Wrong Frequency Research Articles

Prescribing errors and associated factors in discharge prescriptions in the emergency department: A prospective cross-sectional study.

Evidence regarding the prevalence of medication prescribing errors (PEs) and potential factors that increase PEs among patients treated in the emergency department (ED) are limited. This study aimed to explore the prevalence and nature of PEs in discharge prescriptions in the ED and identify potential risk factors associated with PEs. This was a prospective observational cross-sectional study in an ambulatory ED in a tertiary teaching hospital. Data were collected for six months using a customized reporting tool. All patients discharged from ED with a discharged prescription within the study period were enrolled in this study. About 13.5% (n = 68) of the 504 prescriptions reviewed (for 504 patients) had at least one error. Main PEs encountered were wrong dose (23.2%), wrong frequency (20.7%), and wrong strength errors (14.6%). About 36.8% of identified PEs were related to pediatric prescriptions, followed by the acute care emergency unit (26.5%) and the triage emergency unit (20.6%). The main leading human-related causes associated with PEs were lack of knowledge (40.9%) followed by an improper selection from a computer operator list (31.8%). The leading contributing systems related factors were pre-printed medication orders (50%), lack of training (31.5%), noise level (13.0%), and frequent interruption of prescriber and distraction (11.1%). Prescribers' involved with the identified errors were resident physicians (39.4%), specialists (30.3%), and (24.4%) were made by general practitioners. Physicians rejected around 12% of the pharmacist-raised recommendations related to the identified PEs as per their clinical judgment. PEs in ED setting are common, and multiple human and systems-related factors may contribute to the development of PEs. Further training to residents and proper communication between the healthcare professionals may reduce the risk of PEs in ED.

Medication errors in hematology-oncology ward by consultation: The role of the clinical pharmacologist.

Background:The aim was to describe, evaluate and document the prevention of medication errors by clinical pharmacologist consultations in patients with cancer.Methods:We assessed the effect of clinical pharmacologist consultation by the acceptance of interventions recommended due to dosage, frequency, duration of therapy errors and drug-drug interactions (DDIs). All medication errors detected by clinical pharmacologist were reported in the format of medical consultation. A documentation template was designed to collect the patient’s data (sex, age, and diagnosis), prescriptions written, and drug-specific recommendations. For the descriptive analysis of medication errors, the unit of analysis was the number and percentage of errors.Results:A total of 296 patients included in this study with a median age of 48.67±19.76 years of which 47.30% were females. 936 prescribing errors were detected and recommended for their correction. The specialist physicians accepted 897 of prescribed errors. DDIs that were detected in 66.22% of patients, were the most errors in this group of errors (47%). Improper dose (17.41%) wrong frequency (16.67%) and drug-food interaction (10.26%) were after that.Conclusion:Pharmacological consultation in the hematology-oncology ward revealed many medication errors. The trust of physicians in the views of the clinical pharmacologist led to a large part of these errors being accepted and resolved.

Multipoint Optimal Minimum Entropy Deconvolution Adjusted for Automatic Fault Diagnosis of Hoist Bearing

Multipoint optimal minimum entropy deconvolution adjusted (MOMEDA) is a powerful method that can extract the periodic characteristics of signal effectively, but this method needs to evaluate the fault cycle a priori, and moreover, the results obtained in a complex environment are easily affected by noise. These drawbacks reduce the application of MOMEDA in engineering practice greatly. In order to avoid such problems, in this paper, we propose an adaptive fault diagnosis method composed of two parts: fault information integration and extracted feature evaluation. In the first part, a Teager energy spectrum amplitude factor (T‐SAF) is proposed to select the intrinsic mode function (IMF) components decomposed by ensemble empirical mode decomposition (EEMD), and a combined mode function (CMF) is proposed to further reduce the mode mixing. In the second part, the particle swarm optimization (PSO) taking fractal dimension as the objective function is employed to choose the filter length of MOMEDA, and then the feature frequency is extracted by MOMEDA from the reconstructed signal. A cyclic recognition method is proposed to appraise the extracted feature frequency, and the evaluation system based on threshold and weight coefficient removes the wrong feature frequency. Finally, the feasibility of the method is verified by simulation data, experimental signals, and on‐site signals. The results show that the proposed method can effectively identify the bearing state.

1335. Accuracy of Outpatient Antibiotic Prescriptions for Urinary Tract Infection in Pediatric Ambulatory Care

BackgroundAntimicrobial stewardship programs have typically focused on inpatient care, but antibiotics are frequently prescribed at pediatric ambulatory care centers. Ensuring accurate pediatric antibiotic dosing is important to optimize outcomes while minimizing adverse drug effects. Outpatient pharmacists often lack the resources to recommend optimal antibiotic dosing for pediatric infections. The primary objective was to evaluate the accuracy of antibiotic dose, frequency and formulation prescribed. The secondary objective was to describe the most commonly prescribed treatment durations.MethodsA retrospective review of electronic medical records was conducted at two suburban pediatric practices. Patients diagnosed with uncomplicated UTI over a two year period were identified using ICD-10 codes N39, R30 and R35. Patients 2 months-18 years were included if prescribed an oral antibiotic for the treatment of UTI. Data collected included baseline demographics, antibiotic, dose (mg and mg/kg), frequency, formulation, and duration. Antibiotic dose, frequency and formulation were considered accurate if they were consistent with clinical guidelines and tertiary dosing references, allowing for 10% rounding in weight-based doses.ResultsA total of 472 outpatient prescriptions met inclusion criteria. Overall, 24% of dosing regimens were found to be inaccurate. Patients were most commonly prescribed doses that were too low (54/118, 45%) or too high (41/118, 35%). Less frequently, doses exceeded the maximum total dose (9/118, 8%), were given at the wrong frequency (8/118, 7%), or the wrong dosage form was selected (6/118, 5%). Of the commonly prescribed antibiotics, dosing errors were most likely to occur with ciprofloxacin (24/27, 89%) and amoxicillin (33/64; 55%). The majority of patients completed a 10 day course of antibiotics (381, 80%), followed by 7 days (66, 13.9%). Durations of 3 days (20, 4.2%), 5 days (7, 1.5%) and 14 days (2, 0.4%) occurred less frequently.ConclusionErrors in antibiotic dosing occurred with nearly one in four prescriptions written for outpatient UTI from pediatric primary care centers. Durations were most commonly 10 days. Education and resources should be provided to outpatient pediatric providers to optimize antibiotic dosing.Disclosures All Authors: No reported disclosures

Impact of Clinical Pharmacist Interventions in Prescribing Errors in Hospitalized Diabetic Patients with Major Polypharmacy.

Background: While clinical pharmacists are expected to have a potential role in minimizing prescribing errors (PEs) in patients with diabetes, the effectiveness of their interventions on the incidence and clinical significance of PEs remains unclear. Objectives: To investigate the effectiveness of clinical pharmacist interventions in correcting PEs in diabetic patients with major polypharmacy. Methods: This was a prospective pre-post study conducted in a secondary care hospital in Jordan over 4 months. There were 2 phases: Control, in which PEs were identified and categorized and active, in which clinical pharmacists intercepted and corrected PEs. Clinical severity of prescribing incidents was evaluated by an expert panel, comprising a senior clinical pharmacist, an internist, and cardiologist. SPSS V26 was used for data analysis. Results: Of 928 patients, 432 were followed and reviewed during the control phase and 496 during the active phase. Clinical pharmacist interventions reduced PEs by 89.5%; from 27.6% (control) to 2.9% (active). PEs per patient and PEs per medication orders were reduced from 2.1 to 0.2 and from 0.3 to 0.03, respectively. Electronic selection errors, wrong dose frequency, duplicate drugs, and allergy errors disappeared in the active phase. Significant, serious, and lethal errors were significantly reduced from 35.4%, 11.6%, and 0.2% (control) to 13.5%, 3.1%, and 0.0% (active), respectively. drugs related to CVS (OR = 5.2; 95% CI, 3.1-8.6; P < .05) versus drugs related to endocrine system was more likely to be associated with the occurrence of PEs versus no PEs. However, drug belonging to infectious (OR = 0.6; 95% CI, 0.1-0.9; P < .05) versus drugs related to endocrine system was less likely to be associated with the occurrence PEs versus no PEs. Conclusion: Clinical pharmacist interventions significantly reduced PEs in patients with diabetes by 89.5% and most of these interventions were clinically significant.

Systematic Review: Study of the Prescribing Pattern of Antibiotics in Outpatients and Emergency Departments in the Gulf Region

Purpose: To study the prescribing pattern of antibiotics in outpatients and emergency departments in the Gulf region. To compare the appropriateness of prescriptions and antibiotics commonly prescribed for respiratory tract infection. Method: The search was limited to the years 2008–2020, and articles had to be in English. Articles were searched from various resources and evaluated using PRISMA. Forty-one articles were selected and screened, and in the end, 17 articles were included in the study. All articles were selected from the gulf region of six countries: UAE, Saudi Arabia, Qatar, Oman, Yemen, and Bahrain. Only primary literature were included. Inpatient and literature from other countries outside the gulf region were excluded. Result: Penicillins, cephalosporins, and macrolides are highly useful antibiotics for respiratory tract infections. Ceftriaxone IV is recommended in acute respiratory tract infection if therapy with penicillin fails. Most of the antibiotic prescriptions in Gulf countries are inappropriate. Inappropriate antibiotic prescribing in the gulf region varies from place to place and reaches a maximum of 80%. Antibiotics may be prescribed with the wrong dosage or frequency and inappropriate guidelines. Penicillins are prescribed at about 50–60%; the most common penicillins prescribed are amoxicillin and co-amoxiclave. Cephalosporins are prescribed at about 30%, and the most common are third-generation. Macrolides are prescribed at about 17–20%, and the most common macrolides are azithromycin and clarithromycin. Fluoroquinolones are prescribed at about 10–12%, of which levofloxacin and ciprofloxacin are more commonly prescribed with metronidazole at 10%. Conclusion: It is suggested that the antibiotic-prescribing pattern in outpatient and emergency departments in the Gulf region are highly inappropriate and need improvement through education, following guidelines, annual vaccination, and stewardship programs; the most prescribed antibiotic is amoxicillin/co-amoxiclave, and the most often encountered infection in outpatients is acute respiratory tract infection.

Analytic energy gradients for the self-consistent direct random phase approximation.

Analytic energy gradients with respect to nuclear coordinates are derived and implemented for the self-consistent direct random phase approximation (sc-dRPA) method. In contrast to the more common non-self-consistent dRPA methods, the sc-dRPA method does not require a choice for the approach to generate the Kohn-Sham orbitals and eigenvalues serving as input for the dRPA correlation functional. The fact that the sc-dRPA total energy is variational facilitates the calculation of analytic gradients. The analytic gradients are tested against numerical ones and then used to calculate equilibrium geometries and vibrational frequencies for various molecules including weakly bonded dimers and transition metal compounds. The sc-dRPA method can compete in accuracy with Møller-Plesset perturbation theory of second order and with conventional density-functional methods within the generalized gradient approximation or of hybrid type. Indeed, sc-dRPA geometries and vibrational frequencies are most accurate in many cases. Moreover, the sc-dRPA method is robust in the sense that it is applicable to all considered molecules, whereas conventional density-functional methods are not applicable to dispersion bonded dimers, and Møller-Plesset perturbation theory of second order erroneously predicts a number of molecules to be unbound and yields completely wrong vibrational frequencies in some cases. The coupled cluster singles doubles methods yield geometries and vibrational frequencies of a quality that is inferior to that of the other considered methods.

Medication Error and Its Contributing Factors Among Pediatric Patients Diagnosed with Infectious Diseases Admitted to Jimma University Medical Center, Southwest Ethiopia: Prospective Observational Study.

BackgroundMedication errors in pediatric patients are grossly underreported. Pediatric patients are quite susceptible to medication errors. Potential injury by medication error is higher in young children and infants. It results in serious morbidity and mortality. Thus, this study aimed to assess medication error and its contributing factors among pediatric patients diagnosed with infectious diseases admitted to Jimma University Medical Center.MethodsA prospective observational study was conducted among pediatric patients with infectious diseases admitted from April 1 to June 30, 2018. The patient’s written informed consent was obtained after explaining the purpose of the study. The data were collected by structured questionnaire. Data were entered into EpiData version 4.0.2 and then exported to SPSS version 21.0 for analysis. To identify the predictors of medication error, backward logistic regression analysis was done.ResultsFrom a total of the 325 study participants, 136 (41.8%) patients had at least one medication error during their hospital stay. A total of 273 medication errors were identified among 136 patients. Medication errors frequently occurred at prescribing stage 94 (34.4%). The most common types of medication errors were wrong dosing 72 (26.4%) and wrong frequency 47 (17.2%). Presence of disease comorbidity (AOR=1.64, 95%CI=1.01–2.67), being male (AOR=1.79, 95%CI:1.13–2.86) and presence of two infectious diseases (AOR=1.96, 95%CI: 1.20–3.23) and more than three infectious diseases (AOR=2.04, 95%CI: 1.03–4.01) were independent predictors of medication error occurrence.Conclusion and RecommendationMedication errors were common in pediatric patients with infectious diseases in the study area. Presence of comorbidities, being male and the number of infectious diseases were associated with the occurrence of medication errors. Therefore, to reduce medication errors in the study setting, e-prescribing, computerized provider order entry, medication reconciliation, and collaboration of clinical pharmacists with other health professionals are needed.

Observational analysis of medication related errors by clinical pharmacists in a South Indian hospital

Present work was done to evaluate the occurrence of medication errors in general ward of institute of medical sciences to assess the role of clinical pharmacist in error management. The study was conducted for 9 months and Data was acquired from inpatients of general medicine dept by using standard case report form through direct patient interview. The collected data was to identify medication errors by using drug information tools such as , drug interaction checker and reputed journals and statistical interpretations were done. 400 prescriptions were and in that 300 prescriptions were presented with medication errors. 202 were found to be Prescribing errors, 111 Administration errors,45 were dispensing errors, Monitoring errors were 123. Interaction errors (81.18%), prescription in small letters (34.65%), wrong frequency of administration error (32.43%) and wrong time administration of medicine (85.58%), Dispensing wrong quantity of drug (95.5%) were the major medication errors that were observed. Medication errors have been occurring frequently in the general medicine department out of which prescribing errors were more common. Clinical Pharmacist could act as an medical staff by performing consciousness and teaching to medical professionals and by maintaining positive collaboration with other health care providers for patients.

Analysis of Reported E-prescribing Medication Administration Errors at King Saud Medical City, Riyadh: A Cross-Sectional, Retrospective Study

Background: Drug prescription error is a medication error that most frequently happens in healthcare organizations and adversely affects the healthcare consumers. Most medication errors (MEs) but not all are captured and corrected before reaching the patient by designed system controls. Medication administration errors (MAEs) mostly are made by nurses but frequently reported by clinical pharmacists in hospitals in Saudi Arabia.&#x0D; Objective: This study aimed to analyze exclusively the voluntarily reported drug administration errors in a tertiary care hospital in Riyadh city.&#x0D; Methods: This cross-sectional, retrospective study evaluated consecutively collected medication administration report forms over a period of one year from January 1, 2015 to December 31, 2015.&#x0D; Results: The number of MAEs occurring during stage of drug administration constituted 7.1% (n=971) of total medication errors (n=13677). The maximum number of MEs (n=6838, 50%) and MAEs (n=455, 46.9%) occurred during the 4th quarter of the year 2015. The most common MAE happened to be category C (n=888, 91.5%) which means error occurred, reached the patient but without causing any harm. Concerning MAE types, the most common error included wrong frequency (40%) followed by wrong drug (17%), wrong time of administration (16%) and wrong rate of infusion (10%). Nurses made the most of the errors (92.2%) while the clinical pharmacists reported the most MAEs (75.5%). High alert medications (HAM) errors constituted 32.3% (n=314) of MAEs (n=971) and most common HAM errors included the wrong route of administration of Lanus Insulin (15%) followed by Insulin Aspart (15%), Enoxaparin (13%) and Insulin Protamine-Nvomix (12%). Look-alike and sound-alike (LASA) errors constituted 55.2% of MAEs (971/536) and most common LASA drugs identified were Gentamycin (13%), Insulin Mixtard (11%), NPH Insulin (8%) Intralipid vial (8%) and Insulin regular (6%).&#x0D; Conclusion: This retrospective study provides some important tentative pharmacovigilance insights into MAEs, which are partially comparable with current international trends in drug administration errors. Further studies on MAEs are warranted not only in the Kingdom of Saudi Arabia but also other Gulf countries.

Evaluation of pre-chemotherapy antiemetic prescriptions in a hospital unit

Introduction: Antineoplastic drugs, due to their high toxicity, can lead to adverse reactions to drugs, such as emesis, which causes discomfort to the patient. These drugs can be classified according to emetogenic potential and have appropriate treatment protocols. Objectives: The aim of this study is to evaluate whether there is compliance between antiemetic prescription in patients receiving antineoplastic treatment in a hospital unit, according to pre-established emesis prevention protocols. Methods: This is a cross-sectional retrospective study of chemotherapy prescriptions analysis from January to April 2017. Data were analyzed according to the National Comprehensive Cancer Network 2017 Acute Emesis Prevention Protocol. Nonconformities were classified in: wrong medicine; wrong dose; wrong administration frequency and wrong administration route. Results: Of the 919 prescriptions analyzed, 83% did not comply with the protocol. The most common nonconformity found in the study was the wrong dose with the most prevalent scenario being the dexamethasone dose above the required dose. Conclusion: Most of the prescriptions analyzed did not comply with the pre-established protocol. This increases the likelihood of adverse drug reactions, does not effectively prevent emesis, thereby increasing patient weakness, decreasing quality of life, and wasting resources.

Drug-related problems in prescribing for coronary artery diseases in Vietnam: cross-sectional study.

To determine the prevalence, patterns and determinants of drug-related problems (DRPs) in prescribing for coronary artery diseases (CADs) in Vietnam. Retrospective cross-sectional study on outpatients with CADs at a general hospital in Can Tho, Vietnam. DRPs were classified according to Pharmaceutical Care Network Europe definitions. We determined the prevalence and patterns of DRPs. Logistic regression was used to identify the determinants of DRPs. Among 683 patients (mean age 63.4; 64.3% female), the prevalence of DRPs was 61.1%. DRPs comprised inappropriate indication (3.5%), inappropriate dosage (22.2%), wrong frequency of use (24.2%), wrong time of taking medications (4.1%), taking medications at the wrong time around meals (19.2%) and drug interactions (19.3%). Patients who took≥5 drugs were more likely to have DRPs (adjusted odds ratio=1.96; 95% confidence interval=1.31-2.93). Patients without health insurance were more likely to have inappropriate indication (ORa=2.93; 95%CI=1.28-6.70). Taking medications at inappropriate times around meals was common among men (ORa=1.82; 95%CI=1.23-2.69) and among those with health insurance (ORa=1.66; 95%CI=1.05-2.63). Patients<65years old were more likely to be prescribed inappropriate doses (ORa=1.67; 95%CI=1.15-2.45). Prescriptions with≥5 drugs were more likely to be taken at inappropriate frequency (ORa=1.87; 95%CI=1.09-3.21) and to cause drug interactions (ORa=6.48; 95%CI=2.59-16.24). DRPs are common among patients with CADs in Vietnam. The number of DRPs increases with the number of drugs in prescriptions. Further studies should identify other potential determinants of DRPs and effective interventions to improve prescribing practice in Vietnam.

Development of an algorithm to detect methotrexate wrong frequency error using computerized health care data.

We validated an algorithm to detect frequency errors in computerized healthcare data and estimated the incidence of these errors in an integrated healthcare system. We applied Sentinel System analytic tools on the electronic health records of Kaiser Permanente, Northern California, January 1, 2010, through May 30, 2015,to identify rheumatoid arthritis (RA) patients with new use of methotrexate (365-day baseline period). We identified potential methotrexate frequency errors using ICD-9 code 995.20 (adverse drug event), Current Procedural Terminology (CPT) code 96409 for injection of leucovorin and prescription refill patterns. We performed chart review to confirm the frequency errors, assessed performance for detecting frequency errors, and estimated the incidence of chart-confirmed errors. The study included 24,529 methotrexate dispensings among 3,668 RA patients. Among these, 722 (3%) had one dispensing and 23,807 (97.1%) had ≥2 dispensings during 1-year follow-up period. We flagged 653 (2.7%) with a potential medication error (46 with one dispensing and 607 with ≥2 dispensings). We sampled 94 for chart review, and confirmed three methotrexate errors. All three confirmed frequency errors involved a first methotrexate dispensing followed by injected rescue therapy, leucovorin, (positive predictive value, 60%; 95% confidence interval [CI], 15-95%). No potential errors were found among patients with ≥2 dispensings. We estimated the frequency error incidence among one methotrexate dispensing to be 0.4% (95%CI, 0.1% to 1.2%). Rescue therapy is a specific indicator of methotrexate overdose among first methotrexate dispensings. This method is generalizable to other medications with serious adverse events treated with antidotes.

Antibiotic Prescribing Practices and Errors among Hospitalized Pediatric Patients Suffering from Acute Respiratory Tract Infections: A Multicenter, Cross-Sectional Study in Pakistan.

Background and objective: The noncompliance of treatment guidelines by healthcare professionals, along with physiological variations, makes the pediatric population more prone to antibiotic prescribing errors. The present study aims to evaluate the prescribing practices and errors of the most frequently prescribed antibiotics among pediatric patients suffering from acute respiratory tract infections who had different lengths of stay (LOS) in public hospitals. Methods: A retrospective, cross-sectional study was conducted in five tertiary-care public hospitals of Lahore, Pakistan, between 1 January 2017 and 30 June 2017. The study population consisted of pediatric inpatients aged 0 to 9 years. Results: Among the 11,892 pediatric inpatients, 82.8% were suffering from lower acute respiratory tract infections and had long LOS (53.1%) in hospital. Penicillins (52.4%), cephalosporins (16.8%), and macrolides (8.9%) were the most frequently prescribed antibiotics. Overall, 40.8% of the cases had antibiotic prescribing errors related to wrong dose (19.9%), wrong frequency (18.9%), and duplicate therapy (18.1%). Most of these errors were found in the records of patients who had long LOS in hospital (53.1%). Logistic regression analysis revealed that the odds of prescribing errors were lower in female patients (OR = 0.6, 95% CI = 0.1–0.9, p-value = 0.012). Patients who were prescribed with ≥3 antibiotics per prescription (OR = 1.724, 95% CI = 1.1–2.1, p-value = 0.020), had long LOS (OR = 12.5, 95% CI = 10.1–17.6, p-value < 0.001), and were suffering from upper respiratory tract infections (URTI) (OR = 2.8, 95% CI = 1.7–3.9, p-value < 0.001) were more likely to experience prescribing errors. Conclusion: Antibiotics were commonly prescribed to patients who had long LOS. Prescribing errors (wrong dose, wrong frequency, and duplicate therapy) were commonly found in cases of lower respiratory tract infections (LRTIs), especially among those who had prolonged stay in hospital.

Incidence of Medication Errors in the Use of Biotech Medicines in the Pediatric Hospital Setting

The pediatric population is more susceptible to medication errors due to factors such as weight, body surface, immaturity of the enzymatic system to metabolize and excrete drugs, and inability to communicate any sign or negative symptom related to a medication. Currently technological advances confront us with new situations or ethical conflicts, the twenty-first century is considered as the century of biotechnology, stem cells, cloning, gene therapy, new drugs, advances not yet adapted to pediatric clinical practice and valued as a relevant factor causing error. Based on case reports on the use and management of biotech medicines, scientific approach was made to understand in depth the problems faced by the medication system, which directly impacts the patients. The objective of the present work was to document, analyse and evaluate medication errors during the use and management of biotech medicines in the pediatric population treated in a highly specialized hospital from September 2017 to April 2018. Prospective, observational design whose main variable is the medication error including potential errors. The taxonomy of the National Coordinating Council for Medication Error Reporting and Prevention was used. The study was carried out for 24 weeks in the medical specialties of oncology, hematology and immunology, as well as in the respective outpatient areas. Three hundred and fifty follow-ups were selected in the use and management of biotech medicines, found 1085 medication errors. The prevalence of measurement errors is, insufficient monitoring of the medication with 35 %; wrong dose with 19 %, wrong frequency and time of administration, with 14.7 and 8.5 % respectively, for preparation, handling and conditioning is 6.3 % and wrong medication with 6.6 %. The data generated would allow the design and implementation of strategies to strengthen the use and safe management of biotech medicines.

A Novel Method for Extracting Maximum Kurtosis Component and Its Applications in Rolling Bearing Fault Diagnosis

Rolling bearing plays an important role in the overall operation of the mechanical system; therefore, it is necessary to monitor and diagnose the bearings. Kurtosis is an important index to measure impulses. Fast Kurtogram method can be applied to the fault diagnosis of rolling bearings by extracting maximum kurtosis component. However, the final result may disperse the effective fault information to different frequency bands or find wrong frequency band, resulting in inaccurate frequency band selection or misdiagnosis. In order to find the maximum component of kurtosis accurately, an algorithm of frequency band multidivisional and overlapped based on EWT (MDO‐EWT) is proposed in this paper. This algorithm changes the traditional Fast Kurtogram frequency bands division method and filtering method. It builds the EWT boundaries based on the maximum kurtosis component in each iteration and finally obtains the maximum kurtosis component. Through the simulation signal and the rolling bearing inner and outer ring fault signals verification, it is proved that the proposed method has a good performance on accuracy and effectiveness.

Systematic review of computerized prescriber order entry and clinical decision support.

Results of a systematic review of published data on the effect of computerized prescriber order entry (CPOE) with clinical decision support on medication error (ME) and adverse drug event (ADE) rates are presented. Literature searches of MEDLINE, Embase, and other databases were conducted to identify English- and Spanish-language articles on selected CPOE outcomes published from 1995 through 2016; in addition, 5 specific journals were searched for pertinent articles published during the period 2010-16. Publications on controlled prospective studies and before-and-after studies that assessed MEs and/or ADEs as main outcomes were selected for inclusion in the review. Nineteen studies met the inclusion criteria. Data on MEs and ADEs could not be pooled, mainly due to heterogeneity in outcome definitions and study methodologies. The reviewed evidence indicated that CPOE implementation led to an overall reduction in errors at the prescription stage of the medication-use process (relative risk reduction, 0.29 [95% confidence interval, 0.10-0.85]; I 2 = 99%) and reductions in most types of prescription errors, but CPOE also resulted in the emergence of other types of errors. CPOE reduces the overall ME rate in the prescription process, as well as specific types of errors, such as wrong dose or strength, wrong drug, frequency, administration route, and drug-drug interaction errors. The implementation of CPOE can lead to new errors, such as wrong drug selection from drop-down menus.

1784. Impact of a Novel Multidisciplinary Anti-Tubercular Stewardship Program in a Tertiary Care Center in India

BackgroundInaccurate diagnosis of tuberculosis (TB) and inappropriate anti- tubercular therapy (ATT) contribute majorly to the emergence of drug-resistant TB in India, particularly in the private healthcare sector. Our study evaluated the appropriateness of ATT as per Revised National TB control Program at our institution, a large private tertiary center in Kerala, India, after establishment of an Anti-Tubercular Stewardship program (ATTSP).MethodsThe ATTSP was implemented as part of a recently developed Antimicrobial Stewardship Program (ASP). A multidisciplinary team including an administrative physician champion, pulmonologist, infectious disease specialist, and clinical pharmacists met twice weekly to review all patients initiated on ATT and to assess each case for appropriateness in terms of right indication, right drug, right dose, right frequency, and right duration. For each patient who had an inappropriate ATT prescription, appropriate recommendations based on standard treatment guidelines were filed in the charts and communicated to the primary team via email and phone. Compliance to recommendations was monitored. The clinical pharmacists followed up patients after dischargeResultsEight (52%) patients were prescribed ATT appropriately among the 153 patients reviewed from July 2017 to April 2018. Ninety-six interventions were recommended for the 73 cases with inappropriate ATT. Of these inappropriate ATT, 16 were for wrong indication, 27 for wrong drug, 52 for wrong dose and 1 for wrong frequency. Among the 137 accurately diagnosed cases of TB, 52% (71) were definite cases of TB while the rest were presumptive. Pulmonary, extra pulmonary and disseminated TB cases accounted for 45% (62), 50% (69) and 4% (6), respectively. ATT was appropriate in 63% (39) of pulmonary TB, and 54% (37) of extra pulmonary TB.Among 23 pulmonary TB patients with inappropriate ATT, 48% (11) were for wrong drug, 78%(8) for wrong dose and 17%(4) for wrong frequency. The 32 inappropriate extra-pulmonary TB cases included 19% (6) for inappropriate drug selection and 81% (26) for inappropriate dose. Compliance to ATTSP recommendations was 34%.ConclusionTB in India is a vital target for ATT stewardship (10% of patients in this cohort had an inaccurate diagnosis of TB). ATTSP may be a worth initial target for novel ASPs in India.Disclosures K. Kaye, Zavante Therapeutics, Inc.: Scientific Advisor, Consulting fee.

Antiepileptic drug compliance among caregivers of children with epilepsy: An observational cohort study

Background: Poor compliance with antiepileptic drugs (AEDs) not only increases morbidity and mortality rates among the children with epilepsy but it also leads to multiple hospital emergency room visits and enhanced health-care costs. Objective: The objective of the study was to delineate the prevalence and causes of antiepileptic drug non-compliance among caregivers of children with epilepsy in a tertiary care hospital in North India. Materials and Methods: Basic demographic data along with details of AED compliance (method of dispensing, exact dose being dispensed, frequency of administration, missing out on doses, and any side effects noted) were taken from primary caretaker dispensing the medication to the enrolled children with epilepsy on monotherapy with AEDs. Results: Wrong dosage of AED dispensed was reported in 20% (overdosing reported in 8% and underdosing in 12%) of the enrolled children. One child among the study participants receiving an overdose of the prescribed AED had emergency room admission with phenytoin toxicity. One child among the study participants was receiving wrong AED while another was receiving the AED in wrong frequency. Conclusions: The results from the present study highlight the high level of antiepileptic drug noncompliance among caregivers of children with epilepsy and also the various reasons leading to the wrong administration of AEDs to children with epilepsy. These ground level issues related to poor AED compliance, among caregivers of children with epilepsy, can help devise various methods to address these so as to improve the compliance to AEDs by caregivers of children with epilepsy.

Prescribing error and Associated Factors at the Pediatric Ward of Wachemo University Nigist Eleni Mohammed Memorial Hospital, Southern Ethiopia

Background: Pediatrics admitted to hospital have more problems in relative to adults due to prescribing error but there is similarity in adverse events. This reason is that standard doses are given for adults, whereas pediatric patients are medicated based on their body mass and medical cases. This needs a lot of dose adjustment by health care professionals who prescribe the drug, which leads to increase of medication prescribing error. Objective: To determine the magnitude and associated factors of medication prescribing errors (MPE) at pediatric ward of Wachemo University Nigist Eleni Mohamed Memorial Hospital (WUNEMMH), Southern Ethiopia. Methodology: A cross-sectional study was done at pediatric ward from January 1, 2017 to February 1, 2018. All abstracted and observed data from medical records were checked for errors by the Micromedex Drug-Reax database and guidelines for pediatric use in Ethiopia. We analyzed data using SPSS version 22.0. The association between dependent and independent variables were carried out using logistic regression model with statistics significance declared at P-value &lt; 0.05 and 95%CI). The results were presented by descriptive as well as in table form. Results: Out of 622 errors, the highest MPE was wrong dose with error rate of 110 (48.0%).The medication category with most MPE was antibiotics. Pediatrics with one diagnose [AOR = 3.04(95% CI=1.41 - 6.56)] were more likely face wrong combination than with greater than or equal to two diagnoses. Pediatrics less than one year old [AOR= 3.19(95% CI=1.54 - 6.59)] and pediatrics between one and five year [AOR= 4.31(95% CI=2.09 - 8.91)] were more likely face wrong combination than six to ten years old. Patients with one diagnose [AOR = 3.06(95% CI= 1.39 - 6.71)] were more likely have drug omission than with greater than or equal to two diagnoses and pediatrics less than one year old [AOR=2.15(95%CI=1.04-4.44)]; pediatrics with age one up to five year [AOR=4.47(95%CI=2.10-9.50)] were more likely face drug omission than from six to ten years old. It was found that, only patients with one diagnose [AOR=2.57(95% CI=1.17 - 5.67)] were more likely face wrong abbreviation. Patients with age one up to five year [AOR=0.43(95% CI= 0.22 - 0.84)] were more likely face wrong dose than from six to ten years of age. Patients with one diagnose [AOR=2.32(95% CI=1.07 - 5.06)] were more likely to face wrong duration than with greater than or equal to two diagnoses. Conclusion: The overall rate of medication prescribing error is high. The most frequently detected error was wrong dose followed by wrong combination, omission, wrong frequency and wrong route. Age group less than one year, from one to five and prescription with one diagnosis were statistically significant with prescribing error. We recommend staffs to have access for update references and involvement of clinical pharmacist in ward for reducing the medication errors.