The utility of a medical admissions pharmacist in a hospital in Australia

Background Medication-related hospital admissions in Australia have previously been estimated to account for approximately 3% of all hospital admissions, with hospital entry points being a point of vulnerability. The timely medication review and reconciliation by a pharmacist at the early stage of an admission for patients admitted to the Acute Medical Unit (AMU) would be beneficial. Setting The Emergency Department (ED) and AMU in a 300 bed tertiary teaching hospital, in South Australia. Objective To investigate the impact of a Medical Admissions (MA) pharmacist on the proportion of AMU patients who receive a complete and accurate medication history by a pharmacist prior to admission and within 4 h of presentation. Method This prospective observational study with a non-concurrent parallel study design examined a standard clinical pharmacist service within the AMU and ED to a Medical Admissions (MA) Pharmacist, in addition to the standard AMU and ED pharmacist service. Continuous variables were analysed using a two sample t test, whilst categorical data were analysed using Fisher’s exact test. Risk ratios were also calculated for categorical data, with p < 0.05 taken as statistically significant. Main outcome measures Rates of completion of a complete medication history prior to admission and proportion of patients seen within 4 h of presentation by a pharmacist. Results The intervention resulted in more patients receiving a complete medication history prior to admission (2.7% in the control group vs 18.5%, p < 0.01) and being seen by the pharmacist within 4 h of presentation (1.6% in the control group vs 7.5%, p < 0.01). Conclusion Implementation of an extended hours clinical pharmacy service in the form of a medical admissions pharmacist based in the ED significantly increased the number of complete medication histories and clinical reviews completed for patients being admitted to an AMU. These were also completed earlier in the patients’ admission. There was also a small trend toward increasing the proportion of patients discharged by 11 am in the intervention group.     

Drug and chemical poisoning admissions at a teaching hospital in Malaysia

A retrospective review of medical records was carried out to determine the pattern of drug and chemical poisoning cases admitted to a teaching hospital in Malaysia. Medical records of patients admitted during the period January 1987 to December 1995 were reviewed. They accounted for 0.2% of total admissions during the period. While all ages were represented, there was predominance of children, which showed little change throughout the nine-year period. Of all cases of poisoning, 77.8% were unintentional, 12.6% intentional and 9.6% were undetermined. Kerosene, pesticides and medicinal substances remained the common agents associated with poisoning. A significant number of patients sought treatment elsewhere before being admitted to the hospital. Of those who came directly to the hospital, many were presented late in the course of their poisoning. Only seven patients died and none were children. This study supports the need for greater emphasis on prevention of poisoning in children and among farmers in the state.     

Inpatient prescribing errors and pharmacist intervention at a teaching hospital in Saudi Arabia

Background

Prescribing errors phenomena are very common within health care practice. These errors could result in adverse events and harm to patients. Pharmacist has an identified role in minimizing and preventing such errors.

Objectives

To detect the incidence of prescribing errors for hospitalized patient, to evaluate the clinical impact of pharmacist intervention on the detection of these errors, and to propose a program to overcome this problem in a teaching hospital.

Methods

For one month period starting November until December 2009, the inpatient medication charts and orders were identified and rectified by ward and practicing pharmacists within inpatient pharmacy services in a teaching hospital at King Khalid University Hospital (KKUH) at King Saud University, Riyadh, Kingdom of Saudi Arabia on routine daily activities. Data were collected and evaluated. The causes of this problem were identified.

Results

Approximately 113 (7.1%) prescribing errors were detected during the study period out of 1580 medication orders. Wrong strength and wrong administration frequency of the prescribed drug were the most errors encountered in the study, which were 35%, and 23%, respectively. Other errors such as wrong patient, wrong drug, and wrong dose were also encountered. Lack of knowledge of prescribing skill was the main cause of such errors.

Conclusion

Prescribing errors in teaching hospital within inpatient pharmacy services were noticed. The applied method in this project might be implemented as part of pharmacy quality assurance program for ongoing detection and monitoring of such errors. Technology in prescribing process will support the practitioner to reduce the incidence of these errors. Forcing ongoing professional communication and education within the medical team about prescribing errors now appear warranted.     

An evaluation of postoperative pain management in pediatric patients at a university teaching hospital

In recent years, pediatric pain management has begun to receive some much deserved attention. Many misconceptions regarding pediatric pain management have resulted in infants and children receiving inadequate pain control after surgical or invasive procedures. The purpose of this investigation was to evaluate appropriateness of pain management practices, emphasizing drug therapy, in children with acute pain after a surgical procedure. Analgesic use and pain assessment methods were evaluated for 30 pediatric patients undergoing an invasive medical procedure or surgery. Data were collected concurrently on the use of pain medications, potential for drug interactions/duplication of therapeutic classes, pain assessment, patient response to medication, and any adverse effects experienced by a child. Twenty patients (67%) had concurrent orders written for multiple analgesics on admission to the nursing unit. Only 6 of these 20 order sets (30%) designated specific indications for use. Ten of the 14 remaining order sets (those without specific directions for use) contained at least one medication that was inappropriate to treat the expected level of postoperative pain. Fifty-four percent of total physician orders fell outside study criteria for appropriate dosing and scheduling frequency. Patient records revealed that nursing administered the lowest ordered dose 47% of the time, and a failure to consistently conduct pain assessments or document patient response to medication. Eight patients (27%) experienced allergic-type reactions, whereas 7 patients (23%) experienced adverse drug reactions. Information gathered from this review will be used to determine if a need exists to develop hospital guidelines or adopt the Agency for Health Care Policy and Research guidelines for acute pain management in children.     

Alcohol consumption by routine admissions to a Sydney teaching hospital

Between April and August 1985, 500 patients admitted routinely to the Westmead Hospital completed a self reporting questionnaire based on National Heart Foundation (NHF) questionnaire to determine alcohol usage by this group of hospital patients. Routine admissions represent 40-50% of all patients in the Westmead Hospital. The alcohol consumption patterns of this group closely resembled that of the general population as reported in the 1983 NHF survey. Six per cent of all patients were drinking at an 'at risk' level and only 0.8% were consuming at a level definitely believed to damage their health. The survey suggests that routinely admitted patients represent a select group of hospital patients not containing a high percentage of heavy drinkers. If up to 30% of hospital patients have an alcohol intake above accepted 'healthy' levels it is clear that this must occur in other areas of the hospital such as the Orthopaedic and Neurosurgical units where trauma cases are frequently admitted. Future research into these areas would be useful to determine the extent of patient alcohol consumption.     

Reporting of adverse drug reactions in relation to general medical admissions to a teaching hospital in Hong Kong

In Hong Kong, adverse drug reactions (ADRs) are rarely reported. We tried to improve the reporting of ADRs in our medical unit at the Prince of Wales Hospital by promoting the scheme at our regular unit meetings and by including report forms at the time of admission in the case notes of all patients admitted to two general medical wards. Registrars and interns based in these wards were requested to report all ADRs by filling in standard report forms. The hospital records of these patients were then reviewed by one investigator with two aims: (1) to assess the proportions of ADRs being reported; (2) to determine how good junior staff are in reporting ADRs. During a 2-month period in 1992, 430 patients were reviewed. A total of 122 ADRs were present in 98 patients either at the time of admission (n = 66) or after admission (n = 56), and of these, only six (5 per cent) were correctly reported. The diagnosis was either missed or wrong in 29 cases, which represent 24 per cent of the total number of ADRs. The remaining 71 per cent of ADRs were totally ignored. Possible ways to improve the reporting of ADRs in hospital are discussed.     

Profile of hospital admissions following acute poisoning--experiences from a major teaching hospital in south India

This study was conducted to determine the incidence of hospital admissions following acute poisoning, nature of agents involved and change in pattern of poisoning over a 5-year period. Data from hospital records of all admissions to emergency department following acute poisoning collected prospectively were analysed for the period January 1993 to January 1998. A steady increase in deliberate poisoning using pesticides, particularly among young adults, was noted. Kerosene (paraffin) was the commonest poison in children and plant poisons were also common. There were 52 deaths (3.3%) among the 1584 admissions. The majority of deaths were due to pesticides. Poisoning and mortality followed ingestion of readily-available and commonly used agents. Measures to increase public education, counselling and awareness could prevent a number of these admissions.     

Malaria in Birmingham and a London teaching hospital.

During the past five years the incidence of imported malaria increased among patients seen in East Birmingham Hospital and in St Thomas's Hospital, London. Plasmodium vivax was the predominant species in Birmingham, and was almost always acquired by Asian immigrants visiting the Indian subcontinent. In St Thomas's P falciparum was most commonly imported, usually by African immigrants visiting Nigeria and Ghana. Two patients (one Irish, one Japanese) died of falciparum malaria after visiting tropical Africa. In both hospitals the immigrant patients had seldom taken prophylactic drugs, and the few who had, ceased to do so on arrival in the UK and sometimes before leaving the malarious country. Apparently immigrants who visit their homeland do not consult their general practitioners before travelling, are given inappropriate advice, or do not take appropriate advice when given. Since the incidence of imported falciparum malaria in the UK is rising, the following points should be considered: the infection may be lethal, particularly in patients lacking immunity; it can mimic other diseases, which may lead to delayed diagnosis; severe disease may be associated with few parasites on a blood film, and even if the result is negative further tests should be performed; clinicians and hospital pharmacists should be aware of the need to keep permanent stocks of parenteral chloroquine and quinine preparations.     

An organizational approach to the hospital pharmacist shortage.

A Task Force was formed by the Pennsylvania Society of Hospital Pharmacists to review the shortage of hospital pharmacists and to recommend ways to deal with it. Recommendations by the Task Force to PSHP are discussed. These recommendations should place hospitals and their departments of pharmacy in a better position to recruit and retain pharmacists.     

An evaluation of a collaborative pharmacist prescribing model compared to the usual medical prescribing model in the emergency department

BackgroundWorkforce reform has placed a significant focus on the role of non-medical prescribers in the healthcare system. Pharmacists are trained in pharmacology and therapeutics, and therefore well placed to act as non-medical prescribers.ObjectivesTo assess the safety and accuracy of inpatient medication charts within a pharmacist collaborative prescribing model (intervention), compared to the usual medical model (control) in the emergency department (ED). Another objective compared venous thromboembolism (VTE) risk assessment and prescribing, between intervention and control groups.MethodsAdult patients in ED referred for hospital admission were randomised into control or intervention by a block randomisation method, until the required sample size was reached. Medication charts were audited retrospectively by an independent auditor, using validated audit forms.ResultsIntervention group medication charts contained significantly fewer prescribing errors, omissions and discrepancies compared to the control group, and improved documentation of adverse drug reactions. VTE risk assessment and prescribing had higher guideline concordance in the intervention group compared to the control group.ConclusionsThis collaborative prescribing trial showed excellent results in safety and accuracy of pharmacist prescribing when compared to the usual medical model of prescribing. The admitting medical practitioner and extended scope pharmacist prescriber worked as a collaborative team in emergency, which improved Australian national prescribing safety indicators.