BackgroundThe process of distributing drugs to hospitalised patients is complex, which is why it is necessary to establish improvement strategies in hospitals to ensure patient safety, monitoring every point in the process of the distribution of drugs: prescription, validation, preparation and dispensing.1 PurposeTo detect and analyse medication errors (ME) in dispensing inpatients. To assess the impact of pharmaceutical intervention after implementation of corrective measures.Material and methodsFollow-up study pre-post intervention (pre-intervention phase: October 2014 to June 2014 and post-intervention phase: March 2014 to November 2015). The intervention involved implementation of corrective measures in the distribution system of drugs in unit doses to improve the safety of hospital patients. These corrective measures were aimed at all healthcare professionals involved. Corrective measures were: incorporating medication carts (MC) with safety systems, implementing protocols for filling and emptying of MC and implementation of a medication dispensing protocol omitted from clinical units. The amount (%) and type of ME were compared before and after the implementation of corrective measures. Monitoring of ME in dispensing was performed by daily selection of 5 MC.Results160 medication carts (80 pre-intervention phase and 80 post-intervention phase) and 31 360 (15 102 pre-intervention phase and 16 258 post-intervention phase) treatment lines were monitored. 13.10% and 4.37% of ME in the pre-intervention and post-intervention phases were detected, respectively. 5 types of ME were detected in the pre-intervention phase (4.98% missing drugs, 4.71% non-prescription drugs, 2.62% excess drugs, 0.65% deficit drugs, 0.14% repackaging) and 3 in the post-intervention phase (2.18% missing drugs, 1.44% deficit drugs, 0.75% excess drugs). We obtained a reduction in ME of -8.73%. A decrease was observed in ME non-prescription drugs, 88 (-4.71%) and ME with excessive drugs (-1.97%).ConclusionThe main medication errors detected during filling corresponded to missing drugs and excessive drugs. The implementation of standardised protocols in dispensing drugs in individualised doses reduces medication errors and increases safety for hospitalised patients.References and/or AcknowledgementsKa-Chun Cheung, et al. Medication errors: the importance of safe dispensing. Br J Clin Pharmacol 2009;67:676–80No conflict of interest.
BackgroundIn some regions, the pharmaceutical services at nursing homes are held by pharmacists from hospitals in the public network.PurposeTo determine the impact of medicines reconciliation on the prevalence of potentially inappropriate medicines (PIMs) in institutionalised elderly patients and to analyse the most frequently PIMs prescribed.Material and methodsRetrospective non-experimental study conducted between December 2014 and February 2015 at four nursing homes: two in which medicines reconciliation was performed and two others where it was not.The prevalence of PIMs prescribed at the residences in which reconciliation was carried out was compared with the prescription at residences in which it was not. PIM frequency was analysed according to the list of drugs to be avoided in older adults (65 years old or older) included in the 2012 Beers criteria.ResultsA total of 521 patients with a mean age of 83 years were included, 224 at nursing homes where reconciliation was conducted and 297 at residences in which it was not. In the first group of residences, there were 142 (63.4%) patients with inappropriate prescriptions compared with 203 (68.3%) in the other group. At homes where medicines reconciliation was carried out, the total number of prescriptions was 2182, and 239 (10.9%) were PIMs. In the other group of patients, the total number of prescriptions was 2849, and 12.8% (365) were inadequate (p < 0.05 vs reconciliation). The total number of different prescribed specialties which were inadequate for patients was 59 for patients in the medicines reconciliation group and 83 in the other group. For comparison of independent proportions, Epidat software version 3.1 was used.The most frequently prescribed PIMs in the reconciliation group were lorazepam, bromazepam, alprazolam, zolpidem and quetiapine, and in the other group of patients, lorazepam, zolpidem, haloperidol, alprazolam and clorazepate dipotassium.ConclusionThe results of this study show a high prevalence of PIMs in institutionalised elderly patients, although residences with a medicines reconciliation programme had a lower percentage of elderly patients with PIMs and fewer inappropriate prescriptions. The total number of different inadequate specialties was also lower.Regarding PIMs, lorazepam, zolpidem and alprazolam were among the five most commonly prescribed in both groups.References and/or AcknowledgementsBeers Criteria UpdateNo conflict of interest.
BackgroundThe switch from the intravenous (IV) formulation to the subcutaneous (SC) formulation of abatacept (ABA) had been analysed in clinical trials but there are few data regarding the effectiveness and safety of the SC formulation in clinical practice.PurposeTo evaluate the impact of switching from IV to SC abatacept (SC ABA) in patients who were controlled on the IV formulation in a real world setting.Material and methodsObservational retrospective study of patients switched from IV to SC ABA, 125 mg once weekly, between September 2013 and April 2015. Data were collected by reviewing patient clinical records and the database of the local advisory committee for rheumatoid arthritis (RA). Measured parameters were: disease activity score at 28 joints (DAS28), treatment duration, reasons for withdrawal and new biologic agent introduced.Results19 patients were included in our study, 17 women (89.5%) and 2 men (10.5%), mean age 59.6 years. All the patients had low RA activity at the beginning of SC ABA treatment (mean DAS28=3.1).6 patients (31.6%) discontinued; all experienced an arthritic flare (mean DAS28=4.21; p = 0.02 vs baseline) but no adverse effects were described. 5 (83.3%) returned to IV administration after a mean of 7.1 months (range 2.7–10.8). The other patient (16.7%) switched to etanercept. 13 patients (68.4%) have continued SC administration to date with good disease control and no adverse reactions. All five patients that returned to IV ABA also have good disease control to date.ConclusionIn our small case series, SC ABA showed a risk of relapse in 31.6% of cases but reinsertion of IV administration seemed to reinstate disease control. It could be possible that an eventual failure of the SC formulation does not compromise the effectiveness of the ABA therapy itself. Further research with a greater number of patients is needed.References and/or AcknowledgementsReggia R, et al. J Rheumato. 2015;42:193–5No conflict of interest.
BackgroundProton pump inhibitors (PPIs) are often used inappropriately, without an indication, or for longer durations than recommended. Deprescribing is defined as the reduction, withdrawal or discontinuation of inappropriate medication. We aimed to reduce inappropriate drug use by developing and implementing a PPI process in a nursing home.PurposeTo determine the effectiveness of multidisciplinary intervention to deprescribe inappropriate PPIs in older adults in a nursing home.Material and methodsA prospective study completed between January and February 2017. The deprescribing process consisted of four steps: medication reviews conducted by the clinical pharmacist, identification of residents who have completed a minimum of 8 weeks of treatment for heartburn or mild to moderate gastroesophageal reflux disease or esophagitis, and whose symptoms have resolved. The recommendations do not apply to those who have or have had Barrett oesophagus, severe oesophagitis, a documented history of bleeding gastrointestinal ulcers or were taking nonsteroidal anti-inflammatory drugs, presentation and discussion of the results to the medical and nurse staff reminding them to reassess therapy together with tailored educational information, arranging health examinations to planning the withdrawal regimen and monitoring during the 7 months after medication withdrawal.ResultsOne hundred residents of the 160 living in the nursing home (62.5%) were on PPIs. Fifty-three per cent of the cases met the criteria to encourage deprescription and were discussed with the medical team. Eighty-five per cent of the proposed interventions were accepted, resulting in 10 patients having their dose reduced and 45 patients having their PPI deprescribed. Seven months’ later. 12 patients (26.6%) resumed the original dose due to worsening gastrointestinal symptoms. The multidisciplinary intervention resulted in a 33% decrease in PPI use.ConclusionDiscontinuation of PPIs is feasible in a nursing home and a substantial number of the residents treated without a clear indication can safely reduce or discontinue treatment. The multidisciplinary approach facilitates decision making by involving everyone in the intervention.No conflict of interest
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