Analyzing Override Patterns in Profiled Automated Dispensing Cabinets at a Tertiary Care Hospital in Saudi Arabia.

BACKGROUND: Inappropriate ADC overrides pose a significant risk to patient safety. Bypassing pharmacist review during these overrides removes a vital safety check, leaving nurses to review complex medication orders alone. This can lead to overlooking incorrect orders and significantly increasing the potential for medication errors. While ISMP guidelines promote profiled ADCs and safe override practices, there is no national standard for acceptable override rates. OBJECTIVES: Assessing the appropriateness of ADC overrides of profiled ADCs at a tertiary hospital in Saudi Arabia in accordance with ISMP guidelines (3rd core safety process). METHODS: This retrospective observational study reviewed all override transactions for 13 profiled ADCs over a 3-month period, from 1 October 2022 until 31 December 2022. The target override rate was set at no more than 5%. After data exclusions, the data was extracted from electronic records of two integrated systems: the Omnicell® dashboard and the BESTCare® HIS. The study assessed whether the override transactions complying with the standard elements required for appropriate ADC overrides in accordance with ISMP recommendations and hospital regulations. RESULTS: 664 override transactions from profiled ADCs were reviewed and evaluated. Although the overall override limit for profiled ADCs was met (1.9%), multiple inappropriate override practices were revealed. These inappropriate practices are missing physician orders (33.7%), undocumented verbal orders (31.5%), non-urgent physician orders (11%), missing (8.4%) or delayed (33.7%) administration records, and unrecognized override errors (5.3%). Only 3 (0.5%) met all the standard elements required for ADC overrides. CONCLUSION: The target override threshold of 5% is inadequate to demonstrate sufficient adherence to the standard elements of appropriate overrides or effectively prevent medication errors. Consequently, a significantly lower target threshold override limit, well below 5%, should be considered, especially with 24-hour pharmacy services and fully integrated CPOE with ADC system. A multidisciplinary override surveillance team is considered essential.

Selecting an Automated Parenteral Nutrition Compounder Device at a Tertiary Care Institute in Saudi Arabia.

Background: With advances in hospital automation, selecting an automated compounding device (ACD) for compounding parenteral nutrition (PN) may be challenging. A well-designed comparative review that considers safety and technical standards could assist in the selection process. United States Pharmacopeia chapter <797> and The American Society of Hospital Pharmacists (ASHP) has provided guidance on the safety and accuracy of ACDs. Objective: Utilizing a checklist of technical and performance specifications investigators sought to assess the adequacy of compounders available in the Kingdom of Saudi Arabia. Method: Investigators compared the NutriMiX KS-240 and the Exactamix EM 2400. A literature review of practice standards, safety, technical, and performance specifications was conducted. These were developed into a checklist of 46 technical and performance specifications. Investigators evaluated each ACD using the checklist. Results: It was found that 43 (93.48%) of the technical and performance specifications, required by the hospital, were met by the NutriMix KS-240, while 39 (84.78%) were met by Exactamix EM 2400. Conclusion: This review found that although ACDs comply with the majority of standards and specifications, software integration with the hospital information system may be a limiting factor in selecting an ACD. The investigators concluded that the NutriMiX KS- 240 matches the technical and performance specifications for automated compounders required by our institution.

Improving policies and practices for the extemporaneous compounding of oral liquid dosage forms in Saudi Arabian hospitals.

BACKGROUND: Pharmacists rely heavily on available reference material to guide the extemporaneous compounding of medicines. Extemporaneous compounding for individual patients has traditionally not been closely regulated, but is necessary in every setting. OBJECTIVE: To assess the adequacy of the evidence and recommend changes for the master formulae (MFs) used in the extemporaneous compounding manual at five Ministry of National Guard Health Affairs (MNGHA) tertiary care institutions in Saudi Arabia. METHOD: A descriptive cross-sectional study of all extemporaneous oral liquid dosage forms (n=75) was conducted. Investigators sought to establish if the current list of compounded oral liquid dosage forms were registered commercially, backed by a stability study or followed the Saudi Arabia Food and Drug Administration guidance on assigning beyond-use dates. A literature review of stability studies, tertiary references and package inserts was used to verify the MFs. Findings of each MF were tabulated and compared with available stability studies. RESULTS: It was found that 28 (37.3%) oral liquid dosage forms were registered by a regulatory authority, 8 (10.7%) MFs could not be traced to a stability study, while 3 (4%) MFs used beyond-use dates. The taskforce approved 15 (20%) MFs without changes, while 42 (56%) MFs had to be revised. CONCLUSION: This review found that, although resources on the compounding of oral liquid dosage forms exist, pharmacies need to carefully assess their quality and relevance and update local policies and practices. The majority (80%) of the current MFs used in MNGHA institutions were rejected due to inappropriate compounding practices and inaccuracies.

Cost-minimization analysis of imipenem/cilastatin versus meropenem in moderate to severe infections at a tertiary care hospital in Saudi Arabia.

AIM: The aim of this study was to compare the costs of management of moderate to severe infections in patients treated with imipenem/cilastatin (IC) and meropenem (MEM). Pharmacoeconomic studies in Saudi Arabia are scarce. The current hospital formulary contains 2 carbapenems: IC and MEM. These antibiotics share a similar spectrum of activity. There are conflicting reviews with regard to the relative cost-effectiveness of these two agents. METHODS: A retrospective, single-centre cohort study of 88 patients of IC versus MEM in moderate to severe infections was performed, applying cost-minimization analysis (CMA) methods. In accordance with CMA methods, the assumption of equivalent efficacy was first demonstrated by literature retrieved and appraised. Adult patients (⩾18 years old) diagnosed with moderate to severe infections, including skin and skin structure infections (SSIs), sepsis, intra-abdominal infections (IAIs), respiratory tract infections, urinary tract infections (UTIs) and hospital-acquired infections (HAIs), who were prescribed IC 500 mg every six hours intravenously (2 g per day) or MEM 1 g every eight hours (3 g per day), were included in the study. Only direct costs related to the management of the infections were included, in accordance with a payer perspective. RESULTS: Overall there was no difference in the mean total daily costs between IC (SAR 4784.46, 95% CI 4140.68, 5428.24) and MEM (4390.14, 95% CI 3785.82, 4994.45; p = 0.37). A significantly lower medicine acquisition cost per vial of IC was observed when compared to MEM, however there was a significantly higher cost attached to administration sets used in the IC group than the MEM group. Consultation, nursing and physician costs were not significantly different between the groups. No differences were observed in costs associated with adverse drug events (ADEs). CONCLUSION: This study has shown that while acquisition costs of IC at a dose of 500 mg q6 h may be lower than for MEM 1 g q8 h, mean total costs per day were not significantly different between IC and MEM, indicating that medicine costs are only a small element of the overall costs of managing moderate to severe infections.