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BackgroundManagement of catheter related infections (CRIs) depends on the severity, type of catheter and need to keep it. When it is documented, systemic antimicrobial therapy should be started, as antibiotics lock therapy if the central venous catheter (CVC) is not removed. We reviewed the management of CRIs in patients undergoing haemodialysis over 2 years and found that only 18.7% of patients were properly handled. We decided to develop a treatment protocol for this type of infections with the nephrology department.PurposeTo analyse changes in the management of CRIs in patients undergoing haemodialysis after implantation of a management protocol.Material and methodsAn observational and retrospective study was carried out over 6 months in patients undergoing haemodialysis in which intravenous antibiotic therapy was initiated after implementation of a CRI management protocol. The results were compared with the results obtained in a previous study on the implementation of this protocol. The following variables were recorded: sex, age, type of venous access, type of extracted sample (blood cultures, exudate catheter or other sample), microorganisms isolated, intravenous antibiotics used and antibiotic lock therapy in patients with CVC.Results24 requests for intravenous antibiotics for 18 patients were analysed. 66.6% were men, median age 68.9 years and 61.1% of patients had CVC. Blood culture samples were collected in 50% of patients and other samples obtained were urine culture (20.8%), wound exudates (20.8%) and catheter exit site exudates (12.5%). There was no catheter related bacteraemia because all blood cultures were negative. There were 10 positive results for the rest of the samples and Pseudomonas aeruginosa was the most common isolate (50%) followed by coagulase negative staphylococcus (20%). The most common treatment was vancomycin monotherapy (25%), followed by ceftazidime monotherapy (20.8%), a combination of both drugs (16.7%) and gentamicin (12.5%). Antibiotic lock therapy was performed in 70.8% of patients with CVC. Also, 12 pharmaceutical interventions about antibiotic selection, treatment duration or suspension because of negative results were made, and 66.7% were accepted.ConclusionResults have improved after implementation of a CRI management protocol, particularly antibiotic lock therapy (from 18.7% to 70.8%), although it is still necessary to reinforce the need for taking blood cultures in serious infection to discard CRIs.No conflict of interest

Background The intensity of postoperative pain depends on the type of surgical procedure. However, it can be a problem finding the optimal treatment. Purpose To improve medical analgesics prescription according to pain intensity, considering warnings and main drug interactions. Materials and methods We did a bibliographic review from January 2004 to August 2013 in several databases (PubMed, Micromedex, Cochrane, etc.) and scientific journals. Results We designed a postoperative analgesia protocol based on a pain severity prediction according to the type of surgical procedure performed. For surgical procedures associated with mild-moderate pain: Intravenous infusion in 100 ml physiological saline at 2 ml/h for 50 h: Type 1: tramadol 6 mg/ml Type 1-RI (renal impairment): tramadol 4 mg/ml Type 2: metamizole 120 mg/ml Type 3: ketorolac 1.8 mg/ml Type 3-RI: ketorolac 1.2 mg/ml Type 4: tramadol 6 mg/ml + metamizole 120 mg/ml Type 4-RI: tramadol 4 mg/ml + metamizole 120 mg/ml Type 5: tramadol 6 mg/ml + ketorolac 1.8 mg/mlType 5-RI: tramadol 4 mg/ml + ketorolac 1.2 mg/ml For surgical procedures associated with severe pain: Intravenous infusion in 100 ml physiological saline at 2 ml/h for 50 h: Type 1: morphine 0.3 mg/ml + droperidol 0.025 mg/ml Type 2: morphine 1 mg/ml PCA (patient-controlled analgesia) Type 3: morphine 0.3 mg/ml + metamizole 120 mg/ml Type 4: morphine 0.3 mg/ml + dexketoprofen 3 mg/ml Epidural infusion in 250 ml physiological saline at 5 ml/h for 50 h: Type 1: bupivacaine 0.1% Type 2: bupivacaine 0.1% + fentanyl 2 mcg/ml Concomitant analgesia: Paracetamol IV 1 g/6 h (dose adjustment in liver disease) and metamizole IV 2 g/6–8 h or dexketoprofen IV 50 mg/8 h (depending on the type of protocol). General recommendations: To prescribe gastroprotective drugs with non-steroidal anti-inflammatory drugs and antiemetic drugs in nausea or vomiting. Avoid use of intravenous ketorolac or dexketoprofen for more than 2 days. Rescue analgesia: Morphine IV 0.05 mg/kg/4 h or pethidine IV 25–100 mg/4 h. Neuropathic pain: Amitriptyline, pregabalin or duloxetine. Conclusions An analgesics protocol has a role in guiding medical prescriptions and an impact on rational drug use. It contributes to identifying patients who could benefit from a specific drug combination and minimises possible drug side effects. No conflict of interest.

BackgroundTreatment adherence is an essential requirement for achieving the main therapeutic goals. Adherence is particularly important in self-administered drugs, such as recombinant human growth hormone (r-hGH).Easypo auto-injector is a medical device pre-programmed to deliver r-hGH, indicated for replacement of endogenous growth hormone due to growth disorders.Easypod Connect software provides healthcare professionals with reports and data from the patient’s injection history, and analyses patient treatment adherence.PurposeTo analyse treatment adherence of patients treated with Easypo-r-hGH and to assess the impact of pharmacist recommendations on patient adherence.Material and methodsObservational and retrospective study. It recruited patients to whom medicines were dispensed from the hospital pharmacy service in September 2014. We excluded patients treated for under 6 months. It analysed the overall adherence scores obtained from Easypod every 6 months, and the adherence reports were entered in the Electronic Medical Record. In patients with suboptimal adherence (<80%), corrective measures were implemented and data transfer was performed more frequently to check the impact of pharmacist intervention on adherence.Results17 patients were included, 52.9% male. Average age: 6.1 years (1–13). Overall adherence over 80% in 88.2% of patients, range 96.2–100%. Suboptimal adherence was only detected in 2 patients (77% and 52.2%). In both cases the treatment was not administrated by an adult. Pharmacists supplied appropriate advice. The data transfer device was set to report more frequently, finding in both cases an improvement in adherence after the intervention (increased by 5% and 7.6% in 5 and 3 months respectively).ConclusionMonitoring r-hGH adherence can prevent noncompliance failures. Easypod is a direct and reliable method of measuring adherence. Pharmaceutical care for patients treated with r-hGH should include strategies to promote adherence, especially in cases where treatment is not administered by an adult. Monitoring adherence allows an appropriate pharmacist intervention when it is necessary.References and/or acknowledgementsNo conflict of interest.

Background The Outpatient Pharmacy Area (OPA) has experienced an increase in patients and in the number and variety of medicines in recent years. Consequently new strategies are needed to ensure efficient OPA management that will bring benefits for both patients and hospital pharmacy. Purpose To describe the OPA re-engineering process. Its aim was to improve the activity flow of pharmaceutical care services so as to match individual patient needs with the services provided. Materials and methods A Standard Operating Procedure (SOP) was developed in 4 phases: OPA infrastructure was restructured. The Hospital Admissions Service set up an agenda for the OPA, to oversee appointments and collect data. Pharmaceutical and nursing staffs were appropriately trained in using the relevant software to use the agenda. Patients were gradually informed about the new procedures. Indicators were established to monitor the appointments system. Results OPA infrastructure comprises a pharmacists' office, a nurses' office and a waiting room. The SOP defines three types of consultation: a first consultation, a follow-up consultation and continuing-treatment consultations. First consultation: A hospital pharmacist interviews patients the first time they go to the outpatients area, initiates a drug treatment report and counsels on the treatment. Follow-up consultation: Patients are seen by a hospital pharmacist, who identifies and resolves medicines-related problems and monitors pharmacotherapy. Continuing-treatment consultation: Nursing staff dispense medicine every two months, unless the drug treatment is modified. Follow-up and continuing-treatment consultations require an advance appointment. These appointments are made and data is captured at each consultation by a pharmacist or nurse. Indicators: no. of appointments made, no. of patients seen at an appointment, no. of patients seen without an appointment and no. of patients that don't turn up. Conclusions The SOP has been able to minimise variation and promote quality during pharmacist counselling. The SOP has also improved patient flow, waiting times, medicines stock management. Further studies will be needed to evaluate the improvement of the pharmaceutical care services.