Medication Preparation Research Articles

A complexity theory perspective of kaizen: a study in healthcare

Kaizen projects (KPs) change the interactions between the elements of socio-technical systems, and therefore their impacts cannot be fully controlled. By using complexity theory as a lens for making sense of interactions, this study proposes a nine-step framework for assessing and influencing KPs planned, under way, and completed. The most innovative part of the framework is the assessment of the interactions within and between KPs. A study of five KPs carried out in the process of preparation and administration of medications in a surgical ward illustrates the use of the framework. Based on this study and extant theory, seven design propositions that support the framework application were devised. Also, the use of the framework produces descriptive data that sheds light on nuances and unintended consequences of kaizen.

O preparo de medicamentos realizado por um time de medicação: estudo descritivo

The medication team is a work group formed by nurses who dedicate themselves to the stages of the medication system, with certain uniformity in the accomplishment of the activities; however, no standardization of their work process was developed. Aim: describe the preparation of enteral medications and parenteral solutions by the medication team in the neonatal unit. Method: this is a qualitative, descriptive study that uses the action research method. The subjects were the nurses of the medication team of the neonatal unit. Data collection consisted of: document search; observation of medication preparation; and collection of problems at the medication team meeting. Results: updating of the theme and attributions of the nursing team of the neonatal unit; construction of flowcharts related to the preparation of medicines. Conclusion: the study allowed implementing interventions in the preparation of medicines carried out by the study subjects, standardizing the steps and defining the work relationships of the nursing team.

A Cost Minimization Analysis of Ready-to-Administer Prefilled Sterilized Syringes in a Dutch Hospital

PurposePreparation errors occur frequently during conventional preparation of parenteral medication in the clinical environment, causing patient harm and costs for the national health care system. The use of ready-to-administer prefilled sterilized syringes (PFSSs) produced by the hospital pharmacy can reduce preparation errors and the risk of bacteremia from contamination of the intravenous medication. The aim of this research is to compare the total costs of the conventional preparation method (CPM) with the PFSS method. MethodsIn this cost-minimization analysis, costs related to the preparation of the medication, bacteremia from contamination, adverse drug events as a result of preparation medication errors, and wastage of syringes were taken into account. Annual costs in a general Dutch hospital were consistently calculated. Three scenarios were analyzed: (1) all preparations as CPM (864,246 administrations per year), (2) all preparations as PFSSs, and (3) 50% as PFSSs and 50% as CPM. Deterministic and probabilistic sensitivity analyses were performed. FindingsThe first scenario found higher annual costs at €14.0 million (US$16.0 million) compared with the second scenario (€4.1 million, US$4.7 million). The most realistic situation (third scenario) found savings of €4.9 million (US$5.6 million) compared with the first scenario. Sensitivity analyses revealed that cost savings of PFSSs were strongly influenced by decreased risk of medication errors and contamination of intravenous medication. Extrapolating these results nationwide indicated potential savings of >€300 million (US$342 million) if only PFSSs were used. ImplicationsThe use of PFSSs prepared in the hospital pharmacy yielded cost savings compared with the CPM on the ward in the Dutch hospital.

Collaborative Management Strategies for Drug Shortages in Neurocritical Care.

Drug shortages have become all too familiar in the health care environment, with over 200 drugs currently on shortage. In the wake of Hurricane Maria in September 2017, hospitals across the USA had to quickly and creatively adjust medication preparation and administration techniques in light of decreased availability of intravenous (IV) bags used for compounding a vast amount of medications. Amino acid preparations, essential for compounding parenteral nutrition, were also directly impacted by the hurricane. Upon realization of the impending drug shortages, hospitals resorted to alternative methods of drug administration, such as IV push routes, formulary substitutions, or alternative drug therapies in hopes of preserving the small supply of IV bags available and prioritizing them for them most critical needs. In some cases, alternative drug therapies were required, which increased the risk of medication errors due to the use of less-familiar treatment options. Clinical pharmacists rounding with medical teams provided essential, patient-specific drug regimen alternatives to help preserve a dwindling supply while ensuring use in the most critical cases. Drug shortages also frequently occur in the setting of manufacturing delays or discontinuation and drug recalls, with potential to negatively impact patient care. The seriousness of the drug shortage crisis reached public attention by December 2017, when political and pharmacy organizations called for response to the national drug shortage crisis. In this article, we review institutional mitigation strategies in response to drug shortages and discuss downstream effects of these shortages, focusing on medications commonly prescribed in neurocritical care patients.

Nurses' self-assessments of adherence to guidelines on safe medication preparation and administration in long-term elderly care.

Medication-related errors are common in elderly care. Most are detected during the preparation and administration stages of the medication process. Nursing staff have a key role in preventing errors, and it is based on adherence to guidelines. The aim was to determine nursing staff's self-assessments of how they adherence to guidelines on safe medication preparation, administration and asepsis in the medication process in long-term elderly care and to identify factors affecting this adherence. Cross-sectional study was conducted by total sampling at the communal long-term elderly care wards of one healthcare district in Finland in November 2016. Data were collected from nursing staff by using a previously developed web-based questionnaire. The response rate was 39.4% (n=492). One-third of the nurses stated that they do not always follow guidelines when preparing medication, and around a half deviate from them occasionally, when administering medication. The most serious deviation on preparation stage was crushing of sustained release and enteric-coated tablets and mixing of crushed tablets together. On administration stage, the deviation of guidelines of giving medicine in recommended time or in relation to food was common. Associations were detected between the adherence to guidelines and the nurses' experience about the adequacy of their knowledge of pharmacology and infection control, and their skill at performing medication calculations. Deviation from guidelines often causes an error. There is a need to review the teaching of pharmacology, infection control and medication calculations during undergraduate and continuing education. In addition, nursing staff must be reminded about the ethical aspects of safe medication processes and the appropriate attitudes to these processes. Nurses must understand why it is important to follow guidelines when preparing and administering medications, in order to avoid errors.

PMU84 TARGETED LITERATURE REVIEW OF TIME UTILIZATION ASSOCIATED WITH THE USE OF PREFILLED SYRINGES VERSUS CONVENTIONAL SYRINGES

Conventional syringes used for medication administration require more steps to prepare compared to prefilled syringes (PFS). The purpose of this study is to quantify time savings with the use of PFS over conventional vials and syringes in a hospital setting. A targeted literature review was conducted in PubMed and Embase databases using search terms related to PFS, conventional syringes, vials, and time. The search was limited to studies involving human participants, published in a peer-reviewed journal between 2001 and 2018. A study qualified for inclusion if it reported preparation time of hospital injectable medications (including acute care drugs and biologics) with PFS and conventional method. A total of six studies qualified for inclusion. All studies found that PFS are associated with faster preparation times compared to conventional syringes. Reductions in mean preparation times ranged from 27.0%-58.9% (for anesthesia and biologics) with the use of PFS, mostly due to fewer preparation steps. In the case of anesthesiology drugs, a study reported that it takes an average of ∼1 minute for hospital pharmacies to conventionally prepare one anesthesia syringe, with another study reporting that 200 syringes of anesthesia are prepared by hospital pharmacy over 5 weeks. Extrapolating this data for one year, utilization of PFS may allow pharmacies to save 562 to 1,225 minutes in preparation time annually. In addition to anesthesiology drugs, time savings realized from other drugs such as biologics can further increase the annual time savings associated with drug preparation. The use of PFS results in time savings when compared to conventional method. Additionally, using PFS may have patient safety implications such as fewer delays to treatments, a crucial factor in emergent cases, and fewer medication errors. Time saved in medication preparation may allow healthcare workers to dedicate more time towards higher value tasks such as direct patient care.

Drug preparation and administration errors during simulated paediatric resuscitations

IntroductionVery few studies have assessed drug preparation and administration errors during paediatric resuscitation. Current evidence suggests that medication errors in paediatrics are a serious problem. The aim of this study...

Liquisolid pellets: A pharmaceutical technology strategy to improve the dissolution rate of ritonavir

Liquisolid pellets (LPs) prepared by extrusion-spheronization are promising delivery systems to improve the dissolution rate of poorly water-soluble drugs. However, developing LPs for high dose drugs (e.g. antiretroviral ritonavir, RTV) is a major challenge due to technical and quality constraints. In this study, formulations LP1 and LP2 were obtained (RTV 100 mg/unit dose) using microcrystalline cellulose (carrier), Kollidon® CL-SF (coating and disintegrating material) and high load (30%, w/w) of Kolliphor® EL or PEG 400 (non-volatile solvent). LP1 and LP2 had narrow size distribution, good morphological properties, and excellent flowability. The partial conversion of RTV polymorph I to the less soluble form II occurred during the preparation of the liquid medications. LP1 (containing Kolliphor® EL) achieved 82.64 ± 2.17% of drug dissolved in 30 min (Q30min), compared with 53.14 ± 0.6% and 42.42 ± 2.09% for LP2 (containing PEG 400) and Norvir® tablets, respectively. Also, LP1 promoted 1.9-fold/1.7-fold and 8.19-fold/8.29-fold increases in Q30min/DE60min (dissolution efficiency) as compared to neat RTV polymorphs I and II, respectively.

Investigation of healthcare infection risks from water-related organisms: Summary of CDC consultations, 2014-2017.

Water exposures in healthcare settings and during healthcare delivery can place patients at risk for infection with water-related organisms and can potentially lead to outbreaks. We aimed to describe Centers for Disease Control and Prevention (CDC) consultations involving water-related organisms leading to healthcare-associated infections (HAIs). Retrospective observational study. We reviewed internal CDC records from January 1, 2014, through December 31, 2017, using water-related terms and organisms, excluding Legionella, to identify consultations that involved potential or confirmed transmission of water-related organisms in healthcare. We determined plausible exposure pathways and routes of transmission when possible. Of 620 consultations during the study period, we identified 134 consultations (21.6%), with 1,380 patients, that involved the investigation of potential water-related HAIs or infection control lapses with the potential for water-related HAIs. Nontuberculous mycobacteria were involved in the greatest number of investigations (n = 40, 29.9%). Most frequently, investigations involved medical products (n = 48, 35.8%), and most of these products were medical devices (n = 40, 83.3%). We identified a variety of plausible water-exposure pathways, including medication preparation near water splash zones and water contamination at the manufacturing sites of medications and medical devices. Water-related investigations represent a substantial proportion of CDC HAI consultations and likely represent only a fraction of all water-related HAI investigations and outbreaks occurring in US healthcare facilities. Water-related HAI investigations should consider all potential pathways of water exposure. Finally, healthcare facilities should develop and implement water management programs to limit the growth and spread of water-related organisms.

Feed refusal in fattening bulls because of maize silage contamination by Jimson weed (Datura stramonium)

A sudden decrease in feed intake (within 24 hours) without an impaired general condition occurred on a bull-rearing and -fattening farm in western Germany in December 2017. One day later, some of the bulls displayed signs of ruminal tympany (free gas bloat) and the reduction in feed intake became more severe. The maize silage was recognized as the cause of the observed symptoms, because clinical signs first appeared after taking the silage from a different localization within the bunker silo. Maize in this particular section was harvested from a separate area previously affected by wind damage (numerous bent maize plants), where no crop protection (herbicide application) was performed. Fruits and seeds of Jimson weed were identified in the incriminated maize silage samples. Following replacement of the contaminated parts of the maize silage with non-contaminated material and treatment of the clinically affected animals (anti-tympanic medication plus live yeast preparation), the feed intake returned to the normal level and the affected animals recovered within 6 days. The cause of the symptoms was probably the anti-nutritive properties of Datura stramonium that affect the motor function of the gastrointestinal tract.

National Survey of Medication Safety Practice: Preparation of Medication and Dispensing at Primary Healthcare Centers/Community Pharmacies in Riyadh, Saudi Arabia

Pharmacology, Toxicology and Biomedical Reports,2018,4,3,49-57.DOI:10.5530/PTB.2018.4.15Published:September 2018Type:Research ArticleAuthors:Yousef Ahmed Alomi, Adel Mehmas H. Alragas, Manar Mohammed Alslim, Rana Mohammed Alslim, Khulud Abdulrahman Alamoudi, and Zainab Abdulmunem Almuallem Author(s) affiliations:Yousef Ahmed Alomi1, Adel Mehmas H. Alragas2, Manar Mohammed Alslim3, Rana Mohammed Alslim4, Khulud Abdulrahman Alamoudi5, Zainab Abdulmunem Almuallem​6 1The Former General Manager of General Administration of Pharmaceutical Care, The Former Head, National Clinical pharmacy and pharmacy practice, The Former Head, Pharmacy R and D Administration, Ministry of Health, Riyadh, SAUDI ARABIA. 2Medical city-king Saud university, Riyadh, SAUDI ARABIA. 3Staff pharmacist, Prince Sultan Military Medical City, Riyadh, SAUDI ARABIA. 4Staff pharmacist, Ministry of Health, Riyadh, SAUDI ARABIA. 5Narcotic in-charge, Alhammadi hospital Riyadh, SAUDI ARABIA. 6Saudi Food and Drug Authority Riyadh, SAUDI ARABIA. Abstract:Objective: To explore the national medication safety practice in terms of medication preparation and dispensing at Primary Healthcare Centers (PHCs) and Community Pharmacies (CPs) in Riyadh, Kingdom of Saudi Arabia. Methods: This is a 4-month cross-sectional medication safety practice survey conducted at PHCs and CPs in Riyadh. The survey consisted of the modified version of the Medication Safety Self-Assessment® for Community/Ambulatory Pharmacy from the Institute for Safe Medication Practices (ISMP). The survey consisted of a demographic section and 10 domains with 198 questions. The 10 domains included patient information; drug information; communication of drug orders and other drug information; drug labeling, packaging and nomenclature; use of medical devices; environmental factors; staff competency and education; patient education; quality processes; and risk management. This study emphasizes on the medication preparation and dispensing as per the Medication Safety Self-Assessment for Community/Ambulatory Pharmacy, Riyadh. Results: The survey was distributed to 13 PHCs and 23 CPs. The average score of all the ISMP self-assessment of medication safety items at PHCs was 2.75±0.36 (54.94 %) with 95% confidence interval (95% CI) = 2.55–2.95 (P<0.05; range = 2.04–3.38). The average score of all the ISMP self-assessment of medication safety items at CPs was 3.14±0.42 (62.86%) with 95% CI = 2.90–4.38 (P<0.05; range = 2.40–3.88). The average score of the communication of drug orders and other drug information domain at all hospitals were 2.57±0.38 (51.4 %) with 95% CI = 2.36–2.78 (P<0.05; range = 1.92–3.25) at PHCs and in the CPs, it was 2.44±0.35 (48.8 %) with 95% CI = 2.245–2.635 (P<0.05; range = 2.00–3.09). The average score of drug labeling, packaging and nomenclature domain at all hospitals was 2.57± 0.41 (51.4 %) with 95% CI = 2.35–2.79 (P<0.05; range = 1.83–3.08) at PHCs and in CPs, it was 3.2±0.59 (64%) with 95% CI = 2.89–3.51, (P<0.05; range = 2.20–4.05). Conclusion: Fifty percent of medication safety critical elements of ISMP standards was implemented during the preparation and dispensing of medication in the PHCs and CPs. Targeting to improve medication safety key at PHCs and CPs to prevent drug-related problems is required in the Kingdom of Saudi Arabia. Keywords:Adverse drug reaction, Ministry of Health, Pharmaceutical Care, Saudi Arabia, SystemView:PDF (316.8 KB) PDF PDF Images Scores of Items of Communication of Drug Orders and other Drug Information Domain.

Incivility and Patient Safety: A Longitudinal Study of Rudeness, Protocol Compliance, and Adverse Events

Little is known about the impact of social interactions on iatrogenesis and lapses in patient safety. This field-based experience-sampling study of primarily nurses in a general hospital explored the impact of rudeness on patient safety performance, state depletion (that is, exhaustion of mental energy for reflective behavior), and team processes (for example, information sharing). Objective measures of performance were compliance with hand hygiene and medication preparation protocols, as well as archival reports of adverse events. Data were analyzed by department shift (480 shifts [15 days] in 16 departments). A total of 231 rudeness incidents were reported in 98 shifts, most stemming from a patient or family. Compliance with hand hygiene was significantly lower up to 24 hours after rudeness exposure (p = 0.03). Rudeness significantly increased team members' state depletion (p = 0.002) and was associated with decreased information sharing (p = 0.046) but was not directly associated with adverse events or level of compliance with medication and hand hygiene protocols. However, the adverse indirect effect of shifts' temporal proximity to rudeness on poor compliance with medication preparation and team members' information sharing via state depletion was significant. Rudeness exposure was also associated with increased rate of adverse events in the subsequent 24 hours, although this association was not statistically significant. Rudeness exposure was associated with reduced team member compliance with infection control and medication protocols via greater team member state depletion and diminished information sharing.

Knowledge about the administration and regulation of high alert medications among nurses in Palestine: a cross-sectional study

BackgroundMedication errors (MEs) are unintended failures in the drug treatment process that can occur during prescription, dispensing, storing, preparation or administration of medications. High alert medications (HAMs) are defined as those medications that bear the highest risk of causing significant patient harm when used incorrectly, either due to their serious adverse events or to a narrow therapeutic window. Nurses are responsible for administration of HAMs; incorrect administration can have a significant clinical outcome. This study aimed to assess the level of knowledge of HAMs among nurses in government hospitals in West Bank, Palestine.MethodsA cross-sectional study was conducted in 2015, in West Bank, Palestine. Data were collected via a face to face interview questionnaire, which was taken from a previous study. Data were collected by convenient sampling. The questionnaire consisted of four parts: demographic characteristics of the nurses, drug administration knowledge (10 true-false questions), drug regulation knowledge (10 true-false questions), and self-evaluation.ResultsA total of 280 nurses participated in the study; these nurses were working in the emergency room (ER), intensive care unit (ICU), paediatric or medical ward. The response rate was 93%. Nurses were found to have insufficient knowledge about HAMs; 67.1% of participants had a score of less than 70%, with a mean total score of 59.9 ± 15.1. Factors associated with sufficient knowledge among nurses were HAMs training and ICU training, both with p-values of 0.002. Nurses with a master degree, those working in the ICU ward, head nurses, and male nurses were the most knowledgeable groups, with a p-values < 0.001. 81.8% of respondents hoped to obtain additional training. The leading obstacles reported were inconsistent opinions between doctors and nurses (37.9%), and no established standard operating procedure for HAMs (37.1%).ConclusionsLack of knowledge was one of the obstacles that nurses encountered during administration of HAMs which might result in MEs. Nurses reported that they would like to have additional training to update their pharmacology knowledge. Nurses could benefit from additional continuing education and training programs.

Process improvement strategy to prepare and administer bacillus Calmette-Guérin vaccine in compliance with United States Pharmacopeia chapter 800 standards.

This case study describes a multidisciplinary initiative to promote the safe use, preparation, and administration of bacillus Calmette-Guérin (BCG) in patients with bladder cancer that is in compliance with United States Pharmacopeia chapter 800. After an evaluation of a hospital's medication-use process for the preparation and administration of BCG identified inconsistencies with guideline-based procedures for the safe handling and manipulation of hazardous drug products, a revised medication-use process promoting the inclusion of pharmacy services was developed by pharmacy and urology clinic leaders. Implementation of the enhanced medication-use process included (1) the shift of BCG vaccine preparation from urology clinic nurses to a pharmacy equipped with the appropriate engineering controls for the safe preparation of hazardous product, (2) greater involvement by pharmacists in BCG order justification and verification, and (3) a process that ensured just-in-time preparation and delivery of medication for enhanced patient satisfaction. After initial process changes resulted in increased turnaround time from preparation to administration, a study on time to preparation, delivery, and administration was conducted and resulted in complete reduction of turnaround times and increased patient satisfaction. Through a multidisciplinary initiative involving pharmacists, physicians, nurses, and leadership, a new process to promote the safe preparation and administration of the tuberculosis vaccine Mycobacterium bovis BCG was developed and implemented. The results of a post-implementation time study indicated that a standardized approach to scheduling, preparing, and administering BCG was effective in managing the operations of BCG through having high clinic and patient satisfaction.

Hand hygiene and needleless connector decontamination for peripheral intravenous catheter care—time and motion observational study

Good hand hygiene and "scrub the hub" practices are important to prevent bloodstream infections. This observational study (n = 108) found high compliance with "scrubbing the hub," although scrub time was shorter than the recommended duration (average 6.1 seconds). Compliance with hand hygiene before medication preparation (33%) and before medication administration (43%) showed room for improvement compared with postadministration (65%), the emergency setting and glove use were associated with poorer compliance (P < .01).

Evaluation to improve the quality of medication preparation and administration in pediatric and adult intensive care units.

PurposeTo determine the type, frequency, and factors associated with medication preparation and administration errors in adult intensive care units (ICUs) and neonatal ICUs (NICUs)/pediatric ICUs (PICUs).Patients and methodsWe conducted a prospective direct observation study in an adult ICU and NICU/PICU in a tertiary university hospital. Between June 2012 and June 2013, a clinical pharmacist and medical student observed the nursing care staff on weekdays during the preparation and administration of intravenous drugs. We analyzed the frequency and type of preparation and administration errors and factors associated with errors.ResultsSix hundred and three preparations in the adult ICU and 281 in the NICU/PICU were observed. Three hundred and eighty-five errors occurred in the adult ICU and 38 in the NICU/PICU. There were 5,040 and 2,514 error opportunities, with overall error rates of 7.6% and 1.5%, respectively. The total opportunities for error meant each single step of preparation and administration that was relevant for the drug. Most errors applied to the category “uniform mixing” (adult ICU: n=227, 59%; NICU/PICU: n=14, 37%). The multivariate logistic regression results showed a significantly different influence of the “preparation type” for the adult ICU compared with the NICU/PICU with regard to the occurrence of an error. Preparations for adult patients of the LCD type (liquid concentrate with diluent into syringe or infusion bag) were more often associated with errors than the P (powder in a glass vial that must be reconstituted and diluted if necessary), P=0.012, and LC (liquid concentrate into syringe), P=0.002 type.Conclusion“Uniform mixing” was the most erroneous preparation step in intravenous drug preparations in two ICUs. Improvement of nurse training and the preparation of prefilled syringes in the pharmacy might reduce errors and improve the quality and safety of drug therapy.

The burden of at-home preparation of lyophilized parenteral medications: an analysis of contributing factors and implications for chronic disease patients and caregivers

ABSTRACTBackground: In the acute care setting, parenteral medication errors are well-studied. However, there is comparatively little research on how these issues translate to patient- or caregiver-prepared medications in the home, particularly with reconstituted medications.Methods: This was an ethnographic study designed to identify issues associated with four reconstitution use scenarios. Preparation burden was determined by measuring the time and manipulations required to prepare reconstituted medications across three preparation phases (assembly, reconstitution, and transfer). Deviations from product instructions for use, sterility breaches, self-reported preparation complications, and supply storage conditions were also analyzed.Results: A total of 14 participants completed the study. Overall, preparation burden was markedly higher when purpose-built reconstitution devices were not available. The majority of participants reported experiencing at least one complication associated with their medication preparation process; the reconstitution phase was the most significant source of both instructions for use deviations and breaches in sterility. Participants reported that the volume and variety of medication preparation supplies were a significant source of burden.Conclusions: At-home preparation of reconstituted medications poses several challenges for patients and caregivers. As parenteral medications continue to shift towards self-administration, manufacturers should carefully consider the usability of such products and employ purpose-built reconstitution devices whenever possible.

Vacinação e fatores associados entre trabalhadores da saúde

This study aimed to analyze factors associated with vaccination of municipal health workers in Bahia State, Brazil. This was a cross-sectional study from 2010 and 2012 with 3,084 workers in primary and medium-complexity care. The following indicators were described: prevalence of vaccination in the adult calendar according to the Brazilian National Immunization Program (PNI) and the completeness of vaccination regimens according to sociodemographic, economic, work, domestic overload, psychosocial, satisfaction and social support at work, occupational, life habits, health status, and self-rated health variables. Multivariate analysis was performed to assess the joint effect of the study variables. Only 38.5% of the workers reported complete vaccinal status for all the vaccines in the adult calendar. Completeness of the vaccination card showed a positive association with: female gender (95%CI: 1.42-2.10), working directly in patient care (95%CI: 1.26-1.71), having technical resources for the development of the professional activities (95%CI: 1.02-1.34), social support at work (95%CI: 1.02-1.26), contact with biological material (95%CI: 1.39-1.75), preparation of medications (95%CI: 1.10-1.44), and positive self-rated health (95%CI: 1.03-1.41). Factors such as sociodemographic conditions and occupational exposure have an influence on vaccination. Given the resurgence of immune-preventable diseases, it is necessary to monitor health workers' vaccinal status. The phenomenon should be analyzed according to its complexity, focusing on aspects related to resistance that extrapolate the issues usually measured and allow the investigation of beliefs attributed to vaccines.

Bacteriological Quality of Some Local Herbal Drugs Sold In Port Harcourt, Nigeria and Antibacterial Susceptibility of Isolates Compared with Clinical Isolates

The world is witnessing an unprecedented rise in the use of herbal medicines. In Nigeria some individuals solely believe in the curative ability of local herbal drugs for the treatment of different forms of ailment. Most local herbal drugs are advertized to cure more than an aliment such as infections and hepatitis, diabetes and gastroenteritis, malaria, general body pain and weakness etc. The preparation and packaging of these local herbal medications are not carried out under appropriate hygienic conditions and they could be prone to contamination by potential pathogenic bacteria. Aim: The aim of this study was to determine the bacteriological quality of some local herbal drugs marketed in some parts of Port Harcourt Rivers State Nigeria and their antimicrobial activity compared to some orthodox antimicrobial agents. Materials and Methods: Ten (10) different local herbal drugs were purchased from hawkers, examined for bacteriological quality and antibacterial activities. Each of the sample for bacteriological examination were diluted serially in sterile peptone water by pipeting 1mL of the neat to 9ml of sterile peptone water in a test tube and subsequently diluted to 105 and 0.01mL of the last dilution 105 were cultured on Nutrient and MacConkey agar plates. Susceptibility testing were carried out with the isolated bacteria. The susceptibility was compared with that of already identified clinical isolates of E. coli and S. aureus. Results: The results obtained showed E. coli (69.9%), S. aureus (18.9%), Klebsiella sp. (3.7%) and Bacillus sp. (7.5%) respectively. Antimicrobial susceptibility testing of the isolated bacteria from the local herbal drugs were 100% resistant to the orthodox drugs tested against them, whereas the clinical isolates tested were 50% susceptible to the orthodox drugs. The bacteria isolated from herbal drugs and the isolates from clinical specimens were 100% resistant to the local herbal drugs. Conclusion: The bacteriological qualities of the local herbal drugs marketed in some parts of Port Harcourt were poor due to improper hygiene during processing and packaging. Bacterial isolates from the local herbal drugs were resistant to the local herbal drugs and the orthodox drugs. Contaminated local herbal drugs might serve as means of transmitting infections and medium for exchanging resistant genes by the contaminating bacteria. The antibacterial property of herbal drugs may have been altered by the activities of bacteria

Profile of medicines used via oral and gastrointestinal catheter in a Walk-in Service.

To identify the profile of drugs prescribed via oral and gastrointestinal catheter in a Walk-in Service of a University Hospital. Quantitative cross-sectional study in which data were collected from the medical records of hospitalized patients using medication via oral or gastrointestinal catheter at least once a day between April and October 2015. The analysis was performed through descriptive statistics. Out of 568 prescriptions (total), there were 143 different medications. The pharmaceutical form with the greatest number of prescriptions was solid (95.8%), of which 46.1% were simple tablets. The oral route had the highest number of administrations (97.3%). The most prescribed drug class was of anti-infectives (25.9%), but the Omeprazole drug was the most prescribed in the study (40%). There are indications that enable rethinking the care practice and establishing criteria and norms for contributing to the safety and efficacy of services provided in healthcare, especially regarding the preparation and administration of medications via gastrointestinal catheter.