Prescripción enfermera en el contexto de las urgencias y emergencia

The area of the urgencies and emergencies, assisted from all levels and care settings raises, if possible, patterns of work and ways that collaboration between professionals and teamwork make nurse prescription, often pharmacological, a legislative needs in response to increased scientific evidence and through internationally accepted performance algorithms. Enabling the nurse to act according to these concepts and beyond any "doubt and suspicion" of illegality. Taking a consensus necessary training and development and according to professional specialization and differentiation in this area and as arguments to remove any doubt still remains the subject without enclosing any sense and in many sectors.

Recepción, clasificación según escala Manchester y atención sanitaria inicial al paciente que acude a un Dispositivo de Cuidados Críticos y Urgencias (DCCU) con motivo de consulta “Diabetes”: Posibilidad de intervención finalista de la enfermera en la consulta de triage (Triage Avanzado) ante la hipoglucemia. Colaboración multidisciplinar y criterios de derivación

The Andalusian Public Health System (SSPA) is considering the last time an attempt urgent process management through triage consultation, both hospital and primary care environment and tables situations in which the nurse responsible for these consultations can carry out a final statement of which only she is directly responsible through their independent intervention and referral (Triage Advanced). Pose, at once and consistently to the idea of teamwork, where they can be the limits to that intervention finalist and the circuits to follow. This paper proposes a definition line of one of those situations through triage concepts universally tested, and takes full advantage of advanced practice profile offered by nurses Device Critical Care (DCCU) of the SSPA and any the emerging legal and regulatory framework in terms of standardized collaborative prescription, us know legitimate receivers. This work stems from the vision of professionals and our contribution to that line of institutional work that must be consensus.

Prescripción enfermera en el entorno de las urgencias y emergencias. Marco conceptual vs entorno legislado en España

The prescription, widely discussed and defined conceptually in recent years in an environment of widening the spectrum of responsibilities nurse, has capacity for integration and definition in the area of accident and emergency care and carried out over the patient urgently, about emergencies and life-long commitment. Be necessary to frame throughout the legal framework, following the amendment of the Twelfth Additional Provision of Law 29/2006 of guarantees and rational use of drugs and medical devices, can be waived and implementation required, provided under model and through the nursing process and method and as an exponent and endorsementn of science and advanced clinical practice, to join the idea of interdisciplinary professional consensus that the law posed by the preparation and implementation of standardized protocols, algorithms and / or clinical practice guidelines in the context of what has come to be called "collaborative standard prescription": Prescription to the nurse in certain clinical situations in terms of a performance protocol, agreed with multidisciplinary team care health of the population (Group Protocols), which can be considered an intermediate step in the evolution towards independent nurse prescribing, providing nurses experience of a prescription under these protocols and demonstrating their capabilities.

Prescripción, Administración de medicación y Práctica enfermera avanzadas. ¿Argumentos para una nueva definición de funciones en el área de los cuidados de urgencias y emergencias prehospitalarios?: El Ejemplo Andaluz.

Ponencia a la mesa “Definición y funciones de la Enfermería de Urgencias y Emergencias prehospitalarias”. XIII Congreso Nacional de la Sociedad Española de Enfermería de Urgencias y Emergencias (SEEUE). Vídeos disponibles en: https://vimeo.com/21043097

Protocolo para el seguimiento del tratamiento farmacológico individualizado en pacientes con anticoagulación oral

Publicado en la página web de la Consejería de Salud y Bienestar Social / Profesionales / Nuestro Compromiso por la Calidad / Estrategia de cuidados de Andalucía / Estrategia de cuidados de Andalucía

Protocolo para el seguimiento del tratamiento farmacológico individualizado en pacientes con diabetes tipo 2. 2ª ed

Publicado en la página web de la Consejería de Salud y Bienestar Social / Profesionales / Nuestro Compromiso por la Calidad / Estrategia de cuidados de Andalucía / Estrategia de cuidados de Andalucía

Protocolo para el seguimiento del tratamiento farmacológico individualizado en pacientes con sedación paliativa

Publicado en la página web de la Consejería de Salud y Bienestar Social / Profesionales / Nuestro Compromiso por la Calidad / Estrategia de cuidados de Andalucía / Estrategia de cuidados de Andalucía

Estrategia para la mejora del indicador de prescripción en receta ‘Índice sintético de calidad’

Sección "Buenas prácticas en gestión clínica"

An electronic portfolio for quantitative assessment of surgical skills in undergraduate medical education.

BACKGROUND We evaluated a newly designed electronic portfolio (e-Portfolio) that provided quantitative evaluation of surgical skills. Medical students at the University of Seville used the e-Portfolio on a voluntary basis for evaluation of their performance in undergraduate surgical subjects. METHODS Our new web-based e-Portfolio was designed to evaluate surgical practical knowledge and skills targets. Students recorded each activity on a form, attached evidence, and added their reflections. Students self-assessed their practical knowledge using qualitative criteria (yes/no), and graded their skills according to complexity (basic/advanced) and participation (observer/assistant/independent). A numerical value was assigned to each activity, and the values of all activities were summated to obtain the total score. The application automatically displayed quantitative feedback. We performed qualitative evaluation of the perceived usefulness of the e-Portfolio and quantitative evaluation of the targets achieved. RESULTS Thirty-seven of 112 students (33%) used the e-Portfolio, of which 87% reported that they understood the methodology of the portfolio. All students reported an improved understanding of their learning objectives resulting from the numerical visualization of progress, all students reported that the quantitative feedback encouraged their learning, and 79% of students felt that their teachers were more available because they were using the e-Portfolio. Only 51.3% of students reported that the reflective aspects of learning were useful. Individual students achieved a maximum of 65% of the total targets and 87% of the skills targets. The mean total score was 345 ± 38 points. For basic skills, 92% of students achieved the maximum score for participation as an independent operator, and all achieved the maximum scores for participation as an observer and assistant. For complex skills, 62% of students achieved the maximum score for participation as an independent operator, and 98% achieved the maximum scores for participation as an observer or assistant. CONCLUSIONS Medical students reported that use of an electronic portfolio that provided quantitative feedback on their progress was useful when the number and complexity of targets were appropriate, but not when the portfolio offered only formative evaluations based on reflection. Students felt that use of the e-Portfolio guided their learning process by indicating knowledge gaps to themselves and teachers.

Análisis de las prescripciones farmacológicas potencialmente inapropiadas en pacientes mayores en Atención Primaria

Sección "Buenas prácticas en gestión clínica"

Off-label uses of anti-TNF therapy in three frequent disorders: Behçet's disease, sarcoidosis, and noninfectious uveitis.

Tumoral necrosis factor α plays a central role in both the inflammatory response and that of the immune system. Thus, its blockade with the so-called anti-TNF agents (infliximab, etanercept, adalimumab, certolizumab pegol, and golimumab) has turned into the most important tool in the management of a variety of disorders, such as rheumatoid arthritis, spondyloarthropatties, inflammatory bowel disease, and psoriasis. Nonetheless, theoretically, some other autoimmune disorders may benefit from these agents. Our aim is to review these off-label uses of anti-TNF blockers in three common conditions: Behçet's disease, sarcoidosis, and noninfectious uveitis. Due to the insufficient number of adequate clinical trials and consequently to their lower prevalence compared to other immune disorders, this review is mainly based on case reports and case series.

Estudio de las prescripciones farmacológicas en niños a nivel de atención primaria: evaluación de los usos off-label o fuera de ficha técnica.

OBJECTIVE to evaluate the prescription profile and to assess the off-label and unlicensed uses of medicines among non-hospitalised pediatric patients. DESIGN cross-sectional study. SETTING pediatric units in two urban health centers and general emergency room (Hospital Materno-Infantil, Málaga). MAIN MEASUREMENTS sociodemographics variables, reasons for consultation and information about therapeutic medications. The classification of prescriptions was established according to information requirements contained in the Summary of Products Characteristics (SPC). RESULTS A total of 388 children were included (a subsample of 105 treated in the emergency room). Four hundred sixty-two prescriptions (involving 74 different active ingredients) were evaluated. Each infant received and average of 1,7 drugs (95% CI: 1,6-1,9). The most prescribed medicines were ibuprofen, paracetamol, amoxicillin-clavulanate and budesonide. The therapeutic group with the greatest variety of drugs was the respiratory group. 27,4% (95% CI: 23,5-31) of prescriptions were off-label and the main cause was different age (60%; 95% CI: 54,1-63), followed by different dose (21,5%; 95% CI: 18-25), different indication (12%; 95% CI: 9,2-15) and different route of administration (7%; 95% CI: 5,4-10). CONCLUSIONS The rate of off-label uses presents intermediate figures. Around one third of the paediatric outpatients in our sample are exposed to at least one off-label or unlicensed prescription. We should, however, point out that such usage is based on scant official, quality information, although it is not necessarily incorrect. Evidence-based medicine should be encouraged to improve drug therapy in children, as well as following the rules on drugs in special situations.

Acute haematogenous prosthetic joint infection: prospective evaluation of medical and surgical management

The optimum treatment for prosthetic joint infections has not been clearly defined. We report our experience of the management of acute haematogenous prosthetic joint infection (AHPJI) in patients during a 3-year prospective study in nine Spanish hospitals. Fifty patients, of whom 30 (60%) were female, with a median age of 76 years, were diagnosed with AHPJI. The median infection-free period following joint replacement was 4.9 years. Symptoms were acute in all cases. A distant previous infection and/or bacteraemia were identified in 48%. The aetiology was as follows: Staphylococcus aureus, 19; Streptococcus spp., 14; Gram-negative bacilli, 12; anaerobes, two; and mixed infections, three. Thirty-four (68%) patients were treated with a conservative surgical approach (CSA) with implant retention, and 16 had prosthesis removal. At 2-year follow-up, 24 (48%) were cured, seven (14%) had relapsed, seven (14%) had died, five (10%) had persistent infection, five had re-infection, and two had an unknown evolution. Overall, the treatment failure rates were 57.8% in staphylococcal infections and 14.3% in streptococcal infections. There were no failures in patients with Gram-negative bacillary. By multivariate analysis, CSA was the only factor independently associated with treatment failure (OR 11.6; 95% CI 1.29-104.8). We were unable to identify any factors predicting treatment failure in CSA patients, although a Gram-negative bacillary aetiology was a protective factor. These data suggest that although conservative surgery was the only factor independently associated with treatment failure, it could be the first therapeutic choice for the management of Gram-negative bacillary and streptococcal AHPJI, and for some cases with acute S. aureus infections.