M Crespí Monjo

Hospital Universitari Son Espases, Palma, Balearic Islands, Spain

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Publications (14)6.07 Total impact

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    ABSTRACT: Medication errors lead to morbidity and mortality among emergency department (ED) patients. An inaccurate medication history is one of the underlying causes of these errors. This study was performed to determine the prevalence of patients with discrepancies between the medical list information contained in the clinical history compiled on admission to the ED and the list of medications patients are actually taking, to characterize the discrepancies found, and to analyze whether certain factors are associated with the risk of discrepancies. We conducted a cross-sectional, descriptive, observational, multicenter study with an analytic component in the EDs of 11 hospitals in Spain. We compared pharmacist-obtained medication lists (PML) with ED-obtained medication lists (EDML). Discrepancy was defined as one or more differences (in drug or dosage or route of administration) between the EDML and PML. The endpoints were the proportion of patients with discrepancies in their home medical lists, and the prevalence of certain factors among patients with discrepancies and those without. We detected 1476 discrepancies in 387 patients; no discrepancies were found in 20.7%. The most frequent discrepancies involved incomplete information (44.2%) and omission (41.8%). In the bivariate analysis, age, number of medications, and Charlson comorbidity score were significantly associated with discrepancy. In the multivariate analysis, number of medications and hospital were the variables associated with discrepancy. The EDML differed from the list of medications patients were actually taking in 79.3% of cases. Incomplete information and omission were the most frequent discrepancies. Age, number of medications, and comorbidities were related to the risk of discrepancies. Copyright © 2014 Elsevier Inc. All rights reserved.
    No preview · Article · Dec 2014 · Journal of Emergency Medicine
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    ABSTRACT: Objective: To analyze whether pharmacies in public health service hospitals in the Spanish autonomous community of the Balearic Islands are stocking sufficient amounts of poison antidotes. Methods: Descriptive cross-sectional study of public hospital pharmacy stocks of antidotes and other medicines for treating acute poisoning. The head of each hospital pharmacy completed a questionnaire about stocks. The results on which antidotes were in stock, the amounts, and the storage locations were assessed for compliance with recommended quality indicators for emergency care in acute poisonings (CALITOX-2006) and the Antidote Stocking Guidelines (ASG-2009). Results: The 7 hospitals met the CALITOX-2006 availability criteria for over 85% of items and the ASG-2009 criteria for 68%. Inadequate stocking mainly involved sodium sulfate, apomorphine, oral cyanide antidote kits, and crotaline snake antivenonn. An average of 83% of the stocks were adequate; pyridoxine was the substance most often found to be understocked. Activated charcoal and N-acetylcysteine were the items most often overstocked. Glucagon and fomepizole were understocked in the referral hospital. Over 80% of items were stored in appropriate locations in the emergency departments of level 1 hospitals (68% in level 2 hospitals; 94% in the referral hospital). Conclusions: Public health system hospitals are highly compliant with recommendations on stocking antidotes and other medicines to treat acute poisoning (what to stock, where, and in what amounts); the distribution of stocks safely guarantees they will be available when needed. Among level 2 hospitals, a facility's location (proximity to the best-equipped referral hospital for poisonings) had greater influence on compliance than the hospital's level of complexity.
    No preview · Article · Oct 2014 · Emergencias
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    Full-text · Article · Jun 2009 · Farmacia Hospitalaria
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    Full-text · Article · Apr 2008 · Farmacia Hospitalaria
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    ABSTRACT: The purpose of the reconciliation process is to ensure that patients receive all the necessary medication that they had been taking previously, unless a treatment has been modified or discontinued by the physician, making certain that the drugs are correctly prescribed in terms of dose, route and frequency, and that they are adjusted to the condition of the patient and to any new prescription issued in the hospital. The clinical history and interview, the prescription from the primary care center and that issued previously in the hospital are the sources of information required to initiate the process of medication reconciliation. This reconciliation should be carried out according to a standardized procedure and using a registry that enables the systematization of the process. There are a number of standardized formulas, applied in different hospitals, for medication reconciliation. The classification of the discrepancies in reconciliation and the evaluation of the seriousness of the errors, together with the oral or written communication of the reconciliation, should complete the process. The care-related activity of the hospital pharmacist should focus on a horizontal evaluation of drug treatment in the temporal context of the patient-preadmission, hospital stay, discharge-and not be limited exclusively to assessing the hospital treatment.
    No preview · Article · Dec 2006
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    ABSTRACT: Objetivo: Description of pharmaceutical care in an emergency department. Methods: Rotation of a 4th-year resident pharmacist in an emergency department from a third-level hospital for a 3-month period. Documentation and recording of pharmaceutical interventions (PI), reevaluation of such by another pharmacist and calculation of concordance rate. Quantification and classification of resolved consultations. Description of other performed activities. Results: After reviewing 242 patients, 149 pharmaceutical interventions were performed, being an average of 1 PI per every 1.3 patients. The efficiency index (intervened patients/total reviewed patients) was 47.9%. The largest percentage of PIs corresponded to a change in medication (43%), followed by a change in dosage, frequency, pathway or schedule (27.5%) and a complementation of medical orders (11.4%). Regarding PI's impact, 51% effected safety and 49% treatment efficiency. The acceptance of diverse PIs by the professional staff was 98%. The percentage of coincidence with PI reevaluation by another pharmacist was 95.3%. The main reasons for consultation were identification of pharmaceutical specialties, posology-related questions and side effects. Two protocols were created, and two sessions were imparted to the professional staff. Conclusions: The integration of a pharmacist in an emergency department facilitates the detection, prevention and resolution of drug-related problems for ambulatory or prescribed medication in an observation area. It helps in resolving consultations and creating protocols. Rotation in an emergency department as a part of a residency formation program allows for the combination of teaching and pharmaceutical intervention at hospital admision.
    No preview · Article · Nov 2006 · Atencion Farmaceutica
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    ABSTRACT: Objective: To evaluate compliance rate of fondaparinux conditions of use and indications established in our hospital. Method: Two observational studies were conducted a clinical indication study and an usage study. Clinical indication study included, prior surgical procedure, identification of candidates to fondaparinux treatment and their follow-up. Usage study involved a retrospective identification of patients treated with fondaparinux by unit-dose system and their fulfillment of established criteria. Results: In the clinical indication study, from 32 candidate patients 15 not fulfilled fondaparinux conditions of use. In the usage study, from 7 patients treated with fondaparinux two fulfilled established usage criteria and five not fulfilled the criteria related to the type of surgical intervention. Conclusions: Follow-up program showed that the consensus of fondaparinux use were not followed and therefore, after a drug reevaluation, we excluded this drug from the formulary.
    No preview · Article · Jan 2006
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    ABSTRACT: Electronic prescribing is considered a basic measure for the prevention and reduction of medications errors. The goal of this survey was to assess the incidence of errors occurring with electronic versus standard prescription. A prospective, sequential, open-label study to assess errors with electronic prescribing as compared to traditional manual prescribing in two public hospitals in Balearic Islands. Errors regarding medication, diet and/or nursing orders were assesses along four process stages: medical prescription, pharmacy transcription/validation, nursing transcription, and dispensation. With manual prescription 1,576 errors/18,539 therapy orders (8.50%) were identified, whereas with electronic prescription 827 errors/18,885 therapy orders (4.38%) were detected, which represents a relative risk reduction by 48% and an absolute risk reduction by 4.12% (p < 0.0001). Pharmacy transcription/validation errors decreased (1.73 vs. 0.13%, p < 0.0001), as did nursing transcription errors (2.54 vs. 0.81%, p < 0.0001) and dispensation errors (2.13 vs. 0.96%, p < 0.0001); however, the number of prescription errors increased (2.10 vs. 2.40%, p = 0.0401). Electronic prescription is a powerful tool, and one that in this work was shown to decrease medication-, diet-, and nursing care-related errors in a highly significant way; however, it should be developed and maintained in order to achieve safety and effectiveness as required by drug usage.
    No preview · Article · Jul 2005 · Farmacia Hospitalaria
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    ABSTRACT: A probable case of hypersensitivity reaction to Total Parenteral Nutrition (TPN) in a 55 years old patient diagnosed with gastric adenocarcinoma is presented. Onset of TPN infusion coincides with the time of the onset of a disseminated pruritic cutaneous eruption that repeats after a second exposure to nutrition. The likely causes of this hypersensitivity reaction are analyzed.
    No preview · Article · May 2005 · Nutricion hospitalaria: organo oficial de la Sociedad Espanola de Nutricion Parenteral y Enteral
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    ABSTRACT: Objective Electronic prescribing is considered a basic measure for the prevention and reduction of medications errors. The goal of this survey was to assess the incidence of errors occurring with electronic versus standard prescription. Method A prospective, sequential, open-label study to assess errors with electronic prescribing as compared to traditional manual prescribing in two public hospitals in Balearic Islands. Errors regarding medication, diet and/or nursing orders were assesses along four process stages: medical prescription, pharmacy transcription/ validation, nursing transcription, and dispensation. Results With manual prescription 1,576 errors/18,539 therapy orders (8.50%) were identified, whereas with electronic prescription 827 errors/18,885 therapy orders (4.38%) were detected, which represents a relative risk reduction by 48% and an absolute risk reduction by 4.12% (p < 0.0001). Pharmacy transcription/validation errors decreased (1.73 vs. 0.13%, p < 0.0001), as did nursing transcription errors (2.54 vs. 0.81%, p < 0.0001) and dispensation errors (2.13 vs. 0.96%, p < 0.0001); however, the number of prescription errors increased (2.10 vs. 2.40%, p = 0.0401). Conclusions Electronic prescription is a powerful tool, and one that in this work was shown to decrease medication-, diet-, and nursing care-related errors in a highly significant way; however, it should be developed and maintained in order to achieve safety and effectiveness as required by drug usage.
    Full-text · Article · Jan 2005
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    ABSTRACT: A probable case of hypersensitivity reaction to Total Parenteral Nutrition (TPN) in a 55 years old patient diagnosed with gastric adenocarcinoma is presented. Onset of TPN infusion coincides with the time of the onset of a disseminated pruritic cutaneous eruption that repeats after a second exposure to nutrition. The likely causes of this hypersensitivity reaction are analyzed.
    No preview · Article · Jan 2005 · Nutricion hospitalaria: organo oficial de la Sociedad Espanola de Nutricion Parenteral y Enteral
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    ABSTRACT: To assess the impact of pharmaceutical intervention on the use of sequential therapy (ST) with fluoroquinolones. A prospective comparative study of pharmaceutical intervention in two stages: observational stage and intervention stage for ST promotion. In all, 250 patients receiving intravenous therapy with fluoroquinolones (113 with levofloxacin and 137 with ciprofloxacin) were studied, with 76 and 70 patients, respectively, being eligible for a pharmaceutical intervention program to promote ST. Pharmaceutical intervention showed a decreased duration of intravenous therapy and increased duration of oral therapy for both drugs, as well as decreased medication-related costs, all in a statistically significant manner. ST promotion provides an opportunity to expand the role of hospital pharmacists and to optimize fluoroquinolone-based therapy, which results in decreased intravenous treatments and provides a more cost-effective option.
    No preview · Article · Nov 2004 · Farmacia Hospitalaria
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    ABSTRACT: To clinically assess effectiveness of therapeutic interchange from glibenclamide to gliclazide in the hospital setting. An open-label prospective, randomized study with two groups of patients: a reference group (patients still receiving their previous outpatient regimen of glibenclamide) and an interchange group (patients with gliclazide substituted for glibenclamide according to a hospital-approved interchange protocol). The efficacy endpoint used was blood glucose at 3 and 6 days post-intervention. A patient with blood glucose < 200 mg/L was considered clinically controlled, and blood glucose changes < or > 30 mg/dL were considered significant. One hundred and sixteen patients were randomized. Blood glucose on the day before the intervention was 177.9 mg/dL +/- 63.4 in the reference group versus 171.3 mg/dL +/- 52.1 in the interchange group (p = 0.92). Mean blood glucose during the first 3 days post-intervention was 156.1 mg/dL +/- 47.5 and 177.7 mg/dL +/- 36.0 (p = 0.14) in the reference and interchange groups, respectively; and mean values for the first 6 days post-intervention were 142.1 mg/dL +/- 36.0 and 172.8 mg/dL +/- 28.2, respectively (p = 0.01). The overall analysis of blood glucose levels showed a better control in the reference group versus baseline values, which was not seen in the interchange group, where blood glucose remained stable and similar to baseline. In no case were 3-day and 6-day blood glucose mean levels above 200 mg/dL, which may be considered acceptable within the hospital setting. Therapeutic interchange may be safely performed with no clinical impairment, but better controls were achieved in the reference group.
    No preview · Article · Nov 2004 · Farmacia Hospitalaria

  • No preview · Article · · Farmacia Hospitalaria