Search

Background: The 2018 Australian Heart Failure (HF) guidelines strongly recommended commencing sodium‐glucose co‐transporter‐2 inhibitors (SGLT‐2is) in HF patients with type 2 diabetes mellitus (T2DM). The uptake of SGLT‐2is for HF patients with T2DM in our health service is unknown. Aims: To determine the adoption of the 2018 HF guidelines by assessing the temporal trends of SGLT‐2is' usage in HF patients with T2DM at Metro South Health (MSH) hospitals, in South‐East Queensland. Methods: Retrospective analysis of all HF patients (ejection fraction (EF) < 50%) with T2DM who were managed within MSH hospitals between June 2018 and June 2021. Results: A total of 666 patients met the inclusion criteria with 918 HF encounters. Mean age was 72 years and 71% were male (473/666). Mean EF was 30% (SD ± 11%), and mean estimated glomerular filtration rate was 48 mL/min/1.73 m2 (SD ± 25). Fifty‐four per cent (362/666) had contraindications to SGLT‐2is. Among those without contraindications, there was a five‐fold increase in the utility of SGLT‐2is, 7% (2/29) before versus 38% (103/275) after implementation of the HF guidelines (P < 0.001). Patients on SGLT‐2is were younger (64 years vs 69 years, P = 0.002) and had a lower number of HF hospitalisations (1.1 vs 2.1, P = 0.01). Conclusions: During the study period, 54% of our HF patients with T2DM were not on SGLT‐2is due to prescribing guidelines/limitations in the Australian context. We observed a five‐fold significant increase in the uptake of SGLT‐2is before and after implementation of HF guidelines among patients without contraindications to SGLT‐2is. There were significantly fewer HF hospitalisations among patients on SGLT‐2is compared to those without. [ABSTRACT FROM AUTHOR]

Digital transformation in healthcare improves the safety of health systems. Within our health service, a new digital hospital has been established and two wards from a neighbouring paper-based hospital transitioned into the new digital hospital. This created an opportunity to evaluate the impact of complete digital transformation on medication safety. Here we discuss the impact of transition from a paper-based to digital hospital on voluntarily reported medication incidents and prescribing errors. This study utilises an interrupted time-series design and takes place across two wards as they transition from a paper to a digital hospital. Two data sources are used to assess impacts on medication incidents and prescribing errors: (1) voluntarily reported medication incidents and 2) a chart audit of medications prescribed on the study wards. The chart audit collects data on procedural, dosing and therapeutic prescribing errors. There are 588 errors extracted from incident reporting software during the study period. The average monthly number of errors reduces from 12.5 pre- to 7.5 post-transition (p < 0.001). In the chart audit, 5072 medication orders are reviewed pre-transition and 3699 reviewed post-transition. The rates of orders with one or more error reduces significantly after transition (52.8% pre- vs. 15.7% post-, p < 0.001). There are significant reductions in procedural (32.1% pre- vs. 1.3% post-, p < 0.001), and dosing errors (32.3% pre- vs. 14% post-, p < 0.001), but not therapeutic errors (0.6% pre- vs. 0.7% post-, p = 0.478). Transition to a digital hospital is associated with reductions in voluntarily reported medication incidents and prescribing errors. [ABSTRACT FROM AUTHOR]

Introduction: Opioid prescribing rates are continuing to increase in Australia in line with prescribing rates seen internationally. Prescribing limits are one policy strategy to reduce short-term opioid prescribing, but there is limited evidence of their impact., Objective: The aim of this study was to assess the impact of state and national policy interventions on changes to oxycodone 5 mg discharge prescriptions in public hospitals using electronic prescribing in Queensland, Australia by evaluating the proportion of oxycodone 5 mg discharge prescriptions written for ≤ 10 tablets across the study period., Method: This research utilised a retrospective uncontrolled interrupted time-series design and was undertaken at 12 public hospitals using electronic prescribing from December 2018 to February 2021. The study analysed the impact of two sequential policy interventions that limited the recommended quantity of oxycodone 5 mg on discharge for all hospitalised patients. The first state-wide policy came into effect on 19 September 2019 and the second national policy came into effect on 1 June 2020., Results: Over the 27-month period, there were 110,728 discharge prescriptions written in the 12 Queensland hospitals for oxycodone 5 mg. During the baseline period, approximately 50.7% (95% CI 49.5-51.8) of all oxycodone 5 mg prescriptions were from tablet quantities of ≤ 10 tablets. After the implementation of the state-wide policy, the proportion increased by 9% (95% CI 7.4-10.7; p = 0.001). The implementation of the national policy increased the proportion of oxycodone 5 mg prescriptions written for ≤10 tablets by 9.8% (95% CI 8.1-11.5; p < 0.001)., Conclusions: Restrictive prescribing policies at a state and national level may have resulted in decreased quantities of oxycodone 5 mg prescriptions provided on discharge from public hospitals using electronic prescribing in Queensland, Australia. Despite these positive results, continued multi-faceted policy efforts and individual tailored interventions are necessary to ensure safe and judicious opioid prescribing., (© 2022. Crown.)

Background: Cyclones can significantly impact on communities and their healthcare services. Community members with chronic diseases, including opioid dependence, who rely on these healthcare services are placed at an increased risk of treatment disruption during a disaster event. Disruptions to the continuity of the opioid replacement therapy (ORT) service can potentially lead to relapse, withdrawal, and risky behaviours in clients with potential repercussions for the community., Objective: To explore the effects of Queensland (QLD) cyclones on opioid treatment programs within Queensland community and hospital pharmacies from three perspectives., Method: Qualitative research methods were used. Participants comprised five community pharmacists, four Queensland opioid treatment program (QOTP) employees, and five public hospital pharmacists. Participants were identified as they had worked in Townsville, Rockhampton, Mackay, or Yeppoon in a community impacted by a cyclone and involved with ORT supply. Interviews were recorded and data were analysed by two methods - manual coding and the text analytics software Leximancer®., Results: The two themes that emerged from the manual coding process were 'disaster preparedness' and 'continuity of service'. The key themes from the Leximancer® analysis aligned with the two manual coding themes with no new themes identified. Primary dosing site closures in disaster-affected areas led to increased pressures on hospitals and other community pharmacy dosing sites to supply ORT doses to clients. However, a lack of dosing information available to pharmacists and strict legislative requirements made continuity of ORT supply during these cyclones difficult., Conclusion: Continuation of ORT services during and in the aftermath of a cyclone event is complex. This research highlighted a need for a coordination of efforts and shared dosing information between QOTP employees, community pharmacists, and hospital pharmacists. To improve continuity of ORT services, it is essential that these stakeholders engage with each other in preparing for and responding to future events., Competing Interests: Declaration of competing interest No funding or conflicts of interest to declare., (Copyright © 2019 Elsevier Inc. All rights reserved.)