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Background The kind of patients we can find in a geriatric centre have various comorbidities, which implies that they usually have more than one medicine. It is common to have drug interactions. Purpose To evaluate the rational use of proton pump inhibitors (PPIs) in a geriatric centre with 300 beds attached to a second-level hospital. Material and methods We performed a cross descriptive study in all patients of a geriatric centre with PPI treatment in July 2014. Medical histories were reviewed and a database was designed: PPI, drug dose, diagnosis and concomitant NSAID treatment. PPI criteria for use were based on the current evidence available. Esomeprazole was limited to patients with a nasogastric tube, as it´s the only one that can be administered in this way. Results PPIs were prescribed in 80% of patients. Omeprazole was prescribed in 197 patients: 39% (77/197) had a gastrointestinal diagnosis and 61% (120/197) had no indication recorded, of which 57.5% (69/120) were on chronic NSAID treatment. Drug dosages were: 52.3% (103/197) 20 mg/24 h, 20 mg/12 h in 46.7% (92/197) and 0.5% (1/197) with 20 mg/8 h or 40 mg/8 h. The 42.5% (51/120) of patients whose treatment indication was unknown were re-evaluated: In 19.6% (10/51) the drug was suspended, in 58.8% (30/51) doses were changed to 20 mg/24 h. The remaining 21.6 (11%) patients were not changed without a clear medical reason. Esomeprazole was prescribed in 45 patients: 24% (11/45) had digestive diseases and 76% (34/45) had no indication recorded, of whom 61.7% (21/34) were on chronic NSAID treatment. Drug doses were: 66.7% (30/45) 20 mg/24 h and 40 mg/24 h in 33.3% (15/45). The 38.2% (13/34) patients whose treatment indication was unknown were re-evaluated: in 69.2% (9/13) the drug was suspended, 30.8% (4/13) were switched to omeprazole 20 mg/24 h. Only 28.9% (13/45) were carriers of a nasogastric tube. Conclusion Inappropriate use of PPIs was observed in terms of indication and drug dose. Prophylaxis of gastropathy in patients on NSAIDs was the most common correct indication. It is important to incorporate clinical pharmacists in geriatric centre teams to ensure and promote the rational use of medicines. Reference http://dx.doi.org/10.4321/S1130-01082008000200003 No conflict of interest.

Background A previous albumin use study had shown that consumption was continually increasing. Purpose To evaluate the effect of an update in albumin use guidelines and recommendations in our hospital. Materials and methods We conducted a literature review to update our albumin use protocol and to establish alternative treatment options and doses for each approved indication. After Pharmacy and Therapeutics Committee approval of the update and dissemination of the recommendations an observational, descriptive, retrospective study was conducted to evaluate intervention effectiveness. We compared albumin consumption 6 months prior to implementation with consumption 4 months later, and extrapolated to 6 months so that results could be compared. The following variables were analysed: prescribing service, date, number of vials prescribed, treatment costs 6 months before implementation of new protocol and 4 months later. Results A total of 397 treatment lines were included, corresponding to 1090 prescribed albumin vials (732 vials prescribed during the 6 months prior to implementation of the new protocol and 358 vials prescribed during the following 4 months). After data extrapolation, a reduction of 26.43% albumin can be concluded. The General Surgery Department maintained consumption (pre-review consumption: 250 vials, post-review consumption: 250.5 vials). Services where consumption increased were Geriatrics (pre-review consumption: 24 vials, post-review consumption: 58.5 vials), Anaesthesia and Resuscitation (pre-review consumption: 9 vials, post-review consumption: 13.5 vials). Services where consumption decreased were Internal Medicine (pre-review consumption: 160 vials, post-review consumption: 148.5 vials), Intensive Care Unit (pre-review consumption: 70 vials, post-review consumption: 0 vials), Gynaecology (pre-review consumption: 61 vials, post-review consumption: 54 vials), Emergency (pre-review consumption: 45 vials, post-review consumption: 0 vials), Traumatology (pre-review consumption: 81 vials, post-review consumption: 10.5 vials). Consumption reduction was due to alternative recommendations diffusion and dose adjustments. Albumin consumption increased in the Anaesthesia and Resuscitation Service due to the new treatment indication for spontaneous bacterial peritonitis. The reduction in consumption in other services occurred due to, for example, the recommendation to use vasoconstrictors as first-line treatment for hepatorenal syndrome, to use crystalloids as first-line treatment for liver resection >40% and to use 6–8 g/l albumin in paracentesis evacuations >5 litres (by reducing albumin dose per litre evacuated and raising the threshold treatment indication to 5 litres). Conclusions The review, updating and distributing Therapeutic Protocols among physicians, improved prescription rates thus improving the use of drugs. This directly improved treatment, with positive clinical and financial outcomes. No conflict of interest.

Background Adjuvant chemotherapy trials provide little information on safety in elderly patients because they exclude them or pool their results with those of younger patients. Purpose To describe the safety of the different adjuvant chemotherapy treatments used in elderly patients with colon cancer. Materials and Methods Retrospective observational study of colon cancer patients (age >65) diagnosed in 2010 and treated with adjuvant chemotherapy. Each patient was followed from the beginning of the treatment until the end of it. Demographic data, disease stage, antineoplastic agents and treatment-related toxicities were collected from patients’ clinical histories. Results 16 patients (5 women, 11 men) were included in the study with a mean age of 75.1 years. 87.5% and 12.5% of patients had stage III and stage II disease, respectively. 6 patients (37.5%) were treated with a combination of 5-fluorouracil and oxaliplatin regimen (FOLFOX), 4 patients (25%) with capecitabine in monotherapy and the remaining 6 patients (37.5%) with a combination of capecitabine and oxaliplatin regimen (XELOX). Adverse events were documented in 100% of patients. 57 adverse reactions were detected, the most frequent toxicities being: neurotoxicity (75% of patients), fatigue and anorexia (68.8%), diarrhoea (37.5%) and thrombocytopenia (37.5%). 54.5% of the undesirable effects were grade 1, 30.9% grade 2 and 14.6% grade 3 toxicities. There were no grade 4 adverse reactions. XELOX was associated with high rates of hand-foot-syndrome (75% of patients) and XELOX and FOLFOX with a high incidence of neurotoxicity (100% and 83.3% respectively). Oncologists had to delay the cycle or reduce the treatment doses in 11 patients (68.8%) and 5 patients (31.3%) had to discontinue the treatment due to the toxicity. Conclusions A high number of adverse reactions were detected, but majority were grade 1–2. The safety profile of drugs studied in our population is in line with that described in the literature in younger patients. No conflict of interest.

Background Enoxaparin is a safe drug but could cause adverse effects if it accumulates. Purpose To assess the renal function in patients requiring enoxaparin admitted to several wards in our hospital. Materials and methods The authors conducted a prospective observational study for a month (March 2010) which involved the review of prescriptions for enoxaparin on the traumatology, internal medicine and geriatrics wards. The authors recorded the dose of enoxaparin, other drugs prescribed, age and serum creatinine (Cr). The authors calculated the creatinine clearance (CrCl) with abbreviated MDRD in patients with Cr values over 1.1 mg/dl. According to the product information for Clexane, the dose should be adjusted in patients with CrCl≤30 ml/min and clinical monitoring is recommended with CrCl=30–50 ml/min. The standard treatment for deep vein thrombosis is 1 mg/kg/24 h and for thromboembolic disease prophylaxis it is 20 mg/24 h. The authors advised prescribing physicians of potentially risky patterns in writing through the prescription process. The authors drew their attention to patients with CrCl Results Enoxaparin was prescribed to 256 patients, 85 in traumatology, 130 in internal medicine and 41 in geriatrics. The authors detected 141 potential risk patterns: 81 in internal medicine, 37 in traumatology and 23 in geriatrics. Among these 141, 120 were due to high doses of enoxaparin in patients aged over 75 and the remaining 21 were patients with CrCl Conclusions More than half (55%) of the prescriptions analysed were potentially dangerous considering the renal function, and in most cases no change was made after the Pharmacy department drew attention to the risk. Enoxaparin is a safe drug but more attention should be paid to the kidney function of treated patients.

Background Patient9s proper dose is essential for an adequate treatment. Purpose Checking the proper administration of prescribed treatments in a General Hospital. Materials and methods The authors conducted a cross-sectional study about the detection of treatment administration errors, by means of two indicators: the treatment order signing before administration (preadministration signing) and the administration of a different pattern from the prescribed one by nursery (wrong pattern). Original treatment orders were reviewed in the unit dose dispensation area, and errors were reported in writing to the different services. Also, a data collecting sheet was designed, including medical service name, number of treatment orders, number of treatment lines and types of error. Results 168 treatment orders were checked (1085 treatment lines) corresponding to nine hospital floors (traumatology, urology, two surgery services, two internal medicine services, haematology/ophthalmology/oncology, geriatrics/neurology and gynaecology) 48 management errors were detected, 86.33% of them caused by preadministration signing and 16.7% by wrong pattern. Attending to a classification of all these data, six errors (20 treatment orders) were detected in Traumatology, 83.3% of them by wrong pattern and 16.6% by preadministration signing; 1 wrong pattern out of 7 treatment orders in urology; 8 errors (27 orders) in right surgery and 11 errors (18 orders) in left surgery, all due to preadministration signing; 3 errors (27 orders) were detected by preadministration signing in right internal medicine; 11 errors (29 orders) in left internal medicine, 90.9% of them caused by preadministration signing and 9.1% by wrong pattern; in haematology/ophthalmology/oncology services, no administration errors were detected after checking 9 treatment orders; 4 errors (19 orders) were detected by preadministration signing in geriatrics/neurology; and 4 errors (12 orders) in gynaecology, 75% of them by preadministration signing and 25% by wrong pattern. Conclusions Preadministration signing was the most common error, particularly within the surgery service. Apart from that, notifying the administration errors by the pharmacist helps to detect them on time so that they do not continue during hospitalisation.