Insulin pumps: from inception to the present and toward the future

As an alternative to the usual insulin injections, insulin pumps have been introduced as an advanced method of insulin delivery for managing type 1 diabetes mellitus patients. This review documents the history of insulin pump development and the production of 'smart pumps' that offer patients greater dosing accuracy, flexibility, and ease of use. This has resulted in an increase in the number of insulin pump users around the world. This paper also provides a comprehensive survey of the pumps currently available on the market and their specifications. Unique features of each product and the drawbacks are addressed in the review. The future direction of insulin pump development is targeted toward closing the loop, to allow feedback control between an insulin pump and a glucose sensor, and hence finer adjustment of insulin delivery rates as required.

Experiences of children/young people and their parents, using insulin pump therapy for the management of type 1 diabetes: qualitative review

WHAT IS KNOWN AND OBJECTIVE

Advances in medical technology have made insulin pumps an attractive treatment option for patients with type 1 diabetes and in particular for children and young people. Previous studies have accounted the experiences and views of children/young people and their parents for the use of the injection therapy, but very few have focused on the use of insulin pumps. The objective of this review was to identify studies that explore the experiences of children/young people and their parents on the transition from injections to insulin pump therapy, in the context of their social life.

METHODS

A systematic literature search was conducted, and six studies meeting the inclusion and exclusion criteria were identified.

RESULTS

  Views and perspectives from the studies identified mainly focused on: introduction to the pump; reasons for the transition to pump therapy; advantages and disadvantages of this treatment option; and impact on quality of life (QoL). Parents and/or children reported that they learned about pump therapy either formally from a healthcare professional or informally from a friend or the internet. Many reasons were identified for the transition, the most important being the pursuit of stable and controlled blood sugar levels and the desire for a more flexible lifestyle. Participants highlighted the advantages of insulin pumps in terms of improved diabetes control. Moreover, there was a positive impact on the QoL, as insulin pumps provided children greater flexibility in lifestyles especially with regards to meals and socialization. In contrast, psychosocial issues such as pump visibility and physical restrictions were highlighted as disadvantages. Issues such as day-to-day management were also discussed.

WHAT IS NEW AND CONCLUSION

Exploring children/young people's perspectives on the use of pump therapy for managing their diabetes, and parental reflections in caring for those children is important as it provides evidence informing policy for the wider implementation of this technology in the management of diabetes in children. However, the review revealed that there is a scarcity of data in this area and that further research is needed.

Hospital Admission Trends Due to Viral Infections Characterised by Skin and Mucous Membrane Lesions in the Past Two Decades in England and Wales: An Ecological Study

Objectives: This study aimed to investigate the trends in hospital admissions due to viral infections characterized by skin and mucous membrane lesions in England and Wales between 1999 and 2019. Methods: This is an ecological study using publicly available databases in England and Wales; the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. Hospital admissions data were collected for the period between April 1999 and March 2019. Hospital admissions due to viral infections characterized by skin and mucous membrane lesions were identified using the tenth version of the International Statistical Classification of Diseases system, diagnostic codes B00–B09. The trend in hospital admissions was assessed using a Poisson model. Results: Hospital admissions for different causes increased by 51.9% (from 25.67 (95% CI 25.23–26.10) in 1999 to 38.98 (95% CI 38.48–39.48) in 2019 per 100,000 persons, trend test, p < 0.01). The most prevalent viral infections characterized by skin and mucous membrane lesions hospital admissions causes were zoster (herpes zoster), varicella (chickenpox), herpesviral (herpes simplex) infections, and viral warts, which accounted for 26.9%, 23.4%, 18.7%, and 17.6%, respectively. The age group below 15 years accounted for 43.2% of the total number of admissions. Females contributed to 50.5% of the total number of admissions. Hospital admission rate in males increased by 61.1% (from 25.21 (95% CI 24.59–25.82) in 1999 to 40.60 (95% CI 39.87–41.32) in 2019 per 100,000 persons). The increase in females was 43.2% (from 26.11 (95% CI 25.49–26.72) in 1999 to 37.40 (95% CI 36.70–38.09) in 2019 per 100,000 persons). Conclusion: Our study demonstrates an evident variation in hospital admission of viral infections characterized by skin and mucous membrane lesions based on age and gender. Efforts should be directed towards vaccinating high-risk groups, particularly the elderly and females. Moreover, efforts should be focused on vaccinating the young population against varicella, particularly females who are more susceptible to acquiring the infection. Further observational and epidemiological studies are needed to identify other factors associated with increased hospital admission rates.

Insulin pump therapy: impact on the lives of children/young people with diabetes mellitus and their parents

BACKGROUND

Advances in medical technology and research documenting clinical effectiveness have led to the increased use of insulin pumps worldwide. However, their use by children in the UK is relatively limited and there is little evidence regarding their impact on patients' lives.

OBJECTIVE

This study aimed to examine the impact of switching from multiple daily injections to insulin pumps on the glycaemic control and daily lives of children/young people and their families.

SETTING

University College London Hospital, London.

METHOD

Face-to-face semi-structured interviews were conducted with children/young people with type 1 diabetes mellitus (5-17 years; N = 34) and their parents (N = 38), receiving insulin pump therapy and attending paediatric diabetes outpatients clinics at a major university teaching hospital in London. Glycated haemoglobin A1c values from 6 months prior to, and after pump therapy were obtained. Qualitative and quantitative approaches were undertaken for data analysis.

MAIN OUTCOME MEASURE

Glycated haemoglobin A1c and the impact of the use of insulin pumps on the children and their families.

RESULTS

The majority of parents (N = 32) and the children/young people (N = 30) reported that glycaemic control was easier to maintain within the target range with pumps compared to injections. This was supported by glycated haemoglobin A1c measures. Participants generally found the devices easy to use and more acceptable than injections. However, parents and children/young people reported many challenges in the early stages of pump therapy (e.g. 7 children/young had worse control at 6 months after starting CSII). Parents and children/young people reported an overall increase in lifestyle flexibility and an improved ability to participate in home, school and social activities whilst maintaining glycaemic control.

CONCLUSION

Administration of insulin via pumps rather than injections was generally preferred. Participants reported most difficulty at the commencement of use. Pump therapy conferred benefits in terms of glycaemic control, general well-being, enabling young people to be more in control of their condition and live more normal lives, as reported by most participants. These are important goals of health policy for children/young people with long-term conditions in the UK.

A qualitative study exploring patients' experiences regarding insulin pump use

BACKGROUND

Diabetes is a threat to peoples' lives around the world, particularly in the Middle East. Medicine misuse and poor glycaemic control are prevalent among patients with type 2 diabetes, especially insulin-dependent patients (Alsairafi et al., 2016). With advances in medical technology, insulin pumps became a treatment option for patients with type 1 diabetes and those with insulin-dependent type 2 diabetes. However, use of these devices is still lacking in Kuwait, particularly in patients with type 2 diabetes. Information on how patients manage these devices and their efficacy and safety from the perspectives of patients is also lacking (Alsaleh et al., 2016).

OBJECTIVE

To examine the views and experiences of adults with type 2 diabetes regarding the use of insulin pumps compared to their previous insulin delivery methods, in terms of glycaemic control, quality of life, preference, convenience and adherence to doses.

SETTING

The main five secondary-care hospitals in Kuwait: Mobarak Al-Kabeer, Al Amiri, Al Adan, Al Farwaniya and Al Jahra.

METHOD

All adults with type 2 diabetes who used an insulin pump were invited to participate. Data were collected through semi-structured interviews. Data analysis was performed using MAXQDA-11.

RESULTS

A total of eight patients were interviewed. Interviews with patients revealed that using an insulin pump improved patients' glycaemic control and quality of life as a consequence of improved satisfaction and adherence to doses.

CONCLUSION

From the perspective of adults with type 2 diabetes, there are lots of benefits of using insulin pumps over other insulin delivery methods, mainly seen by the improvement of quality of life and patients' adherence to doses. Policy-makers and healthcare professionals (HCPs) must be aware of such benefits and should support the wider implementation of this technology in the country by including patients with type 2 diabetes. Results of this study will help to inform healthcare provision and guideline modifications and to provide guidance for new patients using this therapy.

Knowledge and practice of foot self-care among patients with diabetes attending primary healthcare centres in Kuwait: A cross-sectional study

BACKGROUND

Diabetes mellitus is a major public health issue and is the main cause of morbidity and mortality worldwide. At the time of diagnosis, many patients with type 2 diabetes (T2D) have one or two risk factors for diabetic foot diseases, such as diabetic peripheral neuropathy (DPN) and diabetic foot ulcers (DFUs). Patients can overcome such complications through good knowledge and practice of foot self-care. This study aims to evaluate the knowledge and practice of foot care among patients with diabetes mellitus attending primary healthcare centres (PHCs) in Kuwait and to identify those at risk for developing DPN.

METHODS

A cross-sectional study was conducted using a pre-tested self-administered questionnaire. The questionnaire included questions on demographic characteristics and patients' knowledge and practices of foot care. Adult patients (aged 21 and above) with a diagnosis of diabetes mellitus for at least 1 year were randomly selected from PHCs located in the five governorates of Kuwait. Data were analysed using SPSS, version 26.

RESULTS

A total of 357 patients participated in this study, giving a response rate of 87.3%. The overall mean knowledge score of foot care was 12.7 ± 2.7 (equals 81.3%). Most patients (n = 283, 79.3%) showed good knowledge. In comparison, less than one-third of patients (n = 110, 30.8%) practiced good foot care. The overall mean score of patients' practices was 55.7 ± 9.2 (equals 64.0%). Approximately 17.4% of the patients had a higher risk of developing DPN. University students had lower odds of having good knowledge about foot care [OR: 0.19 (95%CI: 0.04-0.86)]. On the other hand, patients who reported having diabetes for a long duration (10 years and above) [OR: 1.88 (95%CI: 1.11-3.18)] and patients who did not have any other comorbidities [OR: 0.49 (95%CI: 0.26-0.90)] had higher odds of having good foot care knowledge. Patients who were on oral hypoglycaemic agents (OHAs) only had lower odds [OR: 0.63 (95%CI: 0.39-1.00)] of practicing good foot care. Patients who reported having diabetes for a duration between 5 to less than 10 years [OR: 1.75 (95%CI: 1.06-2.90)] and those who are on a diet only [OR: 1.76 (95%CI: 1.06-2.94)] had higher odds of practicing good foot care. Patients who were using combination therapy with OHAs and insulin had a higher risk [OR: 2.67 (95%CI: 1.11-6.41)] of developing DPN. On the other hand, patients who reported that they did not have a previous history of foot ulcer had a lower risk of developing DPN [OR: 0.21 (95%CI: 0.09-0.47)].

CONCLUSION

The knowledge of patients with diabetes regarding foot care is rated as good, while their self-practice is considered satisfactory. To improve the foot care knowledge and self-care practice of patients, healthcare providers (HCPs) need to support patients through educational programmes and appropriate training.

Trends of Hospital Admissions Due to Congenital Anomalies in England and Wales between 1999 and 2019: An Ecological Study

Objectives: To investigate the trends in congenital anomalies-related hospital admissions in England and Wales. Methods: This was an ecological study that was conducted using hospital admission data taken from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. Congenital malformations, deformations and chromosomal abnormalities hospital admissions data were extracted for the period between April 1999 and March 2019. Results: Hospital admission rate increased by 4.9% [from 198.74 (95% CI 197.53–199.94) in 1999 to 208.55 (95% CI 207.39–209.71) in 2019 per 100,000 persons, trend test, p < 0.01]. The most common hospital admissions causes were congenital malformations of the circulatory system, the musculoskeletal system, genital organs, and the digestive system. The most notable increase in hospital admissions rate was observed in congenital malformations of the respiratory system (1.01-fold). The age group below 15 years accounted for 75.1% of the total number of hospital admissions. Males contributed to 57.5% of the whole number of hospital admission. Hospital admission rate between females was increased by 6.4% [from 162.63 (95% CI 161.10–164.16) in 1999 to 173.05 (95% CI 171.57–174.54) in 2019 per 100,000 persons]. Hospital admission rate between males was increased by 3.4% [from 236.61 (95% CI 234.72–238.50) in 1999 to 244.70 (95% CI 242.92–246.49) in 2019 per 100,000 persons]. Conclusions: Males had a higher percentage of hospitalisation compared to females. Further studies to investigate the factors associated with higher hospitalisation rate among males are needed.

Adverse drug reaction reporting among physicians working in private and government hospitals in Kuwait

Introduction

To improve patient safety and care, the identification and reporting of adverse drug reactions (ADRs) should be systematic and mandatory for all healthcare professionals (HCPs). Physicians remain the main HCPs with direct patient care whose role in ADRs reporting should not be ignored.

Objective

To document the awareness and attitude of physicians working in private and government hospitals in Kuwait with regard to pharmacovigilance (PV) and ADR reporting and to identify their practices of reporting ADRs.

Material and methods

A cross-sectional study was conducted using a paper-based 25-item questionnaire. The Statistical Package for Social Science (SPSS) was used for data analysis.

Results

A total of 1017 questionnaires were distributed to the eligible physicians in the government and private hospitals, giving a response rate of 84.2% and 83.0%, respectively (an overall response rate of 83.8%). Private physicians exhibited a better knowledge profile with regards to the purpose of PV (75.2% vs 64.8%; p = 0.002) and the correct ADR definition (75.8% vs 65.3%; p = 0.001). The majority of physicians showed good attitude towards reporting ADRs, nevertheless, private physicians had a significantly stronger belief that reporting ADRs is a professional obligation (93.4% vs 85.5%; p = 0.001). Three quarters of the study population (74.6%) had identified an ADR during their daily practice, however, only a small proportion (34.2%) confirms having ever reported ADRs. Regardless, significantly more private physicians had done so (42.4% vs 29.6%; p < 0.001). ADR reporting was significantly higher in physicians who knew the correct ADRs to be reported (adjusted OR = 1.86, p = 0.036), and those who were aware of any center or ADR reporting system in Kuwait (adjusted OR = 2.88, p = 0.020).

Conclusions

A national PV center empowered by clear legislation on “how” and “what” to report should improve physicians’ reporting practices and hence is required in the country. This should be combined with constant training and education in this regard.

Reporting of Adverse Drug Reactions in Primary Care Settings in Kuwait: A Comparative Study of Physicians and Pharmacists

OBJECTIVE

To investigate and compare knowledge, attitudes, and practices regarding pharmacovigilance (PV) and the reporting of adverse drug reactions (ADR) among physicians and pharmacists in primary care settings.

SUBJECTS AND METHODS

A cross-sectional study was conducted, in which a validated self-administered questionnaire was distributed to 386 physicians and 197 pharmacists in 38 primary care clinics in Kuwait. Categorical variables were described using numbers and percentages. The Pearson χ2 test, Fisher exact test, and Mann-Whitney U test were used as appropriate. p < 0.05 was considered statistically significant.

RESULTS

Of the 583 questionnaires distributed, 485 were completed (by 318 physicians and 167 pharmacists), giving an overall response rate of 83.2%. A total of 52.8% (n = 256) and 70.5% (n = 341) of the study participants were knowledgeable about the definitions of PV and ADR, respectively, with pharmacists demonstrating significantly better knowledge of PV (n = 105/167 vs. 151/318, i.e., 62.9 vs. 47.5%; p < 0.001) and purpose (n = 123/167 vs. 177/318, i.e., 74.1 vs. 55.7%; p < 0.001). However, the majority (n = 434/485; 89.4%) were not aware of an ADR reporting system in Kuwait. Almost every participant (n = 474/485; 97.7%) thought it was necessary to report ADR. However, significantly fewer physicians than pharmacists (n = 248/318 vs. 147/167, i.e., 78.0 vs. 88.0%; p < 0.01) believed that ADR reporting was a professional obligation. Only 27.8% (n = 133/485) had reported ADR, with pharmacists having reported significantly fewer than physicians (n = 35/167 vs. 98/318, i.e., 21.7 vs. 30.8%; p = 0.036).

CONCLUSIONS

This study indicated that the attitude was positive but there was suboptimal knowledge and poor practice among primary care physicians and pharmacists with regard to ADR reporting. Targeted training about ADR reporting while ensuring a robust regulatory framework would encourage ADR reporting practices in the primary health care setting in Kuwait.

Perceived Knowledge, Attitude, and Practices (KAP) and Fear toward COVID-19 among Patients with Diabetes Attending Primary Healthcare Centers in Kuwait

OBJECTIVES

To assess perceived fear and to evaluate the level of knowledge, attitude, and prevention practices (KAP) regarding COVID-19 infection among patients with diabetes mellitus (DM) attending primary healthcare centers (PHCs) in Kuwait. This will help evaluate gaps and provide appropriate support to limit the spread of COVID-19 infection in high-risk patients.

METHODS

A descriptive cross-sectional study was carried out using a self-administered questionnaire. All patients aged 18 years or older attending for follow-up or newly diagnosed with type 1 or type 2 diabetes were eligible to participate in the study. Patients waiting for their regular follow-up appointments at the PHCs were invited verbally to take part in the study. The study excluded patients under the age of 18 and those with significant cognitive or physical impairment that might interfere with independent self-care behavior. The questionnaire included 57 items. The data were analyzed using descriptive statistics.

RESULTS

A total of 294 questionnaires were distributed to patients at PHCs in three health districts (Hawally, Capital, and Farwaniya) in Kuwait; 251 patients agreed to participate in the study, yielding a response rate of 85.4%. The study showed that most patients had moderate knowledge (71.1%) of COVID-19. The majority of correctly responded questions were about the mode of COVID-19 transmission, the most common clinical presentations, and at-risk people. On the other hand, 83.7% (n = 210) identified common cold symptoms (stuffy nose, runny nose, and sneezing) as COVID-19 symptoms. More than half of the patients (n = 146, 58.2%) were unable to identify uncommon COVID-19 symptoms, such as diarrhea and skin rash or discoloration. Most patients had a positive attitude (90.9%) and good prevention practices (83.6%). The overall fear score of the participating patients was 21.6 ± 6.5 (61.7%).

CONCLUSIONS

Regardless of the positive attitude and good preventive practices of the patients, they had moderate knowledge levels about COVID-19. This indicates that there are significant knowledge gaps that still need to be filled. Different strategies can be used for this purpose, such as social media and public information campaigns. Supporting psychological well-being is vital for at-risk patients during a pandemic.

Medication Errors in Secondary Care Hospitals in Kuwait: The Perspectives of Healthcare Professionals

Objectives: Medication errors (MEs) are the most common cause of adverse drug events (ADEs) and one of the most encountered patient safety issues in clinical settings. This study aimed to determine the types of MEs in secondary care hospitals in Kuwait and identify their causes. Also, it sought to determine the existing system of error reporting in Kuwait and identify reporting barriers from the perspectives of healthcare professionals (HCPs).

Material and Methods: A descriptive cross-sectional study was conducted using a pre-tested self-administered questionnaire. Full-time physicians, pharmacists, and nurses (aged 21 years and older) working in secondary care governmental hospitals in Kuwait were considered eligible to participate in the study. Descriptive statistics and the Statistical Package for Social Science Software (SPSS), version 27 were used to analyze the data.

Results: A total of 215 HCPs were approached and asked to take part in the study, of which 208 agreed, giving a response rate of 96.7%. Most HCPs (n = 129, 62.0%) reported that the most common type of ME is “prescribing error,” followed by “compliance error” (n = 83; 39.9%). Most HCPs thought that a high workload and lack of enough breaks (n = 128; 61.5%) were the most common causes of MEs, followed by miscommunication, either among medical staff or between staff and patients, which scored (n = 89; 42.8%) and (n = 82; 39.4%), respectively. In the past 12 months, 77.4% (n = 161) of HCPs reported that they did not fill out any ME incident reports. The lack of feedback (n = 65; 31.3%), as well as the length and complexity of the existing incident reporting forms (n = 63; 30.3%), were the major barriers against reporting any identified MEs.

Conclusions: MEs are common in secondary care hospitals in Kuwait and can be found at many stages of practice. HCPs suggested many strategies to help reduce MEs, including proper communication between HCPs; double-checking every step of the process before administering medications to patients; providing training to keep HCPs up to date on any new treatment guidelines, and computerizing the health system.

The perspectives of patients and physicians on the role of pharmacists in improving medication adherence in type 2 diabetes: a qualitative study

BACKGROUND

Pharmacy practice has been expanded to include responsibility for the outcomes of medication therapy. However, in developing countries the pharmacist's role is still limited to dispensing medications. The aim of this study is to explore the perspectives of patients and physicians on the pharmacist's role in improving medication adherence in type 2 diabetes.

METHODS

Data were collected via semi-structured interviews with patients and physicians. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.

RESULTS

A total of 40 patients and 21 physicians were interviewed. The interviews revealed different pharmacy-related issues that negatively affected patients' adherence, such as a lack of pharmacist counselling and inappropriate scheduling of refills. Various recommendations to improve adherence were emphasised such as dedicating some pharmacists to counselling patients and providing pharmacists with the appropriate training.

CONCLUSION

From the perspectives of patients and physicians, the pharmacist's role in the management of type 2 diabetes is still limited to dispensing medications. In order to improve medication adherence and consequently patient outcomes, policy-makers need to be aware of the importance of supporting pharmacists and providing them with the appropriate training.

Experiences of children/young people and their parents, using insulin pump therapy for the management of type 1 diabetes: qualitative review

WHAT IS KNOWN AND OBJECTIVE

Advances in medical technology have made insulin pumps an attractive treatment option for patients with type 1 diabetes and in particular for children and young people. Previous studies have accounted the experiences and views of children/young people and their parents for the use of the injection therapy, but very few have focused on the use of insulin pumps. The objective of this review was to identify studies that explore the experiences of children/young people and their parents on the transition from injections to insulin pump therapy, in the context of their social life.

METHODS

A systematic literature search was conducted, and six studies meeting the inclusion and exclusion criteria were identified.

RESULTS

  Views and perspectives from the studies identified mainly focused on: introduction to the pump; reasons for the transition to pump therapy; advantages and disadvantages of this treatment option; and impact on quality of life (QoL). Parents and/or children reported that they learned about pump therapy either formally from a healthcare professional or informally from a friend or the internet. Many reasons were identified for the transition, the most important being the pursuit of stable and controlled blood sugar levels and the desire for a more flexible lifestyle. Participants highlighted the advantages of insulin pumps in terms of improved diabetes control. Moreover, there was a positive impact on the QoL, as insulin pumps provided children greater flexibility in lifestyles especially with regards to meals and socialization. In contrast, psychosocial issues such as pump visibility and physical restrictions were highlighted as disadvantages. Issues such as day-to-day management were also discussed.

WHAT IS NEW AND CONCLUSION

Exploring children/young people's perspectives on the use of pump therapy for managing their diabetes, and parental reflections in caring for those children is important as it provides evidence informing policy for the wider implementation of this technology in the management of diabetes in children. However, the review revealed that there is a scarcity of data in this area and that further research is needed.

Trends in Hospital Admissions for Mental, Behavioural and Neurodevelopmental Disorders in England and Wales between 1999 and 2019: An Ecological Study

Objectives: To investigate the trends in hospital admissions for mental, behavioural and neurodevelopmental disorders (MBNDs) in England and Wales. Methods: This is an ecological study using the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. Hospital admission data was collected for the period between April 1999 and March 2019. Results: The most common type of hospital admission was for mental and behavioural disorders due to psychoactive substance use, which accounted for 26.6%. The admission rate among males increased by 8.1% [from 479.59 (95% CI 476.90−482.27) in 1999 to 518.30 (95% CI 515.71−520.90) in 2019 per 1000 persons; p < 0.001]. The admission rate among females increased by 0.3% [from 451.45 (95% CI 448.91−453.99) in 1999 to 452.77 (95% CI 450.37−455.17) in 2019 per 1000 persons; p = 0.547]. The 15−59 years’ age group accounted for 65.1% of the entire number of such hospital admissions, followed by the 75 years and above age group, with 19.0%. Conclusion: We observed an obvious variation in MBNDs influenced by age and gender. Observational studies are needed to identify other factors associated with increased hospital admission rates related to MBNDs, specifically among the young population (aged 15−59 years) and males.

Assessment of a patient safety culture: a nationwide cross-sectional study comparing public and private hospitals in Kuwait

BACKGROUND

Several international health bodies advocate measuring patient safety culture within an organisation as an effective strategy for sustainably improving safety. This study aims to assess and compare patient safety culture across public and private hospitals in Kuwait.

METHODS

A cross-sectional study was conducted utilising the Hospital Survey of Patient Safety Culture. The questionnaire was distributed among clinical staff in public general and private hospitals. Data analysis using Microsoft Excel and SPSS 23 (α level = 0.05) provided an overview of participant characteristics and patient safety culture scores. A model for predicting the determinants of patient safety culture score was constructed from a regression analysis.

RESULTS

A total of 890 questionnaires were distributed equally between the public and private sectors. The overall response rate was 94.9%. Assessment of the positive percentage of patient safety culture showed that nationally, five composites were areas of strength: "Teamwork within Units" (87.2%), "Organizational Learning-Continuous Improvement" (87.5%), "Management Support for Patient Safety" (77.8%), "Feedback & Communication about Error" (75.8%) and "Teamwork across Units" (75.0%). Private hospitals showed these same areas of strength, whereas public hospitals had fewer. Private hospitals scored statistically significant higher positive percentages than public hospitals in most of the composites. Benchmarking against a 2015 study in Kuwait indicates that the positive percentages of six composites increased at the national level, whereas four remained the same. "Staffing" and "Non-punitive response to errors" were strikingly low.

CONCLUSION

In this first national study to assess patient safety culture in public and private hospitals in Kuwait, many areas of safety culture had improved. However, some areas require special attention, although causality cannot be inferred, which is a limitation of the study's design. A comparison between the two sectors revealed differences in the patient safety culture, which might be relevant to the guidelines governing them. Policymakers should set unified guidelines governing staffing in both sectors and devise intervention strategies to develop a culture that establishes learning from adverse events and supports patient safety, incorporating a just culture and whistle-blower protection. In academia, Kuwait University should incorporate patient safety and quality-of-care topics into its curricula.

Hospitalisations related to administration errors of psychotropic drugs: a nationwide retrospective study between 1998 and 2019 in Australia

Objectives: Medication administration error occurs when there is a discrepancy between what the patient received or was planned to receive and what the doctor originally intended. The aim of this study was to examine the trends in hospitalisation related to administration errors of psychotropic drugs in Australia. Materials and Methods: This was a secular trend analysis study that examined the hospitalisation pattern for medication administration errors of psychotropic drugs in Australia between 1998 and 2019. Data on medication administration errors of psychotropic drugs was obtained from The National Hospital Morbidity Database. We analysed the variation in hospitalisation rates using the Pearson chi-square test for independence. Results: Hospitalisation rates related to administration errors of psychotropic drugs increased by 8.3% [from 36.22 (95% CI 35.36-37.08) in 1998 to 39.21 (95% CI 38.44-39.98) in 2019 per 100,000 persons, p < 0.05]. Overnight-stay hospital admission patients accounted for 70.3% of the total number of episodes. Rates of same-day hospitalisation increased by 12.3% [from 10.35 (95% CI 9.90-10.81) in 1998 to 11.63 (95% CI 11.21-12.05) in 2019 per 100,000 persons]. Rates of overnight-stay hospital admission increased by 1.8% [from 25.86 (95% CI 25.13-26.59) in 1998 to 26.34 (95% CI 25.71-26.97) in 2019 per 100,000 persons]. Other and unspecified antidepressants (selective serotonin and norepinephrine reuptake inhibitors) were the most common reason for hospitalisation accounting for 36.6% of the total number of hospitalisation episodes. Females accounted for 111,029 hospitalisation episodes, representing 63.2% of all hospitalisation episodes. The age group 20-39 years accounted for nearly half (48.6%) of the total number of episodes. Conclusion: Psychotropic drug administration error is a regular cause of hospitalization in Australia. Hospitalizations usually required overnight stays. The majority of hospitalizations were in persons aged 20-39 years, which is concerning and warrants further investigation. Future studies should examine the risk factors for hospitalization related to psychiatric drug administration errors.