The primary objective of this quality improvement project was to measure and reduce the number of oxycodone immediate-release tablets dispensed to overnight stay surgical patients at discharge. The secondary objective was to reduce the proportion of inappropriate oxycodone immediate-release prescriptions at discharge. Interrupted time series analysis was performed in four surgical wards of St Vincent's Public Hospital, Sydney. The baseline period was from January 2005 to August 2013. Interventions and followup occurred until July 2017. Baseline audit of oxycodone immediate-release tablet numbers showed prescribing increased significantly with a monthly linear trend of 1.8 (95%CI = 1.4-2.3; p = 0.001) tablets/100 surgical admissions from January 2005 to August 2013. Four sequential interventions produced no significant change in the primary objective. At the end of the first month of a fifth intervention, comprising audit-feedback plus individual academic detailing, the average number of oxycodone tablets decreased by 77 (95%CI 39-115) tablets/100 surgical cases, and the postintervention linear trend was a monthly reduction of 3.2 (coefficient À3.2 (95%CI À4.5 to À1.8); p = 0.001) tablets/100 surgical admissions. Baseline audit showed 27% of oxycodone prescriptions to be inappropriate. Following our intervention, this dropped to 17% (p = 0.048), and then to 10% (p = 0.002) after 3 years.

Background Recording pharmacy activities beyond clinical pharmacist interventions is challenging. Traditional methods of manual data collection are cumbersome and time consuming. Technology, such as barcode scanners, has the potential to provide a portable, reproducible and simplified approach to data collection. Allied health disciplines at St Vincent's Hospital, Sydney successfully switched from manually collecting daily activity data to an electronic system using barcode technology (Activity BarCoding). Aim To introduce Activity BarCoding into the pharmacy department and collect data on daily pharmacy activities. Method Activity BarCoding software was installed and barcode scanners were purchased. Based on the Society of Hospital Pharmacists of Australia's definitions, pharmacy activities were divided into: clinical care, management, distribution services, research, and teaching and training. Sub‐categories were developed for each activity type, as well as interventions to describe clinical activity. Barcodes were produced for all activities. After a 6‐month development phase, implementation began in June 2011. The system was rolled out over 18 months to all pharmacy staff. 12 months after implementation, pharmacists were surveyed about their perceptions of the Activity BarCoding system. Results During November 2012, 39 users recorded 5809.5 hours of activity − 22% (1279.3 h) clinical care, 44% (2573.7 h) distribution services, 13% (777.5 h) management, 2% (96.6 h) research and 1% (61.5 h) teaching and training. Inpatient and outpatient dispensary activities accounted for 40% (1033.5 h) and 28% (712.5 h) of the distribution hours, respectively. Of the 20 users surveyed, 55% disagreed and 15% strongly disagreed that data collection was too labour intensive. Conclusion Activity BarCoding was successfully introduced into the pharmacy department to collect data on daily pharmacy activities. The system was flexible, easy to use and integrated well into a busy work place.

Background: Therapeutic drug monitoring (TDM) is increasingly becoming part of the management of antiretroviral therapy for the treatment of HIV. Aim: To review the role ofTDM in HIV therapy focusing on the indications for its use and resultant changes to drug therapy. Method: A 6-month retrospective review of protease inhibitor TDM requests made by HIV clinicians was conducted. Patient medical records, STOCCA (dispensing program), pathology and the HIV outpatient unit database were reviewed to classify each TDM episode according to indication and outcome. Results: 50 protease inhibitor TDM requests were identified for 38 patients. Indications for use ofTDM included 47 cases of suspected inadequate dosing, two suspected toxicities and one suspected drug interaction. Therapy was altered in approximately 16% of all protease inhibitor TDM requests. Drug dose alterations were recorded for 7 of 4 7 levels measured for adequate dosing and 1 of the 2 levels measured for suspected toxicities. Conclusion: TDM is a valuable tool in managing antiretroviral therapy. It may play an important role in detecting both suboptimal or potentially toxic levels of protease inhibitors, which is an important factor in the success of antiretroviral therapy and the management ofHN.

Background The emergency medicine pharmacist (EMP) represents a new field of pharmacy practice in many hospitals and at St Vincent's Hospital Sydney the EMP visits the emergency department (ED) daily Monday to Wednesday (MW), with other pharmacists providing services on Thursday and Friday. Because newer practice areas need to justify services, barcode technology offers an efficient means to collect service provision data. Aim The aim of this study was to determine whether barcode scanning could be used to efficiently describe and quantify EMP services, including the time involved in undertaking activities. Method The Activity BarCoding (ABC®) system is a commercially available software package that involves using a portable barcode scanner to collect and present data as an activity profile. The ABC® data generated for the EMP were reviewed for September 2012–March 2013. Results The MW EMP spent 124.5 h undertaking ED clinical care activities (1.48 h/day). In all, 634 patients were seen and, on average, the MW EMP spent 8.94 min with each patient (range: 6.97–9.93 min). Both clinical and non‐clinical activities could be described, with time allocation and interventions easily quantifiable. Discussion Barcode technology accurately recorded the variety of and time required for activities performed by the EMP and demonstrated EMP involvement in ED patient care. It provides information that describes and quantifies EMP services that can be used for business case development and service improvements. Further standardisation of activity and intervention categories will enhance data collection, benchmarking possibilities and multicentre research.

No abstract