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Background: Long-staying medical inpatients carry a significant burden of acute and chronic illness. Prediction of their in-hospital and longer-term mortality risk is important. Aim: The aim of this study was to determine to what extent creatinine variability predicts in-hospital and 1-year mortality in inpatients. Design: Retrospective cohort analysis. Methods: Patients were included if aged 18 years or older and if admitted for 7 days or longer. The main outcome variables were mortality in hospital and after discharge. Results: Increasing age, the presence of heart failure and a reduced estimated glomerular filtration rate (eGFR) on admission (<60 ml/min/1.73 m2) all associated with death risk (both in hospital and within a year of discharge). The creatinine change was related to mortality risk for the patient whilst in hospital and within 1 year after discharge independently of these other factors. The threshold of creatinine change, above which the in-hospital mortality rose significantly was 25 μmol/l (P<0.001). A creatinine change of >10 μmol/l predicted significantly higher mortality within a year of discharge (P<0.001). Every 5 mmol/l change in creatinine was associated with an in-hospital mortality increase of 3% (P<0.001) and a 1-year mortality increase of 1% (P<0.007). Conclusions: Patients with a creatinine rise or fall of >10 mmol/l during admission are at higher risk of death after discharge than those with more stable creatinine. These patients therefore merit further attention that might include more focused nutritional assessment, cardiovascular risk factor management or advance care planning. [ABSTRACT FROM AUTHOR]

Background: Prescribing is a complex task with potential for many types of error to occur. Despite the introduction of a standard national medication chart for Australian hospital inpatients in 2006, simple prescribing errors are common. Aim : To compare the effect of quality improvement initiatives on the rate of simple prescribing errors. Design: A prospective, multisite comparison of prescribing education interventions. Methods: Using three hospital sites, we compared site-specific changes in prescribing error rates following use of an online education module alone (low intensity) with prescribing error rates following a high-intensity intervention (comprising the same online education module plus nurse education and academic detailing of junior prescribers). The study period was 4 months between May and August 2011. Results: Full completion of the adverse drug reactions field did not improve after either intervention; however, there was better documentation of some elements following high-intensity intervention. Prescriber performance improved significantly for more elements in the regular prescription category than any other category of prescription. Legibility of medication name improved across all categories following interventions. Clarity of frequency, prescriber name and documentation of indication improved following both high- and low-intensity intervention. Conclusions: Improvements were seen in several prescription elements after the intervention but the majority of elements that improved were affected by both low- and high-intensity interventions. Despite targeted intervention, significant rates of prescribing breaches persisted. The prevalence of prescription breaches partially responds to an online education module. The nature of any additional intervention that would be effective is unclear. [ABSTRACT FROM AUTHOR]