Background Patients admitted to the intensive care unit (ICU) are exposed to medication errors twice as compared to other hospital units. Pharmaceutical care in critically ill patients may increase the quality of patient care by reducing medication errors. Purpose To assess the impact of pharmaceutical interventions (PI) on the health of patients admitted to an intensive care unit. Materials and methods Study to evaluate PI in patients admitted to an ICU with electronic prescribing. Were obtained from medical records data on age, gender, APACHE-II score at admission. The authors defined the impact of PI such as the presence of negative results, positive or no change in the patient's health, potentially avoided by PI and assessed by the rating scale proposed by Overhage et al.1 The medication error detected with PI undertaken provides the clinical relevance of the intervention, the reason for the intervention preceded the detection of a medication error, measured by classifying Overhage et al. modified2 Results 25 patients were included, 19 were men, mean age 53.88±16.69 years. 68% of patients had a APACHE-II score less than 10. A total of 35 PI, 1.4 interventions / patient. 71% of the PI made were accepted. In terms of assessing the impact of PI by the rating scale proposed by Overhage et al1, 8.57% were extremely significant (PI avoids a situation that potentially generate extremely serious consequences), 40% very significant (PI prevents actual or potential damage a vital organ), significant 8.57%(PI leads to better patient care), 28.57% something significant (the benefit of the patient is neutral), 14.29% non-significant(only general information or recommendations, not individualised per patient). The clinical relevance of the PI measured by classifying Overhage et al modified2 was: 5.71% could avoid death (medical error has high potential to produce adverse effects that threaten the patient's life), serious 24.71% (dose of 4 to 10 times higher than normal in a narrow therapeutic index drugs, doses can lead to potentially toxic concentrations…), 28.57% significant lower 31.43%(doses too low for the patient's condition, inappropriate dosage range…), 8.57% absence of error (clarification of the medical order, economic savings). Conclusions The impact of PI evaluated was mostly significant. Half of the PI had a significant or serious clinical relevance. The authors did not perform any action detrimental to the patient.

Background Pharmaceutical care(PC) is the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life. Purpose To analyse the results of a PC program in patients who are infected with the virus of hepatitis C(HCV). Materials and Methods Period of study: April 2007-October 2011. It was aimed to prevent, detect and resolve medication-related problems (MRPs) in HCV patients. Phases: First visit: Prescription validation, medical history revision and elaboration of patient medical record. The authors inform patients about adverse reactions, interactions and healthy lifestyle habits. The authors stress the importance of treatment compliance in order to obtain a sustained viral response and how to minimise the side effects. Subsequent visits: Personalised monitoring, detection of MRPs and Pharmaceutical Intervention (PI). The authors establish visiting hours and evaluate the adherence to the pharmacotheraphy. The adherence calculation is done through dispensing registers. The adherent patient endorses the rule 80/80/80:80% of interferon (IFN), ribavirin (RBV) doses and 80% of the treatment time in relation to the genotype. Results 542 interviews were done in 365 patients under IFN and RBV treatment: oral information 67.16% and both oral and written 32.84%. Face to face interviews 90.22% and telephone ones 9.41%. 27.86% to start the treatment, 69.74% during the treatment, 0.55% by treatment change, 1.66% possible interaction and others 0.18%. Counselling reasons (227), the most frequent were: tiredness 15.86%, mental disorders 11,89%, reaction at the injection site 8.81%, gastrointestinal discomfort 8.81%, pseudo-flu syndrome 8.37%, insomnia 6.61% and pruritus 6.61%. 536 PI were accepted, with recommendations about healthy lifestyle habits and some pieces of advice on medication administration and handling side effects. In 45 times, patients were referred to the specialist doctor. Conclusions The majority of the patients applied for PC during the pharmacotheraphy follow-up, above all, by side effects related to medication. The interviews with the patients reinforce the information on their pharmacotheraphy in order to minimise side effects and resolve MRPs. The PC program in HCV patients helps to improve the safe use of medications and avoids unnecessary visits to the specialist doctor.

Background A high proportion of the information about the patients' medication from the electronic health record contains some error. The importance of these errors has not been studied. Purpose To analyse the importance of the errors contained in the Electronic Health Record EHR relating to patients' usual medication. Materials and methods The information about medication contained in the EHR-D was analysed including all patients with surgical admission between February and November 2010. The errors taken into account were: medicine omitted (error by default), medicine added (error by excess) or medicine with incorrect dose/regimen. Important errors were considered the ones that affected to target medicines, that were: A) medicines with specific management in surgical patients, and B) medicines that have to be reconciled in the first 24 h of the admission in hospital. The proportion of patients with some errors was determined and the average number of errors, for both, general and important errors. Results 167 patients were included, whose EHR-D were found registered an average of 7.8 (CI 95% 7.1 to 8.5) medicines. The 79.6% (N=133) of the EHR-D contained some errors, being found an average of 4.2 (CI 95% 3.6 to 4.7) errors/patient. The distribution by type of error was: 2.8 (CI 95% 2.3 to 3.3) errors by excess, 0.4 (CI 95% 0.3 to 0.6) errors by default and 1, 0 (CI 95% 0.8 to 1.2) errors of incorrect dose/regimen medication. The importance of errors affected to the 62, 9% (N=105) of the histories, with an average of 2.3 (CI 95% 2.0 to 2.5) errors/patient, being 1.2 (CI 95% 1.0 to 1.5) by excess, 0.3 (CI 95% 0.2 to 0.4) by default and 1, 2 (CI 95% 1.0 to 1.5) by incorrect dose/regimen medication. Conclusions Eight out of ten EHR-D contain some error in their registrations of medication, and in six out of ten these errors are considered to be important. Half of the errors found are important ones. The information of the EHR-D should be verified before being used to carry out the reconciliation at the moment of the admission in hospital.