Evaluación de la adherencia al tratamiento con antipsicóticos inyectables de liberación prolongada dentro de un programa de seguimiento farmacoterapéutico / Assessment of adherence to treatment with injectable extended-release antipsychotics within a pharmacotherapeutic follow-up program

Objetivo: Describir un programa de seguimiento farmacoterapéutico de antipsicóticos inyectables de liberación prolongada y evaluar la adherencia de los pacientes incluidos. Método: Se describe un programa de prescripción electrónica, validación y dispensación de antipsicóticos a salud mental y centros de salud, coordinado entre farmacia de hospital y de atención primaria. La adherencia al tratamiento se evaluó mediante un estudio prospectivo, observacional y transversal de un mes realizado en un área sanitaria a más de 500.000 habitantes, en el que se incluyeron todos los pacientes en tratamiento con un antipsicótico inyectable de liberación prolongada. Las variables recogidas fueron: medicamento administrado, frecuencia de admi nis tra ción, centro de administración y si el paciente acudía o no a la administración, considerando que acudía si lo hacía en ± 7 días. Resultados: Se incluyeron un total de 919 pacientes y 1.073 consultas programadas. En la recogida de datos participaron 11 unidades de salud mental y 40 centros de salud. En un 95,7% (1.027) de los casos, los pacientes acudieron a la administración del antipsicótico inyectable de liberación prolongada. No se encontraron diferencias en la adherencia entre los medicamentos ni entre frecuencias de administración, pero sí con respecto al centro donde se administraba el medicamento (unidades de salud mental frente a centros de salud), presentando una ligera mayor adherencia los pacientes de las unidades de salud mental (97,6% frente al 91,1%; p < 0,001). Conclusiones: La elevada adherencia conseguida revela que el programa de seguimiento descrito es efectivo. En el futuro son necesarios estudios de mayor duración que confirmen esta tendencia

Objective: To describe an injectable extended-release antipsychotic pharmacotherapeutic follow-up program and to assess adherence among patients included in the program. Method: A coordinated program is described involving hospital and primary care pharmacy, which included electronic prescription, reviewing, and dispensing of injectable antipsychotic agents in mental health and primary health care centers. Adherence to treatment was assessed in a 1-month prospective observational cross-sectional study which included all patients under treatment with injectable extended-release antipsychotics in a health area of more than 500,000 inhabitants. The variables collected were: medication administered, frequency of administration, administration center, and whether or not the patient attended the center. Patients were considered to have adhered to treatment if they had attended their appointments within a margin of ± 7 days. Results: A total of 919 patients and 1,073 appointments were included. Eleven mental health units and 40 primary health care centers participated in data collection. In 95.7 % (1,027) of cases, the patients attended the appointment. No differences were found in adherence between drugs or administration frequency. However, differences were found between mental health units and primary health care centers. Patient adherence was slightly higher in mental health units (97.6% vs 91.1%; P < 0.001). Conclusions: The high adherence rate shows that the described followup program is effective. Further long-term studies are needed to confirm this trend

Assessment of adherence to treatment with injectable extended-release antipsychotics within a pharmacotherapeutic follow-up program.

OBJECTIVE: To describe an injectable extended-release antipsychotic pharmacotherapeutic follow-up program and to assess  adherence among patients included in the program. METHOD: A coordinated program is described involving hospital and  primary care pharmacy, which included electronic prescription,  reviewing, and dispensing of injectable antipsychotic agents in mental  health and primary health care centers. Adherence to treatment was  assessed in a 1-month prospective observational cross-sectional study  which included all patients under treatment with injectable extended- release antipsychotics in a health area of more than 500,000  inhabitants. The variables collected were: medication administered,  frequency of administration, administration center, and whether or not  the patient attended the center. Patients were considered to have  adhered to treatment if they had attended their appointments within a  margin of ± 7 days. Results: A total of 919 patients and 1,073 appointments were included. Eleven mental health units and 40 primary health care centers participated in data collection. In 95.7 % (1,027) of cases, the  patients attended the appointment. No differences were found in  adherence between drugs or administration frequency. However,  differences were found between mental health units and primary health  care centers. Patient adherence was slightly higher in mental health units (97.6% vs 91.1%; P < 0.001). CONCLUSIONS: The high adherence rate shows that the described  followup program is effective. Further long-term studies are needed to  confirm this trend.

Objetivo: Describir un programa de seguimiento farmacoterapéutico de antipsicóticos inyectables de liberación prolongada y evaluar la  adherencia de los pacientes incluidos.Método: Se describe un programa de prescripción electrónica,  validación y dispensación de antipsicóticos a unidades de salud mental y  centros de salud, coordinado entre farmacia de hospital y de atención primaria. La adherencia al tratamiento se evaluó mediante un estudio  prospectivo, observacional y transversal de un mes realizado en un área  sanitaria a más de 500.000 habitantes, en el que se incluyeron  todos los pacientes en tratamiento con un antipsicótico inyectable de  liberación prolongada. Las variables recogidas fueron: medicamento  administrado, frecuencia de administración, centro de administración y  si el paciente acudía o no a la administración, considerando que acudía  si lo hacía en ± 7 días. Resultados: Se incluyeron un total de 919 pacientes y 1.073 consultas programadas. En la recogida de datos participaron 11  unidades de salud mental y 40 centros de salud. En un 95,7% (1.027)  de los casos, los pacientes acudieron a la administración del  antipsicótico inyectable de  liberación prolongada. No se encontraron  diferencias en la adherencia entre los medicamentos ni entre frecuencias  de administración, pero sí con respecto al centro donde se  administraba el medicamento (unidades de salud mental frente a  centros de salud), presentando una ligera mayor adherencia los  pacientes de las unidades de salud mental (97,6% frente al 91,1%; p <  0,001).Conclusiones: La elevada adherencia conseguida revela que el  programa de seguimiento descrito es efectivo. En el futuro son  necesarios estudios de mayor duración que confirmen esta tendencia.

Cost, Time, and Error Assessment During Preparation of Parenteral Nutrition: Multichamber Bags Versus Hospital-Compounded Bags.

BACKGROUND: Parenteral nutrition (PN) is associated with material and manpower costs and requires preparation time. The aim of this study was to evaluate the cost of PN using multichamber bags (MCBs) compared with hospital-compounded bags (COBs). The secondary aim of this study was to assess and compare preparation time and errors related to the production and preparation processes of PN bags. MATERIALS AND METHODS: A prospective, observational, cost-accounting study was conducted in 10 Spanish hospital pharmacy services. The cost assessments included components, raw materials, and hospital staff. Only PN bags with equivalent volume and nutrition value were included in the analyses. Assessment of errors related to PN was performed simultaneously with the cost and time comparison analyses. RESULTS: Among the 597 PN bags (295 MCBs, 302 COBs) evaluated, 392 PN bags (295 MCBs, 97 COBs) had an equivalent volume and nutrition value. The mean (standard deviation) total cost of the MCB was $62.11 ($12.34) per bag compared with $67.54 ($8.50) per bag for COBs, resulting in a significant cost savings of $5.71. On average, the time required to prepare an MCB was 38 minutes shorter (P < .001). Significantly fewer total number (percent) of errors was observed in the preparation of MCBs (3 [1.0%]) compared with COBs (15 [5.0%]); P < .01). CONCLUSION: The use of MCBs results in significant savings in cost and preparation time, which may have a beneficial effect on the economic burden associated with PN as well as a reduction in errors related to PN preparation.

Evaluación del grado de formación del personal que elabora las nutriciones parenterales en los Servicios de Farmacia / Training degree assessment of staff producing parenteral nutrition in Pharmacy Services

Objetivo: Evaluar el grado de formación del personal que elabora nutrición parenteral en los Servicios de Farmacia. Material y métodos: Se diseñó una encuesta on-line con 17 preguntas en la que se incluyeron los puntos más importantes en la elaboración de nutriciones parenterales. Para el diseño de la encuesta y el análisis posterior se utilizó la aplicación informática Survey monkey®. Resultados: Se obtuvieron un total de 135 respuestas. En el 95% de los Servicios de Farmacia existían normas escritas de elaboración. El 67% contestó que el fosfato se debía añadir cuando se empiezan a añadir los electrolitos y el 34% que no se realizaba la validación de la técnica aséptica de elaboración. En cuanto a la formación, el 19% no la había recibido, considerando necesario recibirla el 99%. Conclusiones: El personal encuestado presenta un grado de formación aceptable, pero son necesarios los cursos de formación que se deben fomentar desde los Servicios de Farmacia (AU)

Objective: To assess the level of expertise of Pharmacy personnel in the manufacturing of total parenteral nutrition. Material and methods: An on-line survey including 17 questions concerning key aspects of TPN manufacturing was designed. Survey monkey software was used to create the survey and to analize its results. Results: 135 answers were received. 95% of the participant Pharmacy services had written standard manufacturing procedures. 67% answered that phosphate salts should be the first electrolite to be additioned into the total parenteral nutrition and 34% affirmed that validation of the aseptic manufacturing technique was not performed. As far as personnel training was concerned, 19% of respondents had not received any specific training, although 99% considered it would be necessary to receive it. Conclusions: The polled personell has an acceptable level of expertise but adequate training courses are still necessary and should be promoted from Pharmacy services (AU)

[Training degree assessment of staff producing parenteral nutrition in Pharmacy Services]. / Evaluación del grado de formación del personal que elabora las nutriciones parenterales en los Servicios de Farmacia.

OBJECTIVE: To assess the level of expertise of Pharmacy personnel in the manufacturing of total parenteral nutrition. MATERIAL AND METHODS: An on-line survey including 17 questions concerning key aspects of TPN manufacturing was designed. Survey monkey software was used to create the survey and to analize its results. RESULTS: 135 answers were received. 95% of the participant Pharmacy services had written standard manufacturing procedures. 67% answered that phosphate salts should be the first electrolite to be additioned into the total parenteral nutrition and 34% affirmed that validation of the aseptic manufacturing technique was not performed. As far as personnel training was concerned, 19% of respondents had not received any specific training, although 99% considered it would be necessary to receive it. CONCLUSIONS: The polled personell has an acceptable level of expertise but adequate training courses are still necessary and should be promoted from Pharmacy services.

Objetivo: Evaluar el grado de formación del personal que elabora nutrición parenteral en los Servicios de Farmacia. Material y métodos: Se diseñó una encuesta on-line con 17 preguntas en la que se incluyeron los puntos más importantes en la elaboración de nutriciones parenterales. Para el diseño de la encuesta y el análisis posterior se utilizó la aplicación informática Survey monkey®. Resultados: Se obtuvieron un total de 135 respuestas. En el 95% de los Servicios de Farmacia existían normas escritas de elaboración. El 67% contestó que el fosfato se debía añadir cuando se empiezan a añadir los electrolitos y el 34% que no se realizaba la validación de la técnica aséptica de elaboración. En cuanto a la formación, el 19% no la había recibido, considerando necesario recibirla el 99%. Conclusiones: El personal encuestado presenta un grado de formación aceptable, pero son necesarios los cursos de formación que se deben fomentar desde los Servicios de Farmacia.

[Indicators monitoring the process of specialized nutritional support. Grupo de Nutrición de la SEFH]. / Indicadores de monitorización del proceso de soporte nutricional especializado.

OBJECTIVE: To identify and develop monitoring indicators of the process of specialized nutritional support that will allow measuring the level of adherence to the established practice standards. METHODS: Those practice standards considered to be key elements of the process were selected to develop performance indicators. The construction of these indicators combined the scientific evidence with expert opinion. Key goals were identified within each standard provided that its consecution would allow increasing the achievement of the standard. Particular improvement initiatives associated to each key goal were generated. Lastly, monitoring indicators were defined allowing undertaking a follow-up of the implementation of the improvement initiatives or either to assess the level of achievement of the key goals identified. RESULTS: Nineteen practice standards were selected representative of the critical points of the process. The strategic map for each standard has been defined, with the identification of 43 key goals. In order to achieve these key goals, a portfolio of improvements has been generated comprising 56 actions. Finally, 44 monitoring indicators have been defined grouped into three categories: 1. Numeric: they assess the level of goal achievement; 2. Dichotomic (yes/no): they inform on the execution of the improvement actions; 3. Results of the practice audits. CONCLUSIONS: We have made available monitoring indicators that allow assessing the level of adherence to the practice standards of the process of specialized nutritional support and the impact of the implementation of improvement actions within this process.

Indicadores de monitorización del proceso de soporte nutricional especializado / Indicators monitoring the process of specialized nutritional support

Objetivo: Identificar y desarrollar indicadores de monitorización del proceso de soporte nutricional especializado, que permitan medir el grado de cumplimiento de los estándares de práctica establecidos. Método: Se seleccionaron los estándares de práctica considerados aspectos clave del proceso sobre los que desarrollar indicadores de rendimiento. La construcción de indicadores combinó la evidencia científica con la opinión de expertos. Se identificaron los objetivos clave dentro de cada estándar cuya consecución permitiera incrementar el alcance del mismo. Se generaron iniciativas de mejora concretas vinculadas a cada objetivo clave. Por último, se definieron indicadores de monitorización que permitieran realizar un seguimiento de la implantación de las iniciativas de mejora, o bien valorar el grado de consecución de los objetivos clave identificados. Resultados: Se han seleccionado 19 estándares de práctica representativos de los aspectos críticos del proceso. Se ha definido el mapa estratégico de cada estándar, identificándose un total de 43 objetivos clave. A fin de alcanzar estos objetivos clave se ha generado una cartera de mejoras integrada por 56 acciones. Por último, se han definido 44 indicadores de monitorización agrupados en tres categorías: 1. Numéricos: valoran el grado de cumplimiento del objetivo; 2. Dicotómicos (si/no): Informan de la ejecución de las acciones de mejora; 3. Resultados de las auditorías de la práctica. Conclusiones: Se dispone de indicadores de monitorización que permiten evaluar el cumplimiento de los estándares de práctica del proceso de soporte nutricional especializado y el impacto de la implantación de acciones de mejora en el mismo (AU)

Objective: To identify and develop monitoring indicators of the process of specialized nutritional support that will allow measuring the level of adherence to the established practice standards. Methods: Those practice standards considered to be key elements of the process were selected to develop performance indicators. The construction of these indicators combined the scientific evidence with expert opinion. Key goals were identified within each standard provided that its consecution would allow increasing the achievement of the standard. Particular improvement initiatives associated to each key goal were generated. Lastly, monitoring indicators were defined allowing undertaking a follow-up of the implementation of the improvement initiatives or either to assess the level of achievement of the key goals identified. Results: Nineteen practice standards were selected representative of the critical points of the process. The strategic map for each standard has been defined, with the identification of 43 key goals. In order to achieve these key goals, a portfolio of improvements has been generated comprising 56 actions. Finally, 44 monitoring indicators have been defined grouped into three categories: 1. Numeric: they assess the level of goal achievement; 2. Dichotomic (yes/no): they inform on the execution of the improvement actions; 3. Results of the practice audits. Conclusions: We have made available monitoring indicators that allow assessing the level of adherence to the practice standards of the process of specialized nutritional support and the impact of the Implementation of improvement actions within this process (AU)