Profile of patients using nasoenteric probe at the adult emergency service in a public hospital

Introduction: Part of the prognosis of hospitalized patient depends on nutritional status and the safety and efficacy of the feeding administration route. Therefore, the aim of this study was to identify data on the indication of nasoenteric tube (NET) prescription to analyze the profile of these patients.Methods: A retrospective cross-sectional study was carried out with data collection in medical records of patients over 18 years of age, of both sexes, treated at the Emergency Adult Service (EAS), using NET.Results: there was a predominance of females (51.9%); neurological disease was the most prevalent underlying disease, and 57.8% had more than one diagnosed disease. Malnutrition, bronchopneumonia, and dysphagia were present in 23.6%, 27% and 40% of the cases, respectively. There was a request for speech-language evaluation in only 8.7% of the patients. And 80.7% did not use NET prior to emergency care. Regarding the indications for the use of NET by group of underlying disease, low food intake was the most prevalent clinical reason described in the medical records, followed by dysphagia, with a higher prevalence of patients taking NET for nutritional reasons. There was no justification for prescription in 15.2% of the sample. There was an association between the variables bronchopneumonia and dysphagia (p = 0.01).Conclusion: It was verified that in the studied population there are risk factors for dysphagia. The analysis of the population profile in the present study contributed to increased knowledge and information about this population regarding the criteria for indication of the use of the alternative route. Keywords: Deglutition disorders; enteral nutrition; emergency medical service

Profile of patients using nasoenteric probe at the adult emergency service in a public hospital

Introduction: Part of the prognosis of hospitalized patient depends on nutritional status and the safety and efficacy of the feeding administration route. Therefore, the aim of this study was to identify data on the indication of nasoenteric tube (NET) prescription to analyze the profile of these patients.Methods: A retrospective cross-sectional study was carried out with data collection in medical records of patients over 18 years of age, of both sexes, treated at the Emergency Adult Service (EAS), using NET.Results: there was a predominance of females (51.9%); neurological disease was the most prevalent underlying disease, and 57.8% had more than one diagnosed disease. Malnutrition, bronchopneumonia, and dysphagia were present in 23.6%, 27% and 40% of the cases, respectively. There was a request for speech-language evaluation in only 8.7% of the patients. And 80.7% did not use NET prior to emergency care. Regarding the indications for the use of NET by group of underlying disease, low food intake was the most prevalent clinical reason described in the medical records, followed by dysphagia, with a higher prevalence of patients taking NET for nutritional reasons. There was no justification for prescription in 15.2% of the sample. There was an association between the variables bronchopneumonia and dysphagia (p = 0.01).Conclusion: It was verified that in the studied population there are risk factors for dysphagia. The analysis of the population profile in the present study contributed to increased knowledge and information about this population regarding the criteria for indication of the use of the alternative route. Keywords: Deglutition disorders; enteral nutrition; emergency medical service

Development of risk score to hospitalized patients for clinical pharmacy rationalization in a high complexity hospital

The aim of the present research was to build a tool to classify patients according to drug theraphy risk so as to rationalize the use of clinical pharmaceutical resources in hospital settings. Risk factors selected in the literature available were carefully revised to be included in the score. The selected factors were submitted to univariate and then to multivariate analysis. The significant results were included in the final score model, which divided the hospitalized patients into three groups: low risk, moderate risk and high risk. After that, the score was applied in the hospital and a "risk classification" map was created of the various sectors of the Hospital de Clínicas de Porto Alegre. The score was applied to 1442 patients in nine different areas of the hospital, with 398 (27.6 %) of them presenting high risk, 612 (42.4 %) moderate risk and 432 (29.9 %) low risk. The high risk units were: Pediatric Oncology, the Intensive Care Unit (ICU) for adults and the Pediatric Intensive Care Unit (PICU). The clinical and surgical units, the Protected Environment Unit (PEU) and the Neonatal Intensive Care Unit (NICU) were classified as moderate risk and the pediatric hospitalization unit as low risk. Considering the patients with renal and/or hepatic problems, cardiac and/or pulmonary problems and immunosuppression and/or immuno deficiency, 50.2 %, 61.5 % and 52.6 %, respectively, presented high score, with all of them taking at least one risk drug.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Application of procurement governance to the supply chain at a public university hospital

Introdução: O tema da governança corporativa vem ganhando cada vez mais destaque nas Organizações Públicas, principalmente a governança nas aquisições, pois objetivam agregar valor ao negócio com riscos aceitáveis, através da adoção de boas práticas de gestão, ética e transparência e cumprimento da legislação pública. Métodos: O trabalho a seguir apresenta um estudo para aprimorar os processos internos da área de Planejamento e Compras em um Hospital Público Universitário, de alta complexidade. As fases de planejamento e compras em uma Instituição hospitalar de grande porte são extremamente desafiadoras visto a variabilidade de produtos necessários para o atendimento das demandas assistenciais, e no caso específico, também de pesquisa e ensino. O volume de processos e de aquisições geradas ao longo do exercício são inúmeras e há um grande contingente de pessoas envolvidas, de forma multidisciplinar. Esse trabalho propôs implementar ações concretas que aprimoram a governança das contratações, com o uso de estratégias e ferramentas voltadas à efetividade dos processos de aquisição, na assertividade, controle e monitoramento dos riscos, mantendo os padrões de qualidade e segurança da Organização. Resultados: Através deste trabalho, obteve-se o aumento de dez pontos percentuais no aproveitamento nas licitações e redução do tempo de tramitação dos processos em de quarenta e um dias. Conclusão: A adoção de ferramentas de governança nas aquisições públicas traz melhores resultados de processo e eficiência nas compras públicas e ainda promove a transparência e a visibilidade das ações aos fornecedores.Introduction: The theme of corporate governance has been gaining increasing prominence in Public Organizations, especially governance in procurement, as it aims to add value to the business with acceptable risks, through the adoption of good management practices, ethics and transparency and compliance with public legislation. Methods: The following work presents a study to improve the internal processes of the Planning and Purchasing area in a Public University Hospital of high complexity. The planning and purchasing phases in a large hospital are extremely challenging due to the variability of products needed to meet the demands of health care, and in this specific case, also of research and teaching. The volume of processes and acquisitions generated throughout the year are numerous and there is a large contingent of people involved, in a multidisciplinary way. This work proposed to implement concrete actions that improve the governance of procurement, with the use of strategies and tools aimed at the effectiveness of procurement processes, assertiveness, control and monitoring of risks, while maintaining the standards of quality and safety of the Organization. Results: Through this work, it was obtained the increase of ten percentage points in the utilization in the bids and reduction of the processing time of the processes in forty-one days. Conclusion: The adoption of governance tools in public procurement brings better process results and efficiency in public purchases and also promotes transparency and visibility of actions to suppliers

Development of a digital twin for the prediction and control of supersaturation during batch cooling crystallization

Fine chemicals produced via batch crystallization with properties dependent on the crystal size distribution require precise control of supersaturation, which drives the evolution of crystal size over time. Model predictive control (MPC) of supersaturation using a mechanistic model to represent the behavior of a crystallization process requires less experimental time and resources compared with fully empirical model-based control methods. Experimental characterization of the hexamine–ethanol crystallization system was performed in order to collect the parameters required to build a one-dimensional (1D) population balance model (PBM) in gPROMS FormulatedProducts software (Siemens-PSE Ltd.). Analysis of the metastable zone width (MSZW) and a series of seeded batch cooling crystallizations informed the suitable process conditions selected for supersaturation control experiments. The gPROMS model was integrated with the control software PharmaMV (Perceptive Engineering Ltd.) to create a digital twin of the crystallizer. Simulated batch crystallizations were used to train two statistical MPC blocks, allowing for in silico supersaturation control simulations to develop an effective control strategy. In the supersaturation set-point range of 0.012–0.036, the digital twin displayed excellent performance that would require minimal controller tuning to steady out any instabilities. The MPC strategy was implemented on a physical 500 mL crystallizer, with the simulated solution concentration replaced by in situ measurements from calibrated attenuated total reflection–Fourier transform infrared (ATR-FTIR) spectroscopy. Physical supersaturation control performance was slightly more unstable than the in silico tests, which is consistent with expected disturbances to the heat transfer, which were not specifically modeled in simulations. Overall, the level of supersaturation control in a real crystallizer was found to be accurate and precise enough to consider future adaptations to the MPC strategy for more advanced control objectives, such as the crystal size

Profile of information about drug interactions requested from the drug information center of a university hospital

Introdução: o Centro de Informações sobre Medicamentos (CIM) busca, através de suas fontes de pesquisa, identificar as possíveis interações medicamentosas que possam prejudicar ou não o paciente no momento da administração. Objetivo: descrever as interações medicamentosas identificadas pelo CIM, a partir de solicitações dos profissionais internos de hospital universitário. Método: foi realizado estudo descritivo, no período de janeiro de 2009 a maio de 2011, das solicitações relacionadas com interações medicamento x medicamento, medicamento x alimentos e sondas enterais e incompatibilidades medicamentosas. Das solicitações, verificou-se a disponibilidade de informação na literatura e a orientação fornecida ao solicitante. Resultados: das solicitações de interações medicamentosas, envolvendo 55 medicamentos, foram informadas 19 interações, na sua maioria moderadas (61%) e de efeito tardio (50%). Das interações medicamento x alimentos (N=15), 26,7% apresentaram efeitos de alteração na farmacocinética dos medicamentos. Para interações envolvendo medicamentos e dietas enterais, 58,3% dos fármacos não apresentavam interação, 25% não foram testados com dietas enterais e 16,7% foram considerados contraindicados. Em relação às incompatibilidades medicamentosas, dos medicamentos solicitados, 52,8% foram compatíveis e 16,1%, incompatíveis. Conclusão: o CIM vem auxiliando na resolução de dúvidas, mas a indisponibilidade de informações na literatura nem sempre permite uma prática segura e correta no momento da administração dos medicamentos.Background: based on research of the literature, the Drug Information Center is aimed at identifying possible drug interactions that may harm patients. Aim: to describe the profile of drug interactions identified by the Drug Information Centre according to the information requested by the staff of a university hospital. Method: a descriptive study was conducted from January 2009 to May 2011. We reviewed the requests related to interactions of drug vs. drug, drug vs. food, and enteral tube and drug incompatibilities. In relation to the information requests, we also investigated the availability of information in the literature and the instructions provided to the requester. Results: among the requests involving 55 drugs, there were 19 drug interactions. Most of them were moderate (61%) and had late effect (50%). Among the drug vs. food interactions (n=15), 26.7% showed changes in the pharmacokinetics of drugs. In terms of interactions involving drugs and enteral feeding, 58.3% of the drugs did not show any interactions, 25% were not tested with enteral feeding, and 16.7% were considered contraindicated. With regard to drug incompatibility, 52.8% of the requests were compatible and 16.1% were incompatible. Conclusion: the Drug Information Center has been useful to assist in the resolution of doubts, but the unavailability of information in the literature not always enables a correct and safe practice of drug administration

Centro de Informações sobre Medicamentos – Avaliação das Informações Passivas em Hospital Universitário no Sul do Brasil

O objetivo deste trabalho foi descrever as atividades passivas realizadas por um Centro de Informações sobre Medicamentos (CIM) de hospital universitário no sul do Brasil. De 2002 a 2008, o total de solicitações recebidas foi de 8035, das quais 30,3% foram realizadas por enfermeiros, 24,3% por farmacêuticos e 15% por técnicos de enfermagem. O tempo gasto para a resposta foi em 56,8% em até 10 minutos. Os temas mais solicitados foram administração de medicamentos (25,6%), identificação do produto (16,4%), posologia (10,6%) e estabilidade (9,6%). O CIM é uma estratégia na busca pelo uso seguro e racional de medicamentos nos hospitais