Pharmaceutical interventions in metabolic and nutritional follow-up of surgical patients receiving parenteral nutrition

Purpose: To assess a control protocol concerning alterations in metabolic follow-up parameters in the context of a pharmaceutical care program designed for surgical patients receiving parenteral nutrition, through determination of the impact of pharmaceutical interventions on associated metabolic complications. Methods: Prospective interventional study of two-months’ duration performed in surgical patients receiving parenteral nutrition. The study variables included predefined biochemical parameters within the metabolic-nutritional profile. Four categories were established to classify the degree to which each parameter was altered: a) no alteration (within normal range); b) alteration with no associated complication; c) moderate complication, and d) severe complication. The type of pharmaceutical intervention carried out included a direct intervention on their part or a recommendation. Statistical differences between the mean analytical values before and after the intervention were assessed by parametric and non-parametric tests (P<.05). Results: A total of 1055 analytical determinations corresponding to44 patients were evaluated. Among them, 239 determinations(22.6%) presented some degree of alteration which corresponded to162 complications. Complication is often defined whit more than one parameter. Ninety-three (57.4%) corrective interventions were carried out by direct intervention and 16 (9.9%) by recommendation. The results showed statistically significant differences or significant trend when the purpose of the pharmaceutical direct intervention(..) (AU)

Objetivo: Evaluar un protocolo de control de las alteraciones de los parámetros metabólicos en el contexto de un programa de atención farmacéutica dirigido a pacientes quirúrgicos con nutrición parenteral, a través del impacto de las intervenciones farmacéuticas en las complicaciones metabólicas asociadas. Metodo: Estudio prospectivo de intervención de 2 meses de duración. Se estudia a pacientes quirúrgicos con nutrición parenteral. Como variables de estudio se incluyen los parámetros bioquímicos predefinidos en el perfil metabólico-nutricional. Se establecen 4 categorías para clasificar el grado de alteración de cada parámetro: a) sin complicación; b) alteración no asociada con complicación; c) complicación moderada, y d) complicación grave. El tipo de intervención del farmacéutico se realiza mediante intervención directa o consejo. Las diferencias estadísticamente significativas entre los valores medios de los valores de los parámetros analíticos previos y posteriores a la intervención farmacéutica se establecen con pruebas paramétricas y no paramétrica (p < 0,05). Resultados: Se evaluaron 1055 parámetros correspondientes a 44 pacientes. En total, 239 (22,6%) presentaron alteración, lo que correspondió a 162 complicaciones (para definir algunas complicaciones se utiliza más de un parámetro), de las cuales 93 (57,4%) se intentaron corregir mediante intervención directa y 16 (9,9%), mediante consejo. Los resultados mostraron diferencias estadísticamente significativas o una tendencia hacia la significación cuando el objetivo de la (..)(AU)

Pharmaceutical interventions in metabolic and nutritional follow-up of surgical patients receiving parenteral nutrition.

PURPOSE: To assess a control protocol concerning alterations in metabolic follow-up parameters in the context of a pharmaceutical care program designed for surgical patients receiving parenteral nutrition, through determination of the impact of pharmaceutical interventions on associated metabolic complications. METHODS: Prospective interventional study of two-months' duration performed in surgical patients receiving parenteral nutrition. The study variables included predefined biochemical parameters within the metabolic-nutritional profile. Four categories were established to classify the degree to which each parameter was altered: a) no alteration (within normal range); b) alteration with no associated complication; c) moderate complication, and d) severe complication. The type of pharmaceutical intervention carried out included a direct intervention on their part or a recommendation. Statistical differences between the mean analytical values before and after the intervention were assessed by parametric and non-parametric tests (P< .05). RESULTS: A total of 1055 analytical determinations corresponding to 44 patients were evaluated. Among them, 239 determinations (22.6%) presented some degree of alteration which corresponded to 162 complications. Complication is often defined whit more than one parameter. Ninety-three (57.4%) corrective interventions were carried out by direct intervention and 16 (9.9%) by recommendation. The results showed statistically significant differences or significant trend when the purpose of the pharmaceutical direct intervention was to increase albumin, prealbumin, potassium or phosphate levels or to decrease C-reactive protein, glucose or triglycerides. Significant differences or significant trend were not seen when no intervention was performed. CONCLUSION: Despite the fact that the parameters assessed may have been influenced by factors other than the parenteral nutrition treatment received, our findings show that systematic monitoring of specific analytic parameters can be effective for attaining success in nutritional therapy, in terms of improvement in nutritional status and prevention and control of associated complications.

[Intermediate syndrome after organophosphate poisoning despite continuous infusion of pralidoxime]. / Síndrome intermedio en el transcurso de una intoxicación por organofosforados a pesar de una infusión continua de pralidoxima.

Acute organophosphate poisoning leads to a cholinergic crisis secondary to an acetylcholine rise, developed by an acetylcholinesterase inhibition. In some cases, after the resolution of the initial cholinergic signs and symptoms, an intermediate syndrome occurs, characterized by a delayed development of proximal and diaphragmatic muscle paralysis. We describe a case of a 67-year-old man who developed an intermediate syndrome after oxydemeton-metryl ingestion in a suicide attempt, despite a continuous pralidoxime infusion. Several hypotheses have been developed to explain the aetiology of this intermediate syndrome (neuromuscular junction dysfunction, inadequate poisoning treatment, late beginning of the oxime administration, etc). Intermediate syndrome manifestation will depend on the organophosphate's organism persistence and its chemical structure, and also on the time elapsed between the poisoning and the antidote administration.

[Optimising the quality of the unit dose dispensing process through the implementation of the semi-automated Kardex system]. / Optimización de la calidad del proceso de dispensación de medicamentos en dosis unitaria mediante la implantación del sistema semiautomático Kardex.

OBJECTIVE: To evaluate the effect of the incorporation of the semi-automated Kardex medication storage and dispensing system on the quality of the filling process of medicine trolleys in unit doses. METHOD: The speed of filling medicine trolleys in unit doses using the Kardex system was analysed retrospectively (n = 33,946 dispensings) and compared with the manual filling system (n = 5,284 dispensings); different filling procedures were used and compared. For each filling system and procedure, we obtained information for the number of dispensings and the time spent carrying this out. The speed of the process was calculated as the number of dispensings per hour. In addition, the drugs contained in the Kardex system were checked and the correspondence between both the actual and the theoretical content was assessed. RESULTS: The speed of the trolley filling process, expressed as the number of dispensings per hour, increased from 394 with the manual system (filling trolleys individually, n = 5,284 dispensings) to 417, 540 and 592 with the Kardex system when trolleys were filled individually (n = 16,530 dispensings), or grouped in two (n = 10,369 dispensings) or in three (n = 7,047 dispensings) respectively, at the start of the filling process. The check of the contents in the Kardex system detected 36% of trays with differences in quantity, one tray with out of date medication and three trays which should in theory have been empty and contained medication. CONCLUSIONS: The Kardex system optimises the speed of trolley filling with regard to the manual system, provided that the trolleys are grouped at the time of starting the preparation. The check of the cabinet contents shows that possibilities of error exist, related to its handling, which can be minimised by incorporating bar codes into the system s replenishment process.

Síndrome intermedio en el transcurso de una intoxicación por organofosforados a pesar de una infusión continua de pralidoxina / Intermediate syndroem after organophosphate poisoning despite continuous infusion of pralidoxime

En las intoxicaciones agudas por insecticidas organofosforados se produce un síndrome colinérgico debido a un aumento de la aceticolina a nivel sináptico, como consecuencia de una inhibición de la acetilcolinesterasa. En algunos casos, tras la resolución de la sintomatología colinérgica, se presenta el síndrome intermedio, caracterizado por una parálisis de la musculatura proximal y diafragmática. Describimos el caso de un paciente de 67 años que desarrolla un síndrome intermedio tras la ingestión de una cantidad desconocida de oxidemetón-metilo en un intento de autolisis, a pesar de la infusión continuada de pralidoxima a dosis altas. Diversas hipótesis tratan de explicar la etiología del síndrome intermedio (disfunción de la unión neuromuscular, instauración de un tratamiento inadecuado o de inicio tardío con oximas, entre otras). Asimismo, su manifestación se ve condicionada por la persistencia del insecticida organofosforado en el organismo, su estructura química o el tiempo transcurrido entre la ingestión del tóxico y la administración del antídoto

Acute organophosphate poisoning leads to a cholinergic crisis secondary to an acetylcholine rise, developed by an acetylcholinesterase inhibition. In some cases, after the resolution of the initial cholinergic signs and symptoms, an intermediate syndrome occurs, characterized by a delayed development of proximal and diaphragmatic muscle paralysis. We describe a case of a 67-year-old man who developed an intermediate syndrome after oxydemeton-metryl ingestion in a suicide attempt, despite a continuous pralidoxime infusion. Several hypotheses have been developed to explain the aetiology of this intermediate syndrome (neuromuscular junction dysfunction, inadequate poisoning treatment, late beginning of the oxime administration, etc). Intermediate syndrome manifestation will depend on the organophosphate’s organism persistence and its chemical structure, and also on the time elapsed between the poisoning and the antidote administration

Optimización de la calidad del proceso de dispensación de medicamentos en dosis unitaria mediante la implantación del sistema semiautomático Kardex® / No disponible

Objetivo: Evaluar el impacto de la incorporación del sistema semiautomático del almacenaje y dispensación de medicamentos Kardex® sobre la calidad del proceso de llenado de carros de medicamentos en dosis unitaria. Método: Se analiza retrospectivamente la velocidad de llenado de carros de medicamentos en dosis unitaria utilizando el sistema Kardex® (n = 33.946 dispensaciones) comparativamente conel sistema de llenado manual (n = 5.284 dispensaciones); se utilizan y comparan diferentes procedimientos de llenado. Para cada sistema y procedimiento de llenado se obtiene el número de dispensaciones y el tiempo invertido en realizarlas y se calcula la velocidad de proceso expresada en número de dispensaciones por hora. También, se revisan los medicamentos contenidos en el Kardex® y se evalúa la concordancia entre el contenido real y teórico del mismo.Resultados: La velocidad del proceso de llenado de carros,expresada en número dispensaciones por hora, pasa de 394 con el sistema manual (llenado de carros individual, n = 5.284 dispensaciones)a 417, 540 y 592 con Kardex®, realizando el llenado individual (n = 16.530 dispensaciones), o agrupando los carros de2 en 2 (n = 10.369 dispensaciones) o de 3 en 3 (n = 7.047 dispensaciones), respectivamente, en el momento de iniciar el llenado.La revisión del contenido del Kardex® permite detectar un 36% de cubetas con diferencias en cantidad, una cubeta con (..) (AU)

Objective: To evaluate the effect of the incorporation of the semi-automated Kardex® medication storage and dispensing systemon the quality of the filling process of medicine trolleys in unitdoses.Method: The speed of filling medicine trolleys in unit dosesusing the Kardex® system was analysed retrospectively (n =33,946 dispensings) and compared with the manual filling system(n = 5,284 dispensings); different filling procedures were used and compared. For each filling system and procedure, we obtained information for the number of dispensings and the time spent carryingthis out. The speed of the process was calculated as the number of dispensings per hour. In addition, the drugs contained in the Kardex® system were checked and the correspondence between both the actual and the theoretical content was assessed. Results: The speed of the trolley filling process, expressed as the number of dispensings per hour, increased from 394 with the manual system (filling trolleys individually, n = 5,284 dispensings)to 417, 540 and 592 with the Kardex® system when trolleys were filled individually (n = 16,530 dispensings), or grouped in twos (n= 10,369 dispensings) or in threes (n = 7,047 dispensings)respectively, at the start of the filling process. The check of the contents in the Kardex® system detected 36% of trays with differences in quantity, one tray with out of date medication and threetrays which should in theory have been empty and contained (..) (AU)