Errors associated with the preparation of aseptic products in UK hospital pharmacies: lessons from the national aseptic error reporting scheme

Background Pharmacy aseptic units prepare and supply injectables to minimise risks. The UK National Aseptic Error Reporting Scheme has been collecting data on pharmacy compounding errors, including near-misses, since 2003. Objectives The cumulative reports from January 2004 to December 2007, inclusive, were analysed. Methods The different variables of product types, error types, staff making and detecting errors, stage errors detected, perceived contributory factors, and potential or actual outcomes were presented by cross-tabulation of data. Results A total of 4691 reports were submitted against an estimated 958 532 items made, returning 0.49% as the overall error rate. Most of the errors were detected before reaching patients, with only 24 detected during or after administration. The highest number of reports related to adult cytotoxic preparations (40%) and the most frequently recorded error was a labelling error (34.2%). Errors were mostly detected at first check in assembly area (46.6%). Individual staff error contributed most (78.1%) to overall errors, while errors with paediatric parenteral nutrition appeared to be blamed on low staff levels more than other products were. The majority of errors (68.6%) had no potential patient outcomes attached, while it appeared that paediatric cytotoxic products and paediatric parenteral nutrition were associated with greater levels of perceived patient harm. Conclusions The majority of reports were related to near-misses, and this study highlights scope for examining current arrangements for checking and releasing products, certainly for paediatric cytotoxic and paediatric parenteral nutrition preparations within aseptic units, but in the context of resource and capacity constraints.

The bond scheme

Under the bond scheme, a pre-determined series of payments would compensate farmers for lost revenues resulting from policy change. Unlike the Single Payment Scheme, payments would be fully decoupled: recipients would not have to retain farmland, or remain in agriculture. If vested in a paper asset, the guaranteed, unencumbered, income stream would be similar to that from a government bond. Recipients could exchange this for a capital sum reflecting the net present value of future payments, and reinvest in other business ventures, either on- or offfarm.With a finite, declining flow of payments, budget expenditure would reduce, releasing funds for other uses.

An adaptive finite element water column model using the Mellor-Yamada level 2.5 turbulence closure scheme

A one-dimensional water column model using the Mellor and Yamada level 2.5 parameterization of vertical turbulent fluxes is presented. The model equations are discretized with a mixed finite element scheme. Details of the finite element discrete equations are given and adaptive mesh refinement strategies are presented. The refinement criterion is an "a posteriori" error estimator based on stratification, shear and distance to surface. The model performances are assessed by studying the stress driven penetration of a turbulent layer into a stratified fluid. This example illustrates the ability of the presented model to follow some internal structures of the flow and paves the way for truly generalized vertical coordinates. (c) 2005 Elsevier Ltd. All rights reserved.

The seasonal forecast of electricity demand: A hierarchical Bayesian model with climatological weather generator

In this paper we focus on the one year ahead prediction of the electricity peak-demand daily trajectory during the winter season in Central England and Wales. We define a Bayesian hierarchical model for predicting the winter trajectories and present results based on the past observed weather. Thanks to the flexibility of the Bayesian approach, we are able to produce the marginal posterior distributions of all the predictands of interest. This is a fundamental progress with respect to the classical methods. The results are encouraging in both skill and representation of uncertainty. Further extensions are straightforward at least in principle. The main two of those consist in conditioning the weather generator model with respect to additional information like the knowledge of the first part of the winter and/or the seasonal weather forecast. Copyright (C) 2006 John Wiley & Sons, Ltd.

The development of a new dust uplift scheme in the Met Office Unified Model

Aeolian mineral dust aerosol is an important consideration in the Earth's radiation budget as well as a source of nutrients to oceanic and land biota. The modelling of aeolian mineral dust has been improving consistently despite the relatively sparse observations to constrain them. This study documents the development of a new dust emissions scheme in the Met Office Unified ModelTM (MetUM) based on the Dust Entrainment and Deposition (DEAD) module. Four separate case studies are used to test and constrain the model output. Initial testing was undertaken on a large dust event over North Africa in March 2006 with the model constrained using AERONET data. The second case study involved testing the capability of the model to represent dust events in the Middle East without being re-tuned from the March 2006 case in the Sahara. While the model is unable to capture some of the daytime variation in AERONET AOD there is good agreement between the model and observed dust events. In the final two case studies new observations from in situ aircraft data during the Dust Outflow and Deposition to the Ocean (DODO) campaigns in February and August 2006 were used. These recent observations provided further data on dust size distributions and vertical profiles to constrain the model. The modelled DODO cases were also compared to AERONET data to make sure the radiative properties of the dust were comparable to observations. Copyright © 2009 Royal Meteorological Society and Crown Copyright

Participation of future pharmacists in a professional development certificate scheme; the paradox of personal identity

The white paper ‘Pharmacy in England’ advocates establishing a new pharmacy regulator, building leadership and integrating undergraduate education.[1] Students must morph into competent pharmacists with the skills, expertise and confidence to lead the profession to 2020 and beyond.[2] One way individuals are encouraged to ‘professionalise’ is through participation in personal/professional development schemes. The British Pharmaceutical Students’ Association (BPSA) and the College of Pharmacy Practice have operated a professional development certificate (PDC) scheme since 2001. The scheme rewards students with a joint certificate for evidence of participation in five accredited activities in one academic year. Although the scheme is relevant to development of students, less than 2% of BPSA members take part annually. We wanted to understand the reasons for the low uptake. Our primary objectives were to examine the portrayal of the scheme and to investigate what it signifies to individuals. We describe our attempts to apply social marketing techniques[3] to the PDC, and we use ‘logical levels of change’[4] to highlight a paradox with personal identity.

The professional development certificate scheme for undergraduates

The professional development certificate scheme, developed by the British Pharmaceutical Students’ Association, can bridge the gap between pharmacy undergraduates, tutors and employers. Jamie Wilkinson, Chris Cairns and Parastou Donyai explain.

The impact of a closed-loop electronic prescribing and automated dispensing system on the ward pharmacist’s time and activities

Objective To assess the impact of a closed-loop electronic prescribing and automated dispensing system on the time spent providing a ward pharmacy service and the activities carried out. Setting Surgical ward, London teaching hospital. Method All data were collected two months pre- and one year post-intervention. First, the ward pharmacist recorded the time taken each day for four weeks. Second, an observational study was conducted over 10 weekdays, using two-dimensional work sampling, to identify the ward pharmacist's activities. Finally, medication orders were examined to identify pharmacists' endorsements that should have been, and were actually, made. Key findings Mean time to provide a weekday ward pharmacy service increased from 1 h 8 min to 1 h 38 min per day (P = 0.001; unpaired t-test). There were significant increases in time spent prescription monitoring, recommending changes in therapy/monitoring, giving advice or information, and non-productive time. There were decreases for supply, looking for charts and checking patients' own drugs. There was an increase in the amount of time spent with medical and pharmacy staff, and with 'self'. Seventy-eight per cent of patients' medication records could be assessed for endorsements pre- and 100% post-intervention. Endorsements were required for 390 (50%) of 787 medication orders pre-intervention and 190 (21%) of 897 afterwards (P < 0.0001; chi-square test). Endorsements were made for 214 (55%) of endorsement opportunities pre-intervention and 57 (30%) afterwards (P < 0.0001; chi-square test). Conclusion The intervention increased the overall time required to provide a ward pharmacy service and changed the types of activity undertaken. Contact time with medical and pharmacy staff increased. There was no significant change in time spent with patients. Fewer pharmacy endorsements were required post-intervention, but a lower percentage were actually made. The findings have important implications for the design, introduction and use of similar systems.