Referral letters to the emergency department: is the medication list accurate?

Medication errors are common when patients transfer across healthcare boundaries. This study was designed to investigate the quality of information on medicines provided by general practitioners (GPs) on emergency department (ED) referral letters. A convenience sample of referral letters to the ED of a teaching hospital was reviewed. The medication list and/or patient\u27s drug allergy status were noted. Medicines reconciliation including patient (or carer) interview was conducted to determine the patient\u27s actual home medication list. This was compared with the GP list and any discrepancies were identified and addressed. A total of 92 referral letters were included in the analysis of which 60 were computer-generated and 32 were hand-written. GPs provided dose and frequency of administration information in 47 (51%) of the letters sampled i.e. 44 (71%) computer-generated versus 3 (10%) hand-written; p \u3c 0.001. In addition, the patient was taking their medicines exactly as per the GP list in 20 (22%) of cases. The patient\u27s drug allergy status was documented in 13 (14%) of the letters

Ted Freeman and the battle for the injured brain: a case history of professional prejudice

This book recounts some experiences of young Australians with catastrophic brain injuries, their families and the medical system which they encountered. Whilst most of the events described occurred two to three decades ago they raise questions relevant to contemporary medical practice.The patients whose stories are told were deemed to be ‘unsuitable for rehabilitation’ and their early placement in nursing homes was recommended. In 2013, it is time to acknowledge that the adage of ‘one size fits all’ has no place in rehabilitation in response to severe brain injury. Domiciliary rehabilitation, when practicable, may be optimal with the alternative of slow stream rehabilitation designed to facilitate re-entry into the community.Patients’ families were impelled to undertake heroic carers’ commitments as a reaction to nihilistic medical prognoses. It is time for the Australian health care system to acknowledge those commitments, and the budgetary burden which they lift from the system by providing family members with support to retrieve career opportunities, most notably in education and employment, which have been foregone in caring.Medical attendants repeatedly issued negative prognoses which were often confounded by the patient’s long term progress. Hopefully, those undertaking the acute care of young people with severe brain injury will strive to acquire an open mind and recognise that a prognosis based on a snapshot observation of the patient, without any longer term contact provides a flawed basis for a prognosis. The story of these patients and of Dr Ted Freeman has wider implications