Evaluation of a simple method for visual detection of microprecipitates in blends of parenteral drug solutions using a focused (tyndall) light beam.

The formation of microprecipitates (sub visible particles) is a critical factor when blending parenteral drug solutions prior to or during intravenous administration to a patient. In cases where compatibility is not documented, analytical screening of such mixtures for physical incompatibility would give a safer foundation for secure administration of such blends to patients. The aim of this article is to report our experiences with visual screening using a focused (Tyndall) light beam for the detection of micro precipitates within blends of drug solutions, a method which may be used in any hospital pharmacy without use of advanced analytical instrumentation. A selection of clinically applied drug solutions was tested for precipitation upon blending in a proportion of 1:1. In order to reduce potential background particle burden, the solutions were filtered through 0.2 micrometer pore size filters prior to mixing. To detect potential precipitation, the solutions were visually inspected using two different types of focused light beams, a 75-watt white, focused light source and a HeNe pocket laser-pointer, for light scattering. For comparison, a light obscuration particle counter test was performed as described in the European Pharmacopeia. An experimental set-up is described, and a detailed protocol is suggested for a method able to detect micro precipitates in drug solution blends by using focused (Tyndall) light. The performance of this method for selected blends is reported in comparison to the Pharmacopeial light obscuration particle count test. Despite the fact that visual inspection using Tyndall light is a simple and low-cost method, it was found sensitive for detecting minute amounts of sub visible particles with detection sensitivity close to the light obscuration particle counting limits stated by the European Pharmacopeia. In cases where an electronic particle counter is not accessible, a sensitive warning signal may be obtained from this approach indicating that it is not advisable to mix such solutions. Certain drug solutions, as well as their actual concentrations, can have an effect on precipitation, and, therefore, should be recorded in mixing tables for clinical use. The Tyndall method employed here may represent an important tool for improving the quality of decisions on whether to give two solutions simultaneously to a patient.

The contribution of a clinical pharmacist to the improvement of medication at a geriatric hospital unit in Norway

The aim of the study was to use a clinical pharmacist in order to improve the medication of patients in a geriatric hospital unit. The hospital had no experience of using a clinical pharmacist before. Methods: A clinical pharmacist participated in the therapeutic team for 27 days during a 4-year period. Drug-related problems were recorded prospectively and discussed before and at the ward round. The results of the physician’s decisions on the current day about potential changes in medication proposed by the pharmacist were continuously recorded. Results: The pharmacist evaluated the medication of 250 patients. At least one drug- related problem was found in 188 (75%) of the patients. For these patients, the physician made 606 decisions concerning potential changes in the medication (3.2 per patient). Thirty percent (184/606) of the decisions were connected to further measurements and to the follow-up of laboratory results, mainly (82%, 151/184) for cardiovascular drugs. Forty-two percent (255/606) of the decisions resulted in the discontinuation of drugs, dosage reduction or a decision to revise the assessment at a later stage during hospitalisation. Medicines with anticholinergic adverse effects were to a great extent withdrawn. Twenty-one percent (129/606) of the decisions were made on drugs with an addiction potential: hypnotics, anxiolytics, as well as analgesics containing tramadol and codeine. The result was often (71%, 91/129) dosage reduction, a change from fixed medication to medication on demand or to discontinuation. Conclusion: Even with a modest participation of once a month, the evaluation of a patient’s medication by a clinical pharmacist led to improved changes and the follow-up of the medication of the elderly (AU)

El objetivo del estudio fue utilizar un farmacéutico clínico para mejorar la medicación de pacientes en un hospital geriátrico. El hospital no tenía experiencia en la utilización de un farmacéutico clínico. Métodos: Un farmacéutico clínico participó en el equipo terapéutico durante 27 días durante un periodo de 4 años. Se registraron prospectivamente los problemas relacionados con medicamentos y discutidos durante y en la ronda clínica. Se registró continuamente los resultados de las decisiones del médico sobre los cambios posibles sugeridos por el farmacéutico. Resultados: El farmacéutico evaluó la medicación de 250 pacientes. Se encontró al menos un problema relacionado con medicamentos en 188 (75%) de los pacientes. Para estos pacientes, el médico tomó 606 decisiones relativas a los cambios en la medicación (3,2 por paciente). El 30% (184/606) de las decisiones estaban relacionadas con posteriores medidas y el seguimiento de resultados, principalmente (82%, 151/184) para medicamentos cardiovasculares. El 42% (205/606) de las decisiones produjeron discontinuación de medicamentos, reducción de dosis o la decisión de revisar la evaluación posteriormente. Los medicamentos con efectos anticolinérgicos fueron en su mayoría retirados. El 21% (129/606) se hicieron sobre medicamentos con potencial adicción: hipnóticos, anxiolíticos, así como analgésicos con tramadol y codeína. El resultado más frecuente (71%, 91/129) fue la reducción de dosis, cambio de medicamentos a dosis fija por medicamentos a demanda o discontinuación. Conclusión: Incluso con una modesta participación una vez al mes, la evaluación de la medicación por un farmacéutico clínico llevó a mejorar los cambios y el seguimiento de la medicación de los ancianos (AU)

The contribution of a clinical pharmacist to the improvement of medication at a geriatric hospital unit in Norway.

UNLABELLED: The aim of the study was to use a clinical pharmacist in order to improve the medication of patients in a geriatric hospital unit. The hospital had no experience of using a clinical pharmacist before. METHODS: A clinical pharmacist participated in the therapeutic team for 27 days during a 4-year period. Drug-related problems were recorded prospectively and discussed before and at the ward round. The results of the physician's decisions on the current day about potential changes in medication proposed by the pharmacist were continuously recorded. RESULTS: The pharmacist evaluated the medication of 250 patients. At least one drug- related problem was found in 188 (75%) of the patients. For these patients, the physician made 606 decisions concerning potential changes in the medication (3.2 per patient). Thirty percent (184/606) of the decisions were connected to further measurements and to the follow-up of laboratory results, mainly (82%, 151/184) for cardiovascular drugs. Forty-two percent (255/606) of the decisions resulted in the discontinuation of drugs, dosage reduction or a decision to revise the assessment at a later stage during hospitalisation. Medicines with anticholinergic adverse effects were to a great extent withdrawn. Twenty-one percent (129/606) of the decisions were made on drugs with an addiction potential: hypnotics, anxiolytics, as well as analgesics containing tramadol and codeine. The result was often (71%, 91/129) dosage reduction, a change from fixed medication to medication on demand or to discontinuation. CONCLUSION: Even with a modest participation of once a month, the evaluation of a patient's medication by a clinical pharmacist led to improved changes and the follow-up of the medication of the elderly.