Applying Quality Improvement methods to address gaps in medicines reconciliation at transfers of care from an acute UK hospital

© Published by the BMJ Publishing Group Limited.Objectives Reliable reconciliation of medicines at admission and discharge from hospital is key to reducing unintentional prescribing discrepancies at transitions of healthcare. We introduced a team approach to the reconciliation process at an acute hospital with the aim of improving the provision of information and documentation of reliable medication lists to enable clear, timely communications on discharge. Setting An acute 400-bedded teaching hospital in London, UK. Participants The effects of change were measured in a simple random sample of 10 adult patients a week on the acute admissions unit over 18â €...months. Interventions Quality improvement methods were used throughout. Interventions included education and training of staff involved at ward level and in the pharmacy department, introduction of medication documentation templates for electronic prescribing and for communicating information on medicines in discharge summaries co-designed with patient representatives. Results Statistical process control analysis showed reliable documentation (complete, verified and intentional changes clarified) of current medication on 49.2% of patients discharge summaries. This appears to have improved (to 85.2%) according to a poststudy audit the year after the project end. Pharmacist involvement in discharge reconciliation increased significantly, and improvements in the numbers of medicines prescribed in error, or omitted from the discharge prescription, are demonstrated. Variation in weekly measures is seen throughout but particularly at periods of changeover of new doctors and introduction of new systems. Conclusions New processes led to a sustained increase in reconciled medications and, thereby, an improvement in the number of patients discharged from hospital with unintentional discrepancies (errors or omissions) on their discharge prescription. The initiatives were pharmacist-led but involved close working and shared understanding about roles and responsibilities between doctors, nurses, therapists, patients and their carers

WASH and Tsg101/ALIX-dependent diversion of stress-internalized EGFR from the canonical endocytic pathway

Stress exposure triggers ligand-independent EGF receptor (EGFR) endocytosis, but its post-endocytic fate and role in regulating signalling are unclear. We show that the p38 MAP kinase-dependent, EGFR tyrosine kinase (TK)-independent EGFR internalization induced by ultraviolet light C (UVC) or the cancer therapeutic cisplatin, is followed by diversion from the canonical endocytic pathway. Instead of lysosomal degradation or plasma membrane recycling, EGFR accumulates in a subset of LBPA-rich perinuclear multivesicular bodies (MVBs) distinct from those carrying EGF-stimulated EGFR. Stress-internalized EGFR co-segregates with exogenously expressed pre-melanosomal markers OA1 and fibrillar PMEL, following early endosomal sorting by the actin polymerization-promoting WASH complex. Stress-internalized EGFR is retained intracellularly by continued p38 activity in a mechanism involving ubiquitin-independent, ESCRT/ALIX-dependent incorporation onto intraluminal vesicles (ILVs) of MVBs. In contrast to the internalization-independent EGF-stimulated activation, UVC/cisplatin-triggered EGFR activation depends on EGFR internalization and intracellular retention. EGFR signalling from this MVB subpopulation delays apoptosis and might contribute to chemoresistance

Smart Materials as Intelligent Insulation

In order to provide a robust infrastructure for the transmission and distribution of electrical power, understanding and monitoring equipment ageing and failure is of paramount importance. Commonly, failure is associated with degradation of the dielectric material; therefore the introduction of a smart moiety into the material is a potentially attractive means of continual condition monitoring. It is important that any introduction of smart groups into the dielectric does not have any detrimental effect on the desirable electrical and mechanical properties of the bulk material. Initial work focussed on the introduction of fluorophores into a model dielectric system. Fluorescence is known to be a visible effect even at very low concentrations of active fluorophores and therefore was thought well suited to such an application. It was necessary both to optimise the active fluorophore itself and to determine the most appropriate manner in which to introduce the fluorophores into the insulating system. This presentation will describe the effect of introducing fluorophores into polymeric systems on the dielectric properties of the material and the findings thus far [1]. Alternative smart material systems will also be discussed along with the benefits and limitations of smart materials as electric field sensors

Simulations of satellite Doppler wind observations

This study will involve two objectives: (1) to develop, through computer simulations, optimal satellite-based sensor scanning techniques for direct measurement of tropospheric winds on the meso- and synoptic scales; and (2) to construct simulations of remotely measured wind fields for assessing impact of such fields on the diagnosis and prognosis of atmospheric phenomena through the use of Observing System Simulation Experiments (OSSE). Using the LAWS Simulation Model (LSM), various global coverage scenarios have been investigated as part of an effort to define the optimal orbit, configuration and sampling strategies for observations of winds for use in global circulation models. Simulated data sets have been provided to GSFC, FSU and several LAWS team members. Particular emphasis has been on providing realistic cloud cover, cirrus backscatter, aerosol distribution and wind variance on scales less than 600 km. Progress is currently being made to incorporate other remote sensors (AIRS/AMSU, STIKSCAT) into the global OSSEs

No-vent fill pressurization tests using a cryogen simulant

The results are described of an experimental program which studied the performance of various no-vent fill techniques for tank-to-tank liquid transfer. The tests were performed using a cryogen simulant (Freon-114) and a test bed consisting of a multiple tank/plumbing network that enabled studies of a variety of different inlet flow and active mixing regimes. Several results and conclusions were drawn from the 26 transfer experiments comprising the program. Most notable was the significant improvement in fill performance (i.e., minimized fill time and maximized fill fraction) with increased agitation of the liquid surface. Another was the close correlation between measured condensation rates and those predicted by recent theories which express condensation as a function of turbulent eddy effects on the liquid surface. In most cases, test data exhibited strong agreement with an analytical model which accounts for tank heat transfer and thermodynamics in a 1 g environment

An XMM-Newton observation of Ton S180: Constraints on the continuum emission in ultrasoft Seyfert galaxies

We present an XMM-Newton observation of the bright, narrow-line, ultrasoft Seyfert 1 galaxy Ton S180. The 0.3-10 keV X-ray spectrum is steep and curved, showing a steep slope above 2.5 keV (Gamma ~ 2.3) and a smooth, featureless excess of emission at lower energies. The spectrum can be adequately parameterised using a simple double power-law model. The source is strongly variable over the course of the observation but shows only weak spectral variability, with the fractional variability amplitude remaining approximately constant over more than a decade in energy. The curved continuum shape and weak spectral variability are discussed in terms of various physical models for the soft X-ray excess emission, including reflection off the surface of an ionised accretion disc, inverse-Compton scattering of soft disc photons by thermal electrons, and Comptonisation by electrons with a hybrid thermal/non-thermal distribution. We emphasise the possibility that the strong soft excess may be produced by dissipation of accretion energy in the hot, upper atmosphere of the putative accretion disc.Comment: 9 pages, accepted for publication in MNRA

Vertical distribution of clouds over Hampton, Virginia observed by lidar under the ECLIPS and FIRE ETO programs

Intensive cloud lidar observations have been made by NASA Langley Research Center during the two observation phases of the ECLIPS project. Less intensive but longer term observations have been conducted as part of the FIRE extended time observation (ETO) program since 1987. We present a preliminary analysis of the vertical distribution of clouds based on these observations. A mean cirrus thickness of just under 1 km has been observed with a mean altitude of about 80 percent of the tropopause height. Based on the lidar data, cirrus coverage was estimated to be just under 20 percent, representing roughly 50 percent of all clouds studied. Cirrus was observed to have less seasonal variation than lower clouds. Mid-level clouds are found to occur primarily in association with frontal activity