Barriers and facilitators of medicines reconciliation at transitions of care in Ireland - a qualitative study.

BACKGROUND: Medication error at transitions of care is common. The implementation of medicines reconciliation processes to improve this issue has been recommended by many regulatory and safety organisations. The aim of this study was to gain insight from healthcare professionals on the barriers and facilitators to the medicines reconciliation implementation process. METHODS: Semi-structured interviews were conducted in Ireland with a wide range of healthcare professionals (HCPs) involved with medicines reconciliation at transitions of care. Thematic analysis was undertaken using an adaptation of a combined theoretical framework of Grol, Cabana and Sluisveld to classify the barriers and facilitators to implementation of medicines reconciliation. RESULTS: Thirty-five participants were interviewed, including eleven community pharmacists (CPs), eight hospital pharmacists (HPs), nine hospital consultants (HCs), five general practitioners (GPs), and two non-consultant hospital doctors (NCHDs). Themes were categorized into barriers and facilitators. Barriers included resistance from existing professional cultures, staff interest and training, poor communication and minimal information and communications technology (ICT) support. Solutions (facilitators) suggested included supporting effective multidisciplinary teams, greater involvement of pharmacists in medicines reconciliation, ICT solutions (linked prescribing databases, decision support systems) and increased funding to provide additional (e.g. admission and discharge reconciliation) and more advanced services (e.g. community pharmacist delivered medicines use review). CONCLUSIONS: Medicines reconciliation is advocated as a solution to the known problem of medication error at transitions of care. This study identifies the key challenges and potential solutions that policy makers, managers and HCPs should consider when reviewing the practices and processes of medicines reconciliation in their own organisations.

'Good cancer gone bad': a narrative review of HPV oropharyngeal cancer and potential poor outcomes.

PURPOSE: Oropharyngeal cancer (OPC) remains a significant health burden and about 15-30% of these have been attributed to the human papillomavirus (HPV). Human papillomavirus-related oropharyngeal cancer (HPV OPC) includes tumours which are detected to be p16INK4A positive or have the HPV DNA detected by in situ hybridisation or polymerase chain reaction. HPV OPC is generally believed to have a relatively good prognosis. More recently, there is a recognised pattern of atypical spread in a highly aggressive subset of HPV OPC. These are HPV OPCs which develop distant metastasis or recurrence. This review raises awareness of this subset of HPV OPC and factors associated with poor outcomes. METHODS: A review of the literature available on HPV OPC was carried out. Studies were sourced from PubMed with searching of relevant headings and sub-headings and cross-referencing. RESULTS: Factors associated with highly aggressive HPV OPC include nodal stage and nodal morphology, alcohol and tobacco use, age and biological characteristics. Treatment options in cases of disease recurrence include salvage resection radiotherapy and/or chemotherapy and management options vary depending on the nature of recurrence and initial treatment. Recent updates in HPV OPC staging have made staging and treatment of tumours more accurate. CONCLUSION: While HPV OPC overall carries a relatively good prognosis, it is important for clinicians to be aware of potentially highly aggressive cases of HPV OPC and to be aware of factors that should prompt close monitoring.

Introduction of an ENT emergency-safe boot camp into postgraduate surgical training in the Republic of Ireland.

BACKGROUND: Otolaryngology (ENT) is a craft surgical specialty, which presents significant challenges for the novice surgical trainee (NST), when managing patients with potentially life-threatening conditions. We assess current evidence behind intensive, simulation-rich training programmes or "boot camps". We outline an ENT emergency-safe boot camp for NSTs and the impact this can have on trainees' competence when dealing with ENT emergencies. METHODS: We designed a standardized "ENT emergency-safe boot camp", aimed at NSTs with a view to up-skilling them in the management of 3 critical clinical scenarios namely post-thyroidectomy haematoma, post-tonsillectomy haemorrhage and epistaxis. All core surgical trainees (CSTs) (n = 54) on the National Surgical Training programme at the Royal College of Surgeons (RCSI) were enrolled on the boot camp. A pre- and post-boot camp anonymised self-assessment was completed by all participants. RESULTS: Trainees' self-assessment demonstrated an increase in median competence scores from 3/5 to 4/5 for management of post-thyroidectomy haematoma and epistaxis. There was a greater increase in self-assessed competence scores from 2/5 to 4/5 for the management of post-tonsillectomy haemorrhage. Ninety-two percent of respondents said the course added to their previous knowledge, 70% of respondents said it improved their technical skills and 85% of participants said the course gave them more confidence with handling ENT related on-call problems. CONCLUSION: Study participants expressed an increase in confidence when dealing with specific ENT emergencies, following boot camp training. This correlates with published data. Patient safety should be enhanced, as a result of participation in this dedicated ENT emergency-safe boot camp.