A study of medication errors during the prescription stage in the pediatric critical care services of a secondary-tertiary level public hospital.

BACKGROUND: Medication Errors (MEs) are considered the most common type of error in pediatric critical care services. Moreover, the ME rate in pediatric patients is up to three times higher than the rate for adults. Nevertheless, information in pediatric population is still limited, particularly in emergency/critical care practice. The purpose of this study was to describe and analyze MEs in the pediatric critical care services during the prescription stage in a Mexican secondary-tertiary level public hospital. METHODS: A cross-sectional study to detect MEs was performed in all pediatric critical care services [pediatric emergency care (PEC), pediatric intensive care unit (PICU), neonatal intensive care unit (NICU), and neonatal intermediate care unit (NIMCU)] of a public teaching hospital. A pharmacist identified MEs by direct observation as the error detection method and MEs were classified according to the updated classification for medication errors by the Ruíz-Jarabo 2000 working group. Thereafter, these were subclassified in clinically relevant MEs. RESULTS: In 2347 prescriptions from 301 patients from all critical care services, a total of 1252 potential MEs (72%) were identified, and of these 379 were considered as clinically relevant due to their potential harm. The area with the highest number of MEs was PICU (n = 867). The ME rate was > 50% in all pediatric critical care services and PICU had the highest ME/patient index (13.1). The most frequent MEs were use of abbreviations (50.9%) and wrong speed rate of administration (11.4%), and only 11.7% of the total drugs were considered as ideal medication orders. CONCLUSION: Clinically relevant medication errors can range from mild skin reactions to severe conditions that place the patient's life at risk. The role of pharmacists through the detection and timely intervention during the prescription and other stages of the medication use process can improve drug safety in pediatric critical care services.

Hospital admissions for bleeding events associated with treatment with apixaban, dabigatran and rivaroxaban.

OBJECTIVES: To analyse the hospital admissions for bleeding events associated with treatment with direct oral anticoagulants (DOACs). To describe the characteristics and outcomes of those patients. METHODS: A retrospective observational study was carried out in the framework of an integral risk management plan of drugs and proactive pharmacovigilance of hospital admissions for bleeding associated with apixaban, dabigatran and rivaroxaban from April 2015 through December 2016. Cases were identified using the information management tool of Orion Clinic (hospital electronic medical history) and by reviewing the hospital discharge reports. Various biometric, clinical and pharmacotherapeutic variables of each patient were registered. RESULTS: 37 hospitalisation episodes for DOAC-induced bleeding in 32 patients (15 received rivaroxaban, 9 apixaban and 8 dabigatran) were detected, representing an incidence rate of 3.44 per 100 person-years (95% CI 2.35 to 4.86). The most common bleeding site was gastrointestinal (27 cases, 73.0%). Intracranial bleeding was rare (three cases, 8.1%). Four patients (12.5%) were receiving DOACs at full doses and had a 'dose reduction indication'. The mean (SD) length of stay was 8.4 (5.2) days. Three patients (8.1%) died during the hospitalisation. Among bleeding episodes without fatal outcome, DOACs were stopped in 14 cases, continued in 14 cases, switched for another DOAC in two cases and the dose was reduced in four cases. CONCLUSIONS: DOACs are associated with serious bleeding events that require hospitalisation. The risk/benefit ratio assessment considering patient preferences and an individualised follow-up, especially in patients who are elderly, polymedicated or have impaired renal function, can help to reinforce the safe use of DOACs.

Cross-sectional analysis of retrospective case series of hospitalisations for gastropathy caused by non-steroidal anti-inflammatory treatment: risk factors and gastroprotection use.

OBJECTIVES: To analyse the risk factors of gastropathy caused by using non-steroidal anti-inflammatory drugs (NSAIDs) in detected hospital admissions and to analyse the use of gastroprotective treatment concerning these risk factors. METHODS: A retrospective observational study was carried out in the framework of an integral risk management plan of drugs and proactive pharmacovigilance of hospital admissions for NSAID-induced gastropathy occurring between 2011 and 2015. Cases were identified after reviewing the ICD-9 codes related to NSAID-induced gastropathy in hospital discharge reports. Various biometric, clinical and pharmacotherapeutic variables of each patient were registered. The gastroprotective criteria set out in the therapeutic decision algorithm of the Valencian Health System were followed. RESULTS: 62 hospital admissions for NSAID-induced gastropathy were detected. The mean length of stay was 5.3±3.8 days. Ibuprofen was the most prevalent NSAID (28 cases, 45.2%). 24 cases (38.7%) took NSAIDs in the week before hospitalisation. The prevalence of relevant risk factors for gastropathy were age >60 years (37 cases, 59.7%), concomitant medication (24 cases, 38.7%) and a history of peptic ulcer (9 cases, 14.5%). 41 patients (66.1%) met gastroprotective major criteria, 18 of whom (43.9%) were using a proton pump inhibitor following a prevention plan. CONCLUSIONS: In this study all relevant gastroprotective criteria were associated with the use of gastroprotection in detected hospital admissions for NSAID-induced gastropathy. However, a lack of gastroprotection was observed in a large number of detected cases with the criteria to use it. The feedback of our results to health area agents can serve to reinforce the safe use of NSAIDs.