Medicamentos termolabiles. Protocolo de actuacion en la rotura de la cadena de frio / Thermolabile drugs. Operating procedure in the event of cold chain failure

Objetivo: Establecer un procedimiento normalizado de trabajo en caso de rotura de cadena de frio. Metodo Se seleccionaron los medicamentos termolabiles incluidos en la guia farmacoterapeutica del hospital y se reviso la bibliografia disponible, clasificandolos en categorias con un protocolo de actuacion en cada caso. Resultados Se revisaron 254 medicamentos (162 principios activos). La distribucion por categorias fue In addition, 433 (4.3%) of dispensed doses were returned to the Pharmacy Department. After the Unit Dose Quality Control Group conducted their feedback analysis, 64 improvement measures for Pharmacy Department nurses, 37 for pharmacists, and 24 for the hospital ward were introduced. Conclusions: The SSS programme has proven to be useful as a quality control strategy to identify Unit Dose Distribution System errors at initial, intermediate and final stages of the process, improving the involvement of the Pharmacy Department and ward nurses (AU)

Objective: To establish a standard operating procedure in the event of cold chain failure. Method: We selected thermolabile drugs included in the hospitals pharmaceutical guide. We performed a review of the available literature, classifying each drug into a given category with an intervention protocol for each one. Results: We reviewed 254 drugs (162 active ingredients). Categories were: A (stable ≥ 28 day sat 25◦C): 65 drugs; B (≥7 days at 25◦C): 47 drugs; C (≥48hat25◦C): 30 drugs; D (< 48 h at25◦C): 47 drugs; E (unstable> 8◦C): 12 drugs; F (batch-dependent) 22 drugs. 31 drugs were not classified in any category. The intervention protocol consisted of establishing a system to monitor the products concerned, and discarding or returning them to the laboratory if they were to exceed the time or temperature limit indicated for each category. Discussion: The aim of this study is to make intervention quicker in the event of cold chain failure (AU)

Documento de Consenso sobre el uso de factores estimuladores de colonias de granulocitos biosimilares para la corrección de la neutropenia asociada en pacientes con cáncer / No disponible

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[Study of drug dose calculation for morbidly obese patients]. / Estudio de la dosificación de fármacos en los pacientes con obesidad mórbida.

INTRODUCTION: The objective of this study is to analyse the appropriateness and characteristics of drug dose calculation for hospitalised, morbidly obese patients. METHODS: Retrospective, descriptive study of dose calculations for drugs prescribed to hospitalised, morbidly obese patients in a tertiary hospital in 2007. The recommendations prepared by the Pharmacy division are used as a standard. RESULTS: We included 62 patients. The mean number of medications prescribed per patient was 12.1 (4-39), and an average of 2.4 (1-10) are listed in the recommendations. A total of 135 drugs were prescribed. Dose calculations for 81 of the above (60 %) coincided with recommendations and 54 (40 %) did not; there were 51 cases of underdosing and three cases of overdosing. DISCUSSION: Improper dosing was detected for prescriptions in the systemic antibiotic and antithrombin drug groups, with underdosing being more common than overdosing.

Estudio de la dosificación de fármacos en los pacientes con obesidad mórbida* / Study of drug dose calculation for morbidly obese patients

Introducción: El objetivo del trabajo es analizar la adecuación de la dosificación de los fármacos en los pacientes hospitalizados con obesidad mórbida y sus características. Métodos: Estudio retrospectivo y descriptivo de la dosificación de los fármacos prescritos a los pacientes hospitalizados con obesidad mórbida en un hospital de tercer nivel durante el año 2007. Se ha utilizado como estándar las recomendaciones elaboradas por el servicio de farmacia. Resultados: Se incluyó a 62 pacientes. La media de las especialidades farmacéuticas prescritas por paciente fue 12,1 (4-39), y 2,4 (1-10) la de los fármacos incluidos en las recomendaciones, con un total de 135 especialidades prescritas. La dosificación de 81 (60 %) de ellas coincidía con las recomendaciones y 54 (40 %) no; en 51 casos fue por infradosificación y en 3, por sobredosificación. Discusión: Se detecta dosificación inadecuada de los fármacos prescritos de los grupos antibióticos sistémicos y antitrombóticos, con predominio de la infradosificación (AU)

Introduction: The objective of this study is to analyse the appropriateness and characteristics of drug dose calculation for hospitalised, morbidly obese patients. Methods: Retrospective, descriptive study of dose calculations for drugs prescribed to hospitalised, morbidly obese patients in a tertiary hospital in 2007. The recommendations prepared by the Pharmacy division are used as a standard. Results: We included 62 patients. The mean number of medications prescribed per patient was 12.1 (4-39), and an average of 2.4 (1-10) are listed in the recommendations. A total of 135 drugs were prescribed. Dose calculations for 81 of the above (60 %) coincided with recommendations and 54 (40 %) did not; there were 51 cases of underdosing and three cases of overdosing. Discussion: Improper dosing was detected for prescriptions in the systemic antibiotic and antithrombin drug groups, with underdosing being more common than overdosing (AU)

Conciliación de la medicación: asumamos la responsabilidad compartida / No disponible

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Fototoxicidad asociada al voriconazol / Voriconazole-associated phototoxicity

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[Comparative study of errors in electronic versus manual prescription]. / Estudio comparativo de errores con prescripción electrónica versus prescripción manual.

OBJECTIVE: Electronic prescribing is considered a basic measure for the prevention and reduction of medications errors. The goal of this survey was to assess the incidence of errors occurring with electronic versus standard prescription. METHOD: A prospective, sequential, open-label study to assess errors with electronic prescribing as compared to traditional manual prescribing in two public hospitals in Balearic Islands. Errors regarding medication, diet and/or nursing orders were assesses along four process stages: medical prescription, pharmacy transcription/validation, nursing transcription, and dispensation. RESULTS: With manual prescription 1,576 errors/18,539 therapy orders (8.50%) were identified, whereas with electronic prescription 827 errors/18,885 therapy orders (4.38%) were detected, which represents a relative risk reduction by 48% and an absolute risk reduction by 4.12% (p < 0.0001). Pharmacy transcription/validation errors decreased (1.73 vs. 0.13%, p < 0.0001), as did nursing transcription errors (2.54 vs. 0.81%, p < 0.0001) and dispensation errors (2.13 vs. 0.96%, p < 0.0001); however, the number of prescription errors increased (2.10 vs. 2.40%, p = 0.0401). CONCLUSIONS: Electronic prescription is a powerful tool, and one that in this work was shown to decrease medication-, diet-, and nursing care-related errors in a highly significant way; however, it should be developed and maintained in order to achieve safety and effectiveness as required by drug usage.

Estudio comparativo de errores con prescripción electrónica versus prescripción manual / Comparative study of errors in electronic versus manual prescription

Objetivo: Evaluar la incidencia de errores que se producencon la prescripción electrónica comparada con la prescripciónmanual.Método: Estudio prospectivo, secuencial y abierto para valorarlos errores con prescripción electrónica comparándola con laprescripción manual tradicional en dos hospitales públicos de lasIslas Baleares. Se han valorado los errores de medicación, dietay/u órdenes de enfermería en cuatro fases del proceso: prescripciónmédica, transcripción/validación en farmacia, transcripciónde enfermería y dispensación.Resultados: Con la prescripción manual se detectaron 1.576errores/18.539 órdenes de tratamiento (8,50%), y con la prescripciónelectrónica 827 errores/18.885 órdenes de tratamiento(4,38%), lo que supone una reducción relativa del riesgo del 48%y una reducción absoluta del riesgo de 4,12% (p < 0,0001). Existeuna disminución de errores de transcripción/validación en farmacia(1,73 vs. 0,13%, p < 0,0001), transcripción de enfermería(2,54 vs. 0,81%, p < 0,0001) y dispensación (2,13 vs. 0,96%, p < 0,0001); sin embargo, en la prescripción se observa un aumentodel número de errores (2,10 vs. 2,40%, p = 0,0401).Conclusiones: La prescripción electrónica es una herramientamuy poderosa que ha mostrado en este trabajo disminuir deforma muy significativa los errores de medicación, dieta y cuidadosde enfermería, pero que hay que desarrollar y mantener paraconseguir la seguridad y efectividad que se pretende en la utilizaciónde medicamentos

Objective: Electronic prescribing is considered a basic measurefor the prevention and reduction of medications errors. Thegoal of this survey was to assess the incidence of errors occurringwith electronic versus standard prescription.Method: A prospective, sequential, open-label study to assesserrors with electronic prescribing as compared to traditional manualprescribing in two public hospitals in Balearic Islands. Errorsregarding medication, diet and/or nursing orders were assessesalong four process stages: medical prescription, pharmacy transcription/validation, nursing transcription, and dispensation.Results: With manual prescription 1,576 errors/18,539 therapyorders (8.50%) were identified, whereas with electronic prescription827 errors/18,885 therapy orders (4.38%) were detected,which represents a relative risk reduction by 48% and an absoluterisk reduction by 4.12% (p < 0.0001). Pharmacy transcription/validationerrors decreased (1.73 vs. 0.13%, p < 0.0001), as did nursingtranscription errors (2.54 vs. 0.81%, p < 0.0001) and dispensationerrors (2.13 vs. 0.96%, p < 0.0001); however, the number ofprescription errors increased (2.10 vs. 2.40%, p = 0.0401).Conclusions: Electronic prescription is a powerful tool, andone that in this work was shown to decrease medication-, diet-,and nursing care-related errors in a highly significant way; however,it should be developed and maintained in order to achieve safetyand effectiveness as required by drug usage

[A prospective comparative study to assess the impact of pharmaceutical intervention in the promotion of sequential therapy with flouroquinolones]. / Estudio prospectivo y comparativo para evaluar el impacto de la intervención farmacéutica en la promoción de la terapia secuencial con fluoroquinolonas.

OBJECTIVE: To assess the impact of pharmaceutical intervention on the use of sequential therapy (ST) with fluoroquinolones. METHODS: A prospective comparative study of pharmaceutical intervention in two stages: observational stage and intervention stage for ST promotion. RESULTS: In all, 250 patients receiving intravenous therapy with fluoroquinolones (113 with levofloxacin and 137 with ciprofloxacin) were studied, with 76 and 70 patients, respectively, being eligible for a pharmaceutical intervention program to promote ST. Pharmaceutical intervention showed a decreased duration of intravenous therapy and increased duration of oral therapy for both drugs, as well as decreased medication-related costs, all in a statistically significant manner. DISCUSSION: ST promotion provides an opportunity to expand the role of hospital pharmacists and to optimize fluoroquinolone-based therapy, which results in decreased intravenous treatments and provides a more cost-effective option.

[A prospective randomized study of sulphonylureas therapeutic interchange in patients with type 2 diabetes mellitus]. / Estudio prospectivo y aleatorizado de intercambio terapéutico de sulfonilureas en pacientes con diabetes mellitus tipo 2.

OBJECTIVE: To clinically assess effectiveness of therapeutic interchange from glibenclamide to gliclazide in the hospital setting. METHODS: An open-label prospective, randomized study with two groups of patients: a reference group (patients still receiving their previous outpatient regimen of glibenclamide) and an interchange group (patients with gliclazide substituted for glibenclamide according to a hospital-approved interchange protocol). The efficacy endpoint used was blood glucose at 3 and 6 days post-intervention. A patient with blood glucose < 200 mg/L was considered clinically controlled, and blood glucose changes < or > 30 mg/dL were considered significant. RESULTS: One hundred and sixteen patients were randomized. Blood glucose on the day before the intervention was 177.9 mg/dL +/- 63.4 in the reference group versus 171.3 mg/dL +/- 52.1 in the interchange group (p = 0.92). Mean blood glucose during the first 3 days post-intervention was 156.1 mg/dL +/- 47.5 and 177.7 mg/dL +/- 36.0 (p = 0.14) in the reference and interchange groups, respectively; and mean values for the first 6 days post-intervention were 142.1 mg/dL +/- 36.0 and 172.8 mg/dL +/- 28.2, respectively (p = 0.01). The overall analysis of blood glucose levels showed a better control in the reference group versus baseline values, which was not seen in the interchange group, where blood glucose remained stable and similar to baseline. In no case were 3-day and 6-day blood glucose mean levels above 200 mg/dL, which may be considered acceptable within the hospital setting. CONCLUSIONS: Therapeutic interchange may be safely performed with no clinical impairment, but better controls were achieved in the reference group.

[Evaluation of a pharmaceutical care program to improve adherence to antiretroviral therapy]. / Evaluación de un programa de atención farmacéutica dirigido a mejorar la adherencia al tratamiento antirretroviral.

OBJECTIVE: To establish the impact of a pharmaceutical care program on the improvement of adherence to antiretroviral therapy, and on patient immunologic and virologic outcome. MATERIALS AND METHODS: A multicenter, observational, prospective study in a HIV-infected patient cohort under treatment with antiretrovirals selected by random sampling in 19 Spanish hospitals. The study lasted 12 months, in which the program was applied through a baseline preprocedural visit and 4 quarterly visits. Adherence estimation was based on pill counting. An adherence > or = 90, or > or = 95% was considered adequate (in two time points). RESULTS: 541 patients were included, most of them were males (68.8%) between 20 and 78 years of age. Major risk groups included injecting drug users (43.4%) and heterosexuals (29.4%). Sixty percent had already received treatment for more than 3 years. Mean baseline viral load and CD4 count values were 32,866 copies/ml and 485 cells/mm3, respectively. Throughout the study a slight increase in the percentage of adherent patients was seen; however, statistical significance was not reached (64.3 and 79.2% of patients showed an adherence > 95 and > 90%, respectively, during the fourth quarter, versus 59.8 and 75.5% at baseline). A statistically significant decrease in viral load and increase in CD4 cells was seen following program application. The percentage of patients with a viral load < 200 copies/ml was 72.2, 76.7, and 75.0% at the 2nd, 3rd, and 4th quarters, respectively, versus 64.2% at baseline. CD4 cell counts increased by 50 cells/mm3 on average from the start to the end of follow-up. CONCLUSIONS: Patients included in the program had a good immunologic and virologic outcome, and a trend towards an increased percentage of patients with good adherence was also seen. These results confirm the need to implement follow-up programs for patients receiving antiretrovirals in order to ensure maximum therapeutic benefits.

Importancia del proceso de selección de medicamentos en la prevención de los errores de medicación / Drug safety. Importance of the process of medicine selection in preventing medication errors

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[Program for the substitution of therapeutic equivalents in the hospital setting]. / Programa para la sustitución de equivalentes terapéuticos en el medio hospitalario.

BACKGROUND: A Program of Therapeutic Equivalents (TEP) is here reported which was elaborated and is currently in force at a third level university teaching hospital. MATERIALS AND METHODS: Therapeutic equivalents were selected within the same pharmacologic group on the basis of approved indications and both efficiency and safety data. RESULTS: TEP considers: a) the substitution of drugs which are considered therapeutic equivalents; b) withdrawal of drugs which have not proved efficiency or are of no interest for inpatients; c) continuation of therapies when changes are not advisable, and d) indistinct use of homologous drugs. From August 1998 up to April 1999, TEP was applied in 505 occasions; it was accepted in 499 (99%) and rejected in 6 (1%). DISCUSSIONS: The substitution of therapeutic equivalents should be viewed in the context of selecting the most appropriate drugs to be used in the hospital setting. TEP should be a consensus document and supervised by the Pharmacy and Therapeutics Commission.

Programa para la sustitución de equivalentes terapéuticos en el medio hospitalario / Programme for the substitution of therapeutic equivalents in the hospital setting

Se presenta un Programa de Equivalentes Terapéuticos (PET) elaborado e implantado en un hospital universitario de tercer nivel. Material y métodos. Los equivalentes terapéuticos se seleccionaron dentro del mismo grupo farmacológico en función de las indicaciones aprobadas y los datos de eficacia y seguridad. Resultados. El PET contempla: a) sustitución de fármacos considerados equivalentes terapéuticos; b) suspensión de fármacos que no han mostrado eficacia o sin interés en pacientes hospitalizados; c) continuación de tratamientos que no es aconsejable modificar, y d) utilización indistinta de fármacos homólogos. Desde agosto de 1998 hasta abril de 1999 se aplicó el PET en 505 ocasiones, fue aceptado en 499 (99 por ciento) y rechazado en 6 (1 por ciento). Discusión. La sustitución de equivalentes terapéuticos debe englobarse en el contexto de la selección de medicamentos más adecuados para su utilización en el medio hospitalario. El PET debe ser un documento consensuado y supervisado por la Comisión de Farmacia y Terapéutica (AU)

[Compliance with hypertension treatment: 10 years of publications in Spain]. / Cumplimiento terapéutico en el tratamiento de la hipertensión: 10 años de publicaciones en España.

INTRODUCTION: Ten years of publications (1984-1993) about drug compliance in spanish hypertensive patients are presented. MATERIAL AND METHODS: A bibliography search of Medline (EBSCO CD-ROM ver 104.1, act Jul 1995), Indice Médico Español (CSIC CD-ROM, act Oct 1993) and other sources has been made. RESULTS: 39 articles have been located and 23 investigational publications have been analysed. All the publications, but one, have evaluated the compliance by an indirect method, mainly patient selfdeclaration. The degree of patient compliance determined by interviews, questionnaires or inquiries is 55.5% (IC 95%: 52.7-58.3). The patient compliance in the publications that use methods based in pill counts is 46.4% (IC 95%: 41.6-51.2). The treatment dropout is present in the 18.5% of the patients (IC 95%: 20.5-16.5). CONCLUSIONS: The drug compliance degree in Spanish patients with hypertension is low.