Farmacia Hospitalaria (English Edition)最新文献

Objective

To identify, classify and quantify the frequency of negative clinical adverse drug reactions (ADR) resulting in hospital admission from the emergency department (ED). To determine ADR preventability, identify ADR-related admission factors, calculate related costs and recognise which drugs are the most often involved.

Method

Cross-sectional, prospective and observational study of patients who were admitted to hospital from the ED. We used the Dader method to detect ADR. We classified ADR in accordance with the Tercer Consenso de Granada (third Granada consensus), and calculated ADR preventability using the Schumock and Thornton scales (modified by Otero et al.), and ADR severity according to Schneider. We considered the direct costs generated during the hospital stay for the economic study. We analysed the correlation between ADR and age, sex, kidney and liver failure, and drug use. We used multiple logistic regression analysis to identify risk factors.

Results

19.4% of admissions were the direct consequence of ADR, 65% of which were preventable. Antineoplastic therapy and immunosupressants caused 38% of ADR. 20.4% of admissions had to be transferred to the intensive care unit (ICU) or caused permanent damage. We found statistical significance between ADR and patients undergoing hormonal therapy, ‘high risk’ drugs and those admitted to the endocrinology department. The ADR-associated cost was €237,377.

Conclusions

ADR-related admission is a problem with a high prevalence, and most cases are preventable.

Off-label use of medication is common in hospital clinical practice and should be applied together with follow-up of a healthcare treatment protocol and in compliance with a procedure which ensures that the patient is informed and that he or she provides informed consent.

A review of the literature on controlling 310 disorders showed that off-label use was indicated for 69 of them (22.3%) with the minimum required scientific evidence.

It would be useful for the Pharmacy and Therapeutics Committee to have a list of the disorders that can be controlled using off-label drugs, providing a reference to those disorders which must follow a healthcare treatment protocol.

A list of the mentioned characteristics is also useful for the hospital pharmacist for validating prescriptions, as it would provide a reference for assessing prescriptions which at first sight could seem questionable.

Finally, this list would be very useful if a search index of all the drugs by disorder was to be included in the Pharmacotherapeutic Guide. It would complement the usual indices which include active ingredients and specialities.

Objective

To assess the technique employed by the autoanalyser Architect^® i1000 sr to determine digoxin in serum samples, compared with the assay developed for AsSYM^® using microparticle enzyme immunoassay (Digoxin II).

Method

A prospective analysis of the samples from 100 requests to monitor patients being treated with digoxin. The samples were processed in AxSYM^® and Architect^®. The techniques were assessed using the linear regression coefficient, determination coefficient, mean absolute error, mean squared prediction error and the Bland-Altman method.

Results

The serum levels showed a correlation coefficient of 0.93. There was nearly a 40% difference for the concentrations between 0.8 and 2 ng/ml and nearly 20% in the rest of the samples analysed.

Conclusions

The Architect^® system is precise; however, from a clinical monitoring point of view, it is unacceptably inaccurate when compared with the AxSYM^®.

Objective

To develop a list of look-alike drug names with tall man letters, that 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, including 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.

Introduction

Hepatocellular carcinoma is the most common and aggressive liver and biliary tumour. Hepatic chemoembolisation with doxorubicin-loaded DC Beads^® is a local therapy for patients with localised nodes, which are not suitable for surgery. The objective of this study is to describe the clinical situations in which this procedure has been used and its early toxicity.

Methods

Retrospective descriptive study of patients treated with doxorubicin-loaded DC Beads^® undergoing hepatic chemoembolisation from October 2006 until July 2009. Data were taken from the Farhos Oncología^® programme and clinical histories.

Results

Twenty-two patients were treated during the study period, 15 men and 6 women, with an average age of 66 years. This technique was used for patients diagnosed with unresectable liver cancer. Out of the patient total, 6 were on the liver transplant waiting list. Patients were assessed using the Child–Pugh score: 15 patients in group A, 5 in group B and 1 in group C; and according to Okuda staging system: 14 were in group I, 6 in group II and 1 in group III. The most common toxicity was post-chemoembolisation in 16 patients, who were treated with symptomatic medication.

Discussion

Using doxorubicin-loaded microspherical DC Beads^® during transarterial chemoembolisation has been adapted to use with scientific evidence and tolerated by all patients. Incidences during administration were mild and were resolved with symptomatic medication.

Objective

To validate a classification sheet for medication errors associated with antineoplastic medication.

Method

Prospective study. A data sheet was designed based on ASHP's classification. Two observers reviewed the treatment prescribed for chemotherapy from the Haematology Department during a month and they classified the errors detected. The interobserver concordance was analysed using the kappa index test. The error categories with a moderate or lower concordance were reviewed, and the need to modify them was evaluated.

Results

A total of 23 error categories were analysed and 162 lines of treatment were reviewed. Only one of the categories was assessable in accordance with its error prevalence, which was the category for incomplete or ambiguous prescriptions (kappa index = 0.458 = moderate concordance). The causes were analysed and subsections within this category itemised.

Conclusion

Our results proved the need to review error classification. Validated tools need to be made available so as to make progress in characterising this type of medication error.

Introduction

The objective of the study was to assess home medication data collected at the emergency department in a tertiary hospital. It also aimed to identify whether any possible deficiencies in this collection were translated as reconciliation errors on admission, to analyse and classify these data and identify the pharmacological groups involved.

Methods

A prospective observational study was carried out which analysed the pharmacotherapeutic data collected at the emergency department. Patients who were admitted to the Pneumology and Internal Medicine wards at the Miguel Servet University Hospital in Zaragoza were included. A list of the home drugs taken before the hospital stay was compiled, assessing whether the quality deficiencies in data collected in the emergency department translated as reconciliation errors at admission. Unjustified discrepancies were considered and classified in line with the criteria of the consensus document on terminology, classification and assessment of the drug reconciliation programmes for 2009.

Results

We included 136 patients, finding reconciliation errors in 86.8%. The total number of reconciliation errors found was 519. The most frequent types were: omitting a drug, missing dose information, missing administration frequency information. Almost 40% of the reconciliation errors found in the Internal Medicine ward were not resolved, which was double to that of the Pneumology ward. Most discrepancies were found for the Digestive System and Metabolism group (24%).

Conclusions

The percentage of patients that experienced reconciliation errors was high (86%), observing an important opportunity to improve at patient admission to the emergency department.

Objective

To assess the efficacy of a new quality control strategy based on daily randomised sampling and monitoring of a sentinel surveillance system (SSS) medication cart, in order to identify medication errors and their origin at different levels of the process.

Method

Prospective quality control study with one-year follow-up. An SSS medication cart was randomly selected once a week and double-checked before dispensing medication. Medication errors were recorded before the cart was taken to the relevant hospital ward. Information concerning complaints after receiving medication and 24-h monitoring was also noted. Type and origin of error data were assessed by a unit dose quality control group, which proposed relevant improvement measures.

Results

Thirty-four SSS carts were assessed, including 5130 medication lines and 9952 dispensed doses, corresponding to 753 patients. Ninety erroneous lines (1.8%) and 142 mistaken doses (1.4%) were identified at the pharmacy department. The most frequent error was dose duplication (38%) and its main cause was inappropriate management and forgetfulness (69%). Fifty medication complaints (6.6% of patients) were mainly due to new treatment at admission (52%), and 41 (0.8% of all medication lines), did not completely match the prescription (0.6% lines) as recorded by the pharmacy department. Thirty-seven (4.9% of patients) medication complaints due to changes at admission and 32 matching errors (0.6% medication lines) were recorded. The main cause also was inappropriate management and forgetfulness (24%). The simultaneous recording of incidences due to complaints and new medication coincided in 33.3%. In addition, 433 (4.3%) of dispensed doses were returned to the pharmacy department. After the unit dose quality control group conducted their feedback analysis, 64 improvement measures for pharmacy department nurses, 37 for pharmacists, and 24 for the hospital ward were introduced.

Conclusions

The SSS programme has proven to be useful as a quality control strategy to identify unit dose distribution system errors at initial, intermediate and final stages of the process, improving the involvement of the pharmacy department and ward nurses.

Objective

To establish a standard operating procedure in the event of cold chain failure.

Method

We selected thermolabile drugs included in the hospital's pharmaceutical guide. We performed a review of the available literature, classifying each drug into a given category with an intervention protocol for each one.

Results

We reviewed 254 drugs (162 active ingredients). Categories were: A (stable ≥28 days at 25 °C): 65 drugs; B (≥7 days at 25 °C): 47 drugs; C (≥48 h at 25 °C): 30 drugs; D (<48 h at 25 °C): 47 drugs; E (unstable >8 °C): 12 drugs; F (batch-dependent) 22 drugs. Thirty-one drugs were not classified into any category.

The intervention protocol consisted of establishing a system to monitor the products concerned, and discarding or returning them to the laboratory if they were to exceed the time or temperature limit indicated for each category.

Discussion

The aim of this study is to make intervention quicker in the event of cold chain failure.

Objective

To review the treatment of hidradenitis suppurativa and the role of etanercept in terms of efficacy and safety.

Methods

Descriptive, cross-sectional and retrospective study. Patients diagnosed with hidradenitis suppurativa who were treated with etanercept (indication not on its Summary of Product Characteristics) until June 2009 were included in the study. The study variables were: age, sex, treatments before and after etanercept, response, adverse effects, duration and reason for stopping treatment.

Results

Antibiotics, contraceptives, corticosteroids, isotretinoin or oral sulfones were used as the first-line treatment. When patients no longer responded to these treatments, the use of etanercept was requested. It was well tolerated but it only led to an initial improvement. It was, therefore, suspended. The options employed included the following: corticosteroids, antibiotics, isotretinoin, contraceptives, immunosuppressive drugs and antiandrogens. Patients who were treated with adalimumab and infliximab as an alternative treatment found that their lesions flared up. Surgery was considered as a last option. At present, the majority of patients are undergoing maintenance therapy with oral treatments.

Conclusions

The treatment of hidradenitis suppurativa is based on antibiotics, corticosteroids or contraceptives. These are able to control the disease temporarily. Etanercept is well tolerated but it only results in an initial improvement. Similar results have been found with infliximab and adalimumab. The affected areas can be controlled with surgery. Therefore, the role of TNF inhibitors in the treatment of hidradenitis suppurativa is controversial.