Indications for use of vitamin k and identification of adverse reactions to oral anticoagulant therapy in hospitalized patients : a descriptive study

Vitamin K is a substance found at low concentrations in the human body, where it plays important roles in coagulation and calcium retention. The objective was to identify indications for use of vitamin K in a sample of hospitalized patients. In this descriptive, case-finding study, inpatients prescribed vitamin K during their hospital stays were assessed to identify the indications for vitamin K administration (thrombocytopenia due to oral anticoagulation or other drugs, vitamin K deficiency, or dietary deficiency). Patients from the Emergency Department and neonates were excluded. Overall, 161 cases were followed. In 73.3% of cases, the indication for vitamin K use was thrombocytopenia due to vitamin K deficiency. Seven patients (4.4%) had INRs outside the target range; of these, four (57%) developed bleeding, which was identified as an ADR. In the majority of patients given vitamin K, the indication was vitamin K deficiency

Profile of drug interactions in hospitalized children

Introduction: The expected therapeutic response may be affected by the presence of drug interactions. With the high number of reports on new drug interactions, it has been difficult for health professionals to keep constantly updated. For this reason, computer systems have helped identify such interactions. Objectives: To verify the rate and profile of drug interactions in medical prescriptions to hospitalized pediatric patients. Methods: A descriptive study investigated prescriptions to hospitalized pediatric patients. The study included patients between 0 and 12 years old, containing 4 or more drugs in their prescriptions. The analysis of interaction and incompatibility possibilities in prescribed drugs used Micromedex / Drug-Reax® program. Results: From 2005 to 2006, 3,170 patients were investigated, and 11,181 prescriptions were analyzed, a mean value of 3.5 prescriptions/patient. In total, 6,857 drug interactions were found, which corresponds to 1.9 interaction/prescription. Among them, relevance to ampicillin and gentamicin, found in 220 (3.2%) prescriptions. In total, 2,411 drug incompatibilities in via y were found, a mean value of 0.5/prescription, with emphasis on vancomycin and cefepime, found in 243 (10.0%) prescriptions. Conclusion: The presence of drug interactions is a permanent risk in hospitals. This way, the utilization of computer programs, pharmacotherapy monitoring of patients and the pharmacist presence in the multidisciplinary team are some manners of contributing to hospitalized patients’ treatment.Introducción: La respuesta terapéutica esperada puede modificarse por la presencia de interacciones medicamentosas. Con el elevado número de comunicaciones de nuevas interacciones medicamentosas, ha sido difícil para los profesionales de la salud mantenerse constantemente actualizados. Por este motivo, los ordenadores han ayudado a identificar estas interacciones. Objetivos: Verificar la tasa y el perfil de las interacciones medicamentosas en las prescripciones médicas a pacientes pediátricos hospitalizados. Métodos: Un estudio descriptivo investigó las prescripciones a pacientes pediátricos hospitalizados. El estudio incluyó pacientes entre 0 y 12 años, que tenían 4 o más medicamentos en sus prescripciones. El análisis de las interacciones y las incompatibilidades posibles en los medicamentos prescritos utilizó el programa Micromedex / Drug- Reax®. Resultados: De 2005 a 2006, se investigó a 3.170 pacientes y se analizaron 11.181 prescripciones con una media de 3,5 recetas/paciente. En total se encontraron 6.857 interacciones medicamentosas, que corresponden a 1,9 interacciones/prescripción. Entre ellas, se encontró relación a ampicilina y gentamicina en 220 (3,2%). En total, se encontraron 2.411 incompatibilidades de vía, con una media de 0,5 por prescripción, con énfasis en vancomicina y cefepime, encontradas en 243 (10,0%). Conclusión: La presencia de interacciones medicamentosas es un riesgo permanente en hospitales. Así que, la utilización de un programa informático, el seguimiento farmacoterapéutico de los pacientes y la presencia de un farmacéutico en el equipo multidisciplinario son algunas de las maneras de mejorar el tratamiento de los pacientes hospitalizados

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

Lean Healthcare applied toward turning a Pharmacy Service Patient Centered

Pharmaceutical service optimization requires a comprehensive understanding of resource usage. The aim of the study is to analyze how Lean Healthcare principles can contribute toward turning a pharmacy service patient-centered and value oriented. Understand how clinical pharmacists’ resources are effectively used by patients in an academic hospital using lean tools, such as value stream mapping and activity designation matrix, determine the amount of time each professional is involved in specific activities, and identify activities that add value. The data were mainly obtained through interviews with professionals, time-motion observational studies, chronoanalysis and meetings with the head of the unit. A process flow map is designed for clinical pharmacy services, and it considers the relationship between the activities and their added value base. An exploration of the map shows that the activity “clinical rounds” is the most time consuming (27%) and not necessarily considered value-added by both parties (pharmacists staff and head of service). It is notable the opportunity the service has to prioritize the high-risk patients and to make a good time management; furthermore, activities that are of high value to patients are being performed and monitored by interns. The role of pharmacists should evolve from now on to be congruent with the new realities of healthcare. When value is questioned, we are encouraged to reflect on the activities engaged in by professional pharmacists in a clinical/surgical unit of a hospital. Through these tools, we could infer how the system is engaged and how it can be transformed toward added value.Introduction. Pharmaceutical service optimization requires a comprehensive understanding of resource usage. The aim of the study is to analyze how Lean Healthcare principles can contribute toward turning a pharmacy service patient-centered and value oriented. Methods. Understand how clinical pharmacists’ resources are effectively used by patients in an academic hospital using lean tools, such as value stream mapping and activity designation matrix, determine the amount of time each professional is involved in specific activities, and identify activities that add value. The data were mainly obtained through interviews with professionals, time-motion observational studies, chronoanalysis and meetings with the head of the unit. Results. A process flow map is designed for clinical pharmacy services, and it considers the relationship between the activities and their added value base. An exploration of the map shows that the activity “clinical rounds” is the most time consuming (27%) and not necessarily considered value-added by both parties (pharmacists staff and head of service). It is notable the opportunity the service has to prioritize the high-risk patients and to make a good time management; furthermore, activities that are of high value to patients are being performed and monitored by interns. Conclusions. The role of pharmacists should evolve from now on to be congruent with the new realities of healthcare. When value is questioned, we are encouraged to reflect on the activities engaged in by professional pharmacists in a clinical/surgical unit of a hospital. Through these tools, we could infer how the system is engaged and how it can be transformed toward added value

Analysis of pharmaceutical interventions using a pharmaceutical monitoring instrument in a Pediatric Intensive Care Unit

Introdução: A pediatria apresenta um cenário bastante específico devido ao uso de medicamentos off-label e carência de estudos científicos direcionados à utilização de medicamentos por essa população. Assim, o farmacêutico clínico pode contribuir na identificação e prevenção de problemas relacionados a medicamentos. Métodos: Estudo de coorte retrospectivo realizado em uma unidade de terapia intensiva pediátrica de um hospital universitário do Rio Grande do Sul. Foram analisadas as intervenções farmacêuticas realizadas entre março de 2016 a julho de 2018 por farmacêuticos clínicos. Tais intervenções foram reclassificadas conforme os critérios de um instrumento de acompanhamento farmacêutico (bundle) utilizado na rotina. Foi realizada análise estatística descritiva das variáveis estudadas. Resultados: Das 582 intervenções farmacêuticas analisadas, as categorias mais prevalentes foram dose (n = 97; 16,7%), necessidade (n = 92; 15,8%) e forma farmacêutica (n = 56; 9,6%). Após reclassificação das intervenções farmacêuticas utilizando o bundle, os critérios mais prevalentes foram: critério 1 (revisão da farmacoterapia; n = 285; 49%), critério 4 (analgesia; n = 78; 13,4%) e critério 10 (antimicrobianos; n = 65; 11,2%). As classes de medicamentos mais frequentes foram os do sistema nervoso (n = 213; 36,6%) e os anti-infecciosos gerais para uso sistêmico (n = 115; 19,8%). A taxa de adesão das intervenções farmacêuticas pela equipe médica foi de 85,1%. Conclusão: A classificação das intervenções farmacêuticas utilizando o bundle pode contribuir no aperfeiçoamento do instrumento tornando-o mais viável para uso na unidade de terapia intensiva pediátrica e direcionar o trabalho do farmacêutico clínico nas situações que geram mais problemas relacionados a medicamentos.Introduction: Pharmaceutical interventions in the pediatric setting are highly peculiar due to the use of off-label drugs associated with the lack of scientific studies on the use of drug therapies in this population. Thus, clinical pharmacists may help identify and prevent drug-related problems. Methods: We conducted a retrospective cohort study in the pediatric intensive care unit of a teaching hospital in Rio Grande do Sul, Brazil. Pharmaceutical interventions conducted between March 2016 and July 2018 were analyzed by clinical pharmacists. These interventions were reclassified according to the criteria of a routine pharmaceutical monitoring instrument (care bundle). We conducted a descriptive statistical analysis of study variables. Results: Of 582 pharmaceutical interventions analyzed, the most prevalent categories were dose adjustment (n = 97; 16.7%), need for drug therapy (n = 92; 15.8%), and dosage forms (n = 56; 9.6%). After reclassification of pharmaceutical interventions, the most prevalent criteria were criterion 1 (review of drug therapy; n = 285; 49%), criterion 4 (analgesia; n = 78; 13.4%), and criterion 10 (antimicrobials; n = 65; 11.2%). The most common drug classes were nervous system agents (n = 213; 36.6%) and anti-infectives for systemic use (n = 115; 19.8%). The rate of adherence to pharmaceutical interventions by the medical team was 85.1%. Conclusions: The classification of pharmaceutical interventions according to the pharmaceutical care bundle may help improve the instrument, allowing its use in the pediatric intensive care unit and guiding clinical pharmacists in situations causing drug-related problems