Reducing medication errors on emergency department discharge: Evaluation of a collaborative pharmacist-medical officer discharge prescription planning model in a tertiary hospital emergency short stay unit.

OBJECTIVE: To implement and evaluate the impact of a collaborative pharmacist-medical officer model of planning discharge prescriptions, Partnered Pharmacist Discharge Prescription Planning (PPDPP) on the safe use of medicines on discharge in an ED short stay unit (SSU). METHODS: A prospective pre- and post-intervention study measured the proportion of medication errors on discharge prescriptions from the SSU using the Five Rights (5Rs) method. Pharmacists assessed discharge prescriptions generated by the medical officers (MO) during the pre-intervention phase (standard practice). During the PPDPP phase, pharmacists planned electronic prescriptions in consultation with MO and completed prescriptions were independently assessed by another pharmacist. RESULTS: There were 163 and 147 prescriptions collected during the pre- and post-intervention phases, respectively. There was a significant difference in the proportion of discharge prescriptions that met all 5Rs between the standard practice (47.2%) and PPDPP phase (91.8%) (P < 0.001). There was no statistical difference seen in the mean time taken from discharge decision to prescriptions given to patients or patients leaving the SSU between the two phases. There was a non-statically significant trend towards a decrease in time taken for patients to obtain prescriptions by 11% (P = 0.16) and for actual departure time by 6% (P = 0.46). Additionally, the proportion of opioids prescribed as one of the high-risk medication classes reduced from 23.8% to 16.2% (P = 0.023) with the PPDPP model. CONCLUSION: The PPDPP model improved medications safety on discharge from the ED SSU. The PPDPP did not impact patient flow parameters as measured in this study.

Lumbosacral plexopathy due to a rupture of a common Iliac artery aneurysm.

We report a case of lumbosacral plexopathy caused by the rupture of a common iliac artery aneurysm. The patient presented with sciatic type symptoms of lower back pain radiating to his left leg with associated numbness and weakness in the L4-S1 distribution. He also had reduced anorectal tone. A CT scan showed a large haematoma in the left side of the pelvis from a ruptured 8 cm common iliac artery aneurysm. Sciatica is commonly due to a prolapsed intervertebral disc, although spinal canal stenosis, spondylolisthesis, piriformis syndrome and spinal tumours and other causes need to be considered. This case serves to increase the awareness of the possibility of another uncommon cause, especially when additional atypical neurological symptoms exist.

Prehospital intubation and chest decompression is associated with unexpected survival in major thoracic blunt trauma.

OBJECTIVE: Application of the Trauma and Injury Severity Score (TRISS) to a trauma population identifies patients with 'unexpected survival'. This study used TRISS analysis to identify 'unexpected survivors' suffering major thoracic trauma, who survived to hospital discharge. Further analysis determined prehospital interventions that appeared to contribute to 'unexpected survival'. METHODS: The present study was a single-centre, retrospective case review with comparative statistical analysis. Patients were identified from the Alfred Trauma Registry between 1 July 2002 and 30 June 2003. RESULTS: There were 336 adult trauma patients treated at The Alfred Trauma Centre with an Injury Severity Score >15 (major trauma) and at least one thoracic Anatomical Injury Score of 3 (severe) or greater. Of the eligible patients, 322/336 (95.8%, 95%[confidence interval] CI 95.1-96.5%) had complete data available for analysis. The study population mortality was 42/322 (13.0%, 95% CI 12.3-13.7%). There were 20 'unexpected survivors' (5.9%) and 5 (1.5%) 'unexpected deaths' on TRISS analysis. Chest decompression and/or endotracheal intubation prehospital was performed on 16/20 'unexpected survivors'. GCS for 'unexpected survivors' and 'expected deaths' (3.8 vs 3.5, P = 0.27) was not a predictor of survival. Respiratory rate per minute (16.2 vs 8.8, P = 0.01) and systolic blood pressure - mmHg (98 vs 80, P = 0.03) were significantly greater in the 'unexpected survivors' group compared with the 'expected death' group. CONCLUSION: For patients sustaining severe thoracic blunt trauma, prehospital intubation and chest decompression appear to be associated with unexpected survival. A low GCS at scene is not predictive of 'unexpected survival' or 'expected death'.