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Smith E, Fox A, Willmers G, Wright D, Stuart B. Impact of implementing the aseptic compounding management system, Medcura, on internal error rates within an oncology pharmacy aseptic unit: a mixed methods evaluation. Eur J Hosp Pharm 2024; 31:220-226. [PMID: 36241376 DOI: 10.1136/ejhpharm-2022-003377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/12/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND As cancer survivorship improves, pressure on oncology services to provide safe, timely treatments increases. Traditional manual compounding processes are error prone, putting patients at risk. Additionally, errors have a detrimental impact on service delivery and staff morale. Information technology is increasingly utilised to improve safety and service delivery of systemic anti-cancer therapy (SACT). The compounding process control system, Medcura, was developed to manage the end-to-end process and reduce transcription and calculation errors. OBJECTIVES To evaluate the impact of implementing Medcura on internal errors and staff perceptions of errors. METHOD An aseptic process control system, Medcura, was implemented in a busy pharmacy chemotherapy production unit. Internal error and severity data were collected and analysed for 14 months before and during implementation, and 24 months after implementation. In addition, one-to-one semi-structured interviews were carried out with pharmacy staff, pre- and post-implementation. Interviews were transcribed and thematically analysed. RESULTS Error rates decreased after implementation from 2.9% to 2.1%. The types of error detected also changed with a decrease in worksheet and labelling errors, and an increase in assembly errors. The severity of the errors, as a percentage of total errors made, also decreased after implementation. Staff were predominantly positive about Medcura; it reduced the number of errors, eased the preparation of worksheets and labels, reduced pressure and work-related stress, and improved job satisfaction. CONCLUSIONS Implementing Medcura has resulted in a reduction in both error rate and severity. Specifically, errors related to label and worksheet generation have seen the largest reduction. Staff have viewed these changes positively and report reduced levels of work-related stress. Further development and roll-out will improve patient safety and staff morale.
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Affiliation(s)
- Emily Smith
- Pharmacy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andy Fox
- Pharmacy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Graeme Willmers
- Pharmacy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Deborah Wright
- Pharmacy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Beth Stuart
- University of Southampton Faculty of Medicine, Southampton, Southampton, UK
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Ferro Rodríguez S, Misa García A. Home antibiotic therapy in elastomeric infusion pumps - past, present and future. Eur J Hosp Pharm 2024:ejhpharm-2024-004166. [PMID: 38653504 DOI: 10.1136/ejhpharm-2024-004166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
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Trippoli S, Fadda V, Messori A. In-hospital expenditure for medical devices: basic benchmarks for interpreting local data. Eur J Hosp Pharm 2024; 31:285-286. [PMID: 37369594 PMCID: PMC11042459 DOI: 10.1136/ejhpharm-2023-003885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
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McIntyre FB, Vickers L, Wallem A, van de l'Isle M, McLean A, Souter C. Practising prioritisation: exploring variation in applying a clinical pharmacy risk stratification tool. Eur J Hosp Pharm 2024; 31:267-273. [PMID: 36600455 DOI: 10.1136/ejhpharm-2022-003369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To evaluate the use of a risk stratification tool and explore the contributing factors to variation in practice by clinical pharmacists. METHODS The quantitative phase was a prospective evaluation of adherence to the risk stratification tool. Patients were selected by convenience sampling from medical wards across two hospital sites. Researchers applied the risk stratification tool to each patient, documented the code, accessed health records in subsequent days, and recorded the code assigned by the pharmacist. These codes were compared. The kappa (κ) coefficient test was performed using SPSS software as a statistical measure of agreement. The qualitative phase was designed using focus groups with clinical pharmacists. One focus group was conducted at each of the two study sites. Participants were grouped to ensure a mix of experience levels. To augment the discussion, participants completed a short survey. Focus groups were recorded and a thematic analysis undertaken. RESULTS The final cohort for quantitative analysis was 73. Researchers and pharmacists allocated the same code to 19 (26%) patients. The highest match rate was observed between researchers and rotational pharmacists. The κ coefficient was 0.039 (slight agreement) with p value=0.52 (not significant). Ten pharmacists participated in the focus groups: three from site 1 and seven from site 2. All participants reported using the principles of the risk stratification tool every day, but they rarely accessed the tool. Pharmacists reported using the tool as a workload management and communication system. CONCLUSIONS Variation in application of the risk stratification tool exists among pharmacists. Focus group participants described multiple scenarios where non-patient factors were considered in assigning a priority code for the patient. A schedule of regular review of the criteria; training and peer review; tool validation; and research identifying the relationship between structured professional judgement and risk stratification tools is recommended.
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Affiliation(s)
- Fiona B McIntyre
- Pharmacy, NHS Forth Valley, Larbert, UK
- Pharmacy, NHS Lothian, Edinburgh, Edinburgh, UK
| | - Lauren Vickers
- College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
- Pharmacy Benefits, University of Kentucky, Lexington, Kentucky, USA
| | - Alexandra Wallem
- College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
- Value, Evidence and Outcomes, Eli Lilly and Company, Indianapolis, Indiana, USA
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Rivasi M, Porretta Serapiglia C, Medici G, Ricchi L. Extravasation of brentuximab vedotin, an antibody-drug conjugate, in a patient with anaplastic large cell lymphoma. Eur J Hosp Pharm 2024:ejhpharm-2024-004089. [PMID: 38448203 DOI: 10.1136/ejhpharm-2024-004089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024] Open
Abstract
Brentuximab vedotin (BV) is an antibody-drug conjugate, consisting of a CD30-directed antibody, conjugated by a protease-cleavable linker to a microtubule disrupting agent auristatin E (MMAE). Although the safety datasheet of BV does not warn of severe toxic effects of extravasation, we report a third case of a patient with anaplastic large cell lymphoma who developed severe epidermal necrosis after extravasation. The reason for what happened could be attributed to the fact that MMAE belongs to the group of vinca alkaloids so it should be handled like other tissue-necrotising chemotherapeutics. Reporting of all cases of extravasation involving new conjugated chemotherapeutic drugs is of the utmost importance to be able to develop updated guidelines. Hospital pharmacists can provide information on how to manage extravasation, assess the potential risk, and have a crucial role in drafting hospital protocols.
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Affiliation(s)
- Marianna Rivasi
- Dipartimento Farmaceutico Interaziendale, Azienda Unità Sanitaria Locale di Modena, Modena, Emilia-Romagna, Italy
| | - Carla Porretta Serapiglia
- Dipartimento Farmaceutico Interaziendale, Azienda Unità Sanitaria Locale di Modena, Modena, Emilia-Romagna, Italy
| | - Gregorio Medici
- Dipartimento Farmaceutico Interaziendale, Azienda Unità Sanitaria Locale di Modena, Modena, Emilia-Romagna, Italy
| | - Lucia Ricchi
- Dipartimento Farmaceutico Interaziendale, Azienda Unità Sanitaria Locale di Modena, Modena, Emilia-Romagna, Italy
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Wilkinson AS, Walker KE, Ozolina L, Machníková R, Johnson AJ, Bhogal N, Pegg K. Integrity performance assessment of a closed system transfer device syringe adaptor lock as a terminal closure for Luer-Lock syringes. Eur J Hosp Pharm 2023; 31:50-56. [PMID: 35410874 PMCID: PMC10800267 DOI: 10.1136/ejhpharm-2021-003148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/29/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the container closure integrity of a closed system transfer device syringe adaptor lock in combination with disposable Luer-Lock syringes as the terminal closure device. The UK National Health Service (NHS) Pharmaceutical Quality Assurance Committee (PQAC) requires syringe integrity data for final storage devices of aseptic products such as chemotherapy drugs when prepared in advance and stored before use, as is standard practice for dose banded drugs. The assessment comprised both physical and microbial integrity testing of the combination closed system/Luer-Lock syringe containers at syringe sizes of 1 mL, 20 mL, and 50 mL. METHODS Integrity testing was performed as described in the NHS Pharmaceutical Quality Assurance Committee yellow cover document, second edition 2013 'Protocols for the Integrity Testing of Syringes', with Chemfort (Simplivia, IL) syringe adaptor lock (SAL) devices as replacement for sterile blind hubs. Microbiological integrity was assessed according to method 1 part 1.4 using Brevundimonas diminuta at 32°C for up to 14 days of contact time. Two positive control devices per syringe size were tested using a blind hub cap as closure which was loosened before the test. Physical integrity was assessed using method 3 of the yellow cover document which is a dye intrusion method. Dye intrusion was assessed both visually and using a validated ultraviolet-visible spectrophotometer method. For each size/batch of test articles a positive control device (n=1) was assessed using a wire wrapped around the syringe plunger tip deliberately compromising integrity. Negative controls for each size (n=1) consisted of devices not immersed in methylene blue dye. RESULTS Chemfort syringe adaptor lock/Luer-Lock syringe combinations were shown to be: (1) free of microbiological contamination after 14 days of contact time (n=60); and (2) free of dye intrusion at all syringe sizes tested (n=61 in total). The data demonstrate 100% closure integrity of the final container system when the Chemfort syringe adaptor lock replaces the syringe hub as the terminal closure device. All positive control devices demonstrated system suitability as container integrity was compromised in all positive control tests. All negative controls were negative for microbial and dye intrusion. CONCLUSIONS Syringe adaptor lock components complied with the NHS Pharmaceutical Quality Assurance Committee yellow cover document syringe integrity requirements when used as the terminal closure of Luer-Lock disposable syringes from 1 mL up to 50 mL. Therefore, syringe adaptor lock (Chemfort) can be used as the terminal closure system for pre-filled syringes of chemotherapeutic drug products prepared in advance in UK NHS pharmacy technical services.
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Affiliation(s)
- Alan Shaun Wilkinson
- R&D, Biopharma Stability Testing Laboratory Ltd, Nottingham, Nottinghamshire, UK
| | - Kate E Walker
- R&D, Biopharma Stability Testing Laboratory Ltd, Nottingham, Nottinghamshire, UK
| | - Laima Ozolina
- R&D, Biopharma Stability Testing Laboratory Ltd, Nottingham, Nottinghamshire, UK
| | - Romana Machníková
- R&D, Biopharma Stability Testing Laboratory Ltd, Nottingham, Nottinghamshire, UK
| | - Andrew J Johnson
- R&D, Biopharma Stability Testing Laboratory Ltd, Nottingham, Nottinghamshire, UK
| | - Navneet Bhogal
- QA Pharmacy, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, Derbyshire, UK
| | - Kate Pegg
- QA Pharmacy, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, Derbyshire, UK
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Jenkins A, Jamieson C, Santillo M. Systematic review of room temperature stability of key beta-lactam antibiotics for extended infusions in inpatient settings. Eur J Hosp Pharm 2023; 31:2-9. [PMID: 37848286 DOI: 10.1136/ejhpharm-2023-003855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Extended infusion (EI) of beta-lactam antibiotics may offer clinical benefits aligned with improved probability of target attainment for critical pharmacokinetic/pharmacodynamic parameters that correlate with efficacy. There is much research interest in prolonged and continuous infusions (collectively, extended infusions) of beta-lactams to improve patient outcomes, particularly in critically ill patients in intensive care. While definitive clinical trial data demonstrating beneficial outcomes is awaited, there has been limited focus on the stability of the agents given by EI, which may be an equally critical parameter. EI may allow for savings in nursing time due to reduced need for drug reconstitution. We set out to examine the data for stability for EI at room temperature, consistent with the requirements of 'A Standard Protocol for Deriving and Assessment of Stability- Part 1 Aseptic Preparation (Small Molecules)', which allows a 5% loss of active pharmaceutical ingredient (API) applicable for those territories that use the British Pharmacopoeia also for a 10% loss applicable in much of rest of the world. METHODS Searches using preferred reporting items for systematic reviews and meta-analyses (PRISMA) principles for stability data on freshly prepared beta-lactam antimicrobials for extended administration at room temperature (at or above 23°C) were conducted in November 2021 and updated in December 2022. RESULTS We found data to support the extension of the shelf life of 12 key beta-lactam antibiotics once reconstituted (aztreonam, amoxicillin, benzylpenicillin, flucloxacillin, piperacillin/tazobactam, cefazolin, cefmetazole, ceftaroline, ceftazidime, ceftriaxone, imipenem and meropenem) compliant with the NHS protocol, and data for five other agents (ticarcillin, cefepime, cefiderocol, cefoxitin and doripenem) which would be acceptable in regions outside the UK beyond that listed in the Summary of Product Characteristics.This review has not been registered under PROSPERO.
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Affiliation(s)
- Abi Jenkins
- Pharmacy, University Hospitals Birmingham, Birmingham, UK
| | | | - Mark Santillo
- UK and University Hospitals Bristol and Weston NHS Trust, Plymouth Bristol, UK
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8
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Trivellato S, Mengato D, Donà D, De Pieri M, Venturini F. Monoclonal antibodies for the early treatment of paediatric COVID-19 patients: a tangible contribution from hospital pharmacists in the lack of evidence. Eur J Hosp Pharm 2023; 30:e33. [PMID: 36202594 PMCID: PMC10647879 DOI: 10.1136/ejhpharm-2022-003562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
| | - Daniele Mengato
- Hospital Pharmacy Department, Padua University Hospital, Padova, Italy
| | - Daniele Donà
- Department for Women's and Children's Health, Division of Pediatric Infectious Diseases, Padua University Hospital, Padova, Italy
| | - Marica De Pieri
- Department for Women's and Children's Health, Division of Pediatric Infectious Diseases, Padua University Hospital, Padova, Italy
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Hufschmid Thurnherr E, Dahmke H, Voirol P, Waldispühl Suter B, Lutters M, Vonbach P. Automation of the medication process in Swiss hospitals: results of a survey. Eur J Hosp Pharm 2023:ejhpharm-2023-003829. [PMID: 37640441 DOI: 10.1136/ejhpharm-2023-003829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES Medication management is a core process in hospital administration. The safety, timeliness and efficiency of medication distribution may be improved by automating logistical and administrative aspects of the process. Forming an accurate high-level picture of current practices may help decision-makers to better advance the state of automation. This study aims to identify which systems for automating the medication process are currently in use in Swiss hospitals, and to what extent each system is used. METHODS A 27-question survey was developed and distributed to Swiss Association of Public Health Administration and Hospital Pharmacists (GSASA) members. The survey focused on enterprise resource planning (ERP) systems, automation of in-hospital distribution and dispensing of pharmaceutical goods, bedside scanning, and the management of drug master data. RESULTS The response rate was 98% (58/59 hospital pharmacies). All institutions had an ERP system in use, most frequently SAP (n=23, 39%). Electronic invoices from suppliers were fully processed by 37% and partially processed by 17% of respondents. Twenty-five percent of respondents reported performing bedside scanning for the purpose of medication administration. Automated medication distribution systems were available in 20 hospitals (34%), of which 13 were central robots and seven were decentralised systems. CONCLUSION A considerable gap remains to achieve closed loop processes between multiple systems. The present results provide an inventory of existing systems and current trends for use by decision-makers in hospitals and hospital pharmacies.
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Affiliation(s)
- Edith Hufschmid Thurnherr
- Institute of Hospital Pharmacy, Inselspital University Hospital Bern, Bern, Switzerland
- 'Information Systems' Working Group, Swiss Association of Public Health Administration and Hospital Pharmacists (GSASA), Bern, Switzerland
| | - Hendrike Dahmke
- Hospital Pharmacy, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Pierre Voirol
- 'Information Systems' Working Group, Swiss Association of Public Health Administration and Hospital Pharmacists (GSASA), Bern, Switzerland
- Pharmacy, CHUV, Lausanne, Vaud, Switzerland
| | - Brigitte Waldispühl Suter
- 'Information Systems' Working Group, Swiss Association of Public Health Administration and Hospital Pharmacists (GSASA), Bern, Switzerland
- Computerised clinical processes service, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Monika Lutters
- 'Information Systems' Working Group, Swiss Association of Public Health Administration and Hospital Pharmacists (GSASA), Bern, Switzerland
- Hospital Pharmacy, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Priska Vonbach
- 'Information Systems' Working Group, Swiss Association of Public Health Administration and Hospital Pharmacists (GSASA), Bern, Switzerland
- PEDeus AG (Pediatric Decision Support), Zurich, Switzerland
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10
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Sin CMH, Huynh C, Maidment ID. Physicians' and nurses' perceptions of the factors influencing the implementation of paediatric clinical pharmacy services in Hong Kong: a qualitative study. Eur J Hosp Pharm 2023:ejhpharm-2023-003796. [PMID: 37541776 DOI: 10.1136/ejhpharm-2023-003796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVES To identify barriers and facilitators that influence the implementation of paediatric clinical pharmacy services in Hong Kong public hospitals from physicians' and nurses' perspectives. METHODS A qualitative study was conducted based on semistructured interviews of physicians and nurses who worked in the field of paediatrics in four public hospitals in Hong Kong. Interviews were held via telephone conversations using spoken Cantonese which were audio recorded, then translated and transcribed directly into English by the research team. Thematic analysis was used for data analysis and reflexivity was engaged through member checking, making field notes and reporting using the Consolidated Criteria for Reporting Qualitative Studies checklist. RESULTS A total of six barriers and five facilitators were identified from interviewing 17 participants, which included 7 physicians and 10 nurses. The barriers identified were the public's lack of understanding and recognition of clinical pharmacists, a culture of medical dominance, lack of resources and heavy workload, the need for a more transparent and defined role of clinical pharmacist at the institutional level, lack of proactive approach and involvement in direct patient care activities. The facilitators identified were the belief in the improvement of patient outcomes and the overall pharmaceutical service efficiency, trust and confidence in clinical pharmacy services, filling the clinical gap as a medicine information provider, and direct and coherent communication as a multidisciplinary team member. CONCLUSIONS Physicians and nurses reported that the implementation of paediatric clinical pharmacy services was adequate, but several key barriers were identified at both the external and internal levels.
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Affiliation(s)
- Conor Ming-Ho Sin
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK
- Pharmacy Department, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
| | - Chi Huynh
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Ian D Maidment
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK
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Hamelin A, Thompson-Desormeaux F, Elliott A, Friciu M, Forest JM, Leclair G. Y-site simulation compatibility study of 10% calcium salts with various injectable solutions during toxicological resuscitation. Eur J Hosp Pharm 2023:ejhpharm-2023-003689. [PMID: 37438091 DOI: 10.1136/ejhpharm-2023-003689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 06/26/2023] [Indexed: 07/14/2023] Open
Abstract
PURPOSE To determine the physical compatibility of 10% calcium chloride and 10% calcium gluconate in combination with injectable solutions, administered in the paediatric and adult intensive care unit setting during toxicological resuscitation involving calcium channel blockers and beta-blockers. METHODS Forty-eight combinations were prepared at room temperature, including the following products: calcium chloride, calcium gluconate, insulin, epinephrine, norepinephrine, highly concentrated dextrose solution, sodium chloride, Plasma-Lyte A and Ringer's lactate. A visual evaluation at times 0, 1, 4, 24, 48 and 72 hours and a particle count test with the LS-20 particle counter at times 0, 4, 24 and 72 hours were performed. The admixtures were considered incompatible if there was a precipitate, a colour change, turbidity, viscosity or a gas formation. The stability of calcium salts was also tested in empty IV bags and syringes by the particle count test. RESULTS All drug mixtures were found to be compatible by visual evaluation and using the particle counter based on United States Pharmacopoeia chapter 788 (USP<788>) specifications. Calcium salts were compatible with insulin and vasopressors in the tested combinations. The stability of 10% calcium salts in empty IV bags and polypropylene syringes was demonstrated for up to 48 hours at room temperature. CONCLUSION All the combinations tested were physically compatible for up to 72 hours at room temperature. Clinical use of calcium salt infusions, at an undiluted concentration, in combination with these injectable solutions in a toxicological resuscitation context is considered clinically acceptable.
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Affiliation(s)
| | | | | | | | | | - Gregoire Leclair
- Faculté de pharmacie, Groupe de Recherche Universitaire sur le Médicament, Université de Montréal, Montreal, Québec, Canada
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Zhou X, Ji H. A risk prediction model of linezolid-induced thrombocytopenia for elderly patients with chronic kidney disease is urgently needed. Eur J Hosp Pharm 2023; 30:e21. [PMID: 35680394 PMCID: PMC10359774 DOI: 10.1136/ejhpharm-2022-003370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Xiaohua Zhou
- Department of Nephrology, Yancheng Third People's Hospital, Yancheng, China
| | - Hongjian Ji
- School of Pharmacy, Jiangsu Vocational College of Medicine, Yancheng, China
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Eijsink JFH, Weiss M, Taneja A, Edwards T, Girgis H, Lahue BJ, Cribbs KA, Postma M. Creating an evidence-based economic model for prefilled parenteral medication delivery in the hospital setting. Eur J Hosp Pharm 2023:ejhpharm-2022-003620. [PMID: 37369597 DOI: 10.1136/ejhpharm-2022-003620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/18/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES Prefilled syringes (PFS) may offer clinical and economic advantages over conventional parenteral medication delivery methods (vials and ampoules). The benefits of converting from vials and ampoules to PFS have been explained in previous drug-specific economic models; however, these models have limited generalisability to different drugs, healthcare settings and other countries. Our study aims to (1) present a comprehensive economic model to assess the impact of switching from vials to PFS delivery; and (2) illustrate through two case studies the model's utility by highlighting important features of shifting from vials to PFS. METHODS The economic model estimates the potential benefit of switching to PFS associated with four key outcomes: preventable adverse drug events (pADE), preparation time, unused drugs, and cost of supplies. Model reference values were derived from existing peer-reviewed literature sources. The user inputs specific information related to the department, drug, and dose of interest and can change reference values. Two hypothetical case studies are presented to showcase model utility. The first concerns a cardiac intensive care unit in the United Kingdom administering 30 doses of 1 mg/10 mL atropine/day. The second concerns a coronavirus (COVID-19) intensive care unit in France that administers 30 doses of 10 mg/25 mL ephedrine/day. RESULTS Total cost savings per hospital per year, associated with reductions in pADEs, unused drugs, drug cost and cost of supplies were £34 829 for the atropine example and €104 570 for the ephedrine example. Annual preparation time decreased by 371 and 234 hours in the atropine and ephedrine examples, respectively. CONCLUSIONS The model provides a generalisable framework with customisable inputs, giving hospitals a comprehensive view of the clinical and economic value of adopting PFS. Despite increased costs per dose with PFS, the hypothetical case studies showed notable reductions in medication preparation time and a net budget savings owing to fewer pADEs and reduced drug wastage.
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Affiliation(s)
- Job F H Eijsink
- Isala klinieken and Department of Health Sciences, University of Groningen, Zwolle, The Netherlands
| | - Mia Weiss
- Becton Dickinson and Company, Franklin Lakes, New Jersey, USA
| | - Ashley Taneja
- Becton Dickinson and Company, Franklin Lakes, New Jersey, USA
- Fairleigh Dickinson University - Florham Campus, Madison, New Jersey, USA
| | - Tyler Edwards
- Becton Dickinson and Company, Franklin Lakes, New Jersey, USA
| | - Haymen Girgis
- Becton Dickinson and Company, Le Pont-de-Claix, France
| | | | | | - Maarten Postma
- Department of Health Sciences, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Economics, Econometrics & Finance, University of Groningen Faculty of Economics and Business, Groningen, The Netherlands
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García-Martín E, Romero-Jiménez RM, Baniandrés-Rodríguez O, Escudero-Vilaplana V, Benedí-González J, de Los Ríos Luna PM, Herranz-Alonso A, Sanjurjo-Sáez M. Anti-interleukin-17 therapies for moderate/severe psoriasis in clinical practice: effectiveness, safety and association with clinical patient factors. Eur J Hosp Pharm 2023:ejhpharm-2022-003594. [PMID: 37094886 DOI: 10.1136/ejhpharm-2022-003594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/03/2023] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVES Interleukin-17 (IL-17) contributes to the pathogenesis of psoriasis. Secukinumab, ixekizumab, and brodalumab are monoclonal antibodies anti-IL-17 antibodies, approved for the treatment of moderate/severe plaque psoriasis.The aim of the study was to describe the effectiveness and safety of anti-IL-17 agents in moderate/severe plaque psoriasis in clinical practice. We also analysed anti-IL-17 therapies' survival, dose adjustment, and clinical patients' factors associated with their effectiveness and safety. METHODS A retrospective, longitudinal study was conducted at a tertiary hospital. We included patients with moderate/severe psoriasis treated with anti-IL-17 agents. The effectiveness was evaluated with Psoriasis Area and Severity Index (PASI) score and safety through the adverse drug reactions (ADRs) collected. RESULTS 38 patients were studied (median age=47.4 years, 71.0% male). The mean number of biological therapies that patients received was 2.6, and anti-IL-17 therapy was the first biological therapy for 36.8% of patients. The median years in treatment were 2.5 (95% CI 1.95 to 2.98) for secukinumab, 1.2 (95% CI 0.36 to 1.47) for ixekizumab, and 0.7 (IQR 0.71) for brodalumab. The median PASI score after 6 months of treatment was 0 (IQR 0) and 85.3% of patients achieved a PASI of 90 (84.0% with secukinumab, 87.5% with ixekizumab, and 100% with brodalumab). Dose adjustment was associated with the line of treatment (p=0.034 for naïve patients), age (p=0.044 for younger patients), and concomitant pathologies (p=0.015 without more diseases).24 patients suffered from ADRs, mainly infections of the upper respiratory tract, and there were no statistically significant differences between the three therapies. CONCLUSIONS Anti-IL-17 agents constitute an effective treatment for patients with moderate/severe plaque psoriasis and for longer. Dose reductions were associated with fewer lines of treatment, younger patients and absence of concomitant pathologies. ADR were minor and similar among the anti-IL-17.
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Affiliation(s)
- Estela García-Martín
- Pharmacy Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - R M Romero-Jiménez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ofelia Baniandrés-Rodríguez
- Dermatology Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Vicente Escudero-Vilaplana
- Pharmacy Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Juana Benedí-González
- Pharmacology, Pharmacognosy and Botany Department, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
| | - Paloma Morales de Los Ríos Luna
- Dermatology Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ana Herranz-Alonso
- Pharmacy Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - María Sanjurjo-Sáez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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15
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Beiler B, Vigneron J, D'Huart E, Demoré B. A new function in the Stabilis database: physical compatibility and incompatibility of injectable drugs to secure Y-site administration. Eur J Hosp Pharm 2023:ejhpharm-2022-003637. [PMID: 36941001 DOI: 10.1136/ejhpharm-2022-003637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/07/2023] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVES In intensive care units, the mixing of injectable drugs via Y-site administration is often necessary. However, some mixtures can lead to physical incompatibility or chemical instability. To assist healthcare professionals, several databases such as Stabilis compile compatibility and stability data. The objectives of this study were to update the online database Stabilis by adding physical compatibility data to the website and to characterise the incompatibility data already present in the database by specifying the phenomenon at the origin of the incompatibility and its time of occurrence. METHODS Bibliographic sources referenced in Stabilis were evaluated using several criteria. After the evaluation, studies were rejected or the data they contain were added to the database. Data entries contained the following information: name of the two injectable drugs involved in the mixture and their concentration if available, the dilution solvent and the phenomenon at the origin of the incompatibility and its time of occurrence for incompatibility data. Three functions of the website were modified, including the 'Y-site compatibility table' function, which allows creation of customised compatibility tables. RESULTS A total of 1184 bibliographic sources were evaluated, 77.3% (n=915) of which were scientific articles, 20.5% (n=243) were Summaries of Product Characteristics and 2.2% (n=26) were communications in a pharmaceutical congress. After evaluation, 28.9% (n=342) of the sources were rejected. From the 71.1% (n=842) sources selected, 8073 (70.2%) compatibility data entries and 3433 incompatibility data entries (29.8%) were made. With the addition of these data, the database contained compatibility and incompatibility data for 431 injectable drugs. CONCLUSIONS Since the update, the 'Y-site compatibility table' function has seen its traffic increased by about 66% (∼1500 tables per month compared with ∼2500 tables per month). Stabilis is now more complete to offer significant help to healthcare professionals with their problems of drug stability and compatibility.
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Affiliation(s)
- Benoît Beiler
- Pharmacy, Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-les-Nancy, France
- Infostab, Heillecourt, Grand Est, France
| | - Jean Vigneron
- Pharmacy, Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-les-Nancy, France
- Infostab, Heillecourt, Grand Est, France
| | - Elise D'Huart
- Pharmacy, Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-les-Nancy, France
- Infostab, Heillecourt, Grand Est, France
| | - Béatrice Demoré
- Pharmacy, Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-les-Nancy, France
- Infostab, Heillecourt, Grand Est, France
- UL UR APEMAC, Vandoeuvre-les-Nancy, Grand Est, France
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16
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Doan K, Smoke S. Antibiotic de-escalation in pneumonia with pharmacist education and ordering of methicillin-resistant Staphylococcus aureus nasal swabs. Eur J Hosp Pharm 2023:ejhpharm-2022-003504. [PMID: 36754620 DOI: 10.1136/ejhpharm-2022-003504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/25/2023] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION When methicillin-resistant Staphylococcus aureus (MRSA) is the causative pathogen in pneumonia, in-hospital mortality rate is approximately 31.2%. However, the occurrence of MRSA pneumonia is uncommon, with a reported incidence of approximately 4.2%. Vancomycin is often empirically used for MRSA pneumonia coverage, but can lead to serious harm. The purpose of this study was to measure the impact of a pharmacy-driven MRSA nares testing protocol on vancomycin and linezolid prescribing patterns and clinical outcomes in patients diagnosed with pneumonia after removal of immediate educational intervention. METHODS This single-centre, quasi-experimental study evaluated the use of a MRSA nasal swab on patients diagnosed with community-acquired pneumonia, hospital-acquired pneumonia and ventilator-associated pneumonia. This study consisted of three phases, the preimplementation phase, the active/educational phase and the postimplementation phase. The primary outcome was intravenous anti-MRSA antibiotic duration of therapy. Secondary outcomes included the occurrence of acute kidney injury, duration of hospital stay, number of vancomycin levels obtained, the number of MRSA nares swabs ordered and time points in the MRSA nares collection process. RESULTS The preimplementation phase (n=39), the active phase (n=45) and the postimplementation phase (n=26) demonstrated similar baseline characteristics. The primary outcome for duration of anti-MRSA therapy 0-72 hours was 61.5% vs 77.8% vs 76.9% (p=0.19). Acute kidney injury was decreased throughout the study at 25.6%, 24.4% and 16.7% (p=0.32). The number of MRSA nares swabs ordered were 23.1%, 60% and 30.8% in each of the phases, respectively (p=0.49). DISCUSSION Our novel approach to measuring the impact of pharmacist education and ordering of MRSA nasal swabs has demonstrated benefits that were sustained for a short period after the intervention was removed. Additional study is required to determine the long-term impact. CONCLUSION The implementation of a hospital-wide anti-MRSA protocol in patients with confirmed or suspected pneumonia indicated sustained changes for at least 3 months after direct intervention.
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Affiliation(s)
- Kevin Doan
- Pharmacy, Stanford Medicine, Stanford, California, USA
| | - Steven Smoke
- Pharmacy, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
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Athanasakis K, Nomikos N, Agorastos G, Zisis K. Hospital pharmaceutical expenditure: a need to focus on an 'obscure' and growing component of pharmaceutical spending. Eur J Hosp Pharm 2023; 30:1-2. [PMID: 36347589 PMCID: PMC9811557 DOI: 10.1136/ejhpharm-2022-003568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Kostas Athanasakis
- Department of Public Health Policy, Laboratory for Health Technology Assessment - LabHTA, University of West Attica, Athens, Greece
| | - Nikos Nomikos
- Department of Public Health Policy, Laboratory for Health Technology Assessment - LabHTA, University of West Attica, Athens, Greece
- Institute for Health Economics, Athens, Greece
| | - Giannis Agorastos
- Department of Public Health Policy, Laboratory for Health Technology Assessment - LabHTA, University of West Attica, Athens, Greece
- Institute for Health Economics, Athens, Greece
| | - Konstantinos Zisis
- Department of Public Health Policy, Laboratory for Health Technology Assessment - LabHTA, University of West Attica, Athens, Greece
- Institute for Health Economics, Athens, Greece
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18
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Hughes S, Heard K, Mughal N, Moore LSP. Burden of enteral supplement interactions with common antimicrobial agents: a single-centre observational analysis. Eur J Hosp Pharm 2022; 29:280-283. [PMID: 33414257 PMCID: PMC9660598 DOI: 10.1136/ejhpharm-2020-002445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 12/01/2020] [Accepted: 12/08/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Oral antimicrobials, including ciprofloxacin, levofloxacin and doxycycline, are susceptible to binding with enteral therapies such as calcium and iron therapies. Administered together, the bioavailability of these antimicrobials is expected to be reduced. METHODS A retrospective case series of patients receiving oral antimicrobials (ciprofloxacin, levofloxacin and doxycycline) was analysed at a single-centre NHS acute hospital (April 2016-September 2019). Patient demographics, including concurrent enteral therapies, were recorded using medical records. Clinically important interactions were defined as doses administered within 2 hours of antimicrobial therapy. RESULTS A total of 4067 prescriptions for the study antimicrobials (ciprofloxacin, n=1905; levofloxacin, n=538; and doxycycline, n=1624) were prescribed for 3584 patients. 1918/3583 (53.5%) of the patients were female, and the median age was 67 years (range 0.5-105.0 years). 810/4067 (19.3%) prescriptions reviewed had an interacting enteral therapy (calcium or iron salt) administered within 2 hours of the study medication. CONCLUSION The concomitant administration of enteral calcium and iron with oral antimicrobials is common within the acute care hospital setting. Approximately one in five patients has a clinically important interaction which may impair oral bioavailability and limit treatment efficacy. As antimicrobial stewardship teams strive for increased intravenous-to-oral de-escalation, it is important that optimum dosing administration is followed to optimise patient outcomes.
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Affiliation(s)
- Stephen Hughes
- Pharmacy, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Katie Heard
- Pharmacy, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nabeela Mughal
- Microbiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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19
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Cheong TS, Zhu B, Chong E. The geriatric clinical pharmacist at the emergency department: a novel front-door transdisciplinary care model. Eur J Hosp Pharm 2022; 30:ejhpharm-2022-003458. [PMID: 35853691 PMCID: PMC10447951 DOI: 10.1136/ejhpharm-2022-003458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Birong Zhu
- Nursing Service, Tan Tock Seng Hospital, Singapore
| | - Edward Chong
- Geriatrics Medicine, Tan Tock Seng Hospital, Singapore
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