A non-compulsory stewardship programme for the management of antifungals in a university-affiliated hospital.

Antimicrobial stewardship programmes promote excellence in the use of antimicrobials by selecting the appropriate antimicrobial agent and the correct dose, route of administration and duration of treatment. However, there is limited experience with such programmes targeting antifungal treatments. We present the results of a non-compulsory programme for the control of antifungals. For 12 months, prescriptions of oral voriconazole or intravenous voriconazole, caspofungin and liposomal amphotericin B were reviewed, and non-compulsory recommendations were made. The incidence and outcome of fungal infections were examined. The results for the dispensed defined daily doses (DDDs) and expenditure on antifungals were compared with those for the previous 12 months. The number of antifungal treatments reviewed was 662. A recommendation to change treatment was made in 29% of the cases, including a change from intravenous to oral treatment (15%), cessation of antifungal treatment (8%), and a change to fluconazole (6%). The DDDs of intravenous voriconazole and caspofungin were reduced by 31.4% and 20.2%, respectively. The DDDs of oral voriconazole and dispensed vials of liposomal amphotericin B were increased by 8.2% and 13.9%, respectively. Expenditure on antifungals was reduced by US$370681.78 (11.8% reduction). The programme was not related to significant increases in the incidence of candidaemia, percentage of persistent/relapsing candidaemia cases, percentage of fluconazole-resistant Candida species, incidence of infections by filamentous fungi, or 12-month mortality in patients with filamentous fungal infections. In conclusion, a stewardship programme targeting antifungals achieved a reduction in antifungal expenditure without reducing the quality of care provided.

[Satisfaction perceived by outpatients and pharmacy auxiliaries in a Hospital Pharmacy Department, as a method of improving quality]. / Satisfacción percibida por los pacientes y por el personal auxiliar de farmacia del área de atención a pacientes externos como método de mejora de la calidad.

OBJECTIVES: To evaluate the satisfaction of pharmacy auxiliaries, and patients attending the Outpatient Pharmacy, after the restructuring of the physical space and the process of dispensing drugs. METHODS: Three months after the restructuring of the Area (January 2009), we gave satisfaction surveys (anonymously and voluntarily) over 2 weeks, to a sample of the 3,300 patients who came per month and another to pharmacy auxiliaries who had worked in the area. The surveys consisted of eight closed questions with a Likert-type format about the physical space and organization, dispensing process and overall satisfaction (primary endpoint). In addition, there was an open question to gather suggestions. RESULTS: A total of 265 patients received the questionnaire (response rate 94%). The most valued aspect was the confidentiality (4.2 ± 0.7) and the worst was the waiting area (3.2 ± 1). There was a 100% response rate from the 26 pharmacy auxiliaries who received the questionnaire. The highest score was obtained by the installation of the bar-code reader (3.9 ± 0.6) and the lowest for organization of the stores (3.1 ± 1.2). They added comments about the lack of personnel, computer systems, organization of space and the lack of clarity of the prescription. The overall patient satisfaction was 4.2 ± 0.6 and that of the auxiliaries was 3.7 ± 0.7. CONCLUSIONS: The results of patients and employees satisfaction surveys have been useful information to assess changes in the area and identify points for improvement. In most of the issues the satisfaction was greater in patients than employees. We believe it is necessary to carry out actions for improving physical space and organization.

[Is it worth knowing the characteristics of inpatient paediatric parenteral nutrition?]. / ¿Es útil conocer las características de la nutrición parenteral en un hospital terciario pediátrico?

OBJECTIVE: To describe the characteristics of inpatient parenteral nutrition during 2008 in a tertiary level paediatric hospital. To compare this practice with recent standards. MATERIAL AND METHODS: Longitudinal, descriptive, and retrospective study of patients under 16 years receiving parenteral nutrition in 2008. Demographic data as well as data of the nutritional support were recorded. RESULTS: A total of 120 children received parenteral nutrition, of whom 63 were under 2 years, 30 between 3 and 7 years, and 27 older than 7 years. They accounted for 1.6% of all the inpatients during that period. Most frequent indication was gastrointestinal surgery (35.5%), followed by non-surgical gastrointestinal diseases (19.8%). The average composition in the first day of parenteral nutrition was: 63.1kcal/kg (SD: 21.3); volume, 76.6ml/kg (SD: 28.4); carbohydrates 9.6g/kg/d (SD: 3.2); amino acids 2.1g/kg/d (SD: 0.6), and lipids 1.9g/kg/d (SD: 1). The mean duration of parenteral support was 10.5 days (SD: 9.8). Internal jugular vein (34.7%) and femoral vein were the most common intravenous access. The main reason to discontinue parenteral nutrition was transition to oral/enteral feedings. The complication rate was 27.3%. CONCLUSIONS: There is an interest in evaluating standard practice in parenteral nutrition in order to develop improvement strategies. Infants and toddlers are the principal candidates for parenteral nutrition. Standardisation is one way to decrease errors in its preparation and prescription.