Benefits, challenges and contributors to the introduction of new hospital-based outpatient clinic pharmacist positions.

Background: Pharmacists working within interprofessional teams in the outpatient setting are well placed to address medication-related problems before and after hospital admission. Therefore, exploration of these roles is warranted. Objectives: To explore pharmacists' and other health professionals' perspectives of the impact of pharmacists working within interprofessional teams in outpatient clinics. Furthermore, we endeavoured to identify both the challenges and contributors to success with the introduction of pharmacists into these settings. Methods: This qualitative study involved semi-structured interviews with both hospital outpatient clinic pharmacists and other clinic health professionals to gain an in-depth understanding of how the introduction of pharmacists into clinics impacted clinic processes, patient care, and relationships with other health professionals. Participants were recruited from the outpatient clinics who had recently added a pharmacist to their service. Participants involved in setting up the roles were invited to participate in a voluntary interview, the transcripts from which were analysed into themes and sub-themes using an inductive and deductive approach. Results: A total of 34 staff were interviewed of which 68% were female and 74% were aged between 31 and 50 years. The cohort included 16 outpatient pharmacists, nine pharmacist team leaders, five clinic nurses and four clinic doctors (specialist consultant or registrar). Three overall themes were identified: the benefits, the contributors, and the challenges of introducing clinical pharmacy services to outpatient clinics. When establishing a clinic role, pharmacists' awareness, adaptability, and strong communication were shown to be key traits to building rapport and trustworthiness with the established clinic team. Conclusions: When pharmacists are integrated into multidisciplinary outpatient clinics they and their colleagues believe that they provide benefits to the patients and the clinics. Decision makers need to be cognizant of factors that contribute to, as well as those that impede, the successful implementation of outpatient pharmacist roles.

The Seniors' Community Hub: An Integrated Model of Care for the Identification and Management of Frailty in Primary Care.

(1) Background: Integrated models of primary care deliver the comprehensive and preventative approach needed to identify and manage frailty in older people. Seniors' Community Hub (SCH) was developed to deliver person-centered, evidence-informed, coordinated, and integrated care services to older community dwelling adults living with frailty. This paper aims to describe the SCH model, and to present patient-oriented results of the pilot. (2) Methods: SCH was piloted in an academic clinic with six family physicians. Eligible patients were community dwelling, 65 years of age and older, and considered to be at risk of frailty (eFI > 0.12). Health professionals within the clinic received training in geriatrics and interprofessional teamwork to form the SCH team working with family physicians, patients and caregivers. The SCH intervention consisted of a team-based multi-domain assessment with person-centered care planning and follow-up. Patient-oriented outcomes (EQ-5D-5L and EQ-VAS) and 4-metre gait speed were measured at initial visit and 12 months later. (3) Results: 88 patients were enrolled in the pilot from April 2016-December 2018. No statistically significant differences in EQ-5D-5L/VAS or the 4-metre gait speed were detected in 38 patients completing the 12-month assessment. (4) Conclusions: Future larger scale studies of longer duration are needed to demonstrate impacts of integrated models of primary care on patient-oriented outcomes for older adults living with frailty.

Piloting the Describing and Evaluating community Pharmacy practice to Improve patients' Care and Treatment tool.

OBJECTIVE: To pilot the Describing and Evaluating community Pharmacy practice to Improve patients' Care and Treatment (DEPICT) tool to determine its utility in collecting data about Australian community pharmacist activities and patient-related encounters. METHODS: DEPICT tool was developed and tested. Two pharmacy students recruited study patients and collected data in four urban pharmacies. KEY FINDINGS: Fourteen pharmacists completed 189 DEPICT forms. Pharmacists' evaluations indicated overall high levels of satisfaction and provided valuable recommendations for improvement. CONCLUSIONS: Pharmacists' feedback will be incorporated into future iterations of DEPICT that will include electronic collection of regional data in urban and rural settings.

Appropriateness of Medications in Older Adults Living With Frailty: Impact of a Pharmacist-Led Structured Medication Review Process in Primary Care.

Background: Older persons with frailty take multiple medications and are vulnerable to inappropriate prescribing. Objective: This study assesses the impact of a team-based, pharmacist-led structured medication review process in primary care on the appropriateness of medications taken by older adults living with frailty. Methods: This was a quasi-experimental pretest-posttest design in 6 primary care practices within an academic clinic in Edmonton, Alberta, Canada. We enrolled community dwelling older adults 65 years and older with frailty who have polypharmacy and/or 2 or more chronic conditions (ie, high-risk group for drug-related issues). The intervention was a structured pharmacist-led medication review using evidence-based explicit criteria (ie, Beers and STOPP/START criteria) and implicit criteria (ie, pharmacist expertise) for potentially inappropriate prescribing, done in the context of a primary care team-based seniors' program. We measured the changes in the number of medications pre- and postmedication review, number of medications satisfying explicit criteria of START and STOPP/Beers and determined the association with frailty level. Data were analyzed using descriptive and inferential statistics (a priori significance level of P < .05). Results: A total of 54 participants (61.1% females, mean age 81.7 years [SD = 6.74]) enrolled April 2017 to May 2018 and 52 participants completed the medication review process (2 lost to hospitalization). Drug-related problems noted on medication review were untreated conditions (61.1%), inappropriate medications (57.4%), and unnecessary therapy (40.7%). No significant changes in total number of medications taken by patients before and after, but the intervention significantly decreased number of inappropriate medications (1.15 meds pre to 0.9 meds post; P = .006). Conclusion: A pharmacist-led medication review is a strategy that can be implemented in primary care to address inappropriate medications.

Developing Preliminary Steps in a Pharmacist Communication - Patient Outcome Pathway.

BACKGROUND: Nonadherence to medication therapy has been associated with poor health outcomes and increased health care costs. The literature describes pharmacists as key health care professionals in identifying and addressing nonadherence issues but does not explain how and why effective pharmacist-patient communication affects patients' medication adherence. Previously published pathways used in linking effective physician-patient communication to patient outcomes are proposed for the context of pharmacist-patient communication. OBJECTIVES: To develop preliminary steps in a pharmacist communication - patient outcome pathway, adapted from a physician-patient communication pathway. METHODS: This longitudinal descriptive study, which took place in a large quaternary hospital, involved hospital pharmacists and patients. Patients' assessment of pharmacist communication behaviours and reporting of patient satisfaction occurred after the pharmacist-patient consultation. Medication-taking behaviour questionnaires were administered before the consultation and again 4 weeks after discharge. Developing the preliminary pathway (based on previously established physician communication pathways) involved 2 steps, with investigation of the following associations: (1) between patient-reported effective communication by pharmacists, as per the Communication Accommodation Theory (CAT), and patient satisfaction; and (2) between patient-reported pharmacist communication and satisfaction and patients' medication-taking behaviour. RESULTS: Twelve pharmacists and 48 patients participated. For step 1, almost all patient-reported pharmacist communication behaviours were positively correlated with patient satisfaction statements. Strong associations between CAT-related pharmacist communication behaviours and patient satisfaction highlighted the pharmacists' behaviours that are important to patients and necessary for effective conversations to take place. In step 2, there were fewer correlations of medication-taking behaviour indices with pharmacist communication behaviours and patient satisfaction. CONCLUSIONS: This study showed how a preliminary pharmacist communication - patient outcome pathway could be successfully adapted from existing physician communication pathways. Such pathways provide an initial platform upon which future pharmacist communication - patient outcome research can be built.

CONTEXTE: Le non-respect de la pharmacothérapie a été associé à de mauvais résultats sur la santé et à une augmentation des coûts des soins de santé. La documentation actuelle décrit les pharmaciens comme étant les professionnels de la santé les mieux placés pour déceler les problèmes de non-respect de la prise de médicaments et pour y répondre. Toutefois, elle n'explique pas comment ni pourquoi une communication efficace entre le pharmacien et le patient incite le patient à respecter sa médication. Les parcours qui ont aidé les médecins à améliorer l'efficacité de la communication avec leurs patients sont désormais proposés aux pharmaciens dans le contexte de leur relation avec le patient. OBJECTIFS: Développer les étapes préliminaires d'un parcours de communication entre le pharmacien et le patient adapté à partir des résultats tirés du parcours de communication entre le médecin et le patient. MÉTHODES: Cette étude descriptive longitudinale, qui s'est déroulée dans un important hôpital de soins quaternaires, portait sur les pharmaciens d'hôpitaux et les patients. L'évaluation par les patients des comportements de communication des pharmaciens et le rapport sur la satisfaction du patient se sont déroulés après la consultation qui a eu lieu entre le pharmacien et le patient. Les questionnaires relatifs à la prise de médicaments ont été administrés avant la consultation et à nouveau quatre semaines après le congé hospitalier. L'élaboration du parcours préliminaire (basée sur les parcours de communication du médecin déjà établis) comportait deux étapes servant à examiner les associations suivantes : (1) le rapport qu'ont fait les patients sur l'efficacité de la communication des pharmaciens conformément à la théorie de l'accommodation de la communication (TAC) et la satisfaction du patient et (2) le rapport qu'ont fait les patients sur la communication des pharmaciens ainsi que leur satisfaction et la prise de médicaments des par les patients. RÉSULTATS: Douze pharmaciens et 48 patients ont participé à l'étude. Concernant la première étape, presque tous les patients ont rapporté que les comportements de communication des pharmaciens étaient positivement corrélés aux énoncés de satisfaction des patients. Les fortes associations entre les comportements de communication liés à la TAC du pharmacien et la satisfaction des patients mettaient en exergue les comportements des pharmaciens qui sont importants pour les patients et nécessaires pour accroître l'efficacité des conversations. Concernant la deuxième étape, les corrélations étaient moindres entre les indices de comportement liés à la prise de médicaments et les comportements de communication du pharmacien ainsi que la satisfaction du patient. CONCLUSIONS: Cette étude a démontré comment un parcours de communication préliminaire entre le pharmacien et le patient peut être adapté avec succès à partir des résultats tirés des parcours de communication existants destinés au médecin. De tels parcours fournissent une plateforme initiale sur laquelle peuvent se développer les recherches futures servant à démontrer les résultats sur les patients de la communication du pharmacien.

Using Discursis to enhance the qualitative analysis of hospital pharmacist-patient interactions.

INTRODUCTION: Pharmacist-patient communication during medication counselling has been successfully investigated using Communication Accommodation Theory (CAT). Communication researchers in other healthcare professions have utilised Discursis software as an adjunct to their manual qualitative analysis processes. Discursis provides a visual, chronological representation of communication exchanges and identifies patterns of interactant engagement. AIM: The aim of this study was to describe how Discursis software was used to enhance previously conducted qualitative analysis of pharmacist-patient interactions (by visualising pharmacist-patient speech patterns, episodes of engagement, and identifying CAT strategies employed by pharmacists within these episodes). METHODS: Visual plots from 48 transcribed audio recordings of pharmacist-patient exchanges were generated by Discursis. Representative plots were selected to show moderate-high and low- level speaker engagement. Details of engagement were investigated for pharmacist application of CAT strategies (approximation, interpretability, discourse management, emotional expression, and interpersonal control). RESULTS: Discursis plots allowed for identification of distinct patterns occurring within pharmacist-patient exchanges. Moderate-high pharmacist-patient engagement was characterised by multiple off-diagonal squares while alternating single coloured squares depicted low engagement. Engagement episodes were associated with multiple CAT strategies such as discourse management (open-ended questions). Patterns reflecting pharmacist or patient speaker dominance were dependant on clinical setting. DISCUSSION AND CONCLUSIONS: Discursis analysis of pharmacist-patient interactions, a novel application of the technology in health communication, was found to be an effective visualisation tool to pin-point episodes for CAT analysis. Discursis has numerous practical and theoretical applications for future health communication research and training. Researchers can use the software to support qualitative analysis where large data sets can be quickly reviewed to identify key areas for concentrated analysis. Because Discursis plots are easily generated from audio recorded transcripts, they are conducive as teaching tools for both students and practitioners to assess and develop their communication skills.

Hospital pharmacists' and patients' views about what constitutes effective communication between pharmacists and patients.

OBJECTIVES: The study's objective was to explore hospital pharmacists' and patients' views about what constitutes effective communication exchanges between pharmacists and patients. METHODS: This was a novel theory-based qualitative study using semi-structured interviews to elicit patients' and pharmacists' perspectives. Pharmacists providing clinical pharmacy services in either inpatient or outpatient settings were recruited first. Eligible patients had been admitted to a study pharmacist's practice area and were prescribed three or more medications to manage a chronic disease(s). Following each pharmacist-patient medication counselling session, semi-structured interviews were held separately with patients and pharmacists. Participants were asked questions intended to explore their views about what constitutes an effective pharmacist-patient conversation. Audio recordings were transcribed verbatim, analysed using a process of inductive thematic analysis and then mapped to Communication Accommodation Theory strategies. Observational notes and reflexive note taking were conducted throughout. KEY FINDINGS: Twelve pharmacists each engaged four individual patients for a total of 48 pharmacist-patient conversations (resulting in 48 separate interviews with pharmacists and patients). An overall shared goal was the assurance of patients' confidence in managing their medications at home. Themes included shared colloquialisms/slang, well-explained information, engagement, established rapport and empowerment. Participants provided rich exemplars for each of the themes. CONCLUSIONS: Pharmacists and patients provided valuable insights about what makes pharmacist-patient interactions effective. Patient-identified preferences for pharmacist-patient exchanges may help guide pharmacy students and practitioners to engage patients in effective conversations.

Investigating strategies used by hospital pharmacists to effectively communicate with patients during medication counselling.

BACKGROUND: Medication counselling opportunities are key times for pharmacists and patients to discuss medications and patients' concerns about their therapy. Communication Accommodation Theory (CAT) describes behavioural, motivational and emotional processes underlying communication exchanges. Five CAT strategies (approximation, interpretability, discourse management, emotional expression and interpersonal control) permit identification of effective communication. OBJECTIVE: To invoke CAT to investigate communication strategies used by hospital pharmacists during patient medication counselling. DESIGN: This was a theory-based, qualitative study using transcribed audiorecordings of patients and hospital pharmacists engaged in medication counselling. SETTING AND PARTICIPANTS: Recruited pharmacists practised in inpatient or outpatient settings. Eligible patients within participating pharmacists' practice sites were prescribed at least three medications to manage chronic disease(s). MAIN OUTCOME MEASURES: The extent to which pharmacists accommodate, or not, to patients' conversational needs based on accommodative behaviour described within CAT strategies. RESULTS: Twelve pharmacists engaged four patients (48 total interactions). Exemplars provided robust examples of pharmacists effectively accommodating or meeting patients' conversational needs. Non-accommodation mainly occurred when pharmacists spoke too quickly, used terms not understood by patients and did not include patients in the agenda-setting phase. Multiple strategy use resulted in communication patterns such as "information-reassurance-rationale" sandwiches. DISCUSSION AND CONCLUSIONS: Most pharmacists effectively employed all five CAT strategies to engage patients in discussions. Pharmacists' communication could be improved at the initial agenda-setting phase by asking open-ended questions to invite patients' input and allow patients to identify any medication-related concerns or issues.

Health Care Professionals' Opinions and Expectations of Clinical Pharmacy Services on a Surgical Ward.

BACKGROUND: Pharmacists have made significant contributions to patient care and have been recognized as integral members of the interprofessional team. Health care professionals differ in their opinions and expectations of clinical pharmacy services. Very little has been published about health care professionals' perspectives on advanced clinical pharmacy roles, such as prescriptive authority or administration of vaccines. In 2013, clinical pharmacy services were introduced in a vascular and general surgery ward where a pharmacist had not previously been assigned. OBJECTIVES: To explore surgical nurses' and physicians' opinions and expectations of clinical pharmacy services and to determine how these views changed over time; to compare pharmacists' views of clinical pharmacy services with those of nurses and physicians; and to develop validated survey tools. METHODS: Three survey tools were created and validated, one for each profession. Surveys were distributed to nurses and physicians assigned to the general and vascular surgery ward before introduction of clinical pharmacy services and 8 months after implementation. Hospital pharmacists were invited to complete the survey at one time point. RESULTS: Differences existed in the opinions of nurses, physicians, and pharmacists about some traditional activities. Nurses and physicians indicated stronger agreement with pharmacists participating in medication reconciliation activities than did pharmacists (p < 0.001), whereas a greater proportion of pharmacists felt that they were the most appropriate health care professionals to provide medication discharge counselling, relative to nurses and physicians (p = 0.001). Respondents supported advanced roles for pharmacists, such as collaborative practice agreements, but there was less support for prescribing, physical assessments, and administration of vaccines. Nurses indicated the strongest agreement with pharmacist prescribing (82% versus 69% among pharmacists and 27% among physicians; p < 0.001). Nurses and physicians expressed strong endorsements of clinical pharmacy services in the surveys' comment sections. CONCLUSIONS: The introduction of clinical pharmacy services to a surgical health care team resulted in high levels of satisfaction among nurses and physicians who responded to this survey. Differences in perceptions of traditional clinical pharmacy service activities and advanced practice roles need to be studied in more depth to better understand the factors influencing health care professionals' views.

Les pharmaciens ont fait d'importantes contributions aux soins aux patients et ils ont d'ailleurs été reconnus comme membres à part entière de l'équipe interprofessionnelle. Les professionnels de la santé ont des opinions et des attentes variées en ce qui concerne les services de pharmacie clinique. Or, il n'y a que très peu de documents publiés à propos des points de vue soutenus par les professionnels de la santé sur les rôles en pharmacie clinique avancée, notamment le droit de prescrire et l'administration de vaccins. En 2013, des services de pharmacie clinique ont fait leur entrée dans une unité de chirurgie générale et vasculaire où aucun pharmacien n'avait été affecté auparavant.

Hospital pharmacists' perceptions of medication counseling: A focus group study.

BACKGROUND: Medication counseling sessions are key times for a pharmacist to speak to patients about their medications and the changes made to their therapies during their hospital stay. OBJECTIVES: To explore hospital pharmacists' perceptions of their roles and goals in patient medication counseling, and perceived barriers and facilitators to achieving their goals. METHODS: Hospital pharmacist focus groups were held in two tertiary referral hospitals. Eligible pharmacists had provided medication counseling within the previous six months in inpatient and/or outpatient settings. Interested pharmacists attended a focus group designed to elicit their opinions and perceptions of patient medication counseling. Focus groups were audio recorded and transcribed verbatim. Inductive thematic analysis was applied to the data to identify initial patterns (codes) which were then organized into common overarching themes using NVivo(®) software. The codes were reviewed for reliability by pharmacists independent of the focus groups. RESULTS: Six, 1-h focus groups were conducted with a total of 24 pharmacists participating. Saturation of information was determined after four focus groups. Greater than 80% consensus was achieved for reliability of the identified codes. A number of themes emerged from these codes around the goals, roles, and the barriers and facilitators to meeting these goals. Pharmacists' patient-centered goals in medication counseling were to build rapport, to empower patients and to improve patients' experience, health and safety. These goals would be accomplished through specific roles such as being an assessor, educator and problem-solver. Pharmacists frequently cited time pressures caused by systemic (hospital), and pharmacy specific processes as key challenges to achieving their goals. Factors that enabled pharmacists to meet their goals were those related to effective interprofessional collaboration and the quality of professional practice (such as training, expanded roles and advanced planning for discharge). CONCLUSIONS: Hospital pharmacists emphasized patient-centered goals in medication counseling and outlined the challenges to meet those goals. The findings from this study will be used to develop strategies for effective communication and inform pharmacy practice changes to improve patient care.

Examining hospital pharmacists' goals for medication counseling within the communication accommodation theoretical framework.

BACKGROUND: Medication counseling opportunities are key times for pharmacists to speak to patients about their medications and any changes made during their hospital stay. Communication Accommodation Theory (CAT) posits that an individual's goals drive their communication behavior. The way in which pharmacists communicate with patients may be determined by the goals they set for these medication counseling sessions. OBJECTIVES: To examine hospital pharmacists' goals in patient medication counseling within the CAT framework. METHODS: Hospital pharmacist focus groups were held in two teaching hospitals. Interested pharmacists attended a focus group designed to elicit their goals in patient medication counseling. Focus groups were audio recorded and transcribed verbatim. NVivo(®) software was used to assist in coding and organization. The codes were reviewed for reliability by pharmacists independent of the focus groups. An inductive thematic analysis was applied to the data. RESULTS: Six 1 h focus groups were conducted with a total of 24 pharmacists participating. Saturation of information was achieved after four focus groups. Greater than 80% consensus was achieved for reliability of the identified codes. Patient-centered themes constructed from these codes were to build rapport, to empower patients and to improve patients' experience, health and safety. Exemplars provided by pharmacists for the goals of building rapport and empowering patients were aligned with five CAT communication behaviors (approximation, interpretability, discourse management, emotional expression and interpersonal control). CONCLUSIONS: Patient-centered goals described by hospital pharmacists for medication counseling aligned well with CAT behaviors necessary for effective communication. Further research using the CAT framework to examine the effectiveness of hospital pharmacist-patient exchanges that include both participants' perspectives is required to better understand how well pharmacists communicate with patients.

Clinical benefits and economic impact of post-surgical care provided by pharmacists in a Canadian hospital.

OBJECTIVE: Clinical pharmacists improve the quality of patient care by reducing adverse drug events (ADEs), length of stay and mortality. This impact is currently not well described in surgery. The objective was to evaluate clinical and economic outcomes after clinical pharmacist services were added to two general surgical wards in an adult hospital. METHODS: This was a prospective, observational study. All clinical interventions to resolve drug therapy problems were documented and assessed for severity, value and the probability of preventing an ADE. Cost avoidance was calculated using two methods: by avoiding additional days in hospital (CA$3593/ADE) or additional hospital costs ($7215/ADE). Two clinical pharmacy specialists and the surgical care pharmacist independently categorized the interventions; disagreements were resolved by consensus. KEY FINDINGS: The pharmacists made 1097 interventions in 6 months with a 98% acceptance rate by surgical staff. Half of the interventions were rated significant for severity (561, 51.1%) and value (559, 51.0%). One-quarter of the interventions had a 40% or greater probability of preventing an ADE (270, 24.6%). Cost avoidance was estimated to be $0.68-1.36 million or $617-1239 per intervention. Pharmacists avoided an additional 867 days in the hospital for surgical patients. CONCLUSION: The pharmacist's role in the management of the drug therapy needs of the post-surgical patient has the potential to improve clinical and patient outcomes and avoid healthcare costs. The inclusion of clinical pharmacists in surgical wards may result in $7 in savings for every $1 invested.

Piloting an outpatient policy for funding drugs and their administration in rheumatology.

To ensure appropriate use of outpatient clinic resources, an inter-professional group drafted a policy for an equitable, consistent process requiring the use of patients' drug insurance. The authors' organization remains the payer of last resort. A pilot tested and further informed this policy by targeting rituximab in rheumatoid arthritis. Staff were in-serviced, resources were arranged and patients were informed. Thirty-nine pilot patients (87%) had drug insurance, resulting in a savings of $304,700. Fifty-one hospital infusions were administered in private clinics, avoiding $19,125 in clinic costs. Patient and staff/stakeholder satisfaction surveys provided valuable feedback. Lessons learned will be applied to the policy and related processes in preparation for an organizational-wide implementation.

Patient outcomes, economic benefits associated with a heparin change in hemodialysis, and nurses' satisfaction.

Heparin is commonly administered during hemodialysis to prevent clotting in the extracorporeal circuit. The authors' unit instituted a change in heparin type and preparation procedure based on patient safety and potential cost savings. Fifty patient charts were reviewed to determine whether the change affected specific patient outcomes. Economic impact measures included drug, supply, and labor costs. No changes in hemodialysis efficacy or rates of adverse events were observed. Annual cost savings were estimated to be $81,627 USD.

Evaluating clinical pharmacy services on a surgical patient-care area: a nurses' satisfaction survey.

OBJECTIVES: To determine nurses' perceptions and expectations of clinical pharmacists prior to, and 9 months after, clinical pharmacy services were introduced on two general and gastrointestinal surgery hospital wards in Canada. METHODS: A survey tool was developed based on previous research, validated to ensure reliability and accuracy, and administered to approximately 70 nurses on the surgery wards. KEY FINDINGS: Response rates for the pre and post surveys were 75% and 67% respectively. Nurses indicated that the quality of pharmacy service improved significantly from pre to post survey (85% versus 95%; P < 0.0001). There was a statistically significant increase in positive responses to seven out of eight statements such as accessibility of pharmacists, timely responses to drug-related questions, and timely delivery of unit doses and intravenous admixtures. Almost all statements about nursing staff expectations showed increases in agreement. At least 85% of nurses indicated their expectations had been met or exceeded for all but one clinical pharmacy service. A higher proportion of nurses in the post survey felt that clinical pharmacists positively impact on their roles and responsibilities as a nurse. Comments from nurses indicated enthusiastic support for clinical pharmacy services. CONCLUSIONS: A survey tool to assess the quality of pharmacy services in the hospital setting has been developed, validated, and distributed. A high level of nurses' satisfaction with the provision of new clinical pharmacy services on general surgery/gastrointestinal surgery wards was demonstrated. Nursing staff were more aware of the responsibilities of clinical pharmacists and how the clinical pharmacist role could assist them in their own nursing practice. The survey may be useful for other wards and other institutions to measure satisfaction with pharmacy services.

Nurses' perceptions of medication safety and medication reconciliation practices.

Medication reconciliation (MR) involves the accurate transfer of medication information across the continuum of care. The aim of this study was to measure nurses perceptions of patient safety, medication safety and current MR practice at transition points in a patient's hospital stay. Surveys were distributed to 111 nursing staff in three general medicine units at Capital Health District, Nova Scotia, in August 2005. A total of 39 nurses (35% response rate) completed the survey. "Teamwork within units" was the safety culture dimension with the highest positive response (98.1%), while the processes of handoffs and transitions received the lowest positive response (42.8%). Key areas identified for improvement relative to the current level of MR practice include institutional patient safety systems (e.g., low confidence in existing systems and procedures), inconsistent practices (e.g., wide variation in whether community pharmacists are contacted to verify medication profiles), lack of communication (e.g., between healthcare professionals) and staffing resources (e.g., MR is perceived as a very time-consuming process). Addressing these challenges prior to implementing a formalized MR program should help to ensure success of the project. The insights gained through the use of this survey may prove valuable to other Canadian healthcare organizations that are implementing MR services.

Nutrient supply enhances both IGF-I and MSTN mRNA levels in chicken skeletal muscle.

Nutrient supply may control muscle growth directly and indirectly through its influence on regulatory factors. The present study focuses on its effects on muscle insulin-like growth factors (IGF-I and -II) and myostatin (MSTN). Their mRNA levels were quantified by real time RT-PCR in pectoralis major (PM) and sartorius (SART) muscles from broiler chickens submitted to different feeding regimens (fed or fasted for 48 h) between hatch and 2 days of age and at 4 weeks of age. In the PM of 4 weeks old broilers, mRNA levels were also evaluated after a 16 h-fast and a refeeding period (refed 24 or 48 h after a 48 h-fast). In the PM muscle, both IGF-I and MSTN mRNA levels increased between 0 and 2 days of age in the fed group, while they remained low in the unfed one. A comparable trend was observed in the SART, but with lesser amplitude. In both muscles of 4 weeks old chickens, a 48 h-fast induced a significant reduction in MSTN mRNA levels (20% of fed state). In the PM, this effect required more than 16 h of fasting to occur and was fully reversed by only 24h of refeeding. IGF-I mRNA levels also varied with nutritional state. They decreased significantly with fasting in the SART muscle. By contrast, IGF-II mRNA levels did not vary significantly. Our data shows for the first time that two major paracrine regulators of muscle growth, IGF-I and MSTN, are sensitive to nutrient supply in hatching chicks, and also that fasting reduced IGF-I and MSTN mRNA levels in muscles of older chickens.