Volume 1, Issue 3
RIPER Poison& Drug Information Center (PDIC),
October 2010 RDT HOSPITAL, Bathalapalli, A.P.
RIPER PDIC Bulletin
Proceedings of International Patient Safety Conference (IPSC),
1st to 3rd October, 2010, AIIMS, New Delhi, India
Working with RDT Under the effective leadership of Dr.
Hospital: L. R. Murmu and Dr. Nishat Ahmed,
All India Institute of Medical Sci-
• To provide high class ences, New Delhi witnessed the first
education to pharmacy International Patient Safety Confer-
students. ence. There were research presenta-
tions from the health care profession-
• To provide unbiased als of USA, UK, Germany, India etc. It
drug and poison informa- was a holistic approach including
doctors, nurses, pharmacists, health
tion to health care
care workers and traditional medicine
professionals & public. practitioners.
The basic objectives were: To en-
• To conduct CME pro-
hance participants’ understanding of
grams for doctors, phar-
important concepts in patient safety
macists and nurses.
and contribute to set off national
agendas for patient safety.
• To serve patients with
caring patient counsel- To exchange information about patient
safety initiatives and explore emerg-
ing.
ing areas of collaboration for better
understanding of the extent of prob-
• To help and improve
lem and develop solutions.
medication dispensing.
To facilitate union of disciplines and
organizations across the continuum of
• To develop a drug test-
care, championing a collaborative,
ing laboratory.
inclusive, multi-stakeholder approach.
M. Weiss of Dept of Ob/Gyn, Carilion
• To collaborate with other
drug information centers. Clinic, Roanoke, VA, USA summarized
that; full course of medical errors and
unanticipated outcomes or events has
• To produce & review
received much attention since the
RDT essential drug list
release of the Institute of Medicine’s
& RDT drug formulary.
report - “To Err Is Human: Building a
safer health system” on November 29,
• To help in reducing 1999.
adverse drug reactions
L. Leape et al, of Harvard School of
and medication errors.
Public Health, Massachusetts, USA
concluded that; the transformations
comprise a major culture change for
healthcare. Achieving them will
Rosiglitazone was Banned in require enlightened leadership, com-
Europe & restricted use in mitment and support from all stake-
USA. On October 7, 2010, holders.
Indian Govt. Suspended Im- Carmen Y Kelly of Agency for Health-
port & Manufacture of it. For care Research and Quality, Rockville,
USA concluded that; pharmacists,
more info, please contact; physicians, nurses, hospitals, and
ipabengal.dic@gmail.com others who are working to improve
quality and patient safety realize that
these goals cannot be achieved by
any one stakeholder. Pharmacists
working with other stakeholders in the
health care system will help to realize
the benefits of these and other safety
enhancing programs.
Christopher P. Landrigan of Children’s
Hospital, Boston, USA has noted that;
altogether, a convincing literature has Chandra M Gulhati, Editor of MIMS,
emerged to demonstrate that serious India delivered two lectures on; Drug
Safety Situation in India. Patient Safety
medical errors and preventable ad-
verse events are common in health in Clinical Trials.
care. Tarun Wadhwa of KLE College of Phar-
Pameela H. Mitchell of Biobehavioral macy, Karnataka, spoke on Safety Issues
in Pediatrics-Changing Trends from
Nursing and Health Systems, Univer-
sity of Washington, USA concluded Bedside Care to Vigilant Monitoring.
that; patient safety is the cornerstone V R Gupta of Fortis Escorts Heart
of high-quality health care. Institute, New Delhi spoke on Prioritiz-
Geeta Mehta of WHO SEARO, New ing Safety Practice in Healthcare.
Delhi, spoke about Patient Safety; Another interesting talk was by Subodh
K of Administrative Staff College of
WHO Resources and Perspective.
India (ASCI) Hyderabad, on Andhra
Manish Shah of National Patient
Pradesh Patient Safety Strategy.
Safety Foundation, USA, delivered two
lectures on; The Three W’s and How Staff and students of various institutions
of Accountability: What, Why, Who, in the country had presented their
and How. Healthcare IT: A Means to posters relevant to the patient safety.
Most of the presentations were from
an End the Unintended Consequences.
pharmacy institutions. Dr. Sunil K. Jain,
Arati Verma of Quality Council of
Chief Pharmacist of AIIMS, New Delhi
India, New Delhi spoke about Non
was instrumental in participation of
Punitive Reporting of Adverse Events.
pharmacy professionals from India. Some
Krishnan S. of Tawam Hospital, Abu of the key research presentations were
Dhabi, UAE spoke about Integrating from Raghavendra Institute of Pharma-
Patient Safety in to the Culture of the ceutical Education and Research (RIPER),
Organization – How to do it.. A.P., Karpagam University, T.N., Guru
Gobind Singh Indraprastha University,
John Sandars of University of Leeds,
New Delhi, KLE University, Karnataka,
UK delivered three lectures on; How
Manipal University, Karnataka, Interna-
to Effectively Implement Patient
tional Institute of Health Management
Safety in Practice. How to Develop a
Research, New Delhi, AIIMS, New Delhi,
Patient Safety Curriculum. How to
Stanely Medical College, Chennai, Govt.
Improve Underperformance in Health
Care Professionals through Perform- Medical College, Chandigarh, B.S. Anang-
ance Mentoring puria Institute of Pharmacy, Faridabad,
Bonnie Arquila of SUNY Downstate
DIPSAR, New Delhi, Moulana Azad
Medical Center, New York delivered
Medical College, New Delhi, and Anna-
malai University, T.N.
two lectures on; 2011 National Patient
Safety Goals. Importance of Cognitive Further reading: http://www.aiims.edu/
aiims/events/ipsc/ipsc-main.htm
Errors in Diagnosis.
 OCTOBER, 201 0, VOLUM E 1, IS SUE 3, PAGE 2 RIP ER PDIC BULLETIN

ABSTRACTS OF POSTER PRESENTATIONS BY RIPER TEAM IN IPSC 2010

HEALTH RELATED OUTCOME RESEARCH ON PATIENTS EXPERIENCED ADVERSE DRUG REACTION WITH NSAID USE
*Vinay G. Pawar, Dixon Thomas, Molly Mathew, C. Vijaya Raghavan
RIPER, Anantapur, A.P., Karpagam University, Coimbatore, T.N., Malik Deenar College of Pharmacy, Kasaragod, Kerala, PSG College of Pharmacy, Coimbatore, T.N.
It is a prospective study that evaluated the cost of illness and reduction in quality of life in male wage earners. The cost of Adverse Drug
Reactions (ADRs) including cost at hospital, wages lost, and transportation cost for hospital visit if any. Naranjo’s scale was used to assess the causality
of adverse drug reactions due to NSAIDs ranging from nausea to peptic ulcer. The total cost spent for managing the ADR was on an average Rs.587
(range Rs. 130-1550). The average daily wage of the patients was around Rs.200. Average days of not working due to ADR were 2. Quality of Life (QOL)
reduction in Karnofsky’s performance rating scale was on an average 27% (range 10-60%). All popular NSAIDs were causing ADRs.

ADVERSE EVENTS AND PHARMACOECONOMIC EVALUATION IN CHRONIC KIDNEY DISEASE (CKD)

*S. Rubia, B. Narasimhulu, K. Yamini Priyanka, V. N. HariKiran, Seeba Zachariah
RIPER, Anantapur, A.P
This qualitative and quantitative evaluation was performed on CKD patients in a South Indian tertiary care teaching hospital. Adverse
reactions reported in one month period were hypotension (13), shivering (5), pruritis (7), vomiting (19), muscle cramps (7), chest pain (21), vascular
access occlusion (6), hypertension (17), fever (20), dyspnea (14), headache (13) and cardiac arrest (2). Patient noncompliance incidences were not taking
the medication7 (15%), missed doses 23 (49%), missed dialysis 12(25%), and demand to stop dialysis in between 5(11%). The average monthly cost of
medication was Rs.572 ± 287.5; range 192.8-1412.8 and median Rs.551. Diabetic patients had a higher cost of medicines (average Rs.757.2) compared
with non-diabetic patients (average 502.6) with a p-value 0.021.

EPIDEMIOLOGICAL ANALYSIS OF ENDSTAGE RENAL DISEASE (ESRD) PATIENTS ATTENDING HEMODIALYSIS

*D. Giri Raja Sekhar, Seeba Zachariah, J. Valsala Kumari, Jacob George
RIPER, Anantapur, A.P., Medical College, Trivandrum, Kerala
This prospective study was conducted in a tertiary government teaching hospital for a period of six months in Kerala. Etiology of ESRD was identified
as diabetes mellitus, hypertension, glomerulonephritis, and others. Co-morbidity of the patients includes hypertension, other cardiovascular diseases,
diabetes, UTIs, COPD, chronic liver disease, dyslipidemia. Acetate buffer solution was used as dialysate in 79% of patients and bicarbonate buffer was
used in 21% patients. The mean blood flow rate was 250ml/min; mean dialysate flow rate was 500ml/min and mean dialysis session was for 240 min.
The longest period on dialysis was 26 months. This was very poor compared to the health standards in developed countries.

HIGH PREVALENCE OF ANEMIA IN WOMEN AT ANANTAPUR, A.P

*K. Usha, N. Sreelalitha, Rohit R. Bhavasar, M. Sophy, M.S. Kannan
RIPER, Anantapur, A.P., RDT, Hospital, A.P.
Data were collected from inpatients of a charitable multispecialty rural hospital with 400 beds at Anantapur, A.P. The study was for a period
one month, April 2010. There was high prevalence of anemia due to various reasons, totaling 205 per month. The lowest age was one year and the
highest was 74 years. Average hemoglobin level was 8.9g/dl (range 2-10.9). Common reasons for anemia were pregnancy (34%) and nutritional
deficiency (7%). Different age groups affected with anemia include 6.8% (1-10yrs), 31.2 %( 11-20yrs), 35.2% (21-30yrs), 7.8% (31-40yrs), 6.8% (41-50yrs),
6.8% (51-60yrs), 5% (61-70+yrs). According to severity, 59 (28.7%) had mild anemia, 124 (60.4%) had moderate anemia and 22 (10.9%) had severe
anemia.
DRUG USE EVALUATION OF BROAD SPECTRUM PENICILLINS
*Y. Samhita Reddy, G. Narayana, M. Jaffer, J. Raveendra Reddy, Y. Padmanabha Reddy
RIPER, Anantapur, A.P., RDT, Hospital, A.P.
This eight month study was conducted on the inpatients prescribed with broad spectrum penicillins in a rural South Indian tertiary care
hospital. Out of 600 cases evaluated only 4 patients were prescribed with amoxicillin as a monotherapy. Ampicillin was commonly prescribed as
monotherapy. ampicillin-cloxacillin combination was rarely prescribed. Patients treated with Amoxiclav stayed in the hospital for an average of 2.2
(±1.4) days and those on ampicillin for 5.4 (±2.3) days. Amoxiclav was prescribed three times a day for 96% of the cases and ampicillin was
prescribed two times daily for 88% of cases. Antibiotics used along with amoxicillin include amikacin, ceftriaxone, clindamycin, erythromycin and
cloxacillin. Antibiotic adjuvants of ampicillin include cefotaxim, amikacin, cefoperazone, amoxicillin and ceftriaxone.

COMPREHENSIVE EVALUATION OF PHARMACY HEALTH CARE PROVIDERS IN SUB URBAN AREAS OF SOUTHERN ANDHRA PRADESH
*A.Srinadh, G. Seetaram, D. K. Sudheer Naik, C. Sowmya, Y. Padmanabha Reddy
RIPER, Anantapur, A.P.
International Pharmaceutical Federation (FIP) scale for the ‘eight star’ pharmacies was used for this study. Among the working pharmacists
one had M. Pharm, one had B. Pharm and 39 (64%) had diploma in pharmacy. There were 20 (33%) unqualified pharmacists. Out of the 61 pharmacists
51 (84%) were males and 10 (16%) were females. Public accessibility to the pharmacies were high for 18 (30%), medium for 15(15%) and low for 28
(45%) pharmacies. Only 38 (62%) pharmacies had the physical presence of pharmacist had average star score of 2.6 and 23(38%) pharmacies were
working without a qualified pharmacist had scored its stars as 1.2 on an average.
 OCTOBER, 201 0, VOLUME 1, IS SUE 3, PAGE 3 RIP ER PDIC BULLETIN

ABSTRACTS OF POSTER PRESENTATIONS BY RIPER TEAM IN IPSC 2010

EVALUATION OF ANTIMALARIAL DRUG USE IN A MALARIA EPIDEMIC AREA

*V. N. HariKiran, D. Giri Raja Sekhar, J. Raveendra Reddy, M. S. Kannan
RIPER, Anantapur, A.P., RDT, Hospital, A.P.
This six months study shows high prevalence of malaria in rural Andhra Pradesh. Total 110 patients were admitted in the hospital
due to clinical malaria (90), Plasmodium vivax malaria (12) and Plasmodium falciparum malaria (08). Two patients in clinical and
P.falciparum malaria were transfused with blood. Average number of hospital stay for all the groups were near to 4 days. Drug of choice for
clinical malaria was chloroquine phosphate 39 (43%); for P.vivax it was primaquine 8(67%) and for P.falciparum malaria it was quinine 5
(63%). Monotherapy was used in 66% of clinical malaria, 42% of P.vivax malaria and 38% of P.falciparum malaria. Other commonly used
drugs were artesunate, artemether and pyrimethamine.

DRUG OF CHOICE FROM MEDICAL ORDERS FOR FEBRILE SEIZURES AT A RURAL SOUTH INDIAN HOSPITAL
*N. Sreelalitha, K. Usha, K. Thejomoorthy, Durgesh Tadepalli
RIPER, Anantapur, A.P., RDT Hospital, A.P.
In our tertiary care pediatric hospital, 53 patients were admitted due to febrile seizures with co-morbidities in the pediatric
department (Male – 51%, Female 49%). The average duration for the hospital stay was 3 days. In typical febrile seizures the average
hospital stay was one day and treated with diazepam and paracetamol. Commonly prescribed antiepileptic drugs were; diazepam (72%),
lorazepam (30%), Phenytoin (15% - in patients who had secondary convulsive disorders other than febrile seizures), Carbamazepine (10% - in
patients who had secondary convulsive disorders other than febrile seizures) & Sodium Valproate (09% - in patients who had secondary
convulsive disorders other than febrile seizures). Patients with mono or combination therapy included, diazepam, the most common
monotherapy (91%).

STEROIDAL ANTI-INFLAMMATORY DRUGS USED IN CHILDRENS’ HOSPITAL

*G. Seetaram, S. K. R. Soumya, E.Vigneshwaran, K. Balaji, Y. Padmanabha Reddy
RIPER, Anantapur, A.P., RDT Hospital, A.P.
Out of 75 steroidal dosage forms prescribed, 61% were inhalations containing mainly budesonide (N=46); 32% were oral
preparations containing prednisolone (N=20) and budesonide (N=4); 7% were injections of hydrocortisone (N=5). Out of 64 steroidal
molecules prescribed in 50 patients, 47% were for asthma and other hyper sensitivity disorders, and another 47% were for bronchopneumonia.
Other indications like urticaria, meningitis etc rarely demanded a steroid. One of the interesting find out was that out of 50, male patients
were 35 and female patients were 15. The male to female ratio in need of steroidal anti inflammatory agents were 2.3:1.

EVALUATION OF DRUG PRESCRIBING INDICATORS FOR RATIONAL USE OF ANTIBIOTICS IN BRONCHOPNEUMONIA

*Rohit R. Bhavasar, A. Srinadh, Dixon Thomas, Durgesh Tadepalli
RIPER, Anantapur, A.P., RDT Hospital, A.P.
The percentage of hospitalizations with one or more antimicrobial was found to be 41.66% in the first month and 32.97% in the
second month. The average number of antimicrobial drugs prescribed per hospitalization was 2. The average cost of antimicrobial drugs
prescribed per hospitalization was Rs.352 (SD±177.52). The average duration of prescribed antimicrobial drug treatment was 4.5 days. The
most commonly prescribed antibiotics were Amoxiclav (46%) followed by Amikacin (33%).

PRE-OPERATIVE AND POST-OPERTIVE ANTIMICROBIAL PROPHYLAXIS IN DIFFERENT TYPES OF SURGERIES

*D. K. Sudheer Naik, Vinay G. Pawar, Y. Samhita Reddy, Hidayatulla Pathan, T. Raghavendra
RIPER, Anantapur, A.P., RDT Hospital, Anantapur, A.P.
Out of total 100 cases collected, hernia cases 16, appendectomy cases 12, haemorrhoid cases 16, fistula cases 12, Z-plasty cases
14, Miscellaneous 30. Cefazolin was the most commonly used pre operative antimicrobial in herniotomy. Metronidazole, Cefuroxime, Cefazolin
were the commonly used pre and post operatively in appendicectomy. Metronidazole was prescribed commonly pre and post operatively in
hemarrhoids. Metronidazole was used pre operatively and along with amoxiclav post operatively in fistula.

WARD ROUNDS FOR PATIENT SAFETY IN HIV / AIDS

*S. K. R. Soumya, K. Thejomoorthy, Gerardo
RIPER, Anantapur, A.P., RDT Hospital, Anantapur, A.P., Care & Support Center, Anantapur, A.P.
A daily ward round provides extensive patient support and bedside teaching. The survey was done on a 50 beds HIV/AIDS
hospital in Anantapur district, Andhra Pradesh. The ward rounds start at 9.30 AM and extend for 21/2 to 3 hours. The ward round team spent
15 to 20 minutes for each patients. The team includes 4 doctors, 3 nurses, 2 ward attendants and 3 Pharm. D students. The bedside
counseling affirms the confidence of patients on their rights. We follow USAIDS and UNAIDS guidelines for rights of HIV/AIDS patients.
 The ‘RIPER’ is the premier educational institution
Raghavendra Institute of
Pharmaceutical Education and promoted by Raghavendra Educational & Rural Develop-
Research ( RIPER)
RIPER ) ment Society. The college is established in 2002 under the
K. R. Palli Cross, Chiyyedu P.O., Anantapur, leadership of four pharmacy graduates including Dr. Y. Pad-
A.P. India 515721
manabha Reddy and Dr. J. Ravindra Reddy. Now the col-
Phone: 08554-255647
Fax: 08554-255646
Contact the Editor: Mr. Dixon Thomas, M.Pharm, M.S.
lege is offering M. Pharm, B. Pharm, D. Pharm, Pharm D
E-Mail: riperdruginfo@gmail.com, dixon.thomas@gmail.com
RIPER PDIC Bulletin Published by the Principal, RIPER, Anantapur— 515721, A.P. and PharmD (PB) courses approved by AICTE, PCI and
Govt. of AP. The college is affiliated to JNT University,
www.riper.ac.in
Anantapur (JNTUA) / SBTET, AP.

Prof. Dr. S. GANAPATHY visited RIPER

More photos of International Patient Safety Conference (IPSC), AIIMS,
Prof. Dr. S. Ganapathy, Principal (and professor in Pharmacog-
nosy and Phytochemistry) of Andhra University College of Pharmaceutical
Sciences visited RIPER on October 7, 2010. Staff & students of our college
were delighted and inspired by his presence. He is one of the favorite
GURU of our Principal Dr. Y. Padmanabha
Reddy Sir.
Dr. S. Ganapathy has also trained
in Pharmacology in the University of
Strathclyde, U.K. and obtained M.Sc. degree
in pharmacology. He is an award winning;
researcher and teacher with perfect blend
of science and divine.