[Prevalence of potentially inappropriate medication in hospitalized elderly patients by using explicit criteria]. / Prevalencia de medicación potencialmente inapropiada en pacientes ancianos hospitalizados utilizando criterios explícitos.

INTRODUCTION: Potentially inappropriate medication (PIM) prescribing in older adults is quite prevalent and is associated with an increased risk for adverse drug events, morbidity, and utilization of health care resources. The aim of this study was to determine the prevalence and type of PIM in polypharmacy elderly patients on admission and discharge and the factors associated with their prescription. Just as the applicability of various explicit criteria selected from the literature and adapted to our area. METHODS: We performed a cross-sectional study for 12 months (March 2010-February 2011) on 179 polypharmacy elderly patients admitted to an Internal Medicine Department. We created a list of 50 PIM using a Delphi approach based on previous published criteria (Beers, Stopp, BMC and Priscus). Through patient interviews, review of medical records and discharge reconciliation report, we identified the prevalence of PIM in the patients. We also analyzed the relationship between different factors and the prescription of PIM. RESULTS: The prevalence of patients with PIM on admission and discharge were 71% and 48%, respectively. Out of the 50 selected PIM, 27 and 26 were detected on admission and discharge, respectively (55.5% and 57.69% included on STOPP criteria). We detected two factors associated with PIM prescription at discharge: severe-total dependence (OR = 1.8) and prescription of more than 11 drugs (OR = 2). CONCLUSIONS: PIM prevalence in our population is very high (70%), especially at hospital admission. These findings support the need for measures aimed at improving the quality of prescriptions, especially on dependent patients with polypharmacy.

INTRODUCCIÓN: En personas mayores la prescripción de medicamentos potencialmente inapropiados (PIM) es muy elevada y se asocia con mayor riesgo de eventos adversos, morbilidad y utilización de recursos sanitarios. El objetivo del presente estudio es conocer la prevalencia y tipo de PIM en pacientes ancianos polimedicados al ingreso y alta hospitalaria, los factores asociados a su prescripción y la aplicabilidad de distintos criterios explícitos seleccionados de la bibliografía y adaptados a nuestro ámbito. MÉTODO: Se realiza estudio observacional transversal durante 12 meses (marzo 2010-febrero 2011), sobre 179 pacientes ancianos polimedicados, ingresados en un servicio de Medicina Interna. Como herramienta para detectar la prescripción inadecuada se seleccionaron 50 PIM a partir de la bibliografía (criterios Beers, Stopp, BMC y Priscus) utilizando una técnica Delphi. A través de entrevista con el paciente, revisión de historias clínicas e informe de conciliación se identificaron los PIM previamente seleccionados. Posteriormente se analizó la relación entre distintos factores y la prescripción de PIM. RESULTADOS: La prevalencia de pacientes con PIM al ingreso fue de 71% y al alta de 48%. De 50 PIM seleccionados, sólo se detectaron 27 y 26 tipos (55,5% y 57,69% criterios STOPP) al ingreso y al alta respectivamente. Los factores asociados a la prescripción de PIM al alta fueron: dependencia severa-total (OR = 1,8; IC 95% 1,0-3,4) y nº de medicamentos mayor de 11 (OR = 2; IC 95% 1,1-3,7). CONCLUSIONES: La prevalencia de PIM en nuestra población es muy elevada (70%) especialmente al ingreso hospitalario, estos resultados apoyan la necesidad de adoptar medidas enfocadas a mejorar la calidad de la prescripción prioritariamente en pacientes dependientes y polimedicados.

Prevalencia de medicación potencialmente inapropiada en pacientes ancianos hospitalizados utilizando criterios explícitos / Prevalence of potentially inappropriate medication in hospitalized elderly patients by using explicit criteria

Introducción: En personas mayores la prescripción de medicamentos potencialmente inapropiados (PIM) es muy elevada y sea socia con mayor riesgo de eventos adversos, morbilidad y utilización de recursos sanitarios. El objetivo del presente estudio es conocer la prevalencia y tipo de PIM en pacientes ancianos polimedicados al ingreso y alta hospitalaria, los factores asociados a su prescripción y la aplicabilidad de distintos criterios explícitos seleccionados de la bibliografía y adaptados a nuestro ámbito. Método: Se realiza estudio observacional transversal durante 12 meses (marzo 2010-febrero 2011), sobre 179 pacientes ancianos polimedicados, ingresados en un servicio de Medicina Interna. Como herramienta para detectar la prescripción inadecuada se seleccionaron 50 PIM a partir de la bibliografía (criterios Beers, Stopp, BMC y Priscus) utilizando una técnica Delphi. A través de entrevista con el paciente, revisión de historias clínicas e informe de conciliación se identificaron los PIM previamente seleccionados. Posteriormente se analizó la relación entre distintos factores y la prescripción de PIM. Resultados: La prevalencia de pacientes con PIM al ingreso fue de 71% y al alta de 48%. De 50 PIM seleccionados, sólo se detectaron 27 y 26 tipos (55,5% y 57,69% criterios STOPP) al ingreso y al alta respectivamente. Los factores asociados a la prescripción de PIM al alta fueron: dependencia severa-total (OR = 1,8; IC 95% 1,0-3,4) y nº de medicamentos mayor de 11 (OR = 2; IC 95% 1,1-3,7). Conclusiones: La prevalencia de PIM en nuestra población es muy elevada (70%) especialmente al ingreso hospitalario, estos resultados apoyan la necesidad de adoptar medidas enfocadas a mejorar la calidad de la prescripción prioritariamente en pacientes dependientes y polimedicados (AU)

Introduction: Potentially inappropriate medication (PIM) prescribing in older adults is quite prevalent and is associated with an increased risk for adverse drug events, morbidity, and utilization of health care resources. The aim of this study was to determine the prevalence and type of PIM in polypharmacy elderly patients on admission and discharge and the factors associated with their prescription. Just as the applicability of various explicit criteria selected from the literature and adapted to our area. Methods: We performed a cross-sectional study for 12 months(March 2010-February 2011) on 179 polypharmacy elderly patients admitted to an Internal Medicine Department. We created a list of 50 PIM using a Delphi approach based on previous published criteria (Beers, Stopp, BMC and Priscus). Through patient interviews, review of medical records and discharge reconciliation report, we identified the prevalence of PIM in the patients. We also analyzed the relationship between different factors and the prescription of PIM. Results: The prevalence of patients with PIM on admission and discharge were 71% and 48%, respectively. Out of the 50selected PIM, 27 and 26 were detected on admission and discharge, respectively (55.5% and 57.69% included on STOPP criteria). We detected two factors associated with PIM prescription at discharge: severe-total dependence (OR = 1.8) and prescription of more than 11 drugs (OR = 2). Conclusions: PIM prevalence in our population is very high(70%), especially at hospital admission. These findings support the need for measures aimed at improving the quality of prescriptions, especially on dependent patients with polypharmacy (AU)

Evaluación de la cultura de seguridad del paciente en el ámbito de un área sanitaria / Assessment of the patient-safety culture in a healthcare district

Objetivos. 1) Describir la frecuencia de actitudes y comportamientos favorables relacionados con la seguridad del paciente en los profesionales sanitarios de un área sanitaria; 2) determinar si el nivel de cultura de seguridad del paciente difiere de otros estudios; y 3) evaluar las dimensiones valoradas negativamente y establecer áreas de mejora. Material y métodos. Estudio descriptivo transversal que recogió los resultados del nivel de cultura de seguridad realizada a una muestra aleatoria de 247 profesionales sanitarios de un área sanitaria utilizando la encuesta Hospital Survey on Patient Safety Culture (HSOPSC) de la Agency for Healthcare Research and Quality (AHRQ) adaptada al castellano. Se analizaron las respuestas positivas y negativas a los 42 ítems y la calificación global comparándose los resultados a nivel internacional y nacional. Resultados. Se analizaron 176 encuestas (tasa respuesta: 71,2%). El 50% califican el clima de seguridad como muy bueno, el 37% como aceptable y el 7% como excelente. Como fortalezas destacan las dimensiones «trabajo en equipo dentro de las unidades» (80,8%) y «expectativas y acciones de la dirección» (80,5%). Como oportunidades de mejora se identifican las dimensiones «dotación de personal» (37,9%), «respuesta no punitiva a los errores» (41,6%) y «notificación de eventos adversos» (49,0%). Conclusiones. Se han identificado las fortalezas y debilidades en la cultura de seguridad en un área sanitaria. El benchmarking realizado a nivel internacional sitúa nuestra cultura de seguridad en la media de los hospitales, mientras que en la comparación realizada con estudios nacionales nuestros resultados son superiores a la media de hospitales (AU)

Objectives: 1) To describe the frequency of positive attitudes and behaviours, in terms of patient safety, among the healthcare providers working in a healthcare district; 2) to determine whether the level of safety-related culture differs from other studies; and 3) to analyse negatively valued dimensions, and to establish areas for their improvement. Material and methods: A descriptive, cross-sectional study based on the results of an evaluation of the safety-related culture was conducted on a randomly selected sample of 247 healthcare providers, by using the Spanish adaptation of the Hospital Survey on Patient Safety Culture (HSOPSC) designed by the Agency for Healthcare Research and Quality (AHRQ), as the evaluation tool. Positive and negative responses were analysed, as well as the global score. Results were compared with international and national results. Results: A total of 176 completed survey questionnaires were analysed (response rate: 71.26%); 50% of responders described the safety climate as very good, 37% as acceptable, and 7% as excellent. Strong points were: «Teamwork within the units» (80.82%) and «Supervisor/manager expectations and actions» (80.54%). Dimensions identified for potential improvement included: «Staffing» (37.93%), «Non-punitive response to error» (41.67%), and «Frequency of event reporting» (49.05%). Conclusions: Strong and weak points were identified in the safety-related culture of the healthcare district studied, together with potential improvement areas. Benchmarking at the international level showed that our safety-related culture was within the average of hospitals, while at the national level, our results were above the average of hospitals (AU)

[Assessment of the patient-safety culture in a healthcare district]. / Evaluación de la cultura de seguridad del paciente en el ámbito de un área sanitaria.

OBJECTIVES: 1) To describe the frequency of positive attitudes and behaviours, in terms of patient safety, among the healthcare providers working in a healthcare district; 2) to determine whether the level of safety-related culture differs from other studies; and 3) to analyse negatively valued dimensions, and to establish areas for their improvement. MATERIAL AND METHODS: A descriptive, cross-sectional study based on the results of an evaluation of the safety-related culture was conducted on a randomly selected sample of 247 healthcare providers, by using the Spanish adaptation of the Hospital Survey on Patient Safety Culture (HSOPSC) designed by the Agency for Healthcare Research and Quality (AHRQ), as the evaluation tool. Positive and negative responses were analysed, as well as the global score. Results were compared with international and national results. RESULTS: A total of 176 completed survey questionnaires were analysed (response rate: 71.26%); 50% of responders described the safety climate as very good, 37% as acceptable, and 7% as excellent. Strong points were: «Teamwork within the units¼ (80.82%) and «Supervisor/manager expectations and actions¼ (80.54%). Dimensions identified for potential improvement included: «Staffing¼ (37.93%), «Non-punitive response to error¼ (41.67%), and «Frequency of event reporting¼ (49.05%). CONCLUSIONS: Strong and weak points were identified in the safety-related culture of the healthcare district studied, together with potential improvement areas. Benchmarking at the international level showed that our safety-related culture was within the average of hospitals, while at the national level, our results were above the average of hospitals.

Cuestionario ISMP-España y estrategia de mejora en el uso seguro del medicamento dentro del Servicio Andaluz de Salud / ISMP-Spain questionnaire and strategy for improving good medication practices in the andalusian health system

Objetivo: Describir la estrategia seguida en los hospitales del Servicio Andaluz de Salud para potenciar el uso seguro del medicamento utilizando como herramienta base el cuestionario de autoevaluación de la seguridad del sistema de utilización de los medicamentos en los hospitales, adaptado por el Instituto para el Uso Seguro de los Medicamentos en España. Material y métodos La estrategia se desarrolló en varias fases. Un análisis del informe de evaluación de la seguridad del sistema de utilización de los medicamentos en los hospitales públicos de Andalucía publicado por el ministerio de Sanidad y Consumo en 2008 seguido del establecimiento de un diagnóstico de partida del grado de seguridad en el uso de los medicamentos en los hospitales andaluces y priorización de las áreas de mejora. El desarrollo de un catálogo de buenas prácticas disponibles en el entorno web del observatorio para la seguridad del paciente de la agencia de calidad sanitaria andaluza, difusión de la estrategia a través de talleres formativos y la puesta en marcha de un sistema de evaluación del grado de cumplimiento de cada una de las buenas prácticas dirigido a hospitales a partir del cual componer un mapa de centros de referencia, completan las actuaciones realizadas. Resultados Se detectaron áreas de mejora en varios de los criterios esenciales del cuestionario. Estas áreas de mejora se relacionaron con procesos habituales que sigue el medicamento en la práctica clínica habitual. Así, se elaboraron 7 guías de buena práctica que recogen de forma transversal todos los elementos de evaluación del cuestionario relacionados con el proceso clínico a mejorar. Conclusiones El cuestionario de autoevaluación adaptado por ISMP-España constituye una buena herramienta para diseñar una intervención sistemática y racional en el uso seguro del medicamento dirigida a un grupo de hospitales que comparten los mismos valores (AU)

Objective: To describe the strategy employed by Andalusian public health service hospitals to foster safe medication use. The self-evaluation questionnaire on drug system safety in hospitals, adapted by the Spanish Institute for Safe Medication Practices was used as a fundamental tool to that end. Material and method: The strategy is developed in several phases. We analyse the report evaluating drug system safety in Andalusian public hospitals published by the Spanish Ministry of Health and Consumption in 2008 and establish a grading system to assess safe medication practices in Andalusian hospitals and prioritise areas needing improvement. We developed a catalogue of best practices available in the web environment belonging to the Andalusian health care quality agency’s patient safety observatory. We publicised the strategy through training seminars and implemented a system allowing hospitals to evaluate the degree of compliance for each of the best practices, and based on that system, we were able to draw up a map of centres of reference. Results: We found areas for improvement among several of the questionnaire’s fundamental criteria. These areas for improvement were related to normal medication procedures in daily clinical practice. We therefore wrote 7 best practice guides that provide a cross-section of the assessment components of the questionnaire related to the clinical process needing improvement. Conclusions: The self-evaluation questionnaire adapted by ISMP-Spain is a good tool for designing a systematic, rational intervention to promote safe medication practices and intended for a group of hospitals that share the same values (AU)

[ISMP-Spain questionnaire and strategy for improving good medication practices in the Andalusian health system]. / Cuestionario ISMP-España y estrategia de mejora en el uso seguro del medicamento dentro del Servicio Andaluz de Salud.

OBJECTIVE: To describe the strategy employed by Andalusian public health service hospitals to foster safe medication use. The self-evaluation questionnaire on drug system safety in hospitals, adapted by the Spanish Institute for Safe Medication Practices was used as a fundamental tool to that end. MATERIAL AND METHOD: The strategy is developed in several phases. We analyse the report evaluating drug system safety in Andalusian public hospitals published by the Spanish Ministry of Health and Consumption in 2008 and establish a grading system to assess safe medication practices in Andalusian hospitals and prioritise areas needing improvement. We developed a catalogue of best practices available in the web environment belonging to the Andalusian health care quality agency's patient safety observatory. We publicised the strategy through training seminars and implemented a system allowing hospitals to evaluate the degree of compliance for each of the best practices, and based on that system, we were able to draw up a map of centres of reference. RESULTS: We found areas for improvement among several of the questionnaire's fundamental criteria. These areas for improvement were related to normal medication procedures in daily clinical practice. We therefore wrote 7 best practice guides that provide a cross-section of the assessment components of the questionnaire related to the clinical process needing improvement. CONCLUSIONS: The self-evaluation questionnaire adapted by ISMP-Spain is a good tool for designing a systematic, rational intervention to promote safe medication practices and intended for a group of hospitals that share the same values.

Seguimiento del paciente anciano polimedicado en un área de salud / Monitoring polymedicated elderly patients in a health care unit

Objetivo Implantar una estrategia coordinada entre la unidad de atención familiar y el servicio de farmacia que posibilite la revisión del tratamiento en pacientes polimedicados. Para ello se ha desarrollado una herramienta informática que permite al médico responsable del paciente visualizar de forma rápida y resumida la descripción del tratamiento farmacológico actualizado, así como la detección de riesgos de iatrogenias y/o ajuste de dosis y consejo farmacoterapéutico. Métodos Para el estudio se ha considerado paciente polimedicado aquel que toma 10 o más medicamentos durante, al menos, un mes. Fases de desarrollo: Diseño de un formulario guía para revisión de tratamientos por el médico de familia. Desarrollo de un informe farmacoterapéutico (IFT) como documento de apoyo al médico para la revisión del tratamiento. Puesta en marcha del circuito coordinado médico de familia-farmacéutico: redacción de instrucciones de trabajo y difusión entre los profesionales implicados. Resultados La población diana del estudio corresponde a 1.897 pacientes polimedicados. Se han emitido 1.897 informes, en los que se recogen: 8.530 recomendaciones (10% alertas de agencias reguladoras, 31% recomendaciones sobre medicación de alto riesgo en paciente anciano, 7% información sobre novedades terapéuticas y 52% recomendaciones sobre uso adecuado del medicamento); 399 interacciones de alta relevancia clínica y 5.036 recomendaciones de ajuste posológico. Estos informes farmacoterapéuticos están permitiendo la revisión del tratamiento de prácticamente el 100% de la población seleccionada. Conclusión El desarrollo e implantación de herramientas informáticas en el seguimiento de pacientes polimedicados permite la elaboración de IFT que facilitan la revisión médica rutinaria del tratamiento farmacológico en un censo de pacientes relativamente amplio (AU)

Objective Implement a coordinated strategy for the family care unit and the pharmacy division in order to enable revising treatment in polymedicated patients. To this end, we have developed a software tool permitting the patient's primary doctor to have a quick, summarised description of the patient's updated pharmacological treatments, and detect iatrogenic risks and/or dosage adjustments and pharmacotherapy advice. Methods In this study, polymedicated patients are defined as those taking 10 or more medications during at least one month. Development phases: Design of a guide form to assist the family doctor in reviewing treatments. Development of a pharmacotherapy report (FTR) as a complementary document to assist the doctor in reviewing treatments. Implementation of a coordinated loop between the family doctor and the pharmacist. Review of work instructions and distribution to involved staff members. Results The target population of the study consists of 1897 polymedicated patients. We issued 1897 reports, containing the following: 8530 recommendations (10% alerts from regulatory authorities, 31% recommendations regarding high-risk drugs in elderly patients, 7% information on new treatments and 52% recommendations on proper drug use); 399 highly relevant drug interactions; and 5036 recommendations for dose adjustment. These pharmacotherapy reports permit treatment to be revised for nearly 100% of the selected population. Conclusion The development and implementation of software tools for monitoring polymedicated patients enables us to create FTRs that facilitate routine medical reviews of pharmacological treatment in a fairly wide range of patients (AU)

[Monitoring polymedicated elderly patients in a health care unit]. / Seguimiento del paciente anciano polimedicado en un área de salud.

OBJECTIVE: Implement a coordinated strategy for the family care unit and the pharmacy division in order to enable revising treatment in polymedicated patients. To this end, we have developed a software tool permitting the patient's primary doctor to have a quick, summarised description of the patient's updated pharmacological treatments, and detect iatrogenic risks and/or dosage adjustments and pharmacotherapy advice. METHODS: In this study, polymedicated patients are defined as those taking 10 or more medications during at least one month. Development phases: Design of a guide form to assist the family doctor in reviewing treatments. Development of a pharmacotherapy report (FTR) as a complementary document to assist the doctor in reviewing treatments. Implementation of a coordinated loop between the family doctor and the pharmacist. Review of work instructions and distribution to involved staff members. RESULTS: The target population of the study consists of 1897 polymedicated patients. We issued 1897 reports, containing the following: 8530 recommendations (10% alerts from regulatory authorities, 31% recommendations regarding high-risk drugs in elderly patients, 7% information on new treatments and 52% recommendations on proper drug use); 399 highly relevant drug interactions; and 5036 recommendations for dose adjustment. These pharmacotherapy reports permit treatment to be revised for nearly 100% of the selected population. CONCLUSION: The development and implementation of software tools for monitoring polymedicated patients enables us to create FTRs that facilitate routine medical reviews of pharmacological treatment in a fairly wide range of patients.