Consequence of delegating medication-related tasks from physician to clinical pharmacist in an acute admission unit: an analytical study.

OBJECTIVES: Studies have shown that medication histories obtained by clinical pharmacists (CPs) are more complete, and that medication reviews by CPs reduce healthcare costs, drug-related readmissions and emergency readmissions. The aim of this study was to identify the consequences of delegating medication-related tasks from physicians to CPs. METHODS: An analytical study based on data from a prospective cluster randomised trial was performed. The intervention consisted of CPs obtaining medication history, performing medication reconciliation and medication review. The physician had to approve the prescriptions and assess changes proposed by the CP. The primary outcome measure was a comparison of changes in the Electronic Medication Module (EMM) and changes proposed by CPs. RESULTS: 232 and 216 patients were included on control days (n=63) and intervention days (n=63). In total, 1018 changes were made in the control group (by physicians). In the intervention group 2123 changes were made, 1808 by CPs and 315 by physicians. In particular, the number of substitutions, registration of drugs and change of instructions for use (eg, administration times) differed between physicians and pharmacists. CPs made 341 written proposals in the intervention group and, of these, 22.9% (95% CI 18.7% to 27.8%) and 50.9% (95% CI 45.5% to 56.2%) were accepted by a physician at discharge from the acute admission unit (AAU) and hospital, respectively. CONCLUSIONS: CPs updated the EMM more thoroughly than physicians, especially entering new prescriptions, substitutions and changing instructions for use. Half of the written proposals were accepted. The extent to which patients benefit from a CP intervention is unknown.

Impact of clinical pharmacist intervention on length of stay in an acute admission unit: a cluster randomised study.

OBJECTIVES: Physicians in acute admission units (AAUs) are obliged to obtain medication history and perform medication reconciliation, which is time consuming and often incomplete. Studies show that clinical pharmacists (CPs) can obtain accurate medication histories, but so far no studies have investigated the effect of this on time measures. Therefore, the objective of the present study was to investigate the effect of a CP intervention on length of stay (LOS) in an AAU. METHODS: The study was designed as a prospective, cluster randomised study. Weekdays were randomised to control or intervention. CP intervention consisted of obtaining medication history and performing medication reconciliation and review. The primary outcome was LOS in the AAU. Secondary outcomes were other time-related measures-for example, physicians' self-reported time spent on medication topics. Finally, the number of documented medications per patient was established. RESULTS: 232 and 216 patients, respectively, were included on control (n=63) and intervention (n=63) days. The mean LOS was 342 (95% CI 323 to 362) min in the intervention group and 339 (95% CI 322 to 357) min in the control group, which was not statistically significantly different. Physicians spent on average 4.3 (95% CI 3.7 to 5.0) min in the intervention group and 7.5 (95% CI 6.6 to 8.5) min in the control group, corresponding to an overall reduction of 43.0% (95% CI 30.9% to 53.0%, p<0.001). The number of documented medications per patient was 10.0 (intervention group) and 8.8 (control group). CONCLUSIONS: This study indicates that LOS in the AAU was not affected by CP intervention; however, physicians reported a significant reduction in time spent on medication topics. TRIAL REGISTRATION NUMBER: Clinical Trial Gov: 1-16-02-379-13.

Candida albicans tricuspid and pulmonic valve endocarditis: challenge of relapsing risk and role of combined medical treatment and surgery.

Candida albicans endocarditis involves infrequently the tricuspid valve and involvement of the pulmonic valve is rare. We report our experience with an immunosuppressed liver-transplanted female who developed both tricuspid and pulmonic valve endocarditis, review the literature and discuss the importance of effective antimycotic therapy combined with surgical replacement of the affected valve.

Three cases of Rothia dentocariosa bacteraemia: frequency in Denmark and a review.

Three cases of non-endocarditis-associated Rothia dentocariosa bacteraermia occurred in Viborg County within the space of a year, whereas no cases have been registered in other parts of Denmark during the last 10 y. Two patients wore dentures but had no history of oral infection, while in the last patient a tooth abscess was detected on examination. R. dentocariosa is a common inhabitant of the oral cavity and the causative agent of a wide spectrum of infectious symptoms. It is only rarely identified in blood cultures, possibly due the inadequacy of the available identification methods.