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Standard teicoplanin dosing regimens should be used with caution in patients with haematological malignancy. Bodyweight, CLCR and serum albumin concentration are important considerations for appropriate dosing.

Objectives To assess the safety culture in an acute medical admissions unit (AMAU) of a teaching hospital in order to benchmark results against international data and guide a unit-based, integrated, risk management strategy.Methods The Safety Attitudes Questionnaire (SAQ), a validated instrument for the measurement of safety culture, was applied to an AMAU. All AMAU healthcare staff (n = 92) were surveyed: doctors, nurses, healthcare assistants (HCAs) and allied healthcare professionals (AHPs). Safety attitude scores for the overall unit and individual caregiver types were assessed across six domains of safety culture.Results When compared against an international benchmark, the AMAU scored significantly higher for four of the six safety domains: p<0.01 for 'teamwork climate', 'safety climate' and 'stress recognition', and p<0.05 for 'job satisfaction'. The difference between nurse manager scores and the overall mean for the study group was statistically significant for the domains of 'teamwork climate' (p<0.05) and 'safety climate' (p<0.01). HCAs scored significantly lower relative to staff overall with regard to 'working conditions' (p<0.05) and 'perceptions of management' (p<0.01). ConclusionsThe SAQ was successfully applied to an AMAU setting giving a valuable insight into staff issues of concern across the safety spectrum: employee and environmental safety, clinical risk management and medication safety.

Written permission has been obtained from all persons named in the acknowledgment.Author Contributions: EM, SOD and SR were primarily involved in patient recruitment. SD, VR, IK and RBR were primarily involved in the audio analysis required for this manuscript. FB was primarily involved in the statistical analysis for this manuscript. BC, and MCM were involved in data collection and data analysis for this manuscript. IS, JS and RWC were involved in all aspects required for this manuscript including patient recruitment, data management, data analysis and were the primary leads in the design of the work. All co-authors were involved in writing and editing this manuscript. Methods:We attached a digital audio device (INCA TM ) to a dry powder inhaler. This recorded when the inhaler was used and analysis of the audio data indicated if the inhaler had been used correctly. These aspects of inhaler use were combined to calculate adherence over time, as an AUC measure. Over a 3 month period a cohort of asthma patients were studied. Adherence to a twice-daily inhaler preventer therapy using this device and clinical measures were assessed. Measurements and Results:Recordings from 239 patients with severe asthma were analysed.Average Adherence, based on the dose counter was 84.4%, whereas the ratio of expected to observed accumulated AUC, Actual Adherence, was 61.8% (p<0.01). Of all adherence measures, only adherence calculated as AUC reflected changes in asthma quality of life, beta agonist reliever use and PEF, over the three months (p<0.05 compared to other measures of adherence). Conclusion:Adherence that incorporates the interval between doses and inhaler technique, and calculated as AUC, is more reflective of changes in quality of life and lung function than the currently used measures of adherence. Electronic monitors are considered to be the gold standard for objectively quantifying adherence (1). Most studies using electronic recording devices have reported adherence as the mean adherence or, the Mean Daily Dose, over the study period (2) (3) (4) The aim of this study was to test the hypothesis that by including the time of use, the interval between doses and accounting for inhaler technique, we could quantify adherence as an Area Under the Curve (AUC) and, furthermore, determine whether adherence calculated using AUC was more reflective of patient outcomes than current methods of assessing adherence. Some of the results of this study have been previously reported in the form of an abstract(18). Methods