Optimizing prophylactic antibiotic use among surgery patients in Ethiopian hospitals.

BACKGROUND: Since 2018, the Ethiopian Ministry of Health (MOH) has been working to institutionalize antimicrobial stewardship (AMS) programs across the country. The US Agency for International Development Medicines, Technologies, and Pharmaceutical Services Program supported Ethiopia's multipronged One Health approach to combat AMR. The objective of this paper was to evaluate the effect of a quality improvement intervention to optimize the use of antimicrobials for surgical prophylaxis. METHODS: Basic AMS interventions were introduced in five hospitals from January to May 2023. The AMS committees and multidisciplinary teams working at the surgical wards were trained and provided on-site support to implement surgical antibiotic prophylaxis (SAP) interventions. A before-after comparison was made for 206 medical records at baseline and 213 during the intervention phase. Qualitative data were gathered through discussions during experience-sharing workshops to supplement the quantitative results. RESULT: There were improvements in the presurgery dose of the prophylactic antibiotic and its timing: the doses within the recommended range increased from 11.2 % to 61.0 % (p < 0.001) and the optimal timing increased from 68 % to 82.6 % (p < 0.001). The hospitals also demonstrated some nonsignificant improvement in the duration of prophylactic antibiotic use (from 35 % to 44.6 % [p = 0.106]), with change in practice hampered by practitioners' resistance to early discontinuation for fear of infection due to perceived weaknesses in infection prevention and control practices. Nonavailability of the recommended antibiotic of choice for surgical prophylaxis was another major challenge in addressing all the elements of SAP. The intervention demonstrated a significant antibiotic-related average cost saving, 51.8 Ethiopian birr (∼1 US dollar) per patient (p = 0.028). CONCLUSION: Short-term investments with basic AMS interventions can help to improve SAP use in surgical wards. However, comprehensive success requires complementing AMS interventions with concurrent attention to proper supply chain and infection prevention and control.

A prospective observational study of drug therapy problems in medical ward of a referral hospital in northeast Ethiopia.

BACKGROUND: Drug therapy problem is any undesirable event experienced by a patient during drug therapy that interferes with achieving the desired goals of therapy. Drug therapy problems are common causes of patient morbidity and mortality. There was no study that has been done on drug therapy problems in the study area, Dessie referral hospital, northeast Ethiopia. METHOD: A prospective observational study was conducted among hospitalized patients in the medical ward of Dessie referral hospital from March 01 to May 31, 2014. Ethical approval was obtained and informed consent was signed by each study participant before the commencement of the study. All patients admitted to the ward during the study period were included in the study. Data regarding each patient's demographics, medical condition, drug therapy and patient compliance to the drug therapy were collected using pretested checklists, and drug therapy problems were determined based on the standard practice and textbooks. Descriptive statistical analysis was done using SPSS Version 20 Software. RESULT: A total of 147 patients were included, 75.51% of whom experienced at least one drug therapy problem. During the 3 month period a total of 159 drug therapy problems were identified of which needs additional drug therapy (35.85%) was the most common followed by unnecessary drug therapy (30.19%) and dosage too low (13.2%). Antibiotics, 75 (40.32%) was the most frequent drug class involved in drug therapy problems followed by cardiovascular drugs, 69 (37.1%) and nonsteroidal anti-inflammatory drugs, 9 (4.84%). Ceftriaxone (25.81%) was the most frequent specific drug prone to the drug therapy problems followed by spiranolactone (14.52%), enalapril (6.45%) and furosemide (6.45%). CONCLUSIONS: Three out of four patients experienced at least one drug therapy problem during their hospital stay in the medical ward, with the most commonly observed DTP being no drug therapy prescribed for a condition requiring drug treatment.

Medication administration errors in an intensive care unit in Ethiopia.

BACKGROUND: Medication administration errors in patient care have been shown to be frequent and serious. Such errors are particularly prevalent in highly technical specialties such as the intensive care unit (ICU). In Ethiopia, the prevalence of medication administration errors in the ICU is not studied. OBJECTIVE: To assess medication administration errors in the intensive care unit of Jimma University Specialized Hospital (JUSH), Southwest Ethiopia. METHODS: Prospective observation based cross-sectional study was conducted in the ICU of JUSH from February 7 to March 24, 2011. All medication interventions administered by the nurses to all patients admitted to the ICU during the study period were included in the study. Data were collected by directly observing drug administration by the nurses supplemented with review of medication charts. Data was edited, coded and entered in to SPSS for windows version 16.0. Descriptive statistics was used to measure the magnitude and type of the problem under study. RESULTS: Prevalence of medication administration errors in the ICU of JUSH was 621 (51.8%). Common administration errors were attributed to wrong timing (30.3%), omission due to unavailability (29.0%) and missed doses (18.3%) among others. Errors associated with antibiotics took the lion's share in medication administration errors (36.7%). CONCLUSION: Medication errors at the administration phase were highly prevalent in the ICU of Jimma University Specialized Hospital. Supervision to the nurses administering medications by more experienced ICU nurses or other relevant professionals in regular intervals is helpful in ensuring that medication errors don't occur as frequently as observed in this study.

Medication prescribing errors in the intensive care unit of Jimma University Specialized Hospital, Southwest Ethiopia.

BACKGROUND: A number of studies indicated that prescribing errors in the intensive care unit (ICU) are frequent and lead to patient morbidity and mortality, increased length of stay, and substantial extra costs. In Ethiopia, the prevalence of medication prescribing errors in the ICU has not previously been studied. OBJECTIVE: To assess medication prescribing errors in the ICU of Jimma University Specialized Hospital (JUSH), Southwest Ethiopia. METHODS: A cross-sectional study was conducted in the ICU of Jimma University Specialized Hospital from February 7 to April 15, 2011. All medication-prescribing interventions by physicians during the study period were included in the study. Data regarding prescribing interventions were collected from patient cards and medication charts. Prescribing errors were determined by comparing prescribed drugs with standard treatment guidelines, textbooks, handbooks, and software. Descriptive statistics were generated to meet the study objective. RESULTS: The prevalence of medication prescribing errors in the ICU of Jimma University Specialized Hospital was 209/398 (52.5%). Common prescribing errors were using the wrong combinations of drugs (25.7%), wrong frequency (15.5%), and wrong dose (15.1%). Errors associated with antibiotics represented a major part of the medication prescribing errors (32.5%). CONCLUSION: Medication errors at the prescribing phase were highly prevalent in the ICU of Jimma University Specialized Hospital. Health care providers need to establish a system which can support the prescribing physicians to ensure appropriate medication prescribing practices.