BackgroundIn Denmark, hospital pharmacies manufacture as well as buy unlicensed pharmaceutical preparations prescribed by physicians. Each Danish hospital pharmacy is responsible for manufacturing and supplying preparations within their own Region; however cross-Regional coordination is limited. This has resulted in a vast portfolio of unlicensed pharmaceutical preparations with possibly many duplications and similar preparations and with different or unknown clinical use, even though the clinical needs are similar throughout the country.PurposeTo identify a common national portfolio corresponding to clinical need by analysing and categorising the use of unlicensed pharmaceutical preparations from all Danish hospital pharmacies.Material and methodsThe study was a retrospective analysis of sales data from 2012 and 2013, which were collected from the electronic system of all Danish hospital pharmacies.The total sales data were analysed by 6 clinical pharmacists representing all major hospital pharmacies. The process was facilitated by a project manager.The clinical pharmacists categorised the existing portfolio according to preparation, formulation and indication. They identified identical preparations, alternatives and estimated the overall clinical relevance. The pharmacists consulted colleagues, physicians and guidelines to ensure broad and accepted categorization.ResultsA total of 2,754 unlicensed pharmaceutical preparations were identified in the existing portfolio. Of these, 739 preparations were considered to be of clinical relevance and should be included in the updated national portfolio of unlicensed pharmaceutical preparations.Indications were allocated to all 739 preparations.ConclusionA national portfolio of extemporaneous pharmaceutical preparations with corresponding indications was identified. The portfolio helps secure a unified content and use of unlicensed pharmaceutical preparations across Denmark, which potentially could lead to increased patient safety.References and/or Acknowledgements1Martin Høj, Emendo A/SNo conflict of interest.

Background Patients poisoned with paracetamol are treated with the antidote N-acetylcysteine (NAC). According to the previous Danish national guidance the first infusion with NAC has to be mixed in 300 ml 5% glucose (or isotonic NaCl). In Denmark 300 ml solutions are only supplied in glass bottles. These are not designed to be used with IV poles. As an alternative 500 ml solution are supplied in infusion bags designed to be used with IV poles. This requires the nurse to withdraws 200 ml of the solution. Pharmacy staff from the Capital Region had been asking the Medicines Information Centre (MIC) whether it was possible to use 250 ml of glucose solution instead of 300 ml. Purpose The task was to investigate the possibility of changing practice when preparing NAC infusions, in order to secure easier, faster and more rational treatment of patients poisoned with paracetamol. Materials and methods Pharmacy staff visiting hospital wards daily had independently been observing the inappropriate and time-consuming preparation of NAC infusions. The MIC was asked to provide a more manageable handling routine in the hospital. The MIC task involved: Reviewing the antidote/emergency management guidelines Reviewing the relevant literature regarding treatment with NAC Discussing the case with the clinical pharmacologist connected to the national Danish Poison Control Hotline. Results The conclusion finally resulted in a change in the national guideline for the treatment of paracetamol poisoning. This change of volume for preparation of NAC infusions further provided additional benefits: faster initiation of treatment improved patient safety due to simpler handling price reduction of approximately 10€ per treatment Conclusions The MIC concluded that 250 ml solution can be used equivalent to 300 ml.