SUMMARY Background Successful management of chronic kidney disease (CKD) depends on patients′ self‐management efforts. Mobile health applications can empower patients with CKD to manage their own condition. We developed, with patient involvement, the MiKidney smartphone application. Aim Evaluate the MiKidney app as an aid to empowering patients with CKD to become more engaged in the management of their condition. Design Pilot single group pre‐ and post‐test intervention study. Setting Renal clinic of an urban University Hospital in Ireland. Patients Aged over 18 years with CKD and able to use a smartphone. Sample size based on expression of interest and availability of free smartphones (n = 23); three patients withdrew prior to T3 data collection (n = 20). Measurements Data were collected at T1 (baseline), T2 (week 6) and when exiting the study (T3, 12 weeks) on physical activity, body measurements and blood parameters. Information on app usage and patient satisfaction collected at T2 and T3. Results There was significant improvement in the six‐minute walking test (p = 0.02), total cholesterol (p = 0.023) and LDL cholesterol (p = 0.005) serum levels and a significant decrease in waist circumstance (p = 0.00) and body fat (p = 0.01) measurements. Eighteen participants found the MiKidney app easy to navigate. Conclusion The MiKidney study highlights the viability and usability of the MiKidney app. It has the potential to empower and motivate patients to understand and self‐manage their condition by providing them with the necessary information on renal diet and symptom management. Additionally, tools such as exercise tracker and reminder alerts are available on a readily accessible user‐friendly platform.
Background An extension to the Mater Campus Hospital Development was anticipated to represent considerable logistical and functional difficulties for the delivery of drugs from one central Pharmacy site. It was proposed that a prospective study be conducted to identify areas of inefficiency in the current requisitions delivery schedule and determine how best to maximise efficiency and facilitate service expansion. Purpose To identify areas of inefficiency in the current requisitions delivery schedule from the MMUH Pharmacy dispensary to wards. To explore the needs and expectations of clinical pharmacists with respect to the current and future scheduling and delivery to identify key areas of concern for impact on clinical pharmacy service. Materials and methods A triangulated method was used to investigate the scheduling, personnel and workload components of the schedule of requisitios deliveries and their effect on the efficiency of medicines delivery. This incorporated direct structured observation of the delivery schedule, quantification of pharmacy ward requisitions using queuing theory and a census of clinical pharmacists with an anonymous structured questionnaire. Results Statistically significant variation (p < 0.001) was identified when deliveries were categorised according to scheduled delivery time and destination. Differences between peak delivery times and other deliveries demonstrated inefficient operation. Queuing theory enabled baseline operating characteristics to be derived. Fluctuations in operating characteristics on the basis of staff numbers were also identified. Clinical pharmacists were generally satisfied or very satisfied with the current delivery times but the inability to guarantee times of drug deliveries was the biggest perceived problem with the delivery schedule. Conclusions This investigation successfully identified inefficiencies within scheduled Pharmacy deliveries. The cumulative findings identified that improvement in productive efficiency can be achieved without additional resources. Recommendations to enhance efficiency were made, providing for the development of evidence-based solutions to the logistical and functional problem of hospital expansion. No conflict of interest.
BackgroundMedication review is an essential part of comprehensive geriatric care, and is a primary function of the clinical pharmacist (CP). A new CP service has been established in a Care of the Elderly (COE) Day Hospital with the aim of improving outcomes from medication use. The CP service centres on medication review and patient education.PurposeTo develop a clinical pharmacy service in the day hospital to improve the quality of pharmaceutical care provided to care of the elderly patients.Material and methodsData from the first 3 months of the service were collected prospectively to measure the quantity and type of CP interventions. The potential clinical outcome of each intervention was assessed by the day hospital CP and a gerontology SpR using a validated visual analogue scale (0–10, 0 representing no potential effect and 10 representing death). The frequency with which advised changes were acted upon by the treating doctor was also recorded.ResultsOne hundred and ninety-five patients (mean 81 years, age range 58–98 years) were reviewed during 33 clinic days. A current medication list was obtained for all patients and an average of 1.8 pharmaceutical care interventions were identified per patient. Of these 340 interventions, the medical team or patient agreed with 54%, 39% were not accepted and 6% had an unknown outcome.The interventions were classified according to type as follows: 18% actual or potential adverse reaction, 14% each for supratherapeutic dose and untreated indication, 11% subtherapeutic dose and 10% each for improper administration, drug without indication and education provided to the patient.The clinical significance mean scores were categorised as leading potentially to minor harm (<3)=10%, moderate harm (3–7)=89% and severe harm (>7)=1%. Good agreement was observed between the two assessors (Pearson correlation coefficient=0.97).ConclusionCP medication usage review in the day hospital has resulted in a positive contribution to the care of elderly patients. Opportunities to improve visibility of the service will be explored.No conflict of interest
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