Pharmacy practice in hospital settings in GCC countries: Pharmacists' medication therapy monitoring activities.

Purpose: Our study aims to provide an overview of medication therapy monitoring practices carried out by pharmacists in hospitals across the Gulf Cooperation Council (GCC) countries. Methods: This is a cross-sectional questionnaire-based study of hospitals located in the GCC. Questions were adopted from the American Society of Health-System Pharmacists (ASHP) national survey. Frequency analyses were used to examine the number and percentages of specific responses to the survey questions. Results: A total of 64 hospitals participated in this survey, reflecting an overall response rate of 52.0%. Almost half of participating hospitals (48.4%) were from Saudi Arabia. Among the 64 participating hospitals, 54.7% monitored their patients daily, 40.6% assigned pharmacists to patient care units for at least eight hours per day, and 42.2% held pharmacists accountable for medication-related outcomes. Moreover, the criteria used to identify patients requiring monitoring, 35.9% relied on the list of high-risk medications, 26.5% relied on specific medical services, 21.9% relied on directions from the hospital committee, and 17.2% relied on lab abnormalities. The most frequently utilized method for monitoring adverse drug events (ADEs) was through notifications from nurses or physicians, observed in 60.9% of participating hospitals. Conclusion: The survey emphasizes the need for hospitals in the GCC to promote increased pharmacist accountability for medication-related outcomes, explore technological solutions to enhance monitoring efficiency and extend the presence of pharmacists in patient care units beyond the current level.

Pharmacy practice in hospital settings in GCC countries: Dispensing and administration.

Purpose: To outline dispensing and administration practices in hospital pharmacy across the Gulf Cooperation Councils (GCC) countries' hospitals. Paucity of data in appraising hospital pharmacy practice in GCC regions motivated us to conduct this study. Methods: A modified survey questionnaire was prepared from the American Society of Health-System Pharmacist (ASHP) survey questions. Three major domains of questions for general characteristics of the medication use process for dispensing and administration were identified. These were, (1) medication distribution system, and medication distribution technology, (2) technology used to compound sterile preparations, compounding I.V. medication and method of compounding nutrition support preparations, (3) medication administration practices, medication orders, medication administration records (MARs), and technician activities. A list of hospitals was obtained from the Ministry of Health of the targeted GCC countries. A secure invitation link containing a survey questionnaire was sent to the participants directly. Results: Sixty-four hospitals responded to this survey. The overall response rate was 52%. Most surveyed hospitals have centralized inpatient medications distribution system (75.0%). About 37.5% of hospitals used automated dispensing cabinets (ADCs) in their patient care areas. Compounding sterile preparations in the pharmacy, barcode verification technology, workflow management technology, and robotic technology were used by 17.2%, 15.6%, and 4.7% of hospitals, respectively. In using safety technology for medication administration, almost all hospitals have partially or completely implemented an electronic health record (EHR). About 40.6% of hospitals used electronic medication administration records (e-MARs), 20.3% used bar-code-assisted medication administration (BCMA), and 35.9% used smart infusion pumps. Conclusion: The results of this survey revealed an opportunity to improve the medication use management process on dispensing and administration practices in hospitals in GCC countries.

Pharmacy practice in hospital settings in GCC countries: Prescribing and transcribing.

PURPOSE: To outline hospital pharmacy practices across the Gulf Cooperation Councils (GCC) countries' hospitals. METHODS: A modified survey questionnaire was prepared from the original 2019 American Society of Health-System Pharmacist (ASHP) survey questions. Survey details were discussed with some pharmacy directors for clarity and relevance. A list of hospitals were obtained from the Ministry of Health of each of the targeted GCC countries. A secure invitation link containing a survey questionnaire was sent to the participants directly. RESULTS: Sixty four hospitals responded to this survey. The overall response rate was 52%. About 47% of the surveyed hospitals considered their drug formularies as closed, and strict. Additionally, only 44% of hospitals compare the effectiveness of products, when taking formulary decisions for drug inclusion. Forty-four percent of hospitals have computerized prescriber order entry (CPOE / EHR) system functionality for formulary system management. At about 39.1% hospitals, pharmacists have the responsibility for managing medication therapies, majority were engaged in providing anticoagulation therapies. About 61% of hospital pharmacies in GCC countries receive medication orders electronically, through CPOE/EHR. Majority (66%) of the hospitals in GCC countries have an active Antimicrobial Stewardship Program (ASP) while only 40% of pharmacists have a key role in providing clinical support. About 57.8% of hospital pharmacy directors reported that pharmacists do not provide ambulatory care clinical pharmacy services in their hospitals. CONCLUSION: In GCC countries' hospitals, there are major areas for improvement to patient care of which pharmacists are uniquely qualified as the medication experts to have the most meaningful outcomes in all of the domains of safe medication use, medication therapy management, antimicrobial stewardship program and participation in outpatient clinics.

Hospital pharmacy practice in Saudi Arabia: Drug monitoring and patient education in the Riyadh region.

BACKGROUND: The purpose of this national survey is to evaluate hospital pharmacy practice in the Riyadh region of Saudi Arabia. The results of the survey pertaining to the monitoring and patient education of the medication use process were presented. METHODS: We have invited pharmacy directors from all 48 hospitals in the Riyadh region to participate in a modified-American Society of Health-System Pharmacists (ASHP) survey questionnaire. The survey was conducted using similar methods to those of the ASHP surveys. RESULTS: The response rate was 60.4% (29/48). Most hospitals (23, 79%) had pharmacists regularly monitor medication therapy for patients. Of these hospitals, 61% had pharmacists monitoring medication therapy daily for less than 26% of patients, 17% monitored 26-50% of patients and 22% monitored more than half of patients daily. In 41% of hospitals, pharmacists routinely monitored serum medication concentrations or their surrogate markers; 27% gave pharmacists the authority to order initial serum medication concentrations, and 40% allowed pharmacists to adjust dosages. Pharmacists routinely documented their medication therapy monitoring activities in 52% of hospitals. Overall, 74% of hospitals had an adverse drug event (ADE) reporting system, 59% had a multidisciplinary committee responsible for reviewing ADEs, and 63% had a medication safety committee. Complete electronic medical record (EMR) systems were available in 15% of hospitals and 81% had a partial EMR system. The primary responsibility for performing patient medication education lays with nursing (37%), pharmacy (37%), or was a shared responsibility (26%). In 44% of hospitals, pharmacists provided medication education to half or more inpatients and in a third of hospitals, pharmacists gave medication education to 26% or more of patients at discharge. CONCLUSION: Hospital pharmacists in the Riyadh region are actively engaged in monitoring medication therapy and providing patient medication education, although there is considerable opportunity for further involvement.

Sickle cell disease subphenotypes in patients from Southwestern Province of Saudi Arabia.

Sickle cell disease (SCD) is common in the Eastern and Southwestern (SW) Provinces of Saudi Arabia. We studied 159 patients with SCD to better characterize its phenotype in the SW Province, where patients usually have a HBB haplotype of African origin. All cases had history and examination, chart review, and laboratory testing. Blood tests were obtained during steady state and included: complete blood count, reticulocytes, hemoglobin electrophoresis, lactate dehydrogenase, and G6PD level. HBB haplotype and presence of α-thalassemia were also determined. Frequency of various SCD complications was as follows: painful episodes of variable severity occurred in majority of patients (98%), osteonecrosis (14%), acute chest syndrome (22%), splenic sequestration (23%), gallstones (34%), stroke (7.5%), priapism (2.6%), serious infections (11.5%), and persistent splenomegaly (11%) beyond 5 years of age. No patient had leg ulcer. History of asthma and high steady state white blood cells count were associated with increased risk of acute chest syndrome. Coinheritance of α-thalassemia was associated with a lower frequency of gallstones. Higher fetal hemoglobin level was associated with persistent splenomegaly but not with other complications. Splenic sequestration was more common among males and was associated with lower steady state hemoglobin. SCD phenotype in the SW Province is variable and comparable with African Americans except for the rarity of priapism and the absence of leg ulcers. Fetal hemoglobin level was not associated with SCD vaso-occlusive complications. New genetic modifiers and environmental factors might modulate the phenotype of SCD in Saudi Arabia.

Hospital pharmacy practice in Saudi Arabia: Prescribing and transcribing in the Riyadh region.

PURPOSE: The purpose of this survey is to outline pharmacy services in hospitals on a regional level in the Kingdom of Saudi Arabia. METHODS: A modified-American Society of Health-System Pharmacists (ASHP) survey questionnaire as pertinent to Saudi Arabia was used to conduct a national survey. After discussing with the pharmacy directors of 48 hospitals in the Riyadh region over the phone on the survey's purpose, the questionnaires were personally delivered and collected upon completion. The hospital lists were drawn from the Ministry of Health hospital database. RESULTS: Twenty-nine hospitals participated in the survey giving a response rate of 60.4%. Approximately 60% of the hospitals which participated in the survey required prior approval for the use of non-formulary medications. About 83.3% of hospitals reviewed compliance with clinical practice guidelines and 72.7% hospitals reported that pharmacists are also actively involved in these activities. Pharmacists in more than 95% of hospitals provided consultations on drug information. A staff pharmacist routinely answering questions was the most frequently cited (74.1%) method by which objective drug information was provided to prescribers. Electronic drug information resources were available in 77.7% of hospitals, although internet use is not widely available to hospital pharmacists, with only 58.6% of hospitals providing pharmacist access to the internet. About, 34.5% of hospitals had computerized prescriber order entry (CPOE) systems with clinical decision-support systems (CDSSs) and 51.9% of the hospitals had electronic medical record (EMR) system. CONCLUSION: Hospital pharmacists are increasingly using electronic technologies to improve prescribing and transcribing of medications in Saudi Arabia.

Hospital pharmacy practice in Saudi Arabia: Dispensing and administration in the Riyadh region.

BACKGROUND: There is very little published data assessing hospital pharmacy practice in Saudi Arabia. Hence, a comprehensive survey has been undertaken to evaluate hospital pharmacy services of the Kingdom of Saudi Arabia. Recently, we published the survey results on the prescribing and transcribing steps of the medication use process. This paper focuses on dispensing and administration. METHODS: A modified-American Society of Health-System Pharmacists (ASHP) survey questionnaire was personally delivered to the pharmacy directors of 48 hospitals in the Riyadh region. Three attempted follow-ups were made within 3 months to non-responders and the surveys were collected upon completion. The survey was conducted using similar methods to those of the ASHP surveys. RESULTS: Twenty-nine hospitals participated in the survey with a response rate of 60.4%. Centralized distribution (74%) is the most commonly used model for inpatient pharmacies. Overall, 21% of hospitals routinely use bar coding technology in medication dispensing. None of the hospitals are using a robotic distribution system to automate the dispensing of unit doses. Automated dispensing cabinets (ADCs) are used by 21% of hospitals as part of their decentralized distribution model. Sixty-one percent of hospital pharmacies have IV admixture preparation area in their facility. In the use of safety technology for medication administration, only one third of hospitals are using electronic medication administration records (eMARs), 7.4% had bar-code-assisted medication administration (BCMA) and 12% had smart infusion pumps. CONCLUSION: Hospital pharmacies in the Riyadh region are fairly well developed in providing dispensing and administration services. Further improvement can be achieved by increasing the use of new technologies such as bar-code technology, unit dose drug distribution systems, pharmacy-based IV admixture services, smart infusion pumps, and automated medication distribution.

The role of pharmacoeconomics in formulary decision making in different hospitals in Riyadh, Saudi Arabia.

OBJECTIVE: To assess the trend of using pharmacoeconomic information by Pharmacy and Therapeutics (P&T) committees when making formulary decisions. DESIGN: A cross-sectional study conducted in 2007, using structured survey questionnaires which were distributed to members of the P&T committees in 11 different hospitals in Riyadh, Saudi Arabia. RESULTS: A total of 100 survey questionnaires were sent to head of pharmacy departments of 11 different hospitals in Riyadh, Saudi Arabia. Out of these, 48 questionnaires were completed and returned. Of the total respondents participated in the study, 64.58% were medical doctors and 16.66% were pharmacists and 75% of the respondents said they have applied pharmacoeconomic evaluations in their decision making process. More than 80% of the respondents perceived that they had a fair knowledge of pharmacoeconomics. Approximately 80% of respondents expressed some degree of agreement that pharmacoeconomics should be applied as a decision making tool. The majority of decision-makers (95%) expressed the interest in attending workshops on pharmacoeconomics. CONCLUSION: The study showed that pharmacoeconomics can play an important role in the P&T committee formulary decisions. However, more education to health care professionals and to hospital administrators should be conducted to facilitate the use of such a tool. Also, hospitals should recruit health care professionals with pharmacoeconomic expertise to manage limited health resources in the best way available.

Preparatory Year Students' Perception of Pharmacy Profession as a Career Choice: A Cross-Sectional Study

Abstract The study attempted to assess preparatory year students' perception towards pharmacists and the pharmacy profession. This cross-sectional survey was conducted between December 2019 and March 2020. The students were invited to complete an anonymous questionnaire via Google Forms®. In total, 244 students, of which 53.7% were female with the mean age of 19.2 ± 0.65, from 12 universities participated in this study. As per our findings, the majority of the respondents (91.8%) regard pharmacy as a well-respected profession, 82.4% thought pharmacists are important decision-makers, 68.4% disagreed that most pharmacists were unkind, and 60.7% did not agree that pharmacy was a low-status occupation. Meanwhile, 95.5% agreed that pharmacists must have a university degree, 88.6% agreed pharmacists must take responsibility for patients, and 82.8% believed pharmacists had to work too hard. Moreover, 62.3% did not think pharmacy was a low-skill occupation, 54.9% did not agree pharmacists must do unpleasant things, and 45.1% disagreed pharmacists only did what physicians requested of them. Lastly, 48.8% had low confidence in choosing pharmacy as a career. The students' overall perception toward pharmacists and the pharmacy profession was favorable. However, only one-fourth of the students displayed a tendency to choose pharmacy as a future career.

The burden of ischemic heart disease at a major cardiac center in Central Saudi Arabia.

OBJECTIVE: To estimate the direct medical costs associated with ischemic heart disease (IHD) at Prince Sultan Cardiac Center (PSCC) in Riyadh, Saudi Arabia. METHODS: This is a prevalence-based prospective observational cost of illness study conducted in PSCC, Riyadh, Kingdom of Saudi Arabia between April and June 2009. All patients diagnosed or suspected of having IHD at admission were included. They were followed up until discharge, or performing coronary artery bypass graft (CABG), or changing diagnosis. Clinical data were extracted from the patients' computerized database, and combined with the unit cost of services to calculate costs. RESULTS: A total of 205 patients were recruited and diagnosed with stable angina (SA, 47.8%), unstable angina (USA, 24.4%), ST-segment elevation myocardial infarction (STEMI, 19.5%), and non-ST-segment elevation myocardial infarction (NSTEMI, 8.3%). Most of the patients were Saudi males, aged between 40-75 years. Eighty-seven percent of patients had 2 or more co-morbidities, and 32% of the patients were obese. The average cost was 40,164 Saudi Riyals (SAR)/patient (US$10,710). Medication contributed the lowest in the costs (3.2%). A cost associated with SA was SAR33,991, USA was SAR35,107, NSTEMI was SAR46,585, and STEMI was SAR58,877 per patient. The lowest mean hospital length of stay was 6.5 days with SA. The average length of stay increased with the number of co-morbidities from 5.67 days (no co-morbidity) to 11.25 days (6 co-morbidities). CONCLUSION: The IHD is of high economic burden in the country. Among IHD types studied, the resource consumption associated to STEMI was the highest in terms of costs, and hospital length of stay.

Pattern of intravenous proton pump inhibitors use in ICU and Non-ICU setting: a prospective observational study.

BACKGROUND/AIM: The use of intravenous acid-suppressive therapy for stress ulcer prophylaxis in critically ill patients with specific risk factors has been recommended for over a decade. However, there is a lack of supporting data regarding the extension of such therapy to non-critically ill patients (non-ICU). The aim of this study was to compare appropriate indications with current practicing patterns in adult non-ICU and ICU patients, contributing factors and financial impact of inappropriate use. MATERIALS AND METHODS: A prospective cross-sectional study was carried out at a tertiary teaching Hospital in Riyadh, Saudi Arabia. For a period of 4 consecutive months, all hospitalized patients on IV PPI, aged 18 and above, were identified. A concise listing of indications considered appropriate for the use of IV PPI was pre-defined based on material from available literature and guidelines. RESULTS: A total of 255 patients received IV PPI. Inappropriate use of IV PPI was significantly higher in non-ICU (71.7%) than in ICU (19.8%) patients (P=0.01). The most common cause for inappropriate use in non-ICU patients was stress ulcer prophylaxis (SUP). In ICU patients, appropriate indicators for IV PPI were SUP (47.9%), PUD (11.5%), and the UGIB (20.8%). There was a high association between appropriate uses of IV PPI with respect to endoscopic procedure and also between appropriate uses of IV PPI to subsequent discharge with oral PPI in non-ICU patients. The total estimated direct cost (drug acquisition cost) for inappropriate use of IV PPI during the study period was 11,000 US dollars. CONCLUSION: Inappropriate IV PPI utilization was predominant in non-ICU patients, mostly for stress ulcer prophylaxis that leads to a waste of resources. Applying appropriate policies, procedures and evidence-based guidelines, educated physicians and surgeons can clearly limit inappropriate IV PPI use.