Analysis of Reported E-prescribing Medication Administration Errors at King Saud Medical City, Riyadh: A Cross-Sectional, Retrospective Study

Background:Drugprescriptionerrorisamedicationerrorthatmostfrequentlyhappensinhealthcareorganizationsandadverselyaffectsthehealthcareconsumers.Mostmedicationerrors(MEs)butnotallarecapturedandcorrectedbeforereachingthepatientbydesignedsystemcontrols.Medicationadministrationerrors(MAEs)mostlyaremadebynursesbutfrequentlyreportedbyclinicalpharmacistsinhospitalsinSaudiArabia.Objective:ThisstudyaimedtoanalyzeexclusivelythevoluntarilyreporteddrugadministrationerrorsinatertiarycarehospitalinRiyadhcity.Methods:Thiscross-sectional,retrospectivestudyevaluatedconsecutivelycollectedmedicationadministrationreportformsoveraperiodofoneyearfromJanuary1,2015toDecember31,2015.Results:ThenumberofMAEsoccurringduringstageofdrugadministrationconstituted7.1%(n=971)oftotalmedicationerrors(n=13677).ThemaximumnumberofMEs(n=6838,50%)and MAEs(n=455,46.9%)occurredduringthe4thquarteroftheyear2015.ThemostcommonMAEhappenedtobecategoryC(n=888,91.5%)whichmeanserroroccurred,reachedthepatientbutwithoutcausinganyharm.ConcerningMAEtypes,themostcommonerrorincludedwrongfrequency(40%)followedbywrongdrug(17%),wrongtimeofadministration(16%)andwrongrateofinfusion(10%).Nursesmadethemostoftheerrors(92.2%)whiletheclinicalpharmacistsreportedthemostMAEs(75.5%).Highalertmedications(HAM)errorsconstituted32.3%(n=314)ofMAEs(n=971)andmostcommonHAMerrorsincludedthewrongrouteofadministrationofLanusInsulin(15%)followedbyInsulinAspart(15%),Enoxaparin(13%)andInsulinProtamine-Nvomix(12%).Look-alikeandsound-alike(LASA)errorsconstituted55.2%ofMAEs(971/536)andmostcommonLASAdrugsidentifiedwereGentamycin(13%),InsulinMixtard(11%),NPHInsulin(8%)Intralipidvial(8%)andInsulinregular(6%).Conclusion:ThisretrospectivestudyprovidessomeimportanttentativepharmacovigilanceinsightsintoMAEs,whicharepartiallycomparablewithcurrentinternationaltrendsindrugadministrationerrors.FurtherstudiesonMAEsarewarrantednotonlyintheKingdomofSaudiArabiabutalsootherGulfcountries

Mental Health First Aid Training: A Study of Community Members’ Pre and Post-training Responses to a 17-Item Questionnaire

Background:Mental Health First Aid, an important component of metal health educational programs, targets naive community members, public, allied mental health personnel, and mental health experts with specific reference as to how these trained aiders should help people in crisis or with mental health conditions in the community.Objective:This study aimed to describe pre-to-post-test assessment of those who were trained in MHFA program.Setting: National Center for Mental Health Promotion, Riyadh, Saudi Arabia.Methods:Trained mental health professionals organized MHFA courses (n=35) for training self-selected, nonrandomized community members (n=862) who were assessed pre-to-post training by using an adapted 17-item questionnaire for measuring the impact of MHFA course on their mental health knowledge, perception, attitude and practice.Results: The participants’ responses to questionnaire were varied at pre-and post-test evaluation and 65% of them showed mild to significant positive changes in their responses, and the rest were not affected positively after this course, possibly attributed to multiple factors related tonaïve community trainees, advanced questionnaire, short timeline and dissimilar instructors.Conclusion: Although all participants well received the MHFA courses, 65% of participants’ pre-to-post-test responses improved positively. The preliminary results of this studyarenot generalizable to the whole community,need to be cautiously interpreted and this research is calling for more studies especially randomized controlledtrials in future.

Epidemiological Trend, Risk Factors, Prevention and Treatment Strategies of Self-directed Violent Behavior: A Critical Appraisal of Relevant Literature

Background:Suicide is an intentional fatal act of self-destructionand largely preventable phenomenon. Early Identification of suicide risk factors, proactive preventive steps and therapeutic interventions tend to reduce robustly its epidemiological trends including associated high mortality around the world. Objective:This review study aimed to critically describe the identified potential risk factors underlying suicide together with a specific focus on its relevant preventive and management strategies. Methods:A selective e-searches of Google Scholar, PubMed/MEDLINE and ScienceDirect of relevant English literature (2000-2019) was conducted by using keywords and Boolean operators, and following exclusion and inclusion criteria included 115 most influentialarticles for this critical review.Results:Suicide is a global preventable phenomenon determined by multiple interconnected risk factors and mechanisms embedded in several levels; population (indigenous people and social media), individual (distal predisposing factors), developmental (mediating factors) and proximal (precipitating factors).Evidently suicide needs multimodal intervention approach in terms of universal, selective and indicated prevention. Conclusion:Suicide is a global heterogeneous phenomenon and needs continuing concerted efforts of multidisciplinary health team and multi-sector stakeholders because its risk pathways and protective factors dynamically changes overtime across the world

Religious Mosque Leaders (Khateebs): Awareness, Perceptions, Practices and Attitude towards Mental Health, Riyadh Region, Saudi Arabia

Background:Mosques are the most holy places in the eyes of Allah-Exalted and Glorified, and the religious mosque leaders (Khateebs) who read 15-20 minutes Khutbah prior to Friday Prayers have great knowledge in religion of Islam and are considered the peace-building leaders through delivering the pertinent Friday sermons around the world.Objective:This online consenting cross-sectional survey explored the mental health awareness, perceptions, attitudes and practices of Khateebs of Riyadh region, Saudi Arabia.Methods:This survey used 14-items self-designed culturally competitive questionnaire and sociodemographic proforma to tap religious mosque leaders’ knowledge, perceptions, practices and attitude towards mental health. Results:Majority of mosque leaders were middle aged with higher education and extensive experience as a model of true interlocutor (Khateeb). Their knowledge and practices revealed were replete with religious and spiritual healing approaches but religious mosque leaders did not completely overlook the role of psychiatric medications and mental health professionals in the management of mentally ill persons. However, religious mosque leaders showed some negative attitudes towards patients with mental disorders, and recommended 10 corrective guides including integration of mosques and religious leaders into mental health system.Conclusion:Despite mosque leader’s good mental health literacy,they need further training to plug certain loopholes traced in their mental health literacy. Researchers should conduct further similar research overcoming the caveats of this survey not only in Saudi Arabia but also globally in Muslim world

Mental Health Awareness Phone Polling Survey: Focus on Community Knowledge, Attitude and Practice, Saudi Arabia

Background: Mental health awareness surveys that assess the broad knowledge of various stakeholders including public nationwide help in the development of relevant strategies to enhance their poor mental health literacy. Objective:The aim of this telephone polling survey was to measure mental health awareness of general public in Saudi Arabia.Method:The participants (n=1068) randomly selected from 13 regions of Saudi Arabia were contacted by 15 trained Saudi girl interviewers for conducting 30-minutes individual interview in Arabic language using a self-designed 15-item questionnaire.Results:About one fourthof responders (23%) reported either personal or family member having mental disorder, and depression and anxiety disorders were the commonest problems. Stigmaagainst mental disorders and consulting health professionals, misperceptions towards psychotropics and social exclusion and shame were variably reported by the participants. Though the participants perceived barriers to have access to MH services, 55% ofresponders reported MH services were of good to excellent grade, and the two most common help-seeking modes were psychiatric and religious and spiritual service providers.Conclusion:Although this community participatory mental health polling survey is found to have encouraging mental health literacy of public participants, evidence based training programs and campaigns for further improving people mental health literacy are needed in Saudi Arabia and elsewhere in the Arabian Gulf countries

Hyperemesis Gravidarum, Wernicke’s Encephalopathy and Korsakoff Syndrome Looked through the Lens of Three Cases, Paper II

Objective: Pregnancy a normal physiological condition is worsened by morning sickness, nausea and vomiting of pregnancy, hyperemesis gravidarum, Wernicke’s encephalopathy and Korsakoff syndrome in vulnerable women with gestation. This report of three cases described hyperemesis gravidarum, Wernicke’s encephalopathy and Korsakoff syndrome in the worsening pregnancies.Methods:Prospective collection of data concerning three pregnant patients seen in Dubai Health Care City, Dubai, United Arab Emirates. Results:All three patients were admitted to the hospital with manifestations of HG and WE and one of them showed additional features of Korsakoff syndrome. One patient developed intractable hyponatremia and central pontine myelinolysis. Two patients developed abortion while one patient's pregnancy ended with successful delivery with living infant. All patients were managed with thiamine, antiemetics, parenteral fluids and electrolytes and one patients required steroid therapy. Conclusion:The findings of these cases are compatible with international literature on HG and its sequential syndromes. This study may enhance awareness of HG, WE and KS and also fill the knowledge gap of professionals providing services to women with worsening health during pregnancy in Arabian Gulf countries

Hyperemesis Gravidarum, Wernicke Encephalopathy and Korsakoff Syndrome: A Critical Appraisal of the Relevant Literature

Background: Hyperemesis g ravidarum tends to r apidly progressin to Wernicke encephal opathy and Korsak off syndromeand, therefore, need stoberecognizedearlyandmanagedpromptlywithtargetedmultimodaltherapies.Objective:Thisstudycriticallyreviewedtherelevantliteratureonclinicalperspectivesofhyperemesisgravidarum,WernickeencephalopathyandKorsakoffsyndrome.Thesecondaryobjectiveofthisstudywastoimprovetheawareness,emphasisonearlydiagnosisandimmediateinterventionconcerningthesesequentialsyndromesinpregnantwomenacrosstheboard.Methods:Electronicsearches(sinceinception-2019)ofPubMed/MEDLINE,GoogleScholar,OvidSP,DoveMedicalPress,ScienceDomainInternational(SDI)andHindawi.comwere

Raynaud’s Disease and Clinical Challenges: A Minireview of Literature with a Spotlight on Acupuncture

Background: Primary Raynaud’s disease preferentially afflicts women with 5% prevalence rate reported in general population, manifests triphasic color phenomenon along with paresthesia involving distal digits and toes and triggered by severe cold and stress.Objective: This review critically describes several perspectives of Raynaud’s diseases with a focus on medical acupuncture.Methods:Electronic searches of relevant data prior to 2019 published in PubMed, MEDLINE, Google Scholar, and ScienceDirect databases were made using the Boolean operators and keywords. Finally, 32 articles that addressed specifically Raynaud’s disease and acupuncture were retained for this minireview.Results:Raynaud’s disease classified into primary and secondary is poorly understoodMini-reviewArticle phenomenon, lacks standard care and, hence,needs patient-centered holistic approach. Evidently, medical acupuncture with safe clinical profile has been effectively used as an alternative therapy in Raynaud’s disease. Outcome results with the use of conservative approaches, modern therapies, behavioral interventions and medical acupuncture vary considerably across the board and primary RD carries better prognosis than secondary RD.Conclusion:Both Raynaud's disease phenomena are complex conditions; need individualized treatment approach including surgical in refractory cases and further rigor studies to unravel their pathophysiology pathways and standardized interventions

Assessment of Hospital Physicians' Knowledge, Awareness, Attitude and Practice of Reporting Adverse Drug Reactions in Jeddah, Saudi Arabia.

Background: Adverse drug reactions (ADRs) are an important cause of morbidity and mortality around the world. Spontaneous reporting of ADRs is considered an essential component of successful pharmacovigilance (PV). Physicians’ unfamiliarity with ADRs and reporting procedures are major factors that lead to sub-optimal reporting of ADRs. Objective: This study explored knowledge, awareness, attitude and practice (KAAP) of physicians towards ADRs and their reporting. Methods: This study was conducted at three general hospitals in Jeddah City. A 7-item, self-administered questionnaire was developed to explore physicians’ KAAP. Results: Majority of physicians had post-graduate qualification (n=243, 72%), were from medical departments (n=146, 43.3%), had long clinical experience (n=258, 77%) and consulted more than 10 patients daily (n=258, 77%). About 72% of physicians were never exposed to ADR training program. More than 60% of physicians were not fully aware of ADR reporting perspectives. Majority of them (75%) knew the correct definition of ADR and adequate knowledge of reportable ADRs (>90%). Majority of physicians depended on textbooks on drugs and therapies (31.2%) and drug package inserts (22.3%) as sources of ADR information. The majority of respondents (>90%) showed positive attitude towards ADRs and ADRs reporting and monitoring system. About 57.6% of physicians had come across ADRs in practice but only 21.7% reported these reactions. Most of physicians agreed to improve KAP towards ADRs reporting. Conclusion: The preliminary findings of this study suggest that though majority of physicians had good awareness and positive attitude towards ADR and ADR reporting, but needed correct knowledge in some areas of ADRs and their reporting system. Majority of physicians were not exposed to ADR training courses. Physicians certainly need ADR training programs in order to further enhance their KAAP towards ADRs and ADR reporting.

Safety of Cupping Therapy in Studies Conducted in Twenty One Century: A Review of Literature.

Background: Cupping therapy is a well-known traditional treatment modality, and has been used in various diseases around the world since ancient times. This method is reported to have a better clinical as well as adverse events (AEs) profile as found in various studies conducted around the world. Aim: This study identifies, assesses, and classifies the adverse events profile of various types of cupping therapies in studies conducted in twenty one century. Methods: Using electronic and hand searches, three databases including Pub Med, Google Scholar and Cochrane library were searched from the year 2000 to 2016. Studies were included in this review provided they reported adverse effects related to cupping therapy. Observational studies were assessed using the WHO-UMC causality scale. Randomized controlled trials were assessed in accordance to the quality of reporting for harm data. Results: Nine hundred seventy nine (n=979) articles were identified. Based on exclusion and inclusion criteria and extensive review of all retrieved articles by two independent reviewers, only 25 studies that included six RCTs, sixteen single case reports and three case series were finally selected. The mostly observed adverse events of cupping therapy were scar formation reported in four studies that described fifty nine cases, and burns reported in two studies described sixteen cases, respectively. The adverse events of cupping therapy could be classified into local and systemic adverse events. Conclusion: Cupping therapy adverse events were infrequently reported, but they were not rare. Most of adverse effects were mild to moderate in severity. Some of the cupping therapy adverse events were preventable by following the general infection control guidelines, hygienic techniques, safety protocols and rigorous training of cupping therapists. Cupping adverse events should be reported in all studies on cupping, and this therapy should be practiced only by qualified medical professionals.

Medication Safety Unit Programs in King Saud Medical City, 2012 – 2013: Safe Medication Management and Use with a Focus on Patient Safety.

Background: Medication safety unit [MSU] streamlines the safe management and use of prescribed medications and reduction in all types of medication errors [MEs], and associated morbidity and mortality resulting in enhanced patient safety, better quality of healthcare services and cost saving. Objective: This study aims to describe MSU programs together with their purposes developed in King Saud Medical City [KSMC], Saudi Arabia and supports them with related policies and guidelines based on qualitative evidence-based research done across the world. Methods: A mixed study was designed to define programs, roles and annual plan of MSU, which was established in year 2012. Multiple awareness campaigns and training courses were organized for highlighting the significance of MSU among healthcare providers and consumers in KSMC. Results: The MSU developed 14 programs and annual medication safety plan of actions together with respective policies, procedures and guidelines, well supported by qualitative evidence-based research data for improving safe medication management and use associated with reported reduction in MEs, and increased patient safety and quality of healthcare. Conclusion: MSU is a useful tool to encourage reporting of MEs, which are reported to increase patient safety and safe medication management and tends to decrease the number of MEs. Beside establishing MSU in all hospitals, this study calls for a randomized controlled study in future that will identify potential risk factors that impact safe medication management and are associated with patient safety not only in Saudi Arabia but also in other Arabian Gulf countries.

Predictors of Weight Gain among Very Low Birth Weight Infants Born at the Maternity and Children Hospitals in Jeddah during 2012-2013.

Background: Growth failure and restricted weight gain in very low birth weight (VLBW) infants remains extremely common despite advances in neonatal care. A majority of VLBW infants leave the hospital with weights below the 10th percentile for age. A variety of measures including nutritional interventions have been considered to achieve adequate weight gain in these infants for preventing short- and long-term lifetime complications. Objective: This study aims to profile factors that impact weight gain among VLBW infants in three Maternity and Children Hospitals in Jeddah City, the Kingdom of Saudi Arabia [KSA]. Methods: A prospective study with short follow-up selected a nonrandom sample of infants for collecting data related to parents and admitted VLBW infants in three hospitals. The medical files of actively admitted VLBW infants [n=61] to the neonatal intensive care unit (NICU) were daily examined for a period of four months through 1st January, 2013 to 30th April, 2013 until their discharge. Results: Within a variety of categorical and continuous parental and infants’ variables, joint family income and total formula milk fed to VLBW infants significantly correlated with weight gain in VLBW infants. However, the most powerful predictor of weight gain in VLBW infants was total formula milk fed to them. Conclusion: This study calls for further studies for identifying other predictors of weight gain in VLBW infants in Saudi Arabia.

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. Objective: This article synthesizes the international literature on electronic health records (EHRs), e-prescribing (EP) and medication errors (MEs) and provides a platform to World Health Organization Eastern Mediterranean Region (WHO-EMR) countries for implementing EHRs and EP in healthcare system. Methods: Computer searches of PubMed, MEDLINE, Quertle®, Google Scholar, Web Knowledge and International Pharmacy Abstract databases were conducted for the years 2000–2014 using several single- and combined-keyword strategies, with 184 articles retained for evaluation. Results: Although e-prescribing integrated with EHR reduces medication errors at all healthcare levels, decreases morbidity and mortality, enhances patient and healthcare provider satisfaction by reducing costs and improving quality of life, it produces different types of medication errors at various stages of the prescription process. An EHR with EP that has a clinical decision support system (CDSS), dose-limit range, drug–drug interaction alert protocols, and formulary decision support helps to improve EP and ensures greater patient safety and other multiple applications. Conclusion: EHRs with EP systems should be implemented in healthcare systems for the sake of better quality healthcare and patient safety throughout the WHO-EMR countries especially in the Kingdom of Saudi Arabia. Evidently there is limited data in these countries and hence further studies are needed to assess impact of EHRs and EP system (EPSs) on medication errors, quality of healthcare, patient safety and outcome, morbidity and mortality rates, patients’ and healthcare providers’ acceptance, and especially its cost-effectiveness.

Handwritten to Electronic Prescriptions: Emerging Views and Practices, Saudi Arabia.

Background: There has been little research on electronic prescribing (EP) in Middle Eastern countries. This is in part due to the slow implementation of electronic health records [EHR] integrated with EP. Electronic prescribing is associated with a considerable reduction in medication errors compared to handwritten prescriptions. Objective: This paper reviews the relevant literature on handwritten and EP in the Kingdom of Saudi Arabia, as well as focusing on global issues including problems related to handwritten prescribing, the role of EP in mitigating these problems, the functions of the EHR system with EP, ways of implementing EP, and identifying potential barriers and challenges in the Middle Eastern region. Search Strategy: Computer searches of PubMed and Google Scholar were conducted using the keywords “handwritten prescription,” “pen and pencil prescription,” “medication prescribing,” “medication errors,” “electronic prescribing,” and “electronic medical records.” Review Article British Journal of Medicine & Medical Research, 4(28): 4607-4626, 2014 4608 These keywords were combined with ‘mechanisms’, ‘standards’, ‘advantages’, ‘disadvantages’, ‘challenges’, ‘plan’, and ‘opportunities’ with the objective of comprehensively retrieving the peer-reviewed articles published in English language journals on this subject. A total of 101 studies were included in this work. Methods: Two of the authors of this work retrieved and reviewed 101 papers that met our inclusion criteria. Any disagreements were resolved by a consensus of all three authors. Results: There were more articles on handwritten prescriptions that involved illegible writing that resulted in medication errors than articles on EP due to a lack of research and slow implementation of EHR system in the Middle East. At global level, e-prescribing that was supported by well-defined standards and careful implementation was associated with a reduction in serious medication errors, morbidity, mortality, and service cost, as well as an increase in work flow efficiency, a higher quality of healthcare service delivery, and greater satisfaction of both healthcare providers and consumers. Electronic prescribing is now being practiced in many major medical centers and specialist hospitals not only in KSA but also in other countries of the region. However, there remains a need to implement EP systems in hospitals, primary care outpatient settings, and throughout the private health sector where it is missing. Conclusion: It is time for the widespread adoption of EP, EHR, and health informatics systems across Middle Eastern countries including KSA, as well as for systematic research to evaluate their effectiveness.

Prevalence and Risk Factors of Very Low Birth Weight in Infants Born at the Maternity and Children Hospitals in Jeddah, Saudi Arabia during 2012-2013.

Background: The prevalence of low birth weight in infants which is associated with a large number of risk factors is increasing worldwide and is a major cause of infant morbidity and mortality. Objective: This study aims to describe demographic, clinical and anthropometric profile of VLBW in infants, its prevalence, associated risk factors and maternal medical complications in three Maternity and Children Hospitals in Jeddah City, Saudi Arabia. Methods: Two study designs used in this research selected two convenient samples of VLBW infants for collecting cross-sectional retrospective and prospective data. The clinical records of VLBW infants [n=387] were reviewed retrospectively for estimating the one year prevalence rate while for identifying the possible risk factors of VLBW infants, the medical files of actively admitted patients [n=61] were daily examined for a period of Original Research Article British Journal of Medicine & Medical Research, 4(27): 4553-4569, 2014 4554 four months. Results: Beside socio demographic, clinical and anthropometric characteristics of VLBW infants, this study estimated the prevalence of VLBW infants to be 3.3% along with underlying risk factors of VLBW, its comorbidities, and maternal medical complications. Conclusion: The prevalence of VLBW infants is constantly increasing not only in Saudi Arabia but also worldwide and VLBW is associated with a variety of possible risk factors. There is a need to conduct a nationwide community-based study on the prevalence and risk factors of VLBW infants in Saudi Arabia.