Clinical Effects of a Pharmacist Intervention in Acute Wards - A Randomized Controlled Trial.

The purpose of the study was to investigate the clinical effect of a clinical pharmacist (CP) intervention upon admission to hospital on inpatient harm and to assess a potential educational bias. Over 16 months, 593 adult patients taking ≥4 medications daily were included from three Danish acute medicine wards. Patients were randomized to either the CP intervention or the usual care (prospective control). To assess a potential educational bias, a retrospective control group was formed by randomization. The CP intervention comprised medication history, medication reconciliation, medication review and entry of proposed prescriptions into the electronic prescribing system. The primary outcome of inpatient harm was identified using triggers from the Institute of Healthcare Improvement Global Trigger Tool. Harms were validated and rated for severity by two independent and blinded outcome panels. Secondary end-points were harms per patient, length of hospital stay, readmissions and 1-year mortality. Harm affected 11% of the patients in the intervention group compared to 17% in the combined control group, odds ratio (OR) 0.57 (CI 0.32-1.02, p = 0.06). The incidence of harm was similar in the intervention and prospective control groups, OR 0.80 (CI 0.40-1.59, p = 0.52) but occurred less frequently in the intervention than in the retrospective control group OR 0.46 (CI 0.25-0.85, p = 0.01). An educational bias from the intervention to the control group might have contributed to this negative outcome. In conclusion, the CP intervention at admission to hospital had no statistically significant effect on inpatient harm.

Antimicrobial activity of selected South African medicinal plants.

BACKGROUND: Nearly 3,000 plant species are used as medicines in South Africa, with approximately 350 species forming the most commonly traded and used medicinal plants. In the present study, twelve South African medicinal plants were selected and tested for their antimicrobial activities against eight microbial species belonging to fungi, Mycobacteria, Gram-positive and Gram-negative bacteria. METHODS: The radiometric respiratory technique using the BACTEC 460 system was used for susceptibility testing against Mycobacterium tuberculosis, and the liquid micro-broth dilution was used for other antimicrobial assays. RESULTS: The results of the minimal inhibitory concentration (MIC) determinations indicated that the methanol extracts from Acacia karoo, Erythrophleum lasianthum and Salvia africana were able to prevent the growth of all the tested microorganisms. All other samples showed selective activities. MIC values below 100 µg/ml were recorded with A. karoo, C. dentate, E. lasianthum, P. obligun and S. africana on at least one of the nine tested microorganisms. The best activity (MIC value of 39.06 µg/ml) was noted with S. africana against E. coli, S. aureus and M. audouinii, and Knowltonia vesitoria against M. tuberculosis. CONCLUSION: The overall results of the present work provide baseline information for the possible use of the studied South African plant extracts in the treatment of microbial infections.

Hospital admission interviews are time-consuming with several interruptions.

INTRODUCTION: The admission interview is an important procedure to reduce medication errors. Studies indicate that physicians do not spend much time on the interview and that the major obstacles are lack of time and heavy workload. The aim of this study was to measure the time physicians spend on admission interviews and to describe factors that affect time consumption. MATERIAL AND METHODS: This time study was conducted at an acute medicine department. Physicians conducting admission interviews were observed, and time consumption was recorded. RESULTS: Fifty admission interviews were observed; they lasted an average of 45 (range 8-84) minutes. The effective time consumption was 32 (range 7-59) minutes. Fifteen (range 3-41) minutes were spent on actually interviewing and examining the patient and compiling the medication history. It took zero to five (mean 2.2) minutes to collect the medication history. The number of interruptions per interview was zero to nine (mean two); they were mostly caused by phone calls from physicians or nurses or by nurses asking for advice on problems with other patients. The mean duration of an interruption was 7.1 minutes. CONCLUSION: Physicians spend an average of 45 minutes on admission interviews and are interrupted up to nine times. Only a few minutes are spent on collecting the medication history. Though the quality of the interviews and the actual error rate were not assessed, the observed working conditions may imply a high potential for medication errors.