Search

Background It is known that drug shortages represent a major challenge for all stakeholders involved in the process, but there is little evidence regarding insights into patients′ awareness and perspectives. This study aimed to investigate the patients-perceived drug shortages experience and their view on outcomes in different European hospital settings. Furthermore, we wanted to explore information preferences on drug shortages. Methods A retrospective, cross sectional, a mixed method study was conducted in six European hospital settings. One hospital (H) from each of this country agreed to participate: Bosnia and Herzegovina (H-BiH), Croatia (H-CR), Germany (H-GE), Greece (H-GR), Serbia (H-SE) and Poland (H-PO). Recruitment and data collection was conducted over 27 months from November 2017 until January 2020. Overall, we surveyed 607 patients which completed paper-based questionnaire. Questions related to: general information (demographic data), basic knowledge on drug shortages, drug shortages experienced during hospitalization and information preferences on drug shortage. Differences between hospital settings were analyzed using Chi-squared test or Fisher’s exact test. For more complex contingency tables, Monte Carlo simulations (N = 2000) were applied for Fisher’s test. Post-hoc hospital-wise analyses were performed using Fisher’s exact tests. False discovery rate was controlled using the Bonferroni method. Analyses were performed using R: a language and environment for statistical computing (v 3.6.3). Results 6 % of patients reported experiences with drug shortages while hospitalized which led to a deterioration of their health. The majority of affected patients were hospitalized at hematology and/or oncology wards in H-BiH, H-PO and H-GE. H-BiH had the highest number of affected patients (18.1 %, N = 19/105, p N = 1/100, p = 0.001). In addition, 82.5 %, (N = 501/607) of respondents wanted to be informed of alternative treatment options if there was a drug shortage without a generic substitute available. Majority of these patients (66.4 %, N = 386/501) prefer to be informed by a healthcare professional. Conclusions Although drug shortages led to serious medical consequences, our findings show that most of the patients did not perceive shortages as a problem. One possible interpretation is that good hospital management practices by healthcare professionals helped to mitigate the perceived impact of shortages. Our study highlights the importance of a good communication especially between patients and healthcare professionals in whom our patients have the greatest trust.

Objectives A suspension for oral use which consists of three non-absorbable antibiotics (amphotericin B, colistin and tobramycin) is often used in clinical practice for the selective decontamination of the digestive tract (SDD) of patients in intensive care. Such a therapy is a preventive tool to minimise the risk of pneumonia and bacteraemia in intubated patients. The administration and the treatment results are controversially discussed. One limiting factor for a unique SDD treatment in the hospitals is a lack of adequate data regarding batch formula and stability for such a formulation. Since no detailed procedures, specifications or stability data are available for manufacturing this formulation there may be discrepancies regarding formulation and stability of suspensions prepared in different pharmacies. The aim of this research was to collect the physicochemical and microbiological stability data of a developed, stable standard formulation under defined storage conditions. The effectiveness of the SDD suspension should be preferably proven over a long period. This would help guarantee that all patients receive the same preparation, therefore, ensuring similar efficacy and improved safety. Methods An adequate formulation composed of the registered, marketed medicinal product Ampho-Moronal suspension (Dermapharm AG, Germany) and a buffered, preserved aqueous solution of colistin and tobramycin both as sulfates has been developed. A stability study has been performed on two batches of the formulation. During the storage, samples were taken and compatibility was verified by physicochemical and microbiological testing in stability-indicating terms of colour, odour, flavour, pH, chemical and microbiological purity as well as in vitro potency. The test methods were built and tailored to be suitable, reliable and precise for the test needs. Results The results show the physicochemical and microbiological stability of the described formulation for defined storage conditions. Conclusions A standardised formulation with a proven stability for at least 6 months under fridge (5°C±3°C) conditions for the SDD of patients in intensive care was established.

I feel enormously honored today to be receiving the Donald E. Francke Medal, and I wish to express my gratitude to the ASHP board of directors, who approved the award. Unlike many of the previous recipients of this prestigious award, I was never able to meet Donald Francke or his wife Gloria

OBJECTIVES: To assess knowledge deficits of patients/parents and prevention strategies. METHODS: After receiving ethics approval, we performed a controlled, quasi-randomised, prospective intervention study. We enrolled patients/parents involved in managing oral medicines in three groups: control (routine care only), handbook intervention and pharmaceutical counselling intervention group. At baseline and after the interventions, we assessed patients’/parents’ knowledge deficits (incorrect or missing answers) by questionnaire. RESULTS: We enrolled 64 patients/parents. At baseline, knowledge deficits among the groups were similar: 17% in controls, 22% in the handbook group and 24% in the pharmaceutical counselling group. After the intervention, knowledge deficits decreased to 13% in the handbook group and to 8% in the pharmaceutical counselling group (NS; p=0.003 compared with controls, respectively). For controls, knowledge deficits remained almost unchanged (19%). Results for the pharmaceutical counselling group showed a strong correlation between baseline knowledge deficits and the extent of the deficit decrease after the intervention (τ=−0.74; p

Objective We performed a retrospective chart analysis in neonates routinely treated with levetiracetam (LEV) in a university setting. Patients and Methods We assessed clinical characteristics of the included neonates. Documented LEV doses and the duration of treatment were evaluated. To assess LEV effectiveness, we compared the need of any additional anticonvulsant as co- and rescue therapies before and following the initiation of LEV treatment. To assess LEV tolerance, we sought to identify documented adverse drug reactions resulting in a termination of LEV treatment. Results We analyzed a total of 72 neonates receiving LEV with a median gestational age at initiation of LEV treatment of 30 4/7 gestational weeks (min., 24 5/7 /max., 43 0/7 weeks). LEV was applied in target doses of 41.7 mg/kg/d (min., 14.4/max., 106.2 mg/kg/d). Patients received LEV treatment at hospital for a median of 28 days (min., 1/max., 195 days). Additional anticonvulsant therapy decreased a week after LEV treatment was initiated ( p = 0.008). We did not find any cases of terminated LEV treatment resulting from adverse drug reactions. Conclusion Long term use of high LEV doses is rather frequent in immature neonates. Our data indicate good effectiveness and a low risk of adverse drug reactions.

A suspension comprising of the three antibiotic substances amphotericin B, colistin sulfate and tobramycin sulfate is often used in clinical practice for the selective decontamination of the digestive tract of patients in intensive care. Since no detailed procedures, specifications or stability data are available for manufacturing this suspension, there may be discrepancies regarding formulation and stability of suspensions prepared in different pharmacies. The aim of this work is to develop a standardized formulation and to determine its stability under defined storage conditions. This would help guarantee that all patients receive the same preparation, therefore ensuring similar efficacy and improved safety. The first step in this process is to develop the required analytical tools to measure the content and purity of the drug substances in this complex mixture. In this paper, the development and validation of these tools as well as the development of the drug suspension formulation is described. The formulation comprises of Ampho-Moronal(®)-Suspension (Dermapharm) and a buffered, preservated aqueous solution of colistin sulfate and tobramycin sulfate. Two simple, well established high-performance liquid chromatography (HPLC) methods in the European Pharmacopoeia (EP) for impurity profiling of the two active ingredients amphotericin B and colistin sulfate were combined with a newly developed sample extraction procedure for the suspension. Sufficient selectivity and stability-indicating power have been demonstrated. Additionally, a new robust routine method was developed to determine possible degradation products of tobramycin sulfate in the investigated suspension. The specificity, precision, accuracy and linearity of the analytical procedures were demonstrated. The recovery rate was in the range of 90-110%. The precision results for the calculated impurities showed variation coefficients of10%. The calibration curves were found to be linear with correlation of greater than 0.9994 for all components. The results show the suitability of the methods for the quality control analysis of the suspension.

ZusammenfassungEinleitung: Salbutamol ist wirksam bei akuter bronchialer Obstruktion. Jedoch können Medikationsfehler in der Salbutamoltherapie unerwünschte Arzneimittelereignisse verursachen. Wir untersuchten daher die Verordnung von Salbutamol in der Routineversorgung.Methoden: Wir analysierten Salbutamolverordnungen konsekutiver Patienten einer allgemeinpädiatrischen Station. Wir verglichen die verordneten Tagesdosen mit den empfohlenen Dosierungen in der Fachinformation und der Nationalen Versorgungsleitlinie Asthma. Wir untersuchten die intra- und interindividuale Variabilität der Dosierung.Ergebnisse: Im dreiwöchigen Untersuchungszeitraum erhielten 38 Patienten eine Salbutamoltherapie an insgesamt 137 Behandlungstagen. Wir fanden 94 Tage mit erhöhten Tagesdosen (im Median 3,0-fach, Q25/Q75 1,5/4,7; Max. 8,0-fach) und intra- und interindividuell sehr heterogene Dosierungen (Range 7,3-fach).Diskussion: Die Salbutamoldosierung war häufig erhöht und intra- und interindividuell sehr unterschiedlich. Dies birgt ein Risiko für unerwünschte Arzneimittelereignisse und sollte daher eine erhöhte Aufmerksamkeit erfahren.

Objectives To identify incompatible intravenous drug combinations in routine paediatric intensive care and evaluate physician and nurse knowledge. Methods In a university paediatric intensive care unit, intravenous drug incompatibilities were analysed using a database and physician and nurse knowledge of incompatibilities was assessed using a questionnaire. Results We analysed 665 prescriptions in 87 patients. Incompatible drug administration was identified in 9 (10%) of the 87 patients with a median of 3 different incompatibilities per patient (Q25/Q75: 1/3). We found 26 incompatible combinations. The most frequently involved drugs were cefotaxime, pantoprazole and vancomycin. A median of 10 of the 15 drug combinations were correctly assessed as compatible or incompatible (Q25/Q75: 8/11). Pantoprazole had a low number (20%) of correct answers. Conclusions One in 10 patients in paediatric intensive care was affected by drug incompatibility, with knowledge deficits seen in a third of assessed combinations. This indicates quality improvement strategies should be urgently implemented by pharmacists.

Objectives We aimed at identifying drug-related problems in pain therapy and assessed the effect of medication management by pharmacists in routine care. Methods We performed a cohort study consisting of a control (no pharmaceutical service) and a medication management group receiving pharmaceutical services including recommendations to physicians. We defined pharmacotherapeutic and administrative drug-related problems in pain therapy and analysed patient charts to assess the outcomes. Active participants in the study were not involved in study assessment. Outcomes were the number of patients and the number of analgesic prescriptions with drug-related problems. Results We analysed 414 medication records (controls: 208, medication management: 206). Our intervention had no influence on the number of patients with drug-related problems following analgesic prescriptions (control: 166/208, 80% vs medication management: 155/206, 75%, p=0.266). In 98 control group patients (47%), we found at least four drug-related problems. This fraction was smaller in the medication management group, with 66 patients (32%; p=0.002). The number of analgesic prescriptions leading to drug-related problems decreased from controls with 381/627 (61%) to 308/654 (47%) in the medication management group (p Conclusions Current pain therapy standards were not strictly adhered to in routine analgesic prescriptions for orthopaedic patients. The inclusion of pharmacists into the team successfully decreased drug-related problems. However, further interventions are required to achieve optimal effects.

Ziel der Studie: Welchen Effekt hat die interdisziplinare Zusammenarbeit mit Pharmazeuten und Psychologen bei depressiven Patienten? Methodik: In einer 3-armigen (jeweils n = 10) randomisierten Pilotstudie wurde die SB (Standardbehandlung) mit SB + MM (pharmazeutisches Medikationsmanagement) und SB + PB (psychologische Beratung) in Bezug auf Anzahl der Arzneimittelwechselwirkungen, Leitlinienkonformitat, Patientenwissen und Medikamentenadharenz (nach MARS) verglichen. Ergebnisse: Die Anzahl der Arzneimittelwechselwirkungen sank durch MM um bis zu 67 % (p Schlussfolgerung: In einer groseren Patientengruppe sollten diese explorativen Ergebnisse nun verifiziert werden.

> The overarching goal of the hospital pharmacy service is to optimise patient outcomes through working collaboratively within multidisciplinary teams in order to achieve the responsible use of medicines across all settings. With an excellent score of 93.6% of the maximum possible agreement level, participants at the European Summit on Hospital Pharmacy in Brussels approved this first statement leading our profession into 2020 and beyond. The statements are concise sentences setting out tasks and a vision of the skills and competencies we should develop and maintain. Translating the overarching first statement into practice is not easy: ‘optimise’ means excellence should never lead to complacency and that under-developed practice must move step by step towards excellence. Inertia and frustration at a lack of resources are not an option. Creativity is required and we should enjoy each small step aimed at improving the outcome of our patients. Achieving the best outcome for patients is not restricted to pharmacists: the statements are the result of a robust Delphi process where patients, physicians and nurses helped us understand their needs and adapt our practice goals to the entire process. ‘Working collaboratively with multidisciplinary teams’ is a challenge and an opportunity at the same time; a challenge as we have to develop social competency in dialogue with other healthcare professionals and patients, and an opportunity as our skills will be recognised by patients and professionals as we interact with them and take responsibility for our advice. The unknown pharmacist in his pharmacy is not the future of our profession. ‘Responsible use of medicines’ refers to a carefully balanced decision between effectiveness, medication safety, the patient's needs and wishes, as well as financial cost. This is not an easy task especially in times of austerity if the requests of patients do not accord with economic constraints. ‘Responsible’ …

Objectives Research conducted by the European Association of Hospital Pharmacists (EAHP), in collaboration with the EuroPharm Forum, investigated the following: the extent to which pharmacists are in contact with each other; the opinions of pharmacists as to the extent to which continuous care is being achieved; and what are the perceived obstacles in this area. Methods A questionnaire was circulated electronically to the respective memberships of both organisations, and was open from 5 December 2012 to 5 February 2013. Results 534 responses were received, 400 (75%) from hospital pharmacists, 106 (20%) from community pharmacists and 28 (5%) from pharmacists working in both sectors. Most replies came from Italy (183, 34%), Denmark (78, 14%) and the UK (33, 5%). Pharmacists described communication as important or very important (hospital pharmacists (212, 53%), community pharmacists (60, 57%)) at admission. Hospital pharmacists thought that communication was either very important or important to a greater degree than community pharmacists (236, 59% vs 50, 47%) at discharge. 27% (108) of hospital pharmacists reported that they had been in contact with a community colleague ‘last week’. Conversely, over half of community pharmacists replied that they had ‘never’ been in contact with a hospital pharmacist. Limitations Sample size may not be representative, and the role of pharmacy technicians was not included. These results should be interpreted with caution due to the descriptive nature and lack of statistical analysis. Conclusions Communication between the two sectors is infrequent, yet pharmacists feel it is important, especially at transitions of care. Integrated IT systems and improved remuneration systems for clinical services may improve this aspect.

BACKGROUND: Anticonvulsants require special consideration particularly at the interface from hospital to ambulatory care. PATIENTS AND METHOD: Observational study for 6 months with prospectively enrolled consecutive patients in a neuropediatric ward of a university hospital (age 0

Hospital pharmacies in Europe are very involved in the education of pharmacy and medical students as well as in the training of technicians and nurses. The picture is similar regarding internal continuing education (which includes education on patient safety), but full or partial reimbursement of expenses is rare. Hospital pharmacists in Europe are involved in clinical research (mostly for clinical trials), drug evaluation and epidemiology studies. Oncology and general teaching hospitals are the most active in this field with general non-teaching hospitals carrying out less research.

Decentralised clinical services, with a pharmacist working in the ward at least 50% of the time or with pharmacists visiting the ward daily, are not very common in Europe. For-profit hospitals offer the service remarkably less than other hospitals, and 39.8% of hospital pharmacies offer clinical services occasionally. There is a variety of patient oriented clinical activities delivered by European hospital pharmacies, including the provision of drug information, pharmacokinetic consultations, therapeutic drug monitoring, management prevention of adverse drug reactions and medication errors. Hospital pharmacy involvement in managing the interface between primary and hospital care is less common. In general, clinical activities are not well documented. For inpatients, on average, only 14.7% and 21.9% of the hospital pharmacies that took part in the survey said they write down their interventions in the medical records and in pharmacy records, respectively. IT systems are broadly used in the provision of drug information but also in profiling patient medication and for dosage calculations. Patient safety is a major interest of hospital pharmacists and, on average, 55.0% of hospital pharmacies recorded that they have implemented a system to ensure patient safety.

BACKGROUND: With the update of the directive 2005/36/EU on the recognition of professional qualifications (2013/55/EU), the European Union (EU) legislation opened also to pharmacists the possibility to define specialisations via a common training framework (CTF). OBJECTIVE: The aim of this study was to review, synthesise and present published evidence on the impact of health educational interventions targeting healthcare professionals on patients’ health outcomes that support a hospital pharmacy CTF in EU. METHOD: The search was carried out in Medline and Cumulative Index to Nursing & Allied Health Literature and was limited to English language full review articles or primary research published since 2000. Data were extracted independently and compared by three of the researchers. RESULTS: Ten papers (9 primary research studies and one literature review) were identified. Almost one-third of the studies (30%, n=3) targeted pharmacists in their research. The majority of studies (80%, n=8) have shown that higher education levels among healthcare professionals improved patient outcomes. No study discussed the importance of a CTF. CONCLUSION: The review of the literature has demonstrated the need for education and training of health personnel to improve patient outcome. Controlled studies about pharmacist education and training in European countries showed that the benefit of a CTF is lacking.

Imparting knowledge and practical skills in hazardous drug handling in nursing students' education is essential to prevent hazardous exposure and to preserve nurses' health.This study aimed at comparing routine nursing education with an additional innovative teaching session.A prospective controlled study in nursing students was conducted in two study periods: (i) a status-quo period (routine education on handling hazardous drugs) followed by (ii) an intervention period (additional innovative teaching session on handling hazardous drugs).Nursing students at a vocational school were invited to participate voluntarily.In both study periods (i) and (ii), the following factors were analysed: (a) knowledge of hazardous drug handling by questionnaire, (b) practical skills in hazardous drug handling (e.g. cleaning) by a simulated handling scenario, (c) contamination with drug residuals on the work surface by fluorescent imaging.Fifty-three nursing students were enrolled. (a) Median knowledge improved from status-quo (39% right answers) to intervention (65%, p0.001), (b) practical skills improved from status-quo (53% of all participants cleaned the work surface) to intervention (92%, p0.001). (c) Median number of particles/mCompared with routine education, knowledge and practical skills in hazardous drug handling were significantly improved after an innovative teaching session. Additionally, the amount of residuals on the work surface decreased. This indicates a lower risk for hazardous drug exposure.

Quality of parents' performance in administering anticonvulsive rescue medication to their children suffering from seizures is unknown. After obtaining ethical approval, we used a questionnaire to ask parents of children with seizures, who had been prescribed rescue medications, about their experience in administering those. To assess the frequency of actually committed drug-handling errors, we let them administer rescue medications to dummy dolls. An expert panel rated the clinical risk of handling errors from "1" (lowest) to "6" (highest). Eighty-one parents completed the study. In the questionnaire, 85 % (100 %) of parents that already conducted rectal (buccal) administration reported that they had never experienced problems. The number of rectal administrations with at least one handling error (97 %, 58/60) was higher than in buccal administration (58 %; 14/24; p 0.001). According to logistic regressions, previous use of rescue medication was not a predictor of the number of committed errors per process (n. s.). All errors were rated with a high clinical risk (class 4-6).By observing parents' administration of rescue medication to dummy dolls, we found a high frequency of clinically relevant drug-handling errors. Most parents, however, self-reported to have never experienced problems while administering rescue medications to their children.• For seizures with duration of more than 5 min, the administration of anticonvulsive rescue medication is recommended. • Outside the hospital, the administration of rescue medication to children is performed most frequently by their parents. What is New: • Most of the parents reported that they had never experienced problems in handling anticonvulsive rescue medication. • But in the observed drug-handling performances, identified errors committed by parents were alarmingly frequent and pose a high clinical risk according to an expert panel.

The objective of the PHAR-QA (Quality assurance in European pharmacy education and training) project was to investigate how competence-based learning could be applied to a healthcare, sectoral profession such as pharmacy. This is the first study on evaluation of competences from the pharmacists’ perspective using an improved Delphi method with a large number of respondents from all over Europe. This paper looks at the way in which hospital pharmacists rank the fundamental competences for pharmacy practice. European hospital pharmacists (n = 152) ranked 68 competences for pharmacy practice of two types (personal and patient care), arranged into 13 clusters. Results were compared to those obtained from community pharmacists (n = 258). Generally, hospital and community pharmacists rank competences in a similar way. Nevertheless, differences can be detected. The higher focus of hospital pharmacists on knowledge of the different areas of science as well as on laboratory tests reflects the idea of a hospital pharmacy specialisation. The difference is also visible in the field of drug production. This is a necessary competence in hospitals with requests for drugs for rare diseases, as well as paediatric and oncologic drugs. Hospital pharmacists give entrepreneurship a lower score, but cost-effectiveness a higher one than community pharmacists. This reflects the reality of pharmacy practice where community pharmacists have to act as entrepreneurs, and hospital pharmacists are managers staying within drug budgets. The results are discussed in the light of a “hospital pharmacy” specialisation.

The number of hospital pharmacies in Europe producing sterile as well as non-sterile medicines has decreased significantly since 2000. In addition, the number of pharmacies preparing total parenteral nutrition, cytotoxics and intravenous admixtures (24.6%, 43.8% and 8.0% of pharmacies, respectively) is quite low and depends to a large extent on the size of the pharmacies, with larger units generally demonstrating significantly higher production activity. There are some differences between eastern and western Europe. Quality control and good manufacturing practice (GMP) seem to be well implemented (61.3% of pharmacies have adopted GMP) and many pharmacies have external certification.

Hospital pharmacies in Europe are responsible for supplying medicines and 56.2% of them also have responsibility for medical devices. The number of medicines listed in formularies varies from 246 to 1982, with the median being 960. Hospital pharmacies in western Europe usually procure their supplies direct from industry, while in eastern Europe medicines are mainly sourced from wholesalers. Own production is significant only in Denmark. Overall, 45.7% of pharmacies join in an alliance with another pharmacy to purchase their supplies. Distribution is mostly centralised (70.1%) and unit-dose supply is common in a few countries (European average 23.4%). Services are also provided to outpatients by 66% of pharmacies. Robotic dispensing is being implemented in few western European countries (mainly The Netherlands, Portugal and Spain), where in average 3.3% of hospitals used such systems in 2005 increasing to 6.7% in 2010. Approximately one third of hospitals use barcode technology for stock control and manual selection of items. Large hospitals have more automation than small hospitals.

The voting system for the summit was developed with two major aims: first to keep a balance between the groups and second to differentiate the levels of agreement in order to identify implementation priorities. As the European Association of Hospital Pharmacists (EAHP) has 34 members, each with a vote, first it was necessary to weight the votes of patient groups and other healthcare professionals (HCP; ie, physicians and nurses) to achieve a 50:25:25 balance. Each association attending the summit had one delegate. Thus pharmacists had a total 34 votes, while patients and HCP had 17 each. The aim was to avoid one group overruling another through numerical superiority. As 31 EAHP members ultimately attended the summit, this proportion was changed to 31:15.5:15.5. The weighting factor was calculated with the formula:![Formula][1] As 12 patient groups attended the summit, their vote was weighted by![Formula][2] And as seven HCP associations attended the summit, their vote was weighted by![Formula][3] In this way it was impossible for pharmacists to overrule the decisions of patients and HCP just because they were in a majority. Voting on a statement was only valid if at least 90% of the delegates expressed their opinion. Thus, out of the 31+12+7=50 delegates, at least 45 had to vote. A quorum was achieved for all statements and for 34 statements (77%) all delegates voted. The delegates voting had four choices: strongly agreed, agreed, disagreed and strongly disagreed. Each possibility was weighted by points ranging from +2 (strongly agreed) to −1 (strongly disagreed). Strong agreement was defined as ≥85% of the maximum number of points, that is, 85% of the points achievable if all voting delegates had strongly agreed:![Formula][4] Agreement … [1]: /embed/graphic-1.gif [2]: /embed/graphic-2.gif [3]: /embed/graphic-3.gif [4]: /embed/graphic-4.gif

In tertiary care, computerized physician order entries may improve performance, cross-linking, and documentation when prescribing drugs. A clinical decision support integrated in these systems is discussed to prevent additional medication errors. For an optimal performance, the implementation into the clinical information systems is required to gain access to patient data (e. g. from laboratory). In routine care, the question rises whether a benefit of the systems can be proven in clinical studies and whether there is a difference between the systems. To achieve optimal results, these systems should also consider specific requirements, i. e. the patient groups and prescribed drugs in the local setting. We performed a systematic literature evaluation searching for published data in the topic electronic prescribing to assess them in a structured analysis considering medical-pharmaceutical aspects. Additionally, we assessed three databases in German language and one in English language taking drug-drug-interactions as an example to compare the identification of drug-related problems. Medication data from our own patients in a paediatric intensive care unit of a university hospital were analysed by the systems. Our results revealed strengths but also limitations of electronic prescribing.

The third United Nations (UN) Sustainable Development Goal focuses on ensuring healthy lives and promoting well-being for people of all ages.[1][1] One target of this goal is to ensure access to safe, effective, quality, and affordable essential medicines and vaccines for everyone worldwide. While

In 2010, the European Association of Hospital Pharmacists (EAHP) conducted its fourth survey on hospital pharmacy practice in Europe. 4748 heads of pharmacy were contacted in all member states through a network of national coordinators. 1283 hospital pharmacies from 30 countries answered the questionnaire with an overall response rate of 27.0%. The average number of beds served by one pharmacy had not changed since 2005 but there was a decrease in complete and an increase in partial hospitalisation. Pharmacists (27%) and qualified technicians (32%) make up 60% of the total staff. The number of pharmacists/100 beds varies from 0.24 (Bosnia and Herzegovina) to 4.35 (UK). Only a few countries did not experience shortages of pharmacists and technicians. European hospital pharmacy staffing (pharmacists and pharmacy technicians) remains, on average, low compared with the USA and has not grown significantly since 1995. Therefore, it can be problematic to make direct comparisons between hospital pharmacy services in the USA and Europe.

Which effects has the interdisciplinary collaboration including pharmacists and psychologists in depressive patients?In a 3-arm (each N = 10) randomized pilot study, we compared SC (standard care by specialized physicians in a tertiary care center) with SC + pharmaceutical medication management and SC + psychological counselling in respect to the number of drug-drug interactions, guideline conformity, patient knowledge, and medication adherence (according to MARS).The number of drug-drug interactions decreased by the MM up to 67 % (p 0.05). Guideline conformity was fulfilled in all groups before and after intervention. Patient knowledge and medication adherence were not influenced by additional medication management or psychological counselling.In a greater patient group, these explorative results should now be verified.

Background The acronym LASA (look-alike sound-alike) denotes the problem of confusing similar- looking and/or sounding drugs accidentally. The most common causes of medication error jeopardizing patient safety are LASA as well as high workload. Case presentation A critical incident report of medication errors of opioids for postoperative analgesia by look-alike packaging highlights the LASA aspects in everyday scenarios. A change to a generic brand of medication saved costs of up to 16% per annum. Consequently, confusion of medication incidents occurred due to the similar appearance of the newly introduced generic opioid. Due to consecutive underdosing no life-threatening situation arose out of this LASA based medication error. Conclusions Current recommendations for the prevention of LASA are quite extensive; still, in a system with a lump sum payment per case not all of these security measures may be feasible. This issue remains to be approached on an individual basis, taking into consideration local set ups as well as financial issues. Electronic supplementary material The online version of this article (doi:10.1186/s13037-014-0047-0) contains supplementary material, which is available to authorized users.

Solid dispersions of bendroflumethiazide (BFMT) in polyethylene glycol 6000 (PEG) and Poloxamer 188 were stressed by heating at various temperatures between 22 and 55 °C, under either 0 or 75% relative humidity (RH). In solid dispersions at 75% RH as well as in aqueous solution, BFMT hydrolyzed as expected. However, BFMT in the solid dispersions hydrolyzed even at 0% RH. A maximum in hydrolysis was observed at 25 and 13 μmol · g−1 for PEG 6000 and Poloxamer 188, respectively. After a lag time of 10 days, hydroflumethiazide (HFMT) was detected in both solid dispersions of BFMT. HFMT is formed by the reaction of the hydrolysis product of BFMT with formaldehyde, which is a degradation product of the polymers. High humidity promotes this reaction.

In stressed solid dispersions of bendroflumethiazide in polyethylene glycol 6000, in polyvinylpyrrolidone K 25, and in Poloxamer 188, associates are postulated to be formed. The effects of the factors, concentration, process of manufacture, pH, relative humidity, and temperature, were investigated by factorial design studies. After about 25 days, a steady state in associate concentration was observed. The formation of these associates is promoted mainly by low percentiles of the guest, high temperature close to the melting point of the solid dispersions, and relative humidity.

Polyvinylpyrrolidone K 25 decreases the solubility of bendroflumethiazide (BFMT) in water at 25 °C at concentrations below 2% (w/v) at pH 7.1 and below 1% (w/v) at pH 1.95, and enhances it above these concentrations, while polyethylene glycol 6000 and Poloxamer 188 continuously enhance this solubility in concentrations up to 5% (w/v). Associates are postulated to be formed, when solid dispersions of BFMT in these polymers are stressed climatically. The amount of BFMT bound in such associates is simply and quickly quantified with an acceptable experimental error by HPLC.

Since anticonvulsants such as valproate or oxcarbazepine have quite a disadvantageous profile of possible adverse drug events (ADEs), safer alternatives are being sought. The newer anticonvulsant levetiracetam is often considered advantageous. We performed a chart review of children and adolescents aged from 0.5 to 16.9 years, who had been started on an initial monotherapy with levetiracetam, valproate, or oxcarbazepine between 2007 and 2011, in order to analyze the therapy’s failure rate during the first year. We differentiated failure of monotherapy due to a lack of effectiveness and due to ADEs. No psychometric tests were performed. Lack of effectiveness and inacceptable ADEs were assumed according to the judgment of physicians and families. Anticonvulsive monotherapy failed in 29/61 (48 %) levetiracetam patients and in 18/49 (37 %) valproate patients (for focal and generalized epilepsies; n.s.). This was caused by a lack of effectiveness in 25/61 (41 %) levetiracetam patients and in 11/49 (22 %) valproate patients (p ≤ 0.05). A modification of therapy due to ADEs was performed in 4/61 (7 %) levetiracetam patients and in 7/49 (14 %) valproate patients (n.s.). An anticonvulsive monotherapy failed in 21/42 (50 %) patients treated with levetiracetam and in 10/34 (29 %) patients treated with oxcarbazepine (for focal epilepsies; n.s.). Changes of monotherapy were caused by a lack of effectiveness in 17/42 (40 %) of levetiracetam patients and in 6/34 (18 %) of oxcarbazepine patients (p ≤ 0.05). ADEs leading to changes in therapy were reported for 4/42 (10 %) of levetiracetam and 4/34 (12 %) of oxcarbazepine patients (n.s.). An initial monotherapy of levetiracetam failed more frequently due to a lack of effectiveness than a monotherapy with valproate or oxcarbazepine. We found no significant difference in therapy failure due to ADEs.

A method for the determination and quantitation of bendroflumethiazide (BFMT) and its degradation products hydroflumethiazide (HFMT) and 5-trifluoromethyl-2, 4-disphamoylaniline (TFSA) using RP-HPLC is described. Good reproducibility and accuracy of the assay can be achieved without the use of a buffer solution in the mobile phase. A pH of 2.0 of the solvent and the use of dark flasks will be important to give a good stability of the samples during automatic injection. The limits of detection for BFMT, HFMT and TFSA were respectively 1.3, 0.8 and 0.7 μ/ml (α = 0.05).

It has often been said that the best way to predict the future is to create it. It was with this thought in mind that the Board of the European Association of Hospital Pharmacists (EAHP) realised the need for the hospital pharmacy profession in Europe to more precisely chart and define the future practice goals and roles that it should achieve in all European countries. This was the essence of the European Summit on Hospital Pharmacy, and the 44 European Statements of Hospital Pharmacy that it created. The statements now form the primary foundation for delivering EAHP's practice development mission, and a charter for improving patient care in hospitals that every EAHP member country can make use of. This special edition of the European Journal of Hospital Pharmacy explains more about the purpose and intent of the statements and the reason they matter for practice improvement in all European health systems. The project took as its basis the excellent work of the International Pharmaceutical Federation (FIP)'s hospital pharmacy section … Correspondence to Dr Roberto Frontini, European Association of Hospital Pharmacists, Rue Abbe Cuypers. 3, Brussels B-1040, Belgium; president{at}eahp.eu

Dr Roberto Frontini, President of the European Association of Hospital Pharmacists, explains the concepts behind the European Summit on Hospital Pharmacy, and why its outcomes should positively impact practice in all European countries. Anniversaries offer a productive opportunity to reflect on the past and contemplate the future. And so it was that in 2012, as we marked the 40th anniversary of the European Association of Hospital Pharmacists, we contemplated how best to continue the pursuance of our guiding mission: to develop and represent the hospital pharmacy profession at the European and international levels. At this time we were also reviewing the findings of the largest ever survey of hospital pharmacy practice in Europe, conducted over the course of 2010, and published in full by the European Journal of Hospital Pharmacy last year. While its findings gave many grounds for gratification in terms of the level of hospital pharmacy practice being achieved in some parts of Europe, it also left us with a keen sense that there was much more to do in terms of ‘raising all ships with the tide’. For this reason we determined upon the concept of an …

Looking back at the history of our journal, I am proud of what we have achieved in the last 10—years. EJHP developed from a newsletter magazine at the beginning into what is now a recognised scientific journal and exciting knowledge source for every hospital pharmacist in Europe. This was and is the result of the enthusiasm of national correspondents and of all colleagues involved in the Editorial Board. However, one of them needs distinguished mention—the past Editor in Chief Professor Arnold Vulto. He was the person with the vision of a scientific practice-orientated journal written by hospital pharmacists for hospital pharmacists, he was the person who reminded us to put our patients at the centre of our actions, and he was the person who searched for the most recent developments of … Correspondence to Dr Roberto Frontini, Universitatsklinikum Leipzig, Leipzig D-04103, Germany; president@eahp.eu

You might ask whether 40 years in existence means being a young or an old association. The European Association of Hospital Pharmacists (EAHP) is young and old. It is like in life: the passing time gives you experience but life means looking into the future. Keeping the curiosity of a child while being an old man with long experience is what we call wisdom. Looking back to the first years of the EAHP, let us understand how difficult it was for the founders to create a European understanding. … Correspondence to Dr R Frontini, EAHP President, Universitatsklinikum Leipzig Liebigstrasse 20, D-04103 Leipzig, Germany; president{at}eahp.eu

The official journal of the European Association of Hospital Pharmacists (EAHP), the European Journal of Hospital Pharmacy (EJHP), is recognised by our colleagues as a valuable source of information and inspiration. With the two issues ‘practice’ and ‘science’, EJHP offered in the past and still offers today, not only news, political information and national profiles, but also results from … Correspondence to Dr R Frontini, EAHP President, Universitatsklinikum Leipzig Liebigstrasse 20, D-04103 Leipzig, Germany; president{at}eahp.eu