Letter to the Editor
Blanket orders, an unadvisable practise, yet more and more frequent
Blanket orders, práctica desaconsejada pero cada vez más frecuente
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Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "718" "paginaFinal" => "719" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Anunciación González López, Álvaro Nava Rebollo, Beatriz Andrés Martín, Ángel Chocarro Martínez, Francisco Herrera Gómez, Henar Santana Zapatero, Julia Diego Martín, Cipriano Escaja Muga, Hugo Díaz Molina, Jesús Grande Villoria" "autores" => array:10 [ 0 => array:4 [ "nombre" => "Anunciación" "apellidos" => "González López" "email" => array:1 [ 0 => "gonzaleza@senefro.org" ] "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" => "Álvaro" "apellidos" => "Nava Rebollo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => 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=> "Cipriano" "apellidos" => "Escaja Muga" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 8 => array:3 [ "nombre" => "Hugo" "apellidos" => "Díaz Molina" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 9 => array:3 [ "nombre" => "Jesús" "apellidos" => "Grande Villoria" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Virgen de la Concha, Zamora, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Virgen de la Concha, Zamora, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Blanket orders</span>, práctica desaconsejada pero cada vez más frecuente" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">One concern in relation to drug safety is to reconcile the patient's treatment when changing to another healthcare area. There are reports showing that hospital admissions and transfers to different hospital services or hospital discharges are a cause of error in the treatment medication.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The process of conciliation of the treatment at discharge includes a double supervision. Both, the list of drugs that the patient was taking prior to admission and the drugs prescribed during admission must be conciled to obtain a single list. Generic orders or instructions, such as “resume usual medication”, “continue the usual treatment” or “maintain the same treatment”, known as <span class="elsevierStyleItalic">blanket orders</span>,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1,2</span></a> are not acceptable.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We have assessed the magnitude of <span class="elsevierStyleItalic">blanket orders</span> in our department, how it has been evolving and associated variables. To that effect, we performed a retrospective analysis of hospital discharges and outpatient reports issued at our hospital's Department of Nephrology from 2006 to 2014. The following variables were collected: date of the report, author, days of admission, age and gender of the patient, presence of multiple pathologies (4 or more diseases), renal replacement therapy (dialysis), use of and the type of <span class="elsevierStyleItalic">blanket order</span>. Our hospital does not have computerised medical records, clinical reports are the only tool available to clinicians to report therapeutic changes.</p><p id="par0020" class="elsevierStylePara elsevierViewall">During the period of evaluation, 2358 clinical reports were issued at our department. After excluding deceased patients (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>61), the number of reports analysed for this study dropped to 2297. Of these, 1190 were hospital discharges (50.5%). Fifty-five per cent (55%) of the patients were male, 68.3% had multiple pathologies and 26% were on dialysis. <span class="elsevierStyleItalic">Blanket orders</span> were used in 50.2% of the cases (1153), with a greater frequency in hospitalised patients than in outpatients (53.1% vs. 47.1%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.004). The types of <span class="elsevierStyleItalic">blanket order</span> found were: “continue the usual treatment” in 65% (751); “as indicated at the time of discharge” in 27.4% (316); “rest of medication as prescribed by another specialist” in 4.16% (48); and other <span class="elsevierStyleItalic">blanket orders</span> in 3.2% (37). The percentages of <span class="elsevierStyleItalic">blanket orders</span> increased over the years (37.5% in 2006 compared with 57.8% in 2014, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0001), but were not influenced by the month issued, nor by the patients’ age or gender. On the contrary, <span class="elsevierStyleItalic">blanket orders</span> were more frequent in patients with multiple pathologies (55.3 vs. 38.1%, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.000), in patients on dialysis (64.8 vs. 44.9%, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.000) and in patients admitted for a short periods of time (mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD) (6.98<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.29 vs. 10.25<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.23 days; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0001).</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Blanket orders</span> are used in almost half of the clinical reports and the data indicate that, far from diminishing, this practice is progressively more frequent. It is not surprising that <span class="elsevierStyleItalic">blanket orders</span> are more common in patients with brief hospital stays and multiple pathologies, in whom therapeutic conciliation is more complex and requires greater effort. Although medical records are not computerised, we do have a follow-up programme for patients on dialysis, which would explain the existence of a high percentage of <span class="elsevierStyleItalic">blanket orders</span> in these patients (possibly by giving them a copy of the software without transcribing such treatment in the discharge report).</p><p id="par0030" class="elsevierStylePara elsevierViewall">The use of <span class="elsevierStyleItalic">blanket orders</span> is a practice that should be eliminated. In fact, they are explicitly prohibited by the JCAHO's Medication Management Standard MM 3.20.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> The existence of this type of order immediately shows that the conciliation of treatment was not done. In 2006, the JCAHO added the requirement of giving to patients the reconciled medication list at discharge, written in appropriate and understandable language.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">We hope that in the future new computer tools will help to improve this type of care; however, awareness of this issue by all professionals will continue to be essential.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that there are no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: González López A, Nava Rebollo Á, Andrés Martín B, Chocarro Martínez Á, Herrera Gómez F, Santana Zapatero H, et al. <span class="elsevierStyleItalic">Blanket orders</span>, práctica desaconsejada pero cada vez más frecuente. Nefrología. 2016;36:718–719.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Conciliación de la medicación" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "O. Delgado Sánchez" 1 => "L. Anoz Jiménez" 2 => "A. Serrano Fabia" 3 => "J. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 8 | 16 |
| 2024 October | 165 | 55 | 220 |
| 2024 September | 125 | 43 | 168 |
| 2024 August | 132 | 73 | 205 |
| 2024 July | 110 | 34 | 144 |
| 2024 June | 147 | 39 | 186 |
| 2024 May | 98 | 45 | 143 |
| 2024 April | 114 | 54 | 168 |
| 2024 March | 92 | 36 | 128 |
| 2024 February | 91 | 43 | 134 |
| 2024 January | 74 | 32 | 106 |
| 2023 December | 76 | 24 | 100 |
| 2023 November | 95 | 28 | 123 |
| 2023 October | 82 | 29 | 111 |
| 2023 September | 65 | 36 | 101 |
| 2023 August | 80 | 27 | 107 |
| 2023 July | 120 | 42 | 162 |
| 2023 June | 95 | 32 | 127 |
| 2023 May | 106 | 41 | 147 |
| 2023 April | 57 | 19 | 76 |
| 2023 March | 107 | 28 | 135 |
| 2023 February | 91 | 23 | 114 |
| 2023 January | 63 | 28 | 91 |
| 2022 December | 81 | 22 | 103 |
| 2022 November | 78 | 30 | 108 |
| 2022 October | 118 | 43 | 161 |
| 2022 September | 101 | 32 | 133 |
| 2022 August | 101 | 39 | 140 |
| 2022 July | 80 | 34 | 114 |
| 2022 June | 88 | 26 | 114 |
| 2022 May | 91 | 32 | 123 |
| 2022 April | 71 | 43 | 114 |
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| 2022 February | 78 | 37 | 115 |
| 2022 January | 121 | 33 | 154 |
| 2021 December | 72 | 41 | 113 |
| 2021 November | 79 | 39 | 118 |
| 2021 October | 67 | 40 | 107 |
| 2021 September | 77 | 37 | 114 |
| 2021 August | 82 | 48 | 130 |
| 2021 July | 71 | 30 | 101 |
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| 2021 May | 66 | 48 | 114 |
| 2021 April | 120 | 42 | 162 |
| 2021 March | 87 | 38 | 125 |
| 2021 February | 52 | 30 | 82 |
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| 2020 December | 55 | 16 | 71 |
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| 2020 October | 57 | 20 | 77 |
| 2020 September | 54 | 11 | 65 |
| 2020 August | 55 | 14 | 69 |
| 2020 July | 32 | 11 | 43 |
| 2020 June | 42 | 15 | 57 |
| 2020 May | 55 | 16 | 71 |
| 2020 April | 47 | 11 | 58 |
| 2020 March | 40 | 19 | 59 |
| 2020 February | 48 | 189 | 237 |
| 2020 January | 42 | 26 | 68 |
| 2019 December | 36 | 26 | 62 |
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| 2019 October | 18 | 13 | 31 |
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| 2019 August | 16 | 17 | 33 |
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| 2019 June | 30 | 14 | 44 |
| 2019 May | 28 | 27 | 55 |
| 2019 April | 45 | 40 | 85 |
| 2019 March | 31 | 27 | 58 |
| 2019 February | 28 | 17 | 45 |
| 2019 January | 24 | 30 | 54 |
| 2018 December | 111 | 52 | 163 |
| 2018 November | 185 | 32 | 217 |
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| 2018 September | 77 | 9 | 86 |
| 2018 August | 47 | 19 | 66 |
| 2018 July | 54 | 10 | 64 |
| 2018 June | 55 | 17 | 72 |
| 2018 May | 79 | 18 | 97 |
| 2018 April | 112 | 10 | 122 |
| 2018 March | 81 | 8 | 89 |
| 2018 February | 107 | 7 | 114 |
| 2018 January | 79 | 6 | 85 |
| 2017 December | 107 | 6 | 113 |
| 2017 November | 49 | 11 | 60 |
| 2017 October | 37 | 6 | 43 |
| 2017 September | 44 | 22 | 66 |
| 2017 August | 41 | 32 | 73 |
| 2017 July | 50 | 15 | 65 |
| 2017 June | 43 | 54 | 97 |
| 2017 May | 47 | 14 | 61 |
| 2017 April | 38 | 15 | 53 |
| 2017 March | 35 | 35 | 70 |
| 2017 February | 36 | 9 | 45 |
| 2017 January | 24 | 4 | 28 |
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