[Treatment of Stenotrophomonas maltophilia meningoencephalitis with intraventricular colistin]. / Administración de colistina intraventricular para el tratamiento de la meningoencefalitis por Stenotrophomonas maltophilia.

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Impacto de las alertas interactivas modales en la prescripción informatizada de ácido valproico y meropenem / Effect of modal computer-based alerts on the prescription of valproic acid and meropenem

Objetivo: Analizar el impacto de las alertas interactivas modales en la incidencia de la prescripción concomitante de ácido valproico (AVP) y meropenem. Material y método: Estudio analítico de intervención desarrollado en un hospital de tercer nivel de 11 meses de duración. Se seleccionaron aquellos pacientes ingresados con diagnóstico de epilepsia y en tratamiento con AVP y meropenem de forma concomitante. En el sistema de prescripción electrónica asistida se incluyó una alerta modal para que avisase al médico cuando se prescribiese de forma conjunta el AVP y meropenem. Para medir el impacto de esta alerta se compararon los resultados obtenidos con los de un periodo anterior en el que la alerta era no modal. Resultados: El número de pacientes en tratamiento concomitante con AVP y meropenen disminuyó de 13 a 4 pacientes (p = 0,046). Sin embargo, disminuyeron el número de peticiones de niveles de AVP y aumentó el número medio de días conjuntos de prescripción de 4,7 a 8,75. Conclusiones: La implementación de alertas modales disminuye la exposición de los pacientes al tratamiento concomitante de meropenem y AVP (AU)

Objective: To analyze the effect of modal computer-based alerts on the concomitant prescription of valproic acid (VPA) and meropenem. Material and method: Analytical intervention study conducted in a tertiary hospital for eleven months. Hospitalized patients with a diagnosis of epilepsy and treated with VPA and meropenem in concomitant therapy were included. In the computerized prescription order entry software an automatic non-modal alert was reconverted to a modal one. This was triggered when the physician introduced VPA and meropenem together in the same prescription. To measure the effect of this alert the prescription habits were compared with a previous period in which the alert was not modal. Results: Modal computer-based alert modified the prescription habit by reducing the number of patients with concomitant treatment from 13 to 4 (P = 0.046). However, it was notable that the number of requests for VPA serum levels decreased, and the average number of concomitant days of treatment rose from 4.7 to 8.75 in those patients in which none of the drugs was suspended. Conclusions: The implementation of modal computer-based alerts reduces patient exposure to concomitant treatment with meropenem and VPA (AU)

[Effect of modal computer-based alerts on the prescription of valproic acid and meropenem]. / Impacto de las alertas interactivas modales en la prescripción informatizada de ácido valproico y meropenem.

OBJECTIVE: To analyze the effect of modal computer-based alerts on the concomitant prescription of valproic acid (VPA) and meropenem. MATERIAL AND METHOD: Analytical intervention study conducted in a tertiary hospital for eleven months. Hospitalized patients with a diagnosis of epilepsy and treated with VPA and meropenem in concomitant therapy were included. In the computerized prescription order entry software an automatic non-modal alert was reconverted to a modal one. This was triggered when the physician introduced VPA and meropenem together in the same prescription. To measure the effect of this alert the prescription habits were compared with a previous period in which the alert was not modal. RESULTS: Modal computer-based alert modified the prescription habit by reducing the number of patients with concomitant treatment from 13 to 4 (P=.046). However, it was notable that the number of requests for VPA serum levels decreased, and the average number of concomitant days of treatment rose from 4.7 to 8.75 in those patients in which none of the drugs was suspended. CONCLUSIONS: The implementation of modal computer-based alerts reduces patient exposure to concomitant treatment with meropenem and VPA.

Análisis de la interacción ácido valproico-meropenem en pacientes hospitalizados / Analysis of the valproic acid-meropenem interaction in hospitalised patients

Introducción: Existen referencias en la literatura acerca de la gravedad de la interacción entre el ácido valproico y el meropenem. Sin embargo, las recomendaciones en cuanto a su manejo son contradictorias, recomendándose en algunos estudios la monitorización más estrecha del antiepiléptico si se emplean juntos y en otros contraindicando su uso concomitante. El objetivo de este trabajo es analizar la interacción entre el ácido valproico y el meropenem y evaluar el impacto de la intervención farmacéutica sobre la utilización de estos fármacos en pacientes hospitalizados. Material y métodos: Estudio de la prescripción concomitante de ácido valproico y meropenem en un hospital de tercer nivel de 1.080 camas dividido en dos periodos: uno retrospectivo y observacional, el otro prospectivo y con intervención farmacéutica. Se compararon los hábitos de prescripción entre ambos periodos. Resultados: Un total de 26 pacientes recibieron ácido valproico y meropenem simultáneamente (13 en cada periodo), no alcanzando ninguno niveles terapéuticos del antiepiléptico durante el tratamiento. La intervención farmacéutica cambió los hábitos de prescripción, disminuyendo a la mitad los días de tratamiento concomitante, cambiando la antibioterapia y/o monitorizando más estrechamente el antiepiléptico. Conclusiones: La interacción entre el ácido valproico y el meropenem es grave, especialmente por la rapidez con la que disminuyen los niveles del antiepiléptico. Se debe evitar el uso concomitante de ambos fármacos, sustituyendo la antibioterapia de manera empírica o según los patrones de resistencia del microorganismo para mantener el mismo tratamiento anticomicial (AU)

Introduction: Published data demonstrate a serious interaction between valproic acid and meropenem. However, recommendations about the management of concomitant treatment are contradictory; some experts recommend closer monitoring of valproic acid serum concentrations and others recommend avoiding concurrent therapy. The purpose of this study is to critically analyse the interaction and to evaluate the impact of pharmaceutical intervention in the use of these drugs in hospitalised patients. Material and methods: Study of the concomitant prescription of valproic acid and meropenem in a general hospital of 1,080 beds divided in to two periods; the first period was retrospective and observational and it was followed by a prospective period involving pharmaceutical intervention. The prescription habits between both periods were compared. Results: A total of 26 patients received concurrent treatment with valproic acid and meropenem (13 per period) and none of them maintained therapeutic serum levels of the antiepileptic drug. Pharmaceutical intervention modified prescription habits, reducing by half the number of days of concomitant treatment, changing the antibiotherapy and/or monitoring serum concentrations more often. Conclusions: The interaction between valproic acid and meropenem is serious, especially because of the dramatic decrease in the antiepileptic serum concentrations. The concomitant use of both drugs should be avoided, replacing the antibiotherapy empirically, or according to the resistance profiles of the microorganism and maintaining the same the anti-epileptic treatment (AU)

Analisis modal de fallos y efectos del proceso de prescripcion, validacion y dispensacion de medicamentos / Failure modes and effects analysis in the prescription, validation and dispensing process

Objetivo Aplicacion de un analisis modal de fallos y efectos al proceso de prescripcion, validacion y dispensacion de medicamentos en pacientes hospitalizados. Metodos Un grupo de trabajo analizo los pasos que componian el proceso desde la prescripcion medica hasta la dispensacion, identificandose los mas criticos y estableciendo los modos potenciales de fallo que podrian producir un error. Se analizaron posibles causas, sus efectos potenciales y los sistemas de control existentes para prevenir su aparicion. Se calculo el Hazard Score, seleccionandose los que tenian una puntuacion (..) (AU)

Objective To apply a failure modes and effects analysis to the prescription, validation and dispensing process for hospitalised patients. Methods A work group analysed all of the stages included in the process from prescription to dispensing, identifying the most critical errors and establishing potential failure modes which could produce a mistake. The possible causes, their potential effects, and the existing control systems were analysed to try and stop them from developing. The Hazard Score was calculated, choosing those that were ≥ 8, and a Severity Index = 4 was selected independently of the hazard Score value. Corrective measures and an implementation plan were proposed. Results A flow diagram that describes the whole process was obtained. A risk analysis was conducted of the chosen critical points, indicating: failure mode, cause, effect, severity, probability, Hazard Score, suggested preventative measure and strategy to achieve so. Failure modes chosen: Prescription on the nurse's form; progress or treatment order (paper); Prescription to incorrect patient; Transcription error by nursing staff and pharmacist; Error preparing the trolley. Conclusions By applying a failure modes and effects analysis to the prescription, validation and dispensing process, we have been able to identify critical aspects, the stages in which errors may occur and the causes. It has allowed us to analyse the effects on the safety of the process, and establish measures to prevent or reduce them (AU)

[Failure modes and effects analysis in the prescription, validation and dispensing process]. / Análisis modal de fallos y efectos del proceso de prescripción, validación y dispensación de medicamentos.

OBJECTIVE: To apply a failure modes and effects analysis to the prescription, validation and dispensing process for hospitalised patients. METHODS: A work group analysed all of the stages included in the process from prescription to dispensing, identifying the most critical errors and establishing potential failure modes which could produce a mistake. The possible causes, their potential effects, and the existing control systems were analysed to try and stop them from developing. The Hazard Score was calculated, choosing those that were ≥ 8, and a Severity Index = 4 was selected independently of the hazard Score value. Corrective measures and an implementation plan were proposed. RESULTS: A flow diagram that describes the whole process was obtained. A risk analysis was conducted of the chosen critical points, indicating: failure mode, cause, effect, severity, probability, Hazard Score, suggested preventative measure and strategy to achieve so. Failure modes chosen: Prescription on the nurse's form; progress or treatment order (paper); Prescription to incorrect patient; Transcription error by nursing staff and pharmacist; Error preparing the trolley. CONCLUSIONS: By applying a failure modes and effects analysis to the prescription, validation and dispensing process, we have been able to identify critical aspects, the stages in which errors may occur and the causes. It has allowed us to analyse the effects on the safety of the process, and establish measures to prevent or reduce them.

[Analysis of the valproic acid-meropenem interaction in hospitalised patients]. / Análisis de la interacción ácido valproico-meropenem en pacientes hospitalizados.

INTRODUCTION: Published data demonstrate a serious interaction between valproic acid and meropenem. However, recommendations about the management of concomitant treatment are contradictory; some experts recommend closer monitoring of valproic acid serum concentrations and others recommend avoiding concurrent therapy. The purpose of this study is to critically analyse the interaction and to evaluate the impact of pharmaceutical intervention in the use of these drugs in hospitalised patients. MATERIAL AND METHODS: Study of the concomitant prescription of valproic acid and meropenem in a general hospital of 1,080 beds divided in to two periods; the first period was retrospective and observational and it was followed by a prospective period involving pharmaceutical intervention. The prescription habits between both periods were compared. RESULTS: A total of 26 patients received concurrent treatment with valproic acid and meropenem (13 per period) and none of them maintained therapeutic serum levels of the antiepileptic drug. Pharmaceutical intervention modified prescription habits, reducing by half the number of days of concomitant treatment, changing the antibiotherapy and/or monitoring serum concentrations more often. CONCLUSIONS: The interaction between valproic acid and meropenem is serious, especially because of the dramatic decrease in the antiepileptic serum concentrations. The concomitant use of both drugs should be avoided, replacing the antibiotherapy empirically, or according to the resistance profiles of the microorganism and maintaining the same the anti-epileptic treatment.

Resultados negativos asociados al uso de medicamentos que motivan ingreso hospitalario / Adverse Drug Reactions Which Provoke Hospital Admission

Objetivo Identificar, clasificar y cuantificar la frecuencia de los resultados clínicos negativos asociados al uso de medicamentos (RNM) como motivo de ingreso hospitalario desde el servicio de urgencias (SU). Determinar el carácter prevenible de los RNM, identificar factores que predisponen al ingreso por RNM, determinar los costes asociados y conocer qué medicamentos se ven implicados con mayor frecuencia. Método Estudio transversal, prospectivo y observacional en pacientes que ingresaban desde el SU. Se aplicó el método Dáder para la detección de RNM. Los RNM se clasificaron según el Tercer Consenso de Granada, la evitabilidad se determinó aplicando el algoritmo de Schumock y Thornton, modificado por Otero et al y la gravedad según Schneider. Para el estudio económico se consideraron los costes directos generados durante el ingreso. Se analizó la asociación entre los RNM y edad, sexo, insuficiencia renal y hepática, y consumo de medicamentos. Se utilizó la regresión logística múltiple para identificar los factores de riesgo. Resultados El 19,4% de los ingresos fueron consecuencia directa de RNM, siendo evitables el 65%. El grupo de terapia antineoplásica e inmunosupresores causó el 38% de los RNM. El 20,4% de los ingresos requirieron traslado a la UCI o provocaron daño permanente. Se encontró una asociación estadísticamente significativa entre los RNM y los pacientes en tratamiento con terapia hormonal, fármacos de «alto riesgo» o ingresados en el servicio de endocrinología. El gasto ocasionado por los RNM fue de 237.377 € (AU)

Objective To identify, classify and quantify the frequency of negative clinical adverse drug reactions (ADR) resulting in hospital admission from the emergency department (ED). To determine ADR preventability, identify ADR-related admission factors, calculate related costs and recognise which drugs are the most often involved. Method Cross-sectional, prospective and observational study of patients who were admitted to hospital from the ED. We used the Dader method to detect ADR. We classified ADR in accordance with the Tercer Consenso de Granada (third Granada consensus), and calculated ADR preventability using the Schumock and Thornton scales (modified by Otero et al.), and ADR severity according to Schneider. We considered the direct costs generated during the hospital stay for the economic study. We analysed the correlation between ADR and age, sex, kidney and liver failure, and drug use. We used multiple logistic regression analysis to identify risk factors.Results19.4% of admissions were the direct consequence of ADR, 65% of which were preventable. Antineoplastic therapy and immunosupressants caused 38% of ADR. 20.4% of admissions had to be transferred to the intensive care unit (ICU) or caused permanent damage. We found statistical significance between ADR and patients undergoing hormonal therapy, ‘high risk’ drugs and those admitted to the endocrinology department. The ADR-associated cost was €237,377.ConclusionsADR-related admission is a problem with a high prevalence, and most cases are preventable (AU)

Análisis de errores de la prescripción manual comparados con la prescripción electrónica asistida en pacientes traumatológicos / Analysis of Errors in Manual Versus Electronic Prescriptions in Trauma Patients

Objetivo Detectar, cuantificar y comparar los errores de medicación producidos con un sistema de prescripción manual frente a un sistema de prescripción electrónica asistida en la fase de prescripción. Método Estudio prospectivo, descriptivo y observacional en dos unidades de hospitalización de traumatología de un hospital general; una con prescripción manual y otra con prescripción electrónica asistida. Se han valorado los errores de prescripción. Resultados Se analizaron 1.536 líneas de tratamiento (393 hojas de tratamiento) de 164 pacientes. Con la prescripción manual se detectaron un 19,54% de errores frente al 9,14% ocasionados con la prescripción electrónica asistida. Los errores de omisión fueron significativamente menores con la prescripción electrónica asistida, principalmente los producidos con fármacos pertenecientes al grupo del sistema nervioso central. Conclusiones Al informatizar la prescripción han descendido un 53% los errores de prescripción. Los errores que más se corrigen son los de omisión, al hacerse la prescripción de manera más completa; y fue destacable la disminución de errores en los fármacos del grupo del sistema nervioso central (AU)

Objective To detect, quantify, and compare the medication error produced with manual versus electronically assisted prescription systems. Methods A descriptive, observational, prospective study in two traumatology hospitalisation units; one with manual prescriptions and the other with electronically assisted prescriptions. Prescription errors were determined. Results We analysed 1536 lines of treatment (393 treatment forms) from 164 patients. With manual prescriptions, we detected errors in 19.54% of cases, compared to 9.4% in electronically assisted prescriptions. Omission errors were significantly lower with electronically assisted prescriptions, especially with drugs that act upon the central nervous system. Conclusions Prescription error has decreased by 53% since computerising the prescription process. This is particularly useful for omission errors, as prescription is more complete. The decrease in error regarding drugs that act on the central nervous system stands out(AU)

Adverse drug reactions which provoke hospital admission.

OBJECTIVE: To identify, classify and quantify the frequency of negative clinical adverse drug reactions (ADR) resulting in hospital admission from the emergency department (ED). To determine ADR preventability, identify ADR-related admission factors, calculate related costs and recognise which drugs are the most often involved. METHOD: Cross-sectional, prospective and observational study of patients that were admitted to hospital from the ED. We used the Dader method to detect ADR. We classified ADR in accordance with the Tercer Consenso de Granada (third Granada consensus), and calculated ADR preventability using the Schumock and Thornton scales (modified by Otero et al), and ADR severity according to Schneider. We considered the direct costs generated during the hospital stay for the economic study. We analysed the correlation between ADR and age, sex, kidney and liver failure, and drug use. We used multiple logistic regression analysis to identify risk factors. RESULTS: 19.4% of admissions were the direct consequence of ADR, 65% of which were preventable. Antineoplastic therapy and immunosuppressants caused 38% of ADR. 20.4% of admissions had to be transferred to the intensive care unit (ICU) or caused permanent damage. We found statistical significance between ADR and patients undergoing hormonal therapy, 'high risk' drugs and those admitted to the endocrinology department. The ADR-associated cost was €237,377. CONCLUSIONS: ADR-related admission is a problem with a high prevalence, and most cases are preventable.

[Advances in the knowledge of the use of micronutrients in artificial nutrition]. / Avances en el conocimiento del uso de micronutrientes en nutrición artificial.

Micronutrients are defined as those compounds necessary for the adequate physiological status of the organism and that may be administered through the daily diet either enteral or parenteral. The term micronutrient encompasses the vitamins and oligoelements, also termed trace elements. Vitamins cannot be synthesized by the organism and are categorized in two groups: water-soluble vitamins (the vitamin B group, C, folic acid, and biotin) and lipid-soluble vitamins (A, D, E, and K). Oligoelements are found in small amounts in the human body, and copper, cobalt, chrome, iron, iodine, manganese, molybdenum, nickel, selenium, and zinc are considered to be essential. The important role of micronutrients in critically-ill patients has been demonstrated, and their influence on the immune system, cancer, burnt, septic, and poly-traumatized patients has extensively been put in evidence. It is important to establish the micronutrients demands for each individual in order to achieve an adequate intake. However, there is little evidence on the necessary intake to achieve proper physiological functioning under different pathologies; therefore, studies bringing light to this situation are needed. The aim of this review is to update the current state of knowledge on micronutrients supplementation in the adult population with pathologies such as cancer, coronary and cardiovascular disease, bowel inflammatory disease, short-bowel syndrome, cystic fibrosis, liver disease, renal failure, respiratory failure, the surgical patient, big-burnt patient, pancreatitis, poly-traumatized patients, sepsis and HIV. After the bibliographical search, we describe the current state of knowledge regarding micronutrients intake in artificial nutrition under the above-mentioned pathologies.

Avances en el conocimiento del uso de micronutrientes en nutrición artificial / Advances in the knowledge of the use of micronutrients in artificial nutrition

Los micronutrientes se definen como compuestos necesarios para un adecuado estado fisiológico del organismo que pueden ser administrados vía oral en la dieta diaria, enteral o parenteral. El término micronutriente engloba las vitaminas y los oligoelementos, también llamados elementos traza. Las vitaminas no pueden ser sintetizadas por el organismo y se dividen en dos grupos: vitaminas hidrosolubles (grupo vitamina B, C, ácido fólico y biotina) y vitaminas liposolubles (A, D, E y K). Los oligoelementos se encuentran en pequeñas cantidades en el cuerpo humano, se consideran esenciales el cobre, cobalto, cromo, hierro, yodo, manganeso, molibdeno, níquel, selenio y zinc. La importancia del papel de los micronutrientes en los pacientes críticos es un hecho constatado, al igual que su influencia en la respuesta inmune en el cáncer, quemados, sepsis y politraumatizados está ampliamente evidenciada. Es importante establecer los requerimientos y necesidades de micronutrientes en cada individuo para que el aporte de los mismos sea adecuado. No obstante, existe poca evidencia sobre el aporte necesario para conseguir un adecuado funcionamiento fisiológico en las distintas patologías, por lo que se hace necesario desarrollar estudios que aclaren esta situación El objetivo de esta revisión es actualizar el estado del conocimiento de la suplementación de micronutrientes en patologías como el cáncer, la enfermedad coronaria y cardiovascular, enfermedad inflamatoria intestinal, síndrome de intestino corto, fibrosis quística, enfermedad hepática, insuficiencia renal, insuficiencia respiratoria, paciente quirúrgico, grandes quemados, pancreatitis, politraumatizados, sepsis y VIH, en pacientes adultos. Tras los resultados de la búsqueda bibliográfica detallamos el estado actual del conocimiento relativo al aporte de micronutrientes en nutrición artificial en las patologías anteriormente mencionadas (AU)

Micronutrients are defined as those compounds necessary for the adequate physiological status of the organism and that may be administered through the daily diet either enteral or parenteral. The term micronutrient encompasses the vitamins and oligoelements, also termed trace elements. Vitamins cannot be synthesized by the organism and are categorized in two groups: water-soluble vitamins (the vitamin B group, C, folic acid, and biotin) and lipid-soluble vitamins (A, D, E, and K). Oligoelements are found in small amounts in the human body, and copper, cobalt, chrome, iron, iodine, manganese, molybdenum, nickel, selenium, and zinc are considered to be essential. The important role of micronutrients in critically-ill patients has been demonstrated, and their influence on the immune system, cancer, burnt, septic, and poly-traumatized patients has extensively been put in evidence. It is important to establish the micronutrients demands for each individual in order to achieve an adequate intake. However, there is little evidence on the necessary intake to achieve proper physiological functioning under different pathologies; therefore, studies bringing light to this situation are needed. The aim of this review is to update the current state of knowledge on micronutrients supplementation in the adult population with pathologies such as cancer, coronary and cardiovascular disease, bowel inflammatory disease, short-bowel syndrome, cystic fibrosis, liver disease, renal failure, respiratory failure, the surgical patient, big-burnt patient, pancreatitis, poly-traumatized patients, sepsis and HIV. After the bibliographical search, we describe the current state of knowledge regarding micronutrients intake in artificial nutrition under the above-mentioned pathologies (AU)

[Analysis of errors in manual versus electronic prescriptions in trauma patients]. / Análisis de errores de la prescripción manual comparados con la prescripción electrónica asistida en pacientes traumatológicos.

OBJECTIVE: To detect, quantify, and compare the medication error produced with manual versus electronically assisted prescription systems. METHODS: A descriptive, observational, prospective study in two traumatology hospitalisation units; one with manual prescriptions and the other with electronically assisted prescriptions. Prescription errors were determined. RESULTS: We analysed 1,536 lines of treatment (393 treatment forms) from 164 patients. With manual prescriptions, we detected errors in 19.54% of cases, compared to 9.4% in electronically assisted prescriptions. Omission errors were significantly lower with electronically assisted prescriptions, especially with drugs that act upon the central nervous system. CONCLUSIONS: Prescription error has decreased by 53% since computerising the prescription process. This is particularly useful for omission errors, as prescription is more complete. The decrease in error regarding drugs that act on the central nervous system stands out.

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

No disponible

No disponible

[Prescription errors after the implementation of an electronic prescribing system]. / Errores de prescripción tras la implantación de un sistema de prescripción electrónica asistida.

OBJECTIVE: This study sets out to identify, compare and evaluate the medication errors of a manual prescribing system and an electronic prescribing system during the prescription and transcription phases. METHOD: A prospective study of two clinical in-patient units (pneumology and infectious diseases) in one general hospital. Two phases were studied; before and after an electronic prescribing system was implemented. Each phase lasted one month. A comparative analysis was carried out of the medication errors in the medical prescription process, the transcription process and the administration recording process carried out by nursing staff as well as the pharmacist s transcriptions/validations. RESULTS: A total of 3,908 patient treatment errors and 129 patient identification errors were detected during both of the periods studied. The rate of errors in patient identification or treatment orders using the manual prescribing system was 14.4 against 1.3% after the electronic system was implemented. The relative risk reduction for infectious diseases and pneumology was 100 and 85.44%, respectively (statistically significant). In general, relative risk reduction was achieved in both units, oscillating between 78.91 and 100%. The absolute risk reduction oscillated between 5.09 and 30.45% for errors in drug data, doses, frequency/time and route of administration. These results were statistically significant. CONCLUSIONS: The electronic prescribing system has reduced errors in the identification, prescription and transcription of pharmacological treatment and has consequently helped to improve the quality and safety of drug treatment received by patients.

Errores de prescripción tras la implantación de un sistema de prescripción electrónica asistida / No disponible

Objetivo: El objetivo de este estudio es detectar, cuantificar ycomparar los errores de medicación producidos con un sistema deprescripción manual comparado con un sistema de prescripciónelectrónica asistida en las fases de prescripción y transcripción.Método: Estudio prospectivo realizado en dos unidades clínicasde hospitalización (neumología y enfermedades infecciosas) deun hospital general. El estudio ha tenido dos fases (antes y despuésde la implantación de la prescripción electrónica asistida) ycada una tuvo una duración de un mes. Se han analizado y comparadolos errores de medicación producidos en los procesos deprescripción médica, transcripción y registro de la administraciónpor el personal de enfermería, así como en la transcripción/validaciónpor el farmacéutico.Resultados: Durante los dos periodos de estudio se detectaronun total de 3.908 errores referentes al tratamiento de lospacientes y 129 correspondientes a los datos identificativos de losmismos. Respecto a los errores cometidos en la identificación delpaciente o la orden de tratamiento, con la prescripción manual seobtuvo una tasa de error del 14,4%, mientras que tras la implantaciónde la prescripción electrónica fue del 1,3%, siendo lareducción relativa del riesgo del 100 y del 85,44% en el serviciode infecciosas y neumología respectivamente (estadísticamentesignificativo). Se ha conseguido una reducción relativa del riesgo,de forma global en ambas unidades, que oscila entre el 78,91% yel 100% y una reducción absoluta del riesgo que oscila entre el5,09 y el 30,45% respecto a los errores en los datos del medicamento,dosis, frecuencia/hora y vía/modo de administración,siendo estos resultados estadísticamente significativos.Conclusiones: La utilización de la prescripción electrónicaasistida ha disminuido los errores en la identificación, prescripcióny trascripción del tratamiento farmacológico y por tanto ha contribuidoa mejorar la calidad y la seguridad de la farmacoterapia aplicadaa los pacientes

Objective: This study sets out to identify, compare and evaluatethe medication errors of a manual prescribing system and anelectronic prescribing system during the prescription and transcriptionphases.Method: A prospective study of two clinical in-patient units(pneumology and infectious diseases) in one general hospital. Twophases were studied; before and after an electronic prescribingsystem was implemented. Each phase lasted one month. A comparativeanalysis was carried out of the medication errors in themedical prescription process, the transcription process and theadministration recording process carried out by nursing staff aswell as the pharmacist’s transcriptions/validations.Results: A total of 3,908 patient treatment errors and 129patient identification errors were detected during both of the periodsstudied. The rate of errors in patient identification or treatmentorders using the manual prescribing system was 14.4against 1.3% after the electronic system was implemented. Therelative risk reduction for infectious diseases and pneumology was100 and 85.44%, respectively (statistically significant). In general,relative risk reduction was achieved in both units, oscillatingbetween 78.91 and 100%. The absolute risk reduction oscillatedbetween 5.09 and 30.45% for errors in drug data, doses, frequency/time and route of administration. These results were statisticallysignificant.Conclusions: The electronic prescribing system has reducederrors in the identification, prescription and transcription of pharmacologicaltreatment and has consequently helped to improvethe quality and safety of drug treatment received by patients