Therapeutics Committee Research Articles

Drug and Therapeutics Committee Structure and Roles in Hospitals: A Scoping Review

Drug and Therapeutics Committees (DTCs) have been identified and promoted as a fundamental model in advancing the rational management and use of essential medicines and health supplies in hospitals since the 1970s. However, there is still a scarcity of comprehensive literature on their current structure and actual roles performed in various countries. We conducted a scoping review using the Pubmed and ResearchGate databases and included eligible articles published between 2010 and 2023, to assess the structure and roles performed by hospital DTCs. The database search yielded 47 potential records, but only seven of these were eligible for inclusion. Studies included were from both high-income and low- and middle-income countries. The structure of DTCs is generally similar across these countries, with minor contextual variations. All DTCs are heterogeneous in composition and contain both medical and non-medical staff. The DTC leadership comprises a chairperson who is usually a senior clinician, and a secretary who is usually a pharmacist. The majority of the DTCs have at least one sub-committee, and antimicrobial stewardship is the most common. The DTCs still perform their customary roles, although their role scope is expanding. In some countries, the DTCs have taken on additional roles due to the evolving medicines management and use problems, and technologies. There is however still a dearth of recent primary data on the structure and roles of DTCs in many countries. We recommend more primary research to understand the status of DTCs in various countries and to provide more insights into the existence and functionality of the DTC sub-committees. Keywords: Drug and Therapeutics Committee; DTC; Irrational Use; P&T Committee; Review; Hospital.

Retinal Vasculitis After Intravitreal Pegcetacoplan: Report From the ASRS Research and Safety in Therapeutics (ReST) Committee.

Purpose: To analyze post-marketing cases of retinal vasculitis after intravitreal pegcetacoplan. Methods: The American Society of Retina Specialists (ASRS) Research and Safety in Therapeutics (ReST) Committee as well as an expert panel performed a retrospective review of cases of retinal vasculitis reported to the ASRS. Clinical and imaging characteristics were reviewed for evidence of retinal vasculitis and analyzed. Results: Fourteen eyes of 13 patients were confirmed to have retinal vasculitis by review of imaging studies. All cases occurred after the first pegcetacoplan injection. Occlusive retinal vasculopathy was confirmed in 11 eyes (79%). Patients presented a median of 10.5 days (range, 8-23 days) after pegcetacoplan injection. All eyes had anterior chamber inflammation, and 12 eyes (86%) had vitritis. Vasculopathy involved retinal veins (100%) more than arteries (73%), and 12 eyes (86%) had retinal hemorrhages. The median visual acuity (VA) was 20/60 (range, 20/30-5/200) at baseline, 20/300 (range, 20/100-no light perception [NLP]) at vasculitis presentation, and 20/200 (range 20/70-NLP) at the last follow-up. Eight eyes (57%) had more than a 3-line decrease in VA, and 6 eyes (43%) had more than a 6-line decrease in VA from baseline to the final follow-up, including 2 eyes that were enucleated. Six eyes (43%) developed signs of anterior segment neovascularization. Conclusions: There is currently no known etiology for vasculitis in this series. Optimum treatment strategies remain unknown. Infectious etiologies should be considered, and corticosteroid treatments may hasten resolution of inflammatory findings. Continued treatment of affected patients with pegcetacoplan should be avoided.

Establishment of a children's Drugs and Therapeutics Committee to ensure evidence-based and cost-effective medical treatment for children.

The prevalence of undocumented medical treatments among children is a significant issue, as well as many EU countries lack access to newly developed children-friendly medicines. Consequently, there is a pressing need for supplementary resources that can facilitate informed decision-making regarding children's medication. We therefore aim to describe the process of establishing a children's Drug and Therapeutics Committee (cDTC), as well as the preparing and implementation of recommendations for children in the capital region of Denmark. Following the guidelines outlined by the World Health Organization, we established a cDTC, and recommendations for paediatric medication practice were constructed from assessments of medication use patterns among children in the capital region between 2019 and 2021. The recommendations were meticulously crafted based on evaluation of the current marketing authorization landscape and existing best available evidence. In 2019, the capital region established the first cDTC supported by expert councils and an editorial board. A total of 2429 purchase item numbers covering 1 222 846 defined daily doses and 592 088 purchased packages covering 10 200 000 defined daily doses were identified in the secondary and primary sectors, respectively. Three comprehensive lists covering recommendations for newborns and children were published between 2021 and 2020 totaling 331 recommended pharmaceutical products. The recommendations primarily intended for use in the secondary healthcare sector were implemented through the revision of 38 paediatric- and six neonatal product ranges throughout capital region. In conclusion, recommendation lists for children governed by a cDTC provide a rational auxiliary tool that can be immediately implemented in the clinic.

OP138 Navigating High-Cost Medicines: Promoting Consistent, Evidence-based Use Of High-Cost Medicines In A Fiscally And Equitable Responsible Manner

IntroductionHospitals play a significant and important role in funding high-cost medicines so patients can access treatments they need. High-cost medicines are often specialty medicines, which contribute to a significant and increasing portion of the hospital budget. It is imperative that these expensive medicines are governed and managed with a fair, standardized evidence-based process. We aim to provide a framework for Drugs and Therapeutics Committees (DTCs).MethodsDuring 2021, Guiding Principles were developed following a literature review and survey of current practices by DTCs in Australia. An Expert Advisory Group (EAG) was convened, comprising individuals with expertise in quality use of medicines, evidence-based medicine and medicines governance. The guiding principles were drafted by the EAG, in consultation with a range of stakeholders and relevant external organizations. All feedback was collated, reviewed and discussed to refine the content of the final Guiding Principles released in January 2022.ResultsSeven overarching principles provide key recommendations for the governance of high-cost medicines:(i)A definition of high‑cost medicines should be determined and clearly articulated for use by each medicines governance committee.(ii)Review of high-cost medicines requires members with relevant expertize to facilitate good and effective decision-making.(iii)The committee should engage directly with the applicant prior to review to ensure a full understanding of the rationale for the request.(iv)consistent, robust and transparent procedure for the assessment of high-cost medicine applications should be defined and implemented for use by each medicines governance committee to ensure fair process.(v)Ethical considerations fundamentally underpin deliberations around high-cost medicines.(vi)The decisions and outcomes of the decision making should be transparent and appropriately communicated to the various audiences.(vii)The high-quality assessment of high-cost medicines requires appropriate training and resourcing.ConclusionsThese national Guiding Principles promote consistent, evidence-based use of high-cost medicines and provide a framework for DTCs to assess and achieve effective governance for the quality use of high‑cost medicines.

OP119 Collectively Improving The Quality Use Of Highly Specialized Medicines: Starting With Biologics

IntroductionIn contrast to high-volume medicines prescribed by general practitioners, low-volume highly specialized medicines have not been supported by national quality use of medicine (QUM) programs in Australia. The first area addressed has focused on optimizing use of biological disease-modifying antirheumatic drugs (bDMARDs).MethodsThe program was designed, developed and implemented in partnership with nine consortium member organizations and four affiliate organizations representing consumer and clinical audiences, program development expertize and implementation capability. The common agenda for the collective impact approach was to achieve better health outcomes for people with inflammatory arthritis, inflammatory bowel disease and plaque psoriasis. Multidisciplinary expert working groups reviewed formative QUM research and agreed on objectives, audiences, messages and interventions. Interventions were selected based on identified barriers, enablers and behavioral drivers, informed by the Theoretical Domains Framework. Interventions were co-designed and tested with end-users. Marketing and promotion activity supported implementation of all interventions through consortium channels and networks. Evaluation includes process, impact and outcome measures, and a realist evaluation of the academic detailing.ResultsProgram objectives were to optimize: (i) first-line therapy before bDMARD use; (ii) first-choice bDMARDs; (iii) biosimilar prescribing and dispensing; (iv) bDMARD dosage; (v) glucocorticoid and analgesic use. Over 60 interventions supporting key messages for each objective were developed for audiences: consumers; rheumatologists, gastroenterologists, dermatologists; pharmacists; drug and therapeutic committees. Interventions implemented between September 2020 and September 2022 included: consumer decision aids, action plans, fact sheets, lived experience videos; living guidelines and evidence summaries; guidance/position statements for hospitals, podcasts, webinars, online learning; prescribing feedback reports; and academic detailing. Uptake of interventions has largely met targets and surveys have demonstrated shifts in specialist and consumer knowledge and behavior in line with key messages and objectives. Realist and outcome evaluation is ongoing.ConclusionsOur experience demonstrates the value of a consortium of stakeholder organizations, with different expertise and interests but agreed goals and roles, working together to progress the quality use of highly specialized drugs.

Practice Variation among Pediatric Endocrinologists in the Dosing of Glucocorticoids in Young Children with Congenital Adrenal Hyperplasia.

A Pediatric Endocrine Society (PES) Drugs and Therapeutics Committee workgroup sought to determine the prescribing practices of pediatric endocrinologists when treating children <10 years of age with congenital adrenal hyperplasia (CAH). Our workgroup administered a 32-question online survey to PES members. There were 187 respondents (88.9% attending physicians), mostly from university-affiliated clinics (~80%). Ninety-eight percent of respondents prescribed the short-acting glucocorticoid hydrocortisone to treat young children, as per the Endocrine Society CAH Guidelines, although respondents also prescribed long-acting glucocorticoids such as prednisolone suspension (12%), prednisone tablets (9%), and prednisone suspension (6%). Ninety-seven percent of respondents indicated that they were likely/very likely to prescribe hydrocortisone in a thrice-daily regimen, as per CAH Guidelines, although 19% were also likely to follow a twice-daily regimen. To achieve smaller doses, using a pill-cutter was the most frequent method recommended by providers to manipulate tablets (87.2%), followed by dissolving tablets in water (25.7%) to create a daily batch (43.7%) and/or dissolving a tablet for each dose (64.6%). Thirty-one percent of providers use pharmacy-compounded hydrocortisone suspension to achieve doses of <2.5 mg. Our survey shows that practices among providers in the dosing of young children with CAH vary greatly and sometimes fall outside of the CAH Guidelines-specifically when attempting to deliver lower, age-appropriate hydrocortisone doses.

Formulary Drug Reviews: Nirsevimab.

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the needs of a facility. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433.

Multisite results from a practice-based self-assessment for oral anticancer agent (OAA) management.

434 Background: The Hematology/Oncology Pharmacy Association (HOPA) supported a 6-month American Society of Clinical Oncology (ASCO) Quality Training Program (QTP) focused on oral anticancer agent (OAA) management. HOPA’s Oral Chemotherapy Collaborative, developed an OAA self-assessment tool to aid in identifying gaps in care regarding OAAs. The purpose of this study is to describe the results of the OAA baseline self-assessment completed by the participating teams. These results will provide insight into areas of future focus for OAA-based quality improvement. Methods: This multisite, retrospective analysis was conducted in September 2022, prior to the HOPA-ASCO QTP program launch. The OAA Self-Assessment was created by HOPA’s Oral Chemotherapy Collaborative utilizing Michigan Oncology Quality Consortium (MOQC’s) pre-existing OAA self-assessment as a guide. The final self-assessment included standards from MOQC, HOPA, and ASCO/ONS and took approximately 10 minutes to complete. Questions were categorized in the following 6 sections: Prescribing (n=25), Education (n=17), Dispensing/Distribution (n=5), Monitoring and Follow-Up (n=8), Practice Management (n=3), and Optimal-State Recommendations (n=4). Team leads from each of 9 participating sites focusing on OAA quality improvement were asked to share the anonymous assessment with team members at their sites who provide care to patients taking OAAs. All response choices were categorized as “never”, “sometimes”, or “always” for the degree to which the OAA standard is followed at the site. Frequency distributions are reported. Results: 105 clinicians (39 pharmacists, 34 nurses, 20 physicians, 10 NP/PAs, and 2 pharmacy technicians) completed the baseline self-assessment from 9 sites. Most standards had a response of “sometimes” or “always”. The area with the largest number of “always” was related to the completion of the OAA prescription. Of the 62 standards, 38 (61%) had at least 1 respondent select “never” and 4.5 respondents/standard (range 1 – 15) selected “never”. Standards that had the highest “never” responses were patient satisfaction monitoring (n=15), use of survivorship program for transition to primary care when appropriate (n=14), use of social determinants of health in OAA treatment decisions (n=13), documentation of treatment consent (n=12), use of therapeutics committee to determine place in therapy of OAAs (n=12), and use of collaborative practice agreements for pharmacists as part of the oncology care team (n=12). Conclusions: Adherence to OAA standards varied between the participating sites. A standardized baseline assessment evaluating current state is helpful in identifying gaps in care and targets for future quality improvement.

Cost-effectiveness of drug therapy prescribed in special situations at hospital

ObjectiveThe Pharmacy and Therapeutics Committee is an advisory body to the medical management of our hospital. Following Royal Decree 86/2015, which regulates the Pharmacy and Therapeutics Committee of the Balearic Islands, this committee prepared a technical report in which it assessed the possible internal use of off-label drugs, drugs for compassionate use, and drugs not included in the hospital's pharmacotherapeutic guide. The objective was to analyse the clinical response achieved with the use of these drugs and their associated costs. MethodRetrospective study of drugs whose use was requested from the hospital's Pharmacy and Therapeutics Committee hospital between January and December 2018. We analysed whether the requested treatment achieved the objective established by the physician. The cost was calculated based on the duration of the treatment until the objective was achieved or until treatment was discontinued. ResultsIn total, 70 requests were analysed: 59% achieved the expected therapeutic goal, 34% were considered to be therapeutic failures, and 7% were lost to follow-up. The overall cost of the 70 authorized treatments was €1,140,240. The average cost per request was €16,288. Oncology and Haematology services submitted more than 50% of the requests, and more than 75% of the budget was allocated to these medical services. ConclusionsMore than half of the treatments analysed by the Pharmacy and Therapeutics Committee of the hospital achieved their therapeutic goal, although the economic cost of their use was high.

Hospital pharmacist challenges in evaluation of scientific evidence and its incorporation to pharmacotherapeutic protocols through therapeutic committees in COVID-19 times

Type 2 coronavirus pandemics that is plaguing almost all the world has caused qualitative and quantitative strains in health systems that have had to be responded to. The lack of known vaccines and effective treatments has generated the need to use drugs with very little evidence for their incorporation into pharmacotherapeutic protocols agreed by the clinical team. The hospital pharmacist, within the multidisciplinary team, has been responsible for critically evaluating the alternatives and positioning them in these protocols.Finally, some ethical and legal questions that should be considered in this scenario are analyzed in this article.

Ifema hospital model. Implementation and start-up of the Pharmacy Department

On the 20th of March 2020, triggered by the public health emergency declared, the Health Authorities in Madrid reported a legal instruction (Orden 371/2020) indicating the organization of a provisional hospital to admit patients with COVID-19 at the Trade Fair Institution (IFEMA).Several pharmacists working in the Pharmacy and Medical Devices Department of the Madrid Regional Health Service were called to manage the Pharmacy Department of the abovementioned hospital. Required permissions to set up a PD were here authorized urgently.Tackling human and material resources, and computer systems for drug purchase and electronic prescription, were some of the initial issues that hindered the pharmaceutical provision required for patients from the very day one.Once the purchase was assured, mainly by direct purchase from suppliers, drug dispensing up to 1,250 hospitalized patients (25 nursing units) and 8 ICU patients was taken on. Dispensing was carried out through either drug stocks in the nursing units or individual patient dispensing for certain drugs.Moreover, safety issues related to prescription were considered, and as the electronic prescription was implemented we attained 100% prescriptions review and validation. The constitution of a multidisciplinary Pharmacy and Therapeutics Committee let agree to a pharmacotherapy guide, prescription protocols, therapeutic equivalences, interactions, and drug dispensing circuits.The Pharmacy Department strategy was to ensure a very quick response to basic tasks keeping the aim to offer a pharmaceutical care of the highest quality whenever possible.Working under a health emergency situation, with many uncertainties and continuous pressure was a plight. However, the spirit of collaboration in and out of the Pharmacy Department was aligned with the whole hospital motivation to offer the highest quality of healthcare. These were possibly the keys to allow caring for almost 4,000 patients during the 42 days that the hospital lasted.

Pharmaceutical services in nursing homes in Spain

ObjectiveTo describe the current situation regarding the specialized pharmaceutical service provision in nursing homes in Spain, from a healthcare perspective reflecting activity, care and services provided. MethodObservational, cross-sectional, multicenter study conducted between February-June 2018 through a survey aimed at all Hospital Pharmacy Units in Spain. Once the initial version was assessed by twelve evaluators whose healthcare assistance work were related to nursing homes, an electronic form was designed, consisting on 10 dimensions and 66 questions. A piloting was carried out by six nursing homes pharmacists. The results were analyzed descriptively. ResultsThe overall response rate was 29.7% (113 out of 380). Out of all studied hospital pharmacy units, 46.0% (n = 52) served nursing homes (9 as Nursing Homes Pharmacy Department) whose characteristics defined a profile of pharmacy unit at hospital, public ownership, consolidation in this activity, with great variability in the number of centers and patients to be attended by service, and with the pharmacist's partial dedication. In 51.3% of cases, nursing homes professionals were represented at pharmacy and therapeutic committees, while 38.5% were from pharmacy services who participated in the selection of medical devices. Also, 67.4% performed an integral management of the therapy. The study has also shown that 34.6% counted on assisted electronic prescription, while 88.5% performed a pharmaceutical validation of the prescription prior to dispensing, which in 71.2% of cases consisted of individualized unit doses. It was found that 42.3% performed a third-level treatment comprehensive review, and 25.0% participated in the interdisciplinary nutritional assessment. It also showed that 34.6% actively participated in either comprehensive geriatric assessment, or clinical cases in interdisciplinary teams, and 46.2% counted on programs for the safe use of medicines. ConclusionsThe specialized pharmaceutical care at nursing homes is a reality, although it presents important differences in essential aspects for the quality of the assistance provided. It is necessary to go in-depth on the care model to be developed, as well as having a greater involvement of pharmacy services to achieve a comprehensive and person-centered care.

Spanish Society of Hospital Pharmacy position paper on biosimilar medicines

Biological medicines nowadays have a great impact, as they offer treatment for diverse diseases and suppose a high cost for health system. Biosimilar medicines contain a version of an active substance already authorized as an original biotechnological medicine, whose patent has expired, and they comply with the guidelines published by the European Medicines Agency. These guidelines, where biosimilarity criteria are established, guarantee comparability between biosimilar product and reference one. Biosimilars’ authorization is carried out through a centralized procedure based on clinical, non-clinical and quality studies. These studies allow the extrapolation of indications, frequently, without carrying out additional analyses. In several European countries, switching between original and biosimilar medicine is considered safe. In Spain, Pharmacy and Therapeutic Committee of hospitals, as consensus bodies among health professionals, are the most suitable bodies to establish the interchangeability criteria in each center. Biosimilar drugs contribute to sustainability and to improvement of the accessibility to medicines. Faced with this situation, Spanish Society of Hospital Pharmacy considers interesting to express its position about biosimilar medicines’ strategies. Spanish Society of Hospital Pharmacy, in September 2015, published an information note about biosimilar medicines, in which its role as medicines similar in quality, safety and efficacy to the originals, but at lower cost, was highlighted. Likewise, it was stressed the role of hospital pharmacists within the Pharmacy and Therapeutic Committee of hospitals, where their knowledge for the selection, evaluation and use of medicines could be useful, in coordination and permanent collaboration with other units or clinical services of hospitals.

Formulary Drug Review: Rezafungin.

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the needs of a facility. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433.

SAT147 A Pharmacist Driven Active Surveillance Program To Reduce Hypoglycemic Recurrences In The Inpatient Setting

Abstract Disclosure: S. Kim: None. H. Tran: None. R.Y. Gianchandani: None. Background: Hyper and hypoglycemia increase morbidity and mortality in hospitalized patients. Glucose excursions are time sensitive and require timely response to prevent future episodes of dysglycemia. As part of a quality improvement initiative, we implemented an Active Glycemic Surveillance (AGS) program in July 2022 targeting patients with hypoglycemia (BG &amp;lt;70 mg/dL) based on a preliminary evaluation that revealed recurrent hypoglycemia was an opportunity for improvement. Pharmacist involvement in glycemic management has been shown to improve clinical outcomes in the acute care setting. Our AGS program is unique in that pharmacist trained in inpatient glycemic management is empowered to directly intervene on antihyperglycemic medication orders under scope of practice by a protocol approved through the pharmacy and therapeutics committee. Intervention: The AGS team consists of an endocrinologist and a diabetes stewardship pharmacist. A policy was developed and approved by P and T that outlines the types of interventions and orders that the diabetes stewardship pharmacist is able to make under scope of practice. These interventions include the ability to order certain labs (POCT BG, HgbA1C), and to adjust or discontinue certain anti-hyperglycemic agents Hospitalized patients who have a BG &amp;lt;70 mg/dL in the last 24 hours are reviewed by the AGS team. Chart review is performed on each patient to identify contributing factors and complicated cases are discussed with the endocrinologist prior to contacting the providers or making changes to orders. Providers are given rationale for changes as well as any other recommendations related to glycemic management. Results: During a 3 month period between August and October 2022, 848 cases of hypoglycemia were evaluated. Of these, 450 (53%) were found to be caused by an antihyperglycemic agent and 401 interventions were made by either the AGS team or other providers. The AGS team made 167 (41.6%) interventions and had a 24 h recurrence rate of 8.3% compared to 16.3% for all other providers. The most common types of interventions made by the AGS team were adjusting the insulin correction scale (78), basal insulin (57), bolus/meal insulin (16), oral medications (10), and TPN insulin (3). Conclusion: Our preliminary data show that a pharmacist-driven active surveillance program can reduce hypoglycemic recurrences. In the short time our AGS program has been implemented we have seen in increased utilization of appropriate correction scales, a decreased reliance on basal insulin or correction scale as the sole means of glycemic management, and an increase in endocrinology consultation for glycemic guidance. Future data will show the impact of this program on our overall hypoglycemia and hyperglycemia rates in future. Presentation: Saturday, June 17, 2023

Point prevalence probing of antimicrobial prescription patterns from a developing country

ABSTRACT Background Irrational use of antibiotics intensifies resistance and jeopardizes advances made in modern medicine. We aimed to conduct a baseline gap analysis survey on antibiotic prescription practices across Pakistan. Research Design and Methods This multi-centered cross-sectional survey was conducted at six public sector tertiary care hospitals from February 2021 to March 2021. Data related to various variables including hospital infrastructure, policies and practices, monitoring and feedback, and epidemiological, clinical, and antibiotic prescription for surveyed patients was collected using World Health Organization (WHO) Point Prevalence Survey (PPS) methodology. Results In a survey of 837 inpatients, 78.5% were prescribed antibiotics. Most commonly prescribed antimicrobial was ceftriaxone (21.7%), followed by metronidazole (17.3%), cefoperazone-sulbactam (8.4%), amoxicillin-clavulanate (6.3%), and piperacillin/tazobactam (5.9%). Surgical prophylaxis (36.7%) and community-acquired infections (24.7%) were the main reasons for antibiotic prescriptions. Single antibiotics were given to 46.7% of patients, 39.9% received a combination of two antibiotics, and 12.5% were prescribed three or more antibiotics. Among six hospitals surveyed, two had drug and therapeutic committees, three had infection prevention and control committees, and one had an antibiotic formulary. Conclusion Findings demonstrate high consumption of broad-spectrum antimicrobials and emphasize the importance of expanding antimicrobial stewardship programs among hospitals. Mentoring clinical teams could help rationalize antimicrobial use.

253 An audit of the inpatient management of Parkinson’s Disease medication in a level four hospital in 2019

Abstract Background Parkinson’s Disease (PD) is a progressive, complex neurodegenerative disease characterised by both motor and non-motor symptoms. PD medications are time sensitive, and their correct prescription and administration are crucial in optimal management strategies. Previous work presented at the Irish Gerontological Society showed a lack of knowledge regarding PD and its medications among healthcare staff in a level four hospital. Methods Data were collected from a retrospective chart analysis of PD admissions in 2019. 115 admissions coded PD were identified from HIPE data. Subsequently, 10 patients were randomly selected from medical, surgical, and orthopaedic admissions respectively (39 admissions). Patients were excluded if they were not on PD-specific medications or if their drug Kardex was not available. 28 patient Kardex’s were reviewed. Data was collected using a predetermined spreadsheet and analysed using Microsoft Excel. Results 100% of patients were on levodopa medication. 86% of patients did not receive their appropriate PD medications in the Emergency department. 21% had errors in medication prescription (omitted drug [n = 4, 14%], incorrect timings [n = 2, 7%]) on admission. 75% missed at least one dose of levodopa. 83 doses of levodopa were missed across the 28 admissions. 40% were because the patient was nil by mouth (NPO), while 21% had no reason documented. 64% of patients had doses of levodopa delayed by more than 1 hour, with over 80% of these in the perioperative period. 5 patients (18%) received antidopaminergic drugs. Conclusion This review highlighted multiple shortcomings in PD medication management during acute admissions. We introduced hospital guidelines for the management of patients with PD while NPO. This guideline includes information on alternatives to oral route, advice regarding the perioperative period, and medications to avoid. It has been approved by the Medications and Therapeutics committee and will be introduced with education sessions at the changeover. We will reaudit practices after 6 months.

Food Oral Immunotherapy: A Survey Among US Practicing Allergists Conducted as a AAAAI Leadership Institute Project and Work Group Report.

Food oral immunotherapy (OIT) is an active form of treatment for food allergies. Although research in this area has been ongoing for many years, the first US Food and Drug Administration-approved product for peanut allergy treatment became available only in January 2020. Limited data exist on OIT services offered by physicians in the United States. This workgroup report was developed to evaluate OIT practices among allergists practicing in the United States. The authors developed an anonymous 15-question survey and was subsequently reviewed and approved by the American Academy of Allergy, Asthma & Immunology Practices, Diagnostics and Therapeutics Committee before distribution to the membership. The American Academy of Allergy, Asthma & Immunology electronically distributed the survey to a random sample of 780 members in November 2021. In addition to questions specific to food OIT, the survey included questions on demographics and professional characteristics of the responders. A total of 78 members completed the survey, yielding a 10% response rate. Fifty percent of responders were offering OIT in their practice. There was a significant difference in experience in OIT originating from research trials in academic versus nonacademic centers. Generally, OIT practices were similar in both settings for the number of foods offered, the performance of oral food challenges before initiating treatment, the number of new patients to whom OIT was offered to per month, and age groups OIT to whom was offered. Almost all of the reported barriers to OIT were similar between settings: staff and time limitations, concerns about safety and anaphylaxis, the need for more education on how to perform, inadequate compensation, and that it was not a significant demand from patients. Clinic space limitations were significantly different and more prominent in academic settings. Our survey revealed interesting trends in the practice of OIT across the United States, with some significant differences arising when academic and nonacademic settings were compared.

Lecanemab.

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the needs of a facility. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433.

Children's Oncology Group's 2023 blueprint for research: Developmental therapeutics.

The Developmental Therapeutics Committee (DVL) identifies and develops new agents and treatment strategies for children/adolescents with cancer, through clinical and translational research. DVL has focused on evaluating the activity of targeted therapy and has evolved from trials with multiple histology strata to biomarker-selected phase 2 trials. These trials have included single-agent studies to evaluate agents such as cabozantinib in multi-disease cohorts, to trametinib, larotrectinib, and lorvotuzumab in disease-specific cohorts, as well as the pediatric Molecular Analysis for Therapy Choice (MATCH) study including multiple single agents targeted for biomarker-selected pediatric tumors. The ongoing vision and direction of DVL is to support the disease committees of COG to develop novel agents and combinations to advance the care of children with cancer.