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Background and ImportanceIn rare diseases such as haemophilia, the access to rigorous information is essential. Aim and Objectives To describe the virtual desktop developed by our pharmacy service for haemophilia patients. It includes shortcuts to selected resources. The aim is to facilitate quick, free and easy access to information about the disease and its treatment.Material and Methods The tool selected to create the virtual desktop was Symbaloo ® (symbaloo.com), which brings together in one place the selected links to useful and rigorous websites.It has been organised in colour -coded sections according to the type of information offered in each block. The name of the virtual desktop is 'Haemophilia for patients'.Results The desktop has a total of 43 web links organised in 16 blocks belonging to 8 sections:

Materials and Methods The study period lasted from September 2011 to January 2012 (inclusive), in a 420-bed hospital. Every day creatinine values over 130 mmol/l were filtered. Treatment was reviewed and we obtained creatinine clearance values (Crockcoft & Gault) of selected patients. After consulting the drug dose adjustment on the sheet and in Micromedex, a report was sent with the pharmaceutical recommendation. Results There were 68 interventions for the 2147 patients studied: Internal Medicine (34) Cardiology (1), Short Stay Unit (5), Orthopaedics (7), Urology (5), Haematology (7) Surgery (5), Neurology (1), Intensive Care Unit (ICU) (2) Oncology (1). 55.9% of notifications were for changes in the dose of enoxaparin (38), 11.8% of amoxicillin-clavulanic acid (8), piperacillin-tazobactam 14.7% (10), 8.8% levofloxacin (6), 2.9% meropenem (2), 2.9% ciprofloxacin (2), 1.5% imipenem (1) and 1.5% aztreonam (1). The proportion of suggested changes accepted was 58.8% (40). 5.9% (4) discontinued treatment, 5.9% (4) were discharged and 29.4% (20) not changed. Of the latter, five were for changes in the pattern of enoxaparin in trauma patients, another 5 from Internal Medicine and 2 more from Haematology and ICU. The rest of them were changes in the pattern of antibiotics (imipenem 1, 2 levofloxacin, 1 meropenem, 1 ciprofloxacin, piperacillin-tazobactam 3) that were given out in the different services. Conclusions A high percentage of doctors followed the recommendations. Part of the unaccepted tally corresponds to trauma patients whose prophylactic regimen of enoxaparin (40 mg/24 h) was not modified due to the service criteria. Some of the antibiotic prescriptions were not changed because of the severity of the patient's illness (1 levofloxacin and 1 Internal Medicine Meropenem Imipenem Oncology and 1). The rest were rejected without explanation. No conflict of interest.

BackgroundOne activity of the Hospital Pharmacist is the monitoring and adjustment of nutritional support in hospitalised patients.PurposeTo describe the interventions of the Pharmacy Service in the adjustment of Parenteral Nutrition (PN) in patients hospitalised in a postoperative intensive care unit.Material and methodsRetrospective six-month study. All pharmaceutical care for patients being treated with TPN were recorded in the electronic patient medical record and in an Excel database.ResultsPN was initiated in 40 patients. 29 cases of postsurgical paralytic ileus, 6 peritonitis and 5 gastrointestinal bleeding.All patients were interviewed and were screened to estimate the prior nutritional status. We also considered the presence of stress factors and based on all these factors, we estimated our patients’ caloric and protein requirements.During this period 442 interventions were performed. A median of 11 interventions per patient was described:Detect food allergy (n = 4, 1%)Prevent refeeding syndrome: start nutritional support with 25% of caloric requirements and 100% of micronutrients and electrolytes in patients with moderate to severe malnutrition (n = 48, 11%).Adjust the ratio of non-protein kilocalories/gram of nitrogen to be 80–100 to achieve protein anabolism (n = 80, 18%).Skew caloric intake in favour of lipids in patients with respiratory distress (n = 30, 7%).Restrict lipids in hypertriglyceridemia (n = 14, 3%).Prevent and treat hepatobiliary complications (lipid restriction, nutrition cycling). (n = 22, 5%).Restrict carbohydrates in hyperglycaemia (n = 18, 4%).Administer glutamine and Omega 3 fatty acids according to hospital protocol (n = 60, 14%).Correct electrolyte imbalances. (n = 136, 31%).Restrict fluids and electrolytes in nephropathy and heart disease (n = 26, 6%).ConclusionThese results show a high demand for pharmaceutical attention in patients with TPN.Incorporation of the pharmacist in this unit makes it possible to monitor patient nutrition during hospitalisation.References and/or AcknowledgementsNo conflict of interest.

BackgroundThe clinical pharmacist’s main functions in parenteral nutrition (PN) are to ensure the appropriate assessment and monitoring of nutritional support according to the type of illness and the patient’s condition and to verify the quality and safety of the solutions prepared.PurposeTo describe the pharmaceutical interventions (PIs) made in patients hospitalised in a postsurgical intensive care unit.To find the degree of acceptance of the PIs and their relevance to patient care.Material and methodsRetrospective six-month study (January–June 2014).All PIs were recorded in each patient’s electronic medical record and in a special data sheet which included the indication for PN, laboratory data, type of nutrition, type of intervention and acceptance.ResultsNutritional monitoring was performed in 40 patients. 442 PIs were carried out during the study period, with a mean of 11 PIs/patient.The PIs were categorised as the following:Nutrition assessment (n = 158; 36%)Intravenous fluids needs (n = 26; 6%)Electrolyte imbalances (n = 136; 30%)Prevention of liver disease caused by PN (n = 34; 8%)Others (food allergies, glucose management, laboratory monitoring, administration of glutamine and omega 3 fatty acids) (n = 88; 20%)The overall degree of acceptance of the interventions was 99%.ConclusionThe high number and variety of types of PI performed by the pharmacist contributed to improving nutritional support and reducing complications, ensuring a more effective and safer use of PN.References and/or AcknowledgementsESPEN Guidelines for adult parenteral nutritionClin Nutr 2009;28:359–479No conflict of interest.