ORCID Profile
0000-0001-9973-217X
Current Organisation
WA Country Health Service
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Publisher: Wiley
Date: 09-2013
DOI: 10.1002/J.2055-2335.2013.TB00253.X
Abstract: To determine volume loss when Schedule 8 (S8) liquid medicines are measured during routine dispensing and checking processes. A literature review and policy review of local, state and territory practices pertaining to S8 liquid medicines discrepancies was conducted, including measuring techniques, monitoring and reporting requirements. Hospital staff and manufacturers were surveyed to identify commonly used measuring techniques relevant to S8 liquid medicines. Subsequently, an experiment was conducted with 3 measuring techniques (bung, needle, cannula) to identify if measuring technique, S8 liquid viscosity, frequency of dispensing and duration of storage influence volume loss. Policy review did not uncover substantial guidelines to inform practice. Survey findings demonstrated a lack of uniformity with the 3 commonly used measuring techniques. These 3 techniques were investigated. A bung with an oral syringe resulted in the least amount of loss independent of the frequency of dispensing or viscosity of the liquid measured less than 1% of the liquid remained in the syringe after a dose was removed. Average discrepancy associated with this technique was 3.4% when the volume recorded in the S8 register was compared to the actual volume measured at each dispensing. Under laboratory conditions, volume loss through routine measurement and dosing of S8 liquid medicines was on average 3.4%. We recommend that a 4% discrepancy for S8 liquid medicines be included in institutional policies when utilising the bung and oral syringe technique.
Publisher: Wiley
Date: 04-2020
DOI: 10.1002/JPPR.1651
Publisher: Wiley
Date: 02-2022
DOI: 10.1002/JPPR.1795
Publisher: CSIRO Publishing
Date: 02-09-2021
DOI: 10.1071/AH21046
Abstract: Objective This study investigated antibiotic prophylaxis (AP) guideline adherence and the cardiac implantable electronic device (CIED) infection rate in two major Australian public teaching hospitals. Methods In a retrospective observational study, the medical records of patients who underwent CIED procedures between January and December 2017 were reviewed (Hospital A, n = 400 procedures Hospital B, n = 198 procedures). Adherence to AP guidelines was assessed regarding drug, dose, timing, route and frequency. Infection was identified using follow-up documentation. Results AP was administered in 582 of 598 procedures (97.3%). Full guideline adherence was observed in 33.9% of procedures (203/598) and differed significantly between Hospitals A and B (47.3% vs 7.1%, respectively P 0.001). Common reasons for non-adherence were the timing of administration (42.3% vs 60.6% non-adherent in Hospitals A and B, respectively P 0.001) and repeat dosing (19.3% vs 78.8% non-adherent in Hospitals A and B, respectively P 0.001). Twenty infections were identified over 626.6 patient-years of follow-up (mean (±s.d.) follow-up 1.0 ± 0.3 years). The infection rate was 3.19 per 100 patient-years (P = 0.99 between hospitals). Two devices were removed due to infection no patients died from CIED infection. Conclusions Although the rate of serious CIED infection was low, there was evidence of highly variable and suboptimal antibiotic use, and potential overuse of AP. What is known about the topic? Previous Australian studies have revealed high rates of inappropriate surgical AP. CIED infections are potentially life threatening, but can be avoided through effective use of AP. However, prolonged durations of AP in this setting may also result in complications, including Clostridioides difficile infection. What does this paper add? This study, the first to our knowledge to focus specifically on adherence to Australian guidelines for AP in CIED procedures, highlighted several common issues between AP in this setting and surgical and procedural AP more broadly. ‘Early’ and ‘late’ dose administration and extended post-procedural AP were common. Only 34% of prescriptions fully adhered to the guidelines practices varied significantly between the two hospitals. What are the implications for practitioners? There is a clear need for institution-specific antimicrobial stewardship strategies to optimise AP in CIED procedures, aligned with the Antimicrobial Stewardship Clinical Care Standard. Patients are being placed at potentially avoidable risk of both complications of extended durations of AP and CIED infection, although the rate of serious CIED infection was low. A standardised approach to surveillance of CIED infections and prospective multisite audits of AP in CIED procedures using a validated tool, such as the Surgical National Antimicrobial Prescribing Survey, are recommended to better inform evidence-based practice. Potential strategies to optimise guideline adherence include prescribing support in patients with immediate penicillin hypersensitivity or methicillin-resistant Staphylococcus aureus colonisation, optimising the in-patient location of drug administration to promote timely dosing, limiting inappropriate post-procedural prophylaxis and routine S. aureus screening and decolonisation.
Publisher: SAGE Publications
Date: 08-04-2019
Publisher: Wiley
Date: 23-05-2022
DOI: 10.1111/IMJ.15393
Abstract: Guidelines advocate multifactorial cardiovascular risk management in patients with diabetes and atherosclerotic cardiovascular disease. In hospitalised patients with diabetes following coronary artery bypass graft (CABG), we aimed to evaluate the impacts of decision-support algorithms for optimising glycaemia and lipid-lowering. We also assessed the safety of initiating sodium-glucose cotransporter 2 (SGLT2) inhibitors near time of hospital discharge. This was a single-site, pre- and post-intervention analysis of glucose and lipid management in consecutive hospitalised patients with diabetes undergoing CABG surgery. The intervention involved education and decision-support algorithms designed by a multidisciplinary committee to guide cardiac surgery unit clinicians. A total of 200 patients were included in the study. The pre- and post-intervention groups had similar baseline characteristics (HbA1c 7.9 ± 1.9% vs 8.1 ± 1.8%). Of 4092 blood glucose measurements, the incidence of levels between 5 and 10 mmol/L was not different post-intervention (55.5% vs 57.0% P = 0.441). Fewer endocrinology consultations occurred (59.0% vs 45.0% P = 0.048) and rates of hypoglycaemia remained low. High-intensity statin was prescribed in >90% pre- and post-intervention, although non-statin lipid-lowering agents remained <10% despite patients not achieving LDL-C targets. No 30-day readmissions for diabetic ketoacidosis occurred in patients prescribed SGLT2 inhibitors. The intervention did not improve inpatient glycaemia or increase non-statin lipid-lowering prescriptions in patients with diabetes following CABG surgery but did reduce reliance on specialty input. Initiation of SGLT2 inhibitor therapy near time of hospital discharge was not associated with safety concerns. Alternative interventions or strategies are required to optimise glycaemia and non-statin lipid-lowering therapy prescribing in this setting.
Publisher: Springer Science and Business Media LLC
Date: 30-05-2020
Publisher: Wiley
Date: 03-2021
DOI: 10.1111/IMJ.15245
No related grants have been discovered for Adam Hort.