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OBJECTIVES: To draft a list of actions and quality indicators for pharmacist care in hospital emergency departments, based on consensus among a panel of experts regarding which actions to prioritize in this setting. MATERIAL AND METHODS: A panel of experts from the Spanish Society of Hospital Pharmacy (SEFH) and the Spanish Society of Emergency Medicine (SEMES) evaluated a preliminary list of potential actions and quality of care indicators. The experts used a questionnaire to assess the proposals on the basis of available evidence. In the first round, each expert individually assessed the importance of each proposed action based on 4 dimensions: evidence base, impact on clinical response and patient safety, ease of implementation, and priority. In the second round the experts attended a virtual meeting to reach consensus on a revised list of proposals; suggestions and comments that had been made anonymously in the first round were included. The group then prioritized each action as basic, intermediate, or advanced. RESULTS: The experts evaluated a total of 26 potential actions and associated quality indicators. No items were eliminated in the analysis of scores and comments from the first round. After the second round, 25 actions survived. Nine were considered basic, 10 intermediate, and 6 advanced. CONCLUSION: The expert panel's list of pharmacist actions and care quality indicators provides a basis for developing a pharmacist care program in Spanish emergency departments on 3 levels of priority. The list can serve as a guide to pharmacists, managers, physicians, and nurses involved in the effort to improve drug therapy in this hospital setting.

OBJETIVO: Desarrollar un conjunto de actividades e indicadores de atención farmacéutica en los servicios de urgencias hospitalarios mediante un consenso colectivo de un panel de expertos que permita priorizar las actividades a realizar por los farmacéuticos en estas unidades. METODO: Un comité formado por miembros de la Sociedad Española de Farmacia Hospitalaria (SEFH) y de la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) evaluó una propuesta inicial de actividades e indicadores potenciales, basados en la evidencia científica disponible, en formato de cuestionario. En una primera ronda, cada uno de los expertos del panel clasificó de forma individual la relevancia de cada una de las actividades propuestas en cuatro dimensiones: evidencia científica, impacto en la respuesta clínica y seguridad para el paciente, facilidad de implementación y grado de prioridad. La segunda ronda se realizó mediante una reunión grupal de forma virtual, a partir del cuestionario modificado de acuerdo con las sugerencias planteadas, así como los comentarios vertidos por los participantes del panel de forma anónima. En esta ronda, cada actividad fue clasificada por consenso como básica, intermedia o avanzada en función del grado de prioridad de implantación considerado por el grupo de expertos. RESULTADOS: Se propusieron un total de 26 potenciales actividades a los expertos, con indicadores asociados. Tras el análisis de las puntuaciones y los comentarios realizados en la primera ronda, no se eliminó ninguna de las actividades propuestas. Tras la segunda ronda, se mantuvieron 25 actividades, de las cuales se puntuaron 9 como actividades básicas, 10 actividades como intermedias y 6 actividades como avanzadas. CONCLUSIONES: El desarrollo del conjunto de actividades e indicadores de atención farmacéutica en urgencias, priorizados por grado de relevancia para la unidad, es la base para el desarrollo de esta cartera de servicios en los hospitales españoles, y sirve como guía tanto para farmacéuticos como para gestores, médicos y enfermeros de la unidad a fin de mejorar la farmacoterapia los pacientes atendidos en los servicios de urgencias.

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Objetivo: Desarrollar un conjunto de actividades e indicadores de atención farmacéutica en los servicios de urgencias hospitalarias mediante un consenso colectivo de un panel de expertos que permita priorizar las actividades a realizar por los farmacéuticos en estas unidades. Método: Un comité formado por miembros de la Sociedad Española de Farmacia Hospitalaria (SEFH) y de la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) evaluó una propuesta inicial de actividades e indicadores potenciales, basados en la evidencia científica disponible, en formato de cuestionario. En una primera ronda, cada uno de los expertos del panel clasificó de forma individual la relevancia de cada una de las actividades propuestas en cuatro dimensiones: evidencia científica, impacto en la respuesta clínica y seguridad para el paciente, facilidad de implementación y grado de prioridad. La segunda ronda se realizó mediante una reunión grupal de forma virtual, a partir del cuestionario modificado de acuerdo con las sugerencias planteadas, así como los comentarios vertidos por los participantes del panel de forma anónima. En esta ronda, cada actividad fue clasificada por consenso como básica, intermedia o avanzada en función del grado de prioridad de implantación considerado por el grupo de expertos. Resultados: Se propusieron un total de 26 potenciales actividades a los expertos, con indicadores asociados. Tras el análisis de las puntuaciones y los comentarios realizados en la primera ronda, no se eliminó ninguna de las actividades propuestas. Tras la segunda ronda, se mantuvieron 25 actividades, de las cuales se puntuaron 9 como actividades básicas, 10 actividades como intermedias y 6 actividades como avanzadas. (AU)

Objective: To draft a list of actions and quality indicators for pharmacist care in hospital emergency departments, based on consensus among a panel of experts regarding which actions to prioritize in this setting. Material and methods: A panel of experts from the Spanish Society of Hospital Pharmacy (SEFH) and the Spanish Society of Emergency Medicine (SEMES) evaluated a preliminary list of potential actions and quality of care indicators. The experts used a questionnaire to assess the proposals on the basis of available evidence. In the first round, each expert individually assessed the importance of each proposed action based on 4 dimensions: evidence base, impact on clinical response and patient safety, ease of implementation, and priority. In the second round the experts attended a virtual meeting to reach consensus on a revised list of proposals; suggestions and comments that had been made anonymously in the first round were included. The group then prioritized each action as basic, intermediate, or advanced. Results: The experts evaluated a total of 26 potential actions and associated quality indicators. No items were eliminated in the analysis of scores and comments from the first round. After the second round, 25 actions survived. Nine were considered basic, 10 intermediate, and 6 advanced. (AU)

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OBJECTIVE: A study about the adherence of the antimicrobial prescriptions to the local guidelines of treatment of infections was conducted in a hospital emergency department to study the clinical and epidemiological characteristics of the patients who received these treatments. Conducting a feasibility study for supporting the design and execution of future studies, addressing specific aspects of the appropriateness of the antimicrobial prescription. METHOD: Observational, descriptive and cross-sectional pilot study, with retrospective data collection about the antimicrobial prescription in a hospital emergency department. Seven cross sections were made, corresponding to seven different days of the week, in seven consecutive weeks. INCLUSION CRITERIA: patient over 14 years of age, with at least one first dose of antimicrobial treatment prescribed on the day of recruitment. The main variable was the inappropriate antimicrobial prescription according to the local guidelines. Epidemiological and clinical parameters of the patients were collected as secondary variables. In order to determine inappropriate prescription a revision was carried out by two specialists in emergencies, two pharmacists and one specialist in infectious diseases, all unrelated to prescriptions. RESULTS: 168 patients with 192 prescriptions were evaluated. Seventy-six (39.6%) of the prescriptions were not conformed to the local treatment guidelines. Of these, 55% were with active antimicrobial coverage against the microorganism but not recommended, 23.5% with inactive drugs, 13.7% presented an inappropriate dose and 7.8% were unnecessary treatment. The strength of agreement in the evaluation of the adequacy of treatment between doctors and pharmacists was high (kappa = 0.71). CONCLUSIONS: A high rate of inappropriate antimicrobial prescriptions was obtained in a hospital emergency department according to local guidelines. The hospital pharmacist has an opportunity to improve the use of antimicrobials in this area.

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OBJECTIVE: A study about the adherence of the antimicrobial prescriptions to the local guidelines of treatment of infections was conducted in a hospital emergency department to study the clinical and epidemiological characteristics of the patients who received these treatments. Conducting a feasibility study for supporting the design and execution of future studies, addressing specific aspects of the appropriateness of the antimicrobial prescription. METHOD: Observational, descriptive and cross-sectional pilot study, with retrospective data collection about the antimicrobial prescription in a hospital emergency department. Seven cross sections were made, corresponding to 7 different days of the week, in 7 consecutive weeks. INCLUSION CRITERIA: patient over 14 years of age, with at least one first dose of antimicrobial treatment prescribed on the day of recruitment. The main variable was the inappropriate antimicrobial prescription according to the local guidelines. Epidemiological and clinical parameters of the patients were collected as secondary variables. In order to determine inappropriate prescription a revision was carried out by 2 specialists in emergencies, 2 pharmacists and one specialist in infectious diseases, all unrelated to prescriptions. RESULTS: One hundred sixty eight patients with 192 prescriptions were evaluated. 76 (39.6%) of the prescriptions were not conformed to the local treatment guidelines. Of these, 55% were with active antimicrobial coverage against the microorganism but not recommended, 23.5% with inactive drugs, 13.7% presented an inappropriate dose and 7.8% were unnecessary treatment. The strength of agreement in the evaluation of the adequacy of treatment between doctors and pharmacists was high (kappa=0.71). CONCLUSIONS: A high rate of inappropriate antimicrobial prescriptions was obtained in a hospital emergency department according to local guidelines. The hospital pharmacist has an opportunity to improve the use of antimicrobials in this area.

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Objetivo: describir la adecuación de las prescripciones de antimicrobianos a las guías de tratamiento locales de infecciones, en el área de urgencias hospitalarias, así como conocer las características clínicas y epidemiológicas de los pacientes que reciben dichos tratamientos. Llevar a cabo un estudio de viabilidad para el diseño y la ejecución de investigaciones que aborden aspectos específicos de la inadecuación de prescripción de antimicrobianos.Métodoestudio piloto observacional, descriptivo y transversal, con recogida de datos retrospectiva de prescripción de antimicrobianos en un servicio de urgencias hospitalario. Se realizaron 7 cortes transversales, correspondientes a los 7 días diferentes de la semana, en 7 semanas consecutivas. Criterios de inclusión: paciente mayor de 14 años de edad, con al menos una primera dosis de tratamiento antimicrobiano prescrita el día del estudio. La variable principal fue la prescripción de antimicrobianos inadecuada según las guías locales. Como variables secundarias se recogieron parámetros epidemiológicos y clínicos de los pacientes. La evaluación de la adecuación la realizaron 2 especialistas médicos de urgencias y 2 especialistas en farmacia hospitalaria, más un tercer evaluador, especialista en enfermedades infecciosas, todos ajenos a la prescripción.Resultadosse evaluaron 168 pacientes con 192 prescripciones. Setenta y seis (39,6%) de las prescripciones no se ajustaron a las guías de tratamiento locales, de estas el 55% fueron con cobertura antimicrobiana activa frente al microorganismo, pero no recomendada, el 23,5% con fármacos inactivos, el 13,7% presentaban una dosis inapropiada y el 7,8% eran tratamientos innecesarios. La fuerza de la concordancia en la evaluación de la adecuación del tratamiento entre médicos y farmacéuticos fue alta (kappa=0,71). (AU)

Objective: A study about the adherence of the antimicrobial prescriptions to the local guidelines of treatment of infections was conducted in a hospital emergency department to study the clinical and epidemiological characteristics of the patients who received these treatments. Conducting a feasibility study for supporting the design and execution of future studies, addressing specific aspects of the appropriateness of the antimicrobial prescription.MethodObservational, descriptive and cross-sectional pilot study, with retrospective data collection about the antimicrobial prescription in a hospital emergency department. Seven cross sections were made, corresponding to 7 different days of the week, in 7 consecutive weeks. Inclusion criteria: patient over 14 years of age, with at least one first dose of antimicrobial treatment prescribed on the day of recruitment. The main variable was the inappropriate antimicrobial prescription according to the local guidelines. Epidemiological and clinical parameters of the patients were collected as secondary variables. In order to determine inappropriate prescription a revision was carried out by 2 specialists in emergencies, 2 pharmacists and one specialist in infectious diseases, all unrelated to prescriptions.ResultsOne hundred sixty eight patients with 192 prescriptions were evaluated. 76 (39.6%) of the prescriptions were not conformed to the local treatment guidelines. Of these, 55% were with active antimicrobial coverage against the microorganism but not recommended, 23.5% with inactive drugs, 13.7% presented an inappropriate dose and 7.8% were unnecessary treatment. The strength of agreement in the evaluation of the adequacy of treatment between doctors and pharmacists was high (kappa=0.71). (AU)

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BACKGROUND: The prescription system known as RELE is the electronic prescribing and dispensing system that has been used by the Balearic Islands Health Service (IB-SALUT, Spain) since April 2006. This repository contains patients' computerised medication profiles (CMPs). Data from studies conducted in other settings have shown the existence of discrepancies between the medications recorded in patients' CMPs and the medications actually taken by the patients. METHODS: Chronic medications recorded in RELE CMPs were compared with those obtained through a structured clinical interview with patients or the persons responsible for the administration of the patients' medications. A descriptive analysis of each discrepancy was performed. Potentially associated factors were analysed using Pearson's χ2 test. RESULTS: Of the 215 CMPs studied, 168 (78%) had discrepancies. The rate of discrepancies in the general population inferred from these results ranged from 72.57% to 83.71%, with a 95% confidence level. Polypharmacy was associated with the presence of discrepancies (χ2: 39.998, 1 df, p<0.0001) as well as patient age >65 years (χ2: 18.949, 2df, p<0.0001) and higher comorbidity (χ2: 12.548, 2 df, p=0.002). The association between the types of discrepancies and their causes showed that prescriber-generated dosage errors were the most common errors (n=116; 27%), followed by patient-generated commissions (n=79; 18%), patient-generated dosage errors (n=77; 18%) and prescriber-generated commissions (n=73; 17%). CONCLUSION: The rate of discrepancies identified in this study shows that clinical interviews with patients during transitions of care continue to be essential.

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Chronic Norovirus infection is particularly challenging in patients with common variable immunodeficiency (CVID) because of their inability to achieve viral clearance and the risk of developing enteropathy leading to intestinal villous atrophy and malabsorption. To date, therapeutic options to eliminate the virus are limited and only ribavirin has been shown to induce viral clearance in norovirus enteropathy associated with CVID. We report a case of a 48-year-old female patient diagnosed with CVID enteropathy possibly related to norovirus infection who failed a ribavirin-based therapy despite dosage optimization through drug plasma level monitoring.

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Objetivo: Los acontecimientos adversos por medicamentos son una causaconocida de asistencia a los servicios de urgencias. El objetivo del proyectoFARM-URG, impulsado por el Grupo de Trabajo REDFASTER de la SociedadEspañola de Farmacia Hospitalaria, es evaluar estos acontecimientos adversos mediante cortes periódicos. En este estudio se muestran los resultadosdel primer registro. Sus objetivos fueron determinar la prevalencia de acontecimientos adversos respecto al total de pacientes atendidos y caracterizarlos.Método: Estudio multicéntrico transversal realizado en los servicios deurgencias de hospitales españoles. La identificación y registro de pacientesse obtuvo a partir del censo de pacientes atendidos en urgencias en elmomento del corte (16 de junio de 2020). Se revisaron las historias clínicasretrospectivamente y se registraron los datos en la plataforma REDCap®.Resultados: En este corte FARM-URG de 2020 participaron 13 hospitales, que evaluaron 772 pacientes, de los cuales 57 (7,4%) habían consultadopor un acontecimiento adverso por medicamentos. El grupo de fármacosantitrombóticos fue responsable de la mayor parte de estos episodios, siendoacenocumarol (22,8%) el principal fármaco implicado. (AU)

Objective: Adverse drug events are a well-known cause of emergency department admissions. FARM-URG is a project promoted by theREDFASTER working group of the Spanish Society of Hospital Pharmacy.Its aim is to evaluate these adverse events through regular prevalencemeasurements. The present study shows the results of the first observations.The goal was to determine the prevalence of adverse drug events withrespect to the total number of patients treated in emergency departmentsand carry out a description of the different events identified.Method: This is a multicenter cross-sectional study carried out in theemergency room of 13 Spanish hospitals. The identification and registration of patients were obtained from the emergency department patientcensus at the time of the first prevalence measurement (16 June 2020). TheREDCap® platform was used for patient registration.Results: The 2020 FARM-URG registry, which included 13 hospitals,evaluated 772 patients, of whom 57 (7.4%) consulted for adverse drugevents. Antithrombotic drugs were responsible for most of these episodes, acenocoumarol being the main drug involved (22.8%). (AU)

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OBJECTIVE: Adverse drug events are a well-known cause of emergency department admissions. FARM-URG is a project promoted by  the REDFASTER working group of the Spanish Society of Hospital  Pharmacy. Its aim is to evaluate these adverse events through regular  prevalence measurements. The present study shows the results of the first observations. The goal was to determine the prevalence of adverse drug  events with respect to the total number of patients treated in emergency  departments and carry out a description of the different events identified. METHOD: This is a multicenter cross-sectional study carried out in the emergency room of 13 Spanish hospitals. The identification and  registration of patients were obtained from the emergency department  patient census at the time of the first prevalence measurement (16 June  2020). The REDCap® platform was used for patient registration. RESULTS: The 2020 FARM-URG registry, which included 13 hospitals, evaluated 772 patients, of whom 57 (7.4%) consulted for  adverse drug events. Antithrombotic drugs were responsible for most of  these episodes, acenocoumarol being the main drug involved (22.8%).  Nine (15.8%) adverse drug events were caused by inappropriate drug  prescriptions according to the STOPP-START criteria. Nineteen (33.0%)  patients returned to the emergency service within 30 days from discharge. CONCLUSIONS: Adverse drug events are a frequent cause of emergency department visits and are commonly associated with a  significant percentage of re-visits. The FARM-URG project has been created with the purpose of obtaining dynamic and updated information on such  events.

Objetivo: Los acontecimientos adversos por medicamentos son una causa conocida de asistencia a los servicios de urgencias. El objetivo del  proyecto FARM-URG, impulsado por el Grupo de Trabajo REDFASTER de la  Sociedad Española de Farmacia Hospitalaria, es evaluar estos  acontecimientos adversos mediante cortes periódicos. En este estudio se  muestran los resultados del primer registro. Sus objetivos fueron  determinar la prevalencia de acontecimientos adversos respecto al total de pacientes atendidos y caracterizarlos.Método: Estudio multicéntrico transversal realizado en los servicios de urgencias de hospitales españoles. La identificación y registro de  pacientes se obtuvo a partir del censo de pacientes atendidos en urgencias en el momento del corte (16 de junio de 2020). Se revisaron las historias  clínicas retrospectivamente y se registraron los datos en la plataforma  REDCap®.Resultados: En este corte FARM-URG de 2020 participaron 13 hospitales, que evaluaron 772 pacientes, de los cuales 57 (7,4%) habían consultado por un acontecimiento adverso por medicamentos. El grupo de  fármacos antitrombóticos fue responsable de la mayor parte de estos  episodios, siendo acenocumarol (22,8%) el principal fármaco implicado.  Nueve (15,8%) de los acontecimientos adversos fueron causados por  fármacos con prescripción inapropiada según los criterios STOPP-START.  Diecinueve (33,0%) pacientes volvieron a visitar el servicio de urgencias  antes de los 30 días del alta.Conclusiones: Los acontecimientos adversos por medicamentos son un motivo frecuente de visita a los servicios de urgencias y están  asociados a un importante porcentaje de visitas posteriores tras el alta. El  proyecto FARM-URG nace con el propósito de obtener información  periódicamente para la posible implementación de medidas preventivas.

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OBJETIVO: La Comisión de Farmacia y Terapéutica, como órgano asesor de la Dirección Médica del hospital y bajo las condiciones del Real Decreto 86/2015, por el que se regula la Comisión de Farmacoterapéutica de las Islas Baleares, elabora un informe técnico donde evalúa la posibilidad de empleo interno de medicamentos off-label, uso compasivo y medicamentos no incluidos en la Guía Farmacoterapéutica del hospital. Asimismo, esta comisión realiza un seguimiento prospectivo de cada una de las solicitudes. El objetivo fue analizar la respuesta clínica alcanzada con el empleo de estos medicamentos, así como el coste asociado. MÉTODO: Estudio retrospectivo de los medicamentos solicitados a la Comisión de Farmacia y Terapéutica del hospital entre enero y diciembre de 2018. Se analizó si con cada tratamiento solicitado se alcanzó el objetivo propuesto por el clínico. Para el cálculo del coste se consideró la duración del tratamiento hasta alcanzar el objetivo propuesto o hasta su interrupción. RESULTADOS: De un total de 70 solicitudes analizadas, un 59% alcanzaron el objetivo terapéutico esperado, un 34% fueron consideradas como fracaso terapéutico y hubo un 7% de pérdidas de seguimiento. El coste de las 70 peticiones fue de 1.140.240 (Euro). La media de coste por solicitud fue de 16.288 (Euro). Más del 50% de las solicitudes fueron realizadas por los servicios de oncología y hematología y más del 75% del presupuesto fue destinado a estos dos servicios. CONCLUSIONES: Más de la mitad de los tratamientos considerados por la Comisión de Farmacia y Terapéutica del hospital alcanzan la finalidad terapéutica deseada, si bien el impacto económico de su empleo es elevado

OBJECTIVE: The Pharmacy and Therapeutics Committee is an advisory body to the medical management of our hospital. Following Royal Decree 86/2015, which regulates the Pharmacy and Therapeutics Committee of the Balearic Islands, this committee prepared a technical report in which it assessed the possible internal use of off-label drugs, drugs for compassionate use, and drugs not included in the hospital's pharmacotherapeutic guide. The objective was to analyse the clinical response achieved with the use of these drugs and their associated costs. METHOD: Retrospective study of drugs whose use was requested from the hospital's Pharmacy and Therapeutics Committee hospital between January and December 2018. We analysed whether the requested treatment achieved the objective established by the physician. The cost was calculated based on the duration of the treatment until the objective was achieved or until treatment was discontinued. RESULTS: In total, 70 requests were analysed: 59% achieved the expected therapeutic goal, 34% were considered to be therapeutic failures, and 7% were lost to follow-up. The overall cost of the 70 authorized treatments was (Euro)1,140,240. The average cost per request was (Euro)16,288. Oncology and Haematology services submitted more than 50% of the requests, and more than 75% of the budget was allocated to these medical services. CONCLUSIONS: More than half of the treatments analysed by the Pharmacy and Therapeutics Committee of the hospital achieved their therapeutic goal, although the economic cost of their use was high

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OBJECTIVE: The Pharmacy and Therapeutics Committee is an advisory body to  the medical management of our hospital. Following Royal Decree 86/2015,  which regulates the Pharmacy and Therapeutics Committee of the Balearic  Islands, this committee prepared a technical report in which it assessed the  possible internal use of off-label drugs, drugs for compassionate use, and drugs  not included in the hospital's pharmacotherapeutic guide. The objective was to  analyse the clinical response achieved with the use of these drugs and their  associated costs. METHOD: Retrospective study of drugs whose use was requested from the  hospital's Pharmacy and Therapeutics Committee hospital between January and  December 2018. We analysed whether the requested treatment achieved the  objective established by the physician. The cost was calculated based on the  duration of the treatment until the objective was achieved or until treatment was discontinued. RESULTS: In total, 70 requests were analysed: 59% achieved the expected therapeutic goal, 34% were considered to be therapeutic failures, and  7% were lost to follow-up. The overall cost of the 70 authorized treatments was  €1,140,240. The average cost per request was €16,288. Oncology and  Haematology services submitted more than 50% of the requests, and more than 75% of the budget was allocated to these medical services. CONCLUSIONS: More than half of the treatments analysed by the Pharmacy and  Therapeutics Committee of the hospital achieved their therapeutic goal, although the economic cost of their use was high.

Objetivo: La Comisión de Farmacia y Terapéutica, como órgano asesor de la  Dirección Médica del hospital y bajo las condiciones del Real Decreto 86/2015,  por el que se regula la Comisión de Farmacoterapéutica de las Islas Baleares,  elabora un informe técnico donde evalúa la posibilidad de empleo interno de  medicamentos off-label, uso compasivo y medicamentos no incluidos en la Guía  Farmacoterapéutica del hospital. Asimismo, esta comisión realiza un seguimiento prospectivo de cada una de las solicitudes. El objetivo fue analizar la respuesta  clínica alcanzada con el empleo de estos medicamentos, así como el coste  asociado.Método: Estudio retrospectivo de los medicamentos solicitados a la Comisión de Farmacia y Terapéutica del hospital entre enero y diciembre de 2018. Se analizó  si con cada tratamiento solicitado se alcanzó el objetivo propuesto por el clínico.  Para el cálculo del coste se consideró la duración del tratamiento hasta alcanzar  el objetivo propuesto o hasta su interrupción.Resultados: De un total de 70 solicitudes analizadas, un 59% alcanzaron el  objetivo terapéutico esperado, un 34% fueron consideradas como fracaso  terapéutico y hubo un 7% de pérdidas de seguimiento. El coste de las 70  peticiones fue de 1.140.240 €. La media de coste por solicitud fue de 16.288 €.  Más del 50% de las solicitudes fueron realizadas por los servicios de oncología y  hematología y más del 75% del presupuesto fue destinado a estos dos servicios.Conclusiones: Más de la mitad de los tratamientos considerados por la  Comisión de Farmacia y Terapéutica del hospital alcanzan la finalidad terapéutica deseada, si bien el impacto económico de su empleo es elevado.

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OBJECTIVES: To evaluate the clinical relevance of pharmacist intervention on patient care in emergencies, to determine the severity of detected errors. Second, to analyse the most frequent types of interventions and type of drugs involved and to evaluate the clinical pharmacist's activity. METHODS: A 6-month observational prospective study of pharmacist intervention in the Emergency Department (ED) at a 400-bed hospital in Spain was performed to record interventions carried out by the clinical pharmacists. We determined whether the intervention occurred in the process of medication reconciliation or another activity, and whether the drug involved belonged to the High-Alert Medications Institute for Safe Medication Practices (ISMP) list. To evaluate the severity of the errors detected and clinical relevance of the pharmacist intervention, a modified assessment scale of Overhage and Lukes was used. Relationship between clinical relevance of pharmacist intervention and the severity of medication errors was assessed using ORs and Spearman's correlation coefficient. RESULTS: During the observation period, pharmacists reviewed the pharmacotherapy history and medication orders of 2984 patients. A total of 991 interventions were recorded in 557 patients; 67.2% of the errors were detected during medication reconciliation. Medication errors were considered severe in 57.2% of cases and 64.9% of pharmacist intervention were considered relevant. About 10.9% of the drugs involved are in the High-Alert Medications ISMP list. The severity of the medication error and the clinical significance of the pharmacist intervention were correlated (Spearman's ρ=0.728/p<0.001). CONCLUSIONS: In this single centre study, the clinical pharmacists identified and intervened on a high number of severe medication errors. This suggests that emergency services will benefit from pharmacist-provided drug therapy services.

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Objective: To estimate the prevalence of potentially inadequate drug prescriptions in elderly patients who attend the Emergency Department. Design: A multicentre randomized clinical trial. Patients over 65 years of age attending the Emergency Department are randomized to the control arm or the intervention arm. In the intervention arm, the pharmacist will review the chronic medication of patients and identify any potentially inadequate prescriptions, according to the STOPP-START criteria. The cases are discussed with the Emergency Specialist and, if considered adequate, a recommendation to modify the treatment is sent to the Primary Care Physician. The control arm will receive the standard of care, not including a systematic review of the adequacy to the STOPP-START criteria. This article presents preliminary outcomes regarding the prevalence of potentially inadequate prescriptions. Outcomes: Four hospitals participated in the study, and 665 patients were included (342 in the control arm and 305 in the intervention arm). The mean age in the control arm was 78.2 years vs. 78.99 in the intervention arm. The total number of medications received by patients at the time of inclusion was 3 275. Of these, 9.3% (CI 95%: 8.3-10.4) were considered potentially inadequate prescriptions according to the STOPP criteria. On the other hand, 81.1% (CI 95%: 76.8-85.4) of the patients evaluated presented potentially inadequate prescriptions. Conclusion: This study has detected a high prevalence of potentially inadequate prescriptions in elderly patients attending the Emergency Department (AU)

Objetivo: Estimar la prevalencia de prescripciones potencialmente inapropiadas en pacientes mayores que acuden a urgencias Diseño: Ensayo clínico multicéntrico aleatorizado. Los pacientes mayores de 65 años que acuden a urgencias son asignados al grupo control o al de intervención. En el grupo de intervención, el farmacéutico revisa la medicación crónica de los pacientes e identifica aquellas prescripciones potencialmente inapropiadas de acuerdo a los criterios STOPP START. Los casos se discuten con el médico de urgencias y, cuando se considera indicado, se envía una recomendación al médico de atención primaria para que modifique el tratamiento. El grupo control recibe los cuidados habituales, que no incluyen una evaluación sistemática de la adecuación a los criterios STOPP START. En este artículo se presentan resultados preliminares respecto a la prevalencia de prescripciones potencialmente inapropiadas. Resultados: En el estudio han participado cuatro centros y se han incluido 665 pacientes (342 en el grupo control y 305 en el de intervención). La edad media en el grupo control ha sido de 78,2 años frente a 78,99 en el grupo de intervención. El número total de medicamentos que recibían los pacientes en el momento de la inclusión fue de 3.243. De estos, el 9,3% (IC 95%: 8,3-10,4) fueron considerados prescripciones potencialmente inapropiadas de tipo STOPP. Por otro lado, el 81,1%. (IC 95%: 76,8-85,4) de los pacientes evaluados presentaron prescripciones potencialmente inapropiadas. Conclusiones: En el estudio se ha detectado una alta prevalencia de prescripciones potencialmente inapropiadas en pacientes mayores que acuden a urgencias (AU)

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RESUMO

OBJECTIVE: To estimate the prevalence of potentially inadequate drug prescriptions in elderly patients who attend the Emergency Department. DESIGN: A multicentre randomized clinical trial. Patients over 65 years of age attending the Emergency Department are randomized to the control arm or the intervention arm. In the intervention arm, the pharmacist will review the chronic medication of patients and identify any potentially inadequate prescriptions, according to the STOPP-START criteria. The cases are discussed with the Emergency Specialist and, if considered adequate, a recommendation to modify the treatment is sent to the Primary Care Physician. The control arm will receive the standard of care, not including a systematic review of the adequacy to the STOPP-START criteria. This article presents preliminary outcomes regarding the prevalence of potentially inadequate prescriptions. OUTCOMES: Four hospitals participated in the study, and 665 patients were included (342 in the control arm and 305 in the intervention arm). The mean age in the control arm was 78.2 years vs. 78.99 in the intervention arm. The total number of medications received by patients at the time of inclusion was 3 275. Of these, 9.3% (CI 95%: 8.3-10.4) were considered potentially inadequate prescriptions according to the STOPP criteria. On the other hand, 81.1% (CI 95%: 76.8-85.4) of the patients evaluated presented potentially inadequate prescriptions. CONCLUSION: This study has detected a high prevalence of potentially inadequate prescriptions in elderly patients attending the Emergency Department.

Objetivo: Estimar la prevalencia de prescripciones potencialmente inapropiadas en pacientes mayores que acuden a urgencias Diseño: Ensayo clínico multicéntrico aleatorizado. Los pacientes mayores de 65 años que acuden a urgencias son asignados al grupo control o al de intervención. En el grupo de intervención, el farmacéutico revisa la medicación crónica de los pacientes e identifica aquellas prescripciones potencialmente inapropiadas de acuerdo a los criterios STOPP START. Los casos se discuten con el médico de urgencias y, cuando se considera indicado, se envía una recomendación al médico de atención primaria para que modifique el tratamiento. El grupo control recibe los cuidados habituales, que no incluyen una evaluación sistemática de la adecuación a los criterios STOPP START. En este artículo se presentan resultados preliminares respecto a la prevalencia de prescripciones potencialmente inapropiadas. Resultados: En el estudio han participado cuatro centros y se han incluido 665 pacientes (342 en el grupo control y 305 en el de intervención). La edad media en el grupo control ha sido de 78,2 años frente a 78,99 en el grupo de intervención. El número total de medicamentos que recibían los pacientes en el momento de la inclusión fue de 3.243. De estos, el 9,3% (IC 95%: 8,3-10,4) fueron considerados prescripciones potencialmente inapropiadas de tipo STOPP. Por otro lado, el 81,1%. (IC 95%: 76,8-85,4) de los pacientes evaluados presentaron prescripciones potencialmente inapropiadas. Conclusiones: En el estudio se ha detectado una alta prevalencia de prescripciones potencialmente inapropiadas en pacientes mayores que acuden a urgencias.

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OBJECTIVES: Antibiotic treatment is vital in patients with severe sepsis/septic shock. The objectives were to assess the degree of concordance between antibiotic prescribed in emergencies and post requirements; to relate it to health outcomes (mortality) and to analyze the reasons for disagreement. MATERIAL AND METHODS: Retrospective descriptive study of antibiotic treatment prescribed in emergencies and the subsequent treatment in patients with criteria of severe sepsis/septic shock in 2013. We collected patient demographic characteristics, infectious focus, antibiotic prescribed from emergencies and subsequent changes. It was considered concordant if there were no changes, if there were changes, but the initial antibiotic was right and suspensions for end of treatment. Mortality and evolution were analyzed. RESULTS: Six hundred patients were included. A 60% experienced changes respect to the antibiotic treatment initiated in emergencies (87.6% justified), with a degree of overall antibiotic concordance of 47.5% The mortality rate at end-point was 9.83%, with no statistically significant relationship with the degree of concordance (OR=0.864 (0.503-1.484)/χ2=0.28; p=0.597). Reasons for change of antibiotic: clinical outcome (17.96%), change of spectrum (35.03%), de-escalation (41.32%), sequential therapy (8.68%). An 11% required ICU admission. Clinical outcomes: resolution of the disease (79.2%), readmission after 30 days (7.7%) and transfer to health centers (4.5%). The median hospital stay was 7 days. CONCLUSIONS: The degree of concordance antibiotic was quite high, and the mortality rate was lower than that described in the literature, without relating to the discordance. The presence of concordance was associated with fewer readmissions and ICU admissions. The main reasons for disagreement were inadequate spectrum selection and change after microbiological crops.

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Objetivos. El tratamiento antibiótico resulta de vital importancia en pacientes con sepsis grave/shock séptico. Los objetivos fueron evaluar el grado de concordancia entre la prescripción de antibióticos realizada en urgencias y prescripciones posteriores; relacionarlo con resultados en salud (mortalidad) y analizar los motivos de discordancia. Material y métodos. Estudio descriptivo retrospectivo del tratamiento antibiótico prescrito desde urgencias y el prescrito posteriormente en pacientes con criterios de sepsis grave/shock séptico en el año 2013. Se recogieron características demográficas, foco infeccioso, antibiótico prescrito desde urgencias y los cambios posteriores, considerándose concordante cuando no había cambio, si había cambio pero el antibiótico inicial era correcto y suspensiones por fin de tratamiento. Se analizó mortalidad y evolución del cuadro. Resultados. Se incluyeron 600 pacientes. El 60% sufrió cambio de tratamiento antibiótico respecto al iniciado en urgencias (87,6% justificados), con un grado de concordancia antibiótica global del 47,5%. La tasa de mortalidad al final del estudio fue 9,83%, no encontrándose relación estadísticamente significativa con el grado de concordancia (OR=0,864 (0,503-1,484)/X2=0,28, p=0,597). Motivos de cambio de antibiótico: evolución clínica (17,96%), cambio de espectro (35,03%), desescalada (41,32%), terapia secuencial (8,68%). El 11% requirió ingreso en Unidad de Cuidados Intensivos (UCI). Evoluciones clínicas: resolución del cuadro (79,2%), reingreso antes de 30 días (7,7%) y traslado a centros sociosanitarios (4,5%). La mediana de estancia hospitalaria fue 7 días. Conclusiones. El grado de concordancia antibiótica resultó bastante alto y la tasa de mortalidad inferior a la descrita en la literatura, sin relacionarse con la discordancia. La presencia de concordancia se asoció a menos reingresos e ingresos en UCI. Los principales motivos de discordancia fueron selección del espectro inadecuado y el cambio tras cultivos microbiológicos (AU)

Objectives. Antibiotic treatment is vital in patients with severe sepsis/septic shock. The objectives were to assess the degree of concordance between antibiotic prescribed in emergencies and post requirements; to relate it to health outcomes (mortality) and to analyze the reasons for disagreement. Material and methods. Retrospective descriptive study of antibiotic treatment prescribed in emergencies and the subsequent treatment in patients with criteria of severe sepsis/septic shock in 2013. We collected patient demographic characteristics, infectious focus, antibiotic prescribed from emergencies and subsequent changes. It was considered concordant if there were no changes, if there were changes, but the initial antibiotic was right and suspensions for end of treatment. Mortality and evolution were analyzed. Results. Six hundred patients were included. A 60% experienced changes respect to the antibiotic treatment initiated in emergencies (87.6% justified), with a degree of overall antibiotic concordance of 47.5% The mortality rate at endpoint was 9.83%, with no statistically significant relationship with the degree of concordance (OR=0.864 (0.503-1.484)/χ2=0.28; p=0.597). Reasons for change of antibiotic: clinical outcome (17.96%), change of spectrum (35.03%), de-escalation (41.32%), sequential therapy (8.68%). An 11% required ICU admission. Clinical outcomes: resolution of the disease (79.2%), readmission after 30 days (7.7%) and transfer to health centers (4.5%). The median hospital stay was 7 days. Conclusions. The degree of concordance antibiotic was quite high, and the mortality rate was lower than that described in the literature, without relating to the discordance. The presence of concordance was associated with fewer readmissions and ICU admissions. The main reasons for disagreement were inadequate spectrum selection and change after microbiological crops (AU)

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Objetivo: Determinar el efecto en los problemas relacionados con la medicación (PRM) de la intervención de un farmacéutico centrada en la conciliación de medicación (CM) en los pacientes 65 años ingresados en una unidad de corta estancia (UCE) vinculada a un servicio de urgencias hospitalario (SUH). Método: Ensayo clínico controlado y aleatorizado de 17 meses de duración (febrero 2013-junio 2014) realizado en la UCE de un SUH. Se incluyeron pacientes 65 años con alto riesgo de sufrir PRM. Ciento treinta pacientes fueron asignados aleatoriamente a un grupo control (n = 65) o a un grupo de intervención (n = 65). El tipo de intervención realizada fue la CM mediante un farmacéutico especialista. La variable de resultado principal fue la frecuencia de PRM resueltos en ambos grupos. Resultados: Se revisaron un total de 3.081 medicamentos en 130 pacientes con una edad media de 79 (DE 7,6) años, de los cuales 66 (50,8%) fueron hombres. Se registraron discrepancias en 1.901 (61,7%) de los medicamentos. Los grupos control y de intervención no tuvieron diferencias significativas respecto a edad, sexo y número de discrepancias encontradas. Se detectaron un total de 213 PRM, 110 (51,6%) en el grupo control y 103 (48,4%) en el grupo de intervención (p = 0,380). La intervención del farmacéutico redujo los PRM de forma estadísticamente significativa (grupo de intervención 83,5% vs grupo control 26,4%; p < 0,001). Conclusiones: La CM mediante la incorporación de un farmacéutico especialista reduce los PRM de los pacientes ancianos de alto riesgo de PRM ingresados en una UCE (AU)

Objective: To determine the effect on medication-related problems (MRPs) of a process of medication reconciliation carried out by a specialized pharmacist for patients aged 65 years or older admitted to an emergency department short-stay unit (SSU). Methods: Randomized clinical trial of 17 months (February 2013-June 2014) in the SSU of a hospital emergency department. Patients were aged 65 years or older at high risk of MRPs. A total of 130 patients were randomized to a control group (n = 65) or the intervention group (n = 65). The reconciliation process (intervention) was carried out by a specialized pharmacist. The main outcome was the number of MRPs resolved in each group. Results: A total of 3081 medications for 130 patients were reviewed. The patients' mean (SD) age was 79 (7.6) years and 66 (50.8%) were men. Discrepancies affecting 1901 medications (61.7%) were detected. The distributions of age, sex, and number of medication discrepancies were similar in the control and intervention groups. A total of 213 MRPs were detected; 110 (51.6%) were in the control group and 103 (48.4%) in the intervention group (P = .380). Through the pharmacist's reconciliation, significantly more of the MRPs were resolved in the intervention group (83.5%) than in the control group (26.4%) (P < .001). Conclusions: Medication reconciliation by a specialized pharmacist in the emergency department reduces MRPs for at-risk elderly patients in a SSU (AU)

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