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Resumen Objetivo Evaluar la incorporacion de un farmaceutico de hospital a la actividad habitual de una unidad de cuidados intensivos (UCI). Diseno Estudio observacional prospectivo para evaluar las intervenciones farmaceuticas, realizadas por un farmaceutico adscrito temporalmente a una UCI, sobre las prescripciones medicas. Ambito UCI medico-quirurgica con 21 camas. Pacientes Se incluyeron los pacientes con al menos una estancia en UCI y se excluyeron los pacientes con ingreso y alta en periodos en los que no se conto con la presencia fisica del farmaceutico. Intervenciones Se realizaban tras la revision diaria de las prescripciones y se comunicaban de forma verbal o escrita al medico responsable. Variables principales Intervenciones realizadas, grupo terapeutico de los medicamentos implicados, forma de realizacion de la intervencion y el grado de aceptacion. Resultados Se realizaron 194 intervenciones en 62 pacientes. La mayoria estaban relacionadas con aspectos de seguridad (33%) y optimizacion de la terapia (32%). Las mas frecuentes se dirigieron a la administracion de medicamentos por sonda nasogastrica (19%) y a la monitorizacion farmacocinetica (14,4%). Los grupos de medicamentos mas implicados fueron los antiinfecciosos en un 33% de los casos y los del aparato digestivo en un 27%. El 56,2% de las intervenciones se realizaron verbalmente y el 80% fueron aceptadas. Conclusiones La adscripcion de un farmaceutico a una UCI y la realizacion de intervenciones sobre las prescripciones han permitido mejorar la seguridad y optimizar la farmacoterapia en mas de la mitad de los pacientes. La alta tasa de aceptacion de las mismas apoyaria la implementacion de este tipo de programas en las unidades de criticos.

Objective To evaluate incorporation of the hospital pharmacist to the routine activity of an intensive care unit (ICU). Design A prospective observational study was carried out to evaluate the impact of pharmacist interventions, made by a pharmacist temporarily assigned to the ICU, upon medical prescriptions. Setting A medical and surgical ICU with 21 beds. Patients Patients with at least one ICU stay were included, while patients with admission and discharge in periods when the pharmacist was not present were excluded. Interventions The interventions were made after daily review of the prescriptions, and were communicated verbally or in writing to the supervising physician. Main variables Number of interventions, therapeutic group of the drugs involved, type of intervention and degree of acceptance. Results A total of 194 interventions were made in 62 patients. The majority were related to safety aspects (33%) and the optimization of therapy (32%). The most frequent interventions were the administration of drugs via the nasogastric tube (19%) and pharmacokinetic monitoring (14.4%). The most frequently involved groups of drugs were anti-infectious agents (33%) and digestive system medications (27%). A total of 56.2% of the interventions were made verbally, and 80% were accepted. Conclusions Pharmacist adscription to an ICU and the implementation of interventions on prescriptions have allowed improvement of safety and the optimization of pharmacotherapy in more than 50% of the patients. The high rate of acceptance of these interventions would support the implementation of such programs in critical care units.

To evaluate incorporation of the hospital pharmacist to the routine activity of an Intensive Care Unit (ICU).A prospective observational study was carried out to evaluate the impact of pharmacist interventions, made by a pharmacist temporarily assigned to the ICU, upon medical prescriptions.A medical and surgical ICU with 21 beds.Patients with at least one ICU stay were included, while patients with admission and discharge in periods when the pharmacist was not present were excluded.The interventions were made after daily review of the prescriptions, and were communicated verbally or in writing to the supervising physician.Number of interventions, therapeutic group of the drugs involved, type of intervention and degree of acceptance.A total of 194 interventions were made in 62 patients. The majority were related to safety aspects (33%) and the optimization of therapy (32%). The most frequent interventions were the administration of drugs via the nasogastric tube (19%) and pharmacokinetic monitoring (14.4%). The most frequently involved groups of drugs were anti-infectious agents (33%) and digestive system medications (27%). A total of 56.2% of the interventions were made verbally, and 80% were accepted.Pharmacist adscription to an ICU and the implementation of interventions on prescriptions have allowed improvement of safety and the optimization of pharmacotherapy in more than 50% of the patients. The high rate of acceptance of these interventions would support the implementation of such programs in critical care units.

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 Metformin is widely used against diabetes type II mellitus. Its most severe adverse effect is lactic acidosis. Although rare, the risk of its development can be increased by kidney failure (KF). Purpose To report on pharmaceutical interventions (PIs) for preventing metformin-associated lactic acidosis (MALA) in diabetics admitted to hospital with KF and to evaluate their degree of acceptance. Material and methods This prospective study (October 2013–March 2014) included all metformin-treated patients admitted. Creatinine clearance (CrCl) was estimated with the Cockcroft-Gault equation. PIs were: PI-1, stop-order for metformin when CrCl Results During the study period, 234 metformin-treated patients were admitted (61.5% males), most frequently to the Cardiology Department (33.3%); mean (standard deviation) age was 71.3 (12.4) yrs; mean dose was 1,552.8 (560.7) mg/day. CrCl Conclusion A small proportion of these patients had KF. A large majority of these required PI, most frequently PI-1. The degree of satisfaction was high and was especially elevated for PI-1 when CrCl was References and/or acknowledgements AEMPS No conflict of interest.

Background A carbapenem stewardship program was developed by a multidisciplinary team of specialists in Infectious Diseases, Critical Care, Pharmacy, Microbiology and Preventive Medicine. It expects to promote and improve the appropriate use of carbapenems. Purpose To analyse the stewardship recommendations regarding the use of carbapenems. Material and methods This prospective study lasted four months (May–August 2014) and was conducted in a tertiary hospital. The stewardship pharmacist selected patients who started carbapenem treatment, then a medical infections specialist recommended continuing or not with carbapenems, at the beginning and on the fifth and the tenth days of treatment, through oral and/or written communication with the prescriber. Resuscitation and paediatric patients were excluded. The variables analysed were: number and timing of interventions; type of recommendations and level of acceptance; cost (€) and defined daily dose (DDD) of carbapenems/100 stays of the period studied and compared with the same period last year; impact on other antimicrobials DDD/100 stays index. Results A total of 210 recommendations were made, of which 69% were at the beginning, 22% on the fifth day and 9% on the tenth day. The recommendations were: antibiotic de-escalation (42%), continuation (38%), suspension of carbapenem (15%) and change of regimen (5%). 89.3% of the recommendations were accepted. Cost and DDD/100 stays of carbapenems were reduced by 63% and 58% over the same period in 2013. Regarding other antimicrobials, we must highlight the increase of DDD/100 stays for cloxacillin (74.6%) and piperacillin/tazobactam (27.4%) over the same period in 2013. Conclusion The implementation of the carbapenem stewardship program has identified more than 60% of carbapenem prescriptions that could be improved. The high level of acceptance of recommendations has significantly reduced the use of carbapenems because many inappropriate treatments were suspended and the use of narrow-spectrum antimicrobials increased. In future analyses, the impact on the Hospital’s resistance profile should be considered. References and/or Acknowledgements 1 SEFH No conflict of interest.

Background In 2012, treatment protocols were agreed for the most common infections (pneumonia, urinary tract, bacteraemia and intra-abdominal catheter), approved by the relevant Committees and implemented in the Intensive Care Unit (ICU). Purpose This study aims to assess the impact on mortality, the financial situation and the profile of antimicrobial prescribing in the ICU before and after implementing the protocols. Material and methods Retrospective observational study comparing 2012 with 2013. The average cost of drugs was used for the financial assessment; we did not include associated indirect costs, nor the possible variation between the number of stays. The number of defined daily doses per 100 admissions (DDD/100 BD) was used to assess the prescription profile. DDD/Total 100 bed days were calculated, including all antimicrobials of the J01, J02 and J03 groups, and antimicrobials considered particularly relevant: carbapenems (imipenem and meropenem), linezolid, daptomycin, tigecycline and echinocandins (caspofungin and anidulafungin). Results The overall antimicrobial consumption was reduced by 17.3% (221.5 vs. 183.2 DDD/100 BD) and costs decreased by 23.9% (€257,476 vs. €195,891). The consumption of all antimicrobials studied reduced in 2013: 17.4% carbapenems (36.99 vs. 30.55 DDD/100 BD), linezolid 38.6% (3.76 vs. 2.31 DDD/100 BD), daptomycin 82.2% (2.86% vs. 0.51 DDD/100 BD), tigecycline 64.9% (4.98 vs. 1.75 DDD/100 BD) and echinocandins 13.8% (3.61 vs. 3 11 DDD/100 BD). ICU mortality was 12.8% in 2012 and 10.9% in 2013. Conclusion Antibiotic treatment protocols in the ICU have resulted in significant antibiotics savings, not only in financial terms but also in number of doses, without increasing mortality. This effect may be relevant to the need to optimise their use in order to prolong their useful life and reduce the selection of resistant organisms. In turn, protocols might be useful to reduce the variability of prescriptions. References and/or Acknowledgements 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.

Background Our 450-bed general hospital had a unit dose dispensing system in 100% of inpatient wards until July 2010, when an automated dispensing system (ADS) incorporating most of the medicines was introduced in the Large Burns Unit (LBU). Purpose To quantify the variation in drug expenses allocated per patient after introduction of an ADS in the LBU and to identify the products mainly affected by this change. Materials and Methods To quantify the variation in the expenses allocated, The authors compared two equal periods of four months, before the introduction of the ADS (September-December 2009) and four months after (September-December 2010). The authors used the average book price to calculate the cost of the Unit, by adding the cost of stock replenishment and unit dose medicines dispensed in the case of the first period and extracted from the ADS in the case of the second period. Results In the period prior to ADS implementation, Unit expenses were 53,037 euros of which 45.43% were allocated to the patient. After ADS implementation, the Unit cost 50,732 euros to run, of which 73.33% were allocated per patient. Of the 68 products that went from dispensing stock to ADS, the ones that mainly affected the change in the medicines expense allocation per patient were: sulfadiazine (47.5%), midazolam (8.5%) atracurium (5.8%), propofol (5.5%) and ketamine (4.3%). Conclusions The medicines that mainly affected the change in the allocation of medicines belong to the D06, N05, M03 and N01 ATC classification groups in financial terms:, these were traditionally dispensed by replenishing stock. This has represented a significant reduction in the Unit stock. The ADS improve the allocation per patient of medicines expenses, including special units with prior unit dose dispensing, which enables the pharmacist to increase the level of knowledge about drug use in the Unit.