Detection and reduction of errors in parenteral nutrition compounding through gravimetric and product control. / [Artículo traducido] Detección y reducción de errores en la elaboración de la nutrición parenteral mediante control gravimétrico y de producto.

OBJECTIVE: To analyze the errors in the preparation of parenteral nutrition in a Pharmacy Service, detected through an already consolidated gravimetric and product quality control, and compare them with those detected during the initial years of implementing this quality control. METHODS: All errors detected through quality control in the compounding of pediatric and adult parenteral nutrition between 2019 and 2021 were prospectively analyzed. This quality control consisted of 3 sequential processes: a visual check, a gravimetric control, and a product control. Errors were classified as gravimetric, when the nutrition had a deviation of more than 5% from the theoretical weight, or as product errors when a qualitative or quantitative error was detected upon reviewing the remainder of the components used. These errors were analyzed in terms of type and the component involved. A comparison was made with the errors detected during the implementation phase of this quality control from 2016 to 2018. RESULTS: A total of 41,809 parenteral nutritions were reviewed, and 345 errors were detected (0.83% of the preparations); of these, 59 errors were found in pediatric nutritions (0.68% of them), and 286 in adult nutritions (0.86% of them). Among these errors, 193 were of gravimetric nature, while 152 were detected through product control. The main components involved in product errors were electrolytes, primarily due to the addition of excessive volumes and the use of incorrect components. A significant absolute reduction of 0.71% (p < 0.05) in the total number of errors was observed when compared to the implementation phase. This reduction was consistent in both gravimetric errors (-0.59%) and product-related errors (-0.12%) (p < 0.05). CONCLUSIONS: Comprehensive quality control of parenteral nutrition preparation is an easily implementable tool that effectively detected and prevented significant errors. Furthermore, its widespread adoption contributed to a reduction in the overall error count.

Detection and reduction of errors in parenteral nutrition compounding through gravimetric and product control.

OBJECTIVE: To analyze the errors in the preparation of parenteral nutrition in a Pharmacy Service, detected through an already consolidated gravimetric and product quality control, and compare them with those detected during the initial years of implementing this quality control. METHODS: All errors detected through quality control in the compounding of pediatric and adult parenteral nutritions between 2019 and 2021 were prospectively analyzed. This quality control consisted of 3 sequential processes: a visual check, a gravimetric control, and a product control. Errors were classified as gravimetric, when the nutrition had a deviation of more than 5% from the theoretical weight, or as product errors when a qualitative or quantitative error was detected upon reviewing the remainder of the components used. These errors were analyzed in terms of type and the component involved. A comparison was made with the errors detected during the implementation phase of this quality control from 2016 to 2018. RESULTS: A total of 41,809 parenteral nutritions were reviewed, and 345 errors were detected (0.83% of the preparations); of these, 59 errors were found in pediatric nutritions (0.68% of them), and 286 in adult nutritions (0.86% of them). Among these errors, 193 were of gravimetric nature, while 152 were detected through product control. The main components involved in product errors were electrolytes, primarily due to the addition of excessive volumes and the use of incorrect components. A significant absolute reduction of 0.71% (P < .05) in the total number of errors was observed when compared to the implementation phase. This reduction was consistent in both gravimetric errors (-0.59%) and product-related errors (-0.12%) (P < .05). CONCLUSIONS: Comprehensive quality control of parenteral nutrition preparation is an easily implementable tool that effectively detected and prevented significant errors. Furthermore, its widespread adoption contributed to a reduction in the overall error count.

Impact of preoperative pharmaceutical care consultation on medication errors in surgical patients: a comprehensive analysis.

OBJECTIVE: Assessing the impact of introducing preoperative pharmaceutical care consultations by analyzing the severity of prevented medication errors (MEs) and their potential effects on the surgical process. METHODS: Preoperative pharmaceutical care consultation was implemented in our hospital to assess the preoperative medication management of surgical patients between the pre-anesthesia consultation and the day of surgery. Pharmacists evaluated the appropriateness of medication management based on a consensus multidisciplinary institutional protocol. All errors identified between 2016 and 2020 were analyzed, and their severity and potential impact on surgery were standardized. A list of therapeutic groups was created to prioritize patients for consultations. RESULTS: During the study period, 3,105 patients attended the consultations and 1,179 MEs were prevented. According to severity, 30.6% of MEs were classified as category E and 26.2% as D. The Number Needed to Treat to prevent a category E or higher ME (indicating potential harm to patients) was 5 patients. About 14.84% of MEs belonged to the prioritized drug groups. One hundred and thirteen errors would have resulted in a surgery delay of more than 24 h, and 175 errors were classified as G-H (irreversible damage). CONCLUSIONS: This study highlights the effectiveness of pharmaceutical care consultations in preventing MEs and improving surgical outcomes.

A comparative study of contamination in three closed systems for the preparation of hazardous drugs through simulations with fluorescein / Estudio comparativo de contaminación de tres sistemas cerrados para la preparación de fármacos peligrosos mediante simulación con fluoresceína

Objective: The objective of this study was to compare the environmental contamination generated during the preparation of cytostatic agents using three different methods through simulations using fluorescein, and the time required for preparation of each method. Method: A comparative study of the processing of fluorescein mixtures using three types of closed systems was conducted at the centralized unit for hazardous drugs of the Pharmacy Department of a General Teaching Hospital. Environmental contamination was detected in critical points of connection, and in splashes produced at any other points. The main variable was qualitative detection of contamination through ultraviolet light when three methods were compared (method A: ChemoClave(R), method B: SmartSite(R)valve and Texium(R)connector, method C: PhaSealTMwith BD luer extension). A final number of 60 mixtures were prepared to detect differences of at least 5%. Results: Qualitative contamination at the critical points during preparation, was seen in groups A and B for every mixture that was processed. No contamination at all in critical points was seen in any of the mixtures prepared using PhaSealTM. Statistically significant differences were found between arms A and C (p < 0.001) and arms B and C (p < 0.001); no differences were found between arms A and B. Conclusions: The combination of PhaSealTMsystem in conjunction with the BD luer extension for administering hazardous drugs from a tree modality system has been shown to be the system with the lowest level of contamination during processing without increasing the time required for preparation of the mixture

Objetivo: El objetivo de este estudio fue comparar la contaminación ambiental generada durante la preparación de fluoresceína y el tiempo de preparación usando tres sistemas cerrados de transferencia diferentes. Método: Estudio comparativo de elaboración de mezclas de fluoresceína con tres tipos de sistemas cerrados en una unidad de mezclas peligrosas de un Servicio de Farmacia de un Hospital General Universitario. Se consideró contaminación ambiental la detectada en los puntos críticos de conexión y las salpicaduras generadas en cualquier otro punto distinto. La variable principal fue la detección cualitativa mediante luz ultravioleta de la contaminación generada cuando se comparan tres sistemas (sistema A: ChemoClave(R), sistema B: válvula SmartSite(R)y conector Texium(R), sistema C: PhaSealTMcon alargadera luer BD). Se prepararon 60 mezclas para poder detectar diferencias de al menos el 5%. Resultados: Se detectó contaminación en los puntos críticos durante la preparación en todas las mezclas de los grupos A y B. No se detectó contaminación en ninguna de las mezclas en las que se usó el sistema cerrado PhaSealTM. Se encontraron diferencias estadísticas entre los grupos A y C (p < 0,001) y entre los grupos B y C (p < 0,001); no se encontraron diferencias entre los grupos A y B. Conclusiones: La combinación del sistema PhaSealTMy la alargadera luer BD para administrar fármacos peligrosos en la modalidad de árbol ha mostrado ser el sistema con el menor nivel de contaminación durante la preparación, sin que esto se traduzca en aumento en el tiempo de elaboración

A comparative study of contamination in three closed systems for the preparation of hazardous drugs through simulations with fluorescein.

OBJECTIVE: The objective of this study was to compare the environmental contamination generated during the preparation of cytostatic  agents using three different methods through simulations using fluorescein, and  the time required for preparation of each method. METHOD: A comparative study of the processing of fluorescein mixtures using three types of closed systems was conducted at the centralized unit for  hazardous drugs of the Pharmacy Department of a General Teaching Hospital. Environmental contamination was detected in critical points of  connection, and in splashes produced at any other points. The main variable was  qualitative detection of contamination through ultraviolet light when three  methods were compared (method A: ChemoClave®, method B: SmartSite®  valve and Texium® connector, method C: PhaSealTM with BD luer extension). A  final number of 60 mixtures were prepared to detect differences of at least 5%. RESULTS: Qualitative contamination at the critical points during preparation, was  seen in groups A and B for every mixture that was processed. No contamination  at all in critical points was seen in any of the mixtures prepared using  PhaSealTM. Statistically significant differences were found between arms A and  C (p < 0.001) and arms B and C (p < 0.001); no differences were found  between arms A and B. CONCLUSIONS: The combination of PhaSealTM system in conjunction with the BD  luer extension for administering hazardous drugs from a tree modality system  has been shown to be the system with the lowest level of contamination during  processing without increasing the time required for preparation of the mixture.

Objetivo: El objetivo de este estudio fue comparar la contaminación ambiental  generada durante la preparación de fluoresceína y el tiempo de preparación  usando tres sistemas cerrados de transferencia diferentes.Método: Estudio comparativo de elaboración de mezclas de fluoresceína con  tres tipos de sistemas cerrados en una unidad de mezclas peligrosas de un  Servicio de Farmacia de un Hospital General Universitario. Se consideró  contaminación ambiental la detectada en los puntos críticos de conexión y las  salpicaduras generadas en cualquier otro punto distinto. La variable principal fue  la detección cualitativa mediante luz ultravioleta de la contaminación  generada cuando se comparan tres sistemas (sistema A: ChemoClave®, sistema  B: válvula SmartSite® y conector Texium®, sistema C: PhaSealTM con  alargadera luer BD). Se prepararon 60 mezclas para poder detectar  diferencias de al menos el 5%.Resultados: Se detectó contaminación en los puntos críticos durante la  preparación en todas las mezclas de los grupos A y B. No se detectó contaminación en ninguna de las mezclas en las que se usó el sistema  cerrado PhaSealTM. Se encontraron diferencias estadísticas entre los grupos A y  C (p < 0,001) y entre los grupos B y C (p < 0,001); no se encontraron diferencias entre los grupos A y B.Conclusiones: La combinación del sistema PhaSealTM y la alargadera luer BD  para administrar fármacos peligrosos en la modalidad de árbol ha mostrado ser  el sistema con el menor nivel de contaminación durante la preparación, sin que  esto se traduzca en aumento en el tiempo de elaboración.