Medication reconciliation as a medication safety initiative in Ethiopia: a study protocol

Medication errors and associated factors among pediatric inpatients in public hospitals of gamo zone, southern Ethiopia

Background

Medication errors are the most common medical errors in the world. In particular, pediatric patients are more susceptible to severe injuries and death. Despite their multidimensional impact, medication errors are not recognized well in developing nations, including Ethiopia. Thus, this study aimed to assess the prevalence of medication errors and associated factors among pediatric inpatients in public hospitals of Gamo zone, southern Ethiopia.

Methods

A facility-based cross-sectional study was conducted among 416 pediatric inpatients from August 1, 2020, to February 30, 2021. Open data kit tools and Stata version 16.0 were used for data collection and analysis, respectively. Bivariable and multivariable analyses were performed to identify factors associated with medication errors. An adjusted odds ratio with a 95% confidence interval was computed and a P-value of <0.05 in the multivariable analysis was set to declare statistical significance.

Results

Overall, 69.5% (95% CI: 64.80, 73.86) of pediatric inpatients experienced medication errors. Unsuitable working environment (aOR: 2.40, 95% CI: 1.48, 3.91), child weight <5 Kg (aOR: 3.72, 95% CI: 1.79, 7.73), medication administered by diploma professionals (aOR: 2.10, 95% CI: 1.31, 3.36), parent involvement (aOR: 0.55, 95% CI: 0.33, 0.95), non-adherence with medication administration rights (aOR: 2.68, 95% CI: 1.32, 5.44) and hospital stay for >5 days (aOR: 1.83, 95% CI: 1.15, 2.93) were significantly associated with medication errors.

Conclusion

Medication errors were high among pediatric inpatients as compared to previous national studies. To reduce the occurrences of medication errors, it is critical to create a suitable working environment, arrange education and training opportunities for providers, involve families in the medication administration process, and strictly adhere to medication administration rights.

Medication safety practices in healthcare facilities in Kaduna State, Nigeria: a study protocol

Background:

In recent years, there has been growing concern about patient safety and this is becoming a global problem. Medication safety can be used to describe systematic assessments of healthcare professionals’ practices as related to safe use of medicines. Identification and prevention of medication errors is the key component of medication safety. This includes multiple aspects of medication practice and other factors that affect it, such as organisational structure, communication, technologies such as those used for dispensing, and strategies pursued by leadership in cultivating and promoting a culture of safety.

Methods:

The study adopted a mixed method approach divided into three phases. Phase I is a quantitative phase and involves an assessment of core medication safety practices in the study sites together with an assessment of patient safety culture through the use of the Hospital Survey on Patient Safety Culture (HSOPSC) developed by US Agency for Health Care Research and Quality (AHRQ). Phase II will involve semi-structured interviews with health care providers and focus group discussions with patients to explore their perspectives on medication safety and to explore their experiences concerning medication safety respectively. Phase III will be an intervention study and will utilise the World Health Organisation (WHO) Patient Safety Curriculum Guide: Multi professional edition as the intervention tool.

Discussion:

The study findings will offer substantial opportunity for improvements. The study will also open up an area of patient safety culture, where not much research has been conducted in Nigeria.

The Excellence of Pharmacy Practice

Over the past 50 years, the role of pharmacists has evolved along with the health care needs of our population. In addition to dispensing medications and ensuring patient safety, today’s pharmacists are taking a larger role as medical counselors, educators and advocates. They are integral part of the health care team, and are among the most trusted and accessible health care professionals. This accessibility allows them to perform more patient care activities, including counseling, medication management, and preventive care screenings. Beyond the care provided to individual patients, pharmacists have expanded their reach to influence the public health of communities. A pharmacist is uniquely positioned to provide disease state management through appropriate medication therapy management that has been demonstrated to improve patient outcomes and decrease overall health care costs. This role is more important than ever as the environment is demanding new practice and payment models that are required to further optimize care and outcomes while addressing the unsustainable increases in health care costs.

Nurses' Perceptions of Patient Safety Culture in Intensive Care Units: A Cross-Sectional Study

BACKGROUND

Patient safety culture is a relatively new focus where little is known about its current status in Egypt's teaching hospitals, mainly intensive care units (ICUs). Therefore, the authors of this study attempted to assess the patient safety culture dimensions from the nurses' perspective.

METHODS

An exploratory cross-sectional study was conducted in two ICUs (pediatric ICU and adult ICU) at the University Hospital over 3 months from October till December 2018. Sixty nurses were interviewed using the Hospital Survey on Patient Safety Culture.

RESULTS

The current study findings revealed an average positive response to individual items ranging from 6% to 51%. The "Organizational learning" dimension had the highest average percent positive patient safety dimension score (51%) among all respondents, while the "Frequency of events reported" dimension had the lowest one (6%). No statistically significant difference was reported between the pediatric and adult ICUs for all mean scores except for the "Non-punitive response to error" dimension which was reported to be greater in the pediatric intensive care unit (PICU) compared to adult ICU (P < 0.005). The overall patient safety grade was rated acceptable by 47.5% of the interviewed nurses.

CONCLUSION

The current study shows that patient safety is fragile in ICUs, and more effort is recommended to increase the awareness of health care providers. Also, hospital managers need to enhance the performance and practices of patient safety within a non-punitive reporting environment.

Perceived barriers to the implementation of clinical pharmacy services in a metropolis in Northeast Brazil

BACKGROUND

CLinical pharmacy services (CPS) are professional services provided by pharmacists, who use their skills and knowledge to take an active role in patient health. These services have expanded in health systems around the world. However, it is important to have a comprehensive understanding of factors that may hinder the implementation of CPS in health systems.

OBJECTIVE

To identify pharmacists' and managers' perceptions of barriers regarding the implementation of CPS in some public health units in a metropolis in Northeast Brazil.

METHODS

This is a qualitative study based on focus groups and semi-structured, face-to-face, in-depth interviews. Participants were health-system pharmacists and managers, selected based on their direct participation in the implementation process. Focus groups were carried out with the pharmacists, and interviews were carried out with managers. The audio and videos were transcribed verbatim in full, and were independently analyzed using content analysis. This study was approved by the Brazilian Committee of Ethics in Research and all participants signed informed consent forms.

FINDINGS

There were two focus groups and five interviews. The discussions generated 240 minutes of recordings. The health-system pharmacists and managers expressed barriers were allocated into five categories to facilitate a comprehensive understanding of the implementation of CPS; these barriers were related to: the local healthcare networks, the healthcare team, the pharmacists, the implementation process, and the patients.

CONCLUSIONS

This study revealed the perceptions of barriers associated with the participants involved in the implementation of CPS in some public health units in a metropolis in Northeast Brazil. The barriers reflect the challenges to be overcome in the CPS implementation process in the health systems.

Evaluation of the impact of pharmacist-led medication reconciliation intervention: a single centre pre-post study from Ethiopia

Background The role of pharmacists in medication reconciliation (MedRec) is highly acknowledged in many developed nations. However, the impact of this strategy has not been well researched in low-and-middle-income countries, including Ethiopia. Objective The aim of this study was to investigate the impact of pharmacist-led MedRec intervention on the incidence of unintentional medication discrepancies in Ethiopia. Setting Emergency department in a tertiary care teaching hospital in Ethiopia. Method A single centre, prospective, pre-post study was conducted on adults (aged 18 years or over) that had been hospitalized for at least 24 h and were taking at least 2 home medications on admission. The intervention involved assignment of a pharmacist to an emergency care team so as to take the best possible medication history and reconcile this list with the current medications in use. Main outcome measure Incidence and potential clinical severity of unintentional medication discrepancies. Results 123 patients were included (pre-intervention, 49; post-intervention, 74). The proportion of patients with at least one unintended discrepancy was reduced from 59 to 10.5% after the intervention (p < 0.001). Similarly, the percentage of patients with potentially severe clinical impact medication discrepancies reduced significantly after the intervention (p < 0.01). Most importantly, the likelihood of occurrence of unintentional medication discrepancies was approximately 17 times more often in the absence of pharmacist intervention (OR 16.45, 95% CI 5.22, 51.85). Conclusion This study has found that pharmacist-led MedRec intervention was impactful, and it was able to minimize the incidence of unintentional medication discrepancies significantly.

Barriers and facilitators to hospital pharmacists' engagement in medication safety activities: a qualitative study using the theoretical domains framework

Background

Hospital pharmacists play a central role in medication safety activities. However, in Ethiopia, this role has been launched recently and little is known regarding the current status of this extended service. Using the Theoretical Domains Framework (TDF), we aimed to identify the barriers and facilitators to hospital pharmacists’ engagement in medication safety activities across various public hospitals in the Amhara region of Ethiopia.

Methods

Eight focus group discussions, using an interview guide that was drawn upon the TDF, were conducted with 44 hospital pharmacists to explore their beliefs regarding their involvement in clinical services. Group discussions were audio-recorded, transcribed verbatim, and analysed using directed content analysis based on the TDF. Relevant domains were identified by applying relevance criteria to each of the domains in the TDF.

Results

Content analysis revealed six domains that influence hospital pharmacists’ engagement in medication safety activities. These domains included ‘Knowledge’, ‘Skills’, ‘Environmental context and resources’, ‘Motivations and goals’, ‘Social influences’ and ‘Social/professional role’. Most hospital pharmacists believed knowledge gap was an issue, as was the lack of training and supportive skills although some expressed as they were competent enough for their skills in identifying medication related problems. Most participants were very much enthusiastic for their extended roles and were positive towards the future of the profession; however, competing priorities along with the lack of remuneration and awareness (of other health care professionals) regarding the profession’s role were barriers to service delivery. There were also a number of resource constraints, such as staffing, infrastructure and government funding, and acceptance rate of pharmacist’s recommendation that were likely to influence the clinical practice of pharmacists.

Conclusion

Using the TDF, this study identified a wide range of barriers and facilitators to hospital pharmacists’ engagement in medication safety activities in resource-limited settings. There existed considerable interrelationships between domains that were perceived to influence hospital pharmacists’ behaviours, and this may assist in designing behaviour change interventions that target common behavioural domains.

Electronic supplementary material

The online version of this article (10.1186/s40545-018-0129-y) contains supplementary material, which is available to authorized users.