Objectives
To compare rates and trends in hospital admissions due to medication misadventure for older adults (≥65 years) with and without dementia.
Methods
A retrospective analysis of hospital admissions that occurred between 2012 and 2016, for medication misadventures among older adults living in regional Australia.
Results
Medication misadventures contributed to 10 555 (4.6%) of the total 228 165 admissions for older adults over the study period. Among these admissions, older adults with dementia were three times more likely to be hospitalised with medication misadventures (14.0%), than their non‐dementia counterparts (4.2%). Medication misadventures relating to “anticoagulants” and “opioids/related analgesics” accounted for the majority of admissions (24.3% dementia vs 30.7% non‐dementia).
Conclusions
This study highlights that the proportion of older adults hospitalised for a medication misadventure is much higher among those with dementia, than those without dementia. Strategies should target older adults, and especially those with dementia, to reduce medication‐related harm and improve patient safety.
To undertake a scoping review of pharmacist activities in opioid medicines management in primary care settings, including those developed or led by pharmacists, or in which pharmacists were members of broader multidisciplinary teams, and to collate the activities, models of care and settings, and reported outcomes. The bibliographic databases MEDLINE, EMBASE, International Pharmaceutical Abstracts, CINAHL, SCOPUS and Web of Science were searched. Studies with quantitative evaluation and published in English were eligible. Participants were patients with any pain category or an opioid use disorder, and healthcare providers. Studies originating in hospitals or involving supply functions were not included. Screening of literature and data charting of results were undertaken by two researchers. The 51 studies included in the scoping review occurred in primary care settings collated into four categories: general practice or primary care clinics, healthcare organisations, community pharmacies and outreach services. Studies were primarily of opioid use in chronic, noncancer pain. Other indications were opioid use disorder, cancer and dental pain. Pharmacist activities targeted risk mitigation, patient and provider education and broader, strategic approaches. Patient-related outcomes included reduced opioid load, improved functionality and symptom management, enhanced access to services and medication-assisted treatments, and engagement in risk-mitigation strategies. Behaviour change of providers was demonstrated. The review has identified the significant contribution that pharmacists working in primary care settings can make to minimise harm from opioids. Strategies implemented in isolation have the potential to further reduce adverse clinical outcomes with greater collaboration and coordination, such as opioid stewardship.
Aim: To assess the adherence of antibiotic prescribing in emergency departments (ED) to hospital guidelines. Method: A four-week concurrent review was undertaken in the ED of three teaching hospitals. All parenteral antibiotic courses initiated in the ED were classified as adherent to guidelines, non-adherent to guidelines or indeterminate. Courses adhering to guidelines were then divided into four prescriber categories: intern, resident, registrar, or consultant. A prescriber questionnaire was administered in one hospital to determine prescriber access to the Antibiotic Guidelines (Therapeutic Guidelines -9th edition). Results: Of the 273 cases of parenteral antibiotics prescribed, 58 (21%) adhered to the hospital guidelines, 197 (72%) did not adhere and 18 (7%) were classified as indeterminate. After considering local prescribing patterns, the proportion of adherence was still only 54%. There were no significant differences in the proportion of adherence between the four prescriber categories. In the surveyed hospital, 71 % of prescribers had access to the Antibiotic Guidelines 9th edition. Conclusion: There was low adherence to antibiotic guidelines within the ED. Prescriber experience was not a significant influence on this result. Aust J Hosp Pharm 1999; 29: 155-8.
Full text free online at www.australianprescriber.com editOriAL In recent years drug regulatory agencies have required drug companies to prepare risk management plans, however these plans are predicated on known risks. The revelation of risks occurs, far too slowly, over time. Better postmarketing surveillance would need to involve more than 10% of adverse drug reactions being reported to the FDA. It would then be sooner rather than later that the required number of adverse reactions occurred to force a change in the product information or the withdrawal of the drug.Drugs which have been available for more than seven years have already gone through the tests of time and the amount of information about their risks has expanded enormously from what was available when they were initially approved. The worst offenders have either been removed from the market or have important new information about harm that will aid prescribers and patients concerning safer use. As a result, for most patients using older drugs for their approved indications, the benefits will hopefully outweigh the risks.
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