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1.
European Journal of Clinical Pharmacology ; 78:S130, 2022.
Article in English | EMBASE | ID: covidwho-1955961

ABSTRACT

Introduction: Zolpidem and zopiclone are widely used for sleep disorders, yet their abuse and dependence potential has been underestimated. The electronic prescription of zolpidem/zopiclone became mandatory on 17.07.2019 in Greece. Objectives: To investigate descriptive characteristics of zolpidem/ zopiclone prescriptions and the impact of the mandatory electronic prescription mandate. Methods: Anonymized prescriptions of zopiclone (ATC: N05CF01) and/or zolpidem (ATC: NC05CF02) that were executed in pharmacies between 01.10.2018 and 01.10.2021 were obtained from the Greek nationwide prescription database. The database covers almost the entire Greek population and it is administrated by IDIKA of the Greek Ministry of Health. We investigated descriptive characteristics of prescriptions, and calculated themonthly number of prescriptions taking into consideration dates with potential impact, i.e., the date of the mandatory electronic prescription mandate (on 17.07.2019) and the date of the first case of COVID-19 in Greece (on 26.02.2020). Results and Conclusion: During the investigated period of three years, there were 1229842 executed prescriptions of zolpidem (89.4%), zopiclone (10.4%) or both (0.3%), considering 156554 unique patients. The patients weremainly elderly (73.1%were ≥ 65 years old) andwomen (64.5%). The majority of the prescription physicians (69.9%) were general practitioners or internists, followed by 17% psychiatrists or neurologists, 5.3% cardiologists, 4.5% physicians in specialty training, 1% nephrologists and 2.4% of physicians with another specialty. After the mandatory electronic prescription mandate and before COVID- 19 in Greece, i.e., between 08.2019 to 03.2020, there was a notable increase of prescriptions in comparison to the previous period from 10.2018 to 07.2019 (median 37267 vs median 34106;Mann-Whitney U=9, p-value=0.009). After COVID-19, the median monthly number of prescriptions was 36363, yet there were variations ranging from 16963 to 39956. In conclusion, the mandatory electronic prescription system could increase the surveillance of drugs with abuse potential such as zolpidem and zopiclone. Nevertheless, the large number of prescriptions in elderly patients and prescribed by primary care physicians is worrisome and warrants further investigation.

2.
General Medicine ; 23(5):11-19, 2021.
Article in Bulgarian | EMBASE | ID: covidwho-1955719

ABSTRACT

In times of global pandemic, telemedicine is emerging as an effective and sustainable solution to stop the spread of COVID-19. The aim of this article is to study the public attitudes towards the application of telemedicine in Bulgaria in the conditions of the COVID-19 pandemic. Material and methods: To study the public attitudes for the application of telemedicine in a pandemic, 253 people were interviewed voluntarily and anonymously. We used our own tools – a questionnaire distributed online. Statistical data processing was performed using IBM SPSS v. 23. Results: Respondents with higher education and healthcare workers were more distrustful of health information on the Internet. Over 75% of the respondents stated that they would use remote medical services for consultation with a medical professional in case of a health problem, and nearly 59% of them would pay for remote medical services for consultation and/or monitoring of treatment. The issuance of an electronic referral, an electronic sick leave form and an electronic prescription could limit the spread of COVID-19 according to 77.4% of them. Almost ¾ of our respondents would install a mobile application to contact a doctor in case of emergency. The preferred means of consulting a medical professional in the current pandemic is a telephone conversation. Conclusion: Telemedicine is essential to ensure that patients have access to medical care. In times of global public health emergency, health systems must rely on remote medical examinations and electronic prescriptions to deal with the further spread of the disease.

3.
Palliative Medicine ; 36(1 SUPPL):102, 2022.
Article in English | EMBASE | ID: covidwho-1916773

ABSTRACT

Background/aims: In early 2020 as the COVID-19 (C-19) pandemic hit the UK, it was anticipated patients dying of C-19 would experience severe and distressing symptoms at end of life. Specific guidance was developed, in addition to established Scottish Palliative Care Guidelines, to advise on managing symptoms of those imminently dying of C-19. We sought to determine whether medications administered to those dying of C-19 differed to those administered to those dying of other primary lung disease (PLD). Methods: Case notes and electronic prescriptions of patients who died in hospital over a seven-week period in 2020 with a primary diagnosis of C-19, known to the hospital specialist palliative care team (HSPCT) were analysed and compared with data from patients with PLD in a similar period in 2019, known to the same HSPCT. Results: 34 patients with C-19 compared with 26 PLD patients (88.5% respiratory malignancy, 7.7% COPD and 3.8% bronchiectasis). Mean age 76 years vs 71. Average time from admission to referral f 8 vs 6 days, time to death average of 2.7 vs 7 days from point of referral . Both groups experienced an average 2.4 symptoms with most common being dyspnoea (76.5% vs 69.2%), pain (73.5% vs 65.4%), agitation (38.2% vs 42.3%) and respiratory secretions (38.2% vs 38.5%). Medications in 24 hours prior to death for C-19 group: morphine equivalent daily dose (MEDD) average 20.4mg versus 62.4mg, midazolam 8.8mg vs 5.8mg, levomepromazine 12.5mg vs 6.25mg, hyoscine butylbromide 60mg vs 100mg. The MEDD in the C-019 group was higher, but increase since admission was 10mg in both groups. Conclusions: Similar symptoms experienced in both groups with possibly more complex symptom control in PLD. C-19 patients had greater requirement for anti-agitation medication while PLD patients had greater opioid requirements. Higher opioid dose in PLD patients secondary to long term symptom control, however average opioid requirements increment by same amount. Doses in C-19 were within the range of established guidelines.

4.
European Journal of Hospital Pharmacy ; 29(SUPPL 1):A159, 2022.
Article in English | EMBASE | ID: covidwho-1916419

ABSTRACT

Background and importance Pharmaceutical validation of inpatient treatments is a fundamental activity in the clinical practice of the hospital pharmacist. Thanks to this, many prescription errors are detected, promoting patient safety. Aim and objectives To describe the interventions performed by a hospital pharmacy resident in the area of pharmaceutical validation, supervised by consultant pharmacists, and to evaluate their degree of acceptance. Material and methods Prospective interventional study conducted during September 2021. Adult inpatients, whose hospital treatment was reviewed, were included. Demographic (sex and age), clinical (clinical judgement (CJ) and inpatient clinical service) and pharmacotherapeutic (number of chronic medicines and polymedication (≥6 drugs)) variables were collected. Interventions were reported to the clinician via electronic prescribing software. They were classified as: Activity (reconciliation on admission/information to the clinician), Adequacy (detection of prescribing error/therapy reconciliation error), Change (therapeutic exchange), Initiation (usual treatment not prescribed/need for additional treatment), Modification Dosage Form (DF) or Posology, Suspension (duplicity/unnecessary medication/allergy). Patient lists and data were collected through medical records and electronic prescribing software, and processed using Excel 2020. Results Interventions were performed in 56 patients. 63.2% male;median age 73 years (IQR 61-80). The most frequent CJ were: heart failure (10.7%), COVID-19 (7.1%), liver dysfunction (7.1%). Services with most interventions: Internal Medicine (25.8%), General/Vascular Surgery (19.4%), Digestive (11.3%). Median number of chronic medicines: 8 (IQR 5-12). Polymedication in 71.4%. 62 interventions were performed (12.9% were 'not evaluable', reasons: discharge/death). Of the evaluable interventions, 77.8% were accepted. The percentages were: duplicity (30.9%), modification DF/posology (23.8%), usual treatment not prescribed (7.1%), therapeutic exchange (7.1%), discontinue medication due to allergy (7.1%), therapy reconciliation error (4.8%), reconciliation on admission (4.8%), information (4.8%), additional treatment (4.8%), prescribing error (2.4%), unnecessary medication (2.4%). Of the accepted interventions, 11.9% were related to high-risk medicines according to the Institute for the Safe Use of Medicines1- 2 (nonsteroidal anti-inflammatory drugs (NSAIDs), betablockers, heparin, immunosuppressants). Of the not-accepted interventions, 50.0% corresponded to errors in home treatment reconciliation. Conclusion and relevance The data obtained demonstrate that clinical interventions performed by the hospital pharmacy resident have a high degree of acceptance, increasing the quality and safety of healthcare and avoiding medication errors.

5.
European Journal of Hospital Pharmacy ; 29(SUPPL 1):A145-A146, 2022.
Article in English | EMBASE | ID: covidwho-1916417

ABSTRACT

Background and importance Isavuconazole is a new antifungal triazole authorised for invasive aspergillosis and mucormycosis. It is a therapeutic alternative to voriconazole and liposomal amphotericin B for invasive aspergillosis, and to liposomal amphotericin B in mucormycosis. Aim and objectives To analyse prescription characteristics of isavuconazole in patients with COVID-19 in an intensive care unit (ICU) as well as its effectiveness and safety. Material and methods A cross-sectional, observational study was conducted (June 2020-April 2021). Patients with COVID-19 in an ICU on treatment with isavuconazole were included. Electronic prescription program and clinical history were used to collect the following data: sex, age, comorbidities, coinfection with other pathogens in addition to SARS-CoV-2, type of therapy (empirical/targeted), duration and previous azole treatment (yes/no). Effectiveness was evaluated by symptoms resolution, reasons for treatment suspension and status (alive/death) 30 days after completion of treatment. Safety was assessed according to adverse events (AE). Results Thirty-three patients (54.5% men) with mean age of 61 (35-77) years were evaluated. Twenty-nine patients (87.9%) had comorbidities, the most frequent were: hypertension (19.1%), dyslipidaemia (12.8%), obesity (11.7%) and diabetes (8.5%). Thirty-two (96.9%) had coinfections, with a mean of 1.8 (SD 1.2) infections/patient. The most implicated pathogens were: Acinetobacter baumanii (18.8%), Candida albicans (11.6%) and Aspergillus fumigatus (8.7%). Twentythree patients (69.7%) received isavuconazole as empirical therapy and 10 (30.3%) as targeted. Mean duration of treatment was 12.3 (SD 7.5) days. Twenty-five (75.6%) patients had not previously received azole treatment, 7 (21.3%) had received voriconazole and 1 (3%) fluconazole. Symptoms resolution was observed in 12 (36.4%) cases. Seven patients (21.2%) discontinued treatment due to negative culture, 12 (36.4%) due to symptoms resolution and 14 (42.4%) due to death. At 30 days completion of treatment, 15 patients (45.5%) remained alive and 18 (54.5%) had died. AE were recorded in 6 cases (18.2%): liver disorders (n=4) and electrolytic alterations (n=2). Conclusion and relevance Most patients presented comorbidities and coinfections in addition to COVID-19. Effectiveness of isavuconazol was adequate in approximately one-third of patients, despite the high severity and clinical complexity. Approximately half the patients remained alive at 30 days following completion of treatment. Isavuconazol was well tolerated in most cases.

6.
European Journal of Preventive Cardiology ; 29(SUPPL 1):i359, 2022.
Article in English | EMBASE | ID: covidwho-1915600

ABSTRACT

Background & Aim: COVID 19 has accelerated the uptake and acceptance of digital health tools for the prevention and management of Cardiovascular Disease. With health systems being urged to learn from the pandemic and to reassess how they will deliver services in future, robust audit and evaluation of digital interventions are required to inform best practice. This study aims to evaluate the clinical outcomes of a digital CVD prevention and rehabilitation programme which was established during COVID 19 to provide cardiac patients with efficient and timely access to a home-based, structured, comprehensive programme of care. Methods: Developed and delivered by an interdisciplinary team (Nurse Prescriber, Physiotherapist, Dietitian, Cardiologist), the core components of this 12 week programme included, behavioural change support, lifestyle modification, medical risk factor management and electronic prescribing of cardio-protective medication. To support self-management, patients were provided with a Fitbit, blood pressure monitor and a workbook to support goal setting and overall tracking of progress. Patients were given access to a bespoke web-based platform and invited to attend weekly (2hr) group-based sessions, which included an exercise component and an interactive educational workshop. Results: Over a 4 month period, 105 patients were referred with an uptake rate of 73% (n=77). Of these, 97% (n=75) enrolled in the programme, with an 85% (n=64) completion rate. Significant improvements in CVD risk factors were observed between initial and end of programme assessment. The proportion of patients meeting guideline-recommended physical activity targets increased from 14 to 82% (p<0.001), mean BMI (kg/m2) reduced from 28.7 to 27.7 (p<0.001), mean Mediterranean diet score improved from 5.2 to 7.3 (p<0.001), and anxiety and depression levels ≥8 (Hospital Anxiety and Depression score) both reduced by more than 50% (p<0.001). The proportions achieving the recommended blood pressure (<130/80 mmHg) and LDL cholesterol targets (<1.4 mmol/L) increased from 24 to 68% (p<0.001) and 14 to 41% (p<0.001), respectively. Conclusion: Outcomes from this programme demonstrate that digital CVD prevention and rehabilitation programmes can achieve the recommended lifestyle, medical and therapeutic targets associated with reduced CVD events and improved health outcomes. This programme represents a scalable, accessible and effective option to deliver vital CVD preventive care in the patient's home.

7.
Journal of Oncology Pharmacy Practice ; 28(2 SUPPL):44-45, 2022.
Article in English | EMBASE | ID: covidwho-1868955

ABSTRACT

Background: In February 2021 Roche announced a new subcutaneous (SC) product to the market;Phesgo. Phesgo was a combination pertuzumab and trastuzumab product which was funded by NHS England for all HER2 positive breast cancer indications. Day case unit capacity is a local and national issue, which has been further highlighted through the COVID19 pandemic with the reduction in treatment chairs due to social distancing and increase in cancer diagnosis and required treatments caused by the backlog from the pandemic. Aim: The aim of this project was to switch all intravenous (IV) pertuzumab and trastuzumab combination patients to SC Phesgo;to alleviate day case unit capacity and to improve the patient experience by June 2021. Methods: A report from CIS Healthcare was run within the electronic prescribing system to highlight all patients and regimes receiving and containing IV pertuzumab;a total of 148 patients network wide. A patient information letter was drafted explaining the change underway which was then emailed or posted out to all patients across the network receiving IV pertuzumab. Alternative regimens containing SC Phesgo were built into the electronic prescribing system;from week commencing 19.04.21 any patient receiving treatment at the tertiary centre (Weston Park Hospital(WPH)) who had received IV pertuzumab and trastuzumab previously would receive SC Phesgo. A patient evaluation questionnaire was distributed to all patients who participated in the switch to SC Phesgo at WPH, to gain qualitative feedback on the switch from the patient perspective. Results: All 148 identified patients receiving IV pertuzumab and trastuzumab were switched to SC Phesgo. Of the 148 patients 81 patients were receiving treatment at WPH, 49 patient evaluation questionnaires were completed;96% of patients were happy with the switch to SC Phesgo. By switching to SC Phesgo there was a weekly average of 48.1 h of chair time saved per week;a 56.9% reduction in chair time for this cohort of treatments and an overall reduction of 5.5% of chair time for the day case unit. In additional to the chair time saved, there was also on average 21.2 nurse hours saved per week;a reduction of 53.5% in nurse time for this cohort and an overall reduction of 4.6% of nurse time for the day case unit. Discussion/Conclusion: By administering SC Phesgo instead of the IV equivalents there have been significant reductions in patient, chair and nurse time. This reduction has help alleviate chair and nurse time capacity issues which were critical prior to the switch in April 2021 due to the COVID19 pandemic. There is an associated cost saving for commissioners despite the number of treatments remaining stable, in March 2021 the cost to the commissioners for all IV pertuzumab and trastuzumab given to breast cancer patients was £320,532.70;in May 2021 this figure (for SC Phesgo) had reduced to £145,956.00. In conclusion the switch the SC Phesgo has improved the patient experience, increased chair and nurse capacity on the day case unit.

8.
Journal of Oncology Pharmacy Practice ; 28(2 SUPPL):29-30, 2022.
Article in English | EMBASE | ID: covidwho-1868952

ABSTRACT

Background: Patient satisfaction with non-medical prescriber (NMP) clinics at the Churchill Cancer Centre (Oxford University Hospitals NHS Foundation Trust) has been reported previously.1 Patient consultations, (face to face or telephone) by prescribing pharmacists in uro-oncology clinics (mostly prostate cancer) have increased significantly and the scope of the role is expanding from cycle 2+clinical reviews to treatment initiation, consent and cycle 1 prescribing. Objectives • To quantify the increase in patient numbers seen or telephoned in prescribing pharmacist clinics, both as whole numbers and as a proportion of the Uro-oncology service (medical oncology). • To identify how the role of the prescribing pharmacist role is expanding to patient care at earlier stages in the treatment pathway. Method: Contribution to the uro-oncology service has been measured using the following parameters (see Table 1). • Number of patient consultations in prescribing pharmacist clinics over the past 12 months, using data from the Trust's Electronic Prescribing and Medicines Administration system. • Proportion of these patient contacts as a percentage of the overall uro-oncology service. • And compared to prior year. Results: In the 12 months to June 2021:- • Uro-oncology prescribing pharmacists have seen or telephoned 61% more patients than the previous 12 months. • 78% of the 889 patient contacts were telemedicine consultations, compared to 20% in the prior 12 months. This is due to the covid pandemic. • The contribution of prescribing pharmacist consultations to the overall uro-oncology service has increased by 7%. Discussion: At the Churchill Cancer Centre two prescribing pharmacists see or telephone an average of 21-24 patients per week. Current scope of the prescribing pharmacist role comprises clinical review of metastatic prostate cancer patients being treated with: luteinizing hormone-releasing hormone (LHRH) agonists, with or without bicalutamide, enzalutamide, abiraterone, docetaxel, cabazitaxel. Clinical consultations typically include: assessment of treatment efficacy and tolerability, prescribing continued treatment, or referral to Consultant, addition of bicalutamide (PSA relapse) or stopping bicalutamide (for PSA withdrawal response), ordering CT or MRI scan if appropriate, managing symptoms e.g. medroxyprogesterone / cyproterone for hot flushes, requesting GP to initiate bone protection (bisphosphonate). The expanding scope of the role includes: liaison with MDT / Consultant for diagnosis and treatment, consenting patient for treatment, cycle 1 prescribing, oral education session prior to starting treatment (patient counselling including safety netting, clinical checks, drug interactions, drug supply). Adherence to treatment pathway (e.g. enzalutamide) to ensure correct blood tests ordered and timing of next clinic review. Conclusion: Prescribing pharmacist clinics enable follow up and treatment of large numbers of uro-oncology patients. The covid pandemic has driven trends for oral systemic anticancer treatment (e.g. enzalutamide) and telemedicine consultations. Expanding the role of the prescribing pharmacist to treatment initiation, patient consent, and cycle 1 prescribing can improve the efficiency of the clinical service and bring opportunities for enhanced skills and development.

9.
Archives of Disease in Childhood ; 107(5):15-16, 2022.
Article in English | EMBASE | ID: covidwho-1868715

ABSTRACT

Aim In March 2020, COVID-19 triggered an NHS directive to reduce face-to-face consultations and adapt to virtual clinics. 1 Hospital pharmacies, each with their own model of care, quickly innovated to ensure patients received their medication safely. The aim of this study was to evaluate the provision of medications optimisation for paediatric patients following virtual outpatient consultations (VOC) and explore potential improvements for future implementations. Method This was a mixed method study using quantitative data;which reviewed medications sent to patients in red, amber, and green categories2 and qualitative data;using patient feedback, to evaluate the processes in three London hospitals. Pathway mapping (PM) sessions, with multidisciplinary team involvement, were conducted across these hospitals to identify areas for improvement and analyse gaps in services. Virtual PM sessions were attended by 30 representatives across the multidisciplinary team including: pharmacists, nurses, consultants, pharmacy technicians, post room attendants;and general, operational, and project managers. Semi-structured questionnaires were used to conduct one to one telephone interviews with patients' families. A separate topic guide was used to interview General practitioners (GP) and primary care network (PCN) pharmacists. The audio recordings were transcribed as 'intelligent verbatim' and analysed using Nvivo. Braun and Clarke's six phases approach was used to conduct an inductive thematic analysis.3 To improve the rigorousness of the study, more than 50% of the transcript were double coded.4 As this was a service evaluation, ethics approval was not necessary. The project was registered with each hospital's clinical audit department. Results The three process maps were analysed and potential improvements for the medicines optimisation pathway were assessed by a paediatric pharmacy subgroup using ease-impact matrix. Potential improvements include: exploration and use of Electronic Prescription Service by secondary and tertiary care, improving communication through Information Technology systems between prescribers and hospital pharmacists, and the creation of a transparent standard operating procedure regarding medication supply following VOC. Seventy-one patients' families across the sites were interviewed between January-May 2021 to reflect on their experience of receiving medications following a VOC. Four GPs and one PCN pharmacist were interviewed in May 2021 to assess on the impact of VOC on primary care. Key reflections from themes generated include the convenience of receiving medications from hospital pharmacies following VOC, satisfaction of the current process, including medicines packaging and medicines information provided to patients and their families. Other reflections included limitations of the current process and its implication on patient safety. Medicines information helplines and education provided by pharmacists were regarded by patients' families and GPs as a valuable attribute. Conclusion Patients' families appreciated the current model of care, however patients' families and primary care healthcare professionals have identified both challenges and suggestions for improvement in delivering the current model. Future research should focus on a mixed mode of integrated care with green and amber medications2 prescribed directly to community pharmacies with clinical screening and counselling conducted by hospital pharmacists.

10.
Archives of Disease in Childhood ; 107(5):9, 2022.
Article in English | EMBASE | ID: covidwho-1868714

ABSTRACT

Aim Develop the hydroxycarbamide prescribing process for sickle cell disease to improve outcomes and patient experience through: implementing electronic prescribing;identifying and addressing non-adherence;optimising doses;improving accessibility of medication and developing a hydroxycarbamide telephone clinic. Method The clinic was planned to be piloted mid-2020 however due to the COVID pandemic requiring more services to be delivered remotely the timeline was accelerated and all patients switched to telephone reviews in March 2020. New patients are commenced on hydroxycarbamide at a face-to-face outpatient appointment which includes counselling and consent, review of baseline bloods, introduction to the telephone clinic and medication counselling. Patients are then eligible for the hydroxycarbamide telephone clinic. Patients attend outpatient phlebotomy for the necessary monitoring blood tests prior to their telephone appointment. At the telephone appointment a virtual review takes place including a review of symptoms, blood results, medication adherence and adverse effects. An 8-12 week supply of hydroxycarbamide is prescribed by a nurse or pharmacist prescriber and sent to the patient's local pharmacy or home address by the hospital outsourced pharmacy. Follow up appointments are made every 8-12 weeks. Patients continue to have face to face medical appointments;the interval is determined by individual patient factors but a minimum of annually. Results In September 2019 (prior to electronic prescribing) an audit of patients who had been on hydroxycarbamide for 9 months or more (n=26) had a mean dose of 21.7mg/kg. A repeat audit in July 2021 showed a mean dose of 26.9mg/kg (n=36). Electronic prescribing has facilitated more accurate prescription records and structured dose escalation. It also supports better monitoring of adherence since it is clear during a review when the next supply should be required. This along with questioning what medication supply patients have at home allows adherence issues to be identified and discussed with patients/carers. An audit of haematology outpatient clinic waiting times prior to implementation showed an average wait time of 82 minutes;one of the recommendations was to implement this telephone clinic. In a patient/carer survey on care during the pandemic, 88% of respondents were happy with the telephone reviews they had received and 82% wished to continue with telephone clinics. Conclusion The results show an escalation in hydroxycarbamide dose which correlates with a higher fetal haemoglobin, this in turn is associated with increased survival.1. This has been facilitated by the increased opportunity to focus on prescribing and medication review. From March 2020 to May 2021, due to the pandemic, dose escalation only took place if patients were admitted with crisis so further improvement may be seen in the future.

11.
Archives of Disease in Childhood ; 107(5):4, 2022.
Article in English | EMBASE | ID: covidwho-1868713

ABSTRACT

Aim On 12 March 2020, the COVID-19 outbreak was declared as a pandemic by the World Health Organisation.1 During this time, paediatric services saw dramatic reductions in children accessing emergency care and routine operations were cancelled, which enabled the paediatric intensive care unit (PICU) team to support the adult critical care expansion by repurposing paediatric beds to open an adult intensive care unit (AICU). Here we describe the pharmacy experience, challenges and learning outcomes faced in converting a PICU to an AICU. Method A trust-wide multidisciplinary critical care tactical group including pharmacy representation was established to coordinate strategy planning, troubleshoot operational and clinical difficulties, and manage communications on a wider scale. Within pharmacy, clinical and operational lead pharmacists led the pharmacy response and supported the front-line pharmacy teams to coordinate and make quick informed decisions to daily challenges. The challenges were made even greater by the need to co-deliver a mixed paediatric/adult unit meaning we had to ensure the safety of both the adults and children receiving medicines. Results Paediatric pharmacy staff were upskilled by the adult critical care pharmacy team, extrapolating existing PICU knowledge and experience and expanding on key differences, as well as offering weekly shadowing opportunities. The use of a mnemonic pharmaceutical tool to review patients enabled paediatric pharmacists to ask the right questions and ensure medicines were managed appropriately. In addition, a quick reference guide to common adult drug doses, bite size educational sessions and use of an app called Clinibee® were developed to disseminate important adult learning points and new guidance. The PICU electronic prescribing system Metavision® was adapted and configured for adult dosing and administration. To reduce prescribing errors and improve safety, doctors on the unit were assigned to either managing adults or paediatric patients. Further informatic changes were required in real time in response to drug supply chain and equipment shortages and changes in clinical policies. A risk assessment of adult medicine stock holding, including high-risk medicines and location of them on the unit helped reduce the risk of mis-selection. Extra nursing support was provided by pharmacy by manufacturing ready to administer injectables and existing medicines management policies adapted. Regular check-ins and staff huddles kept staff updated and provided support where needed. Conclusion Providing an AICU on PICU was one of the biggest challenges ever faced but provided excellent cooperation and collaboration between pharmacy teams. PICU pharmacists have a strong foundation of ICU knowledge to enable them to be redeployed to AICU. Strong clinical and operational leadership is required to navigate uncertain times when staff are working outside their normal practice. Good communication is vital, both upwards, downwards and to the front line to ensure safe ways of working. Resilience planning including staffing, drug and equipment shortages ensured that resources were prioritised. Teamwork with a dedicated focus on wellbeing enabled staff to be supported where needed and ensured our patients received the most clinically effective care.

12.
Irish Journal of Medical Science ; 191(SUPPL 1):S22-S23, 2022.
Article in English | EMBASE | ID: covidwho-1866674

ABSTRACT

COVID-19 has changed how healthcare will deliver services. Faced with a shortage of medical staff and appropriate infrastructure, health services face an enormous challenge in managing COVID-19 patients while continuing to care for patients with other pathologies. The development of robust health information systems and digital health solutions is essential in the provision of healthcare services across Ireland now and in the future (1). The purpose of this report is to collate information from articles, government publications and grey literature in order to assess the impact of digital health on transforming healthcare services during COVID-19 internationally and to compare these interventions to the Irish digital health experience. A comprehensive search was undertaken using PubMed and Google Scholar (2019-present). The review covers three countries;Ireland, Scotland and Denmark. These countries were chosen as they have a similar population and demographics to Ireland. Health services and government agencies implemented digital health solutions in order to allow both routine care to continue and COVID-19 testing, tracing and treatment to be optimised. Digital health solutions include;electronic prescribing, electronic referrals, electronic health records, individual health identifiers, telemedicine and mobile applications. These innovations strengthened the Irish, Danish and Scottish response to the COVID-19 pandemic. This study highlights the importance of robust digital health systems during a time of emergency. The COVID-19 pandemic acted as a catalyst for the rapid introduction of digital health solutions in Ireland. The high uptake of these technologies shows the appetite for such digital technologies in health systems across the globe.

13.
Regul. Rapp. ; 18:31-32, 2021.
Article in English | EMBASE | ID: covidwho-1849326
14.
Clinical Osteology ; 26(4):186-190, 2021.
Article in Czech | EMBASE | ID: covidwho-1820623

ABSTRACT

COVID-19 is an emerging infectious disease that has specific characteristics that interfere with the care of patients with osteoporosis. This article discusses the interfaces between osteological issues and COVID-19. A prevalent fracture very modestly increases the risk of death from COVID-19 but in hospitalized patients, the prevalence of vertebral fracture can be considered another aspect of polymorbidity increasing the likelihood of an adverse course of infection. Vitamin D deficiency correlates with worse outcomes in COVID-19, and sufficient vitamin D saturation is very likely protective in relation to COVID-19. Containment measures at the peak of the pandemic may result in muscle loss and increased risk of falls in the elderly. Densitometry and majority of laboratory tests can be easily delayed in patients with osteoporosis. This also applies to parenteral administration of bisphosphonates, whereas continuation of oral bisphosphonate therapy can be ensured by electronic prescription. Teriparatide should not be discontinued for more than 2–3 months, and the interval between denosumab administrations should not exceed 7 months.

15.
International Journal of Pharmacy Practice ; 30(SUPPL 1):i21-i22, 2022.
Article in English | EMBASE | ID: covidwho-1816102

ABSTRACT

Introduction: Community pharmacy has played a frontline role during the COVID-19 pandemic (1,2). Governments and professional organisations in the United Kingdom and Republic of Ireland (RoI) have acknowledged the need to support and maximise community pharmacy to maintain delivery of patient care. However, the pandemic's impact on day-to-day changes to community pharmacy practice has not been comprehensively examined across the island of Ireland. Aim: To identify changes as communicated by policy and professional bodies to community pharmacy practice across the island of Ireland in preparation for and/or response to the COVID-19 pandemic, and to compare identified changes in Northern Ireland (NI) and RoI. Methods: Government, health service, regulatory and professional organisation websites in both NI and RoI were searched using relevant search terms (e.g. pharmacist, COVID- 19). Any document (e.g. official publications/reports, website pages, circulars) containing information relating to changes to community pharmacy-related infrastructure, funding/resourcing, legislation, guidelines or policies in preparation for, and/ or response to, COVID-19, published between 1st January and 31st October 2020 was included. Guidelines on clinical use of medicines were excluded as this was considered a separate topic. Initial screening of each website was undertaken by one reviewer. Brief details of potentially relevant documents were collated in a spreadsheet. Following removal of duplicates, full-texts of identified documents were assessed for inclusion by two reviewers independently, with discrepancies resolved through discussion. A content analysis was undertaken. Results: In total, 253 documents were identified. Following removal of duplicates and screening, 98 documents were included in the analysis. Most documents were published in the first three months of the pandemic (March-May 2020). A key theme related to medication prescribing and supply, with changes implemented to ensure continued access to medicines. In both NI and RoI, significant changes were made to emergency supply arrangements (e.g. increase in allowable duration of supply at the request of patients). In RoI, legislative changes were made to recognise Healthmail as the national electronic prescription transfer system and to temporarily extend prescription validity. In NI, many community pharmacy services (e.g. Minor Ailments Service, Medicines Use Review) were 'stood down' during initial months of the pandemic. Much of the communication in NI and RoI related to operational changes to ensure business continuity. In both jurisdictions a temporary register of pharmacists was introduced to allow previously registered pharmacists to contribute to the health service response. Additionally, in NI, General Dental Practitioners were redeployed to assist with community pharmacy response. Other areas of focus across both jurisdictions included infection control within a workplace setting, dealing with situations where staff were affected by COVID-19, and the use of personal protective equipment during pharmacy service provision. Conclusion: This study examined changes in community pharmacy practice across two jurisdictions during the COVID-19 pandemic. Whilst our searches were limited to publicly accessible documents only, the overlap in identified changes reflects the similarities in challenges faced by community pharmacists in adapting and responding to COVID-19. The cross-country comparison may help pharmacists and policy-makers to identify optimal approaches for responding to any future public health crises.

16.
Annals of Emergency Medicine ; 78(4):S42-S43, 2021.
Article in English | EMBASE | ID: covidwho-1748275

ABSTRACT

Study Objectives: Providing access to primary care after an emergency department (ED) visit can reduce hospital admissions, improve chronic disease management and reduce repeat (ED) visits. A significant number of patients presenting to our institution either do not have a Primary Care Provider (PCP) or are unable to obtain a timely follow-up with their PCP after ED discharge. The COVID pandemic provided an opportunity to fill this gap by integrating tele-health. We implemented a pilot program called ProPEr Care to provide rapid ED based follow-up in a virtual clinic. This clinic was staffed by either emergency medicine (EM) or dual trained emergency medicine (EM) and internal medicine (IM) physicians with the goal of improving patient outcomes. In addition to addressing medical needs, the clinic physician utilized existing hospital resources such as care coordination and outreach workers to help patients obtain medical insurance and establish long-term primary care. To our knowledge, this program is novel in emergency medicine. Methods: At the time of discharge, the ED physician, at their discretion, can schedule a patient for a ProPEr care clinic visit within the next 7-14 days. An EM or EM-IM trained physician provides the virtual follow-up visit using the Doximity™ platform with video or phone call only options. The goal is to provide a bridge while the patient is in the process of establishing a PCP. We contacted patients via a phone call at least 30 days after their ProPEr care clinic visit and asked a series of 10 follow-up questions. Survey questions were developed based on similar studies from other medical specialties. Data was collected and stored in Microsoft Excel™. Basic demographic data was reported from Tableau™, and survey results were calculated in Microsoft Excel™. Results: The majority of our patients felt they were seen quickly (88%) and that the virtual visit was more convenient than a traditional in-person visit (94%). 72% felt that ProPEr care prevented them from coming back to the ED for the same reason. The ProPEr care clinic was able to arrange referrals for all the patients who needed specialty care (100%) and provided electronic prescriptions for all of the patients who needed refills for their long-term medications (100%). Conclusion: A post ED discharge virtual clinic visit provided by an EM or dual trained EM-IM physicians ensures rapid follow-up care, facilitates specialty referrals and potentially reduces return ED visits. It can also help establish long-term primary care. Future studies should evaluate the cost and benefits of a ProPEr care clinic and its impact on hospital readmissions, and health system utilization. [Formula presented]

17.
Value in Health ; 25(1):S150, 2022.
Article in English | EMBASE | ID: covidwho-1650297

ABSTRACT

Objectives: European studies showed, up to 70% of patients with COVID-19 received antibiotics. In Ukraine, due to the Order of MoH of Ukraine dated 31.12.2020 3094 there is a requirement that antibiotics are contraindicated, they can prescribe only in the presence of laboratory-confirmed bacterial infection or with reasonable suspicion. The study aim was to assess current trends in the consumption of antibiotics in pharmacies during COVID-19 pandemic. Methods: A survey "Assessment of the antibiotic consumption and need for e-prescriptions during the COVID-19 pandemic" was developed. The survey was conducted during postgraduate education using the Google platform. We send 225 and received 205 completed surveys from pharmacists, who have from 5 up 40 work experience years (directors, managers of pharmacies, general pharmacists) from 5 regions of Ukraine. Results: We found that the consumption of antibacterial medicines in 2020, compared to 2019, increased by 50,5%. There were such antibiotics in the greatest consumption: beta-lactames 66.1%;respiratory fluoroquinolones 19.2%;macrolides 14.7% for outpatientsfrom public pharmacies. The analysis showed the most often consumed antibiotics were: azithromycin (65.4%), cefoperazone;(47.6%), cefipim (42.3%), piperacillin sodium, tazobactam sodium (27.5%), meropenem (15.2%). We found that 79.1% of pharmacists consider necessary to more strictly monitoring of the antibiotic prescribing by family doctors. There are 97.5% of pharmacists consider it necessary to release e-prescriptions,reimbursement of antibiotics. Conclusions: A Pharmacist Protocol for the symptomatic treatment of uncomplicated forms of COVID -19 has not yet been introduced in Ukraine, but 83.1% o of pharmacists considered that this protocol is necessary for good pharmacy practice in pandemic. There is prospective to implement e-prescriptions of antibiotics from pharmacies and reimbursement during a COVID-19 pandemic. Pharmacists indicated that patients often take antibiotics without a prescription, which can lead to develop of antibiotic resistance and an increase in the treatment cost in future.

18.
British Journal of Surgery ; 108(SUPPL 7):vii117, 2021.
Article in English | EMBASE | ID: covidwho-1585080

ABSTRACT

Background: Antimicrobial stewardship involves a coherent set of actions geared towards responsible use of antimicrobials. NICE antimicrobial stewardship guidance forms the basis for trust wide standards;the surgical department inconsistently complies to these standards. Aims: Use of PDSA framework to improve departmental antibiotic prescribing practices. Methods: Data collection via MeditechTM prescribing records and documentation. 'Snapshots' of antibiotic prescriptions for surgical inpatients taken collecting the following data: •Correct antibiotic prescribed as per guidelines or positive culture results •Antibiotic prescription reviewed within 72 hours •Samples sent for culture and sensitivity •IV prescriptions reviewed if longer than 72 hours Cycle 1 data collection in August/September 2020, followed by a presentation distributed to junior doctors detailing importance of accurate prescribing. Cycle 2 data collection in October/November 2020 was followed by a summary of documentation/prescribing guidelines being circulated to surgical juniors. The final data collection period took place in November 2020. Analysis via Chi-Squared test. Results: Interventions improved prescribing of correct antibiotics (75 to 89.3%), and documentation of IV antibiotic prescriptions with courses longer than 72 hours (p<0.05). Similar insigificant improvements observed with reviewing prescriptions within 72 hours and samples sent to microbiology. Discussion: Low frequency of samples sent to microbiology as antibiotics often used for surgical prophylaxis and continued post-operatively without prior cultures. Brief documentation on the ward round, accentuated by constraints enforced by Covid-19 pandemic. Conclusion: Positive changes can be achieved from simple interventions. Sustainable changes in prescribing practices require engagement of entire clinical team and amendments to electronic prescribing.

19.
Blood ; 138:1924, 2021.
Article in English | EMBASE | ID: covidwho-1582326

ABSTRACT

Introduction There is growing evidence to support SACT 30-day mortality rate as a key metric for assessing quality of cancer care and a key indicator of avoidable harm to patients from SACT due therapy-related or poor patient selection factors. This has been established for solid organ malignancy. However, data in patients with hematologic malignancy is limited. At the Gloucestershire Hospitals NHS Foundation Trust, a large district general hospital providing specialist care to over 600,000 people, we collated data from our in-house SACT dataset to assess factors that impact the 30-day SACT mortality and establish a benchmark for multidisciplinary, educational mortality meeting discussions on mortality in patients receiving SACT. We aimed to review cases characterizing patients, causes of death and the role of SACT in deaths. Methods This retrospective study included all patients aged 18 years or older with a hematologic malignancy who received SACT between Jan 1, 2016, and Mar 31, 2021, irrespective of the number of previous treatment cycles or regimens and irrespective of their response within the disease trajectory. SACT was defined as any cytotoxic chemotherapy, immunotherapies such as monoclonal antibodies, and targeted biological treatments. We calculated 30-day mortality after the most recent cycle of SACT for these patients. We analyzed whether patient, tumor type, and therapy-related factors were associated with the risk of 30-day mortality. Results A total of 1903 patients with hematologic malignancy received SACT. The 30-day mortality rate for our center was 3.89% for patients receiving SACT and 4.9% of all-cause mortality. In the 30-day mortality cohort the median patient age at death was 71 years (interquartile range (IQR) 52-86);ratio of men to women, 1.18. 30-day mortality increased with age for patients treated with palliative intent or intent to remission (OR 4.9, 95% CI.985-26.255;p=0.0171). Median duration of 30-mortality post SACT was 17 days (IQR 8-22). The commonest malignancy was plasma cell dyscrasias (54%) and 68% receiving treatments with intent to remission. ECOG performance status was 0-2 at final SACT cycle in 65%, 3 in 27% and 4 in 8%. 47% of patients were receiving their first cycle (median number of cycles received 2;IQR 1-3) and 43% receiving first line therapy (median lines of therapy 2;IQR 1-3). Therapy naïve patients had significantly higher 30-day mortality than those who received previous SACT (OR 3.435, 95% CI 2.06-5.66;p<0·0001). 42% of deaths occurred in hospital and 54% were attributed to primary refractory and/or aggressive disease. Other causes of death included infection (19% neutropenic, 15% non-neutropenic) including COVID-19 (3%), major bleed (5%), thromboembolism (1%) and cardiac event (1%). Conclusions SACT data provides “real world” assessment of treatment patterns and outcomes in routine malignant hematology practice. It highlights the importance of systematic data collection and analyses to better inform factors associated with higher risk of 30-day mortality in patients with hematologic malignancy, which ultimately promotes review of clinical decision making and offers an opportunity for service improvements. Our findings shed light into some of the factors that affect the risk of early mortality of patients with hematologic malignancy and provides a way to measure if the health service is improving. The insights into risk factors for 30-day mortality will aid in better understanding for treating clinicians and their patients on predictors of potential harms and benefits of SACT thereby carefully balancing patients' personalized expectations with representative outcomes and treatment risks and should be the focus of discussions about SACT, particularly in pretreated or older patient groups. Neutropenic sepsis remains a significant cause of SACT related mortality warranting further improvements in care. Prospective case discussions together with this retrospective review have generated service improvements at our center including standardizing chemothe apy helpline pathways, systematizing SACT mandatory data recording on e-prescribing system and mandatory response assessments as part of SACT protocols' review. Future research work to examine outcomes based on subtypes of hematologic malignancy and on larger datasets is critical for improving our understanding at delivering the right drugs to the right patients. Disclosures: No relevant conflicts of interest to declare.

20.
Healthcare (Basel) ; 8(4)2020 Dec 15.
Article in English | MEDLINE | ID: covidwho-993526

ABSTRACT

BACKGROUND: E-prescribing is the most important achievement in the automation of the healthcare sector in Poland. Obligatory electronic prescribing came into force on 8 January 2020. This innovation significantly changes the work of doctors. Therefore, it is useful to identify the factors that have an impact on doctors' acceptance levels for the new technology. METHODS: This study employs a survey based on the Unified Theory of Acceptance and Use of Technology (UTAUT) method. Our questionnaire was completed by 144 family doctors in Poland during the technology implementation phase and the initial period of obligatory e-prescribing, between 1 December 2019 and 1 March 2020. RESULTS: The results of the survey indicate that doctors do not believe that e-prescribing improves the effectiveness of their work. In addition, this attitude does not depend on the age of the respondent. We also found, regarding the influence of societal attitudes, that doctors only rarely consider the opinions of others in relation to their job. CONCLUSIONS: The implementation of new technologies in the healthcare system must be accompanied by consideration of how user-friendly the technologies are, and whether the users will have appropriate technical and financial support.

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