Abordaje de la nutrición parenteral mediante la creación de un grupo multidisciplinar / Approach to parenteral nutrition through the creation of a multidisciplinary group

Objetivo: La desnutrición hospitalaria incrementa el riesgo de padecer complicaciones, agravado por la escasa formación y sensibilidad en nutrición clínica del personal sanitario. El objetivo del presente estudio es evaluar la capacidad de optimización de la prescripción de nutrición parenteral como consecuencia de la creación de un grupo multidisciplinar. Métodos: Se creó un equipo multidisciplinar para asesorar a los servicios médico-quirúrgicos en nutrición, optimizar la prescripción de nutrición parenteral e informar y empoderar al paciente.Se establecieron las bases para el funcionamiento de un grupo asesor de nutrición parenteral (GANP) que se reunió de forma diaria para evaluar las prescripciones de nutrición parenteral del centro, realizando una entrevista clínica y una valoración nutricional individualizada y decidió sobre el tratamiento nutricional más adecuado en cada paciente.Se establecieron diferentes grados de desempeño (pobre 0-20%, adecuado 21-50%, bueno 51-80% o excelente >80%) en función del porcentaje de NP centrales asumidas y el grado de satisfacción del paciente.Se proporcionaron encuestas de satisfacción voluntarias a los pacientes, y se valoraron en una escala de 0 a 10.Resultados: Se evaluaron 97 pacientes con NP durante un año. El 100% de las NP centrales fueron asumidas por el GANP (68,3% de las NP totales). El 92,7% de las nutriciones totales estuvieron indicadas correctamente y en el 74,8% la prescripción fue adecuada. El grado de satisfacción medio fue de 9,5/10,0.El programa obtuvo un grado de desempeño excelente. Conclusiones: La creación de un grupo de trabajo multidisciplinar contribuye a la optimización de la terapia nutricional. (AU)

Objective: Hospital malnutrition increases the risk of complications, aggravated by the scarce training and sensitivity in clinical nutrition of health personnel. The objective is to evaluate the optimization capacity of parenteral nutrition prescription as a consequence of the creation of a multidisciplinary group.Methods: A multidisciplinary team was created to advise the medical-surgical services on nutrition, optimize the prescription of parenteral nutrition and inform and empower the patient.The foundations were established for the functioning of a parenteral nutrition advisory group (GANP) that met daily to evaluate the center’s parenteral nutrition prescriptions, conducting a clinical interview and an individualized nutritional assessment and decided on the most appropriate nutritional treatment in each patient.Different degrees of performance were established (poor 0-20%, adequate 21-50%, good 51-80% or excellent >80%) depending on the percentage of assumed central PNs and the degree of patient satisfaction.Voluntary satisfaction surveys were provided to patients, and they were rated on a scale of 0 to 10.Results: 97 patients with PN were evaluated for one year. 100% of the central NPs were assumed by the GANP (68.3% of the total NPs). 92.7% of the total nutritionals were indicated correctly and in 74.8% the prescription was adequate. The average degree of satisfaction was 9.5/10.0.The program obtained an excellent performance grade.Conclusions: The creation of a multidisciplinary working group contributes to the optimization of nutritional therapy. (AU)

Estudio de utilización de albúmina en pacientes no críticos en un hospital de tercer nivel / Study of clinical use of albumin in non-critical patients in a third-level hospital

El uso de albúmina vía intravenosa está extendido y respaldado por la evidencia científica en determinadas situaciones.Sin embargo, resulta común su uso para corregir un deficienteestado nutricional o un hallazgo analítico de hipoalbuminemia, a pesar de la falta de evidencia, el elevado coste y elriesgo de efectos adversos. El objetivo del trabajo es analizary evaluar el uso de albúmina en un hospital de tercer nivel,tras la suspensión de su consideración como medicamentorestringido y la implantación de la prescripción electrónica y,por tanto, la ausencia de necesidad de informar de la indicación y parámetros clínicos en la prescripción. Se realizó un estudio observacional prospectivo de cuatro semanas en el quese revisaron las prescripciones de albúmina. El tratamiento dedatos se realizó mediante el paquete estadístico Stata.Se confirmó el excesivo e incorrecto uso de albúmina, ya que lamayor parte (54,5%) de las prescripciones no se ajustaban a lasindicaciones de ficha técnica o a las principales recomendaciones, la única justificación fue corregir la hipoalbuminemia. Losparámetros analíticos nutricionales estaban en rango de desnutrición y ningún paciente tenía registro de peso corporal. Se detectaron tratamientos de larga duración, que en muchos casosse prolongaron hasta el alta hospitalaria. La mayor parte delcoste total fue en prescripciones no indicadas. Los tres servicioshospitalarios con más consumo de albúmina fueron MedicinaInterna, Oncología y Medicina Digestiva. Se considera necesarioretomar la monitorización intensiva realizada hace años en elhospital por motivos clínicos, económicos y sostenibles. (AU)

The use of intravenous albumin is widespread and supported by scientific evidence in certain situations. However, itsuse is common to improve a poor nutritional status or an analytical finding ofhypoalbuminemia, despite the lack ofevidence, the high cost and the risk ofadverse effects. The objective of thisstudy is to analyze and evaluate the useof albumin in a third-level hospital, afterthe suspension of its consideration as arestricted drug and the electronic prescription implementation, and therefore,the absence of the need to report the indication and clinical parameters in theprescription. A four-week prospective observational study was conducted wherealbumin prescriptions were reviewed. Thedata were processed using the Stata statistical software package.The excessive and wrong use of albumin is confirmed, since most of theprescriptions (54,5%) did not conformto the therapeutic indications of thedata sheet or the main recommendations, the only justification was thecorrection of hypoalbuminemia. Theblood test values showed malnutritionand no patient had a body weight record. Long-term treatments were detected and in many cases they weremaintained until hospital discharge.Most of the total cost was in non-indicated prescriptions. The three hospitaldepartments with the highest albuminconsumption were Internal Medicine,Oncology and Gastroenterology. It isconsidered necessary to reintroducethe intensive monitoring performedyears ago in the hospital for clinical,economic and sustainable reasons. (AU)

[CONSULTENOS: hospital discharge information programmes. Development and results from the first year of operation in 5 hospitals]. / CONSULTENOS: programa de información al alta hospitalaria. Desarrollo y resultados del primer año de funcionamiento en 5 hospitales.

INTRODUCTION: The increased number of adverse effects from medicines occurring due to various discrepancies and medication errors at the time of a patient's discharge from hospital has lead us to develop measures to resolve these issues. The aim of this study is to present the methodology and design of a hospital discharge information programme and to describe the most representative findings. METHODS: A common methodology was established and patients from 5 different hospitals were included in a hospital discharge information programme. An informative interview was carried out at the time of discharge and oral and written information was given regarding the patient's complete treatment at that point. After 7 days a follow up telephone call was made to assess our intervention. The information was collated and the patients' satisfaction with the programme was measured. RESULTS: 6,198 patients were included in the programme, 4,955 (79.86%) were informed. 6,454 interventions were carried out (980 to improve the efficiency of treatment, 531 the efficiency of safety, 4,770 informative interventions and 107 directed at other levels of care). Seven days later 4174 patients were contacted. 14.53% presented a problem with their medications, 8.96% had solved the problem by the time the call was made and 4.4% found that the instructions given to them at the time of being discharged from hospital helped them to solve the problem. There was a high level of satisfaction with the service (4.64 points out of 5). CONCLUSIONS: It is possible to develop a hospital discharge information programme as a care service. A high level of satisfaction has been achieved and safety has improved with regards the use of medication.