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To assess the usefulness of establishing a routine gravimetric as quality assurance after the development of parenteral nutrition (PN) with a gravimetric error less than ± 5%.Prospective study in which 5 to 8 large volume PN were weighed daily during 2 months and for 4 months all small volume PN, considering this the real weight. The theoretical weight was calculated taking into account the densities, volumes of all products used in processing and the weight of the bags used. The gravimetric error was calculated as a percentage compared to the theoretical weight.168 large volume PN and 42 small volume were weighed, gravimetric errors measures were 1.42% (SD=1.31) and 1.26% (SD=0.64), with a gravimetric error less than 5% in 98,8% and 100% respectively.Establishing a routine gravimetric control is an useful strategy that can help to guarantee the quality of the PN development.

Background In April 2015, a national project was created to reduce the rate of patients with nosocomial infections by multiresistant bacterias (MRBs). This project had several recommendations, including ones for improving the use of antibiotics, especially against MRBs. Purpose To analyse the impact of the project on the consumption of antibiotics in our intensive care unit (ICU) during the first months after initiation of the project; and also to assess its economic impact and the number of patients colonised/infected by multiresistant Acinetobacter baumannii (MAB), the most important MRB in our ICU. Material and methods Retrospective, observational study to compare two periods of time (April–September 2015 vs April–September 2014). The number of defined daily dose per 100 admissions (DDD/100A) was used to evaluate consumption of the following antibiotics: glycopeptides, linezolid, daptomycin, tigecycline, colistin and carbapenems. The average cost of these drugs was used to do the economic assessment; we did not considerate either the indirect costs or the possible variation in the number of admissions between the two periods. We supposed that infected/colonised patients by MAB were those that had a positive microbiological test for Acinetobarter baummanni that was resistant to three or more families of antibiotics, including carbapenems. Results Overall antimicrobial consumption was reduced by 45.4% (56.3 vs 30.7 DDD/100A) and costs decreased by 32,9% (42783€ vs 28685€). All studied antibiotics reduced their consumption: 55% for carbapenems (20 vs 9 DDD/100A), 7.4% for linezolid (2.7 vs 2.5 DDD/100A), 56.5% for daptomycin (2.3 vs 1 DDD/100A), 50% for tigecycline (1.8 vs 0.9 DDD/100A) and 48.1 for colistin (16.2 vs 8.4 DDD/100A). There were the same numbers of patients (n = 13) with infection/colonisation with MAB in both studied periods. Conclusion Avoiding the use of unnecessary broad spectrum antibiotics and/or a shorter treatment period could reduce the selective pressure and number of MRBs. In addition, this also could lead to an important saving. Implementation of the project has reduced the use of all studied antibiotics for the treatment of MRBs, but no significant differences were found in the number of patients infected/colonised by MAB. This could be because more time is needed to detect this difference. No conflict of interest.

Background The increase in drug spending and the decrease in resources make it necessary to look for strategies for minimising costs. Purpose To describe the strategy for administering high-consumption intravenous drugs (IVd) directly and estimating the associated resources saved in an Intensive Care Unit (ICU). Materials and Methods We obtained a list of drugs whose consumption in the ICU was more than 1,000 units/year. After a literature review, we selected those that could be safely administered via IVd but are usually administered in intermittent intravenous infusion. We prepared a table containing instructions for their reconstitution and administration. For four weeks two nurses administered the medicines that had been prescribed and were included in the table via IVd, recording: drug, time spent in preparation & administration and adverse reactions related to the route of administration. After collecting data We estimated the direct cost savings in fluids if all drugs consumed by the unit and included in the table had been administered by IVd during 2010. We compared the time spent on the preparation and administration of drug doses used in routine practise versus time used to implement this strategy. Results The ICU used more than 1,000 units/year of each of 39 intravenous drugs, of which 12 were included in the table: metoclopramide, colistimethate, hydrocortisone, phytonadione, pantoprazole, amoxicillin/clavulanic acid, dexamethasone, piperacillin/tazobactam, furosemide, methylprednisolone, meropenem and ranitidine. The nurses made 117 administrations via IVd (following the usual procedure) of these drugs. The average time was 6.5 minutes for preparation and administration of each dose and no adverse reactions were detected related to the route of administration. We estimate the ICU can save 28,000€/year. Conclusions Direct IV administration can be safe and efficient. The extension of a programme of this type throughout the Hospital could increase efficiency and rational use of medicines significantly. No conflict of interest.