No abstract

The work carried out by the GENESIS group has enabled Spanish hospitals to share their drug assessment reports and making them more complete, although there are still some aspects that can be improved.

BackgroundThe prescription system known as RELE is the electronic prescribing and dispensing system that has been used by the Balearic Islands Health Service (IB-SALUT, Spain) since April 2006. This repository contains patients’ computerised medication profiles (CMPs). Data from studies conducted in other settings have shown the existence of discrepancies between the medications recorded in patients’ CMPs and the medications actually taken by the patients.MethodsChronic medications recorded in RELE CMPs were compared with those obtained through a structured clinical interview with patients or the persons responsible for the administration of the patients’ medications. A descriptive analysis of each discrepancy was performed. Potentially associated factors were analysed using Pearson’s χ2 test.ResultsOf the 215 CMPs studied, 168 (78%) had discrepancies. The rate of discrepancies in the general population inferred from these results ranged from 72.57% to 83.71%, with a 95% confidence level. Polypharmacy was associated with the presence of discrepancies (χ2: 39.998, 1 df, p<0.0001) as well as patient age >65 years (χ2: 18.949, 2df, p<0.0001) and higher comorbidity (χ2: 12.548, 2 df, p=0.002). The association between the types of discrepancies and their causes showed that prescriber-generated dosage errors were the most common errors (n=116; 27%), followed by patient-generated commissions (n=79; 18%), patient-generated dosage errors (n=77; 18%) and prescriber-generated commissions (n=73; 17%).ConclusionThe rate of discrepancies identified in this study shows that clinical interviews with patients during transitions of care continue to be essential.

Background Pregnant women are usually excluded from clinical drug trials. However, many women take medicines while they are fertile. Because of this, the pharmacy department agreed with the Department of Obstetrics and Gynaecology (DOG) to write drug teratogenicity reports (TDR) for pregnant women (or women who desired a child). Purpose To evaluate drug teratogenicity and write reports as requested by the DOG. Furthermore, to assess the suitability of prescriptions in the light of recommendations drawn up by the clinical pharmacist. Materials and methods Drug teratogenicity was reviewed from September 2009 to October 2011. Drugs were classified according to drug class and the FDA teratogenicity category (A, B, C, D, X). Category recommendations were as follow: categories A and B: continue treatment; Category C: consider the risk-benefit balance; Categories D and X: stop treatment. The suitability of prescriptions in the light of TDR recommendations was assessed by reviewing the electronic medical records and the electronic ambulatory prescription records. Results 32 TDRs were written, with 59 drugs reviewed. The FDA classification categories were: A (n=2), B (n=6), C (n=31), D (n=18), X (n=2). 49% of drugs taken belonged to the classes antidepressant, benzodiazepines or antiepileptics. During the study period seven of the 32 women were lost to follow-up. In three cases, pregnancy was legally interrupted, and the last 22 women were monitored to the end. Of all the drugs of each of the 22 women monitored, 21 drugs were discontinued (B=1; C=10; D=10; X=1), 12 drugs were continued (A=2; B=1; C=6; D=3) and it was not possible to figure it out in two drugs (B=1; C=1). The prescriptions were appropriate in the light of the TDR recommendations in 88% of the cases. Conclusions The contribution of clinical pharmacists to the multidisciplinary team is increasingly valuable. The TDR and the subsequent monitoring of these special patients improved the knowledge of drugs during pregnancy.

university hospital. Patients 0-35 days old treated with gentamicin and with plasma concentrations (Cp) were reviewed. The descriptive analysis was performed with the SPSSV.24 programme. Results 47 patients with a median age of 3 days (0-33) were studied, 33 male. 26 (55.3%) were <1 week old. 34 (72.3%) were admitted for neonatal sepsis and 7 (14.9%) for urinary infection. Gentamicin was used in combination with ampicillin in 45 cases (95.7%) and empirically in 34 (72.3%). The initially prescribed dose was 4 mg/kg/day in 36 (77%) and 5 mg/kg/day in 8 (17%), with no differences in weeks of life. Cp were extracted with a median of 2 days (1-4) after the start, the median peak was 7.5 mg/L (3.5-21.6) and 29 (62%) had a peak <8 mg/L. The trough was <0.2 mg/L in 26 patients and of those that were quantified, the median was 0.4 mg/L (0.2-1.3), and was higher than 1 mg/L in only one case. It was recommended to increase the dose in 26 (55.3%) and reduce it in 4 (8.5%) patients, with 90% acceptance. A second Cp determination was requested in 16 (34%) cases with a median peak of 9 mg/L (6-12) and trough levels always <0.5 mg/L. It was recommended to increase the dose in 5 cases with an acceptance of 94%. Conclusion and relevance The dose prescribed was lower than recommended in neonates >1 week old. Cp allowed detection and correction of deviations from the recommended peak or trough levels in 64% of cases, mainly due to low peak levels, with high acceptance of TDM. Plasma determination and TDM of gentamicin continues to be an essential tool to achieve the recommended PK/PD profile.