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Objective: To describe the current situation of the hospital pharmacist in intensive care units and their activity in care, in teaching and in research. Method: Multicenter and prospective study through a survey disseminated by the Spanish Society of Hospital Pharmacy, which consisted of several sections: personal and hospital’s data, hospital’s characteristics, pharmacist’s involvement in intensive care units and teaching. Results: A number of 58 completed surveys were obtained. The number of pharmacists involved in intensive care units was 1 in 77.6% of cases, assisting an average of 30.8 beds (5-70). Experience of pharmacists in the intensive care unit was 5 years on average (2 months-25 years). Visitor’s pass assistance and shift changes were between “never” by 36.2% to “daily” by 22.4%. Out of respondents, 93.1% reported a part-time intensive care unit involvement. Regarding activities undertaken, between 40-60% of pharmacists manage narcotics, teaching at intensive care unit, conciliation and safety. Between 60-80%, pharmacists cover clinical nutrition, notarization, optimization of pharmacokinetics and antibiotics; and 84.5% perform pharmacotherapy follow-up. Out of the surveyed pharmacists, 77.6% have specialized medical training, rotating intensive care unit residents in 86% of cases. Conclusions: Most of the surveyed hospitals have one part-time pharmacist in these units. In order to improve the quality of pharmaceutical care of critically ill patients, it would be necessary to extend the involvement in time and staff, regarding the current situation, and a greater number of hospitals should include pharmacists in hospital intensive care units

Objective: To identify indicators of hospital use of antimicrobials from the benchmark analysis of consumption data between hospitals at the same level through the collective judgement of a group of experts. Method: A committee formed by members of the Spanish Societies of Hospital Pharmacy and Infectious Diseases and Clinical Microbiology prepared a proposal of indicators which was submitted to consensus by a panel of 21 experts on infectious diseases, microbiology and antimicrobial therapy, through a modified Delphi method. The panel underwent two rounds of scores by e-mail. Participants assigned a score from 1 (completely disagree) to 9 (completely agree) to the relevance of each indicator in four dimensions: scientific evidence, efficacy and safety, ecological impact and cost. Scores were processed according to the RAND- UCLA method. An indicator was considered to be relevant if at least one dimension other than cost obtained a median score equal to or higher than 7 without disagreement among the panel. Results: The committee submitted an initial proposal of 14 indicators. After the first round of panel scores, one indicator was ruled out and two were modified for moving on to the second round. Finally, 13 indicators were considered relevant. Conclusions: Determining indicators of the hospital use of antimicrobial agents based on consumption can allow the antimicrobial stewardship programs to detect any potential problems with the use of antimicrobial agents, and to help guide their efforts in order to implement actions of improvement, as well as to assess the impact of the measures implemented.

Chronic liver diseases (CLD) alter the kinetics of drugs. Despite dosage adjustment is based on Child-Pugh scores, there are no available recommendations and/or algorithms of reference to facilitate dosage regimens. A literature review about dose adjustment of the drugs from the hospital guide -which are included in the list of the WHO recommended drugs to be avoided or used with caution in patients with liver disease- was carried out. The therapeutic novelties from the last few years were also included. In order to do so, the summary of product characteristics (SPC), the database DrugDex-Micromedex, the WHO recommendations and the review articles from the last 10 years in Medline were reviewed. Moreover, the kinetic parameters of each drug were calculated with the aim of establishing a theoretical recommendation based on the proposal of Delcò and Huet. Recommendations for 186 drugs are presented according to the SPC (49.5%), DrugDex-Micromedex (26.3%) and WHO (18.8%) indications; six recommendations were based on specific publications; the theoretical recommendation based on pharmacokinetic parameters was proposed in four drugs. The final recommendations for clinical management were: dosage modification (26.9%), hepatic/analytical monitoring of the patient (8.6%), contraindication (18.8%), use with caution (19.3%) and no adjustment required (26.3%). In this review, specific recommendations for the practical management of patients with chronic liver disease are presented. It has been elaborated through a synthesis of the published bibliography and completed by following a theoretical methodology.La insuficiencia hepática crónica produce alteraciones que afectan a la cinética de los medicamentos y a pesar de que su ajuste se basa en el índice Child-Pugh, no se disponen de recomendaciones y/o algoritmos de referencia que faciliten su dosificación. Se realizó una revisión bibliográfica de la dosificación en insuficiencia hepática crónica de los medicamentos de la guía del hospital incluidos en el listado de fármacos que la OMS recomienda no utilizar o utilizar con precaución en pacientes con enfermedad hepática, añadiendo las novedades terapéuticas de los últimos años. Para ello se revisaron las fichas técnicas, base DrugDex-Micromedex, recomendaciones de la OMS y artículos de revisión de los últimos 10 años en Medline; además, se calcularon los parámetros cinéticos de cada fármaco con el objeto de establecer una recomendación teórica basada en la propuesta de Delcò y Huet. Se presentan recomendaciones para 186 medicamentos, según lo indicado en la ficha técnica (49,5%), DrugDex-Micromedex (26,3%) y OMS (18,8%); 6 recomendaciones se realizaron en base a publicaciones específicas y en 4 fármacos se propuso la recomendación teórica basada en los parámetros farmacocinéticos. Las recomendaciones finales para el manejo clínico fueron de: modificación de dosis (26,9%), monitorización hepática/analítica del paciente (8,6%), contraindicación (18,8%), emplear con precaución (19,3%) y no requerir ajuste (26,3%). En esta revisión se presentan recomendaciones específicas para el manejo práctico del paciente con insuficiencia hepática crónica, obtenida mediante una síntesis de la bibliografía publicada y completada con aplicación de una metodología teórica.