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Introduction: The use of extracorporeal membrane oxygenation (ECMO) in the post-operative cardiac critical care setting is evolving. Anticoagulation monitoring is among the most challenging aspects of pediatrics. However, there is no consensus on the optimal dosing and monitoring of unfractionated heparin in this setting. To address this, we developed an anti-Xa assay-based protocol derived from the best available clinical and anecdotal evidence of use in ECMO therapy. Objective: To assess the performance of the protocol in achieving the anti-Xa assay therapeutic target. Methods: This prospective single-arm study was conducted in the Pediatric Cardiac Surgical Intensive Care Unit at a large tertiary hospital. We used two different anti-Xa assay intensity levels based on the patient’s bleeding status. Results: The median age was seven months (interquartile range [IQR]: 5–11.25), and the median weight was 5.7 kg (IQR: 3.8–13.82). The median ECMO duration was six days (IQR: 4.5–7.5). The bleeding protocol was used for most of the patients. Seventy percent achieved the anti-Xa assay therapeutic target during the study period (median: 75.5 hours; IQR: 60.5–117.5). Hemorrhagic complications were reported in 40 percent of the patients and thrombotic complications in 25 percent. The median hospital length of stay was 37 days (IQR: 22–43), with a discharge survival rate of 75 percent. Conclusion and Relevance: Despite a failure to achieve the anti-Xa assay target in the first ECMO days, most of our patients achieved the target by the median ECMO duration. Moreover, using two different anti-Xa assay levels reduced thrombotic complications in pediatrics.

Purpose: To explore National Survey of Pharmacy Practice at MOH hospitals in Saudi Arabia 2016-2017: Preparation of medications and Dispensing. Methods: It is a 4-months cross-sectional National Survey of Pharmacy Practice at MOH hospitals in Saudi Arabia. The study consisted of two parts; the demographic information and the second part contained eighty-five questions divided into nine domains drove from American Society of Health-System Pharmacists (ASHP) and Saudi Pharmaceutical Society (SPS) survey, the international standard of Joint Commission of Hospital Accreditation. An electronic questionnaire was distributed to 185 directors of pharmacies at MOH hospitals. The study discussed and analyzed National Survey of Pharmacy Practice at MOH hospitals in Saudi Arabia 2016: Preparation of medications and Dispensing. All analysis is done through survey monkey system. Results: The survey was carried out in 185 hospitals, the rate of reply was 105 (56.75%). The pharmacy services were the drug distribution unit dose 36 (34.3%), repacking operation system 15 (14.3% %), an extemporaneous preparation 22 (21 %), and Intravenous admixture 8 (7.6%) only. The drug distribution by unit dose commonly not existed at the hospital less than 100 beds size 18 (17.14). The Intravenous admixture commonly found at 200-400 beds hospitals 6 (5.7%). The hospital home infusion therapy provided from six (5.7%) hospital pharmacies only. The most outpatient prescriptions dispensed to hospital employees 69 (65.7%) hospital clinic or patients discharged or emergency room 63 (60 %), general public 58 (55.2%), and home healthcare services 31 (29.5%). The most system founded to assure the accuracy of preparations and dispensing. One pharmacist check drug order before dispensing 48 (45.7%), and two pharmacists review high-risk drugs 28 (26.7%) at all type of hospitals bed size. Conclusion: The essential elements of pharmacy, the cost, and improve outcomes associated with drug therapy care of patients as a member of the multidisciplinary care team. [5,6,7] To Provide PC; pharmacists should supply the knowledge of clinical pharmacy and best skills.[7] In Saudi Arabia, PC practice is still improving. In a study of Al-Arifi et al. showed that practice was weak at MOH hospitals. Annual survey of pharmacy services with improving drug distribution system prevent drug-related problem and improve patient care at Hospitals in Saudi Arabia.

Objective: To explore National Survey of Pharmacy Practice at MOH hospitals in Saudi Arabia 2016: drug monitoring and patient’s education. Methods: It is a 4-months cross-sectional National Survey of Pharmacy Practice at MOH hospitals in Saudi Arabia. The study consisted of two parts; the demographic information and the second part contained eighty-five questions divided into nine domains drove from American Society of Health-System Pharmacists (ASHP) and Saudi Pharmaceutical Society (SPS) survey, the international standard of Joint Commission of Hospital Accreditation in addition to the local standards of Saudi Center of healthcare accreditation.[1-7] The parts were pharmacy management and resources, prescribing and medication control, preparation of medications and dispensing, Computerized and pharmacy technology, clinical pharmacy services, drug monitoring and patient’s education, Pharmacy inventory control and stock management, Pharmacy education and training, pharmacy total quality management and drug information services. An electronic questionnaire distributed to the one hundred eighty-five directors of pharmacies at MOH hospitals. The study discussed and analyzed National Survey of Pharmacy Practice at MOH hospitals in Saudi Arabia: the drug monitoring and patient’s education. All analyses are done through survey monkey system. Results: The survey questionnaire was distributed to 185 hospitals; the rate of reply was 105 (56.75%). The most type of drug monitoring reporting existed at hospitals was medication error monitoring 80 (80%) followed by patient counseling reporting 72 (79.12%) and drug information inquires 69 (73.4%). The highest type of drug monitoring was patient education reporting (720,000) annually, followed by pharmacist intervention (468,000) annually and a number of prevented medication error per year was (453,600). The most drug monitoring of clinical impact and cost avoidance in the neonates, pediatrics, adults, and geriatrics patients was poisoning information inquiries 59 (56.56%) followed by the pharmacist intervention 52 (57.61%), and drug information inquires 53 (57.61%). The pharmacy patient education given through outpatient services 86 (81.9% and at the bedside during Hospital stay 19 (24.8%) The most Patient Education program 53 (50.5%) covered less than 50% of the bed. The most hospital pharmacies shared in national diabetic world day 62 (59.0%) and national asthma day 30 (28.6%). Conclusion: The pharmacist had the active role in drug monitoring and patient counseling. Expanding the pharmacy services with regular documentation is highly recommended to improve the quality of the services and patient healthcare outcomes. Key word: Drug monitoring, Patients education, Ministry of Health, Saudi Arabia.

Purpose: To explore National Survey of Pharmacy Practice at MOH hospitals in Saudi Arabia 2016-2017: Preparation of medications and Dispensing. Methods: It is a 4-months cross-sectional National Survey of Pharmacy Practice at MOH hospitals in Saudi Arabia. The study consisted of two parts; the demographic information and the second part contained eighty-five questions divided into nine domains drove from American Society of Health-System Pharmacists (ASHP) and Saudi Pharmaceutical Society (SPS) survey, the international standard of Joint Commission of Hospital Accreditation. In addition to the local standards of Saudi Center of healthcare accreditation. The parts were pharmacy management and resources, prescribing and medication control, preparation of medications and dispensing, Computerized pharmacy technology, clinical pharmacy services, drug monitoring, patient’s education, Pharmacy inventory control and stock management, Pharmacy education and training, and pharmacy total quality management and drug information services. An electronic questionnaire distributed to the 185 directors of pharmacies at MOH hospitals. The study discussed and analyzed National Survey of Pharmacy Practice at MOH hospitals in Saudi Arabia 2016: Preparation of medications and Dispensing. All analysis is done through survey monkey system. Results: The survey was carried out in 185 hospitals, the rate of reply, was 105 (56.75%). The pharmacy services were the drug distribution unit dose 36 (34.3%), repacking operation system 15 (14.3% %), an extemporaneous preparation 22 (21 %), and Intravenous admixture 8 (7.6%) only. The drug distribution by unit dose commonly not existed at the hospital less than 100 beds size 18 (17.14). The Intravenous admixture commonly found at 200-400 beds hospitals 6 (5.7%). The hospital home infusion therapy provided from six (5.7%) hospital pharmacies only. The most outpatient prescriptions dispensed to hospital employees 69 (65.7%) hospital clinic or patients discharged or emergency room 63 (60 %), public 58 (55.2%), and home healthcare services 31 (29.5%). The most system founded to assure the accuracy of preparations and dispensing. One pharmacist checks drug order before dispensing 48 (45.7%), and two pharmacists review high-risk drugs 28 (26.7%) at all type of hospitals bed size. Conclusion: The essential elements of pharmacy the costs, and improve the outcomes associated with drug therapy care of patients as a member of the multidisciplinary care team(5) (6)(7). To Provide PC; pharmacists should supply the knowledge of clinical pharmacy and best skills(7). In Saudi Arabia, PC practice is still improving. In a study of Al-Arifi et al. showed that practice was weak at MOH hospitals. Annual survey of pharmacy services with improving drug distribution system prevent drug-related problem and improve patient care at Hospitals in Saudi Arabia. Key words: Pharmacy Practice, Clinical Pharmacy, Ministry of Health, Saudi Arabia.

Objective: To explore National Survey of Pharmacy Practice at MOH hospitals in Saudi Arabia 2016: Prescribing and medication management. Methods: It is a 4-months cross-sectional National Survey of Pharmacy Practice at MOH hospitals in Saudi Arabia. The study consisted of two parts; the demographic information and the second part contained eighty-five questions divided into eight domains drove from American Society of Health-System Pharmacists (ASHP), Saudi Pharmaceutical Society (SPS) survey, and the international standard of Joint Commission of Hospital Accreditation. The 5-point Likert response scale system was used with closed and ended questions. An electronic questionnaire was distributed to the one hundred eighty-five directors of pharmacies at MOH hospitals. The study discussed and analyzed National Survey of Pharmacy Practice at MOH hospitals in Saudi Arabia: the prescribing and medication management. Results: The survey questionnaire distributed to 185 of hospitals, the rate of reply, was 105 (56.75%) hospitals. The highest score of committee shared by the hospital pharmacy was the pharmacy and therapeutics committee (4.33), quality management committee (4.06), infection control committee (3.88), while the lowest scores were Anticoagulation committee (2.14), DUE committee (2.16) and IV therapy committee (1.99). The most therapeutic guideline available in the hospital pharmacies were antibiotics guidelines (2.91) followed by infection control (2.84) and anticoagulation guidelines (2.13). The majority formulary management method used was restricted prescribing certain expensive drugs 33 (33.1%), review of non-formulary drugs prior approval 27 (25.7%), and the closed drug formulary 14(13.3%). The most drug utilization activities used at the hospitals were Used as the basis for revision of drug-use policies and procedures 44 (41.9%) and Incorporated into medical staff credentialing considerations 27 (25.7%) The pharmacist has the privilege to write medication orders were 18 (17.1%) only. The pharmacist commonly prescribed over the counter medications 19 (57.6%) and antibiotics 15 (45.5%) through the prescription cosigned by physician 55 (52.4%). Followed by Drugs under prescribing protocol 39 (37.1%) and Medications Refill Clinic 26 (24.8%). Conclusion: The hospital seldom participated in the therapeutic guidelines, and the few pharmacists shared in essential hospital committees despite the unique role of providing medication information. Expanding pharmacy activities will improve the prescribing system, patient clinical outcomes, and prevent drug misadventures. Key word: Prescribing, Medication management, Ministry of health, Saudi arabia.