ABSTRACT
BACKGROUND: Nurses in Catalonia have always prescribed health advice, health products, and medication in line with the professional competency of the discipline. Legislation about nurse prescriptions and the implementation of nurse prescribing varies widely among different countries. This article reports data regarding nurse prescribing in Catalonia in 2021 and 2022. METHODS: This retrospective longitudinal study analyzed data from all care-providing units in Catalonia's integrated public health system. RESULTS: The number of nurse prescriptions increased from 139,435 in 2021 to 573,822 in 2022, and the number of nurses issuing prescriptions increased from 3604 in 2021 to 5563 in 2022. The proportion of prescriptions for different products was similar in the two years analyzed. Prescriptions for medication increased by 7.5% in 2022. CONCLUSIONS: Nurse prescribing is a recent advance in Catalonia. Despite some difficulties in rollout, the data indicate that this practice is becoming consolidated, as in other European countries.
ABSTRACT
La pandemia por COVID-19 ha provocado una crisis sanitaria sin precedentes en nuestra historia reciente, con unas peculiaridades clínicas y sociales que han generado un importante papel de los equipos de cuidados paliativos (CP), destacando su participación en la toma de decisiones al final de la vida y en la elaboración de protocolos de sedación paliativa (SP). Una proporción significativa de pacientes con mala evolución, sin mejoría con los tratamientos disponibles ni criterios de ingreso en Unidades de Cuidados Intensivos (UCI), presentaron una alta carga sintomática y elevados niveles de sufrimiento por la refractariedad de los síntomas; por ello, de igual manera que sucede en otras enfermedades terminales, se requirió frecuentemente de la SP. A pesar del elevado número de trabajos sobre la infección por SARS-CoV-2, existe escasez de publicaciones hasta la fecha sobre SP en pacientes COVID. En este artículo revisamos la bibliografía existente y presentamos nuestra experiencia en tres unidades de cuidados paliativos hospitalarias respecto a las indicaciones de SP, fármacos y dosis, considerando además los importantes aspectos éticos en este contexto, como son la información al paciente y a la familia y la toma de decisiones en una situación de confinamiento de la población y de duras medidas de aislamiento. La pandemia por COVID-19 ha supuesto un desafío para todo el sistema sanitario, incluyendo los CP. Debemos aprovechar esta oportunidad para garantizar en el futuro el menor sufrimiento posible de nuestros pacientes, mediante el acceso a medidas terapéuticas como la SP
The COVID-19 pandemic has provoked an unprecedented health crisis in our recent history, with clinical and social peculiarities that have created an important role for Palliative Care (PC) teams, highlighting their participation in decision-making at the end of life and in the development of Palliative Sedation (PS) protocols. A significant percentage of patients with a negative evolution, without improvement with available treatments, or meeting admission criteria in an Intensive Care Unit (ICU) present with a high symptom loads and high levels of suffering due to symptom refractoriness; therefore, as is also the case with other terminal diseases, PS is frequently required. Despite the abundance of literature about the SARS-CoV-2 infection, there is so far a shortage of publications about PS in COVID patients. In this article we review the existing literature and present our experience in three Hospital Palliative Care Units regarding PS indications, drugs, and doses, considering also important ethical aspects in this context such as patient and family information, and decision-making in a situation of population confinement and strict isolation measures. The COVID-19 pandemic has been a challenge for the whole health care system, including PC. We must seize this opportunity to ensure that our patients suffer as little as possible in the future through access to therapeutic measures such as PS
