What You Need To Know About Medication Errors!?

Why should we care about medication errors!?

Medication errors are a huge deal in any healthcare settings, in some situations it can lead to a lawsuit that settles with a sum of millions, or sometimes it can be a cause of patient death.

Medication errors are an avoidable event that can be anticipated, and most of the times actively prevented, when everyone is working by the international standards and the "hospital / healthcare organization" is forcing their policies to minimize ME.

For a healthcare worker, ME are to be learned from and our aim is to prevent future occurrences. Learning means identifying the cause and asking the involved individuals about what circumstances that lead to the error to happen. This leads to the preventing stage and measure to be taken to prevent ME in the future.

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Neonatal Use of Sodium Bicarbonate

Usual dosing

HCO3 needed (mEq) = 0.3 x Wt (kg) x base deficit (mEq/L)
Administer half of calculated dose, and then assess need for remainder

Usual dosage is 1 to 2 mEq/kg IV/IO slowly, with a max concentration of 0.5mEq/ml

Intravenous: Administer slow IV push. Rapid IV administration (10 mL/min) of hypertonic sodium bicarbonate may lead to serious consequences (hypernatremia, a decrease in CSF fluid pressure, and possible intracranial hemorrhage) in neonates and children younger than 2 years. MAX 8 mEq/kg/day The preferred concentration for slow IV administration in neonates is the 4.2% strength (0.5 mEq/mL). Other recommended pediatric concentrations for infusions are 0.25 mEq/mL and 1 mEq/mL.
Do not administer by the endotracheal route
Monitor ABGs, acid/base status, and serum calcium and potassium

Solution Compatibility: D5W, D10W, and NS.

References: Neofax

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Clinical characteristics of 140 patients infected with SARS‐CoV‐2 in Wuhan, China

"Detailed clinical investigation of 140 hospitalized COVID‐19 cases suggests eosinopenia together with lymphopenia may be a potential indicator for diagnosis. Allergic diseases, asthma, and COPD are not risk factors for SARS‐CoV‐2 infection. Older age, high number of comorbidities, and more prominent laboratory abnormalities were associated with severe patients."


Zhang, J‐J, Dong, X, Cao, Y‐Y, et al. Clinical characteristics of 140 patients infected with SARS‐CoV‐2 in Wuhan, China. Allergy. 2020; 00: 1– 12. https://doi.org/10.1111/all.14238

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Starting QM Department

When a hospital chooses to initiate its own quality department and not only hiring experts from outside; then it's raising the standard of healthcare service to the community and aims to offer/deliver competitive healthcare. It does so by applying the current medical practice, supported by advanced technology, state of the art facilities and skilled professionals. In addition, addition, the organization strives to deliver top tier healthcare grade in a safe and patient-centered environment.

The QM Plan and Programs are a collaborative effort made by every single member of the staffing power of the organization.

The design and program employ a systematic approach to quality / patient safety and address's coordination among all components of the organization's quality measurement and control activities.

The plan sets a strong emphasis about measurable safety and performance evaluation of the whole organization that exemplifies and provides services to patients and customers consistent with worldwide standards of excellence.

The aim of this department to support the implementation of the hospital Mission, Vision and Core Values and to enable the creation of an efficient, value driven organization dedicated to meet the needs and expectations of all its patients and customer.

~to be continued

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Potentials for Tetracyclines in the Treatment of COVID-19

Tetracyclines might be coming to help us to have some hope in a prophylaxis protocol for COVID-19. They work by Inhibition of bacterial protein synthesis by binding with the 30S and possibly the 50S ribosomal subunit of susceptible bacteria; they also cause alterations in the cytoplasmic membrane.

Tetracyclines are approved for treatment of
respiratory tract infections caused by Haemophilus influenzae (upper respiratory tract only),
Klebsiella spp. (lower respiratory tract only),
Mycoplasma pneumoniae (lower respiratory tract only),
Streptococcus pneumoniae, or Streptococcus pyogenes.

TETRACYCLINE

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Universal Masking in Hospitals in the Covid-19 Era

Introduction 

As the SARS-CoV-2 pandemic continues to explode, MOH systems are scrambling to intensify their measures for protecting patients and health care workers from the virus. This effort should include universal use of masks by all healthcare workers. In health care settings, First and foremost, a mask is a core component of the personal protective equipment (PPE), HCWs need when caring for symptomatic patients with respiratory viral infections, in conjunction with gown, gloves, and eye protection.

Rationale for Universal Masking Guidance: 

All HCWs working in inpatient units, ambulatory unit, and procedural areas (all clinical units) will be expected to wear surgical face masks, at all times, while in their respective clinical care settings. This universal mask approach will serve to:

  1. Protect patients and HCWs from exposure to infection from asymptomatic COVID-19 infected HCW (a mask achieves source control and decreases the risk of spreading infection)
  2. Protect healthcare workers caring undiagnosed asymptomatic COVID-19 infected patients or patients have mild COVID-19 infection that have not yet been recognized.

Universal Masking Guidance:

  • A single mask can be worn across different cases and between cares of different patients.
  • When providing care to a patient with known or suspected COVID-19 the mask should be removed and wear new one after hand hygiene.
  • Masks must be changed if they become wet or contaminated during a case.
  • Surgical mask is not allowed to be worn outside the clinical care areas.
  • Surgical mask is not allowed to be hanged around the neck or kept in the pocket.
  • Personnel working in nonclinical areas where persons are reliably separated by more than 1.5 meter should not wear masks and when walking through common clinical areas where care is delivered, the mask policy applies. Stop at an entry point prior to entering the clinical area to use surgical masks .These employees should practice principles of social distancing, respiratory etiquette and frequent hand hygiene.

Process to Use and Discard Surgical Mask 

  1. A surgical face mask will be used at the start of each shift, for those individuals working in clinical care units.
  2. Masks will be available at each entrance to the unit, and will be used throughout the shift.
  3. In the event that the mask becomes visibly soiled, wet or damaged, a new mask must be used.
  4. At the end of shift, HCWs will be asked to doff their face masks as they exit the unit. 
  5. Medical waste containers will be placed at each exit for the used masks to be discarded.

Implantation of This Guideline This guideline developed to be applied on the hospital/s that have COVID-19 or any other infectious respiratory disease outbreaks, implementation of this guideline should be under the authority of Regional Command and Control Centre (CCC) with guidance of General Directorate of Infection Prevention and Control (GDIPC).

References:

  1. Universal Masking in Hospitals in the Covid-19 Era, the New England Journal of Medicine, April 3, 2020.
  2. Rothe C, Schunk M, Sothmann P, et al.Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N Engl J Med 2020; 382: 970-1.
  3. Bai Y, Yao L, Wei T, et al. Presumed asymptomatic carrier transmission of COVID 19. JAMA 2020 February 21 (Epub ahead of print).
  4. Li R, Pei S, Chen B, et al. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2). Science 2020 March 16 (Epub ahead of print).
  5. Hoehl S, Rabenau H, Berger A, et al. Evidence of SARS-CoV-2 infection in returning travelers from Wuhan, China. N Engl J Med 2020; 382: 1278-80.
  6. Ng O-T, Marimuthu K, Chia P-Y, et al. SARS-CoV-2 infection among travelers returning from Wuhan, China. N Engl J Med. DOI: 10.1056/NEJMc2003100.

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COVID-19 Safety Guide for Hospital Healthcare Workers

The Saudi Patient Safety Center has launched the "COVID-19 Safety Guide for Hospital Healthcare Workers". The guide recommends Targeted Safe Practices to be applied in light of the Kingdom precautionary measures taken toward COVID-19. The information provided in this guide aims to assist healthcare professionals (healthcare employers/leaders, managers, healthcare practitioners, and healthcare practitioners in specialty areas) to maintain their safety as a   top priority, in addition to; recommendations about surge capacity concept in ICU.

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Dopaminergic Post

how dopamine works?

Dopamine works on both adrenergic and dopaminergic receptors, starting from lower dosing, as you go up effects on adrenergic receptors starts to predominate.

LOWER DOSES
Mainly dopaminergic, working on renal and mesenteric vasodilation

HIGHER DOSES
Same as lower doses, but with beta1-adrenergic action and produce cardiac stimulation; larger doses stimulate alpha receptors

DOSE (ADULT)

ACTION

Low dose
1 to 5 mcg/kg/minute

increased renal blood flow and urine output

Intermediate dose
5 to 10 mcg/kg/minute

same as lower dosing + increased heart rate, cardiac output and contractility

High dose
10 mcg/kg/minute

same as intermediate dosing + vasoconstriction thus increased blood pressure

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Understanding Ketogenic Nutrition Support For Cancer Patients

Ketogenic nutrition support terminology  either parenteral nutrition or enteral feedings concept  is applied to  patients with intractable seizure and some cases in inborn error of metabolism like carbohydrate disorder metabolism and characterized by high fat, low carbohydrate, and maintenance protein contents.

The goal of nutrition support in cancer patients is to minimize wasting but not for ideally nutrition repletion and gaining weight.

Furthermore, the goal of nutrition support in a patient with cancer (adult) maintenance support which is between 23- 25 Kcal/kg/day, not anabolic support as theoretically high calories providing may feed cancer cells as stated in some studies.

The idea behind ketogenic diets is relatively simple. If glucose is the primary fuel for cancer, then lower carbohydrate intake and replace carbohydrates with other sources of fuel, such as fats, in order to push the body’s metabolism into ketosis.

Preclinical and case report studies indicated that the restricted ketogenic diet can be an effective “metabolic therapy” for managing malignant cancer in children and adults.

Addition of Carnitine should be considered along with a high-fat or ketogenic PN solution. Carnitine is a nonessential amino acid that facilitates the transport of fatty acids from long-chain fats into the mitochondria. It is also essential in certain conditions, such as liver disease, trauma, sepsis, and organ failure, and is advised when the major source of calories are derived from fat.

Selenium is an essential trace mineral that is generally included in PN solutions when used longer than four weeks.

I hope this helps.

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Should A Pharmacist Holds PN During Blood Transfusion

The practice of holding Parenteral Nutrition during blood transfusion is to avoid fluid load in short time that may affect cardiopulmonary system.

The average of blood transfusion is between 1 to 4 hrs depending on the number of units. Except platelets that may take just less than one hour. In case of blood transfusion, you have to taper PN rate by half for at least one hour depends on the dextrose concentration in PN. ( no need if patient receiving peripheral PN)

Furthermore, you may recommend fingerstick at the mid of blood transfusion. Regarding, IV lipids you may advise the nurse to commence I.V. lipids after blood transfusion is completed.

So to make it simpler:

  1. Make sure not to infuse Lipid and PN through the same line as Blood; Using the same line of PN and Blood is an absolute contraindication and might cause Blood Dyscrasias.
  2. There is no absolute contraindication of infusing blood with the same time with PN and Lipids using different lumen unless if the patient is fluid overloaded.
  3. Most patients can tolerate the low infusion rate of lipid same time with Blood transfusion; however, most clinicians don’t favor discontinuation and manipulation of lipid.
  4. If the patient is at risk of fluid overload, then hold PN; hold lipid and resume after blood transfusion.
  5. If you know the time of blood transfusion in advance, try to start lipid after completion of blood transfusion. So you avoid holding and restarting.

Hope this helps.

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