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Background In the current coronavirus health crisis, inhaled bronchodilators(IB) have been suggested as a possible treatment for patients hospitalized. Patients with evidence of Covid-19 pneumonia worldwide have been prescribed these medications as part of therapy for the disease, an indication for which this medications could be ineffective taken on account the pathophysiology and mechanisms of disease progression. Objective The main objective was to evaluate whether there is an association between IB use and length of stay. Primary end points were the number of days that a patient stayed in the hospital and death as a final event in a time to event analysis. Pneumonia severity, oxygen requirement, involved drugs, comorbidity, historical or current respiratory diagnoses and other drugs prescribed to treat coronavirus pneumonia were also evaluated. Methods A descriptive, observational, cross-sectional study was performed in this tertiary hospital in Madrid (Spain). Data were obtained regarding patients hospitalized with Covid-19, excluding those who were intubated. The primary and secondary outcomes such as duration of hospitalization and death were compared in patients who received IB with those in patients who did not. Results 327 patients were evaluated, mean age was 64.4±15.8 years. Median length of hospitalization stay was 10 days. Of them 292 (89.3%) overcame the disease, the remaining 35 died. Patients who had received IB did not have less mortality rate (odds ratio 0.839; 95% CI: 0.401 to 1.752) and less hospitalization period when compared with patients who did not received IB (odds ratio 1.280; 95% CI: 0.813 to 2.027). There was no significant association between IB use and recovery or death. Hypertension and diabetes were the most common comorbidities. The prevalence of chronic respiratory disease in our cohort was low (21.1%). Anticholinergics were the IB more frequently prescribed for Covid-19 pneumonia. Better response in patients treated with inhaled corticosteroids was not observed. Conclusion Off-label indication of inhaled-bronchodilators for Covid-19 patients are common in admitted patients. Taken on account our results, the use of IB for coronavirus pneumonia apparently is not associated with a significantly patient´s improvement. Our study confirms the hypothesis that inhaled bronchodilators do not improve clinical outcomes or reduce the risk of Covid-19 mortality. This could be due to the fact that the virus mainly affects the lung parenchyma and the pulmonary vasculature and probably not the airway. More researches are necessary in order to fill the gap in evidence for this new indication.

BackgroundThe use of psychiatric agents in hospitals increases the complexity of pharmacotherapy and the risk of drug–drug interactions.PurposeTo assess the frequency and clinical relevance of interactions associated with the use of antipsychotics, anxiolytics, antidepressants and sedative/hypnotics in a hospital.Material and methodsCross-sectional observational study in which the treatment of adult patients admitted to a general hospital (1,350 beds) was reviewed. The investigators, using a computerised physician order entry program, evaluated pharmacotherapy of inpatients involving antipsychotics, anxiolytics, antidepressants and sedatives/hypnotics. They assessed drug-drug interactions and their clinical significance as described in the literature. Reference sources were the Micromedex database and the Spanish Society of Hospital Pharmacist’s professional guide to drug interactions.ResultsTreatment of 393 patients was analysed. Of these, 179 (45.5%) were prescribed one of the drugs studied; 53.6% were female and 46.4% male with mean age 65 (SD ± 17.7) years. The average number of drugs prescribed per patient was 12 (SD ± 4.41). A total of 221 drug interactions was detected (9.5% pharmacokinetic, 90.5% pharmacodynamic), affecting 70.4% of patients. A total of 42.8% were due to prescription of antipsychotics, 31.1% due to antidepressants, 18.5% to anxiolytics and 7.6% to hypnotics/sedatives. The medical specialties involved were surgery (22.4%), oncology (11.1%), cardiology (8.9%), internal medicine (8.9%) and psychiatry (8.4%). Based on clinical significance, 47.5% of interactions were severe, 25.3% moderate and 27.1% mild. Potential interactions with significant clinical effects were haloperidol-tramadol (increased seizure risk), escitalopram-low molecular weight heparin (increased risk of bleeding) and midazolam-morphine (increased sedation). Three contraindicated combinations were detected: escitalopram-metoclopramide for increased QT interval, linezolid-amitriptyline for serotonin syndrome and risperidone-metoclopramide for neuroleptic syndrome and extrapyramidal reactions.ConclusionPrescription of antipsychotic drugs, antidepressants, anxiolytics and sedatives/hypnotics to inpatients is very common. These drugs cause numerous drug interactions, which can potentially have serious consequences for hospitalised patients.References and/or acknowledgementsPsychiatric DepartmentNo conflict of interest.

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BackgroundMedication errors are common in neonatal units. Errors with potential to cause harm are more likely to occur here due to vulnerability of this population and the complexity of calculations for prescribing and preparing their medications. Errors with high alert medications (HAM) in neonatal units have been reported. These errors bear a heightened risk of causing significant patient harm. The incidence of errors is variable among studies. Having knowledge of your own HAM utilisation rate could help organisations to prioritise safe medication practices.PurposeTo analyse the use of HAM in a neonatal unit as a tool to prioritise patient safety practices.Material and methodsAn observational retrospective study was conducted in 2015 (12 months) in the neonatal unit of a university tertiary hospital. Recorded data of admissions, hospital stays and HAM consumption were analysed. The classification of HAM was according to the ISMP list and high risk drug list adapted to the neonatal or paediatric population (Cotrina et al, 2013).ResultsDuring the study period 1470 admissions and 21 611 stays were registered (14.7 stays per patient). A total of 311 different drugs were used, 23.2% (n=72) were HAM, 11 of these HAM (15.3%) being exclusively on the paediatrics list. 214 607 units were consumed, 11% were HAM (n=23 550). The main HAM detected were: antithrombotics/anticoagulants/heparins (20%), sterile water 500 mL (19%), acetaminophen (13%), general anaesthetics (11%, mainly fentanyl), antibiotics (10%, mainly vancomycin), adrenergic agonists (7%), adrenergic antagonists (3%), opioids (3%), hypertonic glucose (3%) and antiepileptic drugs (3%). The remaining 8% corresponded to: antihypertensives, neuromuscular blocking agents, inotropics, sedatives, electrolytes, antiarrhythmics and insulin. All of these drugs are frequently involved in published medication errors. General safe practices were already implemented in our hospital: protocols, training sessions and courses, summary charts for drug preparation, a dose calculator and a patient safety multidisciplinary group. Specific additional safe practices should be implemented for the HAM most frequently used.ConclusionSpecific strategies in the safe use of antithrombotics, anticoagulants and heparins, sterile water, acetaminophen, fentanyl and vancomycin must be implemented. This is critical in neonatal units, where the use of these HAM is more common and the risk of harm is higher.References and/or acknowledgementsAn Pediatr (Barc)2013;79:360–6.No conflict of interest

BackgroundDysphagia is usually caused by stroke, dementia, ageing or progressive conditions. Manipulations of solid drugs occur frequently in these patients, which may alter bioavailability, efficacy and/or side-effect profile of drugs, leading to medicine administration errors (MAEs).PurposeThe aim of this study was to analyse the drugs most frequently prescribed requiring manipulation in patients with swallowing difficulties, and of these, those which are not suitable for use in this manner (enteric coats, small therapeutic windows, slow release, etc.).Material and methodsA prospective longitudinal study was performed (2 months) in the internal medical unit.Pharmacotherapy prescribed to inpatients with dysphagia was evaluated using a CPOE program.Data collected were: age, drugs requiring manipulation and if manipulation was possible. To avoid MAEs, the pharmacist performed interventions to the nurse and/or prescriber. Acceptance or rejection of the intervention was measured.ResultsPharmacotherapy of 54 inpatients was analysed. Median age was 82 years. Each patient received (on average) 12 different drugs. Seventy-seven per cent of oral drugs were not in an appropriate dosage form.The pharmacist performed a total of 82 interventions: 48 of them involved drugs that could be crushed/dispersed but had alternatives that the physician could switch (liquid or dispersible oral forms) or required precautions associated with manipulation by the nurse (vehicle more appropriate to disperse, worker protection). All interventions were accepted. Drugs most frequently involved were: acenocoumarol with five interventions; levodopa/carbidopa with four; enalapril, pregabalin, risperidone and digoxin with three; and omeprazole, silodosin, amlodipine, duloxetine and atenolol with two. The pharmacist detected 22 different MAEs and performed 34 interventions to avoid them: 15 to the physician (involving drugs not suitable for manipulation), recommended switching to an alternative (67% interventions accepted) and 19 to nurses due to incorrect manipulation (37% accepted). Drugs involved were: pantoprazole with eight interventions, acetylsalicylic-acid and dutasteride/tamsulosin with three, spironolactone with two and other drugs with one.ConclusionMost of the oral medications prescribed to patients with dysphagia were manipulated, which can promote MAEs. The increased MAE rate in these patients means that health professionals need to take extra care when prescribing and administering drugs to these patients. Hospital pharmacists should assess the suitability of medication formulations and discuss swallowing difficulties with the prescriber.References and/or AcknowledgementsAcknowledgements to pharmacists and internal medical unitNo conflict of interest