ObjectivesThe goals of this project included identifying the processes and subprocesses performed in hospital pharmacies, identifying potential adverse events, detecting failure modes and the causes of errors, prioritising the risks identified and designing a map of risks for hospital pharmacies.MethodsA task force composed of hospital pharmacy staff was committed to update the diagram of processes and design a map of processes performed in hospital pharmacies. Risks were identified by failure mode and effect analysis annd prioritised according to their risk priority index (RPI) and criticality. A risk map of adverse events was designed based on the diagram of processes and/or primary activities where the prioritised failure modes were most frequent.ResultsIn total, 99 failure modes associated with 80 adverse events and 129 causes were identified in eight hospital pharmacy areas/subprocesses. The three areas with the highest percentages of failure modes were inpatient pharmaceutical care, pharmacy laboratory and pharmaceutical technology, and medication management. The 25 failure modes (first quartile) with the highest RPI scores (RPI≥20) and the 25 failure modes with the highest frequency and criticality scores were classified as priority.ConclusionsAccording to their RPI, priority failure modes mostly occurred in the area of inpatient pharmaceutical care (92%). However, according to their criticality, priority failure modes were found to homogeneously occur across all pharmaceutical care areas. As general recommendations pharmacists should assume responsibility and leadership in the implementation of safe medication use practices in healthcare centres.
BackgroundDarunavir/cobicistat (DRV/COB) is the first fixed combination inhibitor of protease. Both are metabolised by the cytochrome CYP3A4, the reason why they are susceptible to present a multitude of drug interactions (DI).PurposeTo describe the DI of DRV/COB in HIV patients to avoid and to optimise therapy.Material and methodsRetrospective observational study performed in a county hospital. We reviewed the digital clinical history to collect the following data: patients treated with DRV/COB from 1 January 2016 to 1 November 2016, demographics, duration of treatment, concomitant medications, drugs involved, and DI. We review HIV-drug interactions using the database of the University of Liverpool to classify DI according to the mechanism of action (MA) and their potential severity. The pharmaceutical intervention (PI) was to notify to the prescribing physician, by report attached in the patient’s medical record, the contraindicated interactions (CI).ResultsThirty-five patients, 51% males (n=18). Race: 54% non-Caucasian (n=19). Median age 37 years (IQR 64–20). Median days of treatment 195 (IQR 465–22), total of concomitant medications 199, median 5 (IQR 1–19), DI 31% (n=62) median 1 (IQR 0–8), 40 drugs involved in DI. Type of DI according to their MA: CYP3A inhibition 62% (n=25), inhibition CYP2D6 10% (n=4), inhibition CYP3A and CYP2D6 7% (n=3) and inducer CYP3A 5% MA 15% (n=6). DI type according to its potential severity: high (CI) 15% (n=6) (midazolam, budesonide, phenobarbital, ivabradine, simvastatin and domperidone); and potential: 89% (n=35). PI: accepted 3 (50%): one change from simvastatin to rosuvastatin, one change from phenobarbital to levetiracetam and a change from midazolam to lormetazepam.ConclusionA high rate of DI is observed in patients receiving treatment with DRV/COB. The most relevant interactions are observed at the level of the CYP3A family. Acceptance of PI was low in the case of CI detected, probably because the prescribing physician was unaware of it. To have a higher success rate we could have made a phone call to him to put him on notice. The pharmacist is important in optimising drug therapy.References and/or AcknowledgementsThanks to all my colleagues in the Hospital de Poniente for their selfless helpNo conflict of interest
BackgroundCutaneous diphtheria is a skin infection caused by toxigenic and non-toxigenic strains of Corynebacterium diphtheriae. It is characterised by chronic nonhealing ulcers. Diagnosis may be delayed because it is a rare infection in developed countries. Usual treatment is erythromycin or penicillin, although erythromycin is more effective than penicillin.PurposeTo describe a case of cutaneous diphtheria caused by non-toxigenic C. diphtheriae in a Visiting Friends and Relatives (VFR) patient.Material and methodsData were obtained by a review of the electronic medical records, Pubmed and Uptodate.ResultsA 25-years-old female. No known drug allergy. No usual treatment. She is from Guinea Bissau but she has lived in Spain since she was 7-years-old. She has been on holiday in Guinea Bissau from April to May 2017. Two weeks before her return she had a papular lesion in her left leg and subsequently it was ulcerated. Two days after she returned, she went to the hospital. Progressively similar lesions appeared in both legs, right shoulder and back. Exudate samples from ulcers were taken for microbiological culture and biopsy. In addition, we performed a protocol to care for immigrants: serology for strongyloides, treponema pallidum, plasmodium falciparum/vivas/malariae/ovale and HIV-1/2 were negative as well as PCR for Loa-loa and filarias. Skin histology showed eosinophil infiltrates with a central ulceration. PAS/Ziehl–Neelsen stains remained negative. Microbiological culture of ulcer swabs revealed C. diphtheria with Streptococcus pyogenes group A and methicillin-sensitive Staphylococcus aureus superinfection. PCR analysis for C. diphtheria toxin was negative. Pharyngeal swab cultures remained negative for C. diphtheriae. The patient was treated with erythromycin 500 mg/6 hours for 14 days. Topical treatment included daily fusidic acid. Lesions improved progressively with the treatment. Within 2 weeks all skin lesions had completely resolved.ConclusionCutaneous diphtheria was caused by non-toxigenic C. diphtheria. It is a highly contagious infection. Due to high vaccination rates it is a quite a rare infection in developed countries, but due to the increase in migration and refugees into Europe, more cases are being seen. Cutaneous diphtheria should be included in the differential diagnosis of patients with skin ulcerations, especially in immigrants.No conflict of interest
Background The Septic Ward treats patients with bone-, jointand prosthetic-joint infections. The treatment of these infections requires complex, long-term antibiotic therapies. Clinical pharmacy services were introduced in 2015. This included
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