Degree of technological implementation in intravenous chemotherapy management in hospitals of the Autonomous Community of Madrid / Grado de implantación tecnológica en el manejo de quimioterapia intravenosa en los hospitales de la Comunidad de Madrid

Objective: To understand the degree of technological implementation in the processes of preparation and administration of cytostatics drugs that is available in those hospitals of the Autonomous Community of Madrid where intravenous chemotherapy is prepared. Method: A descriptive observational study through the completion of a survey targeted to the staff responsible for the preparation of this type of treatments. Results: The degree of implementation of assisted electronic prescription is high, there is a medium degree in the case of bar code reading technology, and low in terms of vial re-labelling and gravimetric and voice control for preparation. Conclusions: There is a large room for improvement regarding traceability in the process of preparation and administration of intravenous chemotherapy (AU)

Objetivo: Conocer el grado de implantación tecnológica en los procesos de preparación y administración de citostáticos del que disponen los hospitales de la Comunidad de Madrid en los que se elabora quimioterapia intravenosa. Método: Estudio observacional descriptivo mediante la cumplimentación de una encuesta dirigida al personal responsable de la elaboración de este tipo de tratamientos. Resultados: El grado de implantación de la prescripción electrónica asistida es elevado, medio en el caso de tecnología de lectura de código de barras y bajo en reetiquetado de viales y control gravimétrico y por voz de la elaboración. Conclusiones: Existe un amplio margen de mejora en lo que se refiere a la trazabilidad del proceso de elaboración y administración de mezclas intravenosas de quimioterapia (AU)

Degree of technological implementation in intravenous chemotherapy management in hospitals of the Autonomous Community of Madrid.

OBJECTIVE: To understand the degree of technological implementation in the processes of preparation and administration of cytostatics drugs that is available in those hospitals of the Autonomous Community of Madrid where intravenous chemotherapy is prepared. METHOD: A descriptive observational study through the completion of a survey targeted to the staff responsible for the preparation of this type of treatments. RESULTS: The degree of implementation of assisted electronic prescription is high, there is a medium degree in the case of bar code reading technology, and low in terms of vial re-labelling and gravimetric and voice control for preparation. CONCLUSIONS: There is a large room for improvement regarding traceability in the process of preparation and administration of intravenous chemotherapy.

Objetivo: Conocer el grado de implantación tecnológica en los procesos de preparación y administración de citostáticos del que disponen los hospitales de la Comunidad de Madrid en los que se elabora quimioterapia intravenosa.Método: Estudio observacional descriptivo mediante la cumplimentación de una encuesta dirigida al personal responsable de la elaboración de este tipo de tratamientos.Resultados: El grado de implantación de la prescripción electrónica asistida es elevado, medio en el caso de tecnología de lectura de código de barras y bajo en reetiquetado de viales y control gravimétrico y por voz de la elaboración.Conclusiones: Existe un amplio margen de mejora en lo que se refiere a la trazabilidad del proceso de elaboración y administración de mezclas intravenosas de quimioterapia.

Pharmacokinetics of vancomycin and dosing recommendations for trauma patients.

OBJECTIVES: The objectives of this study were to characterize the population pharmacokinetics of vancomycin in trauma patients and to propose dosing schemes to optimize therapy. PATIENTS AND METHODS: Trauma patients from Hospital Universitario Severo Ochoa (Spain) receiving intravenous vancomycin and routine therapeutic drug monitoring were included. Concentrations and time data were retrospectively collected, and population modelling was performed with NONMEM 7.2; internal and external validations were performed to probe the final model. Finally, several simulations were executed to propose dosing guidelines to reach expected vancomycin concentrations. RESULTS: A total of 118 trauma patients were included; the population was 45% males, with a mean age of 77 years (range 37-100 years) and a mean total body weight (TBW) of 72 kg (range 38-110 kg). The pharmacokinetics of vancomycin was best described by a two-compartment open model; creatinine clearance (CLCR) was related to vancomycin clearance (0.49 ± 0.04 L/h), being diminished by the presence of furosemide (0.34 ± 0.05 L/h). TBW influenced both the central volume of distribution (V1 = 0.74 ± 0.1 L/kg) and peripheral volume of distribution (V2 = 5.9 ± 2 L/kg), but patients with age >65 years showed a larger V1 (1.07 ± 0.1 L/kg). Bootstrapping was performed to internally validate the stability of the final model. External validation was developed using an alternate population of 40 patients with the same characteristics. The validated model was compared with population pharmacokinetic models previously published and showed better predictive performance for trauma patients than the current one. This final model allowed us to propose a new practical dose guideline to reach higher trough concentrations (15-20 mg/L) and AUC0-24/MIC ratios of more than 400 after 4 days of vancomycin treatment. CONCLUSIONS: A new population model was described for trauma patients to optimize vancomycin therapy, showing precise predictive performance to be applied for therapeutic drug monitoring and providing a new practical dose guideline that considers CLCR and concomitant administration of furosemide for these patients.