ObjectivesTo describe a clinical pharmacist’s (CP) activity in an emergency department (ED) regarding medication reconciliation and optimisation of pharmacotherapy of patients at hospital admission.MethodsA 1-year prospective observational study was conducted to analyse the activity of a CP in the ED of a 350-bed hospital in Spain. The CP reviewed home medications and medical prescriptions of patients to perform medication reconciliation if required and intervene if medication errors were detected.ResultsThe CP reviewed medications and medical orders of 1048 patients. 816 patients had home medication: 440 patients (53.9%) were correctly reconciled by the physician; 136 (16.7%) were reconciled by the physician with unintentional discrepancies; and 240 (29.4%) by the CP, with a higher percentage in patients admitted to surgical departments (χ2:38.698; P<0.001). Following pharmaceutical validation, 434 pharmaceutical interventions were performed.ConclusionsThe presence of a CP in an ED could increase the detection of reconciliation errors and help resolve medication errors.
BackgroundWorkplace contamination with antineoplastic drugs put health workers at risk of exposure. The environment may be contaminated even in the absence of any handling as external contamination of vials originating from the pharmaceutical manufacturer is widely reported. It constitutes a source of dermal exposure but also of inhalation exposure as vaporisation of antineoplastic agents at room temperature has also been reported with various drugs, such as cyclophosphamide (CP).PurposeThe main goals of this report were to study surface contamination by CP on several surfaces in areas where cytostatics are prepared and administered and also on the vials and their outer packaging to identify areas for improvement in our working protocols.Material and methodsDrug vials containing CP and their outer packaging were wipe sampled. Different surfaces in the preparation and administration areas were also investigated: the work area inside the safety cabinet (before and after cleaning), the phone and computer keyboard in the preparation room, the bags with diluted cytostatics, the table in the administration area, the toilet door handle and the infusion pump control panel. Analysis was performed by liquid chromatography.ResultsThe amount of CP detected ranged from 0.00019 μg/cm2 to 0.00031 μg/cm2. The highest contamination was found on the work surface of the biological safety cabinet before it was cleaned at the end of the work. There was no contamination on the work area inside the safety cabinet after cleaning or on the phone, or on the computer keyboard or the door handle. Because of these results, working protocols were reviewed and new security measures were included: decontamination of vials after their reception with NaOH 0.03 M solution and elimination of their outer packaging; decontamination of surfaces in the administration area; and nurses to wear gloves to administer medications.ConclusionLow amounts of CP have been detected in preparation and administration areas, as well as on external surfaces of vials and their outer packaging. As a consequence, we changed our daily practice to reduce exposure of health workers.No conflict of interest.
ObjectivesTo describe a medication reconciliation (MR) procedure prepared by the pharmacist for patients admitted for elective surgery and to assess the surgeon’s degree of acceptance.MethodsA 1-year retrospective observational study was conducted. The patient population consisted of patients aged ≥18 years admitted during 2016 for elective surgery and whose planned length of hospital stay was >24 hours. A pharmacist performed MR following a specific protocol. A review of the reconciliations prescribed later by the surgeons was conducted. Statistical analyses were performed for qualitative and quantitative variables.ResultsThe pharmacist prepared a total of 1986 reconciliation reports. The 179 patients reviewed in this study had a mean age of 65.7±11.8 years, 49.2% were women and 98.9% of patients were reconciled by the surgeon in the operating theatre using an electronic prescribing system (85.5% were fully reconciled).ConclusionThe hospital’s MR protocol resulted in almost 100% of patients being reconciled within the subgroup of elective surgery patients by the prescribing surgeons.
BackgroundAt our hospital, the oncology pharmacist participates in the development and implementation of the antiemetic protocol for controlling chemotherapy-induced nausea and vomiting (CINV), evaluates patients’ risk factors and dispenses the antiemetic treatment, and assesses the antiemetic response and optimising antiemetic therapy.PurposeThe aim of this study was to assess the effectiveness of the pharmacist-driven antiemetic prophylaxis in patients undergoing high emetogenic chemotherapy (HEC).Material and methodsWe analysed data from patients starting HEC (cisplatin-based chemotherapy or anthracycline/cyclophosphamide combination [AC]).We have considered the percentage of patients achieving complete response (CR: no vomiting and no rescue) and complete control (CC: CR and no significant nausea), during 0 to 120 hours after chemotherapy administration. We have also calculated the percentage of patients achieving CR and CR after treatment failure and therapy optimisation. CINV were evaluated using a semi-structured clinical interview at every cycle and registering the patient-reported outcomes.At our hospital, the antiemetic prophylaxis consists of granisetron 1 mg/dexamethasone 20 mg before chemotherapy on day 1, followed by dexamethasone 8–0–4 mg plus metoclopramide 10 mg every 8 hours on days 2 to 4 (squeme A). In patients not achieving CR or CC, we use netupitant/palonosetron (300/0.5 mg)/dexamethasone 12 mg before chemotherapy, dexamethasone 8 mg plus metoclopramide 10 mg every 8 hours on days 2 to 4.ResultsThe study included 56 patients receiving 206 chemotherapy cycles (71.4% AC, 28.6% cisplatin-based chemotherapy). Seventy-three per cent of patients completed at least three cycles. Ninety-three per cent of patients started antiemetic prophylaxis with squeme A.Overall CR and CC rates were high and improved over the first three cycles of chemotherapy after treatment optimisation according to clinical response.34% of patients required some change in the antiemetic treatment used as first line, which led to CR plus CC in 69% of them.ConclusionOur antiemetic protocol and a close patient follow-up conducted by the oncology pharmacist led to a good control of HEC-induced nausea and vomiting, that improved during the subsequent cycles after an individualised adjustment of the antiemetic treatment according to the patient-reported outcome.Reference and/or Acknowledgements1. Gralla RJ, et al. Ann Oncology2014Jul;25(7):1333–1339.Conflict of interestCorporate-sponsored research or other substantive relationships:I have participated in a Delphi method supports by Vifor Pharma.Abstract 4CPS-011 Table 1 Complete response Complete control AC Cisplatin Total AC Cisplatin Cycle 1 84.6% 93.7% 87.3% 66.7% 75% 69.1% Cycle 2 92.3% 86.7% 90.1% 76.9% 86.7% 79.6% Cycle 3 93.5% 90% 92.7% 93.5% 80% 90.2%
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