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OBJECTIVE: To design a homogeneous methodology for the registration and analysis of pharmaceutical interventions performed in Spanish critical adults' care units. METHOD: Observational, prospective and multicenter study. In the first stage, a national registry of pharmaceutical interventions will be agreed upon and subsequently all the pharmaceutical interventions performed on adult patients admitted to Spanish CCUs during eight weeks will be recorded. Variables related to the type of CCU, the drug involved in the intervention, type of intervention (indication, effectiveness, safety), recommendation made by the pharmacist and the degree of acceptance will be evaluated. Risk and incidence will be calculated for each of the medication errors detected. The χ2-squared test or Fisher exact test will be used for categorical variables and Mann-Whitney U or Kruskal-Wallis test for continuous variables. All tests will be performed with a significance level αâ¯=â¯0.05 and confidence intervals with confidence 1- α. DISCUSSION: The results obtained from this project will make it possible to obtain a homogeneous classification of the pharmaceutical interventions performed in CCU, a national record and an evaluation of the weak points with the aim of developing strategies for improvement in the pharmaceutical care of the critically ill patient.
ABSTRACT
We describe a Caucasian man in his late 60s who was admitted to the intensive care unit (ICU) with a history of cardiogenic shock secondary to an acute myocardial infarction. The patient's baseline serum creatinine levels were 0.9-1 mg/dL. On day 7 of the admission treatment with quetiapine was initiated due to a delirium episode. The next day the patient developed an erythematous-maculopapular rash and fever, with eosinophilia in the blood count. Over the following days the patient experienced an acute deterioration of kidney function requiring continuous renal replacement therapy. The skin lesions and eosinophilia resolved after withdrawal of quetiapine and systemic steroid therapy was administered. The patient was discharged from the ICU with a serum creatinine level of 2.6 mg/dL. Three months later, blood tests showed no recovery of the kidney function. According to the Naranjo adverse drug reaction probability scale, this event would be classified as 'probable' DRESS syndrome and, based on the RegiSCAR scoring system, was classified as 'definite' DRESS syndrome.
Subject(s)
Drug Hypersensitivity Syndrome , Eosinophilia , Drug Hypersensitivity Syndrome/diagnosis , Drug Hypersensitivity Syndrome/drug therapy , Drug Hypersensitivity Syndrome/etiology , Eosinophilia/chemically induced , Eosinophilia/complications , Eosinophilia/diagnosis , Humans , Kidney , Male , Quetiapine Fumarate/adverse effectsABSTRACT
BACKGROUND: Intravenous drug administration is associated with potential complications, such as phlebitis. The physiochemical characteristics of the infusate play a very important role in some of these problems. AIM: The aim of this study was to standardize the dilutions of intravenous drugs most commonly used in hospitalized adult patients and to characterize their pH, osmolarity and cytotoxic nature to better guide the selection of the most appropriate vascular access. METHODS: The project was conducted in three phases: (i) standardization of intravenous therapy, which was conducted using a modified double-round Delphi method; (ii) characterization of the dilutions agreed on in the previous phase by means of determining the osmolarity and pH of each of the agreed concentrations, and recording the vesicant nature based on the information in literature; and (iii) algorithm proposal for selecting the most appropriate vascular access, taking into account the information gathered in the previous phases. RESULTS: In total, 112 drugs were standardized and 307 different admixtures were assessed for pH, osmolarity and vesicant nature. Of these, 123 admixtures (40%), had osmolarity values >600 mOsm/L, pH < 4 or > 9, or were classified as vesicants. In these cases, selection of the most suitable route of infusion and vascular access device is crucial to minimize the risk of phlebitis-type complications. CONCLUSIONS: Increasing safety of intravenous therapy should be a priority in the healthcare settings. Knowing the characteristics of drugs to assess the risk involved in their administration related to their physicochemical nature may be useful to guide decision making regarding the most appropriate vascular access and devices.
Subject(s)
Infusions, Intravenous/adverse effects , Infusions, Intravenous/standards , Adult , Algorithms , Delphi Technique , Humans , Hydrogen-Ion Concentration , Inpatients , Irritants , Osmolar Concentration , Phlebitis/etiology , Spain , Vascular Access Devices/adverse effects , Vascular Access Devices/standardsABSTRACT
Objetivo: Describir la situación actual del farmacéutico de hospital en las unidades de cuidados intensivos, su actividad asistencial, docente e investigadora. Método: Estudio multicéntrico, prospectivo mediante encuesta difundida por la Sociedad Española de Farmacia Hospitalaria, la cual constaba de varios apartados: datos personales y del hospital, características del hospital, implicación del farmacéutico en la unidad de cuidados intensivos y docencia. Resultados: Se obtuvieron 58 encuestas completadas. El número de farmacéuticos implicados en unidades de cuidados intensivos era 1 en el 77,6% de los casos, atendiendo una media de 30,8 camas (5-70). La experiencia en la unidad de cuidados intensivos del farmacéutico fue de 5 años de mediana (2 meses-25 años). La asistencia al pase de visita o cambios de guardia fue entre "nunca" en un 36,2% a "diariamente" en un 22,4%. El 93,1% de los encuestados reportaron dedicación a tiempo parcial en la unidad de cuidados intensivos. Respecto a actividades desarrolladas, entre el 40-60% gestiona estupefacientes, docencia en unidad de cuidados intensivos, conciliación y seguridad; entre el 60-80% abarca nutrición clínica, protocolización, optimización de antibióticos y farmacocinética, y un 84,5% realizan seguimiento farmacoterapéutico. Un 77,6% cuenta con formación sanitaria especializada, rotando los residentes en la unidad de cuidados intensivos en un 86% de los casos. Conclusiones: La mayor parte de los hospitales encuestados cuenta con un solo farmacéutico a tiempo parcial en estas unidades. Con objeto de mejorar la calidad de la atención farmacéutica del paciente crítico sería necesario ampliar la dedicación en tiempo y personal respecto a la situación actual y que más centros incluyan al farmacéutico en las unidades de cuidados intensivos hospitalarias
Objective: To describe the current situation of the hospital pharmacist in intensive care units and their activity in care, in teaching and in research. Method: Multicenter and prospective study through a survey disseminated by the Spanish Society of Hospital Pharmacy, which consisted of several sections: personal and hospital's data, hospital's characteristics, pharmacist's involvement in intensive care units and teaching. Results: A number of 58 completed surveys were obtained. The number of pharmacists involved in intensive care units was 1 in 77.6% of cases, assisting an average of 30.8 beds (5-70). Experience of pharmacists in the intensive care unit was 5 years on average (2 months-25 years). Visitor's pass assistance and shift changes were between "never" by 36.2% to "daily" by 22.4%. Out of respondents, 93.1% reported a part-time intensive care unit involvement. Regarding activities undertaken, between 40-60% of pharmacists manage narcotics, teaching at intensive care unit, conciliation and safety. Between 60-80%, pharmacists cover clinical nutrition, notarization, optimization of pharmacokinetics and antibiotics; and 84.5% perform pharmacotherapy follow-up. Out of the surveyed pharmacists, 77.6% have specialized medical training, rotating intensive care unit residents in 86% of cases. Conclusions: Most of the surveyed hospitals have one part-time pharmacist in these units. In order to improve the quality of pharmaceutical care of critically ill patients, it would be necessary to extend the involvement in time and staff, regarding the current situation, and a greater number of hospitals should include pharmacists in hospital intensive care units
Subject(s)
Humans , Intensive Care Units/organization & administration , Pharmacists , Pharmacy Service, Hospital/organization & administration , Critical Care , Medication Therapy Management , Medication Reconciliation , Narcotics/therapeutic use , Patient Care Team , Patient Safety , Prospective Studies , Spain/epidemiology , Surveys and Questionnaires , TeachingABSTRACT
OBJECTIVE: To describe the current situation of the hospital pharmacist in intensive care units and their activity in care, in teaching and in research. METHOD: Multicenter and prospective study through a survey disseminated by the Spanish Society of Hospital Pharmacy, which consisted of several sections: personal and hospital's data, hospital's characteristics, pharmacist's involvement in intensive care units and teaching. RESULTS: A number of 58 completed surveys were obtained. The number of pharmacists involved in intensive care units was 1 in 77.6% of cases, assisting an average of 30.8 beds (5-70). Experience of pharmacists in the intensive care unit was 5 years on average (2 months-25 years). Visitor's pass assistance and shift changes were between "never" by 36.2% to "daily" by 22.4%. Out of respondents, 93.1% reported a part-time intensive care unit involvement. Regarding activities undertaken, between 40-60% of pharmacists manage narcotics, teaching at intensive care unit, conciliation and safety. Between 60-80%, pharmacists cover clinical nutrition, notarization, optimization of pharmacokinetics and antibiotics; and 84.5% perform pharmacotherapy follow-up. Out of the surveyed pharmacists, 77.6% have specialized medical training, rotating intensive care unit residents in 86% of cases. CONCLUSIONS: Most of the surveyed hospitals have one part-time pharmacist in these units. In order to improve the quality of pharmaceutical care of critically ill patients, it would be necessary to extend the involvement in time and staff, regarding the current situation, and a greater number of hospitals should include pharmacists in hospital intensive care units.
Objetivo: Describir la situación actual del farmacéutico de hospital en las unidades de cuidados intensivos, su actividad asistencial, docente e investigadora.Método: Estudio multicéntrico, prospectivo mediante encuesta difundida por la Sociedad Española de Farmacia Hospitalaria, la cual constaba de varios apartados: datos personales y del hospital, características del hospital, implicación del farmacéutico en la unidad de cuidados intensivos y docencia.Resultados: Se obtuvieron 58 encuestas completadas. El número de farmacéuticos implicados en unidades de cuidados intensivos era 1 en el 77,6% de los casos, atendiendo una media de 30,8 camas (5-70). La experiencia en la unidad de cuidados intensivos del farmacéutico fue de 5 años de mediana (2 meses-25 años). La asistencia al pase de visita o cambios de guardia fue entre "nunca" en un 36,2% a "diariamente" en un 22,4%. El 93,1% de los encuestados reportaron dedicación a tiempo parcial en la unidad de cuidados intensivos. Respecto a actividades desarrolladas, entre el 40-60% gestiona estupefacientes, docencia en unidad de cuidados intensivos, conciliación y seguridad; entre el 60-80% abarca nutrición clínica, protocolización, optimización de antibióticos y farmacocinética, y un 84,5% realizan seguimiento farmacoterapéutico. Un 77,6% cuenta con formación sanitaria especializada, rotando los residentes en la unidad de cuidados intensivos en un 86% de los casos.Conclusiones: La mayor parte de los hospitales encuestados cuenta con un solo farmacéutico a tiempo parcial en estas unidades. Con objeto de mejorar la calidad de la atención farmacéutica del paciente crítico sería necesario ampliar la dedicación en tiempo y personal respecto a la situación actual y que más centros incluyan al farmacéutico en las unidades de cuidados intensivos hospitalarias.
Subject(s)
Intensive Care Units/organization & administration , Pharmacists , Pharmacy Service, Hospital/organization & administration , Critical Care , Humans , Medication Reconciliation , Medication Therapy Management , Narcotics/therapeutic use , Patient Care Team , Patient Safety , Prospective Studies , Spain , Surveys and Questionnaires , TeachingABSTRACT
OBJECTIVE: Electronic alert systems have shown their capacity for improving the detection of acute kidney injury (AKI). The aim of this study was to design and implement a clinical decision support system (CDSS) for improving drug selection and reducing nephrotoxic drug use in patients with AKI. METHODS: The study was designed as an intervention study comparing a pre and post cohort of patients admitted during April 2014 and April 2015, respectively (phase I and phase II). The intervention was a CDSS which provided kidney function and nephrotoxic drug information. Furthermore, an interruptive alert was designed to detect patients suffering an AKI event while taking a nephrotoxic drug and to see if the dose was then reduced or the drug was discontinued by the physicians. RESULTS: One-third of the inpatients were included in the analysis because they met the inclusion criteria (1004 and 1002 patients in phases I and II, respectively). 735 and 761 of them received at least one nephrotoxic alert (73% vs 76%; p=0.763). 65 and 88 patients suffered AKI during admission (6.5% vs 8.8%; p=0.051). In phase I, patients received 384 nephrotoxic alerts (55%) with 78 (20%) of them provoking a change or discontinuation of the nephrotoxic drug. In phase II this value increased to 154 out of 526 (29%) after implementation of the CDSS (p<0.01). CONCLUSIONS: A CDSS with interruptive alerts that inform of the development of AKI in real time in patients with nephrotoxic drug prescription has a positive impact on the judicious use of these drugs.
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