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C o m p lia n ce w ith G u id elin esK e rri A M cConachy, Sylvia C uell, P asch al J K ent, M alcolm I M cD onald ABSTRACT Objective: To prospectively evaluate the appropriate ness of prophylactic surgical antibiotic use and the cost of inappropriate surgical antibiotic prophylaxis in a 115bed private hospital. Method: Details of prophylactic antibiotic administra tion were recorded by operating theatre nursing staff and the clinical pharmacists assessed the appropriate ness of the indication, antibiotic choice and dose. Surgi cal antibiotic prophylaxis was considered appropriate if it met either the in-house Surgical Antimicrobial Pro tocol or the Antibiotic Guidelines 96197 9th edition. We assessed the timing of administration and analysed the cost of inappropriate drug use and laboratory monitor ing. Results: Surgical antibiotic prophylaxis was indicated in 92% of procedures (230/251) and used, or not used, appropriately in 86% of procedures (215/251). In the 197 cases in which antibiotics were indicated and used: only 62% of doses (122/197) were administered at or less than two hours before induction; and the correct antibiotic was chosen in 90% of cases (178/197). Dos age was correct in 77% of cases overall (192/251), but in 98% of cases when the appropriate antibiotic was chosen (174/178). Single doses were employed in only 68% of procedures (133/197). There was compliance with all five criteria in only 35% of cases. T he annual cost to this hospital of inappropriate antibiotic prophy laxis was estimated at over $40 000. Conclusion: This study demonstrated modest compli ance with current recommendations for surgical anti microbial prophylaxis. As a result, the in-house proto col is being revised to include E N T procedures and a new anaesthetic record form is being developed. Fur ther education is being targeted to anaesthetists, urolo gists, orthopaedic, colorectal and E N T surgeons. A ust J H osp Pharm 1999; 29: 5-9.

Objective: To prospectively review thyroxine replacement therapy at The Geelong Hospital and evaluate the relationship between thyroxine dose and measured thyroid stimulating hormone (TSH) concentration in this population. Method: Patients receiving thyroxine from March to September 1994 were recruited into the study from inpatient and outpatient populations. Patient demographics and details of thyroxine therapy were obtained from the patient's medical record and interview. A TSH level was also measured. Results: Fifty-two patients were recruited into the study and 49 (94%) were female. Thyroid function tests were performed at least every 12 months in 33 patients (63%). TSH concentrations were outside the normal range in 21 patients ( 40% ), with 10 patients ( 19%) recording values above and 11 (21 % ) below the normal range. Conclusion: Given the frequency of abnormal TSH levels in patients receiving thyroxine, the frequency of thyroxine prescription in the community, its narrow therapeutic index and potential adverse effects, the dosage of thyroxine should be carefully monitored. As a primary healthcare professional the clinical pharmacist can advise patients to have annual serum TSH level assessments, refer patients to their local doctor for follow-up, identify potential drug interactions and monitor serum TSH concentrations to avoid both under-treatment and doses higher than recommended.