[Pharmaceutical care for older adults. Application of STOPP-START criteria]. / Atención farmacéutica de adultos mayores. Aplicación de los criterios STOPP-START.

INTRODUCTION: Drug-related problems can be caused by potentially inappropriate prescribing (PIP), one of the most used tools for its identification are the STOPP (Older Persons' potentially inappropriate Prescriptions) - START (Screening Tool to Alert doctors to Right Treatment) criteria. The objective of this study is to determine PIP in older adults who receive pharmaceutical care in the Pharmacotherapy Optimization Unit (POU)-Rosario. MATERIALS AND METHODS: Pharmacoepidemiological observational study, which evaluates the quality of medication use. Workplace: POU-Rosario. Population under study: adults over 60 years of age, who received pharmacotherapy follow-up during the period March 2017 to February 2018. PIPs were identified using the STOPP-START criteria, 2014 version; selecting the most appropriate criteria to assess outpatient pharmacotherapy. Prevalence of PIP and amount of PIP per active principle were estimated. RESULTS: 50 patients older than 60 years received pharmacotherapy follow-up in the POU; 47 patients (94.0%) had at least one PIP corresponding to a STOPP criterion; 17 STOPP criteria were found among the 41 initially selected, leading to 145 PIPs identified. And 7 START criteria among the 11 initially selected, leading to 50 PIPs identified. Medications with a higher amount of PIPs: benzodiazepines and proton pump inhibitors. CONCLUSIONS: This study allowed the identification of a high prevalence of PIP. The data obtained show the usefulness of these criteria. The STOPP-START criteria have been included to support decision making during pharmacotherapy follow-up to propose pharmaceutical interventions, in order to enhance pharmacotherapy. These activities contribute to patient safety, a dimension of health quality.

Prescripción de medicamentos oncológicos en la red de salud pública municipal de Rosario / Study of oncology medicines prescription in public municipal health network of Rosario

INTRODUCCIÓN Los tumores son la segunda causa de muerte en Argentina, y los tratamientos con medicamentos oncológicos constituyen un punto importante de análisis. En virtud de tal afirmativa, interesa contar con datos propios de prescripción de oncológicos en el sistema de salud pública de Rosario. OBJETIVOS Caracterizar la prescripción de medicamentos oncológicos en pacientes adultos, en relación con las políticas de medicamentos de la Secretaría de Salud Pública de la Municipalidad de Rosario (SSPMR). MÉTODOS Se realizó un estudio farmacoepidemiológico observacional descriptivo en pacientes adultos con diagnóstico de tumores y en tratamiento con medicamentos oncológicos en el Servicio de Oncología, Centro de Especialidades Médicas Ambulatorias Rosario (CEMAR) entre enero y junio de 2012. Se aplicaron dos abordajes uno cuantitativo (descripción de la población y de oncológicos prescriptos, concordancia de prescripciones con Guías de Práctica Clínica [GPC] de referencia y cuantificación de prescripciones fuera de prospecto [off-label]), y otro cualitativo (acercamiento al campo de investigación, análisis del marco normativo, identificación de actores clave y realización de entrevistas). RESULTADOS La población en estudio estuvo compuesta por 133 pacientes, con 27 tipos de tumores diferentes; el de mama fue el más frecuente (27,8%). El fluorouracilo fue el más prescripto de los 33 medicamentos oncológicos (12,4%). El 44,4% de los diagnósticos tuvo al menos un medicamento prescripto que no coincidía con lo recomendado por al menos una de las GPC de referencia, y el 16,2% de las prescripciones fue off-label para todos sus productos comerciales. Discusión La prescripción de medicamentos oncológicos es un complejo escenario en el que confluyen diferentes normativas. El equipo de salud no cuestiona la práctica off-label. Las dificultades en el marco regulatorio determinan la búsqueda de consenso al interior del servicio que, además, privilegia la contención de los pacientes.

Seguridad del paciente: aplicación de gestión de calidad para prevenir errores de medicación en el circuito de uso de medicamentos / Patient safety: use of quality management to prevent medication errors in the hospital medication use cycle

Objetivos. Describir los errores de medicación en el circuito de uso de medicamentos en una sala general de internación de un Hospital Público de referencia, e identificar estrategias de intervención en relación a la detección y prevención de estos errores. Método. Estudio descriptivo, transversal. Hospital público general, de 190 camas, en Rosario (Argentina). Recolección de datos en forma diaria y sistemática del circuito de uso de medicamentos en una sala de internación general durante mayo 2009. Una vez identificados y caracterizados los errores, un grupo interdisciplinar aplicó en forma secuencial herramientas de gestión de calidad para reconocer causas y proponer y ponderar soluciones. (Flujograma, diagrama de causa y efecto, tormenta de ideas, grupo nominal y matriz de decisión). Resultados. En el período de estudio se obtiene información de 60 pacientes, con detección de 506 errores de medicación. Los indicadores de incidencia mostraron los siguientes valores: 8,4 errores/paciente y 88,6 errores/100 pacientes-día. De las causas identificadas se definieron como relevantes: «la doble prescripción» y «la falta de normativas claras». De las diferentes soluciones propuestas se planteó como estrategia de intervención incluir en la Historia Clínica una planilla de «prescripción/indicación/administración» con un diseño diferente, habilitando actualización diaria, con un duplicado para la dispensación en Farmacia. Se genera un procedimiento operativo estándar para normatizar esta nueva modalidad de trabajo. Conclusiones. Este trabajo logra, a través de la gestión de la calidad, el compromiso del equipo de salud para generar cambios que buscan tanto la seguridad del paciente como mejorar la calidad de las prestaciones que brinda el hospital(AU)

Objectives. To describe the medication errors in the medication use cycle in a general public hospital, and to identify intervention strategies in relation to the detection and prevention of these errors. Methods. Descriptive study with cross-sectional design. General public hospital of 190 beds, in Rosario (Argentina). Daily and systematic data collection of the circuit of use of medicines during May 2009. Once the errors were identified and classified, an interdisciplinary group sequentially applied different quality management tools to recognize and weigh causes, and propose solutions. (Flowchart, Cause Effect Diagram, Brainstorming, Nominal Group and Matrix Decision). Results. Information on 60 patients was retrieved during the study period, with 506 medication errors detected. The impact indicators showed the following values: 8.4 errors/patient and 88.6 errors/100 patients-day. From the causes identified, two were defined as relevant: “Double prescription” and “Lack of clear policy”. Of the various solutions proposed, an intervention strategy was defined to include a differently designed form for “prescription/indication/administration” in the clinical history which could be updated daily, with a duplicate to Pharmacy for the distribution, as well as a Standard Operating Procedure to standardize this new way of working. Conclusion. This work achieved, through quality management, the commitment of a team of health professionals to seek and make changes for patient safety, and to improve the quality of services provided by the hospital(AU)

[Patient safety: use of quality management to prevent medication errors in the hospital medication use cycle]. / Seguridad del paciente: aplicación de gestión de calidad para prevenir errores de medicación en el circuito de uso de medicamentos.

OBJECTIVES: To describe the medication errors in the medication use cycle in a general public hospital, and to identify intervention strategies in relation to the detection and prevention of these errors. METHODS: Descriptive study with cross-sectional design. General public hospital of 190 beds, in Rosario (Argentina). Daily and systematic data collection of the circuit of use of medicines during May 2009. Once the errors were identified and classified, an interdisciplinary group sequentially applied different quality management tools to recognize and weigh causes, and propose solutions. (Flowchart, Cause Effect Diagram, Brainstorming, Nominal Group and Matrix Decision). RESULTS: Information on 60 patients was retrieved during the study period, with 506 medication errors detected. The impact indicators showed the following values: 8.4 errors/patient and 88.6 errors/100 patients-day. From the causes identified, two were defined as relevant: "Double prescription" and "Lack of clear policy". Of the various solutions proposed, an intervention strategy was defined to include a differently designed form for "prescription/indication/administration" in the clinical history which could be updated daily, with a duplicate to Pharmacy for the distribution, as well as a Standard Operating Procedure to standardize this new way of working. CONCLUSION: This work achieved, through quality management, the commitment of a team of health professionals to seek and make changes for patient safety, and to improve the quality of services provided by the hospital.

[Economic management of institutional pharmacies of the city of Rosario. Quality indicators proposal]. / Gestión económica en establecimientos asistenciales de la ciudad de Rosario. Propuesta de indicadores de calidad.

OBJECTIVE: To compare structures, procedures and results of the pharmaceutical management of institutional pharmacies in the city of Rosario (Argentina), to define the current situation and thus recommend changes. METHOD: Descriptive study, using a questionnaire and quality indicators of an Accreditation Program of Hospital Pharmacies. Evaluated dimensions: selection, acquisition, reception, storage and stock control of drugs and medical devices. Data was collected for a one-year-period in order to obtain indicators. After tabulation, data was discussed in meetings with all the pharmacists that participate in this study, in order to evaluate the situation and propose changes for the Pharmacies, as well as to evaluate the Program based on usefulness of these indicators. RESULTS: The general results illustrate how each institution has different health policies. 43.2% of indicators were answered, 67.6% reached standard values. CONCLUSIONS: This work allowed for an exhaustive analysis of the current situation. The pharmacists made proposals and unified criteria in order to obtain an improved use of the economic resources of each institution.