Medication Reconciliation as a Medication Safety Initiative

Medication errors and their adverse outcomes are the most common cause of patient injuries in hospitals. Medication reconciliation is the safety strategy usually called for, to prevent medication errors that occur at care transitions. This strategy has been adopted as a standard practice in many developed countries. However, in Ethiopia, there were no published studies on medication reconciliation, nor evidence-based interventions aimed to tackle the burden of medication errors. This thesis was a medication safety initiative focusing on medication reconciliation intervention overall, and explored the journey to medication reconciliation service implementation as a medication safety strategy in Ethiopian public hospitals. Given the lack of consistent reports regarding the impact of this strategy, the journey to implementation was guided by synthesise of the evidence supporting the effectiveness of this intervention. The findings of our systematic reviews have shown that medication reconciliation interventions carried out through pharmacist assessment at hospital transitions were found to be an effective strategy for improving clinical outcomes (e.g. adverse drug event-related hospital visits, all-cause readmissions, and emergency department visits), as well as process outcomes, such as the occurrence of medication errors. Therefore, the overarching aim of this thesis was to implement a pharmacist-led medication reconciliation intervention in resource-limited settings. Implementation of medication reconciliation is not an ultimate end but sustainability is an issue, and this should be corroborated by corresponding changes in attitudes, teamwork, communication, culture and leadership. For this purpose, the thesis employed methods from both safety and implementation sciences for successful implementation of the medication reconciliation program. System approaches to patient safety, such as patient safety culture has been explored, and patients’ experiences of medication-related adverse events have been discussed followed by a theoretically robust evidence-based exploration of the barriers to implementation. Patient safety culture in Ethiopian public hospitals has been found lower than the benchmark studies. Importantly, understaffing followed by problems during handoffs and care transitions and punitive response to error were identified as major safety problems. Particularly, handoffs and care transitions were largely affected by the lack of teamwork across units, punitive response to error reporting and managerial inaction for promoting patient safety. In addition to system factors presumed to affect patient safety, other factors such as individual healthcare professionals, patient, and task factors have been identified as challenges to achieve an optimal patient safety in the Ethiopian public hospitals. Resource limitations (e.g. material deficiencies, poor infrastructure) have been indicated as the greatest barriers for patient safety. Patients expressed a range of perceived experiences related to their medication, and a number of strategies required to improve patient safety practices have been suggested. Changes in practice, processes, structure, and systems were believed to help improve patient safety in the Ethiopian health care system. The results of this thesis have demonstrated that hospital pharmacists were very much enthusiastic for their extended roles and were positive towards the future of the profession; however, there were many factors that likely influenced their behaviour in the clinical practice, and these behavioural determinants were predominantly related to ‘Knowledge’, ‘Skills’, ‘Environmental constraints’, ‘Motivation and goals’, ‘Social influences’, and ‘Social/professional role’. While medication errors were highly prevalent at the time of hospital admission, this thesis has also found that pharmacist-led medication reconciliation was able to minimize medication errors significantly. Thus, implementation of medication reconciliation as a medication safety strategy is feasible, and pharmacists may be regarded as key resource personnel for the safe use of medications at the time of hospital admission. However, the sustainability of this service utilization is highly dependent on other behavioural determinants, such as knowledge and skill, competing priorities, and reimbursement for clinical services

INAPPROPRIATE MEDICATION USE IN THE ELDERLY POPULATION ATTENDING GONDAR UNIVERSITY HOSPITAL: A PRELIMINARY ASSESSMENT

Objective: To assess the prevalence and associated factors of potentially inappropriate medications (PIMs) use in the elderly population attending Gondar University Hospital (GUH). Methods: A two years (2011-2012) retrospective cross sectional analysis was conducted in Gondar University Hospital (GUH). Elderly patients, aged ≥65 years treated with prescription drugs were included in the study. Updated Beers criteria (2012 version) independent of diagnosis was employed to determine the appropriateness of each medication prescribed and SPSS (version16.0) was used for data analysis. P-value < 0.05 was considered as significant association indicator between the variables. Results: A total sample of 1252 patients were used in the study, of whom 347(27.72%) were received at least one potentially inappropriate medication. The mean age of the participants was 71.15 ± 6.18. The most commonly used medications were immediate release nifedipine (53.89%), diclofenac (22.19%), ibuprofen (7.78%) and indomethacin (5.19%). PIM use and our variables were not associated with the prevalence of PIM use among the elderly. Conclusion: PIMs prescriptions for elderly population attending GUH are common with no association with any of our demographic or any other variables we set, which implies to work on improving the availability of updated medical information and knowledge for prescribers and to involve in careful monitoring and optimal use of drug regimens of elderly patients attending GUH

Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: A systematic review and meta-analysis

Objectives: Pharmacists play a role in providing medication reconciliation. However, data on effectiveness on patients\u27 clinical outcomes appear inconclusive. Thus, the aim of this study was to systematically investigate the effect of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions. Design: Systematic review and meta-analysis. Methods: We searched PubMed, MEDLINE, EMBASE, IPA, CINHAL and PsycINFO from inception to December 2014. Included studies were all published studies in English that compared the effectiveness of pharmacist-led medication reconciliation interventions to usual care, aimed at improving medication reconciliation programmes. Meta-analysis was carried out using a random effects model, and subgroup analysis was conducted to determine the sources of heterogeneity. Results: 17 studies involving 21 342 adult patients were included. Eight studies were randomised controlled trials (RCTs). Most studies targeted multiple transitions and compared comprehensive medication reconciliation programmes including telephone followup/home visit, patient counselling or both, during the first 30 days of follow-up. The pooled relative risks showed a more substantial reduction of 67%, 28% and 19% in adverse drug event-related hospital revisits (RR 0.33; 95% CI 0.20 to 0.53), emergency department (ED) visits (RR 0.72; 95% CI 0.57 to 0.92) and hospital readmissions (RR 0.81; 95% CI 0.70 to 0.95) in the intervention group than in the usual care group, respectively. The pooled data on mortality (RR 1.05; 95% CI 0.95 to 1.16) and composite readmission and/or ED visit (RR 0.95; 95% CI 0.90 to 1.00) did not differ among the groups. There was significant heterogeneity in the results related to readmissions and ED visits, however. Subgroup analyses based on study design and outcome timing did not show statistically significant results. Conclusion: Pharmacist-led medication reconciliation programmes are effective at improving post-hospital healthcare utilisation. This review supports the implementation of pharmacist-led medication reconciliation programmes that include some component aimed at improving medication safety

Integrating mental health services into human immunodeficiency virus clinics: Lessons from task-sharing between clinical and lay healthcare providers in Ethiopia

Background: Globally, mental health problems are more common among people living with human immunodeficiency virus (PLHIV) than among the general population. Mental health problems affect human immunodeficiency virus (HIV) treatment adherence and retention. To address this challenge, partners used a tasksharing approach among lay healthcare works and clinicians to integrate mental health services into HIV services at pilot hospitals in the Amhara and Tigray regions of Ethiopia. In this model, trained lay healthcare workers proactively screened patients using a mental health screening tool and subsequently linked potential clients with trained clinicians working at HIV clinics for further diagnosis and treatment. Methods: We retrospectively gathered secondary data, including demographic characteristics and diagnosis information, from mental health clinicians’ and case managers’ quarterly reports from HIV clinics during the implementation period (January 1, 2013 to March 31, 2014). Results: During the initial three-month implementation period of the project (January to March 2013), case managers screened 5,862 PLHIV for mental health disorders. Case managers referred 687 (11.7%) patients with suspected mental health disorders to clinicians for further evaluation and management. Of the total patients screened by case managers in this period, clinicians confirmed that 454 (7.7%) had a mental health disorder. Overall, the concordance between the case managers’ screening results and the clinicians’ diagnoses was 67.8% over the 15-month pilot implementation period. Conclusions: Routine screening of PLHIV for mental health disorders helps to proactively identify and manage patients with co-morbidities. The integration of mental health services into HIV care through a task-sharing approach is a feasible strategy that could increase access to mental health services among PLHIV. [Ethiop .J. Health Dev. 2020; 34(1):05-13] Keywords: Mental health, task-sharing, integration, HIV, Ethiopia, Afric

Knowledge and adherence to antiretroviral therapy among adult people living with HIV/AIDS at Tikur Anbessa Specialized Hospital, Ethiopia

Background: Adherence to antiretroviral therapy (ART) is necessary to achieve best virological response, lower the risk of drug resistance, and reduce morbidity and mortality. The objectives of the current study were to assess the extent of knowledge of patients on treatment plan and regimen, determine the rate of adherence and identify factors related to non-adherence to ART.Methods: A cross-sectional study was conducted at Tikur Anbessa Specialized Teaching Hospital, Addis Ababa, Ethiopia, using data from both semi-structured interview (self-report) and ART database (pharmacy refill) during the months of March and April 2013 using a total 350 participants.Results: The results indicated that 33% of the participants had good knowledge on the treatment plan and regimen. Using self-report and pharmacy refill record, 79.1% and 72.9% respectively showed adherence rate of ≥95%. Younger people were found to be less likely to adhere to ART (AOR [95%] = 0.51 [0.30, 0.85]) using pharmacy refill record. Risk factors for ART non-adherence using self-report were use of memory aids (AOR [95%] = 3.46 [1.72, 6.98]), treatment satisfaction (AOR [95%] = 2.33 [1.22, 4.07]), taking co-medication (AOR [95%] = 0.56 [0.32, 0.98]), and regimen switch (AOR [95%] = 0.41 [0.19, 0.85]). Whereas using pharmacy refill record risk factors were, knowledge on treatment plan and regimen (AOR [95%] = 2.50 [1.39, 4.51]), use of memory aids (AOR [95%] = 2.71 [1.34, 5.47]), treatment satisfaction (AOR [95%] = 3.78 [1.47, 9.71]), and regimen switch (AOR [95%] = 0.50 [0.27, 0.92]).Conclusion: Older age, good knowledge on treatment plan and regimen, use of memory aids, treatment satisfaction, and not having co-medications and regimen switch showed more adherence to ART

Polypyrrole–polyaniline-water hyacinth leaf protein concentrate composite for the removal of Cr(VI) from aqueous solution: kinetics, isotherm and thermodynamic studies

ABSTRACT. This work focused on the extraction of “water hyacinth leaf protein concentrate” (WHLPC) and preparation of polypyrrole (PPy), polyaniline (PANI) and polypyrrole-polyaniline copolymer (PPy/PANI) coated WHLPC by in situ polymerization and investigate their application for the removal of Cr(VI) from aqueous solution. After optimizing the experimental conditions like pH, adsorbent dosage, contact time and initial concentration it was found that the kinetics and isotherm data were well fitted to the pseudo-second-order and Langmuir models, respectively. PPy/PANI/WHLPC was found to be an efficient material compared to the other polymer-coated adsorbents with maximum adsorption capacity of 230 mg/g. The presence of counter ions ((NO3-, Cl-, HPO42-, SO42+ and HCO3- ions) slightly decreases the Cr(VI) removal efficiency PPy/PANI/WHLPC. The thermodynamic study reveals that the adsorption of Cr(VI) onto PPY/PANI/WHLPC is endothermic, thermodynamically feasible, and spontaneous. In addition, reusability of the material indicated high removal efficiency for two adsorption cycles.   KEY WORDS: Polypyrrole, Polyaniline, Protein concentrate, Water hyacinth, Chromium Bull. Chem. Soc. Ethiop. 2022, 36(3), 571-584.                                                               DOI: https://dx.doi.org/10.4314/bcse.v36i3.

Rhizobium Inoculation and Chemical Fertilisation Improve Faba Bean Yield and Yield Components in Northwestern Ethiopia

The productivity of the faba bean has declined in Ethiopia, owing to poor management practices, such as blanket fertilisation. In 2018, a field experiment was conducted in a Nitisol soil during the main cropping season in Northwestern Ethiopia, to determine the amount of chemical fertiliser and Rhizobium inoculant to be used for the optimum yield within economic feasibility. The experiment consisted of a factorial combination of five rates of blended NPSZnB fertiliser (0, 60, 121, 180 and 240 kg ha−1) and three rates of inoculant (0, 500 and 750 g ha−1). Sole chemical fertilisation, as well as inoculation, individually produced a seed yield of 2.3–2.5 t ha−1, about 1.0–1.2 t ha−1 more than the control. However, the maximum seed yield (3.3 t ha−1) was recorded from the combined application of both the chemical fertiliser and the inoculant. The seed yield correlated closely with the number of active nodules (R2 = 0.78 **), suggesting a substantial contribution of symbiotic N2 fixation. Inoculation increased the N content of the seed yield by at least 30 kg ha−1. Chemical fertilisation, containing at least 44 kg ha−1 of mineral N does not appear to have an adverse effect on N2 fixation. The combined use of 180 kg ha−1 blended fertiliser with 750 g ha−1 inoculant, producing a maximum net profit of 72,918 birr ha−1 (EUR 2232), is recommended for the study area. This study emphasises that (1) inoculation alone can produce as much seed as the maximum rate of chemical fertilisation, but (2) the maximum yield was produced with a combined use of inoculant and chemical fertiliser, by promoting the vigour of the nodules and N2 fixation

Rhizobium Inoculation and Chemical Fertilisation Improve Faba Bean Yield and Yield Components in Northwestern Ethiopia

The productivity of the faba bean has declined in Ethiopia, owing to poor management practices, such as blanket fertilisation. In 2018, a field experiment was conducted in a Nitisol soil during the main cropping season in Northwestern Ethiopia, to determine the amount of chemical fertiliser and Rhizobium inoculant to be used for the optimum yield within economic feasibility. The experiment consisted of a factorial combination of five rates of blended NPSZnB fertiliser (0, 60, 121, 180 and 240 kg ha−1) and three rates of inoculant (0, 500 and 750 g ha−1). Sole chemical fertilisation, as well as inoculation, individually produced a seed yield of 2.3–2.5 t ha−1, about 1.0–1.2 t ha−1 more than the control. However, the maximum seed yield (3.3 t ha−1) was recorded from the combined application of both the chemical fertiliser and the inoculant. The seed yield correlated closely with the number of active nodules (R2 = 0.78 **), suggesting a substantial contribution of symbiotic N2 fixation. Inoculation increased the N content of the seed yield by at least 30 kg ha−1. Chemical fertilisation, containing at least 44 kg ha−1 of mineral N does not appear to have an adverse effect on N2 fixation. The combined use of 180 kg ha−1 blended fertiliser with 750 g ha−1 inoculant, producing a maximum net profit of 72,918 birr ha−1 (EUR 2232), is recommended for the study area. This study emphasises that (1) inoculation alone can produce as much seed as the maximum rate of chemical fertilisation, but (2) the maximum yield was produced with a combined use of inoculant and chemical fertiliser, by promoting the vigour of the nodules and N2 fixation

Experimental investigation on characteristics of sisal fiber as composite material for light vehicle body applications

Abstract Sisal fiber composites became attractive due to their high specific strength, lightweight and biodegradability. The aim of this work is to examine characteristics of sisal fiber as composite material for light body vehicles on experimental basis. Composite materials prepared using biodegradable natural fibers are found to be most promising materials which can be used in vehicle body which results in reduction of overall weight of the vehicle. In this work sisal fiber was used. Sisal fiber was extracted using knife from the sisal plant leaves collected from Ethiopian highland. To remove cellulosic matter and improve surface roughness of the sisal fiber, it was immersed in sodium hydroxide solution for 24 h. The specimen of composite material is prepared using the general purpose resin as a matrix, the hardener and the sisal fiber as a reinforcement material with the fiber orientation of 00, ± 450, 00 & 900 by using experimental (hand layup fabrication technique). The specimen was prepared and tested as per ECAE and ASTM standard. From the test results it was found that sisal fiber composite is a good light weight replacement for conventional materials in vehicle body applications. From the experiment result it was observed that different orientation of fiber has shown enhanced mechanical properties of the sisal fiber composite material

Community-Based Assessment of People with Chronic Diseases and Conditions Worsening the Severity of COVID-19 in Addis Ababa City Administration

AbstractBackground: the COVID-19 pandemic stayed in a sporadic form for a long time after introducing the coronavirus in the country, later appearing in clusters within communities. During such sporadic and clustered spread of the disease, the government of Ethiopia started identifying suspects through active surveillance for COVID-19. This study aimed to describe people who have chronic illnesses that could be underlying conditions for increased severity of COVID-19.Methods: A survey was conducted in May 2020 using active community-based case surveillance in 30 randomlyselected woredas in Addis Ababa City. Data were collected from each household member by assessing for general conditions and diseases expected to increase their risk of suffering higher severity from COVID-19. Data were stored in M.S. Excel and analyzed using SPSS-version 26 for windows. Descriptive analysis was conducted to know the proportion of persons with chronic diseases, and thus the population with a higher risk of suffering more severity from COVID-19 by place, person, and time. The results are presented using tables and graphs as appropriate.Results: The point prevalence of flu-like syndrome was 51.9 per 100,000 persons, and the prevalence was higher among older people. The study showed that 11,600 per 100,000 households have at least a member with chronic diseases that worsen the severity of COVID-19 morbidity. The survey also found 6,939 and 5,140 households per 100,000 households have diabetes mellitus and hypertension, respectively, and about 1950 per 100,000 households were with bronchial asthma. Nearly a quarter of the households have people with two or more chronic diseases that worsen their risk of facing a more severe course of COVID-19 than it would be for people without those underlying conditions.Discussion: High proportion of households have people with chronic diseases that worsen their risk of suffering a more severe course of COVID-19 than it would be for people without those underlying conditions. The Ministry of Health should devise and implement mechanisms to safeguard people with chronic diseases from contracting the diseases. [Ethiop. J. Health Dev. 2021; 35(2):133-140]Keywords: COVID-19, chronic diseases, severe course of COVID-19, Addis Abab