[Failure mode and effects analysis on computerized drug prescriptions]. / Análisis modal de fallos y efectos en las prescripciones farmacológicas informatizadas.

OBJECTIVE: To identify and analyze errors in drug prescriptions of patients treated in a "high resolution" hospital by applying a Failure mode and effects analysis (FMEA).Material and methods A multidisciplinary group of medical specialties and nursing analyzed medical records where drug prescriptions were held in free text format. An FMEA was developed in which the risk priority index (RPI) was obtained from a cross-sectional observational study using an audit of the medical records, carried out in 2 phases: 1) Pre-intervention testing, and (2) evaluation of improvement actions after the first analysis. An audit sample size of 679 medical records from a total of 2,096 patients was calculated using stratified sampling and random selection of clinical events. RESULTS: Prescription errors decreased by 22.2% in the second phase. FMEA showed a greater RPI in "unspecified route of administration" and "dosage unspecified", with no significant decreases observed in the second phase, although it did detect, "incorrect dosing time", "contraindication due to drug allergy", "wrong patient" or "duplicate prescription", which resulted in the improvement of prescriptions. CONCLUSIONS: Drug prescription errors have been identified and analyzed by FMEA methodology, improving the clinical safety of these prescriptions. This tool allows updates of electronic prescribing to be monitored. To avoid such errors would require the mandatory completion of all sections of a prescription.

[Malnutrition in hospitalized patients: a prospective and randomized study]. / Malnutrición en pacientes hospitalizados: estudio prospectivo y aleatorio.

UNLABELLED: Protein-energy malnutrition (PEM), is probably underestimated in our hospitals. We did this study with the aim of knowing the incidence, distribution and evolution of PEM in a University Hospital with 538 beds. MATERIAL AND METHODS: 301 hospitalized patients, randomly selected, were subjected to a nutritional evaluation upon admittance and after 7 days, by determining albumin and body weigh/ideal weight ratio. RESULTS: The age was 56.7 +/- 18.4 years (x +/- SD), the hospital stay was 7.84 +/- 7.12 days, 194 patients were hospitalized in Medical departments and 107 in Surgical or Medical-surgical departments. The incidence of PEM upon admittance was n = 160 (53%): mild in 93 (30.89%), moderate in 56 (18.60%), and severe in 11 (3.65%). The patients who continued to be hospitalized after 7 days were n = 99 (32.89%), and in these patients the incidence of PEM was n = 66 (66.6%): mild in 33 (33.3%), moderate in 30 (30.3%), and severe in 3 (3.3%). The incidence of PEM was higher at more advanced age (p < 0.05), in patients hospitalized in medical departments (p < 0.05) or in those subjected to surgery (p < 0.05). The hospital stay was longer in those patients who presented PEM upon admittance (p < 0.05). CONCLUSIONS: Malnutrition has an increased incidence in hospitalized patients, it is higher in patients of advanced age or subjected to surgery, and it increases during their stay. The existence of malnutrition upon admittance is related to a longer hospital stay.

[Surgical management of polycystic liver]. / Manejo quirúrgico de la poliquistosis hepática.

Three patients with polycystic liver disease, needing surgical treatment, are reported. In two cases surgical indication was continuous pain and compressive symptoms from an abdominal mass, and in the third case was an infection of the cyst. All patients were treated by fenestration combined with resection of cysts. The postoperative course was uneventful in two patients, but hepatic failure developed in the third case, needing hepatic transplantation. This patient died during this operation. The complications of the disease and its surgical management are revised.