Multi-dose drug dispensing is a challenge across the primary-secondary care interface.

INTRODUCTION: Multi-dose drug dispensing (MDDD) signifies that the patient's medicine is packed in disposable bags corresponding to the dose that should be taken. The purpose of the present study was to investigate how a hospital MDDD instruction was followed. MATERIAL AND METHODS: All patients receiving MDDD on admission to the acute medical admission ward at Bispebjerg Hospital in the period from 1 January to 30 June 2010 were prospectively included in the study. An audit of the medication lists and hospital case records covering the period from admission to discharge was performed. A proportion of patients received a post-discharge home visit. An interview in both sectors was carried out to determine whether the instructions had been followed. RESULTS: Almost 9% of the patients were receiving MDDD on admission. Information on MDDD was recorded in the physician case record for 3.4% of the patients and in the nurse case record for 12.9% of the patients. Changes in MDDD during hospitalization were made for 58.3% of the patients. General practitioners and/or the community pharmacy were notified of changes in MDDD at discharge for 13.6% of the patients. The post-discharge visits and the interview revealed potential issues of concern regarding patient safety. CONCLUSION: MDDD is frequent. Identification and registration of MDDD is only performed sporadically. Changes in MDDD are frequent, but they are rarely accompanied by information to the general practitioner or the community pharmacy. FUNDING: The project was partly funded by the Ministry of Health and Prevention 2009. TRIAL REGISTRATION: The study was approved by the Danish Data Protection Agency.

[Medication errors after hospitalisation due to multi-dose drug dispensing in the primary sector]. / Dosisdispensering som årsag til fejlmedicinering ved sektorovergang.

Multi-dose drug dispensing (MDDD) was introduced in Denmark in 2001 in order to minimize medication errors. In May 2010 44.500 Danish citizens received MDDD. We report two cases where MDDD in the primary sector led to medication errors after hospitalisation, the reason partly being difficulties in getting information on MDDD on admission, lack of knowledge on handling MDDD in hospital and inadequate communication between the primary and the secondary sector. These problems has until now been underestimated.

Intramedullary nailing appears to be superior in pertrochanteric hip fractures with a detached greater trochanter: 311 consecutive patients followed for 1 year.

BACKGROUND AND PURPOSE: In recent years, intramedullary nails (INs) for the treatment of pertrochanteric hip fractures have gained prominence relative to conventional, sliding hip screws (SHSs). There is little empirical background for this development, however. A previous series of ours suggested that the use of SHS was not adequate in situations with fragile or fractured lateral femoral walls, where it often led to lack of healing in a maximally telescoped position. We hypothesized that INs would be the superior implant in these specific circumstances. METHODS: We retrospectively examined 311 consecutive patients treated in our department between 2002 and 2008, with either an IN (n = 158) or an SHS (n = 153) mounted on a 4-hole side-plate, for an AO/OTA type 31A1-2 pertrochanteric fracture with a detached greater trochanter. The status of the lesser trochanter was assessed preoperatively and the integrity of the lateral femoral wall, fracture reduction, and position of the implants were assessed postoperatively. Reoperations due to technical failure were recorded for one year postoperatively. RESULTS: Multivariate logistic regression analysis showed that the groups were similar regarding demographic and biomechanical parameters. The lateral femoral wall was more frequently fractured during SHS implantation (42 patients) than in the IN group (9 patients) (p < 0.001). 6 (4%) of the 158 patients operated with IN had to be reoperated, as compared to 22 (14%) in the SHS group of 153 patients (p = 0.001). INTERPRETATION: IN had a lower reoperation rate than SHS in these pertrochanteric hip fractures with a detached greater trochanter. IN left more lateral femoral walls intact.