Implantación de un sistema de prescripción electrónica asistida aplicada a la nutrición parenteral en un hospital general / Implementation of an assisted electronic prescription system applied to parenteral nutrition in a general hospital

Los sistemas de información integrados y compartidos permiten obtener un elevado nivel de información sobre los procesos, costes y resultados, y reducir considerablemente los errores de medicación. La prescripción electrónica asistida, en el área de nutrición parenteral total, integrado con otras bases de datos del hospital y con el sistema de gestión de medicamentos del hospital, es una herramienta que permite aumentar la seguridad del paciente (disminuyendo los errores de medicación), mejorar la calidad de la asistencia, mejorar los sistemas de información y la gestión de la misma y la eficiencia de los recursos empleados. En este trabajo se describe la implantación de un sistema de prescripción electrónica asistida aplicada a la nutrición parenteral en un hospital general, y la reingeniería de procesos llevado a cabo en el área de nutrición. Esta implantación se ha llevado a cabo por los facultativos médicos del servicio de Nutrición y Dietética y por farmacéuticos del Servicio de Farmacia del Hospital Ramón y Cajal utilizando para ello el programa informático "Nutriwin". Durante dos meses antes y después de su implantación, se ha realizado un seguimiento del tiempo empleado en el circuito prescripción-validación-elaboración-dispensación de las nutriciones parenterales. Tras la implantación las órdenes de tratamiento llegan, en promedio, 1 h 15 minutos antes al Servicio de Farmacia; al evitarse la trascripción se produce, además de la disminución de errores potenciales, un ahorro de 3 min/ nutrición en los cálculos a realizar; la elaboración de las nutriciones puede comenzarse como promedio 1h 20 minutos antes que si se realizara la prescripción manual. Así mismo los prescriptores pueden conocer en tiempo real el perfil nutricional de cada paciente en el episodio en curso así como su histórico. La prescripción electrónica de las órdenes de tratamiento en éste área ha supuesto para nuestro hospital una optimización de los recursos empleados, una disminución de los errores potenciales que se pueden producir, una mejora en la gestión de consumos, y un aumento en la calidad de todo el proceso (AU)

Integrated and shared information systems allow obtaining a high degree of information about processes, costs and outcomes, and considerably reducing prescription errors. Assisted electronic prescription, in the setting of total parenteral nutrition, integrated with other hospital databases and with the hospital drugs management system, is a tool that allows increasing patient' safety (by reducing prescription errors), improving quality assistance, improving information systems and information management and the efficiency of used resources. In this work, implementation of an assisted electronic prescription system applied to parenteral nutrition in a hospital and processes reengineering performed in the nutrition setting are described. This implementation was performed by medical staff from the Nutrition and Diet Department and pharmacists from the Pharmacy Department of Ramón y Cajal Hospital using "Nutriwin" computer software. For two months prior and after its implementation, a follow-up of time consumed in the circuit prescription-validation-elaboration-dispensation of parenteral nutrition formulas has been performed. After implementation, treatment orders reach on average 1 h and 15 minutes sooner the Pharmacy Department; by avoiding transcription, a saving of 3 min per nutrition formula calculations is achieved, besides reducing potential errors; elaboration of nutrition formulas can be started on average 1 h and 20 minutes sooner as compared to manual prescription. Besides, the staff that writes down the prescription may know in real time the nutritional profile for each patient in the current episode and the patient's historic. Electronic prescription of treatment orders in this area has represented for our hospital an optimization of the employed resources, a reduction of potential errors that may occur, an improvement in consumption management, and an increase in the whole process quality (AU)

Effects of normalization of GH hypersecretion on lipoprotein(a) and other lipoprotein serum levels in acromegaly.

BACKGROUND & AIMS: Lipoprotein(a) has been recognized as an important risk factor for cardiovascular disease. Lipoprotein(a) has been found to be elevated in sera of acromegalic patients, possibly contributing to the increased incidence of coronary heart disease found in these patients. In the present study we sought to determine the effects of GH hormonal status on lipoprotein(a) and other lipid parameters, including lipoprotein lipase (LPL) activity. DESIGN: Cross-sectional study. PATIENTS: Twenty acromegalic patients, with either active (n = 12) or controlled (n = 8) acromegaly, were studied. Twenty-nine healthy subjects served as control group for serum lipid measurements. MEASUREMENTS: Serum GH, IGF-1, IGF binding protein-3 (IGFBP-3) and insulin levels were measured in patients. Insulin resistance was measured by the homeostatic model assessment (HOMA). Plasma total cholesterol, triglycerides, HDL-lipids, apolipoproteins A-I and B, lipoprotein(a) and lipoprotein lipase activity were also measured. RESULTS: The highest lipoprotein(a) levels were observed in patients with active acromegaly, followed by patients with controlled acromegaly, whose lipoprotein(a) concentrations were still significantly higher than those of the control group (means +/- SEM: active acromegaly, 0.67+/-0.13 g/l; controlled acromegaly, 0.41+/-0.12 g/l; controls 0.17+/-0.02 g/l; P<0.05). There were no differences in other lipid and lipoprotein values among the groups. In patients, significant correlations were observed between lipoprotein(a) and basal GH levels (r = 0.56, P<0.02), mean GH levels (r = 0.48, P<0.05) and with insulin resistance estimated by HOMA (r = 0.62, P<0.01). No correlations were found between lipoprotein(a) and IGF-1 or IGFBP-3 levels. CONCLUSIONS: Our present results demonstrate that both active acromegalic patients and those with controlled disease have elevated serum lipoprotein(a) concentrations. The findings might suggest that the present biochemical criteria for cure of acromegaly are not strict enough to result in the normalization of all the undesirable metabolic changes found in this disease, and also that significant cardiovascular risk may persist despite successful treatment of acromegaly.