What to do if things go wrong: a guide for junior doctors

This National Patient Safety Agency's booklet is a guide for junior doctors to manage a patient safety incident.

It is organized in 6 sections.

First, a description of a personal experience of having a medical incident. Second, to document the incident in the patient’s medical records and to inform consultant and/or supervisor. Third, to communicate the incident to the patient, family and caregivers and apologise to all. Fourth, to report the incident in a local reporting system. Fifth, the guide enhance that junior doctors, on the frontline of care, are vital in the identification of learning from reporting. Finally, an algorithm is presented to deal with the complaints process in England.

Every section is introduced by an incident description from a relevant medical doctor in England.

It is easy to read and a good example to adapt in every country as a guide to promote good answers to incidents in practice for junior doctors.

Medical error. What to do if things go wrong: a guide for junior doctors


Posted by Pilar Astier
English version by Pilar Astier

Detection of potential interactions by the electronic medical record: A new approach to improve patient safety

The European Journal of General Practice has published the article: Prevalence and typology of potential drug interactions occurring in primary care patients. Authors: López-Picazo JJ, Ruiz JC, Sanchez JF, Ariza A, Aguilera B, Lazarus D, Sanz GR.

The objective of this article is to determine the prevalence and type of potential drug interactions in primary care patients.

It is very interesting because its content is directly related to medical errors and their consequences, adverse effects and drug interactions in primary care. This field has a huge impact on the global patient safety due to the high number of visits, the level of prescription and other factors such as pluripathology.

The authors start from the difficulty of identifying and confirming the actual prevalence of drug interactions, to propose a preventive approach. It is acting on potential drug interactions identified by the electronic medical records (and confirmed by prescription -recipes used-), according to the evidence available, and using software that identifies patients likely to suffer these potential interactions. All this would be completed by a warning system, related to the medical record, that, in real time, allows the family physician identify the potential interaction, and with the automatic proposal of safe therapeutic alternatives. Every active ingredient that each patient can be taking simultaneously is analyzed.

The study confirms the existence of a serious safety problem for patients, because 1 in 20 Spanish citizens is subject to the risk of drug interaction. And, more important, with a high rate of serious or high risk interactions.

At the time of analysis 29.4% of the population took medication. Of these patients, 73.9% took more than one drug and, therefore, was at risk of interactions; more than a half of the potential interactions could be clinically important. However, the percentage of interactions observed is usual in the literature.

There are more interactions among people with chronic conditions, the elderly, females and polymedicated patients. The active ingredients most frequently involved were hydrochlorothiazide, ibuprofen and acenocumarol. Respect to interactions that should be avoided, the most common are combinations with omeprazole, acenocumarol and diazepam.

This approach and the results of this study provide us valuable information and, most of all, a new simple and practical approach, which should not be wasted by the professionals or the institutions involved, for the benefit of our patients.


Edited by José Saura Llamas
English version by Erika Céspedes

MedlinePlus: Talking with your doctor

This website presents, in the section "Health News", some advices for patients to prepare for consultation with their doctors so the patient can participate actively in the care process.

The objective of these tips is the patient to reflect about the importance of his participation, from the position of a formed patient, in the healthcare process. The patient should organize information about his disease to be transmitted to the doctor during the visit. He must also raise the questions necessary to understand their disease: what is happening, what is the evolution and how will be the treatment and the follow-up. After the consultation the patient should not have doubts about the information transmitted by the doctor.

In the news you will find links to other documents of interest for patients, related to the medical consultation:

• Be an active member of your health care team (Food and Drug Administration)
• How to talk to your child's Doctor (Nemours Foundation)
• Tips for talking to your Doctor (American Academy of Family Physicians)

The column on the right contains links to topics of interest: Patient Safety, Patient Rights...


Posted by Lola Martín
English version by Erika Céspedes

The quality, security and content of telephone and face-to-face consultations: a comparative study

Telephone consulting is increasingly used to improve access to care and optimise resources. However, there remains a debate about how such consultations differ from face-to-face consultations in terms of content, quality and safety. To investigate this, a comparison of family doctors' telephone and face-to-face consultations was conducted.

106 audio-recordings, from 19 doctors in nine practices, of telephone and face-to-face consultations, stratified at doctor level, were compared using:

- The Roter Interaction Analysis Scale (RIAS), measuring the content

- The OPTION, that observes patient involvement in decision making

- A modified scale based on the Royal College of General Practitioners (RCGP) consultation assessment instrument, measuring quality and safety

- Patient satisfaction and training (empowerment) were measured using validated instruments.

Telephone consultations were shorter: 4.6 minutes, on average, compared to 9.7 minutes of the face-to-face ones.

The study concludes that although telephone consultations are convenient and judged satisfactory by patients and doctors, they may compromise patient safety more than face-to-face consultations and further research is required to elucidate this.

Telephone consultations are more suited to follow-up and management of chronic diseases than for acute management.

McKinstry B, Hammersley V, Burton C, Pinnock H, Elton R, Dowell J, et al. The quality, safety and content of telephone and face-to-face Consultations: a comparative study. Qual Saf Health Care. 2010 Aug; 19 (4) :298-303.


Posted by Lola Martín
English version by Erika Céspedes

Organisational readiness: exploring the preconditions for success in organisation-wide patient safety improvement programmes

Does any organization can implement a patient safety improvement programme?

What does it need to succeed? What results can be expected?

Quality and Safety in Health Care has published this original research outlining some answers.

UK researchers examined the perceptions of organizational readiness and its relation to the impact of the Safer Patients Initiative (SPI), a national initiative of the Health Foundation to address the patient safety improvement.

To learn about this perceptions they used a mixed-methods design, involving a survey and semistructured interviews with a sample of the improvement groups (consisting of senior executive leads, the principal SPI programme coordinator and the operational leads in each of the SPI clinical work areas) of the four organizations taking part in the first phase of SPI.

They obtained a response rate of 90% and 34 leaders participated in the interviews.

The questionnaire included items on perceptions of readiness in the following aspects:

1. Culture and attitudes toward quality and safety
2. Systems and infrastructure
3. Resource availability, measured on a scale from 1 (low preparation) to 6 (high preparation)

Further, it wondered about organizational stability, measured on a scale from 1 (stable) to 6 (turbulent).

It also asked for a specific score using a scale of 3 (significant strength) to -3 (significant weakness), of 15 factors such as financial resources, medical support, support from nurses, support from managers, etc.

The interviews contained open questions about the preconditions of the organization (culture, history of improvement, quality of information systems and measurement procedures, financial stability...) and the preparatory factors of the initiative (framework for program management, team's initial selection, clinician’s participation, communication and training before deployment...).

For the entire sample, culture and attitudes were better rated than systems and infrastructure and also than availability of resources. Everybody said that their previous history of improvement was important to take the initiative and all also experienced difficulties with the information and assessment systems’ capacity. The importance of the financial balance and the outcome was particularly important for executives.

With respect to specific factors, most were considered strengths but, while managers’ and nursing’s initial support was rated as good, medical initial support was rated worse (it was considered a weakness).

Personal interviews revealed that it is worth reflecting on the influence of the conditions at the beginning of the program. This reflection process gives the organization a valuable learning.

The highest score has the overall perception of preparation in an organization; the greatest impact presents the initiative on quality and security performance, greater sustainability of its benefits and greater success in its deployment in that organization, being leadership style an important factor in this preparation.

So this study, though preliminary, would suggest that prior to start these programmes, organizations would benefit from an assessment of their readiness with time spent in the preparation of its infrastructure, processes and culture. Furthermore, a better knowledge of these preconditions, that mark an organization as qualified to undertake the improvement work, would allow managers to set realistic expectations about the results of safety campaigns.

Burnett S, Benn J, Pinto A, Parand A, Iskander S, Vincent C. Organisational readiness: exploring the preconditions for success in organisation-wide patient safety improvement programmes. Qual Saf Health Care 2010;19:313-317


Posted by Marisa Torijano
English version by Erika Céspedes

Seminar of the Spanish Society of Preventive Medicine, Public Health and Hygiene: Patient safety, a shared commitment, a general interest

The next September 17 will take place in Alicante a Seminar of the Spanish Society of Preventive Medicine, Public Health and Hygiene (Sociedad Española de Medicina Preventiva, Salud Pública e Higiene), in which also participates the Spanish Society for Quality Healthcare (Sociedad Española de Calidad Asistencial, SECA) and the Spanish Association of Health Risks Management and Patient Safety (Asociación Española de Gestión de Riesgos Sanitarios y Seguridad del Paciente, AEGRIS).

Their slogan: "Patient safety, a shared commitment, a general interest”.

Some of the most committed to patient safety will participate, including our colleague Carlos Aibar, who manages a workshop.

It is useful to review the programme and participants and, if you can go, the registration is free, in order of application.


+Info on this web page


Posted by Safe and Healthy
English version by Erika Céspedes

3rd Seminar. Medication errors with vaccines: improving with the professionals

Problem description:

The objective of the 2009 program-contract in our area on medication errors reporting was to report at least 109 errors, which means a 5% of the expected in an area like ours.

The total in 2009 was 192 errors reported. The 26% of these was related to vaccine administration.

Analysis of causes:

A working group is formed with 12 professionals involved in immunization and motivated on patient safety: a pediatrician, nurses and immunization managers. Members of the risk unit of the area coordinate the group.

The group performs an analysis of causes of vaccine-reported errors.

Professionals: lack of training, unclear labeling, bad registration on patient's medical records, bad anamnesis, more than one professional to vaccinate a patient.

Organizational: lack of information in the admission of new professionals and substitutes, neither clear labels nor clear information on vaccine refrigerators, no registration of the vial opening date, failure to follow protocols and institutional advices.

Agents and resources: Errors in OMI drug list, frequent changes in laboratory supplier, multi-dose vaccines, different vaccines with similar labeling, prescribing information in other language, small print on the packaging.

Improvement actions:

Elaboration of an informative brochure and poster on the most common mistakes with vaccines.

The brochure will be given to new professionals and substitutes who will work with vaccines at their welcome, and there will be named a manager for this task in each facility.

The poster will be located in all offices at the primary care facility.

Rearrangement of vaccines in the refrigerator by age of administration.

Development of visible reminders in the refrigerator on the identification and proper placement of vaccines.

Results:

We improve the involvement of professionals in the security ambit.

A professional group makes improvement proposals, which will facilitate its acceptance.

We will assess the impact of these measures with the report of the errors with vaccines throughout 2010.

Presentation by María Dolores Martínez Patiño, UFGRS of the 5th Area of Madrid.

+ Info: http://seguridadpaciente.com/Jornadas10/comunicaciones/Resumen% 20030.pdf


Posted by Fernando Palacio
English version by Erika Céspedes

3rd Seminar. Involving professionals in patient safety

Cristina Cedrún of the Primary Care Area 5 of Madrid, presented the interventions undertaken to improve reporting of incidents.

These interventions achieved the declaration of a 76% above the proposed objective.

The information and involvement were again the key.

The authors are: Cedrún Lastra, C; Martínez Patiño, M.D; Piédrola Martínez, M.


+ Info: http://seguridadpaciente.com/Jornadas10/comunicaciones/Resumen% 20028.pdf

Several posts on reporting adverse events have been published in this blog. Those can be accessed by typing in the search box on the right column the word “notification”.


Posted by Fernando Palacio
English version by Erika Céspedes

3rd Seminar. A project to systematize the communication in drugs administration at emergency situations

The Primary Care Management of Talavera de la Reina presented many presentations at the Seminar. In this one, they comment a very important topic, the risk of error in drugs administration at emergency situations.

Raised the issue, they developed a protocol on this subject that was presented with a video in all healthcare facilities.

The main author is Belen de La Hija.


+ Info: http://seguridadpaciente.com/Jornadas10/comunicaciones/Resumen% 20014.pdf


Posted by Belen de La Hija and Fernando Palacio
English version by Erika Céspedes

A brief synopsis on Patient Safety, WHO/Europe 2010

A brief synopsis on Patient Safety, WHO/Europe 2010.

“This document provides a simplified and non-exhaustive synopsis of the major international patient safety initiatives – past and present – undertaken in the WHO European Region. While patient safety is a complex issue spanning numerous public health and health-care domains, this document adopts a generic understanding of the subject in respect to avoidable harm.

As such, most of the patient safety interventions chosen for this document have a general and cross-cutting character and do not include the many complementary and dedicated actions developed at various levels of the health system and beyond. Moreover, as patient safety is constantly developing better ways to respond to health, economic, social and environmental challenges, the document is to be seen as a 'snapshot' of the current state of affairs in the WHO European Region, and as a work in progress”.

We can find in this document contents related to taxonomy, legislation, initiatives and consensus on safety in the WHO European region, and the list of initiatives related to patient safety, arranged chronologically from 2004 until this moment.

+Info: A brief synopsis on Patient Safety, WHO/Europe 2010 (pdf file)


Posted by Lola Martín
English version by Erika Céspedes

Interview with Pilar Vicente García, nurse, member of the Spanish Association of Latex Allergy

Latex allergy, although currently very common, is still little known. According some studies, in Spain a 2% of the general population has developed it and in risk groups the number may reach a 15%. Once it appears, any area of a person’s life is involved because, where there is no latex?

We interviewed Pilar Vicente García, a member of the Spanish Association of Latex Allergy (Asociación Española de Alérgicos al Látex), and nurse.

S. & H.: Do you think that health professionals are sensitized or trained in this problem?

P.V.G.: Although the situation has improved in the last two or three years, much remains to be done. Nowadays there are many health professionals that do not know what to do when a latex allergic person arrives to their offices o divisions.

What aspects should be improved?

Basically, two things: information and training. It is a disease partially unknown for many health care professionals.

Could you give us some examples?

Well, one would be when a professional see us with elastic underclothes, and says: "Come on, you are allergic to latex and you wear latex elastic!". It is a very uncomfortable comment for the patient. The first thing you think is that they do not believe you are allergic to latex. Fortunately, patients are increasingly trained in patient safety. Then, as calmly as you can, you explain that there are clothes with synthetic materials elastics that do not harm us.

Another example would be the administration of a drug that comes in a glass vial and has a rubber plug; you instinctively ask "the plug is of natural latex?". Answers may be very different... "but I will not touch the plug" or "so I remove the plug and you're done". And there is an answer more and more frequent "I am going to ask, I will make sure". In the first two cases the patient has to explain that the liquid may contain latex proteins and, even though you remove the plug or not touch it, it can cause a reaction. So what occurs is an estrangement between the professional and the patient that does not benefit either party. The third answer may start a rapport with the professional who shows more interest for the problem and investigates whether the plug is natural or synthetic latex. This situation really benefits both parts.

Another situation that causes surprise is when you explain that there are foods that, having proteins similar to those of natural latex, can cause reactions similar to those caused by latex itself. This is what we call “latex-fruit syndrome", since tropical fruits are the most concerned: kiwi, pineapple, banana... but also tomatoes, oranges, melons...

So, no latex-allergic people can eat these foods?

No, according to reports only the 50% of those latex-allergic people develop the “latex-fruit syndrome", and not to all fruits, but the truth is that when the reaction to any of these foods appears, the list often starts to grow.

In addition to training and information, as you mentioned at the beginning, what could be done to improve the situation?

We think that it would be desirable that health care professionals invite patients to their meetings, seminars, etc. and give them the opportunity to explain their day-to-day routine, the obstacles they have to overcome because of their latex allergy, their feelings in relation to health care situations. It is not about confronting or criticizing; it is about intercommunicating and listening to each other, it is about gradually changing the current culture.

Patients know that health care professionals and we have a common goal, our safety, patient safety. Strangely we both walk toward that goal but in parallel and with and askance look, and so, we will never meet. We must learn to walk together, side by side.

What would you emphasize of the actions of your organization, the Spanish Association of Latex Allergy?

The spread of the disease has been very important. We have carried out a number of seminars in different regions specifically directed at health professionals, many of which had recognized health interest. Accurate information has been given to all patients allergic to latex. We have conducted studies in which realization we had always the support of the Ministry of Health and Social Policy, the professionals from different disciplines such as chemists, engineers, biochemists, dermatologists, allergists, etc. and the different areas such as universities, hospitals, nursing schools, research centres in biotechnology, etc.

You may see all this on the Association’s website, www.alergialatex.com. The studies mentioned can be downloaded for free from the Web.

Thank you very much for thinking of us and giving the latex-allergic people the opportunity of being present in the Safe and Healthy blog, which is very interesting.

Thank you very much for your attention.


Interview by Clara Formoso for Safe and Healthy
English version by Erika Céspedes

3rd Seminar. Design and implementation of a protocol on users’ unequivocal identification in primary care

The topic of the unequivocal identification of patients was also present at the Seminar, through this presentation of the Guadalquivir Sanitary District, Córdoba. The authors are Hervás Vargas, A. and Gutierrez Sequera, J.L., who summarize their work thus:

Problem Description: In the provision of health care, the identification of patients involves risks that may result in misdiagnosis, testing, surgery or giving medications or blood products to wrong patients.

Proposal for improvement: The Strategy for Patient Safety of the Andalusian Autonomous Government includes among its objectives the unequivocal identification of citizens that contact with the Andalusian Public Health System and says explicitly that all citizens treated in primary care must be unequivocally identified by at least two data, one of them, the Unique Andalusian Health Record Number (NUHSA). Therefore, we have developed a protocol which aims to establish a policy for secure identification of patients that lets identify reliably the patient as the person to whom the treatment, care or service is focused and, in turn, relate the treatment, care or services with that patient.

Strategy: The scope of our work covers all health services that integrate the eight Clinical Management Units of our Health District: primary care centres, emergency departments, domiciliary care, critical care units, minor surgery, etc., and so to all health and non health professionals who have direct care contact at any time with the patient.

The following tools will be used for diffusion:
1. Sessions/Workshops for health and non health professionals.
2. Brochure for the Citizen Advice Service Professionals.
3. Publication of the document on safety and unequivocal identification of patients in local magazines, aimed at citizens.
4. Publication of the document on safety and unequivocal identification of patients, aimed at professionals in newsletters.

+ Info: http://seguridadpaciente.com/Jornadas10/comunicaciones/Resumen% 20020.pdf


Posted by Fernando Palacio
English version by Erika Céspedes

Time to listen: a review of the methods to solicit patient reports of adverse events

As patient participation is a relatively new addition to patient safety reporting systems, the techniques that are most successful and efficient are not yet known.

The journal Quality & Safety in Heath Care has published this literature review on reporting systems used by patients: populations, contact methods, verification, reporting, incentives, incident rates and reporting terminology.

Two databases were searched: PubMed and MEDLINE (English publications only), obtaining finally 17 publications for review. Of these publications, four focused on Primary Care (PC), and one included both primary and hospital care.

PC patient reporting studies used a combination of methods to collect patient reports: telephone recruitment with a follow up in-person interview, patient’s choice of reporting method (online, written or telephone reporting) and telephone survey. The terminology used to ask the patient about the events has also been variable.

Adverse events were corroborated only in three publications, none of PC. The incidence of nosocomial infections, pressure ulcers and drug-related events reported by patients was shown to be comparable to rates documented by healthcare providers in hospitals and to rates reported in patient safety literature.

The incidence rate for adverse events across settings and populations varied considerably, ranging from less than 0.1 to 5.8 per patient. The results are not comparable. The same happens with the classification of reports.

Thus, the variability found among the publications reviewed is extensive in terms of healthcare settings, method of reporting, time span, terminology, criteria for assessment and response rates, which makes establishing definitive conclusions impossible. It seems that higher response rates are achieved with open questions and solicitation techniques based exclusively on personal experiences by interview. Further research is required to determine the optimal language, method, format and tool for patient reporting. The utility of the incentives should also be studied.

In short, the participation of patients in reporting adverse events is a very interesting field, which represents a valuable new perspective to improve their security, but is soon to offer final conclusions. Further research is required to reach its implementation and to achieve its potential benefits.


A King, J Daniels, J Lim, et al. Time to listen: a review of Methods to request patient reports of adverse events. Qual Saf Health Care 2010 19: 148-157


Posted by Marisa Torijano
English version by Erika Céspedes

3rd Seminar. Safe practices presented by the Functional Unit of Health Risks Management, 4th Area of Madrid

The Functional Unit of Health Risks Management of the 4th Area of Madrid presented the safe practices identified in the last four years.

They define a safe practice as "an action, according to the evidence and knowledge available, to avoid or reduce health risks or adverse effects. It may respond to a particular health care situation or may be useful and/or generalizable to other facilities because of their potential impact on patient safety, frequency or importance. "

In their presentation there is a list of safe practices that are widespread. It is a very interesting list for those who want to implement them in their area of influence.

The authors are Asunción Cañada Dorado, Inmaculada García Ferradal, Carmen García Cubero, Sergio Serrablo Requejo, María Antonia Sánchez Márquez y María José Montero Fernández.

+ Info: http://www.seguridadpaciente.com/Jornadas10/comunicaciones/Resumen% 20059.pdf

See also in this blog: Entrevista a Asunción Cañada a propósito de las Unidades Funcionales de Gestión de Riesgos Sanitarios (Interview with Asunción Cañada about the Functional Units of Health Risks Management)


Posted by Fernando Palacio
English version by Erika Céspedes

Atención Primaria Editorial: semFYC adapts the WHO recommendations on hand hygiene for Primary Care

The journal Atención Primaria publishes in its last number an editorial with the title: La Sociedad Española de Medicina Familiar y Comunitaria adapta las recomendaciones sobre higiene de las manos de la Organización Mundial de la Salud para atención primaria (The Spanish Society of Family and Community Medicine adapts the World Health Organization recommendations on hand hygiene for Primary Care).

The editorial is about why and how the semFYC’s Patient Safety Group, which manages this blog, made recommendations on that subject as well as a summary of its contents.

The full text of the Recommendations on hand hygiene for Primary Health Care workers and for Health Services in Spain can be downloaded here (html) and here (pdf)


Palacio J, Aibar C, Marec R. La Sociedad Española de Medicina Familiar y Comunitaria adapta las recomendaciones sobre higiene de las manos de la Organización Mundial de la Salud para atención primaria (The Spanish Society of Family and Community Medicine recommendations on adapting the hand hygiene of the World Health Organization for Primary Care). Aten Primaria. 2010; 42:401-2.


Posted by Safe and Healthy
English version by Erika Céspedes

The Ministry of Health and Social Policy has posted on the network the presentations of the 5th Conference

Our readers will remember that the last June 3 and 4 was held in Madrid the 5th International Conference on Patient Safety, which has already been reviewed in this blog.

The Spanish Ministry of Health and Social Policy has posted on its Patient Safety Web Site, the presentations of that conference.

It is also an opportunity to visit -for those who have not yet done it- the specific Patient Safety Web which provides interesting and important contents.

Posted by Fernando Palacio
English version by Erika Céspedes

Manual of Patient Safety for nursing

Nurses play a vital role in improving the safety and quality of patient care, not only in health care facilities but also community-based care and the care performed by family members. That is why we echo a publication of 2008 of the Agency for Healthcare Research and Quality (AHQR) that may be useful for nurses to select techniques and interventions with proven effecacy.

The publication of 1 400 pages, is titled Patient Safety and Quality: An Evidence-Based Handbook for Nurses.

It is structured in the following sections:

- Patient Safety and Quality
- Evidence-Based Practice
- Patient-Centered Care
- Work Conditions and Work Environment
- Critical Opportunities for Patient Safety and Quality
- Tools

It is a complete, clear, scientific and practical book.

Hughes RG (ed.). Patient safety and quality: An evidence-based handbook for nurses. (Prepared with support from the Robert Wood Johnson Foundation). AHRQ Publication No. 08-0043. Rockville, MD: Agency for Healthcare Research and Quality, March 2008.


Contribution by Jesús Moreno, a nurse. Entrimo Health Center (Terrachan), Spain.
English version by Erika Céspedes

The effects of on-screen, point of care computer reminders on processes and outcomes of care

A Cochrane review on on-screen computer reminders delivered to health professionals at the point of care, concludes that those ones produce only small to moderate improvements in both process and outcome of care.

Computer reminders are intended to help health care professionals to recall information that they may already know, but could forget easily when doing other activities of care. They also serve to support decisions, provide information or guidance in an accessible format at a particularly relevant. These reminders are able to address multiple topics, are automatic and come at the right time of care.

This Cochrane review found 28 studies that evaluated the effects of different on-screen reminders. The studies tested reminders to prescribe specific drugs, to warn about drug interactions, to provide vaccinations or to order tests.

The review found small to moderate benefits, that is, these reminders improved medical practice in a small percentage by measuring the results against the percentage of patients receiving care according to the reminder given to the professional (e.g. specific medication prescription, performance of a specific task such as sending to a medical specialist, etc.).

They also studied continuous process outcomes, for example, duration of treatment with antibiotics and various markers of disease or health status (e.g., mean blood pressure or cholesterol level). However, the results of improvement patients’ health also achieved small benefits.


Shojania KG, Jennings A, Mayhew A, Ramsay CR, Eccles MP, Grimshaw J. The effects of on-screen, point of care computer reminders on processes and outcomes of care.. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD001096. DOI: 10.1002/14651858.CD001096.pub2


See also in this blog: ¿Se cancelan las alertas sobre medicamentos en la prescripción electrónica?


Posted by Guadalupe Olivera
English version by Erika Céspedes

Pharmacotherapeutic follow-up DaderWeb

The journal Atención Primaria have published the overall results during the first year of initiation and piloting a new Primary Care database accessible from DaderWeb.

This web application arises from the need to optimize all data related to the program Dáder. The program was designed by the Research Group on Pharmaceutical Care, University of Granada, in 1999, and is currently being used in different countries by hundreds of pharmaceutical professionals in thousands of patients. It is based on obtaining the patient's pharmaceutical record in the community pharmacy and the personal pharmaceutical monitoring (SFT) by detecting, preventing and resolving drug-related problems on a continuous, systematic and documented way. It cooperates with the patient and all professionals of the Health System, in order to achieve concrete results that improve the quality of life of patients.

This first year of initiation and piloting is aimed to improve the organization of the information provided, to avoid loss of it, to optimize the processing of data and, ultimately, to enhance the quality of the information stored in it by:

a) Preparation of records and collection of information about its activity,

b) Location and access to updated information and quality,

c) Communication between professionals.

Among the registration documents available in DaderWeb we distinguish the pharmaceutical intervention sheet (HIF), which refer to a possible pharmaceutical care across countries and fields on the detection and intervention on negative results associated with the use of drugs (RNM).

Among their findings, only in the field of primary care in Spain, 234 HIF sent (a RNM for HIF) by 27 community pharmacies, 147 patients involved, with a mean age of 66 years (SD 11.8) and 59.4% of women. The 88.5% of the RNM was clinically manifested when detected.

The most frequent RNM were related to the ineffectiveness of drug therapy, supporting the need for closer monitoring of clinical outcomes of medications.

As most prevalent causes of failure were identified the neglect (17.9%) and the not appropriate dose, regime or duration of treatment (13.7%). In the 16% of cases they did not identify any cause and in a 36.9%, although there was a problem in the application process, it was not specify in the default list provided by the HIF3.

In the 35.9% of cases the pharmacist intervened independently through direct patient education to resolve the RNM. After measuring the appropriate clinical variables indicating, in each case, the development of RNM, these were resolved in the 81.2% of the times.

To systematize the SFT has made great strides thanks to the Dáder program. The evaluation of the quality of the prescription allows to detect any differences, points of improvement and to develop and design appropriate interventions to optimize outcomes in the health field. The Dáder, certainly, is a huge step that should appeal to all community pharmacists in improving the SFT and to build on its steps.

Sabater-Hernández D, Faus D, Fikri-Benbrahim N, García-Cárdenas V. Resultados globales de la base de datos del Programa Dáder de Seguimiento Farmacoterapéutico: 2008. Aten Primaria. 2010;42:297-8.


Contribution by M ª José Montero Fernández. Primary Care Pharmaceutical, Area 4, Madrid.
English version by Jesús Moreno

Held the First Congress of the Health Blogosphere

As announced on this blog, last Monday June 14 was held in Madrid the 1st Congress of the Health Blogosphere.

We presented there our blog Safe and Healthy. The presentation can be downloaded here. It is a summary on what it is and what can be found in safeandhealthypatient.org (the English version of sanoysalvo.es).

The conference was a success of participation and contents, that is why we must thank the organizers.


Posted by Jesús Palacio
English version by Jesús Moreno