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Background Neonatal and paediatric patients are especially vulnerable to serious injury as a result of medication errors due to their small size, physiological immaturity and limited compensatory abilities. The prescription chart remains an essential form of communication of prescribing decisions and instructions. Modifications to the safety features of prescription charts have been shown to reduce the frequency of medication errors. Objective To determine, using the Delphi technique, which safety features should be included in the inpatient neonatal and paediatric prescription chart to help minimise the risk of medication errors associated with the use of the chart. Setting Acute general hospital in Malta. Method A two-round modified e-Delphi process was conducted. The Delphi questionnaire was developed from a mapping process, a literature search and references supporting the literature review. It comprised 155 safety features for consensus. The Delphi panel consisted of nine doctors, five nurses and four pharmacists. Participants were asked to rate their agreement to the inclusion of these features in the local chart using a three-point Likert scale, and to add further comments as necessary at the end of each section. In the second round, participants were given the opportunity to change their individual response in view of the groups' response. Main outcome measure This was set at a 70 % level of agreement. Results Results from each round were analysed to provide the percentage frequencies and number of participants who chose each point from the Likert scale provided, and the response count for each safety feature. A ≥70 % consensus level was achieved on: 115 safety features in Round 1 (total: 155 safety features) and 23 safety features in Round 2 (total: 40 safety features) while only 17 safety features did not achieve consensus at the end of the process. Conclusion Consensus was achieved on 133 safety features to be included in the neonatal and paediatric prescription chart. Five safety features achieved consensus disagreement for their inclusion in the chart. Identifying the appropriate safety features forms part of an essential strategy to reduce the incidence of medication errors associated with the use of the chart in these patients. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Cordina M, Schramm-Gajraj K, Ross J, Lautman K, Jurkovic D. Introduction of a single visit protocol in the management of selected patients with pregnancy of unknown location: a prospective study. BJOG 2011;118:693-697. To prospectively evaluate the efficacy and safety of a modified clinical protocol using serum progesterone for the management of women with a pregnancy of unknown location (PUL). Prospective interventional study. Women with a pregnancy of unknown location and low serum progesterone level. A management protocol was introduced into clinical practice whereby clinically stable patients with PUL and serum progesterone level ≤ 10 nmol/l were discharged after their initial visit. Patients were advised to contact or attend the early pregnancy unit if they developed abdominal pain or heavy vaginal bleeding. Need for repeat visits or intervention following discharge. In total, 6201 pregnant women were seen during the study period. Of those, 676 (10.9%; 95% CI 10.1-11.7%) had an ultrasound diagnosis of PUL, and 252 of the 676 (37%; 95% CI 33.4-40.9%) had progesterone levels ≤ 10 nmol/l, and were followed-up by telephone 4 weeks later or by faxing the GP at an interval if the patient failed to respond. Follow-up was completed in 227 of the 252 women (90.1%). In 212 of the 227 women (93.4%; 95% CI 90.68-96.1%) the pregnancy resolved without any complications, whereas 15 women (6.6%; 95% CI, 3.9-9.32%) re-attended because of persistent or worsening symptoms. Only four of the 227 women (1.7%; 95% CI, 0.3-3.2%) required surgical intervention. None of these experienced any significant complications. A clinical protocol based on serum progesterone measurements is effective for triaging and managing women with PULs. Implementation of the single-visit protocol into routine practice reduces the need for follow-up of these women without compromising their safety. [ABSTRACT FROM AUTHOR]

An abstract of the conference paper "Introduction of a modified protocol for the management of patients with pregnancy of unknown location," by M. Cordina and colleagues is presented.