Dalal Al-Dossari

Electronic Health Records, Electronic Prescribing and Medication Errors: A Systematic Review of Literature, 2000-2014.

Background: The electronic prescribing system, either standalone or embedded in the electronic health record, is a powerful tool in the hands of healthcare providers, as it reduces half of medication errors caused by handwritten prescribing.

A Comparative Analysis of Electronic Prescribing Near Misses in King Saud Medical City, Riyadh, Saudi Arabia

Background: Anear missor close call is a medication error that happened but did not result in injury or damage to the pati ent. These medication errors (MEs) are captured and corrected before affecting the patient either fortuitously or purposefully by designed system controls imbedded in electronic health record (EHR) as well as electronic prescribing systems (EPS). Objective:This study analyzed the reported electronic prescribing near misses (NMs) in King Saud Medical City (KSMC) in Riyadh city. Methods: The ME report forms were consecutively collected over a period of one year,

Analysis of reported e-prescribing near misses in King Saud Medical City, Riyadh

License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Integrated Pharmacy Research and Practice 2013:2 17–24 Integrated Pharmacy Research and Practice Dovepress

Cupping Therapy (Al-Hijamah): Healthcare Professionals' Controversial Beliefs Before and After Training Program, Kingdom of Saudi Arabia

National Center for Complementary and Alternative Medicine, Ministry of Health, Riyadh, Saudi Arabia. Department of Public Health and Community Medicine, Faculty of Medicine, Tanta University, Egypt. 3 Faculty of Medicine, Tanta University, Egypt. Babu Banarsi Das Gupta District Hospital, Bulandshahr, Laxmi Nagar, Bulandshahr, Uttar Pradesh 203001, India. Medication Safety Unit, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia. Drug Poisoning and Information Center, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia.

Analysis of medication errors at a large tertiary care hospital in Saudi Arabia: a retrospective analysis

Background Medication errors (MEs) are common in health care settings and pose a threat for the hospitalized population. Therefore, aspects of MEs were explored in a tertiary setting serving a diverse population. Objective To examine the occurrence, severity and reporting of MEs in hospitalized patients. Methods This retrospective analysis included 10,683 ME report forms that were received by the Medication Safety Unit of King Saud Medical City (KSMC) in 2015. ME outcomes were determined according to the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Index for categorizing MEs algorithm. Results A total of 13,677 MEs in 912,500 prescriptions were reported. The incidence rate of MEs was 1.5% (13,677/912,500). The highest percentage (42.2%) of MEs occurred during the transcription stage, and 70.0% of MEs were reported as near misses. Wrong frequency and wrong concentration accounted for nearly half of the MEs. Conclusion We found 1.5 MEs per 100 prescriptions; more than two-thirds of the MEs were preventable and were intercepted before reaching the patients. Most MEs reported by pharmacists occurred at the transcription stage while wrong frequency was the most common error type encountered. Further studies should explore the clinical consequences of MEs at a healthcare institution.

Adverse drug reaction reporting in a large tertiary hospital in Saudi Arabia: results of an incentive strategy

Background: Underreporting is a common problem with spontaneous adverse drug reaction (ADR) reporting. In this study, we aim to describe the reporting of ADRs in a tertiary hospital and determine the effect of incentives to healthcare professionals on ADR reporting. Methods: In this interventional study, a time series analysis was used to determine the effect of incentives on ADR reporting in a tertiary hospital between 2015 and 2016. The incentive strategy included public commendation of health care providers and nomination for a monthly award. Results: A total of 967 ADRs were reported over a 2-year period. After the introduction of incentives in January 2016, the number of ADR reports per month increased by 40.6 (95% confidence interval: 26.1–55.1). The proportion of serious ADRs reported was significantly higher in 2016 (39/800) than 2015 (0/167) (p < 0.001). In 2016, there was a significant association between profession and serious ADR reporting (p < 0.001). A total of 14/21 ADRs (66.7%) reported by physicians in 2016 were serious compared with 20/700 (2.9%) reported by clinical pharmacists and 5/72 (6.9%) by nurses. Conclusions: ADR reporting was improved by providing incentives, including commendation and reward, to healthcare professionals.

Lean Six Sigma, Root Cause Analysis to Enhance Patient Safety in Healthcare Organizations: A Narrative Review, 2000-2016

Background: Lean Six Sigma [LSS] and Root Cause Analysis [RCA] are powerful quality business tools that cost-effectively improve efficiency and effectiveness of and client satisfaction in healthcare, academia and other industries. RCA, an iterative process helps in the identification of the root cause of an adverse medical incident and injuries and consequently prevents its Mini-review Article Salem et al.; JAMPS, 12(1): 1-26, 2017; Article no.JAMPS.31541 2 recurrence provided RCA recommendations are properly implemented in the healthcare industry. Objective: This narrative review aims to describe the principles and objectives of LSS and RCA tools with a special focus on their diverse roles in healthcare organizations. Methods: A computer searches of PubMed, OvidSP, and Google Scholar (2000-2016) were made using keywords such as Lean, or Six Sigma or lean six sigma or medication errors (MEs) or adverse drug events or RCA which retrieved thousands of references but only 110 articles were included in this paper. Results: Lean, Six Sigma, LSS, and RCA are powerful quality improvement tools that prevent adverse events, produce better quality services and result in enhancing patient satisfaction and safety. These quality tools also decrease costs, work performance variance, waste and increase customer satisfaction and the work performance of healthcare professionals. Conclusion: The use of the quality improvement tools produce better quality healthcare services with greater efficiency, and good outcome and also prevents adverse drug events linked with significant morbidity, mortality and financial burden on the public health around the world.

Medication safety unit programs in King Saud Medical City, 2012-2013: safe medication management and use with a focus on patient safety.

To optimize a nanostructured lipid carriers system (NLC) for the per-oral delivery of valsartan (Val), a model BCS class II drug, in an attempt to enhance its therapeutic performance by increasing both solubility and dissolution. Val-loaded NLCs were prepared using ultrasonic melt-emulsification method. Number of formulation factors including the type of oil/lipid, Val to lipid ratio, and surfactant ratio were investigated. The prepared NLC were evaluated for their particle size and shape, polydispersity index, zeta potential, and drug entrapment efficiency. The in vitro drug release profiles were evaluated using a dialysis bags with cut-off 12KD. The prepared NLCs showed average sizes between 423.99±12.73 and 805.53±39.5 nm, and polydispersity index in the range of 0.287 to 0.361. The zeta-potential values were between -3.34 and -10.59 mV. The entrapment efficiency was not very high between 27.3 to 75.04%. The scanning electron images showed almost spherical shapes with sizes lower than those obtained by light scattering. The in vitro release followed a bi-phasic pattern with an initial rapid Val release followed by a slow release varying according to the composition. Two formulations F2 and F4 showed complete drug release within the first two hours. The optimum surfactant ratio was 37.5% by weight of the total lipid. NLC successfully enhanced the Val release rate and dissolution with high potential to enhance its bioavailability.Results: Of 1435 citation reviewed, 22 studies published in 26 papers were appraised. These studies mainly focused on factors affecting patients reporting of ADRs. None of these studies conducted at North America. Sixteen out of 22 reviewed studies described barriers to the reporting process included: Poor awareness of ADR reporting systems; difficulties with reporting procedure and forms; lack of feedback to ADRs submitted by the patients; confusion as to who reports ADRs and to whom they are reported; poor economic status; ADRs resolved; and prior negative reporting experience. Another 11 out of the 22 reviews studies described the motives for reporting ADRs by patients and those included: prevent others from similar ADRs; inform regulatory bodies, drug manufacturer, HCPs, and public; improve drug safety and medication leaflet and enhance scientific knowledge; improve HCP practices; failure of HCPs to report their ADRs; asked to report ADRs by HCPs; it was serious ADRs; and desire for personal feedback and want more information about the ADRs.W are unfortunately subject to an optimistic bias when we evaluate how, and to what extent, drugs and other medical therapies will become available and accessible to patients on the global level in which pharmaceutical enterprises operate. In developed countries, the pricing and affordability of medicines is a controversial issue that highlights health and economic inequalities, and great challenges for the future. According to the New York Times article Lawmakers Look for Ways to Provide Relief for Rising Cost of Generic Drugs (November 24th 2014), “the cost of many generic medications has increased so much over the past year that prices for many common generic drugs in the USA have surpassed those of their brandname equivalents in other developed countries”. The issue of unaffordable healthcare is more challenging with technological advances and the demographic growth of the geriatric population, including those with cancer and cardiac disease. Legislation can be instrumental in the creation of equitable solutions. The EU member state’s management of healthcare access and drug entry; the implementation of regulatory requirements aimed at ensuring quality, safety, and efficacy of medicines and vaccines for human use; and the European Transparency Directive (Council Directive 89/105) which defines procedural requirements for pricing and reimbursement of medicinal products will be discussed. These issues must be taken into account since few of the hundreds of drugs in clinical development ever reach the stage of final approval, having failed to produce the anticipated results expected by the investigators. These trials can take up to 20 years to complete, and several billion dollars to reach the stage of approval or denial by the regulatory agency involved. When failing to demonstrate viability, preexisting expenditures are allowed to be passed onto the price the pharmaceutical company charges patients. In the cancer industry for example, most new drugs require the patient or insurance company to pay 50-100,000 dollars for a course of treatment which may not offer more than several months of improvement in the clinical response. It is essential that the legislators in each of the countries where the drug is to be introduced be able to negotiate a fee arrangement where the patient will not be denied treatment and the drug company be compensated reasonably for development costs.Copyright: