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Objective To determine (i) the relationship between prescriptions for proton pump inhibitors (PPIs) and upper gastrointestinal conditions, and (ii) compliance with Pharmaceutical Benefits Scheme (PBS) prescribing guidelines for PPIs. Design Drug utilisation evaluation. Setting 800‐bed metropolitan teaching hospital. Participants 253 patients dispensed PPIs from the hospital pharmacy over five consecutive weeks (11 January to 15 February 1999). Main outcome measures Recorded gastrointestinal conditions; previous trial of H2‐ antagonist therapy; compliance with PBS criteria for prescribing PPIs. Results Seventy patients (27.7%) had no appropriate upper gastrointestinal tract investigations, and 62 patients (24%) did not receive an adequate trial of H2‐antagonist therapy before the commencement of a PPI. The major indications for use of PPIs in investigated patients were gastro‐oesophageal reflux in 99 (54%) and peptic ulcer disease in 30 (16.4%). In only 57 patients (22.5%) did PPI prescriptions comply with PBS prescribing guidelines. Clinical indications that failed to meet prescribing criteria included milder forms of gastro‐oesophageal reflux, gastritis/duodenitis, and non‐specific dyspepsia with normal endoscopy results. Conclusion Drug utilisation data indicate widespread use of PPIs outside current prescribing guidelines. Many patients have not had relevant investigations and/or an adequate trial of H2‐antagonist therapy. These findings explain the considerable hospital expenditure on PPIs.

Objectives: To identify and quantify deficiencies in the prescribing/ordering of inpatient and discharge medications and determine strategies to address them. Design and setting: A descriptive study in medical and surgical wards at a tertiary referral teaching hospital. Patients: All available inpatients in 12 medical and 2 surgical wards on two consecutive days and all discharges on a single day. Results: Medication orders for 230 inpatients and 68 discharge patients were audited. A total of 2978 inpatient orders were reviewed including 634 'once only' doses, 1840 regular and 504 'as required' medications. Errors in physician prescribing occurred at a frequency of 25/1000 prescriptions and included 48 ( 1.6%) incorrect, ambiguous or unspecified doses and four prescriptions where the specific oral form was not stated. In 14 (0.5%) cases, the dosing frequency specified was wrong, unclear or absent and there were three cases of duplication. Two patients were prescribed drugs to which they had a documented allergy. Details of previous adverse drug reactions were complete in only 14 of 62 (23%) patients. Of the 68 discharge prescriptions audited, orders for 49 of 329 regular medications (15%) had been unintentionally omitted (range 1-8 medications per patient). Conclusions: The audit identified limitations in the quality of prescribing/ordering which were in part due to deficiencies in the current medication chart and discharge summary. To address these limitations, the medication ordering system has been revised and a multidisciplinary educational program implemented to promote safe and explicit prescribing.Aust J Hosp Pharm 2001; 31: 102-6.

Aim: To review antimicrobial therapy of community-acquired pneumonia (CAP) at the Princess Alexandra Hospital and compare management with institutional guidelines. Method: Clinical pharmacists prospectively reviewed I 00 patients with a diagnosis of CAP during a five-week period in August and September 1998. Clinical and laboratory data were collected from patient records and assessed for compliance with institutional guidelines for the appropriate management of CAP. For the purposes of these guidelines, pneumonia severity was defined according to the clinical condition of the patient and their inherent risk factors. Results: Ninety-nine patients (99%) were prescribed an antibiotic for the treatment of CAP. Ninety-six patients were prescribed parenteral antibiotics for a mean of7 days (range 0-27 days, median 6 days). Seventy-six patients were prescribed oral therapy for a mean duration of 10 days (range 3-21 days, median 9 days). Only 11 of 41 patients (27%) with severe pneumonia received IV erythromycin. Thirteen of28 patients (46%) diagnosed with mild-moderate pneumonia were inappropriately treated with broad-spectrum parenteral agents. Only 45% of patients were treated appropriately.Thirty-three positive sputum cultures were reported (from 54 specimens) and four patients returned more than one isolate. Fourteen per cent of the patients admitted with CAP died during their admission. Conclusions: Community-acquired pneumonia is a major cause of death due to infection. This study showed an underutilisation of parenteral antibiotics for severe pneumonia and an overuse ofbroad-spectrum parenteral antibiotics for moderate pneumonia without co-morbidities. New pneumonia management guidelines have been developed and a further review was recently undertaken in an attempt to reduce inappropriate management of CAP within our institution. Aust J Hosp Pharm 1999; 29: 317-20.

Drug utilization data indicate that COX-2 inhibitors are frequently used first line for degenerative osteoarthritis in the absence of overt inflammation, without prior adequate trial of paracetamol and with disregard for the cautions and contraindications of these agents. These findings may explain the unprecedented Pharmaceutical Benefits Schedule expenditure on COX-2 inhibitors in Australia.