Evaluation of national guidelines for bronchiolitis: AGREEments and controversies.

AIM: Bronchiolitis is a common respiratory illness and is a leading cause of hospitalisation in infancy. We aimed to appraise three recent national bronchiolitis guidelines produced by the Australasian Paediatric Research in Emergency Departments International Collaborative, the National Institute for Health and Care Excellence in the UK and the American Academy of Pediatrics. METHODS: A group of final-year medical students and one senior clinician used the AGREE II tool to appraise each guideline in two stages. First, two students appraised each guideline independently and presented their results. Second, two self-selected students met with the senior clinicians to review all scores to ensure completeness of the appraisal and consistency of AGREE II application. RESULTS: The guidelines scored well overall, with particular strengths in the domains of clarity of presentation, scope and purpose and rigour of development. Comparison of the recommendations across each guideline demonstrated a high degree of consistency. Notable differences included recommendations for the role of palivizumab in prevention of bronchiolitis, the use of continuous pulse oximetry monitoring in the hospitalised patient and the value of respiratory virus testing. CONCLUSIONS: Our appraisal of bronchiolitis guidelines from three high-income countries demonstrated that they were of high quality, with substantial areas of agreement. Most aspects of clinical practice should be uniform for this common paediatric condition. Areas of guideline weakness were in the domains of applicability and editorial independence. We identified three areas of controversy where further research is needed to support stronger evidence-based recommendations.

Considering pharmacy workflow in the context of Australian community pharmacy: A pilot time and motion study.

BACKGROUND: Given time pressures on primary care physicians, utilising pharmacists for chronic disease management is of great interest. However, limited data are available on the current workflow in community pharmacies to guide these discussions. OBJECTIVE: This study aimed to test the feasibility of collecting workflow data from Australian community pharmacies using the Work Observation Method By Activity Timing (WOMBAT) software and provide preliminary data on Australian pharmacy workflow. METHODS: Data were collected from three pharmacies and four variables were recorded: what the pharmacist did, with whom, where and how. All tasks were timed and data were analysed to identify total number of tasks, median time per task, proportion of time per task, and common task combinations. RESULTS: Pharmacists' main tasks consisted of counselling, dispensing and management activities (27%, 21% and 17% respectively of the overall number of tasks) and these tasks also took the majority of their time. Tasks were frequent but short, with the average time per task ranging from 0.55 to 8.46 min and most time was spent in areas without the capacity for patient interaction (51% in the dispensing/compounding area and 6% in the back office). CONCLUSIONS: Pharmacies are dynamic environments with the average task taking 1-2 min. Longer interventions may not be easily integrated into current pharmacy workflow.