Wrong Prescriptions Research Articles

Medication stewardship in the operating theatre in Malaysia: A quality improvement project.

A quality improvement project ('Safe Anaesthesia for ALL-SEAL') was implemented to reduce preventable medication errors and drug wastage in the operating theatre (OT) of a tertiary hospital. The primary objective of this quality improvement project was to prevent the incidence of medication errors, and the secondary objective was to reduce the wastage of unused drugs. A pre-intervention questionnaire and an audit survey were performed, and multidirectional interventions were designed post-survey. A post-intervention survey was conducted to evaluate effectiveness. The incidence of medication errors, including near misses, was assessed for root causes. Unused drugs drawn or diluted in syringes were recorded daily in each OT. The weekly drug orders and mid-week reordering frequency were also monitored. The data were reported as simple means and percentages. Ninety-eight anaesthesia care providers participated in the survey (72.4% doctors and 27.6% anaesthetic nurses). Pre-intervention, 76.1% of respondents had experienced medication errors during their practice. Common errors included misidentification of ampoules or vials (65.2%), miscalculation of dosages (65.2%), improper syringe labelling (56.5%), accidental drug omission (54.3%) and wrong prescriptions (39.1%). The main sources of errors were fatigue/overwork (80.4%) and a hectic OT environment (71.7%). Post-intervention, no incidents of medication errors were reported. In addition, there was a significant reduction in drug wastage. The SEAL project positively prevented medication errors and reduced drug wastage, which should be further validated in other clinical settings.

Patient safety culture and satisfaction in Ghana: a facility-based cross-sectional study

BackgroundGlobally, one of the measures of high performing healthcare facilities is the compliance of patient safety culture, which encompasses the ability of health institutions to avoid or drastically reduce patient...

Dual‐role nurse interpreter perceptions of language barriers and Spanish‐speaking patients: A qualitative study

As the United States population is ever changing and is growing in diverse population patterns, the health care system is called to initiate responsive health care practices that are based on the public's changing and diverse cultural patterns. This study sought to explore the perceptions of certified medical interpreter dual-role nurses and their experiences with Spanish-speaking patients from admission to discharge in hospital stays. A qualitative descriptive case study was applied in this study. Data was collected from nurses working at a United States Southwest Borderland hospital using purposive sampling and semi-structured in-depth interviews. A total of four dual-role nurses participated, and thematic narrative analysis was applied. Four major themes emerged. The main themes were "being a dual-role nurse interpreter," "patient experience," "culture and competence, "and "nursing and caring," With each major theme multiple sub themes emerged. Two sub themes emerged with "being a dual-role nurse interpreter," and two sub themes emerged with "patient experiences." The major themes that emerged from the interviews indicated that the language barrier greatly affects Spanish-speaking patients in their hospital stay. Participants reported having at least one encounter with a Spanish-speaking patient that was not afforded interpretation services or had interpretation from someone other than a qualified interpreter. Patients experienced confusion, apprehension and anger associated with not being able to communicate their needs to the healthcare system. According to the experiences of the certified dual-role nurse interpreters, having a language barrier makes a tremendous impact on the care of Spanish-speaking patients. Nurse participants describe how patients and their family members experience dissatisfaction, anger and confusion when there is a language barrier and most importantly how language barriers have detrimental effects on patients with wrong medication prescriptions and wrong diagnosis. When hospital administration recognize and support nurses as certified medical interpreters as a key component for patient care when assisting persons with limited English proficiency, patients are empowered to become active members of their healthcare regimen. The role of dual-role nurses enables brokering between the healthcare system and serves as a tool to bridge health disparities based on linguistic inequities existing in healthcare. Recruitment and retention of certified medical interpreter trained Spanish-speaking nurses deter errors in healthcare and makes a positive impact on the healthcare regimen of Spanish-speaking patients enabling patient empowerment through education and advocacy.

Reducing Medication Errors in Children's Hospitals.

Knowledge of the prevalence and characteristics of medication errors in pediatric and neonatal patients is limited. This study aimed to evaluate the incidence and medication error characteristics in a pediatric hospital over 5 years and to determine whether serial error prevention programs to optimize a computerized physician order entry (CPOE) system reduce error incidence. We retrospectively reviewed medication errors documented between January 2015 and December 2019. A total of 2,591,596 prescriptions were checked, and 255 errors were identified. Wrong dose prescriptions constituted the most common errors (56.9%). Medications with the highest rate of errors were antibiotics/antiviral drugs (36.9%). Oral route medications comprised the highest portion (60.8%), followed by intravenous ones (28.6%). The most common stage for medication errors was physician ordering (93.3%). Junior residents were responsible for most errors (45.9%). Most errors occurred in the pediatric ward (53.7%). In total, 221 (86.7%) errors were near misses. Only 4 errors (1.6%) were considered significant and required active monitoring or intervention. Type of error, stage of error, staff composition, and severity level of errors were significantly related to the number of errors in different years. There was a statistically significant decrease in errors per 100,000 prescriptions across different years after optimizing the CPOE system. The incidence of medication errors decreased with extensive use of the CPOE system. Continuous application of the CPOE optimization program can effectively reduce medication errors. Further incorporation of pediatric-specific decision-making and support tools and error prevention measures into CPOE systems is needed.

Use of Potassium Hydroxide in Dermatology Daily Practice: A Local Study From Saudi Arabia.

IntroductionPotassium hydroxide (KOH) is an inorganic keratolytic test. It is considered one of the most worldwide methods used in the dermatological field with reasonable reliability and sensitivity. One of its major uses is in identifying fungal elements in the skin, hair, nails, and different body secretions. In this study, we aimed to identify the prevalence of KOH usage in different hospitals in the Al-Ahsa region, Saudi Arabia. Additionally, we aimed to identify the dermatological conditions in which KOH is being used and practiced by physicians.MethodsThis was an anonymous questionnaire-based cross-sectional study that was distributed and carried out among dermatologists in Al-Ahsa city in the Eastern province of Saudi Arabia.ResultsA total of 30 dermatologists completed the study questionnaire. Participants’ ages ranged from 29 to 59 years old with a mean age of 39.5 ± 11.4 years old. 14 (46.7%) dermatologists reported that the KOH test is available in their clinic. Using KOH once a day was reported among 14.3% while 21.4% used it once a week. The most reported condition for KOH use was hair dermatophytes (100%).ConclusionThere is a clear lack of usage and availability of KOH in clinics. The shortage of availability of diagnostic tools, including KOH might affect the diagnosis of several diseases and may cause a waste of resources, wrong prescriptions, and patient’s burden.

Modelling and assessing one- and two-drug dose titrations

In health-care, there is a need to quantify medical errors. Among these errors, we observe wrong dose prescriptions. Drug dose titration (DT) is the process by which dosage is progressively adjusted to the patient till a steady dose is reached. Depending on the clinical disease, drug, and patient condition, dose titration can follow different procedures. Once modeled, these procedures can serve for clinical homogenization, standardization, decision support and retrospective analysis. Here, we propose a language to model dose titration procedures. The language was used to formalize one- and two-drug titration of chronic and acute cases, and to perform retrospective analysis of the drug titration processes on 253 patients diagnosed of diabetes mellitus type 2 and treated with metformin, 321 patients treated of chonic heart failure with furosemide, 155 patients with hyperuricemia treated with allopurinol as initial drug and febuxostat as alternative drug, and 187 hyperuricemia patients with primary drug allopurinol and supplementary drug probenecid, in order to identify different types of drug titration deviations from standard DT methods.

Analysis of antimicrobial and psychotropic prescriptions in the central medication unit of the city of Guaramirim (Santa Catarina State - Brazil) / Análise de prescrições de antimicrobianos e psicotrópicos na unidade central de medicamentos da cidade de Guaramirim (Estado de Santa Catarina - Brasil)

The doctor’s prescription defines the patient’s treatment. In order to use medicine within maximum efficacy and minimum toxicity parameters, the prescription must be properly filled and readable. Although specific laws are applied to guide prescription elaboration, errors persist, and depending on its nature, they may cause from lack of efficacy to adverse effects. The purpose of this study was to evaluate the quality of prescriptions for psychotropic and antimicrobial drugs dispensed by the central pharmacy of the city of Guaramirim, Santa Catarina state, from February 1 to April 30, 2019. A total of 3,780 prescriptions were analyzed, 3,388 of psychotropic drugs and 392 of antimicrobials. The most frequent errors found were omission of telephone number, and address of patients and physicians. Regarding the drugs prescribed, it was observed lack of information on dose, route, and quantity of the drugs, and also the frequent presence of non-standard abbreviations. Most prescriptions were readable, but despite typed prescriptions may solve illegibility issues, which did not reach homogeneously data omission, and it is essential that pharmacists position themselves so as not to dispense wrong prescriptions and that patients demand greater clarification of the prescription at the time of consultation.

English

Tinea capitis  is a common infection among children in Nigeria and appropriate management will reduce its incidence among the pediatric population. The study assessed the opinions of mothers on the local and orthodox management of children infected with Tinea capitis. The study adopted a cross-sectional descriptive survey design and was conducted among 390 women in two states in Southern Nigeria. Pretested, translated questionnaires were administered to them in their various houses, and data analysis was done with SPSS version 20. Findings from the study showed that the majority of the mothers were older adults (42%). Higher percentages of the mothers reported choice of local products for management of Tinea capitis which includes toothpaste (60%), black soap (61%), lime (49%), and herbal cream (41%). However, 66 mothers reported the use of orthodox medication out of which Fulcin (52%) had the highest percentage with wrong prescriptions. In conclusion, mothers used more local products compared to orthodox medication in managing Tinea capitis among children and the effectiveness of such products, in the management of Tinea capitis have not been confirmed. Orthodox medicines were also used inappropriately. Public Health professionals should create awareness among mothers on the proper management of Tinea capitis. Key words: Tinea capitis, local management, orthodox management, mothers.

Identification in Drug Prescription using Artificial Intelligence

Medication errors are one of the safety problems most frequently seen in hospital organizations. It is estimated that 12.2% of all hospitalized patients are involved in some form of adverse drug event (ADE). A significant amount of ADEs result from handing the incorrect drug to a patient or prescribing the wrong medication. Issuing of correct prescriptions is a foundation of patient safety. Many times it has happened thatdue to the doctor’s illegible handwriting, wrong prescriptions are bought by the customer. In this paper, variousmethods using artificial intelligence to identify drugs prescribed for patients and to minimise errors which havebeen happening before. Keywords: Look-Alike, Sound-Alike, Optical Identification, Pill Localisation, You Only Look Once

VOICE BASED PRESCRIPTION USING MACHINE LEARNING

Medicine side effects are the major problem in the world, due to wrong prescriptions thousands of people die every year. Most of these mistakes are due to illegible handwriting which leads to taking the wrong medicine or dosage. To solve this issue, a voice-based prescription came into the picture where the prescription is taken as voice input, and a pdf file is generated which is then emailed to the patient. This method can save wealth and life throughout the world, particularly in developing countries where the prescriptions are generally paper-based. The system proposed in this paper is for those doctors and hospitals that are still using a paper-based handwritten prescription. Keywords: Healthcare, Voice-based, Python, Natural Language Processing (NLP), Electronic Prescription, Text Processing, Electronic Health Record (EHR).

EP.WE.135Analysis of National Bariatric Surgery Related Clinical Incidents

Abstract Background Hundreds of thousands of patient-safety clinical incidents are reported to the National Reporting and Learning System (NRLS) database in the United Kingdom (UK) every year. The purpose of this study was to identify bariatric surgery-related learning points from these incidents. Methods We analysed bariatric surgery-related clinical incidents reported to the UK NRLS database between 01 April 2005 and 31st October 2020. Results We identified 541 bariatric surgery-related clinical incidents in 58 different themes. Preoperative incidents represented 30.31% (N = 164), intraoperative 38.09% (N = 206), and postoperative accounted for 31.61% (N = 171). In terms of severity of incidents, (150;27.7%) were of high severity, whereas medium and low severity incidents were (244;45.1%) and (147;27.2%) respectively. The most common high severity theme was failure of thromboprophylaxis (50;9.2%). Intraoperative high severity incidents included 17 incidents of stapling of orogastric/nasogastric tubes or temperature probes, 8 missed needles, 8 broken graspers, and 6 incidents of band parts left behind. Postoperatively, the most common high severity theme was improper management of diabetes mellitus (DM) (35;6.5%). Medications errors represented a significant proportion of the medium severity incidents and included (26;4.8%) incidents of improper or missed prescription of routine medications and anticoagulants preoperatively and (45;8.3%) wrong prescriptions, dosage or prescribing of contraindicated medications postoperatively. Among the low severity themes identified there were (23;4.3%) incidents of postoperative diet problems, and (19;3.5%) patients listed for wrong procedures. Conclusion We identified 58 specific themes of bariatric surgery-related clinical incidents. Awareness of these themes should help to improve the safety of bariatric surgery worldwide.

SP5.1.3 Analysis of National Bariatric Surgery Related Clinical Incidents: Lessons Learned and a Proposed Safety Checklist for Bariatric Surgery

Abstract Background Hundreds of thousands of patient-safety clinical incidents are reported to the National Reporting and Learning System (NRLS) database in the UK every year. The purpose of this study was to identify bariatric surgery-related learning points from these incidents. Methods We analyzed bariatric surgery-related clinical incidents reported to the UK NRLS database between 01 April 2005 and 31st October 2020. The authors used their experience to identify learning themes and design a safety checklist. Results We identified 541 bariatric surgery-related clinical incidents in 58 different themes. Preoperative incidents represented 30.3% (N = 164), intraoperative 38.1% (N = 206), and postoperative accounted for 31.6% (N = 171). In terms of severity of incidents, (150;27.7%) were of high severity, whereas medium and low severity incidents were (244;45.1%) and (147;27.2%) respectively. The most commonly reported high severity theme was failure of thromboprophylaxis (50;9.2%). Intraoperative high severity incidents included 17 incidents of stapling of orogastric/nasogastric tubes or temperature probes, 8 missed needles, 8 broken graspers, and 6 incidents of band parts left behind. Postoperatively, the most commonly reported high severity theme was improper management of diabetes mellitus (35;6.5%). Medications errors represented a significant proportion of the medium severity incidents and included (26;4.8%) incidents of improper or missed prescription of routine medications and anticoagulants preoperatively and (45;8.3%) wrong prescriptions, dosage or prescribing of contraindicated medications postoperatively. Conclusion We identified 58 specific themes of bariatric surgery-related clinical incidents. We proposed specific recommendations for each incidents theme in addition to a bariatric safety checklist to help improve the safety of bariatric surgery worldwide.

İslam da Psikoloji Tarihi

The science of psychology emerged from the second half of the 1700s and has a function to fill the gap in the religious field. The primary point of modern psychology was the doctrine of sin and the West's pessimistic point of view, so there were problems in understanding human enigma. Failure to analyze people correctly led to the emergence of wrong prescriptions and it was understood that it was important to move towards the spiritual field only with the emergence of transpersonnel psychology and then positive psychology approach. After this phase, it is seen that ancient spiritual traditions centered on Taoism and Hinduism started to be used in psychological therapy and well-being. However, studies on Islamic spirituality have not been conducted in the field of psychology for many years. At this point, the works of Malik Badri and Rajhid Skinner within the scope of Islamic Psychology, theoretical and practical studies of Robert Frager on sufi therapy, theoretical and practical studies and dream analysis studies conducted by Mustafa Merter within the scope of nafs psychology and under the leadership of Erciyes University, Spiritual Psychology studies initiated in 2014 are important studies. When we look at the history of the psychology studies of the Islamic world, in the process that started with El Kindi; Belhi, the first Muslim psychiatrist, studies on anxiety and depression therapy; Findings about child and adolescent psychology made by Ibni Sina and Farabi; Ghazali put forward the conditional reflex theory centuries before Skinner, an important name in behavioral psychology; Mevlana's story and his findings in Mesnevi that go beyond the ages and psychology; Medical and psychological findings of Ibrahim Hakki Erzurumi in Marifetneme; In the exegesis of Abdurrezzak Kasani, the definitions and findings of modern psychology that exceeded human imagination; in fact, it shows that psychology is not new in the Islamic world. It is long time for modern psychology, which has been blown cold to Islam and Muslim scholars for many years, to investigate and take advantage of these values, which are also important for itself. It is necessary to reevaluate the verses of the Qur'an about the nafs, heart and soul within the framework of the ishâri exegesis and to reinterpret Mesnevi in a psychological sense. This study focuses on the birth of psychology and psychology in the Islamic world and past studies and contributions to the field of psychology from the recent period to the present.

Medical Malpractice in India: A Critical Analysis of Liability and Defense Framework

Expectation of a reasonable degree of care is the foundation for alleging a breach of duty. In the wake of recognition of ‘right to health’ as a fundamental right declared universally. Moreover, the era of consumerism has dug deep into the medical profession making consumers aware of their lawful demands and rights making it a weapon in their hands for civil proceeding for tortuous or criminal prosecution for disregard and for lack in service in the consumer courts. The doctor-patient relationship stands on trust and faith. With the life expectancy being increased for technological and advancement in the medical science, no disease seems to be untreatable and challenged. However, concerns are their professional competence, compliance to therapeutic and laboratory standards of MCI on equipments and facilities, Wrong prescriptions, overdoses and non expertise, improperly equipped hospitals and on specific still continue raise agitations amongst the patients and relatives. Given all the justified reasons, often it becomes very difficult to sustain a claim for all the economic and non economic damages.

Modeling Self Medication Risk Factors (A Case Study of Kiambu County, Kenya)

In this paper self-medication risk factors are investigated and multivariate model proposed. A random sample of four major hospitals was selected, one from each sub-county and sample of 728 patients selected from selected hospitals using stratified random sampling. The data was collected using semi structured questionnaires and analyzed in R program after cleaning for non-response. Preliminary analysis was carried to check for statistical significance of the risk factors of age, gender, income, marital, education, employment and insurance status. All proposed risk factors were statistically significant except employment factor when using chi-square test for each of discrete variables while both age and income continuous variables were significant at α =0.05 level of significance when fitting simple logistic regression model. The initial multivariate logistic regression model was fitted and variables of marital and insurance status of persons were statistically insignificant and therefore improved model was fitted less marital and insurance factors. The overall significance of the model was determined using Hosmer and Lemeshow goodness-of-fit test and the model recorded p-value of 0.7751 that indicates that there is no significant difference between observed and predicted probability, therefore the model would be used to predict chance of self-medication in the presence of significant risk factors. In conclusion therefore there is need to initiate legislation on policies that will guide self-medication that include provision of necessary knowledge and regulating the practice to avoid over dose, wrong prescriptions and emergence of human pathogen resistance microorganisms or serious consequences like resistance to medication in future guided by the prevalence results obtained from proposed model.

Analysis of Medical Errors: A Case Study

Analysis of Medical Errors: A Case Study

Postoperative Management of Penetrating and Nonpenetrating External Filtering Procedures.

Correct postoperative management is fundamental to prevent and treat complications and to optimize the success of filtering surgery. Timely control visits and appropriate actions and prescriptions ensure the best outcomes, allow recovery from a number of untoward events, and can reestablish filtration when failure seems imminent. In contrast, a slack follow-up and wrong interventions or prescriptions can lead to the failure of any surgery, no matter how accurately it was carried out, sometimes jeopardizing vision and even the anatomy of the globe. The purpose of this review is to present a rational approach to postoperative follow-up and to synthetically describe how to prevent, recognize and address the most common complications of filtering surgery, pointing out the most common pitfalls in the management of the operated eye.

Prevalencia de prescripción conjunta incorrecta de fármacos anticonvulsivantes y anticonceptivos hormonales Colombia, 2014

<p><strong>Objetivo:</strong> determinar la prevalencia de prescripción conjunta de fármacos antiepilépticos para identificar formulación incorrecta que podría afectar la efectividad de los anticonceptivos hormonales en un grupo de mujeres afiliadas al Sistema General de Seguridad Social en Salud de Colombia.</p><p><strong>Materiales y métodos:</strong> estudio de corte transversal, en el que se seleccionaron registros de mujeres de 15 a 45 años que recibían al menos un fármaco antiepiléptico, entre el 1 y el 31 de marzo de 2014, en una base de datos poblacional de dispensación de medicamentos de un operador logístico en Colombia, para población perteneciente al régimen contributivo y subsidiado en el Sistema General de Seguridad Social en Salud de Colombia. Se evaluaron el tipo de anticonceptivo hormonal y de fármaco antiepiléptico. Se utilizó estadística descriptiva.</p><p><strong>Resultados:</strong> de un total de 2092 pacientes usuarias de fármacos antiepilépticos, se identificaron 89 (4,3 %) casos que tenían por lo menos un antiepiléptico y un anticonceptivo simultáneamente. En 48 mujeres (54 %) se encontró formulación incorrecta de métodos de planificación, como el uso de fármacos antiepilépticos inductores enzimáticos e inyectables combinados (20 casos), el uso de anticonceptivos orales combinados de bajas dosis de estrógenos (16 casos), de progestinas orales (10 casos), y el uso de antiepilépticos no inductores enzimáticos y anticonceptivos orales combinados y dosis altas de estrógenos (2 casos).</p><p><strong>Conclusiones:</strong> un importante número de mujeres usuarias de medicamentos antiepilépticos utiliza métodos hormonales de anticoncepción, y cerca de la mitad de ellas tenían una prescripción anticonceptiva incorrecta, lo que podría resultar en embarazos no deseados o incremento del riesgo de enfermedad tromboembólica.</p>

On the centrality of the current account in international economics

The current account occupies a central position in international economics and policy debates. Indeed, in G20 policy debates the term “global imbalances” is treated as almost synonymous with “current account imbalances.” Current account imbalances do matter and they can be a problem. But this speech argues that this centrality is not that helpful in understanding how the global economy works, especially in a world of free and huge capital flows. And it may even lead to the wrong policy prescriptions, including not paying sufficient attention to potentially more disruptive financial imbalances. A key reason is that, analytically, the current account is asked to shed light on issues for which it is ill-suited, such as the amount of financing a country gets from, or provides to, others, the direction of that financing (who lends to whom), financial instability and the determination of equilibrium interest rates through the familiar saving-investment approach.

Modeling the Role of Infrastructure for Regional Development

Simplistic treatment of infrastructure during regional modeling often produces erroneous results and potentially wrong policy prescriptions. This paper attempts to address this issue and proposes a non-linear formulation for a productivity index in which infrastructure and economic mass (to reflect degree of agglomeration economies) of a region enter as interacting variables. The formulation is numerically tested to examine the effect of infrastructure investment at different level of agglomeration. Finally, the productivity index is used as a part of Constant Elasticity of Substitution (CES) production function, and the model is validated through estimation and calibration techniques using time-series data of Japan's regions. The validated formulation for productivity index, which realistically encompass the role of infrastructure, can potentially be utilized to assess the dynamic impacts of infrastructure in a multiregional context. The result is theoretically robust and practically useful for policy making particularly in developing Asian countries.