Recombinant factor VIIa (rFVIIa) is a recently added new tool for the treatment of haemophilia patients with inhibitors. A major drawback in the use of rFVIIa is its short half-life, which necessitates frequent bolus injections. Thus the use of rFVIIa in continuous infusion appears to be a good alternative. We describe the use of rFVIIa, administered by continuous infusion with a minipump during the insertion of a central venous catheter in a child with a high-titre factor VIII inhibitor. rFVIIa was administered as an intravenous bolus (90 micrograms kg-1 [4.5 kIU kg-1]), 1 h prior to central line insertion, after which the continuous infusion was immediately started for 5 days. The infusion rate was based on the clearance obtained from a previous pharmacokinetic study. Effective haemostasis and normal healing of surgical incisions were achieved after central line insertion. No local thrombophlebitis nor evidence of generalized activation of the coagulation cascade was observed. Single-dose pharmacokinetic parameter values were clearance (Cl) 34.6 mL h-1 kg-1, volume of distribution (Vd) 40.6 mL kg-1 and mean residence time (MRT) 1.17 h. The recovery was 2.27% U-1 kg-1. rFVIIa showed a monophasic decay. Cl during continuous infusion was 23.4 +/- 6.9 mL h-1 kg-1. The administration of rFVIIa by continuous infusion is effective, safe and more convenient when compared to other clotting factors. Moreover, continuous infusion provides significant economic savings (77% decrease in rFVIIa requirements).

BackgroundThe literature reveals that approximately 20% of healthcare professionals fail to document drug allergies (DA) in the electronic records. Breakdowns in the documentation of allergies can lead to medicines errors (MEs).PurposeThe aims of this study were to examine patient DA profiles documented in the electronic records and to determine MEs associated with DAs.Material and methodsRetrospective observational study including all adult patients admitted to our hospital on February 24, 2014. Discharge prescriptions and patient DA profiles entered into the different (non-integrated) electronic records were reviewed.Results258 patients were included in the study. In all patients, a history of an allergic reaction to drugs or not was reported in at least one electronic record: 55% in the patient’s admission prescriptions, 60% in the nursing consumption form and 46.4% in the electronic prescription system. Nevertheless, only in 3% of the cases was it reported in all of the records. In 13.2% of the cases, there were discrepancies between different electronic records. DAs were recorded in 60 patients. The drugs most frequently involved were penicillin (50%) and metamizole (25%). 11 MEs were identified in which a drug was prescribed for a patient with a documented DA. In 6 cases the medicine didn’t reach the patient and was prevented by a pharmacist in four cases. In the other 5, the medicine reached the patients. Fortunately, there was no evidence of any reactions following the administration of the drugs.ConclusionThe existence of different non-integrated electronic records favours inadequately recorded DAs, discrepancies and MEs related to DA. Pharmacists can play an active role in getting adequate DA recording systems into hospitals and improving inpatient safety.References and/or acknowledgementsI thank Dra. Ana Pérez for helpful comments.No conflict of interest.

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