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Background: Hyperkalaemia is managed in the emergency department (ED) following measurement of potassium results by blood gas analysers (BGA) or laboratory analysers (LAB). Aims: To determine the prevalence of clinically significant differences between BGA and LAB potassium results and the impact on ED hyperkalaemia management. Methods: Retrospective analysis of time‐matched ED BGA and LAB potassium samples from 2019 to 2020 (taken within 15 min, one or both results ≥6.0 mmol/L). Mean differences and 95% limits of agreement (LoA) were determined for pairs with one or both results ≥6.0 mmol/L and a separate 500 consecutive sample pairs. Results: Four hundred eighty‐eight matched BGA and LAB samples met the inclusion criteria. Of these, 201 (41.2%) differed by ≤0.5 mmol/L, 169 (34.6%) included a haemolysed LAB sample, and 12 (2.5%) had an unreportable BGA sample. One hundred six (21.7%) pairs differed by >0.5 mmol/L, and 60/106 (57%) had normal LAB potassium results, but BGA indicated moderate/severe hyperkalaemia (two of these pairs received hyperkalaemia treatment). Of patients with a haemolysed LAB sample, or where pairs differed by >0.5 mmol, 48 were treated with insulin and five (10.4%) experienced hypoglycaemia. Mean differences and LoA for pairs with LAB results <6.0 mmol/L but BGA ≥6.0 mmol/L demonstrated unacceptable agreement, with 18 (25.7%) BGA results exceeding 8.0 mmol/L. Conclusions: Potentially significant discordance may occur between BGA and LAB potassium results. Clinicians need to be aware of factors impacting both analytical methods' accuracy (such as poor venepuncture or sample handling, (K) EDTA interference) and undetectable haemolysis with BGA measurements. We recommend BGA hyperkalaemia be confirmed with LAB results using a non‐haemolysed sample where time permits. [ABSTRACT FROM AUTHOR]

Objective: To improve the safety of anticoagulation initiation by increasing the proportion of patients reviewed by a pharmacist. Methods: An electronic intervention was developed to ensure all patients prescribed anticoagulation on discharge were reviewed by an ED pharmacist. Safe anticoagulation initiation was compared for patients seen and not seen. Results: The intervention increased the number of patients seen by an ED pharmacist. Pre-intervention (n = 238) 84.5% of patients were reviewed by a pharmacist. Postintervention (n = 253) 99.6% of patients were reviewed by a pharmacist. Of the 38 patients not reviewed by a pharmacist, 20 (52.6%) had safe anticoagulation initiation and in a sample of 40 patients reviewed by a pharmacist, all 40 (100%) had safe anticoagulation initiation (52.6% vs 100%, P < 0.001). Conclusion: The real-time electronic intervention improved the number of patients reviewed by a pharmacist. ED pharmacist reviewed patients were more likely to have safe anticoagulation initiation. [ABSTRACT FROM AUTHOR]

Objective: To determine the nature, extent, and cost of discrepancies between the quantities of medications supplied to medical departments and administered to patients in public hospitals. Design: Multicentre, retrospective observational study; analysis of electronic pharmacy drug management system (medication supply) and medication administration data for twenty frequently used medications. Setting, participants: Medical, surgical, and emergency department (ED) wards in each of four public hospitals in Melbourne, Victoria, during the 2019 calendar year. Main outcome measures: Discrepancy between the quantity of medication supplied and administered to patients (as proportion of medication supplied), overall and by hospital and ward type; direct cost to the hospitals of the discrepancies. Results: The overall discrepancy rate (all medications, hospitals, ward types) was 19.2% (95% CI, 19.0–19.4%); overall rates by hospital ranged from 5.8% (95% CI, 5.7–5.9%) to 26.7% (95% CI, 26.6–26.9%). The discrepancies were largest for medications useful for self‐treatment: oral antibiotics (eg, phenoxymethylpenicillin 250 mg capsule, 86.8%; 95% CI, 83.1–89.9%) and gastrointestinal medications (eg, ondansetron 4 mg tablet, 53.3%; 95% CI, 52.9–53.7%). Discrepancies were larger for oral than equivalent (or similar) parenteral formulations; they were generally low for controlled medications (temazepam, diazepam, oxycodone). Overall discrepancies were larger for EDs (32.3%; 95% CI, 32.2–32.5%) than for admitted patient wards, but differed between EDs (range: 25.7%; 95% CI, 25.5–26.0% to 39.5%; 95% CI, 39.2–39.7%). The estimated direct cost to hospitals of the discrepancies for the selected medications was $27 800. Conclusion: Substantial quantities of medications supplied to hospital wards and EDs are not accounted for in electronic administration records. [ABSTRACT FROM AUTHOR]

Objective: To report the number of patients discharged from ED with oxycodone immediate release (IR) over 12 months and estimate the proportion who potentially transition to long‐term opioid use and subsequent injectable heroin use. Methods: Retrospective observational data were collected from a major tertiary‐referral metropolitan ED in Melbourne, Australia, describing the number of patients discharged with an oxycodone IR prescription and proportion of discharge scripts filled. These data were projected against published data reporting trends on patients' trajectory to long‐term opioid use, to subsequently estimate the proportion of patients from this cohort that may transition to injectable heroin use. Results: Of the 87 551 ED presentations in 2018, there were 4843 prescriptions written for oxycodone IR for 4102 different patients. An estimated 279 patients may become long‐term opioid users following initial ED presentation. Of these 279 patients, 1.4 patients may potentially transition to injectable heroin use. Conclusion: Modelling opioid use behaviour in an ED population demonstrated the potential development of unintentional long‐term opioid use, and associated harms. Prospective study is required to fully understand trajectories of patients dispensed outpatient therapy from Australian EDs. This is a retrospective observational study to report the number of patients discharged from ED with oxycodone immediate release over 12 months and estimate the proportion who potentially transition to long‐term opioid use and subsequent injectable heroin use. Modelling opioid use behaviour in an ED demonstrated the potential development of unintentional long‐term opioid use, and associated harms. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to examine how changing the electronic ordering sequences for opioid analgesics affected ED outpatient prescribing, and subsequent unused opioid tablets remaining in the community available for diversion. Methods: A descriptive before and after study in adult patients prescribed an opioid analgesic by an ED prescriber for use in the outpatient setting. The hospital electronic prescribing system (FirstNet™) was modified to include smaller quantities of opioid analgesics for discharge. The change in quantity of opioid prescribed and change in quantity of opioid analgesic remaining in the community at follow up was measured pre‐ and post‐intervention using a structured telephone interview. Results: Pre‐ and post‐intervention, 102 and 106 patients were interviewed, respectively. Percentage of prescriptions for oxycodone quantity five tablets increased from 3% to 32% and for quantity 20 tablets fell from 40% to 24% post‐intervention. For paracetamol with codeine, prescriptions for quantity 10 tablets increased from 2% to 24% while for quantity 20 tablets fell from 98% to 76%. Mean number of tablets prescribed per patient fell from 13.8 (SD = 5.1) to 10.8 (SD = 5.6) for oxycodone and from 19.8 (SD = 1.5) to 17.6 (SD = 4.2) for paracetamol with codeine. Fifty‐eight percent of patients in both pre‐ and post‐intervention groups used half or less of the medication prescribed. Conclusion: Modification of an ED electronic prescribing system reduced overall quantities of opioid analgesics supplied and subsequently stored in the community but did not change the proportion of patients (>50%) who reported using half or less of their prescribed opioid medication. [ABSTRACT FROM AUTHOR]

The article presents information about the cohort analysis related to complementary and alternative medicines (CAM) use in patients on warfarin and control groups. It mentions that CAM includes those herbal remedies, vitamin and mineral that can be purchased without a prescription. It also states that patients on warfarin have a tendency to bleed and it is prescribed for patients with a tendency to clotting events.