[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

[Probable hypersensitivity reaction to parenteral nutrition: report of a case]. / Probable reacción de hipersensibilidad a la nutrición parenteral: a propósito de un caso.

A probable case of hypersensitivity reaction to Total Parenteral Nutrition (TPN) in a 55 years old patient diagnosed with gastric adenocarcinoma is presented. Onset of TPN infusion coincides with the time of the onset of a disseminated pruritic cutaneous eruption that repeats after a second exposure to nutrition. The likely causes of this hypersensitivity reaction are analyzed.

Probable reacción de hipersensibilidad a la nutrición parenteral: a propósito de un caso / Probable hypersensitivity reaction to parenteral nutrition: apropos of a case

Se presenta un caso probable de reacción de hipersensibilidad a Nutrición Parenteral Total (NPT) en un paciente de 55 años diagnosticado de adenocarcinoma gástrico. El inicio de la infusión de la NPT coincide en el tiempo con la aparición de una erupción cutánea pruriginosa diseminada que se repite tras una segunda exposición a la nutrición. Se analizan las causas probables de esta reacción de hipersensibilidad (AU)

A probable case of hypersensitivity reaction to Total Parenteral Nutrition (TPN) in a 55 years old patient diagnosed with gastric adenocarcinoma is presented. Onset of TPN infusion coincides with the time of the onset of a disseminated pruritic cutaneous eruption that repeats after a second exposure to nutrition. The likely causes of this hypersensitivity reaction are analyzed (AU)

[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.