The pharmaceutical care bundle: development and evaluation of an instrument for inpatient monitoring

Introduction: Care bundles help healthcare professionals provide the best care possible in a structured and reliable way. The purpose of this study was to develop and apply an instrument for inpatient follow-up by clinical pharmacists, and evaluate its results. Methods: The care bundle was based on previously validated instruments. Population consisted of patients monitored by clinical pharmacists at a general hospital. The study was conducted in two phases: the first involved the development and implementation of the bundle, and the evaluation of pharmaceutical interventions; the second involved analyzing data from patients treated with the bundle over one year. Results: The bundle included fourteen pharmaceutical follow-up criteria used in different patterns by each area of care. In the first phase of the study, 3263 patients were monitored and 536 pharmaceutical interventions were performed, with an 85.3% compliance rate. In the second phase of the study, follow-up data was collected from 21,214 patients. The bundle criteria were used in a similar way in clinical, surgical and cancer patients. Pharmacotherapy review was the most prevalent intervention in all cases (60.1%). Hospital discharge planning and medication reconciliation were performed with a similar frequency in clinical, surgical, pediatric and general patients. Conclusions: The development and validation of a bundle aimed at guiding the clinical activities of pharmacists helped standardize procedures and interventions. Pharmacotherapy review was the bundle criterion with the highest rate of application and interventions due to the hospital's complexity and the need to consider individual patient needs and follow institutional policies. (AU)

Benefícios da hipodermóclise na clínica paliativa de pacientes com câncer: relato de caso / Benefits of hypodermoclysis in palliative care of cancer patients: case report / Beneficios de la hipodermoclisis en la clínica paliativa de pacientes con cáncer: presentación de caso

Introdução: A hipodermóclise é uma via de infusão em pacientes com câncer nos casos em que os acessos oral e endovenoso não estão disponíveis. Considerando a sua utilidade no controle dos sintomas no final de vida, faz-se importante ampliar o conhecimento e a divulgação das experiências quanto aos seus benefícios. Relato de caso: Trata-se de dois relatos de caso de pacientes com câncer, nos quais a hipodermóclise foi utilizada para administração de medicamentos. Conclusão: Essa prática apresentou-se como uma via segura, minimamente invasiva e eficaz no tratamento sintomático dos pacientes com câncer em cuidados paliativos.

Introduction: Hypodermoclysis is an infusion route for cancer patients for whom oral and intravenous routes are not available. Considering its usefulness in the control of end-of-life symptoms, it is important to share knowledge and experiences about its benefits. Case Report: Two cases of cancer patients for whom hypodermoclisis was used as route of drug administration. Conclusion: This practice proved to be a safe route, less invasive and effective in the symptomatic treatment of cancer patients in palliative care.

Introducción: Hipodermoclisis es una vía de infusión para los pacientes con cáncer en aquellos casos en que administración oral y intravenosa se hacen inviables. Em vista de su utilidad en el control de los síntomas en el fin de vida, es importante ampliar el conocimiento y la difusión de experiencias de sus beneficios. Caso clínico: Se trata de dos casos de pacientes que se utilizó la hipodermoclisis para la administración de medicamentos. Conclusión: Esta práctica demostró ser una ruta segura, menos invasiva y eficaz en el tratamiento sintomático de los pacientes con cáncer en cuidados paliativos.

Avaliação de pacientes pós-tratamento com terlipressina / Evaluation of patients after treatment with terlipressin

Introdução: Sangramento de varizes esofágicas e síndrome hepatorrenal são complicações com altas taxas de morbidade e são comuns em pacientes cirróticos.A terlipressina é um fármaco com atividade vasoconstritora utilizado para melhorar as condições clínicas dessas complicações tanto no pré quanto no pós-operatório.Objetivo: Descrever o perfil dos pacientes submetidos ao tratamento com terlipressina, bem como avaliar a situação clínica após o tratamento e seu desfecho.Método: Estudo transversal, descritivo, com análise de prontuários eletrônicos de pacientes que receberam terlipressina em um hospital do sul do Brasil. Osdados analisados foram idade, sexo, período de internação, quantidade de doses administradas ao paciente durante o tratamento com terlipressina, duração dotratamento, causa da internação hospitalar, indicação da terlipressina, se seu usofoi conforme o Protocolo Assistencial de Hemorragia Digestiva (no caso de varizesesofágicas) e condição do paciente na alta.Resultados: Foram avaliados 37 prontuários. Observou-se que 18 (48,7%)pacientes tinham idade superior a 60 anos; 25 (67,6%) eram do sexo masculino;para 18 (48,7%) o tempo de internação ficou em torno de 7 dias; 14 (37,8%) foram internados por sangramento digestivo, sendo que, desses, 11 (78,6%) não puderamseguir as condutas do Protocolo Assistencial de Hemorragia Digestiva; 17 (45,9%)receberam mais de 12 doses de terlipressina, que, para 19 (51,3%), durou até dois dias.Conclusão: Considerando a gravidade dos pacientes, os resultados foram concordantes com os dados disponíveis na literatura. O uso de terlipressina justificase por melhorar as condições clínicas dos pacientes e por aumentar a sobrevida em casos mais críticos.

Background: Variceal bleeding and hepatorenal syndrome are complications with high morbidity and common in cirrhotic patients. Terlipressin is a vasoconstrictor drug used to both pre and postoperatively improve clinical conditions of these two complications.Aim: To describe the profile of patients undergoing treatment with terlipressin and to assess the clinical condition after treatment and its outcome Method: Cross-sectional, descriptive study with analysis of electronic medical records of patients receiving terlipressin in a hospital in the south of Brazil. The data analyzed were age, gender, length of stay, number of doses administered to thepatient during treatment with terlipressin, treatment duration, cause of hospitalization,indication of terlipressin, whether the use of this drug followed the Digestive BleedingCare Protocol (for esophageal varices), and the patient’s condition at discharge.Results: We evaluated 37 medical records. We observed that 18 (48.7%) patientswere aged over 60 years; 25 (67.6%) were male; 18 (48.7%) were hospitalizedaround 7 days; 14 (37.8%) were hospitalized due to gastrointestinal bleeding, and11 of them (78.6%) were not able to follow the Digestive Bleeding Care Protocol;17 (45.9%) received more than 12 doses of terlipressin; and 19 (51.3%) patientsreceived terlipressin until two days.Conclusion: Considering the severity of the patients, the results were consistent with the data available in the literature. The use of terlipressin was justified by the improvement of the patients’ clinical conditions and by the increase in survival incritical cases.