Background The problem of overprescribing and failure to provide appropriate medicines in elderly people has been associated with hospitalisation. Purpose To analyse Inappropriate Prescribing (IP) and Prescribing Omissions (PO) in elderly patients in an attempt to find a link with said patients’ hospitalisation. Materials and methods Retrospective observational study from June to August 2013 with patients admitted to the Internal Medicine Unit in a tertiary hospital. We included patients ≥65 with at least four medicines in their home treatment. We used the STOPP/START criteria to detect IP/PO and compared them to the hospital’s diagnosis. We analysed IP/PO resolved after the hospitalisation process (treatment prescribed at discharge). Exclusion criteria: patients transferred to other units and patients who died. Data collected: sex, age, high comorbidity (Charlson Index ≥2), home treatment, diagnosis, hospitalisation duration, STOPP/START criteria. Results 93 patients were included: 52% male, 48% female; Average age was 79 (range = 66–92), 100% high comorbidity; average of 9 medicines (range = 3–17) prescribed per patient; average of 7 days’ (range = 1–27) hospitalisation. We identified 34 IP and 72 PO in 62% of patients (1.8 criteria/ patient). 71% of criteria related to the diagnosis and 21% of criteria unrelated to the diagnosis were solved after the hospitalisation process. Table 1 lists the IP or OP related to the diagnosis, found in 21 patients (26%). Abstract PS-017 Table 1Patient’s diagnosis related to the IP and PO. Diagnosis Number of Patients Number of IP Number of PO Ischaemic Heart Disease 4 0 4 Ischaemic Stroke 5 0 5 Heart Failure 6 3 6 COPD 2 0 2 Respiratory Failure 2 0 2 Gastrointestinal Bleeding 1 0 1 Diabetic Complication 1 0 1 Conclusions Most under- or overprescribing related to the reason for admission was detected and solved, but the rest is often unnoticed and continues unresolved in the treatment prescribed at discharge. STOPP/START criteria should be incorporated into primary care practice to improve prescription accuracy in older people and prevent morbidities. No conflict of interest.
BackgroundFacial angiofibromas (FA) are the most visible of the cutaneous manifestations of tuberous sclerosis. Current treatments include laser and other invasive techniques. Topical rapamycin is a recent and unauthorised option to treat FA (off-label use) but a commercially available compound has not yet been developed.PurposeTo evaluate the efficacy and safety of a pharmaceutical compound of topical rapamycin in a child with FA.Material and methodsA retrospective review of the literature was conducted to select the vehicle, concentration and posology of the topical formulation. Topical 0.1% rapamycin in petrolatum using the powder from the manufacturer was the pharmaceutical compound selected. This concentration was proposed because it is an effective, efficient and safe therapy in pretreated children. The vehicle selected to prepare this topical preparation was petrolatum because treatment with topical rapamycin solution has reportedly caused local adverse side effects, such as irritation. The treatment was authorised by the hospital management, and the child´s parents were informed and provided informed consent. The authors evaluated efficacy through improvement of lesions and safety was evaluated by adverse effects at 3 months.ResultsA 6-year-old patient with FA was selected for treatment with topical 0.1% rapamycin in petrolatum twice daily to the affected areas on the face. In this patient there was an improvement and clearance of the lesions. No local irritation or serious adverse events were described. Rapamycin blood levels at 3 months were 1.02 ng/mL, far below the therapeutic range (5–15 ng/mL) needed for immunosuppression. The posology was reduced to three times a week instead of daily for maintenance.ConclusionTopical 0.1% rapamycin in petrolatum was an effective treatment for FA in this patient. The preparation formulated in petrolatum was well tolerated with no adverse effects. This pharmaceutical compound could be used as an effective option for treatment of FA in paediatric patients without serious adverse effects. It is necessary to establish how long treatment must be continued.References and/or AcknowledgementsBalestri R, Neri I, Patrizi A, et al. Analysis of current data on the use of topical rapamycin in the treatment of FA. J Eur Acad Dermatol Venereol 2015;29:14-20No conflict of interest.
BackgroundReconciliation errors (RE) represent a security problem and have been identified by organisations such as the Institute for Healthcare Improvement (IHI) and the Joint Commission on Accreditation of Healthcare Organisations (JCAHO) as a priority issue within security strategies for patients.PurposeTo determine the incidence of RE in polymedicated elderly patients admitted to a trauma service and to analyse the type of RE, drug group involved and severity of the RE.Material and methodsProspective observational study conducted between June and September 2015, in which all patients aged 65 years or older on treatment with at least 5 drugs were included. Variables collected were: age, sex, drugs prescribed, RE and severity of RE. The information sources used were electronic clinical and prescribing records and patient interview. Patients were included in the first 24 h after admission. Chronic medication list was collected by consulting the information sources mentioned above. This list was compared with prescriptions performed during hospitalisation. In cases where a discrepancy that required clarification was found, it was discussed with the doctor. To classify a discrepancy as an RE, the prescriber had to accept it as such after seeking clarification.Results67 patients were included with a mean age of 69 years (29.7% men, 70.3% women). 577 drugs were reviewed, resulting in an average of 8.46 medications prescribed per patient with an average of 2.88 RE per patient. The most common RE was omission of drugs (74.09%) followed by different dose, regimen or route (6.14%). According to the Anatomical Therapeutic Chemical Classification level 4, the main groups involved in the RE were benzodiazepines with 15.03% of the RE, HMG Co-A reductase inhibitors (5.23%) and cardioselective beta blockers (4.58%).Regarding the severity of errors, 73.21% reached the patient without damage, 14.59% reached the patient and required monitoring and 12.20% missed the patient. The recommendation made by the pharmacist was accepted in 81.3% of cases.ConclusionThe most common RE was drug omission. The pharmacist has a key role in collecting the best possible medication history from the patient to avoid these RE. Medication reconciliation emerges as an opportunity to establish the role of the pharmacist in the health system, to redefine the doctor-pharmacist-patient relationship and to improve the use of medicines and treatment outcomes.No conflict of interest.
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