Risk Management and Healthcare Policy

BackgroundThe World Health Organization recommends rational drug usage to protect patient health and quality of life. Study assessed the quality of drug prescription and dispensing in a tertiary hospital. MethodsCross-sectional study with retrospective and prospective data collection underpinned by the WHO core prescribing indicators. A cluster sample of 10 clinical units and their attached pharmacies in the hospital. Six hundred prescriptions from the pharmacy over six months were randomly selected to evaluate the prescription indicators, 330 patient encounters observed for patient care indicators, and 48 randomly selected doctors to evaluate factors influencing their prescribing practices across the 10 clinics. Descriptive analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 25 and comparison done across all indicators of rational drug use. ResultsAverage drugs per encounter was 3.4 {+/-} 1.9 drugs. Antibiotics and injections were prescribed in 40.2% and 24.8% encounters respectively. Generic names were used in 43.6% and 97.1% of prescription were from the essential medicine list. Average time for consultation was 17.5 {+/-} 8.0 minutes, dispensing time was 7.7 {+/-} 3.8 minutes, 99.8% of medications were properly labelled, and 82% of patients understood the drug doses. The pharmacies stocked 93.3% of key drugs but no consultation room had the essential drug list. Only 43.7% of physicians demonstrated accurate understanding of rational drug use. ConclusionFindings on the WHO core drug indicators showed poor quality of drug prescription. Brand prescription, polypharmacy, and antibiotic overuse observed requires intensifying training and monitoring on rational drug use.

IntroductionPrescribing medications plays a vital role in patient healthcare. The rational drug use is now a significant concern for public health due to incorrect medication prescribing. In promoting rational evidence-based prescribing, prescriptions will be screened and reviewed by pharmacists before medications are dispensed whereby pharmaceutical care intervention (PCI) will be conducted. MethodsThis study aimed to evaluate the prevalence and types of PCI detected at an inpatient pharmacy and to identify the stage of dispensing process where the PCI are frequently detected. The PCI that included was focusing on the prescribing errors. A cross-sectional observational study was conducted over a period of three months started from 1st March 2023 until 31st May 2023 where new medication orders using Pharmacy Information System (PhIS) of all patients warded screened by Inpatient Pharmacy Department were included. ResultsThe prevalence of PCI was 0.006%. The most common type of interventions performed were the prescribed frequency (31.5%) followed by dose (30.0%), drug (19.2%) and polypharmacy (10.8%). The drug category based on ATC classification with a high percentage of interventions was anti-infective for systemic use (34.6%) followed by nervous system (16.2%) and alimentary tract and metabolism (14.7%). Half of the PCIs were detected during screening stage (51.2%) whiles 36.0% were detected during counterchecking and the least detected is during medication filling (12.8%). The highest prescribing errors was from medical wards (50.7%), followed by surgical (24.1%) and orthopaedics (14.8%). ConclusionThe prescribers and clinical pharmacist and inpatient pharmacist are doing well in maintaining patient care. Prescriptions that involve drug category of anti-infective required more attentions especially on drug choice, dose, frequency, and polypharmacy.

PurposeTo achieve a positive safety culture, staff perception of safety must be frequently measured. There are several active and reactive methods to use to measure safety cultures such as near-miss occurrence, accidental data collection, measuring behavior, self-report method, and safety questionnaires. The safety attitudes questionnaire (SAQ) tool was used to measure safety culture. This tool is widely used in literature and among researchers and has been used and validated in middle eastern cultures. In addition, it has a validated Arabic version. MethodsA cross-sectional study was conducted using anonymous and random sampling. I surveyed all ICU staff working in all the adult ICUs in two of the major hospitals in the eastern province of Saudi Arabia. The short version of the Safety Attitudes Questionnaire was used to assess participants attitudes towards safety culture. The study involved all healthcare providers working in Adult ICU. ResultsThe study occurred over a three-week period in March 2019. A total of 82 completed questionnaires were returned which represented a response rate of 82%. On average, the domain that scored the highest number of positive responses was Job satisfaction with 68.5%, followed by teamwork climate 67.8%, then working conditions 60.1%, 57.1% safety climate, then preparation of management with 53.4%, and finally 46% in Stress recognition. A statistically significant difference was found between the mean SAQ score and the educational level of the participants. Participants with bachelors degrees scored a mean of 50.17 compared to participants hold diploma degrees who scored a mean of 68.81 (P=0.02). Moreover, a significant difference was found between the mean SAQ score and participants specialties. Attending/Staff Physician mean score was 36.40, Nurse Manager/Charge Nurse scored 39.78, and Respiratory therapist mean score was 47.88, compared to mean score of 62.27 for Registered Nurse, and Respiratory supervisor 67.0 (P=0.04). In addition, 79.2% of the respondents did not report any incidents in the last 12 months. ConclusionsThe result of the study shows an unsatisfying level of safety culture among healthcare staff in ICUs. The importance of this study is to establish a baseline for safety climate in these hospitals and specifically ICUs. In addition, by exposing the system weaknesses it helps the administration to strengthen and improve patient care. By decreasing workload and job stress, studies show they have a positive association with increasing job performance.

BackgroundProfessionals are defined in the context of a particular body of knowledge which is obtained through formal education, expanded level of skills, type of certification proving their entry into the profession; a set of behavioral norms called professionalism and attitudes representing high levels of commitment to and identification with a specific profession. Several factor affecting the development of the nursing profession. Recognizing and determining such factors can be the first step to move towards the professionalization of nursing. The objective of this study was to assess professionalism in nursing and factors associated among nurses working in Arsi zone, Public Hospitals, Oromia, Ethiopia 2018. MethodsThis study used an Institutional based cross sectional study design. Self-administered structured questionnaire adapted from RNAO (Registered Nurses association of Ontario) guideline, was used to measure the level of professionalism. The sample was 420 nurses from the six Public Hospitals of Arsi Zone, Oromia, Ethiopia. Data was analyzed using SPSS 20.0. Both bivariate and multivariate analysis were carried out to identify associations. Odds ratio was calculated for related factors with 95% confidence interval (CI). A p-value < 0.05 was considered to be statistically significant. ResultOut of 420 Nurses working in six public Hospitals, 380 responded to the questionnaire, making the response rate of 90.5%. In current study level of professionalism was high among nurses (n=380) with highest percentages on accountability, advocacy, and ethics. Gender (AOR=2.489, 95% CI=1.540-4.023), nursing is indispensable (AOR=1.760, 95% CI=1.104-2.806), job satisfaction (AOR= 1.844, 95% CI = 1.143-2.975) and having up to dated training (AOR= 1.809, 95%CI=1.071-3.055 were significantly associated with overall professionalism level. ConclusionNurses working in public hospitals of Arsi zone have relatively had better professionalism level. Gender, nursing is indispensable, job satisfaction, presence of up-to-dated trainings were found significantly associated with professionalism in nursing. Human resource personnel and CEOs of respective hospitals should develop various training programs for nurses and provide encouraging environments for obtaining better qualities in attributes of professionalism.

Accreditation has become an important benchmark for healthcare organisations, and accordingly, many government hospitals in Kerala got accredited with national level (NABH) and state level (KASH) accreditation programmes. This study examined the quality of public healthcare delivery in these accredited hospitals while having a comparison with the non-accredited hospitals. It also compared the impact of national and state-level accreditation programmes in Kerala public healthcare settings. This cross-sectional study conducted between July 2017 and July 2018, employing a positivist approach using stratified random sampling. In total, 621 samples were collected from in-patients of both accredited (NABH and KASH) (312) and nonaccredited (309) public healthcare institutions in Kerala. Nine constructs overarching the quality of healthcare delivery and patient satisfaction construct are used in the study. The study found that patient satisfaction is identical in both accredited and nonaccredited hospitals (M=4.28). Patient satisfaction in NABH accredited hospital (M=4.27{+/-}0.67874) is lower than that of KASH accredited hospital (M=4.30{+/-}1.25417). The mean score of six constructs of quality healthcare delivery of KASH accredited hospitals is higher than NABH accredited. Thus, the study concluded that accreditation, regardless of its type, has no impact on patient satisfaction even though the accreditation process slightly improved different dimensions of quality healthcare delivery.

IntroductionMedication errors (MEs) are common events in the hospital that compromises the patient safety. Despite high prevalence of MEs being reported, there is a limited information at the outpatient settings. MethodThis study assessed the prevalence and characteristics of MEs by analyzing the data of pharmacist-led interventions recorded between 1st November 2024 to 30th September 2025 at the outpatient department of pharmacy, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH). ResultsOf the 90108 prescriptions dispensed, 2045 (2.27%) MEs were recorded during the study period. Among which, 90.81%, 8.70% and 0.49% accounted to prescribing error, packaging error and dispensing error, respectively. More than half of the prescribing error were attributed with antibiotics (39.3%) and antihypertensives (13.9%) combined. Dosing error (63.5%) was highly prevalent type of prescribing error, followed by wrong frequency (12.0%), no indication (10.0%) and omission (5.7%). The severity of harm related to with prescribing error were observed as; no harm (212, 11.42%), minor (233, 12.55%), moderate (1364, 73.45%) and serious (48, 12.58%). Pharmacist-led interventions has prevented more than 90% of the potential harm related to the prescribing error. ConclusionPrescribing error is the most common type of MEs at the outpatient settings in JDWNRH. Majority of the prescribing errors were found to be moderately severe. Pharmacists-led interventions should be effectively integrated in the disease management system to enhance the overall patient safety. Concerned prescribers should enhance their knowledge, particularly in therapeutic management of infectious disease and hypertension to minimize the prescribing errors.

BackgroundPharmacy value-added services (PVAS) have long been offered in public health institutions across Malaysia as an alternative to conventional counter services for prescription refills, with the aim to reduce the waiting time. ObjectiveTo assess the utilization of the PVAS in individual health institutions, and its association with the achievement of the key performance indicator (KPI) set for the pharmacy waiting time. MethodThis was a cross-sectional study based on the data contributed by 142 hospitals and 648 health clinics throughout 2018. The availability and uptake of the PVAS were summarized as percentages. The impacts of the PVAS uptake and the other institution-related factors on the KPI achievement were further explored using the logistic regression analysis. ResultsApproximately 2.9 million (17.1%) of the refill prescriptions were dispensed via the PVAS. The appointment-and-pickup services (42.7%) and the Integrated Drug Dispensing System (23.7%) emerged as the most commonly used types of PVAS. A higher PVAS uptake was associated with a better KPI achievement (OR=0.91, 95% CI: 0.84-0.98). In contrast, adding a new type of PVAS to the existing services yielded an opposite outcome (OR=1.48, 95% CI: 1.15-1.89). Both the prescription load and location of health institutions were also found have influenced the KPI achievement. ConclusionThe PVAS are generally well accepted in Malaysia and showed to have reduced the pharmacy waiting time. However, strategies to optimize the PVAS uptake are warranted.

BackgroundProlonged length of hospital stay is the most common indicator of poor quality of health care and inefficient utilization of hospital resources. Prolonged hospital stay associated with increased mortality, hospital-acquired infection, and unnecessary utilization of hospital bed and other resources. Predicting length of hospital stay facilitates resource designing and initiates quality improvement activities. However, data regarding the prolonged length of hospital stays, and associated factors were a scarce in Ethiopia. MethodsA hospital-based cross-sectional study was conducted on a sample of 316 adult patients from December 1 to January 10, 2022. A consecutive sampling technique was used during sampling procedure. A structured questionnaire was used to collect data regarding sociodemographic factors, clinical factors, medication factors, and behavioral factors through interview, medical record review and by using check list. The data was entered into the epidata4.6 version and exported to SPSS Version25 for binary logistic regression analysis. To identify factors associated with outcome variable, candidate variables (p<0.25) were fitted to multivariable analysis, and those with P-values<0.05 were considered as factors associated with prolonged length of hospital stay. Odds ratio with corresponding 95% CI was used to indicate the strength of association of variables with prolonged length of hospital stay. ResultOne fourth (24.7%) of the study participants experienced a prolonged length of stay at surgical ward. The odd of a prolonged length of hospital stay was high among patients who had comorbid condition [AOR=4.59, at 95% CI= (2.46-8.56)], who developed surgical site infection [AOR=5.02 at 95% CI= 1.97-12.80)], and who developed hospital acquired pneumonia during hospital stay [AOR= 3.43 at 95% CI= (1.36-8.64)]. Conclusion and recommendationNear to quarter of the study participants experienced prolonged length of hospital stays. Comorbid condition, surgical site infection, and hospital acquired pneumonia were factors associated with prolonged length of hospital stay at surgical ward. Quality of care could be improved by adjusting surgical ward environment to prevent hospital acquired infection and focus on managing complication after surgery. Health care provider should be educating surgical patient about the risk of comorbidity on wound healing and early diagnosis and prevention of comorbid condition.

Background Hand hygiene is the most effective and cost-efficient measure for preventing healthcare-associated infections (HAIs). However, adherence among healthcare workers remains suboptimal, particularly in low-resource settings. Purpose/Aim This study assessed the level of adherence to hand hygiene practices and the factors associated with adherence among healthcare workers at Lubaga Hospital, Kampala City. Methods An analytical cross-sectional study was conducted among 216 healthcare workers selected using stratified random sampling. Data were collected through direct observation using the WHO "Five Moments for Hand Hygiene" checklist and a structured, self-administered questionnaire. Data were analyzed using SPSS version 20. Descriptive statistics were used to summarize the data, while inferential analysis included Pearsons Chi-square tests and Modified Poisson regression to estimate crude and adjusted prevalence ratios (cPR and aPR) with 95% confidence intervals at a significance level of p [&le;]0.05. Results Overall adherence to hand hygiene practices was 69.9%, while 30.1% of participants were non-adherent. At the individual level, gender, cadre, and attitude toward hand hygiene were significantly associated with adherence. Male healthcare workers were less likely to adhere compared to females (aPR = 0.490, 95% CI: 0.226-0.969), while nurses and midwives were more than twice as likely to adhere compared to other cadres (aPR = 2.213, 95% CI: 1.113-4.398). Participants with a positive attitude toward hand hygiene were also significantly more likely to adhere (aPR = 1.462, 95% CI: 1.227-3.226). Resource-related factors, including the availability of alcohol-based hand rub and timely replenishment of supplies, were not significantly associated with adherence. Organizational factors such as recent training in hand hygiene and infection prevention (aPR = 1.771, 95% CI: 1.673-2.989), presence of reminders (aPR = 1.747, 95% CI: 1.538-5.949), feedback on performance (aPR = 0.339, 95% CI: 0.156-0.738), and teamwork (aPR = 3.006, 95% CI: 1.424-6.348) were significantly associated with improved adherence. Conclusion Adherence to hand hygiene practices among healthcare workers was moderate but remains suboptimal. Behavioral and organizational factors, particularly training, feedback, teamwork, and attitude, play a more significant role in influencing and adherence than resource availability alone.

Patient safety remains a global problem that affects both developed and developing countries. Healthcare organizations should focus on the need of assessing safety culture as that will provide basic understanding on safety related perceptions of their staffs. ObjectiveThis study was aimed to assess baseline level and mean score of every domain of the patient safety attitude among doctors and nurses in public hospitals in Selangor and to identify the determinants associated with patient safety attitude in all domains : teamwork, safety climate, working condition, job satisfaction, stress recognition and perception of management. MethodThis was a cross-sectional study utilizing the Safety Attitude Questionnaires (SAQ) involving 142 doctors and 231 nurses in three public hospitals in Selangor. The samples were selected through proportionate stratified random sampling. Data was analysed using descriptive, bivariate and multivariate analysis. ResultsThe response rate was 83% in which job satisfaction (73.78{+/-}20.54) and perception of management (58.98{+/-}16.28) received the highest and lowest mean score, respectively. The factors associated with positive patient safety attitude towards 1)teamwork were position (OR 1.99, p=0.03) and history of attending patient safety training (OR 3.228, p = 0.000); 2) safety climate were history of attending patient safety training (OR 7.283, p = 0.000); 3) job satisfaction were education level (OR 35.709, p=0.000), position (OR 10.598, p=0.000) and history of attending patient safety training (OR 2.883, p = 0.000); 4) perception of management were age (OR 2.084,p=0.021) and work area (OR 2.461,p=0.012); 5) working condition were age (OR2.200,p 0.003) and history of attending patient safety training (OR1.738, p 0.032). ConclusionRespondents with history of attending patient safety training have more positive attitude towards teamwork, safety climate, job satisfaction and working condition. Improving patient safety culture should be priorotized by the hospital management team to inculcate safety culture in healthcare providers. STRENGTHS AND LIMITATIONS OF THIS STUDYO_LIThis study reports the outcomes of patient safety attitude in public hospitals in Malaysia. C_LIO_LIThis study has a good response rate. C_LIO_LIThe study covers both types of hospitals in Malaysia (specialist and non-specialist hospitals). C_LIO_LIThe respondents were from 2 categories of healthcare professionals. C_LIO_LIThe factor of limited time and financial constraint limit the ability to include bigger sample into this study C_LI

BackgroundCommunity pharmacists can play an important role in the management of coronavirus disease-19 (COVID-19) outbreak by providing pharmaceutical care and education services. In addition to providing drug-related services, community pharmacies must take measures to reduce the risk of COVID-19 transmission to customers and technicians in pharmacy. Therefore, a study was designed to assess community pharmacists performance and community pharmacies preparedness during COVID-19 outbreak. Materials & MethodsA cross-sectional study was conducted in Kerman, Iran. A 20-item checklist consisting of nine items assessing the practice of pharmacists regarding use of personal protective equipment (PPE) and education of people about routes of transmission, prophylaxis and treatment of COVID-19 and eleven items evaluating the adherence of pharmacies to principles of reducing the risk of COVID-19 transmission in public places was used. ResultsOf 95 enrolled pharmacists, 55 (57.9%) were female and 78.9% had work experience [&le;] 10 years. More than 90% of pharmacists used appropriate PPE and provided information about medications for prevention and treatment of COVID-19 and routs of its transmission to the pharmacy customers. Phone consultation was done by 71.6% of pharmacists. Concerning the preparedness of pharmacies, 92% of personnel used PPE, and hand sanitizers were available in 89.5% of pharmacies. However, a clear sheet was not placed at counters in the majority of pharmacies, and home delivery services were not provided by most pharmacies. ConclusionsThe practice of most community pharmacists was acceptable. However, stricter measures should be taken to diminish the probability of COVID-19 transmission in community pharmacies.

IMPORTANCEMany organizational and personal factors may contribute to burnout and poor job satisfaction experienced by nurses. Adverse Event Reporting System (AERS) is a key component of organizational-level quality improvement system which impacts workplace wellness for nurses. However, little is known about the underlying influence and mechanism that AERS have on nurse well-being. OBJECTIVETo explore the relationship between the implementation of AERS, burnout, and job satisfaction among psychiatric nurses in China. To uncover the mechanism through which AERS influences burnout and job satisfaction, while examining the mediating effect of workplace violence from patients. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study used the multilevel linear regression analyses with a national sample of 9,744 psychiatric nurses from 41 psychiatric hospitals across 29 provinces in China. Data collection was performed in March 2019, and the analyses were conducted from May to July 2022. MAIN OUTCOMES AND MEASURESThe main outcomes were self-reported burnout and job satisfaction. Burnout was measured by the Maslach Burnout Inventory and job satisfaction was measured using Minnesota Satisfaction Questionnaire. RESULTSAmong 9,744 nurses (mean [SD] age, 34.7 [8.8] years) interviewed, 8064 (82.8%) were female. AERS was positively associated with job satisfaction ({beta}=3.70; p<0.05), but negatively with burnout ({beta}=-3.42; p<0.01) and workplace violence ({beta}=-0.55; p<0.1). Workplace violence was positively associated with burnout ({beta}=2.27; p< 0.01), while negatively associated with job satisfaction ({beta}=-0.81; p<0.01). Mediation analysis indicated that the association between AERS, burnout, and job satisfaction was mediated by workplace violence. CONCLUSIONS AND RELEVANCEThis study highlights that the implementation of AERS is associated with less workplace violence in hospitals, and it may also contribute to lower levels of burnout and higher levels of job satisfaction among psychiatric nurses. Key pointsO_ST_ABSQuestionC_ST_ABSHow does hospitals Adverse Event Reporting System (AERS) impact nurses well-being? What are the underlying mechanisms? FindingsIn this cross-sectional study of 9744 psychiatric nurses, nurses in hospitals with AERS reported significantly lower burnout and job dissatisfaction than those in hospitals without AERS. AERS seems to impact well-being by reducing workplace violence. MeaningAlthough Chinese authorities recently stipulated AERS, not all healthcare organizations have fully implemented it. Reporting and consequent quality improvement actions seem to alleviate workplace violence, especially in patient-provider relationship. This will inform hospital management to further leverage AERS for workplace well-being and satisfaction.

Perioperative safety checklists standardize critical actions, but reliable completion depends on the surrounding work system and team behavior. We conducted a prospective observational analytic study from April to May 2026 in the central surgical unit of a high-volume public teaching referral hospital in Indonesia to examine whether patient safety culture and teamwork were associated with directly observed perioperative safety compliance and whether teamwork mediated the culture-compliance relationship. Patient safety culture was measured with the Hospital Survey on Patient Safety Culture 2.0, teamwork with a 35-item TeamSTEPPS Teamwork Perceptions Questionnaire research adaptation, and compliance by direct role-based observation using a 45-item checklist derived from the AORN Comprehensive Surgical Checklist. Eighty of 92 recruited professionals contributed 240 person-operation observations across 50 operations. Overall compliance was 74.75%, with sign-out lowest at 70.68%. Patient safety culture was associated with teamwork ({beta} = 0.590; 95% CI 0.510-0.770) and directly with compliance ({beta} = 0.407; 95% CI 0.187-0.712). The teamwork-compliance coefficient was positive ({beta} = 0.285; p = 0.046), but the prespecified percentile 95% CI included zero (-0.045 to 0.517). The indirect effect through teamwork was not supported ({beta} = 0.168; p = 0.079). These findings support a system-level interpretation of perioperative safety and identify learning-oriented responses to error, situation monitoring, and sign-out fidelity as measurable targets for future improvement efforts.

IntroductionDespite the increased access to medicine, developing countries receive large amounts of medicines from donations. Donated medication could save lives and alleviate suffering but they could also cause deleterious effects on recipients. These effects can lead to the disposal of harmful drugs, affecting health infrastructure and causing negative. Organizations donate drugs for various reasons, including charitable, publicity, or humanitarian reasons. Despite the need for donated drugs, drug dumping remains a prevalent issue in Sub-Saharan Africa. The volume of pharmaceutical waste that accumulates worldwide is now a major concern. The idea of a sustainable, circular bioeconomy on a global scale is appealing. It prioritizes environmental sustainability and human well-being atop economic recovery. The primary objective of this study was to evaluate the status of donated medicines in Tikur Anbessa Specialized Hospital (TASH) and develop suggestions. Medicines donated from April 2022 up to May 2022 were included in this study Materials and MethodsA cross-sectional survey conducted at an institutional level employed both quantitative and qualitative research methodologies. The study was conducted from April 2022 to May 2022, focusing on pharmaceuticals donated to Tikur Anbessa Specialized Hospital (TASH) between November 2021 and March 2022. For the qualitative part, employees of Tikur Anbessa Specialized Hospital (TASH) working at different dispensary units, and pharmaceutical stores constituted the source population. Results and recommendationsA total of six donors contributed a combined value of 11,715,389 Ethiopian birr worth of medicines, supplies, and equipment. The donated items comprised 45 product categories and a total of 160 individual products. Among these, the most prevalent product categories included Opioids (27.48%), ASRVI (10.22%), PDE-5 Inhibitors (7.70%), Antihemophilic agents (7.34%), Antibiotics (7.02%), Anticonvulsants (5.67%), and Antifungals (3.36%). Management of medicines, supplies, and equipment at Tikur Anbessa Specialized Hospital (TASH) is facilitated through the Pharmaceutical Management Information System (PMIS), similar to other medication management processes. The acquisition of donated medications primarily occurs through both recipient requests and donor initiatives. Delivery of drugs near expiry, too small amount, discontinuation, disposal cost and push pull scenario were among the problems. Simple effective communication among donors and the hospital can uplift these problems and enhance the positive impacts of donations. Furthermore, the hospital needs to update its policy on donation and schedule donations to optimize the effects of donations; as a result promoting sustainability.

SynopsisO_ST_ABSBackgroundC_ST_ABSThe overwhelming, irrational behaviour of using antimicrobial (AM) has added to the amplification and spread of antimicrobial resistance (AMR) burden. Healthcare professionals can curtail the AMR by practicing antimicrobial stewardship (AMS). Keeping this in view WHO has laid down a global action plan to combat AMR including free online availability of openWHO course. So, our study aimed at accessing the knowledge, attitude, and practice (KAP) of practicing doctors towards AMS based on this course in a tertiary care hospital. MethodsThe study was conducted among practitioners (faculty, senior residents, junior residents) in different clinical departments. The study was designed as a KAP survey. A validated self-administered questionnaire consisting of 29 questions was designed and shared among 200 participants through the mail and physically. Apart from observing knowledge/attitude/practice gaps, the difference in response to questions was evaluated among various groups (surgeon vs physician, faculty vs senior resident vs junior resident, openWHO course participant vs openWHO course aware non-participant vs openWHO course unaware non-participants. ResultsResponse rate was 62.5% (n=200). Knowledge on AMS was observed among doctors with >50% near correct responses in each question except for the question asking on IV route of AM administration. A significant knowledge gap was found when a comparison was made between faculty members, senior residents, and junior residents (p <0.001) in the spectrum of activity of AM. Almost all the participants agreed that ASP is a necessity in the hospital and believed that ASP reduces healthcare costs and adverse effects of inappropriate AM prescription. A significant difference between the various groups aspects was also observed. ConclusionKnowledge gap on ASP is observed among all HCPs but significant differences among faculty, senior residents, and junior residents, among openWHO course vs unaware openWHO course participant. This shows faculty has to take the lead including more and more practice and education in ASP. The openWHO course may help in achieving this.

Purposethis research aimed to identify the factors that lead to patients having mistrust towards the healthcare system in Somaliland and use the findings as a foundation for future policies. Methodsa descriptive study was conducted to understand the factors contributing to the populations mistrust of the healthcare system in Hargeisa. Data was collected through interviews with 49 participants using a survey questionnaire administered by interviewers, and convenience sampling was used to select participants based on availability and accessibility. Resultsthrough our analysis, we identified 11 themes that investigate issues influencing healthcare quality, cost, and accessibility, such as financial barriers, diagnostic accuracy, drug use, equipment quality, laboratory role, doctor knowledge and skills, medical ethics, governance, local doctor reputation, foreign healthcare, and the quality of available healthcare services. Conclusionpatient -physician mistrust in Somaliland can be addressed by implementing laws, examining doctors knowledge, and examining hospital facilities. Improving public health sectors and limiting patient payments can reduce healthcare costs. Regulations on drugs can reduce medication errors and restore trust in the healthcare system.

BackgroundPharmaceutical care is a patient-centered practice model in which pharmacists assume responsibility for identifying, preventing, and resolving medication-related problems to optimize therapeutic outcomes. In Nigeria, pharmaceutical care activities within hospital settings have expanded over time; however, evidence describing the frequency of specific pharmacist intervention activities and the structural barriers influencing their delivery at the facility level remains limited. ObjectivesThis study aimed to (1) describe the types and frequency of pharmaceutical care intervention activities performed by pharmacists in a secondary-care facility in Nigeria, and (2) identify barriers limiting effective pharmaceutical care delivery in this setting. MethodsA descriptive cross-sectional survey was conducted among pharmacists at a 50-bed secondary-care facility in Ibadan, Nigeria. All pharmacists employed at the facility were invited to participate. Data was collected using a structured, self-administered questionnaire assessing pharmacist demographics, frequency of intervention activities, perceived barriers to pharmaceutical care delivery, and recommendations for improvement. Quantitative data was analyzed descriptively using frequencies and percentages. ResultsTwelve pharmacists participated in this study (response rate: 92.3%). Pharmacists reported frequent engagement in clinically meaningful interventions, including: therapeutic substitutions (87%), provision of drug information to prescribers (83%), prevention of duplicate therapy, and dosage adjustments. Less frequently reported activities included adverse drug reaction reporting and counseling on medication storage. Major barriers to pharmaceutical care delivery were primarily system-related, including: limited access to patient medical records (92%), inadequate privacy for patient consultations (88%), and inefficient documentation systems (83%). Staffing levels and clinical knowledge were not perceived as major barriers. ConclusionPharmacists in this secondary-care facility actively engaged in medication optimization and patient safety-oriented interventions; however, system-level constraints limited the delivery of comprehensive pharmaceutical care. Addressing infrastructural and documentation barriers is essential to strengthen pharmaceutical care practice in secondary-care hospital settings in Nigeria and similar low-and middle-income country (LMIC) contexts.

Background: Academic achievement is crucial for university students, but various factors affect their performance. This study explores the impact of anxiety, sleep quality, social media use, and socioeconomic status on academic performance (CGPA) among public university students in Bangladesh. Data and Methods: Data were collected from 225 students using a structured questionnaire that assessed anxiety (GAD-7), sleep quality (PSQI), social media use (SMUQ), and socioeconomic status (income, parental education). Structural Equation Modeling (SEM) was used to analyze the relationships between these variables. Outcomes: The results showed that socioeconomic status had a strong positive effect on academic performance ({beta} = 0.745, p < 0.001), while anxiety negatively impacted academic outcomes ({beta} = -0.675, p < 0.001). Sleep quality was positively related to academic performance ({beta} = 0.113, p < 0.05), but with a weaker effect. Social media usage is found to have a negative significant effect on academic performance ({beta} = -0.137, p < 0.001). Conclusion: These findings highlight the importance of controlling social media usage and anxiety to enhance academic performance among adult students. Sleep quality and socioeconomic background of the students are also found to be meaningfully associated with their educational progress.

BackgroundTo investigate the impact of goggles on their health and clinical practice during management of patients with COVID-19. Methods231 nurse practitioners were enrolled who worked in isolation region in designated hospitals to admit patients with COVID-19 in China. Demographic data, goggle-associated symptoms and underlying reasons, incidence of medical errors or exposures, the effects of fog in goggles on practice were all collected. Data were stratified and analyzed by age or working experience. Risk factors of goggle-associated medical errors were analyzed by multivariable logistical regression analysis. FindingsGoggle-associated symptoms and foggy goggles widely presented in nurses. The most common symptoms were headache, skin pressure injury and dizziness. Headache, vomit and nausea were significantly fewer reported in nurses with longer working experience while rash occurred higher in this group. The underlying reasons included tightness of goggles, unsuitable design and uncomfortable materials. The working status of nurses with more working experience was less impacted by goggles. 11.3% nurses occurred medical exposures in clinical practice while 19.5% nurses made medical errors on patients. The risk factors for medical errors were time interval before adapting to goggle-associated discomforts, adjusting goggles and headache. InterpretationGoggle-associated symptoms and fog can highly impact the working status and contribute to medical errors during management of COVID-19. Increased the experience with working in PPE through adequate training and psychological education may benefit for relieving some symptoms and improving working status. Improvement of goggle design during productive process was strongly suggested to reduce incidence of discomforts and medical errors.

IntroductionPatient safety is crucial in healthcare. However, medical errors still occur and can harm patients. When healthcare workers experience adverse events, they can become "second victims" and experience emotional turmoil. Symptoms can persist for months and include hypervigilance and doubts regarding clinical skills. We conducted a study among staff at Kijabe Hospital to examine the second victim experience (SVE) and develop support strategies. MethodsWe conducted an online survey using the Second Victim Experience and Support Tool in May 2023. ResultsOf 900 healthcare workers,121 (13.4%) participated in the survey. The respondents consisted of various cadres including 31 students, 24 nurses, 18 clinical officers, 13 allied health workers, 12 consultants, 10 residents, and 13 from other cadres. Overall, 67.2% of the participants reported an SVE. Among these, 89.7% occurred within the past 12 months of these study. Of these participants, 49.6% provided hands-on or direct patient care, and 38.0% provided both direct and indirect patient care. The psychosocial symptoms reported included depressed mood (27.3%), guilt and frustration (27.3%), feelings of inadequacy and loneliness (24.0%), irritability (20.7%), and recurrent intrusive thoughts or images (19.8%). The physical symptoms reported included fatigue (24.0%), headaches (14.9%), and sleep disturbances (11.6%). Forty-five percent of SVs received support from someone at the hospital, while 27.3% received support from a colleague or a peer. In addition, 22.3% received support from close friends or family members, 6.7% received support from hospital administration or management and 0.8% received support from a pastor and an external counselor. ConclusionsTwo-thirds of healthcare workers had a second victim experience, reporting fatigue, depressed mood, guilt, and frustration. Counseling and psychological support were preferred by staff. Hospital management needs to prioritize staff support and acknowledge this experience to ensure patient safety.