Medication errors in neonatal intensive care unit of a tertiary care hospital in South India: A prospective observational study.

INTRODUCTION: Medication errors (MEs) can prolong hospital stay and are a cause of morbidity and mortality. Studies evaluating MEs and its determinants in Indian neonatal intensive care units (NICUs) are limited. Therefore, this study was done to assess the prevalence, characteristics, determinants, and outcomes of MEs in an Indian NICU setting. METHODOLOGY: A prospective observational study was conducted over a 1-year period (January-December 2016) among neonates receiving medications in NICU. Systematic random sampling was done, and data were collected using a semi-structured questionnaire after obtaining informed consent from the mother. An ME self-reporting system was also established. Data were analyzed using Chi-squared test and Student's t-test. Binary logistic regression was used to analyze the determinants of MEs. RESULTS: Among 269 babies included in the study, 57% (n = 154) were male babies with mean (standard deviation [SD]) birth weight of 2.59 kg (0.701). About 79% (n = 213/269) of the neonates were appropriate for gestational age. The mean (SD) duration of stay in NICU was 7.58 (5.07) days, and 67% of the babies had polypharmacy (use of ≥5 medications). The prevalence of MEs was 22% (95% confidence interval [CI]: 16.96%, 26.84%, n = 108) of all babies, of which only 2% (n = 2) were life threatening. Seventy-seven percent (n = 83) of these errors occurred during administration/preparation and 18% (n = 19) while prescribing. The significant determinants of MEs (adjusted odds ratio [95% CI]) include polypharmacy (4.126 [1.917-8.880]), duration of stay >7 days (1.335 [1.198-1.488]), and babies referred from outside (2.592 [1.217-5.521]). CONCLUSIONS: MEs were common in NICU setting. The occurrence of life-threatening MEs was minimal. Longer duration of hospital stay, polypharmacy, and babies born outside were significantly associated with occurrence of MEs.

Diabetic nephropathy: prescription trends in tertiary care.

Diabetic nephropathy is a leading cause of end stage renal disease. Drug utilization studies could promote rational drug use. The objective of this study was to evaluate prescribing trends in hospitalized patients with diabetic nephropathy. A prospective, observational study was conducted in a tertiary care hospital. The demographic, disease and treatment data of patients with diabetic nephropathy were collected for a period of six months and analysed. Drugs were classified using World Health Organization recommended Anatomic Therapeutic Chemical classification. A total of 755 drugs (7.4 drugs per prescription) were prescribed to 102 study patients, who were all hypertensive and in late stages of diabetic nephropathy. Drug classes with largest representation were those acting on gastrointestinal tract plus metabolism (37%) and cardiovascular drugs (28%). Calcium channel blockers represented the largest antihypertensive drug class (41%). Almost three-fourths of patients received more than one antihypertensive agent. Approximately 37% of patients did not receive any antidiabetic medication. Of those who did, prescriptions for insulin (91%) exceeded those of oral hypoglycaemic drugs (9%). Antimicrobials accounted for 10.2% of all drugs prescribed, of which 31.8% were quinolones. Drugs prescribed by generic name accounted for 11.98%. While all patients received antihypertensive therapy, more than a third were not on any antidiabetic treatment. Antihypertensive poly-therapy was observed in the majority with calcium channel blockers being most frequently prescribed antihypertensive drug class. Insulin was the preferred to hypoglycaemic drugs.

Drug-induced upper gastrointestinal disorders requiring hospitalization: a five-year study in a South Indian hospital.

PURPOSE: To study the clinical spectrum of drug induced upper gastrointestinal tract (GIT) disorders requiring hospitalization and establish the causal relation between drug and disorder using WHO causality definitions. METHODS: Case-records of patients in the Department of Gastroenterology (from January 1998 to December 2002) hospitalized with diagnoses of drug induced upper GIT disorders were analyzed retrospectively. The causality assessment of each disorder was done based on WHO causality definitions. RESULTS: Out of 101 cases identified over the study period, 8 were categorized as certain, 87 as probable and 6 cases as possible. The certain and probable cases (95) were analyzed. Of these, 13 were in 1998, 14 in 1999, 18 in 2000, 20 in 2001 and 30 in 2002. The drug class most commonly implicated with adverse drug reactions was non-steroidal anti-inflammatory drugs (NSAIDs) (76.8%). Among individual drugs, aspirin was most commonly involved (32.6%). Results of endoscopy revealed gastric erosions (40.2%), combination of gastric ulcer and gastric erosions (16.1%), gastric ulcer (15.0%), duodenal ulcer (13.8%), normal (13.8%) and duodenal erosions (1.1%). Risk factors noticed were chronic smoking (16.8%), alcohol consumption (13.7%), smoking and alcohol use (21.1%), history of peptic ulcer (10.5%) and chronic steroid use (1.1%). CONCLUSION: NSAIDs especially aspirin were implicated in maximum number of patients. An increase in occurrence over 5 years, a wide spectrum of disorders and various risk factors were noticed.