No abstract

No abstract

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.

BackgroundSelective decontamination of the digestive tract has been proven to be the best measure to prevent ventilator associated pneumonia (VAP) and the only one that has demonstrated modest reductions in mortality. The preparations are typically non-absorbable, topical admixtures of antibiotics with broad spectrum activity administered either orally and/or enterally applied as an oropharyngeal paste (OP), or as a suspension (decontamination of the digestive tract suspension, DDS).PurposeThe purpose of this study was to analyse the composition, costs of acquisition or elaboration at the pharmacy department (PD) of these preparations to determine the most cost effective option and the annual economic impact of the implementation of this new measure at the anaesthesia critical care unit (ACCU).Material and methodsWe conducted a literature research and analysed if the preparations could be acquired through a regular provider (A) or had to be made at the PD (B). To determine the costs if the preparations were made at the PD, we considered the total costs of raw materials, packaging materials, consumables and staff time.ResultsWe found that antibiotics commonly used were tobramycin, colistin and anfoterincin B (or nystatin instead), and vancomycin was added in the case of methicillin resistant Staphylococcus aureus. We agreed with the ACCU for the PD to provide tobramycin, colistin and nystatin. Preparation costs/acquisition were: OP: €1.43/g A; €0.12/g B; and for DDS: €4.42/10 mL A; €0.70/10 mL B. Regarding the annual consumption, estimating the average of intubated patients per day and the dosage (10 mL DDS every 8 hours and 5 mL orally every 8 hours, equating to 4.58 g B and 1.6g A), we estimated the costs on: €1.556 if we made it and €36.234 if we acquired it. We agreed with the ACCU for the PD to provide these preparations as it may result in estimated annual saving of €24 678.ConclusionAfter analysing the composition, costs of acquisition or elaboration at the PD, we concluded that the elaboration of OP and DDS at the PD significantly saved costs compared with the acquisition of both preparations already commercialised. This implies optimisation of resources, one of the main objectives of healthcare management.References and/or acknowledgementsKlompas M, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol2014;35:S133–54.No conflict of interest