Objective Hospitalisation provides an opportunity to deprescribe (withdraw inappropriate medications), however, safe and effective deprescribing relies on good communication between relevant stakeholders. The aim of this study was to explore the perspectives of Australian hospital and community pharmacists on communicating information about deprescribing at transitions of care and their role in the deprescribing process.Methods A diverse group of hospital and community pharmacists was purposively recruited. Data were collected via individual semi-structured interviews and focus groups that were audio-recorded and transcribed verbatim using NVivo. Each transcript was thematically analysed using an inductive coding approach, performed by two independent coders.Results Thirty-two pharmacists were recruited between June and August 2023. Seventeen participants worked in hospitals, 10 in community pharmacies, and five across both settings. Four themes with 12 subthemes were identified, pertaining to (i) how pharmacists communicate about deprescribing on hospital discharge, (ii) how pharmacists collaborate with other healthcare professionals and patients to optimise deprescribing, (iii) how the role of the pharmacist in deprescribing at transitions of care can be optimised, and (iv) how pharmacists feel about their current and future role in deprescribing.Conclusions Challenges in communicating deprescribing recommendations and ensuring continuity of care when patients transition between care settings were identified. Development of new tools (e.g., templates and guidance on how and what should be communicated) and processes to support communication at the transition of care from hospital to the community are needed to support deprescribing activities.

Objective(s) To describe the reported experience of patients who self-administered voluntary assisted dying medication in Victoria, Australia. Methods A population-based retrospective study of voluntary anonymous feedback survey responses from carers of patients who had self-administered the voluntary assisted dying medication. The participants were carers of patients who self-administered the voluntary assisted dying medication in Victoria, Australia, between 19 June 2019 and 30 June 2025. The main outcome measures were time to swallow the mixture, volume swallowed, time to loss of consciousness and time to death. Results Of 572 patients who self-administered the voluntary assisted dying medication, 563 (98.4%) reported that the patient swallowed the mixture in less than 4 min; and 95.1% swallowed the entire volume. Loss of consciousness was <10 min in 93.2% of patients and reported to be 30 s to under 2 min in four patients. All patients who swallowed the mixture died. The majority of patients (64.1%) were reported to have died in <30 min, with 86% within 1 hour. There were 37 responses (6.5%) where it took more than 2 hours for death to occur and 12 responses where the time taken exceeded 6 hours; the longest reported was 11 hours. 33 of the 37 patients that were reported to have taken longer than 2 hours to die were reported to have swallowed the entire volume of the mixture. Conclusion Self-administration of voluntary assisted dying medication has been demonstrated to be safe and effective with the safeguards in place in Victoria, Australia.

Background: Medication packaging contributes significantly to the overall carbon footprint of pharmaceuticals. Packaging design and material choices greatly influence environmental impact. Aim: To assess the carbon footprint of packaging for a range of medications on an Australian tertiary hospital formulary and identify opportunities to reduce environmental impact. Method: A life cycle assessment was undertaken to calculate the carbon footprint (as CO2 equivalent, [CO(2)e]) of medication packaging across six common product categories: blisters, tablets in bottles, oral liquids in bottles, vials, glass ampoules, and plastic ampoules. Ethical approval was granted by the Alfred Health Ethics Committee (Reference no: 465/23) and the study conforms with the National Health and Medical Research Council Ethical considerations in quality assistance and evaluation activities. Results: Twenty-six products were assessed across the six categories. Within each category, the CO(2)e of the lowest footprint products was between 19% (for glass ampoules) and 76% (for blisters) lower than the highest footprint products. Differences in carbon footprint were mostly due to the use of alternative materials or from smaller packaging (e.g. from less empty space). Recycling aluminium from blisters, or the glass or plastic comprising tablet bottles, also improved the environmental performance of those products, with CO(2)e reductions of up to 81% and 56%, respectively. Some safety features (e.g. printing information over every blister-packed tablet) may conflict with sustainability principles (avoiding empty space). Conclusion: The environmental impact of packaging can be reduced by using materials with a lower footprint, decreasing packaging size and weight, and/or promoting greater recycling of waste materials. Some safety features promote larger packaging and increased use of raw materials, but this is not universally the case.

Background: Pain is one of the most common causes for presentation to the emergency department (ED). Although previous research has identified factors influencing time to analgesia (TTA), impact of isolation, an infection control measure for selected communicable diseases, has not been investigated. Aim: To determine the association between isolation precautions and TTA for patients presenting to the ED with pain. Method: A retrospective cohort study included adult patients with pain requiring analgesia and a Australasian Triage Scale category of 2 or 3 that presented to two metropolitan EDs, located in Melbourne, Australia, between 1 January 2021-31 March 2021. Patients were identified using a Health Registry for Emergency Care. The primary outcome was the proportion of eligible patients that received analgesia within 30 min of their ED arrival. Secondary outcomes included TTA and ED disposition. The primary exposure variable was placement in isolation precautions in the ED. Ethical approval was granted by the Alfred Health Ethics Committee (Reference no: 783/20) and the study conforms with the Australian National statement on ethical conduct in human research. Results: During the study period, 2786 eligible patients were identified. There were no differences in baseline characteristics between exposure groups. Among 541 isolated patients, 3.3% (n = 18) received analgesia within 30 min of ED arrival, compared with 8.0% (n = 180) of the 2245 patients who did not require isolation precautions (odds ratio 0.39, 95% confidence interval 0.24-0.65, p < 0.001). The median TTA was 164 min for patients requiring isolation and 106 min for those that did not (p < 0.001). Conclusion: Among patients presenting to the ED with acute pain, placement in isolation precautions was associated with prolonged TTA. Further research is required to determine specific factors to mitigate delays to analgesia, including for isolated patients.

Background: The omission of time-critical medication doses may result in poor patient outcomes. There are few publications about the influence of electronic medication management (EMM) systems, including automated dispensing cabinets (ADC), on timely medication administration. The study aimed to evaluate the influence of EMM systems, including ADCs, on timely medication administration 6 and 30 months after EMM implementation, focussing on preventable time-critical medication dose omissions and documented reasons for not administering a dose. Methods: Data on doses of regular inpatient medications not administered were obtained from electronic medication records (EMR) over 1 week in March 2019 and 4 weeks in March 2021. An omission was a dose not administered before the next due dose. Time-critical medications were defined using the health service's guidelines. Reasons for doses not being administered were obtained from nursing documentation in the EMR collated from digital health reports. Reasons for time-critical medication doses not given were defined as 'valid' or 'preventable'. Results: In 2019 and 2021, 620 and 2524 patients with 44,756 and 146,940 scheduled medication doses were reviewed. Of these, 4385 (9.8%) and 19,610 (13.4%) doses were not administered. In 2019 and 2021, there were 593 (1.3%) and 1811 (1.2%), p < 0.0001, time-critical doses not administered. Preventable time-critical dose omissions decreased from 0.20% in 2019 to 0.15% (p = 0.015) in 2021. Wards with ADCs had a significantly lower rate of time-critical dose omissions compared to those without ADCs (1.1% vs 1.3%, p = 0.014). Conclusion: With the introduction of an EMM system, there was a decrease in the rate of time-critical medications not administered, including a reduced rate of preventable omissions over the 24-month period. Regular assessment of time-critical medication administration will help target patient safety improvements.

The proliferation of assisted dying legislative reforms globally is a significant change in the social and medico-legal landscape of end-of-life care. Understanding the impacts of these legislative reforms on family members who care for a dying person is vital, yet under-theorised in research. In this article, drawing on semi-structured interviews with 42 carers for a person who has sought assisted dying in Australia, and extending ideas of ontological choreography we explore the new and complex choreographies enacted by carers in their endeavour to arrange a 'good death' for the dying person. We find that desires to fulfil the dying person's wishes are often accompanied by normative pressures, affective tensions and complexities in bereavement. Enacting assisted dying requires carers to perform a repertoire of highly-staged practices. Yet, institutional obstacles and normative cultural scripts of dying can constrain carer assisted dying practices. Understanding the nuances of carers' experiences and how they navigate this new end-of-life landscape, we argue, provides critical insights about how assisted dying legislation is producing new cultural touchpoints for caring at the end of life. Moreover, we show how emerging cultural scripts of assisted dying are impacting in the lives of these carers.

Older people in the emergency department (ED) often pose complex medical challenges, with a significant prevalence of polypharmacy and potentially inappropriate medicines (PIMs) in Australia. A retrospective analysis of 200 consecutive patients aged over 65 years admitted to the emergency short stay unit (ESSU) aimed to identify polypharmacy (five or more regular medications), assess PIM prevalence, and explore the link between pre-admission PIMs and ESSU admissions. STOPP/START version 2 criteria were used for the PIM assessment, with an expert panel categorizing associated risks. Polypharmacy was observed in 161 patients (80.5%), who were older (mean age 82 versus 76 years) and took more regular medications (median 9 versus 3). One hundred and eighty-five (92.5%) patients had at least one PIM, 81 patients (40.5%) had STOPP PIMs, and 177 patients (88.5%) had START omissions. Polypharmacy significantly correlated with STOPP PIM (OR 4.8; 95%CI: 1.90–12.1), and for each additional medication the adjusted odds of having a STOPP PIM increased by 1.20 (95%CI: 1.11–1.28). Nineteen admissions (9.5%) were attributed to one or more PIMs (total 21 PIMs). Of these PIMs, the expert panel rated eight (38%) as high risk, five (24%) as moderate risk, and eight (38%) as low risk for causing hospital admission. The most common PIMs were benzodiazepines, accounting for 14 cases (73.6%). Older ESSU-admitted patients commonly presented with polypharmacy and PIMs, potentially contributing to their admission.

In the previous issue of the Journal of Pharmacy Practice and Research, the Society of Hospital Pharmacists of Australia (SHPA) Standard of practice in palliative care for pharmacy services was published.1 This Standard describes current best practice for the provision of palliative care pharmacy services and demonstrates the depth and breadth of these services that have continued to evolve over the recent decade. This includes describing essential and emerging services and challenges the profession to strive to provide emerging services, in addition to essential services wherever possible. This is indeed a challenge when these services are provided in non-specialist and specialist palliative care settings by individual practitioners with varying degrees of experience and expertise. This professional Practice Standard sets the scene and provides guidance to pharmacists within palliative care interdisciplinary teams, through to those working in more generalist roles in settings with clinicians without palliative expertise and, most importantly, entrenches the essence of the palliative care approach in the profession. Fundamental to this approach is the description within the Standard that everyone shares a fundamental right to safe and high-quality health care, including palliative care services, as is clearly prioritised in the Australian Charter of Healthcare Rights.2 However, there is clear evidence both internationally and within Australia that many patients who would benefit from palliative care service unfortunately do not have access to these.3, 4 This includes the continued lack of awareness within the healthcare sector and the wider community that palliative care services can be complementary to active treatment and not reserved for end-of-life care.5 Continued effort must be made to reduce these barriers to care and integrate palliative care services as early as possible, from when curative or life-prolonging (disease-modifying) treatment is occurring through to when death may be imminent. This is addressed within the Standard where the benefits of palliative care are highlighted for patients first diagnosed with a life-limiting condition receiving active interventions through to patients with progressive, advanced disease with little to no prospect of cure. A conceptual framework to underpin access to palliative care services has also been developed to help guide health professionals.6 This, along with key messaging to facilitate engagement with and promotion of palliative care services, has been advocated as an approach to improve the care of individuals with serious illness. There remain significant challenges to adopting these concepts into routine clinical practice. Unfortunately, palliative care, for many healthcare professionals and patients, is perceived to be only for end-of-life care, and it is paramount that we continue to change this misconception and integrate palliative care services as early as possible to provide the benefits we know exist for patients and their families. SHPA and the authors are to be congratulated for formulating a position on end-of-life care and voluntary assisted dying (VAD) for the profession. This would have been incredibly challenging whilst considering the views of many palliative care pharmacists with differing and valid perspectives. The passion, professional leadership, and commitment of all the authors to this task is to be commended. This work has resulted in a position statement that is true to the underlying principles that everyone shares a fundamental right to safe and high-quality health care. This is reflected in the statement that all patients expressing a desire to access VAD should be supported and referred to appropriate services in their jurisdiction and are not precluded from accessing palliative care services. I am encouraged that pharmacists practicing palliative care will, as this Standard emphasises, offer the same level and quality of palliative care services to any patient, regardless of a decision to access VAD. There continue to be many challenges to improving access to palliative care services, including changes in practice, policy, and education across all sectors.7 This Standard provides a clear consensus for the pharmacy profession to influence the provision of care that is person- and carer-centred. I look forward to my colleagues within the profession embracing the values and priorities that have been so carefully crafted within the Practice Standard into their practice. Michael J. Dooley is Editor-in-Chief of the Journal of Pharmacy Practice and Research. Michael J. Dooley is the Director of the Victorian Voluntary Assisted Dying Pharmacy Service. Michael J. Dooley: conceptualisation, writing – original draft, writing – reviewing and editing. Ethics approval was not required for this editorial as it did not contain any human data or participants. Not commissioned, not externally peer reviewed. This editorial received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Data sharing is not applicable to this editorial as no new data were created or analysed.

BACKGROUND:Analgesia is an important component for patient well-being, but commonly delayed during trauma resuscitation. The Pharmacists in Trauma trial assessed the effects of integrating pharmacists into trauma response teams to improve analgesia delivery and medication management. METHODS:This unblinded randomised trial compared emergency medicine (EM) pharmacist involvement in trauma callouts versus standard care at an Australian level 1 trauma centre. Randomisation was performed via an online single sequence randomisation service. Eligible patients included those managed with a trauma callout during working hours of an EM pharmacist. Pharmacists were able to prescribe medications using a Partnered Pharmacist Medication Charting model. The primary outcome was the proportion of patients who had first dose analgesia within 30 min compared using the χ2 test. RESULTS:From 15 July 2021 until 31 January 2022, there were 119 patients randomised with 37 patients excluded as no analgesia was required. There were 82 patients included for analysis, 39 in the control arm and 43 in the intervention arm. The primary outcome was achieved in 25 (64.1%) patients in the control arm and 36 (83.7%) patients in the pharmacist arm (relative risk 1.31; 95% CI 1.0 to 1.71; p=0.042). Time to analgesia in the control arm was 28 (22-35) mins and 20 (15-26 mins) with pharmacist involvement; p=0.025. In the pharmacist arm, the initial dose of analgesia was prescribed by the pharmacist for 38 (88.4%) patients. There were 27 other medications prescribed by the pharmacist for the management of these patients. There were no differences in emergency and trauma centre or hospital length of stay. CONCLUSION:Addition of the EM pharmacist in trauma response teams improved time to analgesia. Involvement of an EM pharmacist in trauma reception and resuscitation may assist by optimising medication management, with members of the team more available to focus on other life-saving interventions. TRIAL REGISTRATION NUMBER:ACTRN12621000338864.

AIM:Partnered Pharmacist Medication Charting (PPMC) in patients admitted under general medical units has been shown to reduce medication errors. The aim of this study is to evaluate the impact of the PPMC model on medication errors in patients admitted under cancer units in Victorian hospitals.METHODS:A prospective cohort study comparing cohorts before and after the introduction of PPMC was conducted. This included a 2-month pre-intervention phase and 3-month intervention phase. PPMC was implemented during the intervention phase as new model of care that enabled credentialed pharmacists to chart all admission medications, including pre-admission or new medications and cancer therapies, in collaboration with the admitting medical officer. The proportion of medication charts with at least one error was the primary outcome measure.RESULTS:Seven health services across Victoria were included in the study. The majority of health services were using paper-based prescribing systems for oncology. Of the 547 patients who received standard medical medication charting, 331 (60.5%) had at least one medication error identified compared to 18 out of 416 patients (4.3%) using the PPMC model (p < 0.001). The median (interquartile range) inpatient length of stay was 5 (2.9-10.6) days in pre-intervention and 4.9 (2.9-11) days in intervention (p  =  0.88). In the intervention arm, 42 patients had cancer therapy charted by a pharmacist with no errors.CONCLUSIONS:PPMC was successfully scaled into cancer units as a collaborative medication safety strategy. The model was associated with significantly lower rates of medication errors, including cancer therapies. PPMC should be adopted more widely in cancer units in Australia.

We, a group of medical professionals, researchers, patient representatives, and politicians, call for the UK government to commit to a reversal

BACKGROUND:Therapeutic monitoring of infliximab is limited by the time lag between drug-level measurement and dose adjustment, along with the cost of dose escalation. Strategies for dose reduction in stable patients on maintenance infliximab at supratherapeutic levels are uncertain. This study determined the feasibility of a pharmacist-driven strategy for immediate dose adjustment using a sliding scale at the point of care in stable patients with inflammatory bowel disease on maintenance therapy. METHODS:Adult patients with stable disease undergoing maintenance therapy with infliximab infusions, 5 mg/kg every 8 weeks, were prospectively studied. Trough drug levels were assessed by a rapid assay (and later by ELISA) at all infusions for up to 12 months with immediate but quantitatively small dose adjustment according to a sliding scale targeting a therapeutic range of 3-7 mcg/mL. Disease activity was assessed both clinically and biochemically. RESULTS:The rapid assay and ELISA detected similar infliximab levels, and the strategy added approximately 30 minutes to the duration of infusion events. Only 20% of 48 patients (77% with Crohn disease) had baseline trough infliximab concentrations within the therapeutic range. This value increased 3-fold after 24 and 48 weeks of interventions. One in 2 patients had baseline supratherapeutic levels, and most were brought into the therapeutic range without a discernible impact on disease activity by 1 dose adjustment, but 2 or 3 adjustments were generally needed for 29% of patients with subtherapeutic levels. Overall, drug costs were reduced by 4%. CONCLUSIONS:Immediate dose adjustment after infliximab rapid assay performed by a pharmacist using a sliding scale is a feasible strategy. Supratherapeutic infliximab levels can be safely and quickly brought into the therapeutic range using small dose adjustments without affecting disease activity, offsetting (at least partly) costs associated with dose escalation.

Sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) is an established complication in patients undergoing allogeneic hemopoietic stem cell transplantation (HSCT). Defibrotide is an effective and safe pharmacologic option for treating diagnosed SOS/VOD. By exploring data provided to the Australasian Bone Marrow Transplant Recipient Registry (ABMTRR) by centers in Australia and New Zealand, this study aimed to describe the incidence of SOS/VOD and patterns of defibrotide use from 2016 to 2020. Patients who underwent allogeneic hemopoietic stem cell transplantation between 2016 and 2020 were identified from the ABMTRR. Data were extracted for a total of 3346 patients, 2692 from adult centers and 654 from pediatric centers, with a median follow-up of 21.5 months and 33.3 months, respectively. Descriptive statistics were used to describe the patient population, including the incidence of SOS/VOD and defibrotide use. Comparisons were made between patients without SOS/VOD and those with SOS/VOD, divided into defibrotide and no defibrotide cohorts. Associations with overall survival (OS) and day 100 survival with such variables as sex, age, disease at transplantation, stem cell source, conditioning agents, SOS/VOD diagnosis, and use of defibrotide, were determined. The reported incidence of SOS/VOD was 4.1% in adult centers and 11.5% in pediatric centers. Defibrotide was administered to 74.8% of adult patients and 97.3% of pediatric patients with SOS/VOD. Significant variability in the use, dosage, and duration of defibrotide was seen across the adult centers. The day 100 survival rate and median OS for patients managed with defibrotide was 51.8% and 103 days, respectively, for adult patients and 90.4% and not reached, respectively, for pediatric patients. In adults, older age at transplantation, an HLA-matched nonsibling relative donor, and a diagnosis of SOS/VOD treated with defibrotide were associated with reduced OS. In pediatric patients, the patient and transplantation characteristics associated with reduced OS were a diagnosis of SOS/VOD and a ≥2 HLA-mismatched related donor. A collaborative approach across Australasia to diagnosing and managing SOS/VOD, particularly with respect to consistent defibrotide use, is recommended.

ABSTRACT Background Increasing life expectancy has seen a continual rise in older patients who present to hospital with acute decompensation. Pharmacists are well equipped to make medication recommendations in these settings to meet patient care needs, promote harm minimisation, and improve workflow efficiency. The Partnered Pharmacist Medication Charting (PPMC) model enables pharmacists to chart regular medications for patients admitted to the General Medicine Unit (GMU) in collaboration with treating clinicians. The model was expanded to assess the safety of pharmacists additionally charting newly initiated medications. Aim The aim of this study was to assess the safety of the expanded PPMC model through the number of medication errors. Method This prospective observational study was conducted at a tertiary hospital. Patients admitted to the GMU and received PPMC were included. Pharmacists were able to chart any new medications as well as the patients' pre‐admission medications. The primary outcome was the number of medication errors charted on admission. Medication errors were defined as medications charted outside of the specific recommendations documented in the medication management plan written by the PPMC pharmacist and co‐signed by the admitting medical officer. Results A total of 8093 medications were charted by a credentialed pharmacist, with 10% ( n = 816) planned newly initiated medications. Eight (0.98%) medication charting errors were identified in the PPMC model, which included five planned medications omitted. Of the 811 newly charted medications, 87 (10.7%) were amended within 24 h, with the majority being due to change in diagnosis or driven by changes in clinical status or investigative results becoming available. Conclusion The expansion of the PPMC model of care to enable pharmacist charting of new medications was found to be safe. The adoption of the model may aid in reducing medication errors, thereby improving patient care and safety.

Background:Participation in clinical trials is linked to improved patient outcomes. Despite this, most trial participants either reside in, or are treated in metropolitan areas. TrialHub developed hub-and-spoke models to support and grow clinical trial units in outer metropolitan and regional/rural centres in order to boost clinical trial engagement and reduce demands of trial participation on patients from outer metropolitan and regional/rural areas. The aim of this project was to establish a capability framework for clinical trial unit growth and development.Methods:An integrative methods study design was used to inform the co-design and development of the capability framework based on data collected in Victoria during 2020-21. This included reviews of the literature and of existing local resources, infrastructure, and staffing; as well as education, mentoring and support, and a needs assessment through multidisciplinary working groups.Results:We developed a capability framework based on the level of support required for outer metropolitan and regional/rural centres with diverse existing capabilities across Victoria. The framework applies a maturity model to assess resources, processes and practices which impact the capacity and capability of centres to conduct trials safely and sustainably. Each level of the model uses a consistent set of factors to describe the core elements required for safe clinical trial delivery. This benchmarking allows targeted investment to ensure safe and high-quality delivery of trials at newly establishing trial units.Conclusion:The capability framework developed by TrialHub provides a basis for staged, planned and successful trial unit development and trial implementation. Further validation of the framework is required.

Background: Hospital pharmacy dispensaries are busy work environments where staff are involved in a variety of work-related tasks. The proportion of time spent on daily tasks, task prioritisation, multitasking, and interruptions remains largely unknown.Aim: To examine the tasks performed and proportion of time pharmacists and pharmacy technicians in a hospital pharmacy inpatient dispensary spend on various work-related activities.Method: Pharmacists and technicians working in the inpatient dispensary of a large metropolitan health service were directly observed by trained researchers. Tasks were recorded using Work Observation Method By Activity Timing (WOMBAT), a validated technique developed for direct observation studies of health professionals. Timed tasks were allocated to domains detailing the task performed, who performed it, who they interacted with, and where the task was performed. Data were analysed descriptively with independence of 95% confidence intervals (CI) demonstrating statistical significance.Results: Twelve pharmacists and 13 technicians were observed for 107.4 h. Tasks that contributed the greatest proportion of time were: the preparation of discharge prescriptions: pharmacists 32.1% (95% CI 29.9-34.3%) and technicians 21.0% (95% CI 18.3-23.7%); inpatient medication supply 22.5% (95% CI 21.5-23.5%) and 49.3% (95% CI 47.3-51.3%) and; inter-professional communication 13.6% and 14.7% (non-significant [NS]). Tasks were completed independently 89.6% (pharmacists) and 88.9% (technicians) of the time. Pharmacists and technicians were interrupted 6.7 and 5.1 times per hour (p < 0.05), respectively; 8.6% and 9.5% (NS) of the time was spent undertaking at least two tasks simultaneously.Conclusion: This is the first study to examine task time distribution within a hospital inpatient dispensary. Pharmacists and technicians spend the greatest proportion of time on direct medication dispensing-related activities. This study demonstrates a high frequency of multitasking and interruptions, both of which are known risks for dispensing errors.

Aim: Daptomycin therapeutic drug monitoring (TDM) is a potentially valuable intervention for a relatively new drug. The aim of this study was to determine whether daptomycin TDM, including dose adjustment where necessary, improves the clinical outcomes of adult patients with Gram-positive infections.Methods: A systematic review of English-language studies in MEDLINE (Ovid MEDLINE and Epub Ahead of Print, In-process, In-Data-Review & Other Non-Indexed Citations, Daily and Versions), EMBASE via OVID, Cochrane Central Register of Controlled Trials via the OVID platform, Scopus and Web of Science online databases was performed and conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. There was no discrimination on study type or time of publication. Study selection: Adults (age >= 18 years) with a Gram-positive infection requiring treatment with dap-tomycin who received TDM, with subsequent reporting of serum concentrations and dose adjustment where necessary, were included.Results: In total, 2869 studies were identified, of which nine met the inclusion criteria. No studies of daptomycin TDM including a relevant control arm have been published to date. All of the included studies were single-arm observational cohort studies. Broad heterogeneity was observed between the studies in terms of included pathogens, infection types, daptomycin TDM practices, reported clinical outcomes, and reporting of potential confounders.Conclusions: No studies exploring the efficacy of routine daptomycin TDM on patient-centred outcomes in comparison with fixed dosing regimens have been published to date. This represents a key knowledge gap as opposed to an inherent lack of efficacy. Further well-designed, comparative studies are required to determine the role of daptomycin TDM in patients with Gram-positive infections.(c) 2023 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.