Highlights
Few large series have described the clinical characteristics, treatments, costs and outcomes of COVID-19 patients in western countries.
We report our experience with the first 1,255 cases who received anti-COVID-19 treatment at a Spanish hospital.
The prevalence of acute respiratory distress syndrome and mortality was high in the early days of the Spanish epidemic.
Older age, the presence of diabetes, cardiovascular disease, and the presence of severe hypoxemia, lymphocytopenia and increased C-reactive protein at admission are factors independently associated to an increased risk of death.
The cost of COVID-19 treatment is high (€0.44 million per 1,000 hospitalized patients). Higher expenses are attributable to the treatment of acute respiratory distress syndrome with tocilizumab.
The combination of OBV/PTV/r+DSV with or without ribavirin for 12-week settings achieved a high rate of SVR12, with an acceptable safety profile in routine clinical care.
Summary
What is known and objectives
Inadequate management of chronic medication puts patients at risk and causes unnecessary suspension of surgical procedures. The objective of the study was to calculate the rate of cancellation of elective surgical procedures due to inadequate management of chronic medications and to analyse the underlying causes of cancellation.
Methods
We designed an analytic, observational, retrospective study of all elective surgical procedures performed from July to October 2017 in a tertiary hospital. The main variable was the percentage of surgeries cancelled owing to inadequate management of chronic medications. Other variables recorded included demographic characteristics, time between the preanaesthesia evaluation and surgery, drug involved, and the reason for incorrect management of the medication.
Results
During the study period, 5415 surgical procedures were programmed, and 793 (14.6%) were cancelled. Cancellations due to inadequate patient preparation accounted for 5.3% (42 cases), and 19 were related to incorrect medication management (2.4% of the total number of cancellations). The 19 patients, who were mostly men (73.7%), had a median age of 76 years (IQR 68‐81). The drugs involved were acenocoumarol (6), enoxaparin (4), clopidogrel (4), direct‐acting oral anticoagulants (2), acetylsalicylic acid (1), tocilizumab (1) and leflunomide (1). The reasons for drug mishandling were poor understanding of the anaesthesiology recommendations (15) and lack of a preanaesthesia evaluation (4).
What is new and conclusion
Inadequate management of chronic medications (2.4%) is not the most frequent reason for cancellation, although it is one of the easiest to avoid. Based on our results, starting in October 2017, the Pharmacy Department began to offer a pharmaceutical service to patients with doubts about the preoperative management of chronic medications.
ObjectivesTo determine if an advanced medication review carried out in the emergency department (ED) increases the number of pharmacotherapy recommendations (PR) and the severity of the detected prescribing errors.MethodsWe designed an analytic observational prospective cohort study with preintervention assessment (PRE) and postintervention assessment (POST). In PRE, prescription review was done by pharmacists located in the pharmacy department; they took into account only the information provided by the computerised physician order entry system. In POST, pharmacists were physically present in the ED and performed an advanced medication review. The main variables were number of PR and the severity of detected prescribing errors according to the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) severity index. Clinical variables were number of calls to physicians on duty during the first 48 hours of admission, readmissions at 30 days, visits to the ED at 30 days, inhospital mortality and length of stay.ResultsThe study population comprised 102 patients (51 in PRE and 51 in POST). In PRE, the number of PR per patient was 1.1; in POST, this value increased by 53% (1.7 PR per patient; P=0.014), especially in the case of PR related to home medications. The severity of prescribing errors was higher in POST (P=0.004). There was a trend towards better results for all clinical outcomes in POST although statistical significance was not reached.ConclusionsAn advanced medication review in the ED increases the number of PR and the severity of the detected prescribing errors.
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