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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Medicine in the twenty-first century cannot be understood without drugs&#58; without them there is no cure&#44; and with them we have to confront prescribing errors and adverse drug reactions&#46; In 2005 the Spanish government instigated the National Study of Adverse Effects &#40;ENEAS&#41; connected with hospitalisation&#46; It showed that almost 10&#37; of the patients admitted to hospital suffered an iatrogenic adverse effect&#44; and that almost 30&#37; of these were caused by medication&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In 2007 the United States Institute of Medicine published a report entitled &#8220;Preventing Medication Errors&#8221;&#44; emphasising that at least 1&#46;5 million preventable adverse events occur per year in that country&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">There is no standard&#44; internationally accepted definition of what constitutes a medication error&#46; It is therefore difficult to analyse the various studies published on the subject&#46; Moreover&#44; since it is not clear what ought to be communicated&#44; we are dealing with a phenomenon in which what is reported falls far short of its true proportions&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Among the many existing descriptions&#44; there are three outstanding concepts that help us to understand the nature of medication errors and are constantly repeated&#58; errors are preventable&#44; they are not always harmful&#44; and their origins are multifactoral and multidisciplinary&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> But these concepts do not solve the practical issues that the problem raises&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">When a possible medication error arises&#44; most health care professionals do not know the medico-legal consequences of notification&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> If no harm has been done&#44; why report it&#63; And if it has&#8230; &#8220;what is not written down does not exist&#8221;&#46; Worse still&#44; doctors who do decide to report errors enter a demoralising bureaucratic maze in which they do not know how&#44; where or to whom they should address themselves&#46; It is likely that their efforts will have no effect&#46; This closes the vicious circle&#46; Because medication errors are hardly ever reported&#44; we do not know the real extent of the problem&#46; And yet any doctor knows that medication errors can be fatal&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Errors in paediatrics&#58; more frequent and dangerous</span><p id="par0025" class="elsevierStylePara elsevierViewall">In paediatrics it is even more important to analyse safety in drug administration&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Because of the need to calculate dosage on the basis of weight&#44; age or body surface area&#44; and pharmacokinetic and pharmacodynamic differences compared to adults&#44; children are particularly vulnerable to medication errors&#44; and the associated morbidity is potentially greater&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In addition&#44; drugs are commonly used off-label&#46; In a recent survey<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> by the AEP&#39;s Comit&#233; de Medicamentos &#40;Drugs Committee&#41;&#44; 23&#37; of the paediatricians polled were unaware of the existence of this practice&#44; and almost 50&#37; did not know when they used it or reported that they never prescribed drugs off-label&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">An additional problem is the lack of specialised pharmaceutical products properly adapted to paediatric needs&#44; which very often forces doctors to resort to a magistral formula&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Equally serious is the fact that there are currently over 170 drugs of various kinds that are temporarily or permanently out of supply&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> at least 10&#37; of which are paediatric formulations&#46; These shortages oblige paediatricians to work out ways to replace one drug with another or to administer them by routes that have not been adequately tested&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Errors&#58; inevitable&#44; but preventable</span><p id="par0045" class="elsevierStylePara elsevierViewall">All the projects that have helped to bring about an increase in the reporting of medication errors&#44; and a subsequent reduction in such errors&#44; involve similar initiatives&#44; based fundamentally on creating and fostering a culture of drug safety and providing new working tools&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">These initiatives include multidisciplinary safety committees&#44; training courses for all health care staff to raise awareness of drug prescription and administration rules&#44; confidential&#44; anonymous and non-punitive reporting systems&#44; user-friendly forms enabling errors to be communicated rapidly &#40;computer applications&#44; for example&#41;&#44; and designing drug administration manuals and protocols&#46; It is also advisable for prescription forms to be double- or triple-checked &#40;for example&#44; by paediatricians&#44; nurses and pharmacists&#41;&#44; especially with drugs that involve a higher risk of causing serious harm in the event of an error&#44; such as opiates&#44; cytostatic drugs&#44; insulins&#44; anaesthetics&#44; antibiotics and even minor analgesics like acetaminophen&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Computerisation of prescription and administration forms is also recommended&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Medication errors are inevitable&#59; they cannot be completely eradicated&#46; However&#44; they are preventable&#44; and their number and impact can be reduced&#46; It is much the same as with hospital-acquired infections&#46; Just as we sterilise our hands and operating theatres&#44; so is our duty as paediatricians&#44; and as doctors&#44; to have a restless neuron somewhere in our brain that is constantly on the alert&#44; forcing us to check what we prescribe at least twice&#46; And if we do commit or detect an error&#44; to report it&#44; analyse the consequences&#44; examine the causes that led to it&#44; correct them and prevent the same mistake happening again in the near future&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The fact that an error has not led to any consequences does not mean that the next one may not do so&#46; In order for voluntary reporting to work&#44; it is essential that it should be anonymous and that the responsibility in serious or fatal cases should lie with the management and not with one particular professional&#44; since errors are rarely the result of a single person&#39;s carelessness or recklessness&#46; The idea is not that individuals should be immune from blame but that responsibility should be shared&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">However&#44; conscious reporting by doctors is not enough&#46; It is essential to ensure that parents properly understand all the oral and written information they receive&#46; For example&#44; there is no reason why the whole population should know that a &#8220;cc&#8221; is the same as an &#8220;mL&#8221; or understand what the little lines marked on a syringe mean&#46; The patient information leaflet&#44; which even doctors themselves sometimes find difficult to decipher&#44; is not much help&#46; It is not unusual for a paediatrician to have prescribed by weight whilst the leaflet indicates the dose by age&#46; These are aspects of doctor&#8211;patient communication that certainly need to be reviewed&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In addition&#44; multidisciplinary safety committees should be set up in all hospitals and health centres to control&#44; monitor&#44; detect&#44; report and correct medication errors&#46; An essential requirement is to have integrated computer programs containing the patient&#39;s clinical history that automatically alert prescribing paediatricians to drug interactions&#44; unnecessary treatments&#44; allergies&#44; contraindications and inappropriate dosages&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">&#8220;Everybody makes mistakes&#46; The art is in making them when nobody&#39;s looking&#46;&#8221; This quotation&#44; by the actor&#44; writer and playwright Peter Ustinov&#44; sums up perfectly the situation we have to change&#46; The aim is precisely that if we do commit an error&#44; someone should be looking&#44; and that if no one is looking&#44; we should follow Benjamin Franklin&#39;s advice&#58; &#8220;only the righteous man is able to confess his faults and admit mistakes&#46;&#8221; Or better still&#44; Joseph Pulitzer&#39;s regime&#58; &#8220;We do not tolerate mistakes here&#44; and when we discover them we do not rest until we have corrected them&#46;&#8221;</p><p id="par0080" class="elsevierStylePara elsevierViewall">If we had accurate data on the impact of medication errors in paediatrics&#44; they would probably be at least equivalent to a common infectious disease like chicken pox&#46; The vaccine is in our own hands&#44; and no one can take it away from us&#46;</p></span></span>"
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Editorial
Medication errors in paediatrics: In search of a new vaccine
Errores de medicación en pediatría: en busca de una nueva vacuna
R. Piñeiro Pérez
Comité de Medicamentos de la Asociación Española de Pediatría (CM-AEP), Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Medicine in the twenty-first century cannot be understood without drugs&#58; without them there is no cure&#44; and with them we have to confront prescribing errors and adverse drug reactions&#46; In 2005 the Spanish government instigated the National Study of Adverse Effects &#40;ENEAS&#41; connected with hospitalisation&#46; It showed that almost 10&#37; of the patients admitted to hospital suffered an iatrogenic adverse effect&#44; and that almost 30&#37; of these were caused by medication&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In 2007 the United States Institute of Medicine published a report entitled &#8220;Preventing Medication Errors&#8221;&#44; emphasising that at least 1&#46;5 million preventable adverse events occur per year in that country&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">There is no standard&#44; internationally accepted definition of what constitutes a medication error&#46; It is therefore difficult to analyse the various studies published on the subject&#46; Moreover&#44; since it is not clear what ought to be communicated&#44; we are dealing with a phenomenon in which what is reported falls far short of its true proportions&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Among the many existing descriptions&#44; there are three outstanding concepts that help us to understand the nature of medication errors and are constantly repeated&#58; errors are preventable&#44; they are not always harmful&#44; and their origins are multifactoral and multidisciplinary&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> But these concepts do not solve the practical issues that the problem raises&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">When a possible medication error arises&#44; most health care professionals do not know the medico-legal consequences of notification&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> If no harm has been done&#44; why report it&#63; And if it has&#8230; &#8220;what is not written down does not exist&#8221;&#46; Worse still&#44; doctors who do decide to report errors enter a demoralising bureaucratic maze in which they do not know how&#44; where or to whom they should address themselves&#46; It is likely that their efforts will have no effect&#46; This closes the vicious circle&#46; Because medication errors are hardly ever reported&#44; we do not know the real extent of the problem&#46; And yet any doctor knows that medication errors can be fatal&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Errors in paediatrics&#58; more frequent and dangerous</span><p id="par0025" class="elsevierStylePara elsevierViewall">In paediatrics it is even more important to analyse safety in drug administration&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Because of the need to calculate dosage on the basis of weight&#44; age or body surface area&#44; and pharmacokinetic and pharmacodynamic differences compared to adults&#44; children are particularly vulnerable to medication errors&#44; and the associated morbidity is potentially greater&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In addition&#44; drugs are commonly used off-label&#46; In a recent survey<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> by the AEP&#39;s Comit&#233; de Medicamentos &#40;Drugs Committee&#41;&#44; 23&#37; of the paediatricians polled were unaware of the existence of this practice&#44; and almost 50&#37; did not know when they used it or reported that they never prescribed drugs off-label&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">An additional problem is the lack of specialised pharmaceutical products properly adapted to paediatric needs&#44; which very often forces doctors to resort to a magistral formula&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Equally serious is the fact that there are currently over 170 drugs of various kinds that are temporarily or permanently out of supply&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> at least 10&#37; of which are paediatric formulations&#46; These shortages oblige paediatricians to work out ways to replace one drug with another or to administer them by routes that have not been adequately tested&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Errors&#58; inevitable&#44; but preventable</span><p id="par0045" class="elsevierStylePara elsevierViewall">All the projects that have helped to bring about an increase in the reporting of medication errors&#44; and a subsequent reduction in such errors&#44; involve similar initiatives&#44; based fundamentally on creating and fostering a culture of drug safety and providing new working tools&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">These initiatives include multidisciplinary safety committees&#44; training courses for all health care staff to raise awareness of drug prescription and administration rules&#44; confidential&#44; anonymous and non-punitive reporting systems&#44; user-friendly forms enabling errors to be communicated rapidly &#40;computer applications&#44; for example&#41;&#44; and designing drug administration manuals and protocols&#46; It is also advisable for prescription forms to be double- or triple-checked &#40;for example&#44; by paediatricians&#44; nurses and pharmacists&#41;&#44; especially with drugs that involve a higher risk of causing serious harm in the event of an error&#44; such as opiates&#44; cytostatic drugs&#44; insulins&#44; anaesthetics&#44; antibiotics and even minor analgesics like acetaminophen&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Computerisation of prescription and administration forms is also recommended&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Medication errors are inevitable&#59; they cannot be completely eradicated&#46; However&#44; they are preventable&#44; and their number and impact can be reduced&#46; It is much the same as with hospital-acquired infections&#46; Just as we sterilise our hands and operating theatres&#44; so is our duty as paediatricians&#44; and as doctors&#44; to have a restless neuron somewhere in our brain that is constantly on the alert&#44; forcing us to check what we prescribe at least twice&#46; And if we do commit or detect an error&#44; to report it&#44; analyse the consequences&#44; examine the causes that led to it&#44; correct them and prevent the same mistake happening again in the near future&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The fact that an error has not led to any consequences does not mean that the next one may not do so&#46; In order for voluntary reporting to work&#44; it is essential that it should be anonymous and that the responsibility in serious or fatal cases should lie with the management and not with one particular professional&#44; since errors are rarely the result of a single person&#39;s carelessness or recklessness&#46; The idea is not that individuals should be immune from blame but that responsibility should be shared&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">However&#44; conscious reporting by doctors is not enough&#46; It is essential to ensure that parents properly understand all the oral and written information they receive&#46; For example&#44; there is no reason why the whole population should know that a &#8220;cc&#8221; is the same as an &#8220;mL&#8221; or understand what the little lines marked on a syringe mean&#46; The patient information leaflet&#44; which even doctors themselves sometimes find difficult to decipher&#44; is not much help&#46; It is not unusual for a paediatrician to have prescribed by weight whilst the leaflet indicates the dose by age&#46; These are aspects of doctor&#8211;patient communication that certainly need to be reviewed&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In addition&#44; multidisciplinary safety committees should be set up in all hospitals and health centres to control&#44; monitor&#44; detect&#44; report and correct medication errors&#46; An essential requirement is to have integrated computer programs containing the patient&#39;s clinical history that automatically alert prescribing paediatricians to drug interactions&#44; unnecessary treatments&#44; allergies&#44; contraindications and inappropriate dosages&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">&#8220;Everybody makes mistakes&#46; The art is in making them when nobody&#39;s looking&#46;&#8221; This quotation&#44; by the actor&#44; writer and playwright Peter Ustinov&#44; sums up perfectly the situation we have to change&#46; The aim is precisely that if we do commit an error&#44; someone should be looking&#44; and that if no one is looking&#44; we should follow Benjamin Franklin&#39;s advice&#58; &#8220;only the righteous man is able to confess his faults and admit mistakes&#46;&#8221; Or better still&#44; Joseph Pulitzer&#39;s regime&#58; &#8220;We do not tolerate mistakes here&#44; and when we discover them we do not rest until we have corrected them&#46;&#8221;</p><p id="par0080" class="elsevierStylePara elsevierViewall">If we had accurate data on the impact of medication errors in paediatrics&#44; they would probably be at least equivalent to a common infectious disease like chicken pox&#46; The vaccine is in our own hands&#44; and no one can take it away from us&#46;</p></span></span>"
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Article information
ISSN: 23412879
Original language: English
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Idiomas
Anales de Pediatría (English Edition)
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