PBS hospital medication chart development and background

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Safety and Quality > Our Work > Medication Safety > Medication charts > Background and development of medication charts > PBS hospital medication chart development and background

The PBS HMC is an evidence-based chart that builds on the national inpatient medication chart (NIMC). It was trialled in public and private hospitals across Australia.

Healthcare services are expected to demonstrate the use of a compliant standardised chart for accreditation against National Safety and Quality Health Service (NSQHS) Standard 4: Medication Safety. The PBS HMC is a compliant standardised chart.

Only the PBS HMC can be used for PBS claiming. Noncompliant charts:

Are not reflected in any nationally maintained support materials, including education resources
May create medico-legal risks for health service organisations in the event of patient harm related to medication misadventure.

Benefits of the PBS HMC

Reduces the regulatory and administrative burden for health professionals
Improves efficiency and streamline processes for PBS prescribing, dispensing and claiming
Improves medication safety by reducing medicine transcription errors
Improves the quality use of medicines, including PBS medicines prescribed, dispensed and administered to patients in acute care settings
Improves workflow for healthcare providers.

Developing the PBS HMC

The Australian Government Department of Health appointed the Commission to develop the PBS HMC for use in public and private hospitals, and to test its safety and effectiveness. The aim was to reduce the administrative prescribing, dispensing and claiming for PBS medicines in hospitals.

A hospital trial assessed:

Safety and quality of the PBS HMC compared with the NIMC
Compliance with regulatory requirements for PBS data fields
Financial advantages to the hospital
Workflow utility and efficiencies for hospitals, clinicians and pharmacies.

The hospital trial found the safety performance of the PBS HMC compared favourably with the existing medication charts used at the trial sites. This finding was supported by chart audits and site reports. There were no medication incidents associated with the PBS HMC, and using the chart reduced medication transcription errors.

Additional details of the trial can be found in PBS Hospital Medication Chart (PBS HMC) project. Development, trial and evaluation of the PBS HMC in public and private hospitals: phase 1 summary evaluation report

Isolated rectocele	GoR*
Posterior Colporrhaphy (PC) is the procedure of choice	B
Levatorplasty associated with high rate of dyspareunia	B
PC reduced prolapse with equal functional outcome compared to transanal approach	B
Fascial plication is superior to site specific posterior vaginal repair	C
No evidence demonstrating benefit for synthetic or biological graft	C
Those with combined vaginal prolapse and bowel symptoms benefit from colorectal and gynaecologist collaboration	C
Ventral rectopexy and vaginal graft is unnecessary for isolated rectocele	D

Vault prolapse (post hysterectomy)	GoR*
Sacral colpopexy (SC) has significant anatomical and functional advantages when compared with a broad group of vaginal surgery (± mesh)	A
Transvaginal apical mesh confers no advantage when compared to native tissue repairs	A
Uterosacral and sacrospinous colpopexy have similar efficacy for apical prolapse	B
Laparoscopic SC has advantages over both robotic and open approach however the learning curve with the laparoscopic approach is significant	B
Sacrospinous ligament fixation and abdominal sacrocolpopexy have equivalent success rates	B
Vaginal apical suspensions appropriate in those not suitable for SC (Delphi)	C

	GoR*
Vaginal hysteropexy is equally effective as vaginal hysterectomy with apical suspension and is associated with reduced blood loss and operating time	B
Vaginal hysterectomy with apical suspension has a lower reoperation rate for prolapse than abdominal sacro-hysteropexy	B
Salpingectomy ↓ risk of ovarian cancer in women retaining ovaries at the time of hysterectomy	B
Bilateral salpingo-oophorectomy (BSO) at hysterectomy in post-menopausal women ↓ rate of ovarian cancer without ↑ morbidity	B
SC with hysterectomy is not recommended due to high rate of mesh exposure	B
Supracervical hysterectomy has a lower rate of mesh exposure than hysterectomy and SC	B
Sacro-hysteropexy has a ↑ reoperation rate for prolapse than SC with hysterectomy	C
Supracervical hysterectomy has ↑ rate of recurrent POP compared to SC and hysterectomy	C
Although data is not complete, vaginal based apical suspensions should generally be considered for uterine prolapse reserving SC for recurrent or post hysterectomy prolapse	C

Isolated cystocele	GoR*
Anterior Colporrhaphy (AC) is generally recommended however permanent synthetic mesh could be considered for recurrent prolapse if women understand the risk/benefit profile	A
Non-autologous grafts offer no significant advantage over AC	B
Native tissue repair is recommended, but carries a higher risk of prolapse recurrence	B
Mesh repairs are associated with higher risk of adverse events	B
Mesh repair may be considered for recurrent prolapse after patient informed and accepts the risk/benefit	B
Adjunctive fascial slings may be used to prevent recurrent prolapse in high grade cystoceles	C

Prolapse surgery and lower urinary tract functions	GoR*
Women with POP + SUI
Surgery for POP + SUI shows a higher rate of cure of urinary incontinence in the short term	A
Combined POP + SUI surgery carries a higher risk of adverse events	A
Women with POP + occult SUI
POP + occult SUI equals POP and continence surgery (consider staged procedure)	B
Women with POP + occult SUI are at risk of development of incontinence post POP repair alone, with some proceeding to additional SUI surgery at a later date	A
Combined POP + SUI surgery reduces the risk of post operative incontinence	A
Combined POP + SUI surgery increases the risk of adverse events	A
Continent women with POP
POP without occult SUI does not require concomitant continence surgery	B
Women with POP and Overactive Bladder (OAB)
There is low level (inconsistent) evidence to suggest that operative repair can improve OAB symptoms	C

	GoR*
Perioperative physiotherapy did not reduce the rate of recurrent prolapse	A
Stage 3 or Stage 4 prolapse	B
Low volume surgeons have ↑ rate of complications compared to high volume surgeons	B
Patient age < 60 years	C
Less experienced surgeons have higher rates of recurrent prolapse after transvaginal surgery	C
Preoperative widened genital hiatus or levator defects on urinary signs and symptoms: data are inconclusive	D

	GoR*
Inferior outcomes to pubovaginal slings for primary repair, possibly with less voiding dysfunction	B
Outcomes similar or slightly less than synthetic MUS however longer operating time and recovery, slower return to activities of daily living and more prolapse in medium term	B
Laparoscopic approach when performed same technique as open has similar success rate with less morbidity than open approach	B
Lower rates of success, with higher retreatment rates, when compared to pubovaginal slings for primary repair	B

	GoR*
The most extensively researched option for SUI establishing efficacy and safety profile	A
As effective or more effective than colposuspension or pubovaginal sling with less perioperative and post-operative morbidity	B
Recommended surgical treatment female SUI	C

Retropubic versus transobturator mid-urethral sling	GoR*
In the short-term there are similar success rates for retropublic and transobturator	A
Obturator tapes slightly quicker, with less blood loss, bladder perforation and voiding dysfunction difficulties. Most of these differences were small and the complications are readily able to be managed.	A
However in the medium term (>5 years) the reoperation for recurrent SUI greater in obturator group and a small number developed groin pain (3-4%) that is difficult to treat.	B
Retropubic considered as the preferred procedure with transobturator reserved for those patients with a hostile abdomen	C

Retropubic versus transobturator mid-urethral sling	GoR*
In the short‐term there are similar success rates for retropubic and transobturator mid urethral slings	A
Obturator tapes are slightly quicker, with less blood loss, bladder perforation and voiding dysfunction difficulties. Most of these differences were small and the complications are readily able to be managed.	A
However in the medium term (>5 years) the reoperation for recurrent SUI greater in obturator group and a small number developed groin pain (3-4%) that is difficult to treat.	B
Retropubic considered as the preferred procedure with transobturator reserved for those patients with a hostile abdomen	C

Pubovaginal (fascial) sling	GoR*
Similar success rates compared to MUS with longer operating time and possibly higher voiding dysfunction; fascial sling has lower rates of chronic pelvic pain, no risk of erosion or extrusion, and higher rates of post‐operative morbidity	B
Lower rate of bladder perforation during surgery compared to MUS.	B
Fascial sling has higher patient satisfaction and treatment success compared to colposuspension	B
Involves a longer operation, post‐operative hospital stay (2–3 days) and recovery period than MUS	B
Consider in women wishing to avoid mesh‐related complications	–

	GoR*
May be a useful option for recurrent SUI with a well supported urethra	B
Greater symptomatic improvement was observed with surgical treatments, although the advantage needs to be balanced against risk of intervention	C
Consider in women wishing to avoid mesh‐related complications	–