Design strategies in hospital pharmacy department: Mapping a medication system

Pharmacy departments are technical and administrative units in hospitals that relate to several other departments, and thus they have a strategic status on supervising the medication system. The hospital pharmacy department has an important role on patient safety, as it can work on error prevention, avoiding mistakes on the process. If there are no precautions implemented on medication system, there will be greater risk of errors, which could unavoidably harm the patient’s health. In this context, this article reports a research applied on a psychiatric hospital in the state of Santa Catarina, Brazil. The following issue was the starting point of the research: how is the configuration of the medication system in this hospital? The objective was to analyze the system, through mapping, in order to identify strategic opportunities for design. Results demonstrate that the medication system is integrated to the pharmacy, and depends on it. Results also suggests that strategic design interventions on storage, fractionation, separation and dispensation of drugs could contribute to the safety of the system as a whole.Keywords: strategic design, hospital pharmacy department, medication system, error prevention

Design strategies in hospital pharmacy department: Mapping a medication system

Pharmacy departments are technical and administrative units in hospitals that relate to several other departments, and thus they have a strategic status on supervising the medication system. The hospital pharmacy department has an important role on patient safety, as it can work on error prevention, avoiding mistakes on the process. If there are no precautions implemented on medication system, there will be greater risk of errors, which could unavoidably harm the patient’s health. In this context, this article reports a research applied on a psychiatric hospital in the state of Santa Catarina, Brazil. The following issue was the starting point of the research: how is the configuration of the medication system in this hospital? The objective was to analyze the system, through mapping, in order to identify strategic opportunities for design. Results demonstrate that the medication system is integrated to the pharmacy, and depends on it. Results also suggests that strategic design interventions on storage, fractionation, separation and dispensation of drugs could contribute to the safety of the system as a whole.Keywords: strategic design, hospital pharmacy department, medication system, error prevention

The Characterization Of Prescribing Errors And Assessment Of The Impact Of An Educational Interventions Among Medical Officers Working In Kuala Kangsar Hospital

The increasing trend of prescribing error in the healthcare institutes cause it became an issue of concern in Malaysia’s healthcare system. Pharmacist plays an important role to improve and prevent patients receiving these errors. Identification of prescribing errors is important to ensure the interventions successfully improve the prescribing errors. The seriousness of prescribing errors can be evaluated by assessing the errors’ severity. The objectives of the present study were to identify the five most common types of prescribing error characteristics, evaluate the severity of the prescribing errors incidence, determined the percentage of prescribing errors prevented by pharmacists and evaluate the effectiveness of the education intervention. A retrospective study reviewing newly written prescriptions with fulfilled criteria which wrote between 1st April and 30th May 2008 was conducted in a secondary care setting government hospital to analyse the type of prescribing errors. At the same time, the evaluation of severity of each error was done to identify the seriousness of prescribing errors in the hospital. Besides, the restrospective review of prescriptions provided the data on how far the pharmacists practicing their role in preventing prescribing errors. A prospective study on the prescriptions was conducted after 4 month period of educational interventions to evaluate the effectiveness of the improvement plan. Ninety four percent of prescribing errors were clinical potential prescribing errors

PHARMACOKINETICS OF PARENTERAL 13-CIS-RETINOIC ACID FORMULATIONS IN RATS

The pharmacokinetics of three 13-cis-retinoic acid formulations were studied after intraperitoneal (ip) administration to rats. Rats were given ip injections of 2.5 mg of 13-cis-retinoic acid per 360 g of body weight; the drug was administered as an alkaline solution, suspended in corn oil, or as a mixture with polysorbate 80. The alkaline solution was also given intravenously (iv) via the tail vein as a control. The mean elimination rate constant, calculated from data from iv administration, was 0.72 +/- 0.088 h-1 (r = 0.988). The peak concentration in plasma and the time to reach this maximum were 14 mg/L and 0.5 h, 22 mg/L and 2 h, and 10 mg/L and 1 h for the drug administered as an alkaline solution, suspended in corn oil, and as a mixture with polysorbate 80, respectively. The areas under the concentration-time curve (concentration in plasma versus time) were 34.9 +/- 8.78 mg.h/L for the iv dose and 34.1 +/- 9.97, 62.4 +/- 32.3, and 25.9 +/- 12.0 mg.h/L for the ip doses of alkaline solution, suspension in oil, and mixture with polysorbate 80, respectively. Because of the rapid increase of concentration in plasma, which is identical to that of the iv profile, and the ease of its handling and preparation, the ip administered alkaline solution is the preferable formulation

A PHASE-I STUDY OF IOBAPLATIN (D-19466) ADMINISTERED BY 72H CONTINUOUS INFUSION

A phase I trial with continuous intravenous infusion of lobaplatin (D-19466; 1,2-diamminomethyl-cyclobutane-platinum (II)-lactate) for 72 h was performed to determine the maximum tolerated dose (MTD). Each patient received a single dose level, the total dose of lobaplatin ranged from 30 to 60 mg/m2/72 h every 4 weeks. Eleven patients enroled in this study and received a total of 30 courses of lobaplatin (median 2; range 1-6). Thrombo-cytopenia was the dose-limiting toxicity, it reached WHO grade III in three out of six patients at 45 mg/m2/72 h, and WHO grade IV in two out of two patients at 60 mg/m2/72 h. Leucocytopenia was mild, as was nausea and vomiting. Phlebitis at the infusion site was found in three patients. During this trial there were no signs of renal, neuro- or ototoxicity. One patient with ovarian cancer, pretreated with three different platinum complexes, achieved a partial response now lasting for longer than 6 months. In conclusion, thrombocytopenia is the dose-limiting toxicity of lobaplatin administered by 72 h continuous infusion. The recommended phase II dose for this regimen is 45 mg/m2/72 h every 4 weeks

Histone deacetylase inhibitors: an overview of the clinical studies in solid tumors

Experimentele farmacotherapi

Liposomal drug formulations in cancer therapy: 15 years along the road

Personalised Therapeutic

Pharmacogenetics in Oncology: A Promising Field

Pharmacogenetics is a rapidly developing field, especially in oncology. In the most ideal situation pharmacogenetics will allow oncologists to individualize therapy based on patients' individual germline genetic test results. This can help to improve efficacy, reduce toxicity and predict non-responders in a way that alternative therapy can be chosen or individual dose adjustments can be made. Multiple pathways have been studied extensively of which a brief review is presented here. Increased 5FU toxicity is associated with variations in the DPYD gene, TYMS gene and MTHFR gene. Furthermore variations in the UGT1A gene and the ABCB1 gene influence irinotecan metabolism and disposition. Other genetic changes result in reduced DNA repair capacity related to platinum efficacy or reduced cytochrome P450 2D6 activity related to tamoxifen efficacy. Despite the extensive number of pharmacogenetic studies and promising results, it is still unclear when and how pretreatment genetic screening should be implemented in oncology. Future prospective studies should focus on the effect of pharmacogenetics on patient outcome and combine this with cost effectiveness evaluations. Thus supplying us with predictive models helping in deciding when pretreatment genetic screening is useful.Experimentele farmacotherapi

Phenotyping drug disposition in oncology

Personalised Therapeutic

Assay performance and stability of uracil and dihydrouracil in clinical practice

PurposeMeasurement of endogenous uracil (U) is increasingly being used as a dose-individualization method in the treatment of cancer patients with fluoropyrimidines. However, instability at room temperature (RT) and improper sample handling may cause falsely increased U levels. Therefore we aimed to study the stability of U and dihydrouracil (DHU) to ensure proper handling conditions.MethodsStability of U and DHU in whole blood, serum, and plasma at RT (up to 24 h) and long-term stability (>= 7 days) at - 20 degrees C were studied in samples from 6 healthy individuals. U and DHU levels of patients were compared using standard serum tubes (SSTs) and rapid serum tubes (RSTs). The performance of our validated UPLC-MS/MS assay was assessed over a period of 7 months.ResultsU and DHU levels significantly increased at RT in whole blood and serum after blood sampling with increases of 12.7 and 47.6% after 2 h, respectively. A significant difference (p = 0.0036) in U and DHU levels in serum was found between SSTs and RSTs. U and DHU were stable at - 20 degrees C at least 2 months in serum and 3 weeks in plasma. Assay performance assessment fulfilled the acceptance criteria for system suitability, calibration standards, and quality controls.ConclusionA maximum of 1 h at RT between sampling and processing is recommended to ensure reliable U and DHU results. Assay performance tests showed that our UPLC-MS/MS method was robust and reliable. Additionally, we provided a guideline for proper sample handling, processing and reliable quantification of U and DHU