Agreement between pharmacists and physicians on the assessment of appropriateness of antimicrobial prescribing.

INTRODUCTION: Audits for monitoring the quality of antimicrobial prescribing are a main tool in antimicrobial stewardship programs; however, interobserver reliability has not been conclusively assessed. Our objective was to measure the level of agreement between pharmacists and physicians on the appropriateness of antimicrobials prescribing in hospitals. METHODS: A national multicenter, cross-sectional study was conducted of patients who were receiving antimicrobials one day of April 2021. Hospital participation was voluntary, and the study population was randomly selected. Pharmacists and physicians performed a simultaneous, independent assessment of the quality of antimicrobial prescriptions. The observers used an assessment method by which all indicators of the quality of antimicrobial use were considered. Finally, an algorithm was used to rate overall antimicrobial prescribing as appropriate, suboptimal, inappropriate, or not assessable. Gwet's AC1 coefficient was used to assess interobserver agreement. RESULTS: In total, 101 hospitals participated, and 411 hospital antimicrobial prescriptions were reviewed. The strength of agreement was moderate regarding the overall quality of prescribing (AC1=0.51; 95%CI=[0.44-0.58]). A very good level of agreement (AC1>0.80) was observed between pharmacists and physicians in all indicators of the quality, except for duration of treatment, rated as good (AC1=0.79; 95%CI=[0.75-0.83]), and registration on the medical record, rated as fair (AC1=0.34; 95%CI=[0.26-0.43]). The agreement was greater in critical care, onco-hematology, and pediatric units than in medical and surgery units. CONCLUSIONS: In this point prevalence study, a moderate level of agreement was observed between pharmacists and physicians in the evaluation of the appropriateness of antimicrobials prescribing in hospitals.

Haemophagocytic syndrome and paradoxical reaction to tuberculostatics after treatment with infliximab.

CASE: A 44-year-old man was diagnosed with ankylosing spondylitis, on treatment with infliximab. After three doses, he was admitted to hospital with fever, fatigue and nausea. A bone marrow biopsy confirmed haemophagocytic syndrome. He was treated with immunoglobulin, cyclosporine and corticosteroids. CT scan revealed tuberculosis. Tuberculostatic treatment was started 26 days after admission. One month later, he was transferred intensive care with septic shock and acute respiratory distress syndrome. After improvement, he was transferred to the medical ward and later discharged. Two weeks after discharge, he was readmitted with a suspected paradoxical reaction (PR) to tuberculostatics and treated with prednisone. He was discharged 15 days later. CONCLUSIONS: In patients treated with anti-TNF therapy it may be advisable to monitor the signs and symptoms of tuberculosis. HPS is a rare complication of rheumatic diseases. The possibility of developing a PR in immunosuppressed patients treated with antituberculous should be considered.

[Pharmaceutical care strategies to prevent medication errors]. / Estrategias de atención farmacéutica para prevenir errores de medicación.

OBJECTIVE: To evaluate the impact of implementing new programs to improve the quality of the pharmaceutical care and unit-dose distribution system for in-patients. MATERIAL AND METHODS: An observational and prospective study was carried out in a general hospital during two different six-monthly period. Transcription and dispensation errors were evaluated in twelve wards during the first six months. Then, two new measures were introduced: the first- reference ward-pharmacist and the second-a new protocol for checking medication on the ward. Results were evaluated by SPSS v. 14 program. RESULTS: In the transcription evaluation, units without a ward pharmacist did not improve. Transcription errors significantly decreased in three units: gynaecology-urology (3.24% vs. 0.52%), orthopaedic (2% vs. 1.69%) and neurology-pneumology (2.81% vs. 2.02%). In dispensing, only units with the new protocol decreased their medication errors (1.77% vs. 1.24%). CONCLUSIONS: The participation of pharmacists in multidisciplinary teams and exhaustive protocols for dispensing medication were effective in detecting and decreasing medication errors in patients.