Pediatric nurses' experiences of implementing the 'ten right principles' in safe medication management: A descriptive phenomenological study.

PURPOSE: In medication management, the ten right principles framework is an accepted global nursing standard and an important component of medication safety. Especially pediatric patients have a higher risk of harm in medication administration compared to adults. This study aimed to examine the experiences of pediatric nurses in implementing the ten right principles in safe medication management. DESIGN AND METHODS: A descriptive phenomenological approach was used in this study. The study was conducted with 16 pediatric nurses in a public hospital's Pediatric Service and Neonatal Intensive Care Unit. Pediatric nurses' medication practices were observed, and semi-structured interviews were conducted with the nurses after the observation. Observations were conducted using an observation tool, and interviews were conducted using a semi-structured interview form. Qualitative data were analyzed using thematic analysis. RESULTS: In this study, it was observed that although pediatric nurses generally adhered to the ten right principles, they had the most difficulties with the right dose and time principles. As a result of the interviews conducted after the observation, two themes (factors facilitating the implementation of the ten right principles and difficulties in implementing the ten right principles) were formed. CONCLUSIONS: The findings revealed that pediatric nurses achieved safe and effective medication administration and generally adhered to the ten right principles. PRACTICE IMPLICATIONS: This study highlights the positive contribution of pediatric nurses to patient safety by using multiple sources of information and clinical reasoning strategies despite the difficulties they experience in drug administration.

Literature analysis of ADR after the listing of apatinib / 中国药房

OBJECTIVE To explore the characteristics and regulations of adverse drug reactions （ADR） caused by apatinib， and to provide a reference for the safe use of apatinib in clinic. METHODS Case and group reports on ADR and safety evaluation of apatinib were retrieved from Chinese and English databases such as CNKI， Wanfang medical network， VIP and PubMed since its listing in 2014， literature data were extracted and statistically analyzed after screening. RESULTS Totally 101 cases were included， involving 221 ADR. In the above cases， the male-to-female ratio was 1.24∶1， with the highest proportion of patients aged 51 to 70 years， most of the patients were given a dose of 500 mg or more， and the patients given low dose of apatinib combined with other antitumor drugs were also likely to have ADR. One to two types of adverse reaction were the most common， while the types could reach up to six. Most ADR occurred within 30 days after medication， and the systems/organs involved were mainly the cardiovascular system damage，skin and its accessories damage， gastrointestinal system damage and urinary system damage； the main clinical manifestations were hypertension/aggravation，hand-foot syndrome，abdominal pain diarrhea and albuminuria， etc. Hypertension/aggravation， hand-foot syndrome and myelosuppression were the most common serious ADR. Most ADR could be improved/cured by suspension of administration， dose downregulation and symptomatic treatment. All 4 patients who died had underlying diseases， and their ECOG scores all ≥2 points. Special ADR （such as reversible posterior encephalopathy syndrome， psychiatric disorders， and cognitive impairment） were mostly caused by apatinib itself， or may be caused by apatinib in combination with the primary or underlying disease. CONCLUSIONS Advanced age， large dose， combination medication， underlying diseases and poor physical condition might be the high risks for ADR caused by apatinib. It is recommended to monitor the blood pressure，urine protein and skin of hands and feet of all patients with medication on a daily basis，pay attention to the occurrence of special ADR， and timely detect abnormal states and give effective intervention，so as to avoid the aggravation of ADR and other secondary ADR.

Aripiprazole-induced liver injury: a spontaneous reporting database study.

Background: There have been individual case reports of aripiprazole in recent years, both domestically and internationally, but no analysis of the characteristics of the occurrence of adverse reactions/events of drug-induced liver injury with aripiprazole using spontaneous reports has been seen. Methods: Using a retrospective study approach, the 452 adverse reaction/event reports of aripiprazole-induced liver injury collected by the China Adverse Drug Reaction Monitoring System from 1 January 2012 to 31 December 2016 were analyzed and evaluated, and exploring it's the clinical characteristics and related risk factors for liver injury occurrence. Results: Among 452 cases of aripiprazole-induced liver injury ADR/ADE reports, there were 121 cases classified as serious, accounting for 26.8% of the total. There were 250 male and 202 female patients, with a male-to-female ratio of 1.24:1. The age of patients ranged from 11 to 77 years old, with an average age of (34.56 ± 12.81) years old, and a high proportion of young adults in the total population. Some patients had used the drug off-label or at a higher than recommended dosage. The onset of liver injury was generally within 15-90 days after continuous use, while some patients are also accompanied by nausea, vomiting, and weight gain. 70% of the combined drug instructions listed that may cause liver injury. Conclusion: In clinical practice, healthcare professionals should pay closely attention to the adverse reactions and risk factors of liver injury caused by aripiprazole. If there are potential risk factors for liver injury, early and regular monitoring of liver function should be carried out to reduce the occurrence of adverse reactions.

Operationalizing a Medication Safety Gap Assessment for a Large Health System.

Background: Medication errors continue to be a leading cause of medical errors. In the United States alone, 7000 to 9000 people die annually due to a medication error, and many more are harmed. Since 2014, the Institute for Safe Medication Practices (ISMP) has advocated for several best practices in acute care facilities derived from reports of patient harm. Methods: The medication safety best practices chosen for this assessment were based on the 2020 ISMP Targeted Medication Safety Best Practices (TMSBP) and health system-identified opportunities. Each month, for 9 months, select best practices were covered with associated tools to assess the current state, document the gap, and close identified gaps. Results: Overall, 121 acute care facilities participated in most safety best practice assessments. Of the best practices assessed, there were 8 practices that more than 20 hospitals documented as not implemented and 9 practices where more than 80 hospitals had fully implemented them. Conclusion: Full implementation of medication safety best practices is a resource-intensive process that requires strong change management leadership at a local level. As noted by the redundancy in published ISMP TMSBP, there is an opportunity to continue improving safety in acute care facilities across the United States.

Covid-19 Recovery and Growth: Promoting Technology Innovation in Healthcare Sector on Hygiene and Safe Medication Practices in Low-Resourced Nigerian Societies.

Introduction: Globally, the healthcare sector is primarily designated to provide timely, efficient and effective medical services. In African countries like Nigeria, the inequality in the healthcare sector is worsened by the limited coverage of healthcare delivery. This has evolved to an unprecedented effect on the provision of healthcare services in low-resource societies. In the post COVID-19 era, recovery and growth from the pandemic become more demanding with an emphasis on promoting innovative technology in the healthcare sector on hygiene and safe medication practices. Method: Data was sourced from mixed research method. Questionnaires, focus group discussions, and in-depth interviews were used to deduce data from 142 healthcare providers, users, and social workers. Participants were randomly selected from three healthcare institutions in Nsukka, Enugu state. Result: Findings revealed that although greater positive perception (66.7%) holds on promoting innovative technology in the healthcare sector; concerns on negative perceptions (33.3%) were; the choice of medication, cultural health behavior and non-adherence to health guidelines. Major factors militating against innovative technology in healthcare sector were corruption in healthcare system, patients' economic level and poor healthcare delivery. Findings depict that age (χ²cal= 84.0, p=0.000<0.05) and income (χ²cal= 53.7, p=0.000<0.05) of patients were found to be significant in the utilization of innovative technology in healthcare. Evidence-based interventions on innovative healthcare systems on hygiene and safe medication practices were; intensive community health education at the grass-root, implementation of health policies, and tutors' improved healthcare knowledge. Participants showed little knowledge of social workers' engagement in health institutions. Conclusion: Equity in healthcare is a core concern in Sustainable Development Goals. Achieving equal distribution of health services between urban and rural societies in recovery from covid-19 pandemic and growth of the healthcare sector is pegged on promoting innovative technology in hygiene and safe medication practices. The study recommends that social workers' engagement with health providers and users in low-resourced societies could help propagate awareness and self-care management of health challenges through digital information technology in Nigeria.

An Exploration of the Safety of "Pneumonia Prevention No. 1" in Healthy Populations.

Background: "Pneumonia Prevention No.1" belongs to 'traditional Chinese medicine prescription for prevention of viral pneumonia and influenza' was urgently formulated by Notice on Printing the Novel Coronavirus Diagnosis and Treatment Scheme for COVID-19 (Trial Version 3) and Traditional Chinese Medicine Prevention and Treatment Scheme for COVID-19 in Hubei Province (Trial). Because the prescription drug has the bidirectional regulation function of human immune function, moderate improvement of immune function can effectively resist virus invasion, while excessive immune function will produce immune overresponse. Excessive immune response will aggravate the condition of patients with COVID-19, resulting in the death of severe patients. Methods: Twenty medical workers aged 20-60 years old, who had no immune disease, no current disease and healthy physical examination, were selected as participants. The participants took Hubei "Pneumonia Prevention No.1" decoction, one dosage each day, twice a day, for 7 consecutive days. With the before-after control method, blood samples were collected from the median cubital veins before and after medication. Immunoglobulin IgA, IgG and IgM were measured by immunoturbidimetry, and T lymphocyte subsets CD3, CD4, CD8 and CD4/CD8 were measured by flow cytometry. The changes of indexes before and after medication were compared with SPPS 13.0 statistical software. The data were expressed by (mean ± standard deviation). T-test was adopted, and P < 0.05 was considered statistically significant (P < 0.05). Results: The results of this study show that in healthy participants, the immunoglobulin and T lymphocyte subsets did not differ significantly before and after drug administration (P > 0.05). Conclusion: Under normal drug administration circumstances, "Pneumonia Prevention No. 1" had no significant regulating effect on the immune system in a healthy population and did not increase the immune system capacity beyond a reasonable range. It is safe to be used as a prophylactic measure in healthy populations.

Opioid risk stratification in the community pharmacy: The utility of the Opioid Risk Tool.

OBJECTIVE: The objective for this paper is to report on the utility of the Opioid Risk Tool (ORT) to identify patients at elevated risk for opioid misuse and deliver medication safety-related services to them. Patient characteristics based on ORT risk stratification are also described. METHODS: Data from patients screened from September 17, 2018 to May 12, 2021 were descriptively evaluated for distribution of ORT scores, characteristics of patients stratified by ORT score, and services delivered to patients based on ORT score. The ORT generates a score from 0 to 26, with scores of 0-3, 4-7, and 8 or higher representing low, moderate, and high risk of opioid use disorder, respectively. Based upon screening results, pharmacists provided patient-specific education and interventions. RESULTS: A total of 6,460 patients were evaluated. Low, moderate, and high ORT scores were found among 87.5, 8.2 and 3.9% of the patients receiving opioids, respectively. Males comprised 46.1% of the patients, and 27.7% of the patients had received a prior opioid prescription in the last 60 days. As a result of risk stratification, the pharmacist explained opioid use disorder to 18.8, 36.1, and 47.0% of patients with low, moderate and high ORT scores, respectively (p < .001). High ORT scores were significantly associated with the pharmacist introducing the patient to community support services (OR = 2.35), the pharmacist having contacted their provider (OR = 6.41), male gender (OR = 2.06), and having taken an opioid in the last 60 days (OR = 1.76). CONCLUSIONS: The ORT is a useful tool for opioid risk stratification of patients receiving opioid medications in the community pharmacy setting. Such stratification allows the pharmacist to provide individualized services to patients based on their risk profile.

Assessment of self-medication practice and the potential to use a mobile app to ensure safe and effective self-medication among the public in Saudi Arabia.

Background: Self-medication (SM) plays an essential role in maintaining a good quality of life for individuals. Previous studies suggested that efforts are still needed to ensure the safe practice of SM. The advances in technology and the internet have granted the availability of abundant and easily accessed medication information. However, identifying the reliability of information could be a challenge for the public. This study aimed to investigate the attitude toward SM, determinants of SM, and knowledge about medication in Saudi Arabia. Also, this study aimed to assess the willingness to use a mobile app that would be specifically designed to guide the practice of SM. Methods: A cross-sectional study was conducted in a form of an online survey among the public in Saudi Arabia. QuestionPro® platform was utilized to collect data from respondents for two months. Statistical analysis was performed using IBM® SPSS® statistics version 26. Results: A total of 1226 individuals completed the questionnaire. The prevalence of SM practice was 59%. The most frequent reason for not practicing SM was the concern about the drug safety issues (38%). Significant statistical associations were identified between SM and several demographic variables, e.g., age, gender, education, health insurance, and having a chronic illness. Most respondents (82.7%) were aware of the necessity of improving SM practice. Knowledge about different aspects of SM (e.g., proper drug selection and administration) was evaluated based on the consumer's perspective. Our data showed that overall knowledge about SM was limited for many consumers. The assessment of the participant's willingness to use a SM app indicated that 47.6% were interested in using such app. This willingness was significantly associated with the consumer's attitude toward SM and being a chronically ill patient. Conclusion: SM is a common practice in Saudi Arabia. However, public awareness about SM is limited. So, implementing new strategies to enhance knowledge and ensure the safety of SM is important. A large proportion of participants were interested to use a SM app, which would improve SM practice. Therefore, we recommend developing a SM-oriented app to be used by the public in Saudi Arabia.

Safe Medication Management for Polymedicated Home-Dwelling Older Adults after Hospital Discharge: A Qualitative Study of Older Adults, Informal Caregivers and Healthcare Professionals' Perspectives.

Safe medication management is particularly challenging among polymedicated home-dwelling older adults after hospital discharge. This study aimed to identify and categorise the stressors experienced and reconstitution strategies adopted by older adults, their informal caregivers, and healthcare professionals as they manage older adults' medications after hospital discharge. A primary study collected the perspectives of 28 older adults, 17 informal caregivers, and 13 healthcare professionals using a qualitative descriptive design. The Neuman Systems Model was used as the basis for a secondary deductive content analysis. Findings revealed that post-discharge medication management at home involved numerous stressors, often including dysfunctions in communication, collaboration, and coordination between the multiple stakeholders involved. Reconstitution strategies for safe medication management were not always successful or satisfactory and were sometimes identified as stressors themselves. Older adults, informal caregivers, and healthcare professionals' perspectives highlighted several potential opportunities for improving safe medication management through nurse-led, interprofessional, patient-centred practices.

Pictograms for safer medication handling by health care workers: a validation study in nursing students in Poland.

BACKGROUND AND OBJECTIVE: Medication use often causes errors that are dangerous to the health of patients. Previous studies indicate that the use of pharmaceutical pictograms can effectively reduce medication errors. The purpose of this study was to determine the comprehensibility, representativeness, and recall rate of nine medication safety pictograms in a sample of nursing students in Poland in order to validate these images. METHODS: A pictogram validation study was conducted in two phases among nursing students at the Hipolit Cegielski State University of Applied Sciences, Gniezno, Poland. All experimental protocols were approved by the Children's Hospital of Eastern Ontario Research Ethics Board (REB Protocol No: 19/122X). All methods were carried out in accordance with relevant guidelines and regulations. In phase 1, the participants' first exposure to the pictograms, the students were asked to guess the meaning of the pictograms without any additional information in order to assess the pictograms' comprehensibility. To be considered valid, according to ISO standards, the pictograms had to be correctly understood by at least 66.7% of participants. After testing all pictograms, students were given explanations and meanings of the pictograms and asked to rate the representativeness of pictograms. To do so, participants were asked to select a number on a seven-point Likert-style scale to indicate the perceived strength of the relationship between the pictogram and its intended meaning for each pictogram. To be considered valid, a pictogram had to be rated at least five on this scale by at least 66.7% of participants. Phase 2 took place four weeks later, during which recall of the intended meaning and representativeness were assessed following the same procedure. RESULTS: A total of 66 third-year nursing students participated in both phases. In phase 1, of the nine pictograms, six met ISO requirements for comprehensibility and seven met ISO requirements for representativeness. In phase 2, all nine pictograms were correctly understood and rated at least 5 by at least 66.7% of participants. Therefore, all nine pictograms are considered valid. CONCLUSIONS: The nine medication safety pictograms can be deployed, but must be combined with training and a written hazard statement to improve comprehension.

A Novel U-Shaped Association Between Serum Magnesium on Admission and 28-Day In-hospital All-Cause Mortality in the Pediatric Intensive Care Unit.

Objective: Our purpose is to evaluate whether serum magnesium when entering the ICU is related to 28-day in-hospital all-cause mortality in the pediatric ICU. Methods: We used the PIC database to conduct a retrospective analysis to investigate the first-time serum magnesium levels of 10,033 critically ill children admitted to the pediatric ICU, and analyzed association between serum magnesium and all-cause mortality. Smoothing spline plots, subgroup analysis and segmented multivariate logistic regression analysis were conducted to estimate the relative risk between serum magnesium and all-cause mortality. The shape of the curve was used to describe the relationship between magnesium and 28-day in-hospital mortality. Results: There is a non-linear relationship between serum magnesium and 28-day in-hospital all-cause mortality. The U-type relationship between serum magnesium and all-cause mortality was observed. The optimal range of serum magnesium with the lowest risk of mortality was 0.74-0.93 mmol/L. As the serum magnesium level reaches the turning point (0.74 mmol/L), the risk of death decreases by 60% for every 0.1 mmol/L increase in serum magnesium; when the serum magnesium level exceeds 0.93, an increase of 0.1 mmol/L increases the risk of death by 38 %. Conclusion: Serum magnesium has a U-shaped relationship with 28-day in-hospital all-cause mortality. Both low and high serum magnesium can increase the risk of death. The best serum magnesium range when the risk of death is the lowest is 0.74-0.93 mmol/L.

Research progress on pharmacological effect of evodiamine / 中国药理学通报

Evodiamine(EVO)is an indoloquinazoline alkaloid isolated from the fruits of Euodia rutaecarpa,which has long been used in traditional Chinese medicine to treat various diseases.Modern medical research shows that evodiamine has various pharmacological activities and extremely high medicinal value such as anti-inflammation,anti-tumor,losing weight,treating Alzheimer's,and antibacterium.Evodiamine can interact with a variety of proteins.For example,the interaction between evodiamine and TRPV1 induces its activation to exert anti-inflammatory and losing weight; the interaction with DNA topoisomerase I inhibits its function and thus inhibit bacterial proliferation; the interaction with tubulin promotes NLRP3 inflammasome activation,and exerts anti-tumor and anti-inflammatory functions.In recent years,with the in-depth study of evodiamine,pharmacological research and mechanism of evodiamine has significant improvement.Recent progress of pharmacological effect of evodiamine is highlighted in this review.

Predictors of Safe Prescription Opioid Storage and Participation in Drug Take-Back Events: Results from a Statewide Survey.

Improper storage and disposal of prescribed opioids can lead to diversion or accidental poisonings. Studies of emergency department and cancer patients suggest prescription opioids are rarely stored securely or disposed of when unneeded. Safe storage and disposal practices reduce risks for others living in or visiting a household. The purpose of this study is thus to examine prescription opioid storage and participation in drug take-back events among Michigan adults. Participants (N = 702) were recruited through social media advertisements to complete an online survey in July and August 2018. Logistic regression was used to examine correlates of safe storage and disposal. 8.4% (n = 59) of participants reported always keeping opioids locked; 29.8% (n = 209) reported attending a drug take-back event. Black participants and those who believed that illegal drug use was a serious problem had greater odds of locking opioids; participants with higher levels of education or who knew someone who used heroin or misused prescription opioids had lesser odds of locking opioids. Age and race were associated with take-back event participation. Findings identify factors associated with safe prescription opioid storage/disposal and indicate safe storage/disposal seldom occurs. Education and provision of safe storage equipment should be designed for diverse ages, races/ethnicities, and levels of education. Drug take-back events not hosted by law enforcement may have broader appeal, as may those led by Black or other people of color. Wider use of drug donation boxes may facilitate increased disposal among those who do not wish to or cannot attend take-back events.

Recommendations and guidance for providing pharmaceutical care services during COVID-19 pandemic: A China perspective.

BACKGROUND: The novel coronavirus pneumonia (COVID-19), which was first detected in Wuhan City, has now became a pandemic that affecting patients around the world. Particularly, the community patient population are at high risk of infection and are facing potential failure of proper medication use during the pandemic. OBJECTIVE: To discuss community pharmacists' role and the content of pharmaceutical care (PC) during the novel coronavirus pandemic to promote effective prevention and control and safe drug use of the community patient population. METHOD: Collect and summarize the experience Chinese community pharmacies gained from providing pharmacy services during the COVID-19 outbreak, and taking patients' PC needs into consideration, analyze and discuss the methods and strategies that community pharmacies and pharmacists shall use to provide PC during the pandemic. RESULTS: Community pharmacy management teams shall support PC services by providing adequate supply of COVID-19 related medications and preventative products, following environment regulations, and providing sufficient staff trainings. Pharmacists shall use various approaches to provide PC services in drug dispensing, consulting and referrals, chronic disease management, safe use of infusions, patient education, home care guidance and psychological support to promote the COVID-19 pandemic control and ensure safe medication use of community patients during the pandemic. CONCLUSION: PC services in communities during the COVID-19 shall possess different properties due to disease characteristics and related change in patients' need. Community pharmacies shall work as a strong supporter of patient's medication and protective equipment supply. Community pharmacists shall be prepared to provide skilled and effective PC services for community patient population to ensure medication safety and promote the overall COVID-19 pandemic control.

Evaluation of Carer Strain and Carer Coping with Medications for People with Dementia after Discharge: Results from the SMS Dementia Study.

This study reports carer strain and coping with medications for people with dementia with an unplanned admission to hospital, and it evaluates the impact of a safe medication intervention on carer coping and carer strain. This was a quasi-experimental pre/post-controlled trial that included a survey of carers about managing medications for people with dementia after discharge. For 88 carers who completed surveys, 33% were concerned about managing medications, and 40% reported difficulties with medication management, including resistive behaviours by people with dementia. Dose administration aids were used by 72% of carers; however, only 15% reported receiving a recent home medicines review by a community pharmacist. High carer strain was reported by 74% of carers. Carer comments described many issues that contributed to high carer stress, as well as their engagement in vigilant activities to maintain medication safety. Strategies that can contribute to carers managing medications and reducing their strain include an increased use of dose administration aids, increased provision of home medicines reviews, and increased education of health professionals to provide adequate support and education about managing medications.

Improving opioid guideline adherence: evaluation of a multifaceted, theory-informed pilot intervention for family physicians.

OBJECTIVES: Opioid-related deaths continue to increase in North America, an epidemic that was initiated by high rates of opioid prescribing. We designed a multifaceted, theory-informed Opioid Self-Assessment (OSA) package, to increase adherence to the Canadian Opioid Guideline among family physicians. This study aimed to assess changes in Canadian family physicians' knowledge and practices after completing the OSA package. DESIGN: We conducted a mixed-method evaluation using a pre-test and post-test design that involved the collection of both qualitative and quantitative data. SETTING: This research was conducted in the primary care setting in Ontario, Canada. PARTICIPANTS: We recruited a purposive sample of nine family physicians in Ontario who use long-term opioid therapy to treat patients with chronic pain. INTERVENTIONS: The OSA package included four components: an online knowledge test, an online learning programme, a safe medication practice self-assessment questionnaire and chart audit with feedback. OUTCOME MEASURES: Our measures included changes in knowledge, opioid safety practices and physicians' perspectives on the OSA package. RESULTS: We found statistically significant improvements between pre-test and post-test knowledge scores at both baseline and 6-month follow-up. Physicians' scores improved significantly on five of the seven core characteristics of the practice self-assessment questionnaire. On the chart audits, we observed an improvement in patient education between baseline and 6 months. Qualitative interviews showed that participants appreciated embedded resources in the OSA package. The completion of the package stimulated identification of gaps or deficits in practice and served as a useful reminder to discuss risk and safety with patients. Participants described the chart review as helpful in prompting discussions with their patients, identifying deficits and strengths and a 'primary motivator' for project participation. CONCLUSIONS: The OSA package has the potential to improve medication safety practices in primary care related to opioid monitoring and adherence to current opioid guidelines.

Example of a Simulation Design in Nursing Education: Safe Chemotherapy Administration.

Chemotherapy is one of the treatment methods increasingly used in cancer. In this article, we aimed to share our simulation experiences within the scope of the elective course of Cancer Nursing in the Nursing Internship (4th year) program in the process of teaching safe chemotherapy administration methods. Simulation-based experience should be designed to attain specified educational goals and expected results as best as possible. Scenario implementation is based on the criteria of the International Nursing Association for Clinical Simulation and Learning standards. A biologically safe drug preparation cabin in the drug preparation room of a simulation center was used, and a medium-fidelity mannequin-based simulator evaluating the vital signs was utilized as the simulator during the simulation implementation. In the patient history prepared within the scope of the scenario, the students were expected to achieve goals. An analysis was performed by a trainer who followed attentively the implementation during the scenario. In the analysis stage, sessions including 8-10 students were held using the Promoting Excellence and Reflective Learning in Simulation. A checklist was used to evaluate the skill steps of the students objectively. It is thought that this simulation scenario maintained in accordance with the standards of best practice of the International Nursing Association for Clinical Simulation and Learning would guide the readers. The simulation is considered to be an effective method for safe medications, and it is recommended to plan different scenarios according to the levels of students.

Validation of Pictograms for Safer Handling of Medications: Comprehension and Recall among Pharmacy Students.

BACKGROUND: Medication preparation and administration are higher-risk steps in the medication management process. Therefore, medication management strategies, such as warnings and education about medication safety, are essential in preventing errors and improving the safe handling of medications by health care workers. OBJECTIVES: To validate comprehension of 9 pictograms designed to improve medication safety, and to assess long-term recall of these pictograms in a sample of pharmacy students. METHODS: First- and second-year pharmacy students were recruited as participants. The study was divided into 2 phases: comprehension (Phase 1) and long-term recall (Phase 2). In Phase 1, a slideshow of the 9 pictograms was presented to participants, who were asked to write the meaning of and required action for each pictogram. The intended meaning of each pictogram was then presented to the participants. Four weeks later, long-term recall was assessed in Phase 2 of the study using the same method. The meaning and required action that participants provided for each pictogram were reviewed by 3 independent raters. A pictogram was considered to be validated in the pharmacy student population if at least 67% of participants identified the correct meaning or required action during the recall phase. RESULTS: A total of 101 pharmacy students participated in Phase 1 and 67 in Phase 2. In Phase 1, 4 pictograms met the 67% threshold for comprehension. In Phase 2, after training, 7 of the 9 pictograms were validated. CONCLUSIONS: Given the results obtained with pharmacy students, redesign may be necessary for 2 of the pictograms. The use of validated medication safety pictograms on medication labels and other identifiers may prevent errors during medication handling and administration; this is an important avenue of investigation for future studies.

CONTEXTE: La préparation et l'administration des médicaments sont des étapes à risque plus élevé dans le processus de gestion des médicaments. Or, les stratégies de gestion des médicaments, dont les mises en garde et les informations sur la sécurité des médicaments, sont essentielles à la prévention des erreurs et à une manipulation plus sécuritaire des médicaments par les travailleurs de la santé. OBJECTIFS: Valider la compréhension de neuf pictogrammes conçus pour accroître la sécurité des médicaments et vérifier si ces pictogrammes s'inscrivent dans la mémoire à long terme des étudiants en pharmacie. MÉTHODES: On a recruté des participants auprès des étudiants de première et de deuxième année en pharmacie. L'étude était composée de deux phases : compréhension (phase 1) et mémoire à long terme (phase 2). Dans la phase 1, un diaporama de neuf pictogrammes a été présenté aux participants à qui l'on a demandé d'interpréter chaque pictogramme et la mesure qu'il impose. On a ensuite présenté aux participants la signification qu'on voulait donner à chaque pictogramme. Quatre semaines plus tard durant la phase 2, un test de mémoire à long terme employant la méthode de la phase 1 a été effectué. Les réponses des participants quant à la signification et à la mesure à prendre pour chaque pictogramme ont été analysées par trois évaluateurs indépendants. Un pictogramme était considéré comme validé dans la population des étudiants en pharmacie si un minimum de 67 % des participants se souvenait de la signification adéquate et de la mesure à prendre recherchée pendant la phase de test de mémoire à long terme. RÉSULTATS: Au total, 101 étudiants en pharmacie ont participé à la phase 1 et 67 à la phase 2. Dans la phase 1, quatre pictogrammes ont atteint le seuil de 67 % pour la compréhension. Dans la phase 2, après une formation, 7 pictogrammes sur 9 ont été validés. CONCLUSIONS: Compte tenu des résultats obtenus auprès des étudiants en pharmacie, deux des pictogrammes pourraient être appelés à retourner à la planche à dessin. L'ajout de pictogrammes validés de sécurité des médicaments sur les étiquettes et autres marques d'identification de médicaments pourrait éviter des erreurs pendant la manipulation et l'administration de médicaments. Il s'agit là d'une piste de recherche importante pour de futures études.

Applying Healthcare Failure Mode and Effect Analysis to Prevent Medication Errors during Drug Subpackage / 中国药学杂志

OBJECTIVE: To prevent medication errors during drug subpackage and ensure patients' medication safety. METHODS: Healthcare failure mode and effect analysis (HFMEA) was applied to evaluate the potential failure modes and effects during drug repackaging and dispensing. Thereafter rectification measures was analyzed and carried out in order to prevent the recurrence of failure modes. Risk priority numbers (RPNs) before and after the implication of rectification measures were analyzed using paired t tests. RESULTS: After the application of healthcare failure mode and effect analysis, RPN was statistically significantly (P<0.05) reduced by 60% (P=0.000 2), which affecting the incidences of medication errors during drug unit-dose repackaging. CONCLUSION: The application of healthcare failure mode and effect analysis can effectively prevent medication errors during drug subpackage and improve patients' medication safety.

Analysis of 400 New and Serious Adverse Drug Reactions in a Grade Three Class A Hospital / 中国药师

Objective: To explore the characteristics of adverse drug reactions (ADRs) in a grade three class A hospital to provide reference for rational drug use and reduction of ADRs. Methods: The new and serious ADRs reported during 2014 and 2016 were sta-tistically analyzed in terms of the report type, age, gender, administration route, drug variety and involving system. Results: The new and serious ADR reports reached to 400 cases, which accounted for 64. 52% of the total reports. Of the 400 ADR reports,there were 34. 25% distributed in the 60-74-year old. The proportion of male and female in the ADRs was basically equal, while that of male (50. 25% ) was slightly higher than that of female (49. 75% ). There were 57. 00% of ADRs caused by intravenous administration, and 31. 25% caused by anti-infective drugs, in which cephalosporins accounted for the most (32. 00% ). The most common manifesta-tion of ADR was damage to skin and its appendages, which accounted for 33. 00% , followed by the damage to gastrointestinal system (15. 50% ) and hepatorenal function (14. 00% ). Conclusion: Great attention should be paid to monitoring and reporting ADRs in our hospital, and drugs should be rationally used so as to reduce the occurrence of ADRs.