Awareness of the risks of medicines‐related harm in the elderly can enhance medicines safety in vulnerable patients. This article examines the risk factors for medicines‐related harm and the recommended strategies to reduce these risks.

Background: Early Warning Scores alert staff to preventable deterioration. Raised scores should lead to escalation of care. Aims: To establish response of staff to patients scoring National Early Warning Score (NEWS) of six or above and to identify patient and environmental factors affecting escalation by nursing staff. Methods: Service evaluation with prospective review of patient records of 118 beds on four medical wards during 20 night-shifts. Results: During 2360 observed bed days 109 patients triggered NEWS >=6 at least once during the observation period. Nursing staff escalated only 18 (17%) of these patients; nearly all of them had predefined chronic health conditions, the majority fulfilled criteria for frailty. Despite their higher 30-day mortality patients with COPD had lower escalation rates. Additionally wards that had more patients with a NEWS >=6 had lower escalation rates. Conclusion: Alarm fatigue and clinical judgement of staff might result in deviation from escalation protocols.

Background. Central-line associated blood stream infections (CLABSI) are a significant cause of morbidity and mortality for critically ill and immunocompromised patients. The diagnosis can be challenging in children, as prophylactic antibiotics are often started prior to cultures. The purpose of this study was to review the value of catheter tip cultures in diagnosing CLABSI in children and to determine whether alternative laboratory methods of diagnosis might be indicated.Methods. We performed a retrospective review of all semi-quantitative catheter tip cultures from 2010-11. All blood culture data in the preceding two weeks were reviewed to determine their predictive value for CLABSI. Central lines that had a second culture ( peripheral or other central line culture) taken within 24h of each other were analyzed separately as a pair. A survey of HCP ( physicians and nurse practitioners) on the diagnosis of CLABSI in children with central lines was conducted.Results. A total of 274 catheter tips were cultured from 237 patients. The majority of patients had cultures performed in the preceding two weeks (87%). Positive tips cultures were obtained in 13% (n = 35); 28 (80%) had a preceding blood culture with the same organism. Of those patients, 86% (n = 24) had a set of paired cultures sent.Analysis of tip cultures is outlined in the figure, and paired cultures are described further in the table.The survey was distributed to 300 people, with a 25% response rate. Respondents felt line removal had significant clinical impact. Respondents were generally in agreement with IDSA guidelines on indications for line removal.Analysis of tip cultures, and paired cultures.

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