European journal of hospital pharmacy : science and practice最新文献

{"title":"Physical compatibility of ceftazidime-avibactam with selected intravenous antimicrobials in simulated Y-site administration.","authors":"Fangyuan Chen, Haiwen Ding, Sheng Liu, Zhaolin Chen, Liqin Tang, Tong Tong","doi":"10.1136/ejhpharm-2024-004358","DOIUrl":"10.1136/ejhpharm-2024-004358","url":null,"abstract":"<p><strong>Objective: </strong>The primary objective of this study was to evaluate the physical compatibility of ceftazidime-avibactam with selected intravenous antimicrobials during simulated Y-site administration.</p><p><strong>Methods: </strong>Ceftazidime-avibactam (25 mg/mL) was mixed with select intravenous antimicrobials (tigecycline, metronidazole, meropenem, imipenem and cilastatin, fosfomycin, aztreonam and vancomycin) at an equal volume and evaluated using simulated Y-sites. Each admixture was evaluated immediately (0 hour) and after 1, 2, and 4 hours at room temperature (approximately 22°C) for visual characteristics, Tyndall beam, turbidity, pH, spectroscopic absorption of 550 nm and particle counts. If an admixture failed any one of these six assessments, it was considered incompatible.</p><p><strong>Results: </strong>No evidence of incompatibility was observed between the combinations of ceftazidime-avibactam and the seven intravenous antimicrobials in simulated Y-site experiments.</p><p><strong>Conclusion: </strong>Ceftazidime-avibactam was physically compatible with the selected intravenous antimicrobials (tigecycline, metronidazole, meropenem, imipenem and cilastatin, fosfomycin, aztreonam and vancomycin) in simulated Y-site administration.</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Involvement of the hospital pharmacist in securing the chimeric antigen receptor (CAR)-T cell circuit.","authors":"Angélic Bryla, Sophie Lorent, Audrey Vervacke, Garance Scolas, Laurence Alexandre","doi":"10.1136/ejhpharm-2024-004454","DOIUrl":"https://doi.org/10.1136/ejhpharm-2024-004454","url":null,"abstract":"<p><strong>Background: </strong>The introduction of chimeric antigen receptor (CAR)-T cell therapies to the Belgian market represents a major revolution in patient treatment but also poses a challenge for hospitals to adapt. The medicinal status of CAR-T cells means that hospital pharmacists are legally responsible for managing this drug. In Belgium, due to infrastructure and expertise barriers, the hospital pharmacist's responsibilities are often delegated to the cell therapy units in many hospitals. This delegation of tasks effectively excludes the hospital pharmacist from the CAR-T cell circuit.</p><p><strong>Objective: </strong>The aim of the study was to measure the impact of the hospital pharmacist in securing the CAR-T cell circuit using the Failure Mode, Effects and Criticality Analysis (FMECA) method.</p><p><strong>Methods: </strong>The process map and FMECA were performed by a multidisciplinary team. Criticality indices were calculated before and after the implementation of corrective and preventive actions by the hospital pharmacist.</p><p><strong>Results: </strong>The FMECA identified 114 failure modes. Thirteen (11.5%) failure modes were assessed as high criticality, 47 (41.23%) as moderate criticality and 54 (47.8%) as low criticality. The most critical stages highlighted by this study are pharmacovigilance and tarification. The hospital pharmacy played a central role in ensuring the safety of the circuit, being involved in the implementation of 28 corrective and preventive actions, which represent 53% of the FMECA actions. These actions led to a 77% reduction in high-criticality failure modes and a 49% reduction in moderate-criticality failure modes.</p><p><strong>Conclusions: </strong>This study enabled us to identify the potential risks of the CAR-T cell circuit at the Jules Bordet Institute. The hospital pharmacy was involved in resolving 54% (62/114) of the failure modes. This confirms the hospital pharmacist's central role in ensuring the safety of the CAR-T cell circuit.</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physicochemical stability of bevacizumab biosimilar CT-P16 (Vegzelma) concentrate for solution stored in original vials after first opening.","authors":"Laura Kirsch, Helen Linxweiler, Judith Thiesen, Irene Kraemer","doi":"10.1136/ejhpharm-2024-004436","DOIUrl":"https://doi.org/10.1136/ejhpharm-2024-004436","url":null,"abstract":"<p><strong>Objective: </strong>After patent expiry of the bevacizumab originator product, several biosimilars were approved by the European Medicines Agency. In centralised preparation units, product-specific in-use stability data must be considered. Based on the available data, stability information was missing for the concentrate for solution of the bevacizumab biosimilar CT-P16 (Vegzelma, Celltrion) after first opening and prolonged storage. The aim of the study was to investigate the physicochemical stability of CT-P16 25 mg/mL concentrate for solution stored in punctured original glass vials at two different storage temperatures over a 28-day period.</p><p><strong>Methods: </strong>Three bevacizumab 25 mg/mL vials (CT-P16) were stored punctured either light protected at 2-8°C or at 25±2°C for 28 days. Samples were withdrawn on day 0, 1, 7, 14, 21, 28 and analysed by size-exclusion chromatography (SE-HPLC), ion-exchange chromatography (IE-HPLC), and dynamic light scattering (DLS). In parallel, pH values were measured and test vials visually inspected for visible particles and colour changes.</p><p><strong>Results: </strong>After the 28-day storage period, the quantitative SE-HPLC analysis indicated bevacizumab concentrations above 95% of the initial concentration in each test vial. IE-HPLC analysis revealed no signs of instability. DLS measurements showed no significant variation in the mean hydrodynamic diameter and no appearance of small-sized aggregates. The pH values of all samples remained constant, and no visible particles or colour changes were observed.</p><p><strong>Conclusion: </strong>CT-P16 25 mg/mL concentrate was found to be physicochemically stable in the original glass vial after first opening for at least 28 days when stored light protected at 2-8°C or at 25±2°C.</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stability of dexmedetomidine, ketamine and lidocaine combined injectable solution for analgesia.","authors":"Isabelle St-Jean, Djamila Hachemi, Mihaela Friciu, Jean-Marc Forest, Marc Belliveau, David Williamson, Gregoire Leclair","doi":"10.1136/ejhpharm-2024-004177","DOIUrl":"https://doi.org/10.1136/ejhpharm-2024-004177","url":null,"abstract":"<p><strong>Background: </strong>In the context of the opioid epidemic, it is indispensable to reduce the use of opioids and develop new therapeutic alternatives. The combined use of ketamine, lidocaine and dexmedetomidine has been studied for opioid-free anaesthesia and the management of pain to reduce the use of opioids. An opioid-free anaesthesia mixture in one syringe for multimodal anaesthesia has been used in case series and is currently being studied in clinical trials. However, there are no data evaluating the compatibility of the admixture of these three drugs in syringes. The objective of this study was to evaluate the physicochemical stability of the combination of dexmedetomidine, ketamine and lidocaine.</p><p><strong>Methods: </strong>The formulation combining the three active drugs was prepared at a final concentration of 1 µg/mL of dexmedetomidine, 1 mg/mL of ketamine and 10 mg/mL of lidocaine. The formulation was conditioned in syringes; three syringes were placed at 21°C and three others at 5°C. The concentration and the particle count were evaluated at predetermined time points up to 9 days. A validated stability-indicating HPLC method was developed.</p><p><strong>Results: </strong>The study demonstrated the stability of ketamine (1 mg/mL) and lidocaine (10 mg/mL) in the injectable formulation when stored in polypropylene syringes at 5°C and 21°C for up to 9 days. However, dexmedetomidine (1 µg/mL) was stable for 9 days at 5°C, but only for 3 days when stored at 21°C. Therefore, the injectable formulation containing the three active compounds should be stored at 5°C in order to remain stable for 9 days. The particle count was below the threshold for injectable solution for 9 days at both temperatures.</p><p><strong>Conclusion: </strong>This study demonstrated the stability of dexmedetomidine (1 µg/mL), ketamine (1 mg/mL) and lidocaine (10 mg/mL) when stored in a polypropylene syringe at 5°C for up to 9 days.</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unit dose drug dispensing systems in hospitals: a systematic review of medication error reduction and cost-effectiveness.","authors":"Matteo Gallina, Mirko Testagrossa, Alessio Provenzani","doi":"10.1136/ejhpharm-2024-004444","DOIUrl":"https://doi.org/10.1136/ejhpharm-2024-004444","url":null,"abstract":"<p><strong>Background: </strong>Medical errors pose significant risks to patient safety and public health. Automated unit dose drug dispensing systems (UDDSs) have emerged as valuable tools to reduce medication errors while optimising economic and logistical resources.</p><p><strong>Objectives: </strong>This systematic review aims to evaluate studies specifically focused on the impact of automated UDDSs in reducing medication errors and streamlining processes.</p><p><strong>Methods: </strong>A literature search was performed on PubMed, Scopus, and Web of Science, focusing on peer-reviewed articles published between 2019 and 2024. The search, concluded on 24 September 2024, included studies conducted in inpatient hospital settings that assessed automated UDDS effects on medication errors, therapy management and inventory control. Outcomes examined included effects on patient safety, cost-effectiveness and inventory management. Results were synthesised qualitatively.</p><p><strong>Results: </strong>From 3346 references, four studies met the inclusion criteria: a cost-effectiveness analysis, an uncontrolled before-and-after study, and two observational studies. UDDS improved medication processes, reducing drug-related problems, medication handling and dispensing time by 50% per patient per day. Integrated with barcode scanning, UDDS lowered medication administration errors (MAEs) from 19.5% to 15.8% and harmful MAEs from 3.0% to 0.3%. Overall, medication errors dropped by 45-70%, enhancing safety and reducing manual handling risks. UDDS demonstrated cost-effectiveness by significantly reducing MAEs. The study estimated a reduction in MAEs, with a cost-effectiveness ratio of €17.69 per avoided MAE. For potentially harmful MAEs, the cost-effectiveness ratio was estimated at €30.23 per avoided error. These findings suggest substantial long-term savings potential, though the exact magnitude may vary depending on hospital size and implementation specifics CONCLUSIONS: Automated UDDSs improve patient safety by significantly reducing medication errors and delivering cost savings through better inventory management. Challenges such as high initial costs and workflow adjustments can be mitigated through gradual implementation and staff training. Further integration with other healthcare technologies, such as barcoding, real-time tracking, artificial intelligence (AI)-driven error prevention tools and fully automated restocking systems could enhance UDDS benefits and further support hospital processes.</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence and persistence rates for antidiabetic treatments in type 2 diabetes: a real-world study in an Italian region.","authors":"Alessia Romagnoli, Martina Savoia, Gloria Papini, Andrea Caprodossi, Fausto Bartolini","doi":"10.1136/ejhpharm-2024-004383","DOIUrl":"https://doi.org/10.1136/ejhpharm-2024-004383","url":null,"abstract":"<p><strong>Objective: </strong>Achieving glycaemic control is essential to avoid disease progression and diabetes-related complications. Non-adherence and discontinuity in diabetic therapy are major barriers to optimal glycaemic control. The aim of this study was to evaluate adherence, persistence and therapy switching over 1 year in real-life conditions in patients with type 2 diabetes within an Italian region.</p><p><strong>Methods: </strong>A retrospective, observational, non-interventional study was conducted, analysing patients treated with Anatomical Therapeutic Chemical (ATC) Classification A10B drugs dispensed by pharmacies under the local health authority (ASL) of the Umbria region from 1 January 2022 to 31 December 2023. Adherence was measured using the Proportion of Days Covered (PDC), while persistence was calculated as the duration between the start and end of therapy.</p><p><strong>Results: </strong>A total of 6928 patients with type 2 diabetes were analysed. After 1 year, the overall adherence rate was 0.78, with 58% (4017/6928) of patients having adherence greater than 0.80. The lowest adherence was observed in patients treated with metformin +dipeptidyl peptidase 4 (DPP4) inhibitors, with a mean adherence of 0.71 and 36% (142/395) of patients achieving adherence greater than 0.80. Conversely, the highest adherence was seen in patients on sodium-glucose co-transporter 2 (SGLT2) inhibitors, with a mean adherence of 0.91 and 97% (473/487) of patients achieving adherence greater than 0.80. Persistence data showed concerning results, with less than 10% of patients remaining on treatment for 1 year across all drug classes. Among patients initially treated with metformin (n=4427), there was a substantial loss to follow-up, with 3582 patients (81%) discontinuing treatment within the first year.</p><p><strong>Conclusions: </strong>The 1 year data on adherence and persistence for antidiabetic drugs revealed concerning trends. These findings underscore the need for targeted interventions, involving clinicians and pharmacists, to improve adherence and persistence in patients with type 2 diabetes, ultimately ensuring better disease management and reducing long-term healthcare costs.</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contribution of hospital pharmacists to sustainable healthcare: a systematic review.","authors":"Maria Pitard, Ninon Rouvière, Géraldine Leguelinel-Blache, Virginie Chasseigne","doi":"10.1136/ejhpharm-2024-004098","DOIUrl":"10.1136/ejhpharm-2024-004098","url":null,"abstract":"<p><strong>Background: </strong>With a global annual carbon footprint of the healthcare sector of 2 gigatons of CO₂e, healthcare systems must contribute to the fight against climate change. Hospital pharmacists could be key players in ecological transition due to their role in managing healthcare products. The aim of this study was to summarise the evidence on interventions implemented in healthcare facilities involving pharmacists to improve the environmental footprint of healthcare.</p><p><strong>Methods: </strong>This systematic review was conducted following PRISMA 2020 guidelines. The Medline, Web of Science and ScienceDirect databases were searched for studies published between 2013 and 2023. To be eligible for inclusion, studies had to include hospital pharmacists and present contributions aimed at reducing the environmental footprint of healthcare in healthcare facilities. Outcomes were the description of the contribution, the methods used and the stages of healthcare product lifecycle analysed. A Mixed Methods Appraisal Tool was used to assess the risk of bias for each study.</p><p><strong>Results: </strong>Seventeen studies were included. Pharmacists played a leading role in 15 (88%) and had a supporting role in the others. The healthcare products targeted were medicines (59%), medical devices (12%) or both (29%). The stages of the healthcare product cycle addressed by the contributions were elimination (71%), dispensing (35%), procurement and supply (35%), production (29%), and prescription (24%). Only two studies used life cycle assessment and only one assessed all three pillars of sustainability. Two studies had good methodological quality while the rest had at least one element of uncertainty.</p><p><strong>Conclusion: </strong>This review confirms the central role of the pharmacist and the importance of a multidisciplinary approach in implementing eco-responsible actions. It could be useful to hospitals and other teams wanting to improve sustainable actions and it emphasises the importance of collaborating with pharmacists when planning sustainable initiatives. Future eco-responsible initiatives must use robust reproducible methods.</p><p><strong>Trial registration: </strong>PROSPERO #CRD42023406835.</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":"100-105"},"PeriodicalIF":1.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141081143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-use stability of ready-to-administer daratumumab subcutaneous injection solution in plastic syringes.","authors":"Laura Knoll, Judith Thiesen, Martin D Klassen, Lars M H Reinders, Jochen Tuerk, Irene Kraemer","doi":"10.1136/ejhpharm-2023-003928","DOIUrl":"10.1136/ejhpharm-2023-003928","url":null,"abstract":"<p><strong>Objective: </strong>In multiple myeloma patients, daratumumab is preferably injected subcutaneously. The summary of product characteristics of daratumumab subcutaneous injection solution specifies physicochemical stability for the prepared syringe for 24 hours at 2-8°C protected from light, and another 12 hours at room temperature (15-25°C) in ambient light conditions. The aim of this study was to determine the in-use stability of ready-to-administer daratumumab subcutaneous injection solution in different types of syringe and different conditions over a 28-day period.</p><p><strong>Methods: </strong>Daratumumab subcutaneous (DARZALEX 1800 mg) injection solution was withdrawn into disposable three-piece Luer-Lock syringes (20 mL, 50 mL), capped, and stored light protected at 2-8°C or at room temperature (22±2°C) over a maximum period of 28 days. Samples were taken immediately after preparation (day 0) and after 2, 7, 14, 21, and 28 days. Physicochemical stability was determined by ion-exchange high-performance liquid chromatography (IE-HPLC) and size-exclusion high-performance liquid chromatography (SE-HPLC) with ultraviolet detection, pH measurement and visual inspection for particles or colour changes.</p><p><strong>Results: </strong>In the IE-HPLC assay, peak areas and peak-to-peak area ratios remained unchanged over the whole study period, and showed no additional peaks of degraded daratumumab charge variants. In the SE-HPLC assay, neither a formation of aggregates nor of fragments was detected. Daratumumab monomer concentrations exceeded 95% of the initially measured concentrations over the entire test period. pH values remained constant. Test solutions remained clear, and no colour changes or visible particles were detected. All results were independent of storage conditions.</p><p><strong>Conclusion: </strong>Daratumumab subcutaneous injection solution proved to be physicochemically stable in capped three-piece plastic syringes for at least 28 days when stored light protected at 2-8°C or at room temperature (22±2°C). For microbiological reasons aseptic preparation and refrigerated storage are recommended. In-use stability of ready-to-administer daratumumab subcutaneous syringes prepared under appropriate aseptic conditions is given for 28 days.</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":"154-160"},"PeriodicalIF":1.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50161220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility study of the digital tool Max for the patient-provided medication list in the medication reconciliation process prior to hospitalisation: patient willingness and usability, time saved and reliability.","authors":"Pauline Nardone, Sophie Nicolay, Alix-Marie Pouget, Elodie Civade, Mathilde Strumia, Charlotte Laborde Rouzaud","doi":"10.1136/ejhpharm-2024-004293","DOIUrl":"10.1136/ejhpharm-2024-004293","url":null,"abstract":"<p><strong>Purpose: </strong>More than 20% of prescription errors in hospitals are due to an incomplete medication history. Medication reconciliation is a solution to decrease unintentional discrepancies between medications taken at home and hospital prescriptions. It is a normalised clinical activity but it is time consuming. Medication reconciliation usually uses three sources of information for an optimised medical synthesis, one of which is the patient. A conversational robot for patients could be a solution to assist. Numerous digital applications are designed for patients and need to be tested for usability, satisfaction, reliability and time saved.</p><p><strong>Method: </strong>We analysed Max, a conversational robot for patients scheduled for surgery in Toulouse University Hospital, using routinely collected health data in three successive steps. We examined willingness, compliance and patient satisfaction of usability with a Likert questionnaire and measured the time spent with Max and without. Finally, the reliability has been explored.</p><p><strong>Results: </strong>The three successive observational steps were assessment of willingness and compliance (79 patients), time saved (61 patients) and reliability of the tool (68 patients). 71% agreed to use Max after a telephone call but only 73% of patients completed Max entirely. Max was well received and the overall satisfaction of usability was high for ease of use, readability, relevance and number of questions. Max saved a few minutes by optimised medical synthesis compared with a conventional telephone call. However, the reliability appeared to be lower than the human conventional telephone call. Randomised controlled trials are needed to confirm this feasibility study.</p><p><strong>Conclusion: </strong>Max was appreciated by patients and appeared to be suitable for assisting pharmacists in medication reconciliation. The tool established the list of treatments taken by the patient at home but reliability appeared to be lower than a conventional telephone call, recommending a 'double check' on the patient's arrival.</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":"132-136"},"PeriodicalIF":1.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of the accuracy of estimated free phenytoin concentrations in a mixed patient population.","authors":"Niamh S Horton, Sally L Hanton, Leanne Sheppard, Katherine Birch, Carrie A Chadwick","doi":"10.1136/ejhpharm-2023-003878","DOIUrl":"10.1136/ejhpharm-2023-003878","url":null,"abstract":"<p><strong>Objectives: </strong>Phenytoin is an anti-epileptic drug that has a narrow therapeutic index, and therefore requires therapeutic drug monitoring. Only the free fraction is pharmacologically active, and in some cases, accurate determination of the free phenytoin concentration may be essential to prevent phenytoin toxicity. Although it is possible to measure free phenytoin concentration, often only the total concentration is measured, with equations used to estimate the free fraction. Several equations are quoted in the literature with no overall consensus with regard to accuracy. This study aimed to assess the correlation between total and free phenytoin in a mixed patient population, and to compare the accuracy of several different equations used to estimate the free phenytoin concentration.</p><p><strong>Methods: </strong>Fifty-one serum samples were analysed for total phenytoin, free phenytoin and albumin. The measured free phenytoin concentrations were compared against those estimated using five selected equations, identified through a literature search.</p><p><strong>Results: </strong>This study showed poor correlation between the total and measured free phenytoin concentrations, and between the estimated and measured free concentrations. The overall correlation was concentration-dependent, but a correction factor could not be applied to improve the accuracy consistently. The equations assessed showed wide variability between the estimated and measured free phenytoin concentrations, with several showing a clinically significant negative bias when compared with the measured free fraction.</p><p><strong>Discussion: </strong>This study highlights the disparity of the free phenytoin concentrations generated by the equations. Underestimation of free phenytoin concentrations using these equations may result in phenytoin toxicity, bringing into question the safety of using calculated values for patient management in place of physical measurement of free phenytoin concentration by ultra-performance liquid chromatography tandem mass spectrometry.</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":"143-148"},"PeriodicalIF":1.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41116902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}