Abordaje interdisciplinar de la conciliación de la medicación crónica al ingreso en un hospital / An interdisciplinary approach to reconciling chronic medications on admission to Mora d’Ebre local hospital

Objetivos. Reducir los errores de medicación y evitar las interacciones y duplicidades mediante un programa de conciliación de la medicación crónica al ingreso. Crear una lista actualizada de medicamentos conciliados resolviendo las discrepancias antes de 24h del ingreso en planta. Garantizar la medicación necesaria a la dosis, vía e intervalos correctos según la situación clínica del paciente. Material, pacientes y métodos. Estudio observacional, prospectivo, no aleatorizado y no controlado durante el periodo de octubre 2008 a marzo 2009 (ambos incluidos) en un hospital comarcal de primer nivel, donde se concilió la medicación crónica con la del ingreso hospitalario a todos los pacientes ingresados que cumplían los criterios de inclusión. Resultados. Se incluyeron 469 pacientes, conciliándose 3.609 medicamentos de los cuales 2.466 (68,3%) tenían discrepancias: 667 (27,1%) no justificadas y 1.799 (72,9%) justificadas; no tenían discrepancias 1.143 (31,7%). Las discrepancias no justificadas mayoritarias fueron las omisiones de prescripción 662 (26,8%) y las duplicidades 5 (0,2%). En 640 (25,9%) ocasiones el error llegó al paciente sin ocasionar daños y solo en 4 (0,16%) fue precisa su monitorización. Discusión. Mediante el abordaje interdisciplinario del proceso de conciliación de la medicación crónica se han detectado y neutralizado muchos errores de medicación, se han resuelto las discrepancias, neutralizando omisiones, interacciones, duplicidades y se han eliminado los fármacos de bajo valor intrínseco farmacológico, registrándose en la historia clínica informatizada el listado de medicamentos conciliados(AU)

Objectives. To reduce medication errors and prevent interactions and duplications using a Chronic Medication Reconciliation Program on patient admission. To create an updated reconciled medications by resolving discrepancies within 24 hours of admission to the ward. To ensure the necessary medication is given at the dose, route and at the correct intervals depending on the clinical situation of the patient. Material, Patients and Methods. Prospective observational, non-randomised and uncontrolled study during the period from October 2008 to March 2009 (both included) in a primary level local hospital, in which all patients admitted to the hospital who met the inclusion criteria had their chronic medication reconciled on hospital admission. Results. A total of 469 patients were included, with 3609 medications being reconciled, of which 2466 (68.33%) had discrepancies: 667 (27.0%) unjustified and 1799 (72.9%) justified. There were no discrepancies in 1143 (31.6%). The majority of unjustified discrepancies were prescription omissions in 662 (26.8%) and duplications in 5 (0.2%). On 640 (25.9%) occasions the error reached the patient without causing any harm, and only 4 (0.16%) required monitoring. Discussion. Using an interdisciplinary approach in the reconciliation of chronic medication, many medication errors have been detected and neutralised. Discrepancies have been resolved, neutralising omissions, interactions and duplications. Drugs with a low intrinsic pharmacological value were withdrawn, and the list of reconciled medications recorded in the clinical notes(AU)

Medication errors resulting from computer entry by nonprescribers.

PURPOSE: The characteristics of medication errors associated with the use of computer order-entry systems by nonprescribers are discussed. METHODS: A retrospective analysis of records submitted to MEDMARX was conducted for the period from July 1, 2001, to December 31, 2005, to identify all computer-related medication errors made by nonprescribers. Quantitative analysis of the records included the severity of each error, the origin within the medication-use process, the type of error, principal causes, the location within the facility where the error was made, and the therapeutic drug classes frequently involved. Similar data from the University of Pittsburgh Medical Center (UPMC) were also analyzed and compared with the national data set. RESULTS: During the 4.5 years, 693 unique facilities submitted 90,001 medication error records that were the result of computer entry by nonprescribers. The national data set and the UPMC data had similar findings for error severity, error origin, and type of error but showed some differences in the rank ordering of error causes, location where the error occurred, and drug classes frequently associated with such errors. The percentage of harm associated with computer-entry errors was small for both the national data set and UPMC data (0.99% and 0.80%, respectively). Both data sets cited performance deficit as the leading cause of computer-entry errors, but large percentage differences were seen with other causes, including inaccurate or omitted transcription (30% versus 12.6%, respectively), documentation (19.5% versus 10.6%, respectively), and procedure or protocol not followed (21.7% versus 30.3%, respectively). Both data sets implicated the inpatient pharmacy department as the location where most computer-entry errors occurred (49.3% versus 69.0%, respectively). CONCLUSION: Analysis of the characteristics of medication errors associated with the use of computer-entry systems by non-prescribers from both MEDMARX and an individual health system database demonstrated that computer systems create new opportunities for errors to occur. Working closely with information technology personnel dedicated to assisting pharmacy departments and vendors, adequate training of pharmacy staff, and development of national standards for drug information displays in computer order-entry systems may help minimize such errors.

Implementing online medication reconciliation at a large academic medical center.

BACKGROUND: Most examples of successful medication reconciliation (MR) programs have reported on paper-based systems, the most common of which is a standardized MR form that often serves as a medication order form. An interdisciplinary process was undertaken by Bellevue Hospital, New York City, to develop a full, online MR program. PHASE 1. MOVING BEYOND PAPER: In 2005 Bellevue piloted a paper-based MR process. However, this effort was unsuccessful, so an online MR application that would be more accessible and easier to audit was initiated. The longitudinal outpatient medication list--the definitive, electronic medication list for patients in our system--formed the basis of the MR project. The list included every prescription written in the electronic health record (EHR). Historical medication could also be entered into the list, representing a useful function in the outpatient setting for patients who transfer their care to Bellevue and are already on chronic medications. In a two-month pilot in Summer 2006, compliance was achieved for only 20% of patients. PHASE 2. AUDITING AND MANDATORY FUNCTIONALITY: In April 2007, MR was made a mandatory part of the admission process; a blocking function in the EHR prevented medication orders if the admission MR had not been completed. Compliance rates subsequently increased to 90% throughout the hospital. To "close the loop" in the reconciliation process, in November 2007, a discharge reconciliation was made a mandatory part of the discharge process, resulting in 95% compliance. LESSONS LEARNED: Successful implementation of admission and discharge MR suggested several lessons, including (1) mandatory functionality leads to adaptation and integration of MR into housestaff work flows and (2) an electronic MR is preferable to a paper-based process in organizations with an EHR and computerized physician order entry.

Coordinación internivel: proceso clave para la calidad asistencial / Inter-level coordination: key procedure for quality of care

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Inter-rater reliability of a classification system for hospital adverse drug event reports.

Hospital pharmacovigilance systems frequently classify adverse drug event (ADE) reports on various axes such as severity and type of outcome in an attempt to better detect changes in the frequency of certain types of ADEs. The aim of this study was to measure the inter-observer reliability of an ADE classification system. Two pharmacists and two internal medicine physicians reviewed 150 pharmacist-generated ADE reports and used a structured form to classify reports on four domains: the presence or absence of process measures leading to ADE; the individual who initiated the process that potentially leads to ADE; the severity of ADE; and whether the ADE was related to dose. There was wide variation in inter-observer reliability of different elements in a classification system for ADEs. Agreement on specific processes associated with ADEs ranged from poor to moderate, which limits the ability to target accurately processes to improve drug utilization.

Pharmacist-conducted medication reconciliation in an emergency department.

PURPOSE: The effect of pharmacist conducted medication reconciliation on compliance with a hospital's medication reconciliation policy was studied. METHODS: In this eight-week pilot study, one pharmacist worked in the emergency department (ED) to facilitate the safe and accurate transfer of medication histories for admitted patients. During the first four weeks, retrospective chart review was performed for 100 patients in March 2006 to determine the compliance rate to the hospital's medication reconciliation policy (medication reconciliation completed for every patient using the hospital-approved form). Over the next four weeks, the same pharmacist prospectively obtained medication histories from consecutive patients in April 2006; these patients comprised the study group. The pharmacist completed the medication reconciliation form and identified and corrected all discrepancies. Unpaired t tests and Fisher's exact test were used to determine significant differences between groups. RESULTS: The hospital-approved medication form was used for 78% of patients in the control group (78 of 100) and 100% of patients in the study group (60 of 60). The mean +/- S.D. number of errors per form was significantly higher in the control group than in the study group, and the percentage of forms containing at least one error was significantly higher in the control group (p = 0.001 for both comparisons). Allergy documentation was recorded for 62 patients in the study group versus all 60 in the study group (p = 0.001). CONCLUSION: Pharmacist-conducted medication reconciliation in the ED increased compliance to the institution's medication reconciliation policy for admitted patients. Pharmacist-acquired medication histories had significantly fewer errors in documentation and had more documentation of patient allergies.

Potentially inappropriate medications in the elderly: a French consensus panel list.

OBJECTIVE: To evaluate drug-related problems in the elderly, various lists of potentially inappropriate medications have been published in North America. Unfortunately, these lists are hardly applicable in France. The purpose of this study was to establish a list of inappropriate medications for French elderly using the Delphi method. METHOD: A two-round Delphi method was used to converge to an agreement between a pool of 15 experts from various parts of France and from different backgrounds (five geriatricians, five pharmacologists, two pharmacists, two general practitioners, one pharmacoepidemiologist). In round one, they were sent a questionnaire based on a literature review listing medications and clinical situations. They were asked to comment on the potential inappropriateness of the criteria proposed using a 5-point Likert scale (from strong agreement to strong disagreement) and to suggest therapeutic alternatives and new criteria. In round two, the experts confirmed or cancelled their previous answers from the synthesis of the responses of round one. After round two, a final list of potentially inappropriate drugs was established. RESULTS: The final list proposed 36 criteria applicable to people >/=75 years of age. Twenty-nine medications or medication classes applied to all patients, and five criteria involved medications that should be avoided in specific medical conditions. Twenty-five medications or medication classes were considered with an unfavourable benefit/risk ratio, one with a questionable efficacy and eight with both unfavourable benefit/risk ratio and questionable efficacy. CONCLUSION: This expert consensus should provide prescribers with an epidemiological tool, a guideline and a list of alternative therapies.

Pediatric medication errors in the postanesthesia care unit: analysis of MEDMARX data.

Medication errors involving pediatric patients in the postanesthesia care unit may occur as frequently as one in every 20 medication orders and are more likely to cause harm when compared to medication errors in the overall population. Researchers examined six years of records from the MEDMARX database and used consecutive nonprobability sampling and descriptive statistics to compare medication errors in the pediatric data set to those occurring in the total population data set. Nineteen different causes of error involving 28 different products were identified. The results of the study indicate that an organization can focus on causes of errors and products involved in errors to mitigate future error occurrence.

Pharmacists at the forefront: reducing medication errors.

Pharmacists are in a constant battle to prevent medication errors. It is something most pharmacists do not even realize they are doing every day. Some people call it "pharmacist radar." As pharmacists review charts, talk with patients and staff, and interact with prescribers, they are constantly filtering information about medications from numerous sources to ensure that something has not "slipped by" that might cause a medication error. Is that the right dose? Why did the prescriber choose that drug? Where has the facility been keeping that medication? These are just a few questions that are part of the internal dialogue swirling around in senior care pharmacists' heads as they try to ensure the highest level of care for patients.

JCAHO's National Patient Safety Goal for infusion pump free-flow protection: ECRI's assessment of the protection offered by general-purpose, PCA, and ambulatory pumps.

One of the U.S. National Patient Safety Goals promulgated by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is to "improve the safety of using infusion pumps" by ensuring that pumps are protected against free-flow. In this Guidance Article, we provide ECRI's updated guidance for achieving this goal. Free-flow refers to the uncontrolled delivery of an infusion to a patient when a controlled or metered delivery was intended. For more than 20 years--in numerous articles presented in Health Devices and its sister publication Health Devices Alerts--ECRI has offered guidance to help hospitals avoid the dangers of free-flow. The current article is the latest in a series of reports addressing JCAHO's goal; it describes the dangers, provides updated guidance for interpreting JCAHO's goal, and categorizes the available pump models according to the level of free-flow protection offered. This report supersedes Health Devices Alerts Special Reports S0008 (August 23, 2002), S0018 (March 21, 2003), and S0029 (November 14, 2003).

Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts.

BACKGROUND: Medication toxic effects and drug-related problems can have profound medical and safety consequences for older adults and economically affect the health care system. The purpose of this initiative was to revise and update the Beers criteria for potentially inappropriate medication use in adults 65 years and older in the United States. METHODS: This study used a modified Delphi method, a set of procedures and methods for formulating a group judgment for a subject matter in which precise information is lacking. The criteria reviewed covered 2 types of statements: (1) medications or medication classes that should generally be avoided in persons 65 years or older because they are either ineffective or they pose unnecessarily high risk for older persons and a safer alternative is available and (2) medications that should not be used in older persons known to have specific medical conditions. RESULTS: This study identified 48 individual medications or classes of medications to avoid in older adults and their potential concerns and 20 diseases/conditions and medications to be avoided in older adults with these conditions. Of these potentially inappropriate drugs, 66 were considered by the panel to have adverse outcomes of high severity. CONCLUSIONS: This study is an important update of previously established criteria that have been widely used and cited. The application of the Beers criteria and other tools for identifying potentially inappropriate medication use will continue to enable providers to plan interventions for decreasing both drug-related costs and overall costs and thus minimize drug-related problems.

[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.