Objectives: To evaluate whether pharmacists completing the medication management plan in the medical discharge summary reduced the rate of medication errors in these summaries. Design: Unblinded, cluster randomised, controlled investigation of medication management plans for patients discharged after an inpatient stay in a general medical unit. Setting: The Alfred Hospital, an adult major referral hospital in metropolitan Melbourne, with an annual emergency department attendance of about 60000 patients. Participants: The evaluation included patients' discharge summaries for the period 16 March 2015 – 27 July 2015. Interventions: Patients randomised to the intervention arm received medication management plans completed by a pharmacist (intervention); those in the control arm received standard medical discharge summaries (control). Main outcome measures: The primary outcome variable was a discharge summary including a medication error identified by an independent assessor. Results: At least one medication error was identified in the summaries of 265 of 431 patients (61.5%) in the control arm, compared with 60 of 401 patients (15%) in the intervention arm (P<0.01). The absolute risk reduction was 46.5% (95% CI, 40.7–52.3%); the number needed to treat (NNT) to avoid one error was 2.2 (95% CI, 1.9–2.5). The absolute risk reduction for a high or extreme risk error was 9.6% (95% CI, 6.4–12.8%), with an NNT of 10.4 (95% CI, 7.8–15.5). Conclusions: Pharmacists completing medication management plans in the discharge summary significantly reduced the rate of medication errors (including errors of high and extreme risk) in medication summaries for general medical patients. Australia New Zealand Clinical Trials Registry number: ACTRN12616001034426.

Partnering between medical staff and pharmacists to jointly chart initial medications on admission significantly reduced inpatient medication errors (including errors of high and extreme risk) among general medical and emergency short-stay patients with complex medication regimens or polypharmacy.

Aims To undertake a multicentre evaluation of translation of a partnered pharmacist medication charting (PPMC) model in patients admitted to general medical units in public hospitals in the state of Victoria, Australia. Methods Unblinded, prospective cohort study comparing patients before and after the intervention. Conducted in seven public hospitals in Victoria, Australia from 20 June 2016 to 30 June 2017. Patients admitted to general medical units were included in the study. Medication charting by pharmacists using a partnered pharmacist model was compared to traditional medication charting. The primary outcome variable was the length of inpatient hospital stay. Secondary outcome measures were medication errors detected within 24 h of the patients' admission, identified by an independent pharmacist assessor. Results A total of 8648 patients were included in the study. Patients who had PPMC had reduced median length of inpatient hospital stay from 4.7 (interquartile range 2.8–8.2) days to 4.2 (interquartile range 2.3–7.5) days (P < 0.001). PPMC was associated with a reduction in the proportion of patients with at least 1 medication error from 66% to 3.6% with a number needed to treat to prevent 1 error of 1.6 (95% confidence interval: 1.57–1.64). Conclusion Expansion of the partnered pharmacist charting model across multiple organisations was effective and feasible and is recommended for adoption by health services.

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ObjectiveTo test the administration of intravenous (i.v.) propofol at a procedural sedation dose compared to standard therapy for initial management of migraine in the ED.MethodsThis was an open label, randomised controlled pilot trial. Eligible patients were adults with a diagnosis of migraine and planned for treatment with i.v. medications. Patients were randomised to propofol or standard therapy groups. The primary outcome variable was time to discharge (TTD) defined as time from intervention to discharge from the ED. Secondary outcomes were safety of propofol administration and change in pain scores. A reduction of pain by ≥50% or discharge from the ED was defined as favourable. All analyses were performed on an intention‐to‐treat basis.ResultsData from 29 patients were analysed, with 15 patients in the propofol group and 14 patients in the standard therapy group. TTD was significantly lower in the propofol group with median of 290 (interquartile range 162–500) min compared to 554.5 (interquartile range 534–639) min in the standard therapy group (P = 0.021). The hazard ratio for the defined favourable outcome of reduction of pain scores or discharge from the ED was 1.54 (95% CI 0.69–3.41).ConclusionsInitial management of migraine with i.v. propofol at procedural sedation doses significantly reduced TTD compared to standard therapy. We did not detect any significant safety concerns although the study was not adequately powered to detect safety of the intervention and requires validation.

Background Proton pump inhibitors (PPI) are extensively prescribed internationally and in Australia. However, minimal information is available on the appropriateness of PPI use in the general medical population. Aim This study determined the proportion of general medical unit (GMU) inpatients taking a PPI on admission and evaluated the appropriateness of these PPI prescriptions. Methods A single‐centre prospective observational study was conducted from 6 June to 11 July 2016. Consecutive patients were screened, and those taking a PPI prior to admission were included, whereas those not taking a PPI formed the control cohort. Appropriateness of PPI use was evaluated by: (1) reviewing for concordance with the Australian Therapeutic Guidelines and National Prescribing Service Guidelines on PPI use in gastro‐oesophageal reflux disease; (2) assessment of indication, dose and treatment duration by an expert panel consisting of two general physicians and one senior pharmacist. Results Among 440 consecutive GMU patients, 198 (45.0%) were taking a PPI on admission. Of these, 66.2% had an inappropriate indication, dose or treatment duration. The largest category of inappropriate PPI use was excessive treatment duration (43.4%). In terms of comorbid conditions, PPI users had a higher prevalence of osteoporosis and/or history of fracture (42.9% vs 27.2%; p < 0.001) and hypomagnesaemia (10.6% vs 3.4%; p = 0.003). Conclusion Inappropriate PPI use is highly prevalent among GMU inpatients. Given the potential for adverse effects, unnecessary health expenditure and pill burden, strategies should be developed to aid clinicians to consistently consider the utility of continuing long‐term PPI prescriptions in each patient's situation.

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