Sistema de seguridad en la administración de fármacos en servicios pediátricos hospitalarios / Security system in the administration of drugs in hospital pediatric services

Introducción: La administración de fármacos es una práctica cotidiana de mucha responsabilidad ética, social y jurídica, que depende en gran proporción de la implementación de un sistema de seguridad. Objetivo: Evaluar el sistema de seguridad en la administración de fármacos en servicios pediátricos hospitalarios. Métodos: Investigación cuantitativa, descriptiva y transversal realizado en el Hospital Regional Lambayeque de Perú en 2016. Se estudió el universo de enfermeras que laboran en los servicios de hospitalización pediátricos y emergencias, 84 en total. A todas se les aplicó una adaptación del Cuestionario de Autoevaluación del Sistema de Seguridad en la Administración de Fármacos de los hospitales de España. Se calcularon valores absolutos y porcentajes para evaluar el nivel de implementación del sistema. De cada dimensión del cuestionario se hallaron los valores promedios, desviación estándar y valores mínimo y máximo. Resultados: El 40,5 por ciento de las enfermeras consideraron que el sistema de seguridad en la administración de fármacos en las áreas pediátricas se ha implementado parcialmente. Entre las 10 dimensiones de cuestionario, los valores promedios más altos correspondieron a factores del entorno (31,4± 8,3) y competencia y formación profesional (31,4± 8,9). Los promedios más bajos correspondieron a la educación del paciente y familia (9,0 ± 3,5), e información sobre los medicamentos (13,2± 3,8). Conclusiones: El sistema de seguridad en la administración de fármacos en unidades pediátricas del estudio se ha implementado parcialmente. Las dimensiones más críticas son la información sobre el fármaco y al familiar, aspectos que deben ser considerados en un plan de mejora(AU)

Introduction: The administration of drugs is a daily practice that implies big ethical, social and legal responsibilities which depend in a large proportion of a security system´s implementation. Objective: To evaluate the security system in the administration of drugs in hospital pediatric services. Methods: Quantitative, descriptive and cross-sectional research carried out at the Regional Hospital Lambayeque of Peru in 2016. It was studied the sample group of nurses (84 in total) working in the pediatric hospitalization and emergencies services. It was applied to all of them an adaptation of the Self-assessment Questionnaire on the Security System in the Administration of drugs in hospitals in Spain. Absolute values and percentages were calculated to assess the level of implementation of the system. For each dimension of the questionnaire, there were found the mean values, the standard deviation, and the minimum and maximum values. Results: 40.5 percent of the nurses considered that the security system in drugs administration in the pediatric areas has been partially implemented. Among the 10 dimensions of the questionnaire, the highest average values corresponded to environment´s factors (31.4 ± 8.3) and to competence and profesional training (31.4 ± 8.9). The lowest averages corresponded to the education of the patient and the family (9.0 ± 3.5), and information on the medicines (13.2 ± 3.8). Conclusions: The security system in the administration of drugs in pediatric units has been implemented partially. The most critical dimensions are the information on the drugs and the family related ones which are aspects that must be considered in an improvements plan(AU)

Conocimiento del manejo práctico de fármacos en Enfermería. Servicio de reanimación neonatal. Hospital Ginecobstétrico Guanabacoa / Knowledge about practical management of drugs in Nursing. Neonatal resuscitation service. Gynecological and Obstetric Hospital of Guanabacoa

Introducción: El período de nacimiento es una etapa muy vulnerable a cambios, donde en ocasiones es imperiosa la utilización de fármacos para la estabilización. Objetivo: Evaluar la preparación del enfermero que asiste los nacimientos sobre el uso de fármacos. Material y Métodos: Se realizó un estudio descriptivo y retrospectivo, aplicando encuesta previamente validada a enfermeros que asistieron los nacimientos de enero-diciembre 2015 en el Hospital Ginecobstétrico de Guanabacoa. La muestra quedó compuesta por 24 enfermeros que se encontraban laborando físicamente en el centro en igual período de tiempo y lugar. Se analizaron variables relacionadas con afecciones asociadas al manejo de fármacos, así como medicamentos utilizados en el servicio investigado, administración y reacciones adversas de los mismos. Resultados: El 62.5 por ciento no asoció las alteraciones respiratorias a la posibilidad de administración de fármacos, la mayoría conoció los medicamentos que se utilizaron en el servicio investigado y dominaron la administración de los mismos, no así sus reacciones adversas. Conclusiones: La preparación del enfermero que asistió los nacimientos tuvo brechas sobre el uso de fármacos relacionados con las reacciones adversas de los mismos y las afecciones asociadas a su administración(AU)

Introduction: The birth period is a stage which is very vulnerable to changes where, occasionally, the use of drugs is imperative on stabilization. Objective: To assess the nurses´ training in the use of drugs during birth care. Material and methods:A descriptive retrospective study was conducted based on a previously validated questionnaire applied to nurses that cared for births in the Gynecological and Obstetric Hospital of Guanabacoa during the time period January- December 2015. The sample was composed of 24 nurses who were working in the center in the same place and time period. Variables related to conditions associated to the management of drugs were analyzed, as well as the drugs used in the service investigated, their administration, and adverse reactions. Results:The 62.5 percent of them did not associate respiratory disturbances to the possibility of drug administration; most of them knew about the drugs that were used in the service investigated and had a good knowledge of their administration, but not about the adverse reactions. Conclusions: A gap was observed in the training of nurses that cared for births with regard to the use of drugs and their adverse reactions, as well as the conditions associated to their administration(AU)

Design and preparation of a novel colon-targeted tablet of hydrocortisone

ABSTRACT The objective of this research was to design a new colon-targeted drug delivery system based on chitosan. The properties of the films were studied to obtain useful information about the possible applications of composite films. The composite films were used in a bilayer system to investigate their feasibility as coating materials. Tensile strength, swelling degree, solubility, biodegradation degree, Fourier Transform Infrared Spectroscopy (FTIR), Differential Scanning Calorimetry (DSC), Scanning Electron Microscope (SEM) investigations showed that the composite film was formed when chitosan and gelatin were reacted jointly. The results showed that a 6:4 blend ratio was the optimal chitosan/gelatin blend ratio. In vitro drug release results indicated that the Eudragit- and chitosan/gelatin-bilayer coating system prevented drug release in simulated intestinal fluid (SIF) and simulated gastric fluid (SGF). However, the drug release from a bilayer-coated tablet in SCF increased over time, and the drug was almost completely released after 24h. Overall, colon-targeted drug delivery was achieved by using a chitosan/gelatin complex film and a multilayer coating system.

Formulation, characterization and in vivo evaluation of novel edible dosage form containing nebivolol HCl

ABSTRACT The objective of this investigation was to develop a novel oral edible gel dosage form for nebivolol hydrochloride, with suitable rheological characteristics that can provide a means of administering the drug to dysphagic and geriatric patients. Edible gels were prepared using low acetylated gellan gum and sodium citrate in different concentrations. The effect of concentration of the solution on gelation time, viscosity, and drug release was studied. Optimized formulation had "spoon thick" consistency that is considered suitable for dysphagic patients as suggested by National Dysphagia Diet Task Force. The optimized formulation containing gellan gum (0.4 % w/v) and sodium citrate (0.3 % w/v) showed more than 95% drug release in 20 minutes. This formulation also showed significantly better pharmacokinetic profile when compared to marketed conventional tablets in New Zealand white rabbits (n = 3). Optimized formulation was found stable for 6 months when stored at 25 °C ± 0.2 °C/60 ± 5% RH. From this study, it can be concluded that the novel edible gel dosage form containing nebivolol hydrochloride may prove to be more efficacious in the treatment of hypertension in dysphagic patients.

RESUMO O objetivo deste trabalho foi desenvolver um gel comestível para veiculação de cloridrato de nebivolol, com características reológicas adequadas, que podem fornecer meio de administrar o fármaco em casos de disfagia orofaríngea e pacientes geriátricos. Géis comestíveis foram preparados utilizando goma gelana de baixa acetilação e citrato de sódio, em diferentes concentrações. Estudou-se o efeito da concentração da solução no tempo de gelificação, a viscosidade e a liberação do fármaco. A formulação otimizada apresentava consistência de pudim, o que é considerado adequado para pacientes disfágicos como sugerido pela National Dysphagia Diet Task Force. A formulação otimizada contendo 0,4% (m/v) de goma gelana e 0,3% (m/v) de citrato de sódio mostrou que mais de 95% de fármaco foi liberado em 20 minutos. Esta formulação também mostrou, significativamente, melhor perfil farmacocinético, quando comparado com os comprimidos convencionais comercializados administrados a coelhos brancos neozelandeses (n = 3). A formulação otimizada manteve-se estável durante 6 meses, armazenada a 25 oC ± 0,2 °C/60 ± 5% de UR. A partir deste estudo, conclui-se que a nova forma de gel comestível contendo cloridrato de nebivolol pode ser mais eficaz no tratamento de hipertensão em pacientes portadores de disfagia.

Pharmacotherapy review: a proposal to improve medication adherence among hypertensive patients

Abstract Pharmacotherapy review is a structured assessment of medicines, which aims to obtain a partnership with patients to achieve drug treatment goals and agreement about drug dosage, as well as when and how the drugs should be administered. The objective was to analyze the influence of pharmacotherapy review, by scheduling drug administration to improve medication adherence among antihypertensive patients. This study was an uncontrolled intervention developed in three distinct stages. The first stage included data collection on the profile of patients and their medications, and a preliminary assessment of medication adherence. In the second stage, the review report was delivered to patients. In the third stage, the results of blood pressure and medication adherence were assessed. The influence of the revision was measured through statistical tests (p<0.05). The study included 40 patients with a mean age of 58.0 (SD:11.3) years; 72.5% were women. Thirty-three (82.5 %) patients required some intervention, after when there was a significant increase in the number of daily doses (p=0.039) and drug intakes (p=0.025). There was a significant increase in the adherence rate, according to both the Morisky-Green test (p<0.001) and self-reported assessment (p=0.004). There was also an improvement in the levels of systolic (p<0.001) and diastolic (p=0.002) blood pressure and in the number of patients with controlled hypertension (p=0.006). The pharmaceutical service enhanced medication adherence and control of systemic blood pressure; however, it increased the complexity of treatment.

resumo A revisão da farmacoterapia é uma avaliação estruturada dos medicamentos com o objetivo de proporcionar aos pacientes o alcance dos objetivos terapêuticos por meio da forma adequada de administração dos medicamentos. O objetivo foi analisar a influência da revisão da farmacoterapia, por meio do aprazamento dos medicamentos, na adesão à medicação e no controle da hipertensão arterial sistêmica. Trata-se de um estudo de intervenção não controlado desenvolvido em três momentos distintos. No primeiro, realizou-se a coleta de dados sobre o perfil dos pacientes e de suas medicações e a avaliação da adesão; no segundo momento, realizou-se a entrega do relatório da revisão aos pacientes e na terceira etapa avaliou-se o resultado da adesão e pressão arterial. A influência da revisão foi medida por meio de testes estatísticos (p<0,05). Participaram deste estudo 40 pacientes, com média de idade de 58,0 anos (SD:11,3), sendo 72,5% mulheres. Dos pacientes, 33 (82,5%) necessitaram intervenções. Após estas se verificou aumento significativo no número de doses (p=0,039) e no número de tomadas (p=0,025). Houve aumento significativo no número de aderentes tanto pelo teste de Morisky-Green (p<0,001) quanto na avaliação autorreferida (p=0,004). Também, houve melhora nos níveis de pressão sistólica (p<0,001) e diastólica (p=0,002) e no número de pacientes com a pressão controlada (p=0,006). O serviço farmacêutico desenvolvido promoveu aumento da adesão e do controle da pressão arterial, no entanto, aumentou a complexidade do tratamento.