Assessment of prescription and administion errors in medication use process at the University Teaching Hospital in Lusaka, Zambia

Background: Medication errors can occur at any of the five steps of the medication use process: prescribing, transcription, dispensing, administration and monitoring. AIM: This study aimed to ascertain the incidence and types of prescribing and administration errors. METHODS: The study was a prospective cross-sectional study of prescribing and administration errors. Prospective review of treatment charts to detect prescribing errors and prospective observation of nurses preparing and administering drugs to detect administration errors. The study was conducted in the Departments of Internal Medicine, Obstetrics/Gynaecology and Surgery at University Teaching Hospital, Lusaka, Zambia, from December 2013 to March 2014. The study population comprised adult inpatients admitted to the hospital and nurses administering medications to inpatients. The main outcomes of the study were the incidence and types of prescribing and administration errors. RESULTS: A total of 385 patients were studied over 16 weeks. For these Patients, a total of 438 medication orders were written. There were 159 prescribing errors, resulting in an overall prescribing error rate of 36.3%. The most common type of prescribing errors were improper frequency (7.3%), medication omission (5.0%), improper dose (4.8%) and omitted duration (4.6%). 197 administration errors were identified out of the same 438 written medication orders, giving in an overall administration error rate of 45% . The most common type of administration errors were medication omission (23.1%), wrong time (18.9%) and wrong dose (1.6%) CONCLUSION: Prescribing and medication administration errors are common in adults at UTH and there was variation in the error rates across the departments studied. The severity and causes of prescribing and administration errors need to be investigated so that improvements strategies can be employed

Evaluation of pharmacological prophylaxis for deep venous thrombosis in hospitalized patients with risk factors at the university teaching hospitals, Lusaka, Zambia

Background: Deep venous thrombosis is a common clinical problem accounting for high rates of morbidity and mortality. The existence of risk factors, which include trauma, venous stasis, and hypercoagulability, is linked to the occurrence of the condition. Objective of current study was to evaluate DVT risk factors and prophylaxis pattern of use for patients who were admitted at the University Teaching Hospitals in Lusaka, Zambia.Methods: A cross-sectional study was conducted using medical files for patients who were hospitalized at the University Teaching Hospitals in Lusaka, Zambia from May 2020 to June 2021. Two hundred and ninety-six patient files were reviewed, and the Caprini risk assessment model was used to stratify patients into DVT risk categories. Multilinear regression analysis was used to identify factors associated with DVT prophylaxis.Results: Of the 296 patient files that were sampled from ICU, medical, and surgical wards, 198 (66.9%) (>2 caprini score) were eligible for DVT prophylaxis, but only 77 (38.9%) of these eligible patients received prophylaxis. The number of eligible patients for DVT prophylaxis per department was as follows; ICU 50 (100%), Medical 71 (57.7%) and Surgery 77 (62.6%) wards. However, DVT prophylaxis was given to 21 (42%), 33 (46.5%), and 23 (29.9%) patients from the ICU, medical, and surgery, respectively. Enoxaparin was the most commonly used anticoagulant for Venous thromboembolism (VTE) prophylaxis with a mean dose of 60mg (SD±5). Across all departments, the most common predisposing risk factors for DVT were bed confinement for >72 hours (167, 56.4%) and age of 41-60 years (118, 39.8%). In the adjusted model, swollen legs (AOR: 3.6, CI: 1.97, 6.57) and history of VTE (AOR: 21.3, CI: 9.87, 46.08) were significantly associated with a higher likelihood of DVT prophylaxis.Conclusions: Pharmacologic thromboprophylaxis is underutilized in patients in ICU, medical and surgical wards at the university teaching hospitals in Lusaka, Zambia. This study underscores the importance of implementing a DVT risk assessment technique for patients in ICU, medical and surgical wards and administering prophylaxis unless contraindicated

Effects of medication knowledge on medication adherence among hypertensive patients at Matero level one hospital, Lusaka city, Zambia: a cross sectional study

Background: Medication adherence is the mainstay to good treatment outcomes. Failure to adhere to medication in hypertensive patients may lead to considerable deterioration of the disease resulting in increased costs of healthcare and mortality. Knowledge about the name of the drug, indications and side effects may enhance medication adherence. Therefore, the aim of this study was to assess effects of medication knowledge on medication adherence among hypertensive patients.Methods: This was a cross-sectional study that involved 120 hypertensive patients. A structured questionnaire was used to collect data on demographic characteristics. Adherence was assessed using the 8-item Morisky medication adherence scale while patient’s medication knowledge was assessed using a 7-item scale. Multiple logistic regression was used to assess factors associated with medication adherence.Results: The mean age of participants was 59 years (SD±14.9) and 10 (8.3%), 42 (35%) and 68 (56.7%) had adequate, average and poor medication knowledge respectively. The prevalence of adherence in this study was 37.5%. In multivariable logistic regression analysis, uncontrolled blood pressure (BP) (AOR: 0.38, CI: 0.16-0.90) was associated with lower likelihood of adhering to medication.Conclusions: The adherence level to treatment was low and medication knowledge of hypertensive patients was generally poor. Uncontrolled BP was associated with non-adherence. Patients with uncontrolled hypertension should be given health education and counselling regarding their condition to improve medication adherence.

Knowledge, attitude, and practices on disposal methods of expired and unused medicines among students in public academic institutions in Lusaka, Zambia

Background: Unsafe disposal of unused and expired household medicines is a public health problem and mostly occur because of a lack of knowledge towards suitable medicine disposal methods. Thus, we aimed to assess the knowledge, attitude, and practices on the disposal methods of unused and expired medicines among students in public academic institutions in Lusaka, Zambia.Methods: This was a cross-sectional study in which 385 students from three higher learning academic institutions were interviewed face to face using a structured questionnaire from 10th May to 24th June 2019. The cleaned data was then transferred to statistical package for social science (SPSS) version 25.0 for analysis.Results: The mean age of the participants was 23 (SD±2.9). Out of the 385 participants, 215 (55.8%) did not know much about medical waste and 345 (89.6%) of them did not have any previous information regarding proper and safe disposal of unused and expired medicine. However, 351 (91.4%) of the participants appropriately responded that unsafe disposal of unused and expired medicine poses a threat to human health and can harm the environment. Throwing unused and expired medicine in household garbage/bin was the most frequently used disposal practice followed by flushing them in toilet/sink as responded by 231 (60.0%) and 128 (33.3%) of participants respectively. Only 17 (4.42%) reported returning unused and expired medicines to the nearest pharmacy.  Conclusions: The majority of the study participants used unsafe methods to dispose of unused and expired medicine. However, most of the participants acknowledged that unsafe disposal of unused and expired medicines is a public health problem and proposed the need to introduce drug take-back programs in the communities. 

Medication omissions in the first 48 hours after admission: failure in prescribed medicines reaching in-patients in paediatrics wards at the University Teaching Hospitals, Children’s Hospital in Lusaka, Zambia

Background: The first few days of in-patient care are possibly the most significant in a patient’s recovery and any omitted medications during this period may harm the patient or increase their hospital length of stay. Therefore, our study aimed at assessing the frequency of medication administration omission errors and their reasons for the omission in the paediatric wards after admission at University Teaching Children’s Hospital.Methods: This was a descriptive study in which 259 patient files and drug charts were reviewed. Admission prescription charts were studied in detail over a period of four weeks and all drugs prescribed but then not given in the first 48 hours were recorded as omitted medications, along with the reason given for their omission.Results: From the 259 drug charts, a total of 1598 doses of drugs were ordered within 48 hours of admission. However, from this, only a total of 1132 doses were administered with the remaining 466 doses omitted, which accounted for a frequency of 29.2%. When the frequency of medication omission errors was compared, parenteral drugs (70.8% vs. 25.3%, [p=0.0001]), afternoon shift (48.5% vs. 15.8%, [p=0.0001]), and anti-infective medications (69.1% vs. 39.4%, [p=0.0001]) were found to be the most frequently omitted medications. There were also considerably more medication omissions in patients prescribed with more medications (median number: 4, I QR [2, 6] vs. median number: 2, IQR [2, 4], [p=0. 0.001]). The most common reason for the omission was medication unavailability (89.3%), followed by work overload (71.4%), and the patient is off the ward (71.4%).Conclusions: This study revealed that medication omissions are a continuing problem and this may result in increased morbidity and mortality rates. There is a need to put in place specific strategies to reduce this problem.

Familiarity, Knowledge and Practices of Healthcare Professionals Regarding the Pharmacovigilance of Biological Medicines in Lusaka, Zambia: A Multi-Facility Cross-Sectional Study.

Background: Pharmacovigilance of biological medicines is crucial because it ensures that medicines meet the World Health Organization (WHO) standards. In Zambia, there is little information on healthcare professionals’ familiarity, knowledge and practices on the pharmacovigilance of biological and biosimilar medicines. Therefore, this study investigated the familiarity, knowledge, and practices related to the pharmacovigilance (PV) of biological and biosimilar medicines at selected hospitals in Lusaka, Zambia. Methods: The study was an analytical questionnaire-based cross-sectional study conducted among healthcare professionals (HCPs) at the Adult hospital, Cancer Diseases hospital, Paediatrics hospital and Women and New Born Hospital in Lusaka. Data were collected over four weeks in May and June 2021 and subsequently analysed using IBM SPSS version 21. The statistical significance was set at a 95% confidence interval. Results: Of 245 participants, only 115 (48.9%) of the HCPs were familiar with biological medicines to a basic understanding. Regarding the term biosimilars, most of the HCPs (40.9%) never heard of this word. The mean score for knowledge regarding the PV considerations of biological medicines was 4.1 out of 8 questions. Most HCPs used non-proprietary names (44.2%) when prescribing, dispensing, or administering biological medicines. Additionally, more than half (57.3%) of HCPs did not record batch numbers when dispensing or administering biological medicines. Conclusion: Healthcare professionals were more familiar with the term biological medicines than biosimilars. Healthcare professionals generally scored poorly when their knowledge regarding the PV considerations of biological medicines was assessed. Thus, there is a need to provide adequate training and continuous professional development among healthcare professionals on the pharmacovigilance of biological and biosimilar medicines

Impact of the coronavirus disease on the mental health and physical activity of pharmacy students at the University of Zambia: a cross-sectional study

Background: The novel coronavirus disease (COVID-19) is a serious global health problem that has negatively impacted the mental health of students.Methods: We conducted an online descriptive cross-sectional study among 273 undergraduate pharmacy students at the University of Zambia from August to September 2020. A partial proportional odds regression model was used to determine the predictors of anxiety. All statistical tests were set at 95% confidence level (p<0.05).Results: A response rate of 70% was obtained with the majority of the students being female 51.6%. Of the 273 respondents, 23.8% did not experience anxiety, 34.4% experienced mild anxiety, 24.9% experienced moderate anxiety while 16.9% experienced severe anxiety about COVID-19. It was also found that 61.2% of students reported that their attention to mental health increased during the COVID-19 pandemic whereas 44.3% reported an increased resting time with a significant reduction in relaxation 51.3% and physical activity 45.4% time. Factors that affected mental health included; reduced family care (OR: 2.27; 95% CI: 1.09-4.74), not changing attention to mental health (OR: 0.33; 95% CI: 0.18-0.62), being in the final year of study (OR: 0.33; 95% CI: 0.13-0.84), reduced time of resting (OR: 2.10; 95% CI: 1.26-3.50) and feeling helpless (OR: 0.42; 95% CI:0.23-0.75).Conclusions: COVID-19 negatively impacted the mental health and physical activity of pharmacy students at the University of Zambia. This can have negative health and academic outcomes for students going forward. Higher learning institutions and key stakeholders should implement measures to aid students to recover from the impact of COVID-19 on their mental health and physical activity

Antibiotic susceptibility and resistance patterns of diarrhoeagenic Escherichia Coli, Shigella and Salmonella species: A need for antimicrobial stewardship and surveillance programmes

Background Diarrhoeal diseases caused by bacterial pathogens are a major cause of increased morbidity and mortality rates worldwide, especially in vulnerable populations such as children. The emergence of antibiotic resistance has affected antibiotics commonly used in the management of diarrhoea such as ampicillin, co-trimoxazole and tetracyclines. We assessed the antibiotic susceptibility and resistance patterns of diarrhoeagenic Escherichia coli, Shigella, and Salmonella species based on published studies. Method This was a narrative review in which PubMed, Google Scholar, and EMBASE databases were used to search for studies published between January 2010 and January 2021. Results This review shows that diarrhoeagenic Escherichia coli, Shigella species, and Salmonella species are among the microorganisms which have developed high resistance to antibiotics including ampicillin, co-trimoxazole and tetracyclines. However, the three diarrhoeagenic bacteria have a low resistance to ciprofloxacin, norfloxacin, and ceftriaxone and hence can be used as the drugs of choice in diarrhoeal infections. Conclusion There is a high prevalence of diarrhoea caused by Escherichia coli, Shigella species and Salmonella species. Many diarrhoeagenic bacteria have developed multi-drug resistance to antibiotics, more especially to ampicillin, co-trimoxazole and tetracyclines. Antibiotic susceptibility tests of diarrhoeagenic bacteria must be carried out before antibiotics are prescribed. More importantly, antimicrobial stewardship programmes and surveillance systems must be promoted to curb the emergence and spread of antimicrobial resistance both in public and private practicing sites

Awareness and acceptance of COVID-19 vaccines and associated factors among pharmacy students in Zambia

Background: Several vaccines have been developed and administered since coronavirus disease 2019 (COVID-19) was declared a pandemic in March 2020. In April 2021, the authorities in Zambia administered the first doses of the Oxford-AstraZeneca® COVID-19 vaccine. Objective: To assess the awareness and acceptance of COVID-19 vaccines and associated factors among pharmacy students in Zambia. Methods: A cross-sectional study among 326 undergraduate pharmacy students in Lusaka, Zambia, from February through to 25 April 2021. Data were analysed using Stata version 16.1. Multivariable logistic regression was used to determine factors influencing vaccine acceptance. Results: Of the 326 participants, 98.8% were aware of the COVID-19 vaccines, but only 24.5% would accept vaccination. Being of Christian faith was associated with reduced odds of awareness of the COVID-19 vaccine (aOR=0.01; 95% CI: 0.01-0.20). Compared to females, male respondents were 86% more likely to accept the vaccine if it was made available (aOR=1.86; 95% CI: 1.10-3.14). Unmarried compared to married respondents were 2.65 times as likely to accept vaccination (aOR=2.65; 95% CI: 1.06-6.63) whilst unemployed respondents were less likely to accept vaccination (aOR=0.32; 95% CI: 0.16-0.46). Barriers to the acceptability of the vaccine were possible side effects (78.5%) and scepticism about its effectiveness to prevent COVID-19 (10.2%). Conclusion: There was significant vaccine hesitancy toward COVID-19 vaccines among Zambian pharmacy students despite their awareness of the vaccines. Health authorities must work collaboratively with training institutions to mitigate vaccine hesitancy, especially with healthcare students being a key part of the future healthcare workforce overseeing disease prevention strategies

Impact of the Coronavirus Disease (COVID-19) on the Mental Health and Physical Activity of Pharmacy Students at the University of Zambia: A Cross-Sectional Study.

BACKGROUND: The novel coronavirus disease (COVID-19) is a serious global health problem that has negatively impacted the mental health of students. METHODS: We conducted an online descriptive cross-sectional study among 273 undergraduate pharmacy students at the University of Zambia. A partial proportional odds regression model was used to determine the predictors of anxiety. All statistical tests were set at 95% confidence level (p&lt;0.05). RESULTS: A response rate of 70% was obtained with the majority of the students being female 51.6%. Of the 273 respondents, 23.8% did not experience anxiety, 34.4% experienced mild anxiety, 24.9% experienced moderate anxiety while 16.9% experienced severe anxiety about COVID-19. It was also found that 61.2% of students reported that their attention to mental health increased during the COVID-19 pandemic whereas 44.3% reported an increased resting time with a significant reduction in relaxation 51.3% and physical activity 45.4% time. Factors that affected mental health included; reduced family care (OR: 2.27; 95% CI: 1.09-4.74), not changing attention to mental health (OR: 0.33; 95% CI: 0.18-0.62), being in the final year of study (OR: 0.33; 95% CI: 0.13-0.84), reduced time of resting (OR: 2.10; 95% CI: 1.26-3.50) and feeling helpless (OR: 0.42; 95% CI:0.23-0.75). CONCLUSION: COVID-19 negatively impacted the mental health and physical activity of pharmacy students at the University of Zambia. This can have negative health and academic outcomes for students going forward. Higher learning institutions and key stakeholders should implement measures to aid students to recover from the impact of COVID-19 on their mental health and physical activity