What is the current practice of medicines reconciliation in children nationally in the UK?

INTRODUCTION: The National Institute for Health and Clinical Excellence/National Patient Safety Agency (NICE/NPSA) guidelines for medicines reconciliation (MR) on admission to hospital in adult inpatients were introduced in 2007, but they excluded children less than 16 years of age. METHOD: We conducted a survey of 98 paediatric pharmacists (each from a different hospital) to find out what the current practice of MR in children is in the UK. KEY FINDINGS: Responses showed that 67% (43/64) of pharmacists surveyed carried out MR in all children at admission and only a third 34% (22/64) had policies for MR in children. Of the respondents who did not carry out MR in all children, 80% (4/5) responded that they did so in selected children. Pharmacists considered themselves the most appropriate profession for carrying out MR. When asked whether the NICE guidance should be expanded to include children, 98% (54/55) of the respondents answered 'yes'. CONCLUSION: In conclusion, the findings suggest that MR is being conducted inconsistently in children and most paediatric pharmacists would like national guidance to be expanded to include children.

Medicines reconciliation at the point of hospital discharge for children

Objectives: Hospital discharge is a transition of care, where medication discrepancies are likely to occur and potentially cause patient harm. The purpose of our study was to assess the prescribing accuracy of hospital discharge medication orders at a London, UK teaching hospital. The timeliness of the discharge summary reaching the general practitioner (GP, family physician) was also assessed based on the 72 h target referenced in the Care Quality Commission report.1 Method: 501 consecutive discharge medication orders from 142 patients were examined and the following records were compared (1) the final inpatient drug chart at the point of discharge, (2) printed signed copy of the initial to take away (TTA) discharge summary produced electronically by the physician, (3) the pharmacist's amendments on the initial TTA that were hand written, (4) the final electronic patient discharge summary record, (5) the patients final take home medication from the hospital. Discrepancies between the physician's order (6) and pharmacist's change(s) (7) were compared with two types of failures – ‘failure to make a required change’ and ‘change where none was required’. Once the patient was discharged, the patient's GP, was contacted 72 h after discharge to see if the patient discharge summary, sent by post or via email, was received. Results: Over half the patients seen (73 out of 142) patients had at least one discrepancy that was made on the initial TTA by the doctor and amended by the pharmacist. Out of the 501 drugs, there were 140 discrepancies, 108 were ‘failures to make a required change’ (77%) and 32 were ‘changes where none were required’ (23%). The types of ‘failures to make required changes’ discrepancies that were found between the initial TTA and pharmacist's amendments were paracetamol and ibuprofen changes (dose banding) 38 (27%), directions of use 34 (24%), incorrect formulation of medication 28 (20%) and incorrect strength 8 (6%). The types of ‘changes where none were required discrepancies’ were omitted medication 15 (11%), unnecessary drug 14 (10%) and incorrect medicine including spelling mistakes 3 (2%). After contacting the GPs of the discharged patients 72 h postdischarge; 49% had received the discharge summary and 45% had not, the remaining 6% were patients who were discharged without a GP. Conclusion: This study shows that doctor prescribing at discharge is often not accurate, and interventions made by pharmacist to reconcile are important at this point of care. It was also found that half the discharge summaries had not reached the patient's family physician (according to the GP) within 72 h.

The clinical significance of medicines reconciliation in children admitted to hospital

Aims and Objectives: The NICE/NPSA guidance on Medicines Reconciliation in adults upon hospital admission excludes children under the age of 16.1 Hence the primary aim and objective of this study was to use medicines reconciliation to primarily identify if discrepancies occur upon hospital admission. Secondary objectives were to clinically assess for harm discrepancies that were identified in paediatric patients on long term medications at four hospitals across the UK. Method: Medicines reconciliation is a procedure where the current medication history of a patient prior to hospital admission would be taken and verifying the medication orders made at hospital admission against this history, addressing any discrepancies identified. Medicines reconciliation was carried out prospectively for 244 paediatric patients on chronic medication across four UK hospitals (Birmingham, London, Leeds and North Staffordshire) between January – May 2011. Medicines reconciliation was conducted by a clinical pharmacist using the following sources of information: 1) the patient's Pre-Admission Medication (PAM) from the patient's general practitioner 2) examination of the Patient's Own Medications brought into hospital, 3) a semi-structured interview with the parent-carers and 4) identification of admission medication orders written on the drug chart prior to clinical pharmacy input (Drug Chart). Discrepancies between the PAM and Drug Chart were documented and classified as intentional or unintentional. Intentional discrepancies were defined as changes that were made knowingly by the prescriber and confirmed. Unintentional discrepancies were assessed for clinical significance by an expert panel and assigned a significance score based on the likelihood of causing potential discomfort or clinical deterioration: class 1 unlikely, class 2 moderate and class 3 severe.2 Results: 1004 medication regimens were included from the 244 patients across the four sites. 588 of the 1004 (59%) medicines, had discrepancies between the PAM and Drug Chart; of these 36% (n = 209) were unintentional and included for clinically assessment. 189 drug discrepancies 30% were classified as class 1, 47% were class 2 and 23% were class 3 discrepancies. The remaining 20 discrepancies were cases where deviating from the PAM would have been the right thing to do, which might suggest that an intentional but undocumented discrepancy by the prescriber writing up the admission order may have occurred. Conclusion: The results suggest that medication discrepancies in paediatric patients do occur upon hospital admission, which do have a potential to cause harm and that medicines reconciliation is a potential solution to preventing such discrepancies. References: 1. National Institute for Health and Clinical Excellence. National Patient Safety Agency. PSG001. Technical patient safety solutions for medicines reconciliation on admission of adults to hospital. London: NICE; 2007. 2. Cornish, P. L., Knowles, S. R., Marchesano, et al. Unintended Medication Discrepancies at the Time of Hospital Admission. Archives of Internal Medicine 2005; 165:424–429

Restorative Justice and Political Forgiveness: A Comparative Study of Truth and Reconciliation Commissions

This research project involves a comparative, cross-national study of truth and reconciliation commissions (TRCs) in countries around the world that have used these extra-judicial institutions to pursue justice and promote national reconciliation during periods of democratic transition or following a civil conflict marked by intense violence and severe human rights abuses. An important objective of truth and reconciliation commissions involves instituting measures to address serious human rights abuses that have occurred as a result of discrimination, ethnocentrism and racism. In recent years, rather than solely utilizing traditional methods of conflict resolution and criminal prosecution, transitional governments have established truth and reconciliation commissions as part of efforts to foster psychological, social and political healing.

The primary objective of this research project is to determine why there has been a proliferation of truth and reconciliation commissions around the world in recent decades, and assess whether the perceived effectiveness of these commissions is real and substantial. In this work, using a multi-method approach that involves quantitative and qualitative analysis, I consider the institutional design and structural composition of truth and reconciliation commissions, as well as the roles that these commissions play in the democratic transformation of nations with a history of civil conflict and human rights violations.

In addition to a focus on institutional design of truth and reconciliation commissions, I use a group identity framework that is grounded in social identity theory to examine the historical background and sociopolitical context in which truth commissions have been adopted in countries around the world. This group identity framework serves as an invaluable lens through which questions related to truth and reconciliation commissions and other transitional justice mechanisms can be explored. I also present a unique theoretical framework, the reconciliatory democratization paradigm, that is especially useful for examining the complex interactions between the various political elements that directly affect the processes of democratic consolidation and reconciliation in countries in which truth and reconciliation commissions have been established. Finally, I tackle the question of whether successor regimes that institute truth and reconciliation commissions can effectively address the human rights violations that occurred in the past, and prevent the recurrence of these abuses.

A reconciliation of empirical and mechanistic models of the air-sea gas transfer velocity

Models of the air-sea transfer velocity of gases may be either empirical or mechanistic. Extrapolations of empirical models to an unmeasured gas or to another water temperature can be erroneous if the basis of that extrapolation is flawed. This issue is readily demonstrated for the most well-known empirical gas transfer velocity models where the influence of bubble-mediated transfer, which can vary between gases, is not explicitly accounted for. Mechanistic models are hindered by an incomplete knowledge of the mechanisms of air-sea gas transfer. We describe a hybrid model that incorporates a simple mechanistic view—strictly enforcing a distinction between direct and bubble-mediated transfer—but also uses parameterizations based on data from eddy flux measurements of dimethyl sulphide (DMS) to calibrate the model together with dual tracer results to evaluate the model. This model underpins simple algorithms that can be easily applied within schemes to calculate local, regional, or global air-sea fluxes of gases.

A reconciliation of empirical and mechanistic models of the air-sea gas transfer velocity

Models of the air-sea transfer velocity of gases may be either empirical or mechanistic. Extrapolations of empirical models to an unmeasured gas or to another water temperature can be erroneous if the basis of that extrapolation is flawed. This issue is readily demonstrated for the most well-known empirical gas transfer velocity models where the influence of bubble-mediated transfer, which can vary between gases, is not explicitly accounted for. Mechanistic models are hindered by an incomplete knowledge of the mechanisms of air-sea gas transfer. We describe a hybrid model that incorporates a simple mechanistic view—strictly enforcing a distinction between direct and bubble-mediated transfer—but also uses parameterizations based on data from eddy flux measurements of dimethyl sulphide (DMS) to calibrate the model together with dual tracer results to evaluate the model. This model underpins simple algorithms that can be easily applied within schemes to calculate local, regional, or global air-sea fluxes of gases.

Small Steps or Giant Leaps? Defining Reconciliation in the Transition from Conflict in Northern Ireland

The context of Northern Ireland in the transition of conflict has produced a range of efforts to bring about reconciliation. However, definitions and understandings of the nature of reconciliation differ. This paper draws together how reconciliation has been defined in theory in Northern Ireland and elsewhere, examines some models of practice in the light of that theory and illustrates the process of reconciliation through general initiatives in Northern Ireland and specific projects seeking to reconcile at community level. It is concluded that, while political and public processes can set a context and space for engagement to take place, reconciliation is fundamentally about personal encounter and relationship, which have to take place in a range of settings and at all levels of a society that has experienced conflict.

Medication reconciliation at patient admission: a randomized controlled trial

Objective: To measure length of hospital stay (LHS) in patients receiving medication reconciliation. Secondary characteristics included analysis of number of preadmission medications, medications prescribed at admission, number of discrepancies, and pharmacists interventions done and accepted by the attending physician. Methods: A 6 month, randomized, controlled trial conducted at a public teaching hospital in southern Brazil. Patients admitted to general wards were randomized to receive usual care or medication reconciliation, performed within the first 72 hours of hospital admission. Results: The randomization process assigned 68 patients to UC and 65 to MR. LHS was 10±15 days in usual care and 9±16 days in medication reconciliation (p=0.620). The total number of discrepancies was 327 in the medication reconciliation group, comprising 52.6% of unintentional discrepancies. Physicians accepted approximately 75.0% of the interventions. Conclusion: These results highlight weakness at patient transition care levels in a public teaching hospital. LHS, the primary outcome, should be further investigated in larger studies. Medication reconciliation was well accepted by physicians and it is a useful tool to find and correct discrepancies, minimizing the risk of adverse drug events and improving patient safety.

Social security and railroad retirement enactments in the 97th Congress within jurisdiction of the Committee on Ways and Means : Omnibus Budget Reconciliation Act and Economic Recovery Tax Act of 1981 /

At head of title: 97th Congress, 1st session. Committee print. WMCP: 97-15.

Taken

This eighty-minute work examines responses to Australia's Stolen Generations history. Based on recorded interviews with aboriginal survivors of state removal of children, Taken uses music as a metaphor for white Australians listening to these stories, as the music follows the spoken intonation in the interviews.

Embedding university perspectives in university teaching and learning : lessons learnt and possibilities for reforming/decolonising curriculum

Embedding Indigenous knowledge in the curriculum continues to challenge traditional western perspectives on Indigenous epistemologies and cultures. This paper will initially discuss experiences of embedding Indigenous perspectives in the curriculum at an Australian university. The project was inspired by the Reconciliation Statement which ensured funding through Teaching and Learning Large Grants. Its successful outcomes included the creation of identified positions for Indigenous academics within faculties, creation of a resource hub of relevant teaching materials and consistent documentation and awareness of Indigenous perspectives through interviews and workshops. The paper concludes by critically interrogating the methodology used to conceptualise Indigenous knowledge in embedding Indigenous perspectives in a university curriculum. This paper argues for a thorough curriculum reform if a degree of decolonisation of the western constructed Indigenous knowledge and its living systems are desired.

Race and equity in higher education : A harder path for Indigenous academics

Our experiences as Indigenous academics within universities often reflects the experiences we have as Indigenous people in broader society, yet I am still surprised and angered when it is others working in higher education who espouse notions of justice and equity with whom we experience tension and conflict in asserting our rights, values and cultural values. At times it is a constant struggle even when universities have Reconciliation Statements as most of them do now, Indigenous recruitment or employment strategies and university wide anti-racism and anti-discrimination policies and procedures.