Hypoglycemic treatment of diabetic patients in the Emergency Department Caballero Requejo, Carmen; Urbieta Sanz, Elena; Trujillano Ruiz, Abel ...
Farmacia hospitalaria : organo oficial de expresion cientifica de la Sociedad Espanola de Farmacia Hospitalaria,
05/2016, Letnik:
40, Številka:
3
Journal Article
To analyze if the hypoglycemic therapy prescribed in the Emergency Department adapts to the consensus recommendations available, as well as to assess its clinical impact.
A descriptive observational ...study, which included patients awaiting hospital admission, who were in the Observation Ward of the Emergency Department and had been previously diagnosed with diabetes mellitus, and were receiving treatment with hypoglycemic drugs at home. The management of antidiabetic treatment and its clinical impact were assessed.
78 patients were included. At admission to the Emergency Department, treatment was modified for 91% of patients, and omitted for 9%. The most prescribed treatment was sliding scale insulin (68%). The treatments prescribed coincided in a 16.7% with the recommendations by the Spanish Society of Emergency Medicine. After intervention by the Pharmacist, the omission descended to 1.3%, and the adaptation to the recommendations increased to 20.5%. Comparing patients whose treatment coincided with the recommendations and those who did not, the clinical impact was respectively: mean glycemia at 24 hours: 138.3 } 49.5 mg/dL versus 182.7 } 97.1 mg/dL (p = 0.688); mean rescues with insulin lispro: } 1.6 versus 1.5 } 1.8 (p = 0.293); mean units of insulin lispro administered: 4.6 } 12.7 IU versus 6.6 } 11.3 IU (p = 0.155).
We found antidiabetic prescriptions to have a low adaptation to consensus recommendations. These results are in line with other studies, showing an abuse of sliding scale regimen as single hypoglycemic treatment.
To evaluate the results of the implementation of a therapeutic reconciliation procedure (TRP) at admission by the emergency department (ED).
Prospective observational study conducted in the ED of a ...Referral Hospital Area. We collected the results of the implementation of a TRP from September to December 2012. A pharmacist attended daily to emergency department meeting and reviewed medical history to select those patients with high risk of reconciliation error (RE) according TRP. Afterwards, home medication history was elaborated with emergency department and primary care records and interview with the patient or caregiver. Therapeutic reconciliation took place with the emergency physician, considering RE any discrepancies not justified by the doctor. The potential severity of RE was assessed by emergency physicians outside the study using NCCMERP'S categorization.
The pharmacist collected an avarage of 1,3±2,2 home medication more than the emergency physician finding 564 discrepancies with the emergency record in 95,8% of the patients. 167 were RE affecting 69 patients (71,9%). Most of the errors were due to omissions of the drugs. Acceptance by emergency physicians of the reconciliation interventions was 73,9%. 58% of the RE were considered clinically relevants. Other interventions were also performed with an acceptance of 97%. Greater compliance with risk criteria, polypharmacy and pluripathology were associated with present RE and prescription of high-risk medications with the need for intervention.
The application of TRP avoided any error in most of the patients. TRP should extend to all patients at risk who admitted by the ED.
