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Esteban-Cartelle B, Serrano DR, Pérez Menéndez-Conde C, Vicente-Oliveros N, Álvarez-Díaz A, Abete JF, Martín-Dávila P. Stability of meropenem in portable elastomeric infusion devices: which protocol should be implemented in clinical practice? Microbiol Spectr 2024; 12:e0206323. [PMID: 38230930 PMCID: PMC10846201 DOI: 10.1128/spectrum.02063-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/01/2023] [Indexed: 01/18/2024] Open
Abstract
Meropenem has an excellent activity against gram-positive and gram-negative bacteria, including multi-resistant microorganisms. Even though meropenem is a great candidate for outpatient parenteral antimicrobial therapy (OPAT), its physicochemical stability is a major challenge. This work aimed to demonstrate the suitability of including meropenem in OPAT by elucidating its physicochemical stability in a range of commonly prescribed concentrations within portable elastomeric infusion devices. Physical and chemical stability were evaluated at two concentrations commonly used in clinical practice (2 and 25 mg/mL), and three temperatures (2°C-8°C, 25°C, and 32°C) using Accufuser portable elastomeric infusion devices. Drug adsorption onto portable elastomeric infusion devices was also determined at the end of the experiment. Meropenem stability significantly decreased at higher temperatures and when higher drug solution concentrations were used. Meropenem solutions at 2 mg/mL kept the drug content above 95% over 24 h at 2°C-8°C but just for 8 h at 25°C. Nevertheless, solutions containing 25 mg/mL of meropenem showed a dramatic decrease in chemical stability after 8 h 2°C-8°C and just after 4 h at 25°C or 32°C. However, physical stability was kept favorable during this period. The drug adsorption on the material of the elastomeric infusion device was below 1%, indicating the suitability of the chosen device. We propose several administration protocols for meropenem in portable elastomeric infusion devices in clinical practice, according to the results obtained in our study. The results obtained in this study open up the possibility of administering meropenem in an OPAT setting despite its short stability.IMPORTANCEAlthough outpatient parenteral antibiotic therapy can be a good approach to treating infections, a lack of data regarding antibiotic stability in portable elastomeric infusion devices restricts its safe and effective use. Actually, meropenem is used for prolonged periods above 24 h, and it is not physicochemically stable, which can compromise efficacy and toxicity. This work is of high importance to show the clinicians the real shelf life of meropenem when administered in portable elastomeric infusion devices. We propose several administration protocols for meropenem in portable elastomeric infusion devices in clinical practice, according to the stability drug results obtained in our study.
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Affiliation(s)
- Beatriz Esteban-Cartelle
- Department of Pharmaceutics and Food Technology, School of Pharmacy, Complutense University of Madrid, Madrid, Spain
- Pharmacy Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain
| | - Dolores R. Serrano
- Department of Pharmaceutics and Food Technology, School of Pharmacy, Complutense University of Madrid, Madrid, Spain
| | | | | | - Ana Álvarez-Díaz
- Pharmacy Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain
| | - Jesús Fortún Abete
- Service of Infectious Diseases, Ramón y Cajal Hospital, IRYCIS, CIBERINFEC, Madrid, Spain
| | - Pilar Martín-Dávila
- Service of Infectious Diseases, Ramón y Cajal Hospital, IRYCIS, CIBERINFEC, Madrid, Spain
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Esteban-Cartelle B, Serrano DR, Pérez Menéndez-Conde C, Vicente-Oliveros N, Álvarez-Díaz A, Fortún Abete J, Martín-Dávila P. Stability of meropenem in portable elastomeric infusion devices: which protocol should be implemented in clinical practice? Microbiol Spectr 2024; 12:e0206423. [PMID: 38088799 PMCID: PMC10782984 DOI: 10.1128/spectrum.02064-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/16/2023] [Indexed: 01/13/2024] Open
Abstract
IMPORTANCE Although outpatient parenteral antibiotic therapy can be a good approach to treating infections, a lack of data regarding antibiotic stability in portable elastomeric infusion devices restricts its safe and effective use. Actually, meropenem is used for prolonged periods above 24 h, and it is not physicochemically stable, which can compromise efficacy and toxicity. This work is of high importance to show the clinicians the real shelf life of meropenem when administered in portable elastomeric infusion devices. We propose several administration protocols for meropenem in portable elastomeric infusion devices in clinical practice, according to the stability drug results obtained in our study.
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Affiliation(s)
- Beatriz Esteban-Cartelle
- Department of Pharmaceutics and Food Technology, School of Pharmacy, Complutense University of Madrid, Madrid, Spain
- Pharmacy Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain
| | - Dolores R. Serrano
- Department of Pharmaceutics and Food Technology, School of Pharmacy, Complutense University of Madrid, Madrid, Spain
| | | | | | - Ana Álvarez-Díaz
- Pharmacy Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain
| | - Jesús Fortún Abete
- Service of Infectious Diseases, Ramón y Cajal Hospital, IRYCIS, CIBERINF (Centro de Investigación Biomédica en Red de Enfermedades Infecciosas), Madrid, Insituto de Salud Carlos III, Spain
| | - Pilar Martín-Dávila
- Service of Infectious Diseases, Ramón y Cajal Hospital, IRYCIS, CIBERINF (Centro de Investigación Biomédica en Red de Enfermedades Infecciosas), Madrid, Insituto de Salud Carlos III, Spain
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Vélez-Díaz-Pallarés M, Delgado-Silveira E, Fernández-Fradejas J, Montero-Llorente B, Palomar-Fernández C, Montero-Errasquín B, Cruz-Jentoft AJ, Álvarez-Díaz A. Potentially Inappropriate Prescribing in Older People Living With HIV: A Scoping Review. J Acquir Immune Defic Syndr 2023; 94:445-460. [PMID: 37851956 DOI: 10.1097/qai.0000000000003298] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/21/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Antiretroviral therapy has transformed HIV from a progressive and often fatal infection to a chronic disease. Currently, people living with HIV (PLHIV) have near-normal life expectancy; however, they face accelerated ageing and a rise in non-AIDS-defining HIV-associated conditions. Comorbidities increase the number of prescribed drugs and, therefore, the risk of polypharmacy and prescribing potentially inappropriate medications (PIMs). Still, there are no specific tools to identify PIMs in older PLHIV, which opens a pathway to investigate the particularities in the prescription of medication in this population. METHODS We conducted a scoping review in 5 electronic databases for studies reporting the use of tools to identify PIMs in older PLHIV. No language or date restrictions were applied. To complete the search, abstracts published in the most relevant HIV Conferences and Events in their editions from 2010 to 2022 were screened. RESULTS Of 50,193 records returned (13,701 of the databases and 36,492 of the Congresses), 39 studies met the inclusion criteria. Most studies were single-centre and conducted in Europe. Twenty-eight studies were cross-sectional, and most researchers used explicit criteria, mainly Beers and STOPP-START criteria, to identify PIMs. CONCLUSIONS Potentially inappropriate prescribing is frequent among older PLHIV. Explicit conventional tools to identify PIMs in older populations may need to be adapted to tackle the needs of PLHIV. Implicit tools may be more valid, although their use is more time-consuming, and standardization is complex.
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Affiliation(s)
| | - Eva Delgado-Silveira
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal, IRYCIS. Madrid, Spain; and
| | | | | | | | | | | | - Ana Álvarez-Díaz
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal, IRYCIS. Madrid, Spain; and
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Artiles-Medina A, Sáchez-Cuervo M, Gómez-Dos Santos V, Sanz-Álvarez EJ, Álvarez-Díaz A, Burgos-Revilla FJ. Medicines in exceptional circumstances for solid tumours: focusing on evidence, effectiveness, and toxicity profiles. Farm Hosp 2022; 46:133-145. [PMID: 36183206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE To analyse the applications for drugs in special situations (compassionate use, off-label use and foreign drugs) for solid tumours, and to assess the level of evidence supporting these applications, as well as the effectiveness and safety of most frequent drugs. METHOD We performed a cross-sectional study of all applications for drugs in special situations during 2018 and 2019 in a representative third-level centre. We collected data about generic names of drugs, clinical indications, and level of evidence provided on the application form. Furthermore, tumour response was assessed according to the Response Evaluation Criteria in Solid Tumours version 1.1., Progression Free Survival and Overall Survival. Safety was evaluated with the National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0. RESULTS 2,273 drugs in special situations were approved between January 2018 and December 2019. In 431 cases (19%), they were used to treat solid tumours. Out of 431, 291 (67.5%) applications were offlabel drugs, 76 (18%) foreign drugs, and 64 (15%) were compassionate use of drugs. Most of them were supported by phase 3 (47%) or phase 2 (33%) clinical trials. The majority of adverse effects were grade 1 and only in 6/67 cases the treatment was discontinued due to toxicity. CONCLUSIONS A significant number of drugs in special situations are prescribed to Oncology patients. The majority of applications of these drugs was supported by clinical trials. The real-life experience showed an effectiveness and tolerance profile similar to those described in randomised clinical trials.
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Affiliation(s)
- Alberto Artiles-Medina
- Department of Urology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Alcalá University, Madrid. Spain..
| | - Marina Sáchez-Cuervo
- Department of Hospital Pharmacy, Hospital Universitario Ramón y Cajal, Madrid. Spain..
| | - Victoria Gómez-Dos Santos
- Department of Urology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Alcalá University, Madrid. Spain..
| | - Emilio J Sanz-Álvarez
- Department of Pharmacology, Universidad de La Laguna, Santa Cruz de Tenerife. Department of Clinical Pharmacology, Hospital Universitario de Canarias, Santa Cruz de Tenerife. Spain..
| | - Ana Álvarez-Díaz
- Department of Hospital Pharmacy, Hospital Universitario Ramón y Cajal, Madrid. Spain..
| | - Francisco Javier Burgos-Revilla
- Department of Urology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Alcalá University, Madrid. Spain..
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Esteban-Cartelle B, Vicente-Oliveros N, Menéndez-Conde CP, Serrano DR, Martín-Dávila P, Fortún-Abete J, León-Gil LA, Álvarez-Díaz A. Antibiotic stability in portable elastomeric infusion devices: A systematic review. Am J Health Syst Pharm 2022; 79:1355-1368. [PMID: 35511829 DOI: 10.1093/ajhp/zxac122] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE Although outpatient parenteral antibiotic therapy (OPAT) can be a good approach to treatment of infections, a lack of data regarding antibiotic stability in portable elastomeric infusion devices restricts its safe, appropriate, and effective use. The objective of this work was to complete a systematic peer-reviewed analysis of published articles about antibiotic stability in elastomeric infusion devices that provide evidence supporting their use in OPAT. SUMMARY A systematic review following PRISMA guidelines was conducted in January 2021 to identify published articles about antibiotic stability in portable elastomeric infusion devices. The databases used were PubMed, Embase, Web of Science, and a Cochrane database. A total of 1,615 original studies and conference communications were found. After title, abstract, and full-text review, 33 articles met the inclusion criteria. The data obtained included information about the stability of 30 different antibiotics. To our knowledge, this is the first review to summarize the available published data on the stability of antibiotics in portable elastomeric infusion devices. The results highlight the poor stability of some antibiotics in solution and the variability of the laboratory conditions in the included studies. CONCLUSION This systematic review can serve as a useful resource for healthcare professionals involved in providing OPAT using portable elastomeric infusion devices. However, further stability studies should be performed, especially high-quality studies simulating real-life time and temperature conditions.
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Affiliation(s)
- Beatriz Esteban-Cartelle
- Ramón y Cajal University Hospital, Madrid, Spain, and Department of Pharmaceutics and Food Technology, School of Pharmacy, Complutense University of Madrid, Madrid, Spain
| | | | | | - Dolores R Serrano
- Department of Pharmaceutics and Food Technology, School of Pharmacy, Complutense University of Madrid, Madrid, Spain
| | - Pilar Martín-Dávila
- Service of Infectious Diseases, Ramón y Cajal University Hospital, Madrid, Spain
| | - Jesús Fortún-Abete
- Service of Infectious Diseases, Ramón y Cajal University Hospital, Madrid, Spain
| | | | - Ana Álvarez-Díaz
- Pharmacy Department, Ramón y Cajal University Hospital, Madrid, Spain
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Vélez-Díaz-Pallarés M, Beatriz ML, Parro-Martín MÁ, Martínez-Barros H, Maíz L, Nieto R, Gómez-Lozano A, Menacho-Román M, Álvarez-Díaz A. Safety and tolerability of inhaled antibiotics in patients with bronchiectasis. Pulm Pharmacol Ther 2022; 72:102110. [PMID: 35032638 DOI: 10.1016/j.pupt.2022.102110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/28/2021] [Accepted: 01/09/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Bronchiectasis is typically treated with inhaled antibiotics in clinical practice. However, there is a striking lack of standardised procedures for the preparation of noncommercial solutions. We used biochemical parameters to analyse the safety and tolerability of inhaled antibiotics in patients with bronchiectasis, and determined potential associations between the inhaled antibiotics used and adherence to the medications and quality of life. METHODS We conducted a literature review, biochemical testing, and a pilot study of patients admitted to our hospital with noncystic fibrosis bronchiectasis. The MEDLINE database was searched for studies involving inhaled antibiotics to treat bronchiectasis. We analysed the pH, osmolality, and sodium and chloride ion concentrations of the antibiotics used. The pilot study included patients receiving inhaled antibiotic treatment. Demographic data, adherence, and quality of life were recorded and assessed. We determined potential associations between the study variables. RESULTS The literature review identified 429 articles: 106 included precise instructions for diluting antibiotics, and 18 reported data on the biochemical parameters analysed. Laboratory results showed that some antibiotic dilutions were outside the range of tolerability, especially those involving dry powders for intravenous infusion, which must be diluted for their inhalation. Adherence was good in more than 80% of the patients, and higher in men and older patients. Men reported better quality of life. No associations were found between the antibiotics used and the other variables. CONCLUSION Regarding the biochemical parameters analysed, there is a lack of information on the tolerability and biochemical safety of noncommercial dilutions of inhaled antibiotics used to treat bronchiectasis.
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Affiliation(s)
- Manuel Vélez-Díaz-Pallarés
- Pharmacy Department, Hospital Universitario Ramón y Cajal, Carretera de Colmenar Km 9,1, 28034, Madrid, Spain.
| | - Montero-Llorente Beatriz
- Pharmacy Department, Hospital Universitario Ramón y Cajal, Carretera de Colmenar Km 9,1, 28034, Madrid, Spain
| | - María Ángeles Parro-Martín
- Pharmacy Department, Hospital Universitario Ramón y Cajal, Carretera de Colmenar Km 9,1, 28034, Madrid, Spain
| | - Hilario Martínez-Barros
- Pharmacy Department, Hospital Universitario Ramón y Cajal, Carretera de Colmenar Km 9,1, 28034, Madrid, Spain
| | - Luís Maíz
- Pneumology Department, Hospital Universitario Ramón y Cajal, Carretera de Colmenar Km 9,1, 28034, Madrid, Spain
| | - Rosa Nieto
- Pneumology Department, Hospital Universitario Ramón y Cajal, Carretera de Colmenar Km 9,1, 28034, Madrid, Spain
| | - Ana Gómez-Lozano
- Biochemistry Department, Hospital Universitario Ramón y Cajal, Carretera de Colmenar Km 9,1, 28034, Madrid, Spain
| | - Miriam Menacho-Román
- Biochemistry Department, Hospital Universitario Ramón y Cajal, Carretera de Colmenar Km 9,1, 28034, Madrid, Spain
| | - Ana Álvarez-Díaz
- Pharmacy Department, Hospital Universitario Ramón y Cajal, Carretera de Colmenar Km 9,1, 28034, Madrid, Spain
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Morillo-Verdugo R, Álvarez-Díaz A, Gorgas-Torner MQ, Poveda-Andrés JL, Mugarza-Borque F, Díaz-Olmo J. Patient and health practitioner perceptions about the role of hospital pharmacists along the care continuum: the Fharmaconectados Project. Farm Hosp 2021; 45:268-276. [PMID: 34806588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVE To determine the perception of patients and practitioners regarding the role of the hospital pharmacist along the care continuum. METHOD This was a multicenter cross-sectional observational analytical study, carried out in two phases between 15 October and 31 December 2020. In the first phase, a literature search was carried out to identify specific questionnaires that measured the overall satisfaction of patients in relation to the work of hospital pharmacists. Subsequently, a specific consensus-based questionnaire was developed, structured into three areas: care, relationships, and capacity-building and training. The study included patients treated in the participating centers and served by patient associations. They had to be older than 18 years, present with a chronic condition, and be treated with medication for hospital use. In the second phase, a qualitative study was carried out using focus group discussions to analyze how hospital pharmacists are perceived and how they would like to be recognized by patients. Four meetings were held in different territories of Spain. Previously, the research team agreed on the questions to be asked, which were grouped into four sections: healthcare, relational, training and information. RESULTS A total of 482 surveys were obtained. The percentage of patients who expressed a positive view of the role of the hospital pharmacist was 88.0% (n = 424). In the multivariate analysis, the most positive opinions about these professionals were expressed by women and by patients who had received previous care in the hospital, those who had a high opinion of the coordination of these professionals with the rest of the care team, and those who had received the greatest amount of emotional support. Integration of the pharmacist with the healthcare team was found to vary across different hospitals and the hospitals' public image we seen to be related to the way they were pharmacoeconomically managed. In the sections related to capacity-building and training and challenges for the future, respondents emphasized the need to promote the introduction of new patient monitoring technologies. CONCLUSIONS Patients have a good opinion of the service provided by hospital pharmacists, although many are unaware of the significance of their role.
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Affiliation(s)
- Ramón Morillo-Verdugo
- Hospital Pharmacy Department, Hospital Universitario de Valme, AGS Sur de Sevilla, Sevilla. Spain.
| | - Ana Álvarez-Díaz
- Pharmacy Department, Hospital Universitario Ramón y Cajal, Madrid. Spain.
| | | | - José Luis Poveda-Andrés
- Hospital Pharmacy Department, Área Clínica del Medicamento, Hospital Universitari i Politècnic La Fe, Departament de Salut Valencia La Fe, Valencia. Spain.
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Herranz-Alonso A, Rodríguez-González CG, Sarobe-González C, Álvarez-Díaz A, Sanjurjo-Sáez M. Pharmacy Department management and organization. Farm Hosp 2020; 44:5-10. [PMID: 32533661 DOI: 10.7399/fh.11514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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".
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Affiliation(s)
- Ana Herranz-Alonso
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid. España.
| | | | | | - Ana Álvarez-Díaz
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid. España.
| | - María Sanjurjo-Sáez
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid. España.
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Abstract
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.
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Affiliation(s)
| | - Ana Álvarez-Díaz
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal, Madrid. España.
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10
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Vélez-Díaz-Pallarés M, Vicente-Oliveros N, Delgado-Silveira E, Pérez-Menéndez-Conde C, Álvarez-Díaz A, Bermejo-Vicedo T. [Effect of modal computer-based alerts on the prescription of valproic acid and meropenem]. ACTA ACUST UNITED AC 2013; 29:17-21. [PMID: 24120078 DOI: 10.1016/j.cali.2013.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/24/2013] [Accepted: 07/10/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyze the effect of modal computer-based alerts on the concomitant prescription of valproic acid (VPA) and meropenem. MATERIAL AND METHOD Analytical intervention study conducted in a tertiary hospital for eleven months. Hospitalized patients with a diagnosis of epilepsy and treated with VPA and meropenem in concomitant therapy were included. In the computerized prescription order entry software an automatic non-modal alert was reconverted to a modal one. This was triggered when the physician introduced VPA and meropenem together in the same prescription. To measure the effect of this alert the prescription habits were compared with a previous period in which the alert was not modal. RESULTS Modal computer-based alert modified the prescription habit by reducing the number of patients with concomitant treatment from 13 to 4 (P=.046). However, it was notable that the number of requests for VPA serum levels decreased, and the average number of concomitant days of treatment rose from 4.7 to 8.75 in those patients in which none of the drugs was suspended. CONCLUSIONS The implementation of modal computer-based alerts reduces patient exposure to concomitant treatment with meropenem and VPA.
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Affiliation(s)
| | - N Vicente-Oliveros
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal, Madrid, España
| | - E Delgado-Silveira
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - A Álvarez-Díaz
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal, Madrid, España
| | - T Bermejo-Vicedo
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal, Madrid, España
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