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BACKGROUND: The objective of the FeminFER project was to assess the value of ferric carboxymaltose following a multicriteria decision analysis in obstetrics and gynaecology in Spain. METHODS: Ferric carboxymaltose (FCM) and ferrous sulphate were evaluated using the EVIDEM framework. Ten stakeholders participated to collect different perspectives. The framework was adapted considering evidence retrieved with a PICO-S search strategy and grey literature. Criteria/subcriteria were weighted by level of relevance and an evidence-based decision-making exercise was developed in each criterion; weights and scores were combined to obtain the value of intervention relative to each criterion/subcriterion, that were further combined into the Modulated Relative Benefit-Risk Balance (MRBRB). RESULTS: The most important criterion favouring FCM was Compared Efficacy/Effectiveness (0.183 ± 0.07), followed by Patient Preferences (0.059 ± 0.10). Only Direct medical costs criterion favoured FS (-0.003 ± 0.03). MRBRB favoured FCM; 0.45 ± 0.19; in a scale from -1 to + 1. CONCLUSIONS: In conclusion, considering the several criteria involved in the decision-making process, participants agreed with the use of FCM according to its MRBRB.
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Anemia Ferropénica/tratamiento farmacológico , Técnicas de Apoyo para la Decisión , Compuestos Férricos/uso terapéutico , Compuestos Ferrosos/uso terapéutico , Maltosa/análogos & derivados , Complicaciones Hematológicas del Embarazo/tratamiento farmacológico , Femenino , Humanos , Maltosa/uso terapéutico , Embarazo , Medición de Riesgo , España/epidemiología , Participación de los InteresadosRESUMEN
Hospital Pharmacy is today a profession marked by therapeutic advances, with a proactive attitude, focussed on people and their health. The evolution of processes is constant, with the full presence of digitalisation, robotisation, and even artificial intelligence, in an environment that also requires the efficient and sustainable use of these tools. In this context, it is necessary to have a roadmap that guides the advancement of the profession and Hospital Pharmacy Services. Continuing with the philosophy of the 2020 initiative which, with the slogan "Towards the future, safely", defined the strategic lines to advance in the improvement of Hospital Pharmacy practice, the Spanish Society of Hospital Pharmacy wanted to raise the challenges the profession is currently facing and with a view to 2030. With this strategic planning objective, 20 challenges have been identified and developed, which cover the different areas of action and involvement of Hospital Pharmacy and which cover clinical activities, transversal aspects, training, and research, as well as areas related to people and to the organisations or health systems. For each of them, the objectives, standards, tools, and resources have been defined. It is also planned to provide tools that facilitate monitoring of implementation and the impact on the profession, patients, and the environment.
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Servicio de Farmacia en Hospital , Servicio de Farmacia en Hospital/organización & administración , Humanos , España , PredicciónRESUMEN
Hospital pharmacy is today a profession marked by therapeutic advances, with a proactive attitude, focused on people and their health. The evolution of processes is constant, with the full presence of digitalization, robotization and even artificial intelligence, in an environment that also requires the efficient and sustainable use of these tools. In this context, it is necessary to have a roadmap that guides the advancement of the profession and hospital pharmacy services. Continuing with the philosophy of the 2020 initiative which, with the slogan "Towards the future, safely", defined the strategic lines to advance in the improvement of hospital pharmacy practice, the Spanish Society of Hospital Pharmacy wanted to raise the challenges the profession is currently facing and with a view to 2030. With this strategic planning objective, twenty challenges have been identified and developed, which cover the different areas of action and involvement of hospital pharmacy and which cover clinical activities, transversal aspects, training and research, as well as areas related to people and to the organizations or health systems. For each of them, the objectives, standards, tools and resources have been defined. It is also planned to provide tools that facilitate monitoring of implementation and the impact on the profession, patients and the environment.
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Servicio de Farmacia en Hospital , Servicio de Farmacia en Hospital/organización & administración , EspañaRESUMEN
OBJECTIVE: To determine the prevalence and appropriateness of antimicrobial use in Spanish hospitals through a pharmacist-led systematic cross-sectional review. METHOD: A nationwide multicenter cross-sectional study was conducted on 10% of the patients admitted to the participating hospitals on one day in April 2021. Hospital participation was voluntary, and the population was randomly selected. The study sample was made up of patients who, on the day of the study, received at least one antimicrobial belonging to groups J01, J02, J04, J05AB, J05AD or J05AH in the Anatomical Therapeutic Chemical Classification System. The pharmacist in charge made a record and carried out an evaluation of the appropriateness of antimicrobial use following a method proposed and validated by the Pharmaceutical Care of Patients with Infectious Diseases Working Group of the Spanish Society of Hospital Pharmacy. The evaluation method considered each of the items comprising antimicrobial prescriptions. An algorithm was used to assess prescriptions as appropriate, suboptimal, inappropriate and unevaluableResults: One-hundred three hospitals participated in the study and the treatment of 3,568 patients was reviewed. A total of 1,498 (42.0%) patients received antimicrobial therapy, 424 (28.3%) of them in combination therapy. The most commonly prescribed antimicrobials were moxicillin-clavulanic acid (7.2%), ceftriaxone (6.4%), piperacillin-tazobactam (5.8%), and meropenem 4.0%. As regards appropriateness, prescriptions were considered appropriate in 34% of cases, suboptimal in 45%, inappropriate in 19% and unevaluable in 2%. The items that most influenced the assessment of a prescription as suboptimal were completeness f medical record entries, choice of agent, duration of treatment and monitoring of efficacy and safety. The item that most influences the assessment of a prescription as inappropriate was the indication of ntimicrobial agent. Conclusions: The method used provided information on the prevalence and appropriateness of the use of antimicrobials, a preliminary step in the design and implementation of actions aimed at measuring the impact of the use of ntimicrobials within the antimicrobial stewardship programs.
OBJETIVO: Conocer la prevalencia y el grado de adecuación del uso de antimicrobianos en los hospitales españoles mediante una revisión sistemática transversal realizada por farmacéuticos.Método: Estudio multicéntrico, nacional, transversal sobre el 10% de los pacientes ingresados en los hospitales participantes un día del mes de abril de 2021. La participación de los hospitales fue voluntaria y la selección de la población aleatoria. De la población se disgregó la muestra de estudio, constituida por los pacientes que recibían el día del corte al menos un antimicrobiano perteneciente a los grupos J01, J02, J04, J05AB, J05AD y J05AH del Sistema de Clasificación Anatómica, Terapéutica y Química. Sobre la muestra de estudio, el farmacéutico realizó un registro y evaluación de la adecuación del tratamiento antimicrobiano siguiendo una metódica propuesta y validada por el Grupo de trabajo de Atención Farmacéutica al Paciente con nfermedad Infecciosa de la Sociedad Española de Farmacia Hospitalaria. La metódica de evaluación consideró cada una de las dimensiones que conforman la prescripción del antimicrobiano e incluyó un algoritmo para calificar la prescripción global como adecuada, mejorable, inadecuada y no valorable. RESULTADOS: Participaron 103 hospitales y se revisó el tratamiento de 3.568 pacientes, de los que 1.498 (42,0%) recibieron terapia antimicrobiana, 424 (28,3%) en combinación. La prevalencia de los antimicrobianos más frecuentes fue: amoxicilina-clavulánico 7,2%, ceftriaxona 6,4%, piperacilina- tazobactam 5,8% y meropenem 4,0%. Respecto a la adecuación del tratamiento la prescripción, fue considerada adecuada en el 34% de los casos, mejorable en el 45%, inadecuada en el 19% y no valorable en el 2%. Las dimensiones que más influyeron en la calificación de la prescripción como mejorable fueron el registro en la historia clínica, la elección del agente, la duración del tratamiento y la monitorización de la eficacia y seguridad, y como inadecuada la indicación de antimicrobiano. CONCLUSIONES: La metódica utilizada permite conocer la prevalencia y adecuación del uso de antimicrobianos, paso previo para diseñar y emprender acciones de mejora y medir el impacto de su implantación en el marco de los programas de optimización del uso de antimicrobianos.
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Antiinfecciosos , Ceftriaxona , Antibacterianos/uso terapéutico , Antiinfecciosos/uso terapéutico , Ácido Clavulánico , Estudios Transversales , Hospitales , Humanos , Meropenem , Piperacilina , Prevalencia , TazobactamRESUMEN
OBJECTIVE: To identify the predictive factors of hyperglycaemia in patients receiving parenteral nutrition (PN). MATERIAL AND METHODS: Retrospective observational study (January 2016-December 2016) conducted in a 450-bed university hospital. Adult hospitalized patients who received total PN through a central line for at least 48hours were included. The required variables to characterize patients, and those related to the PN received were collected and hyperglycaemia was defined as 3 consecutive glycaemias greater than 150mg/dl or 2 greater than 180mg/dl. A descriptive, comparative bivariate statistical analysis was carried out, as well as a multivariate analysis using binary logistic regression (SPSS.v.24.) RESULTS: 234 patients were included. The prevalence of hyperglycaemia in the population under study was 44.0%. The main differences observed in the bivariate analysis between hyperglycaemic and normoglycemic patients were related to age, previous comorbidities, medical department, presence of sepsis, duration and glucose contribution in PN, as well as blood glucose levels and corticosteroids. The predictors of hyperglycaemia obtained after the multivariate analysis were: renal clearance (OR=.982, 95% CI .968-.996, P=.010), pre-PN glycaemia (OR=1.039, 95% CI 1.026-1.051, P<.001), diabetes mellitus (OR=11.016, 95% CI 3.028-31.697, P<.001), intensive medicine (OR=3.303, 95% CI 1.183-9.219, P=.023), corticosteroids (OR=3.155, 95% CI 1.179-8.226, P=.022). CONCLUSIONS: Decreased renal clearance, high blood glucose levels, diabetes, corticosteroid use, and critical patients are predictors of hyperglycaemia, therefore it would be advisable to consider them in the design of PN start formula.
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Hiperglucemia/etiología , Nutrición Parenteral/efectos adversos , Anciano , Femenino , Humanos , Hiperglucemia/epidemiología , Masculino , Prevalencia , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND AND OBJECTIVE: The objective of this study was to know of the incidence rate of reconciliation errors in elderly poly-medicated patients. PATIENTS AND METHOD: A prospective randomized multicenter study in a cohort of patients at admission or at discharge. Any unjustified discrepancy in medication between chronic treatment and the treatment prescribed in the hospital was considered as a Reconciliation Error. RESULTS: From January 2006 to April 2008 603 patients were analyzed: 318 (52.7%) showed at least one Reconciliation Error. The patients had a total of 3.991 medications registered, 2.340 (59%) showed no discrepancies, 970 (24%) HAD justified discrepancies and 644 (16%) not justified; in 37 (1%) it was not possible to determine whether this was an error or not. Of the 644 unjustified discrepancies, 555 were accepted by the doctor as Reconciliation Errors. Reconciliation Error rate of 13.9%. CONCLUSION: According to this study, 52.7% of elderly poly-medicated patients have reconciliation errors during hospitalization. Medication reconciliation should be a strategic objective to increase the safety of patients.