BackgroundAdverse drug events (ADEs) pose a heavy burden on health systems worldwide. The assessment of risk tool (ART) was developed to help prioritise hospitalised patients for interventions such as medication reconciliation (MR) and review, and to reduce potential ADEs from unintentional medication discrepancies and prescribing errors.AimTo validate ART, and to determine which of the selected 25 flags were significantly associated with risk of unintentional medication discrepancies and prescribing errors.MethodThis was a prospective observational study of 247 admissions to two medical teams in a New Zealand hospital. Study pharmacists undertook MR and review for all eligible admissions over 5 months. A Kruskal–Wallis test was used to determine differences in numbers of unintentional medication discrepancies and prescribing errors, followed by generalised linear modelling, to find the estimated ratio of the mean number of unintentional medication discrepancies between the three ART groups. In part 2 of the study, using multivariable logistic regression, combinations of flags significantly associated with risk were identified.ResultsSignificant differences in the number of unintentional medication discrepancieswere found between the ART risk groups (p<0.0001, Kruskal–Wallis test). Patients in the high-risk group had a significantly greater number of unintentional medication discrepancies than those in the medium- and low-risk groups. There were no significant differences in prescribing errors between the ART risk groups (p=0.08, Kruskal–Wallis test). Flags significantly associated with risk, included ‘more than eight admission medications’, OR=3.7 (95% CI 2.2 to 6.4) and ‘readmission within 30 days’, OR=6.8 (95% CI 3.0 to 15.2), p<0.0001.ConclusionART was effective for prioritising patients for interventions such as MR.

Background Despite the high morbidity and mortality associated with adverse drug events (ADEs) and adverse drug reactions (ADRs) the ability to detect and report them systematically remains inefficient. Aim To investigate if the use of a modified ADE trigger tool could improve the identification of ADRs in hospitals. Method Retrospective review of patients' discharge summaries was conducted at a tertiary care facility over a 5‐week period. A modified ADE trigger tool (based on a previous model) was used to assess four high‐risk medicines (warfarin, heparin, morphine, benzodiazepines). ADEs identified were classified using both the Naranjo probability scale and the WHO ADR classification. Results Data from 528 patients were reviewed, of which 286 (54%) received at least 1 of the 4 high‐risk medicines. 45 patients (8.5%) were identified using the modified trigger tool as having had an ADE during their hospital stay. The modified ADE trigger tool improved the identification of ADRs compared with the spontaneous reporting system, regardless of the classification method used. Both the WHO and Naranjo classification scales yielded higher rates than the spontaneous reporting rate of 0.07% recorded by the New Zealand Centre for ADR Monitoring. Conclusion The modified ADE trigger tool appears to be a sensitive method for identifying ADRs. The results indicate that using the modified trigger tool yields significantly higher ADR reporting rates than the traditional spontaneous reporting system.

A major barrier to Victorians with a terminal illness accessing voluntary assisted dying is the Commonwealth Criminal Code Amendment (Suicide Related Material Offences) 2005 (the Code), which prohibits the use of any electronic forms of communication when discussing suicide. The proliferation of telehealth as a means of access to medical practitioners as a result of the COVID-19 pandemic has heightened the anachronistic prohibition of such communication in relation to voluntary assisted dying, particularly in Victoria, as the federal law arguably prohibits its use. In this paper we explore the definition of suicide and its application to voluntary assisted dying and argue for a revision of the Code, to enable equitable and timely access to voluntary assisted dying for people of Victoria.

Background: Unfractionated heparin is a high-risk medication, as serious adverse events may result from errors of use. Different practices and protocols for unfractionated heparin are used at the three district health boards in Auckland. Concern about the inadequacies of heparin use prompted a collaborative evaluation of adherence to unfractionated heparin protocols and to aid the formulation of solutions for process improvement. Aim: To evaluate the three district health boards' compliance with unfractionated heparin protocols, and to identify issues with prescribing and administration and the occurrence of adverse events. Method: A retrospective audit of all patients started on unfractionated heparin at the three district health boards was undertaken from March to June 2005. An audit tool was developed to evaluate compliance with 6 criteria of prescribing and administration common to each hospital protocol and data were collected on indication and occurrence of adverse events. Results: 61 patients were audited. 51% had a baseline activated partial thromboplastin time (aPTT) measured, 39% had an aPTT measured at 6 hours, 80% received a heparin loading dose (90% as per protocol), 85% received maintenance infusion dose and rate as per protocol and 35% had failed to reach target aPTT at 72 hours. None of the 6 criteria achieved 100% compliance. Conclusion: Compliance with the specified protocols was low. Systems changes have been identified that can improve the safety and effectiveness of unfractionated heparin use.