Background Ward pharmacy technicians (WPTs) support hospital pharmacists in the provision of clinical pharmacy services, however they are under‐utilised in Australia. Aim To evaluate the impact of an expanded WPT role within a 56‐bed subacute aged care inpatient service. Method The expanded WPT role included increased hours (from approximately 15.2 to 38 h/week) and an expanded scope of practice. WPT tasks included: assisting with individual patient medication supply, screening medication charts for changes, assisting with medication reconciliation and recording laboratory data for review by the pharmacist. The impact of the redesigned role on workforce and service‐delivery outcomes was evaluated in a prospective before–after study. Data were collected using self‐report, time‐and‐motion studies, dispensing reports and surveys. Results WPT assistance with individual patient medication supply increased from <60% to >80%. In the new workforce model, the WPT assisted with medication reconciliation and recording laboratory data on admission for more than 80% patients. The proportion of pharmacist time spent on clinical tasks increased from 58.0% to 73.9% (p < 0.0001), and unpaid pharmacist overtime fell from a median of 58.4 to 13.4 min/day (p < 0.0001). The median number of pharmacist interventions to resolve medication‐related problems increased from 4 to 9/day (p < 0.0001), and interventions were made earlier in the admission. There were improvements in ward staff satisfaction with some aspects of the pharmacy service, and in the pharmacist's and WPT’s satisfaction with their roles. Conclusion An expanded WPT role improved clinical pharmacy service‐delivery, staff satisfaction and patient care.

Background Severe hypocalcaemia and hypophosphataemia following the co‐administration of denosumab and IV ferric carboxymaltose has previously been reported in the setting of chronic kidney disease and malignancy. Despite scarce evidence, there has been growing concern amongst clinicians of a possible drug interaction between denosumab and IV iron therapies. Although electrolyte abnormalities are well known side effects of these individual therapies, it is possible that co‐administration of the agents can exaggerate these effects and result in a potentially life‐threatening interaction. Aim We present a case of profound hypocalcaemia and hypophosphataemia following same day administration of denosumab and IV ferric carboxymaltose in a hospitalised older patient. Clinical details An older female with normal renal function, serum calcium, phosphate and 25‐hydroxy‐vitamin D levels, and no history of malignancy was given denosumab 60 mg SC for secondary fracture prophylaxis following an acute osteoporotic fracture. On the same day, she received ferric carboxymaltose 1 g IV for treatment of iron‐deficiency anaemia. Outcomes Following a review of her pathology results during the inpatient hospital admission, profound hypocalcaemia and hypophosphataemia was identified 8 days after denosumab and ferric carboxymaltose administration. Despite supplementation, electrolyte abnormalities persisted for 12 days following administration. Conclusion Although the patient had no pre‐existing risk factors for developing electrolyte disturbance, profound hypocalcaemia and hypophosphatemia following denosumab and IV ferric carboxymaltose administration occurred, suggesting a possible interaction between the two therapies. Caution should be exercised by clinicians when these agents are co‐administered within a close timeframe.

Parkinson's disease is a chronic neurodegenerative disorder that mainly affects older people. It is predominately recognised as a movement disorder; however, the non-motor symptoms are gaining increased recognition. Treating both motor and non-motor symptoms can be challenging. Co-morbidities, in particular dementia, polypharmacy and an increased susceptibility to adverse medication effects often necessitate a different approach to management compared to younger patients. In older people, the mainstay of treatment for motor symptoms is levodopa. However, long-term side-effects including motor fluctuations and dyskinesia can be severely disabling and may require the addition of adjunctive agents including dopamine agonists, catechol-o-methyltransferase inhibitors, monoamine oxidase-B inhibitors and amantadine. Medications can significantly improve symptoms; however, optimal management of motor and non-motor symptoms usually requires a multidisciplinary approach. In this article we present an evidence-based review of Parkinson's disease treatments and guidance to improve clinical management and outcomes in older people.