Improving medication adherence and effective prescribing through a patient-centered prescription model in patients with multimorbidity.

PURPOSE: This study aimed to assess the impact of the patient-centered prescription (PCP) model in medication adherence and effective prescribing in patients with multimorbidity. METHODS: Uncontrolled before-after study in an intermediate care facility in a mixed urban-rural district. Inpatients aged ≥ 65 years with multimorbidity exposed to polypharmacy before hospital admission were consecutively enrolled. Every patient's treatment plan was analyzed through the PCP model, which includes interventions aimed at improving medication adherence. The primary endpoint was the change in the proportion of adherent patients between pre-admission and after discharge for all regularly scheduled long-term medications, using the proportion of days covered (PDC). Secondary endpoints included the change on mean PDC for all long-term medications, number of long-term medications, proportion of patients with hyperpolypharmacy, medication regimen complexity index (MRCI) score, drug burden index (DBI) score, number of potential inappropriate prescribing (PIP), and proportion of patients with ≥ 2 PIPs. RESULTS: Ninety-three non-institutionalized patients were included (mean age 83.0 ± SD 6.1 years). The proportion of adherent patients increased from 22.1 to 51.9% (P < 0.001). Intervention also improved mean PDC [mean difference (95% CI) 10.6 (7.7, 13.5)] and effective prescribing through a reduction on the number of long-term medications [- 1.3 (- 1.7, - 0.9)], proportion of patients exposed to hyperpolypharmacy (- 16.1%, P < 0.001), MRCI score [- 2.2 (- 3.4, - 1.0)], DBI score [- 0.16 (- 1.8, - 1.3)], number of PIPs [- 1.6 (- 1.8, - 1.3)], and proportion of patients with ≥ 2 PIPs (- 53.7%, P < 0.001). CONCLUSION: Studied intervention provides significant effective prescribing and medication adherence enhancements in non-institutionalized older patients with multimorbidity and polypharmacy.

Therapeutic optimization through goal-oriented prescription in nursing homes.

Background People living in nursing homes are highly vulnerable and frail. Polypharmacy and inappropriate prescription (IP) are also common problems. Objectives The objectives of the study are (i) to study the baseline situation and calculate the frailty index (FI) of the residents, (ii) to assess the results of routine clinical practice to do a pharmacotherapy review (patient-centred prescription (PCP) model) (Molist Brunet et al., Eur Geriatr Med. 2015;6:565-9) and (iii) to study the relationship between IP and frailty, functional dependence, advanced dementia and end-of-life situation. Setting Two nursing homes in the same geographical area in Catalonia (Spain). Method This was a prospective, descriptive and observational study of elderly nursing home residents. Each patient's treatment was analysed by applying the PCP model, which centres therapeutic decisions on the patient's global assessment and individual therapeutic goal. Main outcome measure Prevalence of polypharmacy and IP. Results 103 patients were included. They were characterized by high multimorbidity and frailty. Up to 59.2% were totally dependent. At least one IP was identified in 92.2% of residents. Prior to the pharmacological review, the mean number of chronic medications prescribed per resident was 6.63 (SD 2.93) and after this review it was 4.97 (SD 2.88). Polypharmacy decreased from 72.55% to 52.94% and excessive polypharmacy fell from 18.62% to 5.88%.The highest prevalence of IP was detected in people with a higher FI, in those identified as end-of-life, and also in more highly dependent residents (p < 0.05). Conclusions People who live in nursing homes have an advanced frailty. Establishing individualized therapeutic objectives with the application of the PCP model enabled to detect 92.2% of IP. People who are frailer, are functionally more dependent and those who are end-of-life are prescribed with inappropriate medication more frequently.

Does mHealth increase adherence to medication? Results of a systematic review.

AIMS: Adherence to medication is a major problem that affects 50-60% of chronically ill patients. As mobile phone use spreads rapidly, a new model of remote health delivery via mobile phone ­ mHealth ­ is increasingly used. The objective of this study is to provide a comprehensive overview of how mHealth can be used to improve adherence to medication. METHODS: A systematic literature review was conducted using four databases (CINAHL, PubMed, Scopus and PsycARTICLES). Eligible articles available on March 2014 had to be written in English or Spanish and have a comparative design. Articles were reviewed by two authors independently. A Cochrane Collaboration tool was used to assess the studies based on their internal validity. RESULTS: Of the 1504 articles found, 20 fulfilled the inclusion criteria [13 randomised clinical trials (RCT), one quasi-RCT, one non-randomised parallel group study and five studies with a pre-post design]. Nearly all the trials were conducted in high-income countries (80.0%). Articles were categorised depending on the target population into three different groups: (i) HIV-infected patients, n = 5; (ii) patients with other chronic diseases (asthma, coronary heart disease, diabetes mellitus, hypertension, infectious diseases, transplant recipients and psoriasis), n = 11; and (iii) healthy individuals, n = 4. Adherence improved in four of the studies on HIV-infected patients, in eight of the studies on patients with other chronic diseases, and in 1 study performed in healthy individuals. All studies reported sending SMS as medication reminders, healthy lifestyle reminders, or both. Only one trial (HIV-infected patients) had a low risk of bias. CONCLUSIONS: Our results showed mixed evidence regarding the benefits of interventions because of the variety of the study designs and the results found. Nevertheless, the interventions do seem to have been beneficial, as 65% of the studies had positive outcomes. Therefore, more high-quality studies should be conducted.

Respuesta de los autores: Los acontecimientos adversos a medicamentos originados en el servicio de urgencias y el estudio EVADUR / No disponible

No disponible

Evaluación de los acontecimientos adversos a medicamentos originados en el servicio de urgencias / Evaluation of adverse drug reactions in emergency department practice

OBJETIVO: Determinar la incidencia y caracterizar los acontecimientos adversos a medicamentos (AAM) originados en el servicio de urgencias (SU) de un hospital de tercer nivel. Identificar factores de riesgo asociados a la ocurrencia de AAM y evaluar los errores de medicación (EM) implicados en la aparición de los AAM prevenibles. MÉTODO: Estudio observacional descriptivo de revisión de historias clínicas. Durante 3 meses se seleccionaron pacientes atendidos en el SU que finalmente ingresaron en el centro. La identificación de los AAM se realizó siguiendo una metodología previamente establecida basada en la utilización de señales alertantes (triggers). Se utilizaron los algoritmos de Karch-Lasagna y Hallas para evaluar la causalidad y el cuestionario de Schumock-Thornton para la evitabilidad de los AAM. Todos los posibles AAM fueron validados por dos revisores. RESULTADOS: Se detectaron 31 AAM en los 237 pacientes incluidos, que representan una incidencia del 13%. La mayoría de los AAM presentó una relación de causalidad posible o probable (61% y 29%). El 45% de los AAM fue debido a errores de medicación (EM), que podrían haber sido evitados. Entre los AAM evitables, la principal manifestación fue la alteración de la glucemia atribuida al grupo de antidiabéticos. El principal error implicado fue la falta de prescripción de un medicamento necesario (50%) o la omisión en su administración (21%). En el caso de los AAM inevitables, las principales manifestaciones fueron taquicardia e hiperglicemia asociadas a salbutamol y corticoides respectivamente. Los únicos factores asociados a una mayor prevalencia de AAM fueron el número de fármacos administrados en el SU y la atención en el área de mayor gravedad del SU. CONCLUSIONES: La incidencia de AAM durante la estancia en el SU es elevada y potencialmente prevenible. Estos resultados coinciden con la incidencia descrita en el ámbito hospitalario

OBJECTIVE: To assess the incidence of adverse drug reactions (ADRs) in the emergency department of a tertiary care hospital, to determine the characteristics of the ADRs, to identify related risk factors, and to evaluate medication errors associated with preventable ADRs. METHODS: Descriptive observational study based on data extracted from medical records. Patients admitted to hospital after attendance in the emergency department over a 3-month period were included. ADRs were found following a previously established method to identify ADR clues, or triggers, in patient records. The Karch-Lasagna scale and the Hallas algorithm were used to evaluate causality, and the Schumock-Thornton questionnaire was used to assess ADR preventability. All events that were candidates for classification as ADRs were validated by 2 data collectors. RESULTS: In the records for the 237 patients included, 31 ADRs were detected (incidence, 13%). Most of the ADRs could be assigned a possible (61%) or probable (29%) cause. Forty-five percent of the ADRs were caused by medication errors and could have been prevented. The most common preventable ADRs were hypo- or hyperglycemia related to antidiabetic medication. The most common errors involved failure to prescribe a necessary medication (50%) or failure to administer one (21%). The most common unavoidable ADRs were tachycardia and hyperglycemia related to salbutamol and corticosteroids, respectively. The only factors associated with a higher prevalence of ADRs were the number of drugs administered in the emergency department and admission to the acute-care section of the department. CONCLUSIONS: The incidence of ADRs in this study was high and preventable events were detected. These findings are consistent with evaluations of ADRs in the hospital setting)

Programa de atención farmacéutica integrada en pacientes con enfermedades crónicas / Integrated pharmaceutical care programme in patients with chronic diseases

Objetivo: Valorar si un programa de atención farmacéutica integrada (PAFI) en pacientes crónicos mejora la evolución clínica, la calidad de vida de los pacientes y disminuye el consumo de recursos sanitarios. Material y métodos Ensayo clínico, paralelo, abierto y multicéntrico de un PAFI en pacientes con insuficiencia cardiaca (IC) y/o enfermedad pulmonar obstructiva crónica (EPOC) en 8 áreas de salud de Cataluña. Al paciente en intervención le realizaban seguimiento farmacoterapéutico los farmacéuticos de hospital, atención primaria y farmacia comunitaria. Al control, seguimiento habitual. Todos los pacientes fueron seguidos 12 meses y se les realizó un test de calidad de vida al inicio y final del seguimiento. Resultados Participaron 8 hospitales, 8 centros de atención primaria y 109 farmacias comunitarias. Finalizaron el estudio 238 pacientes con un porcentaje de pérdidas del 2,9%. No hubo diferencias significativas en reingresos, visitas al médico o urgencias. Se detectaron 50 problemas relacionados con medicamentos (PRM) en 37 pacientes, siendo estadísticamente significativa la diferencia de PRM entre el grupo intervención y control en pacientes con IC y casi significativa en pacientes con EPOC. El 36% de los PRM fueron moderados-graves. El 94% PRM fueron evitables y el farmacéutico los resolvió en el 90% de los casos. No hubo diferencias entre la calidad de vida al inicio y final del estudio ni en el consumo de recursos sanitarios. Conclusiones Los programas de atención farmacéutica integrada permiten la mejora de la calidad asistencial al paciente, no obstante es necesaria la utilización de registros electrónicos que faciliten la comunicación entre niveles asistenciales (AU)

Objectives: To assess whether an integrated pharmaceutical care programme (IPCP) improvesclinical evolution, patient quality of life, and reduces health costs in chronic patients. Material and methods: A parallel, open, and multi-centre clinical trial of an IPCP in patients with heart failure (HF) and/or chronic obstructive pulmonary disease (COPD) in 8 different health areas in Cataluña. The intervened patient was monitored for pharmacotherapeutic evolution by hospital pharmacists, primary care physicians, and community pharmacists. Controls received normal follow-up. All patients were monitored for 12 months, with quality of life tests administered at the beginning and end of follow-up. Results: We had the participation of 8 different hospitals, 8 primary care centres, and109 community pharmacies. 238 patients completed the study, with 2.9% of participants lost during the study period. There were no significant differences in terms of readmissions, visits to the doctors, or to emergency services. We detected 50 different medication-related problems(MRP) in 37 patients, with a statistically significant difference in terms of MRP between the control and treatment groups of patients with HF, and almost significant differences in COPD patients. MRP were moderate-severe in 36% of cases. MRP were avoidable in 94% of cases, and the pharmacist resolved the issue in 90% of cases. There were no differences in terms of patient quality of life or health costs between the start and end of the study. Conclusions: Integrated pharmaceutical care programs facilitate an improvement in the quality of patient care, but electronic registries are necessary to promote communication between sections of the health care network (AU)

Esencia de menta al 1, 6% como espasmolítico intestinalen la colangiopancreatografía retrógrada endoscópica / 1.6% Peppermint oil solution as intestinal spasmolytic in retrograde endoscopic cholangiopancreatography

Objetivos: La aparición de peristaltismo intestinal puede dificultar la realización de exploraciones o intervenciones mediante colangiopancreatografía retrógrada endoscópica(CPRE). Con el fin de disminuirlo es frecuente la utilización de espasmolíticos sistémicos, pese a los efectos adversos anticolinérgicos que presentan. Se propuso formular una preparación de esencia de menta al 1,6% de uso local para evitar estos efectos adversos. Método: Se formuló la preparación de la esencia de menta al 1,6% según la bibliografía encontrada. La efectividad de la fórmula fue valorada de manera semicualitativa según la disminución del peristaltismo. Resultados: Se ensayaron 2 emulgentes siendo polisorbato el más adecuado. El estudio piloto llevado a cabo en 8 pacientes demostró su efectividad y seguridad en la disminución del peristaltismo intestinal. Conclusiones: La esencia de menta al 1,6% constituye una alternativa efectiva y segura a la utilización de espasmolíticos sistémicos. Se requieren posteriores estudios incluyendo un mayor número de pacientes para establecer su utilidad en la práctica clínica habitual (AU)

Objectives: Intestinal peristalsis can impede explorations and interventions using retrograde endoscopic cholangiopancreatography. Systemic spasmolytics are frequently employed to reduce this phenomenon, in spite of the adverse anti-cholinergic effects they are associated with. We proposed a formula using 1.6% peppermint oil solution with local use in order to avoid these adverse side effects. Method: We formulated a preparation of 1.6% peppermint oil solution in accordance with the medical literature. The effectiveness of the formula was evaluated in a semi-qualitative manneraccording to the reduction in peristalsis. Results: We tested two different emulgents, and polysorbate provided the best results. The pilot study carried out with 8 patients demonstrated its effectiveness and safety in reducing intestinal peristalsis. Conclusions: 1.6% peppermint oil solution constitutes an effective and safe alternative to the use of systemic spasmolytics. More studies are needed with a larger sample size in order to establish its usefulness in normal clinical practice (AU)

[Integrated pharmaceutical care programme in patients with chronic diseases]. / Programa de atención farmacéutica integrada en pacientes con enfermedades crónicas.

OBJECTIVES: To assess whether an integrated pharmaceutical care programme (IPCP) improves clinical evolution, patient quality of life, and reduces health costs in chronic patients. MATERIAL AND METHODS: A parallel, open, and multi-centre clinical trial of an IPCP in patients with heart failure (HF) and/or chronic obstructive pulmonary disease (COPD) in 8 different health areas in Cataluña. The intervened patient was monitored for pharmacotherapeutic evolution by hospital pharmacists, primary care physicians, and community pharmacists. Controls received normal follow-up. All patients were monitored for 12 months, with quality of life tests administered at the beginning and end of follow-up. RESULTS: We had the participation of 8 different hospitals, 8 primary care centres, and 109 community pharmacies. 238 patients completed the study, with 2.9% of participants lost during the study period. There were no significant differences in terms of readmissions, visits to the doctors, or to emergency services. We detected 50 different medication-related problems (MRP) in 37 patients, with a statistically significant difference in terms of MRP between the control and treatment groups of patients with HF, and almost significant differences in COPD patients. MRP were moderate-severe in 36% of cases. MRP were avoidable in 94% of cases, and the pharmacist resolved the issue in 90% of cases. There were no differences in terms of patient quality of life or health costs between the start and end of the study. CONCLUSIONS: Integrated pharmaceutical care programs facilitate an improvement in the quality of patient care, but electronic registries are necessary to promote communication between sections of the health care network.

[1.6% peppermint oil solution as intestinal spasmolytic in retrograde endoscopic cholangiopancreatography]. / Esencia de menta al 1,6% como espasmolítico intestinal en la colangiopancreatografía retrógrada endoscópica.

OBJECTIVES: Intestinal peristalsis can impede explorations and interventions using retrograde endoscopic cholangiopancreatography. Systemic spasmolytics are frequently employed to reduce this phenomenon, in spite of the adverse anti-cholinergic effects they are associated with. We proposed a formula using 1.6% peppermint oil solution with local use in order to avoid these adverse side effects. METHOD: We formulated a preparation of 1.6% peppermint oil solution in accordance with the medical literature. The effectiveness of the formula was evaluated in a semi-qualitative manner according to the reduction in peristalsis. RESULTS: We tested two different emulgents, and polysorbate provided the best results. The pilot study carried out with 8 patients demonstrated its effectiveness and safety in reducing intestinal peristalsis. CONCLUSIONS: 1.6% peppermint oil solution constitutes an effective and safe alternative to the use of systemic spasmolytics. More studies are needed with a larger sample size in order to establish its usefulness in normal clinical practice.

[Pharmaceutical intervention with parenteral nutrition]. / Intervención farmacéutica en el ámbito de la nutrición parenteral.

OBJECTIVE: Description and analysis of pharmaceutical interventions for patients with parenteral nutrition and an assessment of the degree of acceptance. METHOD: Prospective six-month study. Design of a data collection sheet (with personal data, the indication for parenteral nutrition, hospital area, nutrition type, time and type of intervention, type of notification, acceptance) for recording interventions carried out based on normal activities: complete review of pharmacotherapy and clinical history. RESULTS: A total of 265 interventions were carried out during the study period (1.5 interventions/day) with a mean of 2.1 interventions/patient. The overall degree of acceptance was 83.77%; significant differences were found between type of communication for the intervention (oral and/or written) and the degree of acceptance. CONCLUSIONS: Adding a pharmacist to the care team permits direct intervention in partnership with the doctor, and it is an effective method for preventing and resolving the complications, generally metabolic, that are associated with parenteral nutrition. Using this process for resolving medication-related problems in hospitalised patients, principally in surgical areas, is an addition to the pharmacist's activities in the area of nutritional support.

Intervención farmacéutica en el ámbito de la nutrición parenteral / Pharmaceutical intervention with parenteral nutrition

Objetivo Descripción y análisis de las intervenciones farmacéuticas realizadas en el ámbito de la nutrición parenteral (NP) y valoración del grado de aceptación. Método Estudio prospectivo de 6 meses. Se diseñó una hoja de recogida de datos (datos personales, indicación de NP, sala de hospitalización, tipo de nutrición, momento y tipo de intervención, modo de notificación y aceptación) en la que se registraron las intervenciones realizadas a partir de la actividad diaria: revisión completa de la farmacoterapia y de la historia clínica. Resultados Se realizaron un total de 265 intervenciones en el período de estudio (1,5 intervenciones/día) con una media de 2,1 intervenciones/paciente. El grado global de aceptación fue del 83,77%, fueron significativas las diferencias encontradas entre el tipo de comunicación de la intervención (oral y/o escrita) y el grado de aceptación. Conclusiones La integración del farmacéutico en el equipo asistencial permite una intervención directa con el médico, y es un método eficaz para la prevención y resolución de complicaciones asociadas a la NP, principalmente de tipo metabólico. Utilizar este proceso para resolver problemas relacionados con la medicación en los pacientes ingresados, principalmente en salas quirúrgicas, proporciona una calidad añadida a la actividad del farmacéutico en el área del soporte nutricional (AU)

Objective Description and analysis of pharmaceutical interventions for patients with parenteral nutrition and an assessment of the degree of acceptance. Method Prospective six-month study. Design of a data collection sheet (with personal data, the indication for parenteral nutrition, hospital area, nutrition type, time and type of intervention, type of notification, acceptance) for recording interventions carried out based on normal activities: complete review of pharmacotherapy and clinical history. Results A total of 265 interventions were carried out during the study period (1.5 interventions/day) with a mean of 2.1 interventions/patient. The overall degree of acceptance was 83.77%; significant differences were found between type of communication for the intervention (oral and/or written) and the degree of acceptance (AU)

[Detecting adverse drug events during the hospital stay]. / Detección de acontecimientos adversos producidos por medicamentos durante la estancia hospitalaria.

INTRODUCTION: The principal objective was to determine the incidence rate of adverse drug events (ADEs) in hospitalised patients and evaluate the event prevention percentage. METHODS: Multi-centre, prospective observational study lasting four months, performed in five hospitals providing different levels of care. We included all adult patients who were admitted to one of the selected centres for longer than 48 hours and who required pharmacological treatment. ADEs were identified by direct observation and the use of previously defined alarm signals. The Karch-Lasagna scale was used to determine the causality relationship, and the Schumock and Thornton questionnaire adapted by Otero was used to evaluate ADE preventability. Preventable drug-induced adverse events were classified according to the taxonomy that the Ruiz-Jarabo 2000 group defined, and coordinated by ISMP-Spain. RESULTS: We included 1,550 patients, 159 of whom experienced at least one ADE (10.3 %). The preventability percentage was 51.6 %, which represented 5.3 % of the total sample. The endocrine system (34.8 %) and the cardiovascular system (20.7 %) were the most affected by preventable ADEs. Antibiotics were responsible for 16.5 % of all ADEs. 9.3 % of all preventable ADEs were triggered by use of opiates. The vast majority of preventable ADEs (36.3 %) resulted from omitting a necessary medication. Only 4.4 % of preventable ADEs are considered to be serious. CONCLUSIONS: There is a high incidence rate of ADEs during patients' hospital stay (10.3 %), and half of them (51.6 %) could have been prevented. Implementation of an automatic alarm system and certain best practices for problem spots along the care circuit will help detect and avoid preventable ADEs.

Detección de acontecimientos adversos producidos por medicamentos durante la estancia hospitalaria / Detecting adverse drug events during the hospital stay

Introducción: El objetivo principal ha sido determinar la incidencia de acontecimientos adversos producidos por medicamentos (AAM) en pacientes hospitalizados y evaluar su porcentaje de prevención. Métodos: Estudio multicéntrico, prospectivo y observacional de 4 meses de duración, realizado en cinco hospitales de distinto nivel asistencial. Se incluyó a todos los pacientes adultos que ingresaron por más de 48 h en alguna de las unidades seleccionadas y requirieron tratamiento farmacológico. La identificación de los AAM se realizó mediante la observación directa y la utilización de unas señales de alerta, previamente definidas. Se utilizó el algoritmo de Karch-Lasagna, para determinar la relación de causalidad, y el cuestionario de Schumock y Thornton adaptado por Otero et al para evaluar la evitabilidad del AAM. Los AAM prevenibles se clasificaron siguiendo la taxonomía definida por el Grupo Ruiz-Jarabo 2000, coordinado por el ISMP-España. Resultados: Se incluyó a 1.550 pacientes, de los que 159 presentaron, al menos, un AAM (10,3 %). La tasa de evitabilidad fue del 51,6 %, lo que representa un 5,3 % de la muestra total. El sistema endocrino (34,8 %) y el cardiovascular (20,7 %) fueron los más afectados por los AAM prevenibles. Los antibióticos representaron el 16,5 % de todos los AAM. En cuanto a los AAM prevenibles, el 9,3 % de ellos se desencadenaron por la utilización de opiáceos. La gran mayoría de los AAM evitables fue consecuencia de la omisión de un medicamento necesario (36,3 %). Sólo un 4,4 % de los AAM evitables se consideró graves. Conclusiones: La incidencia de pacientes con AAM durante la estancia hospitalaria es alta (10,3 %), y la mitad de ellos (51,6 %) se podría haber prevenido. La implantación de un sistema automático de alertas y ciertas prácticas de mejoras en los puntos conflictivos del circuito sanitario ayudarían a la detección y la prevención de los AAM evitable (AU)

Introduction: The principal objective was to determine the incidence rate of adverse drug events (ADEs) in hospitalised patients and evaluate the event prevention percentage. Methods: Multi-centre, prospective observational study lasting four months, performed in five hospitals providing different levels of care. We included all adult patients who were admitted to one of the selected centres for longer than 48 hours and who required pharmacological treatment. ADEs were identifi ed by direct observation and the use of previously defi ned alarm signals. The Karch-Lasagna scale was used to determine the causality relationship, and the Schumock and Thornton questionnaire adapted by Otero was used to evaluate ADE preventability. Preventable drug-induced adverse events were classifi ed according to the taxonomy that the Ruiz-Jarabo 2000 group defi ned, and coordinated by ISMP-Spain. Results: We included 1,550 patients, 159 of whom experienced at least one ADE (10.3 %). The preventability percentage was 51.6 %, which represented 5.3 % of the total sample. The endocrine system (34.8 %) and the cardiovascular system (20.7 %) were the most affected by preventable ADEs. Antibiotics were responsible for 16.5 % of all ADEs. 9.3 % of all preventable ADEs were triggered by use of opiates. The vast majority of preventable ADEs (36.3 %) resulted from omitting a necessary medication. Only 4.4 % of preventable ADEs are considered to be serious. Conclusions: There is a high incidence rate of ADEs during patients’ hospital stay (10.3 %), and half of them (51.6 %) could have been prevented. Implementation of an automatic alarm system and certain best practices for problem spots along the care circuit will help detect and avoid preventable ADEs (AU)

Estudio de incidencia de los errores de medicación en los procesos de utilización del medicamento: prescripción, transcripción, validación, preparación, dispensación y administración en el ámbito hospitalario / Incident study of medication errors in drug use processes: prescription, transcription, validation, preparation, dispensing and administering in the hospital environment

Objetivo: Determinar la incidencia global y por etapas de los errores de medicación en 6 hospitales de Cataluña, así como los tipos de error y las consecuencias. Método: Diseño prospectivo, cuya variable global es el error de medicación. Se han excluido los errores potenciales. En cada hospital se estudiaron los ingresados en 2 unidades hasta 300 pacientes y se observaron 1.500 administraciones. Se aplicó la taxonomía del National Coordinating Council for Medication Error Reporting and Prevention. El error de prescripción se detectó mediante la revisión de las prescripciones, en la que se comprobaron paciente, medicamento, adherencia a protocolos, interacciones, contraindicaciones, omisión, duplicidad terapéutica, dosis, frecuencia, vía y falta de seguimiento. En la transcripción/validación se comprobó la coincidencia con la orden médica original. En la dispensación, antes de enviar los carros de unidosis, se revisó el contenido de los cajetines, y se contrastó con el listado generado informáticamente. En planta, los observadores comprobaron transcripción, preparación y administración. En todos los procesos se registraron los datos en una hoja específica. La concordancia entre revisores fue moderada (kappa = 0,525). Resultados: Se detectaron 16,94 errores por 100 pacientes-día y 0,98 por paciente: 16 % en prescripción, 27 % en transcripción/validación, 48 % en dispensación y 9 % en administración. El 84,47 % pertenecía a la categoría B (no se alcanzó al paciente), y menos del 0,5 % causaron daño. La población, de 65 años de media, se distribuyó en una relación varón/mujer de 60/40. Los principales grupos terapéuticos fueron: agentes contra la úlcera péptica y el reflujo gastroesofágico, antitrombóticos, y otros analgésicos y antipiréticos, en los que predominaba la forma farmacéutica (..) (AU)

Objective: To determine both the global Incident, and the Incident for stages of medication errors in six Catalonian hospitals, the types of error and the consequences. Method: A prospective design, with the global variable of the medication error. Potential errors have been excluded. The patients admitted to each hospital were studied in 2 groups of up to 300 patients and 1,500 administrations were observed. The NCCMERP taxonomy was applied. The prescription error was detected through the review of prescriptions, checking the patient, medication, adherence to protocols, interactions, contraindications, omission, duplicated therapy, doses, frequency, method, and lack of follow-up. During the transcription/validation, it was verified that the prescription matched the original order. In the dispensing process, the content of the drawers was checked, comparing it to the computer generated list, before sending out the single dose trolley. The transcription, preparation and administration were observed on the wards. The information for all the procedures was registered in a specific data sheet. There was moderate concordance amongst the inspectors (kappa = 0.525). Results: 16.94 errors were detected per 100 patients-day and 0.98 errors per patient: 16 % in prescription, 27 % in transcription/validation, 48 % in dispensing, and 9 % in administration. 84.47 % were category B errors (they did not reach the patient), and < 0.5 % of the errors were harmful. The population, with an average age of 65, had a male/female ratio of 60/40. The principal therapeutic groups were: agents against peptic ulcer and GERD, antithrombotic agents, and other analgesics and antipyretics, (..) (AU)

[Incident study of medication errors in drug use processes: prescription, transcription, validation, preparation, dispensing and administering in the hospital environment]. / Estudio de incidencia de los errores de medicación en los procesos de utilización del medicamento: prescripción, transcripción, validación, preparación, dispensación y administración en el ámbito hospitalario.

OBJECTIVE: To determine both the global Incident, and the Incident for stages of medication errors in six Catalonian hospitals, the types of error and the consequences. METHOD: A prospective design, with the global variable of the medication error. Potential errors have been excluded. The patients admitted to each hospital were studied in 2 groups of up to 300 patients and 1,500 administrations were observed. The NCCMERP taxonomy was applied. The prescription error was detected through the review of prescriptions, checking the patient, medication, adherence to protocols, interactions, contraindications, omission, duplicated therapy, doses, frequency, method, and lack of follow-up. During the transcription/validation, it was verified that the prescription matched the original order. In the dispensing process, the content of the drawers was checked, comparing it to the computer generated list, before sending out the single dose trolley. The transcription, preparation and administration were observed on the wards. The information for all the procedures was registered in a specific data sheet. There was moderate concordance amongst the inspectors (kappa = 0.525). RESULTS: 16.94 errors were detected per 100 patients-day and 0.98 errors per patient: 16 % in prescription, 27 % in transcription/validation, 48 % in dispensing, and 9 % in administration. 84.47 % were category B errors (they did not reach the patient), and < 0.5 % of the errors were harmful. The population, with an average age of 65, had a male/female ratio of 60/40. The principal therapeutic groups were: agents against peptic ulcer and GERD, antithrombotic agents, and other analgesics and antipyretics, principally in a solid oral drug form (58 %). The medications per patient-day were 5.5 and the units of medication were on average 11.21, varying greatly among the institutions. The adjustment of 10 units made the results more uniform. In all the stages, omission was the most frequent error. DISCUSSION: The different methods used and different areas of the investigations make comparisons difficult. This is evident in the harmful errors, the proportion of which is affected by the detection procedure. The number of mistakes avoided during the execution of this project demonstrates the need to improve the planning of the work systems and to establish safety measures.

Evaluación de las prácticas de seguridad de los sistemas de utilización de medicamentos en los hospitales españoles (2007) / Assessment of safety practices for medication-use systems in Spanish hospitals (2007)

Fundamento y Objetivo: Conocer la situación de las prácticas de seguridad de los sistemas de utilización de medicamentos en los hospitales españoles e identificar las áreas de mayor riesgo. Material y Método: Se incluyeron los hospitales que cumplimentaron, del 1 de junio de 2007 al 15 de julio del 2007, el «Cuestionario de autoevaluación de la seguridad del sistema de utilización de los medicamentos», que contiene 232 ítems de evaluación agrupados en 20 criterios esenciales. Resultados: Participaron 105 hospitales de las 17 comunidades autó- nomas. La puntuación media del cuestionario en el total de hospitales fue de 612,7 (39,7% del valor máximo posible) y no se encontraron diferencias según tamaño, capacidad docente o finalidad asistencial. Al analizar los criterios esenciales, los valores más bajos (< 25%) correspondieron a 3 criterios relacionados con formación y competencia de los profesionales, y establecimiento de un sistema de notificación de errores. Otros 9 criterios, con porcentajes del 25 al 50%, se referían a prácticas de: acceso a información sobre pacientes y medicamentos; comunicación de prescripciones; prevención de errores por nombres, etiquetado y envasado; restricción de medicamentos en unidades asistenciales; estandarización de dispositivos de infusión; educación al paciente, y cultura de seguridad y procedimientos de doble chequeo. Conclusiones: Se han identificado numerosas oportunidades de mejora, especialmente en áreas relacionadas con formación, gestión de riesgos, incorporación de nuevas tecnologías y participación de pacientes. La información obtenida puede ser útil para priorizar las prácticas a abordar en las estrategias en seguridad del paciente y como línea basal para efectuar un seguimiento de la implantación de las iniciativas que se acometan (AU)

Material and Method: Those hospitals that completed the «Medication use-system safety self-assessment for hospitals» between June 1 and July 15, 2007, were included in the study. The survey contained 232 items for evaluation grouped into 20 core characteristics. Results: A total of 105 hospitals from the 17 autonomous communities in Spain participated in the study. The average aggregate score for the survey of all the participating hospitals was 612.7 (39.7% of the maximum possible score) and there were no differences found with regard to number of beds, training activity or type of hospital. When core characteristics were analyzed, there were 3 criteria with the lowest values (< 25%), associated with professional training, skills, and the establishment of a system for reporting errors. Another 9 criteria, with percentages between 25% and 50%, reflected practices related to: access to information regarding patients and medications; communication of medication orders; prevention of errors due to naming, labeling, and packaging problems; standardization of medication delivery devices; restriction of medications in patient care units; and safety culture and double-checking procedures. Conclusions: Many opportunities for improvement have been identified, particularly in areas related to training, risk management, incorporating new technologies and patient participation. The information obtained may prove useful for prioritizing practices when establishing patient safety strategies, and as a baseline for successfully monitoring the effectiveness of the initiatives and programs consequently set into motion (AU)

[Updated classification for medication errors by the Ruiz-Jarabo 2000 Group]. / Actualización de la clasificación de errores de medicación del grupo Ruiz-Jarabo 2000.

OBJECTIVE: To update the classification system created by the Ruiz-Jarabo 2000 group to standardize detection, analysis, and recording of medication errors, with the aim of improving its capacity and functionality. METHOD: The classification update was carried out by the Ruiz-Jarabo 2000 working group considering: a) other classifications used by incident reporting systems initiated after the original version had been created; b) suggestions offered by healthcare professionals with respect to the original version; and c) the experiences of the working group itself based on analyses of medication errors gathered in hospitals, and on analyses of reports notified to the ISMP-Spain medication error reporting and learning program. RESULTS: This article presents the updated version of the medication error classification system and describes the main changes made on to the different sections and categories. CONCLUSIONS: The new version may prove to be a useful tool for analyzing and reporting errors with regard to those detected within the framework of activities for improving safety in hospitals and primary care, as well as for those detected as a direct result of patient safety research. Thus, this document is expected to improve medication safety information management in such a way as to allow data to be used ever more efficiently for making medication use systems safer for patients.

Actualización de la clasificación de errores de medicación del grupo Ruiz-Jarabo 2000 / Updated classification for medication errors by the Ruiz-Jarabo 2000 Group

Objetivo: Actualizar la clasificación elaborada por el grupo Ruiz-Jarabo2000 para estandarizar la detección, análisis y registro de loserrores de medicación, con el fin de mejorar su capacidad y operatividad.Método: La actualización de la clasificación se efectuó por el grupo detrabajo Ruiz-Jarabo 2000 considerando: a) otras clasificaciones utilizadaspor sistemas de notificación de incidentes iniciados con posterioridada la realización de la versión inicial; b) las sugerencias formuladaspor profesionales sanitarios acerca de la versión inicial, y c) la experienciagenerada por el propio grupo de trabajo a partir del análisis de loserrores de medicación recogidos en los hospitales y de los errores remitidosal sistema de notificación y aprendizaje del ISMP-España.Resultados: Se presenta la versión actualizada de la clasificación deerrores de medicación y se describen los principales cambios introducidosen los diferentes apartados y categorías.Conclusiones: La nueva versión puede ser un instrumento de utilidadpara el análisis y registro de los errores de medicación, tanto de aquellosdetectados en el marco de las actividades de mejora de la seguridaden hospitales y en atención primaria como de los detectados conpropósitos de investigación acerca de la seguridad del paciente. Asimismo,pretende mejorar la gestión de la información acerca de la seguridaden el uso de los medicamentos, de forma que pueda ser empleadade manera más eficaz para desarrollar sistemas de utilizaciónde medicamentos cada vez más seguros para los pacientes

Objective: To update the classification system created by the Ruiz-Jarabo2000 group to standardize detection, analysis, and recording ofmedication errors, with the aim of improving its capacity and functionality.Method: The classification update was carried out by the Ruiz-Jarabo2000 working group considering: a) other classifications used by incidentreporting systems initiated after the original version had beencreated; b) suggestions offered by healthcare professionals with respectto the original version; and c) the experiences of the workinggroup itself based on analyses of medication errors gathered in hospitals,and on analyses of reports notified to the ISMP-Spain medicationerror reporting and learning program.Results: This article presents the updated version of the medicationerror classification system and describes the main changes made onto the different sections and categories.Conclusions: The new version may prove to be a useful tool for analyzingand reporting errors with regard to those detected within the frameworkof activities for improving safety in hospitals and primary care,as well as for those detected as a direct result of patient safety research.Thus, this document is expected to improve medication safety informationmanagement in such a way as to allow data to be used ever moreefficiently for making medication use systems safer for patients

[Assessment of safety practices for medication-use systems in Spanish hospitals (2007)]. / Evaluación de las prácticas de seguridad de los sistemas de utilización de medicamentos en los hospitales españoles (2007).

BACKGROUND AND OBJECTIVE: To examine the current status of safety practices for medication-use systems in Spanish hospitals and to identify major areas of risk. MATERIAL AND METHOD: Those hospitals that completed the "Medication use-system safety self-assessment for hospitals" between June 1 and July 15, 2007, were included in the study. The survey contained 232 items for evaluation grouped into 20 core characteristics. RESULTS: A total of 105 hospitals from the 17 autonomous communities in Spain participated in the study. The average aggregate score for the survey of all the participating hospitals was 612.7 (39.7% of the maximum possible score) and there were no differences found with regard to number of beds, training activity or type of hospital. When core characteristics were analyzed, there were 3 criteria with the lowest values (< 25%), associated with professional training, skills, and the establishment of a system for reporting errors. Another 9 criteria, with percentages between 25% and 50%, reflected practices related to: access to information regarding patients and medications; communication of medication orders; prevention of errors due to naming, labeling, and packaging problems; standardization of medication delivery devices; restriction of medications in patient care units; and safety culture and double-checking procedures. CONCLUSIONS: Many opportunities for improvement have been identified, particularly in areas related to training, risk management, incorporating new technologies and patient participation. The information obtained may prove useful for prioritizing practices when establishing patient safety strategies, and as a baseline for successfully monitoring the effectiveness of the initiatives and programs consequently set into motion.

Descripción del proceso de certificación ISO 9001/2000 en el área de nutrición parenteral / No disponible

Objetivo: Garantizar la calidad y seguridad e incrementar la satisfacción del usuario ha llevado a organizaciones del ámbitosanitario a integrar un sistema de gestión de calidad en su estructura. Este trabajo describe el proceso de implantación dela norma UNE-EN-ISO-9001/2000 en el área de nutriciónparenteral.Método: Un grupo multidisciplinar definió el alcance de la norma, centrándose en transcripción, acondicionamiento, dispensacióny control microbiológico.Resultados: Se elaboró un procedimiento detallando secuencialmente los circuitos y actividades asociadas, el personal responsable y las pautas de actuación a seguir. Se establecieron indicadoresde calidad y de actividad.Conclusiones: Este proceso ha permitido establecer un sistema normalizado cuyos procesos están perfectamente descritos y documentados, logrando la trazabilidad y supervisión de las fases.Al no disponer de histórico de los datos actualmente obtenidos, no es posible establecer una comparación directa; por tanto, deberá analizarse su evolución en un futuro

Objective: In order to guarantee quality and safety and to increase user satisfaction, healthcare organisations have integratedquality management systems into their structures. This study describes the process for introducing the UNE-EN-ISO-9001/2000 standard in the parenteral nutrition area.Method: A multidisciplinary group established the scope of the standard, focusing on transcription, preparation, dispensation and microbiological control.Results: A detailed procedure describing the sequences of circuits and associated activities, the responsible staff and the action guidelines to be followed was established. Quality and activity markers were also established.Conclusions: This process has enabled a standard system to be implemented, with its operation perfectly described and documented, allowing its stages to be traceable and supervised. As there is no record of the data obtained beforehand, no direct comparison can be made; its evolution must therefore be analysed inthe future