Mistakes and complications in the diagnosis and treatment of children with organic foreign body aspiration

The reason for the publication of this article was the increase in the number of children with long-standing organic foreign bodies in the respiratory tract, the late diagnosis of which causes severe complications. The article presents the three most significant cases from the general series, when the diagnosis and treatment tactics at the stages of treatment were associated with errors both at the prehospital stage and in the hospital. In the first clinical case, as it turned out, the child had aspired multiple foreign bodies. The first bronchoscopy revealed one solid foreign body. Due to severe fibrinous-purulent endobronchitis and contact bleeding, the bronchoscopy procedure was aborted. However, after 10 days, the child independently coughed up the second seed, which was a surprise to us. Control bronchoscopy after 3 weeks revealed no foreign bodies. In the second clinical observation, a child developed bronchiectasis due to a long stay of a foreign body in the respiratory tract. The third case demonstrates the diagnosis and treatment tactics in a child with a foreign body against the background of a coronavirus infection. In the first and third cases, the results of treatment were satisfactory. In the second case, a long stay of peanuts in the respiratory tract led to bronchiectasis in the lower lobe of the left lung, which required its removal. In the follow-up, there are no complaints, the child grows and develops according to age. The study analyzes the mistakes made at the stages of diagnosis and treatment of children with foreign bodies in the respiratory tract. Conclusion. Young children with long-term and atypically current respiratory diseases, dubious and even normal radiological picture with the absence of comprehensive information on the anamnesis of diseases should alert the doctor to the possibility of aspiration of a foreign body in the respiratory tract and serve as the basis for performing bronchoscopy.Copyright © 2023 National Academy of Pediatric Science and Innovation. All rights reserved.

Drug-related problems in patients admitted for SARS-CoV-2 infection during the COVID-19 pandemic.

Introduction: Drug-related problems (DRP) are events or circumstances in which drug therapy does or could interfere with desired health outcomes. In December 2019, a new coronavirus, SARS-CoV-2, appeared. Little knowledge about this type of infection resulted in the administration of various drugs with limited use in other pathologies. Evidence about DRP in patients with COVID-19 is lacking. Objective: The aim of the present study is to describe identified cases of DRP and those drugs involved in the first wave of patients with COVID-19, and evaluate associated risk factors. Material and methods: Observational, retrospective study performed in a tertiary university hospital between 14th March 2020 and 31 May 2020 (corresponding to the first COVID-19 wave). We recruited patients admitted during the study period. Exclusion criteria included age < 18 years; admission to critically ill units; and care received either in the emergency room, at-home hospitalization or a healthcare center. Results: A total of 817 patients were included. The mean age was 62.5 years (SD 16.4) (range 18-97), and 453 (55.4%) were male. A total of 516 DRP were detected. Among the patients, 271 (33.2%) presented at least one DRP. The mean DRP per patient with an identified case was 1.9. The prevailing DRPs among those observed were: incorrect dosage (over or underdosage) in 145 patients (28.2%); wrong drug combination in 131 (25.5%); prescriptions not in adherence to the then COVID-19 treatment protocol in 73 (14.1%); prescription errors due to the wrong use of the computerized physician order entry in 47 (9.2%); and incorrect dosage due to renal function in 36 (7%). The logistic regression analysis showed that patients who received only prescriptions of antibacterials for systemic use (J01 ATC group) faced a higher likelihood of experiencing a DRP (OR 2.408 (1.071-5.411), p = 0.033). Conclusion: We identified several factors associated with an increased risk of DRPs, similar to those reported in other pre-pandemic studies, including a prolonged length of stay, higher number of prescribed drugs and antimicrobial administration. The relevance of pharmacists and tools like pharmacy warning systems can help prevent, identify and resolve DRP efficiently.

Inadvertent intravenous injection of carboprost in a COVID-19-positive patient: A case report

We present a case report of an inadvertent administration of intravenous carboprost in a COVID-19-positive parturient who was taken up for an emergency caesarean section for meconi um-stained liquor. Unintentionally, the patient was administered intravenous carboprost instead of ondansetron. The patient developed breathlessness, uneasiness and hypertension. Despite the mishap, the patient fully recovered and was discharged after 15 days. Although the medical error in the present case was non-harmful, the treating doctor discussed the case with the patient. Conclusion: A case with inadvertent intravenous administration of carboprost in a COVID-19-positive parturient is reported with a good outcome.

Errors Detected in the Telepharmacy Procedure

Background and Importance After the rise of telemedicine with the COVID-19 pandemic, a telepharmacy consultation has been implemented in our hospital in the pharmacy outpatient area, sending medicines to community pharmacies within a population area of 600,000 inhabitants. Aim and Objectives The purpose of this study is to analyse the medication errors (ME) that have occurred during a specific period of time, throughout the process of medication delivery. The aim is finding causes and possible improvements. Material and Methods We carried out a retrospective descriptive study. The errors that occurred between January 2021 and August 2022 (20 months) in the telepharmacy process were analysed, taking into account everything from the preparation in the hospital pharmacy to the collection of the medication by the patient in the community pharmacy. The MEs were collected in a local database. We described date, personal data of the patient, codes assigned to the single shipping route and destination community pharmacy, type of error and step in which the ME was detected. Results In the period studied, a total of 69 MEs were recorded. We break them down into the following types: 20 cases with a quantitative lack of medication (28.99%), 19 cases in which a different medication was sent (27.54%), 15 with another patient's medication (21.74%), 10 with medicine with wrong dose (14.49%), 2 cases in which the medicine was not sent (2.90%) and another 2 in which the medicine was sent badly packaged (2.90%), 1 case in which the one in which the misidentified medicine was sent (1.45%) and 1 case in which a larger quantity was sent (1.45%). 48 MEs were detected by the patient (69.56%), 15 were detected in the community pharmacy (21.74%), 4 were detected in the hospital pharmacy (5.80%) and 2 cases were detected during the transportation of the medication (2.90%). None of the errors detected had consequences for the patient to our knowledge. Conclusion and Relevance Among the MEs detected, the most common were those related to a quantity defect or lack of a medication and those in which a different medication was sent. In general, they are errors that could be avoided by automating processes that are currently carried out manually.

Delirium in nursing homes: the continued case of B.M

This article considers current contemporaneous practical issues of delirium care in nursing homes with reference to a hypothetical case study B.M. I introduce the diagnosis and management of delirium-superim-posed-on-dementia (DSD), being relatively common in patients in advanced phases of illness of many nursing home residents. General principles are discussed, although this article applies mainly to higher income countries. There is inevitably much palliative and end-of-life care in nursing homes, necessitating rigorous advance care planning. Nursing home residents are especially prone to acquiring infections. Urinary tract infections (UTIs) are traditionally the most commonly treat-ed infection among nursing home residents and, indeed, the accurate diagnosis of a UTI poses significant and distinctive challenges in the nursing home setting. There is no denying, however, that recently the global coronavirus (SARS-CoV-2) pandemic has posed an existential threat to both staff and residents of nursing homes. Resident-focused factors are striking. Psychotropic drugs are the most frequently prescribed medications in European nursing homes, but medication errors in nursing homes in general are relatively prevalent. Contributing factors to a high burden from pain for residents include residents belief set that age-related pain is inevitable, as well as un-der-recognition of pain and inappropriate pain assessment by clini-cians. Dehydration is associated with frailty, poor cognition, falls, de-lirium, disability, and mortality. Issues relating to the environment also matter. It is also impossible to ignore the organisational constraints on the provision of high quality care. Faced with widespread staffing short-ages, and many economies in financial distress, one partial solution is to retain current staff longer in nursing homes. Research on nursing home staffing has expanded beyond just staffing levels to include mul-tiple other staffing issues of concern.Copyright © by Societa Italiana di Gerontologia e Geriatria (SIGG).

New medication-related developments in The Hungarian Electronic Prescription System and other eHealth services

In all countries, where electronic health services such as e-prescriptions have been introduced, patient safety has improved and the standard of medical and pharmaceutical care has increased. ePrescription (eRecept) - launched in Hungary as well - has become the most used eHealth module of the EE SZT (National eHealth Infrastructure) by all healthcare providers in the past near 3 years. During the COVID epidemic emergency e-prescription system has been a huge help to patients, relatives and caregivers too. In this period the proportion of electronic issued prescriptions exceeded 90% of all prescriptions written. The e-prescription system contributes to the better and faster information of healthcare professionals, supports the well-based therapy decisions, helps preventing and eliminating medication errors. Adverse drug reactions (allergies, interactions, polypharmacy etc.) can be more easily identified with the daily use of this service. Less paper administration can increase the time and quality of patient counseling both at the doctor's and in the pharmacies. Medication adherence can also be simply monitored by pharmacist as well. After patient registration - using social security number (SSN / TAJ) -, written maximum 1 year earlier and/ or by other pharmacy dispensed prescriptions will be also downloadable soon from the central database. These functions and real time data contribute to the implementation of high-quality pharmacotherapy advising services in pharmacies as healthcare institutions, made in accordance with the specific standards and protocols. The new functions of the Patient Portal (e.g. Legal Representation) and mobile surfaces provide patients and their relatives access to follow their care process, prescriptions, labs, etc., already on their smartphone too. From the beginning of May 2020, serial-produced medical aids mostly sold in pharmacies, can be electronically issued. The full integration of all the medical aids may be completed next year in a separated module. A simple web-based prescriber (socalled miniHIS) has been developed for connected private doctors, who do not consult in institutions. Measured values of the (smart) medical devices can be uploaded into the personal data repository of the Patient Portal on a voluntary basis. Good measurement results of the blood pressure, sugar, body weight, etc. recorded here demonstrate therapy fidelity, providing feedback to the patient and professionals. Telemonitoring services can be build on this module, so the software can send alerts to the assigned doctor, pharmacist or family member. Keeping data protection rules strict, depersonalized pharmacotherapy data uploaded to the central eHealth database will be searchable soon for professional and scientific purposes.

Vaccine management and preparation methods for the COVID-19 vaccine tozinameran

Vaccination is currently considered as the most promising approach to curb the spread of COVID-19. In Japan, the vaccine manufactured by Pfizer was approved in February 2021, and healthcare workers began to be vaccinated on priority. However, due to the complexity of handling of the vaccine, we considered it necessary to establish standard protocols, including for storage and preparation of the vaccine. As a collaborative vaccination facility, our hospital was involved in vaccinating a large number of healthcare workers and needed to manage a large number of vaccines and vaccine recipients;therefore, we constituted a COVID-19 Vaccination System Construction Working Group composed of professionals from multiple fields, in which pharmacists were in charge of vaccine management and preparation. Vaccines were stored using an investigational drug management system to prevent damage. Vaccine preparation was changed from a one-person operation to a shared operation between pharmacists and nurses, and a procedure was established to prevent preparation errors. As a result, we are able to store a large number of vaccines and carry out a large number of vaccinations efficiently, without any preparation errors.

1st Croatian Virtual Congress of Oncology Pharmacy

The proceedings contain 46 papers. The topics discussed include: clinical features and differential diagnosis of the most common malignant tumors of the skin;medication errors in the treatment of pain in cancer patients;hospital pharmacy in 21st century;the NCODA positive quality intervention (PQI): educating your medically integrated team while supporting better patient care with a concise, peer-reviewed, pharmacy-led resource;challenges and possibilities in the prevention and treatment of febrile neutropenia in oncology patients during the COVID-19 pandemic;cancer pain management;oral anticancer medication;and aseptic manufacture (compounding)/preparation of antineoplastic drugs - requirements, standards and guidelines.

Factors Associated with Successful Implementation of Worksite Mindfulness Interventions for Acute Care Nurses

Methods: A multi-phase, sequential, mixed-methods design explored critical aspects of the implementation process for worksite mindfulness-based interventions targeted to clinician groups that included acute care nurses working in academic medical centers. A descriptive, crosssectional survey design was used to obtain information related to variations in worksite mindfulness interventions and implementation processes acrossmultiple U.S. healthcare systems. Factors associated with implementation success were computed using regression analysis. Semi-structured interviews were completed to further explore, evaluate, and clarify strategies that have led to successful implementation and describe intervention, healthcare setting, or process-related barriers to implementation success. Results: Significant predictors of implementation success within academic healthcare systems included offering adapted mindfulness programming (p=.038) and paid time (p=.029) to support employee participation. Of these two predictors, offering paid time for employee participation provided the most significant (p=.008) contribution to organizational implementation success and was validated qualitatively by organizational implementation leaders. Background: Effects of nurse stress and burnout on work engagement, absenteeism, and turnover are well documented as are associations with medication errors and lapses in care. Mindfulness-based interventions are widely recognized for reducing employee stress and improving coping and resilience. However, mechanisms of success and sustainability are difficult to ascertain due to multiple inter-related factors including intervention features, nurse characteristics, and complexities of healthcare environments. The purpose of this study was to determine contextual factors contributing to implementation success of worksite mindfulness-based interventions aimed at supporting nurse health and wellbeing. Conclusion: An understanding of how and why specific development and implementation strategies for mindfulnessbased interventions are successful for nurses may be applicable to other interventions and more broadly to all healthcare professionals in the acute care healthcare environment. This is also valuable information for healthcare organizations that employ interventions targeted to employee well-being, especially considering the significant psychological impact of the COVID-19 pandemic on front line healthcare providers.

CLINICAL INTERVENTIONS IN THE AREA OF INPATIENT PRESCRIPTIONS PERFORMED BY A HOSPITAL PHARMACY RESIDENT

Background and importance Pharmaceutical validation of inpatient treatments is a fundamental activity in the clinical practice of the hospital pharmacist. Thanks to this, many prescription errors are detected, promoting patient safety. Aim and objectives To describe the interventions performed by a hospital pharmacy resident in the area of pharmaceutical validation, supervised by consultant pharmacists, and to evaluate their degree of acceptance. Material and methods Prospective interventional study conducted during September 2021. Adult inpatients, whose hospital treatment was reviewed, were included. Demographic (sex and age), clinical (clinical judgement (CJ) and inpatient clinical service) and pharmacotherapeutic (number of chronic medicines and polymedication (≥6 drugs)) variables were collected. Interventions were reported to the clinician via electronic prescribing software. They were classified as: Activity (reconciliation on admission/information to the clinician), Adequacy (detection of prescribing error/therapy reconciliation error), Change (therapeutic exchange), Initiation (usual treatment not prescribed/need for additional treatment), Modification Dosage Form (DF) or Posology, Suspension (duplicity/unnecessary medication/allergy). Patient lists and data were collected through medical records and electronic prescribing software, and processed using Excel 2020. Results Interventions were performed in 56 patients. 63.2% male;median age 73 years (IQR 61-80). The most frequent CJ were: heart failure (10.7%), COVID-19 (7.1%), liver dysfunction (7.1%). Services with most interventions: Internal Medicine (25.8%), General/Vascular Surgery (19.4%), Digestive (11.3%). Median number of chronic medicines: 8 (IQR 5-12). Polymedication in 71.4%. 62 interventions were performed (12.9% were 'not evaluable', reasons: discharge/death). Of the evaluable interventions, 77.8% were accepted. The percentages were: duplicity (30.9%), modification DF/posology (23.8%), usual treatment not prescribed (7.1%), therapeutic exchange (7.1%), discontinue medication due to allergy (7.1%), therapy reconciliation error (4.8%), reconciliation on admission (4.8%), information (4.8%), additional treatment (4.8%), prescribing error (2.4%), unnecessary medication (2.4%). Of the accepted interventions, 11.9% were related to high-risk medicines according to the Institute for the Safe Use of Medicines1- 2 (nonsteroidal anti-inflammatory drugs (NSAIDs), betablockers, heparin, immunosuppressants). Of the not-accepted interventions, 50.0% corresponded to errors in home treatment reconciliation. Conclusion and relevance The data obtained demonstrate that clinical interventions performed by the hospital pharmacy resident have a high degree of acceptance, increasing the quality and safety of healthcare and avoiding medication errors.

VOLUNTARY ELECTRONIC REPORTING OF MEDICATION ERRORS AND ADVERSE DRUGS EVENTS DURING THE FIRST YEAR OF THE COVID-19 PANDEMIC

Background and importance Evidence regarding the rate of medication errors (ME) and adverse drugs events (ADE) during the COVID-19 pandemic is limited. In that period the risk of ME and unsafe medication practices was potentially higher than average. Thus, voluntary hospital reporting systems are valuable sources of information on ME and ADE. Aim and objectives To describe the ME and ADE registered in the voluntary electronic notification system of our centre (TPSC Cloud) during the first year of the COVID-19 pandemic and compare them with the same period in the previous year. Material and methods A retrospective observational study of ME and AE notifications in the TPSC Cloud from March 2020 to February 2021 compared to notifications recorded from March 2019 to February 2020. Five types of incidents were differentiated: situations with the capacity to cause ME, ME that do not reach the patient, ME that reach the patient without ADE, ME with ADE, and ADE without ME. The drugs involved in those incidents and the professional notifier also were identified. Results 249 incidents were reported from March 2020 to February 2021, which was 31.02% less than in the previous period (n=361) from March 2019 to February 2020. The most common ME was prescription error in both periods (70.4% vs 67.3%). The incident profile by typology was similar in both periods. The most frequent was ME that did not reach the patient (40.24% vs 43.47%), followed by ME that reached the patient without ADE (23.42% vs 28.53%). Systemic anti-infectives drugs were the most involved in both periods (n=57;22.89% vs n=73;20.22%). 84 ADE without ME were reported from March 2020 to February 2021, representing an increase of 500% compared with March 2019 to February 2020 (n=14). Emphasising the notification of 35 ADE of lopinavir/ritonavir and 4 of hydroxychloroquine used in the initial treatment of COVID-19. The main notifier in both periods was the pharmacist (80.48% vs 65.60%). Conclusion and relevance During the first COVID-19 pandemic year, notifications of ME decreased, due to care load pressure, but incident profile was similar. Otherwise, ADE notifications increased notably, due to active pharmacovigilance carried out by pharmacists on off-label drugs used to treat COVID-19.

An assessment of the quality of care and outcomes of inpatients with covid-19 and diabetes

Aim: It is now known that patients with diabetes, who are admitted with covid-19 infection (PWCD), generally have worse outcomes compared to those without diabetes. This study aims to assess the quality of diabetes care provided, and outcomes in such patients. Method: We compared outcomes of the PWCD group with the patients with covid-19 (PWC) group, without diabetes. We also compared the quality of care of a subset of PWCD with a matched group of people with diabetes but no covid-19 infection (PWD). Results: 74 of 411 people with covid-19 admitted, had diabetes (PWCD). Mean length of stay was slightly longer for the PWCD group. The diabetes group were significantly older, and had a significantly higher BMI. Prescription errors were significantly higher in the PWCD group compared to PWD (29 vs 14). Diabetes medication administration errors were also found to be higher in the PWCD group compared to PWD (84 vs 20). Interestingly, number of good glucose days (4 to 12mmol/L) was marginally better in the PWCD group (15) compared to PWD (13). Conclusion: As previously described, the PWCD cohort has more risk factors and mortality as inpatients. Our novel finding is that the quality of diabetes care was worse for the covid-19 and diabetes cohort. Inpatient diabetes teams need to specifically focus on the quality of diabetes care for this group to hopefully help improve outcomes.

Implications of obesity for drug administration and absorption from subcutaneous and intramuscular injections: A primer.

PURPOSE: To discuss the potential implications of obesity for drug administration and absorption from subcutaneous (SC) and intramuscular (IM) injection sites. SUMMARY: The SC and IM routes are useful for the parenteral administration of medications to optimize pharmacokinetic properties such as time to onset and duration of effect, for cost considerations, or for ease of administration, such as when intravenous access is unavailable. The choice of SC or IM injection depends on the specific medication, with SC administration preferred for products such as insulin where a slower and more sustained response is desirable, while IM administration is usually preferred for products such as vaccines where more rapid absorption leads to a more rapid antibody response. Obesity has the potential to influence the rate and extent of absorption, as well as adverse effects, of medications administered by the SC or IM route through changes in SC tissue composition and depth or by inadvertent administration of IM medications into SC tissue because of improper needle length. Potential adverse effects associated with IM or SC injections in addition to pain, bruising, and hematoma formation include sciatic nerve injury, particularly with IM injection in the upper outer quadrant of the buttock; bone contusion or rarely osteonecrosis if the IM injection is excessively deep; and granulomas, fat necrosis, and calcification with SC injection. CONCLUSION: Issues related to medication absorption in obese patients are likely to become more prominent in the future with increasing approvals of a wide range of biotherapeutic agents administered by SC injection. Studies should be directed toward these and other agents to assist with dosing decisions in this challenging population.