BackgroundPIs add quality and safety to the drug treatment process, through records and their subsequent assessment.PurposeTo analyse the PIs made during the process of validating e-prescriptions at a regional hospital.Material and methodsA prospective, observational study of PIs made between August 2011 and August 2014 during the process of validating e-prescriptions by a software application (Silicon), in line with the adaption to Spain of the medication errors classification system of the National Coordinating Council for Medication Error Reporting and Prevention. The sections analysed were: wrong medicine, dose omission, incorrect dose, length of treatment, inadequate monitoring and other errors that included therapeutic duplication and exchange, the frequency, speed, route and technique of administration, preparation/handling and/or conditioning, and pharmaceutical method.Results413 PIs were recorded: 16.5% medicines errors (22% inappropriate/wrong drug for treatment intended), 8.8% dose omission (80% without a prescription stating the medicine required), 26.3% incorrect dose (59.6% dose higher than stipulated), 3.9% length of treatment (69% longer than necessary), 21% inadequate monitoring (94.1% no clinical review) and 24% other errors (30% frequency of administrative error). 52.8% of the PIs were for women. Average age: 65.8. Service areas: 38% internal medicine, 14.5% orthopaedic, 12% general surgery, 10.7% infectious diseases, 7.4% respiratory, 5.5% digestion, other areas with fewer occurrences. Medicines: n = 107 home treatment, n = 19 acenocoumarol, n = 11 serum therapy, n = 13 omeprazole, n = 8 amoxicillin/clavulanic and digoxin, n = 7 furosemide, n = 6 amlodipine and n = 5 metamizole and amphotericin B liposomal.ConclusionThe results show that home treatment accounted for most PIs, which has led to the development of a medicines reconciliation project. Acenocoumarol (high risk drug according to the Institute for Safe Medication Practices) was the drug that generated most PIs, and incorrect dose was the most frequent error. The PI analysis quantified and provided information on the medicines that required intervention, in order to minimise drug-related administration errors.ReferenceNo conflict of interest.

BackgroundThe development of new direct acting antivirals (DAAs) for hepatitis C virus (HCV) represents an evolution in the treatment. As HIV-HCV coinfection is common, evaluation of DAAs’ effectiveness and drug interactions with antiretroviral therapy (ART) is useful in this population.PurposeTo assess the effectiveness of DAAs and drug interactions with ART in HIV/HCV-coinfected patients.Material and methodsRetrospective observational study, including HIV/HCV-coinfected patients who started DAAs (August 2015 to August 2017).Data were obtained from outpatient software, electronic health records or interview with patients.Effectiveness was assessed by achievement of virological response (week 4 of treatment, end of treatment and post-treatment week 12).Interactions between DAAs and ART were evaluated by using the University of Liverpool Drug Interaction database.ResultsSixty-six HIV/HCV-coinfected patients (21.2% females), mean age 50.1 years (40–57; SD 3.9). HCV genotype distribution: 1a (40.9%), 4 (22.7%), 3 (18.2%), 1b (16.7%) and 2 (1.5%). 37.9% had cirrhosis and 15.2% were pretreated HCV patients. Median baseline HCV viral load was 1,942,570 IU/mL.DAA regimens were mostly sofosbuvir/ledipasvir (63.6%), daclatasvir +sofosbuvir (19.7%) and ombitasvir/paritaprevir/ritonavir+dasabuvir (10.6%). Length of HCV treatment was 12 weeks in 89.4%.Before starting DAAs, patients were receiving ART, being triple-drug in 66.7%. Most common ART was: NRTI/NtRTI+NRTI/NtRTI+boosted PI (30.3%), NRTI/NtRTI+NRTI/NtRTI+NNRTI (13.6%), NRTI/NtRTI+NRTI/NtRTI+integrase inhibitor (12.1%), boosted PI (10.6%) and NRTI/NtRTI+boosted PI (9.1%).Thirty-nine potential interactions and five contraindications between DAAs and ART were identified, mostly only required monitoring. In 12 cases, the prescription of DAAs supposed a modification in ART and in one case a dose adjustment for the DAA.At the analysis date, 58 patients had finished treatment, three were still receiving DAAs and five had discontinued it. 63.6% had a rapid virological response (undetectable serum HCV RNA level at week 4 of treatment). Regarding patients who completed DAA regimens, 92.1% had undetectable viral load at the end of treatment. Of 54 patients who had reached post-treatment week 12, 50 had sustained virological response, two presented detectable viral load (resistance mutations were found) and two had missed data.ConclusionDAAs have shown a high effectiveness in HIV/HCV co-infected patients. In this population, an appropriate revision and management of drug interactions with ART is essential.No conflict of interest

Conclusion and relevance Almost half of citizens and physicians currently disagree with vaccination in pharmacies in the Czech Republic. The physicians' main concern is the inability of pharmacists to deal with adverse drug reactions. For citizens, the major disadvantage is locating PBV in a pharmacy.

BackgroundThe incidence of tetanus in Spain is one of the highest in the developed world, especially among men over 60 years of age in rural areas. Tetanus is a notifiable disease. Vaccine rejection can lead to serious illness; some 50 cases are recorded yearly in this country.PurposeCost-benefit analysis associated with caring for a patient who has rejected voluntary vaccination when reporting a dirty wound.Material and methodsAn 82-year-old man reported to the emergency department with an incised wound on the side of his left hand which he had carried for 15 days from a rabbit scratch; he had received no anti-tetanus prophylaxis due to voluntary rejection of vaccination. The patient was admitted from 14 April 2015 to 1 July 2015. On arrival in the intensive care unit (ICU), the patient presented II/III grade tetanus (difficulty in swallowing liquids and solids, sardonic laugh, increased muscle tone in the phalanges of the left hand). Economic calculations were based on APD for medication management, data from the Clinical Management and Documentation Unit and Silicon for electronic prescriptions, and Web Reporting for Pyxis data trials.ResultsThe patient spent 79 days in hospital: 65 in ICU and 14 in the infectious diseases unit (IDU). The cost amounted to 121 225€ (ICU) and 28 448€ (IDU). Pharmacological treatment cost 8938€ (ICU) and 228€ (IDU), including tetanus specific drugs such as midazolam, cisatracurium and pralidoxime. Once diagnosed with tetanus, the patient was given the tetanus vaccine with gamma globulin (15.24€).ConclusionTotal cost: 149 673€, against 15.24€ for preventive vaccine with gamma globulin. Vaccination compliance, including top-ups every 10 years, or complete vaccination at the moment of the accident, would have drastically reduced the risk of contracting tetanus. Evidently, vaccination schedule must be strictly adhered to, even in adulthood, and primary care services must stress the social and economic importance of repeat vaccinations.References and/or AcknowledgementsTétanos. Mariscal Sistiaga F, Galván Guijo B, Palma Gámiz A. Medicina Crítica Práctica. Patología Nueromuscular que cursa con alteraciones respiratorias. 2004. ISBN: 84-7877-349-5Guía de Vacunas. Consejo General de Colegios Oficiales de Farmacéuticos, 2009No conflict of interest.

BackgroundThe hospital pharmacist is responsible for guaranteeing drug safety and efficacy. In 2008, the pharmacy service drew up recommendations for the use of multidose drugs (MD) which, once opened, require proper storage conditions.PurposeTo analyse the storage and conservation of multidose pharmaceutical specialties such as oral or rectal solutions, suspensions and effervescent tablets in nursing units, including intensive care units (ICU) and emergencies, in order to eliminate improper practices and propose better usage.Material and methodsA cross sectional observational study was performed in the hospital`s nursing units in September 2015. An Excel data gathering sheet was designed to include the name and number of the specialities found, number of MD opened, closed, with no written opening date or conservation conditions, prescribed in the electronic prescription programme and other observations.ResultsGlobal analysis: MD found, 118; 2 closed and not expired; 115 opened, with no recorded opening date, expiry date or conservation conditions; and 1 opened with expiry date. Detailed analysis: we designed a quality indicator for multidose drug use (QIMD)). QIMD=number of prescribed specialities/multidose drugs found × 100. Specialty unit: internal medicine 3, QIMD=10.5%; surgery, QIMD=20%; internal medicine 4, QIMD= 5%; orthopaedic surgery, QIMD=17.6%; internal medicine 5, QIMD=25%; digestion, QIMD=10.7%; infectious diseases, QIMD=16%: ICU, QIMD=0%; emergencies, QIMD=100%.ConclusionWe found that 97.5% of MD had been opened with no opening date recorded, which undermines the quality of the pharmaceutical specialty. In addition, 17% of multidose specialties were prescribed. Based on the results, we make three proposals: (1) strengthen the 2008 recommendations by formulating a protocol for handling MD; (2) inform and train nurses to comply with the protocol and (3) design a manual for MD usage and a leaflet on the stability of multidose pharmaceutical specialties.References and/or Acknowledgements No conflict of interest.