Evaluating the Effectiveness of Risk Categories for Prioritising Patients for Best Possible Medication History Completion at a Quaternary Hospital.

Background: The Pharmacist Workload Prioritisation Work Instruction (PWPWI) was developed to optimise clinical pharmacy services, such as best possible medication history (BPMH) completion. Inpatients are assigned a risk category and associated BPMH completion timeframe.

Aim: To determine the proportion of inpatients who met criteria for urgent, high, moderate, and low risk, and the proportion in each category who were reviewed within 24 hours of admission, to inform PWPWI updates.

Pharmacist-led transition of care services in patients with cardiovascular disease: a systematic scoping review.

Introduction: Transition of care (ToC) is a critical time that requires effective management, especially for patients with cardiovascular disease, who have complex health needs. Pharmacists can play an integral role in improving medication safety and care coordination at ToC. This review determined the types of pharmacist-led multidisciplinary ToC services and associated outcomes in patients with cardiovascular disease.

Impact evaluation of the modified adverse inpatient medication event (AIME-Frail) model in hospitalised adults.

Aims: To assess whether the AIME-Frail tool assists in medication management prioritisation and reduces inpatient medication harm events, evaluate tool implementation challenges and enablers, and identify predictive risk factors for medication harm.

Methods: General and geriatric medicine patients at a tertiary hospital in Queensland, Australia were enrolled in a controlled study. Medication harm was identified through electronic medical record (EMR) reviews, a trigger tool, and discussions with treating teams.

The role of triple antithrombotic therapy in patients with atrial fibrillation and coronary stent insertion.

Triple antithrombotic therapy or 'triple therapy' describes the combination of 3 oral antithrombotic medications - an anticoagulant drug (warfarin, apixaban, rivaroxaban or dabigatran) and 2 antiplatelet drugs (usually aspirin plus clopidogrel). Most commonly, triple therapy is indicated for patients who require dual antiplatelet therapy following coronary stent insertion for acute coronary syndrome and long-term anticoagulation for atrial fibrillation. Current evidence supports shorter durations of triple therapy to mitigate bleeding risks without compromising ischaemic protection.

How do residential aged care antibiograms compare with other local resistance data?

Background: Antibiograms can optimize empirical antibiotic prescribing; however, they are not readily available for residential aged care facilities (RACFs) in Queensland, Australia. This study aimed to determine whether alternatively available data can be used to approximate resistance patterns for RACFs.

Methods: Annual RACF-specific antibiograms were compared with local hospital antibiograms accessed through pathology providers.

A scoping review of the clinical utility of adverse drug reaction causality analysis tools for use in the hospital setting.

Introduction: Identification and monitoring of adverse drug reactions (ADRs) and interventions to reduce ADRs are essential for patient safety in hospitals. Causality analysis (CA) is an approach that helps to determine a causal link between medication and patient harm (i.e.

Antibiogram development for Australian residential aged care facilities.

Objective: Knowledge of local antibiotic resistance data, provided by antibiograms (a cumulative summary of in vitro-antimicrobial-susceptibility-test results), can aid prescribing of appropriate empirical antibiotics. This study aimed to explore the feasibility of antibiogram development for residential aged care facilities (RACFs).

Design: Retrospective observational study of culture and sensitivity data.

Evaluating EHR-Integrated Digital Technologies for Medication-Related Outcomes and Health Equity in Hospitalised Adults: A Scoping Review.

The purpose of this scoping review is to identify and evaluate studies that examine the effectiveness and implementation strategies of Electronic Health Record (EHR)-integrated digital technologies aimed at improving medication-related outcomes and promoting health equity among hospitalised adults. Using the Consolidated Framework for Implementation Research (CFIR), the implementation methods and outcomes of the studies were evaluated, as was the assessment of methodological quality and risk of bias. Searches through Medline, Embase, Web of Science, and CINAHL Plus yielded 23 relevant studies from 1,232 abstracts, spanning 11 countries and from 2008 to 2022, with varied research designs.

Assessment of a Geriatric Evaluation and Management in the Home (GEMITH) Service at a Quaternary Hospital: A Retrospective Observational Study.

The increasing aging population in Australia has created a higher demand for specialist geriatric services within hospitals. A Geriatric Evaluation and Management in the Home (GEMITH) service was implemented at a quaternary Queensland hospital. The GEMITH service was unique as it incorporated a specialist pharmacist into the multidisciplinary team.

Evaluating automated machine learning platforms for use in healthcare.

Objective: To describe development and application of a checklist of criteria for selecting an automated machine learning (Auto ML) platform for use in creating clinical ML models.

Materials And Methods: Evaluation criteria for selecting an Auto ML platform suited to ML needs of a local health district were developed in 3 steps: (1) identification of key requirements, (2) a market scan, and (3) an assessment process with desired outcomes.

Results: The final checklist comprising 21 functional and 6 non-functional criteria was applied to vendor submissions in selecting a platform for creating a ML heparin dosing model as a use case.

The adverse inpatient medication event and frailty (AIME-frail) risk prediction model.

Background: Medication harm affects between 5 and 15% of hospitalised patients, with approximately half of the harm events considered preventable through timely intervention. The Adverse Inpatient Medication Event (AIME) risk prediction model was previously developed to guide a systematic approach to patient prioritisation for targeted clinician review, but frailty was not tested as a candidate predictor variable.

Aim: To evaluate the predictive performance of an updated AIME model, incorporating a measure of frailty, when applied to a new multisite cohort of hospitalised adult inpatients.

Evaluation of the Quality and Safety of Venous Thromboembolism Prophylaxis Among Gastroenterology Inpatients at a Tertiary Hospital in Australia.

: Hospital acquired venous thromboembolisms (VTEs) are common and preventable. The Queensland Health VTE prophylaxis guidelines, developed in 2018, provide guidance for risk assessment, and prescribing of anticoagulation for prophylaxis and treatment of hospital inpatients. Currently, there are limited recommendations for gastroenterology patients.

Impact of pharmacists during in-hospital resuscitation or medical emergency response events: A systematic review.

Background: We sought to determine the impact of the presence of a pharmacist on medication and patient related outcomes during the emergency management of critically ill patients requiring resuscitation or medical emergency response team care in a hospital setting.

Methods: We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search of databases from January 1995 to April 2023 was conducted to identify studies of contemporary pharmacist practice.

Clinical impact of antibiograms as an intervention to optimize antimicrobial prescribing and patient outcomes-A systematic review.

Background: Antimicrobial stewardship (AMS) guidelines advocate for the use of antibiograms (cumulative antimicrobial susceptibility test data) as a tool to guide empirical antibiotic prescribing and inform local treatment guidelines. The objective of this review is to evaluate the effectiveness of antibiograms as an intervention to optimize antimicrobial prescribing and patient outcomes.

Methods: Embase, PubMed, CINAHL, and International Pharmacy Abstracts (IPA) databases were searched from inception until September 2022, to identify studies of antibiogram-related interventions in all health care settings.

Predicting Therapeutic Response to Unfractionated Heparin Therapy: Machine Learning Approach.

Background: Unfractionated heparin (UFH) is an anticoagulant drug that is considered a high-risk medication because an excessive dose can cause bleeding, whereas an insufficient dose can lead to a recurrent embolic event. Therapeutic response to the initiation of intravenous UFH is monitored using activated partial thromboplastin time (aPTT) as a measure of blood clotting time. Clinicians iteratively adjust the dose of UFH toward a target, indication-defined therapeutic aPTT range using nomograms, but this process can be imprecise and can take ≥36 hours to achieve the target range.

A multimodal intervention to optimise antimicrobial use in residential aged care facilities (ENGAGEMENT): protocol for a stepped-wedge cluster randomised trial.

Background: Inappropriate antibiotic use can cause harm and promote antimicrobial resistance, which has been declared a major health challenge by the World Health Organization. In Australian residential aged care facilities (RACFs), the most common indications for antibiotic prescribing are for infections of the urinary tract, respiratory tract and skin and soft tissue. Studies indicate that a high proportion of these prescriptions are non-compliant with best prescribing guidelines.

Scoping Review of Studies Evaluating Frailty and Its Association with Medication Harm.

Introduction: Frailty is associated with an increased risk of death and morbid events. Frail individuals are known to have multiple comorbidities which are often associated with polypharmacy. Whilst a relationship between polypharmacy and frailty has been demonstrated, it is not clear if there is an independent relationship between frailty and medication harm.

Evaluation of two European risk models for predicting medication harm in an Australian patient cohort.

Purpose: To externally evaluate the performance of two European risk prediction models, for identifying patients at high-risk of medication harm, in an Australian hospital setting.

Methods: This was a secondary analysis of a pre-existing cohort study described in a recently published study by Falconer et al. (Br J Clin Pharmacol 87(3):1512-1524, 2021) describing the development of a predictive risk model for inpatient medication harm.

Systematic review of machine learning models for personalised dosing of heparin.

Aim: To identify and critically appraise studies of prediction models, developed using machine learning (ML) methods, for determining the optimal dosing of unfractionated heparin (UFH).

Methods: Embase, PubMed, CINAHL, Web of Science, International Pharmaceutical Abstracts and IEEE Xplore databases were searched from inception to 31 January 2020 to identify relevant studies using key search terms synonymous with artificial intelligence or ML, 'prediction', 'dose', 'activated partial thromboplastin time (aPTT)' and 'UFH.' Studies had to have used ML methods for developing models that predicted optimal dose of UFH or target therapeutic aPTT levels in the hospital setting.

The pharmacist informatician: providing an innovative model of care during the COVID-19 crisis.

Objectives: The global coronavirus pandemic has expedited digitisation in every industry, especially healthcare, and has highlighted the potential for informatics pharmacists to provide valuable input into crisis management. Informatics pharmacists can combine their clinical and information technology skills to help provide essential patient safety services related to medication management, procurement and analytics. The objective of this study was to determine the key opportunities for a pharmacist informatician to improve patient care and outcomes during the COVID-19 pandemic.