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This study aims to determine the knowledge and practices of Australian hospital pharmacy staff regarding animal-derived ingredients in medications and reviewing whether commonly used medications contain animalderived ingredients. The study surveyed 67 pharmacy staff and reviewed 20 medications. Ninety-eight percent of staff were aware patients may have religious or cultural restrictions on ingesting animal-derived products; 33% discussed this issue with patients. Information on animal-derived ingredients was readily accessible for 1.6% of medications, with information unavailable for 14%. Staff demonstrated awareness that medications may contain animalderived ingredients, but challenges exist in discussion with patients and in accessing information on animal-derived ingredients. [ABSTRACT FROM AUTHOR]

Traditionally, intramuscular (IM) injections have been avoided in patients with haematological diseases due to the risk of iatrogenic haematoma. Tixagevimab-cilgavimab (Evusheld®) is a novel monoclonal antibody combination used as preexposure prophylaxis against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), for those at highest risk of severe infections. It is delivered as two separate IM injections (1.5 mL each). Patients with haematological disease are at higher risk for severe SARS-CoV-2 infections, which may be partially abrogated by the prophylactic inoculation of tixagevimab-cilgavimab.A combined retrospective and prospective study of patients under the haematology service at a large metropolitan hospital receiving tixagevimab-cilgavimab was conducted. Tixagevimab-cilgavimab was administered IM to all patients, with platelet and factor replacement provided according to local protocols. Patients completed a numerical pain score daily for seven days following the injection, with scores ≥4/10 prompting an ultrasound to identify iatrogenic gluteal haematomas.The study recruited 131 patients; 66 patients were thrombocytopenic, including 10 patients with a platelet count <30 × 109/L. Fourteen patients (10.7%) received a single platelet transfusion prior to tixagevimab-cilgavimab administration, while two patients received fresh frozen plasma. No gluteal haematomas were identified, and only two patients reported an initial pain score of ≥4/10.The intramuscular administration of tixagevimab-cilgavimab in patients with haematological diseases was well tolerated and was not associated with iatrogenic haematoma. [ABSTRACT FROM AUTHOR]

Background: Medications requiring refrigeration for stability are commonly used across hospitals. Temperature-sensitive medications may not have their temperature requirements maintained due to breaches in the cold chain, especially refrigerator failure. This is usually caused by malfunction of the refrigerator unit or by power outage. After multiple power outages at our institution involving refrigerators with temperature probes located in different areas of the refrigerator, we hypothesised that the fixed temperature probe may not accurately reflect the temperature of the medications themselves. Methods: We conducted simulations of power outages in a commonly used medication refrigerator, using additional temperature data loggers, placed on the refrigerator shelf and inside a cardboard box to replicate the temperature inside medication containers to determine if there was a difference in the time to breach cold chain conditions (>8°C) and to return to appropriate refrigerated temperatures (<8°C) when power was restored. Results: All data loggers took a longer time to breach cold chain conditions than the refrigerator probe (12.5 minutes vs 23-26 minutes) but took longer to return to acceptable temperature after power was restored (17.5 minutes vs 70.5-89 minutes). Conclusion: This exploratory research suggests that temperatures vary within a refrigerator depending on the type and location of probe and that medications within may take longer to breach cold chain conditions but also take longer to return to cold chain conditions compared with fixed refrigerator temperature probes. Further research is required to determine whether these variations occur across different sizes/brands of refrigerators and the effect on stability on refrigerated medications. [ABSTRACT FROM AUTHOR]

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Introduction: Traditionally, intramuscular (IM) injections have been avoided in patients with haematological diseases due to the risk of iatrogenic haematoma. Tixagevimab-cilgavimab (Evusheld ® ) is a novel monoclonal antibody combination used as preexposure prophylaxis against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), for those at highest risk of severe infections. It is delivered as two separate IM injections (1.5 mL each). Patients with haematological disease are at higher risk for severe SARS-CoV-2 infections, which may be partially abrogated by the prophylactic inoculation of tixagevimab-cilgavimab., Methods: A combined retrospective and prospective study of patients under the haematology service at a large metropolitan hospital receiving tixagevimab-cilgavimab was conducted. Tixagevimab-cilgavimab was administered IM to all patients, with platelet and factor replacement provided according to local protocols. Patients completed a numerical pain score daily for seven days following the injection, with scores ≥4/10 prompting an ultrasound to identify iatrogenic gluteal haematomas., Results: The study recruited 131 patients; 66 patients were thrombocytopenic, including 10 patients with a platelet count <30 × 10 9 /L. Fourteen patients (10.7%) received a single platelet transfusion prior to tixagevimab-cilgavimab administration, while two patients received fresh frozen plasma. No gluteal haematomas were identified, and only two patients reported an initial pain score of ≥4/10., Conclusions: The intramuscular administration of tixagevimab-cilgavimab in patients with haematological diseases was well tolerated and was not associated with iatrogenic haematoma., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The funding of medication supply in Australian public hospitals is divided between the federal government's Pharmaceutical Benefits Scheme (PBS) and thestate or territory government who pay for the remaining medications not covered under the PBS. For some high-cost medications, such as the monoclonal antibody blinatumomab, the current criteria for PBS funding in public hospitals are challenging. The strict requirement for inpatient admission, due to the risk of potentially serious adverse effects, alongside a lack of PBS reimbursement, while a hospital inpatient, may result in the state bearing the cost. A retrospective review of five patients receiving blinatumomab at our hospital found that, on average, patients remained inpatients for longer than that stipulated to meet PBS funding criteria, predominantly due to adverse effects associated with the medication. This resulted in the state government paying for the medication in full. The upcoming National Medicines Policy review should address the increasing complexity of new medications and their access and funding.