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Rak pri otrocih je redka bolezen. V Sloveniji letno zboli okoli 50 otrok. Pediatrična populacija je še posebej občutljiva, saj je pri njej prisotna drugačna farmakokinetika in farmakodinamika kot pri odraslih, zato imajo zdravniki in farmacevti pomembno vlogo pri določanju odmerkov zdravil in prilagajanju terapije. Ti bolniki po navadi potrebujejo niţje odmerke zdravil, kot je količina v enoodmernem vsebniku. Zaradi nadzorovanih pogojev shranjevanja lahko nekatere citostatike v lekarni shranjujejo do 28 dni, medtem ko je mikrobiološka stabilnost na kliničnem oddelku le 24 ur. Namen magistrske naloge je analizirati, ali je Klinični oddelek za otroško hematologijo in onkologijo Pediatrične klinike Ljubljana zaradi uvedbe centralizirane priprave citostatikov v lekarni ustvaril prihranek na račun daljše stabilnosti učinkovin. Poleg tega je namen naloge tudi ovrednotiti neskladja na naročilnicah za pripravo kemoterapije. V obdobju med aprilom 2013 in marcem 2014 so s centralizirano pripravo citostatikov v lekarni za pediatrične bolnike ustvarili skoraj 37 tisoč evrov prihranka. Največji prihranek so ustvarili z novejšimi učinkovinami, ki imajo še vedno visoko ceno. Pregledali smo 656 naročilnic za pripravo kemoterapije, od tega je 49 % naročilnic vsebovalo vsaj eno neskladje. Skupno je bilo 26 % neskladij klinično nepomembnih, 74 % pa klinično pomembnih, od tega je v 1 primeru farmacevt preprečil, da bi v najslabšem primeru prišlo do smrti bolnika. Zaključimo lahko, da je bila prepustitev centralizirane priprave citostatikov za pediatrične bolnike lekarni uspešna, saj v lekarni ostanke zdravila shranijo v viali in jih lahko v času stabilnosti porabijo za naslednjega bolnika ter s tem prihranijo. Z ovrednotenjem neskladij pa smo ugotovili, da je farmacevtova vloga pri pregledu predpisane kemoterapije pomembna, saj lahko pripomore k varnejšemu zdravljenju pediatričnih bolnikov. Cancer in children is a rare disease. In Slovenia about 50 children develop cancer every year. Pediatric population is more sensitive, because their pharmacokinetics and pharmacodynamics are different than in adults, so physicians and pharmacists play an important role in determining appropriate doses of medicines and in conforming therapy. Pediatric patients usually need lower doses of medicines than is the amount of a monodose-container. Because of the controllable conditions of storage, the pharmacy can store some cytostatics up to 28 days, whereas the microbiological stability on the ward is only 24 hours. The purpose of Master's degree is to analyze, whether the Department for Children Hematology and Oncology of the Pediatric Clinic Ljubljana made any savings after the introduction of centralized cytotoxic drug preparation to the pharmacy unit and due to the longer stability of drugs. Our purpose is also to evaluate the clinical importance of pharmacists' interventions made due to discrepancies prescribed on chemotherapy order forms. Between April 2013 and March 2014 the pharmacy unit saved almost 37.000 € on behalf of the introduction of centralized cytotoxic drug preparation. The highest savings were made by newer active compounds, which are still very expensive. We reviewed 656 chemotherapy order forms, 49 % of these had at least one discrepancy. Together, there were 26 % clinically unimportant discrepancies and 74 % clinically important, in 1 case of these the pharmacist prevented eventual death that could happen as the worst possible consequence. We conclude that the introduction of centralized cytotoxic drug preparation for pediatric patients to the pharmacy unit was successful, because the remainders of the medicines can be stored and used for the next patient during their stability, consequently they can save money. Furthermore, clinical evaluation showed that the pharmacist's role in reviewing the prescribed chemotherapy is important, because it can contribute to a safer medical treatment in pediatric patients. |
