We describe a recent case of Stevens-Johnson Syndrome. A 49-year-old man was admitted to the Intensive Care Unit of an Anaesthesia and Resuscitation Department because of a Fournier gangrene that derived in a sepsis, ventilator-associated pneumonia, and renal failure. He was under treatment with cefepime and suffered a generalized status epilepticus, so started treatment with phenytoin. The next day he developed a "maculous cutaneous eruption in trunk and lower limbs" compatible with a Stevens-Johnson Syndrome. Stevens-Johnson Syndrome is a very severe and potentially fatal multiorganic disease, especially when present in critically ill patients, with a strong drug-related etiology, especially with antiepileptic drugs.

Antecedentes y objetivo: La gravedad e inestabilidad de los pacientes, junto con el alto grado de complejidad de la medicación, hacen de las unidades de cuidados intensivos (UCI) un área crítica de problemas relacionados con la medicación. El objetivo de nuestro estudio fue analizar y evaluar la actividad clínica realizada por el farmacéutico clínico integrado en una UCI y conocer la opinión del personal. Material y método: Estudio descriptivo, prospectivo, de 42 meses de duración. El farmacéutico se integró en la actividad diaria del equipo multidisciplinar de una UCI de 12 camas perteneciente al Servicio de Anestesiología y Reanimación. Se registraron todas las intervenciones farmacoterapéuticas (IF) realizadas, el grado de aceptación, el método de comunicación y destinatario de la intervención, así como la evaluación clínica de las intervenciones aceptadas. Posteriormente, se realizó una encuesta al personal de la unidad sobre la seguridad del paciente y la influencia de la integración del farmacéutico en la unidad. Resultados: Se realizaron un total de 2399 IF con un 97,0% de aceptación. De estas, las mayoritarias fueron las relacionadas con la posología (37,8%) y las consultas al farmacéutico (25,7%). De las IF aceptadas, el 53,7% influyeron sobre la eficacia del tratamiento farmacológico y el 35,1% sobre la tolerancia. En la encuesta realizada al personal de la unidad para valorar la percepción de la integración del farmacéutico se obtuvo una valoración global de de 8,58 ± 1,40 sobre 10. Conclusiones: El farmacéutico hospitalario integrado en el equipo multidisciplinar de UCI puede aportar un valor añadido al proceso farmacoterapéutico del paciente crítico.

BackgroundAntipsychotic drugs should be used in people with dementia only when there is an identified need and the benefits outweigh the risks. Behavioural and psychological symptoms of dementia are common reasons for use of antipsychotic drugs among older individuals with dementia. These drugs are not approved for such use and both the Food and Drug Administration and European Medicines Agency have issued warnings to limit such use.PurposeTo describe the patterns of antipsychotic drug use in ten nursing homes, whose medicines are provided by the referring hospital’s Pharmacy Department.Material and methodsThis cross-sectional study included 6 nursing homes.ResultsA total of 770 elderly residents living in 6 nursing homes were investigated. Overall, 28% of patients used antipsychotic drugs. Particular antipsychotics such as lithium, amisulpride, aripiprazole, ziprasidone, tiaprizal, risperidone injectable and paliperidone injectable were monitored by psychiatry although in some cases the last mental health reports found were from the last year. 20% of patients were treated with quetiapine; half were followed by psychiatry and the others had dementia. 22% of patients were treated with risperidone, 78% of them had dementia. 12% of patients were treated with haloperidol and 4% with levomepromazine; all of them with dementia.ConclusionMany patients, 60%, were followed by the psychiatry service but despite recommendations to avoid the use of antipsychotic drugs in patients with dementia, a large proportion of residents continued to receive such agents for this condition. Future work should establish the appropriateness of antipsychotic drugs in patients with dementia.References and/or acknowledgementsNo conflict of interest.

BackgroundMedication errors in critical care are frequent, serious and predictable. Critically ill patients are prescribed twice as many medications as patients outside the intensive care unit and nearly all will suffer a potential error at some point during their stay.PurposeTo quantify and characterise medication errors in a surgical intensive care unit (SICU).Material and methodsWe conducted a one-month prospective observational study to detect, quantify and score medication errors in a SICU.ResultsA total of 634 observations made over weekdays and weekends were performed including morning, noon and night shifts. 36.27% observations (230) included some type of error, a total of 245 medication errors were detected. According to the type of error found: 52 were prescription errors (21.22%), 2 omissions (0.82%), 44 related to administration technique (wrong speed) (17.96%), 10 omissions of the administration record (4.08%), 97 erroneous preparations (39.59%), 1 wrongly prescribed dose by default (0.41%) and 3 by excess (1.22%), 5 errors related to erroneous administration route (2.04%), 2 erroneous drug monitorization (0.82%) and 29 transcription errors (11.84%). According to severity within categories established by the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP), 26.12% errors were Category A, 10.20% were Category B, 61.63% were Category C, 1.63% Category D and 0.41% Category F.ConclusionDetermining the incidence of medication errors in our system and adopting measures to prevent them is a priority in order to improve the drug treatment process in critically ill patients. The integration of a pharmacist in the intensive care unit is one of the measures that our institution has adopted to reduce medication-related errors and improve quality of care.References and/or acknowledgementsNo conflict of interest.