Conciliação medicamentosa na admissão de pacientes transplantados renais em um hospital universitário / Medication reconciliation in the admission of kidney transplant patients to a university hospital

Introdução:O presente estudo considerou conciliações medicamentosas realizadas na admissão hospitalar de pacientes transplantados renais e intervenções farmacêuticas decorrentes desse processo.Métodos:Trata-se de um estudo transversal realizado no período de julho de 2018 a julho de 2019 no Hospital de Clínicas de Porto Alegre. Foram coletadas as características dos pacientes, as conciliações medicamentosas realizadas pelo farmacêutico clínico, as discrepâncias identificadas pelo mesmo (intencionais e não intencionais) e o resultado das intervenções. Os medicamentos foram classificados de acordo com a Anatomic Therapeutic Chemical (ATC).Resultados:Dos 719 pacientes acompanhados pelo farmacêutico clínico, 175 tiveram a conciliação medicamentosa de admissão realizada, desses, 56 apresentaram discrepâncias não intencionais. Encontramos a média de 2,2 medicamentos omissos por prescrição com desvio padrão de 1,3 medicamentos. No total, foram realizadas 122 intervenções farmacêuticas, sendo que em 61,5% houve adesão por parte da equipe médica. A classe terapêutica com maior ocorrência (43,4%) de discrepâncias não intencionais foi a que atuava sobre o aparelho cardiovascular. As variáveis observadas foram sexo, número de medicamentos nas intervenções (ambas com associação significativa com a adesão médica), idade, tempo de internação, número de medicamentos na internação e número de medicamentos de uso prévio (estas últimas sem associação significativa com a adesão médica). Conclusões:A conciliação medicamentosa previne possíveis erros de medicação, uma vez que a identificação das discrepâncias não intencionais na prescrição médica gera sinalizações que são levadas pelo farmacêutico clínico à equipe assistente, a fim garantir o uso seguro e correto dos medicamentos durante a internação hospitalar.

Introduction:This study considered medication reconciliations performed on hospital admission of kidney transplant patients and pharmaceutical interventions resulting from this process.Methods:This is a cross-sectional study carried out from July 2018 to July 2019 at Hospital de Clínicas de Porto Alegre. The characteristics of the patients, the medication reconciliations performed by the clinical pharmacist, the discrepancies identified by the same (intentional and unintentional) and the result of the interventions were collected. The drugs were classified according to the Anatomic Therapeutic Chemical (ATC). Results:Of the 719 patients monitored by the clinical pharmacist, 175 had medication reconciliation on admission performed, of which 56 had unintentional discrepancies. We found an average of 2.2 missing medications per prescription with a standard deviation of 1.3 medications. In total, 122 pharmaceutical interventions were performed, and in 61.5% there was adherence by the medical team. The therapeutic class with the highest occurrence (43.4%) of unintentional discrepancies was that which acted on the cardiovascular system. The variables observed were gender, number of medications in interventions (both with a significant association with medical adherence), age, length of stay, number of medications in hospitalization and number of medications previously used (the latter without a significant association with medical adherence).Conclusions:Medication reconciliation prevents possible medication errors, since the identification of unintentional discrepancies in the medical prescription generates signals that are taken by the clinical pharmacist to the assistant team, in order to guarantee the safe and correct use of medications during hospitalization.

Pharmacy Information Systems in Teaching Hospitals: A Multi-dimensional Evaluation Study / 대한의료정보학회지

OBJECTIVES: In hospitals, the pharmacy information system (PIS) is usually a sub-system of the hospital information system (HIS). The PIS supports the distribution and management of drugs, shows drug and medical device inventory, and facilitates preparing needed reports. In this study, pharmacy information systems implemented in general teaching hospitals affiliated to medical universities in Tehran (Iran) were evaluated using a multi-dimensional tool. METHODS: This was an evaluation study conducted in 2015. To collect data, a checklist was developed by reviewing the relevant literature; this checklist included both general and specific criteria to evaluate pharmacy information systems. The checklist was then validated by medical informatics experts and pharmacists. The sample of the study included five PIS in general-teaching hospitals affiliated to three medical universities in Tehran (Iran). Data were collected using the checklist and through observing the systems. The findings were presented as tables. RESULTS: Five PIS were evaluated in the five general-teaching hospitals that had the highest bed numbers. The findings showed that the evaluated pharmacy information systems lacked some important general and specific criteria. Among the general evaluation criteria, it was found that only two of the PIS studied were capable of restricting repeated attempts made for unauthorized access to the systems. With respect to the specific evaluation criteria, no attention was paid to the patient safety aspect. CONCLUSIONS: The PIS studied were mainly designed to support financial tasks; little attention was paid to clinical and patient safety features.

Assessment of informatization for the dispensing of medications at a university hospital

INTRODUCTION: Informatics and automation are important tools for the reduction of work, errors and costs in a hospital pharmacy. OBJECTIVES: To describe the structuring and function of an informatized system for the dispensing of medications and to assess its effect on nursing and pharmacy services during the period from 1997 to 2003. MATERIALS AND METHODS: In this descriptive and retrospective study, we performed an analysis of documents addressing the structuring and implementation of the informatized medication dispensing system. In addition, we analyzed the perceptions of nurses, pharmacists and pharmacy assistants who participated in the structuring phase of the system when interviewed about the effect of informatization on administrative aspects (e.g., requisition of medications, presentation of the dispensed medication and system operationalization). RESULTS: The major advantages provided by the new system were 1) the elimination of manual transcripts for prescribed medications, 2) increased speed, 3) better identification of the doses prescribed by physicians, 4) medication labels containing all necessary identification and 5) practicality and safety of optical bar code-based verification of the requested and dispensed medications. CONCLUSIONS: The great majority of the interviewees considered the informatized medication supply system to be of good quality. Analysis of the data provided information that could contribute to the expansion and refinement of the system, provide support for studies regarding the utilization of medications and offer new perspectives for work and productivity.

Medical errors challenges for the health professionals: need of Pharmacovigilance to prevent.

The incidence of different aspects of iatrogenic problems due to drugs is Adverse Events (AEs) 3.7%, Adverse Drug Events (ADEs) 2.4-6.5%, Adverse Drug Reactions (ADRs) is 6.7%. Negligence in serious ADEs and death is 34% and 51% respectively, preventable ADEs is 25-50%. Medication Errors (MEs) occur most often in perscribing (29-56%). The most common cause of MEs is lack of knowledge about the drug (29%) and the patient about 18%. MEs result malpractice claims in 13-25% of cases which occur due to mistakes and slips of action & lapses of memory. The MEs can be prevented by establishing effective Pharmacovigilance control center, which frequently gives proper guidance to the prescribers. Use of computerized decision for prescription writing, effective communication with patient, families, pharmacists and nurses and continuing medical education on information of new drugs and new information on current drugs can be effective tolls to prevent the errors.

El consultorio farmacéutico: un nuevo espacio para la atención farmacéutica / The consulting pharmacist: a new space for pharmaceutical care

En el primer semestre del año 2004 en el Hospital William Allen de Turrialba se implementó un programa de atención y seguimiento farmacoterapéutico que contó con el apoyo administrativo de este centro médico por medio del acceso a un espacio de atención en el edificio de la Consulta Externa. El presente es un trabajo que describe las actividades realizadas y resultados obtenidos del trabajo con pacientes crónicos, en el Consultorio Farmacéutico durante los meses de Febrero a Mayo del 2004. Durante este período los servicios de medicina especializada del hospital, refirieron al servicio de farmacia un total de 46 pacientes, el 68 de estos fueron mayores de 50 años, con un promedio de 1.74 problemas médicos, en su mayoría hipetensos, 25. La moda de consumo de medicamentos fue de 6 y una media de 7.23 más menos 3.84 medicamentos por paciente. Se estableció que las preocupaciones de salud de los pacientes implican en un 81.5, relación con el uso de medicamentos. Se encontraron 34 problemas propios del paciente, 3 problemas de almacenamiento y 34 problemas relacionados con los medicamentos. Se realizaron 122 consultas farmacéuticas y 156 actividades. El 95 de los pacientes abordados refirieron que los problemas iniciales se resolvieron, el mismo porcentaje considera que han adquirido bastante confianza en el uso de sus medicamentos, el 85 refirió que ahora utiliza los medicamentos correctamente. Los médicos tratantes consideraron que sus pacientes utilizan mejor los medicamentos y se han resuelto moderadamente los problemas de éstos. Los tratantes hicieron la observación de que se debe continuar con el seguimiento, incluso ampliarlo hacia los familiares y e incursionar en la visita domiciliar.

Información que las personas recibieron sobre los medicamentos durante la consulta médica ambulatoria de la Seguridad Social / People received information about medications during outpatient social security

Como parte del uso racional de medicamentos se requiere de una prescripción basada en una terapéutica razonada y que la persona usuaria de medicamentos reciba una adecuada información que ayude a la adherencia al tratamiento. Este trabajo es parte de un estudio multicéntrico en Latinoamérica sobre la información que recibieron las personas respecto a los medicamentos durante la consulta médica ambulatoria en un centro de la Seguridad Social. Se entrevistaron inmediatamente después de recibir atención médica, en forma voluntaria, anónima, intencional o no probabilística 500 personas; se obtuvieron datos generales e información recibida sobre el problema de salud, el medicamento, las instrucciones y lo escrito en la prescripción, se creó un índice que luego se reagrupó en tres categorías para valorar si la persona estaba bien, regular o mal informada. Los hallazgos mostraron que las personas entrevistadas en un 21 por ciento estaban bien, 60 por ciento regular y 19 por ciento mal informadas; los factores relevantes relacionados con el proceso de información fueron: sexo...

Normas minimas de calidad de atención al/a la farmacodependiente: en el sector salud, en sus ámbitos público, privado y de de la sociedad civil organizada: Guía y criterios básicos / Minimal normas of addited care

Presenta normas minimas de calidad de atención a la farmacodendiente en el sector salud y sus ámbitos público y privado y de la sociedad civil organizada que posibilten estandarizar y evaluar la calidad de la oferta en la prestación de servicios

Fuentes de información en farmacología / Information sources in pharmacology

En el transcurrir diario de nuestra labor académica y asistencial, frecuente nos enfrentamos a la necesidad de acceder a diversas fuentes de información científica. El uso de estas fuentes ha crecido de manera paralela con el desarrollo científico y tecnológico en los últimos 25 años. Se presenta y discute en este trabajo los principales recursos y fuentes de información disponibles en nuestro medio, especialmente en el área de la farmacología. Exponemos los principales criterios para abordar y discriminar esta información, proponiendo finalmente un flujograma que permita optimizar este proceso.

Sobreusos de tecnologías medicas: racionalidad en la formulacion de lincosaminas / Overuse of medical technology. Rationality of lincosamines formulation

Se presentan los resultados de un estudio descriptivo sobre la racionalidad del uso de las lincosaminas en el total de los pacientes ambulatorios que fueron formulados en un día corriente laborable en el Instituto de Seguros Sociales (ISS) de la seccional Bogotá. Este estudio se hizo con base en la información consignada en las formulas médicas individuales y en los datos de la historia clínica que fundamentaron el diagnóstico o describieron el problema que originó la consulta del paciente. Esta informacion se cotejó con un listado de normas guia para la auditoría del uso de lincosaminas elaboradas por la Administración de Veteranos de los Estados Unidos. Los resultados señalan un empleo completamente injustificado de dichos antibióticos además de una inapropiada formulación de la dosis y duración del tratamiento. Se discuten las implicaciones que sobre la evaluación del uso de tecnologías médicas y sobre la evaluación de la calidad tienen los programas computadorizados como los que en el área de farmacia lleva el ISS en la seccional de Bogotá-Cundinamarca y que sirvieron de fuente de datos de la presente investigación