[Perioperative conflicts between anaesthesiologists and surgeons: ethics and professionalism]. / Conflits en période périopératoire: un enjeu collectif, éthique et professionnel.

In the perioperative period, several potential conflicts between anaesthetists/intensive care specialists and surgeons may exist. They are detrimental to the quality of patient care and to the well-being of the teams. They are a source of medical errors and contribute to burn-out. Patients can become the victims of such conflicts, which deserve ethical reflection. Their resolution through analysis and shared solutions is necessary. This article seeks to analyse these conflicts, taking into account their specificities and constraints. In order to understand this context, it is important to consider the specificities of each group involved and the records of such situations. Several factors can prevent these conflicts, first and foremost the patients themselves and the quality of the care that is provided. Medical deontology aims mainly at preventing and resolving these conflicts. Generally speaking, the quality approach which is increasingly applied in health care institutions (involving declarations of adverse events, morbidity/mortality reviews, benchmarking, analysis and improvement of practices, etc.) also contributes to the prevention and resolution of disagreements. The teaching of communication techniques that begins with the initial training, the evaluation of team behaviours (through simulation training for example), the respect of others' constraints, particularly when it comes to learning, as well as transparency regarding conflicts of interests, are all additional elements of conflict prevention. Lastly, conflicts may at times be caused by deviant behaviours, which must be met with a clear and uncompromising collective and institutional approach. This article concludes by offering a standardised approach for conflict resolution.

Critical appraisal of organ procurement under Maastricht 3 condition.

The ethics committee of the French Society of Anesthesia and Intensive Care (Sfar) has been requested by the French Biomedical Agency to consider the issue of organ donation in patients after the decision to withdraw life-supportive therapies has been taken. This type of organ donation is performed in the USA, Canada, the United Kingdom, the Netherlands and Belgium. The three former countries have published recommendations formalizing procedures and operations. The French Society of Anesthesia and Intensive Care (Société française d'anesthésie et de reanimation [Sfar]) ethics committee has considered this issue and envisioned the different aspects of the whole process. Consequently, it sounded a note of caution regarding the applicability of this type of organ procurement in unselected patients following a decision to withdraw life-supportive therapies. According to French regulations concerning organ procurement in brain-dead patients, the committee stresses the need to restrict this specific way of procurement to severely brain-injured patients, once confirmatory investigations predicting a catastrophic prognosis have been performed. This suggests that the nature of the confirmatory investigation required should be formalized by the French Biomedical Agency on behalf of the French parliamentarians, which should help preserve population trust regarding organ procurement and provide a framework for medical decision. This text has been endorsed by the Sfar.

[Analysis of the implementation of safety practices in the automated medication dispensing cabinets]. / Análisis de la implantación de prácticas seguras en los sistemas automatizados de dispensación de medicamentos.

OBJECTIVE: To determine the degree of implementation of recommended safety practices in the design and use of automated medication dispensing cabinets (ADCs) in Spanish hospitals. METHODS: A descriptive study based on completion of the "Self- Evaluation Survey on the Safety of Automated Medication Dispensing Systems" from 10/10/2012 to 4/10/2013, at voluntarily participating hospitals. The survey contained 93 items grouped into 14 core processes. RESULTS: In the 36 participating hospitals the average score for the completed survey was 307.8 points (66.2% of the highest possible score [LC 95% CI: 63.2-69.2]). The lowest scores were obtained for core processes 9, 12, 13, 8, 3, 4 and 11 referring to the establishment of guidelines for medication removed using the override function (28.4%), training for healthcare professionals (52%), risk management (53%), defining removal procedures (55.3%), use of ADCs in connection with electronic prescribing (60.9%), information that appears on ADC screens (61.8%) and eliminating medications being returned to ADCs (63.9%), respectively. The hospitals that used ADCs in connection with electronic prescribing as their principal system for distribution presented a higher level of implantation of safety practices than those that used ADCs as a complementary distribution system. CONCLUSIONS: ADC installation has been accompanied by the implementation of various safety practices, but there are still numerous areas of risk for which technical, organizational, and system monitoring safety practices must be added in order to minimize errors with this technology.

Objetivo: Conocer el grado de implantación de las prácticas seguras recomendadas para el diseño y utilización de los sistemas automatizados de dispensación (SAD) de medicamentos en los hospitales españoles. Método: Estudio descriptivo que se basó en la cumplimentación voluntaria del "Cuestionario de autoevaluación de la seguridad de los sistemas automatizados de dispensación de medicamentos", entre el 10-10-2012 y el 10-4-2013. El cuestionario contiene 93 puntos de evaluación agrupados en 14 procedimientos esenciales. Resultados: En los 36 hospitales participantes la puntuación media del cuestionario fue de 307,8 puntos (66,2% del valor máximo posible [LC 95%: 63,2-69,2]). Los valores porcentuales más bajos se obtuvieron de menor a mayor en los procedimientos esenciales 9, 12, 13, 8, 3, 4 y 11, referentes al establecimiento de directrices para las retiradas excepcionales de medicamentos (28,4%), formación a los profesionales (52%), gestión de riesgos (53%), definición de los procedimientos de retirada (55,3%), uso de SAD conectados a prescripción electrónica (60,9%), información que aparece en pantalla (61,8%) y eliminación de la devolución de medicamentos a los SAD (63,9%), respectivamente. Los hospitales que utilizaban SAD con conexión a prescripción electrónica como sistema principal de distribución presentaron un mayor grado de implantación de prácticas seguras que los que usaban SAD como sistema complementario. Conclusiones: La instalación de los SAD se ha acompañado de la implantación de varias prácticas seguras, pero existen numerosas áreas de riesgo en las que es necesario establecer prácticas de tipo técnico, organizativo y de monitorización del sistema para minimizar los errores con esta tecnología.

Líquido peritoneal turbio acelular y uso de antagonistas del calcio en diálisis peritoneal / Turbid acellular peritoneal fluid and the use of calcium antagonists in peritoneal dialysis

El líquido peritoneal turbio acelular de etiología no infecciosa es una entidad poco frecuente en diálisis peritoneal y se caracteriza por una concentración elevada de triglicéridos en el líquido peritoneal. Las causas más comunes son las neoplasias, las obstrucciones linfáticas, las pancreatitis, los traumatismos y se ha relacionado también con el uso de algunos fármacos, como los antagonistas del calcio. Las series con un mayor número de casos se han comunicado en población asiática. Recientemente hemos diagnosticado en nuestro centro 4 casos de líquido peritoneal turbio acelular relacionado con el uso de antagonistas del calcio. Nos planteamos revisar las características principales de los casos y estudiar la relación del antagonista del calcio con los niveles de triglicéridos en el líquido peritoneal de los pacientes estables en diálisis peritoneal durante el año 2010. De los cuatro enfermos con líquido peritoneal turbio acelular, el 75 % eran varones y el 75 % estaban en tratamiento con manidipino; en todos los casos se resolvió el problema con la retirada del fármaco. Los niveles de triglicéridos medios fueron de 314 mg/dl. Los niveles medios de triglicéridos de 36 pacientes estables de diálisis peritoneal fueron de 8,1 mg/dl, con un intervalo entre 1 y 35 mg/dl. La media de triglicéridos en los pacientes con o sin tratamiento con antagonistas del calcio fue muy similar: 7,81 y 8,6 mg/dl, respectivamente. No se observaron diferencias en relación con el tipo de antagonista del calcio prescrito. En nuestra experiencia, creemos que los antagonistas del calcio deben ser considerados como causa de líquido peritoneal turbio acelular en los enfermos en diálisis peritoneal, en especial el manidipino. No consideramos útil la determinación de triglicéridos en el líquido peritoneal de los enfermos asintomáticos en tratamiento con antagonistas del calcio (AU)

Turbid acellular peritoneal fluid of a non-infectious aetiology is an uncommon entity in peritoneal dialysis and is characterised by a high concentration of triglycerides in the peritoneal fluid. The most common causes include cancer, lymphatic obstructions, pancreatitis, trauma, and even the use of certain medications such as calcium antagonists. The largest studies concerning this entity have been carried out in patients of Asian descent. We recently diagnosed 4 cases of turbid acellular peritoneal fluid at our institution in relation to the use of calcium antagonists. We reviewed the primary characteristics of these cases and examined the relationship between the use of calcium antagonists and triglyceride levels in the peritoneal fluid of stable patients on peritoneal dialysis during 2010. Of the four patients with turbid acellular peritoneal fluid, 75% were male and 75% were on treatment with manidipine; in all cases, the issue was resolved by suspending medication. Mean triglyceride levels were 314mg/dl. Mean triglyceride levels in 36 stable patients on peritoneal dialysis were 8.1mg/dl, with a range of 1-35mg/dl. Mean triglyceride levels in patients with and without calcium antagonist treatment were very similar, at 7.81mg/dl and 8.6mg/dl, respectively. We did not observe significant differences in terms of the type of calcium antagonist prescribed. In our experience, we believe that calcium antagonists should be considered as a cause of turbid acellular peritoneal fluid in patients on peritoneal dialysis, in particular manidipine. We do not find it useful to determine triglyceride levels in the peritoneal fluid of asymptomatic patients on treatment with calcium antagonists (AU)

Turbid acellular peritoneal fluid and the use of calcium antagonists in peritoneal dialysis.

Turbid acellular peritoneal fluid of a non-infectious aetiology is an uncommon entity in peritoneal dialysis and is characterised by a high concentration of triglycerides in the peritoneal fluid. The most common causes include cancer, lymphatic obstructions, pancreatitis, trauma, and even the use of certain medications such as calcium antagonists. The largest studies concerning this entity have been carried out in patients of Asian descent. We recently diagnosed 4 cases of turbid acellular peritoneal fluid at our institution in relation to the use of calcium antagonists. We reviewed the primary characteristics of these cases and examined the relationship between the use of calcium antagonists and triglyceride levels in the peritoneal fluid of stable patients on peritoneal dialysis during 2010. Of the four patients with turbid acellular peritoneal fluid, 75% were male and 75% were on treatment with manidipine; in all cases, the issue was resolved by suspending medication. Mean triglyceride levels were 314 mg/dl. Mean triglyceride levels in 36 stable patients on peritoneal dialysis were 8.1mg/dl, with a range of 1-35 mg/dl. Mean triglyceride levels in patients with and without calcium antagonist treatment were very similar, at 7.81 mg/dl and 8.6 mg/dl, respectively. We did not observe significant differences in terms of the type of calcium antagonist prescribed. In our experience, we believe that calcium antagonists should be considered as a cause of turbid acellular peritoneal fluid in patients on peritoneal dialysis, in particular manidipine. We do not find it useful to determine triglyceride levels in the peritoneal fluid of asymptomatic patients on treatment with calcium antagonists.

[Critical appraisal of organ procurement under Maastricht 3 condition]. / Analyse critique du prélèvement en condition M3 de Maastricht.

The ethics committee of the French Society of Anesthesia and Intensive Care (Sfar) has been requested by the French Biomedical Agency to consider the issue of organ donation in patients after a decision of withdrawing life supporting therapies has been taken. This category of organ donation is performed in the USA, Canada, United Kingdom, the Netherlands and Belgium. The three former countries have published recommendations, which formalize procedures and operations. The Sfar ethics committee has considered this issue and envisioned the different aspects of the whole process. Consequently, it sounds a note of caution regarding the applicability of this type of organ procurement in unselected patient following a decision to withdraw life supporting therapies. According to the French regulation concerning organ procurement in brain dead patients, the committee stresses the need to restrict this specific way of procurement to severely brain injured patients, once confirmatory investigations predicting a catastrophic prognosis have been performed. It suggests that the nature of the confirmatory investigation required should be formalized by the French Biomedical Agency on behalf of the French parliamentarians. This should help preserving population trust regarding organ procurement and provide a framework to medical decision. This text has been endorsed by the Sfar.

Aplicabilidad clínica de dos índices pronósticos de mortalidad precoz en pacientes añosos incidentes en hemodiálisis: escaso acierto predictivo en el paciente individual / Two prognostic scores for early mortality and their clinical applicability in elderly patients on haemodialysis: poor predictive success in individual patients

Introducción: Existen pocos estudios sobre el pronóstico individual del paciente añoso que inicia hemodiálisis (HD) crónica, pese a que frecuentemente se plantea el dilema entre el posible beneficio y la carga que supone el propio tratamiento. Objetivos: Evaluar la utilidad del índice pronóstico del Registro REIN (REIN) y del modelo predictivo de mortalidad precoz del Registre de Malalts Renals de Catalunya (RMRC) en pacientes añosos incidentes en HD al compararlos con la supervivencia observada. Métodos: Se estudiaron los pacientes mayores de 75 años que iniciaron y siguieron HD en nuestro Servicio entre 2004-2009. Se recogieron variables sociodemográficas, clínicas, comorbilidad, mortalidad y si el inicio de HD fue planificado o no. Se calculó el índice REIN y la probabilidad de mortalidad precoz del RMRC. Resultados: Se analizaron 63 pacientes de una edad media de 80,4 ± 3,9 años, con un número de enfermedades añadidas de 3,4 ± 1,8. Un 59% iniciaron HD por un catéter, un 57,1% tenían enfermedad cardiovascular, el 15,9% neoplasia, el 31,2% enfermedad pulmonar obstructiva crónica y el 19% nefropatía diabética. La supervivencia observada a los 6 y a los 12 meses fue de 79,4 y 73%, respectivamente. Los pacientes que no se valían por sí mismos (21%) presentaban una mayor mortalidad a los 6 meses. El análisis de las curvas ROC (Receiver Operating Characteristic) mostró una escasa concordancia entre la mortalidad observada y los índices REIN (área 0,681, p = 0,046) y RMRC (área 0,594, p = 0,255). Conclusiones: El índice de probabilidad de mortalidad al año del RMRC es poco útil en la práctica clínica para el pronóstico individual. El índice REIN es sólo ligeramente concordante con la mortalidad observada en los primeros 6 meses de HD. Una pobre autonomía funcional fue el principal factor de riesgo de mortalidad precoz en los pacientes añosos que inician HD (AU)

Introduction: Few studies address the individual prognosis of an elderly patient beginning chronic haemodialysis (HD), despite the fact that doctors must frequently weigh the possible benefits and disadvantages of prescribing this treatment. Objectives: Evaluate the usefulness of the REIN Registry’s prognosis score and the predictive index for early mortality proposed by the Catalan Registry of Renal Patients (RMRC, Registre de Malalts Renals de Catalunya) in elderly patients beginning HD by comparing indices with observed survival rates. Methods: We studied patients aged 75 years and older who started and continued HD treatment in our Department between 2004 and 2009. Socio-demographic, clinical, co-morbidity and mortality data were recorded, in addition to whether or not initiating HD was planned. We calculated the REIN score and the RMRC probability of early mortality. Results: We analysed 63 patients with a mean age of 80.4±3.9 years and a mean of 3.4±1.8 additional illnesses. Of these patients, 59% began HD with a catheter; 57.1% had cardiovascular disease, 15.9% neoplasia, 31.2% chronic obstructive pulmonary disease and 19% diabetic nephropathy. Survival rates observed at 6 and at 12 months were 79.4% and 73%, respectively. Patients who began HD on an emergency basis (47.7%) or who were unable to care for themselves (21%) had higher 6-month mortality rates. Analysis of ROC curves (Receiver Operating Characteristic) showed slight concordance between the observed mortality rates and both the REIN score (area 0.681, P=.046) and the RMRC index (area 0.594, P=.255). Conclusions: The RMRC 1-year mortality probability model is not well adapted for individual prognoses in clinical practice. The REIN score only shows slight concordance with the mortality rates observed in the first 6 months of HD. Poor functional independence was the main risk factor for early mortality in elderly patients begining HD treatment

Two prognostic scores for early mortality and their clinical applicability in elderly patients on haemodialysis: poor predictive success in individual patients.

INTRODUCTION: Few studies address the individual prognosis of an elderly patient beginning chronic haemodialysis (HD), despite the fact that doctors must frequently weigh the possible benefits and disadvantages of prescribing this treatment. OBJECTIVES: Evaluate the usefulness of the REIN Registry's prognosis score and the predictive index for early mortality proposed by the Catalan Registry of Renal Patients (RMRC, Registre de Malalts Renals de Catalunya) in elderly patients beginning HD by comparing indices with observed survival rates. METHODS: We studied patients aged 75 years and older who started and continued HD treatment in our Department between 2004 and 2009. Socio-demographic, clinical, co-morbidity and mortality data were recorded, in addition to whether or not initiating HD was planned. We calculated the REIN score and the RMRC probability of early mortality. RESULTS: We analysed 63 patients with a mean age of 80.4 +/- 3.9 years and a mean of 3.4 +/- 1.8 additional illnesses. Of these patients, 59% began HD with a catheter; 57.1% had cardiovascular disease, 15.9% neoplasia, 31.2% chronic obstructive pulmonary disease and 19% diabetic nephropathy. Survival rates observed at 6 and at 12 months were 79.4% and 73%, respectively. Patients who began HD on an emergency basis (47.7%) or who were unable to care for themselves (21%) had higher 6-month mortality rates. Analysis of ROC curves (Receiver Operating Characteristic) showed slight concordance between the observed mortality rates and both the REIN score (area 0.681, P=.046) and the RMRC index (area 0.594, P=.255). CONCLUSIONS: The RMRC 1-year mortality probability model is not well adapted for individual prognoses in clinical practice. The REIN score only shows slight concordance with the mortality rates observed in the first 6 months of HD. Poor functional independence was the main risk factor for early mortality in elderly patients beginning HD treatment.

[Health care models for patients with multiple chronic conditions and the role of the hospital pharmacy/the hospital pharmacist]. / Modelos de atención al paciente pluripatológico y el papel de la farmacia hospitalaria.

INTRODUCTION: Managing care for patients with chronic conditions currently represents one of the greatest challenges to health care systems. As a subgroup of these patients, those with multiple chronic conditions are at greater risk for death or disability, and they consume more resources. They are characterized by the coexistence of two or more chronic illnesses lasting a year or longer which require ongoing medical attention and/or interfere with their daily activities. For these polypathological patients pharmaceutical care would be of special benefit, thus, their needs should be a priority objective for hospital pharmacy. OBJECTIVE: To increase awareness of this type of patients and the characteristics of the principal approaches and health care models proposed to improve chronic disease management, as well as to emphasize the urgency for hospital pharmacists to join these models, and to present various activities that pharmacists might carry out as an integral part of these approaches. RESULTS: Numerous models exist internationally, including the Chronic Care Model and the Kaiser Permanente pyramid of risks. In our country a growing number of initiatives has culminated in the recent Seville Declaration. For the hospital pharmacy, caring for the chronically ill patient following a model that is multi-professional, cooperative, integral, and patient centered, is an enormous task. Pharmacy departments and the Spanish Society of Hospital Pharmacy should reorient their strategies for pharmaceutical care, training, and research. Of special interest are those activities designed to improve adherence, adequacy, and continuity in treatments, all the while emphasizing active patient participation.

Development of a list of look-alike drug names with recommended tall man letters.

OBJECTIVE: To develop a list of look-alike drug names with tall man letters, which will facilitate and standardize the implementation of this technique in safety practices designed to reduce errors caused by look-alike names. MATERIAL AND METHODS: Two structured surveys were carried out. The first survey included 46 pairs, groups, or individual look-alike drug names with tall man letters from the lists established by the FDA, ISMP and CAPCA/ISMP-Canada, and 32 selected from ISMP-Spain and the COF Council database. The second survey included 27 proposals made by those respondents who completed the first survey and 11 from the ISMP updated list. Participants were asked about the usefulness and current implementation of the technique. Ninety pharmacists from different hospitals participated in the first survey and 89 in the second. RESULTS: The list of look-alike drug names with tall man letters which has been developed includes 107 names structured into 44 pairs or groups. Of the respondents, 93.3% felt that this technique should be implemented for identifying medications, not only on pharmaceutical industry labels (91.1%) but also in other places where drug names appear, such as computerized prescription screens (90%), pharmacy system screens (82.2%), automated dispensing cabinet screens (81.1%), labels for pharmacy preparations and shelves, etc. Only 9 hospitals (10%) were using this technique. CONCLUSIONS: The availability of this list of look-alike drug names for which tall man lettering is recommended may encourage the use of this technique for differentiating names in Spain where it is currently not greatly used.

[Updated classification for medication errors by the Ruiz-Jarabo 2000 Group]. / Actualización de la clasificación de errores de medicación del grupo Ruiz-Jarabo 2000.

OBJECTIVE: To update the classification system created by the Ruiz-Jarabo 2000 group to standardize detection, analysis, and recording of medication errors, with the aim of improving its capacity and functionality. METHOD: The classification update was carried out by the Ruiz-Jarabo 2000 working group considering: a) other classifications used by incident reporting systems initiated after the original version had been created; b) suggestions offered by healthcare professionals with respect to the original version; and c) the experiences of the working group itself based on analyses of medication errors gathered in hospitals, and on analyses of reports notified to the ISMP-Spain medication error reporting and learning program. RESULTS: This article presents the updated version of the medication error classification system and describes the main changes made on to the different sections and categories. CONCLUSIONS: The new version may prove to be a useful tool for analyzing and reporting errors with regard to those detected within the framework of activities for improving safety in hospitals and primary care, as well as for those detected as a direct result of patient safety research. Thus, this document is expected to improve medication safety information management in such a way as to allow data to be used ever more efficiently for making medication use systems safer for patients.

[Assessment of safety practices for medication-use systems in Spanish hospitals (2007)]. / Evaluación de las prácticas de seguridad de los sistemas de utilización de medicamentos en los hospitales españoles (2007).

BACKGROUND AND OBJECTIVE: To examine the current status of safety practices for medication-use systems in Spanish hospitals and to identify major areas of risk. MATERIAL AND METHOD: Those hospitals that completed the "Medication use-system safety self-assessment for hospitals" between June 1 and July 15, 2007, were included in the study. The survey contained 232 items for evaluation grouped into 20 core characteristics. RESULTS: A total of 105 hospitals from the 17 autonomous communities in Spain participated in the study. The average aggregate score for the survey of all the participating hospitals was 612.7 (39.7% of the maximum possible score) and there were no differences found with regard to number of beds, training activity or type of hospital. When core characteristics were analyzed, there were 3 criteria with the lowest values (< 25%), associated with professional training, skills, and the establishment of a system for reporting errors. Another 9 criteria, with percentages between 25% and 50%, reflected practices related to: access to information regarding patients and medications; communication of medication orders; prevention of errors due to naming, labeling, and packaging problems; standardization of medication delivery devices; restriction of medications in patient care units; and safety culture and double-checking procedures. CONCLUSIONS: Many opportunities for improvement have been identified, particularly in areas related to training, risk management, incorporating new technologies and patient participation. The information obtained may prove useful for prioritizing practices when establishing patient safety strategies, and as a baseline for successfully monitoring the effectiveness of the initiatives and programs consequently set into motion.

[Prevalence and factors associated with preventable adverse drug events leading to hospital admission]. / Prevalencia y factores asociados a los acontecimientos adversos prevenibles por medicamentos que causan el ingreso hospitalario.

OBJECTIVE: To determine the prevalence of adverse drug events (ADEs) leading to hospital admission, and to assess those that were potentially preventable, identifying the drug classes involved, types of medication errors and the factors associated with the preventable ADEs. METHOD: An observational study, over a six-month period on ADEs that lead or contributed to hospital admissions, carried out in 6 medical units of a university hospital. RESULTS: A total of 259 ADEs were detected of which 159 (61.4%) were assessed to be potentially preventable. The overall prevalence of admissions directly due to ADEs was of 6.7% (177) and to preventable ADEs of 4.7% (125). In addition, 82 ADEs that contributed to hospital admission were detected. Risk factors for preventable ADEs were patient age of 65-74 (OR = 1.40) or = 75 years (OR = 2.70), self-medication (OR = 15.55), prescription in primary care (OR = 2,88) and the use of narrow therapeutic index drugs (OR = 2.40). The drug classes most frequently involved in preventable ADEs were NSAID and aspirin (32.5%), diuretics (15.3%), antihypertensives (9.1%) and digoxin (7.7%). Inadequate therapy monitoring (20.7%), prescription of an inappropriate drug (15.7%) or of an excessive dosage (12.0%), lack of preventive treatment (15.7%), non-adherence (10.6%) and inappropriate self-medication (10.1%) were the most commonly identified types of error. CONCLUSIONS: A high proportion (4.7%) of hospital admissions are caused by potentially preventable ADEs. Results obtained justified the need to adopt measures directed at improving surveillance and prescription quality, and educating patients in safe drug use, focusing especially on older patients and narrow therapeutic index drugs.

[Medication errors: standarizing the terminology and taxomany. Ruiz Jarabo 2000 grand results]. / Errores de medicación: estandarización de la terminología y clasificación. Resultados de la beca Ruiz Jarabo 2000.

OBJECTIVE: To make available a consistent terminology and taxonomy that permits standardization in medication error detection, analysis, classification, and recording. METHODS: A working group consisting of healthcare professionals from four hospitals of varying characteristics was established to develop the terminology and the taxonomy, which was validated through a qualitative analysis of 423 medication errors registered in the participating hospitals. RESULTS: A document with a terminology and a taxonomy for classifying medication errors is presented. CONCLUSIONS: This document will facilitate analysis of the information collected on incidents caused by medication, and will allow comparisons to be made among data gathered in different kinds of settings. In addition, it will be a useful tool for medication safety committees in hospitals in their efforts to set up internal reporting programs designed to identify shortcomings in their medication use systems and to adopt effective measures to reduce the incidence of medication errors.