BackgroundThe chemical stability of coadministered ondansetron (OND) and haloperidol (HAL) in parenteral admixtures has not been described yet.ObjectiveThe aim of the present work is to study the chemical stability and the compatibility of OND and HAL admixtures.MethodsNormal saline solution and dextrose were used to prepare the admixture solutions of the drugs; the materials of the containers were the original plastic bags of the diluents and the stability was studied at 20°C. Compatibility was studied by visual inspection of no colour change and turbidity or precipitation appearance. The concentration of the drugs was studied by ultraviolet detection high-performance liquid chromatography. The method was validated following the Food and Drug Administration and European Medicines Agency guidelines, and the assay enables the measurement of both drugs with a linear calibration curve (r=0.999) over the concentration range 10–100 µg/mL, with acceptable values of linearity, precision and accuracy. Darunavir was used as internal standard.ResultsMost of the admixtures have an adequate concentration until 24 hours(less than 10% of loss). 25% of the samples show a higher loss at 24 hours, and the chemical stability of these samples is 12 hours.ConclusionsThe stability and compatibility of OND and HAL in the coadministered admixtures in Viaflo plastic bags with normal saline or dextrose are suggested at 12 hours.

Background The average hospitalised patient is subject to at least one medicines error per day. More than 40% of medicines errors are believed to result from inadequate medicines reconciliation. PurposeTo investigate the introduction of a medicines reconciliation programme in the orthopaedic surgery unit. Materials and MethodsJanuary 2010–March 2012. The patient selection criteria were ≥65 years old, home treatments ≥5 drugs and anticipated hospital stay ≥3 days. The reconciliation treatment was also performed for any other patients when requested by the doctor. Patients were found to be sensitive to the reconciliation by the pharmacist. Any Drug Related Problems (DRPs) detected were recorded and categorised. A prescription was given with the home treatment, with the aim of continuing treatment, discontinuing it or performing a therapeutic exchange. The process ended with oral and written pharmacotherapeutic information on the day of discharge. ResultsMedicines reconciliation was carried out on 300 patients with an average age of 75.86, average stay of 9.57 days and distribution by gender 224 women (75%) and 76 men (25%).The number of medicines/patient was 6.57. During the prescription by the pharmacist, 1058 drugs were provided according to guidelines, 276 were suspended and in 663 cases a therapeutic exchange was performed. As regards the DRPs detected, 50 were caused on admittance and 15 at discharge. The DRPs were classified as follows: safety 51, effectiveness 10, adherence 2 and indication 2. Types of DRP: overdose 17, adverse reaction 4, need of extra treatment 6, unnecessary medicine 23, unsuitable drug 10, insufficient dosing 4, not dispensed 1. As to the seriousness of the DRPs: class 1: 5 patients didn’t use the medicines that they needed; class 2, 24 patients used medicines that they didn’t need; class 3, 23 patients used an erroneously chosen medicine; class 4,10 patients used an erroneously chosen medicine; class 5, 3 patients used a lower dose and/or a different dosage schedule from that required and/or don’t continue treatment for the full duration of the treatment indicated, according to the Granada consensus of 1998. Conclusions Participation of the pharmacist in the reconciliation of treatment allows DRPs to be detected at admission and discharge and educated the patient on his or her treatment at discharge from the hospital. No conflict of interest.

BackgroundPatients with multiple antiretroviral therapy (MAT), defined as a combination of at least 3 drugs with different mechanisms of action, are on a difficult and costly treatment which may also affect treatment adherence.PurposeTo describe characteristics of HIV patients with multiple antiretroviral therapy and to evaluate the efficacy and adherence to the treatment.Material and methodsRetrospective observational study from June to December 2013. The inclusion criteria for our study were: MAT patients without changes in their treatment in the last 24 weeks. Data collected: demographics, current MAT, duration of treatment for HIV, adherence, resistance profile, viral load (VL) and CD4 count. Patients were classified as adherent (>90%) and non-adherent (<90%) by two independent methods: pharmacy dispensing records and SMAQ (simplified medicines adherence questionnaire) interview. Efficacy was evaluated by CD4 cells count and VL < 50 copies/mL, however we also considered CV < 200 copies/mL as a good indicator of treatment response.ResultsA total of 49 patients were eligible in this study, 76% male, mean age 46.5 ± 9.9 years. The mean no. of MAT drugs was 4 (range 3–6) and the mean duration of treatment for HIV was 12 (range 1–17) years. Regarding resistance studies: 9 patients were resistant to some antiretroviral, it was not possible to perform resistance studies in 10 patients (20.4%) due to the low VL (<1,000 copies/mL), it was not requested in 28 patients (57.1%) and 2 patients did not show resistance. Seven, eight and two patients showed resistance to analogues, non-analogues and protease inhibitors, respectively. The mean adherence was 94% and 40 patients (81.6%) had a percentage adherence superior to 90%. As to the efficacy variables: 32 (65.3%) and 46 (93.8%) patients had VL < 50 copies/mL and <200 copies/mL, respectively and 40 patients (81.6%) had a CD4 cell count >250 copies/mL.ConclusionMost patients had effective treatments. The complexity of the treatment did not have a negative impact on adherence. All patients with a resistance profile had their treatment optimised according to it.References and/or AcknowledgementsNo conflict of interest.

BackgroundThe tyrosine kinase inhibitors (TKI), imatinib, dasatinib and nilotinib, have brought about a paradigm change in the treatment of chronic myeloid leukaemia (CML). Previously, patients had a median survival of 3–5 years, while now it is a chronic disease with life expectation comparable with that of the general population. Adherence to treatment in these patients is an important part of success.PurposeTo determine the adherence rate of patients diagnosed with CML and treated with TKI in our hospital.Material and methodsObservational study from June 2012 to June 2015. We evaluated adherence using two different methods: interview between the patient and pharmacist using the Morisky-Green questionnaire, standardised for multiple chronic diseases; and counting of dispensing drugs. This is possible because, in our country, TKI are only dispensed in hospital pharmacy departments.Patients were considered adherent if they obtained a score ≥90% on both methods.Results21 patients met the criteria to be diagnosed with CML and were also treated with TKI in our hospital during the study period. The average days of treatment was 497 (median 551 days). Results from both methods coincided: the percentage of adherent patients (score ≥90%) was 81% (18 patients). Agreement between these two methods was 100%. For non-adherent patients, compliance rate in no event was <70%, and failure reasons were related to forgetfulness (2/3) and lifestyle (1/3).ConclusionThe results of this pilot study in our hospital were satisfactory. Early detection of non-adherent patients is vital to achieve adherence rates of 100% and minimise the response variability to TKI due to non-adherence.References and/or AcknowledgementsThe patients and physicians.No conflict of interest.

Background Medicines reconciliation is done to avoid errors in patient treatment such as omissions, duplications, dosing errors, drugs not included in the hospital formulary or drug interactions. Admission to hospital is one of the best times to reconcile medicines for patients with multiple comorbidities. Purpose To analyse the pharmacist’s intervention in the medicines reconciliation process in the Emergency Department of a General Hospital. Materials and Methods Prospective observational study in the Emergency Department (ED) of a General Hospital in October 2011 to September 2012. We included all patients admitted to the ED of our hospital whose medical orders (MOs) contained a conflict of medicines. When medical or nursing staff detected a conflict they sent the prescriptions to the unit dose drugs distribution system (UDDDS) and the pharmacist checked the drugs taken by the patient upon admission. All pharmaceutical interventions were recorded at the Pharmacy Department. ResultsDuring the study period 969 MOs were received at the UDDDS and the pharmacist interventions were: 344 (35.5%) exchanged medicines not included in the hospital formulary for other alternatives, 219 (22.6%) exchanged to therapeutic equivalents, 167 (17.2%) exchanged to a brand of the same drug stocked in the hospital, 174 (18%) no alternative dosage forms, 24 (2.5%) interventions for errors in dosing regimen, 17 (1.8%) checked the parenteral or oral route, 7 (0.7%) prevented duplication of treatment and 17 (1.8%) other interventions. Conclusions The role of the pharmacist in medicines reconciliation at patient admission increases coordination between different health care providers and maybe improves the global quality of care. No conflict of interest.

Background Many drugs are prescribed outside the terms of the marketing authorization (off-label), especially in oncology. PurposeTo describe the use of bevacizumab in metastatic breast cancer (MCB), evaluating its suitability after the extension of the indications in 2011 by the European Medicines Agency (EMA). Materials and MethodsRetrospective and descriptive monitoring study carried out between January and December of 2011 on the use of bevacizumab in MBC in a 446-bed tertiary care hospital. Demographic data, regimens, types of treatment, dose, number and frequency of cycles and indications were examined. During the study it was considered according to technical data that treatment regimens with bevacizumab combined with paclitaxel or capecitabine were among the best for metastatic illnesses. ResultsThe total number of patients with MBC in treatment during 2011 was 96, 40.6% (39 patients) of whom were being treated with bevacizumab with an average age of 62 (ranging 45–79). 40 treatments were reviewed (one patient received two different bevacizumab regimens during the monitoring process), 42.5% of which followed the indications authorised by the EMA. The regimens that didn’t fit to the technical data (57. 5%) were as follows: 46% bevacizumab in monotherapy 15 mg/kg/21 days, 54% bevacizumab associated with other cytostatics different from paclitaxel or capecitabine. Combinations with bevacizumab not indicated in the technical data were: 37% bevacizumab 15 mg/kg + liposomal doxorubicin 75 mg/m²/21 days, 37% bevacizumab 15 mg/kg/ 21 days + vinorelbine 25 mg/m² days 1 and 8, 10% bevacizumab 15 mg/kg/21 days, 10% bevacizumab 10 mg/kg +irinotecan to 125 mg/m²/15 days and 6% bevacizumab 15 mg/kg +docetaxel 100 mg/m²/21 days. Conclusions Despite the extension of the bevacizumab indications in 2011 by the European Medicines Agency (EMA) the off-label use of bevacizumab remains high, probably due to the clinical evidence with bevacizumab, which has evolved rapidly in recent years. In this sense, the importance of pharmacists’ role should be stressed in evaluating the use of medicine in relation to the recent evidence of the MBC. No conflict of interest.

A high percentage of colony-stimulating factors use in the Emergency Department does not comply with the medical practice guideline.

BackgroundNon-specific intravenous immunoglobulin (IgIVC) preparations are one of the products of human plasma fractionation. In clinical practice these drugs are expensive as they are used as replacement therapy in patients with primary and secondary immunodeficiencies, as well as immunomodulatory therapy in many autoimmune diseases and systemic inflammatory diseases.PurposeThe purpose of this study was to compare IgIVC consumption and economic costs before and after performing IgIVC fractionation of doses in our hospital.Material and methodsDescriptive observational study in a tertiary teaching care hospital with 413 beds. All patients, both inpatients and outpatients, who received IgIVC from July 2011 to July 2015 were reviewed. Data collected from each patient included age, gender, clinical diagnosis, dosage regimen, unit consumed and cost in Euros.Data were recorded from July 2011 to June 2013 and then from July 2013 to July 2015. During the first stage, the purchased IgIVC doses were 0.5 2.5 5 and 10 g. During the second stage, only 0.5 and 10 g doses were purchased, and the 2.5 and 5 g doses were obtained by splitting the 10 g dose. In this way, one 10 g dose yielded two doses of 5 g and four doses of 2.5 g.ResultsBetween July 2011 and July 2015, 231 patients received doses of IgIVC. Of these,103 (44.58%) were female patients. The most prevailing drug indications were essential thrombocythemia, non-toxic inflammatory neuropathies and myasthenia gravis. The total economic cost was 1 913 730.26€.From July 2011 to June 2013, 96 (41.55%) patients received IgIVC which involved a total economic cost in euros of 871 504.75€ (45.54%). On the other hand, from July 2013 to July 2015, 129 (55.84%) patients received IgIVC, costing 1 024 225.510€ (54.56%).If no fractionated doses of 5 and 2.5 g had been used, the cost from July 2013 to July 2015 would have been 1 082 159.58€, therefore performing fractionated doses of IgIVC provided economic savings of 39 934.07€ (3.70%) over 2 years.ConclusionIgIVC administration has increased over the past 4 years. The economic cost has been greatly reduced by fractionation of doses performed at our hospital.No conflict of interest.