ObjectiveTo investigate the physical and chemical compatibility of pentoxifylline (PTX) with a wide range of parenteral medications used in the neonatal intensive care setting.DesignPTX and drug solutions were combined in glass phials and inspected visually for physical incompatibility. The chemical compatibility was evaluated on the basis of PTX concentrations.ResultsPrecipitation, colour change or turbidity was not visible in any of the test mixtures, indicating no observed physical incompatibility or apparent risk of blockage in narrow-bore intravenous tubing. The PTX concentration was approximately 2.5% and 4.5% lower when combined with dopamine and amoxicillin, respectively. The PTX concentration ratios for all other combinations were in the range of 99%–102%.ConclusionIn simulated Y-site conditions, physical compatibility testing of PTX and 30 parenteral medications revealed no evidence of precipitation. Based on PTX concentration tests, it could be prudent to avoid mixing PTX with dopamine or amoxicillin.

ObjectiveTo investigate the physical and chemical compatibility of pentoxifylline (PTX) with a range of parenteral medications used in neonatal intensive care.DesignPTX and drug solutions were combined in glass vials, inspected for physical incompatibility and evaluated on the basis of PTX concentrations for chemical compatibility.ResultsNo precipitation, colour change or turbidity was observed in any of the test mixtures. The PTX concentration was approximately 5.5% lower when combined with undiluted calcium gluconate injection (100 mg/mL). The PTX concentration ratios for all other combinations, including diluted calcium gluconate injection (50 mg/mL), were in the range of 99.5%–102%.ConclusionIn simulated Y-site conditions, PTX was found to be compatible with 15 parenteral medications and six total parenteral nutrition solutions. Based on PTX concentration tests, it would be prudent to avoid mixing PTX with undiluted calcium gluconate injection.

No abstract

Previous review in the study hospital showed that the pain management following discharge from the Day Surgery Unit (DSU) was inadequate with 6% of patients discharged home with pain medicines. The aim of this audit was to assess the efficacy of the new DSU discharge medication system for patients following day laparoscopy procedures. Pain control following the procedure and patient satisfaction with pain management were also assessed. A total of 100 patients who underwent a day case laparoscopy procedure at the study hospital from 12 June 2018 to 23 April 2019 were included in the study. Patient medical records, anaesthetic and recovery charts were reviewed. Analgesic requirements and pain scores in theatre, recovery, DSU and on discharge were documented. Patients were followed-up by phone interview on analgesic use in the 24 h post discharge, and on patient satisfaction with postoperative pain management. At discharge from the DSU, 88 (88%) patients were supplied analgesics and medicine information leaflets. In the 24 h postoperative phone follow-up, 63 (78.7%) patients indicated they were not in severe pain. Of the 53 patients who reported moderate (n = 36) to severe (n = 17) pain, 47 (88.7%) used analgesics at home. The common analgesics used after discharge were paracetamol (68.8%), tramadol (51.3%), ibuprofen (40%) and celecoxib (25%), Patient satisfaction with pain management in the 24 h post discharge was (69) 86.3%. The new discharge process has improved the supply of analgesic medication and medication information for patients following a day laparoscopy procedure. Patients reported great satisfaction with pain management in the hospital.

Deprescribing is an area of current interest across primary, secondary and tertiary care, and invokes the principles of quality use of medicines. 1 The question is how to optimise deprescribing in each of these settings. 2Authors Anderson et al.3 examine barriers to deprescribing practice in primary care. They propose solutions that include collaborative medication review, shared decision-making and a structured decision framework. Furthermore, these can be applied across care settings. However, while the accredited pharmacist plays an important role in primary care, the full potential and reach of this role has not yet been realised. 4Inappropriate polypharmacy is an important concern for medication safety, a national priority for safety and quality in health care. Indeed, the single most important predictor of harm in the elderly from adverse drug events is the number of prescribed drugs.2 Deprescribing aims to manage polypharmacy through the process of withdrawing inappropriate medications. The authors explore pharmacist barriers to deprescribing where, as a profession, our propensity for rules and certainty may mean strict adherence to guidelines. 3Perhaps as a result, pharmacists are more likely to recommend new medicines rather than ceasing them. 3Pharmacists should learn to appreciate that individualising treatments to meet patient-specific care goals is part of a shared decision-making approach for complex care. 3 We must consider our role in polypharmacy and how we can best contribute to deprescribing in the future. As a hospital pharmacist I can appreciate the inherent difficulty in deprescribing in time-poor clinical environments. Once an accurate medication list is obtained, a collaborative medication review can be undertaken. Unfortunately, in my experience, the medications associated with admission represent the most pressing concerns and often take precedence. The consideration of potentially inappropriate medications is lower down the list of priorities. Indeed, a study of polypharmacy among elderly inpatients in Australia demonstrated no clinically meaningful change in the number of medications between admission and discharge, 5 suggesting a potential lack of deprescribing efforts. However, for patients with a longer duration of stay an opportunity for deprescribing is presented. Hospital physicians and pharmacists should be conscious that a collaborative medication review conducted in this setting could result in clinically meaningful outcomes for their patients. 5Deprescribing is an important advancement in the practice of quality use of medicines and medication safety, which calls for immediate attention. With gathering momentum in this area, the hope is that more evidence and clinical guidelines will provide a clearer path for deprescribing in the complex elderly population. However, in light of current limited evidence, pharmacists across care settings should engage available strategies to overcome deprescribing barriers.