RESUMO
OBJECTIVES: To draft a list of actions and quality indicators for pharmacist care in hospital emergency departments, based on consensus among a panel of experts regarding which actions to prioritize in this setting. MATERIAL AND METHODS: A panel of experts from the Spanish Society of Hospital Pharmacy (SEFH) and the Spanish Society of Emergency Medicine (SEMES) evaluated a preliminary list of potential actions and quality of care indicators. The experts used a questionnaire to assess the proposals on the basis of available evidence. In the first round, each expert individually assessed the importance of each proposed action based on 4 dimensions: evidence base, impact on clinical response and patient safety, ease of implementation, and priority. In the second round the experts attended a virtual meeting to reach consensus on a revised list of proposals; suggestions and comments that had been made anonymously in the first round were included. The group then prioritized each action as basic, intermediate, or advanced. RESULTS: The experts evaluated a total of 26 potential actions and associated quality indicators. No items were eliminated in the analysis of scores and comments from the first round. After the second round, 25 actions survived. Nine were considered basic, 10 intermediate, and 6 advanced. CONCLUSION: The expert panel's list of pharmacist actions and care quality indicators provides a basis for developing a pharmacist care program in Spanish emergency departments on 3 levels of priority. The list can serve as a guide to pharmacists, managers, physicians, and nurses involved in the effort to improve drug therapy in this hospital setting.
OBJETIVO: Desarrollar un conjunto de actividades e indicadores de atención farmacéutica en los servicios de urgencias hospitalarios mediante un consenso colectivo de un panel de expertos que permita priorizar las actividades a realizar por los farmacéuticos en estas unidades. METODO: Un comité formado por miembros de la Sociedad Española de Farmacia Hospitalaria (SEFH) y de la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) evaluó una propuesta inicial de actividades e indicadores potenciales, basados en la evidencia científica disponible, en formato de cuestionario. En una primera ronda, cada uno de los expertos del panel clasificó de forma individual la relevancia de cada una de las actividades propuestas en cuatro dimensiones: evidencia científica, impacto en la respuesta clínica y seguridad para el paciente, facilidad de implementación y grado de prioridad. La segunda ronda se realizó mediante una reunión grupal de forma virtual, a partir del cuestionario modificado de acuerdo con las sugerencias planteadas, así como los comentarios vertidos por los participantes del panel de forma anónima. En esta ronda, cada actividad fue clasificada por consenso como básica, intermedia o avanzada en función del grado de prioridad de implantación considerado por el grupo de expertos. RESULTADOS: Se propusieron un total de 26 potenciales actividades a los expertos, con indicadores asociados. Tras el análisis de las puntuaciones y los comentarios realizados en la primera ronda, no se eliminó ninguna de las actividades propuestas. Tras la segunda ronda, se mantuvieron 25 actividades, de las cuales se puntuaron 9 como actividades básicas, 10 actividades como intermedias y 6 actividades como avanzadas. CONCLUSIONES: El desarrollo del conjunto de actividades e indicadores de atención farmacéutica en urgencias, priorizados por grado de relevancia para la unidad, es la base para el desarrollo de esta cartera de servicios en los hospitales españoles, y sirve como guía tanto para farmacéuticos como para gestores, médicos y enfermeros de la unidad a fin de mejorar la farmacoterapia los pacientes atendidos en los servicios de urgencias.
Assuntos
Medicina de Emergência, Serviço de Farmácia Hospitalar, Humanos, Farmacêuticos, Consenso, Serviço Hospitalar de Emergência, HospitaisRESUMO
Objetivo: Reducir la tasa de eventos adversos (EA) derivados de catéteres vasculares periféricos (CVP) en pacientes atendidos en servicios de urgencias (SU), así como accidentes de bioseguridad en profesionales, mediante una estrategia que combine formación, protocolización de la indicación y catéteres de bioseguridad. Método: Estudio prospectivo, multicéntrico, observacional no postautorización en pacientes atendidos en el SU que precisen de CVP. El estudio tiene dos fases: en la primera se procede a formación, protocolización y monitorización mediante ua lista de comprobación, utilizando CVP convencionales. En la segunda fase se introducen CVP de bioseguridad. Se comparan ambas fases y sus resultados en la reducción de EA y bioseguridad. Resultados: Se incluyeron un total de 520 pacientes: 180 en fase I y 340 en fase II. Se evidencian deficiencias en la técnica relacionadas con la desinfección, mantenimiento del campo estéril y manejo de equipo y apósitos; algunos mejoran significativamente con la progresión del estudio en fase II. Se observaron 86 EA, 34 en Fase I (18,8%) y 52 en fase II (15,4%) (p = ns). Destaca una reducción del 50% de flebitis en fase II. Sobre bioseguridad se detectaron 8 casos (7 salpicaduras, 1 pinchazo accidental) con CVP convencionales (fase I) y 2 salpicaduras con CVP de bioseguridad (fase II), equivalente a una reducción del 36% de accidentes (p = 0,04), especialmente con catéteres de corta duración (p = 0,02). Conclusiones: La combinación de formación, protocolización de la indicación y empleo de CVP de bioseguridad se muestra como una intervención más efectiva para mejorar la seguridad del paciente y del profesional (AU)
Objectives: To test a strategy to reduce the rate of adverse events in patients and safety problems for emergency department staff who insert peripheral venous catheters (PVCs). The strategy consisted of training, implementing a protocol, and introducing safety-engineered PVCs. Methods: Prospective, multicenter, observational, preauthorization study in patients requiring PVC placement in an emergency department. The study had 2 phases. The first consisted of training, implementing a protocol for using conventional PVCs, and monitoring practice. The second phase introduced safety-engineered PVC sets. The number of adverse events in patients and threats to safety for staff were compared between the 2 phases. Results: A total of 520 patients were included, 180 in the first phase and 340 in the second. We detected breaches in aseptic technique, failure to maintain a sterile field, and improper management of safety equipment and devices. Some practices improved significantly during the second phase. Eighty-six adverse events occurred in the first phase and 52 (15.4%) in the second; the between-phase difference was not statistically significant. The incidence of postinfusion phlebitis was 50% lower in the second phase. Seven splash injuries and 1 accidental puncture occurred with conventional PVCs in the first phase; 2 splash injuries occurred with the safety-engineered PVCs in the second phase (36% decrease, P = .04). Differences were particularly noticeable for short-term PVC placements (P = .02). Conclusion: Combining training, a protocol, and the use of safety-engineered PVC sets offers an effective strategy for improving patient and staff safety (AU)
Assuntos
Humanos, Cateterismo Periférico/efeitos adversos, Contenção de Riscos Biológicos/prevenção & controle, Infecções Relacionadas a Cateter/prevenção & controle, Obstrução do Cateter/estatística & dados numéricos, Segurança do Paciente/normas, Pessoal de Saúde/estatística & dados numéricos, Serviços Médicos de Emergência/normas, Tratamento de Emergência/normasRESUMO
OBJECTIVES: To test a strategy to reduce the rate of adverse events in patients and safety problems for emergency department staff who insert peripheral venous catheters (PVCs). The strategy consisted of training, implementing a protocol, and introducing safety-engineered PVCs. MATERIAL AND METHODS: Prospective, multicenter, observational, preauthorization study in patients requiring PVC placement in an emergency department. The study had 2 phases. The first consisted of training, implementing a protocol for using conventional PVCs, and monitoring practice. The second phase introduced safety-engineered PVC sets. The number of adverse events in patients and threats to safety for staff were compared between the 2 phases. RESULTS: A total of 520 patients were included, 180 in the first phase and 340 in the second. We detected breaches in aseptic technique, failure to maintain a sterile field, and improper management of safety equipment and devices. Some practices improved significantly during the second phase. Eighty-six adverse events occurred in the first phase and 52 (15.4%) in the second; the between-phase difference was not statistically significant. The incidence of postinfusion phlebitis was 50% lower in the second phase. Seven splash injuries and 1 accidental puncture occurred with conventional PVCs in the first phase; 2 splash injuries occurred with the safety-engineered PVCs in the second phase (36% decrease, P = .04). Differences were particularly noticeable for short-term PVC placements (P = .02). CONCLUSION: Combining training, a protocol, and the use of safety-engineered PVC sets offers an effective strategy for improving patient and staff safety.
OBJETIVO: Reducir la tasa de eventos adversos (EA) derivados de catéteres vasculares periféricos (CVP) en pacientes atendidos en servicios de urgencias (SU), así como accidentes de bioseguridad en profesionales, mediante una estrategia que combine formación, protocolización de la indicación y catéteres de bioseguridad. METODO: Estudio prospectivo, multicéntrico, observacional no postautorización en pacientes atendidos en el SU que precisen de CVP. El estudio tiene dos fases: en la primera se procede a formación, protocolización y monitorización mediante ua lista de comprobación, utilizando CVP convencionales. En la segunda fase se introducen CVP de bioseguridad. Se comparan ambas fases y sus resultados en la reducción de EA y bioseguridad. RESULTADOS: Se incluyeron un total de 520 pacientes: 180 en fase I y 340 en fase II. Se evidencian deficiencias en la técnica relacionadas con la desinfección, mantenimiento del campo estéril y manejo de equipo y apósitos; algunos mejoran significativamente con la progresión del estudio en fase II. Se observaron 86 EA, 34 en Fase I (18,8%) y 52 en fase II (15,4%) (p = ns). Destaca una reducción del 50% de flebitis en fase II. Sobre bioseguridad se detectaron 8 casos (7 salpicaduras, 1 pinchazo accidental) con CVP convencionales (fase I) y 2 salpicaduras con CVP de bioseguridad (fase II), equivalente a una reducción del 36% de accidentes (p = 0,04), especialmente con catéteres de corta duración (p = 0,02). CONCLUSIONES: La combinación de formación, protocolización de la indicación y empleo de CVP de bioseguridad se muestra como una intervención más efectiva para mejorar la seguridad del paciente y del profesional.
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Objetivos: Valorar el interés que despierta la especialidad de Medicina de Urgencias y Emergencias (MUE) entre los aspirantes a una plaza en el programa de formación MIR (médico interno residente) y los factores que condicionan la elección de esta especialidad. Método: Estudio descriptivo transversal mediante una encuesta estructurada con preguntas cerradas. La variable de interés principal fue la intención de optar por la MUE y el puesto en que la elegirían en el caso de existir dicha especialidad. Resultados: Se realizaron 1.006 encuestas, el 87% (IC 95%: 84,7-89,0) de los aspirantes MIR manifiestaron la conveniencia de crear la especialidad de MUE. El 9% (IC 95%:7,3-11,0) de los encuestados optaría por MUE en primer lugar y el 40,5% (IC 95%:37,4-43,6) estarían dispuestos a realizar la residencia en la especialidad de MUE. Los factores relacionados con una mayor predisposición a la posible elección de la especialidad de MUE si existiera son: la procedencia de un país no comunitario, haber realizado una asignatura de Medicina de Urgencias (MU), tener una edad superior a 26 años, y como factor de menor disposición el pertenecer al grupo de aspirantes con mejores puntuaciones (número de orden de 1-2.500). Los médicos que finalmente han optado por Medicina Familiar y Comunitaria (MFyC) y Medicina Intensiva (MI) son los que con mayor frecuencia han manifestado su intención de solicitar MUE. Conclusión: Los resultados de la encuesta ponen de manifiesto el gran interés de los aspirantes a MIR por la MUE y el elevado número de médicos que solicitarían esta especialidad en primer lugar. El factor que más se relaciona con la opción de escoger la MUE es el conocimiento previo de la especialidad (AU)
Objectives: To assess medical graduates interest in opting for residency training in emergency medicine in Spain and to study factors associated with the choice of this specialty. Methods: Descriptive cross-sectional study based on a structured questionnaire with closed questions. Intention to list emergency medicine among the preferences for residency training and the rank that would be given to that specialty were the dependent variables. Results: A total of 1006 completed questionnaires were received; 87% (95% CI, 84.7%-89.0%) of the respondents thought it would be useful to create a residency program in emergency medicine. This specialty would be ranked as first choice by 9% (95% confidence interval [CI], 7.3%-11.0%); 40% (95% CI, 37.4%-43.6%) would be interested in doing residency training in emergency medicine. Factors related to greater interest in an emergency medicine residency were being from a non-European Union country, having taken a university course in emergency medicine, and age older than26 years. Candidates with higher scores for residency placement (rank between 1 and 2500) were less likely to choose emergency medicine. Physicians who chose a residency position in family and community medicine or intensive care medicine were the ones who most often expressed an interest in emergency medicine. Conclusion: The survey showed that candidates express great interest in an emergency medicine residency and that a large number would choose this specialty as their first choice. Familiarity with the specialty was the factor that was most strongly associated with interest in an emergency medicine residency (AU)
Assuntos
Humanos, Especialização/tendências, Medicina de Emergência, Medicina de Desastres, Internato e Residência/estatística & dados numéricos, Medicina de Família e ComunidadeRESUMO
Objetivos: Evaluar el resultado de la implantación de un programa de atención farmacéutica en un servicio de urgencias (SU) mediante el análisis de las intervenciones farmacéuticas realizadas, y la identificación de los problemas relacionados con los medicamentos (PRM) en el servicio. Método: Incorporación de un farmacéutico a tiempo parcial en el SU durante un periodo de 7 semanas desde febrero 2009. Se incluyeron pacientes de las áreas de boxes, observación y/o críticos del SU que cumplían algún factor de riesgo relacionado con el paciente o con su medicación y/o que tuvieran una alta probabilidad de ingreso. Las variables registradas fueron: datos demográficos, datos clínicos de interés, antecedentes patológicos, medicación habitual, motivo de consulta y medicación prescrita en el SU. Se registraron y clasificaron las intervenciones farmacéuticas asociadas a un PRM, las recomendaciones de terapia secuencial, así como las reacciones adversas a medicamentos(RAM) como motivo de consulta al SU. Resultados: Se incluyeron 90 pacientes (63,7% mujeres), con edad media de 79,3(± 10,6) años. Se registraron 131 intervenciones en 62 (68,9%) pacientes: 120 (91,6%) asociadas a un PRM, de las cuales la intervención mayoritaria 54 (45%) fue iniciar un tratamiento, seguido de la suspensión de un medicamento en 28 (23,3%) casos. Según la clasificación de los PRM, el 53,3% se consideraron de necesidad, en un 15% de efectividad y en un 31,7% de seguridad. Destaca la presencia de polimedicación ( 5 fármacos) como factor de riesgo que requiere intervención farmacéutica en los pacientes incluidos (p = 0,008). La presencia de 2 o más factores de riesgo se mostró como una variable asociada a la aparición de un PRM (p = 0,003). Respecto a la valoración de los medicamentos agrupados por actividad farmacológica, la mayoría de la (..) (AU)
Objective: To assess the implementation of a pharmacist intervention program with in an emergency department, including the analysis of interventions by the pharmacist and identification of medication problems in the department. Methods: A pharmacist was employed part-time in the emergency department for 7 weeks starting in February 2009.Patients with a patient-related or drug-related risk factor or who were likely to be admitted to hospital were included from the areas of the emergency departments cubicles, observation unit, and/or critical case section. The variables recorded were demographic characteristics, clinical data of interest, medical history, medications currently used, reasons for seeking care, and drugs prescribed in the emergency department. Pharmacist interventions related to a medication problem were recorded and classified. Other information gathered included the sequence of therapeutic recommendations and adverse drug interactions as a reason for seeking emergency care. Results: Ninety patients (63.7% women) with a mean (SD) age of 79.3 (10.6) years were studied. One hundred thirty one interventions were recorded for 62 (68.9%) patients. One hundred twenty of these (91.6%) involved a medication problem. Initiating a treatment was the most frequent decision (in 54 [45%] patients); in 28 cases (23.3%) a medication was with drawn. Regarding types of medication problems detected, 53% were (..) (AU)
Assuntos
Humanos, Assistência Farmacêutica/organização & administração, Serviços Médicos de Emergência/organização & administração, Gestão da Segurança/organização & administração, /prevenção & controle, Polimedicação, Interações MedicamentosasRESUMO
OBJECTIVE: The aim of this study was to assess the efficacy and safety of a single intravenous (i.v.) bolus of dexketoprofen trometamol compared with an i.v. infusion of dipyrone in patients with moderate to severe pain due to renal colic. METHODS: A total of 308 patients with renal colic and visual analog scale (VAS) score >/=40 mm participated in a multicenter, randomized, double blind, double-dummy, parallel, and active-controlled study and were randomized to dexketoprofen 25 mg (n = 101), dexketoprofen 50 mg (n = 104), and dipyrone 2 g (n = 103). RESULTS: Mean [+/- standard deviation (SD)] total pain relief (TOTPAR) scores were similar in the dexketoprofen 50 mg (15.3 +/- 8.6) and dipyrone (15.5 +/- 8.6) and slighly higher than in dexketoprofen 25 mg (13.5 +/- 8.6), although significant differences were not achieved. In the same way, patients in the dexketoprofen 50 mg and dipyrone groups showed higher scores in the sum of pain intensity differences (SPID) and the sum of analogue pain intensity differences (SAPID) than patients in the dexketoprofen 25 mg group, reaching statistical significance in comparison with dexketoprofen 25 mg and dipyrone for SPID and SAPID (p < 0.05). The time-effect course for pain intensity differences and pain relief showed significantly higher values for both doses of dexketoprofen during the first 30 min after drug administration (p < 0.05). Dexketoprofen 50 mg and dipyrone groups had 66% and 70%, respectively, of patients with at least 50% of maximum obtainable TOTPAR in comparison with 56% in the dexketoprofen 25 mg group. The study medications were well tolerated. CONCLUSIONS: Dexketoprofen 50 mg administered as a single i.v. bolus was effective for the relief of moderate to severe pain in patients with renal colic, with a good safety profile and efficacy similar to i.v. dipyrone 2 g. Dexketoprofen produced analgesia that was faster in onset.
Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico, Cólica/tratamento farmacológico, Dipirona/uso terapêutico, Cetoprofeno/análogos & derivados, Nefropatias/tratamento farmacológico, Trometamina/análogos & derivados, Doença Aguda, Adolescente, Adulto, Idoso, Análise de Variância, Anti-Inflamatórios não Esteroides/administração & dosagem, Anti-Inflamatórios não Esteroides/efeitos adversos, Dipirona/administração & dosagem, Dipirona/efeitos adversos, Método Duplo-Cego, Feminino, Humanos, Infusões Intravenosas, Injeções Intravenosas, Cetoprofeno/administração & dosagem, Cetoprofeno/efeitos adversos, Cetoprofeno/uso terapêutico, Masculino, Pessoa de Meia-Idade, Trometamina/administração & dosagem, Trometamina/efeitos adversos, Trometamina/uso terapêuticoRESUMO
No disponible
Assuntos
Humanos, Espanha, Observação, Serviço Hospitalar de Emergência, Quartos de PacientesRESUMO
Tras la iniciativa del American College of Surgeons en 1918 la acreditación de centros y servicios sanitarios es una actividad que se ha mantenido en los Estados Unidos de Norteamérica y Canadá. Con posterioridad, otros países como Australia pusieron en marcha sistemas similares. En la última década, en Europa se han iniciado también experiencias de este tipo. En este trabajo se expone un modelo de acreditación de centros y servicios de urgencias y emergencias desarrollado por la SEMES con la finalidad de orientar a los profesionales sobre la mejora de estas unidades. También pretende ser el embrión de los estándares de acreditación para aquellos Servicios que en el futuro se constituyan como Unidades Docentes para médicos especialistas en Medicina de Urgencias (MIR) o de enfermería. Se describe el método seguido y los estándares obtenidos para cada uno de los niveles asistenciales de urgencias: atención primaria, emergencias y hospitales (AU)
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Humanos, Serviços Médicos de Emergência/tendências, Acreditação/tendências, 34002, Avaliação da Tecnologia BiomédicaRESUMO
BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) have been widely used for pain relief in patients with renal colic. Dexketoprofen trometamol is an NSAID that has demonstrated good analgesic efficacy and a good safety profile after oral administration in different models of acute and chronic pain. OBJECTIVE: To assess the analgesic efficacy and safety of single intramuscular doses of dexketoprofen trometamol (25 and 50mg) compared with dipyrone (2g) in moderate to severe pain due to renal colic. STUDY DESIGN: Multicentre, randomised, double-blind, parallel-group study. PATIENTS: PATIENTS of both sexes aged 18-70 years with a diagnosis of renal colic were eligible for randomisation if they presented with at least moderate pain as assessed by visual analogue scale (VAS) scoring ≥40mm on a scale of 100mm immediately before study drug administration. METHODS: Assessment of analgesic efficacy was done using standard pain intensity and pain relief scales. Total scores from baseline to 6 hours after study drug administration were calculated for the sum of pain intensity differences relative to baseline (SPID), sum of analogue pain intensity differences relative to baseline (SAPID) and total pain relief scores (TOTPAR) as primary efficacy endpoints. Secondary efficacy and safety variables were also analysed. RESULTS: A total of 333 patients (dexketoprofen 25mg, n = 112; dexketoprofen 50mg, n = 113; dipyrone 2g, n = 108) were included in the study. No significant differences were found between the treatment groups with regard to SPID (p = 0.797), SAPID (p = 0.852) and TOTPAR (p = 0.716). The time-effect course for pain intensity differences and pain relief showed significantly (p < 0.05) higher values for both doses of dexketoprofen trometamol compared with dipyrone during the first hour after treatment administration. More than 90% of the patients in all three groups achieved pain relief of at least 50% as compared with baseline. Similarly, over 70% of the patients in all three groups considered the received treatment as excellent or good in the overall assessment of efficacy at the end of the study. No dose-effect relationship was observed in this pain model between both doses of dexketoprofen trometamol. All three treatments were well tolerated, showing mostly mild to moderate adverse events. CONCLUSION: Dexketoprofen trometamol is a good analgesic for the treatment of moderate to severe pain due to renal colic, with a good safety profile and an efficacy comparable to that of dipyrone. The significantly greater effect of dexketoprofen trometamol early after administration suggests a faster onset of action, which can be of paramount importance in this condition.
