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Jiménez-Mesa, J. Cotrina-Luque, A. Villalba-Moreno, R. Cumplido-Corbacho, L. Fernández-Fernández" "autores" => array:6 [ 0 => array:4 [ "nombre" => "M.D." "apellidos" => "Guerrero-Aznar" "email" => array:1 [ 0 => "md.guerrero.sspa@juntadeandalucia.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "E." "apellidos" => "Jiménez-Mesa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Cotrina-Luque" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "A." 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"apellidos" => "Fernández-Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de gestión de Farmacia, Hospital Virgen del Rocío, Sevilla, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de gestión de Pediatría, Hospital Virgen del Rocío, Sevilla, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Validación en pediatría de un método para notificación y seguimiento de errores de medicación" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1705 "Ancho" => 1329 "Tamanyo" => 164256 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Medication error categories by severity. Cat A: incident or circumstance that may cause harm; cat B: an error occurred but did not reach the patient; cat C: the error reached the patient, but did not cause patient harm; cat D: the error reached the patient and did not cause patient harm, but required monitoring/intervention; cat E: error with harm.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">An adverse drug event<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> (ADE) is defined as any harm, severe or mild, caused by the medical use of a drug. ADEs are classified into: (1) medication errors (MEs): any preventable incident that may harm the patient or result in the inappropriate use of a drug; and (2) adverse drug reactions (ADRs): an effect which is noxious and unintended, usually nonpreventable, that occurs after the administration of a drug. ADRs are unavoidable.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A potential adverse event, potential error, or “near miss”, is an incident that did not result in injury.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A spontaneous reporting system is a method of pharmacovigilance based on the communication, collection, and evaluation of reports of suspected ADRs. According to the law<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>, MEs that cause harm to the patient must be reported and will be considered as ADRs upon notification, save for errors that result from therapeutic failure due to omission of treatment.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Some of the characteristics of an effective ME notification system described in the literature are<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>: voluntary reporting; invites the active participation of healthcare professionals and patients; gives the choice of anonymous reporting; guarantees the confidentiality of reported information; takes a nonpunitive approach to reporting; encourages reporting of both potential and actual errors of patient injuries resulting from errors; and provides feedback of error analysis and recommendations.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Additional characteristics of a reporting system include: ease of use; availability of both electronic and paper formats; standard taxonomy; severity of outcomes; retrievable data; report generation; and root-cause analysis.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The number of errors that occur in the daily delivery of healthcare is much higher than we would think. It is estimated that 50–96% of errors go unreported. In the EMOPEM study,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> the mean error rate for the 22 participating hospitals was 21.72%, with a minimum of 2.85% and a maximum of 79.02%.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Underreporting of MEs can compromise patient safety. The perceived barriers to notification are fear of consequences; a blame culture; lack of training in reporting, time to report, organisational leadership and support, legal protection, guidelines and policies, staff and resources; lack of understanding why reporting is needed; concern that no action will follow reporting; non-anonymous reporting; and reporting perceived to be bureaucratic.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Paediatric rates of potentially serious MEs can be 3 times greater than adult rates.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> The risk of MEs in paediatrics is particularly high because of the need for dosage calculations based on the patient's weight, age, or body surface area and the patient's condition. Unlicensed use of medications, for which there is little information on the adequate dosage, is also common (for instance, in off-label use or the treatment of rare diseases such as cystic fibrosis).</p><p id="par0045" class="elsevierStylePara elsevierViewall">For potent drugs, when only a small fraction of the adult dose is required for children, it becomes very easy to cause errors because of miscalculation or misplacement of the decimal point.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9–13</span></a> Furthermore, it is often necessary to manipulate adult formulations to obtain smaller doses for paediatric patients. These practises are associated with a high risk for errors, as the bioavailability of a drug that has been manipulated is often unknown and unpredictable. There is a lack of information on compatibility and stability.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">“High alert medications” are defined as drugs that bear a heightened risk of causing significant patient harm or even death when they are used in error. This definition does not suggest that errors associated with these drugs are necessarily more common, but that the consequences of these errors are more severe for the patients. Thus, high alert medications should be a priority objective in any hospital's clinical safety programmes.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Systematic mechanisms to promote safe medication are probably important factors that allow the translation of a safety culture into outcomes, but they may be ineffective in the context of a poor safety culture.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">An overall organisational culture based on trust and error disclosure predicts the intent to disclose a hypothetical error in a patient, while teamwork and a safety culture do not.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Isolated ME rates, based on incident notifications, do not provide a valid measure of patient safety. A high error rate may be suggestive of dangerous practises or of an organisational culture that promotes error reporting. A low rate of MEs could suggest that an organisation engages in successful and safe practises, or that it has a particularly punitive approach to reporting.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Reported near misses lead to corrective action at the organisational level when managers perceive a substantial potential for harm and preventability.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Observational studies<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,18</span></a> help detect safety problems, but are very labour-intensive. The idea for this study came from an observational study that we had conducted in the paediatric oncology unit.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">To measure the safety interventions related to the use of medications we have analysed the variation in reporting rates of MEs, variation in incidence rates of MEs with harm per 10,000 distributed doses, and improvement in the responses to safety questionnaires.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20,21</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The incidence density of MEs is calculated as the number of errors per 100 patients per duration of hospital stay in days.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">We selected 2 factors for our intervention, one based on the culture of error disclosure, and one based on trust.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The decentralisation of reporting and monitoring of MEs at the management level may lead to increased motivation to report in healthcare professionals. It would make sense to make it easier to measure harm, understand causes, seek solutions, implement strategies for improvement, and measure the impact of these strategies within a group of closely interacting professionals.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The 2010–2014 Plan de Calidad del Sistema Sanitario Público de Andalucía (Quality Plan of the Public Health System of Andalusia)<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> contemplates the decentralisation of patient safety organisation to the management units. This inspired us to institute a safety committee in the paediatrics management unit.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The reviewed literature expresses that further research is needed to understand how the way reporting is done affects learning from errors and error prevention, and to identify factors that may lead to improved reporting.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Our hypothesis, based on the available evidence, is that a feeling of trust towards a safety committee within the management unit and easier reporting by means of a simple computer application could contribute to the motivation to report MEs and lead to improved reporting rates.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Our objective was to analyse the impact on error notification of the implementation of a decentralised multidisciplinary safety committee in the paediatrics management unit and the concurrent introduction of a networked computer application for ME reporting by monitoring the error reports and evaluating the safety-improvement strategies implemented by the management unit.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methodology</span><p id="par0115" class="elsevierStylePara elsevierViewall">We conducted an observational, descriptive, pre-post intervention study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Description of new strategy</span><p id="par0120" class="elsevierStylePara elsevierViewall">1. A networked computer application was designed for the confidential reporting and analysis of MEs in the management unit.</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Fields of an error report in the computer application</span><p id="par0125" class="elsevierStylePara elsevierViewall">Error description, severity classification, affected organs or systems, patient age, clinical manifestations, sex, drug/active ingredient, dose, error date, day of the week, type of incident, setting where the error originated, medication process (dispensation, prescription, transcription, preparation, administration), setting where the error was detected, cause of the error, person who made the error, contributing factors, person who discovered the error, measures proposed or taken to prevent the same error from occurring.</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Types of incident</span><p id="par0130" class="elsevierStylePara elsevierViewall">Wrong medication, pharmacological treatment or dose omission, wrong dose, incorrect frequency of administration, wrong dosage form, preparation error, manipulation and/or packaging errors, wrong administration technique, wrong route of administration, wrong rate of administration, wrong time of administration, wrong patient, wrong duration of treatment, insufficient treatment monitoring, deteriorated drug, patient noncompliance.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Severity categories</span><p id="par0135" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></p><p id="par0140" class="elsevierStylePara elsevierViewall">The application was introduced to the staff in clinical meetings of the medical staff and in small group meetings (6 people) for the nursing staff. In both cases, the contents had been developed by consensus</p><p id="par0145" class="elsevierStylePara elsevierViewall">2. A safety committee was instituted within a paediatrics management unit with the participation of clinicians, nurses, and pharmacists.</p><p id="par0150" class="elsevierStylePara elsevierViewall">Monthly meetings lasting one hour were held the first Thursday of every month to analyse MEs and develop improvement strategies based on the analysis. Error analysis feedback was provided to the healthcare staff and the consensus improvement strategies were notified by the submission of meeting minutes to managerial staff.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Analysis of the impact of new strategy</span><p id="par0155" class="elsevierStylePara elsevierViewall">3. An audit was done to analyse MEs—those notified in paper to the central safety committee in the 12 months prior to implementation, as well as those reported by means of the decentralised computer application to the safety committee of the management unit in the 9 months after implementation—and the strategies generated by the analysis of MEs in the pre- and postintervention periods.</p><p id="par0160" class="elsevierStylePara elsevierViewall">Measured variables: number of reported errors per 10,000 days of hospitalisation, overall for each period and by month; number of errors with harm per 10,000 days of hospitalisation; type; severity category; step of the process; professional category of reporter; and medication involved.</p><p id="par0165" class="elsevierStylePara elsevierViewall">The OpenEpi<span class="elsevierStyleSup">®</span><a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">23</span></a> application was used to do the statistical analysis. We performed a descriptive analysis of the variables, calculating the various relative frequencies.</p></span></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results</span><p id="par0170" class="elsevierStylePara elsevierViewall">Preintervention period (January–December 2011): 13 error reports/17,124 days of hospitalisation (7.5/10,000) in children aged 4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4 years; mean monthly number of reports<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation (SD): 1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.</p><p id="par0175" class="elsevierStylePara elsevierViewall">Number of errors with harm or which needed monitoring reported per 10,000 days of hospitalisation: 2.9.</p><p id="par0180" class="elsevierStylePara elsevierViewall">Postintervention period (January–September 2012): 42 error reports/11,801 days of hospitalisation (36/10,000), in children aged 5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4 years; mean monthly number of reports<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD: 5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.</p><p id="par0185" class="elsevierStylePara elsevierViewall">Number of errors with harm or which required monitoring reported per 10,000 days of hospitalisation: 3.4.</p><p id="par0190" class="elsevierStylePara elsevierViewall">There was a 4.6-fold increase in the number of ME reports/10,000 days of hospitalisation in the postintervention period relative to the preintervention period. When we compared the rate of error reporting in the 2 periods, we obtained a rate ratio of 0.21 (95% CI, 0.11–0.39) <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001.</p><p id="par0195" class="elsevierStylePara elsevierViewall">The total number of errors with harm that required reporting per 10,000 days of hospitalisation hardly changed between periods (rate ratio, 0.77; 95% CI, 0.31–1.91; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>.05).</p><p id="par0200" class="elsevierStylePara elsevierViewall">The severity categories for the MEs per 10,000 days of hospitalisation reported in the pre- and postintervention periods are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0205" class="elsevierStylePara elsevierViewall">The reported number of potential errors and errors without harm per 10,000 days of hospitalisation increased by a factor of 17.4 in the postintervention period relative to the preintervention period (rate ratios, 0.005; 95% CI, 0.001–0.026; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001).</p><p id="par0210" class="elsevierStylePara elsevierViewall">In the preintervention period, all the reported errors with harm occurred during administration. In the postintervention period, 75% corresponded to prescription errors and 25% to administration errors.</p><p id="par0215" class="elsevierStylePara elsevierViewall">In the preintervention period, the errors with harm, all of them related to the process of administration, were: morphine hydrochloride overdose, vancomycin extravasation and intrathecal methotrexate overdose. The errors that required monitoring were administration of a NSAID to an allergic patient and of an excess dose of phenobarbital.</p><p id="par0220" class="elsevierStylePara elsevierViewall">The errors with harm in the postintervention period were pain during infusion of paracetamol (administration), prescription of an overdosage of dactinomycin, anaphylactic shock secondary to metamizol administration, and prescription error consisting of swapping the doses of 2 antibiotics.</p><p id="par0225" class="elsevierStylePara elsevierViewall">The number of MEs per 10,000 days of hospitalisation according to the step in the medication process is shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>. The steps carried out by the nursing staff (transcription, preparation, and administration) and by clinicians (prescription) are grouped together in <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>. In the preintervention period, paper reports did not need to specify the steps of the process following the format used later in the postintervention period.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0230" class="elsevierStylePara elsevierViewall">In the preintervention period, 100% of the errors were reported by the nursing staff; in the postintervention period, 79% were reported by nurses, 7% by physicians, and 14% by pharmacists.</p><p id="par0235" class="elsevierStylePara elsevierViewall">The rate of reported errors per 10,000 days of hospitalisation in the steps carried out by the nursing staff increased by a factor of 3.7 (rate ratio, 0.026; 95% CI, 0.01–0.57; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001), and in the steps carried out by physicians, it increased by a factor of 5.4 (rate ratio, 0.018; 95% CI, 0.004–0.074; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001).</p><p id="par0240" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 1</a> shows the therapeutic classification of the drugs involved in the reports. We performed this classification based on the list proposed by our working group after the paediatrics management unit reached a consensus following a review of the literature.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,24</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0245" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a> shows the reported causes of MEs, and <a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a> the number of errors per month notified in the pre- and postintervention periods.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0250" class="elsevierStylePara elsevierViewall">The interventions to promote a culture of safety included multicomponent strategies, with the formation of teams and mechanisms to support communication. Assessing the implemented strategies based on the outcomes was considered of paramount importance.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">25</span></a></p><p id="par0255" class="elsevierStylePara elsevierViewall">In calculating reporting rates, we have used 10,000 days of hospitalisation as the denominator, rather than the 100 commonly used in observational study. We did this because the direct observation method is about 1000 times more efficacious than the method of voluntary reporting, although it tends to miss errors with harm.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,21</span></a></p><p id="par0260" class="elsevierStylePara elsevierViewall">The substantial increase in reporting unaccompanied by an increase in reports of error with harm implies that the motivation to report of healthcare professionals has increased, as manifested by the 17-fold increase in the reporting of potential errors and errors without harm.</p><p id="par0265" class="elsevierStylePara elsevierViewall">The involvement of nursing staff in reporting has increased, as has that of physicians and pharmacists. We were not able to assess the safety climate by means of a survey, as recommended by the Ministerio de Sanidad y Consumo (the Ministry of Health and Consumers),<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">26</span></a> nor the training in safety. The method of training in small groups applied to the nursing staff was more effective than training during clinical sessions, as nurses have reported errors 11 times more often than specialist physicians, who are the smallest professional collective.</p><p id="par0270" class="elsevierStylePara elsevierViewall">Consistent with what we found in our study, communications in recent national congresses also mention the lack of electronic prescription support as an important cause of MEs (44%).<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">27</span></a></p><p id="par0275" class="elsevierStylePara elsevierViewall">The following measures, among others, are recommended to evaluate the efficacy of patient safety strategies: account of the theoretical model explaining why the safety intervention would work, detailed description of the intervention so it can be repeated, description of how the intervention changes over time, and assessment of the effect of the intervention on outcomes.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">28</span></a> We followed these steps in our study. A drop in reporting was observed starting on the seventh month, which coincided with the summer. Thus, we propose refresher training on safety and ME reporting every 6 months.</p><p id="par0280" class="elsevierStylePara elsevierViewall">We believe that the system used in the study, based on user-friendly software, confidential and nonpunitive reporting, training on error reporting based on presentations developed by consensus, and a safety committee within the unit that provides feedback, is successful in fighting the barriers to reporting described in the literature.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,6,11</span></a> In the past, the management unit had not been working in depth towards achieving an error culture and an error disclosure culture.</p><p id="par0285" class="elsevierStylePara elsevierViewall">During the postintervention period, several strategies were proposed in the meetings of the safety committee of the management unit, which were partially implemented: (1) double-checking of paediatric chemotherapy prescriptions; (2) double-checking of high alert drug preparation; (3) introduction of an electronic form for drug prescription and administration; (4) multidisciplinary development of a manual for the administration of high alert drugs in paediatrics (in press) and (5) divulgation of the directives for the prescription and administration of drugs.</p><p id="par0290" class="elsevierStylePara elsevierViewall">The development of interventions, feedback, and the implemented strategies involved the collaboration of clinical, nursing, and pharmacy staff at all times.</p><p id="par0295" class="elsevierStylePara elsevierViewall">The programme described here has been implemented at no cost, as the training sessions have been integrated in previously established programmes, and the safety committee operates during regular working hours. Also, when it is implemented in a new unit, the central safety committee of the hospital is granted access to the computer application, so that experiences in improvement can be shared.</p><p id="par0300" class="elsevierStylePara elsevierViewall">In the future, the safety committee of the unit will develop training sessions to refresh and update theoretical knowledge and techniques for the improvement of information divulgation. The manual for the use of high alert drugs in paediatric care, already developed, will be circulated, and we will evaluate the safety climate and knowledge of the different professional collectives before and after these interventions.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusions</span><p id="par0305" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0310" class="elsevierStylePara elsevierViewall">All professional collectives became involved during the postintervention period.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0315" class="elsevierStylePara elsevierViewall">The motivation of healthcare professionals to report has increased, as evinced by the considerable increase in the reporting of potential errors. The reporting of errors with harm or errors requiring monitoring hardly increased in the same period.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0320" class="elsevierStylePara elsevierViewall">The monthly analysis of the causes of errors in the committee is quick and effective, and is manifested in solutions that are implemented on the go and studied for feedback in short intervals of time.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0325" class="elsevierStylePara elsevierViewall">All of the above suggests that this decentralised reporting system is ideal to plan and monitor safety interventions in the management unit.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0330" class="elsevierStylePara elsevierViewall">We need to evolve at the structural and procedural levels (electronic prescription validated by the pharmacy); offering the necessary safety training; reassessing work loads; and considering the protocols needed in the unit.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0335" class="elsevierStylePara elsevierViewall">We need to maintain the staff's awareness of this subject by means of periodic refresher education, as the interest in reporting declines with the passing of time.</p></li></ul></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicts of interest</span><p id="par0340" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres388691" "titulo" => array:6 [ 0 => "Abstract" 1 => "Objective" 2 => "Materials and methods" 3 => "Measured variables" 4 => "Results" 5 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec367278" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres388690" "titulo" => array:6 [ 0 => "Resumen" 1 => "Objetivo" 2 => "Material y métodos" 3 => "Variables medidas" 4 => "Resultados" 5 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec367277" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methodology" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Description of new strategy" "secciones" => array:1 [ 0 => array:3 [ "identificador" => "sec0020" "titulo" => "Fields of an error report in the computer application" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Types of incident" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Severity categories" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Analysis of the impact of new strategy" ] ] ] ] ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-05-10" "fechaAceptado" => "2013-10-10" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec367278" "palabras" => array:6 [ 0 => "Medication errors" 1 => "System of notice of medication errors" 2 => "Safety committee" 3 => "High risk drugs" 4 => "Paediatrics" 5 => "Preventable adverse events" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec367277" "palabras" => array:6 [ 0 => "Errores de medicación" 1 => "Sistema de notificación de errores" 2 => "Comité de seguridad" 3 => "Medicamentos de alto riesgo" 4 => "Pediatría" 5 => "Acontecimientos adversos prevenibles" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To analyse the impact of a multidisciplinary and decentralised safety committee in the paediatric management unit, and the joint implementation of a computing network application for reporting medication errors, monitoring the follow-up of the errors, and an analysis of the improvements introduced.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">An observational, descriptive, cross-sectional, pre-post intervention study was performed. An analysis was made of medication errors reported to the central safety committee in the twelve months prior to introduction, and those reported to the decentralised safety committee in the management unit in the nine months after implementation, using the computer application, and the strategies generated by the analysis of reported errors.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Measured variables</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Number of reported errors/10,000 days of stay, number of reported errors with harm per 10,000 days of stay, types of error, categories based on severity, stage of the process, and groups involved in the notification of medication errors.</p> <span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Reported medication errors increased 4.6-fold, from 7.6 notifications of medication errors per 10,000 days of stay in the pre-intervention period to 36 in the post-intervention, rate ratio 0.21 (95% CI; 0.11–0.39) (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001). The medication errors with harm or requiring monitoring reported per 10,000 days of stay, was virtually unchanged from one period to the other ratio rate 0.77 (95% IC; 0.31–1.91) (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>.05). The notification of potential errors or errors without harm per 10,000 days of stay increased 17.4-fold (rate ratio 0.005, 95% CI; 0.001–0.026, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001).</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The increase in medication errors notified in the post-intervention period is a reflection of an increase in the motivation of health professionals to report errors through this new method.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analizar el impacto en la notificación de errores de medicación de la puesta en marcha de un comité de seguridad multidisciplinar descentralizado en la unidad de gestión pediátrica, e implantación conjunta de una aplicación informática en red para la comunicación de errores de medicación, mediante seguimiento de los errores y análisis de las mejoras.</p> <span class="elsevierStyleSectionTitle" id="sect0045">Material y métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional, descriptivo, transversal pre-post intervención. Se analizan los errores de medicación notificados a la comisión central de seguridad, en los 12 meses previos a la implantación, y los notificados mediante la aplicación informática descentralizada a la comisión de seguridad de la unidad de gestión, en los 9 meses posteriores, y las estrategias generadas por el análisis.</p> <span class="elsevierStyleSectionTitle" id="sect0050">Variables medidas</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Número de errores notificados por 10.000 días de estancia, número de errores con daño por 10.000 días de estancia, tipo, categoría en función de la gravedad, fase del proceso, colectivo que notifica y medicamentos implicados.</p> <span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se multiplican por 4,6 los errores de medicación notificados —7,6 notificaciones por 10.000 días de estancia en el periodo preintervención y 36 en el postintervención—, razón de tasas de 0,21 (IC 95%: 0,11–0,39) p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">No cambian prácticamente los errores con daño o que necesitaron monitorización notificados por 10.000 días de estancia de un periodo a otro, razón de tasas: 0,77 (IC95%: 0,31–1,91) p<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0,05. Se multiplica por 17,4 la notificación de errores sin daño o potenciales por 10.000 días de estancia, razón de tasas: 0,005 (IC 95%: 0,001–0,026) p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001.</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El incremento de los errores de medicación notificados en el periodo postintervención es reflejo del aumento en la motivación de los profesionales sanitarios para notificar a través de este nuevo método.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Guerrero-Aznar MD, Jiménez-Mesa E, Cotrina-Luque J, Villalba-Moreno A, Cumplido-Corbacho R, Fernández-Fernández L. Validación en pediatría de un método para notificación y seguimiento de errores de medicación. An Pediatr (Barc). 2014;81:360–367.</p>" ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1705 "Ancho" => 1329 "Tamanyo" => 164256 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Medication error categories by severity. Cat A: incident or circumstance that may cause harm; cat B: an error occurred but did not reach the patient; cat C: the error reached the patient, but did not cause patient harm; cat D: the error reached the patient and did not cause patient harm, but required monitoring/intervention; cat E: error with harm.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1510 "Ancho" => 1557 "Tamanyo" => 127533 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Reported medication error by step of the medication process.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1250 "Ancho" => 1364 "Tamanyo" => 98657 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Reported medication errors grouped by steps of medication process.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1258 "Ancho" => 1283 "Tamanyo" => 69152 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Reported causes for medication errors.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1546 "Ancho" => 1553 "Tamanyo" => 145353 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Number of reported errors by month in the preintervention (January–December 2011) and postintervention (January–September 2012) periods.</p>" ] ] 5 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">G-CSF: granulocyte colony stimulating factors; PPIs: proton pump inhibitors.</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Percentages of ISMP high alert drugs are presented in boldface.</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Source: ISMP<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>; Cotrina Luque et al.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">24</span></a></p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Type of medication \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Preintervention (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Postintervention (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>42) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Antibiotic</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">31%</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">29%</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antifungals (liposomal) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antivirals \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gammaglobulins \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">IV and SC insulin</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">8%</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">IV opioids</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">8%</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Inhaled and IV general anaesthetics</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">8%</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">5%</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Cytostatics</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">8%</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">31%</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">G-CSF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Analgesics <span class="elsevierStyleBold">(IV paracetamol)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">8%</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">10%</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Cardiac glycosides (IV inotropes)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">2%</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Antiepileptics</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">2%</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antiparkinsonians \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diuretics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hormones \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Other cardiovascular drugs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PPIs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab598077.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Medications involved in reports.</p>" ] ] 6 => array:5 [ "identificador" => "tbl0005" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => false "mostrarDisplay" => true "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cat a: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Potential error: incident or circumstance that has the capacity to cause harm. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cat b: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Error without harm: an error occurred but did not reach the patient. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cat c: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Error without harm: the error reached the patient but did not cause patient harm. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cat d: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Error without harm: the error reached the patient and did not cause patient harm, but required monitoring/intervention. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cat e: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Error with harm: the error caused temporary harm to the patient and required intervention. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab598076.png" ] ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Errores de medicación" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:4 [ 0 => "M.J. Otero López" 1 => "R. Martín Muñóz" 2 => "M.D. Robles Antúnez" 3 => "C. Codina Jané" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Farmacia hospitalaria" "paginaInicial" => "713" "paginaFinal" => "747" "edicion" => "3<span class="elsevierStyleSup">a</span> edn." 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Year/Month | Html | Total | |
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2024 November | 7 | 11 | 18 |
2024 October | 58 | 38 | 96 |
2024 September | 59 | 36 | 95 |
2024 August | 91 | 66 | 157 |
2024 July | 50 | 43 | 93 |
2024 June | 38 | 20 | 58 |
2024 May | 55 | 32 | 87 |
2024 April | 56 | 21 | 77 |
2024 March | 48 | 24 | 72 |
2024 February | 48 | 31 | 79 |
2024 January | 44 | 30 | 74 |
2023 December | 41 | 24 | 65 |
2023 November | 50 | 17 | 67 |
2023 October | 39 | 20 | 59 |
2023 September | 36 | 24 | 60 |
2023 August | 47 | 22 | 69 |
2023 July | 39 | 26 | 65 |
2023 June | 48 | 33 | 81 |
2023 May | 44 | 20 | 64 |
2023 April | 39 | 25 | 64 |
2023 March | 65 | 29 | 94 |
2023 February | 40 | 18 | 58 |
2023 January | 28 | 24 | 52 |
2022 December | 62 | 37 | 99 |
2022 November | 62 | 38 | 100 |
2022 October | 47 | 52 | 99 |
2022 September | 39 | 40 | 79 |
2022 August | 57 | 60 | 117 |
2022 July | 48 | 39 | 87 |
2022 June | 45 | 36 | 81 |
2022 May | 37 | 45 | 82 |
2022 April | 33 | 41 | 74 |
2022 March | 42 | 43 | 85 |
2022 February | 34 | 27 | 61 |
2022 January | 53 | 49 | 102 |
2021 December | 36 | 40 | 76 |
2021 November | 63 | 51 | 114 |
2021 October | 61 | 63 | 124 |
2021 September | 51 | 33 | 84 |
2021 August | 54 | 49 | 103 |
2021 July | 54 | 29 | 83 |
2021 June | 52 | 31 | 83 |
2021 May | 46 | 42 | 88 |
2021 April | 86 | 38 | 124 |
2021 March | 67 | 19 | 86 |
2021 February | 28 | 9 | 37 |
2021 January | 29 | 19 | 48 |
2020 December | 40 | 19 | 59 |
2020 November | 24 | 18 | 42 |
2020 October | 49 | 12 | 61 |
2020 September | 40 | 20 | 60 |
2020 August | 37 | 11 | 48 |
2020 July | 62 | 16 | 78 |
2020 June | 61 | 13 | 74 |
2020 May | 54 | 24 | 78 |
2020 April | 57 | 12 | 69 |
2020 March | 66 | 26 | 92 |
2020 February | 46 | 19 | 65 |
2020 January | 71 | 18 | 89 |
2019 December | 58 | 24 | 82 |
2019 November | 39 | 16 | 55 |
2019 October | 40 | 17 | 57 |
2019 September | 55 | 13 | 68 |
2019 August | 59 | 25 | 84 |
2019 July | 61 | 20 | 81 |
2019 June | 65 | 24 | 89 |
2019 May | 155 | 39 | 194 |
2019 April | 106 | 24 | 130 |
2019 March | 37 | 16 | 53 |
2019 February | 60 | 29 | 89 |
2019 January | 58 | 19 | 77 |
2018 December | 62 | 38 | 100 |
2018 November | 123 | 24 | 147 |
2018 October | 133 | 36 | 169 |
2018 September | 64 | 9 | 73 |
2018 August | 7 | 0 | 7 |
2018 July | 3 | 0 | 3 |
2018 June | 7 | 0 | 7 |
2018 May | 9 | 0 | 9 |
2018 April | 29 | 0 | 29 |
2018 March | 29 | 0 | 29 |
2018 February | 12 | 0 | 12 |
2018 January | 23 | 0 | 23 |
2017 December | 33 | 0 | 33 |
2017 November | 24 | 0 | 24 |
2017 October | 13 | 0 | 13 |
2017 September | 22 | 0 | 22 |
2017 August | 31 | 0 | 31 |
2017 July | 26 | 0 | 26 |
2017 June | 48 | 18 | 66 |
2017 May | 43 | 4 | 47 |
2017 April | 21 | 6 | 27 |
2017 March | 20 | 10 | 30 |
2017 February | 15 | 2 | 17 |
2017 January | 15 | 3 | 18 |
2016 December | 54 | 10 | 64 |
2016 November | 66 | 6 | 72 |
2016 October | 66 | 7 | 73 |
2016 September | 65 | 4 | 69 |
2016 August | 43 | 8 | 51 |
2016 July | 24 | 3 | 27 |