Saudi Cultural Missions Theses & Dissertations
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Item Restricted Evaluating the Impact of Pharmacist Interventions for High-Risk Patients within a Preoperative Assessment Clinic(Saudi Digital Library, 2025) Aljehani, Yousuf; Suthakaran, Sharanyhan; Bates, Ian; Garfield, SaraBackground: Pharmacists contribute to surgical pathways by optimising high-risk medicines and supporting safe care. While their involvement is recognised, the nature of their specific interventions in surgical settings is not well documented. Aim: To evaluate the impact of pharmacist interventions on the prevention of potential medication-related issues (pMRIs) in surgical patients prescribed high-risk medicines. Methods: A mixed-methods retrospective study design was conducted at a specialist London teaching hospital. A total of 297 referrals were reviewed, with 176 included. Pharmacist actions were categorised using a custom tool to model pMRIs in the absence of intervention. Severity and likelihood were assessed with the SCATH and LORE tools. An expert panel independently rated 18 anonymised cases. Two case exemplars illustrated clinical decision-making. Results: Referrals mainly involved anticoagulants (38.1%), antiplatelets (21.6%), antidiabetics (19.9%), and immunosuppressants (23.9%). A total of 306 interventions were made, including continuation (44.4%), withholding (39.2%), bridging (11.1%), and dose adjustment (5.2%). CFL identified bleeding (n=49), autoimmune exacerbation (n=40), and thrombosis (n=38) as common pMRIs. Severity was disproportionately higher for thrombotic/bleeding events (χ²(4, N=302)=74.9, p<0.001), while likelihood was more often rated likely for these events (χ²(4, N=302)=138.1, p<0.001). Panel agreement was significant for likelihood (W=0.237, p=0.005) but not for severity or intervention appropriateness. Conclusion: Pharmacists in this surgical setting are likely to mitigate severe medication-related harms, particularly thrombotic and bleeding events. Broader referral criteria, systematic documentation, and comparative designs are needed to strengthen evidence of their impact.20 0Item Restricted Improving Organisational Learning from Mefication-related Incident Reports(University of Manchester, 2025) Alshammari, Huda Mohammad; Phipps, Denham; Lewis, Penny; Batista-navarro, Riza theresaMedication-related incidents remain a significant threat to patient safety, yet the learning potential of incident reports is often underutilised due to challenges in data quality, analysis, and feedback mechanisms. This thesis investigates how organisational learning from medication-related incident report data can be enhanced through the use of data science methods; in particular, natural language processing (NLP). The research comprises four empirical studies. Study 1 investigates how Medication Safety Officers (MSOs) in the English National Health Service (NHS) interpret and use incident report data. Using qualitative interviews with 14 MSOs from diverse healthcare settings, it identifies barriers to learning— such as inconsistent data practices and limited analytical capacity—and highlights the role of MSOs in shaping local safety responses. Study 2 describes the development of the Medication-Related Incident Report Annotation (MRIRA) scheme, which is a standardised method for annotating medication incident reports in preparation for NLP analysis. The scheme was iteratively developed using 55 reports drawn from the NHS England Controlled Drug Reporting database. Study 3 evaluates the reliability of MRIRA by measuring inter-annotator agreement using strict and relaxed F1 scores across two medication safety datasets—the NHS England Controlled Drug (CD) Reporting database and the NHS England Learning from Patient Safety Events (LFPSE)/National Reporting and Learning System (NRLS) databases. This study found strong consistency between annotators in annotating core components, based on dual annotation of 15 reports from each dataset (CD reporting and LFPSE/NRLS). Study 4 assesses the content validity of MRIRA through review by subject matter experts, using both quantitative measures (Content Validity Ratio, Content Validity Index, and modified kappa) and qualitative feedback to confirm the scheme’s relevance, importance, clarity, and comprehensiveness. This study involved 12 experts in medication safety and 11 NLP specialists. Collectively, the four studies offer an original contribution to the field of medication safety by identifying persistent challenges in organisational learning and developing a novel, validated annotation scheme (MRIRA) to support structured analysis of narrative incident reports. The MRIRA framework enables the transformation of free-text data into structured representations, laying the groundwork for future integration with analytical tools and automation. While real-world implementation lies beyond the scope of this thesis, the research establishes a methodological foundation for enhancing feedback processes, strengthening analytical capacity, and enabling more consistent learning from medication-related incidents.20 0Item Restricted Evaluation of an Updated Hyperkalaemia Treatment Protocol and Electronic Orderset in Hospitalised Patients: Adherence, Safety Outcomes and Effectiveness.(Saudi Digital Library, 2025) Alrashdi, Ghada; Sawiere, Sarah; Levkovich, Bianca; Lau, WallisBackground: Hyperkalaemia is a life-threatening medical emergency, affecting up to 10% of hospital admissions. In 2023, UK guidance and an MHRA safety alert mandated standardised calcium dosing and structured monitoring, but adherence in practice is unknown. This study is the first large-scale UK inpatient evaluation of adherence, monitoring, safety outcomes and effectiveness following implementation of the updated protocol and electronic orderset. Methods: A retrospective cohort study included adult inpatients (≥18 years) with serum potassium ≥5.5 mmol/L between July-December 2024. Data from the electronic health record were analysed at prescription and episode levels. Results: A total of 379 prescriptions from 234 hyperkalaemia episodes were analysed. Adherence to the calcium gluconate dose (30 mL) was 93.4% overall, higher with orderset use (94.6% vs. 85.7%) but not statistically significant (p = 0.094). Adherence to the insulin-glucose regimen was 99.1%, with full compliance achieved using the orderset (100% vs. 94.4%, p = 0.004). Post-insulin blood glucose monitoring was poor: only 1.7% of prescriptions achieved the target of ≥9 readings within six hours, while 10.8% had none. Orderset use did not improve compliance (p = 0.621). Hypoglycaemia occurred in 17.2% of treated episodes and hyperglycaemia in 28.6%. Treatment effectiveness showed 65.8% achieved normokalaemia after a single prescription, with outcomes more influenced by baseline severity than prescribing method. Conclusions: The updated protocol achieved high dosing adherence, with the orderset supporting standardisation; however, calcium gluconate underdosing and poor glucose monitoring remain safety risks. Embedding predefined monitoring intervals and reinforcing adherence through education may help address these gaps.14 0Item Restricted Hospitalized Patients’ Perception of Medication Safety Engagement in the Kingdom of Saudi Arabia(The Catholic University of America, 2025) Alenizi, Awatif; E. Johnson, Joyce; Asano, Reiko; C. McMullen, PatriciaIn the Kingdom of Saudi Arabia (KSA), medication errors (MEs) during different stages of the medication use process are a significant concern, especially in inpatient hospital units. MEs place hospitalized patients at risk for adverse outcomes. Patient engagement in their medication safety (MS) behaviors may present an extra defense against inadvertent MEs caused by healthcare providers (HCPs). However, little is known about how hospitalized patients choose to engage in MS activities that may reduce or prevent MEs. This descriptive phenomenological study aimed to explore hospitalized patients’ personal perceptions of engaging in MS behaviors to reduce or prevent MEs. Using purposive sampling, the principal investigator interviewed 22 patients hospitalized in medical and surgical units in three KSA hospitals using individual audio-recorded interviews. Using thematic analysis, themes, sub-themes, and categories were identified in relationship to each research question. The key themes that emerged from participants’ experiences receiving medications were limited knowledge of medication, adequacy of procedures taken, good physician communication about the patient’s health condition, limited physician communication about medication, and differences in nurses’ communication during medication administration. The main theme that emerged from participants’ descriptions of factors that encouraged the safe receipt of medications was that changes were needed to encourage MS. The changes included establishing a unified medical record, informing patients about medication side effects, encouraging shared decision-making about medication with patients, and ensuring nurses’ commitment to giving medication on time. Participants reported having a self-perceived role in MS and MS behaviors that hospitalized patients can practice in preventing MEs. Those behaviors were providing accurate and complete information to physicians, checking medication with nurses before receiving it, familiarizing themselves with medication, and reporting side effects. Two themes uncovered factors that influenced patients’ decisions to engage in MS behaviors. These included healthcare provider-related factors, represented by a lack of patient education to practice MS and lack of information offered to patients about medications, and patient-related factors, represented by patient health condition and patient desire. The themes revealed that HCPs’ behaviors, which empowered patients to engage in their MS, were communicating well with patients, educating patients about MS behaviors, and making medication information accessible to patients. HCPs have the potential to facilitate patient engagement in those MS behaviors among hospitalized patients. Thus, this study recommended that HCPs reevaluate their personal philosophies of patient engagement that may influence their behaviors to engage patients in MS. Future research is needed to understand HCPs’ views on hospitalized patient engagement with MS in KSA, develop an instrument to assess patient engagement in MS behaviors and explore hospitalized patient empowerment regarding MS from HCP perspectives.62 0