Yi Pei Liu has passion in improving the health. She is a pharmacist for many years; she is very much interested in long-term care and old age care, so she is willing to participate in such medical work.
Objectives: SSRIs are most generally prescribed antidepressants for elderly, because of their more safety profile compared with the older antidepressants. However, its widespread use leads to an increased occurrence of rare adverse effects, such as increased IOP uveal effusions, and acute bilateral angle closure glaucoma. Thus we review English lectures to evaluate reports of ocular side effects associated with SSRIs. Methods: A review of English lectures in Google Scholar, Pubmed and Ovid Mdeline, which issues were associated with the role of SSRIs in the control of intraocular pressure (IOP) and the evidence for IOP modifications in patients receiving SSRIs. Results: Most cases reported in the literature, the acute angle-closure glaucoma represents with increased IOP is the most important SSRIs-related ocular adverse event. The case report of Joseph et al. also posted high-frequency ultrasonography revealed bilateral choroidal effusions with ciliary body detachments and angle closure after Escitalopram use, but normalization of IOP after discontinuations of Escitalopram. Besides, some literatures reported that SSRIs prescription in elderly must be cautious, because the modulation of IOP, ciliary body and irido-corneal angle becomes poorer with age increasing. Thus, the FDA has issued new warnings for SSRIs in treating depression due to the potential high risk of acute angle-closure glaucoma, especially in elderly. Conclusions: Bilateral acute angle-closure glaucoma and critical increased IOP could be major dangerous ocular side effects of SSRIs. Thus, ophthalmological consultations should be considered before starting and during treatment with any SSRI in patients with glaucomatous risk factors, especially those who are elderly. If ocular side effects appearance after treatment with SSRIs, these drugs should be discontinued as soon as possible.
Maria Jose Merino Plaza is a Pharmacist specialized in Clinical Analysis, responsible for the clinical analysis laboratory of Doctor Moliner Hospital, a medium stay Hospital in Valencia, Spain since 1994. Master in Quality Management. Since 2010 she is responsible for quality of the center and is very committed to the exciting topics related with Job Satisfaction and Patient Safety Culture. At the moment she is conducting her Ph.D. on Quality of Care and Patient Safety in a medium stay Hospital in collaboration with the University of Granada, Spain. Among her professional competences can be highlighted the management of multidisciplinary human teams, the definition and implementation of quality management mechanisms and the high analytical, relational, interpersonal, organizational and empathy skills.
Statement of the Problem: Risk map is a tool that allows the classification of the risks information of the Organization and to visualize its magnitude, facilitating the development of adequate strategies for their management. The Modal Analysis of Failures and Effects (AMFE) is a risk assessment tool widely used in the healthcare field. It is a simple and useful method for the analysis of potential failures with important repercussions and is useful for the analysis of risks related to patient safety. Aim: To identify the most frequent risks related to patient safety in a Chronic Care Hospital, to analyze its causes and to implement improvement actions. Methodology & Theoretical Orientation: Elaboration of an AMFE to visualize graphically the magnitude of the identified risks according to their Index Priority Risk (IPR). Development of QFD's to prioritize the implementation of the proposed improvement actions. Findings: Identification and analysis of 31 failure modes, related with the main processes of the Hospital, identifying multiple causes and preventive actions for each of them. From the elaboration of the risk map, an increase of the security culture and adverse events declaration through the notification system happened, moving from 8 declared in 2013 to 189 in 2014, 299 in 2015 and 301 in 2016. The 3 main failure modes identified, with an IPR of 700 and whose approach was a priority, were the errors related to medication the failures in communication during the transfer of information and the lack of protocols for some tasks or the lack of adherence. Improvement plans were developed with strategies to manage the identified risks. Conclusion & Significance: The AMFE performed in the different processes of the Chronic Care Hospital brings a greater knowledge of them, increases awareness to avoid errors and disseminates greater awareness of a culture that improves patient safety.