Thomas De Rijdt

Hepatic tolerance of repeated intravenous paracetamol administration in neonates.

Introduction:  An intravenous (i.v.) formulation of paracetamol is available, but reports on its hepatic tolerance in neonates are limited. We therefore assessed hepatic tolerance of i.v. paracetamol in neonates.

Time spent by Belgian hospital pharmacists on supply disruptions and drug shortages: An exploratory study

Introduction Supply problems of drugs are an increasing and worldwide problem, also in Belgium. Hospital pharmacists try to manage drug supply problems to minimize the impact on patient care. This study aims to quantify in a detailed manner how much time employees of 17 Belgian hospital pharmacies spend on drug supply problems. Methods During six months, employees of Belgian hospital pharmacies filled in the daily time spent on drug supply problems using a template containing all steps which can be executed to manage drug supply problems. Additionally, Belgian hospital pharmacists were asked to report the drugs which experienced drug supply problems together with the solution for this problem. Results Hospital pharmacists spent a median of 109 minutes a week on drug supply problems, with a minimum of 40 minutes per week and a maximum of 216 minutes per week. Fifty-nine percent of the total time spent on drug supply problems was executed by hospital pharmacists, 27% by pharmacy technicians; the rest was performed by logistic or administrative personnel. About one third of the total time spent was invested in gathering information on the supply problem. About two third of the supply disruptions caused drug shortages, meaning there was a need to switch to another (generic) therapeutic alternative. For most drug shortages, a Belgian generic medicine could be found. However in some cases, the alternative had to be ordered abroad or for some drug shortages, no alternative was available. Conclusion These exploratory results on time spent by hospital pharmacists on drug supply problems in Belgium highlight the economic impact of drug supply problems for hospital pharmacies. A fully reliable, daily updated list on the federal agencies websites would be a major help to hospital pharmacists.

Hospital pharmacists versus hospital administrators: a struggle for clinical pharmacy services.

Healthcare has become a complex multidisciplinary science where we find, on the one hand, disease-related actions, such as diagnosis, treatment, prevention, nursing and chart review, while on the other hand, management skills are needed to keep health and economics in balance. The current financial and economic crisis has had a worldwide impact that also obliges hospital administrators to review, if not cut, expenditure and to work even more efficiently. Within this context, clinical pharmacy services are developing because pharmacists believe them to be excellent tools to guarantee a safe, rational, effective and cost-effective health technology, resulting in a better outcome for the patient and a health economic benefit for hospital administrators. During the past few decades, many economic evaluations of clinical pharmacy services have been published in the literature and have been thoroughly assessed and commented on in multiple reviews [1–5]. Unfortunately, most individual economic evaluations suffer from a poor design and, therefore, lack the necessary quality to justify (dis)investment in clinical pharmacy services. As this has led to a series of comments regarding the reproducibility and generalizability of cost–effectiveness results, multiple authors have called for a standard for health economic research in this domain and have even written recommendations to investigators, authors and editors. The most important issues include the implementation of a control group, provision of sufficient details on the clinical pharmacy service and the setting in which it is delivered, inclusion of all working costs when calculating the net benefit, a correct valuation of non-monetary outcomes, discussion on possible bias and the uncertainty of data, and the conduct of an incremental analysis. Despite these issues, existing research indicates that clinical pharmacy services tend to have favorable benefitto-cost ratios (even when neglecting the excessive amounts reported on cost avoidance), depending on the type of service and the setting.

Appropriateness of Acid Suppression Therapy

Background: The inappropriate startup of long-term acid suppressive therapy (AST) can have clinical and pharmacoeconomic impacts on ambulatory care. Objective: To assess the proportion of patients with appropriate initiation of long-term AST in non–critically ill patients. To describe possible risk factors for nonappropriate AST. To calculate the potential savings when eliminating the nonappropriate startup of AST. Method: This observational, retrospective study evaluated the appropriateness of startup of long-term AST in medical records using a broad variety of international criteria and guidelines and using a validated screening instrument. Results: A sample of 597 patients was included in the analysis. In 57% of them, AST was appropriately initiated. No specific risk profile could be defined. There was some indication that the availability of a clinical pharmacist and the use of standing orders were correlated to the outcome. Extrapolation to the total population (ie, 2836 patients) led to a total cost of €8880 during hospital stay plus an extra €40 391 per month after discharge. Avoiding inappropriate initiation of AST could lead to a saving of €3805 plus €17 441 per month. Conclusion: In all, 43% of initiation of long-term AST in the hospital was inappropriate. The potential savings from avoiding this could be substantial from a health care payer perspective. No patient characteristics that could predict for inappropriate initiation of AST were identified. A correlation between inappropriate initiation and medical disciplines using standing orders that include AST was seen.

Computerised physician order entry and bedside scanning as a tool to improve patient safety

It has been a very long time since hospital pharmacists only moved medication boxes around. For a long time now, the primary focus has been on quality care and patient safety. A few hospital pharmacies have obtained quality standard labels such as ISO 9001, NIAZ and JCI. A short literature review on analysis of what causes medication errors shows that they most often occur at the moment of prescription or transcription and during drug administration. Therefore, the improvement of these processes will have a considerable impact on the optimisation of pharmaceutical care. Electronic prescription has a legal basis in Belgium regarding authenticity of the medical prescription through ‘third party trusted time stamping’. A growing number of hospitals are implementing computerised physician order entry (CPOE). Using this system the prescription is clearly readable and the relevant data are also available in a structured way, which enhances the distribution process and allows for the implementation of prescription assistance (figure 1).

INT-009 Development and implementation of ‘check of medication appropriateness’ in a large tertiary care centre

Background During the last decade, healthcare shifted from a disease-focused approach towards a more patient-focused approach. Hospital pharmacy services experienced a similar development. Traditional drug-oriented services expanded towards patient-oriented services by imbedding computerised clinical decision support systems (CDSSs) in the prescribing process and implementing bedside clinical pharmacy services. However, due to limited resources, clinical pharmacy services are not implemented on a hospital-wide basis in Belgian hospitals. Purpose To guarantee patient safety, a central check of medication appropriateness (COMA) was developed and implemented since March 2016 in the University Hospitals Leuven. Materials and Methods Based on a risk analysis, high-risk prescriptions are checked by a hospital pharmacist for appropriateness. A daily check (0.5 FTE) of automatically generated queries is performed using standardised algorithms. The queries are a result of the screening of all new prescriptions in the electronic prescribing system of the last 24 hours. Interventions are performed via electronic warnings in the patient’s file or phone calls to the treating physician. Results Twelve hospital pharmacists are now involved in the COMA and 79 specific algorithms were developed, covering five pharmacotherapeutic areas of interest: drugs with restrictive indication; overruled interventions raised by CDSS; medication-related biochemical changes; sequential therapy for bio-equivalent drugs; and reimbursement of drugs. During a 18 month period, 92 050 prescriptions were checked for which 24 943 (27%) electronic warnings were sent and 637 (1%) phone calls were carried out. When analysed without automatic warnings for sequential therapy, 39 481 prescriptions were checked for which 2568 (7%) electronic warnings were sent and 637 (2%) phone calls were carried out. Conclusion For the future we obtain the next goals: Evaluation of the acceptance of the current COMA process. Fine–tuning the screening queries with an emphasis on improving specificity. Determining inter–rater validity. Development of new algorithms, also expanding to other areas of interest. Development of an easy access training tool for hospital pharmacists to perform COMA.