause moderate patient harm, 38.5% minor/no harm. The two errors that occurred on the pharmacist-generated lists had the potential to cause moderate patient harm. Conclusion: Pharmacist involvement at the point of discharge had a significant impact on medication safety. However, extension of services is not feasible without an increase in resources and changes in pharmacy systems. The pharmacist-led discharge service was the more feasible option—it allowed a more organised approach, was time-saving for the doctors and prevented errors occurring. This approach could also be trialled in the Australian health care system.

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poster abstracts 91 The successful introduction of standardised practices for patient controlled analgesia Dean Byrnes1, Helen Stewart1, Michael Barras1 1 Mater Health Services, QLD Correspondence: dean.byrnes@mater.org.au

Background: Standardisation of medication use means creating and following streamlined, clinically sound, uniform models of care, thereby reducing variation and complexity. Patient controlled analgesia (PCA) presents a unique opportunity to standardise practice and increase patient safety. Aim: To measure the impact of multiple standardised practices for PCA. Methods: Several standardisation initiatives were introduced into adult surgical and obstetric wards at the X and Y hospitals in December 2009. These included:

x x x x

a dedicated PCA prescribing and administration form standard concentrations of all opioid infusions a mandatory independent double check (IDC) for nurses at PCA set up, syringe/bag changes, rate changes, points of transfer and change of shift guidelines for the use of PCA, including minimum prescribing standards.

Assessment of these initiatives at six months was undertaken using two methods. First an audit of completed PCA forms was conducted, to assess prescribing and nursing documentation. Second, a comparison of the frequency of reported incidents involving PCA pre- and post the change of practice. Results: Fifty-seven PCA orders (54 patients) were audited. The total cumulative hours of PCA use for all patients was 2 101 hours (38.9 hours/patient).

Prescribing. Standard opioid concentrations were used in 100% of orders and 54 (95%) of orders complied with new prescribing standards.

Nursing documentation. A total of 55 (96%) orders had an IDC documented at set-up and syringe/bag change. An average of 6.7 IDCs per order occurred which equated to an IDC every 5.5 hours. Incident reports. 12 incidents were reported from 1 January to 31 November 2009 (334 days), at a rate of 3.6 per 100 days. Only 2 incidents occurred from 1 December 2009 to 25 June 2010 (207 days), at a rate of 0.97 per 100 days. Conclusion: The introduction of standardised practices for PCA has optimised prescribing and nursing documentation and reduced the number of incidents.

92 A multifaceted approach to facilitate safe cyclophosphamide administration Kelly Cairns1, Pauline Dobson1, Mark Loewenthal1, Narelle Orford1, Jennine Lemessurier1, Karen Roberts1, Amanda Madden1 1 John Hunter Hospital, NSW Correspondence: kelly.cairns@hnehealth.nsw.gov.au

Aim: To improve the prescription and administration of intravenous cyclophosphamide. Method: It was identified that IV cyclophosphamide prescription and administration could be improved due to marked variations in indication, duration of therapy, omission of essential concurrent medications, a lack of clear documentation (including the number of cycles and required pre-administration tests). The medical officer responsible for clarification of treatment decisions was not always clear to the infusion lounge nurses. Three key solutions were developed by a multidisciplinary team to improve the safety surrounding this high risk medication:

x x x

A referral and management plan for the entire course of cyclophosphamide treatment. The plan included instructions for monitoring, a best practice example of charting cyclophosphamide and essential concurrent therapy (mesna, ondansetron and hydration). An area wide evidence based infusion protocol. A patient information leaflet to facilitate informed decision-making about cyclophosphamide therapy and to assist with minimisation of adverse effects.

Results: As cyclophosphamide administration in the infusion lounge can only occur with a completed referral and management plan, there has been 100% compliance with using this tool. Physicians prescribing cyclophosphamide have provided feedback that they appreciate the prescribing example on the reverse of the management plan. There have been fewer incidences of incorrect prescribing resulting in a reduction in phone calls between pharmacy and the infusion lounge to have orders recharted. Information is available to the team including: what stage the patient is in their treatment course, the agreed parameters for administration, who is responsible for the patientâ&#x20AC;&#x2122;s treatment, and how they can be contacted. Patients have also appreciated the provision of information in easily understandable language. Conclusion: Cyclophosphamide is a high risk medication that has the potential to cause serious adverse effects if prescribed or administered incorrectly. This multifaceted approach has substantially improved safe administration of a complex regimen.

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poster abstracts 93 The impact of a unit-based clinical pharmacy service on medication prescribing

errors Katherine Chandler1, Sonia Shen1, Andrew Cording1 1 Eastern Health, VIC

Correspondence: katherine.chandler@easternhealth.org.au

Aim: To investigate whether the utilisation of a unit-based clinical pharmacy service model of care would prevent more medication errors prior to the point prescribing and whether this would lead to an overall reduction in the number of medication errors occurring. Methods: The pharmacy department of a medium sized general metropolitan hospital changed from a traditional ward-based clinical pharmacy service to a unit based service in September 2009. Both pre- and post-implementation data was collected by clinical pharmacists using a custom data collection tool over a two-week period. The data collection tool was given to each clinical pharmacist to collect information pertaining to; the number of clinical interventions made; the type of interventions made; and whether the intervention was classified as being ‘reactive’ or ‘proactive’. Reactive interventions were classified as those made after the medication had been written on the medication chart; proactive interventions were those which occurred before the medication was charted. Results: Prior to the implementation of a unit-based clinical pharmacy service, pharmacists reported a total of 359 reactive (98%) and 7 proactive (2%) interventions over a two-week period. Following the implementation of a unit-based service, a similar total number of interventions were collected (282), however considerably more of these interventions (22%) were classed by the clinical pharmacist as being proactive interventions. Conclusion: Changing the model of care being utilised to allow the clinical pharmacists to work more closely with medical staff in the treating unit, in contrast to providing a traditional ward-based clinical service, has demonstrated improvements in patient safety through improvements in the quality of prescribing and enabling the clinical pharmacist to intervene at the point the prescriber writes a medication order rather than detecting the error after it has already occurred and medication may have already been administered to the patient.

94 The impact of a unit-based clinical pharmacy service on discharge efficiency and

waiting times Katherine Chandler1, Sonia Shen1, Andrew Cording1 1 Eastern Health, VIC

Correspondence: katherine.chandler@easternhealth.org.au

Aim: To investigate whether the utilisation of a unit-based clinical pharmacy model of care will lead to improvements in efficiency of the discharge process. Methods: The pharmacy department of a medium sized general metropolitan hospital changed from provided a traditional ward-based clinical pharmacy service to a unit based service in September 2009. Both pre- and post-implementation data was collected using a custom data collection tool over a two-week period. The data collection tool was attached to all discharge prescriptions during the data collection period and measurements were taken as to when the script was given to the pharmacist; when it arrived in the dispensary; when it was completed; and within what time frame the script was required (urgently, within 2 hours, within 4 hours, within 6 hours or tomorrow). Results: Prior to the implementation of a unit based clinical service, 87% of surgical patient discharges and 78% of medical patient discharges were required within a 2-hour timeframe and only 3% and 12% of surgical and medical discharge scripts respectively were supplied to the dispensary the day before discharge. Following the implementation of the unit-based service, a similar number of discharge prescriptions were required with a 2-hour timeframe (90% and 82% for surgical and medical patients respectively). No difference was found in the percentage of discharge prescriptions being written the day before anticipated discharge. Conclusion: Linking the clinical pharmacist to the treating unit in contrast to working independently and providing a ward-based service appears to have little impact on the number of prescriptions written in advance and time taken to write patient discharge prescriptions. Consequently there appears to be little or no improvements in the efficiency of the discharge process or in the time taken for the patient to receive their discharge medications and associated counselling.

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poster abstracts 95 An audit of the rates of prescribing of venous thromboembolism pharmacological

prophylaxis in medical patients admitted through the hospital emergency department Rachael Cheh1, Sally Marotti1 1 The Queen Elizabeth Hospital, SA

Correspondence: rachael.cheh@health.sa.gov.au

Method: All patients admitted to hospital through the emergency department (ED) were included in this study. A venous thromboembolism (VTE) risk stratification checklist was created and adapted from hospital and national guidelines. The checklists were used by pharmacists prospectively to assess patient’s risk of VTE within 24 hours of admission as an inpatient and provide an appropriate recommendation. The checklists were piloted for a week (9 to 15 May 2010) in the emergency department of the hospital. Recommendations derived from the checklist were then written by pharmacists in the patient’s case notes. The completed checklists were retained for further data entry and analysis. Data was entered into a Microsoft Excel spreadsheet for data analysis. Patients who were emergency short stay, on therapeutic anticoagulation or surgical patients were excluded from the study. Patients’ medical records were audited retrospectively to determine rates of prescribing of VTE pharmacological prophylaxis at 24 hours and during their inpatient stay. Statistical analysis was undertaken using NCSS 2007. Results: Of the 236 patients admitted during the audit, 150 were seen by a pharmacist within 24 hours of admission, and 97 remained after exclusions. There were 67% of patients who were classified as high risk patients in which pharmacological prophylaxis would be recommended. A further 1% of patients were classified as moderate risk where pharmacological prophylaxis should be considered. Pharmacological VTE prophylaxis was not recommended in the remaining low risk patients (23%). At the time of review 31.3% of patients who were indicated for pharmacological VTE prophylaxis had it charted at the recommended dose. Pharmacological VTE prophylaxis was charted in 4.3% of patients where it was not indicated. Conclusion: VTE pharmacological prophylaxis is underused. Further education and risk stratification checklists specific to pharmacists need to be implemented.

96 Practice evaluation and identification of CPD needs using the General Level

Framework Jaclyn Costello1, Ian Coombes1 1 Medication Services Queensland, QLD

Correspondence: jackie.costello@gmail.com

The General Level Framework (GLF) is a competency based tool used to evaluate pharmacists’ performance in relation to pharmaceutical review and other clinical activities. It aims to facilitate the provision of specific feedback related to observed performance, self-reflection, identification of training needs, and the formulation of continuing professional development (CPD) plans. The Safe Medication Management Unit (SMMU) provides up-skilling workshops for pharmacists. Workshop 2 focuses on enhancing the skills of general level pharmacists and is intended to dovetail with existing knowledge based seminars such as those provided by SHPA. Aims: x To identify the training and learning needs of pharmacists in Queensland Health (QH) who have undertaken a GLF evaluation in the last 12 months. x To compare the learning objectives of the SMMU Workshop 2 with the development needs of pharmacist’s identified by the GLF process. Method: Training and learning needs for individual pharmacists were reviewed (n=220) and collated using Microsoft Excel. Identified needs were grouped according to GLF competencies and summarised as a total and % of the total. These groups were compared with the learning objectives of Workshop 2 and gaps identified. Results: The five most prevalent recommendations centred around two competency clusters: knowledge (pharmacology, pathophysiology, interactions and side effects) and CPD. A further 10 common recommendations related to skills such as exploring patients’ understanding of illness and treatment, documentation, use of guidelines or references, prioritisation and time management. These areas correlate with the learning objectives of Workshop 2. Review of the content and focus of Workshop 2 to match the needs of early-career pharmacists is under way. Conclusion: The GLF is a valuable tool to assist identification of training and learning needs of pharmacists undertaking pharmaceutical review activities. The most common skills and behaviours identified as areas for improvement correlate with the learning objectives of Workshop 2.

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poster abstracts 97 Preparing a case for extended hours clinical pharmacy services in the emergency

department Sylvia Cuell1 1 Barwon Health, VIC

Correspondence: sylviac@barwonhealth.org.au

Aim: To compile supporting evidence for a business case submission to extend the hours of clinical pharmacy services in the emergency department (ED). Methods: Inpatient admissions from 1600hrs on Friday 28 May to 2400hrs on Sunday 30 May 2010 were identified. Individual patient records for those admitted on Friday or Saturday were further analysed for evidence of medication management issues compromised by the absence of clinical pharmacist involvement until the following Monday. Results: Of a total of 129 patients admitted for multi-day inpatient stay, 124 (96.1%) were unplanned emergency admissions with 114 (88.4%) admitted via ED. All records of patients admitted on either Friday or Saturday were analysed in detail (n=83). Of these, 25 (30.1%) patients were discharged prior to 1200hrs on Monday 31 May. For the remaining 58 patients, ward pharmacists completed medication history interview, reconciliation and review for 48 (82.8%) patients with 41 (70.7%) completed by 1700hrs on Monday 31 May. Twenty-six out of 83 patients were found to have missed 125 doses of 58 regular medications (ongoing or newly initiated) until resolution by the ward pharmacist. The most common reasons for missed doses included unintentional failure to prescribe usual medications (48.4%), delay in writing the medication chart (19.4%) and delay in obtaining stock (19.4%). One patient missed 23 doses of regular medications owing to a 32-hour delay in their medication chart being written. Additional prescribing errors were identified in 11 patients. Types included incorrect or inappropriate dose or frequency, ordering of previously ceased medications and duplication of orders. Conclusion: The lack of clinical pharmacy services on weekends delayed more timely resolution of significant medication management issues. This data combined with correlation of service to peak ED attendance times will be used as supporting evidence of a business case for extended clinical pharmacist hours in ED.

98 Improving access to medicines in Malawi Danielle Deidun1 1 Society of Hospital Pharmacists of Australia Correspondence: danielle.deidun@gmail.com

Objective: To provide a descriptive case report of contributions made to pharmacy services in a rural Malawian hospital. Features: Health care in Malawi is provided free through government institutions; however, government services fall considerably short of meeting health care needs and 37% of health care is provided by private institutions supported by the Christian Health Association of Malawi (CHAM). The majority of pharmacists in Malawi work in the private sector, while pharmacies in government and CHAM facilities are largely staffed by pharmacy technicians, medical assistants, nurses and attendants with minimal training. Access to essential medicines in Malawi is extremely limited with regular shortages of basic antibiotics, HIV therapy, and other essential medicines. This is primarily due to procurement and distribution processes. Intervention: A dedicated two-year pharmacist position was created to build on basic pharmacy services in a small rural community hospital supported by CHAM. Activities included development, implementation and maintenance of an information system for medicines management, providing advice on medicine policy issues, ordering and dispensing medicines, monitoring medicine storage, disposal of expired supplies and financial advice with respect to budgeting and pricing for medicines. A combination of electronic and hard copy procedures relevant to the knowledge and skill sets of those carrying out different tasks were developed. Outcome: The establishment of basic pharmacy services enabled near 100% availability of a predetermined list of essential medicines based on a combination of Malawi standards and World Health Organisation recommendations. Conclusion: Through adequate monitoring and management, it is possible to improve access to medicines on a small scale in Malawi. This is difficult to achieve without qualified pharmacist and pharmacy technician input. A review of allocation of pharmacists to increase qualified staff in government and CHAM facilities may have a great impact on access to medicine and health care in Malawi.

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poster abstracts 99 A strategy to promote individual ownership and responsibility for medication safety Paula Doherty1, Pauline Dobson1, Jennifer MacDonald1, Neridah Thomson1, Sally Milson-Hawke1 1 John Hunter Hospital, NSW Correspondence: Paula.Doherty@hnehealth.nsw.gov.au

Aim: To raise awareness of the importance of medication safety among clinicians and consumers of a multi-facility hospital campus. Methods: The campus Medication Safety Working Party decided to dedicate May 2010 as Medication Safety Month. The primary message for medication safety month was ‘Medication and You’ which highlighted the personal ownership of medication safety that we were hoping to encourage. The target audience was doctors, nurses, pharmacists, inpatients, outpatients and hospital visitors. The activities that were organised for May included:

x x x x x x x x x

high profile doctor as guest speaker to talk on medication safety issues in medical and paediatric grand rounds guessing competition information booths medication safety poster competition and display education sessions for nurses and doctors across the hospital campus throughout the entire month development of medication safety resources e.g. medication safety for inpatients brochure, medication safety for clinicians brochure distribution of branded giveaways e.g. pens, badges and post-it notes, with the secondary message ‘I care about medication safety’ development of medication safety PowerPoint presentations for educators and pharmacists to deliver to staff during the month alignment of related services to focus on medication safety for MAY e.g. Clinical Governance monthly newsletter and the Clinical Unit on Ethics and Health Law monthly lecture.

Results: Approximately 170 nursing staff and 60 junior medical officers attended education sessions, and another 60 staff attended medical and paediatric grand rounds. There were 19 entries into the medication safety poster competition from a wide range of wards and units. More than 100 staff entered the guessing competition. Resources were distributed in 40 ward areas. Conclusion: Medication Safety Month was deemed a successful intervention to raise awareness by the widespread involvement of staff across the hospital campus. Feedback received from staff will direct similar interventions in the future.

100 High cost individual patient usage drugs—a 2-year follow-up study James Dwyer1, Jerry Yik2 1 Melbourne Health, VIC, 2Monash University, VIC Correspondence: James.A.Dwyer@mh.org.au

Aims: To analyse the response to requests for progress reports from clinicians given approval to prescribe high cost individual patient usage (IPU) drugs between September 2007 and September 2009; to report documented therapeutic outcomes and determine if objective or subjective measures of therapeutic response were used. Methods: All applications for high cost IPU drugs (greater than $1 000 per course of treatment) considered by the Drug and Therapeutics Committee (DTC) between September 2007 and September 2009 were reviewed to determine the response rate to requests for progress reports and the number of reports describing a positive patient outcome. The reports were further reviewed to determine the measures of success used and whether they were objective or subjective. Information was sourced from progress reports and medical records. Results: 154 IPU applications were approved and 141 of these (92%) were followed up with a progress report from the prescriber. Of those, 110/154 (71%) were associated with a positive (or partial positive) outcome for the patient and 79 of these reported an objective measure of success. The remaining 31 reports recorded a negative or unchanged outcome. As multiple complex disease states were involved, determining a uniform and appropriate measure of therapeutic response may be inappropriate; specialist medical advice is needed on an individual basis for recommendations on each case. Conclusion: The response to requests for progress reports was higher than a previous study performed at our organisation (129/195) = 66%. Of those received, a majority were associated with a positive outcome for the patient and an objective measure of success. The process of managing high cost IPU drugs by the DTC appears to demonstrate positive objective outcomes in patient care.

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poster abstracts 101 Medication prescribing competency for medical interns Wendy Ewing1, Lisa Ciabotti1, Cate Kelly2 1 Southern Health Pharmacy Department, VIC, 2Southern Health Medical Services, VIC Correspondence: wendy.ewing@southernhealth.org.au

Aim: To implement an assessment of medication prescribing for medical interns to ensure credentialing prior to internship commencement. Method: Medical interns were provided with a step-by-step skills document prior to orientation and a 45-minute tutorial during orientation week detailing prescribing legal requirements, safe prescribing practices and assessment criteria. Completion of a medication chart, intravenous fluid chart and discharge prescription was required for a fictitious case study. Clinical knowledge was not assessed and hence all information required to complete the assessment was provided. Two pharmacists assessed the completed documents against established criteria. Interns that did not pass all mandatory elements were required to repeat the specific task(s) for an additional case study. Interns had the opportunity to review their assessed tasks to identify areas of improvement. A survey was provided to capture the intern’s opinions of the competency assessment. Results: The competency was completed by 69 interns, with 55 (79.7%) not satisfactorily completing all three assessments; 32 (46.3%) for the medication chart, 4 (5.8%) for the fluid chart and 50 (72.5%) for the discharge prescription. The most common reasons for not satisfactorily completing the medication chart was not signing an order, patient surname not written and omission of frequency. For the discharge prescription the reasons were non-compliance with drug of addiction legal requirements, patient identification label not present and patient surname not written. A total of 61 surveys were returned representing a response rate of 91.3%. 90.4% of respondents agreed or strongly agreed the tutorial improved understanding of safe prescribing practices and 98.4% agreed or strongly agreed the prescribing competency assessment was useful. Conclusion: A medication prescribing competency package was successfully introduced, with all interns completing the package prior to their internship commencement. The assessment has the potential to be expanded to all prescribers (medical and non-medical) as a periodic competency process.

102 Putting adverse drug reaction documentation into the spotlight Kerry Fitzsimons1, Carol Simmons1 1 Fremantle Hospital and Health Service, WA

Correspondence: Kerry.Fitzsimons@health.wa.gov.au

Background: It is the clinician’s responsibility to identify, clarify and document any past adverse drug reactions when a patient presents to hospital. A problem arises when a patient is non-responsive and the notes are not available in the emergency department. We uncovered an under-utilised system of adverse drug reaction (ADR) documentation, TOPAS (The Open Patient Administration System), which highlights previous serious ADRs to the clerical staff on the patient’s admission to hospital prompting a print off of reaction details alerting the treating doctor immediately. Objectives: To streamline the addition of ADRs onto TOPAS and improve the quality and quantity of ADR documentation. Methods: A dual system to increase the number of serious ADRs checked and entered onto TOPAS has been developed; firstly to allow senior pharmacists to directly input ADRs onto TOPAS and secondly coding staff can identify patients with ADRs for a pharmacist to clarify and approve for addition to TOPAS. To ensure only serious ADRs (defined as an absolute contraindication to repeat administration) were entered onto the database, guidelines were developed by the Medication Management Review Group. Results: A log of ADRs presented to the pharmacist for approval was reviewed after the first six months of changing the system (February to June 2009) showed that of 190 requests made by coding staff, 179 (94.2%) were approved. In the second six months (July to December 2009) there has been a significant increase in ADRs for approval (502) of which 88% (446) were approved for entry onto TOPAS. Conclusion: The quality and quantity of ADR histories entered onto TOPAS and in the medical notes has improved as has the accessibility of this information to medical staff at the patient’s critical care stage of admission. This is a result of changing our processes of ADR documentation and utilising an underused electronic database system.

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poster abstracts 103 Interns at triage Will Franks1, Kirsty Steffens1, Rachel Sanders1 1 Toowoomba Hospital Pharmacy, QLD

Aim: Prescriptions that enter Toowoomba Hospital Pharmacy are inspected by a pharmacist (triaged) before proceeding to the dispensary to be assembled and checked, ready for patient collection. The triager assesses the appropriateness of the prescription including identifying legal and therapeutic issues and rectifies these appropriately if the situation warrants intervention. Once ready for dispensing, the prescription, in accordance with its level of priority, is given to the dispensary to be prepared. To alleviate outpatient waiting times and improve the availability of pharmacists to counsel patients at pharmacy, pharmacy interns assumed the position of ‘triager’ for outpatient prescriptions. Methods: Interns were situated at the front of pharmacy where it was possible to receive patient prescriptions and counsel as necessary. A computer with appropriate resources (AMH, Mims, eTG, PBS) was made available and if problems were identified, the triage intern proceeded to rectify them accordingly (for example, contacting prescriber or annotating the prescription where appropriate). Results: Interns gained experience and confidence with assessing prescriptions, improving their knowledge base. However, with numerous administrative interruptions occurring due to the positioning of the triager at the front counter, patient waiting times did not improve and interns felt uncomfortable triaging (27% of prescriptions require intervention) when exposed to many distractions. The position of the triager was moved to a convenient location in the dispensary which enables new outpatient prescriptions to be assessed quickly before the patient leaves the pharmacy and less unnecessary interruptions are experienced by the triager. Conclusion: The new role undertaken by intern pharmacists enhances their skills as pharmacists and offers a valuable service to patients. Future developments, depending on time management, may include expansion to discharge prescriptions and inpatient supplies.

104 Introduction of the cardiothoracic pharmacist into a peri-operative clinic Rachel Fyfe1, Sylvia Cuell1, Garth Birdsey1, Diana Bortoletto1 1 Barwon Health, VIC Correspondence: rachelb@barwonhealth.org.au

Aim: To assess the extension of the cardiothoracic pharmacist’s role into a peri-operative clinic (POC). Methods: An audit of admission medication documentation for outpatient cardiothoracic surgical patients was completed pre and post the implementation of the cardiothoracic POC pharmacist. This included the timeliness of the pharmacist admission medication interview, along with the accuracy of pre-admission medication documentation by the admitting medical staff. In POC, the pharmacist documented pre-admission medications on a medication reconciliation form (MRF), to be held in the patient’s medical history, until hospital admission. The pharmacist also confirmed patient awareness of medication cessation pre-operatively. Results: Prior to the commencement of the POC role, the pharmacist completed the MRF on average 1.5 days after patient admission, compared to 7.7 days before surgery at the POC clinic. In the pre group, 17 patients had a mean of 6.4 ± 2.7 pre-admission medications, compared to 5.8 ± 4.1 in the 20 intervention patients. The accuracy of complete pre-admission medication documentation by medical staff was 30.3% (n=109) in the pre group, compared to 47.9% (n=115) in the intervention group. The improved accuracy was important in facilitating the reintroduction of regular medications (where appropriate) following surgery. This intervention also enabled the cardiothoracic pharmacist to be directly and consistently involved in patient medication management from the POC interview through to hospital discharge. This improved the pharmacist’s rapport with patients and allowed for more individualised education. Thorough counselling in this patient group is essential given the significant number of medication changes made in the post-operative period. Patients with specific medication concerns could also be identified prior to surgery, allowing them to be addressed either at clinic or during their inpatient stay. Conclusion: Introduction of the cardiothoracic pharmacist into POC has allowed for improved continuity of care for patients in relation to their medication management.

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poster abstracts 105 Epidemiology of medication error—what we ‘know’ and assume may not be true Tim Garrett1, Diane Reeves1,2, David Went1 1 Central Coast Health Service, Department of Pharmacy, NSW, 2Northern Sydney Central Coast Health, Clinical Governance Unit, NSW Correspondence: timsgarrett@hotmail.com

Aim: To analyse medication errors with a view to identifying key safety risks. Medication-related harm is a major cause of morbidity for hospitalised patients. Harm minimisation is a fundamental professional role for pharmacists but its success is, at least in part, dependant on the quality and accuracy of this data. Methods: All medication safety reports within a health service encompassing 820 beds were retrospectively profiled by error-type, therapeutic-classification, attributed-harm and reporter group over a 12-month period. Results: In total 2 887 pharmacist-generated medication incident reports encompassing 4 453 medications were reviewed. By relating the severity of medication incidents to volume of reports by therapeutic groups (figure 1) and types of error, key areas of significant harm were elucidated. Frequency and severity of medication harm by Therapeutic Group (CCH) 500 Anticoagulants, antithrombotics

N=4453 400 Other antibiotics and anti-infectives Hypoglycaemic agents

Antihypertensive agents

Frequency

300 Nutrition, vitamins and minerals Other endocrine and metabolic agents Antidepressants

200

Narcotic analgesic

Hyperacidity, reflux and ulcers Preventive aerosols and inhalations

Glaucoma preparations

100

Insulin preparations ENT & skin agents

Adrenergic stimulants, vasopressor age

Increasing harm (SA C code)

Importantly, incident reporting practices were found to vary significantly between health professions (figure 2). This translated to markedly different profiles of harm (by ‘therapeutic areas’ and ‘type of error’) between reporter groups. Notifications to IIMS database by problem type and notifier - 2009 100% 75%

ADR Disp

50%

Admin Presc

25% 0% Pharm n=761

Nurse (ckd n=1204)

Doctor (n=20)

Given the greater numbers of nurses in health workforce and the predominance of nursing incident reports in electronic reporting systems the impact of ‘professional reporting characteristics’ significantly alters how medication harm can be viewed at an organisational level. Conclusion: Our method of relating error frequency to attributed harm provides a more strategic approach for targeting safety improvements which is not widely applied. This enhances the identification of both known and emerging medication risks. Our findings identify significant differences in reporting characteristics between different professional groups. Failure to apply this knowledge to generalised medication incident reports may result in misinterpretation of error-reporting data and serious safety failings. Pharmacists are well placed to reduce medication-related harm and should broaden their professional perspective by incorporating these findings to support their analysis of safety incidents and inform safety improvement strategies.

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poster abstracts 106 Factors influencing intervention reporting: it’s all about what you believe Tim Garrett1, Diane Reeves1,2 1 Central Coast Health Service, NSW, 2Northern Sydney Central Coast Health, Clinical Governance Unit, NSW Correspondence: timsgarrett@hotmail.com

Aim: To explore whether pharmacists reported barriers to error reporting are assumed or actual. Method: Our ability to respond to the excess drug-related harm occurring in public hospitals is compromised by significant underreporting of safety incidents. Previous studies have identified a ‘lack of available time’ as a significant barrier to pharmacists reporting incidents. To evaluate the impact of pharmacists duties and ‘available time’ on intervention reporting a workload monitoring tool was used within an 820 bed health service. Over a 12-month period data from this tool was compared with the volume of pharmacist-generated safety incidents reports. Pharmacists also completed a survey to determine their opinions on the reporting of clinical interventions. Results: Pharmacists (n=29) reported 2 883 interventions (mean 23.2 per month). ‘Above average (High)’ reporters (n=9) comprised a significantly greater volume (76%, p=0.006) of total incidents compared to ‘below average (Low)’ reporters. ‘High’ reporters did not differ to ‘Low’ reporters for any variables including; years of experience, grade, time in clinical areas, time in pharmacy, or clinical variables (including; episodes of medication reconciliation, discharge counselling or ward occupancy activity), p>0.05 for all. All pharmacists reported similar beliefs for their professional role in incident reporting but differed in how groups felt this impacted on patient care and safety culture. Conclusion: Whilst pharmacists report time constraints as the most significant barrier to intervention reporting there were no differences in ‘available time’ or ‘opportunity to intervene’ between pharmacists who utilise intervention reporting tool and those who didn’t. This suggests that whilst time-constraints remain a key barrier to reporting of interventions, factors relating to personal belief and motivation drive use of intervention reporting systems. Strategies to mitigate these key barriers will help us meet our professional expectations and improve patient safety.

107 Building patient-centred leaders: pharmacist leaders experience of the Clinical

Leadership Program in Australia Sharon Goldsworthy1, Jennifer Pink1 1 Pharmacy Department, The Queen Elizabeth Hospital, SA Correspondence: sharon.goldsworthy@health.sa.gov.au

Our aim is to describe our journey in the Clinical Leadership Program (CLP) developed by the Royal College of Nursing, United Kingdom building on their learnings from a project identifying attributes of good leaders. The aims of the CLP are to achieve safe, quality, person-centred care by developing health care professionals’ leadership strategies. We had found that several nursing colleagues we admired for their patient centric care and willingness to challenge the status quo, had done this program. This, and encouragement from our General Manager, led to us apply for positions in the first interprofessional cohort, promoted to allied health; medical; and nursing/midwifery professionals. The CLP is a two-tiered professional development program involving local facilitators each working with up to six clinical leaders. The program runs over a year and involves participation in workshops, monthly ‘action learning sets’, 360 degree feedback, one-on-one coaching, mentoring, development of a professional development plan, undertaking patient-focused activities and incorporating reflection into our day. Workshops are run in an adult learning model with facilitators introducing provided activities that the leaders then use their collective knowledge to explore. For example, the team building workshop explores attributes and consequences of highly functioning teams, leading into scoring our own team functioning. Activities are often fun and many can be taken back into the workplace for further learning/development. Key successes for us in the program included; self management; challenging how and why we do things; shifting our focus from urgent to important—and finding the urgent vanish. The program has broadened our networks and we have changed our leadership style to more reflect the things that ‘make good leaders’. Our 360 degree feedback supports our leadership development.

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poster abstracts 108 Eight into three does work—guardrails and patient safety James Grant1, Lynette Loy1, Bryson Swan1, Elizabeth Donegan1, Karen Boch1, Carol Morrison1 1 Princess Alexandra Hospital, QLD Correspondence: james_grant@health.qld.gov.au

Advances in infusion technology has led to the development of Guardrails®, a software application that can be installed on infusion pumps that gives the user the ability to choose the medication or product that is being infused and places safety limits on its administration. This technology has now been implemented in a number of facilities within Australia. To describe the process undertaken to develop the safety limits for every relevant medication used at this facility and the introduction of this system into a tertiary referral centre, involving 900 devices over a limited period of time. Of critical importance was the development of a dataset with limits for all of the medications being administered. A crucial aspect in this development was accommodating all of the clinicians’, units’ and users’ preferences to ensure transferability across the entire site. Coordinating data from many sources required the use of a variety of tracking and amalgamation tools. This tool mimicked the data required for the drug limits and tracked the location of pumps being field tested, which areas had commented on the development of the dataset and an index of the facility staff involved in the creation, review and approval of the project. The electronic medium can limit communication and face-to-face meetings became essential. Likewise, the amalgamation tools were the first step in the development of a functional dataset. Field testing on actual pumps was essential. Profiles for different areas of care were streamlined from eight into three while accommodating the wishes of all involved and achieving optimal patient safety. No errors have been noted in the dataset. Approximately six months after the implementation of the Guardrails® technology safety data will be downloaded from many of the pumps for analysis to see if the system is preventing administration errors.

109 Getting the basics WRITE—assisting medical interns with safe prescribing Kirsty Grant1, Debbie Tansacha1, Derek Just1 1 Redcliffe Hospital, QLD Correspondence: kirsty_grant@health.qld.gov.au

Background: Medical interns play a major role in the patient discharge process by completing discharge prescriptions. They are novice prescribers who have acquired varied levels of knowledge and understanding of safe prescribing practices through their undergraduate studies. With many public hospitals now utilising the pharmaceutical benefits scheme (PBS) for supply of discharge medications, it is imperative that clinicians are also aware of and follow the PBS prescribing regulations. Aims: To develop and deliver an education and training package to positively influence the outcomes and behaviours of medical interns towards safe prescribing and documentation. Intervention strategies focused on the mechanics of writing discharge prescriptions with an emphasis on legibility, safety, legalities and PBS standards. Method/results: A case-based education package was delivered to interns prior to the commencement of clinical duties. Teaching focused on the expected legal and PBS standards clinicians are required to follow whilst writing prescriptions. Interns were required to complete prescriptions in a sample clinical record to demonstrate their application and understanding of prescribing practices. These results were then audited to form the baseline data. At the end of specified terms interns were interviewed and provided with a report of their audit results together with individual feedback incorporating common errors made by the group. Results were benchmarked against their peer group and the most up-to-date hospital wide audit results. Improvements include: Baseline Term audit Hospital benchmark Compliance with legal regulations 80% 99% 100% Compliance with PBS standards 70% 93% 79% Interns were receptive to feedback provided and data reflects corresponding improvements in prescribing practices, with intern results equalling hospital wide statistics. Conclusion: Education at orientation is only the beginning. Continued mentoring and feedback of progress is important to assist in improving and sustaining a changed culture in medicine where safe prescribing is intrinsic to clinical practice.

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poster abstracts 110 Adverse drug reactionsâ&#x20AC;&#x201D;is the patient in the loop? Linda Graudins1, Ingrid Hopper2, Rowena Fary1, Julie Lord1, Michael Dooley1,3 1 Pharmacy Department, Alfred Health, VIC, 2Clinical Pharmacology, Alfred Health, VIC, 3Monash University, VIC Correspondence: l.graudins@alfred.org.au

Aim: To evaluate existing methods of informing patients, their community pharmacist and primary care physician, regarding details of adverse drug reactions (ADR) experienced during hospitalisation. Method: ADR reports are reviewed fortnightly by an ADR committee, which provides a letter detailing ADR and management advice and a summary card for the patient. This is sent to the patient requesting them to show the letter to their local doctor/pharmacist and keep the card. Patients were contacted by telephone one month later to assess uptake. Results: From February to June 2010, 70 suspected drug reactions were reviewed, involving 92 agents. Fifty patients were identified for follow up. As of July 2010, 32 patients (64%) were contacted with 91% aware that they had experienced an ADR. Twelve patients (24%) were admitted because of an ADR. Four hadnâ&#x20AC;&#x2122;t realised an ADR had occurred until they received the letter. 54% thought the letter was useful. Twenty-three (72%) thought the card was useful, with 56% carrying the card in their wallet and 28% filing it with their medical documents. Half would like a letter also sent directly to their doctor. Twelve (37%) patients had shown or were intending to show the letter to their doctors. Only two (6%) had shown it to their pharmacist. The majority (91%) would recommend this system to other hospitals. Of the 38 discharge summaries available, the ADR was documented in 80%, details of the reaction in 76% and management advice in 13%. Conclusion: The ADR notification letter was not universally shown to local doctors or pharmacists, but the majority of patients kept the card on hand. As the majority of discharge summaries did not contain specific advice regarding ADR the use of a detailed letter and patient card improves communication to other health care providers and usage could be further improved.

111 Addressing medication safety by stealth: raising the relevance of adverse drug

reaction documentation Toni Howell1, Hayley Zarth1, Lisa McKenzie1, Jan Argent1, Ros Williamson, Janelle Penno1 1 Melbourne Health, VIC Correspondence: toni.howell@mh.org.au

Aim: Adverse drug reaction (ADR) documentation and communication of this information across multiple admissions were identified as areas of poor performance when this tertiary teaching hospital conducted the Medication Safety Self Assessment in 2008. A perception by doctors and nurses that review of this information was a low priority was cited as a reason for this deficiency. This project aimed to improve medication safety in a sustainable way by improving the relevance of the process to all hospital staff and embed it into routine practice. Methods: The multidisciplinary improvement team used Lean Six Sigma methodology and incorporated human factors engineering principles into the process review. Applying the new national guidelines from the Australian Commission for Safety and Quality in Health Care (ACSQHC) for patient identification was integral to the strategy. Other strategies included streamlining documentation and condensing all significant patient alerts onto one form, reducing unnecessary duplication and ensuring review of the medication safety issue of ADR documentation which was the primary focus of the pharmacists in the team. Results: Following project implementation, the patient alert forms were found to be present in more than 80% of all patient histories (previously only 19%) and of those patients with a known serious alert, this information was documented on the patient alert form more than 70% of the time (previously only 3%). Ongoing compliance audits are to be conducted by the quality unit due to the multidisciplinary nature of the information. Conclusion: A multidisciplinary, multifaceted approach resulted in an organisation wide improvement in documentation and review of significant patient alerts of all types across multiple admissions, and subsequently that of ADRs which was our primary focus. By ensuring relevance to all hospital staff, in particular new ACSQHC recommendations for patient identification, we have achieved comprehensive stakeholder engagement and improvements in medication safety.

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staying alive 2010

poster abstracts 112 Dexamethasone for bronchopulmonary dysplasia—a 4-year review Lisa Hughes1, Laura Leung1 1 Royal Women’s Hospital

Background: One of the treatment modalities used in bronchopulmonary dysplasia (BPD) to facilitate extubation among ventilator dependant infants is postnatal steroids (PNS). The current regimen is a 10-day course of dexamethasone, following the Dexamethasone: A Randomised Trial (DART) protocol with a maximum total dose of 1780 microgram/kg. High dose PNS have several side effects including gastrointestinal perforation, hyperglycaemia and growth restriction. Aim: To review the prescribing of dexamethasone in accordance with the DART protocol and determine the total dose, duration and whether any short term side effects were experienced. Method: All patients who were prescribed dexamethasone during the period 1/1/2006 to 31/12/2009 were identified. Patients who received dexamethasone for BPD were included. Their medical records were then retrieved and the following data was collected: gestation and weight at birth, number of courses, prolongation of any courses, total dose of dexamethasone, side effects including hypertension, glycosuria, hyperglycaemia requiring insulin, gastrointestinal bleed or perforation and cardiac hypertrophy. Results: During the study period, 45 patients received dexamethasone for BPD with a median gestation of 25 weeks and birth weight 650g. 13/45 (29%) patients were prescribed dexamethasone according to the DART protocol and 29/45 (64%) babies had prolonged courses. Of the 29 that had prolonged courses, 18 patients received greater than 1780 microgram/kg of dexamethasone, with the maximum total dose received being 9100 microgram/kg. Side effects were rare with the most common being glycosuria. 32/45 (71%) patients had hypertension prior to treatment with dexamethasone which continued during treatment, however no patients developed hypertension during treatment. Conclusion: Two thirds of patients were prescribed dexamethasone that was not in accordance with the DART protocol and 40 per cent of patients received more than the maximum dose of dexamethasone allow on the DART protocol. Short term side effects were minimal.

113 Implementation of a deterministic inventory management system using order-point

order quantity (Q,R) theory Colin Hui1, Phuc Phan1, Michael Dooley1,2 1 Pharmacy Department, Alfred Health, VIC, 2Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, VIC Correspondence: c.hui@alfred.org.au

Background: Managers are often baffled with the question ‘what is the optimum level of inventory?’ Simply relying on past experience is insufficient. Q, R theory is a set of formulae which allow the user to calculate the optimum order quantity (Q) and replacement (R) stock requirement (safety stock) through statistical means. Aim: To implement a new deterministic inventory control system using the Q, R theory in a particular pharmacy campus and evaluate the impact by examining the changes in stockholding value. Method: In January 2010, the operations manager formed a team to evaluate the existing purchasing system of a selected pharmacy. Twelve-month purchasing data was isolated through Crystal Report. A physical stock count was carried out to determine the actual stockholding value. Through Excel manipulation, key variables comprised of weekly average and standard deviation of purchasing quantity, holding cost, lead-time and price were extracted. These variables were then fitted into the Q, R formula to calculate the re-order point (R) and optimum ordering quantity (Q). The purchasing system was updated with the new quantities and stockholding value was monitored. Results: The selected pharmacy purchased $25.3m over 304 product lines between January and December 2009. Approximately 98.8% of the purchased value was associated with Section 100 drugs. Drugs were ordered once a week, stockholding value ranged from $714K to $900K. In late January, the stockholding value of $700K was confirmed by a physical stock take. The purchasing system (i-pharmacy) was updated in mid February. Since implementation, ordering frequency has increased to twice weekly, stockholding value has decreased by an average of $150K. Conclusion: Q, R theory calculates the optimum re-order point and ordering quantity systematically, based on historical data. Consequently, it made a positive impact on stockholding over a period of three months.

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poster abstracts 114 Does a medication reconciliation pharmacist reduce medication errors at the

community-hospital interface? Angela James1, Shannon Ferguson1, Angela Stathopoulos1 1 Royal Victorian Eye and Ear Hospital, VIC

Aim: To implement a medication reconciliation pharmacist (MRP) on admission at a specialist teaching hospital and assess the effect on inpatient medication prescribing errors. Method: A pre-implementation audit of 50 inpatients was conducted over a four-week period to determine baseline prescribing errors for patient’s own medication. The MRP role was implemented in March 2010 for planned overnight stay patients who were deemed high risk. Eligible patients, identified in pre-admission, were contacted by the MRP prior to admission. Patients were reminded to bring all medications into hospital in original containers. Upon admission, the pharmacist interviewed the patient/carer and documented a complete medication history on a standard form. This was reconciled with a second source to ensure accuracy. The MRP then transcribed current medications onto the medication chart for review and endorsement by the doctor. The doctor was required to sign and date the orders to convert them into valid orders for administration. A post-implementation audit is currently being conducted to determine the impact of the MRP on the incidence of inpatient medication prescribing errors. Results: The pre-implementation audit revealed 50% of patients admitted to hospital had one or more prescribing errors (mean number per patient = 1.02; maximum = 6). A total of 14% of patient’s own medications were charted incorrectly. Preliminary post-implementation data for 39 patients are: mean prescribing errors per patient = 0.20; maximum = 2. Conclusion: Our audit suggests that the implementation of a medication reconciliation pharmacist in a specialist teaching hospital can reduce inpatient prescribing errors. This should ensure improved medication management at the community-hospital interface.

115 The role of the pharmacist in improving evidence based health care of paediatric

patients at the Australian Children’s Clinical Trials Centre Pathma D Joseph1, Kimberley Lilischkis1,2 1 The Children’s Hospital at Westmead, NSW, 2University of Sydney, NSW Correspondence: pathmam@chw.edu.au

Aim: The paediatric clinical trials centre, aims to be a leading global facility for the conduct of high quality, ethical clinical trials in children and to improve evidence-based health care. Methods: Literature indicates that the number of medicinal products registered for paediatric patients is limited. A paediatric trials centre was identified as necessary to encourage and facilitate quality research to improve the safe and efficacious paediatric therapeutic options available. Paediatric researchers were engaged in discussions to identify support required to ensure good clinical practice (GCP) in trials, more efficient use of resources, better recruitment and greater involvement in multi-centre, international studies. Additionally, contacts were made with key stakeholders and with national and international clinical trial centres. The key success factors for a paediatric trials centre were identified; in particular the role of the clinical trials pharmacist in such an initiative was defined. Results: The key human resources that were required to establish the trials centre and meet stakeholder requirements included a project coordinator, a clinical trials pharmacist and a biostatistician. These resources were essential to support investigators, to improve competence and to ensure GCP compliance. The clinical trials centre also provides access to secure storage, investigational product management, assistance with regulatory affairs, GCP training, scientific review of protocols and development of standard operating procedure templates. The centre is developing national and international collaborations to promote prioritisation of paediatric health issues and to engage the public in clinical research. The clinical trials centre has improved the quality and quantity of paediatric clinical trials and the clinical trials pharmacist has played a key role in this success. Conclusion: The role of the clinical trials pharmacist in a multidisciplinary clinical trial centre is critical to the centre’s success. This expanded pharmacy role contributes significantly to improving paediatric evidence-based health care within a global network.

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poster abstracts 116 Using technology to support continuous professional development Neil Keen1, Peter Halstead2 1 Canberra Hospital, ACT, 2Australian Pharmacy Council Correspondence: Neil.Keen@act.gov.au

Aim: To describe the method and results of using wireless technology to enhance SHPA continuing education (CE). Methods: The National Pharmacy Board requires CE to be assessed to qualify as a knowledge improvement activity. Most events use retrospective questioning for assessment. SHPA recommends planned, personalised continuous professional development (CPD). Specific support programs are not readily available. Newer technology utilised in academic environments may support these requirements with real-time personal feedback. To test this, a wireless device was sourced along with pharmacology and clinical competency questions from the Australian Pharmacy Council. Questions with multiple choice answers allowed participants to answer each question with the device recording responses. Model answers with reasoning, plus own and group responses were fed back. Participants recorded personal results and knowledge gaps for CPD self planning. They also completed an evaluation survey. Results: Twenty members attended the event and 25 questions were completed. The device recorded participant response data for each question, which could be later reviewed. For example, question 10 responses were: a, 8%; b, 23%; c, 38%; d, 8%; e, 23% respectively. Nine questions (36%) provided results below 65% (APC competency threshold) for the correct answer, suggesting general areas for branch CE focus. In the participant survey 81% of respondents identified knowledge gaps and 56% intended to use this to inform their own CPD. The technology was thought to improve feedback (69%) and enhance the CE event (80%). All respondents (100%) thought the branch had a role to assist CPD planning. Conclusion: Instantaneous feedback technology appears to be suitable for adaptation to pharmacist CE events. It showed some success in real time assessment of knowledge and may assist individual CPD planning. This approach may increase member value derived from CE activities.

117 Consumer demographics and medication supply demands in a public nurse-led walk-

in centre Miriam Lawrence1, Neil Keen1 1 The Canberra Hospital, ACT

Correspondence: Neil.Keen@act.gov.au

Aim: To report on patient presentation patterns and relationship to supply of medications at a walk-in centre (WiC). Methods: The first Australian publicly funded, nurse-led WiC providing no appointment consultations opened in May 2010. WiC practice scope authorises advanced nurse practitioners to administer and supply medicines for minor illness and injury. Other medication needs are referred as appropriate to community pharmacy (S2, S3), general practice (chronic medications) or the emergency department (serious, complex and acute medication needs). Early patterns of medication use have tested appropriateness of medication clinical guidelines developed. They inform general practice and community pharmacy concerns regarding workload diversion, consumer safety and business impact. Results: During the first month of operation, the WiC has seen an average of 41 patients per day. The most common presentations are: URTI 21%, wounds 9%, genitourinary 7% and a range of minor illness and injuries within the WiC scope. Patients are approximately equal in gender balance and predominately between 18 and 35 years of age. Average consultation time (inclusive of waiting) is around 60 minutes. The WiC treats 41% of presentations. Of those patients referred, 29% are to the GP, 14% to the ED and 0.4% to community pharmacy. Presenting patients would have alternatively attended their GP (52%), visited the ED (26%) or self-cared (11%). Only 1% would have visited their pharmacy, which may represent a self-selected population not currently utilising this resource. Medicines have been supplied 155 times in 1 230 consultations (13%). Antibiotics were the most commonly issued, including: amoxicillin (22%), phenoxymethylpenicillin (19%) and trimethoprim (13%). Beyond such quantitative aspects which is still preliminary data and not yet validated, further evaluation of quality and safety of medication management in the WiC is ongoing. Conclusion: Presentations in the first month of WiC service describe the treatment population accessing the service. Medication use is a significant aspect of therapies recommended during consultations.

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poster abstracts 118 Assessing intern doctors prescribing skills at orientation to hospital Miriam Lawrence1, Darren Roberts2 1 The Canberra Hospital, ACT, 2St Vincent’s Hospital, NSW Correspondence: Miriam.Lawrence@act.gov.au

Aim: To use a prescribing exercise for intern doctors on orientation to hospital to identify skills and knowledge gaps and to develop rapport between clinical pharmacists and interns. Method: Studies have demonstrated that intern doctors do not feel adequately prepared to prescribe safely. We applied a previously described prescribing exercise and survey in our 2009 intern orientation. Results of the prescribing exercise were marked and individual feedback was given the following day. Groups of eight interns and two clinical pharmacists discussed the marked prescriptions and specific areas of deficit were identified. Results of the survey and the discussion and were used to guide later intern training. A modified version of the survey was applied at the end of the intern year. Results: Fifty-two interns completed the prescribing exercise and survey at orientation. Results were similar to what was reported by Hilmer et al. The mean score for the prescribing exercise was 59.5%, with over 50% prescribing ticarcillin-clavulanate when the patient had a documented penicillin allergy. Many of the interns reported the personal feedback and discussion of the results to be invaluable. It improved their understanding of the prescribing process and highlighted individual areas of weakness. Target areas for further education included analgesia, aperients and therapeutic drug monitoring, training sessions on these topics were conducted. At the end of the year 29 interns completed the modified survey. Results indicated that interns felt better prepared to prescribe, however significant areas of weakness still existed. Conclusion: This practical approach to assessment of prescribing skills and individual feedback had several benefits. It highlighted individual shortfalls, it allowed targeted education and it was a great team building exercise. Because of the many benefits we have repeated the process in 2010 and hope to continue to do so in the future.

119 The journey of an emergency department specialist pharmacist beyond the clinical

role Shu Lay1 1 Hornsby Ku-Ring-Gai Hospital, NSW

Aim: To reflect on the evolving ED pharmacy service beyond the clinical role. Method: ED clinical pharmacy services were introduced in early 2007 following a quality project. Since then the service has supported regular involvement in and implementation of many multidisciplinary quality initiatives: 1.

Initial project—Safer Systems Saving Lives (SSSL) program (2007)—aimed to reduce adverse medication outcomes via sustainable medication reconciliation.

Warfarin Working Party (2007) aimed to reduce warfarin misadventures.

Initiated transfer procedure for patient’s own S8 and S4D medications whilst being transferred/discharged from ED (2008).

Implemented the ED challenge for medical officers to improve five charting principles highlighted as deficient in an audit (2009).

Initiated the ‘Beetle Challenge’ for nurses to improve Pyxis Med-Station medication safety issues (2010).

Results: Each of these quality initiatives has had positive outcomes: 1.

Introduction of an ED pharmacist reduced the mean error rate via medication reconciliation from 69% to 25%. Pharmacist received an Area Health Service Recognition Award.

Non-administration of warfarin decreased to an average of 0.6 per month; a warfarin ‘flag’ was developed and this work was submitted to the NSW Health Quality Awards 2009.

Patient’s own S8 and S4Ds are now no longer left in ED after the patient has been transferred/discharged.

The five basic charting principles have markedly improved e.g. use of non-approved abbreviations decreased from 43% to 3%. This challenge is being considered by our Area’s NSW Health Quality Awards 2010 judging committee.

Medications are rarely left outside of the Pyxis Med-Station and less unexpected ‘physical’ stock-outs.

Conclusion: The pharmacy service has evolved and continues to evolve into a service which offers more than typical clinical pharmacy services. It engages medical and nursing staff to maintain good work practices in medication safety and initiates and implements quality activities.

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poster abstracts 120 A review of the diabetes record and insulin medicine chart Melissa Lee1, Molika In1 1 The Royal Women’s Hospital

Background: Insulin administration is fundamental to achieving optimal glycaemic control. However, insulin is a high risk medicine with the potential to cause significant harm if used in error. To improve the management of hospitalised patients with diabetes, a diabetes record and insulin medicine chart (DRIMC) was introduced. The chart was designed to integrate prescribing orders, records of insulin administration and blood glucose monitoring. Aim: To evaluate the use of the DRIMC, by reviewing documentation of prescribed orders, administration according to medical orders and pharmacy endorsement. Method: A retrospective audit of the DRIMC was conducted to review:

x x x x

clarity of prescribed regular insulin orders, top-up orders and sliding scale orders correct administration of insulin correct monitoring of blood glucose levels pharmacy endorsement of insulin orders and insulin administration.

Data was collected from randomly selected patients with diabetes, who were in-patients between September 2009 and March 2010. Results: Seventy-five DRIMCs were reviewed. For patients prescribed regular insulin (n=36), 94% of orders were written correctly. Top-up insulin orders (n=27) and sliding scale insulin regimens (n=6) were written correctly on 85% and 83% of occasions respectively. Prescribers indicated times to monitor patient blood glucose levels on 56% of DRIMCs. Administration of regular insulin doses occurred for 68% of prescribed doses. Furthermore, 50% of top-up insulin orders, to supplement regular insulin, were administered. Patients prescribed sliding scale insulin regimens received 61% of doses. When indicated by the doctor, 94% of blood glucose levels were measured and correctly documented. Pharmacist endorsement of insulin orders and administration occurred on 18 occasions (24%). Conclusion: Improvements to the DRIMC are required to maximise its effectiveness in the management of hospitalised patients with diabetes. Suggested changes to the DRIMC may help to reduce insulin prescribing and administration incidents.

121 Clinical pharmacy services: providing access and equity for rural patients Anne Leversha1, Lyn Billington1 1 Latrobe Regional Hospital, VIC, 2Monash University, VIC Correspondence: anne.leversha@monash.edu

Objective: To ensure the provision of a comprehensive clinical pharmacy service at Latrobe Regional Hospital (LRH), a Victorian regional hospital, in order to maintain the integral and vital risk management strategy and cost effective care for patients and the hospital. Method: A variety of strategies were examined in relation to two issues. Firstly, the prevention of incidents—clinical pharmacists’ contribution to medication safety is multifaceted and often their contribution is unacknowledged because the detection of medication and therapeutic errors, or near misses, occurs prior to medication administration. Secondly, recruitment and retention of clinical staff—this has always been more difficult in rural localities compared to metropolitan areas. Results: A number of strategies have been implemented at LRH that have assisted in maintaining the level of clinical pharmacist staffing which has meant the service remains safe and efficient. These have included: x focusing on clinical functions such as providing a medication history as soon as possible after admission, with the aim of reducing medication errors x ensuring that medication safety receives the appropriate attention through the continuous review of medications and the identification of systems requiring improvement x having pharmacy technicians assist the pharmacist in non-clinical work, to allow pharmacists to concentrate on clinical functions x providing a culture of professional development within the department, which includes a weekly clinical meeting to develop the clinical skills of the pharmacists x promoting LRH to pharmacy students as a recruitment strategy. Conclusion: Where there are pharmacist shortages, as is evident in many rural areas, staff have to increase their percentage of time spent on medication supply, which can result in a reduction in access to clinical pharmacy services, with the concomitant threat to risk management and cost effective care. The strategies implemented at LRH have successfully addressed these issues.

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poster abstracts 122 Introduction of a weekend clinical pharmacist service to an intensive care unit Bianca Levkovich1,2, Shin Choo1, Diane Walters1, Michael Dooley1,2 1 Alfred Health, VIC, 2Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, VIC Correspondence: b.levkovich@alfred.org.au

Aim: To establish a dedicated clinical pharmacist service to ICU on weekends and public holidays, to improve continuity of pharmaceutical care to the sickest patients. Methods: Clinical pharmacist services to the ICU were identified as being compromised on weekends due to the provision of services on a Monday to Friday basis. Allocation of weekend clinical pharmacy resources were discharge-driven, focusing on other wards. Funding was sought and secured for the provision of a dedicated 0.7 EFT on weekends and public holidays. In consultation with ICU medical and nursing leadership a prioritised service was designed and implemented. Baseline services were measured by examining the electronic handover tool already in place for weekend clinical pharmacy services throughout the hospital. Success of the improved service was assessed by an evaluation of a checklist tool monitoring pharmacistsâ&#x20AC;&#x2122; activities, in conjunction with the electronic handover tool. Results: Before implementation, few ICU patients were reviewed on weekends. Often, newly admitted patients waited up to 60 hours before being reviewed by a clinical pharmacist. Under the improved ICU service clinical pharmacist review of new, complex and unstable patients, and those requiring therapeutic drug monitoring or supply of new medications, were prioritised. The majority of patients are seen daily, including weekends and public holidays. Interaction with nursing staff and medical team rounds also facilitated the identification and review of patients who had deteriorated. The service has resulted in a more comprehensive clinical pharmacy service being provided to ICU patients. Conclusion: The role of pharmacists in maintaining patient flow cannot be understated. This work demonstrates that a dedicated clinical pharmacist in the ICU at weekends improves the pharmaceutical care of critically ill patients. This represents a significant step in demonstrating the value of extended hours services of clinical pharmacists. Plans are in place to extend this service.

123 Dispensing, counselling, clinical reviews and beyond Judy Lin1, Peter Ludlow1 1 Logan Hospital Pharmacy Department, QLD Correspondence: peter.ludlow@me.com

Aim: Logan Hospital has doubled the intake of junior medical officers (JMOs) in 2010. The aim of this project is to conduct a two-hour prescribing workshop, by the pharmacy department, to 40 medical interns during their orientation. Methods: Adult learning principles were applied in the prescribing workshop, which consisted of two 20-minute didactic lectures and 80-minute case scenarios. The lectures were presented by senior pharmacists on prescribing (national inpatient medication chart and hospital PBS prescriptions) and medication safety. The JMOs were then divided into 8 smaller groups for case scenarios, which required them to identify common issues on drug allergy, medication history, medications with alternative route of administration, duplication of orders, discharge prescribing, insulin prescribing etc. Each group was allocated 10 minutes for each case to determine problems and provide solutions. The case scenarios were facilitated by pharmacists. Each pharmacist was assigned to a case scenario and rotated among JMOs until all 8 cases were discussed. Results: Positive feedback on the workshop was received from the Medical Education Unit. The interns found the session was helpful and well presented. On a criterion scale of 1 to 5 (5 being very positive), 99.9% of the ratings were in the 4â&#x20AC;&#x201C;5 category. Some of the interns commented that the case scenarios were very useful and practical learning tools. Small groups were good for hands-on experience. Some interns would like to have had more scenarios on insulin, gentamicin, and warfarin dosing. The feedback will be used to improve education next year. Conclusion: The prescribing workshop was greatly appreciated by the interns. For our pharmacy department, it has provided a unique opportunity for pharmacists to meet and support JMOs from the beginning of their internship. This project has demonstrated that pharmacists, regardless of their level of experience, can play a role in educating JMOs.

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poster abstracts 124 Home medicine reviews in partnership: working together with an Aboriginal health

worker Angela Madden1,2, Margaret Oâ&#x20AC;&#x2122;Brien1 1 Danila Dilba Health Service, NT, 2Royal Darwin Hospital, NT Correspondence: kerry@mpevents.com.au

Objective: To work alongside an Aboriginal health worker in order to achieve culturally appropriate, and clinically useful, patient outcomes from Home medicine reviews (HMRs). To provide an alternative to the standard model of HMR provision by developing a collaborative approach to practice. Clinical features: Over a period of seven months (from October 2009 to May 2010), 35 HMRs were undertaken for patients of an Aboriginal medical service in the Northern Territory. Each visit was conducted by a consultant pharmacist together with an Aboriginal health worker. Interventions, case progress and outcomes: The Aboriginal health worker acted as a cultural escort in each case. This collaborative approach to HMR provision aimed to achieve improvements in: cultural safety, pharmacist access to patients, timeliness of HMRs and communication. In addition, there was shared learning between the health professionals conducting the HMRs, resulting in improved understanding of medication management and wider Indigenous health issues by the Aboriginal health worker and consultant pharmacist respectively. An individual patient is used during this presentation in order to illustrate this alternative model to the standard HMR practice structure. Conclusion: This partnership model of undertaking HMRs demonstrated multifaceted benefits; both clinical and educational. This case report is jointly presented by a consultant pharmacist and an Aboriginal health worker.

125 Evaluation of a clinical pharmacy service to an acute medical unit Sally Marotti1 1 The Queen Elizabeth Hospital, SA

Correspondence: sally.marotti@health.sa.gov.au

Background: In February 2009 a 12-bed acute medical unit (AMU) was opened in a large metropolitan teaching hospital, this was expanded to 20 beds in November 2009. Aim: To determine if a full clinical pharmacy service can be provided to an AMU with the resources provided (1.0 FTE) and to estimate actual clinical pharmacist resourcing requirements. Method: Data was collected prospectively seven days a week from May 2009 to June 2010. The AMU clinical pharmacist recorded data on tasks undertaken, and total required tasks for each day. Data was collated an analysed to determine minimum staffing requirements for the AMU. Results: From May to November, there were an average number of 5.6 new patients per day, 12.5 inpatients and 2.8 discharges requiring discharge reconciliation and medication list. Of these 84% had an admission medication history taken within 24 hours of admission, 74% of charts were reviewed each day, 95% of discharges were reconciled by the pharmacist, and only 43% were provided with a medication list on discharge. From December to June, there were an average number of 8.5 new patients per day, 27 inpatients and 3.4 discharges requiring discharge reconciliation and medication list. Of these 77% had an admission medication history taken within 24 hours of admission, 58% of charts were reviewed each day, 78% of discharges were reconciled by the pharmacist, and only 26% were provided with a medication list on discharge. The ability of the pharmacist to undertake minimum daily tasks was related more closely to throughput than bed numbers. Pharmacist resources provided to the unit was not sufficient to undertake the minimum daily tasks. It is estimated that in excess of two FTE clinical pharmacists are required for the 20-bed AMU unit. Discussion: Provision of clinical pharmacy services resourcing to an AMU should be based on patient throughput, and take into consideration the minimum daily tasks required to be undertaken by a clinical pharmacist.

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poster abstracts 126 ‘Making acid’—the use of ammonium chloride in a urine acidification test Claire McCormack1 1 Gosford Hospital, Northern Sydney Central Coast Health, NSW Correspondence: cmccormack@nsccahs.health.nsw.gov.au

Objective: To describe the preparation of a urine acidification test that was used in a difficult case to confirm a diagnosis and direct future treatment options for the patient. Clinical features: A 44-year-old male presented with intermittent profound muscle weakness and near-complete paralysis. The blood profile showed metabolic acidosis and K+=2.3. After investigation, a diagnosis of hypokalemic-periodic-paralysis (HPP) was made with the proposed cause of hypokalemia being distal tubular renal acidosis (dRTA). To confirm this diagnosis, an acid loading test was needed to induce mild systemic acidosis. Interventions and discussion: Pharmacy was asked to prepare a urine acidification test using ammonium chloride. A search ensued to find formulation and dosing guidelines. Ammonium chloride dissociates to ammonia and H+ ions. In dRTA (where the collecting tubule fails to secrete H+), the high acid load would confirm the diagnosis by demonstrating the kidneys inability to acidify the urine (urine pH remains >5.3). The ‘short ammonium chloride test’ dose was found to be 0.1–0.2g/kg. In case reports, tablets and capsules were used but having access only to ammonium chloride powder, it was necessary to locate a suitable formula. Its water solubility is 1:2.7, but due to extreme emetic properties and bitter taste, a 100mg/mL formula using peppermint water as a diluent was used. Case progress: The patient received a single dose of 10.6g ammonium chloride (0.1g/kg, wt=106kg). Serum bicarbonate samples were taken at 0 and 6 hours and urine samples were collected hourly for six hours. The results confirmed a diagnosis of dRTA as serum bicarbonate levels fell and urine pH remained >5.3. Conclusion: Novel tests to aid in the diagnosis of rarer conditions often require extensive collaboration with pharmacy departments. This case brought new knowledge to both medical and pharmacy teams and the resulting diagnosis directed subsequent patient care.

127 Oral chemotherapy—implementation of practice guidelines for general dispensary

staff Robert McLauchlan1, Jim Siderov1, Alice Chow1, Steve Yeoh1 1 Austin Health, VIC Correspondence: robbie.mclauchlan@austin.org.au

Aims x To survey non-oncology pharmacists about attitudes towards dispensing oral chemotherapy x To develop and implement department practice guidelines x To assess compliance with these guidelines and the impact on patient waiting times. Methods: A multi campus survey of pharmacists was conducted to assess attitudes and behaviour surrounding oral chemotherapy. This included new orders, repeats, and when dispensing on a weekend with limited support available. A small working party was established to develop and implement a policy and procedure for oral chemotherapy based on published standards. The key points are: pharmacist only handling; creation of a chemotherapy regimen reference with practice points; mandatory clinical checks; restrictions on quantities supplied; requirements for labelling and counselling; check by second pharmacist; and completion of checklist for each dispensing. After implementation of the policy, oral chemotherapy checklists and computer records were examined for 70 outpatient prescriptions dispensed during September 2009. Prescription turnaround times were determined for three months before, and three months following implementation. Results: Survey results indicated the majority of general pharmacists lack confidence when dispensing oral chemotherapy. Behaviour patterns differed with new orders, repeats, and on the weekend. All pharmacists requested more information and educational resources to be made available. Compliance rates with the guideline were found to be high. 100% of dispensings had a mandatory checklist completed, 80% of the dispensing labels included all required information, and 95% of dispensings were checked by a second pharmacist. At one campus there was no difference in turnaround times before and after implementation, but at a second campus the average waiting time increased from 27 to 42 minutes. Conclusion: The department has successfully implemented an oral chemotherapy policy to address pharmacist concerns and enhance patient safety. Pharmacist participation in outpatient haematology and oncology clinics is planned which should further streamline processes.

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poster abstracts 128 Advanced pharmacy experiential hospital placements in Australia for University of

Maryland students Michelle Nalder1, Michelle Vienet1 1 The Royal Melbourne Hospital, VIC

Correspondence: michelle.nalder@mh.org.au

Objective: To describe the Australian perspective and experience of providing advanced pharmacy experiential hospital placements to final-year students from the School of Pharmacy, University of Maryland (UM), United States of America (USA). Methods: An affiliation agreement was reached between the Australian hospital and the University of Maryland. Areas of speciality practice suitable for an advanced experiential pharmacy placement according to UM requirements were determined and agreement to act as supervising preceptors was obtained from the specialist clinical pharmacists working in these areas. Five-week experiential programs were developed in accordance with University requirements whilst maximising opportunities available in the specialty area. Programs included provision of pharmaceutical care, case presentations, literature evaluation, topic discussions and communication with health care providers. Feedback between students, supervising clinical pharmacists and student placement coordinator occurred throughout the placement. Supervising pharmacists provided formal feedback and evaluation at the midpoint and conclusion of the rotation in accordance with UM requirements. Outcomes: Four students have successfully undertaken an advanced pharmacy experiential placement in renal transplantation and one in haematology. Feedback from students has been overwhelmingly positive, with students using the insights into Australian practice to broaden their pharmacy perspectives. The international placement has provided some students with an advantage when seeking postgraduate employment. Preceptors found the students to be highly motivated, eager to learn and keen to gain insights into Australian practice. Glimpses into USA practices are also beneficial for the preceptors. There is continued demand for the placements and the program is entering its third year. Conclusion: Australian hospital pharmacists are well placed to provide experiential learning placements of high standard for international pharmacy students. Benefits from participation in such programs include the opportunity for Australian pharmacists to learn more about pharmacy practice in other countries and to establish contacts for ongoing international collaboration.

129 Does the consultation order in a multidisciplinary elective surgical pre-admission

clinic influence the frequency and quality of prescribing for inpatient medication charts? Hale Andrew1,2, Lisa Nissen3,4 1 Medication Services Queensland, QLD, 2Pharmacy Department, Princess Alexandra Hospital, QLD, 3Pharmacy Australia Centre of Excellence, University of Queensland, QLD, 4Centre for Safe and Effective Prescribing, University of Queensland, QLD Correspondence: l.nissen@uq.edu.au

Objectives: Patients in pre-admission clinic (PAC) see four health care professionals to ensure they are fit for surgery: nurse, resident medical officer (RMO), pharmacist and anaesthetist. This project aimed to identify the most efficient order for consultations involving the pharmacist and RMO for the production of a complete and accurate medication chart. Methods: PAC workflow was mapped by following patients through clinic and recording the order of consults and time spent with each practitioner. Medication charts were audited for quality of prescriptions to assess whether medications could be administered safely and effectively, and whether any corrections were made to medication charts. Results: Twenty-one patients were observed through clinic, 19 were taking regular medication. Fifteen patients saw the pharmacist before the RMO, 6 patients saw the RMO first. 63% of patients on medication had a medication chart prescribed. Only one out of four patients who saw the RMO first had a medication chart prescribed, compared to 11 out of 15 who saw the pharmacist first. Of 147 prescriptions generated, 16 (11%) were identified as requiring amendment. The most common error was omission of administration times; with incorrect administration times, wrong dose, wrong formulation of correct drug and no strength of medication being the others. Amendments were made by the PAC pharmacist for allergies and ADRs on 4 out of 21 medication charts, as this information was not ascertained by the RMO who saw the patient first. Conclusion: Medication charts were more likely to be prescribed by RMOs when the patient saw the pharmacist first and the medication history was available. Even with the history available, medication charts prescribed showed an 11% error rate. This small audit shows the value of the pharmacistâ&#x20AC;&#x2122;s role in PAC, and may highlight possible future opportunities for pharmacists to be more involved in the production of inpatient medication charts.

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poster abstracts 130 Pharmacy in the Solomon Islands Samantha Nothling1 1 UCH Pharmacy

Correspondence: samantha.nothling@uchealth.com.au

Background: In April 2010, a Brisbane private hospital sent one pharmacist and two registered nurses to the Helena Goldie Hospital (HGH) in the Solomon Islands, as part of a new ongoing program aimed to develop relationships and share skills and knowledge. Aim: To view the pharmacy officer’s role in a 78 bed hospital (servicing a population of approximately 25 000) in a remote community in the Solomon Islands. Discussion: Pharmacy officer training is a two-year course in Honiara, primarily focused on outpatient dispensing, ward imprest management and stock control. Clinical pharmacology is not taught in detail and such services are not provided at HGH. HGH conducts monthly health clinics in surrounding remote communities which are only accessible via boat. A pharmacy officer will accompany a multidisciplinary team to ensure medications are transported, stored and dispensed according to national guidelines. The Solomon Islands have a strict drug donation policy that endeavours to improve the quality of drug donations without hindering their supply. If provided, inappropriate donations can create extra work for an already overstretched capacity of human resources and transport. At HGH, donated drugs are stored separately to those ordered from Honiara and are only used when these supplies are exhausted. Local and national medication shortages can occur regularly and therefore stock management needs to be tightly controlled to ensure any unnecessary shortages are avoided. Cold chain and controlled drug recording and dispensing procedures are similar to those followed in Australia. Conclusion: Pharmacy officers at HGH in the Solomon Islands provide an essential service ensuring both the hospital and community receive safe and timely medications. The aim for the second trip (scheduled for September 2010) will be to work closely with the HGH pharmacy department to attempt to rectify some of their stock management issues currently being experienced.

131 ‘Are you being served?’ Hospital pharmacists ask community pharmacists. Tara O’Brien1, Mazdak Zamani1, Andrew Cording1 1 Maroondah Hospital, Eastern Health, VIC

Aim: To optimise the relationship and communication between hospital and community pharmacists and to determine whether community pharmacists needs are being met by hospital pharmacy service. Methods: The 20 community pharmacies most commonly sourced by inpatients at a medium sized metropolitan hospital were selected. These pharmacies were contacted by phone to arrange a face to face meeting, between a clinical hospital pharmacist and the pharmacist responsible for overseeing medication management of nursing home patiens and patients requiring dosage administration packs. The meetings took place at the community pharmacy and consisted of an informal overview of the hospital’s clinical pharmacy services, pertinent to the community pharmacy. The community pharmacists completed a feedback form to rate services being provided, outlined their specific needs, and commented further on any other issues. Results: The hospital pharmacy services were rated by the community pharmacists from 0 (unsatisfactory), to 10 (fantastic), with a score of 5 being a satisfactory rating. Four areas of service were rated. Phone calls received to arrange the exchange of information was rated 7 on average. Informing community pharmacies of changes to patients’ medications received a 6.5. Providing options for supply rated highest at 7.5 and receiving sufficient notice on discharge rated lowest at 6. The pharmacies which have a cut off time for changes, generally wanted them supplied by 3pm. Nineteen pharmacies found the ‘Medilist’ generated from the discharge PBS useful. Phone, fax and post were the preferred method of contact between the hospital and the community. Two of the pharmacies were unaware how to contact the hospital. Conclusion: Interfacing hospital and community pharmacists allowed for an open forum to discuss procedures already in place, limitations at both ends and opportunities to streamline processes to best communicate and serve each other to build upon the relationship between community and hospital pharmacists.

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staying alive 2010

poster abstracts 132 Loading dosing of phenytoin in adult intensive care patients—are we even close to

therapeutic concentrations? Jason Roberts1,2, Michael Putt1, Andrew Udy1,2, Jennifer Martin2, Paul Jarrett1, Nathaniel Salmon1, Jeffrey Lipman1,2 1 Royal Brisbane and Women’s Hospital, QLD, 2The University of Queensland, QLD Correspondence: j.roberts2@uq.edu.au

Aims: The aim of this study was to assess the adequacy of loading doses of phenytoin administered to critically ill patients and to identify the risk factors for sub-therapeutic concentrations. Methods: Both free and total phenytoin concentrations were measured in two or three plasma samples for each patient using high performance liquid chromatography. Samples were collected within 24 hours of administration of the prescribed loading dose. Population pharmacokinetic modelling, was undertaken using NONMEM®. Statistical analysis was undertaken using SPSS (version 17.0). Results: Fifty-three patients (total of 153 plasma samples) were included. Enrolled patients had a mean age of 47.5 (+18.0) years, a total body weight of 84.1 (+21.3) kg and a blood albumin concentration of 30.7 (+5.9) g/L. Sixty-eight per cent of patients were male and the majority (49%) were prescribed phenytoin as part of the treatment bundle for traumatic brain injury. The population values for clearance and volume of distribution for phenytoin were 0.024L/kg/hr and 1.08L/kg respectively. The loading dose was within recommended guidelines (10–20mg/kg) for the majority of cases. Protein binding was consistently ~90% when albumin concentrations were >25g/L and lower albumin concentrations were associated with higher unbound phenytoin concentrations. The percentage of free and total trough concentrations that were therapeutic were 49% and 38% respectively. Conclusion: This study has developed a population pharmacokinetic model for phenytoin in critically ill patients. Hypoalbuminaemia was shown to be the critical factor in altered dosing requirements. In approximately 50% of patients, the trough phenytoin concentration was sub-therapeutic at 24 hours, suggesting that more aggressive dosing may be appropriate given the high risk of seizures in this patient population.

133 Implementation of the Paediatric National Inpatient Medication Chart into a neonatal

intensive care and neonatal special care unit Lisa Robertson1, Noeline Hudson1 1 Flinders Medical Centre, SA

Correspondence: lisa.robertson@health.sa.gov.au

Aim: To assess the impact of implementing the Paediatric National Inpatient Medication Chart (NIMC) (short and long stay versions) in the neonatal unit on both medication safety and staff acceptability. Method: Prior to implementation medical and nursing staff were provided with education sessions based on the national education resources. Infants were commenced on short stay NIMC until medically stable then the long stay NIMC was introduced. Audits (prior, 1, 3 and 6 months post) were conducted using the Paediatric NIMC short audit tool. Medication incidents were analysed using information obtained from Australian Incident Monitoring System (AIMS). Staff satisfaction was surveyed using a locally developed audit tool. Results: Data obtained from the Paediatric NIMC short audit tool indicated an improvement in all core parameters as recommended by the Australian Commission on Safety and Quality in Healthcare, with significant improvements in documentation of patient ID, weight, ADRs, indication and correct dose. The previous medication chart did not have the ability to record these minimum parameters. Analysis of medication incidents (n=29) for the 20 months prior to NIMC implementation indicated the previous medication chart did not contribute to all medication incidents however extra information offered by the NIMC may have prevented 4 errors (14%). There was a slightly increased rate of medication incidents in the six months post implementation (n=11), however there was also an increased pharmacy presence post implementation. There were mixed perceptions with the staff survey, however overall it was felt that the NIMC provided improvements in reducing medication errors. Conclusion: The Paediatric NIMC offers advantages for medication safety in the neonatal unit, however there are limitations, particularly in the intensive care setting. Recommendations include using the short stay NIMC until infant is out of NICU or developing a NIMC with multiple pages, which may minimise risk of omissions and enhance staff acceptability.

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poster abstracts 134 An innovative eMR pharmacy consult/review sub-system as an enabling instrument

for serving quality and education agenda Ahmad Sayar1, Margaret Macarthur1, Melinda Yeung1, Helen Wong1, Julie Tran1, Pushminder Saran1, Kurshid Chaudhry1 1 Blacktown Hospital, NSW

Correspondence: Ahmad.Sayar@swahs.health.nsw.gov.au, Margaret_Macarthur@wsahs.nsw.gov.au, Pushminder.Saran@swahs.health.nsw.gov.au, Khurshid.Chaudhry@swahs.health.nsw.gov.au

Background: With the implementation of eMR system and Garling Stage One recommendations, pharmacists practicing at university teaching hospitals are at the threshold of an era for building and demonstrating our professional capacity as clinicians. This comes with a need for an enabling profession-specific electronic infrastructure. Aim: To develop and evaluate the utility value of an innovative eMR pharmacy consult/review sub-system for capturing the data on the relevant Garling Stage One recommendation response items and as an educational medium. Method: An eMR pharmacy consult/review sub-system has been developed to enable ‘ticking’ on templates the listed clinical functions performed, with provision for free-text entry of notes if needed. These listed clinical functions capture the performance data corresponding to Garling recommendations 1, 28, 56(d), 58(b), 60(a, c) and 61(a, b, c) for future retrieval and analysis. Results: Preliminary assessment of the utility value of this electronic tool revealed the following outcomes: Outcome

Enabling process

Time efficiency

not having to hunt around the ward looking for the patients’ paper folders in order to document service performed not having to queue up to write in the patients’ paper notes eliminating illegibility problem of handwriting simultaneous accessibility of patient’s pathology reports with Window Operating System at the time of writing service notes learning-in-action for ward pharmacists to develop skills of ‘how to write’ and ‘what to write’ in medical records facilitated by educator-lead brain-storming sessions supporting junior doctors with written pharmacotherapy review notes for medical team consultation and discussion.

Legibility More timely documentation Action learning of pharmacotherapy review Educational support to junior doctors’ training

Discussion: Our eMR pharmacy consult/review sub-system is still at its early stage of clinical use. With the built-in action learning, there is great potential for this electronic tool becoming an enabling instrument in serving both quality and education agenda. Acknowledgment: Ahmad Sayar has made significant contribution to the design of this tool.

135 Sustained results with a closed system drug transfer device in minimising cytotoxic

surface contamination Jim Siderov1 1 Austin Health, VIC

Correspondence: jim.siderov@austin.org.au

Aim: To evaluate the role of a closed system transfer device (CSTD) in maintaining reduced levels of surface contamination with cyclophosphamide 30 months after implementation in a large teaching hospital. Methods: This was a pre- and post-intervention study in which chemical contamination was tested at baseline then at 5, 12 and 30 months after the introduction of the CSTD. Cyclophosphamide was used as a surrogate marker for all cytotoxic drugs. Surface wipe sampling was performed at 12 specified sites within the cytotoxic suite using a standardised technique. Wipe samples at 12 months and 30 months were also taken from the external surface of six commercial products of cyclophosphamide sourced from a commercial admixture company. These were included due to a change in work practice. Results: After 30 months, contamination remained reduced in 7 of the 12 sites sampled (58%) compared to baseline. Three site samples (25%) remained unchanged. Results from two sample sites at 30 months showed increased levels of surface contamination from baseline, 5 months and 12 months. Previously these were lower than baseline at 5 months and 12 months. Commercial products showed significant contamination, higher than any other surface tested. The mean level of contamination at 30 months was four times higher than that at 12 months. Conclusion: The use of a CSTD maintains levels of contamination over a prolonged period. Pharmacies which source products from a commercial admixture company should be aware that these products contribute significantly to contamination at the workplace despite the use of a CSTD.

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poster abstracts 136 Capacity planningâ&#x20AC;&#x201D;evidence-based management Peter Smart1 1 Sir Charles Gairdner Hospital, WA

Correspondence: peter.smart@health.wa.gov.au

Aim: To determine the capacity of our department allowing us to maximise our efficiency and better display our resource requirements. Definition of capacity planning: The process of determining the capacity (be it in the workforce, equipment or premises) needed by an organisation to meet change in demands for its services or products and using this information to improve efficiency or plan for an impending change. Methods: We began by determining the actual theoretical capacity of each role in the outpatient pharmacy. This meant defining output measures (e.g. number of scripts received in window, number of items typed, number of patients counselled). Measurements then took place to establish average times taken to perform these tasks that could then be extrapolated to incorporate our available workforce. We also used recommended workload levels to ensure safety was not compromised (e.g. SHPA guidelines of 20 prescriptions checked per pharmacist, per hour). Results: Our results showed that the outpatient pharmacy was running at capacity or over capacity on almost every day. The data we collected gave us a maximum number of patients (120) and a maximum number of items (320) that could be safely processed by the outpatient pharmacy at full staffing levels with our current structure. Conclusion: Developing a capacity planning model has:

x x x x x x

allowed us to determine our workload pressures in the dispensary helped us identify how staff are best distributed to increase efficiency allowed us to easily identify when we are working above and below capacity given us better evidence and information to argue for the retainment or addition of staff helped us to know when services are operating at unsafe levels helped identify bottlenecks or constraints in our current systems.

137 A common sense approach to medicines management in Pacific island countries Beverley Snell1, Fabian Kong2 1 Centre for International Health, Burnet Institute, VIC, 2Centre for Population Health, Burnet Institute, VIC Correspondence: bev@burnet.edu.au

Pacific Island countries (PICs) face many daily challenges to ensure a reliable supply of essential medical supplies to meet the needs of the people. Appropriate policies and structures and strategies are needed to maintain reliable supply through efficient procurement, storage, supply and rational use within strengthened health systems. National medicines policies (NMP) must be in place as a guide for action covering all areas relevant to pharmaceuticals management in the public, private, non-government organisations and church sectors. Under the NMP, therapeutic committees are empowered as the leading clinical coordinating body, as well as the reference point for all activities with medicines-related components. The committee is responsible for developing treatment guidelines and for over-seeing rational use strategies. The challenges faced by health service providers in Pacific Island countries are unique and are associated with extreme isolation and enormous distances between and within nations; limited human resource capacity; and very limited purchasing power (very small populations and no economy of scale). Accurate record-keeping, forecasting and quantification of needs are crucial to maintenance of supply and local capacity must be strengthened. The sharing of information within the region regarding management training needs, drug information resources, and suppliers of quality medicines at competitive prices has been a helpful strategy. In many PICs a single pharmacist is responsible for developing and maintaining the entire pharmaceutical system. While international technical inputs based on â&#x20AC;&#x2DC;first worldâ&#x20AC;&#x2122; experiences can cause problems, appropriately skilled Australian volunteer pharmacists can help strengthen components of the system through common sense approaches as well as help develop human resource capacity to support the system.

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poster abstracts 138 Diagnostic to therapy work up Lu Song1, Philip Kwok1, Marliese Alexander1, Peter Eu1 1 Peter MacCallum Cancer Centre, VIC Correspondence: Lu.Song@petermac.org

Somatostatin analogues such as octreotide can be readily labelled with a radioisotope to enable diagnosis and therapeutic options for patients with neuroendocrine tumours (NETs). Somatostatin receptors are often present on NETs and this should allow radiolabelled somatostatin analogues to localise at these sites providing a potentially better understanding of the disease and consequently the prognosis of the patients. Visualisation of the tumour and its sites with a labelled somatostatin analogue tracer is now part of an essential diagnostic workup for therapy options, especially for patients with inoperable or metastatsised NETs. One such therapy option is in the use of targeted radionuclide therapy in which a high dose of radiation is selectively targeted to the tumour sites. This is achieved when a tracer dose confirms that the selected carrier, in this case octreotide, selectively localises at the tumour sites. This same pharmaceutical is then labelled with a therapeutic type of radionuclide and administered to deliver a high dose of radiation to the tumour sites. Side effects associated with cancer therapies using radiolabelled peptides are not common and mostly mild with rare incidents of renal side effects such as myelodysplastic syndrome or renal failure. Renal protective agents can be used as part of the comprehensive cancer therapy regime to further reduce any potential damages to the kidneys during such therapies. This is one of the involvements of pharmacists in pharmaceutical preparations and interventions to optimise therapy outcomes while minimising untoward effect profiles.

139 How can pharmacists improve warfarin management along the continuum of care? Leanne Stafford1, Gregory Peterson1, Luke Bereznicki1, Shane Jackson1, Ella van Tienen1, Manya Angley2 1 UMORE, School of Pharmacy, University of Tasmania, TAS, 2Sansom Institute for Health, University of South Australia, SA Correspondence: leannes2@utas.edu.au

Aim: To describe the outcomes of a collaborative post-discharge warfarin management service and discuss its potential integration into practice within the Australian Pharmaceutical Advisory Council (APAC) guidelines. Methods: The post-discharge service was implemented at eight sites across Tasmania, SA and NSW. Patients discharged from hospital taking warfarin received two or three home visits by a warfarin-trained accredited pharmacist. Visits involved point-of-care INR monitoring, warfarin education and a home medicines review (HMR), in collaboration with patientsâ&#x20AC;&#x2122; GPs and community pharmacists. The incidence of warfarin-related adverse events and levels of warfarin knowledge in the intervention group were compared with those of a usual care group 8 and 90 days post-discharge. Patient satisfaction was evaluated via a postal questionnaire, qualitative interviews and focus groups. Results: Compared with usual care (n=139), the service (n=129) was associated with decreased rates of combined major and minor haemorrhagic events at day 8 (7.4% vs 0.9%, p<0.05) and day 90 (14.7% vs 5.3%, p<0.05), fewer combined haemorrhagic and thrombotic events at day 8 (8.3% vs 0.9%, p<0.05) and day 90 (19.0% vs 6.4%, p<0.05) and improved persistence with therapy (83.6% vs 95.2%, p<0.05). The service produced improved warfarin knowledge levels at day 8 (77.9% vs 64.8%, p<0.001), with a trend towards continued improvement at day 90 (p=0.07). Patient and pharmacist feedback was positive, especially regarding the convenience of the home visits and improved opportunities for warfarin education. Conclusion: This service improved health outcomes in patients taking warfarin in the high-risk post-discharge period. Hospital pharmacists could play an important role in the delivery of the service by identifying eligible patients and facilitating HMR referrals. With pharmaceutical reform promoting wider implementation of the APAC guidelines and potential changes being made to the HMR program, pharmacists practicing along the continuum of care could cooperate to reduce the risk of warfarin-related misadventure.

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poster abstracts 140 Pharmacists team up! Re-engineering hospital pharmacy to improve patient care and

better support junior pharmacists Dana Strumpman1, Joanne Rimington1 1 Prince of Wales Hospital, NSW

Correspondence: dana.strumpman@sesiahs.health.nsw.gov.au

Aim: To introduce a team approach to clinical pharmacy which would provide a more efficient and effective pharmacy service, centred on the needs of patients and providing an over-arching support structure to junior pharmacists. Background: Prior to implementation of this approach, clinical pharmacists worked individually to cover a particular ward area with minimal support and within a limited timeframe due to excessive daily commitments within the pharmacy department, including inpatient and outpatient dispensing. This meant that pharmacists were not covering all beds within the hospital on a daily basis and time spent was often fragmented which limited their clinical effectiveness. Some wards had a very limited clinical pharmacy service and the timely provision of a high quality pharmacy service could not always be met due to the number of pharmacists available. Due to pharmacists having limited ward time, problems associated with medication charts often had to be dealt with by dispensary staff rather than at ward level with minimal information regarding the patient. This meant uninformed decisions being made with undue pressure on dispensary pharmacists. Introduction of pharmacy teams: Eight clinical pharmacy teams were formed. Each team has a team leader who is a pharmacist of grade 2 level and above with extensive clinical experience in the particular clinical area. Other team members include rotational grade 1/2 pharmacists plus pharmacist interns rostered with each team on a periodic basis throughout their 12-month training program. This approach has provided an improved, more responsive, patient focused clinical pharmacy service and has increased the time spent by pharmacists participating in interdisciplinary ward activities. Rearrangement of the skill mix has enabled more experienced pharmacists to work closely with junior staff thus maximising the effectiveness of clinical activities and improving the shared learning process. A tool was developed to facilitate the mentoring process.

141 The effectiveness of a standardised Echinacea preparation in preventing colds, flu

and other respiratory disorders for air travellers Evelin Tiralongo1, Rod Lea1, Shirley Wee1, Michelle Hanna1, Lyn Griffiths1 1 Griffith University, QLD Correspondence: e.tiralongo@griffith.edu.au

Aim: This study aimed to identify whether an Australian standardised Echinacea formulation is safe and effective in the prevention of respiratory and other symptoms associated with long haul flights. Methods: We report on a randomised, double-blind placebo controlled clinical trial with 175 participants who were travelling return from Australia to America, Europe or Africa for a period of 1â&#x20AC;&#x201C;5 weeks on non-stop commercial flights via economy class. Participants were using coated Echinacea tablets (root extract, standardised to 4.42mg alkylamides) or placebo tablets, and trial dosing consisted of three protocols (priming, travel and sick), depending on the phase of travel of the participants and their health status. Outcomes were assessed using a survey which included questions about upper respiratory symptoms (based on WURSS-44), quality of life (based on SF-36) and the occurrence of additional air travel related symptoms such as sleep disturbances, headache and occurrence of cold sores. Each participant completed this survey before travel (baseline), after travel (return) and at four weeks after return from travel (follow-up). Results: With regard to respiratory illness, a significantly reduced percentage of affected participants in the Echinacea group compared to placebo was observed immediately after travel (P=0.05) and at follow-up (P=0.03). The latter difference was around 1.5 fold (i.e. 25% Echinacea vs 39% placebo). When comparing baseline and follow-up, there was no difference (P=0.35) for the Echinacea group suggesting these participants had returned to pre-travel levels in terms of respiratory health, whereas in the placebo group a higher percentage of participants were affected by respiratory illness at follow-up compared to baseline (22% vs 29%, respectively), but this was not statistically significant (P=0.21). Conclusion: This study showed that supplementation with these Echinacea tablets, if taken before, during and after travel, benefits respiratory health for travellers on long haul flights.

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poster abstracts 142 Medication management options for patent ductus arteriosus Mary Tredinnick1, Karen Hose2, Pieter Koorts2 1 Pharmacy Department, Royal Brisbane and Women’s Hospital, QLD, 2Grantley Stable Neonatal Unit, Royal Brisbane and Women’s Hospital, QLD

Aim: Review medication management options available to treat patent ductus arteriosus (PDA) when supplies of Indocid PDA run out globally. Method: To investigate if there are other manufacturers of injectable indomethacin that can supply the product. To investigate the appropriateness of the substitute medication suggested by the Indocid importer. To manage the change process relating to the medication used within the Neonatal Intensive Care Unit (NICU) for PDA management. Results: Existing management of PDA includes an early prophylactic course of treatment with indomethacin injection in extremely low birth weight neonates (less than 1000g), followed by echocardiography. If there is still a significant PDA this is followed up with a treatment course of indomethacin, either via injection or orally. The NICU currently administers approx 75 prophylactic and 35 treatment courses per annum of indomethacin. Once stock of indomethacin injections run out, no further stock is expected to be available until the end of 2010, leaving no choice but to consider other injectable medication options. The importer suggested ibuprofen injections as an option of treatment of PDA. The most recent Cochrane review of ibuprofen for treatment of PDA concludes that there is no significant difference in the effectiveness of ibuprofen and indomethacin in closing a PDA. However, ibuprofen appears to be associated with an increased risk of pulmonary complications compared to indomethacin. Additionally, the most recent Cochrane review of ibuprofen prophylaxis for the prevention of PDA concludes that due to the side effect profile of ibuprofen, and the increased risk of severe pulmonary hypertension, that there is insufficient evidence to support its use for prophylaxis. Conclusion: The NICU will need to change its practice when it exhausts its current supply of indomethacin PDA injection to include earlier diagnostic echocardiography and ibuprofen treatment of those neonates diagnosed with a significant PDA.

143 Becoming a ‘jack of all trades’ rural and remote pharmacy practitioner Vanessa Brown1, Judith Coombes1, Rhonda Tulk1 1 Queensland Health, QLD Correspondence: Rhonda_tulk@health.qld.gov.au

Aim: To pilot and evaluate a mentor scheme of site visits to new rural sole pharmacy practitioners. Background: Rural sole pharmacy practitioners work with limited support staff and many are first-year graduates lacking adequate management, advocacy and leadership skills. They are required to become a ‘jack of all trades’, capable of running a pharmacy department holistically and juggling various competing demands, whilst dealing with personal issues associated with moving to a rural location. Method: Four first-year graduates commenced employment in January 2010 as rural sole pharmacy practitioners. An experienced rural pharmacist conducted a week long site visit with each pharmacist during April 2010. The pharmacists were able to demonstrate what they were doing on site and obtain advice on how to progress issues. Queensland pharmacists utilise a General Level Framework (GLF) to assess clinical competencies. A General Level Framework Plus (GLF+) that incorporated a fourth management competency cluster was drafted, which was trialled during the site visits to identify areas for further training. Outcome measures included mentee and mentor feedback. All five participants provided written and verbal feedback, which the authors reviewed. Results: Results highlighted the mentor scheme was well accepted, the most valuable aspect being the face to face opportunity to work with an experienced rural practitioner. Participants described the experience as ‘positive, helpful, reassuring, valuable and extremely relevant.’ All indicated they would benefit from further mentor visits. Feedback on the GLF+ highlighted that changes would improve future use. Conclusion: The opportunity to support new rural sole pharmacy practitioners was professionally rewarding. As there is little management mentoring provided, it would be beneficial to further develop and formalise the mentor scheme to ease the transition into these new and challenging roles. The draft GLF+ is a useful tool, used in conjunction with the site visits.

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poster abstracts 144 Implementing medication reconciliation on discharge in a paediatric hospital Adela Vidicki-Mastilovich1, Brian Lilley1, Kay Stewart2 1 Royal Children’s Hospital, 2Monash University, VIC Correspondence: adela.vidicki@rch.org.au

Aim: To improve patient safety by implementing and evaluating the impact of a proactive discharge medication reconciliation procedure on the frequency, type and potential clinical significance of unintentional medication discrepancies (UMDs) in a paediatric hospital. Method: Up to 60% of all medication errors in hospitals occur at admission, intra-hospital transfer and discharge. A baseline audit was conducted to determine the frequency, type and potential clinical significance of UMDs occurring in a paediatric hospital with the current discharge process where the pharmacist reconciles medication against a written prescription. A discharge medication reconciliation form (DMRF) was implemented that included a pharmacist generated best possible medication discharge list (BPMDL). The new process involved a more proactive role for the pharmacist where the BPMDL served as a guide for the doctors in writing the prescription. A post-intervention audit was conducted to determine the impact of the DMRF. Two independent, senior clinicians classified the UMDs for their potential clinical significance. Results: A total of 285 patients were included in the study, 158 patients in the baseline audit and 127 patients in the post-intervention group. In the baseline audit, there was a total of 227 UMDs (1.44 per patient). In the post-intervention group there were 52 UMDs (0.41 per patient). Excluding the pharmaceutical benefit scheme (PBS) discrepancies, there were 70 discrepancies (0.44 per patient) preintervention and 16 discrepancies (0.12 per patient) post-intervention. The most common discrepancies were related to PBS, with the second most common being omissions of medications. The identified UMDs were of a lower potential clinical significance postintervention. Conclusion: Medication discrepancies occurring at discharge from a paediatric hospital are common, preventable and wide-ranging in type. The implementation of a documented and structured discharge medication reconciliation procedure with proactive pharmacist involvement has been successful in reducing the frequency and potential clinical significance of UMDs.

145 Eculizumab—a novel therapeutic approach for atypical haemolytic uraemic syndrome Adela Vidicki-Mastilovich1 1 Royal Children’s Hospital

Correspondence: adela.vidicki@rch.org.au

Objective: To report a case of an 18-month-old boy with plasma therapy resistant aHUS who responded to therapy with eculizumab, a humanised anti-C5 monoclonal antibody. Clinical features: Atypical haemolytic uraemic syndrome (aHUS) is the rare form of haemolytic uraemic syndrome (HUS) associated with poor outcomes, and a relapsing or progressive course. The development of aHUS has been linked to an uncontrolled activation of the alternative pathway of the complement system that involves the C5 molecule. The patient presented at 7 months of age with acute renal failure, haemolytic anaemia, thrombocytopenia, and hypertension. He had no history of preceding diarrhoeal illness and an infectious cause was not found. Peritoneal dialysis was initiated but was complicated by several episodes of bacterial peritonitis. The patient failed to respond to intensive plasma exchange, fresh frozen plasma infusions and plasmapheresis. A decision was made to trial therapy with eculizumab, a humanised anti-C5 monoclonal antibody. Intervention and outcomes: This patient was treated with an initial eculizumab dose of 600mg followed by weekly doses of 300mg. Eculizumab is not registered in Australia and was procured by the pharmacist ensuring adequate documentation and approval. The doses were made in the pharmacy sterile unit following investigation on its stability and concentration requirements. Eculizumab therapy was well tolerated. Following six weekly eculizumab doses the serum creatinine was on a sustained downward trend and had improved significantly by the tenth dose. Lactate dehydrogenase and haematological parameters improved significantly over this time. This patient’s response to eculizumab was significant but slower than that reported in previous case reports. Conclusion: This case report highlights the potential benefits and good tolerability of eculizumab therapy in the management of aHUS, and the important role of the pharmacist. The use of eculizumab as a therapeutic approach for aHUS warrants further investigation in clinical trials.

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poster abstracts 146 The Medication Error Minimisation Scheme (Mems) in an Australian tertiary intensive

care unit Susan Welch1, Jeff Breeding1, Fay Burrows1, Hergen Buscher1, Carmen Frost1, Susan Whittam1, Nicola Matthews1, Alison Wong1, Jane MacGauley1, Khai Shin Wong1 1 St Vincentâ&#x20AC;&#x2122;s Hospital, NSW Correspondence: swelch@stvincents.com.au

Aim: To foster a culture of safety that supports and encourages all intensive care unit (ICU) clinicians to prescribe, check and administer all drugs thoroughly and correctly. Methods: A multidisciplinary project within the ICU involving nurses, pharmacists and doctors was undertaken (2009/2010). The team met monthly to discuss, plan and implement the development of the project and to report back to members on related activities. Specific goals were to:

x x x x x

increase reported medication incidents by 50% by November 2009 reduce auditable medication errors related to incorrect rate, incorrect compatibility and incorrect labelling by January 2010 reduce errors of documentation of omitted medications by 50% by January 2010 complete baseline medication surveys of nurses and doctors to identify further areas for possible improvement by September 2009 complete follow-up medication surveys by April 2010 to review any changes which resulted from interventions made post baseline survey.

A series of audits of drug charts, intravenous prescriptions and infusions and surveys were undertaken. This was in conjunction with focused education and information sessions and provision of further staff resources. Results: Review of reported errors revealed that the level of reporting increased from approximately 2 month to approximately 6 month. An initial audit of intravenous medications revealed an 11.5% error rate related to rate of infusion, labelling and compatibility of infusions. An audit of omitted medications revealed that omitted medications were documented correctly on 66% of occasions. Follow up audits following interventions revealed a reduced intravenous-related medication error rate to 3.2% and correctly documented omitted medications improved to 78.6%. Baseline medication survey results enabled focused interventions in areas including: reporting culture, open disclosure, nasogastric administration, drug information resources and safe prescribing and administration practices. Conclusion: This multidisciplinary approach to addressing medication errors was able to achieve improvements in medication safety practices and culture within the ICU.

147 Medication errors at dischargeâ&#x20AC;&#x201D;impact of clinical pharmacist reconciliation process

at ward level Karen Whitfield1, Kenny Wong2 1 Royal Brisbane and Womenâ&#x20AC;&#x2122;s Hospital, QLD, 2University of Queensland, QLD Correspondence: karenwhitfield65@yahoo.com

To evaluate the effectiveness of medication discharge reconciliation conducted by ward pharmacists. Three surgical and one medical ward were included in the study. Data was collected over two weeks for patients discharged Monday to Friday during normal working hours. A list of patients discharged during the previous 24 hours was produced using the hospital computer system. Data was collected for discharge prescriptions seen by the ward pharmacist, prescriptions not seen by the pharmacist and patients discharged without a prescription. Medication errors together with clarifications made by the pharmacist were documented. In total 67% (n=52) of discharge prescriptions were seen and reconciled by the pharmacist prior to discharge. Of these 77% contained medication errors requiring clarification. Errors included: legal requirements (25%), dosage adjustments (60%), omitted medications (28%), medications to be restarted (60%), PBS issues (43%). Fourteen (18%) patients received a discharge prescription without seeing the pharmacist. A retrospective analysis indicated that: 50% of these prescriptions had omitted medications, 21% required a dosage adjustment, 28% contained legal issues, 21% PBS issues. None of these patients received a medication discharge summary. Twelve (15%) patients were discharged without a prescription. Of these 2 patients received no medications, 2 had newly started regular medications, 7 had new temporary medications, 2 had medications that had been ceased in hospital and 1 patient had had a dose adjustment. None of these patients received a medication discharge summary by the pharmacist. Eight of these patients would have benefited from seeing a pharmacist prior to discharge. A total of 77% of discharge prescriptions seen by the pharmacist were found to contain a medication error requiring clarification and 33% of patients were not seen by the pharmacist prior to discharge. Common errors included omitted medications from the discharge prescription including those that required to be restarted after hospital admission.

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poster abstracts 148 Development and implementation of a method to evaluate the skills of pharmacists

involved in an aminoglycoside monitoring service Jennifer Willis1, Karen Whitfield1 1 Royal Brisbane and Womenâ&#x20AC;&#x2122;s Hospital, QLD Correspondence: karenwhitfield65@yahoo.com

To develop and implement a method to evaluate the skills of pharmacists involved in an aminoglycoside monitoring service. Pharmacists were invited to attend a one-hour voluntary aminoglycoside training session conducted by a senior pharmacist. The session included an explanation of the hospital aminoglycoside guidelines and 10 worked examples spanning a range of difficulties. Pharmacists were then subsequently asked to sit a one-hour open book examination involving five scenarios covering all aspects of aminoglycoside dosage recommendations and monitoring. Questions were marked by two clinical pharmacists independently. Pharmacists were deemed competent if all questions were answered correctly. Pharmacists who were not deemed competent were provided feedback on their performance. Further training was offered if required and they were asked to sit a further examination. Pharmacists were asked to provide feedback on the process. Twenty-five pharmacists attended the initial training program, 26 pharmacists sat the examination and 17 were found to be competent achieving 5 out of 5 correct answers. Fifteen pharmacists completed the feedback questionnaire. 14/15 pharmacists agreed positively that the assessment process had been useful in helping them to understand the dosing and monitoring requirements. 11/15 pharmacists agreed positively that the process had improved their confidence to make recommendations about dosing and monitoring. 14/15 pharmacists agreed positively that they thought the process was fair and 11/15 pharmacists agreed that the process was practical as opposed to theoretical. All 15 respondents agreed positively that the process was useful and that their skills were evaluated effectively. The aminoglycoside agents were identified as a high risk group of medications. Formally evaluating pharmacistsâ&#x20AC;&#x2122; skills in making appropriate dosage recommendations and monitoring requirements provide a qualitative process to ensure appropriate and safe recommendations are made. This process could be extended to other high risk medications including anticoagulants, insulin and opioid analgesic agents.

149 Cost analysis of outsourcing parenteral cytotoxics in a major teaching hospital Mardi Wills1, Virginia Sharley1 1 Royal Adelaide Hospital, SA

Correspondence: mardi.wills@health.sa.gov.au

Introduction: The volume of parenteral cytotoxic preparations prepared in a major public tertiary hospital has steadily increased over the last 10 years. In the last financial year alone, there was an 11% increase in volume, however staffing levels have remained constant. Aim: To assess the feasibility of outsourcing the manufacturing of parenteral chemotherapy preparations. Methods: The costs associated with the in-house production of parenteral cytotoxics for the month of September 2009 were calculated. Items made for clinical trials, unavailable from the commercial supplier, other than for parenteral administration and very expensive items or with expiry dates of less than 72 hours were excluded from the analysis as these items will still be produced inhouse. The total in-house costs included cytotoxic medication, consumables, staffing and clean room garments. Other costs such as cleaning, computer costs, equipment depreciation and maintenance were not included as these costs will be ongoing. The theoretical cost of outsourcing the manufacture of the remaining items in this period was calculated based on current industry fees. An average cost per item was determined for both in-house and outsourced methods. This figure was used to estimate the annual cost for each of the methods, based on statistics for the 2009â&#x20AC;&#x201C;10 financial year. The difference in these two costs was determined. Results: The cost of outsourcing manufacturing is significantly higher than in-house production. Conclusion: A number of additional full-time equivalent pharmacists or technicians could be employed with the savings achieved by maintaining in-house production.

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poster abstracts 150 Using link analysis techniques to improve the productivity of dispensary staff Chui Yap1, Andreas Iffland2, Skip Lam1, Ben Leung1 1 Peninsula Health, VIC, 2St Georg Hospital, Eisenach, Germany Correspondence: CYap@phcn.vic.gov.au

Aim: We conducted an observational study of dispensary staff to understand how their physical movements and behaviour relate to their activities. Link analysis and lean principles were used to improve the productivity of the dispensary. Methods: An independent observer shadowed and recorded the staff activities and their physical interactions with the environment and equipment over a few days. Link analysis was used to systematically evaluate traffic patterns and communications between various workstations and individuals in the dispensary. Results: The results of the link analysis were presented to the pharmacy staff. Staff members frequently forget to obtain essential patient details (e.g. concession card numbers and allergies) when receiving prescriptions. This resulted in multiple interruptions during dispensing and trips between the workstations and the windows. A checklist of questions to ask when receipting prescriptions was placed on all dispensing windows. Staff members were also observed to make frequent trips to the store to obtain ice packs and eskies for patients transporting refrigerated items. As a result, eskies and ice packs are now available in the dispensary. Other unnecessary staff movements that were eliminated were forgetting to take a pen into the drugs of addiction vault and looking for staff members when receiving phone calls for them. Lean principles were applied to setup and tidy the dispensary bench on a daily basis. Items, including drugs and containers, were required to be stocked up during quiet times. Standard stationeries (eg staplers and scissors) were replicated at each workstation. Drug usage reports were used to review the drugs on the frequently dispensed shelves. Conclusion: Observational investigation and the use of link analysis to map the movement of dispensary staff have led to identification of inefficiencies. Staff members were happy to be involved in suggesting and implementing more productive practices and improve the physical layout.

151 A qualitative comparison of three drug information databases in Australia Melissa Yong1, Skip Lam1, Alice Lam1, Jan de Clifford1, Peter Blewitt1 1 Peninsula Health Network, VIC Correspondence: myong@phcn.vic.gov.au

Aim: To qualitatively evaluate the scope and completeness of drug information provided by the Multum drug monographs within the Cerner Millennium clinical system with standard Australian references. Method: Ten drugs from three drug references, AusDI and Australian Medicines Handbook (AMH) and the Multum database, were compared using the following categories: indication, contraindications, dose, pregnancy and lactation recommendations, and administration instructions. Each of the three references were rated for scope and completeness of information by an expert panel consisting of senior clinical pharmacists from an acute metropolitan hospital. Where there were ambiguities, additional ‘gold standard references’ including the Royal Women’s Hospital 2010 Pregnancy and Breastfeeding Medicines Guide, e-Therapeutic Guidelines Complete, and Paediatric Pharmacopeia 13th Edition, and Briggs’ Drugs in Pregnancy and Lactation were used. Scope was assessed by reviewing if the reference contained each of the above categories or not; 1 for ‘yes’ and 0 for ‘no’. Completeness was scored by ranking the references out of 3 for each category; 3 for the reference being the most complete, or closest to the supportive reference used, and 1 for the least complete, or least similar to the supportive reference. Results: Interim results from 10 drugs found that AMH ranked highest for overall completeness (130/180), while Multum was lowest (101/180). AusDI averaged highest for scope at 90% (54/60) whilst Multum had the lowest average at 65% (39/60), lacking data for 50% of drugs in three categories: contraindication, dosing and administration. Conclusion: Based upon current findings, the AMH is the most comprehensive source of drug information to support prescribers. The American database, Multum, was found to be the least comprehensive reference in this study. Our findings suggest that it requires revision in order to make its content more applicable to the Australian market. To further validate these findings, another 20 medications will be assessed.

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poster abstracts 152 Unit-based clinical pharmacy services—what do doctors think? Mazdak Zamani1, Katherine Chandler1 1 Eastern Health, VIC

Correspondence: mazdak.zamani@easternhealth.org.au

Aim: To gather doctors’ opinions on a new unit-based clinical pharmacy service recently implemented at a metropolitan hospital. Methods: The pharmacy department of a medium sized general metropolitan hospital changed from providing a traditional ward-based clinical pharmacy service to a unit based service in September 2009. A simple feedback form which included eight ten-point Likert scale questions plus a comment section was designed and distributed to all medical doctors (total of 34 interns, residents and registrars) six months following the commencement of the new service. Results: Overall feedback was very positive with over 88% of the responders recommending the unit-based clinical pharmacy service be implemented at other similar public hospitals. The majority of junior medical staff strongly agreed that the unit based clinical pharmacy service model helped them improve their drug knowledge and prescribing skills. Conclusion: A change to unit based clinical pharmacy services appears to have been well accepted by medical staff with the majority strongly agreeing that a close relationship with the clinical pharmacists facilitated the admission and discharge process and had a positive impact on patient care. Importantly, it appears junior medical staff in particular found having a unit pharmacist on the team to be a useful resource that enhanced their drug knowledge and prescribing skills.

1970s to now—changes in technicians training and roles 153 Restructure of imprest supply produced financial benefits with increased accuracy Melanie Anderson1, Jennifer O’Hara1 1 John Hunter Hospital, NSW

Correspondence: melanie.anderson@hnehealth.nsw.gov.au

Aim: To quantify financial benefits to wards and pharmacy department achieved after the introduction of vendor managed inventory (VMI) for supply of imprest and the creation of a senior imprest technician role. Method: In early 2009 there were a significant amount of errors being reported involving incorrect imprest items being supplied to the wards. A double checking process was implemented where two technicians worked together to pick and deliver alternate ward imprest. Logistics, staffing compatibility and time scheduling made this process very challenging. In November 2009 a new system of imprest supply of drugs to the wards was implemented, vendor managed inventory. This has provided an independent second check of all stock going to the ward utilising the external picking process by the wholesaler. The senior imprest technician has continued to double check all items not ordered through the VMI process and therefore still being ‘picked’ from pharmacy stock. Multiple errors were corrected by the senior imprest technician, which resulted in the correct drugs being taken to the wards. Result: A review of the periodic stock takes has indicated the errors have dramatically reduced since VMI was introduced. May 2009 had $10 570.62 in variance of value for stock that was charged incorrectly. May 2010 only had $431.54 in variance of stock value. Stock on hand has reduced by $200 000 with further reduction possible. Out of 887 previously stocked products in imprest store we now hold 223. The reduced number of items stocked in the imprest store as a result of the VMI ordering process has been a key factor in the reduced number of picking errors by the technicians. Conclusion: Reducing errors and increasing accuracy is a vital aspect of imprest supply. The huge savings due to the stock being correctly accounted for is financially beneficial for the pharmacy department and the wards.

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poster abstracts 154 Adverse event/allergy documentation—a small step to utilising pharmacy technicians Sophie Arthur1, James Radford1, Cal Winckel1, Krishna Shah1, Elina Christopher1, Samantha Lawrence1 1 Ipswich Hospital Pharmacy, QLD

Background: Current data suggests that documentation of patient allergies and adverse drug reactions into dispensing software by pharmacists occurs for less than one-third of patients on admission. Pharmacist-identified barriers to data input include time, failing to remember and limited access to computers. Aim: To assess the feasibility of, and provide the basic skills necessary for a dedicated pharmacy technician to undertake allergy and adverse drug reaction interviews, and complete the appropriate documentation for new inpatients. Method: A pharmacy technician was provided with basic skills training to both interview patients and to accurately document the appropriate information. The technician collected patient information regarding previous adverse and allergic reactions and ensured complete documentation on the inpatient medication chart and in iPharmacy. A senior pharmacist verified accuracy of the technician’s work. Results: A total of 57 new inpatients were assessed by the pharmacy technician over the study period, including 18 (32%) patients with identified allergies/ADRs. The technician spent an average of 30 minutes each day assessing patients and entering information in the relevant charts or systems. Conclusion: Providing a dedicated pharmacy technician to document patient allergies and adverse drug reactions ensured that all inpatients captured by the project had important information entered into the dispensing system, compared to the 33% input rate by pharmacists. This project investigates the possible extended roles that pharmacy support staff may play in the future of pharmacy practice.

155 Improving the uptake of influenza vaccination in high risk elderly patients—a

pharmacy technician’s role Sarah Chao1, Lisa Hansen1 1 Peninsula Health, VIC

Aim: To implement and assess the impact of an active early identification system by a pharmacy technician in improving the uptake rate of influenza vaccination in high risk inpatients in a 60-bed geriatric evaluation and assessment centre. Method: Patients who have not been vaccinated prior to admission were identified by the pharmacy technician during the routine weekly medication drawer checks. Patients who have not been prescribed influenza vaccine on medication chart were identified and their current influenza vaccination status determined by interviewing the patient or a family member or carer. The patient’s local general practitioner was contacted if the patient or carer was unable to give an accurate history. Pharmacy technician forwarded names of unvaccinated patients who have given consent to influenza vaccination to the treating doctor for further evaluation and prescribing of vaccine. As with the previous year, doctors were also encouraged to identify suitable patients for vaccination during their admission interview with the patient. Results: As of 21 June 2010, there has been a 78% increase in the number of inpatients receiving influenza vaccination during inpatient stay (from 23 in 2009 to 41 in 2010). The final results will be reported in November. Conclusion: The active early identification system for influenza vaccination by the pharmacy technician has resulted in a significant improvement in the number of high risk patients vaccinated against influenza. The project has highlighted the active role and contribution that hospital pharmacy technicians can have in improving patient care when working together with doctors and pharmacists. Doctors appreciated the pharmacy technician’s input in confirming patient’s vaccination status with local GPs as this allowed more time for doctors to continue with other clinical duties.

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poster abstracts 156 How many trees can we save? Sabine Heymann1, Cathy Larsen1 1 Southern Health, VIC

Correspondence: sabine.heymann@southernhealth.org.au

Aim: To reduce the amount of waste produced by the pharmacy department through recycling and the implementation of waste minimising practices. Background: Our pharmacy department had minimal services or procedures in place to recycle and minimise waste. Consequently a large volume of paper and recyclable material was inappropriately discarded and not recycled. Our hospital offers recycling services to departments including bins for paper, plastic, glass and cardboard, however these services were not utilised to their full extent by the pharmacy department. Method: Areas where improvements could be made were identified and practical solutions found. These are outlined below:

x x x x

waste generation stock requisitions: staff encouraged to only print a stock requisition where a paper trail is necessary (e.g. controlled drugs) faxes: the fax machine was re-programmed to not print individual paper confirmations after each fax recycling: recycling bins were placed throughout the department and the staff educated to raise awareness and prevent the inappropriate disposal of recyclable material. A person was allocated to monitor the recycling process. To gauge the effectiveness of the recycling project the amount of paper recycled was weighed before being placed in the recycling bin.

Results: Over four weeks the weight of paper recycled by the pharmacy department was 32.5 kg. This is equivalent to 75% of one tree being recycled. Over a year this would equate to nine trees being recycled. Conclusion: After the initial introduction there was a noticeable shift in the amount of paper being wasted in favour of that being recycled. The pharmacy department currently recycles the equivalent of nine trees per year. We hope to improve upon this figure in the future with the aim of recycling at least one tree per month.

157 Coming alive â&#x20AC;Ś and staying alive Michelle Suhr1, Janette Hodgson1, Kellie Saunders1 1 Toowoomba Health Services, QLD

Our role as pharmacy assistant/technician has developed greatly over the last 30 years at Toowoomba Health Service Hospital. The pharmacy began with just one assistant whose main responsibilities were very limited. The pharmacy assistant/technician role has evolved to be a specialised member of the pharmacy team. Throughout the years more educated and more experienced staff have become a necessity to cope with the ongoing demands of an expanding hospital. We needed to expand staff numbers when PBS was implemented early in 2005 and we now have 10 assistants/technicians. Reduced patient length of stay has resulted in faster turnover of stock of both imprest and individually dispensed medications (original supply and resupply.) The assistant/technician processes MAPs (medication action plan) and produces the DMR (discharge medication record), for final check by the pharmacist, at discharge. Our role has developed in response to changing technology and implementation of the APAC guidelines. We have risen to the challenge by embracing the study of Hospital/Health Services Pharmacy Assistant Support Certificates III and IV through Charles Sturt University. The desire for assistants/technicians to branch out into more challenging roles has resulted in a more efficient service provided by pharmacy. Toowoomba Hospital pharmacy is developing the role of the pharmacy assistant/technician to be a highly respected position. At Toowoomba Hospital pharmacy we believe our pharmacy assistants/technicians are more of an asset than ever before.

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poster abstracts 158 Oops! I nearly did it againâ&#x20AC;&#x201D;near-miss dispensing error reporting Joanne Kelly1, Natalie Bula1 1 Pharmacy Department, The Canberra Hospital, ACT Correspondence: joanne.kelly@act.gov.au

Aim: To implement a near-miss error reporting system for hospital pharmacy technicians and to identify a focus for future quality improvement initiatives. Methods: Firstly we designed a dispensing error reporting form which was based on an old form no longer in use, forms from other hospitals, relevant SHPA conference proceedings, and current literature. Next the form was completed by either the checking pharmacist or dispensing technician over a three-week period of data collection. Dispensing technicians worked individually to complete the entire dispensing process and only errors detected prior to leaving the pharmacy were reported. Finally we analysed the data and compared our findings to data available in the literature. Results: From the three-week reporting period 22 forms were completed by 11 different dispensing technicians. Our near miss error rate was 22 in 11 427 total items dispensed (0.19%). References from the UK and Australia suggest a dispensing error occurrence of 0.02â&#x20AC;&#x201C;0.8%. Consensus within the United States of America suggests that an error rate upper limit of 2% can be tolerated within pharmacy dispensaries. The most frequently reported errors were: incorrect strength dispensed, incorrect directions on the label, omission of a drug to be dispensed, and selecting the wrong drug from the shelf. The most common causes were perceived by respondents to be: interruption, neglecting the self check process, and inexperience/unfamiliarity; however ten forms did not specify a cause. Conclusion: We successfully developed a near-miss dispensing error form. The data we collected showed our dispensing error rate and cause/s are within and consistent with the international dispensing error occurrences. A major limitation of this study was that it relied partly on self reporting. From the key errors and cause/s our study identified, a safer dispensing process was developed and implemented.

159 Urinary incontinence in a heart failure population Jane La1 1 Princess Alexandra Hospital, QLD

Correspondence: jane_la@health.qld.gov.au

Urinary incontinence is a common problem affecting 3.8 million Australians. Risk factors include age, heart disease (including heart failure), certain medications, obstructive sleep apnoea, and constipation. Patients with congestive heart failure (CHF) have a number of these risk factors. There is limited research regarding the prevalence of urinary incontinence in the heart failure population, however, there is some evidence attributing urinary incontinence to causation for poor medication adherence. Objective/aim: To identify the prevalence of urinary incontinence in a heart failure population. To identify any correlations between urinary incontinence and the effect on patient quality of life, diuretic doses, or medication compliance. Methods: Surveys were posted out to 190 people, which included demographic questions, and validated tools such as, RUIS survey, IIQ-SF7 scale questions, and MARs questionnaire. They were used to assess incontinence, quality of life, and medication compliance, respectively. The data was collated into SPSS and non-parametric data analyses were performed. Results: Overall prevalence of incontinence was 50% (n=44) from a total of 88 surveys. Risk factors associated with incontinence showed no significant difference between subjects with incontinence or without incontinence (p>0.05). However, increasing age was correlated with higher prevalence of incontinence. The severity of incontinence correlated with a poorer quality of life from the IIQ scale (p<0.001). Results also showed that frusemide doses correlated with incontinence (p<0.05), which also affected compliance, as shown by the correlation between diuretic medication and medication compliance using the MARS questionnaire (p=0.023). Conclusion: Approximately half of the CHF population sampled experiences urinary incontinence, although, there were nil significant differences in the presence of urinary incontinence between the subjects with or without risk factors. Patients with a poorer quality of life tended to adjust their medications, particularly frusemide doses. This study suggests that a greater focus on education and better management of urinary incontinence in a CHF population would positively impact on patient quality of life and management of medications important for CHF.

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poster abstracts 160 Vendor managed inventory within a major teaching hospital Kate Lilleyman1, Anthony Byers1, Michelle Jeffery1, Kylea Lane1, Jenny Crane1 1 Royal North Shore Hospital, NSW Correspondence: klilleyman@nsccahs.health.nsw.gov.au

Aim: Drug distribution has a major impact on scarce pharmacy technician resources. In addition, the quantity of stock held by pharmacy to supply imprest requirements can be large and take up valuable space in often cramped pharmacy departments, as well as tying up a lot of money in inventory. An alternative way of managing imprest was evaluated in order to increase efficiency and allow technicians to be utilised in other roles. Method: A project was undertaken, with an external consulting firm, to evaluate a vendor managed inventory (VMI) service within a large teaching hospital. The process involved pharmacy staff checking ward imprests and generating orders which were transferred electronically to the supplier. Each imprest order was then packed separately by the supplier and delivered to the pharmacy for delivery to the ward. Six wards were chosen to participate in the trial. Two suppliers offering this service were trialled, both managing imprest supply for three wards. Ward imprest lists and stock holdings were reviewed, in consultation with nursing staff. Specific reports were developed by the consulting firm to allow drug usage to be evaluated and recommendations for stock levels made. All imprest orders were checked for accuracy on delivery from the suppliers. Results: Results were analysed after a 12-week period. Nursing staff did not report any issues with VMI. Both suppliers achieved high levels of accuracy and reliability (>95%), however the packing processes of one supplier were preferred. It was decided to implement VMI across the hospital using this supplier. Conclusion: As at June 2010 VMI has been implemented in 52% of total imprest volume. Work practices have been changed to accommodate set deadlines and delivery times for orders. As VMI increases, more responsibility for imprest will be transferred to pharmacy stores staff, allowing technicians to be redeployed elsewhere.

161 Medication storage on wards: whoâ&#x20AC;&#x2122;s looking? Noman Masood5, Jayshree Tosar2, Claire West2, Mark MacIsaac1 1 Northern Beaches Health Service, NSW Correspondence: nmasood@nsccahs.health.nsw.gov.au

Aim: To review security and storage conditions of medications on wards across two Northern Beaches Hospitals. Methods: This across-site review was carried out in consultation with the nursing administration to identify shortcomings in two key areas of security and environment of medication storage as identified by NSW Department of Health circular 2007_77 as well as manufacturersâ&#x20AC;&#x2122; recommendations and local policy. 12 specific security criterion and 9 storage criterion were identified and developed into an audit tool. Wards had to pass each criterion in order to achieve an overall pass. Audit was carried out using the ward pharmacy technician service. After a baseline phase, identified issues were formally forwarded to nursing administration. After an education phase, a follow up audit was then carried out to assess the effect of this intervention on practice and control of physical conditions. Results: A total of 14 wards were audited during this study. None of them passed all of twelve security criterion in the first phase. There were 52 recorded failures of security (range 2â&#x20AC;&#x201C;7). The most common security failure was unlocked and open drug room doors (n=14). Similarly, in the storage audit, none of the wards complied with all criterions and had an overall failure rate of 6.5 per ward (n=85). Results were significantly different across but not inter-specialty with across-site ED, ICU, Medical and Surgical wards scoring similar results. In the post intervention phase significant changes in proportion were observed but none of the wards were able to fully comply. Most wards reported a move towards overcoming infrastructural limitations. A number of nursing work practices were modified in order to comply with standards. Conclusion: Storage of medications on the ward is an important issue that can potentially have patient and workforce implications and pharmacy technicians can guide nursing staff towards adopting optimal practice.

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poster abstracts 162 Prescribing linezolid instead of vancomycin for severe MRSA infection Ian Mawbey1 1 Dubbo Base Hospital, NSW

Correspondence: ian.mawbey@gwahs.health.nsw.gov.au

Aim: To evaluate the appropriateness of prescribing linezolid instead of vancomycin for the treatment of severe MRSA infection. Methods: Data was collected both prospectively and retrospectively from patients prescribed linezolid at Dubbo Base Hospital. Data was collected for 25 patients using a specifically designed data collection form. The collected data was intended to determine adherence to the hospital criteria for linezolid prescribing including indications, process and outcome indicators. The original form was piloted on two patients then modified. Costs due to inappropriate use were estimated by determining the difference in daily acquisition costs between the comparative medications. Results: Five of the patients (20%) had documented evidence of MRSA and four of these (16%) met the criteria through severe renal impairment or failed vancomycin treatment. Apart from reinforcing local policy, academic detailing both individually and in groups would be recommended for professional staff to improve education. Provision of written information including having the criteria readily accessible such as posters and reminder cards would be included. The acquisition cost of linezolid was much higher than vancomycin however the monitoring cost for vancomycin was not included. The reduction in the length of stay for one antibiotic over the other could not be determined and would impact significantly on costs. Conclusion: The results from the evaluation indicate a benchmark that can be improved upon with the appropriate interventions. The issue investigated is only one part of a broader approach to improve antibiotic stewardship throughout the hospital. The inappropriate use of antibiotics will otherwise continue to contribute to emerging antibiotic resistance and the escalation of costs in providing therapy in a health system with limited resources.

163 Recording of pharmacist-initiated interventions in the dispensary and clinical settings Vaishali Padhye1, Olimpia Nigro1, Karen Macolino1, Susan Elborough1, Christopher Doecke1 1 Royal Adelaide Hospital, SA

Aim: To investigate the recording of pharmacist-initiated interventions in both the dispensary and ward setting; specifically to scope the extent to which they are made; why and how they are made, their nature and whether they are formally recorded. Method: During a two-week study period any pharmacist-initiated interventions made for inpatients of the haematology unit were collected. Dispensary pharmacists were asked to self-report interventions and any interventions made by the unitâ&#x20AC;&#x2122;s clinical pharmacist were documented by the principle investigator. Results: A total of 66 interventions were made during the two-week study period for 35 patients; 9 (13.6%) initiated by dispensary pharmacists and 57 (86.4%) by the clinical pharmacist. Overall, only 22 (33.3%) interventions were recorded. All interventions made by dispensary pharmacists were documented on the faxed medication chart, while 66.7% (6/9) were recorded using the pharmacy computer dispensing program. A total of 22.8% (13/57) of interventions made by the clinical pharmacist were recorded; majority of which were documented in the medical record (11/13). All clinical pharmacist interventions, including those documented, were communicated verbally to medical staff. Most interventions were made while the pharmacist was reviewing inpatient medication management (34/57), with others resulting during discharge medication reconciliation or ward rounds. The nature of the interventions made by the clinical pharmacist mostly included input into dosages (17/57) and involved optimising therapy (13/57); including recommending alternate therapies to avoid potential drug interactions. The main intervention made by dispensary pharmacists involved confirming therapy for restricted antibiotics according to hospital protocols (5/9). Conclusion: The majority of interventions made by clinical pharmacists are not formally recorded, as verbal communication at the point of intervention is the main method employed. Dispensary pharmacists always record interventions informally on the faxed medication chart, with formal recording in the pharmacy dispensing program occurring in many instances.

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poster abstracts 164 A drug use evaluation of heparin induced thrombocytopenia Sally Porter1 1 Queensland Health, QLD

Aim: To identify patients who have had heparin induced thrombocytopenia (HIT) or heparin induced thrombocytopenia thrombosis (HITT) at a tertiary facility between May 2005 and June 2009 and determine if platelet monitoring, monitoring of alternative anticoagulants efficacy, and treatment of HIT/HITT occurred appropriately. The results of this review were then compared to a similar review conducted in 2006. Methods: A retrospective medical records case audit was conducted on all patients identified as having HIT or HITT with a positive heparin associated antibodies test (DiaMed Heparin/PF4 antibody test or Stago Elisa test). Results: There were 29 patients identified for inclusion in this review period. Twelve patients received danaparoid as treatment of HIT, 8 lepirudin, 3 bivalirudin and 1 patient was managed with dabigatran. Monitoring of treatment was appropriate in all cases according to the consensus guidelines. There were 11 cases with thromboembolic complications associated with HIT (5 DVTs, 2 PEs, 1 stroke, 1 ischaemic gut, 1 arterial thrombosis. There were seven deaths (23%), three of which were associated with HIT or the treatment of HIT which is a lower rate than previously stated in the literature. Conclusion: HIT continues to be a significant adverse drug event though its frequency remains low when considering the wide spread use of heparin for prevention and treatment of thrombosis. The rates of occurrence over the past four years at this facility have increased from that of the previous five years. Dabigatran is a new therapy which may have place in the management of HIT however there remains little evidence for its.

165 Competency-based assessment and training in the procurement of pharmaceuticals

for pharmacy technicians Arti Thakerar1, Dharamjit Singh1, Dorothy Grima1, James Mellor1 1 Peter MacCallum Cancer Centre, VIC Correspondence: arti.thakerar@petermac.org

Background: Pharmacy technicians are trained in various roles including procurement. This presents opportunities and challenges for personal development of technicians in the pharmaceutical supply chain. The cost effective and timely availability of medications is a critical aspect of service provision in the hospital pharmacy setting. Efficient work-flow in both the dispensary and wards require consistent delivery of the right products, in the right quantity, to the right place, at the right time and at the lowest total cost. Pharmacy procurement includes a number of different activities. The core tasks include: ordering, receiving, credit returns, invoicing, backorder and product substitution tracking, maintaining minimum/maximum levels, and communicating stock problems. Aim: To plan and implement procurement competency based training and assessment standards for pharmacy technicians in procurement in a hospital pharmacy. Method: A literature review was undertaken to identify recognised standards. The pharmacy management procedure manual was studied as a guide to service provision and standards of practice to ensure consistent quality throughout the supply chain processes. An inventory model presentation was updated to improve understanding of the job dimension and insights of the role. This presentation was then used as a training method for two pharmacy technicians. This training was followed up by an observation checklist which was developed to provide guidelines on expectations of the training program. Results: Two pharmacy technicians successfully completed the competency assessment. Both technicians were deemed competent in managing and maintaining a robust procurement process. Conclusion: Technicians have developed a better understanding of work requirements and gained confidence to tasks in the area of pharmacy recruitment.

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poster abstracts 166 2010: a NSW pharmacy technician workforce survey Becky Walsh1 1 Prince of Wales Hospital Pharmacy Department, NSW Correspondence: becky.walsh@sesiahs.health.nsw.gov.au

In 2010, a survey was conducted to evaluate the pharmacy technician workforce in NSW public hospitals. The survey aimed to gain insight into the distribution of technician award classifications, education and certification, and gather important information on the changing workplace and the challenges encountered by pharmacy departments in maintaining and developing their technician workforce. The survey was sent to19 directors of pharmacy via email and requested figures on technician full-time equivalent (FTE) establishments, vacancies, ‘part-time’ technicians, classification and qualifications. A response was received from 25 sites. The results were compared to a similar survey conducted in 2007 to identify and evaluate any variations. The 2010 results revealed a greater portion of the technician workforce have achieved certification than those that remain unqualified. The survey indicated a majority of sites employ assistants/technicians on a ‘part-time’ basis and overall a greater number are employed as technicians than assistants. Most are employed as pharmacy technicians grade 2 and the fewest employed as grade 4 pharmacy technicians. This is consistent with the 2007 survey. Several sites indicated difficulties with re-grading technicians following certification impeding career progression and competing pressures for pharmacist and technician resources may limit the time pharmacy departments can dedicate to technician education. The recent survey results highlight the importance of on-going commitment to technician training and certification in NSW public hospital pharmacies. The indication that levels of qualified technicians exceed unqualified technicians may be attributed to availability of funding through government incentives and individual hospitals to encourage technicians to achieve certification. The results also indicate a change in the way technicians are employed and function in the workplace given the number employed on a ‘part-time’ basis. The small number of grade 4 technicians is of concern and may be symptomatic of under-utilisation of technicians in a management capacity or insufficient technicians with additional managerial qualifications to support these positions.

167 Multi-drug resistant tuberculosis in pregnancy Jenny Willis1 1 Royal Brisbane and Women’s Hospital, QLD

Background: Australia has one of the lowest rates of tuberculosis in the world. However, proximity to Torres Strait and Papua New Guinea (PNG) presents a challenge. Tuberculosis is one of the three leading infectious diseases causing death in PNG. The occurrence of multidrug-resistant tuberculosis (MDRTB) adds to the difficulty of TB control in this region. Isoniazid and rifampicin remain the few drugs available for treatment that are highly effective but MDRTB is resistant to these agents. Treating MDRTB presents a problem in terms of availability of suitable agents, logistics of medication administration and delivery to remote regions. Compared with first line drugs, second line agents are considered less effective and more toxic. Treating MDRTB during pregnancy is difficult and published safety and efficacy data is scarce. Case: A 34-year-old lady PNG national (HIV negative), 30 weeks pregnant was transferred from a local PNG hospital to a North Queensland hospital with suspected miliary tuberculosis. Isoniazid, rifampicin, ethambutol and pyrazinamide were commenced empirically. Subsequent Mycobacterium tuberculosis culture and sensitivity tests revealed MDRTB. Therapy was modified to isoniazid, ethambutol, pyrizinamide, moxifloxacin, capreomycin and para-amino salicylic acid, taking into consideration effective therapeutic combination and potential side-effects to the foetus. She was transferred to a tertiary hospital until delivery. The baby was commenced on isoniazid and pyridoxine following delivery. Pharmacists are key players in the treatment of TB by sourcing non-marketed medications, optimising therapy, promoting adherence, providing information about drug therapy and monitoring for adverse effects and drug interactions. Discussion: Although Australia has low rates of tuberculosis we must be able to respond with appropriate treatment as need arises. There are a number of documented cases of MDRTB in pregnancy but no standard guidelines. This case demonstrates a positive outcome for mother and child using second-line agents.

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poster abstracts Other 168 Discharge Management of Acute Coronary Syndrome project Amela Korajkic1, Angela Given1, Steven Ivulich1, Anthony Dart2, Stephen Duffy2, Harvey Newnham3, Karen Sanders2, Margaret Way4, Robyn Wright4, C Kam1, Michael Dooley1,5 1 Pharmacy Department, Alfred Health, VIC, 2Cardiovascular Medicine, Alfred Health, VIC, 3General Medicine, Alfred Health, VIC, 4Clinical Governance Unit, Alfred Health, VIC, 5Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, VIC Correspondence: a.korajkic@alfred.org.au

Background: The Discharge Management of Acute Coronary Syndrome (DMACS) project is a national multi-centre quality improvement initiative funded by the National Prescribing Service (NPS) and facilitated by therapeutic advisory/QUM groups in each state. The Alfred was one of 50 health services that participated in this national project. Aim: To improve the management of acute coronary syndromes (ACS) at the point of discharge based on the Australian National Heart Foundation (NHF) and Cardiac Society of Australia and New Zealand (CSANZ) Guidelines. Method: This was a pre- and post-intervention study. The methodology involved an education intervention by clinical pharmacists trained in academic detailing to a range of medical, nursing and pharmacy staff, data collection pre- and post-intervention and feedback of audit results to clinical staff. The patient medical record was audited following discharge for the prescription of guideline recommended ACS medications, evidence of lifestyle modification education and an ACS management plan. Patients’ general practitioners (GP) were surveyed 14 days post discharge regarding communication of the ACS plan. Patients were then followed up 90 days post discharge for changes to medication therapy and lifestyle modification. Results: A total of 90 patients were recruited (50 baseline, 40 follow-up) from the general medical and cardiac units at The Alfred. Overall there was a 36% improvement (p=0.002) in the prescription of ACS medications, specifically angiotensin-converting enzyme (ACE) inhibitor or angiotensin II-receptor blocker (ARB) (54% baseline, 78% follow-up, p=0.04) and beta blockers (60% baseline, 82% follow-up, p=0.021); improved communication regarding medications and ACS management plan to the GP (although not statistically significant); improved patient adherence with all ACS medications at 90 days (35% baseline, 64% follow-up, p=0.03) and advice to attend cardiac rehabilitation (75% pre, 96% post, p=0.018). Conclusion: These results suggest that one-on-one and small group education sessions were helpful in improving the prescription of ACS medications, advice on lifestyle modification and communication with GPs.

169 Reconciliation of changes to handwritten discharge prescriptions and those

generated using an electronic medication management system Diana Bui1, Katrina Richardson1, Elizabeth Glasson1, Susan Welch1 1 St Vincent’s Hospital, NSW Correspondence: dbui@stvincents.com.au

Background: Literature has shown that 12–20% of discharge prescriptions have an error. Recent work demonstrated that 17% of items on electronically generated discharge prescriptions had a change made to them, 77% of which were not reconciled in electronic medication management systems (eMMS). Despite these data, there is a belief that computer-generated discharge prescriptions are without error. When patients represent to hospital their previous discharge prescriptions are used to inform medication histories on arrival. If these are not correct this leads to errors in medication histories and/or medications charted. Aim: To determine the level of changes made on discharge prescriptions (handwritten and electronic Medication Management System) that are reconciled in the finalised version in the medical record and/or eMMS. Methods: A retrospective study of all discharge prescriptions received in pharmacy over a one-week period (2009) was conducted. Prescriptions with changes made were identified, and the number and type of changes recorded which included: changes in frequency, drug, dose, form, duration and any additions and deletions made to the prescription. A cross-check of these prescriptions with the finalised version in the medical record and/or eMMS was performed to determine the level of reconciliation. Results: 161 discharge prescriptions (94 handwritten, 67 eMMS) containing 1058 items were reviewed. 10.6% (112/1058) of items had changes made (58 handwritten, 54 eMMS). 89% (100/112) were not reconciled in the finalised version in the medical record (46/58 items) and/or eMMS (54/54 items). Frequency of administration, addition of items and dosage changes were identified as the most common changes. Conclusion: The degree of errors and level of reconciliation identified in this study concur with previous investigations and indicate a need for medical education to improve practice. These results suggest improvements in reconciliation of changes to discharge prescriptions could be made by implementing a pharmacist-enabled editing function in an eMMS.

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poster abstracts 170 Putting risk into perspectiveâ&#x20AC;&#x201D;how many medications do we administer in a year? Wendy Ewing1, Lisa Ciabotti1 1 Southern Health Pharmacy Department, VIC

Correspondence: wendy.ewing@southernhealth.org.au

Aim: To estimate the number of medications administered in a year at a major metropolitan hospital in an attempt to provide context to clinical risk management of medication administration errors. Method: A prospective audit was conducted across wards and clinical areas at all sites over a five day period in February 2009. Medication and intravenous infusion charts, for a random selection of patients, were analysed to determine the number of medications prescribed and subsequent number of administrations in the previous 24-hour period. The average number of administrations per patient on a particular ward was established, and then extrapolated by multiplying by the number of ward beds. Where data was unable to be collected, the average from a ward with a similar patient group was used for the extrapolation. For the emergency departments (ED), extrapolation was calculated by using the average number of presentations. For the chemotherapy day units (CDU), the average number of chemotherapy products and pre-medications administered per day was used. The 24-hour data was further extrapolated by multiplying by 365 to obtain an annual estimate. Medications administered in operating theatres, recovery wards, delivery suite, nurseries attached to maternity wards, dialysis units, outpatient clinics, diagnostic imaging, cardiac catheter laboratories and Medihotel were not included in the audit. Results: The extrapolations reveal over 6 494 000 medication administrations occurs each year across all sites: 5 579 755 in inpatient wards, 842 785 in EDs and 71 905 in chemotherapy day units. Conclusion: It is estimated that almost 18 000 administrations occur each day and over 6 494 000 occur per year across the organisation. Whilst this highlights the importance of continual review and improvement of this task it also puts into perspective the relatively low number of reported medication administration errors in relation to the total number of administrations.

171 Amiodarone and carbimazole: severe adverse effects limiting treatment options Catherine George1 1 The Royal Melbourne Hospital, VIC

Objective: To report a case of amiodarone induced thyrotoxicosis requiring total thyroidectomy, following the development of neutropenia while taking carbimazole. Clinical features: A 66-year-old male presented with conscious ventricular tachycardia (VT) and automatic implantable cardiac defibrillator (AICD) activation. History included ischaemic cardiomyopathy, coronary artery bypass graft surgery (CABG), atrial fibrillation, amiodarone induced thyrotoxicosis (AIT), type 2 diabetes, chronic renal impairment, gout, hypertension, and dyslipidaemia. Admission medications were carbimazole, metoprolol CR, mexiletine, warfarin, aspirin, atorvastatin, fenofibrate, candesartan/hydrochlorothiazide, chlorthalidone, allopurinol, and omeprazole. The patient had a history of recurrent VT which responded to amiodarone, and a secondary prevention AICD was inserted. AIT first occurred in 2004 after six months of treatment, leading to cessation of the drug. Despite this, a significant amount of amiodarone was administered (following CABG) in 2009, again causing thyrotoxicosis. VT was subsequently managed with mexiletine and metoprolol CR, and carbimazole was commenced in February 2010. Upon re-presentation with VT in May, paramedics administered bolus amiodarone. Biochemistry showed persistent thyrotoxicosis. Bloods on admission also revealed significant neutropenia, likely due to carbimazole. The patient became febrile, and blood cultures confirmed E.Coli and Streptococcal bacteraemia. Thyrotoxicosis, and/or sepsis, were thought to have triggered VT storm. Interventions, case progress and outcome: Carbimazole was ceased immediately. VT was managed with procainamide and sotalol. A thyroid scan showed minimal iodine uptake, suggesting receptor blockade by amiodarone, therefore radioactive iodine ablation was precluded and thyroidectomy deemed necessary. Filgrastim was administered until neutropenia resolved, and meropenem used to treat bacteraemia. Successful thyroidectomy allowed recommencement of amiodarone, and thyroxine was commenced. Conclusion: This case highlights the significance of two well-documented adverse effects, and the need for close monitoring. The use of amiodarone for life threatening VT in this patient, needed to be balanced against its significant toxicity and ultimate need for thyroidectomy to enable its ongoing use.

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poster abstracts 172 A case of desvenlafaxine induced extrapyramidal side effects Angela Given1, Louise Grannell1, Harvey Newnham2 1 Alfred Health, VIC, 2General Medicine, Alfred Health, VIC Correspondence: a.given@alfred.org.au

Introduction: Desvenlafaxine is a serotonin and noradrenaline reuptake inhibitor antidepressant, PBS listed in 2009, and is the active metabolite of venlafaxine. We report a case of extrapyramidal side effects (EPSE) associated with desvenlafaxine. Case report: A 56-year-old male with a long history of schizophrenia was transferred from a private psychiatric facility where he was being treated for depression/anxiety. He presented with a 3–4 day history of increasing stiffness of his upper limbs, head, neck. The lower limbs were affected to a lesser extent. He was unable to swallow and had difficulty speaking as he could not move his mouth. He exhibited generalised weakness and an unsteady, shuffling gait. Recent changes to his medications included the crossover from sertraline to desvenlafaxine, and the subsequent dose increase of desvenlafaxine. Desvenlafaxine was ceased and benztropine was effective in treating symptoms. The Advisory Committee on the Safety of Medicine (ASCOM) have had at least 20 reports of adverse EPSE with venlafaxine, and the UK MHRA Adverse Drug Reaction Drug Analysis Prints have about 150 reports of a variety of dyskinesias and movement disorders caused by venlafaxine. As the active metabolite of venlafaxine, desvenlafaxine induced EPSE is the most probable cause in this case, however there is only one similar report recorded by ASCOM. An interaction between desvenlafaxine and risperidone was considered through a desvenlafaxine inhibitory effect on CYP-2D6, however this was considered unlikely as the patient was previously on sertraline, a known 2D6 inhibitor, and did not exhibit any EPSE. Conclusion: Although rarely reported, this case illustrates that desvenlafaxine can cause extrapyramidal side effects.

173 The individual patient usage database—a tool for tracking, reporting and managing

non formulary, off-label and high-cost medication use Gillian Campbell1, Terry Melocco1, Vinh Bui1, Karim Ibrahim1 1 St Vincent’s Hospital, NSW Correspondence: kibrahim@stvincents.com.au

Introduction: A key activity of Drug and Therapeutics Committees (DTC) is to review requests for medications for individual patient usage (IPU). These are most often requests to use non-formulary drugs, off-label indications, or high cost drugs. Aim: To describe the use of an IPU database. Method: An Excel® database is used to report, monitor and track IPUs considered by the DTC. Each month an IPU report is presented to the DTC. The report lists medications considered, doses, indications and approximate costs. DTC members often provide further advice regarding submissions. Trends highlighted can lead to DUE projects or formulation of new hospital guidelines/policies. Monthly reports are also provided to key clinicians/managers to monitor usage and expenditure, e.g. monthly rituximab usage for lung transplant rejection, or darbepoetin for anaemia secondary to ribavirin use. When presented with unusual applications the database is used as a resource tool and also is used to follow up individual patients who may have been given a three-month approval with further treatment requiring a clinical update. Results: In 2009 325 IPU requests for 81 different medications were reviewed. 13 requests were not approved. Formulary applications have since been received for 3 medications/indications; botulinum toxin in rehabilitation, parecoxib by acute pain service and hepatitis A vaccine. Streamlined application processes have been created for 7 regularly requested medications: rituximab for treatment of lung transplant rejection, antibiotic infusors, levosimendan for heart failure and sildenafil/bosentan/ambrisentan/sitaxentan for pulmonary hypertension. Most commonly received requests were for antibiotic infusor bottles (n=82) and rituximab (n=45) making up 39% of all requests. The database is a valuable tool for analysis and recording of medication use and is an asset in the process of formulary review and maintenance.

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poster abstracts ®

174 The wonderful world of Botox : an evaluation on the use of botulinum toxin type A Mona Kiani1, Charlotte Sant Portanier1, Robert Clement James1 1 Hollywood Private Hospital Pharmacy, WA Correspondence: kianimona@gmail.com

Aim: An evaluation of the clinical indications and therapeutic doses of Botulinum toxin type A (Botox®) in adult clinical practice was undertaken and compared against current medical literature. Methods: Patients dispensed Botox® over a one-year period were identified. The patient hospital records were reviewed and information including age, sex, weight, allergies, indication, site of administration, dose administered, readmission for subsequent doses (where applicable), adverse effects, prescribing doctor and specialty were recorded. All data was collated and entered into a Microsoft Excel® spreadsheet for analysis. Results: A total of 140 vials were dispensed within the study period of which 79 (56%) were for in-hospital non-cosmetic use of 33 patients (17 males and 16 females). All of these patients were included in the evaluation. The four major therapeutic indications for Botox® identified were: treatment of chronic anal fissures (n=11; 33%), achalasia (n=3; 9%), cerebral palsy (n=8; 24%) and overactive bladder (n=10; 30%). Dosing for Botox® was found to be largely dependant on the condition that was being treated as well as the anatomical site of administration and therapeutic benefit from previous dosing. Efficacy was not always recorded in patient notes however 8 patients were re-admitted for a second treatment and 1 patient for a third treatment. No adverse effects were documented. Conclusion: Although Botox® is commonly known for its cosmetic applications it is widely used for its ability to manage conditions associated with over active muscular or glandular tissues. The doses of Botox® administered within this setting correlated with current literature even though evidence may be inconsistent, inconclusive and/or lacking due to the small population of the published trials.

175 Automated creation of a comprehensive consumer medication chart from

iPharmacy™ Skip Lam1, Peter Blewitt1, Ben Leung1, Jan deClifford1 1 Peninsula Health, VIC Correspondence: slam@phcn.vic.gov.au

Aim: To create an application that can generate a comprehensive medication chart (CMC) with patient friendly drug information without additional workload. Methods: In 2006, our outreach pharmacist was manually generating a CMC using an EXCEL™ template with product images, tablet or capsule markings, indications, administration instructions, common side effects and other relevant information. This is because the iPharmacy™ medication chart only has product names, dosage instructions and administration times. This was a time consuming process and subjected to possible data entry errors. Our project was to automate the process by linking iPharmacy dispensing data with our patient friendly drug information. Data from the EXCEL™ template was transferred to an ACCESS™ database. Information created in the database was automatically updated each night to a new iPharmacy™ drug table. The table currently contains 1 616 medications. A Crystal™ report was written to combine the information from the dispensing tables and the drug table including product images to produce an individualised CMC. Results: Since mid 2006, we have generated over 11 000 charts. Anecdotal feedback has indicated that consumers do appreciate the CMCs. The Victorian Patient Satisfaction Monitor is an ongoing patient satisfaction survey to assist hospitals in identifying strategies that can improve services and patient satisfaction. It has specific questions regarding medicines and our results have improved slightly. Explanation of medicines Surveys conducted (Sep 08 – Feb 09 and Jun 09 to Dec 09) AFTER introduction of CMC Surveys conducted (Mar 05 – Aug 05 and Sep 05 to Feb 06) BEFORE introduction of CMC Improvements

87% 85.5% 1.8%

Explanation of medicine side effects 77.5% 75% 3.3%

Explanation of medicines needed post-hospital 89% 85.5% 4.1%

Conclusion: The new application has enabled the generation of a comprehensive medication chart without additional workload. Consumers has benefited from the scope and depth of information provided.

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poster abstracts 176 When mouth ulcers turn nasty—a case for infliximab in Behçets disease Beverley Lamb1, Angela Stathopoulos1, Shannon Ferguson1 1 The Royal Victorian Eye and Ear Hospital, VIC Correspondence: Beverly.Lamb@eyeandear.org.au

Objective: To report a case of Behçets disease managed with infliximab. Clinical features: A previously well 23-year-old Caucasian female (JC) was referred with a three-month history of blurred vision (R 6/60, L 6/18) and bilateral panuveitis, which developed two weeks post partum. JC also had a two-year history of recurrent painful oral and genital ulcers attributed to stress—treated unsuccessfully with valaciclovir and Bonjela®. On examination, JC had erythematous nodosum on her left leg and right ankle, painful genital ulcers, body sweats and vitritis. Investigations showed FBE/UEC/LFT screens as normal with CRP <1, ESR 25, Vasculitic screen showed-ANA/ANCA/Rh factor negative, CCP Abs negative (<16). JC had a normal chest X-ray, was syphilis, Hep B and HIV negative, and quantiferon negative. Behçets disease was confirmed after the patient was found to be HLA B51 positive. Interventions and case progress: The patient was commenced on oral prednisolone and homatropine and steroid eye drops in December 2008. In March 2009, JC had orbital floor and intravitreal steroid injections; mycophenolate was commenced and ceased (due to non compliance) and cyclosporin added. Through April to September 2009, JC had multiple presentations with reduced vision, arthritis and oral ulcers during which cyclosporin and prednisolone doses were increased, and colchicine added. Azathioprine was added (and ceased again due to non compliance) in November 2009. In February 2010, due to significant worsening of vision, a decision was made to add a course of five infliximab doses. Outcome: JC has responded well to treatment with infliximab after four doses. Her eyes have remained stable apart from increased intraocular pressure, and she has no mouth ulcers, genital ulcers or rash. She has been able to reduce doses of both prednisolone and cyclosporin. Conclusion: This case provides support for the ‘off label’ use of infliximab in Behçets disease.

177 Exploring the benefits of the information contained in a local adverse drug reaction

database Ian Larmour1, Kerryn Barned1 1 Southern Health, VIC

Correspondence: ian.larmour@southernhealth.org.au

Aim: To examine options for the increased utilisation of information contained in a local adverse drug reaction (ADR) database to gain an insight into medication safety and to assist the development of future education strategies. Method: The ADR Review Subcommittee selected a number of high risk and frequently prescribed medications for review. The electronic ADR database, containing over 12 years of reports, was used to examine the types of ADRs reported. Although the database is routinely used, it was felt that this rich source of information could also be utilised in other ways. Various reports were prepared and analysed. Results: The analysis of the ADR report data uncovered a number of interesting observations. For instance, of the 60 reports for NSAIDs and the 47 reports for COX2 inhibitors, the percentage of reports for gastrointestinal bleeding were similar in both groups. However the number of hypersensitivity reactions were higher for NSAIDs. Of the 52 cases involving HMG Co-A reductase inhibitor drugs, 37% of reports involved myopathy, myalgia or rhabdomyolysis, but nearly as many (31%) involved cholestatic jaundice or elevated LFTs. For amiodarone (44 reports), half of the reports involved hyperthyroidism or thyrotoxicosis, but only 4.5% of reports related to hypothyroidism. Lung complications accounted for 12% of reports. Furthermore 18% of reports involved a drug interaction. This and other data has provided valuable insights into the characterisation of ADRs to enable a more targeted education program to be developed. Such information harvesting may become increasingly important when ADR data can be linked with e-prescribing data. Conclusion: The valuable information obtained from the review of the ADR database enabled a more targeted approach to ADR education.

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poster abstracts 178 The Beetle challenge Shu Lay1, Catherine Richards1, Harvey Lander1, Charles Lawrie1, Rosalyn Ferguson1, Sam Crawford1, Leonie Hillard1 1 Hornsby Ku-Ring-Gai Hospital, NSW

Aim: To encourage the nurses in the emergency department (ED) to: Be accurate and Efficient Every time you remove Tablets Liquids Everything from the MedStation which will help to ensure stock levels are correct and medication safety is observed. Method: With the support of the ED Nursing Unit Manager, the ‘Beetle’ challenge started in March 2010. Training is provided to nursing staff to promote accurate use of the Pyxis MedStation in terms of removal of required individual doses, correcting stock balances, and not leaving excess medication outside of the MedStation. A poster is also displayed near the MedStation outlining the challenge. Inventory transaction slips are printed for any inventory function performed. During the challenge the slips are collected and at the end of the day, five slips are randomly chosen. The details on these five slips are verified as correct and valid and then the nurses are rewarded with chocolates. General observation and random audits from Pyxis reporter detect any suspicious results. At the end of the two-week period, a lucky winner is drawn from all the transaction slips collected and a grand prize is awarded. Results: At one stage, the number of medications left outside of the MedStation reached 43. This reduced to zero during the challenge and the trend has been maintained. The number of unexpected ‘physical’ stock outs has also been reduced to zero ensuring that medication is available when needed and is restocked when required. Conclusion: This challenge has engaged nursing staff to correct a practice that was becoming a serious medication safety issue and a stock balance nightmare. With education and a reward mechanism a problem has been solved while also satisfying nurses’ requests to be involved in a quality activity that improves, rewards and maintains good work practices.

179 The emergency department challenge—Five chaRting Events Doctors Do Omit Shu Lay1, Catherine Richards1, Charles Lawrie1, Harvey Lander1, Judith Muller1, Stacey Poole1 1 Hornsby Ku-Ring-Gai Hospital, NSW

Aim: To improve five basic charting principles highlighted as deficient in the 2009 NIMC (National Inpatient Medication Chart) audit. The five charting principles requiring attention were: insufficient Patient identification (ID) insufficient alleRgy status sIgnature unidentifiable unclear ‘frequenZy’ and incomplete S Eight PRN orders. Method: A two-week program of education and rewards was introduced and repeated in each intern rotation. Education sessions reinforce the correct charting principles and are conducted at handover rounds and/or individually. During the challenge period, prescribers who adhere to the correct practices are rewarded with a chocolate. A leader board and a frog stamp are used to track the number of chocolates received by the prescribers. A major prize is awarded at the end of the two-week period to the prescriber with the most stamps. The winner is announced and displayed on the doctor’s notice board for two weeks. An additional element was introduced in 2010 to further encourage the use of the Medication History Form (MHF) by prescribers. A second ‘stamp’ is awarded to those prescribers who not only fulfil the five basic charting principles but who also complete the MHF. Results: The original and subsequent challenges have been well received by prescribers. A follow-up mini audit conducted in March 2010 revealed improvement in 4/5 principles e.g. clear frequency and directions improved from 36% to 88% and correct patient ID improved from 53% to 84%. Completion rate of the MHF increased to 75% during the challenge period and remains high at 69% during non-challenge times. Conclusion: A combination of education and rewards has proved successful in changing behaviour and encouraging good charting principles. This fun challenge has achieved positive outcomes whilst also concentrating on medication safety issues and has become a routine education tool for emergency department prescribers.

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poster abstracts 180 The use of carglumic acid in treating acute hyperammonaemia crisis in a 2-year-old

with propionic acidaemia Yuet Han (Joyce) Liew1, Carolyn Ellaway2 1 Department of Pharmacy, The Children’s Hospital at Westmead, NSW, 2Department of Biochemical Genetics, The Children’s Hospital at Westmead, NSW Correspondence: joyceL1@chw.edu.au

Objective: To investigate the use of carglumic acid in the treatment of acute hyperammonaemia in a 2-year-old with propionic acidaemia. Clinical features: The first child of consanguineous Bengali parents presented in the neonatal period with encephalopathy, seizures, hyperammonaemia and metabolic acidosis. Urinary organic acid and plasma acylcarnitine analyses showed metabolites consistent with the diagnosis of propionic acidemia. By 2 years of age, she had profound global developmental delay, seizures, microcephaly and required gastrostomy feeds. She had numerous presentations with metabolic decompensation with an increased frequency in the last six months. Interventions, case progress and outcome: At times of hyperammonaemia, she was treated with maximal doses of intravenous sodium benzoate and arginine. In addition, she was protein restricted and had intravenous glucose and lipid 20% to prevent protein catabolism. However, in the last six months, she presented on several occasions with severe metabolic encephalopathy and hyperammonaemia that did not respond to the usual treatments. Oral carglumic acid was considered a treatment option to reduce ammonia quickly without requiring haemofiltration. On four separate admissions, a single dose of carglumic acid, 1000mg (80mg/kg) was successful in reducing the ammonia within 24 hours. Unfortunately, she died as a consequence of persistent encephalopathy and respiratory insufficiency after a decision to allow a natural death. Conclusion: This case highlights the successful use of carglumic acid in the treatment of acute hyperammonaemia secondary to propionic acidaemia.

181 An audit of ondansetron use in a tertiary paediatric hospital Yuet Han (Joyce) Liew1 1 The Children’s Hospital at Westmead, NSW Correspondence: joyceL1@chw.edu.au

Aim: To evaluate the use of ondansetron in the in-patient setting over 10 days and compare its use with the approved Drug and Therapeutics Committee (DTC) guidelines. Methods: A prospective study was conducted over 10 days using medication chart review and dispensing report of all in-patients. Exclusion criteria were patients in intensive care and those whose stay exceeded 30 days. Use of ondansetron was considered ‘compliant’ by measure of the approved indications determined by the DTC: if there is a contraindication or failure to metoclopramide, for the treatment of chemotherapy-induced (CINV) or radiotherapy-induced nausea and vomiting (RINV), for the treatment of PONV and for anything outside its approved indication, pain team consult was required. No distinction was given to the use of ondansetron for nausea, retching or vomiting. The data was analysed per ‘indication use of ondansetron’. Results: Demographic data showed a skewed distribution. Patients were between the ages of 3 months to 17 years old. There were 86 compliant indications and 24 non-compliant indications. Non-compliance was reported highest in the nausea and vomiting (N/V) group (23/26). Compliance to DTC guidelines was satisfactory for CINV/RINV and PONV groups. Thirteen out of 23 non-compliant indications were prescribed by ED physicians. Most were ‘stat’ orders and ‘prn’ orders with the patient receiving an average of two doses. This is unlikely to contribute to the high monthly expenditure $12 000/month of ondansetron despite a reduction in cost due to expiration of patent of Zofran®. Other paediatric hospitals with similar restrictions have also indicated that ondansetron has been used outside of its restrictions similar to our hospital. Conclusion: There is approximately 78% compliance in the use of ondansetron across the hospital. A comprehensive guideline on the use of anti-emetics for the non-PONV and non-CINV patients and education would improve compliance of ondansetron use.

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poster abstracts 182 An assessment of the use of ciprofloxacin at Mount Gambier Hospital Liz Mampallil1, Catherine Hughes1 1 Mount Gambier and Districts Health Service, SA Correspondence: liz.mampallil@health.sa.gov.au

Aim: To identify why there is a variation with ciprofloxacin use at MGH when compared to other SA hospitals and to analyse if ciprofloxacin use was appropriate as per MGDHS policies. Furthermore, the audit aims to identify the resources that prescribers utilise for selection of antibiotics in the rural setting in the absence of an infectious disease team and a restricted clinical pharmacy service. Methods:

x x x x x x

dispensing records for ciprofloxacin were obtained through Ascribe over dates 01/01/2009 till 01/01/2010 patient’s Medical Record Number (MRN) was used to access medical records to identify the indication for antibiotic therapy data was collected using a data collection tool OASIS was used to establish presence of a culture tests and sensitivity to ciprofloxacin prior to it being prescribed prescribing was compared against MGDHS ciprofloxacin policies a medical officer (MO) survey will be conducted after the audit to assess MO understanding of MGDHS antibiotic restrictions, and to assess what resources doctors access prior to the selection of antibiotic therapy.

Results: 52 patients included in audit had either intravenous or oral ciprofloxacin prescribed during their hospital admission. 27% of these had ciprofloxacin prescribed more than once in that same year. 70% of the patients had cultures taken, and out of this 71% of the cultures had tested positive to a variety of bacteria. 51% of the bacteria species were sensitive to ciprofloxacin. Prior to prescribing ciprofloxacin, doctors had obtained infectious disease approval, or had consulted a specialist in infectious disease, or consultant in the ward in 19% of the cases. Overall, ciprofloxacin was prescribed for appropriate indications in 36% of the cases. Conclusion: Ciprofloxacin wasn’t prescribed as per MGDHS antibiotic restrictions policies in 64% of the cases reviewed in this audit. An education campaign will be developed to ensure judicious selection of antibiotics by prescribers.

183 Drug-induced Sweet’s syndrome due to Trimethoprim/Sulfamethoxazole Amy McRae1, Michelle SY Goh2,3 1 Pharmacy Department, Alfred Health. Vic, 2Dermatology Dept, Alfred Health. Vic, 3Cancer Centre, Peter MacCallum Cancer Institute. Vic Correspondence: amy.mcrae@alfred.org.au

Objective: To report a case of drug-induced Sweet’s syndrome caused by Trimethoprim/Sulfamethoxazole. Clinical features: CD, a 37-year-old Caucasian female with a background history of asthma, bronchiectasis and IgG subclass 2 hypoglobulinaemia, was admitted to hospital with flu-like symptoms, a fever (38.5°C) and a three-day history of a rash. She had been prescribed Trimethoprim/Sulfamethoxazole by her GP ten days prior for infective exacerbation of bronchiectasis. One week after commencement of Trimethoprim/Sulfamethoxazole, she developed small papules on the chest that progressed into painful, burning, itchy pseudovesicular erythematous plaques, affecting the torso, limbs and face with mucosal involvement. Interventions, case progress and outcome: On admission, drug-induced Sweet’s syndrome was suspected and Trimethoprim/Sulfamethoxazole was ceased. Skin biopsy showed diffuse dermal neutrophillic infiltrate and moderate dermal oedema, consistent with Sweet’s syndrome. Peripheral blood showed normal neutrophil count (4.72x10^9/L, normal 1.9–8.0). The C-reactive protein was markedly elevated (399 mg/l, normal < 5). Blood cultures were negative and skin swabs were negative for viral PCR and bacterial culture. She was commenced on prednisolone (0.7mg/kg/24hrly). She had empirical intravenous aciclovir until the Herpes simplex virus PCR returned negative. For symptom relief at mucosal sites, she had Hypromellose eye drops, an almond oil nasal spray and a sodium bicarbonate/benzydamine mouthwash. Cetirizine, paracetamol and oxycodone were prescribed to relieve the itch, pain and burning that is typical of Sweet’s syndrome. She had salbutamol and nebulised normal saline for mild exacerbation of bronchiectasis. The fever and skin lesions significantly improved within 48 hours, she was discharged four days later with a seven-day tapering prednisolone regimen. Conclusion: This case highlights the importance of early recognition of drug-induced Sweet’s syndrome. There was rapid recovery after cessation of the causative drug, Trimethoprim/Sulfamethoxazole. As shown in previous case reports, Trimethoprim/Sulfamethoxazole is a known trigger of this uncommon condition.

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poster abstracts 184 Rivaroxaban and enoxaparin for venous thromboembolism prophylaxis Jemma McWiggan1 1 Hollywood Hospital Pharmacy, WA

Aim: To evaluate the use and adverse effects of rivaroxaban compared to enoxaparin in venous thromboembolism (VTE) prophylaxis in elective hip and knee replacements in a private hospital. Method: A retrospective audit of patients who received VTE prophylaxis following a total hip replacement (THR) or total knee replacement (TKR) over a six-month period was carried out. Patient notes were reviewed for time of treatment initiation following wound closure, time between the epidural removal and dose administration, duration of treatment, adverse events experienced, missed doses and early cessation of treatment (if applicable). Data was analysed and patients matched to a control group of patients prescribed enoxaparin. Results: Seventy-one (71) patients were eligible for the rivaroxaban group (n=53 TKR, n=18 THR) and 73 patients for the control (n=57 TKR, n=16 THR). More patients in the rivaroxaban group had doses withheld (15.2% vs 12.4%) however rivaroxaban was ceased in fewer patients (9.7% vs 16.4%). The majority of patients in both groups were not commenced at the recommended time post wound closure (86% rivaroxaban vs 82.2% enoxaparin). Fewer patients in the rivaroxaban group continued treatment for the recommended duration (21.1% vs 47.9%). Seven (7) patients from each treatment group experienced a documented adverse event which resulted in cessation of treatment. No patients in the rivaroxaban group developed a VTE compared to five (5) patients in the enoxaparin group. Only half the patients in both groups had epidurals removed at recommended times (48.4% rivaroxaban vs 50% enoxaparin). Conclusion: Discrepancies between recommendations in guidelines and prescribing constraints resulted in rivaroxaban not being used for the recommended duration. Rivaroxaban had a similar adverse event profile and a lower incidence of VTE prophylaxis failure compared to enoxaparin.

185 An evaluation of parents/carers’ skills in managing fever and cough and cold in

children Rebekah Moles1, Ruchi Bakshi1, Bandana Saini1, Kylie Williams1, Jared Brown2, Natalie Tasker2, Elsa Hietbrink1 1 University of Sydney, NSW, 2The Children’s Hospital Westmead, NSW Correspondence: rebekah.moles@sydney.edu.au

Children’s fever and cough and cold medicines are commonly used over-the-counter medicines. International studies however have highlighted that there may be issues of inappropriate use and dosing errors. Objective: To profile caregiver management of fever and cough and cold in children under five. Methods: Caregivers (parents and staff) were recruited from day-care centres in Sydney. Their skills were observed and actions recorded based on fever and cough and cold scenarios. Results: 97 caregivers were recruited with 131 observations of dose measurements. In the fever scenario, 45% of caregivers gave medicine without taking a temperature, or when the temperature was below 38°C. Alarmingly, only 14% of caregivers managed the scenario appropriately, (i.e. gave medicine at the correct time, stated and measured a correct does, and stated an appropriate dosing interval). In the cold and flu scenario, 46% of caregivers chose to medicate. Interestingly paracetamol was used often (54% of the medicines chosen), despite no pain or fever present. Those that chose not to medicate were recorded as handling the scenario appropriately (54%). During all dosing scenarios, 48% of caregivers stated a correct dose for their child based on weight. 66% of caregivers were able to accurately measure the dose they intended, however this only equated to 34% of the doses being appropriately calculated and subsequently measured accurately. Discussion: The ability of caregivers to accurately measure and administer doses is vital. The risk of dose error is increased in children’s medicines as the doses are often small and inappropriate dosing devices are commonly used. Determining the motivations to use these medicines as well as dosing behaviours is necessary to establish adequate interventions to prevent harm and improve the quality use of medicines in children.

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poster abstracts 186 Evaluation of the effectiveness of an intravenous heparin infusion order form for acute

coronary syndromes Thao Nguyen1, Sally Marotti1 1 Queen Elizabeth Hospital, SA

Aim: To evaluate the effectiveness of a heparin infusion order form using a weight-based heparin nomogram in achieving APTT within the target range for patients with acute coronary syndromes (ACS). Background: In May 2010 a new intravenous heparin infusion order form was implemented to guide prescribing using a weight-based heparin nomogram. Although no changes were made to previous dosage recommendations, this study was designed to evaluate compliance with the nomogram, and achievement of treatment goals. Methods: The baseline audit was undertaken in 2001 over a three-month period, and the post implementation audit from 19 May to 26 June. Cardiology patients were identified prospectively with an APTT >50 seconds from laboratory data. Patients diagnosed with ACS receiving heparin therapy were then chart reviewed retrospectively. A total of 84 patients were included in the baseline audit and 46 patients in the follow-up audit. Results: Patients using the intravenous heparin infusion order form took longer to achieve an APPT within the target with a median time of 15.5h in the follow up audit compared with 8.75h in the baseline audit. At 6h and at 24h, 27% and 74% respectively had an APTT within the target range in the follow-up audit, compared to 51% and 72% in the baseline audit. Compliance with the form was inadequate, with some patients not receiving the recommended bolus dose of heparin, or APTT levels at the recommended 6h post commencement of heparin. Conclusion: The current study demonstrates deficiencies with compliance that reinforces a need to provide education when implementing new initiatives. This is reflected in the longer time it took to achieve APTT levels within the target range.

187 Storage of refrigerated medicines in clinical areas Rosemarie Oblimar1 1 The Canberra Hospital, ACT

Aim: To asses the current storage conditions of refrigerated medicines in clinical areas of our institution. Methods: SHPA Standards of Practice for the Distribution of Medicines in Australian Hospitals makes recommendations regarding the storage of medications outside of the pharmacy department. Anecdotal reports at our institution suggest that current conditions for storage of refrigerated medicines in clinical areas are suboptimal. Current storage conditions in each of the different clinical areas (wards and clinics) were audited by pharmacy technical staff. Audit criteria included size, age, condition and current content of the refrigerators, presence of data loggers and space available for increasing refrigerator size. Results: 27 fridges in 33 clinical areas were audited. The majority of the refrigerators were small bar size fridges (66%). 44% were old and/or damaged but most appeared in good, clean condition. Almost 60% of the fridges audited contained items other than imprest items such as food or juice and only 37% contained data loggers to monitor temperature ranges. Only 38% of the clinical areas had available space to accommodate a large fridge if required. Conclusion: Maintaining pharmaceuticals at their recommended storage conditions is essential for medication safety. The results of this audit suggest that storage conditions in some clinical areas did not meet the SHPA standards, predominantly due to poor condition, non-medication storage and/or lack of monitoring. Further analysis using data loggers to indicate temperature range in all refrigerators may be beneficial. Results of this audit will be used to improve and standardise storage conditions of refrigerated medicines in our institution, and education of nursing staff on the standards of practice for refrigerated medication storage will be required.

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poster abstracts 188 Pyxis in the ‘superclinic’ setting with no pharmacy on site—does it work? Sonia Shen1, Andrew Cording1 1 Eastern Health, VIC

Correspondence: sonia.shen@easternhealth.org.au

Aims: To determine the useability and staff acceptance of an automated medication system (Pyxis Medstation 3500 system) in the operating suite and day chemotherapy centre of a newly built ‘superclinic’ where no onsite pharmacy exists. Methods: A survey was given to all users of the automated medication system, including anaesthetists and nursing staff, to gain feedback about the Pyxis Medstation 3500 system. Data collected specifically related to the overall useability and staff acceptance of the system in the context of a superclinic environment where no onsite pharmacy exists. Results: Surveys were completed with the all users finding the system easy to use. Generally, the feedback was very positive about the implementation of the automated medication system in the facility. Most feedback agreed that pharmacy support was sufficient and required. However, it was noted that all day chemotherapy staff would prefer an onsite pharmacy, whereas all the day surgery staff were satisfied with having the automated medication system on site. Conclusion: In the setting of a superclinic without a pharmacy on site, the Pyxis Medstation 3500 system has been demonstrated to be usable for its intended purpose and is well accepted by nursing and anaesthetic staff. It is also noted that feedback supports the notion that an automated medication system augments, rather than replaces, pharmacy services and the need for pharmacy services are still seen as an integral component of health care delivery in the superclinic setting.

189 Recombinant activated factor VII: a high cost lifesaving drug—is it used

appropriately? Sarah Thomas1, Liane Ward-Panckhurst1, Kathryn Sturgiss1 1 The Canberra Hospital, ACT

Aim: To review the use of recombinant activated factor VII (RAFVII) in a tertiary referral hospital; specifically assessing indication, dose and prescribing trends compared to the current hospital protocol. Method: A retrospective review of medical records for patients treated with RAFVII during March 2008 – March 2010 was undertaken. A data collection tool was used to standardise information based on usage patterns, patient specific identifiers, indication for use, dose given and prescribing trends. Results: Twenty-six patients were reviewed in this study over the investigative period. All of the subjects were treated with RAFVII as a result of massive refractory haemorrhage, after the appropriate transfusion of blood products had occurred. However the specific indication for use and patient co-morbidities varied considerably in our subject group. Of the patients investigated 31% of patients were cardiothoracic patients, 23% were general surgery patients, 12% were obstetric patients and 8% were gastroenterology patients. The dosing of RAFVII in this study showed considerable variation; a single dose of RAFVII was given in 81% of patients and 19% of patients were administered two doses. Additionally 54% of patients were administered the guideline dose of 90mcg/kg as per protocol, with 27% of patients being administered a dose either above or below the guideline. Documented haematology involvement in the authorisation of RAFVII use was adhered to as per protocol in 65% of patients. Conclusion: This study of 26 patients identified that aspects of the protocol on the use of RAFVII in massive refractory haemorrhage were being followed. This study highlighted the broad potential indications for use of this potentially life saving yet high cost drug. Further education and consideration of the protocol criteria needs to occur to ensure the appropriate use of RAFVII in the future.

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poster abstracts 190 An audit of Pentavite and iron use in the neonatal setting Rita Wardan1, Molika In1, Catherine Timpano1, Christina Vytilingam1 1 Royal Womens Hospital Correspondence: rita.wardan@thewomens.org.au

Aims: To audit use of Pentavite® and iron supplement prescribing in the neonatal setting and assess concordance with the current practice guideline as well as latest evidence. Method: This audit was carried out prospectively over a one-week period in January 2010. Patient’s information collected from medical record, inpatient medicine chart and pathology results for all newborns admitted to the neonatal unit. Hospitals with neonatal services within Australia were contacted to find out their current practices and a literature search was completed to determine latest evidence. Results: Fifty-three newborns admitted during the audit period. All were either less than 32 weeks gestation, weigh less than 2kg at birth or born to vitamin D deficient mothers, nine were excluded from data analysis. Pentavite® was prescribed at 5 to 7 days post commencement of enteral feeds for 40% (18/45) of occasions. However another trend was found, Pentavite® was only prescribed on or after the day when full enteral feeds was reached in 95.5% (43/45) of occasions. Iron supplement was prescribed as per guideline criteria (n=29 at time of study), but only 62% (18/29) of babies were prescribed the iron supplement at day 28 to 29 of life. At the time of iron initiation, eight babies with haemoglobin level less than 100g/L were prescribed iron supplement twice a day. All other babies’ haemoglobin level was above 100g/L and were prescribed daily dose, as per protocol. A table was complied reflecting current prescribing guidelines across Australia and were found to be quite diverse for both Pentavite® and iron. Conclusion: The neonatal guideline for Pentavite® needs to be reviewed to reflect the current practice in the neonatal unit and perhaps supplementation is not necessary for babies who are formula or fortified breastmilk fed. Iron supplement prescribing practice is in-line with the current recommended guideline.

191 Vitamin A formulation in paediatrics Rita Wardan1, Molika In1 1 Royal Womens Hospital

Correspondence: rita.wardan@thewomens.org.au

Background: A baby admitted to the neonatal unit with cholestasis required vitamin A therapy. There is no commercial product of vitamin A liquid. The leading local children’s hospital recommended piercing vitamin A capsules and drawing out the liquid. Due to OHS reasons this process was completed in pharmacy but as we withdrew the liquid from each capsule we noticed there was a big discrepancy in volume between capsules. Aim: To assess the accuracy of Blackmore’s vitamin A capsule content. Methods: Research was conducted to find out whether vitamin A liquid preparation existed in any form. Major hospitals were contacted to research their method of vitamin A administration in their paediatric population. Blackmore’s Vitamin A, 5000 international unit per capsules, is the current available product. Blackmore’s pharmaceutical was contacted to ascertain the volume or density of the vitamin A capsule but as this is a listed, not registered product, this information is unknown. To determine the volume of vitamin A per capsule, we tested 20 Blackmore’s Vitamin A capsules. The following information was collected: initial weight (g) of the capsule, final weight (g) of the capsule after removal of vitamin A liquid, weight of volume aspirated (g) as well as volume aspirated (ml). Results: The volume in each 5000IU vitamin A capsule varies between 0.21ml and 0.32ml with an average of 0.27ml. Conclusion: The current practice using Blackmore’s vitamin A capsule does not deliver the anticipated dose. There are some new combination products that contain liquid vitamin A i.e. vitamin A and E as well as vitamin A, D and E solutions. As most paediatric patients with cholestasis also require the above mentioned vitamins, these combination products may be useful but the ratios may not be appropriate, as was the situation with our newborn.

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poster abstracts 192 Rivaroxaban HITs the spot Katrina Warwicker1, Tandy-Sue Copeland1 1 Fremantle Hospital, TAS Correspondence: k.warwicker@gmail.com

Objective: To report the use of rivaroxaban in a patient with a history of heparin induced thrombocytopenia (HIT) after exposure to enoxaparin. Clinical features: Mr SC, a morbidly obese, 46-year-old Caucasian male was admitted with overt liver failure in 2007. Enoxaparin 150mg twice daily was initiated for treatment of a deep venous thromboembolism (DVT). His platelet count decreased from 194x109U/L on admission to 4x109U/L in a period of 23 days. Simultaneously, the patient developed a nose bleed and haematomas formed on all limbs. The HIT screen was negative but given the clinical picture, the consultant diagnosis was HIT. His platelet function returned to normal after ceasing enoxaparin. Given his past response, a non-heparin alternative was required for venous thromboembolism (VTE) prophylaxis during his hip replacement surgery this year. Intervention: The pharmacist was consulted to identify a possible alternative to heparin. Danaparoid and dabigatran are both indicated for VTE prophylaxis in hip surgery but supply issues rendered them unavailable. Literature suggests that fondaparinux can also cause HIT. Rivaroxaban was deemed the most appropriate choice as it is indicated for VTE prophylaxis in hip surgery, requires no invasive monitoring and is administered orally, thus aiding early discharge and home therapy. Rivaroxaban 10mg daily was initiated for 35 days post surgery. Case progress: During treatment with rivaroxaban his platelets remained within the normal range (150–400x109U/L). He did not experience symptoms of thrombosis or thrombocytopenia. Outcome: Mr SC received effective prophylaxis for his surgery and did not experience any adverse drug related effects. Conclusion: Rivaroxaban is a potentially useful drug for VTE prophylaxis in patients previously experiencing HITS. There is no published data detailing its use in HIT patients. This report supports the role of rivaroxaban in VTE prophylaxis in patients with a history of HIT.

193 Educating medical students in drug use evaluation methods Gillian Campbell1, Ric Day2, Susie Welch3 1 Pharmacy Department, St Vincent’s Hospital, NSW, 2Therapeutics Centre, St Vincent’s Hospital, NSW, 3St Vincent’s Hospital, NSW Correspondence: swelch@stvincents.com.au

Aim: To use drug use evaluation (DUE) methodologies to teach medical students to display an understanding of the key components of ‘quality use of medicines’ and to understand their role in ensuring this in practice. Methods: Medical students undertaking a 12-week rotation within the clinical pharmacology department spend time with the DUE pharmacist to learn about quality use of medicines. This includes learning about the functions of the drug committee, management and implementation of decisions made, and audit of compliance. Each student is required to carry out a DUE activity and present the results back to the clinical pharmacology team and the DUE pharmacist. A number of DUE tools are used to put quality use of medicines into a practical teaching opportunity. Results: Students have undertaken audits using the NSW TAG clinical indicators for antithrombotic use on medical and surgical wards, compliance audits with CEC/NSW Health recommendations and policies, e.g. use and storage of midazolam, and ADR reviews following reports pulled through medical record coding. Conclusion: This education process provides medical students with an excellent opportunity to review medication use in hospitals. It also provides the department with resources to collate spot check data on areas of interest in the organisation. It also provides excellent feedback opportunities for students to suggest improvements to the systems currently in place.

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poster abstracts 194 Impact of the implementation of pharmaceutical reforms on non-prescription

medication management in post-natal women discharged from hospital Lisa Whennan1, Luke Grzeskowiak2 1 Women’s and Children’s Hospital, 2Sansom Institute for Health Research, University of South Australia, SA Correspondence: lisa.whennan@health.sa.gov.au

Aim:

To determine whether post natal patients purchase recommended non-prescription medications after being discharged home.

To identify factors associated with whether or not post natal patients purchase recommended non-prescription medications after being discharged home.

Method: Post natal women were asked to complete a brief questionnaire with a midwife at a home visit within one week of discharge. The questionnaire included patient demographics and questions relating to which non-prescription medications were recommended, whether they were purchased or not, and reasons why they were not purchased. Results: During the project, 63 questionnaires were completed within one week of discharge. Fifty-two (81%) women were recommended to purchase medications following discharge, with a total of 134 medications recommended. Overall, of the medications recommended, 43 (32%) were not purchased. Half of these medications were not purchased because they were no longer required (50%), 10% of women could not remember what to purchase, 10% were unable to get to a pharmacy or supermarket and 5% did not have enough time. Women who take regular medication and women who received a ‘discharge medication’ pamphlet appeared more likely to purchase recommended medications following discharge. Before being discharged home, 32 (54%) of women reported seeing a pharmacist. Notably, of those women recommended iron (14), 4 (28%) had not purchased it at the time of follow-up. Encouragingly, of those recommended vitamin D (17), only one woman had not purchased it at the time of follow-up. Conclusion: This audit identified that most women purchase recommended non-prescription medications following discharge, with the most common reason for not purchasing medications being that they were no longer required. Concerning, though, is that almost a third of women did not purchase iron tablets and therefore may not be receiving adequate supplementation necessitating the need for further research into this area.

195 Investigation of the extent that clinical handover is undertaken by pharmacists for

patients transferred within the hospital and to explore pharmacists’ perceptions of the need for effective clinical handover Karen Whitfield1, Ying Xu2, Karen Allen1 1 Royal Brisbane and Women’s Hospital, QLD, 2University of Queensland, QLD Correspondence: karenwhitfield65@yahoo.com

To investigate the extent that pharmaceutical handover is undertaken for patients transferred within the hospital. Pharmacists (20) were asked to identify patients transferred internally during hospital admission over two weeks. Patients admitted to the emergency department and subsequently transferred to a ward were excluded. Type of handover provided to the receiving pharmacist and any medication-related issues documented. Pharmacists were asked to comment on the effectiveness of handover and if no handover was given, what information would have been advantageous to improve communication. Pharmacists were surveyed to explore perceptions about effective handover. Fifty-three patients were identified that had been transferred internally. Type of handover included: verbal (16 patients), written (2 patients), no handover (35 patients). Medication action plans were completed for 41 patients and medication histories and reconciliation were provided for 43 and 38 patients respectively. However, pharmacists identified that a handover would have been beneficial in 25 patients, to clarify issues relating to: antimicrobial therapy, pain management, newly commenced/ceased medications, anticoagulation management. Pharmacists commented that complex patients, in-particular those transferred from intensive care, required a comprehensive handover. Questionnaire results (90% response rate) indicated that 72% of pharmacists used a clinical profile regularly but only 22% for handover. Most (94%) agreed positively that handover was beneficial for patient care continuity. Barriers to handover included: time restraints, handwriting legibility, timely handover, inconsistency of approach. Information duplication was evident and identified as an ineffective use of resources and potentially error prone. A significant number of patients were found to be transferred internally. Verbal handover was commonly used, although for many patients, no handover was provided. Several barriers were identified to handover and inconsistency of approach was evident. However, effective handover was perceived to be paramount to continuity of care. Several strategies were identified to improve the process including producing a standard operating procedure.

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presenter index

Adams, R .............................................. 81 Alexander, S ........................................ 168 Alhawassi, T ........................................ 146 Anderson, M........................................ 203 Ang, EQ............................................... 146 Arthur, S ...................................... 147, 204 Barned, K ............................................ 127 Barras, M............................. 101, 102, 116 Behan, K ............................................. 128 Bennett, A ............................................. 98 Benson, S............................................ 129 Bereznicki, L .......................................... 83 Booth, J............................................... 169 Booth, M ............................................. 169 Brearley, L ............................................. 62 Brown, S ............................................. 147 Brumby, S ........................................... 113 Bufe, C ................................................ 170 Bui, D .................................................. 211 Buising, K .............................................. 87 Bula, N .................................................. 90 Burke, R .............................................. 170 Burrows, J ........................................... 171 Butler, E............................................... 171 Byrnes, D............................................. 172 Caird, P ................................................. 81 Cairns, K.............................. 129, 130, 172 Callaghan, K .......................................... 94 Casey, H.............................................. 104 Chan, M ................................................ 62 Chandler, K ......................................... 173 Chang, T ............................................. 148 Chaudhry, K ........................................ 194 Cheh, R ............................................... 174 Chen, K ............................................... 100 Chieng, R .............................................. 79 Choo, S ............................................... 115 Cichero, J .............................................. 88 Clifford, L ............................................. 106 Collins, P ............................................. 130 Coombes, I.......................................... 110 Cooper, G.............................................. 70 Corallo, C ............................................ 131 Cording, A ........................................... 192 Cortis, L................................................. 61 Costello, J ........................................... 174 Cotta, O............................................... 131 Cree, M ....................................... 113, 162 Crossing, S.......................................... 120 Croucher, A ......................................... 162 Cuell, S................................................ 175 De Zylva, J........................................... 132 deClifford, J ......................................... 117 Deidun, D ............................................ 175 Dillon, S ............................................... 119 Diprose, E.................................... 132, 148 Dobbin, M.............................................. 59 Doherty, P ................................... 133, 176 Dooley, M .............................................. 96 Driscoll, S ............................................ 149 Duguid, MJ ............................................ 87 Dwyer, J .............................................. 176 Elliott, R ................................... 65, 75, 149 Emerson, C ......................................... 133

Evans, J ................................................ 82 Ewing, W ..................................... 177, 212 Eyles, J................................................ 134 Falkland, M.......................................... 150 Fary, R................................................. 111 Fazli, O ................................................ 110 Fernando, P................................. 134, 150 Figueroa, K .......................................... 163 Finn, S................................................. 145 Fitzsimons, K ....................... 103, 151, 177 Forster, R .............................................. 82 Foyle, T ................................................. 72 Frank, M ................................................ 89 Franks, W ............................................ 178 Fuller, A ................................................. 74 Fyfe, R................................................. 178 Garrett, T..................................... 179, 180 Gelavis, A .............................................. 65 George, C............................................ 212 Gilbert, D ............................................. 163 Gillard, J .............................................. 155 Given, A....................................... 211, 213 Gloyne, L............................................. 135 Godbole, G............................................ 95 Goldsworthy, S.................................... 180 Gordon, J ............................................ 112 Grant, J ............................................... 181 Grant, K............................................... 181 Graudins, L.......................................... 182 Grygiel, R............................................... 97 Gysslink, P............................................. 80 Hagan, J................................................ 94 Hampson, J......................................... 135 Hansen, L............................................ 204 Harman, K ........................................... 114 Harris, C .............................................. 120 Heymann, S......................................... 205 Higgins, S............................................ 136 Hodgson, J.......................................... 205 Hogg, M ................................................ 88 Holmes, A............................................ 114 Howden, BP .......................................... 73 Howell, T ....................................... 66, 182 Hsu, N................................................. 164 Hughes, J.............................................. 60 Hughes, L............................................ 183 Hui, C .................................................. 183 Ibrahim, K.................................... 136, 213 James, A ............................................. 184 James, L ............................................. 151 Johannesen, M.................................... 152 Jones, C................................................ 97 Joseph, PD.................................... 71, 184 Joyce, K .............................................. 137 Keen, N ............................................... 185 Keith, C ............................................... 161 Kelly, J................................................. 206 Khalessi-Rad, M .................................. 137 Khalil, H ............................................... 152 Kiani, M ............................................... 214 Klusak, A ............................................. 138 Kong, D................................................. 94 Korajkic. A ........................................... 211 La, J .................................................... 206

Lam, S ................................................ 214 Lamb, B .............................................. 215 Lane, C ............................................... 104 Larizza, M............................................ 138 Larmour, I............................................ 215 Larson, C ............................................ 153 Lawrence, M ............................... 103, 186 Lay, S.......................................... 186, 216 Lee, M................................................. 187 Leversha, A ......................................... 187 Levkovich, B........................................ 188 Li, J ..................................................... 107 Liew, YH...................................... 139, 217 Lilleyman, K ......................................... 207 Lim, A.................................................. 153 Ludlow, P ............................................ 188 Lyons, B.............................................. 106 Macarthur, M....................................... 194 Madden, A .......................................... 189 Mampallil, L ......................................... 218 Mannion, P .......................................... 139 Mantas, S.............................................. 92 Marotti, S .................................... 174, 189 Masood, N .......................................... 207 Mawbey, I............................................ 208 McConnel, L........................................ 118 McCormack, C .............................. 99, 190 McDonough, M ..................................... 59 McGovern, T ....................................... 118 McGrath, A.......................................... 154 McKenzie, D.......................................... 61 McKinnon, RA ....................................... 75 McLachlan, A ...................................... 154 McLachlan, B ........................................ 71 McLauchlan, R .................................... 190 McNamara, K ........................................ 89 McNeil, V............................................. 140 McRae, A ............................................ 218 McWiggan, J ....................................... 219 Merritt, J.............................................. 140 Minge, N ............................................. 155 Moles, R.............................................. 219 Mulvogue, K ........................................ 141 Murnane, J ............................................ 98 Nalder, M ............................................ 191 Newton, I............................................... 60 Nguyen, T............................................ 220 Nissen, L ..................................... 168, 191 Nothling, S .......................................... 192 O’Brien, M........................................... 189 O’Brien, T............................................ 192 O’Doherty, R ....................................... 141 O’Hara, J............................................. 203 O’Hara, K ............................................ 155 O’Shea, T.............................................. 64 Oblimar, R ........................................... 220 Padhye, V............................................ 208 Pang, RK............................................... 64 Parker, D ..................................... 104, 105 Patel, B ........................................... 89, 90 Penno, J...................................... 156, 164 Percival, M........................................... 156 Pham, L .............................................. 157 Phung, M ............................................ 157

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presenter index Platis, A ............................................... 167 Plevin, D .............................................. 112 Plover, C................................................ 69 Porter, S ................................................ 69 Porter. S .............................................. 209 Price, G ................................................. 96 Pricolo, A ............................................... 80 Pulver, L ...................................... 115, 116 Rai, D .................................................. 142 Razi Zaidi, ST................................. 92, 107 Reeve, E .............................................. 158 Reeves, D ...................................... 66, 143 Richards. C.......................................... 216 Roberts, G....................................... 77, 95 Roberts, J.................................... 108, 193 Robertson, L........................................ 193 Rozynski, D ................................... 67, 165 Sagar, Y .............................................. 158 Saran, P .............................................. 194 Saunders, K......................................... 205 Sayar, A............................................... 194 Sbeghen, R ......................................... 159 Scholes, S ............................................. 76 Schulz, T ............................................... 73 Scott, L................................................ 165 Semmler, J ............................................ 91 Shen, S ............................................... 221

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Sheridan, B.......................................... 110 Siderov, J ............................ 101, 143, 194 Simic, M ................................................ 91 Smart, P .............................................. 195 Snell, B................................................ 195 Song, L ............................................... 196 Soulsby, N............................................. 78 Stacey, S............................................... 70 Stafford, L ........................................... 196 Strumpman, D ............................. 159, 197 Sweeney, M........................................... 67 Symons, J ............................................. 89 Taylor, S .................................. 63, 77, 100 Teoh, WKS .......................................... 102 Thakerar, A.................................... 76, 209 Thomas, S........................................... 221 Tiralongo, E ................................. 160, 197 Torresi, J ............................................... 74 Trajceska, L ......................................... 166 Tran, M................................................ 144 Tran, T................................................... 63 Tredinnick, M....................................... 198 Tuffin, P ......................................... 99, 166 Tulk, R................................................. 198 Urbancic, K ......................................... 144 Varghese, J ......................................... 109 Vidicki-Mastilovich, A ........................... 199

Vienet, M ............................................. 191 Walsh, B.............................................. 210 Walton, C ............................................ 105 Wardan, R ........................................... 222 Warwicker, K ....................................... 223 Webster, I.............................................. 87 Weeks, G .............................................. 68 Weidner, D .......................................... 167 Welch, S................................ 68, 200, 223 Wenzel, T ............................................ 167 Whennan, L......................................... 224 Whitfield, K .......................... 200, 201, 224 Williams, D........................................... 161 Williams, L ................................... 111, 161 Willis, J ................................ 145, 201, 210 Wills, M ............................................... 201 Witney, K............................................. 145 Wong, V .............................................. 114 Worthington, R ...................................... 93 Xin, X................................................... 160 Yap, C................................................. 202 Yin, C .................................................... 93 Yong, M .............................................. 202 Young, C....................................... 72, 133 Zamani, M ................................... 192, 203

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