Indicadores de calidad en el proceso de almacenamiento y dispensación de medicamentos en un Servicio de Farmacia Hospitalaria / Quality indicators in the storage and dispensing process in a Hospital Pharmacy

Objetivo. Establecer indicadores para evaluar la calidad de los procesos de almacenamiento y dispensación relacionados con los sistemas semiautomáticos de carrusel vertical (SSADV) y horizontal (SSADH). Material y métodos. Estudio observacional descriptivo entre enero-diciembre de 2012. Definición de indicadores de calidad, se estableció un valor objetivo planificado (OP) y se calculó el valor en el año 2012 (VO). Resultados. Se definieron y calcularon 5 indicadores de calidad en el proceso de almacenamiento y dispensación de medicamentos relativos a: indicador 1, error de llenado de carro de unidosis: OP (< 1,67%), VO (1,03%); indicador 2, precisión del llenado de los carros de unidosis utilizando un SSADV: OP (< 15%); VO (11,5%); indicador 3, fiabilidad del inventario de medicamentos en el proceso de entradas de medicamentos en un SSADH: OP (< 15%); VO (6,53%); indicador 4, fiabilidad del inventario de medicamentos en el proceso de preparación de pedidos de planta de medicamentos en un SSADH: OP (< 10%), VO (1,97%); indicador 5, precisión del proceso de preparación de pedidos de medicamentos de las unidades clínicas utilizando el SSADH: OP (< 10%), VO (10,41%). Conclusiones. El establecimiento de indicadores ha permitido valorar la calidad en términos de seguridad, de precisión y fiabilidad de los sistemas semiautomáticos para el almacenamiento y dispensación de medicamentos (AU)

Objective. To establish indicators for the evaluation of the quality of the storage and dispensing processes related to semiautomatic vertical (SAVCS) and horizontal (SAHCS) carousel systems. Material and Methods. Descriptive observational study conducted between January-December 2012. Definition of quality indicators, a target value is established and an obtained value is calculated for 2012. Results. Five quality indicators in the process of storage and dispensing of drugs were defined and calculated: indicator 1, error filling unidose trolleys: target (< 1.67%), obtained (1.03%); indicator 2, filling accuracy unidose trolleys by using an SAVCS: target (< 15%), obtained (11.5%); indicator 3, reliability of drug inventory in the process of drug entries using an SAHCS: target (< 15%), obtained (6.53%); indicator 4, reliability of drug inventory in the picking process of orders replacement stock of clinical units using an SAHCS: target (< 10%), obtained (1.97%); indicator 5, accuracy of the picking process of drug orders using an SAHCS: target (< 10%), obtained (10.41%). Conclusions. Establishing indicators has allowed the quality in terms of safety, precision and reliability of semiautomatic systems for storage and dispensing drugs to be assessed (AU)

[Quality indicators in the storage and dispensing process in a Hospital Pharmacy]. / Indicadores de calidad en el proceso de almacenamiento y dispensación de medicamentos en un Servicio de Farmacia Hospitalaria.

OBJECTIVE: To establish indicators for the evaluation of the quality of the storage and dispensing processes related to semiautomatic vertical (SAVCS) and horizontal (SAHCS) carousel systems. MATERIAL AND METHODS: Descriptive observational study conducted between January-December 2012. Definition of quality indicators, a target value is established and an obtained value is calculated for 2012. RESULTS: Five quality indicators in the process of storage and dispensing of drugs were defined and calculated: indicator 1, error filling unidose trolleys: target (<1.67%), obtained (1.03%); indicator 2, filling accuracy unidose trolleys by using an SAVCS: target (<15%), obtained (11.5%); indicator 3, reliability of drug inventory in the process of drug entries using an SAHCS: target (<15%), obtained (6.53%); indicator 4, reliability of drug inventory in the picking process of orders replacement stock of clinical units using an SAHCS: target (<10%), obtained (1.97%); indicator 5, accuracy of the picking process of drug orders using an SAHCS: target (<10%), obtained (10.41%). CONCLUSIONS: Establishing indicators has allowed the quality in terms of safety, precision and reliability of semiautomatic systems for storage and dispensing drugs to be assessed.

[Analysis of initial antiretroviral therapy in HIV-infected patients]. / Análisis del tratamiento antirretroviral inicial en pacientes VIH.

INTRODUCTION: The timing of highly active antiretroviral therapy (HAART) initiation and regimen combination treatment for HIV-infected patients are parameters requiring assessment, since they decisively influence results. The aim of the study was to evaluate initial HAART in HIV-infected patients in our hospital. MATERIALS AND METHODS: Retrospective study of the first 6 months after initiation of HAART in all treatment-naive adult patients so treated from January 2001 to June 2002. Baseline plasma viral load (PVL) and CD4+ count and HAART combination regimens were analyzed as well as therapy effectiveness and safety at 12 and 24 weeks after initiation of treatment. RESULTS: HAART was initiated in 85 patients, 45 of which met the inclusion criteria. Eighty seven percent (87%) of the patients had a baseline CD4+ count < 350 cells/microl. Fifty-nine percent of treatments consisted of regimens based on non-nucleoside analogs, 34% were based on protease inhibitors, and 7% on nucleosides. The CD4+ count increased in 78 and 73% of patients at the 12th and 24th week respectively, and the percentage of patients with no detectable PVL was 67 and 71%, respectively. No significant differences in effectiveness were seen between the different combination regimens. CONCLUSIONS: In most cases HAART may recover immune status and control PVL in treatment-naive HIV-infected patients. No differences were seen between combination regimens at the initiation of therapy.

[Change of antiretroviral therapy in HIV-infected patients]. / Cambio del tratamiento antirretroviral en el paciente VIH.

INTRODUCTION: Antiretroviral therapy adherence plays a vital role in treatment onset and in the durability of antiviral response. In addition, clinical status, plasma viral load, and CD4+ cell count are essential in making therapeutic change decisions in various clinical situations. The aim of our study was to assess the reasons for therapy change in both treatment-naive and treatment-experienced patients, and to know the casuistry of antiretroviral therapy change. PATIENTS AND METHODS: A retrospective study of 100% of patients who underwent at least one antiretroviral treatment change from January to December 2002. The type of antiretroviral therapy before and after change was analyzed, as were the causes leading to treatment change. RESULTS: During year 2002, 131 patients (20.15%) had their antiretroviral therapy modified, and the total number of treatment changes in these patients was 151. An analysis of treatment changes revealed that 69 modifications resulted from intolerance/toxicity (45%), 51 from therapeutic failure (34%), 14 from lack of adherence (9%), 10 from therapy simplification (7%), 1 from therapy enhancement (1%), and 6 from other causes (4%). CONCLUSIONS: Adverse events such as (resulting from) intolerance, renal colic, lipodystrophy, pancreatitis, etc., are responsible for a high incidence of therapy changes, mostly in treatment-naive patients. Therapeutic failure and lack of adherence are further causes of medically-relevant therapy modifications.

Fenitoína: intoxicación paradójica; descripción de 4 casos / Phenytoin: paradoxical toxicity; a discussion of 4 cases

Introducción: La sobredosificación con fenitoína origina una amplia variedad de signos y síntomas: ataxia, nistagmus, pérdida de la consciencia. Ocasionalmente se puede observar un incremento de la frecuencia de las convulsiones en pacientes con niveles séricos elevados de fenitoína y sin evidencia de síntomas habituales de sobredosificación: intoxicación paradójica. Objetivo: Estudio de la frecuencia de la intoxicación paradójica de fenitoína y análisis de la situación clínica del paciente. Pacientes y método: Estudio prospectivo del 100 por ciento de los pacientes monitorizados por el Servicio de Farmacia durante el periodo agosto-diciembre de 1998, con niveles séricos de fenitoína superiores al rango terapéutico y que presentaban convulsiones. La determinación analítica de las muestras se realizó mediante el análisis de inmunofluorescencia polarizada. De cada paciente se siguió su evolución a través de su ficha farmacoterapéutica e historia clínica. Resultados: El número de pacientes fue 1.706, 124 con niveles séricos superiores al rango terapéutico, de los cuales 3 hombres y 1 mujer, con un rango de edades entre 17 y 73 años, diagnosticados de epilepsia, en tratamiento crónico con fenitoína, acudieron a Urgencias por presentar cuadros convulsivos. Se solicita la determinación de niveles séricos de fenitoína por sospecha de incumplimiento terapéutico o infradosificación. En los 4 casos se suspendió la fenitoína hasta alcanzar niveles dentro de rango terapéutico; reiniciándose con pautas posológicas ajustadas a los niveles plasmáticos. Conclusiones: La intoxicación paradójica nos puede inducir a errores, por ello debemos descartar esta posibilidad en pacientes con exacerbación de crisis epilépticas a tratamiento con fenitoína (AU)

[Phenytoin: paradoxical toxicity; a discussion of 4 cases]. / Fenitoína: intoxicación paradójica; descripción de 4 casos.

INTRODUCTION: Phenytoin overdosing results in a wide variety of signs and symptoms - ataxia, nistagmus, loss of consciousness. On occasions increased frequence of seizures may be seen in patients with high phenytoin serum levels and no evidence of standard toxicity symptoms - paradoxical toxicity. OBJECTIVE: To study the frequency of phenytoin paradoxical toxicity, and to analyze patients" clinical status. PATIENTS AND METHOD: Prospective study of 100% of patients monitored by the Pharmacy Department during August-December, 1998 and who had phenytoin serum levels above therapeutic range and seizures. Laboratory determinations in samples was performed by polarized immunofluorescence analysis. The outcome of each patient was monitored through their pharmacotherapeutic record and clinical history. RESULTS: The number of patients was 1706; 124 of wich had serum levels above the therapeutic range. Out of this group, 3 males and 1 female, with ages ranging from 17 to 73, a diagnosis of epilepsy, and chronic therapy using phenytoin, come to our Emergency Department because of convulsions. Serum levels of phenytoin were ordered due to suspected lack of compliance or underdosing. In all 4 patients phenytoin was discontinued until the therapeutic range was reached, to be then reset with plasma level-adjusted dosages. CONCLUSIONS: Paradoxical toxicity may lead to errors, and therefore we should rule out such possibility in patients with exacerbated epilepsy undergoing treatment with phenytoin.