Conciliación de la medicación al ingreso en paciente crónico pediátrico: estudio multicéntrico

Conciliación de la medicación; Discrepancia; PediatríaMedication reconciliation; Discrepancy; PaediatricsConciliació de la medicació; Discrepància; PediatriaIntroduction Medication reconciliation (MC) is one of the main strategies to reduce medication errors in care transitions. In Spain, several guidelines have been published with recommendations for the implementation and development of MC aimed at the adult population, although paediatric patients are not included. In 2018, a study was carried out that led to the subsequent publication of a document with criteria for selecting paediatric patients in whom CM should be prioritised. Objectives To describe the characteristics of paediatric patients most likely to suffer from errors of reconciliation (EC), to confirm whether the results of a previous study can be extrapolated. Methodology Prospective, multicentre study of paediatric inpatients. We analysed the CE detected during the performance of the CM on admission. The best possible pharmacotherapeutic history of the patient was obtained using different sources of information and confirmed by an interview with the patient/caregiver. Results 1043 discrepancies were detected, 544 were identified as CD, affecting 317 patients (43%). Omission of a drug was the most common error (51%). The majority of CD were associated with drugs in groups A (31%), N (23%) and R (11%) of the ATC classification. Polymedication and onco-haematological based disease were the risk factors associated with the presence of CD with statistical significance. Conclusions The findings of this study allow prioritisation of CM in a specific group of paediatric patients, favouring the efficiency of the process. Onco-haematological patients and polymedication are confirmed as the main risk factors for the appearance of CD in the paediatric population.Introducción La conciliación de la medicación (CM) es una de las principales estrategias para disminuir los errores de medicación en las transiciones asistenciales. En España existen publicadas diferentes guías con recomendaciones para la implantación y desarrollo de la CM orientadas a población adulta, sin estar los pacientes pediátricos incluidos. En el año 2018 se llevó a cabo un estudio que permitió la posterior publicación de un documento con criterios de selección de pacientes pediátricos en los que priorizar la CM. Objetivos Describir las características de los pacientes pediátricos con mayor probabilidad de sufrir errores de conciliación (EC), para confirmar si los resultados de un estudio previo son extrapolables. Metodología Estudio prospectivo y multicéntrico con pacientes pediátricos ingresados. Se analizaron los EC detectados durante la realización de la CM al ingreso. La mejor historia farmacoterapéutica posible del paciente fue obtenida utilizando diferentes fuentes de información y confirmándose con una entrevista con el paciente/cuidador. Resultados Se detectaron 1.043 discrepancias, determinándose como EC 544, afectando a 317 pacientes (43%). La omisión de algún medicamento fue el error más común (51%). La mayoría de los EC se asociaron con los medicamentos de los grupos A (31%), N (23%) y R (11%) de la clasificación ATC. La polimedicación y la enfermedad de base onco-hematológica fueron los factores de riesgo asociados a la presencia de EC con significación estadística. Conclusiones Los hallazgos de este estudio permiten priorizar la CM en un grupo concreto de pacientes pediátricos, favoreciendo la eficiencia del proceso. Los pacientes onco-hematológicos y la polimedicación se confirman como los principales factores de riesgo para la aparición de EC en población pediátrica.The study was funded by the Fundación Española de Farmacia Hospitalaria through the 2019–2020 grant programme

Estudio multicéntrico de conciliación de la medicación en onco-hematología pediátrica

Conciliación de la medicación; Pediatría; OncologíaMedication reconciliation; Pediatrics; OncologyConciliació de la medicació; Pediatria; OncologiaObjective To determine the prevalence of reconciliation errors on admission to hospital in the pediatric onco-hematological population in order to check whether they are similarly susceptible to these reconciliation errors as adults and to describe the characteristics of the patients who suffer them. Methods A 12-month prospective, multicentre study of medication reconciliation on admission in the pediatric onco-hematological population to assess the incidence of reconciliation errors and to describe the characteristics of the patients. Results Medication reconciliation was performed in 157 patients. At least a medication discrepancy was detected in 96 patients. Of the discrepancies detected, 52.1% were related to patient's new clinical situation or by the physician, while 48.9% were determined to be reconciliation errors. The most frequent type of reconciliation error was the “omission of a medication”, followed by “a different dose, frequency or route of administration”. A total of 77 pharmaceutical interventions were carried out, 94.2% of which were accepted. In the group of patients with a number equal to or greater than 4 drugs in home treatment, there was a 2.1-fold increase in the probability of suffering a reconciliation error. Conclusions In order to avoid or reduce errors in one of the critical safety points such as transitions of care, there are measures such as medication reconciliation. In the case of complex chronic pediatric patients, such as onco-hematological patients, the number of drugs as part of home treatment is the variable that has been associated with the presence of medication reconciliation errors on admission to hospital, and the omission of some medication was the main cause of these errors.Objetivo Determinar la prevalencia de errores de conciliación al ingreso hospitalario en la población pediátrica onco-hematológica para comprobar si ésta presenta una susceptibilidad similar a la de los adultos para sufrir estos errores de conciliación y describir las características de los pacientes que los sufren. Método Estudio prospectivo y multicéntrico, de 12 meses de duración, de conciliación de medicación al ingreso en población pediátrica onco-hematológica para evaluar la incidencia de errores de conciliación y describir las características de los pacientes en los que se producen. Resultados Se concilió la medicación de 157 pacientes. En 96 pacientes se detectó al menos 1 discrepancia de la medicación. De las discrepancias detectadas el 52,1% fueron justificadas por la nueva situación clínica del paciente o por el médico responsable mientras que el 48,9% se consideraron errores de conciliación. El tipo de error de conciliación más frecuente fue la «omisión de algún medicamento», seguido por «una dosis, frecuencia o vía de administración diferente». Se efectuaron un total de 77 intervenciones farmacéuticas, de las que se aceptaron el 94,2%. En el grupo de pacientes con un número igual o mayor a 4 fármacos en tratamiento domiciliario se observó un incremento de 2,1 veces la probabilidad de sufrir un error de conciliación. Conclusiones Para evitar o reducir los errores en uno de los puntos críticos de seguridad como son las transiciones asistenciales, existen medidas, como la conciliación de la medicación. En el caso de los pacientes pediátricos crónicos complejos, como los pacientes onco-hematológicos, el número de fármacos como parte del tratamiento domiciliario es la variable que se ha asociado a la presencia de errores de conciliación al ingreso hospitalario, siendo la omisión de algún medicamento la causa principal de estos errores

Outpatients' opinion and experience regarding telepharmacy during the COVID-19 pandemic: the Enopex Project

[Abstract] Background: Telepharmacy, as a remote pharmaceutical care procedure, is being used worldwide during the COVID-19 pandemic, with the aim of preserving the health of patients and professionals. Its future development should incorporate the assessment of patient perception, but no research study has investigated it. Objective: The objective was to poll the opinions and experiences of outpatients with telepharmacy through a purpose-developed questionnaire and to assess it's quality through an internal validity and reliability analysis. Methods: Cross-sectional observational study of adult patients who used telepharmacy services during the COVID-19 lockdown period in Spain. The subjects answered a 24-item questionnaire, after giving their informed consent. Place of delivery, informed pharmacotherapeutic follow-up, opinion about telepharmacy, future development, ethics/satisfaction, and coordination constituted the six questionnaire categories. After assessing the adequate sample size with the Kaiser-Meyer-Olkin test, the Bartlett sphericity test analyzed the validity of the questionnaire. The intraclass correlation coefficient and Cronbach's α coefficient calculations verified the reliability and internal consistency. Results: A total of 9442 interviews were administered to patients from 81 hospitals, of which 8079 were valid (52.8% female). A 54.1% were aged between 41-65 years; 42.7% had been in treatment for more than 5 years; 42.8% lived between 6-31 miles from the hospital. As many as 96.7% of patients were "satisfied" or "very satisfied" with telepharmacy, 97.5% considering it complementary to their usual follow-up; 55.9% expressed a preference for being followed up face to face when visiting the hospital. 75.6% said they had rather receive their medication at home. The sample size obtained was deemed appropriate [the Kaiser-Meyer-Olkin test (0.789) and Bartlett's sphericity test (p<0.005)]. The reliability analysis resulted in a Cronbach α = 0.7. Conclusion: Patients have shown high satisfaction with telepharmacy and the ENOPEX questionnaire is a tool with sufficient validity and reliability to be used in the evaluation of the care that patients receive through telepharmacy

Dosis diaria definida de antimicrobianos en la población neonatal

Consumo de antimicrobianos; Prescripción de antimicrobianos en neonatos; NeonatologíaAntimicrobial consumption; Neonatal antimicrobial prescription; NeonatologyConsum d'antimicrobians; Prescripció d'antimicrobians a nounats; NeonatologiaBackground Antimicrobial defined daily dose (DDD), a standardized metric to assess antimicrobial consumption in adult population, has limitations hampering its use in neonatal patients. This study proposes an alternative DDD design applicable for neonates. Methods Neonates (<1 month-old) from 6 Spanish hospitals during a 12-months period were included. Weight and weeks gestational age of each neonate were the variables collected. DDD (g) for each antimicrobial was calculated by multiplying the obtained weight times the recommended dose (mg/kg) of the antimicrobial for the most common infectious indication selected by the Delphi method. Results A total of 4820 neonates were included. Mean age was 36.72 weeks of gestational age and Mean weight was 2.687 kg. Standardized DDD (intravenous; oral route) for representative antimicrobials were: Amoxicillin (0.08; 0.08), amoxicillin-clavulanic acid (0.27; 0.08), ampicillin (0.27; x), cloxacillin (0.13; 0.13), penicillin G sodium (0.12), cefazolin (0.13), cefuroxime (0.27; x), cefotaxime (0.27), ceftazidime (0.27), ceftriaxone (0.13), cefepime (0.27) piperacillin-tazobactam (0.54), aztreonam (0.24), azithromycin (0.03; 0.03), clindamycin (0.04; 0.04), amikacin (0.04), gentamicin (0.01), metronidazole (0.04; 0.08), ciprofloxacin (0.04; 0.05), levofloxacin (x;x), fluconazole (0.02; 0.02), itraconazole (0.01; 0.01), fosfomycin (0.27). Restricted antimicrobials: meropenem (0.11), teicoplanin (0.02), vancomycin (0.08; 0.11), linezolid (0.08; 0.08), daptomycin (x), amphotericin B liposomal (0.01). Conclusions A useful method for antimicrobial DDD measurement in neonatology has been designed to monitor antimicrobial consumption in hospital settings. It should be validated in further studies and thereby included in the design for neonatal antimicrobial stewardship programs in the future.Antecedentes La dosis diaria definida de antimicrobianos (DDD), un método estandarizado para evaluar el consumo de antimicrobianos en la población adulta, tiene limitaciones que dificultan su uso en la población neonatal. Este estudio propone un diseño alternativo de la DDD aplicable a los recién nacidos. Métodos Se incluyeron neonatos (< 1 mes) de 6 hospitales españoles durante un período de 12 meses. El peso y las semanas de edad gestacional de cada recién nacido fueron las variables recogidas. Las DDD (g) de cada antimicrobiano se calcularon multiplicando el peso obtenido por la dosis recomendada (mg/kg) del antimicrobiano para la indicación infecciosa más común seleccionada por el método Delphi. Resultados Se incluyeron un total de 4.820 recién nacidos. La edad media fue de 36,72 semanas de edad gestacional y el peso medio fue de 2,687 kg. La DDD estandarizado (intravenoso; oral) para antimicrobianos seleccionados fueron: amoxicilina (0,08; 0,08), amoxicilina-ácido clavulánico (0,27; 0,08), ampicilina (0,27; x), cloxacilina (0,13; 0,13), penicilina G sódica (0,12), cefazolina (0,13), cefuroxima (0,27; x), cefotaxima (0,27), ceftazidima (0,27), ceftriaxona (0,13), cefepima (0,27) piperacilina-tazobactam (0,54), aztreonam (0,24), azitromicina (0,03; 0,03) clindamicina (0,04; 0,04), amikacina (0,04), gentamicina (0,01), metronidazol (0,04; 0,08), ciprofloxacina (0,04; 0,05), levofloxacina (x; x), fluconazol (0,02; 0,02), itraconazol (0,01; 0,01), fosfomicina (0,27). Antimicrobianos restringidos: meropenem (0,11), teicoplanina (0,02), vancomicina (0,08; 0,11), linezolid (0,08; 0,08), daptomicina (x), anfotericina B liposomal (0, 01). Conclusiones Se ha diseñado un método útil para la medición de las DDD de antimicrobianos en neonatología para controlar el consumo de antimicrobianos en entornos hospitalarios. Debería validarse en estudios posteriores para incluirse en el diseño de los programas de administración de antimicrobianos neonatales en el futuro

Survey on the situation of telepharmacy as applied to the outpatient care in hospital pharmacy departments in Spain during the COVID-19 pandemic

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.YesObjetivo: 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 servicios 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

Analysis 2016-2021 of the development of the MAPEX outpatient pharmaceutical care Project by Regions in Spain

Objetivo: analizar la evolución del proyecto «Mapa Estratégico de Atención Farmacéutica al Paciente Externo» (MAPEX) por comunidades autónomas en España, a través del análisis de los resultados de la encuesta de situación comparativa entre los años 2016 y 2021. Métodos: un comité de expertos nacionales pertenecientes a la Sociedad Española de Farmacia Hospitalaria elaboró la Encuesta MAPEX sobre la situación de las unidades de pacientes externos, que constó de 43 preguntas específicas de aspectos relacionados con estructura, contexto, integración, procesos, resultados y formación, docencia e investigación. Se llevó a cabo en 2 periodos, uno en 2016 y otro en 2021 (con 3 preguntas adicionales en 2021, relacionadas con los avances de la iniciativa MAPEX y las líneas prioritarias a seguir). Se realizó un análisis comparativo de resultados a nivel nacional y por comunidad autónoma. Resultados: participaron 141 hospitales en 2016 y 138 en 2021, con representación de las 17 comunidades autónomas. El análisis de los resultados mostró mejoras significativas en todas las dimensiones de la encuesta, con variabilidad entre las diferentes regiones. De entre las mejoras más importantes, destacó el desarrollo y consolidación de la telefarmacia, la mayor especialización del farmacéutico por áreas de conocimiento y su integración en equipos multidisciplinares. La mejora del modelo asistencial se consideró el mayor avance a nivel general (65%) y la atención farmacéutica no presencial a nivel de centro (48,2%). Se consideraron líneas prioritarias de trabajo la expansión y aplicación práctica de la metodología de atención farmacéutica (66,4%), la investigación (58,4%) y la formación en todas las iniciativas MAPEX (53,3%). Conclusiones: la implantación y desarrollo de las iniciativas MAPEX ha supuesto un impacto positivo en la evolución en todos los ámbitos asistenciales de la atención farmacéutica al paciente externo. La encuesta permite identificar por comunidades autónomas los puntos significativos de mejora y los aspectos a desarrollar a través de acciones de fortalecimiento y correctoras. La expansión del proyecto en los próximos años supondrá un avance hacia la excelencia de la atención y en la mejora de los resultados en salud.Objective To analyse the evolution of the MAPEX Project (Strategic Map of Pharmaceutical Care for Outpatients) by regions in Spain, through the results of the comparative situation survey between 2016 and 2021. Methods A committee of national experts belonging to the Spanish Society of Hospital Pharmacy prepared the MAPEX Survey on the situation of Outpatient Units, which consisted of 43 specific questions on aspects related to structure, context, integration, processes, results and training, teaching, and investigation. It was carried out in 2 periods, one in 2016 and another in 2021 (with 3 additional questions in 2021, related to the progress of the MAPEX initiative and the priority lines to follow). A comparative analysis of results was carried out at the national level and by regions in Spain. Results 141 hospitals participated in 2016 and 138 in 2021, with representation from the 17 autonomous communities. The analysis of the results shows significant improvements in all the dimensions of the survey, with variability between the different regions. Among the most important improvements, the development and consolidation of telepharmacy stood out, the greater specialisation of pharmacists by areas of knowledge and their integration into multidisciplinary teams. The improvement of the healthcare model was considered the greatest advance at a general level (65%), and remote pharmaceutical care at the hospital level (48.2%). Priority lines of work were considered the expansion and practical application of the pharmaceutical care methodology (66.4%), research (58.4%), and training in all MAPEX initiatives (53.3%). Conclusions The implementation and development of the MAPEX initiatives has had a positive impact on the evolution in all healthcare areas of pharmaceutical care for outpatients. The situation survey makes it possible to identify by regions the significant points for improvement, as well as those areas to be developed through strengthening and corrective actions. The expansion of the project in the coming years will mean progress toward excellence in care and in the improvement of health results.Sociedad Española de Farmacia Hospitalaria (SEFH) Proyecto MAPEX-SEF

Development of Antimicrobial Defined Daily Dose (DDD) for the Pediatric Population

Antimicrobial stewardship programs (ASPs) optimize antimicrobial use, improve patient outcomes, and reduce resistance. To assess the effectiveness of ASPs, it is necessary to have indicators that can be widely used. Defined daily dose (DDD) was designed by WHO for the adult population as a consumption indicator. However, there are no DDDs adapted to the pediatric population. The main objective of this study is to establish the most appropriate DDD values in this population. An observational, retrospective, multicenter study was conducted. Antimicrobial prescriptions were collected from pediatric wards of seven Spanish tertiary hospitals for 2 years. The DDDs obtained from the prescriptions were compared with the theoretical DDDs agreed upon in the first stage. To select the optimal DDD, the following were analyzed: power value, magnitude obtained from the differences in the DDD, statistical significance, and degree of agreement in the stipulated doses. A total of 4788 prescriptions were collected. Pediatric DDD was defined for 30 different antimicrobials. A potency >80% was obtained in 24 antibiotics. 51.2% of the selected DDD correspond to Phase I and 39.5% from Phase II. Pediatric DDD of different antimicrobials was obtained, providing an indicator that can be used globally in different hospitals to analyze the consumption and efficacy of ASPs

Development of Antimicrobial Defined Daily Dose (DDD) for the Pediatric Population

Antimicrobial stewardship programs (ASPs) optimize antimicrobial use, improve patient outcomes, and reduce resistance. To assess the effectiveness of ASPs, it is necessary to have indicators that can be widely used. Defined daily dose (DDD) was designed by WHO for the adult population as a consumption indicator. However, there are no DDDs adapted to the pediatric population. The main objective of this study is to establish the most appropriate DDD values in this population. An observational, retrospective, multicenter study was conducted. Antimicrobial prescriptions were collected from pediatric wards of seven Spanish tertiary hospitals for 2 years. The DDDs obtained from the prescriptions were compared with the theoretical DDDs agreed upon in the first stage. To select the optimal DDD, the following were analyzed: power value, magnitude obtained from the differences in the DDD, statistical significance, and degree of agreement in the stipulated doses. A total of 4788 prescriptions were collected. Pediatric DDD was defined for 30 different antimicrobials. A potency &gt;80% was obtained in 24 antibiotics. 51.2% of the selected DDD correspond to Phase I and 39.5% from Phase II. Pediatric DDD of different antimicrobials was obtained, providing an indicator that can be used globally in different hospitals to analyze the consumption and efficacy of ASPs