ORCID Profile
0000-0001-9822-7083
Current Organisations
Monash University
,
National Drug and Alcohol Research Centre
,
UNSW
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Publications
The assessment and pharmacological management of osteoporosis after admission for minimal‐trauma fracture at a major metropolitan centre
Publisher: Wiley
Date: 28-11-2020
DOI: 10.1002/JPPR.1674
Mo1854 - Pharmacist-Led Proactive Therapeutic Drug Monitoring with Infliximab (Proximo): Utility of and Cost Saving Associated with the use of a Rapid Assay for Assessing Drug Level
Publisher: Elsevier BV
Date: 05-2018
Prophylaxis and Management of Postoperative Atrial Fibrillation and Flutter in Patients Undergoing Surgery for Coronary Artery Disease and Valvular Heart Disease
Publisher: Elsevier BV
Date: 2018
Use of Dual Antiplatelet Therapy in Combination With Oral Anticoagulants Following Percutaneous Coronary Intervention
Publisher: Elsevier BV
Date: 2018
Reducing the Burden of Complex Medication Regimens: SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) Cluster Randomized Controlled Trial
Publisher: Elsevier BV
Date: 08-2020
Comparing the accuracy of medication order verification between pharmacists and a tech check tech model: A prospective randomised observational study.
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.SAPHARM.2017.11.007
Abstract: Medication errors have the potential to cause significant harm and the final verification of dispensed medications is essential to patient safety. There is international evidence to demonstrate that trained pharmacy technicians can safely and accurately undertake the verification of medication orders in ward-based unit dose containers. There is a need for evaluation of pharmacy technician verification of medication orders in broader contexts including the hospital inpatient dispensary. To compare the accuracy of Accuracy Checking Pharmacy Assistants (ACPTs) to pharmacists when verifying inpatient medication orders within the hospital pharmacy setting. This 'real world' single-blinded study was conducted in the inpatient dispensary of a major tertiary hospital in Melbourne, Australia. Inpatient medication orders were randomly allocated to an ACPT or pharmacist for final verification, before being reviewed for accuracy by an independent research pharmacist blinded to study allocation. Errors identified by the reviewing pharmacist were documented and severity was assessed by an independent Medication Safety pharmacist. Between February and August 2014, three ACPTs verified 4718 items with 75 errors missed (1.59%), and twelve pharmacists verified 4194 items with 158 errors missed (3.77%). There was a statistically significant difference between both total and minor error rates, with pharmacists missing significantly more errors (total errors: p < 0.0001 minor errors: 1.42 vs 3.53% p < 0.0001). There was no statistically significant difference in the rate of major errors missed by the two groups (0.17 vs 0.24% p = 0.48). This study is the first of its kind in the hospital dispensary setting, demonstrating that the overall accuracy of ACPTs was greater than pharmacists for verifying dispensed medication orders. ACPTs missed fewer minor and overall errors than pharmacists, indicating that trained pharmacy technicians can verify medication orders safely and accurately. This study provides support for the tech-check-tech model in the hospital setting.
The impact of an innovative pharmacist-led inpatient opioid de-escalation intervention in post-operative orthopedic patients
Publisher: Weston Medical Publishing
Date: 05-2020
Abstract: Objective: Many patients are discharged from hospital after surgery with excessive doses of opioid, and prescription opioid addiction has become a serious public health problem. Inpatient opioid de-escalation performed by clinical pharmacists may assist in reducing opioids before discharge. We aimed to evaluate whether clinical pharmacist-led opioid de-escalation for inpatients after orthopedic surgery led to significant reductions in opioid use at discharge, without resulting in greater pain intensity and side effects.Design: This retrospective pre- ost-intervention study evaluated patients before and after implementation of a pharmacist-led opioid de-escalation service.Setting: A major tertiary institution.Participants: Ninety eight participants underwent de-escalation, and 98 controls received standard care following orthopedic surgery.Intervention: Pharmacist-led opioid de-escalation was initiated after discharge from the institution's Acute Pain Service.Main outcome measure: Primary outcome was total morphine oral equivalence (MOE) required in the 24-hours before discharge between the two groups. Secondary outcomes included pain intensity scores and opioid-related side effects. Results: The post-intervention group used significantly less opioids in the 24 hours preceding discharge compared with the precohort (total MOE 30 vs 45 mg p = 0.025).There were no differences in pain intensity at rest (p = 0.19) or with movement (p = 0.19). Cases experienced significantly less constipation (29 vs 49 percent p = 0.004) no differences were observed for other side effects.Discussion: We observed statistically similar pain intensity ratings, in the setting of significantly lowered opioid doses among the post-intervention group prior to discharge.Conclusion: Pharmacist-led inpatient opioid de-escalation is effective, does not increase pain intensity, and reduces constipation. Hospitals should explore the viability of extending pharmacist-led opioid de-escalation to other surgical patients and following hospital discharge, aiming for opioid cessation.
An Observational Analysis of Medication Use During 5,727 Medical Emergency Team Activations at a Tertiary Referral Hospital.
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.JCJQ.2019.03.001
Abstract: Medical emergency teams (METs) rescue deteriorating patients as the response arm of hospital rapid response systems. This study aimed to (1) investigate medication use during MET activations by describing the type, frequency and access sources of medications and (2) assess associations between patient characteristics, MET activation criteria, and outcomes and MET medication use. A single-center, retrospective study from a prospective database of MET activations in an Australian tertiary referral hospital was undertaken. Consecutive adult MET activations over a 12-month period were included. Across the study period, there were 5,727 MET activations with medications used at 33.5% (n = 1,920). Of 2,648 medications used, cardiac system agents (n = 944 35.6%) were the most common category used, while intravenous electrolytes (n = 341 12.9%) and opioid analgesics (n = 248 9.4%).were the most frequently used medications. Most commonly, medications were sourced from ward stocks. High blood pressure, heart or respiratory rate, pain, and multiple activation criteria were associated with MET medication use (p < 0.001). Patients who required medications were less likely to remain on the ward, and immediate admission to the ICU was approximately doubled (odds ratio = 1.90 95% confidence interval = 1.47-2.45). Medication use by the MET was common and associated with escalation to intensive care. A wide variety of medications, principally from ward stocks, were used with some predictability based on activation criteria. Local system improvements have demonstrated that by focusing on common MET syndromes and medications, further investigation can refine and improve medication use and management systems for deteriorating patients.
Educating junior doctors and pharmacists to reduce discharge prescribing of opioids for surgical patients: a cluster randomised controlled trial
Publisher: AMPCo
Date: 10-10-2020
DOI: 10.5694/MJA2.50812
P428 Pharmacist-led proactive therapeutic drug monitoring with infliximab (PROXIMO): Utility of and cost-saving associated with the use of a rapid assay for assessing drug level
Publisher: Oxford University Press (OUP)
Date: 16-01-2018
Impact of medication regimen simplification on medication incidents in residential aged care: Simpler randomized controlled trial
Publisher: MDPI AG
Date: 06-03-2021
DOI: 10.3390/JCM10051104
Abstract: In the SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) cluster-randomized controlled trial, we investigated the impact of a structured medication regimen simplification intervention on medication incidents in residential aged care facilities (RACFs) over a 12-month follow-up. A clinical pharmacist applied the validated 5-step Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE) for 96 of the 99 participating residents in the four intervention RACFs. The 143 participating residents in the comparison RACFs received usual care. Over 12 months, medication incident rates were 95 and 66 per 100 resident-years in the intervention and comparison groups, respectively (adjusted incident rate ratio (IRR) 1.13 95% confidence interval (CI) 0.53–2.38). The 12-month pre ost incident rate almost halved among participants in the intervention group (adjusted IRR 0.56 95%CI 0.38–0.80). A significant reduction in 12-month pre ost incident rate was also observed in the comparison group (adjusted IRR 0.67, 95%CI 0.50–0.90). Medication incidents over 12 months were often minor in severity. Declines in 12-month pre ost incident rates were observed in both study arms however, rates were not significantly different among residents who received and did not receive a one-off structured medication regimen simplification intervention.
Impact of medication regimen simplification on medication administration times and health outcomes in residential aged care: 12 month follow up of the SIMPLER randomized controlled trial
Publisher: MDPI AG
Date: 08-04-2020
DOI: 10.3390/JCM9041053
Abstract: In the SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) cluster-randomized controlled trial, we evaluated the impact of structured medication regimen simplification on medication administration times, falls, hospitalization, and mortality at 8 residential aged care facilities (RACFs) at 12 month follow up. In total, 242 residents taking ≥1 medication regularly were included. Opportunities for simplification among participants at 4 RACFs were identified using the validated Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE). Simplification was possible for 62 of 99 residents in the intervention arm. Significant reductions in the mean number of daily medication administration times were observed at 8 months (−0.38, 95% confidence intervals (CI) −0.69 to −0.07) and 12 months (−0.47, 95%CI −0.84 to −0.09) in the intervention compared to the comparison arm. A higher incidence of falls was observed in the intervention arm (incidence rate ratio (IRR) 2.20, 95%CI 1.33 to 3.63) over 12-months, which was primarily driven by a high falls rate in one intervention RACF and a simultaneous decrease in comparison RACFs. No significant differences in hospitalizations (IRR 1.78, 95%CI 0.57–5.53) or mortality (relative risk 0.81, 95%CI 0.48–1.38) over 12 months were observed. Medication simplification achieves sustained reductions in medication administration times and should be implemented using a structured resident-centered approach that incorporates clinical judgement.
Evaluation of NovoRapid infusion as a treatment option in the management of diabetic ketoacidosis.
Publisher: Wiley
Date: 11-2017
DOI: 10.1111/IMJ.13607
Abstract: This study evaluates the clinical efficacy and safety of NovoRapid (insulin aspart) compared to Actrapid™ (human neutral insulin) for diabetic ketoacidosis (DKA). In this retrospective study involving 40 patients, no statistically significant differences were observed between biochemical variables, infusion duration or complications in patients treated with insulin aspart or human neutral insulin. These results support the use of insulin aspart as an effective and safe alternative to human neutral insulin in DKA.
Use of pharmacological and nonpharmacological treatments for chronic noncancer pain among people using opioids: a longitudinal cohort study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 17-09-2021
DOI: 10.1097/J.PAIN.0000000000002484
Abstract: Although multimodal management of chronic noncancer pain (CNCP) is recommended, long-term treatment utilization patterns among people using opioids are not well known. The Pain and Opioids IN Treatment study recruited Australian adults receiving opioids for CNCP for more than 6 weeks from community pharmacies. Pharmacological (opioid and nonopioid analgesics and psychotropic medicines) and nonpharmacological (physical, mental health, and specialized) treatments used in the previous 12 months and 30 days were collected annually over 4 years (2015-2018). Associations were explored between 30-day treatment use and sociodemographic characteristics and pain measures. Overall, 1334 participants completed at least one annual follow-up. The median pain severity (5.0, interquartile range [IQR] 3.8 to 6.3) and pain interference scores (5.7, IQR 3.9-7.3) indicated moderate pain throughout the study period, despite most participants reporting the use of nonopioid pharmacological (12 month: 97.6% and 30 day: 96.8%) and nonpharmacological treatments (12 month: 91.8% and 30 day: 66.1%). Some treatment use was inconsistent with guidelines: ongoing nonsteroidal anti-inflammatory drugs and sedative-hypnotic use were common, whereas fewer people engaged with pain management programs (12 month: 22.3%). Private health insurance was associated with using physical (adjusted odds ratio 1.61, 99.5% confidence intervals 1.15-2.24) and specialized nonpharmacological treatments (adjusted odds ratio 1.47, 99.5% confidence intervals 1.14-1.91). This study demonstrates that many Australians taking opioids long-term for CNCP also use nonopioid pharmacological and nonpharmacological treatments. The use of pharmacological treatments including nonsteroidal anti-inflammatory drugs, psychotropic medicines, and gabapentinoids, outside guidelines, warrants review. Furthermore, despite Australia's universal healthcare scheme subsidising some nonpharmacological treatments, overall use of these treatments was associated with having private health insurance, highlighting a need for more equitable service provision.
Self-reported challenges obtaining ongoing prescription opioids among Australians with chronic non-cancer pain
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.DRUGPO.2022.103708
Abstract: Policies to address opioid-related harms include strategies to reduce opioid prescribing for new and ongoing pain management. Concerns have been raised that people with chronic non-cancer pain (CNCP) may be adversely affected by prescribing restrictions, and by involuntary tapering and cessation of opioids. We describe self-reported challenges obtaining prescription opioids among people prescribed opioids long-term for CNCP and explore associations with participant and treatment characteristics. This cross-sectional study analysed data from a longitudinal cohort study of Australians prescribed restricted opioids for CNCP. In 2018, 861 participants who took part in Year 5 follow-up and who also reported past 12-month opioid use were asked about challenges obtaining opioid prescriptions, including prescriber access-related difficulties obtaining prescriptions or having opioids tapered or ceased involuntarily. Associations between challenges and demographics, treatment characteristics including daily opioid dose as oral morphine equivalent milligrams (OME mg/day), substance use disorder (SUD), and opioid dependence were assessed. Overall, 285 (31%) participants reported at least one challenge, predominantly prescriber access-related difficulties (n=177/285 62%). Prescriber access-related difficulties were associated with younger age (adjustedOR 0.94 per year increase, 95%CI 0.93-0.96), and past 12-month pharmaceutical opioid dependence (adjustedOR 2.25, 95%CI 1.33-3.80). Involuntary opioid tapering or cessation was reported by 73 participants (26% of those reporting challenges) and was associated with lifetime SUD diagnosis (adjustedOR 2.15, 95%CI 1.15-3.90), and opioid doses of ≥200 OME mg/day (adjustedOR 2.41, 95%CI 1.18-4.88). One-third of participants with CNCP reported experiencing challenges obtaining prescriptions for opioids or having their opioid medicines involuntarily reduced. Given increasing restrictions to opioid access, it is important that strategies to reduce opioid-related harms are balanced against the current treatment needs of people prescribed opioids long-term for CNCP.
Unintentional mortality associated with paracetamol and codeine preparations, with and without doxylamine, in Australia.
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.FORSCIINT.2017.11.026
Abstract: Misuse of paracetamol, codeine and doxylamine combination analgesics may lead to addiction and mortality. This study aimed to (1) identify unintentional deaths in Australia associated with use of combination analgesic products containing paracetamol, codeine and doxylamine (2) describe cases characteristics, including demographics and additional medication use and (3) identify common factors associated with misuse and mortality of these medicines in Australia. This retrospective case series analysed National Coronial Information System data to identify cases of unintentional death attributable to paracetamol, codeine and doxylamine products between 2002 and 2012. Three Eastern Australian states: New South Wales, Queensland, Victoria, comprising a population of approximately 18.6 million people. 441 unintentional deaths attributed to paracetamol/codeine products were identified doxylamine was detected in 102 cases (23%). Overall unintentional death rates rose from 0.9-per-million in 2002 to 3.6-per-million in 2009, declining to 1.9-per-million in 2012. Median age at time of death was 48, half of all cases occurred between 35-54 years of age, and 57% were female. Concomitant medication use was detected in 79% of cases, including benzodiazepines, other opioids, psychiatric medications, alcohol and illicit drugs. Behaviours consistent with drug misuse including doctor harmacy shopping, excessive dosages and extended use, were identified in 24% of cases. This study identified 441 deaths associated with codeine-combination analgesic products across three Australian states with an average of 40 deaths per year. Death commonly involved multiple substance use and abuse behaviours indicative of misuse and dependence.
Related Organisations
Related Funding Activities
No related grants have been discovered for Ria Hopkins.