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Background Extra-Corporeal Life Support (ECLS) is a method of life support used to treat patients with severe respiratory and/or cardiac failure refractory to conventional modes of treatment. Nosocomial infections in these patients are associated with increased morbidity and mortality along with increased lengths of intensive care unit (ICU) and hospital stay. No international best-practise consensus guidelines exist for treatment and/or prophylaxis of infections in this patient group. Purpose To examine the rate of nosocomial infection in MMUH ECLS patients as well as the consumption of antimicrobials in the treatment and prevention of these infections. Materials and MethodsIn a retrospective cohort study, the pharmacy records from a daily multi-disciplinary microbiology round reviewed all patients who are on ECLS. The use of prophylactic and therapeutic antimicrobials in these patients was assessed as well as the background ICU bloodstream infection rate. Results Data analysis yielded a total of 17 patients over a two-year period, with a total of 444 ECLS days. In total, there were 17 infections in this cohort including 4 (24%) blood-stream infections (yielding a rate of 9.0 per 1000 ECLS days). The first four ECLS patients received antibacterial (vancomycin) and antifungal (caspofungin) prophylaxis for the duration of ECLS, whereas the later cohort of 13 did not. In the cohort of patients who received prophylactic antimicrobials, defined daily doses (DDDs) per 100 ECLS days for vancomycin and meropenem were 49.54 and 49.63 respectively. For the non-prophylaxis cohort this was 25.31 and 37.73 respectively. Conclusions The infection rate in this cohort was low. In particular, the bloodstream infection rate compared favourably with previously published rates, and was comparable with the 'background' bloodstream infection rate of the ICU population as a whole. Antimicrobial use in ECLS patients was high relative to overall ICU antimicrobial use.No conflict of interest. NutritioNal status of hospitalised patieNts with head aNd Neck caNcer

BackgroundPatients in post acute care services (PACS) usually require multiple transcriptions of their drug chart. The general drug chart which is used for all acute care patients allows for 14 days of administration of a prescribed medication. The development of a long stay drug chart (LSDC) to accommodate a greater number of days of administration was proposed for usage in the PACS.PurposeTo introduce and evaluate a LSDC in the PACS.Material and methodsA 1 month prospective pre-implementation baseline study was conducted by the clinical pharmacist, using a data collection form, to establishthe number of general drug charts in use in the PACS,the time taken to review these charts andthe number of transcription errors noted.A pilot LSDC was developed and introduced, in which the number of days of administration was extended from 14 to 37. A 1 month prospective study was conducted 6 weeks after the introduction of the LSDC, to establish its impact on (a), (b) and (c) above.ResultsThe results from the pre- and post-implementation study included:(1) Number of fully transcribed drug charts in use was reduced by 42%. (2) The average time taken by the clinical pharmacist to review each drug chart was very similar between the two groups (6 min). (3) Number of transcription errors noted was numerically less (10 vs 14) in the post-implementation group but the study was not powered to detect a statistically significant difference.ConclusionThe feedback from medical and nursing staff was very positive. As expected, the number of drug charts in use was reduced and there was a numerical reduction in transcription errors. As there were fewer drug charts to review, clinical pharmacist time was saved. Despite a slight increase in associated cost, the universal benefits of the LSDC will lead to roll out throughout the PACS.No conflict of interest

Background Incorrect use of transdermal patches can and has resulted in significant patient harm, including death. Multidisciplinary guidelines to ensure their safe use have been developed in-house and disseminated to all hospitals in the country. Purpose To produce easy-to-use guidance for staff that would promote safe practice in all aspects of patch use, including prescribing, application, documentation, removal and disposal. Materials and methods A patient-focused group addressed all safety concerns around transdermal patch use and subsequently developed guidelines based on best practice points cited in the literature as well as innovative practice-based elements developed by the group. The processes identified the roles of each healthcare professional in their patients’ safety and care. Results Guidance has been developed to inform all healthcare staff of the potential dangers and necessary safety procedures required each time a transdermal patch is used. The implementation of these new processes throughout our hospital serves to improve patient safety. This is likely to lead to a long-term, sustained improvement in patient safety in the MMUH. This information is now available throughout Ireland via the Irish Medication Safety Network. Consistent implementation will optimise transdermal drug delivery and improve all aspects of patient safety associated with its use. Conclusions No such guidance exists in any other healthcare facility, either in Ireland or internationally, therefore the requirement for this work went beyond the needs of the MMUH. It was envisaged that by using a multidisciplinary approach for development of guidance, the work could be tailored to have relevance for, and benefit patients, beyond the environs of the MMUH and therefore would be suitable for national dissemination and implementation. No conflict of interest.