BackgroundPegylated Interferon-alpha-2b (pegIFNα2b) is an effective agent for the treatment of haematological malignancies. As it does not inhibit DNA synthesis, this agent may be safe for use during pregnancy.PurposeTo describe 2 cases of successful pregnancies in patients with haematological disorders treated with pegIFNα2b.Material and methodsMedical record review and literature search.ResultsPatient 1: 30-year-old woman diagnosed with polycythaemia vera at age 13, well-controlled with hydroxyurea. Chemotherapy was interrupted due to the patient’s desire for a second pregnancy and treatment with pegIFNα2b 50mcg/week subcutaneously was initiated. (During the first pregnancy she received non-pegylated-IFNα2b with good progression but low tolerance due to influenza-like symptoms). 5 months later, she became pregnant, but was hospitalised due to headaches which caused a dose reduction to 30 mcg/week of pegIFNα2b. Finally, the patient delivered a healthy male infant. 15 days later, pegIFNα2b treatment was interrupted to recommence the usual treatment with hydroxyurea.Patient 2: 27-year-old woman with Philadelphia chromosome-positive chronic myeloid leukaemia diagnosed at age 22, well-controlled with imatinib. The patient interrupted antineoplastic treatment due to her desire to conceive a child and subcutaneous treatment with pegIFNα2b at 50 mcg/week was initiated. She became pregnant after 4 months and pegIFNα2b dose was increased to 80 mcg/week and developed hypothyroidism which was treated with levothyroxine. Finally, the patient delivered a healthy male infant and 1 month later, she discontinued pegIFNα2b and levothyroxine treatment to recommence her usual treatment with imatinib.Both were normal full-term deliveries. Infant growth and development have been normal to date (follow-up time of 2 and 3 years). Blood tests were normal during pregnancies. Only mild anaemia and slight neutrophilia were detected in the first patient, but did not require treatment interruption.ConclusionPegIFNα2b was well tolerated, safe and effective, and caused no complications during the pregnancies. Since chemotherapy agents involve teratogenic effects, pegIFNα2b might be a safe treatment option during pregnancy, although further teratogenic studies are necessary.References and/or acknowledgementsNo conflict of interest.
BackgroundTo increase the pharmacist presence in the computerised medical record (CMR) emerged as one of the improvement actions (IA) when internal customer feedback (satisfaction surveys to medical staff) was examined during the implementation of a Quality Management System (QMS) based on ISO 9001:2008 standard in a Pharmacy Service.PurposeTo analyse the degree of acceptance (DA) of the pharmacotherapeutic recommendations (PRs) after pharmacist participation in the CMR.Material and methods4-week ambispective quasi-experimental study (pre-intervention (A) 15 August–30 August’14; post-intervention (B) 1 September–15 September’14) performed in the Unit-Dose Drug Dispensing System (UDDDS) with manual prescription, nurse transcription and subsequent validation by a pharmacist, in a level-II hospital (411 beds, 52.8% of them with UDDDS). During period B the pharmacist wrote an advisory note in the CMR (MambrinoXXIv5.4®) called “Pharmaceutical Care”, in addition to submitting the printed PR form (PPRF) with the prescription; while during period A, only the PPRF was sent. End points: ward [medical, surgical, medical-surgical (MS)], drug, type of PR, degree of acceptance. Data collection and processing: Farmatools-Dominion, Excel.Results93 PRs were recorded [period A (38 PRs, 32 patients, 74.9 ± 13.4 years old; 63.2% male); period B (55 PRs, 47 patients, 72.8 ± 17.6 years old, 74.5% male)]. Type of ward: medical (39.5% A vs. 36.4% B), surgical (57.9% A vs. 52.7% B) and MS (2.7% A vs. 10.9% B). Main drugs involved: proton pump inhibitors (15.8% A vs. 9.1% B), potassium-fluid replacement treatment (15.8% A vs. 5.5% B), not included in guide (NIG) (42.1% A vs. 36.4%B). Major types of PR: substitution of medicines NIG for available therapeutic alternatives (36.8% A vs. 34.5% B), dose/dosage regimen modification (10.5% A vs. 16.4% B), drug interactions (10.4% A vs. 8.9% B), monitoring hypo/hyperkalaemia (21.1% A vs. 5.5% B). The degree of acceptance was 63.3% A vs. 79.5% B.ConclusionThe QMS identified weak points in order to establish IA. Moreover, sharing the CMR and making it accessible to health personnel was found to improve coordination and communication of care, creating an opportunity for pharmacists to develop a comprehensive patient-centred plan and to promote their integration in the interdisciplinary healthcare team.References and/or acknowledgementsNo conflict of interest.
BackgroundAutomated dispensing cabinets (ADC) allow medications to be stored and dispensed near the point of care, improving efficiency in drug distribution. Nevertheless, new technologies are not exempt from errors.PurposeTo analyse if there are stock discrepancies (SD) in drugs included in ADC.Material and methodsA descriptive observational prospective study was conducted during October 2014. Medicines contained in three ADC were inventoried. ADC were placed in internal medicine/haematology departments, digestive/oncology/cardiology departments and urgency service.We evaluated: global rate of SD; global rate of SD by drawer type; rate of SD per ADC; and rate of SD by drawer type per ADC.Three drawer types were defined: multiple drug access drawers (MDAD), single drug access drawers (SDAD) and single dose dispensing pockets (SDDP).Results1082 drugs were inventoried. 395 presented SD (36.5%): 279 (25.8%) in MDAD, 115 (10.6%) in SDAD and only 1 (0.1%) in SDDP. SD distribution by ADC is shown in table 1.Abstract DD-022 Table 1Total No of drugs by ADCTotal SD by ADC (%)Multiple drug access drawers SD (%)Single drug access drawers SD (%)Single dose dispensing pockets SD (%)Internal medicine/haematology departments393146 (37.2%)115 (29.3%) (261 drugs)31 (7.9%) (116 drugs)0 (0%) (16 drugs)Digestive/oncology/cardiology departments416169 (40.6%)103 (24.7%) (209 drugs)66 (15.9%) (166 drugs)0 (0%) (41 drugs)Urgency service27380 (29.3%)61 (22.3%) (178 drugs)18 (6.6%) (78 drugs)1 (0.4%) (17 drugs)ConclusionThe more drug storage is in an ADC, the more SD are found. Discrepancies were more common with MDAD because users could remove more doses and different drugs than requested. Therefore, although new technologies are designed to improve both safety and efficiency in medicine management in hospitals, the use of ADC should include an evaluation of possible error opportunities, to implement strategies focused on preventing or minimising these errors. taking more care with those drawers where you can access the whole medication. Appropriate ADC handling is crucial to guarantee fast and safe access to medications in clinical units.No conflict of interest.
BackgroundProtease inhibitor treatment (PIT) represents an important advance for patients with hepatitis C. However, PIT may produce haematological adverse events (HAE).PurposeTo analyse the impact of HAE in hepatitis C patients who have been treated with PIT.Material and methodsRetrospective observational study (December 2012–August 2014) of patients with PIT who suffered HAE requiring supportive treatment in a general hospital.Data collected:Medical record review: weight, treatment (drug, dose, length of treatment) and HAE.Outpatients database: cost of real (including supportive treatment) and theoretical (without HAE) treatment per patient.Results12 patients (7 with telaprevir, 5 with boceprevir) began PIT. 6 (3 male and 3 female) median age 53.3 ± 3.2 years suffered from HAE, requiring supportive treatment (4 patients with weight ≥75 kg).Telaprevir patients:2 patients presented neutropenia between 8th and 12th week. The pegylated-interferon-?2a dose was reduced and they were treated with filgrastim 48 MIU until 36th and 43th week, respectively, when they stopped their treatment due to other adverse events (AE).2 patients (1 co-infected with HIV) suffered anaemia from 6th and 8th week. Their ribavirin dose was reduced. One patient was given epoetin-alfa 40,000 IU until 7th week when he stopped treatment due to other AEs. The HIV-co-infected patient began darbepoetin-alfa 50–100 mcg (treatment finished after 48 weeks). Both needed blood transfusions (this cost was not evaluated).Boceprevir patients:1 patient stopped PIT at 7th week for severe neutropenia, having reduced pegylated-interferon-a2b dose previously. Afterwards, one dose of filgrastim 30 MIU was necessary.1 patient reduced pegylated-interferon-?2a dose for severe thrombocytopenia in the 8th week. Later, he was given eltrombopag 25 mg until the end of PIT (48 weeks).The real cost was €179,439.9 and theoretical cost €169,674.9.Conclusion50% of patients with treatment with IP needed supportive treatment to manage HAE. The real cost was higher than the theoretical cost (6.8%), but they could continue their PIT, although 4 patients had to finish it later because of other side effects.References and/or acknowledgementsNo conflict of interest.
BackgroundOne of the leading objectives of healthcare organisations is continuous quality improvement. It is necessary to plan and implement monitoring, measurement, analysis and control for the improvement processes of quality management system (QMS) and demonstrate the ability of processes to achieve the planned results.PurposeTo analyse continuous quality improvement in the oncology pharmacy unit (OPU) of a pharmacy service (PS) certified with a QMS based on ISO 9001:2008 standard.Material and methodsRetrospective observational study in a second level hospital, in which OPU had a workload of 636 preparations/month and 182 patients/month. The main key process involved was sterile compound preparation, but other processes were included, such as pharmacoeconomics, drug safety, dispensation and logistics.We revised all documents during and after implementation of QMS (December 2013–September 2015), recording data from incidents logbook, FarhosOncology and QMS computer file (Openkm): Number of incidents, medications errors (ME) and non-conformities.Quality indicators (QI): QI1 (% intravenous mixture of chemotherapy returned to PS; standard ≤1%) and QI2 (errors registered in the progress of chemotherapy; standard ≤1%).Corrective actions.Recommendations for improvement.ResultsWe collected 199 incidents identified by PS staff in the incidents logbook, 6% of which were detected in the OPU. The major processes involved were logistics (58.3%) and dispensation (33.3%). We detected 69 ME (medical prescription (43.5%), preparation/dispensation (21.7%), administration (10.1%), pharmaceutical validation (17.4%) and extravasation/effusion (7.2%)), 14.5% of which produced damage to the patient.13.3% of all non-conformities (n = 15) were related to the OPU and some corrective actions were carried out: (1) managing appointments in the admission service to avoid work overload in the outpatient pharmacy; (2) increasing the amount of medications dispensed; and (3) PS staff training and meetings.The monthly averages of QI were 0.35% (QI1) and 0.5% (QI2), reaching standard values.The recommendations for improvement were: (1) creating a new outpatient pharmacy to dispense oncological and haematological oral drugs, (2) implementation of a new laminar flow cabinet to allow traceability of chemotherapy preparations and (3) implementation of the control automatic system to all refrigerators to improve the logistics of oncology and haematology drugs.ConclusionQMS are important work tools which help us to improve healthcare quality, pharmacotherapeutics and patient safety.No conflict of interest.
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