Alicia Herrero

Prescripción electrónica asistida como nueva tecnología para la seguridad del paciente hospitalizado

Concern about patient safety is a priority in the quality policy of health systems. In the pharmacotherapeutic process, from prescription to administration of drugs, failures that cause unwanted effects in patients may occur. This is especially common in patients with multiple pathologies and polypharmacy, common in medical specialities services. To analyze and identify the causes that trigger medical errors is essential to prevent their occurrence. In this context, computerized physician order entry appear as an attractive tool for ensuring patients safety.

Symptomatic thromboembolic events in patients treated with intravenous-immunoglobulins: Results from a retrospective cohort study

AIMS To estimate the incidence and predictors of symptomatic arterial and venous thromboembolic events (TEE) from intravenous immunoglobulin (IVIg) therapy according to its indications. METHODS We performed a retrospective cohort study of patients seen at our institution and treated with IVIg over a 36-month period. Indications, comorbility and comedication associated with TEE were identified by a stepwise logistic regression analysis. RESULTS Of 303 patients included with at least one infusion of IVIg over three years, TEE were identified in a total of 50 patients treated with IVIg, for an incidence of 16.9% (CI 95%: 13.0-21.6); 27 (54%) arterial (9.1%;CI 95%: 6.3-13.0%) and 23 (46%) venous TEE (7.8%; CI95%: 5.2-11.4%), overall mortality was 32%. Per indication there were more patients with autoimmune conditions, secondary immunodeficiency, dysimmune neuropathies, acute rejection of solid organ transplantation and sepsis. Patients with TEE were significantly older, were more likely to be men, they had more comorbid conditions; the doses of IVIg were high (589.4mg/kg/day vs 387.0mg/kg/day, p<0.001) and differences in comedication were found. The stepwise logistic regression analysis retained high doses of IVIg (OR 3.03; CI 95%: 1.49-5.67) and diuretics therapy (OR 1.69; CI 95%: 1.06-3.97) when combined with the usual comorbid confounders. CONCLUSIONS The incidence of TEE from IVIg therapy remains high at one in six patients treated. The most remediable factor is a high daily IVIg load. Decreasing the daily IVIg dose together with carefully weighing diuretics therapy and comorbid risk factors may be the keys to saving lives.

Improving linezolid use decreases the incidence of resistance among Gram-positive microorganisms

Surveillance studies have shown the emergence of infections with linezolid-resistant bacteria. The relationship between appropriate linezolid use and the spread of linezolid resistance among Gram-positive microorganisms in a single tertiary referral centre was evaluated. In an initial observational study, a prospective prescription-indication study was conducted on intensive care areas and haematology, neurosurgery, vascular surgery and nephrology wards during 2009. An intervention through follow-up feedback on audit results from May-June 2010 was then conducted. From July-December 2010, a second drug-use study of linezolid was conducted, with the same objectives and methodology. To assess the antimicrobial pressure of linezolid, an ecological study was conducted from 2006-2010 in the same hospital wards. Indications for linezolid in the initial study were considered suitable in 38.5% of cases, whilst in the second study the rate was 51.2% (33% increase). Linezolid consumption fell by 57% in the second half of 2010. A significant correlation was found between its inadequate use (DDD/1000 patient-days) and the incidence of linezolid-resistant strains/1000 patient-days (r=0.93; P=6.9e-024); 85% of the variability in the incidence of linezolid resistance was predicted by its inadequate use. Its partial correlations were significant for Enterococcus faecium (r=0.407; P=0.049), Staphylococcus epidermidis (r=0.874; P=2.3e-008) and Staphylococcus haemolyticus (r=0.406; P=0.049) but not Staphylococcus aureus (r=0.051; P=0.704). A relationship was found between appropriate linezolid use and the incidence of linezolid-resistant strains of E. faecium, S. epidermidis and S. haemolyticus.

RevisiónPrescripción electrónica asistida como nueva tecnología para la seguridad del paciente hospitalizadoComputerized physician order entry as a new technology for patients’ safety

Concern about patient safety is a priority in the quality policy of health systems. In the pharmacotherapeutic process, from prescription to administration of drugs, failures that cause unwanted effects in patients may occur. This is especially common in patients with multiple pathologies and polypharmacy, common in medical specialities services. To analyze and identify the causes that trigger medical errors is essential to prevent their occurrence. In this context, computerized physician order entry appear as an attractive tool for ensuring patients safety.

La prescripción electrónica asistida en pacientes hospitalizados en un servicio de Neumología

Patient medical care requires a level of individualised care, so technological support is becoming increasingly necessary, if not essential. Even so, the effort required to apply new technologies in the health system is not always sufficient, taking into account that they could be key factors for the safety of the patient. Treatments are often prescribed manually, which could lead to errors due to ambiguity of the prescriptions, illegibility, calculation errors or transcription errors. The increasing sophistication of computer systems and programs used in the hospital care setting can be fundamental in reducing risks for the patient, detecting and correcting errors, contributing to making decisions using help support and reducing costs in the long-term. Polymedicated patients with the usual multiple diseases in medical specialty departments, such as Chest Diseases, can particularly benefit from the application of these new technologies.

The Assisted Electronic Prescription in Patients Hospitalised in a Chest Diseases Ward

Abstract Patient medical care requires a certain degree of individualized attention, and to this end technological support is becoming increasingly necessary, if not essential. Even so, the efforts directed at applying new technologies in the health-care system are not always sufficient, especially when taking into account that they could be key factors in patient safety. Treatments are often prescribed manually, which could lead to errors due to ambiguity of the prescriptions, illegibility, calculation errors or transcription errors. The increasing sophistication of computer systems and programs used in the hospital care setting can be fundamental in reducing patient risk, detecting and correcting errors, contributing to making decisions by means of help applications and reducing costs in the long-term. Polymedicated patients with common multiple diseases in medical specialty departments, such as Pulmonology, can particularly benefit from the application of these new technologies.

New technologies as a strategy to decrease medication errors: how do they affect adults and children differently?

BackgroundMedication error can occur throughout the drug treatment process, with special relevance in children given the risk of adverse effects resulting from a medication error is more prevalent than in adults. The significance of medication error in children is also greater because small error that would be tolerated in adults can cause significant damage in children. Moreover, the likelihood of injury is higher than in adults.Data sourcesBased on the data published, most medication errors take place in prescribing and administration stages in both populations. Taking in account that child’s risk factors are different from those of adults, with some specific causes to pediatrics, we have reviewed available data about new technologies as a strategy to reduce pediatric medication errors.ResultsEven though there is a lack of standardized definitions and terminology that makes studies difficult to compare, we checked that new technologies have proven to be effectives in reducing medication errors, mainly computerized physician order entry (CPOE) and platforms to aid decision-making. However, we also observed that the use of these informatic tools can also generate new errors.ConclusionsImplementation of CPOE programs for pediatrics, communication improvement between healthcare professionals taking care of admitted children and the knowledge of these programs should be the mayor priorities for the safety of hospitalized children.

Strategies for improving documentation and reducing medication errors related to drug allergy

New technologies like computerized physician order entry systems, that includes a support alert for drug allergies, can be an effective tool to prevent medical errors related to drug hypersensitivity most of them caused by lack of documentation and information.

Informed consent in clinical research; Do patients understand what they have signed?

Informed consent is an essential element of research, and signing this document is required to conduct most clinical trials. Its aim is to inform patients what their participation in the study will involve. However, increasingly, their complexity and length are making them difficult to understand, which might lead patients to give their authorization without having read them previously or without having understood what is stated. In this sense, the Ethics Committees for Clinical Research, and Pharmacists specialized in Hospital Pharmacy and Primary Care in their capacity as members of said committees, play an important and difficult role in defending the rights of patients. These Committees will review thoroughly these documents to guarantee that all legal requirements have been met and, at the same time, that they are easy to understand by the potential participants in a clinical trial.

PS-008 The effect of disease-modifying antirheumatic drugs on the suspension of biologic al treatment due to adverse effects

Background Anti-TNF drugs (AD)s have been a major advance in the control of chronic rheumatic diseases, however they sometime have important adverse drug effects (ADEs). Purpose To assess the frequency of AD and disease-modifying antirheumatic drug (DMARD) combinations leading to withdrawal of biological treatment (BT) due to ADEs. Material and methods Observational study in a tertiary hospital (1,350 beds). Outpatients on BT followed in a rheumatic disease unit were included. We evaluated patients who had been prescribed infliximab, etanercept or adalimumab concomitantly with DMARDs (between November 1999 and March 2013). The primary end point was BT withdrawal due to ADEs. Results 444 patients out of 531 took DMARDs at the same time as ADs. 52 (11.7%) discontinued treatment due to ADEs as did 10 patients receiving anti-TNF monotherapy (11.5%) (OR = 0.27; p > 0.05). 160 patients took leflunomide, 28 of them (17.5%) discontinued AD due to ADEs. This risk of discontinuation was significantly higher than in patients receiving other concomitant DMARDs (OR = 1.984; p < 0.05). However, methotrexate seemed to have a protective effect regarding the risk of stopping ADs (OR = 0.567; CI95%: 0.319–1.010; p > 0.05). The frequency of AD withdrawal was similar when comparing patients on monotherapy versus polytherapy (anti-TNF and DMARDs) regardless of drug or diagnoses. Only leflunomide showed significantly higher ADEs which led to BT interruption (OR = 1.984; p < 0.05). We did not detect a significant increase in ADEs when other DMARDs were used concomitantly with BT. We found less probability of withdrawal for patients treated with anti-TNF in combination with methotrexate (OR = 0.567; IC95% (0.319–1.010); p > 0.05). There was an increase in discontinuations with each additional number of concomitant DMARDs up to a maximum of three. Conclusion Association of anti-TNF with different DMARDs did not modify the risk of BT withdrawal as a consequence of ADEs. As a DMARD was added to any AD, the number of its discontinuations increased. The addition of BT treatment concomitantly with leflunomide significantly increased the risk of anti-TNF discontinuation due to ADEs, while patients taking methotrexate with BT were less likely to develop ADEs. References and/or acknowledgements Rheumatology Department No conflict of interest.