Current Perspectives and Concerns Facing Hospital Evacuation: The Results of a Pilot Study and Literature Review.

OBJECTIVE: To analyze the evacuation preparedness of hospitals within the European Union (EU). METHOD: This study consisted of 2 steps. In the first step, a systematic review of the subject matter, according to the PRISMA flow diagram, was performed. Using Scopus (Elsevier, Amsterdam, Netherlands), PubMed (National Library of Medicine, Bethesda, MD), and Gothenburg University´s search engine, 11 questions were extracted from the review and were sent to representatives from 15 European Union (EU)- and non-EU countries. RESULTS: The findings indicate that there is neither a full preparedness nor a standard guideline for evacuation within the EU or other non-EU countries in this study. A major shortcoming revealed by this study is the lack of awareness of the untoward consequences of medical decision-making during an evacuation. Some countries did not respond to the questions due to the lack of relevant guidelines, instructions, or time. CONCLUSION: Hospitals are exposed to internal and external incidents and require an adequate evacuation plan. Despite many publications, reports, and conclusions on successful and unsuccessful evacuation, there is still no common guide for evacuation, and many hospitals lack the proper preparedness. There is a need for a multinational collaboration, specifically within the EU, to establish such an evacuation planning or guideline to be used mutually within the union and the international community.

Ability of Dentists and Students to Detect Caries by Using the International Caries Detection and Assessment System.

OBJECTIVE: To evaluate the ability of dentists and dental students to detect caries by using the International Caries Detection and Assessment System (ICDAS). MATERIALS AND METHODS: A cross-sectional study was conducted in Riyadh city and in the College of Dentistry at King Saud University (KSU) in Saudi Arabia. The study sample included a cluster sampling of 50 private clinics (100 dentists) and all 3rd-, 4th-, and 5th-year students (393 students). Data were collected using an electronic questionnaire. The ability score of detecting caries for each group was identified by calculating the mean percentages of the score. The data were entered into SPSS Version 20. One-way ANOVA was used for comparing quantitative data. RESULTS: The overall response rate of the survey was 64.5% (318/493). A total of 62.6% (199) of respondents know about ICDAS. All groups had difficulty assessing the activity of caries in Code 2. There were significant differences among all groups in the ability to detect caries (P-value: 0:00). Moreover, 4th- and 5th-year students had the highest mean of percentage ability score (53.8% and 57.6%, respectively) to detect caries using ICDAS compared to 3rd-year students and general practitioners (38.6% and 38.7%, respectively). CONCLUSION: Overall, detection of early dental caries limited to enamel was confusing and difficult. The abilities of dentists and dental students to detect caries using ICDAS were low and require improvement by continuing further clinical training.

Prescribing of potentially inappropriate medications among the elderly population in an ambulatory care setting in a Saudi military hospital: trend and cost.

AIM: To explore the prevalence of potentially inappropriate medication (PIM) use in the elderly, to identify the trends and the patterns of prescribing such medication, and to calculate the associated direct medication cost of such practice in a Saudi hospital. METHODS: This was a retrospective cross-sectional study of patients who were aged 65 years or older on at least one PIM. The source of our data was outpatient pharmacy prescription records at Riyadh Military Hospital (RMH) for 2002, 2003 and 2004. Beers' explicit criteria for PIM was used to identify these medications. RESULTS: A total of 20521 PIM were identified. The prevalence of PIM for 2002, 2003 and 2004 was 2.5%, 2.3% and 2.1%, respectively. A total of 43.6% of the patients had filled a prescription of one PIM, 18% filled two PIM and 38.4% filled three or more PIM. Digoxin accounted for 23.7% of these PIM. The most commonly prescribed medications were cardiovascular medications at 26.7%. The total direct cost that was associated with inappropriate prescribing was 518314 Saudi Riyals (US$138217) during the study period. CONCLUSION: PIM prescribing in RMH was less compared with what was published in the literature in other countries. It was unclear whether these results reflect the level of elderly healthcare services provided to RMH patients or because of underreporting. Drug utilization review programs, medical education, recruiting physicians and clinical pharmacists who are specialized in geriatrics, finding safer medications or integration of computer software to detect such medications during prescriptions entry can improve the medical services provided to the elderly.

The use of pharmacoeconomic evidence to support formulary decision making in Saudi Arabia: Methodological recommendations.

In pharmacoeconomics the costs and consequences of alternative medications are compared. Many countries have begun to use pharmacoeconomic evidence to support decisions on licensing, pricing, reimbursement, or addition to the formulary. In Saudi Arabia, it is not mandatory to submit cost effectiveness evidence to support licensing or addition to the formulary decisions however, data will be considered if submitted. Previous evidence suggests that the use of pharmacoeconomic evidence by Saudi Pharmacy and Therapeutic (P&T) committee members in formulary decisions making process is limited mainly because of lack of expertise and lack of resources. This paper intended to provide Saudi P&T decision makers with a clear set of best practice methodological recommendations to help in increasing the utilisation of pharmacoeconomic evidence in the formulary decisions making process.

Home intravenous antibiotics in a tertiary care hospital in Saudi Arabia.

BACKGROUND AND OBJECTIVE: Home intravenous (IV) antibiotic programs are becoming increasingly popular worldwide because of their efficacy and safety. However, in Saudi Arabia these programs have not yet become an integrated part of the health care system. We present our experience with a home IV antibiotic program, as one of the major health care providers in Saudi Arabia. DESIGN AND SETTING: Retrospective chart review of patients enrolled in the King Abdulaziz Medical City Home Health Care IV Antibiotic Program from 1 May 2005 (the start of the program) until 30 December 2007. METHODS: In addition to demographic characteristics, we collected data on the site of infection, the clinical diagnosis, the isolated microorganisms, and the type of antibiotics given. Outcome measures evaluated included the relapse rate, failure rate, the safety of the program, and readmission rates. RESULTS: Of the 155 patients enrolled, 152 patients completed the program. Those who completed the program had a mean (SD) age of 52.8 (23.9) years. The mean (SD) duration of the IV antibiotic treatment was 20.6 (17) days. Three patients refused to complete the intended duration of therapy. Peripherally inserted central catheter (PICC) lines were utilized in 130 patients (86%). One-hundred and thirty-one patients completed the intended duration of therapy, although the therapy was changed from the initial plan for 21 (13.8%) patients. Readmission to the hospital during therapy was required for 13 patients (8.5%). Osteomyelitis was the most frequently encountered diagnosis (65 patients, 42.8%), followed by urinary tract infection (36 patients, 23.7%). CONCLUSIONS: The home health care-based IV antibiotic program was an effective and safe alternative for in-patient management of patients with non-life-threatening infections, and was associated with a very low complication rate. Home IV antibiotic programs should be used more frequently as part of the health care system in Saudi Arabia.

Accuracy of the medication history at admission to hospital in Saudi Arabia.

OBJECTIVE: Inaccurate medication history at admission to hospitals leads to preventable adverse drug events, which in turn increase mortality, morbidity, and health care costs. The objective of this study was to investigate the role of pharmacists in identifying discrepancies in medication histories at admission to a tertiary referral hospital in Saudi Arabia. METHODS: We performed a prospective observational study in a 1200 bed tertiary hospital in Riyadh, Saudi Arabia. Patients were included if they were aged 16 years or older, were taking 5 or more medications, and were able to communicate or were accompanied by a caregiver who could communicate. Over 2 months in 2009, a pharmacist interviewed patients to ascertain all medications used prior to hospitalization, then all discrepancies were discussed with the admitting physician and unintended discrepancies were reported as errors. RESULTS: A pharmacist interviewed 60 patients who were taking 564 medications total. Of these patients, 65% were male, and their mean age was 62. Patients were taking an average of 9.4 medications. Twenty-two (37%) patients had at least one discrepancy, with the most common being omissions of medications (35%) and dosage errors (35%). The mean age for patients with discrepancies was 64.6 years, and without discrepancies, 60.8 years (P = 0.37). CONCLUSION: Inaccurate medication history at admission to a hospital was common in Saudi Arabia. This has the potential to cause harm to patients if it remains undetected. Pharmacists could potentially play a major role in obtaining this medication history at the time of hospital admission.

Evaluation of drug and poison information center in Saudi Arabia during the period 2000-2002.

OBJECTIVE: To evaluate the profile of the requestors, the number and content of questions which were received during the period of May 2000 - December 2002. METHODS: A total of 1967 requests were evaluated. The questions were sorted according to source of callers, caller identification, the content of the questions, search data and time required to answer the questions. All data analysis were performed using the Statistical Package for Social Sciences Version 9.0. RESULTS: The questions were received from different places, including Riyadh (90.1%), overall the Kingdom (8.9%) and gulf countries (1%). The Drug and Poison Information Center (DPIC) provides information to pharmacists, community, employee of King Saud University, physicians, nurses, dentists and others. The type of requests most frequently inquired about were drug related, health related, article/information, and poisoning. Requested data include information about therapeutics uses, drug identification, articles, adverse effects, dosage/administration, drug interactions, poisoning, with very few questions about availability, pregnancy and lactation, and IV incompatibilities. The most common resources used were Drugdex and internet, reference books, Iowa Drug Information Services (IDIS), PubMed and Poisondex. The time devoted to the service is varied ranging from 5 minutes to weeks. CONCLUSION: This study emphasizes on how important to document type of the activities of the DPIC to be used as a vital quality assurance tool. It also revealed the need to stimulate more requestors particularly physicians by advertising the drug information activities or possibly by establishing a website for the DPIC.

Initial emergency department trauma scores from the OPALS study: the case for the motor score in blunt trauma.

OBJECTIVES: To compare the predictive accuracy of the Revised Trauma Score (RTS), the Glasgow Coma Scale (GCS), and their components in blunt trauma patients. METHODS: This multicenter prospective cohort study was conducted in 20 communities as part of the Ontario Prehospital Advanced Life Support (OPALS) Study. It included adult trauma patients with Injury Severity Scores >12. The assessments made by trauma team leaders for the RTS, GCS, and their subscales were analyzed: 1) receiver operating characteristic (ROC) curve areas and Kendall's tau c correlation coefficient (Tc) for survival to hospital discharge, 2) Mann-Whitney U test and Tc correlations for intensive care unit admission, and 3) Spearman correlations with the disability measure Glasgow Outcome Scale. RESULTS: The authors analyzed data from 795 blunt trauma patients with these characteristics: median age of 40 years, 70% male, and 18% mortality. The scores that best predicted survival were the RTS (ROC = 0.83, Tc = 0.39), the GCS (ROC = 0.82, Tc = 0.38), the motor component of the GCS (ROC = 0.81, Tc = 0.37), and the verbal component of the GCS (ROC = 0.81, Tc = 0.36). Only scores for the RTS (p = 0.03), the GCS (p = 0.02), and the motor component of the GCS (p = 0.03) showed a significant association with admission to the intensive care unit. The associations with disability were weak in all scores. CONCLUSIONS: The initial emergency department motor score showed the highest predictive validity among all of the other components. These results suggest its validity for blunt trauma triage when compared with the GCS or RTS.