Home medicines reviews: a national survey of Australian accredited pharmacists’ health service time investment

Background: In Australia, polypharmacy and medication-related problems are prevalent in the community. Therefore, medicines safety initiatives such as the Home Medicines Review (HMR) service are critical to health care provision. While the evidence continues to expand around HMR service, little is known of accredited pharmacists’ experiences of HMR time investment. Objective: This study aimed to explore accredited pharmacists’ experiences of HMR practice regarding time investment in the study’s defined HMR Stages: 1 (initial paper-based assessment and review), 2 (in-home patient-accredited pharmacist consultation), and 3 (HMR report collation, generation, completion, and provision to the patient’s General Practitioner, including any liaison time). Methods: An electronic survey was developed and piloted by a panel of reviewers. Convenience sampling was used to distribute the final anonymous survey nationally via professional pharmacy organisations. Data were analyzed for frequency distributions and a chi-square test of independence was performed to evaluate any association between demographic variables relating to HMR time investment. Results: There was a total of 255 survey respondents, representing approximately 10% of national accredited pharmacist membership. The majority were experienced accredited pharmacists who had completed >100 HMRs (73%), were female (71%), and aged >40 years (60%). Regarding time investment for a typical instance of HMR, most spent: <30 minutes performing Stage 1 (46.7%), and 30-60 minutes performing Stage 2 (70.2%). In Stage 3, 40.0% invested 1-2 hours, and 27.1% invested 2-3 hours in HMR report collation and completion. Quantitative analysis revealed statistically significant (p=0.03) gender findings where females performed longer patient consultations than males (Stage 2) (AU)

Home medicines reviews: a national survey of Australian accredited pharmacists' health service time investment.

BACKGROUND: In Australia, polypharmacy and medication-related problems are prevalent in the community. Therefore, medicines safety initiatives such as the Home Medicines Review (HMR) service are critical to health care provision. While the evidence continues to expand around HMR service, little is known of accredited pharmacists' experiences of HMR time investment. OBJECTIVE: This study aimed to explore accredited pharmacists' experiences of HMR practice regarding time investment in the study's defined HMR Stages: 1 (initial paper-based assessment and review), 2 (in-home patient-accredited pharmacist consultation), and 3 (HMR report collation, generation, completion, and provision to the patient's General Practitioner, including any liaison time). METHODS: An electronic survey was developed and piloted by a panel of reviewers. Convenience sampling was used to distribute the final anonymous survey nationally via professional pharmacy organisations. Data were analyzed for frequency distributions and a chi-square test of independence was performed to evaluate any association between demographic variables relating to HMR time investment. RESULTS: There was a total of 255 survey respondents, representing approximately 10% of national accredited pharmacist membership. The majority were experienced accredited pharmacists who had completed >100 HMRs (73%), were female (71%), and aged >40 years (60%). Regarding time investment for a typical instance of HMR, most spent: <30 minutes performing Stage 1 (46.7%), and 30-60 minutes performing Stage 2 (70.2%). In Stage 3, 40.0% invested 1-2 hours, and 27.1% invested 2-3 hours in HMR report collation and completion. Quantitative analysis revealed statistically significant (p=0.03) gender findings where females performed longer patient consultations than males (Stage 2). More HMR career experience resulted in statistically significant (p=0.01) less time performing Stage 1 (initial paper-based assessment and review); with a trend to less time performing Stage 3 (HMR report writing). CONCLUSIONS: Accredited pharmacists invest significant time in performing comprehensive HMRs, especially during in-home patient consultations and during HMR report collation and completion. Their significant HMR time investment as medicines experts provides insight for program and workforce considerations and warrants further research to better understand their work processes for optimizing medicines use and improving health.

Reducing inappropriate polypharmacy: the process of deprescribing.

Inappropriate polypharmacy, especially in older people, imposes a substantial burden of adverse drug events, ill health, disability, hospitalization, and even death. The single most important predictor of inappropriate prescribing and risk of adverse drug events in older patients is the number of prescribed drugs. Deprescribing is the process of tapering or stopping drugs, aimed at minimizing polypharmacy and improving patient outcomes. Evidence of efficacy for deprescribing is emerging from randomized trials and observational studies. A deprescribing protocol is proposed comprising 5 steps: (1) ascertain all drugs the patient is currently taking and the reasons for each one; (2) consider overall risk of drug-induced harm in individual patients in determining the required intensity of deprescribing intervention; (3) assess each drug in regard to its current or future benefit potential compared with current or future harm or burden potential; (4) prioritize drugs for discontinuation that have the lowest benefit-harm ratio and lowest likelihood of adverse withdrawal reactions or disease rebound syndromes; and (5) implement a discontinuation regimen and monitor patients closely for improvement in outcomes or onset of adverse effects. Whereas patient and prescriber barriers to deprescribing exist, resources and strategies are available that facilitate deliberate yet judicious deprescribing and deserve wider application.

Does nurse self-testing affect catheter choice?

BACKGROUND: Involving patients in decision making about their care requires expert knowledge and understanding of patients' perspectives. Knowledge comes from several sources and experience; however, the self-testing of products by health professionals who teach clean intermittent self-catheterisation (CISC) has not been investigated. AIM: This study aimed to assess the impact of self-testing on catheter evaluation by continence nurses. METHODS: Sixteen continence nurses self-tested two catheters and completed a questionnaire on their opinions about the catheter, routine self-testing and whether the study would make them change their usual practice. RESULTS: Almost half of the participants found self-testing intermittent catheters a useful experience and some of those who did not routinely self-test said they would do so in future. CONCLUSION: Self-testing intermittent catheters can provide useful knowledge to those who teach CISC.

An overview of suprapubic catheter care in community practice.

This paper gives a broad overview of suprapubic catheterization. Community nurses can often feel they lack experience with suprapubic catheter general care and routine changes. This paper sets out the advantages and disadvantages of suprapubic catheters, the procedure for routine change and the golden rules for general care. The paper contains an introduction on trouble shooting.

Using bladder ultrasound to detect urinary retention in patients.

Bladder ultrasound is now considered a safer alternative to catheterisation in the diagnosis of urinary retention. This article outlines how bladder ultrasound works and its practical uses.

A study of the structure of the crystalline bacterial biofilms that can encrust and block silver Foley catheters.

The aim of this study was to examine the structure of the crystalline bacterial biofilms that encrust and block silver/hydrogel-coated latex catheters. Scanning electron microscopy was used to examine the crystalline deposits that were found encrusting catheters obtained from six patients undergoing long-term catheterization in a community setting. Large populations of bacilli and cocci were seen on all catheters developing on a basal foundation layer of crystalline material. These observations show that in patients prone to catheter encrustation, crystalline material formed in the urine can cover the surfaces of silver catheters. Extensive bacterial biofilms then develop on the crystals, shielded from the underlying silver. It is suggested that if antimicrobials are to be incorporated into catheters to prevent encrustation, they must diffuse out from the catheter surface and reduce the viable cell populations of the urease producing bacteria that elevate the urinary pH and trigger crystal formation.

Urinary urge incontinence: causes and management strategies.

Bladder control is a skill most people learn in childhood, so if control is lost in adult life the impact can be very significant, particularly on the quality of life of the person affected. There are many causes of loss of bladder control, ranging from neurological conditions to menopause, as well as certain medications. This article discusses urinary urgency and urge incontinence, examines its causes and diagnosis, and provides an overview of the nursing interventions available to treat the problem.

Underactive bladder syndrome.

Underactive bladder syndrome causes difficulty in voiding, resulting in incomplete bladder emptying. This article describes common causes of the condition, patient assessment and the available management options.

pH testing in catheter maintenance: the clinical debate.

The pH of urine is widely recognized as being a major contributory factor in urinary catheter encrustation. What is less widely appreciated is the range of factors that affect the pH of urine, and which therefore affect the reliability and validity of urine pH testing. This article examines the validity of various urinary pH testing methods and discusses the theoretical and practical implications of the uncertainty surrounding their practical value.

Regaining continence after radical prostatectomy.

In this article, the author examines incontinence following radical prostatectomy and describes how nurses can provide advice, support and care for these patients.

The overactive bladder.

The problem of an overactive bladder is common and can have a major impact on patients' lives. This article describes the possible causes of the condition and the interventions available to help to control it.

The value of continence training: does it change clinical practice?

It is estimated that one in six people over 40 are incontinent 'several times a month' and that most of them will not have sought help (Perry et al, 2000). Containment of the problem is no longer the first-line treatment and patients should be given access to an assessment, with a management plan addressing the cause of incontinence. It is thought that around 70% of the estimated population with continence problems in the UK would show a good response to treatment (Royal College of Physicians (RCP), 1995). However, it is recognized that healthcare professionals need knowledge and training to deliver care (Brittain et al, 2001). Previous studies have shown continence education, for both professionals and users, to be cost-effective because investment in techniques to promote continence can reduce dependence on incontinence containment products (Bradley and Morgan, 1998; Williams et al, 1999). This study was based on the belief that there is an educational gap between what is taught and what is practised (Macleod, 1998; Severinsson, 1998). The study drew on an opportunistic sample of students attending continence-training courses. They were asked to complete pre- and post-course questionnaires. Using a follow-up research design, three periods of data were collected. Data were analysed using Microsoft Excel and the Statistical Package for Social Science (SPSS). The results conclude that there was a statistically significant change in the quantitative measure - the test result - but qualified nurses were experiencing some difficulty relating the theory to clinical practice.