FrancophonIA/ELRC3.0 huggingface dataset:
English: Different reasons for the occurrence of medication error have been identified.
Danish: Der er afdækket forskellige årsager til forekomsten af medicineringsfejl.
English: • For the treatment of cancer, various administration schedules including daily dosage may be used;
Danish: • Til behandling af kræftsygdomme kan der anvendes forskellige doseringsregimer, herunder daglig dosering;
English: The feedback received from healthcare professional organisations also provided further insight on the root causes for errors.
Danish: Feedbacken fra sundhedsfaglige organisationer har også givet mere indsigt i kerneårsagerne til fejlene.
English: Despite additional risk minimisation measures having already been put in place, reports continued to be received.
Danish: Selvom der allerede er iværksat yderligere risikominimerende foranstaltninger, indkommer der fortsat sådanne rapporter.
English: Systematic review by Saedder and colleagues (2014)1 revealed that 47% of all serious medication errors were caused by only seven drug classes, with methotrexate topping the list in percentage of incidents.
Danish: En systematisk gennemgang ved Saedder og kolleger (2014)1 har vist, at 47 % af alle alvorlige medicineringsfejl forårsages af kun syv lægemiddelklasser, hvor methotrexat står for den højeste procentdel af hændelser.
English: In addition, bulk packaging bear the risk of losing warning information at the time of repackaging which is e.g. common practice in medical centres/hospitals.
Danish: Ved bulkpakninger er der desuden risiko for at gå glip af advarselsinfoen ved ompakning, hvilket f.eks. er almindelig praksis på klinikker/hospitaler.
English: In addition, the PRAC requested the development of a patient card to be inserted inside or attached to the outer packaging.
Danish: PRAC har desuden henstillet til, at der udarbejdes et patientkort, som kan indsættes i eller vedhæftes den ydre emballage.
English: Admission to hospital and transfer of care between institutions and physicians was also noted as a root cause due to poor or a lack of communication between patient/physician, physician/physician, physician/nurse.
Danish: Hospitalsindlæggelse og skift mellem institutioner og læger anføres også som en kerneårsag til ringe eller manglende kommunikation mellem patient/læge, læge/læge og læge/sygeplejerske.
English: In particular, it was reported that bulk packaging such as bottles or tubes does not allow tracking, i.e. easy counting, of the remaining tablets, making it difficult both for patients and caregivers to notice the error.
Danish: Det er navnlig blevet rapporteret, at bulkpakninger som f.eks. beholdere og rør ikke muliggør sporing, idet det ikke er let at tælle de resterende tabletter, hvilket gør det vanskeligt for både patienter og omsorgspersoner at opdage fejlen.
English: The case report analyses showed that the elderly patient population was more predisposed for inadvertent daily use of methotrexate, with more than half of the cases reporting elderly population (65 or over).
Danish: Analyserne af hændelsesrapporterne har vist, at ældre patienter er mere tilbøjelige til fejlagtig daglig dosering af methotrexat, idet over halvdelen af de rapporterede tilfælde omfatter ældre patienter (65 eller derover).
English: • The Pharmacovigilance Risk Assessment Committee (PRAC) considered the procedure under Article 31 of Directive 2001/83/EC for medicinal products containing methotrexate;
Danish: • Udvalget for Risikovurdering inden for Lægemiddelovervågning (PRAC) har behandlet sagen vedrørende methotrexat-holdige lægemidler i henhold til artikel 31 i direktiv 2001/83/EF.
English: Medication errors were also associated with the use of bulk packaging.
Danish: Der er også set medicineringsfejl ved anvendelse af bulkpakninger.
English: In addition, splitting the dose in multiple intakes should no longer be recommended;
Danish: Derudover bør det ikke længere anbefales at opdele dosen i flere indtag.
English: This included the responses submitted by the marketing authorisation holders in writing as well as the views of patients and healthcare professionals;
Danish: Gennemgangen omfattede de skriftlige svar fra indehaverne af markedsføringstilladelse samt input fra patienter og sundhedspersoner.
English: In view of the differences, the PRAC recommended an increased consistency in the implementation of this measure by defining clear, concise and unambiguous warnings for the outer and inner packaging of these products.
Danish: For at imødegå disse forskelle anbefaler PRAC, at denne foranstaltning gennemføres med større konsistens, så der defineres tydelige, præcise og utvetydige advarsler, der skal stå på disse lægemidlers ydre og indre emballage.
English: In the context of this review, the PRAC discussed, in consultation with patients and healthcare professionals, how the risk minimisation measures already in place could be further strengthen and if further measures should be implemented.
Danish: Under gennemgangen har PRAC drøftet med patienter og sundhedspersoner, hvordan de risikominimerende foranstaltninger, der allerede er truffet, kan blive skærpet, og om der bør træffes yderligere foranstaltninger.
English: • For the treatment of autoimmune diseases, which require immunosuppressive therapy like rheumatoid arthritis, psoriasis, Crohn's disease and other autoimmune diseases, it is prescribed as a single low-dose, once a week.
Danish: • Til behandling af autoimmune sygdomme, der kræver immunsupprimerende terapi, f.eks. reumatoid artritis, psoriasis, Crohns sygdom og andre autoimmune tilstande, ordineres det som en lav dosis én gang om ugen.
English: Furthermore, of the 74 articles that met the review's inclusion criteria, 73 contained information about a serious adverse reaction caused by methotrexate-related medication error (found in the FDA Adverse Event Reporting System).
Danish: Ud af de 74 artikler, der opfyldte gennemgangens inklusionskriterier, indeholdt 73 desuden oplysninger om en alvorlig bivirkning forårsaget af methotrexat-relaterede medicineringsfejl (fundet i de amerikanske sundhedsmyndigheders bivirkningsrapporteringssystem).
English: It is indicated in the treatment of cancers such as acute lymphoblastic leukaemia (ALL) and various inflammatory conditions, including rheumatoid arthritis, juvenile idiopathic arthritis, psoriasis, and psoriatic arthritis and as steroid sparing adjunctive therapy in Crohn's disease.
Danish: Det er indiceret til behandling af kræftsygdomme som f.eks. akut lymfatisk leukæmi (ALL) og forskellige inflammatoriske tilstande, herunder reumatoid artritis, juvenil idiopatisk artritis, psoriasis og psoriasisartritis, samt som steroidbesparende tillægsbehandling ved Crohns sygdom.
English: • A direct healthcare professionals communication was also agreed, together with a communication plan;
Danish: • Der er også vedtaget en plan for direkte kommunikation med sundhedspersoner, herunder fremsendelse af brev.
English: On 22 March 2018 Spain therefore triggered a referral under Article 31 of Directive 2001/83/EC resulting from pharmacovigilance data, and requested the PRAC to assess the root causes and the impact of the risk of medication errors on the benefit-risk balance of oral formulation of methotrexate and to issue a recommendation on whether the relevant marketing authorisations should be maintained, varied, suspended or revoked.
Danish: På baggrund af disse lægemiddelovervågningsdata indledte Spanien den 22. marts 2018 derfor en indbringelsesprocedure i henhold til artikel 31 i direktiv 2001/83/EF og bad PRAC om at vurdere kerneårsagerne til medicineringsfejlene og betydningen af risikoen herfor for benefit/risk-forholdet for methotrexat i oral formulering og fremsætte en anbefaling om, hvorvidt de pågældende markedsføringstilladelser bør opretholdes, ændres, suspenderes eller tilbagekaldes.
English: The educational material should also include a reminder for the pharmacist to counsel the patient about the inadvertent daily instead of once-weekly dosing.
Danish: Informationsmaterialet bør også indeholde en påmindelse til apotekspersonalet om at rådgive patienten, hvad angår risikoen for fejlagtig daglig dosering i stedet for ugentlig dosering.
English: It was noted that many different wordings and styles of warnings have been implemented, from very small information on one side of the packaging in black to large red framed information on several sides of the outer packaging, inclusion of a calendar or place to mark the day of intake as well as different texts for the warning.
Danish: Det blev bemærket, at der har været mange forskellige ordlyde og advarselstyper, fra en meget lille tekst på den ene side af emballagen i sort skrift til en stor tekst i rød ramme på flere sider af den ydre emballage, påtryk af en kalender eller plads til at markere, hvilken dag lægemidlet skal tages, samt forskellige typer advarselstekster.
English: Lack of knowledge and clarity on the weekly dosing schedule in some indications was also recurring feature and not limited to patient level.
Danish: Manglende viden og manglende tydelighed, hvad angår doseringsregimet med indgivelse én gang ugentligt i nogle indikationer, er også noget, der går igen, og som ikke er begrænset til patientniveau.
English: A direct healthcare professional communication was also agreed, together with a communication plan, to inform relevant healthcare professionals of the new recommendations and risk minimisation measures agreed.
Danish: Der er også vedtaget en plan for direkte kommunikation med relevante sundhedspersoner for at informere disse pr. brev om de nye anbefalinger og de vedtagne risikominimerende foranstaltninger.
English: Similarly, the boxed warning in SmPC section 4.2 already agreed to be added to the product information of the oral formulations as outcome of the PSUSA should be also reflected in the product information of methotrexate parenteral formulations.
Danish: Tilsvarende bør den indrammede advarsel, der skal anføres i produktinformationen (produktresuméets punkt 4.2) for orale formuleringer af methotrexat, også anføres i produktinformationen for parenterale formuleringer, jf. PSUSA'en.
English: Dividing the prescribed dose in multiple intakes was reported as a risk factor for medication error and no robust evidence could be provided to support the effectiveness of this regimen or identify patient groups for whom benefits of dividing the dose would outweigh the risk of medication errors.
Danish: En opdeling af den ordinerede dosis i flere indtag er rapporteret som en risikofaktor for medicineringsfejl, og der er ikke fundet robust evidens, der understøtter dette regimes effektivitet, ligesom der ikke er identificeret patientgrupper, for hvem fordelen ved en opdeling af dosen vil opveje risikoen for medicineringsfejl.
English: • The PRAC investigated the root causes for the abovementioned risk of medication errors and noted that these can occur at all stages of the medication process;
Danish: • PRAC har undersøgt kerneårsagerne til ovenfor omtalte risiko for medicineringsfejl og bemærker, at disse kan finde sted på alle stadier af medicineringsprocessen.
English: Serious cases of overdose, sometimes fatal, have been reported in patients inadvertently receiving the product daily instead of weekly for indications that require weekly dosing.
Danish: Der er rapporteret om alvorlige tilfælde af overdosering, indimellem med dødelig udgang, hos patienter, der ved en fejl har fået produktet dagligt i stedet for ugentligt ved indikationer, der kræver ugentlig dosering.
English: The risks associated with inappropriate use of methotrexate daily instead of weekly make methotrexate one of the most known high-risk medications prone to medication errors.
Danish: De risici, der er forbundet med fejlagtig brug af methotrexat dagligt i stedet for ugentligt, gør methotrexat til et af de lægemidler, hvor der er højest risiko for medicineringsfejl.
English: The ambiguity due to the product being authorised in different indications with different dosing schedules and lacking clear and visible warnings alerting on the once weekly dosing schedule on the packaging and the use of bulk packaging were identified as root causes for medication errors.
Danish: Den tvetydighed, der skyldes, at produktet er godkendt til forskellige indikationer med forskellige doseringsregimer, og det faktum, at der ikke står tydelige og visuelle advarsler på emballagen om, at produktet skal indgives én gang ugentligt, samt anvendelse af bulkpakninger blev identificeret som kerneårsager til medicineringsfejl.
English: Other subgroups of patients were also identified at risk such as patients with impaired memory and cognitive functions, patients with visual impairment, patients who have difficulties to follow written instructions, patients who split their weekly oral methotrexate dose, patients with co-morbidities and co-medications.
Danish: Andre delgrupper af patienter vurderes også at være omfattet af risikoen, f.eks. patienter med nedsat hukommelse og kognition, patienter med nedsat syn, patienter, der har svært ved at følge skriftlige anvisninger, patienter, der opdeler deres ugentlige orale methotrexat-dosis, og patienter, der har flere sygdomme og skal have anden medicin samtidigt.
English: • The PRAC considered the totality of the data submitted for methotrexate-containing products with regard to the important identified risk of medication errors when methotrexate intended for once weekly use is taken daily by mistake, the root causes for this risk and the effectiveness of the risk minimisation measures in place.
Danish: • PRAC har gennemgået alle de fremsendte data vedrørende methotrexat-holdige lægemidler, hvad angår den afdækkede væsentlige risiko for medicineringsfejl, når methotrexat til indtagelse én gang ugentligt ved en fejl bliver taget dagligt, kerneårsagerne til denne risiko og effektiviteten af de iværksatte risikominimerende foranstaltninger.
English: • The PRAC finally agreed on targeted follow-up questionnaires should be used for all cases of medication errors reported with methotrexate and resulting in overdose.
Danish: • Endelig har PRAC vedtaget, at der skal anvendes målrettede opfølgningsspørgeskemaer i alle indberettede sager om medicineringsfejl med methotrexat og deraf følgende overdosering.
English: The day of the week methotrexate treatment should be taken should be written on the card by the patient.
Danish: Patienten bør notere den ugedag, hvor methotrexat skal tages, på kortet.
English: The PRAC further agreed during its April 2018 plenary meeting to extend the scope to include also parenteral formulations of methotrexate, in view of a number of cases reported with these formulations as well, and due to the fact that for a high number of cases reported as “incorrect schedule of dose administration” with methotrexate, the route of administration and the pharmaceutical form had not been specified.
Danish: Desuden vedtog PRAC på sit plenarmøde i april 2018 at udvide gennemgangen til også at omfatte parenterale formuleringer af methotrexat, da der også er indberettet en række sager med disse formuleringer, og da indgivelsesvej og lægemiddelform ikke er specificeret i mange af de indberettede sager vedrørende "fejlagtig hyppighed af dosering" af methotrexat.
English: • In addition, the PRAC also recommended other changes to the product information of all methotrexate-containing products with at least one indication requiring once weekly dosing to include that only physicians with expertise in using methotrexate-containing medicines should prescribe them and that healthcare professionals should ensure that patients or their carers will be able to follow the once weekly dosing schedule.
Danish: • Desuden anbefaler PRAC også andre ændringer i produktinformationen for alle methotrexatholdige lægemidler med mindst én indikation, der kræver indgivelse én gang ugentligt, således at det anføres, at kun læger med ekspertise i anvendelse af methotrexat-holdige lægemidler bør ordinere disse, og at sundhedspersoner bør sikre sig, at patienterne eller deres omsorgspersoner er i stand til at følge doseringsregimet med indgivelse én gang ugentligt.
English: • The PRAC noted that severe, life-threatening and fatal cases of overdose due to medication errors with methotrexate-containing medicinal products continue to be reported and that the risk minimisation measures in place have not been sufficiently effective to prevent medication errors, in particular with the oral formulations of methotrexate;
Danish: • PRAC bemærker, at der fortsat indberettes svære, livstruende og fatale tilfælde af overdosering, der skyldes medicineringsfejl med methotrexat-holdige lægemidler, og at de iværksatte risikominimerende foranstaltninger ikke har været tilstrækkeligt effektive til at forebygge medicineringsfejl, navnlig med orale formuleringer af methotrexat.
English: An update of the product information of all methotrexate products with at least one indication requiring a once weekly dosing schedule was recommended accordingly.
Danish: Det anbefales derfor, at produktinformationen for alle methotrexat-holdige lægemidler med mindst én indikation, der kræver dosering én gang ugentligt, opdateres i overensstemmelse hermed.
English: The data showed that severe, life-threatening and fatal cases of overdose due to medication errors with methotrexate-containing medicinal products continue to be reported despite the risk minimisation measures in place.
Danish: Dataene har vist, at der fortsat indberettes svære, livstruende og fatale tilfælde af overdosering som følge af medicineringsfejl med methotrexat-holdige lægemidler på trods af de iværksatte risikominimerende foranstaltninger.
English: In addition, although the number of cases reporting medication errors with parenteral formulations was smaller than with oral formulations, the risk of medication error by daily intake/use rather than once weekly is considered a general problem for all methotrexate-containing products with at least one indication that requires once a week dosing.
Danish: Selvom antallet af sager vedrørende medicineringsfejl ved parenterale formuleringer er mindre end ved orale formuleringer, vurderes risikoen for medicineringsfejl i form af dosering/anvendelse dagligt i stedet for én gang ugentligt desuden at være et generelt problem for alle methotrexat-holdige lægemidler med mindst én indikation, der kræver indgivelse én gang ugentligt.
English: While daily instead of once weekly use of methotrexate was mainly reported with oral dosage forms in non-oncologic indications, predominantly rheumatoid arthritis and psoriasis, there were also cases with the use of parenteral formulations, as well as many reports which did not specify the route of administration.
Danish: Der er hovedsagelig rapporteret om fejlagtig daglig brug i stedet for ugentlig brug af methotrexat ved orale formuleringer i ikke-onkologiske indikationer, primært reumatoid artritis og psoriasis, men dette ses også ved brug af parenterale formuleringer, ligesom der er mange rapporter, hvor indgivelsesvejen ikke er angivet.
English: In EU/EEA, despite the risk minimisation measures in place, cases of medication errors are still occurring.
Danish: På trods af de risikominimerende foranstaltninger sker der stadig medicineringsfejl i EU/EØS.
English: For this reason, the PRAC was of the view that the visual reminder agreed for the outer packaging of the oral formulations of methotrexate should also be implemented on the outer packaging of the parenteral formulations of methotrexate with at least one indication requiring once weekly dosing, and that the shorter warning agreed for the immediate packaging of the oral formulations should be implemented on the intermediate (where applicable) and immediate packaging of the parenteral formulations.
Danish: Derfor vurderer PRAC, at den visuelle påmindelse, der skal anføres på den ydre emballage for orale formuleringer af methotrexat, også bør anføres på den ydre emballage for parenterale formuleringer af methotrexat, hvor der er mindst én indikation, der kræver indgivelse én gang ugentligt, og at den korte advarsel, der skal anføres på den indre emballage for orale formuleringer, også bør anføres på den mellemliggende (hvis relevant) og indre emballage for parenterale formuleringer.
English: It was also agreed that for all tablet formulations of methotrexate, bottles and tubes currently used as immediate packaging should be replaced by blisters.
Danish: Hvad angår alle tabletformuleringer af methotrexat, er det også blevet vedtaget, at de beholdere og rør, der aktuelt anvendes som indre emballage, bør udskiftes med blisterkort.
English: • The PRAC concluded that there is a need to further strengthen the current risk minimisation measures by adding warnings in the product information and visual reminders on the outer, intermediate and immediate packaging of methotrexate-containing medicinal products with at least one indication requiring a once weekly dosing, for both oral and parenteral use;
Danish: • PRAC vurderer, at der er behov for at skærpe de nuværende risikominimerende foranstaltninger ved at tilføje advarsler i produktinformationen og anføre visuelle påmindelser på den ydre, mellemliggende og indre emballage for methotrexat-holdige lægemidler med mindst én indikation, der kræver indgivelse én gang ugentligt (for både oral og parenteral anvendelse).
English: To minimise the risk of prescribing errors due to lack of knowledge by the prescriber of the weekly dosing schedule of methotrexate for the treatment of auto-immune diseases, the PRAC was of the view that methotrexate should only be prescribed by physicians with expertise in the use of methotrexate and a full understanding of the risks of methotrexate therapy.
Danish: For at minimere risikoen for ordineringsfejl, som skyldes manglende viden hos den læge, der ordinerer methotrexat til indgivelse én gang ugentligt ved behandling af autoimmune sygdomme, vurderer PRAC, at methotrexat udelukkende bør ordineres af læger med ekspertise i anvendelse af methotrexat og fuld forståelse af risiciene ved methotrexat-behandling.
English: Based on the available data, the PRAC noted that the abovementioned risk of medication errors can occur at all stages of the medication process, from prescription to administration.
Danish: Ud fra de tilgængelige data har PRAC bemærket, at ovenfor omtalte risiko for medicineringsfejl kan ses i alle stadier af medicineringsprocessen fra ordinering til indgivelse.
English: In view of the above, the Committee considers that the benefit-risk balance of methotrexatecontaining medicinal products remains favourable subject to the agreed conditions to the marketing authorisations, and taking into account the agreed amendments to the product information and other risk minimisation measures.
Danish: I lyset af ovenstående vurderer udvalget, at benefit/risk-forholdet for methotrexat-holdige lægemidler fortsat er positivt under forudsætning af, at de vedtagne betingelser for markedsføringstilladelserne og de vedtagne ændringer af produktinformationen og øvrige risikominimerende foranstaltninger gennemføres.
English: The risk of medication errors due to inadvertent daily instead of once weekly dosing is an important identified risk and all methotrexate-containing products for which additional risk minimisation measures are required to address this risk (i.e. replacement of bottles/tubes by blisters, implementation of educational material and patient card), should have a risk management plan (RMP) in place listing all pharmacovigilance activities and risk minimisation measures agreed.
Danish: Risikoen for medicineringsfejl, der skyldes fejlagtig daglig dosering i stedet for ugentlig dosering, er en væsentlig identificeret risiko, og for alle methotrexat-holdige lægemidler, hvor der kræves yderligere risikominimerende foranstaltninger for at imødegå denne risiko (dvs. udskiftning af beholdere/rør med blisterkort, anvendelse af informationsmateriale og patientkort), bør der udarbejdes en risikostyringsplan (RMP) med angivelse af alle vedtagne lægemiddelovervågningsaktiviteter og risikominimerende foranstaltninger.