Assessment of the degree of awareness among post-graduate medical physicians and Pharmacists about look-alike, sound-alike drug and potential medication errors

Background: With thousands of drugs currently in the market, the potential for medication errors due to confusing drug names amongst practising physicians, pharmacists and patients is significant. The existence of confusing drug names is one of the most common causes of medication error. There are many look-alikes, sound-alike (LASA) combinations that could potentially result in medication errors. There is insufficient data about medication errors due to LASA. Hence, we conducted the present study to determine the degree of awareness regarding LASA drugs among post graduate medical physicians and Pharmacists.Methods: This study was a cross-sectional, questionnaire-based survey, conducted among 137 year post graduate medical residents of a tertiary care teaching hospital and 121 local pharmacists in an urban metropolitan Indian city.Results: There were 34% resident doctors and 17% pharmacists were aware of concept of LASA drugs. Only 46% resident doctors and 22% pharmacists had knowledge about the full form of LASA. Among resident doctors, 39% came across prescription errors due to LASA drugs. Only 69% of the pharmacists agreed that they consulted their doctors when they faced problems due to prescription errors due to similar looking and similar sounding drugs.Conclusions: Look-Alike, Sound-Alike (LASA) drugs are common source of medication errors. Our study suggests that there is lack of awareness about LASA drugs amongst resident doctors and pharmacists, which may contribute to occurrence of medication errors. Therefore, combined efforts by prescribers, pharmacists, organizations, manufacturers and patients is required to overcome medication errors due to LASA drugs.

Analysis of 400 New and Serious Adverse Drug Reactions in a Grade Three Class A Hospital / 中国药师

Objective: To explore the characteristics of adverse drug reactions (ADRs) in a grade three class A hospital to provide reference for rational drug use and reduction of ADRs. Methods: The new and serious ADRs reported during 2014 and 2016 were sta-tistically analyzed in terms of the report type, age, gender, administration route, drug variety and involving system. Results: The new and serious ADR reports reached to 400 cases, which accounted for 64. 52% of the total reports. Of the 400 ADR reports,there were 34. 25% distributed in the 60-74-year old. The proportion of male and female in the ADRs was basically equal, while that of male (50. 25% ) was slightly higher than that of female (49. 75% ). There were 57. 00% of ADRs caused by intravenous administration, and 31. 25% caused by anti-infective drugs, in which cephalosporins accounted for the most (32. 00% ). The most common manifesta-tion of ADR was damage to skin and its appendages, which accounted for 33. 00% , followed by the damage to gastrointestinal system (15. 50% ) and hepatorenal function (14. 00% ). Conclusion: Great attention should be paid to monitoring and reporting ADRs in our hospital, and drugs should be rationally used so as to reduce the occurrence of ADRs.

Applying Healthcare Failure Mode and Effect Analysis to Prevent Medication Errors during Drug Subpackage / 中国药学杂志

OBJECTIVE: To prevent medication errors during drug subpackage and ensure patients' medication safety. METHODS: Healthcare failure mode and effect analysis (HFMEA) was applied to evaluate the potential failure modes and effects during drug repackaging and dispensing. Thereafter rectification measures was analyzed and carried out in order to prevent the recurrence of failure modes. Risk priority numbers (RPNs) before and after the implication of rectification measures were analyzed using paired t tests. RESULTS: After the application of healthcare failure mode and effect analysis, RPN was statistically significantly (P<0.05) reduced by 60% (P=0.000 2), which affecting the incidences of medication errors during drug unit-dose repackaging. CONCLUSION: The application of healthcare failure mode and effect analysis can effectively prevent medication errors during drug subpackage and improve patients' medication safety.

Qualitative Study for Medication Use among the Hearing Impaired in Korea

OBJECTIVE: Because of communication difficulties, the hearing-impaired face many disadvantages throughout their lives. One of those is limited access to health care services, particularly medication service. Though they suffer from problems related to taking medication properly, there have been few studies on their actual condition of medication use in Korea. This study is to investigate any obstacles to properly taking medications and, therefore, to suggest preliminary evidence for policy measures to improve safe medication use among the hearing-impaired. METHODS: Study participants consisted of hearing-impaired individuals living in Seoul. We also interviewed two sign language interpreters in order to illuminate health care state of the hearing-impaired. In-depth interview for each study participant was recorded and was translated into a written script for analysis. RESULTS: Study participants were comprised of four women (66.6%) and two men (33.3%). There were one participants in 20's, two participants in 30's, one 40's, and two 50's. Sign language interpreters were all women. One was in her 30's and the other was in her 40's. Communication difficulties have been found to be key barrier to use medication safely. A negative image of pharmacists also hinders safe medication usage, lowering access to local pharmacy and leading discretional self-medication. This article provides pharmacists with solutions to promote adherence in this population. CONCLUSION: The hearing-impaired had limited access to medication-related information as well as using services in a hospital and local pharmacy due to their disability. Institutional improvement for safe medication usage among the hearing-impaired is necessary.

Literature Study on the Security of TCM Injection / 中国药房

OBJECTIVE:To provide reference for rational use of TCM injection in the clinic. METHODS:Retrieved from CNKI,VIP,Wanfang database and PubMed database,literatures about top 10 TCM injections in the list of report number stated in 2014 CFDA ADR monitoring report were researched in recent 30 years. By literature retrospective study,ADR/ADE induced by TCM injection were analyzed. Combining with post-marketing drug safety re-evaluation and rationality study,the security of clini-cal use of TCM injection was evaluated. RESULTS:A total of 2013 literatures were retrieved,1354 were. Most organs or systems were involved in ADR,especially cardiovascular system,respiratory system,skin and its appendants. Allergic reaction was main clinical manifestation,among which server ADR was allergic shock. Ten ADR/ADE-inducing TCM injections had the lower consis-tency with instructions in the original diseases,solvent,dosage concentration and compatibility application. Consistency rate of original diseases,solvent and dosage concentration was 78.30%,77.94% and 74.64%;81.73% of them were used individually. CON-CLUSIONS:ADR/ADE induced by TCM injection is serious. It is urgent to improve post-marketing revaluation scheme from the aspects of safety and rationality.

Application and Practice of Risk Managements Analysis Methods in Medication Error Prevention in Medi-cal Institutions / 中国药师

Medication safety is one of patient safety goals, and medication error prevention is its main content. Risk managements such as hazard analysis and critical control points ( HACCP) and failure mode and effect analysis ( FMEA) with a lot of applications in health care field have a proper condition to be used for medication error prevention. A risk management was carried out for medication error prevention through the design and practice in our hospital, which contained the following 7 steps:the medication error prevention project was determined, the management team was made up, the links of medication and types of medication errors were confirmed, the critical control points were determined by using HACCP, the critical control points were analyzed by using FMEA, the links with high scores were performed improvement in prevention plan, and the improvement plan was applied and evaluated. The results showed the risk management used in medication error prevention is flexible and practical, which is especially suitable for the risk management for high-alter drugs.

Comprehensive evaluation and risk control measures of Xanthii Fructus / 中国中药杂志

By retrieving domestic and foreign literatures, the authors provided a systematic review for effects of Xanthii Fructus, toxicity recorded in ancient/current literatures and relevant toxicological experience, and summarized clinical characteristics of clinical cases related to Xanthii Fructus and influencing factors. In addition to liver and kidney injuries as the major side effects of Xanthii Fructus, neurotoxicity and cardio-toxicity of Xanthii Fructus were also common clinical adverse events. However, there have been a few animal experimental studies so far. Oral administration and external application with Xanthii Fructus have often caused skin reactions, even such severe cases as exfoliative dermatitis. The authors suggested standardizing the clinical medication, avoiding to use untreated prescriptions and unprocessed herbs, ensuring the effective and safety use of Xanthii Fructus in strict accordance with the recommended dosage and usage in pharmacopeia, paying attention to the accumulation of safety signals, strengthening studies on toxic substance, toxicity mechanism, and synergy and attenuation effects.

ITS2 barcoding DNA region combined with high resolution melting (HRM) analysis of Hyoscyami Semen, the mature seed of Hyoscyamus niger / 中国天然药物

Hyoscyami Semen, the mature dried seed of Hyoscyamus niger L., has long been used as a traditional Chinese medicine to treat human diseases. Hyoscyami Semen is found in local markets in China. In markets, sellers and buyers commonly inadvertently mix the seeds of H. niger with the seeds of related species such as Hygrophila salicifolia (Vahl) Nees, Astragalus complanatus R. Br., Cuscuta australis R. Br., Cuscuta chinensis Lam., and Impatiens balsamina L. because of their similar morphologies or similar names. Thus, developing a reliable method for discriminating H. niger seeds from its adulterants is necessary to reduce confusion and ensure the safe use of Hyoscyami Semen. The present study was designed to evaluate the efficiency of high-resolution melting analysis combined with DNA barcoding (Bar-HRM) with internal transcribed spacer 2 to discriminate H. niger. Our results show that Bar-HRM successfully identified the adulterants and detected the proportion of H. niger DNA extract within an admixture. In particular, HRM detected H. niger DNA extract in A. complanatus DNA extract at concentrations as low as 1%. In conclusion, the Bar-HRM method developed in the present study for authenticating H. niger is rapid and cost-effective. It can be used in the future to guarantee the purity of Hyoscyami Semen for the clinical use.

Qualitative Study for Medication Use among Visually Impaired in Korea

OBJECTIVE: The visually impaired have limited access to health care services and related information, and thus, they can have serious hurdles against properly taking medications. Despite that it is important to improve self-care ability of the visually impaired for correct medication use, there have been few studies investigating their needs for health care services in Korea, particularly focusing on proper medication usage. This study is to explore safety-related issues regarding mediation usage among the visually impaired based on in-depth interview. We particularly focus on any obstacles for safe use of medicines including experience on medication-related adverse effects in order to provide preliminary evidence for policy measures to improve proper medication use among the visually impaired. METHODS: Study sample was visually impaired individuals who resided in Seoul area and were registered in the National Association of Visually Impaired. The association helped the process of recruiting the study participants. In-depth interview for each study participants was conducted. Each interview was recorded and later converted into a written script to extract core contents for the analysis. RESULTS: The study participants comprised of three women (42.9%) and four men (57.1%). One was in his 20's, and there were four participants in 30's and two in 40's. Fully impaired participants were majority (5 out of 7). Limitation to physical access to health care providers and health information were the key factors to hamper safe medication utilization among the study participants. Difficulty reading medication information and may take the wrong medication or incorrect doses of medication, resulting in serious consequences, including overdose or inadequate treatment of health problems. Visually impaired patients report increased anxiety related to medication management and must rely on others to obtain necessary drug information. Pharmacists have a unique opportunity to pursue accurate medication adherence in this special population. This article reviews literature illustrating how severe medication mismanagement can occur in the visually impaired elderly and presents resources and solutions for pharmacists to take a larger role in adherence management in this population. CONCLUSION: The visually impaired had difficulties reading medication information and identifying medicines, and took incorrect doses of medications. Public support for safe medication use and medication management among the visually impaired is necessary.

Analysis of 277 ADR Reported in Our Hospital / 中国药师

Objective:To survey the status quo of ADR occurred in our hospital. Methods:Totally 277 ADR reports were collect-ed and analyzed statistically in our hospital from January 2010 to June 2013. Results:Among the ADR cases,the ratio of male to fe-male was 1∶1. 565, and 59. 93% of ADR occurred in the people over 50 years old. Totally 240 ADR cases (86. 64%) were induced by intravenous administration and 32 ADR cases (11. 87%) were induced by oral administration. Totally 167 ADR cases were caused by antibiotics (60. 29%), among them, 54 cases wero by cephalosporins (32. 34%), 47 cases by quinolones (28. 14%) and 32 ca-ses by cephamycins (19. 16%). Totally 42 ADR cases were caused by traditional Chinese medicine injections (15. 16%), and 18 ca-ses were caused by cardiovascular system drugs (6. 5%). The main clinical manifestations were lesion of skin and its appendant organr and digestive system injury with 162 cases (58. 48%) and 62 cases (22. 38%), respectively. Conclusion: It is necessary to strengthen clinical ADR monitoring, rationally use antibiotics and emphasize the importance of safe medication of traditional Chinese medicine injections.

Building and operation of the pharmacovigilance system in the hospital / 中华医院管理杂志

Objective Effective intervention on the setbacks and safety loopholes of clinical medication, in an effort to explore, establish and improve the ADR watchfulness system in the hospital step by step. MethodsCollection and compilation of ADRs and drug compatibility cases found in 2010 in the hospital. Intervention on drugs of safety risk exposure or medication factors by means of the ADR prewarning mechanism, medical rounds by hospital's directors regarding drug issues, communication between pharmacists and clinicians, ADR monitoring leadership team, and pharmaceutical affairs council. Results 143 cases of ADR were interfered with among all the 393 ADR cases reported by clinical departments in 2010, accounting for 36.4％ of all the reported cases. ConclusionHospitals need to pay more attention to the monitoring, analyzing and evaluation of ADRs, and take efficient intervention means to make drug use more rational and ensure safe medication for the people.

Investigation on Drug Utilization and Safe Medication in Gestational Patients of a Hospital / 中国药房

OBJECTIVE:To evaluate the drug utilization and safe medication in gestational women in a hospital. METHODS: The drug utilization in 505 gestational women in a hospital from July 2007 to Jan. 2008 was investigated,with FDA's drug classification system during gestation as control. RESULTS & CONCLUSION: 35.84% of the patients received drugs during gestation;54.01% used drugs in the first 3 gestational months;56.15% used at least 2 kinds of drugs in combination;traditional Chinese medicine or Chinese patent medicines were the first choice for gestational women. The drug use for gestational women was prudent and basically in line with FDA's drug classification system during gestation;however,some drugs which pose risks for fetus were also used. There is as yet no guiding principle for safe medication of gestational women in China,thus it is imperative to establish safe drug use system for gestational women.