RESUMO
BACKGROUND: The effects of an early and prolonged lockdown during the coronavirus disease 2019 (COVID-19) pandemic on cardiovascular intensive care units (CICUs) are not well established. OBJECTIVES: This study analyses patterns of admission, mortality and performance indicators in a CICU before and during the Argentine lockdown in the COVID-19 pandemic. METHODS: This is a retrospective observational cross-sectional study of all consecutive patients aged 18 years or more admitted to the cardiac intensive care unit at a high-volume reference hospital in Buenos Aires, Argentina, comparing hospitalization rates, primary causes of admission, inpatient utilization indicators, pharmacy supplies' expenditures and in-hospital mortality between 5 March and 31 July 2020, with two corresponding control periods in 2019 and 2018. RESULTS: We included 722 female patients [mean age of 61.6 (SD 15.5) years; 237 (32.8%)]. Overall hospitalizations dropped 53.2% (95%CI: 45.3, 61.0%), from 295.5 patients/year over the periods 2018/2019 to 137 patients in 2020. Cardiovascular disease-related admissions dropped 59.9%, while admission for non-cardiac causes doubled its prevalence from 9.6% over the periods 2018/2019 to 22.6% in the study period (P < 0.001).In the period 2020, the bed occupancy rate fell from 82.2% to 77.4%, and the bed turnover rate dropped 50% from 7.88 to 3.91 monthly discharges/bed. The average length of stay doubled from 3.26 to 6.75 days, and the turnover interval increased from 3.8 to 8.39 days in 2020.Pharmacy supplies' expenditures per discharge increased 134% along with a rise in antibiotics usage from 6.5 to 11.4 vials/ampoules per discharge (P < 0.02).Overall mortality increased from 7% (n = 41) to 13.9% (n = 19) (P = 0.008) at the expense of non-cardiac-related admissions (3.6-19.4%, P = 0.01). CONCLUSIONS: This study found a significant reduction in overall and cardiovascular disease-related causes of admission to the cardiac intensive care unit, worse performance indicators and increased in-hospital mortality along the first 5 months of the early and long-lasting COVID-19 lockdown in Argentina. These results highlight the need to foster public awareness concerning the risks of avoiding hospital attendance. Moreover, health systems should follow strict screening protocols to prevent potential biases in the admission of patients with critical conditions unrelated to the COVID-19 pandemic.
Assuntos
COVID-19/epidemiologia , Doenças Cardiovasculares/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Adulto , Idoso , Argentina/epidemiologia , Ocupação de Leitos/estatística & dados numéricos , Estudos Transversais , Feminino , Política de Saúde , Mortalidade Hospitalar/tendências , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pandemias , Serviço de Farmácia Hospitalar/economia , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Estudos Retrospectivos , SARS-CoV-2RESUMO
OBJECTIVE: To perform a cost-benefits analysis of a clinical pharmacy (CP) service implemented in a Neurology ward of a tertiary teaching hospital. METHODS: This is a cost-benefit analysis of a single arm, prospective cohort study performed at the adult Neurology Unit over 36 months, which has evaluated the results of a CP service from a hospital and Public Health System (PHS) perspective. The interventions were classified into 14 categories and the costs identified as direct medical costs. The results were analyzed by the total and marginal cost, the benefit-cost ratio (BCR) and the net benefit (NB). RESULTS: The total 334 patients were followed-up and the highest occurrence in 506 interventions was drug introduction (29.0%). The marginal cost for the hospital and avoided cost for PHS was US$182±32 and US$25,536±4,923 per year; and US$0.55 and US$76.4 per patient/year. The BCR and NB were 0.0, -US$26,105 (95%CI -31,850 - -10,610), -US$27,112 (95%CI -33,160-11,720) for the hospital and; 3.0 (95%CI 1.97-4.94), US$51,048 (95%CI 27,645-75,716) and, 4.6 (95%CI 2.24-10.05), US$91,496 (95%CI 34,700-168,050; p < 0.001) for the PHS, both considering adhered and total interventions, respectively. CONCLUSIONS: The CP service was not directly cost-benefit at the hospital perspective, but it presented savings for forecast cost related to the occurrence of preventable morbidities, measuring a good cost-benefit for the PHS.
Assuntos
Serviço de Farmácia Hospitalar/economia , Adulto , Brasil , Análise Custo-Benefício , Hospitais Universitários , Humanos , Estudos ProspectivosRESUMO
WHAT IS KNOWN AND OBJECTIVE: A framework to evaluate the impact of clinical pharmacists in intensive care units (ICUs) in Chile has not yet been established. This study evaluates the cost avoidance and cost-benefit ratios of clinical pharmacist interventions in terms of treatment optimization in an adult ICU in southern Chile. METHODS: Clinical pharmacist interventions in a multidisciplinary adult ICU were assessed between January and December 2019. Only interventions suggested by pharmacists and accepted by the healthcare team were included in the analysis. Interventions were classified into six categories, and cost avoidance (in US dollars) was calculated for each category using a systematic validated approach. A cost-benefit ratio for clinical pharmacy services in the adult ICU was also calculated. RESULTS AND DISCUSSION: Over the 12-month period, 505 interventions were performed in 169 patients, of whom 62% were male. Interventions were classified into the following six categories: adverse drug event prevention (18%), which led to $87 882 in savings; resource utilization (ie change in medication route) (10%), which led to $50 525 in savings; individualization of patient care (ie dose adjustment) (36%), which led to $57 089 in savings; prophylaxis (ie initiation of stress ulcer prophylaxis) (<1%), which led to $167 in savings; hands-on care (ie bedside monitoring) (23%), which led to $57 846 in savings; and administrative and supportive tasks (ie patient own medication evaluation) (13%), which led to $9988 in savings. The total cost savings over the year-long period were $263 500, resulting in a cost-benefit ratio of 1:24.2. WHAT IS NEW AND CONCLUSION: The participation of a clinical pharmacist in a multidisciplinary ICU team reduces healthcare expenditures through treatment optimization translated into cost avoidance. This study has corroborated prior evidence that clinical pharmacist involvement in ICUs provides economic value and quality assurance in healthcare settings.
Assuntos
Unidades de Terapia Intensiva/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Adulto , Idoso , Chile , Redução de Custos , Análise Custo-Benefício , Feminino , Custos de Cuidados de Saúde , Humanos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/normas , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/economia , Equipe de Assistência ao Paciente/normas , Farmacêuticos/economia , Farmacêuticos/normas , Serviço de Farmácia Hospitalar/economia , Serviço de Farmácia Hospitalar/normas , Papel Profissional , Estudos Prospectivos , Garantia da Qualidade dos Cuidados de SaúdeRESUMO
ABSTRACT OBJECTIVE: To perform a cost-benefits analysis of a clinical pharmacy (CP) service implemented in a Neurology ward of a tertiary teaching hospital. METHODS: This is a cost-benefit analysis of a single arm, prospective cohort study performed at the adult Neurology Unit over 36 months, which has evaluated the results of a CP service from a hospital and Public Health System (PHS) perspective. The interventions were classified into 14 categories and the costs identified as direct medical costs. The results were analyzed by the total and marginal cost, the benefit-cost ratio (BCR) and the net benefit (NB). RESULTS: The total 334 patients were followed-up and the highest occurrence in 506 interventions was drug introduction (29.0%). The marginal cost for the hospital and avoided cost for PHS was US$182±32 and US$25,536±4,923 per year; and US$0.55 and US$76.4 per patient/year. The BCR and NB were 0.0, -US$26,105 (95%CI −31,850 − -10,610), -US$27,112 (95%CI −33,160-11,720) for the hospital and; 3.0 (95%CI 1.97-4.94), US$51,048 (95%CI 27,645-75,716) and, 4.6 (95%CI 2.24-10.05), US$91,496 (95%CI 34,700-168,050; p < 0.001) for the PHS, both considering adhered and total interventions, respectively. CONCLUSIONS: The CP service was not directly cost-benefit at the hospital perspective, but it presented savings for forecast cost related to the occurrence of preventable morbidities, measuring a good cost-benefit for the PHS.
Assuntos
Humanos , Adulto , Serviço de Farmácia Hospitalar/economia , Brasil , Estudos Prospectivos , Análise Custo-Benefício , Hospitais UniversitáriosRESUMO
PURPOSE: The pharmacist-led implementation of a smart pump-electronic medical record (EMR) interoperability program at a hospital within a regional health system is described. SUMMARY: Smart pump-EMR interoperability involves a wireless, bidirectional connection by which infusion information transmitted by the EMR prepopulates infusion devices, reducing keystokes and opportunities for manual programming errors. The smart pumps transmit time-stamped infusion data to the EMR for nurse documentation. Use of interoperability technology forces the use of dose-error reduction software so that 100% of prepopulated infusions and dosage adjustments are protected. To improve i.v. medication safety and documentation at a 286-bed hospital within an 8-hospital health system, pharmacists led an initiative to implement smart pump-EMR interoperability as a first step toward systemwide implementation. The hospital's smart pump-EMR interoperability initiative resulted in patient safety and revenue-generation gains in the first 8 months after implementation. The mean number of keystrokes needed to program an infusion was reduced from 15 to 2 (an 86% decrease). Pump alerts, alert overrides, and reprogrammed or cancelled infusions were decreased. In addition, the program improved outpatient charge capture, resulting in $370,000 in incremental revenue. CONCLUSION: A pharmacist-led implementation of smart pump-EMR interoperability led to measurable, data-based improvements in i.v. medication safety and improved accuracy, timeliness, and efficiency of i.v. infusion documentation. Revenue was increased due to improved charge capture for outpatient i.v. infusions.
Assuntos
Registros Eletrônicos de Saúde/organização & administração , Bombas de Infusão , Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Tecnologia sem Fio , Registros Eletrônicos de Saúde/economia , Segurança de Equipamentos , Humanos , Segurança do Paciente , Farmacêuticos/economia , Serviço de Farmácia Hospitalar/economia , Fatores de TempoRESUMO
Objective To demonstrate economic impact of pharmaceutical evaluation in detection and prevention of errors in antineoplastic prescriptions. Methods This was an observational and retrospective study performed in a cancer hospital. From July to August 2016 pharmacists checked prescriptions of antineoplastic and adjuvant drugs. Drug-related problems observed were classified and analyzed concerning drug, pharmaceutical intervention, acceptability and characteristic of the error. In case of problem related to dose, we calculated a deviation percentage related with correct dose and value spent or saved. Data were analyzed using descriptive statistics with frequency and percentage. Results A total of 6,104 prescriptions and 12,128 medications were evaluated. Drug-related problems were identified in 274 (4.5%) prescriptions. Most of them was due to lack of information (n=117; 36.1%). Problems associated with dose accounted for 32.1% (n=98) of the total. In 13 cases (13.3%) ranging of prescribed dose was 50% greater than the correct dose. Intercepted drug-related problems provided savings of R$54.081,01 and expenses of R$20.863,36, therefore resulting in a positive balance of R$33.217,65. Each intervention promoted saving of R$126,78 with an acceptance rate of 98%. Main pharmaceutical interventions were information inclusion (n=117; 36.1%) and dose change (n=97; 29.9%). All errors were classified as error with no harm. Conclusion Simple actions such as prescription checking are able to identify and prevent drug-related problems, avoid financial losses and add immeasurable value to patient safety.
Assuntos
Prescrições de Medicamentos/estatística & dados numéricos , Erros de Medicação/prevenção & controle , Neoplasias/tratamento farmacológico , Segurança do Paciente , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Institutos de Câncer , Prescrições de Medicamentos/economia , Humanos , Erros de Medicação/economia , Serviço de Farmácia Hospitalar/economia , Estudos RetrospectivosRESUMO
Background Problems related to pharmacotherapy are common in patients admitted to the paediatric intensive care unit (PICU) and are associated with increased healthcare costs. Data on the impact of clinical pharmacist interventions to prevent pharmacotherapy-related problems and to minimize costs in the PICU are limited. Objectives To evaluate the number and type of clinical pharmacist interventions in the PICU and to determine cost savings associated with them. Setting a ten bed PICU of a tertiary-care university hospital in Brazil. Method This was a prospective, observational study conducted over 1-year. The Failure Mode and Effects Analysis (FMEA) tool was applied at the beginning of the study to assess drug-related risks in the PICU and to guide clinical pharmacist interventions. Main outcome measure Number and type of clinical pharmacist interventions and healthcare-related costs. Results One hundred sixty-two children were followed-up by the clinical pharmacist and 1586 prescriptions were evaluated; pharmacotherapy-related problems were identified in 12.4% of them. Sixteen of 75 failure modes identified by FMEA were potentially reduced by the clinical pharmacist interventions. There were 197 interventions with a cost saving of R$ 15,118.73 (US$ 4828.00). Clinical pharmacist interventions were related to drug interaction and therapeutic monitoring (34.5%), drug selection (22.3%), dosing and frequency (16.8%), prescription (13.2%) and administration (13.2%). Ninety-seven per cent of the clinical pharmacist interventions were accepted by the medical team. The interventions with larger cost savings were related to administration (39%). Conclusion The clinical pharmacist interventions minimized the risks of pharmacotherapy-related problems and contributed to the reduction of costs associated with medical prescription.
Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Unidades de Terapia Intensiva Pediátrica/economia , Erros de Medicação/economia , Erros de Medicação/prevenção & controle , Serviço de Farmácia Hospitalar/economia , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos ProspectivosRESUMO
ABSTRACT Objective To demonstrate economic impact of pharmaceutical evaluation in detection and prevention of errors in antineoplastic prescriptions. Methods This was an observational and retrospective study performed in a cancer hospital. From July to August 2016 pharmacists checked prescriptions of antineoplastic and adjuvant drugs. Drug-related problems observed were classified and analyzed concerning drug, pharmaceutical intervention, acceptability and characteristic of the error. In case of problem related to dose, we calculated a deviation percentage related with correct dose and value spent or saved. Data were analyzed using descriptive statistics with frequency and percentage. Results A total of 6,104 prescriptions and 12,128 medications were evaluated. Drug-related problems were identified in 274 (4.5%) prescriptions. Most of them was due to lack of information (n=117; 36.1%). Problems associated with dose accounted for 32.1% (n=98) of the total. In 13 cases (13.3%) ranging of prescribed dose was 50% greater than the correct dose. Intercepted drug-related problems provided savings of R$54.081,01 and expenses of R$20.863,36, therefore resulting in a positive balance of R$33.217,65. Each intervention promoted saving of R$126,78 with an acceptance rate of 98%. Main pharmaceutical interventions were information inclusion (n=117; 36.1%) and dose change (n=97; 29.9%). All errors were classified as error with no harm. Conclusion Simple actions such as prescription checking are able to identify and prevent drug-related problems, avoid financial losses and add immeasurable value to patient safety.
RESUMO Objetivo Demonstrar o impacto econômico da avaliação farmacêutica na detecção e na prevenção de erros em prescrições de antineoplásicos. Métodos Estudo observacional e retrospectivo realizado em um hospital oncológico. De julho a agosto de 2016, prescrições contendo antineoplásicos e fármacos adjuvantes ao tratamento foram avaliadas por farmacêuticos. Os problemas detectados relacionados a medicamentos foram classificados e analisados quanto ao medicamento, à intervenção farmacêutica, à aceitabilidade e à caracterização do erro. Quando o problema envolveu dose, calcularam-se a percentagem de desvio em relação à dose correta e o valor gasto ou economizado. Os dados foram analisados por estatística descritiva com aplicação de frequência e percentual. Resultados Foram avaliadas 6.104 prescrições e 12.128 medicamentos. Identificaram-se problemas relacionados a medicamentos em 274 (4,5%) prescrições, sendo a maioria causado por falta de informações (n=117; 36,1%). Quando reunidos, os problemas envolvendo dose representaram 32,1% (n=98) do total. Em 13 casos (13,3%), a variação da dose prescrita em relação à correta foi maior do que 50%. Os problemas relacionados a medicamentos interceptados representaram economia de R$54.081,01 e gastos de R$20.863,36, resultando em saldo positivo de R$33.217,65. Cada intervenção promoveu economia de R$126,78 com aceitabilidade de 98%. As principais intervenções foram inclusão de informações (n=117; 36,1%) e alteração de dose (n=97; 29,9%). Todos os erros foram considerados sem dano. Conclusão Ações simples de serem implantadas, como análise de prescrições, são capazes de identificar e prevenir problemas relacionados a medicamentos, evitar perdas financeiras e agregar imensurável valor na segurança do paciente.
Assuntos
Humanos , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Segurança do Paciente , Erros de Medicação/prevenção & controle , Neoplasias/tratamento farmacológico , Serviço de Farmácia Hospitalar/economia , Prescrições de Medicamentos/economia , Institutos de Câncer , Estudos Retrospectivos , Erros de Medicação/economiaRESUMO
OBJECTIVE: To evaluate the costs and patient safety of a pilot implementation of an automated dispensing cabinet in a critical care unit of a private tertiary hospital in São Paulo/Brazil. METHODS: This study considered pre- (January-August 2013) and post- (October 2013-October 2014) intervention periods. We considered the time and cost of personnel, number of adverse events, audit adjustments to patient bills, and urgent requests and returns of medications to the central pharmacy. Costs were evaluated based on a 5-year analytical horizon and are reported in Brazilian Reals (R$) and US dollars (USD). RESULTS: The observed decrease in the mean number of events reported with regard to the automated drug-dispensing system between pre- and post-implementation periods was not significant. Importantly, the numbers are small, which limits the power of the mean comparative analysis between the two periods. A reduction in work time was observed among the nurses and administrative assistants, whereas pharmacist assistants showed an increased work load that resulted in an overall 6.5 hours of work saved/day and a reduction of R$ 33,598 (USD 14,444) during the first year. The initial investment (R$ 206,065; USD 88,592) would have been paid off in 5 years considering only personnel savings. Other findings included significant reductions of audit adjustments to patient hospital bills and urgent requests and returns of medications to the central pharmacy. CONCLUSIONS: Evidence of the positive impact of this technology on personnel time and costs and on other outcomes of interest is important for decision making by health managers.
Assuntos
Equipamentos e Provisões Hospitalares/economia , Unidades de Terapia Intensiva/economia , Sistemas de Medicação no Hospital/economia , Serviço de Farmácia Hospitalar/economia , Serviço de Farmácia Hospitalar/métodos , Centros de Atenção Terciária/economia , Brasil , Análise Custo-Benefício , Equipamentos e Provisões Hospitalares/estatística & dados numéricos , Custos de Cuidados de Saúde , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Sistemas de Medicação no Hospital/estatística & dados numéricos , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos , Fatores de TempoRESUMO
OBJECTIVE: To evaluate the costs and patient safety of a pilot implementation of an automated dispensing cabinet in a critical care unit of a private tertiary hospital in São Paulo/Brazil. METHODS: This study considered pre- (January-August 2013) and post- (October 2013-October 2014) intervention periods. We considered the time and cost of personnel, number of adverse events, audit adjustments to patient bills, and urgent requests and returns of medications to the central pharmacy. Costs were evaluated based on a 5-year analytical horizon and are reported in Brazilian Reals (R$) and US dollars (USD). RESULTS: The observed decrease in the mean number of events reported with regard to the automated drug-dispensing system between pre- and post-implementation periods was not significant. Importantly, the numbers are small, which limits the power of the mean comparative analysis between the two periods. A reduction in work time was observed among the nurses and administrative assistants, whereas pharmacist assistants showed an increased work load that resulted in an overall 6.5 hours of work saved/day and a reduction of R$ 33,598 (USD 14,444) during the first year. The initial investment (R$ 206,065; USD 88,592) would have been paid off in 5 years considering only personnel savings. Other findings included significant reductions of audit adjustments to patient hospital bills and urgent requests and returns of medications to the central pharmacy. CONCLUSIONS: Evidence of the positive impact of this technology on personnel time and costs and on other outcomes of interest is important for decision making by health managers.