Role of the hospital pharmacist in an Italian antimicrobial stewardship programme.

The inappropriate use of antimicrobial agents is contributing to an increasing phenomenon of bacterial resistance. For this reason, there is a growing interest in 'antimicrobial stewardship', a series of coordinated and multidisciplinary interventions aimed to promote the safe and appropriate use of antimicrobials in which the pharmacist's contribution is necessary for the optimal choice of drug, dose, duration of therapy and the implementation of cost containment strategies. AIM OF THE STUDY: We wanted to create a reference model and a specific training manual on antibiotic stewardship to introduce the role of the department pharmacist with specific infection disease skills in the Italian health system hospitals. METHODS: This study was conducted in six Italian hospitals for 24 months. It was divided into three phases: definition of indicators (as defined daily doses/100 days of hospitalisation, switches from intravenous (IV) to oral and from empirical to targeted therapies, etc) elaboration of research protocol; sharing, application and detection of the indicators and selection of centres involved; analysis and sharing of results and subsequent drafting and distribution of the training manual.Statistical analysis focused on possible differences between the frequencies of the aforementioned switches. Differences were analysed comparing the values recorded in the first quarter with those of the third quarter trough a χ² test. Statistical significance was set at p<0.05. RESULTS: The pharmacist's work showed a statistically significant increase in the conversion from IV to oral antibiotic therapy (χ² (1.496)=9112 ; p=0.0025; df=1). It was also detected a 5% improvement in appropriate dosing, 34% reduction in drug stocks, 4% increase in allergy reports and 275% increase in the number of adverse drug reactions reported. CONCLUSIONS: In this study, the interventions of the antibiotic stewardship pharmacist led to an improvement in quality of care, resource efficiency and healthcare professional awareness.

Clinical pharmacy services in Germany: a national survey.

OBJECTIVES: Clinical pharmacy services in German hospitals appear to be underdeveloped compared with other European countries. However, recent developments have increased the interest in expanding these services. Detailed data about the current state of clinical pharmacy services in Germany are lacking. This survey establishes the current level of pharmacy services in Germany and the barriers to implementation. METHODS: An online survey conducted in 2017 was distributed to directors of all 389 German hospital pharmacies. The survey contained 26 questions addressing hospital and pharmacy characteristics, clinical pharmacy services provided, the number of clinical pharmacists and the frequency as well as the quality assurance of these services. RESULTS: There were 133 responses (34%). Of these, 84 (63%) pharmacies provided some form of clinical pharmacy services. Based on the 389 contacted pharmacies, a clinical pharmacy service is available in at least 22% of hospital pharmacies in Germany. On average there are 2.4 full-time equivalent (FTE) clinical pharmacists per hospital employed, although there is a wide variation in numbers (0.3-22 FTE) and service provision between hospitals. Clinical pharmacy services are generally provided on a daily or weekly basis, with a principal focus on general surgery, critical care and general medicine wards. CONCLUSIONS: This is the first survey providing a detailed picture of clinical pharmacy services in Germany. There is wide variation in clinical service provision among hospitals, with some hospitals having developed a comprehensive range of clinical services. Compared with other countries, particularly the UK where the focus has shifted to provision of 7-day clinical services, the gap in clinical pharmacy services remains large. The focus should be turned to refining clinical pharmacy services in hospital admissions and discharge planning while also improving Health IT, the opportunities for specialisation and aligning education in accordance with the EAHP common training framework.

Exploring the adverse effects of chemotherapeutic agents used in the treatment of cervical and ovarian cancer from the patients' perspective: a content analysis of the online discussion forums.

OBJECTIVES: This study aimed to explore the adverse effects of chemotherapeutic agents used in the treatment of ovarian and cervical cancer by analysing patients' views posted in online discussion forums. METHOD: UK-centred online discussion forums were used to identify discussion threads on ovarian and cervical cancer between 2008 and 2017. The study was approved by the University of Bournemouth ethics committee. 272 discussion threads with 644 participants from four online discussion forums (Cancer Research UK, Macmillan, Ovacome and Jo's Cervical Cancer Trust) were identified. The threads were exported into NVivo and a thematic content analysis was conducted to identify study themes. RESULTS: Of the 644 participants, 19.4% had a diagnosis of cervical cancer and 80.6% had a diagnosis of ovarian cancer. Four main themes related to: (1) treatment plan, (2) adverse effects, (3) perception of treatment and (4) hospitalisation were identified. Patients' perceptions about their treatment were reported to be positive across all chemotherapeutic agents. 312 adverse effects were reported by patients with cervical cancer taking cisplatin, with fatigue (52.1%) and nausea (30.6%) being the two most frequently reported adverse effects. With regard to the treatment of ovarian cancer, 402 adverse effects were reported by patients on carboplatin and paclitaxel, with neuropathy (29.3%) and fatigue (28.0%) being the two most commonly reported adverse effects. CONCLUSION: The online discussion forums allowed patients to express their concerns in a blame-free environment that provided novel insight into the impact of chemotherapy-associated adverse effects on patients with cervical and ovarian cancers. Real-life experiences shared by patients can help the healthcare professionals to find the right balance between prolonged survival and quality of life.

Combination of ceftaroline and daptomycin as treatment for complicated osteomyelitis.

Osteomyelitis is an infection involving bone. Staphylococcus aureus is the pathogen most frequently implicated; less frequently involved are other gram-positive organisms, such as Staphylococcus epidermidis, and also gram-negative organisms. The antibiotic of choice for treatment of osteomyelitis caused by methicillin-resistant staphylococci (MRS) is vancomycin, although other alternatives such as daptomycin or teicoplanin are also considered. Osteomyelitis caused by MRS can be difficult to treat safely and effectively. This case report describes the successful use of daptomycin combined with ceftaroline for the treatment of osteomyelitis caused by methicillin-resistant S. epidermidis (MRSE) in a 54-year-old woman, emphasising the clinical pharmacist's role in antimicrobial stewardship programmes. This alternative combination has been studied in the treatment of methicillin-resistant S. aureus (MRSA), but it may also be useful in MRSE.

Pilot study to evaluate knowledge of person-centred care, before and after a skill development programme, in a cohort of preregistration pharmacists within a large London hospital.

INTRODUCTION: Aperson-centred approach to healthcare encompasses personalised care, supporting the individual to recognise their strengths and promote their independence. Preregistration pharmacists , who arenew pharmacy graduates undertaking their training year of practice before qualification,may need support embedding this in practice. OBJECTIVE: To explore the knowledge and confidence in person-centred care (PCC) in a cohort of 12 preregistration pharmacists before and after receipt of an inhouse pharmacy-focused skill development programme using qualitative and quantitative measures. METHODS: Two half-day skill development sessions were delivered to 12 preregistration pharmacists. Assessment forms were completed before and after the skill development sessions, including quantitative data gathered via Likert scales and qualitative, narrative responses. Responses were coded and classified into themes. Participants submitted one written reflective account demonstrating the use of PCC in medicines-related patient consultations following completion of the skill development programme. RESULTS: Assessment forms were received from all participants. Self-reported knowledge of PCC improved from the start of the first session to the end of the second session. The average score for the understanding of PCC rose from 6.5 to 9.6 (Likert scale of 0-10) to the end of the second session. Qualitative analysis identified five person-centred themes, including active listening, using open questions, supporting and empowering patients, developing a shared agenda, and encouraging patients to take ownership of their medicines. CONCLUSIONS: Confidence and knowledge increased from the start of session 1 to the end of session 2. and analysis of the reflective accounts and themes also identified increased knowledge of PCC. This work aligns with previous hospital trust work, which identified that a training programme increased awareness and provided foundation knowledge. A short programme to develop PCC skills was effective in improving the PCC knowledge of 12 preregistration pharmacists. A review of pharmacists' written accounts of their consultations suggests that these skills were integrated into practice.

Involvement of interleukin 6 in SARS-CoV-2 infection: siltuximab as a therapeutic option against COVID-19.

The aim of the study was to explore the involvement of interleukin 6 in SARS-CoV-2 infection, and to position the drug siltuximab in the management of severe forms of COVID-19. A bibliographic search was performed in Pubmed on the immune response to the disease, and in ClinicalTrials.gov on clinical trials with interleukin 6 blockers. Interleukin 6 is involved in the cytokine cascade, which originates as a consequence of an excessive immune response secondary to viral infection, aggravating lung affectation. Blockers of this cytokine (tocilizumab, sarilumab and siltuximab) are being studied as a strategy for treating the disease. Siltuximab is a monoclonal antibody indicated in Castleman's disease that could be administered in a single dose of 11 mg/kg in severe forms of COVID-19 that have increased interleukin 6.

Impact of Medicines Helplines on patient satisfaction, patient outcomes and medicines safety for hospital patients: the development of a rating scale and an evaluation of patients' opinions.

OBJECTIVE: To develop a rating scale and assess the impact of advice from Medicines Helplines on patient outcomes, medicine-related risks and patient satisfaction. METHODS: All patients who contacted two hospital pharmacy Medicines Helplines during the study were invited to complete a questionnaire about their experience of the helpline service and the outcome following the advice. A rating scale was developed and an expert panel of Medicines Information (MI) pharmacists rated the impact of the helpline advice on patient care or outcomes and risk/safety. RESULTS: Of 111 questionnaires sent to patients, 67 were completed (60% response rate). The majority of patients said they would use the service again (96%; 64/67), 81% (54/67) felt more reassured after calling the helpline and 61% (41/67) rated the service excellent (highest rating). The majority followed the advice (93%, 62/67), of which 19% (12/62) reported improved health or cure as a result. The consensus of an independent expert panel found that helpline advice had a positive impact on patient outcomes in 74% (46/62) of cases, and on medication safety in 71% (44/62). The rating scale was used successfully and validated. CONCLUSIONS: The validated rating scale is a useful tool for rating the impact of MI advice on patient outcomes and medication-related risks. The Medicines Helplines had a positive impact on patient outcomes according to patients and the expert panel. The panel found patients reduced the risk of harm from their medicines when advice was followed. Patients valued the service as an easily accessible source of useful information about medicines.

Bioethics: a challenge and an opportunity for hospital pharmacists.

OBJECTIVES: Traditionally, pharmacy ethics in Europe has held an insignificant place in the scheme of pharmaceutical education. We embraced the idea that bioethics should be an integral part of a pharmacist's education and professional practice, especially in hospital pharmacy where the concept of 'pharmaceutical care' should be revitalised to strengthen the broad-based and patient-oriented responsibilities of the clinical pharmacist. METHODS: We decided to structure a bioethics course tailored to pharmacists who are specialising in hospital pharmacy. We first created a training network partnership between a university and a research hospital to integrate classroom teaching with skill-specific practical experience. Our course pilot project introduces, in two of the four years of the national specialty programme, general topics and practical bioethical issues. RESULTS: A pilot course on ethics for the School of Specialisation in Hospital Pharmacy began at the Padua University in 2014. in February 2017 we contacted the same students again, asking them further questions about their experience. Several students asked to examine more cases and to deal with the few arguments that questioned them on an ethical level. On the whole, through the comments of trainees, the needs of those who are facing an unfamiliar subject, which is perceived as important, emerge. CONCLUSION: Even if we are aware that this is a pilot project and requires more data, dissemination of this experience into a wider network will help us to define an effective educational pathway in collaboration with other Specialty Schools of Hospital Pharmacy.

Developing person-centred consultation skills within a UK hospital pharmacy service: evaluation of a pilot practice-based support package for pharmacy staff.

A person-centred approach to care is central to NHS England's health policy agenda and a standard for pharmacy practice from the General Pharmaceutical Council. Health coaching is a method of delivering person-centred care. A pilot of a health coaching support package, including a 2-day course and practice-based follow-up, was delivered to 70 London North West Healthcare NHS Trust pharmacy staff between December 2015 and July 2017. OBJECTIVES: To evaluate the support package, identifying key themes from course feedback, evaluating staff perception and evidence of application in practice. To identify key benefits of the support package. METHODS: Qualitative analysis of written course feedback was undertaken to identify staff learning themes about person-centred care. The themes were used to design a survey, administered to support package recipients (staff), exploring staff perception of the package. Qualitative review of written examples highlighted use of person-centred themes in practice. RESULTS: Twelve person-centred themes emerged from 49 course evaluations forms, describing what participants learnt about patient-centred care. Of 24 surveys completed, respondents reported increased awareness of themes; however, use in practice varied between themes. Overall, respondents valued the support package and rated practice-support more highly than the course for ongoing development. Patient examples described the use of themes in practice. CONCLUSIONS: The support package increased awareness of person-centred themes, portrayed within the practice examples submitted. While the course provided a foundation for use of a person-centred approach, continuing practice-based support is desired by staff to embed learning into day-to-day practice.

EAHP European Statements Survey 2017, focusing on sections 2 (Selection, Procurement and Distribution), 5 (Patient Safety and Quality Assurance) and 6 (Education and Research).

OBJECTIVES: The 2017 EAHP European Statements Survey focussed on sections 2, 5 and 6 of the European Statements of Hospital Pharmacy. Statistical data on the level of implementation and on the main barriers to implementation of the Statements were collected. A further aim was to identify barriers in general, such as lack of awareness. METHODS: An online questionnaire was sent to all hospital pharmacies in European Association of Hospital Pharmacists (EAHP) member countries. Data were analysed at Keele University School of Pharmacy, UK by and the EAHP Survey Group. RESULTS: There were 783 complete responses (response rate 17.4%). Some 42% of responders worked in teaching hospitals, 76% of hospital pharmacies had 10 or less pharmacists, and 46% of hospital pharmacies served over 500 beds.Five questions revealing the lowest implementation levels were further analysed in greater detail. Only 30% of respondents reported that their hospital pharmacists routinely publish hospital pharmacy practice research, and only 50% are involved in the development of local or national guidelines. 45% of respondents reported that computerised decision support was used to reduce the risk of medication errors in their hospitals, 69% stated that they had contingency plans for medicines shortages and 60% answered that they had had reason to contact their medicines authority because of drug shortages. 63% reported that the transcription step had been eliminated from the medicines administration process. CONCLUSIONS: The survey has provided the EAHP with an overview of the implementation level as well as the barriers to and drivers of implementation of sections 2, 5 and 6. This is important for informing the plans of EAHP and its members so that implementation can be fully supported.

Improvement on prescribing appropriateness after implementing an interdisciplinary pharmacotherapy quality programme in a long-term care hospital.

OBJECTIVES: To determine the prevalence of inappropriate prescribing in elderly patients with polypharmacy admitted to a long-term care hospital (LTCH) and to evaluate the impact of an interdisciplinary pharmacotherapy quality programme on improvement of prescribing appropriateness. METHODS: An interventional, longitudinal, prospective study was conducted in a Spanish LTCH (October 2013 to July 2014) including 162 elderly (≥70 years) patients with polypharmacy (≥5 medications). Pharmacists conducted the pharmacotherapy follow-up of patients with medication reconciliation, pharmacotherapeutic optimisation and educational interviews from admission to discharge. Reconciliation errors, potentially inappropriate medications (PIMs), potentially prescribing omissions (PPOs) and significant drug interactions rates were calculated. The impact of the programme was evaluated considering the difference between the inappropriateness score per patient (total number of reconciliation errors, PIMs, PPOs and significant drug interactions) before and after implementing pharmacotherapy recommendations. RESULTS: At admission, 163 reconciliation errors (median(range), 1(1-6)) in 92 (56.8%) patients (65.6% drug omissions), 335 PIMs (2(1-6)) in 147 (90.7%) patients (39.3% use ≥2 anticholinergic drugs), 43 PPOs (1(1-3)) in 32 (19.8%) patients (48.5% statin omission) and 594 significant drug interactions (4(1-19)) in 130 (80.2%) patients were detected. After implementing pharmacotherapy recommendations, statistically significant reductions in admission reconciliation errors (8.3% to 0.1%), PIMs (17.0% to 12.2%), PPOs (2.2% to 0.7%) and significant drug interactions (30.2% to 26.8%) rates were found. The programme achieved a 31% improvement in prescribing appropriateness, with a statistically significant reduction in the inappropriateness score (6(IQR:4-9) to 4(IQR:2-7)). CONCLUSION: Reconciliation errors, PIMs and drug interactions are highly prevalent in elderly patients with polypharmacy admitted to an LTCH. This interdisciplinary pharmacotherapy quality programme seems to be a useful approach in the improvement of prescribing appropriateness in a high-risk older population.