Determination of the cross-contamination and validation of the cleaning process for an automated personalised dosing system.

OBJECTIVE: To determine the degree of cross-contamination and to validate a cleaning process for an Automated Personalised Dosing System (APDS), respecting the permitted residue transfer limits. METHOD: An analytical determination by high pressure liquid chromatography with mass spectrometry was performed for 11 drugs considered critical for their potential for contamination, toxicity (National Institute for Occupational Safety and Health (NIOSH) List 2016) and/or narrow therapeutic index. The test was carried out for three consecutive weeks, seven repetitions per week, in a state of maximum contamination and maximum cleanliness. The main validation criterion of the cleaning protocol was to quantify that the active ingredients measured were below the Permitted Daily Exposure index or fraction 1/1000 of the minimum daily dose, both in a state of maximum contamination and when the APDS is in a clean condition, for an average number of tablets consumed per person per day. RESULTS: In all the samples analysed, some compound could always be quantified below 2% of the permitted transfer limits, highlighting the presence of paracetamol and carbamazepine. In the state of maximum contamination, the mean±SD values of paracetamol and carbamazepine were 5.83±1.56 µg and 0.22±0.07 µg, respectively, without significant differences in mean values over the 3 weeks of the study. After the cleaning protocol was executed, only paracetamol and carbamazepine were detected, with the average values being 4.67 µg (95% CI 3.92 to 5.43, p<0.05) and 0.07 µg (95% CI 0.03 to 0.10, p<0.05) lower than the state of maximum contamination, respectively. CONCLUSIONS: In all cases the level of cross-contamination for an APDS was below the pre-established limits. The cleaning protocol has been validated, confirming APDS decontamination of the most critical medicines.

Impacto de la automatización en la seguridad de la dispensación de medicamentos a centros sociosanitarios / The impact of automation on the safety of drug dispensing in nursing homes

Objetivo:Comparar la incidencia y la gravedad de los errores de dispensación notificados cuando la dispensación a centros sociosanitarios se realiza con un sistema de pastilleros frente a un sistema automatizado de dispensación específicamente seleccionado. Método: Estudio retrospectivo observacional pre-post en siete centros socio-sanitarios geriátricos. Se comparan los errores de dispensación comunicados voluntariamente de dos periodos distintos: dispensación en pastilleros semanales (año 2013) y dispensación semanal con un sistema automatizado de dosificación personalizada Xana 4001U2 Tosho® para medicamentos orales sólidos, acompañada de dispensación manual para otras formas farmacéuticas (año 2015). Se analizan datos de funcionalidad, cognición y farmacológicos de los residentes atendidos en ambos periodos. Resultados: La media de edad (83,9 y 83,6 años; p > 0,05) y la función física (índice de Barthel 41,8 y 44,2; p > 0,05) de los residentes fueron comparables, mientras que existieron diferencias estadísticamente significativas en la función cognitiva (MEC-35 20,3 y 21,7; p < 0,0,5). Se comunicaron 408 errores de dispensación con la dispensación manual, comparada con los 36 que se comunicaron con la dispensación automatizada, lo que supone una reducción relativa de un 91%. De estos errores, 43 frente a 6 alcanzaron al residente, respectivamente, y 5 errores frente a 1 requirieron al menos seguimiento. Conclusiones: La implantación de un sistema automatizado de dosificación personalizada ha permitido mejorar significativamente la seguridad en la dispensación y posterior administración de medicamentos sólidos a centros socio-sanitarios. La comunicación voluntaria de errores de medicación ha permitido comparar la seguridad en cuanto a la dispensación de dos sistemas diferentes de dispensación a centros sociosanitarios

Objective: To compare the rate and severity of reported dispensing errors in nursing homes using manual medication dispensation vs automated dispensation with a specifically selected Automated Dispensing System. Method: A pre-post retrospective observational study conducted in 7 nursing homes. Comparison of voluntarily reported dispensing errors in 2 periods under a manual dispensing system of weekly pill boxes (data from 2013) and an Automated drug dispensing and Packaging System Xana 4001U2 Tosho® for oral solid medications used in combination with a manual system for other drug forms (data from 2015). We analysed patient function, cognition, and pharmacological data from both periods. Results: The residents’ mean age (83.9 vs 83.6 years; P > .05) and physical functioning (Barthel index 41.8 vs 44.2; P > .05) were similar, but not their level of cognitive functioning (MMSE 20.3 vs 21.7; P < .05). During 2013 (manual system) 408 errors were detected, whereas in 2015 (automated system) only 36 were detected. This represents a reduction of 91% in dispensing errors. A total of 43 errors reached the patient in 2013 vs 6 errors in 2015. Of these, 5 errors vs 1 error, respectively, required monitoring. Conclusions: The introduction of an Automated drug dispensing and Packaging System significantly improves safety in the dispensing and administration of solid medications in nursing homes. The voluntary reporting of errors facilitated comparisons of safety during the 2 periods under different dispensing systems

The impact of automation on the safety of drug dispensing in nursing homes.

OBJECTIVE: To compare the frequency and seriousness of notified dispensing errors in nursing homes when medication is dispensed manually versus automatically using a specifically selected automatic dispensing system. METHOD: A pre-post retrospective observational study in 7 nursing homes. We  compare voluntarily notified dispensing errors in a manually dispensed weekly  system on the one hand (year 2013), with an Automated Tablet Dispensing and  Packaging System Xana4001U2 Tosho® for oral solid drugs used in combination  with a manual system for other drug forms (year 2015), on the other. We  analyze patient function, cognition and pharmacological data in two time  periods. RESULTS: Residents' mean age (83.9 vs 83.6 years; p > 0.05) and physical functioning (Barthel index 41.8 vs 44.2; p > 0.05) were similar, but not  cognitive functioning (MMSE 20.3 vs 21.7; p < 0.0,5). During the year previous to the automated dispensing, 408 errors were detected with the manual system, whereas only 36 were detected in the following yearwith the automated system. This represents a reduction of 91% in dispensing errors. 43 errors reached the patient during the manually dispensing year, versus 6 during the automated year. And 5 errors versus 1 required monitoring. CONCLUSIONS: The introduction of an automatic tablet dispensing and packaging  system has shown to be an important improvement in safety in the dispensing  and administration of solid drugs in nursing homes. The voluntary notification of  errors has permitted the comparison of safety during two time periods with  different dispensing systems.

Objetivo: Comparar la incidencia y la gravedad de los errores de dispensación notificados cuando la dispensación a centros sociosanitarios se  realiza con un sistema de pastilleros frente a un sistema automatizado de  dispensación específicamente seleccionado.Método: Estudio retrospectivo observacional pre-post en siete centros  sociosanitarios geriátricos. Se comparan los errores de dispensación  comunicados voluntariamente de dos periodos distintos: dispensación en  pastilleros semanales (año 2013) y dispensación semanal con un sistema  automatizado de dosificación personalizada Xana 4001U2 Tosho® para  medicamentos orales sólidos, acompañada de dispensación manual para otras  formas farmacéuticas (año 2015). Se analizan datos de funcionalidad, cognición  y farmacológicos de los residentes atendidos en ambos periodos.Resultados: La media de edad (83,9 y 83,6 años; p > 0,05) y la función física  (índice de Barthel 41,8 y 44,2; p > 0,05) de los residentes fueron comparables,  mientras que existieron diferencias estadísticamente significativas en la función  cognitiva (MEC-35 20,3 y 21,7; p < 0,0,5). Se comunicaron 408 errores de  dispensación con la dispensación manual, comparada con los 36 que se  comunicaron con la dispensación automatizada, lo que supone una reducción  relativa de un 91%. De estos errores, 43 frente a 6 alcanzaron al residente,  respectivamente, y 5 errores frente a 1 requirieron al menos seguimiento.Conclusiones: La implantación de un sistema automatizado de dosificación personalizada ha permitido mejorar significativamente la seguridad  en la dispensación y posterior administración de medicamentos sólidos a centros  sociosanitarios. La comunicación voluntaria de errores de medicación ha permitido comparar la seguridad en cuanto a la dispensación de dos sistemas  diferentes de dispensación a centros sociosanitarios.

Epidemiología infecciosa en centros gerontológicos / Infection epidemiology in gerontology centres

Introducción. Los procesos infecciosos en centros gerontológicos (CG) constituyen una de las causas importantes de mortalidad y descompensación de patologías crónicas concomitantes. Para conocer su magnitud y distribución, se inició un sistema de vigilancia epidemiológica. Material y métodos. Durante los años 2006-2009 se realizó un estudio de prevalencia en 4 CG de Fundación Matia. Se midió la prevalencia realizando un corte anual, recogiendo: tipo de infección, datos demográficos, factores de riesgo y uso de antibióticos. La incidencia se midió en un CG como centro piloto durante 2 años, recogiendo: tipo de infección y uso de antibióticos. Resultados. La prevalencia en los CG osciló entre el 4,80 y el 6,44%. La densidad de incidencia de infección en el estudio piloto estuvo entre 3,45-5,77 infecciones por 1.000 residentes-día. La localización infecciosa más frecuente, y en este orden, fue la respiratoria, la urinaria y la cutánea. La incidencia de infección respiratoria es mayor de manera estadísticamente significativa ante la presencia de disfagia, malnutrición y enfermedad pulmonar obstructiva crónica. Sin embargo, en la incidencia infección urinaria no se aprecia relación significativa con los diferentes factores de riesgo analizados. Conclusiones. La frecuencia y las repercusiones de las infecciones nosocomiales en este tipo de centros pone de relieve la necesidad de controles epidemiológicos periódicos para adaptar planes de intervención y desarrollar medidas preventivas adecuadas(AU)

Introduction. Infection processes in gerontology centres (GC) are one of the main causes of mortality and aggravation of concomitant chronic diseases. An epidemiological surveillance system was set up to find out their magnitude and distribution. Material and methods. A prevalence study was conducted during the years 2006-2009 in 4 GCs of the Matia Foundation. Prevalence was measured by making an annual cut-off, recording: infection type, demographic data, risk factors and antibiotic use. The incidence was measured for two years in one GC as a pilot centre, recording: infection type and antibiotic use. Results. The prevalence in the GCs varied between 4.8% and 6.44%. The infection incidence density in the pilot study was between 3.45-5.77 infections per 1,000 resident days. The most common infection location and in this order were, respiratory, urinary and cutaneous. The incidence of respiratory infection is more statistically significant in the presence of dysphagia, malnutrition and COPD. However, no significant relationship was seen in the incidence of urinary infection with the different risk factors analysed. Conclusions. The frequency and repercussions of nosocomial infections in GCs demonstrate the need for intervention plans and the development of adequate prevention measures(AU)

[Infection epidemiology in gerontology centres]. / Epidemiología infecciosa en centros gerontológicos.

INTRODUCTION: Infection processes in gerontology centres (GC) are one of the main causes of mortality and aggravation of concomitant chronic diseases. An epidemiological surveillance system was set up to find out their magnitude and distribution. MATERIAL AND METHODS: A prevalence study was conducted during the years 2006-2009 in 4 GCs of the Matia Foundation. Prevalence was measured by making an annual cut-off, recording: infection type, demographic data, risk factors and antibiotic use. The incidence was measured for two years in one GC as a pilot centre, recording: infection type and antibiotic use. RESULTS: The prevalence in the GCs varied between 4.8% and 6.44%. The infection incidence density in the pilot study was between 3.45-5.77 infections per 1,000 resident days. The most common infection location and in this order were, respiratory, urinary and cutaneous. The incidence of respiratory infection is more statistically significant in the presence of dysphagia, malnutrition and COPD. However, no significant relationship was seen in the incidence of urinary infection with the different risk factors analysed. CONCLUSIONS: The frequency and repercussions of nosocomial infections in GCs demonstrate the need for intervention plans and the development of adequate prevention measures.