Pub Date : 2021-03-01DOI: 10.1136/EJHPHARM-2021-EAHPCONF.362
I. Lafeber, J. Tichem, Hcm Bijleveld-Olierook, DM Kweekel, Pph Le Brun, H. Guchelaar, Kjm Schimmel
Background and importance Commercially available tablets often don’t meet patients’ needs, as is the case for children. Three-dimensional (3D) printing can possibly achieve this. However, most investigated 3D printing techniques for production of pharmaceutical preparations may not be suitable for chemically unstable drugs. In addition, quality requirements are not well established. Aim and objectives A proof-of-principle study was conducted using a low heat, solvent-free extrusion-based 3D printing technique. Furosemide and sildenafil immediate release tablets containing paediatric appropriate dosages were the model products. The quality requirements as stated by the European Pharmacopoeia (EP) were evaluated. Materials and methods Formulations containing furosemide, 2 mg or 10 mg per tablet, or sildenafil, 4 mg per tablet, were slightly heated to a semi-solid to allow printing. The tablets were analysed for weight distribution (EP 2.9.5.), content uniformity (EP 2.9.40.) and dissolution profile (EP 2.9.3.), using an analytical balance, high-performance liquid chromatography ultraviolet and UV/VIS spectrophotometry, respectively. Content uniformity and dissolution analyses were performed in triplicate. Linear regression analysis was performed to assess tablet mass and content. Results The weight distribution met the requirements of EP 2.9.5 with a relative standard deviation of 1.26%. The acceptance values of the content uniformity of furosemide 2 mg, 10 mg and sildenafil 4 mg ranged between 4.2–10.6, 4.8–8.9 and 6.6–9.2, respectively, where a maximum value of 15 was accepted. A linear correlation between tablet mass and content was found. Furosemide 10 mg and sildenafil 4 mg showed a dissolved content of >80% after 45 minutes, indicating an immediate release profile. For furosemide 2 mg batches, the second testing level had to be used. This preparation also met the requirement of an immediate release profile. Additionally, the tablets should also have sufficient microbiological stability (EP 5.4.1.) and mechanical strength (EP 2.9.7. and 2.9.8.), though an adjusted test for mechanical strength is necessary for applicability to 3D printed tablets. Conclusion and relevance This proof-of-principle study shows lower temperature 3D printing can be useful in enabling production of personalised tablets. Further investigation of suitable quality tests for 3D printed tablets will be performed in further studies.
{"title":"NP-015 Quality assessment of 3D printed sildenafil and furosemide tablets for the paediatric population using an innovative extrusion-based technique","authors":"I. Lafeber, J. Tichem, Hcm Bijleveld-Olierook, DM Kweekel, Pph Le Brun, H. Guchelaar, Kjm Schimmel","doi":"10.1136/EJHPHARM-2021-EAHPCONF.362","DOIUrl":"https://doi.org/10.1136/EJHPHARM-2021-EAHPCONF.362","url":null,"abstract":"Background and importance Commercially available tablets often don’t meet patients’ needs, as is the case for children. Three-dimensional (3D) printing can possibly achieve this. However, most investigated 3D printing techniques for production of pharmaceutical preparations may not be suitable for chemically unstable drugs. In addition, quality requirements are not well established. Aim and objectives A proof-of-principle study was conducted using a low heat, solvent-free extrusion-based 3D printing technique. Furosemide and sildenafil immediate release tablets containing paediatric appropriate dosages were the model products. The quality requirements as stated by the European Pharmacopoeia (EP) were evaluated. Materials and methods Formulations containing furosemide, 2 mg or 10 mg per tablet, or sildenafil, 4 mg per tablet, were slightly heated to a semi-solid to allow printing. The tablets were analysed for weight distribution (EP 2.9.5.), content uniformity (EP 2.9.40.) and dissolution profile (EP 2.9.3.), using an analytical balance, high-performance liquid chromatography ultraviolet and UV/VIS spectrophotometry, respectively. Content uniformity and dissolution analyses were performed in triplicate. Linear regression analysis was performed to assess tablet mass and content. Results The weight distribution met the requirements of EP 2.9.5 with a relative standard deviation of 1.26%. The acceptance values of the content uniformity of furosemide 2 mg, 10 mg and sildenafil 4 mg ranged between 4.2–10.6, 4.8–8.9 and 6.6–9.2, respectively, where a maximum value of 15 was accepted. A linear correlation between tablet mass and content was found. Furosemide 10 mg and sildenafil 4 mg showed a dissolved content of >80% after 45 minutes, indicating an immediate release profile. For furosemide 2 mg batches, the second testing level had to be used. This preparation also met the requirement of an immediate release profile. Additionally, the tablets should also have sufficient microbiological stability (EP 5.4.1.) and mechanical strength (EP 2.9.7. and 2.9.8.), though an adjusted test for mechanical strength is necessary for applicability to 3D printed tablets. Conclusion and relevance This proof-of-principle study shows lower temperature 3D printing can be useful in enabling production of personalised tablets. Further investigation of suitable quality tests for 3D printed tablets will be performed in further studies.","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"63 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87500453","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 : 2021-03-01DOI: 10.1136/EJHPHARM-2021-EAHPCONF.345
R. S. D. Moral, I. G. Giménez, A. Bejarano, Emilio Barrientos
Background and importance High alert medications are those that, when they are not being properly used, are more likely to cause serious or even fatal harm to patients. Chronic patients are especially vulnerable to these possible errors because of their comorbidity and polypharmacy. The Ministry of Health, Social Services and Equality of Spain promotes the implementation of improving safe practices for those patients. In 2014, a panel of experts developed a list of high alert drugs for chronic patients to prioritise practices for improving safety in these patients. This list was named the HAMC list (high alert medications for patients with chronic illnesses) and was published by the Ministry of Health, Social Services and Equality of Spain. Aim and objectives To analyse the prevalence of prescribed medications included in the HAMC list in a nursing home. Material and methods A descriptive, transversal, retrospective study was carried out in September 2020 that included all residents with chronic illnesses in a nursing home assigned to our pharmacy service. Variables recorded were: demographic data, number of prescribed medicaments, and number and type of prescribed medicaments included in the HAMC list. Results 81 patients were included (59 men) with a mean age of 72 (56–94) years. 721 drugs were prescribed, and 186 were included in the HAMC list. At least 1 HAMC was prescribed in 86% of patients, with a mean of 3 HAMC per patient (1–7). The therapeutic groups of the drugs on the HAMC that were prescribed were: benzodiazepines (63% of patients), inhibitors of platelet aggregation (36%), antipsychotics (26%), beta-adrenergic blockers (26%), oral hypoglycaemics agents (26%), loop diuretics (19%), oral anticoagulants (11%), antiepileptics (9%), opioids (9%), including minor and major opioids, insulin (7%), eplerenone/spironolactone (7%), immunosuppressants (1%) and non-steroidal anti-inflammatory drugs (1%). Conclusion and relevance HAMC were widely prescribed. Benzodiazepines were the therapeutic group most prescribed from the HAMC list in our population, followed by antiplatelets and antipsychotics. The HAMC list is a useful tool for a first approach in the detection of patients who may be at a higher risk of serious harms if medication errors occur. Implementation of specific safe practices for those drugs could reduce potential or real errors in these patients. References and/or acknowledgements Conflict of interest No conflict of interest
{"title":"5PSQ-226 Analysis of high alert medication prescriptions in a nursing home","authors":"R. S. D. Moral, I. G. Giménez, A. Bejarano, Emilio Barrientos","doi":"10.1136/EJHPHARM-2021-EAHPCONF.345","DOIUrl":"https://doi.org/10.1136/EJHPHARM-2021-EAHPCONF.345","url":null,"abstract":"Background and importance High alert medications are those that, when they are not being properly used, are more likely to cause serious or even fatal harm to patients. Chronic patients are especially vulnerable to these possible errors because of their comorbidity and polypharmacy. The Ministry of Health, Social Services and Equality of Spain promotes the implementation of improving safe practices for those patients. In 2014, a panel of experts developed a list of high alert drugs for chronic patients to prioritise practices for improving safety in these patients. This list was named the HAMC list (high alert medications for patients with chronic illnesses) and was published by the Ministry of Health, Social Services and Equality of Spain. Aim and objectives To analyse the prevalence of prescribed medications included in the HAMC list in a nursing home. Material and methods A descriptive, transversal, retrospective study was carried out in September 2020 that included all residents with chronic illnesses in a nursing home assigned to our pharmacy service. Variables recorded were: demographic data, number of prescribed medicaments, and number and type of prescribed medicaments included in the HAMC list. Results 81 patients were included (59 men) with a mean age of 72 (56–94) years. 721 drugs were prescribed, and 186 were included in the HAMC list. At least 1 HAMC was prescribed in 86% of patients, with a mean of 3 HAMC per patient (1–7). The therapeutic groups of the drugs on the HAMC that were prescribed were: benzodiazepines (63% of patients), inhibitors of platelet aggregation (36%), antipsychotics (26%), beta-adrenergic blockers (26%), oral hypoglycaemics agents (26%), loop diuretics (19%), oral anticoagulants (11%), antiepileptics (9%), opioids (9%), including minor and major opioids, insulin (7%), eplerenone/spironolactone (7%), immunosuppressants (1%) and non-steroidal anti-inflammatory drugs (1%). Conclusion and relevance HAMC were widely prescribed. Benzodiazepines were the therapeutic group most prescribed from the HAMC list in our population, followed by antiplatelets and antipsychotics. The HAMC list is a useful tool for a first approach in the detection of patients who may be at a higher risk of serious harms if medication errors occur. Implementation of specific safe practices for those drugs could reduce potential or real errors in these patients. References and/or acknowledgements Conflict of interest No conflict of interest","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83074667","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 : 2021-03-01DOI: 10.1136/EJHPHARM-2021-EAHPCONF.210
M. Solano, C. Faure, C. Pain, P. Loriod, A. Maes, P. Marguet, M. Kroemer, A. Rumpler, É. Daguindau, S. Limat, A. Clairet
Background and importance The transition to oral therapies in patients with multiple myeloma (MM) offers potential benefits to patients, however they must self-manage their medications and adherence can become an issue. It has been shown that patient satisfaction with medication has a strong positive correlation with adherence in chronic diseases. To date, there is no standard method of measuring adherence. Aim and objectives The aim of this study was to estimate the adherence rate of oral antimyeloma therapies using two indirect methods and to identify risk factors for medication non-adherence. A secondary aim was to explore patients’ and caregivers’ perceptions of their medications. Material and methods We carried out a cross sectional, observational, prospective, multicentre survey based on a self-reported questionnaire. All consecutive MM patients, with at least 3 months of oral therapy prescriptions were included. The structured and validated 6 item Girerd Scale and the medication possession ratio (MPR) were used for measuring medication adherence, and the SATMED-Q questionnaire was used for measuring patient satisfaction with the medication. An analysis of risk factors for non-adherence to oral therapy was performed using univariate analysis. Patients’ and caregivers’ opinions about their medications were assessed with a score from 0 (no importance) to 10 (highest importance). Results 101 of 116 analysed patients participated in the survey, giving a response rate of 87%. The prevalence of adherence to oral antimyeloma therapy was estimated at 51.5% using the questionnaire, corresponding to a high level of adherence (ie, score=6). According to the MPR, adherence was evaluated at 96%, which was also considered high (ie, MPR ≥0.80). With both methods combined, adherence was estimated at 50.5%. One risk factor for non-adherence to oral antimyeloma therapy was identified: Eastern Cooperative Oncology Group Performance Status (ECOG-PS) >2 (p value=0.007). One predictive factor for good adherence to oral antimyeloma therapy was also identified: high satisfaction with treatment (p=0.01). No statistically significant difference was observed between patients and caregivers’ perceptions of their medications. Conclusion and relevance Determining risk factors that influence adherence could be helpful to better identify patients at a higher risk for non-adherence, to personalise therapeutic information and education, and to improve the quality of healthcare overall. References and/or acknowledgements Conflict of interest No conflict of interest
{"title":"4CPS-378 Oral therapy adherence and satisfaction in patients with multiple myeloma","authors":"M. Solano, C. Faure, C. Pain, P. Loriod, A. Maes, P. Marguet, M. Kroemer, A. Rumpler, É. Daguindau, S. Limat, A. Clairet","doi":"10.1136/EJHPHARM-2021-EAHPCONF.210","DOIUrl":"https://doi.org/10.1136/EJHPHARM-2021-EAHPCONF.210","url":null,"abstract":"Background and importance The transition to oral therapies in patients with multiple myeloma (MM) offers potential benefits to patients, however they must self-manage their medications and adherence can become an issue. It has been shown that patient satisfaction with medication has a strong positive correlation with adherence in chronic diseases. To date, there is no standard method of measuring adherence. Aim and objectives The aim of this study was to estimate the adherence rate of oral antimyeloma therapies using two indirect methods and to identify risk factors for medication non-adherence. A secondary aim was to explore patients’ and caregivers’ perceptions of their medications. Material and methods We carried out a cross sectional, observational, prospective, multicentre survey based on a self-reported questionnaire. All consecutive MM patients, with at least 3 months of oral therapy prescriptions were included. The structured and validated 6 item Girerd Scale and the medication possession ratio (MPR) were used for measuring medication adherence, and the SATMED-Q questionnaire was used for measuring patient satisfaction with the medication. An analysis of risk factors for non-adherence to oral therapy was performed using univariate analysis. Patients’ and caregivers’ opinions about their medications were assessed with a score from 0 (no importance) to 10 (highest importance). Results 101 of 116 analysed patients participated in the survey, giving a response rate of 87%. The prevalence of adherence to oral antimyeloma therapy was estimated at 51.5% using the questionnaire, corresponding to a high level of adherence (ie, score=6). According to the MPR, adherence was evaluated at 96%, which was also considered high (ie, MPR ≥0.80). With both methods combined, adherence was estimated at 50.5%. One risk factor for non-adherence to oral antimyeloma therapy was identified: Eastern Cooperative Oncology Group Performance Status (ECOG-PS) >2 (p value=0.007). One predictive factor for good adherence to oral antimyeloma therapy was also identified: high satisfaction with treatment (p=0.01). No statistically significant difference was observed between patients and caregivers’ perceptions of their medications. Conclusion and relevance Determining risk factors that influence adherence could be helpful to better identify patients at a higher risk for non-adherence, to personalise therapeutic information and education, and to improve the quality of healthcare overall. References and/or acknowledgements Conflict of interest No conflict of interest","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86319769","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 : 2021-03-01DOI: 10.1136/EJHPHARM-2021-EAHPCONF.160
I. Solazzi, M. Guidi, P. Abrate, EC Zinetti
Background and importance In the past years, many biological drugs have been approved for the treatment of moderate-to-severe plaque psoriasis. Aim and objectives We aimed to describe the population of outpatients treated with biological drugs for moderate-to-severe plaque psoriasis according to the number and type of therapeutic shifts. Material and methods We identified patients treated with a biological drug for moderate-to-severe plaque psoriasis (code ICD-9-CM 696.1 other psoriasis) from February 2017 to September 2020. Data were collected from drug refills by our pharmacy and electronically recorded. Biological drugs were considered according to the mechanism of action: anti-TNF-α (adalimumab, certolizumab, etanercept), anti-IL-17 (brodalumab, ixekizumab, secukinumab) and anti-IL-23 (guselkumab, risankizumab, tildrakizumab and ustekinumab). The therapeutic shift was intended as a change in the active substance, regardless of changes from an originator to its biosimilar/s, the pharmaceutical form (pen or syringe) or the dose. Results From February 2017 to September 2020, 357 patients were treated with at least one biological drug for plaque psoriasis. Median age was 50.7 years (range 5.9–91.7) and 221 (61.9%) patients were men. 282 patients (79%) were treated with only one biological drug: 75 patients with anti-TNF-α, 132 with anti-IL-17 and 75 with anti-IL-23. 65 patients (18.2%) were treated with two biological drugs in sequence (table 1). Conclusion and relevance More than 97% of patients were treated with only one (79%) or two (18.2%) biological drugs for moderate-to-severe plaque psoriasis, with a prevalence of anti-IL-17. Further investigation of the causes for the change from one to another biological drug is needed. These could include adverse events, ineffectiveness or other reasons. References and/or acknowledgements Conflict of interest No conflict of interest
{"title":"4CPS-328 Biological drugs for the treatment of moderate-to-severe plaque psoriasis: analysis according to the mechanism of action","authors":"I. Solazzi, M. Guidi, P. Abrate, EC Zinetti","doi":"10.1136/EJHPHARM-2021-EAHPCONF.160","DOIUrl":"https://doi.org/10.1136/EJHPHARM-2021-EAHPCONF.160","url":null,"abstract":"Background and importance In the past years, many biological drugs have been approved for the treatment of moderate-to-severe plaque psoriasis. Aim and objectives We aimed to describe the population of outpatients treated with biological drugs for moderate-to-severe plaque psoriasis according to the number and type of therapeutic shifts. Material and methods We identified patients treated with a biological drug for moderate-to-severe plaque psoriasis (code ICD-9-CM 696.1 other psoriasis) from February 2017 to September 2020. Data were collected from drug refills by our pharmacy and electronically recorded. Biological drugs were considered according to the mechanism of action: anti-TNF-α (adalimumab, certolizumab, etanercept), anti-IL-17 (brodalumab, ixekizumab, secukinumab) and anti-IL-23 (guselkumab, risankizumab, tildrakizumab and ustekinumab). The therapeutic shift was intended as a change in the active substance, regardless of changes from an originator to its biosimilar/s, the pharmaceutical form (pen or syringe) or the dose. Results From February 2017 to September 2020, 357 patients were treated with at least one biological drug for plaque psoriasis. Median age was 50.7 years (range 5.9–91.7) and 221 (61.9%) patients were men. 282 patients (79%) were treated with only one biological drug: 75 patients with anti-TNF-α, 132 with anti-IL-17 and 75 with anti-IL-23. 65 patients (18.2%) were treated with two biological drugs in sequence (table 1). Conclusion and relevance More than 97% of patients were treated with only one (79%) or two (18.2%) biological drugs for moderate-to-severe plaque psoriasis, with a prevalence of anti-IL-17. Further investigation of the causes for the change from one to another biological drug is needed. These could include adverse events, ineffectiveness or other reasons. References and/or acknowledgements Conflict of interest No conflict of interest","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89181584","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 : 2020-03-11DOI: 10.1136/ejhpharm-2019-002074
Emily Turner, M. Kennedy, Abigail Barrowcliffe
Introduction Pharmacists in the UK can register as independent pharmacist prescribers (IPPs) on completion of appropriate higher education training. IPPs have had the same prescribing privileges as medical doctors since 2009. Despite the years since their introduction, there are little data available to demonstrate the frequency and type of errors made by IPPs. Furthermore, there is no literature available comparing IPPs to doctors with regards to prescribing safety. This study aimed to start to fill this gap in the literature. Methods Pharmacists working in one National Health Service (NHS) Trust, in areas with a large proportion of prescribing undertaken by IPPs, were purposefully recruited to collect data over a 1-week period in May 2018. They collected data on all prescription items validated that were prescribed by IPPs and doctors. Errors that were identified were recorded in detail. Data collection forms and error definitions were taken from the EQUIP Study, a large study looking at prescribing errors by junior doctors in the hospital setting. Results 5840 prescriptions items were recorded; 1026 (17.6%) were prescribed by an IPP. 479 errors were recorded in total. Experienced IPPs, had a 1% error rate (seven errors); IPPs with less experience had a 0% error rate. Overall the error rate for pharmacists was 0.7% (95% CI 0.0% to 1.0%). In comparison, doctors made an average of 9.8% errors (95% CI 9.0% to 11.0%). Pharmacists made significantly less prescribing errors than doctors (p<0.01). 85.7% of IPP errors were recorded as minor in significance, compared with an average of 31.7% for all doctor’s prescribing errors. Actual patient harm occurred from 0.04% of all prescriptions. Conclusion In a single NHS Trust, pharmacists make significantly less prescribing errors than doctors. Embedding IPPs with more integrated roles in the multidisciplinary team is recommended. Further large trials are required to validate the results of this study.
在英国，药剂师在完成适当的高等教育培训后可以注册为独立药剂师开处方者(ipp)。自2009年以来，ipp享有与医生相同的开药特权。尽管ipp引入已有多年，但几乎没有数据可以证明ipp所犯错误的频率和类型。此外，在处方安全性方面，没有文献对ipp和医生进行比较。本研究旨在填补这一文献空白。方法2018年5月，有目的地招募一家国家卫生服务信托机构(NHS Trust)的药剂师，收集为期1周的数据，这些地区的药剂师主要是由ipp承担处方。他们收集了所有经过ipp和医生验证的处方项目的数据。详细记录了已识别的错误。数据收集表格和错误定义来自EQUIP研究，这是一项针对医院初级医生处方错误的大型研究。结果共记录处方5840张;1026例(17.6%)由IPP开具处方。总共记录了479个错误。经验丰富的ipp有1%的错误率(7个错误);经验较少的ipp的错误率为0%。药师的总体错误率为0.7% (95% CI 0.0% ~ 1.0%)。相比之下，医生的平均错误率为9.8% (95% CI 9.0%至11.0%)。药师的处方错误率明显低于医生(p<0.01)。85.7%的IPP错误被记录为轻微错误，而所有医生处方错误的平均比例为31.7%。实际对患者造成伤害的处方占所有处方的0.04%。结论在单一的NHS信托中，药剂师的处方错误明显少于医生。建议在多学科团队中嵌入具有更综合作用的ipp。需要进一步的大型试验来验证这项研究的结果。
{"title":"An investigation into prescribing errors made by independent pharmacist prescribers and medical prescribers at a large acute NHS hospital trust: a cross-sectional study","authors":"Emily Turner, M. Kennedy, Abigail Barrowcliffe","doi":"10.1136/ejhpharm-2019-002074","DOIUrl":"https://doi.org/10.1136/ejhpharm-2019-002074","url":null,"abstract":"Introduction Pharmacists in the UK can register as independent pharmacist prescribers (IPPs) on completion of appropriate higher education training. IPPs have had the same prescribing privileges as medical doctors since 2009. Despite the years since their introduction, there are little data available to demonstrate the frequency and type of errors made by IPPs. Furthermore, there is no literature available comparing IPPs to doctors with regards to prescribing safety. This study aimed to start to fill this gap in the literature. Methods Pharmacists working in one National Health Service (NHS) Trust, in areas with a large proportion of prescribing undertaken by IPPs, were purposefully recruited to collect data over a 1-week period in May 2018. They collected data on all prescription items validated that were prescribed by IPPs and doctors. Errors that were identified were recorded in detail. Data collection forms and error definitions were taken from the EQUIP Study, a large study looking at prescribing errors by junior doctors in the hospital setting. Results 5840 prescriptions items were recorded; 1026 (17.6%) were prescribed by an IPP. 479 errors were recorded in total. Experienced IPPs, had a 1% error rate (seven errors); IPPs with less experience had a 0% error rate. Overall the error rate for pharmacists was 0.7% (95% CI 0.0% to 1.0%). In comparison, doctors made an average of 9.8% errors (95% CI 9.0% to 11.0%). Pharmacists made significantly less prescribing errors than doctors (p<0.01). 85.7% of IPP errors were recorded as minor in significance, compared with an average of 31.7% for all doctor’s prescribing errors. Actual patient harm occurred from 0.04% of all prescriptions. Conclusion In a single NHS Trust, pharmacists make significantly less prescribing errors than doctors. Embedding IPPs with more integrated roles in the multidisciplinary team is recommended. Further large trials are required to validate the results of this study.","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"6 1","pages":"149 - 153"},"PeriodicalIF":0.0,"publicationDate":"2020-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80477115","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 : 2020-03-09DOI: 10.1136/ejhpharm-2019-002072
M. Aiezza, A. Bresciani, G. Guglielmi, Marida Massa, Elena Tortori, R. Marfella, Emilio Aliberti, A. Iannuzzi
Objectives Older adults are a vulnerable and growing segment of the population with a high burden of comorbid conditions. As a consequence of increased co-morbidity, drug use in older adults is high, and polypharmacy has been linked to higher risk of adverse drug–drug interactions, morbidity, and mortality. The aim of the study was to evaluate the prevalence and nature of potentially inappropriate medications (PIMs) in a group of hospitalised older patients, and verify whether the use of ‘Beers criteria’ and/or ‘START & STOPP’ criteria could lead to deprescribing of drugs and reduce the length of stay in the hospital. Methods Two hundred acutely ill patients aged ≥65 with multimorbidity admitted to the Division of Internal Medicine were enrolled in the study. Enrolled patients were admitted as medical emergencies and observed during their hospitalisation at the Emergency Department and subsequently at the Division of Internal Medicine. The pharmacological treatments taken by patients at home, during hospitalisation and at discharge, were examined, identifying inappropriate prescriptions (IPs), according to ‘Beers criteria’ and ‘START and STOPP’ criteria. Results There were 487 IPs: 175 according to the Beers criteria; 50 according to the STOPP criteria; one according to the START criteria; 107 major interactions; 152 minor interactions; one off-label drug; and one duplicated pharmacotherapy. Twenty-three adverse drug reactions (ADRs) were recorded: the most frequent were abnormalities of serum electrolytes (35%); haemorrhagic events (22%); and accidental falls from benzodiazepine use (9%). The correct application of these criteria decreased IPs by 38% and reduced the number of drugs prescribed by the physician during the stay in the medical ward and at discharge by 19%. Conclusions The use of criteria that detect IPs reduced PIMs and ADRs, increased safety in older patients, and reduced the number of drugs prescribed but did not reduce the length of stay in hospital.
{"title":"Medication review versus usual care to improve drug therapies in hospitalised older patients admitted to internal medicine wards","authors":"M. Aiezza, A. Bresciani, G. Guglielmi, Marida Massa, Elena Tortori, R. Marfella, Emilio Aliberti, A. Iannuzzi","doi":"10.1136/ejhpharm-2019-002072","DOIUrl":"https://doi.org/10.1136/ejhpharm-2019-002072","url":null,"abstract":"Objectives Older adults are a vulnerable and growing segment of the population with a high burden of comorbid conditions. As a consequence of increased co-morbidity, drug use in older adults is high, and polypharmacy has been linked to higher risk of adverse drug–drug interactions, morbidity, and mortality. The aim of the study was to evaluate the prevalence and nature of potentially inappropriate medications (PIMs) in a group of hospitalised older patients, and verify whether the use of ‘Beers criteria’ and/or ‘START & STOPP’ criteria could lead to deprescribing of drugs and reduce the length of stay in the hospital. Methods Two hundred acutely ill patients aged ≥65 with multimorbidity admitted to the Division of Internal Medicine were enrolled in the study. Enrolled patients were admitted as medical emergencies and observed during their hospitalisation at the Emergency Department and subsequently at the Division of Internal Medicine. The pharmacological treatments taken by patients at home, during hospitalisation and at discharge, were examined, identifying inappropriate prescriptions (IPs), according to ‘Beers criteria’ and ‘START and STOPP’ criteria. Results There were 487 IPs: 175 according to the Beers criteria; 50 according to the STOPP criteria; one according to the START criteria; 107 major interactions; 152 minor interactions; one off-label drug; and one duplicated pharmacotherapy. Twenty-three adverse drug reactions (ADRs) were recorded: the most frequent were abnormalities of serum electrolytes (35%); haemorrhagic events (22%); and accidental falls from benzodiazepine use (9%). The correct application of these criteria decreased IPs by 38% and reduced the number of drugs prescribed by the physician during the stay in the medical ward and at discharge by 19%. Conclusions The use of criteria that detect IPs reduced PIMs and ADRs, increased safety in older patients, and reduced the number of drugs prescribed but did not reduce the length of stay in hospital.","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"75 1","pages":"160 - 164"},"PeriodicalIF":0.0,"publicationDate":"2020-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86175630","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 : 2020-03-09DOI: 10.1136/ejhpharm-2019-002155
S. Blanco-Dorado, M. D. Bellés Medall, Ó. Pascual-Marmaneu, M. Campos‐Toimil, F. Otero-Espinar, Rafael Rodríguez-Riego, T. Rodríguez-Jato, I. Zarra-Ferro, M. Lamas, A. Fernández-Ferreiro
Objective Voriconazole is an antifungal agent used in the treatment of aspergillosis and fluconazole-resistant Candida infections. Therapeutic drug monitoring (TDM) of voriconazole is recommended to optimise clinical results. The aim of this study was the development and validation of a high performance liquid chromatography (HPLC) method for measuring voriconazole in human serum, and comparison with an ARK immunoassay method. Methods Linearity, precision, accuracy and stability of the HPLC method were validated according to the US Food and Drug Administration (FDA) and European Medicines Agency (EMA) guidelines. The method was applied to the analysis of 58 trough serum samples from patients treated with voriconazole, and the HPLC-UV (ultraviolet) method was compared with an ARK immunoassay. The correlation of both methods was studied by the Pearson regression coefficient and the concordance of the values was evaluated by the Bland-Altman and Passing-Bablok methods. Results All validation parameters met the criteria set out in the FDA and EMA guidelines. The standard curve was linear over a concentration range of 0.25–16 µg/mL with a limit of quantification of 0.125 µg/mL. No interactions between voriconazole and other drugs was observed and voriconazole was stable after 1 month at −80°C. Comparison of the HPLC method and the enzyme immunoassay method showed a linear correlation with a systematic error of −0.61 µg/mL between both methods. Conclusion The method developed is simple and fast and can be easily applied for routine therapeutic drug monitoring of voriconazole. The HPLC-UV method was more sensitive than the immunoassay method and there was concordance with the immunoassay. Consequently both methods could be used, considering the correlation between them.
{"title":"Therapeutic drug monitoring of voriconazole: validation of a high performance liquid chromatography method and comparison with an ARK immunoassay","authors":"S. Blanco-Dorado, M. D. Bellés Medall, Ó. Pascual-Marmaneu, M. Campos‐Toimil, F. Otero-Espinar, Rafael Rodríguez-Riego, T. Rodríguez-Jato, I. Zarra-Ferro, M. Lamas, A. Fernández-Ferreiro","doi":"10.1136/ejhpharm-2019-002155","DOIUrl":"https://doi.org/10.1136/ejhpharm-2019-002155","url":null,"abstract":"Objective Voriconazole is an antifungal agent used in the treatment of aspergillosis and fluconazole-resistant Candida infections. Therapeutic drug monitoring (TDM) of voriconazole is recommended to optimise clinical results. The aim of this study was the development and validation of a high performance liquid chromatography (HPLC) method for measuring voriconazole in human serum, and comparison with an ARK immunoassay method. Methods Linearity, precision, accuracy and stability of the HPLC method were validated according to the US Food and Drug Administration (FDA) and European Medicines Agency (EMA) guidelines. The method was applied to the analysis of 58 trough serum samples from patients treated with voriconazole, and the HPLC-UV (ultraviolet) method was compared with an ARK immunoassay. The correlation of both methods was studied by the Pearson regression coefficient and the concordance of the values was evaluated by the Bland-Altman and Passing-Bablok methods. Results All validation parameters met the criteria set out in the FDA and EMA guidelines. The standard curve was linear over a concentration range of 0.25–16 µg/mL with a limit of quantification of 0.125 µg/mL. No interactions between voriconazole and other drugs was observed and voriconazole was stable after 1 month at −80°C. Comparison of the HPLC method and the enzyme immunoassay method showed a linear correlation with a systematic error of −0.61 µg/mL between both methods. Conclusion The method developed is simple and fast and can be easily applied for routine therapeutic drug monitoring of voriconazole. The HPLC-UV method was more sensitive than the immunoassay method and there was concordance with the immunoassay. Consequently both methods could be used, considering the correlation between them.","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"34 1","pages":"154 - 159"},"PeriodicalIF":0.0,"publicationDate":"2020-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90362383","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 : 2020-03-01DOI: 10.1136/ejhpharm-2020-eahpconf.169
C. Fernández Zamora, T. Rodríguez Martínez, MA Meroño Saura, S. Clavijos Bautista, J. Plaza Aniorte, P. Pacheco López, MÁ Carvajal Sánchez, J. Ibáñez Caturla, MD Nájera Pérez
Background and importance Simplification of antiretroviral treatments (ART) improves adherence and comfort, and may prevent some adverse effects caused by ART. Aim and objectives To assess the effectiveness (plasma viral load (PVL test) <50 copies/mL) of the combination of dolutegravir (DTG) and lamivudine (3TC) without a third antiretroviral drug in patients diagnosed with HIV infection who were previously treated with a three drug regimen of ART. Material and methods In January 2019, we studied a cohort of patients who were undergoing treatment with DTG+3TC in a two drug regimen. Once these patients were selected, we carried out a prospective study of the PVL test after 6 months of treatment. Results Thirty-three patients were receiving treatment with the DTG+3TC combination in January 2019. Patients were aged 24–72 years (mean 46.27 years). The previous PVL test was undetectable in 69.70% of patients, detectable (<50 copies/mL) in 27.27% of patients and 1 patient (3.03%) had a viral load of >50 copies/mL. After 6 months of treatment, the PVL test was undetectable in 75.75% of patients, detectable (<50 copies/mL) in 15.15% and detectable (>50 copies/mL) in 3.03%. Two patients discontinued treatment. Conclusion and relevance The combination of DTG+3TC seemed to be an effective alternative to other ART when we re-evaluated patients after 6 months of treatment. We found a PVL <50 copies/mL in 96.96% and 90.90% of patients before and after the change in ART. References and/or acknowledgements 1. Cahn P, Madero JS, Arribas JR, et al. GEMINI Study Team. Dolutegravir plus lamivudine versus dolutegravir plus tenofovir disoproxil fumarate and emtricitabine in antiretroviral-naive adults with HIV-1 infection (GEMINI-1 and GEMINI-2): week 48 results from two multicentre, double-blind, randomised, non-inferiority, phase 3 trials. Lancet 2019;393:143–155. No conflict of interest.
{"title":"4CPS-068 Effectiveness of dolutegravir and lamivudine therapy in a two drug regimen in a third level hospital","authors":"C. Fernández Zamora, T. Rodríguez Martínez, MA Meroño Saura, S. Clavijos Bautista, J. Plaza Aniorte, P. Pacheco López, MÁ Carvajal Sánchez, J. Ibáñez Caturla, MD Nájera Pérez","doi":"10.1136/ejhpharm-2020-eahpconf.169","DOIUrl":"https://doi.org/10.1136/ejhpharm-2020-eahpconf.169","url":null,"abstract":"Background and importance Simplification of antiretroviral treatments (ART) improves adherence and comfort, and may prevent some adverse effects caused by ART. Aim and objectives To assess the effectiveness (plasma viral load (PVL test) <50 copies/mL) of the combination of dolutegravir (DTG) and lamivudine (3TC) without a third antiretroviral drug in patients diagnosed with HIV infection who were previously treated with a three drug regimen of ART. Material and methods In January 2019, we studied a cohort of patients who were undergoing treatment with DTG+3TC in a two drug regimen. Once these patients were selected, we carried out a prospective study of the PVL test after 6 months of treatment. Results Thirty-three patients were receiving treatment with the DTG+3TC combination in January 2019. Patients were aged 24–72 years (mean 46.27 years). The previous PVL test was undetectable in 69.70% of patients, detectable (<50 copies/mL) in 27.27% of patients and 1 patient (3.03%) had a viral load of >50 copies/mL. After 6 months of treatment, the PVL test was undetectable in 75.75% of patients, detectable (<50 copies/mL) in 15.15% and detectable (>50 copies/mL) in 3.03%. Two patients discontinued treatment. Conclusion and relevance The combination of DTG+3TC seemed to be an effective alternative to other ART when we re-evaluated patients after 6 months of treatment. We found a PVL <50 copies/mL in 96.96% and 90.90% of patients before and after the change in ART. References and/or acknowledgements 1. Cahn P, Madero JS, Arribas JR, et al. GEMINI Study Team. Dolutegravir plus lamivudine versus dolutegravir plus tenofovir disoproxil fumarate and emtricitabine in antiretroviral-naive adults with HIV-1 infection (GEMINI-1 and GEMINI-2): week 48 results from two multicentre, double-blind, randomised, non-inferiority, phase 3 trials. Lancet 2019;393:143–155. No conflict of interest.","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"99 1","pages":"A79 - A79"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75854838","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 : 2020-03-01DOI: 10.1136/ejhpharm-2020-eahpconf.86
J. Valor, Jl Revuelta, MS Pernía López, A. H. Alonso, M. S. Sáez, Gregorio Marañón
Background and importance Codeine mixed with calcium salts filled into capsules is used to treat chronic diarrhoea in transplant, oncological and geriatric patients, and in patients with irritable bowel disease. At least 11 500 hard capsules are regularly prepared from a manually blended powder mixture in the hospital pharmacy per month. Turbula 2F2 blender has been introduced into the hospital pharmacy to optimise the mixing process. Aim and objectives To establish optimal blending time and speed for mixing of codeine with the Turbula 2F2 blender and to verify homogeneity by determining the amount of codeine in the samples, a validated spectrophotometric analytical method was used. Material and methods The total amount of prepared mixture was 245.7 g containing 4.5 g of codeine phosphate (1.83%). The optimal rotation speed of Turbula was established as 49 rounds per min (RPM) based on visual analysis with colourant instead of codeine. A 2 litre polyethylene container for homogenisation was used. Calcium carbonate was premixed with colloidal silica, and codeine and tricalcium phosphate added. Five samples for analysis were taken from different places in the container after 5, 10, 15 and 20 min of mixing. Expression of relative standard deviation (RSD) was used to evaluate the homogeneity of codeine in the mixture. Results The results are summarised in table 1.Abstract 3PC-039 Table 1 Time of mixing at 49 RPM Sample No Content of codeine (%) RSD 5 min 1 1.84 2.47 2 1.79 3 1.77 4 1.79 5 1.89 10 min 6 1.75 1.91 7 1.72 8 1.74 9 1.72 10 1.81 15 min 11 1.59 3.82 12 1.73 13 1.76 14 1.62 15 1.64 20 min 16 1.58 5.47 17 1.69 18 1.74 19 1.49 20 1.67 Conclusion and relevance Based on the results, the optimal time of 10 min was estimated for mixing of the codeine mixture at 49 RPM. The use of the Turbula 2F2 mixer was beneficial in reducing pharmacy staff exposure to powder particles of hazardous drugs and in reducing the risk of cross contamination in the laboratory. References and/or acknowledgements No conflict of interest.
{"title":"3PC-039 Optimisation of mixing an oral powder mixture of codeine prepared in the hospital pharmacy for filling into hard capsules","authors":"J. Valor, Jl Revuelta, MS Pernía López, A. H. Alonso, M. S. Sáez, Gregorio Marañón","doi":"10.1136/ejhpharm-2020-eahpconf.86","DOIUrl":"https://doi.org/10.1136/ejhpharm-2020-eahpconf.86","url":null,"abstract":"Background and importance Codeine mixed with calcium salts filled into capsules is used to treat chronic diarrhoea in transplant, oncological and geriatric patients, and in patients with irritable bowel disease. At least 11 500 hard capsules are regularly prepared from a manually blended powder mixture in the hospital pharmacy per month. Turbula 2F2 blender has been introduced into the hospital pharmacy to optimise the mixing process. Aim and objectives To establish optimal blending time and speed for mixing of codeine with the Turbula 2F2 blender and to verify homogeneity by determining the amount of codeine in the samples, a validated spectrophotometric analytical method was used. Material and methods The total amount of prepared mixture was 245.7 g containing 4.5 g of codeine phosphate (1.83%). The optimal rotation speed of Turbula was established as 49 rounds per min (RPM) based on visual analysis with colourant instead of codeine. A 2 litre polyethylene container for homogenisation was used. Calcium carbonate was premixed with colloidal silica, and codeine and tricalcium phosphate added. Five samples for analysis were taken from different places in the container after 5, 10, 15 and 20 min of mixing. Expression of relative standard deviation (RSD) was used to evaluate the homogeneity of codeine in the mixture. Results The results are summarised in table 1.Abstract 3PC-039 Table 1 Time of mixing at 49 RPM Sample No Content of codeine (%) RSD 5 min 1 1.84 2.47 2 1.79 3 1.77 4 1.79 5 1.89 10 min 6 1.75 1.91 7 1.72 8 1.74 9 1.72 10 1.81 15 min 11 1.59 3.82 12 1.73 13 1.76 14 1.62 15 1.64 20 min 16 1.58 5.47 17 1.69 18 1.74 19 1.49 20 1.67 Conclusion and relevance Based on the results, the optimal time of 10 min was estimated for mixing of the codeine mixture at 49 RPM. The use of the Turbula 2F2 mixer was beneficial in reducing pharmacy staff exposure to powder particles of hazardous drugs and in reducing the risk of cross contamination in the laboratory. References and/or acknowledgements No conflict of interest.","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"45 1","pages":"A40 - A40"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74703965","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 : 2020-03-01DOI: 10.1136/ejhpharm-2020-eahpconf.459
P. Declercq, F. V. D. Aa, L. Pourcq, Isabel Spriet
Background and importance Before we implemented an oral nutrition protocol, parenteral nutrition (PN) was standard of care after elective radical cystectomy (RC) patients in our hospital. PN is expensive, with often metabolic and infectious complications. Aim and objectives The main objective of this study was to explore the impact of the introduction of an oral nutrition protocol on catheter-related bloodstream infection (CRBSI) incidence. Besides, length of stay and parenteral nutrition (PN) associated costs were compared. Materials and methods In this large retrospective case-control study, before (PN group) and after the implementation of the oral nutrition protocol (since March 2010), two cohorts of 549 patients who underwent an elective RC were included. A central venous catheter was present in every patient, which is standard of care. The incidence of a CRBSI, the length of stay and PN associated costs were compared. Results In both the control (June 2000–March 2010) and the case (March 2010–December 2017) group, an equal number of 549 patients were included. CRBSI was reduced from 22 (4%) to 10 (1.8%) (p=0.031). The median length of stay between both groups, 20 [17 – 25] days before vs. 17 [14 – 21] days after the implementation of the oral nutrition protocol, also differed significantly (p<0.001). Implementing the oral nutrition protocol resulted in a parenteral nutrition associated cost saving of €470 per patient. Conclusion and relevance This large follow-up study showed that an oral nutrition protocol is associated with a reduction in CRBSI. Besides, postponing PN in favour of oral nutrition enhances recovery and is associated with cost savings. In conclusion, we believe that the clinically relevant results of our study are confirming that oral nutrition should be standard of care in elective regular RC patients.
{"title":"NP-001 Impact of an oral nutrition protocol in patients treated with elective radical cystectomy: a long term follow-up","authors":"P. Declercq, F. V. D. Aa, L. Pourcq, Isabel Spriet","doi":"10.1136/ejhpharm-2020-eahpconf.459","DOIUrl":"https://doi.org/10.1136/ejhpharm-2020-eahpconf.459","url":null,"abstract":"Background and importance Before we implemented an oral nutrition protocol, parenteral nutrition (PN) was standard of care after elective radical cystectomy (RC) patients in our hospital. PN is expensive, with often metabolic and infectious complications. Aim and objectives The main objective of this study was to explore the impact of the introduction of an oral nutrition protocol on catheter-related bloodstream infection (CRBSI) incidence. Besides, length of stay and parenteral nutrition (PN) associated costs were compared. Materials and methods In this large retrospective case-control study, before (PN group) and after the implementation of the oral nutrition protocol (since March 2010), two cohorts of 549 patients who underwent an elective RC were included. A central venous catheter was present in every patient, which is standard of care. The incidence of a CRBSI, the length of stay and PN associated costs were compared. Results In both the control (June 2000–March 2010) and the case (March 2010–December 2017) group, an equal number of 549 patients were included. CRBSI was reduced from 22 (4%) to 10 (1.8%) (p=0.031). The median length of stay between both groups, 20 [17 – 25] days before vs. 17 [14 – 21] days after the implementation of the oral nutrition protocol, also differed significantly (p<0.001). Implementing the oral nutrition protocol resulted in a parenteral nutrition associated cost saving of €470 per patient. Conclusion and relevance This large follow-up study showed that an oral nutrition protocol is associated with a reduction in CRBSI. Besides, postponing PN in favour of oral nutrition enhances recovery and is associated with cost savings. In conclusion, we believe that the clinically relevant results of our study are confirming that oral nutrition should be standard of care in elective regular RC patients.","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"133 1","pages":"A215 - A215"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74879963","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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