This review highlights the importance of clinical information on prescriptions and that incomplete or poor documentation may contribute to prescribing errors. It also emphasises the importance of pharmacists in the identification and correction or resolution of potential prescribing errors. There is a need to develop a well-validated measure to assess the severity of prescribing errors that will better address their clinical significance and risk.

Background and aims Prolonged neonatal jaundice is a common presentation in newborns and rarely requires intervention; however it is important to rule out sinister causes such as biliary atresia. The outcome of this study was to analyse the demographics of infants presenting with prolonged jaundice, investigations undertaken and results of these tests in relation to NICE guidelines. Methods We retrospectively identified infants over 2 years (January 2012 to December 2013) coded to have a prolonged jaundice screen. Analysing the case notes, 90 infants had a screen performed, from age 14 to 71 days of life, with an average of 21 days of life. Results Of the infants screened, 18 (20%) patients were found to have abnormal initial results, with significant abnormalities in 3 (3.3%) patients. One infant who presented at day 71 of life was identified to have biliary atresia, one infant had a urinary tract infection, and one infant had a positive reducing sugar and confirmed to be lactose intolerant. Four patients had ABO incompatibility but were otherwise well. Conclusion In our study, we found only one baby with conjugated hyperbilirubinaemia who presented late. The remainder of the babies investigated for prolonged jaundice were benign. Majority of the infants (72%) were breastfed, which is a well-recognised cause for prolonged jaundice. As such, the authors propose that in well babies with pigmented stools, performing the prolonged jaundice screen at 21 rather than 14 days could reduce the burden of carrying out unnecessary tests without causing significant detriment to these patients.

deficiencies and insufficient/unsafe levels of staffing. The associated declining self-respect, frustration, and guilt cause work-dissatisfaction, burnout, turnover, and consequently, diminished patient care. In this survey study, perceived appropriateness of care and levels of moral distress were evaluated across time. We also determined if respondents' background predicted moral distress levels. Methods After baseline assessment (background, moral distress, ethical climate), nurses and physicians of our level-III NICU evaluated day-levels of perceived appropriateness of care, the different aspects of moral distress, and ethical climate, at the end of five randomly selected shifts. Results Response rate: nurses 87(77%)/physicians 30(91%). Moral distress (range 1-16) was low at baseline (M = 2.21; SD = 1.55), but significantly higher for nurses than for physicians (M = 2.40/SD = 1.68 vs M = 1.68/SD = 0.98; p = 0.01). Nurses were less likely to disagree with treatment than physicians (OR = 2.62, p = 0.02). Moral distress at day-level (range1-4) was very low (M = 0.08/SD = 0.21) and significantly depended on being religious (b= 0.16; 95% CI= 0.03 to 0.28) and perceived 'overtreatment' (b = 0.18; 95% CI= 0.07 to 0.30), contrary to 'undertreatment' (b = 0.17; 95% CI -0.63 to 0.29). Highest scores were observed for the following aspects of moral distress: provider (dis)continuity, communication about patient care, and (un)safe levels of staffing. Conclusion In earlier studies, 'expressing concerns' and 'facilitated ethics conversations' proved to diminish moral distress. Possibly in our NICU the existence of structured-multi-disciplinary-medical-ethical-decision-making explains the (very)low levels of moral distress. Aim To develop a Tier 3, family-focused weight management intervention for the early years. Background In the UK roughly 1 in 4 children are overweight or obese by the time they start primary school. According to the literature there are no proven models for working with children under 6 years with extreme obesity. We were required to develop a Tier 3 weight management intervention as part of the Care Pathway for Children's Weight Management in Cornwall. Methodology A review of national guidance and both nationally and locally run programmes for children's weight management was undertaken. The key aspects for successful interventions, appropriate for the early years, were identified. A pilot programme was then developed by our team. Results Successful programmes were already running for children aged 7-13 years The LEAF (Lifestyles, Eating and Activity for Families) clinic was developed for children 6 years and under. It comprises a multi-disciplinary clinic with Community Paediatrician, Specialist Children Dietician and Specialist Activity Advisor, followed by a group intervention in a community setting, before multi-disciplinary follow-up. The intervention covers a broad range of topics that aim to help empower parents to make changes that ultimately improve the body mass index of their children. After...

Intensive Care Unit (PICU) is a key factor when considering the quality of care received by our patients. Methods All admissions to the PICU during 2011 were examined and all readmissions to the unit were identified. A readmission was defined as those requiring PICU < 48 hours following discharge. Patients who were readmitted for an elective procedure within the specified time were discounted. Results During 2011, 511 children had 615admissions to the PICU. 12 children were readmitted for acute care having deteriorated in the ward setting. 2 of the 12 children required 2 readmissions. 5 of the readmissions took place between April and September. The remaining 9 occurred during October to March. Conclusions It remains a subject of debate as to whether or not any of the redamissions could have been avoided as hindsight is always easy. With nearly double the amount readmissions occuring during the winter months, it could be argued that the children were discharged prematurely due to bed pressures. This a serious concern and one which we will continue to monitor.