21 Congress of the EAHP ABSTRACTBOOK

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ABSTRACT

BOOK

21 st

_{Congress of the EAHP}

16-18 March 2016

Vienna, Austria

EUR OPEAN JOURNAL OF HOSPIT AL PHARMA CY Mar ch 2016 V olume 23 Supplement 1 P ag es A1–A262

S1

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Abstracts from the EAHP 2016 Congress

A1 Clinical pharmacy

A104 Drug distribution

A118 Drug information and pharmacotherapy

A158 General management

A167 International posters

A172 Other hospital pharmacy topics

A178 Pharmacokinetics and pharmacodynamics

A195 Production and preparation

A214 Patient safety and risk management

A250 Author index

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Presentations on Wednesday, 16 March, 14:00–15:30, Room 93

Time Poster number Poster nominee oral presentations

Author

14:00 DD-021 Medicine supply chain of a central pharmacy: risk mapping

shortage

F Charra

14:10 PP-001 Contamination with cytotoxic drugs in the workplace –

ESOP pilot study

E Korczowska

14:20 PP-039 Double checking manipulations for complex and/or high

risk preparations

A Alcobia Martins

14:30 CP-055 The clinical pharmacist resolves medication related

problems in cranio, maxillofacial and oral surgery patients

E Tudela-Lopez

14:40 CP-085 The impact of pharmacist interventions on safety

and cost savings

M Tovar Pozo

14:50 CP-219 Effectiveness and safety of switching to dual antiretroviral

therapy in a treatment experienced HIV cohort

J Luis Revuelta

15:00 DD-027 Implementation and evaluation of an appointment based

model for outpatients attended in a hospital pharmacy

F J Alvarez Manceñido

15:10 PKP-031 Clinical pharmacokinetics of everolimus in lung

transplantation: strategies of monitoring

M Martín Cerezuela

Presentations on Thursday, 17 March, 09:00–10:30, Room 93

Time Poster number Poster nominee oral presentations

Author

09:00 PS-072 Does the computerised physician order entry system

reduce prescribing errors for inpatients? A before and after study

N Rouayroux

09:10 DI-008 Apps for paediatric dosing – an evaluation P Vonbach

09:20 PS-036 Improving pharmacological treatment: real time safety

audits

P A López

09:30 PS-046 Materiovigilance ex ante risk management A Dubromel

09:40 OHP-001 Health related quality of life and its associated factors

among South Asian and Middle Eastern patients with chronic diseases in the UK

F Alhomoud

09:50 CP-127 Inappropriate prescribing in elderly patients attending

the emergency room

I Sánchez Navarro

10:00 PS-049 Prospective detection of adverse drug reactions among

2.263 hospitalised children over a 19month period: EREMI intermediate report

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Confidence from Evidence

and Real World Experience

Evidence from clinical and real world studies in SPAF

1–3

_{and PE/DVT}

4,5

makes Xarelto

®

_{the world’s most prescribed NOAC,}

6

_{with over}

18 million patients treated across all 7 indications worldwide.

a,7,8

Xarelto 2.5 mg film-coated tablets (Refer to full SmPC before prescribing.)

▼ This medicinal product is subject to additional monitoring. Composition: Active ingredient: 2.5 mg rivaroxaban. Excipients: Microcrystalline

cellulose, croscarmellose sodium, lactose monohydrate, hypromellose, sodium laurilsulfate, magnesium stearate, macrogol 3350, titanium dioxide (E171), iron oxide yellow (E172). Indication: Prevention of atherothrombotic events in adult patients after an acute coronary syndrome (ACS) with elevated cardiac biomarkers, co-administered with acetylsalicylic acid (ASA) alone or with ASA plus clopidogrel or ticlopidine. Contraindications: Hypersensitivity to the active substance or any of the excipients; active clinically significant bleeding; lesion or condition considered a significant risk for major bleeding; concomitant treatment with any other anticoagulants except under specific circumstances of switching anticoagulant therapy or when unfractionated heparin is given at doses necessary to maintain an open central venous or arterial catheter; concomitant treatment of ACS with antiplatelet therapy in patients with a prior stroke or a transient ischaemic attack (TIA); hepatic disease associated with coagulopathy and clinically relevant bleeding risk including cirrhotic patients with Child Pugh B and C; pregnancy and breast feeding. Warnings and Precautions: Clinical surveillance in line with anticoagulation practice is recommended throughout treatment. Xarelto should be discontinued if severe haemorrhage occurs. Increasing age may increase haemorrhagic risk. Not recommended: in patients with severe renal impairment (creatinine clearance <15 ml/min); in patients receiving concomitant systemic treatment with strong concurrent CYP3A4- and P-gp-inhibitors, i.e. azole-antimycotics or HIV protease inhibitors; in patients with increased bleeding risk; in patients receiving concomitant treatment with strong CYP3A4 inducers unless the patient is closely observed for signs and symptoms of thrombosis; not recommended due to lack of data: treatment in combination with antiplatelet agents other than ASA and clopidogrel/ticlopidine; in patients below 18 years of age; in patients concomitantly treated with dronedarone. Use with caution: in conditions with increased risk of haemorrhage; in patients with severe renal impairment (creatinine clearance 15 – 29 ml/min) or with renal impairment concomitantly receiving other medicinal products which increase rivaroxaban plasma concentrations; in patients treated concomitantly with medicinal products affecting haemostasis; in patients > 75 years of age or with low body weight; when neuraxial anaesthesia or spinal/epidural puncture is employed. Patients on treatment with Xarelto and ASA or Xarelto and ASA plus clopidogrel/ ticlopidine should only receive concomitant treatment with NSAIDs if the benefit outweighs the bleeding risk. In patients at risk of ulcerative gastrointestinal disease prophylactic treatment may be considered. Although treatment with rivaroxaban does not require routine monitoring of exposure, rivaroxaban levels measured with a calibrated quantitative anti-Factor Xa assay may be useful in exceptional situations. Xarelto contains lactose. Undesirable effects: Common: anaemia, dizziness, headache, eye haemorrhage, hypotension, haematoma, epistaxis, haemoptysis, gingival bleeding, gastrointestinal tract haemorrhage, gastrointestinal and abdominal pains, dyspepsia, nausea, constipation, diarrhoea, vomiting, pruritus, rash, ecchymosis, cutaneous and subcutaneous haemorrhage, pain in extremity, urogenital tract haemorrhage, renal impairment, fever, percipheral oedema, decreased general strength and energy, increase in transaminases, post-procedural haemorrhage, contusion, wound secretion. Uncommon: thrombocythemia, allergic reaction, dermatitis allergic, cerebral

abnormal, urticaria, haemarthrosis, feeling unwell, increases in: bilirubin, blood alkaline phosphatase, LDH, lipase, amylase, GGT. Rare: jaundice, muscle haemorrhage, localised oedema, bilirubin conjugated increased, vascular pseudoaneurysm (uncommon in prevention therapy in ACS following percutaneous intervention). Frequency not known: compartment syndrome or (acute) renal failure secondary to a bleeding. Post-marketing observations (frequency no assessable): angioedema and allergic oedema, cholestasis and hepatitis (incl. hepatocellular injury), thrombocytopenia.

Classification for supply: Medicinal product subject to medical prescription. Marketing Authorisation Holder: Bayer Pharma AG, D-13342 Berlin, Germany Further information available from: [email protected] Version: EU/4 Xarelto 10 mg / 15 mg / 20 mg film-coated tablets (Refer to full SmPC before

prescribing.) ▼ This medicinal product is subject to additional monitoring.

Composition: Active ingredient: 10 mg / 15 mg / 20 mg rivaroxaban. Excipients:

Microcrystalline cellulose, croscarmellose sodium, lactose monohydrate, hypromellose, sodium laurilsulfate, magnesium stearate, macrogol 3350, titanium dioxide (E171), iron oxide red (E172). Indications: 10 mg: Prevention of venous thromboembolism (VTE) in adult patients undergoing elective hip or knee replacement surgery. 15 mg / 20 mg: Prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation with one or more risk factors, such as congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, prior stroke or transient ischaemic attack. Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of recurrent DVT and PE in adults. Special populations: Patients undergoing cardioversion: Xarelto can be initiated or continued in patients who may require cardioversion. Contraindications: Hypersensitivity to the active substance or any of the excipients; active clinically significant bleeding; lesion or condition if considered a significant risk for major bleeding; concomitant treatment with any other anticoagulants except under specific circumstances of switching anticoagulant therapy or when unfractionated heparin is given at doses necessary to maintain an open central venous or arterial catheter; hepatic disease associated with coagulopathy and clinically relevant bleeding risk including cirrhotic patients with Child Pugh B and C; pregnancy and breast feeding. Warnings and Precautions: Clinical surveillance in line with anticoagulation practice is recommended throughout treatment. Xarelto should be discontinued if severe haemorrhage occurs. Increasing age may increase haemorrhagic risk. Not recommended: in patients with severe renal impairment (creatinine clearance <15 ml / min); in patients receiving concomitant systemic treatment with strong concurrent CYP3A4- and P-gp-inhibitors, i.e. azole-antimycotics or HIV protease inhibitors; in patients with increased bleeding risk; in patients receiving concomitant treatment with strong CYP3A4 inducers unless the patient is closely observed for signs and symptoms of thrombosis; not recommended due to lack of data: in patients below 18 years of age, in patients concomitantly treated with dronedarone. For 15 mg / 20 mg only: in patients with prosthetic heart valves, in patients with PE who are haemodynamically unstable or may receive thrombolysis or pulmonary embolectomy. Use with caution: in conditions with increased risk of haemorrhage; in patients with severe renal impairment (creatinine clearance 15 – 29 ml / min) or with renal impairment concomitantly receiving other medicinal products

with medicinal products affecting haemostasis; when neuraxial anaesthesia or spinal / epidural puncture is employed. For 15 mg / 20 mg only: specific dose recommendations apply for patients with moderate to severe renal impairment and in case of DVT / PE-patients only if the patient’s assessed risk for bleeding outweighs the risk for recurrent DVT / PE. In patients at risk of ulcerative gastrointestinal disease prophylactic treatment may be considered. Although treatment with rivaroxaban does not require routine monitoring of exposure, rivaroxaban levels measured with a calibrated quantitative anti-Factor Xa assay may be useful in exceptional situations. Xarelto contains lactose. Undesirable effects: Common: anaemia, dizziness, headache, eye haemorrhage, hypotension, haematoma, epistaxis, haemoptysis, gingival bleeding, gastrointestinal tract haemorrhage, gastrointestinal and abdominal pains, dyspepsia, nausea, constipation, diarrhoea, vomiting, pruritus, rash, ecchymosis, cutaneous and subcutaneous haemorrhage, pain in extremity, urogenital tract haemorrhage (menorrhagia very common in women < 55 years treated for DVT, PE or prevention of recurrence), renal impairment, fever, peripheral oedema, decreased general strength and energy, increase in transaminases, post-procedural haemorrhage, contusion, wound secretion. Uncommon: thrombocythemia, allergic reaction, dermatitis allergic, cerebral and intracranial haemorrhage, syncope, tachycardia, dry mouth, hepatic function abnormal, urticaria, haemarthrosis, feeling unwell, increases in: bilirubin, blood alkaline phosphatase, LDH, lipase, amylase, GGT. Rare: jaundice, muscle haemorrhage, localised oedema, bilirubin conjugated increased, vascular pseudoaneurysm. Frequency not known: compartment syndrome or (acute) renal failure secondary to a bleeding. Post-marketing observations (frequency not assessable): angioedema and allergic oedema, cholestasis and hepatitis (incl. hepatocellular injury), thrombocytopenia.

Classification for supply: Medicinal product subject to medical prescription. Marketing Authorisation Holder: Bayer Pharma AG, D-13342 Berlin, Germany Further information available from: [email protected] Version: EU/5 References: 1. Patel M.R., Mahaffey K.W., Garg J. et al. Rivaroxaban versus

Warfarin in non-valvular atrial fibrillation. N Engl J Med. 2011;365(10):883–91.

2. Camm J., Amarenco P., Haas S. et al. XANTUS: A Real-World, Prospective,

Observational Study of Patients Treated with Rivaroxaban for Stroke Prevention in Atrial Fibrillation. Eur Heart J. 2015:doi:10.1093/eurheartj/ehv466.

3. Tamayo S., Peacock F., Patel M. et al. Characterizing major bleeding in

patients with non-valvular atrial fibrillation: a pharmacovigilance study of 27,467 patients taking Rivaroxaban. Clin. Cardiol. 2015;38(2):63–8. 4. Prins M.H. Lensing A.W.A., Bauersachs R. et al. Oral rivaroxaban versus standard therapy for the treatment of symptomatic vehous thromboembolism: a pooled analsis of the EINSTEIN-DVT and PE randomized studies. Thrombosis J. 2013;11(1):21. 5. Ageno W., Mantovani L.G., Haas S., et al. Safety and effectiveness of oral rivaroxaban versus standard anticoagulation for the treatment of symptomatic deep-vein thrombosis (XALIA): an international, prospective, non-interventional study. Lancet Haemat. 2015:doi.org/10.1016/ S2352-3026(15)00257-4. 6. IMS Health MIDAS, Database: Monthly Sales December 2015. 7. Calculation based on IMS Health MIDAS, Database: Monthly Sales December 2015. 8. Xarelto®_{(rivaroxaban). Summary of Product}

PE, pulmonary embolism; DVT, deep vein thrombosis; SPAF, stroke prevention in atrial fibrillation. NOAC, non-vitamin K antagonist oral anticoagulant. Calculation based on IMS Health MIDAS, Database: Monthly Sales December 2015. a_{Indications may vary by country.}

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“Interchangeability of biologicals in the EU –

the science, practice, ethics and cost side?”

The European Association of Hospital Pharmacists

(EAHP) is accredited by the Accreditation Council for

the 2016 Synergy Satellite

at its 21st Congress:

Wednesday, 16 March 2016

11:30am to 1:00pm

Hall D, ACV

Vienna, Austria

ACPE programme number: 0475-0000-16-004-L04-P /Contact hours: 1.5, CEUs: .15. A knowledge based activity

grant from Roche

Prof. Dr. Daan Crommelin

Prof. Dr. Paul Declerck

Prof. Dr. Arnold Vulto

Prof. Dr. Paul Cornes

Introduction

The regulatory rules of engagement in Europe

The hospital pharmacist’s tools to make the choice

Is our present system economically sustainable?

Presenters

Facilitator

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Clinical pharmacy

CP-001 IMPACT OF PHARMACIST LED EDUCATION ON CANCER CHEMOTHERAPY

F Xu, Y Wang. Fengxian Hospital-Southern Medical University, Department of Pharmacy, Shanghai, China

10.1136/ejhpharm-2016-000875.1

Background Oncology pharmacy is one of the most active areas of pharmacy practice. How to better serve cancer patients is a noteworthy topic for oncology pharmacists.

Purpose To evaluate the impact of pharmacist led education on cancer chemothearpy.

Material and methods A randomised controlled study was con-ducted at the department of oncology at our hospital. 155 can-cer patients were randomly assigned to a control group (n = 76) or an education group (n = 79), based on a random num-ber table. Patients in the education group were given a booklet ‘Skills with cancer patients’ and a session with a pharmacist, twice a week, for 2 months. Each session lasted approximately 30 min. Patient in the control group only received conventional chemothearpy without any pharmaceutical care/service. Ques-tionnaires on KAP (knowledge, attitude, practice) and QOL (quality of life) were used to assess the impact of pharmacist education at the end of chemotherapy. Data were analysed with SPSS 13.0 software.

Results During the study, two patients dropped out and two withdrew in the control group while two dropped out in the education group. There were no differences with respect to demographic or clinical characteristics between the two groups. Before the education intervention, there were no significant dif-ferences in KAP or QOL scores (baseline values) between the two groups. At the end of the study, knowledge, attitude and behaviour scores were notably increased from 9.94 ± 3.84, 15.64 ± 3.93 and 4.82 ± 0.84 to 17.11 ± 2.11, 22.04 ± 12.38 and 5.69 ± 0.47, respectively, in the education group. In the control group, only knowledge score was increased signifi-cantly while no notably change for attitude or behaviour scores. However, the final KAP scores in the education group were sig-nificantly increased compared with those in the control group. At the end of study, patients’ emotional function and overall quality of life were increased while fatigue, nausea and vomit-ing, pain, insomina, constipation and diarrhoea scores were decreased significantly in the education group. No significant change occurred in the control group. Between the two groups, significant changes occurred for each score.

Conclusion Educational pharmacy intervention led by clinical pharmacists has a positive role in increasing chemotherapy related knowledge, improving patient’s negative emotions, cop-ing better with chemotherapy adverse reactions and amelioratcop-ing the QOL of cancer patients.

REFERENCES AND/OR ACKNOWLEDGEMENTS

China Guangdong Hospital Pharmacy grant (No.2012ZX001) No conflict of interest.

CP-002 MANAGING POLYPHARMACY IN GERIATRIC PATIENTS– A COMPARISON OF DIFFERENT ASSESSMENT TOOLS USED FOR MEDICATION REVIEWS

1_{M Nagano,}2_{TP Egger,}1_{K Nemec.}1_{Anstaltsapotheke SMZ-Ost/Donauspital, Wien, Austria;} 2_{Pflegewohnhaus Donaustadt, Wien, Austria}

10.1136/ejhpharm-2016-000875.2

Background Geriatric patients often suffer from multiple chronic diseases. Polypharmacy as well as age related physiological changes expose them to a high risk of drug related adverse events. Poor adherence and potentially inappropriate medicines (PIMs) are a further challenge for prescribers.

Purpose When performing a medication review, it is important to not only check for overtreatment in order to reduce polyphar-macy, but also to include a check for undertreatment and for inappropriate medication.

Material and methods Widely recognised tools to assess the medication of geriatric patients are the STOPP (Screening Tool of Older Persons’ Prescriptions)/START (Screening Tool to Alert doctors to Right Treatment) criteria, the Medication Appropri-ateness Index (MAI) and lists with PIMs. For this study, the med-ication lists of 50 geriatric patients (level of care 3) in a nursing home were analysed in detail using these three instru-ments. The medication review of each patient was repeated within 6 months to record the acceptance of the interventions. Results Overall, the pharmacist pointed to a possible drug related problem in 28% of all prescribed medicines, equivalent to three possible drug related problems per patient. Over 50% of the interventions suggested by the pharmacist were accepted and kept until the following review.

Conclusion The type and number of drug related problems was strongly dependent on the assessment tool. This should be taken into account when introducing an assessment tool into daily rou-tine. It is also important to note that the number of identified problems neither corresponds to the clinical significance of the problem nor to the quality of the medication before the review was performed. To put it bluntly, the mere number of interven-tions should not be seen as the main indicator of pharmaceutical care. Instead, more weight should be put on the clinical signifi-cance of these interventions.

1 Gallagher P, Ryan C, Byrne S, et al. STOPP (Screening Tool of Older Persons’ Pre-scriptions) and START (Screening Tool to Alert doctors to Right Treatment). Con-sensus Validation. Int J Clin Pharm Ther 2008;46:72–83

No conflict of interest.

CP-003 DEPRESCRIBING PSYCHOACTIVE MEDICATION FOR GERIATRIC PATIENTS IN A MULTIDISCIPLINARY WAY

D Kindt, A Verhaeghe, S Desmet, K Verhelle. AZ Groeninge, Clinical Pharmacy, Kortrijk, Belgium

10.1136/ejhpharm-2016-000875.3

Background A lot of studies emphasise the incidence of serious harm caused by polymedication in elderly patients. The use of

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benzodiazepines and/or combinations with other psychoactive medications in particular can increase the risk of confusion, falls, cognitive impairment and other adverse drug events.

Purpose To guard the safety and quality of life of geriatric patients receiving polymedication by reducing the use of psycho-active medication in a multidisciplinary way with the clinical pharmacist, geriatrician, general practitioner and home pharmacist.

Material and methods During a test conducted over 5 weeks, patients were screened. Inclusion criteria were the presence of a contraindication for benzodiazepines, a dose equivalent to 20 mg diazepam or a pharmacodynamic synergistic interaction (anti-depressant, antipsychotics, anticholinergics, sedative antihista-minics and opioids). The clinical pharmacist informed the patient about the impact of benzodiazepines. If the patient agreed to reduce the psychoactive medication, the geriatrician and general practitioner were contacted to decide which medica-tion to reduce and to confirm the reducmedica-tion schedule.

Results In the test, 30 patients met the inclusion criteria. 6 were not approachable, and in 4 patients the psychoactive medication had already been stopped in the hospital. 70% of the patients informed agreed to reduce their psychoactive medication. 10% were excluded by the geriatrician, and for 15% a reduction was suggested via the discharge letter. The general practitioner always supported the effectuation of the reduction.

This project resulted in the development of a multidiscipli-nary workflow and some practical tools that can be used by any doctor or pharmacist.

Conclusion Deprescribing psychoactive medication for elderly people can successfully be implemented by the development of a multidisciplinary workflow (clinical pharmacist–specialist–general practitioner–home pharmacist) and by providing some practical tools.

Our goal of patient safety could be achieved and led to satis-faction of patients and caregivers.

STOPP criteria, https://www.nhg.org/sites/default/files/content/ nhg_org/uploads/2015-05-07_stoppcriteria_eindversie_pdf.pdf

Beers criteria, http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC3571677/

www.bcfi.be

http://benzoschema.knmp.nl/benzos_enduser_pt http://wiki.psychiatrienet.nl/index.php/

CP-004 ANALYSIS OF TREATMENT WITH PEMBROLIZUMAB IN PATIENTS WITH METASTATIC MELANOMA IN THE EXPANDED ACCESS PROGRAMME (EAP)

E Togliardi, G Lanzo, G Antonacci, R Langella, C Della Costanza, G Saibene. Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Farmacia Ospedaliera, Milano, Italy 10.1136/ejhpharm-2016-000875.4

Background Metastatic melanoma was an ‘orphan drug’ pathol-ogy until a few years ago. But in the past years research has pro-duced new therapeutic options, among them pembrolizumab. So an expanded access programme for patients (pt) with metastatic melanoma in PD after therapy with ipilimumab has been started Purpose Analysis of the treated sample in terms of characteris-tics, and effectiveness and safety.

Material and methods Evaluation of pt treated from June 2014 to May 2015, creating a database in Excel to collect and analyse data consulting drug accountability and electronic medical records.

Results The requests for activation were 50; 35 of these (70%) were treated with pembrolizumab 2 mg/kg Q3W until progres-sion, 15 (30%) did not enter the programme (7 died before starting the treatment, 3 were in declined health status, 3 moved to another hospital and 2 enrolled in another trial). Among the pt treated, mean age was 60 (range 17–83) years; 63% were male, 37% female, 8 (23%) died from causes not drug related, 3 (8%) interrupted treatment because of a decline in general con-ditions, 8 (23%) interrupted for PD and 16 (46%) are carrying on the treatment. The mean duration of treatment was 5.1 cycles (range 1–15), about 4 months. 2 patients developed PD within the third cycle whereas 9 (26% of enrolled patients) have already received more than 5 cycles. 3 pt have received only 1 cycle as they have just been enrolled in the programme. 6 (17%) of the treated pt experienced an adverse reaction (2 diarrhoea, 2 cutaneous rash, 1 thrombocytopenia and 1 elevated transaminase level).

Conclusion Although this is an interim analysis on a restricted sample, the results are essentially in line with those obtained in clinical studies. In fact, 46% of pt responded to the therapy and the drug was well tolerated. 31% of pt interrupted the treatment in advance because of a sharp decline in general condition; only 23% for PD. Pt will be kept under observation because it is important to value the long term results, especially considering that pembrolizumab will imminently be available in UE clinical practice

REFERENCES AND/OR ACKNOWLEDGEMENTS EAP pembrolizumab in metastatic melanoma No conflict of interest.

CP-005 ASSOCIATION BETWEEN MEDICATION ADHERENCE AND EFFECTIVENESS IN THE USE OF DEFERASIROX FOR THE TREATMENT OF TRANSFUSIONAL IRON OVERLOAD IN MYELODYSPLASTIC SYNDROME

1

V Escudero-Vilaplana, 2O Mejias-Gomez, 2J Leal de la Encina, 3S Osorio-Prendes,

1_{X Garcia-Gonzalez,} 1_{RM Romero-Jimenez,} 1_{CG Rodriguez-Gonzalez,} 1_{M Tovar-Pozo,} 1_{A Herranz-Alonso,}1_{M Sanjurjo-Saez.}1_{Hospital General Universitario Gregorio Marañon,}

Pharmacy, Madrid, Spain;2_{University of Alcala, College of Pharmacy, Alcalá de Henares,}

Spain;3Hospital General Universitario Gregorio Marañon, Hematology, Madrid, Spain 10.1136/ejhpharm-2016-000875.5

Background Literature states the importance of medication adherence in the effectiveness of deferasirox for the treatment of transfusional iron overload in some hematologic pathologies such asb thalassemia or sickle-cell disease. However, there is no data about patients with myelodysplastic syndrome (MDS). Purpose Our objective is to evaluate the impact of medication adherence in the effectiveness of deferasirox for the treatment of transfusional iron overload in patients with MDS.

Material and methods A longitudinal, retrospective, observatio-nal study was performed in a tertiary hospital. The inclusion cri-teria were age over 18 years, MDS diagnosis and treatment with deferasirox for transfusion-dependent iron overload from Janu-ary 2011 to April 2015.

Treatment effectiveness was estimated by serum ferritin (SF) and adherence was measured by medication possession ratio

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(MPR). Patients were deemed adherent when MPR was 90%. The correlation between deferasirox dosage, SF and adherence over time was also assessed.

Results 35 patients were included. Median (p25, p75) SF at baseline was 1636 mg/L (1100, 1634), which fell to 1399 mg/L (824, 1772) during follow-up. The median rate of adherence during treatment was 92% (90, 95); although only 54.8% of the patients had a rate of adherence 90% in every follow-up measurement. A statistically significant correlation between adherence and SF was observed (r= -0.288, p = 0.004). Associa-tion between adherence and its potentially predictive variables was described in Table 1.

Conclusion The found association between adherence and treat-ment effectiveness is especially relevant; according to our results adherent patients have lower values of SF than non-adherent patients.

Abstract CP-005 Table 1 Deferasirox median dose, number of dose changes and SF during treatment and their relationship with adherence

Median dose (mg)

Number of changes in dosage

Final serum ferritin (mg/L) Adherent patients 1125 (968, 1479) 0.50 (0.00, 1.00) 1204 (567, 1652)* Non-adherent patients 1240 (1150, 1406) 1.00 (0.00, 1.00) 1430 (955, 1815)* Adherent patients= adherence 90%. Data is expressed as median (p25, p75). *Statistically significant differences between adherent and non-adherent patients (p < 0.05).

REFERENCES AND/OR ACKNOWLEDGEMENTS No conflict of interest.

CP-006 KETOCONAZOLE AND PERFORMANCE STATUS AS PREDICTIVE FACTORS OF RESPONSE TO ABIRATERONE IN METASTASIC PROSTATE CANCER IN REAL LIFE CONDITIONS

M Tovar, V Escudero, A Ribed, C Ortega, A Herranz, M Sanjurjo. Hospital General Universitario Gregorio Marañon, Hospital Pharmacy, Madrid, Spain

10.1136/ejhpharm-2016-000875.6

Background Abiraterone is an oral antiandrogen therapy approved in September 2011 by the European Medicines Agency (EMA) for metastatic castration resistant prostate cancer (mCRPC) in men whose disease had progressed on a docetaxel based chemotherapy, and was included in our hospital´s formu-lary in 2012.

Purpose To assess the effectiveness of abiraterone in patients with mCRPC in our hospital in real life conditions, and to ana-lyse previous ketoconazole therapy and patient performance sta-tus as prognostic factors of response to treatment with abiraterone.

Material and methods A retrospective longitudinal study was carried out from January 2012 to October 2014. We included all patients that had started treatment with abiraterone for mCRPC after chemotherapy progression in our hospital, exclud-ing those from clinical trials. Patients’ medical records were reviewed and the following data were collected: demographics (date of birth), pharmacotherapeutic (dosing, treatment duration, previous treatments) and clinical variables (performance status

(Eastern Cooperative Oncology Group scale– ECOG), progres-sion date). The main outcome was progresprogres-sion free survival (PFS), assessed by Kaplan-Meier plots. Analyses with log rank test stratified by prior ketoconazole therapy and performance status were also performed.

Results 36 patients (mean age 78 years old (range 65–87)) were included in the study. They had predominantly an ECOG score >1 (83.3%) and no previous ketoconazole therapy (63.9%). Median duration of treatment with abiraterone was 7.1 months (range 3.0–23.7) and dose reductions were not required. A median PFS of 7.5 months (95% CI 5.14 to 9.85) was deter-mined. Patients with no previous ketoconazole therapy had a median time to progression of 9.5 months (95% CI 5.7 to 11.4) compared with 6.9 months (95% CI 4.3 to 9.8) in the previous ketoconazole therapy group (95% CI 4.4 to 6.1) (p = 0.5). Per-formance status subgroup analysis results were: median PFS 7.5 months (95% CI 5.4 to 9.5) in patients with ECOG £1 vs. 6.3 months (95% CI 2.5 to 10.1) in the ECOG >1 group (p = 0.6). Conclusion The effectiveness of abiraterone in the treatment of mCRPC under real life conditions is consistent with clinical tri-als. Patients without previous ketoconazole treatment and a good performance status had better progression free survival outcomes, although the results were not statistically significant. REFERENCES AND/OR ACKNOWLEDGEMENTS

COU-AA-301 study. No conflict of interest.

CP-007 SWITCHING FROM INTRAVENOUS TO SUBCUTANEOUS FORMULATION OF ABATACEPT IN A REAL WORLD SETTING

1_{R López-Sepúlveda,}2_{N Martínez Casanova,}3_{I Vallejo Rodríguez,}3_{M Carrasco Gomariz,} 3_{F Artime Rodríguez,}3_{M Rodriguez Goicoechea,}3_{MA Calleja Hernandez,}3_{J Cabeza Barrera.} 1

Distrito Sanitario Granada-Metropolitano. UGC de Farmacia Provincial de Granada, Granada, Spain;2_{Consejería de Sanidad de Madrid, Pharmacy, Madrid, Spain;}3_Complejo

Hospitalario Granada. UGC de Farmacia Provincial de Granada, Pharmacy, Granada, Spain 10.1136/ejhpharm-2016-000875.7

Background The switch from the intravenous (IV) formulation to the subcutaneous (SC) formulation of abatacept (ABA) had been analysed in clinical trials but there are few data regarding the effectiveness and safety of the SC formulation in clinical practice.

Purpose To evaluate the impact of switching from IV to SC aba-tacept (SC ABA) in patients who were controlled on the IV for-mulation in a real world setting.

Material and methods Observational retrospective study of patients switched from IV to SC ABA, 125 mg once weekly, between September 2013 and April 2015. Data were collected by reviewing patient clinical records and the database of the local advisory committee for rheumatoid arthritis (RA). Meas-ured parameters were: disease activity score at 28 joints (DAS28), treatment duration, reasons for withdrawal and new biologic agent introduced.

Results 19 patients were included in our study, 17 women (89.5%) and 2 men (10.5%), mean age 59.6 years. All the patients had low RA activity at the beginning of SC ABA treat-ment (mean DAS28=3.1).

6 patients (31.6%) discontinued; all experienced an arthritic flare (mean DAS28=4.21; p = 0.02 vs baseline) but no adverse effects were described. 5 (83.3%) returned to IV administration

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after a mean of 7.1 months (range 2.7–10.8). The other patient (16.7%) switched to etanercept. 13 patients (68.4%) have con-tinued SC administration to date with good disease control and no adverse reactions. All five patients that returned to IV ABA also have good disease control to date.

Conclusion In our small case series, SC ABA showed a risk of relapse in 31.6% of cases but reinsertion of IV administration seemed to reinstate disease control. It could be possible that an eventual failure of the SC formulation does not compromise the effectiveness of the ABA therapy itself. Further research with a greater number of patients is needed.

1 Reggia R, et al. J Rheumato. 2015;42:193–5

CP-008 DEOXYNUCLEOTIDES DTMP AND DCMP IN THE TREATMENT OF MITOCHONDRIAL MYOPATHY BY MUTATIONS ON THE TK2 GENE

S Cifuentes, S Francisco, I Alferez, E Molina. Hospital Torrecardenas, Pharmacy, Almería, Spain

10.1136/ejhpharm-2016-000875.8

Background Mitochondrial DNA (mtDNA) depletion syndromes (MDS) attribute secondary heterogeneous diseases to defects in the mitochondrial respiratory chain. MDS are due to primary defects in nDNA genes that cause secondary defects in mtDNA. One of these genes is TK2, which codifies timidin-kinase (TK2), a necessary mitochondrial enzyme for the phosphorylation of the pyrimidine nucleosides (thymidine and cytidine), giving rise to deoxythymidine monophosphate (dTMP) and deoxycytidine monophosphate (dCMP). Currently, there is no effective treat-ment for mitochondrial diseases.

Purpose To analyse deoxynucleotide use in mitochondrial diseases.

Material and methods A boy aged 2 years and 10 months pre-sented with progressive weakness and regression of psychomotor development. After 8 months from the beginning of his symp-toms, the patient could not walk or remain standing. An investi-gation of the TK2 gene identified two mutations. Currently, in Columbia University, a favourable effect in animal models has been achieved with oral administration of dTMP and dCMP 200 mg/kg/day which delays disease progression and doubles mice survival rate. This treatment has already being used in three patients worldwide with positive results.

Application and authorisation for compassionate use of these deoxynucleotides, which the patient cannot synthesise, as substit-utive therapy, was sought. Review of the patient’s clinical history from diagnosis to his present situation is reported.

Results After 4 months of treatment, the patient has improved his muscular capacity and head support. His parents confirm evi-dent clinical improvement.

Conclusion In patients with a TK2 mutation, positive results and absence of secondary effects with the resulting benefit in health and quality of life are being obtained with deoxynucleotides. Further prospective well designed studies are needed to quantify the possible benefit of these treatments.

REFERENCES AND/OR ACKNOWLEDGEMENTS Eil y Likallio and Anu Suomalainen1,2

Research Program Unit, Molecular Neurology, Biomedicum-Helsinki, University of Helsinki

Department of Neurology, Helsinki Central Hospital, Hel-sinki, Finland

CP-009 IMPACT OF CONCILIATION IN INSTITUTIONALISED GERIATRIC PATIENTS

1_{R López-Sepúlveda,} 1_{MS Martín Sances,} 1_{S Anaya Ordóñez,} 1_{MA García Lirola,} 1_{ME Espínola García,} 2_{F Artime Rodríguez,} 2_{M Carrasco Gomariz,} 2_{M Rodríguez}

Goicoechea,2J Cabeza Barrera. 1Distrito Sanitario Granada– Metropolitano. UGC de Farmacia Provincial de Granada., Pharmacy, Granada, Spain; 2_{Complejo Hospitalario}

Granada. UGC de Farmacia Provincial de Granada, Pharmacy, Granada, Spain 10.1136/ejhpharm-2016-000875.9

Background In some regions, the pharmaceutical services at nursing homes are held by pharmacists from hospitals in the public network.

Purpose To determine the impact of medicines reconciliation on the prevalence of potentially inappropriate medicines (PIMs) in institutionalised elderly patients and to analyse the most fre-quently PIMs prescribed.

Material and methods Retrospective non-experimental study conducted between December 2014 and February 2015 at four nursing homes: two in which medicines reconciliation was per-formed and two others where it was not.

The prevalence of PIMs prescribed at the residences in which reconciliation was carried out was compared with the prescrip-tion at residences in which it was not. PIM frequency was ana-lysed according to the list of drugs to be avoided in older adults (65 years old or older) included in the 2012 Beers criteria. Results A total of 521 patients with a mean age of 83 years were included, 224 at nursing homes where reconciliation was con-ducted and 297 at residences in which it was not. In the first group of residences, there were 142 (63.4%) patients with inap-propriate prescriptions compared with 203 (68.3%) in the other group. At homes where medicines reconciliation was carried out, the total number of prescriptions was 2182, and 239 (10.9%) were PIMs. In the other group of patients, the total number of prescriptions was 2849, and 12.8% (365) were inadequate (p < 0.05 vs reconciliation). The total number of different prescribed specialties which were inadequate for patients was 59 for patients in the medicines reconciliation group and 83 in the other group. For comparison of independent proportions, Epidat software version 3.1 was used.

The most frequently prescribed PIMs in the reconciliation group were lorazepam, bromazepam, alprazolam, zolpidem and quetiapine, and in the other group of patients, lorazepam, zolpi-dem, haloperidol, alprazolam and clorazepate dipotassium. Conclusion The results of this study show a high prevalence of PIMs in institutionalised elderly patients, although residences with a medicines reconciliation programme had a lower percent-age of elderly patients with PIMs and fewer inappropriate pre-scriptions. The total number of different inadequate specialties was also lower.

Regarding PIMs, lorazepam, zolpidem and alprazolam were among the five most commonly prescribed in both groups. REFERENCES AND/OR ACKNOWLEDGEMENTS

1 Beers Criteria Update

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Thursday, 17 March 2016 - 12:00pm to 1:30pm

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CP-010 PHYSICIANS’ ACCEPTANCE RATE OF PHARMACY INTERVENTIONS IN HOSPITALISED PATIENTS IN AN ABDOMINAL SURGERY WARD IN A GENERAL HOSPITAL

1_{D Kuruc,}2_{J Pavicic Astalos,}3_{M Zagrajski Brkic.}1_{General Hospital}_{“Dr. Tomislav Bardek”}

Koprivnica, Hospital Pharmacy, Koprivnica, Croatia; 2_{General Hospital} _{“Dr. Tomislav}

Bardek” Koprivnica, Opthamology Department, Koprivnica, Croatia;3

General Hospital“Dr. Tomislav Bardek” Koprivnica, Psychiatry Department, Koprivnica, Croatia

10.1136/ejhpharm-2016-000875.10

Background Although the role of the clinical hospital pharmacist as an important part of the multidisciplinary team has been studied, little is known from the literature about the impact of pharmacy intervention (PI) on optimising pharmacotherapy in abdominal surgery patients. In our small country, to date, no information is available.

Purpose The main goal was to improve patient safety and clini-cal pharmacy. Subgoals were using this evidence to implement throughout the whole hospital; and national improvement initia-tive to reduce medication errors.

Material and methods Clinical pharmacists were regularly doing medication reviews at the abdominal surgery department. Inter-actions were analysed by LexiComp Online. A PI form that was invented in the clinical hospital a year before was used and pre-sented to the physician team at the next day morning rounds. Acceptance rate was noted as change in therapy. Descriptive stat-istical methods were used.

Results The survey was conducted from 1 October 2014 to 31 March 2015. All patients older than 18 years hospitalised at the examined ward were included in the study (539). 3773 therapy forms were analysed, of which there were 57 PI. Drug interac-tions stage D and X were the most common types of interven-tion (77%) of which almost half were accepted (48%). All interventions regarding dosing interval and duplication of ther-apy were accepted. Acceptance rate of PI (53%) can be attrib-uted to a new role of hospital pharmacist in this hospital as part of a healthcare team, lack of physician time and differences in opinion between pharmacists and doctors.

Conclusion The study confirmed the importance and essential role of the clinical pharmacist as part of the multidisciplinary healthcare team, especially in abdominal surgery patients. The results are consistent with a small number of clinically significant medication errors that could be prevented, but they represent a remarkable cost to the healthcare system and can result in seri-ous adverse effects in patients. With the knowledge based on clinical evidence, pharmacists´accepted interventions by physi-cians can optimise pharmacotherapy and patient safety.

My gratitude to general hospital Dr Tomislav Bardek Koprivnica, Croatia, and the people who helped me to conduct the study

CP-011 COST EFFECTIVENESS OF HEPATITIS C TREATMENTS IN A TERTIARY HOSPITAL

1_{R López-Sepúlveda,} 2_{C Valencia Soto,} 2_{M Carraco Gomariz,} 3_{N Martinez Casanova,} 2_{F Artime Rodríguez,}2_{MA Calleja Hernandez,}2_{J Cabeza Barrera.}1_{Distrito Sanitario Granada}

– Metropolitano. UGC de Farmacia Provincial de Granada, Granada, Spain; 2_Complejo

Hospitalario Granada. UGC de Farmacia Provincial de Granada, Pharmacy, Granada, Spain;

3_{Consejería de Salud de Madrid, Pharmacy, Madrid, Spain}

10.1136/ejhpharm-2016-000875.11

Background Viral hepatitis is a major public health problem, affecting millions of people worldwide. There is a great need for cost effectiveness analysis in real life settings as newly introduced treatment strategies result in high sustained viral response (SVR) rates but are more costly.

Purpose The aim of the study was to assess outcomes and costs of treating patients with chronic hepatitis C in clinical practice in a tertiary hospital.

Material and methods Retrospective observational study includ-ing hepatitis C patients who completed treatment with new drugs between January 2012 and April 2015. Measured variables were: age, sex, antiviral agent used and treatment costs. The information sources used were computerised medical records. Treatments with boceprevir (BOC), telaprevir (TLV), simeprevir (SIM), sofosbuvir (SOF) and simeprevir+sofosbuvir (SIM+SOF) were analysed. Patients who had SVR at 12 weeks post treat-ment and were awaiting the outcome at 24 weeks post-treattreat-ment were considered cured. Selling laboratory prices for each treat-ment were considered, given that BOC is provided at no cost from the 32nd week. The formula used to calculate the average cost per SVR in treated patients = spendings for all patients treated with the selected drug/number of patients showing SVR at week 24 week. The cost of non-successful treatments = cost of treatment dispensed to patients not reaching SVR with the selected drug/number of patients not reaching SVR.

Results 138 patients with a mean age of 53.2 years were included (67.4% men). 45.6% received TLV, 21% BOC, 16.7% SIM+SOF, 11.6% SIM and 5.1% SOF. The percentage of cured patients was: BOC 69%, TLV 46%, SIM 75%, SOF 100% and SIM+SOF 86.96%. Average costs per SVR in each treatment were: BOC C¼ 29542, TLV C¼ 42636, SIM C¼ 31466, SOF C

¼ 35043 and SIM+SOF C¼ 57649. Average costs for not achiev-ing SVR in each treatment were: BOC C¼ 16519, TLV C¼ 16716, SIM C¼ 17599, SOF C¼ 0 and SIM+SOF C¼ 50130.

Conclusion Sofosbuvir seems to be the most cost effective treat-ment analysed in real life settings but future studies involving more patients are needed to confirm these results.

Our insight on real life treatment outcomes and costs can serve as a reference for a comparison with other treatments. REFERENCES AND/OR ACKNOWLEDGEMENTS

1 Stahmeyer JT. J Viral Hepat 2015 Sep

CP-012 PARENTERAL NUTRITION IN ABDOMINAL SURGERY: IMPROVEMENT IN 2014?

1_{C Van Wetter,}2_{D Brandt,}1_{O Tassin,}1_{F Anckaert.}1_{Grand Hôpital de Charleroi, Hospital}

Pharmacy, Gilly, Belgium;2_{Grand Hôpital de Charleroi, Abdominal Surgery, Gilly, Belgium}

10.1136/ejhpharm-2016-000875.12

Background In 2013, we conducted a 6 month observational study (abstract CP-016 EAHP 2014) about the use of parenteral nutrition (PN) in the perioperative period in abdominal surgery. Following this study, surgeons were given specific information in order to improve prescription, and dietitians were trained to screen treatments.

Purpose This is a follow-up study. The purpose is to highlight improvements that should manifest by an increase in prescription of enteral nutrition (EN), dietitian consultations, compliance with guidelines (especially in the postoperative period) and

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screening malnutrition. Prescription in diverticulitis and in the postoperative period should decrease.

Material and methods Selection of patients having received PN between January and July 2014.

Retrospective analysis of medical charts by the clinical pharmacist.

Results There was an improvement in the number of patients receiving EN as well as in those having benefited from a consul-tation with the dietitians (figure 1).

Prescription for diverticulitis decreased in 2014 (2013, 15%; 2014, 0%). However, the postoperative indications (orange) still represented a significant proportion of patients (2013, 35%; 2014, 34%). For these patients, a 7 day postoperative period without PN should have been observed in order to comply with the guidelines. This was the case for none of the patients in 2014 (13.04% in 2013). Hence we finally see that malnutrition is well reported in 2014 (21%, 2013: 9%) (Figure 2).

Conclusion All of the goals were achieved except for those con-cerning postoperative PN. These observations are the result of dispensing more information about adequate use of PN and die-titian involvement. However, more information should be given about the use of postoperative PN.

REFERENCES AND/OR ACKNOWLEDGEMENTS Espen Guidelines (Braga et al. 2009) No conflict of interest.

CP-013 IMPACT OF SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITORS ON CARDIOVASCULAR OUTCOMES IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: A SYSTEMATIC REVIEW

Z Nasr. Qatar University, College of Pharmacy, Doha, Qatar 10.1136/ejhpharm-2016-000875.13

Background Sodium-glucose co-transporter 2 (SGLT2) inhibitors are a novel class of antidiabetics proven to reduce blood pres-sure, blood glucose and body weight. However, the long term safety implications of these agents remain unclear.

Purpose This systematic review aimed to evaluate the available clinical trial evidence pertaining to long term cardiovascular (CV) safety of SGLT2 inhibitors.

Material and methods The databases EMBASE (1980–April 2015) and MEDLINE (1948–April 2015) were searched. Search terms included ‘SGLT2 inhibitors’, ‘Canagliflozin’, ‘Dapagliflo-zin’, ‘Empagliflozin’, ‘cardiovascular’, ‘safety’, ‘myocardial infarc-tion’, ‘stroke’ and ‘cardiovascular death’. Randomised controlled trials assessing CV safety of SGLT2 inhibitors compared with placebo or anti-diabetic medications were included. Two investi-gators independently extracted study data (study design, dura-tion, populadura-tion, interventions and CV safety outcomes), and completed risk of bias assessments (sequence generation, alloca-tion concealment, blinding, incomplete outcome data, or selec-tive outcome reporting and other biases). Outcomes included CV death, myocardial infarction and stroke.

Results A total of 455 studies were identified in the electronic search and 14 from other sources. 31 studies remained after screening titles and abstracts, with 16 randomised clinical trials included after full text review. All studies reported at least one of the pre-defined outcomes (CV death, myocardial infarction and stroke). 12 cases of non-fatal myocardial infarction or stroke and 14 CV deaths were observed in SGLT2 inhibitor groups ver-sus 1 case of angina and 5 CV deaths in comparator groups. Risk of bias assessment showed mixed results, with overall qual-ity assessments deemed unclear for 5 of 16 studies (31.3%). Conclusion Findings showed CV outcomes do occur in patients taking SGLT2 inhibitors yet the clinical significance remains unclear. These results can be considered hypothesis generating, as studies were limited by inadequate power and/or follow-up time. Future studies are needed to further assess the efficacy and safety profiles of these new agents before they become widely adopted in clinical practice.

CP-014 IMPACT OF DISCHARGE PHARMACEUTICAL COUNSELLING ON PATIENT ADHERENCE TO ANTI-INFECTIVE TREATMENT

1_{L Salomon,}1_{C Bordes,}1_{G Leguelinel-Blache,}1_{H Poujol,}1_{JM Kinowski,}2_{A Sotto,}1_{H Faure.} 1

CHU Carémeau, Pharmacy, Nimes Cedex 9, France; 2CHU Carémeau, Infectious and Tropical Diseases Unit, Nimes Cedex 9, France

10.1136/ejhpharm-2016-000875.14

Background For years, bacterial resistance can affect the effec-tiveness of anti-infective treatment. Non-adherence is one of the factors responsible for the development of resistance that results in treatment failures, deaths and additional costs. Several activ-ities could improve patient adherence, one of which is discharge pharmaceutical counselling (DPC).

Purpose The aim of the study was to assess the impact of DPC on adherence to anti-infective treatment prescribed for acute infection, as well as the patient’s understanding and knowledge about his treatment.

Material and methods A prospective, single centre, interven-tional study was performed in a unit of infectious and tropical diseases, from November 2014 to July 2015. Patients were rand-omised to one of two groups: a control group which did not benefit from DPC and an interventional group which benefitted from DPC. The patient’s adherence to anti-infective treatment was assessed indirectly by telephone contact with the community pharmacist and the patient. During the patient’s interview, a quiz Abstract CP-012 Figure 1

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was used to assess understanding and knowledge of the treatment.

Results After 33 weeks, 89 patients were enrolled in the study, of whom 45 were in the interventional group. Median age was 64 (44; 76) years and the proportion of men was 53.9%. Finally, 49.4% of patients were non-adherent: 61.4% in the control group versus 37.8% in the interventional group (p < 0.05). In the interventional group, only 6.7% of patients involuntarily omitted at least a drug intake versus 31.8% in the control group (p < 0.01). DPC seemed to improve knowledge of anti-infective treatment (increase of 1 point in the quiz score; p = 0.052). Indeed, patients were more aware of side effects when they had DPC (25% in the control group vs 64.4% in the interventional group; p < 0.0005).

Conclusion DPC halved the rate of non-adherence, reducing involuntarily drug omission and improving patient’s knowledge to anti-infective treatment, including knowledge of side effects. Thus it would be interesting to extend this practice to other healthcare units. In order to optimise clinical pharmacy activities, identification of risk factors for non-adherence should help to develop DPC by targeting patients at risk of non-adherence. No conflict of interest.

CP-015 AN EVALUATION OF THE TYPES AND CONTRIBUTING FACTORS OF DISPENSING ERRORS IN HOSPITAL PHARMACY

1_{K Aldhwaihi,}2_{N Umaru,}3_{C Pezzolesi,}2_{F Schifano.}1_{University of Hertfordshire, Department}

of Pharmacy- Pharmacology and Postgraduate Medicine, Hatfield, UK; 2University of Hertfordshire, Department of Pharmacy- Pharmacology and Postgraduate Medicine, Hatfield, UK;3_{University of Hertfordshire, Department of Pharmacy- Pharmacology and Postgraduate}

Medicine, Hatfield, UK

10.1136/ejhpharm-2016-000875.15

Background Dispensing medication is a chain of multiple stages, and any error during the dispensing process may cause high potential risk for the patient. Few research studies have investi-gated the nature and the contributory factors that are associated with dispensing errors in hospital pharmacies.

Purpose To determine the nature and severity of unprevented dispensing errors reported in the hospital pharmacy at Luton and Dunstable Hospital in the UK; and to explore the pharmacy staff’s perceptions of contributory factors to dispensing errors and strategies to reduce these errors.

Material and methods A mixed method approach was used and encompassed two phases. Phase I: a retrospective review of dis-pensing error reports for an 18 month period from 1 January 2012 to 30 June 2013 was conducted. An assessment of the potential clinical significance of the dispensing errors was under-taken. Data were analysed using descriptive statistics. Phase II: self-administered qualitative questionnaires were distributed to the dispensary team at the hospital. Content analysis using NVivo software was undertaken.

Results 766 medication error reports were documented and 49 (6.4%) reports were related to dispensary incidents. The most frequently reported dispensing errors were: dispensing the wrong medicine (n = 9, 18.4%), labelling the wrong strength (n = 8, 16.3%) and dispensing the wrong strength (n = 7, 14.3%). The majority of the dispensing errors had minor or moderate potential to harm patients. Look-alike/sound-alike medicines, high workload, lack of staff experience, fatigue and loss of con-centration during work, hurrying through tasks and distraction

in the dispensary were the most common contributory factors. Furthermore, ambiguity of the prescriptions was also reported as a contributory factor in the hospital.

Conclusion Decreasing distractions in the pharmacy are needed to enhance patient safety. Furthermore, monitoring and report-ing errors, and educatreport-ing the dispensary team about these errors are also needed. An e-prescribing system may help to improve dispensing efficiency and safety. The findings of this study re-emphasise the fact that dispensing errors are widespread in hos-pital pharmacy. Therefore, efficient interventions need to be implemented to mitigate these errors.

Many thanks to the Saudi Ministry of Health for the scholar-ship and funding my study

CP-016 ANALYSIS OF ANTIBIOTIC PRESCRIPTIONS FOR SURGICAL PROPHYLAXIS IN PATIENTS WITH UPPER AND LOWER EXTREMITY INJURIES AT THE PAEDIATRIC SURGERY CLINIC

1_{I Sviestina,}2_{J Mozgis,}3_{D Mozgis.}1_{University Children}_{’s Hospital/Riga Stradins University,}

Faculty of Pharmacy, Riga, Latvia;2_{Riga Stradins University, Faculty of Medicine, Riga,}

Latvia;3_{Riga Stradins University, Public Health and Epidemiology Department, Riga, Latvia}

10.1136/ejhpharm-2016-000875.16

Background There are numerous audits performed in order to evaluate the appropriateness of the use of antibiotics (AB) in sur-gical prophylaxis in adult populations, but there is still a short-age of data regarding paediatric surgery.

Purpose To analyse prescribed AB and AB doses to patients with upper and lower extremity injuries before and after introduction of hospital recommendations for surgical prophylaxis (HR) at the paediatric surgery clinic (PSC) and to evaluate the usefulness of the AB electronic prescription form.

Material and methods Retrospective study. Patients aged <18 years hospitalised at the PSC were included in the study. Study period: 2011–2014. All data on patients were obtained from the patients’ medical records (2011–2013), as well as from the hos-pital software (2014). The HR (accepted in September 2013) and the summary of the product characteristic (SPC) were used as information resources for analysis of dosing errors. The cefa-zolin dose in the HR was 25 mg/kg but in SPC it was 25–50 mg/kg. AB prescriptions were analysed before the introduction of the HR (201–013) and after (2014).

Results 743 (66%) patients had AB prophylaxis in 201–013. In 2014, there were 367 electronically filled AB prescription forms. 546 (73%) patients had the correct duration of AB prophylaxis (1 dose) in 201–013 but in 2014, 254 (69%) patients. In 2011– 2013, AB choice (cefazolin) was correct in 377 (51%) cases com-pared with 361 (98%) cases in 2014. In 2011–2013, AB doses were wrong in 217 (59%) prescriptions according to HR com-pared with 268 (74%) prescriptions in 2014. According to SPC, AB doses were wrong in 120 (33%) prescriptions in 2011–2013 and in 34 (9%) prescriptions in 2014.

Conclusion Although the guidelines were discussed and accepted by surgeons only a few positive trends (eg, the correct AB choice) were observed with AB treatment guidelines not having a major impact on AB use. The electronic AB prescription form did not improve the situation either. There is a need for new

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ways of promoting adherence to guidelines and appropriate anti-biotic use.

1 Ciofi Degli Atti M, et al. Eur J Clin Pharmacol 2015;71:483-8 2 Formaini N, et al. J Pediatr Orthop 2012;32:737-40

CP-017 RECONFIGURATION TO SINGLE BED WARDS:

QUANTIFICATION OF THE TIME IMPACT ON THE WARD BASED CLINICAL PHARMACY SERVICE

M Kieran, C Meegan. Mater Misericordiae University Hospital, Pharmacy, Dublin, Ireland Rep

10.1136/ejhpharm-2016-000875.17

Background The ward visit and individual patient review is a primary role of the ward-based Clinical Pharmacist.

In 2012, clinical areas such as theatres, radiology and selected wards relocated to a new state of the art building. Relocation of wards involved a reconfiguration of the ward layout from a combination of multiple bedded rooms with some single bed rooms to an entirely single bedded configuration. New building wards occupy approximately twice the surface area of existing hospital wards. While the reconfiguration improves clinical effi-ciency, patient satisfaction and infection control, there had been little focus on resource utilisation. From a Pharmacy perspective, drug storage rooms and drug delivery locations increased on some wards, coupled with an increased surface area to walk. Purpose To quantify the time impact of moving to a single bed ward configuration on the Clinical Pharmacist ward based service.

Material and methods Clinical Pharmacist ward visits were timed over a two week period on wards pre and post relocation to the Whitty Building. The results were analysed. Qualitative feedback from the clinical pharmacists on ward visit time differences was reviewed

Results 6 wards relocated to a single bed configuration. The average time to complete a Clinical Pharmacist ward visit on these wards increased by a total of 1.6 h per day, an average of 0.27 h per ward.

The average time to complete a Clinical Pharmacist ward visit per bed increased with the relocation to single bedded wards on 5 out of the 6 wards. The average time to complete a Clinical Pharmacist ward visit per bed increased by 1 min per patient. Conclusion Clinical Pharmacist ward visit timings increased with ward relocations to single bedded wards. Root causes analysis identified causative factors which include the ward surface area, an increase in drug storage locations, patient turnover and amendments to outpatient clinic locations

1 Infection Prevention and Control Bulding Guidelines for Acute Hospitals in Ireland; A Strategy for the Control of Antimicrobial Resistance in Ireland (SARI), 2008, accessed via www.hspc.ie

CP-018 OUTPATIENT PARENTERAL ANTIBIOTIC THERAPY (OPAT) – A QUALITATIVE STUDY OF PATIENT PERSPECTIVES IN THOSE CHOOSING NOT TO SELF-ADMINISTER

1_{A Tonna,}1_{V Paudyal,}2_{K Forbes-McKay,}3_{S Falconer,}1_{G Anthony,}3_{I Tonna,}3_{R Laing,} 3_{A Mackenzie,}3_{G Macartney,}3_{D Stewart.}1_{Robert Gordon University, School of Pharmacy}

and Life Sciences, Aberdeen, UK; 2Robert Gordon University, School of Applied Social Studies, Aberdeen, UK;3_{Aberdeen Royal Infirmary, Ward 111, Aberdeen, UK}

10.1136/ejhpharm-2016-000875.18

Background OPAT is a well established treatment for administra-tion of intravenous (IV) antibiotics, and models of administraadministra-tion include home self-administration. Despite this offering advan-tages, statistics indicate that less patients in the research centre home self-administer compared with other national centres.1 Purpose To explore the understanding and beliefs around home self-administration in a cohort of patients who choose not to home self-administer.

Material and methods Qualitative, semi-structured, in-depth interviews were undertaken with a purposive sample of patients. Included patients were attending the outpatient clinic for IV anti-biotic administration, had received more than 7 days of antibiot-ics and were aged 16 years and over. A semi-structured interview schedule, underpinned by the Theoretical Domains Framework (TDF), was developed. Interviews were audio recorded and transcribed verbatim. Data were analysed themati-cally by sever researchers using the TDF as the coding frame-work. The study was approved by the appropriate ethics committees.

Results 20 participants were approached and all agreed to partic-ipate. 13 were male, with a mean age of 54 years (SD 17.6). Themes mapped almost all of the TDF behavioural determi-nants. The key behavioural determinants were knowledge, beliefs about capabilities, beliefs about consequences and environment, context and resources. Patients appeared to be very knowledge-able about their disease and its management, and had good pro-cedural knowledge for administration of IV antibiotics. Most were very positive about their capabilities to home self-adminis-ter, provided they were given the appropriate support, training and confidence. However, few had any knowledge about the options available to them to administer IV antibiotics, particu-larly home self-administration.

Conclusion The main barrier to not self-administering appears to be the lack of knowledge about options available for IV antibi-otic administration. Although patients may have been given this knowledge, there is an opportunity to review practice and develop an intervention to educate, train and support patients with home self-administration.

1 Barr DA, Semple L, Seaton RA. Outpatient parenteral antimicrobial therapy (OPAT) in a teaching hospital-based practice: a retrospective cohort study describ-ing experience and evolution over 10 years. Int J Antimicrob Agents 2012;39:407-13