Journal of Pharmacy Practice and Research最新文献

{"title":"Self-reported neuropsychiatric adverse reactions in people receiving bictegravir combined with emtricitabine/tenofovir alafenamide","authors":"Aleksandra Trakilovic BPharm (Hons), GradCertPharmPrac,&nbsp;Linda Velta Graudins BPharm, DipHospPharm, DipClinPharmacoEpid, AdvPracPharm, FSHPA,&nbsp;Ar Kar Aung BMedSci, MBBS, FRACP, MPHTM,&nbsp;Jennifer Hoy MBBS, FRACP,&nbsp;Christopher K. Fairley MBBS, Ph. D, FRACP, FAFPHM, FACSHP,FAChSHM, FRCP, FAHMS,&nbsp;Ivette Aguirre MClinPharm, GradCertPharmPrac, BPharm, BAppSc(MedLabSc)","doi":"10.1002/jppr.1867","DOIUrl":"10.1002/jppr.1867","url":null,"abstract":"<p>The integrase-inhibitor bictegravir combination antiretroviral therapy (ART) Biktarvy became available in Australia in October 2018. Neuropsychiatric adverse drug reactions (ADRs) are associated with bictegravir and may affect persistence and adherence to treatment. The aim of this study was to describe the type and frequency of reported neuropsychiatric reactions in people dispensed Biktarvy. Ethics approval was obtained from Alfred Hospital Ethics Committee (Project No. 541/20). Data were collected from records of people dispensed Biktarvy between October 2018 and May 2020 and who subsequently had a new neuropsychiatric reaction reported to the organisation's ADR Review Committee. Data were sourced from ADR reports, medical and dispensing records, and included demographics, medical history, and concurrent medicines with known psychiatric adverse reactions. Data were analysed descriptively. Biktarvy was dispensed to 1265 patients. Twenty-two (1.7%, 95% confidence interval [CI] 1.0–2.5%) people reported 50 neuropsychiatric ADRs, including abnormal dreams (<i>n</i> = 13), sleep disorders (<i>n</i> = 5), and headaches (<i>n</i> = 5). The median time from initiation to reaction was 13 (interquartile range [IQR] 4–94) days. Eighteen patients discontinued Biktarvy (1.4%, 95% CI 0.85–2.24). There was no statistically significant difference in discontinuation of Biktarvy between people who did or did not have a pre-existing psychiatric diagnosis (p = 0.58). Concurrent medicines with known psychiatric adverse reactions were used by 10 people. A low rate of reported neuropsychiatric ADRs lead to discontinuation of Biktarvy, similar to rates in Biktarvy trials. This study adds to the post-marketing surveillance data of Biktarvy tolerance amongst people living with human immunodeficiency virus (HIV).</p>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"53 4","pages":"195-199"},"PeriodicalIF":2.1,"publicationDate":"2023-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1867","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49136977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the most cost-beneficial way to prepare micafungin for paediatric oncology patients?","authors":"Erica Li BPharm,&nbsp;Evonne Smith BPharm, GDipClinPharm","doi":"10.1002/jppr.1865","DOIUrl":"10.1002/jppr.1865","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>A recent change in local paediatric antifungal guidelines resulted in an increase in micafungin use. Micafungin is an expensive medicine costing AUD $80 per vial. The pharmacy aseptic production unit (APU) has the ability to compound doses to share vials of micafungin to minimise wastage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To determine whether aseptically compounded and individually prepared doses of micafungin would be more cost-beneficial than nurses using whole vials prepared on the ward, and to determine which dose and numbers of doses would be most cost-beneficial to compound.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A time and motion study of 20 patients determined how long it took for nurses and the pharmacy APU to prepare doses. An economic analysis of time, cost of labour, and consumables outlined the cost to make one to seven doses with doses ranging from 10 to 200 mg.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>On average, it took the pharmacy APU 42 min and nurses 9 min to prepare a single dose. Aseptically compounding one dose, whole vials (doses of 50 mg increments), and doses near whole vials had no cost-benefit. Aseptically compounding five doses or more had would result in a cost-benefit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Depending on the dose required, cost savings could be obtained when the pharmacy APU prepared multiple doses, with a maximum saving of $350.10 for a 7-day course. Determining baseline costs of micafungin preparation is relevant if there are future requests to compound medicines as the data could be extrapolated and applied to the new request.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"53 4","pages":"171-176"},"PeriodicalIF":2.1,"publicationDate":"2023-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42403238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time for change: improving neuromuscular blocking agent safety in Australia","authors":"Amy McRae BPharm, MPharm,&nbsp;Linda Velta Graudins BPharm, Dip Hosp Pharm, PostGrad Clin Epid, FSHPA, Adv Prac Pharm,&nbsp;Wendy Jane Ewing BPharm,&nbsp;Thuy Bui BPharm, MClinPharm, FSHP,&nbsp;Glenn Downey MBBS, FANZCA,&nbsp;David Edmund Piers Bramley MBBS, MPH, FANZCA,&nbsp;Michael J. Dooley BPharm, GradDipHospPharm, PhD, FSHP, FISOPP, FAAQHC, Adv Prac Pharm","doi":"10.1002/jppr.1864","DOIUrl":"10.1002/jppr.1864","url":null,"abstract":"<p>Incidents involving mis-selection and administration of neuromuscular blocking agents (NMBAs) leading to patient harm resulted in the initiation of activity in Victorian hospitals to review the management of this high-risk group of medicines. Local risk mitigation strategies, such as in-house labelling and restricting access, were considered partially effective, but it was recognised that a national approach was required. In 2015, hospital pharmacists — together with anaesthetist colleagues and peak patient safety organisations — made a submission to the Therapeutic Goods Administration (TGA) describing safety risks with NMBAs, with recommendations for improved NMBA labelling. This report describes the five-year process which eventually led to the TGA mandating manufacturers to place alert labelling on NMBA products. As a result of this effort, a Victorian Therapeutics Advisory Group (VicTAG) grant enabled the development of a ‘NMBA Safer Practice Advisory Tool for Australian Hospitals’, providing a standard guide to monitor the safe use of NMBAs.</p>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"53 4","pages":"200-203"},"PeriodicalIF":2.1,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1864","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47476225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency department pharmacist impact on time to administration of heparin: a brief report","authors":"Taylor M. Brisben PharmD,&nbsp;Cody R. Maldonado PharmD, BCCCP,&nbsp;Michaela M. Bruner PharmD,&nbsp;Rachel L. Ott MD FACS,&nbsp;Sarah K. Spilman MA,&nbsp;Jeffrey W. Jansen PharmD, BCIDP","doi":"10.1002/jppr.1866","DOIUrl":"10.1002/jppr.1866","url":null,"abstract":"<p>In the United States, venous thromboembolisms (VTE) and acute coronary syndrome (ACS) are significant causes of morbidity and mortality. Anticoagulant medicines, such as heparin, are often indicated to stop or prevent clot formation, and early administration of heparin has been associated with reduced mortality. There is no literature evaluating whether administration of heparin is expedited when pharmacists are involved in patient care in the emergency department (ED). The purpose of this study was to determine whether the presence of an ED pharmacist decreased time to heparin administration for patients with VTE or ACS. This study was approved by the institutional review board at the Sisters of Charity of Leavenworth (SCL) Health Institutional Review Board (reference number: 2021-047). This retrospective cohort analysis evaluated patients who presented to the ED between 1 January 2019 and 30 May 2022 and received an order for unfractionated heparin with a confirmed diagnosis of VTE or ACS. The chi-square test and Wilcoxon ranked-sum test were used to detect differences between groups. A total of 65 patients were included in the analyses. Comparison of the median time between order and administration of heparin revealed that patients with an order placed while a pharmacist was present in the ED received heparin sooner than patients without an ED pharmacist present (32 min vs 50 min, p = 0.02). Time to administration of heparin was significantly shorter when a pharmacist was present in the ED at the time the order was placed by the care team. Findings suggest that the presence of an ED pharmacist expedites time to heparin administration.</p>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"53 3","pages":"143-146"},"PeriodicalIF":2.1,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1866","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48423151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Compliance of good storage practices of pharmacies and medicine outlets: a scoping review","authors":"Carly Ching PhD,&nbsp;Mohammad Ahsan Fuzail BS,&nbsp;Muhammad H. Zaman PhD,&nbsp;Veronika J. Wirtz PhD","doi":"10.1002/jppr.1854","DOIUrl":"10.1002/jppr.1854","url":null,"abstract":"<p>Ensuring good storage practices (GSPs) of medicine outlets is important to maintain and ensure the safety, quality, and efficacy of dispensed medicines. The objective of this scoping review was to determine the most common GSP compliance issues within pharmacies and medicine outlets. PRISMA extension for scoping reviews guidelines were followed, and PubMed and Google Scholar were searched to identify the relevant primary literature from January 2016 and February 2022. All study designs in English were eligible for inclusion as long as they reported quantitative data for the fulfilment of individual GSP activities. Duplicate independent screening of the search results was undertaken. Quality assessment was performed on studies for final inclusion. Data extraction was performed by one reviewer, and the observed aggregate percentage compliance (% compliance), along with 95% confidence interval for the root GSP operation, was calculated. Of the 380 records identified, 15 articles were included. The studies were conducted in 10 countries and the majority were participatory research studies. Fire safety had the lowest aggregate % compliance (0.9%). Controlled substance, climate, light, ventilation and temperature and stock and bookkeeping operations all had overall aggregate % compliance levels below 50%. Despite evidence of basic controls and measures, we identified low compliance for many GSP operations. To ensure the integrity of medicines, it is important to increase the enforcement of security measures, invest resources in personnel training, account for informal vendor practices, and facilitate sharing global data publicly from external and governing body inspections and reviews of storage practices.</p>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"53 3","pages":"101-109"},"PeriodicalIF":2.1,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1854","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49547271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaccine cold chain in remote environments: culturally appropriate training opportunities, an evaluation","authors":"Suzanne Belton PhD,&nbsp;Rosalie Schultz PhD,&nbsp;Tobias Speare MPH","doi":"10.1002/jppr.1862","DOIUrl":"10.1002/jppr.1862","url":null,"abstract":"<p>Vaccines are temperature-sensitive, and they may lose effectiveness without correct storage. Research in remote Australia raised questions regarding the integrity of the vaccine cold chain to Aboriginal communities and prompted the development of a video resource, Vaccine Story, to raise awareness of maintaining the cold chain. This study describes the development and evaluation of the Vaccine Story video. Local engagement helped to refine and produce the video. Ethics approval was gained from the Menzies School of Health Research Human Ethics Committee (20–3807) and the Central Australian Human Ethics Committee (17–2869) in 2020. The evaluation was considered low risk to all participants. An online anonymous survey tested the appropriateness and effectiveness of the Vaccine Story video to enhance knowledge and awareness of risks to the vaccine cold chain and the potential implementation of the Vaccine Story video. Diverse health professionals and other staff (<i>n</i> = 83) completed the survey. Responses highlighted a lack of training around the packing and transport of vaccines, particularly for non-clinical support staff. Respondents stated the health messaging in the Vaccine Story video was effective. Over half of respondents (52%) recommend the use of the video as a training tool. The Vaccine Story video addresses some concerns regarding vaccine transportation and storage in remote Aboriginal communities through strengthening understanding of the importance of cold chain.</p>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"53 3","pages":"147-151"},"PeriodicalIF":2.1,"publicationDate":"2023-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1862","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43755094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The roles and perspectives of an informatics pharmacist practicing in the Australian healthcare setting: a qualitative study","authors":"Nur Fazlini Ismail BPharm,&nbsp;Centaine Snoswell PhD MPH BPharm,&nbsp;Vivien Banks BPharm,&nbsp;Nazanin Falconer PhD DipGrad BPharm","doi":"10.1002/jppr.1860","DOIUrl":"10.1002/jppr.1860","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The implementation of digital healthcare systems in hospitals globally and in Australia has led to the introduction of the informatics pharmacist as a career in the healthcare system. However, informatics pharmacists are not yet part of routine clinical services in Australia, so their perspective and roles are not well understood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To explore pharmacists' and other health professionals' perspectives of the roles of informatics pharmacists within interprofessional teams in Australian health care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>This study used semi-structured interviews with experts in pharmacy and/or informatics. They were recruited using convenience sampling and snowballing. The interviews were audio-recorded and transcribed and analysed using inductive thematic techniques to identify major themes. Ethical approval was received from the local institutional Human Research Ethics Committee (Approval No: 2020000069).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The process of inductive thematic analysis was used to analyse the interview transcriptions of 11 participants. Six themes were identified: (1) a promising future for the informatics pharmacists, (2) education, (3) specific skills, (4) scope of informatics role, (5) impacts, and (6) barriers. Participants described the career of informatics pharmacists as an emerging specialty in today's healthcare systems. The roles of informatics pharmacists in Australian health care are described together with the skills and knowledge required for these roles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A key role of informatics pharmacists is to facilitate the appropriate use of digital systems to prevent medication errors and improve patients' safety. While international experience has shown the potential scope for an informatics pharmacist, this research shows the use of informatics pharmacists in Australia is in its infancy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"53 3","pages":"116-125"},"PeriodicalIF":2.1,"publicationDate":"2023-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1860","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45259629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a unit dose approach to managing oral opioid liquids in an Australian hospital","authors":"Lewis Bint BPharm, MBA,&nbsp;Matthew Rawlins BPharm, MBA,&nbsp;Ashleigh Lawrence BPharm, Hons,&nbsp;Ken Tam BPharm,&nbsp;Barry Jenkins BPharm","doi":"10.1002/jppr.1861","DOIUrl":"10.1002/jppr.1861","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Liquid opioids (controlled drugs) in multidose bottles (MDBs) are associated with measurement losses, overfill variance, gradual contamination, and potential theft. Western Australian state poisons regulations and policies require rigorous accountability and previous reports have highlighted shortcomings in historical arrangements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To describe the process and outcomes of a transition to unit dose pod (UDP) formulations for oral liquid opioids at our institution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A UDP of oral oxycodone liquid was developed in partnership with a third-party compounder and piloted on a paediatric ward. Additional UDP opioid formulations were developed and gradually replaced MDBs across our institution. Reportable discrepancies and staff satisfaction were compared between MDBs and UDPs. This project was registered as a quality improvement project (GEKO 27758) and considered exempt from human research and ethics approval by the South Metropolitan Health Service Human Research Ethics Committee.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between May 2017 and May 2018, 3062 UDPs were distributed with nil discrepancies, and 133 MDBs were distributed with 16 discrepancies (0% vs 12%). Most staff (92%) reported more efficient inventory counts and improved confidence in product integrity for UDPs. Staff administrative overhead required to manage reportable discrepancies from volume errors was essentially eliminated. Five UDP opioid formulations were implemented in 27 inpatient wards including methadone-maintenance UDPs for inpatient use. By late 2020, UDPs were in use across 19 hospitals in Western Australia (WA), with annual use exceeding 33 000 units.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The UDP simplifies the management of controlled drug liquids by eliminating discrepancies associated with MDBs inventory management and increasing staff confidence in product quality, leading to significant uptake across WA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"53 3","pages":"135-142"},"PeriodicalIF":2.1,"publicationDate":"2023-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49218558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fred J Boyd 2022 oration","authors":"Michael J. Dooley BPharm, GradDipHospPharm, PhD, FSHP Adv Prac Pharm","doi":"10.1002/jppr.1857","DOIUrl":"10.1002/jppr.1857","url":null,"abstract":"","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"53 2","pages":"96-99"},"PeriodicalIF":2.1,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46995386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Echinocandin use in an Australian tertiary hospital: implications for antifungal stewardship","authors":"Courtney Ierano BPharm(Hons), GradCertPharmPrac, PhD,&nbsp;Mia Percival BBiomedSc, BHlth, MedSc(Hons),&nbsp;Susan Poole BPharm, GradDip Epidem Biostat,&nbsp;Kathryn Mackie BPharm, GradDipClinPharm, BCGP,&nbsp;Zohal Rashidzada BPharm, MClinPharm,&nbsp;Carmela Corallo BPharm, GradDipHospPharm,&nbsp;James. H. Mcmahon MBBS, FRACP, MPH, PhD,&nbsp;Catherine Orla Morrissey MB, BCh, FRACP, Grad Dip (Clin Epi), PhD, AFRACMA,&nbsp;Alison Duncan BPharm, GradDipClinPharm","doi":"10.1002/jppr.1859","DOIUrl":"10.1002/jppr.1859","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Invasive candidiasis (IC) surveillance demonstrates an increasing incidence of resistance to azole-based therapy. Consequently, echinocandins are often considered first-line treatment for IC in critically ill patients. To better understand the complexities of decision-making around echinocandin initiation, an evidence-based audit tool was developed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To describe echinocandin initiation and compliance with current guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A retrospective audit of echinocandin initiation was conducted between 1 January 2020 and 31 December 2020 at a quaternary referral hospital. An audit tool was developed by infectious diseases physicians and antimicrobial stewardship pharmacists, capturing patient demographics, microbiological results, indication for therapy, and risk factors for invasive fungal disease (IFD). Local guideline compliance was determined. This project was determined to be a quality improvement project and was not required to undergo ethical review according to the Alfred Hospital Ethics Committee procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred sixty-seven patients were initiated on 214 courses of echinocandin therapy. Caspofungin was most commonly prescribed (<i>n</i> = 172, 80%). Of the 167 patients, most (<i>n</i> = 119, 71%) were in the intensive care unit at the time of initiation. Empiric therapy for sepsis or infection of unclear source was the most commonly documented indication (<i>n</i> = 117, 55%); 71% (<i>n</i> = 153) of all courses were deemed empiric therapy, followed by directed therapy (<i>n</i> = 55, 26%). The most common risk factors for IFD were recent exposure to broad-spectrum antimicrobial therapy (<i>n</i> = 165, 99%) and the presence of a urinary catheter (<i>n</i> = 141, 84%). Most first doses were compliant with local guidelines (<i>n</i> = 144, 67%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Echinocandin therapy was commonly prescribed in critically ill patients with risk factors for IFD. Although the majority of prescriptions were empiric and compliant with local guidelines, improved guidelines incorporating additional patient factors should be included in future antifungal stewardship initiatives.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"53 3","pages":"126-134"},"PeriodicalIF":2.1,"publicationDate":"2023-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46289988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}