Elementos facilitadores no processo de doação de órgãos na perspectiva dos profissionais / Facilitating elements in the organ donation process from the perspective of professionals

Objetivou identificar os elementos facilitadores no processo de doação de órgãos e tecidos para transplante, na perspectiva dos profissionais das Comissões Hospitalares de Transplantes. Estudo descritivo, qualitativo, realizado com 20 profissionais que compõem as Comissões Intra-Hospitalares de Doação de Órgãos e Tecidos para Transplante. A coleta de dados ocorreu por meio de entrevista semiestruturada, analisados por meio da técnica do Discurso do Sujeito Coletivo. Emergiram três ideias centrais que versaram sobre os profissionais atuantes na Terapia Intensiva e Emergência como membros da Comissão Hospitalar de Transplantes; Suporte da Central Estadual de Transplante; Coordenação da Comissão Hospitalar de Transplantes. Identificou-se como elementos facilitadores no processo de doação de órgãos e tecidos os profissionais das comissões do quadro funcional das respectivas unidades envolvidas no processo. É necessário um serviço organizado e articulado, de profissionais capacitados e de liderança resolutiva para garantir sucesso no processo de doação de órgãos e tecidos para transplantes.

This work has aimed to identify the facilitating elements in the organ and tissue donation process for transplantation from the perspective of professionals from Brazilian Hospital Transplantation Commissions. This is a descriptive, qualitative study conducted with twenty professionals who make up the In-Hospital Commissions for Organ and Tissue Donation for Transplantation. Data collection took place through semi-structured interviews analyzed using the Collective Subject Discourse technique. Three central ideas have emerged, which address the professionals working in Intensive Care and Emergency as members of the Hospital Transplantation Commission (CHT), the Support from the State Transplant Center (CET), and the Coordination of the Hospital Transplantation Commission. The facilitating elements of the organ and tissue donation process were the professionals of the commissions from the respective units involved in the process. An organized and articulated service, with trained professionals and resolute leadership, is necessary to ensure the success in the organ and tissue donation process for transplantation.

Hypertension in adolescents and young adults referred to a tertiary hypertension clinic in Cape Town, South Africa.

To audit the young patients referred to the Hypertension Clinic at Groote Schuur Hospital that predominately serves the underprivileged communities of Cape Town.Folders of patients between the ages of 15 and 30 years over a 2 year period were reviewed. The data collected included demographic, clinical and laboratory data, investigations, causes of hypertension, and presence of hypertensive organ damage.Of the 110 patients reviewed, 61 (55.5%) were females, 22 (20%) Black African, and 88 (80%) of Mixed Ancestry. Eight (7.3%) were found to be normotensive, 16 (14.5%) had a secondary cause and 86 (78.2%) had essential hypertension. Thirty five (31.8%) were current or previous smokers, and 11 (10%) admitted to current or prior use of metamphetamines. A family history of hypertension in a first degree relative was present in 80 (72.7%) patients. Comorbidities present were diabetes in 7 (6.4%) patients, metabolic syndrome in 13 (11.8%), and obesity in 26 (23.6%), but 42.6% had a body mass index (BMI) <25 kg/m. Chronic kidney disease (CKD) was present in 29 (26.4%) patients and ECG left ventricular hypertrophy in 56 (50.9%). Overall organ damage was present in 72 (65.5%) patients.In this cohort of young hypertensives most patients had essential hypertension with a strong family history. Significant organ damage was identified. High risk behavior, including smoking and illicit drug use, and obesity were identified as contributing factors. Secondary causes were identified in 14.2%. These results suggest a targeted approach to the investigation of young hypertensives for secondary causes, and significant opportunities for lifestyle intervention.

Poor infection prevention and control standards are associated with environmental contamination with carbapenemase-producing Enterobacterales and other multidrug-resistant bacteria in Swiss companion animal clinics.

BACKGROUND: Intensive medical care in companion animal clinics could pose a risk for the selection and dissemination of multidrug-resistant organisms (MDROs). Infection prevention and control (IPC) concepts are key measures to reduce the spread of MDROs, but data on IPC standards in companion animal clinics is sparse. The study assessed IPC standards in seven companion animal clinics and practices in Switzerland by structured IPC audits and combined results with environmental MDRO contamination and MDRO carriage of the personnel. METHODS: IPC audits were held between August 2018 and January 2019. The observations in 34 IPC areas were scored based on predefined criteria (not fulfilled/partially fulfilled/fulfilled = score 0/1/2). Environmental swabs and nasal and stool samples from veterinary personnel were tested for methicillin-resistant (MR) staphylococci and macrococci and for colistin-resistant, extended-spectrum ß-lactamase- and carbapenemase-producing (CP) Enterobacterales (CPE). Species was identified by MALDI-TOF MS, antimicrobial resistance determined by microdilution and ß-lactam resistance gene detection, and genetic relatedness assessed by REP-/ERIC-PCR and multilocus sequence typing. RESULTS: Of a maximum total IPC score of 68, the institutions reached a median (range) score of 33 (19-55). MDROs were detected in median (range) 8.2% (0-33.3%) of the sampling sites. Clinics with low IPC standards showed extensive environmental contamination, i.e. of intensive care units, consultation rooms and utensils. CPE were detected in two clinics; one of them showed extensive contamination with CP Klebsiella pneumoniae (ST11, blaOXA-48) and MR Staphylococcus pseudintermedius (ST551, mecA). Despite low IPC scores, environmental contamination with MDROs was low in primary opinion practices. Three employees were colonized with Escherichia coli ST131 (blaCTX-M-15, blaCTX-M-27, blaCTX-M-14). Two employees carried CP E. coli closely related to environmental (ST410, blaOXA-181) and patient-derived isolates (ST167, blaNDM-5). MR Staphylococcus aureus (ST225, mecA) and MR S. pseudintermedius (ST551, mecA) of the same sequence types and with similar resistance profiles were found in employees and the environment in two clinics. CONCLUSIONS: The study indicates that IPC standards in companion animal clinics are variable and that insufficient IPC standards could contribute to the evolution of MDROs which can be transferred between the environment and working personnel. The implementation of IPC concepts in companion animal clinics should urgently be promoted.

Paediatric Day Case Tonsillectomy - Audit of a New Programme.

Aims The primary objective of this audit was to assess 30-day unplanned admission or readmission rates following day case tonsillectomy. Secondary objectives included assessing demographic characteristics of patients and surgical and anaesthetic techniques employed. Methods Retrospective chart review was performed. Results 34 tonsillectomies or adenotonsillectomies were performed for children aged between 5 and 17 years. A total of six patients (17.6%) were either admitted from the day ward or readmitted within 30 days. This was not statistically significantly greater than the maximum acceptable rate of 15% as recommended by ENT UK and the Royal College of Surgeons (95% confidence intervals 4.8% - 30.5%, p = 0.33). Of these admissions, one (2.9%) was due to nausea and inadequate oral intake, one (2.9%) was due to clinical concerns regarding sleep apnoea and four readmissions (11.8%) were due to bleeding. Anaesthesia techniques used varied considerably. Conclusion Further multidisciplinary co-operation and standardisation of care may help to improve this programme and reduce unplanned admission and readmission rates.

Validity Evidence for a Knowledge Assessment Tool for a Mastery Learning Scrub Training Curriculum.

PURPOSE: To examine the validity evidence for a scrub training knowledge assessment tool to demonstrate the utility and robustness of a multimodal, entrustable professional activity (EPA)-aligned, mastery learning scrub training curriculum. METHOD: Validity evidence was collected for the knowledge assessment used in the scrub training curriculum at Stanford University School of Medicine from April 2017 to June 2018. The knowledge assessment had 25 selected response items that mapped to curricular objectives, EPAs, and operating room policies. A mastery passing standard was established using the Mastery Angoff and Patient-Safety approaches. Learners were assessed pre curriculum, post curriculum, and 6 months after the curriculum. RESULTS: From April 2017 to June 2018, 220 medical and physician assistant students participated in the scrub training curriculum. The mean pre- and postcurriculum knowledge scores were 74.4% (standard deviation [SD] = 15.6) and 90.1% (SD = 8.3), respectively, yielding a Cohen's d = 1.10, P < .001. The internal reliability of the assessment was 0.71. Students with previous scrub training performed significantly better on the precurriculum knowledge assessment than those without previous training (81.9% [SD = 12.6] vs 67.0% [SD = 14.9]; P < .001). The mean item difficulty was 0.74, and the mean item discrimination index was 0.35. The Mastery Angoff overall cut score was 92.0%. CONCLUSIONS: This study describes the administration of and provides validity evidence for a knowledge assessment tool for a multimodal, EPA-aligned, mastery-based curriculum for scrub training. The authors support the use of scores derived from this test for assessing scrub training knowledge among medical and physician assistant students.

Implementing participation-focused services: A study to develop the Method for using Audit and Feedback in Participation Implementation (MAPi).

BACKGROUND: It is widely agreed that children's services should use participation-focused practice, but that implementation is challenging. This paper describes a method for using audit and feedback, an evidence-based knowledge translation strategy, to support implementation of participation-focused practice in front-line services, to identify barriers to implementation, and to enable international benchmarking of implementation and barriers. METHOD: Best-practice guidelines for using audit and feedback were followed. For audit, participation-focused practice was specified as clinicians' three observable behaviours: (a) targets participation outcomes; (b) involves child/parent in setting participation outcomes; and (c) measures progress towards participation outcomes. For barrier identification, the Theoretical Domains Framework Questionnaire (TDFQ) of known implementation barriers was used. A cycle of audit and barrier identification was piloted in three services (n = 25 clinicians) in a large U.K. healthcare trust. From each clinician, up to five randomly sampled case note sets were audited (total n = 122), and the clinicians were invited to complete the TDFQ. For feedback, data on the behaviours and barriers were shared visually and verbally with managers and clinicians to inform action planning. RESULTS: A Method for using Audit and feedback for Participation implementation (MAPi) was developed. The MAPi audit template captured clinicians' practices: Clinicians targeted participation in 37/122 (30.3%) of the sampled cases; involved child/parent in 16/122 (13.1%); and measured progress in 24/122 (19.7%). Barriers identified from the TDFQ and fed back to managers and clinicians included clinicians' skills in participation-focused behaviours (median = 3.00-5.00, interquartile range [IQR] = 2.25-6.00), social processes (median = 4.00, IQR = 3.00-5.00), and behavioural regulation (median = 4.00-5.00, IQR = 3.00-6.00). CONCLUSIONS: MAPi provides a practical, off-the-shelf method for front-line services to investigate and support their implementation of participation-focused practice. Furthermore, as a shared, consistent template, MAPi provides a method for generating cumulative and comparable, across-services evidence about levels and trends of implementation and about enduring barriers to implementation, to inform future implementation strategies.

Validation of the Fracture Mobility Score against the Parker Mobility Score in hip fracture patients.

INTRODUCTION: The Parker Mobility Score has proven to be a valid and reliable measurement of hip fracture patient mobility. For hip fracture registries the Fracture Mobility Score is advised and used, although this score has never been validated. This study aims to validate the Fracture Mobility Score against the Parker Mobility Score. PATIENTS AND METHODS: The Dutch Hip Fracture Audit uses the Fracture Mobility Score (categorical scale). For the purpose of this study, five hospitals registered both the Fracture Mobility Score and the Parker Mobility Score (0-9 scale) for every admitted hip fracture patient in 2018. The Spearman correlation between the two scores was calculated. To test whether the correlation coefficient remained stable among different patient subgroups, analyses were stratified according to baseline patient characteristics. RESULTS: In total 1,201 hip fracture patients were included. The Spearman correlation between the Fracture Mobility Score and Parker Mobility Score was strong: 0.73 (p = < 0.001). Stratified for gender, age, ASA score, dementia, Index of Activities of Daily Living (KATZ-6 ADL score), living situation and nutritional status, the correlation coefficient varied between 0.40-0.84. For patients aged 90 and over and having an ASA score of III-IV who suffered from dementia, had a KATZ-6 ADL score of 1-6, lived in an institution and/or were malnourished, the correlation was moderate. CONCLUSION: The Fracture Mobility Score is overall strongly correlated with the Parker Mobility Score and can be considered as a valid score to measure hip fracture patient mobility. This may encourage other hip fracture audits to also use the Fracture Mobility Score, which would increase the uniformity of mobility score results among national hip fracture audits and decrease the overall registration load.

Pharmacist-led therapeutic carbohydrate restriction as a treatment strategy for type 2 diabetes: the Pharm-TCR randomized controlled trial protocol.

BACKGROUND: The current treatment paradigm for type 2 diabetes mellitus (T2D) typically involves use of multiple medications to lower glucose levels in hope of reducing long-term complications. However, such treatment does not necessarily address the underlying pathophysiology of the disease and very few patients achieve partial, complete, or prolonged remission of T2D after diagnosis. The therapeutic potential of nutrition has been highlighted recently based on results of clinical trials reporting remission of T2D with targeted dietary approaches. During the initial phase of such interventions that restrict carbohydrates and/or induce rapid weight loss, hypoglycemia presents a notable risk to patients. We therefore hypothesized that delivering very low-carbohydrate, low-calorie therapeutic nutrition through community pharmacies would be an innovative strategy to facilitate lowering of glycated hemoglobin (A1C) while safely reducing the use of glucose-lowering medications in T2D. METHODS: A community-based randomized controlled trial that is pragmatic in nature, following a parallel-group design will be conducted (N = 200). Participants will have an equal chance of being randomized to either a pharmacist-led, therapeutic carbohydrate restricted (Pharm-TCR) diet or guideline-based treatment as usual (TAU). Pharm-TCR involves a 12-week very low carbohydrate, calorie-restricted commercial diet plan led by pharmacists and lifestyle coaches with pharmacists responsible for managing medications in collaboration with the participants' family physicians. Main inclusion criteria are diagnosis of T2D, currently treated with glucose-lowering medications, age 30-75 years, and body mass index ≥ 30. The primary outcome is a binary measure of use of glucose-lowering medication. Secondary outcomes include A1C, anthropometrics and clinical blood markers. DISCUSSION: There are inherent risks involved if patients with T2D who take glucose-lowering medications follow very low carbohydrate diets. This randomized controlled trial aims to determine whether engaging community pharmacists is a safe and effective way to deliver therapeutic carbohydrate restriction and reduce/eliminate the need for glucose-lowering medications in people with T2D. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03181165. Registered on 8 June 2017.

Undetected Cortrak tube misplacements in the United Kingdom 2010-17: An audit of trace interpretation.

OBJECTIVES: Determine why Cortrak-guided, undetected tube misplacement may occur in relation to the system of trace interpretation used. METHODOLOGY: From 2010 to 2017 we obtained seven of the eight Cortrak traces from the United Kingdom where misplacement was undetected and the patient received feed. Seven suffered serious harm. Each misplacement was interpreted by three systems: screen position, manufacturer guidance and gastrointestinal (GI) flexures. SETTING: National and local records. MAIN OUTCOME MEASURES: Ability to identify misplacement. RESULTS: Traces that were later identified as misplacements, could not be differentiated from GI position when they wholly or partially: a) overlapped with the GI screen area plotted from historical records (57-71%) or b) met both manufacturer guidance criteria or were confused with receiver misplacement or unusual anatomy and reached the lower left quadrant (14-71%). Conversely, all lung misplacements were identified as unsafe using the GI flexure system. All three systems failed to detect the intra-peritoneal trace. Traces were inconsistently stored by healthcare centres. CONCLUSION: Trace file storage should be mandated by and accessible to relevant health authorisation bodies to improve safety research. Screen position alone and manufacturer guidance fail to consistently differentiate the shape of safe from unsafe traces. GI flexure interpretation appears safer but requires testing in larger studies.

Estimating the public health impact of a national guideline on cervical cancer screening: an audit study of a program in Campinas, Brazil.

BACKGROUND: A Brazilian guideline on cervical cancer screening was released in 2011. The objective was to verify changes in screening indicators around this period. METHODS: An audit study which sample was all screening tests performed by the public health system of Campinas city from 2010 to 2016. Variables were absolute tests numbers, excess tests, intervals and results, by age. For trend analysis was used Cochran-Armitage × 2 and linear regression. RESULTS: Were carried out 62,925 tests in 2010 and 43,523 tests in 2016, a tendency at a reduction (P = 0.001). Excess tests were higher than 50% over the years, with a tendency at a reduction (P < 0.001). Tests performed on women under 25 ranged from 20.2 to 15.4% in the period (P < 0.001), while in the 25-64 years age-group, it ranged from 75.1 to 80.2% (P < 0.001). In 2010 the most frequent interval was annual (47.5%) and in 2016 biennial (34.7%). There was a tendency at a reduction in the proportion of tests performed at the first time and those with an annual interval (P < 0.001), and also a tendency at an increase in tests with intervals equal to or greater than biannual (P < 0.001). We observed a tendency at a reduction in LSIL and HSIL-CIN2 results (P = 0.04 and P = 0.001, respectively), and a tendency at an increase in HSIL-CIN3 result (P = 0.02). CONCLUSION: The proportion of cervical cancer screening tests performed out of the recommendation showed a significant reduction in the period. This indicates a tendency to align cervical cancer screening in Campinas with the standards recommended.

Processo de trabalho da comissão de doação de órgãos e tecidos: percepção da equipe / Work process of the organ and tissue donation committee: team perception

Objective: to know the team's perception of the work process of an Intra-Hospital Transplant Organ and Tissue Donation Commission (CIHDOTT). Method: descriptive research of qualitative nature. Held with ten CIHDOTT members from a public hospital in northwestern Paraná. Single interviews were recorded, transcribed and subjected to thematic content analysis. Results:Three thematic categories emerged, which relate the daily work activities of the service, the challenges experienced in the work of CIHDOTT and themotivational factors of acting on the committee. Final Considerations: To the ceaseless work towards greater organ and tissue uptake in line with the need to comply with current legislation, workers face major challenges related to the hospital's physicalstructure and the understanding of aspects that surround their roles by professionals outside the committee. However, the humanization of the peculiar care provided and the teamwork of the current CIHDOTT motivate them.

Objetivo: conhecer a percepção da equipe sobre o processo de trabalho de uma Comissão Intra-Hospitalar de Doação de Órgãos e Tecidos para Transplante (CIHDOTT). Método: pesquisa descritiva, de natureza qualitativa. Realizada com dez membros de uma CIHDOTT de um hospital público do Noroeste do Paraná. As entrevistas individuais foram gravadas, transcritas e submetidas à análise de conteúdo temática. Resultados: Emergiram três categorias temáticas, as quais relacionam as atividades laborais cotidianas do serviço, os desafios vivenciados no trabalho da CIHDOTT e os fatores motivacionais de atuar na comissão. Considerações Finais: Ao trabalho incessante rumo à maior captação de órgãos e tecidos alinhada à necessidade de cumprir a legislação vigente, os trabalhadores enfrentam grandes desafios relacionados à estrutura física hospitalar e o entendimento de aspectos que entornam sua função por profissionais externos à comissão. Porém, a humanização do cuidado peculiar prestado e o trabalho em equipe da atual CIHDOTT os motivam.

The use and feasibility of an online software system to support assessment of accuracy and consistency in applying the Australasian Triage Scale.

BACKGROUND: The purpose of this study was to evaluate the use and feasibility of a software system called the Triage Quality Assessment Software in New South Wales emergency departments, to assist in evaluating triage decision accuracy and consistency of emergency nurses in applying the Australasian Triage Scale. METHOD: A descriptive, exploratory study comprising of retrospective audit data and survey, was conducted 12-months post-implementation of the Triage Quality Assessment Software system. RESULTS: Between January to December 2018, a total of 39 audits were completed comprising 4214 triage records, of which 3952 (93.3%) contained sufficient information to be evaluated. Triage decision accuracy was 58.3% with a moderate level (KW=0.57) of consistency demonstrated. Overall feasibility was high (4.2). Findings confirmed learnability (4.3), usability (4.2) and acceptability (4.2) of Triage Quality Assessment Software. CONCLUSION: This is the first software system to be developed to assist in evaluating triage decision accuracy and consistency in applying the Australasian Triage Scale. This study provides evidence that triage decision accuracy and consistency are detectable and quantifiable. The feasibility of Triage Quality Assessment Software is supported, with further testing needed to fully evaluate its role in emergency department triage quality improvement.

Management of postpartum hemorrhage in a rural hospital in Kenya: a best practice implementation project.

INTRODUCTION: Postpartum hemorrhage accounts for 34% of maternal deaths in Kenya. The World Health Organization guidelines on postpartum hemorrhage are not always followed despite being prominently promoted in hospitals. OBJECTIVES: The objectives of this study were to assess the current practice of health workers in the prevention and management of postpartum hemorrhage and to implement strategies to promote best practice. METHODS: A baseline audit with five evidence-based audit criteria was conducted using the Joanna Briggs Institute Practical Application of Clinical Evidence System. Strategies to improve compliance were implemented and a follow-up audit was carried out using the same data collection methods. Results of both audits were compared. RESULTS: The baseline audit showed that 90% of health workers were aware of the existence and location of the national guidelines. Almost two thirds (65%) of staff had received education on postpartum hemorrhage within the last two years. Only 30% had received specific training on the use of the guidelines and compliance with the guidelines was 0%. At the follow-up audit, the proportion of health workers who had received recent education on postpartum hemorrhage and specific training on the use of a protocol increased to 90%. The use and documentation of a protocol for postpartum hemorrhage increased to 100%. Compliance in prenatal risk assessment for postpartum hemorrhage decreased from 65% to 35%. CONCLUSIONS: Knowledge of the guidelines did not translate into their use during management of patients with postpartum hemorrhage. The introduction of a tool and staff education and training improved compliance.

Faculty Perceptions of Entrustable Professional Activities to Determine Pharmacy Student Readiness for Advanced Practice Experiences.

Objective. To quantify pharmacy faculty members' perceptions of the importance of entrustable professional activities (EPAs) and the expected level of entrustment that should be achieved to determine APPE readiness. Methods. Entrustable professional activities define the core skills and tasks expected of new pharmacy graduates and may serve as a logical framework for determining pharmacy student readiness to begin advanced pharmacy practice experiences (APPEs). A five-question survey was distributed to all faculty members, staff members, and administrators at Ferris State University College of Pharmacy. Respondents were asked to rate 18 statements mapped to 12 EPAs on the perceived importance of each statement and the expected level of entrustment students should achieve to determine readiness for APPEs. Thresholds were used to determine consensus for importance and level of entrustment for each statement. Results. Of the 44 faculty members surveyed, 28 (63.6%) responded. A strong consensus was reached on the level of importance for 16 of 18 statements (89%), while two statements demonstrated moderate consensus (11%). No strong consensus was identified on levels of entrustment. Seven (39%) of 18 statements demonstrated moderate entrustment consensus and 11 (61%) statements demonstrated little consensus. Conclusion. Strong consensus was identified regarding which EPAs are important to determine students' APPE readiness; however, no strong consensus was found when evaluating levels of entrustment. Lack of consensus regarding entrustment raises several questions that require further study and clarification as the implementation of EPAs continues throughout the Academy.

An Audit for Radiotherapy Planning and Treatment Errors From a Low-Middle-Income Country Centre.

AIMS: To report the findings of an audit for radiotherapy errors from a low-middle-income country (LMICs) centre. This would serve as baseline data for radiotherapy error rates, their severity and causes, in such centres where modern error reporting and learning processes still do not exist. MATERIALS AND METHODS: A planned cross-sectional weekly audit of electronic radiotherapy charts at the radiotherapy planning and delivery step for all patients treated with curative intent was conducted. Detailed analysis was carried out to determine the step of origin of error, time and contributing factors. They were graded as per indigenous institutional (TMC) radiotherapy error grading (TREG) system and the contributing factors identified were prioritised using the product of frequency, severity and ease of detection. RESULTS: In total, 1005 consecutive radically treated patients' charts were audited, 67 radiotherapy errors affecting 60 patients, including 42 incidents and 25 near-misses were identified. Transcriptional errors (29%) were the most common type. Most errors occurred at the time of treatment planning (59.7%), with "plan information transfer to the radiation oncology information system" being the most frequently affected sub-step of the radiotherapy process (47.8%). More errors were noted at cobalt units (52/67; 77.6%) than at linear accelerators. Trend analysis showed an increased number of radiotherapy incidents on Fridays and near-misses on Mondays. Trend for increased radiotherapy errors noted in the evening over other shifts. On severity grading, most of the errors (54/60; 90%) were clinically insignificant (grade I/II). Inadequacies and non-adherence towards standard operating procedures, poor documentation and lack of continuing education were the three most prominent causes. CONCLUSION: Preliminary data suggest a vulnerability of LMIC set-up to radiotherapy errors and emphasises the need for the development of longitudinal prospective processes, such as voluntary reporting and a continued education system, to ensure robust and comprehensive safe practises on par with centres in developed countries.

The prescription of lidocaine patches in osteoarthritis-a complete audit cycle.

OBJECTIVES: Nationally, 5% of the population have been prescribed topical lidocaine patches (TLPs). These patches cost €77-230 per month. The only licensed indication for TLP is post-herpetic neuralgia (PHN). It has not proven to be effective for any other indication including musculoskeletal and post-surgical pain. It is estimated that only 5-10% of patients on TLP have PHN. The aim of this study was to audit the number of inpatients currently prescribed TLP-appropriately and inappropriately-and to examine the prescribing patterns. METHODS: The acute inpatient population was audited in August 2017 to determine TLP prevalence. Demographics, indication, prescriber grade, and whether TLP was commenced during the current admission were recorded. Education was given surrounding indications and licensed usage of TLP. The acute inpatient population was subsequently re-audited in February 2018. RESULTS: There were 304 patients included in the initial study and 300 in the repeat study. The most common indication was musculoskeletal pain in each study, 75 and 77.78%, respectively. The number of inpatients on TLP fell from 17.1% (n = 52) to 6% (n = 18) after the intervention. The potential savings between the study periods are therefore €31,418-93,840 in total and €23,100-69,000 in musculoskeletal patients. CONCLUSION: A large proportion of inpatients are inappropriately prescribed TLP predominantly for musculoskeletal pain, resulting in substantial avoidable cost to the hospital. Education of prescribers and implementation of policies is required to limit inappropriate prescribing.

Development of pharmacy resident leadership skills through creation of a regional ambulatory care forum.

BACKGROUND AND PURPOSE: Action-based leadership activities help refine leadership skills. This paper describes an experiential, longitudinal leadership experience for post-graduate year two (PGY2) pharmacy residents in ambulatory care. EDUCATIONAL ACTIVITY AND SETTING: As part of a leadership and advocacy rotation, two PGY2 ambulatory care pharmacy residents collaborated with a state association, North Carolina Association of Pharmacists, to co-chair a newly formed regional ambulatory care forum in the western part of the state. The residents developed charges for the group, directed and organized the leadership team meetings, moderated the member events of approximately 30 participants, and served as liaisons to the state association and its members. Two residency preceptors who supervised the academic and leadership experiences for the residency program provided oversight for the residents with the forum. Residents completed written and oral self-reflections, received formative feedback from the forum's leadership team and leadership preceptor, participated in a 360-degree leadership evaluation, and received quarterly summative evaluations. FINDINGS: Skills developed included leading a group, event planning, advocacy, networking, communication, professional writing, creating a shared vision, teamwork, and collaboration. SUMMARY: Serving in leadership roles within professional organizations can provide PGY2 pharmacy residents with practical hands-on leadership opportunities to help prepare them for positional and non-positional leadership roles in the future.