[Prescription and preparation of parenteral nutrition at Spanish hospitals]. / Prescripción y elaboración de nutrición parenteral en los hospitales españoles.

OBJECTIVE: To identify habits related to prescription and preparation of parenteral nutrition in Spain and their adequacy to current recommendations. METHOD: A questionnaire was administered in order to collect information about the characteristics of diets used at each hospital and the way they were prepared. The questionnaire was available through the web page of the Spanish Society of Hospital Pharmacy. RESULTS: Forty five hospitals answered the questionnaire. More than 90% of the hospitals reported that they used diets with a fixed or standard composition and 66.6% reported that they bought diets available in the market with a defined composition. Fifty seven point five per cent of the hospitals always prepared "all in one" parenteral nutrition and 37.5% prepared them only for adults. A 5% provided the lipids separately, both for adults and for children. Forty five per cent of the hospitals reported that they did not use organophosphates as source of phosphate. Almost 60% alternate the introduction of vitamins and trace elements. Differences were also found regarding the type of lipids provided and the use of filters. Most hospitals used multi-layer bags and photoprotection. CONCLUSIONS: There is quite a lot of diversity in the patterns of prescription and preparation of parenteral nutrition in our country. Further consensus documents should be written about these topics.

[Cytostatic prescription errors: an analysis of causes, and proposals regarding their prevention]. / Errores de prescripción en citostáticos: análisis de sus causas y propuestas para prevenirlos.

OBJECTIVE: To collect and analyze prescription errors for parenterally-administered cytostatic drugs, to identify causes from results obtained, and to suggest feasible solutions to prevent them. METHOD: In our hospital, parenterally-administered cytotoxic drugs are prepared in the Pharmacy Department, where 100% of prescriptions are validated with the help of a software program. Prescription errors detected at validation over a 2-year period of time were recorded in a specific form to facilitate analysis. RESULTS: In all, 292 possible errors were detected and 183 were confirmed; most resulted from dosing errors, followed by incorrect treatment duration. Other errors detected included: dose or drug omitted, wrong administration route, wrong patient, and wrong medication. The following measures were suggested: improvement of the data processing system at the Pharmacy Department, implementation of an electronic prescription system, continuous updating of cytostatic therapy protocols, and inclusion of cytostatic prescription recommendations within Pharmacotherapeutic Guidelines. CONCLUSION: Most common errors included doses above or below the correct ones, with the primary cause being poor handwriting in manual prescriptions. Active recording of prescription errors is essential if an analysis of real causes in our setting is to be undertaken, as well as to making proposals and implementing definite solutions.

[Influence of antiretroviral therapy characteristics on pediatric patient adherence]. / Influencia de las características del tratamiento antirretroviral en la adherencia del paciente pediátrico.

OBJECTIVE: To analyze difficulties in achieving optimal adherence to antiretroviral therapy as perceived by pediatric patient caregivers in relation to treatment characteristics. METHODS: Design of a subjective numeric scale-based questionnaire, and its administration to caregivers of pediatric patients undergoing active antiretroviral therapy in our hospital, after verbal informed consent for interviewing. The questionnaire aimed to assess on a scale from 0 (no difficulty for adherence) to 5 (maximal difficulty) a number of treatment-related factors: a) number of drugs and dosage regimen; b) organoleptic properties of drugs; c) treatment administration; d) adverse events; and e) antiretroviral therapy effectiveness perceived by caregiver. The questionnaire was proposed to all caregivers, and was performed by a pharmacist in a private space within the pharmacy department. RESULTS: The questionnaire was administered to 28 caregivers of the 32 pediatric patients undergoing active antiretroviral therapy. The following factors were evaluated as entailing moderate difficulties: smell, deglutition, and the immediate gastrointestinal adverse effects of protease inhibitors in liquid dosage form. The only factor evaluated as entailing great difficulty was protease inhibitors flavour in the liquid dosage form. Therapy effectiveness perception was evaluated as high. CONCLUSIONS: According to the overall results from our survey, caregivers evaluated the following factors as entailing moderate to high difficulties for correct adherence: number of drugs in the antiretroviral combination, organoleptic properties (smell, taste) of protease inhibitors (PI), PI-related deglutition problems, and PI-related immediate gastrointestinal adverse events. These factors may be considered potential obstacles for adequate adherence to antiretroviral therapy in pediatric patients.