A STUDY OF MEDICATION ERRORS IN GENERAL MEDICINE WARDS OF THE SOUTH INDIAN TERTIARY CARE HOSPITAL

ABSTRACTObjective: To identify and evaluate medication errors, opportunities like medication documentation errors and possible drug-drug interactions by aclinical pharmacist, in general, medicine wards of the South-Indian tertiary care hospital.Methods: A study was conducted for a period of 6-month. The data were collected by chart review method from the inpatient records from the dayof admission to the day of discharge. If medication error or any opportunity to cause error was observed, it was documented and clinical pharmacistinterventions were done. The parameters, such as medication error rate, types of errors, opportunities of errors, and outcome of errors, wereevaluated.Results: A total of 32 medication errors were reported in 497 patients and the medication error rate was 6.4%. Administration errors (28; 87.5%)were found to be higher than prescription errors (4; 12.5%). Omission error was the most common (12; 42.9%) administration error. Factors whichincrease the risk of medication errors such as medication documentation errors were found in 316 (63.6%) medication orders and 203 (40.8%) had574 possible drug-drug interactions of which the majority (65.2%) of the interactions were of moderate severity. The outcome of error was found tobe error, no harm category for the majority (90.6%) of errors. 32 pharmacist interventions were done and 29 (90.6%) were accepted by health-careprofessionals.Conclusion: A medication error reporting is a new and evolving concept in Indian hospitals. This study highlights the role of a clinical pharmacist indetection, evaluation, and prevention of medication errors in an Indian hospital.Keywords: Medication error, Hospital, Medication error outcome, Clinical pharmacists' intervention, Documentation errors

Potential Drug Interactions at One Indian Teaching Hospital.

BackgroundThe potential drug-drug interaction (pDDI) increases as the number of concomitant medications increases. Patients with cardiovascular disorders are at higher risk for drug-drug interactions because of the types and number of drugs they receive. While drug interactions are reported to be common, there is no published report of the prevalence of such interactions among Indian cardiac patients.  The aim of the present study was to identify the pattern of pDDI and document any observed interaction. It was also planned to evaluate the demography of patients and correlate it with the drug-drug interactions.Method  A prospective observational study from Oct 2007 to Apr 2008 was carried out in ‘cardiology department’ of a hospital in South India. Those patients who were taking at least two drugs and had a hospital stay of at least 48 hours were included in the study. The medications of the patients were analyzed for possible interactions. Factors associated with pDDI were studied. The actual interactions that were observed during the hospital stay in the study subjects were documented.ResultsA total of 812 patients were included in the study. 388 pDDIs were identified among 249 patients. The incidence of pDDI was 30.67%. The most common potential interactions were between aspirin & heparin (29.38%), and clopidogrel & heparin (7.21%). Drug class most commonly involved were antiplatelets, anticoagulants and diuretics. Majority of interactions were of moderate severity, delayed onset, and pharmacodynamic in nature. 68 actual interactions were observed in the observed cases.ConclusionThe present study identified pDDIs and also documented interactions in cardiovascular patients. Factors which had correlation with adverse drug interactions were identified. This study highlights the need for screening prescriptions of cardiovascular patients for pDDIs and proactive monitoring of patients who have identified risk factors; this helps in detection and prevention of possible adverse drug interactions.

Perspectives of patients and healthcare professionals on metabolic monitoring of adult prescribed second-generation antipsychotics for severe mental illness: A meta-synthesis

Objectives We conducted a meta-synthesis of qualitative studies to synthesize the views of psychiatric patients on second-generation antipsychotics (SGAs) and the healthcare providers about the metabolic monitoring of adult-prescribed SGAs. Methods A systematic search was conducted in four databases through SCOPUS, PubMed, EMBASE, and CINAHL to identify qualitative studies of patients’ and healthcare professionals’ perspectives on the metabolic monitoring of SGAs. Initially, titles and abstracts were screened to exclude articles that were not relevant followed by full-text reading. Study quality was assessed by using Critical Appraisal Skills Program (CASP) criteria. Themes were synthesized and presented as per the Interpretive data synthesis process (Evans D, 2002). Results A total of 15 studies met the inclusion criteria and were analyzed in meta-synthesis. Four themes were identified: 1. Barriers to metabolic monitoring; 2. Patient related concerns to metabolic monitoring; 3. Support system by mental health services to promote metabolic monitoring; and 4. Integrating physical health with mental health services. From the participants’ perspectives, barriers to metabolic monitoring were accessibility of services, lack of education and awareness, time/resource constraints, financial hardship, lack of interest on metabolic monitoring, patient capacity and motivation to maintain physical health and role confusion and impact on communication. Education and training on monitoring practices as well as integrated mental health services for metabolic monitoring to promote quality and safe use of SGAs are the most likely approaches to promote adherence to best practices and minimize treatment-related metabolic syndrome in this highly vulnerable cohort. Conclusion This meta-synthesis highlights key barriers from the perspectives of patients and healthcare professionals regarding the metabolic monitoring of SGAs. These barriers and suggested remedial strategies are important to pilot in the clinical setting and to assess the impact of the implementation of such strategies as a component of pharmacovigilance to promote the quality use of SGAs as well as to prevent and/or manage SGAs-induced metabolic syndrome in severe and complex mental health disorders

Perspectives of patients and healthcare professionals on metabolic monitoring of adult prescribed second-generation antipsychotics for severe mental illness: A meta-synthesis.

ObjectivesWe conducted a meta-synthesis of qualitative studies to synthesize the views of psychiatric patients on second-generation antipsychotics (SGAs) and the healthcare providers about the metabolic monitoring of adult-prescribed SGAs.MethodsA systematic search was conducted in four databases through SCOPUS, PubMed, EMBASE, and CINAHL to identify qualitative studies of patients' and healthcare professionals' perspectives on the metabolic monitoring of SGAs. Initially, titles and abstracts were screened to exclude articles that were not relevant followed by full-text reading. Study quality was assessed by using Critical Appraisal Skills Program (CASP) criteria. Themes were synthesized and presented as per the Interpretive data synthesis process (Evans D, 2002).ResultsA total of 15 studies met the inclusion criteria and were analyzed in meta-synthesis. Four themes were identified: 1. Barriers to metabolic monitoring; 2. Patient related concerns to metabolic monitoring; 3. Support system by mental health services to promote metabolic monitoring; and 4. Integrating physical health with mental health services. From the participants' perspectives, barriers to metabolic monitoring were accessibility of services, lack of education and awareness, time/resource constraints, financial hardship, lack of interest on metabolic monitoring, patient capacity and motivation to maintain physical health and role confusion and impact on communication. Education and training on monitoring practices as well as integrated mental health services for metabolic monitoring to promote quality and safe use of SGAs are the most likely approaches to promote adherence to best practices and minimize treatment-related metabolic syndrome in this highly vulnerable cohort.ConclusionThis meta-synthesis highlights key barriers from the perspectives of patients and healthcare professionals regarding the metabolic monitoring of SGAs. These barriers and suggested remedial strategies are important to pilot in the clinical setting and to assess the impact of the implementation of such strategies as a component of pharmacovigilance to promote the quality use of SGAs as well as to prevent and/or manage SGAs-induced metabolic syndrome in severe and complex mental health disorders

Effectiveness and Safety of Heparinized Saline versus Normal Saline in Maintaining Patency of Peripheral Intravenous Locks in Neonates at a Tertiary Care Hospital

Introduction: Heparinized saline is usually used as a regular flush solution to prevent occlusion of peripheral intravenous locks in neonates but the risks associated with the use of heparin cannot be ignored in these patients. Aim: To assess and compare the efficacy and safety of Heparinized Saline (HS) and Normal Saline (NS) flush solution in neonates. Materials and Methods: A prospective study was conducted for a period of 12 months using 1 unit/ml HS and NS 0.9% solution. The mean number of catheters removed due to nonelective reasons was calculated to evaluate the effectiveness of flushing solutions. To evaluate the safety, the reason for catheter removal was noted and platelet nadir was used to assess the thrombocytopenia. Poisson regression, Pearson Chi-square test and stratified analysis were conducted. Results: Data were analysed from 100 neonates. We found no significant difference between HS and NS flushes in neonates in maintaining the patency of 24 gauge peripheral intravenous locks {rate ratio= 1.12, p-value =0.584}. Gestational age, body weight and site of insertion did not significantly affect the patency. The reasons for removal of catheter were similar in both the groups and majority were due to non-elective reasons. HS group reported more cases of thrombocytopenia that was attributed to sepsis. Conclusion: Standard NS can be considered as an alternative flush in neonates as both the solutions were found to be equally efficacious and safe in our patient group. Factors like gestational age, body weight and site of insertion did not significantly affect the patency