BackgroundHealth services are under pressure to accommodate increasing numbers of emergency department presentations. This can contribute to prescribing errors. Integration of a pharmacist into the general medical team may reduce the incidence of prescribing errors on discharge and improve patient flow and medical staff satisfaction.AimThis study evaluated the effect of an integrated pharmacy service provided to the general medical units (GMUs) on patient flow and medical staff satisfaction.MethodThis study was a 4‐week pre‐ and postintervention study involving GMUs at a major metropolitan hospital in Australia. During the intervention period, an integrated clinical pharmacy service, which included attending medical ward rounds and assisting with the preparation of discharge prescriptions, was provided to medical units. The primary endpoint was the median time (min) past 9am that patients were discharged from the ward. Secondary outcomes included the proportion of prescriptions requiring an amendment and medical staff satisfaction with the service.ResultsThere were 87 and 84 patients discharged from the medical units before and after the intervention. During the intervention period, pharmacists prepared 79% of prescriptions, which reduced the proportion requiring an amendment from 65% to 17% (p < 0.01). Patients were discharged 77 min earlier during the postintervention period (median 380 vs 303 min after 9am; p = 0.03). Medical staff felt the integrated clinical pharmacy service improved patient flow and should be incorporated into standard practice.ConclusionsAn integrated clinical pharmacy service with proactive pharmacist intervention within the GMUs improved patient flow and medical staff satisfaction, and decreased prescriptions requiring an amendment.

Objective: To describe the epidemiology, treatment and monitoring of treatment outcomes of patients presenting to the ED with hyperkalaemia. Methods: We undertook a retrospective observational study in a mixed adult/paediatric ED over five 3-month periods. Consecutive patients were included if they had an initial serum or blood gas potassium ≥6.0 mmol/L. Patients were excluded if their principal diagnosis was diabetic ketoacidosis, their blood sample was haemolysed or the blood gas result was inconsistent with a subsequent serum potassium. Data were extracted from electronic medical records and two senior emergency registrars independently assessed available ECGs. Moderate and severe hyperkalaemia were potassium 6.0-6.4 and ≥6.5 mmol/L, respectively. Results: Overall, 392 patients were included (mean age 73.7 years, triage category 1 or 2 28.3%, admitted 91.3%). Three hundred and twentyone (81.9%, 95% confidence interval [CI] 77.6-85.5%) patients took one or more medications that predis-pose to hyperkalaemia and 335 (85.5%, 95% CI 81.5-88.7%) had one or more predisposing comorbidities. Two hundred and seventyone (69.1%, 95% CI 64.3-73.6%) patients had moderately severe and 121 (30.9%, 95% CI 26.4-35.7%) had severe hyperkalaemia. Two hundred and fifty-nine (66.1%, 95% CI 61.1-70.7%) patients were administered at least one medication in ED to lower the potassium concentration and 51 (13.0%, 95% CI 9.9-16.8%) were dialysed. One hundred and eighty-seven patients received intravenous insulin: 40 (21.4%) had documented biochemical hypoglycaemia, but 45 (24.1%) had no post-insulin blood glucose level documented. Hyperkalaemia-associated ECG changes were uncommon. Conclusion: Most ED patients with hyperkalaemia have identifiable clinical and medication-related risk factors. Variations in care were widespread and monitoring for iatrogenic adverse events was suboptimal.

These findings suggest that there is a potential for sodium fusidate to cause drug interactions when used with other agents that are substrates for rCYP1A2, rCYP2C9, rCYP2C19, rCYP2D6 or rCYP3A4. Understanding the basis of this potential drug interaction will assist in safer use of sodium fusidate in clinical practice.

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