Abstract Background Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting in pregnancy with potential sequelae including hypovolaemia, electrolyte imbalance, and malnutrition, which can result in adverse maternal–foetal outcomes. Aim To explore Australian women's experiences and perceptions regarding the pharmacological management of HG. Method An online, cross‐sectional survey, conducted in Australia from July–September 2020, captured data on participant demographics, experience of HG, and use and experience of medication treatments. Three survey questions included free‐text response fields. One hundred and eighty‐nine women provided free‐text responses to at least one of these three questions, which provided qualitative data that were thematically analysed. Ethical approval was granted by Adelaide University Human Research Ethics Committee (Reference no: H‐2020‐090) and the study conforms to Australian National statement on ethical conduct in human research . Informed consent was obtained from all participants via the distribution of project information to potential participants indicating their involvement was voluntary and anonymous. Participants confirmed their consent through completion of the survey. Results Three major themes were identified. Theme 1: ‘inadequate recognition and management of HG’ indicated women reported many clinicians lacked suitable training to diagnose patients, were either not aware of, or were not following clinical HG management guidelines, and were not apprised of current safety and side effect profiles of common antiemetic medications. Theme 2: ‘challenging inequities in HG healthcare’ revealed educational and financial status may influence treatment outcomes, and systemic barriers to effective management exist in the Australian healthcare system. Finally, Theme 3: ‘the extensive and unrelenting burden of HG’ demonstrated the severe nature of HG can lead to extreme debility and impaired quality of life, and results in psychological trauma that can extend beyond birth and affect future family planning. Conclusion Opportunities exist to improve experiences and outcomes for women with HG. Well‐structured strategies, such as improved education for health practitioners, changes to the Pharmaceutical Benefits Scheme, and expansion of outpatient care modalities could result in improved recognition and management of HG.
Abstract Background Since 2015, pharmacists have become increasingly involved in primary care and interdisciplinary healthcare teams. Subsequently, literature related to pharmacist interventions in primary care has grown rapidly and there is a need to systematically map this research to understand how the profession's clinical focus has evolved and conceptually matured. Aim This study aimed to identify research concerning pharmacist interventions in primary health care, published from January 2015 to 26 January 2026, and use bibliometric mapping to identify core research themes and trends and assess the maturity of these themes. Method A total of 691 relevant documents were retrieved using Scopus and analysed. Advanced bibliometric techniques were employed using VOSviewer, Biblioshiny, OpenRefine and biblioMagika software to conduct performance mapping and author keyword co‐occurrence analysis. Network, density and thematic maps were generated to visually demonstrate thematic maturity, topic saturation and the evolution of the research domains over time. Ethics approval was not required for this research article as it utilised published data and did not contain human participants or data. Results Research output related to pharmacist interventions in primary care exhibited sustained, exponential growth, peaking in 2025. The core literature remained robustly anchored in community pharmacy settings. Co‐occurrence and thematic mapping identified five highly interconnected clusters. The key terms ‘comprehensive medication management’ and ‘patient‐centred care’ represented a rapidly emerging, rather than declining, research trajectory. Conclusion The literature analysed reflected a mature, global transition towards proactive, multidisciplinary pharmacist‐led care. To further advance the pharmacy profession, future research must examine settings beyond community pharmacy to address critical gaps, such as specialised ambulatory care and psychosocial interventions, and ultimately optimising macro‐level population health outcomes.
Abstract Background An increase in the ageing population across long‐term care facilities (LTCFs) has led to an increased risk of polypharmacy. Pharmacist‐led deprescribing (PLD) can reduce these risks but there are limitations to its widespread uptake. Aim To explore PLD interventions for residents in RACFs, focusing on outcomes measured and research gaps. Design A scoping review was conducted following the Arksey and O'Malley 2005 framework and reported in line with the Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) guidelines. CINAHL, Embase, PubMed, and Scopus were searched for peer reviewed articles on deprescribing interventions in older adults in LTCFs that were published online and in the English language from 2017–May 2024. Results Nine studies were included. Across the included studies, reductions in inappropriate medication use were commonly reported following PLD interventions, while the effects on patient‐related outcomes varied. Some studies showed reductions in drug burden index scores and falls, specifically those targeting sedative or anti‐cholinergic medications. Adverse events were inconsistently assessed, and effects on cognitive function and quality of life (QoL) were mixed. Two studies reported on economic outcomes, indicating cost savings associated with deprescribing. Significant variation was observed in outcome measures used to assess deprescribing across studies. Conclusion PLD interventions in residential aged care have been evaluated using a wide range of medication‐related, clinical, patient‐related, implementation, and economic outcomes across different settings. Limited long‐term evidence exists for cognitive and QoL outcomes. A significant gap in findings is the variability in the outcomes reported in deprescribing intervention studies. Standardised outcome measures are needed to support more rigorous evaluation and comparison of PLD interventions.
Abstract Background Transitions of care (TOC) between hospital and community settings are high‐risk periods for medication‐related problems (MRPs), often caused by inadequate information transfer between healthcare settings. Community pharmacists are well positioned to support continuity of care; however, they are frequently excluded from the transitional care team. Understanding information transfer and the role of community pharmacists in TOC is essential to improving patient outcomes during this high‐risk period. Aim The aim of this scoping review was to comprehensively map and synthesise the existing evidence on medication information transfer during TOC and the roles of community pharmacists. Design This review followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for scoping reviews (PRISMA‐ScR) guidelines and applied the Arksey and O'Malley framework in accordance with the Joanna Briggs Institute Population, Concept, Context model. Cochrane Library, Embase, PubMed, CINAHL and Scopus were searched for peer‐reviewed articles that addressed medicine information transfer and the role of community pharmacists during TOC for patients discharged from hospital to community settings, published between 2013 and 2025. Data were charted using a pre‐defined Excel template and findings were narratively synthesised and thematically grouped. Results A total of 42 studies were included in the analysis. Studies demonstrated that community pharmacist‐led post‐discharge medication management improved patient outcomes. However, effective clinical handover to community pharmacy was often inconsistent or delayed. Implementation of community pharmacist services was limited by high workloads, a lack of reimbursement and non‐integrated digital health systems. Conclusion This review highlighted that poor communication and incomplete information transfer during TOC contribute substantially to poor patient outcomes, and that community pharmacists play a critical role in mitigating these risks through medication reconciliation, medication reviews and patient counselling. Strengthening digital interoperability, standardising discharge documentation and integrating community pharmacists within multidisciplinary frameworks are essential to optimise post‐discharge care.
Background The use of medication is the most common intervention in health care, with adverse drug events a leading cause of preventable healthcare harm. Increasingly, virtual pharmacy services have been implemented to support hospitals that lack the access to clinical pharmacy services to support patient safety and best practice medicines management.Aim This research examined the potential return on investment of a virtual clinical pharmacy service (VCPS) conducted in rural and remote hospitals in New South Wales, Australia.Method The original study adopted a stepped wedge randomised controlled trial design implemented in eight facilities. The VCPS involved clinical pharmacists providing virtual clinical pharmacy services consistent with recognised standards of practice for hospital pharmacy via videoconferencing, the electronic medical record and electronic medication management. The cost of clinical pharmacists' time to deliver services was compared with the benefit, expressed as avoided medication-related hospital admission, of pharmacist identified and physician accepted and actioned medication-related interventions stratified using the Nesbitt probability method. The return on investment (ROI) analysis modelled variations in parameters using a population of 1000 patients with 1000 simulations. Ethical approval was granted by the Greater Western Human Research Ethics Committee (Reference no: 2019/ETH13355) and the study conforms to Australian National Statement on Ethical Conduct in Human Research.Results The study included 527 participants in the intervention group, with pharmacists identifying 878 medication issues and 73% of interventions accepted and actioned by the physician. The modelled return on investment of the VCPS was estimated at 20.43 (95% confidence interval [CI] 17.57, 23.30), suggesting that for every AUD $1 invested, potential savings of between $17.57 and $23.30 could be generated.Conclusion The integration of virtual clinical pharmacy services into Australian rural and remote hospitals can reduce medication-related problems encountered in hospitals, leading to cost savings and improvements in patients' quality of life.
Abstract Aim In hyperuricaemic patients undergoing contrast procedures, although the mechanisms linking hyperuricaemia and contrast‐induced nephropathy (CIN) remain uncertain, effective prevention of CIN is essential. This review aimed to analyse drug or therapeutic intervention approaches used to mitigate CIN in patients with hyperuricaemia. Data sources PubMed, Embase, Scopus and Cochrane Library were searched between 2014 and 2025 for studies that included adult patients undergoing angioplasty or angiography and received any drug or therapeutic intervention to prevent CIN and included hyperuricaemia as a comorbidity. Study selection Randomised controlled trials (RCTs), published in English, that reported the incidence of CIN based on a study‐specific definition were included. Only RCTs were included, with all other study designs excluded. The Risk of Bias (RoB) 2 tool was utilised to ascertain RoB. This review was conducted and reported according to the Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) 2020 statement. Results Of the 78 initially identified studies, ten were removed for duplication, and after title and abstract screening, 51 studies were excluded. Of the remaining 17 studies, seven full text versions could not be retrieved and subsequently excluded. After assessing against the inclusion criteria, three studies were included in the analysis. Two (66.6%) of the studies adopted the same definition of CIN, and the average total incidence of CIN from all studies was 13.1%. Two studies assessed the use of febuxostat as an intervention, and all three studies used intravenous hydration in their respective control arm. Prevention strategies included intravenous hydration, febuxostat, oral hydration and N ‐acetylcysteine. Conclusion Febuxostat showed potential in preventing CIN in high‐risk hyperuricaemic patients with chronic kidney disease, but evidence was limited and heterogeneous across studies. Our review was limited to only three RCTs with heterogeneous interventions and variable patient populations. The reported 13.1% for total incidence of CIN should be viewed as a descriptive summary of risk rather than a clinically generalizable rate, underscoring the need for larger, standardised and methodologically rigorous trials to define optimal prophylactic strategies.
Background: Vancomycin is first-line treatment for methicillin-resistant Staphylococcus aureus (MRSA) infections. However, despite guideline recommendations, there is no evidence that targeting vancomycin trough concentrations of >= 15 mg/L in children confers clinical benefit and is associated with vancomycin-associated nephrotoxicity (VAN). Aim: This study aimed to evaluate the impact of a vancomycin safety bundle on VAN and vancomycin utilisation in hospitalised paediatric inpatients. Method: A pre-post-intervention study was conducted in a tertiary paediatric hospital comparing January-December 2018 (pre-intervention) to May 2019-April 2020 (post-intervention). Hospitalised children, aged 30 days to <18 years, that received intravenous vancomycin with at least one trough concentration were included. The intervention bundle comprised: (1) lowered empiric vancomycin trough targets (5-15 mg/L), (2) enhanced creatinine monitoring (concomitant serum creatinine with vancomycin trough), (3) guideline modification (reduced pre-authorised indications for empiric vancomycin use), and (4) prescriber education initiatives. Ethical approval was granted by the WA Child and Adolescent Health Service Research Ethics Committee, Governance Evidence Knowledge Outcomes Program (Reference no: 41830) and the study conforms with the National Health and Medical Research Council's Ethical considerations in quality assistance and evaluation activities. Results: A total of 314 vancomycin prescriptions were analysed (n = 204 pre-intervention; n = 110 post-intervention). Post-intervention, VAN incidence decreased almost twofold from 0.46 to 0.25 episodes per 1000 patient bed days (p <= 0.01), and vancomycin prescription days decreased by 19%. Total hospital drug costs for vancomycin decreased by AUD $16 033. Overall, and for paediatric invasive MRSA, no significant difference in clinical outcomes or 30-day mortality was observed between study periods. Conclusion: This study demonstrated the implementation of a vancomycin safety bundle significantly reduced paediatric VAN and vancomycin utilisation without compromising clinical outcomes. These data support antimicrobial stewardship interventions to improve medication safety for children.
Background It is sometimes clinically desirable to administer oxycodone concurrently with compound sodium lactate via the same intravenous (IV) line; however, there are limited stability and compatibility data for this combination. Aim To determine the stability of oxycodone in compound sodium lactate IV solution. Method The study was conducted at a major metropolitan hospital in Melbourne, Australia. Oxycodone stock solutions were prepared as 1 mg/mL in sodium chloride 0.9% and in compound sodium lactate in polyolefin IV bags. The oxycodone 1 mg/mL in sodium chloride 0.9% was diluted to 0.5 and 0.1 mg/mL with compound sodium lactate. These, and the 1 mg/mL in compound sodium lactate solution, were injected into the Y-site section of two different types of giving set ('Pump' and 'Blood') tubings and stored under two conditions (room temperature and 37 degrees C). Sampling timepoints were baseline (time 0), then 8, 24, and 48 h for room temperature and 4, 8, 24, and 48 h for 37 degrees C. The stock solutions were also stored at room temperature and analysed. Samples were visually checked for physical changes and analysed using high-performance liquid chromatography. Stability was determined against the European Medicines Agency limit (+/- 5% from baseline). Ethics approval was not required for this research article as it was a stability study and did not contain human participants or data. Results The difference from baseline was within the European Medicines Agency limit of under 5% for all samples at 24 h. Sample appearance did not change, and additional peaks in the chromatograms were not observed. Conclusion Oxycodone 0.1, 0.5, and 1 mg/mL mixed with compound sodium lactate is stable for 24 h in IV administration lines.
Background Conscientious objection (CO) recognises healthcare practitioners' freedom of conscience but can impact equitable access to services. There is limited research in understanding CO among pharmacists. Aim To investigate CO among pharmacists in New Zealand, including support for and factors influencing CO decisions in providing various medicines and services, and attitudes towards benefits and concerns associated with CO. Method A cross-sectional, anonymous online survey was conducted among 294 registered pharmacists in New Zealand. Fisher's exact test and regression analyses were performed to assess and associate participants' demographics with responses to support for CO, prevalence of CO, and qualitative questions. Thematic analysis was used to explore the qualitative findings on benefits and concerns about CO. Ethical approval was granted by the University of Auckland Human Participants Ethics Committee (Reference no: UAHPEC26360) and the study conforms with the Declaration of Helsinki. Informed consent was obtained from all participants via distribution of project information indicating participation was voluntary and anonymous. Results Approximately two-thirds of participants (n = 195, 66.3%) supported pharmacists' right to CO, although the majority (n = 252, 85.7%) reported no experience with CO. When asked about willingness to supply medicines, participants most frequently objected to medical abortifacient medicines, the emergency contraceptive pill, and gender-affirming hormone therapy. Participants with a religion were more likely to support CO (odds ratio [OR] 3.83, 95% confidence interval [CI] 2.25, 6.54, p < 0.001) while age (51-60 years) and religion appeared to be associated with a higher CO prevalence (Age adjusted OR 7.06, 95% CI 2.25, 22.16, p < 0.001; Religion adjusted OR 6.99, 95% CI 1.42, 34.37, p = 0.017). Conclusions Our findings suggest the majority of New Zealand pharmacists support CO and will practice CO in line with the New Zealand Code of Ethics for pharmacists in ensuring continuity of care. Future research should specifically explore the impact of rurality on access to pharmacies and service disparities.
Abstract Purpose of Review Telepharmacy has emerged as a digital extension of pharmacy services, offering remote consultations, medication reviews, and prescription verifications. While adoption has accelerated, particularly during the COVID‐19 pandemic, challenges persist in community pharmacy settings. This review explored the key barriers and facilitators influencing the implementation of telepharmacy from the perspectives of community pharmacists. Source of Information A literature search was conducted in PubMed, Embase, and CINAHL to identify original research articles published between 2014–2024. Studies were included if they examined community pharmacists' perspectives on telepharmacy, and highlighted barriers and facilitators to its implementation. Identified studies were screened, and data were extracted and grouped into themes for synthesis. This review was structured in line with key principles of the Scale for the Assessment of Narrative Review Articles (SANRA). Key Findings Eleven studies met the inclusion criteria. The most reported barriers included regulatory uncertainty, technological and infrastructural limitations, financial constraints, workload, privacy concerns, and limited digital literacy among both pharmacists and patients. Conversely, key facilitators included pharmacists' willingness to adopt telepharmacy, technical advancements, improved patient access to care, governmental support, and recognition of telepharmacy's role in public health and healthcare accessibility. Conclusion Telepharmacy presents a viable solution to bridging healthcare access gaps, particularly in underserved communities. However, its full integration into community pharmacy practice depends on addressing regulatory, financial, and technological barriers while building pharmacists' willingness and must be supported by government policies. Future efforts should focus on developing guidelines, standardising digital infrastructure, and providing training to equip pharmacists with the necessary skills for digital health care. Expanding telepharmacy within community pharmacies has the potential to enhance medicines management, improve healthcare accessibility, and optimise patient outcomes.
Background Analgesic stewardship (AGS) programs, a novel concept in Australia, aim to assess and optimise opioid and other analgesia by carrying out medication reviews and providing clinical recommendations to the treating teams. Aim This study aimed to determine the rate and extent of acceptance of AGS team recommendations among adult inpatients within a metropolitan hospital network. Method This 12-month retrospective study included patients admitted to an acute hospital within an approximate 1500-bed hospital network between 1 January-31 December 2023. Patients were included if they had at least one AGS progress note documented during their hospital stay. Quantification of AGS recommendations, evaluation of recommendation outcomes, and comparison of recommendation acceptance against hospital site, medical unit, and patient demographics were conducted. Patients for whom none of the AGS recommendations were accepted were analysed thematically. This project was exempt due to the local policy requirements that constitute research by the Eastern Health Research Ethics Committee (Reference no: QA24-056-109 074). The justification for this exemption was as follows: the project only was retrospective, utilised routinely collected data, and Australian National statement on ethical conduct in human research. Results A total of 2047 AGS recommendations were identified across 901 patients (median age 78 years, range 18-105, 61% female), with a median of two recommendations per patient (interquartile range 2-3). For 620 patients (69%), all recommendations were implemented. The most common reason for non-acceptance was recommendations being missed by the treating team. Recommendations made at the largest hospital site by bed number were associated with higher acceptance (odds ratio [OR] 1.93, 95% confidence interval [CI] 1.37-2.73). Acceptance was also higher for surgical units (OR 2.02, 95% CI 1.35-3.01), corresponding to approximately double the odds, than for non-surgical units. Younger adult patients (aged <65 years) had higher odds of recommendation acceptance than those aged >= 65 years (OR 1.65, 95% CI 1.07-2.55). Conclusion AGS recommendation acceptance rate was high, particularly for adult patients (<65 years) admitted under surgical units. Addressing factors associated with non-acceptance and examining longitudinal trends may further optimise AGS service impact on opioid and analgesia use.
Background The use of accurate thermometers is critical in young (aged <3 months old) infants given the significant risk of serious infection in this age group. Best practice guidelines recommend direct electronic thermometers (axilla or rectal) for infants aged <3 months. Infrared thermometers (forehead or tympanic) are inaccurate in this patient population. Families commonly use infrared devices, which are available from pharmacies. Aim The primary aim of this study was to investigate the recommendations made in community pharmacies regarding thermometers for use in newborn infants and secondarily, to understand why particular thermometers were recommended. Method A prospective, observational cross-sectional 'secret shopper' study was conducted from July to September 2022. Researchers sought pharmacy advice regarding suitable thermometer use for a newborn from pharmacies located in Melbourne, Australia. Ethics approval was granted by the Royal Children's Hospital Melbourne Human Research Ethics Committee (Reference no: 72682) and the study conforms with the Australian National statement on ethical conduct in human research. Results From 122 pharmacies, the best-practice recommendation (use of direct thermometer) was made 9.8% of the time. Infrared thermometers were recommended 84.4% of the time, regardless of pharmacy type, socioeconomic status of the pharmacy location or whether a pharmacist or retail assistant provided the advice. Conclusion Despite clinical guideline recommendations that direct devices should be used in infants aged <3 months, infrared thermometers were overwhelmingly recommended in this sample of pharmacies. This research demonstrated the need for improved education regarding best practice for measuring temperatures in newborns.
Background Gender diversity in healthcare is essential for fostering an inclusive environment that enhances quality of care and improves health outcomes. Diverse perspectives drive innovation and better decision-making in patient care. Pharmacy practice has evolved significantly in the last decade, along with growing recognition of the importance of diversity. While progress has been made in achieving gender balance within pharmacy organisations, research on gender diversity in pharmacy academia remains limited.Aim To assess gender representation in published pharmacy research by examining editorial board membership and authorship patterns in research manuscripts and letters to the editor published in the Journal of Pharmacy Practice and Research (JPPR).Method Issues of JPPR published from 2000-2024 (at five-year intervals) were extracted (at five-year intervals) from Wiley Online Library. Data on the number of women and men were collected for authors of research articles, authors of letters to the editor, and editorial board composition. Ethics approval was not required for this research as it utilised published data and did not involve human participants or data.Results The study evaluated 27 issues of JPPR and a total of 141 research articles and 75 letters to the editor. Female researchers increased from 41% in 2000 to 60% in 2024, with senior authorship (indicated by first or last named author) rising from 30% to 61%. Female representation in letters to the editors also increased from 30% in 2000 to 33% in 2024. However, editorial board representation of women declined slightly from 28% in 2000 to 24% in 2024.Conclusion While significant progress has been made in female representation in authorship, aligning with trends in the Australian pharmacy workforce, under-representation persists in editorial leadership roles.
Background Entrustable Professional Activities (EPA) are units of professional practice that can be entrusted once competence is demonstrated. Although widely used across health professions, evidence on interprofessional EPA assessments, where one profession evaluates another, is limited. Aim This study aimed to provide insights into the assessment practices of pharmacists and supervising doctors evaluating medical interns undertaking prescribing assessments in clinical practice. Method This pilot study evaluated an interprofessional EPA assessment model for medical intern prescribing across an Australian multi-site hospital network where pharmacists, consultants, and registrars acted as assessors. Data were collected on the specific prescribing tasks assessed, entrustment decisions, case complexity, and assessment duration and frequency. This project was exempt due to the local policy requirements that constitute research by the Monash Health Research Office (Reference no: RES-24-0000-166Q). The justification for this exemption was as follows: the study conforms with the National Health and Medical Research Council Ethical considerations in quality assurance and evaluation activities and while the addition of pharmacist assessors was new, the study utilised only routinely collected data. Informed consent was obtained from all participants via the distribution of project information indicating participation was voluntary. Participants provided their consent by participating in EPA assessments. Results From June-October 2024, 114 prescribing EPA assessments were conducted: 28 (25%) were conducted by pharmacists, 16 (14%) by consultants, and 70 (61%) by registrars. There were no differences between assessor groups in prescribing tasks (p = 0.408) and case complexity (p = 0.071). Entrustment decisions varied significantly (p < 0.001), with pharmacists (67.8%) and registrars (80.0%) selecting the highest trust level more frequently than consultants (31.3%). Assessment duration also varied (p < 0.001), with median (interquartile range [IQR] Q1, Q3) durations of 12.5 (10, 15) min for pharmacists, 10 (5, 15) min for consultants, and 6.5 (5, 10) min for registrars. Median (IQR) assessment frequency per assessor over the five-month study period was 1.5 (1, 4.75) for pharmacists, 1 (1, 1) for consultants, and 1 (1, 2) for registrars. Conclusion Pharmacists, alongside supervising doctors, can serve as assessors for medical interns prescribing EPA assessments. The longer assessment duration observed with pharmacists offers new insights into interprofessional assessment practices.
Background Ketamine is a versatile anaesthetic and analgesic often used in emergency departments (ED) and intensive care units (ICU). Ketamine requires weight-based dosing for both adult and paediatric patients which makes accurate dosing challenging, particularly in emergent settings.Aim The aim of this drug utilisation evaluation (DUE) was to assess the appropriateness of ketamine dosing in the ED and ICU at a rural community hospital in Montana, USA.Method A retrospective chart review of patients who received >= 1 dose of ketamine from 1 January 2022-1 October 2023. The primary objective was to evaluate the appropriateness of dosing, according to 2023 Lexicomp recommendations. Secondary outcomes included dosing by location, indication, and patient population. The total number of ketamine doses administered was analysed using frequency distributions. Results were expressed as both counts and percentages. Ethical approval was granted by the Intermountain Institutional Review Board, Privacy Board (Reference no: 1052659) and the study conforms with the Declaration of Helsinki.Results One hundred eighty-seven patients received 219 doses of ketamine from 1 January 2022-1 October 2023. The majority of doses were appropriate (total: 87.2%; ED: 85.0%; ICU: 94.2%). The majority (86.7%) of ketamine doses per indication were appropriate. Doses administered to paediatric patients were appropriate 100% of the time, 85.4% of doses were appropriate in adult patients, and and in patients with obesity, doses were appropriate 80.3% of the time.Conclusion Over a period of 21 months, 87.2% of ketamine doses were administered appropriately in an emergency setting, demonstrating an overall caution with usage. Optimal dosing strategies depend on the clinical indication, with dissociative doses (1-2 mg/kg) providing rapid induction. Careful titration and monitoring for adverse effects are essential to maximising efficacy and safety. Standardised protocols and further research are needed to refine dosing strategies and optimise patient outcomes.
Background Medicines are the most common healthcare intervention. However, disposal of pharmaceutical waste in health facilities contributes significantly to financial costs and carbon emissions, and incorrect disposal can lead to environmental contamination. Appropriate segregation of pharmaceutical waste at the point of use is critical to reduce waste in hospitals.Aim The aim of this study was to assess the effectiveness of a ward-based education programme to optimise pharmaceutical waste management, through increasing staff knowledge, capability and opportunity to segregate waste and measure changes in waste, costs, carbon emissions, and staff motivation, knowledge, and behaviour.Method We developed and implemented a brief education intervention for staff in patient care areas of a regional hospital and introduced a recycling option for medication blister strips. The intervention encouraged better waste segregation and recycling knowledge and practices. Numbers and weights of pharmaceutical waste bins collected for incineration during a five-month intervention period (January-May 2024) were compared with a two-year pre-intervention period (January 2022-December 2023) using interrupted time series analysis. Pre- and post-intervention surveys assessed staff waste management knowledge, attitudes, and behaviour. Ethical approval was granted by the Greater Western Human Research Ethics Committee (Reference no: 2023/ETH01746) and the study conforms to Australian National Statement on Ethical Conduct in Human Research. Informed consent was obtained from all participants for participation in the education and surveys via distribution of project information and confirmation of electronic consent.Results We found weak evidence of lower bin numbers sent for incineration (p = 0.051) and greater bin weights (p = 0.052). Additionally, 140 L of medication blister strips were collected for recycling. Survey responses post-education suggested that staff had improved knowledge of pharmaceutical waste management, disposal, and recycling.Conclusion This brief intervention generated improvements in waste management among staff in hospital wards without disruption to work routines. Appropriate education coupled with sustained resources and infrastructure can improve pharmaceutical waste management at point of use with potential benefits for health and the environment.
Background Tacrolimus is a potent immunosuppressant that is widely used to treat various inflammatory or immunity-mediated diseases and prevent organ transplant rejection. Although tacrolimus is commercially available in 0.5 mg, 1 mg, and 5 mg capsules for oral administration, no registered liquid or semi-solid dosage of tacrolimus exists in Australia. Currently, demand for tacrolimus suspensions and ointments is fulfilled by compounded formulations prepared by compounding pharmacies.Aim This research aimed to develop and validate a stability-indicating high-performance liquid chromatography (HPLC) method to determine tacrolimus in different formulations and then assessed the long-term stability of tacrolimus in suspensions (1 mg/mL) prepared in Oral Mix, SF (sugar-free) (OM), Ora-Blend SF (sugar-free) (OB), and ointment (0.1%) in petrolatum when stored at controlled room temperature for 12 months.Method The analytical performance parameters of the developed HPLC assay, comprising selectivity, specificity, linearity, accuracy, and precision, were evaluated according to the International Conference on Harmonisation (ICH) Q2(R1) guidelines. Tacrolimus concentration, drug breakdown research, pH, colour, and odour were assessed over a 12-month period in suspensions and ointment. Ethics approval was not required for this research article as it was a stability study and did not contain human participants or data.Results The HPLC assay method was found to be precise for quantification of tacrolimus in oral suspensions and onitment. The tacrolimus suspensions based on OM or OB exhibited no alteration in appearance, pH, or odour over the 12-month study period. Both tacrolimus suspensions retained >= 93% of the initial concentration over 12 months at room temperature. The ointment formulation maintained a tacrolimus content of >= 92% for the 12-month duration.Conclusion Both tacrolimus suspensions and ointment formulations demonstrated physical and chemical stability for up to one year, for samples that were kept under room temperature conditions.
Background Pill-swallowing difficulty is common yet under-recognised, and patients rarely seek or receive support from healthcare professionals. Lubricating jelly pastes are widely available in Japan, yet evidence for their effectiveness in pill administration remains limited. The PILL-5 enables validated, self-reported screening of clinically relevant pill-swallowing difficulty. Aim This study aimed to explore whether a lubricating jelly paste reduced self-reported pill-swallowing difficulties using the Japanese version of the PILL-5 questionnaire. Method In a pilot randomised, parallel-group trial, 24 participants with PILL-5 scores >= 2 were stratified and randomised 1:1 to one-week pill intake using a lubricating jelly paste (IDDSI Level 4) (intervention group) or pill intake as usual (control group). The PILL-5 was administered at baseline, Day 1, and Day 7. The primary outcome was change in total PILL-5; between-group differences were tested with the exact Mann-Whitney U test. Ethical approval was granted by the Ethics Review Committee of Fujita Health University (Reference no: HM20-076; HM20-619) and the study conforms with the Declaration of Helsinki. Informed consent was obtained from all participants via the distribution of project information and completion of written consent forms. The study was registered in the UMIN Clinical Trials Registry (UMIN-CTR) (Registration ID: UMIN000057324). Results The median PILL-5 scores at baseline were 4.5 and 5.5 for the intervention and control groups, respectively (p = 0.525). At Day 1, median scores were 3.0 and 4.5 in the intervention group and control group, respectively and on Day 7, median scores were 3.0 and 4.0 in the intervention and control groups, respectively. From baseline to Day 1, the between-group median difference in change (intervention minus control) was 2 (95% confidence interval [CI] 0-2, p = 0.037), indicating a greater reduction in the intervention group. On Day 7, the between-group difference was 1 (95% CI 0-2, p = 0.119) and not significant. Conclusion Lubricating jelly paste use was associated with an early, self-reported reduction in PILL-5 scores at Day 1, with a significant between-group difference. By Day 7, the between-group difference was not significant, likely due to floor effects from low baseline severity. Future studies with stricter inclusion criteria and larger sample sizes are warranted to further clarify the potential benefits.
