Nursing interventions as part of an integral pharmaceutical care team.

OBJECTIVE: To describe interventions carried out by nurses in the Pharmaceutical Care Unit upon admission and in Outpatient Consultation (FACE) with the aim of promoting effective, safe and efficient pharmacotherapy for hospitalised patients. METHOD: A descriptive study of nursing activity carried out in the Outpatient Consultation Unit between April 2008 and March 2009. The nurse performs five specific, formalised activities: clarifying differences in the medical records related to drugs allergies or intolerances, identifying pharmacotherapy discrepancies between acute and chronic treatment, identifying opportunities for improving pharmacotherapy, contributing to patient education about his/her treatment upon discharge and dispensing limited duration drugs (less than 30 days) upon discharge to avoid accumulation of medication at home. RESULTS: During the study period the nurse took part in the pharmacotherapy administered to 1,360 patients (57.6% of total patients treated by the integral pharmaceutical care team), for a total of 1,709 individual interventions. These interventions were performed in order to clarify differences in medical records regarding drug allergies or intolerances (n=111), to identify pharmacotherapy discrepancies between acute and chronic treatment (n=118), to identify opportunities for improving pharmacotherapy (n=263), and upon discharge in order to educate the patient about his/her treatment (n=31) and to dispense limited duration drugs (n=1186). CONCLUSIONS: The nurse's contribution to the integral pharmaceutical care team helps to improve the quality of pharmacotherapy in terms of effectiveness, safety and efficiency pharmacotherapy.

[Therapeutic interchange of drugs not included in the hospitals pharmacotherapeutic guide: a quality program]. / Programa de calidad aplicado a la sustitución de medicamentos no incluidos en la Guía Farmacoterapéutica del hospital.

BACKGROUND: Standardised substitution of those drugs not included in the hospitals formulary constitutes one of several methods used to improve therapeutic efficiency, due to reduction of variability in pharmaceutical practice and prevention of potential medication errors. OBJECTIVES: To evaluate quality of drug substitution procedures in those drugs not included in the hospital's formulary. METHODS: Assessment study in a surgical hospital with 314 beds, using structural, process and outcome criteria from 1998 to 2002. RESULTS: Compliance degree for structure, process and outcome criteria were 100, 89 and 35%, respectively, while the established standards were 100%. Prevalence values for patients with substituted medication, increased from 2.9 (95%CI, 2.4-3.6) in 1998 to 11.1% (95%CI, 10.2-12.1) in 2002. Non-substituted drugs annual cost decreased from 20,199 in 1998 to 12,356 Euro in 2002. Drug substitution made by the pharmacist had an acceptance degree of 82.5%. No interchange errors were found in 126 replaced drugs. CONCLUSIONS: The development of quality programs to improve drug prescription adherence to the hospitals formulary, specially those that promote therapeutic interchange under the Pharmacy Committee guidance, are helpful strategies to make a proficient management of patients pharmacotherapy.

Actividades de enfermería como parte de un equipo de atención farmacéutica integral / Nursing interventions as part of an integral pharmaceutical care team

Objetivo Describir las intervenciones desarrolladas por la enfermera adscrita a la Unidad de Atención Farmacéutica al alta y en Consultas Externas (FACE) con el fin de promocionar una farmacoterapia efectiva, segura y eficiente en el paciente hospitalizado. Método Estudio descriptivo de la actividad de enfermería asignada a la Unidad FACE entre abril de 2008 y marzo de 2009. La enfermera tiene asignadas cinco actividades específicas y protocolizadas que son: clarificar diferencias en los registros de alergias/intolerancias a medicamentos, identificar discrepancias relativas al tratamiento farmacoterapéutico crónico, identificar oportunidades de mejora farmacoterapéutica, mejorar el conocimiento de los tratamientos prescritos al alta y evitar el acúmulo de medicación en los domicilios mediante la dispensación de tratamientos de duración limitada (inferior a 30 días).Resultados Durante el periodo de estudio la enfermera actuó en 1.360 (57,6%) pacientes de los 2.362 pacientes atendidos por la Unidad FACE. La enfermera realizó un total de 1.709 intervenciones de las cuales 111 fueron para resolver diferencias en el registro de alergias/intolerancias a medicamentos, 118 para solucionar discrepancias en el tratamiento crónico, 263 fueron por identificación de oportunidades de mejora farmacoterapéutica, 1.186 dispensaciones de tratamientos de duración limitada y 31 estuvieron orientadas a mejorar la educación farmacoterapéutica de los pacientes al alta hospitalaria. Conclusiones La enfermera contribuye a la consecución de los objetivos generales de la unidad FACE y por lo tanto a la mejora de la calidad farmacoterapéutica en términos de efectividad, seguridad y eficiencia (AU)

Objective To describe interventions carried out by nurses in the Pharmaceutical Care Unit upon admission and in Outpatient Consultation (FACE) with the aim of promoting effective, safe and efficient pharmacotherapy for hospitalised patients. Method A descriptive study of nursing activity carried out in the Outpatient Consultation Unit between April 2008 and March 2009. The nurse performs five specific, formalised activities: clarifying differences in the medical records related to drugs allergies or intolerances, identifying pharmacotherapy discrepancies between acute and chronic treatment, identifying opportunities for improving pharmacotherapy, contributing to patient education about his/her treatment upon discharge and dispensing limited duration drugs (less than 30 days) upon discharge to avoid accumulation of medication at home. Results During the study period the nurse took part in the pharmacotherapy administered to 1360 patients (57.6% of total patients treated by the integral pharmaceutical care team), for a total of 1709 individual interventions. These interventions were performed in order to clarify differences in medical records regarding drug allergies or intolerances (n=111), to identify pharmacotherapy discrepancies between acute and chronic treatment (n=118), to identify opportunities for improving pharmacotherapy (n=263), and upon discharge in order to educate the patient about his/her treatment (n=31) and to dispense limited duration drugs (n=1186).Conclusions The nurse's contribution to the integral pharmaceutical care team helps to improve the quality of pharmacotherapy in terms of effectiveness, safety and efficiency pharmacotherapy (AU)

Seguimiento farmacológico del hipoparatiroidismo durante el embarazo: descripción de un caso / Fharmacologic follow-up of hypoparathyroidism during pregnancy: a case report

Se describe un caso de hipoparatiroidismo adquirido por tiroidectomía y posterior embarazo. La hipocalcemia fue corregida mediante aporte oral de calcio (0,5 g/12 horas); dosis que fue duplicada y suplementada con calcitriol (0,5 µg) en la 31ª semana de embarazo. Con motivo de la cesárea, se determinaron las dosis de calcio vía parenteral considerando una bioequivalencia oral del 38 por ciento, administrándose 765 mg de calcio mediante perfusión intravenosa. Las pérdidas de calcio producidas por la cesárea se corrigieron mediante la administración de Ringer Lactado (90 mg de calcio). El tratamiento del hipoparatiroidismo en el embarazo pretende evitar estados de hipocalcemia que producirían alteraciones fetales o abortos. La terapia combinada de calcio y calcitriol es habitual, si bien las dosis utilizadas deben aumentarse en el tercer trimestre del embarazo y disminuirse tras el parto. Por ello, se recomienda monitorizar el calcio plasmático y conseguir un manejo farmacoterapéutico seguro y eficaz (AU)