Background The presence of a clinical pharmacist in a hospital's Emergency Department (ED) is important to decrease the potential for medication errors. To our knowledge, no previous studies have been conducted to evaluate the impact of implementing clinical pharmacy services in the ED in Qatar. Objective To characterize the contributions of clinical pharmacists in a short stay unit of ED in order to implement and scale-up the service to all ED areas in the future. Methods A retrospective study conducted for 7 months in the ED of Hamad General Hospital, Qatar. The intervention recommendations were made by clinical pharmacists to the physician in charge during medical rounds. Results A total of 824 documented pharmacist recommendations were analyzed. The interventions included the following: Providing information to the physician (24.4 %) and recommending medication discontinuation (22.0 %), dose adjustment (19.3 %), medication addition (16.0 %), changes in frequency of medications (7.6 %), medication resumption (5.7 %), and patient education (5.0 %). Conclusion Clinical pharmacists in the ED studied play an important role in patient care.
Patient: Female, 40Final Diagnosis: Dexmedetomidine withdrawalSymptoms: Severe agitation • sweating • tachycardiaMedication: —Clinical Procedure: NoneSpecialty: Critical Care MedicineObjective:Unusual or unexpected effect of treatmentBackground:Dexmedetomidine is a sedating agent approved for use in non-intubated patients and procedural sedation due to its efficacy in conscious sedation and minimal risks of respiratory depression. Previous reports proved the effectiveness of clonidine in treatment of withdrawal symptoms, but none have discussed cases with coexisting non-controlled psychiatric illness and prolonged duration of dexmedetomidine exposure.Case Report:We report a case of a 40-year-old woman diagnosed with viral meningitis. Due to her complicated psychiatric illness and viral meningitis, she developed severe agitation unresponsive to standard therapy. The patient had to be placed on dexmedetomidine, to which she developed dependence. There were several attempts to gradually withdraw dexmedetomidine but these were unsuccessful despite adding multiple antipsychotic medications. Withdrawal was manifested in multiple symptoms, including severe agitation, sweating, and tachycardia. Clonidine was used and was an effective treatment option to successfully withdraw the patient from dexmedetomidine. A smaller initial dose was used due to low baseline systolic blood pressure, which was successful.Conclusions:This report proves that clonidine is an effective option for treatment of dexmedetomidine dependence compared to other antipsychotic agents. The present report is the first to discuss severe psychiatric illness and prolonged dexmedetomidine duration (>7 days) in a non-intubated patient. Dexmedetomidine withdrawal must be considered in the differential diagnosis of patients with psychiatric illness, which can be easily treated with clonidine.
Background Medication errors (MEs) are defined as any errors occurring in the process of using a medicine, regardless of whether an injury occurred or the potential for injury was present (near miss). Traditional error reporting systems have limited success due to the time involved in reporting, complicated processes, inadequately friendly user interfaces and the use of paper-based reporting. We explored the effect of a new integrated reporting process by making the error reporting link within a clinical pharmacist intervention documentation program. The result could improve reporting rates and details for accurate internal quality review and improve medicines use systems. Purpose To examine medication error reporting rates, types of error and staff involvement in reporting through the new electronic system, which is integrated into a clinical pharmacy intervention program and to compare the outcome with the previous paper-based system. Materials and methods Interventional study comparing paper-based reporting at baseline (6 months preceding the intervention, June–November 2012) with reporting after the electronic system was introduced (December 2012–May 2013). Error reporting functionality was made by asking the key question ‘Did this intervention detect/correct an error?’. If yes, the error was categorised according to National Coordinating Council for Medication Error Reporting and Prevention index (response range from A to I). Results Baseline ME reporting created 12 reports (9 category D and 3 E) initiated by 25% of the clinical pharmacy staff. 6 months after introducing the electronic link, the number had risen to 377 reports initiated by 78% of clinical pharmacy staff (reports were 118 near misses (category A&B), 196 C, 42 D, 10 E, 10 F and 1 H). Conclusions By using a streamlined interface design, we were successfully able to improve reporting rates, details of MEs and staff involvement in this setting. The resultant system was encouraging and reflects error reporting more accurately, which will allow us to understand the factors contributing to these errors and to establish prevention strategies. No conflict of interest.
Objective Compare efficacy and safety of liraglutide (1.8 mg subcutaneous once daily) and exenatide (10 mcg subcutaneous twice daily) in uncontrolled type 2 diabetes at 26 and 52 weeks. Method A retrospective observation study of uncontrolled type 2 diabetes patients who took liraglutide or exenatide in addition to their anti‐diabetic medications. This study was conducted at Hamad Medical Corporation, the predominant public healthcare organization in Qatar. The primary outcome was the change in haemoglobin A1C (HbA1C) after 26 and 52 weeks. Key finding Two hundred and two patients were included in this study (liraglutide 98, exenatide 114). There was no significant HbA1C change observed between two groups at either 26 or 52 weeks (P = 0.23 and 0.40 respectively). However, more patients in the liraglutide group achieved HbA1C ≤7% at week 26. Liraglutide reduced the mean Fasting blood glucose (FBG) more than exenatide at week 26 and 52. Although both medications were associated with some benefits in other studied variables at a certain point (e.g. weight losses, blood pressure), neither of them were able to show a significant change from baseline. No patients in either group reported drug‐related side effects (e.g. nausea and vomiting) or episodes of hypoglycaemia during the treatment period. Conclusions Exenatide and liraglutide resulted in similar glycaemic effects (HbA1C and fasting plasma glucose changes) in patients with type 2 diabetes who were sub‐optimally controlled with other anti‐diabetic therapy. However, this study supports the effectiveness of both medications for weight reduction at both endpoints. A prospective large‐scale study is recommended to overcome the study limitations.
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