Editorial

Meet the team


Family Practice - a global perspective

The status of health and medicine in the Middle East - disease control


Histopathological relationship between severity of inflammatory reaction in gastritis and intensity of Helicobacter pylori in the antrum

Hypospadias: does the usage of Clomiphene citrate influence the incidence

Level of Hemoglobins in Sickle Cell Trait in Basrah using HPLC


Assure Safer Drug Therapy in the Middle East


An Investigation of Medical staff awareness of patientsí rights in Fasa hospitals and Medical centers

The investigation of effective factors on patientsí satisfaction Parent-Adolescent Relationships in the City of Amol


An epidemiological survey on maternal mortality rate and fatcors contributing to maternal mortality in rural area of Peshawar



Microdilution In Vitro Susceptibility Testing of 71 species of Dermatophytes isolated from pediatric cases in Nigeria against five antifungal agents


Development of Encounter Forms for Cardiovascular Disease Risk Management

 


Abdulrazak Abyad
MD, MPH, MBA, AGSF, AFCHSE

Editorial office:
Abyad Medical Center & Middle East Longevity Institute
Azmi Street, Abdo Center,
PO BOX 618
Tripoli, Lebanon

Phone: (961) 6-443684
Fax:     (961) 6-443685
Email:
aabyad@cyberia.net.lb

 
 

Lesley Pocock
medi+WORLD International
572 Burwood Road,
Hawthorn 3122
AUSTRALIA
Emai
l
: lesleypocock

 


Assure Safer Drug Therapy in the Middle East

 
AUTHORS

Roman Konovalov, Aroma Software

Dr. Rafiq R. A. Abou-Shaaban, Ajman University

Seven years ago, in 1999, the Institute of Medicine in the United States published its report" To Err Is Human: Building a Safer Health System". The report claims that medical errors [1] cause between 44,000 and 98,000 death s in the USA every year. Using the more conservative figure, medical errors rank as the eighth leading cause of death, killing more Americans than motor vehicle accidents, breast cancer, or AIDS. In addition to this extraordinary human toll, medical errors result in annual direct costs of $17 to $29 billion in the United States. Finally, fear of becoming a victim of medical errors, may lead patients to delay obtaining potentially beneficial medical care, which may allow their illnesses to worsen [2].

A big part of Medical Errors are related to the mistakes made by a doctor during the Drug Therapy. Doctor might miss particular contra-indicated drugs while making prescription for the patient, make mistakes because of sound-alike or look-alike medications, or prescribe the wrong dose for a child or even misinterpret the Lab Result because of drug therapy.

As it is the job of healthcare professionals to provide healthcare services to people, they should work in an adequately equipped medical environment, that provide them with information about patient's current therapy and disease state as well as drug information software to provide alerts and precautions to reduce medication errors.

Currently, healthcare professionals use very different sources of drug information to learn about medications and their interactions. Some hospitals use Micromedex or First DataBank, the international drug databases that contain a huge number of drugs available worldwide. But because of the price, these products are not available for small clinics and private doctors. Some doctors download free drug database for US or UK markets on their PDAs from the web. Certain part of healthcare professionals uses drug catalogs published by HCP Healthcare Publications or similar companies. Of course, the Internet is also a source of drug information for doctors. It's also possible to download a list of drugs registered in the country from the Ministry of Health web site, but it's a simple plain list with product's brand name and price information.

In spite of the fact that there is a certain number of sources that might help healthcare professionals to get information about the drugs, there is no product exists on the market that would contain full details about the medications that are presented in UAE or the entire Middle East. And even more, only small number of currently available sources of drug information can be integrated into the existing hospital's Electronic Patient Record.

In the late 2005, software company Business Information System started the project to create the expert system that would contain drug database as well as logic to check drug-drug interactions, dose check, sound-alike or look-alike drugs and many other things. The system got code name DRUGS and was intended to be used as a part of hospital's Electronic Patient Record.

In the beginning of year 2006 another software development company based in UAE, Aroma Software, started the similar project to create Drug Database that would contain all drugs available in the United Arab Emirates. The information about each drug would contain the details like Generic Name, prescription recommendations, precautions, contra-indicated drugs and diseases and so on. The product would also contain the logic to check drug-drug interactions, dose check and precautions. The project got a code name Snowhorse. It was intended to be used first as stand-alone application and then as a component that might be integrated into hospital's Electronic Patient Record.

In early July 2006 both companies had made a decision to merge their efforts and create common program that would implement the ideas of both companies in helping healthcare professionals to deliver safer drug therapy to their patients. The new joint project got a name Greenrain. As a first step, the product will be marketed in United Arab Emirates, then in GCC countries and finally in other countries in the Middle East.

 

 

 

First of all, the product will help doctors to reduced medication errors. At the time doctor make a prescription, the program performs the following checks:

  1. Drugs currently used have the same Generic Name as currently prescribed drugs - this check will prevent any duplication in therapy and avoid Adverse Drug Events.
  2. Contra-indicated drugs with currently used to find drugs in the prescription that conflict with currently used drugs.
  3. Contra-indicated diseases of the patient to find drugs in the prescription that conflict with the diagnosed diseases.
  4. Drugs with the same therapeutic use - this will help doctors to avoid duplication in therapy. If currently prescribed drug is in the same therapeutic use as currently used drug, then Greenrain makes a check for sound-alike and look-alike drugs.
  5. All the checks above are made against the other drugs in the same prescription.
  6. Dose check to find the situations when currently prescribed drug has wrong dosage taking in consideration Renal and Hepatic Impairment possibility.
  7. Finally, the program provides doctors with drug information to make it easy for them to learn the details about particular drugs, its indications, contraindications, precautions etc.

The second, Greenrain helps doctors to avoid misinterpretation of Lab Results due to Drug Therapy. At the time when new Lab Results are saved in hospital system, they are checked against currently used drugs and currently prescribed drugs to see if there are any drugs currently taken by the patient that might affect the Lab Results.

The third, the program checks precautions of each currently prescribed drug regarding the Pregnancy, Habit, Influence of food or drinks, Drug Availability, Discontinuation, Prolonged use, Start and stop conditions and so on.

The fourth, Greenrain support drug substation by checking if currently prescribed drug can be replaced by another drug based on Generic Name. Any particular drug might be replaced by another one with the same efficacy by with less side effects, or to insure that patient gets cheaper drug with the same efficacy to promote patient compliance.

All the checks mentioned above are possible because of the drug database that is included into the program. The drug database contains information about all drugs approved and licensed by Ministry of Health of United Arab Emirates and it will be regularly updated as new information is available.

The program will be released in two major versions. Doctor version that contains full drug search facility and basic functionality for creating prescriptions and managing patient details, and Hospital version that might be smoothly integrated into hospital's Electronic Patient Record.

The Greenrain will significantly help to improve the quality of Healthcare Services in the region. The benefits the program brings might be considered from two different perspectives.

From the medical point of view, the safety of the patient will be increases because of the fact that number of Medication Errors will be reduced through the checks explained above. The program provides doctors with information and alerts to warn about possible issues with the particular drug or Lab Results. By providing the mechanism to warn doctor about possible problems, the mortality and morbidity of the population due to Adverse Drug Events will be decreased.

From financial perspective, the number of patient visits will be reduced, as well as patient's stay in the hospital will become shorter. This will allow hospitals to save additional budget that is currently spent on the treatment of Medication Errors consequences.

 

Figure 1. Drug Details - Click here to open PDF document

Figure 2. Search Drugs - Click here to open PDF document

Figure 3. Interaction Details - Click here to open PDF document

Figure 4. Interaction Search- Click here to open PDF document

 

 

 


REFERENCES
1. To Err is Human, Chapter 2: Errors in Health Care: A Leading Cause of Death and Injury; By the Institute of Medicine (IOM); Available at:http://books.nap.edu/books/0309068371/html/49.html#pagetop
 
2. Prevention of Medical Errors; By National Center of Continuing Education; Available at http://www.nursece.com/onlinecourses/9011.html