Medication reconciliation on admission in paediatric chronic patients: A multicentre study.

INTRODUCTION: Medication reconciliation (MC) is one of the main strategies to reduce medication errors in care transitions. In Spain, several guidelines have been published with recommendations for the implementation and development of MC aimed at the adult population, although paediatric patients are not included. In 2018, a study was carried out that led to the subsequent publication of a document with criteria for selecting paediatric patients in whom CM should be prioritised. OBJECTIVES: To describe the characteristics of paediatric patients most likely to suffer from errors of reconciliation (EC), to confirm whether the results of a previous study can be extrapolated. METHODOLOGY: Prospective, multicentre study of paediatric inpatients. We analysed the CE detected during the performance of the CM on admission. The best possible pharmacotherapeutic history of the patient was obtained using different sources of information and confirmed by an interview with the patient/caregiver. RESULTS: 1043 discrepancies were detected, 544 were identified as CD, affecting 317 patients (43%). Omission of a drug was the most common error (51%). The majority of CD were associated with drugs in groups A (31%), N (23%) and R (11%) of the ATC classification. Polymedication and onco-haematological based disease were the risk factors associated with the presence of CD with statistical significance. CONCLUSIONS: The findings of this study allow prioritisation of CM in a specific group of paediatric patients, favouring the efficiency of the process. Onco-haematological patients and polymedication are confirmed as the main risk factors for the appearance of CD in the paediatric population.

Safe handoff practices and improvement of communication in different paediatric settings.

Inadequate information management, especially during patient handoff, contributes to a large part of health care-related adverse events. The Committee for Quality of Care and Patient Safety of the Asociación Española de Pediatría has developed this document to provide an overview of handover practices in different paediatric care settings (emergency, inpatient, intensive care, neonatal and primary care). It describes resources to achieve safe and effective communication in all these settings, such as standardised handoff tools. It also proposes recommendations for the prevention of medication errors during the handover process, to improve safety in interhospital and intrahospital patient transfer, and to optimise communication and continuity of care in chronically ill and medically complex children.

Do not do recommendations in different paediatric care settings.

INTRODUCTION: There are many initiatives aimed at eliminating health care interventions of limited utility in clinical practice. The Committee on Care Quality and Patient Safety of the Spanish Association of Pediatrics (AEP) has proposed the development of "DO NOT DO" recommendations (DNDRs) to establish a series of practices to be avoided in the care of paediatric patients in primary, emergency, inpatient and home-based care. MATERIAL AND METHODS: The project was carried out in 2 phases: a first phase in which possible DNDRs were proposed, and a second in which the final recommendations were established by consensus using the Delphi method. Recommendations were proposed and evaluated by members of the professional groups and paediatrics societies invited to participate in the project under the coordination of members of the Committee on Care Quality and Patient Safety. RESULTS: A total of 164 DNDRs were proposed by the Spanish Society of Neonatology, the Spanish Association of Primary Care Paediatrics, the Spanish Society of Paediatric Emergency Medicine, the Spanish Society of Internal Hospital Paediatrics and the Medicines Committee of the AEP and the Spanish Group of Paediatric Pharmacy of the Spanish Society of Hospital Pharmacy. The initial set was limited to 42 DNDRs, and the selection over successive rounds yielded a final set of 25 DNDRs, with 5 DNDRs for each paediatrics group or society. CONCLUSIONS: This project allowed the selection and establishment by consensus of a series of recommendations to avoid unsafe, inefficient or low-value practices in different areas of paediatric care, which may contribute to improving the safety and quality of paediatric clinical practice.

Results of a national survey on knowledge and use of complementary and alternative medicine by paediatricians.

INTRODUCTION: The use of certain Complementary and Alternative Medicines (CAM) in children has been documented in Spain. The main aim of this study is to estimate the knowledge, recommendations, and use of CAM by Spanish paediatricians. MATERIAL AND METHODS: A national study was conducted from June to July 2020 using an online questionnaire. Two e-mails were sent to paediatricians who were members of the Spanish Association of Paediatrics (AEP). RESULTS: Out of 1414 responses received, acupuncture was considered as a science by 31.8%. Homeopathy was recommended to parents by 28.1%. CAM was used by 21.3% of physicians, at least once, to improve their own health. Only 3.8% had ever replaced a conventional treatment with CAM. The following variables were associated with a greater disposition to prescribe homeopathy: female, age over 45 years old, paediatricians working in Primary Care, and paediatricians working in private healthcare. CONCLUSIONS: This AEP Committee on Medicines questionnaire provides new data that should be considered alarming and should ask for a serious thinking on the use of CAM in Spain. Some paediatricians are recommending parents to give treatments not supported by scientific evidence to their children. This practice could be potentially harmful, especially when conventional treatment is being replaced.

Estudio multicéntrico de la incidencia y evitabilidad de los incidentes por medicamentos en pacientes que acuden a los servicios de urgencias pediátricas.

Objetivo: Determinar la incidencia, gravedad y evitabilidad de los  incidentes por medicamentos detectados en los pacientes que acuden a los servicios de urgencias pediátricas, e identificar los grupos de edad de mayor riesgo y los medicamentos implicados.Método: Estudio multicéntrico observacional prospectivo, realizado entre  marzo y junio de 2017, en pacientes entre 0 y 16 años que acudieron a los servicios de urgencias pediátricas de ocho hospitales públicos españoles. Se recogieron tres tipos de incidentes: eventos adversos por medicamentos, errores de medicación e intoxicaciones accidentales. Los incidentes se caracterizaron atendiendo a su gravedad, evitabilidad, grupos de edad afectados y medicamentos implicados.Resultados: Durante el periodo de estudio se registraron 99.797 visitas a los servicios de urgencias pediátricas y se recogieron 334 incidentes por medicamentos en 334 pacientes, de los cuales el 52,4% fueron varones, con una media de edad de 47,1 ± 44,4 meses. La incidencia de pacientes  con incidentes fue del 0,3%. Del total de incidentes, 264 (79%) fueron considerados prevenibles y 158 (47,3%) produjeron daño a los pacientes. Los incidentes detectados fueron 144 (43,1%) eventos adversos por medicamentos, 218 (65,2%) errores de medicación (74 de ellos errores con daño, que se incluyen asimismo como eventos adversos prevenibles) y 46 (13,7%) intoxicaciones accidentales. Los preescolares (edad: 1-5 años) presentaron el 60,8% de los incidentes, siendo también el grupo de edad con un mayor porcentaje de incidentes prevenibles (64%). Un total de 351 medicamentos estuvieron implicados en los incidentes y pertenecieron mayoritariamente a tres grupos terapéuticos: antiinfecciosos de uso sistémico (171; 48,7%), sistema nervioso (66; 18,8%) y sistema respiratorio (41; 11,7%).Conclusiones: La incidencia de incidentes por medicamentos en los pacientes pediátricos que acudieron a servicios de urgencias fue inferior a la referida en pacientes adultos, si bien prácticamente la mitad de los incidentes detectados causaron daños a los pacientes. Los niños preescolares (1-5 años) fueron identificados como el grupo de edad con mayor riesgo. Los incidentes registrados estuvieron causados por un número reducido de medicamentos. Un elevado porcentaje de los incidentes fueron prevenibles, lo que confirma la imperiosa necesidad de implementar medidas de prevención de incidentes en esta población.

Objetivo: Determinar la incidencia, gravedad y evitabilidad de los  incidentes por medicamentos detectados en los pacientes que acuden a los servicios de urgencias pediátricas, e identificar los grupos de edad de mayor riesgo y los medicamentos implicados.Método: Estudio multicéntrico observacional prospectivo, realizado entre  marzo y junio de 2017, en pacientes entre 0 y 16 años que acudieron a los servicios de urgencias pediátricas de ocho hospitales públicos españoles. Se recogieron tres tipos de incidentes: eventos adversos por medicamentos, errores de medicación e intoxicaciones accidentales. Los incidentes se caracterizaron atendiendo a su gravedad, evitabilidad, grupos de edad afectados y medicamentos implicados.Resultados: Durante el periodo de estudio se registraron 99.797 visitas a los servicios de urgencias pediátricas y se recogieron 334 incidentes por medicamentos en 334 pacientes, de los cuales el 52,4% fueron varones, con una media de edad de 47,1 ± 44,4 meses. La incidencia de pacientes  con incidentes fue del 0,3%. Del total de incidentes, 264 (79%) fueron considerados prevenibles y 158 (47,3%) produjeron daño a los pacientes. Los incidentes detectados fueron 144 (43,1%) eventos adversos por medicamentos, 218 (65,2%) errores de medicación (74 de ellos errores con daño, que se incluyen asimismo como eventos adversos prevenibles) y 46 (13,7%) intoxicaciones accidentales. Los preescolares (edad: 1-5 años) presentaron el 60,8% de los incidentes, siendo también el grupo de edad con un mayor porcentaje de incidentes prevenibles (64%). Un total de 351 medicamentos estuvieron implicados en los incidentes y pertenecieron mayoritariamente a tres grupos terapéuticos: antiinfecciosos de uso sistémico (171; 48,7%), sistema nervioso (66; 18,8%) y sistema respiratorio (41; 11,7%).Conclusiones: La incidencia de incidentes por medicamentos en los pacientes pediátricos que acudieron a servicios de urgencias fue inferior a la referida en pacientes adultos, si bien prácticamente la mitad de los incidentes detectados causaron daños a los pacientes. Los niños preescolares (1-5 años) fueron identificados como el grupo de edad con mayor riesgo. Los incidentes registrados estuvieron causados por un número reducido de medicamentos. Un elevado porcentaje de los incidentes fueron prevenibles, lo que confirma la imperiosa necesidad de implementar medidas de prevención de incidentes en esta población.

[Off-label pediatric medicines in Spain]. / Medicamentos fuera de ficha técnica en Pediatría.

Since 2009, the use of off-label and unlicensed drugs has been regulated in Spain. In pediatrics, this exceptional use is more common than in other medical specialties. It varies from 10% to 90% of all prescriptions in children. This variability is due to differences in methodology, classification and sources of information used, and also to the different pediatrics subspecialties. In addition, the knowledge of several pediatricians on this issue is limited and more than half do not comply with the law, in many cases due to ignorance. However, the use of off-label and unlicensed drugs is legal and necessary. The Medicines Committee of the Spanish Association of Pediatrics (CM-AEP) considers that it is necessary to improve the existing information on medicines in the pediatric population. Therefore, the CM-AEP works out a document where suggestions and actions are proposed to achieve it, because children's health deserves it.

[Results of a national survey on knowledge and use of complementary and alternative medicine by paediatricians]. / Resultados de una encuesta nacional sobre conocimiento y uso de pseudociencias por parte de los pediatras.

INTRODUCTION: The use of certain Complementary and Alternative Medicines (CAM) in children has been documented in Spain. The main aim of this study is to estimate the knowledge, recommendations, and use of CAM by Spanish paediatricians. MATERIAL AND METHODS: A national study was conducted from June to July 2020 using an online questionnaire. Two e-mails were sent to paediatricians who were members of the Spanish Association of Paediatrics (AEP). RESULTS: Out of 1,414 responses received, acupuncture was considered as a science by 31.8%. Homeopathy was recommended to parents by 28.1%. CAM was used by 21.3% of physicians, at least once, to improve their own health. Only 3.8% had ever replaced a conventional treatment with CAM. The following variables were associated with a greater disposition to prescribe homeopathy: female, age over 45 years old, paediatricians working in Primary Care, and paediatricians working in private healthcare. CONCLUSIONS: This AEP Committee on Medicines questionnaire provides new data that should be considered alarming and should ask for a serious thinking on the use of CAM in Spain. Some paediatricians are recommending parents to give treatments not supported by scientific evidence to their children. This practice could be potentially harmful, especially when conventional treatment is being replaced.

[Position Statement From The Spanish Association Of Paediatrics Medicines Committee Concerning The Use Of Alternative Medicine And Pseudo-Science In Children]. / Posicionamiento del Comité de Medicamentos de la Asociación Española de Pediatría en relación con el uso de medicinas alternativas y seudociencias en niños.

Currently, there are some therapies that are being practiced without adjusting to the available scientific evidence. The terminology is confusing, encompassing terms such as "alternative medicine", "natural medicine", "complementary medicine", "pseudoscience" or "pseudo-therapies". The Medicines Committee of the Spanish Association of Paediatrics considers that no health professional should recommend treatments not supported by scientific evidence. Also, diagnostic and therapeutic actions should be always based on protocols and clinical practice guidelines. Health authorities and judicial system should regulate and regularize the use of alternative medicines in children, warning parents and prescribers of possible sanctions in those cases in which the clinical evolution is not satisfactory, as well responsibilities are required for the practice of traditional medicine, for health professionals who act without complying with the "lex artis ad hoc", and for the parents who do not fulfill their duties of custody and protection. In addition, it considers that, as already has happened, Professional Associations should also sanction, or at least reprobate or correct, those health professionals who, under a scientific recognition obtained by a university degree, promote the use of therapies far from the scientific method and current evidence, especially in those cases in which it is recommended to replace conventional treatment with pseudo-therapy, and in any case if said substitution leads to a clinical worsening that could have been avoided.

Oxytocin Receptor Antagonist (Atosiban) in the Threat of Preterm Birth: Does It Have Any Effect on Breastfeeding in the Term Newborn?

AIM: Oxytocin is a hormone involved in the mechanism of breastfeeding, uterine contractions, and social relationships. Atosiban (competitive oxytocin antagonist) is one of the most commonly used tocolytics for the threat of preterm labor in Europe. The aim of this study is to determinate if the administration of atosiban has any influence in the type of feeding in the term newborn at discharge. The secondary objective is to verify its effectiveness for the prevention of preterm delivery and in the possibility of applying treatment to complete lung maturation. MATERIALS AND METHODS: Retrospective cohort study carried out in a tertiary University Hospital distinguished by WHO-UNICEF as a Baby-Friendly Hospital Initiative. The analysis included 264 women exposed to atosiban during a period of 4 years. One hundred met inclusion criteria. Unexposed infants born right after and before the exposed ones were selected as the not exposed subgroup (n = 200). RESULTS: Among women treated with atosiban, 82% maintained exclusively breastfed (EBF), 8% had mixed breastfeeding, and 10% had formula feeding at discharge. In the nonexposed group, 82% maintained EBF, 9.5% had mixed breastfeeding, and 8.5% had formula feeding at discharge (p = 0.84). 97.5% of pregnant women treated with atosiban received corticosteroid for lung maturation, and 49.5% completed gestation with term newborns. CONCLUSION: There were no significant differences in the type of feeding at discharge between the atosiban group and the nonexposed group. In most cases, the administration of tocolytic therapy allowed to complete lung maturation.

[Recommendations for the preparation and administration of antituberculosis drugs in children. Second phase of the Magistral Project of the Spanish Network for the Study of Paediatric Tuberculosis (pTBred)]. / Recomendaciones para la elaboración y administración de fármacos antituberculosos en niños. Segunda fase del Proyecto Magistral de la Red Española de Estudio de la Tuberculosis Pediátrica (pTBred).

The Spanish Network for the Study of Paediatric Tuberculosis has shown a lack of national consensus on the treatment of tuberculosis in children, partly due to the unavailability of paediatric presentations of antituberculosis drugs. The harmonisation of tuberculosis treatment in children is a priority in Spain. A joint action is proposed by a group of Spanish experts in childhood tuberculosis and in the area of Paediatric Pharmacology. To this end, a pTBred-led workgroup of members from five scientific bodies has been created. Drug pharmaceutical compounding in oral suspensions or oral solutions are recommended as follows: isoniazid 50mg/mL, pyrazinamide 100mg/mL, and ethambutol 50mg/mL. Raw materials, period of validity, and storage conditions are specified. Recommendations for the use of fixed-dose combination drugs are also established. If oral solutions/suspensions or fixed-dose combination drugs are not appropriate, the use of crushed tablets is recommended. Adherence to treatment and optimal dosing of antituberculosis drugs are critical in the control and eradication of TB. This multidisciplinary document provides an opportunity to promote the appropriate treatment of paediatric tuberculosis in Spain, and should become a useful tool for paediatricians and pharmacists.