BackgroundAppropriate, accurate and timely distribution of medicines to patients is a pharmacist’s responsibility. Automated dispensing cabinets (ADCs) improve efficiency in distribution; but patient safety may be compromised if they are used incorrectly.PurposeTo analyse pharmaceutical interventions in ADC dispensing, in order to adopt steps that improve patient safety.Material and methodsA descriptive study was conducted in a 470-bed specialist hospital. Over 8 months (April–December 2013) pharmaceutical interventions in drugs dispensing to 9 infirmary units with ADC were collected. Interventions were made and recorded during ADC drug replacement in hospital wards, or during incident resolution at the pharmacy cabinet control point. All interventions made during the study period were analysed to determine their category and frequency. Interventions were recorded according Hernández and Poveda’s classification of medicines errors in ADC.Results290 interventions were collected. The most frequent type of intervention was that related to incorrect ADC procedures and handling (59.7%). In this category, interventions were due to stock discrepancies (79), medicine devolutions discrepancies (35), lack of concordance with opiate stocks (25), wrong medicine location (17), and drug load (17). Another category identified was intervention related to the structure and functioning of the ADC (29.3%), and includes the following events: door blockage (29), drawer break/obstruction (14), other mechanical structural fault (19), mistakes in the ADC-hospital census connection (8), system breakdown (7), refrigerator failure (7) and electric supply failure (1). The less frequent intervention categories were those related to inappropriate handling and storage (11.0%), and included interventions caused by expired medicines (15), lack of opiate prescriptions (6), damaged medicines (3), cabinet start-up (1), quarantine drug unload (19), and other reasons (6).ConclusionThe most common interventions on automated dispensation process are related to handling of cabinets. Therefore it’s necessary to remind nurses periodically that correct handling of ADCs is essential to guarantee medicine availability and optimal storage, both necessary for safe drug use.References and/or acknowledgementsNo conflict of interest.

BackgroundBiological treatments are responsible for numerous side effects, some of which can trigger a medical consultation by the patient in primary care. When these drugs are prescribed and dispensed, the process is not reflected in the patient’s records so the primary care physician does not know which patients are treated with these drugs.PurposeTo describe the impact of a care model that puts alerts in electronic records to enable primary care physicians to identify rheumatology patients on biological treatment and their associated adverse reactions.Material and methodsA retrospective observational study of patients from the Rheumatology Unit on biological treatment and analysis of the most frequent adverse reactions produced by these drugs that could cause a consultation in primary care. The study period was one year (October 2013–September 2014). A search of adverse events classified as very common (≥1/10 patients) of each drug and the number of patients identified in the APD-ATHOS program was conducted.ResultsA total of 7 drugs was identified and 461 patients were treated. The most-used drugs were etanercept (N = 209, 45.3%) and adalimumab (N = 172, 37.3%). Adverse reactions that would have had a higher frequency of occurrence and could generate a consultation in primary care were: respiratory tract infections (N = 48, 10.4%), hypercholesterolemia (N = 22.5, 4.9%), headache (N = 20, 4.3%), leukopenia (N = 17.2, 3.7%), nausea (N = 17.2, 3.7%), rash (N = 17.2, 3.7%), musculoskeletal pain (N = 17.2, 3.7%), increased liver enzymes (N = 3.9, 0.8%). A total of 163 patients might present one of these adverse reactions.ConclusionA high number of patients could benefit from alerts, as they provide primary care professionals with relevant information about common adverse events.ReferenceGutiérrez Fernández D, Foncubierta Fernández A, Anguita Carazo JL. Adalimumab desensitization protocol in a patient with a generalized urticarial reaction and angioedema following adalimumab administration. J Investig Allergol Clin Immunol 2014;24(4):273–5No conflict of interest.

BackgroundFollowing the introduction of a new iodine-containing contrast medium (IC) (iomeprol) to our hospital formulary, an unexpected increase in adverse drug reactions (ADRs) to the IC was observed. Consequently, a root cause analysis (RCA) was made to identify the causes of adverse events, and to suggest improvements to prevent recurrences.PurposeTo determine the corrective measures resulting from an RCA to investigate the unexpected increase in ADRs associated with the introduction of a new IC (iomeprol) in the hospital, and to evaluate the effectiveness of measures implemented.Material and methodsThe study was made in a 460-bed specialty hospital. The RCA multidisciplinary team was composed of medical and nursing directors and supervisors of radiology and pharmacy units. Steps followed in RCA involve: 1-problem description and data collection, 2-organisational system analysis, 3-human factor analysis, 4-team and material management analysis, 5-patient-related factors analysis, 6-RCA team proposal. The monthly number of ADRs notified before and after RCA was used to assess the effectiveness of corrective measures. Notifications of IC ADRs were extracted from the records of yellow card reports, as well as patient data, drug data and ADR data.ResultsProposals generated by RCA were: 1-to retrain radiology technicians and doctors on the use of IC pumps for administration, 2-to inspect pump calibration, 3-to verify the premedication needed. In the period 2009–2012 average notification of IC ADRs was 0.87/month. Since iomeprol was introduced in 2013/03 until RCA was performed (2013/05/08) 9 notifications were recorded (6/month); type and severity were similar to the previous period. Retraining and pump calibration inspection were finalised in June. The average IC ADR notification rate in the period July–December 2013 was 1.67/month. In the period January–October 2014, the notification rate was 0.89/month, similar to that before introduction of the new IC.Conclusion1. Technical training, machine calibration and patient evaluation were identified by RCA as aspects to improve. 2. After corrective measures had been taken, IC RCA notification has returned to the usual value.References and/or acknowledgementsNo conflict of interest.

Background The restricted use policy was established to assist the correct use of medicines. The Pharmacy and Infections Committee agreed to authorise indications for use that accorded with treatment protocols and clinical practice guidelines; once these prescribing rules were decided, the next step was pharmaceutical validation of the prescriptions. Computer-assisted prescribing provides information to prescribers and facilitates checking. Purpose To assess the usefulness of computer-assisted prescribing in restricted-use drugs in our hospital. Materials and methods The PRESEL application is used for electronic prescribing. Restricted drugs and the indications for their authorised use were defined in PRESEL. When prescribing these medicines it was necessary to type the clinical indication; at the same time authorised indications were shown on screen as advice. During the validation process the pharmacist could accept the prescription or not, and record the prescribing indication in PRESEL. At the time of this study, our hospital used computer-assisted prescribing for 49% of surgical beds. Prescriptions written between June 2010 and May 2011 were studied. Information about the restricted-use drugs prescribed, authorised indications, and clinical unit prescriptions were collected and analysed. Results During the study period, there were 50,990 electronic prescriptions for 5,210 patients. 113 restricted-drug prescriptions for 10 different drugs were recorded. None of them was rejected. The antimycotics posaconazole and micafungin were the most prescribed (37%), followed by the antibiotics tigecycline and linezolid (28%). The most frequent indication for antimycotics was ‘prophylaxis of fungal infections in immunocompromised haematopoietic stem cell transplantation recipients’; for antibiotics the most frequent was ‘complicated intra-abdominal infection’. The majority of prescriptions were written on the Haematology (65.49%), Infectious Diseases (7.96%), Surgery (5.31%) and Neurology (5.31%) wards. Conclusions In our hospital antifungals and antibiotics are most common restricted-use drugs. Haematology and Infectious clinical services are the main prescribers. Computer-assisted prescription applications are useful to set restrictions and to check if prescriptions comply.

Background Current guidelines (GESIDA/PNS-2012) for antiretroviral therapy (ART) in adults recommend the combination of 3 drugs for the treatment of chronic HIV infection. Purpose To analyse the ART in adult HIV-infected patients monitored in our hospital. Materials and Methods A retrospective and descriptive analysis was conducted at the Outpatient Hospital Pharmacy studying the types of ART in HIV adult patients treated on 1 January 2012. Dates were obtained from the electronic outpatient database. Results 1226 patients were receiving ART. The type of therapy was: monotherapy in 40 patients (3.3%), dual therapy in 37 (3%), triple in 1107 (90.3%), quadruple in 32 (2.6%), quintuple in 7 (0.5%), sixfold in 2 (0.2%) and sevenfold in 1 (0.08%). 156 different treatments were observed with 22 drugs. The most common ART combinations were 2 nucleoside reverse transcriptase inhibitors (NRTI) plus a non-nucleoside reverse transcriptase inhibitor (NNRTI) in 585 patients (47.7%), followed by 2 NRTIs plus a protease inhibitor (PI) in 345 (28.1%) and 3 NRTIs in 75 (6.1%). 43.2% (530) received PI therapy and, mainly, boosted. The combinations tenofovir-emtricitabine or lamivudine-efavirenz were the most frequently prescribed in 358 patients (29.2%), followed by abacavir-lamivudine-efavirenz in 89 (7.3%), tenofovir-emtricitabine-lopinavir-ritonavir in 80 (6.6%), tenofovir-emtricitabinedarunavir-ritonavir in 74 (6%) and abacavir-lamivudine-zidovudine in 72 (5.9%). All patients received oral treatment and 3 of them subcutaneous treatment with the T-20 fusion inhibitor. 621 patients (50.7%) received once-daily treatment (49.3%), 604 twice-daily and one patient three doses daily. Regarding the number of dosage forms, 337 (27.5%) patients were taking one, 273 (22.3%) five, 238 (19.4%) three, 77 (14.4%) were taking two. Conclusions On January 2012, 76% of our hospital HIV patients treated with ART were taking triple combinations of 2 NRTIs + 1 NNRTI or 1 PI. All patients except one received once or twice daily treatment and 42% took 1 or 2 dosage forms/day. No conflict of interest.