BackgroundMedication is the leading cause of adverse events related to healthcare. One of the most common safety issues is the lack of accurate and complete information about a patient’s medications during transitions between different levels of care.PurposeTo characterise and evaluate the impact of the implementation of a Medication Reconciliation Programmed (MRP) on the neurosurgery service at a university general hospital.Material and methodsRetrospective study between September 2014 and September 2016 in a university general hospital.The MRP is performed by the pharmacist when the patient is admitted to the neurosurgery department and requested. Home treatment is reviewed from the digital pharmacotherapeutic history and confirmed with the patient by interview. After that, the pharmacist makes recommendations according to the clinical situation of the patient, the drugs already prescribed in their hospital treatment and the ‘Guide to continuity of care for the management of perioperative medication’ developed by the pharmacy service. These recommendations are recorded in each patient’s medical history. When the patient is discharged, a pharmacotherapeutic report is drawn up containing the medication prescribed for discharge and the outpatient medication, which must be continued as a schedule and with identifying illustrations.In order to evaluate the activity of the PCM, it has been measured: patient data, drug-related problems (DRP) identified, days spent in hospital, number of reconciled drugs and intervention carried out (continuation, suspension or therapeutic exchange).ResultsDuring the study period, the pharmacy service reconciled the treatment of 54 neurosurgery patients.The average age of the patients was 65±14 years. The median hospital stay was 5 days (1–30). The number of reconciled drugs was 337, with an average of 6±3 drugs per patient.According to the guide previously mentioned, pharmaceutical interventions were: 49% continue with the usual treatment, 40% discontinue usual treatment during hospitalisation and 11% required therapeutic interchange.Finally, two DRPs were detected and resolved.ConclusionPatients hospitalised in the neurosurgery service can find benefit with MRP performed by pharmacists, ensuring an adequate pharmacotherapeutic approach between the different levels of healthcare.References and/or AcknowledgementsNeurosurgery service.Pharmacy service.No conflict of interest
BackgroundNon-specific intravenous immunoglobulin (IgIVC) preparations are one of the products of human plasma fractionation. In clinical practice these drugs are expensive as they are used as replacement therapy in patients with primary and secondary immunodeficiencies, as well as immunomodulatory therapy in many autoimmune diseases and systemic inflammatory diseases.PurposeThe purpose of this study was to compare IgIVC consumption and economic costs before and after performing IgIVC fractionation of doses in our hospital.Material and methodsDescriptive observational study in a tertiary teaching care hospital with 413 beds. All patients, both inpatients and outpatients, who received IgIVC from July 2011 to July 2015 were reviewed. Data collected from each patient included age, gender, clinical diagnosis, dosage regimen, unit consumed and cost in Euros.Data were recorded from July 2011 to June 2013 and then from July 2013 to July 2015. During the first stage, the purchased IgIVC doses were 0.5 2.5 5 and 10 g. During the second stage, only 0.5 and 10 g doses were purchased, and the 2.5 and 5 g doses were obtained by splitting the 10 g dose. In this way, one 10 g dose yielded two doses of 5 g and four doses of 2.5 g.ResultsBetween July 2011 and July 2015, 231 patients received doses of IgIVC. Of these,103 (44.58%) were female patients. The most prevailing drug indications were essential thrombocythemia, non-toxic inflammatory neuropathies and myasthenia gravis. The total economic cost was 1 913 730.26€.From July 2011 to June 2013, 96 (41.55%) patients received IgIVC which involved a total economic cost in euros of 871 504.75€ (45.54%). On the other hand, from July 2013 to July 2015, 129 (55.84%) patients received IgIVC, costing 1 024 225.510€ (54.56%).If no fractionated doses of 5 and 2.5 g had been used, the cost from July 2013 to July 2015 would have been 1 082 159.58€, therefore performing fractionated doses of IgIVC provided economic savings of 39 934.07€ (3.70%) over 2 years.ConclusionIgIVC administration has increased over the past 4 years. The economic cost has been greatly reduced by fractionation of doses performed at our hospital.No conflict of interest.
BackgroundCritically ill patients experience many pathophysiological changes that can affect the effectiveness of pharmacological treatment.PurposeTo describe the recommendations of dosage and monitoring of vancomycin used in the intensive care unit and to assess whether these are adequate to achieve optimal early therapeutic levels.Material and methodsRetrospective observational study carried out from January to December 2016 in a hospital with 21 beds of critically ill patients. This unit did not use any specific guides for the dosage of the antibiotic therapy with vancomycin. For this reason, we assessed whether the initial dosage was ideal to achieve effective antibiotic levels. The following variables were collected from the program GestLab®: sex, age, weight, dosage prior to the monitoring, time from the beginning of the treatment until the first monitoring, and time to target blood range levels. Finally, initial vancomycin trough serum level (Cv) was recorded by classifying it according to its relationship with the target therapeutic range in: in range (IR), overdose (OD) and underdose (UD).It was considered as optimum a therapeutic range concentration between 10 and 15 mcg/mL, except in some serious infections (as well as pneumonia, endocarditis, meningitis, osteomielitis, bacteraemia, sepsis or Methicillin-resistant staphylococcus aureus infections) in which Cv goals were 15 to 20 mcg/mL.ResultsOne hundred and forty-eight determinations, for 58 patients who required intensive care and were treated with vancomycin, were recorded.In 69% of the cases, the treatment with vancomycin was initiated with a 1 g/12 hour dose, 24.1±7.1 (10–44) mg/kg/day, regardless of patient characteristics and type of infection. The time until the first determination was 2.4±1.4 (1–9) days.The target range was 10 to 15 mcg/mL in 69% of the cases. In the first control: 76% of the patients were UD, 14% OD and only 10% IR. The mean time to manage concentrations in the range was 5.3±2.2 (3–12) days, for which an average of 2.6±0.8 (2–5) determinations were required. To achieve concentrations in this range, a mean dose is required of of 29.9±18.5 (6.4–88.9) mg/kg/day.ConclusionWith the current dosage, three of every four first controls are UD, delaying the proper treatment of the infection. To avoid this, one could consider an initial load dose of vancomycin.Plasma levels of systematic monitoring can be very useful to achieve rank levels as soon as possible.References and/or AcknowledgementsTo our colleagues, thank you.No conflict of interest
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