Berko Panyin Anto

Medication safety strategies in hospitals--a systematic review.

BACKGROUND Medication safety is an essential component of patient safety in health care delivery. Providing strategies to effectively prevent medication errors and adverse drug events in hospitals has gained international recognition. OBJECTIVE The aim of this paper was to review systematically the research literature on the various interventions for providing medication safety in hospitals. METHOD Eight healthcare databases were searched for full research articles written in English. Reference lists of included studies were also searched. Research studies involving delivery of interventions in hospitals with the aim of preventing or reducing medication errors and adverse drug events were examined. RESULTS Forty-two studies were selected. Most of the studies were before and after designs without comparative control groups. Forty studies identified interventions contributing to the prevention and reduction of medication errors. Six broad types of interventions were identified: computerized physician order entry with or without clinical decision support systems, automation, computer assisted, barcode technology, pharmacist role, training and system designs. CONCLUSION Though studies have provided evidence for individual interventions, there are concerns about the extent of their effectiveness. This has implications for policy makers and clinicians to adopt multifaceted approach in providing medication safety in their hospitals.

Error-provoking conditions in the medication use process: the case of a government hospital in Ghana.

Objective This study aimed to explore error-provoking factors prevalent in hospitals that have the potential to cause medication errors and to create awareness of the existence of medication errors. Methods A total of 200 medical folders of in-patients in the health facility were randomly selected and assessed based on a checklist to record potential medication errors. The medication use process and working environment as well as drug packages and labels in the pharmacy were observed, and potential medication errors were documented. Findings Of the 162 valid in-patient folders studied, 60.5% of the patients did not receive the actual quantity of drugs they were supposed to. Illegible handwriting on medication orders and prescription were common observations in the folders studied. Look-alike medicine packages and labeling were found. The working space in the dispensary was congested, and distractions (e.g., ringing personal telephones, being called from one task to attend to another, and unnecessary conversation between personnel) were common. Conclusions This study has highlighted the vulnerability of the medication use process in the study site to medication errors. The findings may just be a tip of the iceberg; therefore, the researchers plan undertaking a multicenter study. In the absence of that, however, there is a need for a national policy on patient safety, and a national policy on incident reporting would help in determining the incidence, types, and potential causes of medication errors to improve patient safety.

Malaria rapid diagnostic test evaluation at private retail pharmacies in Kumasi, Ghana

Objective: Malaria rapid diagnostic test (MRDT) provides a good alternative to malaria microscopy diagnosis, particularly in resource-constrained settings. This study therefore evaluated MRDT in private retail pharmacies (PRPs) as a critical step in community case malaria management. Methods: In a prospective, cross-over, validation survey at six PRPs in the Ashanti Region of Ghana, 1200 patients presenting with fever in the preceding 48 h were sampled. Fingerstick blood samples were collected for preparation of thick and thin blood films for malaria microscopy. Categorized patients (600 each) went through the processes of MRDT or presumptive diagnosis (PD) of malaria. The malaria disease prevalence of the study area was established. Selectivity (Se), specificity (Sp), positive predictive value (PPV) along with false discovery rate (FDR), and negative predictive value (NPV) along with the false omission rate (FOR), and diagnostic odds ratio (DOR) of MRDT were then calculated. Findings: While 43.0% tested positive using the MRDT, 57.0% tested negative. However, 62.0% MRDT-negative patients in addition to all the MRDT positives were given artemether-lumefantrine. Of those diagnosed by PD, 98.2% were prescribed with an antimalarial (microscopy however confirmed only 70.3% as positive). Se and Sp of the MRDT were 90.68 ± 11.18% and 98.68 ± 1.19%, respectively. Malaria prevalence was estimated to be 43.3%. PPV was 98.0%, FDR was 2.0%, NPV was 98.0%, FOR was 2.0%, and DOR was 2366.43. Conclusion: Results highlighted good performance of MRDTs at PRPs which could inform decision toward its implementation.

Medication Administration Errors in an Adult Emergency Department of a Tertiary Health Care Facility in Ghana.

Objectives This study determined the incidence, types, clinical significance, and potential causes of medication administration errors (MAEs) at the emergency department (ED) of a tertiary health care facility in Ghana. Methods This study used a cross-sectional nonparticipant observational technique. Study participants (nurses) were observed preparing and administering medication at the ED of a 2000-bed tertiary care hospital in Accra, Ghana. The observations were then compared with patients’ medication charts, and identified errors were clarified with staff for possible causes. Results Of the 1332 observations made, involving 338 patients and 49 nurses, 362 had errors, representing 27.2%. However, the error rate excluding “lack of drug availability” fell to 12.8%. Without wrong time error, the error rate was 22.8%. The 2 most frequent error types were omission (n = 281, 77.6%) and wrong time (n = 58, 16%) errors. Omission error was mainly due to unavailability of medicine, 48.9% (n = 177). Although only one of the errors was potentially fatal, 26.7% were definitely clinically severe. The common themes that dominated the probable causes of MAEs were unavailability, staff factors, patient factors, prescription, and communication problems. Conclusions This study gives credence to similar studies in different settings that MAEs occur frequently in the ED of hospitals. Most of the errors identified were not potentially fatal; however, preventive strategies need to be used to make life-saving processes such as drug administration in such specialized units error-free.

Introducing Malaria Rapid Diagnostic Tests (MRDTs) at Registered Retail Pharmacies in Ghana: Practitioners' Perspective

Aims: In much of Africa, Ghana inclusive, malaria has traditionally been diagnosed and treated presumptively: any patient with fever was presumed to have malaria and treated with antimalarial drugs. In this study, the retail pharmacies practitioners’ perspectives on the implementation of Malaria Rapid Diagnostic Tests was sought and decisions analyzed in themes, using Realist Conceptual Approach. Study Design: Cross-sectional quantitative and purposive study. Place and Duration of Study: Registered private pharmacies in Ashanti Region of Ghana, between September and November, 2013.

Structured pharmaceutical care improves the health-related quality of life of patients with asthma

BackgroundAsthma as a chronic health condition can be controlled when in addition to clinical care, adequate education and support is provided to enhance self-management. Like many other chronic health conditions improved self-management positively impacts the health-related quality of life (HRQoL). It can therefore be said that a well-structured pharmaceutical care delivery that addresses the issues related to patient education and support towards self-management stands a good chance of positively impacting asthma control.This study evaluated the impact of a structured pharmaceutical care delivery on asthma control.MethodsA prospective pre-/post- intervention study of a single cohort of 77 adult out-patients visiting specialist asthma clinics in Ghana were assessed for HRQoL and peak expiratory flow rates (PEFR) one month after pharmaceutical care intervention. Pharmaceutical care intervention covered education on the health condition, pharmacotherapy and self-management issues as well as correction of inhaler-use technique, where necessary and when to urgently seek medical care. The mean difference of the HRQoL and PEFR values were subjected to paired samples t-test analysis.ResultsDelivery of a structured pharmaceutical care led to a significant improvement in asthma specific quality of life and PEFR. The mean paired difference of the HRQoL for a cohort of patients with asthma post- pharmaceutical care intervention was 0.697(95% CI: 0.490 - 0.900) at t = 6.85 (p < 0.05). The mean paired difference for PEFR post intervention was 17.533 (95% CI: 2.876 - 32.190) at t = 2.384 (p = 0.02).ConclusionThis study identified important challenges with both the pharmacologic and the non-pharmacologic management of adult asthma patients. Inadequate inhaler-use skills, widespread occurrence of preventable adverse events and irregular use of preventer medicines were prevalent among patients. At one month after pharmaceutical care intervention, patients with asthma in a cohort follow-up study showed significant improvements with regard to asthma-specific quality of life, peak flow rates and knowledgeTrial registrationGHS-ERC: 08/9/11 of October 19, 2011.