The impact of medication reconciliation and review in patients using oral chemotherapy

Background and aim Verifying and reviewing a patients medication list can detect and reduce drug related problems (DRPs). However little is known about its effects in patients using oral chemotherapy. The aim of this study was to evaluate the impact of these interventions and the adapted Medication Appropriateness Index (aMAI) as a tool to carry out a medication review. Methods A case-control study was carried out. The hospital pharmacist performed a medication reconciliation and medication review, using the aMAI tool, in 54 patients starting oral chemotherapy. Discrepancies, DRP's and associated pharmaceutical interventions were reported via the electronic patient record (EPR). After one month, the acceptance rate was measured and the aMAI score recalculated. Kappa statistics were used to test intra- and interrater reliability. Results The medication list in the EPR was incomplete in 74,1% of patients with an average of 2.4 errors per patient. After medication review, the aMAI score decreased significantly from 7.2 to 5.4 (SD = 4,7; p <0.001), indicating an improvement in the appropriateness of the drugs patients were taking. Acceptance rates were 41,4% and 53,2% for advices resulting from medication reconciliation and medication review respectively. Kappa values of 0.90 and 0.70 respectively indicate good intra- and interrater reliability. Discussion and conclusion The study shows that medication reconciliation can identify and address discrepancies. Furthermore, medication review seems to ensure that drug treatment better meets patient needs. The aMAI was a reliable tool. Future research will have to determine the clinical relevance of these interventions.

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.

COVID-19 Knowledge and Pandemic-Associated Distress among the Hospital Pharmacist Workforce in China

Background: The unprecedented disruption brought about by the global coronavirus disease 2019 (COVID-19) pandemic had produced tremendous influence on the practice of pharmacy. Sufficient knowledge of pharmacists was needed to deal with the epidemic situation, however, outbreak also aggravated psychological distress among healthcare professionals. Therefore, this study aimed to determine knowledge about the pandemic and related factors, prevalence and factors associated with psychological distress among hospital pharmacists of Xinjiang Province, China. Methods: An anonymous online questionnaire-based cross-sectional study was conducted via WeChat, a popular social media platform in China, during the COVID-19 outbreak from 23th to 27th February 2020. The survey questionnaire consisted of 4 parts including informed consent section, demographic section, knowledge about COVID-19 and assessment of overall mental health through World Health Organization Self-Reporting Questionnaire (SRQ-20). A score of 8 or above on SRQ-20 was used as cut-off to classify the participant as in psychological distress. SRQ-20 score and related knowledge score were used as dependent variables, demographic characteristics (such as gender, age, monthly income, etc) were used as independent variables, and univariate binary logistic regression was used to screen out the variables with p<0.05. Then, the filtered variables were used as independent variables, multivariate logistic regression models were used to analyze associations with sufficient knowledge of COVID-19 and psychological distress. Results: A total of 365 pharmacists participated in the survey, fewer than half (35.1%, n=128) of pharmacists attained a score of 6 or greater (out of 10) in overall disease knowledge, and most were able to select effective disinfectants and isolation or discharge criteria. In multivariable model, age ages 31-40(OR=3.25, p<0.05), ages 41-50(OR=2.96, p<0.05) vs >50 (referent); primary place of practice in hospitals: drug supply (OR=4.00, p<0.01), inpatient pharmacy(OR=2.06, p<0.01), clinical pharmacy (OR=2.17, p<0.05) vs outpatient pharmacy (referent); monthly income Renminbi (RMB, China’s legal currency) 5000-10000 (OR=1.77, p<0.05) vs <5000 (referent); contact with COVID-2019 patients or suspected cases (OR=2.27, p<0.01); access to COVID-19 knowledge remote work+ on-site work(OR=6.07, p<0.05), single on-site work (OR=6.90, p<0.01) vs remote work (referent) were related to better knowledge of COVID-19. Research found that 18.4% of pharmacists surveyed met the SRQ-20 threshold for distress. Self-reported history of mental illness (OR=3.56, p<0.05) and working and living in hospital vs delay in work resumption (OR=2.87, p<0.01) were found to be risk factors of psychological distress. Conclusion: Further training of COVID-19 knowledge was required for pharmacists. As specific pharmacist groups were prone to psychological distress, it was important for individual hospitals and government to consider and identify pharmacists’ needs and take steps to meet their needs with regard to pandemic and other work-related distress.

A retrospective analysis of the impact of a hospital pharmacist-led procalcitonin protocol

Disclaimer In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Procalcitonin is a precursor hormone to calcitonin that increases in response to systemic inflammation, especially of bacterial origin, and is otherwise undetectable in healthy states. Studies have shown that following effective antimicrobial treatment, procalcitonin levels steadily decline. To be utilized however, procalcitonin determinations must be ordered at specific times during a patient’s antimicrobial treatment. A retrospective medication-use evaluation of patients was performed at Medical Center Hospital and showed that in 70% of patients, initial procalcitonin levels were ordered inappropriately and procalcitonin levels were trended inconsistently during antibiotic treatment. Methods A pharmacist-led procalcitonin protocol was developed and presented to medical staff committees for approval. Data was collected from patients presenting with suspected or confirmed sepsis or lower respiratory tract infections for whom procalcitonin levels were utilized. Patient outcomes before and after protocol implementation were compared. Results A total of 400 patients were included in the study. The primary outcome of appropriate ordering of initial procalcitonin levels was improved in the postprotocol group relative to the preprotocol group (28% of patients [n = 56] vs 72% of patients [n = 144]; P &lt; 0.001). Patients in the postprotocol group had a procalcitonin level checked at discontinuation more frequently (8% [n = 16] vs 37% [n = 74], P &lt; 0.001) and had a higher rate of appropriate discontinuation of antibiotics (12% [n = 21] vs 46% [n = 77]; P &lt; 0.001). The postprotocol group also had fewer mean days of antibiotic therapy (9.17 vs 6.01; P &lt; 0.001). Conclusion Studies have shown the usefulness of procalcitonin levels for antimicrobial stewardship, but for procalcitonin testing to be properly utilized it must be ordered at the correct times during the patient’s therapy. The implementation of a hospital-wide pharmacist-led protocol resulted in an increase in appropriate ordering of baseline procalcitonin levels.

REDUCTIONS IN MEDICATION WASTAGE AND COSTS IN A PEDIATRIC INTENSIVE CARE UNIT BY CHANGING THE ORDER ENTRY SYSTEM

Objective: The intensive care unit (ICU) drug therapies have a significant impact on hospital costs, and reducing these costs has become a critical concern for hospitals. In this study, the researchers tested the theory on whether changing the ordering system of medications in the pediatric ICU (PICU)1, reduces drug wastage so that the nurse can request a fraction of one vial or ampule. More precisely, the study aimed to reduce the medication cost and wastage in our pediatric center. Methods: This study was conducted in the 16-bed PICU of Imam Hossein Hospital, which is a referral tertiary care teaching pediatric hospital with 185 beds in ten wards. A fractional ordering alternative was added to the hospital information system of the PICU of the pediatric hospital. Nurses were taught by the hospital pharmacist to understand the new way of ordering the drugs. Several highly used drugs were chosen for the intervention. The data were analyzed by an independent sample t-test using SPSS software. Results: Based on the results, changing the method of requesting medications for PICU patients and the random checking of floor stocks and the expired drugs in PICU reduced the number and cost of all medications. Conclusion: Overall, the collaboration of nurses and pharmacists can lead to cost savings in hospitals.

Engagement of hospital pharmacists and technicians to optimize staffing schedules

Challenges exist in developing work schedules for hospital pharmacy staff due to the need to meet around the clock patient care requirements. Work–life integration and reduced burnout are increasingly important considerations in staff schedules. However, information regarding methods to systematically improve scheduling satisfaction is currently lacking. Hospital pharmacist scheduling surveys were reviewed for solutions in a retreat setting to address growing concerns at our institution. All hospital pharmacists and technicians were surveyed to understand opportunities to improve their schedules. Subsequently, pharmacists participated in a retreat to identify opportunities to share work, prioritize for scheduling improvements, and develop a staffing restructure proposal. Out of 172 pharmacists, 84% completed surveys, whereas 55% of 196 technicians responded. The highest ranked scheduling improvement was a more consistent schedule for both pharmacists and technicians. Several solutions identified during the pharmacist retreat were incorporated into a proposal including decreased weekend staffing frequency (every 3rd to a mix of every 3rd and every 4th), improved scheduling consistency and reduced evenings. Negotiation was among the methods used to identify scheduling solutions. Engagement of frontline staff to lead staffing restructure is expected to ensure success of scheduling changes. Future directions include measuring pharmacist burnout and staff satisfaction before and after change implementation. If successful, the retreat and technician-developed proposal can be used for implementing technician schedule improvements.

Gene therapy and hospital pharmacy: the experience of the Hospital Pharmacy unit of L. Vanvitelli university hospital

Background: Since hospital use of gene therapy requires close cooperation between doctors and pharmacists to ensure correct drug handling and administration, it is essential to define standard operating procedures (SOPs) for each phase of the process to ensure therapeutic success in compliance with the safety of patient and healthcare professionals. Among the available gene therapy medicines, voretigene neparvovec is used to treat hereditary dystrophy of the retina caused by biallelic mutations in the RPE65 gene. The aim of this article is to describe the experience of the Hospital Pharmacy unit of L. Vanvitelli university hospital in the management of treatment with voretigene neparvovec in the first two pediatric patients treated in Italy. Methods: SOPs were developed for all phases of gene therapy management process (procurement, receipt, storage, handling, transport of the finished product and waste disposal). Particular attention was paid to the training of personnel involved, to ensure maximum compliance with the procedures at all stages of the process. Results: SOPs were developed according to the European Association of Hospital Pharmacist (EAHP) policies and in full agreement with the operating procedures established by the manufacturer, ensuring correct storage and handling of the drug, as well as safe administration to patients. Conclusions: This example confirms the importance of close collaboration in a multidisciplinary team between hospital pharmacists, ophthalmologists experienced in the treatment of patients with hereditary retinal dystrophies and surgeons experienced in subretinal surgery to ensure the correct management of gene therapy with voretigene neparvovec, through compliance with shared operating procedures.