Dispensing errors in Lebanese community pharmacies: incidence, types, underlying causes, and associated factors

OBJECTIVES: To assess the incidence, types, the causes of as well as the factors associated with dispensing errors in community pharmacies in Lebanon. METHODS: An observational cross-sectional study was conducted in 286 pharmacies located all over Lebanon. Data were collected by senior pharmacy students during their experiential learning placement. Collected data included information on the types of dispensing errors, the underlying causes of errors, handling approaches, and used strategies for dispensing error prevention. Data were analyzed using multiple logistic regression to determine factors that were associated with dispensing errors. RESULTS: In the twelve thousand eight hundred sixty dispensed medications, there were 376 dispensing errors, yielding an error rate of 2.92%. Of these errors, 67.1% (252) corresponded to dispensing near-miss errors. The most common types of dispensing errors were giving incomplete/incorrect use instructions (40.9% (154)), followed by the omission of warning(s) (23.6% (89)). Work overloads/time pressures, illegible handwriting, distractions/interruptions, and similar drug naming/packaging were reported as the underlying causes in 55% (206), 23.13% (87), 15.15 % (57), and 7% (26) of the errors respectively. Besides, high prescription turnover volume, having one pharmacist working at a time, and extended working hours, were found to be independent factors that were significantly associated with dispensing errors occurrence (p < 0.05). CONCLUSIONS: This study sheds light on the need to establish national strategies for preventing dispensing errors in community pharmacies to maintain drug therapy safety, considering identified underlying causes and associated factors

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Avaliação do processo de dispensação de medicamentos na saúde indígena por meio da simulação de atendimento / Drug dispensing process evaluation in Brazilian indigenous health care using simulation

Introdução: A atuação do farmacêutico no atendimento da população indígena ainda é pouco explorada no Brasil. Em 2016, foi realizado curso de capacitação em parceria com o Ministério da Saúde e a Universidade Federal do Rio Grande do Sul para profissionais farmacêuticos atuantes na saúde indígena visando atender as necessidades e especificidades desta população específica. Uma das etapas do curso foi a realização da simulação da dispensação de medicamentos como forma de aprimoramento e consolidação dos conhecimentos. Métodos: Estudo transversal e retrospectivo que avaliou as gravações das simulações de dispensação de medicamentos a pacientes indígenas através de formulário específico. Resultados: A pontuação geral dos participantes variou de 2,4 a 8,3 pontos. Os casos de infecção pediátrica foram os que apresentaram o pior desempenho entre os participantes. A média de tempo para realização da dispensação foi de 8,8 minutos. Em relação ao conhecimento técnico, os participantes apresentaram uma média de 4,4 pontos. Conclusão: O baixo desempenho dos participantes nas simulações reflete o despreparo dos farmacêuticos para realizarem a dispensação de medicamentos a pacientes indígenas. As limitações quanto as barreiras linguísticas e culturais foram identificadas de forma marcante na avaliação das simulações. (AU)

Introduction: The pharmacist's role in providing care to the indigenous population is still little explored in Brazil. In 2016, a training course sponsored by the Ministry of Health and the Federal University of Rio Grande do Sul was offered for pharmaceutical professionals working in indigenous health care to meet the needs and specificities of this population. One of the course sections was based on drug dispensing simulation as a way of improving and consolidating knowledge. Methods: This cross-sectional, retrospective study evaluated recordings of drug dispensing simulations with indigenous patients using a specific form. Results: The overall score of the participants ranged from 2.4 to 8.3 points. The cases of pediatric infection had the worst performance among the participants. The mean dispensing time was 8.8 minutes. Regarding technical knowledge, the participants had a mean score of 4.4 points. Conclusion: The poor performance of the participants in the simulations reflects pharmacists' lack of preparation to dispense medications to indigenous patients. Limitations regarding language and cultural barriers were markedly identified in the evaluation of simulations. (AU)

Incidencia de la dispensación de fármacos antihipertensivos en farmacias del municipio Bayamo. Granma. Diciembre 2019 / Incidence of the dispensing of antihypertensive drugs in pharmacies of the municipality Bayamo. Granma. December 2019

La dispensación es el acto por excelencia del farmacéutico, es donde la atención farmacéutica comienza su camino hacia la excelencia y el cliente se convierte en paciente, es donde nace la trasformación de nuestras unidades de farmacia de simples puntos de ventas en instituciones de salud. Teniendo en cuenta dicha afirmación realizamos un estudio descriptivo observacional para identificar la incidencia de la dispensación en dos farmacias comunitarias del municipio Bayamo, donde el universo estuvo conformado por 4461 pacientes con tratamiento con antihipertensivo inscriptos en las unidades Rosa La Bayamesa y Jesús Menéndez, la muestra estuvo constituida por el 32 por ciento del universo. En el análisis de la información se aplicó el método del conteo simple, métodos empíricos como la entrevista, la encuesta, la observación y el análisis documental; además del análisis-síntesis, inductivo–deductivo e histórico-lógico, dentro de los métodos teóricos. Los resultados de la investigación aportaron que el 73 por ciento de los pacientes encuestados nunca disfrutaron el beneficio del acto de la dispensación y solo el 9 por ciento declararon ser beneficiados siempre por este acto, además se observaron varios impedimentos que imposibilitan al farmacéutico realizar la dispensación de medicamentos de forma correcta(AU)

Dispensing is the pharmacist's act par excellence, it is where pharmaceutical care begins its path to excellence and the customer becomes a patient, it is where the transformation of our pharmacy units from simple points of sale into health institutions is born. Bearing this statement in mind, we carried out a descriptive observational study to identify the incidence of dispensing in two community pharmacies in the Bayamo municipality, where the universe consisted of 4461 patients with antihypertensive treatment enrolled in the Rosa La Bayamesa and Jesús Menéndez units, the sample it was made up of 32 percent of the universe. In the information analysis, the simple counting method, empirical methods such as the interview, the survey, the observation and the documentary analysis were applied; in addition to the analysis-synthesis, inductive-deductive and historical-logical, within the theoretical methods. The results of the research contributed that 73 percent of the surveyed patients never enjoyed the benefit of the act of dispensing and only 9 percent declared that they always benefited from this act, in addition, several impediments were observed that make it impossible for the pharmacist to dispense medicines correctly(EU)

Crisis de la prestación farmacéutica en los centros penitenciarios: el tratamiento de la hepatitis C / Crisis in pharmaceutical provisions within prisons: sanitary treatment of hepatitis C

El inicio de la andadura de nuevos medicamentos antivirales, como el boceprevir y telaprevir, específicos para el tratamiento de la hepatitis C, trajo nuevas esperanzas de curación para los afectados; esperanzas que se concentraron especialmente en un grupo ciudadano con una alta prevalencia de la enfermedad como la población reclusa y que chocaron de frente con las limitaciones que conllevaban: el aumento de los efectos adversos y el considerable aumento del coste del tratamiento. La ineficaz gestión de los tratamientos por parte de las instituciones, centradas más en las reclamaciones entre comunidades autónomas y el Gobierno por la asunción de los costes, revelaron en el seno del conflicto jurídico un problema de fondo con respecto a la prestación farmacéutica en los centros penitenciarios, donde se pusieron de relieve el incumplimiento del trasvase de competencias en materia de sanidad penitenciaria y la anacronía de la normativa penitenciaria en materia de fármacos con respecto a la legislación vigente, así como la desorganización de la prestación farmacéutica en los recintos penitenciarios. Problemas todos ellos que imponen la necesidad de la reflexión sobre la gestión de un sistema sanitario que afecta a una parte de la población privada de libertad y que tiende a ser olvidada

The beginning of the new antiviral drugs, such as boceprevir and telaprevir, specific for the treatment of Hepatitis C, brought new hopes of healing for those affected; hopes that especially affected to a group of people with a high prevalence of the disease, as the inmate population, and that clashed head-on with the limitations that entailed: the increase in side effects and the considerable increase in the cost of treatment. The inefficient management of the treatments by the institutions, focused more on the claims between the Autonomous Communities and the Government for the assumption of the costs, revealed in the heart of the legal conflict a substantive problem regarding the pharmaceutical provision in the prisons, where the breach of the transfer of powers in the field of prison health, and the anachronism of prison regulations regarding drugs with respect to current legislation, as well as the disorganization of pharmaceutical provision in prisons were highlighted. Problems all of them that impose the need for reflection on the management of a health system that affects a part of the population deprived of liberty and that tends to be forgotten

Dispensa de antibióticos no distrito de manhiça: conhecimentos e atitudes dos provedores formais e informais / Dispensing antibiotics in the district of manhiça: knowledge and attitudes of formal and informal providers formal and informal providers

Introdução: Actualmente, os antibióticos constituem a classe de medicamentos mais consumidos no mundo. Apesar dos ganhos que o uso prudente de antibióticos possa ter na saúde dos indivíduos, a sua dispensa descontrolada e não apropriada representa uma ameaça grave à saúde pública, estando associada às taxas, cada vez crescentes, de resistência aos mesmos. Em Moçambique, informação sistemática relativa à dispensa de antibióticos é escassa. Objectivo: Analisar o conhecimento, as atitudes e os factores contextuais que orientam a prática de dispensa de antibióticos pelos provedores formais e informais que operam no distrito de Manhiça. Material e métodos: Foi conduzido um estudo com uma abordagem qualitativa, do tipo fenomenológico. A recolha de dados foi feita no distrito de Manhiça, no Sul de Moçambique. Foram realizadas 16 entrevistas em profundidade com provedores de antibióticos formais e informais. Todas as entrevistas foram gravadas e posteriormente transcritas e analisadas seguindo uma combinação de análise de conteúdo e temática, à luz da Teoria da Construção Social da Realidade de Berger e Luckmann. Resultados: Participaram no estudo 12 provedores formais (técnicos de farmácia e agentes polivalentes elementares (APEs) e quatro provedores informais (vendedores nas residências e ambulantes). Os técnicos de farmácia mostraram um conhecimento básico tanto sobre antibióticos e resistência antibiótica alinhado com a perspectiva biomédica, como a consciencialização em relação a parte dass normas de dispensa de antibióticos. As formações profissionais, os formulários nacionais de medicamentos e a internet são, segundo os técnicos de farmácia, as suas principais fontes de informação sobre os antibióticos. Os provedores de antibióticos informais e APEs demonstraram um conhecimento limitado em relação aos antibióticos, à resistência aos antibióticos e à norma de dispensa de antibióticos, sendo a consulta aos provedores de saúde formais apontada como o meio de obtenção de orientações sobre a sua conduta clínica. Em relação às práticas reportadas de dispensa de antibióticos pelos diferentes tipos de provedores, verificou-se que todos os provedores verificam a validade dos antibióticos e providenciam informação oral ou escrita antes de dispensarem antibióticos. A maioria dos provedores de antibióticos (APEs, informais) relatou que questiona sobre a história clínica dos utentes, observa os sinais/sintomas dos utentes e dispensa antibióticos para casos de tosse banal e gripe...

Introduction: Antibiotics are currently the most consumed class of drugs in the world. Despite the gains that the prudent use of antibiotics can have in the individual health, their uncontrolled and inappropriate dispensing represents a serious threat to public health and is associated with the increasing rates of resistance. In Mozambique, systematic information on antibiotic dispensation is scarce. Objective: To analyse the knowledge, attitudes and contextual factors that guide the practice of antibiotic dispensing by formal and informal providers operating in Manhiça district. Material and methods: A qualitative study with a phenomenological approach was performed. Data collection was conducted in Manhiça, a district of Southern Mozambique. Sixteen in-depth interviews were conducted with formal and informal antibiotic providers. All interviews were recorded, transcribed, and analysed following a combination of content and thematic analysis based on the Social Construction of Reality Theory of Berger and e Luckmann. Results: Twelve formal providers (pharmacy technicians and community health workers (APEs) and four informal providers (home seller and ambulant drug seller) participated in the study. The pharmacy technicians revealed a basic knowledge of both antibiotics and antibiotic resistance aligned with the biomedical perspective, as well as awareness of part of the country antibiotic dispensing regulations. Professional training, National Medicine Forms and the internet are the main source of information regarding antibiotics reported by the pharmacy technicians. Informal antibiotic providers and APES have shown limited knowledge about antibiotics, antibiotic resistance and the country regulations to dispense antibiotic. In addition, the formal health providers were pointed out by them as the means source of obtaining guidance on their clinical conduct. Regarding the reported antibiotic practices, according to the different types of providers in the study, it was found that all providers verify the expiration date of antibiotics and provide oral or written information before dispensing antibiotics. The majority of antibiotic providers (APEs, informal providers) reported questioning the clinical history, observe the signs/symptoms of users and dispense antibiotics for common cough and flu…

Producción y consumo de fitofármacos y apifármacos durante la pandemia de COVID-19 en Cuba, marzo a junio de 2020 / Production and consumption of phytopharmaceuticals and apipharmaceuticals during the COVID-19 pandemic in Cuba, March to June 2020

Objetivos. Determinar el aporte del personal de los servicios farmacéuticos comunitarios al aseguramiento de la producción de fitofármacos y apifármacos elaborados a nivel localdispensarial, incluidos en el protocolo de actuación nacional para la COVID-19, así como el consumo de estas formulaciones. Materiales y métodos. Se realizó un estudio retrospectivo, observacional, descriptivo y longitudinal, donde se analizaron los informes mensuales de producción, en el período comprendido entre marzo y junio. De estos se obtuvo la información de los diez fitofármacos y apifármacos seleccionados. Se determinaron los planes de producción para cada una de estas formulaciones y su cumplimiento, así como el consumo de estos. Resultados. Entre marzo y junio se produjeron en el país 7 401 001 unidades de los diez fitofármacos y apifármacos seleccionados, el 125,5% de lo planificado. De ellos, la mayor producción correspondió al orégano jarabe 10% (1 725 156 unidades) y al Imefasma jarabe (1 648 037 unidades). El aloe jarabe (50%) y la cebolla jarabe (10%) fueron los dos fitofármacos con mayor porcentaje de producción con respecto al plan. La Habana fue la provincia con el mayor volumen de producción (1 315 008 unidades); la menor producción correspondió al municipio especial Isla de la Juventud (18 107 unidades). De las 7 401 001 unidades producidas en el período, se consumieron 6 754 910 (91,3%). Conclusiones. Desde los servicios farmacéuticos se aseguró la producción, a nivel local-dispensarial, de los diez fitofármacos y apifármacos seleccionados para el enfrentamiento de la pandemia de COVID-19 en Cuba. Se sobrepasó la producción de todos estos fitofármacos y apifármacos y su consumo fue alto.

Objectives. To determine the contribution of the staff of the community pharmaceutical services to ensuring the production of phytopharmaceuticals and apipharmaceuticals produced at the local-dispensary level, included in the national action protocol for COVID-19, as well as the consumption of these formulations. Materials and methods. It was carried out a retrospective, observational, descriptive, and longitudinal study, where the monthly reports of production were analyzed, in the period from March to June. From these, the information of the ten selected phytopharmaceuticals and apipharmaceuticals was obtained. The production plans for each of these formulations and their compliance were determined, as well as their consumption. Results. Between March and June, 7,401,001 units of the ten selected phytopharmaceuticals and apipharmaceuticals were produced in the country, 125.5% of what was planned. Of these, the highest production corresponded to oregano syrup 10% (1,725,156 units) and Imefasma syrup (1,648,037 units). Aloe syrup (50%) and onion syrup (10%) were the two phytopharmaceuticals with the highest percentage of production with respect to the plan. Havana was the province with the highest production volume (1 315 008 units); the lowest production corresponded to the special municipality Isle of Youth (18 107 units). Of the 7,401,001 units produced in the period, 6,754,910 (91.3%) were consumed. Conclusions. From the pharmaceutical services, it was ensured the production, at a local-dispensary level, of the ten phytopharmaceuticals and apipharmaceuticals selected for the confrontation of the COVID-19 pandemic in Cuba. The production of all these phytopharmaceuticals and apipharmaceuticals was surpassed and their consumption was high.

Acesso aos medicamentos restritos a farmácias distritais do município de Porto Alegre: com usuários de três unidades de saúde / Access to medicines restricted to district pharmacies in the city of Porto Alegre: with users from three health units

O objetivo deste estudo foi avaliar o acesso, pela população, aos medicamentos restritos às 10 farmácias distritais do município de Porto Alegre, prescritos dentro do Sistema Único de Saúde a partir de registro das prescrições por meio de fotografia. A metodologia empregada foi de um estudo exploratório prospectivo com abordagem quantitativa. A coleta de dados ocorreu simultaneamente nos dispensários de medicamentos das três unidades de saúde vinculados ao Grupo Hospitalar Conceição, ao longo dos meses de agosto e setembro de 2019, mediante a autorização do paciente, através da assinatura do Termo de Consentimento Livre e Esclarecido. A amostra foi coletada leatoriamente, de acordo com a apresentação, por parte dos usuários, das prescrições. Na posse dos registros fotográficos, verificou-se, através do Sistema Eletrônico de Dispensação do município de Porto Alegre (DIS), a retirada ou não os medicamentos prescritos que eram restritos às farmácias distritais deste município.Foram registradas 67 prescrições, totalizando 77 medicamentos. O estudo contou com a participação de 65,67% de mulheres e 34,33% de homens. A idade média dos participantes foi de 39,69 anos para as mulheres e 31,19 anos para homens. A classe farmacológica dos antibióticos obteve o maior número de prescrições registradas (59,74%), os antipsicóticos obtiveram 24,67% dos registros, os anticolinérgicos 9,09%, os antivirais, antiparasitários, antiepiléticos e estrogênios tiveram um registro de 1,30% cada na amostra. Na amostra total, a retirada destes medicamentos, pela população,....

Gripe española y otras enfermedades en el Dispensario Infantil de Quito, Ecuador (1918-1919) / Spanish flu and other diseases in the Quito Children's Dispensary (1918-1919)

OBJETIVO PRINCIAPL: Analizar la morbimortalidad en el Dispensario Infantil de Quito anexo al Hospital San Juan de Dios durante la época de la epidemia de gripe española, su correlación con el contexto socioeconómico, las condiciones de salubridad de la ciudad y la morbimortalidad en otras localidades. METODOLOGÍA: Con los registros de atención conservados en el Museo Nacional de Medicina Eduardo Estrella se estructuró un estudio historiográfico médico, descriptivo y analítico de la morbimortalidad entre enero de 1918 y abril de 1919. Se analizó la morbilidad por entidades patológicas, por grupos de edad y por sus determinantes sociales. RESULTADOS PRINCIPALES: El Dispensario atendió 8.882 infantes, 4.370 niñas (49,20 %) y 4.460 varones (50,22 %). Su edad estuvo comprendida entre 1 día y 17 años. Los menores de 2 años fueron 4.598 (51,77%). La mayoría, 8.735 (98,35 %), procedía de Quito. Los registros con diagnóstico fueron 8.738. En 144 casos no hubo diagnóstico. Se registraron 9 defunciones por enfermedades diarreicas, respiratorias y otras infecciosas, entre ellas una defunción por gripe. La enfermedad más frecuente fue la gripe, con 2.780 casos (31,29 %) del total. La morbilidad prevalente fue por patología digestiva, principalmente enfermedades diarreicas y por patología respiratoria con predominio de gripe. La tosferina, endémica en Quito, tuvo prevalencia limitada. El paludismo, endémico en los valles cercanos a Quito, presentó 54 casos (0,61%) del total. Fue erradicado en la serranía en 1956. La varicela, otras enfermedades eruptivas de la infancia y las parasitosis intestinales tuvieron menor presencia, al igual que las enfermedades carenciales. Los niños con gripe recibieron principalmente lactancia materna. Aquellos con enfermedades diarreicas recibieron más frecuentemente alimentación mixta, lo cual podría reflejar las limitadas condiciones sanitarias para la preparación de los alimentos. CONCLUSIÓN PRINCIPAL: El perfil de morbi-mortalidad, con prevalencia de gripe y enfermedades digestivas y respiratorias, obedece no solo a la pandemia de gripe española, sino al empobrecimiento predominante, las condiciones socio económicas y el déficit de infraestructura sanitaria. El perfil de morbimortalidad es similar al encontrado en 1917 en el DIHSJD y en otros estudios de morbimortalidad infantil en la región y en España

OBJECTIVE: To analyze the morbidity and mortality in the Quito Children's Dispensary attached to the San Juan de Dios Hospital during the time of the Spanish flu epidemic, its correlation with the socioeconomic context, the city's health conditions and morbidity and mortality in other locations. METHODS: With the care records kept in the Eduardo Estrella National Museum of Medicine, a medical, descriptive and analytical historiographic study of morbidity and mortality between January 1918 and April 1919 was structured. Morbidity was analyzed by pathological entities, by age groups and by their social determinants. RESULTS: The Dispensary attended 8,882 infants, 4,370 girls (49.20%) and 4,460 boys (50.22%). Her age was between 1 day and 17 years. 4,598 (51.77%) children under 2 years of age. The majority, 8,735 (98.35%), came from Quito. The records with diagnosis were 8,738. In 144 cases there was no diagnosis. There were 9 deaths from diarrheal, respiratory and other infectious diseases, including one death from influenza. Pertussis, endemic in Quito, had a limited prevalence. Malaria, endemic in the valleys near Quito, presented 54 cases (0.61%) of the total. It was eradicated in the highlands in 1956. Chickenpox, other childhood eruptive diseases and intestinal parasites were less prevalent, as well as deficiency diseases. Children with the flu were primarily breastfed. Those with diarrheal illnesses more frequently received mixed feeding, which may reflect the limited sanitary conditions for food preparation. CONCLUSIONS: The morbidity and mortality profiles, with prevalence of influenza and digestive and respiratory diseases, are due not only to the Spanish flu pandemic, but also to the prevailing impoverishment, socio-economic conditions and the deficit of health infrastructure. The morbidity and mortality profiles are similar to that found in 1917 in the DIHSJD and in other studies of infant morbidity and mortality in the region and in Spain

Fatores associados a erros de dispensação de medicamentos: contribuição à melhoria de sistemas de medicação / Factors associated with medication dispensing errors: contributions to improve medication systems / Factores asociados a errores de dispensación de medicamentos: contribución para mejorar los sistemas de medicación

Objetivo: identificar tipos de erros na dispensação de medicamentos (ED), analisar fatores associados e propor medidaspara prevenção de acidentes. Método: estudo transversal realizado com 5.604 medicamentos dispensados em hospital universitário brasileiro, em 2016/2017. Após obtenção dos dados, pela aplicação de checklist e abertura dos kits de dispensação, utilizou-se regressão hierarquizada ajustada para identificação dos fatores associados ao ED. Resultados: os ED ocorreram em 236 medicamentos e os métodos de cálculo mostraram as taxas: 4,2%, 7,3% e 24,9%. Os principais erros foram de conteúdo por desvio de qualidade e de omissão. No modelo final da regressão, permaneceram associadas ao aumento da chance de ED as variáveis: turno da noite e presença de fonte de interrupção/distração. Conclusão: a frequência de ED foi mais baixa quando se utilizou o método de cálculo do Ministério da Saúde. Os fatores relacionados ao turno noturno e ao uso de fontes de interrupção/distração podem estar associados a ED, especialmente a omissão.

Objective: to identify types of medication dispensing (DE) errors, to analyze its associated factors and to propose action for preventing accidents. Method: a cross-sectional study was performed with 5,604 drugs dispensed in a Brazilian teaching hospital, in 2016/2017. After data collection, by applying a checklist and opening dispensing kits, adjusted hierarchical regression was applied to identify factors associated with DE. Results: DE occurred in 236 medications and calculation methods led to the rates: 4.2%, 7.3%. and 24.9%. The main dispensing errors were related to content, due to quality deviation, and omission. In the final regression model, the following variables remained associated with an increased chance of DE: overnight shift and the presence of interruption/distraction sources. Conclusion: the frequency of DE was low when using the calculation method of the Brazilian Ministry of Health. Factors related to the night shift and the use of interruption/distraction sources can be associated with DE, especially those related to omission.

Objetivo: identificar los tipos de errores en la dispensación de medicamentos (ED), analizar los factores asociados y proponer medidas de prevención de accidentes. Método: estudio transversal realizado con 5,604 medicamentos dispensados en un hospital universitario brasileño, en 2016/2017. Después de obtidos los datos, aplicando un checklist y abriendo los kits de dispensación, se utilizó la regresión jerárquica ajustada para identificar los factores asociados con la DE. Resultados: ocurrió ED en 236 medicamentos y los métodos de cálculo mostraron las tasas: 4.2%, 7.3% y 24.9%. Los principales errores fueron de contenido debido a la desviación de calidad y la omisión. En el modelo de regresión final, las variables: turno nocturno y presencia de fuentes de interrupción/distracción permanecieron asociadas con mayor probabilidad de ED. Conclusión: la frecuencia de DE fue menor cuando se utilizó el método de cálculo del Ministerio de Salud. Los factores relacionados con el turno nocturno y el uso de fuentes de interrupción/distracción pueden estar asociados con DE, especialmente la omisión.

Medication dispensing, additional therapeutic recommendations, and pricing practices for acute diarrhoea by community pharmacies in Germany: a simulated patient study

Background: In Germany over-the-counter medications (OTC) - which since 2004 are no longer subject to binding prices - can only be purchased in pharmacies. Pharmacy owners and their staff therefore have a special responsibility when dispensing, advising on and setting the prices of medications. Objective: The aim of this study was to assess medication dispensing, additional therapeutic recommendations and pricing practices for acute diarrhoea in adults and to evaluate the role of the patient's approach (symptom-based versus medication-based request) in determining the outcome of these aspects. Methods: A cross-sectional study was conducted from 1 May to 31 July 2017 in all 21 community pharmacies in a medium-sized German city. Symptom-based and medication-based scenarios related to self-medication of acute diarrhoea were developed and used by five simulated patients (SPs) in all of the pharmacies (a total of 84 visits). Differentiating between the different test scenarios in terms of the commercial and active ingredient names and also the prices of the medications dispensed, the SPs recorded on collection forms whether the scenario involved generic products or original preparations as well as whether recommendations were made during the test purchases regarding an additional intake of fluids. Results: In each of the 84 test purchases one preparation was dispensed. However, a preparation for oral rehydration was not sold in a single test purchase. On the other hand, in 74/84 (88%) of test purchases, medications with the active ingredient loperamide were dispensed. In only 35/84 (42%) of test purchases, the patient was also recommended to ensure an 'adequate intake of fluids' in addition to being dispensed a medication. In symptom-based scenarios significantly more expensive medications were dispensed compared to the medication-based scenarios (Wilcoxon signed rank test: z = -4.784, p < 0.001, r = 0.738). Also within the different scenarios there were enormous price differences identified - for example, in the medication-based scenarios, even for comparable loperamide generics the cheapest preparation cost EUR 1.99 and the most expensive preparation cost EUR 4.53. Conclusions: Oral rehydration was not dispensed and only occasionally was an adequate intake of fluids recommended. There were also enormous price differences both between and within the scenarios investigated

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Availability and rationality of fixed dose combinations available in Kaduna, Nigeria

Background: Fixed-dose drug combinations (FDCs), are combinations of two or more active drugs in a single dosage form. Despite the advantages obtained from the use of these agents, there is increasing evidence questioning the rationality of several FDCs found in pharmaceutical markets-especially those in developing countries like Nigeria. Objectives: To describe the availability of FDCs in drug retailing outlets located in Kaduna Nigeria, and to assess FDC registration status and inclusion on national and international essential medicines lists (EMLs). Rationality of selected FDCs was also assessed. Methods: A cross-sectional survey was carried out from June to September 2018 in 60 registered pharmacies and patent medicine shops selected through multi-stage sampling. A data collection form was used to obtain information on the generic names and strengths of the active ingredients of the FDCs, their country of manufacture and evidence of registration with the Nigerian drug regulatory agency. To assess rationality, a scoring rubric developed from earlier studies was used. Data collected was coded and entered into a Microsoft excel 2016 spreadsheet for analysis. Descriptive statistics (frequencies and percentages) were used to report the data collected. Results: FDCs encountered included 74 oral tablets/capsules, 52 oral liquids and 23 topical semi solids. Majority of the available FDCs were registered by Nigerian drug regulatory agency (91.5%), although only 8.5% and 6.5% in total were included on the Nigerian EML and the WHO model list respectively. Of the 99 FDCs assessed for rationality, 58 (58.6%) were found to be rational. Irrational FDCs included drugs acting on the respiratory tract (29.3%), analgesics (26.8%) and anti-infectives (22%). Conclusions: A wide variety of FDCs were available in the study area, even though not all of them were rational. There is an urgent need for policy makers within the country to develop better detailed guidelines for FDC registration

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Percepção da equipe de enfermagem sobre a utilização de dispensários eletrônicos / Perception of nursing staff on the use of automated dispensing cabinets

Introdução: O uso de dispensários eletrônicos em instituições de saúde tem sido associado à otimização do tempo da equipe de enfermagem e a redução de erros relacionados à medicamentos. Este estudo buscou avaliar a percepção da equipe de enfermagem sobre os dispensários eletrônicos. Métodos: Estudo exploratório utilizou a técnica de grupo focal e foi realizado com técnicos de enfermagem e enfermeiros de oito unidades de internação. Resultados: Para realização da técnica de grupo focal foi necessária a realização de nove encontros em 2015, com a participação de 27 profissionais de enfermagem. De forma geral, a equipe de enfermagem demonstrou estar satisfeita com o uso do equipamento, relatando a necessidade de adequações e melhorias no processo de trabalho associado ao dispensário. Os profissionais relataram que os sistemas de dispensários eletrônicos contribuem para a segurança do paciente. Conclusão: Os resultados possibilitam a elaboração de estratégias para melhorar o processo de trabalho que envolve o dispensário eletrônico, com foco contínuo na segurança do paciente. (AU)

Introduction: The use of automated dispensing cabinets in health care institutions has been associated with optimization of nursing staff's time and reduction in medication-related errors. This study aimed to evaluate the perception of a nursing team regarding automated dispensing cabinets. Methods: This exploratory study used a focal group technique and included nurses and practical nurses from eight admission units. Results: To conduct the focal group technique, nine meetings were held in 2015, with participation of 27 nursing professionals. In general, the nursing staff showed satisfaction with the use of the equipment, but reported a need for adjustments and improvements in the work process associated with the dispensing system. Professionals reported that automated dispensing systems contribute to patient safety. Conclusions: The results allow the formulation of strategies to improve the work process involving automated dispensing cabinets, with a continuous focus on patient safety. (AU)

Manual de buenas prácticas de dispensación / Dispensation good practice manual

La presente publicación describe un conjunto de normas, establecido con el objetivo de asegurar un uso adecuado de los medicamentos, estableciendo criterios, metodologías y requisitos para el cumplimiento de las buenas prácticas de dispensación de productos farmacéuticos establecidas en el Reglamento de Establecimientos Farmacéuticos aprobado por Decreto Supremo Nº 021-2001-SA