Teletrials, the new norm? Expert recommendations for teletrials into the future: Findings from the Clinical Oncology Society of Australia Clinical Trial Research Professionals Group Workshop.

INTRODUCTION: The Australasian Teletrial Model was piloted in co-funded sites across Australia. The purpose was to extend the reach of clinical trials using telemedicine to improve equity and access to this treatment pathway for oncology patients. Experts across Australia gathered to share the learnings of implementation so that future directions can be effective and sustainable. METHODS: The 1-day workshop was attended in person and virtually. Attendees were invited to analyze and disseminate the results. Recordings from the presentations were coded independently by three researchers and synthesized. The results were sent to the authorship team for further review to build consensus on the findings in three drafts. RESULTS: Four key themes were identified: "Being on the Same Page," "Building Foundations," "Key Roles in Teletrials," and "Incentives." Although there were many successes that were accelerated by the COVID-19 pandemic, there is work still to be done. CONCLUSION: The Australasian Teletrial Model has been identified as acceptable and feasible. Future directions need to continue to work on streamlining regulatory processes, implementation and monitoring, and build knowledge to further build networks across Australia.

The impact of automated medicine dispensing units on nursing workflow: A cross-sectional study.

BACKGROUND: Automated medication dispensing cabinets are ubiquitous in hospitals in the United States and prevalent in Canada, but they are still relatively new to health services elsewhere. The automation of medication management using distributed dispensing units is aimed at improving stock management and patient safety; however, the evidence for the latter remains equivocal, and the impact on nursing workflow is poorly understood. OBJECTIVE: This study evaluated the impact on the nursing workflow of a distributed automated medication dispensing system. The research aimed to explore the acceptability and utility of this system in a variety of clinical settings and to investigate similarities and differences in the use of the dispensing cabinets across different clinical areas. DESIGN: A cross-sectional design was employed. SETTING: The setting was a newly constructed 450-bed regional Australian tertiary hospital. PARTICIPANTS: The study involved 174 registered nurses and 12 pharmacy assistant staff from general ward and specialty areas who were using the automated medication dispensing cabinets. METHODS: Methods included a hospital-wide survey of users and an observation study of nursing workflow around the automated medication cabinets in specific clinical areas. RESULTS: The majority of staff were satisfied with the system and were positive about the overall safety and security. Key concerns related to access delays, and increased time needed due to walking distance and interruptions from other staff. Staff perceived that the automated medication dispensing cabinet use slowed medication administration processes as a result of queueing, and it also had other impacts on workflow. The system was found to expedite processes around controlled/narcotic drug administration. Re-stocking requirements presented operational issues; pharmacy assistants were observed waiting for opportunities to complete re-stocking tasks in the face of competing clinical requirements. Nurses from general wards were more satisfied with the system than those from specialty areas. CONCLUSIONS: Automated medication dispensing cabinets were widely accepted by nurses in a large newly opened hospital in a variety of acute clinical areas despite disruptions to workflow. Adaptations for access were more acceptable to nurses in general wards than those in specialty areas prompting consideration of redesign to improve suitability. Tweetable abstract: Automated medication cabinets change nursing workflow because of queueing, interruptions from other staff and increased walking. Ward nurses are more accepting of such workflow disruptions than speciality area nurses #medicationsafety #nurseworkflow #nursesatisfaction (268 char).

Adsorption and Leachable Contamination of Flucloxacillin, Cyclosporin and Amiodarone Following Delivery Through an Intravenous Administration Set.

PURPOSE: Interactions between a pharmaceutical drug and its delivery device can result in changes in drug concentration and leachable contamination. Flucloxacillin, amiodarone and cyclosporin were investigated for drug concentration changes and leachable contamination after delivery through an intravenous administration set. METHODS: Flucloxacillin, amiodarone and cyclosporin were delivered through an intravenous administration set and the eluate analysed by HPLC-UV and HPLC-MS. RESULTS: The average recovery of flucloxacillin was 99.7% and no leachable compounds were identified. The average recovery of cyclosporin was 96.1%, which contrasts previous findings that have reported up to 50% loss of cyclosporin. This is likely due to the use of DEHP-free administration sets in this study, as adsorption of cyclosporin is linearly related to DEHP content. The average recovery of amiodarone was 91.5%. 5-hydroxymethylfurfural was identified in the amiodarone solution following delivery through the administration set as well as the 5% glucose solution used for delivery. CONCLUSIONS: Drug/administration set interactions may modify pharmaceuticals during delivery. In this study, only 90% of the amiodarone was delivered through a generic administration set. Given the growing use of generic administration sets in hospital settings, validation of the suitability of their use is required to ensure patient safety and expected levels of efficacy.