BackgroundCalcinosis cutis is caused by accumulation of calcium salts in the tissues, with subcutaneous nodules, atrophy and ulceration over the affected area. The therapeutic approach is not clearly established, particularly in neonates.PurposeTo treat calcinosis cutis in a topical non-invasive way in two premature neonates and to describe their clinical evolution.Developing a standard operating procedure (SOP) for compounding a 10% sodium thiosulfate W/O topical cream.Material and methodsA systematic bibliographic search for available therapeutic options was made. An article by Pérez-Moreno et al.1 was found, describing the elaboration procedure of a 10% sodium thiosulfate W/O cream and its use in a 6-year-old child with calcinosis cutis. However, no evidence was found regarding topical treatment of calcinosis cutis in neonates.Risks and benefits of using the topical formula in premature neonates were assessed: excipients were found to be suitable and the risk of incremented absorption was considered acceptable.It was decided to reproduce the formula for its use in two cases of IV calcium extravasation (confirmed by echography and clinical signs) in two premature neonates (born at 31 and 34 weeks).Modus operandi consisted of:Dissolving 10 g of pentahydrated sodium thiosulfate in 10 mL of distilled water.Adding it to the external oil phase (a commercial cold cream (COLDBASE) was used qs 100 g).Mixing it until an homogeneous W/O emulsion was obtained.ResultsThe elaboration process was simple, and the resultant cream homogeneous and with suitable organoleptic characteristics.Clinical evolution was satisfactory in both patients, gradually reducing visible injuries, subcutaneous calcifications, induration and swelling. Both patients regained arm mobility completely.ConclusionTreatment of calcinosis cutis with topical sodium thiosulfate was safe and effective in both patients. The clinical benefit in premature patients was thereby confirmed in these cases.References and/or AcknowledgementsPérez-Moreno MA, Álvarez del Vayo-Benito C, Flores-Moreno S, et al. Calcinosis cutánea grave tratada exitosamente con una fórmula magistral tópica W/O de tiosulfato sódico al 10%. Acta Pediatr Esp 2014;72:e9-10No conflict of interest.

BackgroundBefore October 2015, the dispensing procedure in the Home Care Service (HCS) was manual where medication for each patient was sent from the pharmacy service (PS) weekly in an individual bag. This procedure required high economic, time and human resources. For any treatment start or change, an individual order was requested as a pro re nata (PRN) medicine. Occasionally a global return of accumulated drugs was made.PurposeIn October 2015, the PS implemented an automated dispensing cabinet linked to an electronic prescribing programme (ADCLEP), Omnicell, in the HCS. PS replaced drugs automatically 2 days a week and staff from HCS placed them into the ADCLEP. The aim of this study was to evaluate the consequences of such implementation in the dispensing procedure evaluating the economic, time and human resources.Material and methodsData were obtained from our electronic prescribing programme e-Osabide and our management computer programme SAP. A comparison between a period of 2 months (from 1 January to 29 February) was made in 2015 and 2016. The items registered were: number of PRN medicines; economic cost (€); and dispensing time and staff resourcesResults 2015 2016 No of PRN medicines 24757 Dispensing time (min) 1920640 Dispensing staff 8 pharmacy assistants + 1 pharmacist2 pharmacy assistant + 1 pharmacist Cost (€) 50 26340 377ConclusionThe number of PRN medicines decreased by79%, dispensing time by 67%, dispensing staff resources by 67% and economic cost by 20%. Eliminating individual preparation and minimising the number of PRNs have had a great impact on PS care work. The main reason why the number of PRNs decreased is that the ADCLEP contains most of the medicines used by HCS.Economic cost was reduced due to more accurate and better adaptation to the patient’s needs. Even though it has not been measured, prescriptions were updated more accurately and this could have led to less medication errors.Other advantages detected were no delay in the disposition of medicines and improvement in control of narcotics (book is generated automatically).We had no way of measuring the number of returns but the perception was that they decreased to almost none. ADCLEP is an efficient system and could be exported to other services.No conflict of interest

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