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Drug Use Evaluation of Beta-Blockers in Medical Wards of Nedjo General Hospital, Western Ethiopia.

ABSTRACT: Introduction:Beta-blocker use evaluation is a performance method that focuses on the evaluation of beta-blocker use processes to achieve optimal patient outcomes. Several studies conducted in different hospitals revealed a high incidence of inappropriate prescription of beta-blockers among hospitalized patients. Therefore, it is important to identify inappropriate beta-blocker prescribing since they may increase the risk of hospitalizations. Despite this, there was no study conducted related to drug use evaluation of beta-blockers in Nedjo general hospital (NGH). Thus, this study was aimed at assessing the use evaluation of beta-blockers in medical wards of NGH. Methods:A retrospective cross-sectional study was conducted at medical wards of NGH from January 1, 2016, to December 31, 2017. Results:Out of the total of 149 medical record of patients that contains beta-blockers, 84 (56.37%) were males and about one-third (31.54%) of the patients ages were between 41 and 50 years. Propranolol was the most commonly prescribed beta-blocker (62.76%), and 94.56% of beta-blockers were prescribed with correct indication. There were about 51%, 46.31%, 64.43%, and 46.98% of beta-blockers prescribed with the correct dose, duration, frequency, and route of administration, respectively. Regarding the routes of administration, 70 (46.98%) of them were prescribed with the correct route. Most drugs interacting were propranolol with cimetidine 26 (68.42%), and the most frequent condition for which beta-blockers were prescribed was hypertension (32.89%). Conclusion:Overall, there was an inappropriate use of beta-blockers in terms of dosage and durations. So, prescribers of NGH should strictly adhere to the national treatment guideline when prescribing medications. Additionally, drug information centers have proved useful and effective in promoting rational drug use. Hence, it should be recommended for general use.

SUBMITTER: Fekadu G

PROVIDER: S-EPMC7284961 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Drug Use Evaluation of Beta-Blockers in Medical Wards of Nedjo General Hospital, Western Ethiopia.

Fekadu Ginenus G Bekele Firomsa F Bekele Kumera K Hanbisa Sagni S Belay Gemechis G Maqbool Mudasir M

Cardiovascular therapeutics 20200522

<h4>Introduction</h4>Beta-blocker use evaluation is a performance method that focuses on the evaluation of beta-blocker use processes to achieve optimal patient outcomes. Several studies conducted in different hospitals revealed a high incidence of inappropriate prescription of beta-blockers among hospitalized patients. Therefore, it is important to identify inappropriate beta-blocker prescribing since they may increase the risk of hospitalizations. Despite this, there was no study conducted rel ...[more]

PMID: 32565908

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Project description:Background:Ceftriaxone is one of the most commonly used antibiotics due to its availability, wide spectrum of activity and low toxicity. However, irrational use of ceftriaxone is one of the current issues in most countries, especially developing ones. Objective:The aim of this study was to evaluate ceftriaxone utilization in different wards of Ras-Desta Memorial General Hospital (RDMGH) in Ethiopia. Methods:An institution-based retrospective cross-sectional study was conducted on randomly selected 1,079 patients who were admitted to RDMGH from May 2017 to April 2018. A structured data abstraction format was used to collect data from patients' medical chart. Micromedex® drug interaction checker was used to identify significant drug-drug interactions, and national and international guidelines were used to evaluate the appropriateness of ceftriaxone use. The data were analyzed by using SPSS version 20.0. Results:Among the 1,079 patients enrolled, ceftriaxone was utilized by 601 (55.7%) patients, and these patients were considered for evaluation of appropriateness and subsequent analysis. Among 601 patients, ceftriaxone was used for therapeutic purpose in 362 (60.2%) patients; of which, 359 (99.2%) were for empiric therapy and the rest 239 (39.8%) were for prophylaxis. In the majority of the patients, the dose of ceftriaxone was 2g/day 472 (78.6%) and for a duration of 2-7 days 409 (68.1%). Inappropriate use of ceftriaxone was observed among 237 (39.4%) patients with regard to indication, dose/frequency and duration. About half (49.3%) of the deviation from the guidelines was observed from surgical and gynecologic/obstetrics wards. Among the co-prescribed medications with ceftriaxone, ringer lactate, warfarin and heparin were found to have a significant drug-drug interaction. Conclusion:This study revealed that inappropriate use of ceftriaxone was high in RDMGH. This may increase the emergence of resistant pathogens which may lead to treatment failure and increase cost of therapy. Therefore, adherence to current evidence-based guidelines is recommended.

Project description:BackgroundAdverse drug events (ADEs) are an important public health problem with considerable clinical and economic costs. However there are limited studies of ADE incidence in adult inpatients in low-income countries, particularly in Ethiopia. Hence, this study aimed to assess the incidence of adverse drug events and associated factors in patients hospitalized in the medical wards of Wolaita Sodo University teaching referral hospital (WSUTRH).MethodsA prospective observational study was conducted involving 240 patients admitted to the medical wards of WSUTRH. A checklist was used for data collection, while standard tools were employed for assessing the probability and characterization of ADEs. A multifaceted approach involving daily chart review, patient interview, attendance at ward rounds and/or meetings, and staff reports were employed to collect the data. To identify factors independently associated with ADEs, logistic regression analysis was conducted using Stata version 15.ResultsPatients were followed from ward admission to discharge, accounting for 2200 patient-days of hospital stay. Overall, 976 medications were ordered during the hospital stay. Sixty-four ADEs were identified with an incidence of approximately 27 per 100 admissions and 29 per 1000 patient days. Of the total ADEs, 59% were preventable. Regarding the severity, 2% of the ADEs were severe, while 54% were moderate. The risk of ADEs increased with longer hospital stay (LOHS) (p = 0.021), in patients with blood and immune disease diagnosis (p = 0.001), use of cardiovascular medicines (p = 0.028), and an increase in the number of medications prescribed (p = 0.021).ConclusionsIn this study, ADEs were identified in about one-quarter of the participants. Longer hospital stays, blood and immune diseases, cardiovascular medicines use, and multiple medication use had increased the likelihood of ADE occurrences. The majority of the ADEs were preventable, indicating the existence of a window of opportunity to ensure patient safety.

Project description:The utility of pharmacist consultation for drug-induced liver injury (DILI) management has not been explored. This retrospective cohort study evaluated the impact of a pharmacist active consultation (PAC) service on the management and outcome in patients with DILI. Consecutive patients meeting clinical biochemical criteria for DILI were enrolled at a tertiary teaching hospital between 1 January 2020 and 30 April 2022. The Roussel Uclaf Causality Assessment Method was used to assess causality between drug use and liver injury for each suspected DILI patient. Included patients were grouped according to whether they received PAC, and a proportional hazard model with multivariate risk adjustment, inverse probability of treatment weighting (IPTW), and propensity score matching (PSM) was used to assess DILI recovery. In the PSM cohort, the quality of medical care was compared between PAC and no PAC groups. A total of 224 patients with DILI (108 who received PAC and 116 who did not) were included in the analysis. Of these patients, 11 (10%) were classified as highly probable, 58 (54%) as probable, and 39 (36%) as possible DILI in the PAC group, while six patients (5%) were classified as highly probable, 53 (46%) as probable, and 57 (49%) as possible DILI in the no PAC group (p = 0.089). During patient recovery, PAC was associated with a ∼10% increase in the cumulative 180-day recovery rate. The PAC group had a crude hazard ratio (HR) of 1.73 [95% confidence interval (CI): 1.23-2.43, p = 0.001] for DILI 180-day recovery, which remained stable after multivariate risk adjustment (HR = 1.74, 95% CI: 1.21-2.49, p = 0.003), IPTW (HR = 1.72, 95% CI: 1.19-2.47, p = 0.003), and PSM (HR = 1.49, 95% CI: 1.01-2.23, p = 0.046). In the PSM cohort, PAC was more likely to identify suspect drugs (90% vs. 60%, p < 0.001) and lead to timely withdrawal of the medication (89% vs. 57%, p < 0.001). Thus, PAC is associated with a better quality of medical care for patients with DILI and can improve patient outcomes.

Project description:The levels of indoor air microbial load in hospitals are very crucial to the health of patients and health care workers and are to be regularly monitored and maintained at an acceptable level. However, this problem remains overlooked, particularly in developing countries including Ethiopia. A hospital-based cross-sectional study is designed to determine the indoor air microbial load (settle plate technique), microbial isolates (standard microbiological techniques), bacterial susceptibility profiles (Kirby-Bauer disk diffusion technique), and associated factors, in different wards of the title Hospital, southern Ethiopia. An observational checklist was used to collect relevant information related to the associated factors; descriptive and inferential statistics were applied using Statistical Package for Social Sciences (SPSS); p-values ≤ 0.05 in the multivariable analysis were considered statistically significant. The total average bacterial and fungal load of the selected wards was 1914±1081.4 Colony Forming Units (CFU)/m3 (95% CI: 1718.5-2109.48 CFU/m3) and 1533.7±858.8 CFU/m3 (95% CI: 1378.5-1688CFU/m3) respectively. The highest mean bacterial (1914±1081.4 CFU/m3) and fungal (1533.7±858.8 CFU/m3) loads were found in the male surgical and female medical wards respectively. A total of 229 bacterial and 139 fungal isolates were obtained; Gram-positive bacteria were the predominant type, 130 (56.7%), particularly the isolates of Staphylococcus aureus, 46 (20.1%). The predominant fungal isolates were Aspergillus sp., 53(38%). Percentages of multidrug-resistant (MDR), extended-spectrum beta-lactamase (ESBL), and carbapenemase producers respectively were 48.5, 26.5, and 25%. High room crowd index [p = 0.003; Adjusted Odds Ratio (AOR) 12.5 (Confidence Interval (CI) 95%: 2.42-65)], presence of damp/wet materials [p = 0.025; AOR 7 (CI 95%: 1.3-37.4)], intense room traffic [p = 0.004; AOR 9.6 (CI 95%: 1.2-79.3)], inappropriate storage of food and drugs [p = 0.008; AOR 7.5 (CI 95%: 1.7-32)], and unclean environment [p = 0.03; AOR 5.8 (CI 95%: 1.2-28)] showed statistical significance concerning the indoor air microbial loads; most of the wards in Arba Minch General Hospital (AMGH) stand high and not in an acceptable level as per the WHO and the European Commission standards on indoor air microbial load. Periodic air surveillance and infection prevention control programs are required to reduce the transmission of these microbes to inpatients, visitors, and health care workers.

Project description:BackgroundContinuous monitoring of vital signs (CMVS) using wearable wireless sensors is increasingly available to patients in general wards and can improve outcomes and reduce nurse workload. To assess the potential impact of such systems, successful implementation is important. We developed a CMVS intervention and implementation strategy and evaluated its success in 2 general wards.ObjectiveWe aimed to assess and compare intervention fidelity in 2 wards (internal medicine and general surgery) of a large teaching hospital.MethodsA mixed methods sequential explanatory design was used. After thorough training and preparation, CMVS was implemented-in parallel with the standard intermittent manual measurements-and executed for 6 months in each ward. Heart rate and respiratory rate were measured using a chest-worn wearable sensor, and vital sign trends were visualized on a digital platform. Trends were routinely assessed and reported each nursing shift without automated alarms. The primary outcome was intervention fidelity, defined as the proportion of written reports and related nurse activities in case of deviating trends comparing early (months 1-2), mid- (months 3-4), and late (months 5-6) implementation periods. Explanatory interviews with nurses were conducted.ResultsThe implementation strategy was executed as planned. A total of 358 patients were included, resulting in 45,113 monitored hours during 6142 nurse shifts. In total, 10.3% (37/358) of the sensors were replaced prematurely because of technical failure. Mean intervention fidelity was 70.7% (SD 20.4%) and higher in the surgical ward (73.6%, SD 18.1% vs 64.1%, SD 23.7%; P<.001). Fidelity decreased over the implementation period in the internal medicine ward (76%, 57%, and 48% at early, mid-, and late implementation, respectively; P<.001) but not significantly in the surgical ward (76% at early implementation vs 74% at midimplementation [P=.56] vs 70.7% at late implementation [P=.07]). No nursing activities were needed based on vital sign trends for 68.7% (246/358) of the patients. In 174 reports of 31.3% (112/358) of the patients, observed deviating trends led to 101 additional bedside assessments of patients and 73 consultations by physicians. The main themes that emerged during interviews (n=21) included the relative priority of CMVS in nurse work, the importance of nursing assessment, the relatively limited perceived benefits for patient care, and experienced mediocre usability of the technology.ConclusionsWe successfully implemented a system for CMVS at scale in 2 hospital wards, but our results show that intervention fidelity decreased over time, more in the internal medicine ward than in the surgical ward. This decrease appeared to depend on multiple ward-specific factors. Nurses' perceptions regarding the value and benefits of the intervention varied. Implications for optimal implementation of CMVS include engaging nurses early, seamless integration into electronic health records, and sophisticated decision support tools for vital sign trend interpretation.

Project description:BackgroundFailure to recognize acute deterioration in hospitalized patients may contribute to cardiopulmonary arrest, unscheduled intensive care unit admission and increased mortality.PurposeIn this systematic review we aimed to determine whether continuous non-invasive respiratory monitoring improves early diagnosis of patient deterioration and reduces critical incidents on hospital wards.Data sourcesStudies were retrieved from Medline, Embase, CINAHL, and the Cochrane library, searched from 1970 till October 25, 2014.Study selectionElectronic databases were searched using keywords and corresponding synonyms 'ward', 'continuous', 'monitoring' and 'respiration'. Pediatric, fetal and animal studies were excluded.Data extractionSince no validated tool is currently available for diagnostic or intervention studies with continuous monitoring, methodological quality was assessed with a modified tool based on modified STARD, CONSORT, and TREND statements.Data synthesisSix intervention and five diagnostic studies were included, evaluating the use of eight different devices for continuous respiratory monitoring. Quantitative data synthesis was not possible because intervention, study design and outcomes differed considerably between studies. Outcomes estimates for the intervention studies ranged from RR 0.14 (0.03, 0.64) for cardiopulmonary resuscitation to RR 1.00 (0.41, 2.35) for unplanned ICU admission after introduction of continuous respiratory monitoring.LimitationsThe methodological quality of most studies was moderate, e.g. 'before-after' designs, incomplete reporting of primary outcomes, and incomplete clinical implementation of the monitoring system.ConclusionsBased on the findings of this systematic review, implementation of routine continuous non-invasive respiratory monitoring on general hospital wards cannot yet be advocated as results are inconclusive, and methodological quality of the studies needs improvement. Future research in this area should focus on technology explicitly suitable for low care settings and tailored alarm and treatment algorithms.

Project description:Background: Delirium in older inpatients is a serious problem. The presence of a window in the intensive care unit has been reported to improve delirium. However, no study has investigated whether window-side bed placement is also effective for delirium prevention in a general ward. Objectives: This study aims to clarify the association between admission to a window-side bed and delirium development in older patients in a general ward. Design: This research is designed as a retrospective cohort study of older patients admitted to the internal medicine departments of Shinshu University Hospital, Japan. Participants: The inclusion criteria were the following: (1) admitted to hospital internal medicine departments between April 2009 and December 2018, (2) older than 75 years, (3) admitted to a multi-patient room in a general ward, and (4) unplanned admission. The number of eligible patients was 1,556. Exposure: This study is a comparison of 495 patients assigned to a window-side bed (window group) with 1,061 patients assigned to a non-window-side bed (non-window group). When patients were transferred to the other type bed after admission, observation was censored. Main Measures: The main outcome of interest was "delirium with event" (e.g., the use of medication or physical restraint for delirium) within 14 days after admission as surveyed by medical chart review in a blinded manner. Key Results: The patients had a median age of 80 years and 38.1% were female. The main outcome was recorded in 36 patients in the window group (10.7 per thousand person-days) and 84 in the non-window group (11.7 per thousand person-days). Log-rank testing showed no significant difference between the groups (p = 0.78). Multivariate analysis with Cox regression modeling also revealed no significant association for the window group with main outcome development (adjusted hazard ratio 0.90, 95% confidence interval of 0.61-1.34). Conclusions: Admission to a window-side bed did not prevent delirium development in older patients admitted to a general ward.

Project description:IntroductionDrug-related problems can affect the treatment outcomes of hospitalized patients and outpatients that lead to morbidity and mortality. Despite this, there were scanty of studies among patients with infectious diseases in Ethiopia. As the result, this study was tried to assess the magnitude and determinants of drug therapy problems among infectious disease patients admitted to the medical wards of Wollega University Referral Hospital.MethodsA prospective observational study was conducted from May to August 2019. The prevalence and types of drug- related therapy problems were studied using the Pharmaceutical Care Network Europe Foundation classification system, and adverse drug reaction was assessed by using the Naranjo algorithm. Multivariable logistic regression analysis was used to determine the predictors of drug-related problems, and a significant association was declared if p-value < 0.05.ResultOf the 172 study participants, 106 (61.6%) were males, and the patient's mean age was 39.1 ± 14.31 years. Over the study period, 123 (71.51%) patients had drug-related problems. Need for additional drug therapy was the widely occurred drug-related problem that accounts for 107 (22.77%), and the most common drug-associated with the drug therapy problem was ceftriaxone (77 (44.77%)). This inappropriate use of ceftriaxone might be due to the preference of physicians to prescribe this broad spectrum antibiotic in which it was prescribed for the majority of the infectious disease etiology. Polypharmacy (adjusted odds ratio (AOR) = 2.505, 95% confidence interval (CI): 1.863-11.131), length of hospital stay ⩾ 7 days (AOR = 4.396, 95% CI: 1.964-7.310), and presence of co-morbidity (AOR = 2.107, 95% CI: 1.185-4.158, p = 0.016) were determinants of drug-related problems.ConclusionThe magnitude of drug-related problems was found to be high. Hence, the clinical pharmacy service should be established to tackle inappropriate indications, ineffective drug therapy, and adverse drug events in the study area.

Project description:The elderly are considered as special population, as they differ from younger adults in terms of comorbidity, polypharmacy, pharmacokinetics, vulnerability to drug-drug interactions and adverse drug reactions. Despite the fact that the elderly patients are at high risk of having drug interaction and potential adverse outcomes, studies in this regard are scarce in resource limited settings like Ethiopia. The aim of this study was to assess the prevalence and determinants of potential drug-drug interaction in elderly patients admitted to medical ward of Ayder Referral Hospital in Northern Ethiopia.A cross sectional study was conducted among elderly inpatients aged 60 years and above. The study was conducted from February to May 2014. Prescribed drugs being taken concurrently for at least 24 h were included and checked for drug-drug interaction using Micromedex® 2.0 online drug reference. Data were analyzed using statistical software, statistical package for social sciences for windows version 20. Logistic regression model was used to analyze factors associated with occurrence of drug interaction. P value of <0.05 was considered statistically significant.A total of 140 patients were participated in the study. The mean age (±standard deviation) of participants was 68 (±7) years. Majority (61.4 %) of patients were diagnosed with cardiovascular and/or renal diseases. A total of 814 drugs were prescribed with a mean of 6 (±4) medications per patient during a 13 (±9) days of hospital stay. About two-third (62.2 %) of the respondents were exposed to at least one potential drug-drug interaction. Among these 3.6, 32.9 and 25.7 % of patients had taken contraindicated drug combination, at least one major and at least one moderate drug-drug interaction, respectively. Patients with five or more prescribed medications were four times at risk of having drug-drug interaction (P = 0.00; adjusted odds ratio 4.047; 95 % confidence interval 1.867-8.775).Drug-drug interaction in elderly patients was common in this resource limited set-up. Awareness creation and clinical pharmacist involvement in minimizing the risk associated with potentially harmful drug combinations are needed.

Dataset Information

Drug Use Evaluation of Beta-Blockers in Medical Wards of Nedjo General Hospital, Western Ethiopia.

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Drug Use Evaluation of Beta-Blockers in Medical Wards of Nedjo General Hospital, Western Ethiopia.

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