The CPOE system almost completely eliminated MEs with antineoplastic drugs in the Haematology Department. No new types of MEs were observed once physicians had become accustomed to using the system. However, some MEs were not eliminated. Constant diligence is needed to analyse and evaluate MEs associated with the CPOE system and their causes, such that the limitations of CPOE can be identified and overcome and the medication-use process associated with antineoplastic agents improved.

BackgroundMedication costs are increasing, and hospital budgets are small. Clinical trials are an alternative for medication cost savings.PurposeTo assess the savings for medication by inclusion of patients in myeloma multiple (MM) clinical trials (CT).Material and methodsA retrospective, observational and descriptive study was conducted from January 2013 to December 2015 in the pharmacy department of a university hospital. Ongoing MM clinical trials were included. Exclusion criteria were: CT without patients enrolled and CT without patients on treatment. The following data were collected by the pk ensayos application: protocol number, study design, phase, arms (experimental vs control), medication information (provided or not by the CT sponsor, marketed or not), patient information (randomisation number, assigned arm, start and end date of treatment, number of dispensed medications). For the economic evaluation, the direct cost recorded in the application for the medication management in the pharmacy (Gestockwin) was used. Indirect costs were estimated for medications not marketed. This was calculated by the direct cost of the therapeutic alternative in routine clinical practice.Results17 MM clinical trials were ongoing during the study. 64.7% (11) of the CT were excluded: 5 CT had not enrolled any patients and 6 CT did not have any patients on treatment. 100% of the CT included were phase III. The sponsor provided all the medication necessary for the study in 66.6% (4) of the CT and partially in the 33.4% (2). The investigational medications involved were: zoledronic acid, bortezomib, bulsufan, daratumumab, denosumab, dexamethasone, elotuzumab, lenalidomide and MLN9708. The total number of patients were 42. The average number of patients included in a CT were 7 (2–19). The cost savings were €683 886. The average per CT was €113 981.12 (€5463–428 846)) and per patient was €16.283 (€271–12 620). The annual average was €341 943.17.ConclusionConducting MM clinical trials has led to important cost savings for the hospital.No conflict of interest

Background Acenocoumarol interacts with widely-used drugs. In many cases, the result is an increase in the International Normalised Ratio (INR) which can have a significant clinical effect on patients. Purpose To determine the frequency of concomitant prescription of acenocoumarol and levofloxacin, ciprofloxacin, fluconazole, amiodarone and clarithromycin in hospitalised patients. To quantify the increase of INR and determine the management of over-anticoagulation. Materials and methods Prospective observational study (15 May - 15 June 2013) in a university hospital with 1070 beds. Hospitalised patients in chronic treatment with acenocoumarol were included. Age, sex, interacting drugs, acenocoumarol use, initial INR and INR 24 h after starting interacting drugs were recorded. INR values over 3.5 in atrial fibrillation (AF) and dilated cardiomyopathy and over 3 in other labelled uses were considered as supratherapeutic. The pharmacist informed physicians about interactions through the Computerised Physician Order Entry (CPOE). Pharmacist contacted doctors by phone if the INR increased. Results 61 patients (78 ± 9.8 years) were included (30 male). Acenocoumarol indications were AF (86.9%), heart valve (8.2%) and post infarction (4.9%). We recorded 63 interactions and INR was classified as supratherapeutic in 28.6% of the prescriptions (18). See Table 1. Abstract DI-084 Table 1 Interacting drugs Interactions detected,% (n) Patients with increased INR,% (n) Levofloxacin 58.7% (37) 27.0% (10) Ciprofloxacin 7.9% (5) 60.0% (3) Amiodarone 26.9% (17) 23.6% (4) Fluconazole 1.6% (1) 100% (1) Clarithromycin 4.8% (3) 0.0% (0) All the increased INRs were observed in patients suffering from AF except for two (heart valve and post infarction). The mean increment was 2.3 (0.5–5.6). Physicians contacted about prescribing acenocoumarol in 7 patients (38.8%) with increased INR, reduced the dose in 1 (5.5%) and prescribed vitamin K in 2 (11.1%). Conclusions The frequency of interactions is high. Levofloxacin was responsible for most cases of over-anticoagulation. Patients management consisted of discontinuing acenocoumarol, reducing its dose or administrating vitamin K. No conflict of interest.