Hypophosphatemia in postoperative patients with total parenteral nutrition: influence of nutritional support teams.

UNLABELLED: PURPOSE, SETTING AND SUBJECTS: We conducted a prospective, descriptive study of postoperative patients under total parenteral nutrition controlled by a Multidisciplinary Nutritional Support Team in a tertiary care hospital. Between january 2002 and november 2003. Data of nutritional status, nutritional support, hypophosphatemia, electrolyte and metabolic complications were reviewed. RESULTS: 215 postoperative patients (63.3% male, 68 +/- 13.9 years old, 47.4% neoplasia). were included. Nutritional support according nutritional needs was made during fasting 14.2 +/- 18.4 days. Mild-moderate initial malnutrition was present in 58% of patients. 18.1% developed postoperative hypophosphatemia 96 hours after starting total parenteral nutrition containing phosphate. 37.7% patients showed moderated and 6.5% severe hypophosphatemia. Nutritional intervention corrected hypophosphatemia (p < 0.001). Factors related to hypophosphatemia were hypokalemia, hypomagnesemia, hypercalcemia, female sex, neoplasia, 96-hour postoperative period and duration of nutrition. CONCLUSIONS: Prevalence of hypophosphatemia in postoperative patients with total parenteral nutrition is high and needs timely monitoring. The intervention of Multidisciplinary Nutritional Support Team is effective detecting and correcting postoperative hypophosphatemia.

Clinical and economic impact of a pharmacist-intervention to promote sequential intravenous to oral clindamycin conversion.

A multicentre, prospective, controlled study compared the clinical efficacy, safety and economic impact of a pharmacist intervention to promote sequential intravenous to oral clindamycin conversion. A total of 473 patients receiving intravenous clindamycin for at least 72 hours were included in the study. Two groups were established: an intervention group (204 patients) in which an informative sheet recommending the sequential treatment was provided, and a control group (269 patients). Clindamycin was prescribed for respiratory infections in 38.9% and for prophylaxis in surgery in 25.4% of the patients (71% were contaminated surgery). No difference between groups regarding sex, infection severity, health status or clinical progress was observed. Both the step-down treatments after 72 hours of intravenous clindamycin and the change to the oral route later on, were significantly increased with the intervention (p < 0.001, p < 0.001 respectively). No significant differences between both groups were found in the number of patients with adverse effects associated with the i.v. therapy, although the incidence tended to be lower in the intervention group (49/204 intervention versus 85/269 control, p = 0.07). Compliance with the recommended clindamycin dosing regimen was significantly higher in the intervention group, in which 1.3 days reduction of intravenous therapy provided an average cost savings of PTA5246 (95% CI 2556-7935) per treatment. A higher reduction of 1.7 days was achieved in those patients candidates for switch therapy on the third day of intravenous clindamycin. A sequential program with clindamycin may provide a cost-effective alternative to conventional therapy and the introduction of an information sheet is a cost-effective strategy to promote it.

Computer-assisted antimicrobial-use monitoring.

The development and use of a hospital-pharmacy-based, computer-assisted antimicrobial monitoring program are described. In the pharmacy department of a teaching hospital in Spain, a manual system for collecting data on use of antimicrobial agents was replaced with a computer-assisted program that compiles data on culture and sensitivity results, the number of patients receiving antimicrobial or bacteriostatic agents (including combination therapy), and the specific agents used by hospital ward, clinical department, and physician. The antimicrobial report is reviewed daily by a pharmacist, and identified problems are discussed with the prescribing physician; about two hours per day is spent in this activity. Data for 1984 compiled by the computer program regarding the use of antimicrobial agents by group and by hospital ward and the relationship between cost and use of antimicrobial agents were evaluated. Based on the computer-generated data, guidelines for antibiotic use in surgical prophylaxis were proposed, and the pharmacy and therapeutics committee approved a new antibiotic policy that led to a reduction in the use of cephalosporins and to subsequent cost savings. Antimicrobial use at this hospital is similar to that reported at other institutions. In 1984 penicillins were the most commonly used agents, followed by aminoglycosides and cephalosporins. Antimicrobial agents accounted for 24.4% of all drug costs. This computer-assisted system of antimicrobial monitoring was used effectively to assess both individual patient therapy and overall antimicrobial use in a teaching hospital.