Audit of intravenous antifungal therapy used for Candida infections at a South African private hospital
- Authors: Van Dyk, Jacklyn Kate
- Date: 2020
- Subjects: Candidiasis
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/46380 , vital:39600
- Description: The epidemiological landscape of the candida species has changed with the emergence of MDR strains globally and in South Africa. The aim of this study was to critically evaluate the compliance to guidelines in the use of intravenous antifungal therapy when treating invasive Candidainfections in a South African private hospital.Objective One was to determine the prevalence of Candida auris(C.auris) in the sample. Objective Two examined the relationship between high-risk patients and positive microbiological cultures. Objective Three studied the prescribing utilisation of the intravenous antifungalsin the form of a clinical audit. Objective Four compared these prescribing patternsto current guidelines by evaluating whether the antifungal course was non-compliant, of suboptimal compliance or compliant. Objective Five was to design a protocol for ward pharmacists to use when assessing antifungal treatment for candidiasis. The research design consisted of a retrospective, non-experimental, cross-sectional analysis of intravenous antifungal use in the management of systemic Candida infections in a private sector hospital in the Gauteng province, South Africa.A positive research paradigm with a quantitative clinical audit was used in this study. The most prevalent species cultured was C.auris with 31 of the 77 positive cultures. Risk stratifying patients was validated with 70% of high risk patients (Candida Score >2.5 and positive β-D-glucan) having a corresponding positive culture. Echinocandins were the most frequently utilised antifungal class, with caspofungin being the most used antifungal in the sample. The average duration of therapy for the echinocandins ranged between 11 and 16 days. Compliance to guidelines was evaluated accordingto: reason for initiation; drug choice and drug dose. Three levels of compliance were determined: non-compliant, sub-optimal compliance and compliant. xivThe overall compliance,according to recommended treatment guidelines,was found to be suboptimal, with anidentified need foranintervention which targets thedosing of the antifungals used. In conclusion, the research findings highlight the importance of reviewing antifungal prescribing habits and the need for antifungal stewardship programmes.
- Full Text:
- Date Issued: 2020
- Authors: Van Dyk, Jacklyn Kate
- Date: 2020
- Subjects: Candidiasis
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/46380 , vital:39600
- Description: The epidemiological landscape of the candida species has changed with the emergence of MDR strains globally and in South Africa. The aim of this study was to critically evaluate the compliance to guidelines in the use of intravenous antifungal therapy when treating invasive Candidainfections in a South African private hospital.Objective One was to determine the prevalence of Candida auris(C.auris) in the sample. Objective Two examined the relationship between high-risk patients and positive microbiological cultures. Objective Three studied the prescribing utilisation of the intravenous antifungalsin the form of a clinical audit. Objective Four compared these prescribing patternsto current guidelines by evaluating whether the antifungal course was non-compliant, of suboptimal compliance or compliant. Objective Five was to design a protocol for ward pharmacists to use when assessing antifungal treatment for candidiasis. The research design consisted of a retrospective, non-experimental, cross-sectional analysis of intravenous antifungal use in the management of systemic Candida infections in a private sector hospital in the Gauteng province, South Africa.A positive research paradigm with a quantitative clinical audit was used in this study. The most prevalent species cultured was C.auris with 31 of the 77 positive cultures. Risk stratifying patients was validated with 70% of high risk patients (Candida Score >2.5 and positive β-D-glucan) having a corresponding positive culture. Echinocandins were the most frequently utilised antifungal class, with caspofungin being the most used antifungal in the sample. The average duration of therapy for the echinocandins ranged between 11 and 16 days. Compliance to guidelines was evaluated accordingto: reason for initiation; drug choice and drug dose. Three levels of compliance were determined: non-compliant, sub-optimal compliance and compliant. xivThe overall compliance,according to recommended treatment guidelines,was found to be suboptimal, with anidentified need foranintervention which targets thedosing of the antifungals used. In conclusion, the research findings highlight the importance of reviewing antifungal prescribing habits and the need for antifungal stewardship programmes.
- Full Text:
- Date Issued: 2020
Compliance with good distribution practice guidelines for cold chain products among pharmaceutical wholesalers in South Africa
- Authors: Masebe, Zandisile
- Date: 2020
- Subjects: Pharmaceutical industry
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/46390 , vital:39581
- Description: Background: The South African pharmaceutical cold chain distribution industry is highly regulated. Cold chain pharmaceutical products require storage in a cold room, in a temperature-controlled environment between (2°C-8°C) and the cold chain must be maintained at all times throughout the distribution process. The incorrect handling, storage, transport and distribution of cold chain products may reduce the potency and therapeutic effectiveness of the product which in turn may result in treatment failure. The research was aimed at determining the level of compliance to current Good Distribution Practice guidelines for cold chain products among pharmaceutical wholesalers and distributors in South Africa. Methodology: The study made use of quantitative research techniques. A purpose designed online questionnaire was used as a data collection tool from the study participants. The judgmental sampling technique was used in this study as it was found to be the most appropriate method for the research question. Phase one of the study was to conduct a pilot study at two Port Elizabeth pharmaceutical wholesalers. The data was analysed using Microsoft Excel®, chi-square test for goodness of fit and content analysis. The data was further analysed using a descriptive and inferential statistics approach to determine the level of compliance to regulatory guidelines for cold chain products.Results:The results obtained from the empirical study revealed that less than 50% of the study respondents indicated compliance to the factors listed in the regulatory guidelines for cold chain products distribution.These factors include cold chain monitoring, alternative power sources, validation of cold chain boxes and route transport validation.Conclusion:The wholesale pharmaceutical industry is experiencing challenges to comply with factors necessary to ensure compliance with GDP guidelines for cold chain products. Through the study it was proven that there is evidence of commitment by the industry to implement the GWP and GPP amendment guidelines, despite less than 50% of the respondents reporting compliance to the guidelines. Recommendations were provided to improve the level of compliance to guidelines for cold chain products by pharmaceutical wholesalers in South Africa.
- Full Text:
- Date Issued: 2020
- Authors: Masebe, Zandisile
- Date: 2020
- Subjects: Pharmaceutical industry
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/46390 , vital:39581
- Description: Background: The South African pharmaceutical cold chain distribution industry is highly regulated. Cold chain pharmaceutical products require storage in a cold room, in a temperature-controlled environment between (2°C-8°C) and the cold chain must be maintained at all times throughout the distribution process. The incorrect handling, storage, transport and distribution of cold chain products may reduce the potency and therapeutic effectiveness of the product which in turn may result in treatment failure. The research was aimed at determining the level of compliance to current Good Distribution Practice guidelines for cold chain products among pharmaceutical wholesalers and distributors in South Africa. Methodology: The study made use of quantitative research techniques. A purpose designed online questionnaire was used as a data collection tool from the study participants. The judgmental sampling technique was used in this study as it was found to be the most appropriate method for the research question. Phase one of the study was to conduct a pilot study at two Port Elizabeth pharmaceutical wholesalers. The data was analysed using Microsoft Excel®, chi-square test for goodness of fit and content analysis. The data was further analysed using a descriptive and inferential statistics approach to determine the level of compliance to regulatory guidelines for cold chain products.Results:The results obtained from the empirical study revealed that less than 50% of the study respondents indicated compliance to the factors listed in the regulatory guidelines for cold chain products distribution.These factors include cold chain monitoring, alternative power sources, validation of cold chain boxes and route transport validation.Conclusion:The wholesale pharmaceutical industry is experiencing challenges to comply with factors necessary to ensure compliance with GDP guidelines for cold chain products. Through the study it was proven that there is evidence of commitment by the industry to implement the GWP and GPP amendment guidelines, despite less than 50% of the respondents reporting compliance to the guidelines. Recommendations were provided to improve the level of compliance to guidelines for cold chain products by pharmaceutical wholesalers in South Africa.
- Full Text:
- Date Issued: 2020
Evaluation of product x pre and post cpv implementation
- Authors: Killian, Christopher Grant
- Date: 2020
- Subjects: Pharmaceutical industry
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/46447 , vital:39577
- Description: Purpose: Stage 3 of the pharmaceutical process validation lifecycle, is called continued process verification (CPV). CPV is the final stage of lifecycle management and is intended to provide ongoing assurance that during routine production that a process remains in a state of control. Since CPV is a relatively new focus area for regulators, many legacy products will not have undergone Stage 3 process validation. Therefore, an opportunity existed to review the impact and challenges of implementing CPV on a legacy product. Methodology: This study employed quantitative analysis to evaluate the impact of CPV on process stability and end product quality for Product X, a legacy product manufactured at a generics manufacturing facility. Initial Stage 3a CPV was used to review historical process data and identify special cause variation. Corrective and preventative actions were taken to address these statistical outliers and the impact of these process changes were evaluated in Stage 3b. Results: CPV implementation appeared to have an effect on process control, stability and capability for Product X. In Stage 3b, an increase in statistical outliers along with significant changes to process mean and standard deviation were seen for the critical process parameters, average mass and hardness. An improvement in process capability for the critical quality attributes, assay and dissolution, was also seen. Conclusion: The largest benefit of CPV implementation, especially for a legacy product, is the process knowledge gained. This provided opportunities for process improvement and ultimately benefited patient safety.
- Full Text:
- Date Issued: 2020
- Authors: Killian, Christopher Grant
- Date: 2020
- Subjects: Pharmaceutical industry
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/46447 , vital:39577
- Description: Purpose: Stage 3 of the pharmaceutical process validation lifecycle, is called continued process verification (CPV). CPV is the final stage of lifecycle management and is intended to provide ongoing assurance that during routine production that a process remains in a state of control. Since CPV is a relatively new focus area for regulators, many legacy products will not have undergone Stage 3 process validation. Therefore, an opportunity existed to review the impact and challenges of implementing CPV on a legacy product. Methodology: This study employed quantitative analysis to evaluate the impact of CPV on process stability and end product quality for Product X, a legacy product manufactured at a generics manufacturing facility. Initial Stage 3a CPV was used to review historical process data and identify special cause variation. Corrective and preventative actions were taken to address these statistical outliers and the impact of these process changes were evaluated in Stage 3b. Results: CPV implementation appeared to have an effect on process control, stability and capability for Product X. In Stage 3b, an increase in statistical outliers along with significant changes to process mean and standard deviation were seen for the critical process parameters, average mass and hardness. An improvement in process capability for the critical quality attributes, assay and dissolution, was also seen. Conclusion: The largest benefit of CPV implementation, especially for a legacy product, is the process knowledge gained. This provided opportunities for process improvement and ultimately benefited patient safety.
- Full Text:
- Date Issued: 2020
Perceptions of the preparedness of pharmacy graduates for internship responsibilities in the industrial pharmacy
- Putsoane, Mathabelo Maliboche
- Authors: Putsoane, Mathabelo Maliboche
- Date: 2020
- Subjects: Pharmacy students
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/46395 , vital:39593
- Description: Pharmacy graduates in South Africa are expected to undertake a compulsory one-yearinternship in diversepharmacy settings. These settings includethe industrial pharmacy sector,where they are expected to integrate furtherthe knowledge and skills they have acquired during their undergraduate training before entering into the pharmacy profession. The success of graduatesduring the internship,therefore, depends amongst other thingson their perceptions of preparedness. However, the perceptions of South African pharmacy graduates preparedness for the industrial pharmacy settingis not reportedin light of the shift in global pharmacy education from product-based to patient-based education which thus provided the impetus for this study.Semi-structured interviews with individual pharmacy graduateswere utilised to explorethe perceptions of the preparedness regarding the technical and generic skills required of an industrial pharmacy intern. Inductive data analysisculminated in thedevelopment of themes and subthemes. A lack of preparedness as perceived by graduateswas a result of a lack of industrial pharmacy experientialwork-basedpractical training and patient-focused education. Graduates perceived themselves to be fairly prepared with communication and teamwork skills; however, their problem-solving skills werenot clear due tothe scope of work ofanintern pharmacist which hinders them from solvingproblems.Though graduates expressed that they had acquired adequate theoretical training, the lack of practical application resulted in inadequate technical skills preparedness. Graduatespreparedness for the industrial pharmacy can be improved by work-based placements of students in the industry pharmacy setting which will assist students to integrate theory with practice.
- Full Text:
- Date Issued: 2020
- Authors: Putsoane, Mathabelo Maliboche
- Date: 2020
- Subjects: Pharmacy students
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/46395 , vital:39593
- Description: Pharmacy graduates in South Africa are expected to undertake a compulsory one-yearinternship in diversepharmacy settings. These settings includethe industrial pharmacy sector,where they are expected to integrate furtherthe knowledge and skills they have acquired during their undergraduate training before entering into the pharmacy profession. The success of graduatesduring the internship,therefore, depends amongst other thingson their perceptions of preparedness. However, the perceptions of South African pharmacy graduates preparedness for the industrial pharmacy settingis not reportedin light of the shift in global pharmacy education from product-based to patient-based education which thus provided the impetus for this study.Semi-structured interviews with individual pharmacy graduateswere utilised to explorethe perceptions of the preparedness regarding the technical and generic skills required of an industrial pharmacy intern. Inductive data analysisculminated in thedevelopment of themes and subthemes. A lack of preparedness as perceived by graduateswas a result of a lack of industrial pharmacy experientialwork-basedpractical training and patient-focused education. Graduates perceived themselves to be fairly prepared with communication and teamwork skills; however, their problem-solving skills werenot clear due tothe scope of work ofanintern pharmacist which hinders them from solvingproblems.Though graduates expressed that they had acquired adequate theoretical training, the lack of practical application resulted in inadequate technical skills preparedness. Graduatespreparedness for the industrial pharmacy can be improved by work-based placements of students in the industry pharmacy setting which will assist students to integrate theory with practice.
- Full Text:
- Date Issued: 2020
A proposed baseline South African antimicrobial stewardship curriculum for the Bachelor of Pharmacy programme
- Authors: Khan, Yasmine
- Date: 2019
- Subjects: Pharmacy -- Study and teaching -- South Africa , Pharmacy -- Practice -- South Africa Drug utilization -- Dissertations Drug utilization -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/35752 , vital:33805
- Description: Antimicrobial stewardship refers to the healthcare practice which ensures the judicious and appropriate prescribing of antimicrobial agents. The primary purpose of antimicrobial stewardship entails minimising the progression of antimicrobial resistance; the rise of which is recognised as a threat to global health and safety. The pharmacist is recognised nationally and internationally as a key role player in the implementation of antimicrobial stewardship. Education of healthcare practitioners in antimicrobial stewardship is a recognised strategic enabler for the containment of antimicrobial resistance in South Africa. The primary aim of the study was to develop a proposed baseline antimicrobial stewardship curriculum which is suitable for implementation into the Bachelor of Pharmacy programmes offered by South African schools of pharmacy. The aims and objectives of the study were achieved through the conduction of four study phases: the content analysis, academic review, expert consultation and curriculum development. The content analysis investigated the structure and content of international antimicrobial stewardship curricula, and the national policy governing antimicrobial stewardship implementation in South Africa. Frequency distributions of trends from the reviewed literature informed the development of the initial draft antimicrobial stewardship curriculum for pharmacy students. In terms of content, the principles which emerges with high frequency, which were thus emphasised in the initial draft curriculum, included: the strategic objectives (governance, surveillance, antimicrobial stewardship and infection prevention); strategic enablers (education, communication, legislation and research); dose optimisation; audit and feedback; formulary restriction; collaboration; pre-authorisation; and de-escalation. Available literature did not provide extensive detail regarding the curriculum structure utilised internationally, particularly with regards to the number of contact hours dedicated to the curriculum content and the year level at which antimicrobial stewardship was incorporated in the degree programme (variable between studies). From the content analysis it was evident that a mixed methods pedagogy and use of multiple assessment techniques were recommended. The academic review phase allowed for further insight to be obtained into the content and structure of antimicrobial stewardship curriculum content which was presented in the pre-existing Bachelor of Pharmacy degree programmes. Furthermore, the academic review required that nominated participants from each school of pharmacy indicate which antimicrobial prescribing principles should be incorporated in the proposed baseline antimicrobial stewardship curriculum. The results of the academic review phase were collated with the content analysis in order to develop the updated draft antimicrobial stewardship curriculum. It was interesting to note that large variation in content and structure related to antimicrobial stewardship which was presented by the various schools of pharmacy in South Africa. In terms of curriculum content, recommendations made by academic professionals informed the development of relative importance groupings, which allowed for the various antimicrobial stewardship principles to be tiered according to importance for inclusion in the proposed baseline antimicrobial stewardship curriculum. The large variation in antimicrobial stewardship curriculum structure posed as a challenge for the development of the proposed baseline curriculum, requiring that the structure remain flexible in order for feasible incorporation into the pre-existing Bachelor of Pharmacy degree programmes offered by the various schools of pharmacy in South Africa. The expert consultation phase explored the perceptions of multiple key health disciplines who serve as part of antimicrobial stewardship teams in South Africa with regards to the role of the pharmacist in antimicrobial stewardship; and the minimum level of antimicrobial stewardship knowledge and skills which pharmacy students should possess prior to entry into practice. The results of the expert consultation phase were collated with the results of the content analysis and academic review phase in order to develop the final proposed baseline antimicrobial stewardship curriculum. The findings of the expert consultation phase indicated great variability regarding the perceived role of the pharmacist in antimicrobial stewardship within and between health disciplines. Furthermore, the relative perceived importance of various antimicrobial stewardship strategies and antimicrobial prescribing principles were explored, which informed the tiering of content in the final proposed antimicrobial stewardship curriculum.
- Full Text:
- Date Issued: 2019
- Authors: Khan, Yasmine
- Date: 2019
- Subjects: Pharmacy -- Study and teaching -- South Africa , Pharmacy -- Practice -- South Africa Drug utilization -- Dissertations Drug utilization -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/35752 , vital:33805
- Description: Antimicrobial stewardship refers to the healthcare practice which ensures the judicious and appropriate prescribing of antimicrobial agents. The primary purpose of antimicrobial stewardship entails minimising the progression of antimicrobial resistance; the rise of which is recognised as a threat to global health and safety. The pharmacist is recognised nationally and internationally as a key role player in the implementation of antimicrobial stewardship. Education of healthcare practitioners in antimicrobial stewardship is a recognised strategic enabler for the containment of antimicrobial resistance in South Africa. The primary aim of the study was to develop a proposed baseline antimicrobial stewardship curriculum which is suitable for implementation into the Bachelor of Pharmacy programmes offered by South African schools of pharmacy. The aims and objectives of the study were achieved through the conduction of four study phases: the content analysis, academic review, expert consultation and curriculum development. The content analysis investigated the structure and content of international antimicrobial stewardship curricula, and the national policy governing antimicrobial stewardship implementation in South Africa. Frequency distributions of trends from the reviewed literature informed the development of the initial draft antimicrobial stewardship curriculum for pharmacy students. In terms of content, the principles which emerges with high frequency, which were thus emphasised in the initial draft curriculum, included: the strategic objectives (governance, surveillance, antimicrobial stewardship and infection prevention); strategic enablers (education, communication, legislation and research); dose optimisation; audit and feedback; formulary restriction; collaboration; pre-authorisation; and de-escalation. Available literature did not provide extensive detail regarding the curriculum structure utilised internationally, particularly with regards to the number of contact hours dedicated to the curriculum content and the year level at which antimicrobial stewardship was incorporated in the degree programme (variable between studies). From the content analysis it was evident that a mixed methods pedagogy and use of multiple assessment techniques were recommended. The academic review phase allowed for further insight to be obtained into the content and structure of antimicrobial stewardship curriculum content which was presented in the pre-existing Bachelor of Pharmacy degree programmes. Furthermore, the academic review required that nominated participants from each school of pharmacy indicate which antimicrobial prescribing principles should be incorporated in the proposed baseline antimicrobial stewardship curriculum. The results of the academic review phase were collated with the content analysis in order to develop the updated draft antimicrobial stewardship curriculum. It was interesting to note that large variation in content and structure related to antimicrobial stewardship which was presented by the various schools of pharmacy in South Africa. In terms of curriculum content, recommendations made by academic professionals informed the development of relative importance groupings, which allowed for the various antimicrobial stewardship principles to be tiered according to importance for inclusion in the proposed baseline antimicrobial stewardship curriculum. The large variation in antimicrobial stewardship curriculum structure posed as a challenge for the development of the proposed baseline curriculum, requiring that the structure remain flexible in order for feasible incorporation into the pre-existing Bachelor of Pharmacy degree programmes offered by the various schools of pharmacy in South Africa. The expert consultation phase explored the perceptions of multiple key health disciplines who serve as part of antimicrobial stewardship teams in South Africa with regards to the role of the pharmacist in antimicrobial stewardship; and the minimum level of antimicrobial stewardship knowledge and skills which pharmacy students should possess prior to entry into practice. The results of the expert consultation phase were collated with the results of the content analysis and academic review phase in order to develop the final proposed baseline antimicrobial stewardship curriculum. The findings of the expert consultation phase indicated great variability regarding the perceived role of the pharmacist in antimicrobial stewardship within and between health disciplines. Furthermore, the relative perceived importance of various antimicrobial stewardship strategies and antimicrobial prescribing principles were explored, which informed the tiering of content in the final proposed antimicrobial stewardship curriculum.
- Full Text:
- Date Issued: 2019
Development of a framework for a proposed antimicrobial usage reporting tool for public sector hospitals
- Authors: Ramjan, Yumna
- Date: 2019
- Subjects: Anti-infective agents
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/43030 , vital:36727
- Description: Background: The inappropriate and unnecessary use of antimicrobials has increased the need to monitor antimicrobial usage so as to identify inappropriate use. In order to support the antimicrobial stewardship (AMS) programme, it is important to quantify the usage of antimicrobials and this can be achieved by promoting the use of AMS utilisation metrics. They are used to measure the progress and efficacy of an AMS programme (Brotherton, 2018).Primary Aim of Research: The primary aim of the research was to develop a framework for a proposed antimicrobial usage reporting tool, which would integrate with various data sources in order to be used by AMS practitioners to optimise antimicrobial usage in the South African public sector hospital setting.Methodology: The study was divided into three phases: a preliminary phase, a developmental phase and a post-developmental phase. The preliminary phase focused on obtaining a comprehensive understanding of the type and nature of the AMS utilisation metrics and subsequently identifying the views on the usage, usefulness and clinical relevance of those AMS utilisation metrics using a quantitative questionnaire, which was conducted among infectious disease specialists, pharmacists, medical prescribers, i.e. prescribers who were not specialists and clinical pathologists employed at tertiary level, public sector hospitals in the Eastern Cape province of South Africa. Consequently, a qualitative semi-structured interview was conducted among healthcare professionals who were involved in the daily implementation of AMS in the workplace. Results obtained from the quantitative component and qualitative component were integrated in order to develop a framework for a proposed antimicrobial usage reporting tool. Results: The Defined Daily Dose (DDD), Prescribed Daily Dose (PDD) and Days of Therapy (DOT) were identified as the most common AMS metrics (Grau et al., 2013). However, the DDD was the only AMS metric currently recommended by the South African National Department of Health (South African National Department of Health, 2017a)and it was the only AMS metric currently being utilised at two of the five research sites in the Eastern Cape province of South Africa. It was identified that data pertaining to antimicrobial usage was available and was being extracted from Rx Solution®. However, the programme did not have the ability of automatically producing the reports, hence, emphasising on the need for an antimicrobial usage reporting tool for South African public sector hospitals. Therefore, the framework for the proposed antimicrobial usage reporting tool would integrate antimicrobial stock management data with the following AMS utilisation metrics: DDD, DOT and PDD, were considered for inclusion in the proposed antimicrobial usage reporting tool. Conclusion: The qualitative findings obtained during the post-developmental phase, therefore, established that although an electronic platform for the purpose of monitoring antimicrobial usage for the South African public sector hospitals was required, there would be many challenges obstructing the implementation of the proposed antimicrobial usage reporting tool.
- Full Text:
- Date Issued: 2019
- Authors: Ramjan, Yumna
- Date: 2019
- Subjects: Anti-infective agents
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/43030 , vital:36727
- Description: Background: The inappropriate and unnecessary use of antimicrobials has increased the need to monitor antimicrobial usage so as to identify inappropriate use. In order to support the antimicrobial stewardship (AMS) programme, it is important to quantify the usage of antimicrobials and this can be achieved by promoting the use of AMS utilisation metrics. They are used to measure the progress and efficacy of an AMS programme (Brotherton, 2018).Primary Aim of Research: The primary aim of the research was to develop a framework for a proposed antimicrobial usage reporting tool, which would integrate with various data sources in order to be used by AMS practitioners to optimise antimicrobial usage in the South African public sector hospital setting.Methodology: The study was divided into three phases: a preliminary phase, a developmental phase and a post-developmental phase. The preliminary phase focused on obtaining a comprehensive understanding of the type and nature of the AMS utilisation metrics and subsequently identifying the views on the usage, usefulness and clinical relevance of those AMS utilisation metrics using a quantitative questionnaire, which was conducted among infectious disease specialists, pharmacists, medical prescribers, i.e. prescribers who were not specialists and clinical pathologists employed at tertiary level, public sector hospitals in the Eastern Cape province of South Africa. Consequently, a qualitative semi-structured interview was conducted among healthcare professionals who were involved in the daily implementation of AMS in the workplace. Results obtained from the quantitative component and qualitative component were integrated in order to develop a framework for a proposed antimicrobial usage reporting tool. Results: The Defined Daily Dose (DDD), Prescribed Daily Dose (PDD) and Days of Therapy (DOT) were identified as the most common AMS metrics (Grau et al., 2013). However, the DDD was the only AMS metric currently recommended by the South African National Department of Health (South African National Department of Health, 2017a)and it was the only AMS metric currently being utilised at two of the five research sites in the Eastern Cape province of South Africa. It was identified that data pertaining to antimicrobial usage was available and was being extracted from Rx Solution®. However, the programme did not have the ability of automatically producing the reports, hence, emphasising on the need for an antimicrobial usage reporting tool for South African public sector hospitals. Therefore, the framework for the proposed antimicrobial usage reporting tool would integrate antimicrobial stock management data with the following AMS utilisation metrics: DDD, DOT and PDD, were considered for inclusion in the proposed antimicrobial usage reporting tool. Conclusion: The qualitative findings obtained during the post-developmental phase, therefore, established that although an electronic platform for the purpose of monitoring antimicrobial usage for the South African public sector hospitals was required, there would be many challenges obstructing the implementation of the proposed antimicrobial usage reporting tool.
- Full Text:
- Date Issued: 2019
Multi-drug resistant tuberculosis related adverse drug reactions: implementation of a documentation tool
- Authors: Cheng, Amber
- Date: 2019
- Subjects: Multi-drug resistant tuberculosis
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/44662 , vital:38151
- Description: Multi-drug resistant tuberculosis (MDR-TB) is an ever-growing problem in South Africa (SA). According to the literature, minimal documentation is done on adverse drug reactions (ADRs), specifically in the MDR-TB population. Co-administration of medications is typical for the treatment of drug resistant forms of TB, which leads to high incidences of ADRs during the treatment period, especially in patients with comorbid disease states. This before-and-after study investigated the impact of an intervention (education training presentation and implementation of a purpose-designed documentation tool) on the current documentation pattern in a public sector hospital in the Nelson Mandela Metropole. In order to measure the sustainability of the intervention, the study compared data from the pre-intervention phase to data collected from the post-intervention immediate phase and post-intervention delayed phase. Study results indicated that the intervention appeared to have had a positive effect on the frequency and variety of ADR documentation (2.1 and 1.3 fold increase, respectively) related to MDR-TB by the hospital staff of a public sector hospital, however, the positive change was not sustainable for longer than a three month period post intervention. It is recommended that factors such as: proper adoption; management; and additional resources are required to implement positive changes to documentation practices. Further studies need to be conducted in South Africa regarding the treatment of drug resistant tuberculosis, in order to establish safer treatment guidelines and more promising ADR reporting practices, which will ultimately improve patient care.
- Full Text:
- Date Issued: 2019
- Authors: Cheng, Amber
- Date: 2019
- Subjects: Multi-drug resistant tuberculosis
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/44662 , vital:38151
- Description: Multi-drug resistant tuberculosis (MDR-TB) is an ever-growing problem in South Africa (SA). According to the literature, minimal documentation is done on adverse drug reactions (ADRs), specifically in the MDR-TB population. Co-administration of medications is typical for the treatment of drug resistant forms of TB, which leads to high incidences of ADRs during the treatment period, especially in patients with comorbid disease states. This before-and-after study investigated the impact of an intervention (education training presentation and implementation of a purpose-designed documentation tool) on the current documentation pattern in a public sector hospital in the Nelson Mandela Metropole. In order to measure the sustainability of the intervention, the study compared data from the pre-intervention phase to data collected from the post-intervention immediate phase and post-intervention delayed phase. Study results indicated that the intervention appeared to have had a positive effect on the frequency and variety of ADR documentation (2.1 and 1.3 fold increase, respectively) related to MDR-TB by the hospital staff of a public sector hospital, however, the positive change was not sustainable for longer than a three month period post intervention. It is recommended that factors such as: proper adoption; management; and additional resources are required to implement positive changes to documentation practices. Further studies need to be conducted in South Africa regarding the treatment of drug resistant tuberculosis, in order to establish safer treatment guidelines and more promising ADR reporting practices, which will ultimately improve patient care.
- Full Text:
- Date Issued: 2019
Pharmacists’ perceptions of the effects of the Consumer Protection Act of 2008 on the pharmacy profession in South Africa: an exploratory study
- Authors: Cumberlege, Karin
- Date: 2019
- Subjects: South Africa -- Consumer Protection Act, 2008 , Consumer protection -- Law and legislation -- South Africa Pharmacists -- Legal status, laws, etc. -- South Africa Pharmacy -- Practice -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/38057 , vital:34312
- Description: The pharmacy profession is highly regulated through a number of statutes and codes all of which are devised in the public interest. The Consumer Protection Act, No 68 of 2008 (CPA) is a relatively recent addition to these regulatory measures and purports to protect consumers in their relations with suppliers, which includes the pharmacist-patient relationship. Heightened consumer awareness is increasing litigious consumer behaviour, making it important for pharmacists to be aware of their legal duties as providers of pharmaceutical care to consumers and therefore, to appreciate the potential implications of the CPA. This study aimed to determine South African pharmacists’ perceptions of the potential effect of the CPA on the pharmacy profession. Specific objectives included establishing the extent to which pharmacy law and ethics are incorporated into pharmacy curricula at various tertiary pharmacy institutions. The literature review identified the pharmacy categories providing pharmaceutical care services, whilst investigating medico-legal aspects of such services. Selected consumer rights in the CPA were considered in the context of pharmacists’ ethical obligations to consumers, thereby identifying potential areas of liability for pharmacists. Content and curriculum development pertaining to pharmacy education and training, focusing on pharmacy law and ethics, were assessed. A mixed methods research design was used to achieve the aim of the study. This included focus groups, telephone interviews, and a questionnaire survey amongst registered pharmacists. The themes identified in the focus groups were included in the telephone interviews. Likewise, themes identified from both the focus groups and telephone interviews, were incorporated in the questionnaire survey. The results identified a disparity in pharmacists’ education and training received from the respective tertiary pharmacy institutions. The results showed that pharmacists do not necessarily appreciate the potential implications of the CPA for pharmacists, portending an increased likelihood of liability. This finding also has implications for the training of pharmacists.
- Full Text:
- Date Issued: 2019
- Authors: Cumberlege, Karin
- Date: 2019
- Subjects: South Africa -- Consumer Protection Act, 2008 , Consumer protection -- Law and legislation -- South Africa Pharmacists -- Legal status, laws, etc. -- South Africa Pharmacy -- Practice -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/38057 , vital:34312
- Description: The pharmacy profession is highly regulated through a number of statutes and codes all of which are devised in the public interest. The Consumer Protection Act, No 68 of 2008 (CPA) is a relatively recent addition to these regulatory measures and purports to protect consumers in their relations with suppliers, which includes the pharmacist-patient relationship. Heightened consumer awareness is increasing litigious consumer behaviour, making it important for pharmacists to be aware of their legal duties as providers of pharmaceutical care to consumers and therefore, to appreciate the potential implications of the CPA. This study aimed to determine South African pharmacists’ perceptions of the potential effect of the CPA on the pharmacy profession. Specific objectives included establishing the extent to which pharmacy law and ethics are incorporated into pharmacy curricula at various tertiary pharmacy institutions. The literature review identified the pharmacy categories providing pharmaceutical care services, whilst investigating medico-legal aspects of such services. Selected consumer rights in the CPA were considered in the context of pharmacists’ ethical obligations to consumers, thereby identifying potential areas of liability for pharmacists. Content and curriculum development pertaining to pharmacy education and training, focusing on pharmacy law and ethics, were assessed. A mixed methods research design was used to achieve the aim of the study. This included focus groups, telephone interviews, and a questionnaire survey amongst registered pharmacists. The themes identified in the focus groups were included in the telephone interviews. Likewise, themes identified from both the focus groups and telephone interviews, were incorporated in the questionnaire survey. The results identified a disparity in pharmacists’ education and training received from the respective tertiary pharmacy institutions. The results showed that pharmacists do not necessarily appreciate the potential implications of the CPA for pharmacists, portending an increased likelihood of liability. This finding also has implications for the training of pharmacists.
- Full Text:
- Date Issued: 2019
Pharmacy personnel practices with regard to the sale of non-prescription asthma medication in community pharmacies in the Eastern and Western Cape
- Gebers, Benjamin Herman Charles
- Authors: Gebers, Benjamin Herman Charles
- Date: 2019
- Subjects: Pharmacy -- Practice , Pharmaceutical services -- South Africa -- Eastern Cape Pharmaceutical services -- South Africa Western Cape Drug utilization Asthma
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/39752 , vital:35354
- Description: Short Acting Beta Agonist (SABA) inhalers in South Africa are available to patients without a prescription from an authorised prescriber. This study utilised a mystery shopping technique to observe, record and compare the dispensing practices of pharmacy personnel, when dispensing a reliever inhaler, to the minimum requirements set out by the South African Pharmacy Council. The results of this study indicated that there was no adherence to the minimum requirements when dispensing a reliever inhaler.
- Full Text:
- Date Issued: 2019
- Authors: Gebers, Benjamin Herman Charles
- Date: 2019
- Subjects: Pharmacy -- Practice , Pharmaceutical services -- South Africa -- Eastern Cape Pharmaceutical services -- South Africa Western Cape Drug utilization Asthma
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/39752 , vital:35354
- Description: Short Acting Beta Agonist (SABA) inhalers in South Africa are available to patients without a prescription from an authorised prescriber. This study utilised a mystery shopping technique to observe, record and compare the dispensing practices of pharmacy personnel, when dispensing a reliever inhaler, to the minimum requirements set out by the South African Pharmacy Council. The results of this study indicated that there was no adherence to the minimum requirements when dispensing a reliever inhaler.
- Full Text:
- Date Issued: 2019
Simulated learning: integrating clinical knowledge into the dispensing process
- Authors: Klitsie, Monique
- Date: 2019
- Subjects: Medicine -- Study and teaching -- Simulation methods , Pharmacy -- Study and teaching Hospital pharmacies -- South Africa Pharmacy management -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/42239 , vital:36638
- Description: Pharmacy education has experienced a continual shift in the emphasis of the practice of pharmacy, requiring pharmacists to practice high levels of competence in performing the dispensing process while incorporating clinical knowledge using complex levels of cognitive skill. This highlights the need for opportunities within the learning environment which both require and facilitate the integration of clinical knowledge-based cognitive skills into the dispensing process. Simulation-based education has been demonstrated to assist in gradually increasing the level of complexity of tasks requiring performance by students in clinical settings. This study explored ways in which a computer-based dispensing program, MyDispense, could be used to facilitate the integration of clinical knowledge-based cognitive skills into the dispensing process. In the study, simulated patient scenarios for MyDispense were developed, which required the integration of a hierarchy of cognitive skills into the dispensing process. These were evaluated in order to assess the level of cognitive skills required to complete the clinical scenarios created. The developed MyDispense-based clinical scenarios were then piloted with a group of pharmacy students, after which a focus group was used to explore the students’ experience of the ability of MyDispense to integrate clinical knowledge into the dispensing process. This qualitative study adopted an exploratory approach in order to understand the potential benefit of computer-based simulated learning as a means of integrating clinical knowledge-based cognitive skills into the dispensing process. Purposive and convenience sampling was used in this study and data collection was through the completion of purpose-designed assessment forms by pharmacy lecturers and focus groups with student participants. Data from the assessment forms was used as feedback to further refine the clinical scenarios, and the focus group recording was transcribed and analysed using a thematic analysis approach. The scenarios assessed by the pharmacy lecturers were shown to require high levels of cognitive skills as described by Bloom’s Revised Taxonomy (Anderson & Krathwohl, 2001) and necessitated that the students plan, construct, design, and generate information to complete the scenarios. The pharmacy students successfully practiced the MyDispense scenarios as an adjunct to a clinical module and reported that the scenarios had assisted them in learning for the clinical module. The students acknowledged that they were required to apply their clinical knowledge and make clinical decisions while completing the scenarios. This study demonstrates that simulation-based education can be used as a beneficial educational tool for teaching the application of complex clinical knowledge-based cognitive skills to the dispensing process. It provides a valuable means of preparing students for professional work-based pharmacy practice.
- Full Text:
- Date Issued: 2019
- Authors: Klitsie, Monique
- Date: 2019
- Subjects: Medicine -- Study and teaching -- Simulation methods , Pharmacy -- Study and teaching Hospital pharmacies -- South Africa Pharmacy management -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/42239 , vital:36638
- Description: Pharmacy education has experienced a continual shift in the emphasis of the practice of pharmacy, requiring pharmacists to practice high levels of competence in performing the dispensing process while incorporating clinical knowledge using complex levels of cognitive skill. This highlights the need for opportunities within the learning environment which both require and facilitate the integration of clinical knowledge-based cognitive skills into the dispensing process. Simulation-based education has been demonstrated to assist in gradually increasing the level of complexity of tasks requiring performance by students in clinical settings. This study explored ways in which a computer-based dispensing program, MyDispense, could be used to facilitate the integration of clinical knowledge-based cognitive skills into the dispensing process. In the study, simulated patient scenarios for MyDispense were developed, which required the integration of a hierarchy of cognitive skills into the dispensing process. These were evaluated in order to assess the level of cognitive skills required to complete the clinical scenarios created. The developed MyDispense-based clinical scenarios were then piloted with a group of pharmacy students, after which a focus group was used to explore the students’ experience of the ability of MyDispense to integrate clinical knowledge into the dispensing process. This qualitative study adopted an exploratory approach in order to understand the potential benefit of computer-based simulated learning as a means of integrating clinical knowledge-based cognitive skills into the dispensing process. Purposive and convenience sampling was used in this study and data collection was through the completion of purpose-designed assessment forms by pharmacy lecturers and focus groups with student participants. Data from the assessment forms was used as feedback to further refine the clinical scenarios, and the focus group recording was transcribed and analysed using a thematic analysis approach. The scenarios assessed by the pharmacy lecturers were shown to require high levels of cognitive skills as described by Bloom’s Revised Taxonomy (Anderson & Krathwohl, 2001) and necessitated that the students plan, construct, design, and generate information to complete the scenarios. The pharmacy students successfully practiced the MyDispense scenarios as an adjunct to a clinical module and reported that the scenarios had assisted them in learning for the clinical module. The students acknowledged that they were required to apply their clinical knowledge and make clinical decisions while completing the scenarios. This study demonstrates that simulation-based education can be used as a beneficial educational tool for teaching the application of complex clinical knowledge-based cognitive skills to the dispensing process. It provides a valuable means of preparing students for professional work-based pharmacy practice.
- Full Text:
- Date Issued: 2019
Application of a quality by design approach to optimise an existing product
- Authors: Maxwell, Taryn Lee
- Date: 2018
- Subjects: Pharmaceutical chemistry , Drugs -- Design Pharmaceutical technology
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/32752 , vital:32341
- Description: Quality by design is a science and risk based approach whereby quality is built into the product or process during the pharmaceutical development. although quality by design is encouraged for pharmaceutical development. it is possible to apply quality by design to optimize an existing product as part of a continual improvement strategy. the purpose of this study is to determine which factors should be considered to justify the application of quality by design to optimize an existing product.
- Full Text: false
- Date Issued: 2018
- Authors: Maxwell, Taryn Lee
- Date: 2018
- Subjects: Pharmaceutical chemistry , Drugs -- Design Pharmaceutical technology
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/32752 , vital:32341
- Description: Quality by design is a science and risk based approach whereby quality is built into the product or process during the pharmaceutical development. although quality by design is encouraged for pharmaceutical development. it is possible to apply quality by design to optimize an existing product as part of a continual improvement strategy. the purpose of this study is to determine which factors should be considered to justify the application of quality by design to optimize an existing product.
- Full Text: false
- Date Issued: 2018
Barriers to picking and packing in pharmaceutical warehousing and distribution in South Africa
- Authors: Kemp, Nicholas
- Date: 2018
- Subjects: Pharmaceutical industry -- Materials management , Warehouses -- Management Pharmaceutical industry -- South Africa Physical distribution of goods -- Management
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/30627 , vital:30994
- Description: Barriers within the supply chain play an evident role in decreasing its efficiency. The supply chain system is not well documented in the pharmaceutical sector. The aim of this study was to identify any barriers to the movement of picking and packing operators within 6 distribution facilities throughout South Africa using a time and motion analysis. A pilot study was initially conducted to choose the stopwatch application for Android® devices and to ensure reliability of the tools utilised. The motions during the processes of fulfilling an order were identified during the case picking, bulk picking and packing processes by direct observation of operators. The direct observation was performed using a stopwatch application for Android® devices and a tool on Microsoft Excel®. The data was analysed using Microsoft Excel®, using a student’s T-test and an analysis of variance (ANOVA) approach to identify similarities and differences between the facilities. The data was further analysed using a descriptive statistics approach to identify the common barriers amongst the distribution centres. Thereafter, the data was analysed by identifying a value-quotient. The value-quotient was used to identify how much time was spent on value-adding activities with each facility. The observation of the operators was done randomly at each facility to avoid subjectivity and bias. Results: The pilot study identified which stopwatch application was to be utilised. The pilot study aided to improve upon the design of the data collection tool used for the transcribing of the timing operation. The student’s T-test and ANOVA revealed that there were statistically significant differences in case picking amongst facilities, namely using the radio frequency identification devices (RFID), picking and transfer of stock. In the bulk picking process, there was a statistically significant difference amongst the facilities, namely using the RFID, pick and transfer of stock. In the packing process there was a statistically significant difference amongst the facilities in the packing process. The analysis of barriers within the distribution centres revealed that the 16 common barriers amongst the picking processes at the facilities included raising the platform, waiting for colleagues to depart an aisle, RFID malfunctions and answering their phones. No common barriers during the packing process was identified. The value-quotient revealed that most of the facilities spent more than 50 percent of their time on value-adding activities during the case picking, bulk picking and packing processes. A time and motion analysis proved to be an effective method to identify similarities and barriers between the six facilities. It was recommended to investigate a few of the basic operations to improve upon, as well as the possibility of implementing a barcoded system to the stock.
- Full Text:
- Date Issued: 2018
- Authors: Kemp, Nicholas
- Date: 2018
- Subjects: Pharmaceutical industry -- Materials management , Warehouses -- Management Pharmaceutical industry -- South Africa Physical distribution of goods -- Management
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/30627 , vital:30994
- Description: Barriers within the supply chain play an evident role in decreasing its efficiency. The supply chain system is not well documented in the pharmaceutical sector. The aim of this study was to identify any barriers to the movement of picking and packing operators within 6 distribution facilities throughout South Africa using a time and motion analysis. A pilot study was initially conducted to choose the stopwatch application for Android® devices and to ensure reliability of the tools utilised. The motions during the processes of fulfilling an order were identified during the case picking, bulk picking and packing processes by direct observation of operators. The direct observation was performed using a stopwatch application for Android® devices and a tool on Microsoft Excel®. The data was analysed using Microsoft Excel®, using a student’s T-test and an analysis of variance (ANOVA) approach to identify similarities and differences between the facilities. The data was further analysed using a descriptive statistics approach to identify the common barriers amongst the distribution centres. Thereafter, the data was analysed by identifying a value-quotient. The value-quotient was used to identify how much time was spent on value-adding activities with each facility. The observation of the operators was done randomly at each facility to avoid subjectivity and bias. Results: The pilot study identified which stopwatch application was to be utilised. The pilot study aided to improve upon the design of the data collection tool used for the transcribing of the timing operation. The student’s T-test and ANOVA revealed that there were statistically significant differences in case picking amongst facilities, namely using the radio frequency identification devices (RFID), picking and transfer of stock. In the bulk picking process, there was a statistically significant difference amongst the facilities, namely using the RFID, pick and transfer of stock. In the packing process there was a statistically significant difference amongst the facilities in the packing process. The analysis of barriers within the distribution centres revealed that the 16 common barriers amongst the picking processes at the facilities included raising the platform, waiting for colleagues to depart an aisle, RFID malfunctions and answering their phones. No common barriers during the packing process was identified. The value-quotient revealed that most of the facilities spent more than 50 percent of their time on value-adding activities during the case picking, bulk picking and packing processes. A time and motion analysis proved to be an effective method to identify similarities and barriers between the six facilities. It was recommended to investigate a few of the basic operations to improve upon, as well as the possibility of implementing a barcoded system to the stock.
- Full Text:
- Date Issued: 2018
Delivery of pharmaceutical services and care at three primary healthcare clinics with different dispensing models in the Nelson Mandela Bay Health District
- Authors: Bobbins, Amy Claire
- Date: 2018
- Subjects: National health insurance -- South Africa , Community health services -- South Africa Pharmaceutical services -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/23580 , vital:30583
- Description: As South Africa moves into an era of National Health Insurance (NHI), the idea of primary health care (PHC) re-engineering is placed at the forefront; however, the role of the pharmacist in this process remains vague. Task-shifting of the dispensing process to pharmacist’s assistants and nurses in PHC clinics is a common phenomenon, but the implications of this on the provision of pharmaceutical services and care to patients is largely unstudied. Thus, this study aims to explore these pharmacist-based, pharmacist’s assistant-based and nurse-based dispensing models present in PHC clinics. A two-phase, mixed methods approach was utilised, comprising of a pharmaceutical services audit and semi-structured interviews. The interviews provided insight into the lived experiences of personnel and patients of pharmaceutical care provision. Results revealed that although basic pharmaceutical services may be available at clinics with each of the three dispensing models, the quality is of a varying standard due to challenges in infrastructure and maintenance and poor personnel support. Furthermore, the provision of quality pharmaceutical care is minimal with all three dispensing models, resulting in a missed opportunity to optimise patient health outcomes in patient-centred PHC.
- Full Text:
- Date Issued: 2018
- Authors: Bobbins, Amy Claire
- Date: 2018
- Subjects: National health insurance -- South Africa , Community health services -- South Africa Pharmaceutical services -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/23580 , vital:30583
- Description: As South Africa moves into an era of National Health Insurance (NHI), the idea of primary health care (PHC) re-engineering is placed at the forefront; however, the role of the pharmacist in this process remains vague. Task-shifting of the dispensing process to pharmacist’s assistants and nurses in PHC clinics is a common phenomenon, but the implications of this on the provision of pharmaceutical services and care to patients is largely unstudied. Thus, this study aims to explore these pharmacist-based, pharmacist’s assistant-based and nurse-based dispensing models present in PHC clinics. A two-phase, mixed methods approach was utilised, comprising of a pharmaceutical services audit and semi-structured interviews. The interviews provided insight into the lived experiences of personnel and patients of pharmaceutical care provision. Results revealed that although basic pharmaceutical services may be available at clinics with each of the three dispensing models, the quality is of a varying standard due to challenges in infrastructure and maintenance and poor personnel support. Furthermore, the provision of quality pharmaceutical care is minimal with all three dispensing models, resulting in a missed opportunity to optimise patient health outcomes in patient-centred PHC.
- Full Text:
- Date Issued: 2018
Future role of community pharmacy in the national health insurance
- Authors: Aluko, Olubusola Aderonke
- Date: 2018
- Subjects: National health insurance -- South Africa , Health care reform -- South Africa Community health services -- South Africa Pharmacy -- Practice -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/21472 , vital:29525
- Description: Governments all over the world have shown interest in the healthcare system and various policies and measures have been adopted to ensure optimum health of the people. Inequity in health provision in South Africa is a great challenge. In South Africa, the healthcare system is currently characterised by distinctly different public and private sectors. The public sector serves approximately 84% of the population while the private sector services the smaller portion, 16% of the population. However, the expenditure in both the private and public sectors is almost the same, with approximately five times more being spent per capita in the private sector than in the public sector. The South African health care system is therefore unbalanced with respect to expenditure per capita resulting in inequitable access to, and quality of, health services. In particular, relative to the population it serves and the disease burden that it carries, the public sector is under-resourced. In order to address the inequities characteristic of the current two-tiered system, the South African Government is in the process of implementing a National Health Insurance (NHI). The NHI will provide a means of pooling all healthcare funding, thereby providing a means of cross subsidization within the public sector. Funding contributions will be linked to the ability of an individual to pay and benefits will be determined by an individual’s need for care. A core principle of NHI is to provide access to quality care. It has been suggested that within a NHI system private pharmacies may be contracted through service agreements to provide both chronic and acute medicines. However, there are currently no policies specifying the roles and functions of pharmacists in the NHI or in a re-engineered Primary Health Care system, although it has been suggested that for South Africa to have a successful healthcare system it requires the support and assistance of pharmacists. Research suggests that the majority of pharmacists do not believe that the NHI is a suitable means to address South Africa’s healthcare problems and many do not agree with the principles behind it. This study describes the perceptions and attitudes of community pharmacists and the lay public in Nelson Mandela Bay Metropole toward NHI and the potential role of community pharmacists within the NHI. A qualitative approach was used to provide an in-depth exploration of the attitudes and perceptions of community pharmacists and the lay public in Nelson Mandela Bay Metropole (NMBM). It is envisaged that this understanding will provide a basis for addressing pharmacists’ concerns and may contribute towards the further development of the role and the scope of practice of community pharmacists in the NHI. Semi-structured, in-depth interviews were conducted with both community pharmacists and with members of the public. The interviews were digitally recorded and then transcribed. The transcriptions were coded and analysed thematically. The analysis of the themes identified revealed that while community pharmacists and the public are aware of NHI they are uncertain as to how it is being implemented. However, both community pharmacists and patients see NHI as an advantage and display a positive attitude towards NHI.
- Full Text:
- Date Issued: 2018
- Authors: Aluko, Olubusola Aderonke
- Date: 2018
- Subjects: National health insurance -- South Africa , Health care reform -- South Africa Community health services -- South Africa Pharmacy -- Practice -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/21472 , vital:29525
- Description: Governments all over the world have shown interest in the healthcare system and various policies and measures have been adopted to ensure optimum health of the people. Inequity in health provision in South Africa is a great challenge. In South Africa, the healthcare system is currently characterised by distinctly different public and private sectors. The public sector serves approximately 84% of the population while the private sector services the smaller portion, 16% of the population. However, the expenditure in both the private and public sectors is almost the same, with approximately five times more being spent per capita in the private sector than in the public sector. The South African health care system is therefore unbalanced with respect to expenditure per capita resulting in inequitable access to, and quality of, health services. In particular, relative to the population it serves and the disease burden that it carries, the public sector is under-resourced. In order to address the inequities characteristic of the current two-tiered system, the South African Government is in the process of implementing a National Health Insurance (NHI). The NHI will provide a means of pooling all healthcare funding, thereby providing a means of cross subsidization within the public sector. Funding contributions will be linked to the ability of an individual to pay and benefits will be determined by an individual’s need for care. A core principle of NHI is to provide access to quality care. It has been suggested that within a NHI system private pharmacies may be contracted through service agreements to provide both chronic and acute medicines. However, there are currently no policies specifying the roles and functions of pharmacists in the NHI or in a re-engineered Primary Health Care system, although it has been suggested that for South Africa to have a successful healthcare system it requires the support and assistance of pharmacists. Research suggests that the majority of pharmacists do not believe that the NHI is a suitable means to address South Africa’s healthcare problems and many do not agree with the principles behind it. This study describes the perceptions and attitudes of community pharmacists and the lay public in Nelson Mandela Bay Metropole toward NHI and the potential role of community pharmacists within the NHI. A qualitative approach was used to provide an in-depth exploration of the attitudes and perceptions of community pharmacists and the lay public in Nelson Mandela Bay Metropole (NMBM). It is envisaged that this understanding will provide a basis for addressing pharmacists’ concerns and may contribute towards the further development of the role and the scope of practice of community pharmacists in the NHI. Semi-structured, in-depth interviews were conducted with both community pharmacists and with members of the public. The interviews were digitally recorded and then transcribed. The transcriptions were coded and analysed thematically. The analysis of the themes identified revealed that while community pharmacists and the public are aware of NHI they are uncertain as to how it is being implemented. However, both community pharmacists and patients see NHI as an advantage and display a positive attitude towards NHI.
- Full Text:
- Date Issued: 2018
Impact of South African patient law on medicines and generic substitution
- Authors: Jaganath, Bhavrith
- Date: 2018
- Subjects: Drugs -- South Africa -- Generic substitution , Generic drugs -- South Africa Patent laws and legislation Patents
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/22243 , vital:29907
- Description: Generic substitution of medicine is a mandatory cost- saving alternative made available to the public in South Africa . the availability of registered genetic medicine in the country is controlled by the South African Health products regulatory authority (SAHPRA), Formally known as the medicines control council (MCC), through the medicines and related substances act, No. 101 of 1965.
- Full Text:
- Date Issued: 2018
- Authors: Jaganath, Bhavrith
- Date: 2018
- Subjects: Drugs -- South Africa -- Generic substitution , Generic drugs -- South Africa Patent laws and legislation Patents
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/22243 , vital:29907
- Description: Generic substitution of medicine is a mandatory cost- saving alternative made available to the public in South Africa . the availability of registered genetic medicine in the country is controlled by the South African Health products regulatory authority (SAHPRA), Formally known as the medicines control council (MCC), through the medicines and related substances act, No. 101 of 1965.
- Full Text:
- Date Issued: 2018
Method validation for the quantification of casticin in vitex agnus castus fruit using an ftir multivariate chemometric model
- Authors: Du Toit Louw, Philippus
- Date: 2018
- Subjects: Drugs -- Analysis -- Methodology -- Evaluation , Alternative medicine -- Research , Liquid chromatography
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/30917 , vital:31222
- Description: The Complementary and Alternative Medicines (CAMS) and dietary supplement industry is an R8.84 billion a year industry in South Africa, with the sector expected to grow 12% annually. The industry has largely been unregulated up until 15 November 2013, when the South African government amended the Medicines and Related Substance Control Act (Act 101 of 1965) to include the definition of “Complementary Medicines” and “Health Supplements”. The emphasis of the new regulations is largely on the quality and safety of CAMS products. Manufacturers therefore need to demonstrate that the active ingredients used in manufacturing will be of an appropriate and consistent quality. The research question therefore is: Can a chemometric multivariate model be used to develop a rapid, cost effective method to quantify casticin, the major chemical constituent of Vitex agnus-castus (VAC) that can be used during routine quality control procedures? The primary aim of this study was to prepare a validated method using fourier transform infrared spectroscopy (FTIR) to quantify the casticin content in VAC fruit. The results from the HPLC analysis were as follows; the penduletin eluted at a retention time of 12.419 ± 0.376 minutes. The casticin eluted at a retention time of 12.943 ± 0.018 minutes. The casticin content for the samples ranged from 0.0115 – 0.0147% m/m casticin content with an average of 0.0134%. This is well below the pharmacopoeia requirement of not less than (NLT) 0.08% casticin content as described in the British Pharmacopoeia (BP). The results obtained from the HPLC analysis were used to construct the FTIR calibration model. The calibration model consisted of 18 spectra with 530 selected data points. The model was specific for casticin as spectral regions in the calibration model can be correlated to a known IR spectral response associated with the carbonyl group of casticin. The calibration equation in the xii form of % m/m casticin content had a coefficient of determination (R2) value of 0.9855 and a root mean square error of cross-validation (RMSECV) of 0.000119. The accuracy of the model had recoveries of between 98 - 102% for the actual vs true prediction. The percentage relative standard deviation (%RSD) between nine repeated measurements was 3.46%, this does not meet the International Conference of Harmonisation (ICH) requirement for precision of not more than (NMT) 2% RSD. The range of the calibration model was between 0.01147 and 0.01469 % m/m casticin content as established by the calibration model. The robustness of the method was assessed by challenging the model with samples that fall outside of the concentration of range of the model. This was established by quantifying previously scanned samples of VAC that is not part of the calibration set. The model was able to verify if the tested samples prediction was outside of the validated calibration range. The method was subsequently also challenged with a sample of a different identity to VAC. The model indicated that the sample tested does not fall in the range of the method and was clearly recognised as an outlier. The method was rapid and does not require any expensive solvents or timeconsuming sample preparation. However, the method does not meet the ICH requirements for method validation, the method does show potential and further method development and expansion of the calibration model can ensure that the method be validated.
- Full Text:
- Date Issued: 2018
- Authors: Du Toit Louw, Philippus
- Date: 2018
- Subjects: Drugs -- Analysis -- Methodology -- Evaluation , Alternative medicine -- Research , Liquid chromatography
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/30917 , vital:31222
- Description: The Complementary and Alternative Medicines (CAMS) and dietary supplement industry is an R8.84 billion a year industry in South Africa, with the sector expected to grow 12% annually. The industry has largely been unregulated up until 15 November 2013, when the South African government amended the Medicines and Related Substance Control Act (Act 101 of 1965) to include the definition of “Complementary Medicines” and “Health Supplements”. The emphasis of the new regulations is largely on the quality and safety of CAMS products. Manufacturers therefore need to demonstrate that the active ingredients used in manufacturing will be of an appropriate and consistent quality. The research question therefore is: Can a chemometric multivariate model be used to develop a rapid, cost effective method to quantify casticin, the major chemical constituent of Vitex agnus-castus (VAC) that can be used during routine quality control procedures? The primary aim of this study was to prepare a validated method using fourier transform infrared spectroscopy (FTIR) to quantify the casticin content in VAC fruit. The results from the HPLC analysis were as follows; the penduletin eluted at a retention time of 12.419 ± 0.376 minutes. The casticin eluted at a retention time of 12.943 ± 0.018 minutes. The casticin content for the samples ranged from 0.0115 – 0.0147% m/m casticin content with an average of 0.0134%. This is well below the pharmacopoeia requirement of not less than (NLT) 0.08% casticin content as described in the British Pharmacopoeia (BP). The results obtained from the HPLC analysis were used to construct the FTIR calibration model. The calibration model consisted of 18 spectra with 530 selected data points. The model was specific for casticin as spectral regions in the calibration model can be correlated to a known IR spectral response associated with the carbonyl group of casticin. The calibration equation in the xii form of % m/m casticin content had a coefficient of determination (R2) value of 0.9855 and a root mean square error of cross-validation (RMSECV) of 0.000119. The accuracy of the model had recoveries of between 98 - 102% for the actual vs true prediction. The percentage relative standard deviation (%RSD) between nine repeated measurements was 3.46%, this does not meet the International Conference of Harmonisation (ICH) requirement for precision of not more than (NMT) 2% RSD. The range of the calibration model was between 0.01147 and 0.01469 % m/m casticin content as established by the calibration model. The robustness of the method was assessed by challenging the model with samples that fall outside of the concentration of range of the model. This was established by quantifying previously scanned samples of VAC that is not part of the calibration set. The model was able to verify if the tested samples prediction was outside of the validated calibration range. The method was subsequently also challenged with a sample of a different identity to VAC. The model indicated that the sample tested does not fall in the range of the method and was clearly recognised as an outlier. The method was rapid and does not require any expensive solvents or timeconsuming sample preparation. However, the method does not meet the ICH requirements for method validation, the method does show potential and further method development and expansion of the calibration model can ensure that the method be validated.
- Full Text:
- Date Issued: 2018
Patients and healthcare professionals’ experiences of medicine unavailability at a primary healthcare centre in the Nelson Mandela Bay Metropole
- Authors: Ndzamela, Sisipo
- Date: 2018
- Subjects: Primary care (Medicine) -- South Africa -- Nelson Mandela Bay Municipality , Pharmacy -- Practice -- South Africa -- Nelson Mandela Bay Municipality Medical economics
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/22431 , vital:29969
- Description: Medicine stock-outs and shortages are being increasingly reported throughout South Africa. Primary healthcare centres are largely affected as many of them don’t have pharmacists and pharmacist support personnel to manage medicine stock levels. With the efforts to improve medicine availability and accessibility healthcare professionals have adopted informal networks through a borrowing system of medicines with other facilities The aim of this study was to explore and describe the experiences of patients and healthcare professionals of the unavailability of medicines at a primary healthcare (PHC) centre in the Nelson Mandela Bay Metropole. Using a qualitative approach, indepth interviews were conducted with 8 patients and 12 healthcare professionals including doctors, a pharmacist, pharmacy support personnel and nurses at a primary healthcare centre. These interviews were digitally recorded, transcribed and thematically analysed using Atlas.ti® network. The following major themes were identified; types of medicines that are unavailable, causes of stock-outs, psychological influence on both patients and healthcare professionals, compensatory measures and the central chronic dispensing and distribution program. Patient experiences included dissatisfaction and loss of confidence in the healthcare service delivery. Dissatisfied patients expressed emotions of anger and frustration. Also, unavailability of medicines resulted in stressed and burnt out healthcare professionals who have endured violence and verbal abuse from patients because of medicine stock-outs. Participants suggested that medicine stock-outs and shortages are most often due to delays in the delivery of stock by the depot. To counteract these effects healthcare professionals have adopted a borrowing system with other clinics. Furthermore, it was evident that the Central Chronic Medicine Dispensing and Distribution program (CCMDD) implemented by the Department of Health to improve availability and accessibility of medicines was perceived to be ineffective. Therefore, the issue of medicine stock-outs negatively affects service delivery, and those involved experience psychological harm which then affects inter-professional relationships. Overcoming this issue would promote a better healthcare system within the country.
- Full Text:
- Date Issued: 2018
- Authors: Ndzamela, Sisipo
- Date: 2018
- Subjects: Primary care (Medicine) -- South Africa -- Nelson Mandela Bay Municipality , Pharmacy -- Practice -- South Africa -- Nelson Mandela Bay Municipality Medical economics
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/22431 , vital:29969
- Description: Medicine stock-outs and shortages are being increasingly reported throughout South Africa. Primary healthcare centres are largely affected as many of them don’t have pharmacists and pharmacist support personnel to manage medicine stock levels. With the efforts to improve medicine availability and accessibility healthcare professionals have adopted informal networks through a borrowing system of medicines with other facilities The aim of this study was to explore and describe the experiences of patients and healthcare professionals of the unavailability of medicines at a primary healthcare (PHC) centre in the Nelson Mandela Bay Metropole. Using a qualitative approach, indepth interviews were conducted with 8 patients and 12 healthcare professionals including doctors, a pharmacist, pharmacy support personnel and nurses at a primary healthcare centre. These interviews were digitally recorded, transcribed and thematically analysed using Atlas.ti® network. The following major themes were identified; types of medicines that are unavailable, causes of stock-outs, psychological influence on both patients and healthcare professionals, compensatory measures and the central chronic dispensing and distribution program. Patient experiences included dissatisfaction and loss of confidence in the healthcare service delivery. Dissatisfied patients expressed emotions of anger and frustration. Also, unavailability of medicines resulted in stressed and burnt out healthcare professionals who have endured violence and verbal abuse from patients because of medicine stock-outs. Participants suggested that medicine stock-outs and shortages are most often due to delays in the delivery of stock by the depot. To counteract these effects healthcare professionals have adopted a borrowing system with other clinics. Furthermore, it was evident that the Central Chronic Medicine Dispensing and Distribution program (CCMDD) implemented by the Department of Health to improve availability and accessibility of medicines was perceived to be ineffective. Therefore, the issue of medicine stock-outs negatively affects service delivery, and those involved experience psychological harm which then affects inter-professional relationships. Overcoming this issue would promote a better healthcare system within the country.
- Full Text:
- Date Issued: 2018
Pharmacist perceptions of pharmacy support personnel in the pharmaceutical manufacturing sector in Port Elizabeth
- Authors: Worthington, Nicole
- Date: 2018
- Subjects: Pharmacists -- South Africa -- Port Elizabeth
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/42434 , vital:36659
- Description: Pharmacy support personnel (PSP) are employed across multiple pharmaceutical sectors in South Africa. They assist pharmacists in the manufacturing sector, while under their direct, personal supervision, to carry out the pharmacists’ functions listed in the South African Good Manufacturing Practice guidelines, within a defined scope of practice. Prior to 2013, all PSP training was workplace-based. The recent introduction of a university-based qualification for PSP has resulted in two routes for students to qualify as PSP. This study employed a qualitative, phenomenological design using semistructured interviews with pharmacists employed in pharmaceutical manufacturing. Their perceptions regarding PSP who had trained via the two training routes where interpreted through thematic analysis in order to determine whether a perceived difference in the abilities of the two cadres of PSP exists. Pharmacists generally expressed a more positive perception of PSP who qualified through the university-based programme. Strengths and weaknesses of both routes of training were identified, with areas of possible improvement identified for both programmes. Furthermore, a mutually supportive pharmacist – PSP relationship was deemed important in order to achieve optimal functionality in the workplace. The need for both pharmacists and PSP to be made aware of the roles that they play in this relationship was highlighted.
- Full Text:
- Date Issued: 2018
- Authors: Worthington, Nicole
- Date: 2018
- Subjects: Pharmacists -- South Africa -- Port Elizabeth
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/42434 , vital:36659
- Description: Pharmacy support personnel (PSP) are employed across multiple pharmaceutical sectors in South Africa. They assist pharmacists in the manufacturing sector, while under their direct, personal supervision, to carry out the pharmacists’ functions listed in the South African Good Manufacturing Practice guidelines, within a defined scope of practice. Prior to 2013, all PSP training was workplace-based. The recent introduction of a university-based qualification for PSP has resulted in two routes for students to qualify as PSP. This study employed a qualitative, phenomenological design using semistructured interviews with pharmacists employed in pharmaceutical manufacturing. Their perceptions regarding PSP who had trained via the two training routes where interpreted through thematic analysis in order to determine whether a perceived difference in the abilities of the two cadres of PSP exists. Pharmacists generally expressed a more positive perception of PSP who qualified through the university-based programme. Strengths and weaknesses of both routes of training were identified, with areas of possible improvement identified for both programmes. Furthermore, a mutually supportive pharmacist – PSP relationship was deemed important in order to achieve optimal functionality in the workplace. The need for both pharmacists and PSP to be made aware of the roles that they play in this relationship was highlighted.
- Full Text:
- Date Issued: 2018
Medication errors in a private hospital closed intensive care unit: a retrospective analysis of process change
- Authors: Cruickshank, Deborah Claire
- Date: 2017
- Subjects: Medication errors
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/15501 , vital:28259
- Description: Healthcare professionals should be concerned about the safety of the patients in their care and the references to patient safety go back as far as the Hippocratic Oath. Study of literature however shows that medical errors are still of concern and the majority of medical errors are medication errors. The aim of the study was to determine whether process changes introduced reduced both the medication prescribing and medication administration errors in the intensive care unit, thereby contributing to an increase in overall patient safety in the intensive care unit. This study retrospectively analysed the effect of the process changes on medication prescribing and administration errors. The research objectives were to: Identify the number and type of prescribing medication errors prior to the implementation of process changes; Identify the number and type of administration medication errors prior to the implementation of process changes; Identify the process changes implemented; o Determine number and type of prescribing medication errors post the implementation of process changes; Determine number and type of administration medication errors post the implementation of process changes; Assess whether the process changes affected the number and type of prescribing medication errors; and o Assess whether the process changes affected the number and type of administration medication errors. In the Phase One (1 November 2013 to 31 January 2014) 534 patient prescription charts for 172 patients were examined. Medication error rates of 57.6% (n=99) of individual patients reviewed and 18.4% of total patient prescription charts reviewed were found. A total of 69 medication prescribing errors were found in Phase One. This equates to an error percentage of 12.9% per patient chart reviewed and 40.1% per patient reviewed. Thirty medication administration errors were identified in Phase One of the study representing 17.4% of patients reviewed and 5.6% of patient prescription charts reviewed. Medication administration errors included both errors of commission, incorrect doses administered, (n=19) and omission, dose missed, (n=11). Process changes were then introduced and the results of these changes analysed in Phase Two (1 April 2014 to 31 December 2014) show an overall reduction in total medication errors with relation to number of patients reviewed from 57.6% in Phase One to 40.5% in Phase Two. In relation to number of prescription charts reviewed the medication error rate in Phase One was 18.4% and in Phase Two 14.4%. Prescribing errors in relation to number of patients reviewed reduced from 40.1% in Phase One to 26.19% in Phase Two. Overall reductions in percentage of errors were seen in all categories of prescribing errors except duplication of therapy which showed a slight increase. Based on the number of patients reviewed a reduction of prescribing errors was seen in the following categories: transcription errors (13.3% to 7.6%), anticoagulant not prescribed when indicated (3.5% to 2.4%), medication safety (5.2% to 2.9%), dose errors (9.3% to 6.6%) and duration of therapy (6.3% to 3.6%). An increase in the duplication of therapy error rate was seen (2.3% to 3.1%). There was also a reduction in administration errors in relation to number of patients reviewed with a total number of errors of 17.4% in Phase One and 15.8% in Phase Two. The number of prescribing errors per medication chart in Phase Two showed a statistically significant reduction (p=.002). A statistically significant reduction was also seen when the number of errors per patient was reviewed (p=.008). The total number of medication administration errors per medication chart showed a significant reduction (p=.042) as did the number of administration errors per patient (p=.003). When combining the total number of medication errors (both prescriobing and administration) a significant reduction was seen for both the number of charts reviewed (p=.001) and the number of patients reviewed (p=.002). These results indicate that the desired goal of increasing patient safety with regard to medication errors has been achieved but ongoing study is required to ensure the sustainability of the process changes.
- Full Text:
- Date Issued: 2017
- Authors: Cruickshank, Deborah Claire
- Date: 2017
- Subjects: Medication errors
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/15501 , vital:28259
- Description: Healthcare professionals should be concerned about the safety of the patients in their care and the references to patient safety go back as far as the Hippocratic Oath. Study of literature however shows that medical errors are still of concern and the majority of medical errors are medication errors. The aim of the study was to determine whether process changes introduced reduced both the medication prescribing and medication administration errors in the intensive care unit, thereby contributing to an increase in overall patient safety in the intensive care unit. This study retrospectively analysed the effect of the process changes on medication prescribing and administration errors. The research objectives were to: Identify the number and type of prescribing medication errors prior to the implementation of process changes; Identify the number and type of administration medication errors prior to the implementation of process changes; Identify the process changes implemented; o Determine number and type of prescribing medication errors post the implementation of process changes; Determine number and type of administration medication errors post the implementation of process changes; Assess whether the process changes affected the number and type of prescribing medication errors; and o Assess whether the process changes affected the number and type of administration medication errors. In the Phase One (1 November 2013 to 31 January 2014) 534 patient prescription charts for 172 patients were examined. Medication error rates of 57.6% (n=99) of individual patients reviewed and 18.4% of total patient prescription charts reviewed were found. A total of 69 medication prescribing errors were found in Phase One. This equates to an error percentage of 12.9% per patient chart reviewed and 40.1% per patient reviewed. Thirty medication administration errors were identified in Phase One of the study representing 17.4% of patients reviewed and 5.6% of patient prescription charts reviewed. Medication administration errors included both errors of commission, incorrect doses administered, (n=19) and omission, dose missed, (n=11). Process changes were then introduced and the results of these changes analysed in Phase Two (1 April 2014 to 31 December 2014) show an overall reduction in total medication errors with relation to number of patients reviewed from 57.6% in Phase One to 40.5% in Phase Two. In relation to number of prescription charts reviewed the medication error rate in Phase One was 18.4% and in Phase Two 14.4%. Prescribing errors in relation to number of patients reviewed reduced from 40.1% in Phase One to 26.19% in Phase Two. Overall reductions in percentage of errors were seen in all categories of prescribing errors except duplication of therapy which showed a slight increase. Based on the number of patients reviewed a reduction of prescribing errors was seen in the following categories: transcription errors (13.3% to 7.6%), anticoagulant not prescribed when indicated (3.5% to 2.4%), medication safety (5.2% to 2.9%), dose errors (9.3% to 6.6%) and duration of therapy (6.3% to 3.6%). An increase in the duplication of therapy error rate was seen (2.3% to 3.1%). There was also a reduction in administration errors in relation to number of patients reviewed with a total number of errors of 17.4% in Phase One and 15.8% in Phase Two. The number of prescribing errors per medication chart in Phase Two showed a statistically significant reduction (p=.002). A statistically significant reduction was also seen when the number of errors per patient was reviewed (p=.008). The total number of medication administration errors per medication chart showed a significant reduction (p=.042) as did the number of administration errors per patient (p=.003). When combining the total number of medication errors (both prescriobing and administration) a significant reduction was seen for both the number of charts reviewed (p=.001) and the number of patients reviewed (p=.002). These results indicate that the desired goal of increasing patient safety with regard to medication errors has been achieved but ongoing study is required to ensure the sustainability of the process changes.
- Full Text:
- Date Issued: 2017
- «
- ‹
- 1
- ›
- »