Implementation and evaluation of a collaborative clinical pharmacist's medications reconciliation and charting service for admitted medical inpatients in a metropolitan hospital.

WHAT IS KNOWN AND OBJECTIVE: Medication errors on admission can persist throughout the episode of care and on to discharge leading to inappropriate management that can compromise patients' care. The aim of the study was to develop, implement and evaluate the role of pharmacist-led medication reconciliation and charting service for patients admitted to an Acute Assessment and Admission Unit via the Emergency Department in an electronic medication management environment at a metropolitan Australian hospital. METHODS: Following the credentialing of an experienced clinical pharmacist to perform collaborative medication charting, a prospective parallel study of medication errors was undertaken. Patients were randomly allocated to an intervention (n = 56) or a usual care (control) (n = 54) arm. Medication orders were charted by the medical staff in the usual care arm, whereas the pharmacist charted the medications in the intervention arm. An independent clinical pharmacist reviewed all the medication orders at 24 h after admission and errors recorded. The severity of errors was rated by a 'blinded' consultant physician and an independent senior pharmacist according to a standardized matrix. The potential time saving for the medical staff was investigated. A survey was conducted to assess the perception, acceptance and satisfaction of the service. RESULTS AND DISCUSSION: The intervention arm (reconciliation performed by pharmacist) achieved an error reduction greater than 80%. The average error rate decreased from 4·41 to 0·52 errors per patient (P < 0·0001) and 0·43-0·05 errors per order (P < 0·005). The severity of the errors was also diminished. Time evaluation estimated that the pharmacist can save more than 30 min per patient for the admitting medical officers. Staff satisfaction survey indicated that the service was well received by the medical staff. WHAT IS NEW AND CONCLUSION: A model of a collaborative clinical pharmacist reconciliation and charting service for admitted medical patients in an Australian hospital was successfully implemented. The service was well received and has shown to save medical staff time allowing them to attend to other duties. Moreover, the pharmacist charting and reconciliation service has resulted in a statistically significant reduction in medication errors.

Boomerang pillows and respiratory capacity in frail elderly women.

An exploratory study was done to determine whether frail elderly women placed on boomerang pillows would have an altered minute volume after 10 minutes. A convenience sample of 18 subjects took part in the study. A repeated measures design was used in which subjects served as their own controls. After 10 minutes on the boomerang pillows, there was a significant reduction in the minute volume of subjects. Boomerang pillows may be contraindicated in people with reduced lung capacity due to age; however, further research on a larger sample of frail elderly women is indicated.

Boomerang pillows and respiratory capacity.

An experimental study was done to determine whether subjects placed on boomerang pillows would have lower vital capacities than subjects placed on straight pillows after 30 minutes. A sample of 42 subjects took part in the study in a nursing laboratory. A crossover design was used in which subjects were measured in both conditions. The findings indicated that there was no significant difference in the vital capacities of subjects in the two conditions. An associated finding was that the vital capacities were significantly lower in a semi-Fowler's position than in a straight chair. It was concluded that boomerang pillows are safe to use for persons without respiratory problems. Further research is needed into the effect of boomerang pillows on persons with respiratory deficits.