A study on patient safety with reference to medication errors at a tertiary care hospital

Background: The objective of this present study was to determine and evaluate the nature and types of medication errors (MEs) in a tertiary care hospital.Methods: This was a prospective, observational study was conducted on medication errors in a tertiary care hospital, Kakinada during January 2019 to December 2019. MEs were categorized as prescription error (PE), transcription error (TE), dispensing error (DE), and administration error (AE). The case records and treatment charts were reviewed. The one-way ANOVA test for independent measures was done for statistical analysis.Results: A total of 5792 patients were included during the study period. Total numbers of MEs were n=353 (6.10%). The most common ME was TEs n=191 (54%) followed by AEs n=117 (33%). Nursing errors n=316 were more compared to doctors’ errors n=18. The one-way Anova test for independent measures was done for statistical analysis; the f-ratio value is 6.44654. The p-value is 0.004332. The result is significant at p<0.05.Conclusions: There is a need to establish effective ME reporting system to reduce its incidence and improve patient care and safety. Regular trainings and interdepartmental sharing of facts on medication errors should be done at regular intervals.

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A prospective observational study of medication errors in general medicine department in a tertiary care hospital

Drug Metabolism and Drug Interactions ◽

10.1515/dmdi-2012-0032 ◽

2013 ◽

Vol 28 (1) ◽

Author(s):

Marimuthu Karthikeyan ◽

Devi Lalitha

Keyword(s):

Observational Study ◽

Medication Errors ◽

Prospective Observational Study ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

General Medicine ◽

Care Hospital ◽

Medicine Department

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Assessment of adverse drug reaction profile of the disease-modifying anti-rheumatic drugs at the department of orthopaedics in a tertiary care hospital, Silchar, Assam, India

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20191592 ◽

2019 ◽

Vol 8 (5) ◽

pp. 1007

Author(s):

Vijoy S. Kairi ◽

Pinaki Chakravarty ◽

Arun Kumar Sipani

Keyword(s):

Prospective Observational Study ◽

Tertiary Care Hospital ◽

Early Recognition ◽

Tertiary Care ◽

P Value ◽

Care Hospital ◽

Case Record ◽

Medical College ◽

Disease Modifying ◽

Reaction Profile

Background: The mainstay of treatment of Rheumatoid Arthritis (RA) is the use of the disease-modifying anti-rheumatic drugs (DMARDs). Methotrexate, sulfasalazine and hydroxychloroquine are some of the DMARDs which are used in combination for the treatment of RA. The current study was undertaken to assess the adverse drug reactions (ADRs) of DMARDs that are commonly encountered with the treatment of RA.Methods: The present study was designed as a prospective, observational study on newly diagnosed patients with RA. Patients diagnosed with RA above 18 years (excluding pregnant women) of either sex who were prescribed DMARDs in combination were included. ADRs reported spontaneously by the patients and also responses obtained in a questionnaire related to likely ADRs from the patients was recorded in the case record form. Statistical analysis was done using graph pad and p value <0.05 was considered to be statistically significant.Results: A total of 47 patients attending the Outpatient Department of Orthopaedics, Silchar Medical College and Hospital, Silchar, Assam, India were screened for the study. ADRs were monitored up to the last visit on 41 patients excluding the patients who were lost and who were not able to adhere to the treatment. A total of 27 ADRs were reported from 19 ADR forms. Gastrointestinal manifestations were the most common adverse effects of combination DMARDs seen in 10 patients (24.39%). Severity assessment done using modified Hartwig and Siegel scale that showed majority of the ADRs were mild (74.07%).Conclusions: Present study showed that DMARDs are well-tolerated and have an acceptable toxicity profile as majority of ADRs seen were mild. It was however difficult to prevent the occurrence of ADRs. Proper monitoring of therapy is needed for early recognition of ADRs.

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Visual Outcome of Ocular Trauma Presenting in a Tertiary Care Hospital in Sahiwal

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v36i2.987 ◽

2020 ◽

Vol 36 (2) ◽

Author(s):

Ahmad Zeeshan Jamil ◽

Muhammad Luqman Ali Bahoo

Keyword(s):

Visual Acuity ◽

Ocular Trauma ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Sampling Technique ◽

Visual Outcome ◽

P Value ◽

Care Hospital ◽

Open Globe ◽

Patient Reported

Purpose: To find the visual outcome of ocular trauma presenting in a tertiary care hospital in Sahiwal. Study Design: Descriptive observational study. Place and Duration of Study: This study was conducted at District Headquarter Teaching Hospital affiliated with Sahiwal Medical College, Sahiwal from January 2016 to June 2019. Material and Methods: Four hundred and thirty five patients were included in the study by convenient sampling technique. Patient’s age, gender, occupation, activity at the time of injury, nature of object causing trauma, duration of trauma, visual acuity at the time when patient reported to hospital, the time delay before coming to the hospital were recorded. Ocular injuries were classified according to Birmingham ocular trauma terminology. Detailed ocular examination was performed. Patients were managed and post-management visual acuity at three months was recorded. Results: Mean age of patients was 29.07 ± 12.53 years. There were 219 (50.3%) closed globe and 216 (49.7%) open globe injuries. In 59 (13.6%) cases, cause of injury was metal object. In 146 (33.6%) cases injury was classified as contusion. In 164 (37.7%) cases cornea was involved. Majority of the patients were male. Eighty-seven patients presented within 1 day after trauma. In 154 (35.4%) patients, visual acuity at the time of presentation was 6/12 or better while in 171 (39.3%) cases it was less than 6/60. Chi-square test was used to calculate the difference between pre and post-management visual acuity. This difference was statistically significant with p-value less than 0.05 Conclusion: Ocular trauma cases, if properly and timely managed, have a statistically significant increase in visual acuity.

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Opportunistic infection at the start of antiretroviral therapy and baseline CD4+ count less than 50 cells/mm3 are associated with poor immunological recovery

Journal of Basic and Clinical Physiology and Pharmacology ◽

10.1515/jbcpp-2018-0105 ◽

2019 ◽

Vol 30 (2) ◽

pp. 163-171

Author(s):

Amod Tilak ◽

Smita Shenoy ◽

Muralidhar Varma ◽

Asha Kamath ◽

Amruta Tripathy ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Opportunistic Infection ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Hiv Positive ◽

P Value ◽

Care Hospital ◽

Long Term Treatment ◽

Immunological Recovery

AbstractIntroductionThere is a dearth of studies assessing the efficacy and immunological improvement in patients started on antiretroviral therapy (ART) in India. This study was undertaken to assess the 2-year treatment outcomes in HIV-positive patients initiated on ART in a tertiary-care hospital.MethodsAfter approval from the Institutional Ethics Committee, adult HIV-positive patients from a tertiary-care hospital, initiated on ART between January 2013 and February 2015, were included in the study. Data on clinical and immunological parameters were obtained from medical case records over a period of 2 years after initiation of therapy. Intention-to-treat analysis was done using a descriptive approach, using SPSS version 15 (SPSS Inc. Released 2006. SPSS for Windows, Version 15.0. Chicago, SPSS Inc.). A logistic regression analysis was done to assess the predictors for poor outcomes. A p-value <0.05 was considered statistically significant.ResultsART was initiated in 299 adult patients. At 1 and 2 years, the median (interquartile range) change in CD4+cell count was 65 (39, 98) cells/mm3and 160 (95, 245) cells/mm3. The change observed after 2 years of treatment initiation was statistically significant compared with that after 1 year. Three deaths occurred during the study period and 28 were lost to follow-up. Male sex, presence of at least one opportunistic infection at the start of therapy, and baseline CD4+count <50 cells/mm3were associated with poor immunological recovery.ConclusionsWith long-term treatment and regular follow-up, sustained clinical and immunological outcomes can be obtained in resource-limited settings.

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Impact of Computerized Prescriber Order Entry on Medication Errors at an Acute Tertiary Care Hospital

Hospital Pharmacy ◽

10.1177/001857870303800314 ◽

2003 ◽

Vol 38 (3) ◽

pp. 227-231 ◽

Cited By ~ 14

Author(s):

Chike Augustine Igboechi ◽

Carol L. Ng ◽

Chuiling S. Yang ◽

Althea N. Buckner

Keyword(s):

Medication Errors ◽

Tertiary Care Hospital ◽

Positive Impact ◽

Tertiary Care ◽

Care Hospital ◽

Order Entry ◽

Clinical Interventions ◽

Continuous Quality ◽

Computerized Prescriber Order Entry ◽

Drug Therapy Problems

The authors analyzed medication errors documented in a hospital's database of clinical interventions as a continuous quality improvement activity. They compared the number of errors reported prior to and after computerized prescriber order entry (CPOE) was implemented in the hospital. Results indicated that in the first 12 months of CPOE, overall medication errors were reduced by more than 40%, incomplete orders declined by more than 70%, and incorrect orders decreased by at least 45%. Illegible orders were virtually eliminated but the level of medication errors categorized by drug therapy problems remained significantly unchanged. The study underscores the positive impact of CPOE on medication safety and reemphasizes the need for proactive clinical interventions by pharmacists.

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Frequency Of Post-operative Hypocalcaemia Following Thyroid Surgery At A Tertiary Care Hospital Of Sindh

Journal of Bahria University Medical and Dental College ◽

10.51985/jbumdc2018oa3 ◽

2017 ◽

Vol 08 (01) ◽

pp. 07-10

Author(s):

Summaya Qazi ◽

Khalil ahmed Almani ◽

Rizwanullah Junaid Bhanbhro ◽

Diya Ram Khatri

Keyword(s):

Serum Calcium ◽

Thyroid Surgery ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

University Hospital ◽

P Value ◽

Care Hospital ◽

Long Duration ◽

Symptomatic Hypocalcemia ◽

Laboratory Investigations

Objective: The present study was conducted to determine the frequency of post-operative hypocalcaemia following thyroid surgery at a tertiary care hospital of Sindh Study design: Observational study Place and Duration: Department of surgery, Isra University Hospital from December 2014 to July 2017. Materials and Methods: 100 cases of thyroid swellings were selected according to inclusion and exclusion criteria. Pre- operative patient history, physical examination, thyroid gland examination and laboratory investigations were performed. A serum calcium levels <8 mg/dl was taken as hypocalcemia. Data was analyzed on SPSS 21 version and P value (P< 0.05) was considered significant. Results: Of 100 patients, 67% were female and 33% were male (P=0.0001). Female dominancy was noted with female to male ratio of 2.03:1. Age (mean± SD) was noted as 37.5 ± 9.5 years (19 – 48 years). Frequency of symptomatic hypocalcaemia was noted in 23% subjects post operatively. Mean± SD serum calcium and phosphate in post operative hypocalcemia subjects was noted as 7.31 ± 0.38 mg/dl and 2.95 ± 0.63 mg/dl respectively. Majority of symptomatic hypocalcemia were noted within 72 hours post operatively. Conclusion: The present study reports 23% frequency of post thyroidectomy hypocalcemia noted within 72 hours post operatively. Goiters of long duration, recurrent goiters, hyperthyroidism and goiters with retro sternal extensions were found risk factors for the post thyroidectomy hypocalcemia.

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Prognostic factors and outcome of Post-Neonatal Tetanus in an intensive care unit of a Tertiary Care Hospital

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.5.656 ◽

2019 ◽

Vol 35 (5) ◽

Author(s):

Nighat Sultana ◽

Attia Bari ◽

Mehwish Faizan ◽

Muhammad Sarwar

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Prognostic Factors ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Neonatal Tetanus ◽

P Value ◽

Care Hospital

Objective: To determine the prognostic factors and outcome of tetanus in children of post-neonatal age admitted in the intensive care unit (ICU) of a tertiary care hospital. Methods: This prospective cross sectional study, carried out in the Pediatric ICU of The Children’s Hospital Lahore from Jan 2013 to March 2017. Children of both genders with age range of two months to 16 years diagnosed clinically as tetanus were included. All 132 patients were scrutinized for all possible risk factors, need for mechanical ventilation and outcome. Data was analyzed by SPSS version 20. Results: Mean age of children was 7.5±3.4 years with male predominance (70.5%). Only (38.6%) received three doses of vaccination but none had booster dose. Trauma (43.2%) encompassed maximum predisposing factor followed by ear or nose prick and ear discharge. Mean duration of ICU stay was 20±13.3 days. Mortality rate was (17.4%). Ventilator support was given to (78.8%). Neurological outcome was normal in (82.6%). Trauma, ear or nose prick in girls and ear discharge were significantly associated with poor outcome and death with p-value of <0.001, 0.011 and <0.001 respectively. Other factors associated with poor outcome were need for mechanical ventilation and neurological impairment with p-value of 0.001 and <0.001 respectively. Conclusion: Tetanus is causing our children to suffer from devastating disease. Vaccination status is not satisfactory and along with trauma, ear discharge and ear or nose prick are identifiable risk factors. To combat these issues large scale vaccination and booster doses remains promising option. doi: https://doi.org/10.12669/pjms.35.5.656 How to cite this:Sultana N, Bari A, Faizan M, Sarwar M. Prognostic factors and outcome of Post-Neonatal Tetanus in an intensive care unit of a Tertiary Care Hospital. Pak J Med Sci. 2019;35(5):---------. doi: https://doi.org/10.12669/pjms.35.5.656 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Biochemical parameters (lactate dehydrogenase, serum albumin) as early predictor of severe dengue

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20170690 ◽

2017 ◽

Vol 4 (2) ◽

pp. 464

Author(s):

Poornima Shankar ◽

Prarthana B.

Keyword(s):

Lactate Dehydrogenase ◽

Dengue Virus ◽

Serum Albumin ◽

Dengue Fever ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Severe Dengue ◽

P Value ◽

Care Hospital ◽

Biochemical Tests

Background: Dengue fever (DF) is the arboviral infection with the largest incidence worldwide. Clinical expression of dengue virus infection varies from no symptoms to severe dengue with shock. It is the most rapidly spreading vector borne disease in the world. Nearly 100 million cases of Dengue fever and between 250,000 and 500,000 cases of severe dengue are annually reported to the WHO. The objective of this study was to study aims at determining the LDH and serum albumin levels as early parameter to predict the severity of Dengue illness.Methods: A observational clinical study conducted at K.I.M.S hospital, Bangalore, Karnataka, a tertiary care hospital. Children admitted in KIMS Hospital, Bangalore, Karnataka, a tertiary care hospital, Serum LDH and serum albumin levels are measured using the blood sample taken on the 3rd day of fever after confirmation of dengue fever (NS1 Ag- positive).Results: Study enrolled 150 patients with confirmed infection of Dengue virus who were admitted to paediatric unit between July 2014 and December 2016. Serum samples taken 72-96 hours within onset of fever were used for biochemical tests. Of 150 patients, 40 developed Severe Dengue (SD). Cases of SD had higher levels of lactate dehydrogenase (LDH) and low levels of serum albumin. Multivariate analysis showed that early alterations of LDH levels i.e. Out of 40 patients who developed severe dengue, 37 patients i.e. 92.7% had raised levels of LDH with levels more than >600 IU and<3 levels of serum albumin 13 patients i.e 32.5% of severe dengue cases with P value of < 0.001, which showed significant association.Conclusions: Early alterations of biochemical parameter like LDH and serum albumin can predict Severe Dengue in patients with acute dengue illness.

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Frequency of infantile colic in neonates presenting At Tertiary Care Hospital.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.11.4588 ◽

2020 ◽

Vol 27 (11) ◽

pp. 2357-2362

Author(s):

Anwar Muhammad ◽

Muhammad Asghar Ali ◽

Ali Hammad

Keyword(s):

Gestational Age ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Cross Sectional Study ◽

P Value ◽

Care Hospital ◽

Infantile Colic ◽

Cross Sectional ◽

Alternative Measures ◽

Hospital Study

Objectives: To determine the frequency of infantile colic in neonates presenting at tertiary care hospital. Study Design: Cross Sectional Study. Setting: Department of Neonatology, Civil Hospital, Bahawalpur. Period: From January 2018 to August 2018. Material & Methods: Total 467 neonates either male or female were selected for this study. Total 467 neonates with complaints of crying and fussing either male or female were selected for this study and infantile colic was assessed in selected neonates by using Wessel criteria. Results: Total 467 neonates were selected for this study. Mean age of the neonates was 24.94 ± 2.39 months, mean gestational age and mean weight was 39.42 ± 1.22 weeks and 3.27 ± 0.62g respectively. Infantile colic was found in 322 (69%) neonates. Infantile colic was found in 61 (33.33%) neonates, 136 (94.44%) neonates, 75 (87.21%) neonates and 50 (92.59%) neonates respectively. Statistically significant association between infantile colic and type of feeding with p value 0.000. Infantile colic was found in 147 (84.97%), 95 (67.86), 62 (49.21%) and 18 (64.29%) neonates respectively in 37 weeks, 38 weeks, 39 weeks and 40 weeks gestational age group. Statistically insignificant association between infantile colic and gestational age was noted with p value 0.000. Conclusion: Results of present study showed higher rate of colic in infants. Development of colic was highly associated with gestational age, birth weight and type of feeding. There is no effective medical treatment (like anti-colic and herbal drugs) but alternative measures may relieve or prevent further colic attacks.

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