The annual Hajj pilgrimage in Mecca, Saudi Arabia, attracts millions of Muslims from around the world, creating a unique mass gathering (MG). The World Health Organization has expressed concerns regarding unsafe pharmaceutical practices and medication errors, emphasizing the importance of addressing medication safety in high-risk environments. During the Hajj, nurses are responsible for preparing intravenous (IV) medications, which may increase the potential for medication preparation errors. This review seeks to underscore the critical measures necessary for ensuring medication safety when handling IV medications in critical care settings during Hajj MGs. Furthermore, the review proposes a streamlined guide for the preparation and dosage of IV critical care medications, including antidotes, to support healthcare providers in maintaining medication safety throughout the Hajj. By adopting these recommendations, healthcare professionals can significantly improve the safety and overall well-being of pilgrims participating in the Hajj pilgrimage.

Background: Rheumatic heart disease (RHD) is a leading cause of heart disease in children and young adults in developing countries and is considered a significant cause of cardiovascular diseases. Antimicrobial prophylaxis is recommended as secondary prevention for heart complications caused by recurrent acute rheumatic fever. Objective: Our study aims to describe the prescribing patterns of RHD antibiotic secondary prophylaxis among eligible patients and highlight the frequency of valvular heart disease complications requiring intervention. Materials and Methods: A single-center retrospective study was conducted at a tertiary hospital in Saudi Arabia. The study included all patients 5 years old and above diagnosed with rheumatic heart fever and/or RHD and eligible for secondary prevention between January 2009 and December 2018. The primary outcome is the frequency of RHD secondary prophylaxis prescribed for eligible patients. Results: Among 806 patients who were screened, 272 patients were eligible for inclusion. A total of 194 (71.3%) were female, and 146 (53.67%) were older than 40. RHD secondary prophylaxis prescribing adherence was found in only 14 of 272 (5.14%). A total of 185 of 272 (68%) patients had at least one cardiac-related intervention during the follow-up period. Valvular heart disease progression was found in 72 of 185 (38.9%) after a primary intervention. Overall mortality was 30 (11%). Conclusion: Our study found low prescribing adherence to RHD secondary prevention among eligible patients in an area with a high disease prevalence. A larger sample size is needed to confirm these findings.