Medication reconciliation at admission and discharge: an analysis of prevalence and associated risk factors.

INTRODUCTION: Medication errors are frequent at care transition points and can have serious repercussions. Study objectives were to examine the frequency/type of reconciliation errors at hospital admission and discharge and to report on the drugs involved, associated risk factors and potential to cause harm in a healthcare setting with comprehensive digital health records. MATERIAL AND METHODS: A prospective observational 2-year study was conducted in the Internal Medicine Department of a regional hospital. The best possible medication history was obtained from different sources by clinical pharmacists and compared with prescriptions at admission and discharge. The frequency and type of reconciliation errors were studied at admission and discharge, evaluating risk factors for their occurrence and their potential to cause harm. RESULTS: The study included 814 patients (mean age: 80.2 years). At least one reconciliation error was detected in 525 (64.5%) patients at admission, with a mean of 2.2 ± 1.3 errors per patient and in 235 (32.4%) patients at discharge. Drug omission was the most frequent reconciliation error (73.6% at admission and 71.4% at discharge); 39% of errors at admission and 51% at discharge had potential to cause moderate or severe harm. The risk of error at admission was higher with more pre-admission drugs (p < 0.001) and, among patients with reconciliation errors, the number of errors was significantly higher in those receiving more drugs pre-admission or with more comorbidities. The risk at discharge was higher in patients with more drugs prescribed at discharge (p = 0.04) and in those with a longer hospital stay (p = 0.03). CONCLUSIONS: Medication reconciliation procedures are required to minimise medication discrepancies and enhance patient safety. Integration of patient health records across care levels is necessary but not sufficient to prevent errors.

Topical endotracheal mitomycin C as a complementary treatment for endoscopic treatment of recurrent laryngotracheal stenosis.

OBJECTIVE: To describe the preparation of topical endotracheal mitomycin C and the clinical outcomes of four patients with recurrent and severe laryngotracheal stenosis (LTS) treated with adjuvant topical mitomycin C. METHOD: Literature review to determine the concentration and method of preparation of topical mitomycin C for endotracheal use. Review of clinical histories. RESULTS: We established a concentration of 0.4 mg/ml topical mitomycin C for the treatment of laryngotracheal stenosis. In the treated cases, we applied a 0.4 mg/ml solution to the wound site following laser surgery and dilatation with bronchoscope. Three patients remain asymptomatic from a respiratory perspective, and treatment failed in one case. CONCLUSIONS: LTS treatment is complex due to the continuous development of granulation tissue and fibrosis following injury to the airways. Topical mitomycin C seems to be the ideal adjuvant agent thanks to its powerful antifibrotic effects.

Determination of tramadol, metamizole, ropivacaine, and bupivacaine in analgesic mixture samples by HPLC with DAD detection.

A high-performance liquid chromatography-diode array detection method was developed and validated to simultaneously determine tramadol (TMD), metamizole (MTZ), ropivacaine (RPV), and bupivacaine (BPV) in the presence of 4-methylaminoantypirine (4-MAA), the metabolite of MTZ, in analgesic mixtures samples used in Patient Controlled Analgesia (PCA). Chromatographic separation is achieved with a C-18 column using a mixture of ACN-methanol-water adjusted to pH 3.0 with NaH(2)PO(4) 0.05M (10:25:65 v/v) in an isocratic mobile phase at a flow rate of 0.8 mL/min. 0.5 mg/mL of Na(2)SO(3) in the water of the mobile phase was necessary to prevent the fast MTZ hydrolysis process to 4-MAA. Ultraviolet-diode array detection was used and chromatograms were registered at the wavelength of 230 nm. The method was linear in the range of 2.2-80.0 mg/L for TMD, 4.1-140.0 mg/L for MTZ, 2.3-40.0 mg/L for RPV, and 2.9-40.0 mg/L for BPV. Validation of the method was made in terms of accuracy, intra- and interday precision, as well as quantification and detection limits. The hydrolysis of MTZ to 4-MAA was studied and verified by mass spectrometry. The developed method was used successfully to evaluate the chemical stability of binary analgesic TMD mixtures with MTZ, RPV, or BPV. The mixtures were tested at standard concentrations used in PCA and in different storage conditions. When mixtures contained MTZ, a chromatographic peak from the metabolite 4-MAA was always detected in the chromatograms.