Background During care transitions, discrepancies and medication errors often occur, putting patients at risk, especially older patients with polypharmacy. Objective To assess the results of a medication reconciliation and information programme for discharge of geriatric patients conducted through hospital information systems. Setting A 1300-bed university hospital in Madrid, Spain. Method A prospective observational study. Geriatricians selected candidates for medication reconciliation at discharge, and sent an electronic inter-consultation request to the pharmacy department. Pharmacists reviewed the medication list, comparing it with electronic prescriptions, medication previously prescribed by primary care physicians and other medical records, and resolved any discrepancies. An individualized and tailored drug information at discharge sheet was sent to geriatricians and made available to primary care physicians. Main outcome measure The number and type of discrepancies, the number, type and severity of errors, and the main pharmacological groups involved. Results Medication reconciliation was performed for 118 patients with a mean age of 87 years (SD 5.9), involving a total of 2054 medications, or 17.4 per patient. Discrepancies were found in 723 (35 %) drugs, 105 of which were considered medication errors (15 %); 66 patients (56 %) had at least one error. This gave 0.9 reconciliation errors per patient reviewed and 1.6 per patient with errors. Of the 105 errors, 14 (13 %) were considered serious. The most frequent errors were incomplete prescriptions (40 %) and omissions (35 %). Conclusion An electronic medication reconciliation programme helps pharmacists detect serious medication errors in frail elderly patients and provides complete and up-to-date written information to prevent additional errors at home.
Background The objective of the FeminFER project was to assess the value of ferric carboxymaltose following a multicriteria decision analysis in obstetrics and gynaecology in Spain. Methods Ferric carboxymaltose (FCM) and ferrous sulphate were evaluated using the EVIDEM framework. Ten stakeholders participated to collect different perspectives. The framework was adapted considering evidence retrieved with a PICO-S search strategy and grey literature. Criteria/subcriteria were weighted by level of relevance and an evidence-based decision-making exercise was developed in each criterion; weights and scores were combined to obtain the value of intervention relative to each criterion/subcriterion, that were further combined into the Modulated Relative Benefit-Risk Balance (MRBRB). Results The most important criterion favouring FCM was Compared Efficacy/Effectiveness (0.183 ± 0.07), followed by Patient Preferences (0.059 ± 0.10). Only Direct medical costs criterion favoured FS (-0.003 ± 0.03). MRBRB favoured FCM; 0.45 ± 0.19; in a scale from -1 to + 1. Conclusions In conclusion, considering the several criteria involved in the decision-making process, participants agreed with the use of FCM according to its MRBRB.
Background In 2006, the European Parliament approved paediatric standards (Paediatric Regulation 1901/2006) in order to stimulate the development of paediatric clinical trials (PCT) reducing off-label drug use (ODU). Purpose To evaluate the variation in PCT and ODU in children over the last 6 years since this paediatric regulation came into force. We also analysed the type of PCT and characteristics of drugs involved in PCTs or prescribed in conditions that they are not approved (off label). Materials and methods Observational retrospective study in a 252-bed children’s hospital which forms part of a tertiary hospital. The main outcome measured was the number of PCT carried out per year and ODU per year (from 2007 to 2012). Furthermore, PCT design, type of drugs used in both conditions (experimental and off-label), and reasons for off-label use according to the summary of product characteristics were assessed as well. Results We analysed 87 drugs involved in PCT and 449 non-investigational drugs, of which 117 (26%) were considered off-label prescriptions. We observed an increase in PCT carried out per year from 9 in 2007 to 23 in 2011, reaching 19.3% of total clinical trials performed in our centre. Off-label drug use remained stable over the study period. The most common type of PCT design was phase III non-randomised open-label (27.6%). Concerning the drugs involved, antibiotics and antineoplastic-immunosuppressant agents were the most common drugs investigated in PCT, while off-label prescriptions mainly involved hypnotics-sedatives and anticoagulants. Most cases of these off-label prescriptions were related to the lack of studies. Conclusions Since January 2007 when the paediatric regulations came into force in the European Union, an increase of PCT performed has been detected in our centre. However, this fact has not affected off-label drug use which has not changed mainly due to a lack of research into drugs in children. No conflict of interest.
and public hospitals, inside hospital pharmacies and at the patient's home. The Recommendation is to protect patients needing anticancer drug treatments. Highlight: the hospital should provide working instruments and develop a procedure including all instructions for proper anticancer drug management. They also have to: draw up a Patient Safety Training Plan, promote communication and integration among health professionals, provide accurate and complete information to patients and their families, consider the psychological and emotional state of patients and give detailed indications for the delivery of drugs at discharge. Conclusions The Recommendation is a reference for health professionals involved in handling anticancer drugs, providing information about the patient's objectives and expected benefits from treatment. The document provides guidance aimed at preventing errors that can occur during anticancer drug treatment and includes recommendations encouraging the promotion of clinical governance. A verification of this Recommendation is expected soon. Many experts gave their suggestions to facilitate its implementation. No conflict of interest. Reconciliation and dRug infoRmation to geRiatRic Polymedicated Patients at dischaRge using infoRmation technology
medication administration. Analysis of the reality will serve as a base to develop suggestions leading to preventive and corrective actions with consequences for the quality of nursing care provided.One of the risk areas of nursing care is timing drug administration with food as well as food and drink composition. The partial goal was to explore this reality and identify suboptimal and potentially hazardous practices. Material and methods The research was implemented in four selected cooperating hospitals, specifically in three of their wardssurgical, internal, and follow-up wards in the form of a prospective, multicentric, observation-intervention study. In the first part of this study, all nurses administering medications to all patients hospitalised in each of the above-stated wards during the observation period (morning, noon, evening) were observed by a team of unshadowed external investigators (pharmacist and nurse) for three consecutive days. Data were recorded onto a preprepared recording sheet and subsequently typed into a web database.Results During this study, 58 nurses administrating 5330 solid oral drugs for 313 patients over 36 days were observed. We discovered that the timing of the food was suboptimal and potentially severe in 18.1% and 2.4% of cases, respectively. In order to ingst a drug, tea was used in 63% of cases, still water in 22% of cases and coffee with milk in nearly 5.8% of cases. Potentially significant drink-drug interactions were identified in nearly 1.5% of cases. Conclusion and relevanceWe found that little or no attention was paid to appropriate food, drink and drug management on the wards. These primary data will be used for interventions in this study and as the base for further research.
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