Background There are concerns about maintaining appropriate clinical staffing levels in Emergency Departments. Pharmacists may be one possible solution. Objective To determine if Emergency Department attendees could be clinically managed by pharmacists with or without advanced clinical practice training. Setting Prospective 49 site cross-sectional observational study of patients attending Emergency Departments in England. Method Pharmacist data collectors identified patient attendance at their Emergency Department, recorded anonymized details of 400 cases and categorized each into one of four possible options: cases which could be managed by a community pharmacist; could be managed by a hospital pharmacist independent prescriber; could be managed by a hospital pharmacist independent prescriber with additional clinical training; or medical team only (unsuitable for pharmacists to manage). Impact indices sensitive to both workload and proportion of pharmacist manageable cases were calculated for each clinical group. Main outcome measure Proportion of cases which could be managed by a pharmacist. Results 18,613 cases were observed from 49 sites. 726 (3.9%) of cases were judged suitable for clinical management by community pharmacists, 719 (3.9%) by pharmacist prescribers, 5202 (27.9%) by pharmacist prescribers with further training, and 11,966 (64.3%) for medical team only. Impact Indices of the most frequent clinical groupings were general medicine (13.18) and orthopaedics (9.69). Conclusion The proportion of Emergency Department cases that could potentially be managed by a pharmacist was 36%. Greatest potential for pharmacist management was in general medicine and orthopaedics (usually minor trauma). Findings support the case for extending the clinical role of pharmacists.

Paediatric patients attending Emergency Departments were judged by pharmacists to be suitable for management outside a hospital setting in approximately 1 in 11 cases, and by hospital independent prescriber pharmacists in 4 in 10 cases. With further training, it was found that the total proportion of cases that could be managed by a pharmacist was 45%. The greatest impact for pharmacist management occurs in general medicine and orthopaedics.

BackgroundA standardised electronic paediatric drug database was needed in order to aid paediatric drug dose selection within both prescribing and clinical pharmacist screening.PurposeTo determine a system of information inputs and checks to support the development of an electronic paediatric drug database (DD). The DD is designed as a clinical support tool to aid paediatric drug dose selection within both prescribing and clinical pharmacist screening.Material and methodsA multi-disciplinary team was appointed that included senior and junior medical staff, senior and junior pharmacists, pharmacy technicians, data analyst/database engineer, nursing staff and project manager. The DD was built in MS Access 2007. Information arbitration is provided by a senior oversight team consisting of the Deputy Chief Medical Officer, Chair of Drugs and Therapeutics Committee and Director of the Academic Practice Unit (a clinical pharmacist).ResultsCommon data sources used in clinical practice were identified as suitable for information harvesting. The DD system is based on 5 core data fields: Drug, Indication, Route, Age, and Dose; known as DIRAD. Each DIRAD is unique with processes in place to ensure they are not duplicated. Input of a draft DIRAD occurs at level 1 (L1), which is the lowest level in the 5 level process. Passage through the system to final approval at L5 requires acceptance of the DIRAD at each and every level in the process. To date (July 2014) over 3,000 DIRADs have been entered into the system representing 765 drug entities. Reference to relevant dm + d codes is allowed within the DD structure. Migration of the system to a Sequel Server (SQL) platform is planned.ConclusionThe developed 5 stage process has been successfully used to capture and validate clinical information suitable to support electronic prescribing of medicines for paediatrics.References and/or AcknowledgementsNo conflict of interest.

Ethanol up to 0.5% is recommended for use as a solvent in mouse embryonic stem cell (mESC) differentiation assays such as the Embryonic Stem Cell Test. However, lower concentrations have been shown by some to alter mESC differentiation. In this study, we further explored the dose‐ and time‐dependent affects of ethanol on mESC differentiation into cardiomyocytes using the hanging drop culture method and J1 mESC. Among control cultures (no ethanol), rhythmically contracting cells were observed in cultures after 11 days at a frequency of 蠅64%. With continuous ethanol exposure, a significant (p 蠄 0.05) decrease in the fraction of cultures containing contracting cells was observed by 蠅68% at ethanol concentrations of 0.3% and higher and was accompanied by a 蠅30% loss of cells. With ethanol exposure during the first two days of culture only (the embryoid body stage), no significant change in the frequency of contracting cells per culture, or number of cells, was observed after 11 days at ethanol concentrations up to 0.5%. These results suggest that ethanol concentrations below 0.5% can reduce the frequency of contracting cells, at least in part, by reducing the number of cells during differentiation, and that the most sensitive time‐frame for ethanol toxicity is after the embryoid body stage. Grant Funding Source: Supported by NSF DUE‐0622421

BackgroundThere have been concerns about maintaining appropriate clinical staff levels in Emergency Departments in England.1 One possible solution to alleviating the workforce pressure is the extension of clinical activity performed by non-medical staff – including pharmacists.2 Aims and objectivesTo determine if Emergency Department attendees aged from 10–25 years (adolescents) could be clinically managed by community pharmacists or hospital pharmacist independent prescribers with or without further advanced clinical practice training.MethodA prospective 49 site cross-sectional observational study of patients attending Emergency Departments (ED) in England, UK. Each site was requested to collect data for 400 admissions of all ages. Pharmacist independent prescribers (one for each site) were asked to identify patient attendance at their Emergency Department, record anonymised details of the cases – age, weight, presenting complain, clinical grouping (e.g. medicine, orthopaedics) and categorise each one into one of four possible categories: CP, Community Pharmacist, cases which could be managed by a community pharmacist outside an ED setting; IP – cases that could be managed in ED by a hospital pharmacist with independent prescriber status; IPT, Independent Prescriber Pharmacist with additional training – cases which could be managed in ED by a hospital pharmacist independent prescriber with additional clinical training; and MT, Medical Team only – cases that were unsuitable for the pharmacist to manage. An Impact Index was calculated for the two most frequent clinical groupings using the formula: Impact index (I)=proportion of the total workload of the clinical grouping (w) multiplied by the percentage ability of pharmacists to manage that clinical group (a). I=wa. The higher the Impact Index the greater potential for pharmacists to support the clinical workload related to that group.Results2993 out of 18 613 (16%) attendees were young patients aged from 10 to 25 years of age (median 20 years, interquartile range 17–22 years) of which 1530 were female and 1463 were male. Of the 2993 patients, 6% of the cases were judge to be suitable for the community pharmacist (CP), 5% suitable for a hospital pharmacist independent prescriber (IP), 37% were deemed as suitable for a hospital independent prescriber with additional training (IPT) and the remaining 52% were only suitable for the medical team (MT). The most frequent clinical groups and Impact Index were general medicine=16.97 and orthopaedics=15.51.ConclusionEmergency Department attendees who were young patients were judged by independent prescriber pharmacists to be suitable for clinical management by community pharmacists outside a hospital setting in approximately 1 in 16 admissions, and by a hospital independent prescriber pharmacists in 1 in 20 cases. With further training, it was found that the total proportion of cases that could potentially be managed by a pharmacist (CP, IP or IPT) came to 48%. The greatest potential impact for pharmacist management occurs i...