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51. Additional file 1 of Medicines use before and after comprehensive medicines review among residents of long-term care facilities: a retrospective cohort study

Author

Sluggett, Janet K., Caughey, Gillian E., Air, Tracy, Moldovan, Max, Lang, Catherine, Martin, Grant, Carter, Stephen R., Jackson, Shane, Stafford, Andrew C., Wesselingh, Steve L., and Inacio, Maria C.

Abstract

Additional file 1: Supplementary Table 1. Codes used to identify medicine classes of interest, and corresponding prescription durations. Supplementary Table 2. Weekly number of defined daily doses of medicines per 1000 resident-days before and after the index date among individuals who did and did not receive an RMMR in the 0-3 months and 3-6 months after RACF entry. Supplementary Table 3. Weekly prevalence of medicines use during the study period among individuals with an index date in the 6-12 months after RACF entry. Supplementary Figure 1. Group assignment based on the date of an individual’s first RMMR relative to first entry into permanent residential aged care. Supplementary Figure 2. Time frame for assessing medicines use pre- and post-index date. Supplementary Figure 3. Time periods analyzed in the segmented regression models. Supplementary Figure 4. Weekly number of DDDs available for use per 1000 resident-days for individuals with an index date in the 0-3 months after RACF entry for medicines with possible changes in use post-RMMR compared to individuals without an RMMR. Supplementary Figure 5. Weekly number of DDDs available for use per 1000 resident-days for individuals with an index date in the 3-6 months after RACF entry for medicines with possible changes in use post-RMMR compared to individuals without an RMMR. Supplementary Figure 6. Weekly number of DDDs per 1000 resident-days in the four months before and after the index date for individuals with an index date within 6-12 months of RACF entry. Supplementary Figure 7. Weekly prevalence of medicines use in the four months before and after the index date for individuals with an index date in the 6-12 months after RACF entry.

Published
2022
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53. Medication Regimen Complexity and Risk of Bleeding in People Who Initiate Oral Anticoagulants for Atrial Fibrillation: A Population-Based Study.

Author

Chen, Esa Y H, Zhao, Jiaxi, Ilomäki, Jenni, Sluggett, Janet K, Bell, J Simon, Wimmer, Barbara C, Hilmer, Sarah N, Blais, Joseph E, Wong, Ian C K, and Chan, Esther W

Subjects
ORAL medication, ATRIAL fibrillation, INTRACRANIAL hemorrhage, DRUGS, AT-risk people
Abstract

Background Oral anticoagulants (OACs) are high-risk medications often used in older people with complex medication regimens. This study was the first to assess the association between overall regimen complexity and bleeding in people with atrial fibrillation (AF) initiating OACs. Methods Patients diagnosed with AF who initiated an OAC (warfarin, dabigatran, rivaroxaban, apixaban) between 2010 and 2016 were identified from the Hong Kong Clinical Database and Reporting System. Each patient's Medication Regimen Complexity Index (MRCI) score was computed. Baseline characteristics were balanced using inverse probability of treatment weighting. People were followed until a first hospitalization for bleeding (intracranial hemorrhage, gastrointestinal bleeding, or other bleeding) and censored at discontinuation of the index OAC, death, or end of the follow-up period, whichever occurred first. Cox regression was used to estimate hazard ratios (HR) between MRCI quartiles and bleeding during initiation and all follow-up. Results There were 19 292 OAC initiators (n = 9 092 warfarin, n = 10 200 direct oral anticoagulants) with a mean (standard deviation) age at initiation of 73.9 (11.0) years. More complex medication regimens were associated with an increased risk of bleeding (MRCI > 14.0–22.00: aHR 1.17, 95% confidence interval [CI] 0.93–1.49; MRCI > 22.0–32.5: aHR 1.32, 95%CI 1.06–1.66; MRCI > 32.5: aHR 1.45, 95%CI 1.13–1.87, compared to MRCI ≤ 14). No significant association between MRCI and bleeding risk was observed during the initial 30, 60, or 90 days of treatment. Conclusion In this cohort study of people with AF initiating an OAC, a more complex medication regimen was associated with higher bleeding risk over periods longer than 90 days. Further prospective studies are needed to assess whether MRCI should be considered in OAC prescribing. [ABSTRACT FROM AUTHOR]

Published
2023
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55. Predictors of hospitalisations and emergency department presentations shortly after entering a residential aged care facility in Australia: a retrospective cohort study

Author

Inacio, Maria C, primary, Jorissen, Robert N, additional, Wesselingh, Steve, additional, Sluggett, Janet K, additional, Whitehead, Craig, additional, Maddison, John, additional, Forward, John, additional, Bourke, Alice, additional, Harvey, Gillian, additional, and Crotty, Maria, additional

Published
2021
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60. National Changes in Outpatient Systemic Antibiotic Use During the Coronavirus Disease 2019 Pandemic in Australia

Author

Sluggett, Janet K, Dinh, Yen H, Wesselingh, Steven L, Inacio, Maria C, and Caughey, Gillian E

Subjects
AcademicSubjects/MED00290, Prescriptions, SARS-CoV-2, Correspondence, Outpatients, COVID-19, Humans, Practice Patterns, Physicians', Child, Drug Prescriptions, Pandemics, Anti-Bacterial Agents
Abstract

The objective of our study was to describe trends in US outpatient antibiotic prescriptions from January through May 2020 and compare with trends in previous years (2017-2019).We used data from the IQVIA Total Patient Tracker to estimate the monthly number of patients dispensed antibiotic prescriptions from retail pharmacies from January 2017 through May 2020. We averaged estimates from 2017 through 2019 and defined expected seasonal change as the average percent change from January to May 2017-2019. We calculated percentage point and volume changes in the number of patients dispensed antibiotics from January to May 2020 exceeding expected seasonal changes. We also calculated average percent change in number of patients dispensed antibiotics per month in 2017-2019 versus 2020. Data were analyzed overall and by agent, class, patient age, state, and prescriber specialty.From January to May 2020, the number of patients dispensed antibiotic prescriptions decreased from 20.3 to 9.9 million, exceeding seasonally expected decreases by 33 percentage points and 6.6 million patients. The largest changes in 2017-2019 versus 2020 were observed in April (-39%) and May (-42%). The number of patients dispensed azithromycin increased from February to March 2020 then decreased. Overall, beyond-expected decreases were greatest among children (≤19 years) and agents used for respiratory infections, dentistry, and surgical prophylaxis.From January 2020 to May 2020, the number of outpatients with antibiotic prescriptions decreased substantially more than would be expected because of seasonal trends alone, possibly related to the coronavirus disease 2019 pandemic and associated mitigation measures.

Published
2021

61. Additional file 1 of The risk of fall-related hospitalisations at entry into permanent residential aged care

Author

Inacio, Maria C., Moldovan, Max, Whitehead, Craig, Sluggett, Janet K., Crotty, Maria, Corlis, Megan, Visvanathan, Renuka, Wesselingh, Steve, and Caughey, Gillian E.

Abstract

Additional file 1: Supplementary Table 1. Hospitalisation coding algorithm to identify fall-related hospitalisations. Supplementary Table 2. Individual characteristics at entry into permanent residential aged care by fall-related hospitalisations within 90 days or 365 days of entry (not included in Table 1). Supplementary Table 3. Individual characteristics at entry into permanent residential aged care from Aged Care Funding Instrument Assessment1 by fall-related hospitalisations within 90 days or 365 days of entry (not included in Table 1). Supplementary Table 4. Medication use characteristics within 90 days prior to entry into permanent residential aged care by fall-related hospitalisations within 90 days or 365 days of entry (not included in Table 1). Supplementary Table 5. Hospital related health care utilisation within 1 year prior of entry into permanent residential aged care by individuals��� fall-related hospitalisations within 90 days or 365 days of entry (not included in Table 1). Supplementary Table 6. Other health care service utilisation within 1 year prior of entry into permanent residential aged care by individuals��� fall-related hospitalisations within 90 days or 365 days of entry (not included in Table 1). Supplementary Table 7. Variables and coding used to recreate risk factors included in the Fracture Risk Assessment Tool for Community Dwelling Older People (FRAT-up)2 and prevalence of risk factor in the study cohort. Supplementary Table 8. Risk Estimates Using the Fracture Risk Assessment Tool for Community Dwelling Older People (FRAT-up)2.

Published
2021
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74. Fatal poisonings involving clozapine: A 16-year review of Australian coronial investigations.

Author

Dawson, Jessica L, Sluggett, Janet K, Schumann, Jennifer L, Procter, Nicholas G, and Bell, J Simon

Subjects
*RETROSPECTIVE studies, *CLOZAPINE, *CASE studies, *DEATH, *DRUG toxicity, DRUG therapy for schizophrenia
Abstract

Objective: Concerns about intentional and unintentional poisoning present a barrier to wider use of clozapine in treatment-resistant schizophrenia. The objective of this study was to investigate decedent demographics and trends in fatal poisonings in Australia involving clozapine. Methods: This was a retrospective case series of all fatal drug toxicity reported to an Australian coroner between 1 May 2000 and 31 December 2016 where toxicological analysis detected clozapine. Cases were identified using the National Coronial Information System. Demographics extracted included age and gender of the decedent, year and location of death, cause and manner of death and drugs detected in post-mortem samples. Results: There were 278 poisoning deaths where clozapine was detected in toxicological analyses. Three-quarters of all cases (n = 207) involved men and the median age at death was 38.5 years (interquartile range: 16 years). Three-quarters of the deaths occurred in the home. Overall, 15.8% of deaths were deemed intentional, 57.5% unintentional and 24.5% of unknown intent. While the annual number of intentional self-poisonings remained constant with <5 per year, the overall number of fatalities increased due to an increase in unintentional poisonings. Multiple drug toxicity was reported in 55.0% of cases and clozapine alone in 45.0% of cases. The most common co-reported medications were antidepressants, benzodiazepines and opioids detected in 47.1%, 44.4% and 41.2% of multiple drug toxicities, respectively. Conclusion: This was the first Australia-wide review of all fatal drug poisonings reported to a coroner involving clozapine. Fatalities were most common in men and occurred at home. Multiple drug toxicity generally involved psychotropic, sedative or opioid analgesic medications. Despite increasing clozapine use, rates of intentional poisoning have remained constant and low. Developing a better knowledge of unintentional fatalities presents an opportunity to minimise harm. [ABSTRACT FROM AUTHOR]

Published
2022
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77. Root Cause Analysis to Identify Medication and Non-Medication Strategies to Prevent Infection-Related Hospitalizations from Australian Residential Aged Care Services

Author

Sluggett, Janet K., primary, Lalic, Samanta, additional, Hosking, Sarah M., additional, Ritchie, Brett, additional, McLoughlin, Jennifer, additional, Shortt, Terry, additional, Robson, Leonie, additional, Cooper, Tina, additional, Cairns, Kelly A., additional, Ilomäki, Jenni, additional, Visvanathan, Renuka, additional, and Bell, J. Simon, additional

Published
2020
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79. 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

Author

Sluggett, Janet K., primary, Hopkins, Ria E., additional, Chen, Esa YH, additional, Ilomäki, Jenni, additional, Corlis, Megan, additional, Van Emden, Jan, additional, Hogan, Michelle, additional, Caporale, Tessa, additional, Ooi, Choon Ean, additional, Hilmer, Sarah N., additional, and Bell, J. Simon, additional

Published
2020
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87. National Trends in Antibiotic Use in Australian Residential Aged Care Facilities, 2005–2016.

Author

Sluggett, Janet K, Moldovan, Max, Lynn, David J, Papanicolas, Lito E, Crotty, Maria, Whitehead, Craig, Wesselingh, Steve L, Rogers, Geraint B, and Inacio, Maria C

Subjects
*ANTIBIOTICS, *CONFIDENCE intervals, *CROSS-sectional method, *REGRESSION analysis, *NURSING care facilities, *RESIDENTIAL care, *DRUG utilization, *ELDER care, *LONG-term health care
Abstract

Background Understanding current patterns of antibiotic use in residential aged care facilities (RACFs) is essential to inform stewardship activities, but limited utilization data exist. This study examined changes in prevalence and consumption of antibiotics in Australian RACFs between 2005–2006 and 2015–2016. Methods This population-based, repeated cross-sectional analysis included all long-term permanent residents of Australian RACFs between July 2005 and June 2016 who were aged ≥ 65 years. The yearly prevalence rate of antibiotic use and number of defined daily doses (DDDs) of systemic antibiotics per 1000 resident-days were determined annually from linked pharmaceutical claims data. Trends were assessed using ordinary least squares regression. Results This study included 502 752 residents from 3218 RACFs, with 424.9 million resident-days analyzed. Antibiotics were dispensed on 5 608 126 occasions during the study period, of which 88% were for oral use. Cefalexin, amoxicillin-clavulanic acid, and trimethoprim were the most commonly dispensed antibiotics. The annual prevalence of antibiotic use increased from 63.8% (95% confidence interval [CI], 63.3%–64.4%) to 70.3% (95% CI, 69.9%–70.7%) between 2005–2006 and 2015–2016 (0.8% average annual increase, P  < .001). There was a 39% relative increase in total consumption of systemic antibiotics, with utilization increasing from 67.6 to 93.8 DDDs/1000 resident-days during the study period (average annual increase of 2.8 DDDs/1000 resident-days, P  < .001). Conclusions This nationwide study showed substantial increases in both prevalence of use and total consumption of antibiotics in Australian RACFs between 2005 and 2016. The increasingly widespread use of antibiotics in Australian RACFs is concerning and points to a need for enhanced efforts to optimize antibiotic use in this setting. [ABSTRACT FROM AUTHOR]

Published
2021
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95. Medication administration in Australian residential aged care: A time‐and‐motion study.

Author

Chen, Esa Y. H., Bell, J. Simon, Ilomäki, Jenni, Corlis, Megan, Hogan, Michelle E., Caporale, Tessa, Van Emden, Jan, Westbrook, Johanna I., Hilmer, Sarah N., and Sluggett, Janet K.

Subjects
ELDER care, COGNITION disorders, COMMUNICATION, DEGLUTITION disorders, DOCUMENTATION, DRUG administration, NURSES, PATIENT safety, TIME, WORK measurement, RESIDENTIAL care, DESCRIPTIVE statistics
Abstract

Rationale/aim: Medication administration is a complex and time‐consuming task in residential aged care facilities (RACFs). Understanding the time associated with each administration step may help identify opportunities to optimize medication management in RACFs. This study aimed to investigate the time taken to administer medications to residents, including those with complex care needs such as cognitive impairment and swallowing difficulties. Method: A time‐and‐motion study was conducted in three South Australian RACFs. A representative sample of 57 scheduled medication administration rounds in 14 units were observed by a single investigator. The rounds were sampled to include different times of day, memory support units for residents living with dementia and standard units, and medication administration by registered and enrolled nurses. Medications were administered from pre‐prepared medication strip packaging. The validated Work Observation Method By Activity Timing (WOMBAT) software was used to record observations. Results: Thirty nurses were observed. The average time spent on scheduled medication administration rounds was 5.2 h/unit of average 22 residents/day. The breakfast medication round had the longest duration (1.92 h/unit). Resident preparation, medication preparation and provision, documentation, transit, communication, and cleaning took an average of 5 minutes per resident per round. Medication preparation and provision comprised 60% of overall medication round time and took significantly longer in memory support than in standard units (66 vs 49 seconds per resident per round for preparation, 79 vs 58 for provision; P <.001 for both). Almost half (42%) of tablets/capsules were crushed in memory support units. The time taken for medication administration was not significantly different among registered and enrolled nurses. Conclusions: Nurses took an average of 5 minutes to administer medications per resident per medication round. Medication administration in memory support units took an additional minute per resident per round, with almost half of tablets and capsules needing to be crushed. [ABSTRACT FROM AUTHOR]

Published
2021
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97. SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER): study protocol for a cluster randomised controlled trial

Author

Sluggett, Janet K., primary, Chen, Esa Y. H., additional, Ilomäki, Jenni, additional, Corlis, Megan, additional, Hilmer, Sarah N., additional, Van Emden, Jan, additional, Ooi, Choon Ean, additional, Nguyen, Kim-Huong, additional, Comans, Tracy, additional, Hogan, Michelle, additional, Caporale, Tessa, additional, Edwards, Susan, additional, Quirke, Lyntara, additional, Patching, Allan, additional, and Bell, J. Simon, additional

Published
2018
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100. Protocol for a randomised crossover trial to evaluate patient and nurse satisfaction with electronic and elastomeric portable infusion pumps for the continuous administration of antibiotic therapy in the home: the Comparing Home Infusion Devices (CHID) study

Author

Hobbs, Jodie G, primary, Ryan, Melissa K, additional, Ritchie, Brett, additional, Sluggett, Janet K, additional, Sluggett, Andrew J, additional, Ralton, Lucy, additional, and Reynolds, Karen J, additional

Published
2017
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