The Effect of Modern Educational Strategies in Reducing Intravenous Drug Administration Error: A Non-Randomized Clinical Trial

Introduction: Among medication errors, intravenous medication administration errors are especially important. The lack of medication information can be one of the causes of medication errors. Using electronic education may facilitate quick access to the update resources. The objective of this study is the evaluation of an appropriate educational strategy to reduce intravenous drug administration errors by staff, including error in drug dosage, before-, during- and after- prescription assessment, evaluation of injection site, proper solvent selection, volume of solvent, length of injection, and patient training. Methods: This is a single group interventional study, carried out in three hospital wards of Shiraz University of Medical Sciences in 2008-9. Samples were intravenous drugs prescribed by nursing staff. Intravenous administrations was observed and recorded before and 6 months after the educational intervention. Educational intervention for all nursing staff responsible for drug administration, was a workshop composed of a blend of lectures, practice, reflection and E-learning opportunities on medication errors and resources. Data analysis was done with MC-Nemar and binomial tests. Results: In this study, evaluations of errors in 603 administrations of intravenous medication (30 drugs) have been done regarding ten variables. After education, there was a decreased frequency of errors in before prescription assessment (60.5% to 6.6%), evaluation of injection site (25.3% to 3.4%), length of injection (50.1% to 27.6%), during prescription assessment (42.7% to 16.7), after prescription assessment (42.3% to 17.2%) and patient training (91.2% to 75.6%) (P < 0.05). Conclusion: The use of modern strategies and introducing rsources (electronic data bases and sofwares) in hospital wards is important in decreasing medication errors, as it facilitates the nurses’ access to the update sources of medication information

Synthesis and Antibacterial Activity of Novel Levofloxacin Derivatives Containing a Substituted Thienylethyl Moiety

Background and the purpose of the study Piperazinyl quinolones such as ciprofloxacin, ofloxacin and levofloxacin are an important group of quinolone antimicrobials which are widely used in the treatment of various infectious diseases. In the present study, we synthesized a new series of levofloxacin derivatives and evaluated their antibacterial activities. Methods:The N-substituted analogs of levofloxacin 6a-j were prepared by nucleophilic reaction of Ndesmethyl levofloxacin 11 with thienylethyl bromide derivatives 8 or 9. All target compounds were tested using conventional agar dilution method in comparison to levofloxacin and N-desmethyl levofloxacin and their MIC values were determined against a panel of Gram-positive and Gram-negative bacteria. Results:All compounds showed significant antibacterial activities against Gram-positive bacteria (MIC = 0.04-6.25 mug/mL); however, the activity against Gram-negative bacteria was lower (MIC = 1.56-100 mug/mL). As is evident from the data, oxime derivatives 6e, 6h and 6i are superior in inhibiting the growth of Gram-positive bacteria (MIC = 0.04-0.19 mug/mL), and their activities were found to be 5-25 times better than N-desmethyl levofloxacin 11 and equal or better than levofloxacin 4. Conclusion:We have designed and synthesized novel quinolone derivatives bearing functionalized thienylethyl moiety on the piperazine ring of levofloxacin. The results of antibacterial screening against Gram-positive and Gram-negative bacteria revealed that the introduction of functionalized thienylethyl moiety on the piperazine ring of levofloxacin can improve the activity against Gram-positive bacteria. Gram-positive bacteria are responsible for a wide range of infectious diseases, and rising resistance in this group is causing increasing concern. Thus, this study introduces structural features of levofloxacin scaffold for development of new candidates in the field of anti-Gram positive chemotherapy