Pharmacy Unit Research Articles

Hubungan Kesesuaian Penulisan Resep dengan Formularium Nasional Terhadap Mutu Pelayanan pada Pasien Jaminan Kesehatan Nasional di Rumah Sakit Umum di Bandung

Pharmaceutical service is one of the activities in hospital that support health service quality. One of the factors that can improve quality of pharmaceutical services is prescription services. In the era of National Health Insurance, prescription given to the patients should be based on the National Formulary. If prescriptions did not suit the national formulary, it would influence the services quality on pharmacy unit. The purposes of this study were to determine suitability of prescription outpatients' national health insurance with national formulary and to determine the relationship of the suitability of prescription with a national formulary to service quality in pharmacy unit in one of general hospitals in Bandung. A cross sectional with servqual questionnaire was used to the patients and the 262 prescription samples needed were taken in January 2017. Mann Whitney test is used for bivariate analysis. The result indicated 91.7% prescriptions was suited the national formulary and the rest was not. There was a significant difference between prescription suitability with the national formulary to service quality in pharmacy unit in the hospital with p-value 0.00 (p< 0,05). It can be concluded that higher percentage of prescriptions suitability with the national formulary in hospital related with the better service quality of pharmacy unit.

Trends in the Prescription and Long-Term Utilization of Antidementia Drugs Among Patients with Alzheimer's Disease in Spain: A Cohort Study Using the Registry of Dementias of Girona.

Acetylcholinesterase inhibitors (AChEIs) and the N-methyl D-aspartate-antagonist memantine are indicated for the symptomatic treatment of Alzheimer's disease (AD). Our aims were to describe the baseline characteristics of patients with AD according to prescription of these treatments after the diagnostic work-up to describe long-term trends in the use of these medications and to identify baseline characteristics associated with the frequency of use of each treatment. This was a cohort study with a sample of 2992 patients with AD recorded in the Registry of Dementias of Girona (ReDeGi) between 2007 and 2014. Consumption of AChEIs and memantine was assessed using the Pharmacy Unit database from the Public Catalan Healthcare Service. We used generalized estimating equation analyses to identify the baseline characteristics associated with the consumption of AChEIs and memantine over time. Most of the patients (70.4%; 95% confidence interval [CI] 68.7-72.0) were prescribed antidementia medication at the time of diagnosis. Of these, 75.0% (95% CI 73.1-76.8) were prescribed AChEIs, 14.7% (95% CI 13.2-16.3) were prescribed an AChEI plus memantine, and 10.3% (95% CI 9.0-11.6) were prescribed memantine. Advanced age reduced the likelihood of AChEI consumption. Mild dementia severity increased the use of AChEIs, and moderate-advanced dementia increased the likelihood of memantine consumption. After diagnosis, the likelihood of AChEI consumption decreased from the first year until the fifth, whereas the likelihood of memantine consumption, either alone or in combination with AChEIs, increased. Antidementia drug use in this study showed the initial use of AChEIs alone with later use of AChEIs in combination with memantine and memantine alone in older patients with severe AD. Our findings are in agreement with current clinical practice guidelines for the pharmacological treatment of AD.

Abstract P5-14-12: Long-term outcome of HER2-normal early stage breast cancer (ESBC) patients (Pts) treated with docetaxel-cyclophosphamide (TC) chemotherapy (CTx): Mature results of a single-institution experience

Abstract BACKGROUND Anthracycline(A)-containing regimens (AReg) became an established standard (neo)adj CTx for ESBC following fairly consistent demonstration of a modest superiority over older anti-metabolite/alkylating CTx. However, substantial translational data and a recently presented pooled analysis [Blum, 2016] suggest that this superiority could be largely driven by greater benefits in specific ESBC subgroups, i.e. HER2-altered BrCa (due to co-amplification of topoisomerase 2 and HER2), and triple-negative BrCa (TNBC). A are cardiotoxic (including late onset of cardiomyopathic congestive heart failure) and potentially leukaemogenic. In late 2006, following the results of the first USONC randomized clinical trial that showed superior outcomes of the non-AReg TC (docetaxel/cyclo­phosphamide) over AC, we established a routine, uniform policy of TC for all Pts receiving (neo)adj CTx for HER2-normal ESBC. We report the mature follow up of this single-institution unselected experience. METHODS We performed a retrospective outcome analysis of all Pts who received at least 1 cycle of (neo)adj TC (docetaxel 75 mg/m2 + cyclophosphamide 600 mg/m2 IV every 3 weeks) at our Department for HER2-normal ESBC and with at least 5 years of follow up (FU). Pts were identified by systematic analysis of the dataset of the Oncology Pharmacy Unit. Information on tumour characteristics [e.g. axillary lymph nodes (N) metastases, hormonal receptors (HR) and HER2 status] and Pts FU were retrieved and collected into an ad hoc designed database. Pts with node-positive (N+) ESBC received TC×6 cycles, and Pts with high-risk node-negative (N−) [e.g. primary tumour (T) &amp;gt;2 cm, or HRneg, or T &amp;gt;3 cm] ESBC received TC×4 cycles. Pts received adjuvant hormone therapy and radiotherapy as per standard of care. From 2008 on, many lower risk HR+/N− Pts were not given CTx due to OncotypeDx availability. RESULTS Between September 2006 and December 2015, 810 female HER2-normal ESBC Pts were treated with (neo)adj TC. In the final outcome analysis we included 464 Pts treated before June 2011 thus having a minimum FU of 5 years. Pts characteristics are: median age 53 yrs (range 30-77), N− 246 (53%), N+ 218 (47%), hormone receptors positive (HR+) 391 (84%), TNBC 73 (16%). The database was locked as of June 1st 2016. Median FU from first cycle of TC is 7.5 yrs (range 5.3-10). 63 BrCa-specific relapse events (defined as time to local, regional or distant recurrence, invasive contralateral breast cancer, excluding non-breast second primaries) have been observed, accounting for an overall Relapse-Free Survival (RFS) rate of 86.4%. 42 deaths have occurred, 36 (86%) due to BrCa, accounting for an Overall Survival (OS) rate of 91%. RFS and OS rates for the different Pts subgroups are reported in Table 1 Table 1 - Outcome parameters RFS (%)OS (%)All Pts8691HR+/N-9396HR+/N+8190TN/N-9191TN/N+5858 CONCLUSIONS These mature data with long FU suggest that the outcome for a large cohort of unselected Pts with HER2-normal HR+ ESBC (regardless of nodal status) and for TN/N− ESBrCa treated with nonAReg TC is excellent. However, N+TN ESBrCa in this setting remains a significant clinical challenge. Citation Format: Losurdo A, Gullo G, Buckley C, Lowry C, Ballot J, Silva N, Hammond L, Crown J. Long-term outcome of HER2-normal early stage breast cancer (ESBC) patients (Pts) treated with docetaxel-cyclophosphamide (TC) chemotherapy (CTx): Mature results of a single-institution experience [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-14-12.

Evaluation of the causes and cost impact of returned intravenous medications at a tertiary care hospital in Riyadh, Saudi Arabia

Purpose: To evaluate the main reasons for returning intravenous (IV) medications and to determine its cost impact in an in-patient setting in a Saudi tertiary care hospital. Methods: The study was conducted over a one-month period at the central IV room of the in-patient pharmacy unit at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. All returned IV medications were evaluated in terms of frequency, causes and cost. Results: The total number of IV medications returned was 2,061 items. The most common reasons for returning IV medications were drug discontinuation (933 items, 45.3 %), dispensing of an extra quantity (396 items, 19.2 %), patient deaths (173 items, 8.4 %), dose changes (171 items, 8.3 %) and drugs being held (150 items, 7.3 %). The total cost of all the returned IV medications was US$26,805.80), which accounts for (13.65 %) of the total pharmacy’s budget. Wasted medication cost was US$13,877.80) which constitute 51.77 % of returned medication cost. Conclusions: The results of this study indicate that IV medication wastage is a serious problem with significant cost impact, with drug discontinuation and dispensing of an extra quantity of medication being the two main reasons for returning IV medications. Effective communication among health care professionals, pharmacist training, and adherence to standard practice guidelines might be the most vital strategies to reduce medication wastage. Keywords: Medication wastage, In-patient, Cost impact, Intravenous medications, Tertiary care

Medication reconciliation in psychiatric hospitals: some reflections

Medication errors are one of the most common causes of harm in hospitalised patients, and these errors are often due to medication discrepancies at care transitions. Psychiatric hospitals have various characteristics that make medication reconciliation particularly challenging, such as: the length and number of admissions; the high number of care transitions; the difficulty of conducting a clinical interview with patients; the characteristics of psychoactive drugs; and segmentation in healthcare. In this paper, we present a series of real cases of medication discrepancies detected in our daily clinical practice in the pharmacy unit in order to illustrate the factors that aggravate the problem in psychiatric hospitals.

Effect of prescription waiting time on patient satisfaction mediated by service quality of pharmacy unit in public hospital in Bandung city

Background: The Indonesia National Health Insurance (NHI) is one of the social protections to ensure all people to health. Improving the quality of good service is a demand for pharmacy unit to improve the services quality, especially in improving the rate of pharmaceutical services and patient satisfaction that has been regulated in the Ministry of Health. Aims and Objectives: This study aims to measure influence between prescription waiting time and the level of patient satisfaction mediated by the quality of pharmacy unit service as a mediator at the public hospital in Bandung City. Materials and Methods: A cross-sectional questionnaire-based and direct observation method was conducted from February to April 2017. The questionnaire and observation sheet were used to obtain primary data to 302 NHI patients. Data were analyzed using structural equation modeling using software smartPLS. Results: Based on the result, general and compounding prescriptions’ waiting time is not suited with the standard. The waiting time has no positive and significant effect on the quality of pharmacy unit service with t-value of 0.532. The quality of service has a positive significant effect on patient satisfaction with t-statistics of 14.477. The waiting time has a positive and significant effect on patient satisfaction with t-statistics of 1.771 (t-table > 1.96, α = 0.05). Conclusion: The path model proposed did not fit and must be evaluated the length of waiting time and service quality as mediator. Waiting time has a positive influence on patient satisfaction even though the rate of services is slow. Then, the better pharmacy services given, then the much more patient satisfied to the hospital.

Errors in prescriptions and their preparation at the outpatient pharmacy of a regional hospital

Adverse effects of medications are an important cause of morbidity and hospital admissions. Errors in prescription or preparation of medications by pharmacy personnel are a factor that may influence these occurrence of the adverse effects Aim: To assess the frequency and type of errors in prescriptions and in their preparation at the pharmacy unit of a regional public hospital. Prescriptions received by ambulatory patients and those being discharged from the hospital, were reviewed using a 12-item checklist. The preparation of such prescriptions at the pharmacy unit was also reviewed using a seven item checklist. Seventy two percent of prescriptions had at least one error. The most common mistake was the impossibility of determining the concentration of the prescribed drug. Prescriptions for patients being discharged from the hospital had the higher number of errors. When a prescription had more than two drugs, the risk of error increased 2.4 times. Twenty four percent of prescription preparations had at least one error. The most common mistake was the labeling of drugs with incomplete medical indications. When a preparation included more than three drugs, the risk of preparation error increased 1.8 times. Prescription and preparation of medication delivered to patients had frequent errors. The most important risk factor for errors was the number of drugs prescribed.

Establishing a Hospital Pharmacy in Nepal: Experiences and Challenges

<p style="text-align: justify;">Hospital pharmacy in Nepal is in the state of infancy where pharmacists are struggling to gain their professional recognition. The first hospital pharmacy in Nepal was set up some 50 years ago but has not gained the popularity as this achievement was limited to some missionary hospitals. No any governmental hospitals own their pharmacy until 2015, the year in which Hospital Pharmacy Service Directive was passed which stated that every hospital should have their own pharmacy. This has given some hopes for pharmacy professionals as some of the government hospitals have already started running their own pharmacy and stopped renting the pharmacy space on contract. However, multiple challenges exists in setting up a hospital pharmacy and expand the services for the care of patients, some private hospitals have run a well-functioning pharmacy unit on its own. Some of these hospitals have delivered good pharmacy services like use of computerized billing system, dispensing and counseling by qualified pharmacy personnel, drug information. Involvement of dedicated manpower and support from the hospital management are equally important for the smooth running of hospital pharmacy. <p style="text-align: justify;"><strong>Key words:</strong> Challenges, Experiences, Hospital pharmacy, Nepal, Rational drug use.

Antibiotic prescription pattern in a Ghanaian primary health care facility.

IntroductionA major challenge to the provision of health care worldwide is the irrational use of antibiotics. To help promote rational use of drugs, standard treatment guidelines (STG) and essential medicine lists and facility-specific formularies have been developed to be used by clinicians. This study assessed the prescription pattern of antibiotics and explored the use of STG by clinicians.MethodsA prospective cross sectional study that made use of seven core drug use indicators was conducted from February, 2017 to July, 2017. Prescribing indicators were assessed using 388 prescriptions that were submitted for filling and dispensing at the pharmacy unit of the hospital. Clinicians were interviewed to assess their use of STG. Data were analyzed using SPSS version 20.0 with a p-value of < 0.05 considered as statistically significant.ResultsA total of 1351 drugs were prescribed for 388 patients. The average number of medicines per prescription was 3.5. Of the 388 prescriptions, 55.2% bore antibiotics, with amoxicillin (22.5%) and ciprofloxacin (18.4%) being the most prescribed antibiotics. Patients' knowledge about their medications was found to be significantly associated with the number of drugs per prescription (p = 0.001), age (p = 0.015) and educational level (p = 0.001). Only 41.7% of prescribers had copies of STG and used them.ConclusionThe prescribing and dispensing practices in the hospital were generally not satisfactory with a low patronage of STG among prescribers. In order to improve the situation, clinicians should practice evidence based medicine rather than empirical treatment of conditions as well as use the STG in practice.

Beban Kerja Subyektif dan Obyektif Tenaga Farmasi Rawat Jalan di Rumah Sakit

In 2014 patient visits to pharmacy services increased 75% from the previous year. Man power in the pharmacy unit was not comparable with the number of pharmacy service.The availability of human resources isinadequate when being compared to the number of outpatient pharmacy visits, therefore it influenced the respon time up to 43,91% for non paten drugs which as not in accordance with the standart services minimum pharmacy services. This data indicate that there was overload capacity on man power in outpatient pharmacy unit. The purpose of this study was to show wordload category on man power in outpatient pharmacy unit, particularly to pharmacists and assistants pharmacists. This was quantitative descriptive study. There were 26 samples consisting of 1 pharmacist, 16 asisstants pharmacists in depo 1 and 9 asisstants pharmacists in depo 5 outpatient pharmacy unit. Data collected by observation for 2 week in working hours. Result of the study was pharmacicts and assitants pharmacists in depo 1 had subjective and objective workload in overload category while depo 5 inmoderate category.Keywords: subjective and objective workload, pharmacicts and assitants pharmacists, work sampling

Intravenous paracetamol vs. ketoprofen for pain management after the abdominal aortic surgery – pharmacokinetics and therapeutics

Introduction. Acute postoperative pain continues to be a dilemma to patients and clinicians.Aim. To define the efficacy, tolerability and pharmacokinetics of paracetamol and ketoprofen in patients after the abdominal aortic surgery. Setting and design in University hospital – intensive therapy unit (clinical part), clinical pharmacy and biopharmacy unit (biochemical part), and pharmaceutical company (statistical part). Prospective randomized study.Material and Methods. 40 adult patients (50–84 years) undergoing abdominal aortic surgery were randomized equally into two groups. After extubation the patients in group 1 (G1) were administered a 1 g paracetamol infusion, and in group 2 (G2) – a 100 mg ketoprofen infusion, both within 15 minutes. All the patients received an epidural infusion of bupivacaine with fentanyl. The following parameters were recorded: mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), plasma concentration of paracetamol and ketoprofen. Postoperative pain was assessed with the visual analogue scale (VAS).Results. The mean values of the MAP, HR and CVP were within normal limits in the both groups. No significant differences were noticed in the assessment of postoperative pain and total use of an opioid. The mean therapeutic plasma concentration of paracetamol and ketoprofen remained up to 180 minutes and up to 120 minutes, respecively.Conclusions. The study enabled us to conclude that intravenous paracetamol as well as ketoprofen have good effectiveness and tolerability. There is no need to modify dosage of these drugs to elderly patients. After paracetamol infusion the therapeutic plasma concentration remains longer than after the ketoprofen infusion.

Intravenous paracetamol vs. ketoprofen for pain management after the abdominal aortic surgery – pharmacokinetics and therapeutics

Introduction. Acute postoperative pain continues to be a dilemma to patients and clinicians.Aim. To define the efficacy, tolerability and pharmacokinetics of paracetamol and ketoprofen in patients after the abdominal aortic surgery. Setting and design in University hospital – intensive therapy unit (clinical part), clinical pharmacy and biopharmacy unit (biochemical part), and pharmaceutical company (statistical part). Prospective randomized study.Material and Methods. 40 adult patients (50–84 years) undergoing abdominal aortic surgery were randomized equally into two groups. After extubation the patients in group 1 (G1) were administered a 1 g paracetamol infusion, and in group 2 (G2) – a 100 mg ketoprofen infusion, both within 15 minutes. All the patients received an epidural infusion of bupivacaine with fentanyl. The following parameters were recorded: mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), plasma concentration of paracetamol and ketoprofen. Postoperative pain was assessed with the visual analogue scale (VAS).Results. The mean values of the MAP, HR and CVP were within normal limits in the both groups. No significant differences were noticed in the assessment of postoperative pain and total use of an opioid. The mean therapeutic plasma concentration of paracetamol and ketoprofen remained up to 180 minutes and up to 120 minutes, respecively.Conclusions. The study enabled us to conclude that intravenous paracetamol as well as ketoprofen have good effectiveness and tolerability. There is no need to modify dosage of these drugs to elderly patients. After paracetamol infusion the therapeutic plasma concentration remains longer than after the ketoprofen infusion.

Acceptance model of a Hospital Information System

PurposeThe purpose of this study is to develop a model of Hospital Information System (HIS) user acceptance focusing on human, technological, and organizational characteristics for supporting government eHealth programs. This model was then tested to see which hospital type in Indonesia would benefit from the model to resolve problems related to HIS user acceptance. MethodThis study used qualitative and quantitative approaches with case studies at four privately owned hospitals and three government-owned hospitals, which are general hospitals in Indonesia. The respondents involved in this study are low-level and mid-level hospital management officers, doctors, nurses, and administrative staff who work at medical record, inpatient, outpatient, emergency, pharmacy, and information technology units. Data was processed using Structural Equation Modeling (SEM) and AMOS 21.0. ResultsThe study concludes that non-technological factors, such as human characteristics (i.e. compatibility, information security expectancy, and self-efficacy), and organizational characteristics (i.e. management support, facilitating conditions, and user involvement) which have level of significance of p<0.05, significantly influenced users’ opinions of both the ease of use and the benefits of the HIS. This study found that different factors may affect the acceptance of each user in each type of hospital regarding the use of HIS. Finally, this model is best suited for government-owned hospitals. ConclusionsBased on the results of this study, hospital management and IT developers should have more understanding on the non-technological factors to better plan for HIS implementation. Support from management is critical to the sustainability of HIS implementation to ensure HIS is easy to use and provides benefits to the users as well as hospitals. Finally, this study could assist hospital management and IT developers, as well as researchers, to understand the obstacles faced by hospitals in implementing HIS.

Compreensão da prescrição de medicamentos em uma unidade básica de saúde: autorrelato do usuário e aferição pelo pesquisador

Aims: To evaluate the understanding of drug prescriptions by patients, comparing the user self-report with the researcher assessment.Methods: A cross-sectional study was conducted from November 2013 to February 2014 at a Basic Health Unit in the city of Belo Horizonte, Minas Gerais, Brazil. Users 18 years of age or older who sought medicines in the unit's pharmacy, for themselves or for minors under their care, were interviewed. The selection of the sample was non-probabilistic, for convenience. During the interview, the users informed if they had understood the following data of the prescriptions: drug name, dose and frequency of administration. Participants then repeated the data for researchers, being allowed to check the prescriptions at the same time. After the interviews, the answers to the questions were interpreted by the researchers, who evaluated the agreement between the information provided by the users and the actual instructions of the recipes, using the Kappa test.Results: Data were collected from 69 users of the unit's pharmacy (corresponding to 69 delivered prescriptions). Fifty-nine (85.5%) users reported having understood all the prescriptions data (self-report), while according to the measurement of the researchers, 23 (33.3%) were the respondents who simultaneously understood all data, relating to the name of the drug, number of daily doses and schedule. Kappa test indicated a degree of agreement between self-report and measurement of researchers of 0.138 (slight) considering all items of the prescription, and specifically on the number of doses the agreement was -0.055 (poor).Conclusions: Self-reported rate of patient's understanding of drug prescriptions was higher than the assessed by the researchers. This result suggests that self-report of patients with respect to the understanding of prescriptions has limitations and should be interpreted with caution both in research and in clinical practice. It is recommended to enhance the means of providing information to patients, in order to contribute to the proper understanding of drug prescriptions.

Organizational ethnography of direct drugs distribution in Parma AUSL.

The locations where healthcare organizations directly distribute medications to patients in specific circumstances, such as at hospital discharge, are settings at risk of professional errors. Using organizational ethnography methodology, we sought to explore the characteristics of points of direct distribution of drugs (PDD) in the AUSL of Parma and identify aspects of the delivery process that could potentially generate errors. We conducted 75 3-hour observations (225 hours at total) of the two Parma AUSL PDDs. The nature of the observations was known by PDD professionals but blinded to PDD patients. In one PDD, we shadowed the pharmacist responsible for the entire drug distribution process, as well as followed the pattern of drug packaging from the Centralized Logistic Pharmacy Unit in Reggio Emilia to the Parma Pharmaceutical Department. In the other PDD, we carried out observations in the patient waiting room and conducted interviews with patients and PDD professionals. Collected data were evaluated via content analysis and study results were presented to the study-working group for further discussion. Research findings highlighted a limited number of errors in drug delivery process. The most frequently observed errors by pharmacists were incorrect interpretation of prescriptions, dispensation of wrong dosage, and failure to deliver a prescribed drug to the patient. Potential sources of error were repeated interruptions of the pharmacist workflow, such as phone calls, helping colleagues in emergency situations and serving an excessive number of patients. Based on these results, the study-working group proposed logistical and organizational modifications of PDD and delivery process to improve quality and reduce risks.

An Observational Case Study of Near-peer Teaching in Medical and Pharmacy Experiential Training

Objective. To compare peer teaching in a medical and a pharmacy clinical teaching unit and to provide suggestions for future research in pharmacy near-peer teaching. Methods. This exploratory observational study used principles of ethnographic methodology for data collection and analysis. Observations were collected in a large downtown teaching hospital. An average of 4-6 hours per day were spent observing a team of medical trainees from the Faculty (School) of Medicine in the general internal medicine (unit for two weeks, followed by a team of pharmacy trainees in an ambulatory hemodialysis (HD) unit for two weeks. Data was collected through field notes and informal interviews that were audiotaped and subsequently transcribed. Data was interpreted by the observer and reviewed weekly by two impartial pharmacists. Results. Five major themes emerged: (1) influence of peer teaching hierarchy; (2) educational distance between peer learners and teachers; (3) effect of the clinical teaching unit size on peer learning; (4) trainees' perception of their teaching role in the clinical teaching unit; and (5) influence of daily schedule and workload on peer teaching. As opposed to pharmacy, a hierarchy and pyramidal structure of peer teaching was observed in medical experiential training. There appeared to be no effect of educational distance on near peer teaching; however, perception of teaching role and influence of daily schedule affected near-peer teaching. Conclusion. Through initial comparisons of medical and pharmacy clinical teaching units, this study provides a reflection of elements that may be necessary to successfully implement near-peer teaching in pharmacy experiential training. Future studies in this area should assess learning outcomes and participant satisfaction, preceptor workload, and impact on patient care.

The Development of the Problem Solving Framework in Managing Unregistered Drugs: Pharmacists Perspectives

Background: Unregistered drug is one of the main important issues in Malaysia and is being taken very vigorously by the Malaysian Ministry of Health (MOH). However, the performance of the Pharmacy Enforcement Division amazingly increased but the problem still remains. Objective: The objective is to develop the problem solving framework by exploring the pharmacist perceptive on unregistered drugs. Methods: This study took place in pharmacist practice (hospital, community pharmacy and enforcement pharmacy unit) in Klang Valley. Sixteen pharmacists participated. The data were analysed using constant comparison method. Results: During the interview, many themes had emerged and some issues have been considered and some themes are either acceptable or unacceptable to be implemented in the framework. The findings are then categorized into three categorical themes: Current situation, contributing factors of unregistered drugs and solution. The findings had emerged two different pathways which are the themes that increased unregistered drugs and the themes that decreased unregistered drugs. Those themes are the perceptions from the pharmacist as respondents towards the unregistered drugs problem in Malaysia. Majority of them believed if there is the problem it must have the solution. Conclusion: As a conclusion, this study is to develop solutions and strategies in managing unregistered drugs in Malaysia by exploring practitioner (pharmacist) who practically with this issues and have experienced with consumers. The development of a problem-solving framework is useful and beneficial for future studies and the framework acts as a professional audit for comparison with the current situation and practice. Key words: Unregistered drugs, Problem-solving framework, Pharmacist, Perspectives, Malaysia.

Off-label prescription of drugs at hospital

ObjectivesTo develop a procedure for management of off-label medications, and to analyze the treatments, indications, and hospital units which will request them more frequently, as well as which variables will have an impact on the authorization decision, and its economic impact. MethodsA procedure was designed where clinicians would complete request forms and the Hospital Unit would prepare reports assessing their efficacy, safety, convenience, and cost. The request forms for the past five years were analyzed. ResultsA total of 834 applications were received, and 88.1% of these were accepted. The authorization rates were higher for Paediatric Units (95.7% vs. 86.6%; p<0.05). The reasons for considering prescriptions as off-label were: different indication (73.2%), different combination (10.2%), different line of treatment (8.6%) and different age (8%). A 73.4% of requests were for antineoplastic drugs, and the most frequently prescribed were rituximab (120) and bevacizumab (103). The quality of evidence supporting the prescriptions was moderate-low, though no direct relationship with the likelihood of approval was demonstrated (p = 0.413). The cost of the approved medications was 8,567,537 €, and the theoretical savings for those drugs rejected was of 2,268,642 €. There was a statistically significant decrease in the authorization rate (p < 0.05, Student’s t test) when spending increased. ConclusionsThe responsibility for assessing off-label prescriptions has fallen on the Pharmacy Unit. It has not been demonstrated that the quality of evidence represents a decisive variable for approval of treatment; on the other hand, age and cost have demonstrated a significant impact.

Improvement of Inventory Control Using Continuous Review Policy in A Local Hospital at Bandung City, Indonesia

This research was aimed to analyze the excess inventories issue in pharmacy and medical equipment unit at a localrnhospital in Bandung which affected the service level of the hospital. As one of the busy hospital in Java, proven by the higher amountrnof the patient/year than in other average Java typical hospital, the hospital needs to concern about the pharmaceutical and medicalrnequipment inventories in order to fulfill patients’ needs and in the same time keeping the inventory level under control. Therefore, anrninventory control evaluation was conducted to determine the appropriate number of inventories and time of order to avoid thernexcessive goods in central warehouse of the hospital. By using probabilistic inventory model and continuous review policy, thernpharmaceutical inventory in the hospital was calculated to compare the ideal and actual amount of the average inventory levelrn(AIL). ABC (Always, Better, Control) classification also classified in this research to identify the proper item which potentiallyrncan be reduced from the inventory. From the analysis, we have discovered that the hospital potentially able to reduce almost Rp 830rnmillion or 57% from the overstock inventory level by using continuous review policy as the basis of inventory control calculationrnsystem.

An ion-pairing, reversed-phase liquid chromatography method to assess the cross-contamination of cancer chemotherapy infusions prepared in a dual-operator aseptic isolator.

Cytotoxics are usually prepared in a centralized pharmacy unit in a controlled hospital environment. Despite the rigorous operating procedures used for such preparations, contamination is theoretically possible - for example due to vial switches. Therefore products ought to be checked in order to determine whether quality control measures are adequate. Numerous strategies have been applied locally to ensure the safety of both patients and operators but the efficacy of these methodologies has not previously been examined. The aim of this study was to develop an analytical method sensitive enough to detect traces of anti-cancer drugs, in order to evaluate cross-contamination between infusions prepared in a dual-operator isolator in the dedicated pharmacy unit. We developed a high performance liquid chromatography (HPLC) method with ultraviolet (UV) detection to identify and quantify the following seven drugs: 5-Fluorouracil, Cytarabine, Gemcitabine, Irinotecan, Doxorubicin, Epirubicin, and Daunorubicin. We assessed the levels of cross-contamination in 20 random preparations. We achieved separation of the seven drugs in less than 28 min, with a lower limit of quantification capable of detecting cross-contamination. An assessment of 20 preparations revealed no cross-contamination. We developed a reproducible and sensitive HPLC method which could be a potentially useful tool for use in practice. We checked the level of cross-contamination in anti-cancer drug infusions and confirmed that the process in current use was safe. This study is the first to assess cross-contamination in anti-cancer preparations. This work is the first step in an extensive programme of quality control, whose aim is to ensure the safety of both patients and operators. Copyright © 2015 John Wiley & Sons, Ltd. Development of a reproducible and sensitive HPLC method capable of detecting seven anticancer drugs. This method could be used alongside MS detection, to check for biological contamination of nursing and pharmacy staff with anticancer drugs. No cross-contamination was detected in cancer chemotherapy infusions prepared in a dual-operator aseptic isolator.