Errores de medicación en el Servicio de Medicina de un hospital de alta complejidad / Monitoring medication errors in an internal medicine service

Background: Patients admitted to internal medicine services receive multiple drugs and thus are at risk of medication errors. Aim: To determine the frequency of medication errors (ME) among patients admitted to an internal medicine service of a high complexity hospital. Material and Methods: A prospective observational study conducted in 225 patients admitted to an internal medicine service. Each stage of drug utilization system (prescription, transcription, dispensing, preparation and administration) was directly observed by trained pharmacists not related to hospital staff during three months. ME were described and categorized according to the National Coordinating Council for Medication Error Reporting and Prevention. In each stage of medication use, the frequency of ME and their characteristics were determined. Results: A total of 454 drugs were prescribed to the studied patients. In 138 (30,4%) indications, at least one ME occurred, involving 67 (29,8%) patients. Twenty four percent of detected ME occurred during administration, mainly due to wrong time schedules. Anticoagulants were the therapeutic group with the highest occurrence of ME. Conclusions: At least one ME occurred in approximately one third of patients studied, especially during the administration stage. These errors could affect the medication safety and avoid achieving therapeutic goals. Strategies to improve the quality and safe use of medications can be implemented using this information.

Cómo optimizar la seguridad en el uso de medicamentos en urgencia / How to optimize the safe use urgency medicines

Medication errors are defined as any preventable event that may cause harm to the patient or lead to inappropriate medication use. There are factors that determine the occurrence of medication errors in health services, such as: insufficient knowledge of patient care load, fast speed in care, variety and complexity of the routes of drug administration, among others. There are multiple studies in Emergency Departments where increased incidence of medication errors where observed. In our Emergency Department the frequency of medication errors was established at 29.4 percent. To avoid these errors, prevention strategies were generated depending on the type of error. As specific strategies in our emergency department we have assured the presence of a clinical pharmacist in the health team, local protocols for indications have been created and ongoing training of health personnel has been mandatory. The objective of these measures is to ensure quality and safety of patient care. We recognize that errors will occur due to the type of care we provide, and therefore we should implement measures at hand to reduce them...

Errores de medicación en la Unidad de Cuidados Intensivos / Medication errors in the Unit Intensive Care

The safety and quality care are two attributes of the health care that are closely related. The critically ill patients are vulnerable to medical errors, and may experience preventable adverse events, often associated with drugs. The errors in the medication use process may occur at any stage, it is ordering, transcription, dispensing, preparation or administration. Medication errors (ME) can occur in one third of patients hospitalized in an ICU and have the potential to cause permanent damage to patients and longer hospital stay, with the resulting emotional and financial cost associated. Although technology can reduce the likelihood for adverse drug events, the optimal methods for implementation, integration, and evaluation in clinical practice remain unclear. In this paper we present some strategies and interventions to reduce the incidence of ME and optimize the safety and quality of care of critically ill patients (AU)

Errores de medicación en pacientes críticos adultos de un hospital universitario: Estudio prospectivo y aleatorio / Prospective assessment of medication errors in critically ill patients in a university hospital

Background: Critically ill patients are especially vulnerable to medication errors (ME) due to their severe clinical situation and the complexities of their management. Aim: To determine the frequency and characteristics of ME and identify shortcomings in the processes of medication management in an Intensive Care Unit. Patients and Methods: During a 3 months period, an observational prospective and randomized study was carried out in the ICU of a university hospital. Every step of patient's medication management (prescription, transcription, dispensation, preparation and administration) was evaluated by an external trained professional. Steps with higher frequency of ME and their therapeutic groups involved were identified. Medications errors were classified according to the National Coordinating Council for Medication Error Reporting and Prevention. Results: In 52 of 124 patients evaluated, 66 ME were found in 194 drugs prescribed. In 34% of prescribed drugs, there was at least 1 ME during its use. Half of ME occurred during medication administration, mainly due to problems in infusion rates and schedule times. Antibacterial drugs had the highest rate of ME. Conclusions: We found a 34% rate of ME per drug prescribed, which is in concordance with international reports. The identification of those steps more prone to ME in the ICU, will allow the implementation of an intervention program to improve the quality and security of medication management.

Uso de medicamentos en el adulto mayor / Use of pharmaceutical preparations in the aged

The high growth of the elderly population has put health systems in situations never before seen. In parallel with the development of Geriatrics, in recent years, pharmacology has begun to investigate the changes in response to drugs related to human aging. Have been found changes in the pharmacokinetics and pharmacodynamics, which might explain because many drugs cause different responses in the elderly and because this age group has increased incidence and prevalence of adverse drug reactions. With the available data, it has been determined a group of potentially inappropriate medications in the elderly because the risks exceed the benefits. Inadequate use of drugs in the elderly patient leads to falls, delirium, hypotension, acute renal failure, abnormal electrolytic balance, among others, thereby generating more hospitalizations, adverse reactions, among others, which leads to increased dependency and deterioration of the functionality. For the previous reasons, the selection of drugs in the elderly patient must consider aspects pharmacokinetics, pharmacodinamics, cost - efficiency and safety profile from a perspective of the geriatrics, understanding that the drugs in these patients not always have the same response that an adult.