A regular clinical pharmacy service to wards is well established in Britain, yet there has been little practice research in this area. In this study, we established how pharmacists distribute their time between different activities on all the wards. All 28 pharmacists in two London hospitals were observed. The observer recorded their activities at one minute intervals and categorised the activity. Thirty‐three hours and five minutes of observations were made. The pharmacists visited a total of 55 wards, and checked 982 drug charts. The major activities were prescription monitoring, which accounted for 31 per cent ± 2 per cent, of the time (mean of pooled data ± 95 per cent confidence intervals), travel to wards 21 per cent ± 2 per cent, stock control 12 per cent ± 1 per cent, transcription 8 per cent ± 1 per cent and clinical monitoring (such as checking giving sets) 7 per cent ± 1 per cent. The proportion of time spent on each activity was very similar between the two sites, except for the category “transcription”, which took 11 per cent ± 2 per cent of the time in one hospital, where all discharge prescriptions were transcribed onto ward pharmacy sheets (allowing processing in the pharmacy without the need for drug charts to leave the ward), and 3 per cent ± 1 per cent at the other site, in which they were not transcribed. These results demonstrate that, when on the ward, pharmacists spend the majority of their time in a clinical role. The methodology is simple to use and appears reproducible. This work, if repeated locally, could be used to highlight areas of inefficiency, and could be used to test and predict the impact of other methods of delivery of clinical pharmacy.
In this study, health promotion activity in community pharmacies and pharmacists' perceptions of the barriers to increasing health promotion activity were investigated. A stratified sample (30) was investigated u s i n g a structured interview.Health promotion activities were undertaken in all pharmacies in the study. The number of times advice was given or a query dealt with was estimated to be around 1,400 per week for this sample. Health promotion activity was 2.5 times more likely to be reactive than proactive. Other issues were identified which suggest that pharmacists' activities in this field tend to be passive and product orientated. Barriers identified included remuneration issues, space, time, training and insufficient liaison with other health professionals and health promotion units.
Intensive care unit treatment in patients >65 yrs with a first-day sequential organ failure assessment score >15 is not futile To the Editor:With great interest, we read the study by Kaarlola and colleagues (1), concerning long-term survival, quality of life, and quality-adjusted life-years among critically ill elderly patients. In their study, outcome and quality aspects were investigated in 882 patients older than 65 yrs. We were intrigued by their sentence under the Discussion that all patients in their study with a day-1 Sequential Organ Failure Assessment (SOFA) score Ͼ15 died in the intensive care unit (ICU). This seemed to differ from our experience. After a explorative database analysis of prospectively collected data, we found that in 13,989 consecutive patients admitted to our ICU, 7,984 patients were Ͼ65 yrs of age. Of these elderly patients, 131 had a day-1 SOFA score Ͼ15. The hospital mortality of these patients was 65 of 131. A hospital survival rate of 50% in those Ͼ65 yrs with a day-1 SOFA of Ͼ15 contrasts with the 100% mortality reported by Kaarlola et al.Under the Discussion, it is stated that a systematic bias toward overestimated quality-adjusted life years may exist if intensive care is withheld from elderly patients or selection in admission occurs and not all elderly patients are included in the analysis. It is possible, therefore, that the reported 100% mortality rate with day-1 SOFA score in patients Ͼ65 yrs could have been perceived as futile therapy, resulting in overestimated quality-adjusted life years. We agree with the authors that older age alone is not a valid reason to withhold intensive care; we disagree with their implicit statement that ICU treatment in patients Ͼ65 yrs with a first-day SOFA score Ͼ15 is futile.The authors have not disclosed any potential conflicts of interest. REFERENCE1. Kaarlola A, Tallgren M, Petillä V: Long-term survival, quality of life, and quality-adjusted life-years among critically ill elderly patients.
The aim of this study was to determine the quality of inpatient prescription writing.Prescriptions frop a teaching hospital and a district general hospital were assessed against prescription writing standards drawn from the British National Formulary and local procedures. The prescription charts were from a stratified sample of inpatients discharged between July, 1989, and July, 1990. Over 400 inpatients' charts, containing 4,536 prescriptions, were examined. Depending on the type of prescription, between 12 per cent and 32 per cent failed to use the approved name of the drug and 4 to 10 per cent were illegible or ambiguous. The dose was written incorrectly in 11 to 26 per cent of cases. Failures were particularly common in "as required" prescriptions, with 2 1 per cent potentially allowing an overdose of a drug to be given and 5 per cent indicating more than one route of administration. Three per cent of fluid additive prescriptions had not had the type of fluid defined. The standard of inpatient prescription writing needs to be improved. This paper offers objective standards which could be used to start a regular audit process.WHEN reading a prescription there should be no doubt about ;hat the piescriber intended. The increasing complexity of drug treatment in the 1960s and the inadequacy of the prescribing process in hospitals led to prescribing errors.'.2 In 1970, the Gillie report3 recommended new practices. Prescription charts were designed to ensure that the prescriber's intentions were clear to nurses, pharmacists and medical colleagues. Pharmacists now visit wards to monitor the appropriateness of prescribing, to clarify any ambiguities on the prescription chart and to supply drugs actording to the prescription. The prescription charts currently in use are designed to be clear and unambiguous; in addition, guidance on good prescription writing is given in the British National Formulary. A proportion of prescribers infringe these guidelines and misuse the prescription chart, which may lead to drug administration errors if not detected and corrected. The aim of this study was to examine the extent to which prescribers infringed good prescription writing practice. The appropriateness of prescribing was not assessed. MethodsIn July, 1990, prescription charts were extracted from the notes of patients discharged in the previous year from a teaching hospital and a district general hospital. The sample of notes removed was stratified so that the distribution of patients by specialty was proportional to hospital discharge statistics for the previous year. A total of 434 inpatient prescription charts was examined, half taken from each site. Specialist areas with different prescription charts or prescription writing practices were excluded. The specialties included were: Cardiology, geriatrics, general medicine, general surgery, dental, ophthalmology, orthopaedics, ear nose and throat, and urology.As both hosDitals used the same design of prescription chart, the five prescription categories -"regular", "once only",...
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