Multidisciplinary system for detecting medication errors in antineoplastic chemotherapy.

OBJECTIVE: To analyze medication errors (MEs) in a multidisciplinary system with a Computerized Pharmacotherapy Process (CPP) in cancer patients. DESIGN: A longitudinal, prospective 2-year (January 2003 -to December 2004) cohort study was made in adult patients administered antineoplastic treatment in Services of Oncology and Haematology. MEs were identified by double cross-validation of each stage of the pharmacotherapeutic process (prescription, preparation, dispensing, administration, and follow-up) carried out by the multidisciplinary team (physician, pharmacist, nurse) with CPP assistance. VARIABLES: Number of MEs per 1000 patient-days, percentage according to the stage of the pharmacotherapeutic process and the severity of intercepted ME (scored from 1 = no damage to the patient, to 5 = patient death). RESULTS: A total of 1311 patients were receiving treatment, and MEs were identified in 225. Out of a total of 13,158 patient-days, 276 MEs were detected, equivalent to 20.9 MEs per 1000 patient-days; of these, 16.8 MEs per 1000 patient-days (80%) were intercepted and did not affect any patient. The detected ME distribution according to pharmacotherapeutic stage was: prescription 75.7%, preparation 21.0%, dispensing 1.8%, administration 1.1%, and follow-up 0.4%. ME distribution according to severity was: grade 1 : 15.9%, grade 2 : 49.6%, grade 3 : 33.7%, grade 4 : 0.7%, and grade 5 : 0%. The system intercepted 98.9% of all MEs with severity >or=3 (MEs with a potential for causing patient damage). CONCLUSIONS: The multidisciplinary system with a well-established CPP detects 20.9 MEs per 1000 patient-days and intercepts 98.8% of all MEs with a potential for causing patient damage.

Errores de conciliación en el ingreso y en el alta hospitalaria en pacientes ancianos polimedicados. Estudio prospectivo aleatorizado multicéntrico / Reconciliation errors at admission and departure in old and polymedicated patients. Prospective, multicenter randomized study

Fundamento y objetivo: El objetivo del estudio es conocer la incidencia de los errores de conciliación en el ingreso y en el alta hospitalaria en pacientes ancianos polimedicados así como los factores de riesgo asociados. Pacientes y método: Estudio prospectivo aleatorizado y multicéntrico en el ingreso o en el alta hospitalaria. Cualquier discrepancia no justificada entre el tratamiento crónico y el prescrito en el hospital se consideró un error de conciliación. Resultados: Se incluyeron 603 pacientes, de los cuales 318 (52,7%) presentaron al menos un error de conciliación. De las 3.991 prescripciones, 2.340 prescripciones (59%) no mostraron discrepancias, mientras que 970 prescripciones (24%) fueron discrepancias justificadas y 644 prescripciones (16%) fueron discrepancias no justificadas; en 37 prescripciones (1%) no fue posible determinarlo. De las 644 discrepancias no justificadas, en 555 discrepancias, el médico las aceptó como error de conciliación (tasa de errores de conciliación del 13,9%). Discusión: El 52,7% de los pacientes ancianos polimedicados presentaron errores de conciliación durante su estancia hospitalaria, lo que implica el 13,9% de los medicamentos. La conciliación de la medicación debe ser un objetivo estratégico para mejorar la seguridad de los pacientes (AU)

Background and objective: The objective of this study was to know of the incidence rate of reconciliation errors in elderly poly-medicated patients. Patients and method: A prospective randomized multicenter study in a cohort of patients at admission or at discharge. Any unjustified discrepancy in medication between chronic treatment and the treatment prescribed in the hospital was considered as a Reconciliation Error. Results: From January 2006 to April 2008 603 patients were analyzed: 318 (52.7%) showed at least one Reconciliation Error. The patients had a total of 3.991 medications registered, 2.340 (59%) showed no discrepancies, 970 (24%) HAD justified discrepancies and 644 (16%) not justified; in 37 (1%) it was not possible to determine whether this was an error or not. Of the 644 unjustified discrepancies, 555 were accepted by the doctor as Reconciliation Errors. Reconciliation Error rate of 13.9%. Conclusion: According to this study, 52.7% of elderly poly-medicated patients have reconciliation errors during hospitalization. Medication reconciliation should be a strategic objective to increase the safety of patients (AU)

[Reconciliation errors at admission and departure in old and polymedicated patients. Prospective, multicenter randomized study]. / Errores de conciliación en el ingreso y en el alta hospitalaria en pacientes ancianos polimedicados. Estudio prospectivo aleatorizado multicéntrico.

BACKGROUND AND OBJECTIVE: The objective of this study was to know of the incidence rate of reconciliation errors in elderly poly-medicated patients. PATIENTS AND METHOD: A prospective randomized multicenter study in a cohort of patients at admission or at discharge. Any unjustified discrepancy in medication between chronic treatment and the treatment prescribed in the hospital was considered as a Reconciliation Error. RESULTS: From January 2006 to April 2008 603 patients were analyzed: 318 (52.7%) showed at least one Reconciliation Error. The patients had a total of 3.991 medications registered, 2.340 (59%) showed no discrepancies, 970 (24%) HAD justified discrepancies and 644 (16%) not justified; in 37 (1%) it was not possible to determine whether this was an error or not. Of the 644 unjustified discrepancies, 555 were accepted by the doctor as Reconciliation Errors. Reconciliation Error rate of 13.9%. CONCLUSION: According to this study, 52.7% of elderly poly-medicated patients have reconciliation errors during hospitalization. Medication reconciliation should be a strategic objective to increase the safety of patients.

Conciliación de la medicación / Conciliation in medication

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Pharmaceutical validation as a process of improving the quality of antineoplastic treatment.

OBJECTIVE: To quantify the improvement added by standardization of pharmaceutical validation (PV) of antineoplastic treatment to the processes of prescription and preparation of the pharmacotherapeutic sequence, in terms of prevention and reduction of medication errors (ME). DESIGN: Prospective cohort study during two years (from 2001-2002) for oncohaematologic patients (inpatients and outpatients) that compared the percentage of medication errors detected and resolved and the number of medication errors with potential clinical significance (severity value >or=4) intercepted during PV in both years. RESULTS: During the PV processes, 202 ME were identified and resolved, which is the equivalent of 16.88 ME/1,000 patient-days. In 2001 14.08 ME/1,000 patient-days were detected and 19.83 ME/1,000 patient-days in 2002. This means that the effectiveness of the identification method increased by 41%. The number of ME intercepted with clinical significance (severity value >or=4) increased in a statistically significant manner by 2.18 times in 2002. CONCLUSION: This study shows that the standardization of PV is an effective method of improving the quality of antineoplastic treatment use, by increasing the ability to intercept ME.