Anticuerpos antidigoxina y fallo renal: efecto rebote. A propósito de un caso / Antidigoxin antibodies and renal failure: rebound toxicity. A case report

En situaciones de riesgo vital asociadas a una intoxicación digitálica están indicados los fragmentos de unión al antígeno (Fab) antidigoxina cuya eliminación es mayoritariamente renal. Las alteraciones cardiacas asociadas a esta intoxicación pueden traducirse en oligoanuria. Dado que ni la digoxina, ni los complejos Fab-digoxina pueden eliminarse por hemofiltración o hemodiálisis, la presencia de insuficiencia renal es una limitación importante para el tratamiento de pacientes con intoxicación digitálica con Fab antidigoxina. Se describe el caso de una paciente con insuficiencia renal e intoxicación digitálica a la que se le administran en 2 ocasiones Fab antidigoxina. A las 61 horas de la primera administración se observó un rebote en los niveles de digoxina. Esta misma situación se repitió a las 38 horas de la segunda administración del antídoto. Encontramos una correlación entre el estado clínico de la paciente y las determinaciones analíticas, lo que sugiere que, tras las dos administraciones del antídoto, se produjo un efecto rebote. (AU)

Anti-digoxin antigen-binding fragments (Fab) are indicated in life-threatening situations associated with digitalis toxicity. The elimination of anti-digoxin Fab occurs through the renal route. The cardiac alterations associated with this toxicity translate into oligoanuria. Since neither digoxin nor Fab-digoxin complexes can be removed by hemofiltration or hemodialysis, the presence of renal failure is an important limitation for the treatment with anti-digoxin Fab of patients with digitalis toxicity. The case of a patient with renal insufficiency and digitalis toxicity is described, who were administered Fab antidigoxin on 2 occasions. At 61 hours after the first administration, a rebound effect in digoxin levels was observed. This same situation was repeated 38 hours after the second administration of the antidote. We found a correlation between the patient’s clinical status and the analytical determinations, which suggests that, after the two administrations of the antidote, there was a rebound effect.(AU)

Conciliación de la medicación al ingreso y alta hospitalaria. Una experiencia consolidada / Medication reconciliation at admission and discharge. A consolidated experience

La conciliación de la medicación es actualmente una de las principales estrategias para reducir los errores de medicación relacionados con la transición asistencial. Objetivo. Describir una metodología de trabajo que permita garantizar la continuidad asistencial del paciente en relación con la farmacoterapia, al ingreso y al alta hospitalaria. Material y método. Se describe la metodología implantada en un hospital de tercer nivel y los principales resultados de la conciliación de medicación al ingreso y alta de pacientes mayores de 75 años en el Servicio de Traumatología durante el año 2014. Resultados. Las fases de la metodología fueron: 1. obtención de la historia farmacoterapéutica (al menos 2 fuentes de información); 2. análisis de discrepancias y validación de la medicación al ingreso: se realizó un check list para estandarizar el proceso; 3. comunicación del perfil farmacoterapéutico: se diseñó un formulario en la historia clínica electrónica; y 4. conciliación de la medicación al alta hospitalaria e información al paciente: entrega de esquema posológico y recomendaciones al paciente. Aplicando esta metodología, en 2014 se conciliaron 318 pacientes ingresados en traumatología (294 al ingreso y alta). El 35,5% presentó al menos un error de conciliación. La media de errores por paciente conciliado fue de 0,69. En el 74,1% de los pacientes se entregó información escrita al alta. Conclusiones. Esta metodología ha permitido establecer un flujo de trabajo que facilita la coordinación interprofesionales; disminuir los errores de medicación y dar respuesta a uno de los principales problemas de la continuidad asistencial (AU)

Medication reconciliation is currently one of the main strategies to reduce medication errors related to transitional care. Objective. To describe a method that would ensure continuity of patient care as regards drug therapy from admission to discharge. Methods. A description is presented on the methodology implemented in a tertiary hospital and the main results of medication reconciliation at admission and discharge of patients older than 75 years in the Trauma Unit during 2014. Results. The phases of the methodology were: 1. Obtain medication history (at least two sources of information); 2. Analysis of discrepancies and validation of medication on admission: A checklist was made to standardise the process, 3. Report on the pharmacotherapeutic profile: a form was designed in electronic medical records, and 4. Medication reconciliation at discharge and patient information: presenting the dosing schedule and recommendations to the patient. The medication of 318 patients admitted to Trauma was reconciled (294 at admission and discharge) by applying this methodology during the study period. There was at least one medication reconciliation error in 35% of cases. The mean error per patient reconciled was 0.69. Written discharge information was given to 74.1% of patients. Conclusions. This methodology has allowed a workflow to be established that facilitates coordination between healthcare providers, in order to reduce medication errors and to respond to one of the main problems of continuity of care (AU)

[Medication reconciliation at admission and discharge. A consolidated experience]. / Conciliación de la medicación al ingreso y alta hospitalaria. Una experiencia consolidada.

UNLABELLED: Medication reconciliation is currently one of the main strategies to reduce medication errors related to transitional care. OBJECTIVE: To describe a method that would ensure continuity of patient care as regards drug therapy from admission to discharge. METHODS: A description is presented on the methodology implemented in a tertiary hospital and the main results of medication reconciliation at admission and discharge of patients older than 75 years in the Trauma Unit during 2014. RESULTS: The phases of the methodology were: 1. Obtain medication history (at least two sources of information); 2. Analysis of discrepancies and validation of medication on admission: A checklist was made to standardise the process, 3. Report on the pharmacotherapeutic profile: a form was designed in electronic medical records, and 4. Medication reconciliation at discharge and patient information: presenting the dosing schedule and recommendations to the patient. The medication of 318 patients admitted to Trauma was reconciled (294 at admission and discharge) by applying this methodology during the study period. There was at least one medication reconciliation error in 35% of cases. The mean error per patient reconciled was 0.69. Written discharge information was given to 74.1% of patients. CONCLUSIONS: This methodology has allowed a workflow to be established that facilitates coordination between healthcare providers, in order to reduce medication errors and to respond to one of the main problems of continuity of care.