The occurrence of hypersensitivity reactions including rare but life‐threatening Stevens–Johnson syndrome (SJS) and drug‐induced hypersensitivity syndrome (HSS) limits the use of the anticonvulsant c...

Objectives: The aim of the study was to investigate the efficacy of intravenous (IV) smart pumps with drug libraries and dose error reduction system (DERS) to intercept programming errors entailing high risk for patients in an adult intensive care unit (ICU). Methods: A 2-year retrospective study was conducted in the adult ICU of the Hospital Juárez de México in Mexico City to evaluate the impact of IV smart pump/DERS (Hospira MedNet) technology implementation. We conducted a descriptive analysis of the reports generated by the system’s software from April 2014 through May 2016. Our study focused on the upper hard limit alerts and used the systems’ variance reports and IV Medication Harm Index methodology to determine the severity of the averted overdoses for medications with the highest number of edits. Results: The system monitored 124,229 infusion programs and averted on 36,942 deviations of the preset safe limits. Upper hard limit alerts accounted for 26.4% of pump reprogramming events. One hundred sixty-six significant administration errors were intercepted and prevented, and IV Medication Harm Index analysis identified 83 of them as highest-risk averted overdoses with insulin accounting for 51.8% of those. The rate of compliance with the safety software during the study period was 69.8%. Conclusions: Our study contributes additional evidence of the impact of IV smart pump/DERS technology. These pumps effectively intercepted severe infusion errors and significantly prevented adverse drug events related to dosing. Our results support the implementation of this technology in ICUs as a minimum safety standard and could help drive an IV infusion safety initiative in Mexico.

Mediante sus efluentes, los hospitales contribuyen a la ocurrencia de microcontaminantes emergentes como los fármacos, en el agua. Este trabajo cuantificó la presencia de nueve fármacos en las aguas residuales de tres hospitales privados de México con 66, 92 y 120 camas, respectivamente. Las muestras se caracterizaron fisicoquímicamente y, empleando cromatografía líquida de alta resolución acoplada a espectrometría de masas (UPLC-MS/MS), se reportaron las siguientes concentraciones máximas promedio: paracetamol (38740.11±33832.15 ng/L), naproxeno (6321.42±11074.86 ng/L), ketorolaco (1429.80±237.94 ng/L), ibuprofeno (249.46±143.68 ng/L), ranitidina (149.60±303.70 ng/L), hidrocortisona (96.72±57.21 ng/L), dexametasona (33.02±41.23 ng/L), esomeprazol (22.85±24.12 ng/L) y omeprazol (22.50±23.97 ng/L). En aguas tratadas se detectó una reducción del 67 al 100% en los niveles de hidrocortisona, naproxeno, paracetamol y ranitidina. Los resultados obtenidos informan la presencia de fármacos que no habían sido reportados previamente en efluentes hospitalarios mexicanos y demuestran el impacto de las plantas de tratamiento, contribuyendo a la evidencia existente para impulsar acciones de regulación, innovación tecnológica y monitoreo.

The purpose of this study was to assess prescription rationality and most common prescription errors at the primary care clinic of a Mexican university.A retrospective drug utilization review of indication-prescription type was carried out. A random sample of 370 medical records of patients assisted over a year period, were reviewed. Prescription appropriateness was evaluated according to the variables: indication, dosage regimen, administration route, contraindications, interactions, medication duplicity, unnecessary or missing medications. Prescriptions were rated as appropriate (no prescription errors found) or inappropriate (at least one prescription error found). The benefit-risk ratio was calculated for each prescription. This study revealed a 58% of inappropriate prescriptions in the Mexican primary care university clinic, mostly due to errors on dosage regimen and innapropiate drug selection. As a result of chi2 analysis, it was found that the pharmacotherapeutic variables chosen for the prescription assessment in this study, were determinant in prescription appropriateness rating. Nimesulide, ciprofloxacin, ranitidine, ketorolac and paracetamol were the most prescribed drugs as well as the most common cause of errors found. The prescription error rate revealed by this study addresses the need for strategies to improve prescription's quality. Introducing pharmacists as a key part of health care team is a mean proposed to prevent medication errors and to solve the urgency of pharmaceutical care implementation in all primary care facilities in Mexico. O objetivo deste trabalho foi avaliar a racionalidade das prescrições como também os erros mais comuns nas prescrições emitidas pelo Centro de Saúde de uma Universidade no México. Foi realizado um estudo retrospectivo de utilização de medicamentos que requeria prescrição médica. 370 expedientes médicos foram aleatoriamente selecionados e revisados, obtendo uma mostra estatísticamente representativa do total de consultas médicas realizadas no período de um ano. A validade da prescrição médica foi feita utilizando as seguintes variáveis: indicação, doses recomendada, via de administração, contra-indicações, interações, duplicação de medicamentos, medicamentos desnecessários ou faltantes. As prescrições médicas foram classificadas como: apropriada (se não foram encontrados erros nas prescrições) ou inapropriada (se foram encontradas ao menos um erro na prescrição). A razão risco-beneficio foi calculada para cada prescrição médica. O estudo revelou alta incidência de prescrições inapropriadas no Centro de Saúde da Universidade do México (58%), causada pelos erros nas doses recomendadas e na seleção do medicamento relacionado com a necessidade do paciente. Como resultado da análise chi2 , foi encontrado que as variáveis fármaco-terapêuticas escolhidas neste estudo para avaliar a prescrição médica, foram determinantes para classificar as prescrições como apropriadas. Nimesulide, ciprofloxacin, ranitidine, ketorolac e paracetamol representaram o maior número de medicamentos prescritos assim como a maior causa de erros encontradas nas prescrições. É importante que um farmacêutico valide os medicamentos prescritos no Centro de Saúde. Este estudo justifica o papel que os farmacêuticos mexicanos deveriam desempenhar para evitar erros na prescrição, como parte importante da equipe médica, assim como a urgência de implementar os cuidados farmacêuticos em todos os estabelecimentos dos Centros de Saúde no México

Purpose: Drug utilization research (DUR) contributes to inform policymaking and to strengthen health systems. The availability of data sources is the first step for conducting DUR. However, documents that systematize these data sources in Latin American (LatAm) countries are not known. We compiled the potential data sources for DUR in the LatAm region.Methods: A network of DUR experts from nine LatAm countries was assembled and experts conducted: (i) a website search of the government, academic, and private health institutions; (ii) screening of eligible data sources, and (iii) liaising with national experts in pharmacoepidemiology (via an online survey). The data sources were characterized by accessibility, geographic granularity, setting, sector of the data, sources and type of the data. Descriptive analyses were performed.Results: We identified 125 data sources for DUR in nine LatAm countries. Thirty‐eight (30%) of them were publicly and conveniently available; 89 (71%) were accessible with limitations, and 18 (14%) were not accessible or lacked clear rules for data access. From the 125 data sources, 76 (61%) were from the public sector only; 46 (37%) were from pharmacy records; 43 (34%) came from ambulatory settings and; 85 (68%) gave access to individual patient‐level data.Conclusions: Although multiple sources for DUR are available in LatAm countries, the accessibility is a major challenge. The procedures for accessing DUR data should be transparent, feasible, affordable, and protocol‐driven. This inventory could permit a comparison of drug utilization between countries identifying potential medication‐related problems that need further exploration.