Análise das ações tomadas pela comissão de farmácia e terapêutica do Instituto Dante Pazzanese de Cardiologia em 2021 e 2022 / Analysis of the actions taken by the pharmacy and therapeutics committee of the Instituto Dante Pazzanese de Cardiologia in 2021 and 2022

INTRODUÇÃO E OBJETIVOS: A Comissão de Farmácia e Terapêutica (CFT) é uma instância de caráter consultivo e deliberativo que assessora a Diretoria Geral com objetivo de formular diretrizes e promover uso racional de medicamentos. O objetivo foi mensurar decisões tomadas pela CFT que impactem positivamente para economia de recurso orçamentário sem prejuízo assistencial. MÉTODOS: Estudo descritivo realizado no período de janeiro de 2021 a dezembro de 2022 sobre as ATAS mensais da CFT e sistema de gestão hospitalar eletrônica. Os dados coletados foram: assuntos discutidos, deliberação, valor unitário do medicamento. Foi considerado assuntos com impacto financeiro: substituição da padronização, despadronização, inclusão de medicamento com dosagem de melhor manejo, inclusão de restrição de prescrição para itens de alto valor. Os dados foram coletados em planilha Excel. RESULTADOS E DISCUSSÃO: Foram avaliadas 24 ATAS de CFT, em que foram selecionados temas voltados para farmacoeconomia. Do total, havia 5 pautas (21%) focadas no assunto: despadronização: 2 (40%): metoprolol 100 mg (tem de 50 mg), bosentana 62,5 mg (pertence ao Componente Especializado e o paciente já faz uso domiciliar e passa a ser orientado a trazer de casa), substituição: 1 (20%) sildenafila de 20 mg para 50 mg (preço unit de $12,20 para $0,49), inclusão de dosagem: 1 (20%) alteplase 10 mg ($491,19) sendo que o alteplase 50 mg custa $ 2.356,55 (dose depende do peso e havia desperdício) e inclusão de restrição 1 (20%): levosimendana ($4.900,00). Baseado no consumo anual, fizemos o cálculo de economia: metoprolol e bosentana ($4.373,37), sildenafila ($109.383,11), alteplase ($17.971,22), levosimendana ($ 88.200,00). Essa mudança não deixou o paciente desassistido, pois foi considerado substituições viáveis envolvendo o corpo clínico para adequação de prescrições médicas e apoio da Diretoria Clínica. CONCLUSÃO: Na busca de diminuir gastos com medicamentos sem afetar a assistência do paciente, a Comissão de Farmácia e Terapêutica possibilitou meios para economizar recurso orçamentário, promovendo reuniões extras com alguns setores estratégicos para demonstrar gastos com determinados itens e propor medidas que pudessem minimizar esse impacto financeiro. Houve uma compreensão e aceitação das áreas envolvidas. No montante, o hospital conseguiu economizar R$ 219.927,70. Financiamento e agradecimento: Aos membros da Comissão de Farmácia e Terapêutica que opinaram e sugeriram alternativas terapêuticas plausíveis.

Drugs supply and pharmaceutical care management practices at a designated hospital during the COVID-19 epidemic.

The coronavirus disease-19 (COVID-19) is caused by the novel severe acute respiratory syndrome coronavirus that was first detected at the end of December 2019. The epidemic has affected various regions of China in different degrees. As the situations evolve, the COVID-19 had been confirmed in many countries, and made a assessment that it can be characterized as a pandemic by the World Health Organization on March 11, 2020. Drugs are the main treatment of COVID-19 patients. Pharmaceutical service offers drug safety ensurance for COVID-19 patients. According to COVID-19 prevention and control policy and requirements, combined with series of diagnosis and treatment plans, pharmacists in the first provincial-level COVID-19 diagnosis and treatment unit in Jilin Province in Northeast China have established the management practices of drug supply and pharmaceutical care from four aspects: personnel, drugs supply management, off-label drug use management and pharmaceutical care. During the outbreak, the pharmaceutical department of THJU completed its assigned workload to ensure drug supply. So far, no nosocomial infections and medication errors have occurred, which has stabilized the mood of the staff and boosted the pharmacists' confidence in fighting the epidemic. For the treatment of COVID-19, pharmacists conducted adverse reaction monitoring and participated in the multidisciplinary consultation of COVID-19. Up to now, the COVID-19 patients admitted to THJU have not shown any new serious adverse reactions and been cured finally. The hospital pharmacy department timely adjusted the work mode, and the formed management practices is a powerful guarantee for the prevention and control of the COVID-19 epidemic. This paper summarized the details and practices of drug supply and pharmaceutical services management to provide experience for the people who involving in COVID-19 prevention and contain in other abroad epidemic areas.

From natural disaster to pandemic: A health-system pharmacy rises to the challenge.

PURPOSE: This report describes a health-system pharmacy's response to a natural disaster while staff members simultaneously prepared for the coronavirus disease 2019 (COVID-19) pandemic. By detailing our experience, we hope to help other institutions that are current facing or could encounter similar crises. SUMMARY: In early March 2020, a tornado destroyed the health system's warehouse for storage of most clinical supplies, including personal protective equipment and fluids. The pharmacy purchasing team collaborated with suppliers and manufacturers to recover losses and establish alternative storage areas. Days later, the pharmacy department was forced to address the impending COVID-19 pandemic. Key elements of the COVID-19 response included reducing the potential for virus exposure for patients and staff; overcoming challenges in sourcing of staff, personal protective equipment, and medications; and changing care delivery practices to maintain high-quality patient care while maximizing social distancing. The pharmacy department also created distance learning opportunities for 70 pharmacy students on rotations. After an initial plan, ongoing needs include adjustment in patient care activities if significant staff losses occur, when and how to resume clinical activities, and how to best utilize the resources accumulated. Elements of practice changes implemented to reduce COVID-19 threats to patients and pharmacy personnel have proven beneficial and will be further evaluated for potential continuation. CONCLUSION: The pharmacy department's efforts to respond to a natural disaster and unprecedented pandemic have proven successful to this point and have illuminated several lessons, including the necessity of cohesive department communication, staff flexibility, prioritization of teamwork, and external collaboration.

Lessons from one year experience of pooled procurement of pharmaceuticals: exploration of indicators and assessing pharmacies` performance.

BACKGROUND: Joint procurement of medicines is a way to improve access and justice in developing countries. The aim of this study is to determine local indicators for assessing the performance of joint procurement agencies and compare the indicators in those pharmacies which use centralized purchasing before and after this change. METHODS: This was a mixed method study. In the first qualitative phase, 3 expert panels were held including 20 national experts who were selected through purposeful sampling. Data was analyzed applying a five-stage framework analysis using MAXQDA. In the second quantitative phase, financial, supply and procurement, physical and functional indicators of two hospitals affiliated with joint procurement were assessed and the satisfactions of patients from the pharmacy performance were compared applying a valid questionnaire. Data was analyzed using SPSS through independent test, Paired t-test and ANOVA. RESULTS: Results show that after settlement of joint procurement, the cost of transportation has increased by 54%, a part of the cost of overhead has increased by 30%, the cost of manpower has increased by 88.9% and cost of insurance of warehouses has increased by 71.85% in 2016 compared to 2015. In addition, the total costs of holding were 89.8% of selling revenue. In other words, the profit was about 10% of revenue in total. Moreover the average score of pharmacies under the Holding has been higher than similar ones in all aspects of satisfaction from the patients` points of view. CONCLUSION: The one-year experience of deploying centralized purchasing to supply medicine has led to increased income and patient satisfaction. However, increase in staffing costs, longevity, overhead and warehouse costs have been significant that need appropriate monitoring and interventions. Graphical abstract Graphical abstract of lessons from one year experience of pooled procurement of pharmaceuticals in south of Iran.

Análise dos potenciais eventos adversos e reações adversas a medicamentos em Hospital de Minas Gerais: estudo exploratório sobre os fatores contribuintes / Analysis of potential adverse events and adverse drug reactions at Hospital de Minas Gerais: exploratory study on contributing factors

Eventos adversos (EA) são definidos como lesão ou dano não intencional que resulta em incapacidade ou disfunção, temporária ou permanente, e/ou prolongamento do tempo de permanência hospitalar ou morte em decorrência do cuidado em saúde prestado. Dentre eles estão os incidentes relacionados a medicamentos. Diante da escassez de conhecimento epidemiológico sobre os EA no país, este estudo propôs analisar os incidentes relacionados a medicamentose os potenciais eventos adversos (pEA) registrados em prontuários de internação de adultos em hospital geral do Estado de Minas Gerais, no ano de 2015. Metodologicamente foram utilizados instrumentos de coleta para verificar a ocorrência de pEA e reação advesa medicamentosa (RAM) baseados no Canadian Adverse Events Study:Tracking Form. Foram realizadas análises descritivas considerando grupos de variáveis: características do paciente, dados da admissão, fatores intrínsecos e extrínsecos e critérios de rastreamento de pEA. As análises consistiram em avaliar as frequências absoluta e relativa dos fatores indicados pelo instrumento de coleta. Para a análise das possíveis correlações e associações com pEA e RAM, foram realizados testes de correlação de Spearman, Qui-quadrado e Teste Exato de Fisher, respectivamente. Para a identificação de possíveis preditores de pEA foram realizados Testes de Regressão Logística. Em todos os testes foram adotados nível de significância de e α=0,05 e intervalo de confiança de 95%.Os fatores: orientação do farmacêutico, reconciliação medicamentosa e ordem fonada fornecida pelos médicos foram analisadas descritivamente. Os resultados mostraram correlação positiva entre idade e dias de internação e associação entre pEA e o atendimento via SUS e o tipo de internação eletiva. Houve evidência de associação entre pEA e os fatores intrínsecos: diabetes, insuficiência cardíaca, hipertensão arterial e história de alcoolismo e os extrínsecos:sonda urinária fechada, cateter arterial, cateter venoso central, nutrição enteral, sonda nasogástrica, ventilação mecânica e bomba de infusão.Os resultados mostraram, ainda, associação significativa entre pEA e RAM.A regressão logística apontou que os preditores: atendimento (SUS), caráter eletivo, idade, tempo de internação, hipertensão arterial, diabetes, uso de nutrição enteral, sonda nasogátrica e ventilação mecânica aumentam a chance de pEA. Concluiu-se que as RAM estão associadas ao pEA e que as características dos pacientes (idade) associadas a fatores intrínsecos e extrínsecos, tipo de convênio e caráter de internação podem potencializar a ocorrência de EA em ambiente hospitalar

Adverse events (AE) are defined as unintentional injury or damage not wonted that results in incapacity or dysfunction temporary or permanent disability, and / or extendimy temp of hospital story or death as a result of health care provided. Among them, are the incidents related to medicines, facing the lock of epidemiological. Epidemiological knowledge about AE in the country, this study got proposed to analyze the incidents related to the medicines and potencial adverse events scored in adults and potential adverse events (pAE) recorded in adult hospitalization records in a general hospital in the state of Minas Gerais in the year of 2015, in 2015.It was used Methodologically, instruments to verify the occurrence of Potencial adverse event (pEA) and adverse drug reaction (ADR) by the the Canadian Adverse Events Study: Tracking Form. Descriptive analyzes were accomplished considering groups of variables: features of patient, admission data, intrinsic and extrinsic factors, and pEA screening criteria. The analyzes consisted of evaluating the absolute and relative frequencies of the factors indicated by the collects instrument. For the analysis of possible correlations and associations with pEA and RAM, were accomplisheb tests of Spearman's correlation tests, Chi-square and Fisher's exact tests were performed, respectively. To identify possible predictors of pEA, Logistic Regression Tests were accomplished tests of logistic regression. All over the tests, were adapted level of meaning of α= 0.05 and a confidence interval of 95%. The results have shown positive correlation between age and hospitalization doy and between association between pEA and the treatment by SUS, elective type. were adopted. The factors: pharmacist guidance, drug reconciliation, and phoned order provided by physicians were analyzed descriptively. The results showed a positive correlation between age and days of hospitalization and association between ASD and SUS care and the type of elective hospitalization. There was evidence of an association between pEA and intrinsic factors: diabetes, heart failure, hypertension and history of alcoholism and extrinsic factors: closed urinary tube, arterial catheter, central venous catheter, enteral nutrition, nasogastric tube, mechanical ventilation and infusion pump. The results also showed a significant association between pEA and RAM. The logistic regression indicated that the predictors: attendance (SUS), elective character, age, length of stay, hypertension, diabetes, use of enteral nutrition, nasogastric tube and mechanical ventilation increase the chance of pEA. It was concluded that ADRs are associated with ASP and that patient characteristics (age) associated with intrinsic and extrinsic factors, type of agreement and hospitalization character may potentiate the occurrence of AE in a hospital environment

Operating a patient medicines helpline: a survey study exploring current practice in England using the RE-AIM evaluation framework.

BACKGROUND: Patient medicines helplines provide a means of accessing medicines-related support following hospital discharge. However, it is unknown how many National Health Service (NHS) Trusts currently provide a helpline, nor how they are operated. Using the RE-AIM evaluation framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance), we sought to obtain key data concerning the provision and use of patient medicines helplines in NHS Trusts in England. This included the extent to which the delivery of helplines meet with national standards that are endorsed by the Royal Pharmaceutical Society (standards pertaining to helpline access, availability, and promotion). METHODS: An online survey was sent to Medicines Information Pharmacists and Chief Pharmacists at all 226 acute, mental health, specialist, and community NHS Trusts in England in 2017. RESULTS: Adoption: Fifty-two percent of Trusts reported providing a patient medicines helpline (acute: 67%; specialist: 41%; mental health: 29%; community: 18%). Reach: Helplines were predominantly available for discharged inpatients, outpatients, and carers (98%, 95% and 93% of Trusts, respectively), and to a lesser extent, the local public (22% of Trusts). The median number of enquiries received per week was five. IMPLEMENTATION: For helpline access, 54% of Trusts reported complying with all 'satisfactory' standards, and 26% reported complying with all 'commendable' standards. For helpline availability, the percentages were 86% and 5%, respectively. For helpline promotion, these percentages were 3% and 40%. One Trust reported complying with all standards. Maintenance: The median number of years that helplines had been operating was six. Effectiveness: main perceived benefits included patients avoiding harm, and improving patients' medication adherence. CONCLUSIONS: Patient medicines helplines are provided by just over half of NHS Trusts in England. However, the proportion of mental health and community Trusts that operate a helpline is less than half of that of the acute Trusts, and there are regional variations in helpline provision. Adherence to the national standards could generally be improved, although the lowest adherence was regarding helpline promotion. Recommendations to increase the use of helplines include increasing the number of promotional methods used, the number of ways to contact the service, and the number of hours that the service is available.

El papel de la evaluación económica en las Comisiones Farmacoterapéuticas de dos hospitales de tercer nivel / The role of the economic evaluation in the Pharmacoterapeutic Committees of the two hospital of third level

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A Calculation Tool and Process to Pre-Position Pharmaceuticals for Anthrax Post-Exposure Prophylaxis.

Anthrax, caused by Bacillus anthracis, is considered a severe bioterrorism threat because of its high mortality rate. The Chicago Healthcare System Coalition for Preparedness and Response (CHSCPR) aims to pre-position antibiotic medical countermeasures (MCMs) at healthcare facilities in order to provide on-site anthrax post-exposure prophylaxis. Pharmacists proposed moving toward a new process that involved the development of a standardized calculation methodology for acquiring supply drugs. This was an interventional quality improvement project aimed at optimizing inventory, acquisition, and distribution of antibiotic MCMs for anthrax post-exposure prophylaxis at Chicago hospitals for hospital personnel, associated first responders, and their families. The primary goal of the project was to pre-position a sufficient quantity of pharmaceuticals to allow Chicago hospitals to function as closed points of dispensing (PODs) for 72 hours; a secondary goal was to provide a 96-hour supply of anthrax post-exposure prophylaxis. A total of 35 Chicago hospitals were invited to participate in this intervention study, and 30 hospitals agreed to participate. Based on our calculation tool, we initially identified 6 (20%) hospitals with adequate oral doxycycline and ciprofloxacin inventory to last 72 hours and 3 (10%) hospitals with inventory to last 96 hours as a closed POD for anthrax post-exposure prophylaxis. The necessary quantities of medication needed to establish 72 and 96 hours of anthrax post-exposure prophylaxis were calculated by the CHSCPR and negotiated with a drug wholesaler to obtain product with maximum shelf-life and discounted pricing. Acting as a group purchaser, the CHSCPR organized drop shipment of medication directly to facilities from a wholesaler. This systematically calculated, pre-deployed pharmaceutical cache enhanced availability of antibiotic MCMs for anthrax post-exposure prophylaxis in 30 Chicago hospitals, allowing them to function as closed PODs for 96 hours during an incident.

Renal transplant patients' preference for the supply and delivery of immunosuppressants in Wales: a discrete choice experiment.

BACKGROUND: Prescribing policy recommendations aimed at moving immunosuppressant prescribing for renal transplant patients from primary to secondary care may result in benefits of increased safety and reduced cost. However, there is little evidence of patients' preferences for receiving their immunosuppressant therapy from hospitals compared to community dispensing. The aim of this study was to elicit patient preferences for different service configurations focusing in particular on home delivery versus collection of medication from hospital. METHODS: A discrete choice experiment was administered to 265 renal transplant patients in North Wales. Respondents were presented 18 pairwise choices, labelled as either home delivery or hospital collection, and described by the attributes: frequency of supply, waiting time (for delivery or collection) and method of ordering (provider contact, patient contact via phone, patient contact electronically). Data were analysed using a random-effects logit model and marginal rates of substitution calculated based on the waiting time attribute. RESULTS: A response rate of 63% was achieved, with 5332 usable observations from 150 respondents. Method of delivery (ß coefficient 1.21; 95% confidence interval 1.05 to 1.38), frequency of supply (0.05; 0.03 to 0.08) waiting time (-0.00, -0.00 to -0.00), provider contact (desirable) (0.20; 0.12 to 0.27), patient contact by telephone (desirable) (0.09; 0.01 to 0.17) and patient contact electronically (undesirable) (-0.292; -0.37 to -0.21) were statistically significant (p < 0.05). Results indicate that patients are willing to increase waiting time by nearly 10 h to have a home delivery service. CONCLUSION: Patients indicate a clear preference for a home delivery service. They prefer providers to make contact when new immunosuppressant supplies are required and show preference against ordering medication electronically. A policy for secondary care prescribing and hospital collection of medicines does not align with this preference.

National study on the adequacy of antidotes stocking in Lebanese hospitals providing emergency care.

BACKGROUND: Antidotes stocking is a critical component of hospital care for poisoned patients in emergency. Antidote stocking represents a major health challenge worldwide and in Lebanon. Systematic data monitoring of antidote stocking in Lebanese hospitals is lacking. The objective of this study is to assess the adequacy of antidotes stocking in Lebanese hospitals according to type and quantity and explore the characteristics associated with their differential availability. METHODS: Data collection to assess antidote availability and its correlate was undertaken through a self-administered questionnaire. The questionnaires were distributed by the unit of surveillance at the Ministry of Public Health to eligible hospitals providing emergency care services. The list of essential antidotes was adapted from the World Health Organization (WHO) list and the British Columbia Drug and Poison Information Centre. RESULTS: Among the 85 Lebanese hospitals surveyed none had in stock all the 35 essential antidotes required. The frequency of stocking by type of antidote varied from a minimum of 1.2 % of the hospitals having a (cyanide kit) to 100 % availability of (atropine and calcium gluconate). Teaching hospitals and those with a large bed-capacity reported a higher number of available antidotes for both immediate and non-immediate use than non-teaching hospitals while controlling for the hospital geographical region and public vs private sector. CONCLUSION: The Lebanese hospitals have a suboptimal stock of essential antidotes supply. It is recommended that the Lebanese Ministry of Public Health monitors closely on the hospital premises the adequacy and availability of essential antidotes stock.

Results of a Nationwide Capacity Survey of Hospitals Providing Trauma Care in War-Affected Syria.

IMPORTANCE: The Syrian civil war has resulted in large-scale devastation of Syria's health infrastructure along with widespread injuries and death from trauma. The capacity of Syrian trauma hospitals is not well characterized. Data are needed to allocate resources for trauma care to the population remaining in Syria. OBJECTIVE: To identify the number of trauma hospitals operating in Syria and to delineate their capacities. DESIGN, SETTING, AND PARTICIPANTS: From February 1 to March 31, 2015, a nationwide survey of 94 trauma hospitals was conducted inside Syria, representing a coverage rate of 69% to 93% of reported hospitals in nongovernment controlled areas. MAIN OUTCOMES: Identification and geocoding of trauma and essential surgical services in Syria. RESULTS: Although 86 hospitals (91%) reported capacity to perform emergency surgery, 1 in 6 hospitals (16%) reported having no inpatient ward for patients after surgery. Sixty-three hospitals (70%) could transfuse whole blood but only 7 (7.4%) could separate and bank blood products. Seventy-one hospitals (76%) had any pharmacy services. Only 10 (11%) could provide renal replacement therapy, and only 18 (20%) provided any form of rehabilitative services. Syrian hospitals are isolated, with 24 (26%) relying on smuggling routes to refer patients to other hospitals and 47 hospitals (50%) reporting domestic supply lines that were never open or open less than daily. There were 538 surgeons, 378 physicians, and 1444 nurses identified in this survey, yielding a nurse to physician ratio of 1.8:1. Only 74 hospitals (79%) reported any salary support for staff, and 84 (89%) reported material support. There is an unmet need for biomedical engineering support in Syrian trauma hospitals, with 12 fixed x-ray machines (23%), 11 portable x-ray machines (13%), 13 computed tomographic scanners (22%), 21 adult (21%) and 5 pediatric (19%) ventilators, 14 anesthesia machines (10%), and 116 oxygen cylinders (15%) not functional. No functioning computed tomographic scanners remain in Aleppo, and 95 oxygen cylinders (42%) in rural Damascus are not functioning despite the high density of hospitals and patients in both provinces. CONCLUSIONS AND RELEVANCE: Syrian trauma hospitals operate in the Syrian civil war under severe material and human resource constraints. Attention must be paid to providing biomedical engineering support and to directing resources to currently unsupported and geographically isolated critical access surgical hospitals.

[Pharmaceutical Service after the Fukushima Disaster: A Case Report of Soma General Hospital].

  Despite being damaged by the 2011 Tohoku earthquake, tsunami, and nuclear disaster, Soma General Hospital, located approximately 40 km north of Fukushima Daiichi nuclear power plant, was able to fulfill its role as a key regional hospital in northeast Fukushima. To elucidate the pharmaceutical service in response to the disaster, we investigated the hospital's operations in 2011 according to the medical records and prescriptions. One of the difficulties that the department of pharmaceutical service faced at that time was the increase in emergency healthcare requests by evacuated patients from other hospitals and clinics. Herein, we propose the following countermeasures to be considered in future disaster preparations: (1) establishing a medical and pharmaceutical service coordinator for disaster relief; (2) sharing all local patients' medical information in emergencies (at least contraindicated drugs or allergy history); and (3) reviewing disaster stockpiles, especially pharmaceuticals (both at the hospital and in nearby locations).

Intravenous iron: barriers and facilitators to its use at nine maternity hospitals in New South Wales, Australia.

BACKGROUND: Anaemia in pregnancy is mostly due to iron deficiency, and the use of intravenous (IV) iron is gaining acceptance as a treatment option. Recently released obstetric transfusion guidelines recommend IV iron for obstetric patients in certain situations, including when oral formulations are poorly tolerated, unlikely to be well absorbed, or when rapid restoration of iron stores is required. AIMS: To identify barriers and facilitators to the use of IV iron in pregnancy among nine maternity hospitals in New South Wales, Australia. MATERIALS & METHODS: A qualitative research study was undertaken using semi-structured interviews. Nine maternity units were chosen to cover a range of clinical settings and obstetric blood transfusion rates. Interviews were conducted with haematologists, obstetricians and midwives, and included questions about the use of IV iron in each institution. Interviews were transcribed and coded, and NVivo software was used to develop themes. RESULTS: A total of 125 interviews were conducted: 61 with doctors. The use of IV iron differed between hospitals and individual doctors. There were hospital/pharmaceutical, clinician and patient factors which acted as either barriers or facilitators to the use of IV iron. Where perceived barriers outweighed facilitators in a particular hospital, doctors were less likely to use IV iron. DISCUSSION: The use of IV iron, as perceived by doctors, differed across hospitals. There are some potentially modifiable barriers to the use of IV iron that may need to be addressed for IV iron to be available to obstetric patients not tolerating oral formulations or requiring rapid restoration of iron stores.

The Impact of a Shortage of Pharmacy-Prepared Ephedrine Syringes on Intraoperative Medication Use.

BACKGROUND: Anesthesia-related medication shortages have become increasingly common in the United States. We tested whether a local shortage of pharmacy-prepared ephedrine syringes, replaced by provider-prepared ephedrine, was associated with provider-level changes in ephedrine and phenylephrine use and patient-level changes in intraoperative hemodynamics. METHODS: Consecutive patients undergoing general and orthopedic surgery at a tertiary care center were included 1 month before and 1 month after the start of the pharmacy-prepared ephedrine syringe shortage. Lowest mean arterial blood pressure and slowest heart rate were obtained as measures of hemodynamics. Adjusted associations were tested using mixed-effects regression with repeated measures. RESULTS: Three hundred four patients before the shortage and 298 patients after the shortage began were included. The administration of at least 1 bolus of ephedrine was significantly more common before versus during the shortage (148/304 [48.7]% vs 117/298 [39.3]%; P = 0.0199). After adjusting for age, sex, ASA physical status, surgery type, anesthesia provider, and operative duration, patients were significantly less likely to receive ephedrine during the shortage (relative risk [RR] = 0.78 [95% confidence interval {CI}, 0.61-0.96]; P = 0.0198) and more likely to receive a phenylephrine bolus (RR = 1.27 [95% CI, 1.02-1.51]; P = 0.0357). Patient hemodynamics assessed by slowest heart rate or lowest mean arterial blood pressure did not differ significantly during the shortage. CONCLUSIONS: There was an alteration in medication administration patterns during a shortage of pharmacy-prepared syringes. Changes in ephedrine and phenylephrine use were noted; however, patient hemodynamics remained comparable. Provider use patterns were sensitive even to a relative and not absolute medication shortage as observed in this study.

Insights into European drug shortages: a survey of hospital pharmacists.

Drug shortages are a complex and global phenomenon. When a drug cannot be delivered at the moment of patient demand, every stakeholder in the health care system is affected. The aim of this study was to investigate the characteristics, clinical impact, financial impact and management of drug shortages in European hospital pharmacies and identify opportunities for prevention and mitigation of drug shortages in Europe. An online survey was designed based on a review of the literature and interviews and was sent to subscribers of Hospital Pharmacy Europe between June and September 2013. Forty-five percent of respondents (n = 161) indicated that life sustaining or life preserving drugs such as oncology drugs were affected by drug shortages. More than 30% of respondents indicated that drug shortages in Europe were always or often associated with increased costs for hospitals, increased personnel costs and more expensive alternative drugs (n = 161). On the question when information about a drug shortage was obtained, 42% of respondents answered that information from the pharmaceutical company was obtained at the time of no delivery, 50% indicated that information from the wholesaler was obtained at the time of no delivery, while 40% of respondents indicated that information was never or rarely received from the government (n = 161). Fifty seven percent of respondents strongly agreed that an obligation to the producer to notify further shortages could help to solve the problem (n = 161). These results showed that pharmaceutical companies and wholesalers are already involved in the management of drug shortages, while a role is still reserved for the government. Mandatory notification in advance and centralized information can help to reduce workload for hospital pharmacists, will allow early anticipation of drug shortages and will facilitate mitigation of the clinical impact on patients.

Sistema organizativo para implementar el ejercicio de la atención farmacéutica hospitalaria en Santiago de Cuba / Organizational system for implementation of the pharmaceutical care practice at hospital in Santiago de Cuba province

Introducción: a partir de 1990 se han desarrollado programas de Atención Farmacéutica en ambiente hospitalario, centrando su atención en el Seguimiento farmacoterapéutico, sin embargo, la comunidad científica internacional farmacéutica visualiza problemáticas como la ausencia de un ejercicio sistematizado, continuo y permanente. Objetivo: diseñar un sistema organizativo para implementar el ejercicio de la atención farmacéutica como práctica profesional, en el ámbito hospitalario cubano, específicamente en la provincia Santiago de Cuba. Métodos: para el diseño del sistema se aplicaron herramientas del método sistémico; se definieron: partes componentes, principios, estructura y representación gráfica, así como, características y enfoque. Resultados: se propuso un sistema organizativo complejo, dinámico, probabilístico, adaptable e inestable, dependiente de la integración de factores interactuantes que son: sistema de relaciones esenciales, estructura, proceso y resultado; aplicable a cualquier actividad farmacéutica hospitalaria orientada a la clínica, bajo los conceptos de la atención farmacéutica. Conclusiones: la implementación del sistema propuesto se podrá constituir en elevada contribución para la atención farmacéutica hospitalaria en Cuba, en la medida en que las recomendaciones puedan ser adoptadas por las autoridades sanitarias cubanas(AU)

Introduction: starting from 1990, several pharmaceutical care programs have been developed at the hospital setting, focused on the pharmacotherapeutic follow-up of the patient. However, the international scientific community of pharmacists has envisaged some problems such as the lack of systematic, continuous and permanent implementation. Objective: to design an organizational system to support the pharmaceutical care as a professional practice at the Cuban hospital settings, particularly in Santiago de Cuba province. Methods: the systemic method tools were used for the system design and the components, the principles, the structure and the graphic presentation as well as the characteristics and the approach were all defined. Results: acomplex, dynamic, probabilistic, adaptive and unstable system was put forward, which will depend on the integration of interacting factors as the following: System of essential relationships, Structure, Process and Result will be applicable to any clinic-oriented pharmaceutical activity at hospital under the concepts of the Pharmaceutical Care. Conclusions: the implementation of the suggested system could represent a significant contribution to the pharmaceutical care at hospital in Cuba as long as the Cuban health authorities adopt the recommendations made in this respect(AU)

Sistema organizativo para implementar el ejercicio de la atención farmacéutica hospitalaria en Santiago de Cuba / Organizational system for implementation of the pharmaceutical care practice at hospital in Santiago de Cuba province

INTRODUCCIÓN: a partir de 1990 se han desarrollado programas de Atención Farmacéutica en ambiente hospitalario, centrando su atención en el Seguimiento farmacoterapéutico, sin embargo, la comunidad científica internacional farmacéutica visualiza problemáticas como la ausencia de un ejercicio sistematizado, continuo y permanente. OBJETIVO: diseñar un sistema organizativo para implementar el ejercicio de la atención farmacéutica como práctica profesional, en el ámbito hospitalario cubano, específicamente en la provincia Santiago de Cuba. MÉTODOS: para el diseño del sistema se aplicaron herramientas del método sistémico; se definieron: partes componentes, principios, estructura y representación gráfica, así como, características y enfoque. RESULTADOS: se propuso un sistema organizativo complejo, dinámico, probabilístico, adaptable e inestable, dependiente de la integración de factores interactuantes que son: sistema de relaciones esenciales, estructura, proceso y resultado; aplicable a cualquier actividad farmacéutica hospitalaria orientada a la clínica, bajo los conceptos de la atención farmacéutica. CONCLUSIONES: la implementación del sistema propuesto se podrá constituir en elevada contribución para la atención farmacéutica hospitalaria en Cuba, en la medida en que las recomendaciones puedan ser adoptadas por las autoridades sanitarias cubanas(AU)

INTRODUCTION: starting from 1990, several pharmaceutical care programs have been developed at the hospital setting, focused on the pharmacotherapeutic follow-up of the patient. However, the international scientific community of pharmacists has envisaged some problems such as the lack of systematic, continuous and permanent implementation. OBJECTIVE: to design an organizational system to support the pharmaceutical care as a professional practice at the Cuban hospital settings, particularly in Santiago de Cuba province. METHODS: the systemic method tools were used for the system design and the components, the principles, the structure and the graphic presentation as well as the characteristics and the approach were all defined. RESULTS: acomplex, dynamic, probabilistic, adaptive and unstable system was put forward, which will depend on the integration of interacting factors as the following: System of essential relationships, Structure, Process and Result will be applicable to any clinic-oriented pharmaceutical activity at hospital under the concepts of the Pharmaceutical Care. CONCLUSIONS: the implementation of the suggested system could represent a significant contribution to the pharmaceutical care at hospital in Cuba as long as the Cuban health authorities adopt the recommendations made in this respect(AU)

Determinación de stock de medicamentos y productos médicos para tratamiento inicial en desastres utilizando la tecnica DELPHI en un Hospital del interior de la Provincia de Córdoba (Argentina) / Drugs and medical products stock determination for initial treatment in disaster situations using delphi technique in a hospital in the interior of the province of Cordoba (Argentina) / Determinação do estoque de medicamentos eprodutos médicos para tratamento inicial emdesastres empregando a técnica delphi em umhospital do interior da província de Córdoba (Argentina)

El objetivo de este trabajo fue determinar el stock de medicamentos y productos médicos para el tratamiento inicial de víctimas en masa en un hospital de la provincia de Córdoba (Argentina).Se utilizó la Técnica Delphi como método de consenso. Se solicitó la participación de 13 profesionales entre médicos y enfermeras del Hospital Dr. Arturo U. Illia de la ciudad de Alta Gracia, coordinados por una farmacéutica. Se realizaron 3 cuestionarios por medio de los cuales se arribó a la selección de los insumos necesarios para la atención de víctimas en masa para un plazo de 48 horas.Se determinaron dos listados finales con 25 medicamentos y 25 productos médicos, respectivamente.La utilización de esta técnica en la mencionada selección, agilizó el consenso en la toma de decisiones respecto a la inclusión de los insumos en cuestión.

The objective of this work was to determine the stock of drugs and medical products for the initial treatment of mass casualties at a hospital in the province of Córdoba (Argentina). Delphi Technique was used as the consensus method. Thirteen practitioners including physicians and nurses from Dr. Arturo U. Illia Hospital, in the city of Alta Gracia, were requested to participate, coordinated by a pharmacist. Three questionnaires were produced to come to a selection of the necessary products for mass casualty management during a 48-hour period. Two final lists were made with 25 drugs and 25 medical products, respectively. The use of this technique for the above mentioned selection accelerated consensus in decision making regarding the inclusion of the items in question