book of poster abstracts - expert events · references. p umapathy et al (2012) trop j pharm res,...

2018 APSA Annual Conference: Book of Poster Abstracts

Book of Poster Abstracts

200 Naturally-Derived Sortase A (SrtA) inhibitors as alternative treatments for superbug infections

Sitah M Alharthi1, Helen He3, Adam Ye3, Zyta Ziora2, Peter M Moyle1. School of Pharmacy, the University of Queensland (UQ)1, Woolloongabba, QLD, Australia; Institute for Molecular Bioscience, UQ2, St Lucia, QLD, Australia; School of Dentistry, UQ3, Herston, QLD, Australia.

Introduction. Antimicrobial resistance (AMR) is a major global health challenge. It is estimated to cause 10 million deaths yearly, and significant lost productivity. Resistance to first-line drugs used to treat Staphylococcus aureus (S. aureus) infections is a major cause of infection and death in health facilities and the community. Hence, there is an urgent need to develop new antibacterial agents. A promising, novel target for such agents is bacterial sortase A (SrtA), which plays an important role in the anchoring of surface proteins to the bacterial cell wall. Aims. To develop safe and effective formulations of four naturally-derived, poorly water soluble and inexpensive SrtA inhibitors, which can be combined with other antimicrobial extracts or synthetic peptides, to develop combination treatments for superbug infections with novel mechanisms of action, against which resistance is unlikely to develop. Methods. Formulations of each SrtA inhibitor, which improve their biocompatibility, were developed. The antimicrobial activity of each formulation was compared using three antimicrobial susceptibility tests (broth microdilution, agar dilution and the disk diffusion), with modifications to optimise the readout of antimicrobial activity in the presence of poorly-soluble compounds. Results. The broth microdilution assay was not a suitable readout for antimicrobial activity of the SrtA inhibitors due to the observance of precipitation over the course of the experiment, which prevented visual identification of the minimal inhibitory concentration (MIC). Simple modifications to this assay, to detect bacterial growth, allowed for rapid screening of antimicrobial activity. The agar diffusion assay could also be used, but is low throughput, while the disc diffusion assay was not suitable for quantifying antimicrobial activity. From this data, SrtA inhibitor formulations were identified, which had improved compatibility with aqueous buffers, and which displayed additive or synergistic activity with other novel antimicrobial agents. Discussion. Methods to readout antimicrobial activity of SrtA inhibitors and novel formulations to improve the biocompatibility of these compounds were developed. This information will provide a useful means to develop new treatments for antimicrobial resistant infections.

201 Alpha-mangostin attenuates depression like symptoms in diabetic rats by inhibiting monoamine oxidase activity in the brain

Subrat Kumar Bhattamisra, Sasikala Chinnappan, Nur Azalea Binti Muhammad Zainal Ashikin, Siti Hajar Amirah Binti Bahanurdin, Mayuren Candasamy, Jithendra Panneerselvam. School of Pharmacy, International Medical University, Bukit Jalil 57000, Kuala Lumpur, Malaysia Introduction. Currently, neurological problems including depression in chronic diabetic patients are increasingly studied to explore the link between diabetes and its influence in the brain activities. Alpha-mangostin, an active constituent of mangosteen has neuroprotective and hypoglycaemic effect. Aims. Alpha-mangostin was tested for its effect on depression like symptoms and manoamine oxidase (MAO) activity in diabetic rats. Methods. Diabetes was induced in male Wistar rats by a single dose of streptozotocin (55 mg/kg, i.p.). Rats with blood glucose level (≥250 mg/dl) were selected for the diabetic groups. Four groups with six rats in each group were used for the study. Normal control (NC) and diabetic control (DC) groups were the normoglycaemic and hyperglycaemic rats treated with normal saline respectively. Alpha-mangostin (100 mg/kg, p.o.) was administered to a normoglycaemic and a diabetic group for three consecutive weeks. At the end, rats were subjected to forced swimming test (FST) and tail suspension test (TST). After the behavioural tests, rats were sacrificed and the brain MAO-A, MAO-B, brain-derived neurotrophic factor (BDNF) and malondialdehyde (MDA) levels were estimated in the brain tissue homogenate. Results., Alpha-mangostin significantly (p<0.05) reduced the immobility period (Sec) in both FST (77.6±13.6 vs. 142.3±11.0) and TST (64.9±8.1 vs. 97.7±88.5) in diabetic rats. Further, it significantly (p<0.01) attenuated the MAO-A and MAO-B activity to 8752.5±30.6 and 9268.6±1404.1 U/L respectively in diabetic rats. Alpha-mangostin significantly (p<0.05) elevated the BDNF levels (192.4±0.39) and reduced the MDA concentration (1.85±0.17 vs. 2.62±0.23) in the brain compared to the DC. Discussion. Diabetes induction in rats demonstrated depression like symptoms and increase in MAO activity supporting the evidence of the link between diabetes and depression. Furthermore, alfa-mangostin treatment reversed the depression like symptoms in diabetic rats that may be attributed to its MAO inhibitory activity and some extent to its neuroprotective and antioxidant effect.


202 Reverse Phase Photo Diode Array Detector HPLC Method for Estimation of Metformin Hcl (MTF) & Gliclazide (GLZ) Assay as Marketed Pharmaceutical Synergistic Tablets for Diabetes Treatment Using Internal Reference Standard Shraddha S. Ghodke1. Department of Pharmaceutics, UCL School of Pharmacy, University College London, London, England, United Kingdom. Introduction. The proposed research sheds light on simultaneous estimation of MTF and GLZ as synergistic formulation; using RP HPLC. Aims. To develop and validate precise and simple method for analysis of MTF and GLZ with internal reference standards and marketed formulation including impurity characterization. Methods. Method development and validation including peak purity test. Inertsil C18 (250 mm × 4.6 mm, 5.0 µ) was selected for symmetrical peaks with high resolution and wavelength was 238 nm. Final standard preparations were obtained for MTF and GLZ with concentration of 0.5µg/ml and 0.06 μg/ml. Linearity was determined for MTF in the range of 0.25-0.75 µg/ml and for GLZ 0.03-0.09 µg/ml as well as Impurity A in tablets. Method was validated using system suitability %RSD, accuracy, precision, ruggedness, robustness using internal reference standards. 7 independent sample solutions (as 100% accuracy) for, MTF (5µg/ml) and GLZ (0.06µg/ml) including placebo (0.42µg/ml) were injected into the HPLC. Results. The linearity values were for Impurity A, MTF and GLZ were not less than 0.99 in the acceptable limits. For marketed tablets the average drug content was found to be 99.52 % for MTF and 99.70 % for GLZ of the labelled claim. No interfering peaks were observed. RSD was 1.54% (Impurity A), 0.73 % (MTF) and 0.78 (GLZ). Accuracy (% Recovery) was found within 98%-102% range. The mean percentage recoveries were 99.73% and 99.56% respectively. Standard and sample method precision were <2 (p=0.05). The test results were found to be statistically significant. Discussion. The proposed method gives good resolution between MTF and GLZ within short analysis time (< 8 min). The method is very simple, rapid, and economic. High percentage of recovery shows the method is free from interference of excipients present in the formulations. This method can be applied for LC-MS and Bioanalytical studies. References. P Umapathy et al (2012) Trop J Pharm Res, 11 (1): 107

203 Synthesis and surface immobilization of silver nanoparticles delivery as efficient antibacterial agent

Hanif Haidari1, Zlatko Kopecki2, Krasimir Vasilev2, Allison Cowin2, Sanjay Garg1. School of Pharmacy & Medical Science, University of South Australia, ADL, SA1, Future Industries Institute, University of South Australia, Mawson Lakes SA2. Introduction. Due to the increasing in antimicrobial resistance alongside the increasing prevalence of wounds in our society, wound infection is becoming a major concern that needs new strategies for its effective management. Silver has been used for many years for the treatment of infection however, the widespread application of silver to wounds is not advocated due to its potential toxicity and clinical efficacy. Silver nanoparticles (AgNP) are being developed that can deliver the potential beneficial antimicrobial effects of silver however, limited studies have examined controlled loading of AgNP onto a surface to not only control silver ion release but to provide high antimicrobial activity without inducing cytotoxicity. Aims. Herein, we report a versatile substrate independent approach to deposit a thin functionalised film on a surface of material to enable covalent immobilization of AgNP. Methods. The method consists of first depositing a functional 2 Methy -oxazoline (Pox) polymer on a substrate and subsequent time-controlled AgNP immobilization. Silver nanoparticles functionalised with the carboxylic acid group are irreversibly bound to a plasma deposited Pox thin films to prevent the nanoparticle release while providing slow oxidation to release silver ion. The biocompatibility of modified surfaces was evaluated in vitro against human fibroblast and its anti-biofilm activity was determined against A. baunamii and P. aeruginosa. Results. This study reports generation of functionalised surface on any type of substrate materials. Subsequently it provides evidence on ability to conveniently control the amount of silver immobilized on a surface. Controlled immobilization and the nature of the covalent binding to the surface reduce the nanoparticle oxidation and extend the lifetime of the dressing. The immobilized nanoparticle showed significant antibacterial potential against gram negative and gram-positive bacteria. Discussion. This innovative approach to create plasma deposited surface allows flexible control over the amount of loaded AgNP and the rate of release of silver ions. This strategy has the potential to overcome the current toxicity of AgNP that is encountered on current wound dressings and could open new horizon for the design of next generation antibacterial wound dressings.


204 Novel pH-responsive zwitterionic vancomycin-chitosan nanovesicles: In vitro antimicrobial activity against Staphylococcus aureus (SA) and Methicillin Resistance Staphylococcus Aureus (MRSA).

Daniel Hassan1, Calvin A. Omolo1#, Chunderika Mocktar1, Thirumala Govender1#. 1Discipline of Pharmaceutical Sciences, College

of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, South Africa. Introduction. Infectious disease caused by Methicillin resistant Staphylococcus aureus (MRSA) resistance is a serious global concern [Morehead & Scarborough 2018]. The current conventional dosage forms effectiveness against MRSA have contributed to the antimicrobial resistance crisis [Medina C et al. 2018]. Therefore, developing a novel material is essential for efficient delivery of antibiotics to combat limitations such as inadequate concentration of drug at infectious sites, as increased exposure of healthy sites and poor patient compliance which lead to antimicrobial resistance. Aims. The aim of the study was to synthesize a novel pH-responsive zwitterionic lipid (OLAtBAc) from oleylamine and formulate vancomycin (VM) chitosan nanovesicles for effective delivery and targeting of SA and MRSA infections. Methods. The novel OLAtBAc was synthesized and characterized using 1H, 13C NMR and FT-IR. The novel nanovesicles (VM-OLAtBAc-NVs1) were prepared using ionic gelation method and characterized for their particles size, polydispersity index (PDI), zeta potential (ZP), encapsulation efficiency (EE %), drug-loading capacity (DLC %), surface morphology (SM), differential scanning calorimetry (DSC), in vitro drug release and in vitro antibacterial activity. Results. The nanovesicles showed a size, PDI, ZP, EE% and DLC% of 198.0±14.04 nm, 0.137±0.02 and -6.95±6.50 mV, 45.61±0.54% and 8.92±2.34% w/w respectively at physiological pH with negative surface switching to positive at pH 6.0. The VM release from the nanovesicles was faster and sustained at pH6 as compared to pH 7.4. The SM and DSC confirmed the structure to be spiracle and VM entrapped in the core respectively. The nanovesicles demonstrated 6.56 and 52.9-fold antimicrobial activity increased against SA and MRSA respectively at pH 6.0 compared to bare VM. Discussion. These findings confirmed that OLAtBAc can be used as an effective material for complexation with biodegradable chitosan (CH) to form nanovesicles with pH responsiveness and enhanced antibacterial activity, thereby showing potential for improved treatment of infections. Morehead & Scarborough (2018) Primary Care: Clinics in Office Practice, pp 467-484 Medina C et al (2018) Journal of Biomedical Materials Research Part A, pp 1400-1412

205 Development of a physiologically-based pharmacokinetic model for intravenous lenalidomide in mice

Mr Jim Hughes, University of South Australia Lenalidomide is used widely in B-cell malignancies for its immunomodulatory activity. It is primarily eliminated via the kidneys, with a significant proportion of renal elimination attributed to active processes. Lenalidomide is a weak substrate of P-glycoprotein (P-gp) though it is unclear whether P-gp is solely responsible for lenalidomide transport. A physiologically-based pharmacokinetic model was developed using the Open Systems Pharmacology Suite to explore the pharmacokinetics of lenalidomide in a variety of tissues. Data were available for mice dosed intravenously at 0.5, 1.5, 5 and 10 mg/kg, with concentrations measured in plasma, brain, heart, kidney, liver, lung, muscle and spleen. P-gp expression and activity were sourced from literature. The model predictions in plasma, heart, kidney, liver, lung and spleen were representative of the observed data. Contrary to the data, model predictions for the brain showed no drug reaching brain tissue when P-gp was expressed at the blood-brain barrier. The data were better described if P-gp was removed from the blood-brain barrier and instead implementing the transporters intracellularly. Local sensitivity analysis showed that transporter activity was the most sensitive parameter in these models for exposure when observing the area under the concentration curve and maximum concentration. As P-gp transport at the blood-brain barrier did not explain the observed brain concentrations alone, there may be other transporters involved in lenalidomide disposition.


206 Pan-transcriptomic analysis identified common differentially expressed genes in response to polymyxins in Acinetobacter baumannii

Mengyao Li1, Su Mon Aye1, Maizbha Uddin Ahmed1, 2, Mei-Ling Han1, Chen Li3, 4, Jiangning Song4,5, John Boyce1, David Powell6, Mohammad A. K. Azad1, Tony Velkov7, Yan Zhu1 and Jian Li1. Monash Biomedicine Discovery Institute, Infection & and Immunity Program and Dept of Microbiology, Monash Univ1, Clayton, VIC; Monash Institute of Pharmaceutical Sciences, Monash Univ2, Parkville, VIC; Institute of Molecular Systems Biology, ETH Zurich3, Zurich, Switzerland; Dept of Biochemistry and Molecular Biology, Monash Univ4, Clayton, VIC; Faculty of Information Technology, Monash Univ5, Clayton, VIC; Monash Bioinformatics Platform, Monash Univ6, Clayton, VIC; Dept of Pharmacology and Therapeutic Sciences, Univ of Melbourne7, Parkville, VIC. Introduction. Polymyxins are the last-line lipopeptide antibiotics to combat multidrug-resistant (MDR) Acinetobacter baumannii infections. Outbreaks of polymyxin-resistant MDR A. baumannii are increasingly reported world-wide, highlighting the need for novel antimicrobial therapies. However, it is largely unclear how A. baumannii precisely responds to polymyxin treatment. Aims. The primary aim if our study was to conduct a pan-transcriptomic analysis of A. baumannii to determine their common gene expression pattern in response to polymyxin treatment. Methods. RNA-Seq raw reads of five A. baumannii strains were retrieved from Gene Expression Omnibus and aligned to the corresponding reference genomes by SubRead. Read counts were summarised by featureCounts and the differentially expressed genes were determined by edgeR. Orthologs were determined for the five strains using Roary and functional enrichment was conducted to determine significantly perturbed pathways by polymyxin treatments.

Results. Overall, 2,822 orthologs were identified across the five strains. After 0.75 MIC or 2 mg/L polymyxin treatments for 15 min, 41 genes were commonly up-regulated, including those related to membrane damage, lipoprotein and phospholipid trafficking, BaeSR two-component system, efflux pump and poly-N-acetylglucosamine biosynthesis; six genes were commonly down-regulated, three of them were involved in fatty acid biosynthesis. Discussion. This pan-transcriptomic study suggested that in A. baumannii polymyxins rapidly damage bacterial membrane integrity, induce the expression of efflux pump, and supress fatty acid biosynthesis. These findings provide important mechanistic insights into optimising novel polymyxin therapies against MDR A. baumannii.

207 Mitigation of the Pharmaceutical Food Effect: Investigation of Nanocrystals and Lipids

Tahlia R Meola1,2, Desmond Williams1, Kristen Bremmell1, Nicky Thomas1,2, Clive Prestidge1,2. School of Pharmacy and Medical Sciences, University of South Australia1, Adelaide, SA, Australia; ARC Centre of Excellence in Convergent Bio-Nano Science & Technology2, Australia. Introduction. Lipid-based formulations mimic the pharmaceutical food effect by enhancing the solubilisation of poorly water-soluble drugs. More recent approaches explore drug nanocrystals which have the ability to undergo rapid dissolution, irrespective of the presence or absence of food. In this study, LBDDS and nanocrystals, and their synergistic effect, were investigated using the antipsychotic drug, lurasidone (LUR). Methods. A LUR nanosuspension was fabricated using high pressure homogenisation. LUR silica-lipid hybrid (SLH) microparticles were prepared via homogenisation of a Capmul MCM emulsion containing drug, and overnight stirring with silica nanoparticles, prior to spray-drying. In vitro solubilisation studies were performed in simulated fed or fasted intestinal media under digesting conditions. Results. High pressure homogenisation was a successful method to reduce the particle size of LUR crystals to 512 ± 17 nm. As a result, the LUR nanosuspension increased the extent of dissolution 1.7-fold in comparison to pure, unmodified drug. Additionally, LUR nanosuspension reached a fasted-state solubilisation level equivalent to pure drug in the fed-state (1.9 μg/mL). SLH formulations enhanced fasted-state solubilisation levels up to 24-fold higher than pure LUR. Discussion. Particle size reduction allowed for LUR to undergo rapid dissolution irrespective of ‘food content’. SLH formulations encapsulated LUR in its molecularly dispersed state, thus avoiding the rate-limiting dissolution step, and significantly reducing fed/fasted state variability. Porter C et al (2008) Adv Drug Deliv Rev, 60:673-691 Meola T et al (2018) Eur J Pharm Biopharm, 129:145-153


208 Population pharmacokinetics of ribavirin in lung transplant recipients and examination of current and alternate dosing regimens

Eliza Milliken 1,‡, Auke ES de Zwart 2,‡, Jan-Willem C Alffenaar 2, Deborah JE Marriott 3, Annelies Riezebos-Brilman 4, Ana Schteinman 3, 5, Allan M Evans 6, Allan R Glanville 1, 3, Erik AM Verschuuren 2, Stephanie E Reuter 6, 7. 1 University of Notre Dame, Sydney, Australia; 2 University of Groningen, Groningen, Netherlands; 3 St Vincent’s Hospital, Sydney, Australia; 4 University of Utrecht, Utrecht, Netherlands; 5 University of New South Wales, Sydney, Australia; 6 University of South Australia, Adelaide, Australia; 7 The University of Newcastle, Newcastle, Australia. ‡ Authors contributed equally. Introduction. Ribavirin is used in the treatment of respiratory paramyxovirus infection in lung transplant recipients; however, its pharmacokinetic profile in the transplant population is unknown despite the potential for alterations due to underlying pathology. Furthermore, the ability of current regimens to meet exposure targets has not been established. Aim. This study examined the pharmacokinetics of ribavirin in a lung transplant population from which current and alternate dosing regimens were assessed. Methods. Population pharmacokinetic modelling was conducted in NONMEM using concentration-time data from 24 lung transplant recipients and 6 healthy volunteers. Monte Carlo simulation was used to assess the ability of dosing regimens to achieve pre-specified target concentrations. Results and Conclusions. A three-compartment model with first order elimination most adequately described ribavirin concentration-time data, with creatinine clearance and patient type (i.e. lung transplant) identified as significant covariates in the model. Simulations indicate that current regimens achieve efficacious concentrations within 24 hours of treatment initiation that increase to supra-therapeutic levels over the treatment period. A regimen of 8 mg/kg q6h oral for 48 hours followed by 8 mg/kg q24h oral for the remainder of the treatment period was predicted to result in >90% of patients exhibiting concentrations within the defined target range throughout the entire treatment course. Additional work to formally establish of target therapeutic concentrations is required; however, this study provides a valuable first step in determining optimal ribavirin treatment regimens for paramyxovirus infections in the lung transplant population.

209 Novel Nanoemulgel for Topical Delivery of Tea Tree Oil: Development and Optimization

Thabata Muta1, Krishna Kathawala1, Ankit Parikh1, May Song1, Jackson Thomas2, Sanjay Garg1 1School of Pharmacy and Medical

Sciences, University of South Australia, Adelaide, SA, Australia, 2Faculty of Health, University of Canberra, Canberra, ACT, Australia

Introduction: Tea tree oil (TTO) has been used as a topical antimicrobial agent for several decades with clinical efficacy. Despite its noteworthy therapeutic significance, some physical properties of TTO such as lipophilicity, volatility and instability, limit its clinical potential. Nanoencapsulation of TTO can improve its physical stability and therapeutic potential through protection against rapid volatilization and improved skin permeation. Aims: To develop and optimize a Nanoemulgel formulation as a potential vehicle for topical delivery of TTO using a mixture experimental design. Methods: The mixture experimental design was used to optimize the processing parameters of Nanoemulsion. The effects of Surfactant (5-20% w/w), Co-surfactant (5-50% w/w) and water (25-80% w/w) on the droplet size, Polydispersity Index (PDI) and % Transmittance of TTO nanoemulsion were investigated. The optimized nanoemulsion was formulated using a pH-sensitive polymer Carbopol 974P. Results and Discussion: The optimum composition of TTO, surfactant, co-surfactant and water showed Nanoemulsion with 21.38 nm particle size, 0.224 PDI and 96.9% Transmittance, which provided an excellent agreement with the predicted response value derived from a mathematical model. The pH of Nanoemulgel (4.8-4.9) with Carbopol 974P (1.5% w/w) was close to the human skin. Conclusion: TTO loaded Nanoemulgel holds promise for the topical delivery of TTO. This study warrants further in vivo and clinical evaluations. Thomas, J., et al., Treatment of scabies using a tea tree oil-based gel formulation in Australian Aboriginal children: protocol for a randomised controlled trial. BMJ Open, 2018. 8(5): p. e018507. Sinha, P., et al., Development, optimization, and characterization of a novel tea tree oil nanogel using response surface methodology. Drug Dev Ind Pharm, 2016. 42(9): p. 1434-45.


210 Rheological characterisation of hyaluronic acid hydrogels for ocular delivery of somatostatin

Abdur Rashid 1,2, Ayman Allaham 1, Simon Young1, Bilal Shaikh1 and Thilini R. Thrimawithana1 Discipline of Pharmacy, RMIT University1, Bundoora, VIC, Australia. Department of Pharmaceutics, King Khalid University2, Abha, ASIR, Kingdom of Saudi Arabia.

Introduction: Somatostatin is a native peptide and it is down regulated in microvascular complication of diabetic eye. However, somatostatin is not stable and forms nanofibers in the presence of electrolytes (1). Aims: This study aims to determine the effect of hyaluronic acid in reducing the nanofibril formation of somatostatin. Methods: Hyaluronic acid aqueous systems of 0.25% w/w, 0.5% w/w and 0.75% w/w concentrations were prepared in both simulated lachrymal fluid (SLF) and water. The gels were prepared with and without somatostatin and rheological properties were determined at day 2, day 7 and day 10. Release studies were performed using a slide-A-Lyzer dialysis cassette to determine the rate of release of somatostatin from hyaluronic acid gels. A validated HPLC method was used to quantify the amount of somatostatin released at pre-determined time points. Results: The rheological studies showed that the viscoelasticity of 0.25% w/w and 0.5% w/w hyaluronic acid aqueous systems increased up to 7 days of storage. Thereafter the viscoelasticity decreased considerably. The effect of equilibration time on viscoelasticity of 0.75% w/w was less. At 4 days, 67% of somatostatin incorporated in hyaluronic acid gels was released. Discussion: Equilibration time has a significant impact on the viscoelasticity of hyaluronic acid aqueous systems. Somatostatin remained stable within these aqueous systems and hyaluronic acid may be used as a hydrogel platform to deliver somatostatin to ocular tissue. 1. Rai, U. et al (2015) Therapeutic uses of somatostatin and its analogues: current view and potential applications.

Pharmacol Ther. 152: 98-110

211 Investigation for binding of polymyxin B and colistin with lung surfactant

Lv Wang1, Veronika Wirth1, Ke Chen1, Jiping Wang1, Phillip Thompson2, Kade Roberts1, Tony Velkov3, Jian Li1. Biomedicine Discovery Institute, Department of Microbiology, Monash University1, Clayton, VIC, Australia; Medicinal Chemistry, Monash Institute of Pharmaceutical Sciences, Monash University2, Parkville, VIC, Australia; Pharmacology & Therapeutics, The University of Melbourne3, Parkville, VIC, Australia. Introduction. Gram-negative ‘superbugs’ become resistant to almost all classes of available antibiotics except polymyxins. Intravenous administration of polymyxin B or colistimethate (a prodrug of colistin) is not efficacious for pulmonary infections in patients. Our animal PK/PD studies have shown that the efficacy of parenteral polymyxin B and colistin against lung infection is limited by low pulmonary exposure and binding to lung surfactant. However, there is limited information in the literature regarding binding of polymyxins with lung surfactant. Method. A series of experiments were conducted to measure the binding of polymyxin B and colistin with lung surfactant. Briefly, polymyxin B or colistin (final concentration of 5 µg/mL) was added in different matrix (healthy rat and mouse lavages; Survanta®, a natural bovine lung surfactant extract; the solution of phosphatidylcholine, phosphatidylglycerol, phosphatidylethanolamine, sphingomyelin, cholesterol or bovine serum albumin) and incubated at 37°C for 30 min. All samples were centrifuged at 250,000 x g, 37°C for 4 hours. The concentration of polymyxin B and colistin in the supernatant and resuspend samples were analysed using LC-MS/MS. Results. Polymyxin B and colistin highly bound to the components in rat and mouse lavage samples (>95%), in Survanta® solution (74.5-94.7%) and in bovine serum albumin solution (79.4-94.6%). However, the binding of polymyxin B and colistin to most phospholipids was low (0.5-17.3%) except for phosphatidylglycerol (83.1-93.6%). Conclusion. The high binding rates of polymyxin B and colistin with lung surfactant partly explains that the less efficacy of intravenous polymyxins for pulmonary infections in patients. Also, the current results indicate that the proteins play an important role on binding between polymyxins and lung surfactant. Further studies should confirm the specific protein, and will focus on the modification of the chemical structure of polymyxins in order to reduce their binding with lung surfactant for development of new polymyxins specifically against lung infections caused by Gram-negative ‘superbugs’.


212 Chitosan nanoparticles for oral antigen delivery: a permeability approach.

Leah Wright1,2, Anthony Wignall1,2, Timothy Barnes1, Benjamin Thierry2,3, Clive Prestidge1,2. School of Pharmacy and Medical Science, UniSA, Adelaide, SA, Australia; ARC Centre of Excellence in Convergent Bio-Nano Science and Technology2, Adelaide, SA, Australia; Future Industries Institute, UniSA, Adelaide, SA, Australia. Introduction. Oral vaccination is widely desired in order to improve patient compliance and facilitate direct delivery of antigens to immune cells via M-cells. Delivery however is significantly limited by gastric degradation of antigens coupled with low permeability through the gut. Particulate delivery is explored due to their ability to physically protect antigens and enhance uptake and permeability, although this is not optimised. Aims. To fabricate & characterise FITC-ovalbumin (FITC-OVA) loaded chitosan nanoparticles (CSNPs) for release kinetics, cytotoxicity and permeability behaviour using Transwell, Ussing chamber and Intestine-on-a-Chip (IOAC) models. Methods. CSNPs were formed via ionotropic gelation of pH 5.8 CS solution with a sodium tripolyphosphate and FITC-OVA solution. Particle toxicity against Caco-2 cells was evaluated via MTT assay for mitochondrial activity and transepithelial resistance tracking of monolayers. CSNPs were administered to Caco-2 monolayers in a Transwell model and permeability analysed over a 2 hour period with cells lysed following cessation of study for uptake analysis. Results. CSNPs were synthesised with a particle size of 270 nm and zeta potential of +24.9 mV. Protein loading of 2% was obtained with an encapsulation efficiency of 61%. Cytotoxicity and membrane integrity analysis showed no significant effect at ≤1 mg/mL. Permeability behaviour in a Transwell setup indicated reduced free protein in the basolateral chamber when administered in CSNPs however increased cellular uptake. Discussion. Particles were loaded with 2% w/w protein and subsequently displayed biphasic release behaviour with 27% release in the first 48 hours and complete release observed at 14 days. Enhanced FITC-OVA uptake was observed in cell lysate following 2 hour incubation with CSNPs however this did not translate to permeability indicating poor basolateral release of FITC-OVA. Overall, a safe dosage level of CSNPs has been elucidated and preliminary uptake and permeability analysis show promising results for oral vaccine delivery.

213 Investigating knowledge regarding antibiotics among pharmacy students in Australian universities

M. H. F. Sakeena1, 2, Alexandra A Bennett3, Andrew J McLachlan1. 1. Sydney Pharmacy School, The University of Sydney, NSW, Australia; 2. Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka; 3. NSW Therapeutic Advisory Group, NSW, Australia Introduction. Inappropriate antibiotic use is an important factor for the development and spread of Antimicrobial resistance (AMR) globally. Pharmacists are a key health care team member and adequate education is important for pharmacy students to use and dispense antibiotics appropriately. The aim of this study was to investigate knowledge regarding antibiotics and it’s use among pharmacy students in Australian universities and to compare this between junior and senior pharmacy student groups. Methods. A cross-sectional study was conducted at the fourteen universities in Australia that offer pharmacy degree programmes. All pharmacy students in each university were invited to participate in this study. Ethical requirements were ensured and data was collected using a self-administered questionnaire. The study instrument comprised 5 major sections: demographic information, self-reported antibiotic use, knowledge of antibiotic uses in human health, knowledge of AMR and antibiotic use in agriculture. Descriptive data analysis and Chi square tests were performed using SPSS v22 to identify frequencies, percentages and associations. Results. 525 pharmacy students completed the online questionnaire. Majority of participants (88%) reported antibiotic use in the past year. Senior pharmacy students (n=274) reported significantly better antibiotic knowledge for disease conditions than junior students (n=251), p<0.05. Significantly higher percentage of the junior pharmacy students incorrectly indicated that antibiotic use is appropriate for the management of cold and flu conditions p<0.05. Discussion. This study found that pharmacy students commonly report using antibiotics in Australian universities. There is a notable inappropriate antibiotic use among junior pharmacy students. A comparison between junior and senior pharmacy students suggests that pharmacy education is associated with improved understanding of appropriate antibiotic use among pharmacy students in Australian universities.


214 A Roadmap for Pharmacy Assistant Career Advancement

Tricia Holmes1, Sharon Goldsworthy1. The Queen Elizabeth Pharmacy Department1, Adelaide, SA, Australia; Aim: To develop a competency based progression program providing a pathway for career advancement for the SA Pharmacy assistant workforce. Method: In 2017 SA Pharmacy released a 5-year Workforce Roadmap which identified a prioritised requirement t for a robust development framework to streamline progression for pharmacy assistants from the OPS1 (entry level) to the OPS2 level. Following wide consultation a program was drafted utilising a structured process to validate proficiencies across a range of dispensary tasks demonstrating the higher level competency. Having successfully undertaken a calculations test and following a positive line manager referee report a candidate may enter the program to undergo specific training and structured evaluation by supervisors in a set of core distribution and dispensing practices. A set of training tools was developed to ensure consistency of practice and standardised evaluation of a candidate’s progress. A workbook that details a set of defined professional practice reviews and ongoing assessments records the candidate’s incremental progression across a raft of core competencies. Entry into the program is voluntary and there has been wide acceptance of the concept by the assistant workforce, pharmacy management and executive. Conclusion: SA Pharmacy delegates undertook staff presentations across all 16 SA Pharmacy locations in April 2018 to present the tool to

the state-wide OPS1 workforce. The relevant Union and a human resources representative attended these consultations

following which the program was rolled out across SA Pharmacy in July 2018. An initial cohort of twenty candidates commenced work in the program immediately following its release.

215 Stroke survivors’ medication beliefs and adherence to medications for secondary prevention of stroke

Catherine Li1, Judith A Coombes1,2, Debra Rowett1, Jennifer Whitty1, Darshan Shah2, William N Cottrell1. School of Pharmacy, University of Queensland1, Brisbane, QLD, Australia; Medical Stroke Unit, Princess Alexandra Hospital2, Brisbane, QLD, Australia. Introduction. Perceived low necessity beliefs and high concerns beliefs towards medication predicts poor adherence in stroke patients which, declines over time. Yet, knowledge about changes in medication beliefs over time is lacking. Aims. To examine changes in medication beliefs over one year and, the relationship between medication beliefs and self-reported adherence in patients one year after experiencing a stroke. Methods. Patients diagnosed with a stroke or transient ischaemic attack who provided consent were interviewed at bed-side immediately post-stroke and by telephone at one-year post-stroke. The interview elicited patients’ beliefs towards secondary preventative stroke medications using the Beliefs about Medicines Questionnaire-Specific (BMQ-S) (Horne, et al. 1999). The BMQ-S consists of the necessity and concerns subscale with five questions each, each scoring out of 5. The difference of BMQ-S necessity and concerns scores generates the necessity-concerns differential (NCD). Patient’s self-reported adherence was also assessed using the Medication Adherence Questionnaire (MAQ) (Morisky, et al. 1986). NCD scores at one-year post-stroke were compared to NCD scores collected immediately post-stroke. The NCD scores of adherent patients (MAQ score = 4/4) were compared to the NCD scores of non-adherent patients (MAQ score less than 4/4) at one-year post-stroke. Comparative results were analysed using Mann-Whitney U test. Results. 53 patients (mean age 67±13.5 years and 30.2% females) completed the MAQ and BMQ-S at one-year post-stroke. The median (IQR) NCD score immediately after a stroke was 5 (3-8) compared to 5 (2-8) at one-year post-stroke and showed no statistical significance (p = 0.942). At one-year post-stroke, adherent patients had a significantly (p = 0.018) higher median (IQR) NCD score of 7 (2.75-10) compared to 4 (2-7) achieved by non-adherent patients. Discussion. Results of this study demonstrated that beliefs remained stable over one year and an association between adherence and beliefs towards secondary preventative stroke medication was observed at one-year post-stroke. Horne, R, et al (1999). Psychology and Health 14(1): 1-24. Morisky, D.E., et al (1986). Medical Care 24(1):67-74.


216 Breastfeeding education provided to university health students: is it enough to support breastfeeding women?

Caitlin Merz1, Alison Shield1, Alyson McClatchey1. Faculty of Health, University of Canberra1, Bruce, ACT, Australia. Introduction. The improved health outcomes of breastfeeding for mother and infant are well established, however, only 14% of Australian infants are exclusively breastfed to the WHO recommended six months. Studies indicate that women place significant value on the breastfeeding advice provided by health professionals, highlighting the need for their knowledge and education to be sufficient. Despite this, many health professionals report a lack of knowledge and confidence in their understanding of breastfeeding due to insufficient education and training. Aims. To investigate the quantity, delivery mode and content of breastfeeding education that is provided to university health profession students; specifically, those studying nursing, medicine, pharmacy, and midwifery. Methods. A two-phase cross-sectional study was undertaken, consisting of a survey of subject conveners of medical, pharmacy, midwifery and nursing programs across Australia, followed by interviews with a sub-sample of volunteers. Students enrolled in Midwifery and Pharmacy at University of Canberra were also surveyed. Data was analysed using Qualtrics and NVivo. Results. Midwifery could be considered the profession requiring the most comprehensive lactation education and the survey demonstrated that only the midwifery programs covered 7 key content areas consistently. Midwifery students received the most breastfeeding education with 78% of programs delivering more than 10 hours of content while 81% of pharmacy programs and 60% of nursing delivered less than 2 hours. Delivery of content was integrated across the degree for students in midwifery and nursing, while in pharmacy breastfeeding content was typically delivered as a stand-alone module. 80% pharmacy and 100% midwifery students felt that breastfeeding information was a useful skill required for them in their profession, however 90% and 24% respectively did not feel that the amount of education received was adequate. Discussion. Pharmacy programs deliver significantly less breastfeeding education than midwifery programs, which is reflected in Pharmacy students feeling the amount of education that they receive is inadequate. This may lead to insufficient content consolidation and poor knowledge integration into practice. Improvements in education may need to be made to provide appropriate levels of support to breastfeeding women by non-midwifery health professionals.

217 Kahoot! Identifying where students need support within a large multidisciplinary clinical therapeutics unit.

Kyle M. Gardiner1, Libby McCourt1, Kaitlyn Porter1, Manuel Serrano Santos1 1School of Clinical Sciences1, Queensland University of Technology, QLD, Australia Introduction: Kahoot! can be used to motivate students to learn.1 Kahoot! is an online quiz platform that allows interactive formative assessment by incorporating a points-based system and audio cues to create an engaging and competitive learning environment for students.2 Currently, no literature has explored the value of Kahoot! in identifying where support for students is required during an undergraduate semester. Aim: The aim of this project is to discuss the value of Kahoot! in the continuous review of a newly designed unit Methods: Throughout the first semester of 2018, a total of 130 workshops were offered covering 13 weeks of content relating to clinical therapeutics. Kahoot! quizzes were utilised in each workshop to formatively assess the content covered. The de-identified results collected were overall participation, proportion of correct answers and the time taken to select an answer. Simple descriptive statistics were used to identify trends. De-identified qualitative comments were obtained from students at the end of semester regarding their perceptions of these quizzes. Results: Despite class attendance reducing towards the end of the semester, performance in the Kahoot! quizzes improved slightly over the semester. Two drops in performance were identified and are thought to align with complex topics and increased study load. Although students reported high acceptability of the quizzes, time was often listed as a barrier. This was observed in direct contrast to results demonstrating that students answered correctly in less than half the allocated time for each question type: simple (10 seconds), standard (20 seconds) and complex (60 seconds). Discussion: Feedback from students validated the use of this tool in the given tertiary education setting. These analyses have improved the understanding of areas that require review such as topic timing, topic complexity and study load. References: 1. Ismail MA-A, Mohammad JA-M. Kahoot: a promising tool for formative assessment in medical education. Education in Medicine Journal. 2017;9(2). 2. Wang AI, Lieberoth A. The effect of points and audio on concentration, engagement, enjoyment, learning, motivation, and classroom dynamics using Kahoot. Paper presented at: European Conference on Games Based Learning; 2016.


218 Supporting nurses in the administration of medicines in paediatric wards: a descriptive study

Jose Manuel Serrano Santos1, Suzanne Williams2, David Kavanagh3, Steven Watson4, Jade Lowe5, Adrienne Hudson5. School of Clin Sciences, Queensland Univ of Technology1, Brisbane, QLD, Australia; School of Nurs, Queensland Univ of Technology2, Brisbane, QLD, Australia; School of Psychol & Counselling, Queensland Univ of Technology3, Brisbane, QLD, Australia; School of Psychology, Newcastle University, UK4; Centre for Children’s Health Research5, Brisbane, QLD, Australia; Introduction: Administering medication to children is a challenging process for nurses and it has been accepted as a complex issue that is affected by factors including the patient’s age and cognitive function.1 Young children have high dependency on nurses’ involvement when receiving medication during a hospital admission.2 However, the impact of these challenging administrations on nurse’s confidence has not been explored. The aim of this study is to identify behavioural factors challenging the administration of medication to children during hospital admission and to describe likely factors affecting nurse’s confidence during these administrations. Methods: A cross-sectional study design was utilised. A quantitative survey (that also allowed open comments) was design to identify factors affecting the administration of medication, the frequency of them, and the confidence on this processes as reported by nurses in 4 wards of a children’s hospital in Brisbane, Australia. Only those registered and enrolled nurses that administer medication to children in the hospital were included. Results: A total 27 nurses participated in the study. Anticipation by the patient and presence of other Healthcare Professionals in the room were seen as factors that contributed negatively to the administration, but the presence of parents and comfort provided by parents and nursed were seen as positive factors. Nurses’ confidence was high, however nurses with less than 5 years of experience were likely to demand more guidance on how to improve the administration of medication compared with their more experienced peers (p<0.05). Discussion: In order to improve adherence to treatment, it is essential to optimise the acceptability of medication by children. The findings of this study will inform the design of an evidence based guidance for nurses that aims to reduce medicine aversion in children at bedside administration. 1. Hanghøj S, Boisen KA. Self-Reported Barriers to Medication Adherence Among Chronically Ill Adolescents: A Systematic

Review. J Adolesc Health. 2014;54(2):121-138. 2.Matsui D. Current Issues in Pediatric Medication Adherence. Pediatric Drugs. 2007;9(5):283-288.

219 The pain of opioids on discharge: Exploring prescribing patterns and handover to primary care for geriatric patients

Dina Aburas1, Adaire Prosser2, Ivanka Hendrix2, Vijayaprakash Suppiah1,3, Jacinta Johnson1,2 School of Pharmacy and Medical Sciences, University of South Australia1, Adelaide, SA, Australia. SA Pharmacy, SA Health2, Adelaide, SA, Australia. Australian Centre for Precision Health, University of South Australia3, Adelaide, SA, Australia. Introduction. In Australia, there has been a striking increase in the use of opioids and opioid-related harms. Opioids supplied on discharge from hospital contribute substantially to the pool of opioids within the community. Some patients prescribed opioids on discharge intended for short term use transition to chronic opioid use. It is hypothesised that insufficient handover to primary care teams regarding the patient’s pain management plan may contribute to sub-optimal pain management and ongoing opioid use post-discharge.

Aims. To determine 1) the proportion of geriatric patients prescribed new immediate release (IR) and/or slow release (SR) opioids on discharge from hospital, and 2) the proportion of geriatric patients discharged on analgesia for whom a pain plan and/or explicit ‘short-term use only’ instructions communicated within the discharge summary.

Methods. A retrospective audit of all geriatric patients discharged from a public hospital in SA between Jan-Jun 2018 was undertaken. Data regarding baseline, inpatient and discharge opioid prescribing and handover information provided in the discharge summary was obtained via medical record review. Quantitative and descriptive statistics were used to analyse these data.

Results. Of the 274 geriatric patient discharges analysed, 116 (42%) were discharged on opioids. Of these, 75 (65%) were prescribed new opioids; 56 (75%) received new IR opioids, 48 (64%) received new SR opioids and 29 (39%) received both new IR and SR opioids. Only 40 (15%) patients discharged with analgesia had a pain management plan included in their discharge summary, and only 3 (1%) included explicit instructions for short-term use.

Discussion. Although guidelines are in place to support safer prescribing of opioids during transitions of care, for a substantial proportion of geriatric patients the handover information to primary care did not include recommendations regarding ongoing pain management upon discharge. Possible contributing factors are explored, and solutions to improve handover on discharge are discussed.


220 Audit of levetiracetam usage for seizure prophylaxis in Traumatic Brain Injury patients at a Tertiary Teaching Hospital

Oksana Burford1, Sarah Mason1, Rina Kimata1, Louise Wichmann², Richard Parsons1. School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, WA1; Pharmacy Department, Fiona Stanley Hospital, Murdoch, WA2 Introduction. Post traumatic seizure incidence is greatest within 24 hours post Traumatic Brain Injury (TBI). It is a common complication and prophylactic antiepileptics are used for a short period of time to prevent early seizures. In previous years, phenytoin was used prophylactically to prevent seizures although the usage of levetiracetam is now becoming widely adopted due to its favourable pharmacokinetic and pharmacodynamics characteristics, despite its increased cost. The prescribing trends are moving towards favouring levetiracetam as a prophylactic medication. Aims. To explore the usage of levetiracetam for seizure prophylaxis in patients with traumatic brain injury at a tertiary teaching hospital, with a focus on determining if the treatment was reviewed at 14 days and ceased in patients who had been seizure free during this period. Methods. In this retrospective audit-analysis, 265 patients were identified and included as having suffered a TBI and admitted to the State Rehabilitation Centre (SRC) ward of Fiona Stanley Hospital between February 2016 and January 2018. 203 patients were eligible to be included in the study. Patient files were analysed for relevant data including whether patients were prescribed levetiracetam for prophylactic use. Relevant patient details were submitted into the online data collection program, Survey Monkey. The information gathered was then exported to an SPSS dataset for analysis. Results. Of the 203 patients included in the study, only 42 patients were treated prophylactically with levetiracetam during their stay at the SRC ward. One patient experienced a seizure whilst taking levetiracetam during their stay and was switched to an alternative step up therapy. Out of the 41 patients taking prophylactic levetiracetam, 28 (68.3%) of the patients were reviewed and treatment was ceased within the timeframe outlined in the formulary guidelines. Discussion. For most patients who were treated with levetiracetam and admitted to the SRC ward, the Fiona Stanley Hospital Formulary was successfully followed and levetiracetam usage was reviewed and ceased within fourteen days of commencement. Patients who did not have their treatment ceased within the recommended fourteen day period, were more likely to have a clear treatment plan post-discharge.

221 Usability and utility of a mobile application to improve medication adherence among ambulatory care patients in Malaysia

Sara Chew1, Pauline SM Lai1, Chirk Jenn Ng1, Department of Primary Care Medicine, University Malaya1, Kuala Lumpur, Wilayah Persekutuan, Malaysia. Introduction: Mobile applications can be used to decrease medication administration-related errors and improve medication adherence among ambulatory care patients. Aim: To develop a mobile application (Med Assist) to improve medication adherence and to explore its usability and utility among ambulatory care patients in Malaysia. Methods: This study was divided into two phases: the design and the development of Med Assist. The design phase was conducted from January-July 2014. A mock-up application was designed based on literature review and existing medication adherence applications, and presented to the steering committee. Alpha testing on prototype v1 was then conducted and changes were made to improve the application from April 2014 to February 2016, producing prototype v4. Beta testing was conducted from March-May 2016 at a primary care clinic in Kuala Lumpur. We recruited ambulatory care patients, >21 years of age, who were on at least two long-term medications. Two in-depth interviews were conducted. The first interview was to assess the usability of Med Assist. Participants were asked to download Med Assist into their phone and to concurrently think aloud when using Med Assist. The second interview (conducted at least 7 days later after the first interview) was to assess the utility of Med Assist using retrospective probing. Results: A functional medication adherence application was developed. During beta testing, 13 participants were recruited (6 males, 7 females). Five themes emerged from usability testing: ease of navigation, interface aesthetic, confusion caused by terms used, user preference and technical issues encountered. Five themes emerged from utility testing: medication adherence, medication management, medication knowledge, dual language and Med Assist as medium of communication. Discussion: The design and development of Med Assist involved a steering committee, allowing the application to be more user-centered. Users of Med Assist reported that they were adherent to their medications and felt that their knowledge regarding their medications improved (when they entered their medication details into Med Assist). The final prototype was tested with real end-users which enhanced the usability and utility of Med Assist.


222 Can community pharmacists overcome barriers to partner treatment for chlamydia in regional and remote Western Australia?

Rhonda M Clifford1, Noëlle Blum1,2, Helen Wood1, Sajni Gudka1. Dept of Pharmacy, Univ of Western Australia1, Perth, WA, Australia; Dept of Pharmacy, Univ of Basel2, Basel, Switzerland. Introduction. Chlamydia trachomatis is the most frequently notified sexually transmissible infection in Australia. Sexual partners of chlamydia-positive patients need chlamydia testing, and treatment if required, to minimise spread of infection. This process, standard partner therapy, involves multiple appointments and is often under-utilised. Internationally, Accelerated Partner Therapy (APT) simplifies the process to encourage treatment. However, partner therapy for chlamydia is not well understood in the unique setting of regional and remote Western Australia (WA), where incidence of infection is higher than in metropolitan regions. Aims. To understand barriers and facilitators to standard partner therapy and APT for prescribers and pharmacists in regional and remote WA, and explore community pharmacists’ potential role in partner therapy for chlamydia. Methods. Semi-structured interviews were developed for prescribers (general practitioners, nurse practitioners, registered nurses and Aboriginal Health Workers) and community pharmacists. Interviews were piloted and refined with stakeholder input, and conducted via telephone. Results. Ten prescribers and nine pharmacists from regional and remote WA were interviewed. Despite modifying standard partner therapy for easier access, prescribers identified many barriers. Partners who were unmotivated to seek testing and treatment, or were difficult to contact, provided the most common barriers. However, they found that offering empirical treatment to sexual partners was a facilitator to the process. The absence of a local community pharmacy was identified as a barrier to APT in some rural areas, as was the lack of privacy in a pharmacy setting. Prescribers and pharmacists felt that pharmacists could facilitate the process by providing sexual partners with education and another avenue for chlamydia testing, and ensuring safe and appropriate use of medicine. Discussion. Provision of partner therapy for chlamydia remains particularly challenging in regional and remote WA, despite streamlining the process. Where available, community pharmacists could be the key to improved accessibility for sexual partners to seek out education, testing and treatment for chlamydia in a trusted healthcare setting.

223 Pharmacist-led smoking cessation services in Ethiopia: knowledge and skill gap analysis

Daniel A Erku1,2, Bisrat Hailemeskel3 Sewunet A Belachew1. School of Pharmacy, University of Gondar, Gondar, Ethiopia; School of Pharmacy, University of Queensland, Brisbane, QLD, Australia, College of Pharmacy, Howard University, Washington, United States. Introduction. Advice provided by healthcare professionals can contribute to the success of efforts to quit smoking. Pharmacists, being the most accessible healthcare professionals among the community, provides a unique opportunity to deliver a more proactive smoking cessation services Aims. The present study aimed at 1) assessing the knowledge and attitude of pharmacists and pharmacy students regarding smoking/smoking cessation and 2) to document the extent of community pharmacists’ involvement in the provision of smoking cessation services in Ethiopia. Methods. This study utilized a cross-sectional and direct observation methods. A series of questionnaires were administered to final year pharmacy students and practicing pharmacists. Two scenarios simulating tobacco use in pregnancy and cardiovascular patient were selected and played by two well trained simulated patients (SPs). Findings were analyzed and presented using mean total scores, analysis of variances (ANOVA) and independent sample t-test. Results. A total of 410 participants [(213 out of 238 pharmacy students; response rate 89.5% and 197 out of 361 pharmacists; response rate (54.6%)] completed the survey. Both pharmacy students and practicing pharmacists had positive attitudes toward smoking cessation and both groups had similar mean knowledge scores. A total of 80 simulated visits were conducted. Recipients of training on smoking cessation had significantly higher mean knowledge and attitude scores as compared to those who did not received such training. The majority of the pharmacists demonstrated poor history taking practice and seldom assessed the patients’ nicotine dependence level. Nicotine replacement therapies (NRTs) were supplied in only 10 of the visits, and suggested but not dispensed in 35 of the visits. On the other hand, pharmacists in 59 visits counsel patients to visit addiction specialists and physicians. Discussion. Educating pharmacists about smoking cessation supports as part of a continuous professional development and providing a hands-on customized educational intervention, such as a practice guidelines in a form of Ask-Advise-Refer approach, about smoking cessation would be useful.


224 Beliefs and self-reported practices of healthcare professionals regarding electronic cigarettes: a mixed-methods systematic review and synthesis

Daniel A Erku1, Coral E Gartner2,3, Kylie Morphett2, Kathryn J Steadman1. School of Pharmacy, University of Queensland1, Brisbane, QLD, Australia; School of Public Health, University of Queensland2, Brisbane, QLD, Australia. Introduction. Advice provided by healthcare professionals (HCPs) can contribute to the success of efforts to quit smoking. In the absence of evidence-based clinical guidelines, HCPs may be more likely to depend on their own beliefs when discussing about electronic cigarettes with their clients. Aims. This systematic review explored the views of healthcare professionals (HCPs) regarding the efficacy of electronic cigarettes as a smoking cessation aid, and their perceived safety and health risks. The review also examines the extent of patient-healthcare provider communication about electronic cigarettes, and whether HCPs recommend for or against their use. Methods. Four electronic databases (PubMed, Embase, CINAHL, and PsycINFO) were searched to identify articles published since 2003. Twenty-nine quantitative, eight qualitative and one mixed-method study met inclusion criteria. Thematic synthesis was employed to analyse qualitative data. Results. There was wide variation across the studies regarding the beliefs about the efficacy of electronic cigarettes as a smoking cessation aid. Although the majority of HCPs believed that electronic cigarettes are safer than combustible cigarettes, they also expressed concerns over the long term safety of electronic cigarettes, uptake by adolescents, and the potential for electronic cigarettes to act as a ‘gateway’ to tobacco products. While the majority of HCPs did not proactively screen all patients or recommend electronic cigarettes use, they appear to support the use of electronic cigarettes among patients with smoking related co-morbidities, heavy smokers with previous unsuccessful quit attempts, or if the patient expresses interest in trying them. Discussion. Overall, HCPs appear to hold diverse views about the efficacy and safety of electronic cigarettes. HCPs’ endorsement of electronic cigarettes as a smoking cessation aid or a low risk alternative to combustible cigarettes seems to depend largely on patients’ overall health status and presence of other competing risk factors. Our review highlights HCPs’ need for further training and support regarding electronic cigarettes use, which would enable them to guide their clients in making evidence-based decisions.

225 Drug-related problems encountered by patients undergoing dialysis in Malaysia: a preliminary report

Kent KK Goh1, Pauline SM Lai1. Soo Kun Lim2 Department of Primary Care Medicine1, Medicine (Nephrology)2, Faculty of Medicine, University of Malaya, Kuala Lumpur, WILAYAH PERSEKUTUAN, Malaysia Introduction. Patients on dialysis have multiple co-morbidities and are prescribed with many medications. This may result in drug-related problems (DRPs). Aims. To assess drug-related problems encountered by patients undergoing haemodialysis in Malaysia. Methods. This cross-sectional study was conducted from June-September 2018 at a tertiary hospital and its affiliated dialysis centres in Kuala Lumpur. We recruited patients ≥21 years who have been on dialysis for >3 months. All DRPs were classified according to the Pharmaceutical Care Network Europe Classification v8.01. Results. For this pilot study, 12 patients were recruited [median age=60 years, mean no. of medications (SD)=9.0(1.9)). Eight out of 12 (66.7%) patients had DRPs, of which 9 DRPs were found. The type of problems encountered were adverse drug events (ADRs) (66.7%) and unnecessary drug-treatment (33.3%). There were 17 causes of DRPs: no indication for drug (11.8%), wrong drug administered (5.9%), drug under-administered (17.6%), drug dose too high (5.9%), patient used/took less than prescribed (17.6%), patient unable to use drug as directed (5.9%), inappropriate drug according to guidelines (5.9%), inappropriate duplication of therapeutic group (5.9%), inappropriate drug (within the guidelines but otherwise contra-indicated) (5.9%) patient takes food that interact (5.9%), drug over-administered (5.9%) and patient used/took more than prescribed (5.9%). The prescriber was informed of all 9 DRPs, where patient counseling was provided to 4 patients, drug was stopped for 3 patients and a new drug was started for 1 patient. Five interventions were accepted and fully implemented, one intervention was accepted and partially implemented, one intervention was accepted but not implemented and 2 interventions were not proposed. Five DRPs were totally solved, 1 was partially solved, 3 were not solved. Discussion. Prevalence of DRPs was high (66.7%) among our patients. We were unable to compare our findings with previous studies as none measured this outcome. The ADRs reported in our study was high (66.7%) when compared to a previous study (7.1%). Drugs given without indication in our study (11.8%) was similar to a previous pooled analysis (14.9%). Our preliminary findings suggest that patients on haemodialysis are on many medications, and may be at a higher risk of experiencing DRPs.


226 Development of two medication adherence scales: a patient-administered and a healthcare professional-administered scale to assess medication adherence among adults in Malaysia using the nominal group technique

Sheron SL Goh 1, Pauline SM Lai 1, Su-May Liew 1, Kit Mun Tan 2, Siew Siang Chua 3, Wen Wei Chung 4. Department of Primary Care Medicine1; Medicine2, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia; School of Pharmacy, Taylor’s University3, Subang Jaya, Selangor, Malaysia; Department of Pharmacy4, University Malaya Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia. Introduction: The nominal group technique (NGT) is a consensus method, used to generate ideas and to develop instruments of measure. This abstract describes how two instruments were developed using this technique. Aim: To develop two medication adherence scales: a patient-administered and a healthcare professional (HCP)-administered medication adherence scales to assess medication adherence among adults in Malaysia. Methods: The NGT was conducted over half a day in August 2018 at the University of Malaya, Kuala Lumpur, Malaysia. Twenty persons were approached to participate in the NGT, but only seven (two patients with chronic disease, two doctors, two pharmacists and one nurse) attended the group discussion. The NGT is a highly structured face-to-face group interaction which provides participants an opportunity to share their personal views and opinions with others. This NGT was conducted in four stages: silent generation, round robin, clarification and ranking. During silent generation, each participant was provided with a list of items prepared by the researcher based on a comprehensive literature review. Participants were then given the opportunity, one at a time, to share their ideas during the round robin process. Clarification of ideas was then generated through discussion. Each participant was then independently asked to rank the importance of ideas based on a 10-point Likert-like scale (1=least important; 10=most important). Results: Two medication adherence scales were developed. The patient-administered had three domains (adherence, belief and knowledge) with 20 items, whilst the HCP-administered scale had three similar domains with 17 items. These items will be reviewed by an expert panel for face and content validity and pilot tested. Subsequently, the instruments will be subjected to reliability and validity tests. Discussion: Compared to the Delphi method, a NGT is a faster method to generate ideas for developing an instrument, as it can be completed in one session. However, the disadvantage of performing a NGT is that it requires participants to attend a meeting which can last several hours.

227 Assessing visibility of medication identifiers on blister strips dispensed within a tertiary metropolitan hospital; a multi-step medication safety audit

Vanessa Koumi1, Jacinta Johnson1,2. School of Pharmacy and Medical Sciences, University of South Australia1, Adelaide, SA, Australia; Flinders Medical Centre, SA Pharmacy2, Southern Adelaide Local Health Network, SA, Australia. Introduction. Medication errors frequently involve administration of the wrong drug or dose. Difficulty reading medication identifiers original blister packaging when cut to provide small quantities can be concerning for nursing staff, as with ambiguity the risk of dosing delays and administration errors increases. Aims. To determine the proportion of inpatient tablet or capsule dispensings within our institution that could lead to issues regarding identification of drug name and/or strength, based upon visibility of these details on cut medication blister strips. Methods. Visibility of drug name and strength on the blister packaging of medications for inpatient use were audited in April 2018. Tablets and capsules were reviewed at three phases of the supply process including: in the dispensary inventory, before leaving the dispensary while packing for the pharmacy courier and when stored on a range of inpatient hospital wards. Dispensing and nursing staff were unaware of the audit data collection to minimise bias. Results. Totals of 402, 188 and 408 solid tablets and capsules were audited from the dispensary inventory, leaving pharmacy and inpatient wards respectively. Across all three audits, 81% - 85% of medications were packaged in blisters compared to bottles, with 17% and 8% of blister-packaged medications leaving the dispensary and on the ward, respectively, cut into strips of less than 5 tablets or capsules. Impaired visibility of either drug name and/or strength was identified in 5% of such inpatient medications leaving the dispensary and 2% on the ward. Discussion. Following the audit strategies to minimise the risk of medication misadventure were identified by a multidisciplinary team to include additional labelling of cut blister strips and transfer of tablets to labelled bottles where necessary, to minimise opportunities for medications to be placed into labelled dispensing bags incorrectly. Conclusion. Results indicate current processes are largely effective in minimising risk related to lack of visibility of drug name and strength on cut medication blister strips. Despite this there remains room for improvement to optimise medication safety.


228 Validity and reliability of the Patient Assessment of Chronic Illness Care instrument among patients with diabetes mellitus in Malaysia

Ahmad F Azam1,2, Pauline SM Lai2, Adina Abdullah2, Nik Sherina Hanafi2. Health Clinic Peringgit, Ministry of Health1, Malacca, Malaysia; Department of Primary Care Medicine, Faculty of Medicine, University of Malaya2, Kuala Lumpur, Wilayah Persekutuan, Malaysia Introduction: Patient centred care (PCC) has proven to improve patient outcomes and to reduce patient burden. The Patient Assessment of Chronic Illness Care (PACIC) was developed to assess patients’ perspective of alignment of primary care to the chronic care model (CCM), which encompasses both evidence-based medicine and PCC. In Malaysia, the Malay PACIC has been validated. However, English is an important second language in Malaysia and spoken by many Malaysians. Aim: To validate the English version of the PACIC among patients with diabetes mellitus in Malaysia. Methods: This study was conducted from November to December 2016, at two primary care clinics. Two sites were selected as we wanted to assess the discriminative validity of the PACIC. Site 1 is a Malaysian Ministry of Health-run primary care clinic, whilst site 2 is a University-based primary care clinic. Only site 1 monitors the performance of patients annually and encourages them to achieve their Hba1c target using a standard checklist. Patients with diabetes mellitus who understand English were asked to fill the PACIC at baseline and two weeks later. Results: A total of 200/212 participants agreed to participate (response rate=94.3%). Confirmatory factor analysis revealed that the PACIC was a 5-factor model. The overall PACIC score and the score in 2/5 domains were significantly higher at site 1 compared to site 2. The overall Cronbach’s α was 0.924. At test-retest, intra-class correlation coefficient values ranged from 0.641-0.882. Discussion: The PACIC was able to discriminate the integrated care provided. Site 1 had a higher overall PACIC score as it monitored patients’ clinical outcomes and provided a higher level of integrated care. This may be because the diabetes care delivery model at site 1 mirrors the CCM, as it encourages patients to be involved in their own self-management. The overall Cronbach α of the PACIC was > 0.7, indicating adequate internal consistency. At test-retest, Spearman rho values were > 0.6, indicating stable reliability. In conclusion, the English PACIC was found to be a valid and reliable instrument to assess the quality of integrated care among patients with diabetes mellitus in Malaysia.

229 Sleep disturbance among Malaysian patients with end stage renal disease who have pruritus

Inayat U Rehman1,2, Pauline SM Lai 3, Soo Kun Lim 4, Tahir M Khan1. School of Pharmacy, Monash University1, Bandar Sunway, Selangor, Malaysia; Department of Pharmacy, Abdul Walk Khan University2, Mardan, Pakistan, Department of Primary Care Medicine3, Department of Medicine (Division of Nephrology)4, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia Introduction: Chronic kidney disease (CKD)-associated pruritus is a frequent and compromising complication among patients on hemodialysis, and a challenge for both physicians and patients to manage. Aim: To determine the prevalence of CKD-associated pruritus and its impact on sleep quality among patients undergoing haemodialysis in Malaysia, and its associating factors. Method: A cross-sectional study was conducted from February 2017 to September 2017 at a tertiary hospital and its affiliated dialysis centers, in Kuala Lumpur, Malaysia. Included were patients >18 years of age who were undergoing haemodialysis and could understand Malay. Participants were asked to fill the Malay 5D-itch scale and the Malay Pittsburgh sleep quality index (PSQI) upon recruitment. Results: A total of 334/344 patients were recruited (response rate=100%). The majority were male (59.6%) and Chinese (61.7%). A total of 61.3% had pruritus, of which most patients (63.4%) reported that their pruritus was mild. More than half (54.1%) reported that they slept >6 hours, and 93.2% experienced no sleep disturbances during the night. However; the overall PSQI median score [IQR] was 6.0 [5.0-9.0], indicating “bad sleep”. A higher age and the more severe the pruritus significantly affected sleep quality (p<0.001). Discussion: The prevalence of CKD-associated pruritus in our study was similar to previous studies in Malaysia, but higher than studies from Pakistan (14%), Nigeria (16.1%) and Iran (41.9%). This may be due to the study design, cohort studied and instruments used to assess CKD-associated pruritis. Most of our patients (86.3%) reported that their pruritus was mild, which was higher than previous studies. This could be due to the use of medium- or high-flux dialyzers in our setting, which may have reduced the severity of uremic pruritus. However; the overall PSQI median score was 6.0 indicating “bad sleep”. Our findings were unexpected as the majority of the patients reported that they slept >6hours, and experienced no sleep disturbances at night. Older patients and the severity of pruritis were associated with poorer sleep quality.


230 General practitioners’, nurses’ and pharmacists’ perceptions of psychotropic monitoring in Australian aged care facilities

Aili V. Langford1, Garzee Tracey Ngo1, Timothy F. Chen1, Chris Roberts2, and Carl R. Schneider1 Faculty of Pharmacy, The University of Sydney1, Sydney, NSW, Australia; Sydney Medical School (Northern), The University of Sydney2, Sydney, NSW, Australia. Introduction. Current evidence suggests that the modest benefit of psychotropic use in the geriatric population is outweighed by associated morbidity and mortality. Psychotropic monitoring by Health Care Professionals (HCPs) may be valuable in reducing adverse effects and improving clinical rationale. The extent to which psychotropic monitoring occurs in Aged Care Facilities (ACFs) and influencing factors are not well established. Aims. This study aimed to explore psychotropic monitoring from the perspective of general practitioners’ (GPs), registered nurses and accredited pharmacists. Methods. A purposive sample of 27 HCPs working in ACFs was recruited. Semi-structured interviews were conducted with 5 GPs, 12 nurses and 10 pharmacists. A range of questions assessing perceptions of monitoring, facilitators, barriers and proposed solutions were included. Interviews were transcribed verbatim and analyzed through an inductive coding approach using NVivo 11 software. Results. Monitoring was revealed as a multi-faceted concept, influenced by factors at the individual, group, organization and system level. Thematic analysis revealed 6 key themes pertinent to psychotropic monitoring in ACFs: (i) Beliefs and attitudes, (ii) Capability, (iii) Opportunity, (iv) Communication, (v) Guidance and (vi) Regulation. Eighteen further sub-themes were elicited and explored. GPs, pharmacists and nurses conceptualized monitoring differently, but all felt psychotropic monitoring in ACFs was suboptimal and recognized a need for improvements in practices. Discussion. HCPs play an integral role in psychotropic monitoring and are instrumental to the success of initiatives to improve practices. Variability in HCPs’ beliefs and attitudes as well as organizational culture should be considered when designing implementation strategies for interventions to ameliorate suboptimal monitoring practices.

231 A qualitative study to explore medicine experiences: the views of medically under-served patients Asam Latif1, Shahida Choudhary1, Nargis Gulzar1, Nasa Abbasi1. School of Health Sciences, University of Nottingham1, Nottingham, United Kingdom. Introduction. People who are marginalised or ‘medically under-served’ (e.g. people with disabilities; from Black, Asian, and Minority Ethnic backgrounds; the homeless) continue to experience significant inequalities around access to healthcare services. These groups are often under-researched and so their views are often seldom heard. Aims. The aim of this study is to explore the medicine needs of patients from marginalised communities, their knowledge and experience of one national English community pharmacy service ‘Medicine Use Reviews’ (MURs), and the ways in which such services could be better tailored to peoples’ preferences. Methods. Twenty qualitative semi-structured interviews were conducted with patients who have been identified as belonging to a medically under-served group; ten of whom were interviewed after receiving an MUR from a pharmacist. Details of the protocol are reported elsewhere [1] Results. Patients from marginalised groups generally reported poor management of their medical conditions and significant problems with adherence to prescribed medicines. Their experience of pharmacy services was found to be variable with many experiencing discrimination or disadvantage as a result of their status. Most patients suggested that health services should be more appropriately tailored to benefit people from marginalised groups. For those who had received an MUR, their awareness of the support they received from the pharmacist, beyond their medicine supply function, was improved. Their relationship with the pharmacist had also improved and they found the discussion during the MUR to be helpful in addressing their medicine-related concerns. Discussion. This study highlights the significant issues that patients from medically under-served groups face when managing their health and medicines. The MUR service appeared to be well received and benefitted patients from these groups. Policy makers and commissioners should ensure that healthcare is tailored to individual’s needs, preferences and circumstances to ensure that there is equity of care to all. 1. Latif A, et al. Supporting underserved patients with their medicines: a study protocol for a patient/professional coproduced education intervention for community pharmacy staff to improve the provision and delivery of Medicine Use Reviews (MURs). BMJ open. 2016 Dec 1;6(12):e013500.


232 Utilisation of reflective practice strategies in healthcare clinical environments and implications for pharmacy practice

Jeannette Le1, Efi Mantzourani2, Shane Desselle3, John M Lonie4, Cherie Lucas1. Graduate School of Health, University of Technology Sydney, Sydney1, NSW, Australia1; School of Pharmacy and Pharmaceutical Sciences, Cardiff University2, Cardiff, UK; Social, Behavioural & Administrative Sciences, Touro University3, Valleo, CA, USA; Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University4, NY, USA. Introduction. Reflective practice strategies assist healthcare practitioners to draw on earlier experiences to extract more effective decisions in clinical situations. Aims. To evaluate current literature assessing how reflective practices have been employed in healthcare clinical environments and to inform how pharmacists may facilitate reflective environments for optimal patient care. Methods. A literature review of published papers from Jan 1993- May 2018 was conducted from Jan 2018 through to May 2018 using PRSIMA Guidelines (2009). Three databases were searched: PubMed, SCOPUS and Web of Science (ISI). The inclusion criteria included studies that were conducted in clinical environments and exclusion criteria included studies examined in educational environments. Results. A trend in the utilisation of reflective practice frameworks, strategies and/or tools across an array of healthcare disciplines were identified in twenty-three published papers that met the inclusion criteria. The disciplines include: Medicine (n=10), Nursing (n=5), Pharmacy (n=2), Allied health (n=5) and Multidisciplinary environments (n=1). Discussion. The review has highlighted the importance of practitioners engaging in reflective practice with emphasis on an improvement in critical thinking ability and communication to make better informed clinical choices. Further studies are required to address the gaps in literature and for the development of transferable reflective practice skills that may be valuable for clinical pharmacy practice.

233 Enhancing future pharmacy practice through integration of reflective practice strategies to embed self-development in a medication safety culture

Jeannette Le1, Efi Mantzourani2, Shane Desselle3, John M Lonie4, Cherie Lucas1. Graduate School of Health, University of Technology Sydney, Sydney1, NSW, Australia1; School of Pharmacy and Pharmaceutical Sciences, Cardiff University2, Cardiff, UK; Social, Behavioural & Administrative Sciences, Touro University3, Valleo, CA, USA; Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University4, NY, USA. Introduction. Optimal patient centred care and medication safety can be better facilitated in healthcare disciplines through the incorporation and application of various reflective practice strategies and/or tools in the daily roles of healthcare practitioners. Aims. To investigate the perceptions of pharmacy practitioners of the utility and effectiveness of reflective practice strategies and/or tools as used in their clinical practice environment. Methods. The current University of Technology Sydney (UTS) pharmacy preceptors (n=99) were emailed two open-ended questions via a LimeSurvey linked to anonymous responses exploring perceptions of how they deal with a critical incident in their practice environment and what reflective practice strategies they utilise and find effective in these cases. Results. A total of 15 participant respondents included community pharmacist (n=7), hospital pharmacists (n=4) and 4 incomplete surveys. Overarching themes included: (i) barriers to effective reflective practice, (ii) value of reflective practice and (iii) difficulty of measuring effectiveness of reflective practices. Despite identified challenges, all participants agreed that the integration of reflective practice strategies empowered them to foster an environment for continual professional development. Discussion. The results support value of reflective practice for practitioners to achieve patient centred care by improving medication safety through education and vigilance.


234 Exploring patients’ understanding and interpretations of prescription medicine label directions: a qualitative study

Andrew Campbell1, Mario Atmaja2, Aaron Chan2, Madeleine King2, Janesha Rangi2, Natalia Popowicz1,2, Kenneth Lee2. Sir Charles Gairdner Hospital1, Nedlands, WA, Australia; University of Western Australia2, Crawley, WA, Australia. Introduction. Currently, there are no studies on how patients understand prescription medicine label directions in Australia. While international studies have quantitatively identified some general characteristics of label directions that influence a patients’ ability to correctly interpret label directions, few have qualitatively explored how patients actually interpret label directions, and what, from the patient’s own perspective, may help or hinder their ability to correctly interpret directions. Aims. To explore patients’ understanding of prescription medicine label directions and to identify barriers and enablers that may influence a patient’s ability to interpret such directions correctly. Methods. Semi-structured interviews were conducted with 20 inpatients at a WA public hospital to gauge their understanding and opinions of different label directions. Each participant was presented with 10 different prescription medicine labels with each label containing a different direction/way to phrase a medication direction. Participant responses were thematically analysed using the framework method. Results. The way dose frequencies are written on a label appeared to be a key theme. For example, participants commented that frequency expressed as specific time(s) on the label (e.g. at 8am) assisted them to correctly interpret directions and many participants preferred to have specific times on the label. Conversely, participants often commented that frequencies expressed as number of times per day (e.g. twice daily) was confusing because the dosing times were not specific enough. Additionally, some participants found it difficult to understand directions that were phrased as multiple sentences, often because more attention was paid to a certain sentence or the sentences were considered as unrelated instructions. Discussion. From the patient perspective, including specific dosing times on a label might facilitate correct interpretation of label directions, as well as use of single-sentence directions. Such factors could be considered when writing label directions so as to assist patients in the correct interpretation of prescription medication labels.

235 Cross cultural adaptation and validation of the Malay Advance Care Planning Questionnaire in Malaysia

Mun Kit Lim1,2, Pauline SM Lai1, Pei Se Wong2, Sajaratulnisah Othman1, Fadzilah Hanum Mohd Mydin1. Department of Primary Care Medicine, Faculty of Medicine, University of Malaya1, Kuala Lumpur, Wilayah Persekutuan, Malaysia; School of Pharmacy, International Medical University2, Kuala Lumpur, Wilayah Persekutuan, Malaysia. Introduction: The Advance Care Planning Questionnaire (ACPQ) was recently developed and validated in English to assess the knowledge, attitude and practice of Malaysians regarding advance care planning. However, many Malaysians may not be fluent in English, as Malay is the national language of Malaysia. Aim: To cross culturally adapt and validate the Malay ACPQ in Malaysia. Methods: The ACPQ was translated to Malay according international guidelines and pilot tested in 5 participants. The final version was then administered by a trained researcher to community-dwelling adults >21 years of age and who could understand Malay, at baseline and two weeks later. Results: A total of 222/232 participants agreed to participate (response rate = 96.0%). The majority were female (72.1%) and Malay (54.1%), with a median age of 29 years (interquartile range = 12). Exploratory factor analysis found that the ACPQ was a 4-factor model with adequate sampling in all domains [Kaiser-Meyer-Olkin (KMO)>0.7, Bartlett’s test of sphericity χ2=8.0-1075.0, p<0.05], except for the domain “avoid thinking about death” (KMO=0.448). Cronbach α ranged from 0.557-0.947. At test-retest, quadratic weighted kappa values for all domains ranged from 0.340-0.674; except for the “justifications for not having ACP” domain which ranged from -0.200-0.467. Discussion: Sampling adequacy was not achieved for the domain “avoid thinking about death”, as only 8 participants who were against ACP answered this domain. Cronbach α was low for the domain “avoid thinking about death” (0.557) as it only had 3 items. Additionally, the deletion of item D17 in the domain “justifications for ACP” (0.602) would increase the Cronbach α from 0.602 to 0.691. However, this item was retained as it did not encounter any problems during the validation of the English ACPQ and we wanted the two versions to be the same. At test-retest, quadratic weighted kappa was low for the domain “justifications for not having ACP” due to the small number of participants (n=8). In conclusion, the Malay ACPQ was found be valid and reliable instrument to assess the knowledge, attitude and practice regarding ACP in Malaysia.


236 Assessment of knowledge, attitude and practice towards advance care planning among ambulatory care patients in Malaysia.

Mun Kit Lim1,2, Pauline SM Lai1, Pei Shan Lim1, Pei Se Wong2, Sajaratulnisah Othman1, Fadzillah Hanum1. Department of Primary Care Medicine, Faculty of Medicine, University of Malaya1, Kuala Lumpur, Wilayah Persekutuan, Malaysia; School of Pharmacy, International Medical University2, Kuala Lumpur, Wilayah Persekutuan, Malaysia. Introduction: Despite the known benefits of advance care planning (ACP), it is not legislated in Malaysia and no study has been conducted to assess the knowledge, attitude and practice (KAP) of ambulatory care patients in Malaysia. Aim: To assess the KAP of ambulatory care patients regarding ACP in Malaysia and its associating factors. Methods: This cross-sectional study was conducted from July-September 2019 at a primary care clinic in Kuala Lumpur. Ambulatory care patients aged >21 years old who were able to understand English or Malay were recruited to fill the validated Advance Care Planning Questionnaire (ACPQ) (with the assistance of a trained research assistant) while waiting to see the doctor. Systematic random sampling was used to reduce bias. Results: A total of 385/393 participants agreed to participate (response rate=98.0%). The majority (55.8%) were female. Regarding participants’ knowledge, only 3.1% have heard about ACP and 5.2% knew about ACP. In terms of attitude towards ACP, 85.7% participants felt that discussion on ACP was necessary and 86.0% agreed that ACP services should be provided in primary care clinics, after the term “ACP” has been explained to them. In terms of practice, 84.4% were receptive in discussing ACP in the future. A higher income level was found to be associated with preference for ACP (p=0.039). Discussion: The knowledge of ambulatory care patients regarding ACP in Malaysia (5.2%) was similar to Hong Kong (4.0%), but lower than Singapore (14.4%). This maybe due to the lack of legislation of ACP in Malaysia and Hong Kong, which may then have resulted in the topic being rarely discussed. Despite the low levels of knowledge, participants in Malaysia were receptive towards discussing ACP (>80%), which was similar to findings from Hong Kong (88%). Malaysian ambulatory care patients (>80%) were as willing as Singaporean ambulatory care patients (81.8%) to begin ACP discussion with their primary care physician, suggesting similar health belief.

237 Examining quality improvement evaluations of the Dose Administration Aid preparation process by community pharmacies

Nguyen G T H A,1 Haywood A,1 Walpola R L.1 School of Pharmacy and Pharmacology,1 Griffith University, Gold Coast, QLD, Australia. Introduction: Dose administration aids (DAAs) are designed to assist patients who may have difficulty managing their medicines and to aid compliance with their prescribed medication regimen. Whilst there are many studies that have evaluated the benefits of DAAs, limited work has investigated the safe provision of DAAs. Aims: The objective of this study is to evaluate the safety and appropriateness of dose administration aids by reviewing research papers and studies done about dose administration aid Methods: A scoping review was conducted using MEDLINE, EMBASE, CINAHL and Scopus, with articles evaluated according to the Joanna Briggs Institute Guidelines. To ensure comprehensive search of the literature, key word and abstract text search were performed. Results: A total of 612 research papers were generated from the search with six primary studies meeting the search criteria. It was found that there was a high risk of error in the preparation and supply of dose administration aid, and the incident rate of blister pack preparation was lower when compared to the use of sachet and dosette box. The studies included identified a number of different types of preparation errors that occurred including wrong drugs packed, incorrect dose wrong quantity, expired medicines and missing drugs. Discussion: Whilst the current literature has identified the incidence rate and types of errors that occur in the preparation and supply of DAAs, the literature has provided limited insight into the contributory factors that result in these errors other than communication. It is necessary that further work to both evaluate the contributory factors that result in these errors as well as how applicable current guidelines are in the provision of the DAA Service.


238 A comparison of perioperative medication guidelines of hospitals in South Australia

Neethu Fathima Omar1, Renly Lim1, Lisa Kalisch Ellett1, Sally Marotti1, 2, Libby Roughead1. 1. School of Pharmacy and Medical sciences, University of South Australia, Adelaide, Australia; 2. SA Health, Adelaide, Australia Introduction. Perioperative medication guidelines provide guidance to clinicians to manage the medications of patients prior to a planned surgery. However, there is no published study evaluating the consistency of recommendations in perioperative medication guidelines in Australia. Aims. To compare the perioperative medication guidelines across the hospitals in South Australia Methods. We analyzed the similarity among the perioperative medication guidelines across public hospitals in South Australia. The World Health Organization Anatomic Therapeutic and Chemical Classification 2018 was used to categorize medications. Criteria were developed to assess the level of agreement between the guidelines, which were then used by two independent assessors to assess agreement. The clinical consequences of disagreeemnts were found by searching the literature. Articles on effects of continuing and holding these medications in surgery were searched for evidence. Results. The majority of the guidelines were in agreement (75%), however up to one quarter were in disagreement. Strong agreement was obtained between assessment of the two raters (K= 0.821 at p= <.005). The disagreements on medication recommendations were on continuing vs holding pre surgery and holding time of medications presurgery. Disagreement on medication recommendations were found for Vitamin E, tranexamic acid, diuretics, immunospuppressants, disulphiram and theophylline. Disagreement on number of days of holding was observed for antithrombotics, anti-inflammatory & anti-rheumatic products and moclobemide. There was limited evidence on effect of majority of medications in surgery. One metanalysis and two prospective studies reported increased intraoperative bleeding in patients who took NSAIDs pre surgery. Discussion. There is limited evidence on the effect of continuing and discontinuing these medications in surgery. Evidence suggests that the difference on holding time of NSAIDs may cause intraoperative blood loss if sufficient days are not allowed for drug elimination. An audit on usage of perioperative medication guidelines in hospitals is suggested to investigate the effect of these variations on surgical outcomes of the patients.

240 Attitudes towards deprescribing: results of a nationally representative sample of older adults in the United States

Emily Reeve1,2, Jennifer Wolff3,4, Maureen Skehan3, Elizabeth A Bayliss5,6, Sarah Hilmer1,7, Cynthia Boyd3,4. NHMRC CDPC, Kolling Inst of Medical Research, Fac of Med and Health, Univ of Sydney1, Sydney, NSW, Aus; Geriatric Med Research and Coll of Pharm, Dalhousie Univ and Nova Scotia Health Auth2, Halifax, NS, Can; Dept of Health Policy and Management, Johns Hopkins Bloomberg Sch of Public Health3, Baltimore, MD, US; Center for Transformative Geriatric Research, Div of Geriatric Med and Gerontol, Johns Hopkins Univ Sch of Med4, Baltimore, MD, US; Inst for Health Research, Kaiser Permanente Colorado5, Aurora, CO, US; Dept of Family Med, Univ of Colorado Sch of Med6, Aurora, CO, US; Depts of Clinical Pharmacol and Aged Care, Royal North Shore Hosp7, Sydney, NSW, Aus

Introduction. Use of harmful and/or unnecessary medications in older adults is prevalent. Primary care clinicians report that patient resistance to medication withdrawal is a significant barrier to deprescribing. Although patient engagement is critical in safe and effective medication use, nationally representative data regarding patient perspectives on medication use and willingness to consider discontinuation of medications are notably absent. Aims. To describe the attitudes of older adults towards deprescribing and determine whether individual characteristics are associated with these attitudes. Methods. Population-based observational study of US Medicare beneficiaries 65 years and older. Data were taken from the Medication Attitudes module (n=2124) in round 6 of the National Health and Aging Trends Study. The questions in this module were drawn from the Patients’ Attitudes Towards Deprescribing questionnaire. Sampling weights were applied to take into account survey nonresponse and differential probabilities of selection. Results. Ninety-two percent of older adults reported being willing to stop one or more of their medicines if their doctor said it was possible and 67% wanted to reduce the number of medicines that they are taking. Older adults taking six or more medications had greater odds than those taking less than six medications of being willing to stop taking one or more of their medicines (adjusted odds ratio (aOR)=2.90, 95% CI=1.74-4.82) and wanting to reduce the number of medicines that they are taking (aOR=2.31, 95% CI=1.71–3.13). Discussion. Healthcare providers considering deprescribing as part of comprehensive, patient centered care, should be reassured that the vast majority of older adults are open to having one or more of their medicines stopped if their doctor said it was possible, and more than two-thirds want to reduce their number of medicines.


241 Cross-cultural adaptation and validation of the Osteoporosis Prevention and Awareness Tool (OPAAT) in Malaysia

Anisha K Sandhu1,2, Pauline SM Lai1, Li Shean Toh3, Yew Kong Lee1, Alexander TB Tan4, Nagammai Thiagarajan5

Department of Primary Care Medicine1, Medicine (Endocrinology)4, Faculty of Medicine, University of Malaya, Kuala Lumpur, WILAYAH PERSEKUTUAN, Malaysia; School of Pharmacy, Monash University Malaysia2, SELANGOR, Malaysia; Division of Pharmacy, University of Tasmania3, Hobart, TAS, Australia; Government Health Clinic Kuala Lumpur5, WILAYAH PERSEKUTUAN, Malaysia. Introduction: The English Osteoporosis Prevention and Awareness Tool (OPAAT) has been validated in Malaysia. However, Malay is the national language of Malaysia and spoken by the majority of Malaysians. Aims: To cross-culturally adapt and validate the Malay OPAAT among post-menopausal women in Malaysia. Methods: The OPAAT was translated from English to Malay according to international guidelines. The OPAAT was then validated from February-August 2018 at a tertiary hospital in Kuala Lumpur. We recruited post-menopausal women ≥50 years, who were able to understand Malay. Healthcare professionals were recruited to assess the discriminative validity of the OPAAT. All participants were asked to answer the OPAAT at baseline and two weeks later. Results: 200/280 post-menopausal women (response rate=71.4%) and 61/90 healthcare professionals (response rate=67.8%) were recruited. The mean±SD accuracy rate of the OPAAT was 64.9±13.0, of which 3/30 (10.0%) items were “difficult”, 11/30 (36.7%) items were “moderately easy”, and 16/30 (53.3%) items were “easy”. The overall Cronbach’s α value was 0.765. Kappa values ranged from 0.113-0.549, where 22/30 (73.3%) items were in moderate agreement, 7/30 (23.3%) items were in fair agreement and 1/30 (3.3%) item (item no. 6) was in poor agreement. Healthcare professionals had higher OPAAT scores than post-menopausal women (87.1±7.3 vs 64.9±13.0, p<0.001). Discussion: The Malay OPAAT was moderately easy to answer when compared to the English OPAAT. This could be due to the fact that Malaysians may comprehend Malay better than English. The overall Cronbach’s α value was >0.7 indicating adequate internal consistency. At test-retest, one item had a poor Kappa value. This could be due to participants guessing the answers to the item at test and retest. As with the English OPAAT, the Malay OPAAT was able to discriminate between the knowledge level of post-menopausal women and healthcare professionals. This highlights the importance in providing suitable patient education to improve the overall knowledge on osteoporosis and its prevention in the Malaysian population.

242 Stability of the EpiPen® formulation (epinephrine) under real world temperature conditions

Marcus Femia1, Robert Barrett1, Jack Clement1, Kevin Murray2, Liza Seubert1, Lee Yong Lim1, Cornelia Locher1, Sandra Salter1. School of Allied Health1, School of Population and Global Health2, The University of Western Australia1, Perth, WA, Australia. Introduction. Epinephrine is crucial for first-line treatment of anaphylaxis. Epinephrine autoinjectors (such as EpiPen®) must be carried at all times by patients at risk, however it is difficult to always maintain recommended storage temperatures (20-25°C), both before and after dispensing. Aims. We investigated epinephrine stability in the EpiPen® formulation exposed to higher temperatures (up to 80°C), in order to mimic conditions inside transport vehicles, enclosed spaces or other storage areas where inside temperature may be 20-40°C higher than outside temperature. Methods. Epinephrine solution was prepared according to the approved EpiPen® formulation. High-performance liquid chromatography (HPLC) amber glass vials (2mL) were overfilled then stored continuously at 20-25°C (control), 37°C, 60°C, 80°C and cycled between 80°C (8 hours) and 20-25°C (16 hours) for 21 days. Baseline (time=0) and residual epinephrine concentrations in three separate batches of vials sampled at known intervals (n=3 per batch) were analysed using a validated HPLC assay. Results were interpreted against ‘shelf-life’ expiry (time to <90% of baseline concentration). Results. After 488 hours, the mean residual epinephrine concentration (±SEM) was 94.5±1.64% after storage at 20-25°C, 94.2±0.6% at 37°C and 83.2±0.58% at 60°C. Only 52.1±1.4% remained after 440 hours of storage at 80°C and 71.7±1.2% after 528 hours of cycled heating at 80°C. Discussion. Shelf life of the EpiPen® formulation was maintained after 3 weeks’ continuous storage at 20-25°C and 37°C. Storage at 60°C and 80°C continuously, and cycled between 80°C and 20-25°C for 3 weeks resulted in concentrations below shelf life. This epinephrine formulation appears stable when carried on the person, however exposure to higher temperatures (e.g. in a car, outdoors, or in an emergency services shed) may impact shelf life. Vigilance in consideration of local temperature remains important as reduced concentration may impact therapeutic efficacy. Further research is required to clarify longer term stability (>12 months) of epinephrine stored beyond recommended temperatures (20-25°C), in line with likely real world storage.


243 Interviews with key stakeholders: opinions about and attitudes to pharmacy health coaching

Harjit K Singh1, Gerard A Kennedy1, Ieva Stupans1. The School of Health and Biomedical Sciences, RMIT University1, Melbourne, VIC, Australia. Introduction. Health coaching is a service that is provided to patients by health care professionals for the purpose of disease management and health risk prevention. It involves a collaborative patient -centred interaction between the patient and coach for the purpose of a behavioural change, through the process of goal setting and follow-up. Internationally, the provision of health coaching services through community pharmacy has shown benefits in the outcomes of patients with chronic health conditions. Despite this however, health coaching by pharmacists is not currently provided within Australian community pharmacies as a service. Aims. The aim of this project was to evaluate the opinions and attitudes of key stakeholders within the pharmacy profession about the concept of health coaching. The project also aimed to identify gaps in knowledge about health coaching within this group in the pharmacy profession. Methods. Interviews with key stakeholders within the pharmacy industry were carried out. The analysis and interpretation of the interview transcripts has provided insight into the views on the concept of heath coaching within community pharmacy. Results. The study is on-going, but analysis of preliminary data indicated the emergence of the following key themes: “positive view of health coaching in pharmacy”; “potential concerns about health coaching in pharmacy”; “barriers to integrating health coaching into pharmacy”; “facilitators to integrating health coaching into pharmacy” and “potential benefits of integrating health coaching into pharmacy”. These themes demonstrate the overall perceived value of health coaching within community

pharmacy, and suggest that the main impediments to its introduction relate to the lack of pharmacist skills and remuneration. Discussion. The outcomes of this research will be used to raise awareness of health coaching within the Australian pharmacy profession.

244 Stability Evaluation of Pre-Diluted Suxamethonium Chloride Injection in Polypropylene Luer-Lok Syringes

Yunmei Song1, Yuen Nie Chen1, Alka Garg2, Ambados Fotios2, Qian Zhang1, Sanjay Garg1, School of Pharmacy and Medical Sciences, University of South Australia1, Adelaide, SA, Australia; SA Pharmacy, Women’s and Children’s Hospital2, North Adelaide, SA, Australia Introduction. Suxamethonium (SUX) chloride is an important part of neonatal care, being used as a muscle relaxant. Its use as an emergency drug, and its high risk nature, make it a suitable candidate to be available as pre-filled syringes, ready to be used in critical care settings. This removes the steps of dilution of the ampoules in stressful emergency situations, which can lead to ten times overdose and other calculation errors. It also saves time that it takes to dilute and prepare the syringes providing quick treatment to the neonates. Aims. The objective of this study was to determine the shelf life (physical and chemical stability) of pre-diluted SUX chloride injection (5 mg/mL) in a 3 mL polypropylene luer-lok syringe. Methods. A stability test protocol was developed to determine the shelf life at room temperatures (25 ± 2 ᵒC), refrigerated (4 ± 2 ᵒC) and frozen (-20 ᵒC) with the protection from light. Three batches of SUX chloride (5 mg/mL) containing 0.9% sodium chloride were aseptically prepared and tested for long-term stability under above temperatures. Chemical stability was determined using a HPLC-UV system. Physical stability was evaluated by visual clarity inspection under fluorescent light with black and white backgrounds. A shift of pH beyond usual range specified by manufacturer (pH 3-5) was denoted as indicative of a potential degradation. An assay method was developed and validated. Samples were withdrawn on day 0, 1, 3, 5, 7, 14, 21, 28, 84, 168 and analysed. Results. This study confirmed that more than 90% of the initial concentration of SUX chloride (5 mg/mL) was retained throughout the assay at room temperatures (25 ± 2 ᵒC), refrigerated (4 ± 2 ᵒC) and frozen (-20 ᵒC) for 168 days. The lower one-sided 95% Confidence Interval demonstrated same results for all sample time points. Based on visual, pH and concentration investigation, no significant physiochemical change occurred during 168 days period in any sample. Discussion. The study findings suggest that solutions of SUX chloride (5 mg/mL) can be stored in polypropylene luer-lok syringes for up to 168 days at 4 ± 2 ᵒC and -20 ᵒC and 25 ± 2 ᵒC with protection from light. Boehm J. et al (1984) Am J Hosp Pharm,41, 300-302.


245 Drug use evaluation of intravenous metronidazole

M Joy Spark1, George Papadopoulos1,2, Ala'A Jahfar1. Faculty of Medicine and Health, University of New England1, Armidale, NSW, Australia; Pharmacy Department, Armidale Rural Referral Hospital2, Armidale, NSW, Australia. Introduction. Oral metronidazole is a suitable alternative to intravenous (IV) metronidazole in patients who are able to tolerate oral therapy. Oral metronidazole has a high bioavailability (98.9%) with plasma concentrations peaking 0.25 – 4 hours after dosing; decreases treatment risks for the patient; offers drug cost (10c vs $1 /dose) and administration time savings . Aims. To examine the prescribing pattern of IV metronidazole in an Australian hospital setting with a specific focus on cases where the substitution of IV therapy with oral therapy would have been possible. Methods. A retrospective drug audit of all patients admitted to the surgical ward at Armidale Rural Referral Hospital, between January 2018 and June 2018 was conducted. All patients administered IV metronidazole were included in the study. Prescribing was assessed against Hunter New England and eTG guidelines for compliance. Results. Medical records of 950 patients were examined. Over the 6 month period 80 patients were found to have received IV metronidazole (39 patients for prophylaxis and 41 for treatment). Patients received between 1 and 32 IV doses of metronidazole (Md=4.5, IQR 3 to 8 doses) over 1 to 15 days (Md=3, IQR 1.25 to 4 days). Oral therapy was contraindicated for 59 patients with nil by mouth being the main reason. Treatment was assessed as optimal (8/8) for 32(40%) patients and unjustified (0/8) for 13 (16%) patients who received IV metronidazole. In total 469 IV doses were prescribed, of these 216 (46%) were found to be suitable for oral therapy and 149 (32%) were prescribed outside of the guidelines. Discussion. Almost 50% of IV metronidazole doses could be replaced by oral doses reducing treatment risks to the patient and costs to the hospital. Clinicians should be encouraged to use the most clinically appropriate and cost-effective oral doses whenever possible. A review for current prescribing practices could be undertaken to minimise the inappropriate use of metronidazole.

247 Over-treatment (OT) and under-treatment (UT) of type 2 diabetes (T2D) in aged care: a systematic review protocol

Jacquelina Stastinopoulos1, J Simon Bell1,2, Janet K Sluggett1,2. Centre for Medicine Use & Safety, Faculty of Pharm and Pharm Sci, Monash Univ1, Parkville, VIC, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital2, Hornsby, NSW, Australia. Introduction. OT and UT of T2D can lead to unplanned hospitalisations for hypoglycaemia and hyperglycaemia, respectively. There is no consensus regarding criteria used to define OT and UT among residents with T2D. Because hypoglycaemia typically causes worse outcomes compared to hyperglycaemia in older people (Lipska et al 2014), there has been recent increased focus within guidelines on prevention of hypoglycaemia, which could result in UT. Aim. The aim of this systematic review is to investigate the prevalence of, outcomes and factors associated with, OT and UT of T2D in older people living in residential aged care facilities (RACFs). Methods. The protocol was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for systematic review protocols (PRISMA-P) and will be prospectively registered with PROSPERO. Using a pre-specified search strategy, selected databases will be searched for peer-reviewed journal articles published from year 2000 to 2019. Case reports and case series will be excluded. Studies including residents of RACFs will be eligible for inclusion if (1) OT and/or UT are quantitatively defined based on glycosylated haemoglobin A1c levels ± pre-specified resident characteristics and/or clinical outcomes; and (2) prevalence, outcomes and factors associated with OT and/or UT can be extracted from the paper for residents included in the study. One reviewer will perform the searches and title screening. Two reviewers will independently screen abstracts, review full articles, assess methodological quality using the Joanna Briggs Institute Critical Appraisal tools and extract data. Disagreements will be adjudicated by a third reviewer. Results. A narrative synthesis of the results and, if appropriate, a meta-analysis will be conducted. Findings will be disseminated via national/international conference presentations and peer-reviewed publication. Discussion. Identification of HbA1c thresholds commonly used to define OT and UT in RACFs and associated outcomes will be a novel addition to diabetes therapy research and may inform future guideline development. Lipska KJ et al (2014) JAMA Intern Med 174(7):1116-24


248 Role of New Zealand community pharmacists in opioid substitution treatment

Rebecca J Suddaby, Caroline J Morris, Ben Gray. Dept Primary Health Care and General Practice, Univ of Otago, Wellington, New Zealand. Introduction. Opioid addiction is a chronic relapsing health condition affecting over 9000 New Zealanders. Opioid Substitution Treatment (OST), dispensed by community pharmacists (CPs), is a recognised strategy in reducing the burden of illicit opioid use, and is being increasingly managed by collaborative primary care teams. CPs can play an integral role in supporting clients on their recovery journey, as well as liaising with the rest of the OST team. Aims. To explore the current role of CPs in the provision of OST, with specific focus on how CPs perceive their role within the OST team, as well as identifying barriers and facilitators to providing healthcare and addiction support to people receiving OST. Methods. Data from in-depth interviews with four strategic stakeholders within the New Zealand addiction sector were used to inform a semi-structured interview schedule for use with a purposive sample of 12 CPs. Ten audio-recorded interviews exploring CPs’ current practices in providing OST, barriers and facilitators to OST service provision, and their perceived role within the OST team have been completed to date. Interviews are being transcribed verbatim, coded and analysed iteratively using a thematic approach. Results. Preliminary analysis suggests that CPs acknowledge there is an important relationship between OST clients and their CP, but there is variation in the OST service being provided, and how the CP perceives their role within the OST service. CPs discussed a lack of resources (e.g., staffing levels, training), challenges communicating with prescribers and key workers, and the volatile nature of some OST clients as barriers to a more effective service. CPs also identified a perceived lack of inclusion within the OST team. Discussion. Due to an established and often long-term relationship with OST clients, CPs have the potential to provide regular addiction support and healthcare advice to a population recognised as being at risk of poor health outcomes. CPs have frequent contact with clients and can offer valuable insight with regard to clients’ mental and physical wellbeing. Increased resourcing and improved communication channels with other members of the OST team could facilitate better healthcare for this vulnerable population.

249 The pharmacist and patient death: Are we prepared for the emotional and professional impacts?

Robin B. Parr1, Esther T.L. Lau1, Marea Patounas1, Hung M. Tran1, Tony Hall1. School of Clinical Sciences (Pharmacy), Faculty of Health, Queensland University of Technology (QUT)1, Brisbane, QLD, Australia. Introduction. In traditional healthcare the pharmacist’s role is primarily focussed on the optimisation of medicines to enhance and preserve life. With the introduction of physician-assisted dying in Australia, pharmacists may be confronted with moral or ethical dilemmas impacting professionally and emotionally on the pharmacist, such as the need to dispense medicines or have conversations about medicines with the explicit aim of ending life. Aims. To investigate the perspectives of pharmacists who practice in end-of-life care regarding their preparedness for the emotional and professional impacts of patient death, and how current and future pharmacists can prepare for this change in practice. Methods. An online survey was distributed via professional pharmacist organisations seeking the opinions of Australian pharmacists who practice in end-of-life care settings (e.g. oncology, palliative care, intensive care, geriatrics, emergency departments). Results. A total of 53 responses were collected. Most of the respondents felt that pharmacists who had never worked in end-of-life care settings would not be prepared for having interactions or conversations associated with patient death. Half of the participants indicated they did not feel prepared for interacting with patient families regarding patient death. The majority (93%) of participants did not feel their pharmacy degree assisted in preparing them for such patient interactions, and had to learn on the job. Mentoring and education to support bereavement were highlighted to be the most beneficial for preparing current and future pharmacists for this practice change. Discussion. These results highlight the need for additional education and support for pharmacists around the impacts of patient death, perhaps with starting as early as the pharmacy degree; and the need for and future research into this area of pharmacy practice.

book of poster abstracts - expert events · references. p umapathy et al (2012) trop j pharm res,...

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