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Background Drugs returned by patients have to be managed properly. Purpose To analyse drugs returned by patients and the associated financial impact after the implementation of a quality system (corrective action to ensure traceability of these drugs). Materials and methods Retrospective descriptive study of returns recorded after implementation of the improved procedure for ‘return of drugs for the patient’, from March 2011 to June 2013. The auxiliary records the return in formalised form indicating date, name of the patient, drug, number of units, batch and expiry date. The pharmacist validates the return based on a decision algorithm allowing the acceptance or rejection of the drug, taking into account whether it is in date, the physical appearance of the product and the storage conditions at home. If the drug is accepted, it is recorded back in the APD-Prism software and is labelled with ‘Return accepted drug’ so it can be traced to the patient to whom the returned medicine is dispensed. WE analysed the number of patients who returned drugs, units of returned drugs, therapeutic group of returned drugs (according to ATC classification), causes of the return and the financial impact associated with returned drugs. Results During the study period, 132 patients out of 1811 returned 77 different drugs corresponding to 400 lines of returns and 10,377 returned units. The main therapeutic groups and amounts of returned units were: J05 antivirals (44.7%), L01 antineoplastics (23%), J01 anti-infectives for systemic use (5.7%), C02 antihypertensives (4.4%), L04 immunosuppressants (4.3%), L03 immunomodulators (3.8%) and L02 endocrine drugs (3.3%). Returned drugs were accepted for the following reasons: end of treatment (31%), change of treatment (21.8%), death (12%), less than the expected treatment duration (11.8%), change of dose (11.3%), adverse reactions (10.3%), did not start the treatment (1.3%) and patient transfer (0.5%). The total value of returns was 188,862 € (0.77% of total), of which 4.6% were not accepted due to being expired (30%), defective (30%), badly stored (20%) and to opening of the primary multi-dose container (abiraterone) (20%). Conclusions A standard procedure for return of drugs facilitates the traceability of drugs and optimises the use of resources allocated to the budget line of drugs. It should inform patients of the importance of returning drugs no longer needed and their proper storage. The cost opportunity in the repackaging of drugs dispensed in the outpatient area should be discussed. No conflict of interest.

Background Satisfaction surveys are an important tool for ascertaining patient opinions. Purpose To evaluate the degree of satisfaction with interferon beta-1a pre-filled pens and patient preferences. Materials and methods We conducted a survey of patients who were treated with interferon beta-1a after the change from syringe to pre-filled pen. The survey, conducted by the pharmacist after the second device had been dispensed in the Outpatient department, picked up the following aspects: a) self-administration (yes or no), b) ease of use (preparation and injection), rated from 0 (more difficult) to 10 (easier), c) adverse effects (pain, hematoma, induration, redness and swelling and flu-like symptoms), d) preference for syringe or pre-filled pen and reason, e) overall satisfaction, rated from 0 (lowest) to 10 (highest). The assessment of pain at the injection site was measured by a visual analogue scale (VAS). Results All patients (44) completed the survey. 84% self-administered with the pen. The average score received both for ease of preparation and injection was 9. 9% did not like the pen because they had difficulty with device preparation and 2.3% because the safety lock release had failed. Adverse effects experienced: hematoma (13.6%), induration (13.6%), redness and swelling (6.8%) and flu-like symptoms (6.8%). Pain at the injection site obtained an average of 2.14. 88.7% preferred the pen, the main reason was ease of injection (56.4%) and other reasons were: the need to spend less time (25.7%), ease of preparation (7.7%), reduced pain (5.1%) and less anxiety due to the injection (5.1%). The overall patient satisfaction was 8.7. Conclusions The degree of satisfaction was high; some patients did prefer the syringe but weren’t given the option of continuing to use it. The majority preferred the pre-filled pen because of the ease of use. They agreed with the goal of changing the presentation in the Pharmacy Service. The change did not cause an increase in the perception of adverse reactions associated with the device. No conflict of interest.

Background Hepatitis C virus (HCV) infection is a major health problem in the western world. Current treatment with interferon (IFN) and ribavirin (RBV) is able to produce a sustained virological response in approximately 50% of patients with genotype-1. Telaprevir (TPV) represents a change in the treatment of HCV. Purpose To describe the proportion of patients who had undetectable plasma HCV-RNA at week 4 and 12 of treatment, the haemoglobin and platelets level during treatment and the most frequently reported adverse events. Materials and Methods We conducted a retrospective study of all patients who started triple therapy in 2012. We collected demographics (age and sex), genotype, pre-treatment response, haemoglobin, platelets, plasma HCV-RNA at weeks 0, 4 and 12 and reported adverse events. Results Since January 2012, 9 patients began treatment with RBV+IFN+TPV with a mean of age of 49 (SD:6.2). 89% were male. Genotype-1a was predominant (95%). Five patients were previous non-responders, three were relapsers and one was missing. The mean haemoglobin at weeks 0, 4 and 12 was 15.5 (SD:1.2), 13.0 (SD:1.7), and 11.3.(SD:1.9) mg/dl respectively and the mean platelets at week 0, 4 and 12 were 217 (SD:142.4), 132 (SD:46.2) and 121 (SD:33.9) respectively. The mean of plasma HCV-RNA at the beginning was log 6.55 (SD:0.39). At week 4, 8 patients (88.9%) had undetectable plasma HCV-RNA and 1 had to discontinue treatment (HCV-RNA: log5.63). At week 12, 7 patients had undetectable plasma HCV-RNA. One patient had to discontinue treatment due to severe anaemia. The most frequent adverse event was anaemia (89%); in two cases it was even necessary to administer erythropoietin. Other adverse events were rash, fatigue and haemorrhoids. Conclusions Our rate of undetectable plasma HCV-RNA at week 4 is high (89%) which allowed TPV to be suspended at week 12 and RBV+IFN treatment to be shortened to 24 weeks. Anaemia was the major serious adverse event reported. No conflict of interest.

Background The increase in drug spending and the decrease in resources make it necessary to look for strategies for minimising costs. Purpose To describe the strategy for administering high-consumption intravenous drugs (IVd) directly and estimating the associated resources saved in an Intensive Care Unit (ICU). Materials and Methods We obtained a list of drugs whose consumption in the ICU was more than 1,000 units/year. After a literature review, we selected those that could be safely administered via IVd but are usually administered in intermittent intravenous infusion. We prepared a table containing instructions for their reconstitution and administration. For four weeks two nurses administered the medicines that had been prescribed and were included in the table via IVd, recording: drug, time spent in preparation & administration and adverse reactions related to the route of administration. After collecting data We estimated the direct cost savings in fluids if all drugs consumed by the unit and included in the table had been administered by IVd during 2010. We compared the time spent on the preparation and administration of drug doses used in routine practise versus time used to implement this strategy. Results The ICU used more than 1,000 units/year of each of 39 intravenous drugs, of which 12 were included in the table: metoclopramide, colistimethate, hydrocortisone, phytonadione, pantoprazole, amoxicillin/clavulanic acid, dexamethasone, piperacillin/tazobactam, furosemide, methylprednisolone, meropenem and ranitidine. The nurses made 117 administrations via IVd (following the usual procedure) of these drugs. The average time was 6.5 minutes for preparation and administration of each dose and no adverse reactions were detected related to the route of administration. We estimate the ICU can save 28,000€/year. Conclusions Direct IV administration can be safe and efficient. The extension of a programme of this type throughout the Hospital could increase efficiency and rational use of medicines significantly. No conflict of interest.

Background A growing body of evidence suggests that proton pump inhibitors (PPIs) may adversely interact with clopidogrel, diminishing the antiplatelet effect. The potential for increased risk of thrombotic complications warrants cautious use of this drug combination. When concomitant clopidogrel and PPI treatment is considered necessary, pantoprazole or ranitidine may offer a safe choice. Purpose To analyse the prescription profile and financial impact of an alert that was added to the assisted electronic prescription program (EPP) and is triggered by a prescription for concomitant clopidogrel and omeprazole treatment. A safer choice that is pantoprazole or ranitidine is suggested to assist health professionals. Materials and methods Retrospective cohort study. Period A (before this alert was added) April–June 2010: pantoprazole was the only PPI included in the hospital9s formulary and Period B (after this alert was introduced) April–June 2011: omeprazole and pantoprazole as the low cost and the alternative options respectively for prescribing PPIs. The authors looked at all the clopidogrel prescriptions in both periods of study. Patient code, age (years), gastric protector drug (none, omeprazole, pantoprazole, ranitidine), dose (mg/day) and treatment cost/day data were collected from the EPP. Main outcome and measures: number of patient with PPIs as the treatment for gastric protection and average treatment cost/day. Statistical analysis: OR with its 95% CI and t-test were used to compare the two periods. Results A total of 360 patients were included in Period A (70% men) with a mean age of 72.2 (IC 95% 70.8 to 73.5) and 327 in Period B (68.9% men) with a mean age of 72.5 (IC 95% 71.2 to 73.8). The change from Period A to Period B was: the percentage of patients treated with a PPI fell from 68.9% to 24.7% (OR=0.15; IC 95% 0.11 to 0.21; p Conclusions The prescription profile for PPIs was modified by the introduction of the alert. Fewer patients taking clopidogrel are now being prescribed a PPI and a safer drug is used more often. The cost per patient is now lower.