Farmacia Hospitalaria (English Edition)最新文献

Objective

To determine both the global incident, and the incident for stages of medication errors in 6 Catalonian hospitals, the types of error, and the consequences.

Method

A prospective design, with the global variable of the medication error. Potential errors have been excluded. The patients admitted to each hospital were studied in 2 groups of up to 300 patients and 1500 administrations were observed. The NCCMERP taxonomy was applied.

The prescription error was detected through the review of prescriptions, checking the patient, medication, adherence to protocols, interactions, contraindications, omission, duplicated therapy, doses, frequency, method, and lack of follow-up. During the transcription/validation, it was verified that the prescription matched the original order. In the dispensing process, the content of the drawers was checked, comparing it to the computer generated list, before sending out the single dose trolley. The transcription, preparation and administration were observed on the wards. The information for all the procedures was registered in a specific data sheet. There was moderate concordance amongst the inspectors (kappa=0.525).

Results

Sixteen point ninety-four errors were detected per 100 patients-day and 0.98 errors per patient: sixteen percent in prescription, 27% in transcription/validation, 48% in dispensing, and 9% in administration. Eighty-four point forty-seven percent were category B errors (they did not reach the patient), and <0.5% of the errors were harmful. The population, with an average age of 65, had a male/female ratio of 60/40. The principal therapeutic groups were: agents against peptic ulcer and GERD, antithrombotic agents, and other analgesics and antipyretics, principally in a solid oral drug form (58%). The medications per patient-day were 5.5 and the units of medication were on average 11.21, varying greatly among the institutions. The adjustment of 10 units made the results more uniform. In all the stages, omission was the most frequent error.

Discussion

The different methods used and different areas of the investigations make comparisons difficult. This is evident in the harmful errors, the proportion of which is affected by the detection procedure. The number of mistakes avoided during the execution of this project demonstrates the need to improve the planning of the work systems and to establish safety measures.

Objective

To determine how single nucleotide polymorphisms located on genes MDR1, CYP3A4, and CYP3A5 affect the absorption kinetics of cyclosporine in cardiac transplant patients.

Method

We selected a sample of 30 adult patients having previously undergone a primary cardiac transplant and who had received cyclosporine as an immunosuppressant. During the first month after the transplant, we performed a pharmacokinetic study of each patient to determine values in the cyclosporine concentration area under the 12-hour curve, steady-state cyclosporine concentration, maximum cyclosporine concentration, and time to reach that concentration. Single nucleotide polymorphisms were genotyped in all patients MDR1 3435C > T, CYP3A4-390A > G, and CYP3A5 6986A > G.

Results

Being a carrier of the T-allele for polymorphism MDR1 3435C > T is associated with higher values in the cyclosporine concentration area under the 12-hour curve (P=.01) and in steady-state cyclosporine concentration (P=.05), compared with those from patients who do not carry that allele.

Discussion

Our results show that genotype differences in MDR1 3435C > T can explain part of the variability in cyclosporine absorption among individuals in the population of Spanish cardiac transplant recipients.

Objective

To design a programme for pharmaceutical care for the elderly with renal failure in 3 nursing homes in the region of Valencia.

Method

A 9-month long, prospective study into pharmaceutical interventions was carried out. The study assessed the development of renal function and the effectiveness of drug dosage adjustment with pharmacokinetics affected by renal failure in patients with creatinine clearance below 30 mL/min.

Results

Fifty-two residents of 251 centres presented creatinine clearance lower than 30 mL/ min. Forty-seven out of 74 pharmaceutical interventions were accepted. The drugs which were mainly used were: diuretics, antibiotics, anti-inflammatories, antiemetics, and ranitidine. Although the process of renal disease continued its course, in most cases the follow-up parameters of effectiveness and safety (in terms of renal toxicity) were maintained within the established limits.

Conclusion

The interventions carried out showed, in most cases, to be safe (renal toxicity) and effective, with some exceptions which required more individual follow-up.

Objective

To compare the adaptation of medical prescriptions according to the dosage guides in patients with renal disease, before and after applying a pharmaceutical intervention programme. The secondary objectives were to prepare a guide to dosing in renal disease and to measure the prevalence of prescription of drugs with renal risk.

Method

Non-randomised, experimental interventional study (before/after) conducted in a general hospital with 800 beds, including hospitalised patients, over the age of 18, with kidney disease and drugs with renal risk prescribed in their pharmaco-therapeutic profile. The study was designed to be carried out in 2 descriptive cross-cutting phases (control group) and a prospective interventional cohort study (intervention group). The primary variable was the percentage non-adaptation according to the stage of renal disease.

Results

The study included 185 patients, 88 in the control group and 97 in the intervention group. In the intervention group, the prevalence of non-compliance before and after the intervention was 18.7% and 2.1%, representing a statistically significant reduction in nonadaptation of the dose. The costs saved with the pharmaceutical intervention programme were 1939.63 euro over 2 months, the average saving per medication intervened amounting to 62.57 euro (95% CI, 23.99–101.14 euro; P=.02).

Conclusions

The results of the study indicate that the application of a pharmaceutical care model based on the prospective validation of drugs with renal risk, very significantly improved the adaptation of dosing regimens in kidney disease.

Introduction

Hypersensitivity reaction to abacavir (a powerful inverse transcriptase inhibitor) is a serious adverse effect that limits its use in antiretroviral treatment and requires a high level of clinical surveillance. Certain haplotypes of the primary histocompatibility complex proteins (HLA-B*5701) are very significant predictors of the risk of hypersensitivity to this drug. The purpose of this study is to identify the cases where a probable hypersensitivity reaction to abacavir presented the HLA-B*5701 allele.

Method

A retrospective study was conducted in all HIV-1 positive adult patients infected treated with abacavir between January 2000 and December 2007, in Department 6 of the Agencia Valenciana de Salud (Valencia Health Agency). The adverse effects developed by the patients were collected to determine which cases presented a probable clinically diagnosed hypersensitivity reaction. Finally, these 39 patients were screened for HLA-B*5701.

Results

In total, 323 patients were treated with abacavir between 2000 and 2007. The treatment was discontinued in 12.1% (n=39 patients) presenting a hypersensitivity reaction. Nine (23.1%) of these were HLA-B*5701 positive. Eight patients presented skin rash and positivity was observed in only single patient with gastrointestinal symptoms and fever.

Conclusions

The administration of the HLA-B*5701 gene test may be of benefit in clinical practice, because it prevents diagnostic errors of the hypersensitivity reaction and enables more accurate interpretation of the symptoms.

Objective

The objective of the study was to describe the consumption of oral analgesics (OA) in people aged ≥65 years, and distinguish between easy-to-swallow (ETS) formulations and solid forms.

Methods

Real data study with a cross sectional design. Electronic anonymous medical records of one year of primary care activity (July 2007–June 2008) were retrospectively reviewed. Inclusion criteria: patients aged ≥65 years receiving OA. Subgroups: institutionalized/non institutionalized. It was considered the oral analgesics use as a principal variable. Study variables: socio-demographic, pharmaceutical formulations (solid and ETS), co morbidities, type of analgesics, geriatric scales (Minimental, Barthel), and poly-medication. Multiple logistic regression analysis models were applied. Program SPSSWIN, statistical signification P<.05.

Results

Overall 78% patients regularly consumed OA. A total of 11 344 patients were studied; mean age 75.1 (7) years; female 61.5%. Two percent of patients were institutionalized and were older (OR=1.2), predominantly female (OR=1.3), had more co morbidity (OR=3.5; P<.001) and lower geriatric scale scores. OA were 13.8% of total drug consumption (95% CI, 13.2- 14.4); NSAIDs 69.5% and opioids 17.6%. Poly-medication 90.6% (96% institutionalized vs 90.5% non institutionalized; P=.019). Thirty-one point one percent of patients used ETS whose use was associated with stroke (OR=2.7), neuropathy (OR=2.4; P<.001), and urinary incontinence. Institutionalized patients consumption of paracetamol, tramadol, and aceclofenac was higher (54.3%, 19%, and 7.6%, respectively).

Conclusions

The use of OA was high, particularly in institutionalized patients. NSAIDs use was higher than expected compared to opioids that were lower than expected. The use of ETS analgesics was lower than expected given the reduced swallowing capacity of elderly patients.

Objective

To evaluate the incidence of cardiotoxicity associated with treatment with trastuzumab in clinical practice by describing its characteristics, progress, and associated risk factors.

Methods

Retrospective observational study of patients with HER2-positive breast cancer treated with trastuzumab in the first quarter of 2007 in a tertiary hospital. Follow-up was performed from start of treatment until the end of March 2008. The data sources used were the oncological computer program Oncowin® from the pharmacy department and the patient clinical history. We gathered variables related to patient baseline characteristics, treatment, and safety.

Results

The study included 61 patients. 19 women (32.8%) presented cardiotoxicity, which was the second most common adverse affect of those frequently attributed to the treatment. The average time for toxicity to appear was 7 months, with an average FEVI decrease of 15.6 (9.1) points. In 63.2% of the patients it was symptomatic, and its most frequent manifestation was stress-induced dyspnoea, with a single case of congestive heart failure. Cardiotoxicity led to suspension of treatment in 22.9% of the total patients, which was definitive for 7 out of the 14 patients who interrupted the treatment. No statistically significant differences were found for the possible risk factors.

Conclusions

The incidence of cardiotoxicity in clinical practice is much higher than expected. The important clinical implication of this information and the increasing use of trastuzumab mean that there is a new challenge for the optimal treatment of HER2-positive breast cancer.

Objective

Analyse the profile of parenteral preparation and treatment (anti-neoplastic and supplementary) that were dispensed and returned to the Pharmacy Department, the reasons why they were not administered, their reuse and the associated direct costs.

Method

Longitudinal study over 8 months (October 2004-May 2005) in a tertiary hospital with centre for preparing anti-neoplastic agents (including supplementary treatment) in its Pharmacy Department. The variables studied, downloaded from the Oncofarm® application, are as follows: a) patients and diagnostics; b) returned treatments, classified by reason returned, pharmaco-therapeutic scheme, cycle, and day; c) returned preparations (anti-neoplastic and supplementary) that were reused; and d) direct costs.

Data is presented with its absolute and relative frequencies and confidence intervals of 95% normalised at 1000 patients/day.

Results

Eighty-four treatments were returned by 66 patients for a total of 139 preparations corresponding to 3429 patients/day. This figure represents 24.5 (95% CI, 19.6-30.2) treatments that were prepared and not administered per 1000 patients/day, mainly due to clinical causes (n=47). Colon neoplasia and treatment with 5-fluorouracil and levofolinic acid presented the highest number of returns. The returned preparations made up 1.45% (95% CI, 1.2-1.7) of those produced. The percentage of reuse is 98%, which results in savings of €10 432.55 (90% of the cost of the treatments that are returned).

Conclusions

The application of quality, effectiveness, and safety criteria to anti-neoplastic treatments that are prepared and returned to the Pharmacy Department allows a more efficient preparation process.

Objectives

To evaluate the effectiveness and safety of 2% diltiazem ointment in the treatment of anal fissure. To analyse the relationship between healing and diagnosis, and duration of the treatment, and the number of applications.

Methods

A prospective observational study of all patients diagnosed with anal fissure that began treatment with topical diltiazem between January and June in 2007. Diltiazem ointment was prepared in the Pharmacy Service. Effectiveness and safety were assessed by a telephone survey conducted with each patient after 8 weeks of treatment, adding it to the patient's clinical records. The variables that were analysed were healing, adverse effects, diagnosis, duration of treatment, and number of applications, among others. Follow-up was carried out for up to 1 year until complete healing of the fissure. The data analysis was carried out by descriptive statistics, crosstabs, and x².

Results

A total of 70 patients were included in the study and anal fissure healed in 48.6% of them. Healing occurred in 54.5% of patients with anal fissure and in 33.3% of patients with anal fissure and haemorrhoids. Some adverse effects occurred in 30% of patients. Therapy was abandoned due to adverse reactions for 5.7%. The fissure was cured for 60% of patients who underwent treatment for a month or more. More than twice-daily applications did not lead to improved healing. There were no significant statistical differences in these results.

Conclusions

Despite not having found statistical differences between the analysed variables, treatment of anal fissures with 2% diltiazem ointment has avoided surgery in nearly 50% of patients, with few adverse effects.

Objective

To analyse the proportion of patients whose blood pressure values have remained within the established therapeutic aim, so as to reduce cardiovascular risk following therapeutic exchange of angiotensin II receptor antagonists (AIIRA).

Methods

Analytical, observational, prospective, longitudinal study with pre-post analysis. Patients undergoing AIIRA treatment who were not included in the hospital's pharmacotherapeutic guide were included in the study over those who had undergone a normalised therapeutic exchange of AIIRA. Variable response: proportion of patients whose blood pressure levels (BP levels) remained within the established therapeutic aim for the prevention of cardiovascular accidents. Other variables: systolic and diastolic blood pressure values (SBP and DBP) in the month prior to hospitalisation and after therapeutic exchange, antihypertensive medication, comorbidities.

Results

Thirty-seven patients were included in the study. Following therapeutic exchange, 81.08% maintained BP values within the range established by the European Society of Hypertension-European Society of Cardiology Committee. SBP difference: 4.82 (95% confidence interval [CI], −1.09 to 10.74; P=.107); DBP difference: −0.15 (95% CI, −3.27 to 2.97; P=.924), and therefore not clinically significant.

Conclusions

The normalised procedure for therapeutic exchange of AIIRA is effective and safe for patients in terms of maintaining BP, which allows for adequate control of BP during the hospital stay.