Assessment of the Medication Administration Errors in the Tertiary Hospital in Saudi Arabia: A prospective Observational Study

Medication errors can occur at any of the three steps of the medication use process: prescribing, dispensing and administration. Drug administration errors were the second most frequent type of medication error, after prescribing errors, but the latter were often intercepted; hence, administration errors were more probably to reach the patients. Therefore, this study was conducted to determine the frequency and types of drug administration errors in a Taif hospital ward. Prospective study based on a disguised observation technique in nine wards in a general hospital in Taif, Saudi Arabia (800 beds). A pharmacist accompanied nurses and witnessed the preparation and administration of drugs to all patients during the three drug rounds on each of six days per ward. The main outcomes were the number, type and clinical importance of errors and associated risk factors. The drug administration error rate was calculated. Relationships between the drug dose frequency, dosage form and types of medication administration error were measured. A total of 7105 medications administered by 250 nursing staff members to 700 patients were observed. Observers intervened in seven administrations. There are 1769 medication administration errors confirmed. The most common medication administration errors were drug preparation error (40.56%, n =727) then, improper dose error (18.58%, n=333); the most common drug class error was Antibiotic (38.9%, n =399) then Analgesic and anti-inflammatory drugs (17%, n =176). The most drug dose frequency had Drug preparation error was seen in a drug used three times a day by 484. MAEs were more likely to occur in the evening shift compared to the morning and afternoon shifts. The study indicates that the frequency of drug administration errors in developing countries such as Malaysia is similar to that in developed countries

Fluoroscopic Anatomy of Right-Sided Heart Structures for Transcatheter Interventions

Performing transcatheter tricuspid valve interventions requires a thorough knowledge of right-heart imaging. Integration of chamber views across the spectrum of imaging modalities (i.e., multislice computed tomography, fluoroscopy, and echocardiography) can facilitate transcatheter interventions on the right heart. Optimal fluoroscopic viewing angles for guiding interventional procedures can be obtained using pre-procedural multislice computed tomography scans. The present paper describes fluoroscopic viewing angles necessary to appreciate right-heart chamber anatomy and their relationship to echocardiography using multislice computed tomography. (c) 2018 by the American College of Cardiology Foundation

Repeat Transcatheter Aortic Valve Replacement for Transcatheter Prosthesis Dysfunction.

BACKGROUND Transcatheter aortic valve replacement (TAVR) use is increasing in patients with longer life expectancy, yet robust data on the durability of transcatheter heart valves (THVs) are limited. Redo-TAVR may play a key strategy in treating patients in whom THVs fail. OBJECTIVES The authors sought to examine outcomes following redo-TAVR. METHODS The Redo-TAVR registry collected data on consecutive patients who underwent redo-TAVR at 37 centers. Patients were classified as probable TAVR failure or probable THV failure if they presented within or beyond 1 year of their index TAVR, respectively. RESULTS Among 63,876 TAVR procedures, 212 consecutive redo-TAVR procedures were identified (0.33%): 74 within and 138 beyond 1 year of the initial procedure. For these 2 groups, TAVR-to-redo-TAVR time was 68 (38 to 154) days and 5 (3 to 6) years. The indication for redo-TAVR was THV stenosis in 12 (16.2%) and 51 (37.0%) (p = 0.002) and regurgitation or combined stenosis-regurgitation in 62 (83.8%) and 86 (62.3%) (p = 0.028), respectively. Device success using VARC-2 criteria was achieved in 180 patients (85.1%); most failures were attributable to high residual gradients (14.1%) or regurgitation (8.9%). At 30-day and 1-year follow-up, residual gradients were 12.6 ± 7.5 mm Hg and 12.9 ± 9.0 mm Hg; valve area 1.63 ± 0.61 cm2 and 1.51 ± 0.57 cm2; and regurgitation ≤mild in 91% and 91%, respectively. Peri-procedural complication rates were low (3 stroke [1.4%], 7 valve malposition [3.3%], 2 coronary obstruction [0.9%], 20 new permanent pacemaker [9.6%], no mortality), and symptomatic improvement was substantial. Survival at 30 days was 94.6% and 98.5% (p = 0.101) and 83.6% and 88.3% (p = 0.335) at 1 year for patients presenting with early and late valve dysfunction, respectively. CONCLUSIONS Redo-TAVR is a relatively safe and effective option for selected patients with valve dysfunction after TAVR. These results are important for applicability of TAVR in patients with long life expectancy in whom THV durability may be a concern