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Ian Wong - One of the best experts on this subject based on the ideXlab platform.
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Parenteral Drug Administration Errors by Nursing Staff on an Acute Medical Admissions Ward During Day Duty
Drug Safety, 2001Co-Authors: Joanne Bruce, Ian WongAbstract:Background: Parenteral therapy is a route of Administration for Drugs which are poorly absorbed via the oral route and it can provide a rapid response during an emergency. However, poorly prepared and/or administered Parenteral therapy can cause potential harm to patients such as thrombus formation, severe hypersensitivity reactions and infection. Very few studies have investigated the incidence of medication errors associated with Parenteral Drug Administration. Objectives: To determine the error rate during preparation and Administration of Parenteral medications by nursing staff and to propose strategies to reduce the error rate during Parenteral Administration. Methods: A direct, disguised observation technique was used. The first author (JB) observed and recorded errors that occurred during the preparation and Administration of Parenteral medications on an admissions ward between 8.00am and 4.30pm from Monday to Friday for a 4-week period during December 1998. The staff were told that the observer was timing the Administration; therefore they were not aware of the true nature of the study. This study was approved by the hospital audit committee. Results: Drug Administration was witnessed for a 4-week period providing 107 opportunities for error. 27 errors were observed which equated to an error rate of 25.2% [95% confidence interval (CI) 17.0 to 33.5%] including wrong time errors. Excluding wrong time errors, the most frequently occurring type of error, reduced the error rate to 10.3% (95% CI 3.8 to 14.9%). Discussion: The error rate was lower than reported in the literature, this may be due to different methodologies, small sample size or effective nursing training and operating procedures. In the observed hospital, only nursing staff who have completed a training package are allowed to administer Parenteral medications. Conclusion: Based on our small study, and 2 previous small studies, we can conclude that Parenteral medication Administration errors are common in the UK; however, these studies are too small-scale to detect rare and serious errors.
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Parenteral Drug Administration errors by nursing staff on an acute medical admissions ward during day duty
Drug Safety, 2001Co-Authors: Joanne Bruce, Ian WongAbstract:Background: Parenteral therapy is a route of Administration for Drugs which are poorly absorbed via the oral route and it can provide a rapid response during an emergency. However, poorly prepared and/or administered Parenteral therapy can cause potential harm to patients such as thrombus formation, severe hypersensitivity reactions and infection. Very few studies have investigated the incidence of medication errors associated with Parenteral Drug Administration.
Joanne Bruce - One of the best experts on this subject based on the ideXlab platform.
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Parenteral Drug Administration Errors by Nursing Staff on an Acute Medical Admissions Ward During Day Duty
Drug Safety, 2001Co-Authors: Joanne Bruce, Ian WongAbstract:Background: Parenteral therapy is a route of Administration for Drugs which are poorly absorbed via the oral route and it can provide a rapid response during an emergency. However, poorly prepared and/or administered Parenteral therapy can cause potential harm to patients such as thrombus formation, severe hypersensitivity reactions and infection. Very few studies have investigated the incidence of medication errors associated with Parenteral Drug Administration. Objectives: To determine the error rate during preparation and Administration of Parenteral medications by nursing staff and to propose strategies to reduce the error rate during Parenteral Administration. Methods: A direct, disguised observation technique was used. The first author (JB) observed and recorded errors that occurred during the preparation and Administration of Parenteral medications on an admissions ward between 8.00am and 4.30pm from Monday to Friday for a 4-week period during December 1998. The staff were told that the observer was timing the Administration; therefore they were not aware of the true nature of the study. This study was approved by the hospital audit committee. Results: Drug Administration was witnessed for a 4-week period providing 107 opportunities for error. 27 errors were observed which equated to an error rate of 25.2% [95% confidence interval (CI) 17.0 to 33.5%] including wrong time errors. Excluding wrong time errors, the most frequently occurring type of error, reduced the error rate to 10.3% (95% CI 3.8 to 14.9%). Discussion: The error rate was lower than reported in the literature, this may be due to different methodologies, small sample size or effective nursing training and operating procedures. In the observed hospital, only nursing staff who have completed a training package are allowed to administer Parenteral medications. Conclusion: Based on our small study, and 2 previous small studies, we can conclude that Parenteral medication Administration errors are common in the UK; however, these studies are too small-scale to detect rare and serious errors.
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Parenteral Drug Administration errors by nursing staff on an acute medical admissions ward during day duty
Drug Safety, 2001Co-Authors: Joanne Bruce, Ian WongAbstract:Background: Parenteral therapy is a route of Administration for Drugs which are poorly absorbed via the oral route and it can provide a rapid response during an emergency. However, poorly prepared and/or administered Parenteral therapy can cause potential harm to patients such as thrombus formation, severe hypersensitivity reactions and infection. Very few studies have investigated the incidence of medication errors associated with Parenteral Drug Administration.
Diana Faulds - One of the best experts on this subject based on the ideXlab platform.
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Oral ciprofloxacin: a pharmacoeconomic evaluation of its use in the treatment of serious infections.
PharmacoEconomics, 1993Co-Authors: Julia A. Balfour, Diana FauldsAbstract:The broad spectrum of antibacterial activity and favourable pharmacokinetic profile of ciprofloxacin permit oral treatment of many serious infections which have traditionally necessitated Parenteral antibacterial therapy. This has been demonstrated in comparative studies, in which ciprofloxacin was as effective and well tolerated as standard Parenteral therapies (usually aminoglycoside/beta-lactam combinations or broad spectrum cephalosporins) in small numbers of patients with infections of the lower respiratory tract, urinary tract, skin and soft tissue, and bones and joints. Oral ciprofloxacin is considerably less expensive than most Parenteral therapies, does not necessitate therapeutic Drug monitoring and can be administered on an outpatient basis. In addition, Administration by the oral route is more comfortable and convenient for the patient. Pharmacoeconomic studies have confirmed that substitution of oral ciprofloxacin for Parenteral therapy in the treatment of serious infections can achieve considerable savings in Drug acquisition costs, and labour and supplies associated with Parenteral Drug Administration, and may allow early discharge from hospital, resulting in even greater savings. Mean reductions of 43 to 83% were achieved in antibacterial costs in 3 randomised prospective studies, when patients received oral ciprofloxacin instead of various Parenteral agents, from the beginning of treatment, or after 3 days' Parenteral therapy. It can be concluded that oral ciprofloxacin offers considerable scope for cost avoidance when appropriately substituted for Parenteral therapy in the treatment of serious infections.
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Oral Ciprofloxacin
PharmacoEconomics, 1993Co-Authors: Julia A. Balfour, Diana FauldsAbstract:Synopsis The broad spectrum of antibacterial activity and favourable pharmaceutical profile of ciprofloxacin permit oral treatment of many serious infections which have traditionally necessitated Parenteral antibacterial therapy. This has been demonstrated in comparative studies, in which ciprofloxacin was as effective and well tolerated as standard Parenteral therapies (usually amino- glycoside/β-lactum combinations or broad spectrum cephalosporins) in small numbers of patients with infections of the lower respiratory tract, urinary tract, skin and soft tissues, and bones and joints. Oral ciprofloxacin is considerably less expensive than most Parenteral therapies, does not necessitate therapeutic Drug monitoring and can be administered on an outpatient basis. In addition, Administration by the oral route is more comfortable and convenient for the patient. Pharmacoeconomic studies have confirmed that substitution of oral ciprofloxocin for Parenteral therapy in the treatment of serious infections can achieve considerable savings in Drug acquisition costs, and labour and supplies associated with Parenteral Drug Administration, and may allow early discharge from hospital, resulting in even greater savings. Mean reductions of 43 to 83% were achieved in antibacterial costs in 3 randomised prospective studies, when patients received oral ciprofloxacin instead of various Parenteral agents, from the beginning of treatment, or after 3 days’ Parenteral therapy. It can be concluded that oral ciprofloxacin offers considerable scope for cost avoidance when appropriately substituted for Parenteral theraphy in the treatment of serious infections. Disease and Treatment Considerations Managemcnt of serious infections has traditionally neccssitated hospitalisation and adm inistratio n of Parenteral antibacterial therapy. Antibacterial agents usuall y constitute th e largest single componcnt of pharmaceutical expenditure in an institution and may account for 30 to 50% of the Drug budget. The nuoroquinolone antibacterial cipronoxacin offers the possibility of oral treatment of many infections which previously required Parenteral antibacterial thcrapy. [t has a wide spectrum of antibacterial activity which includes Pseudomonas aeruginosa and other multiply resistan t Gramnegative pathogens. Following oral Administration of therapeutic dosages, ciprofloxacin attain s concentrations sufficient to inhibit growth of the majority of bacteria in most OOdy tissues and fluids. and has a serum half-life of around 4 hours, allowing twice-daily Administration in most types of infection. Clinical tria ls have shown that oral cipronoxacin is effective and well tolerated in the trcatment of a range of infections, including those of the [o wt:r rt:5piratory, urinary and gastrointestinal tTacts, skin and skin structures, and bones and joints. Data from comparative studies involving small numbers of patients indicate that oral cipronoxacin is as effective as standard Parenteral therapies (usually aminoglycoside/I’I-Iactam combinations or broad spectrum eephalosporins) in treating serious infections in hospitalised patients. Pharmacoeronomic Benefits and Costs Parenteral dosage forms are gencrally morc expensive than oral formulat ions and inc ur considerable material costs (e.g. syringes, needles, cannula, Administration set and accessories, reCOnstituting nuids) and labour costs (nursing/pharmacy stafJ) for preparation and Administration. On the other hand, oral Administration requires minimal expertise, time and materials. However. the greatest cost avoidance may occur when patients receiving oral antibacterial therapy are able to be discharged earlier from hospital. or do not require admission to hospital. since patients arc often hospitalised primarily to receive Parenteral antibacterial therapy. As cipronoxacin is welliolcratoo. adverse effects arc nat likely to add significantly to the cost of therapy, and monitoring of plasma Drug concentrations is nOI necessary, in contrast to the aminoglycosides and vancomycin. Oral treatment is also more comfonablc and convenient for the patient and avoids the risks of phlebitis, extravasation and other adverse effects associated with Parenteral deli very. In the US. acceptance of oral cipronoxacin as a substitute for traditional Parenteral therapy in serious infections is likely to depend on the palienl mix of individual hospitals, with the greatest potential advantages for those institutions with a high proponion of prospectively paid diagnosis-related groups (ORG) status patients and managed-care institutions. In contrast, loss of income from private and third-pany re lrospcclive reimbursement m ulting from decreased use of Parenteral antibacterials, with consequent shonening of hospital stay. may discourage acceptance of oral cipronoucin in some institutions which are reimbursed by day of treatment rather than by episode of care. Pharmacoeconomic Analyses Pharmacoeconomic analyses in hospitalised patienlS demonstrate that substitution of oral cipronoxacin in place of Parenteral antibacterial therapies in the treatment of serious infections can achieve considerable reductions in Drug acquiSition costs and costs of labour and supplies associated with preparation and Administration of Parenteral therapy, whether give n from the OUtset or after a few days’ Parenteral therapy. The randomised studies prospectively compared oral eipronoxaein and alternative Parenteral regimens. while in other analyses hYPOthetical savings were estimated by comparing actual costs of cipronoucin therapy with projected costs ofahemative therapies. In aU except one study, the cost of cipronOXicin th erapy was compared with those of various regimens prescribed on an individual patient basis. and mean cost savings were calculated. However. it was nOI clear whether branded or generic formulations were used. In prospective studies. mean reductions in antibacterial therapy costs ranged from 43 to 83%, when patients were switched from various parcnteraltherapies to oral cipronoxacin after 3 days’ treatment for various serious infections, or received oral cipronoxacin instead of intramuscular cefamandole for lower respiratory tract infection from the outset of treatment. However, all of the analyses took different cost factors into consideration. and only one included costs of therapeutic Drug monitoring, adverse effects and trea tment failure, wilhout itemising these separately. Length of hospital stay was nOI a useful end-point in some studies, because of confounding factors; nevenheless, several investigators reponed that cipronoxaein recipients were able to be discharged earlier than patients receiving Parenteral therapy.
Julia A. Balfour - One of the best experts on this subject based on the ideXlab platform.
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Oral ciprofloxacin: a pharmacoeconomic evaluation of its use in the treatment of serious infections.
PharmacoEconomics, 1993Co-Authors: Julia A. Balfour, Diana FauldsAbstract:The broad spectrum of antibacterial activity and favourable pharmacokinetic profile of ciprofloxacin permit oral treatment of many serious infections which have traditionally necessitated Parenteral antibacterial therapy. This has been demonstrated in comparative studies, in which ciprofloxacin was as effective and well tolerated as standard Parenteral therapies (usually aminoglycoside/beta-lactam combinations or broad spectrum cephalosporins) in small numbers of patients with infections of the lower respiratory tract, urinary tract, skin and soft tissue, and bones and joints. Oral ciprofloxacin is considerably less expensive than most Parenteral therapies, does not necessitate therapeutic Drug monitoring and can be administered on an outpatient basis. In addition, Administration by the oral route is more comfortable and convenient for the patient. Pharmacoeconomic studies have confirmed that substitution of oral ciprofloxacin for Parenteral therapy in the treatment of serious infections can achieve considerable savings in Drug acquisition costs, and labour and supplies associated with Parenteral Drug Administration, and may allow early discharge from hospital, resulting in even greater savings. Mean reductions of 43 to 83% were achieved in antibacterial costs in 3 randomised prospective studies, when patients received oral ciprofloxacin instead of various Parenteral agents, from the beginning of treatment, or after 3 days' Parenteral therapy. It can be concluded that oral ciprofloxacin offers considerable scope for cost avoidance when appropriately substituted for Parenteral therapy in the treatment of serious infections.
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Oral Ciprofloxacin
PharmacoEconomics, 1993Co-Authors: Julia A. Balfour, Diana FauldsAbstract:Synopsis The broad spectrum of antibacterial activity and favourable pharmaceutical profile of ciprofloxacin permit oral treatment of many serious infections which have traditionally necessitated Parenteral antibacterial therapy. This has been demonstrated in comparative studies, in which ciprofloxacin was as effective and well tolerated as standard Parenteral therapies (usually amino- glycoside/β-lactum combinations or broad spectrum cephalosporins) in small numbers of patients with infections of the lower respiratory tract, urinary tract, skin and soft tissues, and bones and joints. Oral ciprofloxacin is considerably less expensive than most Parenteral therapies, does not necessitate therapeutic Drug monitoring and can be administered on an outpatient basis. In addition, Administration by the oral route is more comfortable and convenient for the patient. Pharmacoeconomic studies have confirmed that substitution of oral ciprofloxocin for Parenteral therapy in the treatment of serious infections can achieve considerable savings in Drug acquisition costs, and labour and supplies associated with Parenteral Drug Administration, and may allow early discharge from hospital, resulting in even greater savings. Mean reductions of 43 to 83% were achieved in antibacterial costs in 3 randomised prospective studies, when patients received oral ciprofloxacin instead of various Parenteral agents, from the beginning of treatment, or after 3 days’ Parenteral therapy. It can be concluded that oral ciprofloxacin offers considerable scope for cost avoidance when appropriately substituted for Parenteral theraphy in the treatment of serious infections. Disease and Treatment Considerations Managemcnt of serious infections has traditionally neccssitated hospitalisation and adm inistratio n of Parenteral antibacterial therapy. Antibacterial agents usuall y constitute th e largest single componcnt of pharmaceutical expenditure in an institution and may account for 30 to 50% of the Drug budget. The nuoroquinolone antibacterial cipronoxacin offers the possibility of oral treatment of many infections which previously required Parenteral antibacterial thcrapy. [t has a wide spectrum of antibacterial activity which includes Pseudomonas aeruginosa and other multiply resistan t Gramnegative pathogens. Following oral Administration of therapeutic dosages, ciprofloxacin attain s concentrations sufficient to inhibit growth of the majority of bacteria in most OOdy tissues and fluids. and has a serum half-life of around 4 hours, allowing twice-daily Administration in most types of infection. Clinical tria ls have shown that oral cipronoxacin is effective and well tolerated in the trcatment of a range of infections, including those of the [o wt:r rt:5piratory, urinary and gastrointestinal tTacts, skin and skin structures, and bones and joints. Data from comparative studies involving small numbers of patients indicate that oral cipronoxacin is as effective as standard Parenteral therapies (usually aminoglycoside/I’I-Iactam combinations or broad spectrum eephalosporins) in treating serious infections in hospitalised patients. Pharmacoeronomic Benefits and Costs Parenteral dosage forms are gencrally morc expensive than oral formulat ions and inc ur considerable material costs (e.g. syringes, needles, cannula, Administration set and accessories, reCOnstituting nuids) and labour costs (nursing/pharmacy stafJ) for preparation and Administration. On the other hand, oral Administration requires minimal expertise, time and materials. However. the greatest cost avoidance may occur when patients receiving oral antibacterial therapy are able to be discharged earlier from hospital. or do not require admission to hospital. since patients arc often hospitalised primarily to receive Parenteral antibacterial therapy. As cipronoxacin is welliolcratoo. adverse effects arc nat likely to add significantly to the cost of therapy, and monitoring of plasma Drug concentrations is nOI necessary, in contrast to the aminoglycosides and vancomycin. Oral treatment is also more comfonablc and convenient for the patient and avoids the risks of phlebitis, extravasation and other adverse effects associated with Parenteral deli very. In the US. acceptance of oral cipronoxacin as a substitute for traditional Parenteral therapy in serious infections is likely to depend on the palienl mix of individual hospitals, with the greatest potential advantages for those institutions with a high proponion of prospectively paid diagnosis-related groups (ORG) status patients and managed-care institutions. In contrast, loss of income from private and third-pany re lrospcclive reimbursement m ulting from decreased use of Parenteral antibacterials, with consequent shonening of hospital stay. may discourage acceptance of oral cipronoucin in some institutions which are reimbursed by day of treatment rather than by episode of care. Pharmacoeconomic Analyses Pharmacoeconomic analyses in hospitalised patienlS demonstrate that substitution of oral cipronoxacin in place of Parenteral antibacterial therapies in the treatment of serious infections can achieve considerable reductions in Drug acquiSition costs and costs of labour and supplies associated with preparation and Administration of Parenteral therapy, whether give n from the OUtset or after a few days’ Parenteral therapy. The randomised studies prospectively compared oral eipronoxaein and alternative Parenteral regimens. while in other analyses hYPOthetical savings were estimated by comparing actual costs of cipronoucin therapy with projected costs ofahemative therapies. In aU except one study, the cost of cipronOXicin th erapy was compared with those of various regimens prescribed on an individual patient basis. and mean cost savings were calculated. However. it was nOI clear whether branded or generic formulations were used. In prospective studies. mean reductions in antibacterial therapy costs ranged from 43 to 83%, when patients were switched from various parcnteraltherapies to oral cipronoxacin after 3 days’ treatment for various serious infections, or received oral cipronoxacin instead of intramuscular cefamandole for lower respiratory tract infection from the outset of treatment. However, all of the analyses took different cost factors into consideration. and only one included costs of therapeutic Drug monitoring, adverse effects and trea tment failure, wilhout itemising these separately. Length of hospital stay was nOI a useful end-point in some studies, because of confounding factors; nevenheless, several investigators reponed that cipronoxaein recipients were able to be discharged earlier than patients receiving Parenteral therapy.
Ahamed H Idris - One of the best experts on this subject based on the ideXlab platform.
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intravenous versus intraosseous access for Parenteral Drug Administration in out of hospital cardiac arrest
Journal of the American College of Cardiology, 2018Co-Authors: Purav Mody, Rohan Khera, Nimesh Patel, Pamela Owens, Jarett D Berry, Mark S Link, Ahamed H IdrisAbstract:The current guidelines suggest either intravenous (IV) or intraosseous (IO) access for Drug Administration in patients with out-of-hospital cardiac arrest (OHCA). However, their patterns of use in a real-world setting are not known. Using data from the multicenter Dallas-Fort Worth Resuscitation
