Reducing medication errors in HIV-positive patients: Influence of a clinical pharmacist

Background: The roll-out of antiretroviral medicines has improved life expectancy in people living with HIV (PLHIV). This has resulted in more patients being hospitalised for non-communicable diseases, increasing risk for medication errors (MEs). Pharmacists, through medication reconciliation, may identify and reduce MEs in this population. Objectives: To describe the importance of a pharmacist’s involvement in identifying and quantifying types of MEs. Method: A quantitative, prospective observational study was conducted over 14 weeks. A pharmacist reviewed HIV-positive, hospitalised patients’ files, using a data collection instrument, to determine the prevalence of MEs in PLHIV. The study pharmacist recommended appropriate actions to the prescriber to resolve MEs and documented resolution of the MEs. Results: The study population of n = 180 patient files were reviewed 453 times, identifying 466 MEs. Medication errors included incorrect medication reconciliation from history (19; 4.1%), prescription omission (17; 3.7%), duplication of therapy (10; 2.2%), missed doses (265; 57.1%), incorrect dosing (103; 22.2%), incorrect administration frequency (2; 0.4%), incorrect duration of therapy (15; 3.2%) and drug-drug interactions (18; 3.9%). More than half (58.2%) of the MEs were resolved in less than 24 h, with involvement of the pharmacist. Conclusion: This study demonstrates the magnitude of MEs experienced in hospitalised PLHIV and highlights the role clinical pharmacists play in identifying and resolving MEs to improve patient outcomes

Use of granulocyte colony-stimulating factor in patients with chemotherapy-induced neutropaenia

Background: Febrile neutropaenia (FN) and resultant infections are the major cause of treatment-related morbidity and mortality in patients receiving chemotherapy. Clinical practice guidelines recommend the use of granulocyte colony-stimulating factors (G-CSF) to reduce the risk of FN and ensuing complications in patients receiving chemotherapy. Despite these recommendations, inappropriate usage of G-CSF has been reported. Aim: To assess prescribing patterns and adherence to international guidelines of G-CSF in adult patients with chemotherapy-induced neutropaenia (CIN) at the haematology oncology wards of the Dr George Mukhari Academic Hospital (DGMAH) and compliance to guidelines. Methods: Medical records of adult patients who received G-CSF were reviewed retrospectively between 01 January 2018 and 31 July 2018. Results: Of the 128 patient files screened, 57 cases met the inclusion criteria. Duration of treatment with G-CSF was not in accordance with guidelines in more than 50% of the patients and in 43.86%, G-CSF dosing deviated from recommended guidelines. Conclusion: The study demonstrated over-prescribing of G-CSF due to either increased doses or duration of G-CSF therapy. Although prescribed for the correct indication, the dosage was often too high or the duration was too long, even once an acceptable neutrophil nadir count was reached. Interventions to optimise the use of G-CSF are required and the pharmacist may play a role in this regard. Contribution: The administration of the correct doses of G-CSF can reduce both the severity and duration of neutropaenia. Over-prescribing and incorrect dosing may contribute to patient morbidity and add to the financial burden of healthcare

Knowledge and perceptions of final year nursing students regarding antimicrobials, antimicrobial resistance, and antimicrobial stewardship : findings and implications to reduce resistance

Abstract: Antimicrobial resistance (AMR) is increasingly seen as the next pandemic in view of high morbidity and mortality rates, with Sub-Saharan Africa currently having the highest mortality rates driven by high rates of inappropriate prescribing in ambulatory care. In South Africa, nurses typically provide a range of services, including prescribing, in public ambulatory care clinics. However, little is currently known about the perception of final year nursing students regarding antibiotic use, AMR, and anti-microbial stewardship (AMS). Consequently, we sought to address this important evidence gap. A quantitative descriptive study using a self-administered online questionnaire via Google Forms was undertaken among six universities offering a Baccalaureus of Nursing. Knowledge on the classes of antibiotics, organisms covered, and mechanism of action was lacking. The sample size to achieve a confidence interval of 95% with a 5% error margin was 174, increased to 200 to compensate for possible attrition. Only 15.3% of nurses knew ceftazidime is not a 4th generation cephalosporin and only 16.1% knew clavulanic acid does not decrease inflammation at the site of infection. In addition, only 58.9% and 67.7% agreed that the prescribing of broad-spectrum antibiotics and poor infection control respectively increases AMR. AMS was also not a well-known concept among final year nurses. The lack of knowledge regarding antibiotics, AMR and AMS, among final year nurses can have important repercussions in practice once qualified. Consequently, this information gap needs to be urgently ad-dressed going forward with updated curricula and post-qualification educational activities to reduce AMR in South Africa

HIV/AIDS awareness among first year pharmacy students and the role of the university

As HIV/AIDS continues to spread and affect the lives of millions of people, a sense of urgency has developed about the imperative need to stop the epidemic. Education is the key to change knowledge, attitudes and behaviour. There is currently a gap in education programmes targeting youths of ages 18-24 years, for example, those enrolled in tertiary institutions. The aim of the study was therefore to establish the level of HIV/AIDS awareness among undergraduate pharmacy students at the University of Limpopo (Medunsa Campus)/ Tshwane University of Technology Schools of Pharmacy. A structured questionnaire was administered to pharmacy students on entry to the programme. Although the students of 2003, 2004 and 2005 obtained mean percentage HIV/AIDS awareness scores in the range of 70%-80%, they had inadequate knowledge of some transmission routes, events that occur when HIV invades the body, the “window period” and some symptoms. These knowledge gaps should be addressed by universities by integrating HIV/AIDS policies and education fully into all aspects of their planning, operations and teaching

HIV and AIDS knowledge of Pharmacy students at the University of Limpopo (Medunsa Campus)/Tshwane University of Technology before and after a teaching intervention

Healthcare workers need to be qualified to deal with the specific requirements of the HIV/AIDS syndrome, which demands technical and scientific knowledge and understanding of the disease. Adequate knowledge about HIV/AIDS is an important means to reduce stress and could result in better care and improve information to the general public. Because of the community service nature of pharmacies, pharmacists are in the front line when it comes to treating minor illnesses, as patients will often approach a pharmacist with a health query before they see a medical practitioner. Hence, pharmacists have opportunities to recognise potential opportunistic infections or other HIV-associated complications and to refer patients for evaluation and management. The objective of this study was to assess the level of scientific knowledge of HIV/AIDS of undergraduate pharmacy students before and after a teaching intervention aimed to improve students’ scientific knowledge of the subject. A controlled study was carried out by administering pre- and post-intervention questionnaires to control and study groups. The study group was taken from the various BPharm student groups during 2004 and 2005. Although each group acted as its own control, an additional control group of first year dentistry students was included in 2005. The mean HIV/AIDS knowledge scores and the knowledge gains of the control and study groups were compared before and after the intervention. The knowledge gains from the interventions were statistically significant. The increases indicate the positive effect of the teaching intervention. The teaching intervention can therefore be recommended to be part of the undergraduate BPharm curriculum

Patient views regarding the down referral system of patients with chronic diseases at Dr George Mukhari Academic Hospital, Ga- Rankuwa, South Africa

If the referral system between healthcare facilities is not operating efficiently it could result in the underuse of lower level facilities and the overuse of higher-level facilities. Studies have shown that it is difficult to have a properly functioning patient referral system when patients by-pass the system. This study sought to determine patient views regarding the down referral system of patients with chronic diseases at Dr George Mukhari academic hospital (DGMAH). A quantitative study using a cross- sectional descriptive design was conducted. The first 450 stable patients from the various OPD clinics, having a six months repeat prescription, willing to participate in the study and provided consent completed the researcher-administered questionnaire. Descriptive statistics were used to analyse data. The majority of the patients interviewed in the study were females (78.2%), 51 years and older (70%). Fifty two percent of patients (210) complied with the down referral system because it is convenient for them; 60.9% of patients reported that non-availability of medicines at clinics was the main reason for it not being a good system and 22% of the patients came back to the hospital if they did not get medicine from the clinic. Poor service and bad staff attitudes (54.6%) were the most listed reasons by patients for regarding clinic staff as being incompetent. Non-availability of medicines and poor service delivery at clinics were the main reasons for patients returning to the hospital to collect medicine.Keywords: Down referral system, patient views, stable chronic patients, DGMAH

Patient satisfaction at accredited antiretroviral treatment sites in the Gert Sibande District

Background: Patient satisfaction has been used as a significant indicator of quality services provided by healthcare personnel. With the largest antiretroviral therapy (ART) programme in the world, the healthcare industry is struggling increasingly with challenges of meeting patients’ requirements and expectations for quality ART service provision. This study was conducted in order to identify the importance of factors contributing to satisfaction or dissatisfaction. Aim: This study sought to explore and describe the general satisfaction or dissatisfaction of patients with accredited ART hospital sites at public health facilities in the Gert Sibande District, Mpumalanga and to identify factors contributing to either satisfaction or dissatisfaction. Setting: Six hospitals that initiated ART in the district, participated in the study. Method: The study was conducted using a sample of 300 patients. Proportional random sampling was used in selecting the number of patients from each facility. A structured interview with each participating patient was conducted using a standardised structured questionnaire. The first available required number of patients that complied with requirements from each of the six hospitals was selected for the interview. Descriptive statistics were used to analyse data and data with qualitative aspects were captured and categorised manually. Results: The major factors contributing to satisfaction included the availability of medicines and knowledge regarding how to take medication. Factors contributing to dissatisfaction on the part of the patients included confidentiality issues, long waiting periods, shortage of staff and dirty toilets. Conclusion: This study indicated general satisfaction with the ART-related services at the accredited ART hospital sites in the Gert Sibande District. Regular monitoring and evaluation are recommended

Glaucoma: a brief update for 2017

Glaucoma is a complex condition of the eye and the second leading cause of blindness around the globe. It is an ophthalmic neurodegenerative condition and is characterised by a raised intra-ocular pressure (IOP). The latter also constitutes the only modifiable risk factor in glaucoma management. When left untreated patients may gradually experience a visual field loss, and even lose their sight completely. This article provides a brief overview of this condition, the pharmacological treatment options that are available in South Africa, as well as the rational use thereof