Medication errors in community pharmacies: Evaluation of a standardized safety program

Background: The mandated reporting of medication-related errors in community pharmacies including incidents resulting in inappropriate medication use and near misses intercepted before reaching the patient can be utilized as learning opportunities to aid in the prevention of future events. Objectives: To examine reporting uptake, trends, and initial learnings from medication errors reported by community pharmacists to the Assurance and Improvement in Medication Safety (AIMS) Program based in Ontario, Canada between April 1st, 2018, and June 30th, 2021. Methods: A descriptive analysis was conducted of all events reported to the AIMS Program during the study period. The web-based reporting form includes a series of mandatory and optional fields completed by the reporter. Individual medications were grouped into broader classes prior to conducting the analysis. Results: Among the 31,768 event reports received from 2856 community pharmacies, there were 19,639 incidents and 12,129 near misses. Low reporting followed by a rapid increase was observed during expansion of the AIMS Program in 2018, with almost 60% of Ontario community pharmacies submitting at least 1 event over the study period. In most cases (90.5%), no patient harm was reported. The most frequent event types involved the incorrect drug (19.5%), concentration (17.2%) or quantity (14.5%). Approximately 25% of events were identified by the involved patient or their agent. When looking at medication classes, antihypertensives, opioids and antidepressants were involved in over one-quarter of overall and higher severity events. Environmental staffing problems and interruptions were the contributory factor and sub-factor most frequently reported, respectively. Conclusions: This study provides insights into engagement with the AIMS Program by Ontario community pharmacy teams since implementation in 2018. The identification of the circumstances and medications associated with both incidents and near misses, aids in the continued development of strategies and processes to help prevent future events

Expression of complement components, receptors and regulators by human dendritic cells

Integration of innate and adaptive arms of the immune response at a cellular and molecular level appears to be fundamental to the development of powerful effector functions in host defence and aberrant immune responses. Here we provide evidence that the functions of human complement activation and antigen presentation converge on dendritic cells (DCs). We show that several subsets of human DCs [i.e., monocyte derived (CD1a+CD14−), dermal (CD1a+DC-SIGN+), Langerhans (CD1a+Langerin+), myeloid (CD1c+CD19−), plamacytoid (CD45RA+CD123+)] express many of the components of the classical and alternative and terminal pathways of complement. Moreover human DCs have receptors known to detect the biologically active peptides C3a and C5a (C3aR, C5aR) and the covalently bound fragments C3b and metabolites iC3b and C3d which serve in immune adhesion (i.e., CR3, CR4, CRIg). We also show that the human DC surface is characterised by membrane bound regulators of complement activation, which are also known to participate in intracellular signalling (i.e., CD46, CD55, CD59). This work provides an extensive description of complement components relevant to the integrated actions of complement and DC, illuminated by animal studies. It acts as a resource that allows further understanding and exploitation of role of complement in human health and immune mediated diseases