Blinatumomab use in pediatric ALL: Taking a BiTE out of preparation, administration and toxicity challenges

Blinatumomab is the first in its class bispecific T-cell engager monoclonal antibody, which binds to CD19 expressed on B-cells and CD3 expressed on T-cells, resulting in lysis of CD19-positive cells common in B-cell malignancies. Blinatumomab is Food and Drug Administration (FDA) approved for the treatment of adults and children with relapsed/refractory or minimal residual disease (MRD) positive precursor B-cell ALL (B-ALL). Despite impressive efficacy for the approved indications and favorable toxicity profile compared to standard-of-care chemotherapy, blinatumomab presents unique health-system challenges related to preparation, administration, toxicity monitoring and medication error prevention. Blinatumomab delivery also offers plethora of opportunities for interdisciplinary planning and collaboration. The purpose of this paper is to discuss practical considerations for safe blinatumomab delivery from the pharmacy and nursing perspectives.

COMO CALCULAR O CUSTO DE TECNOLOGIAS QUE PREVINEM OS ERROS DE MEDICAÇÃO

Objetivo: Relatar a experiência de desenvolvimento de uma metodologia para o cálculo do custo de tecnologias que previnem o erro de medicação em uma instituição hospitalar. Método: Estudo descritivo, do tipo relato de experiência, que descreve uma metodologia desenvolvida para o cálculo do custo de tecnologias que previnem o erro de medicação em instituição hospitalar. Resultados: As tecnologias foram classificadas em leve, leve-dura e dura. Para o cálculo do custo, foi aplicado método de custeio direto, utilizando as variáveis de mão de obra e materiais e/ou equipamentos utilizados para o uso dessas tecnologias. Após cálculo de cada variável individualmente, estas foram somadas obtendo-se os custos das tecnologias preventivas. Conclusões: O conhecimento do método de cálculo desse custo proporciona uma visão real do investimento, auxiliando a tomada de decisão do gestor, e incentivo à prevenção do erro de medicação. HOW TO CALCULATE TECHNOLOGY COST TO PREVENT MEDICATION ERROS ABSTRACT Purpose: To report the experience in the development of a methodology in order to calculate the cost of technology that prevents medication error in a hospital institution. Method: Descriptive study, a case report format, describing a methodology developed to calculate the cost of technology in order to prevent medication error in a hospital institution. Results: Technologies were classified as soft, soft-hard and hard. Direct costing method was applied with a view to calculate the cost by using labor variables and/or equipment for the use of those technologies. Thereafter the calculation of each variable, they were summed and it was possible to obtain the cost of preventive technologies. Conclusion: Awareness about calculation method provides a real overview of the investment; it benefits the manager’s decision taking and encourages the medication error prevention. Descriptors: Patient’s safety. Medication erros. Cost and cost analyses. Investiments in health. Economy and Nursing.

Verifying Medication Orders in the Older Population: Are We Using Enough Caution?

OBJECTIVE: To test the common hypothesis that pharmacists may use more caution and resources when processing pediatric versus geriatric medication orders in the hospital setting.<br/> DESIGN: A 26-item electronic survey was distributed to a sample of participating academic medical-center pharmacy directors with the request to disseminate it to staff pharmacists. The survey was resent at two-week intervals on two occasions.<br/> MAIN OUTCOME MEASURE(S): To identify if pharmacists take more caution when processing geriatric or pediatric medication orders, to characterize the frequency pharmacists use drug information resources when processing these orders, and to assess the level of importance pharmacists place on guidelines for medication error prevention when processing medication orders.<br/> RESULTS: A total of 173 out of 271 pharmacists completed the survey, resulting in a high final completion rate of 63.8%. Most were clinical, residencytrained pharmacists. A majority of respondents stated that they take more caution when verifying pediatric medication orders than they do for orders for older people (125 out of 172, or 72.7%). Pharmacists report they were 4.2 times more likely to refer to a drug information resource for ≥ 50% of pediatric orders versus geriatric orders (pediatric: 118 out of 171, or 69.0% vs. geriatric: 59 out of 172, or 34.3%; P < 0.001, or 95% confidence interval [CI] 4.156 [2.647-6.524]). Finally, pharmacists familiar with the guidelines for medication error prevention were 2.3 times more likely to state the pediatric guidelines were very important (pediatric: 51/171, or 29.8% vs. geriatric: 27/172, or 15.7%; P = 0.002, or 95% CI 2.28 [1.35-3.86]).<br/> CONCLUSION: This survey reveals evidence for attitudinal differences in work practices for pharmacists working with medication orders relating to different age groups. Given the challenges involved in drug treatment for the older patient population, a similar level of caution, preparedness to refer to drug information, and to use guidelines should apply for both pediatric medication orders and those for older people, in order to provide safe and comprehensive care.

Verifying Medication Orders in the Older Population: Are We Using Enough Caution?

OBJECTIVE: To test the common hypothesis that pharmacists may use more caution and resources when processing pediatric versus geriatric medication orders in the hospital setting.<br/> DESIGN: A 26-item electronic survey was distributed to a sample of participating academic medical-center pharmacy directors with the request to disseminate it to staff pharmacists. The survey was resent at two-week intervals on two occasions.<br/> MAIN OUTCOME MEASURE(S): To identify if pharmacists take more caution when processing geriatric or pediatric medication orders, to characterize the frequency pharmacists use drug information resources when processing these orders, and to assess the level of importance pharmacists place on guidelines for medication error prevention when processing medication orders.<br/> RESULTS: A total of 173 out of 271 pharmacists completed the survey, resulting in a high final completion rate of 63.8%. Most were clinical, residencytrained pharmacists. A majority of respondents stated that they take more caution when verifying pediatric medication orders than they do for orders for older people (125 out of 172, or 72.7%). Pharmacists report they were 4.2 times more likely to refer to a drug information resource for ≥ 50% of pediatric orders versus geriatric orders (pediatric: 118 out of 171, or 69.0% vs. geriatric: 59 out of 172, or 34.3%; P < 0.001, or 95% confidence interval [CI] 4.156 [2.647-6.524]). Finally, pharmacists familiar with the guidelines for medication error prevention were 2.3 times more likely to state the pediatric guidelines were very important (pediatric: 51/171, or 29.8% vs. geriatric: 27/172, or 15.7%; P = 0.002, or 95% CI 2.28 [1.35-3.86]).<br/> CONCLUSION: This survey reveals evidence for attitudinal differences in work practices for pharmacists working with medication orders relating to different age groups. Given the challenges involved in drug treatment for the older patient population, a similar level of caution, preparedness to refer to drug information, and to use guidelines should apply for both pediatric medication orders and those for older people, in order to provide safe and comprehensive care.

Revista Edição Completa Nº 76 - Janeiro / Fevereiro / Março - 2016

Metodologia de análise de causa raiz para avaliação e prevenção de erros de medicação Methodology analysis of root cause for evaluation and medication error prevention Gustavo Dias da Silva, Zenith Rosa Silvino, Raí Moreira RochaCultura de vigilância em unidade de terapia intensiva: uma estratégia de contenção da resistência bacteriana Intensive care unit surveillance culture: a containment strategy of bacterial resistance Rafaela Alves Arcanjo, Adriana Cristina OliveiraDiagnósticos de enfermagem no contexto pediátrico Nursing diagnosis in pediatric context André Luiz Gomes de Oliveira, Zenith Rosa SilvinoEstratégia multimodal de higienização das mãos na escola: relato de experiência Multimodal strategy for cleaning the hands at school: case studies Paulo Silas Ribeiro Nunes, Carla Moema Fontoura Abissulo, Márcia da Silva Teixeira Fernandez, Ana Karine Ramos Brum, Zenith Rosa Silvino, Helen Campos FerreiraPerfil socioeconômico e funcional do idoso hospitalizado Socioeconomic and functional profile of elders hospitalized Valquíria Carvalho Silva, Thaisa Araújo de Souza, Fátima Helena do Espírito Santo, Thayane Dias dos Santos, Carla Lube de Pinho Chibante, Willian de Andrade Pereira de Brito Profissionais de doação de órgãos e sua saúde mental: reflexões sob olhar de Christophe Dejours Organ donation of professional and their mental health: reflections on look Christophe Dejours Thiago Nogueira Silva, Claudia Mara de Melo Tavares, Paula Isabella Marujo Nunes da Fonseca, Raísa Correia de Souza, Marilei de Melo Tavares e Souza, América Carolina Brandão de Melo SodréEstudo comparativo entre as técnicas de planimetria e fotografia como instrumentos para mensuração de feridas Comparative study among planimetry and photography techniques as instruments for wounds measurement Ana Paula Cardoso Tavares, Ana Luiza Soares Rodrigues, Beatriz Guitton Renaud Baptista de Oliveira O ensino de enfermagem a luz da dialética marxista: uma reflexão acerca da prática pedagógica Nursing education the light of the marxist dialectic: a reflection on the pedagogical practice Iellen Dantas Campos Verdes Rodrigues, Viviane Euzébia Pereira Santos, Alexsandra Rodrigues Feijão, Bárbara Coeli Oliveira da Silva, Vinicius Lino de Souza Neto, Richardson Augusto Rosendo da SilvaA utilização oportuna dos sistemas de informação em saúde pelo enfermeiro de rede básica Use of timely information systems in health for basic nursing network André Luiz de Souza Braga, Marilda Andrade, Elaine Antunes Cortez Sofrimento psíquico em crianças e adolescentes: a família como foco do cuidado de enfermagem Psychic suffering in teens: a how family nursing care of focus Josie Lourdes Costa, Mariana Moreira Neves, Márcia Ribeiro Braz, Carlos Marcelo Balbino, Marilei de Melo Tavares e Souza, Zenith Rosa Silvino

Utilization of neonatal medication error prevention strategies: a clinical practice survey of Australian and New Zealand neonatal units

Background: Medication errors are common in neonatal care and can lead to significant harm. We sought to explore utilization of various medication error prevention strategies across Australian and New Zealand neonatal units (NNUs) through a clinical practice survey. Methods: An electronic survey was distributed in October 2016 to relevant staff at each of the 29 level III NNUs identified as members of the Australian and New Zealand Neonatal Network (ANZNN). The survey contained questions relating to a range of medication error prevention strategies identified from a previous systematic review on the topic. The evaluated interventions targeted different aspects of the medication-use process including prescribing, evaluation/checking of orders by clinical pharmacists, transmission, preparation and dispensing of orders, storage of medications, and medication administration. Results: From the 20 respondents, the evidence-based strategies most commonly utilized were use of smart pumps ( n = 18; 90%), and ward-based clinical pharmacists ( n = 17; 85%). Interventions least commonly utilized included barcode scanning with medication administration ( n = 0; 0%), electronic prescribing and clinical decision support ( n = 1; 5%), and dedicated medication administration nurse ( n = 2; 10%). The total number of evidence-based medication error prevention strategies utilized in each NNU ranged from 2 to 10 (median = 7), 10 of 16 strategies were utilized by less than 50% of NNUs. Conclusion: While evidence supports utilization of a number of medication error prevention strategies, these appear inconsistently utilized across current practice settings.