Dose 4 You: Dose Division Calculator-A Tool to Reduce Calculation Errors.

Background: Medication dosing calculation errors can cause significant harm to patients, especially in the pediatric population. Crushing tablets for dose division purposes may increase the risk of calculation errors, which can lead to incorrect dosing and compromised patient safety. This study aimed to develop a calculator to eliminate calculation errors associated with dose division. Methods: Using the Wix platform, a group of pharmacists created a user-friendly webpage "Dose 4 You." To enable accurate dose division calculations, the advanced language model Chat GPT and Visual Studio were used. The tool assists healthcare professionals through a step-by-step process, allowing them to enter the necessary dose and medication requirements. The Dose 4 You web page's reliability and feasibility were assessed using retrospective data and validated questionnaires, including the System Usability Scale (SUS), respectively and a Likert scale-based acceptance questionnaire. Results: The Dose 4 You website calculated the required amount of powdered tablet to achieve the desired dose with 100% accuracy. The obtained SUS score was 88.38, indicating excellent usability. The average score of all questions for acceptance was found to be 4.7 ± 0.15 indicating a strong agreement on the tool's usefulness and effectiveness. Conclusion: Dose 4 You is a reliable tool that improves patient safety by streamlining dose calculations and lowering calculation errors. The tool's ease of use, practicality in daily clinical practice, and potential to reduce medication errors are highlighted by the positive perception among healthcare professionals. Dose 4 You's successful implementation demonstrates the power of technology and collaboration in transforming medication administration and improving patient outcomes. Similar innovative solutions to optimize healthcare practices can be explored in future health informatics endeavors.

Development of the EldenCare application: Empowering physicians and clinical pharmacists towards enhancing elderly care.

The growing healthcare burden on the elderly population, combined with an increase in prescription drug use, necessitates the development of novel solutions for improving elderly care. EldenCare connects doctors, clinical pharmacists, and elderly patients. EldenCare was developed by a multidisciplinary team comprising geriatricians, clinical pharmacists, and software engineers. The software offers various features tailored to the needs of each user group, revolutionizing medication management and patient care. For geriatricians, EldenCare provides efficient means of recording patient information, scheduling appointments, and documenting follow-up. Clinical pharmacists can take advantage of the software's advanced features, including identifying medication risks, facilitating dose adjustments, identifying potentially inappropriate medications, and tracking adverse drug reactions. Elderly patients benefit from features such as medication alerts, appointment management, medication lists and an adverse drug reaction diary. The study is divided into five distinct phases: requirements phase, design phase, coding & unit testing phase-frontend, coding & unit testing phase-database/cloud, testing phase. The expected benefits of the EldenCare software include increased medication safety, improved communication between healthcare providers and patients, and improved healthcare outcomes for older adults. EldenCare aims to revolutionise medication management and promote a patient-centered healthcare system by empowering clinical pharmacists and engaging older adults in their care-using technology.

Assessment of Medication Safety Incidents Associated with High-alert Medication Use in Intensive Care Setting: A Clinical Pharmacist Approach.

Background: High-alert medications (HAMs) potentiate heightened risk of causing patient harm ranging from 0.24 to 89.6 errors per 100 prescriptions. High-alert medications are crucially utilized in the intensive care settings (ICUs) due to their excellent potential in delivering therapeutic efficacy, yet these medications could cause severe harm if used inappropriately. Despite the cautious use of these medications, medication safety issues persist, which compromises patient safety. Methods: A prospective interventional study was conducted in ICUs for a period of 6 months. The HAMs were adopted from the Institute for Safe Medication Practices (ISMP) list of HAMs that were used. A suitably designed medication error assessment form was used to capture the necessary data, including demographics, medications, medication error, and the contributing factors. The National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) index was used to categorize the medication errors (MEs). The error rate was calculated using error rate formula. Continuous variables were expressed as mean ± standard deviation, whereas categorical variables were presented in frequencies and percentages. Results: A total of 165 patients were enrolled during the study period, with 98 (59.4%) being male and 67 (40.6%) female. The majority [54 (32.73%)] of the study participants belonged to the 61-70 age range. A total of 204 MEs were reported, of which [92 (41.5%)] errors were prescribing errors, followed by documentation errors [69 (33.82%)] and administration errors [43 (21.08%)]. The baseline medication error rate was noted to be 160.12/1,000 patient days. Potassium chloride, tramadol, propranolol, aspirin, insulin, and metoprolol were identified as the most common HAMs to cause errors. According to NCC MERP classification, 41.18% were categorized as category B, followed by category C (35.78%). An overall of 666 contributing factors (CFs) were identified for 204 errors. Stress (24.32%) was the most common factor that contributed to the MEs, followed by workload (21.47%). Conclusion: While great strides have been adopted in error prevention, yet the goal of making HAM errors "never" event has not been achieved. Thus, an active surveillance by a clinical pharmacist could support the healthcare team in promoting patient care. How to cite this article: Aradhya PJ, Ravi R, Subhash Chandra BJ, Ramesh M, Chalasani SH. Assessment of Medication Safety Incidents Associated with High-alert Medications Use in Intensive Care Setting: A Clinical Pharmacist Approach. Indian J Crit Care Med 2023;27(12):917-922.

Artificial intelligence in the field of pharmacy practice: A literature review.

Artificial intelligence (AI) is a transformative technology used in various industrial sectors including healthcare. In pharmacy practice, AI has the potential to significantly improve medication management and patient care. This review explores various AI applications in the field of pharmacy practice. The incorporation of AI technologies provides pharmacists with tools and systems that help them make accurate and evidence-based clinical decisions. By using AI algorithms and Machine Learning, pharmacists can analyze a large volume of patient data, including medical records, laboratory results, and medication profiles, aiding them in identifying potential drug-drug interactions, assessing the safety and efficacy of medicines, and making informed recommendations tailored to individual patient requirements. Various AI models have been developed to predict and detect adverse drug events, assist clinical decision support systems with medication-related decisions, automate dispensing processes in community pharmacies, optimize medication dosages, detect drug-drug interactions, improve adherence through smart technologies, detect and prevent medication errors, provide medication therapy management services, and support telemedicine initiatives. By incorporating AI into clinical practice, health care professionals can augment their decision-making processes and provide patients with personalized care. AI allows for greater collaboration between different healthcare services provided to a single patient. For patients, AI may be a useful tool for providing guidance on how and when to take a medication, aiding in patient education, and promoting medication adherence and AI may be used to know how and where to obtain the most cost-effective healthcare and how best to communicate with healthcare professionals, optimize the health monitoring using wearables devices, provide everyday lifestyle and health guidance, and integrate diet and exercise.

A Clinical Pharmacist-led Approach on Reducing Drug Related Problems Among Patients with Neurological Disorders: An Interventional Study.

Background: Neurological disorders are common in the general population and the majority of patients have other chronic diseases, necessitating the use of multiple medications, which increases the incidence of drug-related problems (DRPs). Studies from different countries discovered an average of 0.29-1.45 DRPs per patient admitted into the neurology unit. Objectives: To identify common DRPs and to evaluate the impact of clinical pharmacist's interventions in resolving the identified DRPs in patients with neurological disorders. Methods: A prospective interventional study was conducted in the Department of Neurology in a tertiary care teaching hospital in Southern India, for a period of six months. Patients aged ≥18 years and had been hospitalized for >24 h, were intensively monitored until discharge for the occurrence of any DRPs and pharmacist interventions were provided. The identified DRPs were classified according to Hepler and Strand's Classification. Results: A total of 310 prescriptions were reviewed, of which 174 patients (mean age 45.93 ± 2.49 years) experienced at least one DRP during their hospital stay. The average DRP per patient was found to be 1.75, with drug-drug interactions [254 (83%)] being the predominant DRPs, followed by adverse drug reactions [13 (4%)], and drug duplications [9 (3%)]. Most of the drug-drug interactions were pharmacokinetic [144 (56.69%)]. Hyponatremia [2 (15%)]; and nausea and vomiting [2 (15%)] were most commonly reported ADRs. All 306 DRPs involved active clinical pharmacist intervention, of which [275 (89.87%)] of pharmacists' interventions were accepted, which led to modification of the therapy. Conclusion: Monitoring the use of drugs allowed the clinical pharmacist to detect DRPs and to suggest interventions that promote rational drug prescribing, therapy optimization and enhanced patient safety.

Materiovigilance in Intensive Care Units: An Active Surveillance.

Background: Medical devices are the vital part of healthcare system. The use of medical devices is higher in the intensive care units leading to increased exposure rendering the exponential rise in incidence of medical device associated adverse events (MDAEs). Timely detection and reporting of MDAEs can help reduce the disease and associated liabilities. Objective: To determine the rate, patterns, and predictors of MDAEs. Methods: An active surveillance was carried out in the intensive care units (ICUs) of a tertiary care teaching hospital located in southern India. The patients were monitored for MDAEs which were reported based on MvPI guidance document 1.2. The predictors were calculated using an odds ratio at 95% confidence interval. Results: A total of 185 MDAEs were reported amongst 116 patients, of which the majority [74 (63.7%)] were males. Most of the MDAEs were attributed to urethral-catheters [42 (22.7%)] among which a high majority of 34 were associated with urinary tract infections (UTI), followed by ventilators [35 (18.9%)] with all events causing pneumonia. Urethral catheters and ventilators are both classified as categories B and C respectively based on device risk classification provided by the Indian Pharmacopoeia Commission (IPC). Over 58% of MDAEs were reported among the elderly. The causality assessment was possible for 90 (48.6%) MDAEs whereas 86 (46.4%) were probable. The majority of the MDAEs reported were serious [165 (89.2%)] and only [20 (10.8%)] were found to be non-serious on the severity scale. Most [104 (56.2%)] of the devices attributed to MDAEs were single-use devices, of which [103 (55.6%)] were destroyed and only [81 (43.7%)] were retained in healthcare facilities. Conclusions: Despite the best possible care in the intensive care units (ICUs), MDAEs are inevitable, adding to the burden of patients in terms of suffering, disease, extended hospital stay, and increased costs. MDAEs require rigorous monitoring of patients, especially in the elderly population and patients with increased exposure to multiple devices.

Amiodarone-Induced Hyponatremia in An Elderly Patient: A Rare Case Report.

Amiodarone is an antiarrhythmic drug belonging to Vaughan-Williams Class III with additional Class IV effects, which is known to cause many adverse drug reactions (ADRs) necessitating close monitoring. In about 20% of patients, their therapy is discontinued due to adverse effects such as hepatic impairment, thyroid dysfunction, and several pulmonary complications. Although dyselectrolytemia is a common adverse reaction reported with many cardiac medications, the incidence of hyponatremia associated with amiodarone intake is not reported widely in the literature. We are reporting a case of a 73-year-old female patient, with hypertension and ischemic heart disease (IHD) receiving oral amiodarone, presenting with severe hyponatremia, requiring recurrent hospitalization. Amiodarone was found to be responsible after evaluating for the possible causes of hyponatremia. As the incidence of amiodarone-associated hyponatremia is unknown, and not many cases are reported, this case report serves to sensitize the clinician to consider amiodarone-induced hyponatremia as one of the differential diagnoses in cases of unexplained hyponatremia.

Ethical considerations and clinical trials during a pandemic: A blessing with a burden.

Any healthcare systems during a pandemic undergo tremendous pressure in pursuit of effective treatment to treat and limit the spread of the disease and its implications. Conducting clinical trials to find the potential therapy is the only way to battle the current coronavirus disease-2019 pandemic. The majority of the countries have joined the cause and are carrying out clinical studies in various capacities. As a result, the ethical committees have encountered a sudden inflow of a large number of trial proposals that have placed them under pressure. Although ethical committees play a vital role in protecting patient safety and preserving research integrity, they need to make sure the efficiency and integrity of review are preserved and the standards of review are not relaxed. Thus, the participants' dignity is well guarded while keeping a close check on their safety.

Leukocytoclastic Vasculitis Following COVID-19 Vaccination: A Case Report.

Background: Hypersensitivity or Leukocytoclastic vasculitis (LCV) following the COVID-19 vaccination has been reported rarely all over the world. LCV can be induced by certain factors such as infections, autoimmune disorders, malignancy, or some classes of drugs. Case presentation: A 32-year-old man, who was a known case of seizure disorder from his childhood presented to the department of dermatology with itchy red lesions on extremities and abdomen for the past 1 month. He explains a history of COVID-19 vaccination 1-month back and experienced itching on his lower limbs on the same day at night. A gradual worsening of the condition was observed day by day. He was hospitalized and diagnosed as LCV through clinical and laboratory findings. Conclusion: This case highlights a temporal association with the event of vaccination. The causality assessment showed an indeterminate causal association to LCV with COVID-19 Vaccination.

Antifungal therapy in the management of fungal secondary infections in COVID-19 patients: A systematic review and meta-analysis.

OBJECTIVES: The prevalence of fungal secondary infections among COVID-19 patients and efficacy of antifungal therapy used in such patients is still unknown. Hence, we conducted this study to find the prevalence of fungal secondary infections among COVID-19 patients and patient outcomes in terms of recovery or all-cause mortality following antifungal therapy (AFT) in such patients. METHODS: We performed a comprehensive literature search in PubMed®, Scopus®, Web of Sciences™, The Cochrane Library, ClinicalTrial.gov, MedRxiv.org, bioRxiv.org, and Google scholar to identify the literature that used antifungal therapy for the management fungal secondary infections in COVID-19 patients. We included case reports, case series, prospective & retrospective studies, and clinical trials. Mantel Haenszel random-effect model was used for estimating pooled risk ratio for required outcomes. RESULTS: A total of 33 case reports, 3 case series, and 21 cohort studies were selected for final data extraction and analysis. The prevalence of fungal secondary infections among COVID-19 patients was 28.2%. Azoles were the most commonly (65.1%) prescribed AFT. Study shows that high survival frequency among patients using AFT, received combination AFT and AFT used for >28 days. The meta-analysis showed, no significant difference in all-cause mortality between patients who received AFT and without AFT (p = 0.17), between types of AFT (p = 0.85) and the duration of AFT (p = 0.67). CONCLUSION: The prevalence of fungal secondary infections among COVID-19 patients was 28.2%. The survival frequency was high among patients who used AFT for fungal secondary infections, received combination AFT and AFT used for >28 days. However, meta-analysis results found that all-cause mortality in COVID-19 patients with fungal secondary infections is not significantly associated with type and duration of AFT, mostly due to presence of confounding factors such as small number of events, delay in diagnosis of fungal secondary infections, presence of other co-infections and multiple comorbidities.

Impact of pharmacist care in the management of autoimmune disorders: A systematic review of randomized control trials and non-randomized studies.

INTRODUCTION: Autoimmune disorders are chronic, self-mediated, misdirected immune responses against their own immune system. It required intensive, complex and costly drug treatment regimen increased the risk of pharmacotherapy error and adversely affects patients. Hence, pharmacist care will have vital roles in autoimmune disorders to achieve health related outcomes. OBJECTIVES: This review aimed to gather evidence on the impact of pharmacist care on clinical, humanistic and economic outcomes, adherence to medications, and drug related problems in the management of autoimmune disorders among the usual care group. METHODOLOGY: A comprehensive review conducted in compliance with the PRISMA statement and systematic search was performed across five databases included PubMed Central, Web of Sciences, Scopus, Cochrane Library andgoogle scholar from inception until August 2020. This research included full-text articles of randomized and non-randomized studies that evaluated impact of pharmacist care in autoimmune disorders. RESULTS: A total of nine studies were included (seven RCTs and two non-RCTs), including 829 patients with autoimmune disorders. A total of four studies (80%) show an enhancement in at least one clinical parameter due to pharmacist care. A substantial improvement in at least one humanistic parameter observed in all five studies (100%). While four out of five studies (80%) clearly displayed a remarkable improvement in medication adherence in the pharmacist care group from baseline to the completion of follow-ups. One study quantified a 99.08% resolution of DRPs in the pharmacist care group. Another study estimated the cost of medical resources uses per patient and found no difference in cost-effectiveness over six months between groups. CONCLUSION: This review reinforces the vital contribution of pharmacists to achieve clinical outcomes, humanistic outcomes, adherence to medications and DRPs in the efficient management of autoimmune disorders. However, no notable changes in economic outcomes were observed in this review.

Assessment of the Sociodemographic Profile, Pattern, and Outcomes of Intentional Poisoning Cases in an Emergency Department of a Tertiary Care Teaching Hospital.

Background: Intentional self-poisoning has become a major health problem in low- and middle-income countries. Aims: We aimed to assess the sociodemographic profile, pattern, and outcomes of intentional poisoning cases in the emergency department of a tertiary care teaching hospital. Method: A prospective observational study was conducted at the department of emergency medicine of a South Indian tertiary care hospital for 1 year to study the sociodemographic profile, pattern, and outcomes of intentional poisoning cases. Results: The majority of poisonings were observed in the male population (64.5%) and among the age group of 19-40 years (65.2%). Poisoning was prevalent in rural/semi-urban populations (77.5%) and in people engaged in agriculture (28.4%) for their livelihood. Pesticides were the most common agents implicated (65.9%) in poisonings. Based on the Glasgow Coma Scale (GCS) and Poison Severity Scale (PSS), the majority of people with poisoning presented with mild (53.9%) and minor symptoms (36.3%). In 78.5% of the cases, patients recovered while mortality was observed in 5.4% of cases. Conclusion: There was a strong association between outcomes of poisoning and age. Organophosphate pesticides were the most commonly implicated substances in poisonings. Regulation policies should be made by the government to regulate the transport, distribution, and use of insecticides and pesticides.

Efficacy and Safety of Non-Steroidal Anti-Androgens in Patients with Metastatic Prostate Cancer: Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Prostate cancer (PCa) is the sixth primary cause of cancer death. However, conflicts are present about the efficacy and safety of Non-steroidal anti-androgens (NSAA) for its treatment. The aim of this study was to assess the efficacy and safety of NSAAs versus any comparator for the treatment of advanced or metastatic PCa (mPCa). METHODS: MEDLINE and the Cochrane Library were searched. References of included studies and clinicaltrials.gov were also searched for relevant studies. Only English language studies after 1990 were considered for review. Randomized controlled trials (RCTs) examining the efficacy and safety of NSAAs as compared with any other comparator including surgery or chemotherapy in mPCa patients were included. The outcomes include efficacy, safety and the tolerability of the treatment. The Cochrane Risk of Bias Assessment Tool was used for quality assessment. Two authors were independently involved in the selection, extraction and quality assessment of included studies and disagreements were resolved by discussion or by consulting a third reviewer. RESULTS: Fifty-eight out of 1307 non-duplicate RCTs with 29154 patients were considered for the review. NSAA showed significantly better progression-free survival [PFS] (Hazard ratio [HR], 0.60; 95% confidence interval [CI], 0.46-0.78; P=0.0001), time to distant metastasis or death [TTD] (HR, 0.80; 95% CI 0.73-0.91; P<0.0001), objective response (Odds ratio [OR], 1.64; 95% CI 1.06-2.54; P=0.03) and clinical benefits (OR, 1.33; 95% CI 1.08-1.63; P=0.006) as compared to the control group. There was no significant difference observed between the groups in terms of overall survival (HR, 0.95; 95%CI, 0.87-1.03; P=0.18) and time to progression (HR, 0.93; 95% CI 0.77-1.11; P=0.43). Treatment-related adverse events were more with the NSAA group, but the discontinuation due to lack of efficacy reason was 43% significantly lesser than the control group in patients with mPCa. Rest of the outcomes were appeared to be non-significant. CONCLUSION: Treatment with NSAA was appeared to be better efficacious with respect to PFS, TTD, and response rate with considerable adverse events when compared to the control group in patients with metastatic PCa.

Active surveillance of adverse events following immunization (AEFI): a prospective 3-year vaccine safety study.

BACKGROUND: Vaccines used in national immunization programs are considered safe and effective but immunization safety has become as important as the efficacy of vaccination programs. The objective of the study was to detect adverse events following immunization (AEFIs) to all vaccines administered to a pediatric population in India. METHODS: The prospective active vaccine safety surveillance study enrolled eligible children in the age group 0-5 years receiving vaccination from the immunization center at JSS Hospital, Mysuru. Study participants were monitored at the site for 30 min following vaccination and a telephonic survey was made after 8 days to identify all AEFIs. Causality assessment of the AEFIs were done using a new algorithm developed by the safety and vigilance department of the World Health Organization. RESULTS: The incidence of reported AEFIs was 13.7%. The most frequently reported AEFI was fever (n = 3095, 93.2%) with an incidence of 109.7 per 1000 doses of vaccine administered, followed by persistent crying (n = 69, 2.4 per 1000 doses of vaccine) and diarrhea (n = 57, 2.0 per 1000 doses of vaccine). The majorly implicated vaccine for AEFIs was Pentavac® followed by BCG. Consistent causal association to immunization was observed in 93.4% of cases. CONCLUSIONS: A high incidence rate of AEFI was observed in our study population when compared with previous published studies. AEFI surveillance studies help to detect changes in the frequency of adverse events, which may be an alert to consider vaccine quality or identify a specific risk among the local population.

Pharmacist-Initiated Medication Error-Reporting and Monitoring Programme in a Developing Country Scenario.

Medication errors (MEs) often prelude guilt and fear in health care professionals (HCPs), thereby resulting in under-reporting and further compromising patient safety. To improve patient safety, we conducted a study on the implementation of a voluntary medication error-reporting and monitoring programme. The ME reporting system was established using the principles based on prospective, voluntary, open, anonymous, and stand-alone surveillance in a tertiary care teaching hospital located in South India. A prospective observational study was carried out for three years and a voluntary Medication Error-reporting Form was developed to report medication errors MEs that had occurred in patients of either sex were included in the study, and the reporters were given the choice to remain anonymous. The analysis was carried out and discussed with HCPs to minimise the recurrence. A total of 1310 medication errors were reported among 20,256 hospitalised patients and the incidence was 6.4%. Common aetiologies were administration errors [501 (38.2%)], followed by prescribing and transcribing errors [363 (28%)]. Root-cause of these MEs were distractions, workload, and communications. Analgesics/antipyretics (19.4%) and antibiotics (15.7%) were the most commonly implicated classes of medications. A clinical pharmacist initiated non-punitive anonymous ME reporting system could improve patient safety.

Impact of Pharmacist-Psychiatrist Collaborative Patient Education on Medication Adherence and Quality of Life (QOL) of Bipolar Affective Disorder (BPAD) Patients.

Background: Bipolar Affective Disorder (BPAD) is one of the leading causes of disability globally. Medication non-adherence and low quality of life (QOL) are the major challenges associated with the treatment of BPAD patients. Objective: Aim of this study was to assess the impact of pharmacist-psychiatrist collaborative patient education on medication adherence and QOL of BPAD patients. Methodology: A prospective randomized control study was conducted in the psychiatry outpatient department in a tertiary care setting. The eligible patients were enrolled and randomized into test (collaborative care) and control (usual care) groups. Patient education was provided by pharmacists to the test group patients, along with the usual care provided to all the patients. Patients were followed for three follow-ups of nearly 1 month intervals. Medication adherence and QOL were assessed by Medication Adherence Rating Scale and WHOQOL-BREF questionnaire, respectively. T-test was used and P-values < 0.05 were considered statistically significant. Results: Out of 75 patients enrolled, 73 patients were followed for all the three follow-ups and completed the study. Thirty-eight patients belonged to test and 35 were in control group. The mean age of patients was 34.21 ± 10.91 years. Forty-eight (65.75%) patients belonged to age group of 18-39 years. There were 41 males (56.16%) and 32 female patients (43.83%) in the study. Mean improvement in medication adherence and QOL of the test and control groups were found to be 2.06 ± 0.15 (<0.001) and 13.8 ± 10.5 (<0.05), respectively. Conclusion: This study concluded that pharmacist-psychiatrist collaborative patient education can significantly improve the medication adherence and QOL of the BPAD patients. Statistically significant results indicating improved patient care and outcomes were possible when pharmacists worked as a team with psychiatrists.

Towards patient safety: assessment of medication errors in the intensive care unit in a developing country's tertiary care teaching hospital.

OBJECTIVES: To determine the incidence, causes, patterns and outcomes of medication errors (MEs) in the intensive care unit. METHODS: The ME reporting system was established using the principles based on prospective, voluntary, open, anonymous and stand-alone surveillance in a tertiary care teaching hospital located in southern India. MEs involving patients of either sex were included in the study, and the reporters were given the choice to remain anonymous. The analysis was carried out to determine the patterns, causes and outcomes of the reported errors and was discussed with healthcare professionals (HCPs) to minimise the recurrence of MEs. RESULTS: A total of 292 MEs were reported voluntarily among 5137 admitted patients and the incidence of MEs was 5.6%. Administration errors (n=143, 49%) were the most common type of MEs reported followed by prescription errors (n=56, 19%) and dispensing errors (n=43, 15%). Factors responsible for MEs were related to performance deficit of HCPs due to excessive workload, fatigue, unclear interpersonnel communications and patient-related factors, which accounted for 37.6%, 13.1%, 9.6% and 7.7%, respectively. The majority of the reported MEs had an outcome of category C and A, based on the National Coordinating Council for ME Reporting and Prevention (NCC MERP) outcome category scale, amounting to 42.2% and 41.7%, respectively. CONCLUSIONS: Although the majority of MEs that reached the patients did not cause any harm, providing continuous education and awareness of MEs to HCPs and patients may minimise the scope of the factors that may contribute to MEs and improve overall patient safety.

A Prospective Surveillance of Pharmacovigilance of Psychotropic Medicines in a Developing Country.

AIMS/OBJECTIVES: Psychotropic drugs are associated with significant short-term and long-term safety issues which may affect patients' mental health, physical health and cost of care. EXPERIMENTAL DESIGNS: This was a prospective study conducted in psychiatry department of a tertiary care hospital. Study included patients of any age and either sex who presented with psychiatric illness as diagnosed by ICD-10 and were receiving at least one psychotropic agent. The study involved both intensive and spontaneous reporting methods to identify ADRs. Causality, Severity, Preventability of reported ADR was assessed using standard scales. PRINCIPLE OBSERVATION: Of 4321 patients reviewed, 1630 patients met study criteria, 990 ADRs were identified from 613 patients at an overall incidence rate of 37.6%. Antidepressants were the commonest group of agents implicated in ADRs (42%) followed by Antipsychotics (41%). Escitalopram (15.9%) and Olanzapine (12.1%) were the most commonly implicated medications. Most commonly involved system organ class was Gastrointestinal system (22.7%) followed by Central and peripheral nervous system (17.8%). Dry mouth (10.2%), weight gain (8.18%) and tremors (5.85%) were the commonly reported ADRs. Female gender (p = 0.002), Co-morbid conditions (p = 0.001) and drug- drug interactions (p = 0.000) were found as risk factors in developing ADRs in psychiatry patients. CONCLUSION: Patients receiving psychotropic medicines need routine monitoring to ensure their safety and adherence.

A Case Report of Isotretinoin-induced Manic Psychosis.

Isotretinoin, an oral vitamin A derivative, used to treat severe treatment-resistant acne. Psychiatric side effects of isotretinoin particularly depression and suicidal thoughts have been well documented. We report a case of isotretinoin-induced manic psychosis in a young female without a family history and history of mental illness.