Unidad de Farmacia Materno-Infantil. Servicio de Farmacia del Hospital General Universitario Gregorio Marañón / Maternal-Pediatric Pharmacy Unit. Pharmacy Department of the Hospital General Universitario Gregorio Marañón

La misión de nuestro Servicio de Farmacia es ‘Contribuir a mejorar la salud y la calidad de vida de la población del área sanitaria, mediante una prestación farmacéutica efectiva, segura y eñciente, en un marco de asistencia integral y continua’. Para llevarlo a cabo, la atención farmacoterapéutica se realiza de una manera descentralizada, con farmacéuticos consultores incorpo rados a los equipos clínicos. El nuevo hospital Materno-Infantil se inauguró en 2003 con prescripción electrónica, armarios automatizados de dispensación en toda la hospitalización, y actualmente dispone de dos farmacéuticos de plantilla ubicados físicamente en el edificio. El farmacéutico pediátrico es responsable de la prestación farmacéutica en su área, así como de la gestión clínica, logística , económica, de calidad, docencia e investigación. En este sentido, se han desarrollado líneas de trabajo para mejorar el circuito de utilización del medicamento, fundamentalmente en prescripción y administración. En el campo de la docencia, numerosos residentes, no solo de nuestro hospital, sino de otros Servicios de Farmacia tanto nacionales como internacionales, se forman en nuestra área de farmacia. Con respecto a la investigación, los farmacéuticos forman parte de la Red de Investigación en Salud Materno—Infantil y del Desarrollo (Red SAMID), liderando y colaborando en numerosos proyectos financiados en convocatorias selectivas nacionales (AU)

The mission of our Pharmacy Service is to help to increase health and life quality in our population health area providing an effective, safe and efficient pharmaceutical care in an integral and continuos health assistance framework. In order to do that, pharmaceutical care has been decentralized by integrating consultant pharmacists in clinical teams. The new maternity and children's hospital opened up in 2003 with computerized order entry, automatic dispensing systems in all in-patients wards and two staff pharmacists located in the same building at present. Pediatric pharmacists are not only responsible for providing pharmaceutical care in their areas, but also they are in charge of the clinical, logistic, economic and quality management as well as teaching and researching tasks. Accordingly, several strategies have been implemented in order to improve medication use circuit, especially in prescription and administration stages. Regarding teaching tasks, a great number of residents, not only from our own hospital, but also from other national and international Pharmacy Departments, choose our rotation to develop training skills in our area. In terms of research activities, pharmacists are members of the Research Network on Maternal and Child Health and Development (Red SAMID) and have led and collaborated in several funded national competitive projects (AU)

Administración segura de medicamentos intravenosos en pediatría: 5 años de experiencia de una Unidad de Cuidados Intensivos Pediátricos con bombas de infusión inteligentes (AU) / Safe intravenous administration in pediatrics: A 5-year Pediatric Intensive Care Unit experience with smart pumps

OBJETIVOS: Estimar el impacto de la implantación de bombas de infusión inteligentes en una unidad de cuidados intensivos pediátricos en cuanto al número y tipo de errores de administración interceptados DISEÑO: Estudio observacional, prospectivo, realizado de enero de 2010 a marzo de 2015 con las bombas volumétricas y de jeringa disponibles en el hospital. Ámbito: Unidad de Cuidados Intensivos Pediátricos de un hospital general de tercer nivel. PARTICIPANTES: Todas las infusiones programadas con bomba de infusión en los pacientes ingresados en la Unidad de Cuidados Intensivos Pediátricos. INTERVENCIONES: Elaboración de una biblioteca de fármacos con límites de seguridad a través de la cual se programarían todas las infusiones intravenosas prescritas. Variables principales: Se analizó la adherencia a la biblioteca de fármacos y el número y tipo de errores evitados según las alarmas generadas en el sistema. RESULTADOS: Se interceptaron 283 errores reales de programación durante los 62 meses que duró el estudio. En el 58% de los errores estuvo implicado un fármaco de alto riesgo, como agonistas y antagonistas adrenérgicos, sedantes, analgésicos, bloqueantes neuromusculares, opiáceos, potasio e insulina. Durante este período, la adherencia media de los usuarios al software de seguridad fue del 84%. CONCLUSIONES: La implantación de bombas de infusión inteligentes ha demostrado ser eficaz en la intercepción de errores de programación relacionados con fármacos de alto riesgo. Esta herramienta es susceptible de implantarse en otras unidades de pacientes críticos, tanto adultos como pediátricos. La colaboración multidisciplinar es clave para el éxito del proceso

OBJECTIVES: To estimate the impact of smart pump implementation in a pediatric intensive care unit in terms of number and type of administration errors intercepted. DESIGN: Observational, prospective study carried out from January 2010 to March 2015 with syringe and great volumen infusion pumps available in the hospital. SETTING: A tertiary level hospital pediatric intensive care unit. PARTICIPANTS: Infusions delivered with infusion pumps in all pediatric intensive care unit patients. INTERVENTIONS: Design of a drug library with safety limits for all intravenous drugs prescribed. MAIN VARIABLES: Users' compliance with drug library as well as number and type of errors prevented were analyzed. RESULTS: Two hundred and eighty-three errors were intercepted during 62 months of study. A high risk drug was involved in 58% of prevented errors, such as adrenergic agonists and antagonists, sedatives, analgesics, neuromuscular blockers, opioids, potassium and insulin. Users' average compliance with the safety software was 84%. CONCLUSIONS: Smart pumps implementation has proven effective in intercepting high risk drugs programming errors. These results might be exportable to other critical care units, involving pediatric or adult patients. Interdisciplinary colaboration is key to succeed in this process

[Clinical guidelines for infantile-onset Pompe disease]. / Guia clinica de la enfermedad de Pompe infantil.

Infantile-onset Pompe disease has a fatal prognosis in the short term unless it is diagnosed at an early stage and enzyme replacement therapy is not started as soon as possible. A group of specialists from different disciplines involved in this disease have reviewed the current scientific evidence and have drawn up an agreed series of recommendations on the diagnosis, treatment and follow-up of patients. We recommend establishing enzyme treatment in any patient with symptomatic Pompe disease with onset within the first year of life, with a clinical and enzymatic diagnosis, and once the CRIM (cross-reactive immunological material) status is known.

TITLE: Guia clinica de la enfermedad de Pompe infantil.La enfermedad de Pompe infantil tiene un pronostico fatal a corto plazo si no se diagnostica precozmente ni se inicia un tratamiento enzimatico sustitutivo lo antes posible. Un grupo de especialistas de las diferentes disciplinas involucradas en esta enfermedad ha revisado la evidencia cientifica actual y ha elaborado por consenso una serie de recomendaciones para el diagnostico, el tratamiento y el seguimiento de los pacientes. Se recomienda instaurar tratamiento enzimatico en todo paciente con enfermedad de Pompe sintomatica de comienzo en el primer año de vida, con diagnostico clinico y enzimatico, y una vez conocido el estado CRIM (material inmunologico con reactividad cruzada).

Safe intravenous administration in pediatrics: A 5-year Pediatric Intensive Care Unit experience with smart pumps. / Administración segura de medicamentos intravenosos en pediatría: 5 años de experiencia de una Unidad de Cuidados Intensivos Pediátricos con bombas de infusión inteligentes.

OBJECTIVES: To estimate the impact of smart pump implementation in a pediatric intensive care unit in terms of number and type of administration errors intercepted. DESIGN: Observational, prospective study carried out from January 2010 to March 2015 with syringe and great volumen infusion pumps available in the hospital. SETTING: A tertiary level hospital pediatric intensive care unit. PARTICIPANTS: Infusions delivered with infusion pumps in all pediatric intensive care unit patients. INTERVENTIONS: Design of a drug library with safety limits for all intravenous drugs prescribed. MAIN VARIABLES: Users' compliance with drug library as well as number and type of errors prevented were analyzed. RESULTS: Two hundred and eighty-three errors were intercepted during 62 months of study. A high risk drug was involved in 58% of prevented errors, such as adrenergic agonists and antagonists, sedatives, analgesics, neuromuscular blockers, opioids, potassium and insulin. Users' average compliance with the safety software was 84%. CONCLUSIONS: Smart pumps implementation has proven effective in intercepting high risk drugs programming errors. These results might be exportable to other critical care units, involving pediatric or adult patients. Interdisciplinary colaboration is key to succeed in this process.

Infección sistémica por citomegalovirus: influencia del tratamiento con foscarnet en los niveles plasmáticos de calcio y magnesio / Systemic cytomegalovirus infection: Changes in serum calcium and magnesium levels with foscarnet treatment

La infección por citomegalovirus es frecuente en pacientes trasplantados cardiacos. Foscarnet se utiliza, con evidencia limitada, como tratamiento de segunda línea tras el fracaso de ganciclovir en estos pacientes. Presentamos un caso de alteraciones electrolíticas por foscarnet administrado para el tratamiento de infección por citomegalovirus en un paciente pediátrico trasplantado cardiaco. La infección se resolvió tras 6 semanas de tratamiento, apareciendo niveles de calcio iónico bajos durante la infusión del fármaco e hipomagnesemia mantenida tratada con suplementos, que revirtieron al retirar el fármaco

Cytomegalovirus infection is common in cardiac transplant patients. Foscarnet is used, with limited evidence, as second-line treatment after ganciclovir failure in these patients. We describe the case of a paediatric cardiac transplant patient who developed electrolyte disturbances during foscarnet treatment for cytomegalovirus infection. The infection resolved after 6 weeks of treatment. Low ionized calcium and magnesium levels were observed during the drug infusion, which were treated with supplements. The serum levels reverted to normal after drug withdrawal

[Systemic cytomegalovirus infection: changes in serum calcium and magnesium levels with foscarnet treatment]. / Infección sistémica por citomegalovirus: influencia del tratamiento con foscarnet en los niveles plasmáticos de calcio y magnesio.

Cytomegalovirus infection is common in cardiac transplant patients. Foscarnet is used, with limited evidence, as second-line treatment after ganciclovir failure in these patients. We describe the case of a paediatric cardiac transplant patient who developed electrolyte disturbances during foscarnet treatment for cytomegalovirus infection. The infection resolved after 6 weeks of treatment. Low ionized calcium and magnesium levels were observed during the drug infusion, which were treated with supplements. The serum levels reverted to normal after drug withdrawal.

Empleo clínico de los probióticos y aspectos prácticos de su empleo / No disponible

No disponible

Formación pediátrica para el desarrollo de actividades clínicas / Paediatric training for developing clinical activities

Resumen El farmacéutico, por su formación general en el ámbito de la Farmacia Hospitalaria, tiene la capacidad para analizar e implantar mejoras en los circuitos de prescripción, dispensación y administración de medicamentos, lo cual repercute en la mejora de la seguridad global en la utilización de medicamentos. El objetivo principal del farmacéutico pediátrico es mejorar la calidad asistencial del paciente mediante una atención individualizada a través de la validación de las prescripciones médicas y del seguimiento farmacoterapéutico, que permita una farmacoterapia efectiva, segura y eficiente. Esta revisión nace del fruto de una experiencia multidisciplinar entre el Servicio de Farmacia y la Unidad de Cuidados Intensivos Pediátricos, cuyos objetivos fueron analizar el papel del farmacéutico residente en la UCIP para establecer líneas de mejora en sus actividades que potencien el uso racional del medicamento y diseñar un programa docente para el farmacéutico pediátrico que pueda servir como modelo inicial para otros centros (AU)

The general training received by pharmacists in Hospital Pharmacy enables them to analyse and implement improvements in the prescription, dispensing and administration of medications. This may lead to an increase in the overall safety of the use of drugs. The main goal of the paediatric pharmacist is to improve patient care by greater attention to the individual via validation of medical prescriptions and pharmaceutical follow-up, leading to safe, effective and efficient pharmacotherapy. This is a multidisciplinary review by the Pharmacy Department and Paediatric Intensive Care Unit. The objectives were to analyse the role of a resident pharmacist in PICU to identify improvements to promote rational drug use, and to design a teaching program for paediatric pharmacists that may serve as a reference for other centres (AU)

Validation of a method for recording pharmaceutical interventions.

WHAT IS KNOWN AND OBJECTIVE: The validation of a method for recording pharmaceutical interventions measures the instrument's ability to provide consistent values when the same analysis is performed several times. Our aim was to validate the inter-rater reliability of the method used to record pharmaceutical interventions in our hospital. METHODS: We recorded interventions in a database, entering variables related to the patient, treatment and impact of the recommendation. We also recorded the type, cause and clinical significance of the negative outcome associated with use of the medicinal product (NOM). Twenty interventions performed during a 3-year study period (2007-2009) were randomly tested for consistency to analyse the kappa (κ) coefficient statistic of the recommendations as coded by nine senior and junior clinical pharmacists. RESULTS AND DISCUSSION: There were 87·8% global consistency for NOM cause, 66·1% for intervention impact and 95·0% for NOM type. Agreement was substantial for 'intervention reasons', with a κ value of 0·74 (95%CI 0·61-0·87), fair for 'intervention impact', with a κ value of 0·24 (95%CI 0·15-0·32) and excellent for 'NOM type', with a κ value of 0·87 (95%CI 0·71-1·00), respectively. Our results are globally good, especially with regard to the analysis of intervention reasons and NOM type, which matches other authors' findings. Furthermore, our validation method is suitable for recording and considering the impact of pharmaceutical interventions. WHAT IS NEW AND CONCLUSION: We describe a systematic method for clinical pharmacists to record their activities and assess their value. This methodology should help in the development of clinical pharmacy in Spain and should be translatable to other settings.

[Paediatric training for developing clinical activities]. / Formación pediátrica para el desarrollo de actividades clínicas.

The general training received by pharmacists in Hospital Pharmacy enables them to analyse and implement improvements in the prescription, dispensing and administration of medications. This may lead to an increase in the overall safety of the use of drugs. The main goal of the paediatric pharmacist is to improve patient care by greater attention to the individual via validation of medical prescriptions and pharmaceutical follow-up, leading to safe, effective and efficient pharmacotherapy. This is a multidisciplinary review by the Pharmacy Department and Paediatric Intensive Care Unit. The objectives were to analyse the role of a resident pharmacist in PICU to identify improvements to promote rational drug use, and to design a teaching program for paediatric pharmacists that may serve as a reference for other centres.

Setting up an emergency stock for metabolic diseases.

INTRODUCTION: Therapeutic management of inborn errors of metabolism (IEMs) is complicated. The drugs involved are classified as orphan, and their supply depends on whether they are orphan medicines, investigational drugs, or need to be prepared as a compounded formula. MATERIALS AND METHODS: We analyzed emergency criteria, availability, and permanent location of metabolic drugs within the hospital. Information on therapeutic usage, administration, and dosage was also recorded. RESULTS: A stock for treating IEMs should include chelating agents, drugs to treat deficiencies, enzyme supplements, and other specific treatments. Hyperammonemia was considered to be life-threatening; therefore, an emergency supply of drugs to treat this condition should be kept permanently in the hospitalization unit. CONCLUSIONS: Emergency drug stocks are highly recommended in tertiary hospitals in order to improve care for patients susceptible to IEM.