Gaps and bridges in the discharge from Acute Medical Units to Home : – a qualitative, multidisciplinary, cross-setting perspective

dansk resume   FORMÅL At undersøge sundhedsprofessionelles erfaringer, synspunkter og oplevelser af udskrivelse af patienter fra en akutafdeling til hjemmet for at afdække gaps og bridges i patientovergangene. BAGGRUND Overgange af dårlig kvalitet kan føre til genindlæggelse og uhensigtsmæssige helbredsudfald. Problemer relateret til informationsoverførsel, opfølgningsinstruktioner og samarbejde forårsager ineffektive overdragelser mellem sektorer. DESIGN En kvalitativ undersøgelse med individuelle og fokusgruppeinterviews med hospitalspersonale (læger og sygeplejersker), kommunale sygeplejersker og praktiserende læger (n=20). Interviews blev analyseret ved hjælp af tematisk analyse struktureret efter tre a priori definerede temaer; information, opfølgning og samarbejde. RESULTATER Ni undertemaer kom ud af temaerne. Både akutafdelingens personale og sundhedsfaglige i primær sektor identificerede huller i forbindelse med overdragelse af information, koordinering af opfølgning og ansvar samt viden om tilbud i den anden sektor. KONKLUSION Resultater fra denne undersøgelse understøtter tidligere undersøgelser, der fremhæver flere huller i det tværsektorielle samarbejde. Gensidig manglende viden om henholdsvis primærsektorens tilbud og akutafdelingens praksis; uformelle og ikke-standardiserede udskrivelsesprocedurer og fraskrivelse af ansvar i overgangsprocessen.     AIM To investigate health care professionals’ experiences, views and ideas about the discharge of patients from an Acute Medical Unit (AMU) to home to uncover gaps and bridges in the transitional care process.    BACKGROUND Poor quality transitions can lead to readmission and unfavourable health outcomes. Problems related to information transfer, follow-up instructions and collaboration cause inefficient handovers between sectors. DESIGN A qualitative study using individual and focus group interviews with hospital staff (physicians and nurses), community nurses and general practitioners (n=20). Interviews were analysed using thematic analysis structured by three a priori defined themes; information, follow-up, and collaboration. RESULTS Nine subthemes emerged from the themes. Both AMU staff and primary care providers identified gaps related to handover of information, coordination of follow-up and responsibility, and knowledge on offers in the other sector.    CONCLUSION Findings from this study supports previous studies highlighting several gaps in the cross-sectorial collaboration. Mutual lack of knowledge on primary care offers and AMU practice, respectively; informal and unstandardized discharge procedures; and renunciation of responsibility in the transition process were major gaps revealed by the participants

The medication process in a psychiatric hospital:Are errors a potential threat to patient safety?

PURPOSE: To investigate the frequency, type, and potential severity of errors in several stages of the medication process in an inpatient psychiatric setting. METHODS: A cross-sectional study using three methods for detecting errors: (1) direct observation; (2) unannounced control visits in the wards collecting dispensed drugs; and (3) chart reviews. All errors, except errors in discharge summaries, were assessed for potential consequences by two clinical pharmacologists. SETTING: Three psychiatric wards with adult patients at Aalborg University Hospital, Denmark, from January 2010–April 2010. THE OBSERVATIONAL UNIT: The individual handling of medication (prescribing, dispensing, and administering). RESULTS: In total, 189 errors were detected in 1,082 opportunities for error (17%) of which 84/998 (8%) were assessed as potentially harmful. The frequency of errors was: prescribing, 10/189 (5%); dispensing, 18/189 (10%); administration, 142/189 (75%); and discharge summaries, 19/189 (10%). The most common errors were omission of pro re nata dosing regime in computerized physician order entry, omission of dose, lack of identity control, and omission of drug. CONCLUSION: Errors throughout the medication process are common in psychiatric wards to an extent which resembles error rates in somatic care. Despite a substantial proportion of errors with potential to harm patients, very few errors were considered potentially fatal. Medical staff needs greater awareness of medication safety and guidelines related to the medication process. Many errors in this study might potentially be prevented by nursing staff when handling medication and observing patients for effect and side effects of medication. The nurses’ role in psychiatric medication safety should be further explored as nurses appear to be in the unique position to intercept errors before they reach the patient

Biotin starvation causes mitochondrial protein hyperacetylation and partial rescue by the SIRT3-like deacetylase Hst4p

The essential vitamin biotin is a covalent and tenaciously attached prosthetic group in several carboxylases that play important roles in the regulation of energy metabolism. Here we describe increased acetyl-CoA levels and mitochondrial hyperacetylation as downstream metabolic effects of biotin deficiency. Upregulated mitochondrial acetylation sites correlate with the cellular deficiency of the Hst4p deacetylase, and a biotin-starvation-induced accumulation of Hst4p in mitochondria supports a role for Hst4p in lowering mitochondrial acetylation. We show that biotin starvation and knockout of Hst4p cause alterations in cellular respiration and an increase in reactive oxygen species (ROS). These results suggest that Hst4p plays a pivotal role in biotin metabolism and cellular energy homeostasis, and supports that Hst4p is a functional yeast homologue of the sirtuin deacetylase SIRT3. With biotin deficiency being involved in various metabolic disorders, this study provides valuable insight into the metabolic effects biotin exerts on eukaryotic cells