Retrospective review of medication allergy labeling among patients admitted to a tertiary hospital in Qatar.

Background: Timely access to accurate, up-todate drug allergy information is critical to avoid potentially life-threatening adverse drug reactions (ADRs). However, the completeness and accuracy of allergy documentation remain a challenge. Inappropriate allergy documentation usually necessitates alternative treatments, increases costs, and may negatively impact patients' outcomes. Objectives: Review medication allergy labeling documentation, identify the most reported medication class, and describe allergic reactions based on the reported severity. Methods: A retrospective cross-sectional audit including all medication allergy labeling documentation for patients admitted to Hamad General Hospital (HGH) from January-December 2022 was conducted. A list of patients with medication allergies was generated from the pharmacy system, which included patients' demographics, medication names, documented allergy severity, and any other comments. The list was reviewed, and medications were categorized into different classes. Results: 2856 allergy documentation for 2431 unique patients were identified and included in the analyses. The mean age of included patients was 43 years old, with 73.2% (1780) being females. Among the reported allergic reactions, 11.8% (336) were documented as severe allergic reactions, 51.1% (1457) were moderate, and 37.1% (1060) were mild. Antibiotics were the most common documented allergens, representing 42.1% of all reported allergies, followed by non-steroidal anti-inflammatory drugs (20.7%, n=591), and paracetamol (5.3%, n=151). Of all the reported allergies, only 6 (0.21%) cases had documented confirmatory allergy tests done. Further analysis of the reported allergies revealed that 1.2% (34) of the allergies had documentation to counteract the allergy labeling through either revised patient history or re-challenging. Despite such, allergy labeling was kept in the medical profile without proper de-labeling. Conclusion: Allergy labeling documentation is a key to safe medication prescribing. However, standardized allergy documentation should be implemented to include a brief description and onset of the symptoms. Additionally, a safe de-labeling pathway should be adopted. Most of the allergy documentation was based on patients' or family/parents' reports, while actual allergies observed by a healthcare provider were limited.

Labeling of penicillin allergy in patients admitted to a tertiary hospital in Qatar: A retrospective audit.

BACKGROUND: Penicillin (PNC) allergy is a major healthcare concern that necessitates antibiotic substitution which is associated with increased costs, worse clinical outcomes, and increased risks of antimicrobial resistance. Many patients are labeled as PNC allergic; however, this has been rarely confirmed. In this audit, we aimed to determine the characteristics of PNC allergy labeling. METHODS: A list of all the patients labeled with PNC allergy who presented to the Hamad General Hospital (HGH) for any medical reason from January to December 2021 was generated from pharmacy system. Of those, 30% were randomly selected for audit review. Electronic health records of the selected patients were retrospectively reviewed to identify the allergy labeling characteristics and whether the patients had recently received an antibiotic within the PNC class without developing any allergic reaction. RESULTS: Of the 464 patients identified with labelled PNC allergy, 139 patients were randomly selected and reviewed. Of the reviewed patients, 82 (59%) were women with an average ( ± SD) age of 46 ( ± 16.5) years. Forty-six patients were categorized to have a mild PNC allergy, and only 18 were categorized as severe with the remaining patients categorized as having a moderate PNC allergy. Despite documentation of severity, an accurate description of the allergic reaction event was significantly lacking with only 30/139 (21.5%) patients having clear documentation of the event description. Twenty (14.4%) patients labeled as PNC allergic received at least one antibiotic within the PNC class (e.g., piperacillin-tazobactam, ampicillin-sulbactam, or amoxicillin-clavulanic acid) safely without any documented reactions. Interestingly, of those 20 patients, 4 were categorized as being severely allergic to PNC. However, as more than 80 patients presented to the hospital for reasons not requiring antibiotics; experiences with PNC could not be assessed effectively. CONCLUSION: Poor documentation of the details of allergic reactions may falsely affect future antibiotic decisions. The results of this audit highlight the need for standardizing the documentation process of medication allergy. In addition, reviewing the patient's experience with other drugs within the PNC class can guide healthcare providers during the PNC allergy evaluation.

The experience of Hamad General Hospital collaborative anticoagulation clinic in Qatar during the COVID-19 pandemic.

Hamad General Hospital Anticoagulation Clinic is one of the largest collaborative-practice clinics of its type in Qatar. The patients being followed at this clinic are typically complex and vulnerable. During the coronavirus disease 2019 pandemic, measures were implemented at the clinic to minimize the exposure of patients and healthcare providers to the acute respiratory syndrome coronavirus-2 and to promote social distancing. These measures included extending INR-recall period, transitioning to direct oral anticoagulant drugs whenever feasible, home visits to elderly and immunocompromised patients for INR testing, establishing an anticoagulation hotline, and relocation of warfarin dispensing from the main pharmacy to the anticoagulation clinic. In addition, the clinic shifted its multidisciplinary team meetings onto an online platform using Microsoft Teams. Telehealth consultations were extensively utilized to closely follow up with the patients and ensure that anticoagulation efficacy and safety remained optimal. The aim of this paper is to share our experience and describe the measures adopted by the clinic as part of the Hamad Medical Corporation response to the emerging situation.

Assessment of Dapagliflozin Effectiveness as Add-on Therapy for the Treatment of Type 2 Diabetes Mellitus in a Qatari Population.

The effectiveness of dapagliflozin in the management of type-2 diabetes mellitus (T2-DM) is an essential issue for establishing a basis for prescribing dapagliflozin. This study aimed to assess the effectiveness of dapagliflozin in combination with other hypoglycemic agents (OHAs) in reducing glycated hemoglobin (HbA1c) and fasting blood glucose (FBG) at 3, 6, 9 and 12 months. This retrospective observational study included all patients who visited the endocrine clinics at Hamad Medical Corporation (HMC) and were treated with dapagliflozin. Demographics and laboratory data were obtained retrospectively from computerized patient medical profiles (eMR-viewer). The main outcome measures were the differences in HbA1c and FBG from baseline at different months. Eighty-one Qatari patients were found to have received dapagliflozin during the study period; 72% of them (n = 58) were males, with a mean age of 57.0 ± 9.0 years and a mean baseline HbA1c of 9.0 ± 1.4%. Administration of dapagliflozin as an add-on therapy was found to decrease HbA1c significantly by 0.8 percentage point after 6 months (P = 0.006) and by 1.5 percentage point after 12 months (P = 0.062). FBG was significantly reduced at 6 months and 9 months (P = 0.001 and P = 0.03, respectively). Dapagliflozin effectively reduced the HbA1c level and FBG when used in combination with other OHAs or insulin within 6 to 12 months.

Communicating medication risk to cardiovascular patients in Qatar.

Purpose Patient safety is gaining prominence in health professional curricula. Patient safety must be complemented by teaching and skill development in practice settings. The purpose of this paper is to explore how experienced pharmacists identify, prioritize and communicate adverse drug effects to patients. Design/methodology/approach A focus group discussion was conducted with cardiology pharmacy specialists working in a Doha hospital, Qatar. The topic guide sought to explore participants' views, experiences and approaches to educating patients regarding specific cardiovascular therapy safety and tolerability. Discussions were audio-recorded and transcribed verbatim. Data were coded and organized around identified themes and sub-themes. Working theories were developed by the three authors based on relevant topic characteristics associated with the means in which pharmacists prioritize and choose adverse effect information to communicate to patients. Findings Nine pharmacists participated in the discussion. The specific adverse effects prioritized were consistent with the reported highest prevalence. Concepts and connections to three main themes described how pharmacists further tailored patient counseling: potential adverse effects and their perceived importance; patient encounter; and cultural factors. Pharmacists relied on initial patient dialogue to judge an individual's needs and capabilities to digest safety information, and drew heavily upon experience with other counseling encounters to further prioritize this information, processes dependent upon development and accessing exemplar cases. Originality/value The findings underscore practical experience as a critical instructional element of undergraduate health professional patient safety curricula and for developing associated clinical reasoning.