Drug, Healthcare and Patient Safety最新文献

Background: Post-anesthesia recovery is a continuous process which is considered to be complete after the patient returns to their preoperative physiological state. Although all patients who have had an operation under anesthesia are in a potentially unstable physiological state, most patients recover safely without significant problems due to better and immediate post-anesthesia care. Therefore, this study aimed to assess the staffing and service provision in the post-anesthesia care unit.

Methods: A multicenter, institution-based cross-sectional study was conducted in post-anesthesia care units from November 28 to December 31, 2020. The data were collected using a questionnaire prepared from standards and guidelines of the American Society of Anesthesiologists, the American Association of Nurse Anesthetists, and the Royal College of Anesthetists by direct observation.

Results: Ten hospitals found in Amhara regional state were examined for their staffing of and service provision in their post-anesthesia care units. The total ratio of nurses assigned in post-anesthesia care units to post-anesthesia care unit beds was around 1:3, with a minimum and a maximum ratio of 1:8 and 1:2, respectively. The average number of patients admitted in post-anesthesia care units per week was 98. Eighty percent of the hospitals' post-anesthesia care units had no policy or caregivers for cardiac arrest management.

Conclusions and recommendations: Standards, policies, and guidelines are not well prepared and posted so as to be visible to every caregiver. The majority of the hospitals have staff without special training for the management of possible complications in the post-anesthesia care unit. Generally, hospitals need to ensure standardized patient care in the post-anesthesia care unit for better and safer patient outcomes.

Background: Sodium hyaluronate/chondroitin sulfate fixed combination plays an essential role in the treatment of keratoconjunctivitis sicca, a multifactorial disease accompanied by ocular symptoms like alteration of the tear film. Despite low or no absorption of such drugs, these can cause secondary effects. An essential tool in the study of medication behavior is active pharmacovigilance. Unlike spontaneous reporting pharmacovigilance, this tool allows an appraisal of adverse drug reactions (ADRs)' real incidence, a higher capacity to identify safety signals, the relationship with concomitant drugs and pathologies prevalent in the study population. This study aimed to evaluate the safety profile and identify and/or assess adverse reactions in an uncontrolled population.

Methods: Active pharmacovigilance by Drug Event Monitoring was performed. A total of 3 follow-up calls were made for 30 days for the identification of the ADRs, tolerability (ADR severity, seriousness, long term sequelae, and duration) and the possible risks (safety signals, medical interactions) of sodium hyaluronate and chondroitin sulfate (HUM).

Results: Thirty-five ADRs were identified in the 212 patients included in the study (0.17 ADR/patient). The 35 ADRs were classified into 3 System Organ Class (SOC) groups: general disorders and administration site conditions (74.2%), eye disorders (22.9%), and nervous system disorders (2.9%); and 4 Preferred Term (PT) groups: burning sensation (74.2%), followed by blurred vision (20%), ocular pain (2.9%) and headache (2.9%). All the ADRs were categorized as mild and not serious. No statistically significant differences were found in concomitantly medications, posology and age groups.

Conclusion: Good tolerability to the solution was identified, with a low incidence of ADRs. Just the same, all the associated ADRs were consistent with the information found in HUM's physicochemical profile and the physiopathology of DED. No unknown risks were identified, reinforcing HUM's safety profile.

The care of older patients with cancer is becoming increasingly complex. Common challenges for this population include management of comorbidities, safe transitions of care, and appropriate medication use. In particular, polypharmacy-generally defined as the regular use of five or more medications-and inappropriate medication use can lead to adverse effects and poor outcomes in older adults with cancer, including falls, hospital readmissions, cognitive impairment, poor adherence to essential medications, chemotherapy toxicity, and increased mortality. Managing polypharmacy across different cancer care settings is often challenging. Providers face barriers to safe and successful medication management that may include lack of time, absence of reimbursement, underappreciation of the scale of polypharmacy-related harm, lack of ownership of deprescribing efforts, and poor communication across care settings. Existing literature on managing inappropriate medication use and polypharmacy in older adults with cancer has often focused on ideal state settings in which resources are plentiful and time is purposefully allocated for medication interventions. This paper presents a narrative, rather than a systematic review, of studies published in the past decade that provided detailed information on medication management and polypharmacy across cancer care settings. This review aims to also summarize different healthcare provider roles in taking action against inappropriate medication use and polypharmacy in older adults with cancer.

Introduction: Patients presenting to the emergency department (ED) frequently require procedural sedation and analgesia (PSA) to facilitate procedures, such as joint reduction. Proper documentation of screening demonstrates awareness of the necessity of presedation assessment. It is unknown if introducing emergency physicians (EPs) at the ED improves presedation assessment and documentation. In this study the differences in documentation of ED sedation and success rates for reduction of hip dislocations in the presence versus absence of EPs are described.

Methods: In this retrospective descriptive study, we analyzed data of patients presenting with a dislocated hip post total hip arthroplasty (THA) shortly after the introduction of EPs. The primary outcome measure was the presence of documentation of presedation assessment. Secondary outcomes were documentation of medication, vital signs, and success rate of hip reductions.

Results: In the two-year study period, 133 sedations for hip reductions were performed. Sixty-eight sedations were completed by an EP. The documentation of fasting status, airway screening, analgesia use, and vital signs was documented significantly more often when an EP was present (respectively 64.9%, 80.3%, 37.4%, and 72.7%, all P < 0.001). There was no difference in success rate of hip reductions between the groups.

Conclusion: PSA in the ED is associated with superior documentation of presedation assessment, medication, and vital signs when EPs are involved.

The role of patient adherence in improving the efficacy of any treatment is widely accepted, as well as its impact in optimizing the use of healthcare resources and associated costs. Adherence is particularly affected in chronic conditions, such as rheumatoid arthritis (RA), requiring long-term therapies and a commitment of the patient to manage his/her disease. Methotrexate (MTX) is one of the mainstays of treatment for several immune-mediated inflammatory joint and skin diseases, especially RA. The use of parenteral MTX, particularly when administered as a subcutaneous (SC) injection, has recently raised a great interest to overcome the limitations of oral MTX. For addressing this issue, new optimized self-injection systems have been developed to improve the ease of use of SC MTX. Increasing evidence shows how patients tend to opt for autoinjectors over prefilled syringes or conventional syringes in terms of easiness of use, preference and satisfaction, regardless of whether the treatment is a biologic or MTX. Additionally, positive views and beliefs of patients about treatment may contribute to increasing expectations of effectiveness and treatment adherence. Similarly, the implementation of prefilled pens in clinical practice might be a way to facilitate and simplify the self-injection of SC MTX delivery, optimizing adherence and treatment outcomes as a consequence. This article aimed to review the available literature data on the use of MTX autoinjectors and their impact on treatment adherence and patients' perceptions.

Background: Cytotoxic drugs (CDs) administration and occupational exposure is a worldwide concern. Inappropriate handling may cause toxic residues to infiltrate hospital environments and patient care areas, and can even be traced to patients' homes. Hence, the study sought to assess knowledge and practices on the safe handling of cytotoxic drugs Among Oncology Nurses at Tertiary Teaching Hospitals in Addis Ababa, Ethiopia.

Methods: The researchers conducted a hospital-based cross-sectional study among 77 nurses from April 1-30, 2019. Purposive sampling was used in recruiting the respondents. Structured questionnaires were filled through self-administered interviewing. Data were analyzed using SPSS version 23 software. Multiple linear regression was performed to see the association between dependent variables and independent variables at a p-value of less than 0.05.

Results: Mean score of knowledge and practice of nurses was 7.82±2.22 out of 15 and 22.1±5.50 out of 40 respectively. Nearly 69% of nurses reported the lack of training program on the handling of CDs at their workplaces and the use of Personal Protective Equipment (PPE) remains suboptimal as none used all of PPE. Nurses who had not heard about CDs had an average knowledge score of 0.33 points lower than nurses who had heard about CDs (p ≤ 0.01). Nurses who have scored higher knowledge points had 0.33 points more practice score of safe CD handling than those who had lower knowledge score (p < 0.05) and also married nurses had average safe CDs handling practice score 0.27 points lower than their counterparts (p < 0.05).

Conclusion: Nurses' knowledge and practice of safe handling of cytotoxic drugs are inadequate. Nurses who have scored higher knowledge points and are married were more likely to practice safe CD handling. Provision of proper PPE and training regarding the handling of CDs for Oncology Nurses are recommended and chemotherapy safety protocol and guidelines should be established.

Background: Irrational use of drugs has been one of the major problems around the globe. However, the degree of the problem is higher in developing countries like Ethiopia. The WHO has developed several indicators to evaluate the practices of drug use. This study aimed to assess the overall drug use practices using standard WHO indicators in Lumame Primary Hospital.

Methods: Hospital-based retrospective cross-sectional study was employed to investigate the overall drug use practices at the hospital. Six hundred prescriptions were selected from a total of 19,242 prescriptions by systematic sampling technique over one year from July 1, 2019, to June 30, 2020, in a retrospective review. For the patient care study, 100 patients were selected for collecting the required information. Facility indicators were assessed by checking the availability of STG/formularies and essential drugs. The results were interpreted according to the standard values of WHO.

Results: All 600 sampled prescriptions were 100% standard. Weight, dosage form, and quantity were written in 1.5-13.3% of the prescriptions. Patient address was recorded in 51%, while qualification of prescriber and dispenser were recorded in 71.5% and 56% of the cases, respectively, but all other information were complete in 88.5-100% of the prescriptions. The mean number of drugs per encounter, generic prescribing, prescribing from essential drug list, encounters with antibiotics and injectable drugs were 2.3, 97.9%, 99.8%, 48.8%, and 11.2%, respectively. The average dispensing time was found to be 171.9 seconds. Percentage of actually dispensed drugs, adequacy of labeling, patient knowledge, and patient satisfaction were 95.3%, 22.6%, 83%, and 88%, respectively. About 92% of tracer drugs and all reading materials, except national drug list and facility-level drug formulary, were available in the study period.

Conclusion: Generally, appreciable results were obtained for most of the indicators but improvement in antibiotic prescribing, polypharmacy and labeling practice is recommended.

Introduction: Inappropriate drug utilization may reduce the best possible benefits of drug therapy, and patients may not be cured, they may be exposed to toxicity, and medications may be wasted. The aim of this study is to assess household-level drug utilization practices and their associated factors.

Methods: A cross-sectional community-based study was conducted from January 15 to March 15, 2020. In total, 847 households selected by stratified multistage sampling were visited. Bivariate and multivariable analyses for association were carried out using a binary logistic regression model. The statistical significance of an association was confirmed at p<0.05.

Results: Of the total 847 households, 378 (44.6%) were found to store drugs at home at the time of datacollection. In the 371 households that allowed observation of the drugs stored, a mean of 2.51 (SD=1.68) drugs per household was found; 40.2% of stored medicines were not in use at the time of the study. The prevalences of medication hoarding, sharing, and allopathic self-medication were 20.4%, 26.3%, and 43.8%, respectively. Higher monthly income and the presence of a child aged under 5 years were significantly associated with drug hoarding. The presence of an elderly person aged above 65 years and the presence of a family member with chronic illness were significantly associated with drug hoarding and sharing. Families with higher educational status were less likely to hoard and share medicines. The presence of stored drugs at home was significantly associated with the practice of self-medication.

Conclusion: A high prevalence of inappropriate drug utilization was observed. Factors such as the presence of a family member with chronic illness, elderly people, and children under 5, higher income, and the presence of stored drugs were significantly associated with inappropriate drug utilization. Families of higher educational status were less likely to hoard and share medicines.

Purpose: Rubbing the hands with alcohol-based handrub (ABHR) is globally recommended as the preferred approach to prevent healthcare-associated infections in most routine encounters with patients, except in cases handwashing with soap and water is advised. Inappropriate utilization of ABHR could have detrimental effects, most importantly during the coronavirus disease (COVID-19) pandemic, which include exposure of healthcare professionals to healthcare-associated infections and the development of resistant microorganisms. In a hospital setting, the utilization of ABHR among frontline healthcare workers including pharmacy professionals is low. Therefore, the purpose of this study was to explore the current practice of hand rubbing among pharmacy professionals in public hospitals of Addis Ababa during the pandemic of COVID-19.

Methods: The study was a cross-sectional study using a self-reported questionnaire conducted among pharmacy professionals in public hospitals found in Addis Ababa from 10th May to 9th June, 2020 to recognize ABHR utilization rate. Data were collected on a sample of 384 pharmacy professional by a self-administered questionnaire. Data analysis was done using software for the statistical package for social science version 25.0. To identify the significant predictors of ABHR utilization practice bivariable and multivariable logistic regressions were carried out. Crude odds ratio and adjusted odds ratio with 95% confidence interval were calculated to determine the predictors.

Results: Out of 384 participants, three hundred and four participants were included in the final analyses after the exclusion of incomplete responses. Female participants represented 41.4% of the study participants. More than half (58.9%) of the pharmacy professionals had sufficient knowledge on ABHR utilization for COVID-19 prevention. Similarly, 56.6% of pharmacy professionals had positive attitude towards ABHR for COVID-19 prevention. But only 35.9% of the study participants had good ABHR utilization practice.

Conclusion: Despite the modest level of knowledge and attitude towards ABHR, pharmacy professionals' utilization practice of ABHR for COVID-19 prevention was found to be suboptimal. Provision of ABHR solutions through hospitals and increasing the awareness of pharmacy professionals on ABHR needs to be encouraged.

Introduction: Despite self-medication empowers patients in making decisions about the management of minor illnesses independently, the prevalence among health care professionals has sharply increased throughout the world. Self-medication has negative consequences on both the health care professionals themselves and health care delivery. Hence, this study assessed self-medication practices and associated factors among health care professionals at Debre Markos Comprehensive Specialized Hospital.

Methods: A facility-based cross-sectional study was conducted using a structured questionnaire among health care professionals working at Debre Markos Comprehensive Specialized Hospital from October 10 to 25, 2020. A systematic random sampling technique was employed to select 227 study participants. Multivariate logistic regression was computed using the statistical package for social sciences version 20 and variables with a p-value less than 0.05 were taken as statistically significant. Results were presented in the form of tables and graphs.

Results: Among 227 health professional, 164 (72.2%; 95% CI: 66.0%, 77.7%) practiced self-medication. Of these, 107 (65.2%; 95% CI: 57.3%, 71.8%) stated the negative consequence of self-medication. Drug resistance 96 (89.7%) and adverse drug reaction 95 (88.8%) were reported as a consequence. The predictor of self-medication among health professionals was the pharmacy profession (AOR: 11.88, 95% CI (1.38-102.38)). The most common disease conditions for practicing self-medication were headache 153 (93.3%), respiratory tract infection 116 (70.7%) and gastrointestinal symptoms 103 (62.8%). Pain killers 154 (93.9%), antibiotics 122 (74.4%), and antacid 101 (61.6%) were frequently used for self-medication and health professionals got the medicines from drug retail shops 130 (79.3%) and workplace 104 (63.4%). Mild disease condition 128 (78%), time-saving 124 (75.6%), and accessibility 97 (59.1%) were the reasons for self-medication.

Conclusion: More than two-thirds of health professionals practiced self-medication and reported the negative consequence of self-medication. The predictor of self-medication was the pharmacy profession. The provision of appropriate health education was recommended for promoting rational medication use.