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

Objectives: Acceleration of the haemostasis process after dermatological surgery predominantly relies on mechanical methods, such as the use of sutures or staples. To our knowledge, there is currently no commercialised haemostatic agent for this specific application. Due to the protein precipitation properties of the 50% (w/v) aluminium chloride hexahydrate solution, its physicochemical stability and maintenance of sterility over a 6 month period were assessed.

Methods: Aluminium chloride hexahydrate was dissolved in sterile water to obtain a 50% (w/v) solution, which was subsequently sterilised through filtration. The solution was then placed in brown glass vials and kept at 20-25°C. The physicochemical stability and sterility of the solution were assessed at four different time points (D0, M1, M3 and M6). At each time point, pH and osmolality were measured, the chloride concentration of the sample was evaluated using the Mohr method, and aluminium identification was carried out through a precipitation method. In addition, the sterility of the solution was also assessed at each time point, according to the European Pharmacopoeia method.

Results: The pH, osmolality and chloride concentration values remained stable and were concordant with the expected values throughout the study. Aluminium was identified in each sample. The sterility of the solution was maintained over the study period.

Conclusions: The physicochemical stability and sterility of the 50% (w/v) aluminium chloride hexahydrate solution were maintained for 6 months. These results indicate that the solution can be prepared in advance.

Brentuximab vedotin (BV) is an antibody-drug conjugate, consisting of a CD30-directed antibody, conjugated by a protease-cleavable linker to a microtubule disrupting agent auristatin E (MMAE). Although the safety datasheet of BV does not warn of severe toxic effects of extravasation, we report a third case of a patient with anaplastic large cell lymphoma who developed severe epidermal necrosis after extravasation. The reason for what happened could be attributed to the fact that MMAE belongs to the group of vinca alkaloids so it should be handled like other tissue-necrotising chemotherapeutics. Reporting of all cases of extravasation involving new conjugated chemotherapeutic drugs is of the utmost importance to be able to develop updated guidelines. Hospital pharmacists can provide information on how to manage extravasation, assess the potential risk, and have a crucial role in drafting hospital protocols.

Objectives: This paper combines the concepts of design thinking and benchmarking in an aseptic manufacturing context. Design thinking is a problem-solving approach that aims to understand user needs, generate ideas, prototypes and test solutions. There are no published examples in the Irish healthcare setting. There are also no national legislative frameworks in Ireland for compounding medicine in unlicensed hospital aseptic compounding units (ACUs). This study aims to apply design thinking principles to the development of a benchmarking process in the absence of existing frameworks.

Methods: A literature review of design thinking research and international best practice guidelines regarding sterile product manufacture documentation was undertaken to develop an initial prototype benchmarking tool. Design thinking principles were implemented by recruiting and empathising with key senior stakeholders (N=5). Semistructured interviews were conducted with these stakeholders to aid the defining, ideation and optimisation of the prototype tool. The optimised tool was then prototyped and tested in practice by end users (N=11), within an Irish ACU. End users were interviewed regarding their experience of using the tool. Transcripts of interviews were coded, and thematic analysis was undertaken to generate overarching themes to support its further development.

Results: The design thinking approach enabled the development of a benchmarking tool, which was optimised by empathising with key stakeholders. Through the process of empathising, defining, ideation, prototyping and testing, a useful benchmarking tool was developed which was deemed appropriate and accepted by its users.

Conclusions: Design thinking provides a platform for collaboration to deliver innovation and drive quality improvement in healthcare settings. The design thinking process was successful in delivering a user-centred tool for documentation procedures in an aseptic unit, which was accepted for use by end users. When exisiting guidleines and regulations are considered, design thinking shows promise as an innovation tool in Irish aseptic units, manufacturing facilities and the wider healthcare context.

Objective: Drug-related problems (DRPs) are a frequent reason for visits to the emergency department (ED). However, data about the characteristics associated with early revisits are limited. We aimed to identify clinical phenotype clusters of patients admitted to emergency rooms due DRPs to identify those patients with the highest risk of new visits.

Methods: We included consecutive patients admitted to EDs due DRPs (February 2021 to December 2022), including DRP admissions in 2023 as validation cohort. We employed K-means clustering to group patients according to adjusted morbidity groups (GMA), age, and number of drugs at admission. To determine the optimal number of cluster centres, we used the elbow method. The impact of 30-day revisits in each cluster was assessed.

Results: 1611 patients (mean (SD) age 75.0 (15.1) years) were included. We identified six clusters, with 30-day revisits rates ranging from 14.8% to 24.5%. The main groups of drugs implicated in the DRP episodes were diuretics (190 patients; 11.8%). The most common DRP diagnoses were constipation (191; 11.9%) and gastrointestinal bleeding (158; 9.8%). Six clusters of patients were identified. Significantly higher 30-day revisits in patients identified in cluster 4 (24.5% vs 17.5%; p=0.007). The highest revisit rate was observed in the cluster including patients with a higher number of drugs and GMA status.

Conclusions: Patients admitted to the ED due DRPs exhibit varying revisit rates across different clinical phenotypes. K-means clustering aids in identifying patients who derive the greatest rates of readmission, and is a useful tool to prioritise interventions in these units.

Objective: We report our experience with the use of ceftaroline in combination with daptomycin or vancomycin for methicillin resistant coagulase negative Staphylococcus bacteraemia.

Methods: A multicentre retrospective study was carried out at three institutions of adult patients with methicillin resistant S. epidermidis or S. lugdunensis bacteraemia who were managed with either daptomycin or vancomycin in combination with ceftaroline.

Results: Twelve patients met the inclusion criteria. All patients who received combination therapy had sterile blood cultures on the subsequent blood cultures drawn following ceftaroline initiation. Those who received ceftaroline combination within 7 days had a faster time to blood culture sterilisation than those who received ceftaroline combination therapy after 7 days (6 (3-7) days vs 17 (12-19) days, p=0.031).

Conclusions: The results from this case series support the use of ceftaroline combination therapy in patients with methicillin resistant coagulase negative Staphylococcus bacteraemia whose blood cultures failed to sterilise with vancomycin or daptomycin alone.

Background: Immune-mediated inflammatory diseases (IMIDs) are a group of disorders characterised by acute or chronic inflammation. Adalimumab and infliximab are the cornerstones of their pharmacotherapy. This study aimed to determine whether variations in the volume and citrate content of different subcutaneous adalimumab formulations result in differences in pain perception during administration.

Methods: A retrospective, cross-cohort study was conducted. Patients who had experienced a change in subcutaneous adalimumab formulation in the past year were recruited. Pain perception was evaluated using a visual analogue scale ranging from 1 to 10 points. Patients were assigned to three groups based on the type of formulation change they experienced: reduction in citrate and volume, reduction in volume only or reduction in citrate only. Data were analysed via ANOVA to determine if there were differences in perceived pain among the three patient groups.

Results: A total of 68 patients were included, of whom 39 (57.4%) experienced a reduction in both volume and citrate, 20 (29.4%) experienced only a reduction in volume and 9 (13.2%) experienced only a reduction in citrate. Analysis showed that all three groups experienced a reduction in perceived pain during administration: 2.46±0.24, 0.3±0.57 and 0.66±1.11 points, respectively (p<0.001).

Conclusions: Our results show that in all three scenarios, perceived pain was reduced. If both volume and citrate are reduced, this effect is greater. Therefore, it is recommended to use formulations with the lowest citrate buffer concentration and the lowest possible volume to minimise pain during adalimumab administration.

Background: Adults who are critically ill frequently require multiple intravenous infusions through limited vascular access, making Y-site co-infusion unavoidable. However, much of the primary compatibility literature uses concentrations, diluents and visual-only methods that do not reflect contemporary intensive care unit (ICU) practice, risking false reassurance at the bedside.

Objective: To create an ICU-specific, concentration-matched Y-site compatibility chart aligned to standardised infusion concentrations and to identify compatible, conditional, incompatible and no-data drug-pairs.

Methods: We performed a PRISMA (preferred reporting items for systematic reviews and meta-analyses) guided, method-stratified synthesis (1970-2025) of in-vitro Y-site evidence from PubMed, Trissel's and Micromedex. Classifications privileged instrumented endpoints (pH, turbidimetry, sub-visible particles, high-performance liquid chromatography) over visual inspection. Drug-drug pairs were mapped to our tertiary adult ICU formulary; medicines with an established ward standard were deemed ICU standardised.

Outcomes: compatible (C), compatible in saline only (Csf), conditional (concentration/diluent dependent; applied only when at least one medicine was ICU standardised), incompatible-physical (Ie/Ip/It) or chemical (Iq)-or no data (ND).

Results: Among 4465 mapped drug-pairs, 43.94% were compatible (C 42.37%, Csf 1.57%); 2.53% were conditional; 8.24% were incompatible-predominantly physical; and 45.29% lacked eligible evidence. High-risk clusters included lipid emulsions (eg, propofol, clevidipine), extreme-pH agents (eg, amiodarone, furosemide), phenytoin and calcium salts. For morphine hydrochloride, evidence was sparse (76% ND, 21% compatible, 1% conditional, 2% incompatible). Amiodarone exemplified concentration non-concordance; with an ICU concentration of 15 mg/mL, 34% of amiodarone drug-pairs had compatibility that was concentration dependent.

Conclusions: At standardised ICU concentrations, fewer than half of potential Y-site pairings are unequivocally compatible and nearly half have no concentration-matched data. A conservative, method-stratified framework anchored to exact concentration and diluent mitigates risk and exposes evidence gaps. Applying a conservative, method-stratified framework anchored to exact concentration and diluent mitigates risk while revealing priority evidence gaps-especially for lipid emulsions, calcium-containing solutions, extreme-pH drugs and opioids. Embedding the chart within the electronic prescribing and medicines administration (EPMA) system can deliver checks, standardise line allocation, reduce uncertain Y-site mixing and prioritise dedicated lumens for high-risk agents.