Margarita Ruano

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.

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.

Impact of electronic prescription alerts on medication errors related to vitamin K antagonists in hospitalised patients

Objectives To analyse the impact of the computerised prescription order entry (CPOE) alerts on the reduction of errors due to medication interactions in the prescribing process of vitamin K antagonists. Methods Prospective study over 3 months in a 1400-bed university tertiary care centre gifted with CPOE software, which includes medication interaction alerts. Adult patients receiving oral anticoagulant treatment with vitamin K antagonists with international normalised ratio ≥4 were included. The reason for their hyperanticoagulation was evaluated. We analysed the impact of incorporating interactive alerts in the prescription of vitamin K antagonists in terms of reduction of medication errors by comparing results with a previous period with no interaction alerts incorporated in the software. The main outcome measure was medication errors. Results Implementation of alerts reduced the number of medication errors caused by drug interactions by 71.4% (p=0.02). The number of errors diminished from 10.5 per month to 3 when interaction alerts were introduced. Conclusions Implementation of a CPOE interaction alert programme reduces interaction errors. Additionally, the use of this new technology allowed us to perform a thorough analysis of data and to identify and implement actions aimed at improving patient safety.

5PSQ-092 Analysis of off-label uses of inhalers in hospitalised patients

Background The high prevalence of respiratory diseases leads to high consumption of inhaled bronchodilators (IBs) not always appropriately indicated. It is important for patients and for the healthcare systems that a proper indication and use not only achieves greater efficacy and adherence to the treatment, but also because of the high economic impact of these medications. Purpose To analyse indications for which IBs are used in hospitals and how many of them were off-label. Medical specialties involved in the prescriptions of IBs and whether they were initiated at admission or in primary care were also evaluated. Material and methods Descriptive, observational, cross-sectional study in a tertiary hospital of 1350 beds in Spain. Pharmacotherapy including IBs that are prescribed to inpatients in our centre are registered in an electronic prescription program (FarmaTools® version 5.0). Primary outcome: number of hospitalised patients treated with IBs whose indication is considered off-label. Authorised indications by the European Medicines Agency were considered appropriate. Results The pharmacotherapy of 555 admitted patients was analysed, 104 patients (18.7%) were prescribed IBs (63.6% males, mean age 70±14.2). 33 of them (31.7%; 95% CI: 22.9 to 41.6) were used for off-label indications: 54.5% for non-respiratory diseases, mainly heart diseases (46.1%) and 45.4% for respiratory diseases without bronchoconstriction (respiratory failure in 24.2% and respiratory infections in 15.1%). The remaining 67 (64.4%) were prescribed for approved indications (85.1% COPD and 14.9% asthma). Forty-one (39.4%) treatments with IBs were initiated at admission and 63 (60.6%) in primary care. As for the medical specialties responsible for the inhaler first prescription, 29 (46%) of them were initially prescribed by general practitioners and 34 (54%) by pneumologists. Conclusion A high proportion of admitted patients are prescribed BIs, many of them used for off-label indications for which they have not proved effective. Physicians, when prescribing IBs to patients with respiratory distress, should assess comprehensively whether indication is adequate or not taking into account that they are useful if it is associated with bronchoconstriction. On the other hand, hospital pharmacists when reviewing treatments at admission have a good opportunity for deprescribing IBs inappropriately initiated in primary care in order to avoid inefficiency and potential adverse effects. References and/or Acknowledgements Pharmacy and pneumology ward staff. No conflict of interest

5PSQ-108 Reducing errors of oral medication administration in patients with dysphagia

Background Dysphagia is a prevalent difficulty among ageing adults predominately because of conditions such as stroke or dementia. In patients over 65-years-old, the prevalence of dysphagia ranges from 7% to 13%. To ensure safety during oral medication administration, patients require an appropriate oral dosage form. Purpose The aim of this study was to avoid errors of oral medication manipulation and administration in dysphagic patients. Material and methods A prospective longitudinal study was performed for 2 months in the Internal Medicine Unit. Using a computerised physician order entry program, pharmacists detected inpatients with dysphagia, reviewed prescription to identify inadequate dosage forms and checked the manipulation of solid oral dosage forms. Data collected were: age, sex, number of medications prescribed by patient, liquid or dispersible oral formulations, solid oral formulations prescribed that required a previous manipulation, administration errors, pharmaceutical interventions during prescription or administration and percentage of acceptance. Data were analysed using Microsoft® Excel. Results Pharmacotherapy of 54 inpatients was analysed. Median age was 82 (55–99) years and 29 (54%) were females. Each patient received, on average, 12 different medications. Seventy-seven per cent of oral medications prescribed were not in an appropriate dosage form. Pharmacists made 64 interventions to ensure a safe administration and 52 (81%) were accepted by nurses. A total of 20 (12 during the first month) administration errors were detected. Pharmacists made 25 interventions to recommend alternative solid dose formulations, switch to liquid or dispersible oral formulations, alternative routes or change medication: 20 of these (80%) were accepted by physicians. During the first month the intervention’s acceptance rate was 67% by nurses and 50% by physicians, and during the second month it was 90% and 60% respectively. Conclusion Most oral medications (77%) prescribed to dysphagic patients were manipulated. This fact can promote administration errors. We detected 20 errors because of manipulation of medicines that should never be crushed or opened. We have observed an improvement in the intervention’s acceptance, increasing from 67% to 90% in administration and 50% to 60% in prescription. Administration errors were reduced in 20%, therefore, pharmacists play an important role in medicines’ optimisation in patients with dysphagia. References and/or Acknowledgements Pharmacy, rehabilitation and internal medicine units staff. No conflict of interest

Juego de patentes. Sobre medicamentos genéricos y biosimilares.

The protection provided by patents on medicines has a limited duration. The expiry of patents expiration allows copies of the drugs to be released, competing with original. At first, they were identical to the original, known as generic drugs, but in recent years, due to the marketing of biological therapies and the expiry of many of their patents, biosimilar drugs have also emerged. These are not exact copies of the original, but, like generic drugs, biosimilar drugs have to demonstrate equivalence to the reference drugs in quality, safety and efficacy. Nevertheless, despite their importance and contribution to sustainability of health system, doctors are sometimes unaware of differences between them, and their impact in terms of clinical and economic effects. An attempt is made to review and clarify certain aspects often unknown by physicians, despite their involvement in their use.

PS-076 Prevalence of qt prolongation upon hospitalisation and the analysis of potentially related primary care treatments in cardiology patients

Background QTc (corrected QT interval) prolongation can lead to acute ventricular arrhythmias. A risk factor for this condition is the use of drugs that potentially prolong the QTc interval. Purpose To analyse the effect of QTc-prolonging drugs (QTPDs) on the QTc interval of patients admitted to cardiology units. Drug-drug interactions that could increase this effect were also evaluated. Material and methods Observational, prospective study was completed in a tertiary hospital (1,350 beds) from July–September 2014. QTc intervals upon admission were measured by two arrhythmologists for prolonged QTcs (>450 ms for men, >460 ms for women per American Heart Association/European Heart Association consensus). Patients with pacemakers or wide QRS (>120 ms) were excluded. Home and inpatient drug treatment regimens were evaluated by pharmacists for QTPDs and drug-drug interactions. Results Over the study period, 111 patients were evaluated (median age = 71.8 years, 38.2% female). Upon admission, 34 patients (30.6%, 95% CI: 22.2–40.1) had a prolonged QTc interval (mean QTc = 488.53 ± 21.8 ms). Of these, 9 patients (26.5%) had a home regimen that included at least one QTPD. A difference was not found between the mean QTcs of patients treated with QTPDs (486.0 ± 17.8 ms), QTPDs with interacting drugs (487.8 ± 20.8 ms), or no QTPDs (480.5 ± 22.1 ms). Half of the QTPDs prescribed were antidepressants. Furthermore, 18 patients (52.9%) were taking interacting medicines prior to admission that potentially contributed to this QTc prolongation (beta-blockers = 94.0%; diuretics = 61.1%). Conclusion Almost one-third of patients hospitalised in cardiology units had a prolonged QTc interval at admission, increasing their risk of developing potentially fatal arrhythmias. Before hospitalisation, the majority of patients were receiving QTPDs or interacting medicines; however, this study did not observe a related increased risk of QTc prolongation (limited by a small sample size). It is unknown how further treatment in the hospital affects these patients’ risk. Therefore, it is recommended to evaluate QTc intervals of cardiology patients upon admission and closely monitor for additional risk factors of QTc prolongation and arrhythmias during hospitalisation. References and/or acknowledgements Nursing staff No conflict of interest.

GM-002 Improving medicines management in the hospital discharge setting through pharmacist intervention in the synchronisation of computer applications

Background Lack of synchronisation between hospital applications involved in the medicines use process (MUP) leads to inefficient use of resources. Purpose To prove that pharmacist intervention (PI) in the integration of information recorded in computer applications improves medicines management in the discharge setting (DS). Material and methods Longitudinal, prospective, study (10 days) in a tertiary hospital (1,350 beds). Adult patients being discharged from medical and surgical specialties were evaluated (410 beds). Discharges are recorded in a bed management computer application (BMCA). Every 20 min this information is transferred to CPOE so that electronic prescriptions (EPs) are automatically inactivated. At discharge, because of lack of synchronisation, EPs were incorrectly remaining active. This outdated information was transferred to the automated pharmacy medicines dispensing systems (APMDS) which meant that these medicines were being dispensed to the ward as if the discharged patients were being admitted. Subsequently, they were returned to the pharmacy. Pharmacists confirmed discharges daily, consulting the BMCA. Once verified, they updated EPs in CPOE, avoiding unnecessary dispensing of medicines. Primary endpoint: number of EPs updated by PI in COPE. We also analysed the number of medicines whose unnecessary dispensing and subsequent return to pharmacy was avoided by PI and working time saved. Results We evaluated 361 patients DS. PI updated EPs of 132 (36.6%) outdated because of lack of synchronisation between BMCA and CPOE. The remaining 229 didn’t require PI, as the information recorded in CPOE when it was transferred to APMDS was correct. 1,012 EPs out of 3,327 (30.4%) were updated by PI. Without PI, these prescriptions would have generated unnecessary dispensing of 3,601 medicines. PI led to a total saving of 9.36 h of two pharmacy technicians’ work re-entering medicines unnecessarily dispensed to the ward. Conclusion PIs reduced dispensing failures arising from lack of real-time transmission between hospital applications. Greater synchronisation between BMCA and CPOE would have avoided most of them. PIs improved MUP in DS, saving time and avoidable pharmacy workload. Reference Nursing staff No conflict of interest.