IDENTIFICATION OF SAFETY ALERT BY MONITORING ANALYTICAL PARAMETERS AND HIGH-RISK DRUGS

Early detection of  adverse  drug  reactions  (ADR) increases patient  safety.  Our  objective  was  to  identify  ADR  by  monitoring laboratory  parameters  and  high-risk  drugs.  We  carried  out  a two-month  prospective  observational  study  in  a  Internal Medicine  Department,  with  daily  recording  of  drugs  prescribed and  the  following  parameters:  Na,  K,  Ca,  serum  creatinine, glomerular  filtration  rate  (GFR),  INR,  glucose,  haemoglobin, platelets,  ALT,  AST,  bilirubin,  GGT,  alkaline  phosphatase,  TSH, T4,  and  blood  digoxin.  High-risk  drugs  were  closely  monitored. 52  patients  included,  of  whom  46.2%  experienced  an  ADR.  We observed  an  association  with  drugs  in  25.5%,  as  follows: reduction  in  GFR,  26.9%  (associated  with  loop  diuretics [41.7%],  angiotensin-converting  enzyme  [ACE]  inhibitors [33.3%],  angiotensin  II  receptor  blockers  [ARB]  [16.6%],  andanti-diabetic  drugs  [8.3%]);  hypokalemia,  22.3%  (associated with  loop  diuretics  [50.0%],  potassium-free  fluid  [37.5%],  and salbutamol  [12.5%]);  hyperkalemia,  14.4%  (associated  with ACE  inhibitors  [60.0%]  and  ARB  [40.0%]);  INR  out  of  range, 10.8%  (associated  with  drug  interactions  [66.7%]); hyperglycemia,  8.1%  (associated  with  corticosteroids  [66.7%] and  anti-diabetic  drugs  [33.3%]);  and  other  conditions,  18.8%. We  conclued  that  patient  safety  could  be  improved  by implementing  warnings  in  electronic  prescriptions  in  cases  of  a decrease  in  GFR  or  modification  of  potassium  levels  in  patients who are prescribed loop diuretics, ACE inhibitors, or ARBs.Key words:   Adverse drug reaction,  clinical decision support,  high-risk drug, safety

Clinical Characteristics and Prognosis of COPD Patients Hospitalized with SARS-CoV-2

Objective To describe the characteristics and prognosis of patients with COPD admitted to the hospital due to SARS-CoV-2 infection. Methods The SEMI-COVID registry is an ongoing retrospective cohort comprising consecutive COVID-19 patients hospitalized in Spain since the beginning of the pandemic in March 2020. Data on demographics, clinical characteristics, comorbidities, laboratory tests, radiology, treatment, and progress are collected. Patients with COPD were selected and compared to patients without COPD. Factors associated with a poor prognosis were analyzed. Results Of the 10,420 patients included in the SEMI-COVID registry as of May 21, 2020, 746 (7.16%) had a diagnosis of COPD. Patients with COPD are older than those without COPD (77 years vs 68 years) and more frequently male. They have more comorbidities (hypertension, hyperlipidemia, diabetes mellitus, atrial fibrillation, heart failure, ischemic heart disease, peripheral vascular disease, kidney failure) and a higher Charlson Comorbidity Index (2 vs 1, p<0.001). The mortality rate in COPD patients was 38.3% compared to 19.2% in patients without COPD (p<0.001). Male sex, a history of hypertension, heart failure, moderate–severe chronic kidney disease, presence of cerebrovascular disease with sequelae, degenerative neurological disease, dementia, functional dependence, and a higher Charlson Comorbidity Index have been associated with increased mortality due to COVID-19 in COPD patients. Survival was higher among patients with COPD who were treated with hydroxychloroquine (87.1% vs 74.9%, p<0.001) and with macrolides (57.9% vs 50%, p<0.037). Neither prone positioning nor non-invasive mechanical ventilation, high-flow nasal cannula, or invasive mechanical ventilation were associated with a better prognosis. Conclusion COPD patients admitted to the hospital with SARS-CoV-2 infection have more severe disease and a worse prognosis than non-COPD patients

Inappropriate antibiotic use in the COVID-19 era: Factors associated with inappropriate prescribing and secondary complications. Analysis of the registry SEMI-COVID

Background: Most patients with COVID-19 receive antibiotics despite the fact that bacterial co-infections are rare. This can lead to increased complications, including antibacterial resistance. We aim to analyze risk factors for inappropriate antibiotic prescription in these patients and describe possible complications arising from their use. Methods: The SEMI-COVID-19 Registry is a multicenter, retrospective patient cohort. Patients with antibiotic were divided into two groups according to appropriate or inappropriate prescription, depending on whether the patient fulfill any criteria for its use. Comparison was made by means of multilevel logistic regression analysis. Possible complications of antibiotic use were also identified. Results: Out of 13,932 patients, 3047 (21.6%) were prescribed no antibiotics, 6116 (43.9%) were appropriately prescribed antibiotics, and 4769 (34.2%) were inappropriately prescribed antibiotics. The following were independent factors of inappropriate prescription: February-March 2020 admission (OR 1.54, 95%CI 1.18-2.00), age (OR 0.98, 95%CI 0.97-0.99), absence of comorbidity (OR 1.43, 95%CI 1.05-1.94), dry cough (OR 2.51, 95%CI 1.94-3.26), fever (OR 1.33, 95%CI 1.13-1.56), dyspnea (OR 1.31, 95%CI 1.04-1.69), flu-like symptoms (OR 2.70, 95%CI 1.75-4.17), and elevated C-reactive protein levels (OR 1.01 for each mg/L increase, 95% CI 1.00-1.01). Adverse drug reactions were more frequent in patients who received ANTIBIOTIC (4.9% vs 2.7%, p < .001). Conclusion: The inappropriate use of antibiotics was very frequent in COVID-19 patients and entailed an increased risk of adverse reactions. It is crucial to define criteria for their use in these patients. Knowledge of the factors associated with inappropriate prescribing can be helpful

Errores de prescripción, trascripción y administración según grupo farmacológico en el ámbito hospitalario

Background: Most studies of medication errors are focused only on finding global prevalence by patients, by phases or according to a certain group of medication. It’s just a partial view of the problem. To analyze and compare the prevalence of errors in prescription, transcription and administration, and their clinical repercussions in different pharmacological groups in a third-level hospital. Methods: Prospective inclusion study with direct observation disguised as medication administration and comparison with prescriptions and transcriptions at history clinical. The ME and its clinical effects were classified by expert consensus. We calculated the different error rates and their repercussions with their confidence intervals at 95%. Then we compared using Chi-square tests. Results: We studied 5,578 prescribed drugs and we observed the administration of 1,879 doses. A total of 117 different pharmacological groups were found, although 50.1% of the prescriptions belonged to only 9 types. We found heparins had a lower prevalence of errors in prescription and transcription and aspirin also had a lower prevalence of prescription errors. On the opposite side, a greater number of errors were obtained in transcription of Paracetamol, Metamizole and Laxatives and a prevalence of errors in the administration phase superior to rest in Paracetamol and in Proton Pump Inhibitors. The impact of medication error increased as medication process progressed, being similar between groups in prescription. In transcription, Heparins and Corticosteroids presented more serious errors. In administration, medication error are more serious for Diuretics and Statins (p <0.05). Conclusions: Drugs considered potentially dangerous present fewer errors (Heparins, Corticoids), but more serious. Drugs with the highest prevalence of errors were Paracetamol and Inhibitors of proton pump but had a lower impact.Fundamentos: La mayoría de los estudios sobre errores de medicación se centran sólo en hallar prevalencias globales por pacientes, por fases del proceso o según un determinado grupo de fármacos, por lo que se da una visión parcial. El objetivo de este trabajo fue analizar y comparar la prevalencia de errores en prescripción, trascripción y administración y sus repercusiones clínicas en los principales grupos farmacológicos en un hospital de tercer nivel. Métodos: Estudio de inclusión prospectiva con observación directa disfrazada de la administración de medicamentos y comparación con prescripciones médicas y trascripciones presentes en la historia clínica. Los errores de medicación y sus efectos fueron clasificados por consenso de expertos. Se calcularon las diferentes tasas de errores y sus repercusiones con sus intervalos de confianza al 95% y se compararon utilizando la prueba de Chi cuadrado. Resultados: Se estudiaron 5578 fármacos prescritos, aunque se observó sólo la administración de 1879 dosis. Se encontraron un total de 117 grupos farmacológicos, donde el 50,1% (2795) de las prescripciones pertenecían sólo a 9 tipos. La prevalencia de errores de prescripción global fue de 4,79%, de trascripción de 14,61% y de administración 9,32%. Por grupos, las Heparinas tuvieron una menor prevalencia de errores en la fase de prescripción y en la de trascripción. Se obtuvo mayor número de errores en trascripción de los Analgésicos como el Paracetamol y el Metamizol y de los Laxantes, y una prevalencia de errores en administración superior al resto en Analgésicos como el Paracetamol y en los Inhibidores de la Bomba de Protones. Las repercusiones clínicas de los errores de medicación en la fase de prescripción fueron parecidas entre grupos farmacológicos. En trascripción Heparinas y Corticoides presentaron errores más graves, mientras que en la administración fueron los IECAS y las Estatinas (p<0,05). Conclusiones: Los fármacos considerados clásicamente como de alto riesgo presentaron menos errores (Heparinas, Corticoides), pero más graves. Los fármacos con mayor prevalencia de errores fueron los Analgésicos (Paracetamol) y los Inhibidores de la Bomba de Protones, pero tuvieron una menor repercusión clínica

Inadequate use of antibiotics in the covid-19 era: effectiveness of antibiotic therapy

Background: Since December 2019, the COVID-19 pandemic has changed the concept of medicine. This work aims to analyze the use of antibiotics in patients admitted to the hospital due to SARS-CoV-2 infection. Methods: This work analyzes the use and effectiveness of antibiotics in hospitalized patients with COVID-19 based on data from the SEMI-COVID-19 registry, an initiative to generate knowledge about this disease using data from electronic medical records. Our primary endpoint was all-cause in-hospital mortality according to antibiotic use. The secondary endpoint was the effect of macrolides on mortality. Results: Of 13,932 patients, antibiotics were used in 12,238. The overall death rate was 20.7% and higher among those taking antibiotics (87.8%). Higher mortality was observed with use of all antibiotics (OR 1.40, 95% CI 1.21-1.62; p < .001) except macrolides, which had a higher survival rate (OR 0.70, 95% CI 0.64-0.76; p < .001). The decision to start antibiotics was influenced by presence of increased inflammatory markers and any kind of infiltrate on an x-ray. Patients receiving antibiotics required respiratory support and were transferred to intensive care units more often. Conclusions: Bacterial co-infection was uncommon among COVID-19 patients, yet use of antibiotics was high. There is insufficient evidence to support widespread use of empiric antibiotics in these patients. Most may not require empiric treatment and if they do, there is promising evidence regarding azithromycin as a potential COVID-19 treatment