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1.
Ann Pharm Fr ; 78(6): 464-468, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33038310

RESUMO

On January 4 2020, the World Health Organization (WHO) reported the emergence of a cluster of pneumonia cases in Wuhan, China due to a new coronavirus, the SARS-CoV-2. A few weeks later, hospitals had to put in place a series of drastic measures to deal with the massive influx of suspected COVID-19 (COronaroVIrus Disease) patients while securing regular patient care, in particular in the intensive care units (ICU). Since March 12th, 77 of the 685 COVID-19 patients admitted to our hospital required hospitalization in the ICU. What are the roles and the added-value of the critical care pharmacist during this period? His missions have evolved although they have remained focused on providing health services for the patients. Indeed, integrated into a steering committee created to organize the crisis in the intensive care units, the role of the clinical pharmacist was focused on the organization and coordination between ICU and the pharmacy, the implementation of actions to secure practices, to train new professionals and the adaptation of therapeutic strategies. He participated to literature monitoring and increased his involvement in the clinical research team. He provided a link between the ICU and the pharmacy thanks to his knowledges of practices and needs.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Cuidados Críticos , Pandemias , Farmacêuticos , Pneumonia Viral/epidemiologia , Ensaios Clínicos como Assunto/organização & administração , Membro de Comitê , Equipamentos e Provisões Hospitalares/provisão & distribução , França , Humanos , Serviços de Informação , Armazenamento e Recuperação da Informação , Comunicação Interdisciplinar , Descrição de Cargo , Administração de Materiais no Hospital , Segurança do Paciente , Preparações Farmacêuticas/provisão & distribução , Serviço de Farmácia Hospitalar/organização & administração , Papel (figurativo)
2.
Farm. hosp ; 44(4): 135-140, jul.-ago. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-191014

RESUMO

OBJETIVO: Analizar la situación de la implantación y desarrollo de la telefarmacia aplicada a la atención farmacéutica a pacientes externos de los servicios de farmacia hospitalaria en España durante la pandemia por la COVID-19. MÉTODO: Se envió una encuesta online de 10 preguntas a todos los socios de la Sociedad Española de Farmacia Hospitalaria a las seis semanas del inicio del periodo de confinamiento por la pandemia. Se solicitó una única respuesta por hospital. Se incluyeron preguntas sobre la realización de atención farmacéutica no presencial con dispensación a distancia previa al inicio de la crisis sanitaria, los criterios de selección de pacientes, los procedimientos de envío de medicación y los medios utilizados, el número de pacientes que se han beneficiado de la telefarmacia y el número de envíos realizados. Por último, se identificó la realización o no de teleconsulta previa al envío de medicación y si la actividad quedó registrada. RESULTADOS: Un 39,3% (n = 185) del total de hospitales públicos del Sistema Nacional de Salud pertenecientes a todas las comunidades autónomas respondieron a la encuesta. El 83,2% (n = 154) de los ser-vicios de farmacia hospitalarios no realizaban actividades de atención farmacéutica no presencial con telefarmacia que incluyeran envío de medicación antes del inicio de la crisis sanitaria. En el periodo de estudio se atendieron 119.972 pacientes y se realizaron 134.142 envíos de medicación. La mayoría de los hospitales no utilizaron criterios de selección de pacientes. El 30,2% de los centros seleccionaron en función de las circunstancias personales del paciente. La dispensación domiciliaria y entrega informada (87%; 116.129 envíos) fue la opción utilizada de forma mayoritaria para el envío. Los medios para hacer llegar la medicación fueron, principalmente, la mensajería externa (47%; 87 centros) o medios propios del hospital (38,4%; 71 centros). Un 87,6% de los hospitales realizaron teleconsulta previa al envío de medicación y el 59,6% registró la actividad de telefarmacia en la agenda de citación. CONCLUSIONES: La implantación de la telefarmacia aplicada a la atención a pacientes externos en España durante la pandemia ha sido elevada. Así se ha podido garantizar la continuidad de los tratamientos de un elevado número de pacientes


OBJECTIVE: To analyze the status of the implementation and development of telepharmacy as applied to the pharmaceutical care of outpatients treated at hospital pharmacy services in Spain during the COVID-19 pandemic. METHOD: Six weeks after the beginning of the confinement period, an online 10-question survey was sent to all members of the Spanish Society of Hospital Pharmacists. A single response per hospital was requested. The survey included questions on the provision of remote pharmaceutical care prior to the onset of the health crisis, patient selection criteria, procedures for home delivery of medications and the means used to deliver them, the number of patients who benefited from telepharmacy, and the number of referrals made. Finally, respondents were asked whether a tele-consultation was carried out before sending patients their medication and whether these deliveries were recorded. RESULTS: A total of 39.3% (n = 185) of all the hospitals in the National Health System (covering all of Spain's autonomous regions) responded to the survey. Before the beginning of the crisis, 83.2% (n = 154) of hospital pharmacy services did not carry out remote pharmaceutical care activities that included telepharmacy with remote delivery of medication. During the study period, 119,972 patients were treated, with 134,142 deliveries of medication being completed. Most hospitals did not use patient selection criteria. A total of 30.2% of hospitals selected patients based on their personal circumstances. Home delivery and informed delivery (87%; 116,129 deliveries) was the option used in most cases. The means used to deliver the medication mainly included the use of external courier services (47.0%; 87 hospitals) or the hospital's own transport services (38.4%; 71 hospitals). As many as 87.6% of hospitals carried out teleconsultations prior to sending out medications and 59.6% recorded their telepharmacy activities in the hospital pharmacy appointments record. CONCLUSIONS: The rate of implementation of telepharmacy in outpatient care in Spain during the study period in the pandemic was high. This made it possible to guarantee the continuity of care for a large number of patients


Assuntos
Humanos , Assistência Farmacêutica/organização & administração , Serviço de Farmácia Hospitalar/métodos , Pandemias , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Serviços Terceirizados/métodos , Serviço de Farmácia Hospitalar/organização & administração , Espanha , Inquéritos e Questionários , Telemedicina/tendências , Infecções por Coronavirus/prevenção & controle , Pneumonia Viral/prevenção & controle
3.
Farm Hosp ; 44(4): 135-140, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32646343

RESUMO

OBJECTIVE: To analyze the status of the implementation and development of  telepharmacy as applied to the pharmaceutical care of outpatients treated at  hospital pharmacy services in Spain during the COVID-19 pandemic. METHOD: Six weeks after the beginning of the confinement period, an online 10- question survey was sent to all members of the Spanish Society of Hospital  Pharmacists. A single response per hospital was requested. The survey included  questions on the provision of remote pharmaceutical care prior to the onset of  the health crisis, patient selection criteria, procedures for home delivery of  medications and the means used to deliver them, the number of patients who  benefited from telepharmacy, and the number of referrals made. Finally,  respondents were asked whether a teleconsultation was carried out before  sending patients their medication and whether these deliveries were recorded. RESULTS: A total of 39.3% (n = 185) of all the hospitals in the National Health  System (covering all of Spain's autonomous regions) responded to the survey.  Before the beginning of the crisis, 83.2% (n = 154) of hospital pharmacy  services did not carry out remote pharmaceutical care activities that included  telepharmacy with remote delivery of medication. During the study period,  119,972 patients were treated, with 134,142 deliveries of medication being  completed. Most hospitals did not use patient selection criteria. A total of 30.2%  of hospitals selected patients based on their personal circumstances. Home  delivery and informed delivery (87%; 116,129 deliveries) was the option used in most cases. The means used to deliver the medication mainly included the use  of external courier services (47.0%; 87 hospitals) or the hospital's own transport services (38.4%; 71 hospitals). As many as 87.6% of hospitals carried out  teleconsultations prior to sending out medications and 59.6% recorded their  telepharmacy activities in the hospital pharmacy appointments record. CONCLUSIONS: The rate of implementation of telepharmacy in outpatient care in  Spain during the study period in the pandemic was high. This made it possible to guarantee the continuity of care for a large number of patients.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Betacoronavirus , Infecções por Coronavirus , Pandemias , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Pneumonia Viral , Telemedicina/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Serviços de Assistência Domiciliar/organização & administração , Número de Leitos em Hospital , Humanos , Sistemas de Medicação/organização & administração , Sistemas de Medicação/estatística & dados numéricos , Seleção de Pacientes , Serviço de Farmácia Hospitalar/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Espanha , Telemedicina/organização & administração , Carga de Trabalho
4.
Am J Health Syst Pharm ; 77(22): 1874-1884, 2020 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-32710774

RESUMO

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has created unprecedented challenges for health systems around the world. We describe our approach to adapting the pharmacy leadership structure to address critical medication shortages through innovative data analysis, procurement strategies, and rapid implementation of medication policy. SUMMARY: Yale New Haven Health deployed a system incident management command structure to effectively respond to the COVID-19 crisis. System pharmacy services adopted a similar framework to enable efficient communication and quick decision-making in key domains, including drug procurement and policy. By refining a model to project health-system medication needs, we were able to anticipate challenges and devise alternative treatment algorithms. By leveraging big data and creating a system knowledge base, we were able to consolidate reporting and coordinate efforts to ensure system success. Various procurement strategies were employed to ensure adequate supply, including frequent communication with our wholesaler, sourcing direct from suppliers, outsourcing of sterile products compounding to registered 503B outsourcing facilities, and acquisition of active pharmaceutical ingredients for compounding of essential medications. Strategic positioning of pharmacists within the health system's incident command response teams and rapid adaption of drug use policy governance fueled accelerated response and nimble implementation. Communication was streamlined and executed via multiple outlets to reach a broad audience across the health system. CONCLUSION: With medication shortages posing a threat to patient care, dynamic pharmacy leadership proved essential to providing patient care at the height of the COVID-19 pandemic. System alignment and the rapid adaption of the existing framework for drug shortage management and medication use policy were crucial to success in crisis response.


Assuntos
Infecções por Coronavirus , Formulários de Hospitais como Assunto/normas , Liderança , Pandemias , Assistência ao Paciente/tendências , Preparações Farmacêuticas/provisão & distribução , Serviço de Farmácia Hospitalar/organização & administração , Farmácia/tendências , Pneumonia Viral , Centros Médicos Acadêmicos , Connecticut , Formulários Farmacêuticos como Assunto , Humanos , Comunicação Interdisciplinar , Sistemas de Medicação no Hospital , Farmacêuticos
5.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32611807

RESUMO

BACKGROUND AND OBJECTIVES: Vancomycin remains one of the most commonly prescribed antibiotics in NICUs despite recommendations to limit its use for known resistant infections. Baseline data revealing substantially higher vancomycin use in our NICU compared to peer institutions informed our quality improvement initiative. Our aim was to reduce the vancomycin prescribing rate in neonates hospitalized in our NICU by 50% within 1 year and sustain for 1 year. METHODS: In the 60-bed level IV NICU of an academic referral center, we used a quality improvement framework to develop key drivers and interventions including (1) physician education with benchmarking antibiotic prescribing rates; (2) pharmacy-initiated 48-hour antibiotic time-outs on rounds; (3) development of clinical pathways to standardize empirical antibiotic choices for early-onset sepsis, late-onset sepsis, and necrotizing enterocolitis; coupled with (4) daily prospective audit with feedback from the antimicrobial stewardship program. RESULTS: We used statistical process u-charts to show vancomycin use declined from 112 to 38 days of therapy per 1000 patient-days. After education, pharmacy-initiated 48-hour time-outs, and development of clinical pathways, vancomycin use declined by 29%, and by an additional 52% after implementation of prospective audit with feedback. Vancomycin-associated acute kidney injury also declined from 1.4 to 0.1 events per 1000 patient-days. CONCLUSIONS: Through a sequential implementation approach of education, standardization of care with clinical pathways, pharmacist-initiated 48-hour time-outs, and prospective audit with feedback, vancomycin days of therapy declined by 66% over a 1-year period and has been sustained for 1 year.


Assuntos
Gestão de Antimicrobianos/estatística & dados numéricos , Prescrição Inadequada/prevenção & controle , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Vancomicina/uso terapêutico , Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/organização & administração , Brasil , Procedimentos Clínicos , Enterocolite Necrosante/tratamento farmacológico , Hospitais Pediátricos/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Humanos , Prescrição Inadequada/estatística & dados numéricos , Recém-Nascido , Doenças do Recém-Nascido/tratamento farmacológico , Serviço de Farmácia Hospitalar/organização & administração , Estudos Prospectivos , Melhoria de Qualidade , Sepse/tratamento farmacológico
8.
Farm Hosp ; 44(7): 5-10, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32533661

RESUMO

The WHO declared the SARS- CoV-2 outbreak a pandemic in March 11, 2020.  Spain has been the third country with the highest number of reported cases of  COVID-19. In the face of the pandemic, the authorities of the Autonomous  Community of Madrid led an unprecedented transformation of hospital services  by increasing the number of beds available, setting up temporary field hospitals  in fairgrounds, and transforming hotels into support centers for patients with  mild symptoms of COVID-19. In the light that this crisis will continue to be a real threat for the years to come, our hospital pharmacies need to be better prepared for similar outbreaks in the future. During the COVID-19 pandemic, the  Department of Hospital Pharmacy of Hospital General Universitario Gregorio  Marañón has faced four challenges: an exponential increase in the demand for  resources, constant changes to therapeutic protocols and approaches, regulatory changes, and a dramatic impact on hospital staff (strain on human resources  and psychological impact). This article is aimed at describing the main  organizational changes implemented to the Department of Hospital Pharmacy of  Hospital GU Gregorio Marañón and its relationship with other hospital  pharmacies of the Community of Madrid. An account is provided of the strategies to be adopted for reorganizing a Department of Hospital Pharmacy and achieve a safe and effective use of medications. Strategies range from the creation of  integral hospital task groups (COVID-crisis task group, protocolization task  group, research task group) to the adaptation of the internal organization of the  Department of Hospital Pharmacy, which encompasses aspects related to  management and leadership; a communication plan (internal and external);  staff management, and the reorganization and adaptation of processes. People,  patients and professionals are at the core of these strategies. This paper is a  reflection on key factors of "humanization in COVID times".


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Serviço de Farmácia Hospitalar , Pneumonia Viral , Antivirais/provisão & distribução , Antivirais/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/prevenção & controle , Planejamento em Desastres , Recursos em Saúde , Necessidades e Demandas de Serviços de Saúde , Hospitais Gerais/organização & administração , Humanos , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Serviço de Farmácia Hospitalar/organização & administração , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/prevenção & controle , Relações Profissional-Paciente , Equipamentos de Proteção , Garantia da Qualidade dos Cuidados de Saúde , Espanha , Telemedicina
9.
Farm Hosp ; 44(7): 11-16, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32533662

RESUMO

The purpose of this article is to report the experience of the Department of Hospital Pharmacy of a mid-size hospital during the peak of the COVID-19 pandemic. The human and material resources available in a mid-size hospital were more limited than in larger hospitals of the region. In this article, we describe how this Department of Hospital Pharmacy was reorganized to meet the increase in activity, the strategies developed and the  lessons learned for future pandemics. The COVID-19 pandemic had a higher  impact in Leganes, a city in the south of Madrid, with a population of 190,000.  In the face of the dramatic increase in the proportion of patients attending our  hospital between March and April 2020, the Severo Ochoa University Hospital  increased the number of beds by 24.5% and fitted out new premises inside and  outside the hospital (sports centers). The mean number of patients seen in our  Emergency Department every day passed from 70-80 to a peak of 286 patients, with 652 hospitalized patients. The situation of emergency created by  this infectious disease, with management protocols changing constantly, had a  dramatic impact on the activity of hospital pharmacies. Thus, the pandemic has  affected areas of economic management, magistral preparation, dispensing of  medication to inpatients, ambulatory patients, patients monitored at home,  institutionalized patients, and patients from private hospitals and field hospitals.  Other areas affected include training, clinical trials, pharmacovigilance, and  counseling boards. Two strategies were adopted to overcome these problems: a  strategy centered on human resources (staff reinforcement, reallocation of  responsibilities), and a strategy centered on processes (some processes were  reinforced to meet the increase in activity, whereas other were temporarily suspended or reduced to the minimum).Conclusions: The Department of Hospital Pharmacy plays a key role  in hospitals and has been significantly reinforced to meet the dramatic impact of  the pandemic on this service. This Department has been able to reorganize its  processes and take over new responsibilities such as telepharmacy and home  dispensing. Hospital pharmacies play a crucial role in  pharmacotherapeutic decisions in hospitals. As in other Departments, training is  the area more significantly affected by the pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Pandemias , Serviço de Farmácia Hospitalar/organização & administração , Pneumonia Viral/tratamento farmacológico , Ensaios Clínicos como Assunto , Planejamento em Desastres , Composição de Medicamentos , Prescrições de Medicamentos/estatística & dados numéricos , Previsões , Necessidades e Demandas de Serviços de Saúde , Número de Leitos em Hospital , Hospitais Universitários/organização & administração , Hospitais Urbanos/organização & administração , Humanos , Pacientes Internados/estatística & dados numéricos , Sistemas de Medicação no Hospital/organização & administração , Espanha , Desenvolvimento de Pessoal
10.
Farm Hosp ; 44(7): 17-20, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32533663

RESUMO

COVID crisis has abruptly broken into our hospitals, and many difficulties have  emerged, including those related to supply logistics. A huge number of new  patients, a fast internal reorganization process and many other changes were  suddenly established. These circumstances revealed the need to increase stocks  of drugs, both for basic treatment as well as for specific SARS-CoV-2 infection  management. At the same time, other problems (shortages, new and complex  purchasing procedures, etc.) surfaced, so they could risk safety along the  pharmacotherapeutic process. The main objective was to develop and implement all the necessary measures within the logistics circuit in order to ensure the  availability of medicines for patients, as safely and effectively as possible, during the Coronavirus crisis. Firstly, two pharmacists were appointed to coordinate the whole process, and a preliminary analysis of the following aspects was carried  out an estimation of needs to make an initial drug provisioning, a storage  feasibility study and a global analysis of the logistics process to detect critical  points. Three different circuits for medicines supply were established as some  drugs were operated by Agencia Española de Medicamentos y Productos  Sanitarios (AEMPS) or Servicio Madrileño de Salud (SERMAS), and others were  under no restrictions. For stocks control, inventory was frequently reviewed and  monitoring of prescription trends was implemented. For all new medicinal  products, compliance with security standards was reviewed and relabeling was  carried out if necessary. Criteria were defined for the storage of overstocks and  it was placed an isolated area for quarantined drugs. Shortages inevitably  occurred but their effects were partly mitigated by AEMPS and SERMAS. After  all, we consider that the implemented procedure for logistics management may  be reproducible, and the key points we have identified are the following: to  enhance our quality management system, to develop an Action Plan for  Healthcare Emergencies and to ensure the adequate training for all pharmacy  staff. Furthermore, we also should address other aspects: to establish storage  optimization strategies, to focus on a more advanced logistics management  model, as well as to take advantage of the extraordinary multidisciplinary  network, which has been consolidated during this COVID pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Preparações Farmacêuticas/provisão & distribução , Serviço de Farmácia Hospitalar/organização & administração , Pneumonia Viral , Antivirais/provisão & distribução , Antivirais/uso terapêutico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Planejamento em Desastres , Rotulagem de Medicamentos , Prescrições de Medicamentos/estatística & dados numéricos , Armazenamento de Medicamentos , Educação Continuada em Farmácia , Necessidades e Demandas de Serviços de Saúde , Humanos , Comunicação Interdisciplinar , Inventários Hospitalares , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Gestão da Qualidade Total
11.
Farm Hosp ; 44(7): 21-23, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32533664

RESUMO

Medical devices have become essential to the prevention and control of the  COVID-19 pandemic, being crucial for health professionals and patients in  particular, and the population in general. It is important to be aware of the laws  that regulate the management, distribution, and control of medical devices.  Article 82 of the Spanish Law 29/2006 on Guarantees and Rational Use of  Medicines and Medical Devices establishes that it is the responsibility of Hospital  Pharmacy Services "to participate in and coordinate the purchase of medicines and medical devices in the hospital to ensure an efficient acquisition  and rational use of medical devices". For this reason, working groups of the Spanish Society of Hospital Pharmacy and other scientific societies have issued technical guidelines and consensus statements to provide technical support and updated information on the use of masks, individual  protection equipments and other medical devices. In addition, the shortage of  medical devices caused by the high demand has resulted in the uncontrolled  production and distribution of medical devices. This phenomenon, added to the  fraudulent selling of medical devices, highlights the need for a closer surveillance of the market to guarantee the efficacy and safety of available medical devices. A rational use of medical devices is necessary to ensure the availability and safety of these products, which requires the involvement of  different stakeholders, including hospital pharmacists. Thus, it is essential that  hospital pharmacists receive specific training in technical aspects concerning the possession and use of medical devices. This will help guarantee an effective and safe use of medical products. The acquisition and use of medical  devices requires a keen understanding of the technical and legal aspects  concerning these products, which makes hospital pharmacists essential for the  integral management of medical devices.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Equipamentos e Provisões , Pandemias , Serviço de Farmácia Hospitalar , Pneumonia Viral , Equipamentos de Proteção , Certificação , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Aprovação de Equipamentos , Equipamentos e Provisões/normas , Equipamentos e Provisões/provisão & distribução , Previsões , Fraude , Necessidades e Demandas de Serviços de Saúde , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Pandemias/prevenção & controle , Serviço de Farmácia Hospitalar/organização & administração , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Equipamentos de Proteção/provisão & distribução , Ventiladores Mecânicos/provisão & distribução
12.
Farm Hosp ; 44(7): 24-27, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32533665

RESUMO

Type 2 coronavirus pandemics that is plaguing almost all the world has caused  qualitative and quantitative strains in health systems that have had to be responded to. The lack of known vaccines and effective treatments has generated the need to  use drugs with very little evidence for their incorporation into pharmacotherapeutic  protocols agreed by the clinical team. The hospital pharmacist, within the  multidisciplinary team, has been responsible for critically evaluating the alternatives and positioning them in these protocols. Finally, some ethical and legal questions  that should be considered in this scenario are analyzed in this article.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Medicina Baseada em Evidências , Pandemias , Farmacêuticos , Serviço de Farmácia Hospitalar/organização & administração , Comitê de Farmácia e Terapêutica/organização & administração , Pneumonia Viral , Protocolos Clínicos , Infecções por Coronavirus/tratamento farmacológico , Tratamento Farmacológico/normas , Humanos , Comunicação Interdisciplinar , Uso Off-Label/ética , Uso Off-Label/legislação & jurisprudência , Equipe de Assistência ao Paciente , Serviço de Farmácia Hospitalar/legislação & jurisprudência , Pneumonia Viral/tratamento farmacológico , Guias de Prática Clínica como Assunto , Propaganda , Papel (figurativo)
13.
Farm Hosp ; 44(7): 28-31, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32533666

RESUMO

During the pandemic caused by the SARS-CoV-2 virus, pharmacy services have  had to adapt their service portfolio, and yet ensure efficient, equitable and  quality pharmaceutical care. Given the limited scientific evidence available, most drugs have been used off-label or in the context of clinical trials, which should be the preferred option in order to create new evidence. Among kind different  situations we have faced are the increase in workload, the expansion of  coverage to new wards and ICUs and shortages, which have caused the use of  alternative drugs and even other routes of administration. Given that covid-19  affects elderly population with greater severity and many of them are  polymedicated, great effort have been focused on monitoring interactions, both  pharmacokinetic and pharmacodynamic (specially prolongation of the QT  interval), monitoring correct concentrations of electrolytes, nutritional support,  adaptation of chemotherapy treatment protocols and anticoagulant  management, among others. The use of personal protective equipment added  difficulty for nursing work and some measures had been taken to minimize the  number of entries into the rooms. Eventually, team's split to guarantee care, the challenge of teleworking, remote validation, telemedicine and telepharmacy for  communication between professionals and patients, as well as training in this pandemic situation have been a challenge for our profession. These  difficulties have risen up new learning opportunities we hope will be useful to us  in the event we have to face similar situations in the future.


Assuntos
Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Pacientes Internados , Pandemias , Serviço de Farmácia Hospitalar/organização & administração , Pneumonia Viral/tratamento farmacológico , Assistência ao Convalescente , Comunicação , Comorbidade , Infecção Hospitalar/prevenção & controle , Vias de Administração de Medicamentos , Interações Medicamentosas , Monitoramento de Medicamentos , Previsões , Pessoal de Saúde/educação , Necessidades e Demandas de Serviços de Saúde , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Uso Off-Label , Educação de Pacientes como Assunto , Segurança do Paciente , Equipamento de Proteção Individual , Farmacovigilância , Relações Profissional-Paciente , Telemedicina
14.
Farm Hosp ; 44(7): 32-35, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32533667

RESUMO

The Intensive Care Unit (ICU) of the University Hospital of Fuenlabrada was  forced to critically increase its capacity in the COVID-19 pandemic. The objective of this work is to describe the activities promoted by the pharmacist in the care  of the critically ill patient in this context. A new organizational structure was  designed, analyzing the tasks necessary to make the processes profitable. Two  pharmacists joined the critical patient care to help the pharmacist who was  already integrated in the ICU team. The development of the operational  structure was carried out on three levels. The healthcare activity highlights the  daily participation of pharmacists in the two clinical sessions in which the ICU  teams evaluated all cases and made decisions. This in turn facilitated the  pharmaceutical validation that was carried out in the critical units themselves. In addition, one of the pharmacists created the Immuno-COVID Committee, in  which they participated together with different specialists for therapeutic  decision-making in the most complex cases. On the other hand, the availability  of human and material resources allowed the implantation of centralized  elaboration in the Pharmacy Service of many intravenous mixtures, including  antibiotics elastomers Pumps for continuous infusion, and non-sterile  elaborations. In logistics management, in addition to the acquisition of COVID- 19 therapies, the reconciliation with nursing activity stands out. The physical presence of the pharmacist favored the detection of needs, the  availability in time of medications in the unit, including sterile and non-sterile  preparations, and coordination with the central pharmacy. In knowledge  management, the participation of the pharmacist in the working group for the  development of the hospital management protocol COVID-19 stands out. The  daily presence in the unit and the joint work with the entire multidisciplinary team demonstrate the value that the pharmacist can bring. In addition to  efficient resource management, support for clinical decision-making and  improvement actions, it provides the climate of inter-professional trust necessary to respond to the complexity of the critical patient and promote joint  projects.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Unidades de Terapia Intensiva , Pandemias , Farmacêuticos , Pneumonia Viral , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/enfermagem , Infecções por Coronavirus/terapia , Cuidados Críticos , Tomada de Decisões , Gerenciamento Clínico , Equipamentos e Provisões Hospitalares/provisão & distribução , Necessidades e Demandas de Serviços de Saúde , Hospitais Universitários , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente , Preparações Farmacêuticas/provisão & distribução , Serviço de Farmácia Hospitalar/organização & administração , Comitê de Farmácia e Terapêutica/organização & administração , Pneumonia Viral/epidemiologia , Pneumonia Viral/enfermagem , Pneumonia Viral/terapia , Papel Profissional , Espanha/epidemiologia
15.
Farm Hosp ; 44(7): 36-39, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32533668

RESUMO

The COVID-19 pandemic is placing huge strain on health systems and professionals. Emergency departments and their pharmacy services have been the first to face this challenge before any other pharmacy units. This article provides a description of the experience of two public hospitals  located in the Autonomous Community of Madrid, Spain. Team working and  reciprocal trust have made it possible to meet the unprecedented demand for  health services and has facilitated rapid decision making. Strategies have been  developed to guarantee the availability, distribution and safe use of medications. Other strategies have included favoring communication within Emergency  Departments pharmacy services, and between these services and Emergency  Departments during the pandemic. Multidisciplinary cooperation and information  sharing have traditionally formed the base for efficient and quality work, along  with solid technologies that guarantee a safe use of medications. The crucial role of information and communication technologies during the pandemic may give  rise to a new model of pharmaceutical care, which should not replace face-to- face Emergency Department pharmacist support and advice. Promoting the re- humanization of healthcare and pharmacy services is essential. An adequate  technical training and the development of abilities such as flexibility, planning  and coordination skills, and an assertive communication and management of  emotions will be key to the successful management of unimaginable settings in  the future.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Serviço Hospitalar de Emergência/organização & administração , Unidades de Terapia Intensiva , Pandemias , Farmacêuticos , Pneumonia Viral , Competência Clínica , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Tomada de Decisões , Gerenciamento Clínico , Prescrições de Medicamentos/estatística & dados numéricos , Previsões , Necessidades e Demandas de Serviços de Saúde , Hospitais Universitários , Humanos , Controle de Infecções/organização & administração , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Comunicação Interdisciplinar , Sistemas de Medicação no Hospital/organização & administração , Equipe de Assistência ao Paciente , Preparações Farmacêuticas/provisão & distribução , Serviço de Farmácia Hospitalar/organização & administração , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Espanha/epidemiologia
16.
Farm Hosp ; 44(7): 40-42, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32533669

RESUMO

Since the implementation of the Antimicrobial Therapy Optimization Programme, hospital pharmacy specialists have collaborated with infectious disease specialists on a regular basis in most hospitals in Spain.  Cooperation between these professionals ensures the integrated management of patients with infectious diseases and the appropriate use of antimicrobials in  hospitals. The COVID-19 pandemic forced hospital pharmacists to abruptly  suspend all their structured activities and concentrate on the health crisis.  Realtime information sharing between different medicine specialties is an  effective strategy to generate and maintain treatment protocols adapted to each center, with continuous evidence-based modifications as new publications appear. Hospital pharmacies had to reorganize their activities to  respond to the pandemic. On the one side were patients with COVID-19, and on  the other were routine hospital pharmacy tasks, with the added difficulty of  adapting to individual protection measures. New communication and  collaboration strategies were adopted. Protocols were established for the  management of COVID-19 patients, with continuous changes; special  medications had to be prepared and distributed; circuits were designed for the  home- or institution-based care of patients; internal circuits were created to  minimize the movements of hospital staff and professionals caring for COVID-19  patients. The most effective antiviral drug and anti inflammatory therapy  remains elusive. In this scenario, hospital pharmacists emerge as a key player,  as they have a deep understanding of the mechanisms of action of drugs and  potential interactions. In a setting where experimental drugs preferably tested in clinical trials are being used, the role of hospital pharmacists in interdisciplinary  teams has become essential for the optimization of clinical outcomes.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Unidades Hospitalares , Comunicação Interdisciplinar , Pandemias , Equipe de Assistência ao Paciente , Farmacêuticos , Serviço de Farmácia Hospitalar/organização & administração , Pneumonia Viral , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Cuidados Críticos , Tomada de Decisões , Gerenciamento Clínico , Necessidades e Demandas de Serviços de Saúde , Hospitais Universitários , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Infectologia/organização & administração , Pacientes Internados , Unidades de Terapia Intensiva/organização & administração , Preparações Farmacêuticas/provisão & distribução , Comitê de Farmácia e Terapêutica/organização & administração , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Espanha/epidemiologia
17.
Farm Hosp ; 44(7): 43-48, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32533670

RESUMO

The COVID-19 pandemic is having a devastating effect on the nursing homes for dependent older people. The difficulty of management of this crisis is aggravated by the frailty of the people served and by the specific characteristics of the care  area, mainly the fact of not being integrated into the health system. The  objective of this work is to describe the pharmaceutical care developed by a  hospital pharmacy service established in a nursing home and, from a more  global perspective, analyze the strengths and weaknesses found from the  various experiences of hospital pharmacy in all spanish autonomous  communities to deal with this pandemic. Specialized pharmaceutical care has  provided rigor in the validation and treatments review processes from a  comprehensive perspective, maximizing safety and collaborating in the  establishment of the therapeutic intensity degree most appropriate to the  individual situation, has ensured the availability of all necessary medications,  has collaborated in the acquisition and management of personal protective equipment, has been able to adapt the dispensation processes to the internal  nursing homes sectorization and has facilitated the coordination between the  nursing home and the health system. It is clear that the crisis casued by COVID- 19 has put relevance of the need to integrate the social-health level into the  health system. And also, the contribution of specialized pharmaceutical care in  improving healthcare coverage and coordination with health services has  highlighted the urgency of developing the current legislation, prioritizing the  establishment of pharmacy services able to provid specialized and specific care  for this area, so that it meets healthcare needs and is integrated into the health  system.


Assuntos
Assistência Ambulatorial/organização & administração , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Casas de Saúde/organização & administração , Pandemias , Serviço de Farmácia Hospitalar/organização & administração , Pneumonia Viral/tratamento farmacológico , Idoso , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/prevenção & controle , Infecções Comunitárias Adquiridas/transmissão , Comorbidade , Infecções por Coronavirus/enfermagem , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Surtos de Doenças , Interações Medicamentosas , Feminino , Idoso Fragilizado , Humanos , Controle de Infecções/organização & administração , Masculino , Sistemas de Medicação no Hospital/organização & administração , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Admissão e Escalonamento de Pessoal , Pneumonia Viral/enfermagem , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Polimedicação , Espanha/epidemiologia
18.
Farm Hosp ; 44(7): 49-52, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32533671

RESUMO

As in other areas of the health system, COVID-19 has had a dramatic impact on  hospital compounding. This area has faced numerous challenges, including the  shortage of frequent-use products (hydroalcoholic solutions, lopinavir/ritonavir  suspension), the use of new preparations for SARS-CoV-2 (tocilizumab,  remdesivir), or requests from overwhelmed wards unable to assume the safe  preparation of a high volume of medications (intravenous solutions). The  demand for all types of preparations (topic and oral medications, intravenous  solutions) has increased dramatically. This increase has highlighted the shortage of resources allocated to this area, which has made it difficult to meet the high  demand for preparations. In addition, the pandemic has revealed the scarcity of  research on such basic aspects as agent stability and drug compatibility. One of  the most relevant conclusions drawn from the COVID-19 pandemic is that the  basic areas of hospital pharmacy, along with other, must be maintained and  reinforced, as these are the areas that make us essential.


Assuntos
Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Composição de Medicamentos , Pandemias , Serviço de Farmácia Hospitalar/organização & administração , Pneumonia Viral/tratamento farmacológico , Administração Oral , Antivirais/provisão & distribução , Antivirais/uso terapêutico , Transfusão de Componentes Sanguíneos , Desinfecção , Vias de Administração de Medicamentos , Interações Medicamentosas , Estabilidade de Medicamentos , Contaminação de Equipamentos/prevenção & controle , Excipientes , Previsões , Serviços de Assistência Domiciliar , Humanos , Hidroxicloroquina/administração & dosagem , Hidroxicloroquina/química , Infusões Intravenosas , Lopinavir/administração & dosagem , Equipamento de Proteção Individual/provisão & distribução , Plasma Rico em Plaquetas , Ritonavir/administração & dosagem , Soluções
19.
Farm Hosp ; 44(7): 53-56, 2020 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-32533672

RESUMO

In response to the SARS-CoV-2 pandemic, the Hospital Pharmacy Services have  quickly adapted to respond to a critical situation characterized by the constant  and continuous admission of patients with severe pneumonia who needed  treatment, requiring a transformation of the hospital in order to increase the  number of hospital and critical beds. Moreover, other out-ofhospital spaces have  been transformed into hospitalization units to absorb the large number of  patients that had to be treated and isolated. To guarantee the distribution of  medicines and the quality of the pharmaceutical care, drug distribution systems,  such as unit dose and automated dispensing systems, have undergone  transformations. Standard stocks were assigned for COVID units, and different  dispensing circuits to avoid the risk of cross-contamination between COVID and  non-COVID units were created, as well as disinfection protocols for medication  transport systems and medication return protocols. All this without forgetting  COVID treatment protocol's changes that were affected by the availability of the  drugs. The increase in the number of beds in out-of-hospital spaces, such as  field hospitals, hotels, socio-medical centers and nursing homes, has challenged  Pharmacy Services, since new medication dispensing and conciliation circuits  have been created forcing the increase of pharmacy staff's presence and  modifying work shifts, to afford all the new tasks successfully. Development of  contingency plans for the different Pharmacy Service activities and providing  fluent communication channels are key elements for crisis situations or health  emergencies such as the current pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Farmacêuticos , Serviço de Farmácia Hospitalar/organização & administração , Pneumonia Viral , Desinfecção , Armazenamento de Medicamentos , Prescrição Eletrônica , Equipamentos e Provisões/provisão & distribução , Previsões , Necessidades e Demandas de Serviços de Saúde , Número de Leitos em Hospital , Unidades Hospitalares , Humanos , Unidades de Terapia Intensiva , Sistemas de Medicação no Hospital/organização & administração , Alta do Paciente , Admissão e Escalonamento de Pessoal , Recursos Humanos
20.
Farm Hosp ; 44(7): 57-60, 2020 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-32533673

RESUMO

On the 20th of March 2020, triggered by the public health emergency declared,  the Health Authorities in Madrid reported a legal instruction (Orden 371/2020)  indicating the organization of a provisional hospital to admit patients with  COVID-19 at the Trade Fair Institution (IFEMA). Several pharmacists working in  the Pharmacy and Medical Devices Department of the Madrid Regional Health  Service were called to manage the Pharmacy Department of the  abovementioned hospital. Required permissions to set up a PD were here  authorized urgently. Tackling human and material resources, and computer  systems for drug purchase and electronic prescription, were some of the initial  issues that hindered the pharmaceutical provision required for patients from the  very day one. Once the purchase was assured, mainly by direct purchase from suppliers, drug dispensing up to 1,250 hospitalized patients (25 nursing units) and 8 ICU patients was taken on. Dispensing was carried out  through either drug stocks in the nursing units or individual patient dispensing  for certain drugs. Moreover, safety issues related to prescription were  considered, and as the electronic prescription was implemented we attained  100% prescriptions review and validation. The constitution of a multidisciplinary  Pharmacy and Therapeutics Committee let agree to a pharmacotherapy guide,  pres cription protocols, therapeutic equivalences, interactions, and drug  dispensing circuits. The Pharmacy Department strategy was to ensure a very  quick response to basic tasks keeping the aim to offer a pharmaceutical care of  the highest quality whenever possible. Working under a health emergency  situation, with many uncertainties and continuous pressure was a plight.  However, the spirit of collaboration in and out of the Pharmacy Department was  aligned with the whole hospital motivation to offer the highest quality of  healthcare. These were possibly the keys to allow caring for almost 4,000  patients during the 42 days that the hospital lasted.


Assuntos
Infecções por Coronavirus , Assistência à Saúde/organização & administração , Hospitais Urbanos/organização & administração , Modelos Teóricos , Pandemias , Serviço de Farmácia Hospitalar/organização & administração , Pneumonia Viral , Betacoronavirus , Assistência à Saúde/legislação & jurisprudência , Assistência à Saúde/métodos , Prescrição Eletrônica/normas , Fiscalização e Controle de Instalações/legislação & jurisprudência , Previsões , Planejamento de Instituições de Saúde , Necessidades e Demandas de Serviços de Saúde , Hospitalização , Hospitais Urbanos/legislação & jurisprudência , Humanos , Comunicação Interdisciplinar , Segurança do Paciente , Serviço de Farmácia Hospitalar/legislação & jurisprudência , Comitê de Farmácia e Terapêutica/organização & administração , Garantia da Qualidade dos Cuidados de Saúde , Espanha
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