effect was also extended to dose omission and
delays on base ward level within the first 24 hours
(Figures 5 and 6). The ED pharmacist intervention
demonstrated a statistically significant reduction
in dose omissions and delays, both while patients
were waiting within ED, and also at base ward
level.
Further analysis around prescribing of APMs
within ED, demonstrated an impact on the
number of dose omissions at base ward level
within the first 24 hours of inpatient stay (Figure
7). Although a lower percentage of doses were
either delayed or omitted, the difference was
not statistically significant (p>0.05).
Length of stay
The mean length of stay for patients who did not
receive pharmacist intervention in the ED was 10
days, which was similar to a mean of 11 days in
patients who had a pharmacist intervention.
However a trend was observed where generally
longer inpatient stays were found in patients who
had a higher percentage of missed doses in the
first 24 hours of inpatient stay combined with
their ED stay (Figure 8). This trend was not found
to be statistically significant.
No particular trend was observed when total
length of inpatient stay was plotted against the
number of co-morbidities recorded for the patient
(Figure 9). The relative numbers of co-morbidities
patients suffered remained at a consistent
percentage irrespective of total length of stay. Age
may be associated with risk of prolonged stay
(Figure 10), with only 10% of patients under the
age of 70 spending more than seven days as an
FIGURE 3
Identification and prescription of anti-parkinson’s
medication within the ED
Yes
No
100
90
80
70
60
50
40
30
20
10
0
Indentified as taking
Anti-parkinson Medication
Prescribed Anti-parkinson
Medication within ED
inpatient, compared with 53.3% over the age
of 70.
Deterioration within the ED
All cases were also assessed for deterioration of
clinical PD symptoms (as defined by increased
stiffness, swallowing difficulties or reduced
mobility from baseline) in the admitted patients.
There is documented clinical worsening of PD
symptoms for ten patients while in the ED. None
of these cases involved a pharmacist intervention.
In all ten cases, patients had at least one dose
omitted in ED.
FIGURE 4
Dose omissions in the ED
Pharmacist
Number
Number of Number
intervention
of patients scheduled of doses
PD doses
given on
time
Number
of doses
delayed
Number
% doses
of doses
omitted
omitted
% doses
omitted or
delayed
No 70 105
28 16 61 58.1*
73.3*
Yes 19 26 21 3 2 7.7*
19.2*
Total 89 131
49 19 63 48.1
62.6
*p<0.05
FIGURE 5
Dose omissions within first 24 hours of inpatient admission (excluding ED stay)
Pharmacist
Number
Number of Number
intervention
of patients scheduled of doses
PD doses
given on
time
Number
of doses
delayed
Number
% doses
of doses
omitted
omitted
% doses
omitted or
delayed
No 70 302
237
20 45 14.9*
21.5*
Yes 19 79 75 2 2 2.5*
5.1*
Total 89 381
312
22 47 12.3
18.1
*p<0.05
17
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