María I. Baena

Terms used in patient safety related to medication: a literature review

There is a lack of homogeneity in the terminology used in the context of patient safety related to medication. The aim of this review was to identify the terms and definitions used in patient safety related to medication within the scientific literature.

Resultados negativos asociados con la medicación en un servicio de urgencias hospitalario

Objective: To find out the prevalence of negative results associated with medication (herein referred to as NRM) in patients attending the emergency department. To classify the results by severity, avoidability and cost, as well as to establish the factors associated with their appearance. Method: Observational, descriptive and cross-sectional study carried out in the emergency department of a tertiary hospital. Patient surveys and emergency department records were used as sources of information. The Dader Method and guidelines from the Third Consensus of Granada were used. Pearson’s c2 test was used to find the association between age, gender and number of drugs and showing signs of NRM. Avoidability was measured using Baena et al’s criteria and severity was assessed according to whether or not the patient had been admitted into an observation stall or on to a hospital ward. Results: 24.4% of patients visited the emergency department because of NRM. 16.1% needed to be hospitalised to solve their health issue. 83.9% of all patients with NRM and 77.3% of those hospitalised due to NRM could have been avoided. Statistically, there was a higher prevalence of NRM in patients taking 5 or more different drugs. An estimated e 14,666,178 was spent on treating avoidable NRM cases in 2003. Conclusions: The prevalence of NRM in those who attended the emergency department, the high percentage of avoidability and the cost imposed on the Health Service seem to sufficiently argue a case for the consideration that NRM as a problem which requires the implementation of prevention programmes based on drug-treatment monitoring.

Magnitude of the white-coat effect in the community pharmacy setting: The MEPAFAR study

BACKGROUND There is little information regarding the community pharmacy blood pressure (CPBP) measurement method and their differences with home (HBP) or ambulatory BP (ABP). The aim of this study was to measure such differences and their variation over successive visits. METHOD Cross-sectional study carried out in eight pharmacies in Gran Canaria (Spain). The study included 169 treated hypertensive patients. BP was measured at the pharmacy (four visits), at HBP (4 days) and 24-h ABP monitoring. We defined pharmacy white-coat effect (PWCE) as differences between CPBP and HBP (home PWCE) or daytime ABP (ambulatory PWCE). RESULTS The overall (pooled values for all visits) ambulatory PWCE was not significantly different from zero for systolic BP (SBP) (-0.4 mm Hg (95% confidence interval (CI): -1.8 to 1.1)), but greater than zero for diastolic BP (DBP) (3.4 mm Hg (95% CI: 2.3 to 4.6)). The overall home PWCE was not significantly different from zero, both for SBP (1.2 mm Hg (95% CI: -0.1 to 2.6)) and DBP (0.1 mm Hg (95% CI: -0.7 to 1.0)). The ambulatory and home PWCE on the first visit were greater than zero (P < 0.001) (SBP/DBP): 3.5/4.8 and 1.9/1.5 mm Hg, respectively; but showed important reductions at the second visit and became not significantly different from zero, except the ambulatory PWCE in DBP, which persisted until the last visit. CONCLUSION The trend in the PWCE decreased over the successive visits to the pharmacy. Only the ambulatory PWCE in DBP proved to be statistically greater than zero after the second visit. Repeated CPBP measurements could be a useful alternative to assess the response to antihypertensive treatment.

Clinical value of blood pressure measurement in the community pharmacy

Aim of the study To investigate whether the measurement of blood pressure in the community pharmacy is a valuable method to diagnose hypertension, to assess the need and the effectiveness of anti-hypertensive treatments, or, in general, to make clinical decisions. Method Information has been extracted from articles published in English and in Spanish, from January 1989 to December 2009, in indexed magazines in MEDLINE and EMBASE. To perform the search, multiple and specified terms related to the community pharmacy setting, to blood pressure measurement and to the comparison and agreement between blood pressure measurement methods were used. Selected articles were those that: (1) compared and/or measured the agreement (concordance) between community pharmacy blood pressure measurements obtained in repeated occasions, or (2) compared and/or measured the agreement between the community pharmacy blood pressure measurement method and other measurement methods used in clinical practice for decision-making purposes: blood pressure measurement by a physician, by a nurse and home or ambulatory blood pressure monitoring. Articles were included and analyzed by two investigators independently, who essentially extracted the main results of the manuscripts, emphasizing the assessment of the blood pressure measurement methods used and the completed statistical analysis. Results Only three studies comparing the community pharmacy blood pressure measurement method with other methods and one comparing repeated measurements of community pharmacy blood pressure were found. Moreover, these works present significant biases and limitations, both in terms of method and statistical analysis, which make difficult to draw consistent conclusions. Conclusion Further research of high quality is needed, which results can guide the clinical decision-making based on the community pharmacy blood pressure measurement method.

Negative results related to drugs required in hospitalisation

OBJECTIVE To assess the prevalence of negative clinical outcomes associated with medication as a cause of hospital admission and to determine their characteristics (types, categories, avoidability, severity and the drug groups involved.) To determine possible risk factors related to the appearance of this problem. METHOD An observational study carried out over a three month period in a department of the university hospital, 163 patients were selected at random. The information obtained from the patient interview, the revision of clinical records and clinical sessions were used to then identify negative clinical outcomes using the Dader method. RESULTS In 27 cases (16.6 %; 95 % confidence interval [CI], 1.6 to 23.0), negative clinical outcomes associated with medication were considered to be the main cause of hospital admission. The most frequent negative clinical outcomes associated with medication were untreated health problems, non-quantitative ineffectiveness and quantitative safety problems respectively. The overall prevalence of preventable admissions due to negative clinical outcomes associated with medication was 88.9 %; (95 % CI, 71.9 to 96.1 %.) With regards to severity, 74.1 % (95 % CI, 55.3 to 86.1 %) of the total admissions were moderate. The most common drugs implicated in hospital admissions were: antibacterial for systemic use, cardiovascular and non steroidal anti-inflammatory agents. Apart from age, no other factors were found for hospital admissions due to negative results associated with medication. CONCLUSIONS Negative clinical outcomes associated with medication as cause of hospital admission are a prevalent problem and most of them are avoidable with pharmacotherapeutic follow-up.

Application of the SCORE and Wilson–Grundy methods for the assessment of cardiovascular risk in community pharmacies

Background:  The assessment and follow‐up of patients with risk factors, or with cardiovascular disease (CVD), involves estimating and monitoring their CVD risk (CVDR). There are different opinions about the most appropriate method for this.

Negative results associated with medication in the emergency department of a hospital

OBJECTIVE To find out the prevalence of negative results associated with medication (herein referred to as NRM) in patients attending the emergency department. To classify the results by severity, avoidability and cost, as well as to establish the factors associated with their appearance. METHOD Observational, descriptive and cross-sectional study carried out in the emergency department of a tertiary hospital. Patient surveys and emergency department records were used as sources of information. The Dader Method and guidelines from the Third Consensus of Granada were used. Pearsons chi2 test was used to find the association between age, gender and number of drugs and showing signs of NRM. Avoidability was measured using Baena et als criteria and severity was assessed according to whether or not the patient had been admitted into an observation stall or on to a hospital ward. RESULTS 24.4% of patients visited the emergency department because of NRM. 16.1% needed to be hospitalised to solve their health issue. 83.9% of all patients with NRM and 77.3% of those hospitalised due to NRM could have been avoided. Statistically, there was a higher prevalence of NRM in patients taking 5 or more different drugs. An estimated euro 14,666,178 was spent on treating avoidable NRM cases in 2003. CONCLUSIONS The prevalence of NRM in those who attended the emergency department, the high percentage of avoidability and the cost imposed on the Health Service seem to sufficiently argue a case for the consideration that NRM as a problem which requires the implementation of prevention programmes based on drug-treatment monitoring.

Impact of a pharmaceutical care programme for patients with chronic disease initiated at the emergency department on drug-related negative outcomes: a randomised controlled trial

Background The resolution of potential drug-related problems is a priority of pharmaceutical care programmes. Objectives To assess the clinical impact on drug-related negative outcomes of a pharmaceutical care programme focusing on the resolution of potential drug-related problems, initiated in the emergency department for patients with heart failure (HF) and/or chronic obstructive pulmonary disease (COPD). Methods Controlled trials, in which older adults (≥65 years) receiving four or more medications admitted to the emergency department for ≥12 hours for worsening of HF and/or COPD were randomised (1:1) to either a pharmaceutical care programme focusing on resolving potential drug-related problems initiated at the emergency department (intervention group (IG)) or standard care (control group). Comparisons between the groups were made for the proportion of patients with drug-related negative outcomes, number of drug-related negative outcomes per patient, mean stay, patients readmitted within 180 days and 180-day mortality. Results 118 patients were included, 59 in each group. Fewer patients in the IG had drug-related negative outcomes (37 (62.7%) vs 47 (79.7%) in the control group (p=0.042)). Fewer drug-related negative outcomes per patient occurred in the IG (56 (0.95 per patient) vs 85 (1.44 per patient) in the control group (p=0.01)). The mean stay was similar between groups (194.7 hours in the IG vs 242.5 hours in the control group (p=0.186)). No difference in revisits within 180 days was found (32 (54.24%) in the IG vs 22 (37.3%) in the control group (p=0.065)). 180-Day mortality was detected in 11 (18.6%) patients in the IG compared with 13 (22%) in the control group (p=0.647). Conclusion A pharmaceutical care programme focusing on resolving potential drug-related problems initiated at the emergency department has a favourable clinical impact, as it reduces the number and prevalence of drug-related negative outcomes. No difference was found in other outcome variables. Trial registration number NCT02368548.