Qatar Medical Journal - 3 - HMC Collaborative Pharmacy 2016 Conference Proceedings, June 2017

Background and aim: Medication errors (MEs) are a major global issue, adversely impacting patient safety and health outcomes. Promoting patient safety through minimising MEs is therefore a key global healthcare objective. This study aims to systematically review the incidence, nature and causes of MEs in hospitalised patients in Middle Eastern countries. Method: A systematic search of studies related to MEs originated from Middle Eastern countries was performed using the following databases: MEDLINE, EMBASE, International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Cochrane Database of Systematic Reviews (CDSR), Centre for Review and Dissemination (CRD) database, Joanna Briggs Institute Library. A systematic review protocol was developed and registered with the Centre for Reviews and Dissemination (CRD). The title, abstract and full article were screened for inclusion. Each paper was assessed by two reviewers for methodological quality prior to inclusion in the review. Studies were critically appraised prior to data extraction and findings synthesised using a narrative approach. Results: Database searching identified 2611 studies; 51 met the inclusion criteria and originated from nine of fifteen Middle Eastern countries, largely Iran, Saudi Arabia and Israel. Preliminary review results indicate error incidence rates of between 11 and 90% of patients (depending on the method of data collection), with the categories of errors reported being mostly prescribing errors followed by administration, dispensing and transcribing. Deficiencies in staff knowledge, lack of experience, insufficient training, poor adherence with protocols and policies, miscommunication and excessive workload were identified as major causative factors. Conclusion: MEs occur at high rates of incidence in the Middle East. Causes of errors are multifactorial and should be targeted in future interventions, which are likely to be complex interventions at varying levels within the healthcare systems.

This project is funded by QNRF (NPRP project NPRP–388-3-095).

Introduction: Under-reporting of adverse drug reactions (ADRs) and low-quality reporting are a widespread phenomenon globally.¹ There is a need for more insight on the role of pharmacists and other healthcare professionals in ADR reporting. This study primarily aimed to compare the rates, quality, and characteristics of ADR reports received from different healthcare providers in Rumailah Hospital (RH) in Qatar. Methods: A retrospective descriptive analysis of ADR reports submitted by healthcare providers in RH between 1 January 2012 and 1 October 2014 was conducted. Outcome measures included rate of ADR reporting, quality, causality scores as well as characteristics of the reported ADRs. Results: A total of 92 ADR reports were submitted by different healthcare providers, of which 42% were submitted by pharmacists, 38% by physicians, and 9% by nurses. Most of the ADR reports by physicians (66%), nurses (63%) and pharmacists (41%) were judged to be of high quality (grade 2) based on WHO scheme (p>0.05%).² Sixty percent of the submitted ADR reports were for medications considered ‘possibly’ causing the event according to Naranjo causality score, while 30% were considered probable (p < 0.05%). Most of the ADR reports were type B (54%) and were unpreventable (64%) according to the Medication Appropriateness Index (MAI).³ One hundred percent and 91% of nurses and physicians' ADR reports were for unpreventable events, respectively, while 41% of pharmacists' reports were definitely preventable ADRs (p < 0.05%). Conclusion: ADR reporting in RH was undertaken by different healthcare professionals and was generally of high quality. ADRs reported were often unpreventable. There were differences between characteristics and causality scores of ADR reports between different healthcare professionals.

Introduction: Piperacillin/tazobactam is a bacteriolytic combined antibiotic that contains the extended-spectrum penicillin antibiotic, piperacillin, and the β-lactamase inhibitor, tazobactam. The piperacillin/tazobactam acts against several gram-positive and -negative bacteria. Some of the most common adverse reactions of piperacillin/tazobactam are diarrhea (7–11%) and fever (2–5%). The least common reported adverse reactions of piperacillin/tazobactam are hematological reactions ( < 1%), which include leukopenia, neutropenia, and/or thrombocytopenia. The use of piperacillin/tazobactam during pregnancy is considered to be moderately safe (pregnancy category B) for the human embryo-fetus. We report a case of piperacillin/tazobactam-induced fever, leukopenia, neutropenia, and thrombocytopenia during pregnancy in Qatar. Case description: A 33-year-old pregnant patient (22 weeks of gestation, gravid 6 para 3 plus 2 miscarriages) was admitted to Women's Hospital, Doha, Qatar and was treated for preterm premature rupture of membrane (PPROM) with erythromycin for 10 days. Afterwards, she was treated with piperacillin/tazobactam for asymptomatic urinary tract infection (Pseudomonas species). After 15 days of piperacillin/tazobactam treatment, she developed fever, leukopenia, neutropenia, and thrombocytopenia. These adverse reactions were reversed after the discontinuation of use of piperacillin/tazobactam combination. Discussion: In Qatar and worldwide, there are no reported cases regarding any form of bone marrow suppression or fever induced by piperacillin/tazobactam during pregnancy. Using the Naranjo Adverse Drug Reaction Probability scales, the score was found to be eight representing a probable adverse drug reaction. Conclusion: We report a case of probable fever, leukopenia, neutropenia, and thrombocytopenia induced by piperacillin/tazobactam in a pregnant woman. It is important for healthcare professionals to be aware of the possibility of these serious adverse drug reactions while using this antibiotic combination. All patients must be monitored carefully while being treated with this combination, especially pregnant women.

Background: Metformin hydrochloride (MH) is a widely used medication for diabetes mellitus. For that, the availability of numerous multisourced MH in the drug market puts health care providers in a difficult situation for choosing the suitable brand and the possibility of interchangeable use. Objective: The aim of this study is to test 10 brands and generics of local and regional MH multisourced tablets to assess their in vitro bioequivalence and interchangeability. Methods: The in vitro bioequivalence assessment tests were carried out for ten brands of MH tablets (500 mg except one brand of 850 mg dose) based on the US Pharmacopoeia (USP 34) guideline recommendations. The content analysis test was done on 20 tablets for each brand using the UV method following USP 34 procedure and phosphate buffer (pH 6.8). Dissolution test was performed for six tablets from each brand using apparatus one (basket), with a rate of 100 rounds per minute (rpm) and 1000 ml phosphate buffer. UV scanning and calibration curve were performed to calibrate and validate the UV spectrophotometer. Dissolution profiles were compared with the reference Glucophage from Qatar by calculating the similarity factor (f2). Results: Product numbers 2, 4, 5, 8, 9, and 10 had percent dissolved within 95–105% as an acceptable range for a content test according to USP 34. All the brands had more than 70% dissolved within 45 minutes. Similarity factor results revealed that product numbers 1, 3, 4, 5, 7, and 10 were bioequivalent with the reference because they had f2 more than or equal to 50%. Conclusion: From the 10 tested products, only Glucophage® (Qatar), Diaphage®, Diamet® (Palestine), Glucophage® (Oman), Glucomet, and Glucophage® (Thailand) can be interchangeable with the chosen innovator brand (Glucophage®).

Background and objective: Neonatal intensive care unit (NICU) is the unit rendering healthcare service for ill or premature newborn infants. Neonates are considered very high-risk patients and consequently they are more impacted by any prescribing error.

On the other hand, prescribing errors are more common in pediatrics and in particular in NICU due to frequent changes in medication's dose and frequency based on postnatal age/weight; or due to immature organ function that alters drugs' absorption or excretion rate 1. Accordingly, identifying and reducing potential causes of prescribing errors in NICUs is a major patient safety priority. The objective is to reduce the frequency of antimicrobial prescribing errors in NICU, Women's Hospital, HMC by 50% versus base line (NICU medication error reported not to exceed 10% of total Women's Hospital medication errors reported) in 10 months (May 2015–January 2016). Methodology: We implemented quality improvement methodology PDSA to make improvements in the prescribing process, focusing on making an entire NICU quality outcome better consistently. Our quality improvement principle focused on the systems that created the current outcome. What NICU prescribers are doing is getting us what we are getting. To GET something different, we have to DO something different. Two PDSA cycles have been performed: PDSA 1 (April–May 2015) *NICU medication errors data have been shared with Quality and Patient Safety Committee and NICU department.

* Improvement team was formed to initiate quality improvement intervention for NICU antimicrobial prescribing error trending.

* Schedule Series of interactive educational sessions were provided by NICU clinical pharmacist. To NICU physicians, the aim of those sessions was to ensure full understanding of the Antimicrobial Dosing Chart by physicians.

* Studying the quality improvement, the team decided to roll out PDSA 2 cycle. PDSA 2 (July–September 2016)

* Creating a Mini Quick reference of the antimicrobial chart to be easily referred by the physician if needed in any prescribing issue.

* Sharing the chart with NICU physicians. Result: Intervention led to a slight primary progress. Studying this progress 10 month projection, the team identified low probability to reach the improvement forecasted. PDSA 2 intervention significantly enhanced the progress leading to 50% less reports including antimicrobial prescribing errors – coming from NICU. Significant reduction of NICU antimicrobial prescribing errors reflected improvement in total NICU medication error reports as a percentage of the hospital reports. Conclusion: Antimicrobial prescribing errors reporting trend has negatively impacted the overall NICU service quality. Implementing quality improvement project: two cycles of PDSA have reduced not only the antimicrobial prescribing error reports, but also the overall medication error reports in NICU.