Elena Villamañán

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.

Computerized physician order entry in the cardiac intensive care unit: effects on prescription errors and workflow conditions.

PURPOSES To evaluate the effects of a computerized physician order entry (CPOE) system in the cardiac intensive care unit by detecting prescription errors (PEs) and also to assess the impact on working conditions. METHODS A longitudinal, prospective, before-after study was conducted during the periods before and after the implementation of the CPOE system. Clinical pharmacists were responsible for the registration, description and classification of PEs, and their causes and severity, according to an international taxonomy. Professionals were also surveyed for their opinion, concerns, and level of satisfaction. RESULTS A total of 470 treatment orders containing 5729 prescriptions were evaluated. The CPOE resulted in a marked reduction in the number of PEs: error rate was 44.8% (819 errors among 1829 prescriptions) with handwritten orders and 0.8% (16 among 2094 prescriptions) at the final electronic phase (P < .001). Lapses were the main cause of error in both prescription methods. Most errors did not reach the patients. Errors related with the computerized system were scarce. Most users were satisfied with many aspects of this technology, although a higher workload was reported. CONCLUSIONS Computerized physician order entry in the cardiac intensive care unit proved to be a safe and effective strategy in reducing PEs and was globally well received by professionals.

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.

Colquicina, ¿qué hay de nuevo. viejo?

Over de past years use off-label of colchicine has notably increased, mainly as a result of the latest studies published about its efficacy in the prevention of recurrence after acute or recurrent pericarditis and pericarditis after cardiac surgery. Nevertheless, colchicine use has been associated with serious drug interactions and toxicity with high morbimortality. Taking into account the recent results about the efficacy of colchicine in pericarditis management, we envisage an increase in the use of this drug by clinicians. In this review we analyse the risks and current recommendations for a safety use of this ancient drug.

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.

Complications associated with the use of oral anticoagulation in patients with pulmonary arterial hypertension from two referral centers

Anticoagulants are widely used in patients with pulmonary arterial hypertension (PAH) to prolong survival. However, there is a lack of robust evidence demonstrating the benefits of anticoagulants in PAH patients and very little is known about the complications of their use in this population. The objective of this study is to compare the safety of routine administration of oral anticoagulants between PAH patients who were and were not treated with oral anticoagulants. This observational, retrospective cohort study included consecutive patients with confirmed PAH from two centers: Brigham and Women’s Hospital in Boston and Hospital Universitario La Paz in Madrid from January 2009 to August 2015. The study group comprised patients who received therapeutic anticoagulation; patients who had never received anticoagulants were placed in the control group. Of the 201 included patients, 60.2% were treated with oral anticoagulants and 39.8% were not treated. The hazard ratio for major bleeding was 2.7 (95% confidence interval [CI] = 1.1–6.8; P = 0.036). The incidence rate for the anticoagulation group was 4.7 per 100 patient-years (95% CI = 2.5–8.0). The most frequent major hemorrhage was gastrointestinal bleeding with 24 cases (72.7%). Prior bleeding, poor anticoagulation, HAS-BLED score ≥3, diabetes, and number of medications were factors that increased the risk of major bleeding in patients using anticoagulants. The harmful effects of anticoagulants could outweigh the benefits in PAH patients. Therefore, anticoagulants should be prescribed on a case-by-case basis and should not be systematically recommended.

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.