Clinical pharmacy is a fast-growing discipline in Europe, ensuring optimisation and a guarantee of safety in therapeutic management. Within a hospital the intensive care unit (ICU) typically admits the most severely ill patients who require expensive medications. These patients may be at risk for potentially serious adverse events, especially when medication errors occur. This study aims to evaluate the pharmacoeconomic and clinical impact of pharmaceutical care and service within ICUs. A systematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 methodology was conducted to identify pharmacoeconomic studies published from 2017 to 2021 in Pubmed, Web of Science, and Science Direct. A qualitative methodological assessment of the studies was made using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) grid. Among the 525 articles identified from the databases, 11 were selected. Clinical benefits were mostly measured in terms of a reduction in the risk of adverse events related to care and reductions in the duration of mechanical ventilation and in-ICU and in-hospital length-of-stays. No impact on the mortality rate was demonstrated. All studies reported cost-benefit ratios ranging from €2.48 to €24.20 per €1 invested. The avoided costs per patient ranged from €29.73 to €194.24 per day of hospitalisation. The mean CHEERS compliance score was 63%±17%, demonstrating the heterogeneous quality of these analyses. International pharmacoeconomic evaluations on the impact of the clinical pharmacist operating in the ICU revealed both economic and clinical benefits for the patient. Larger randomised studies are required to confirm the major role of the pharmacist in the ICU. Data are available upon reasonable request.
临床药学在欧洲是一门快速发展的学科，它确保了治疗管理的优化和安全。在医院中，重症监护室（ICU）通常接收需要昂贵药物治疗的重症患者。这些患者可能面临潜在的严重不良事件风险，尤其是在用药错误的情况下。本研究旨在评估重症监护病房内药物护理和服务的药物经济学和临床影响。研究按照《系统综述和荟萃分析首选报告项目》（Preferred Reporting Items for Systematic Reviews and Meta-Analyses，PRISMA）2020 方法对文献进行了系统综述，以确定 2017 年至 2021 年期间在 Pubmed、Web of Science 和 Science Direct 上发表的药物经济学研究。采用卫生经济评估综合报告标准（CHEERS）网格对这些研究进行了定性方法学评估。在数据库中确定的 525 篇文章中，选出了 11 篇。临床获益主要体现在降低了与护理相关的不良事件风险、缩短了机械通气时间、缩短了重症监护室和住院时间。对死亡率没有影响。所有研究报告的成本效益比从每投入 1 欧元为 2.48 欧元到 24.20 欧元不等。每位患者每天住院所避免的费用从 29.73 欧元到 194.24 欧元不等。CHEERS依从性的平均得分为63%±17%，表明这些分析的质量参差不齐。关于临床药师在重症监护室开展工作的影响的国际药物经济学评估显示，临床药师为患者带来了经济和临床两方面的益处。要确认药剂师在重症监护室中的主要作用，还需要进行更大规模的随机研究。如有合理要求，可提供相关数据。
{"title":"Pharmacoeconomic and clinical impact of pharmaceutical service in the intensive care unit: a systematic review","authors":"Lilia Simonetti, Jean-Yves Lefrant, Bogdan Cireașă, Hélène Poujol, Géraldine Leguelinel-Blache","doi":"10.1136/ejhpharm-2024-004208","DOIUrl":"https://doi.org/10.1136/ejhpharm-2024-004208","url":null,"abstract":"Clinical pharmacy is a fast-growing discipline in Europe, ensuring optimisation and a guarantee of safety in therapeutic management. Within a hospital the intensive care unit (ICU) typically admits the most severely ill patients who require expensive medications. These patients may be at risk for potentially serious adverse events, especially when medication errors occur. This study aims to evaluate the pharmacoeconomic and clinical impact of pharmaceutical care and service within ICUs. A systematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 methodology was conducted to identify pharmacoeconomic studies published from 2017 to 2021 in Pubmed, Web of Science, and Science Direct. A qualitative methodological assessment of the studies was made using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) grid. Among the 525 articles identified from the databases, 11 were selected. Clinical benefits were mostly measured in terms of a reduction in the risk of adverse events related to care and reductions in the duration of mechanical ventilation and in-ICU and in-hospital length-of-stays. No impact on the mortality rate was demonstrated. All studies reported cost-benefit ratios ranging from €2.48 to €24.20 per €1 invested. The avoided costs per patient ranged from €29.73 to €194.24 per day of hospitalisation. The mean CHEERS compliance score was 63%±17%, demonstrating the heterogeneous quality of these analyses. International pharmacoeconomic evaluations on the impact of the clinical pharmacist operating in the ICU revealed both economic and clinical benefits for the patient. Larger randomised studies are required to confirm the major role of the pharmacist in the ICU. Data are available upon reasonable request.","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"63 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142253932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-06DOI: 10.1136/ejhpharm-2024-004214
Roland Benjamin van den Berg, Minke M van Bommel, Lennart J Stoker, Elsbeth M Westerman
The recommended approach for administering vancomycin involves intermittent peripheral infusion at a concentration of 5 mg/mL,1 while continuous central venous infusion has gained ground due to the reduced risk of renal injury and heightened probability of attaining pharmacokinetic objectives compared with intermittent dosing.2 However, adhering to the recommended concentration of 5 mg/mL for continuous vancomycin administration notably increases the total volume and necessitates frequent syringe replacements compared with concentrations ≥20 mg/mL. Within our hospital setting, vancomycin is administered via continuous infusion at a concentration of 40 mg/mL to mitigate fluid overload and reduce the need for frequent syringe changes. Recently, Masse et al demonstrated that non-filtered vancomycin solutions at concentrations ranging from 25 to 80 mg/mL diluted in sodium chloride (NaCl) 0.9% and water for injections exceeded the European Pharmacopoeia …
{"title":"Assessment of particle contamination in vancomycin syringe pumps following fluid withdrawal using three diverse aseptic reconstitution techniques","authors":"Roland Benjamin van den Berg, Minke M van Bommel, Lennart J Stoker, Elsbeth M Westerman","doi":"10.1136/ejhpharm-2024-004214","DOIUrl":"https://doi.org/10.1136/ejhpharm-2024-004214","url":null,"abstract":"The recommended approach for administering vancomycin involves intermittent peripheral infusion at a concentration of 5 mg/mL,1 while continuous central venous infusion has gained ground due to the reduced risk of renal injury and heightened probability of attaining pharmacokinetic objectives compared with intermittent dosing.2 However, adhering to the recommended concentration of 5 mg/mL for continuous vancomycin administration notably increases the total volume and necessitates frequent syringe replacements compared with concentrations ≥20 mg/mL. Within our hospital setting, vancomycin is administered via continuous infusion at a concentration of 40 mg/mL to mitigate fluid overload and reduce the need for frequent syringe changes. Recently, Masse et al demonstrated that non-filtered vancomycin solutions at concentrations ranging from 25 to 80 mg/mL diluted in sodium chloride (NaCl) 0.9% and water for injections exceeded the European Pharmacopoeia …","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"149 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140886285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-02DOI: 10.1136/ejhpharm-2023-004023
Enrique Contreras Macías, Juan Miguel Espina Lozano, Maria Dolores Cantudo-Cuenca, Maria de las Aguas Robustillo-Cortés, Estefanía Gabella-Bazarot, Ramón Morillo-Verdugo
Objectives This study aimed to assess and compare the occurrence of 3-HIT in people living with HIV (PLWH) and seronegative patients. Additionally, the study investigated whether HIV infection could serve as a predictor of the presence of 3-HIT. Methods A cross-sectional study was conducted between December 2022 and January 2023 to compare PLWH with a group of seronegative patients with chronic diseases attending an outpatient hospital pharmacy service. The 3-HIT concept encompasses the simultaneous presence of non-adherence to concomitant treatment (NAC), drug–drug interactions (DDIs), and high pharmacotherapeutic complexity in polymedicated patients. The assessment of 3-HIT compliance included NAC, evaluated using both the Morisky-Green questionnaire and electronic pharmacy dispensing records. DDIs were analysed using the Liverpool University and Micromedex databases. Pharmacotherapeutic complexity was measured using the Medication Regimen Complexity Index (MRCI) tool. Logistic regression analysis was performed to identify independent factors related to 3-HIT. Additionally, an explanatory logistic model was created to investigate whether HIV infection, along with other adjustment variables, could predict compliance with the 3-HIT concept. Results The study included 145 patients: 75 PLWH and 70 seronegative patients. The median age was 40 versus 39 years, respectively (p=0.22). Seronegative patients exhibited a higher prevalence of NAC (p<0.01). HIV infection was identified as a protective factor in the context of DDIs (p<0.01). Male sex (p<0.01) and age (p=0.01) were identified as being associated with an MRCI ≥11.25 points. A higher prevalence of 3-HIT was observed in seronegative patients (18.7% vs 48.6%, p<0.01). However, the developed regression model identified HIV infection as a risk factor associated with an increased likelihood of 3-HIT (OR 4.00, 95% CI 1.88 to 8.52, p<0.01). Conclusions The 3-HIT concept exhibited a high prevalence among seronegative patients with chronic diseases, with HIV infection identified as a predicted risk factor for NAC and the development of 3-HIT. Data are available upon reasonable request. Study data are available upon reasonable request.
{"title":"Comparative analysis of the prevalence 3-HIT concept in people living with HIV and seronegative patients with chronic conditions. Cross-3HIT Project.","authors":"Enrique Contreras Macías, Juan Miguel Espina Lozano, Maria Dolores Cantudo-Cuenca, Maria de las Aguas Robustillo-Cortés, Estefanía Gabella-Bazarot, Ramón Morillo-Verdugo","doi":"10.1136/ejhpharm-2023-004023","DOIUrl":"https://doi.org/10.1136/ejhpharm-2023-004023","url":null,"abstract":"Objectives This study aimed to assess and compare the occurrence of 3-HIT in people living with HIV (PLWH) and seronegative patients. Additionally, the study investigated whether HIV infection could serve as a predictor of the presence of 3-HIT. Methods A cross-sectional study was conducted between December 2022 and January 2023 to compare PLWH with a group of seronegative patients with chronic diseases attending an outpatient hospital pharmacy service. The 3-HIT concept encompasses the simultaneous presence of non-adherence to concomitant treatment (NAC), drug–drug interactions (DDIs), and high pharmacotherapeutic complexity in polymedicated patients. The assessment of 3-HIT compliance included NAC, evaluated using both the Morisky-Green questionnaire and electronic pharmacy dispensing records. DDIs were analysed using the Liverpool University and Micromedex databases. Pharmacotherapeutic complexity was measured using the Medication Regimen Complexity Index (MRCI) tool. Logistic regression analysis was performed to identify independent factors related to 3-HIT. Additionally, an explanatory logistic model was created to investigate whether HIV infection, along with other adjustment variables, could predict compliance with the 3-HIT concept. Results The study included 145 patients: 75 PLWH and 70 seronegative patients. The median age was 40 versus 39 years, respectively (p=0.22). Seronegative patients exhibited a higher prevalence of NAC (p<0.01). HIV infection was identified as a protective factor in the context of DDIs (p<0.01). Male sex (p<0.01) and age (p=0.01) were identified as being associated with an MRCI ≥11.25 points. A higher prevalence of 3-HIT was observed in seronegative patients (18.7% vs 48.6%, p<0.01). However, the developed regression model identified HIV infection as a risk factor associated with an increased likelihood of 3-HIT (OR 4.00, 95% CI 1.88 to 8.52, p<0.01). Conclusions The 3-HIT concept exhibited a high prevalence among seronegative patients with chronic diseases, with HIV infection identified as a predicted risk factor for NAC and the development of 3-HIT. Data are available upon reasonable request. Study data are available upon reasonable request.","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140828825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-15DOI: 10.1136/ejhpharm-2023-004047
Delphine Bourneau-Martin, Aurelie Grandvuillemin, Marina Babin, Charlotte Mullet, Hillary Said, Morgane Cellier, Helene Geniaux, Sophie Gautier, Mathilde Beurrier, Gwenaelle Veyrac, Laurence Lagarce, Marie-Laure Laroche, Marie Briet
Objectives Drug shortages are of increasing concern to worldwide public health. The consequences of drug shortages for patient safety have been little studied, especially from a pharmacovigilance point of view. In this context, the network of French pharmacovigilance centres conducted the CIRUPT study (Conséquences Iatrogènes des RUPTures de stock/iatrogenic consequences of drug shortages) based on a prospective campaign of adverse effects occurring in the context of drug shortage notifications. Methods All notifications involving a shortage drug submitted to the French pharmacovigilance centres between 1 January 2020 and 30 June 2021 were collected and registered in the French national pharmacovigilance database with the standardised high level term ‘product supply and availability issues’ and with predefined keywords in the narrative section. Results 224 cases were included, involving mainly adverse drug reactions (ADRs) (n=131/224, 59%) and medication errors (n=51/224, 23%); 29% of the cases were serious. The most represented classes of shortage drugs were: vaccines (n=78/224, 35%); drugs for acid-related disorders (H2-receptor antagonists) (n=27/224, 12%); antineoplastic agents (n=17/224, 8%); and antiepileptics (n=15/224, 7%). In 82% of cases, the involved shortage drug was the subject of information delivered to health professionals by the National Agency for the Safety of Medicines and Health Products. Drug shortages were associated with an ADR related to replacement drugs in 59% (n=131/224) of the cases, drug inefficacy in 18% (n=41/224), and/or an aggravation of the underlying disease in 11% (n=25/224). Conclusions From a pharmacovigilance point of view, a large diversity of anatomical therapeutic classes is involved and the risk related to drug shortages is not limited to drugs registered on ‘major therapeutic interest or essential drug’ lists. Information from health agencies is not sufficient to avoid the risks, and further strategies should be developed. Data are available upon reasonable request. The data presented in this study are available on request from the corresponding author. The request should be accompanied by a research protocol. The data are not publicly available due to European ethical and legal restrictions.
{"title":"Adverse drug effect in the context of drug shortage: the CIRUPT prospective study from the French pharmacovigilance network","authors":"Delphine Bourneau-Martin, Aurelie Grandvuillemin, Marina Babin, Charlotte Mullet, Hillary Said, Morgane Cellier, Helene Geniaux, Sophie Gautier, Mathilde Beurrier, Gwenaelle Veyrac, Laurence Lagarce, Marie-Laure Laroche, Marie Briet","doi":"10.1136/ejhpharm-2023-004047","DOIUrl":"https://doi.org/10.1136/ejhpharm-2023-004047","url":null,"abstract":"Objectives Drug shortages are of increasing concern to worldwide public health. The consequences of drug shortages for patient safety have been little studied, especially from a pharmacovigilance point of view. In this context, the network of French pharmacovigilance centres conducted the CIRUPT study (Conséquences Iatrogènes des RUPTures de stock/iatrogenic consequences of drug shortages) based on a prospective campaign of adverse effects occurring in the context of drug shortage notifications. Methods All notifications involving a shortage drug submitted to the French pharmacovigilance centres between 1 January 2020 and 30 June 2021 were collected and registered in the French national pharmacovigilance database with the standardised high level term ‘product supply and availability issues’ and with predefined keywords in the narrative section. Results 224 cases were included, involving mainly adverse drug reactions (ADRs) (n=131/224, 59%) and medication errors (n=51/224, 23%); 29% of the cases were serious. The most represented classes of shortage drugs were: vaccines (n=78/224, 35%); drugs for acid-related disorders (H2-receptor antagonists) (n=27/224, 12%); antineoplastic agents (n=17/224, 8%); and antiepileptics (n=15/224, 7%). In 82% of cases, the involved shortage drug was the subject of information delivered to health professionals by the National Agency for the Safety of Medicines and Health Products. Drug shortages were associated with an ADR related to replacement drugs in 59% (n=131/224) of the cases, drug inefficacy in 18% (n=41/224), and/or an aggravation of the underlying disease in 11% (n=25/224). Conclusions From a pharmacovigilance point of view, a large diversity of anatomical therapeutic classes is involved and the risk related to drug shortages is not limited to drugs registered on ‘major therapeutic interest or essential drug’ lists. Information from health agencies is not sufficient to avoid the risks, and further strategies should be developed. Data are available upon reasonable request. The data presented in this study are available on request from the corresponding author. The request should be accompanied by a research protocol. The data are not publicly available due to European ethical and legal restrictions.","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140592656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-10DOI: 10.1136/ejhpharm-2023-004066
Darija Kuruc Poje, Raymond William Fitzpatrick, Claire Stevens, Carl Machin, Jonathan Underhill, Petr Horák, Aida Batista, András Süle, Nenad Miljković, Claudia Plesan, Stephanie Kohl, Gonzalo Marzal Lopez
Objective From 1995, the European Association of Hospital Pharmacists (EAHP) has regularly investigated the progress of the hospital pharmacy profession in Europe, and identified key barriers and drivers of this. The most recent ‘Investigation of the Hospital Pharmacy Profession in Europe’ was conducted from November 2022 to March 2023. Methods The online questionnaire was sent to all hospital pharmacies in EAHP member countries. The investigation was drafted using the same questions as the 2015 baseline survey. Where possible and relevant, responses were compared with the data from previous surveys that monitored the implementation of the EAHP statements. Keele University, Centre for Medicines Optimisation, School of Pharmacy and Bioengineering, UK analysed the data. Results The overall number of responses was 653, with a better response rate of 19% compared with 14% in 2018 statements survey. The findings indicated that participating hospital pharmacies have similar characteristics to previous surveys. Section 1 (Introductory statements and governance), section 2 (Selection, procurement and distribution), section 3 (Production and compounding), section 5 (Patient safety and quality assurance) questions were generally answered positively, with results ranging from 52% to 90%. However, results for section 4 (Clinical pharmacy services) returned lower levels of positivity, with responses from 8 of the 15 questions being less than 60%. When asked what is preventing hospital pharmacists from achieving implementation of these activities, most answers were limited capacity, not considered to be a priority by managers, or other healthcare professionals do this. The last section focused on self-assessment and action planning, with fewer than 50% of positive responses; COVID-19 preparedness and vaccines with mixed positive and negative responses. Furthermore, implementation of the falsified medicines directive impacted the medication handling processes in 50% or more of the answers. Regarding sustainability, the majority (59%) of respondents felt a greater focus should be on sustainability from an organisational or management perspective. Conclusion Results offer valuable insights into the hospital pharmacy profession throughout Europe. While there have been improvements in certain areas, challenges remain, particularly in implementing clinical pharmacy services. The findings provide a foundation for further dialogue, advocacy, and strategic planning to advance the role of hospital pharmacists and enhance patient care in Europe’s healthcare systems. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
{"title":"Investigation of the hospital pharmacy profession in Europe","authors":"Darija Kuruc Poje, Raymond William Fitzpatrick, Claire Stevens, Carl Machin, Jonathan Underhill, Petr Horák, Aida Batista, András Süle, Nenad Miljković, Claudia Plesan, Stephanie Kohl, Gonzalo Marzal Lopez","doi":"10.1136/ejhpharm-2023-004066","DOIUrl":"https://doi.org/10.1136/ejhpharm-2023-004066","url":null,"abstract":"Objective From 1995, the European Association of Hospital Pharmacists (EAHP) has regularly investigated the progress of the hospital pharmacy profession in Europe, and identified key barriers and drivers of this. The most recent ‘Investigation of the Hospital Pharmacy Profession in Europe’ was conducted from November 2022 to March 2023. Methods The online questionnaire was sent to all hospital pharmacies in EAHP member countries. The investigation was drafted using the same questions as the 2015 baseline survey. Where possible and relevant, responses were compared with the data from previous surveys that monitored the implementation of the EAHP statements. Keele University, Centre for Medicines Optimisation, School of Pharmacy and Bioengineering, UK analysed the data. Results The overall number of responses was 653, with a better response rate of 19% compared with 14% in 2018 statements survey. The findings indicated that participating hospital pharmacies have similar characteristics to previous surveys. Section 1 (Introductory statements and governance), section 2 (Selection, procurement and distribution), section 3 (Production and compounding), section 5 (Patient safety and quality assurance) questions were generally answered positively, with results ranging from 52% to 90%. However, results for section 4 (Clinical pharmacy services) returned lower levels of positivity, with responses from 8 of the 15 questions being less than 60%. When asked what is preventing hospital pharmacists from achieving implementation of these activities, most answers were limited capacity, not considered to be a priority by managers, or other healthcare professionals do this. The last section focused on self-assessment and action planning, with fewer than 50% of positive responses; COVID-19 preparedness and vaccines with mixed positive and negative responses. Furthermore, implementation of the falsified medicines directive impacted the medication handling processes in 50% or more of the answers. Regarding sustainability, the majority (59%) of respondents felt a greater focus should be on sustainability from an organisational or management perspective. Conclusion Results offer valuable insights into the hospital pharmacy profession throughout Europe. While there have been improvements in certain areas, challenges remain, particularly in implementing clinical pharmacy services. The findings provide a foundation for further dialogue, advocacy, and strategic planning to advance the role of hospital pharmacists and enhance patient care in Europe’s healthcare systems. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140571765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cancer research has grown significantly in recent years with the advent of targeted therapies and immunotherapies. Hospital pharmacies with clinical trials and production units need to manage and produce these new drugs. Unlike the industry, where processes are automated, hospital pharmacy processes are often manual. The flow of these experimental drugs should be secured.1 Hospital pharmacies can choose from several production in-process control methods, the most common of which is human-visual double-checking or computer-assisted preparation with automated visual control by camera or automated gravimetric control by connected scales. This method, which uses computer-assisted double-checking, has …
{"title":"When gravimetry is debated by sponsors of clinical studies","authors":"Aline Voidey, Isabelle Sommer, Alessia Marino, Laurent Carrez, Farshid Sadeghipour","doi":"10.1136/ejhpharm-2024-004153","DOIUrl":"https://doi.org/10.1136/ejhpharm-2024-004153","url":null,"abstract":"Cancer research has grown significantly in recent years with the advent of targeted therapies and immunotherapies. Hospital pharmacies with clinical trials and production units need to manage and produce these new drugs. Unlike the industry, where processes are automated, hospital pharmacy processes are often manual. The flow of these experimental drugs should be secured.1 Hospital pharmacies can choose from several production in-process control methods, the most common of which is human-visual double-checking or computer-assisted preparation with automated visual control by camera or automated gravimetric control by connected scales. This method, which uses computer-assisted double-checking, has …","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"205 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140592638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-10DOI: 10.1136/ejhpharm-2024-004170
Daniele Mengato, Sabrina Trivellato, Caterina Pedrolo, Francesco Paolo Russo, Francesca Venturini
Understanding the multifaceted challenges of medication self-management is crucial for enhancing patient outcomes and averting adverse events. Pharmacist-led patient education programmes (PEPs) have proven effective in improving adherence and mitigating errors, especially in chronic diseases.1 2 However, the lack of official recognition or clear leadership from hospital pharmacists hampers widespread adoption of PEPs across Europe. Given the complexity of medications requiring intricate self-management, delegating PEPs provision to hospital pharmacists is imperative due to their expertise. At the University Hospital of Padova, we have implemented a process to assist patients with hepatitis D virus (HDV) in adhering to medications with challenging self-management procedures. HDV, a ‘superinfection’ exclusive to individuals with chronic hepatitis B, necessitates meticulous management to prevent …
{"title":"Pharmacist-led patient education improves medication self-management and adherence in chronic hepatitis D virus patients: insights from the EXPLAIN project","authors":"Daniele Mengato, Sabrina Trivellato, Caterina Pedrolo, Francesco Paolo Russo, Francesca Venturini","doi":"10.1136/ejhpharm-2024-004170","DOIUrl":"https://doi.org/10.1136/ejhpharm-2024-004170","url":null,"abstract":"Understanding the multifaceted challenges of medication self-management is crucial for enhancing patient outcomes and averting adverse events. Pharmacist-led patient education programmes (PEPs) have proven effective in improving adherence and mitigating errors, especially in chronic diseases.1 2 However, the lack of official recognition or clear leadership from hospital pharmacists hampers widespread adoption of PEPs across Europe. Given the complexity of medications requiring intricate self-management, delegating PEPs provision to hospital pharmacists is imperative due to their expertise. At the University Hospital of Padova, we have implemented a process to assist patients with hepatitis D virus (HDV) in adhering to medications with challenging self-management procedures. HDV, a ‘superinfection’ exclusive to individuals with chronic hepatitis B, necessitates meticulous management to prevent …","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"205 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140592834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-10DOI: 10.1136/ejhpharm-2023-004065
Moninne Howlett, Suzanne McCarthy, Virginia Silvari, Bryony Dean Franklin, Raisa Laaksonen
Objectives Medication errors (MEs) are a leading cause of morbidity and mortality in the healthcare system. Patients admitted to intensive care units (ICUs) are potentially more susceptible to MEs due to severity of illness, the complexity of treatments they receive and the challenging nature of the ICU setting. The European Association of Hospital Pharmacists established a Special Interest Group (SIG) to undertake a programme of work to develop and prioritise recommendations to support medication safety improvement in ICUs across Europe. Methods Initial policy recommendations for medication safety within the ICU environment were developed following reviews of the literature and engagement with relevant stakeholders. A Delphi panel of 21 members of the SIG, that comprised healthcare professionals (HCPs) with expertise in ICU and/or medication safety, was convened in 2022. We conducted two rounds using a modified Delphi technique whereby participants anonymously ranked on a 9-point Likert Scale the policy recommendations according to their priority for implementation. Results In total, 32 policy recommendations were developed. In Delphi Round 1, 19 HCPs participated; consensus was achieved on most recommendations and partial consensus on six. In Delphi Round 2, 18 HCPs participated. After two Delphi rounds, consensus was achieved on all 32 recommendations. All recommendations were considered ‘high priority’ except one that was considered ‘medium priority’. Conclusions Through this study it was possible to develop and prioritise evidence-based policy recommendations to enhance medication safety, which may contribute to reducing MEs in ICUs across Europe. All recommendations were considered ‘high priority’ for implementation except one, indicating the perceived value of these recommendations in improving medication safety through preventing MEs in ICUs. Data are available upon reasonable request
{"title":"Development and prioritisation of policy recommendations for medication safety improvement for intensive care units: a European Association of Hospital Pharmacists Special Interest Group Delphi Study","authors":"Moninne Howlett, Suzanne McCarthy, Virginia Silvari, Bryony Dean Franklin, Raisa Laaksonen","doi":"10.1136/ejhpharm-2023-004065","DOIUrl":"https://doi.org/10.1136/ejhpharm-2023-004065","url":null,"abstract":"Objectives Medication errors (MEs) are a leading cause of morbidity and mortality in the healthcare system. Patients admitted to intensive care units (ICUs) are potentially more susceptible to MEs due to severity of illness, the complexity of treatments they receive and the challenging nature of the ICU setting. The European Association of Hospital Pharmacists established a Special Interest Group (SIG) to undertake a programme of work to develop and prioritise recommendations to support medication safety improvement in ICUs across Europe. Methods Initial policy recommendations for medication safety within the ICU environment were developed following reviews of the literature and engagement with relevant stakeholders. A Delphi panel of 21 members of the SIG, that comprised healthcare professionals (HCPs) with expertise in ICU and/or medication safety, was convened in 2022. We conducted two rounds using a modified Delphi technique whereby participants anonymously ranked on a 9-point Likert Scale the policy recommendations according to their priority for implementation. Results In total, 32 policy recommendations were developed. In Delphi Round 1, 19 HCPs participated; consensus was achieved on most recommendations and partial consensus on six. In Delphi Round 2, 18 HCPs participated. After two Delphi rounds, consensus was achieved on all 32 recommendations. All recommendations were considered ‘high priority’ except one that was considered ‘medium priority’. Conclusions Through this study it was possible to develop and prioritise evidence-based policy recommendations to enhance medication safety, which may contribute to reducing MEs in ICUs across Europe. All recommendations were considered ‘high priority’ for implementation except one, indicating the perceived value of these recommendations in improving medication safety through preventing MEs in ICUs. Data are available upon reasonable request","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"100 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140592637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-05DOI: 10.1136/ejhpharm-2023-004033
Esther Vanderstuyft, Julie Hias, Laura Hellemans, Lucas Van Aelst, Jos Tournoy, Lorenz Roger Van der Linden
Background Atrial fibrillation occurs in nearly half of geriatric inpatients and is a major cause of morbidity and mortality. Suboptimal anticoagulation use is an important concern in this population. This study aimed to evaluate the appropriateness of antithrombotic therapies in this patient cohort. Methods A retrospective analysis was conducted on the geriatric wards of a teaching hospital in Belgium, on a background of clinical pharmacy services. The first 90 atrial fibrillation patients from 2020 to 2022 were included if they received an oral anticoagulant. We assessed utilisation and appropriateness of antithrombotics at discharge, examined reasons for guideline deviations, and explored factors associated with underdosing. Temporal associations for appropriateness and type of anticoagulant (vitamin K antagonist (VKA) vs direct oral anticoagulant (DOAC)) were assessed. Results The mean age of patients was 86.5 (±5.3) years and the median CHA2DS2-VASc score was 5 (interquartile range (IQR) 4–6). At discharge, 256 (94.8%) patients used a DOAC; nine (3.3%) used a VKA; one (0.4%) a DOAC-antiplatelet combination, and in four patients (1.5%) all antithrombotics were discontinued. The majority (64.4%) of patients received reduced DOAC doses with apixaban prescribed in 40.7%. In 39 (14.4%) patients, antithrombotic use was considered inappropriate, mostly without a rationale (23/39). Year 2022 (odds ratio (OR) 0.104; 95% confidence interval (CI), 0.012–0.878) was the sole determinant for underdosing. No significant differences were found with respect to appropriateness (p=0.533) or anticoagulant class (p=0.479) over time. Conclusion Most geriatric inpatients received a justified reduced DOAC dose. A significant proportion was managed inappropriately with underdosing (= unjustified reduced dose) being most common. Frequently no rationale was provided for deviating from trial-tested doses. The datasets generated and analysed during the study are available from the corresponding author on reasonable request.
{"title":"Appropriateness of antithrombotics in geriatric inpatients with atrial fibrillation: a retrospective, cross-sectional study","authors":"Esther Vanderstuyft, Julie Hias, Laura Hellemans, Lucas Van Aelst, Jos Tournoy, Lorenz Roger Van der Linden","doi":"10.1136/ejhpharm-2023-004033","DOIUrl":"https://doi.org/10.1136/ejhpharm-2023-004033","url":null,"abstract":"Background Atrial fibrillation occurs in nearly half of geriatric inpatients and is a major cause of morbidity and mortality. Suboptimal anticoagulation use is an important concern in this population. This study aimed to evaluate the appropriateness of antithrombotic therapies in this patient cohort. Methods A retrospective analysis was conducted on the geriatric wards of a teaching hospital in Belgium, on a background of clinical pharmacy services. The first 90 atrial fibrillation patients from 2020 to 2022 were included if they received an oral anticoagulant. We assessed utilisation and appropriateness of antithrombotics at discharge, examined reasons for guideline deviations, and explored factors associated with underdosing. Temporal associations for appropriateness and type of anticoagulant (vitamin K antagonist (VKA) vs direct oral anticoagulant (DOAC)) were assessed. Results The mean age of patients was 86.5 (±5.3) years and the median CHA2DS2-VASc score was 5 (interquartile range (IQR) 4–6). At discharge, 256 (94.8%) patients used a DOAC; nine (3.3%) used a VKA; one (0.4%) a DOAC-antiplatelet combination, and in four patients (1.5%) all antithrombotics were discontinued. The majority (64.4%) of patients received reduced DOAC doses with apixaban prescribed in 40.7%. In 39 (14.4%) patients, antithrombotic use was considered inappropriate, mostly without a rationale (23/39). Year 2022 (odds ratio (OR) 0.104; 95% confidence interval (CI), 0.012–0.878) was the sole determinant for underdosing. No significant differences were found with respect to appropriateness (p=0.533) or anticoagulant class (p=0.479) over time. Conclusion Most geriatric inpatients received a justified reduced DOAC dose. A significant proportion was managed inappropriately with underdosing (= unjustified reduced dose) being most common. Frequently no rationale was provided for deviating from trial-tested doses. The datasets generated and analysed during the study are available from the corresponding author on reasonable request.","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140571759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-05DOI: 10.1136/ejhpharm-2023-004048
Lana Mohammad, Waeil Al Naeem, Musaab Ramsi, Shaikha Al Neyadi, Aminu Abdullahi, Azhar Rahma, Tasnim Heider Dawoud
Objectives Haemodynamic changes following intravenous acetaminophen are well studied in adults. Limited data are published in critically ill paediatric patients, especially from the Middle East. We aim to investigate haemodynamic effects and incidence of hypotension with intravenous acetaminophen in critically ill children, with a focus on understanding factors influencing these effects. Methods We retrospectively reviewed patients who received intravenous acetaminophen between July and December 2022. A haemodynamic event was defined as drop of >15% in systolic blood pressure (SBP) or mean arterial blood pressure (MAP) within 120 min after drug administration. Hypotension was defined as either drop in SBP below the 5th percentile for age, or a haemodynamic event associated with tachycardia, increased lactate or treatment with fluid/vasopressors. Logistic regression was performed to quantify relationships between patients’ characteristics and the occurrence of haemodynamic event and hypotension. Results A haemodynamic event was observed in 50/156 patients (32%) post-acetaminophen. Mean MAP (SD) before and after acetaminophen was 69.6 mm Hg (14.8) and 67.4 mm Hg (13.9), respectively (p=0.001). Mean SBP (SD) before and after acetaminophen was 95.4 mm Hg (18.2) and 92.8 mm Hg (19.2), respectively (p=0.006). Baseline MAP, median (interquartile range (IQR)) was 76.0 (64.0–85.3) and 66.0 (57.0–74.5) in patients with and without haemodynamic events, respectively (p=0.004). Only 38/156 patients (24%) met the definition for hypotension. Baseline MAP, median (IQR) was 62.0 (51.8–79.0) in patients with, and 68.5 (62.0, 79.3) in patients without hypotension (p=0.036). Baseline shock, vasoactives, mechanical ventilation and paediatric sequential organ failure assessment were not significantly associated with hypotension. Only MAP was found to be associated with both haemodynamic event (adjusted odds ratio (AOR) 1.05, 95% CI 1.02–1.10) and hypotension (AOR 1.06, 95% CI 1.02–1.10) even after controlling for other confounders. Conclusions Administration of intravenous acetaminophen in critically ill children can lead to haemodynamic changes, including clinically significant hypotensive events. No data are available.
{"title":"Haemodynamic effects of intravenous acetaminophen in critically ill paediatric patients: a retrospective chart review","authors":"Lana Mohammad, Waeil Al Naeem, Musaab Ramsi, Shaikha Al Neyadi, Aminu Abdullahi, Azhar Rahma, Tasnim Heider Dawoud","doi":"10.1136/ejhpharm-2023-004048","DOIUrl":"https://doi.org/10.1136/ejhpharm-2023-004048","url":null,"abstract":"Objectives Haemodynamic changes following intravenous acetaminophen are well studied in adults. Limited data are published in critically ill paediatric patients, especially from the Middle East. We aim to investigate haemodynamic effects and incidence of hypotension with intravenous acetaminophen in critically ill children, with a focus on understanding factors influencing these effects. Methods We retrospectively reviewed patients who received intravenous acetaminophen between July and December 2022. A haemodynamic event was defined as drop of >15% in systolic blood pressure (SBP) or mean arterial blood pressure (MAP) within 120 min after drug administration. Hypotension was defined as either drop in SBP below the 5th percentile for age, or a haemodynamic event associated with tachycardia, increased lactate or treatment with fluid/vasopressors. Logistic regression was performed to quantify relationships between patients’ characteristics and the occurrence of haemodynamic event and hypotension. Results A haemodynamic event was observed in 50/156 patients (32%) post-acetaminophen. Mean MAP (SD) before and after acetaminophen was 69.6 mm Hg (14.8) and 67.4 mm Hg (13.9), respectively (p=0.001). Mean SBP (SD) before and after acetaminophen was 95.4 mm Hg (18.2) and 92.8 mm Hg (19.2), respectively (p=0.006). Baseline MAP, median (interquartile range (IQR)) was 76.0 (64.0–85.3) and 66.0 (57.0–74.5) in patients with and without haemodynamic events, respectively (p=0.004). Only 38/156 patients (24%) met the definition for hypotension. Baseline MAP, median (IQR) was 62.0 (51.8–79.0) in patients with, and 68.5 (62.0, 79.3) in patients without hypotension (p=0.036). Baseline shock, vasoactives, mechanical ventilation and paediatric sequential organ failure assessment were not significantly associated with hypotension. Only MAP was found to be associated with both haemodynamic event (adjusted odds ratio (AOR) 1.05, 95% CI 1.02–1.10) and hypotension (AOR 1.06, 95% CI 1.02–1.10) even after controlling for other confounders. Conclusions Administration of intravenous acetaminophen in critically ill children can lead to haemodynamic changes, including clinically significant hypotensive events. No data are available.","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"2014 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140571609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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