Study on Role of In-patient Pharmacist in Prescribed Drug Handling, Mixing, Infusing and Spillage Handling of Chemotherapeutic Drug-Cisplatin in a Tertiary Hospital Pharmacy

The in-patient pharmacist in a cancer hospital plays a major role in patient care especially in patient taking chemotherapy and other narrow indexed drugs as a part of cancer treatment. The pharmacist works as one of the members of cancer treatment team along with physician, oncologist, nurse and other medical professionals. An oncology pharmacist has major role in chemotherapeutic drug handling, mixing, infusing and spillage handling in a disciplined manner. In order to get hands on training about ‘‘oncology-pharmacy’’, it is a mandatory novel pharmaceutical department where a hospital pharmacist who works in oncology will have to get training in handling of chemotherapeutic drugs. The pharmacists who are interested in cancer care will involve in various facets cancer care; from chemotherapeutic drug regimen preparation, mixing of dosage regimen, infusing and finally spillage handling. Hence, it is a mandatory criterion for a graduate pharmacist to get hands on training in specialty Centre to take the responsibility as oncology in-patient pharmacist. The inpatient pharmacist can also be a clinical investigator for various clinical trials involving chemotherapeutic medication usage in patients with cancer. Current study shows that an inpatient pharmacist can play a major role in handling, mixing, infusing and spillage handling of chemotherapeutic drugs in a cancer care centre. The pharmacists are also responsible for reducing drug waste, dealing with drug shortages and reducing exposure to hazardous cytotoxic drugs. The current study suggests that the pharmacist in a cancer care hospital should specially be trained for the handling of chemotherapeutic drugs, mixing and infusion, spillage handling and wastage handling in order to provide accurate treatment for patient and to avoid untoward damage to the person who is handling.

Das Team in der Neurorehabilitation

Neurological rehabilitation is rehabilitative therapy that is concerned with neurological patients in a multi-professional team under the leadership of a physician. The members of this interdisciplinary team work together closely with an intense exchange of knowledge and competence. This primary treatment team includes specialists in neuropsychology, speech therapy, occupational therapy and physiotherapy (including physical therapy), along with social workers and co-therapeutic nursing. Other forms of therapy may also be included. A secondary team is defined by the cooperation of the neurologist with other medical fields, e.g., neurosurgery, geriatrics, psychiatry, orthopedics and neuropediatrics. A tertiary team exists in the form of organizational cooperation between the medical und economic clinic management with insurance companies and political decision makers. Every kind of rehabilitation is basically multi-professional from an organizational viewpoint, and it is performed interdisciplinarily applying the methods of all therapeutic disciplines to create synergies. This particularly applies to neurorehabilitation, as in this field – generally following a disease or an injury to the brain as the central regulation organ – several different disorders occur in combination: sensorimotor symptoms and signs like paralysis, spasticity, dysphagia and loss of coordination; cognitive or speech disorders; or finally psychological alterations like depression or anxiety. Therefore it is particularly important that the professional team members match and coordinate their therapeutic procedures to reach common rehabilitative goals. »Multi-professional« in this context means that the representatives of the different therapeutic fields work with the patient on an advanced competency level, and »interdisciplinary« means that the members of the team work together closely with thorough cross-consultation between their disciplines. Transdisciplinary cooperation represents the highest level of team competency and includes regularly adopting the tasks and therapeutic procedures from other disciplines. All kinds of cooperation are performed under the supervision of a physician who assumes full responsibility for the rehabilitative therapy, including the prescription of medication and introduction of acute interventions, e.g., surgical procedures. This paper is only concerned with the primary – therapeutic – team. The secondary and tertiary forms of team cooperation are planned to be published separately.

Patient preferences of healthcare delivery in irritable bowel syndrome: a focus group study

Background Irritable bowel syndrome (IBS) is a highly prevalent disorder with significant negative impact on quality of life of patients that results in high healthcare use and costs. Improving healthcare outcomes for IBS patients is warranted, however the exact needs of IBS patients with regard to therapy and control of symptoms are unknown. Methods Focus group interviews, using a two-stage model, were performed with twenty-three IBS patients meeting Rome III criteria and one mother of a patient, from four different regions from the Netherlands. Results Twenty-four participants were included of whom majority were female (n = 21), mean age was 43 years, and mean duration of IBS was 18 years. Five categories of patients’ perspectives were identified: clear communication, a multidisciplinary treatment team, centers of expertise, focus on scientific research and information about IBS that is widely available for patients. Conclusions Based on these findings we highlight the need for IBS care givers to take these key items into account in IBS care. These elements aid clinicians, but mostly patients, in coping and management of symptoms and subsequent healthcare outcomes, reducing overall healthcare use and costs.

Including dental professionals in the multidisciplinary treatment team of head and neck cancer patients improves long-term oral health status

Objective To assess in a cross-sectional study the impact of including dental professionals in the multidisciplinary treatment team of head and neck squamous cell carcinoma (HNSCC) patients on the long-term oral health status. Materials and methods Oral health status, dental care behaviours, and oral health–related quality of life were assessed based on a clinical and radiographic examination, interview, and medical records in patients treated for HNSCC ≥ 6 months ago. This patient group (‘cohort 2’) was treated in a multidisciplinary treatment team including dental professionals and compared to a group of HNSCC patients previously treated at the same university, but without dental professionals included in the multidisciplinary treatment team (‘cohort 1’). Results Cohort 2 consisted of 34 patients, who had received a dental check-up and if necessary, treatment by dental professionals prior to the initiation of cancer treatment. This cohort showed significantly improved oral hygiene habits and a better periodontal health status compared to cohort 1. However, cohort 2 still presented high demand for treatment due to active carious lesions; only a few, statistically insignificant improvements were detected compared to cohort 1. Conclusion Including dental professionals in the multidisciplinary treatment team of HNSCC patients has a positive impact on patient oral health status—primarily in terms of periodontal disease—6 months and longer after finishing cancer therapy. Clinical relevance A team-based approach including dental professionals specialised in head and neck cancer improves oral health status.

80. The Utility of Cultures for Isolated Fevers in Patients with Influenza or COVID-19 Receiving Extracorporeal Membrane Oxygenation

Background Critically ill patients receiving extracorporeal membrane oxygenation (ECMO) are at elevated risk for nosocomial infection. Physiological responses to infection on ECMO are difficult to interpret as many clinical characteristics are controlled by the circuit including temperature. This study aimed to determine the culture positivity rates in patients receiving ECMO with influenza or COVID-19. Methods A single center retrospective study was performed on all patients who received ECMO support at a single institution between December 2014 and December 2020 with influenza or COVID-19. All cultures ordered were reviewed for indication. Patients with fever without specific clinical syndrome or signs of decompensation, such as increasing vasopressor requirement were included. Infections and contaminants were defined by treatment team. Results A total of 45 patients received ECMO with an admission diagnosis of influenza or COVID-19 during the study period. This cohort had a median age of 44 (interquartile range (IQR): 36-53) and was predominantly male (84%). The median time on ECMO was 360 hours (IQR: 183-666). 43/137 (31%) of infectious workups were ordered for isolated fever. The most common workup ordered for fever was combination blood cultures (BC) and urine cultures (UC) (13, 30%), followed by combination BC, UC, and respiratory cultures (RC) (11, 26%). Four (9%) infections were identified (3 blood stream, 1 respiratory) and five (12%) cultures grew contaminants (1 blood, 1 respiratory, 2 urine). Culture positivity rate was greatest for BC (3/35, 9%) followed by RC (1/19, 5%), and lowest for UC (0/26, 0%). Conclusion Although cultures are commonly ordered for isolated fever in patients with influenza and COVID-19 receiving ECMO, culture positivity rate is low. In particular, no urinary tract infections were identified and the screening for urinary tract infection in patients receiving ECMO with isolated fever is not beneficial. Further work identifying signs and symptoms associated with infection is needed to improve diagnostic stewardship in this population that is high risk for nosocomial infections. Disclosures All Authors: No reported disclosures

1032. Evaluation of a Multiplex Rapid Diagnostic Panel in Respiratory Specimens from Critically Ill Patients with Hospital-Acquired Pneumonia

Background Rapid diagnostic tests can be a valuable aide in clinical decision-making but often cost more than traditional cultures. Prior to its implementation at our institution, we sought to evaluate the potential clinical and financial impact of using the FilmArray® Pneumonia Panel® (FP panel) in patients with hospital-acquired pneumonia (HAP). Methods This was a retrospective, observational, comparative study conducted at an 885-bed academic medical center. Respiratory samples obtained by bronchoalveolar lavage or tracheal aspiration from adult intensive care unit (ICU) patients with a diagnosis of HAP from Nov 2019 – Feb 2020 were tested by the FP panel in addition to routine cultures. Medical records were reviewed to determine potential changes in antimicrobial therapy if FP panel results were known by the treatment team in real time. A cost analysis was also performed incorporating the cost of the FP panel and the savings associated with the potential avoidance of antibiotics and other rapid diagnostic tests normalized per patient. Results 56 patients met study criteria. FP panel results could have prompted a change in therapy in 36 (64.3%) patients, with a mean reduction in time to optimized therapy of approximately 51 hours. The panel identified 3 cases where the causative pathogen was not treated by empiric therapy and 34 opportunities for antibiotic de-escalation, the most common being the discontinuation of empiric vancomycin. 36 patients had been tested with a Respiratory Virus Panel, which could have been avoided if the FP panel was used. The potential therapy impact based on specific ICU and respiratory culture results is summarized in Table 1. The cost analysis calculated an additional cost of &10 per patient associated with using the FP panel. Table 1. Potential Changes in Therapy Based on Patient Location and Culture Result Conclusion The FP panel could have prompted a change in therapy in about two-thirds of patients studied. Its potential benefits include quicker time to optimized therapy, reduced exposure to and cost of broad-spectrum antimicrobials, and reduced cost of other rapid diagnostic tests. Disclosures James Johnson, PharmD, FLGT (Shareholder) Vera Luther, MD, Nothing to disclose

Patient Resources in a Cancer Center

Despite the emergence of more effective targeted therapies, cancer treatment remains a complex process requiring a holistic patient-centered approach, beyond the direct medical care offered by the treating hematologist/oncologist. This entails empowering patients with knowledge about prescribed regimens and their risks and side effects, within a multifaceted treatment team involving hematologists/oncologists, advanced practice providers, nurses, nutritionists, and pharmacists, among others. Additionally, a multitude of resources are generally available including financial, religious, and spiritual support to help patients in the treatment journey. This chapter describes resources generally available to cancer patients, as well as an array of supporting services in a cancer center to address the patient needs.

An acute change? Does treatment within a therapeutic community for personality disorders affect local acute service use

Purpose The intensive 18-month treatment in the personality disorder (PD) therapeutic community (TC) is felt to offer improvement in many aspects of patients’ lives. This study aims to understand if the use of acute services was also affected via a service evaluation project. Design/methodology/approach The authors collected data from electronic records on the use of local services in the two years before, during and the two years after treatment in the TC. Specifically, the authors counted inpatient bed days, Emergency department (ED) presentations and days under home treatment team and liaison psychiatry; the authors used ANOVA to analyse the data. Findings The study included 25 adult service users, 17 female and 8 male, with an average age of 40. Whilst there were reductions in the use of inpatient beds and ED presentations, on analysis, these were not found statistically significant. The small size of the study is a limitation and may limit the generalisability of the findings. The study concludes there may be reductions in acute psychiatric service use during and after treatment in the TC. The findings were not statistically significant; the authors suggest larger multi-centre studies may be able to demonstrate statistical significance. Originality/value PD patients have a relatively high use of acute psychiatric services compared to other patient groups. The authors are not aware of any similar studies in the published literature.

520 - Benefits of Assertive Community Treatment for Persons with Severe Mental Illness and Cancer

Breast cancer, the most commonly diagnosed cancer in women worldwide, is responsible for one in six cancer deaths (Sung, H. et al., 2021). Women with schizophrenia have an associated increased incidence of breast cancer compared to the general population (Grassi & Riba, 2020). Patients with severe mental illness are noted to have disparities in accessing and initiating cancer treatment especially among those who are older (Iglay et al., 2017). A case vignette will be presented to illustrate the care and interventions provided by an American Assertive Community Treatment team which fostered supportive treatment engagement and improved the quality of life for a patient that chose to forgo recommended cancer treatment. This presentation will highlight the essential nature of the Assertive Community Treatment team in supporting decisional capacity, facilitation of a patient’s grief and acknowledgement of one’s own mortality as well as incorporation of medical and palliative care. The attendee will appreciate the importance of the multidisciplinary approach for persons with chronic mental illness and co-morbid cancer diagnoses.

Application of interdisciplinary collaborative hospice care for terminal geriatric cancer patients: A prospective randomised controlled study

Background Hospice care (HC) is specialized medical care for terminal patients who are nearing the end of life. Interdisciplinary collaborative hospice care (ICHC) is where experts from different disciplines and patients/caregivers form a treatment team to establish shared patient care goals. However, the ICHC efficacy has not been frequently studied in the terminal geriatric cancer patients (TGCPs) population. This study aimed to gain insight into ICHC provided to TGCPs by an ICHC team and identify factors to ameliorate multidimensional HC. Methods 166 TGCPs were equally divided into ICHC group and life-sustaining treatments (LSTs) group as control. The scores of these questionnaires [such as EORTC QLQ-C30, Hamilton Anxiety Scale], the median survival time (MST), symptoms improvement, the median average daily cost of drugs (MADDC), the median total cost of drugs (MTDC) in the last 2 days, and medical care satisfaction were observed in both groups. Results After treatment, the emotional function and symptoms in the ICHC group were statistically higher improvement than those in the LSTs group (P < 0.05). The MADDC and the MTDC in the last 2 days were statistically lower in the ICHC group than those in the LSTs group (P < 0.01). In addition, the overall satisfaction situation and the cooperation ability in the ICHC group were statistically higher than those in the LSTs group (P < 0.01). Conclusion The ICHC could provide TGCPs with coordinated, comfortable, high-quality, and humanistic care.