Use of a generic protocol in documentation of prescription errors in Estonia, Norway and Sweden

Beskriver en studie hvor hensikten var å evaluere egnethet av et generisk instrument for å dokumentere forskrivningsproblemer som krever kontakt med lege før utlevering.Pharmacists have an important role in detecting, preventing, and solving prescription problems, which if left unresolved, may pose a risk of harming the patient. Objective: the objectives of this study were to evaluate the feasibility of a generic study instrument for documentation of prescription problems requiring contact with prescriber before dispensing. The study was organized: 1) by countries: Estonia, Norway and Sweden; 2) by type of prescriptions: handwritten prescriptions, printouts of prescriptions in the electronic medical record and electronically transmitted prescriptions to pharmacies; and 3) by recording method - self-completion by pharmacists and independent observers. Methods: observational study with independent observers at community pharmacies in Estonia (n=4) and Sweden (n=7) and self-completed protocols in Norway (n=9). Results: pharmacists' in Estonia contacted the prescriber for 1.47% of the prescriptions, about 3 times as often as in Norway (0.45%) and Sweden (0.38%). Handwritten prescriptions dominated among the problem prescriptions in Estonia (73.2%), printouts of prescriptions in the electronic medical record (89.1%) in Norway and electronically transmitted prescriptions to pharmacies (55.9%) in Sweden. More administrative errors were identified on handwritten prescriptions and printouts of prescriptions in the electronic medical record in Estonia and in Norway compared with electronically transmitted prescriptions to pharmacies in Sweden (p<0.05 for prescription types and p<0.01 for countries). However, clinically important errors and delivery problems appeared equally often on the different types of prescriptions. In all three countries, only few cases of drug interactions and adverse drug reactions were identified. Conclusion: despite the different patterns of prescription problems in three countries, the instrument was feasible and can be regarded appropriate to document and classify prescription problems necessitating contact with prescriber before dispensing, irrespective of the type of prescription or recording method

Medication errors in the Middle East countries: a systematic review of the literature

Background: Medication errors are a significant global concern and can cause serious medical consequences for patients. Little is known about medication errors in Middle Eastern countries. The objectives of this systematic review were to review studies of the incidence and types of medication errors in Middle Eastern countries and to identify the main contributory factors involved. Methods: A systematic review of the literature related to medication errors in Middle Eastern countries was conducted in October 2011 using the following databases: Embase, Medline, Pubmed, the British Nursing Index and the Cumulative Index to Nursing & Allied Health Literature. The search strategy included all ages and languages. Inclusion criteria were that the studies assessed or discussed the incidence of medication errors and contributory factors to medication errors during the medication treatment process in adults or in children. Results: Forty-five studies from 10 of the 15 Middle Eastern countries met the inclusion criteria. Nine (20%) studies focused on medication errors in paediatric patients. Twenty-one focused on prescribing errors, 11 measured administration errors, 12 were interventional studies and one assessed transcribing errors. Dispensing and documentation errors were inadequately evaluated. Error rates varied from 7.1% to 90.5% for prescribing and from 9.4% to 80% for administration. The most common types of prescribing errors reported were incorrect dose (with an incidence rate from 0.15% to 34.8% of prescriptions), wrong frequency and wrong strength. Computerised physician rder entry and clinical pharmacist input were the main interventions evaluated. Poor knowledge of medicines was identified as a contributory factor for errors by both doctors (prescribers) and nurses (when administering drugs). Most studies did not assess the clinical severity of the medication errors. Conclusion: Studies related to medication errors in the Middle Eastern countries were relatively few in number and of poor quality. Educational programmes on drug therapy for doctors and nurses are urgently needed

La prescripción electrónica asistida: instrumento clave para la disminución de los problemas relacionados con los medicamentos en el hospital

Objetivo: Evaluar el efecto de la implantación de la prescripción electrónica asistida (PEA) en una unidad clínica sobre los problemas relacionados con los medicamentos (PRM) y sobre el grado de aceptación de las intervenciones farmacéuticas. Métodos: Estudio prospectivo, casi experimental. Se revisaron las prescripciones farmacológicas de un servicio de medicina interna durante dos periodos secuenciales de 3,5 meses cada uno (antes y después de la implantación de la PEA). Se registraron todos los PRM detectados en ambas fases. Se analizó también la aceptación de la intervención farmacéutica ante cada error. Resultados: Durante los 7 meses del estudio se detectaron un total de 4.023 PRM, 3.785 en la fase de prescripción manual (PM) y 238 en la fase de PEA; la tasa de PRM por paciente ingresado era de 16,9 en PM y de 1,07 en PEA, lo que supone una reducción estadísticamente significativa del 93,67%. Si omitimos los PRM de identificación de la orden médica, se obtiene una reducción del 43,21%. Con la introducción de la PEA, desaparecieron los PRM de identificación de la orden médica y de transcripción en farmacia, disminuyeron los de dosis no adecuada, duración no adecuada e interacciones, y aumentaron los de error en la identificación del medicamento. Conclusiones: La implantación de la PEA ha disminuido de forma significativa la tasa total de PRM y la de PRM de importancia mayor. La proporción de intervenciones farmacéuticas no contestadas por el médico ha disminuido significativamente

La prescripción electrónica asistida: instrumento clave para la disminución de los problemas relacionados con los medicamentos en el hospital

Objetivo: Evaluar el efecto de la implantación de la prescripción electrónica asistida (PEA) en una unidad clínica sobre los problemas relacionados con los medicamentos (PRM) y sobre el grado de aceptación de las intervenciones farmacéuticas. Métodos: Estudio prospectivo, casi experimental. Se revisaron las prescripciones farmacológicas de un servicio de medicina interna durante dos periodos secuenciales de 3,5 meses cada uno (antes y después de la implantación de la PEA). Se registraron todos los PRM detectados en ambas fases. Se analizó también la aceptación de la intervención farmacéutica ante cada error. Resultados: Durante los 7 meses del estudio se detectaron un total de 4.023 PRM, 3.785 en la fase de prescripción manual (PM) y 238 en la fase de PEA; la tasa de PRM por paciente ingresado era de 16,9 en PM y de 1,07 en PEA, lo que supone una reducción estadísticamente significativa del 93,67%. Si omitimos los PRM de identificación de la orden médica, se obtiene una reducción del 43,21%. Con la introducción de la PEA, desaparecieron los PRM de identificación de la orden médica y de transcripción en farmacia, disminuyeron los de dosis no adecuada, duración no adecuada e interacciones, y aumentaron los de error en la identificación del medicamento. Conclusiones: La implantación de la PEA ha disminuido de forma significativa la tasa total de PRM y la de PRM de importancia mayor. La proporción de intervenciones farmacéuticas no contestadas por el médico ha disminuido significativamente

Master of Science

thesisCampylobacteriosis is a foodborne and waterborne zoonotic gastrointestinal illness and the most common cause of acute gastroenteritis worldwide. In the United States Campylobacter infections are second only to Salmonella as the most common cause of gastroenteritis, accounting for an estimated 2.4 million symptomatic infections annually. It is estimated that the total cost of foodborne illness in the United States is $152 billion of which$18.8 billion is attributed to Campylobacter. Diagnosis can be challenging because the organism is difficult to isolate, grow, and identify. Clinical manifestation of Campylobacter is indistinguishable from other enteric pathogens; (Salmonella, Shigella, Yersinia, Clostridium difficile, and E. coli 0157:H7 and other enterohemorrhagic E. coli) therefore, a presumptive diagnosis cannot be made putting them at risk for untreated infection. There are a growing number of diagnostic methods available for detection and/or isolation of Campylobacter species from stool, but there is currently no national or state public health testing guidelines. Eight assays were evaluated for performance in the detection of Campylobacter species in stool. The assays are comprised of four culture medias (CVA, CSM, Cefex, and mCCDA); three EIA/ELISA kits (ImmunoCard STAT! Campy, Premier Campy and ProSpecT Campy); and one molecular method (FilmArray GI panel). The FilmArray GI panel due to its ability to detect viable and nonviable organism was used as the gold standard. To verify the gold standard was accurate all positive FilmArray samples were analyzed by DNA sequencing. The sensitivity and specificity, respectively, of each assay are as follows: CVA 87.8%, 100%; CSM 87.8%, 100%; Cefex 87.8%, 100%; mCCDA 78.0%, 100%; ImmunoCard STAT! Campy 31.7%, 65.2%; Premier Campy 80.5%, 26.1%; and the ProSpecT Campy 75.6%, 82.6%. In contrast the FilmArray produces a sensitivity and specificity of 100% when compared to culture. Furthermore the FilmArray GI panel takes the least amount of time to produce a result, 1 hour compared to 48-72 hours for culture. In conclusion, the FilmArray GI panel is the most sensitive, specific, rapid, cost effective, and objective method for the detection of Campylobacter species in stool. Molecular assays such as the FilmArray GI panel should replace traditional culture techniques in the microbiology lab

Propuesta para una guía de prescripción en población geriátrica en una institución de régimen especial

Los pacientes geriátricos representan un gran reto para realizar una adecuada prescripción debido a que poseen importantes cambios en sus esferas vitales que propician fragilidad, múltiples comorbilidades, entre otros. Se desarrolló un estudio observacional retrospectivo que permitió cuantificar la frecuencia de prescripciones inadecuadas mediante la revisión de Historias Clínicas en una institución de régimen especial teniendo en cuenta variables como cantidad de medicamentos, indicación, pauta de dosificación, duplicidad terapéutica, interacciones, contraindicaciones, y se aplicó la metodología STOPP en 300 pacientes geriátricos mayores de 65 años y con un consumo de más de 5 medicamentos. Se encontró que la mitad de las prescripciones tienen al menos un criterio de prescripción potencialmente inapropiada siendo el más importante el uso de medicamentos no indicados. Finalmente se propuso una guía para el uso racional de medicamentos en la población geriátrica con todas las características específicas para esta institución.Abstract. Geriatric patients represent a major challenge for appropriate prescription because they have significant changes in vital areas that encourage their fragility, multiple comorbidities, among others. Developed a retrospective observational study that quantified the frequency of inappropriate prescriptions by medical record review in a special scheme institution considering variables such as number of medications, indication, dosing regimen, therapeutic duplication, interactions, contraindications, and STOPP methodology applied in 300 elderly patients over 65 years and with a consumption of more than 5 medications. Was found in a half of prescriptions have at least one inappropriate potentially prescription criterion being the most important the use of drugs not indicated. Finally, proposed guidelines for the rational use of drugs in the elderly with all the specifics for this institution.Maestrí