Search

Objective. To explore Australian Muslim patients' perceptions and experiences surrounding medication management practices during Ramadan. Methods. This was a qualitative exploration of the views and experiences of Muslim patients who were hospitalised during or shortly prior to Ramadan 2021. Data comprised comments obtained from a cross-sectional telephone or face-toface questionnaire about medications and Ramadan fasting at a tertiary-referral hospital in Melbourne, Australia. A purposeful criterion sampling approach was employed for participant recruitment. Data were analysed using thematic analysis. Data were coded inductively and subthemes and themes were developed via an iterative process. Results. Comments were provided by 88 patients born in a wide range of countries and with a variety of medical and surgical co-morbidities. Themes identified included interpretation of Ramadan fasting, altering medications to facilitate fasting, perceptions about healthcare professionals and health knowledge. Many patients altered their medications to facilitate Ramadan fasting and there was considerable variability in interpretation of what breaks the fast. Patients' perceptions and previous experiences with healthcare professionals determined whether they sought advice about managing their medications during Ramadan or dismissed advice and/or self-managed their medications, sometimes inappropriately. Conclusions. This exploration of Australian Muslim patients found diverse views and experiences around medication practices during Ramadan -- past relationships with healthcare professionals influenced this practice. As there are ramifications for physical, spiritual and family wellbeing, it is imperative that healthcare professionals partner with their Muslim patients to optimise their medication management and health outcomes for Ramadan. [ABSTRACT FROM AUTHOR]

On 21 November 2016, during a thunderstorm asthma event, an external disaster was called in our Emergency Department (ED), the first since comprehensive implementation of electronic clinical documentation. This study compared medication ordering and administration documentation during surge (thunderstorm asthma) and non-surge (control) conditions. Retrospective audit of ED patients presenting with asthma between 21 and 23 November 2016 (72-h thunderstorm asthma period) and equivalent 72-h periods of the preceding three weeks (control period). Demographic details, medical history and treatment were extracted from Cerner Millennium. During the thunderstorm asthma and control periods, 318 and 164 patients presented with respiratory symptoms; 302 (95.0%) and 27 (16.5%) were due to asthma, respectively. Salbutamol was ordered and administration signed on the Medication Administration Record for 122/302 (40.4%) thunderstorm asthma and 21/27 (77.8%) control patients (p < 0.01). During the thunderstorm asthma period, 52/302 (17.2%) patients had no documentation on the Medication Administration Record or any ED notes of receiving salbutamol, whilst during the control periods 2/27 (7.4%) patients had no such documentation. Similar disparities with corticosteroids and ipratropium were identified. Quality of medication documentation declined during surge conditions. These data have informed policies for future surge events, when higher risk medications might be required. [ABSTRACT FROM AUTHOR]

Objective To determine the prevalence and nature of off-label and unlicenced (off-label/unlicenced) medicine administration to paediatric ED patients. Methods We undertook a retrospective, observational study in six EDs ( July 2011 to June 2012, inclusive). Patients, aged 0-17 years, who were administered a medicine in the ED were included. At each site, 50 eligible patients were randomly selected each month of the study period. An explicit review of each patient's records was undertaken. Medicines were classified as on or off-label/unlicenced according to categories of use approved by the Therapeutic Goods Administration. Results There were 3343 patients enrolled (56.5% men, mean ± SD age 6.7 ± 5.4 years). Of the 6786 medicine doses administered, 2072 (30.5%, 95% CI 29.4-31.7%) were off-label/unlicenced. The off-label/unlicenced doses were administered to 1213 (36.3%, 95% CI 34.7-37.9%) patients. Patients administered an off-label/unlicenced medicine were younger than those who were not ( P < 0.01). Salbutamol, ondansetron, ipratropium, fentanyl and oxycodone were the medicines most commonly administered off-label. In 910 (44.0%) cases, the dose/frequency was not approved; in 592 (28.6%), there was an unapproved indication for treatment; in 158 (7.6%), the medicine was administered via an unapproved route; in 154 (7.4%) the medicine was not approved for the weight or age; and in 74 (3.5%) an unlicenced product was administered. The remaining cases had combinations of reasons. Conclusions Off-label/unlicenced medicine administration is common. A registry of commonly used off-label medicines is recommended in which the safety and efficacy of their off-label use have been demonstrated by published evidence. [ABSTRACT FROM AUTHOR]

Objective The study aims to evaluate the impact of a nurse-initiated analgesia pathway ( NIAP) intervention for paediatric patients in the ED. Methods We undertook a pre- and post-intervention trial in a large, tertiary referral, mixed ED. The intervention comprised development and implementation of a comprehensive NIA Standing Order. In addition to paracetamol, which nurses could initiate pre-intervention, they were authorised to administer ibuprofen, paracetamol/codeine combinations and topical local anaesthetics prior to a doctor assessing the patient. All nurses were trained and credentialed prior to administering the NIAP. Patients aged 5-17 years with a triage pain score of ≥4 ( Wong- Baker or numerical rating scale) were eligible for enrolment. The primary outcome was time to analgesia. Secondary outcomes were the proportion of patients who received 'adequate analgesia' and parental satisfaction with ED pain management (measured 48 h post-discharge). Results Fifty-one children were enrolled in both the pre- and post-intervention periods. Patient sex and mean age, weight and triage pain score did not differ between the groups ( P > 0.05). At post-intervention, significantly more patients received nurse-initiated analgesia (3.0% vs 43.9%; P < 0.001) and the median time to analgesia was significantly reduced (58 min vs 23 min; P < 0.01). Also, significantly more patients received 'adequate analgesia' post-intervention (41.2% vs 72.5%; P < 0.001). At follow up, the proportion of parents who were very satisfied with their child's overall pain management trended upwards in the post-intervention period (47.1% vs 66.7%; P = 0.07). No adverse events were observed during either period. Conclusion The NIAP significantly reduced time to analgesia. It was associated with high levels of parental satisfaction. [ABSTRACT FROM AUTHOR]

Aim: To assess continuity of medication management during transition from hospital to residential care facilities (RCFs). Method: Telephone interviews with RCF staff were performed 24 hours after patient transfer to determine the proportion of patients with: missed or significantly delayed doses; RCF medication chart not written/updated in time for the first dose; suitably packed medications not available for the first dose; and RCF medication chart written/updated by a locum doctor. Retrospective audit was used to identify discharge summary discrepancies. Results: Seventy-five doses for 37/202 (18.3%) patients were missed or significantly delayed in the 24 hours after discharge. One hundred and twenty-five (61.9%) patients did not have their medication chart written/updated and 77 (38.1%) did not have suitably packed medications available for the first dose. Locum doctors wrote RCF medication charts for 66 (32.7%) patients. One hundred and ninety-seven of 392 (50.3%) changes to regularly scheduled medications were communicated. Conclusions: Strategies are needed to address gaps in the continuity of medication management. [ABSTRACT FROM AUTHOR]

Aim: To investigate complementary and alternative medicines (CAM) knowledge and use in patients on warfarin and matched controls, and the association between CAM use and adverse events (bleeding or clotting). Method: A retrospective cohort study was undertaken in the emergency department of a Melbourne hospital. Patients in the warfarin and control groups were those taking/not taking warfarin, respectively (groups matched for age and gender). An investigator-administered questionnaire was used to collect data on CAM knowledge and use, and bleeding/clotting events during the previous 6 months. The international normalised ratio (INR) data during the previous 6 months were obtained from medical and pathology records. Results: 246 warfarin and 246 control group patients were enrolled. Approximately 50% in each group indicated that they knew of the potential for CAM-drug interactions. Only 60 (24%) patients in the warfarin group reported having been advised about CAM use. Compared to controls, a similar proportion of warfarin patients reported CAM use (29% vs 37%; p = 0.07) and significantly fewer used a CAM known to interact with warfarin ('interacting CAM') (11% vs 19%; p = 0.03). In the warfarin group, CAM users and non-users reported a similar number of events below and above their therapeutic INR range and when the INR exceeded 5. CAM users in the warfarin group tended to have more abnormal bleeding events (42% vs 30%; p = 0.06) but a similar number of clotting events (9% vs 10%; p = 0.8) than CAM non-users. Warfarin patients who used 'interacting CAM' had significantly more clotting events than those who used CAM not known to interact with warfarin (18% vs 2%; p = 0.02). Conclusion: CAM knowledge in people on warfarin was poor. 'Interacting CAM' used concomitantly with warfarin may be associated with increased rates of clotting events. [ABSTRACT FROM AUTHOR]