[Concordance of medication prescription records in the hospitalised surgical patient]. / Concordancia de los registros de prescripción de medicamentos en el paciente quirúrgico hospitalizado.

INTRODUCTION: Electronic prescription is the prescription system that allows healthcare professionals to send medication prescriptions directly to community pharmacies and the outpatient unit of Hospital Pharmacy Services for dispensing. However, there is difficulty in obtaining a reliable pharmacotherapeutic history in chronic patients through electronic prescription upon hospital admission as a critical point for adequate treatment adaptation. Therefore, the pharmacist as a member of the multidisciplinary team must ensure, through medication conciliation, an adequate transition of care through the correct management of the treatment that the chronic patient requires during their hospitalization. OBJECTIVES: To evaluate the quality of electronic prescription records for routine chronic treatment by analyzing the concordance of the electronic prescription. MATERIAL AND METHODS: Observational, cross-sectional and retrospective study at the General University Hospital of Elche. Hospitalized patients in charge of the Orthopedic Surgery and Traumatology, Urology and Neurosurgery Services in which the responsible doctor requested medication reconciliation by the Pharmacy Service between January 2022 - December 2022 were included. RESULTS: 378 patients, 209 (55.3%) women and 169 (44.7%) men, with a mean age±standard deviation of 71.0±11.6 years and 69.0±11.8 years, respectively. The total percentage of patients with discrepancies in the electronic prescription with respect to the usual chronic treatment was 60.6%, reflecting that only 39.4% of the patients had non-discordant electronic prescriptions. CONCLUSIONS: More than half of hospitalized surgical patients present discrepancies in the medications prescribed in the home electronic prescription, which justifies the importance of treatment reconciliation upon admission carried out by hospital pharmacists.

Evaluación del grado de adherencia al tratamiento intravenoso no antineoplásico de pacientes ambulatorios / Evaluation of the degree of adherence to non-antineoplastic intravenous treatment of ambulatory patients

Introducción: La falta de adherencia al tratamiento farmacológico es un problema prevalente y relevante en la evolución clínica.Objetivo: Evaluar el grado de adherencia al tratamiento intravenoso no antineoplásico de pacientes crónicos que acuden al hospital de día (HD), identificar los factores relacionados y analizar los desvíos de programación de la cita previa en el HD y su impacto en el Servicio de Farmacia (SF).Material y métodos: Estudio descriptivo longitudinal retrospectivo de tres años de duración (2017-2019) que incluyó a los pacientes que acudieron al HD a administrarse el tratamiento. Los datos de adherencia se extrajeron de los registros del SF y los datos demográficos-clínicos, de las historias clínicas electrónicas. El grado de adherencia se expresó en porcentaje (adherencia adecuada ≥90%). La asociación entre las variables y el grado de adherencia se estudió mediante test estadísticos de contraste de hipótesis.Resultados: Se incluyeron 300 pacientes, 60% mujeres, edad media 47 años. El 18% presentaron una adherencia inadecuada. La adherencia se asoció con la edad, el medicamento administrado, el intervalo posológico y la persistencia al tratamiento (p<0,05). El 5,6% del trabajo de HD se desvió de la programación suponiendo un trabajo adicional para el SF.Conclusiones: El grado de adherencia al tratamiento era inadecuado en casi una cuarta parte de la población. La edad, el medicamento infundido, el intervalo posológico y la persistencia al tratamiento se asociaron con la adherencia de los pacientes. Los desvíos en la programación de HD se tradujeron en trabajo sobreañadido para el SF. (AU)

Introduction: The lack of adherence to pharmacological treatment of patients with chronic diseases it is a relevant problem.Objective: To assess the degree of adherence to the non-chemotherapy intravenous treatment of chronic patients who came to the outpatient clinic (OC), to identify the possible specific factors related to therapeutic compliance and to analyze the appointment changes in the OC and its impact on the Pharmacy Department (PD).Material and methods: Retrospective longitudinal descriptive study of three years duration (2017-2019). This included patients who went to the OC to receive the treatment. Adherence data were extracted from the PD records and demographic-clinical data from the review of electronic health records. Besides, the degree of adherence was expressed as a percentage (adherence adequate ≥90%). The association between the variables studied and the degree of adherence was estimated by means of statistical tests of hypothesis contrast.Results: A total sample size of 300 patients were included, mean age 47 years, 60% women. Adherence of the treatment was inadequate in 18% of patients. The variables that showed a statistically significant association with adherence were the age, the drug delivered, the dosage interval and the persistence of treatment (p<0.05). 5.6% of OC work deviated from schedule and it meant additional work to the PD.Conclusions: The degree of adherence to the intravenous ambulatory treatment was inadequate in approximately a quarter of the population. The age, the infused drug, the dosage interval and the persistence of treatment were the variables that showed association with the adherence. Changes to OC programming resulted in over-added work for the PD. (AU)

[Pharmaceutical intervention in duration of antimicrobial treatment at hospital ambit]. / Actuación farmacéutica en el control de la duración del tratamiento con antimicrobianos en el ámbito hospitalario.

OBJECTIVE: To estimate the acceptance of the pharmaceutical intervention in controlling duration of antimicrobial therapy and to evaluate their impact on optimizing the treatment. METHODS: Prospective observational study for two years in a General University Hospital. For the patients record, we followed non critical adult patients with antibiotic treatment. When the duration of antimicrobial treatment not complied with established criteria for each antibiotic and pathology, there was a communication with the physician, at which is recommended to assess the need for continue treatment. The acceptance of pharmaceutical intervention was collected and afterwards we analyzed the impact of this work by antimicrobial consumption and incidence of Clostridium difficile. RESULTS: . In 122 patients the pharmacist made a pharmaceutical intervention due to prolonged antibiotic treatment. The most prevalent antibiotics were ß-lactams, specifically meropenem. The intravenous administration was more frequent. In 77 cases it was decided to recommend the suspension of treatment, we conducted an orally prospective intervention at 70.15 % and the rest of interventions were written. Acceptance was 65.95 % and 65.00%, respectively. During the study period, the DDD of the antimicrobials decreased by 8.89% and expenditure on antimicrobials one 40.12%. The incidence of C. difficile was stable. CONCLUSIONS: . In a hospital, a pharmaceutical counselling program on the duration of antimicrobial therapy is well accepted by the prescriber physician, but it must be improved. The route of information does not affect the degree of acceptance. These actions could involve a reduction of antimicrobial consumption.

Atención farmacéutica en pacientes ingresados con insuficiencia renal / Pharmaceutical care in renal insufficiency inpatients

Objetivos: Valorar los resultados de un programa de ajuste posológico en pacientes hospitalizados con enfermedad renal, describir los medicamentos mayoritariamente implicados y determinar el grado de aceptación de la intervención farmacéutica realizada. Método: Estudio prospectivo, de intervención no aleatorizada, de 15 meses de duración en pacientes hospitalizados con función renal alterada (Creatinina sérica > 1,4 mg/dL) y en tratamiento con medicamentos que precisan ajuste en insuficiencia renal. La variable principal fue el porcentaje de adecuación posológica según la tasa de filtrado glomerular. También se evaluó la aceptación global por servicio clínico, el grupo farmacoterapéutico más prescrito de forma inadecuada, las monitorizaciones farmacocinéticas que se derivaron de la intervención y el carácter educativo de la misma. Resultados: Se identificaron un total de 384 pacientes de los que 341 presentaban un aclaramiento de creatinina entre 10-50 ml/min. Se revisaron 2.807 medicamentos prescritos, de éstos, 2.052 no requerían ajuste posológico en insuficiencia renal y 508 estaban correctamente ajustados. 247 prescripciones eran susceptibles de un ajuste posológico de las cuales 164 prescripciones era necesario un ajuste posológico concreto. Se realizaron recomendaciones posológicas en 200 ocasiones, y se aceptaron un total de 131. Los fármacos con mayor número de intervenciones fueron la enoxaparina, levofloxacino, amoxicilina-clavulánico y digoxina. Conclusiones: La implantación del programa de atención farmacéutica ha tenido una buena aceptación entre los facultativos prescriptores, siendo los antibióticos el grupo farmacológico más susceptible de realizar un ajuste posológico sobre una mayoría de pacientes con insuficiencia renal moderada (AU)

Background and objective: To asses the outcomes of posological adjust program in renal impairment inpatients, describe the drugs more usually involved, and determine the degree of acceptance of the pharmaceutical intervention made. Material and method: A fifteen months-prospective study, in renal insufficiency inpatients (serum creatinine > 1,4 mg/dL) treated with drugs that needs posological adjustment. The primary outcome was the ratio of adequate dosage of the treatment, according with the glomerular filtration rate. We also evaluated the global acceptation rate, the drugs inadequate prescribed more frequently, phamacokinetic analysis derived from the pharmaceutical intervention and its educative character. Results: 384 patients were identified, and 341 of them presented a glomerular filtration rate between 10-50 ml/min. 2.807 prescribed drugs were reviewed, and 2.052 of them didn’t require posological adjustment in renal insufficiency, 508 prescribed drugs were correctly adjusted. 247 pres - criptions were susceptible of posological adjustment and 164 of them, needed a concrete posological adjustment. We performed 200 posological recommendations, and 131 were accepted. The drugs with a higher number of interventions were enoxaparine, levofloxacin, amoxicillin-clavulanic and digoxin. Conclusions: The implementation of the pharmaceutical care program was accepted between physicians, being antibiotics the group more susceptible of doing a posological adjustment in most patients with renal impairment (AU)

[Pharmaceutical care in renal insufficiency inpatients]. / Atención farmacéutica en pacientes ingresados con insuficiencia renal.

BACKGROUND AND OBJECTIVE: To asses the outcomes of posological adjust program in renal impairment inpatients, describe the drugs more usually involved, and determine the degree of acceptance of the pharmaceutical intervention made. MATERIAL AND METHOD: A fifteen months-prospective study, in renal insufficiency inpatients (serum creatinine > 1,4 mg/dL) treated with drugs that needs posological adjustment. The primary outcome was the ratio of adequate dosage of the treatment, according with the glomerular filtration rate. We also evaluated the global acceptation rate, the drugs inadequate prescribed more frequently, phamacokinetic analysis derived from the pharmaceutical intervention and its educative character. RESULTS: 384 patients were identified, and 341 of them presented a glomerular filtration rate between 10-50 ml/min. 2.807 prescribed drugs were reviewed, and 2.052 of them didn%#39;t require posological adjustment in renal insufficiency, 508 prescribed drugs were correctly adjusted. 247 pres - criptions were susceptible of posological adjustment and 164 of them, needed a concrete posological adjustment. We performed 200 posological recommendations, and 131 were accepted. The drugs with a higher number of interventions were enoxaparine, levofloxacin, amoxicillin-clavulanic and digoxin. CONCLUSIONS: The implementation of the pharmaceutical care program was accepted between physicians, being antibiotics the group more susceptible of doing a posological adjustment in most patients with renal impairment.