Choosing Medicines Wisely

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The Society of Hospital Pharmacists of Australia (SHPA) is proud to be the first pharmacist member organisation to join Choosing Wisely Australia^®, an initiative of NPS MedicineWise.

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SHPA is committed to facilitating the safe and effective use of medicines, which is the core business of pharmacists, and recognises that Quality Use of Medicines (QUM) in hospitals is an important contributor to overall health system performance. Medication misadventure and inappropriate use of medicines result in approximately 230,000 hospital admissions in Australia each year, with an estimated annual cost of $1.2 billion to the healthcare system.
In this issue of AHHB, a number of Choosing Wisely recommendations, related to the use of antibiotics, are discussed (see page 36-37) and these may provide a fresh approach for antimicrobial stewardship in hospitals and the community.
In essence, QUM is about choosing ALL medicines wisely, based on the available evidence. SHPA’s five Choosing Wisely statements reflect the need for judicious selection of treatment options, and this may include choosing to not prescribe medicine.
The statements were developed through an extensive consultation process. Over 40 statements with supportive evidence were proposed to SHPA’s working party indicating our member’s interest in the better use of medicines across our health system. A shortlist of 10 statements were then considered by SHPA’s membership and the final five ratified by SHPA’s Federal Council.
SHPA’s five statements are:

1. 
   Don’t initiate and continue medicines for primary prevention, in individuals who have a limited life expectancy.
   The proactive de-prescribing of medicines no longer required or of benefit to the patient, is integral to end-of-life care and advance care planning. Estimates of the cost of potentially inappropriate medicines accessed through the PBS in older patients is between $240 and $450 million each year.


2. Don’t initiate an antibiotic without an identified indication and a predetermined length of treatment or review date. (see page 36)


3. 
   Don’t initiate and continue antipsychotic medicines for behavioural and psychological symptoms of dementia for more than 3 months.
   Sometimes not using a medicine is the best choice. Antipsychotic medicines should only be considered when non-pharmacological interventions have failed and the patient has symptoms that are distressing for them, their family or co-residents.


4. 
   Don’t recommend the regular use of oral non-steroidal anti-inflammatory medicines (NSAIDs) in older people.
   NSAIDs should not be recommended without consideration of the patient’s additional disease or conditions such as: kidney disease, a history of peptic ulcer disease, hypertension or heart failure.


5. 
   Don’t recommend the use of medicines with sub-therapeutic doses of codeine (<30mg for adults) for mild to moderate pain.
   There is evidence that doses of codeine less than 30mg every 6 hours are no more effective than paracetamol or an NSAID alone. Combination analgesics with low dose codeine should not be recommended for mild to moderate pain.

Full details about SHPA’s Choosing Wisely Australia recommendations are available at www.choosingwisely.org.au/recommendations/shpa
More information about SHPA’s involvement with Choosing Wisely Australia is available at www.shpa.org.au/SHPA
Kristin Michaels
CEO Society of Hospital
Pharmacists of Australia
Kristin Michaels is the Chief Executive Officer of The Society of Hospital Pharmacists of Australia, with a keen interest and experience in health system design. She is a seasoned Board Director in both the primary, acute and aged care sectors. Kristin holds qualifications in Arts, Organisational Leadership, Governance and Health Service Management. She is a Fellow of the Australian Institute of Company Directors and is accredited as an International Partnership Broker.