Impact of pharmacist involvement on medication safety in interprofessional transfer of care activity.

AIM: Any transition of patient care is a high-risk time for communication error. This paper explores whether the presence of a pharmacist as part of an interprofessional group provides additional benefit and safety in transitions of care. METHOD: Six pharmacy interns and newly qualified pharmacists joined participants from seven other health professional training programmes to take part in an interprofessional education activity. Participants were assigned to 24 mixed-professional groups. Each group was required to craft a discharge summary for the same simulated patient. Groups without a pharmacist were given additional written documentation, including medication reconciliation, discharge prescription and discharge recommendations. The 24 discharge summaries were assessed for any medication-related information, both positive and negative. Groups with a pharmacist (6) were compared with groups who did not have a pharmacist (18) for completeness and accuracy of medication management. RESULTS: An in-person pharmacist provided more thorough, comprehensive, accessible and accurate information for the community team (p=0.003). Although there was no difference in the absolute number of medication errors between the groups (p=0.057), the groups with a pharmacist showed a significant reduction in the severity of the errors (p=0.009). This result happened despite the groups without a pharmacist being provided with all the required medication information for safe transition of care. CONCLUSION: These findings support the case for greater involvement from a pharmacist in a patient's healthcare team, particularly for any transition of care. Healthcare teams that include a pharmacist are more likely to exceed minimum safety expectations and make less severe errors.

Gastrointestinal decontamination in paediatric exploratory ingestions.

AIM: To review the effect of treatment changes in paediatric exploratory ingestion at Christchurch Hospital. METHODS: We carried out a retrospective review of paediatric patients presenting with potentially toxic ingestion during six month periods of 1994, 1996 and 1999. RESULTS: All three groups were comparable in respect to age and gender. There were minor changes in the range and proportion of substances ingested - with those in the 1999 group more likely to have taken paracetamol. In 1994, 36% of children were treated with syrup of ipecac. By 1996, only 9% were given ipecac, with 49% treated with activated charcoal. By 1999, 12% were treated with activated charcoal, while 88% received no decontamination. There was a lower admission rate in the 1999 group with no overall change in outcome. CONCLUSIONS: It is rare for paediatric exploratory ingestions to result in significant toxicity. Gastrointestinal decontamination should not be routinely used in these patients as the risk of the procedure may outweigh the risk of the poison exposure.