ORCID Profile
0000-0003-4385-8544
Current Organisations
Murdoch Children's Research Institute
,
Deakin University
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Wiley
Date: 28-01-2023
DOI: 10.1002/JPPR.1852
Abstract: 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. 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. 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. 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. 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.
Publisher: Wiley
Date: 12-2020
DOI: 10.1002/JPPR.1699
Publisher: The Society of Hospital Pharmacists of Australia
Date: 25-02-2022
DOI: 10.24080/GRIT.1354
Publisher: Wiley
Date: 25-03-2023
DOI: 10.1002/JPPR.1859
Abstract: Invasive candidiasis (IC) surveillance demonstrates an increasing incidence of resistance to azole‐based therapy. Consequently, echinocandins are often considered first‐line treatment for IC in critically ill patients. To better understand the complexities of decision‐making around echinocandin initiation, an evidence‐based audit tool was developed. To describe echinocandin initiation and compliance with current guidelines. A retrospective audit of echinocandin initiation was conducted between 1 January 2020 and 31 December 2020 at a quaternary referral hospital. An audit tool was developed by infectious diseases physicians and antimicrobial stewardship pharmacists, capturing patient demographics, microbiological results, indication for therapy, and risk factors for invasive fungal disease (IFD). Local guideline compliance was determined. This project was determined to be a quality improvement project and was not required to undergo ethical review according to the Alfred Hospital Ethics Committee procedures. One hundred sixty‐seven patients were initiated on 214 courses of echinocandin therapy. Caspofungin was most commonly prescribed ( n = 172, 80%). Of the 167 patients, most ( n = 119, 71%) were in the intensive care unit at the time of initiation. Empiric therapy for sepsis or infection of unclear source was the most commonly documented indication ( n = 117, 55%) 71% ( n = 153) of all courses were deemed empiric therapy, followed by directed therapy ( n = 55, 26%). The most common risk factors for IFD were recent exposure to broad‐spectrum antimicrobial therapy ( n = 165, 99%) and the presence of a urinary catheter ( n = 141, 84%). Most first doses were compliant with local guidelines ( n = 144, 67%). Echinocandin therapy was commonly prescribed in critically ill patients with risk factors for IFD. Although the majority of prescriptions were empiric and compliant with local guidelines, improved guidelines incorporating additional patient factors should be included in future antifungal stewardship initiatives.
Publisher: Wiley
Date: 29-03-2023
DOI: 10.1111/CTR.14982
Abstract: The frequency and significance of cytomegalovirus (CMV) infection in seropositive (R+) heart transplant recipients (HTR) is unclear, with preventative recommendations mostly extrapolated from other groups. We evaluated the incidence and severity of CMV infection in R+ HTR, to identify risk factors and describe outcomes. R+ HTR from 2010 to 2019 were included. Antiviral prophylaxis was not routinely used, with clinically guided monitoring the local standard of care. The primary outcome was CMV infection within one‐year post‐transplant secondary outcomes included other herpesvirus infections and mortality. CMV infection occurred in 27/155 (17%) R+ HTR. Patients with CMV had a longer hospitalization (27 vs. 20 days, unadjusted HR 1.02, 95% CI 1.00–1.02, p = .01), higher rate of intensive care readmission (26% vs. 9%, unadjusted HR 3.46, 1.46–8.20, p = .005), and increased mortality (33% vs. 8%, unadjusted HR 10.60, 4.52–24.88, p .001). The association between CMV and death persisted after adjusting for multiple confounders (HR 24.19, 95% CI 7.47–78.30, p .001). Valganciclovir prophylaxis was used in 35/155 (23%) and was protective against CMV (infection rate 4% vs. 27%, adjusted HR .07, .01–.72, p = .025), even though those receiving it were more likely to have received thymoglobulin (adjusted OR 10.5, 95% CI 2.01–55.0, p = .005). CMV infection is common in R+ HTR and is associated with a high burden of disease and increased mortality. Patients who received valganciclovir prophylaxis were less likely to develop CMV infection, despite being at higher risk. These findings support the routine use of antiviral prophylaxis following heart transplantation in all CMV R+ patients.
Publisher: Springer Science and Business Media LLC
Date: 02-01-2021
Publisher: Wiley
Date: 19-03-2022
DOI: 10.1002/JPPR.1802
Abstract: To investigate physical health outcomes associated with medications prescribed to manage chronic physical conditions in people living with dementia and determine whether a dementia diagnosis altered drug utilisation patterns for physical health conditions. Medline, Embase, Central and Scopus were searched 01/2011 to 12/2020. Experimental and observational studies, where participants with dementia using medications prescribed by doctors to prevent or treat one or more chronic comorbid physical condition, were compared to no intervention, usual care, or a non‐dementia comparison group. The outcomes of interest were clinically meaningful physical outcomes, and medication utilisation patterns. Ten studies met the inclusion criteria. All were of medium to high quality relative to their study design. Mixed findings were reported for ischemic stroke ( n = 3), all‐cause mortality ( n = 3) and bleeding‐related outcomes ( n = 2). This is likely due to the heterogeneity in exposures reported. One study found that people with dementia, receiving antidiabetic management, had a higher rate of severe hypoglycaemia compared to people without dementia. Medication utilisation pattern outcomes included oral anticoagulant use before stroke‐related hospitalisation ( n = 1), antithrombotic medication use before stroke‐related hospitalisation ( n = 1), cardiovascular medication use for secondary prevention of ischemic heart disease ( n = 1), antidepressant medication discontinuation ( n = 1), osteoporosis treatment ( n = 1), diabetic medication use ( n = 2), and antihypertensive medication discontinuation ( n = 1). This systematic review showed there is currently insufficient evidence to conclude that medication management in people with dementia should differ substantially to people without dementia. Comprehensive and high‐quality evidence is needed to improve confidence that medication prescribing achieves optimum clinical outcomes, quality of life, and benefit‐to‐risk determination in this vulnerable population.
Publisher: Wiley
Date: 19-08-2022
DOI: 10.1002/JPPR.1825
Abstract: There are few studies evaluating the workforce and the time allocated to tasks performed by clinical specialty pharmacists in Australia. The aim of this study was to quantify the time that clinical specialty pharmacists spend on various activities. A Work Observation Method by Activity Timing (WOMBAT) time and motion study was conducted at a tertiary‐referral metropolitan health service with comprehensive unit‐based clinical pharmacy services. Direct observations of clinical pharmacists were conducted by researchers during weekdays. Tasks and times observed were categorised into domains of ‘What, Who, How, and Where’, accounting for interruptions and multitasking. Eighteen clinical cardiology, respiratory, and geriatric pharmacists were observed over 171.2 h. The majority of time involved direct patient care activities (76.1% [95% confidence interval 72.6–79.6%]), including admission‐related (7.6%), discharge‐related (16.2%), and inpatient clinical tasks (52.5%). Activities were undertaken independently (55.9%) with doctors (26.2%), with nurses (10.5%), or with patients (9.6)% 19.1% of the pharmacist’s day involved multitasking. The tasks most frequently performed together were inpatient clinical activities, including rounding and daily medicine review. This study quantified the typical task allocation of clinical pharmacists in cardiology, respiratory, and geriatric units. It demonstrated that in a hospital setting supported by comprehensive operational pharmacy services, clinical pharmacists working in acute and subacute clinical specialities, predominately undertake direct patient care tasks that have been shown to improve patient safety.
Publisher: Wiley
Date: 02-2021
DOI: 10.1002/JPPR.1709
Publisher: Springer Science and Business Media LLC
Date: 27-10-2021
No related grants have been discovered for Mia Percival.