Using the Human Factors Framework to understand the origins of medication safety problems in community pharmacy : A qualitative study

Background: Community pharmacy practice in the Kingdom of Saudi Arabia (KSA) faces many challenges. In KSA, there is a lack of empirical research about medication safety in this setting. Objective: To explore the safety problems associated with medication supply from community pharmacies in KSA and compare different stakeholder perspectives. Methods: Four focus groups and individual interviews were conducted in Riyadh, KSA, in February–May 2013. All group discussions were recorded, transcribed and translated from Arabic into English, except the professional group, which was conducted in English. Thematic analysis was performed using the Human Factors Framework (HFF). Results: The groups comprised "professionals" (n = 8; one female), community pharmacists (n = 4; all male) and two pharmacy user groups (females, n = 11 and males, n = 8). Medication safety problems identified were categorised into nine categories representing the HFF. Seven main themes were identified from these categories: commercial pressure on community pharmacy; illegal supply of prescription medication; lack of enforcement of regulations; the healthcare system; self-medication; patient trust in pharmacists: and communication failure. Themes that emerged only from the "professionals" and community pharmacists were the different role of the regulatory organisations and the reasons behind lack of enforcement, while the community pharmacist group focused on the relationship between owners and managers. Pharmacy users expressed a need for information about medication and that the primary role of the pharmacist should be as an information provider. Furthermore, they perceived pharmacists to be vendors rather than healthcare professionals. Conclusion: Many medication safety problems were identified, attributable to individuals (patient, pharmacist), pharmacy and organisational factors. These results will be used to develop interventions to improve medication safety

Nanoparticle Mediated Delivery of RNA Oligonucleotides for Lung Cancer Therapy

Despite the global burden of lung cancer, current treatment regimens are marred by low efficacy and dose-related toxicity. Accordingly, novel therapeutic strategies are highly warranted. RNA interference and RNA aptamer platforms hold great therapeutic potential for regulating aberrant proteins implicated in lung cancer pathogenesis. Clinical translation, however, has been hampered by the lack of safe and efficacious delivery vectors. Due to their unique quantum properties and tunable design, nanoparticles are materializing as potent gene carriers. This thesis focused on the engineering and characterization of two nanoparticle constructs for the delivery of siRNA and RNA aptamer oligonucleotides. The first nanocarrier was comprised of a gold core and an organic shell, consisting of alternating hydrophilic and hydrophobic domains. This “striped” conformation enabled energy-independent cell membrane penetration and endosomal evasion. When conjugated to anti-sense oligonucleotides, these nanoparticles retained their penetrating capacities. However when conjugated to siRNA, nanoparticles lost their cell- penetrating capabilities and entered cells through energy-driven endocytic routes, compromising their gene silencing efficiency. The second nanocarrier consisted of a detonation nanodiamond core with a shell of RNA oligonucleotides. Nanodiamond-siRNA constructs were found to be biocompatible, to exhibit robust cellular internalization, and to downregulate mRNA and protein expression in two gene models. Knockdown potential, however, was limited by endosomal sequestration and slow siRNA release. In future, nanodiamonds would benefit from the attachment of acid-buffering polymers to enable endosomal escape and more potent gene silencing effects. Nanodiamonds were additionally functionalized with RNA aptamers for cancer cell targeting and therapeutic EGFR blockade. These chimeras were found to enhance binding affinities to EGFR targets relative to unfunctionalized aptamers, and to selectively induce cell apoptosis in EGFR-expressing lung cancer cell lines. As these aptamers were able to target both wild-type and mutant EGF receptors, they can potentially serve as adjuncts to TK inhibitors and anti-EGFR monoclonal antibodies in the clinic, thus expanding the scope of EGFR therapies. The work in this thesis accentuates the importance supra-molecular assembly in the context of biointerfacial interactions and proposes design schemas for those endeavoring to develop nanoparticle carriers for oligonucleotide delivery and cancer therapy

Using the Human Factors Framework to understand the origins of medication safety problems in community pharmacy : A qualitative study

Background: Community pharmacy practice in the Kingdom of Saudi Arabia (KSA) faces many challenges. In KSA, there is a lack of empirical research about medication safety in this setting. Objective: To explore the safety problems associated with medication supply from community pharmacies in KSA and compare different stakeholder perspectives. Methods: Four focus groups and individual interviews were conducted in Riyadh, KSA, in February–May 2013. All group discussions were recorded, transcribed and translated from Arabic into English, except the professional group, which was conducted in English. Thematic analysis was performed using the Human Factors Framework (HFF). Results: The groups comprised “professionals” (n = 8; one female), community pharmacists (n = 4; all male) and two pharmacy user groups (females, n = 11 and males, n = 8). Medication safety problems identified were categorised into nine categories representing the HFF. Seven main themes were identified from these categories: commercial pressure on community pharmacy; illegal supply of prescription medication; lack of enforcement of regulations; the healthcare system; self-medication; patient trust in pharmacists: and communication failure. Themes that emerged only from the “professionals” and community pharmacists were the different role of the regulatory organisations and the reasons behind lack of enforcement, while the community pharmacist group focused on the relationship between owners and managers. Pharmacy users expressed a need for information about medication and that the primary role of the pharmacist should be as an information provider. Furthermore, they perceived pharmacists to be vendors rather than healthcare professionals. Conclusion: Many medication safety problems were identified, attributable to individuals (patient, pharmacist), pharmacy and organisational factors. These results will be used to develop interventions to improve medication safety.</p

Assessing System Thinking in Senior Pharmacy Students Using the Innovative “Horror Room” Simulation Setting: A Cross-Sectional Survey of a Non-Technical Skill

System thinking is an important competency for all healthcare professionals as it is a required skill to provide safe patient care. However, the literature does not describe how students gain such a skill or the manner in which it is assessed. Purpose: This study aimed to assess pharmacy students’ non-technical skills in the form of system thinking and error detection in a simulated setting. Results were correlated with the number of errors students were able to identify in a team-based simulation activity called the “horror room.” Patients and methods: A cross-sectional survey was administered after completion of the “horror room” simulation activity to identify elements of system thinking and error detection. Survey respondents were senior students enrolled in a patient safety course. System thinking elements identified in the survey were then linked to the number of errors reported. Results: Sixty-six students participated in the activity. Their mean grade point average (GPA) was 4.72 (standard deviation (SD) 0.22), and the mean number of errors detected was 8 (SD 2). The average total system thinking score (STS) was 68 (SD 8.4). There was no association between the number of errors detected and STS; however, a positive association was found between GPA and STS (Spearman’s correlation coefficient = 0.27, p = 0.030). The most common type of error detected was a medication safety error (100%). Conclusions: High STS showed that teaching theory is important for students to learn concepts; however, knowing the ideas associated with system thinking does not necessarily translate into practice, as evidenced by the low number of errors students were able to detect

Assessing System Thinking in Senior Pharmacy Students Using the Innovative “Horror Room” Simulation Setting: A Cross-Sectional Survey of a Non-Technical Skill

System thinking is an important competency for all healthcare professionals as it is a required skill to provide safe patient care. However, the literature does not describe how students gain such a skill or the manner in which it is assessed. Purpose: This study aimed to assess pharmacy students’ non-technical skills in the form of system thinking and error detection in a simulated setting. Results were correlated with the number of errors students were able to identify in a team-based simulation activity called the “horror room.” Patients and methods: A cross-sectional survey was administered after completion of the “horror room” simulation activity to identify elements of system thinking and error detection. Survey respondents were senior students enrolled in a patient safety course. System thinking elements identified in the survey were then linked to the number of errors reported. Results: Sixty-six students participated in the activity. Their mean grade point average (GPA) was 4.72 (standard deviation (SD) 0.22), and the mean number of errors detected was 8 (SD 2). The average total system thinking score (STS) was 68 (SD 8.4). There was no association between the number of errors detected and STS; however, a positive association was found between GPA and STS (Spearman’s correlation coefficient = 0.27, p = 0.030). The most common type of error detected was a medication safety error (100%). Conclusions: High STS showed that teaching theory is important for students to learn concepts; however, knowing the ideas associated with system thinking does not necessarily translate into practice, as evidenced by the low number of errors students were able to detect.</jats:p