Community Pharmacists’ knowledge and practice towards antibiotic resistance in Kuwait

© Taqi et al (2020). Pblished by University of Huddersfield Press. This is an Open Access article. https://creativecommons.org/licenses/by/4.0/.The misuse of antibiotics is a factor contributing to the rise of resistance particularly in countries where there is a lack of procedures for restricting and auditing antibiotic prescriptions. There is very limited data from Kuwait exploring the community pharmacists’ role towards reducing antibiotic misuse and resistance and so the aim of this study is to assess community pharmacists’ knowledge and practice towards antibiotic resistance in Kuwait. A cross sectional study was conducted among the primary care centers’ pharmacists in Al-Asema and Hawally districts in Kuwait between June-July 2018, using a self-administered online questionnaire. Out of 274, 156 pharmacists completed the questionnaire. A total of 148 pharmacists (95%) strongly agreed/agreed that antibiotics can cause allergic reaction. Moreover, results showed that a significant proportion of the participants (n= 42, 27.6%) never take part in antimicrobial awareness campaigns to promote the optimal use of antibiotics. Pharmacists in primary care settings in Kuwait have excellent knowledge and good practice toward antibiotics resistance. These findings will aid in encouraging collaborative work between pharmacists and other health care professional to limit antibiotic resistance in Kuwait and provide further insight in designing future interventions to reduce antibiotic resistance in Kuwait.Peer reviewedFinal Published versio

Factors contributing towards women booking late for antenatal care in the UK

Background: In order to improve outcomes for mothers and babies, and to fully utilise the antenatal screening programmes in the UK, women are advised to access antenatal care prior to 10 weeks gestation. This study aims to identify reasons as to why women may book late for antenatal care. Methods: A structured systematic literature search was undertaken using a PICO framework to identify research papers that focused upon barriers leading to late booking for antenatal care in the UK. Inclusion criteria were articles published in English between January 2001 and October 2020. Electronic databases (PubMed, CINAHL, Cochrane, NICE, internurse, Google Scholar, Scopus, ScienceDirect and OpenGrey) were searched using a combination of terms such as ‘antenatal’, ‘late booking’, ‘barriers’ and ‘UK’. Articles were critically assessed for inclusion and 10% of these were then independently screened by a second reviewer to ensure validity; Thematic analysis was then undertaken to identify the most commonly occurring themes. Ethical approval: Ethical approval was not required as all literature utilised was available in the public domain. Findings: The database search identified 1964 papers published between 2001– 2020. After removing duplicates, 1642 were of potential interest. Following screening of the title and abstract, 1624 were excluded because of lack of specificity to the study criteria. The full texts of 18 papers were assessed and a further 6 excluded, resulting in 12 papers for critical review. From these 12 papers with10 common themes were identified. These were Social/Lifestyle factors, Ethnicity, Awareness/acceptance of pregnancy, Unaware of importance/need to book early, Language barriers and Previous antenatal care experience. Other issues such as Maternal age, Religious/cultural beliefs, Service provider issues and Multiparity were also identified. Discussion and conclusions: Factors leading to late booking were complex, with many of the themes being intrinsically linked. Difficult social circumstances, lack of support, judgement by care providers and language barriers were strongly associated with women not being able to, or not choosing to, access care. Improved accessibility to services, provision of childcare, the use of interpreters and community engagement projects are recommended to improve early access to antenatal care

Barriers to implementing antimicrobial stewardship programmes in three Saudi hospitals: Evidence from a qualitative study

© 2019 International Society for Chemotherapy of Infection and Cancer Objectives: This study explored antimicrobial stewardship programme (ASP) team members’ perspectives regarding factors influencing the adoption and implementation of these programmes in Saudi hospitals. Methods: This was a qualitative study based on face-to-face semistructured interviews with healthcare professionals involved in ASPs and activities across three Ministry of Health (MoH) hospitals in Saudi Arabia (n = 18). Interviews were also conducted with two representatives of a General Directorate of Health Affairs in a Saudi region and two representatives of the Saudi MoH (n = 4) between January–February 2017. Results: Despite the existence of a national strategy to implement ASPs in Saudi MoH hospitals, their adoption and implementation remains low. Hospitals have their own antimicrobial stewardship policies, but adherence to these is poor. ASP team members highlight that lack of enforcement of policies and guidelines from the MoH and hospital administration is a significant barrier to ASP adoption and implementation. Other barriers include disintegration of teams, poor communication, lack of recruitment/shortage of ASP team members, lack of education and training, and lack of health information technology (IT). Physicians’ fears and concerns in relation to liability are also a barrier to their adoption of ASPs. Conclusion: This is the first qualitative study exploring barriers to ASP adoption and implementation in Saudi hospitals from the perspective of ASP team members. Formal endorsement of ASPs from the MoH as well as hospital enforcement of policies and provision of human and health IT resources would improve the adoption and implementation of ASPs in Saudi hospitals

Perceptions regarding antimicrobial use and resistance among adult hospital patients in Saudi Arabian Ministry of Health (MOH) Hospitals

Background: Education, a key strategy within antimicrobial stewardship programmes (ASPs), has been mainly directed towards healthcare professionals and prescribers more than hospitalised patients. Aim: To examine patients' knowledge and perceptions of antibiotic use and resistance, while evaluating the institutional role of patient education on antibiotic use in two Saudi Arabian hospitals, one with an implemented ASP and one without an ASP. Method: A cross-sectional self-administered survey was developed and piloted. A total of 400 surveys were distributed , 200 within the hospital with an ASP and another 200 within the hospital without an ASP. Data were coded and analysed. Ethical approval was obtained before the start of the study. Findings: 176 patients responded to the survey with 150 surveys completed and analysed. 78% of patients agreed that they should only take an antibiotic when prescribed by the doctor, however they still tended to keep left over antibiotics for future use. 84% of patients were unaware 'antibiotic resistance', with 48% believing that antibiotics help them get better quicker when they had a 'cold'. Information on antibiotic use and resistance were provided to patients in the hospital with an ASP in contrast to the hospital without an ASP. Conclusion: Overall there are poor perceptions regarding antibiotic use and resistance among hospital patients in Saudi Arabia. Patients in the hospital with ASP demonstrated greater knowledge during their hospitalisation. ASPs should not only focus on educating healthcare professionals but should involve the patients and seize the opportunity to educate them while hospitalised

Systematic review of the safety of medication use in inpatient, outpatient and primary care settings in the Gulf Cooperation Council countries

Background Errors in medication use are a patient safety concern globally, with different regions reporting differing error rates, causes of errors and proposed solutions. The objectives of this review were to identify, summarise, review and evaluate published studies on medication errors, drug related problems and adverse drug events in the Gulf Cooperation Council (GCC) countries. Methods A systematic review was carried out using six databases, searching for literature published between January 1990 and August 2016. Research articles focussing on medication errors, drug related problems or adverse drug events within different healthcare settings in the GCC were included. Results Of 2094 records screened, 54 studies met our inclusion criteria. Kuwait was the only GCC country with no studies included. Prescribing errors were reported to be as high as 91% of a sample of primary care prescriptions analysed in one study. Of drug-related admissions evaluated in the emergency department the most common reason was patient non-compliance. In the inpatient care setting, a study of review of patient charts and medication orders identified prescribing errors in 7% of medication orders, another reported prescribing errors present in 56% of medication orders. The majority of drug related problems identified in inpatient paediatric wards were judged to be preventable. Adverse drug events were reported to occur in 8.5–16.9 per 100 admissions with up to 30% judged preventable, with occurrence being highest in the intensive care unit. Dosing errors were common in inpatient, outpatient and primary care settings. Omission of the administered dose as well as omission of prescribed medication at medication reconciliation were common. Studies of pharmacists’ interventions in clinical practice reported a varying level of acceptance, ranging from 53% to 98% of pharmacists’ recommendations. Conclusions Studies of medication errors, drug related problems and adverse drug events are increasing in the GCC. However, variation in methods, definitions and denominators preclude calculation of an overall error rate. Research with more robust methodologies and longer follow up periods is now required.Peer reviewe

Promoting patient safety using Failure Mode and Effect Analysis (FMEA)

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Is failure mode and effect analysis reliable?

To test the reliability of failure mode and effect analysis (FMEA) within a hospital setting in the United Kingdom.Peer reviewe

Failure mode and effects analysis too little for too much?

Failure mode and effects analysis (FMEA) is a structured prospective risk assessment method that is widely used within healthcare. FMEA involves a multidisciplinary team mapping out a high-risk process of care, identifying the failures that can occur, and then characterising each of these in terms of probability of occurrence, severity of effects and detectability, to give a risk priority number used to identify failures most in need of attention. One might assume that such a widely used tool would have an established evidence base. This paper considers whether or not this is the case, examining the evidence for the reliability and validity of its outputs, the mathematical principles behind the calculation of a risk prioirty number, and variation in how it is used in practice. We also consider the likely advantages of this approach, together with the disadvantages in terms of the healthcare professionals' time involved. We conclude that although FMEA is popular and many published studies have reported its use within healthcare, there is little evidence to support its use for the quantitative prioritisation of process failures. It lacks both reliability and validity, and is very time consuming. We would not recommend its use as a quantitative technique to prioritise, promote or study patient safety interventions. However, the stage of FMEA involving multidisciplinary mapping process seems valuable and work is now needed to identify the best way of converting this into plans for action.Peer reviewe

Flipped classrooms in pharmacy education: A systematic review

© 2023 The Author(s). Published by Elsevier B.V. on behalf of King Saud University. This is an open access article under the Creative Commons Attribution-NonCommercial-NoDerivatives CC BY-NC-ND licence, https://creativecommons.org/licenses/by-nc-nd/4.0/Background In recent years, flipped classrooms (FCs) have gained popularity in higher education, particularly among healthcare students. The FC model is a blended learning approach that combines online learning with in-class activity. This has prompted many instructors to assess how they teach and prepare successful graduate students for today's society. Additionally, colleges and universities have been challenged to deliver curricula that are relevant to the needs of students and to provide the rising skills and knowledge that are expected to be acquired by students. Objective This systematic review aims to evaluate the flipped classroom teaching approach in pharmacy education and to provide a summary of the guidance for the introduction and implementation of the flipped classroom model in pharmacy educational programs. Method This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Eight databases were cross-screened by four reviewers, following key terms and predefined inclusion and exclusion criteria. A form was developed to extract relevant data from the reviewers. Qualitative data within the studies reporting students’ and educators’ perceptions and views on the FC model were also analyzed using a thematic analysis. Studies were appraised using the Medical Education Research Quality Instrument (MERSQI) and the Joanna Briggs Institute (JBI) checklist for qualitative research. Results The reviewers screened 330 articles, of which 35 were included in the review. The themes identified were implementation, academic performance outcomes, student satisfaction with the flipped classroom model, and long-term knowledge retention. Most studies (68%) have found that flipped learning enhances students’ success and exam performance. Six (27%) studies reported no statistically significant difference in academic performance. However, two studies reported lower long-term knowledge retention in FC learning than in lecture-based learning. The students’ perceptions of the FC approach were assessed in 26 studies, and the majority reported positive feedback. However, some students found the pre-class homework difficult to complete before class, and some expressed dissatisfaction with the inconsistent grading and unclear assessment questions in the FC model. Overall, the FC model was found to enhance the students’ critical thinking and communication skills, self-confidence, and time management. Conclusions The findings of this review indicate that pharmacy students generally found the flipped classroom model preferable to traditional lectures. However, this preference is conditional on the effective implementation of this approach and alignment within the core instructional elements. The issue of increased workload for students associated with self-directed pre-class learning may present a challenge.Peer reviewe

Prescribing errors in hospital inpatients : a three-centre study of their prevalence, types and causes

To compare the prevalence and causes of prescribing errors in newly written medication orders and how quickly they were rectified, in three NHS organisations.Peer reviewe