Exploring medication error causality and reporting in the Middle East.

The "Medication Without Harm, WHO Global Patient Safety Challenge", published by the World Health Organization in 2017, calls for action to reduce patient harm as a result of unsafe medication practices and medication errors. Medication error-related research conducted within the Middle East has been noted to be of poor quality. The aim of this thesis was to investigate issues relating to medication error causality and suboptimal reporting of medication errors, with the intention of contributing to the development of theory-informed interventions. The first phase was a PROSPERO-registered systematic review, which aimed to critically appraise, synthesise and present the available evidence around the incidence/prevalence, nature and causes of medication errors among hospitalised patients in Middle Eastern countries. Findings indicated the lack of robust and rigorous research, both generally and also specifically in Qatar. There was a clear need for theory-informed primary research. The second phase collated data recorded in medication error reports submitted within Hamad Medical Corporation (HMC), Qatar. The estimated incidence of medication errors in HMC (as derived from medication error reports) was 0.44 per 1,000 medication orders, which is lower than previous studies published in the region and elsewhere. According to Reason's Accident Causality Model, the vast majority were considered as active failures (i.e. slips, lapses, mistakes and violations). One further key finding was that the reports featured a lack of details, hence limiting any synthesis and conclusions. Notably, behaviour change theories could not be applied and so specific targeted research was warranted. The third phase comprised qualitative focus groups with samples of health professionals in HMC, to explore the perspectives of health professionals on issues of medication error causes, contributory factors and error reporting. The thesis suggests that the following Theoretical Domains Framework (TDF) determinants are potentially associated with these errors: social/professional role and identity; emotions; and environmental context and resources. There was a lack of recognition of nurses' roles and frequent policy non-adherence. Stress was perceived to be a major contributor to errors, as was excessive workload and lack of staff at key times. Discussions on issues of medication error reporting identified a number of facilitators and barriers. The TDF domain of emotions featured heavily, with several key themes emerging as barriers to reporting: fear and worry; concern about an investigation that would likely follow reporting; and concern about the impact on evaluation and appraisal processes. This doctoral research has generated original findings that can be used as part of intervention development, aiming to improve medication safety and optimise medication error reporting systems. Future work should now focus on the feasibility/piloting phase of the Medical Research Council guidelines on complex interventions

Misoprostol for miscarriage management in a woman with previous five cesarean deliveries: a case report and literature review.

Background: Misoprostol is an effective medical method for the management of pregnancy loss. However, data on its efficacy and safety in women with previous cesarean deliveries are limited. Case presentation: We report a 36-year-old patient, gravida 11 para 6, with a diagnosis of missed miscarriage at 15 weeks of gestation. The patient had a significant obstetric history of previous five cesarean deliveries and uterine rupture. Following patient counseling about the medical and surgical options of managing her miscarriage, the patient opted for medical method. Low-dose misoprostol of 100 μg was inserted vaginally and repeated again after 6 hours. The patient had an uneventful complete miscarriage following the second dose of misoprostol. No uterine rupture, no extra vaginal bleeding, and no blood transfusion were observed. Conclusion: We conclude that adopting a low-dose misoprostol protocol could be potentially safe and effective in managing second trimester missed miscarriage in women with repeated cesarean deliveries and/or uterine rupture history. Further studies are needed to confirm these results

Overview of pharmacovigilance practices at the largest academic healthcare system in the State of Qatar.

Adverse Drug Reactions (ADRs) are major global concern, adversely impacting patient safety and health outcomes. ADRs cause significant morbidity and mortality among hospitalised patients, causing greater length of hospital stay, increased healthcare costs and patient dissatisfaction to the treatments. Pharmacovigilance (PV), a process of detecting, monitoring and preventing drug-related harm, plays a vital role to ensure patient safety. ADR reporting is the cornerstone of PV. PV practices in Qatar are relatively new and are evolving rapidly. The purpose of this article is to explore the medication safety practices (notably ADR reporting) at the largest academic healthcare center in Qatar. The article further provides evidence on how information related to ADRs are generated and interpreted. Furthermore, it describes how a designated center for monitoring medication safety activities was established at the largest healthcare provider in Qatar

A retrospective drug use evaluation of cabergoline for lactation inhibition at a tertiary care teaching hospital in Qatar.

Background: Breastfeeding is considered as gold standard for infant nutrition and should be interrupted only when a compelling indication exists. Certain medical conditions such as abortion, stillbirth, HIV infection, or infant galactosemia and certain medications such as chemotherapy necessitate lactation inhibition to protect the health of mother and infant. Drug use evaluation (DUE) studies are done to explore the current practice in a setting and help to identify areas in which further information and education may be needed by clinicians. Objective: The aim of this study was to conduct a DUE of cabergoline to assess indications for lactation inhibition, dosage regimen, and its safety. Method: A retrospective cross-sectional DUE study was conducted over a period of 4 months from September 1, 2013, till December 31, 2013, at the Women's Hospital, Qatar. All cabergoline prescriptions written for lactation inhibition within 10 days of delivery or abortion were included in the study. A descriptive data analysis was undertaken. Results: Of the 85 patients included, stillbirth (50.6%) was considered as the main reason for lactation inhibition, followed by abortion (27.1%) and neonatal death (12.9%). The remaining 9.4% of the patients had live baby, and the majority of them were prescribed cabergoline for lactation inhibition because their maternal medical conditions required the use of drugs with insufficient safety data (n=6). Seventy-four percent of patients received cabergoline at accurate time and dose. However, 14% of the patients had preexisting hypertensive disorder and 58.3% of them were diagnosed as uncontrolled hypertension. Conclusion: The current DUE study found that cabergoline was mainly used to inhibit lactation for patients with stillbirth, abortion, and neonatal death. In mothers who use medications for other medical conditions, benefits and risks of breastfeeding should be carefully balanced before prescribing cabergoline. Current prescribing pattern can be further enhanced through informing health care providers regarding appropriate cabergoline dosage regimen and its safety in patients with uncontrolled hypertension

Safety of levetiracetam in pregnancy and lactation: a systematic review.

Most women with active seizures are often encouraged to continue their antiepileptic medications during pregnancy to avoid serious fetal or maternal complications. Levetiracetam (LEV) is a newer antiepileptic drug used as adjunctive therapy in patients with refractory partial seizures with or without secondary generalization. Because of its broad-spectrum activity, LEV is becoming increasingly used in women with epilepsy of childbearing potential, during pregnancy and thus also during lactation. First generation anti-epileptics are known to cause Major Congenital Malformations (MCM) and developmental problems. However, there is paucity of literature on information regarding safety of Levetiracetam (second generation), use in pregnancy and breastfeeding. The purpose of the present study was to summarize the scientific evidence behind use of LEV during pregnancy and lactation

Knowledge, perception, attitude and experience of pharmacist in Qatar towards drug use in pregnancy: a cross-sectional study.

Pregnancy is a state of altered physiology and medication use during this period is remarkably challenging. Pharmacists are medication experts with great knowledge of pharmacology, pharmacokinetics and are trained to apply evidence based clinical knowledge. In a study done in the USA Mitchell et al found that use of medications, either prescribed or purchased over the counter (OTC), occurred in 88.8% of all pregnancies. Whereas, in Europe, prevalence estimates of prescribed medication use vary considerably across countries, ranging from 26% in Serbia to 93% in France. Given their central role to provide medication related advice to patients we conducted a questionnaire based survey to identify the knowledge, attitude, perception and experience of pharmacist in Qatar towards drug use in pregnancy

Incidence, nature and causes of medication errors in hospitalised patients in Middle Eastern countries: a systematic review protocol.

The review will consider studies, which focus on errors in hospitalised patients (of any age or speciality) in any of the countries of the Middle East. Studies of hospital practitioners (or other key stakeholders) which capture data on causes of errors will also be included. Quantitative outcomes are related to each of the review questions as follows: the incidence of medication errors and incidence of classifications of prescribing, administration and dispensing errors; the nature (e.g. classification, severity, patient outcomes) of errors; causes and contributory factors leading to errors

A case of probable esomeprazole-induced transient liver injury in a pregnant woman with hyperemesis.

We report a case of 22-year-old primigravida presented to Women's Hospital - Hamad Medical Corporation emergency with severe epigastric pain, nausea, and vomiting. On admission, she was dehydrated with remarkably worsening symptoms. Laboratory findings revealed significantly elevated liver enzymes with unknown etiology. Her past medical history showed an admission for nausea and vomiting 3 weeks previously and she was discharged on antiemetics, and esomeprazole for the first time. Due to the predominantly elevated liver enzymes, the clinical pharmacist discussed the possibility of esomeprazole-induced adverse effects and suggested to suspend esomeprazole based on the evidence from literature review. The liver enzymes showed a substantial improvement within days after the discontinuation of the drug; however, a rechallenge was not done since it could have adversely affected the mother or the fetus. Using the Naranjo Adverse Drug Reaction Probability scales, the adverse reaction due to esomeprazole was classified as 'probably'

Maternal and perinatal outcomes and pharmacological management of Covid-19 infection in pregnancy: a systematic review protocol

Over 4.2 million confirmed cases and more than 285,000 deaths, COVID-19 pandemic continues to harm significant number of people worldwide. Several studies have reported the impact of COVID-19 in general population; however, there is scarcity of information related to pharmacological management and maternal and perinatal outcomes during the pandemic. Altered physiological, anatomical, and immunological response during pregnancy makes it more susceptible to infections. Furthermore, during pregnancy, a woman undergoes multiple interactions with the health care system that increases her chance of getting infected; therefore, managing pregnant population presents a unique challenge. This systematic review seeks to answer the following questions in relation to COVID-19: What are the different clinical characteristics presented in maternal and perinatal population? What are the different maternal and perinatal outcome measures reported? What are the distinct therapeutic interventions reported to treat COVID-19? Is it safe to use "medications" used in the treatment of COVID-19 during antenatal, perinatal, postnatal, and breastfeeding? The search will follow a comprehensive, sequential three step search strategy. Several databases relevant to COVID-19 and its impact on pregnancy including Medline, CINAHL, and LitCovid will be searched from the inception of the disease until the completion of data collection. The quality of this search strategy will be assessed using Peer Review of Electronic Search Strategies Evidence-Based Checklist (PRESS EBC). An eligibility form will be developed for a transparent screening and inclusion/exclusion of studies. All studies will be sent to RefWorks, and abstraction will be independently performed by two researchers. Risk of bias will be assessed using Cochrane Risk of Bias tool for randomized controlled trials, Newcastle-Ottawa Quality Assessment Scale for non-randomized studies, and for case reports, Murad et al. tool will be used. Decision to conduct meta-analysis will be based on several factors including homogeneity and outcome measures reported; otherwise, a narrative synthesis will be deemed appropriate. This systematic review will summarize the existing data on effect of COVID-19 on maternal and perinatal population. Furthermore, to the best of our knowledge, this is the first systematic review addressing therapeutic management and safety of medicines to treat COVID-19 during pregnancy and breastfeeding. This systematic review has been registered and published with Prospero ( CRD42020172773 )

Perspectives of healthcare professionals in Qatar on causes of medication errors : A mixed methods study of safety culture

This publication was made possible by NPRP grant NPRP 7-388-3-095 from Qatar National Research Fund (a member of Qatar Foundation). The statements made herein are solely the responsibility of the authors.Peer reviewedPublisher PD