Y Rahali

Interactions between injectable anticancer drugs and polyvinyl chloride bags: Evaluation of the adsorption phenomenon after reconstitution

Introduction During the reconstitution of a drug and during its storage, there are risks of interactions between the drug and the bag used for the preparation. Polyvinyl chloride is a material used in the manufacture of a large part of chemotherapy infusion bags. It is subject to many interactions like sorption of drugs and release of phthalate additives. Material and Methods Seven anticancer drugs used in pediatric oncology were involved in our study. After reconstitution of the anticancer agents in polyvinyl chloride bags, the adsorption phenomenon between the container and the contents is evaluated by infrared spectroscopy by analyzing the inner surface of the polyvinyl chloride. Subsequently, for the anticancer agents which exhibited an adsorption–container–content, the analysis was carried out by ultraviolet–visible spectrophotometry in order to examine the kinetics of the concentration of reconstituted anticancer drugs. Results All the polyvinyl chloride bags gave a spectrum identical to the spectrum of the reference bag, except the bags used to reconstitute etoposide whose spectra showed 12 additional peaks. With the absorbances measured by ultraviolet–visible spectrophotometry at different times, the analysis of variance statistical analysis shows that there is a significant difference in absorbances between t0 and all the other measurement times. Conclusion This study testifies to the existence of a container–content interaction between etoposide and polyvinyl chloride. Thus, reconstitution of etoposide for intravenous infusion into a polyvinyl chloride bag should be used immediately. For etoposide preparations intended for storage beyond 24 h, it is recommended to use a container other than the polyvinyl chloride bag.

5PSQ-122 Contribution of the monitoring of quality indicators on improving paediatric’s hospital pharmacy’s performance

Background The implementation of quality indicators within the hospital pharmacy have a fundamental role in the creation of its value. It contributes significantly to the achievement of the strategic goals of the structure and allows managers to measure and manage in a better way their performance. Purpose The aim is to explore the hospital pharmacy practice in terms of the use of quality indicators and their relation to performance. Material and methods We have measured the internal process performance indicators and the support process efficiency indicators over the last 3 years, by measuring the customer satisfaction rate and calculating the rate of breakage, deterioration, expiry of drugs and medical devices and the rate of reactivity of corrective actions, whose formula has been previously determined in advance. The data needed for this calculation were collected using the nonconformity reporting sheets and the pharmacy database as well as a questionnaire sent to the hospital’s clinical departments. The calculated results were compared to the analysis threshold set for each indicator. Results Measuring the internal process indicators over the years 2015, 2016 and the first half of 2017 showed that the strategic objectives set for all the performance indicators have been achieved for the 3 years except breaking indicators of drugs has increased in August of 2016 by a rate of 13%, which exceeds the normal threshold: this is a breakdown of 17 products and an efficiency rate of immediate actions that has decreased slightly to 68.8% compared to the threshold (>70%) during the month of December of the same year. These non-conformities have pushed the pharmacy team to review the shortcomings and take corrective measures. And regarding the effectiveness of process indicators support, a significant improvement was observed in 2016 compared to the previous year. Conclusion We can say that performance is positively associated with quality indicators That allow us to achieve fixed goals and objectives, and to make immediate or long-term decisions in order to improve and increase the performance of the concerned structure. Reference and/or Acknowledgements 1. Meftah H, et al. Contribution of hospital pharmacy ISO certification 9001 on improving performance indicators: Experience of pharmacy of a paediatric hospital. Eur J Hosp Pharm2017. No conflict of interest

5PSQ-099 Cytotoxic preparation unit: evaluation of clinical services satisfaction in three hospitals

Background Safety and quality requirements with prescription, preparation and administration of cytotoxic drugs represent a challenge for all healthcare professionals. A major objective of centralised preparation is to improve the quality of the final product, and thus the safety of the patient. Purpose The aim of this study was to evaluate the perception of clinical services towards the cytotoxic preparation unit (CPU) performance in the Moroccan Institute of Oncology, in the Paediatric Hospital, and in the Cheikh Zaid University Hospital in Rabat, in order to improve the quality, safety and efficiency of cytotoxic preparations. Material and methods Data were collected by face-to-face structured interviews carried out by a pharmacy intern with doctors and nurses who provide clinical services in three hospitals in Rabat, using a questionnaire containing seven close-ended questions concerning the main aspects of CPU service. The interviewees attributed for each question a score (from 1 to 5) according to an ascending satisfaction scale. Results The questionnaire was proposed to 40 healthcare professionals, of which 32 replied (participation rate of 80%). 87.5% were nurses (28/32) and 12.5% (4/32) were doctors. The perception of clinical services towards the CPU performance was generally satisfactory and comparable in the three establishments. Seventy-five per cent of the interviewees were very satisfied with the availability and cooperation of the pharmacy’s professionals. The labels and packaging of cytotoxic preparations were satisfactory for 60% of participants, while delivery time and drugs dispensibility were judged as satisfactory by only 25% of the interviews. Forty-three per cent of professionals were somewhat satisfied towards the overall service quality. Analysis of the low satisfaction rate concerning delivery time has shown that the time of arrival of prescriptions to the pharmacy and transfer of preparations to clinical services was too long. Concerning drugs dispensibility, the problem is caused mainly by stock rupture. In order to improve the CPU service, the delivery time to the clinical services should be reduced and a better management of drugs stock is a necessity. Conclusion In the quest for optimal quality and patient safety, an external evaluation of the CPU by its clients is essential. It is also necessary to identify the causes of dissatisfaction and allow improvement by implementing corrective and preventive measures. No conflict of interest

3PC-031 The influence of dead volume on reconstitution of injectable drugs

Background Parenteral drug administration plays an important role in hospitals. It is well known that a certain amount of a drug remains at the end of the infusion and is not administered to the patient because of the dead volume: this dead volume could be the origin of an underdosing. Purpose The aim of this study is to determine the dead volume of the injectable delivery system including the serum bag, perfusion tubulure, syringe and short catheter used for the reconstitution and administration of injectable drugs, and its impact on variation of the prepared doses. Material and methods We weighed, using an analytical balance, all the medical devices (serum bag, perfusion tubulure, syringe and short catheter) used in the administration of an injectable drug before and after the passage of an antibiotic solution. We can thus determine the dead volume remaining in each material. Statistical analysis were performed with SPSS 13. 0. Results The table shows that the dead volume differed between medical devices (p<0.001). It was significant for the serum bag and perfusion tubulure, and low for syringes and short catheters. The overall dead volume is estimated at 4.5±1.7 mL.Abstract 3PC-031 Table 1 Medical device Dead volume mean± SD (mL) (n =30 ) Serum bag 2.61±1.71 Syringe 2.5 mL 0.06±0.003 Syringe 5 mL 0.07±0.003 Syringe 10 mL 0. 07±0. 003 Syringe 50 mL 0.09±0.003 Perfusion tubulure 1.74±0.02 Short catheter G22 0.01±0.001 Short catheter G24 0.01±0.003 Conclusion A considerable amount of the infusion volume, and therefore of the antibiotic, depending on the concentration, is lost at the end of the infusion due to the dead volume depending on the medical devices used as demonstrated in this study and in other studies.1 Loss of a potential amount of a drug can constitute a problem regarding safety and efficacy of therapy, especially for drugs with narrow therapeutic margins. This is especially important for the serum bag and perfusion tubulure, where the dead volume is about 2.61 mL and 1.74 mL respectively. References and/or Acknowledgements 1. Cheikh A, Rhali Y, Mefetah H, Sbai I, Mojemmi B, Draoui M, Bouatia M. The influence of the dead volume of the closed system (spike–connector–syringe) on the reconstitution of injectable drugs. Eur J Hosp Pharm24(1):A214–A216. No conflict of interest

GM-028 Contribution of hospital pharmacy iso certification 9001 v 2008 on improving performance indicators: experience of pharmacy of a paediatric hospital

Background Quality is a tool for clarification of the missions and relationships within the hospital pharmacy and units of care. It is a tool for standardisation of customer–supplier relationships within the institution by contracting; it is also a guarantee of continuous improvement of services provided to patients. Purpose Our goal was to present the experience of our hospital pharmacy in the implementation of a quality management system which received ISO 9001 v 2008 certification. Material and methods After implementation of the quality management system in the pharmacy, the effectiveness of internal and external processes was evaluated through several indicators. Results The results of the key indicators before and after certification are summarised in the table. Indicator Before (%) After (%) The shortage rate of drugs 7 1 The shortage rate of medical devices 24 2 The pre-emption rate of drugs 0.6 0.01 The pre-emption rate of medical devices 0.08 0 The drug and medical devices deterioration rate 0 0 The effectiveness rate for immediate action 40 75 The response rate to patient complaints 40 100 The drug needs satisfaction 62 97 The medical devices needs satisfaction 45 95 The rate of compliance of commitments to purchase drugs 81 98 The rate of compliance of commitments to purchase medical devices 53 89 Rate of satisfaction with training requests 100 100 Rate of satisfaction with recruitment requests 67 80 Conclusion The pharmacy certification process has improved several indicators of performance (drug and medical devices needs satisfaction, rate of compliance of commitments to purchase drugs and medical devices, etc) and has maintained a high level for other indicators (drug and medical devices deterioration rate and rate of satisfaction with training requests). Improving these indicators has allowed repositioning of the pharmacy in other hospital units and a significant improvement in the quality of pharmaceutical services within the hospital. The success was the result of the involvement of management and hospital staff. The aim is to respond positively to the growing needs of a population of vulnerable children. References and/or acknowledgements Acknowledgements to the director and team of the paediatric hospital. No conflict of interest

DD-007 Contribution of electronic prescriptions on time management at the hospital pharmacy

Background Medicines prescription is the centrepiece in the triad of care (patient–prescriber–pharmacy). The electronic prescription has long been considered an effective means to reduce transcription errors as well as securing the flow of drugs at the hospital level. However, the experience of the Massachusetts General Hospital of Boston team found an error rate comparable between manual and electronic prescriptions (11.7%) 1 What about the time saving that electronic prescribing can provide compared with manual prescribing? Purpose The objective of this work was to evaluate the impact of electronic prescription of medicine on time saving of the pharmaceutical team compared with manual prescription in our hospital. Material and methods We analysed the prescriptions received and processed in our hospital pharmacy over a period of 1 month according to good dispensing practices. We calculated the time between receipt of prescriptions and dispensation of medicines by the pharmaceutical team for both prescription modalities (electronic and manual). Results 384 (58%) manual prescriptions and 276 (42%) electronic prescriptions were analysed, prepared and dispensed by the pharmacy team in our hospital. The average length of preparation of manual prescriptions was 25±10 min and the average length of preparation of electronic prescriptions was 15 min±5. The difference was statistically significant (p<0.001). The number of drugs dispensed by prescription is more important for electronic prescriptions (2.2 vs 1.8 (p=0.005)). Conclusion Our team found a considerable gain in time (10 min by prescription or 170 min per day) between prescription of medicines by physicians and their dispensation by the hospital pharmacy despite the high number of drugs dispensed in the case of electronic prescriptions. This time saved would allow the pharmaceutical team to focus on other activities, more precisely the pharmacological analysis of prescriptions and hospital preparations. References and/or acknowledgements 1. Nanji KC, Rothschild JM, Salzberg C, et al. Errors associated with outpatient computerised prescribing systems. J Am Med Inform Assoc2011;18:767–73. No conflict of interest

GM-001 Role of the pharmacist in hospital: What is the perception of health professionals?

Background The pharmacist has a central role in a hospital. However, in the absence of regulation (law) that defines the role and prerogatives of the hospital pharmacist in developing countries, the missions of the pharmacists are many, and perceptions of other health professionals on the role played by pharmacists in hospital are disparate. Purpose To determine the perception of health professionals about the role of the hospital pharmacist. Three questions were asked of health professionals: (1) What is the role of the pharmacist in the hospital? (2) Can we run a hospital without a pharmacist? (30 What is the perception of hospital pharmacists in relation to their missions? Material and methods A survey was conducted among different categories of health professionals (pharmacists, physicians, nurses and technicians in three hospitals). Tables 1–3 were presented to health professionals to assess their perceptions on the role of hospital pharmacists. Results 120 responses were collected and analysed. The results are summarised in tables 1–3.Abstract GM-001 Table 1 Perception of health professionals on the role of the hospital pharmacist Mission % Pharmaceutical products procurement 98 Therapeutic monitoring 18 Pharmaceutical preparation 56 Pharmacoeconomics 72 Risk management 58 Development of hospital 62Abstract GM-001 Table 2 Perception of the indispensability of the pharmacist in relation to the tasks defined Mission Yes No All missions in table 1 x x  Conclusion Procurement is the most important function performed by pharmacists in hospitals in the eyes of health professionals. Therapeutic monitoring is the least. Other tasks of the hospital pharmacist that are perceived as important include application of pharmacoeconomics rules. The pharmacist is seen by health professionals as an essential and non-essential professional for all missions selected. The regulatory prerogatives of hospital pharmacists should be more specific and clarified. The illegal practice of hospital pharmacy should be severely punished.Abstract GM-001 Table 3 Perception of hospital pharmacists in relation to their missions Mission % Pharmaceutical knowledge <15 Work organisation 50–60 Address book (pharmaceutical manufacturers) and strategic position (dispensing of pharmaceutical products) 40–50 References and/or Acknowledgements Acknowledgements to the pharmacy team at Cheikh Zaid Hospital. No conflict of interest.

GM-005 Financial evaluation of cataract surgery in a public health hospital

Background With more than 1,000 cataracts operations performed per year, our hospital is considered one of the national reference centres for this surgery. In contrast to Extracapsular Cataract Extraction (ECCE), phacoemulsification is the most used technique at our hospital (84% of cataracts operated on) and requires costly consumables contributing to the overall cost of care. Purpose To compare the proportion of Pharmaceutical Products (PPs) costs in the amounts billed according to cataract surgery types and to patients’ Medical Tariff Categories (MTC). Material and methods To evaluate the cost of the PPs used in uncomplicated cataract surgery with lens implantation by both standard techniques, and its impact on the amount billed to patients’ MTC, we studied data from 1,073 patients operated on in 2013 (901 by phacoemulsification and 172 by ECCE). Information relating to the cost of PPs and billing packages was collected from our hospital’s financial department. Results Our study results (table 1) reveal that for phacoemulsification, the cost of PPs consumes 64% of the billing package in insured patients and 93% of the billing package in uninsured patients, in contrast to the ECCE for which the cost of PPs consumes only 20% of the billing packages in both patients’ MTC.Abstract GM-005 Table 1 Cost per patient of PPs compared to the overall billing package MTC ECCEPPCost ECCEBillingpackage PhacoemulsificationPPCost PhacoemulsificationBillingpackage Insured patients (15%) €45 €227 €203 €318 Uninsured patients (85%) €45 €218* €203 €218* * Excluding hospitalisation fees (€9 per day), radiology and medical biology fees. Conclusion Phacoemulsification is the most used technique, preferred for its many advantages. However it requires costly PPs that consume the greatest share of billing packages, especially in uninsured patients. These findings require the billing of this surgical act to be re-evaluated and a revision downwards of the necessary PP acquisition prices. References and/or acknowledgements No conflict of interest.