Pharmacist tracking and correction of medication errors: An improvement project in the observation ward of the emergency department.

OBJECTIVE: The risk of medication errors is high in emergency departments. Implementation of medication reconciliation activity complemented by pharmaceutical analysis of prescription is an effective way to reduce drug related problems. This study aimed to assess the potential clinical impact of these activities to prevent medication errors for the observation ward patients. The secondary objective was to assess these activities' cost-avoidance and benefit-to-cost ratio. MATERIAL AND METHODS: This study was conducted in a 16-bed unit, over a 5-month period. The patients' demographic and treatment details, and data from pharmaceutical activities were collected and analyzed by a pharmacist. Two pharmacists and an emergency physician assessed the potential clinical impact of medication errors. RESULTS: Medication reconciliation for 250 patients (15.7% of 1589 admitted patients) and pharmaceutical analysis of prescription for 302 patients (19%) were performed by the pharmacist. Medication reconciliation detected 752 errors in 197 patients; 19% were related to high-risk medications and 14% had a potential clinical impact assessed as major, critical or fatal. Pharmaceutical analysis of prescription revealed 159 drug related problems in 118 patients; of which 26% involved high-risk medications and 24% had a potential clinical impact assessed "at least major". In total, 16% of pharmacist interventions had a potential clinical impact assessed "at least major" in 33% of patients: this represents 1.8 pharmacist interventions formulated per day. CONCLUSION: The presence of a pharmacist in the observation ward of the emergency department is useful in detecting iatrogenic drug related problems and reducing their medical impact. The benefit-to-cost ratio is favorable for the hospital.

Cost Savings and Efficacy in Management of Paracetamol Poisoning in a 23-hours Emergency Department Observation Unit: A Comparison to Inpatient Care.

Introduction Emergency department observation units (EDOU) have been shown to be effective in decreasing hospitalization rates and length of stay (LOS) for various conditions. However, cost savings and efficacy in the management of poisoning in EDOU have not been widely studied. The objective of our study is to compare the costs and effectiveness of managing paracetamol poisoned patients in the EDOU with those treated in the inpatient wards. Methods We conducted a historical controlled observational study comparing paracetamol-poisoned patients (who received at least 21 hours of IV N-acetylcysteine [NAC]) admitted to the EDOU during 2013-2014 with similar patients admitted to inpatient ward during 2011, 2013-2014.  Results We found 136 patients admitted to the inpatient ward and 95 to our EDOU due to paracetamol poisoning but only 78 and 39 patients respectively fulfilled the inclusion criteria. Between the EDOU and inpatient ward groups, we found similar demographics, poisoning presentation, treatment, and adverse event profiles. There were no fatalities and only two patients (one from each group) developed hepatotoxicity. The "medical" length of stay was 31.9 hours shorter in the EDOU group compared to the inpatient ward group (23.3 versus 55.2 hours). EDOU patients have statistically significant savings (comparing bill size) of S$784 per patient. Conclusions Admission to the EDOU resulted in significant cost savings and 58% decreased LOS when compared to inpatient wards. The EDOU is a cost-effective and safe alternative for the management of selected paracetamol poisonings requiring NAC. Further studies would be needed to verify these results.

Performance of an emergency department observation unit protocol in reducing length of stay for acetaminophen overdose: a retrospective study.

INTRODUCTION: Acetaminophen is one of the most common causes of poisoning among developed countries. The emergency department observation unit (EDOU) has been increasingly used in the management of various conditions to reduce hospitalisation but its efficacy in not well studied in management of poisoned patients. In this study, we aim to study the effectiveness of our EDOU in the management of acetaminophen overdosed patients. RESULTS: Medical records of patients admitted from the emergency department from 2012 to 2016 for acetaminophen overdose were reviewed. One hundred ninety-five patients presenting with acetaminophen overdose were admitted to the EDOU while 184 were admitted to the general ward. Of these, 27 patients admitted to EDOU did not meet the admission criteria for it while 71 patients who met EDOU criteria were admitted to the ward instead. For patients who fulfilled EDOU admission criteria, median length of stay for EDOU patients was 23 h (IQR 19-24) while that for those admitted to the ward was 66 h (IQR 62.5-88.3). CONCLUSION: The EDOU is a safe alternative to hospitalisation for patients presenting with acetaminophen poisoning. It is also associated with a shorter length of stay for such patients. Further studies need to be done to assess the cost-effectiveness of EDOU for management of patients presenting with acetaminophen overdose.

Alternatives to ward admission from the emergency department.

There is ever-increasing pressure on hospital resources in general and emergency departments (ED) in particular. At the same time, there is increasing recognition that traditional inpatient ward-based care is not necessary for the majority of children presenting to the ED with acute illness, and that there are patient, family and hospital benefits to pursuing other options. Here, we describe alternative pathways for children presenting to the ED, including short stay and observational medicine, hospital-in-the-home and non-admission enhanced care, in other words, additional management practices or pathways for children who are discharged from the ED. We discuss the principles, models and practical considerations involved in each of these.

Experience of nursing scheduling in the Ebola treatment center observation ward / 中国实用护理杂志

Objective To investigate the characteristics of the diagnosis and treatment center for Ebola observing ward and reduce infection risk according to allocation scheduling method of nursing staff. To provide reference for other similar tasks. Methods We used the method of grouping fixed group scheduling method and fixed working hours to identify and refine the content of nursing work. Results A total of 65 cases of suspected Ebola including 5 cases diagnosed as EVD patients were cured. No case of infection occurred in nursing staff. Conclusions During the infectious disease nursing work, reasonable personnel allocation and scheduling method can make the nursing staff work with full energy and strength and ensure the realization ofzero infectiontargets.

A study on the magnitude and the effectiveness of the observation ward of hospital universiti sains malaysia.

BACKGROUND: The observation ward (OW) allows patients to be reassessed and monitored before deciding either to admit or to discharge them. This is a six-month descriptive cross-sectional study conducted in the observation ward of the Emergency Department (ED) of Hospital Universiti Sains Malaysia, Kelantan. The objective of this study was to examine the demographic characteristics and clinical profiles of adult observed patients and to determine the effectiveness of OW management. METHODS: Patients were selected randomly by convenience sampling. One hundred and twenty-four patients were included in the study. The mean age was 40.3 ± 18.5 years (95% CI: 37.2 to 43.8). RESULTS: Among the common clinical problems were abdominal discomfort (23%), diarrhoea and vomiting (13%) and fever (13%). Reasons for OW admission included diagnostic uncertainty (63%) and short course of treatment (33%). The mean length of stay was 4.1 ± 1.8 hours (95% CI=3.8 to 4.4 hours). Most of the patients (85%) were discharged. CONCLUSIONS: The OW of HUSM is effective in managing adult patients as determined by the hospitalisation rate and the length of stay.

A Study on the Magnitude and the Effectiveness of the Observation Ward of Hospital Universiti Sains Malaysia

Background: The observation ward (OW) allows patients to be reassessed and monitored before deciding either to admit or to discharge them. This is a six-month descriptive cross-sectional study conducted in the observation ward of the Emergency Department (ED) of Hospital Universiti Sains Malaysia, Kelantan. The objective of this study was to examine the demographic characteristics and clinical profiles of adult observed patients and to determine the effectiveness of OW management. Methods: Patients were selected randomly by convenience sampling. One hundred and twenty-four patients were included in the study. The mean age was 40.3 ± 18.5 years (95% CI: 37.2 to 43.8). Results: Among the common clinical problems were abdominal discomfort (23%), diarrhoea and vomiting (13%) and fever (13%). Reasons for OW admission included diagnostic uncertainty (63%) and short course of treatment (33%). The mean length of stay was 4.1 ± 1.8 hours (95% CI=3.8 to 4.4 hours). Most of the patients (85%) were discharged. Conclusions: The OW of HUSM is effective in managing adult patients as determined by the hospitalisation rate and the length of stay.

El sector de observación ¿Es necesario en un Servicio de Urgencia Pediátrico? / Is the observation ward (OW) relevant for a pediatric emergency service (ES)?

La atención en el Servicio de Urgencia (SU) es proporcionada en boxes de examen, sector de observación (SO), sala de tratamientos y camas de hospitalización. Objetivos: Indagar aspectos importantes de la estructura de atención en el SO y establecer si sus pacientes difieren de los atendidos en otros sectores del SU (sSU). Material y Método: Previamente estudiamos la estructura de consultas al SU, en una muestra de 4 356 casos. De estos, 1 549 que ingresaron al SO fueron analizados en variables de interés: edad, sexo, hora de ingreso, diagnósticos, estudios de laboratorio, medicamentos usados y luego comparados con los del sSU. Para el efecto, se construyó una base de datos en Excel de Office 2000. La estadística descriptiva incluyó, promedios, medianas, porcentajes y en las medidas de dispersión se recurrió a desviación estándar y rangos. En lo inferencial, intervalos de confianza del 95%, prueba de ?2 con corrección de Yates y estudio de tendencia lineal también por ?2, utilizando el programa Epi Info 6,04. Resultados: La edad mostró una mediana de 25 m (7 d a 199 m). El 52,3% fueron hombres. La distribución por edad fue diferente en el sSU y SO, esencialmente entre los menores de 24 m, quienes además tuvieron mayor probabilidad de ingresar al SO (p = 0,0000). Observamos diferencias importantes en la distribución de los diagnósticos que originan la atención en sSU o en SO. Las internaciones desde SO (10,4%), fueron más frecuentes que desde el sSU (2,8%) (p = 0,000). En 802 atenciones se registraron las horas de ingreso-egreso al SO, constatando que el 31,7% permaneció por 4 hs o más, variando según patología: Síndrome Bronquial Obstructivo: 5,3 hs (1-15), Infección Urinaria: 5,3 hs (3-9), Diarrea con deshidratación: 8,5 hs (3-16). Las principales causas de hospitalización fueron: Bronconeumonía y Síndrome febril. La mayoría de los casos con Laringitis (98%), Crisis asmática (100%), deshidratación diarreica (96,5%), Convulsión febril ...

Management of patients in Emergency is provided in examination boxes, observation rooms, treatment units and hospitalization. Objective: to describe important aspects of health care structure in the OW and establish if the management of these patients differ from others attended in the rest of Emergency areas. Method: 1549 children located in the OW were analyzed out of 4356 cases attending Emergency, in terms of age, sex, time at admission, diagnosis, laboratory exams and treatments. Descriptive statistics included medians, ranks, percentages and SD. Inferential statistics included 95% confidence intervals. For statistical testing, chi square with Yates correction and chi square for trend were used with Epi Info 6,04. Results: Median age was 25 months (7 days to 199 months) and 52,3% were males. Age distribution was significantly different between ES and OW groups, where infants younger than 2 years were more frequently located in the OW (p < 0,0000). Hospitalization from OW was higher (10,4%) compared to ES (2,8%) (p = 0,000). The most common causes for admission were pneumonia and febrile syndrome; instead, most cases of laryngitis (98%), acute asthma (100%), enteric dehydration (96,5%) and febrile seizures (85,7%) were resolved at OW without admission. Conclusions: Patients handled at OW were significantly different from those seen in ES. OW is relevant for ES functioning, where various acute diseases are resolved, avoiding further hospitalization.