Yolanda Larrubia

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.

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.

Answer to the comment on 'potential medication errors associated with computer prescriber order entry'.

First, we would like to thank Fayaz-Bakhsh et al. for the comments related to our article that was published in your journal about electronic prescribing and medication errors [1]. We are in agreement about the importance of medication errors due to their negative effects on patients and their repercussions on the healthcare system. As is referenced in the letter, of the strategies directed to minimize errors, those that have demonstrated one of the best efficacy have been assisted CPOE and the development of prescription decision support. Nevertheless, this system, in our opinion, presents two important shortcomings: the introduction of new errors (as shown in our study) and the difficulty applying CPOE to special populations, such as pediatrics or critical patients. In accordance with the authors that you have referenced and along with the available evidence [2], CPOE has demonstrated a lower efficacy in reducing errors in pediatric patients compared to adults. There are risk factors specific to the pediatric population that may lead to medication errors. It has been seen that these generally occur in the prescribing phase and are due to incorrect unit conversions or incorrect dose calculations. In the pediatric population, it is common to make an error in the positioning of the decimal point, causing a tenfold change in dose. While in adults, medication errors related to dose calculations typically lead to a two-fold increase [3]. Thus, medication errors can more easily cause severe consequences in this vulnerable population. There is also the added inconvenience of the difficulty in adapting the CPOE programs, which are designed for adults, to the pediatric. In many cases, this is a complex process that causes many problems in hospitals that treat both adult and pediatric patients. Similarly, critical patients are another vulnerable population in which medication errors are caused by unit specific risk factors. The efficacy of CPOE is limited by the complexity and variability of each patient’s clinical case. The treatment of such patients requires continuous changes and the rapid implementation of the therapies may be hindered by the additional workflow of CPOE. This also introduces new errors from the use of this technology and fixed pharmaceutical management strategies, for example fluid-therapy [4]. These limitations make the use of these programs difficult in the critical care setting. For all these reasons, and in accordance with your letter, we also think that despite the value of the CPOE in increasing patient safety, such systems have two major drawbacks: the complexity to adapt them to specific patient populations and new errors related to this technology. It would be desirable that these programs include decision support specifically designed for different patient populations. E. Villamañán (&) M. Ruano Y. Larrubia A. Herrero Pharmacy Department, La Paz University Hospital, Paseo de La Castellana 261, 28046 Madrid, Spain e-mail: evillabueno@telefonica.net

PS-088 Medicines not available in the hospital are a potential risk of adverse drug events

Background The process of reconciling medicines not available in the hospital has been demonstrated to be a powerful strategy to prevent adverse drug events. Purpose To evaluate drug prescription and administration errors after medicines reconciliation (MR) involving medicines not available in the hospital (MNAH) prescribed prior to admission. Materials and methods We conducted a cross-sectional, observational study in an academic medical centre using computerised physician-order entry (CPOE). After MR at admission, when clinicians decided that these medicines needed to be continued during hospitalisation, since they were not included in the CPOE database, they were prescribed as a generic product, ‘MNAH’ with the drug name and dosage. The main outcome measured was medicines errors involving MNAH detected in the prescription and administration phases. Results We analysed 338 MNAH prescribed to 207 inpatients, mainly for chronic cardiovascular diseases. We detected 211 prescription errors (62.4%, 95% CI: 57–67.6) most of them related to route of administration and dose and 47 drug administration errors (13.9%, 95% CI: 10.4–18). Omission was the principal type of error in both cases. The main causes of these errors were CPOE program deficiencies (62.1%, 95% CI: 55.1–68.6) and lack of information about medicines history in medical records (31.3%, 95% CI: 25.1–38). Most errors did not reach the patient or reached the patient without causing any harm. Errors that caused harm to patients were due to drug duplication. Clinicians considered that 65.9% (95% CI: 59–72.2) of errors could have been avoided with an improved CPOE system. Conclusions Errors associated with prescription and administration of MNAH after MR are common among adult inpatients. Our results suggest that there are two main weak points: i) lack of coordination and available information for clinicians about patients’ medicines history, ii) CPOE deficiencies related to MNAH prescription. No conflict of interest.

[Colchicine: what's up, doc?].

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.