Effectiveness and cost effectiveness of pharmacist input at the ward level: a systematic review and meta-analysis

Background Pharmacists play important role in ensuring timely care delivery at the ward level. The optimal level of pharmacist input, however, is not clearly defined. Objective To systematically review the evidence that assessed the outcomes of ward pharmacist input for people admitted with acute or emergent illness. Methods The protocol and search strategies were developed with input from clinicians. Medline, EMBASE, Centre for Reviews and Dissemination, The Cochrane Library, NHS Economic Evaluations, Health Technology Assessment and Health Economic Evaluations databases were searched. Inclusion criteria specified the population as adults and young people (age >16 years) who are admitted to hospital with suspected or confirmed acute or emergent illness. Only randomised controlled trials (RCTs) published in English were eligible for inclusion in the effectiveness review. Economic studies were limited to full economic evaluations and comparative cost analysis. Included studies were quality-assessed. Data were extracted, summarised. and meta-analysed, where appropriate. Results Eighteen RCTs and 7 economic studies were included. The RCTs were from USA (n=3), Sweden (n=2), Belgium (n=2), China (n=2), Australia (n=2), Denmark (n=2), Northern Ireland, Norway, Canada, UK and Netherlands. The economic studies were from UK (n=2), Sweden (n=2), Belgium and Netherlands. The results showed that regular pharmacist input was most cost effective. It reduced length-of-stay (mean= -1.74 days [95% CI: -2.76, -0.72], and increased patient and/or carer satisfaction (Relative Risk (RR) =1.49 [1.09, 2.03] at discharge). At £20,000 per quality-adjusted life-year (QALY)-gained cost-effectiveness threshold, it was either cost-saving or cost-effective (Incremental Cost Effectiveness Ratio (ICER) =£632/ QALY-gained). No evidence was found for 7-day pharmacist presence. Conclusions Pharmacist inclusion in the ward multidisciplinary team improves patient safety and satisfaction and is cost-effective when regularly provided throughout the ward stay. Research is needed to determine whether the provision of 7-day service is cost-effective.Peer reviewe

Patient Safety in the World

AbstractPatient safety is a fundamental principle of health care. However, many medical practices and risks associated with health care are emerging as major challenges for patient safety globally and contribute significantly to the burden of harm due to unsafe care. Available evidence suggests hospitalizations in low- and middle-income countries lead annually to 134 million adverse events, contributing to 2.6 million deaths. About 134 million adverse events worldwide give rise to 2.6 million deaths every year. Estimates indicate that in high-income countries, about 1 in 10 patients is harmed while receiving hospital care. This problem affects both high-income countries and low- and middle countries even if priorities and issues may differ. The most important adverse events concern medication procedures, healthcare-associated infections, surgical procedures, injection safety, blood transfusions, venous thromboembolism, sepsis, and diagnostic and radiation errors. Since 1999 when the Institute of Medicine (IOM) published its report "To err is human," some progress has been made but patient harm is still a daily problem in healthcare. As a matter of fact, new threats are emerging due to population aging, along with new treatments and technologies which must be dealt with in addition to still-unresolved, long-standing problems. In this context, it is very important to adopt an international common strategy that creates networks, shares knowledge, programs, tools, good practices and develop and track indicators focusing on the specific priorities of each country and region

Infection Prevention and Control

AbstractHealthcare-associated infections (HAI) are adverse events exposing patients to a potentially avoidable risk of morbidity and mortality. Antimicrobial resistance (AMR) is increasingly contributing to the burden of HAIs and emerging as of the most alarming challenges for public health worldwide. Practically, harm mitigation and risk containment demand cross-sectional initiatives incorporate both approaches to infection prevention and control and methodologies from clinical risk management

Guidelines and Safety Practices for Improving Patient Safety

AbstractThis chapter explains why clinical practice guidelines are needed to improve patient safety and how further research into safety practices can successfully influence the guideline development process. There is a description of the structured process by which guidelines that aim to increase the likelihood of a higher score are created. Proposals are made relating to (a) the live updating of individual guideline recommendations and (b) tackling challenges related to the improvement of guidelines

Une construction syntaxique négligée dans la langue homérique ?

The starting point of the author's reflections is the doubling of objects - a construction which is widespread in Balkan languages. The origin of this construction, being a well-established subject of linguistic research, has failed to be satisfactorily explained. However, it may be observed that the doubled construction has in Greek a longer tradition than is commonly acknowledged, since in Homer there are some records of a very similar syntactic phenomenon, i.e. the doubling of objects by means of the pronouns μιν, οι and ό. Furthermore, a certain regularity observable in the Homeric construction may suggest that this is a grammatical, and not only stylistic phenomenon. Even though the Modern Greek construction cannot be directly related to that of Homeric Greek, one may suppose that there is an indirect relation between them, which fact must be taken into account in further investigations of the origin of the doubling of objects in Balkan languages.Le point de départ des réflexions de l'auteur est le redoublement des compléments — construction répandue dans les langues balkaniques — , dont l'origine a fait couler beaucoup d'encre sans être pourtant éclaircie. Cependant, on peut observer que la construction double en grec a une histoire plus longue que les linguistes ne le pensaient, car chez Homère il y a des attestations d'un phénomène très semblable, à savoir le redoublement des objets à l'aide des pronoms μιν, oi et ó. En plus, on peut remarquer la régularité avec laquelle cette construction y apparaît, ce qui suggère qu'il s'agit d'un phénomène d'ordre grammatical et non seulement stylistique. Bien que la construction néo-grecque ne puisse pas continuer directement celle de la langue homérique, on peut supposer l'existence d'une relation indirecte entre les deux, dont on doit tenir compte dans les recherches sur l'origine du redoublement des objets dans les langues balkaniques.Slawomirski Jerzy. Une construction syntaxique négligée dans la langue homérique ?. In: Revue des Études Anciennes. Tome 90, 1988, n°3-4. pp. 325-328

Sustaining Quality Improvement In Hospital Falls Prevention Systems By Using A Community Of Practice

Aim This quality improvement project aimed to evaluate the feasibility and effectiveness of using a Community of Pra ctice (CoP) model to sustain continuous quality improvement in system ide inpatient falls prevention activity. Method The setting was a state wide group drawn from large and small metropolitan and rural hospitals. A Falls Prevention CoP was created foll owing stakeholder engagement and identification of key CoP roles. No additional funding was obtained. Data were collected using an online survey which evaluated CoP members’ self -perception of adequacy of communication, resourcing, support and levels of knowledge. The efficacy of the CoP in promoting organisational change was evaluated by an audit measuring falls prevention practice change across all participating hospitals. Results CoP gatherings were attended by an average of 25 members. There were 7 5 total responses to three online surveys. Members responding that communication between Falls Network stakeholders was optimal to achieving work tasks effectively increased from 29.1% (n=7) at baseline to 79% (n=15) at 24 months. After 24 months 89% (n= 17) of respondents reported that the Falls CoP was important or very important in assisting them to perform their work in falls prevention and 73% (n=14) responded that their participation in the Falls CoP had resulted in changes in practice at their indiv idual hospital site. There as over 90% compliance at participating hospitals to 10 of the 14 falls prevention standards measured Conclusions and implications for practice Changes facilitated by individual CoP members and the CoP group have resulted in i mproved communication, learning and information sharing among health workers and standardisation of key processes across the state wide health setting. A CoP can be a valuable, cost neutral addition to sustaining falls prevention practice in health care sytems ith established programs. Other clinical groups working collaboratively should consider instituting a Community of Practic