Conciliação medicamentosa na admissão de pacientes transplantados renais em um hospital universitário / Medication reconciliation in the admission of kidney transplant patients to a university hospital

Introdução:O presente estudo considerou conciliações medicamentosas realizadas na admissão hospitalar de pacientes transplantados renais e intervenções farmacêuticas decorrentes desse processo.Métodos:Trata-se de um estudo transversal realizado no período de julho de 2018 a julho de 2019 no Hospital de Clínicas de Porto Alegre. Foram coletadas as características dos pacientes, as conciliações medicamentosas realizadas pelo farmacêutico clínico, as discrepâncias identificadas pelo mesmo (intencionais e não intencionais) e o resultado das intervenções. Os medicamentos foram classificados de acordo com a Anatomic Therapeutic Chemical (ATC).Resultados:Dos 719 pacientes acompanhados pelo farmacêutico clínico, 175 tiveram a conciliação medicamentosa de admissão realizada, desses, 56 apresentaram discrepâncias não intencionais. Encontramos a média de 2,2 medicamentos omissos por prescrição com desvio padrão de 1,3 medicamentos. No total, foram realizadas 122 intervenções farmacêuticas, sendo que em 61,5% houve adesão por parte da equipe médica. A classe terapêutica com maior ocorrência (43,4%) de discrepâncias não intencionais foi a que atuava sobre o aparelho cardiovascular. As variáveis observadas foram sexo, número de medicamentos nas intervenções (ambas com associação significativa com a adesão médica), idade, tempo de internação, número de medicamentos na internação e número de medicamentos de uso prévio (estas últimas sem associação significativa com a adesão médica). Conclusões:A conciliação medicamentosa previne possíveis erros de medicação, uma vez que a identificação das discrepâncias não intencionais na prescrição médica gera sinalizações que são levadas pelo farmacêutico clínico à equipe assistente, a fim garantir o uso seguro e correto dos medicamentos durante a internação hospitalar.

Introduction:This study considered medication reconciliations performed on hospital admission of kidney transplant patients and pharmaceutical interventions resulting from this process.Methods:This is a cross-sectional study carried out from July 2018 to July 2019 at Hospital de Clínicas de Porto Alegre. The characteristics of the patients, the medication reconciliations performed by the clinical pharmacist, the discrepancies identified by the same (intentional and unintentional) and the result of the interventions were collected. The drugs were classified according to the Anatomic Therapeutic Chemical (ATC). Results:Of the 719 patients monitored by the clinical pharmacist, 175 had medication reconciliation on admission performed, of which 56 had unintentional discrepancies. We found an average of 2.2 missing medications per prescription with a standard deviation of 1.3 medications. In total, 122 pharmaceutical interventions were performed, and in 61.5% there was adherence by the medical team. The therapeutic class with the highest occurrence (43.4%) of unintentional discrepancies was that which acted on the cardiovascular system. The variables observed were gender, number of medications in interventions (both with a significant association with medical adherence), age, length of stay, number of medications in hospitalization and number of medications previously used (the latter without a significant association with medical adherence).Conclusions:Medication reconciliation prevents possible medication errors, since the identification of unintentional discrepancies in the medical prescription generates signals that are taken by the clinical pharmacist to the assistant team, in order to guarantee the safe and correct use of medications during hospitalization.

Operating a patient medicines helpline: a survey study exploring current practice in England using the RE-AIM evaluation framework.

BACKGROUND: Patient medicines helplines provide a means of accessing medicines-related support following hospital discharge. However, it is unknown how many National Health Service (NHS) Trusts currently provide a helpline, nor how they are operated. Using the RE-AIM evaluation framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance), we sought to obtain key data concerning the provision and use of patient medicines helplines in NHS Trusts in England. This included the extent to which the delivery of helplines meet with national standards that are endorsed by the Royal Pharmaceutical Society (standards pertaining to helpline access, availability, and promotion). METHODS: An online survey was sent to Medicines Information Pharmacists and Chief Pharmacists at all 226 acute, mental health, specialist, and community NHS Trusts in England in 2017. RESULTS: Adoption: Fifty-two percent of Trusts reported providing a patient medicines helpline (acute: 67%; specialist: 41%; mental health: 29%; community: 18%). Reach: Helplines were predominantly available for discharged inpatients, outpatients, and carers (98%, 95% and 93% of Trusts, respectively), and to a lesser extent, the local public (22% of Trusts). The median number of enquiries received per week was five. IMPLEMENTATION: For helpline access, 54% of Trusts reported complying with all 'satisfactory' standards, and 26% reported complying with all 'commendable' standards. For helpline availability, the percentages were 86% and 5%, respectively. For helpline promotion, these percentages were 3% and 40%. One Trust reported complying with all standards. Maintenance: The median number of years that helplines had been operating was six. Effectiveness: main perceived benefits included patients avoiding harm, and improving patients' medication adherence. CONCLUSIONS: Patient medicines helplines are provided by just over half of NHS Trusts in England. However, the proportion of mental health and community Trusts that operate a helpline is less than half of that of the acute Trusts, and there are regional variations in helpline provision. Adherence to the national standards could generally be improved, although the lowest adherence was regarding helpline promotion. Recommendations to increase the use of helplines include increasing the number of promotional methods used, the number of ways to contact the service, and the number of hours that the service is available.

Tele-pharmacy in remote medical practice: the Royal Flying Doctor Service Medical Chest Program.

In recent times remote medical practice has been developed into a unique discipline in its own right with telehealth one of the eight defining key features. Since 1942, the telemedicine consultation service provided by the Royal Flying Doctor Service in Australia has been supported by a tele-pharmacy program known as the Medical Chest Program. The contents of the chest comprise more than 85 items, including medications and equipment which can be prescribed during a telehealth consultation to cover both emergency care and definitive treatment for less serious conditions. By 2006 there were 3500 medical chests placed throughout Australia. Specifically, the state of Queensland had 21 470 telehealth consultations from 1 July 2005 to 30 June 2006, resulting in the prescription of at least one medical chest item in 2938 (13.7%) consultations. Queensland data regarding medication indicate that antibiotics (26%), analgesics (23%) and gastrointestinal medications (12%) were the most common categories of dispensed medications, and that the most common clinical diagnostic categories for the consultation resulting in dispensed medications were respiratory (17%), skin (15%) and abdominal conditions (13%). In summary, the RFDS medical chest program continues to be a successful large scale provider of medications to those living in remote Australia, enabling early access to medications for both emergencies and definitive care, while minimising the need for mail-order pharmacy or patient travel. This model of care may provide an important template for those designing service delivery models in other remote jurisdictions.

Desabastecimiento y suministro irregular de medicamentos: problemas urgentes / Shortages and irregular supply of medicines: an urgent problem

Actualmente en el Estado español se están produciendo problemas en el suministro de medicamentos a los serviciosfarmacéuticos. En el presente artículo se revisa la normativa vigente acerca de la distribución de medicamentos.Se comentan además las posibles causas del problema. También se analizan los medios que desarrolla el Estadopara evitar esta problemática y la postura de la Comunidad Valenciana que, de manera pionera, quiere regular enmateria de distribución farmacéutica, mediante una normativa con rango de Ley, para evitar los problemas quese suscitan

In this paper, we discuss the problems arising from the current supply problems of medicines to pharmacy outlets inSpain, as well as a revision of present regulations governing their distribution. In addition to the possible causes, ananalysis of the measures developed by the state to combat these problems has been made, as well as an assessment ofthe impact of new pioneering legislation passed by the regional government of Valencia, aimed at finding a solution

Interacciones farmacólogicas detectadas en una farmacia comunitaria / Pharmacological interactions detected ata Community Pharmacy Office

Objetivos: El objetivo de este trabajo es conocer las interacciones farmacológicas potenciales (IFP) detectadas en una farmacia comunitaria, como primer paso para la elaboración e implantación de un procedimiento normalizado de trabajo (PNT) de intervención farmacéutica ante la detección de IFP. Métodos: Estudio observacional prospectivo. El estudio se realiza en una farmacia comunitaria de Benalmádena (Málaga) con los pacientes que acuden por su medicación durante 8 meses. Se han registrado las IFP con la ayuda de un programa informático que utiliza la base de datos del Consejo General de Colegios Oficiales de Farmacéuticos (CGCOF) y que es capaz de emitir una señal de alerta al farmacéutico ante asociaciones de medicamentos capaces de producir IFP en el momento de la dispensación. Resultados: Se han detectado un total de 203 IFP, de las que un 17,2% (IC 95%: 12,0-22,4) corresponde a las detectadas en pacientes incluidos en el servicio de seguimiento farmacoterapéutico de la oficina de la farmacia. Además de las detectadas en este tipo de pacientes, en un 10,3 (IC 95%: 6,1-14,5) de las IFP se ha realizado algún tipo de intervención farmacéutica. Las principales IFP por grupos terapéuticos por orden de frecuencia han sido: diuréticos-antidiabéticos, glucósidos cardiotónicos-diuréticos eliminadores de potasio, betabloqueantes-antidiabéticos, alopurinol-diuréticos y estrógenos-paracetamol. Conclusiones: Las IFP que han motivado más intervenciones farmacéuticas son las de mecanismo químico-farmacéutico, en las que está involucrada la automedicación y las detectadas en pacientes con historia farmacoterapéutica. Tan importante como las fuentes de información críticas y selectivas sobre IF, es la existencia de historias farmácoterapéuticas completas de los pacientes en la farmacia comunitaria, que permitiría una valoración más real de la relevancia de las IFP. La implantación de PNT podría potenciar el papel de la farmacia comunitaria en la detección y comunicación de interacciones relevantes a los profesionales médicos (AU)

Objectives: To know the potential drug interactions (PDI) detected in a community pharmacy, as a first step to design and to implant a Standardized Working Protocol (SWP) for pharmaceutical intervention when faced with detection of PDI. Methods: Prospective observational study. The study took place in a community pharmacy in Benalmádena (Málaga) with the patients who acquired their medical prescriptions during 8 months. PDI were registered with the aid of a computer programme which uses the Spanish General Council of Pharmacist data base and it's able to display on the computer screen the PDI detected whilst processing the prescription. Main results: 203 PDI were detected, of which 17.2% (CI 95%: 12.0-22.4) were detected among patients adhered to drug therapy follow up service of the pharmacy. Beside the PDI detected in this type of pacients, in 10.3% (CI 95%: 6.1-14.5) of PDI a pharmaceutical intervention was carried out. The main PDI per therapeutic group and per order of frequency were: diuretics-hypoglycemic drugs, digoxinpotassium eliminating diuretics, betablockers-hypoglycemic drugs, allopurinol-diuretics and estrogens-paracetamol. Conclusions: The PD! that caused more pharmaceutical interventions were the physiochemical interactions, the interactions where self medication was involved and the detected among patients receiving drug therapy follow up service of the pharmacy. So important as critical and selective drug interactions information sources, is the existence of a complete patient medication record in the community pharmacy, which would permit a more real valoration of the clinical significance of the PDI. It is hoped that implantation of SWP could increase the pharmacy community function in the detection and communication of significant drug interactions to the patient's physician (AU)