Background: The aim of this study was to analyze the percentage of patients admitted to the ICU having received the vaccine against COVID-19, to describe the clinical profile of vaccinated patients admitted to the ICU, and to assess the humoral immune response to vaccination. Methods: In this multicenter prospective descriptive cohort study, consecutive critically ill patients with confirmed SARS-CoV-2 pneumonia who received at least one dose of the SARS-CoV2 vaccine were included. The time of study was from 1 July to 10 August of 2021. Results: Of the 94 consecutive patients from seven Andalusian ICUs admitted during the time of study, 50 (53.2%) received at least one dose of anti SARS-CoV2 vaccine. No patient was admitted having previously had SARS-CoV2 infection. The B.1.617.2 (Delta) variant was the most frequently identified, in 80.76% of cases. Patients with a complete vaccination with non-optimal antibody levels were immunocompromised. Fifteen patients were admitted to the ICU with Acute Respiratory Distress Syndrome (ARDS) without having completed their vaccination; the clinical profile was younger and with less comorbidities compared to patients with full vaccination. There were no differences in severity of ARDS. Conclusions: Most of the patients who were admitted to the ICU having received a dose of the vaccine were not optimally vaccinated; fully vaccinated patients who did not obtain optimal serum antibody levels were patients considered immunocompromised.

ObjectivesTo describe a medication reconciliation (MR) procedure prepared by the pharmacist for patients admitted for elective surgery and to assess the surgeon’s degree of acceptance.MethodsA 1-year retrospective observational study was conducted. The patient population consisted of patients aged ≥18 years admitted during 2016 for elective surgery and whose planned length of hospital stay was >24 hours. A pharmacist performed MR following a specific protocol. A review of the reconciliations prescribed later by the surgeons was conducted. Statistical analyses were performed for qualitative and quantitative variables.ResultsThe pharmacist prepared a total of 1986 reconciliation reports. The 179 patients reviewed in this study had a mean age of 65.7±11.8 years, 49.2% were women and 98.9% of patients were reconciled by the surgeon in the operating theatre using an electronic prescribing system (85.5% were fully reconciled).ConclusionThe hospital’s MR protocol resulted in almost 100% of patients being reconciled within the subgroup of elective surgery patients by the prescribing surgeons.

BackgroundTo demonstrate the added value that pharmacists bring, it is essential that all activities undertaken to improve therapy in the hospital are recorded and quantified.PurposeTo analyse the pharmaceutical interventions with potential to avoid adverse drug events (ADE) in hospitalised patients and to calculate the cost avoided with them.Material and methodsRetrospective study of pharmaceutical interventions carried out over 3 months, using the registration in the pharmacy software and its exportation to Excel, where variables were registered. Avoided cost was calculated from multiplying 1.7 days, which is the average stay increase due to an ADE according to the bibliography, cost of the stay and probability of ADE occurrence if it had not been intervened.ResultsOver a period of 3 months, 10 pharmacists performed 1238 interventions, in 958 hospitalised patients in charge of 15 clinical departments: 18.7% of interventions were carried out in internal medicine, 16.2% in traumatology, 14.8% in general surgery, 10.9% in urology and8.4% in gynaecology-obstetrics. Reasons for intervention were: treatment reconciliation (41.4%), therapeutic exchange (16.5%), narrow therapeutic window/high-risk drug (9.6%), moderate adverse reaction (6.9%), renal impairment adjustment (4%), relevant interaction (3.5%), 2 to 4 times upper/lower dosage (2.7%), other dosage adjustments (2.7%), therapeutic doubling (2.2%), other optimisations (1.5%), severe adverse reaction (1.5%), clarification/completing medical order (1.3%), adequacy of antibiotic treatment (1.3%), providing relevant information (1.2%), low-risk drug lacking/remaining (1.1%), pharmaceutical form/administration route with toxicity risk or therapeutic failure (0.8%), allergy (0.6%), sequential therapy (0.6%), four to 10 times upper/lower dose (0.2%), mild adverse reaction (0.2%) and asking for blood test (0.2%). Acceptance of interventions was 84.7%, with 7.2% interventions being non-valued. Accepted pharmaceutical interventions were estimated to have avoided a cost of €169,816, by preventing prolongation of the hospital stay due to ADE.ConclusionRegistration of pharmaceutical interventions is essential for analysing and quantifying the role of the pharmacist as part of the care team. This study allows us to conclude that the pharmacist is involved in optimising the pharmacotherapy of hospitalised patients in all clinical departments, contributing to the prevention of ADE, which means an increase in patient safety, as well as cost savings for the sanitary system.No conflict of interest

BackgroundMedication reconciliation (MR) is one of the measures with greater impact on safety in the use of the drug. Reconciliation errors appear frequently in the transitions between the different levels of care, especially at hospital discharge.PurposeEvaluate the impact of a MR project performed by pharmacists on medical discharge summaries.Material and methodsA protocol was performed to support the MR at discharge by the pharmacy service in a 350-bed hospital and developed over 4 weeks. The pharmacist went to the hospitalisation area from Monday to Friday at the end of the morning and he made the MR prior to discharge. He conducted a structured pharmacotherapeutic interview with the patient to know the home medication prior to admission and later discussed with the physician the new medication that would be added and if there was any modification of the previous medication. A report with active principle, dosage/posology and pharmacotherapeutic recommendations was elaborated. Subsequently, the medical discharge summaries were reviewed and a database was developed in which were included demographic variables (sex, age, no pre-admission drugs) and as a primary endpoint if the physician included in his summary all medication of the patient (complete summary), as well as whether there was any treatment with a finite duration and if this was included in the instructions to the patient. We also selected a sample of discharged patients before the pharmacist’s intervention to compare both groups. Bivariate analysis and logistic regression analysis was used using SPSS software.ResultsTwenty-eight patients were recruited in the pre-intervention group and 27 in the post-intervention group: median age (IQR) 65.2 years (50.4–71.6) vs 77.9.(61.1–84.2) (p=0.004), sex 66.7% males vs. 51.7% (p=0.653) respectively. Median number of drugs prior to admission (IQR) was four drugs (0–10) vs eight (5–12) (p=0.028), respectively. Regardless of the age of patients in the post-intervention group, they are about four times more likely to have a complete medical discharge summary (OR: 3.97, 95% CI: 1.18 to 13.3) (p=0.026). The percentages of medical reports with duration specified in the pre- and post-groups were, respectively, 0% vs. 18.5% (p=0.023).ConclusionThe participation of the pharmacist improves the process of MR at discharge, favouring that it is performed in a greater number of patients and that information provided at discharge is more complete.References and/or AcknowledgementsWe thank the research team for their supportNo conflict of interest

BackgroundAccording to official data in 2016, antibiotics’ (AB) comsumption in surgery service in our centre was 970.75DDD/1000patient-days. In detail, piperacillin-tazobactam (P/T) and amoxicillin-clavulanic (A/C) was 259.47DDD/1000patient-days and 340.38DDD/1000patient-days, respectively. It was observed that an improvement in the use of AB in the surgery service was necessary, since the data are beyond the comsumption of AB in the region where our hospital is situated.PurposeTo analyse the effectiveness of a programme of pharmacist intervention in the reduction of the global use of antibiotics in inpatient care in the surgery service, with special focus on A/C and P/T consumption.Material and methodsAn interdisciplinary meeting between the surgery and pharmacy departments was held. Here, all the protocols of surgery treatment were revised. It was observed that all of them included P/T as an antibiotic prophylaxis. According to the guidelines, the pharmacist proposed to replace P/T by A/C as a treatment of choice, and restrict the post-surgical treatment to three doses by default, setting it out in the electronic prescription program. In addition, the pharmacist revised daily all the antibiotics prescribed with a duration larger or equal to 7 days, and carried out consultations with the surgeons so that they could value several options: antibiotic de-scaling, to finish treatment andto extract cultures. The global consumption of DDD/1000patient-days and the AC and P/T consumption was drawn from the first semester of 2017, and it was compared to the corresponding data in the first semester of 2016.ResultsThe global consumption of antibiotics in the surgery service was reduced from 970.75DDD/1000patient-days in 2016 to 847.37DDD/1000patient-days in 2017 (-10.15%). With regards to A/C, the consumption was reduced from 340.48DDD/1000patient-days in 2016 to 247.78DDD/1000patient-days in 2017 (-27.21%) and the consumption of P/T was reduced from 259.47DDD/1000patient-days in 2016 to 210.58DDD/1000patient-days in 2017 (-18.84%).ConclusionThe incorporation of a programme of interdisciplinary intervention to optimise the adaptation and duration of antibiotic treatment in the general surgery floor has achieved a reduction in the consumption of antibiotics, specially A/C and P/T, with the presence of the pharmacist.References and/or AcknowledgementsTo the surgery service for their collaboration in this projectNo conflict of interest