Bleeding Complications in Patients With Severe Frostbite Injury.

Frostbite is caused by exposure to cold temperatures and can lead to severe injury resulting in amputations. Tissue plasminogen activator (tPA) is a thrombolytic agent that has demonstrated efficacy preventing amputation in frostbite patients. The goal of frostbite management with tPA is to salvage tissue without causing clinically significant bleeding complication. The purpose of this study was to characterize bleeding complications in severe frostbite patients managed with and without tPA. Retrospective chart review of severe frostbite patients admitted to a single ABA verified burn center. Bleeding events were grouped: category 0: no bleed; category 1: bleed not resulting in change or intervention; category 2: bleed resulting in change of management; and category 3: bleed resulting in change of management and intervention. Over a 7-year period, 188 patients were included in the study. Most patients had no documentation suggesting a bleeding complication: 69.7% category 0, 19.1% category 1, 4.8% category 2, and 6.4% category 3. There was no significant difference in category 2 or 3 bleeding complications between patients treated with or without tPA. Overall, 9 of the 143 patients (6.3%) treated with tPA had a category 2 or 3 bleeding complication within 12 hours of tPA completion and 12 of 143 (8.4%) within 24 hours of tPA completion. Based on the low risk of severe bleeding and significant benefit relative to limb or digit salvage demonstrated in this study, we conclude that tPA is safe and effective for the treatment of frostbite in appropriately selected patients.

Interventions performed by New Zealand community pharmacists while dispensing prescription medications.

OBJECTIVE: To investigate the number and type of interventions performed by New Zealand community pharmacists when dispensing new prescriptions. METHOD: All community pharmacies in Dunedin, New Zealand (29) were asked to use a tally system to record the types of interventions performed, the time taken and the number of prescription items processed per day. Data was collected for one full week for 20 pharmacies. RESULTS: In total 24,059 prescription items were dispensed by the 20 pharmacies over one week. There were 1,551 separate interventions recorded with a recorded time of 1,684 min. These interventions occurred at a rate of 64 interventions per 1,000 prescription items. Of recorded interventions, bureaucratic and generic substitution problems accounted for 81%. These combined interventions occurred at a rate of 52 per 1,000 prescription items and totalled 50% of the time spent on prescription interventions. Whilst clinical interventions were recorded at a rate of 13 per 1,000 items, they accounted for the remaining 50% of time spent. CONCLUSION: Half of the time spent by community pharmacists in Dunedin, New Zealand on prescription interventions consists of correcting bureaucratic and legal issues, limiting the time pharmacists can spend on clinical services.