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      Errores de prescripción, trascripción y administración según grupo farmacológico en el ámbito hospitalario Translated title: Errors of prescription, transcription and administration according to pharmacological group at hospital

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          Abstract

          RESUMEN 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.

          Translated abstract

          ABSTRACT 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.

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          Benzodiazepine Use in Older Adults: Dangers, Management, and Alternative Therapies.

          Several major medical and psychiatric organizations, including the American Geriatrics Society, advise against using benzodiazepines or nonbenzodiazepine hypnotics in older adults. Despite these recommendations, benzodiazepines continue to be massively prescribed to a group with the highest risk of serious adverse effects from these medications. This article summarizes legitimate reasons for prescribing benzodiazepines in the elderly, serious associated risks of prescribing them, particularly when not indicated, barriers physicians encounter in changing their prescription patterns, and evidence-based strategies on how to discontinue benzodiazepines in older patients. Although more research is needed, we propose several alternatives for treating insomnia and anxiety in older adults in primary care settings. These include nonpharmacological approaches such as sleep restriction-sleep compression therapy and cognitive behavioral therapy for anxiety or insomnia, and as well as alternative pharmacological agents.
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            Medication error prevention by clinical pharmacists in two children's hospitals.

            The purpose of this study was to record prospectively the frequency of and potential harm caused by errant medication orders at two large pediatric hospitals. The objective of the study was to assess the impact of pharmacist intervention in preventing potential harm. The study was conducted during a 6-month period. A total of 281 and 198 errors were detected at the institutions. The overall error rates for the two hospitals were 1.35 and 1.77 per 100-patient days, and 4.9 and 4.5 per 1,000 medication orders, respectively. Pediatric patients aged 2 years and less and pediatric intensive care unit patients received the greatest proportion of errant orders. Neonatal patients received the lowest rate of errant orders. The most common type of error was incorrect dosage, and the most prevalent type of error was overdosage. Antibiotics was the class of drugs for which errant orders were most common. Orders for theophylline, analgesics, and fluid and electrolytes, including hyperalimentation, were also frequently in error. In general, the error rate was greatest among physicians with the least training, but no physician group was error free. Involving pharmacists in reviewing drug orders significantly reduced the potential harm resulting from errant medication orders.
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              Evaluation of drug administration errors in a teaching hospital

              Background Medication errors can occur at any of the three steps of the medication use process: prescribing, dispensing and administration. We aimed to determine the incidence, type and clinical importance of drug administration errors and to identify risk factors. Methods Prospective study based on disguised observation technique in four wards in a teaching hospital in Paris, France (800 beds). A pharmacist accompanied nurses and witnessed the preparation and administration of drugs to all patients during the three drug rounds on each of six days per ward. Main outcomes were number, type and clinical importance of errors and associated risk factors. Drug administration error rate was calculated with and without wrong time errors. Relationship between the occurrence of errors and potential risk factors were investigated using logistic regression models with random effects. Results Twenty-eight nurses caring for 108 patients were observed. Among 1501 opportunities for error, 415 administrations (430 errors) with one or more errors were detected (27.6%). There were 312 wrong time errors, ten simultaneously with another type of error, resulting in an error rate without wrong time error of 7.5% (113/1501). The most frequently administered drugs were the cardiovascular drugs (425/1501, 28.3%). The highest risks of error in a drug administration were for dermatological drugs. No potentially life-threatening errors were witnessed and 6% of errors were classified as having a serious or significant impact on patients (mainly omission). In multivariate analysis, the occurrence of errors was associated with drug administration route, drug classification (ATC) and the number of patient under the nurse's care. Conclusion Medication administration errors are frequent. The identification of its determinants helps to undertake designed interventions.
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                Author and article information

                Journal
                resp
                Revista Española de Salud Pública
                Rev. Esp. Salud Publica
                Ministerio de Sanidad, Consumo y Bienestar social (Madrid, Madrid, Spain )
                1135-5727
                2173-9110
                2019
                : 93
                : e201901004
                Affiliations
                [4] Toledo orgnameServicio de Salud de Castilla-La Mancha orgdiv1Gerencia de atención Integrada de Talavera de la Reina España
                [1] Leganés Madrid orgnameHospital Universitario Severo Ochoa orgdiv1Servicio de Medicina Preventiva España
                [2] Madrid orgnameHospital General Universitario Gregorio Marañón orgdiv1Servicio de Medicina Interna Spain
                [3] Granada Andalucía orgnameUniversidad de Granada orgdiv1Facultad de Ciencias de la Salud orgdiv2Departamento de Fisioterapia. Terapia Ocupacional Spain
                [5] Talavera de la Reina orgnameUniversidad de Castilla-La Mancha orgdiv1Facultad de Terapia Ocupacional, Logopedia y Enfermería Spain
                Article
                S1135-57272019000100403 S1135-5727(19)09300000403
                06280825-1163-4e7e-a385-94697741ea1b

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

                History
                : 09 August 2018
                : 08 November 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 41, Pages: 0
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                Transcription,Trascripción,Prescription,Prescripción,Adverse events,Eventos adversos,Pharmacological groups,Grupos farmacológicos,Medication errors,Administración,Errores de medicación,Administration

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