European journal of hospital pharmacy : science and practice最新文献

Objective: The primary objective of this study was to evaluate the physical compatibility of ceftazidime-avibactam with selected intravenous antimicrobials during simulated Y-site administration.

Methods: Ceftazidime-avibactam (25 mg/mL) was mixed with select intravenous antimicrobials (tigecycline, metronidazole, meropenem, imipenem and cilastatin, fosfomycin, aztreonam and vancomycin) at an equal volume and evaluated using simulated Y-sites. Each admixture was evaluated immediately (0 hour) and after 1, 2, and 4 hours at room temperature (approximately 22°C) for visual characteristics, Tyndall beam, turbidity, pH, spectroscopic absorption of 550 nm and particle counts. If an admixture failed any one of these six assessments, it was considered incompatible.

Results: No evidence of incompatibility was observed between the combinations of ceftazidime-avibactam and the seven intravenous antimicrobials in simulated Y-site experiments.

Conclusion: Ceftazidime-avibactam was physically compatible with the selected intravenous antimicrobials (tigecycline, metronidazole, meropenem, imipenem and cilastatin, fosfomycin, aztreonam and vancomycin) in simulated Y-site administration.

Objectives: Oral anticoagulants present significant risks of iatrogenic complications. An educational programme dedicated to patients treated with vitamin-K antagonists (VKAs) or direct oral anticoagulants (DOACs) was set up in our cardiology department in 2013. The aim of this study is to describe and assess our programme's effectiveness, through evaluation of patients' skills and adherence, and to identify associated factors.

Methods: Skills were assessed through a questionnaire designed by our multidisciplinary team, targeting different items, and a global score was rated from 0 to 1. Adherence was assessed using a validated tool. Data from patients educated between January 2013 and December 2021 were collected retrospectively. R software was used for statistical analysis, performing Student or χ² tests for comparison of variables and univariate linear regression analysis for identification of variability factors. A value of p<0.05 was considered significant.

Results: Since 2013, 934 patients were educated, representing 14.7% of patients with oral anticoagulants in cardiology units. Mean±SD age was 68.7±16.4 years and the proportion of men was 58.9%. After hospital discharge, skills were assessed for 334 patients: mean score was 0.80±0.17 (minimum 0.1 to maximum 1). Younger patients presented higher scores than older ones (p<0.001). Adherence was assessed for 331 patients: levels were high, medium and low for 58%, 31.4% and 10.6% of them, respectively. Women presented higher adherence than men (p=0.01). Neither oral anticoagulant type (VKA or DOAC) nor characteristics of educational sessions presented significant association with skills or adherence.

Conclusions: Our programme educated a large number of patients and seems to fit with VKAs and DOACs. Improvement areas could be to increase patient assessment and to reinforce education of elderly patients.

Background: The introduction of chimeric antigen receptor (CAR)-T cell therapies to the Belgian market represents a major revolution in patient treatment but also poses a challenge for hospitals to adapt. The medicinal status of CAR-T cells means that hospital pharmacists are legally responsible for managing this drug. In Belgium, due to infrastructure and expertise barriers, the hospital pharmacist's responsibilities are often delegated to the cell therapy units in many hospitals. This delegation of tasks effectively excludes the hospital pharmacist from the CAR-T cell circuit.

Objective: The aim of the study was to measure the impact of the hospital pharmacist in securing the CAR-T cell circuit using the Failure Mode, Effects and Criticality Analysis (FMECA) method.

Methods: The process map and FMECA were performed by a multidisciplinary team. Criticality indices were calculated before and after the implementation of corrective and preventive actions by the hospital pharmacist.

Results: The FMECA identified 114 failure modes. Thirteen (11.5%) failure modes were assessed as high criticality, 47 (41.23%) as moderate criticality and 54 (47.8%) as low criticality. The most critical stages highlighted by this study are pharmacovigilance and tarification. The hospital pharmacy played a central role in ensuring the safety of the circuit, being involved in the implementation of 28 corrective and preventive actions, which represent 53% of the FMECA actions. These actions led to a 77% reduction in high-criticality failure modes and a 49% reduction in moderate-criticality failure modes.

Conclusions: This study enabled us to identify the potential risks of the CAR-T cell circuit at the Jules Bordet Institute. The hospital pharmacy was involved in resolving 54% (62/114) of the failure modes. This confirms the hospital pharmacist's central role in ensuring the safety of the CAR-T cell circuit.

Background: Tachyphylaxis is the rapid development of drug tolerance following repeated administration.

Objectives: To evaluate the United States Food and Drug Administration Adverse Event Reporting System (USFDA AERS) data for drugs significantly associated with tachyphylaxis using disproportionality analysis.

Methods: Disproportionality analysis was used for detecting safety signals for identifying drugs associated with tachyphylaxis. Frequentist and Bayesian statistical methods were employed to detect signals, identifying anesthetics, immunosuppressants, antineoplastics, and psychoactive drugs with positive associations.

Results: Data from 29,153,222 reports between 2004 and 2024 were examined, and 242 reports of tachyphylaxis included. Tachyphylaxis was observed with corticosteroids, opioids, antihistamines, psycholeptics, nitroglycerin, antineoplastics, immunosuppressants, sympathomimetics, psychoanaleptics and psycholeptics that are well documented. Tachyphylaxis was also observed with propofol, cisatracurium, oxcarbazepine, and cabergoline emphasizing the need for further investigation. Hospitalization was reported in 16.9% of cases, with 5% leading to disability and 2.5% resulting in death.

Conclusion: While this study provides valuable insights into drug-related tachyphylaxis, limitations such as underreporting and lack of detailed clinical context exist. Future research should focus on understanding underlying mechanisms and developing strategies to mitigate tachyphylaxis in long-term treatments.

Objectives: To evaluate the impact of centralising the reconstitution of biological medicines from hospital wards to a hospital pharmacy aseptic facility on the amount and costs of medicine waste.

Methods: Data from 1 January 2021 to 30 November 2021 were collected from an electronic patient record system, including dose, timing and site of the administration of infliximab, rituximab and vedolizumab across 31 wards. The average wholesale prices were obtained from the Finnish national database. Three hypothetical models were compared. In Model A, the medicine residual was discarded after reconstitution on the ward. In Model B, the medicine residual was reused on the ward within the next 12 hours for the subsequent reconstitutions. In Model C, all medicine reconstitutions were centralised. Mean medicine waste costs were calculated and compared between models. Regression analysis was conducted to assess the relationship between ward size and medicine waste costs.

Results: The total calculated medicine waste costs at wholesale prices were higher in decentralised models (Models A and B) compared with the centralised model (Model C). The largest cost savings between Models A and C were observed with rituximab (€110 012), while the smallest were with vedolizumab (€46 162). Comparing Models B and C, rituximab also had the greatest savings (€73 524), with infliximab showing the least (€23 014). The number of reconstituted medicines was associated with higher waste costs. A 10% increase in reconstituted medicines led to a 3.1% decrease in relative waste costs.

Conclusions: Centralisation may reduce the amount and costs of medicine waste. However, other associated factors should also be considered, such as transport and storage of ready-to-administer medicines, personnel costs and the impact on the quality and safety of care.

Changes in absorption and bioavailability of drugs have been described after bariatric surgery, especially shortly after the procedure. When a significant drug-drug interaction also occurs, it is difficult to predict the final combined effect of the surgery and the interaction. In this article, we present a case report of a patient with chronic psychiatric poly-medication including carbamazepine, a strong cytochrome P450 3A4 (CYP3A4) inducer. Significant changes in serum drug concentrations were observed during the 6 months after the surgery, including increased levels of quetiapine and trazodone, that cannot be attributed to the post-surgical alteration of absorption from the gastrointestinal tract. The influence of fluctuating carbamazepine levels on concomitant medication seemed to outweigh the effect of reduced absorption after surgery. This report highlights the need for careful pre-surgical evaluation of the patient's pharmacotherapy and pre- and post-operative therapeutic drug monitoring to prevent destabilisation of chronic conditions.

Objective: To determine the extent to which recommended paracetamol loading doses are administered in an academic paediatric hospital and to determine whether paracetamol loading doses are necessary to achieve the therapeutic target concentration of 10 mg/L in (pre)term neonates and children.

Methods: A retrospective study was performed including (pre)term neonates and children who were hospitalised between 1 January 2023 and 1 January 2024 and received at least one dose of intravenous or rectal paracetamol. The number of treatments with and without a paracetamol loading dose was evaluated. Pharmacokinetic simulations were performed to determine the effect of the loading dose on paracetamol steady-state concentrations (C_ss).

Results: We included 911 intravenous and 1402 rectal treatment periods, with loading doses administered in 21% and 1% of the cases, respectively. Pharmacokinetic simulations show that an intravenous or rectal loading dose reaches C_ss concentrations within the first dose, while without a loading dose, C_ss is only reached after 12 hours for intravenous and 18 hours for rectal administration.

Conclusion: Our results indicate that in most cases, paracetamol loading doses are not administered in an academic paediatric hospital, which will strongly delay paracetamol C_ss. We conclude that the treatment of (pre)term neonates and children with paracetamol can and should be improved.

Background: Compounding allows the use of medicines in paediatric patients that are not always available in appropriate dosages. Some of the commonly used excipients have been associated with toxicity events in neonates.

Objectives: To evaluate the exposure to potentially harmful excipients (PHEs) in neonates using compounded medicines and admitted to the neonatal intensive care unit (NICU) of a university hospital in Portugal.

Methods: Observational study with neonates using the 10 most prescribed compounded liquid oral medicines with a PHE in a hospital NICU. The daily intake of excipients listed in the European Study of Neonatal Exposure to Excipients (ESNEE) was calculated in NICU newborns (September 2019 to August 2020) by summing the daily dose of excipients in the compounded and all commercial medicines prescribed (Ethics CHUSJ CE-OP84-2021).

Results: 65 neonates used the 10 most prescribed compounded medicines containing a PHE. These neonates had 629 prescriptions, with 139 containing at least 1 PHE (31 different compounded or commercial medicines), resulting in 241 exposures to an ESNEE PHE: 125 propylparaben (89.9% of the prescriptions), 98 propylene glycol (70.5%), 6 benzyl alcohol (4.3%), 5 ethanol (3.6%), 4 sodium benzoate (2.9%), 2 sorbitol (1.4%) and 1 polysorbate 80 (0.7%). Excessive daily intakes of propylene glycol were found in 49 newborns (75.4%), followed by benzyl alcohol in 5 newborns (7.7%). One neonate was exposed to an excessive amount of 5 ESNEE PHEs and 2 other neonates to 3 ESNEE PHEs.

Conclusions: The frequent use of PHEs in compounded medicines for neonates was identified, and neonates were exposed to PHEs exceeding the maximum recommended daily intake. Propylene glycol was the excipient most associated with these events.

Background: Significant efforts have been directed towards systematically documenting and classifying pharmacist interventions (PIs), generating relevant data for professionals' practice and improving the quality of patient care and health outcomes. However, the paucity of PI evaluation tools hinders data generation, harmonisation and sensible application.

Aim: This study aimed to develop and validate a comprehensive questionnaire to assess pharmacists' opinions and practices concerning documenting and classifying PIs in Portuguese hospital settings.

Method: The tool development underwent face, content, construct validity procedures and scale reliability calculations grounded in the attitudinal framework. An exploration of the instrument dimensionally was accomplished through factor analysis. Face validity, content validity, construct validity and scale reliability were the selected validation parameters.

Result: A 37-item scale was developed comprising an initial sociodemographic section (8 items) and three explanatory attitudinal-based domains: Cognitive (6 items), Behavioural (14 items), and Affective (9 items). The scale showed adequate overall psychometric properties. Within the Affective domain, factor analysis revealed three latent explanatory factors: Process (4 items), Outcome (3 items) and Satisfaction (2 items).

Conclusion: This newly developed tool can contribute to assessing pharmacists' perspectives and routines in documenting and classifying PIs within hospital environments.