Pharmacists' knowledge and counselling on fall risk increasing drugs in a tertiary teaching hospital in Nigeria

Beers criteria and potentially inappropriate medications in elderly: awareness, practice, knowledge and barriers among community pharmacists in Nigeria

Background

Potential inappropriate medications (PIMs) used in the elderly are an avoidable source of disease and death. Beers Criteria is among the commonly used measures that document PIMs. Community pharmacists’ knowledge on PIMs and existing criteria are essential to moderate the use of PIMs which would enhance overall health outcomes and costs. This study investigates awareness, knowledge, practice, and barriers of PIMs among community pharmacists in Ibadan, Nigeria.

Methods

A cross-sectional study was carried out on 109 community pharmacists with the use of a self-administered questionnaire. Nine clinical vignettes based on the 2019 Beers Criteria were used to evaluate PIMs knowledge. Practice behavior regarding elderly clients was evaluated using a 5-point Likert scale with six items. Data were summarized by descriptive and inferential statistics.

Results

Respondents who knew guidelines that listed specific PIMs were (49; 47.1%), and of these, (21; 42.9%) were aware of Beers Criteria. From all the respondents, only 45 (41.3%) demonstrated good knowledge of Beers Criteria, while 82 (75.2%) narrated good practice when dealing with elderly clients in terms of asking suitable questions and contemplating their ages while dispensing medications. Major barrier identified was lack of knowledge of Beers Criteria (80; 73.4%). Pharmacists who were aware of Beers Criteria statistically had better knowledge than others (p = 0.003).

Conclusion

Beers Criteria awareness among community pharmacists is sub-optimal in Ibadan, Nigeria. Although practice when dealing with elderly customers was satisfactory, the knowledge was unsatisfactory. This underscores the need to intensify the awareness and use of guidelines that document specific PIMs such as Beers Criteria among community pharmacists.

Nurses’ perceptions of fall risk factors and fall prevention strategies in acute care settings in Saudi Arabia

Aim

This study aimed to explore nurses’ perceptions of the factors associated with falls and of fall prevention strategies in acute care settings in Saudi Arabia.

Design

This is a cross‐sectional, correlational, descriptive study.

Methods

Data were collected from 102 nurses using a survey on the risk factors and prevention strategies of injurious falls.

Results

We found that impaired balance and muscle strength, limited mobility, and an inability to follow safety instructions were reported as the top factors in falls. Multidisciplinary fall prevention strategies are effective in reducing the prevalence of falls. Nurses with higher levels of education had higher perceptions towards the risk factors of falls. Formal patient safety training, including fall prevention education programmes, were shown to reduce falls by making nurses more aware of fall risk factors and prevention strategies. The findings of this study can be used to inform managers about factors that may contribute to falls in acute care settings.

Antimicrobial stewardship: Assessment of knowledge, awareness of antimicrobial resistance and appropriate antibiotic use among healthcare students in a Nigerian University

BACKGROUND

Inappropriate use of antibiotics is a major cause of antimicrobial resistance (AMR). Inadequate knowledge about AMR among healthcare students could affect their practice of antimicrobial stewardship as future healthcare professionals. This study aims to assess the use of antibiotics and knowledge of AMR among future healthcare professionals of a Nigerian University.

METHODS

Respondents' knowledge of antimicrobial resistance, use of antibiotics, and source of antibiotics in the past 12 months was explored using a self-administered questionnaire. Multivariate analyses were used to evaluate the relationship between specific variables and respondents' knowledge.

RESULTS

Of the 939 questionnaires administered to the students, 866 were filled given a response rate of 92.2 %. A total of (765; 88.3 %) of the respondents were aware that antimicrobial resistance makes it harder to eliminate the infection from the body as existing drugs become less effective. In all 824, (95.2 %) of the respondents had use antibiotics in the past 12 months. The use of antibiotics to treat malaria was self-reported by (175; 21.2 %). About half (432; 52.4 %) purchased the antibiotics from community pharmacies, while others obtained their antibiotics from the hospitals (192; 23.3 %), patent medicine stores (150; 18.2 %), and friends and family (50; 6.1 %) in the last 12 months. In all 506, (58.4 %) had good knowledge of antimicrobial resistance. Logistic regression shows that students in 3rd to 6th year 9.29 [AOR = 9.29, 95 % CI: (3.7-22.96)], had greater knowledge of antimicrobial resistance.

CONCLUSIONS

The healthcare students demonstrated a moderate knowledge of AMR. This underscores the need to adopt several educational tactics to introduce the concepts of AMR to the students and ensure there are strict policies to regulate the flow of antibiotics.

Hospital pharmacy outpatient medication dispensing and counselling practices in North-Western Nigeria: an observational study

OBJECTIVE

To describe outpatient medication dispensing and counselling processes in pharmacies located in eight hospitals in North-Western Nigeria.

METHODS

An observational study was conducted from January to March 2020 in 19 hospital pharmacies located in the eight hospitals. Two types of observations were carried out, structured observations to describe the content of patient medication counselling encounters and general observations of other activities. Quantitative data were generated from the structured observations, whereas qualitative data were collected from field notes and informal discussions with dispensers. Data collected during the structured observations were descriptively analysed, whereas other data collected during the general observation periods were grouped and organized into categories.

KEY FINDINGS

A total of 782 patient counselling encounters were observed during the structured observations. The most frequent types of information provided by the dispensers during these encounters included dose (98%) and route of administration (85%). Information about the name(s), indication(s), side effect(s) of medication as well as the importance of adherence were provided in less than 5% of these cases. Dispensers also made attempts to verify ownership of prescriptions to be dispensed in only 35% of these cases. Other issues observed included lack of interventions by dispensing staff during these processes. A total of 100 dispensing errors were observed, and provision of incomplete information (usually about duration of medicines use) was the most common type of dispensing error seen.

CONCLUSIONS

Several problems were observed with the medication dispensing and counselling processes for outpatients in the hospital pharmacies observed. Interventions aimed at improving these processes are required if patients are to use their medicines correctly and safely.

Prevalence, knowledge and perception of self-medication practice among undergraduate healthcare students

BACKGROUND

Globally, self-medication is a common practice, and an increasingly perceived necessity to relieve burdens on health services. However, inappropriate self-medication may result to reduced health outcomes, increased antimicrobial resistance and economic waste. Healthcare students are the future health professionals who will be consistently responsible for educating the public on rational use of medication. This study therefore aimed to assess the prevalence, knowledge and perception of self-medication practices among healthcare students.

METHODS

A cross-sectional study was carried out among 866 healthcare students in a Nigerian University, comprising medical, nursing and pharmacy students. Information was garnered from respondents using a self-administered questionnaire. Data were summarized with descriptive statistics, while Chi-square and logistic regression tests were used for categorical variables at p < 0.05.

RESULTS

Mean age was 21 ± 2.8 years, and female respondents were 447 (51.6%). Prevalence of self-medication among respondents was 473 (54.6%). A total of 288 (55.3%) demonstrated good knowledge of self-medication practices, comprising 250 (52.2%) among those who have previously self-medicated and 229 (47.8%) among those who had not. Reasons for engaging in self-medication practices were mentioned to include treatment of minor ailments (357; 32.4%), while 248 (22.5%) believed they had the medical knowledge of what to use. Analgesic (353; 30.1%), antimalarial (352; 30.0%), and antibiotics (182; 15.5%) were the commonest classes of medication used for self-medication. Headache (363; 18.4%), malaria (334; 16.9%), and cough (184; 9.3%) were the most frequently treated conditions. More than half (281; 59.4%) of the respondents' purchased their self-medicated drugs from the community pharmacy. Gender and respondents' disciplines were found to be the independent predictors for good knowledge of self-medication practice.

CONCLUSION

Prevalence of self-medication among the studied healthcare students is moderately high, while approximately half demonstrates good knowledge and perception of self-medication practices. Stimulation for self-medication practice largely arise from the perception of treating minor ailments. This underscores a need for advocacy on responsible self-medication practice during the formal training of these future health professionals, in order to avert its imminent/widespread negative consequences.

Medications and the risk of falls among older people in a geriatric centre in Nigeria: a cross-sectional study

Background Falls are a major cause of morbidity and hospitalization in older people. Many drugs have been shown to increase the risk of falls in this population. Few empirical data exist on the use of fall-risk-increasing drugs among older people of sub-Saharan Africa countries. Objective This study aimed to assess the prevalence and predictors of falls, and the association between FRIDs, drugs causing orthostatic hypotension and falls. Setting Geriatric center, University College Hospital, Ibadan, Nigeria. Methods A cross-sectional study of 400 older patients aged ≥ 60 years selected consecutively at the geriatric centre, between September and November 2019, were interviewed using a semi-structured questionnaire. Socio-demographic information, medication utilization, and history of falls were obtained. Bivariate and multivariate analyses were carried out using SPSS 23. Alpha was set at 0.05. Main outcome measure Prevalence and predictors of falls among ambulatory older patients. Results The mean age of the older patients was 72.4 ± 7.3 years and 255 (63.7%) were females. The total number of FRIDs and ODs used by older patients was 578 (35.2%). The prevalence of fall was 181 (45.3%) which was significantly higher among the females compared with the males (51.8% vs 33.8%) p = 0.01. Classes of medications such as anti-Parkinson's (p = 0.027), sedatives (p = 0.033), antipsychotics (p = 0.011) and anticholinergic (p = 0.027) were significantly associated with fall. Predictive factors for falls on logistic regression were female [OR = 2.375; 95% CI 0.274-3.704, p = 0.001] and use of antipsychotics [OR = 5.132; 95% CI 1.352-19.480, p = 0.016]. Conclusion The prevalence of falls was high and being a woman ≥ 60 years is a major risk factor for falling. Interventions to decrease falls in older patients by drug modification and deprescribing of FRIDs and ODs might reduce fall-related injuries. Thus, a multidisciplinary approach is essential for intervention to reduce the risk of falls and improve therapeutic outcomes among older patients.