PP89 The Investigation And Development Of A National Formulary Monitoring System Across Wales

IntroductionThe New Treatment Fund (NTF), launched in January 2017, aims to support the faster introduction of new medicines recommended by the National Institute for Health and Care Excellence (NICE) and the All Wales Medicines Strategy Group (AWMSG). The NTF requires seven health boards and one trust to make recommended medicines available within 60 days of any positive recommendation decision. The project goal was to develop a system for demonstrating how monitoring the NTF improves medicines access for the people of Wales.MethodsThe process was derived via a series of task and finish group meetings with relevant stakeholders. The monitoring criteria were agreed through a collaborative expert approach using a nominal group technique. This determined a minimal dataset of formulary status, which included time to formulary addition. Pre-NTF medicines data (n = 59) were available for a six-month period.ResultsBy the three-year milestone of the NTF, the average time taken for newly recommended medicines (n = 219) to become available to patients across Wales had decreased by eighty-five percent from 90 to 13 days (p < 0.01).ConclusionsAn innovative and robust system has been created for accurately monitoring the formulary addition of medicines within the NTF, supporting the rapid and comprehensive uptake of medicines deemed clinically and cost effective by NICE and the AWMSG.

Evaluation of medication changes following severe COVID-19 infection: a multicentre evaluation

BackgroundCritically ill patients often experience several transitions of care following critical illness. Research has explored the challenges which patients have with medication management across these transitions. It is unclear whether patients admitted to critical care due to COVID-19 will have similar challenges. The aim of this study was to explore medication management in critical care survivors following severe COVID-19.MethodsBetween 3 and 7 months post hospital discharge, patients who had been admitted to critical care due to severe COVID-19 were invited to an established recovery service. During the clinic consultation a medication review was performed by a pharmacist. This included medicines reconciliation, assessing the appropriateness of each of the prescribed medications and identification of medication changes. We also assessed changes to pain management in the discharge period.ResultsIn total, 78 patients had a full medication review available. Over 70% of patients were taking an increased dose of medicine or a new medicine at clinic. There was a significant overall increase in new medication during the clinic consultation, across different British National Formulary classifications (OR: 1.73 (95% CI: 1.28 to 2.34), p<0.001). Compared with pre critical care admission, there was a significant increase in the number of patients taking regular analgesia following severe COVID-19 infection (23 (29.5%) vs 39 (50%), p<0.001).ConclusionFollowing severe COVID-19, patients may require new or increasing doses of medicines. Ongoing review of these patients is crucial to ensure optimal outcomes.

Similarity and Consistency Assessment of Three Major Online Drug-Drug Interaction Resources

AIM: To explore the level of agreement on drug-drug interaction (DDI) information listed in three major online drug information resources (DIRs) in terms of: (1) interacting drug pairs; (2) severity rating; (3) evidence rating and (4) clinical management recommendations. METHODS: We extracted DDI information from the British National Formulary (BNF), Thesaurus, and Micromedex. Following drug name normalisation, we estimated the overlap of the DIRs. We annotated clinical management recommendations either manually, where possible, or through application of a machine learning algorithm. RESULTS: The DIRs contained 51,481 (BNF), 38,037 (Thesaurus), and 65,446 (Micromedex) drug pairs involved in DDIs. The number of common DDIs across the three DIRs was 6,970 (13.54% of BNF, 18.32% of Thesaurus, and 10.65% of Micromedex). Micromedex and Thesaurus overall showed higher levels of similarity in their severity ratings, while the BNF agreed more with Micromedex on the critical severity ratings and with Thesaurus on the least significant ones. Evidence rating agreement between BNF and Micromedex was generally poor. Variation in clinical management recommendations was also identified, with some categories (i.e. Monitor and Adjust dose) showing higher levels of agreement compared to others (i.e. Use with caution, Wash-out, Modify administration). CONCLUSIONS: There is considerable variation in the DDIs included in the examined DIRs, together with variability in categorisation of severity and clinical advice given. DDIs labelled as critical are more likely to appear in multiple DIRs. Such variability in information could have deleterious consequences for patient safety, and there is a need for harmonisation and standardisation.

Tingkat Efisiensi Penggunaan Resep Dokter Spesialis Menggunakan Metode K-Means Clustering

The National Formulary (Fornas) is a list of drugs stipulated in a Decree of the Minister of Health of the Republic of Indonesia, which is used as a guideline for hospitals in drug supply for participants of the National Health Insurance (JKN) program. Doctor's prescription is one indicator of the quality of hospital services. Prescribing drugs based on guidelines will provide efficiency in the supply of drugs. The purpose of this study was to facilitate controlling drug supplies, safe use of drugs and control costs and quality of treatment. K-Means Clustering is a method of grouping data into clusters using the K-Means algorithm. The data used in this study was a specialist doctor's prescription in December 2019 which was sourced from the Pharmacy department of the Meranti Islands District Hospital. The results of this research with the K-Means Clustering method consisted of 3 (three) clusters, namely cluster 0 obeying Fornas as many as 2 polyclinics, cluster 1 being less obedient to Fornas as many as 2 polyclinics and cluster 2 not obeying Fornas as many as 3 polyclinics. This research can be used as a reference and evaluation to hospital management on the efficiency level of using specialist doctor's prescriptions in improving the quality of hospital services.

Discovering and comparing types of general practitioner practices using geolocational features and prescribing behaviours by means of K-means clustering

Traditionally General Practitioner (GP) practices have been labelled as being in Rural, Urban or Semi-Rural areas with no statistical method of identifying which practices fall into each category. The main aim of this study is to investigate whether location and other characteristics can provide a tautology to identify different types of GP practice and compare the prescribing behaviours associated with the different practice types. To achieve this monthly open source prescription data were analysed by practice considering location, practice size, population density and deprivation rankings. One year’s data was subjected to k-means clustering with the results showing that only two different types of GP practice can be classified that are dependent on location characteristics in Northern Ireland. Traditional labels did not describe the two classifications fully and new classifications of Metropolitan and Non-Metropolitan were used. Whilst prescribing patterns were generally similar, it was found that Metropolitan practices generally had higher prescribing rates than Non-Metropolitan practices. Examining prescribing behaviours in accordance with British National Formulary (BNF) categories (known as chapters) showed that Chapter 4 (Central Nervous System) was responsible for most of the difference in prescribing levels. Within Chapter 4 higher prescribing levels were attributable to Analgesic and Antidepressant prescribing. The clusters were finally examined regarding the level of deprivation experienced in the area in which the practice was located. This showed that the Metropolitan cluster, having higher prescription rates, also had a higher proportion of practices located in highly deprived areas making deprivation a contributing factor.

502 Benefits of Rivaroxaban over Enoxaparin in Trauma and Orthopaedics

Aim Our Aim was to show what the benefits of Rivaroxaban over Enoxaparin post-operatively in trauma and orthopaedics. Doing a meta-analysis of previous studies and comparing post-op thrombotic risk in both rivaroxaban and Enoxaparin. To compare costs of using Enoxaparin vs Rivaroxaban in the major trauma centre. Method Meta-analysis of four studies conducted;Lassen 2008, Turpie 2005, Turpie 2009, Xie 2017 and Zou 2014. Gathered data from the British national formulary about Rivaroxaban cost and enoxaparin cost. Results This illustrated that rivaroxaban after TKA(Total knee Arthroplasty) had a significantly lower rate of symptomatic VTE, symptomatic DVT, asymptomatic DVT, distal DVT, and proximal DVT (shown in figure 1). The study shows that rivaroxaban after TKA is more effective than enoxaparin and did not increase major bleeding or cause increased mortality Major venous thromboembolism occurred in 9 of 908 patients (1.0%) given rivaroxaban and 24 of 925 (2.6%) given enoxaparin in a study done by Lassen et al Rivaroxaban requires less training for the patient, enoxaparin requires the patient to be taught proper administration. Rivaroxaban is considerably cheaper compared to enoxaparin. Enoxaparin provided by both Inhixa and Clexane cost £30.27 for a batch of 10 pre-filled disposable injections of 40mg, whilst rivaroxaban costs £18 for 10 tablets of the dose 10mg. Conclusions Rivaroxaban is cheaper to use for post-op anticoagulation, less resource intensive as patient is not required to be taught optimal administration method. Rivaroxaban has significantly reduced occurrence of thrombus compared to that of enoxaparin (based of the meta-analysis).

Correlation between the level of knowledge of drug managers and drug management in several primary health centres in Malang regency

Background: Drug management is one of the primary health centre management activities that aims to ensure the continuity and affordability of pharmaceutical preparations. Aim: This study aims to determine the relationship between the level of knowledge of drug managers and drug management in several primary health centres of Malang regency. Method: The study was observational analytic using questionnaire instruments to analyse the level of knowledge of drug managers and three checklists to analyse drug management through three indicators of drug management: (1) conformity of stock to the national formulary, (2) conformity of stock to the disease patterns, and (3) the percentage of expired drugs. Result: There was no significant relationship between the level of knowledge and the first (p = 0.842), second (p = 0.236), and the third indicator (p = 0.361). Conclusion: Not all drug lists in the national formulary are required by each primary health centre. The inventory is adjusted to the consumption and epidemiology.

Assessment of Patient’s Response about Adverse Drug Reactions Receiving AC (Adriamycin, Cyclophosphamide) Therapy: A Survey Research

Background: Adverse drug reactions (ADRs) are most common among cancer patients receiving treatment. AC therapy which is a combination protocol of Adriamycin (doxorubicin) and Cyclophosphamide are the common therapies used for breast cancer treatment due to their effectiveness and cost of therapy breast cancer. AC combination is administered every 3 weeks, and 4 cycles are given. Objectives: To assess various ADRs reported by patients on AC combination therapy and their severity to ensure safe and effective treatment. Design: Prospective observational. Setting: Cancer hospital Jamshoro Pakistan. Patients and Methods: A hospital based observational study included 160 female patients suffering from breast cancer and receiving AC combination for treatment by purposive sampling method from June 2015- January 2018 at cancer hospital Jamshoro Pakistan. ADRs reported were compared against international standard references of drug literature such as British National Formulary (BNF) 2017 and ADR severity assessment scale (Modified Hartwig and Siegel scale). Main Outcome Measures: Frequency and severity of ADRs. Results: The common ADRs reported were, nausea and vomiting, acidity, fatigue, hair fall as common non-hematologic and leukopenia among hematologic ADRs. Those patients reported high severity ADRs according to severity scale persist for longer duration and required antidote for management with medical intervention. Conclusion: The present study shows that a patient’s response towards AC therapy is critical and therefore each patient must be monitored and those at high risk of developing ADRs from this therapy must be provided additional care.

A survey of mHealth use from a physician perspective in paediatric emergency care in the UK and Ireland

There has been a drive towards increased digitalisation in healthcare. The aim was to provide a snapshot of current apps, instant messaging, and smartphone photography use in paediatric emergency care. A web-based self-report questionnaire was performed. Individual physicians working in paediatric emergency care recorded their personal practice. One hundred ninety-eight medical doctors completed the survey. Eight percent of respondents had access to institutional mobile devices to run medical apps. Eighty-six percent of respondents used medical apps on their personal mobile device, with 78% using Apple iOS devices. Forty-seven percent of respondents used formulary apps daily. Forty-nine percent of respondents had between 1–5 medical apps on their personal mobile device. Respondents who used medical apps had a total of 845 medical apps installed on their personal device, accounted for by 56 specific apps. The British National Formulary (BNF/BNFc) app was installed on the personal mobile device of 96% of respondents that use medical apps. Forty percent of respondents had patient confidentiality concerns when using medical apps. Thirty-eight percent of respondents have used consumer instant messaging services, 6% secure specialist messaging services, and 29% smartphone photography when seeking patient management advice. Conclusion App use on the personal mobile devices, in the absence of access to institutional devices, was widespread, especially the use of a national formulary app. Instant messaging and smartphone photography were less common. A strategic decision has to be made to either provide staff with institutional devices or use software solutions to address data governance concerns when using personal devices. What is Known:• mHealth use by junior doctors and medical students is widespread.• Clinicians’ use of instant messaging apps such as WhatsApp is the widespread in the UK and Ireland, in the absence of alternatives. What is New:• Personal mobile device use was widespread in the absence of alternatives, with the British National Formulary nearly universally downloaded to physicians’ personal mobile devices.• A third of respondents used instant messaging and smartphone photography on their personal mobile device when seeking patient management advice from other teams in the absence of alternatives.

The assortment analysis of chlorhexidine-containing medicines and procurement data of state and municipal organizations

Chlorhexidine is an effective cationic antiseptic and disinfectant that has been used in medical practice for decades. It is generally recommended to use different concentrations of aqueous or alcoholic solutions of chlorhexidine for different therapeutic purposes. Objective. To determine the proportions of different chlorhexidine concentrations in medicines purchased by state and municipal organizations and to identify possible issue of chlorhexidine formulations utilization in the suboptimal or insufficient concentrations. Results. The vast majority of the chlorhexidine-containing medicines found in the State Register of Medicines of Ukraine are 0.05% solutions for external use, 0.05% gels for dental and urological use and vaginal suppositories (pessaries) with 16 mg of chlorhexidine in one dose. While the most common representatives of chlorhexidine-containing medicines abroad are solutions with a concentration of 4% and 2%, as well as mouthwashes with a concentration of 0.12%. The highest share - 96% - among the procurements of chlorhexidine-containing medicines by state and municipal organizations is 0.05% aqueous solution for external use. Instructions for medical use of 0.05% aqueous chlorhexidine solution for external use contain indications that are not supported by international documents: WHO Model List of Essential Medicines and British National Formulary. Conclusions. The obtained results suggest probable cases of irrational use of chlorhexidine medicines in medical practice in Ukraine. The consequences of such cases are not limited to the failure to achieve therapeutic goals or to the development of nosocomial infection, but includes also the selection of chlorhexidine-resistant strains of microorganisms. Key words: chlorhexidine; assortment analysis; medicinal procurements study; suboptimal concentration; rational pharmacotherapy