In recent decades, dramatic changes of the role of the Danish community pharmacist have contributed to widespread uncertainty among professionals about the future content of their job. This case study, which is based on qualitative research interviews and documentary material, describes how key actors belonging to 10 different relevant social groups who have been influential in shaping the role of Danish community pharmacists have different perceptions of the pharmacy profession. These perceptions include: the community pharmacist as a provider of technical, standardised advice, the pharmacist as a drug expert, the pharmacist as a leader, and the pharmacist as a provider of individualized advice. Five future scenarios for the community pharmacist ranging from a role as a pharmacist with no future to a role as the provider of individualized information and future role developer are also described and analysed in the paper. The case study is theoretically based on a specific social constructivist theory, the Social Construction of Technology (SCOT).

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

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.

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.