Clinical guidelines for the processes surrounding the alteration of medication dose forms and relevant pharmaceutical information are needed in all residential homes for older people. Ongoing education for nurses in this area is also required.

Objectives: To determine the extent to which medications are altered or crushed prior to administration to residents of aged‐care facilities, the medications involved and the methods employed. Method: Observation of medication rounds at a representative sample of South Australian aged‐care facilities. Results: At least one medication was altered in 34% of the 1207 occasions of medication administration observed within ten residential aged‐care facilities in South Australia. 17% of medicines which were altered, had the potential, because of the alteration, to cause increased toxicity, decreased efficacy, unpalatability, safety or stability concerns. The process of altering medicines was found to be problematic. In all occasions where more than one medicine was altered, they were crushed together within the same vessel. In 59% of occasions where the same vessel was shared amongst residents, the vessel was not cleaned between residents and in 70% of cases where medicines were altered, spillage, and thus potential loss of dosage, was observed. Conclusions: Guidelines outlining best practice for the alteration and administration of medications in residential aged‐care facilities are required. In addition, accurate and up‐to‐date information needs to be available for carers and health practitioners in residential aged‐care facilities detailing those medications which should not be altered, the potential risks of alternating medicines and other options.

Background COVID‐19 vaccination represents a key preventative part of the Australian public health approach to the SARS‐CoV‐2 pandemic. Hospital inpatients are frequently high‐risk for severe COVID‐19 and death. Anecdotes of high‐risk inpatients being unvaccinated and a lack of EMR visibility of COVID‐19 vaccination status prompted this study as these patients could represent a risk to themselves, staff, other patients and service provision. Aims To determine the uptake of COVID‐19 vaccine among inpatients at an adult Australian tertiary public hospital and identify reasons for non‐vaccination. Methods A point‐prevalence study of patient‐reported COVID‐19 vaccine status was conducted on 26 th October 2021 via an in‐person interview with collection of demographic factors and reasons for non‐vaccination. Results Of 368 (68% of inpatients) participants, 280 (76%) reported receiving at least 1 COVID‐19 vaccine dose. Vaccination status was associated with older age, having received the flu vaccine, being born in Australia and not requiring an English‐language interpreter. The majority (88%) of participants had at least 1 co‐morbid risk factor for severe COVID‐19. Of the unvaccinated (n=88), 67% were willing to be vaccinated with 54% of those indicating vaccination in hospital would be helpful and 42% requesting approval from their doctor. Conclusions Vaccine uptake in our cohort is sub‐optimal. Existing public health programs have failed to reach this high‐risk, vulnerable population. Changes to the national vaccination strategy to include a parallel in‐hospital program for all hospital encounters and target culturally and linguistically diverse individuals may improve uptake among this high‐risk, hard to reach group of patients. This article is protected by copyright. All rights reserved.

Objective Increasing antimicrobial resistance and a concurrent paucity of new antimicrobials marketed increases the risk that patients will develop infections resistant to currently available drugs. This study aimed to determine the range of clinical indications for which unregistered antimicrobials are prescribed at two tertiary hospitals in South Australia to identify any trends over a 2-year period. The effects of recent regulatory changes to the Special Access Scheme (SAS) were assessed. Methods Data were extracted from application forms submitted to the Therapeutic Goods Administration to access unregistered antimicrobials via the SAS pathway at two Australian tertiary hospitals for the period July 2015–June 2017. Average weighted antimicrobial prices were retrieved from the hospital iPharmacy (DXC Technology, Macquarie Park, NSW, Australia) dispensing system. To estimate the effect of a new access pathway (Category C), the SAS classification for each application was retrospectively assessed over time with each regulatory change. Results Between July 2015 and June 2017, 477 SAS applications for 29 different antimicrobials were submitted for 353 patients at the two hospitals. The most common indications were tuberculosis (43.6%) and refractory Helicobacter pylori (10%). Regulatory changes reduced the proportion of applications requiring preapproval for access. Conclusions Although the introduction of a new pathway has decreased the administrative burden when accessing unregistered antimicrobials, this study highlights the range of clinical conditions for which there are no registered drugs available in Australia. What is known about the topic? With increasing antimicrobial resistance and a paucity of novel antimicrobials entering the market, access to older, previously less-used antimicrobials is increasingly important in clinical practice. Accessing unregistered antimicrobials is common practice in Australian hospitals, but the range of clinical indications for which they are used is unclear. What does this paper add? Increasing antimicrobial resistance and a concurrent paucity of new antimicrobials being marketed globally is increasing the risk that patients may develop infections that cannot be treated with registered products. This study describes the range of clinical conditions for which registered antimicrobials are not available or appropriate, illustrating the challenges associated with sustainable access to effective treatments. What are the implications for practitioners? Access to effective antimicrobials in a timely manner is essential for optimal patient outcomes. Reliance on unregistered products is associated with increased risks regarding timely access to safe, quality-assured, effective medicines.