Secular trends in the utility of SGLT-2 inhibitors in heart failure patients with type 2 diabetes mellitus across Metro South Health hospitals in South-East Queensland.

BACKGROUND: The 2018 Australian Heart Failure (HF) guidelines strongly recommended commencing sodium-glucose co-transporter-2 inhibitors (SGLT-2is) in HF patients with type 2 diabetes mellitus (T2DM). The uptake of SGLT-2is for HF patients with T2DM in our health service is unknown. AIMS: To determine the adoption of the 2018 HF guidelines by assessing the temporal trends of SGLT-2is' usage in HF patients with T2DM at Metro South Health (MSH) hospitals, in South-East Queensland. METHODS: Retrospective analysis of all HF patients (ejection fraction (EF) < 50%) with T2DM who were managed within MSH hospitals between June 2018 and June 2021. RESULTS: A total of 666 patients met the inclusion criteria with 918 HF encounters. Mean age was 72 years and 71% were male (473/666). Mean EF was 30% (SD ± 11%), and mean estimated glomerular filtration rate was 48 mL/min/1.73 m2 (SD ± 25). Fifty-four per cent (362/666) had contraindications to SGLT-2is. Among those without contraindications, there was a five-fold increase in the utility of SGLT-2is, 7% (2/29) before versus 38% (103/275) after implementation of the HF guidelines (P < 0.001). Patients on SGLT-2is were younger (64 years vs 69 years, P = 0.002) and had a lower number of HF hospitalisations (1.1 vs 2.1, P = 0.01). CONCLUSIONS: During the study period, 54% of our HF patients with T2DM were not on SGLT-2is due to prescribing guidelines/limitations in the Australian context. We observed a five-fold significant increase in the uptake of SGLT-2is before and after implementation of HF guidelines among patients without contraindications to SGLT-2is. There were significantly fewer HF hospitalisations among patients on SGLT-2is compared to those without.

The impact of transition to a digital hospital on medication errors (TIME study).

Digital transformation in healthcare improves the safety of health systems. Within our health service, a new digital hospital has been established and two wards from a neighbouring paper-based hospital transitioned into the new digital hospital. This created an opportunity to evaluate the impact of complete digital transformation on medication safety. Here we discuss the impact of transition from a paper-based to digital hospital on voluntarily reported medication incidents and prescribing errors. This study utilises an interrupted time-series design and takes place across two wards as they transition from a paper to a digital hospital. Two data sources are used to assess impacts on medication incidents and prescribing errors: (1) voluntarily reported medication incidents and 2) a chart audit of medications prescribed on the study wards. The chart audit collects data on procedural, dosing and therapeutic prescribing errors. There are 588 errors extracted from incident reporting software during the study period. The average monthly number of errors reduces from 12.5 pre- to 7.5 post-transition (p < 0.001). In the chart audit, 5072 medication orders are reviewed pre-transition and 3699 reviewed post-transition. The rates of orders with one or more error reduces significantly after transition (52.8% pre- vs. 15.7% post-, p < 0.001). There are significant reductions in procedural (32.1% pre- vs. 1.3% post-, p < 0.001), and dosing errors (32.3% pre- vs. 14% post-, p < 0.001), but not therapeutic errors (0.6% pre- vs. 0.7% post-, p = 0.478). Transition to a digital hospital is associated with reductions in voluntarily reported medication incidents and prescribing errors.

Impact of Policy Interventions on Oxycodone Prescribing in Queensland, Australia: An Uncontrolled Interrupted Time Series Study.

INTRODUCTION: Opioid prescribing rates are continuing to increase in Australia in line with prescribing rates seen internationally. Prescribing limits are one policy strategy to reduce short-term opioid prescribing, but there is limited evidence of their impact. OBJECTIVE: The aim of this study was to assess the impact of state and national policy interventions on changes to oxycodone 5 mg discharge prescriptions in public hospitals using electronic prescribing in Queensland, Australia by evaluating the proportion of oxycodone 5 mg discharge prescriptions written for ≤ 10 tablets across the study period. METHOD: This research utilised a retrospective uncontrolled interrupted time-series design and was undertaken at 12 public hospitals using electronic prescribing from December 2018 to February 2021. The study analysed the impact of two sequential policy interventions that limited the recommended quantity of oxycodone 5 mg on discharge for all hospitalised patients. The first state-wide policy came into effect on 19 September 2019 and the second national policy came into effect on 1 June 2020. RESULTS: Over the 27-month period, there were 110,728 discharge prescriptions written in the 12 Queensland hospitals for oxycodone 5 mg. During the baseline period, approximately 50.7% (95% CI 49.5-51.8) of all oxycodone 5 mg prescriptions were from tablet quantities of ≤ 10 tablets. After the implementation of the state-wide policy, the proportion increased by 9% (95% CI 7.4-10.7; p = 0.001). The implementation of the national policy increased the proportion of oxycodone 5 mg prescriptions written for ≤10 tablets by 9.8% (95% CI 8.1-11.5; p < 0.001). CONCLUSIONS: Restrictive prescribing policies at a state and national level may have resulted in decreased quantities of oxycodone 5 mg prescriptions provided on discharge from public hospitals using electronic prescribing in Queensland, Australia. Despite these positive results, continued multi-faceted policy efforts and individual tailored interventions are necessary to ensure safe and judicious opioid prescribing.

The effect of Computerised Physician Order Entry on prescribing errors: An interrupted time-series study at a secondary referral hospital in Australia.

BACKGROUND: Computerised Physician Order Entry (CPOE) software is increasingly used across the world to improve medication safety. However, few high-quality studies have reviewed the impact of CPOE on prescribing errors and patient harm. OBJECTIVE: To investigate the effect of a hybrid CPOE-paper prescribing system on prescribing errors at a secondary hospital site. DESIGN: An interrupted time-series study was conducted by identifying prescribing errors via prospective medical chart review before and after the implementation of CPOE across three medical wards. PARTICIPANTS: The medication orders of all patients admitted to the medical wards during the study period were reviewed. INTERVENTION: Implementation of a CPOE across three medical wards. MEASURES: A blinded expert panel risk stratified the errors according to level of severity, preventability and potential for harm. Pearson's chi square and segmented regressions were used to determine if there were differences in prescribing errors pre- and post-CPOE implementation. KEY RESULTS: A total of 10,535 medication orders were reviewed pre-CPOE and 13,841 medication orders reviewed post-CPOE. Analysis demonstrated that after implementation of CPOE there were reductions in the proportion of orders with one or more of any error (-30.1%, 95 %CI: -36.5%, -23.7%, p < 0.001). Reductions in the proportion of orders with one or more errors were seen across the error categories of dosing errors (-20.1%, 95 %CI: -25.1%, -15%, p < 0.001), procedural/administrative errors (-18.9%, 95 %CI: -22.8%, -15%, p < 0.001), and therapeutic errors (-2.6%, 95 %CI: -4.1%, -1%, p = 0.002). Post-CPOE there were reductions in the proportion of orders with at least one non-intercepted serious error (-12.6%, 95 %CI: -16.4%, -8.8%, p < 0.001). CONCLUSION: The introduction of CPOE was associated with reductions in prescribing errors. There is also evidence that this translated into a reduced risk of harm to patients post-CPOE implementation through the reduction in actual adverse drug events.

Disaster preparedness amongst pharmacists and pharmacy students: a systematic literature review.

OBJECTIVES: In the aftermath of a disaster, the services provided by pharmacists are essential to ensure the continued health and well-being of the local population. To continue pharmacy services, it is critical that pharmacists are prepared for disasters. A systematic literature review was conducted to explore pharmacists' and pharmacy students' preparedness for disasters and the factors that affect preparedness. METHODS: This review was conducted in April 2020 through electronic databases CINAHL, MEDLINE, Embase, PubMed, Scopus and PsycINFO, and two disaster journals. Search terms such as 'pharmacist*', 'disaster*' and 'prepared*' were used. The search yielded an initial 1781 titles. Articles were included if they measured pharmacists or pharmacy students' disaster preparedness. After screening and quality appraisal by two researchers, four articles were included in final analysis and review. Data were extracted using a data collection tool formulated by the researchers. Meta-analysis was not possible; instead, results were compared across key areas including preparedness ratings and factors that influenced preparedness. KEY FINDINGS: Three articles focused on pharmacy students' preparedness for disasters, and one on registered pharmacists' preparedness. Preparedness across both groups was poor to moderate with <18% of registered pharmacists found to be prepared to respond to a disaster. Factors that potentially influenced preparedness included disaster competency, disaster interventions and demographic factors. CONCLUSION: For pharmacists, the lack of research around their preparedness speaks volumes about their current involvement and expectations within disaster management. Without a prepared pharmacy workforce and pharmacy involvement in disaster management, critical skill and service gaps in disasters may negatively impact patients.

"Vital in today's time": Evaluation of a disaster table-top exercise for pharmacists and pharmacy staff.

BACKGROUND: While the importance of pharmacists' involvement in disaster management is becoming increasingly recognised in the literature, there remains little research on methods for preparing pharmacists and pharmacy staff for disasters. OBJECTIVE(S): To investigate the use of a table-top disaster exercise to improve disaster awareness and preparedness for pharmacists and pharmacy staff attending The Society of Hospital Pharmacists of Australia (SHPA) Medicine Management conference 2019. METHODS: A table-top disaster exercise was developed by the research team and presented as a workshop at the SHPA's annual conference in 2019. The workshop presented attendees with the hypothetical 'Cyclone Oma' that was tracking across the fictional state of 'New Cardiff'. Each workshop table was assigned a different hospital and was required to respond to Cyclone Oma as the scenario evolved. Workshop attendees were invited to complete a pre- and post-survey assessing their perceptions of disaster management and preparedness for pharmacists and pharmacy staff. RESULTS: The pre- and post-workshop survey was completed by 41 out of the 47 attendees. Participants' assessments of their understanding of disaster management activities increased after attending the workshop (p< 0.001). Most participants felt the workshop improved their understanding of their role in a disaster (87.8%, 36/41) and allowed them to identify their strengths and weaknesses in disaster management (90.2%, 37/41). The workshop was well received with 92.7% (38/41) of participants stating they would like further continuing professional development opportunities in disaster management. CONCLUSIONS: This is the first disaster table-top exercise in Australia targeted specifically at the pharmacy workforce to be conducted and evaluated. The exercise improved understanding of disaster management and was well received by the participants. This research calls for further education and training opportunities in disaster management targeted at the pharmacy workforce.

Evaluation of Disaster Preparedness and Preparedness Behaviors among Pharmacists: A Cross-Sectional Study in Australia.

INTRODUCTION: In a disaster aftermath, pharmacists have the potential to provide essential health services and contribute to the maintenance of the health and well-being of their community. Despite their importance in the health care system, little is known about the factors that affect pharmacists' disaster preparedness and associated behaviors. STUDY OBJECTIVE: The goal of this study was to determine the factors that influence disaster preparedness behaviors and disaster preparedness of Australian pharmacists. METHODS: A 70-question survey was developed from previous research findings. This survey was released online and registered Australian pharmacists were invited to participate. Multiple linear regression was used to determine the factors that influenced preparedness and preparedness behaviors among pharmacists. RESULTS: The final model of disaster preparedness indicated that 86.0% of variation in preparedness was explained by disaster experience, perceived knowledge and skills, colleague preparedness, perceived self-efficacy, previous preparedness behaviors, perceived potential disaster severity, and trust of external information sources. The final model of preparedness behaviors indicated that 71.1% of variation in previous preparedness behaviors can be explained by disaster experience, perceived institution responsibility, colleague preparedness, perceived likelihood of disaster, perceived professional responsibility, and years of practice as a pharmacist. CONCLUSION: This research is the first to explore the significant factors affecting preparedness behaviors and preparedness of Australian pharmacists for disasters. It begins to provide insight into potential critical gaps in current disaster preparedness behaviors and preparedness among pharmacists.

Continuation of opioid replacement program delivery in the aftermath of cyclones in Queensland, Australia: A qualitative exploration of the perspectives of pharmacists and opioid replacement therapy staff.

BACKGROUND: Cyclones can significantly impact on communities and their healthcare services. Community members with chronic diseases, including opioid dependence, who rely on these healthcare services are placed at an increased risk of treatment disruption during a disaster event. Disruptions to the continuity of the opioid replacement therapy (ORT) service can potentially lead to relapse, withdrawal, and risky behaviours in clients with potential repercussions for the community. OBJECTIVE: To explore the effects of Queensland (QLD) cyclones on opioid treatment programs within Queensland community and hospital pharmacies from three perspectives. METHOD: Qualitative research methods were used. Participants comprised five community pharmacists, four Queensland opioid treatment program (QOTP) employees, and five public hospital pharmacists. Participants were identified as they had worked in Townsville, Rockhampton, Mackay, or Yeppoon in a community impacted by a cyclone and involved with ORT supply. Interviews were recorded and data were analysed by two methods - manual coding and the text analytics software Leximancer®. RESULTS: The two themes that emerged from the manual coding process were 'disaster preparedness' and 'continuity of service'. The key themes from the Leximancer® analysis aligned with the two manual coding themes with no new themes identified. Primary dosing site closures in disaster-affected areas led to increased pressures on hospitals and other community pharmacy dosing sites to supply ORT doses to clients. However, a lack of dosing information available to pharmacists and strict legislative requirements made continuity of ORT supply during these cyclones difficult. CONCLUSION: Continuation of ORT services during and in the aftermath of a cyclone event is complex. This research highlighted a need for a coordination of efforts and shared dosing information between QOTP employees, community pharmacists, and hospital pharmacists. To improve continuity of ORT services, it is essential that these stakeholders engage with each other in preparing for and responding to future events.

Still Burning: An Exploration of the Impacts of the 2018/2019 Tasmanian Summer Bushfires on Community Pharmacy Operations in Affected Communities.

INTRODUCTION: Human-induced climate change is increasing the likelihood and severity of wildfires across the globe. This has negative consequences for the health of affected communities through the loss of health systems' infrastructure and disrupted health services. Community pharmacies are a central hub between patients and the health care system and can provide continuity of care during wildfires. However, there is little in peer-reviewed literature about the impacts of wildfires on community pharmacy operations. STUDY OBJECTIVE: The aim of this study was therefore to explore the impacts of the 2018/2019 summer bushfires in Tasmania, Australia on community pharmacy operations in affected areas. METHODS: Semi-structured telephone interviews were conducted with four community pharmacists who were working in the affected region during the bushfires. Interviews were audio recorded and transcribed verbatim. Qualitative data were analyzed using two methods- manual coding utilizing NVivo software and Leximancer analysis. Inter-rater reliability was ensured by two researchers analyzing the data independently. Differences in coding were discussed and agreement reached through negotiation amongst the research team. RESULTS: From the manual coding analysis, five key themes emerged - communication and collaboration; support; patient health challenges; pharmacist experiences in delivering health care; and future planning. These aligned with the five themes that emerged from the Leximancer analysis - community; local; town; patients; and work. Participants described working during the wildfires as difficult, with multiple challenges reported including communication difficulties, operational barriers such as power cuts, legislative barriers, logistical issues with obtaining and storing medication supplies, and lack of preparation, support, and funding. They highlighted a lack of operational and financial support from the government and received most assistance from local council bodies and local branches of professional pharmacy organizations. CONCLUSION: During disasters, community pharmacies help reduce the burden on public hospitals by maintaining medication supplies and treating patients with minor ailments. However, increased support and inclusion in disaster management planning is needed to continue this role.

Optimizing Prednisolone Loading into Distiller's Dried Grain Kafirin Microparticles, and In vitro Release for Oral Delivery.

Kafirin microparticles have potential as colon-targeted delivery systems because of their ability to protect encapsulated material from digestive processes of the upper gastrointestinal tract (GIT). The aim was to optimize prednisolone loading into kafirin microparticles, and investigate their potential as an oral delivery system. Response surface methodology (RSM) was used to predict the optimal formulation of prednisolone loaded microparticles. Prednisolone release from the microparticles was measured in simulated conditions of the GIT. The RSM models were inadequate for predicting the relationship between starting quantities of kafirin and prednisolone, and prednisolone loading into microparticles. Compared to prednisolone released in the simulated gastric and small intestinal conditions, no additional drug release was observed in simulated colonic conditions. Hence, more insight into factors affecting drug loading into kafirin microparticles is required to improve the robustness of the RSM model. This present method of formulating prednisolone-loaded kafirin microparticles is unlikely to offer clinical benefits over commercially available dosage forms. Nevertheless, the overall amount of prednisolone released from the kafirin microparticles in conditions simulating the human GIT demonstrates their ability to prevent the release of entrapped core material. Further work developing the formulation methods may result in a delivery system that targets the lower GIT.