Background: Pharmacists are among the most accessible health care professionals in the community, yet are often not involved in community palliative care teams. Objective: We investigated community pharmacists' attitudes, beliefs, feelings, and knowledge about palliative care as a first step towards determining how best to facilitate the inclusion of community pharmacists on the palliative care team. Method: A cross-sectional descriptive survey design was used. Subjects: Community pharmacists around Australia were invited to participate; 250 completed surveys were returned. Measurements: A survey was constructed to measure pharmacists' knowledge and experience, emotions and beliefs about palliative care. Results: Pharmacists were generally positive about providing services and supports for palliative care patients, yet they also reported negative beliefs and emotions about palliative care. In addition, pharmacists had good knowledge of some aspects of palliative care, but misconceptions about other aspects. Pharmacists' beliefs and knowledge about palliative care predicted-and therefore underpinned-a positive attitude towards palliative care and the provision of services and supports for palliative care patients. Conclusion:The results provide evidence that pharmacists need training and support to facilitate their involvement in providing services and supports for palliative care patients, and highlight areas that training and support initiatives should focus on.

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The provision of appropriate discharge analgesia can be challenging and is often prescribed by some of the most junior members of the medical team. Opioid abuse has been considered a growing public health crisis and physician overprescribing is a major contributor. In 2015 an initial audit of discharge analgesia at the Royal Perth Hospital led to the development of discharge analgesia guidelines. Compliance with these guidelines was assessed by a follow-up audit in 2016, which showed improved practice. This audit assesses discharge analgesia prescribing practices two years following guideline implementation. Dispensing data were obtained for analgesic medication over a three-month period from April to July 2017 and 100 unique patients were chosen using computer generated randomisation. Patients' medical records were assessed against the hospital's Postoperative Inpatients Discharge Analgesia Guidelines. The data collected were then compared with equivalent data from the previous 2015 and 2016 audits. Overall 83.4% of the 170 discharge analgesia prescriptions written were compliant with guidelines. The highest overall compliance rates were achieved for paracetamol (100%, up from 95.9% in 2016), celecoxib (96%, down from 100% in 2016), and oxycodone immediate release (IR) (74%, down from 88.9% in 2016). The quantity of oxycodone IR given on discharge complied with quantity guidelines in only 56% of cases. Overall there has been a significant and sustained improvement in appropriateness of discharge analgesia prescribing since 2015, though the results from 2017 show less compliance than 2016 and that achieving compliance with quantity guidelines is an ongoing challenge. This demonstrates the challenge of obtaining high adherence to guidelines over a longer time period.

This pilot study of 16 patients explored the use of two fibrinolytic inhibitors, tranexamic acid and aminocaproic acid, for the suppression of tumor-associated hemorrhage. The effects of such bleeding include anemia requiring transfusion, practical difficulties with dressings, and psychological morbidity from constant reminder of poor physical health. Cessation of bleeding occurred in 14 of the 16 patients treated. The average time until significant improvement in bleeding was just 2 days and the average time for complete cessation was 4 days. We conclude that fibrinolytic inhibitors are potentially useful agents in palliative care.

Aim To describe the prescribing patterns of dexamethasone in a cohort of palliative care inpatients. Method Data were collected from a consecutive sample of patients admitted to 2 palliative care units over an 8 week period. Data on dexamethasone use was also collected, i.e. indication for use, dosages, concurrent medications, adverse effects, blood glucose levels and reasons for changes in dose. Results 359 patients were admitted during the recruitment period and 185 (52%) were prescribed dexamethasone. 37 (20%) patients were prescribed dexamethasone for specific indications, such as cerebral disease, spinal cord compression and bowel obstruction. The majority of dexamethasone was prescribed for non‐specific indications: poor appetite, nausea, and poor wellbeing. A range of doses was prescribed for each indication and during their inpatient stay most patients (65%) had their dose reduced. Adverse effects were commonly reported; 117 (63%) patients experienced adverse effects attributable to dexamethasone. Conclusion Dexamethasone use is widespread in palliative care for a myriad of indications.