Intervención farmacéutica en pacientes quirúrgicos con alteraciones electrolíticas / Drug treatment in surgical patients with electrolyte imbalances

Objetivo Determinar cuali y cuantitativamente las alteraciones electrolíticas (relacionadas con potasio, fósforo, magnesio y calcio) en pacientes ingresados en áreas de cirugía general y gastrointestinal, el porcentaje de dichas alteraciones detectado por el equipo médico y el grado de aceptación de las recomendaciones realizadas desde el Servicio de Farmacia Hospitalaria. Método Estudio prospectivo de 7 meses. Toda alteración detectada se registró en una hoja de recogida de datos (datos personales, sala de hospitalización, tipo de alteración, detección por equipo médico, tipo de intervención farmacéutica, modo de notificación, aceptación de la intervención, fecha de corrección de la alteración, paciente en tratamiento con nutrición parenteral).Resultados Se detectaron 100 alteraciones en 66 pacientes (231 analíticas revisadas). Se realizaron un total de 78 intervenciones. La mayoría de alteraciones se debieron a hipokalemias e hipomagnesemias, siendo la hipofosfatemia la alteración más frecuente en pacientes portadores de nutrición parenteral. El grado de aceptación de la intervención farmacéutica por parte del equipo médico fue superior cuando la información fue oral (100 vs 35% escrita). Se consiguió el doble de analíticas de comprobación tras las intervenciones (RR 2,1; IC 95% 1,11-3,94, p=0,006). La aceptación de la intervención comportó una mayor proporción de resoluciones de la alteración respecto a los casos en los que no se aceptó (RR 1,5; IC 95% 1,01-2,24, p=0,04).Conclusiones Este estudio pone de manifiesto que las alteraciones electrolíticas en pacientes quirúrgicos son frecuentes y su grado de detección y seguimiento por parte del equipo médico es bajo. Por ello, el farmacéutico podría contribuir en la mejora de dichos aspectos participando en la atención a estos pacientes (AU)

Objective To qualitatively and quantitatively determine electrolyte imbalances (potassium, phosphorus, magnesium and calcium) in patients admitted for general and gastrointestinal surgery, the degree of these imbalances in percentage detected by medical staff, and the acceptance of the recommendations made by the Hospital Pharmacy Department. Method Seven-month prospective study. Any alteration detected was recorded on a data collection form (personal data, hospital ward, type of alteration, detection by medical staff, type of pharmaceutical intervention, form of notification, acceptance of the intervention, date of imbalance correction, patient receiving parenteral nutrition).Results100 imbalances were detected in 66 patients (231 analytical tests revised). A total of 78 interventions were carried out. Most changes were due to hypokalaemia and hypomagnesaemia, hypophosphataemia being the most frequent abnormality in patients receiving parenteral nutrition. The acceptance of pharmaceutical intervention was higher if the information was oral (100% vs. 35% written). Twice the number of analytical tests were performed after interventions (RR: 2.1, 95% CI: 1.11 to 3.94, P=.006). When pharmaceutical intervention was accepted there was a greater number of imbalance resolutions in comparison with those cases which did not accept (RR: 1.5, 95% CI: 1.01 to 2.24, P=.04).Conclusions This study shows that electrolyte imbalances are common in surgical patients and the level of detection and monitoring by medical staff is low. Therefore, the pharmacist could help in improving this aspect (AU)

[Drug treatment in surgical patients with electrolyte imbalances]. / Intervención farmacéutica en pacientes quirúrgicos con alteraciones electrolíticas.

OBJECTIVE: To qualitatively and quantitatively determine electrolyte imbalances (potassium, phosphorus, magnesium and calcium) in patients admitted for general and gastrointestinal surgery, the degree of these imbalances in percentage detected by medical staff, and the acceptance of the recommendations made by the Hospital Pharmacy Department. METHOD: Seven-month prospective study. Any alteration detected was recorded on a data collection form (personal data, hospital ward, type of alteration, detection by medical staff, type of pharmaceutical intervention, form of notification, acceptance of the intervention, date of imbalance correction, patient receiving parenteral nutrition). RESULTS: 100 imbalances were detected in 66 patients (231 analytical tests revised). A total of 78 interventions were carried out. Most changes were due to hypokalaemia and hypomagnesaemia, hypophosphataemia being the most frequent abnormality in patients receiving parenteral nutrition.The acceptance of pharmaceutical intervention was higher if the information was oral (100% vs. 35% written). Twice the number of analytical tests were performed after interventions (RR: 2.1, 95% CI: 1.11 to 3.94, P=.006). When pharmaceutical intervention was accepted there was a greater number of imbalance resolutions in comparison with those cases which did not accept (RR: 1.5, 95% CI: 1.01 to 2.24, P=.04). CONCLUSIONS: This study shows that electrolyte imbalances are common in surgical patients and the level of detection and monitoring by medical staff is low. Therefore, the pharmacist could help in improving this aspect.

[Pharmaceutical intervention with parenteral nutrition]. / Intervención farmacéutica en el ámbito de la nutrición parenteral.

OBJECTIVE: Description and analysis of pharmaceutical interventions for patients with parenteral nutrition and an assessment of the degree of acceptance. METHOD: Prospective six-month study. Design of a data collection sheet (with personal data, the indication for parenteral nutrition, hospital area, nutrition type, time and type of intervention, type of notification, acceptance) for recording interventions carried out based on normal activities: complete review of pharmacotherapy and clinical history. RESULTS: A total of 265 interventions were carried out during the study period (1.5 interventions/day) with a mean of 2.1 interventions/patient. The overall degree of acceptance was 83.77%; significant differences were found between type of communication for the intervention (oral and/or written) and the degree of acceptance. CONCLUSIONS: Adding a pharmacist to the care team permits direct intervention in partnership with the doctor, and it is an effective method for preventing and resolving the complications, generally metabolic, that are associated with parenteral nutrition. Using this process for resolving medication-related problems in hospitalised patients, principally in surgical areas, is an addition to the pharmacist's activities in the area of nutritional support.

Descripción del proceso de certificación ISO 9001/2000 en el área de nutrición parenteral / No disponible

Objetivo: Garantizar la calidad y seguridad e incrementar la satisfacción del usuario ha llevado a organizaciones del ámbitosanitario a integrar un sistema de gestión de calidad en su estructura. Este trabajo describe el proceso de implantación dela norma UNE-EN-ISO-9001/2000 en el área de nutriciónparenteral.Método: Un grupo multidisciplinar definió el alcance de la norma, centrándose en transcripción, acondicionamiento, dispensacióny control microbiológico.Resultados: Se elaboró un procedimiento detallando secuencialmente los circuitos y actividades asociadas, el personal responsable y las pautas de actuación a seguir. Se establecieron indicadoresde calidad y de actividad.Conclusiones: Este proceso ha permitido establecer un sistema normalizado cuyos procesos están perfectamente descritos y documentados, logrando la trazabilidad y supervisión de las fases.Al no disponer de histórico de los datos actualmente obtenidos, no es posible establecer una comparación directa; por tanto, deberá analizarse su evolución en un futuro

Objective: In order to guarantee quality and safety and to increase user satisfaction, healthcare organisations have integratedquality management systems into their structures. This study describes the process for introducing the UNE-EN-ISO-9001/2000 standard in the parenteral nutrition area.Method: A multidisciplinary group established the scope of the standard, focusing on transcription, preparation, dispensation and microbiological control.Results: A detailed procedure describing the sequences of circuits and associated activities, the responsible staff and the action guidelines to be followed was established. Quality and activity markers were also established.Conclusions: This process has enabled a standard system to be implemented, with its operation perfectly described and documented, allowing its stages to be traceable and supervised. As there is no record of the data obtained beforehand, no direct comparison can be made; its evolution must therefore be analysed inthe future

[Description of the ISO 9001/2000 certification process in the parenteral nutrition area]. / Descripción del proceso de certificación ISO 9001/2000 en el área de nutrición parenteral.

OBJECTIVE: In order to guarantee quality and safety and to increase user satisfaction, healthcare organisations have integrated quality management systems into their structures. This study describes the process for introducing the UNE-EN-ISO-9001/2000 standard in the parenteral nutrition area. METHOD: A multidisciplinary group established the scope of the standard, focusing on transcription, preparation, dispensation and microbiological control. RESULTS: A detailed procedure describing the sequences of circuits and associated activities, the responsible staff and the action guidelines to be followed was established. Quality and activity markers were also established. CONCLUSIONS: This process has enabled a standard system to be implemented, with its operation perfectly described and documented, allowing its stages to be traceable and supervised. As there is no record of the data obtained beforehand, no direct comparison can be made; its evolution must therefore be analysed in the future.