[Reduction of prescription error and its adverse effects in the pediatric intensive care area]. / Reducción del error de prescripción y de sus efectos adversos en el área pediátrica de cuidados intensivos.

INTRODUCTION: Prescription is the node of medication management and use that most frequently presents medication errors, according to various studies. This study aims to analyze prescriptions before and after the incorporation of a multidisciplinary round in the pediatric intensive care area and its implication in the occurrence of adverse drug events. METHODS: This is an uncontrolled before and after study. RESULTS: 100 patients were studied before and 100 after, range 1-17 years, mean age: 6.4 SD: 8.7. 55.5% (n = 111) were men. A prescription error was detected before the intervention of 12% (n = 12) and after 0% of the intervention, 0%, p = 0.001. A total of 45 adverse events were detected, that is, 45 adverse events per 100 admissions and 38, that is, 38 events per 100 admissions, before and after the intervention respectively (p > 0.05). CONCLUSION: The intervention was useful to reduce prescription error in this sample of patients.

Introducción: La prescripción es el nodo del manejo y uso de medicamentos que con mayor frecuencia presenta errores de medicación, según diversos estudios. Este estudio tiene como objetivo analizar las prescripciones antes y después de la incorporación de una ronda multidisciplinar en el área de cuidados intensivos pediátricos y su implicación en la ocurrencia de eventos adversos por medicamentos. Métodos: Se trata de un estudio antes y después, no controlado. Resultados: Se estudiaron 100 pacientes antes y 100 después, rango 1-17 años, edad media: 6.4 DE: 8.7. El 55.5% (n = 111) eran varones. Se detectó un error de prescripción antes de la intervención del 12% (n = 12) y después de intervención, del 0%, p = 0.001. Se detectó un total de 45 eventos adversos por 100 ingresos y 38 eventos por 100 ingresos, antes y después de la intervención respectivamente (p > 0.05). Conclusión: La intervención fue útil para disminuir el error de prescripción en esta muestra de pacientes.

Patient safety culture in South America: a cross-sectional study.

BACKGROUND: Every year, millions of patients suffer injuries or die due to unsafe and poor-quality healthcare. A culture of safety care is crucial to prevent risks, errors and harm that may result from medical assistance. Measurement of patient safety culture (PSC) identifies strengths and weaknesses, serving as a guide to improvement interventions; nevertheless, there is a lack of studies related to PSC in Latin America. AIM: To assess the PSC in South American hospitals. METHODS: A multicentre international cross-sectional study was performed between July and September 2021 by the Latin American Alliance of Health Institutions, composed of four hospitals from Argentina, Brazil, Chile and Colombia. The Hospital Survey on Patient Safety Culture (HSOPSC V.1.0) was used. Participation was voluntary. Subgroup analyses were performed to assess the difference between leadership positions and professional categories. RESULTS: A total of 5695 records were analysed: a 30.1% response rate (range 25%-55%). The highest percentage of positive responses was observed in items related to patient safety as the top priority (89.2%). Contrarily, the lowest percentage was observed in items regarding their mistakes/failures being recorded (23.8%). The strongest dimensions (average score ≥75%) were organisational learning, teamwork within units and management support for patient safety (82%, 79% and 78%, respectively). The dimensions 'requiring improvement' (average score <50%) were staffing and non-punitive responses to error (41% and 37%, respectively). All mean scores were higher in health workers with a leadership position except for the hospital handoff/transitions item. Significant differences were found by professional categories, mainly between physicians, nurses, and other professionals. CONCLUSION: Our findings lead to a better overview of PSC in Latin America, serving as a baseline and benchmarking to facilitate the recognition of weaknesses and to guide quality improvement strategies regionally and globally. Despite South American PSC not being well-exploited, local institutions revealed a strengthened culture of safety care.

Eventos adversos asociados al cuidado de la salud en adultos internados en dos hospitales de alta complejidad de Argentina / Healthcare-associated harm in adult patients hospitalized in two tertiary care centers in Argentina

Resumen El daño asociado al cuidado de la salud es relevante y altamente prevenible. El Global Trigger Tool es la principal metodología en uso para su cuantificación. Los objetivos del trabajo fueron cuantificar mediante dicha herramienta el daño asociado al cuidado durante la internación, caracterizar los tipos de daño involucrados, identificar los factores asociados y describir la utilización de la información recabada. Se trata de un estudio longitudinal retrospectivo. Se detectaron 266 eventos adversos totales entre los dos hospitales: 138 eventos en el Hospital A, y 128 eventos en el Hospital B. Esto es 61.3 eventos cada 1000 días paciente, y 62.5 eventos cada 1000 días paciente en A y B respectivamente, p = 0.3. En términos generales, construyendo una sola población de los dos hospitales, se hallaron 32 eventos adversos cada 100 admisiones, y 64.3 eventos cada 1000 días/pacientes. Los eventos estaban asociados en orden decreciente de frecuencia a: medicación (45.5%), infecciones (32.4%), procedimientos sin infección (15.2%), tromboembolismo pulmonar (4.8%), úlceras por presión (1.4%), dispositivos (0.7%). Las variables asociadas fueron polimedicación y polimorbilidad. Los factores asociados a la aparición de eventos adversos fueron el sexo femenino (OR: 2.1), la administración de medicamentos de alto riesgo (OR 2.3), la edad ≥ 80 años (OR 2.6) y el registro de ≥ 3 transferencias entre salas durante la internación (OR 2.9). Las tasas de daño observadas son comparables a las tasas evaluadas por el mismo método en estudios internacionales.

Abstract The damage associated with health care is relevant and highly preventable. The Global Trigger Tool is a leading methodology in use for its quantification. Our study aimed to quantify, through this tool, the damage associated with care during hospitalization, characterize the types of damage involved, identify the associated factors and describe the use of the information collected. We conducted a retrospective longitudinal study. A total of 266 adverse events were detected between the two hospitals: 138 events in Hospital A, and 128 in Hospital B, the patient days analyzed in each hospital were 2089 and 2046 respectively. This is 61.3 events every 1000 patient days, and 62.5 events every 1000 patient days in A and B respectively, p = 0.3. In general terms, constructing a single population of the two hospitals, 32 adverse events were found every 100 admis sions, and 64.3 events every 1000 days / patients. The events were associated in decreasing order of frequency with: medication (45.5%), infections (32.4%), procedures without infection (15.2%), pulmonary thromboembolism (4.8%), pressure ulcers (1.4%), devices (0.7%). The associated variables were polypharmacy and polymorbid ity. Factors associated with the occurrence of adverse events were female gender (OR: 2.1), administration of high-risk medications (OR 2.3), age ≥ 80 years (OR 2.6), and registration of ≥ 3 transfers between wards during hospitalization (OR 2.9). The observed damage rates are comparable to the rates evaluated by the same method in international studies.

[Healthcare-associated harm in adult patients hospitalized in two tertiary care centers in Argentina]. / Eventos adversos asociados al cuidado de la salud en adultos internados en dos hospitales de alta complejidad de Argentina.

The damage associated with health care is relevant and highly preventable. The Global Trigger Tool is a leading methodology in use for its quantification. Our study aimed to quantify, through this tool, the damage associated with care during hospitalization, characterize the types of damage involved, identify the associated factors and describe the use of the information collected. We conducted a retrospective longitudinal study. A total of 266 adverse events were detected between the two hospitals: 138 events in Hospital A, and 128 in Hospital B, the patient days analyzed in each hospital were 2089 and 2046 respectively. This is 61.3 events every 1000 patient days, and 62.5 events every 1000 patient days in A and B respectively, p = 0.3. In general terms, constructing a single population of the two hospitals, 32 adverse events were found every 100 admissions, and 64.3 events every 1000 days / patients. The events were associated in decreasing order of frequency with: medication (45.5%), infections (32.4%), procedures without infection (15.2%), pulmonary thromboembolism (4.8%), pressure ulcers (1.4%), devices (0.7%). The associated variables were polypharmacy and polymorbidity. Factors associated with the occurrence of adverse events were female gender (OR: 2.1), administration of high-risk medications (OR 2.3), age = 80 years (OR 2.6), and registration of = 3 transfers between wards during hospitalization (OR 2.9). The observed damage rates are comparable to the rates evaluated by the same method in international studies.

El daño asociado al cuidado de la salud es relevante y altamente prevenible. El Global Trigger Tool es la principal metodología en uso para su cuantificación. Los objetivos del trabajo fueron cuantificar mediante dicha herramienta el daño asociado al cuidado durante la internación, caracterizar los tipos de daño involucrados, identificar los factores asociados y describir la utilización de la información recabada. Se trata de un estudio longitudinal retrospectivo. Se detectaron 266 eventos adversos totales entre los dos hospitales: 138 eventos en el Hospital A, y 128 eventos en el Hospital B. Esto es 61.3 eventos cada 1000 días paciente, y 62.5 eventos cada 1000 días paciente en A y B respectivamente, p = 0.3. En términos generales, construyendo una sola población de los dos hospitales, se hallaron 32 eventos adversos cada 100 admisiones, y 64.3 eventos cada 1000 días/pacientes. Los eventos estaban asociados en orden decreciente de frecuencia a: medicación (45.5%), infecciones (32.4%), procedimientos sin infección (15.2%), tromboembolismo pulmonar (4.8%), úlceras por presión (1.4%), dispositivos (0.7%). Las variables asociadas fueron polimedicación y polimorbilidad. Los factores asociados a la aparición de eventos adversos fueron el sexo femenino (OR: 2.1), la administración de medicamentos de alto riesgo (OR 2.3), la edad = 80 años (OR 2.6) y el registro de = 3 transferencias entre salas durante la internación (OR 2.9). Las tasas de daño observadas son comparables a las tasas evaluadas por el mismo método en estudios internacionales.

Polimedicación, prescripción inapropiada y eventos adversos a fármacos en ancianos hospitalizados: un problema de seguridad del paciente / Polymedication, inappropriate prescription and adverse events to drugs in hospitalized elderly: a patient safety problem / Polimedicação, prescrição inadequada e eventos adversos a medicamentos em idosos hospitalizados: um problema para a segurança do paciente

RESUMEN Introducción: La esperanza de vida ha ido en aumento y la posibilidad de padecer una o más patologías crónicas, por ejemplo, diabetes mellitus, hipertensión arterial, etc. es alta. La respuesta a los medicamentos en los adultos mayores es marcadamente diferente que en los adultos no ancianos pues se trata de un organismo donde las consecuencias directas del envejecimiento son de relevancia (reducción de la capacidad metabólica del hígado, reducción de la capacidad de filtrado del riñón, hipoclorhidria, entre otros). Objetivo: Analizar la polifarmacia, la prescripción inapropiada y los eventos adversos en adultos mayores hospitalizados. Materiales y métodos: Estudio descriptivo de corte transversal. Resultados: Se estudiaron 318 pacientes. La frecuencia de pacientes polimedicados fue 89 % (283). La prescripción inapropiada, 18,9 %. Los fármacos mayormente presentes en los esquemas de pacientes polimedicados fueron benzodiacepinas, AINEs, anticoagulantes y antihipertensivos. Los pacientes con eventos adversos han sido 179 (56,3 %), de ese porcentaje un 30,2 % (54) ha recibido tratamiento con otro medicamento para resolver el evento producido por un medicamento, eso es la llamada cascada de prescripción o de medicamentos. Conclusiones: La polimedicación es alta y causa eventos adversos, es necesario insistir en el trabajo integral para reducir este problema sanitario.

SUMMARY Introduction: Life expectancy has been increasing and the possibility of suffering from one or more chronic pathologies, for example, diabetes mellitus, arterial hypertension, etc. is high. The response to medications in older adults is markedly different than in non-elderly adults since it is an organism where the direct consequences of aging are relevant (reduction of the metabolic capacity of the liver, reduction of the filtering capacity of the kidney, hypochlorhydria, among others). Objective: To analyze polypharmacy, inappropriate prescription, and adverse events in hospitalized older adults. Materials and methods: Descriptive cross-sectional study. Results: 318 patients were studied. The frequency of polymedicated patients was 89 % (283). Inappropriate prescription, 18.9 %. The drugs most present in the regimens of polymedicated patients were benzodiazepines, NSAIDs, anticoagulants and antihypertensives. Patients with adverse events have been 179 (56.3 %), of that percentage 30.2 % (54) have received treatment with another drug to resolve the event produced by a drug, which is the so-called prescription or prescription cascade. Conclusions: Polypharmacy is high and causes adverse events, it is necessary to insist on comprehensive work to reduce this health problem.

RESUMO Introdução: A expectativa de vida vem aumentando e a possibilidade de sofrer de uma ou mais patologias crónicas, como por exemplo, diabetes mellitus, hipertensão arterial etc. é alta. A resposta aos medicamentos em idosos é marcadamente diferente da de adultos não idosos, pois é um organismo onde as consequências diretas do envelhecimento são relevantes (redução da capacidade metabólica do fígado, redução da capacidade de filtragem do rim, hipocloridria, entre outros). Objetivo: Analisar polifarmácia, prescrição inadequada e eventos adversos em idosos hospitalizados. Materiais e métodos: Estudo transversal descritivo. Resultados: 318 pacientes foram estudados. A frequência de pacientes polimedicados foi de 89% (283). Prescrição inadequada, 18,9%. Os medicamentos mais presentes nos esquemas dos pacientes polimedicados foram benzodiazepínicos, AINEs, anticoagulantes e anti--hipertensivos. Os pacientes com eventos adversos foram 179 (56,3%), desse percentual 30,2% (54) receberam tratamento com outro medicamento para resolução do evento produzido por um medicamento, que é a chamada prescrição ou receita em cascata. Conclusões: A polifarmácia é elevada e causa eventos adversos, é necessário insistir em um trabalho abrangente para reduzir esse problema de saúde.

Una estrategia para reducir el error de prescripción de medicamentos en pacientes hospitalizados / A strategy to reduce medication prescription error in hospitalized patients

Resumen Los errores de prescripción representan un relevante problema en salud. Este trabajo se propone analizar el error de prescripción de medicación en pacientes hospitalizados antes y después de una intervención múltiple. Se trata de un estudio cuasi experimental de tipo antes-después no controlado. La intervención consistió en la estandarización del proceso de prescripción y el entrenamiento del personal que prescribe. El porcentaje de error de prescripción antes de la intervención fue del 28.8% (n = 182), es decir 28.8 prescripciones incorrectas cada 100 prescripciones médicas. El dominio más frecuente de error fue: dosis in adecuada 52.2% (n = 95), medicamento incorrecto 33% (n = 60), días de tratamiento inapropiado 4.4%(n = 8) y otros 10.4% (n = 19). Luego de la intervención el error descendió a 4.3% (n = 26): 4.3 prescripciones con error cada 100 efectuadas, siendo el error más frecuente la dosis incorrecta: 76.9% (n = 20), otros 23.1% (n = 6). El daño asociado a medicación inadecuadamente prescripta antes y después fue de 0.95 (n = 6) eventos y 0.33 (n = 2) eventos cada 100 admisiones, respectivamente. La intervención de mejora resultó útil para la reducción del error de prescripción en esta institución y muestra de pacientes.

Abstract Prescription errors represent a relevant health problem. This work aims to analyze the medication prescription error in hospitalized patients before and after a multiple intervention. This is a quasi-experimental study of the uncontrolled before-after type. The intervention consisted of the standardization of the prescription process and the training of the prescribing staff. The percentage of prescription error before the intervention was 28.8% (n = 182), that is, 28.8 incorrect prescriptions per 100 medical prescriptions. The most frequent domain of error was: inappropriate dose 52.2% (n = 95), followed by incorrect medication 33% (n = 60), by days of inappropriate treatment 4.4% (n = 8) and others 10.4% (n = 19 ). After the intervention, the error decreased to 4.3% (n = 26), that is, 4.3 pre scriptions with error every 100 prescriptions, the most frequent error being the incorrect dose: 76.9% (n = 20), another 23.1% (n = 6 ). The harm associated with inadequately prescribed medication before and after was 0.95 (n = 6) events and 0.33 (n = 2) events per 100 admissions respectively. The improvement intervention was useful for reducing the prescription error in this institution and patient sample.

[A strategy to reduce medication prescription error in hospitalized patients]. / Una estrategia para reducir el error de prescripción de medicamentos en pacientes hospitalizados.

Prescription errors represent a relevant health problem. This work aims to analyze the medication prescription error in hospitalized patients before and after a multiple intervention. This is a quasi-experimental study of the uncontrolled before-after type. The intervention consisted of the standardization of the prescription process and the training of the prescribing staff. The percentage of prescription error before the intervention was 28.8% (n = 182), that is, 28.8 incorrect prescriptions per 100 medical prescriptions. The most frequent domain of error was: inappropriate dose 52.2% (n = 95), followed by incorrect medication 33% (n = 60), by days of inappropriate treatment 4.4% (n = 8) and others 10.4% (n = 19 ). After the intervention, the error decreased to 4.3% (n = 26), that is, 4.3 prescriptions with error every 100 prescriptions, the most frequent error being the incorrect dose: 76.9% (n = 20), another 23.1% (n = 6 ). The harm associated with inadequately prescribed medication before and after was 0.95 (n = 6) events and 0.33 (n = 2) events per 100 admissions respectively. The improvement intervention was useful for reducing the prescription error in this institution and patient sample.

Los errores de prescripción representan un relevante problema en salud. Este trabajo se propone analizar el error de prescripción de medicación en pacientes hospitalizados antes y después de una intervención múltiple. Se trata de un estudio cuasi experimental de tipo antes-después no controlado. La intervención consistió en la estandarización del proceso de prescripción y el entrenamiento del personal que prescribe. El porcentaje de error de prescripción antes de la intervención fue del 28.8% (n = 182), es decir 28.8 prescripciones incorrectas cada 100 prescripciones médicas. El dominio más frecuente de error fue: dosis inadecuada 52.2% (n = 95), medicamento incorrecto 33% (n = 60), días de tratamiento inapropiado 4.4%(n = 8) y otros 10.4% (n = 19). Luego de la intervención el error descendió a 4.3% (n = 26): 4.3 prescripciones con error cada 100 efectuadas, siendo el error más frecuente la dosis incorrecta: 76.9% (n = 20), otros 23.1% (n = 6). El daño asociado a medicación inadecuadamente prescripta antes y después fue de 0.95 (n = 6) eventos y 0.33 (n = 2) eventos cada 100 admisiones, respectivamente. La intervención de mejora resultó útil para la reducción del error de prescripción en esta institución y muestra de pacientes.

Medición de la incidencia de eventos adversos atribuidos a la atención sanitaria en un Departamento de Pediatría de un hospital universitario / Measurement of the incidence of care-associated adverse events at the Department of Pediatrics of a teaching hospital

Introducción. Los eventos adversos pueden ser detectados por diversas herramientas de pesquisa. En la población pediátrica, la Pediatric Global Trigger Tool busca gatillos en la historia clínica para detectar daño asociado al cuidado, tanto prevenible como no prevenible. Objetivo. Medir la incidencia de eventos adversos en el Departamento de Pediatría utilizando dicha herramienta. Conocer los tipos de eventos y las variables asociadas. Población y métodos. Estudio de incidencia, de corte longitudinal. Resultados. Se estudiaron 318 pacientes; media de edad: 2,99 años (rango: 0-17); porcentaje de mujeres: 164 (el 51,57 %). Se halló un 11 % de eventos por cada 100 admisiones, 15,5 eventos cada 1000 días-paciente. Los eventos más frecuentes fueron asociados a medicación: el 48,57 % (n = 17); a bacteriología (infecciones): el 42,85 % (n = 15); y a cuidados: el 8,57 % (n = 3). Diecinueve eventos fueron leves (el 54,28 %), 14 (el 40 %) prolongaron la hospitalización (moderados) y 2 (el 5,71 %) requirieron soporte vital (graves). Se hallaron 168 gatillos, 0,53 gatillos por paciente, 74,4 gatillos cada 1000 días-paciente y 4,8 gatillos por cada evento adverso. En el análisis de regresión logística multivariada, las variables asociadas a la aparición de los eventos adversos fueron medicamentos de alto riesgo, sexo femenino, peso, número de transferencias dentro del hospital y estancia superior a 5 días. Conclusiones. La utilización de la Pediatric Global Trigger Tool permite identificar eventos adversos en pacientes pediátricos hospitalizados y ayudar a encauzar acciones de mejora, de acuerdo con las variables asociadas.

Introduction. Adverse events may be detected using different screening tools. In the pediatric population, the Pediatric Trigger Tool looks for triggers in the medical record to detect preventable and non-preventable care-associated harm. Objective. To measure the incidence of adverse events at the Department of Pediatrics using this tool. To know the types of events and associated outcome measures. Population and methods. Longitudinal cohort study. Results. A total of 318 patients were included; mean age: 2.99 years (range: 0-17); 164 (51.57 %) were girls. There were 11 % of events per 100 admissions, 15.5 events per 1000patient-days. The most common events were associated with medication use: 48.57 % (n = 17); bacteriology (infections): 42.85 % (n = 15); and care: 8.57 % (n = 3). Nineteen events were mild (54.28 %), 14 (40 %) extended the length of stay (moderate), and 2 (5.71 %) required vital support (severe). A total of 168 triggers were detected; 0.53 triggers per patient, 74.4 triggers per 1000 patient-days, and 4.8 triggers per adverse event. In the multivariate logistic regression analysis, the outcome measures associated with the development of adverse events were high-risk medications, female sex, weight, number of transfers within the hospital, and length of stay longer than 5 days. Conclusions. Using the Pediatric Trigger Tool helped to identify adverse events in hospitalized pediatric patients and guide improvement measures based on associated outcome measures.

Measurement of the incidence of care-associated adverse events at the Department of Pediatrics of a teaching hospital. / Medición de la incidencia de eventos adversos atribuidos a la atención sanitaria en un Departamento de Pediatría de un hospital universitario.

INTRODUCTION: Adverse events may be detected using different screening tools. In the pediatric population, the Pediatric Trigger Tool looks for triggers in the medical record to detect preventable and non-preventable care-associated harm. OBJECTIVE: To measure the incidence of adverse events at the Department of Pediatrics using this tool. To know the types of events and associated outcome measures. POPULATION AND METHODS: Longitudinal cohort study. RESULTS: A total of 318 patients were included; mean age: 2.99 years (range: 0-17); 164 (51.57 %) were girls. There were 11 % of events per 100 admissions, 15.5 events per 1000patient-days. The most common events were associated with medication use: 48.57 % (n = 17); bacteriology (infections): 42.85 % (n = 15); and care: 8.57 % (n = 3). Nineteen events were mild (54.28 %), 14 (40 %) extended the length of stay (moderate), and 2 (5.71 %) required vital support (severe). A total of 168 triggers were detected; 0.53 triggers per patient, 74.4 triggers per 1000 patient-days, and 4.8 triggers per adverse event. In the multivariate logistic regression analysis, the outcome measures associated with the development of adverse events were high-risk medications, female sex, weight, number of transfers within the hospital, and length of stay longer than 5 days. CONCLUSIONS: Using the Pediatric Trigger Tool helped to identify adverse events in hospitalized pediatric patients and guide improvement measures based on associated outcome measures.

Introducción. Los eventos adversos pueden ser detectados por diversas herramientas de pesquisa. En la población pediátrica, la Pediatric Global Trigger Tool busca gatillos en la historia clínica para detectar daño asociado al cuidado, tanto prevenible como no prevenible. Objetivo. Medir la incidencia de eventos adversos en el Departamento de Pediatría utilizando dicha herramienta. Conocer los tipos de eventos y las variables asociadas. Población y métodos. Estudio de incidencia, de corte longitudinal. Resultados. Se estudiaron 318 pacientes; media de edad: 2,99 años (rango: 0-17); porcentaje de mujeres: 164 (el 51,57 %). Se halló un 11 % de eventos por cada 100 admisiones, 15,5 eventos cada 1000 días-paciente. Los eventos más frecuentes fueron asociados a medicación: el 48,57 % (n = 17); a bacteriología (infecciones): el 42,85 % (n = 15); y a cuidados: el 8,57 % (n = 3). Diecinueve eventos fueron leves (el 54,28 %), 14 (el 40 %) prolongaron la hospitalización (moderados) y 2 (el 5,71 %) requirieron soporte vital (graves). Se hallaron 168 gatillos, 0,53 gatillos por paciente, 74,4 gatillos cada 1000 días-paciente y 4,8 gatillos por cada evento adverso. En el análisis de regresión logística multivariada, las variables asociadas a la aparición de los eventos adversos fueron medicamentos de alto riesgo, sexo femenino, peso, número de transferencias dentro del hospital y estancia superior a 5 días. Conclusiones. La utilización de la Pediatric Global Trigger Tool permite identificar eventos adversos en pacientes pediátricos hospitalizados y ayudar a encauzar acciones de mejora, de acuerdo con las variables asociadas.

Reducción de prescripción inapropiada y eventos adversos a medicamentos en ancianos hospitalizados / Reduction of inappropriate prescriptions and adverse effects to medications in hospitalized elderly patients

La combinación de prescripción inapropiada de medicamentos (PIM) y prescripción apropiada omitida (PPO) en ancianos requiere intervenciones múltiples para reducir su magnitud y los subsecuentes eventos adversos. Este estudio tiene como objetivo evaluar la PIM, la PPO, y los eventos adversos a medicamentos (EAM) antes y después de la intervención de un farmacéutico clínico sobre la prescripción del médico. En un estudio de tipo pre-post, se analizó la prescripción de un total de 16 542 fármacos realizada a 1262 pacientes aplicando los criterios STOPP-START (screening tool of older people's prescriptions/screening tool to alert to right treatment). La intervención consistió en la difusión de los criterios STOPP-START en todas las áreas del hospital mediante clases y publicaciones y las sugerencias diarias del farmacéutico clínico al médico responsable sobre la prescripción a cada paciente. Antes de la intervención, la PIM fue 48.9% al ingreso y 46.1% al egreso y luego de la intervención 47.4% al ingreso y 16.7% al egreso. La PPO antes de la intervención fue 10% al ingreso y 7.6% al egreso; después de la intervención fue 12.2% al ingreso y 7.8% al egreso. El porcentaje de pacientes con EAM fue 50.9% antes de la intervención y 34.4% después. Las readmisiones a emergencias fueron 12.2% y 4.7% antes y después de la intervención. La PIM, los EAM, el error de conciliación, la interacción medicamentosa clínicamente grave y el delirio fueron reducidos significativamente. Se concluye que, coincidiendo con buena parte de la literatura internacional, la intervención obtuvo resultados positivos.

Together, potentially inappropriate prescribing of medications (PIP) and appropriate prescribing omission (APO) constitute a problem that requires multiple interventions to reduce its size and the occurrence of adverse drug events (ADE). This study aims to assess PIP, APO, ADE before and after the intervention of a clinical pharmacist over medical prescriptions for elderly hospitalized patients. In a before-after study, a total of 16 542 prescriptions for 1262 patients were analyzed applying the criteria defined in both STOPP- START (screening tool of older people's prescriptions and screening tool to alert to right treatment). The intervention consisted in lectures and publications on STOPP-START criteria made available to all the areas of the hospital and suggestions made by the clinical pharmacist to the physician on each individual prescription. Before intervention, PIM was 48.9% on admission and 46.1% at discharge, while after the intervention it was 47.4% on admission and 16.7% at discharge. APO was 10% on admission and 7.6% at discharge, while after intervention it was 12.2% on admission and 7.9% at discharge. ADE were 50.9% before and 34.4% after intervention. The frequency of return to emergency was 12.2% and 4.7% before and after intervention. PIM, EAM, conciliation error, clinically serious drug interaction, and delirium were reduced to statistically significant levels. In line with various international studies, the intervention showed to attain positive results.

[Reduction of inappropriate prescriptions and adverse effects to medications in hospitalized elderly patients]. / Reducción de prescripción inapropiada y eventos adversos a medicamentos en ancianos hospitalizados.

Together, potentially inappropriate prescribing of medications (PIP) and appropriate prescribing omission (APO) constitute a problem that requires multiple interventions to reduce its size and the occurrence of adverse drug events (ADE). This study aims to assess PIP, APO, ADE before and after the intervention of a clinical pharmacist over medical prescriptions for elderly hospitalized patients. In a before-after study, a total of 16 542 prescriptions for 1262 patients were analyzed applying the criteria defined in both STOPP- START (screening tool of older people's prescriptions and screening tool to alert to right treatment). The intervention consisted in lectures and publications on STOPP-START criteria made available to all the areas of the hospital and suggestions made by the clinical pharmacist to the physician on each individual prescription. Before intervention, PIM was 48.9% on admission and 46.1% at discharge, while after the intervention it was 47.4% on admission and 16.7% at discharge. APO was 10% on admission and 7.6% at discharge, while after intervention it was 12.2% on admission and 7.9% at discharge. ADE were 50.9% before and 34.4% after intervention. The frequency of return to emergency was 12.2% and 4.7% before and after intervention. PIM, EAM, conciliation error, clinically serious drug interaction, and delirium were reduced to statistically significant levels. In line with various international studies, the intervention showed to attain positive results.

Hypertensive urgencies in the emergency department: evaluating blood pressure response to rest and to antihypertensive drugs with different profiles.

To study the efficacy of a treatment strategy for the management of hypertensive urgencies, the authors evaluated 549 patients admitted to the emergency department. They were first assigned to a 30-minute rest period, then a follow-up blood pressure measurement was carried out. Patients who did not respond to rest were randomly assigned to receive an oral dose of an antihypertensive drug with different mechanisms of action and pharmacodynamic properties (perindopril, amlodipine, or labetalol), and blood pressure was reassessed at 60- and 120-minute intervals. A satisfactory blood pressure response to rest (defined as postintervention systolic blood pressure < 180 mm Hg and diastolic blood pressure < 110 mm Hg, with at least a 20 mm Hg reduction in basal systolic blood pressure and/or a 10-mm Hg reduction in basal diastolic blood pressure) was observed in 31.9% of population. Among nonresponders, 79.1% had a satisfactory blood pressure response to the antihypertensive drug treatment in a 2-hour average follow-up period. No major adverse events were observed. This treatment strategy, based on standardized rest as an initial step and different antihypertensive drugs, can be effective and safe for the management of patients with hypertensive urgencies.