W3 REPLY

NEED HELP

Need help to reply three post.

1- Each reply should be atleast 200 words.

2- One to two scholarly references

3- APA style needs to be followed.

4- Each reference should have reference at the end

5-

Reference should be within last 5 years

DQ-1

The study I chose was, Physician Acceptance of Pharmacist Recommendations about Medication Prescribing Errors in Iraqi Hospital, as I would like to work as an ACNP in an ICU setting. This study measures the incidences and types of medication prescribing errors (MPE) in Iraqi hospitals and also calculates the percentage of physician to pharmacist agreement with pharmacist recommendations (Al-Jumaili et al., 2016). The pharmacists checked the medications prescribed against recommendations and errors using the Medscape WebMD, LLC phone application as a reference ( Al-Jumaili et al., 2016). The findings included that there were 99 MPE or an incidence rate of 6.57% (Al-Jumaili et al., 2016). The MPE is broken down into categories of errors such as drug-drug interactions at 65.7%, incorrect doses at 16.2%, unnecessary medications 8.1%, contra-indications at 7.1%, incorrect drug duration at 2%, and untreated conditions at 1% (Al-Jumaili et al., 2016). An interesting point that this study points out is that MPEs is higher in Iraqi hospitalized patients than in the U.S and UK, but lower than Brazil, Ethiopia, India, and Croatia (Al-Jumaili et al., 2016). This study also indicates that the inclusion of a referencing application that compares ordered medications and situations to a guideline or database such as the phone reference application they used would lead to a large reduction in MPEs (Al-Jumaili et al., 2016).

Another study, Prescribing erors in Electronic Prescriptions for Outpatients Intercepted by Pharmacists and the Impact of Prescribing Workload on Error Rate in a Chinese Tertiary-care Women and Children’s Hospital, also has data from their study that agrees with the previous study (Yang, Liao, Lin, & Wu, 2019). In this study, there was an error rate identified at 0.35% but there was no correlation to an increased or decreased workload meaning that wether the workload was busy or slow, the error rate remained the same (Yang et al., 2019). The study also states that having a pharmacist review all electronic orders allows for identification and rectification of prescribing errors (Yang et al., 2019). Essentially, having a second set of eyes on your prescriptions allows for the identification and reduction of errors to the patient.

After reading this study and thinking about how I am going to prevent MPEs in my clinical practice to prevent prescribing errors I would like to take the suggestion of the study and reference my prescriptions against the guidelines to see if I am within guidelines that are recommended. I think the trouble would be finding a reputable, reliable reference source. The study utilized Medscape’s WebMD phone application. Another point was from the second study where having a pharmacist review your prescription would help reduce errors reaching the patinets. I would also listen to pharmacist’s recommendations and have a conversation with them when they call to speak about the orders I have written. Another option would be to ensure that I have the up to date policies and procedures for medication prescribing available at the facility I am employed and I can use that as a reference when I am prescribing medications. In the state of Florida, as of right now, APRNs still have to have a physician supervision agreement, so I would imagine that if I had any questions regarding medications prescriptions I could ask my physician supervisor.

References:

AL-jumali, A.A.A., Jabri, M., Al-Rekabi, M., Abbood, D., & Hussein, A.H. (2016). Physician Acceptance of Pharmacist Recommendations about Medication Prescribing Errors in Iraqi Hospitals. INNOVATIONS in Pharmacy, (3). https://doi-org.lopes.idm.oclc.org/10.24926/iip.v7i3.443

Yang, J., Liao, Y., Lin, W., & Wu, W. (2019). Prescribing errors in electronic prescriptions for outpatients intercepted by pharmacists and the impact of prescribing workload on error rate in a Chinese tertiary-care women and children’s hospital. BMC Health Services Research, (1).

https://doi-org.lopes.idm.oclc.org/10.1186/s12913-019-4843-1

DQ-2

This is an international study done in Egypt to assess the impact of electronic prescription in the type and rate of medication errors in the prescription and dispensing phase of medication delivery to patients in an outpatient clinic setting and formulated recommendations. The electronic system had minor significant 2% decreased in prescribing errors, 1.2 % decrease in dispensing errors, and significant 18.2% increase in the error free prescription in the electronic phase when compared to hand written phase but it failed to significantly decrease dispensing errors like wrong medicine and wrong dosage form and no difference in the volume of communication between pharmacists and the prescribers (Kenawy, & Kett, 2019). The suggestion was more advanced and trusted system needed for efficient in reducing error rates and pharmacy workflow (Kenawy, & Kett, 2019). Another study done to assess the inter-professional clinical communication between pharmacist, other health professionals to medication errors found that 17 studies out of 18 showed communication medication errors (Sassoli, & Day, 2017). The suggestion was to have a structured communication (verbal and non-verbal) is highly recommended and effective in preventing these errors as per the literature review and the reason is due to the involvement of different professionals, and different steps in the cycle from the correct prescription through to correct administration (Sassoli, & Day, 2017).

These findings were a huge impact on health industry and as a health care provider the process start from us and I will follow the safety guidelines from Food and Drug administration (FDA) and other health and safety organizations for the safe practices in prescribing, and also following administrative and institutional and pharmacy policy and protocols for my prescription and ask the pharmacist for suggestions when in doubt. I need to have information on local prevalence of the infectious disease and the antibiotics specific for treating those infections. Considering all patient factors with prescription, writes legibly if using the script and clear communication in the electronic and printed form to patient as well to the electronic communication to pharmacists, including the contact number in case to contact if needed for clarification will be enforced. Clear instruction to patient and family to call for clarifications and open communication and clarifications of questions and education regarding the medication is important to prevent possible medication error.

FDA, and Division of medication error prevention and analysis (DMEPA) collaborates with external stakeholders, regulators, patient safety organizations such as the institute for safe medication practices (ISMP), standard setting organization such as the united states pharmacopeia and researchers for their safety rules for the prevention of medication errors. I will be following the guidelines and medications reference in the pharmacy website such as Lexicomp and web med are all the steps for effective intervention to prevent them and addressing the safety rules to prevent medication errors (FDA, 2020).

Reference.

Food and drug administration (FDA). (2020) Medication errors related to CDER-regulated drug products. Retrieved on 01/15/2020 from

https://www.fda.gov/drugs/drug-safety-and-availability/medication-errors-related-cder-regulated-drug-products

Kenawy, A. S., & Kett, V. (2019). The impact of electronic prescription on reducing medication errors in an Egyptian outpatient clinic. International journal of medical informatics, 127, 80-87. https://doi.org/10.1016/j.ijmedinf.2019.04.005

Sassoli, M., & Day, G. (2017). Understanding pharmacist communication and medication errors: A systematic literature review. Asia Pacific Journal of Health Management, 12(1), 47 https://search.informit.com.au/documentSummary;dn=832463700662537;res=IELAPA

DQ-3

According to the Center for Drug Evaluation and Research (CDER) Annual report on the new drugs approved by the FDA, there are a plethora of new medications that have been approved for use in patients who are experiencing a number of illnesses (2019b). The drug that was chosen to be analyzed is called Xenleta (Center for Drug Evaluation and Research, 2019b). Xenleta’s active ingredient is lefamulin and its primary usage is to treat adults with community-acquired bacterial pneumonia (Center for Drug Evaluation and Research, 2019b). Xenleta was approved for use in adults on August 19th, 2019 (Center for Drug Evaluation and Research, 2019b). Xenleta is a semi-synthetic pleuromutillin antibiotic (Center for Drug Evaluation and Research, 2019b). Pleuromutillin antibiotics are a new class of antibiotics that work by binding to 50-S subunit of the bacterial ribosome and blocks substrate binding of bacteria RNA during replication (Center for Drug Evaluation and Research, 2019b).

Xenleta can be given intravenously or by an IV infusion of 150mg over one hour twice a day for five to seven days, and can switch to tablets to complete treatment as a 600mg tablet every 12 hours for five days (Center for Drug Evaluation and Research, 2019a). Xenleta is similar to moxifloxacin in improving signs and symptoms of pneumonia and moxifloacin was the drug chosen for effectiveness to be compared against Xenleta (Center for Drug Evaluation and Research, 2019a). Moxifloxacin is a fluoroquinolones that is used for treating pneumonia, plague, skin, and an abdominal infection since it works well by interfering with bacterial DNA replication (Wadi Al-Ramahi et al., 2018).

With the evolution of bacteria becoming antibiotic resistant I believe that new medications that have different mechanisms of action are essential to have available when combating different infections. However, I also believe that there needs to be a standard set of guidelines to choose from in terms of which antibiotic to choose first, second, and so on. Just like classifications of vasopressors when combating hypotension there are first line, second line, and third line drugs that work. I would like to see the same system be developed for antibiotics when combating infections. I believe that this system will help prevent antibiotic resistance from developing in bacteria. For example, in bacterial pneumonia, Moxifloxacin would be the first line in treating bacterial pneumonia, and then if that yields less than favorable results, the switch could be made to Xenleta as a second-line antibiotic. Overall I would agree with this drug being availiable on the market to combat community acquired bacterial pneumonia as it provides additional options when prescribing.

References:

Center for Drug Evaluation and Research. (2019a). Drug Trials Snapshots: XENLETA. Retrieved January 13, 2020, from https://www.fda.gov/drugs/resources-information-approved-drugs/drug-trials-snapshots-xenleta.

Center for Drug Evaluation and Research. (2019b). Novel Drug Approvals for 2019. Retrieved January 13, 2020, from https://www.fda.gov/drugs/new-drugs-fda-cders-new-molecular-entities-and-new-therapeutic-biological-products/novel-drug-approvals-2019.

Wadi Al-Ramahi, A., Ramadan, M., Waad Jaber, M., Abushanab, L., Mughrabi, M., Alshamayleh, N., … Anzueto. (2018). Speed of recovery in adult patients with community-acquired pneumonia; moxifloxacin versus levofloxacin. Journal of Infection in Developing Countries, 12(10), 878–886. https://doi-org.lopes.idm.oclc.org/10.3855/jidc.10335