How useful are medication patient information leaflets to older adults? A content, readability and layout analysis.

BACKGROUND: Patient information leaflets (PILs) are the most important information source for older patients to effectively manage their drug therapy. OBJECTIVE: The objective of this study is to evaluate the appropriateness of current available PILs for use by older adults. METHODS: The content of the PILs were assessed by checking the availability of information relevant to older patients including pharmacokinetics, safety and dose instructions. The layout of the PILs was evaluated using criteria derived from the relevant regulatory guidelines on the design of PILs. The Gunning Fog Index was used to determine the readability of the PILs to older adults. RESULTS: Total of 48 PILs were analysed involving 25 drug substances for the treatment of cardiovascular disease and type 2 diabetes. One out of the 48 PILs contained information on pharmacokinetic changes in older patients and only 15 % of the PILs specified the age of the older person. Thirty-one percent of the PILs provided nonspecific warnings to the older population, while only 15 % included specific side effects that could occur in the older generation. Text font sizes of the PILs were generally too small for older adults to read, with only 9 % of the PILs used type size 12 or over. The readability of 63 % of the PILs had a score above 12, which is considered difficult for older people to understand. CONCLUSION: Currently available medication PILs are inappropriate for use by older adults to manage their medications effectively, which could adversely affect patient safety and adherence to drug therapy.

Is Mindful Reflective Practice the way forward to reduce medication errors?

BACKGROUND: Medication errors can seriously affect patients and healthcare professionals. In over 60% of cases, medication errors are associated with one or more contributory; individual factors including staff being forgetful, stressed, tired or engaged in multiple tasks simultaneously, often alongside being distracted or interrupted. Routinised hospital practice can lead professionals to work in a state of mindlessness, where it is easy to be unaware of how both body and mind are functioning. OBJECTIVE: Mindfulness, defined as moment-to-moment awareness of the everyday experience, could represent a useful strategy to improve reflection in pharmacy practice. The importance of reflection to reduce diagnostic errors in medicine has been supported in the literature; however, in pharmaceutical care, reflection has also only been discussed to a limited extent. There is expanding evidence on the effectiveness of mindfulness in the treatment of many mental and physical health problems in the general population, as well as its role in enhancing decision making, empathy and reducing burnout or fatigue in medical staff. Considering the benefits of mindfulness, the authors suggest that healthcare professionals should be encouraged to develop their practice of mindfulness. This would not only be beneficial in relieving stress, increasing attention levels and awareness, but it is believed that the integration of mindfulness and reflective practice in a 'Mindful Reflective Practice' could minimise some of the individual factors that lead to medication errors. CONCLUSIONS: Mindfulness Reflective Practice could therefore represent an important element in pre-registration education and continual professional development for pharmacists and other healthcare professionals.

Human factors in clinical handover: development and testing of a 'handover performance tool' for doctors' shift handovers.

OBJECTIVE: To develop and test a handover performance tool (HPT) able to help clinicians to systematically assess the quality and safety of shift handovers. DESIGN: The study used a mixed methods approach. In the development phase of the tool, a review of the literature and a Delphi process were conducted to sample five generic non-technical skills: communication, teamwork, leadership, situation awareness and task management. Validity and reliability of the HPT were evaluated through direct observation and during simulated handover video sessions. SETTING: This study was conducted in the Paediatrics, Obstetrics and Gynaecology wards of a UK district hospital. PARTICIPANTS: Thirty human factor experts participated in the development phase; 62 doctors from various disciplines were asked to validate the tool. MAIN OUTCOME MEASURES: Item development, HPT validity and reliability. RESULTS: The tool developed consisted of 25 items. Communication, teamwork and situation awareness explained, respectively, 55.5, 47.2 and 39.6% of the variance in doctors rating of quality. Internal consistency and inter-rater reliability of the HPT were good (Cronbach's alpha = 0.77 and intra-class correlation = 0.817). CONCLUSIONS: Communication determined the majority of handover quality. Teamwork and situation awareness also provided an independent contribution to the overall quality rating. The HPT has demonstrated good validity and reliability providing evidence that it can be easily used by raters with different backgrounds and in several clinical settings. The HPT could be utilized to assess doctors' handover quality systematically, as well as teaching tool in medical schools or in continuing professional development programmes for self-reflective practice.

Pharmacy services to UK emergency departments: a descriptive study.

OBJECTIVE: To describe current hospital pharmacy services and facilities provided to United Kingdom Emergency Departments (EDs), identify potential roles for pharmacy technicians and possible benefits pharmacists may bring to the ED. SETTING: Emergency care specialist interest group workshop at an UK Clinical Pharmacy Association (UKCPA) conference in 2004. Workshop attendance was open to pharmacists and technicians. METHOD: A descriptive study using a voluntary self-completed questionnaire covering ED services, pharmacy services and facilities to the ED and potential roles and benefits. RESULTS: Of 40 questionnaires distributed, 31/40 (78%) were returned representing 25 NHS hospitals. Most (72%) EDs received some level of pharmacy service. Emergency Department skill-mix, ED service models and pharmacy services varied. Pharmacists' current roles were similar across EDs, with input into guideline development and review 12/25 (48%), patient group directions 11/25 (44%), provision of training 11/25 (44%), provision of advice (general and clinical)/liaison 10/25 (40%) and drug history taking 11/25 (40%). Potential roles identified for pharmacy technicians included assessment of patients' own drugs, support for drug history taking, stock management and drug storage. Further benefits pharmacists could bring to EDs included rationalisation of medicines on admission, identification of ADRs causing admission, support with complex medicine issues, new prescribing skills, supporting the maximum waiting time target and facilitating discharge. CONCLUSION: Pharmacy services have developed to support service provision in EDs with similar roles to in-patient pharmacists. Pharmacy services in some EDs are now extensive with funded, full-time pharmacy posts but pharmacy service review is required to optimise ED patient care where there is limited or no current pharmacy input. New pharmacy services must fit with local ED service models and skill mix. Evaluation of these new services is vital to maximise benefit to patients and the NHS.

The influence of continuing professional development portfolio records on pharmacy practice.

OBJECTIVES: The aim of this study was to undertake an in-depth investigation of the influence of continuing professional development (CPD) portfolios on pharmacy practice in the hospital setting. The objectives were to explore the views of pharmacists regarding the contribution of CPD records to professional practice and examine the influence of time and experience on pharmacists' views of recording professional practice. METHOD: A qualitative design was used to explore the views of pharmacists over 12 months. Pharmacists were stratified according to years of practice in the UK National Health Service (NHS). The methods used involved semi-structured in-depth face-to-face interviews. The interviews were undertaken at three time points. The pharmacists were gathered into three focus groups to test the consistency of the interviews. A purposive sampling method used nine NHS Teaching and Non-Teaching hospital pharmacists in the London area. KEY FINDINGS: The participants included four males and five females, who had been qualified for between 0.1 and 21 years. Three key themes emerged for how CPD records contribute to practice: (1) lack of contribution to practice, (2) tacit contribution and (3) mentality. Overall, the recording process made little if any change in professional practice. The more experienced participants were less likely to be able to explain any changes in practice and there were no consistent changes in the views expressed over time. CONCLUSIONS: The contribution of CPD recording to enhancing practice in hospital pharmacists was difficult to demonstrate. This study has also illustrated the power relationships involving control mechanisms used by the NHS, and the UK pharmacists' regulatory body, which are discussed in the context of the Panopticon model of self-regulated behaviour. Further research is needed to establish the value of CPD recording.

The extent and characteristics of United Kingdom hospital pharmacists keeping, or not keeping, a professional development portfolio.

OBJECTIVES: The aim of this study was to examine the use of continuing professional development (CPD) portfolios by hospital pharmacists. The objectives were to assess the extent to which pharmacists use portfolios in CPD and to examine the attitudes/beliefs which differentiate those who do and do not keep a portfolio. METHOD: Participants completed two questionnaires: (1) personality traits were examined using the Big-Five questionnaire and (2) a new Pharmacist Portfolio-Engaging Behaviour Questionnaire (PPEBQ) examined the attitudes and beliefs. What constitutes a portfolio was left to the interpretation of the participants, but it was specified that the survey was about participants' views of producing written records of their professional practice for CPD. The setting was hospital pharmacists based in the London area in December 2004. KEY FINDINGS: Overall, 134 pharmacists (78%) returned both questionnaires, and 80 stated that they kept a portfolio and 52 stated that they did not (two questionnaires were returned spoilt). There was no significant difference in the age or number of years qualified between those with and without a portfolio. Three personality traits were linked to keeping a portfolio (conscientiousness, agreeableness and emotional stability). Pharmacists with a portfolio scored highly on the perceived behavioural control and behavioural intention scales of the PPEBQ. CONCLUSIONS: The Big-Five personality questionnaire is a useful tool to investigate pharmacists' use of a portfolio. Results of the PPEBQ suggested that hospital pharmacists who had a portfolio were concerned with having control over its production. However, the PPEBQ requires further development to improve its reliability. These findings have implications for the educational support of CPD.