Look-alike sound-alike (LASA) medication errors in Thai hospitals / Errores de medicación por sonido similar (LASA) en hospitales tailandeses

Look-alike sound-alike (LASA) drugs cause a high proportion of medication errors in hospitals. Drug lists available in hospitals are diverse and complicated. Presently, each hospital has its own LASA drug list and unique management strategies to minimize and prevent LASA errors. Objective: This study aimed to explore the prevalence of LASA drug lists, types of LASA drugs, and categories of medication errors in hospitals in Thailand. Methods: For this crosssectional study, questionnaires were developed and distributed along with a letter to 500 government hospitals (selected from a total of 1,309 hospitals) in Thailand via mail from April to June 2021. Data were analyzed using descriptive statistics (frequencies and percentages). Results: A total of 128 hospitals participated in this study (response rate: 25.60%), including 12 tertiary hospitals (9.38%), 33 secondary hospitals (25.78%), 24 large primary hospitals (18.75%), 51 small primary hospitals (39.84%), and eight private hospitals (6.25%). A total of 2,510 pairs of LASA drugs were identified, which included 1,674 (66.69%) tablets/capsules (Simvastatin 10-Simvastatin 20 pair had the highest frequency), 427 injections (17.01%) (Ceftriaxone-Ceftazidime pair had the highest frequency), 85 liquid dosage forms (3.39%) (Milk of magnesia-alum milk pair had the highest frequency), 74 special techniques in medicine (2.95%) (Seretide evohaler®-Seretide accuhaler® pair had the highest frequency), 49 external used drugs (1.95%) (Clotrimazole cream-Clobetasol cream pair had the highest frequency), and 28 powder dosage forms (1.12%) (ORS for pediatrics-ORS for adult pair had the highest frequency). Conclusion: Despite relevant awareness among healthcare professionals, LASA medication errors occur in hospitals. The most frequent similarities among LASA drugs were detected in their names/pronunciations, and the most common errors belonged to Category B.(AU)

Evaluation of The Rational Drug Use (RDU) Literacy Among Undergraduate Students

Background: Irrational drug usage is a global concern. WHO recommended a strategy for integrating education and awareness on the rational use of medicine into general education programs. Objective: To evaluate the rational drug use (RDU) literacy among the undergraduate students of Ubon Ratchathani University. Methods: This mixed-methods research consists of a quantitative cross-sectional study with a self-administered RDU literacy questionnaire and a qualitative in-depth interview study. Descriptive statistics and inferential statistics were used in the quantitative study. Thematic analysis was used in the qualitative study. Results: Students who participated in this study included 640 undergraduate students. Approximately half of the participants never studied a RDU-related course (50.94%). Although the findings revealed that most of the participants (73.13%) had good RDU literacy, many participants had less frequency of the right options on some questions (e.g., advertisement of health products). Health sciences students were 2.8 times more likely than non-health sciences students to have good RDU literacy (AOR=2.835, 95% CI: 1.752-4.587). Four main themes were derived from the qualitative study: 1. Definition of RDU; 2. Facilitators; 3. Concerns; 4. RDU country. Conclusion: While the majority of participants demonstrated good RDU literacy, some actually engaged in irrational drug use. Activities promoting RDU literacy among undergraduate students, particularly in faculties other than health sciences, are still required (AU)

Enhancing extemporaneous preparations in Thai Hospitals: exploring variation, common formulations, and challenges and needs related to extemporaneous preparations

Objective: This study aimed to assess the diversity of extemporaneous preparations, identify the prevalent formulations, and highlight the challenges and opportunities for standardization and improvement of extemporaneous preparation practices. Methods: A survey was conducted among 88 Thai hospitals representing the public and private sectors. The questionnaire gathered information on general hospital characteristics, detailed aspects of extemporaneous compounding, and the specific extemporaneous formulations used. Results: The survey revealed significant variations in extemporaneous preparations among Thai hospitals, with oral liquids, semisolids, and eye preparations commonly employed. The primary oral liquid formulations used were suspensions, syrups, and solutions. Specific medications frequently used in extemporaneous preparations were also identified. The challenges encompassed space, personnel, skills, raw materials, equipment, standardized formula information, preparation process information, funding, and other factors. Conclusion: A survey among Thai hospitals revealed significant variations in extemporaneous preparations in 88 participating hospitals. Common formulations used in extemporaneous compounding include oral liquid preparations, such as suspensions, syrups, solutions, semisolid preparations, and eye preparations. Stakeholder involvement, implementation of standardized operating procedures, resource allocation, comprehensive training programs, and collaboration among hospitals, pharmaceutical companies, and regulatory agencies are recommended to enhance extemporaneous compounding practices (AU)

An Overview of Pharmaceutical Production in Thai Hospitals.

Purpose: The purpose of this research was to provide an overview of pharmaceutical production in Thai hospitals. Methods: A cross-sectional survey was developed to study pharmaceutical production in the 1347 Thai hospitals. A representative sample was chosen using multistep selection arriving at a final total of 750 hospitals. Five experts in hospital pharmacy production were recruited to evaluate the content validity. The questionnaire consisted of 2 parts: (1) general details of the hospitals and (2) the type of pharmaceutical products. The latter classification were further divided into 6 types: (1) nonsterile products, (2) extemporaneous preparations, (3) total parenteral nutrition, (4) intravenous admixtures, (5) cytotoxic preparations, and (6) herbal medicine products. All data were analyzed via descriptive statistics. Results: From the 750 questionnaires sent out, 395 hospitals (52.67%) responded to the questionnaires. Regarding the 395 respondent sample group, approximately 60% of the hospitals were involved in pharmaceutical production. The top 3 pharmaceutical products were as follows: (1) cytotoxic preparations (315 items); (2) liquid nonsterile preparations (60 items), and (3) liquid extemporaneous preparations (52 items). The most frequently mentioned reasons for the production of each dosage form were as follows: (1) no commercially available product in appropriate dosage form or strength needed and (2) product was prepared following the hospital's policy. The support needs in hospital pharmacy production were revealed as follows: (1) master formula, (2) quality assurance and quality control processes, (3) equipment, (4) standard references, (5) buildings, (6) personnel, (7) budget, (8) raw material suppliers, and (9) the coordination between the faculties of pharmaceutical sciences and hospitals. Conclusions: Approximately 60% of the respondents had pharmaceutical production in their hospitals. The greatest need for support was for a master formula to inform hospital-based pharmaceutical production. These findings provide essential information, especially for stakeholders, to understand the professional challenges and likely pharmaceutically related health service changes in the future.

Effect of processing history on the surface interfacial properties of budesonide in carrier-based dry-powder inhalers.

Influence of air-jet micronization, post-micronization conditioning and storage on the surface properties of budesonide in dry-powder inhaler formulations was investigated. Crystalline budesonide was air jet-micronized and conditioned using organic vapor. Particle engineering was also used to fabricate respirable particles of budesonide. Surface imaging by atomic force microscopy suggested that micronized material possessed process-induced surface disorder, which relaxed upon conditioning with organic vapor. Particle engineered material was devoid of such surface disorder. Surface interfacial properties of all batches were different and correlated to in vitro fine particle delivery. The surface properties and in vitro performance of the conditioned material changed upon storage of the budesonide at 44% relative humidity and 25°C, while the micronized and particle-engineered material remained stable. These data suggest that processing conditions of budesonide affected the surface properties of the material, which was demonstrated to have direct affect on dry-powder inhaler formulation performance.

Characterisation and functionality of inhalation anhydrous lactose.

The relationships between the physicochemical properties and functionality in dry powder inhaler (DPI) performance was investigated for inhalation grade anhydrous lactose and compared to monohydrate grades. The excipients were characterised using a range of techniques including particle size analysis, moisture sorption and powder rheometry. The inhalation anhydrous lactose grades were readily characterisable. The aerosolisation performance of capsule based DPI formulations containing budesonide (200microg) and different grades of lactose evaluated using inertial impaction measurements produced fine particle doses of budesonide ranging from 24 to 49microg. There were no apparent relationships between aerosolisation performance and excipient characteristics, such as particle size and powder density. However, formulations containing lactose grades which exhibit higher powder fluidisation energy values resulted in higher fine particle doses of budesonide.

Engineering of crystalline combination inhalation particles of a long-acting beta2-agonist and a corticosteroid.

PURPOSE: Engineering of inhalation particles incorporating, in each individual particle, a combination of a long-acting beta-agonist and a glucocorticosteroid in a pre-determined and constant ratio for delivery via a dry powder inhaler (DPI). METHODS: Individual crystalline particles containing both the glucocorticosteroid fluticasone propionate (FP) and long-acting beta-agonist salmeterol (SX) were prepared, in a ratio of 10:1, using the solution atomization and crystallization by sonication (SAX) process. Combination drug particles were characterized by particle size, morphology, crystallinity and aerosolisation efficiency using inertial impaction. RESULTS: Combination drug particles were spherical and crystalline, with a median diameter of 4.68 +/- 0.01 microm. Aerosolisation of formulations containing combination drug particles resulted in greater uniformity in delivery ratios of both actives across all stages of the impactor before and after storage. CONCLUSIONS: Actives in a pre-determined dose ratio can be crystallised in a single particle using the SAX process.