AN INVESTIGATION OF ERRORS: THE PREPARATION AND ADMINISTRATION OF PARENTERAL MEDICATIONS IN AN INTENSIVE CARE UNIT OF A TERTIARY TEACHING HOSPITAL IN MALAYSIA

Objective: This study was carried out to investigate the incidence, types, and factors associated with parenteral medication preparation/administration errors. The study also investigates the concentration accuracy of prepared drug infusions and the adherence to good practices by the nurses.Methods: This was a prospective study conducted in a general intensive care unit (GICU) of a tertiary teaching hospital in Malaysia, using an observation method. The preparation and administration of the parenteral medications by the nurses were observed, and the details were recorded using a standard checklist. The drug infusions (noradrenaline) prepared by the nurses were collected for a concentration analysis using a high-performance liquid chromatography (HPLC).Results: This study found that 79% of the parenteral medications prepared and administered had one or more error. There were 33% doses with 2 or more errors while 6% doses contained 3 errors. The most common errors involved incorrect drug preparation (57%), followed by incorrect administration rate (33%). There was no double-checking performed in the preparation/administration of all (100%) parenteral doses. In terms of concentration accuracy, 48% of the prepared drug infusions contained errors. Failure to label syringe properly was found to result in more errors per dose (P<0.001).Conclusion: Error during preparation and administration of parenteral medications is common in Malaysia's intensive care unit setting. Incorrect drug preparation and wrong administration rate were both error ‘hot spots' identified in this study, and must be targeted for intervention. Some of the recommendations to improve parenteral medication safety include providing education, centralised admixture services, and interdisciplinary collaboration.Keywords: Medication error, Nurses, Parenteral medication, Intensive care unit, Observatio

Examination of Influence of Ethnic Identity Development on the Counselling Trainees’ Multicultural Counselling Competencies

Background Ethnic identity awareness has become one of the important variables that impact the counsellor’s multicultural counselling competencies and to understand clients in the counselling relationship. Objective The purpose of the study was to assess the influence of ethnic identity development on the multicultural counselling competencies of counselling trainees at a public university in Malaysia. Methods Two scales were used in this study which include the Multigroup Ethnic Identity Measure (MEIM) and Multicultural Counselling Inventory (MCI). The first instrument measured the process of ethnic identity development of counselling trainees and the second instrument measured the students’ multicultural counselling competencies. Results The result showed that there was a significant influence of ethnic identity development on the multicultural counselling competencies of counselling trainees. Ethnic identity achievement, ethnic behavior, and multicultural training were the significant predictors of counselling trainees’ multicultural counselling competencies. Conclusion These results yield useful information for understanding the relative importance of ethnic identity awareness in developing the counsellor’s multicultural competencies

Effect of processing condition on the yield of Oscimum Gratissimum extract

Ocimum gratissimum (O. gratissimum) is a medicinal plant which native in Southeast Asia. Containing various compound with medicinal value, it acts as herb and spices in cooking, perfumery and used in traditional preparation. It is reported that O. gratissimum has many phenolic compounds which responsible for many biological activities such as eugenol, limonene, ocimene and rosmarinic acid. Scientific studies regarding O. gratissimum are widely known due to its beneficial therapeutic properties, such as antioxidant, antibacterial, anti-inflammatory and others. However, different extraction techniques approaches will give different effects on extraction yield of bioactive compounds according to the processing condition such as solvent polarity, concentration of solvent, temperature and solvent to sample ratio that applied. This study applied Soxhlet and Ultrasonic-assisted Extraction (UAE) techniques to determine the extraction yield of O. gratissimum. The results indicated Soxhlet techniques requires 2 hours, sample to solvent ratio; 1:10 and temperature at 60oC to obtained highest yield of O. gratissimum extract with percentage yield at 1.723% compared to others processing conditions. Meanwhile, UAE techniques showed highest yield of O. gratissimum extract at sample to solvent ratio at 1:10 with results 20.60% and 60% Methanol as the best solvent for extraction. Throughout analysis, UAE techniques was chosen as the methods of extraction for O. gratissimum with processing conditions that gives high yield of extraction

Chemometrics study and spectral database development of pharmaceuticals and herbal products; malaysian perspective

This research was initiated as part of the fight against the public health problems of rising counterfeit, substandard, and poor quality medicines and herbal products in the Malaysian market. A simple, quick and cost-effective drug screening procedure using an incremental near infra-red [NIR] spectral database of common medicines in combination with principal component analysis [PCA] was developed to facilitate drug analysis without depending on standard compounds or products from manufacturers. The novelty of the approach is demonstrated by this two-tier method which allowed application in product identification, drug quality study, herbal analysis, and the detection of counterfeit and adulterated medicines. The NIR spectra database consisted of almost 4,000 spectra from 15 types of medicines and 3 types of herbal preparations, acquired and stored in the database throughout the study. The optimization procedure developed in this thesis on the database produced a search strategy using correlation and first derivative correlation algorithms on the full spectrum. The cut-off points of the hit quality index (HQI) were determined to classify the unknown sample in four categories; similar batch/match [classification type 1, 0.2). The same set of spectra were analysed by multivariate methods, including PCA. This two-tier screening approach proved successful when challenged firstly using simple compound drugs followed by complex mixtures of herbal preparations and then using alleged counterfeit and adulterated samples seized by the authority. The method developed has allowed samples to be identified without known background information which was difficult using other qualitative NIR techniques that required reference products for comparison. It is also allowed selection of suspected samples for further extensive analyses and in detection of adulterant contaminating herbal preparations. The outcomes of this thesis should support further qualitative and quantitative researches on drugs and herbals products in Malaysian universities. The developed spectral database of drugs will providea valuable tool to assist in drug quality surveillance nation-wide

Qualitative comparison of Malaysian and UK paracetamol tablets by Near-Infra Red

Peer reviewe

Chemometrics analysis of solid herbal products and development of spectral databases

UK-PharmSci 2010 - The Science of Medicine. Abstracts from the UK ConfPeer reviewe

Rapid detection of sildenafil analogue in Eurycoma longifolia products using a new two-tier procedure of the near infrared (NIR) spectra database

A simple and cost-effective two-tier drug screening procedure comprises a 'dedicated' NIR spectral database of common medicines and a 'unified' database was developed to detect the sildenafil analogue in Eurycoma longifolia products. Diffuse reflectance spectra of ten commercial herbal products containing E. longifolia were obtained over the wavelength range of 1100-2500 nm. The spectral search of two products purchased via the internet against a dedicated database of reputable E. longifolia products have resulted in the similarity index of more than 0.1 which indicated significantly different spectra. Further searches against the unified database showed a close match to the spectra of drug containing sildenafil citrate suggesting the presence of a sildenafil analogue. This finding was supported by clustering of these spectra in the PCA score plot within 5 2014 Elsevier Ltd. All rights reserved

Antiperspirant and Antibacterial Activities of <i>Curcuma xanthorrhiza</i> Extract as a Potential Alternative Treatment for Hyperhidrosis

Hyperhidrosis is a condition characterized by excessive sweating that affects at least 5% of the world’s population. It is normally associated with unpleasant body odour which requires continuous maintenance throughout life. Antiperspirants and deodorants are the first-line treatments for hyperhidrosis. However, association of this class of product with the risk of other diseases has increased the search for an effective antiperspirant from natural sources. This study aimed to investigate the antibacterial and antiperspirant activities of Curcuma xanthorrhiza Roxb. Using an in vitro microbial assay against specific bacteria responsible for body odour and rat foot pad analysis. Quality control of the fractionated extract was conducted using reversed-phase HPLC based on two active markers: xanthorrhiza and curcumin. Toxicity tests were conducted based on the OECD guidelines (50–2000 mg/kg). Inhibition zone, MIC, and MBC values of the hexane fraction of C. xanthorrhiza showed equivalent antibacterial activity to positive control (p > 0.05). No swelling, redness, or rashes were observed at the injection area throughout the study. Treatment with 40, 80, and 160 mg/kg of the extract significantly decreased the sweat excretion up to 79.34% (p C. xanthorrhiza is able to reduce sweat excretion in a rat model and inhibit the growth of bacteria causing body odour

Use of near infrared spectroscopy and spectral databases to assess the quality of pharmaceutical products and aid characterization of unknown components

This research was initiated as part of the fight against public health problems of rising counterfeit, substandard and poor quality medicines and herbal products. An effective screening strategy using a two-step combination approach of an incremental near infrared spectral database (step 1) followed by principal component analysis (step 2) was developed to overcome the limitations of current procedures for the identification of medicines by near infrared spectroscopy which rely on the direct comparison of the unknown spectra to spectra of reference samples or products. The near infrared spectral database consisted of almost 4000 spectra from different types of medicines acquired and stored in the database throughout the study. The spectra of the test samples (pharmaceutical and herbal formulations) were initially compared to the reference spectra of common medicines from the database using a correlation algorithm. Complementary similarity assessment of the spectra was conducted based on the observation of the principal component analysis score plot. The validation of the approach was achieved by the analysis of known counterfeit Viagra samples, as the spectra did not fully match with the spectra of samples from reliable sources and did not cluster together in the principal component analysis score plot. Pre-screening analysis of an herbal formulation (Pronoton) showed similarity with a product containing sildenafil citrate in the database. This finding supported by principal component analysis has indicated that the product was adulterated. The identification of a sildenafil analogue, hydroxythiohomosildenafil, was achieved by mass spectrometry and Nuclear Magnetic Resonance (NMR) analyses. This approach proved to be a suitable technique for quick, simple and cost-effective pre-screening of products for guiding the analysis of pharmaceutical and herbal formulations in the quest for the identification of potential adulterants

Effect of processing condition on the yield of oscimum gratissimum extract

Ocimum gratissimum (O. gratissimum) is a medicinal plant which native in Southeast Asia. Containing various compound with medicinal value, it acts as herb and spices in cooking, perfumery and used in traditional preparation. It is reported that O. gratissimum has many phenolic compounds which responsible for many biological activities such as eugenol, limonene, ocimene and rosmarinic acid. Scientific studies regarding O. gratissimum are widely known due to its beneficial therapeutic properties, such as antioxidant, antibacterial, anti-inflammatory and others. However, different extraction techniques approaches will give different effects on extraction yield of bioactive compounds according to the processing condition such as solvent polarity, concentration of solvent, temperature and solvent to sample ratio that applied. This study applied Soxhlet and Ultrasonic-assisted Extraction (UAE) techniques to determine the extraction yield of O. gratissimum. The results indicated Soxhlet techniques requires 2 hours, sample to solvent ratio; 1:10 and temperature at 60oC to obtained highest yield of O. gratissimum extract with percentage yield at 1.723% compared to others processing conditions. Meanwhile, UAEtechniques showed highest yield of O. gratissimum extract at sample to solvent ratio at 1:10 with results 20.60% and 60% Methanol as the best solvent for extraction. Throughout analysis, UAE techniques was chosen as the methods of extraction for O. gratissimum with processing conditions that gives high yield of extraction