CONFERENCE HANDBOOKeventsites.e9.co.nz/nzhpa/wp-content/uploads/sites/4/2014/09/NZPH… · exhibition stands to say hello, see what’s new, ... New Zealand’s National School of

FRIDAY 5 TO SUNDAY 7 SEPTEMBER 2014 | CQ HOTEL, CUBA STREET, WELLINGTON

INTEGRATION AND COLLABORATION

www.nzhpa2014.co.nz

CONFERENCE HANDBOOK

New Zealand Hospital Pharmacists’ Association Conference 20142

ACKNOWLEDGMENTSThe Organising Committee would like to extend their gratitude to all the sponsors and exhibitors without whom this conference would not have been possible. Please take the time to visit all the exhibition stands to say hello, see what’s new, and complete the quiz competition to win an iPad Mini.

In particular we acknowledge the following sponsors:

Silver Sponsors

Bronze Sponsor

New Zealand Hospital Pharmacists’ Association Conference 2014 3

CONTENTS

Welcome 4General Information 5Social Programme 8Invited Speakers 9Programme and Abstracts Friday 13 Saturday 35 Sunday 63Posters 73 Exhibition Floor Plan 82Exhibitor Directory 83Exhibitor Information 84Abstract Index 107

Prize Paper and Poster SponsorsBest Overall Paper – The Dr L Berry Award New Zealand Pharmacy Education and Research Foundation

Best Paper from a Recently Graduated Pharmacist – The JS Peel Award School of Pharmacy, The University of Auckland

Best Paper by an Intern/Student New Zealand’s National School of Pharmacy, The University of Otago

Best Paper by a TechnicianNew Zealand Hospital Pharmacists’ Association

Best Paper in Medication Safety/Innovation MIMS New Zealand

Best Paper in Clinical Research/AuditNew Zealand Hospital Pharmacists’ Association

Best Poster Overall New Zealand Hospital Pharmacists’ Association

Best Poster by an Intern/Student New Zealand’s National School of Pharmacy, University of Otago


WELCOMEKia ora koutou!

It is our very great pleasure to welcome you to Wellington for the 2014 NZHPA Conference.We hope that your weekend is refreshing, invigorating and fun.

The programme includes both national and international speakers, with workshops that will certainly get you thinking differently.

We have an interesting and exciting social programme organised to allow you meet new people and also catch up with those you haven’t seen for a while.

We would like to thank all of our sponsors. Without their support this event would not be taking place.

We would also like to thank all of the presenters for coming along and taking the time to share their experience and practices with their peers.

We hope you enjoy the conference and leave refreshed with a sense of “I can do that….”

Tēnā rāwā atu koe

ORGANISING COMMITTEECo-ConvenorsChris JayKatrina Tandecki

CommitteeBrian Almand Alise Van ElswijkMargaret Briggs Maree HedgesMara Coler Judy KoscieleckiRachael Cooke Amanda PolwinBrendan Dalton Joanne SmithJessica Dodd

CONFERENCE ORGANISERSForumPoint2 LimitedPO Box 1008, WMCHamilton 3240Contact: Paula Armstrong, Project ManagerT: +64 7 838 1098E: [email protected]


GENERAL INFORMATION

REGISTRATION AND INFORMATION DESKThe registration desk is staffed by Paula and Melanie who welcome your enquiries on any conference detail or local information. The desk will be open from Friday 5 September at 12.00pm (noon).

Useful Telephone NumbersRegistration Desk Staff:Paula 027 649 2081Melanie 021 113 0289

CQ Hotel 0800 873 553Wellington Combined Taxis 04 384 4444 Super Shuttle 0800 748 885 or 09 522 5100

ATTENDEE LISTThere is a list of attendees in your conference bag.

CERTIFICATE OF ATTENDANCE A certificate of attendance can be found inside your registration envelope.

EVALUATION An online evaluation survey will be emailed to attendees after the conference. We welcome your feedback and would be grateful for a few minutes of your time to complete this.

Paper based feedback will be requested in all workshops and we would appreciate your time to complete these.

INSURANCERegistration fees do not include personal, travel or health insurance of any kind. Neither the New Zealand Hospital Pharmacists’ Association nor ForumPoint2 Limited take responsibility for delegates failing to take out adequate insurance cover.

INTERNET ACCESSComplimentary Wifi access is available to conference delegates.

MOBILE PHONESDuring conference sessions please set mobile phones to silent or vibrate. We ask that mobile phones are not used while sessions are in progress.

NAME BADGESAll conference attendees and industry representative are asked to wear their name badges at all times during the conference and social functions. It is your official entrance pass to the sessions, catering and exhibition.


PARKINGParking is available in the Marion Street Tournament car park, a three minute walk from the venue.

PRESENTERS’ INFORMATIONOral presentationsPresentations are being loaded in the speakers’ room, the Boardroom, located on level 1 in the conference area. Please go to the speakers’ room to load and check your presentation as soon as possible after your arrival at the conference. The speakers’ room will be open for loading presentations at the following times only:

Friday 5 September 12.00pm to 12.45pm 3.20pm to 4.00pm 5.30pm to 6.00pm

Saturday 6 September 8.15am to 9.00am 10.30am to 11.00am 12.15pm to 1.15pm 2.45pm to 3.15pm

Sunday 7 September 8.30am to 9.00am 10.00am to 10.30am

If you wish to use your own laptop please go to the speakers’ room and see the technician sooner rather than later.

Please be in the conference room where you are presenting ten minutes before the start of the session to check your presentation, familiarise yourself with the AV set-up and meet the session chair.

POSTER PRESENTERSPoster presenters please report to the registration desk for allocation of a poster number and location of your poster board. Posters will be displayed in the Piano Bar. Posters must be displayed by 3.00pm on Friday and removed by Sunday at 10.30am. Posters are to be manned Saturday between 12.45pm and 1.15pm.

POWERPOINT PRESENTATIONSPowerPoint presentations will be available on the NZHPA’s website (www.nzhpa.org.nz) following the conference where presenter approval has been given.

SESSIONS CHAIRSTen minutes before the session you are chairing, please be in the conference room to meet the presenters. Please ensure each session starts and finished at the advertised time.

SPECIAL DIETSIf you have advised us of any special dietary requirements on your registration form these have been notified to the chef. Vegetarian options are located on the main buffet.

There will be a “pre-ordered special dietary requirement” table located in the catering


area for other special diets. Please make yourself known to the catering staff at the social functions. Any problems please contact the staff at the conference registration desk.

Water StationsWater stations will be available throughout the venue.

WorkshopsAttendance at workshops has been pre-booked on your registration form and workshop numbers are limited and ticketed. If you wish to change from the session you have previously indicated, please swap your ticket with another willing participant.

DISCLAIMER OF LIABILITY Whilst we have endeavoured to ensure that information on the conference website and printed material is accurate, details may be subject to change without notice. Any corrections or amendments will be notified as soon as possible. In the event of industrial disruptions, or service provider failures, neither the New Zealand Hospital Pharmacists Association nor ForumPoint2 Limited will accept any responsibility for losses incurred by delegates and their partners.

Acceptance of oral free papers does not indicate endorsement by the conference committee of any product or activity that the session may promote.

Although care has been taken to ensure accuracy, the conference committee does not accept liability for any errors in published abstracts.

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SOCIAL PROGRAMME

Welcome FunctionFriday 5 September 20145.30pm – 7.00pmVenue: Exhibition Area, CQ HotelThis function is an occasion to catch up with friends and colleagues, chat with the exhibitors and other delegates whilst enjoying drinks and nibbles and viewing the exhibition.

Conference Dinner Saturday 6 September 2014 6.40pm Meet in hotel reception to join the walking bus to the venue 7.00pm – midnightFrom 10.15pm until midnight shuttle bus from Mac’s Function Centre to CQ HotelVenue: Mac’s Function Centre, WellingtonTheme: The Sevens

Your ticket includes your meal, limited beverages and entertainment. Please bring cash, eftpos or credit card to purchase additional beverages.

Entertainment:Get ready to dance the evening away to the fabulous sounds of Wellington band, The Noodles.

ImportantPlease take your ticket with you to the dinner (inside your name badge pocket), these will be collected. If you have a ticket for the dinner, but will no longer be attending, please advise the ForumPoint2 team at the conference registration desk.


SPEAKERS

Doctor Victoria Ferraresi Dr Ferraresi is the Director of Pharmacy Services for Pathways Hospice, Sunnyvale, California. She manages the hospice prescription plan, and is a clinician and educator, overseeing the provision of clinical pharmacy services for approximately 410 patients cared for in their homes.

Victoria is an Associate Professor of Clinical Pharmacy at the School of Pharmacy, University of California at San Francisco (UCSF) and

is a Fellow of the American and the California Societies of Health System Pharmacists. She is a graduate of the University of San Francisco (BS in Biology) and UCSF School of Pharmacy, where she also completed her residency in Hospital and Clinical Pharmacy.

She has been a clinical pharmacist in a community hospital pain clinic, for a home infusion pharmacy, in the Stanford University Hospital surgical theater (a service she created) and their post-operative surgical services and in a regional poison control center.

Victoria often presents and has published; she is the author of “End-of-Life Care” in the 10th edition of Applied Therapeutics: The Clinical Use of Drugs.

Dr Ferraresi is an active member in a number of pharmacy and hospice organizations, and is currently the Chair of the House of Delegates for the California Society of Health System Pharmacists and as such is a member of their Board of Directors and Executive Committee.

Her career has focused on the innovative provision of patient care by pharmacists as part of an interdisciplinary group.

She lives near San Francisco with her husband, and grown children happily nearby.

Professor Michael Dooley Professor Dooley holds a joint appointment as Director of Pharmacy at Alfred Health and Professor of Clinical Pharmacy, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences of Monash University in Melbourne Australia.

He is also the current President of the Society of Hospital Pharmacists of Australia. His career has focused in the acute healthcare sector and has spanned special clinical roles in oncology through to senior leadership positions within health services. He

contributes to many national and local professional committees and working parties related to improving the delivery of quality health care services.


Associate Professor Caroline Bell Associate Professor Bell is Associate Professor at the Department of Psychological Medicine, University of Otago School of Health Sciences, Christchurch and is the clinical head of the Anxiety Disorders Service, CDHB. Since the Canterbury earthquakes she has also set up and run a specialist mental health service set up to treat people with post traumatic earthquake related distress. She is also studying the psychological and neurobiological effects of the

earthquakes in both people presenting with significant traumatic responses from the earthquakes and those identifying as resilient.

Mark Sorenson Mark Sorenson’s softball career started in the Hutt Valley back in 1973 for the Cardinals Club. He was named Wellington Sportsman of the Year in 1988, 1996 and 2000 and Hutt Valley Sportsman of the Year in 1985, 1988, 1996 and 2000. In 1997 he was awarded the Member of the New Zealand Order of Merit, Queens Service Award for Services to Softball and the Community.

During his impressive sport career the Black Sox attended six consecutive World Championships, three times as captain. This team were World Champions in 1984, 1996, 2000 and 2004.

Mark has been selected 12 times to the “All World Team” by the International Softball Congress (this is a world record, no-one has ever played for this team for over 11 years) and selected six times consecutively to the “All American Team” at the USA Nationals and voted the tournament’s Most Valuable Player in 1990 and 1992.

As well as his highly successful sporting career on the playing field, Mark has also been appointed Black Sox Head Coaching role in 2013. To cap his successful sporting career, Mark recently claimed the No 51 spot in the book, NZ’s 100 Top History Makers in Sport.


Unlike generics, biosimilar mAbs* are not exact copies of the innovator product

For more information visit the Roche Medical Information stand. *Monoclonal antibodies. TAPS NA7296

Simple molecule Simple biologic Complex biologic

ASPIRIN INSULIN MONOCLONAL ANTIBODYMODE OF ACTION

SIMPLEwell understood

COMPLEXwell understood

COMPLEXwith multiple

pathways involved


Rapid & sustained fistula healing with ReMiCade in CRohn’s disease1

† Responses were maintained from week 10 through week 54.Reference: 1. Sands BE, et al. N Eng J Med, 2004; 350(9):876-85.

Janssen-Cilag Pty Ltd, Auckland. Before prescribing Remicade please review the Minimum Prescribing Information on page 4.

Adapted from Sands BE, et al, 2004. Multicentre, double-blind, placebo-controlled trial of 306 adult patients with fistulising CD randomized to treatment with REMICADE 5mg/kg or placebo. All patients underwent 3-dose REMICADE induction therapy, the 195 patients responding were randomly assigned at week 14 to receive infliximab or placebo maintenance. Response to induction therapy defined as ≥50% reduction from baseline in number of draining fistulas at weeks 10 and 14.

Rapid fistula healing with REMICADE induction Sustained fistula closure with REMICADE maintenance†

36% had complete closure of all fistulaethroughout 54 weeks of treatment with REMICADE1

(vs 19% for placebo; p=0.009)

Patients received REMICADE 5 mg/kg at weeks 0, 2 & 6. Patients received REMICADE 5 mg/kg at weeks 0, 2 & 6 and 8-weekly thereafter.

had complete closure of all fistulaeat 2 weeks with REMICADE131%

48% had complete closure of all fistulaeat 14 weeks with REMICADE1

5698JAN Remicade RR FCD ad v5.indd 1 9/08/13 3:02 PM

SPECIALTY PHARMACEUTICALS

ONCOLOGY IV SAFETY AND INFUSION SYSTEMS

HOSPIRA BIOLOGICS – BIOLOGICAL CONFIDENCE™

SMART PUMP TECHNOLOGY

MEDICATION SAFETY SOFTWARE

WORLD’S LEADING PROVIDER OF INJECTABLE DRUGS AND INFUSION TECHNOLOGIES

Hospira NZ Limited. Tel 0800 629 637© Hospira Pty Ltd 2014 120602HOSP. August 2014

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1. PLENARY SESSIONFriday 5 September 2.00pm – 2.50pm

The Role of the Pharmacist in Hospice and Palliative Care Victoria Ferraresi


2. PLENARY SESSIONFriday 5 September 2.50pm – 3.20pm

Dreams to Reality Mark Sorenson


3. CONCURRENT SESSION 1AFriday 5 September 4.00pm – 4.15pm

Using Fat-Free Mass to Describe the Dose-Response Relationship of Heparin in PaediatricsHesham S Al-Sallami1

[email protected] School of Pharmacy, University of Otago, Dunedin

IntroductionUnfractionated heparin (UFH) is the drug of choice in paediatric patients undergoing cardiac surgery. The ability to predict the dose-response relationship of UFH is essential in order to optimise its dosage. To describe the pharmacokinetics of UFH in paediatrics, various size descriptors (i.e. total body weight and body surface area) are used. However, these size descriptors do not correlate well with drug clearance and their use in dose calculation may result in over- or under-dosing particularly at the extrema of size. Recently fat-free mass (FFM) has been suggested as a better descriptor of size in relation to drug disposition.

AimTo develop and evaluate a model to predict the dose-response relationship of unfractionated heparin in paediatrics using various size descriptors as covariates.

MethodData from 64 infants and children who received 75-100 IU/kg of unfractionated heparin during cardiac angiography was analysed. Four plasma samples were collected around 15, 30, 45, and 120 minutes post dose. Heparin concentration was measured using the protamine titration assay. One and two compartment pharmacokinetic models with linear and non-linear elimination were fitted to the data using the non-linear regression software NONMEM v7.2. Various patient covariates such as age, sex, weight, and FFM were tested. The final model was evaluated using the likelihood ratio test and visual predictive checks (VPCs).

ResultsOne compartment pharmacokinetic model with linear elimination provided the best fit. Between-subject variance for CL and V were estimated and were allowed to co-vary. Size (weight and FFM) had substantial influence on model performance. FFM provided a small but statistically significant improved fit.

ConclusionA model to describe the time-course of heparin concentration was developed in a paediatric population. FFM was shown to describe drug disposition well and should be used in dose calculation after appropriate evaluation.

Justification for presentationThis work demonstrates how body composition can influence drug disposition and dosing. The findings have direct relevance to pharmacists working with anticoagulants and in paediatrics but also to all pharmacists involved in drug dose-individualisation.



Systematic Discharge - A SMOOTH Transition from Project to Sustainable ProgrammeNisha Bangs1, Lawn R1, Assink L1

[email protected] Middlemore Hospital Pharmacy Department

Context / existing situationMedication errors occur commonly during transitions of care. Evidence suggests the incidence of adverse drug events following hospital discharge is as high as 11%. 1 There are several causes of errors at the discharge interface and a systematic approach to minimising the risk is crucial to patient safety.

Planned changeDevelop and provide an integrated medication management service using Institute of Healthcare Improvement (IHI) collaborative methodology and quality improvement principles to deliver efficient, reliable, accurate and standardised quality of care for patients at discharge by reducing variability and improving patient safety

MethodsStarting in September 2013, a change package was developed using Institute of Healthcare Improvement methodology, which involved using several small tests of change (PDSA cycles). Once the change package had been developed and tested, KPI’s were implemented and data collected for several months. Results were reported monthly to Counties Manukau Health management, showcasing numbers of patients seen and errors prevented. A business case was developed and presented to key stakeholders, culminating in the approval of 3 permanent FTE’s in May 2014.

Measurement of improvementThe key measures used were • Number of patients seen• Number of errors prevented (and the cost implication of those errors)

Effects of changesThere is now a standardised process for pharmacist involvement in discharge, resulting in improved patient safety. The 3 additional FTE’s will ensure the sustainability of the service. Currently around 70% of all high risk patients are being seen at discharge, as well as a number of low and medium risk patients

Lessons learnt / implications for othersSupporting improvement initiatives with good data to justify the need for change and business cases can enable successful projects to transition into business as usual programmes.A “How to guide” has been developed to enable others to learn from our experience.

Justification for presentationSuccessfully focusing on transitions of care in the acute care setting is becoming increasingly important for patient safety and managing acute care demand.



Infliximab Usage and Compliance with PHARMAC Hospital Medicines List Restrictions by Canterbury District Health BoardSarah McCrostie1, Vella-Brincat J1, Barclay M1

[email protected] District Health Board, Christchurch

IntroductionInfliximab expenditure at Christchurch Hospital is high and increasing (from $179,000 in January-March 2011 to $671,000 in the same period in 2014). The newly introduced Hospital Medicines List (HML) carries a large number of restrictions on infliximab use within New Zealand hospitals.

Aim1. To document the use of infliximab and compliance of prescribing at Christchurch Hospital with the HML.

MethodPatients dispensed infliximab at Christchurch Hospital from 1/7/13 to 11/3/14 were identified from ePharmacy. Patient details, admissions information and clinic letters were accessed via Health Connect South. Data recorded included dosing, disease activity scores, symptom progression and reassessment. Data were then compared to the HML infliximab restrictions.

Results79 patients were prescribed infliximab between 1/7/13 and 11/3/14. Of these patients, 51% (=40) had been started on infliximab prior to this period. Over the 8 month period, 12 patients ceased infliximab: 8 due to ineffectiveness, 3 due to treatment course ending and 1 due to poor compliance.

ConclusionBased on the information available, it appeared that 85 % (33/39) of prescriptions for infliximab since 01/07/13 were within the HML restrictions. However, 33% (11) of patients that appeared to fit restrictions did not have all necessary data in their clinical notes required to confirm this. There was a lack of structure for data recording. These systems need to be improved to increase clarity of infliximab use.

Justification for presentationThis research confirms the increasing use of infliximab and that in the large majority of cases, infliximab use fits the HML criteria. However, there is a need for improved documentation of this HML-restricted drug.



Liver Transplantation During Pregnancy - Hepatitis B Case StudyMichelle Singh1

[email protected] Auckland District Health Board

IntroductionHepatitis B virus (HBV) is a common virus in New Zealand that affects the liver. Chronic HBV can lead to cirrhosis, liver cancer and liver failure if not detected and managed in early stages, and is the leading cause of liver cancer. Estimates indicate that 100,000 people in New Zealand and 350 million people worldwide are infected with the virus. HBV in pregnancy is difficult to treat and, if left untreated, is easily passed from mother to unborn baby. This is a case study of an emergency liver transplant performed during pregnancy.

Case descriptionA 36-year-old 23 weeks pregnant woman was admitted to Auckland City Hospital with untreated acute-on-chronic hepatitis B. She presented with confusion, lethargy and jaundice which escalated over several days to end stage liver disease. An emergency liver transplant was undertaken with care being taken to minimise harm to the foetus. Pharmacist medication review led to changes in the choice of immunosuppressant therapy (mycophenolate was unsafe for use and tacrolimus monotherapy immunosuppressant therapy was used instead of the usual dual therapy. The baby was born at 34 weeks by caesarean section and care until then involved both the liver transplant and obstetric teams.

Discussion Immunosuppressive agents are important in reducing the risk of rejection of new solid organ post transplantation. This case illustrates the benefits versus risks of the usual pharmacotherapy in treating a pregnant woman, Important decisions were made ensuring that the new organ had the lowest risk of rejection, while ensuring the safety of the foetus. Standard dual immunosuppressant therapy was unsafe for use and the tacrolimus monotherapy was used, with higher target blood levels to avoid risk of rejection.

ConclusionThis unique and complex case illustrates the management of a liver transplant patient in a pregnancy setting and the involvement of the clinical pharmacist in patient care.

Justification for presentationThis is the first case of liver transplantation performed during pregnancy in New Zealand so a big learning experience to be shared to others. Also, pharmacists can find themselves being asked for advice on immunosuppressant therapy in solid organ transplant patients and this case study will help them understand more about these medicines.


7. CONCURRENT SESSION 1BFriday 5 September 4.00pm – 4.15pm

Medicines Reconciliation in Rural HospitalsJoanna Batcup 1

[email protected] Canterbury District Health Board, Christchurch Hospital, Christchurch

Context / existing situationIn its Annual Plan 2013-14, Canterbury District Health Board (CDHB) committed to adopting the Health Quality and Safety Commission’s guidelines on Medication Safety that all patients admitted to DHB hospitals receive medicines reconciliation within 24 hours. While CDHB has made substantial progress in implementing this in all its major hospitals, those 740 patients per annum directly admitted to the 8 small rural hospitals do not receive this service. Medical services at the rural hospitals are contracted from the local general practices that have close relationships with the community pharmacies.

Planned changeTo develop cost-effective solutions to enable CDHB meet this national requirement in its rural hospitals.

MethodsA project brief was developed to train community pharmacy technicians to attend their local rural hospital to undertake Medicines History taking, this would then be used by the community pharmacist to facilitate Medicines Reconciliation. Training was developed and then provided both at the main hospital and at each rural hospital site. A site plan was developed for each rural hospital based on their current work practices to ensure the process was safe and efficient for all concerned.

Measurement of improvementMonthly reports to the CDHB pharmacy manager are consolidated to measure the number of Medicines Reconciliation undertaken.

Effects of changesStandardisation of medicines reconciliation across all CDHB inpatient facilities. Improved medicines transfer of care into rural hospitals.

Lessons learnt / implications for othersIntegration and collaboration with our community colleagues has led to better services to our patients and better relationships.

Justification for presentationThis is the first time that this service has been undertaken in this way and could easily be applied to other areas with rural situations.



Relax and Breathe. Magnesium Sulphate in Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD): Does it Work? Bevan Clayton-Smith1, Mukerji S1, Shahpuri B1, Smith N1, Armstrong P1, Hardy M1, Marchant G1, Marsh E2

[email protected] Pharmacy Department, MidCentral DHB, 2 Emergency Department, MidCentral DHB

IntroductionThe bronchodilatory effects of intravenous magnesium have been poorly explored in acute exacerbations of COPD (AECOPD). Limited evidence, varying and confounding protocols, heterogeneity in doses, timing of intravenous magnesium and conflicting conclusions have led to a degree of uncertainty regarding its role in AECOPD.

AimTo investigate the effects of intravenous magnesium sulphate in acute exacerbations of COPD (AECOPD), when given in conjunction with standard bronchodilator therapy.

MethodA single centre, randomised, double-blinded, parallel group, placebo-controlled trial. In addition to standard bronchodilator therapy, 32 AECOPD patients were blinded to receive intravenous saline (placebo) (n=17) or 2g magnesium sulphate (n=13). Spirometry was performed at presentation (TA), after initial bronchodilator therapy (TB) and immediately (T0), at 60minutes (T60) and 120 minutes (T120) post trial drug infusion. Primary outcomes were FEV1 and FVC at T0, T60 and T120. Secondary outcomes were admission rates, length of stay and requirement for NIV or mechanical ventilation. A brief questionnaire was administered to determine medication use, smoking status and Flu vaccine uptake. Percentage differences and means with SDs were produced. Significance level was set at P< 0.05. A T-test was used to compare the groups at various time points with the baseline at TA.

ResultsGreater improvements were seen in FEV1 at T0, T60 and T120 compared to TA in the magnesium group (at T120, mean percentage change in FEV1 was 33.1% with magnesium versus 11.9% in the placebo group, p=0.002, 95%CI, -33.7 to -8.7). Similar improvements were noted with FVC in the magnesium group at all times compared to TA. There was also reduced hospital length of stay seen in the magnesium group (3.18 days versus 5.47 days in placebo group). There were no adverse events with magnesium.

ConclusionIntravenous magnesium sulphate as adjunct therapy to standard bronchodilator treatment in AECOPD patients presenting to ED may improve lung function in the short term.

Justification for presentationThis study promotes the integration and collaboration between Pharmacy and ED staff to design, develop and deliver a study that determines the effectiveness of a medicine within an acute clinical setting for the benefit of patients.



Validation of the Assessment of Risk Tool for Prioritisation of Inpatients for Clinical Pharmacy ServicesFalconer N1, Sanjoy Nand2, Liow D2

[email protected],2 Middlemore Hospital, Auckland

IntroductionMedication Reconciliation (MR) is an effective strategy to reduce medication errors and ADEs during transitions in care (1). However MR is resource intensive, hence a targeted approach is required for timely clinical pharmacy intervention. In October 2011 Middlemore Hospital developed an electronic patient prioritisation tool, the Assessment of Risk Tool (ART), which ranked patients by risk of medication-related harm based on trigger flags for ADEs to guide prioritisation for MR and timely clinical pharmacist interventions (2).

AimTo validate the ART and determine its effectiveness for identifying patients at high risk of ADEs for MR and clinical pharmacist review.

MethodA prospective observational study of 247 admissions was undertaken with two clinical pharmacists blinded to ART providing usual pharmacy services such as MR and clinical reviews in general medicine over a three month period. Interventions were analysed to determine the association between the patient’s ART score and the number of unintentional medication discrepancies identified by the MR process, and other prescribing errors identified through daily chart reviews.

ResultsA total of 97 admissions (39%) were categorised as high risk (score > 22). Using a generalized linear model, patients in the high risk group were found to have three times the number unintentional medication discrepancies compared to patients in the low risk group; with an estimated ratio of mean number of unintentional medication discrepancies of 3.1 (95% C.I. 2.1-4.7) (p<0.0001). For all other prescribing errors no significant differences were found across the ART risk categories (p = 0.08). Analysis also revealed that certain flags are better indicators of unintentional medication errors than others to further refine ART’s sensitivity.

ConclusionThe ART is an effective method for prioritising patients for timely clinical pharmacist interventions such as MR by identifying patients at the highest risk for medication related harm.

References1. Agrawal, A. and W.Y. Wu. Reducing medication errors and improving systems reliability using

an electronic medication reconciliation system. Jt. Comm. J. Qual. Pat. Saf., 2009. 35(2): p. 106-114

2. Falconer, N. Nand, S. Liow, D. Jackson, A. Seddon, M. Development of an electronic patient prioritisation tool for clinical pharmacist interventions. AJHP., 2014. 71: p.4311-320

Justification for presentationThe ART was the first electronic, virtually real-time application developed for clinical pharmacy services in NZ and potentially internationally. Its effectiveness for identifying patients at risk for ADEs can assist others to develop a robust approach for prioritising scarce resources.



“Grow Your Own”– Impact of Implementing a Career Progression Pathway at Middlemore HospitalSanjoy Nand1

[email protected] Middlemore Hospital, Auckland

IntroductionMaintaining an appropriately skilled hospital pharmacist workforce remains a challenge for New Zealand Hospitals. A career framework provides an important part of the infrastructure needed to develop and maintain a sustainable workforce. The progress made in this front at the national level has been encouraging. Implementation will be a key challenge. Here we describe the implementation of a career pathway for clinical pharmacists, its uptake and impact on staff development.

Case descriptionUntil recently Middlemore Hospital did not have a structured career pathway for pharmacists. General clinical pharmacists had limited opportunities to move up due to limited availability of higher positions which could only be accessed by appointment to a designated position (specialist/leadership) vacancy. While there was movement in salary, there was no systematic recognition of growth in knowledge and skills. Salary progression involved undertaking merit criteria which were considered inconsistent with limited relevance to development. With few incentives for undertaking progression uptake was low. To encourage development and progression in an effort to grow our own talent we developed and implemented a career progression pathway early this year.

DiscussionWith limited local experience, international evidence and experience was used to develop and implement the career structure. Criteria were set for the various levels which reflected knowledge, skills and competency requirements. A key challenge was aligning the new pathway and criteria with the existing collective agreement progression processes. Good support from all resulted in successful implementation. The uptake of progression has increased over 10 fold with a similar increase in uptake of structured learning and competency assessment. The pathway has enabled us to develop our workforce capability significantly.

ConclusionThe implementation of a structured career pathway is complex but rewarding for the pharmacist workforce. Successful implementation can provide encouragement and engagement in career development enabling improved workforce capability.

Justification for presentationCareer progression is a key agenda for NZ’s hospital pharmacy workforce. Significant progress has been made toward a national framework and hospitals would keen to use this to develop their workforce. Lessons learnt from our experience would therefore be useful.


11. CONCURRENT SESSION 1CFriday 5 September 4.00pm – 4.15pm

Audit of Drug Concentration Monitoring of Antifungals in Canterbury District Health Boards’ Bone Marrow Transplant UnitGray Barnett, Vella-Brincat J, Doogue [email protected]

Introduction: Drug concentration monitoring (DCM) is provided for antifungals at Canterbury District Health Board (CDHB). Antifungal DCM is used to ensure adequate and consistent drug exposure in high risk patients. Previous studies have found highly variable use of antifungal DCM in haematology units. We evaluated antifungal DCM in the Bone Marrow Transplant Unit (BMTU) at CDHB.

Aim:To describe antifungal DCM in the CDHB BMTU.

Methods:All BMTU patients dispensed the antifungals voriconazole, itraconazole and posaconazole from 1st January 2010 to 31st March 2014 were identified from the dispensing software ‘ePharmacy’ at Christchurch Hospital. Demographic data including: date of birth, weight, malignancy; and antifungal treatment data including: start date of therapy, loading dose(s), maintenance dose, were collected from clinical records. Fungal isolate and date and time of serum antifungal concentration were obtained from the Canterbury Health Laboratories database. These data were then grouped according to antifungal and analyzed for compliance to DCM guidelines.

Results: 49 patients were dispensed antifungal’s: 26 females, median (IQ range) age 54 (34 - 62) years, median (IQ range) weight 70 (61-82) kg. Of the 49 patients 18 (37 %) underwent DCM and of these 10 were compliant with DCM guidelines. 38 of the 49 patients (78%) received antifungals prophylactically and no significant differences in the occurrence of DCM was seen between treatment and prophylaxis therapy (p=0.36).

Voriconazole Itraconazole Posaconazole

Number treated 21 13 15

Indication: Fungal treatment Fungal prophylaxis

8 13

112

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Underwent DCMDCM compliantnot steady statenon trough sample

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Conclusion:Inappropriate DCM use is common and this may compromise dose adjustment. Education may result in better use of this resource. Antifungal DCM in the CDHB is inconsistent we have proposed revised guidelines for the BMTU.

Justification for presentationWe believe this audit is of significant interest to all Pharmacists involved in DCM and those with an interest in Oncology. It reveals areas of that could be significantly improved the quality of DCM within CDHB BMTU, which in turn could be used to improve practice at other centers around the country.



The Development and Assessment of a Chronic Care Management Team in Waikato DHBJan Goddard1, McNabb F1

[email protected] Waikato DHB, Hamilton

Context/Existing situationAs people live longer, the burden of chronic conditions is an increasing strain on healthcare systems. Healthcare organisations require new approaches to manage these populations and to assess the outcomes of such innovations.

Planned changeThe chronic care management (CCM) team was created to improve medicine-related health outcomes for a defined group of patients with chronic conditions who were likely to benefit from an in-depth pharmacy service.

MethodsThe project was proposed by Pharmacy Services and funded through the DHB’s Planning and Funding department. This plan incorporated the DHB’s priority conditions of cardiovascular disease, diabetes, COPD, oncology and mental health.The CCM team provides a service to prioritised patients, including:• Medicine reconciliation • Clinical review • Education • Referral to hospital and community services as required• Production of medicine information cards • Discharge checks • Where necessary, liaison with community pharmacy

A tool to enable the production of a list of priority patients was also developed to streamline patient selection.

Measurement of improvementData for patients seen over five years of the service has been analysed to determine if evidence exists for a positive impact. Emergency Department (ED) presentations and hospital admissions before and after the first date of interaction with the CCM team were compared.

Effects of changesBasic comparisons show a reduction in both admission and ED presentation rates following contact with the CCM service. Results of a statistical analysis, as well as the strengths and limitations, will be presented at the conference.

Lessons learntCCM pharmacists are able to deliver comprehensive and effective interventions to prioritised patients. Although more complex research is required to fully elucidate the impact of such a service, relatively simple data collection enables analysis of matched-patient outcomes.

Justification for presentationThis presentation summarises a working chronic care model with demonstrated reductions in hospital and ED presentations, and so a contribution to easing the burden on health systems with limited resources.



A New Zealand Anticoagulation Education Clinic: Expanding the Emergency Department Clinical Pharmacy Service (Updated)Katrina Tandecki1

[email protected] Hutt Valley District Health Board, Lower Hutt, Wellington

Context / existing situationMedication education is an integral part of emergency department (ED) pharmacists’ roles. Patients being commenced on anticoagulation therapies, namely warfarin, enoxaparin and dabigatran, require in depth education in order to prevent adverse events, build patients’ confidence, ensure adherence, and inform patients of medication risks and benefits.

In order to streamline a chaotic, rushed, warfarin education process, the ED clinical pharmacy service has created a daily, pharmacist-led, anticoagulation education clinic.

Planned changeTo establish a dedicated, pharmacist-run education clinic to provide information and support to patients regarding newly started anticoagulation medications. To promote more effective, efficient collaboration between members of the multidisciplinary team.

MethodsA simple procedure for scheduling patients into the anticoagulation education clinic was outlined. Daily clinics take place in our Medical Assessment and Planning Unit (MAPU). Data is collected and analysed using Excel.

Measurement of improvementA total of 369 patients were educated by the ED pharmacist on their blood-thinning treatments from April 2009 through April 2014. Of these, 287 (77.8%) patients were formally booked into the pharmacy education clinic. Participation in the education clinic was documented in the notes, and relevant information was handed over to the care teams involved.

Effects of changesA planned anticoagulation education clinic improves patients’ quality of care, as well as streamlining time management. Multiple patients can access medication information simultaneously and benefit from questions posed to a group, while creating multitasking opportunities for other clinical pharmacists.

Lessons learnt / implications for othersThe introduction of a pharmacist-run anticoagulation education clinic was a natural progression of the ED clinical pharmacy service, especially with the development of an ED/MAPU deep vein thrombosis pathway. A designated time for pharmacy education helps disseminate drug information to patients and caregivers, in a less stressful, yet focused environment. This pharmacist-run clinic endeavours to bridge the continuity of care between primary and secondary care.

Justification for presentationThe pharmacist-led anticoagulation education clinic illustrates the collaborative effort between several healthcare professionals to provide quality care for our patients. The anticoagulation education clinic highlights how pharmacy is working smarter to capture financial savings.



Anti-NMDA Receptor EncephalitisRicky Wan1

[email protected] Department of Pharmacy, Auckland District Health Board (ADHB)

IntroductionAnti-NMDA receptor encephalitis is a rare form of encephalitis that occurs most commonly in young women. In these patients it is usually associated with the presence of a teratoma in the ovaries. Standard treatment involves surgical resection of teratoma, if present, and immunotherapy. This report describes a girl with confirmed anti-NMDA receptor encephalitis and her treatment in hospital.

Case descriptionGH is an 18-year old female with a past medical history of bipolar affective disorder with psychosis, which was treated with clozapine. GH presented to ADHB 9 days after she had fallen from a horse. Her mother reported that she had worsening mental health. Over the next few hours, she developed ataxia, abnormal seemingly involuntary movements, hypersalivation, fever, incontinence, seizures and a dropping Glasgow Coma Scale. A lumbar puncture was performed and it confirmed the presence of anti-NMDA receptor antibodies. To date, she has had a left oophorectomy for her teratoma and has been trialed on various pharmacological treatments including immunoglobulin therapy, methylprednisolone, chemotherapy and other immunomodulators (cyclophosphamide with rituximab and alemtuzumab with intrathecal methotrexate) that have been recommended by international experts and local neurologists. Pharmacy involvement included recommendation of PCP/HSV prophylaxis during immunosuppression, drug administration, liaison between specialists, procurement and etc. Sadly, almost six months later, GH remains in intensive care unit still under sedation while her progress is carefully monitored.

DiscussionThis case demonstrates the lack of experience and evidence in treating anti-NMDA receptor encephalitis since its official classification in 2007. First line agents have failed and there is currently no clear evidence regarding next line therapy. Alemtuzumab and intrathecal methotrexate were tried after discussions with a paediatric neurologist from the Czech Republic who used it with positive results in a 9-year old female patient.

ConclusionLittle evidence is available for the treatment of anti-NMDA receptor encephalitis past first- and second-line treatment. More research, experience and knowledge about the disease will assist clinicians in the management of this condition in the future.

Justification for presentationThis case study aims to increase the awareness of anti-NMDA receptor encephalitis and explain possible underlying mechanisms of treatment-resistant mental health disorders.


15. CONCURRENT SESSION 1DFriday 5 September 4.00pm – 4.15pm

Tweaking Dispensing Quantities to Reduce Wastage – a Large Reward for a Small ChangeKim Brackley1, Daya J1, Biswas D2

[email protected] Department of Pharmacy, City, Auckland District Health Board (ADHB)2 Quality Improvement Department, Auckland District Health Board

Context / existing situationAt ADHB large quantities of medicines were being returned unused to pharmacy each week. The potential wastage that was occurring was a concern, as was the increased time taken to process returns by pharmacy staff.

Planned changeTo investigate the causes of the high quantities of medicine returns and implement changes to address the causes identified.

MethodsWe convened a project team and used Lean and Six Sigma methodologies to identify the causes of the wastage. One of the main contributory factors was oversupply from the dispensary: quantities equal to three days’ treatment with IV medicines and seven days’ treatment with other medicines were routinely dispensed to patients on most acute wards. The adjusted quantity to be dispensed was determined using average, median and upper quartile length of stay and negotiated with the ward pharmacist and charge nurse. We piloted the changes in a small number of wards before rolling out to the remainder of the hospital.

Measurement of improvementThe financial savings from reducing the quantity dispensed to patients and, as a countermeasure, the number of redispensing of the same medicine to patients.

Effects of changesThe period of supply to the majority of acute wards was reduced to between three to five days and the supply of IV medicines reduced to two days. This reduction resulted in savings of $1,358,655 from March 2013 to the end of April 2014. The number of redispensing of the same medicine to a patient did not change significantly and remained about 20% (of all dispensed medicines). Anecdotally dispensary staff did not note an increase in workload and nursing staff have not complained about running out of dispensed medicines.

Lessons learnt / implications for othersThe application of quality improvement methodology allowed us to question and systematically investigate established practice. This enabled significant sustainable savings to ADHB to be made without impacting on the continuity of patient care.

Justification for presentationThis study could serve as a prompt for other departments to consider the financial savings that can be made relatively simply by making small tweaks in dispensed quantities.



My Life as a Paediatric Pharmacist PrescriberDianne Wright1

[email protected] Taranaki Base Hospital, New Plymouth

IntroductionI have been a paediatric and neonatal pharmacist for over 25 years – the last 15 years at Taranaki Base Hospital. I am privileged to be considered an integral member of the Paediatric multidisciplinary team. We know how each other ‘operates’ and have a mutual respect for each other’s roles.Prior to gaining prescribing rights I was involved in recommending medicines/doses to be prescribed, blood tests to be done etc - with the doctors physically charting those recommendations. Hence, the Paediatricians were very supportive of my wish to become a paediatric pharmacist prescriber.

AimThe aims of this presentation are:• A brief overview of the study/training required to become qualified as a

pharmacist prescriber in New Zealand• A summary of my prescribing from 12 July 2013 to 31 July 2014• The value my prescribing adds to my role as a paediatric pharmacist and member

of the paediatric team

MethodA record is kept of all my prescribing episodes which will inform the prescribing statistics presented e.g. number of medication charts reviewed, number of prescriptions written, medicines prescribed, reasons for prescribing.

ResultsFrom 12 July 2013 to 31 March 2014 I reviewed 1953 medication charts and wrote 252 prescriptions involving 45 different medicines. The top four categories of my prescribing to date are:• dose correction 23.6%• signing of medicines given under Standing Orders 19.2%• signing of incomplete prescriptions 12%• re charting medicines 11.2%.

ConclusionMy pharmacist roles still apply with the additional ability to prescribe. Being able to effect dose adjustment for efficacy and/or safety; being able to effect antibiotic adjustment with sensitivity results; prescribe against protocols and order laboratory tests results in faster delivery of optimal patient care, greater collaboration between myself and the paediatric medical staff, and a greater opportunity for educating junior medical staff on the use of medicines in paediatric patients.

Justification for presentationI was one of the inaugural pharmacist prescribers in New Zealand, and the only Paediatric pharmacist prescriber. I believe the ‘story’ I have to tell will be more effectively delivered via an oral presentation, rather than via a poster.



First Do No Harm – a Cautionary Tale about the Confusing Nature of Bacterial or Viral Meningitis and Toxic EncephalopathyCarolyn Coulter1

[email protected] Dunedin Hospital Pharmacy, Southern DHB, Dunedin

IntroductionIn-patient medical therapy of acute conditions is generally assumed to provide a high degree of benefit with low risk, but occasionally the risks are great. It is important to evaluate medical therapy to ensure there is not excessive harm to patients, and to consider whether adverse drug reactions are the source of ongoing clinical problems.

Case descriptionA 66 year old female patient was treated for recurrent, sub-optimally treated bacterial or viral meningitis on at least three separate occasions, in three different hospitals, with IV aciclovir and IV ceftriaxone resulting in pulmonary oedema and acute kidney injury, without resolution of the meningitis. On transfer to a tertiary hospital for nephrology, neurology, and infectious diseases review, and treatment of the acute kidney injury, there was debate whether the patient had ongoing meningitis or in fact a toxic encephalopathy. Due to the worsening neurological function, and the lack of any infectious evidence, there was a strong suspicion of beta-lactam induced encephalopathy. The nephrologist made the decision to stop all possible toxins, so the antibiotic and antiviral were ceased, along with nearly all other medicines, whereupon the patient made a dramatic and almost miraculous recovery.

DiscussionThis case highlights two less common adverse drug reactions, acute kidney injury most likely due to aciclovir, and toxic encephalopathy possibly resulting from high dose beta-lactam use in conjunction with a greatly reduced renal clearance, that were identified because of a single clinician’s high degree of suspicion. As pharmacists it is important to watch for adverse drug reactions, including those more rare events, especially in patients who are clinically declining despite intensive medical therapy.

ConclusionMedical therapy is not without risk and adverse drug reactions can be simultaneously substantial, and life-threatening, while difficult to identify, making it very difficult to “first do no harm.”

Justification for presentationRare but severe adverse drug reactions, like beta-lactam induced encephalopathy, are predominantly identified from clinical experience combined with a high degree of suspicion. Hence it is important for pharmacists, who see fewer clinical cases than doctors, to learn about these serious reactions.



An Audit of Prescribing in a Paediatric WardEmma Smith1

[email protected] Services, Waikato District Health Board, Hamilton

IntroductionMedication errors account for approximately 5% of serious events reported by District Health Boards (1). In children, there is a greater risk of medication error, due to many factors including the need for calculations and weight-adjusted dosing (2). The national medication chart was developed and used nationally to reduce medication errors and increase patient safety (3).

Aims1. To identify the incidence and main sources of error in regards to quality of

prescribing within a paediatric medical ward. 2. To design a targeted intervention based on the main errors identified.3. To evaluate the improvement in quality of prescribing as a result of the

intervention.

MethodA comprehensive audit tool based on the national medication charting standards (3) was used over two consecutive weeks on inpatient medication charts in a paediatric medical ward. The results were analysed to find the incidence and type of errors encountered. Targeted feedback was developed, based on the sources of errors identified. This involved feedback to the prescribers by a presentation and educational flyers. Following this, charts were audited for a further two weeks. Results were compared to the baseline data to assess the efficacy of the intervention.

ResultsResults will be analysed and presented at NZHPA conference 2014.

ConclusionPending results.

References1. Health Quality & Safety Commission. 2012. Making our Hospitals Safer: Serious and Sentinel

Events reported by District Heath Boards in 2011/12. Wellington: Health Quality & Safety Commission. Available at: http://www.hqsc.govt.nz/

2. Manias E, Kinney S, Cranswick N, Williams A. Medication errors in hospitalised children. Journal of Paediatrics and Child Health. 2014;50:71-7.

3. Health Quality & Safety Commission. 2012. Medication Charting Standard, Version 3. Wellington: Health Quality & Safety Commission. Available at: http://www.hqsc.govt.nz/

Justification for presentationI believe this research will be of value in identifying areas for improvement in prescribing quality and the impact of the intervention. We aim for this to aid in reducing medication errors and improving patient safety.


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19. PLENARY SESSIONSaturday 6 September 9.00am – 10.00am

The Contribution of Pharmacy Services to Patient Care: How to Get the Message Across Michael Dooley1,2

[email protected] Alfred Health, Melbourne, Australia2 Monash University, Melbourne, Australia

Pharmacy services must be valued as a ‘must have’ by those that influence the choice of services to be supported and funded. There are many pharmacy services that improve the care and outcomes of patients. Many of which have been implemented widely and many of which that have had limited uptake. In addition, there are many services that will be proposed in the future that could be provided by pharmacists that may impact of patient outcomes. These, and the continuation of existing pharmacy services need to be justified. It is imperative that those providing or advocating these services have an understanding of the myriad of influences on priority setting and decision making that will influence whether these services are supported.

There are many factors that influence the adoption of practices, services and products. There are completing priorities in the provision of health care service. There are a range of jurisdictional policy directions that must be appreciated that influence the outcomes that are prioritised. There are performance requirements that have to be achieved including financial, access and service performance. This includes a range of mechanisms used to monitor health service performance and these must be understood.

The contribution of pharmacy services to patient care must be able to be expressed in terms of improvements in care. This includes addressing access, service delivery, financial imperatives, patient outcomes and patients’ experiences. Developments in pharmacy services must be aligned with the broader priorities for health care provision and not only be focused on professional priorities.

This presentation will illustrate the challenges of demonstrating the contribution of pharmacy services to patient care with local examples of initiatives of varying success.


20. CONCURRENT SESSION 2ASaturday 6 September 11.00am – 11.15am

Establishing the Pharmacist Role in a Surgical Pre-Admission Clinic: The ADHB ExperienceBrkic L1, Grace Chan1, Monkhouse J1 [email protected] Auckland District Health Board

Context / existing situationPharmacists working within surgical pre-admission clinics (PAC) have been shown to improve the accuracy of medication histories and improve patients’ medicine management in the peri-operative period.1 In 2012, in order to meet the national target of improving patient access to elective surgery, ADHB initiated a redesign of the surgical pre-admission pathway. This created an opportunity to pilot the role of a clinical pharmacist within PAC.

Planned changeThe aim was to implement and establish the pharmacist role so they could have the opportunity to take patient medication histories, provide advice on the peri-operative management of medicines and enhance the overall quality of care provided to patients.

MethodsA six-week pilot was performed during 2012. Funding for one FTE pharmacist was obtained and their role at PAC was established. Governance documents (standard operating procedure, peri-operative management of medications guideline and pharmacist training workbook) were developed.

Measurement of improvementThe pilot showed that medication history discrepancies were identified in 22% of patients with 47% of these patients having at least one discrepancy. Of all the discrepancies identified 90% were omissions.2 Currently ongoing measurements of the pharmacist’s performance are being collected and will be presented.

Effects of changesThe pharmacist has become a core member of the PAC team and actively contributes to the peri-operative management of patients’ medications. The multidisciplinary team value the pharmacist’s input and advice.

Lessons learnt / implications for other• In order to capitalise on the effect of clinic pharmacist, only patients who have

been cleared for surgery with confirmed dates should be seen.• Ensuring work done by the pharmacist at PAC is being carried through onto ward

level to maximise impact on patient care.

References:1. Hales A, Coombes I et al. peri-operative medication management: expanding the role of

pre-admission clinic pharmacist in a single center, randomised controlled trial of collaborative prescribing. BMJ Open 2013;3:e003027.doi:10.1136/bmjopen-2013-003027

2. Bryan T, Sarten F, et al. Surgical Pre-admit Clinic Improvement Pilot (31st Jan – 9th Mar 2012). ADHB Improvement Specialists, Central Project Office.

Justification for presentationOur journey in the establishing of this role can serve as reference material for other district health boards looking at implementing pharmacist at pre-admission clinic.



A Randomized Controlled Trial of Mobile Phone Text Messaging (SMS) Adherence Support for Emergency Department Patient PrescriptionsLee H1, Earnest Pidakala2, Larkin GL1, 2

[email protected] Emergency Care Research Group, Department of Surgery, School of Medicine, University of Auckland2 Counties Manukau Health, Emergency Care Department and Middlemore Hospital Clinical Pharmacy, Auckland

IntroductionTo optimise medication adherence in emergency care (EC) patients, healthcare communications must be salient, efficient, personalized, and patient-friendly. Novel communication modalities such as mobile phone text messaging (SMS) may be one solution to meet this need.

AimTo assess the impact of a mobile phone text messaging intervention (TXT Rx) on patients discharged from a large urban, multiethnic emergency department.

MethodsDischarged EC patients were randomized into either intervention (tailored SMS text messaging) or control (generic health messaging) groups. Intervention participants received the tailored TXT Rx program which comprised medication reminders, appointment reminders and self-management knowledge texts relevant to their complaint category. Intervention participants receive real-time, bi-directional feedback using ecologic momentary assessment. Both groups receive messages daily for 7 days. At 7-10 days following discharge, a follow-up phone interview with the patient was conducted to assess the primary outcomes of the study:1. Medication adherence (prescription filled and collected, pill count); 2. Appointment adherence; 3. Medical literacy (knowledge about their disease/injury) and;4. Overall hospital satisfaction.

ResultsPreliminary analyses of data from 180 patients (Intervention n=110; Control n=70) who completed the study showed a significant improvement in patients’ medical literacy in the intervention group (p=0.011). Medication adherence analyses showed 87.4% of intervention patients reported total or partial adherence, while 12.6% reported no adherence. The percentages were 78.8% versus 21.2%, respectively, for control. Further analysis is currently underway separating adherence rates for different classes of medications. No differences were found between the intervention and control patients in appointment adherence and hospital satisfaction (p>0.05). Qualitative feedback revealed over 60% of patients found the texting intervention medication reminders helpful.

ConclusionDischarged EC patients randomized to receive tailored text messages upon discharge reported high rates of satisfaction with the messages and experienced significantly larger increases in medical literacy than patients sent general health messages only.


References1. Larkin G, Beautrais A, Meredith T, Tabakakis K. TXT Rx: Using Health Information Technology

to Safely Discharge Suicidal Patients From the Emergency Department Annals of emergency medicine. 2009;54(3):S127.

2. Van Dulmen S, Sluijs E, Van Dijk L, et al. Furthering patient adherence: a position paper of the international expert forum on patient adherence based on an internet forum discussion. BMC Health Services Research. 2008;8:47.

3. Shepperd S, Doll H, Angus RM, et al. Avoiding hospital admission through provision of hospital care at home: a systematic review and meta-analysis of individual patient data. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne. Jan 20 2009;180(2):175-182.

Justification for presentationWe designed a New Zealand first SMS messaging intervention for medication adherence for patients discharged from EC. This represents a cost-effective, patient-centred form of post-discharge care and results of this study will inform further development of tailored text messaging case management programme.



Gentamicin Prescribing Practices at Counties Manukau District Health Board (CMDHB) - An AuditMerusha Naidoo1, Kam A1

[email protected] Middlemore Hospital, CMDHB, Auckland

Introduction Gentamicin is an aminoglycoside antibiotic used to treat severe infections. Its use is limited due to toxic side effects such as acute kidney injury (AKI). Recently a trend has been identified between the increasing incidence of AKI and associated gentamicin prescribing at CMDHB.

Aim1. To conduct an audit exploring gentamicin prescribing and monitoring practices at

CMDHB. 2. To identify areas for improvement to reduce the risk of developing AKI when

gentamicin is prescribed.

MethodAn audit was conducted looking at patients referred to the renal consult team as a result of AKI with associated gentamicin prescribing between January 2013 and January 2014. Patient clinical notes and medication charts were examined and the recommended gentamicin dose, as per the CMDHB guideline, was compared to the gentamicin dose prescribed. For each case study, the gentamicin dose prescribed was evaluated as either being within the CMDHB guideline or not.

ResultsEight case studies were reviewed and the prescribed gentamicin doses were compared to dose recommendations as per the CMDHB guidelines. Three patients were prescribed gentamicin doses within the recommended dose range, while four patients were prescribed gentamicin doses above the recommended dose range. Of these cases, one fatality occurred due to gentamicin-associated AKI. Inconsistencies in monitoring were also found.

Conclusion The cause of AKI was found to be multifactorial and not due to gentamicin alone. Gentamicin prescribing practices at CMDHB requires revision. Overall, the eight case studies have identified that CMDHB guidelines may need to be reviewed as a result of AKI occurring even at recommended doses. Further research is required to determine whether it may be beneficial to regulate/restrict gentamicin prescribing in high risk populations. Improved monitoring of trough levels and education for health practitioners is also necessary.

Justification for presentationInappropriate prescribing and monitoring of gentamicin can lead to severe consequences including AKI and even death. Our audit highlights the importance of raising awareness of this issue and the possible need to review guidelines to improve patient safety.


23. CONCURRENT SESSION 2ASaturday 6 September 12.00pm – 12.15pm

The Safer Medicine Admissions Review Team (SMART) Approach for Responding to Acute Care Demand Over Extended Hours Perry R1, Liow D1, O’Malley H1, Cathy Street 1, Nand S1, Eagleton C1

[email protected] Counties Manukau DHB, Auckland

Context / existing situationIn response to a growing number of general medicine (GM) admissions, increasing time taken for patients to be seen in Emergency Care (EC) and an unacceptably high rate of medication errors with the potential to cause patient harm; SMART is a model of care that involves the medical team pharmacist collaboratively admitting patients with their team doctors at the start of the patient’s hospital journey in EC. With nearly 40% of GM admissions occurring between 4-10pm, challenges included extending the service hours to 8am-10pm to maximise the safety and efficiency benefits.

Planned changeTo implement the SMART model of care for all GM teams, Monday to Friday, 8am to 10pm.

MethodsThe implementation of the SMART model of care has occurred progressively over the past year. A working party involving pharmacy, medical and quality improvement staff has met weekly to plan testing and to review ongoing data using improvement methodology from the Institute for Healthcare Improvement (IHI).

Measurement of improvementOver 2,600 patients have been seen by SMART, with clinical pharmacists making over 1,200 contributions to patient care and intervening to prevent patient harm in nearly 400 cases.

Specific aims are to provide safer and timelier care, with measures of improvement developed, validated, then automated to capture and monitor progress for the following;• 95% of patients seen to have a completed medicines reconciliation (MR) within 6

hours of hospital presentation• Reduce preventable medication error rate to zero, and• Reduce average wait time for patients referred to general medicine

Effects of changesIn addition to the medication safety benefits and system efficiencies achieved, SMART has also enabled a culture of teamwork and collaboration, enhancing relationships with colleagues as well as patients.

Lessons learnt / implications for othersThe SMART model effectively moves clinical pharmacist resources to the front of the hospital, facilitating prospective and proactive care at the earliest point of clinical decision making and prescribing.

Justification for presentationSMART is the first large-scale, systematic application of a team-based pharmacist and doctor collaborative admission model, providing clinical pharmacy services over extended hours in response to acute patient care demand. This is a New Zealand first.


24. CONCURRENT SESSION 2BSaturday 6 September 11.00am – 11.15am

How Accurate? – Accuracy of the Medication List Obtained From General PractitionersSherryn Fox1, Edmondson S1

[email protected] Canterbury District Health Board, Christchurch

IntroductionThe accuracy of the medication history sources used during the medication history taking process is an area which has not garnered much attention in the past. If the accessed sources of information are initially inaccurate, it can add to confusion during the Medicine Reconciliation process of collating the best list of a patient’s medications, where conflicting sources of information can be a time consuming and labour intensive process.

AimTo evaluate the rate of discrepancies identified during admission to the Christchurch Hospital Emergency Department (ED) relative to the medication list provided from general practice for patients who were reviewed by a pharmacy technician.

MethodAll patients who attended the ED at Christchurch Hospital between the 16th October 2013 and the 8th November 2013 and had a medication history obtained by the ED pharmacy technician were included. Data collection was undertaken at the time the patient presented to the ED. The GP medication list was obtained through contacting the GP practice directly or from their GP referral. This list was compared to the list obtained by the pharmacy technician through consultation of multiple sources. Discrepancies identified in the GP medication list during the admission process were analysed using descriptive statistics.

ResultsData was collected for 56 patients. Patients were aged between 20 and 93 years old (median 72 years). Patients had between 1 and 14 regular medications (median 6). 35 patients (63%) were identified as having one or more discrepancies. From these patients, 89 discrepancies were identified with additions and omissions being the most common discrepancy.

ConclusionThis audit demonstrates discrepancies occur between information provided by GP practices and other sources. Hospital staff need to be aware of this when this information is provided by GP’s to ensure that this information is checked with another entirely different source, including the patient where possible, to obtain the most accurate list.

Justification for presentationWe believe that these findings have implications for any practitioner undertaking a medication history during the patient’s journey. Understanding the limitations of any one source of information is necessary to accurately obtain that ‘best list.’ This highlights a very real problem which will not solely be the domain of CDHB.



A Missed Opportunity to Lower Cardiac Event Rates? Low Statin Treatment/Compliance Rates at MidCentral DHBAnthea Gregan1, Stowers S1

[email protected] Palmerston North Hospital, Palmerston North

IntroductionThe ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults 2013 state that anyone with a LDL serum cholesterol level ≥ 4.9 mmol/L should be assessed for statin treatment. Epidemiological data shows a strong relationship between serum LDL levels and the risk of cardiovascular disease, and clinical trials have shown that lowering LDL with statins leads to a 30% decrease in the risk of cardiovascular events.

AimTo assess the level of statin prescribing in those with a recorded LDL serum level ≥ 4.9 mmol/L between Aug and November 2013 in the Midcentral area.

MethodWe were supplied with the NHIs of 1180 patients who had an LDL serum level ≥ 4.9 mmol/L between 15th August and 15th November 2013. The dispensing records of these patients were then checked in Clinisafe® for records of cholesterol lowering medication from 15th August 2013 until the end of March 2014.

ResultsOf the 1180 patient results, 75 were invalid or repeats. The remainder were split into five categories: Out of area patients with no dispensing history in Clinisafe® (32%), patients with a dispensing history in Clinisafe® but no statin dispensed (39.6%), those on alternative cholesterol medications (3.7%), those with one dispensing or a dispensing history that may indicate poor compliance (9.5%), and those with two or more statins dispensed (15.2%).

ConclusionApplying the ACC/AHA guidelines to our snapshot, statin dispensing in patients with a LDL serum cholesterol level ≥ 4.9 mmol/L is much lower than expected. What is unclear is the reason. It could be due to lack of awareness of prescribers not prescribing statins for this patient group, statins being prescribed but patients are not presenting scripts or a considered decision between prescriber and patient not to prescribe. There may be multiple reasons for this, and we plan to explore these further.

Justification for presentationThis highlights a guideline that applies statin usage to a larger group than those with cardiovascular disease; are we missing an opportunity to lower cardiovascular event rates, given the apparent low prescribing shown in this snapshot.



Using the STOPP Screening Criteria to Identify Potentially Inappropriate Prescribing in Older People Admitted to Middlemore HospitalGray S1, Sanjoy Nand2

[email protected] Waitemata District Health Board, Auckland 2 Counties Manukau District Health Board, Auckland

IntroductionPotentially inappropriate prescribing (PIP) can be defined as ‘the use of medications in situations where the risk of an adverse drug event (ADE) outweighs the clinical benefit’. Older people are at relatively higher risk of PIP than younger people as they generally have more co-morbidity and are prescribed more medications. PIP is a concern as it has been shown to be associated with an increased risk of ADEs. Adverse drug events, in turn, can lead to unnecessary hospitalisations as well as patient harm. The prevalence of PIP in older people at Middlemore Hospital was unknown.

AimTo determine the prevalence of PIP in inpatients aged 75 years and over admitted to Middlemore and to identify areas of potential improvement.

MethodIn this retrospective observational study, medication lists of 408 patients were screened using the STOPP (Screening Tool of Older Persons Prescriptions), an internationally developed screening tool to measure PIP. Inclusion criteria were patients admitted to medical and geriatric wards between January and March 2013 who did not die during their hospital stay. Medicines list information was obtained from electronic documents on medication histories and discharge summaries. Information on medicines given during the stay was obtained from Pyxis© data. Surgical patients were excluded due to poor quality of medicines lists in their discharge summaries.

ResultsThe prevalence of PIP in our study population was 50% on admission dropping to 46% on discharge. The change was not statistically significant. This was in keeping with other international studies. Proton pump inhibitors, benzodiazepines and aspirin were commonly implicated in PIP.

ConclusionOur study provides baseline knowledge of the prevalence of PIP in older people admitted to Middlemore Hospital. In our view the prevalence of 50% is sufficiently high to warrant action being taken to reduce the prevalence of PIP.

Justification for presentationIdentifying potentially inappropriate prescribing is a key component of providing safer patient care and managing polypharmacy in the elderly. The use of the STOPP criteria is a useful tool to deciding where interventions could be targeted.


27. CONCURRENT SESSION 2BSaturday 6 September 12.00pm – 12.15pm

Improving Skills and Utilising Technician Workforce in Medicines InformationNic Hayden1, Nicki Thomson1, Kelly Rodgers1

[email protected], [email protected], [email protected] 1 Capital and Coast District Health Board (CCDHB), Wellington

Context /existing situationAt CCDHB we have been trying to expand the pharmacy technician role to assist with our clinical service. We had been experiencing issues with being able to retain experienced technicians so investigations were made to see where technicians could be utilised more and assist with the provision of the pharmacy service, and improve job satisfaction.Current Medicines Information (MI) staffing situation prior to introducing a technician: 1 fulltime pharmacist, 1 part time (0.5FTE) pharmacist and occasionally an intern.No technician has worked in a clinical MI role previously at CCDHB.

Planned changeDevelop and implement a training programme for a pharmacy technician in the medicines information service.

MethodsA training programme was developed by the principal technician, MI Pharmacist and training and education pharmacist, to provide guidance for the MI pharmacy technician. This training tool was based around the UKMI pharmacy technician training. The technician on the clinical rotation was rostered in MI to begin the training.

Measurement of improvementIncreased amount of time for the MI pharmacist to spend on more complicated enquiries, and other tasks such as enquiry checking, resource review, bulletin writing etc.

Effects of changesThe training programme has met and exceeded expectations. The MI technician rotation benefits both the individual (improved job satisfaction) and the area.

Lessons learnt / implications for othersThe skills the technicians develop in MI benefit them greatly in all other areas of the pharmacy department, especially in other clinical roles such as medicines reconciliation.

Justification for presentationNo other technicians currently work in an MI department in New Zealand. It is important to share this service development and highlight the benefits experienced. Expanding the technician role will help staff retention and the provision of our pharmacy service.


28. CONCURRENT SESSION 2CSaturday 6 September 11.00am – 11.15am

Opiate Information on Discharge - What is on the Discharge Summary?Emma Henderson, Young [email protected] and Coast District Health Board (CCDHB), Wellington

IntroductionOpiates are recognised as a high risk medicine both nationally and internationally. Since 2007 CCDHB has noticed a gradual increase in adverse events related to opioid use. To address this, CCDHB has started a program of work to improve the safe use of opiates for both inpatients and outpatients at CCDHB. As part of this work we needed to assess what information is being communicated to GPs after patients are discharged on an opiate.

AimTo review the quality and type of information documented on the patient’s discharge summary when they receive a prescription for opiates on discharge.

MethodOver a one month period patients issued a CD script via Pyxis were reviewed for inclusion. For included patients the discharge summary was reviewed to see if information about dosing, indication & length of treatment was clear. Information was also reviewed to see if patients were co-prescribed other sedating medicines and if the patients had had an opiate related re-admission recently.

ResultsOf 107 discharge summaries audited, 13% had no mention of an opiate in the discharge summary. 31% contained some opiate-related information in the discharge medications list as well as the treatment and management section, which was considered best practice. Co-prescribing an opiate with other sedating medications was evident in 54 of the 107 patients. Tramadol was given concurrently to 25 patients discharged on an opiate. Opiate related re-admission occurred in only 5 patients.

ConclusionThe current quality of information provided about opiates on the discharge summary is variable. It is of concern that 13% of discharge summaries did not mention an opiate at all and over 50% of patients were prescribed concomitant sedating medicines. It is clear that additional training and guidance on what information should be provided on the discharge information is needed.

Justification for presentationWe believe this work is important to share as it gives an overview of quality of information about opiates on discharge. It will also give us the opportunity to share ways we are planning to improve this.



Don’t Get Stuck - A Collaborative Approach to Minimise Opioid-Induced ConstipationAngela Lambie1, Lee A1, McGuinniety C1, Parsotam N2, Jarvis N1, Hawke L1, Evans S1, Sherwood C1, Salton K1, Bezuidenhout L1, Lunny J1

[email protected] Waitemata District Health Board, Auckland2 Health Quality and Safety Commission, Auckland

Context / existing situationEffective pain control is integral to recovery from injury, surgery and illness. Opioids are a key component of pain management but their use can place patients at risk of harm such as over sedation and respiratory depression, nausea, vomiting and constipation. Harm can be caused by overdosing of opioids, inadequate monitoring and poor management. Patients who experience opioid-related harm have a significant increase in length of hospital stay and cost of hospitalisation.

Planned changeTo reduce opioid-related constipation on an elective orthopaedic ward.

MethodsConvene a multidisciplinary working group including pharmacists, nurses, a doctor, consumer and dietician to work collaboratively for 6 months on the following interventions: education sessions for clinicians, pre-printed laxative stickers for medication charts, development of a nurse-led ward bowel chart, non-pharmacological management of constipation, and tools to improve patient knowledge and self-management.

Measurement of improvementMeasure the rate of opioid harms and the rate constipation harms per 1000 patient admissions, using Trigger Tool methodology.

Effects of changesConstipation occurred more often in patients who did not have the laxative stickers on their charts, patients who did not have laxatives prescribed until requested, patients who were not administered laxatives regularly, patients who refused laxatives and patients who had poorly documented administration records and bowel charts.

Lessons learnt / implications for othersThe collaborative approach was essential to set realistic goals and execute them effectively. The initial aim was to reduce opioid-related harm including over sedation and respiratory depression, nausea, vomiting and constipation. The working group soon discovered that it would be more effective to focus on constipation alone. The decision to down-scale enabled us to concentrate our energy where we could make a sustainable difference. We uncovered the main reasons for opioid-related constipation so could work towards managing these issues together.

Justification for presentation The collaborative nature of this project ensured that consistent messages were disseminated effectively to clinicians and patients. Representatives from several areas were involved from the beginning to incorporate change into practice in a realistic and sustainable way.



The Implementation of Pharmacy Technicians in the Role of Medicine ReconciliationMark Wyper1, Saunders M1

[email protected] 1 Capital and Coast District Health Board (CCDHB), Wellington, New Zealand

Context / existing situationMedication history taking has long been regarded as a job to be carried out by pharmacists. At CCDHB we recognised that pharmacy technicians can take on much of this role - making the service more efficient and effective, whilst increasing job satisfaction for our technicians.

Planned changeA rigorous training package was designed to allow pharmacy technicians to accurately collect medication histories and refer these to pharmacists for final clinical checking. Not only was this a benefit to the service, but also provided the technicians involved with a greater clinical knowledge base and a better insight into the work done outside the pharmacy department.

MethodsThe training involves hands on ward experience, written and oral assessments and a range of practical case studies which cover a spectrum of potential medication history issues. The technician ‘passed’ the training after successfully completing three assessed medication histories. Pharmacists were briefed in the best ways to utilise technicians within clinical areas.

Measurement of improvementMeasurements included an increase in the number of medicine reconciliations initiated and a reduction in the length of time taken to initiate reconciliation after admission. This should lead to a reduced number of clinical incidents and near misses.

Effects of changesThe changes reduced the workload for pharmacists, allowing for more time spent on clinical issues. It helped to ensure that the medicine reconciliation service is all together faster and safer for both staff and patients.

Lessons learnt / implications for othersAlthough it has shown to be effective, the intensive training proved to be time consuming for both the technician receiving the training and the pharmacists providing it. Staffing shortages have resulted in the position be unfilled in favour of more high priority tasks. Despite this, it has been effective in all of the areas it has set out to improve when members of staff have been available to fulfil the role.

Justification for presentationMedication history taking is still a relatively new role for technicians in NZ. We believe our training package is unique in its thoroughness and varied nature and has the potential to be utilised by other hospitals across the country.


31. CONCURRENT SESSION 2CSaturday 6 September 12.00pm – 12.15pm

Bubble Boy Disease – A Case of Severe Combined Immunodeficiency Disease (SCID)Preetika Vareed1

[email protected] Starship Children’s Health (ADHB), Auckland

IntroductionSCID is a primary immunodeficiency condition that results from inherited defects of the immune system (T and B cells).1 Both these cells are important in fighting infections. The incidence of SCID is rare and is reported to be 1:40,000-50,000 live births.2 This report describes a case of SCID.

Case descriptionMaster AC was transferred to Starship Children’s Health from Palmerston North hospital at 14 weeks of age. He initially presented with severe respiratory distress and bloody stools. He was born at 41 weeks after an unremarkable pregnancy but was noted to have failure to thrive, diarrhoea and oral thrush at one month of age. On admission to Starship, he underwent various investigations and was found to be positive for cytomegalovirus (CMV), Pneumocystis jiroveci pneumonia (PJP), adenovirus and oesophageal candidiasis (OC). He was diagnosed with SCID based on immunological results, which required treatment before a curative bone marrow transplant (BMT) could be performed. Master AC underwent intensive treatment of his infections with ganciclovir (CMV), co-trimoxazole (PCP), cidofovir (adenovirus) and fluconazole (OC). Pharmacist input included recommendation on drug dosing in paediatrics, calculation of renal function, monitoring medication toxicity and medication procurement.

DiscussionRisk factors of SCID include consanguinity, family history of SCID or infant death.1 Symptoms include recurrent infections, chronic diarrhoea and failure to thrive.1 Master AC did not have any risk factors; however, he displayed all the classical signs of the disease. Without intervention, death from infection usually occurs within the first 2 years of life.

ConclusionThis report illustrates the rare case of SCID, and the most appropriate pharmaceutical treatments for CMV, PCP, adenovirus and OC. It also illustrates how pharmacists can be actively involved in the management of such patients with advising on appropriate dosage recommendations, managing side effects, monitoring toxicity and procurement of medicines.

References1. Bonilla F. Severe combined immunodeficiency (SCID): An overview. UpToDate. April 2014. 2. Verbsky J, Thakar M, Routes J. The Wisconsin approach to newborn screening for severe

combined immunodeficiency. J Allergy Clin Immunol. 2012;129(3):622

Justification for presentationAlthough this is a rare case, it illustrates the importance of aggressively managing opportunistic bacterial and viral infections that commonly occur in immunocomprised (e.g. oncology) or immuno-deficient patients. Knowledge about management of such patients would be beneficial to many pharmacists.


32. CONCURRENT SESSION 2DSaturday 6 September 11.00am – 11.15am

From Good to Great – Developing and Implementing a Gold Standard in Clinical Pharmacy Service to Older People’s HealthShaheen Mannan1, Nand S1, Pireva A1

1 Middlemore Hospital Pharmacy, Auckland

Context / existing situationThe Atlas of Healthcare Variation on polypharmacy ranks Counties as having the highest rates of medicines in patients aged 65 to 85. Elderly who are frail or have multiple comorbid conditions and take a number of medicines are more susceptible to medicine related morbidity and mortality. Clinical pharmacy services to the elderly during their hospital stay and transition to home is critical to patient safety and outcomes. While the service we provide to our geriatric wards is comprehensive, the lack of a systematic approach, consistency and timely intervention meant that not all patients received the same level of care. Some medicines problems were addressed too late in the patient journey impacting on monitoring of therapy changes.

Planned changeWe developed a change package to improve the timeliness of our services to inpatients in our geriatic wards. This included ensuring medication reconciliation occurred within the first 24 hours of admission, standardising the clinical input expectations and ensuring all medication lists in the discharge summary were reconciled by the pharmacist. A standardised decision pathway for providing medication card was also implemented.

MethodsWe measured baseline data on timeliness of medication reconciliation at admission and number of discharges contributed to. We used PDSA cycles to test changes to see which changes resulted in an improvement.

Measurement of improvementWe measured timeliness and completeness of clinical activities as key measures of improvement. We looked at errors prevented at admission and discharge as markers of outcome

Effects of changesWe improved care by improving the timeliness of our interventions and reducing potential errors. We also improved engagement of prescribers in making pharmacists partners in pharmaceutical care.

Lessons learnt / implications for othersSmall changes leading to improvement and a teamed approach to quality improvement can have significant benefits to patient care.

Justification for presentationThe Atlas of Health Variation indicates polypharmacy in elderly as a significant issue in New Zealand. The risks of polypharmacy can be mitigated by improving medication management in this population. Sharing this improvement is therefore relevant in the NZ context.



A Prospective Audit of Clinical Pharmacist ActivitiesAleksandra Milosavljevic1, Brackley K1, Monkhouse J1

[email protected] 1 Auckland District Health Board (ADHB), Auckland

IntroductionIn recent years the pharmacy department at ADHB has been placing emphasis on improving services. During this time gaps have been identified in the department’s understanding of what pharmacists do on a regular workday. More could be known about the activities they undertake, the time taken to complete each activity, as well as the type and number of interruptions they encounter. This information would contribute to capacity planning and help restructure rosters, increase work efficiency and help manage workload.

AimTo describe the work activities of clinical pharmacists at ADHB.

MethodA prospective observational study of pharmacist’s work activities was undertaken. Pharmacists were shadowed by an independent observer for two days each in April 2014 and their daily activities and interruptions were recorded using Activity Log Pro® app on a tablet. Prior to the shadowing an online questionnaire was sent to all pharmacists which asked them to estimate how they spend a typical work day.

ResultsFour clinical pharmacists (two junior and two senior) with a variety of clinical and operational work areas were shadowed and 25 pharmacists (49%) completed the questionnaire. On average each pharmacist spent 14 minutes per day talking to patients, which was in line with the majority of beliefs, with most believing they spend between 0 to 15 minutes. On average pharmacists spent 99 minutes clinically reviewing patient’s therapy, compared with the pharmacists estimate of 1 to 3 hours. The number of interruptions during the workday varied between 21 to 50 per pharmacist, most of which were from pharmacy staff (55%).

ConclusionWhen comparing actual versus estimated activities, it is evident that pharmacist’s estimates of their activities appeared to be reasonably accurate. Further analysis of data will contribute to more detailed understanding of which pharmacist activities add value to patient care.

Justification for presentationAt present the department has limited data about pharmacist’s activities and thus rely heavily on estimates. This project has the potential to help with capacity planning; ultimately improving pharmacy services. Such information may be reflective of other hospitals in NZ.



Providing a Value Added Clinical Pharmacy Service to General Medical Wards at Auckland City HospitalJoe Monkhouse1, Subramoney M1

[email protected] Auckland District Health Board (ADHB), Auckland

Context / existing situationAt Auckland City Hospital (ACH), the clinical pharmacy service provides medicines reconciliation (MR), medication review and medicines counselling to patients. However, the service was not being provided consistently to general medical wards. This impacted the quality of care, resulting in missed opportunities for contributing to the care of patients at high risk of medication errors.

Planned changeThe goal of the project was to consistently identify all patients at high risk of medication related harm in the General Medicine service and to enable clinical pharmacists to complete targeted interventions, such as medicines reconciliation and drug therapy reviews, for those patients likely to derive the greatest benefit.

MethodsUsing Six–Sigma quality improvement methodology, a project team worked systematically to identify the problem, analyse potential root causes and implement solutions. The business intelligence department was approached to assist in the development of an automated prioritisation report based on available electronic clinical information. The General Medical pharmacist team was reconfigured and used the prioritisation tool to review patients in an order of priority. Clinical standard work practices and team ‘huddles’ were developed and implemented.

Measurement of improvementKey measures included the total rate of MR for all patients admitted into the general medical service and the percentage of high risk patients reviewed within 72 hours.

Effects of changesAt baseline, only 5% of patients were receiving MR on ACH’s general medical wards. At the end of the pilot, MR rates had risen fivefold to 27% with no additional clinical pharmacist resource. In addition, 90% of high risk patients are being reviewed by a pharmacist within 72 hrs.

Lessons learnt / implications for othersThe resourcing challenge faced by ACH’s clinical pharmacy service is not unique in New Zealand. Using a structured quality improvement methodology, it is possible to implement sustainable improvements to a clinical pharmacy service without an increase in clinical pharmacist resource.

Justification for presentationThe lessons learnt (good and bad) from our quality improvement journey are ones that other pharmacy departments in NZ may find useful when considering improvements to their own clinical service.


35. CONCURRENT SESSION 2DSaturday 6 September 12.00pm – 12.15pm

Antimicrobial Usage Point Prevalence Study at Auckland DHBRuchika Tandon1, Duffy E1

[email protected] Auckland District Health Board, Auckland

IntroductionThere is an emerging trend of increasingly extensive use of antimicrobial agents, development of drug-resistant organisms and unnecessary healthcare expenditure within hospital services resulting from 20-50% of antimicrobials being used inappropriately1,2. Point prevalence studies are a well-established means of effectively identifying antimicrobial prescribing practices and specific areas for targeting interventions in the future 3.

AimWe looked to establish the current prescribing patterns of antimicrobials within adult services at Auckland District Health Board (ADHB).

MethodA point prevalence study of antimicrobial usage of all patients admitted to adult wards at ADHB over a two-week period in April 2014. A comprehensive review of clinical notes, medication charts and Concerto® records was conducted and parameters involved in the prescribing process, their nature and extent of documentation were identified. Data was entered into HanDBase® and analysed in Microsoft Excel® using descriptive statistics and percentages.

Results 230 of the 579 patients surveyed (40%) were prescribed antimicrobials at the time of review and a total of 313 prescriptions were written. The most common route of administration for antimicrobials was intravenous at 69.5% followed by 30.5% being administered orally. At the time of prescription, the intended treatment duration was documented for 9.3% of antimicrobials, and the indication was documented for 32%. The Infectious Diseases team was involved in the prescribing of 9% of antimicrobials.

ConclusionIt is evident that there is a lack of documentation by prescribers in the area of antimicrobial usage. The majority of antimicrobials were prescribed without documented involvement of the Infectious Disease team. The use of intravenous antimicrobials is high and represents an area for improvement.

References1. Usluer G, Ozgunes I, Leblebicioglu H. A multicenter point-prevalence study: antimicrobial prescription

frequencies in hospitalized patients in turkey. Ann Clin Microbiol Antimicrob. 2005 Oct 3; 4: 16. 2. Dean B, Lawson W, Jacklin A, Rogers T, Azadian B, Holmes A. The use of serial point-prevalence

studies to investigate hospital anti-infective prescribing. Int J Pharm Pract. 2002; 10: 121-5.3. Duguid M, Cruickshank M, editors. Antimicrobial Stewardship in Australian Hospitals.

Canberra: Biotext; 2011.

Justification for presentationWe believe this research is of interest as it indicates that documentation of antimicrobial prescribing is poor at Auckland District Health Board and that usage of intravenous antimicrobials is higher than expected. This research allows for more targeted interventions to be implemented in the future and improve antimicrobial prescribing practices within Auckland District Health Board.


36. CONCURRENT WORKSHOP 3ASaturday 6 September 1.15pm – 2.45pm

Hauora Māori and Hospital Pharmacists and Technicians – Unpacking the Suitcase Shane Ruwhiu [email protected] Care (Whakapai Hauora) Charitable Trust, Palmerston North

AimUnderstanding the hospital pharmacist and hospital technician role and Hauora Māori.

Learning outcomes/objectivesConfidence in applying your skills can be applied to Māori patients.

ContentThe workshop will provide participants with insight into everyday challenges that patients come across when managing their medicines. Pharmacists and pharmacy technicians are well placed to assist patients understand their medicines better and assist with practical solutions to challenges faced by patients.

Format of activitiesExamples of medicine management challenges that our patients experience will be discussed in small peer groups, followed by discussion and feedback within the larger group setting.

Target audienceHospital pharmacists and pharmacy technicians.

Justification for workshopUnderstanding the challenges that Māori patients may have with medicine management within our current models of practice is required for hospital pharmacists and technicians to provide appropriately focused medicine management advice, and so address the differing health status of Māori and non- Māori patients.


37. CONCURRENT WORKSHOP 3BSaturday 6 September 1.15pm – 2.45pm

The Role of the Pharmacist in Hospice and Palliative CareVictoria [email protected] Hospice and Home Health, Sunnyvale, California, USAUniversity of California San Francisco, School of Pharmacy

Aim This workshop will explore the role of the pharmacist as part of an interdisciplinary team (IDT) providing hospice or palliative care at the end-of-life, the unique perspective provided by a pharmacist in this role and review pain and symptoms commonly seen at the end-of life.

Learning outcomes/objectives After attending this workshop, participants will:• Be able to identify opportunities for pharmacists in hospice and palliative care• Identify the contributions of pharmacists to the hospice team• Be familiar with strategies to manage pain and other symptoms at the end-of-life

Content Material to be covered includes an overview of hospice and palliative care, the pharmacist as a member of the hospice team and why this can be an extremely rewarding and challenging area of practice. Dr Ferraresi will describe how she created her practice and how pharmacists can impact patient care by creatively focusing on the safe, effective and evidence based use of medications, to meet the needs of the hospice patient and their families and caregivers.The workshop will conclude with a case-based review of managing pain and other symptoms.

Format of activities The activity will be a lecture with case studies and ample time for discussion and questions.

Target audience This workshop is for pharmacists interested in learning about opportunities for them in hospice care, and providing safe, effective pain and symptom management to terminally ill patients.

Justification for workshop The author has created an innovative program for patients at the end-of-life. This workshop will be of interest to any pharmacist wanting to get involved in this highly rewarding, challenging practice or to learn more about pain and symptom management.


38. CONCURRENT WORKSHOP 3CSaturday 6 September 1.15pm – 2.45pm

Medication Review- “Not Just about Medicines” - The Patient as the Central FocusRachel Cooke1, Althea Lord1, Mary Daly1

[email protected] Hutt Valley DHB, Lower Hutt

AimMedication review is an important part of medication management. This workshop takes a multi-disciplinary view to this process and also considers that the patient should have an integral role in the review process.

Learning outcomes/objectivesParticipants will be able to identify problems, suggest and negotiate an amenable outcome for the patient, deciding when to use evidence based medicine or clinical judgement. They should be able to develop a plan for the initiation of change, and communicate this to the other members of the multi-disciplinary team and patient.

Format of activitiesCase-related example(s) with group discussion and feedback

Target audienceThose new to medication reviews and those who wish to hone their skills.


39. CONCURRENT WORKSHOP 3DSaturday 6 September 1.15pm – 2.45pm

Expanding Clinical Services: Hints and PitfallsMichael Dooley1,2


AimThe aim of the workshop is to explore the challenges and pitfalls in expanding clinical pharmacy services and to provide practical hints and approaches that can influence success.

Learning outcomes/objectivesThe learning outcomes from this workshop, through presentation of practical examples of success and failure, are that participants will: • Be able to identify the key enablers and barriers to expanding clinical pharmacy

services• Be able to consider approaches to negate potential barriers • Have a greater understanding of the drivers of decision making

ContentThere are significant challenges and opportunities for improving patient care though clinical pharmacy services. However, there are often constraints within the workplace that limit the ability to expand services. Despite this, there are many example of success where clinical pharmacy services have increased in capacity, in complexity and in impact. Professor Michael Dooley will provide practical examples of approaches to the successful expansion of clinical pharmacy services. This will include a focus on prioritisation of pharmacy services and strategies to identify barriers to success and hints to overcome. The workshop will include opportunities to work through some potential ideas for clinical pharmacy services and develop practical steps for progressing these initiatives.

Format of activitiesThere will be three components of the workshop:• Presentation of practical examples of approaches to the successful expansion of

clinical pharmacy services. • Small group peer discussion of possible services to expand and approaches to

support.• Interactive debate regarding possible approaches.

Target audienceThe target audience is any individuals who are either providing clinical pharmacy services or involved in the planning and/or implementation of these services. Clinical pharmacists through to pharmacy managers will benefit from the workshop.

Justification for workshopClinical pharmacy services at Alfred Health in Melbourne are recognised as one of the most innovative and comprehensive programs around. There have been a range of successes and failures associated with the development of the program and practical insights into what has been critical to this success will be valuable to those involved in developing clinical pharmacy services.


40. Saturday 6 September 3.15pm – 3.45pm

Hospital Pharmacy and its role in Community Pharmacy ServicesAndrea Shirtcliffe, Androulla KotrotsosCommunity Health Service Improvement, Sector Capability and Implementation, Ministry of Health

Community pharmacy is heading into the final year of what has been one of the most significant practice changes the sector has seen in over twenty years. The new service and funding model for community pharmacy utilises pharmacists’ skills in medicines management and moves the profession towards a patient-centred care model.

There have been many successes’ to date, with community pharmacy now providing adherence management services to around 137,000 patients with long term conditions. There are also 2,500 patients who are receiving anti-coagulant management services from their pharmacist. As the Ministry continues to progress the infrastructure that will allow pharmacists to implement management plans and make informed decisions on patient care individual to their needs, community pharmacy is now looking to work closer with pharmacists working in all aspects of the profession, to ensure there is a smooth continuation of care across the system.

Hospital pharmacists, as well as those working in clinical roles across primary care play a critical role in this, and are an important link to help patients with medicines adherence difficulties access these services.

While the agreement may sit with community pharmacy, ensuring that all pharmacists have an understanding of how the Community Pharmacy Services Agreement works in practice, is essential to its success. All pharmacists have a role in effective discharge, reconciliation and referral into the new services being provided by their peers in the community.



MAX HEALTH AWARD LECTURE House Officer Prescribing: Building a sustainable interprofessional education platform to improve medication safetyAvril LeeQuality Improvement Specialist-Pharmacy, Waitemata District Health Board

Prescribing is the commonest therapeutic intervention, but a major source of inadvertent harm for hospital patients. Improving prescribing practice is part of our patient safety agenda. The PGY1 year is an opportunistic time to teach the correct prescribing skills and increase awareness of how prescribing correctly reduces harm.

We wanted to design and implement an effective programme linking teaching and practice in a meaningful way. Evidence based learning principles were applied to actively engage PGY1’s in medication safety and improve their prescribing skills.

The programme is successful and has enhanced interprofessional understanding. Teamwork is one of the most effective ways to ensure safe patient care (WHO). This has been achieved by role modelling collaboration both in practice and in formal teaching.

Education on prescribing practice should be led by those who know the most about the subject – pharmacists. The identification of an expert pocket of clinical practice and its utilisation in house officer teaching is a model that can be used.

Developing pharmacists to become clinical leaders does improve prescribing practice.



MA- ORI HEALTH AWARD LECTURE Impact of Increased Prescription Charges on Māori Brendan McIntosh1, Te Karu L2, Norris P3, Tordoff J4. [email protected] 1 University of Otago, Dunedin

Introduction The recent increase in prescription charges to $5 per item may be exacerbating health inequalities for Māori. Māori already face many barriers to access to appropriate healthcare and increased prescription charges have added to these.

Aim Māori receiving prescriptions for medicines are interviewed kanohi ki te kanohi to investigate the effect the price increase is having.

Method A literature review on similar situations elsewhere was carried out using Ovid Medline. Then after ethical approval and discussions with my Marae – Puketeraki – a pānui was sent around local Māori health organisations. Participants were given an information sheet and then interviews were conducted involving questions around their health and living situations and how they cope with the increased prescription charges.

Results Overall the increased price has meant Māori ‘struggle’ more. Three main coping strategies were identified; reducing doctors visits, manipulating own medicine regimens and prioritising other expenditures. Mana played a big role in the way participants coped with the increase; one participant went without medicines because she did not want to ask for help. Those that had heard of it loved the prescription subsidy card and to some it made no difference, as they could not afford to go to the doctor in the first place. Most participants had good relationships with their pharmacist however the cultural competency gap was still evident.

Conclusion Overwhelmingly it seems people are struggling more as their budgets tighten. The $2 increase per item can change a situation so much so that patients are unable to visit a GP in the first place. This has directly led to participants in this study being admitted to hospital. Those that struggle the most are parents with primary school aged children. These people sacrifice a lot, including their own health, in order to ensure children are getting medicines when needed.

Justification for presentation A prescription charge increase for Māori on a low income with a chronic condition can be the difference between whānau eating for the week or missing out on their medicines and ending up in hospital; posing a negative effect on our health system.

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43. PLENARY SESSIONSunday 7 September 9.00am – 9.50am

Shaky Times - The Canterbury Earthquakes and All that has FollowedCaroline BellUniversity of Otago, Christchurch

The Canterbury earthquake sequence began in 2010 and involved three major earthquakes and over 12,000 aftershocks resulting in widespread damage to the city of Christchurch. The significant economic and practical consequences which followed, particularly with insurance companies and delays in rebuilding, then created significant secondary stressors further compounding the difficulties of many. As a result of the disaster people have presented with a wide spectrum of responses ranging from those with severe post traumatic stress disorder and depression to those who report being completely unaffected, and everything in between. Now 4 years on from the first earthquake Dr Bell will discuss the psychological impact of the Canterbury earthquakes and including prescribing patterns in Canterbury over this period.


44. CONCURRENT WORKSHOP 4ASunday 7 September 10.30am – 12.00pm

Hauora Māori and Hospital Pharmacists and Technicians – Unpacking the Suitcase Shane Ruwhiu [email protected] Care (Whakapai Hauora) Charitable Trust, Palmerston North

AimUnderstanding the hospital pharmacist and hospital technician role and Hauora Māori.

Learning outcomes/objectivesConfidence in applying your skills can be applied to Māori patients.

ContentThe workshop will provide participants with insight into everyday challenges that patients come across when managing their medicines. Pharmacists and pharmacy technicians are well placed to assist patients understand their medicines better and assist with practical solutions to challenges faced by patients.

Format of activitiesExamples of medicine management challenges that our patients experience will be discussed in small peer groups, followed by discussion and feedback within the larger group setting.

Target audienceHospital pharmacists and pharmacy technicians.

Justification for workshopUnderstanding the challenges that Māori patients may have with medicine management within our current models of practice is required for hospital pharmacists and technicians to provide appropriately focused medicine management advice, and so address the differing health status of Māori and non- Māori patients.


45. CONCURRENT WORKSHOP 4BSunday 7 September 10.30am – 12.00pm

THE ROLE OF THE PHARMACIST IN HOSPICE AND PALLIATIVE CAREVictoria [email protected] Hospice and Home Health, Sunnyvale, California, USAUniversity of California San Francisco, School of Pharmacy

Aim This workshop will explore the role of the pharmacist as part of an interdisciplinary team (IDT) providing hospice or palliative care at the end-of-life, the unique perspective provided by a pharmacist in this role and review pain and symptoms commonly seen at the end-of life.

Learning outcomes/objectives After attending this workshop, participants will:• Be able to identify opportunities for pharmacists in hospice and palliative care• Identify the contributions of pharmacists to the hospice team• Be familiar with strategies to manage pain and other symptoms at the end-of-life

Content Material to be covered includes an overview of hospice and palliative care, the pharmacist as a member of the hospice team and why this can be an extremely rewarding and challenging area of practice. Dr Ferraresi will describe how she created her practice and how pharmacists can impact patient care by creatively focusing on the safe, effective and evidence based use of medications, to meet the needs of the hospice patient and their families and caregivers.The workshop will conclude with a case-based review of managing pain and other symptoms.

Format of activities The activity will be a lecture with case studies and ample time for discussion and questions.

Target audience This workshop is for pharmacists interested in learning about opportunities for them in hospice care, and providing safe, effective pain and symptom management to terminally ill patients.

Justification for workshop The author has created an innovative program for patients at the end-of-life. This workshop will be of interest to any pharmacist wanting to get involved in this highly rewarding, challenging practice or to learn more about pain and symptom management.


46. CONCURRENT WORKSHOP 4CSunday 7 September 10.30am – 12.00pm

Medication Review- “Not Just about Medicines” - The Patient as the Central FocusRachael Cooke1, Althea Lord1, Mary Daly1

[email protected] Hutt Valley DHB, Lower Hutt

AimMedication review is an important part of medication management. This workshop takes a multi-disciplinary view to this process and also considers that the patient should have an integral role in the review process.

Learning outcomes/objectivesParticipants will be able to identify problems, suggest and negotiate an amenable outcome for the patient, deciding when to use evidence based medicine or clinical judgement. They should be able to develop a plan for the initiation of change, and communicate this to the other members of the multi-disciplinary team and patient.

Format of activitiesCase-related example(s) with group discussion and feedback

Target audienceThose new to medication reviews and those who wish to hone their skills.


47. CONCURRENT WORKSHOP 4DSunday 7 September 10.30am – 12.00pm

Expanding Clinical Services: Hints and PitfallsMichael Dooley1,2


AimThe aim of the workshop is to explore the challenges and pitfalls in expanding clinical pharmacy services and to provide practical hints and approaches that can influence success.

Learning outcomes/objectivesThe learning outcomes from this workshop, through presentation of practical examples of success and failure, are that participants will: • Be able to identify the key enablers and barriers to expanding clinical pharmacy

services• Be able to consider approaches to negate potential barriers • Have a greater understanding of the drivers of decision making

ContentThere are significant challenges and opportunities for improving patient care though clinical pharmacy services. However, there are often constraints within the workplace that limit the ability to expand services. Despite this, there are many example of success where clinical pharmacy services have increased in capacity, in complexity and in impact. Professor Michael Dooley will provide practical examples of approaches to the successful expansion of clinical pharmacy services. This will include a focus on prioritisation of pharmacy services and strategies to identify barriers to success and hints to overcome. The workshop will include opportunities to work through some potential ideas for clinical pharmacy services and develop practical steps for progressing these initiatives.

Format of activitiesThere will be three components of the workshop:• Presentation of practical examples of approaches to the successful expansion of

clinical pharmacy services. • Small group peer discussion of possible services to expand and approaches to

support• Interactive debate regarding possible approaches

Target audienceThe target audience is any individuals who are either providing clinical pharmacy services or involved in the planning and/or implementation of these services. Clinical pharmacists through to pharmacy managers will benefit from the workshop.

Justification for workshopClinical pharmacy services at Alfred Health in Melbourne are recognised as one of the most innovative and comprehensive programs around. There have been a range of successes and failures associated with the development of the program and practical insights into what has been critical to this success will be valuable to those involved in developing clinical pharmacy services.


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POSTER PRESENTATIONS Poster No. Title

1 The use of chlorhexidine-containing products within Middlemore Hospital: An AuditJulia Corfe-Tan, Mannan S

2 Optimizing Gentamicin Use in the Emergency Department at Christchurch HospitalSherryn Fox, Gardiner S, Vella-Brincat J

3 An Audit of the Pre-Operative Levosimendan use at Capital and Coast District Health Board (CCDHB)Blake Jackson, Young S

4 Withdrawal.....From Opioid PrescribingKate Kilpatrick, Goddard J, King S, Proctor, Ragupathy R, Vickers J

5 Analgesics on Discharge Prescriptions from Christchurch HospitalAshleigh Kortegast, Vella-Brincat J, Fox S, Doogue M,

6 Keep Calm and Chart On – A New Dialysis Medication ChartNicola Seto, Chandra A

Supported by:


POSTER 1The Use of Chlorhexidine-Containing Products Within Middlemore Hospital: An AuditJulia Corfe-Tan1, Mannan S2

[email protected] Middlemore Hospital CMDHB, Auckland2 Middlemore Hospital CMDHB, Auckland

IntroductionChlorhexidine is commonly used as a topical antiseptic due to its ability to bind proteins within the skin and mucosa (1). It can be found in a number of different products used within the hospital-setting, such as surgical scrubs, mouthwashes, topical creams, and impregnated into dressings and catheters. Adverse effects to chlorhexidine have been reported in a number of countries (2). The type of reactions documented range from contact dermatitis to anaphylaxis. It has been suggested that because chlorhexidine is commonly used for sterilisation or in combination with other ingredients exposure may not be clearly documented in patients notes or on the medicine chart (2). For this reason, chlorhexidine may be overlooked as the causative agent if allergy or adverse reactions occur.

AimThe aim of this project is to develop a comprehensive list of all the chlorhexidine-containing products used within Middlemore hospital. Through development of this list this project aims to improve the awareness of chlorhexidine allergy and adverse reaction and reduce the risk of chlorhexidine exposure to patients with identified chlorhexidine allergy or adverse reaction.

MethodAn audit investigating all the products containing chlorhexidine used in Middlemore hospital will be conducted in order to develop a list for reference and educational purposes. As a background for this project an audit will be conducted to investigate the incidence of chlorhexidine allergy and adverse reaction within Middlemore hospital.

Results (pending)To be presented. The results will include presentation of the list of chlorhexidine-containing products and findings regarding the incidence of chlorhexidine allergy and adverse reaction in Middlemore hospital.

Conclusion (pending)To be presented.

References 1. Caloguiri GF, Di Leo E, Trautmann A, Nettis E, Ferrannini A et al. Chlorhexidine

Hypersensitivity: A Critical and Updated Review. J Allergy Ther 4. 2013 Jun 25;4(4): doi: 10.4172/2155-6121.1000141

2. Garvey LH, Roed-Petersen J, Husum B. Is there a risk of sensitization and allergy to chlorhexidine in health care workers? Acta Anaethesiol Scand. 2003;47:720-724

Justification for presentationThis project aims to create awareness about chlorhexidine allergy and adverse reaction within the hospital setting and provide recommendations for prevention of exposure to patients with identified chlorhexidine allergy or adverse reaction.


POSTER 2Optimising Gentamicin Use in the Emergency Department at Christchurch HospitalSherryn Fox, Gardiner S, Vella-Brincat [email protected] District Health Board, Christchurch

IntroductionGentamicin use within the Emergency Department (ED) has potential to influence dosing on the wards, particularly if the expected monitoring does not initially occur. Whether the doses prescribed in the Emergency Department are adequate and safe for the patient is important as there are risks and costs associated with both under- and overdosing with gentamicin.

AimTo document doses, drug concentration monitoring and compliance with guidelines of gentamicin use in the Christchurch Hospital ED.

MethodPatients given gentamicin in ED during the four weeks from 28th of April 2014 were identified by nursing staff on administration. Data collected by the nursing staff included the dose, and the weight of the patient if known. Using patients’ NHIs, clinical notes were accessed on Health Connect South (electronic patient system) to ascertain the presenting complaint, diagnosis and relevant laboratory results including creatinine and eGFR. Subsequent doses, if any, were also collected. Data was analysed using descriptive statistics in Graphpad PrismTM.

ResultsData were collected for 64 patients who attended the ED during the audit timeframe. Median (range) age was 59 (15 - 91) years and weight (n= 34) was 70 (40 – 104) kg. The median (range) dose was 5 (2.8 – 7.0) mg/kg. Three patients were identified as being tetraplegic, and received doses of 290 to 400 mg. Only one of these patients had a weight recorded, giving a 5.3 mg/kg dose. Median (range) eGFR was 76 (18 – 125) ml/min/1.73m2. Three patients received a subsequent dose of gentamicin while in hospital. One of these had gentamicin concentration monitoring done from the dose given in ED.

ConclusionFurther education of the ED medical team needs to be undertaken to ensure appropriate use of gentamicin and to optimise therapy fully for the individual patient. Doses used for the three tetraplegic patients were higher than that recommended within the CDHB guidelines.

Justification for presentationThis audit highlights the importance of monitoring gentamicin use right from the first dose in hospital. Sharing these results may help other hospitals assess this first chance at treating a patient correctly and safely.


POSTER 3An Audit of the Pre-Operative Levosimendan Use at Capital and Coast District Health Board (CCDHB)Blake Jackson, Young [email protected] Pharmacy Department, Capital and Coast District Health Board, Wellington.

IntroductionPre-operative use of levosimendan is currently an unlicensed indication in New Zealand.1 CCDHB has a pre-operative levosimendan guideline on the safe and appropriate use of levosimendan for patients undergoing high-risk cardiac surgery.2 Due to the high cost of levosimendan it was decided to audit use and therefore whether the guideline was being adhered to.

MethodA retrospective audit from April 2013 to April 2014 of pre-operative levosimendan use at CCDHB was implemented. Patients prescribed levosimendan during this period were identified via the WINDOSE pharmacy computer system. Data was collected on the rate and duration of infusion and the adherence to the current CCDHB guidelines.

A literature search was performed via EMBASE to retrieve relevant articles relating to pre-operative levosimendan use. A request was made through the NZHPA discussion group to obtain other DHB’s levosimendan guidelines.

ResultsFrom April 2013 to April 2014, 18 patients were dispensed levosimendan at CCDHB; 14 for pre-operative use. The literature search identified ten articles, four of which discussed levosimendan use pre-operatively. Infusion rates varied between 0.1-0.4 mcg/kg/min. From the NZHPA discussion group, six levosimendan guidelines were obtained. No guidelines discussed the use of levosimendan in a pre-operative setting.

ConclusionLevosimendan is currently used in a pre-operative setting at CCDHB to optimise patients undergoing high-risk cardiac surgery. There are a limited number of studies discussing pre-operative levosimendan use and it appears no other centres in NZ use this drug in this manner. As the pre-operative levosidmendan is an unlicensed indication it is important that the current CCDHB guidelines are followed, we will be presenting the data to our cardiothoracic department along with recommended changes.

References1. Pharmacy Retailing (NZ) Limited. Levosimendan datasheet. 2010.

Available from: http://www.medsafe.govt.nz/profs/datasheet/s/Simdaxinj.pdf 2. Capital & Coast DHB. Pre-operative levosimendan in high-risk cardiac surgery (Guideline).

2013.

Justification for presentationCurrently levosimendan use varies between centres. As the pre-operative use is an unlicensed indication and due to the high cost of levosimendan, we expect that knowledge of what our centre is doing would be interesting to other DHBs.


POSTER 4Withdrawal….…From Opioid Prescribing Kate Kilpatrick1

[email protected] Pharmacy Services, Waikato Hospital, Hamilton

IntroductionAlthough morphine is still the opioid of choice for the management of severe pain other strong opioids are used to manage pain in the hospital setting. Oxycodone use has dramatically increased since it became fully subsidised in 2005, with most prescribing occurring in hospitals (1, 2, 3). A pilot study at Waikato Hospital showed current oxycodone prescribing is not always in accordance with accepted practice, which may also affect prescribing of other opioids. It is important to audit current prescribing of orally administered strong opioids and this audit will form the basis for interventions to improve opioid prescribing.

Aim• To conduct a baseline audit to assess prescribing trends of orally administered

strong opioids• To design and deliver an intervention to improve opioid prescribing• To evaluate the effectiveness of the intervention at promoting prescribing change

MethodThe audit tool developed for the pilot study proved effective for data collection and has been adapted to include other opioids. Data will be collected retrospectively from the charts of patients who are discharged from orthopaedic wards over ten consecutive weekdays. The audit will include strong opioids (methadone, morphine, oxycodone) administered orally only. This baseline data will be used to identify trends in opioid prescribing which will form the basis for an education programme with medical and nursing staff. A subsequent audit will be conducted to determine the efficacy of the interventions at improving opioid prescribing.

ResultsResults from the pilot audit showed opioid prescribing was not in accordance with nationally accepted best practice guidelines. The results of the audit described above will be presented at the conference.

ConclusionIt is thought that prescriber education and promotion of current guidelines used by Waikato DHB will improve prescribing of strong opioids. The cycle of audit, intervention and re-audit will ensure such an intervention is evidence based.

Justification for presentationThere is evidence to suggest that strong opioids are not always prescribed according to nationally accepted best practice guidelines. It is important to determine the effectiveness of interventions at promoting prescribing change and facilitating safe and appropriate opioid use.

References1. Pharmaceutical Management Agency. New pain treatment subsidised for NZers [media

release]. Wellington: New Zealand Government; 2005 August. Accessed on 26th May 2014. Available from http://www.pharmac.govt.nz/2005/08/05/050805d.pdf

2. Robinson G, Wilson H. Update on oxycodone: what can primary care do about the problem. Best Practice Journal. 2012 May; 44:8-16

3. Oxycodone: Place in Therapy. Best Practice Journal. 2009 November; 24:28-31


POSTER 5Analgesics on Discharge Prescriptions From Christchurch Hospital Ashleigh Kortegast, Vella-Brincat J, Fox S, Doogue M [email protected] Hospital Pharmacy, Christchurch

IntroductionThere has been a worldwide rise in use of prescription opioids with oxycodone use reaching epidemic proportions in the USA1; this has led to patient harm and criminality. A similar trend of rising prescription opioid use has been reported in NZ2. Concerns have been expressed about increasing opioid (particularly oxycodone) prescribing by Christchurch Hospital doctors.

AimTo describe the analgesics prescribed on discharge from the Emergency Department (ED), Orthopaedic Outpatient Clinic (OOC) and Orthopaedic Inpatient Wards (OIW) at Christchurch Hospital.

MethodA retrospective cohort study of patients discharged from ED, OOC and OIW was undertaken. The discharge record and prescription of consecutive patients discharged from ED over ten days in May 2014 were manually reviewed and all analgesic prescribing recorded. The controlled drug book was used to cross check patients prescribed a controlled drug analgesic. For all patients, prescribed analgesics the following information was recorded; age, sex, indication for analgesia, analgesic(s), dose, and the duration/quantity of supply. The data were analysed using descriptive statistics.

ResultsOf the 1473 patients discharged from ED, 250 patients (17%) were prescribed one or more analgesics (see table below). The mean age was 34 years (SD 16) and 124 were female. The major indications for analgesic prescribing by ED were musculoskeletal pain 43%, soft tissue injuries 18% and visceral pain 15%. During the study period no patient received a discharge prescription for oxycodone (95% CI -0-0.25%).

Table: Top 6 analgesics prescribed on discharge

Analgesic Percentage prescribed on discharge (n=250)

Paracetamol 76%

Ibuprofen 69%

Codeine 59%

Tramadol 4.4%

Diclofenac 3.2%

Morphine 1.6%


ConclusionCurrently few patients are being discharged from ED with controlled drugs prescriptions. Simple analgesia is the usual method of treatment for these patients. Oxycodone prescribing does not appear to be problematic.

1. Laxmaiah Manchikanti, Bert Fellows, Hary Ailinani et al. Therapeutic use, abuse, and nonmedical use of opioids: A ten-year perspective. Pain Physician, 2010; 13:401-435.

2. Royal Australian College of Physicians. Prescription Opioid Policy: Improving the management of chronic non-malignant pain and prevention of problems associated with prescription opioid use. April 2009.

Justification for presentationGP’s and community pharmacists have raised concerns about hospital prescribed opioid analgesia in the community. This is a pertinent topic for most hospitals and would not solely be an issue for CDHB. Quantifying a potential major public health problem to inform decision making was the basis of this audit.


POSTER 6Keep Calm and Chart On – A New Dialysis Medication Chart Nicola Seto, Chandra A

[email protected], [email protected] District Health Board (ADHB), Auckland

Context / existing situationThe National Medication chart (NMC) was rolled out at ADHB in March 2013. However, the adult services dialysis units continued to use the local medication chart because the NMC did not suit the chronic nature of medication orders in this area. For example, the administration section of the NMC could not accommodate intermittent (up to three times weekly) haemodialysis treatment over 3 months. In order to align with NMC standards and the needs of the dialysis unit, we needed to develop a chart which was fit for purpose.

Planned changeTo design a dialysis medication chart for ADHB that met the needs of the renal/dialysis service.

MethodsA working group was convened, comprising the Renal Pharmacist, Medication Safety Pharmacist, prescribers and dialysis unit staff representing each area of the renal service. Key desirable design features were selected using the NMC, Middlemore and North Shore Hospitals’ dialysis charts and the local ADHB chart. A prototype was created using Adobe Illustrator. Haemodialysis staff were asked to comment on the prototype and feedback to the working group. A final prototype was developed for the pilot study.

Measures of success A three-month pilot study will be undertaken with an audit to compare the effect of design features on prescribing and administration recording in the prototype chart versus the original ADHB medication chart. A staff satisfaction survey is planned during/after the pilot period.

Effects of changeThis project involved collaborative multidisciplinary team work to produce a dialysis medication chart that aims to be effective and acceptable to the end-users while contributing to safer prescribing and administration recording practices.

Lessons learnt / implications for othersThis medication chart design may be adapted to work in dialysis units in other DHBs or other hospital settings that require a longer-life chart for chronic prescriptions.

Justification for presentationThis is a step towards standardisation of a dialysis medication chart for regional and potentially national renal services.


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Exhibition Floorplan


EXHIBITOR DIRECTORY

Stand number

ADIS 3

Aspen Pharmacare 8

Astra Zeneca 10

Baxter Healthcare 14

Becton Dickinson Limited - BD 9

Biomed Ltd 1

CareFusion 5

EBOS Healthcare 17

Global Medics Limited 13

Health Quality & Safety Commission 23

Hospira 2

Janssen 4

Link Healthcare 7

Max Health 11

Medicines New Zealand 20

MIMS New Zealand Ltd 21

New Zealand’s National School of Pharmacy, University of Otago 12

Orion – A Perrigo Company 6

PHARMAC 15

REM SYSTEMS Ltd 18

Roche Products (NZ) Ltd 22

Sanofi 16

School of Pharmacy, The University of Auckland 19


ADIS Stand 3Level 1, 5 The Warehouse WayNorthcoteAuckland 0627T: +61 4 4993 4322E: [email protected]/adisContact: William Jaye

Products on display:1. Pharmacovigilance Insight2. Reactions Weekly3. Drug Safety

Whatever challenges the day brings you, Springer is on hand to arm you with the latest information on patient care, drug development and the management of illnesses. From the extensive selection of eBooks and Journals available in the Hospital and Health Collection, to the leading clinical drug evaluation content in Adis Journals, you can have a wealth of knowledge at your fingertips. Interested in drug safety? Look no further than the pharmacovigilance solutions from Adis – the trusted experts for over 30 years.

ASPEN PHARMACAREStand 8PO Box 62027Mt WellingtonAuckland 1641T: +64 9 570 1080F: +64 9 915 9581E: [email protected]

Products on display:1. Ferinject ®

2. Simdax ®

3. Eltroxin®

4. Circadin®

Aspen Pharmacare offer a diverse range of tried and trusted brands in New Zealand. The product mix ranges across Ethical, Primary and Secondary care with key brands being Circadin®, Eltroxin®, Ferinject®, Redipred® and Simdax®. For more information visit www.aspenpharma.co.nz


ASTRA ZENECAStand 10Private Bag 92175/299Auckland 1142T: +64 9 306 5650F: +64 9 306 5651E: [email protected]: Carla Dias

Products on display:1. Brilinta2. Zoladex3. Iressa

AstraZeneca is a world leading pharmaceutical company, with a broad range of innovative and effective medicines designed to fight disease in important areas of healthcare. AstraZeneca focuses resources on six therapy areas where we believe our skills can make the most difference: respiratory, cancer, cardiovascular, gastrointestinal, infection and neuroscience.

BAXTER HEALTHCARE Stand 1433 Vestey DriveMt WellingtonAuckland 1060T: +61 2 8845 1528F: +61 2 8845 1688E: [email protected]: Joanne Keen

Products on display:1. Chemotherapy2. Antibiotics3. Analgesics

Baxter Healthcare develops, manufactures and markets products that save and sustain the lives of people with haemophilia, immune disorders, infectious diseases, kidney disease, trauma, and other chronic and acute medical conditions. As a global, diversified healthcare company, Baxter applies a unique combination of expertise in medical devices, pharmaceuticals and biotechnology to create products that advance patient care worldwide.


BECTON DICKINSON LIMITED - BDStand 9PO Box 14651PanmureAuckland 1741 T: +64 9 573 2132F: +64 9 574 2469E: [email protected]: Sandra McKenzie

Products on display:1. PhaSeal2. Oral Syringes

BD is a leading medical technology company that partners with customers and stakeholders to address many of the world’s most pressing and evolving health needs.

Our innovative solutions are focused on improving drug delivery, enhancing the diagnosis of infectious diseases and cancers, supporting the management of diabetes and advancing cellular research.

We have nearly 30,000 associates in 50 countries who strive to fulfil our purpose of “Helping all people live healthy live” by advancing the quality, accessibility, safety and affordability of healthcare around the world. For more information, please visit www.bd.com/anz

BIOMED LTDStand 152 Carrington RoadPoint ChevalierAuckland 1025T: +64 9 815 5405F: +64 9 815 5406E: [email protected], [email protected]: Greg Dunne / Jessica Gordon

Products on display:1. Topicaine2. Omeprazole3. Cocaine Syringes

Biomed is one of the few pharmaceutical companies that continue to manufacture in New Zealand and employs kiwis.

We continue to operate a fully fledged injection production plant. The company offers a comprehensive range of products such as IV fluids, PCA’s, epidurals, intrathecal bags and syringes.

Our CAPS department compounds a full range of TPN customized for the local market.


CAREFUSIONStand 5PO Box 14518PanmureAuckland 1741T: 0508 422 734F: 0508 422 735E: [email protected], [email protected]: Debbie Douglas / Lesley Cox

Products on display:1. Alaris System®

2. Pyxis®

3. Rowa4. Metro Carts

CareFusion delivers clinically proven products and services that measurably improve the productivity and safety of healthcare globally. We help our customers improve patient care by focusing on two of the biggest issues affecting healthcare; medication errors and infection prevention.

Our family of products and services include some of the most widely recognised brand names in their categories including the leading brands of ALARIS®, PYXIS®, ROWA, SmartSite® Vialshield, Guardrails®, and SorbaView®.

EBOS HEALTHCARE Stand 17PO Box 302 161North HarbourAuckland 0751T: +64 9 415 3267F: +64 9 415 4004E: [email protected]: Jo Forrest

Product on display:1. Nipro Surefusor

EBOS Healthcare is a significant supplier of high quality medical and surgical products, capital equipment and consumables to Hospital and Tertiary care providers. EBOS is a New Zealand owned company with clinical speciality teams who ensure high calibre technical and educational support is provided to the country’s Health Sector.


GLOBAL MEDICS LIMITEDStand 1342 Andrew Baxter DriveAirport OaksAuckland 2022T: 0800 456 633F: +64 9 920 9901E: [email protected]: Karl Stanners

Products on display:1. MedDispense2. AccessPoint

The Global Medics Group is a young dynamic company servicing the Australasian market with unique and niche products to one of our four market segments – Pharmacy / IT. Global Medics is at the leading edge of Healthcare Logistics and Pharmacy Management. Specialist safe medication dispensing, medication packaging, pharmacy automation and mobile computing systems enable control and accountability for all staff and management levels involved ensuring the highest level of patient care and safety. These products are set apart by their simplicity of use, and furthermore their cost-effectiveness along with large cost savings at operational level.

HEALTH QUALITY & SAFETY COMMISSIONStand 23PO Box 25496Wellington 6011T: +64 4 901 6040F: +64 4 901 6079E: [email protected]

The Health Quality & Safety Commission works with clinicians, providers and consumers to improve health and disability services.

Our priority is to reduce patient harm from healthcare associated infections, surgery, medication and falls. The Commission is coordinating a national patient safety campaign focused on reducing harm in these areas.

Our vision is a world-class and patient-centred health care and disability support system in New Zealand.

Quality and safety improvements will mean fewer people harmed, more lives saved, and financial savings within the sector.

Find out more about the Commission and Open for better care at www.hqsc.govt.nz.


HOSPIRAStand 2PO Box 9178Marion SquareWellington 6141T: +64 4 384 7463F: +64 4 384 9433www.hospira.comContact: Simon Higgins

Products on display:1. Specialty Injectable Pharmaceutical range2. Oncology IV and Safety Infusion Systems3. Smart Pump Technology

Hospira is a specialty hospital pharmaceutical company offering sterile injectable pharmaceuticals, infusion devices and acute-care pharmaceuticals. Through these highly specialized products, Hospira ANZ offers unique solutions to the challenges faced by healthcare professionals in their clinical practice. Hospira ANZ has offices in Melbourne, Sydney, Wellington, with manufacturing, research and development sites in Mulgrave, Victoria and Adelaide, South Australia. Hospira has significant heritage in Australia and New Zealand dating back to 1845 when FH Faulding opened a pharmacy in Adelaide.

Learn more at www.hospira.com.au.

JANSSENStand 4PO Box 62185Sylvia ParkAuckland 1644T: +64 9 523 8700F: +64 9 588 1398E: [email protected]: Tania Hawkes

Products on display:1. Remicade2. Sustenna3. Velcade

At Janssen, we collaborate with the world for the health of everyone in it. What matters most to us is a healthy outcome for each patient. We’re committed to providing safe and effective medicines as well as the services and support that contribute to healthy outcomes. We’re focusing our unique model of innovation on some of the most


devastating diseases and the most complex medical challenges of our time, across five therapeutic areas; Immunology, Oncology, Neuroscience, Cardiovascular Medicine, and Infectious Disease.

Products include Remicade for Crohn’s disease, ulcerative colitis, rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. Invega Sustenna for schizophrenia and Velcade for myeloma.

LINK HEALTHCAREStand 7Level 31, Vero Centre48 Shortland StreetAuckland 1140T: +64 9 358 7146 / 021 980 785E: [email protected], [email protected]: Muj Blake / Heather McNeill

Product on display:1. Procurement Service

LINK Healthcare (“LINK”) is a specialist Pharmaceutical and Medical Technology business operating in the regions of New Zealand, Australia, Asia and Southern Africa.

Our mission is to strive for excellence in the marketing and distribution of a vitally important and unique range of specialist products that enhance the well-being of thousands of people throughout our territory.

LINK provides exceptional sales, marketing and distribution infrastructure and is partnered with blue chip pharmaceutical companies from around the world, allowing the company to offer a unique and substantial portfolio of ‘medicine and technology that matters’.


MAX HEALTHStand 11PO Box 65231Mairangi BayAuckland 0754T: +64 9 815 2664E: [email protected]: David Pascoe / Patrick Forrester

Products on display:1. Oxycodone2. Dexamethasone

Max Health Ltd – providing products and solutions to the New Zealand Health Care Market. We distribute a variety of pharmaceutical products in New Zealand for a number of international partners and pride ourselves in providing the type of service that keeps our customers coming back. We are a small (but perfectly formed) company, with many years of pharma experience between the directors, and a business model that allows us to tap into the expertise of specific skilled providers in regulatory, technical and other specialist disciplines. Our size keeps us efficient. Our expertise, local knowledge and network of contacts ensures that we deliver quality … in everything we do.

MEDICINES NEW ZEALANDStand 20PO Box 10447Wellington 6143T: +64 4 494 1154E: [email protected], [email protected]: Kevin Sheehy / Carolyn Cummins

The right medicines and vaccines when we need them means better health for kiwis.


MIMS NEW ZEALAND LTDStand 21PO Box 31348MilfordAuckland 0741T: +64 9 488 4278F: +64 9 489 6240E: [email protected]: Jim Chuang

Product on display:1. MIMS Gateway

MIMS is New Zealand’s most used and trusted medicines resource. Since 2001 every doctor and pharmacist has been referring to this valuable resource. MIMS philosophy is to provide users with relevant information within their workflow and at the point of care.

MIMS has invested to ensure user expectations are satisfied wherever possible as the medicines environment changes. Our most recent hospital initiative is MIMS Gateway – a unique solution tailored to users’ individual needs.

You can learn more about this exciting new development from MIMS by visiting us at stand #21. Sign up to our email list to receive the latest MIMS Gateway update and you could win a new tablet.

NEW ZEALAND’S NATIONAL SCHOOL OF PHARMACY, UNIVERSITY OF OTAGOStand 12PO Box 56 Dunedin 9054T: +64 3 479 7271F: +64 3 479 7034E: [email protected]/pharmacy/pppContact: Denise Botting

Products on display:1. Postgraduate Certificate in Pharmacy - Endorsed in Medicines Management - Endorsed in Social Pharmacy2. Postgraduate Diploma in Clinical Pharmacy3. Master of Clinical Pharmacy4. Postgraduate Certificate in Pharmacist Prescribing


Our well-established distance learning programmes are available at postgraduate level providing Certificate, Diploma and Master’s opportunities. These programmes are taught by people from both the profession and from the School’s academic staff. Through these programmes we are serving pharmacy through educational excellence.

ORION LABORATORIES (NZ) LTD Stand 6PO Box 781 Whangaparoa 0932T: +64 9 424 3102F: +64 9 424 3864E: [email protected]: Bronwyn Hamilton

Products on display:1. LMX4 Topical Local Anaesthetic Cream2. ClearLax Taste Free Osmotic Laxative

ORION NZ markets an extensive range of Perrigo quality products including therapeutic pharmaceuticals such as prescription medicines, over-the-counter medicines, formulated devices, antiseptics and disinfectants. We also offer contract manufacturing services to other organisations and to hospitals seeking specialised product manufactured in a TGA approved facility.

ORION NZ is continuing its commitment to provide the highest quality products and service for our customers, to improve patienet outcomes. We also offer support to our customers through the development of new products and presentations to provide delivery of everyday healthcare.


PHARMACStand15PO Box 10254Wellington 6143T: +64 4 460 4990F: +64 4 460 4995www.pharmac.govt.nz

Product on display:1. Patient information materials

PHARMAC is the New Zealand Government agency that decides, on behalf of District Health Boards, which pharmaceuticals (medicines and medical devices) are subsidised. PHARMAC ensures New Zealanders get the best possible health outcomes from money the Government spends on pharmaceuticals. PHARMAC’s work includes medicines prescribed in the community; vaccines; hospital medical devices; and pharmaceuticals prescribed and used in DHB hospitals.

As well as making pharmaceuticals available, PHARMAC works to promote the responsible use of medicines by running public information and social marketing campaigns.

REM SYSTEMS LTDStand 18PO Box 90147 Victoria Street WestAuckland 1142T: 027 566 7453F: +64 9 570 3287E: [email protected]: Jacquie Pillay

Products on display:1. EQUASHIELD Closed System Transfer Devices2. Baxter Oral/Enteral Range3. Codan Cytotoxic Delivery Systems

REM SYSTEMS Ltd supplies New Zealand’s medical professionals with leading products and technologies that are designed to improve patient outcomes. We have products relevant to every clinical setting including Pharmacy. Visit with us at the 2014 NZHPA Conference to learn more about products such as EQUASHIELD Closed System Transfer Devices, Sporeclear Hard Surface and Hand Disinfectants CODAN Pharmaceutical Mixing and Withdrawal Products, CODAN Cytotoxic Delivery Systems, Baxter Oral/Enteral Dispensers, Medline PPE and Cytotoxic Spill Kits and more. If you can’t find what you’re looking for, talk to us about having a product sourced or customised to your requirements.


ROCHE PRODUCTS (NZ) LTDStand 22PO Box 109 113NewmarketAuckland 1149T: 0800 656 464E: [email protected]

At Roche we focus on developing medicines and diagnostics that will help patients live longer, better lives - from early detection and prevention of disease, to diagnosis, treatment and treatment monitoring.

Roche Products is the pharmaceutical division of Roche in New Zealand. Based in Newmarket, Auckland, we employ 50 staff in the areas of clinical research, medical information, product distribution, sales and marketing.

Roche is the leading provider of oncology medicines in New Zealand as well as providing innovative medicines for the treatment of many other diseases, such as rheumatoid arthritis and hepatitis.

SANOFIStand 1656 Cawley StreetEllerslieAuckland 1051T: +64 9 580 1180F: +64 9 580 1811E: bridget.o’[email protected]: Bridget O’Connor

Products on display:1. Clexane2. Lantus

Sanofi, a global and diversified healthcare leader, discovers, develops and distributes therapeutic solutions focused on patients’ needs. Sanofi has core strengths in the field of healthcare with seven growth platforms: diabetes solutions, human vaccines, innovative drugs, rare diseases, consumer healthcare, emerging markets and animal health. Sanofi is listed in Paris (EURONEXT: SAN) and in New York (NYSE: SNY).


SCHOOL OF PHARMACY, THE UNIVERSITY OF AUCKLANDStand 19Private Bag 92019Auckland 1142T: +64 9 373 7599E: [email protected]/en/sop.htmlContact: Maree Jensen

Products on display:1. Postgraduate education2. Research showcase

The School of Pharmacy at The University of Auckland has an established place in educating at undergraduate and post graduate level, with graduates working in in clinical practice, research and academia.

We are developing and fostering further teaching and research opportunities with hospital pharmacists, and believe research collaborations will achieve advances in heath care delivery in specific areas of clinical practice that will work well for hospital pharmacy teams.

The Clinical Pharmacy Post Graduate programme is centred in Clinical practice to extend knowledge in both breadth and depth, promoting deep learning and it’s application in the workplace.

New opportunities are developing for hospital based pharmacist prescribers - they will continue to improve health outcomes as well as professional satisfaction.


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Participant Organisation Abstract Page Number

Al-Sallami, Hesham School of Pharmacy, Otago University 17

Bangs, Nisha Middlemore Hospital 18

Barnett, Gray Canterbury DHB 25

Batcup, Jo Christchurch Hospital 21

Bell, Caroline University of Otago, Christchurch 65

Brackley, Kim Auckland DHB 30

Chan, Grace Auckland DHB 39

Clayton-Smith, Bevan MidCentral DHB 22

Corfe-Tan, Julia Counties Manukau DHB, Middlemore Hospital

73

Cooke, Rachael Hutt Valley DHB 58, 68

Coulter, Carolyn Dunedin Hospital Pharmacy 32

Daly, Mary Hutt Valley DHB 58, 68

Dooley, Michael Alfred Health & Monash University 38, 59, 69

Ferraresi, Victoria Pathways Home Health, Hospice & Private Duty

15, 57, 67

Fox, Sherryn Canterbury DHB 44, 74

Goddard, Jan Waikato DHB 27

Gregan, Anthea Palmerston North Hospital Pharmacy 45

Hayden, Nic Capital & Coast DHB 47

Henderson, Emma Capital & Coast DHB 48

Jackson, Blake Capital & Coast DHB 75

Kilpatrick, Kate Waikato District Health Board 76

Kortegast, Ashleigh Christchurch Hospital Pharmacy 77

Kotrotsos, Androulla Ministry of Health 60

Lambie, Angela Waitemata DHB 49

ABSTRACT INDEX


Participant Organisation Abstract Page Number

Lee, Avril Waitemata DHB 61

Lord, Althea Hutt Valley DHB 58, 68

Mannan, Shaheen Middlemore Hospital 52

McCrostie, Sarah Canterbury DHB 19

McIntosh, Brendan University of Otago 62

Milosavljevic, Aleksandra

Auckland City Hospital 53

Monkhouse, Joe Auckland DHB 54

Naidoo, Merusha Counties Manukau Health 42

Nand, Sanjoy Middlemore Hospital 23, 24, 46

Pidakala, Earnest Counties Manukau Health 40

Rodgers, Kelly Capital & Coast DHB 47

Ruwhiu, Shane Best Care (Whakapai Hauora) Charitable Trust

56, 66

Seto, Nicola Auckland DHB 79

Shirtcliffe, Andrea Ministry of Health 60

Singh, Michelle Auckland DHB 20

Smith, Emma Waikato Hospital 33

Sorenson, Mark 16

Street, Cathy Counties Manukau DHB 43

Tandecki, Katrina Hutt Hospital 28

Tandon, Ruchika Auckland DHB 55

Thomson, Nicki Capital & Coast DHB 47

Vareed, Preetika Auckland DHB 51

Wan, Ricky Auckland DHB 29

Wright, Di Taranaki DHB 31

Wyper, Mark Capital & Coast DHB 50

CONFERENCE2015

New Zealand Hospital Pharmacists’ AssociationTe Ka- hui Whakarite Rongoa- Ho- hipera o Aotearoa

NAPIER WAR MEMORIAL CONFERENCE CENTRE, NAPIERFRIDAY 28 TO SUNDAY 30 AUGUST 2015

Documents

CONFERENCE HANDBOOKeventsites.e9.co.nz/nzhpa/wp-content/uploads/sites/4/2014/09/NZPH… · exhibition stands to say hello, see what’s new, ... New Zealand’s National School of