THE NATURAL AND PREVALENCE OF MEDICATION ERRORS IN A TERTIARY HOSPITAL IN INDONESIA

Objective: Medication error is the most common errors in a hospital setting and a serious issue that intimidate the safety of the patient and may cause mortality and morbidity. The aim of this study is to explore the rate of medication errors reporting in an Indonesian hospital. Methods: This study is retrospective and descriptive. This research was conducted at dr. Soeradji Tirtonegoro General Hospital Medical Center from January to June 2020. Medication error reporting, which was reported for six months, was the sample of the study. Results: On the period, 105,171 prescribing sheets were collected. 9.5% of the total prescribing sheets are categorized as Medication Error (ME). The highest incident of ME was prescribing error (88.24%), then followed by transcribing error (7.61%), dispensing error (4.02%), and the last was administration error (0.13%). Conclusion: The most common incident occurred at prescribing stage because the hospital is not supported by electronic prescription. Medication error is an inevitable event during the medication process. But, the incidents can be minimized by implementing some preventive strategies to improve patient safety and safe drug use

Impact and Prevention of Psychiatric Polypharmacy in the Elderly

Adequate medication management is a focus of effective care that is often overlooked in caring for adults with comorbid psychiatric and physical conditions, especially in patients who are treated by multiple care providers and have a variety of health issues at the same time. The purpose of this project was to develop evidence-based policies and practice guidelines to reduce polypharmacy in elderly patients in a rural outpatient psychiatric clinic. Bandura\u27s self-efficacy theory was used to inform the project for its value in assessing motivation, capacity for self-regulation, and perceptions of individual ability. An interdisciplinary team of stakeholders explored best practices for electronic health records (EHR) in a rural mental health facility, created policy and practice guidelines, and developed implementation and evaluation plans to guide the initiative as it moves forward. The team included physicians, psychiatrists, psychologists, nurse practitioners, nursing support staff, social workers, and substance abuse counselors. The team explored approaches for implementing EHR-based medication management based on research in the current literature and goals/objectives of each department. Team members identified major issues and proposed guideline changes based on evidence in their own fields. The team then collaborated to develop policies and practice guidelines in a series of meetings designed to build consensus for supporting a unified set of products to be accepted by all departments. The resulting policies and practice guidelines are accompanied by plans for implementation and evaluation that provide the institution with a comprehensive solution to polypharmacy in elderly patients. This project may improve overall quality of care by reducing medication and preventing health complications related to polypharmacy

Assessment of the latest prescribed drug-related problems

OBJECTIVE: Drug-related problems (DRPs) could affect patient care and lead to deleterious manifestations, therefore, this investigation aimed to review the recently published studies concerning DRPs to improve their availability to clinical pharmacists, hoping that this information will be supportive and relevant to their practice settings. MATERIALS AND METHODS: A search of Elsevier, Sage, Springer/Nature, and Wiley online libraries on Egyptian Knowledge Bank (EKB) was limited to the cumulative period from 1/1/2015 to 20/10/2020. The abstracts of 156 articles were critically reviewed and 50 articles were included based on relevance while excluding books. The selected articles reported DRPs and different strategies to reduce them. Moreover, drug-drug interactions (DDIs) in various patient populations were confirmed by many articles. Additionally, potential drug-drug interactions (pDDIs) predisposing factors were reported by others. RESULTS: 24 articles (48%) illustrated DDIs, 5 articles (10%) demonstrated ADRs, 4 articles (8%) showed medication errors (MEs), and 25 articles (50%) revealed efforts to reduce DRPs. The psychiatric population is at the utmost risk of pDDIs. Polypharmacy was the furthest recurrently reported risk factor related to DDIs. Adverse drug events (ADEs) increased healthcare costs. Different strategies to avoid DRPs were published through the stated period. CONCLUSIONS: Our findings can be supportive to healthcare professionals in enhancing their patients’ quality of care by reducing the exposure to ADEs

Світовий досвід застосування цифрових технологій у процесі надання фармацевтичної допомоги (фрагмент дослідження)

Digitization of healthcare and pharmaceutical care has a significant impact on the development and functioning of these industries. Virtual tools provide significant benefits by improving access to medicines, as well as real-time diagnosis and treatment. Aim. To analyze and generalize literature sources on the use of digital technologies in the process of providing pharmaceutical care and determine further prospects for application. Materials and methods. The search for information sources in foreign databases WoS, Scopus, PubMed was conducted mainly over the past five years; theoretical (analysis and synthesis of scientific literature and normative sources, generalization, classification, analytical, comparative and logical) and empirical (description, comparison) methods were used. Results. The features of digital transformation in the process of providing pharmaceutical care are considered taking into account the processes of digitalization and healthcare in general. It is noted that digitization, which previously seemed desirable, but not mandatory, has become an absolute necessity. The main priorities and trends in the processes of modern transformation of pharmaceutical care are determined, which make it possible to form and master current innovations and develop the ability to work in a patient-centered paradigm. Conclusions. Time requires the expansion of pharmaceutical services through digital technologies, some of them have already become widespread (e-prescriptions, mobile applications, digital dosing technologies), and it significantly improves pharmaceutical care due to a personalized approach to the patient, wider interaction between doctors and patients, the possibility of using information for effective analysis and decision-making, transformation of business processes for rapid response in real time. Digital interventions by pharmacists have a positive impact on health in general. There is limited evidence on the cost-effectiveness of digital interventions, which has led to hesitancy in applying this approach, and it requires further study.  Цифровізація охорони здоров’я та фармацевтичної допомоги суттєво впливає на розвиток і функціонування цих галузей. Віртуальні інструменти надають значні переваги, покращуючи доступ до ліків, а також діагностики та лікування в реальному часі. Мета – аналіз й узагальнення джерел літератури щодо використання цифрових технологій у процесі надання фармацевтичної допомоги, а також у визначенні подальших перспектив застосування. Матеріали та методи. Проведено пошук джерел інформації в закордонних базах даних WoS, Scopus, PubMed здебільшого за останні п’ять років. Було використано теоретичні (аналіз і синтез наукової літератури й нормативних джерел, узагальнення, класифікації, аналітичний, порівняльний, логічний) та емпіричні (опис, порівняння) методи. Результати дослідження. Розглянуто особливості цифрової трансформації в процесі надання фармацевтичної допомоги з огляду на загальну цифровізацію охорони здоров’я. Зазначено, що цифровізація, яка раніше здавалася бажаною, але не обов’язковою, перетворилася на абсолютну необхідність. Визначено основні пріоритети й тенденції в процесах сучасного перетворення фармацевтичної допомоги, що дають змогу формувати й опановувати актуальні інновації та розвивати здатність працювати в парадигмі пацієнтоцентричності. Висновки. Час вимагає урізноманітнення фармацевтичних послуг через цифрові технології, частина яких уже набула поширення (е-рецепти, мобільні програми, цифрові технології дозування), що суттєво покращує фармацевтичну допомогу внаслідок персоналізованого підходу до пацієнта, більш широкої взаємодії лікарів і пацієнтів, можливості застосування інформації для ефективного аналізу та прийняття рішень, трансформування бізнес-процесів для оперативного реагування в реальному часі. Цифрові втручання фармацевтів позитивно впливають на стан здоров’я загалом. Досить обмежені докази економічної ефективності цифрових втручань спричиняють нерішучість застосування цього підходу, а також зумовлюють подальше вивчення.

Guideline-led prescribing to heart failure patients in Ireland and Egypt

Introduction: Guidelines strongly recommend patients with Heart Failure (HF) be treated with multiple medications proven to improve clinical outcomes, as tolerated. Guideline-led prescribing of HF evidence-based medicines is strongly associated with improved survival, prognosis, and quality of life in HF. The guidelines strongly recommend, and the optimal patient outcomes are achieved with an appropriate prescription of target doses of all HF therapies. The degree to which gaps in medication use and dosing persist in contemporary Irish or Egyptian practices is unclear. Aim: To assess guideline-led prescribing of the evidence-based HF medications in routine clinical practice in Ireland and Egypt and to assess the prevalence of HF-specific potentially inappropriate prescribing in the same Irish and Egyptian clinical settings. Method: Firstly, a narrative literature review was undertaken to determine and compare the available data and gaps in knowledge regarding HF management in Ireland as a developed European country, and Egypt as a developing Middle-Eastern country, with a particular focus on the guideline-directed medical therapies. Secondly, a systematic review was undertaken to identify the objective quantitative tools to assess the quality of HF prescribing practice. Next, a prospective cohort study was conducted on an Irish outpatient population to evaluate the extent of use and dosing of the guideline-directed medical therapies. Then, a multicentre retrospective study was carried out in 14 Long-Term Care (LTC) facilities in Cork County to assess the prevalence of appropriate and potentially inappropriate prescribing practices. In Egypt, a longitudinal observational study was conducted in order to evaluate the prescribing quality and patterns in HF patients in an Egyptian critical care setting at discharge. Finally, a descriptive survey was developed to address the barriers to guideline-led prescribing in a middle-income setting. Results: The literature review identified many gaps in knowledge in the Egyptian and Irish literature on HF. For instance, the studies included in the review did not discuss the target dose prescribing. The systematic review identified the widespread use of the Guideline Adherence Index (GAI-3) in 13 studies worldwide in the quantitative assessment of HF prescribing. The Irish HF outpatient study showed room for optimising the prescription of the guideline-directed medical therapies in 34% of ambulatory patients. No patient achieved the 100% target dose of all three evidence-based medications. The prevalence of potentially inappropriate prescribing was 20%. The Irish LTC study showed that patients with HF were older than those without HF (84.8 ± 7.4 vs 83.4 ± 7.9 years, p-value = 0.024). Loop diuretic was the most frequently prescribed HF medication up to 88% of the total population and renin-angiotensin system inhibitors to 24.2% only. The prevalence of potentially inappropriate prescribing in LTC was 24%. On the other hand, the Egyptian longitudinal study showed the moderate adherence level at discharge from the critical care unit but the potential role of clinical pharmacy service in HF drug therapy optimisation via improving beta-blocker prescription rates by from 24% to 38% and reducing digoxin rates from 34% to 23%. However, the service did not improve the overall guideline adherence levels or the prevalence of inappropriate prescribing. The survey explored some new aspects in HF practice, such as the urgent need for locally-drafted guidelines and the more significant implementation of clinical pharmacy service to optimise the implementation of guideline-led prescribing in routine clinical practice. Conclusion: This thesis has made a significant contribution to the knowledge and generated a much needed conceptual understanding of the complexity of HF guideline-led prescribing. This work reflects the moderate adherence levels to guidelines and high prevalence of potentially inappropriate prescribing in the two countries. None of the prescribers either in Ireland or Egypt prescribed at least a renin-angiotensin system inhibitor to all HF patients despite the strong, long-standing evidence

Medication Reconciliation as a Medication Safety Initiative

Medication errors and their adverse outcomes are the most common cause of patient injuries in hospitals. Medication reconciliation is the safety strategy usually called for, to prevent medication errors that occur at care transitions. This strategy has been adopted as a standard practice in many developed countries. However, in Ethiopia, there were no published studies on medication reconciliation, nor evidence-based interventions aimed to tackle the burden of medication errors. This thesis was a medication safety initiative focusing on medication reconciliation intervention overall, and explored the journey to medication reconciliation service implementation as a medication safety strategy in Ethiopian public hospitals. Given the lack of consistent reports regarding the impact of this strategy, the journey to implementation was guided by synthesise of the evidence supporting the effectiveness of this intervention. The findings of our systematic reviews have shown that medication reconciliation interventions carried out through pharmacist assessment at hospital transitions were found to be an effective strategy for improving clinical outcomes (e.g. adverse drug event-related hospital visits, all-cause readmissions, and emergency department visits), as well as process outcomes, such as the occurrence of medication errors. Therefore, the overarching aim of this thesis was to implement a pharmacist-led medication reconciliation intervention in resource-limited settings. Implementation of medication reconciliation is not an ultimate end but sustainability is an issue, and this should be corroborated by corresponding changes in attitudes, teamwork, communication, culture and leadership. For this purpose, the thesis employed methods from both safety and implementation sciences for successful implementation of the medication reconciliation program. System approaches to patient safety, such as patient safety culture has been explored, and patients’ experiences of medication-related adverse events have been discussed followed by a theoretically robust evidence-based exploration of the barriers to implementation. Patient safety culture in Ethiopian public hospitals has been found lower than the benchmark studies. Importantly, understaffing followed by problems during handoffs and care transitions and punitive response to error were identified as major safety problems. Particularly, handoffs and care transitions were largely affected by the lack of teamwork across units, punitive response to error reporting and managerial inaction for promoting patient safety. In addition to system factors presumed to affect patient safety, other factors such as individual healthcare professionals, patient, and task factors have been identified as challenges to achieve an optimal patient safety in the Ethiopian public hospitals. Resource limitations (e.g. material deficiencies, poor infrastructure) have been indicated as the greatest barriers for patient safety. Patients expressed a range of perceived experiences related to their medication, and a number of strategies required to improve patient safety practices have been suggested. Changes in practice, processes, structure, and systems were believed to help improve patient safety in the Ethiopian health care system. The results of this thesis have demonstrated that hospital pharmacists were very much enthusiastic for their extended roles and were positive towards the future of the profession; however, there were many factors that likely influenced their behaviour in the clinical practice, and these behavioural determinants were predominantly related to ‘Knowledge’, ‘Skills’, ‘Environmental constraints’, ‘Motivation and goals’, ‘Social influences’, and ‘Social/professional role’. While medication errors were highly prevalent at the time of hospital admission, this thesis has also found that pharmacist-led medication reconciliation was able to minimize medication errors significantly. Thus, implementation of medication reconciliation as a medication safety strategy is feasible, and pharmacists may be regarded as key resource personnel for the safe use of medications at the time of hospital admission. However, the sustainability of this service utilization is highly dependent on other behavioural determinants, such as knowledge and skill, competing priorities, and reimbursement for clinical services

Optimising cancer supportive care in Qatar

According to the 2022 World Health Organisation (WHO) statement, cancer was the world's leading cause of death in 2020, accounting for up to 10 million deaths, close to one in every six. Whereas, the 2020 UK Cancer Research report showed that in England and Wales, more than 375,000 cases are diagnosed with cancer every year during the period of 2016 - 2018, with 167,147 cases of fatalities over 2017-2019 (Cancer Research UK, 2020). A cancer diagnosis and its following treatment can have an overwhelming effect on a patient's QoL, as well as on the life of their family (NICE, 2019). Regardless of their individual circumstances, cancer type, stage, or anti-cancer medication, all cancer patients have a fundamental right to supportive care (NICE, 2019). Hence, it is crucial to optimise cancer supportive care, in order to improve patients' clinical outcomes, compliance with therapy, QoL, and cost effectiveness of cancer care, as well as to ensure that cancer patients get the most out of their anticancer treatments. Real-world studies enable oncology healthcare professionals to comprehend regional variances in clinical practise and the reported real-world outcomes. RCTs frequently exclude participants with co-morbid conditions, advanced age, and low performance status. This leaves a gap in the body of knowledge regarding the effectiveness and safety of cancer therapy for this cohort of patients. Therefore, it is necessary to have a deeper knowledge of Real-World Evidence (RWE) to better understand therapy outcomes in real practice (Banerjee and Prasad, 2020). The Multidisciplinary Team (MDT) approach has been proven to improve patients’ clinical outcomes. The oncology pharmacist is a core member of cancer MDTs in Qatar. Over the last 15 years, oncology clinical pharmacists have been showing a significant independent role in cancer supportive care in Qatar, which significantly reflects on clinical, economic, and psycho-social outcomes of cancer patients. This thesis contributes to cancer supportive care real-world research, and different approaches towards improvement of therapeutic outcomes. It includes six studies, with a considerable representation of different real-world research methodologies, including a retrospective cohort study, a prospective cohort study, a healthcare survey, a Point Prevalence Survey (PPS), a systematic review, and a mixed method study. The aim of the KP1 study was to assess the impact of the oncology pharmacists' interventions during the discharge reconciliation process in the outpatient pharmacy. This study included a total of 4293 orders of medications for 591 patients/prescriptions. The results revealed a sum of 278 (47%) prescriptions required pharmacists’ interventions. Plus, 32% (190/591) of the prescriptions had medication discrepancies, and 21% (122/591) had medication errors, as detected by the pharmacists. In KP2, the purpose was to assess how different healthcare providers (HCPs) perceived the oncology clinical pharmacy service in NCCCR. The results showed that different oncology HCPs in Qatar perceived a growing need for the clinical pharmacy profession in the following proportions: 96% for pharmacists, 90% for doctors, and 64% for nurses, with statistical significance (p=0.002). The majority of respondents noted that the clinical pharmacy service has the greatest influence with detecting medication errors (85%), patients’ education (82%), and participation in clinical rounds (82%). Focusing on cancer drugs related complications, KP3 aimed to assess the safety of Bone-Targeting Agents (BTAs) in bone metastasis. This study included 271 patients who received 1141 doses of BTAs (denosumab and zoledronic acid). The results showed – with statistical significance – that in Qatar’s population hypocalcaemia was more frequent in denosumab patients than zoledronic acid patients. Whereas, about 60% of hypocalcaemia patients on both drugs did not receive calcium or vitamin D supplements. KP4 was a systematic review, aimed to identify the most popular techniques for diagnosing and managing the haematological Immune Related Adverse Events (irAEs) with the use of Immune Checkpoint Inhibitors (ICIs) by analysing the published data from case reports and case series. This study included 49 articles in total, with 118 cases reported haematological irAEs with ICIs. It concluded that, the most frequent irAEs were thrombocytopenia, haemolytic anaemias, and aplastic anaemias. Furthermore, steroids were used in 68% (80/118) of the reported events for the management of haematological irAEs, with a failure rate of 20% (16/80). KP5 and KP6 are two studies focused on Antimicrobial Stewardship (AMS). KP5 was a PPS conducted to identify the prevalence of antimicrobial use for oncology patients in Qatar. It showed that by including 58 inpatients, the overall prevalence of antibiotic use was 43% (25/58). However, the compliance with the regional prescribing restriction requirements fell short of expectations, as only 58% (19/33) of prescriptions were issued by privileged prescribers. While in KP6, the study's aim was to assess the level of AMS knowledge, outcomes, and barriers among Qatar's cancer management team. This study included a total of 219 prescriptions during the course of the 6 PPSs. The results showed that the compliance continued to be low as 60% (similar to KP5). Yet, educational interventions resulted in significant improvement, with an overall compliance rate of 96%. In conclusion, this thesis will address the published real-world studies conducted using a variety of methodologies on cancer supportive care in Qatar, and shed light on recommendations and strategies for improving the outcomes of this type of care, as well as how they relate to clinical practise

Clinical Pharmacist Involvement in Mental Health Hospital in the Home

While the benefits of clinical pharmacist (CP) services have been comprehensively described in other healthcare settings, there is a paucity of evidence describing the role of the CP within the mental health (MH) Hospital-in-the-Home (HiTH). This suite of studies – a scoping review, an autoethnography, a quantitative medication safety study and a qualitative study – has comprehensively described the integration and evolution of the CP role, and provided preliminary evidence of the value of the MH-HiTH CP

Prescription drug errors in Anand District

Not availabl