CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Os Erros de MedicaÃÃo (EM) sÃo um importante desafio a ser superado na promoÃÃo do uso racional de medicamentos, fator contribuinte para o desenvolvimento de serviÃos de saÃde eficazes e seguros para os pacientes. EM podem ocorrer em vÃrias etapas da cadeia de utilizaÃÃo de medicamentos. No Brasil, pouco se conhece sobre o perfil dos erros e sobre a seguranÃa do processo de prescriÃÃo. Baseado na abordagem sistÃmica do erro foi realizado um estudo exploratÃrio, com determinaÃÃo da taxa de prevalÃncia de erros de prescriÃÃo clinicamente significativos (TPEPCS) e da taxa de seguranÃa do processo de prescriÃÃo de medicamentos (TSPPM) nas unidades de Cardiologia, Pneumologia e Pediatria de um hospital de referÃncia do CearÃ. No perÃodo de 20 de agosto a 03 de setembro de 2007, em dias alternados, foram analisadas 140 prescriÃÃes mÃdicas (PM), totalizando 1017 itens contendo medicamentos. A maioria das PM (75% - n=105) foram recebidas pelo serviÃo de farmÃcia no turno da tarde, 61,4% (n=86) pertencia a pacientes do sexo masculino e 22,2% (n=31) pertencia a pacientes com idade de 60 a 69 anos. No prontuÃrio dos pacientes das PM selecionadas, nÃo houve relato de alergia a medicamentos em 83,6% (n=117), nem registro do peso em 60% (n=84). Quanto aos componentes legais da prescriÃÃo, houve ausÃncia do registro do nÃmero do prontuÃrio em 63,3% (n=89), da unidade de internaÃÃo em 59,3% (n=83), do carimbo do prescritor em 28,6% (n=40) e da assinatura do mÃdico em 15% (n=21). Foram identificadas interaÃÃo medicamento-medicamento em 28,6% (n=40) das PM, interaÃÃo medicamento-alimento em 14,3% (n=20) e erros de prescriÃÃo clinicamente significativos (EPCS) em 25,9%, (n=30) sendo o mais recorrente a detecÃÃo de interaÃÃo medicamentosa potencialmente significante (26,61% - n=95). Boa parte dos medicamentos envolvidos nos EPCS (63,3% - n=201) pertenceu a classe terapÃutica de medicamentos cardiovasculares e houve a suspeita de ReaÃÃo Adversa a Medicamentos em apenas 1,8% (n=18) dos medicamentos prescritos. A denominaÃÃo mais utilizada na prescriÃÃo dos medicamentos foi a genÃrica (60,2% - n=612) e a concentraÃÃo nÃo foi prescrita em 56,4% (n=574) dos itens contendo medicamentos. Foi prescrito o diluente em 35,1% (n=65) dos medicamentos classificados como injetÃveis, enquanto nÃo foi prescrita a velocidade de infusÃo em 59,3% (n=121) dos injetÃveis e soluÃÃo para hidrataÃÃo. TambÃm foram prescritas informaÃÃes adicionais em 14,7% (n=150) dos itens contendo medicamentos e utilizadas abreviaturas em 97,6% (n=993) destes, sendo mais comum a abreviatura da via de administraÃÃo (36% - n=833). Ao final, foram calculadas a TPEPCS (35,10%) e TSPPM (64,9%), indicando a necessidade da reavaliaÃÃo do processo de prescriÃÃo e implementaÃÃo das estratÃgias educacionais. Portanto, a identificaÃÃo da taxas referidas constitui o primeiro passo na busca da prevenÃÃo de erros. PorÃm, para que ela possa estabelecer-se no Ãmbito hospitalar, sem propiciar um ambiente de puniÃÃes, faz-se necessÃrio que a responsabilidade pela seguranÃa do paciente seja vista como coletiva e que a abordagem sistÃmica do erro seja aplicada cotidianamente. / Medication errors are a great challenge to the rational use of drugs, which is a significant contributing factor to the development of effective and safe health assistance services to patients. Medication errors can occur at various stages in the drug use process. In Brazil, little is known about the profile of errors and the prescription process safety. In order to determine the prevalence rate of errors in prescribing clinically significant drugs (PREPCS) and the safety rate on prescription drug procedures (SRPDP), an exploratory study based on an approach in systematic error estimation was carried out at Cardiology, Pneumology and Pediatrics Units of a reference hospital in the State of CearÃ. From August 20 to September 3, 2007, on alternate days, 140 medical prescription â totaling 1,017 items containing drugs â were analyzed. Most medical prescriptions (75% - n=105) were received by the department of pharmacy in the afternoon shift; 61.4% (n=86) had been given to male patients and 22.2% (n=31) had been given to patients between 60 to 69 years of age. In 83.6% (n=117) of records of patients to whom the selected medical prescriptions had been given, no allergy to drugs were reported, and in 60% (n=84) of them the patientsâ weight was not informed. In regard to the legal components of the prescriptions, the patient record number was not informed in 63.3% (n=89) prescriptions; the hospital unit was not informed in 59.3% (n=83) prescriptions; the prescriberâs stamp was not stamped in 28.6% (n=40) prescriptions; and 15% (n=21) prescriptions had not been signed by the doctor. Drug-drug interactions were identified in 28.6% (n=40) medical prescriptions; drug-food interactions were identified in 14.3% (n=20) medical prescriptions; and clinically significant prescription errors (CSEP) were found in 25.9% (n=30) medical prescriptions, and the detection of potentially significant drug interactions (26.61% - n=95) was the most recurrent. Most drugs involved in CSEP (63.3% - n=201) belonged to a therapeutic class of cardiovascular medicines and there was suspicion of Adverse Drug Reaction in only 1.8% (n=18) of the prescription drugs. Generic names were most commonly used in the medical prescriptions (60.2% - n=612); and the concentration was not prescribed in 56.4% (n=574) of items containing drugs. The dilluent was prescribed in 35.1% (n=65) of injection drugs, while no infusion speed and hydration solution were prescribed in 59.3% (n=121) of injection drugs. Additional information was prescribed in 14.7% (n=150) of the items containing drugs; and abbreviations were used in 97.6% (n=993) of them, and administration routes were the most common abbreviations used (36% - n =833). And finally, the PREPCS (35.10%) and SRPDP (64.9%) were ascertained, thus indicating the need to reevaluate the process of prescribing and implementing educational strategies. Therefore, the identification of the aforesaid rates is the first step to be taken in order to prevent errors. However, in order to use them at hospitals without creating a punishment environment, the responsibility for the patientâs safety must be collective and an approach in systematic error estimation must be made regularly.

Bakgrund: Läkemedel är den vanligaste behandlingsformen inom sjukvården och samtidigt det är det bästa och mest effektiva alternativet, så är användningen av läkemedel förenat med risker och bieffekter. Dessa bieffekter är en av de ledande anledningarna till dödsfall i de flesta länder. Upp till 60 % av läkemedelsrelaterade problem skulle kunna undvikas. Det kan vara ett fel som kommer att skada, eller har potential att skada patienten, även kallad undvikbar läkemedelsavvikelse, som kan förekomma i läkemedelskedjan. I SVerige avlider 3150 personer per år av sådana skador. Syfte: Syftet med studien är att beskriva de undvikbara läkemedelsavvikelser som har rapporterats inom Synergi i Landstinget i Östergötland under 2011. Metod: Genomgång av landstinget avvikelserapporteringssystem Synergi med rapporter relaterade till läkemedel. Utifrån beskrivningen i fritexten bedömdes det som det handlade om en undvikbar läkemedelsavvikelse. Resultat: Under 2011 inkom 2750 rapporter varav 2320 klassades som undvikbara läkemedelsavvikelser och 6,7 % (n=155) av dessa ledde till skador. En patient avled till följd av en undvikbar läkemedelsavvikelse. Den vanligaste typen av fel var brist i rutin (n=1255) och vanligaste konsekvensen var uteblivna doser (n=604). Warfarin var det läkemedel som förekom i flest rapporter (n=140), medan uteblivna/för låga doser av heparin ledde till flest allvarliga skador (n=3). Slutenvården stod för 52 % (n=1211) av alla rapporter och även 80 % (n=125) av skadorna. Slutsats: Bristande rutiner kan vara en vanlig orsak till läkemedelsavvikelser. Därför behöver den svenska sjukvården satsa på att förbättra och förenkla sina rutiner, både mellan avdelningar och enskilt för att förbättra patientsäkerheten. Den har kommit en bit på väg, men behöver tydligare riktlinjer och mer utbildning och information till både avdelningar och de enskilda personer som arbetar inom sjukvården. / Background: Drugs are the most common way to treat illnesses in healthcare and the best and most efficient alternative. At the same time you must keep i mind that the use of drugs is always associated with risks and side effects. These side effects or adverse drug reactions are among the leading causes of death in many countries. At least 60 % of adverse drug reactions are preventable. A preventable drug reation is called a medication error. A medication error occurs when a failure in the treatment leads to harm to the patient, or has the potential to lead to harm to the patient. The treatment process is a chain of several events, from the diagnosis of an illness and the choice of drugs, to monitoring the administration. There are many steps from start to the end that all have the potential to lead to mistakes. Medication errors can lead to great costs for healthcare, poor quality of life for the patient or even death. In Sweden it is estimated that 3150 patients die annually caused by medication errors. Purpose: The purpose of this study was to describe medication errors in Landstinget i Östergötland (the County Council of Östergötland) in 2011. Method: Search was done through the error report system, Synergi, with medication error as a priority. From the description in the primary text judge if the report described a medication error. Results: During 2011 2750 reports were submitted to Synergi, and 2320 of these were identified as medication errors. 6,7 % (n=155) of these medication errors had caused harm to the patient, one of them died due to medication error. The most common type of failure was some sort lack of routine (n=1255) and it usually lead to errors of omission; whern a dose that should have been given was not (n=604). Warfarin, an anticoagulantia, was the most frequent drug in the reports (n=140), while a low dose/missed dose of heparin, another anticoagulantia, lead to harm that was classified as serious, to the patients (n=3). MOre than halfr of the reports were fro inpatient care, 52 % (n=1211) and also 80 % (n=125) of medication errors that caused harm to the patients. Conclusion: Lack of routine can be a major cause of medication errors and therefore Swedish healthcare needs to improve routines and even simplify them for easier and faster access for the staff. The cooperation between members of the staff in hospitals, health centers and community home care sholud be better to improve the safety of patients. The healthcare needs more guidance and education to overcome the lack of routines and even more resources for a labor intensive activity where the need for healthcare is increasing

Background: Drug administration is a main duty of a nurse’s clinical role. It involves great risk in patients’ lives and can potentially cause great harm. Despite many safeguards, preventable medication errors still occur. The aim of this descriptive quantitative study is to explore geriatric nurses’ perceptions of medication errors, perceived causes and their reporting behaviours. Methods: A self- report standardized survey was used to collect data from a purpose sample of nurses (n=17) working on geriatric wards at the Montfort hospital located in the province of Ontario. Data entry and analysis were done by using Statistical Package for the Social Sciences (SPSS) version 12 and presented using frequencies, number and percentage. Results: The most frequently identified causes of medication errors were failure to check patient’s name band with the patient’s medication administration record (MAR), nurses' tiredness, illegible physician handwriting, and nurses’ miscalculations of medication doses. In general, nurses were usually sure of constitutes a medication error and when to report it. However, only 30% of errors were perceived by nurses to be reported to the nurse manager. More than half (64.7%) of participants perceived that, some errors are not reported because nurses are afraid of the reaction they will receive from the nurse manager and the majority of them will notify the physician than to complete an incident report. Conclusion: Recognizing a medication error is the first step to reduce report and eliminate them, especially in acute care settings. Finding suggests that nurses need more educational reenforcement as to various issues related to medication errors, particularly defining and reporting these errors. Furthermore, the introduction of hospital policies and the development of structured protocols on drug administration may decrease medication errors. The hospital administration system needs to stress the importance of reporting errors and adopt a non-punitive approach to safeguard patient safety.

Doctor of Philosophy / Department of Statistics / Weixing Song / In this dissertation, goodness-of-fit tests are proposed for checking the adequacy of parametric distributional forms of the regression error density functions and the error-prone predictor density function in measurement error models, when replications of the surrogates of the latent variables are available. In the first project, we propose goodness-of-fit tests on the density function of the regression error in the errors-in-variables model. Instead of assuming that the distribution of the measurement error is known as is done in most relevant literature, we assume that replications of the surrogates of the latent variables are available. The test statistic is based upon a weighted integrated squared distance between a nonparametric estimate and a semi-parametric estimate of the density functions of certain residuals. Under the null hypothesis, the test statistic is shown to be asymptotically normal. Consistency and local power results of the proposed test under fixed alternatives and local alternatives are also established. Finite sample performance of the proposed test is evaluated via simulation studies. A real data example is also included to demonstrate the application of the proposed test. In the second project, we propose a class of goodness-of-fit tests for checking the parametric distributional forms of the error-prone random variables in the classic additive measurement error models. We also assume that replications of the surrogates of the error-prone variables are available. The test statistic is based upon a weighted integrated squared distance between a non-parametric estimator and a semi-parametric estimator of the density functions of the averaged surrogate data. Under the null hypothesis, the minimum distance estimator of the distribution parameters and the test statistics are shown to be asymptotically normal. Consistency and local power of the proposed tests under fixed alternatives and local alternatives are also established. Finite sample performance of the proposed tests is evaluated via simulation studies.

Class of 2016 Abstract / Objectives: Analyze electronic prescription errors made by a community health center. Determine the time it takes to correct electronic prescription errors in a community pharmacy. Ascertain whether or not a collaborative practice agreement would be beneficial. Methods: The store computer system was used to generate a report of all prescriptions received at a community pharmacy from a community health center during a 6-month period. Using an Excel sheet, one author kept track of how many electronic prescriptions were received, the number and type of errors, and the time it took to get an error corrected. Results: There were 1896 electronic prescriptions sent from a community health center to a community pharmacy; 61 contained an error (3.24%). On average, it took the doctor’s office 111.7 hours to call back and clarify the mistake. Conclusions: There was not a significant amount of prescribing errors that occurred during the data collection period. However, the time it took for the doctor’s office to call back was significant and translates to patients not being able to get their medications on time.

M.Phil. / Cataracts have been identified as one of the leading causes of blindness, especially in the developing world. The only presently known effective treatment for this growing problem is surgical removal of the opaque lens followed by replacement with an artificial intra ocular lens. Newer methods have brought greater success, and greater costs. For people in the developing world, these newer methods are not always an option. Together with the increased cost, there is a growing demand because of this worldwide problem. This increased need for surgery has lead to the development of waiting lists in the state funded hospitals. To qualify for a cataract extraction in most state funded hospitals, a best visual acuity of 6/60 is required, compared to the 6/12 to 6/24 levels required in the industrial countries and private practices. With these levels of visual impairment in the developing world, many patients are left functionally blind for long periods of time until cataract extraction can be performed. Older methods such as extra-capsular cataract extraction are still being used in the developing world. This is mostly due to the increased density of the cataracts at the time when the extraction can be performed because of the long waiting time leading to further maturation of the cataract. This method requires a large corneal incision, which is normally closed with nylon sutures. With this method of surgery meticulous wound closure is very important, and in many cases surgically induced astigmatism is one of the unwanted consequences. It was therefore decided, for the purpose of this study, to use autokeratometric data to explore the refractive effects of two different methods of corneal wound closure following planned extra-capsular cataract extraction (ECCE). Astigmatism is a major problem associated with extra capsular cataract extraction, especially when the wound is closed by means of sutures. Studies by Minassian et al. (2001), Jacobi (2003) and Dowler et al. (2000) all show that newer methods of cataract extraction making use of smaller incisions and therefore fewer sutures show faster recovery and less astigmatism. These methods are however mostly restricted to private practice, and therefore potentially unsuited for use in developing countries. The type of material used for wound closure is another very important factor. Depending on the method of suturing wound gape and wound compression can cause increased amounts of astigmatism. Using a method of wound closure that would cause less traction on the cornea could therefore cause less of a problem postoperatively. Tissue adhesives such as Tisseel® fibrin glue could be such an alternative. Studies by Henrick et al. (1987), Kim and Kharod (2007) and Bhatia (2006) show that fibrin glue forms a watertight, non irritating wound while promoting the healing process by the cross linking of collagen fibres.

No description available.

Magister Pharmaceuticae - MPharm / The objectives of the present study were to describe the type and frequency of prescribing errors and error frequency, to determine the error frequency for different drug classes, to identify potential drug interactions and drug-disease interactions to point out off-label prescribing and to evaluate risk factors of prescribing errors. Methods: This prospective cross sectional study was conducted over a period of 6 months from July 2012 to December 2012 in 2 specialist wards and 2 general medical wards at Red Cross War Memorial Children’s Hospital in Cape Town in South Africa. Only prescriptions generated by doctors in the above mentioned wards were assessed. Convenience sampling was used to select 200 prescription charts for analysis. Information relating to prescribing error, potential drug interaction, potential drug-disease interactions, off-label prescribing and potential risk factors of prescribing error were entered into excel spreadsheet and analysed using STATA versions 11&12. The mass of the patients was converted into weight-for-age z-score (WAZ) using WHO 2006 child growth standards. Univariate analysis and multiple logistic regression were used to identify risk factors of prescribing errors. Results: Of the 200 children on whom prescribing information was analysed, 40 (20%) were severely underweight and a further 25(12.5%) were moderately underweight. A total of 1402 prescribing errors were documented in 1282 drug items prescribed, a rate of 1.09 errors per drug item prescribed. Incomplete prescription information was the most common type of prescribing error, present in 65.6% of all drug items prescribed. The error frequency was high for all drug classes ranging from 57.9% of all respiratory drug items prescribed to 86.4% of all gastro intestinal system drug items prescribed. The number of potential drug-drug interactions was low i.e. 20 potential pharmacodynamics and 49 potential pharmacokinetic drug interactions were identified. The number of potential drug-disease interactions was also low i.e. 39 or 0.03% per drug item prescribed. Furthermore 57 off-label prescribing incidences were recorded. Senior doctors posed a significant risk factor for prescribing errors, an OR 1.95, 95% CI 1.46 – 2.61. Conversely, prescriptions written up in the general wards compared to the specialty wards (an OR 0.65. 95% CI 0.47-0.90) and prescribing during weekends compared to weekdays (an OR 0.71, 95% CI 0.53-0.96) were associated with lower prescribing error risk. Conclusion: This study provided valuable information about prescribing practices in children at RCWMCH. There is a need to improve prescribers’ practice at RCWMCH considering the type of errors observed viz. missing information, use of wrong drug name, abbreviations, legibility concerns and lack of clarity of the prescriptions, among others. Based on this study results further intervention studies are recommended to investigate the level of medical student’s training w.r.t prescribing practice.

>Magister Scientiae - MSc / There exists an extensive statistics literature dealing with non-parametric deconvolution, the estimation of the underlying population probability density when sample values are subject to measurement errors. In parametric deconvolution, on the other hand, the data are known to be from a specific distribution. In this case the parameters of the distribution can be estimated by e.g. maximum likelihood. In realistic cases the measurement errors may be heteroscedastic and there may be unknown parameters associated with the distribution. The specific realistic case is investigated in which the measurement error standard deviation is proportional to the true sample values. In this case it is shown that the method of moment’s estimation is particularly simple. Estimation by maximum likelihood is computationally very expensive, since numerical integration needs to be performed for each data point, for each evaluation of the likelihood function. Method of moment’s estimation sometimes fails to give physically meaningful estimates. The origin of this problem lies in the large sampling variations of the third moment. Possible remedies are considered. Due to the fact that a convolution integral needed to be calculated for each data point, and that this has to be repeated for each iteration towards the solution, maximum likelihood computing cost is very high. New preliminary work suggests that saddle point approximations could sometimes be used for the convolution integrals. This allows much larger datasets to be dealt with. Application of the theory is illustrated with simulation and real data.

Spelling is one of the most important components of writing at single-word level and is regarded as a vital part of written communication. Also spelling is seen as an important tool in writing. Without the ability to spell as a broader aspect of writing, a person could not be called literate in the conventional sense of the word. Although the spelling is so important, learners in the foundation phase especially in grade three commit interlingual spelling errors. This means that at this stage learners transfer patterns of the mother tongue to the second language. By so doing that they write English words as the way they are pronounced in their mother tongue. Hence this study investigated grade three teachers’ strategies to help English second language learners overcome interlingual spelling errors. In exploring these strategies this study adopted a qualitative approach in order to ensure reliability and validity of the study. The data gathering instruments used included semi-structured interviews, classroom observations and document analysis. One primary school in Mdantsane a township in East London District was purposively selected to form the context of the study. The medium of instruction in this school is isiXhosa in the foundation phase and English is taught as a subject. Two teachers and their classes participated in this study. The findings of the study revealed that different factors contribute to interlingual spelling errors. These factors are status of the parent (they were illiterate), pronunciation, language borrowing and language transfer. It is also revealed that teachers have a limited number of strategies to teach learners overcome interlingual spelling errors instead they use strategies to teach spelling generally.