Aflibercept in exudative age related macular degeneration refractory to ranibizumab.

PURPOSE: The aim of this study is to determine the effectiveness, safety and cost of aflibercept in the treatment of wet age-related macular degeneration (ARMD) refractory to ranibizumab. METHODS: Retrospective observational study was conducted on patients diagnosed with wet ARMD, and previously treated with ranibizumab. Efficacy variables assessed were changes in visual acuity (BCVA) and anatomical improvements in the most affected eye. Factors associated with improvement of BCVA with aflibercept were also studied. Adverse events related to the aflibercept administration were recorded. Cost analysis data were collected from the hospital perspective, and only taking the direct medical costs into account. Cost-effectiveness analysis was calculated using the aflibercept treatment cost, and effectiveness calculated as BCVA gained. RESULTS: A total of 50 eyes corresponding to 46 patients were included. The median follow-up period was 4.6 months (range: 1.0-6.0). Improvement in visual acuity after the first 2 doses and at the end of the follow-up period was observed in 32.0 and 28.0% of treated eyes, respectively. None of the variables studied was associated with an improvement in the BCVA after treatment. No significant differences were found in the average monthly cost between treatments. CONCLUSIONS: Aflibercept is shown to be an effective treatment in a significant number of patients resistant to treatment with ranibizumab, presenting a cost similar to that generated during the final stages of treatment with ranibizumab.

Mejora del proceso farmacoterapéutico del paciente hospitalizado mediante la metodología Lean Seis Sigma / Improving inpatient pharmacoterapeutic process by Lean Six Sigma methodology

Introducción. La metodología Lean Seis Sigma se utilizó para mejorar procesos, eliminar desperdicios, reducir costes y aumentar la satisfacción de clientes. Objetivo. Analizar los resultados obtenidos con la metodología Lean Seis Sigma en el diagnóstico y la mejora del proceso farmacoterapéutico del paciente hospitalizado durante el cambio estructural y organizativo de un hospital terciario. Material y métodos. Ámbito: hospital general terciario con 1.000 camas. Diseño del estudio: observacional y prospectivo. Se desplegaron las etapas definir, medir, analizar, mejorar y controlar (DMAIC) entre marzo y septiembre de 2011, actualizando el Project Charter inicial según resultados. Población y muestra: 131 pacientes hospitalizados con tratamientos prescritos en las 24 h siguientes al ingreso y con 4 medicamentos. Variables: indicadores de seguridad (errores de medicación) y de eficiencia (tiempos de demora y reclamaciones). Resultados. La proporción de pacientes con algún error de medicación se redujo del 61,0 (25/41 pacientes) al 55,7% (39/70 pacientes) en 4 meses. Los porcentajes de errores, con respecto a las oportunidades de error, en distintas fases del proceso disminuyeron: prescripción 5,1 (19/372) a 3,3% (19/572); preparación 2,7 (14/525) a 1,3% (11/847 oportunidades); y administración: 4,9 (16/329) a 3,0% (13/433). Las reclamaciones se redujeron del 10,0 (2.119/21.038 pacientes) a 5,7% (1.779/31.097 pacientes). El impacto económico se estimó en 76.800 euros evitados. Conclusiones. Se observó una mejora del proceso farmacoterapéutico y un impacto financiero positivo que ha repercutido en la seguridad del paciente y la eficiencia de la organización. La normalización y la formación de profesionales podrían ser proyectos futuros de Lean Seis Sigma (AU)

Background: Lean Six Sigma methodology has been used to improve care processes, eliminate waste, reduce costs, and increase patient satisfaction. Objective: To analyse the results obtained with Lean Six Sigma methodology in the diagnosis and improvement of the inpatient pharmacotherapy process during structural and organisational changes in a tertiary hospital. Material and methods: Scope: 1.000 beds tertiary hospital. Design: prospective observational study. The define, measure, analyse, improve and control (DMAIC), were deployed from March to September 2011. An Initial Project Charter was updated as results were obtained. Population and sample: 131 patients with treatments prescribed within 24 h after admission and with 4 drugs. Variables: safety indicators (medication errors), and efficiency indicators (complaints and time delays). Results: Proportion of patients with a medication error was reduced from 61.0% (25/41 patients) to 55.7% (39/70 patients) in four months. Percentage of errors (regarding the opportunities for error) decreased in the different phases of the process: Prescription: from 5.1% (19/ 372 opportunities) to 3.3% (19/572 opportunities); Preparation: from 2.7% (14/525 opportunities) to 1.3% (11/847 opportunities); and administration: from 4.9% (16/329 opportunities) to 3.0% (13/433 opportunities). Nursing complaints decreased from 10.0% (2119/21038 patients) to 5.7% (1779/31097 patients). The estimated economic impact was 76,800 euros saved. Conclusions: An improvement in the pharmacotherapeutic process and a positive economic impact was observed, as well as enhancing patient safety and efficiency of the organization. Standardisation and professional training are future Lean Six Sigma candidate projects (AU)

[Improving inpatient pharmacoterapeutic process by Lean Six Sigma methodology]. / Mejora del proceso farmacoterapéutico del paciente hospitalizado mediante la metodología Lean Seis Sigma.

BACKGROUND: Lean Six Sigma methodology has been used to improve care processes, eliminate waste, reduce costs, and increase patient satisfaction. OBJECTIVE: To analyse the results obtained with Lean Six Sigma methodology in the diagnosis and improvement of the inpatient pharmacotherapy process during structural and organisational changes in a tertiary hospital. SCOPE: 1.000 beds tertiary hospital. DESIGN: prospective observational study. The define, measure, analyse, improve and control (DMAIC), were deployed from March to September 2011. An Initial Project Charter was updated as results were obtained. POPULATION AND SAMPLE: 131 patients with treatments prescribed within 24h after admission and with 4 drugs. VARIABLES: safety indicators (medication errors), and efficiency indicators (complaints and time delays). RESULTS: Proportion of patients with a medication error was reduced from 61.0% (25/41 patients) to 55.7% (39/70 patients) in four months. Percentage of errors (regarding the opportunities for error) decreased in the different phases of the process: Prescription: from 5.1% (19/372 opportunities) to 3.3% (19/572 opportunities); Preparation: from 2.7% (14/525 opportunities) to 1.3% (11/847 opportunities); and administration: from 4.9% (16/329 opportunities) to 3.0% (13/433 opportunities). Nursing complaints decreased from 10.0% (2119/21038 patients) to 5.7% (1779/31097 patients). The estimated economic impact was 76,800 euros saved. CONCLUSIONS: An improvement in the pharmacotherapeutic process and a positive economic impact was observed, as well as enhancing patient safety and efficiency of the organization. Standardisation and professional training are future Lean Six Sigma candidate projects.

[Effectiveness and adequacy of tolvaptan prescription in hospitalized patients]. / Efectividad y adecuación de la prescripción de tolvaptán en pacientes hospitalizados.

PURPOSE: To analyse the effectiveness of the use of Tolvaptan and the adequacy of Tolvaptan prescription at a tertiary level hospital. METHODS: Prospective observational study of Tolvaptan prescrip - tion from October of 2010 to December of 2011. RESULTS: 30 patients (60.0% males) were included, 50.0% of which were diagnosed with heart failure and 30.0% with SIADH. Tolvaptan allowed achieving sodium levels higher than 135 mEq/L in 53.3% of the patients with a mean baseline value of 125.3±7.3 mEq/L. The median treatment duration was 5.0 days (interquartile range=3-45). A significant increase of uric acid associated to Tolvaptan treatment was observed. The prescription was in agreement to what has been established in GFT in 63.3% of the cases. CONCLUSIONS: Tolvaptan increases sodium levels by 7.5 mEq/L, both in SIADH-associated hyponatremia and in heart failure, with an appropriate safety profile.

Objetivo: Analizar la efectividad del uso de tolvaptán y la adecuación de su prescripción en un hospital de tercer nivel. Método: Estudio observacional prospectivo de las prescripciones de tolvaptán desde octubre de 2010 hasta diciembre de 2011. Resultados: Se incluyeron 30 pacientes (60,0% varones), 50,0% diagnosticados de insuficiencia cardíaca y 30,0% de SIADH. Tolvaptán permitió alcanzar niveles de sodio superiores a 135 mEq/L en el 53,3% de los pacientes que partían con una media de 125,3±7,3 mEq/L. La mediana de días de tratamiento fue de 5,0 (rango intercuartílico = 3-45). Se observó un incremento significativo de los niveles de ácido úrico asociado al tratamiento con tolvaptán. La prescripción se adecuó a lo establecido en la GFT en el 63,3% de los casos. Conclusiones: Tolvaptán incrementa un 7,5 mEq/L los niveles de sodio tanto en hiponatremia secundaria al SIADH como en insuficiencia cardiaca.

Efectividad y adecuación de la prescripción de tolvaptán en pacientes hospitalizados / Effectiveness and adequacy of tolvaptan prescription in hospitalized patients

Objetivo: Analizar la efectividad del uso de tolvaptán y la adecuación de su prescripción en un hospital de tercer nivel. Método: Estudio observacional prospectivo de las prescripciones de tolvaptán desde octubre de 2010 hasta diciembre de 2011. Resultados: Se incluyeron 30 pacientes (60,0% varones), 50,0% diagnosticados de insuficiencia cardíaca y 30,0% de SIADH. Tolvaptán permitió alcanzar niveles de sodio superiores a 135 mEq/L en el 53,3% de los pacientes que partían con una media de 125,3±7,3 mEq/L. La mediana de días de tratamiento fue de 5,0 (rango intercuartílico = 3-45). Se observó un incremento significativo de los niveles de ácido úrico asociado al tratamiento con tolvaptán. La prescripción se adecuó a lo establecido en la GFT en el 63,3% de los casos. Conclusiones: Tolvaptán incrementa un 7,5 mEq/L los niveles de sodio tanto en hiponatremia secundaria al SIADH como en insuficiencia cardiaca (AU)

Purpose: To analyse the effectiveness of the use of Tolvaptan and the adequacy of Tolvaptan prescription at a tertiary level hospital. Methods: Prospective observational study of Tolvaptan prescription from October of 2010 to December of 2011. Results: 30 patients (60.0% males) were included, 50.0% of which were diagnosed with heart failure and 30.0% with SIADH. Tolvaptan allowed achieving sodium levels higher than 135 mEq/L in 53.3% of the patients with a mean baseline value of 125.3±7.3 mEq/L. The median treatment duration was 5.0 days (interquartile range = 3-45). A significant increase of uric acid associated to Tolvaptan treatment was observed. The prescription was in agreement to what has been established in GFT in 63.3% of the cases. Conclusions: Tolvaptan increases sodium levels by 7.5 mEq/L, both in SIADH-associated hyponatremia and in heart failure, with an appropriate safety profile (AU)

Monitorización de errores de medicación en dispensación individualizada mediante el método del carro centinela / No disponible

Objetivo Analizar la eficacia de una nueva estrategia de control de calidad basada en el muestreo aleatorio y seguimiento de carros de dispensación de dosis unitaria (carro centinela) para identificar los errores en las distintas fases del proceso de dispensación y sus causas. Método Estudio prospectivo para valoración de eficacia de un control de calidad en la identificación de errores de dispensación durante un periodo de 12 meses. Una vez por semana fue aleatoriamente seleccionado un carro de medicación denominado «carro centinela» y doblemente revisado antes de la dispensación. Se registraron los errores de medicación en la revisión, antes de ser conducido a la unidad de hospitalización así como las reclamaciones tras su recepción y monitorización durante las 24h siguientes. Un grupo de calidad de dosis unitarias instaurado al efecto analizó el tipo y origen de los errores y propuso las correspondientes acciones de mejora. Resultados Se analizaron 34 carros centinela que incluyeron 5.130 líneas de medicación, y 9.952 dosis dispensadas correspondientes a 753 pacientes. Se identificaron 90 (1,8%) líneas con error de tratamiento y 142 (1,4%) dosis erróneas en la preparación en el servicio de farmacia. El error más frecuente fue la duplicidad de dosis (38%) y el fallo de memoria o atención la causa que más lo generó (69%). Cincuenta medicaciones (6,6% de pacientes) reclamadas debido principalmente al inicio de nuevos tratamientos por ingreso (52%) y 41 (0,8% del total de líneas) discrepancias respecto a la prescripción fueron registradas en el Servicio de Farmacia. En la unidad de hospitalización se registraron 37 (4,9% de pacientes) medicaciones reclamadas en su mayoría por nuevo ingreso (43,2%) y 32 (0,6% de líneas) por discrepancias con la prescripción original, cuya causa más frecuente fue fallo de memoria o falta de atención (24%). El grado de coincidencia en el registro simultáneo de incidencias por reclamaciones y demanda de nueva medicación fue del 33,3%. Además se devolvieron 433 (4,3%) dosis no administradas. Tras el análisis de calidad se generaron 64, 37 y 24 acciones de mejora dirigidas al equipo de enfermería de farmacia, farmacéuticos y Unidad de Hospitalización, respectivamente. Conclusiones: El programa del carro centinela ha demostrado su eficacia en la identificación de errores de dispensación de dosis unitarias mediante un control de calidad instaurado al principio, durante y al final del proceso, facilitando una mayor implicación de los profesionales relacionados con el mismo (AU)

Objective To assess the efficacy of a new quality control strategy based on daily randomised sampling and monitoring of a sentinel surveillance system (SSS) medication cart, in order to identify medication errors and their origin at different levels of the process. Method Prospective quality control study with one-year follow-up. An SSS medication cart was randomly selected once a week and double-checked before dispensing medication. Medication errors were recorded before the cart was taken to the relevant hospital ward. Information concerning complaints after receiving medication and 24-h monitoring was also noted. Type and origin of error data were assessed by a unit dose quality control group, which proposed relevant improvement measures. Results Thirty-four SSS carts were assessed, including 5130 medication lines and 9952 dispensed doses, corresponding to 753 patients. Ninety erroneous lines (1.8%) and 142 mistaken doses (1.4%) were identified at the pharmacy department. The most frequent error was dose duplication (38%) and its main cause was inappropriate management and forgetfulness (69%). Fifty medication complaints (6.6% of patients) were mainly due to new treatment at admission (52%), and 41 (0.8% of all medication lines), did not completely match the prescription (0.6% lines) as recorded by the pharmacy department. Thirty-seven (4.9% of patients) medication complaints due to changes at admission and 32 matching errors (0.6% medication lines) were recorded. The main cause also was inappropriate management and forgetfulness (24%). The simultaneous recording of incidences due to complaints and new medication coincided in 33.3%. In addition, 433 (4.3%) of dispensed doses were returned to the Pharmacy Department. After the Unit Dose Quality Control Group conducted their feedback analysis, 64 improvement measures for Pharmacy Department nurses, 37 for pharmacists, and 24 for the hospital ward were introduced. Conclusions: The SSS programme has proven to be useful as a quality control strategy to identify Unit Dose Distribution System errors at initial, intermediate and final stages of the process, improving the involvement of the Pharmacy Department and ward nurses (AU)

[Monitoring medication errors in personalised dispensing using the Sentinel Surveillance System method]. / Monitorización de errores de medicación en dispensación individualizada mediante el método del carro centinela.

OBJECTIVE: To assess the efficacy of a new quality control strategy based on daily randomised sampling and monitoring a Sentinel Surveillance System (SSS) medication cart, in order to identify medication errors and their origin at different levels of the process. METHOD: Prospective quality control study with one year follow-up. A SSS medication cart was randomly selected once a week and double-checked before dispensing medication. Medication errors were recorded before it was taken to the relevant hospital ward. Information concerning complaints after receiving medication and 24-hour monitoring were also noted. Type and origin error data were assessed by a Unit Dose Quality Control Group, which proposed relevant improvement measures. RESULTS: Thirty-four SSS carts were assessed, including 5130 medication lines and 9952 dispensed doses, corresponding to 753 patients. Ninety erroneous lines (1.8%) and 142 mistaken doses (1.4%) were identified at the Pharmacy Department. The most frequent error was dose duplication (38%) and its main cause inappropriate management and forgetfulness (69%). Fifty medication complaints (6.6% of patients) were mainly due to new treatment at admission (52%), and 41 (0.8% of all medication lines), did not completely match the prescription (0.6% lines) as recorded by the Pharmacy Department. Thirty-seven (4.9% of patients) medication complaints due to changes at admission and 32 matching errors (0.6% medication lines) were recorded. The main cause also was inappropriate management and forgetfulness (24%). The simultaneous recording of incidences due to complaints and new medication coincided in 33.3%. In addition, 433 (4.3%) of dispensed doses were returned to the Pharmacy Department. After the Unit Dose Quality Control Group conducted their feedback analysis, 64 improvement measures for Pharmacy Department nurses, 37 for pharmacists, and 24 for the hospital ward were introduced. CONCLUSIONS: The SSS programme has proven to be useful as a quality control strategy to identify Unit Dose Distribution System errors at initial, intermediate and final stages of the process, improving the involvement of the Pharmacy Department and ward nurses.

Evaluación de la efectividad y la seguridad del natalizumab en el tratamiento de la esclerosis múltiple remitente recidivante / Assessment of the effectiveness and safety of natalizumab for treating relapsing-remitting multiple sclerosis

Objetivo Evaluar la efectividad y la seguridad del natalizumab en el tratamiento de la esclerosis múltiple remitente recidivante en un hospital de tercer nivel. Método Estudio observacional, prospectivo, de los pacientes adultos tratados con natalizumab desde mayo de 2007 hasta febrero de 2009. Tratamiento: natalizumab 300mg cada cuatro semanas. Criterio de respuesta: valoración de la progresión de la enfermedad, aparición de brotes y evaluación de imágenes mediante resonancia magnética. Se han recogido las reacciones adversas durante el tratamiento con natalizumab. Resultados Treinta pacientes (el 73% eran mujeres); promedio de edad: 34±8,4 años; escala expandida del estado de discapacidad medio basal: 3,4±1,3, y número de brotes en el último año: 2,1±1,2. Cinco pacientes suspendieron el tratamiento, uno por abandono del tratamiento, dos por ineficacia y dos por reacciones anafilácticas. Catorce pacientes completaron un año de tratamiento con resultados satisfactorios. Se obtuvieron reducciones de la escala expandida del estado de discapacidad del 36, el 47, el 31, el 54 y el 28% a los 3, los 6, los 9, los 12 y los 15 meses de tratamiento, respectivamente. La prevalencia de pacientes libres de recidiva fue del 94, el 76 y el 54% a los 3, los 6 y los 12 meses, respectivamente. Las imágenes de resonancia magnética al año de tratamiento correspondientes a 11 pacientes no mostraron nuevas lesiones. Dos pacientes sufrieron reacciones anafilácticas graves y otro sufrió una reacción urticarial. Un 6,6% de los pacientes presentó anticuerpos neutralizantes que motivaron la suspensión del tratamiento. Conclusiones La efectividad y la seguridad obtenidas en nuestros pacientes sugieren que el natalizumab constituye una alternativa para los pacientes refractarios o con formas agresivas de esclerosis múltiple, aunque falta conocer los efectos a largo plazo y la evolución de la aparición de anticuerpos neutralizantes (AU)

Objective Assessing the effectiveness and safety of natalizumab for treating relapsing-remitting multiple sclerosis in a tertiary hospital. Method Observational, prospective study of adult patients treated with natalizumab from May 2007 until February 2009. Treatment: 300mg natalizumab every four weeks. Response criteria: assessment of disease progression, appearance of flare-ups and assessment of magnetic resonance images. Adverse reactions during treatment with natalizumab were recorded. Results Thirty patients (73% female); average age 34±8.4 years; mean baseline EDSS 3.4±1.3; number of flare-ups in the past year 2.1±1.2. Treatment was discontinued in five patients, due to refusal in one case, ineffectiveness in two cases and anaphylaxis in the other two cases. Fourteen patients completed one year of treatment with satisfactory results. A lower EDSS score by 36%, 47%, 31%, 54% and 28% was obtained at 3, 6, 9, 12 and 15 months of treatment respectively. The prevalence of relapse-free patients was 94%, 76% and 54% at 3, 6 and 12 months. MRI imaging studies in 11 patients one year after they began treatment showed no new lesions. Two patients suffered severe anaphylactic shock and another one had an outbreak of urticaria. The presence of neutralising antibodies was the reason for suspending treatment in 6.6% of the patients. Conclusions The treatment's effectiveness and safety in our patient group suggest that natalizumab is a treatment for refractory patients or those with aggressive types of multiple sclerosis, although we do not yet know about its long-term effects and the evolution of the appearance of neutralising antibodies (AU)

Assessment of the effectiveness and safety of natalizumab for treating relapsing-remitting multiple sclerosis.

OBJECTIVE: Assessing the effectiveness and safety of natalizumab for treating relapsing-remitting multiple sclerosis in a tertiary hospital. METHOD: Observational, prospective study of adult patients treated with natalizumab from May 2007 until February 2009. TREATMENT: 300 mg natalizumab every four weeks. Response criteria: assessment of disease progression, appearance of flare-ups and assessment of magnetic resonance images. Adverse reactions during treatment with natalizumab were recorded. RESULTS: Thirty patients (73% female); average age 34 ± 8.4 years; mean baseline EDSS 3.4 ± 1.3; number of flare-ups in the past year 2.1 ± 1.2. TREATMENT was discontinued in five patients, due to refusal in one case, ineffectiveness in two cases and anaphylaxis in the other two cases. Fourteen patients completed one year of treatment with satisfactory results. A lower EDSS score by 36%, 47%, 31%, 54% and 28% was obtained at 3, 6, 9, 12 and 15 months of treatment respectively. The prevalence of relapse-free patients was 94%, 76% and 54% at 3, 6 and 12 months. MRI imaging studies in 11 patients one year after they began treatment showed no new lesions. Two patients suffered severe anaphylactic shock and another one had an outbreak of urticaria. The presence of neutralising antibodies was the reason for suspending treatment in 6.6% of the patients. CONCLUSIONS: The treatment's effectiveness and safety in our patient group suggest that natalizumab is a treatment for refractory patients or those with aggressive types of multiple sclerosis, although we do not yet know about its long-term effects and the evolution of the appearance of neutralising antibodies.

[Assessment of a reconciliation and information programme for heart transplant patients]. / Evaluación de un programa de conciliación e información al paciente trasplantado cardíaco.

INTRODUCTION: The objective is to assess a pharmaceutical care programme for heart transplant patients upon patient admission and discharge. MATERIAL AND METHODS: Observational study of heart transplant patients, performed during the first quarter of 2007. Upon admission, the patient was interviewed regarding home treatments, adherence, allergies and adverse effects, and his/her prescriptions were compared with the last discharge report (drug reconciliation). At time of discharge, treatment was checked against the last hospital prescription (reconciliation) and an informative report was drawn up and personally delivered to the patient. Subsequently, a satisfaction questionnaire was carried out by telephone. Drug-related problems were recorded using Atefarm software. RESULTS: The programme was applied to 24 patients upon admission and 23 upon discharge. No drug interactions were detected. Treatment adherence was higher than 90%. 37.5% of patients informed of an adverse reaction. Medication-related problems were identified in 16 patients (45.7%) for 6.6% of medications, most of which (38%) were for infection prophylaxis; medication omission was the most frequently-detected error. Positive evaluation of the information that was received was higher than 90%. CONCLUSIONS: Pharmacotherapeutic follow-up upon admission and discharge resolves and prevents problems while improving patient information and satisfaction. Limitations on personnel prevent the population's requests from being met.

Evaluación de un programa de conciliación e información al paciente trasplantado cardíaco / Assessment of a reconciliation and information programme for heart transplant patients

Introducción El objetivo es evaluar un programa de atención farmacéutica al ingreso y al alta hospitalaria del paciente trasplantado cardíaco. Material y métodos Estudio observacional realizado el primer trimestre de 2007 en pacientes trasplantados cardíacos. Al ingreso, se entrevistó al paciente sobre tratamientos domiciliarios, adherencia, alergias, efectos adversos y se comparó la prescripción con el último informe de alta (conciliación). Al alta, se comparó el tratamiento con la última prescripción hospitalaria (conciliación) y se elaboró un boletín informativo, entregándolo personalmente al paciente. Posteriormente, se realizó un cuestionario telefónico sobre satisfacción. Los problemas relacionados con los medicamentos (PRM) fueron registrados en la aplicación Atefarm®. Resultados El programa al ingreso se aplicó a 24 pacientes y al alta a 23. No se detectaron interacciones. La adherencia al tratamiento fue superior al 90%. El 37,5% de los pacientes comunicó alguna reacción adversa. Se identificaron PRM en 16 pacientes (45,7%), en un 6,6% de los medicamentos, la mayoría (38%) pertenecientes a profilaxis infecciosa, siendo la omisión del medicamento el error principalmente detectado. La valoración positiva de la información recibida superó el 90%.ConclusionesEl seguimiento farmacoterapéutico al ingreso y al alta resuelve y previene problemas y favorece la información y satisfacción del paciente. Las limitaciones de personal impiden cumplir las demandas de la población (AU)

Introduction The objective is to assess a pharmaceutical care programme for heart transplant patients upon patient admission and discharge. Material y methods Observational study of heart transplant patients, performed during the first quarter of 2007. Upon admission, the patient was interviewed regarding home treatments, adherence, allergies and adverse effects, and his/her prescriptions were compared with the last discharge report (drug reconciliation). At time of discharge, treatment was checked against the last hospital prescription (reconciliation) and an informative report was drawn up and personally delivered to the patient. Subsequently, a satisfaction questionnaire was carried out by telephone. Drug-related problems were recorded using Atefarm® software. Results The programme was applied to 24 patients upon admission and 23 upon discharge. No drug interactions were detected. Treatment adherence was higher than 90%. 37.5% of patients informed of an adverse reaction. Medication-related problems were identified in 16 patients (45.7%) for 6.6% of medications, most of which (38%) were for infection prophylaxis; medication omission was the most frequently-detected error. Positive evaluation of the information that was received was higher than 90% (AU)

Calidad del proceso farmacoterapéutico a través de errores de medicación en un hospital terciario / Quality of drug treatment process through medication errors in a tertiary hospital

Objetivo: Evaluar la calidad del proceso farmacoterapéutico en un sistema de dosis unitaria y prescripción electrónica asistida en un hospital terciario, a través de errores de medicación. Métodos: Se realizó un estudio observacional prospectivo de errores de medicación en 308 pacientes hospitalizados, por revisión de la prescripción médica, la validación farmacéutica y la medicación preparada y dispensada, y por observación directa de la administración de medicamentos. La variable, el error de medicación, se analizó en la fase del proceso farmacoterapéutico, el tipo y la causa de error. Se definieron indicadores de calidad (relación porcentual de errores respecto a oportunidades de error) en cada fase. Resultados: De los 308 pacientes estudiados, en 107 se detectó al menos 1 error de medicación (34,7%); hubo un total de 137 errores distribuidos en: omisión de alergia y descripción de la prescripción (20,4%), prescripción/validación (28,5%), dispensación (23,4%) y administración de medicamentos (27,7%). El error más frecuente fue la omisión de dosis (19,7%) y la selección de especialidad farmacéutica (16,1%). La causa más común fue fallos de memoria y descuidos con el 53,3%. Los indicadores de calidad por fases fueron: 2,3% para la omisión de alergia del paciente; 0,9% para la prescripción; 1,6% para la prescripción/validación; 8,2% para la dispensación, y 2,1% para la administración de medicamentos. Conclusiones: Se estima que en 35 de 100 pacientes ocurre un error en su proceso farmacoterapéutico. Se identifican oportunidades de mejora basadas en la normalización y la formación de profesionales para realizar tareas técnicas y manejar la tecnología (AU)

Objective: To assess the quality of drug treatment process in a unit dose and assisted electronic prescription system in a tertiary hospital, by looking at medication errors. Methods: A prospective, observational study into medication errors was carried out on 308 hospitalised patients. This was done by assessing medical prescriptions, pharmaceutical validation, prepared and dispensed medication and by directly observing drug administration. The variable, i.e. the medication error, was analysed in the drug treatment process so as to decipher the type and cause of the error. Quality indicators were defined at each stage (percentage relationship between errors and opportunities for error).Results: Of the 308 patients studied, 107 had at least 1 medication error (34.7%). There were a total of 137 errors: omission of allergy and prescription description (20.4%), prescription/validation(28.5%), dispensing (23.4%) and drug administration (27.7%). The most frequent error was dose omission (19.7%) and choice of pharmaceutical product (16.1%). The most common cause of error was forgetfulness or a lack of attention to detail (53.3%). The quality indicators by stage were: 2.3% for omission of the patient’s allergies;0.9% for prescription; 1.6% for prescription/validation; 8.2% for dispensing, and 2.1% for drug administration. Conclusions: It is estimated that 35 patients in every 100 experience errors in their drug treatment process. Opportunities for improvement are identified based on standardisation and training for professionals in carrying out technical tasks and using technology (AU)

[Medication errors in a tertiary hospital with three different drug delivery systems]. / Errores de medicación en un hospital terciario con tres sistemas de distribución de medicamentos diferentes.

OBJECTIVE: To estimate the proportion of medication errors in a tertiary hospital, global and for each delivery medication system, to describe the error types and the implied medications, and to analyze the factors associated to the same ones. METHODS: Errors were identified from direct observation of 2,242 opportunities for error (administered doses or prescribed doses not given) by 6 couples of observers. Delivery medication systems were stock in ward, unit dose with electronic prescription and unit dose with computerized transcription. Logistic regression was used to evaluate the association between errors and certain factors. RESULTS: The medication error rate was of 7.2% (CI 95%: 6.1-8.3), and 4.4% (CI 95%: 3.6-5.3) of them reached the patient. For delivery systems, the error rate was of 9.5% (CI 95%: 7.4-11.9) for stock in ward, 7.8% (CI 95%: 5.9-10.0) for electronic prescription and 4.7% (CI 95%: 3.4-6.4) for computerized transcription. The highest error frequency was observed in the administration phase (58.4%) and the omitted dose was the most prevalent error (31.7%). The error rate was associated to the pharmacotherapeutic process, the schedule of administration and the unit of hospitalization. CONCLUSIONS: In one of each 14 opportunities for error a medication error takes place. The different delivery medication systems have different error rates.

Errores de medicación en un hospital terciario con tres sistemas de distribución de medicamentos diferentes / Medication errors in a tertiary hospital with three different drug delivery systems

Objetivo: Estimar la proporción de errores de medicación en un hospitalterciario, tanto de manera global como por sistemas de distribuciónde medicamentos, describir los tipos de error y los medicamentosimplicados y analizar los factores asociados a los mismos.Método: Los errores se identificaron mediante la observación directade 2.242 oportunidades de error (dosis administradas o lasprescritas y no administradas de medicamentos) por 6 pares deobservadores. Los sistemas de distribución fueron stock en planta,dosis unitarias con prescripción electrónica asistida y dosis unitariascon transcripción informatizada. Se utilizó la regresión logísticamúltiple para valorar la asociación entre errores y determinados factores.Resultados: El porcentaje global de error de medicación fue del7,2% (IC del 95%, 6,1-8,3), y un 4,4% (IC del 95%, 3,6-5,3) alcanzaronal paciente. Por sistemas de distribución, el porcentaje de error demedicación fue de 9,5% (IC del 95%, 7,4-11,9) para el stock en planta,7,8% (IC del 95%, 5,9-10,0) para la prescripción electrónica asistiday 4,7% (IC del 95%, 3,4-6,4) para la transcripción informatizada.La mayor frecuencia de errores se observó en la fase de administración(58,4%) y la dosis omitida fue el tipo de error más prevalente(31,7%). El riesgo de error se asoció al proceso farmacoterapéutico,al horario de administración y al tipo de unidad de hospitalización. Conclusiones: En una de cada 14 oportunidades de error se produceun error de medicación. Los distintos sistemas de administraciónde medicamentos tienen tasas de error diferentes

Objective: To estimate the proportion of medication errors in a tertiaryhospital, global and for each delivery medication system, to describethe error types and the implied medications, and to analyze thefactors associated to the same ones.Methods: Errors were identified from direct observation of 2,242 opportunitiesfor error (administered doses or prescribed doses not given)by 6 couples of observers. Delivery medication systems werestock in ward, unit dose with electronic prescription and unit dosewith computerized transcription. Logistic regression was used to evaluatethe association between errors and certain factors.Results: The medication error rate was of 7.2% (CI 95%: 6.1-8.3),and 4.4% (CI 95%: 3.6-5.3) of them reached the patient. For deliverysystems, the error rate was of 9.5% (CI 95%: 7.4-11.9) for stock inward, 7.8% (CI 95%: 5.9-10.0) for electronic prescription and 4.7%(CI 95%: 3.4-6.4) for computerized transcription. The highest errorfrequency was observed in the administration phase (58.4%) andthe omitted dose was the most prevalent error (31.7%). The errorrate was associated to the pharmacotherapeutic process, the scheduleof administration and the unit of hospitalization.Conclusions: In one of each 14 opportunities for error a medicationerror takes place. The different delivery medication systems have different error rates

[Quality of drug treatment process through medication errors in a tertiary hospital]. / Calidad del proceso farmacoterapéutico a través de errores de medicación en un hospital terciario.

OBJECTIVE: To assess the quality of drug treatment process in a unit-dose and assisted electronic prescription system in a tertiary hospital, by looking at medication errors. METHODS: A prospective, observational study into medication errors was carried out on 308 hospitalised patients. This was done by assessing medical prescriptions, pharmaceutical validation, prepared and dispensed medication and by directly observing drug administration. The variable, i.e. the medication error, was analysed in the drug treatment process so as to decipher the type and cause of the error. Quality indicators were defined at each stage (percentage relationship between errors and opportunities for error). RESULTS: Of the 308 patients studied, 107 had at least 1 medication error (34.7%). There were a total of 137 errors: omission of allergy and prescription description (20.4%), prescription/validation (28.5%), dispensing (23.4%) and drug administration (27.7%). The most frequent error was dose omission (19.7%) and choice of pharmaceutical product (16.1%). The most common cause of error was forgetfulness or a lack of attention to detail (53.3%). The quality indicators by stage were: 2.3% for omission of the patient's allergies; 0.9% for prescription; 1.6% for prescription/validation; 8.2% for dispensing, and 2.1% for drug administration. CONCLUSIONS: It is estimated that 35 patients in every 100 experience errors in their drug treatment process. Opportunities for improvement are identified based on standardisation and training for professionals in carrying out technical tasks and using technology.

[Alerts system associated with computerized physician order entry: analysis and identification of improvement points]. / Sistema de alertas asociado a prescripción electrónica asistida: análisis e identificación de puntos de mejora.

OBJECTIVE: To make a quantitative analysis of the alerts associated with a computerized physician order entry system and identify opportunities to improve the system. METHOD: A retrospective observational study in a general hospital with 750 beds, 500 of which have a computerized physician order entry system installed. The frequency per type and medication of 525,691 alerts produced for a year in the prescription of drug treatments to 15,466 patients was analysed, entering these on a database. The system includes three categories of alert relating to the drug, the characteristics of the patient and the hospital medicine policy. By means of a failure mode and effects analysis, opportunities for improving the system were identified and corrective measures were suggested. RESULTS: It has been observed that from the total of 1,084 drugs, 20 of them produce 34% of alerts. The ten most frequently active ingredients involved are: potassium chloride, acenocumarol, imipenem, lorazepam, diazepam, mycophenolate, enoxaparin, tacrolimus, calcium carbonate and cyclosporine. The most frequent alerts generated during electronic prescription are associated with duplicated therapy (35.4%), renal failure (27.6%) and risk due to advanced age (17.2%), with these groups accounting for 80.2% of the total. The excess of alerts and information provided by the alerts were identified as priority improvement points. CONCLUSIONS: The system produced excessive alerts which led to the risk of them being ignored and reducing the capacity to prevent adverse drug events. Modifications are required for the design of the alert system, which also needs to be continuously updated.

Sistema de alertas asociado a prescripción electrónica asistida: análisis e identificación de puntos de mejora / No disponible

Objetivo: Realizar un análisis cuantitativo de alertas asociadasa un sistema de prescripción electrónica asistida e identificar oportunidadesde mejora de dicho sistema.Método: Estudio observacional retrospectivo en un hospitalgeneral con 750 camas, de las cuales 500 disponen de prescripciónelectrónica asistida. Se analizó la frecuencia por tipo y medicamentode 525.691 alertas generadas durante un año en laprescripción de los tratamientos farmacológicos de 15.466pacientes, trasfiriéndose para ello a una base de datos. El sistemacontempla tres categorías de alertas relacionadas con el medicamento,las características del paciente y la política de medicamentosdel hospital. Mediante análisis de modos de fallos y efectos seidentificaron oportunidades de mejora del sistema y se propusieronacciones correctoras.Resultados: Se observó que 20 medicamentos del total de1.084 generaron el 34% de las alertas, siendo los diez principiosactivos más frecuentemente implicados: cloruro potásico, acenocumarol,imipenem, lorazepam, diazepam, micofenolato, enoxaparina,tacrolimus, carbonato cálcico y ciclosporina. Las alertas más frecuentesgeneradas durante la prescripción electrónica se asociaroncon duplicidad terapéutica (35,4%), insuficiencia renal (27,6%) yriesgo por geriatría (17,2%), constituyendo estos grupos el 80,2%del total. Se identificaron como puntos de mejora prioritarios lasobrecarga de alertas y la información facilitada por las alertas.Conclusiones: El sistema genera excesivas alertas con el consiguienteriesgo de ser ignoradas y de disminuir su capacidad parala prevención de acontecimientos adversos a medicamentos. Serequieren modificaciones en el diseño del sistema de alertas, asícomo la actualización continua de las mismas

Objective: To make a quantitative analysis of the alerts associatedwith a computerized physician order entry system and identifyopportunities to improve the system.Method: A retrospective observational study in a general hospitalwith 750 beds, 500 of which have a computerized physicianorder entry system installed. The frequency per type and medicationof 525,691 alerts produced for a year in the prescription ofdrug treatments to 15,466 patients was analysed, entering theseon a database. The system includes three categories of alert relatingto the drug, the characteristics of the patient and the hospitalmedicine policy. By means of a failure mode and effects analysis,opportunities for improving the system were identified and correctivemeasures were suggested.Results: It has been observed that from the total of 1,084drugs, 20 of them produce 34% of alerts. The ten most frequentlyactive ingredients involved are: potassium chloride,acenocumarol, imipenem, lorazepam, diazepam, mycophenolate,enoxaparin, tacrolimus, calcium carbonate and cyclosporine. Themost frequent alerts generated during electronic prescription areassociated with duplicated therapy (35.4%), renal failure (27.6%)and risk due to advanced age (17.2%), with these groups accountingfor 80.2% of the total. The excess of alerts and informationprovided by the alerts were identified as priority improvementpoints.Conclusions: The system produced excessive alerts which ledto the risk of them being ignored and reducing the capacity toprevent adverse drug events. Modifications are required for thedesign of the alert system, which also needs to be continuouslyupdated

Diagrama de Ishikawa y análisis de barreras aplicado a un error de medicación que induce rabdomiólisis / No disponible

No disponible