Transfer of care of postsurgical patients from hospital to the community setting: cross-sectional survey of primary care physicians.

BACKGROUND: Postsurgical management is often delegated to family physicians once patients are discharged from hospital, but management of such patients may not be effectively communicated. We examined transfer of care of postsurgical patients by surveying family physicians. METHODS: An electronic, self-administered survey was administered from November 2012 to March 2014 to family physicians affiliated with 4 academic and community hospitals in Toronto, Canada. RESULTS: A total of 109 of 589 (19% response rate) family physicians completed the survey. The majority (76%) did not believe that the current transfer of care process was adequate. Uncertainty regarding management resulted in one or more adverse patient events for over half of respondents (62%). CONCLUSIONS: A discrepancy exists between what family physicians desire to have included in transfer tools and the frequency with which these variables are included. Family physicians believe that the current process of transfer of care for postsurgical patients is inadequate and may contribute to adverse events.

Nosocomial tuberculosis exposures at a tertiary care hospital: a root cause analysis.

BACKGROUND: Exposure of health care workers (HCWs) to patients with active TB continues to occur despite implementation of TB control policies. METHODS: We conducted a root-cause analysis of TB exposures at a tertiary care hospital. Clinical and management details of all confirmed cases identified in 2011 were summarized. Cases were independently reviewed by an expert panel that determined the type (ie, delay in initiating, incorrect use of or premature removal of control measures), preventability, and root cause(s) of each error (exposure). RESULTS: Fifteen cases were reviewed. Ten errors were identified in 7 (47%) cases. Cases associated with errors were older than those without errors (68 y vs 40 y; P = .037). Most cases (12/15) were foreign born. A delay in initiating airborne precautions accounted for 70% (7/10) of the errors. The expert panel determined that 80% (8/10) of the errors were preventable or possibly preventable. The most common root causes were failure to consider TB and failure to obtain and interpret imaging. Advanced age, atypical presentation, and presence of comorbid illnesses were common among the preventable cases. CONCLUSIONS: TB control policies do not prevent all exposures. Our findings suggest that consideration of TB in elderly patients with risk factors, even if their signs and symptoms can be explained by an alternative diagnosis or are atypical, followed by a review of imaging studies, can further reduce this risk.

Drug formulations that require less than 0.1 mL of stock solution to prepare doses for infants and children.

Intravenous doses of medications require formulations that permit accurate preparation and administration. Current equipment does not permit accurate measurement of volumes less than 0.1 mL. In a study of four hypothetical standard pediatric patients, we found that 28 common medications required less than 0.1 mL of available formulation to prepare the dose. In a clinical study of actual use in a pediatric intensive care unit (ICU), 5245 (7.4%) of 71 218 intravenous doses required preparation from less than 0.1 mL of stock solution. For 28.5% of the 1531 ICU admissions, at least one dose was prepared from a volume of less than 0.1 mL. Our findings identify a substantial source of dosing error. Correction will require revision of preparation methods, regulatory requirements and manufacturing practices.

Documentation of pediatric drug safety in manufacturers' product monographs: a cross-sectional evaluation of the canadian compendium of pharmaceuticals and specialities.

OBJECTIVE: To describe the provision of pediatric drug safety information in a national formulary of manufacturers' drug product monographs. METHODS: We performed a cross-sectional evaluation of comprehensive product monographs contained in the 2005 Canadian Compendium of Pharmaceuticals and Specialities (CPS). We abstracted data describing indications for prescription, statements about pediatric safety, available preparations, and provision of dosing guidelines. For each monograph we classified pediatric safety data as either present, present but limited or absent. We then described the pediatric safety data in CPS monographs for drugs listed in the published formulary of the Hospital for Sick Children, Toronto, Ontario, Canada. RESULTS: A total of 2232 product monographs were screened; 684 were excluded and 1548 (66%) were further analyzed. 1462 (94%) had indications that did not exclude children. Pediatric safety information was present in 592 (38%), present but limited in 148 (10%), and absent in 808 (52%) drug monographs. Safety statements were absent in 224 (14%) drug monographs that provided both dosing guidelines and formulations suitable for administration to children, and in 214 (52%) of 411 drugs in the pediatric hospital formulary. CONCLUSION: We evaluated a widely available national source of pediatric prescribing information. Safety data for children was not mentioned in more than half of the product monographs. Moreover, the provision of safety data was discordant with indications for prescription, the availability of pediatric formulations, and dosing guidelines within the monographs, and with inclusion in a pediatric hospital formulary. Our study suggests that the presentation of pediatric safety data in drug product monographs can be improved to better inform prescribing and to optimize pharmacotherapy in children.