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Pharmaceutical care in the <br/> Arabic-speaking Middle East: literature review and country informant feedback
Background The philosophy and practice of pharmaceutical care (PC) has challenged Middle Eastern pharmacists to embrace a new paradigm that focuses on outcomes of care rather than products or tasks. Although the application of PC was found to be associated with a reduction in adverse drug reactions length of hospital stay and cost of care in the developed world the status and application of the practice remains less clear in the Arabic-speaking Middle East (ME). The aim of this project was to describe the current status of PC services in a number of Arabic-speaking ME countries. Methods We conducted literature search to identify what had been published on the status of PC in the ME. We also invited individuals who have good understanding of the pharmacy environment in the respective country. The individuals identified were asked to respond to a set of standardized questions relating to PC services in their countries. Results The literature search generated 12 publications in total. Ten country informants agreed to provide information on PC practice and pharmacy practice in general in their respective countries and they ultimately provided information related to these areas. Conclusions The PC concept is still often confused with clinical pharmacy which remains to be a priority in several countries in the region. Pharmacy education is rapidly changing change in many of the ME. These changes are hoped to reflect a wider recognition and application of PC services in the hospital and community settings.
Incidence, nature and causes of medication errors in hospitalised patients in Middle Eastern countries: A systematic review
Background and aim: Medication errors (MEs) are a major global issue adversely impacting patient safety and health outcomes. Promoting patient safety through minimising MEs is therefore a key global healthcare objective. This study aims to systematically review the incidence nature and causes of MEs in hospitalised patients in Middle Eastern countries. Method: A systematic search of studies related to MEs originated from Middle Eastern countries was performed using the following databases: MEDLINE EMBASE International Pharmaceutical Abstracts Cumulative Index to Nursing and Allied Health Literature PsycINFO Cochrane Database of Systematic Reviews (CDSR) Centre for Review and Dissemination (CRD) database Joanna Briggs Institute Library. A systematic review protocol was developed and registered with the Centre for Reviews and Dissemination (CRD). The title abstract and full article were screened for inclusion. Each paper was assessed by two reviewers for methodological quality prior to inclusion in the review. Studies were critically appraised prior to data extraction and findings synthesised using a narrative approach. Results: Database searching identified 2611 studies; 51 met the inclusion criteria and originated from nine of fifteen Middle Eastern countries largely Iran Saudi Arabia and Israel. Preliminary review results indicate error incidence rates of between 11 and 90% of patients (depending on the method of data collection) with the categories of errors reported being mostly prescribing errors followed by administration dispensing and transcribing. Deficiencies in staff knowledge lack of experience insufficient training poor adherence with protocols and policies miscommunication and excessive workload were identified as major causative factors. Conclusion: MEs occur at high rates of incidence in the Middle East. Causes of errors are multifactorial and should be targeted in future interventions which are likely to be complex interventions at varying levels within the healthcare systems.
This project is funded by QNRF (NPRP project NPRP–388-3-095).
Misoprostol use in medical evacuation of spontaneous miscarriage: Pilot drug use evaluation study at the Women's Hospital in Qatar
Background: Misoprostol is a synthetic prostaglandin E1 that induces cervical effacement and uterine contractions at all gestational ages thus facilitating uterine evacuation and pregnancy termination. Successful medical evacuation of spontaneous miscarriage with minimal adverse effects can be performed using misoprostol-only regimen if given as indicated and if the administered dose frequency of the dosage and number of total doses are appropriate. Aim: To conduct a drug use evaluation by investigating indications appropriateness of dosing and clinical outcome of misoprostol-only regimen when used for medical evacuation of spontaneous miscarriage at the Women's Hospital in Doha Qatar. Materials and methods: A retrospective descriptive drug use evaluation was conducted on women with spontaneous miscarriage who received misoprostol for medical evacuation during August 2013. The current practice at the Women's Hospital was compared with the recommendation from the World Health Organization (WHO). Patients were stratified into three groups based on weeks of amenorrhea. Results: A total of 107 patients received misoprostol during August 2013 of which 33 (31%) were included in the study. In these patients the main indication for misoprostol use was missed miscarriage (54.5%). In the group of patients at ≤ 9 weeks of gestation 80% received an initial dose of 800 μg 80% received frequency within the WHO recommendation and the majority had surgical evacuation (80%). In the group of patients at 10–12 weeks of gestation more than 80% received an initial dose of 800 μg 6% received frequency within the WHO recommendation and more than 75% had successful medical evacuation. In the group of patients at 13–22 weeks of gestation more than 80% received an initial dose of 400 μg more than 80% received frequency within the WHO recommendation and 54% had successful medical evacuation. Overall more than 70% of the patients received ≤ 3 total doses of misoprostol and more than 60% had successful medical evacuation as a clinical outcome. Conclusions: Despite the current practice at the Women's Hospital not always being in accordance with the WHO recommendation successful medical evacuation was achieved in most patients.