Off-label drug use in an adult intensive care unit of a Brazilian hospital

Abstract The objective of this study was to determine the prevalence and describe the factors associated with off-label drug use in an adult intensive care unit (ICU) of a Brazilian hospital. An analytical, cross-sectional, prospective study was conducted in the adult ICU population from March 2018 to May 2018. Off-label use of medication was classified by indication, dosage, route of administration, type and volume of diluent, and duration of administration. Most patients were female (57.89%), non-elderly (56.14%), and had a mean age of 54.44 ± 17.15 years. The prevalence of off-label drug use was 70.31%, but was not associated with the clinical severity of the patients. A statistically significant association was observed between label use of drugs and prescribing potentially inappropriate medicines (PIM). The most common reasons for off-label drug use were therapeutic indication (19.58%) and volume of diluent (23.30%). Drug administration by enteral tubes accounted for the largest number of off-label uses due to route of administration (90.85%). There was a higher prevalence of off-label use of systemic antimicrobials (14.44%) and norepinephrine (9.28%). Our study provided a broad characterization of off-label drug use in an adult ICU and showed why it is important for health professionals to evaluate the specific risks and benefits of this practice

Preservation of hearing in partial deafness patients who received two different regimes of corticosteroid therapy following cochlear implantation: one-year observations

Abstract The objective of this study was to assess how different modes of steroid therapy affect hearing preservation in Partial Deafness Treatment group of patients. In this study, the group consisted of 46 (24 women, 22 men; aged 18-78 years) cochlear implant patients divided into 3 subgroups. In the first subgroup (N = 13), patients underwent standard intravenous (IV) steroid therapy following implantation. In the second (N = 16), patients underwent prolonged treatment with a combination of oral and IV corticosteroids. Third subgroup (N = 17) was a control group who received no steroids therapy. The mean hearing preservation rate was 52.1% (SD = 36.7) in patients receiving standard steroid therapy, 71.4% (SD = 22.7) in patients with prolonged steroid therapy, and 22.1% (SD = 33.9) in control patients. The smallest variation of hearing preservation rate was observed in patients with prolonged steroid therapy and was 9.9 dB. In comparison, the mean change in patients with standard steroid therapy was 11.7 dB and for control patients the figure was 18.0 dB. A combination of intravenous and oral steroid therapy seems to be optimal and stabilizes hearing thresholds and preserves hearing.

Development of high-alert medication list based on expert consensus and healthcare workers investigation / 中国药学杂志

OBJECTIVE: To develop high-alert medication list that complies with Chinese medication practice. METHODS: The study was organized by the Group of Medication Safety Experts, Hospital Pharmacy Committee, Chinese Pharmaceutical Association. Selection criteria for high-alert drugs were developed with Delphi consensus among 18 medication safety experts, then two rounds of survey followed. The first round contained open-ended questions, by which the respondents were asked to nominate high-alert medications in addition to ISMP list according to the selection criteria. The new nominations were classified and screened by the experts group to get a preliminary list. The second round was grading scale survey. The healthcare workers who responded to the first round survey were asked to grade on their familiarity to and the risk degree of each medication in the preliminary list. With familiarity as the weight, the weighted risk averages and standard deviations of each medicine were calculated to decide if the medication was included in the high alert medication list or not. RESULTS: Selection criteria of high alert medications were developed, which contains 6 items and were used in the first round survey. Totally 782 healthcare workers in 23 hospitals responded to the survey. Through two rounds of survey, 24 classes and 14 specific medications were included in the final list. Compared with ISMP list, the newly added were two more classes, including reproductive toxic drugs and intravenous theophylline, 4 more specific medications, including topical potassium permanganate, 5 mg•mL-1 atrophine injection, lyophilizing thrombin powder and arsenic trioxide for injection. CONCLUSION: A high-alert medication list is developed with two more classed and four more drugs newly adding to the ISMP list, which complies better with Chinese healthcare practice.

Application of PDCA Cycle Method in High-alert Medication Management of Our Hospital / 中国药房

OBJECTIVE:To improve high-alert medication management in our hospital. METHODS:According to assessment criteria of JCI,referring to the problems of high-alert medication management in our hospital,PDCA(plan,do,check,action)cy-cle method,reverse fishbone diagram and other methods were adopted to formulate and implement relevant countermeasures. Com-pliance rate of 29 departments was evaluated within 12 months after the implementation of countermeasures. RESULTS:Relevant emergency measures were formulated for 2 negative factors by reverse fishbone diagram;whole-course and orderly quality control of high-alert medication was conducted through establishing high-alert medication management institutions,formulating high-alert medication management system and quality measurement criteria,strengthening staff training and education,improving hospital in-formation system,etc. The compliance rate of departments increased from 53% in Jan. to 100% in Jun.(P<0.05),and kept sta-ble until Dec. CONCLUSIONS:PDCA cycle improves the systemization and standardization of high-alert medication management and multiple department cooperation,and contributes to the safety of drug use.