Nuevas tecnologías aplicadas al proceso de dispensación de medicamentos. Análisis de errores y factores contribuyentes / New technologies applied to the medication-dispensing process, error analysis and contributing factors

Objetivo Calcular la prevalencia de los errores producidos en diferentes sistemas de dispensación de medicamentos, las etapas en que se producen y los factores contribuyentes. Métodos Estudio observacional prospectivo. Se revisaron las etapas del proceso de dispensación en 5 sistemas de dispensación: stock o botiquín de planta, sistema de distribución de medicamentos en dosis unitaria (SDMDU) sin prescripción electrónica asistida (PEA), SDMDU con PEA, sistema automatizado de dispensación (SAD) sin PEA y SAD con PEA. Se identificaron los errores de dispensación, las etapas en que ocurrieron dichos errores y sus factores contribuyentes. Resultados De 54.169 oportunidades de error, se detectaron 2.181 errores. Tasa de error: stock, 10,7%; SDMDU sin PEA, 3,7%; SDMDU con PEA, 2,2%; SAD sin PEA, 20,7%; SAD con PEA, 2,9%. Etapa más frecuente en la que se produce el error: stock, preparación del pedido; SDMDU sin PEA y con PEA, llenado del carro; SAD sin PEA y con PEA, llenado del SAD. Error más frecuente: stock, SAD sin PEA y con PEA, omisión; SDMDU con PEA, diferente cantidad de medicamento; SDMDU sin PEA, sobra medicamento. Factor contribuyente: stock, SAD sin PEA y con PEA, rotura de stock/desabastecimiento; SDMDU con PEA, personal sin experiencia y sistema de comunicación deficiente entre profesionales; SDMDU sin PEA, sistema de comunicación deficiente entre profesionales. Conclusiones La aplicación de nuevas tecnologías en el proceso de dispensación ha aumentado su seguridad, concretamente la implantación de la PEA ha permitido disminuir los errores en el proceso de dispensación (AU)

Objective Calculate error prevalence occurred in different medication-dispensing systems, the stages of occurrence, and contributing factors. Methodology Prospective observational study. The staging of the dispensing process were reviewed in five dispensing systems: Stock, Unitary-Dose dispensing systems (UDDS) without Computerized Prescription Order Entry (CPOE), CPOE-UDDS, Automated Dispensing Systems (ADS) without CPOE and CPOE-ADS. Dispensing errors were identified, together with the stages of occurrence of such errors and their contributing factors.Results2,181 errors were detected among 54,169 opportunities of error. Error-rate: Stock, 10.7%; no-CPOE-UDDS, 3.7%, CPOE-UDDS, 2.2%, no-CPOE-ADS, 20.7%; CPOE-ADS, 2.9%. Most frequent stage when error occurs: Stock, preparation of order; no-CPOE-UDDS and CPOE-UDDS, filling of the unit dose cart; no-CPOE-ADS and CPOE-ADS, filling of the ADS. Most frequent error: Stock, no-CPOE-ADS and CPOE-ADS, omission; CPOE-UDDS, different amount of drug and no-CPOE-UDDS, extra medication. Contributing factor: Stock, CPOE-ADS and no-CPOE-ADS, stock out/supply problems; CPOE-UDDS, inexperienced personnel and deficient communication system between professionals; no-CPOE-UDDS, deficient communication system between professionals. Conclusions Applying new technologies to the dispensing process has increased its safety, particularly, implementation of CPOE has enabled to reduce dispensing errors (AU)

[New technologies applied to the medication-dispensing process, error analysis and contributing factors]. / Nuevas tecnologías aplicadas al proceso de dispensación de medicamentos. Análisis de errores y factores contribuyentes.

OBJECTIVE: Calculate error prevalence occurred in different medication-dispensing systems, the stages of occurrence, and contributing factors. METHODOLOGY: Prospective observational study. The staging of the dispensing process were reviewed in five dispensing systems: Stock, Unitary-Dose dispensing systems (UDDS) without Computerized Prescription Order Entry (CPOE), CPOE-UDDS, Automated Dispensing Systems (ADS) without CPOE and CPOE-ADS. Dispensing errors were identified, together with the stages of occurrence of such errors and their contributing factors. RESULTS: 2,181 errors were detected among 54,169 opportunities of error. Error-rate: Stock, 10.7%; no-CPOE-UDDS, 3.7%, CPOE-UDDS, 2.2%, no-CPOE-ADS, 20.7%; CPOE-ADS, 2.9%. Most frequent stage when error occurs: Stock, preparation of order; no-CPOE-UDDS and CPOE-UDDS, filling of the unit dose cart; no-CPOE-ADS and CPOE-ADS, filling of the ADS. Most frequent error: Stock, no-CPOE-ADS and CPOE-ADS, omission; CPOE-UDDS, different amount of drug and no-CPOE-UDDS, extra medication. Contributing factor: Stock, CPOE-ADS and no-CPOE-ADS, stock out/supply problems; CPOE-UDDS, inexperienced personnel and deficient communication system between professionals; no-CPOE-UDDS, deficient communication system between professionals. CONCLUSIONS: Applying new technologies to the dispensing process has increased its safety, particularly, implementation of CPOE has enabled to reduce dispensing errors.

Análisis de los fallos detectados en el proceso de dispensación de medicamentos y los factores contribuyentes / Analysis of failures detected during the medication-dispensing process and their contributing factors

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[Metabolic role of glutamine and its importance in nutritional therapy]. / Papel metabólico de la glutamina y su importancia en la terapia nutricional.

The advances in the field of nutritional support have made certain nutrients very relevant, which, although they have been known for a long time, at present represent an important chapter in nutrition, entering into what is known as "nutritional pharmacology". Among these nutrients is glutamine, an amino acid classified as non-essential, but which in certain circumstances may become to be considered as an "essential nutrient". In the present review, a review is made of its metabolic role, synthesis and degradation, metabolic routes and functions under normal conditions as well as under critical conditions. It is known that glutamine stimulates the synthesis and inhibits the degradation of proteins, it is an important vehicle for the transport of nitrogen and carbon within the tissues, it stimulates the synthesis of hepatic glycogen, it is an energy source for cell division, for the growth of different cells of rapid replication, such as enterocytes, colonocytes, and fibroblasts, as well as for other cells of the immune system, such as lymphocytes and macrophages. Thus its role in the maintenance of structure, in metabolism and function of the intestinal mucosa, and in dysfunctions of the immune system. In parenteral nutrition, at present there are no preparations which include it, given the stability problems which it presents, although attempts have been made to resolve this, using different possibilities, such as di-peptides. However, in enteral nutrition, the diets tend to include it, although in a small proportion. Nevertheless, having recognized its beneficial role in a certain type of patients, at present there are diets which contain glutamine in higher doses, with the object of attempting to cover the increased demands of glutamine which shall arise in these situations. The inclusion of glutamine in nutritional therapy is supported by multiple studies which reflect the beneficial effect of this nutrient, both in enteral nutrition as in parenteral nutrition.