Therapeutic duplication on the general surgical wards

Therapeutic duplication is the practice of prescribing multiple medications for the same indication or purpose without a clear distinction of when one agent should be administered over another. This is a problem that occurs frequently, especially on electronic prescribing records (EPR) as the medication chart is not always reviewed before prescribing. The aim of this Quality Improvement Project (QIP) was to reduce therapeutic duplication to 0% through educating the general surgical team. Prescriptions of all general surgical patients in the surgical wards were reviewed daily for a month. EPR was used to check if there were any duplications or identical class of drug prescribed. Patient documentation was thoroughly checked to rule out if the duplication was intentional. Following this, if duplication was still unclear, the relevant teams would be contacted for clarification. Any unintentional error was removed, and data was collected. The QIP results were presented to the local general surgical meeting and our fellow colleagues were educated on the importance of safe prescribing and on how to prevent prescribing errors. The baseline of therapeutic duplications on the general surgical wards was 9% prior to our first cycle. Following the presentation of data and educating the surgical team at the surgical meeting, the number of errors seemingly reduced, however, there was a jump to 22% of therapeutic duplication on a particular Friday which brought the average of therapeutic duplication to 8.77%. The team was reminded again about the importance of correct prescribing and after the second cycle, the number of errors reduced to 5.29%. For the third audit cycle, the team was presented with the reaudited data and following this, the number of errors dropped down to 3.12%. Therapeutic duplication should never occur as this could cause a risk to patient harm. Through educating the surgical team and reminding our team regularly, the average number of errors reduced by more than half of the original number. In our hospital, the main source of safety net is through pharmacists and nurses, however as shown, this is not enough to prevent all therapeutic errors. A more sustainable intervention such as an alert on EPR prior to prescribing may be required to maintain a low therapeutic duplication average and prevent patient harm.

EVALUATION OF CARBAPENEM USE AMONG PATIENTS AT INTENSIVE CARE UNIT (ICU) IN SANA'A, YEMEN

Drug Utilization Evaluation (DUE) studies are designed to evaluate and improve the rational use of medications. In this study, DUE has focused on drugs used in high risk patients such as critically ill cases. Carbapenems are beta-lactam type antibiotics with broad-spectrum of activity which cover gram-positive, gram-negative and anaerobic bacteria. The heavy use of carbapenems (imipenem or meropenm) could increase the risk of multi-drug resistant (MDR) pathogens. This study was a prospective and cross sectional study performed at intensive care unit (ICU) of Al-Matwakel hospital in Sana'a, Yemen. The study was conducted from September 2018 to March 2019. All of the patients were on imipenem or meropenem as an empiric treatment or based upon microbiology culture results included in the study. Total of 80 patients at ICU were evaluated. The results of the study showed that empiric therapy was in most cases (91.25%; P< 0.001).In addition; about 36.3% of the patients required dosage adjustment according to glomerular filtration rate (GFR) stages. Also according to GFR calculation, 43.8% of the patients were in stage 3. In the present study, the frequency of therapeutic duplication of ceftriaxone with carbapenem was reported in 38 patients. The major drug-drug interactions were observed with tramadol-imipenem, tramadol-meropenem, and amlodipine-simvastatin. The result of the study showed that empiric therapy was unjustified in most cases (91.25%). In addition, about 36.3% of the patients required dosage adjustment according to GFR stages. According to GFR calculation, 43.8% of the patients were in stage 3. In the present study, the frequency of therapeutic duplication and drug-drug interactions were observed. Peer Review History: UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file Average Peer review marks at initial stage: 4.5/10 Average Peer review marks at publication stage: 8.0/10 Reviewer(s) detail: Name: Dr. (Mrs) Amaka Mgbahurike Affiliation: University of Port Harcourt, Nigeria E-mail: [email protected] Name: Dr. Mahmoud S. Abdallah Affiliation: University of Sadat city, Egypt E-mail: [email protected] Comments of reviewer(s):

Physician and pharmacist satisfaction and clinical needs for the real-time medication surveillance program in South Korea

Background Since December 2010, a nationwide real-time medication surveillance program has been implemented in Korea to prevent potential adverse drug reactions. Our goal was to evaluate physicians’ and pharmacists’ satisfaction and clinical needs for the medication surveillance program in Korea. Methods Both web- and paper-based surveys were conducted using a structured questionnaire among 1164 physicians and pharmacists from May 23, 2014 to August 11, 2014. The survey consisted of questions about the participant’s satisfaction with the medication surveillance program, clinical usefulness, clinical need for the medication surveillance program, and sociodemographic characteristics. Multivariate ordinal logistic regression was performed to investigate the factors influencing satisfaction levels with the medication surveillance program. Results We analyzed data from 1120 respondents, including 503 physicians and 617 pharmacists. Overall, 63.1% of the respondents were satisfied with the medication surveillance program. Pharmacists were more satisfied with the program than were physicians (69.1% vs. 55.6%; adjusted odds ratio, 2.13; 95% confidence interval, 1.65–2.76). Among the respondents, 77.8% cited a decrease in therapeutic duplication to be a major improvement resulting from the medication surveillance program, 82.6% considered the drug–drug interaction information useful, and 48.7% suggested that the program should include information on liver or kidney disease–drug interaction. Conclusions Overall, 63.0% of physicians and pharmacists were satisfied, and a decrease in therapeutic duplication was regarded as the most beneficial component. Further improvements by considering clinical needs of physicians and pharmacists will be needed to increase satisfaction.

Fixed-dose combination antihypertensives and risk of medication errors

ObjectiveWhile fixed-dose combinations (FDC) can improve adherence, they may add complexity to the prescribing/dispensing process, potentially increasing risk of medication errors. This study aimed to determine if prescriptions for antihypertensive FDCs increase the risk of therapeutic duplication and drug–drug interactions (DDI).MethodsThis retrospective observational study used administrative pharmacy claims data from the Irish Primary Care Reimbursement Service. Prescriptions dispensed to adults in 2015 were included if they contained an antihypertensive FDC, or the same drugs prescribed separately. The outcomes were therapeutic duplication and potentially serious DDI involving FDC drugs. Relative risk (RR) of these outcomes, adjusted for prescription and patient factors, was determined using generalised linear models with Poisson distributions and propensity score matching.ResultsThis study included 307 833 FDC prescriptions (67.0%) and 151 632 separate component prescriptions. Half of patients prescribed FDCs were female with a mean age of 67.1 (SD 12.5) years and, compared with separate component prescriptions, FDCs were less often coprescribed with other cardiovascular medications. Therapeutic duplication occurred in 0.8% of prescriptions, most often involving calcium channel blockers, and 10.6% contained a DDI (most often amlodipine and simvastatin). The RR of therapeutic duplication on FDC prescriptions compared with separate component prescriptions was 1.46 (95% CI 1.17 to 1.83) and the adjusted RR was 2.06 (95% CI 1.64 to 2.60). For DDIs, there was no significant difference between FDC and separate component prescriptions after confounder adjustment.ConclusionsThis study found FDCs were associated with increased risk of duplication. When considering prescribing FDCs, this safety consideration should be weighed against potential benefits.