ObjectiveIncorrect storage and handling of refrigerated medicines may result in destruction of medicines and financial loss for hospitals. At the Medicine Information Centre we receive and answer queries on drug-related issues. In this study we aimed to investigate and quantify savings made following advice supplied by the Medicine Information Centre in reply to queries regarding the incorrect storage of refrigerated medicines.MethodsA retrospective study was conducted by systematically reviewing each drug when the cold chain had been impaired, in order to determine whether the drug could continue to be used, possibly with a shortened expiry date. Thus, by examining all cases of incorrect storage, the value of drugs that pharmacists advised could be used despite a broken cold chain, could be estimated.ResultsThe Medicine Information Centre dealt with 171 cases concerning incorrect storage in 2013. Data show that advice from Medicine Information Centre pharmacists resulted medicine cost savings of DKK 13 million (approx. €1.7 million) in hospitals in the Capital Region for that year.ConclusionsSubstantial savings can be made by seeking the advice of a team of information pharmacists regarding the incorrect storage of medicines.

BackgroundThe Medicine Information Centre in the Capital Region of Denmark aims to promote the safe, effective and efficient use of medicines in order to improve quality of answers to inquiries from clinicians on drug related problems. A close knit group of highly experienced pharmacists and clinical pharmacologist work together on a daily basis.PurposeTo demonstrate the benefits of two healthcare professional groups contributing their specific knowledge and skills, exemplified by medical treatment related inquiries of a 4 month old infant with rickets.Material and methodsMedicinInfo received a question regarding dilution of ergocalficerol (vitamin D) injection 100 000 IE/mL for a 4 month old paediatric patient with normal kidney and liver function for the treatment of rickets. Oral administration was not an option in this case. In total, the patient is prescribed 3000 IE intramuscular ergocalciferol by the paediatrician. However, this was not possible unless the drug was diluted. Initially the pharmacist considered every opportunity for dilution of the drug, as well as possible alternative treatments. Then the clinical pharmacologist was consulted to assess which drug and route of administration would be the most appropriate.Results Contribution from the pharmacist: ergocalciferol injection 100 000 IE/mL: administration intramuscular. Metabolised in the liver and kidney to calcitriol. Can only be diluted with medium chain triglyceride oil.alfacalcidol injection 2 µg/mL: administration intravenous. Metabolised in the liver to calcitriol. A disadvantage is that it contains propylene glycol which may cause side effects if elimination is reduced.calcitriol injection 1 µg/mL. Administration intravenous. Contribution from the clinical pharmacologist: intramuscular ergocalciferol is not recommended for a 4-month-old infant due to poor blood circulation in the muscle, as the drug is probably not absorbed and therefore has no effect. Furthermore, the risk of developing muscle necrosis is high. Joint assessment: Decostriol or Etalpha would be preferable in this particular case, despite the fact that one must be careful not to overdose.ConclusionThe case illustrates that interdisciplinary collaboration between pharmacist and clinical pharmacologist increases the quality of answers to drug related inquiries from healthcare professionals, as both professions’ professional competencies is utilised.No conflict of interest

BackgroundThe Medicines Information Centre is contacted when medicine has been exposed to temperatures deviating from their specific standard storage conditions. In order to determine whether or not the medicine should be discarded, many factors have to be taken into consideration.When lacking approved stability data, we must deduce and extrapolate from facts to make a ‘professional judgement’ (eg, can it be used conditioned by reduced shelf life?). This may result in variations in our case handling and hence conclusions.There are a number of incentives which support investing time in finding a rational solution other than discarding the medicine (eg, a large number of medicine stored in the refrigerator are very expensive and we experience more frequent backorder situations). Handling a case of a medicine stored incorrectly can be resource consuming and therefore it is also relevant to find a balance between the time invested in case handling and the price of the medicine.PurposeTo develop a procedure which embraces tools and guidelines to ensure uniform quality and consistency in our decision making regarding a medicine stored under non-standard conditions.Material and methodsIn addition to professional judgement, we have developed the following tools and guidelines to support the caseworker.List of databases and sources of information retrieval: SmPC;local database of previous cases;UK database;Micromedex and other databases on storage and stability;manufacturer.A guide to use shelf life estimation methods (ie, when to use an equation to estimate the reduced expiration date).De minims limit: Obtaining a balance between resources spent on case handling and the cost of the medicine.ResultsOver a 5 month period, 330 medicines were processed as having incorrect storage. In 186 cases (56%) only guidelines and tools were applied; in 85 cases (26%) guidelines, tools and professional judgement were applied; and in 59 cases (18%) only professional judgement was applied. All of the above mentioned guidelines and tools were applied in the cases.ConclusionAll of the guidelines and tools are important and useful in the case handling of incorrect storage of drugs, but they cannot stand alone in all cases. Professional judgement remains an essential element to complete the cases.No conflict of interest.

Background The hospital pharmacy unit for the preparation of licenced sterile medicines manufactures 110 different extemporaneous preparations and licenced medicines for injection or infusion. This unit needs a tool for production planning i.e. an assessment of which medicines are critical and hence must always be in stock. PurposeTo create a tool for risk assessments for all medicines manufactured in the unit, enabling appropriate prioritising of resources from a treatment perspective. Materials and Methods All risk assessments are executed and stored in SAID (National question and answer database). The advantages of this method are that each risk assessment is quality assured and acts as a dynamic document that can be updated regularly. Risk assessments are based on relevant literature (e.g. Summary of Product Characteristics and Micromedex). For each risk assessment the following is examined as a minimum: Which patient group will benefit from the medicine? Therapeutic indications and administration Are there any alternative treatments? Does a synonymous/analogous medicine exist? Any safety concerns regarding method of administration? Can the manufacturers maintain the flow of supply? Based on the above the risk assessments are allocated a score 1 to 5, which indicates the severity of a back order. Results The risk assessments were distributed as follows: 18% scored 5 (no alternative medicine exists) 38% scored 4 (analogous medicine exists) 24% scored 3 (synonymous extemporaneous or non-licenced medicine exists) 9% scored 2 (synonymous medicine exists) 11% scored 1 (more than one analogue/synonym exists) The risk assessments showed that none of the medicines could be dispensed from a treatment perspective. Shorter periods of back order of some medicines can be tolerated with no effect of patient care and safety, if alternative synonyms/analogous medicines are supplied from other manufacturers. Conclusions Risk assessments have given the unit a tool for production planning and prioritising the manufacturing of medicines. No conflict of interest.

РЕЗЮМЕ Цел: Неправилното съхранение и манипулация на замразени лекарства може да доведе до унищожаването им и до финансова загуба за болниците. В Информационния център за лекарства получаваме и отговаряме на запитвания относно проблеми, свързани с лекарства. В настоящото изследване, извършено след консултации, предоставени от Информационния център за лекарства в отговор на запитвания относно неправилното съхранение на замразени лекарства, целта ни е да проучим и определим количествено икономиите. Методи: Бе проведено ретроспективно изследване посредством систематичен преглед на всяко лекарство, когато студената верига бъде нарушена, за да се определи дали лекарството може да продължи да се използва, вероятно с по-кратък срок на годност. По този начин, проверявайки всички случаи на неправилно съхранение, може да бъде приблизително изчислена стойността на лекарствата, за които фармацевтите препоръчват, че може да бъдат използвани, въпреки нарушената студена верига. Резултати: Информационният център за лекарства е разгледал 171 случая относно неправилно съхранение през 2013 г. Данните показват, че консултациите, предоставени от фармацевтите от Информационния център за лекарства, са довели до икономии на разходи за лекарства в размер на 13 милиона датски крони (приблизително 1,7 милиона евро) в болници в Столичния регион за тази година. Изводи: Може да бъдат направени значителни икономии като се търси съвет от екип информационни фармацевти относно неправилното съхранение на лекарства.