[Causes and factors associated with reconciliation errors in medical and surgical services]. / Causas y factores asociados a los errores de conciliación en servicios médicos y quirúrgicos.

OBJECTIVE: The objective of this study was to determine the main causes of errors of medication reconciliation at hospital admission in medical and surgical department and establish factors associated with medication reconciliation errors. MATERIAL AND METHOD: Cross-sectional study. We included all patients admitted to two services and two surgical for a month. To determine the presence of error reconciliation, the pharmacist compared the medication history interview by the order physician. The factors associated with errors were identified by multivariate logistic regression analysis. RESULTS: 221 patients were included, of which 58.4% had at least one error reconciliation. We detected 629 discrepancies, 339 (53.9%) reconciliation errors. The incidence of errors in medical services was 24.3% and in the surgical services 43.0% (p <0.001) in both groups being most prevalent error of omission (46.2% and 50.8%). Regarding factors associated, the equation determines that patients older than 65 years, polymedicated and taking oral antidiabetic are more likely to have an error with a sensibility of 75.2% and a specificity of 68.5%. CONCLUSION: There is a high rate of error reconciliation in medical and surgical patients, which confirms the need to implement a strategy to reduce these errors. Given the difficulty of applying the process to all patients, the strategy must be directed to patients who are at increased risk of error.

Objetivo: Determinar las principales causas de errores de conciliacion de la medicacion al ingreso hospitalario tanto en los servicios medicos, como en los quirurgicos y que factores se asocian a dichos errores de conciliacion. Material y método: Estudio observacional transversal. Se incluyeron todos los pacientes que ingresaron en dos servicios medicos y dos quirurgicos durante un mes. Para determinar la presencia de error de conciliacion se cotejo la historia realizada por el farmaceutico con la del medico prescriptor. Los factores asociados a los errores se identificaron mediante un analisis de regresion logistica multivariante. Resultados: Se incluyeron 221 pacientes, de los cuales el 58.4% presentaron al menos un error de conciliacion. Se detectaron un total de 629 discrepancias, 339 (53.9%) errores de conciliacion. La incidencia de errores en los servicios medicos fue del 24.3% y en los quirurgicos del 43.0% (p.

Causas y factores asociados a los errores de conciliación en servicios médicos y quirúrgicos / Causes and factors associated with reconciliation errors in medical and surgical services

Objetivo: Determinar las principales causas de errores de conciliación de la medicación al ingreso hospitalario tanto en los servicios médicos, como en los quirúrgicos y que factores se asocian a dichos errores de conciliación. Material y método: Estudio observacional transversal. Se incluyeron todos los pacientes que ingresaron en dos servicios médicos y dos quirúrgicos durante un mes. Para determinar la presencia de error de conciliación se cotejo la historia realizada por el farmacéutico con la del médico prescriptor. Los factores asociados a los errores se identificaron mediante un análisis de regresión logística multivariante. Resultados: Se incluyeron 221 pacientes, de los cuales el 58.4%presentaron al menos un error de conciliación. Se detectaron un total de 629 discrepancias, 339 (53.9%) errores de conciliación. La incidencia de errores en los servicios médicos fue del 24.3% y en los quirúrgicos del 43.0% (p<0.001) siendo en ambos grupos el error más prevalente el de la omisión (46.2% y 50.8%).En cuanto a los factores asociados, la ecuación determina que los pacientes mayores de 65 años, polimedicados y que toman antidiabéticos orales tienen mas probabilidad de presentar un error con una sensibilidad del 75.2% y una especificidad del 68.5%. Discusión: Existe una elevada tasa de pacientes con error de conciliación tanto en pacientes médicos como quirúrgicos, lo que corrobora la necesidad de implantar una estrategia dirigida a la reducción de dichos errores. Ante la dificultad de aplicar el proceso a la totalidad de los pacientes, la estrategia debe ir dirigida a los pacientes que presentan un mayor riesgo de error

Objective: The objective of this study was to determine the main causes of errors of medication reconciliation at hospital admission in medical and surgical department and establish factors associated with medication reconciliation errors. Material and method: Cross-sectional study. We included all patients admitted to two services and two surgical for a month. To determine the presence of error reconciliation, the pharmacist compared the medication history interview by the order physician. The factors associated with errors were identified by multivariate logistic regression analysis. Results: 221 patients were included, of which 58.4% had at least one error reconciliation. We detected 629 discrepancies,339 (53.9%) reconciliation errors. The incidence of errors in medical services was 24.3% and in the surgical services 43.0%(p <0.001) in both groups being most prevalent error of omission(46.2% and 50.8%). Regarding factors associated, the equation determines that patients older than 65 years, polymedicated and taking oral ant diabetic are more likely to have an error with a sensibility of 75.2% and a specificity of 68.5%. Conclusion: There is a high rate of error reconciliation in medical and surgical patients, which confirms the need to implement a strategy to reduce these errors. Given the difficulty of applying the process to all patients, the strategy must be directed to patients who are at increased risk of error

Determination of reference values for serum folate and vitamin B12 using three different immunoassays: is it worth making an effort to produce them in our laboratory?

BACKGROUND: Despite being a widely studied concept, the reference interval is the most widely used medical decision-making tool. As such, it is vital that these limits are correctly established and regularly reviewed in the clinical laboratory. METHODS: The reference population comprised 315 healthy individuals selected a priori from Bizkaia province. Blood and serum samples were sent for subsequent assay of vitamin B12 and folate using three immunochemical methods. Reference values were calculated using non-parametric methods. RESULTS: The reference values for serum vitamin B12 and folate were almost identical to those obtained previously using the same methods. Use of new reference values led to an increase in the kappa value despite the low agreement in the case of vitamin B12 (0.4 - 0.62). However, precision obtained for vitamin B12 (94.48 - 96.55%) and folate (95.77 - 97.18%) was very high. The intraclass correlation coefficient ranged from 0.723 to 0.894. Furthermore, a Passing-Bablok regression analysis gave acceptable correlation coefficients of 0.75 - 0.94 for vitamin B12 and 0.92 - 0.95 for folate. CONCLUSIONS: Vitamin B12 and folate deficiencies are currently being over-diagnosed leading to an increase in the number of unnecessary consultations. The main conclusion that can be drawn from our study has resulted in a change in reference values in our laboratory, with a subsequent increase in our ability to accurately detect possible deficiencies. Furthermore, as this study involved all methods currently in use in the Basque healthcare network, its conclusions can be extrapolated to the whole population covered by Osakidetza, thereby improving the rational use of healthcare funding.

Evaluación de la utilización de heparinas de bajo peso molecularcomo profilaxis de tromboembolismo venoso en pacientes demedicina interna / No disponible

Introducción: Existe suficiente evidencia para recomendarla tromboprofilaxis rutinaria en pacientes médicos con factores de riesgo, siendo las heparinas de bajo peso molecular (HBPM) la opción más adecuada para realizarla. El objetivo es conocer el grado de riesgo de tromboembolismo venoso (TEV) en pacientes de medicina interna tratados con HBPM en profilaxis, los hábitos de prescripción y su adecuación al protocolo del hospital, así como detectar la prevalencia de pacientes no tratados con riesgo. Material y método: Estudio descriptivo y prospectivo de 2 meses de duración sobre los pacientes ingresados en medicina interna. Se reclutaron aquellos con prescripción profiláctica de HBPM y se determinó su grado de riesgo de TEV y la dosis de HBPM adecuada, según el “Protocolo de prevención de enfermedad tromboembólica” de nuestro hospital. Paralelamente se analizaron los pacientes no tratados para estimar si eran subsidiarios de profilaxis con HBPM. Resultados: Al 30% de los ingresados se le prescribió una HBPM profiláctica, de los que el 43,5% recibió una prescripción ajustada a su grado de riesgo. Sus factores de riesgo más destacados fueron: edad, encamamiento, HTA, cardiopatía de riesgo, diabetes mellitus, dislipemias y EPOC. El test c20,05 entre grado de riesgo y HBPM instaurada reveló que no existía asociación. Del grupo de pacientes no tratados, el 72% presentaron un nivel de riesgo moderado o alto. Conclusiones:1. Una gran proporción de los pacientes estudiados presentan nivel considerable de riesgo de TEV. 2. No se observa relación entre nivel de riesgo y profilaxis pautada (AU)

Background: Sufficient evidence exists to recommend routine thromboembolic disease prophylaxis for medical inpatients with risk factors -with low-molecular-weight- heparins being(LMWH) the most suitable treatment option. The objective is to determine the thromboembolic risk level of Internal Medicine patients with LMWH prophylaxis, prescription habits and the iradequacy to hospital’s standards, as well as prevalence of non treated patients at risk. Material and methods: Descriptive and prospective study of internal medicine patients for 2 months. Patients with prophylactic LMWH prescription were chosen, and their thrombo embolicrisk level and suitable LMWH dose was determined according to the hospital’s “thromboembolic disease prevention standards”.On the other hand, patients with no LMWH prophylaxis were analysed in order to judge their candidacy. Results: 30% of patients had a prophylactical LMWH prescription, with 43.5% of these prescriptions being adequate to the risk level. The main risk factors were: age, bed-stay, hypertension,cardiopathy with risk factors, diabetes mellitus, dislipemias and COPD. c20.05 test between risk level and prescribed LMWH revealed no association. 72% of patients without LMWH prescription had a moderate or high risk level. Conclusions:1. A high proportion of the patients studied have a considerable thromboembolic risk level.2. There is not a statistical relationship between thromboembolic risk level and LMWH prescription.3. There is a high percentage of patients with no LMWH prophylaxis which could be eligible for it.4. A pharmaceutical intervention would be useful to approachpharmacological prophylaxis to each patient’s risk (AU)

Biotransformation in vitro of the 22R and 22S epimers of budesonide by human liver, bronchus, colonic mucosa and skin.

The pharmacological effects of glucocorticoids are greatly influenced by their pharmacokinetic properties. In the present report, the in vitro biotransformation of the 22R and 22S epimers of the topical steroid budesonide was studied in the S-9 fraction of human liver, bronchus, skin and colonic mucosa. The disappearance of unchanged epimers of budesonide was measured during 90 min of incubation by high performance liquid chromatography. The rate of disappearance was high in human liver while little biotransformation occurred in bronchial tissue and colonic mucosa, and none was detected in the skin. A marked decay of the initial concentration of unchanged budesonide epimers was noticed after 2 h incubation in cultured human hepatocytes, while only a small decrease was observed after 24 h incubation in cultured human airway smooth muscle cells and BEAS-2B cells. The 22R epimer of budesonide suffered greater in vitro biotransformation than the 22S epimer in human hepatic, bronchial and colonic tissues. These findings extend those of other studies, and confirm that the high therapeutic ratio of budesonide is due to negligible local biotransformation combined with high level of liver metabolism for locally absorbed budesonide.