Medication errors in hospitals in the Middle East: a systematic review of prevalence, nature, severity and contributory factors

The aim was to critically appraise, synthesise and present the evidence of medication errors amongst hospitalised patients in Middle Eastern countries, specifically prevalence, nature, severity and contributory factors. CINAHL, Embase, Medline, Pubmed and Science Direct were searched for studies published in English from 2000 to March 2018, with no exclusions. Study selection, quality assessment (using adapted STROBE checklists) and data extraction were conducted independently by two reviewers. A narrative approach to data synthesis was adopted; data related to error causation were synthesised according to Reason’s Accident Causation model. Searching yielded 452 articles, which were reduced to 50 following removal of duplicates and screening of titles, abstracts and full-papers. Studies were largely from Iran, Saudi Arabia, Egypt and Jordan. Thirty-two studies quantified errors; definitions of ‘medication error’ were inconsistent as were approaches to data collection, severity assessment, outcome measures and analysis. Of 13 studies reporting medication errors per ‘total number of medication orders’/ ‘number of prescriptions’, the median across all studies was 10% (IQR 2–35). Twenty-four studies reported contributory factors leading to errors. Synthesis according to Reason’s model identified the most common being active failures, largely slips (10 studies); lapses (9) and mistakes (12); error-provoking conditions, particularly lack of knowledge (13) and insufficient staffing levels (13) and latent conditions, commonly heavy workload (9). There is a need to improve the quality and reporting of studies from Middle Eastern countries. A standardised approach to quantifying medication errors’ prevalence, severity, outcomes and contributory factors is warranted.Other Information Published in: European Journal of Clinical Pharmacology License: https://creativecommons.org/licenses/by/4.0See article on publisher's website: http://dx.doi.org/10.1007/s00228-019-02689-y</p

Cost-Effectiveness of Fetal Fibronectin Testing to Predict Preterm Birth in Pregnant Women with Symptoms of Premature Labour

Objective To evaluate the cost-effectiveness of fetal fibronectin (fFN) versus no-fFN testing to detect true preterm labor in qualifying women with preterm labor symptoms at risk for preterm birth. Design Retrospective cost-effectiveness analysis. Method Retrospective cost-effectiveness analysis of fFN versus no-fFN testing to detect preterm labor at Women's Wellness and Research Center (WWRC), Qatar, was conducted. Clinical data of pregnant women were obtained from Cerner medical records from 2017-2022, whereas cost data were obtained from the pharmacy as well as finance and costing departments of HMC. The model included direct medical costs; thus, the perspective of HMC was adopted. Included resources were (i) fFN testing use, (ii) medications use (i.e. tocolytic, steroid), (iii) diagnostics and laboratory tests received during hospitalization (iv) management of adverse drug events, and (v) hospital stay excluding other resource costs. A decision analytic model was constructed to follow possible consequences of fFN or no-fFN testing. Primary end points were the success rate in prolonging delivery, defined as delivery at 48 hours following receiving one cycle of atosiban and antenatal corticosteroids from initial presentation to the emergency department as well as overall direct medical cost of management. Study population of 200 pregnant women between 24-34 weeks of gestational age at risk for preterm birth was used. Sensitivity analysis was conducted to enhance robustness of conclusions against input uncertainties and to increase generalizability of results. Results Our preliminary data showed that hundred women were available for inclusion in each study group. The fFN group had 12% success rate in prolonging delivery at 48 hours following receiving one cycle of atosiban and antenatal corticosteroids compared to 5% with no-fFN group, [risk ratio (RR)= 0.93; 95% CI, 0.85 to 1.01; P = 0.08]. fFN testing was estimated to dominate the no-fFN testing group, at a cost saving of QAR 236,702 (US$64,850), with total healthcare costs of QAR 171,623 (US$ 47,020) versus QAR 408,325 (US$ 111,870), respectively. Sensitivity analysis confirmed robustness of conclusions. Conclusions To the best of our knowledge, this is the first cost-effectiveness evaluation in the literature that provides new insights into the benefits of fFN versus no-fFN testing to detect preterm labor in women between 24-34 weeks of gestational age with preterm labor symptoms at risk for preterm birth. The fFN testing might be associated with prolonging delivery at 48 hours at a considerably lower cost. The study findings support recent trends in favor of fFN use.</p

Cost-Benefit Analysis of Antimicrobial Stewardship Program in Women’s Health at Hamad Medical Corporation in Qatar

Background It is estimated that half of all antimicrobial agents prescribed are either unnecessary or inappropriately used In Qatar, a survey revealed that approximately 82% of people used antibiotics without a prescription, and 45% did not complete their antibiotic courses It is undisputed that the emergence of antimicrobial resistance is detrimental to not only health and wellbeing but also the healthcare system There is a lack of solid evidence to adequately inform decision makers seeking optimal allocation of resources in relation to antimicrobial stewardship programs (ASPs) Objective To estimate the economic impact of premature ASP use versus mature ASP use in the women’s health settings in Qatar Methods The study is a retrospective review of the patients who received any of the targeted antimicrobials by the HMC’s ASP during two time periods; premature ASP use versus mature ASP use Period one was defined as the 12 months immediately upon ASP implementation (May 1, 2015-April 30, 2016), and period two was defined as a recent 12 months of ASP implementation (February 1, 2019- January 31, 2020) • The study was conducted in the women’s health wards in HMC The targeted antimicrobial use in this study is based on that performed in cohort of patients admitted to the inpatient wards of women wards during the study follow-up durations Sample size was planned based on the premature ASP use within 1-year duration (i.e. May 1, 2015 to April 30, 2016) versus mature ASP use within 1-year duration (i.e. February 1, 2019 to January 31, 2020) The overall economic benefit of the ASP maturity was calculated as the sum of the cost savings and the cost avoidance, associated with the service, minus the operational cost of the service Sensitivity analyses (SA) were conducted to enhance the robustness of the study conclusion and the generalizability of study findings Results The total cost saving due to reduction in DDDs and resources with ASP maturity is QAR 26,163 The cost avoided was QAR 103,874 in favor of the mature period The reduction in total operational cost was QAR12,477 in favor of the mature period Sensitivity analyses were insensitive to majority of input uncertainties (Figures 1 and 2) The main contributing factor was cost of hospitalization Conclusions This study demonstrates that ASP maturity may offset or reduce costs to QAR 26,163 by minimizing antimicrobials consumption and resource utilization </ul

Maternal and Neonatal Outcomes Post Bariatric Surgery: A Population-Based Study

Objectives  This study had two primary objectives. First, to evaluate the incidence, risk factors, and maternal and neonatal outcomes among pregnant women post-BS (the exposed group). Second, to evaluate these outcomes among pregnant women without a history of BS, these include women who are obese, overweight, and with normal weight (non-exposed groups). Design This population-based study was conducted using 12-month retrospective registry data from the PEARL-Peristat Study at the Women's Wellness and Research Center (WWRC) in Qatar. Methods: We examined 6,212 parturient women and their offspring. Participants were classified into exposed (post-BS) (N=315) and non-exposed (N=5897). Statistical analysis was conducted using SPSS 28 software. We analyzed the risk factors and outcomes using univariate and multivariable regression. Results were reported as odds ratios (cOR) and adjusted aOR with 95% confidence intervals (CI), while incidences were reported as percentages. P value was regarded as significant at Results Qatari, advanced maternal age, Parity >1, diabetes, and hypertension were found to be significant risk factors for women with post-BS. In addition, women in the post-BS group were found to be significantly more likely to have a cesarean delivery (37.5% vs. 24%, aOR=1.59, CI 1.18-2.14), preterm babies (10% vs. 7%, aOR=1.66, CI 1.06-2.59), and stillbirth (1.6% vs. 0.4%, aOR=4.53, CI 1.33-15.50) compared to the normal weight women group. Moreover, post-BS women had a higher risk of low-birth-weight neonates than obese (15% vs. 8%, aOR= 1.77, CI 1.153-2.73), overweight (15% vs. 7%, aOR=1.63, CI:1.09-2.43), and normal weight (15% vs. 8%, aOR=1.838, CI 1.23-2.75) women. Finally, women in the post-BS group were more likely to have low-birth weight neonates ( In contrast, post-BS had a lower risk of gestational diabetes than obese (19% vs. 40%, aOR=0.39, CI: 0.29-0.54) overweight (19% vs. 32%, aOR= 0.57, CI 0.42-0.79) women. Similarly, compared to the overweight group, post-BS had a lower incidence and risk of assisted birth (4% vs. 9%, aOR=0.46, CI 0.21-0.99). On the other hand, obesity significantly increased the risk of gestational diabetes, cesarean deliveries, and labor induction in comparison to the other groups. Conclusion  Pregnancies with post-BS should be considered a high-risk group for some outcomes and should be monitored closely. These findings may guide the future clinical decisions of antenatal and postnatal follow-up for post-BS women. </p