Structured teaching provided an effective and acceptable method of teaching the medicines management skills needed in the PRHO year. The structured approach complemented variable precourse clinical experience.

Pharmacists have become increasingly involved in influencing prescribing. Pharmaceutical education has changed accordingly, with increased teaching in therapeutics, partly on hospitals wards, giving students an insight into diseases and helping communication with clinicians. To extend this idea we have designed joint therapeutics teaching sessions with pharmacy and medical students. The scheme involves final year pharmacy students who have completed a course in clinical pharmacy and medical students who have completed their second MB. Interdisciplinary pairs of students are assigned a patient with common medical and therapeutic problems, such as arthritis, diabetes and cardiac failure; patients on multiple drug treatments are preferred. They jointly obtain a history: the medical student performs basic clerking, while the pharmacy student obtains the medication history. The medical student subsequently presents a brief medical history, with a summary of the patient's current problems. For each problem, the pharmacy student presents the current therapy, its rationale and how it is to be monitored. Experience with 73 students over 3 years has shown that almost all found sessions with students from another discipline useful. Few felt that members of the pairs contributed unequally. The main problem appeared to be insufficient time (although 2 1/2 h were allowed). Most students favoured more such sessions. Little difference in ability appeared between the two disciplines; there was considerable co-operation and little nascent 'professional rivalry'. The medical students were more comfortable interviewing patients, and the pharmacy students more confident analysing drug therapy. It is concluded that such interdisciplinary sessions are a successful method of clinical teaching and should be encouraged.

H yperkalemia is common in hospitalized patients, with an estimated prevalence of 1%-10%. 1,2 Hyperkalemia can lead to life-threatening cardiac arrhythmias. The risk of arrhythmias increases with serum potassium values >6.5 mmol/L, and hyperkalemia is associated with increased in-hospital mortality. 3 Treatment for hyperkalemia is indicated by a combination of the absolute serum potassium level, the rate of change of potassium level, and the presence of electrocardiogram abnormalities.Intravenous insulin stimulates the sodium/potassium-ATP pump, leading to intracellular uptake of potassium. Recommendations vary regarding the optimal dosing of insulin and dextrose for the treatment of hyperkalemia. 4 Hypoglycemia is a common complication following treatment of hyperkalemia with insulin/dextrose. The reported incidence in hospitalized patients ranges from 6% to 75% depending on the population studied, the doses of insulin/ dextrose administered, and the definition of hypoglycemia. [5][6][7][8] Hypoglycemia itself is associated with increased morbidity and mortality in hospitalized patients. 9 The aims of this study were to describe the incidence of hypoglycemia following hyperkalemia treatment with intra-venous insulin/dextrose in inpatients in a large (900-bed) UK teaching hospital and to determine the risk factors predisposing to hypoglycemia.

Management of paracetamol overdose (POD) is common in the emergency department (ED) and forms part of the clinical effectiveness audit programme of the British Association for Emergency Medicine. N-acetylcysteine (NAC) infusion regimens for the treatment of POD are complicated and prescribing and administration errors have been well documented. This study assessed the ability of doctors and nurses to calculate correct doses using manual calculation skills and a weightbased NAC dosing chart when prescribing and preparing NAC infusions. With manual calculations, errors were made by doctors and nurses in 26% of cases collectively. No errors were made using the dosing chart. The dosing chart ensured 100% accuracy in dose calculations, which may translate into improved patient safety.T reatment of paracetamol overdose (POD) with N-acetylcysteine (NAC) prevents hepatic failure. Suboptimal treatment may adversely affect patient outcome. NAC infusion regimens require complex calculations to be made by both prescribers and nurses preparing infusions. 1Errors with intravenous medicines requiring multiple step preparation or complex calculations have been highlighted.2 3 The use of dosing charts to prevent medication errors associated with complex calculations has been proposed by the Department of Health as a risk reduction strategy. 4 Typically, doses of NAC, diluent fluids and their volumes and durations of infusions are prescribed by doctors on intravenous infusion charts. In the UK, the preparation and administration of parenteral treatment is usually performed by trained nurses who calculate volumes of a 20% NAC solution (ParvolexH) required to prepare infusions based on doctors' prescriptions. When preparing NAC infusions, calculation errors have resulted in doses varying by more than 50% from the intended dose. 4 In 2005, there were 112 000 attendances to our emergency department (ED). Approximately 80 patients per month presented with a POD and 25% of these were treated with NAC. The infrequency with which NAC dose and volume calculations are performed in our department may increase the risk of medication errors. Most NAC prescribing for POD is initiated in EDs where pharmacists do not routinely check prescriptions or drug administration to ensure safe medicine use. Incorrect prescriptions for NAC infusions initiated in the ED have been identified and corrected by pharmacists when patients have been reviewed following admission to wards.The aim of this study was to compare the accuracy of doses and volumes calculated manually by ED staff when prescribing and preparing NAC infusion regimens with those derived from a weight-based NAC dosing chart. METHODSA weight-based NAC dosing chart (fig 1), based on the standard treatment regimen for POD in adults (http:// www.spib.axl.co.uk; http://emc.medicines.org.uk/emc/industry/ default.asp?page = displaydoc.asp&documentid = 1127), 5 was designed by pharmacists in conjunction with ED practitioners. Doctors and nurses of all grades involved in NAC prescribing and administrat...

This study highlights that detailed analysis of data from reports is essential in understanding MIs and developing strategies to prevent their recurrence. Using DDDs in the analysis of MIs allowed determination of an incident rate providing more useful information than the absolute numbers alone. It also highlighted the disproportionate risk associated with less commonly prescribed antibiotics not identified using MI reporting rates alone.