Socio-environmental consideration of phosphorus flows in the urban sanitation chain of contrasting cities

Understanding how cities can transform organic waste into a valuable resource is critical to urban sustainability. The capture and recycling of phosphorus (P), and other essential nutrients, from human excreta is particularly important as an alternative organic fertilizer source for agriculture. However, the complex set of socio-environmental factors influencing urban human excreta management is not yet sufficiently integrated into sustainable P research. Here, we synthesize information about the pathways P can take through urban sanitation systems along with barriers and facilitators to P recycling across cities. We examine five case study cities by using a sanitation chains approach: Accra, Ghana; Buenos Aires, Argentina; Beijing, China; Baltimore, USA; and London, England. Our cross-city comparison shows that London and Baltimore recycle a larger percentage of P from human excreta back to agricultural lands than other cities, and that there is a large diversity in socio-environmental factors that affect the patterns of recycling observed across cities. Our research highlights conditions that may be "necessary but not sufficient" for P recycling, including access to capital resources. Path dependencies of large sanitation infrastructure investments in the Global North contrast with rapidly urbanizing cities in the Global South, which present opportunities for alternative sanitation development pathways. Understanding such city-specific social and environmental barriers to P recycling options could help address multiple interacting societal objectives related to sanitation and provide options for satisfying global agricultural nutrient demand.

How to assemble a patient-centered pharmacy QI program

The QI program is patient driven. The question "How does this monitoring affect the patient?" is central to decisions on designing indicators. Time spent on the various levels of quality assessment in the Pharmacy QI Committee is proportional to patient impact. Personnel time devoted to concurrent review of dosing and drug interaction overrides, drug information response accuracy, and therapeutic drug monitoring reflects the importance the Pharmacy Department places on maintaining a drug therapy safety net. The patient is central to the pharmacy QI program. The spirit of the Joint Commission's standards is met; acceptable documentation completes the requirements.

Interventions: a quality assessment tool for the pharmacy department and the medical staff

The intervention tracking system at Texas Children's Hospital has evolved from a simple log to a pocket book of check-off forms requiring minimal writing. Information gathered from the intervention data has progressed from merely notification that a call was made to tracking numbers and types of interventions to including the pharmacists in the information loop. Pharmacists are assured that the time spent documenting interventions provides data for medical staff QI, pharmacy QI, and feedback to themselves as well. No documentation is wasted; no separate data collection is required. Intervention categories with medical staff-approved indicators are treated as a concurrent DUE. Depending on the rate of acceptance of pharmacists' recommendations, physicians, pharmacists, or both are targeted for education. Analysis of the acceptance rate may also indicate the need for systems changes more profoundly affecting one or the other of the groups.