Diseño de un modelo de atención farmacéutica infantil para la validación de órdenes médicas en hospitales españoles / Development of a Paediatric Pharmaceutical Care Model for validating prescriptions orders in Spanish Hospitals

El presente proyecto desarrolla un modelo de Atención Farmacéutica Infantil para la validación de órdenes médicas de pacientes pediátricos. Para su desarrollo, se realizó un estudio del perfil de seguridad en la prescripción en 8 hospitales españoles pediátricos. Se registraron 667 intervenciones (49,3%-error dosis; 15,1%-forma farmacéutica errónea; 10,7%-medicamento incorrecto 9,3%-frecuencia errónea, entre otros). Posteriormente se desarrolló dicho modelo siguiendo la metodología Delphi con un panel de 50 expertos. Como resultado se obtiene un modelo con 39 cuestiones dividido en 3 niveles de complejidad: básico, intermedio y avanzado, con sus respectivas herramientas para el chequeo y perfectamente exportable a otros hospitales (AU)

This project develops a model for Pharmaceutical Care Child validation of pediatric medical orders. For its development, a study of the safety profile in prescribing Spanish in 8 pediatric hospitals. There were 667 interventions (49.3%-error dose, 15.1%, wrong dosage form, 10.7%, 9.3% wrong medicine-often erroneous, among others). Subsequently that model was developed by the Delphi methodology with a panel of 50 experts. The result is a model with 39 questions divided into three levels of complexity: basic, intermediate and advanced, with their respective tools for checking and perfectly exportable to other hospitals (AU)

Profile of prescribing errors detected by clinical pharmacists in paediatric hospitals in Spain.

BACKGROUND: Pharmaceutical care involves three essential functions: identifying potential and real medication-related problems, solving real medication-related problems and preventing potential medication related problems. OBJECTIVE: To describe the profile of prescribing errors detected and prevented by paediatric clinical pharmacists in medical orders for inpatients in Spain. SETTINGS AND METHODS: A prospective, descriptive, multicentre epidemiological study on medical orders for inpatients aged 1 day to 18 years, conducted between July and October 2011 at eight hospitals treating paediatric patients. MAIN OUTCOME MEASURE: primary variables were most common errors, including clinical severity (according to a previously validated instrument), pharmacotherapeutic groups and drugs most commonly involved, the impact of pharmaceutical interventions, as well as the population receiving most interventions, and type of prescription (manual of electronic) and dispensation system (ward stock, unit-dose or automated dispensing cabinets) that are most involved in Spain. RESULTS: A total of 667 interventions related to quality of the prescription were recorded at eight sites. 21 were excluded. 41.2 % concerned manual prescribing systems, and 58.8 % electronic prescribing systems. The interventions were performed on patients with a mean age of 5 years (standard deviation 5.43). In interventions concerning prescribing errors, 212 different drugs were involved, mainly belonging to the group of anti-infectives. The main factor triggering pharmacist's recommendations was dose errors of 1.5-10 times the recommended dose. Therefore, the main prescription errors are dosing errors (49.3 %). With regard to the clinical severity of these prescribing errors, 51.9 % (306 cases) were considered significant, 26.3 % (155 cases) of minor significance, 19.8 (117 cases) were clinically serious and 2.0 % (12 cases) were potentially fatal. There was a 95.4 % global acceptance rate for recommendations. The impact of accepted interventions showed that 64.7 % had a significant impact on patient health outcome, highlighting 1.1 % with a highly significant impact. The activity level of the paediatric clinical pharmacists was highly variable, with a median of 0.014 interventions/bed-day during the data collection period. CONCLUSION: In view of the importance of the dosing errors in the prescription phase, and the clinical relevance of the errors detected, it seems to be necessary to implement measures as the development of decision support systems for paediatric dosing and strengthen the presence of pharmacists as a key element in preventing prescribing errors from reaching patients, thus ensuring that children receive effective, safe and efficient drug therapy.

Two-round Delphi technique for the consensual design of a paediatric pharmaceutical care model.

The main goal of clinical pharmacists is to improve patient care quality by providing individualised care. This is achieved by validating prescriptions and performing pharmacotherapeutic follow-up, leading to effective, safe and efficient drug therapy. However, there is no specific model for medication order validation in paediatrics addressing the distinct issues of paediatric drug use or the greater susceptibility of medication errors occurring in this patient group. For this reason we intended to design and reach consensus on a paediatric pharmaceutical care model by applying a two-round Delphi technique. In order to define the levels of complexity in reaching consensus for the model, three variables were taken into account: level of access to patient medical and drug records (partial vs. total), access to medical and nursing staff attending the patient (on-site vs. off-site) and the pharmacist available time (limited vs. adequate). In order to describe the minimum items to be included in the validation process at each of the three levels of complexity, we analysed the safety profile in the medication order prescription previously defined in an epidemiological study in eight hospitals with a total capacity of 1565 paediatric beds. A panel of experts was recruited (50 experts from 20 different hospitals) and the questionnaire was completed. Consensus was established at 70% of agreement by experts for an item. Following debate on the items that did not obtain consensus, a second round was performed, after which the final consensus model was defined. After two rounds of consultation, consensus was obtained for 39 out of the 41 items that were surveyed. Of these, 17 were then used for the basic validation model (e.g. weight/age check, dose/weight check), 13 were implemented in the intermediate level (e.g. identification of adverse effects from excipients) and 9 were incorporated at advanced level (e.g. reconciliation at discharge for patients at risk). By applying the model, based on homogenous criteria for action, the clinical pharmacist's role will improve, and in turn, this will doubtlessly reduce drug errors through medication order validation.