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Background: The provision of information by pharmacy staff is a key factor to ensure patients’ understanding and quality use of medications, including antibiotics. However, little is known regarding the transmission of information between pharmacy staff and patients in Indonesia. Objective: This study aimed to identify information on antibiotics provided by pharmacy staff and recalled by patients in an Indonesian outpatient setting. Methods: The study was conducted in a hospital outpatient clinic in Malang, Indonesia, in 2019. A checklist was used to obtain the data on information provided by pharmacy staff, while interviews were conducted to determine information recalled by patients (only presenting patients were included); a total of 15 information items - i.e. 14 essential and one secondary - were observed. Descriptive analysis was used to summarise data on the checklists (‘given’ versus ‘not given’) as well as responses from the interviews (‘recalled’ versus ‘missed’). Results: Eleven pharmacy staff (two pharmacists and nine pharmacy technicians) were involved in providing information for patients obtaining oral antibiotics during the study period. Of 14 essential information items, only about half was given by pharmacy staff, with pharmacists significantly providing on average more information items than pharmacy technicians (7.96 versus 7.67 respectively; p90%) included “antibiotic identification”, “indication”, administration directions (i.e. “dosage”, “frequency”, “hour of administration”, “administration before/after meal”, “route of administration”), and “duration of use”. A total of 230 patients consented to the study, giving 79.9% response rate. The average number of information items recalled by patients was 7.09 (SD 1.45). Almost all patients could recall information on administration directions [i.e. “route of administration” (97.0%), “frequency” (95.2%), “dosage” (92.6%), “hour of administration” (85.7%), “administration before/after meal” (89.1%)] and “duration of use” (90.9%). Fewer patients were able to recall “antibiotic identification” (76.5%) and “indication” (77.0%). Conclusions: Pharmacy staff provided antibiotic information in a limited fashion, while patients showed adequate ability to recall the information given to them. Further study is needed to better understand the effective process of information transmission between pharmacy staff and patients, especially if more information was provided, to better optimise the use of antibiotics in outpatient settings in Indonesia.

Background: Based on a retrospective study performed at our institution, 38% of inpatients living with human immunodeficiency virus (HIV) were found to have a medication error involving their anti-retroviral (ARV) and/or opportunistic infection (OI) prophylaxis medications. Objective: To determine the impact of a dedicated HIV-trained clinical pharmacist on the ARV and OI prophylaxis medication error rates at our institution. Methods: A prospective quality improvement project was conducted over a six month period to assess the impact of a dedicated HIV-trained clinical pharmacist on the ARV and OI prophylaxis medication error rates. IRB approval received. Results: There were 144 patients included in this analysis, who experienced a combined 76 medication errors. Compared to historical control study conducted at our institution, the percent of patients who experienced a medication error remained stable (38% vs. 39%, respectively) and the error rate per patient was similar (1.44 vs. 1.36, p=NS). The percent of medication errors that were corrected prior to discharge increased from 24% to 70% and the median time to error correction decreased from 42 hours to 11.5 hours (p

Objective: The objectives of this study were to evaluate the current practice of postoperative fluid prescribing and assess the effectiveness of pharmacist-led intervention in the implementation of the National Institute of Health and Care Excellence (NICE) fluid therapy guideline in an Iraqi hospital. Methods: The prospective interventional study was conducted at AL-Hilla Teaching Hospital, Babylon, Iraq between November 2017 and July 2018. The study included two phases: The pre-intervention phase with 84 patients and the post-intervention phase with 112 patients. A pharmacist provided training and educational sessions for the hospital physicians and pharmacists about the NICE guideline of fluid therapy. The researcher calculated the amount of given post-operative fluids and compared to the NICE guideline and also measured the patients’ body weight, serum Na, K and creatinine pre-and post-operatively. Results: The pre-intervention phase showed no correlation between the amounts of prescribed fluids and body weight which caused increases in patients’ body weight. In pre-intervention phase, 6% of patients experienced hyponatremia, 19% had hypernatremia and 7.1% had hypokalemia. In the post-intervention phase, abnormal level of electrolytes and patient weight gain decreased significantly. Additionally, the intervention led to a strong correlation between body weight and amount of prescribed fluids in addition to lowering the incidence of electrolyte disturbances. Conclusions: A high proportion of patients in the pre-intervention phase experienced fluid overload, weight gain and electrolyte disturbances when fluid therapy was not prescribed in accordance with the NICE guidelines. The pharmacist-led intervention increased the surgeon awareness of the proper use of the NICE guideline which decreased the incidence of fluid-related complications and the inconsistency of fluid prescribing. Pharmacists can play a critical role to enhance post-operative fluid prescribing and minimize fluid-induced complications.

Background: Patients requiring medications during discharge are at risk of discharge medication errors that potentially cause readmission due to medication-related events. Objective: The objective of this study was to develop interventions to reduce percentage of patients with one or more medication errors during discharge. Methods: A pharmacist-led quality improvement (QI) program over 6 months was conducted in medical wards at a tertiary public hospital. Percentage of patients discharge with one or more medication errors was reviewed in the pre-intervention and four main improvements were developed: increase the ratio of pharmacist to patient, prioritize discharge prescription order within office hours, complete discharge medication reconciliation by ward pharmacist, set up a Centralized Discharge Medication Pre-packing Unit. Percentage of patients with one or more medication errors in both pre- and post-intervention phase were monitored using process control chart. Results: With the implementation of the QI program, the percentage of patients with one or more medication errors during discharge that were corrected by pharmacists significantly increased from 77.6% to 95.9% (p

Background: There is a dearth of literature on perceptions of preparedness to practise, which explores the extent to which educational institutions prepare their students to fulfil their professional role. Objective: The aim of this study was to explore perceptions of preparedness to practise among Saudi Arabian pharmacy graduates working in hospital. Method: Face-to-face, semi-structured interviews were conducted with ten hospital pharmacists based in four hospitals in the Eastern Province of Saudi Arabia who had qualified within the last five years from a Saudi Arabian School of Pharmacy. Interviews focused on expectations of hospital practise, perceptions of preparedness and challenges encountered, and reflections on how to better prepare students. Interviews were audio-recorded, transcribed and analysed thematically by two independent researchers using the Framework Approach. Results: Five key themes were identified: expectations versus reality of practise; issues relating to university course; practice related training; adapting to the work environment; and proposed improvements to undergraduate education. Participants were generally disappointed to find practise was not as expected. University training was largely didactic, with skills such as critical thinking not being sufficiently developed. Where practice related training was provided, it was variable in length and content. Cultural issues, most notably working in a mixed sex environment, were also considered to impact preparedness. Suggested improvements included greater focus on skills development and structured training placements. Conclusions: Participants experiences in university, and experiential placements varied greatly and were perceived to impact greatly on preparedness to practise. Further multiple perspective exploration of perceptions of preparedness to practise is warranted.

Background: Currently, clinical pharmacists have in-depth therapeutic knowledge and scientific skills to act as drug therapy experts in healthcare settings. Objective: The aim of this study was to assess the opportunities and challenges of clinical pharmacy services from the health practitioners’ perspective in University of Gondar (UOG) hospital Ethiopia. Methods: A qualitative study was performed using face-to-face in-depth interviews with health practitioners who were directly involved in clinical pharmacy services (clinical pharmacists, physicians, and nurses) in UOG hospital. Results: A total of 15 health professionals from various specialties were interviewed to express their views towards clinical pharmacists’ competencies and identified challenges and opportunities regarding their clinical services. Based on interviewees report, the opportunities for clinical pharmacists includes acceptance of their clinical services among health specialties, new government policy and high patient load in hospital. However, inadequacy of service promotions, lack of continuity of clinical pharmacy services in wards, poor drug information services, lack of commitment, lack of confidence among clinical pharmacists, conflict of interest due to unclear scope of practice, and absence of cooperation with health workers were some of the challenges identified by the interviewees. Conclusion: We identified health professionals working in UOG hospital are receptive towards clinical pharmacy services, but identified some of the potential challenges that needed to be focused to strengthen and promote clinical pharmacy services. Further, the opportunities at hand also need to be utilized astutely to boost the services.

Background: Drug and Therapeutics Committees (DTCs) were founded about a century ago as a guide for dealing with drugs in hospitals. Since then, it has shown a vital role in rational drug use in terms of regulatory and educational activities. Objective: To describe structures, functions, and activities of hospital DTCs. Methods: A questionnaire was developed based on previous studies. Questions consisted of information on respondents’ demographics; structures, functions, and activities of DTCs; drug selection process and resources used, and factors and criteria used in drug selection. Results: The overall response rate was 95%. DTCs were mainly present in most large hospitals (45%). All DTCs had hospital pharmacists in their structure and most of them (66%) met monthly. The main responsibilities of DTCs were related to general prescribing policies. The number, frequency, and severity of adverse drug reactions were the most reported criteria for the drug selection process. Legal implications for practical, economic, and organizational factors were the most important factors that were reported for drug selection. Conclusions: DTCs are mainly present in most large hospitals. The main responsibilities of the DTC in Jordanian hospitals are general prescribing policies, drug selection, hospital formulary editing, and reporting of ADR to external authorities.

Background: Inappropriate use of antimicrobial agents is one of the most important factors in inducing resistance and prolonged hospitalization as well as increase in patient mortality rate. Objective: The aim of this study was to evaluate aminoglycosides (AGs) usage pattern at intensive care units (ICUs) of Nemazee hospital Shiraz, Iran. Methods: In this cross-sectional study, the usage pattern of AGs was evaluated during 32 months. Guidelines for AGs usage were approved by the drug and therapeutic committee of the hospital, and criteria were developed to assess 11 parameters involving AGs therapy, such as proper indication for the use of the drug, dosage and duration of therapy. Clinical parameters, such as microbial culture and sensitivity, serum creatinine (SCr) and creatinine clearance, and white blood cell count were evaluated. Results: Ninety-five patients were recruited, 50 male and 45 females. In most patients (64%) the origin of infection was hospital and only in 36% of them, community was the source. Ventilator associated pneumonia (27%), central nervous system (25%) and urinary tract infection (10%) were the most important indications for AGs prescription. Scores of AGs usage at Nemazee hospital was calculated as 5.9 out of 11, which meant that in only 54% of cases AGs prescription was based on guideline proposed by the Department of Clinical Pharmacy of Nemazee Hospital. Conclusions: Non-adherence to the guidelines occurred frequently in the ICUs of Nemazee hospital. Prescription of loading dose, and AGs level measurement were not done and evaluating microbiological data was often neglected. Incorporating pharmacists in the health care team and holding training programs for physicians and nurses with the goal of raising awareness about the proposed guideline.

Background: Pharmacist involvement has been shown to improve various aspects of patient care. Patients undergoing knee and hip replacement surgery generally experience post-operative pain and discomfort. Pain control can impact patient satisfaction, as reported by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Objective: The current pilot study aims to measure the potential impact that incorporating pharmacists into preoperative patient education programs has on the response to select HCAHPS questions. Methods: Patient responses to two select HCAHPS questions related to pain were recorded for a year prior to pharmacist involvement in a comprehensive preoperative patient education program (2012) and a year after pharmacists became actively involved (2013). Results: In all reporting surgical patients, there was a modest 3.68% improvement in mean scores reflecting patient’s feelings that hospital staff did “everything they could” to attend to their pain (mean2012=3.66, SD=0.63 versus mean2013=3.80, SD=0.43, p=0.018, Mann-Whitney U test). There was a non-significant 2.98% improvement in scores reflecting the level that pain was “well controlled” (mean2012=3.54, SD=0.651 versus mean2013=3.65, SD=0.554, p=0.069, Mann-Whitney U test) in surgical patients. Conclusion: The results suggest comprehensive pharmacist involvement in patient education prior to joint replacement surgery may impact HCAHPS scores related to pain control. While the observed potential improvements were modest, the current results justify larger, multi-institution prospective studies to better elucidate the impact pharmacists can have on pain management in patients undergoing joint replacement.

Background: Early intravenous to oral (IV-PO) antibiotics switch, which is one of the important elements in antimicrobial stewardship (AMS) is not well implemented in Malaysian district hospitals. A systematic interventional strategy is required to facilitate IV-PO antibiotic switch. Objective: This study aimed to evaluate the impact of printed AMS recommendations on early IV-PO antibiotics switch practice in district hospitals. Methods: This study was an interventional study conducted in medical wards of eight Sarawak district hospitals from May to August 2015. In pre-intervention phase, pharmacists performed the conventional practice of reviewing medication charts and verbally informed the prescribers on eligible IV-PO switches. In post-intervention phase, pharmacists attached printed checklist which contained IV-PO switch criteria to patients’ medical notes on the day patients were eligible for the switch. Stickers of IV-PO switch were applied to the antibiotic prescription to serve as reminders. Results: 79 and 77 courses of antibiotics were studied in the pre-intervention phase and post-intervention phase respectively. Timeliness of switch was improved by 1.63 days in the post-intervention phase (95%CI 1.26:2.00 days, p