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Background Double-checking the administration of medications has been standard practice in paediatric hospitals around the world for decades. While the practice is widespread, evidence of its effectiveness in reducing errors or harm is scarce. Objectives To measure the association between double-checking, and the occurrence and potential severity of medication administration errors (MAEs); check duration; and factors associated with doublechecking adherence. Methods Direct observational study of 298 nurses, administering 5140 medication doses to 1523 patients, across nine wards, in a paediatric hospital. Independent observers recorded details of administrations and double-checking (independent; primed--one nurse shares information which may influence the checking nurse; incomplete; or none) in real time during weekdays and weekends between 07:00 and 22:00. Observational medication data were compared with patients' medical records by a reviewer (blinded to checking-status), to identify MAEs. MAEs were rated for potential severity. Observations included administrations where double-checking was mandated, or optional. Multivariable regression examined the association between doublechecking, MAEs and potential severity; and factors associated with policy adherence. Results For 3563 administrations double-checking was mandated. Of these, 36 (1.0%) received independent double-checks, 3296 (92.5%) primed and 231 (6.5%) no/incomplete double-checks. For 1577 administrations double-checking was not mandatory, but in 26.3% (n=416) nurses chose to double-check. Where double-checking was mandated there was no significant association between double-checking and MAEs (OR 0.89 (0.65-1.21); p=0.44), or potential MAE severity (OR 0.86 (0.65-1.15); p=0.31). Where double-checking was not mandated, but performed, MAEs were less likely to occur (OR 0.71 (0.54-0.95); p=0.02) and had lower potential severity (OR 0.75 (0.57-0.99); p=0.04). Each double-check took an average of 6.4 min (107 hours/1000 administrations). Conclusions Compliance with mandated double-checking was very high, but rarely independent. Primed double-checking was highly prevalent but compared with single-checking conferred no benefit in terms of reduced errors or severity. Our findings raise questions about if, when and how double-checking policies deliver safety benefits and warrant the considerable resource investments required in modern clinical settings. [ABSTRACT FROM AUTHOR]

Background To date, there is no national or international consensus on which key performance indicators ( KPIs) should be used to measure hospital pharmacy performance. Aim To explore hospital pharmacists' perspectives on the role of KPIs and to use their perspectives to suggest a set of KPIs for use in Australian hospital pharmacy practice. Methods The study comprised of two parts. Part A involved semi-structured interviews with hospital pharmacists from major Sydney metropolitan hospitals; interviews were conducted until theme saturation was attained. Part B involved an online survey comprising Likert-scale responses and open-ended questions; the survey was distributed nationally to pharmacists via the Society of Hospital Pharmacists of Australia ( SHPA) eNewsletter and Facebook page. Results Part A: 19 hospital pharmacists were interviewed. Part B: 49 online surveys were received (after excluding incomplete submissions). Overall, the emergent themes identified that hospital pharmacists agreed that KPIs are a valuable tool for individual and departmental performance measurement; the use of KPIs was challenged by data collection difficulties, a lack of engagement from staff, and a lack of clarification regarding the intended use of KPIs and their relevance. The study identified a consolidated set of seven KPIs, proposed as standard measures for hospital pharmacy practice. Conclusion There is a perceived need to develop national standardised KPIs to demonstrate the value of pharmacy services at the individual and departmental levels. However, there are challenges that will need to be addressed before the implementation of a set of consolidated KPIs that encompasses the full scope of pharmacy activities. [ABSTRACT FROM AUTHOR]

Aim: Intravenous immunoglobulin (IVIG) is an expensive therapy used in immunodeficiency and autoimmune disorders. Increasing demands and consequent shortages result in a need for usage to conform to guidelines.Method: We retrospectively evaluated IVIG use for neuroimmunological indications and adherence to existing guidelines in a major Australian paediatric hospital between 2000 and 2014.Results: One-hundred and ninety-six children (96 male, 100 female; mean age at disease onset 6y 5mo [range 3mo-15y 10mo], mean age at first IVIG dose 7y 2mo [range 3mo-16y 5mo]) received IVIG for neuroimmunological indications during the study period (28.1% had Guillain-Barré syndrome), representing 15.5% of all hospital indications. In total, 1669 IVIG courses were administered (total 57 221g, median 78g/patient, range 12-5748g). The highest median numbers of courses were in chronic inflammatory demyelinating polyneuropathies, opsoclonus-myoclonus ataxia syndrome, suspected immune-mediated epilepsies, and Rasmussen's encephalitis. Adverse reactions occurred in 25.5% of patients, but these were mostly minor. Outcome at follow-up was best in anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis, Guillain-Barré syndrome, and myasthenia gravis, and worst in Rasmussen's encephalitis and epilepsies. The total cost of IVIG was US$2 595 907 (median $3538/patient, range $544-260 766). Of patients receiving IVIG, 45.4% to 57.1% were given the therapy for 'weak' indications or indications 'not listed' in international guidelines. Some entities commonly treated with IVIG in current practice, such as anti-NMDAR encephalitis and transverse myelitis, are not listed in most guidelines.Interpretation: Our study demonstrates that IVIG is generally well tolerated but expensive, and discloses discrepancies between guidelines and clinical practice in paediatric neurology, suggesting both the need for greater adherence to current recommendations, and for recommendations to be updated to accommodate emerging indications. [ABSTRACT FROM AUTHOR]