Evaluating knowledge, attitude and practice of intensive care unit nurses in administering medications via enteral tubes

Introduction : The purpose of the study was to evaluate Intensive Care Unit nurses’ knowledge, attitude, self-reported practice, and observed practice regarding medication administration via enteral feeding tube.Method:in this cross sectional study, a questionnaire and a checklist was developed for evaluating the nurses' knowledge, attitude, self-reported practice and real practice regarding medication administration via enteral feeding tube. Mean score of knowledge, and the percentage of different domains of attitude and practice was reported.Results: 53 nurses were included in this study. The mean number of medications which were prescribed for each patient was 15.8±4.5. From these medications, 5.5±2.8 drugs were administered via enteral feeding tube. There were few nurses (5%) with proper knowledge regarding correct dosage forms selection. About half of the nurses had proper knowledge regarding tube flushing and drug dilution,however according to direct researcher’s observation, 11% of nurses flushed the tubes before medication administration.Conclusion:The current study showed the disparity between the nurses' knowledge, self-reported practice, and proper performance in drug administration through enteral feeding tube. The most important problems in knowledge and attitude of nurses included crushing the dosage forms and in real practice in diluting medications and tube flushes domain.  </p

Antibacterial susceptibility patterns of porphyromonas gingivalis isolated from chronic periodontitis patients

Objectives: To test the antimicrobial sensitivity of Porphyromonas gingivalis to a panel of eight orally administrable antibiotics in chronic periodontal diseases and to evaluate factors associated with periodontitis in adult patients. Study Design: A total of fifty strains of P. gingivalis were isolated from one hundred and twenty adult patients with chronic perio-dontitis. Identification of bacteria was carried out by anaerobic culture and biochemical tests. Selected colonies of P. gingivalis were used to evaluate the antibacterial activities of penicillin, metronidazole, amoxicillin, amoxicillin/clavulanic acid, clindamycin, doxy-cycline, ciprofloxacin and azithromycin. Results: Most of the patients were female, age ranging between 40 to 50 years. Majority of the patients frequently had scaling and depths of periodontal pockets in infected teeth were 5-8 mm and most of them had hemorrhage during sampling. Susceptibility testing revealed a sensitivity of 100% of P. gingivalis to azithromycin, doxycycline and amoxicillin/clavulanic acid but lower susceptibilities were found for the rest of antibiotic agents evaluated. Conclusions: Frequent scaling in women aged between 40-50 years had positive correlation with chronic periodontitis. The application of antibiotics in conjuction with mechanical debridation, may reflect in the level of resistance of P. gingivalis in patients with chronic periodontal infections. This could suggest periodical antibiotic susceptibility testing is necessary to determine the efficacy of antimicrobial agents if the perfect curing of chronic periodontal diseases after mechanical debridation is meant. Further clinical studies are required to confirm the in vitro results. The only limitation in this study was identification of bacteria to species rather than subspecies level. © Medicina Oral S.L

Performance of Drug and Poison Information Center within a Referral University Hospital in Southwest of Iran

Background: Drug and Poison Information Centers (DPICs) provide quick, easy, valid and reliable access to medication and toxin information for professionals, health workers and the public. The purpose of this study is to report the services provided by a university hospital DPIC within 1 year. Methods: This descriptive study reports all scientific questions asked from DPIC of Namazi hospital in Shiraz from the September 2016 to the August 2017. The information include the number of questions, the ward that ask the question, the questioner's profession, the method of asking questions, the method of responding, the type of question, and the resources used to answer them. After extraction of duplicates, data were analyzed by using the Excel software. Results: The total number of contacts registered during the study period was 485. The most number of questions were received in July and the lowest in November. Major questions were asked from the health-care team working in Namazi hospital and mostly from the nursing group (44.7%). Most of the questions (79.6%) were asked and responses were provided (67.1%) by the telephone device. Of all incoming inquiries, drug indication (13.3%), adverse drug reactions (ADR) (13.3%), storage (11.8%), and the method of preparation as well as administration (11.7%) were among the most common types of questions. The most frequent ward in asking questions was the pediatric intensive care unit (13.1%). The most widely used drug information resource to answer questions was the UptoDate® (47.5%). Conclusion: DPIC services in the hospital settings can decrease or prevent ADRs as well as medication errors, improve the pattern of medication use, and result in cost saving

Drug utilization evaluation of Rivaroxaban in both inpatient and outpatient settings: Using standard guidelines

Stroke-related atrial fibrillation (AF), deep vein thrombosis (DVT), and pulmonary thromboembolism (PE) are among the most common thromboembolic events. recently, direct oral anticoagulants (DOACs) have been slowly replacing warfarin. Rivaroxaban is a DOAC frequently prescribes to control thrombotic events. The safety and efficacy of Rivaroxaban are dependent on appropriate prescription, dosage, and other factors. This study is aimed to evaluate the Rivaroxaban utilization based on the standard protocol in both inpatient and outpatient settings. This cross-sectional/observational study was conducted for six months from 1st August 2018 to 1st February 2019 at a private hospital and also an outpatient clinic in Shiraz, Iran. First, a clinical pharmacist defined a standard protocol for Rivaroxaban utilization and several indexes (9 indexes for Non-valvular AF (NVAF) patients and 10 indexes for DVT/PE patients). Second, participants were classified into three groups (NVAF inpatients, NVAF outpatients, and DVT/PE patients). Finally, the adherence of Rivaroxaban utilization indexes in each group to was evaluated accordingly. Two hundred and forty one eligible patients were recruited into this study. Most patients (N=208), were NVAF. Rivaroxaban utilization was appropriate in 71.9%, 65.8%, and 50.6% of patients within groups 1, 2, and 3, respectively. Although medication interaction, administration regarding time/meal, and dose adjustment based on renal function showed the lowest compliance, the monitoring laboratory data and considering the underlying disorders were completely matched with the protocol. This study showed some critical errors in both settings, especially in DVT/PE patients (49.4% no match). Hence, the most productive collaboration must be developed between clinical pharmacists and clinical practitioners

Determining Frequency of Prescription, Administration and Transcription Errors in Internal Intensive Care Unit of Shahid Faghihi Hospital in Shiraz with Direct Observation Approach: Prescription, administration and transcription errors

Medication errors (MEs) are the most common error in ICUs. In fact, 78% of all serious errors in ICUs are due to MEs. Therefore, detecting MEs has vital significance. The goal of this study was to investigate the frequency, type and consequences of different types of errors including prescribing, transcribing and administration errors in an ICU of a large teaching hospital. Disguised direct observation method was used to detect errors. A pharmacy student observed 307 doses in 46 days of 6 h shifts. Observation data were entered in a form designed specifically for this purpose. Two hundred and fourteen MEs were identified in 307 doses. This is equivalent to 69.7% of total error. The error breakdown is as follows: administration errors 43.1%, preparation errors 24.1% and transcription errors 2.5%. Administration techniques and monitoring were determined to be the most common errors of MEs. Nearly, 89.4% of errors did not result in imminent danger to the patients. In the ICU under this study, the most common MEs were administration and prescription errors. To improve the quality of care in the ICU and reduce MEs, efforts should be directed to correct the wrong administration technique and inappropriate monitoring. The use of pharmacy department in drug preparation instead of drug preparation by nurses, using protocols for IV infusions, providing equipment and trained personnel for therapeutic drug monitoring and measuring medications level may help reduce suboptimal drug prescription and administration

Evaluation of aminoglycosides utilization in intensive care units of a teaching hospital in southern Iran

Background: Inappropriate use of antimicrobial agents is one of the most important factors in inducing resistance and prolonged hospitalization as well as increase in patient mortality rate. Objective: The aim of this study was to evaluate aminoglycosides (AGs) usage pattern at intensive care units (ICUs) of Nemazee hospital Shiraz, Iran. Methods: In this cross-sectional study, the usage pattern of AGs was evaluated during 32 months. Guidelines for AGs usage were approved by the drug and therapeutic committee of the hospital, and criteria were developed to assess 11 parameters involving AGs therapy, such as proper indication for the use of the drug, dosage and duration of therapy. Clinical parameters, such as microbial culture and sensitivity, serum creatinine (SCr) and creatinine clearance, and white blood cell count were evaluated. Results: Ninety-five patients were recruited, 50 male and 45 females. In most patients (64%) the origin of infection was hospital and only in 36% of them, community was the source. Ventilator associated pneumonia (27%), central nervous system (25%) and urinary tract infection (10%) were the most important indications for AGs prescription. Scores of AGs usage at Nemazee hospital was calculated as 5.9 out of 11, which meant that in only 54% of cases AGs prescription was based on guideline proposed by the Department of Clinical Pharmacy of Nemazee Hospital. Conclusions: Non-adherence to the guidelines occurred frequently in the ICUs of Nemazee hospital. Prescription of loading dose, and AGs level measurement were not done and evaluating microbiological data was often neglected. Incorporating pharmacists in the health care team and holding training programs for physicians and nurses with the goal of raising awareness about the proposed guideline

Intravenous Methylprednisolone, a Possible Cause of the Atrial Fibrillation: Atrial fibrillation by methylprednisolon

We are presenting a case illustrating atrial fibrillation (AF) following the use of methylprednisolone in a patient with pelvic and femur fracture. A48- year- old man with no significant past medical history, was admitted to the emergency department after injury in a car accident. He suffered a multiple bone fracture with chief complaints of pain and shortness of breath. He was transferred to the ICU. To preventfat embolism syndrome, he was treated with methylprednisolone 500 mg every 6 h. About 4 h after the second dose, his normal sinus rhythm changed to a sinus tachycardia and then to AF. The methylprednisolone therapy was discontinued. After about 8 h of methylprednisolone discontinuation, the patient's normal sinus rhythm returned. Corticosteroids have been utilized for prevention and treatment of fat embolism syndrome, although there is uncertainty about their effectiveness. Cardiac dysrhythmias have been reported following the use of methylprednisolone. One possible mechanism of methylprednisolone induced AF is the direct effect on cell membrane, resulting in potassium efflux, which in turn, may initiate cardiac dysrhythmias. Previous methylprednisolone-associated AF case reports suggest a higher chance of AF occurrence with higher dose of methylprednisolone. Corticosteroids should be used with caution, especially when high doses are indicated and in patients with high risk for arrhythmias

Pharmacokinetic Evaluation of Two Doses of Aminophylline/Theophylline Administered as Multiple Intermittent Infusions to Iranian Apneic Premature Neonates: Pharmacokinetic of multiple intermittent infusions aminophylline/theophylline

Many premature neonates suffer from apnea, and aminophylline is administrated for them. The objective of this study was to reveal pharmacokinetic (PK) parameters of theophylline in Iranian premature neonates. Premature neonates (68) who were admitted in the Neonatal Intensive Care Unit (NICU) of Namazi, Hafez, and Zeinabieh Hospitals were included in the study. All of them received 5 mg/kg aminophylline. One group received 1 mg/kg/8 h and the other group received 2 mg/kg/8 h as maintenance dose. One blood sample was taken in steady-state on just before eleventh dose. Theophylline level was determined with immunoassay kit. There was a significant difference in average serum concentration (Cave ss ) between two dosing levels (7.69±2.92 µg/ml vs. 11.44±3.80 µg/ml). Furthermore, the total clearance and volume of distribution were significantly different in two groups. No significant correlation could be found between the gender and Cave ss in different dosing levels. Postnatal age and postconceptional age have significant relationship with Cave ss just in the second group. According to theophylline serum concentrations, these two dosages produce therapeutically safe and effective blood levels. Pharmacokinetic parameters in these patients–in two dosing groups–approximately are correlated with other reported and recommended amounts

Evaluating Adherence of Health-Care Team to Standard Guideline of Colistin Use at Intensive Care Units of a Referral Hospital in Shiraz, Southwest of Iran

Purpose: To evaluate colistin use according to global standard drug consumption in intensive care units of a referral hospital in Shiraz, Iran Methods: A prospective, interventional study was performed during an 11 month period on 100 patients admitted to ICUs of a teaching hospital being treated with colistin for at least 3 subsequent doses. Required demographic, clinical, and paraclinical data were gathered by a pharmacist. Fifteen indexes were considered to evaluate colistin use. A clinical pharmacist reviewed indication and dose of colistin at the time of prescribing this agent. Results: In our study population, pneumonia (69%) was the main indication of colistin. In 87% of patients, colistin administration was based on microbiological laboratory evidence. Continuation of therapy was inappropriate in 5% of cases. By the intervention of the clinical pharmacist, colistin was discontinued in all patients in whom empirical therapy was continued incorrectly. None of the patients received loading dose of colistin. The maintenance dose, dose interval, and duration of treatment of colistin were appropriate in 76%, 71%, and 100% of patients, respectively. For none of the patients, the pharmacokinetic dosing method was used. In all patients, serum creatinine and WBC count were evaluated on daily basis. The sum indexes of colistin use were relevant to standard guidelines in 67.33% of the cases.Conclusion: The results of this study highlight the necessity of the pharmaceutical care team participation in all stages of treatment with antibiotics. After pharmacist interventions, some criteria of colistin utilization were corrected and brought closer to standard values