2009 November 05

Improved quality in the hospital discharge summary reduces medication errors–LIMM: Landskrona Integrated Medicines Management.

Eur J Clin Pharmacol Start a Discussion »

Nov 052009

Improved quality in the hospital discharge summary reduces medication errors--LIMM: Landskrona Integrated Medicines Management.

Eur J Clin Pharmacol. 2009 Oct;65(10):1037-46

Authors: Bergkvist A, Midlöv P, Höglund P, Larsson L, Bondesson A, Eriksson T

PURPOSE: We have developed a model for integrated medicines management, including tools and activities for medication reconciliation and medication review. In this study, we focus on improving the quality of the discharge summary including the medication report to reduce medication errors in the transition from hospital to primary and community care. METHODS: This study is a longitudinal study with an intervention group and a control group. The intervention group comprised 52 patients, who were included from 1 March 2006 until 31 December 2006, with a break during summer. Inclusion in the control group was performed in the same wards during the period 1 September 2005 until 20 December 2005, and 63 patients were included in the control group. In order to improve the quality of the medication report, clinical pharmacists reviewed and gave feedback to the physician on the discharge summary before patient discharge, using a structured checklist. Medication errors were then identified by comparing the medication list in the discharge summary with the first medication list used in the community health care after the patient had returned home. RESULTS: By improving the quality of the discharge summary, patients had on average 45% fewer medication errors per patient (P = 0.012). The proportion of patients without medication errors was 63.5% in the control group and 73.1% in the intervention group. However, this increase was not significant (P = 0.319). Patients who used a specific medication dispensing system (ApoDos) had a 5.9-fold higher risk of suffering from medication errors than those without this medication dispensing system (P < 0.001). CONCLUSION: Review and feedback on errors in the discharge summary, including the medication report and a correct medication list, reduced medication errors during the transfer of information from hospital to primary and community care.

PMID: 19557400 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Effect of clinical pharmacists on care in the emergency department: a systematic review.

Am J Health Syst Pharm Start a Discussion »

Nov 052009

Effect of clinical pharmacists on care in the emergency department: a systematic review.

Am J Health Syst Pharm. 2009 Aug 1;66(15):1353-61

Authors: Cohen V, Jellinek SP, Hatch A, Motov S

PURPOSE: A systematic literature review was conducted to ascertain the scope of involvement of clinical pharmacists in the emergency department (ED); summarize economic, humanistic, and clinical outcomes data; describe current limitations of these data; and identify areas for future research. METHODS: A search of MEDLINE, The Cochrane Library, International Pharmaceutical Abstracts, and CINAHL Plus databases was conducted. Articles were included in this review if the title and abstract indicated that the article's content addressed the scope of involvement of pharmacists in the ED or pharmacist interventions in the ED and their associated outcomes, such as humanistic outcomes, cost avoidance, or improved quality. Qualitative analyses were conducted to characterize pharmacists' activities and effects in the ED. RESULTS: Of the 533 returned citations, only 17 met the inclusion criteria. Each provided a description of clinical pharmacy services at 12 different institutions. Descriptions of these institutions and job responsibilities of the ED pharmacists are described. Six studies reported information about pharmacist interventions, including the number and types of interventions, time spent per intervention, and acceptance rate of interventions. Four studies reported cost-related outcomes data. CONCLUSION: A review of the literature revealed that pharmacists have been involved in the ED for decades. Services provided by pharmacists in the ED included traditional clinical pharmacy services, responding to medical emergencies, providing consultations on medication issues, identifying and reducing medication errors, and conducting medication histories at hospital admission. Some services were shown to be cost saving or cost avoiding.

PMID: 19635771 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Cancer-related fatigue: the approach and treatment.

J Gen Intern Med Start a Discussion »

Nov 052009

Cancer-related fatigue: the approach and treatment.

J Gen Intern Med. 2009 Nov;24 Suppl 2:S412-6

Authors: Escalante CP, Manzullo EF

As the volume of cancer survivors continues to increase, clinicians are being faced with a growing number of patients with cancer-related fatigue (CRF). Survivors with a variety of malignancies may experience fatigue. Many potential barriers to the identification of this symptom in a cancer survivor may exist, due in part to both the patient and the clinician. Assessment of patients for fatigue is important because it can profoundly effect their daily lives. Many factors contribute to CRF. Hence, the clinician may face a daunting challenge in attempting to alleviate CRF. Treatment modalities for CRF include nonpharmacologic interventions, such as psychosocial interventions, exercise, sleep therapy, and acupuncture. Pharmacologic interventions include stimulants, namely modafinil and methylphenidate. In some patients antidepressants may be beneficial. Clinicians should assess cancer survivors for the presence of fatigue and focus on its treatment in an attempt to ensure that these patients have the best possible symptom control.

PMID: 19838841 [PubMed - in process]

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2009 ACCF/AHA Focused Update on Perioperative Beta Blockade. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.

Circulation Start a Discussion »

Nov 052009

2009 ACCF/AHA Focused Update on Perioperative Beta Blockade. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.

Circulation. 2009 Nov 2;

Authors: Fleischmann KE, Beckman JA, Buller CE, Calkins H, Fleisher LA, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Robb JF, Valentine RJ

PMID: 19884474 [PubMed - as supplied by publisher]

Link to Article at PubMed

2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.

Circulation Start a Discussion »

Nov 052009

2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.

Circulation. 2009 Nov 2;

Authors: Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF

PMID: 19884473 [PubMed - as supplied by publisher]

Link to Article at PubMed

Major Bleeding, Mortality, and Efficacy of Fondaparinux in Venous Thromboembolism Prevention Trials.

Circulation Start a Discussion »

Nov 052009

Major Bleeding, Mortality, and Efficacy of Fondaparinux in Venous Thromboembolism Prevention Trials.

Circulation. 2009 Nov 2;

Authors: Eikelboom JW, Quinlan DJ, O'Donnell M

BACKGROUND: -Bleeding is a strong predictor of death in patients hospitalized for arterial thrombosis who are treated with antithrombotic therapy, but the prognostic importance of bleeding in patients receiving antithrombotic prophylaxis for venous thromboembolism is uncertain. Methods and Results-Using Cox proportional hazards modeling, we examined the association between major bleeding and death at 30 days using pooled individual patient data from 8 large randomized controlled trials (n=13 085) comparing fondaparinux with control (low-molecular-weight heparin or placebo) for the prophylaxis of venous thromboembolism in hospitalized surgical or medical patients. Patients who developed major bleeding were older, were more likely to be male, had a lower body weight and lower creatinine clearance, and were more likely to be receiving fondaparinux. At 30 days, the risk of death was 7-fold higher among patients with a major bleeding event (8.6% versus 1.7%; adjusted hazard ratio, 6.96; 95% confidence interval, 4.60 to 10.51). There was a consistent pattern of reduced mortality in patients treated with fondaparinux irrespective of whether patients experienced major bleeding (6.8% versus 11.4%; hazard ratio, 0.58; 95% confidence interval, 0.27 to 1.23) or no major bleeding (1.5% versus 1.9%; hazard ratio, 0.77; 95% confidence interval, 0.59 to 1.02; P for heterogeneity=0.47). Conclusions-Major bleeding in hospitalized surgical and medical patients participating in venous thromboembolism prevention trials is a strong predictor of mortality.

PMID: 19884469 [PubMed - as supplied by publisher]

Link to Article at PubMed

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