BackgroundIn exercising their hospital activity, the pharmacist is faced with multiple tasks that can compromise, for security reasons, a positive trend in the health status of patients.There are areas that are traditionally regarded as critical (preparation of non-sterile formulations, handling cytotoxic or other sterile mixtures).The Cytotoxic Preparation Manual, by the Portuguese Council in Hospital Pharmacy Specialty, states: “double checking should be implemented in the critical steps of the preparation process. Double checking should be carried out independently by a second person or by a computerised system”. Compliance with this recommendation is not uniform in the various hospitals due to a shortage of human resources.PurposeTo create conditions for the fulfilment of the double validation process by eliminating the actual and permanent physical presence of a second element in the preparation of sterile room mixtures, keeping the final quality of the process.Material and methodsMultiple image capture methods in handling the environment in the laminar air flow chamber were tested, after consultation with the national Data Protection Authority, which enabled such viewing. The final solution was a system composed of special glasses with a high definition camera which enables real time recording with up to 30 images per second and marking of critical points that can be downloaded to a computer for a verification process.ResultsThe test phase was successfully passed, after correct viewing images in the real work environment. The ocular device allows the use of a visor and does not interfere with the manipulation. It allows identification of the drug, solvent validation and identification of a reconstituted final volume for the patient and medical prescription. The validation can be done elsewhere from the pharmaceutical services, outside the clean room, and consists of the display of marked critical points and, in doubtful cases, the full view of the event. This validation reduces by at least 75% the time allocated to the second element.ConclusionThe possibility of implementation/maintenance of the double validation process, reducing by more than 75% of the associated workload and elimination of sterile equipment required for entry into the clean room, enables compliance with the rules of the Cytotoxic Preparation Manual, with rationalisation of associated resources.References and/or AcknowledgementsManual de Preparação de CitotóxicosNo conflict of interest.
BackgroundAccording to legislation, prescription of carbapenems and quinolones should be reduced by 50% by 2020. The Support Programme for Antimicrobial Prescription aims to survey the incidence rate of multi-drug-resistant microorganisms.PurposeThe objectives were to reduce the consumption of carbapenems by 10% and quinolones by 5% by the end of the year, reducing indicators of infection, defined daily dose (DDD) and DHD (DDD/1000 inhabitants/day) 2015/2014.Material and methodsLongitudinal prospective study. Prescriptions are indicated by the pharmacists who classify requirements as empirical prescriptions, inappropriate prescribing and microbiologically documented prescriptions. If necessary, the prescriptions are changed by infectiologists. We compared data from January to August 2015 with the same period in 2014.Patients were admitted between June and August 2015.ResultsThe variation between the DDD was 88.8% for carbapenems, and 94.7% (intravenous) and 79.3% (oral) for quinolones. The carbapenems decreased by 11.2% in total DDD. The intravenous quinolones decreased by 5.3% and the oral reduction was 15.6%. The DHD values were calculated and had the same trend of decreasing consumption.During the study period, 263 patients were identified. We analysed 183 carbapenem and 81 quinolone prescriptions. 152 were men and mean age was 68.8 ± 15.9 years. The most common site of infection was urinary tract infection.Intervention occurred in 92 empirical prescriptions, 52 inappropriate prescribing, 79 documented and 36 according to the protocol. The prescription was changed in 59 patients. Duration of therapy was 7.3 days for patients without an intervention and 4.9 days with an intervention.We found that in 116 microbial isolates, 55 were multi-resistant. Of the monitored patients, 199 were discharged, 32 died and 32 remain hospitalised.ConclusionThe proposed objective was attained by August. The national target to reduce the DHD was also fulfilled. There has been investment in surveillance of surgical prophylaxis protocols, as reflected in the decreasing consumption of quinolones.References and/or AcknowledgementsDespacho No 1400 A/2015 10 Fevereiro Diário República 28 (2015)No conflict of interest.
BackgroundAccording to Portuguese legislation, consumption of carbapenems and quinolones should be reduced by 50% by 2020. The aim of the Antibiotic Stewardship Programmes is surveillance of antibiotic consumption and a decrease in incidence rate of multidrug resistant microorganisms.PurposeThe objectives of GCL-PPCIRA (Local Coordination Group Prevention Programme and Infections Control and Antimicrobial Resistance) were to reduce the number of inappropriate prescriptions and duration of antibiotic therapy, and prevent the emergence of antimicrobial resistance.Material and methodsThis was a prospective study. Antibiotics prescriptions between June 2015 and May 2016 were analysed by the pharmacist by reviewing patient medical records. The pharmacist classified the requirements as empirical, inappropriate and documented prescriptions. Statistics: Stata 10.1 (5% significance level).Results618 patients were identified, mean (SD) age 68 (16.6) years and 54.9% men, resulting in 734 prescriptions of carbapenems (71%) and quinolones (29%). The most common site of infection was the urinary tract (31.3%). According to the prescribed therapeutic intervention, 150 (20.4%) were empirical, 275 (37.5%) were inappropriate, 231 (31.5%) were documented and 77 (10.5) were according to the protocol approved by the institution.Mean duration of treatment was 9.4 days for documented prescriptions, 8.8 days for empirical prescriptions, 7.1 days for prescriptions according to the protocol and 6 days for inappropriate prescriptions (p=0.0001). PPCIRA changed 118 (16.1%) prescriptions. The interventions reduced the mean duration of therapy: 4.7 days for prescriptions with interventions and 8.4 days for those without (p<0.0001). It was found that in 362 prescriptions with microbial isolates, 201 were multidrug resistant microorganisms (55.5%).Prescriptions for patients who were discharged with an antibiotic (23.7%) had a lower mean duration of treatment and a lower proportion of prescriptions with multidrug resistant microorganisms than prescriptions for patients who were discharged without an antibiotic (61.7%) or for patients who died (14.6%): 6.4 days and 33.8% for multidrug resistant microorganisms, 8.2 and 62.8% and 8.1 and 49.1%, respectively (p=0.0001 and p<0.001). 14 (13.1%) deaths were directly attributed to infection.ConclusionThe PPCIRA work has resulted in a timely intervention during the prescription process. The investment in surveillance of therapeutic protocols has been reflected in a decrease in the duration of inappropriate prescriptions and the fulfilment of targeted therapy.References and/or acknowledgementsDespacho No 3844-A/2016 DR 2ª serie No 52–15 de Março de2016.No conflict of interest
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