BackgroundThere is growing interest in global health participation among emergency care doctors in the UK. The aim of this paper was to describe the demographics of members and fellows of the Royal College of Emergency Medicine involved in global health, the work they are involved in, as well as the benefits and barriers of this work.MethodsWe conducted a survey to include members and fellows of the Royal College of Emergency Medicine describing the context of their global health work, funding arrangements for global health work and perceived barriers to, and benefits of, global health work.ResultsThe survey collected 1134 responses of which 439 (38.7%) were excluded. The analysis was performed with the remaining 695 (61.3%) responses. Global health involvement concentrated around South Asia and Africa. Work contexts were mainly direct clinical service (267, 38%), curriculum development (203, 29%) and teaching short courses (198, 28%). Activity was largely self-funded, both international (539, 78%) and from UK (516, 74%). Global health work was not reported to contribute to appraisal by many participants (294, 42.3%). Funding (443, 64%) and protected time (431, 62%) were reported as key barriers to global health productivity.DiscussionParticipants largely targeted specialty development and educational activities. Lack of training, funding and supported time were identified as barriers to development. Galvanising support for global health through regional networks and College support for attracting funding and job plan recognition will help UK-based emergency care clinicians contribute more productively to this field.

No abstract

BackgroundThe emergency departments have operating characteristics that make them especially prone to the occurrence of medication errors (ME). Moreover, usual medication management in this area is more complicated. Hence, any intervention to minimise ME is justified, including medication reconciliation in a multidisciplinary way.PurposeTo analyse the intervention of a pharmacist in an emergency observation unit, and to focus on reducing ME, including pharmaceutical validation of free text medication orders and medication reconciliation.Material and methodsA prospective cross sectional study was carried out from January to March 2016. We analysed patients who were admitted to the emergency observation unit in a tertiary referral hospital daily at the start of the working day. We validated the medication orders as free text for all patients aged >65 years, and we carried out a process of reconciliation of medication in patients aged >65 years who were awaiting admission to a hospital bed. We communicated verbally with the doctors any medication related problems that we detected. These recommendations and their acceptance were recorded and classified in Excel format.Results289 patients were validated of whom 105 (36.3%) had reconciliation of medication. We conducted 153 interventions: medication related problems concerning allergies 2.6% (4), change in dose or dose regimen 11.8% (18), change in route of administration or pharmaceutical form 3.9% (6), complete the medication dose or dose regimen 9.8% (15), complete the route of administration 3.9% (6), information about treatment at home 1.3% (2), start medication not prescribed 9.2% (14), drug interaction 4.6% (7), adaptation to the hospital´s pharmacotherapy guide 34% (52), inadequate drug suspension 4.6% (7), unnecessary drug suspension 3.3% (5), suspension of drugs with a controversial therapeutic use 1.3% (2), suspension of the medication that the patient was not taking at home 5.2% (8) and therapeutic duplicity 4.6% (7). The doctors accepted 134 of the 153 recommendations (87.6%).ConclusionThe intervention of the pharmacist in the emergency departments may reduce ME of medical orders as a free text. As our results show, the degree of acceptance was high. This initiative could be the beginning of other activities related to the safe use of medicines in which the pharmacist is involved.No conflict of interest

Background Electronic prescribing (EP) is a useful tool for improving the safety and adaptability of the prescription process. Surveys enable us to find out the satisfaction of users and potential areas for improvement. Purpose To find out how satisfied doctors and nurses of the Internal Medicine Service (IMS) were with EP. Materials and Methods In 2010 the ‘Mambrino XXI’ electronic medical record, which is an EP module, was implemented in a 100-bed general hospital. In 2012 the Pharmacy Service developed an anonymous and confidential survey that was given to the doctors and nurses of the ISM. The questionnaire included 6 questions rated with a Likert scale (1: very bad/strongly disagree, 2: bad/disagree, 3: Regular/indifferent; 4: good/agree, 5: very good/strongly agree): 1. How do you consider the ease of use? 2. How does the speed of the application seem to you? 3. Are the alerts for allergies and duplications useful? 4. Do you think it prevents medication errors and improves safety? 5. Is the design of printed orders satisfactory? 6. What do you think about the support from the Pharmacy Service? An overall satisfaction question was also included with 4 answers: very satisfied, satisfied, dissatisfied, very dissatisfied. Results 6 doctors and 10 nurses completed the questionnaire. The average score was 3.7 for question 1; 2.9 for question 2; 3.9 for question 3; 3 for question 4; 3.1 for question 5 and 4.1 for question 6; 6 respondents were very satisfied, 5 satisfied and 5 dissatisfied. Conclusions The survey evaluated aspects of practise use, safety and Pharmacy Service support. More than two-thirds of doctors and nurses of the ISM were satisfied with the EP. There are opportunities for improve all the aspects investigated, especially the programme speed, the perceived safety and the design of printed medical orders. No conflict of interest.

Background The ward drug trolley process is error-prone so therefore pharmacists should take measure to recognise and prevent them. Purpose To evaluate the rates and types of dispensing errors (DE) during the drug trolley process. Materials and methods Prospective observational study. Data were collected for 44 working days in 2009 and 2010. The hospital had 350 beds with seven medical and four surgical wards. 84.3% of beds use a unit-dose dispensing system (UDDS) plus written transcription (UDDS-WT) and 15.7% use UDDS plus computerised prescription order entry (UDDS-CPOE). Each day pharmacists randomly selected one or two trolleys and checked them. Dispensing errors were classified as: Type 1: wrong patient, Type 2: omission of drug, Type 3: drug not prescribed, Type 4: Wrong dose, route or dosage form and Type 5: Quantity error. The authors calculated the dispensing error rate (DER) by dividing DE by the opportunities for error (OE: total units dispensed+doses prepared in the drug trolleys). Results The observations were conducted on 56 drug trolleys (1928 beds): 36 medical and 20 surgical, 14 428 total of doses prepared and dispensed (OE). 137 DEs were detected: 1.46% (2) type 1, 40.15% (55) type 2, 32.17% (44) type 3, 13.14% (18) type 4 and 13.14% (18) type 5. The most frequent errors are type 2 and type 3, related to the prescription changes after the drug trolley process. The DE rate was 0.95% (137 of 14,428). The DE rate in UDDS-WT was 0.91% (117 of 12868) and in UDDS-CPOE it was 1.28% (20 of 1560). Conclusions The short period of our study and the great difference in the methodology used in other studies hinder the comparison with their results. Although there are almost no differences between our DE rate in the two modalities of dispensing, it was not possible to compare them as the OE varied substantially. Despite the fact that the DE rate was low, recognising the incidence and types of medication errors allows us to analyse the causes to help achieve maximum patient safety.