Journal of Pharmaceutical Care
Volume:2 Issue: 3, Summer 2014

Antibiotics prescribed in the presumptuous treatment of infections may be ineffective if causative pathogens acquire resistance to prescribed antibiotics. In the absence of patient follow ups for treatment outcome assessments, healthcare providers may be unaware of the effectiveness of antibiotic treatments they provide. In the empiric treatment of infections particularly, such situations may compromise appropriate selection of antibiotics. The study aimed at assessing the effectiveness of antibiotics prescribed in the empiric treatment of infections using a methodology based on information derived from antibiograms. Culture sensitivity test results and relevant data on antibiotic treatment among inpatients from selected hospitals were used to construct an antibiogram and also determine pathogen associations with infections and antibiotics most frequently prescribed in their empiric treatment. Parameters describing levels of antibiotic activities against pathogens associated with given infections were defined and used to evaluate the effectiveness of prescribed antibiotics. Clinical validity of results was assessed by comparing results of a simultaneous treatment outcome evaluation of antibiotic treatments of selected infections carried out. The methodology was used to successfully evaluate the effectiveness of commonly prescribed antibiotics. Ampicillin and co-trimoxazole, two of the antibiotics most prescribed in the empiric treatment of infections, were predicted to be grossly ineffective in treating staphylococcal and Gram-negative bacilli (GNB) infections for which they were observed to be prescribed. Polymicrobial causes of infections attributable mainly to gram-positive cocci and gram-negative bacilli were established as an etiological feature of most infections. Multiple antibiotic treatments were shown, in effect, to be more effective than single use of the agents in treating most infections.

Medication errors are mentioned as the most common important challenges threatening healthcare system in all countries worldwide. This study is conducted to investigate the most significant factors in refusal to report medication errors among nursing staff. The cross-sectional study was conducted on all nursing staff of a selected Education & Treatment Center in 2013. Data was collected through a teacher made questionnaire. The questionnaires’ face and content validity was confirmed by experts and for measuring its reliability test-retest was used. Data was analyzed by descriptive and analytic statistics. 16th version of SPSS was also used for related statistics. The most important factors in refusal to report medication errors respectively are: lack of reporting system in the hospital(3.3%), non-significance of reporting medication errors to hospital authorities and lack of appropriate feedback(3.1%), and lack of a clear definition for a medication error (3%). there was a significant relationship between the most important factors of refusal to report medication errors and work shift (p:0.002), age(p:0.003), gender(p:0.005), work experience(p<0.001) and employment type of nurses(p:0.002). Factors pertaining to management in hospitals as well as the fear of the consequences of reporting are two broad fields among the factors that make nurses not report their medication errors. In this regard, providing enough education to nurses, boosting the job security for nurses, management support and revising related processes and definitions are some factors that can help decreasing medication errors and increasing their report in case of occurrence.

Thalassemic patients undergoing Hematopoietic Stem Cell Transplantation (HSCT) are faced with cumulative high level of oxidative stress and depletion of critical antioxidants. Administration of antioxidants, is promising towards minimizing oxidative damage in both thalassemic and HSCT patients. This was a prospective cross-sectional observational study. Patients as a part of institutional protocol were received Vitamin C (Vit C) (all the patients received oral Vit C; 200 mg and 400 mg Vit C, if they were less or more than 20 kg respectively plus 10 mg/kg/day intravenous infusion of Vit C).We measured plasma Vit C and total antioxidant (TAs) levels at four different time points; baseline, transplantation day (0), day +7 and day +14. We calculated mean and standard error for plasma levels of Vit C and TAs. Fifthy patients enrolled in this study (mean age 7.97± 3.53). In all four time points, means of Vit C and TAs serum levels were under their reference values and their highest means were belong to baseline. Serum TAs and Vit C both depleted significantly from baseline to day 0 (P: 0.00 for both variables), then increased up to day +7 and it keeps rising till day +14 (P: 0.00 from day 0 to day +7 and +14 for both variables). These changes were significant through the measurement time. There is also a significant correlation between baseline Vit C and baseline TAs (P: 0.11). This means the higher level of Vit C is correlated with higher level of TAs and vice versa. We did not observe any beneficial effects of administering Vit C in thalassemic patients undergoing HSCT in order to increase or prevent depletion of Vit C and TAs serum levels. This could be resolved by further investigations carrying out higher doses or longer duration and having a control group.

Over 90% of pharmacy students’ work in pharmacies after graduation which needs both knowledge and skill, thus one of the most essential courses of their education is pharmacy clerkship. An important part of an educational program is the evaluation of the trainees. Different studies show that conventional written exams are not successful in evaluating the skills of the students and can mostly evaluate their knowledge. Thus Objective Structured Clinical Examination (OSCE) is used to evaluate the students in different aspects. An OSCE and a conventional test were given to a group of students at the end of basic community pharmacy clerkship course. The OSCE test consisted of six different stations (reading prescriptions, identifying drugs, pharmacist’s recommendation, patient education, drug information resources, and drug usage instructions). Two questions were asked at each station by different examiners. The scores and results of these tests were compared and analyzed. There was no significant correlation between OSCE final scores and written test scores (P: = 0.217). No significant correlation between each station’s score and the written test score was found. The absence of significant correlation between OSCE and conventional exams shows that the skills evaluated by OSCE cannot be evaluated by the best possible written tests. This type of examination is not commonly used in Iran’s pharmacy schools but due to the findings of this study, it seems that this multiform method, despite being more difficult to arrange, can be a more suitable and relevant way to evaluate basic community pharmacy clerkship compared to conventional written tests.

In most Iranian hospitals, the nurses in the wards prepare intravenous (IV) drugs and unfortunately pharmacists are not involved in this process. The severity of the patients in Intensive Care Unit (ICU) heightens the risk of errors. More over the frequency of using IV drugs in this unit is high, so we decided to determine the frequency and types of errors, which occur in the preparation and administration of commonly, used IV medications in an ICU. A prospective cross sectional study was performed from November 2013 to August 2014, in the intensive care unit in Shahid-Sadoughi hospital in Yazd. Medication errors occurred in the process of preparation and administration of IV drugs, were recorded by a pharmacy student and were evaluated by direct observation, according to the method established by Barker and McConnell. A total number of 843 intravenous doses were evaluated. The most common type of error (34.26%) was the injection of IV doses faster than the recommended rate followed by preparation (15.69%), administration (9.23%) and compatibility with doctor’s order (6.24%). Amikacin was the most common drug involved in errors (41.67%). Most of errors were occurred at afternoon (8 p.m, 28.36%). According to our study the rate of errors in preparation and administration of IV drugs was high in this ICU. Employing more nurses, using developed medical instruments and clinical pharmacists can help to decrease these errors and improve the quality of patient care.

Thrombolytic agents are among the medications that are used widely for the treatment of thromboembolic disorders and myocardial infarction (MI). Despite the world-wide availability of newer specific agents, streptokinase (SK) is still the most frequently used medication from this class in Iran. Hence we conducted this study to review the adverse reactions to this medication which were reported in the Iranian studies. We preformed this study by searching the English resources such as Pubmed, Google scholar and Scopus. Additionally, we searched Google scholar, Scientific Information Database, Magiran and IranMedex to cover Persian articles.We found 50 articles from the mentioned resources after deleting the duplicated records. Nineteen articles remained after implementing the inclusion and exclusion criteria. In most of the studies the indication for SK treatment was MI. Assessment of streptokinase ADRs was the main focus of 7 studies. The most frequent adverse drug reaction (ADR) was related to the cardiovascular system. Among them arrhythmia and hypotension were the most frequent ones. The second most prevalent ADR was bleeding followed by allergic reactions. In two studies only a single system ADR was studied: neurologic adverse effects and elevation in liver enzymes. Only very limited number of studies assessed the causality of the ADRs which made the interpretation of the results difficult. Among the associated factors that were assessed as risk factors of ADRs, age was the focus of 2 studies. The Iranian studies reported frequent ADRs similar to previous reports. However, due to the heterogeneity of the studies we could not describe the frequency and severity of reported ADRs in a more clear and precise conclusion.

Bacillus Calmette-Guérin (BCG) is indicated for treatment of primary or relapsing flat urothelial cell carcinoma in situ (CIS) of the urinary bladder. Disseminated infectious complications occasionally occur due to BCG as a vaccine and intravesical therapy. Intramuscular (IM) or Intravenous (IV) administrations of BCG are rare medication errors which are more probable to produce systemic infections. This report presents 13 years old case that several steps medication errors occurred consequently from physician handwriting, pharmacy dispensing, nursing administration and patient family. The physician wrote βHCG instead of HCG in the prescription. βHCG was read as BCG by the pharmacy staff and 6 vials of intravesical BCG were administered IM twice a week for 3 consecutive weeks. The patient experienced fever and chills after each injection, but he was admitted 2 months after first IM administration of BCG with fever and pancytopenia. Unfortunately four month after using drug, during second admission duo to cellulitis at the sites of BCG injection the physicians diagnosed the medication error. Using handwritten prescription and inappropriate abbreviations, spending inadequate time for taking a brief medical history in pharmacy, lack of verifying name, dose and wrote before medication administration and lack of considering medication error as an important differential diagnosis had roles to occur this multi-steps medication error.