Medication safety practices in hospitals: A national survey in Saudi Arabia

Healthcare Professionals' Perception Regarding Patient Rights and Safety in Najran, Saudi Arabia

BACKGROUND

Patient safety and rights are the most crucial aspects of healthcare quality. In Saudi Arabia, there is a paucity of evidence concerning the perspectives of healthcare providers on the rights and safety of patients. Hence, this study aimed to assess the perceptions of healthcare providers toward patients' rights and safety in Najran, Saudi Arabia.

METHODOLOGY

A cross-sectional study was undertaken in Najran, Saudi Arabia, from December 2022 to October 2023, utilizing an online survey. This study included 307 healthcare providers who responded to the questionnaire via Google web link (Google LLC, Mountain View, California, United States).

RESULTS

The present research comprised 307 healthcare personnel, of whom 65.8% were male and possessed a variety of academic backgrounds. The participants exhibited a high level of support for patients' rights, as evidenced by their agreement with 88.4-90% of questions on a variety of dimensions; this demonstrated their dedication to providing patient-centered care. Concerning medical errors, a significant proportion of respondents (74.9-86.1%) exhibited comprehensive comprehension and a readiness to disclose such incidents. Diverse viewpoints surfaced regarding the attribution of errors, the necessity of reporting, and the accountability for disclosure. The interdependence of patient rights and attitudes towards patient safety was highlighted by substantial positive correlations.

CONCLUSION

The viewpoints of healthcare professionals regarding medical errors and patients' liberties were discussed in this study. Advocacy for patients' rights is indicative of a commitment to patient-centered care that prioritizes autonomy and transparency. Although most participants demonstrated a willingness to report medical errors and possess a solid comprehension of their causes, divergent views emerged regarding attribution and disclosure. The interrelation between patient rights and attitudes toward patient safety was supported by positive correlations. The significance of continuous education in healthcare to promote a safety culture and enhance patient-centric practices is underscored by these results. Future research is needed to investigate the effects of culturally tailored interventions on the attitudes and practices of healthcare providers in Najran with regard to patient rights and safety.

Nurses' perspectives on medication errors and prevention strategies in residential aged care facilities through a national survey

BACKGROUND

Medication errors are common in residential aged care facilities (RACFs) due to several factors. Effective medication management is essential to prevent medication errors among older people particularly due to the complexity of co-morbidities they can experience.

OBJECTIVES

This study aimed to examine and quantify the contributing factors of medication errors from nurses' perspectives and the prevention strategies to reduce medication errors among older adults living in RACFs.

METHODS

A survey with 140 completed responses from registered nurses (RNs) and endorsed enrolled nurses (EENs) working in RACFs across Australia were included in the study. The survey had 24 items, related to contributing factors of medication errors, and the prevention strategies. Descriptive statistics and exploratory factor analysis were used in the data analysis process.

RESULTS

The study identified medication errors are caused by contributing factors such as use of agency staffing (70.4%) and delays in receipt of laboratory results (94.3%). However, it also identified suggestions to reduce medication errors in RACFs, for example use of electronic alerts (88.3%), and efficient laboratory communication (91.8%). Our results revealed three key factors for causes (workload, interprofessional involvement and interruptions) and suggestions (medication safety alerts, medication process improvement and effective reporting).

CONCLUSION

Medication errors in RACFs are a global problem being one of the leading causes of morbidity and mortality. The knowledge and awareness of the factors associated with medication errors and the prevention strategies can guide potential quality improvement plans and contribute to minimisation of risk associated with medication safety in RACFs.

IMPLICATIONS FOR PRACTICE

The study recommends strategies for best practices in medication management such as interprofessional collaboration, implementing standardised policies and electronic alerts to reduce medication errors in RACFs.

Patients' Perceptions of Safety in Primary Healthcare Settings: A Cross-Sectional Study in the Qassim Region of Saudi Arabia

This study assessed patients' perceptions of safety and experiences in primary healthcare in the Qassim region of Saudi Arabia. Between July and September 2022, 730 patients from primary healthcare centers were surveyed using a multi-staged cluster random sampling approach. The Patient-Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire was used to measure patients' perceived safety and experience in primary healthcare settings within the past year. Descriptive analyses were performed to report patients' perceived safety experiences. The statistical analysis examined individual items and scales. A considerable proportion of patients reported encountering safety problems, ranging from 11% (vaccine-related) to 27% (diagnosis-related). Diagnostic errors were the most common perceived safety problem (26.7%), followed by communication issues (24.1%) and medication errors (16.3%). Between 26% and 40% experienced harm, including financial problems (40%), increased care needs (32.4%), physical health issues (32%), limitations in activities (30.6%), increased healthcare needs (30.2%), and mental health concerns (26.8%). Patient-reported safety experiences reported in our study offer valuable insights into primary care safety in Saudi Arabia. Collecting routine patient feedback is crucial for addressing identified safety problems and implementing standardized procedures.

Assessment of Medication Errors Among Anesthesia Clinicians in Saudi Arabia: A Cross-Sectional Survey Study

Introduction

Anesthetic drugs are prepared and administrated without referral to the pharmacy or other medical departments. We aimed to assess the occurrence of anesthetic drug errors in Saudi Arabia. We also determined the contributing factors, reporting strategies, and clinicians' opinions of the preventive measures.

Methods

We conducted a cross-sectional web-based survey study using a validated tool. A total of 300 anesthesia clinicians completed the survey (146 anesthesiologists and 154 anesthesia technology specialists). We measured descriptive statistics to describe the demographic characteristics and performed inferential statistics to examine associations and differences.

Results

Sixty-nine percent of respondents had experienced an anesthetic drug error at least once in their career. The two primary factors that caused drug errors were haste (60.3%) and heavy workload (60.3%). On syringe labeling, 56.3% withdrew the drug then labeled the syringe, and 43.7% labeled the syringe then withdrew the drug. The chi-square test revealed that clinicians who labeled the syringe first then withdrew the drug made errors more frequently (p = 0.036). The test also showed that clinicians with less experience had committed more errors (p = 0.015). On reporting drug errors, 77.7% of respondents identified the fear of medicolegal issues as the most common barrier to reporting errors. Respondents believed that double-checking the medication and color-coded syringe labels were the most effective strategies to reduce errors (82% and 64%, respectively). The Mann-Whiney U test revealed significant differences between the two specialties about their opinions of the preventive measures.

Conclusions

There was a high occurrence rate of anesthetic drug errors in Saudi Arabia. Policymakers need to unify the syringe-labeling practice, and future research needs to focus on what makes a nonpunitive culture to encourage reporting errors.

Medication reconciliation process: Assessing value, adoption, and the potential of information technology from pharmacists' perspective

The Medication Reconciliation (MedRec) process aims to improve patient safety through safe prescription and medication administration. A validated survey was carried out to address aspects related to MedRec process, its obstacles, the role of information technology, and the required functionalities for optimizing the MedRec process. A total of 81% of the survey's respondents acknowledged the roles of EHR (62% of respondents), PHR (41%), and electronic medication registration list (33%) as necessary technology tools for MedRec. Most respondents emphasized the need to compile multiple medications' entries of information technology systems into one application (96.4%), allowing the entries from community pharmacies (90.6%). Further, incorporating information technology into the MedRec process presents a challenge in terms of legal responsibility (92 %) and the ability to integrate medications with other hospitals and community medications (78.6%). Findings affirm the need for a well-designed MedRec process aided with information technology solutions. The external data and user preferences should be considered when redesigning the MedRec process. The study also suggests initiating a policy that mandates sharing data necessary for creating a compiled medication list for each patient. MedRec is an indispensable tool for building a fruitful medication management system in a healthcare organization.

Medication Error Concept and Reporting Practices in Saudi Arabia: A Multiregional Study Among Healthcare Professionals

Background

Medication errors pose a risk for individual patients and for public health, with the misuse and overuse of medications being linked to severe patient safety problems. Therefore, the objective of this study was to investigate healthcare professionals’ (HCPs’) knowledge about medication errors, their knowledge about medication error reporting systems, and predictors for HCPs to report medication errors in Saudi Arabia.

Methods

An observational cross-sectional study was conducted among HCPs (physicians, pharmacists, and nurses) between January and March 2020. The study included 6 distinct locations in the Saudi Arabian regions of Hail, Al-Qassim, Al-Jouf, Al-Madinah, the eastern region, and the western region. Descriptive statistical and inferential analyses were computed using Statistical Package for the Social Sciences (SPSS) v.22.

Results

In total, 980 questionnaires for 348 (35.5%) physicians, 144 (14.7%) pharmacists, and 488 (49.8%) nurses were distributed with a response rate of 100%. Interestingly, only 277 (28.3%) of the HCPs had a good understanding of the stages of medication errors. With regard to reporting practices, a high number of the HCPs, 576 (58.8%), had not reported medication errors in their workplaces, and nearly 369 (37.7%) of respondents said they believe that legal implications are a major barrier to the reporting of medication errors. More than half, 524 (53.5%), of HCPs revealed that no clear electronic system is available for the reporting of medication errors in most hospitals. In addition, 537 (54.8%), of the HCPs had not attended any training programs regarding medication error reporting systems within the past year, which is alarming.

Conclusion

Our study identified a huge lack of the reporting of medication errors, knowledge about medication error stages, and training on medication errors. Therefore, an urgent need to address these weaknesses exists.

Policy Discourses: Shifting the Burden of Healthcare from the State to the Market in the Kingdom of Saudi Arabia

Saudi Arabia has modified from a predominantly free, public, and comprehensive system under a welfare model to more of a mixed-economy model of healthcare. The welfare state slowly moved to a liberal model, emphasizing market forces to dominate in the provision of healthcare and the private sector was trusted to provide a better provision of healthcare. The country has to confront enormous problems in the health sector due to population growth, lifestyle changes, the shift of disease patterns, elevated expectations, escalated healthcare costs, limited infrastructure and resources, and poor management practice in the provision of healthcare. Moreover, the government has been emphasizing the need to bring in private sector investment to improve quality and efficiency, development of manpower, and standardization of services. As the current pattern of healthcare is unsustainable, the country is planning to restructure the present healthcare system toward institutionalizing it to meet future challenges. The governments must make an appropriate amount of effort to build their healthcare systems by transforming and modifying the challenges faced by society and its political-economic systems. The government should encourage equity, and fairness in the provision of healthcare.

The comparative assessment of awareness, perspective, and basic practice skills about the Saudi pharmacovigilance system among students of different health-care professionals of a Saudi Female University

INTRODUCTION

The low reporting of adverse drug reactions (ADRs) in Saudi Arabia is prevalent among health-care professionals and is responsible for poor ADR signal detection. Therefore, all healthcare institutes connected with patient concern require joint and sustained efforts to strengthen ADR reporting by providing harmless and efficient medication.

OBJECTIVES OF THE STUDY

The current study was performed to estimate the awareness corresponding to the knowledge, perspective, and basic practice skills about the Saudi pharmacovigilance system among students of different health-care professionals of a Saudi Female University.

MATERIAL & METHODS

A questionnaire was planned and standardized by a thorough literature review. Questions were classified: Group 1 had ten knowledge-based, group 2 five attitude-based, and group 3 four basic practice skills-based questions of pharmacovigilance (PV). Also, determinants that hindered them from becoming part of the pharmacovigilance program were reported. Such 600 questionnaires were distributed among the interns, final and prefinal year students of different health care professionals of Princess Nourah bint Abdulrahman University, Riyadh. The participants' awareness and practice skills were graded in 3 categories as unacceptable, inadequate, and adequate, depending upon the mean score along with identification of their type of perception towards PV. The data was interpreted by calculating the frequencies, one-way ANOVA, and by post-hoc Tukey-Kramer HSD multiple comparison test.

RESULTS

Five hundred ninety-two questionnaires were statistically investigated. Students' awareness and basic practice skills of pharmacovigilance were found to be inadequate, but positive perception towards PV.

CONCLUSION

Our study showed that awareness and practice skills of PV among students of different health care professionals stand insufficient but favourable perceptions towards PV. Regular educative interventions can increase these parameters of pharmacovigilance.

Medication safety practices in healthcare facilities in Kaduna State, Nigeria: a study protocol

Background:

In recent years, there has been growing concern about patient safety and this is becoming a global problem. Medication safety can be used to describe systematic assessments of healthcare professionals’ practices as related to safe use of medicines. Identification and prevention of medication errors is the key component of medication safety. This includes multiple aspects of medication practice and other factors that affect it, such as organisational structure, communication, technologies such as those used for dispensing, and strategies pursued by leadership in cultivating and promoting a culture of safety.

Methods:

The study adopted a mixed method approach divided into three phases. Phase I is a quantitative phase and involves an assessment of core medication safety practices in the study sites together with an assessment of patient safety culture through the use of the Hospital Survey on Patient Safety Culture (HSOPSC) developed by US Agency for Health Care Research and Quality (AHRQ). Phase II will involve semi-structured interviews with health care providers and focus group discussions with patients to explore their perspectives on medication safety and to explore their experiences concerning medication safety respectively. Phase III will be an intervention study and will utilise the World Health Organisation (WHO) Patient Safety Curriculum Guide: Multi professional edition as the intervention tool.

Discussion:

The study findings will offer substantial opportunity for improvements. The study will also open up an area of patient safety culture, where not much research has been conducted in Nigeria.

The Privatization of Health Care System in Saudi Arabia

Saudi Arabia's Vision 2030 highlights the development of the health care sector through privatization. This study examines the factors that prompted the privatization of the health care sector in Saudi Arabia. This is a scoping review based on an extensive review of both published and unpublished documents. We have accessed different search engines and databases to collect various research publications, journal articles, government reports, policy and planning documents, and relevant press reports/articles. While privatization of the health care sector in Saudi Arabia has experienced an upward trend, the public health care sector remains vital to bring in overall improvements in the health of all sections of Saudi Arabia's population. Keeping this in view, the government must strengthen its public health care sector to ensure affordable, accessible, and high-quality health care for all. This manuscript focuses on the policy aspect of the privatization of health care and is based on secondary research material. Increased privatization leads to rising expenses in health care, while adversely affecting equity and accountability in the provision of its services. Although this study is an independent analysis of Saudi Arabia's health care system, lessons learned from this context could be used widely for policy-making in other countries with similar socioeconomic settings.

Reducing Missed Medication Doses in Intensive Care Units: A Pharmacist-Led Intervention

Objective:

The objectives of this study were to investigate the frequency and reasons for missing doses and impact of a pharmacist-led intervention to reduce the missed doses in intensive care units.

Methods:

This study was completed in two phases. In the first phase, a retrospective quality assurance audit was conducted to quantify the problem of missed doses from the pharmacist/nurse communication slip record. The frequency and potential reasons for missing dose occurrences were identified and listed, and respective solutions were finalized by a joint health-care team. In the second phase of the study, post-intervention analysis was done for a period of 1 month to check the impact of intervention. The data were recorded from pharmacy/nursing communication forms for medication, dosage form, route of administration (ROA), frequency of missed doses, and underlying reasons for missing doses.

Findings:

There was a substantial reduction in the number of incidences of missed doses in post-intervention phase. The number of events decreased from 190 (pre-intervention; 2 months) to 11 (post-intervention; 1 month), 389 to 87, and 133 to 12 for automatic stop order, unknown reason, and late mix medication, respectively. No missed dose event was recorded secondary to order overseen and inactive patient status in post-intervention phase. Moreover, identified reasons, ROA, frequency, and the system status were the significant predictors of missing doses.

Conclusion:

The findings of this study emphasized the need to introduce better documentation procedures and continuous surveillance system to decrease the number of missing doses and further improve already established drug distribution service.

Medication safety knowledge, attitude, and practice among hospital pharmacists in Lebanon

BACKGROUND

Studies showed that pharmacists have little experience with adverse drug reactions (ADRs) reporting due to insufficient knowledge of the concept of ADR and pharmacovigilance (PV). There is an urge to assess hospital pharmacists' knowledge in medication safety practices.

OBJECTIVE

To evaluate the knowledge, attitude, and practice, among hospital pharmacists in Lebanon concerning ADRs and PV concepts.

METHODS

A cross-sectional study, conducted between March and July 2016, enrolled 187 hospital pharmacists in all Lebanese districts.

RESULTS

Concerning knowledge, 60.8% of the pharmacists said that ADR is an injury caused by appropriate and suboptimal care, while 74.6% of them said it can be preventable and nonpreventable. Moreover, 47.5% of them defined PV as being the study that detects, assesses, understands, and prevents adverse effects. Furthermore, 55.1% believed that PV concerns drug, herbal, medical devices, and vaccine problems. Concerning attitude, 61% of the pharmacists said they do not support direct ADR reporting by the patient. Of them, 78.6% confessed that ADR reporting is a professional obligation to them while 88.2% admitted that it is time-consuming with no outcome. When it comes to practice, 64.2% had been trained to report ADRs. Only 20.8% and 24.2% confessed reporting ADRs more than once a week, respectively. More than half (54.5%) said that they report the ADR to the patient's prescriber.

CONCLUSION

Lebanese hospital pharmacists have little knowledge about the concept and process of PV and spontaneous ADRs reporting system. However, these pharmacists have positive attitudes, but very little practice with reporting systems. Educational programs are urgently needed to emphasize the role and responsibility of pharmacists in PV practices and to raise awareness towards ADR reporting process.

Adverse drug reaction reporting in a large tertiary hospital in Saudi Arabia: results of an incentive strategy

BACKGROUND

Underreporting is a common problem with spontaneous adverse drug reaction (ADR) reporting. In this study, we aim to describe the reporting of ADRs in a tertiary hospital and determine the effect of incentives to healthcare professionals on ADR reporting.

METHODS

In this interventional study, a time series analysis was used to determine the effect of incentives on ADR reporting in a tertiary hospital between 2015 and 2016. The incentive strategy included public commendation of health care providers and nomination for a monthly award.

RESULTS

A total of 967 ADRs were reported over a 2-year period. After the introduction of incentives in January 2016, the number of ADR reports per month increased by 40.6 (95% confidence interval: 26.1-55.1). The proportion of serious ADRs reported was significantly higher in 2016 (39/800) than 2015 (0/167) (p < 0.001). In 2016, there was a significant association between profession and serious ADR reporting (p < 0.001). A total of 14/21 ADRs (66.7%) reported by physicians in 2016 were serious compared with 20/700 (2.9%) reported by clinical pharmacists and 5/72 (6.9%) by nurses.

CONCLUSIONS

ADR reporting was improved by providing incentives, including commendation and reward, to healthcare professionals.

Attitudes of doctors and nurses toward patient safety within emergency departments of two Saudi Arabian hospitals

Background

A hospital culture that promotes and insures patient safety is a critical aspect for the effective delivery of hospital services and patient care. Yet there are significant patient health and safety issues in hospitals worldwide. This study aims to investigate doctors’ and nurses’ attitudes toward patient safety in the emergency departments (ED) of two Saudi hospitals.

Method

A cross-sectional survey using a validated Safety Attitudes Questionnaire (SAQ) was used. Total of 503 ED doctors and nurses completed SAQ. Correlation analysis, using Spearman’s Rho, was performed between the number of incidents reported and each dimension of the SAQ.

Results

The mean score of each SAQ dimension was < 75%, indicating that nurses and doctors generally had less than a positive safety attitudes. This was especially prominent with dimensions of stress recognition (58.1%) and perceptions of hospital management (56.9%). Furthermore, nurses reported significantly lower on the teamwork climate dimension than doctors (p < .01), whereas doctors reported significantly lower on the hospital work conditions dimension than nurses (p < .01). There was a significant negative correlation between the number of errors reported and teamwork climate, job satisfaction, and work conditions.

Conclusion

Safety attitudes of doctors and nurses employed in EDs of Saudi hospitals are less than positive and correlate with the number of reported errors. Safety training interventions and management support would appear to be the most likely avenues to improve the safety attitudes and performance within Saudi ED’s.

Medication safety officer preparatory course: Outcomes and experiences

Purpose

Few hospitals employ a medication safety officer. A medication safety officer preparatory course was planned using a structured curriculum to prepare pharmacists with the knowledge and skills to start medication safety officer activities. The current study aims to assess the outcome, as change in knowledge, of a hospital medication safety officer preparatory course.

Methods

We conducted a three-day course in February 2011 in Riyadh, Saudi Arabia. It was developed to provide attendees with the essential knowledge and skills to become a medication safety officer. Teaching methodologies included didactic teaching, group discussions, case presentations, and an independent study of medication safety materials. The content of the course focused on the various roles of a medication safety officer, the importance of medication safety in a health care setting, the incidence of adverse drug events in a hospital setting, strategies to identify and prevent adverse events, the use of root cause analysis and failure mode and effect analysis, the role of an officer in hospital accreditation, and ways for promoting safety culture. Assessment of the course outcome was accomplished by comparing scores of knowledge level before and after the course. The knowledge level was assessed by a 20-item exam which was developed and validated by course instructors.

Results

Twenty-one participants attended the course and completed both the baseline and after-course assessment questionnaires. The majority was male (N = 14, % = 66.7) with a job experience of 1–5 five years (N = 10, % = 47.6). The knowledge score increased from 14.3 ± 1.90 (mean ± standard deviation) at baseline to 18.5 ± 1.43 after successfully completing the course (P < 0.001).

Conclusion

A three-day medication safety officer preparatory course has been shown to significantly improve attendee knowledge about medication safety. Educating health care professionals is an important tool to help ensure the safety of patients.

A P&T Committee's Transition to a Complete Electronic Meeting System-A Multisite Institution Experience

PURPOSE

In the last few decades, changes to formulary management processes have taken place in institutions with closed formulary systems. However, many P&T committees continued to operate using traditional paper-based systems. Paper-based systems have many limitations, including confidentiality, efficiency, open voting, and paper wastage. This becomes more challenging when dealing with a multisite P&T committee that handles formulary matters across the whole health care system. In this paper, we discuss the implementation of the first paperless, completely electronic, Web-based formulary management system across a large health care system in the Middle East.

SUMMARY

We describe the transitioning of a multisite P&T committee in a large tertiary care institution from a paper-based to an all-electronic system. The challenges and limitations of running a multisite P&T committee utilizing a paper system are discussed. The design and development of a Web-based committee floor management application that can be used from notebooks, tablets, and hand-held devices is described. Implementation of a flexible, interactive, easy-to-use, and efficient electronic formulary management system is explained in detail.

CONCLUSION

The development of an electronic P&T committee meeting system that encompasses electronic document sharing, voting, and communication could help multisite health care systems unify their formularies across multiple sites. Our experience might not be generalizable to all institutions because this depends heavily on system features, existing processes and workflow, and implementation across different sites.

Medication reconciliation errors in a tertiary care hospital in Saudi Arabia: admission discrepancies and risk factors

Background:

Medication reconciliation is a major component of safe patient care. One of the main problems in the implementation of a medication reconciliation process is the lack of human resources. With limited resources, it is better to target medication reconciliation resources to patients who will derive the most benefit from it.

Objective:

The primary objective of this study was to determine the frequency and types of medication reconciliation errors identified by pharmacists performing medication reconciliation at admission. Each medication error was rated for its potential to cause patient harm during hospitalization. A secondary objective was to determine risk factors associated with medication reconciliation errors.

Methods:

This was a prospective, single-center pilot study conducted in the internal medicine and surgical wards of a tertiary care teaching hospital in the Eastern province of Saudi Arabia. A clinical pharmacist took the best possible medication history of patients admitted to medical and surgical services and compared with the medication orders at hospital admission; any identified discrepancies were noted and analyzed for reconciliation errors. Multivariate logistic regression was performed to determine the risk factors related to reconciliation errors.

Results:

A total of 328 patients (138 in surgical and 198 in medical) were included in the study. For the 1419 medications recorded, 1091 discrepancies were discovered out of which 491 (41.6%) were reconciliation errors. The errors affected 177 patients (54%). The incidence of reconciliation errors in the medical patient group was 25.1% and 32.0% in the surgical group (p<0.001). In both groups, the most frequent reconciliation error was the omission (43.5% and 51.2%). Lipid-lowering (12.4%) and antihypertensive agents were most commonly involved. If undetected, 43.6% of order errors were rated as potentially requiring increased monitoring or intervention to preclude harm; 17.7% were rated as potentially harmful. A multivariate logistic regression model showed that patients aged ≥65 years, polypharmacy, and prescriptions for hypoglycemic drugs and warfarin were more likely associated with reconciliation errors.

Conclusion:

There is a high failure rate in medication reconciliation process in patients admitted to the medical and surgical department. The reconciliation process proves to be a useful tool since nearly half of avoided reconciliation errors were unintentional and had the potential for harm. This strategy, based on our results and the difficulty of applying the process to all patients should be directed primarily to the patients at increased risk of error.

An assessment of the basic medication safety practices in Khartoum State hospitals

Purpose

To assess the presence of medication safety practices in Khartoum State hospitals.

Methods

A previously used questionnaire was used to evaluate medication safety practices. The main practices evaluated were the presence of a medication safety committee and error-reporting system, look-alike sound-alike (LASA) medications list, control of concentrated electrolyte solutions, care transitions, information technology, drug information and other medication safety practices. The primary investigator visited a stratified sample from all the three cities that comprise Khartoum State and interviewed the pharmacy supervisor of each hospital. Descriptive statistics were performed using SPSS V.22.

Results

A total of 41 senior pharmacists or pharmacy supervisors from 41 hospitals were interviewed. Only 2% of the hospitals had a list of LASA medications and 5% had a list of error-prone abbreviations. Only 5% of the hospitals had a medication safety committee, and none of the hospitals had a medication safety officer. None of the hospitals involved pharmacists in obtaining medication histories. Concentrated electrolytes were available in the floor stock in 67% of the hospitals. Although 24% of the hospitals used a computer system in their pharmacy to enter prescriptions, none of these hospitals required entry of patient allergies before entering a drug order.

Conclusions

Most of the hospitals in Khartoum State did not implement basic medication safety practices. Therefore, the Ministry of Health in Sudan should enforce laws and regulations making implementation of medication safety practices mandatory to ensure patient safety.

Incidence of adverse drug events in public and private hospitals in Riyadh, Saudi Arabia: the (ADESA) prospective cohort study

OBJECTIVES

To determine the incidence of adverse drug events (ADEs) and assess their severity and preventability in four Saudi hospitals.

DESIGN

Prospective cohort study.

SETTING

The study included patients admitted to medical, surgical and intensive care units (ICUs) of four hospitals in Saudi Arabia. These hospitals include a 900-bed tertiary teaching hospital, a 400-bed private hospital, a 1400-bed large government hospital and a 350-bed small government hospital.

PARTICIPANTS

All patients (≥12 years) admitted to the study units over 4 months.

PRIMARY AND SECONDARY OUTCOME MEASURES

Incidents were collected by pharmacists and reviewed by independent clinicians. Reviewers classified the identified incidents as ADEs, potential ADEs (PADEs) or medication errors and then determined their severity and preventability.

RESULTS

We followed 4041 patients from admission to discharge. Of these, 3985 patients had complete data for analysis. The mean±SD age of patients in the analysed cohort was 43.4±19.0 years. A total of 1676 ADEs were identified by pharmacists during the medical chart review. Clinician reviewers accepted 1531 (91.4%) of the incidents identified by the pharmacists (245 ADEs, 677 PADEs and 609 medication errors with low risk of causing harm). The incidence of ADEs was 6.1 (95% CI 5.4 to 6.9) per 100 admissions and 7.9 (95% CI 6.9 to 8.9) per 1000 patient-days. The occurrence of ADEs was most common in ICUs (149 (60.8%)) followed by medical (67 (27.3%)) and surgical (29 (11.8%)) units. In terms of severity, 129 (52.7%) of the ADEs were significant, 91 (37.1%) were serious, 22 (9%) were life-threatening and three (1.2%) were fatal.

CONCLUSIONS

We found that ADEs were common in Saudi hospitals, especially in ICUs, causing significant morbidity and mortality. Future studies should focus on investigating the root causes of ADEs at the prescribing stage, and development and testing of interventions to minimise harm from medications.

Knowledge of healthcare professionals about medication errors in hospitals

CONTEXT

Medication errors are the most common types of medical errors in hospitals and leading cause of morbidity and mortality among patients.

AIMS

The aim of the present study was to assess the knowledge of healthcare professionals about medication errors in hospitals.

SETTINGS AND DESIGN

A self-administered questionnaire was distributed to randomly selected healthcare professionals in eight hospitals in Madinah, Saudi Arabia.

SUBJECTS AND METHODS

An 18-item survey was designed and comprised questions on demographic data, knowledge of medication errors, availability of reporting systems in hospitals, attitudes toward error reporting, causes of medication errors.

STATISTICAL ANALYSIS USED

Data were analyzed with Statistical Package for the Social Sciences software Version 17.

RESULTS

A total of 323 of healthcare professionals completed the questionnaire with 64.6% response rate of 138 (42.72%) physicians, 34 (10.53%) pharmacists, and 151 (46.75%) nurses. A majority of the participants had a good knowledge about medication errors concept and their dangers on patients. Only 68.7% of them were aware of reporting systems in hospitals. Healthcare professionals revealed that there was no clear mechanism available for reporting of errors in most hospitals. Prescribing (46.5%) and administration (29%) errors were the main causes of errors. The most frequently encountered medication errors were anti-hypertensives, antidiabetics, antibiotics, digoxin, and insulin.

CONCLUSIONS

This study revealed differences in the awareness among healthcare professionals toward medication errors in hospitals. The poor knowledge about medication errors emphasized the urgent necessity to adopt appropriate measures to raise awareness about medication errors in Saudi hospitals.

Implementation of safety standards of compounded sterile preparations in hospital pharmacies: a multinational cross-sectional study

Objectives

To evaluate implementation of safety standards of compounded sterile preparations in different hospitals.

Methods

This cross-sectional study included 124 hospitals from 19 countries. A survey was developed based on the guidelines and safety practices of the Institute for Safe Medication Practices (ISMP) for sterile preparations compounding, and was sent to the members of the Intravenous and Parenteral Nutrition experts' network (IV PN experts' network) in the Gulf region and beyond using SurveyMonkey software.

Results

124 pharmacists were invited to participate in this study. Only 39 (31.5%) pharmacists from seven countries responded: 16 (41%) of the participants were pharmacy supervisors, and 23 (59%) had >10 years of work experience. However, a majority, 27 (69%), of the respondents were from Saudi Arabia. Written policies and procedures for sterile preparations compounding were available in 37 (95%) hospitals. The concentrated electrolytes were removed from all patient care areas in 28 (72%) hospitals, and 30 (77%) hospitals clearly labelled those as high-alert medications. The use of advanced technologies, such as bar code verification or IV robotics, for compounding sterile preparations were not implemented in 27 (69%) hospitals.

Conclusions

Minimum standards and best practice recommendations to ensure safety of sterile preparation compounding were implemented in many hospitals of different countries. However, advanced technologies were not implemented by the majority of the hospitals.

Knowledge and attitude of health-care professionals in hospitals towards pharmacovigilance in Saudi Arabia

BACKGROUND

Drug safety has major implications for patients' lives. However, this concept is still considered new to some healthcare professionals.

OBJECTIVE

This study aims to investigate the knowledge and awareness of Saudi healthcare professionals to pharmacovigilance (PV). Setting Governmental and private hospitals at three main cities in Saudi Arabia (Riyadh, Jeddah, and Dammam).

METHODS

A cross-sectional survey among healthcare professionals (pharmacists, physicians, and nurses) within 12 Saudi hospitals was conducted between November and December 2012. The questionnaire consisted of 18 questions assessing the knowledge, awareness, and attitude of healthcare professionals (HCPs) towards science and the concept of PV. Descriptive statistics were used to analyze the data. The data were analyzed using Statistical Analysis Software (SAS 9.3). Main outcome measure Knowledge, attitude and practice of HCPs toward pharmacovigilance.

RESULTS

Three-hundred and thirty-two healthcare professionals completed the survey (response rate 72 %), 110 (34 %) physicians, 106 (33 %) pharmacists, and 104 (32 %) nurses. More than half of the participants (55 %) did not know the correct definition of PV. Two-thirds of the respondents, 207 (65.5 %), had knowledge of the aim of post-marketing surveillance, yet only 113 (36.9 %) were aware that the National Pharmacovigilance and Drug Safety Center is the official body for monitoring adverse drug reaction in Saudi Arabia. In addition, 34.7 % agreed that lack of time could be a major barrier for reporting. The majority of the respondents (78.4 %) believed that reporting was a professional obligation and hospitals should have a drug safety department.

CONCLUSIONS

There was a limited knowledge of pharmacovigilance that could have affected reporting incidence. Educational intervention and a practical training program need to be applied by the drug regulatory body as well as health authorities to enhance the pharmacovigilance and drug safety culture in Saudi Arabia.

An intervention to improve inpatient medication management: a before and after study

AIM

To optimise medication administration, prevent medication errors and improve inpatient safety.

BACKGROUND

Interventions are needed to reduce medication-related errors and to improve patient safety.

METHOD

A five-point management intervention strategy was developed and implemented. A quasi-experimental design was used to examine its effects.

RESULTS

Comparing pre-intervention data with post-intervention data, the rate of accurate compliance with medication policies and procedures increased from 86.7% (645/744 doses observed) to 97.5% (725/744). The success rate of medication administration procedures increased from 94.0% (466/496 doses observed) to 96.8% (480/496). Nurse-initiated medication error reports/total medication error reports increased from 77.1% (101/131) to 95.1% (58/61). Rate of inpatient satisfaction with medication increased from 92.1% (3427/3720) to 98.3% (3656/3720). Complaints related to nursing medication administration decreased from 23 to 6 (73.9% reduction).

CONCLUSION

The five-point management intervention strategy improved inpatient medication safety: medication errors were reduced, nurses' awareness and skills of medication safety enhanced, inpatient satisfaction improved. However, randomised controlled trials are needed to test its effectiveness.

IMPLICATIONS FOR NURSING MANAGEMENT

A systematic approach is vital to address the issues of medication errors and patient safety.