Counting Koalas from space: Integrating remote sensing, GIS and traditional ecological survey techniques

Proceedings of the 11th Australasian Remote Sensing and Photogrammetry Conference

Medicines reconciliation in comparison with NICE guidelines across secondary care mental health organisations

Background Medicines reconciliation-identifying and maintaining an accurate list of a patient's current medications-should be undertaken at all transitions of care and available to all patients. Objective A self-completion web survey was conducted for chief pharmacists (or equivalent) to evaluate medicines reconciliation levels in secondary care mental health organisations. Setting The survey was sent to secondary care mental health organisations in England, Scotland, Northern Ireland and Wales. Method The survey was launched via Bristol Online Surveys. Quantitative data was analysed using descriptive statistics and qualitative data was collected through respondents free-text answers to specific questions. Main outcomes measure Investigate how medicines reconciliation is delivered, incorporate a clear description of the role of pharmacy staff and identify areas of concern. Results Forty-two (52 % response rate) surveys were completed. Thirty-seven (88.1 %) organisations have a formal policy for medicines reconciliation with defined steps. Results show that the pharmacy team (pharmacists and pharmacy technicians) are the main professionals involved in medicines reconciliation with a high rate of doctors also involved. Training procedures frequently include an induction by pharmacy for doctors whilst the pharmacy team are generally trained by another member of pharmacy. Mental health organisations estimate that nearly 80 % of medicines reconciliation is carried out within 24 h of admission. A full medicines reconciliation is not carried out on patient transfer between mental health wards; instead quicker and less exhaustive variations are implemented. 71.4 % of organisations estimate that pharmacy staff conduct daily medicine reconciliations for acute admission wards (Monday to Friday). However, only 38 % of organisations self-report to pharmacy reconciling patients' medication for other teams that admit from primary care. Conclusion Most mental health organisations appear to be complying with NICE guidance on medicines reconciliation for their acute admission wards. However, medicines reconciliation is conducted less frequently on other units that admit from primary care and rarely completed on transfer when it significantly differs to that on admission. Formal training and competency assessments on medicines reconciliation should be considered as current training varies and adherence to best practice is questionable.

Business strategy and the environment in a traditional manufacturing sector

This research is concerned with the relationship between business strategy and the environment within traditional sectors. It has sought to learn more about the strategic environmental attitudes of SMEs compared with large companies operating under the same market conditions. The sector studied is the ceramics industry (including tableware & ornamental-ware, sanitary ware & tiles, bricks, industrial & advanced ceramics and refractories) in the UK and France. Unlike the automotive, oil, chemical, steel or metal processing sectors, this industry is one of the few industrial sectors which has rarely been considered. The information on this sector was gathered by interviewing people responsible for environmental issues. The actual programme of valid interviews represents approximately a quarter of the UK and French ceramics industry which is large enough to enable a quantitative analysis and significant and non-biased conclusions. As a whole, all companies surveyed agreed that the ceramics activity impacts on the environment, and that they are increasingly affected both by environmental legislation, and by various non-legislative pressures. Approaches to the environmental agenda differ significantly among large and small companies. Smaller companies feel particularly pressed both by the financial costs and management time required to meet complex and changing legislation. The results of this survey also suggest that the ceramics industry sees environmental issues in terms of increased costs rather than new business opportunities. This is due principally to fears of import substitution from countries with lower environmental standards. Finally, replies indicate that generally there is a low level of awareness of the current legislative framework, suggesting a need to shift from a regulatory approach to a more self-regulated approach which encourages companies to be more proactive

An evaluation of the epidemiology of medication discrepancies and clinical significance of medicines reconciliation in children admitted to hospital

Aims: To determine the incidence of unintended medication discrepancies in paediatric patients at the time of hospital admission; evaluate the process of medicines reconciliation; assess the benefit of medicines reconciliation in preventing clinical harm. Method: A 5 month prospective multisite study. Pharmacists at four English hospitals conducted admission medicines reconciliation in children using a standardised data collection form. A discrepancy was defined as a difference between the patient's preadmission medication (PAM), compared with the initial admission medication orders written by the hospital doctor. The discrepancies were classified into intentional and unintentional discrepancies. The unintentional discrepancies were assessed for potential clinical harm by a team of healthcare professionals, which included doctors, pharmacists and nurses. Results: Medicines reconciliation was conducted in 244 children admitted to hospital. 45% (109/244) of the children had at least one unintentional medication discrepancy between the PAM and admission medication order. The overall results indicated that 32% (78/244) of patients had at least one clinically significant unintentional medication discrepancy with potential to cause moderate 20% (50/244) or severe 11% (28/244) harm. No single source of information provided all the relevant details of a patient's medication history. Parents/carers provided the most accurate details of a patient's medication history in 81% of cases. Conclusions: This study demonstrates that in the absence of medicines reconciliation, children admitted to hospitals across England are at risk of harm from unintended medication discrepancies at the transition of care from the community to hospital. No single source of information provided a reliable medication history.

Reducing medicines waste in the community

There is increasing concern at the amount and cost of prescribed medicines that are unused or wasted and then have to be disposed of. Previous studies have used health promotion and Dispose Unwanted Medicines Properly campaigns targeted at the patient to describe and quantify the annual cost of waste. The reasons patients return unused drugs to pharmacies have also been explored. The paper focuses on patient explanations for not needing medication; categorized as: over-collection in the past, self-management strategies, changes in medical condition, other changes in patient circumstances, or the repeat medicines policy at the surgery. The aim of the original study was to make a measurable change in prescribed medicines with a reduction in medicines wastage, whilst at the same time achieving improved standards of pharmaceutical care. Information on patient needs and behaviour came from consultation in the pharmacy monitoring forms and interview. The study was based on two medical practices in the West Midlands, UK, comparing an outer city and an inner city population. The participants were general practitioners, pharmacists and 350 repeat prescription patients. Prescriptions were issued for two three-month periods. The outcome was that 23.8% of the prescribed items were not dispensed, at a value of £13.1K, 58% of the medications that would be expected to be regularly supplied were collected. The study suggests that closer professional management at the point of dispensing and an understanding of patient experiences can help reduce the amount of unwanted medication collected by patients.

Medicines management across the primary-hospital healthcare interface: a study of paediatric patients

A comparison of medicines management documents in use by NHS organisations in the West Midlands confirms that there are important differences between the primary care and hospital sectors in respect to medicines management interface issues. Of these, two aspects important to paediatric patients have been studied. These are the transfer of information as a patient is admitted to hospital, and access to long-term medicines for home-patients. National guidance provided by NICE requires medication reconciliation to be undertaken on admission to hospital for adults. A study of paediatric admissions, reported in this thesis, demonstrates that the clinical importance of this process is at least as important for children as for adults, and challenges current UK guidance. The transfer of essential medication information on hospital admission is central to the medication reconciliation process. Two surveys of PCTs in 2007 and again in 2009 demonstrate that very few PCTs provide guidance to GPs to support this process. Provision of guidance is increasing slowly but remains the exception. The provision of long-term medicines for children at home is hindered by this patient population often needing unlicensed drugs. Further studies demonstrate that primary care processes regularly fail to maintain access to essential drugs and patients and their carers frequently turn to hospitals for help. Surveys of hospital medical staff (single site) and hospital nurses (six UK sites) demonstrates the activity these healthcare workers perform to help children get the medicines they need. A similar survey of why carers turn to a hospital pharmacy department for urgent supplies (usually termed rescue-medicines) adds to the understanding of these problems and supports identifying service changes. A large survey of community pharmacies demonstrates the difficulties they have when dispensing hospital prescriptions and identifies practical solutions. This programme concludes by recommending service changes to support medication management for children.

Returned medicines:Waste or a wasted opportunity?

Background: Re-use of unused medicines returned from patients is currently considered unethical in the UK and these are usually destroyed by incineration. Previous studies suggest that many of these medicines may be in a condition suitable for re-use. Methods: All medicines returned over two months to participating community pharmacies and GP surgeries in Eastern Birmingham PCT were assessed for type, quantity and value. A registered pharmacist assessed packs against set criteria to determine the suitability for possible re-use. Results: Nine hundred and thirty-four return events were made from 910 patients, comprising 3765 items worth £33 608. Cardiovascular drugs (1003, 27%) and those acting on the CNS (884, 24%) were most prevalent. Returned packs had a median of 17 months remaining before expiry and one-quarter of packs (1248 out of 4291) were suitable for possible re-use. One-third of those suitable for re-use (476 out of 1248) contained drugs in the latest WHO Essential Drugs List. Conclusion: Unused medicines are returned in substantial quantities and have considerable financial value, with many in a condition suitable for re-use. We consider it appropriate to reopen the debate on the potential for re-using these medicines in developing countries where medicines are not widely available and also within the UK. © The Author 2007, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.

An analysis of returned medicines in primary care

Objective: The number of pharmaceutical items issued on prescription is continually rising and contributing to spiralling healthcare costs. Although there is some data highlighting the quantity, in terms of weight of medicines returned specifically to community pharmacies, little is known about the specific details of such returns or other destinations for wasted medications. This pilot study has been designed to investigate the types and amounts of medicines returned to both general practices (GPs) and associated local community pharmacies determining the reasons why these medicines have been returned. Method: The study was conducted in eight community pharmacies and five GP surgeries within East Birmingham over a 4-week period. Main outcome Measure: Reason for return and details of returned medication. Results: A total of 114 returns were made during the study: 24 (21.1) to GP surgeries and 90 (78.9) to community pharmacies. The total returns comprised 340 items, of which 42 (12.4) were returned to GPs and 298 (87.6) to pharmacies, with the mean number of items per return being 1.8 and 3.3, respectively. Half of the returns in the study were attributed to the doctor changing or stopping the medicine; 23.7 of returns were recorded as excess supplies or clearout often associated with patients' death and 3.5 of returns were related to adverse drug reactions. Cardiovascular drugs were most commonly returned, amounting to 28.5 of the total drugs returned during the study. Conclusions: The results from this pilot study indicate that unused medicines impose a significant financial burden on the National Health Service as well as a social burden on the United Kingdom population. Further studies are examining the precise nature of returned medicines and possible solutions to these issues. © Springer 2005.

The role of trust in the transition from traditional to electronic B2B relationships in agri-food chains

E-business adoption rates in the agri-food sector are rather low, despite the fact that technical barriers have been mostly overcome during the last years and a large number of sophisticated offers are available. However, concerns about trust seem to impede the development of electronic relationships in the agri-food chains as trust is of particular importance in any exchange of agri-food products along the value chain. Drawing on existing research, characteristics and dimensions of trust are initially identified both in traditional and in electronic B2B relationships and a typology of trust is proposed. The aim of the paper is to provide an overview of the implementation and use of trust elements that e-commerce offers dedicated to agri-food sector. This assessment will show the current situation and discuss gaps for further improvement with the objective to facilitate the uptake of e-commerce in agri-food chains. © 2009 Elsevier B.V. All rights reserved.