Real-world prevalence and consequences of potential drug-drug interactions in the first-wave COVID-19 treatments.

WHAT IS KNOWN AND OBJECTIVE: Initial treatment recommendations of COVID-19 were based on the use of antimicrobial drugs and immunomodulators. Although information on drug interactions was available for other pathologies, there was little evidence in the treatment of COVID-19. The objective of this study was to analyse the potential drug-drug interactions (pDDIs) derived from the medication used in COVID-19 patients in the first pandemic wave and to evaluate the real consequences of such interactions in clinical practice. METHODS: Cohort, retrospective and single-centre study carried out in a third-level hospital. Adult patients, admitted with suspected COVID-19, that received at least one dose of hydroxychloroquine, lopinavir/ritonavir, interferon beta 1-b or tocilizumab and with any pDDIs according to "Liverpool Drug Interaction Group" between March and May 2020 were included. The possible consequences of pDDIs at the QTc interval level or any other adverse event according to the patient's medical record were analysed. A descriptive analysis was carried out to assess possible factors that may affect the QTc interval prolongation. RESULTS AND DISCUSSION: Two hundred and eighteen (62.3%) patients of a total of 350 patients admitted with COVID-19 had at least one pDDI. There were 598 pDDIs. Thirty-eight pDDIs (6.3%) were categorized as not recommended or contraindicated. The mean value difference between baseline and pDDI posterior ECG was 412.3 ms ± 25.8 ms vs. 426.3 ms ± 26.7 ms; p < 0.001. Seven patients (5.7%) had a clinically significant alteration of QTc. A total of 44 non-cardiological events (7.3%) with a possible connection to a pDDI were detected. WHAT IS NEW AND CONCLUSION: The number of pDDIs in patients admitted for COVID-19 in the first pandemic wave was remarkably high. However, clinical consequences occurred in a low percentage of patients. Interactions involving medications that would be contraindicated for concomitant administration are rare. Knowledge of these pDDIs and their consequences could help to establish appropriate therapeutic strategies in patients with COVID-19 or other diseases with these treatments.

Standardization Consensus of a Hospital Drug Database: An Efficient Tool.

BACKGROUND: Although the electronic prescribing software is the same for all hospitals of a regional health service, each has its own drug database, which it is responsible for maintaining. The aim of this study was to develop a consensus to standardize the hospital drug database of the electronic prescribing software, and to apply this tool to the electronic prescribing system of an oncology outpatient clinic of a Spanish tertiary-level hospital. Additionally, we sought to analyze the impact of the implemented actions on the health care services provided. METHODS: This was a prospective study carried out over a period of 15 months by a group of pharmacists representing all Organizational Integrated Management Systems of a regional health service, and coordinated by the General Subdirectorate of Pharmaceuticals. RESULTS: A total of 500 drugs and 500 active pharmaceutical ingredients included in the hospital drug database were standardized to implement the electronic prescribing system in the oncology outpatient clinic. The implementation of such standardization process yielded a 70% decrease in medication errors. In the satisfaction survey concerning the usefulness of the tall-man letters implemented in the electronic prescribing system, the interviewed doctors reported the highest levels of satisfaction. CONCLUSIONS: The creation of consensus documents to standardize the hospital drug database served to unify the information available in the regional hospital pharmacy services of an autonomous community. In addition, the implementation of the electronic prescribing system in the oncology outpatient clinic of a tertiary-level hospital resulted in a decrease in the number of medication errors.

Short Stay Unit and Emergency Department: Pharmacotherapeutic Interventions and Its Impact.

The incidence of adverse effects in hospitals is very high and a lot of them are related to medication. The most important factor in pharmaceutical interventions to reduce adverse effects is medication reconciliation, and this process is indispensable during hospital care. Reasons for reconciliation errors are numerous but high-rotation care unit, such as emergency department and short stay units (SSUs) are more hazardous areas for patient safety. Prospective observational study was performed for 3 months. Medication reconciliation and pharmacotherapeutic interventions were carried out. Indicators regarding coverage of the program, quality of prescription, and reconciliation were established and a financial analysis was done. A total of 843 patients were studied and pharmacotherapeutic intervention was carried out in 310 patients. A total of 2463 drugs were checked and 452 pharmacotherapeutic interventions were carried out. The most of these interventions belong to cardiovascular system. A total of 149 interventions were according to the pharmacotherapeutical hospital formulary and 303 were drug-related problems (DRPs). The most frequent cause of DRP was drug omission, followed by incomplete prescriptions. Of the DRP, 56.8% were reconciliation errors. The most common recommendation was starting treatment. An overall saving of $49,846.31 is estimated in this study according to the risk of an increased stay for DRP and the cost of avoidable stays. Patient's safety was increased by pharmacist's involvement on emergency department and SSUs. In SSUs, there are many polymedicated patients, so this is the most suitable place to involve the pharmacist. Pharmacist's interventions are equally accepted in both services.