Impact of the implementation of vasoactive drug protocols on safety and efficacy in the treatment of critically ill patients.

WHAT IS KNOWN AND OBJECTIVE: The correct management of high-alert medications is a priority issue in expert recommendations for improving the clinical safety of patients. Objectives were to assess the impact of the implementation of vasoactive drug (VAD) protocols on safety and efficacy in the treatment of critically ill patients. METHODS: A prospective before-and-after study on the implementation of different VAD protocols, comparing medication errors (MEs) rates, mean intensive care unit (ICU) stay, mean blood pressure (MAP), heart rate (HR) and oxygen saturation. RESULTS AND DISCUSSION: The study included 432 patients. There was a statistically significant decrease in prescribing errors (55·9%), validation errors (68·1%) and medication administration records (MAR) errors (78·8%). No differences were found between the two phases in ICU stay, MAP, HR and oxygen saturation. WHAT IS NEW AND CONCLUSION: Implementation of protocols decreases variability in clinical practice, reduces the incidence of MEs and maintains the effectiveness of VAD therapy in critically ill patients.

The impact of a computerized physician order entry system on medical errors with antineoplastic drugs 5 years after its implementation.

WHAT IS KNOWN AND OBJECTIVE: Computerized physician order entry (CPOE) systems reduce medical errors (MEs). Nevertheless, a CPOE system may also lead to new types of errors, especially when it is first implemented. The objectives of this study were to determine the impact of a CPOE on the number of MEs and to identify the types of MEs in prescriptions issued by the Haematology Department 5 years after the implementation of the CPOE system. METHODS: We conducted a prospective analytical study on the implementation of a CPOE system at the Pharmacy Department of the Hospital Ramon y Cajal (Madrid, Spain). The study comprised three phases: a pre-implementation phase, an implementation phase conducted in the Haematology Department and a post-implementation phase, which was conducted 5 years after the implementation of the CPOE system. One hundred and fifty prescriptions per pre- and post-implementation phase were consecutively included in the study. A previously described classification scheme was used to detect and classify MEs. RESULTS AND DISCUSSION: The implementation of a CPOE system was associated with a large reduction in MEs. One hundred and fourteen patients (pre-implementation phase) were compared to 82 patients (post-implementation phase). The total number of MEs per 100 patients decreased from 236·8 (95% CI: 212·1-261·3) to 10·9 (95% CI: 5·8-19·6), with an absolute risk reduction of 36·2 (95% CI: 32·6-39·9). The percentage of prescriptions with an ME decreased from 37·5% to 1·2% (P < 0.001). In the pre-implementation phase, the drugs most frequently associated with MEs were rituximab (35·9%), cyclophosphamide (13%) and methotrexate (7%). In the post-implementation phase, 44·4% of prescription errors involved methotrexate. Five years after the implementation of the CPOE system, the majority of MEs were eliminated, the number of remaining errors (quantity, concentration and ambiguous prescription errors) decreased, and no new types of ME were detected. WHAT IS NEW AND CONCLUSION: The CPOE system almost completely eliminated MEs with antineoplastic drugs in the Haematology Department. No new types of MEs were observed once physicians had become accustomed to using the system. However, some MEs were not eliminated. Constant diligence is needed to analyse and evaluate MEs associated with the CPOE system and their causes, such that the limitations of CPOE can be identified and overcome and the medication-use process associated with antineoplastic agents improved.

Validación de una clasificación de errores de medicación para su utilización en quimioterapia / Validating a Classification Scheme for Medication Errors to be Used in Chemotherapy

Objetivo Validar una hoja de clasificación de errores de medicación asociados a medicamentos antineoplásicos. Métodos Estudio prospectivo. Se diseñó una hoja de recogida de datos sobre la base de la clasificación de la American Society of Health-System Pharmacists. Dos observadores revisaron las líneas de tratamiento de las prescripciones de quimioterapia del Servicio de Hematología durante un mes y clasificaron los errores detectados. Se analizó la concordancia interobservador mediante el test del índice kappa. Se revisaron las categorías de error en las que se obtuvo una concordancia moderada o inferior y se valoró si era necesaria su modificación. Resultados Se analizaron un total de 23 categorías de error y se revisaron 162 líneas de tratamiento. Únicamente una de las categorías fue valorable en función de su prevalencia de error, la de prescripción incompleta o ambigua (índice kappa=0,458=concordancia moderada). Se analizaron las causas y se desglosaron subapartados dentro de esta categoría. Conclusión Nuestros resultados evidenciaron la necesidad de la revisión de la clasificación de errores. Es necesario disponer de herramientas validadas para avanzar en la caracterización de este tipo de errores de medicación (AU)

Objective To validate a classification sheet for medication errors associated with antineoplastic medication. Method Prospective study. A data sheet was designed based on ASHP's classification. Two observers reviewed the treatment prescribed for chemotherapy from the Haematology Department during a month and they classified the errors detected. The interobserver concordance was analysed using the kappa index test. The error categories with a moderate or lower concordance were reviewed, and the need to modify them was evaluated. Results A total of 23 error categories were analysed and 162 lines of treatment were reviewed. Only one of the categories was assessable in accordance with its error prevalence, which was the category for incomplete or ambiguous prescriptions (kappa index=0.458=moderate concordance). The causes were analysed and subsections within this category itemised. Conclusion Our results proved the need to review error classification. Validated tools need to be made available so as to make progress in characterising this type of medication error (AU)

[Validating a classification scheme for medication errors to be used in chemotherapy]. / Validación de una clasificación de errores de medicación para su utilización en quimioterapia.

OBJECTIVE: To validate a classification sheet for medication errors associated with antineoplastic medication. METHOD: Prospective study. A data sheet was designed based on ASHP's classification. Two observers reviewed the treatment prescribed for chemotherapy from the Haematology Department during a month and they classified the errors detected. The interobserver concordance was analysed using the kappa index test. The error categories with a moderate or lower concordance were reviewed, and the need to modify them was evaluated. RESULTS: A total of 23 error categories were analysed and 162 lines of treatment were reviewed. Only one of the categories was assessable in accordance with its error prevalence, which was the category for incomplete or ambiguous prescriptions (kappa index=0.458=moderate concordance). The causes were analysed and subsections within this category itemised. CONCLUSION: Our results proved the need to review error classification. Validated tools need to be made available so as to make progress in characterising this type of medication error.

[Detection and analysis of adverse drug reactions in a general hospital's emergency department]. / Detección y análisis de reacciones adversas a medicamentos en el servicio de urgencias de un hospital general.

OBJECTIVE: To detect and analyze adverse drug reactions (ADR) leading to emergency room visits in our hospital, as well as their severity and outcome, and medications most commonly involved, from selected alerting diagnoses. METHOD: A retrospective study for the period from January 2003 to December 2004, where all reports by the emergency department including our wanted diagnoses were reviewed. RESULTS: A total of 1,626 reports with alerting diagnoses were found, of which 444 (27.3%) were confirmed as potential adverse drug reactions. Of 444 cases, 345 (77.7%) were discharged to their homes and 90 (20%) were admitted. In all, 52.9% of adverse drug reactions were considered moderate, and 19.6% were considered serious. The major age group involved was that of patients older than 65 years (65.1%), and was involved in 83.9% of adverse drug reactions. Drugs most commonly involved included insulins (26.1%), diuretics (17.3%), digoxin (10.9%), and oral antidiabetics (9.5%). Major organs and systems involved included the endocrine system (55.6%), musculoskeletal system (11%) and cardiovascular system (10.8%). CONCLUSIONS: Drugs commonly used in clinical practice, including insulins, diuretics or oral antidiabetics induce many of the adverse reactions that lead patients to visit emergency departments. A closer monitoring of therapies is still needed to prevent adverse drug reactions.

Detección y análisis de reacciones adversas a medicamentos en el servicio de urgencias de un hospital general / Detection and analysis of adverse drug reactions in a general hospital's emergency department

Objetivo: Detectar y analizar a partir de unos diagnósticos alertantes seleccionados las reacciones adversas a medicamentos (RAM) que ocasionaron consultas al servicio de urgencias de nuestro hospital, su gravedad y la evolución de los pacientes afectados, así como los fármacos más comúnmente implicados en las mismas. Método: Estudio retrospectivo perteneciente al periodo enero 2003-diciembre 2004, en el que se revisaron todos aquellos informes elaborados por el servicio de urgencias en los que figuraban los diagnósticos buscados. Resultados: Se encontraron un total de 1.626 informes con los diagnósticos alertantes, de los cuales 444 (27,3%) se confirmaron como posibles reacciones adversas a medicamentos. De los 444 casos, 345 (77,7%) recibieron el alta domiciliaria y 90 (20%)fueron ingresados. El 52,9% de las reacciones adversas fueron consideradas moderadas y el 19,6% graves. El principal grupo de edad afectado fue el de los mayores de 65 años (65,1%) y estuvo implicado en el 83,9% de las reacciones adversas graves. Los fármacos más comúnmente implicados fueron las insulinas (26,1%), los diuréticos (17,3%), la digoxina (10,9%) y los antidiabéticos orales (9,5%). Los principales órganos y aparatos afectados fueron el sistema endocrino (55,6%), el aparato músculo esquelético (11%) y el aparato cardiovascular (10,8%). Conclusiones: Fármacos de uso muy habitual en la práctica clínica como las insulinas, diuréticos o antidiabéticos orales ocasionan muchas de las reacciones adversas que llevan a los pacientes a los servicios de urgencias. El control más estrecho de los tratamientos sigue siendo necesario para prevenir la aparición de reacciones adversas a medicamentos

Objective: To detect and analyze adverse drug reactions (ADR) leading to emergency room visits in our hospital, as well as their severity and outcome, and medications most commonly involved, from selected alerting diagnoses. Method: A retrospective study for the period from January 2003 to December 2004, where all reports by the emergency department including our wanted diagnoses were reviewed. Results: A total of 1,626 reports with alerting diagnoses were found, of which 444 (27.3%) were confirmed as potential adverse drug reactions. Of 444 cases, 345 (77.7%) were discharged to their homes and 90 (20%) were admitted. In all, 52.9% of adverse drug reactions were considered moderate, and 19.6% were considered serious. The major age group involved was that of patients older than 65 years (65.1%), and was involved in 83.9% of adverse drug reactions. Drugs most commonly involved included insulins (26.1%), diuretics (17.3%), digoxin (10.9%), and oral antidiabetics (9.5%). Major organs and systems involved included the endocrine system (55.6%), musculo skeletal system (11%) and cardiovascular system (10.8%). Conclusions: Drugs commonly used in clinical practice, including insulins, diuretics or oral antidiabetics induce many of the adverse reactions that lead patients to visit emergency departments. A closer monitoring of therapies is still needed to prevent adverse drug reactions