Mapa de riesgo de medicamentos de alto riesgo en un hospital de tamaño medio

espanolObjetivo: Identificar que tipo de medicamentos de alto riesgo (MAR) y con que frecuencia se utilizan en las diferentes unidades del hospital para poder optimizar recursos y establecer prioridades de actuacion.Metodos: En marzo de 2017 se inicio el desarrollo de un programa de MAR en el hospital, integrando acciones implementadas y otras nuevas. Se detectaron los MAR a partir de la lista del Institute for Safe Medication Practice para pacientes agudos, y las soluciones diluidas de potasio a criterio del hospital. Se realizo un estudio observacional transversal del consumo de MAR durante 2017 en urgencias, unidad de cuidados intensivos (UCI), bloque quirurgico (BQ), plantas de hospitalizacion de cirugia de corta estancia (CCE), materno-infantil (MI), medicina interna de agudos (MIA), medicina interna de paliativos (MIP), cirugia general (CIR), traumatologia (TR), psiquiatria, unidad de radiodiagnostico (RX), unidad de hemodialisis (HD) y los hospitales de dia de administracion intravenosa (HDAI) y de pruebas diagnosticas (HDPD).Resultados: Se identificaron 249 MAR (un 22,5% de los medicamentos del hospital), lo que representa un 16% del consumo del hospital. Las unidades que utilizaron mas MAR fueron BQ, UCI, CIR, MIP y MIA. Estas unidades mostraron una tasa de riesgo mas alta, junto con BQ y TR. En algunas unidades, como urgencias, UCI, CIR, MIA y MIP, se consumieron mas de 60 MAR diferentes. Los analgesicos opioides fue el grupo terapeutico mas utilizado en urgencias (37,7%), MIP (37,7%) y TR (26,3%); los sustitutos del plasma y soluciones para infusion (SPSI) en HD (78%) y CIR (27%); los antitromboticos en CCE (60%) y MIA (54,2%), y los anestesicos en BQ (50,7%) y HDPD (81%). En UCI, los MAR mas utilizados fueron los relajantes musculares (42,31%), en RX los contrastes (97,1%), en HDAI los citostaticos (65,2%), en MI la terapia cardiaca (34,6%) y en psiquiatria los antidiabeticos (72%). En general, los antitromboticos, los SPSI, los anestesicos, los analgesicos opioides, los antidiabeticos, los contrastes, la terapia cardiaca, los citostaticos, los relajantes musculares y los psicolepticos constituyeron el top ten de MAR utilizados en nuestro centro.Conclusiones: Nuestras areas de mayor riesgo por su consumo de MAR fueron: BQ, UCI, MIP, MIA, CIR y TR. Los anticoagulantes fueron el grupo terapeutico mas utilizado en el hospital. EnglishGoal: To identify which types of high-alert medications (HAMs) are used in various hospital units and how often in order to optimise resources and establish priorities for action.Methods: In March 2017, development of an HAM programme began at the hospital, integrating both implemented actions and new ones. HAMs were detected from the Institute for Safe Medication Practice list for acute patients and diluted potassium solutions at the hospital’s discretion. A cross-sectional observational study of HAM consumption in 2017 was carried out in the emergency department, intensive care unit, surgical ward, short-stay surgery hospitalisation floors, mother-child department, acute internal medicine, palliative internal medicine, general surgery, traumatology, psychiatry, the X-ray unit, the haemodialysis unit and the intravenous administration and diagnostic day hospitals.Results: 249 HAMs were detected, 22.5% of the hospital medicines, representing 16% of hospital consumption. The units that used the most HAM were the surgical ward, the ICU, general surgery, palliative internal medicine and acute internal medicine. These units showed a higher risk rate, along with the surgical ward and traumatology. In some units such as the emergency department, ICU, general surgery, acute internal medicine and palliative internal medicine, more than 60 different HAMs were consumed. Opioid analgesics were the most commonly used therapeutic group in the emergency department (37.7%), in palliative internal medicine (37.7%) and traumatology (26.3%). Plasma substitutes and infusion solutions in the day hospitals (78%) and general surgery (27%). Antithrombotics in short-stay surgery (60%) and in acute internal medicine (54.2%). Anaesthetics in the surgery ward (50.7%) and diagnostic day hospital (81%). In ICU, the most used HAMs were muscle relaxants (42.31%), in X ray, contrasts (97.1%), in intravenous administration day hospital, cytostatics (65.2%), in mother-child, cardiac therapy (34.6%) and in psychiatry, antidiabetics (72%). In general, antithrombotics, plasma substitutes and infusion solutions, anaesthetics, opioid analgesics, anti-diabetics, contrasts, cardiac therapy, cytostatics, muscle relaxants and psycholeptics were the top ten HAMs used at our centre.Conclusions: The areas of greatest risk due to consumption of HAMs were the surgical ward, the intensive care unit, palliative internal medicine, acute internal medicine, surgery and traumatology. Anticoagulants were the most commonly used treatment group at the hospital.