No abstract

Hazardous medicines have the potential to cause harm via occupational exposure. We describe the development of a guideline to clarify the risks of occupational handling of non‐cytotoxic hazardous medicines, and provide practical advice for frontline staff in the hospital setting. Nurses and pharmacists in Victorian hospitals were surveyed to capture their experience, whilst a literature review located 14 national or jurisdictional guidance documents. Nurses and pharmacists reported variance in practices when handling an example medicine (mycophenolate). Many found existing guidance around hazardous non‐cytotoxic medicines unclear or confusing. Medicines were categorised into four groups: cytotoxic medicines; hazardous non‐cytotoxic medicines; medicines that primarily pose a risk to men and women actively trying to conceive and women who are pregnant or breastfeeding; and medicines that are irritants to mucous membranes or airways. An institutional guideline was developed, with recommendations synthesised into a single‐page chart for quick reference at the point of care.

Objectives Adverse medication events are associated with a significant number of hospital admissions, and the appropriate recording of these events plays a vital role in medication safety. We set out to analyse the time and extrapolated cost in reporting adverse drug reactions (ADRs). Methods A time and motion study of the tasks involved in reviewing, assessing, reporting and communicating ADRs was done over a period of 2 months. Key findings We found a median of 69 min was needed in background work per ADR report. Conclusion The commitment involved in the support of this program is considerable and will encourage further refinement to streamline the process.

Background

Background: Diabetes control frequently deteriorates during hospitalisation and changes to management are often required. Aim: To evaluate the prevalence, diabetes type, admitting unit and glycaemic control of hospital inpatients with diabetes mellitus and the use of insulin‐to‐test orders (sliding scales). Method: Information on demographics, glycaemic control and insulin‐to‐test orders were collected for inpatients with diabetes mellitus by surveying medical records, 48 hours of blood glucose levels (BGLs) and drug charts. Results: Of the 698 inpatients, 108 (15%) had diabetes comprising 24 (22%) with type 2 controlled with diet, 39 (36%) with type 2 treated with oral hypoglycaemic agents, 40 (37%) with type 2 treated with insulin with or without oral hypoglycaemic agents and 5 (5%) with type 1. Diabetes was present in 82/351 (23%) medical, 7/61 (11%) psychiatric and 19/286 (7%) surgical patients. Control was ideal (BGL 3.5‐8.0 mmol/L) in 12% and modest (BGL 3.5‐8.0 mmol/L, plus at least one BGL 8.1‐12 mmol/L) in 29%, leaving 59% suboptimal (BGL not 3.5‐12 mmol/L). Severe hyperglycaemia (at least one BGL≥20 mmol/L) occurred in 12% and moderate hyperglycaemia (at least one BGL≥15 but none≥20 mmol/L) in 30%. Hypoglycaemia (at least one BGL < 3.5 mmol/L) was documented in 11%. Mean BGL was < 6 mmol/L in 5%, 6.1–8.0 mmol/L in 33%, 8.1‐10 mmol/L in 23%, and > 10 mmol/L in 39%. Suboptimal control was identified in 100% of type 1, 87% of type 2 treated with insulin with or without oral hypoglycaemic agents, 58% of type 2 treated with oral hypoglycaemic agents, and 9% of type 2 controlled with diet (p < 0.0001). There was no difference in glycaemic control between patients from medical, psychiatric or surgical units. Insulin‐to‐test orders, used in 34 (31%) patients, were judged as ‘safe’ in only 9 (26%) patients. Conclusion: Management of inpatients with diabetes requires improvement, supporting the need for guideline development and continuing education.