Background: Healthcare is challenged by a rapidly growing group of patients with multi-morbidity and polypharmacy. Increasing activity and specialization puts pressure on healthcare sectors. Medication errors in cross-sectoral transition of patients are often seen. The aim of the study was to explore drug-related problems (DRPs) in the transition of patients between sectors and to develop and pilot-test a cross-sectoral hospital pharmacist intervention to overcome some of these problems. Methods: DRPs in cross-sectoral transitions were explored from four perspectives; the literature, the primary and secondary healthcare sector and the patients. An intervention was developed from the findings through co-creation between pharmacists, doctors and a nurse. The intervention was piloted and evaluated from data on the included patients and the activities performed. Results: DRPs in transitions from general practice (GP) to hospital were caused by inadequate focus on updating the Shared Medication Record (SMR). For patients being discharged, DRPs were described with multiple facets; for example, missing information on medication changes, lacking patient involvement and problems with dose-dispensed medicine or electronic prescriptions. An intervention with a pharmacist in a shared employment between Hospital Pharmacy and GP was developed and piloted. The intervention included medication reconciliation and updating SMR for patients referred to hospital; and medication review, overview of medication changes and follow-up telephone calls for patients discharged from hospital. The intervention identified and solved several DRPs; in this way, medication errors were avoided. Access to health records in both sectors was important in the identification and resolution of DRPs. Conclusion: DRPs in cross-sectoral transitions are multifaceted and the experiences depend on the point of view. The cross-sectoral hospital pharmacist intervention identified and solved several DRPs and medication errors were avoided. The intervention made sense to both healthcare sectors and patients. Shared employment and unique access to health records in both sectors showed to be of importance in the identification and resolution of DRPs. Plain language summary Development and pilot-test of a pharmacist intervention for patients in transition between hospital and general practice Background: Healthcare is challenged by a rapidly growing group of patients with multiple chronic diseases treated with several drugs at the same time. The aim of the study was to explore drug-related problems in the transition of patients between the hospital and patients’ general practitioner and to develop and pilot-test a pharmacist intervention to overcome some of these problems. Methods: Drug-related problems in patient transitions were explored from the perspectives of the hospital, the general practitioner, the patients and the literature. An intervention was developed from the findings by pharmacists, doctors and a nurse. The intervention was pilot-tested and evaluated from the descriptions of the included patients and activities performed. Results: Drug-related problems in transitions from general practice to hospital were caused by inadequate focus on updating the Shared Medication Record. For patients being discharged, drug-related problems were related to for example missing information on medication changes sparse involvement of the patient in their own treatment problems with medicine dispensed on a dose dispensing machine at the local pharmacy. An intervention with a pharmacist in a shared employment between Hospital Pharmacy and general practice was developed and piloted. The intervention included talking to the patient about their medication and updating the Shared Medication Record for patients referred to hospital medication review, overview of medication changes and follow-up telephone calls for patients discharged from hospital to general practice. The intervention identified and solved several drug-related problems. Access to health records in both the general practice and at the hospital was important in the identification of drug-related problems. Conclusions: Drug-related problems in cross-sectoral transitions are multifaceted. The pharmacist intervention identified and solved several drug-related problems. The intervention made sense to the general practitioner, hospital and patients. Shared employment and unique access to health records in both the general practice and at the hospital showed to be of importance in the identification of drug-related problems.

Background Adverse events associated with poor dose calculation skills among nurses on paediatric wards are frequent and may lead to increased morbidity and mortality. An E-learning program has successfully been implemented in one paediatric ward in Denmark and is used for competency training and revision. Purpose To evaluate a nationwide up-scaling of an E-learning program on paediatric nurses’ dose calculation skills. Materials and methods The intervention contained training on dose calculation skills using an E-learning program and a teaching session provided by the hospital pharmacy. Nurses in 8 paediatric wards throughout Denmark participated. Dose calculation skills were evaluated by a “before” and “after” test containing 15 generic calculation tasks. Nurse satisfaction with study participation was evaluated by a questionnaire survey. Results Of the 97 nurses completing the “before” test, only 36 (37%) completed the “after” test and 15 (42%) of those had trained 1 h or less using the E-learning program. The questionnaire was filled in by 55 nurses. The test results showed mean scores of 75.9% (pre-training) and 79.9% (post-training) of correct answers. According to the questionnaire survey, the majority of the nurses reported: improvement in their calculation skills (30 out of 54), satisfaction with the E-learning program (33 out of 36), satisfaction with the teaching lesson (36 out of 41) and satisfaction with the collaboration with the hospital pharmacy (47 out of 53). The majority were positive towards the E-learning program, test and teaching in the future. Conclusions The study found a tendency to improvement in dose calculation skills among nurses completing both tests, despite only a little training using the E-learning program. The majority of the participants were satisfied with the E-learning program and were positive towards it as a future initiative. However, the study completion rate was low suggesting that the up-scaling model needs further development for successful implementation. No conflict of interest.

BackgroundIn our country, a newly formed working group coordinates and develops clinical and ward pharmacy services nationally. In 2014, the group agreed on, produced and implemented, national standards for ward pharmacy services. The 35 standards are classified into two groups: basic elements that must be present when providing the ward pharmacy services (n = 16) and optional elements that can be included if resources are available and the service is requested by the ward (n = 19). The standards cover all aspects of ward pharmacy (eg, logistics, storage, provision of information, patient specific elements and prescription review).PurposeNational benchmarking was carried in October 2014 to investigate to what degree the services were provided by hospitals in our country, and to establish a baseline for ward pharmacy services nationally.Material and methodsAn electronic questionnaire was sent to the members of the national working group, representing all public hospitals in the country (n = 24). A questionnaire was completed for each hospital (defined as one or a group of hospitals under one Hospital Directors Board). For each of the 35 standards, the reporter was required to specify whether the standards were carried out on all, many, few or no wards at their hospital.Results11 of the 16 basic ward pharmacy elements were met fully by all hospitals in our country. The remaining five elements were carried out on all or nearly all wards (21–23 of the 24 hospitals).There was larger variation with respect to the optional ward pharmacy elements, both geographically and regarding the type of optional element. Four elements, primarily related to activities in and around the ward stockroom, were carried out in over 60% of wards, while the seven patient specific elements were only carried out routinely on a few wards.ConclusionIn 2014, nearly all hospitals in our country carried out the basic ward pharmacy elements on all wards. There was greater variation nationally regarding the optional elements. Some were carried out nearly everywhere, while others were carried out on no or few wards. The varying provision of optional elements at particular hospitals probably reflects a lack of resources or demand, rather than a lack of willingness.No conflict of interest.

Background Denmark’s first Multidisciplinary Clinic for non-specific cancer symptoms opened at Silkeborg Regional Hospital in 2009. In 2013 a clinical pharmacist was integrated into the clinic to carry out full medicines reviews on patients. One success criterion was that 70% of the recommendations made by the pharmacist should be clinically relevant. Assessment of clinical relevance is often subjective. To determine the clinical relevance a certain level of consensus was required and therefore a modified Delphi method was employed. Purpose To describe the use of a modified Delphi method to reach consensus in an expert panel evaluating the clinical relevance of pharmacist’s recommendations. Materials and methods An expert panel of 9 healthcare professionals (3 hospital physicians, 3 general practitioners, 2 clinical pharmacists, 1 pharmacologist) received 23 randomised pharmacist recommendations. The experts scored the recommendations using the six categories described in Hatoun’s ranking system. Category 3 to 6 was classified as having clinical relevance. The experts sent their scoring with arguments to the facilitator, who provided an anonymous summary of the experts’ scoring and arguments for the second round, so that the cases where no consensus was previously achieved could be revised by the experts. In cases of no consensus after 2 rounds the project group evaluated the scores. Results From the set there was consensus in 48% of recommendations after the first round. After the second round, consensus increased to 87%. The overall results showed that 87% of the recommendations were clinically relevant. The members of the expert panel themselves, expressed professional interest in arguments presented by the other members of the group. They also found it convenient that they could participate without having to meet. Conclusions The modified Delphi method enabled a group of experts from different professions to evaluate the recommendations, reaching a high level of consensus. No conflict of interest.