Background Hypersensitive reactions (HSRs) often require that the provoking medication be discontinued but chemotherapeutic drugs are often essential for the treatment of the disease. Rapid drug desensitization is a procedure that induces temporary tolerance to the drug allowing continuation of treatment in patients who have presented HSRs. Most of the desensitization protocols use 3 bags with sequential dilutions of the drug, which are infused in gradual steps. However, it has not been sufficiently investigated whether dilution is essential for successful desensitization. Objective The objective of this study was to evaluate the efficacy and safety of a new one-bag desensitization protocol which uses a single solution of 1 mg/mL throughout the procedure allowing to reduce time and simplifying the desensitization procedure. Methods Retrospective observational study was carried out in adult patients with HSRs to chemotherapy agents who received a new nondilution one-bag desensitization protocol between 2016 and 2021. Results A total of 130 desensitization procedures with an undiluted one-bag protocol were performed on 17 patients with HSRs to chemotherapy. One hundred and seven (82.3%) were for desensitization to CBDCA, 15 (11.5%) for oxaliplatin, 4 (3.1%) for paclitaxel and 4 (3.1%) for brentuximab. All of the 130 procedures were successfully accomplished, and all patients could receive their target dose. No breakthrough reactions (BTRs) occurred in 77% (100/130) of desensitizations, and only mild reactions (grade 1) with skin symptoms were observed in 23% (30/130) of desensitizations. Conclusion and Relevance The undiluted one-bag desensitization protocol was safe and effective and has been adopted as the standard of care at our institution in treating patients with HSRs to chemotherapeutic drugs as it requires less time and simplifies the desensitization procedure, optimizing risk management.

Background In January 2011 the old Xeral-Calde hospital in the city of Lugo moved to new premises. The new hospital management decided to set up an automated storage and dispensing system in the intensive care unit. Purpose To analyse the automated Pyxis dispensing system in the hospital's intensive care unit (ICU) from the financial and human resources point of view. Materials and methods A drugs list was established for use in the Pyxis system. Large volume medicines and emergency trolley medicines were not included. They were arranged in the Pyxis by size, frequency of use and safety considerations. A period of 10 days was set aside for training the unit personnel, facilitating the integration of the Pyxis system into the department and involving the whole personnel in the process. To acquire and data capture The authors used the SINFHOS Drugstore management software, the Web Reporting associated with the Pyxis storage system and the hospital collaborated with us over supervision. Results The average monthly / patient cost in ICU comparing the periods January–March, 2010 (without the Pyxis system) and January–March, 2011 (with the Pyxis system) was reduced by 20.3%. The number of drugs stocked has increased 11.4%, but less space is needed for storage in the unit. The pharmacy staff was required to spend more time on personnel training, each nursing assistant needing about 14 h’ more training a week; however nurses working in ICU were able to reduce the time taken for their daily work by an average of two h. Conclusions Introducing the Pyxis system in the intensive care unit is seen as a step forward in both the ICU and the pharmacy. The main advantages were the decrease in costs assigned to the unit by the reduction of accumulated stock, more information is available about the medicines for each patient and bureaucratic work has been reduced in the ICU, giving staff more time for patient care.

Background The authors wanted to compare the traditional system of dispensing medicines and the new automated Kardex medicines storage and dispensing system. Purpose To describe the process of introducing an automated Kardex medicines storage and dispensing system in the pharmacy service and to evaluate its use during the first three months. Materials and methods To prepare for the internal Kardex system drug list The authors excluded from the selection process artificial nutrition, anticancer drugs, thermolabile products, antidotes and areas of medical exclusivity. Each drug was entered into the Kardex system software (Mercurio) with maximum and minimum allowed stock levels, as well as a physical space required for its intrinsic volume and repackaging. The authors started to use the Kardex system for hospital dispensing in December 2010 and the assessment period was three months of active use. The authors used the pharmacy Mercurio and Sinfhos software to acquire and capture data. Results Initially, the internal Kardex system was used for 62% of all pharmacy drugs. The percentage of free holes was 25.5% in week 3 of activity, decreasing to 9.14% in week 12. The average number of daily prescriptions dispensed and properly completed was 7.6 in week 3 and increased to 38.6 at week 12, whereas the traditional storage system catered for an average of 14.4 orders. The difficulties The authors experienced were mainly due to lack of medicines and lack of repackaged drugs for stock. Conclusions In spite of the great initial difficulty and the resistance of nursing assistants to the Pharmacy service, The authors consider that the automated Kardex medicines storage and dispensing system offers us advantages. The authors can dispense prescribed drugs and operate Pyxis replacement stations with more efficient management of human resources. The Kardex system software provides information on incidents that arise during dispensing, to make it possible to quantify and analyse our mistakes.

Background The Department of Health and The Department of Labour and Welfare signed an agreement to develop a Pharmaceutical Care Program in a centre that serves 122 people with severe intellectual disability. Purpose To evaluate the clinical and economic impact of a Pharmaceutical Care Program, conducted by our Pharmacy Service, and to analyse the drug's usage profile in this centre. Materials and methods One year retrospective observational study (January-December 2010) describing the implemented procedures and collecting the following information: a)cumulative drug consumption and the estimated savings generated by purchasing the drugs directly from the manufacturer, hence avoiding the cost of both the mark-up of the wholesaler (9.6%) and the community pharmacy (27,9%); b)classification of the consumption by therapeutic group; c)percentage of drugs not included in the pharmaceutical guide. Tools: computer applications Edu®, Silicon® and Sinfhos®. Results The centre is located 34 kilometres away from the hospital, so The authors have designed an operating procedure that aims to optimise the human resources available while keeping an excellent quality of pharmaceutical care. The Pharmacy Service receives daily orders by fax from the centre. These are validated and transcribed by the pharmacist into Silicon® that same day. Any queries are resolved daily by phone. The Pharmacy service prepares a weekly unidosis and the pharmacist visits the centre once a week in order to facilitate communication between the Pharmacy Service and the centre's healthcare staff and to manage and date check the drug stock. During the study period: The cumulative consumption of drugs was €98,106. Applying a margin of 37.5% (9.6%+27.9%) the direct savings amounted to €36,790. The analysis showed that therapeutic groups accounting for higher costs are those included in the nervous system (66%), followed by enteral nutrition (15%). From the 311 different drugs that the centre uses, 93% belong to the pharmaceutical guide of the hospital. Conclusions Because the patients suffer from specific chronic conditions The authors were able to design and implement a procedure by means of which a part-time specialist pharmacist ensures the quality of care in terms of safety (daily validation of medical orders) and effectiveness (direct saving €3,066/month). The pharmaceutical care agreement ensures rational drug use and aids prescribing through the introduction of a pharmaceutical guide and a program of therapeutic equivalents.