The role of community pharmacists as advisors on prescription medication

This thesis describes the historical and functional evolution of British community pharmacists showing the succession of a compounding role by a supply function with incumbent bureaucracy. Development of a role as advisors on prescription medication is reviewed and the potential benefit explored by reviewing patients' lack of understanding about their medication following advice from general medical practitioners. Although ethical directives and specific guidance could be identified for the application and use of additional labels, little was found for provision of verbal advice. No comprehensive research was found to describe the prescription medication advisory role of community pharmacists. The present thesis primarily addresses this lack of knowledge. For a total of 651/2 days between June 1988 and February 1989 the discussions of twenty of twenty four randomly selected community pharmacists which involved prescription medication were tape recorded, transcribed and the circumstances observed. For half this time a poster advertising community pharmacists' advisory service was displayed. Verbal advice was provided by the community pharmacist to 473 of 3519 individuals involved with prescription medication. Two types of community pharmacists were identified, proactive and reactive. Irrespective of type, a constant level of requests for advice was noted. Overall, display of the poster was not associated with any significant effect on the quantity of advice; however, it was associated with changes in the nature of advice with greater emphasis on 'Specific problem' and 'Side effects' over 'What is prescribed' and 'What to do with it'. Although reiteration of the prescribers' directions and verbalising additional label warnings accounted for the majority of verbal advice, qualitative analysis revealed an element of independent judgement. The sociological literature on the professions provides an understanding for the observations. It is argued that guidance for verbal advice provided in the British National Formulary may facilitate community pharmacists' prescription medication advisory role

Standards of lithium monitoring in mental health trusts in the UK

<p>Abstract</p> <p>Background</p> <p>Lithium is a commonly prescribed drug with a narrow therapeutic index, and recognised adverse effects on the kidneys and thyroid. Clinical guidelines for the management of bipolar affective disorder published by The National Institute for Health and Clinical Excellence (NICE) recommend checks of renal and thyroid function before lithium is prescribed. They further recommend that all patients who are prescribed lithium should have their renal and thyroid function checked every six months, and their serum lithium checked every three months. Adherence to these recommendations has not been subject to national UK audit.</p> <p>Methods</p> <p>The Prescribing Observatory for Mental Health (POMH-UK) invited all National Health Service Mental Health Trusts in the UK to participate in a benchmarking audit of lithium monitoring against recommended standards. Data were collected retrospectively from clinical records and submitted electronically.</p> <p>Results</p> <p>436 clinical teams from 38 Trusts submitted data for 3,373 patients. In patients recently starting lithium, there was a documented baseline measure of renal or thyroid function in 84% and 82% respectively. For patients prescribed lithium for a year or more, the NICE standards for monitoring lithium serum levels, and renal and thyroid function were met in 30%, 55% and 50% of cases respectively.</p> <p>Conclusions</p> <p>The quality of lithium monitoring in patients who are in contact with mental health services falls short of recognised standards and targets. Findings from this audit, along with reports of harm received by the National Patient Safety Agency, prompted a Patient Safety Alert mandating primary care, mental health and acute Trusts, and laboratory staff to work together to ensure systems are in place to support recommended lithium monitoring by December 2010.</p

Rotation device for snowboard bindings

A need has developed for snowboarders to rotate their front foot, allowing for ease of mobility on flat terrain and ski lifts. Four designs were proposed and compared with each other and the initial design constraints. The final design consists of two circular plates. The bottom plate is fixed to the snowboard while the top plate attaches to the boot binding and can rotate relatively to the fixed bottom plate. The final design allows a 90-degree rotation, which accommodates any riding stance. Three iterations of the final design were machined in an attempt to isolate and eliminate all flaws. Each was tested on the slopes of Mt. Wachusett, and the final iteration performed admirably under all types of riding

Drug name confusion: evaluating the effectiveness of capital ("Tall Man") letters using eye movement data

Medication errors commonly involve confusion between drug names that look or sound alike. One possible method of reducing these errors is to print sections of the names in "Tall Man" (capital) letters, in order to emphasise differences between similar products. This paper reports an eye-tracking experiment that evaluates this strategy. Participants had their eye movements monitored while they searched for a target product amongst an array of product packs. The target pack was replaced by a similar distractor in the array. Participants made fewer errors when the appearance of the names had been altered, that is, they were less likely to incorrectly identify a distractor as the target drug. This result was reflected in the eye movement data.Medication error Drug labelling Look-alike names Eye movements Tall Man letters Patient safety

Drug name confusion: evaluating the effectiveness of capital ("Tall Man") letters using eye movement data

Medication errors commonly involve confusion between drug names that look or sound alike. One possible method of reducing these errors is to print sections of the names in ‘‘Tall Man’’ (capital) letters, in order to emphasise differences between similar products. This paper reports an eye-tracking experiment that evaluates this strategy. Participants had their eye movements monitored while they searched for a target product amongst an array of product packs. The target pack was replaced by a similar distractor in the array. Participants made fewer errors when the appearance of the names had been altered, that is, they were less likely to incorrectly identify a distractor as the target drug. This result was reflected in the eye movement data

The influence of tall man lettering on drug name confusion: a laboratory-based investigation in the UK using younger and older adults and healthcare practitioners

The influence of tall man lettering on drug name confusion: a laboratory-based investigation in the UK using younger and older adults and healthcare practitioner