The effects of electronic prescribing on the quality of prescribing

Aims To investigate the effects of electronic prescribing (EP) on prescribing quality, as indicated by prescribing errors and pharmacists' clinical interventions, in a UK hospital. Methods Prescribing errors and pharmacists' interventions were recorded by the ward pharmacist during a 4 week period both pre- and post-EP, with a second check by the principal investigator. The percentage of new medication orders with a prescribing error and/or pharmacist's intervention was calculated for each study period. Results Following the introduction of EP, there was a significant reduction in both pharmacists' interventions and prescribing errors. Interventions reduced from 73 (3.0% of all medication orders) to 45 (1.9%) (95% confidence interval (CI) for the absolute reduction 0.2, 2.0%), and errors from 94 (3.8%) to 48 (2.0%) (95% CI 0.9, 2.7%). Ten EP-specific prescribing errors were identified. Only 52% of pharmacists' interventions related to a prescribing error pre-EP, and 60% post-EP; only 40% and 56% of prescribing errors resulted in an intervention pre- and post-EP, respectively. Conclusions EP improved the quality of prescribing by reducing both prescribing errors and pharmacists' clinical interventions. Prescribers and pharmacists need to be aware of new types of error with EP, so that they can best target their activities to reduce clinical risk. Pharmacists may need to change the way they work to complement, rather than duplicate, the benefits of EP.

The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study

Objectives: To assess the impact of a closed-loop electronic prescribing, automated dispensing, barcode patient identification and electronic medication administration record (EMAR) system on prescribing and administration errors, confirmation of patient identity before administration, and staff time. Design, setting and participants: Before-and-after study in a surgical ward of a teaching hospital, involving patients and staff of that ward. Intervention: Closed-loop electronic prescribing, automated dispensing, barcode patient identification and EMAR system. Main outcome measures: Percentage of new medication orders with a prescribing error, percentage of doses with medication administration errors (MAEs) and percentage given without checking patient identity. Time spent prescribing and providing a ward pharmacy service. Nursing time on medication tasks. Results: Prescribing errors were identified in 3.8% of 2450 medication orders pre-intervention and 2.0% of 2353 orders afterwards (p<0.001; χ2 test). MAEs occurred in 7.0% of 1473 non-intravenous doses pre-intervention and 4.3% of 1139 afterwards (p = 0.005; χ2 test). Patient identity was not checked for 82.6% of 1344 doses pre-intervention and 18.9% of 1291 afterwards (p<0.001; χ2 test). Medical staff required 15 s to prescribe a regular inpatient drug pre-intervention and 39 s afterwards (p = 0.03; t test). Time spent providing a ward pharmacy service increased from 68 min to 98 min each weekday (p = 0.001; t test); 22% of drug charts were unavailable pre-intervention. Time per drug administration round decreased from 50 min to 40 min (p = 0.006; t test); nursing time on medication tasks outside of drug rounds increased from 21.1% to 28.7% (p = 0.006; χ2 test). Conclusions: A closed-loop electronic prescribing, dispensing and barcode patient identification system reduced prescribing errors and MAEs, and increased confirmation of patient identity before administration. Time spent on medication-related tasks increased.

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.

Electronic marking of statistics assessments for bioscience students

We describe the main features of a program written to perform electronic marking of quantitative or simple text questions. One of the main benefits is that it can check answers for being consistent with earlier errors, so can cope with a range of numerical questions. We summarise our experience of using it in a statistics course taught to 200 bioscience students.

WREN: electronic management system for facilities management

This paper describes a case study of an electronic data management system developed in-house by the Facilities Management Directorate (FMD) of an educational institution in the UK. The FMD Maintenance and Business Services department is responsible for the maintenance of the built-estate owned by the university. The department needs to have a clear definition of the type of work undertaken and the administration that enables any maintenance work to be carried out. These include the management of resources, budget, cash flow and workflow of reactive, preventative and planned maintenance of the campus. In order to be more efficient in supporting the business process, the FMD had decided to move from a paper-based information system to an electronic system, WREN, to support the business process of the FMD. Some of the main advantages of WREN are that it is tailor-made to fit the purpose of the users; it is cost effective when it comes to modifications on the system; and the database can also be used as a knowledge management tool. There is a trade-off; as WREN is tailored to the specific requirements of the FMD, it may not be easy to implement within a different institution without extensive modifications. However, WREN is successful in not only allowing the FMD to carry out the tasks of maintaining and looking after the built-estate of the university, but also has achieved its aim to minimise costs and maximise efficiency.

The influence of commercial film-forming polymers on reducing salt spray injury in evergreen oak (Quercus ilex L.) and laurel (Prunus laurocerasus L.)

A field trial was undertaken to determine the influence of four commercially available film-forming polymers (Bond [alkyl phenyl hydroxyl polyoxyethylene], Newman Crop Spray 11E™ [paraffinic oil], Nu-Film P [poly-1-p menthene], and Spray Gard [di-1-p menthene]) on reducing salt spray injury on two woody species, evergreen oak (Quercus ilex L.) and laurel (Prunus laurocerasus L.). Irrespective of species, the film-forming polymers Nu-Film-P and Spay Gard did not provide any significant degree of protection against salt spray damage irrespective of concentration (1% or 2%) applied as measured by leaf chlorophyll concentrations, photosynthetic efficiency, visual leaf necrosis, foliar sodium and chloride content, and growth (height, leaf area). The film-forming polymer Newman Crop Spray 11E™ provided only 1-week protection against salt spray injury. The film-forming polymer Bond provided a significant (P < 0.05) degree of protection against salt spray injury 3 months after application as manifest by higher leaf chlorophyll content, photosynthetic efficiency, height and leaf area, and lower visual leaf necrosis and foliar Na and Cl content compared with nontreated controls. In conclusion, results indicate that application of a suitable film-forming polymer can provide a significant degree of protection of up to 3 months against salt spray injury in evergreen oak and laurel. Results also indicate that when applied at 1% or 2% solutions, no problems associated with phytotoxicity and rapid degradation on the leaf surface exist.

Evaluation of film forming polymers to control apple scab (Venturia inaequalis (Cooke) G. Wint.) under laboratory and field conditions

A detached leaf bioassay was used to determine the influence of several film forming polymers and a conventional triazole fungicide on apple scab (Venturia inaequalis (Cooke) G. Wint.) development under laboratory in vitro conditions, supported by two field trials using established apple cv. Golden Delicious to further assess the efficacy of foliar applied film forming polymers as scab protectant compounds. All film forming polymers used in this investigation (Bond, Designer, Nu-Film P, Spray Gard, Moisturin, Companion PCT12) inhibited germination of conidia, subsequent formation of appressoria and reduced leaf scab severity using a detached leaf bioassay. Regardless of treatment, there were no obvious trends in the percentage of conidia with one to four appressoria 5 days after inoculation. The synthetic fungicide penconazole resulted in the greatest levels of germination inhibition, appressorium development and least leaf scab severity. Under field conditions, scab severity on leaves and fruit of apple cv. Golden Delicious treated with a film forming polymer (Bond, Spray Gard, Moisturin) was less than on untreated controls. However, greatest protection in both field trials was provided by the synthetic fungicide penconazole. Higher chlorophyll fluorescence Fv/Fm emissions in polymer and penconazole treated trees indicated less damage to the leaf photosynthetic system as a result of fungal invasion. In addition, higher SPAD values as measures of leaf chlorophyll content were recorded in polymer and penconazole treated trees. Application of a film forming polymer or penconazole resulted in a higher apple yield per tree at harvest in both the 2005 and 2006 field trials compared to untreated controls. Results suggest application of an appropriate film forming polymer may provide a useful addition to existing methods of apple scab management. (C) 2008 Elsevier Ltd. All rights reserved.

Construction of coordination polymers of cadmium(II) with mixed hexamethylenetetramine and terephthalate or thiocyanate ligands

Three new polymeric complexes [Cd(hmt)(SCN)(2)(H2O)(2)](n) (1), [Cd-3(mu(2)-hmt)(2)(SCN)(6)(H2O)(2)](n) (2), and [Cd-2(hmt)(2)(tP)(2)(H2O)(6)](n) (3) [hmt = hexamethylenetetramine, tp = terephthalate] have been synthesized and characterized by single crystal X-ray diffraction. Both the compounds 1 and 2 are 1-D polymers where Cd units are linked by double end-to-end thiocyanate bridges but in 2 the chain is wider containing three cadmium atoms instead of one as found in 1. In both compounds the coordination environment around cadmium atom is distorted octahedral. Compound 3 is a three-dimensional polymer having water-filled microporous channels. Both tp and brut are mu(2)-bridged. One of the acid groups of tp is coordinated in chelating bidentate and the other in monodentate fashion. Half of its Cd atoms are hexa-coordinated and the rest are hepta-coordinated. Thermogravimetric analysis and X-ray diffraction study of 3 show that its framework remains intact upon removal of water molecules. The flexibility of coordination number around cadmium atoms (six or seven) probably plays an important role in establishing the rigidity of the framework. (C) 2003 Elsevier Ltd. All rights reserved.

A novel approach to processing high-performance polymers that exploits entropically driven ring-opening polymerization

Blends of the poly(ether sulfone) derived from 4,4'-biphenol and 4,4'-dichlorodiphenylsulfone (Radel-R(TM)) with its homologous macrocyclic oligomers show greatly lowered melt viscosities relative to that of the parent polymer, potentially enabling more facile production and fabrication of fiber-reinforced composite materials. The macrocycles can then undergo entropically driven ring-opening polymerization in situ. The required blends can be obtained easily in one step, by carrying out polycondensations at concentrations lower than those usually used for polymer synthesis.

A variational method for the calculation of spin-rovibronic energy levels of any triatomic molecule in an electronic triplet state

The triatomic spin-rovibronic variational code RVIB3 has been extended to include the effect of two uncoupled electrons, for both (3)Sigma(-) and (3)Pi (Renner-Teller) electronic states. The spin-orbital-rotational kinetic energy is included in the usual way, via terms (J+L+S). The phenomenological terms AL.S and lambda 2/3(3S(z)(2)) are introduced to reproduce the 3 spin-orbit and spin-spin splittings, respectively. Calculations are performed to evaluate the spin-rovibronic energy levels of CCO (X) over tilde (3) Sigma(-) and CCO (A) over tilde (3) Pi for which the Born-Oppenheimer potentials are derived from high-accuracy ab initio calculations.

Vibrational energy levels for the electronic ground state of the diazocarbene (CNN) molecule

The vibrational energy levels of diazocarbene (diazomethylene) in its electronic ground state, (X) over tilde (3) Sigma(-) CNN, have been predicted using the variational method. The potential energy surfaces of (X) over tilde (3) A" CNN were determined by employing ab initio single reference coupled cluster with single and double excitations (CCSD), CCSD with perturbative triple excitations [CCSD(T)], multi-reference complete active space self-consistent-field (CASSCF), and internally contracted multi-reference configuration interaction (ICMRCI) methods. The correlation-consistent polarised valence quadruple zeta (cc-pVQZ) basis set was used. Four sets of vibrational energy levels determined from the four distinct analytical potential functions have been compared with the experimental values from the laser-induced fluorescence measurements of Wurfel et al. obtained in 1992. The CCSD, CCSD(T), and CASSCF potentials have not provided satisfactory agreement with the experimental observations. In this light, the importance of both non-dynamic (static) and dynamic correlation effects in describing the ground state of CNN is emphasised. Our best theoretical fundamental frequencies at the cc-pVQZ ICMRCI level of theory, v(1) = 1230, v(2) = 394, and v(3) = 1420 cm(-1) are in excellent agreement with the experimental values of v(1) = 1235, v(2) = 396, and v(3) = 1419cm(-1) and the mean absolute deviation between the 23 calculated and experimental vibrational energy levels is only 7.4 cm(-1). It is shown that the previously suggested observation of the v(3) frequency at about 2847cm(-1) was in fact the first overtone 2v(3).

Microfabrication of high-performance aromatic polymers as nanotubes or fibrils by in situ ring-opening polymerisation of macrocyclic precursors

Melt-phase nucleophilic ring-opening polymerisation of macrocyclic aromatic ethers and thioethers at high temperatures within the cylindrical pores of an anodic-alumina membrane, followed by dissolution of the template, enables replication of the membrane's internal pore structure and so affords high-performance aromatic polymers with well-defined fibrillar or tubular morphologies.