Continuous infusion of antibiotics using elastomeric pumps in the hospital at home setting.

OBJECTIVE: To describe the avoided costs and to analyze the effectiveness of intravenous antibiotic treatment in continuous perfusion in patients at Hospital at Home Units (HHU) administered using elastomeric infusion pumps (EIP) prepared in a Hospital Pharmacy Service (HPS). METHODS: Retrospective observational study of the number and type of EIP prepared in the HPS and of the treated patients. Study period: January 2017-December2018. Analyzed data: demographic data of patients, location of infection, responsible microorganism, medication and type of EIP, dose and duration of treatment and its effectiveness in terms of cure or non-cure or patient's death. Economic valuation considering: costs of EIP, nursing time needed for preparation and cost of HHU care. RESULTS: A total of 1,688 EIP to treat 102 patients resulted in 106 episodes of outpatient treatment of parenteral antibiotic therapy (OPAT) for 1,409 days, thereby avoiding 1,409 days of hospital admission. A total of 59.8% of the patients were men and the mean age was 70.5 ± 17 years. A 31.1% and 68.9% of the cases were empirical and pathogen-directed treatments, respectively. The most used antimicrobials were piperacillin/tazobactam (42.7%), ceftazidime (24.5%), meropenem (19.8%), ceftolozane/tazobactam (2.8%), and cloxacillin (1.9%). Mean duration of treatment was 13.29 ± 8.60 days. Location of infection: respiratory (42.5%), urinary (17.9%), skin and soft tissue (12.3%), bacteraemia (11.3%), osteomyelitis (7.5%), abdominal (3.8%) and 4.7% in other locations. The cure rate was 84%. Total avoided cost: 580,788.28€ in the 24 months studied. CONCLUSIONS: This program represents very important economic savings for the health system, and the effectiveness of the antibiotic treatment has not been compromised.

Indicadores de calidad en el proceso de almacenamiento y dispensación de medicamentos en un Servicio de Farmacia Hospitalaria / Quality indicators in the storage and dispensing process in a Hospital Pharmacy

Objetivo. Establecer indicadores para evaluar la calidad de los procesos de almacenamiento y dispensación relacionados con los sistemas semiautomáticos de carrusel vertical (SSADV) y horizontal (SSADH). Material y métodos. Estudio observacional descriptivo entre enero-diciembre de 2012. Definición de indicadores de calidad, se estableció un valor objetivo planificado (OP) y se calculó el valor en el año 2012 (VO). Resultados. Se definieron y calcularon 5 indicadores de calidad en el proceso de almacenamiento y dispensación de medicamentos relativos a: indicador 1, error de llenado de carro de unidosis: OP (< 1,67%), VO (1,03%); indicador 2, precisión del llenado de los carros de unidosis utilizando un SSADV: OP (< 15%); VO (11,5%); indicador 3, fiabilidad del inventario de medicamentos en el proceso de entradas de medicamentos en un SSADH: OP (< 15%); VO (6,53%); indicador 4, fiabilidad del inventario de medicamentos en el proceso de preparación de pedidos de planta de medicamentos en un SSADH: OP (< 10%), VO (1,97%); indicador 5, precisión del proceso de preparación de pedidos de medicamentos de las unidades clínicas utilizando el SSADH: OP (< 10%), VO (10,41%). Conclusiones. El establecimiento de indicadores ha permitido valorar la calidad en términos de seguridad, de precisión y fiabilidad de los sistemas semiautomáticos para el almacenamiento y dispensación de medicamentos (AU)

Objective. To establish indicators for the evaluation of the quality of the storage and dispensing processes related to semiautomatic vertical (SAVCS) and horizontal (SAHCS) carousel systems. Material and Methods. Descriptive observational study conducted between January-December 2012. Definition of quality indicators, a target value is established and an obtained value is calculated for 2012. Results. Five quality indicators in the process of storage and dispensing of drugs were defined and calculated: indicator 1, error filling unidose trolleys: target (< 1.67%), obtained (1.03%); indicator 2, filling accuracy unidose trolleys by using an SAVCS: target (< 15%), obtained (11.5%); indicator 3, reliability of drug inventory in the process of drug entries using an SAHCS: target (< 15%), obtained (6.53%); indicator 4, reliability of drug inventory in the picking process of orders replacement stock of clinical units using an SAHCS: target (< 10%), obtained (1.97%); indicator 5, accuracy of the picking process of drug orders using an SAHCS: target (< 10%), obtained (10.41%). Conclusions. Establishing indicators has allowed the quality in terms of safety, precision and reliability of semiautomatic systems for storage and dispensing drugs to be assessed (AU)

[Quality indicators in the storage and dispensing process in a Hospital Pharmacy]. / Indicadores de calidad en el proceso de almacenamiento y dispensación de medicamentos en un Servicio de Farmacia Hospitalaria.

OBJECTIVE: To establish indicators for the evaluation of the quality of the storage and dispensing processes related to semiautomatic vertical (SAVCS) and horizontal (SAHCS) carousel systems. MATERIAL AND METHODS: Descriptive observational study conducted between January-December 2012. Definition of quality indicators, a target value is established and an obtained value is calculated for 2012. RESULTS: Five quality indicators in the process of storage and dispensing of drugs were defined and calculated: indicator 1, error filling unidose trolleys: target (<1.67%), obtained (1.03%); indicator 2, filling accuracy unidose trolleys by using an SAVCS: target (<15%), obtained (11.5%); indicator 3, reliability of drug inventory in the process of drug entries using an SAHCS: target (<15%), obtained (6.53%); indicator 4, reliability of drug inventory in the picking process of orders replacement stock of clinical units using an SAHCS: target (<10%), obtained (1.97%); indicator 5, accuracy of the picking process of drug orders using an SAHCS: target (<10%), obtained (10.41%). CONCLUSIONS: Establishing indicators has allowed the quality in terms of safety, precision and reliability of semiautomatic systems for storage and dispensing drugs to be assessed.

[Proton pump inhibitors in paediatrics]. / Inhibidores de la bomba de protones en pediatría.

In last years the use in the pediatric area of proton pump inhibitors (omeprazole, lansoprazole, pantoprazole, rabeprazole and esomeprazole) is more often, nevertheless the clinical trials carried out are poor. The aim of this work is to analyse the bibliography published about this kind of drugs in children and to make a revision of its use in the last seven years. More studies with omeprazole and lansoprazole have been developed, to be exact omeprazole and lansoprazole is present in 122 bibliographic appointments and 34 for lansoprazole, which include studies that demonstrate a good tolerance and efficacy. The remaining proton pump inhibitors count with very few studies. The main therapeutic indications were the eradication of Helicobacter pylori, gastroesophageal reflux disease and esophagitis. The number of patients included in the reviewed studies is quite heterogeneous, from 8 to 122 and the age range between 8 days and 17 years. On the other hand, it could be highlighted the non-existence of formulations adapted to the pediatric population and the difficulty of administration specially in the youngest patients. As in many other drugs, it would be necessary to carry out clinical trials in order to determinate the pharmacologic parameters at difference ages, which will allow a safe and effective administration, and its authorization by all Health Authorities.

Inhibidores de la bomba de protones en pediatría / Proton pump inhibitors in pediatrics

En los últimos años el uso de los inhibidores de la bomba de protones(omeprazol, lansoprazol, pantoprazol, rabeprazol y esomeprazol), en pediatría es cada vez más frecuente; sin embargo los ensayos clínicos realizados son escasos. El objetivo de este trabajo es analizar la bibliografía publicada sobre este grupo de fármacos en niños y hacer una revisión de su utilización en los últimos siete años. De todos ellos, omeprazol y lansoprazol son los que cuentan con mayor número de estudios, en concreto de omeprazol se han encontrado 122 citas bibliográficas y de lansoprazol 34 citas bibliográficas, que incluyen estudios que demuestran una buena tolerancia y eficacia. El resto de fármacos de la serie cuenta con muy pocos estudios. Las patologías que motivaron la prescripción fueron principalmente erradicación de Helicobacter pylori, reflujo gastroesofágico y esofagitis. El número de pacientes incluidos en los estudios revisados es muy heterogéneo, desde 8 a 122 y las edades estaban comprendidas entre 8 días y 17 años. Por otra parte, cabe destacar la inexistencia de formulaciones adaptadas a la población pediátrica y la dificultad que supone su administración, sobre todo a los pacientes de menor edad. Como ocurre con otros muchos fármacos, sería necesario realizar ensayos clínicos que determinaran todos los parámetros farmacológicos en los distintos grupos de edad, y así permitir una administración segura y eficaz, así como su autorización por los diferentes registros sanitarios

In last years the use in the pediatric area of proton pump inhibitors (omeprazole, lansoprazole, pantoprazole, rabeprazole and esomeprazole) is more often, nevertheless the clinical trialscarried out are poor. The aim of this work is to analyse the bibliography published about this kind of drugs in children and to make a revision of its use in the last seven years. More studies with omeprazole and lansoprazole have been developed, to be exact omeprazole and lansoprazole is present in 122 bibliographic appointments and 34 for lansoprazole, which include studies that demonstrate a good tolerance and efficacy. The remaining proton pump inhibitors count with very few studies. The main therapeutic indications were the eradication of Helicobacter pylori, gastroesophageal reflux disease and esophagitis. The number of patients included in the reviewed studies is quite heterogeneous, from 8 to 122 and the age range between 8 days and 17 years. On the other hand, it could be highlighted the non-existence of formulations adapted to the pediatric population and the difficulty of administration specially in the youngest patients. As in many other drugs, it would be necessary to carry out clinical trials in order to determinate the pharmacologic parameters at difference ages, which will allow a safe and effective administration, and its authorization by all Health Authorities

[Drug use in neonatology units of 6 Spanish hospitals]. / Utilización de medicamentos en Unidades de Neonatología de 6 hospitales españoles.

OBJECTIVE: To determine the status of drug use in Neonatology units regarding: 1. Frequency of use for drugs unauthorised by DirecciA(3)n General de Farmacia y Productos Sanitarios. 2. Suitability of commercial presentations regarding actual needs of patients. METHOD: Two cut-off points were established for 100% of patients admitted to Neonatology Units in 6 Spanish hospitals. Data on demography and therapeutic drug profile were collected, as well as on whether doses were or not prepared by Pharmacy departments. Approval for each drug regarding indication, age range, dosage and administration route was assessed. RESULTS: The number of patients included was 346. In all, 17.6% of patients were under treatment with unauthorised drugs, the reason being age in 78.7% and indication in 21.3%. Master formula preparation was needed for 22% of patients because of a lack of commercial preparations suited for paediatric age. Pharmacy departments prepared 25% of prescribed drugs. CONCLUSIONS: The use of unauthorised drugs in Neonatology is a common fact. Pharmacy departments are actively involved in Neonatology-related drug therapies: counselling and/or processing for compassionate unauthorised drug use, master formula preparation, intravenous mixtures, etc. Therapeutics in Neonatology benefits from specialised pharmaceutical involvement.

Utilización de medicamentos en Unidades de Neonatología de 6 hospitales españoles / Drug use in Neonatology Units of six Spanish hospitals

Objetivo: Conocer la situación de la utilización de medicamentos en Unidades de Neonatología en cuanto a: 1. Frecuencia de utilización de medicamentos no autorizados por la Dirección General de Farmacia y Productos Sanitarios.2. Adaptación de las presentaciones comerciales a las necesidades reales de estos pacientes. Método: Se realizaron 2 cortes de prevalencia en el 100 por ciento de los pacientes ingresados en las Unidades de Neonatología de 6 hospitales españoles. Se recogen datos demográficos, perfil farmacoterapéutico y si la preparación de las dosificaciones se realiza en el Servicio de Farmacia. Para cada medicamento se evalúa su autorización en cuanto a indicación, rango de edad, dosis y vía de administración. Resultados: El número de pacientes incluidos fue de 346. El 17,6 por ciento de los pacientes estaba a tratamiento con medicamentos no autorizados, siendo en el 78,7 por ciento la edad el principal motivo y en el 21,3 por ciento la indicación no autorizada. En el 22 por ciento de los pacientes fue necesaria la elaboración de fórmulas magistrales por no existir presentaciones comerciales adecuadas a la edad pediátrica. El Servicio de Farmacia preparó el 25 por ciento de los medicamentos prescritos. Conclusiones: La utilización de medicamentos no autorizados en neonatología es frecuente. El Servicio de Farmacia participa activamente en la farmacoterapia neonatológica: asesoramiento y/o tramitación como uso compasivo de medicamentos no autorizados, elaboración de fórmulas magistrales, mezclas intravenosas, etc. La terapéutica en neonatología se beneficia de la participación farmacéutica especializada (AU)