ABSTRACT

Abstracts PCNE Working Symposium 2014

Medication review, drug-related problems and standards and guidelines14–15 March 2014, Sliema, Malta

� Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2014

Abstract 1437

Omission impossible: a snapshot of medication dose omissionsin an Australian Teaching Hospital

Rhonda Clifford1, Malcolm Roberts1, Daniel Mattner1,Thomas Hartnett1

1The University of Western Australia (rhonda.clifford@uwa.edu.au)

Background Medication errors are a continuing burden on the Aus-

tralian health care system. Medication dose omissions account for a

significant portion of hospital related medication errors and can occur

for a variety of therapeutic or non-therapeutic reasons. Non-thera-

peutic medication dose omissions have been reported at high levels

and have been shown to have potential for patient harm.

Purpose To determine the frequency of medication dose omissions in

an Australian tertiary hospital and identify the reasons for omission.

Method A retrospective audit of medication charts of discharged

patients was conducted across 5 wards (3 medical, 2 surgical) in a

tertiary teaching hospital. Data was collected between March 2013 and

May 2013. Medication dose omissions of medications prescribed for

regular administration were identified, and their characteristics were

recorded (for example; the reason for omission). Reasons for omission

were classified as non-therapeutic or therapeutic using their National

Inpatient Medication Chart code. Additional demographic and medi-

cation factors were recorded, such as age and medication classification.

Findings 286 patients were included (medical = 160, surgi-

cal = 126) of which 235 (82.1 %) had at least one medication dose

omission. A total of 2,836 omissions were recorded from 23,942

regular medication doses, giving an omission frequency of 11.8 %.

1,941 (68.4 %) of omissions were identified as non-therapeutic which

accounted for 8.1 % of all doses. The most common reason for

omission was ‘refused’ (38.5 %), followed by ‘withheld’ (23.7 %).

535 (18.9 %) medication dose omissions had no documented reason

for omission. Paracetamol was the most commonly omitted medica-

tion accounting for 19.9 % of all omissions with 75.8 % of these due

to patient refusal.

Conclusion 1 in 13 medication doses were omitted for non-thera-

peutic reasons which raises potential issues for patient safety and

treatment efficacy. The high level of omissions with no documented

reason suggests a need for more rigorous documentation of medica-

tion administration

Abstract 1438

Improving the management of anaphylaxis in the community:are action plans the key?

Rhonda Clifford1, Sandra Salter1, Gemma Cadby1,Brock Delfante1, Sarah de Klerk1

1The University of Western Australia (rhonda.clifford@uwa.edu.au)

Background Anaphylaxis is a severe form of allergic reaction that

is rapid in onset and may be fatal. Adrenaline auto-injector devices

(AAIDs) are used first-line for anaphylaxis occurring in the com-

munity. Community pharmacists routinely supply AAIDs and play a

crucial role counselling patients on how and when to use their

device.

Purpose To assess the rate and predictors of appropriate AAID

demonstration and anaphylaxis counselling provided by Western

Australian (WA) community pharmacists.

Method Using simulated patient methodology, 271 pharmacies in

Perth WA, were assessed between March and April 2012. Simulated

patients enacted a scenario requesting AAID demonstration by the

pharmacist. Appropriate AAID demonstration (correctly demonstrat-

ing all AAID steps) and appropriate counselling (as defined by the

ASCIA Action Plan for Anaphylaxis) were assessed and then recor-

ded after each visit. Variables of interest were analysed using Chi

square or Fisher’s exact tests, with predictors analysed using logistic

regression.

Findings Of 271 pharmacists, 96 % (n = 260) did not provide either

appropriate AAID demonstration or anaphylaxis counselling. Asking

whether the patient had an ASCIA Action Plan for Anaphylaxis,

and using written information to support verbal counselling

were predictors of appropriate demonstration and counselling (OR

16.12).

Conclusion AAID demonstration and anaphylaxis counselling pro-

vided by pharmacists was suboptimal. ASCIA Action Plans for

Anaphylaxis were identified as a tool that may significantly increase

appropriate AAID demonstration and anaphylaxis counselling. Phar-

macists play an important role optimising management of anaphylaxis

patients. There is little research describing AAID demonstration or

anaphylaxis counselling provided by pharmacists. Our study showed

significant room for improvement in AAID demonstration and ana-

phylaxis counselling exists.

123

Int J Clin Pharm (2014) 36:847–857

DOI 10.1007/s11096-014-9952-7

Abstract 1439

Prescribing of benzodiazepines for insomnia and behaviouraland psychological symptoms of dementia in residential agedcare facilities

Rhonda Clifford1, Malcolm Roberts, Lynda Blogg,Nao Suzuki

1The University of Western Australia (rhonda.clifford@uwa.edu.au)

Background Benzodiazepines (BZDs) are commonly used to treat

sleep disturbances and behavioural and psychological symptoms of

dementia (BPSD) in residential aged care facilities (ACFs). The

elderly are particularly vulnerable to the adverse effects of these

medications. In Australia, guidelines exist for the prescribing BZDs in

this group of patients, however there is a lack of research comparing

actual prescribing patterns with guidelines.

Purpose To review prescribing patterns for the use of BZDs in

selected ACFs and compare this with best practice guidelines.

Method A cross-sectional analysis of BZD prescribing for residents

aged ¡Y65 years was undertaken. Data were obtained from medica-

tion charts, medical records and case notes that included demographic

information, BZD prescribing and other parameters listed in guide-

lines. Prescribing patterns were compared to National Prescribing

Service (NPS) guidelines and Therapeutic Guidelines.

Findings Two aged care providers with facilities over six locations

were included in the study; 193 residents were recruited. Seventy-one

(37 %) residents were prescribed a BZD, most commonly temazepam

and oxazepam. The majority of prescriptions complied with guide-

lines with respect to dose, but all exceeded the recommended duration

of therapy. Fifty-five (77 %) residents prescribed a BZD suffered

from a co-morbidity for which guidelines recommend the avoidance

of BZDs, most commonly a history of falls.

Conclusion Although the choice and dose of BZD were appro-

priate, the extended duration of BZD therapy meant that

prescribing did not adhere to guidelines. Residents suffering from

co-morbidities where BZDs should be avoided were also frequently

prescribed a BZD.

Abstract 1444

Home medicines review in the elderly

F. A. Costa1, I. Miranda1, P. Cavaco Silva1, A. I. Fernandes1, C.Carneiro1, N. Taveira1

1Instituto Superior Ciencias da Saude Egas Moniz, Portugal

(Alvesdacosta.f@gmail.com)

Background Portugal has been facing the double-aging of its popu-

lation rapidly with a current aging index of 129.4 %, the fifth higher

in Europe. Old age is commonly associated with a high comorbidity

index, polypharmacy and often DRPs, including adherence problems

and potentially inappropriate medications (PIMs).

Purpose To develop a university-based programme where students

actively engage in managing the medication of elderly patients. To

test the feasibility of such approach To evaluate the impact of

medication review on selected patient outcomes (clinical and

humanistic).

Method A pilot study will be undertaken using a quasi-experimental

design. Patients will be recruited in 2 settings: day care centre and

community pharmacy. Inclusion criteria are to be C75 y.o., to be on

C5 medicines, to live alone or with spouse. Exclusion criteria are to

be institutionalized, to have a professional career or to be unable to

understand what the study involves. Patients will be followed for

6 months with measurements made at baseline, 3 months and at the

end of study. The intervention group will receive a weekly visit of a

student who will prepare individualized medication using the DAA

system. Medication will be reviewed using Beers, START and

STOPP criteria. Recommendations to the clinician will be made

whenever appropriate. Outcomes: adherence measured using pill-

count and MMAS-4; PIMs detected and removed; potentially omitted

medications (POMs) detected and added; proxy measures whenever

appropriate (e.g. glycaemia, cholesterol, B.P.)

Findings The study will start in February. This presentation aims to

discuss with peers the selected methodology.

Conclusion This project intends to demonstrate that students properly

supervised may be a valuable resource to enhance the quality of care

provided to the elderly, whilst giving the students a worthwhile

experience that develops further their competencies in medication

review and in direct patient care.

Abstract 1445

Drug relation problems in Polish patients with chronic illness

A. Skowron1, J. Dymek1, A. Golda1, P. Pelka1

1Department of Social Pharmacy, Faculty of Pharmacy, Jagiellonian

University, Krakow, Poland (jdymek@cm-uj.krakow.pl)

Background The medication consumption in Poland per patient is

one of the highest in Europe. Its increase is connected to medication

advertisement and expand list of drugs available without a prescrip-

tion that the patient can also purchase outside the pharmacy.

Purpose The aim of the study was quantitative and qualitative ana-

lysis of drug related problems and their causes occurring in

hypertensive, diabetic and asthma/COPD population.

Method The study has been carried out between 2008 and 2011.

The pharmacists could include patient with hypertension, or diabe-

tes, or asthma and/or COPD. The data about diagnosis, results of

self-control and medication and diet supplements were gathered

during the face to face interview. All gathered data were used in

qualitative and quantitative analysis of DRP. We use the PCNE

classification v.5.01.

Findings 267 patients, who met including criteria were involved in

the study. The average age of the patients was 63 years (24–88)

and BMI 28.4 (17.8–44.3). Most patients suffered (73.3 %) from

one chronic disease, about 84.3 % of all respondents had hyper-

tension and nearly 30 % had diabetes. More than five medication

were used chronically and about four temporally per an average

patient. About seven problems detected per and average patient.

One medication caused of nearly 1.5 DRPs. Most commonly

detected DRP were: potential interaction P4.1 (60.7 %), drug dose

too low or dosage regime not frequent enough P3.1 (12.0 %) and

side effect suffered (non-allergic) P1.1 (11.2 %). Patients most

often reported as adverse symptoms from the gastrointestinal tract

(28 %) and cough (12 %).

Conclusion Results of the study indicate that polypharmacy is a

common problem among patients with chronic diseases in Poland.

Almost every medication can cause a DRP. Pharmacists should

focus on medication reviews and pharmaceutical care programs,

including patients education, to improve effectiveness and safety of

pharmacotherapy.

848 Int J Clin Pharm (2014) 36:847–857

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Abstract 1446

Prevalence of inappropriate prescribing of inhaled corticosteroidsfor respiratory tract infections in the Netherlands

Martina Teichert1, Andre Wissenburg2, Peter A.G.M de Smet3,Tjard Schermer4, Michel Wensing4

1KNMP Den Haag, the Netherlands, Radboud UMC Nijmegen, the

Netherlands. 2Radboud UMC Nijmegen, SAL apotheek Schuytgraag

Arnhem. 3KNMP Den Haag, Radboud UMC Nijmegen. 4Radboud

UMC Nijmegen (m.teichert@knmp.nl)

Background In Australian among patients with only one ICS dis-

pensing and no other respiratory medications (‘one off ICS’), 44 %

were co-dispensed oral antibiotics. These patients unlikely to have

chronic airways disease.

Purpose To investigate the extend of one-off ICS dispensing and

their potential use for management of respiratory infections in the

Netherlands.

Method Data were obtained from the Dutch Foundation of Pharma-

ceutical Statistics that collects dispensing data from almost all 1,950

Dutch community pharmacies. Patients with at least one ICS dis-

pensing in 2011 were included. Patients with a single ICS dispensing

in 2011 and no other respiratory medication 1 year before and after

were identified (one off ICS). One off ICS with an oral antibiotic co-

dispensed within 7 days was considered for treatment of a respiratory

infection. With multivariate logistic regression the influence on

receiving one-off ICS was calculated for co-dispensing of oral anti-

biotics as main predictor of interest.

Findings Data were available from 1,725 pharmacies. Within

845,068 ICS users 10 % were dispensed one-off ICS, from which

12.9 % were co-dispensed oral antibiotics. For potential use for

respiratory infections one-off ICS was dispensed mostly on GP’s

prescription. ICS was mainly prescribed in fixed combinations with

long acting bronchodilators. Total costs for one off ICS dispensing in

2011 were € 555,000. The suspicion that one off ICS was also used

for treatment of respiratory infections was confirmed by the finding

that co– dispensed oral antibiotics increased risk of for a one-off ICS

dispensing within all ICS users by 26 % (OR 1.26, 95 % CI

1.22–1.29) .

Conclusion Although in the Netherlands ICS prescribing for respi-

ratory infections was considerable lower than in Australia, given the

potential side effects of ICS and avoidable medication costs, there is

still room for improvement of ICS prescribing in the Netherlands.

Efforts for this should be undertaken by General Practitioners with

community pharmacists.

Abstract 1447

Pharmacist involvement to decrease drug related problem (DRP)among geriatric patients in Indonesian primary health centres

Desi Suryani1, Anton Bahtiar2, Retnosari Andrajati2

1Governmental Health Office in District Karanganyar, Central Java

Province, Indonesia. 2Pharmacy Faculty, University of Indonesia,

Depok, Indonesia (desini782@gmail.com)

Background Studies have demonstrated that geriatrics often suffered

from many diseases and were prescribed a lot of drugs. Therefore,

Drug Related Problem (DRP) is common among geriatric patients.

Purpose To obtain a decrease in geriatric’s DRPs after pharmacist

involvement, and to analyse the difference in DRPs due to different

mode of pharmacist recommendations.

Method It’s a quasi-experimental study. The primary health centres

were divided randomly into 2 groups (6 primary health centres each

group). First group, the physicians received pharmacist recommen-

dation by discussion and the second group the physicians received

recommendation via letter. DRP analysis were conducted 1 month

before and 1 month after pharmacist involvement from all geriatric

inpatient’s medical records. Main outcome measure. The main

outcome included DRPs, were divided as the problems and the

causes, classified according to Indonesian translated version of

PCNE V 6.2. DRP were identified based on journal and other rel-

evance literature.

Findings A total of 205 patients before and 202 patients after phar-

macist involvement were analysed. First group consist of 121 patients

before and 108 patients after pharmacist involvement. Second group

consist of 84 patients before and 94 patients after pharmacist

involvement. The most common geriatric’s problem was patients

suffer from toxic effect. The most common cause was inappropriate

drug selection. DRPs were decreased by discussion, the differences

were significant by Wilcoxon signed rank test in the number of

problems (p = 0.027) and causes (p = 0.028). DRPs were also

decreased by recommendation letter, the differences were significant

based on paired t test in the number of problems (p = 0.003) and

causes (p = 0.004). Discussion with the physicians decreased more

problems (p = 0.001) and causes (p = 0.002), with the decreasing

number of problems were (20.83 ± 8.931) and the decreasing number

of causes were (25.33 ± 11.431) than recommendation letter

(4.17 ± 1.941) and (5.17 ± 2.483) respectively.

Conclusion Pharmacist involvement decreased DRPs among geriatric

inpatients. Discussing DRPs to the physician who treats patient is

more effective than giving recommendation via letter only. PCNE V

6.2 DRP system classification system is useful to document DRPs

among geriatrics as it can help pharmacist develop plans to reduce

DRPs.

Abstract 1448

Evaluation of a Danish pharmacist student–physician medicationreview collaboration model

Susanne Kaae, Lotte Stig Nørgaard, Ellen Westh Sørensen1

1Department of Pharmacy, Faculty of Health and Medical Science,

University of Copenhagen (susanne.kaae@sund.ku.dk)

Background Interprofessional collaboration between pharmacists

and physicians to conduct joint home medication reviews (HMR) is

important for optimizing the medical treatment of poly-pharmacy

patients. Collaboration has proved difficult to achieve. The HMR

program ‘‘Medisam’’ was launched in 2009. The program is special as

it involves patients, pharmacy internship students, the (pharmacist)

tutors of the pharmacy students and physicians.

Purpose The aim of this study was to evaluate if the Medisam pro-

gram is an effective way to induce HMR collaboration between

pharmacy internship students and physicians as a mean to develop

HMR collaboration between trained pharmacists and physicians.

Method Semi-structured interviews about existing collaboration were

conducted with pharmacy internship students along with their tutors;

and physicians partners. The theoretical framework forming the

analyses was derived especially from works of Bradley et al., and

Snyder et al. on pharmacists/physician collaboration regarding:.

trustworthiness, role specification and professional interaction Ten

matching pairs of student-physician collaboration were studied across

Denmark.

Findings Collaboration had been obtained for the majority of inter-

viewees. However, students expressed the need of a more interaction

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with physicians but were found hesitant to discuss this in open.

Written collaboration contracts did not ensure role specification.

Developing trustworthiness through mutual professional interdepen-

dence by students being recognized by physicians to contribute to

improved patient outcomes, was limited.

Conclusion Some challenges to collaboration were identified thereby

questioning whether the Medisam program is an effective way to

enhance HMR collaboration between educated pharmacists and

physicians. Solutions to the identified challenges include students and

their pharmacist tutors to find ways to present their collaborative

needs to physicians and for students to illustrate more explicitly the

benefits patient achieve if physicians implement the recommendations

of students.

Abstract 1449

Patient adherence to antihypertensives in Slovenia

Ana Janezic1, Igor Locatelli1, Martina Dolenc2, Mitja Kos1

1Chair of Social Pharmacy, University of Ljubljana - Faculty of

pharmacy, Slovenia. 2University of Ljubljana - Faculty of pharmacy,

Slovenia (mitja.kos@ffa.uni-lj.si)

Background In patients with hypertension, non-adherence is a sig-

nificant risk factor that is related to the reduced control of blood

pressure leading to significant elevation of risk for serious cardio-

vascular diseases.

Purpose To validate a Slovenian version of a self-reported 8 item

Morisky Medication Adherence Scale (MMAS-8) and to evaluate

patient adherence to antihypertensives in Slovenia. Additionally, to

assess risk factors related to patient non-adherence.

Method MMAS-8 was translated to Slovenian language by two

experts, consensus was reached on the Slovenian version, which was

then back translated to English language and compared to the original

version. Validation of the Slovenian versions of MMAS-8 and eval-

uation of adherence was performed on a sample of adult Slovenian

speaking patients which were enrolled by pharmacists in a randomly

allocated sample of Slovenian community pharmacies. Patients that

were dispensed at least one antihypertensive medicine were asked to

fill out the survey at home and return it by regular mail. The survey

included MMAS-8 questionnaire and patient socio-demographic data,

namely; sex, age, monthly income, education category, smoking

status, and the data regarding anthypertensives (AH) (treatment

duration, number of medicines taken and the dosage regimen). The

degree of adherence was determined according to the score resulting

from the MMAS-8 questionnaire. The risk factors of patient non-

adherence were estimated using multinominal logistic regression in

IBM SPSS Statistics version 21.

Findings In total 468 patients returned completed surveys. Among

them 58 % were female; 14 % were younger than 55 years, 33 %

were between 55 and 65, while 53 % were older than 65; the majority

(85 %) were non-smokers. Almost all the patients (95 %) were

treated for hypertension more than 1 year; 37 % of the patients were

taking only one AH drug, 32 % were concomitantly taking 2 AH

drugs, the other were concomitantly taking 3 or more AH drugs; 45 %

of the patients take the AH drug once per day. Fifty-three percent of

patients had high adherence rate (scored 8 points), 31 % had medium

adherence rate (scored 6 or 7 points), 16 % had low adherence rate

(scored 6 or less). Older patients were more adherent (odds ratio for

adherence was 1.5–1.7; p \ 0.01).

Conclusion Approx. 50 % of patients have an ideal adherence score

according to MMAS-8. Patients that are older and have less antihy-

pertensives are more adherent.

Abstract 1450

Development of shared care guidelines in rheumatology

Daniel Grixti1, Jonathan Vella1, Julian Fearne1, Louise Grech1,Maresca Attard Pizzuto1, Anthony Serracino-Inglott1

1Department of Pharmacy, University of Malta

(louise.grech@um.edu.mt)

Background The use and administration of rheumatology drugs such

as disease modifying antirheumatic drugs and biological agents

requires effective patient monitoring at all settings of care. Within a

multidisciplinary team setting such as rheumatology, shared care

guidelines improve the management of patient care and outline

responsibilities of the pharmacist within the team.

Purpose To develop shared care guidelines for rheumatology drugs

used in the treatment of various rheumatic conditions with the intent

of providing seamless care between primary and secondary care

settings.

Method A literature review was carried out to identify already

existing shared care guidelines in rheumatology Discussions with an

expert panel consisting of a consultant rheumatologist, specialised

rheumatology nurse, rheumatology specialist trainee, a research and

academic pharmacist, general practitioner, and a community phar-

macist were undertaken. This was done to identify which

rheumatology drugs need revision and amendments, as well as to

determine which other drugs necessitate the development of new

shared care guidelines. A comparative study was carried out to ana-

lyse the key principles required to be included in the template. The

designed shared care guidelines will be evaluated by an expert panel

at the Rheumatology Clinic. Following approval, the shared care

guidelines will be published online for public access.

Findings Consultation with the multidisciplinary team yielded the

need for revision of the currently available patient management

guidelines available for rituximab, infliximab, and zolendronic acid. It

was concluded that new guidelines need to be written for the following

drugs used in rheumatology: methotrexate, leflunomide, sulphasal-

azine, gold injections, azathioprine, ciclosporine, etanercept, and

adalimumab to help in the standardisation of treatment. The following

set of parameters were designated to be included in the guidelines;

indication, co-administration of other drugs as necessary, dose, contra-

indications, cautions, drug interactions, baseline screening, initial

monitoring, stable dose monitoring, vaccination, side-effects and

clinical pharmacist responsibilities.

Conclusion The shared care guidelines for rheumatology drugs out-

lined above will provide the necessary information for healthcare

professionals to further improve and effectively manage and monitor

patients.

Abstract 1451

When skills are not enough: home medication reviews (HMRs)seen through tutors’, pharmacy students’ and GPs’ competencyglasses

Lotte Stig Nørgaard1, Susanne Kaae1, Ellen Westh Sørensen1

1Department of Pharmacy, Faculty of Health and Medical Science,

University of Copenhagen (lotte.norgaard@sund.ku.dk)

Background An HMR program (‘‘Medisam’’) was launched in

2008–2010 in Denmark. The program involves patients, pharmacy

internship students, the (pharmacist) tutors of the pharmacy students

and GPs.

850 Int J Clin Pharm (2014) 36:847–857

123

Purpose The aim of the study was to evaluate if Medisam was an

effective way to induce HMR collaboration between pharmacy

internship students and GPs. In order to conduct joint HMRs, though,

students need to possess special competencies. So what were the

pharmacy student’s competencies in relation to carrying out HMRs—

seen from the participating student’s, tutor’s and GPs point of view?

Methods The aim of the study was to evaluate if Medisam was an

effective way to induce HMR collaboration between pharmacy

internship students and GPs. In order to conduct joint HMRs, though,

students need to possess special competencies. So what were the

pharmacy student’s competencies in relation to carrying out HMRs—

seen from the participating student’s, tutor’s and GPs point of view?

Findings Generally the GPs, the students and the supervisors agreed

that students possess good technical HMR skills, but that their joint

competencies were challenged by issues concerning professional

socialization and judgement. The three groups also agreed that the

student’s communicative skills were sufficient for doing HMRs, but

that they lacked clinical expertise and understanding for the patient’s

entire clinical picture. As to professional socialization, the majority of

students stated that they—in the pharmacy—were socialized into a set

of values based on humbleness and cautiousness concerning the GP

dialogue—and the GPs agreed. Another component of professional

socialization dealt with tutors’ and students’ attitudes towards

patients; thus in order for a patient to be of pharmaceutical interest

many and/or potentially serious drug-related problems are ‘‘needed’’.

With regard to judgement, students stated that they would like to

make patient advice judgments themselves without permission from

their tutor; that they realize their own limitations and know when to

ask their for advice; and they agree with their supervisors that GPs are

to be treated differently in the HMR-dialogue. Tutors and GPs state

that student’s HMR-related trust and confidence comes with experi-

ence and cant be learned from basic university teaching and reading.

Conclusion The study has shown how skills, professional socializa-

tion and judgement are closely woven, and that student’s technical

skills were not sufficient for doing good HMRs.

Abstract 1452

Evolution of pharmaceutical care definitions: the PCNE definition2013

Samuel S. Allemann1, J.W. Foppe van Mil2, Lea Botermann3,Karin U. Berger, Nina Griese3, Kurt E. Hersberger1

1University of Basel, Switzerland, 2Van Mil Consultancy,

the Netherlands, 3ABDA—Federal Union of German Associations

of Pharmacists, Germany (s.allemann@unibas.ch)

Background The board of the Pharmaceutical Care Network Europe

felt the need to redefine Pharmaceutical Care (PhC) and to answer the

question: ‘‘What is Pharmaceutical Care in 2013’’. This is especially

important, when developing guidelines for PhC. During a moderated

1-day meeting prior to the PCNE working conference 2013, 14

members of PCNE and 10 additional experts developed a PCNE

definition of Pharmaceutical Care (PhC): « Pharmaceutical Care is

the pharmacist’s contribution to the care of individuals in order to

optimize medicines use and improve health outcomes.»

Purpose All participants of the pre-conference meeting received a

summary of an extensive literature review 2 weeks in advance. The

aims of this work were to review existing definitions of PhC and to

show their evolution until the contemporary PCNE definition.

Method We conducted a literature search in the MEDLINE database

(1964–January 2013). Keywords included ‘‘Pharmaceutical Care’’,

‘‘Medication (Therapy) Management’’, ‘‘Medicine Management’’,

and ‘‘Pharmacist Care’’ in the title or abstract together with the term

‘‘defin*’’. To ease comparison between definitions, we developed a

standardised syntax to paraphrase the definitions.

Findings The initial literature search produced 186 hits, with 8 unique

PhC definitions. Hand searching identified a further 11 unique defi-

nitions. We paraphrased these 19 definitions using the standardised

syntax (provider, recipient, subject, outcome, activities). Analysing

the paraphrased definitions revealed the following attributes and

corresponding frequency for each domain: Provider: Practitioner (4;

21 %), the pharmacist (5; 26 %), the pharmacist and his team (1;

5 %), not specified (9; 49 %). Recipient: (individual) patient (15;

79 %) (collective of) patients (3; 16 %), not specified (1; 5 %).

Subject: Pharmacotherapy (9; 49 %), drug-related needs (8; 41 %),

drug use (1; 5 %), not specified (1; 5 %). Outcomes: optimal out-

comes of therapy (5; 26 %), optimal quality of life (5; 26 %), optimal

pharmacotherapy (2; 11 %), not specified (5; 26 %), others (2; 11 %).

Activities: not specified (14; 74 %), others (5; 26 %).

Conclusion t was possible to paraphrase definitions of PhC using a

standardised syntax focusing on the provider, recipient, subject,

outcomes, and activities included in PhC practice. The attributes

for each domain differ greatly between definitions, making it dif-

ficult to differentiate PhC from other terms and to decide what it

includes. The contemporary PCNE definition of PhC may be used

as a guideline for European researchers and, ultimately, practitio-

ners to describe their research, activities in patient care, or teaching

activities.

Abstract 1453

Risks in pharmacist prescribing guidelines

Maresca Attard Pizzuto1, Anthony Serracino Inglott1,Lilian M. Azzopardi1

1Department of Pharmacy, University of Malta

(maresca.attard-pizzuto@um.edu.mt)

Background Risk is part of daily language and is used in a variety of

contexts. One might talk about ‘risk’ as the probability of an incident

happening or not happening, about success or failure. The main

benefit of following guidelines is to improve patients’ quality of care,

however, the potential risks should not be neglected.

Purpose To examine the risks of following or not following guide-

lines in pharmacist prescribing.

Method Risk assessments and ways of determining risks were

examined in other processes extraneous to pharmacy. Ways of

adapting these activities to pharmaceutical processes were studied.

Proposals to apply these activities in adherence with guidelines such

as the NICE guidelines, guidelines in pharmacist prescribing and

established formularies are suggested. Methods to evaluate risks

involved in strict adherence to the formulary as well as the risk of

ignoring the formulary are identified.

Findings Industries that were evaluated include banking, insurance,

airline and food. A common feature of all industries was that risks are

documented onto ‘risk registers’ containing a record of all risks as

categorised in terms of impact and likelihood. Risk registers also

record mitigating measures, responsibilities of risk owners and

deadlines for taking agreed actions. The development of a risk reg-

ister is part of the Risk Management Process. Risks are assigned

‘Likelihood and Impact’ scores by first considering the inherent risk

and after looking at the mitigating actions being taken to limit the

company’s exposure, a score is assigned upon the residual risk. Such

measures need to be implemented to identify and assess risks in

guidelines for pharmacist prescribing, which involves a delicate

evaluation of benefits and risks within a holistic clinical picture. The

risks of not following recommendations provided by guidelines could

Int J Clin Pharm (2014) 36:847–857 851

123

be extremely serious. However, following guidelines has its disad-

vantages too, in that recommendations may be too restrictive for

individual patients, hindering professional judgment. Scientific

evidence about what to recommend is often misinterpreted. Recom-

mendations are influenced by the experience of guideline developers

and treatments experts believe are good for patients may be inferior to

other options. Patients’ needs may not be the only priority when

developing guidelines, since they may be recommended to protect

special interests.

Conclusion The examination exercise undertaken in other processes

extraneous to pharmacy helps to provide a framework for the

development of risk assessment strategies to be used in different

pharmaceutical scenarios, particularly in assessing risks in pharmacist

prescribing guidelines to improve outcomes.

Abstract 1454

Should the first step in a medication review: the medicationreconciliation—be performed by nurses or by pharmacists?

Trine Aag1, Beate Garcia2, Kirsten K. Viktil3

1Hospital Pharmacy of North Norway, Tromsø, Norway. 2Hospital

Pharmacy of North Norway, Tromsø, and Department of Pharmacy,

Faculty of Health Sciences, U. 3School of Pharmacy, University of

Oslo, and Diakonhjemmet Hospital Pharmacy, Oslo, Norway

(kirsten.viktil@diakonsyk.no)

Background The first step before performing a medication review is

to verify that the patient’s medication list is correct. When patients

move between different levels of care, this is a challenging task that

may be solved by introducing medication reconciliation (MR) at each

care level change. MR is traditionally a pharmacist task. There is a

lack of studies describing MR performed by other health care

personnel.

Purpose We aimed to explore the outcome of MR when performed

by nurses or clinical pharmacists with regard to frequency, type and

clinical relevance of medication discrepancies (MDs) identified, and

time spent on the MR process.

Method A non-blinded, randomized controlled trial was performed at

the Department of cardiology at the University Hospital of North

Norway (UNN) during autumn 2012. The nurses and pharmacists

underwent the same MR training program run by an independent

clinical pharmacist. A total of 201 patients were randomized to

pharmacist group (PG) or nurse group (NG). Identified MDs were

recorded and discussed with the responsible physician. Time spent

during the different processes was recorded. An independent expert

group (n = 3) retrospectively assessed the clinical relevance of the

MDs.

Findings At least one MD was identified in 78 % of the 100 patients

in the PG, and 84 % of the 101 patients in the NG, p = 0.269. Among

these patients, the mean number of MDs identified were 3.1 (SD 2.1)

and 2.8 (SD 2.2) in the PG and NG, respectively, p = 0.528. ‘Omitted

drug’ was the most frequent type of medication discrepancy identified

for both study groups. Mean time spent during the MR process

(including discussion and documentation) was significantly lower in

PG (22.9 min, SD 11.6) compared to NG (32.2 min, SD 20.3), p

Conclusion Most patients had MDs in their medication list when

admitted to the department of cardiology. This emphasizes the

importance of performing MR as a first step before a medication

review. This study shows no significant difference between nurses and

clinical pharmacists with regards to number of MDs with clinical

relevance identified. The clinics should staff and organize their

resources to reduce risk and increase patient safety. In this work,

clinical pharmacists could have an important role in training nurses.

Abstract 1455

Potential DRP related to computerized physician order entry:an updating of DRP classifications needed

Olatz Urbina1, Elena Gonzalez-Colominas1, Sonia Luque1, OliviaFerrandez1, Esther Salas1, Santiago Grau1

1Pharmacy Department-Hospital del Mar, Barcelona, Cataluna, Spain

(94007@hospitaldelmar.cat)

Background Despite the fact that implementation of Computerized

Physician Order Entry (CPOE) is recommended to improve patient’s

safety, literature has revealed safety risks associated with this system.

Identification and quantification of potential drug-related problems

(DRP) related to an incorrect use of CPOE (DRP-CPOE) is crucial in

order to correct and avoid them.

Purpose To analyse types of potential DRP-CPOE and main drugs

involved in them and to compare the characteristics of admitted

patients presenting a DRP-CPOE versus other DRP.

Method Prospective observational study carried out in hospitalized

patients during 2012. Data collected: total DRP and DRP-CPOE

(types and main drugs involved), demographic data (age, sex);

admitting department (surgical or medical). Chi square or Fisher’s

exact test for categorical variables, Student’s T test or ‘‘U’’ Mann–

Whitney test for quantitative variables.

Findings Total DRP: 3,558; DRP-CPOE: 707 (19.87 %). Types of

DRP-CPOE and main drugs involved (frequency [5 %): —Drug

included in the hospital formulary, but prescribed as ‘‘not available’’:

36 (5.1 %) [montelukast 3 (8.3 %)]—Double prescription: 187

(26.4 %) [ondansetron 29 (15.5 %), pantoprazole 29 (15.5 %), acet-

aminophen 27 (14.4 %), bemiparin 17 (9.1 %)]—Incorrect units of a

prescribed dose, resulting in a higher or lower recommended dosage:

251 (35.5 %) [amoxicillin–clavulanic acid 24 (9.6 %), vancomycin

13 (5.2 %)]—Inappropriate frequency of administration: 63 (8.9 %)

[digoxin 10 (15.9 %)]—Inappropriate route of administration: 6

(0.8 %)—Inappropriate treatment duration: 53 (7.5 %) [cefazolin 18

(34.0 %), digoxin 6 (11.3 %)]—Unintended medication discrepances

of dosage (prescribed dosage different from patients’ existing dos-

age): 109 (15.4 %) [digoxin 17 (15.6 %)]—Clinical trial drug

prescribed as ‘‘not included in hospital formulary’’ instead of using a

specific application of CPOE clinical trials: 2 (0.3 %) Admitted

patients with DRP-CPOE versus other DRP: men [362 (51.2 %) vs

1,564 (54.9 %); p = 0.081]; age [66.0 (18.9) vs 68.4 (16.3) years;

p = 0.001]; surgical admission [346 (48.9 %) vs 1,059 (37.1 %);

p \ 0.001].

Conclusion The fact that digoxin, a drug with a narrow therapeutic

range, be one of the drugs most involved in CPOE-DRP is worri-

some.—Surgical admitted are at higher risk of developing a potential

DRP-CPOE.—The development of a specific multidisciplinary com-

mittee to assess clinicians use of CPOE and to introduce new

suggestions for optimizing this tool is essential to improve patients’

safety.—According to the potential clinical impact of DRP-CPOE, it

is crucial to identify and quantify this kind of DRP through updating

current DRP classifications.

Abstract 1456

Medication use review service in Qatar: a nationwide studyon knowledge, attitudes and practices of community pharmacists

Ahmed Babiker1, Ahmed Awaisu2, Louise Carson3

1Pharmacy and Drug Control Department, Supreme Council

of Health, Doha-Qatar. 2College of Pharmacy, Qatar University,

852 Int J Clin Pharm (2014) 36:847–857

123

Doha - Qatar. 3School of Pharmacy, Queens University Belfast, UK

(ahussein@sch.gov.qa)

Background The incidence of chronic diseases is increasing globally.

Non-adherence to medications and other medication-related problems

are common among patients receiving medications for chronic ill-

nesses. Medication use review (MUR) is a service provision with

accredited pharmacist undertaking structured adherence-centred

reviews with patients on multiple medications. To our knowledge,

MUR services are not yet available in community pharmacies in

Qatar

Purpose This study aims to evaluate the knowledge, attitudes and

perception of community pharmacists towards establishing MUR as

an extended role in patient care.

Method A cross-sectional survey using a self-administered ques-

tionnaire was conducted among community pharmacists in Qatar

from December 2012 to January 2013. The study population involved

pharmacists practicing in the private community pharmacy setting.

Data collected were analysed using SPSS� version 20. Descriptive

and inferential statistics were used for data analysis. The study was

approved by the Institutional Review Board of the Supreme Council

of Health, Qatar

Findings A total of 123 community pharmacists responded to the sur-

vey (response rate 56 %; 123/220). The mean knowledge score (±SD)

was 71.4 % ± 14.7 %. An overwhelming proportion of the participants

(97 %) were able to identify the scope of MUR in relation to chronic

illnesses and at enhancing the quality use of medicines. Further, 80 % of

the community pharmacists were able to identify patients of priority for

inclusion in an MUR program. However, less than half of the phar-

macists knew that acute conditions are not the principal focus of MUR

services. At least 95 % of the participants acknowledged that provision

of MUR services is a great opportunity for an extended role of com-

munity pharmacists and that MUR makes an excellent use of the

pharmacists professional skills in the community. The participants

generally reported concerns about time, dedicated consultation area,

and support staff as significant barriers towards MUR.

Conclusion This study suggests that community pharmacists in Qatar

had sufficient knowledge about the concept of MUR and its scope, but

there were still important areas of deficiencies about the practice. The

findings have important implications on policy and practice, partic-

ularly pertaining to the implementation of MUR as an extended role

of pharmacists and as part of Qatar National Health Strategy to move

primary health care forward in the country. Further training and

education through continuing professional development programs and

accreditation is warranted for community pharmacists before imple-

menting MUR service in Qatar.

Abstract 1457

Clinical medication reviews in a naturalistic setting: drug-relatedproblems identified in the elderly with polypharmacy

Jacqueline Hugtenburg1, Sek Hung Chau2, Peter Van der Ven2,Petra Elders 3, Danielle Jansen3

1VU University Medical Center, Department of Clinical

Pharmacology. ‘2VU University Medical Center, Department

of Epidemiology and Biostatistics. 3VU University Medical Center,

EMGO+ Institute (JG.Hugtenburg@vumc.nl)

Background Most of our knowledge about drug-related problems

(DRP) identified in elderly patients with polypharmacy is based on

medication reviews conducted in research settings rather than in

naturalistic settings. In addition, data on the acceptance rate of pro-

posed interventions to resolve DRP in a naturalistic setting is lacking.

Purpose This study investigated the prevalence of identified DRP in a

large group of elderly with polypharmacy by means of a clinical

medication review (CMR) and the acceptance rate of the proposed

interventions in a naturalistic setting.

Method A cross-sectional study based on results of CMR of 3,807

elderly patients (¡Y65 years) with polypharmacy (¡Y5 drugs) com-

pleted between January and August 2012. Data was acquired from

318 Dutch community pharmacies affiliated to Nederlandse Service

Apotheek Beheer, a franchise organisation for independent commu-

nity pharmacies, located across the Netherlands. Data was extracted

from the community pharmacists¡ databases and entailed: year of

birth, gender, dispensing data, identified DRP, DRP—categories,

activities, consultations performed, proposed and accepted interven-

tions and diseases.

Findings 3,807 CMR were performed with elderly patients with pol-

ypharmacy across 258 pharmacies. The participants had a mean age of

78 ¡A 7.7 years; 57.9 % were female. On average, a patient used 9.5

¡A 3.4 chronic drugs. On average, 3.0–2.3 (range 1–26) DRPs were

identified. The DRP-categories overtreatment (25.5 %) and under-

treatment (15.9 %) were found most frequently. Stopping the use of a

drug was suggested most frequently (19.6 %), followed by monitoring

of the patient (18.4 %), e.g. measuring of the blood pressure or per-

forming a blood test. 46.2 % of the proposed interventions was

accepted, in 23.7 % of the cases, the intervention differed from the

proposal and in 30.1 % of the cases, no intervention was performed.

Conclusion The number of DRP was similar to previous studies.

Overtreatment and under treatment comprised 40 % of DRP and can

be identified using STOPP/START criteria. For additional support of

CMR, the Amsterdam Tool listing 125 DRP may be suitable. Good

co-operation between pharmacist and GP may improve the accep-

tance of proposed interventions.

Abstract 1458

Identification of pharmaceutical care needs for a samplepopulation of rheumatoid arthritis patients on methotrexate

Louise Grech1, Bernard Coleiro1, Andrew A. Borg1, AnthonySerracino Inglott1, Lilian M. Azzopardi1

1Department of Pharmacy, Faculty of Medicine and Surgery,

University of Malta (louise.grech@um.edu.mt)

Background Effective and safe pharmacological management of

rheumatoid arthritis patients depends the safe prescribing, monitoring

and administration of disease modifying anti-rheumatic drugs and

biological agent. Pharmaceutical care services implemented within a

multidisciplinary team can further improve medication monitoring.

Purpose To assess the impact of a pharmaceutical care service

offered to patients within the rheumatology department out-patient

setting in a general public hospital.

Method Rheumatoid arthritis adult patients who were on metho-

trexate regularly attending the rheumatology out-patient clinic (RC)

were eligible to participate in the study. Pharmaceutical care issues

identified during visits at the RC were documented. The drug therapy

problems identified were categorized into an amended classification

developed by colleagues (McAnaw, 2003) at the Strathclyde Institute

of Pharmacy and Biomedical Sciences. Each of the pharmaceutical

care issue identified was categorized as either an actual or potential

drug therapy problem. Actions (checks or changes) needed to resolve

each care issue problem were documented in the care plan within the

patient’s medical file.

Findings A total of 88 patients were recruited in the study. The mean

(SD) age of the patients was 60.8 (11.6) years. The mean number of

years on methotrexate was 10 years. A total of 106 pharmaceutical

Int J Clin Pharm (2014) 36:847–857 853

123

care issues were identified for the 88 patients giving a mean of 1.2 per

patient where 72 % (n = 76) were actual drug therapy problems

requiring alteration of the therapeutic plan and 28 % (n = 30) were

potential drug therapy problems requiring resolution by reference

back to the therapeutic plan. The most common actual drug therapy

problem identified was inappropriate compliance (28.8 %) followed

by additional medication needs (18.2 %) and unnecessary medication

prescribed (16.7 %). The most common potential drug therapy

problem identified was related to potential adverse events (70 %)

followed by inappropriate compliance (16.7 %).

Conclusion The pharmaceutical care intervention led to the identifi-

cation of drug therapy problems which were subsequently discussed

with the physicians. References: McAnaw JJ. Development of novel

approaches to demonstrate the quality of drug therapy use. PhD

thesis. Department of Pharmaceutical Sciences. Glasgow: University

of Strathclyde. 2003

Abstract 1459

Development and validation of medication assessment toolsspecific for rheumatoid arthritis

Louise Grech1, Bernard Coleiro, Andrew A. Borg, AnthonySerracino Inglott, Victor Ferrito, Lilian M. Azzopardi

1Department of Pharmacy, Faculty of Medicine and Surgery,

University of Malta (louise.grech@um.edu.mt)

Background Medication assessment tools are evidence-based

instruments intended for the evaluation of prescribing trends and

monitoring of adherence to established guidelines. Medication

assessment tools have been specifically designed and implemented in

the management of heart failure, acute coronary syndrome, diabetes

mellitus, pain management in cancer and asthma.

Purpose The aim of the study was to develop, validate and evaluate a

novel pharmaceutical care model based on medication assessment

tools.

Method Guidelines, recommendations and standards on rheumatoid

arthritis and its management as set out by the American College of

Rheumatology (ACR), the European League against Rheumatism

(EULAR), the British Society for Rheumatology (BSR) and the

National Institute for Clinical Excellence (NICE) were used to

develop the Rheumatoid Arthritis Medication Assessment Tool

(RhMAT). The summary of product characteristics for each drug

included in the RhMAT were used as reference for criteria related to

pharmacological properties of the respective drugs. The medication

assessment tool was designed in the form of a table bearing in mind

that the tool will be used in a busy clinic where documentation can

be time consuming. The RhMAT was validated by an expert panel

consisting of 3 Consultant Rheumatologists, 2 academic pharma-

cists, an academic science professor and a rheumatology nurse

specialist. The expert panel assessed applicability of the tool to the

practical scenario, presentation, robustness and validity of the data

provided. Literature review was carried out to choose the outcome

measures of quality of life and adherence to treatment plans pre-

scribed to patients.

Findings The developed RhMAT was designed in the form of a table

consisting of 11 separate sections dealing with general criteria for RA,

use of analgesics, methotrexate, sulphasalazine, hydroxychloroquine,

leflunomide, gold injections, general prebiologic screening, biologic

therapy, use of glucocorticoids, remission cases. Following the expert

panel review one of the statements was split into 2 separate statements

to increase specificity. This was repeated for another statement. The

Health Assessment Questionnaire was chosen to be used as outcome

measures to quality of life. The compliance questionnaire was used to

assess the adherence to treatment plans prescribed.

Conclusion The developed RhMAT was designed to be used in a

busy adult rheumatology out-patient clinic as part of an ongoing

multidisciplinary pharmaceutical care service ensuring that the level

of practice offered is up to international standards wherever permitted

by internal protocols.

Abstract 1460

Validation and adaptation of the PCNE classification V 6.2 for usein Slovenian community pharmacies

Nejc Horvat1, Mitja Kos1

1Chair of Social Pharmacy, University of Ljubljana - Faculty

of pharmacy (mitja.kos@ffa.uni-lj.si)

Background There is no validated DRP classification available in

Slovenian language or formally used in practice.

Purpose To translate and validate The PCNE Classification V 6.2 for

use in Slovenian community pharmacies.

Method Firstly, The PCNE classification v 6.2 was translated into

the Slovenian language by a forward–backward procedure. The

Slovenian version was then discussed in an expert panel of 9

community and hospital pharmacists and two researchers. A con-

sensus was reached in the expert panel to adapt the classification.

The adapted version was piloted and validated (VS1) by 31 com-

munity pharmacists based on the PCNE set of 20 scenarios.

Problems, causes and interventions were coded. The coding incon-

sistencies were discussed by the expert panel. A consensus was

reached on the final version of the classification. The adapted ver-

sion was used in a validation study (VS2), where 33 community

pharmacists allocated in two groups coded two sets of 20 DRP cases

(all together 40 DRP cases) which were gathered during routine

pharmacy practice in Slovenia. Coding inconsistencies were ana-

lysed and the perceived difficulties with the classification were

discussed in the expert panel. A final adapted version of the DRP

classification was formed.

Findings In VS1 the average coding consistency was 74 % (±16 %)

for Problems, 75 % (±20 %) for Causes and 92 % (±11 %) for

Interventions. In VS2 the average coding consistency was 83 %

(±16 %) for Problems, 85 % (±17 %) for Causes and 80 %

(±20 %) for Interventions. The following major adaptations of the

classification were performed: —A ‘‘potential problem’’ was added

as a primary domain to The Problem section. Namely, potential

problems are predicted by risk factors.—The Causes section was

renamed to Risk factors. The causality between exposure (risk

factors) and problems is only predicted.—The primary domains in

The Risk factors section were organized into prescribing, dispensing

and use of drugs. This layout aids to the clarity.—Use of drugs was

organized into intentional and unintentional use of drugs which

emphasizes the difference in behaviour of patients and subsequent

interventions of pharmacist.—The primary domains in The Inter-

ventions section were divided according to the communication and

agreement with the prescriber. Despite high consistency in the

coding for interventions the expert panel believed that the Inter-

vention section content depends on the actual services run in

practice.

Conclusion The results of the validation procedure offer a possibility

to get an additional insight into the performance of the existing

classification and possibilities for their optimisation.

854 Int J Clin Pharm (2014) 36:847–857

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Abstract 1461

Classification for pharmaceutical interventions in patient orientedcare: a new concept

Karen A. Maes1, Kurt E. Hersberger1, Markus Messerli1,Markus L. Lampert2

1Pharmaceutical Care Research Group, University of Basel,

Switzerland. 2Clinical Pharmacy, Kantonsspital Baselland,

Bruderholz, Switzerland (karen.maes@unibas.ch)

Background In patient care, we defined a ‘‘pharmaceutical interven-

tion’’ as a recommendation initiated by a pharmacist in response to a

drug-related problem in an individual patient occurring in any phase

of the medication process. In daily practice, a classification helps to

document interventions and data generated provide a pool for epide-

miological studies. Most existing instruments have not been routinely

implemented in practice yet and none has been used parallel in com-

munity pharmacy and hospital settings. In Switzerland, a classification

system was implemented in several hospitals, while in community

pharmacies no standardised classification is used. To ease seamless care

and to promote mutual information, the structure of the classification

system should be similar but provide different levels of complexity.

Purpose To develop a new concept of classification for pharmaceu-

tical interventions suitable for both, primary and secondary care,

which could be integrated into a patient file.

Method Previously, we developed and validated a new classification

system for hospital setting (GSASA system), starting with an expert

panel discussion. During the adaptation of the system for the use in

community pharmacies, further discussion rounds followed and rel-

evant classification systems were retrieved by literature research. As a

first exploratory trial to test the suitability of the system in ambulatory

settings, we analysed protocols of medication reviews (Polymedica-

tion-Check, PMC) performed by a community pharmacist and we

classified the interventions using the GSASA system.

Findings We identified the need for a new computerized classification

system which allows high flexibility in documenting pharmaceutical

interventions. Corresponding to the complexity of the case, the avail-

able information, the type of medication review, and the need for

follow-up, different levels of classification may be indicated. This

instrument should be suitable for both, community and hospital phar-

macy practices to provide continuity of care. In a total of 65 medication

reviews, 190 pharmaceutical interventions were performed. All of them

could be classified with the GSASA system (median of 3 per PMC).

Most frequent interventions were ‘‘patient counselling, training’’ (69;

36.3 %) ‘‘optimisation of administration’’ (45; 23.7 %), ‘‘dose adjust-

ment’’ (13; 6.8 %) and ‘‘therapy monitoring’’ (13; 6.8 %).

Conclusion The GSASA classification system proved to be suitable

to classify interventions of medication reviews performed in primary

care. Further refinements are needed to improve the precision of the

system. Thus, the development of one classification system suitable

for both, primary and secondary care, flexible for addressing different

levels of complexity, and easily to be integrated in daily practice is a

promising approach.

Abstract 1462

Implementation and evaluation of the Dutch multidisciplinaryguideline (MDR) polypharmacy in the elderly

Jacintha Van Balen1, Zamire Damen-van Beek1,Marjorie Nelissen-Vrancken2, Monique Verduijn1,Menno Van Woerkom2

1Dutch College of General Practitioners (NHG). 2Dutch Institute for

Rational Use of Medicine (IVM) (j.vanbalen@nhg.org)

Background The MDR Polypharmacy in the Elderly (2012) gives

recommendations for performing a medication review from the points

of view from physician, pharmacist and patient. It contains five steps:

patient history, analysis, prescribers consultation, informing the

patient and follow-up/monitoring.

Purpose To investigate the feasibility of and problems with the

implementation of the MDR Polypharmacy in the Elderly in daily

practice.

Method General practitioners (GPs) and pharmacists of 3 pharma-

cotherapy counselling groups performed the method recommended in

the MDR in 60 patients. The groups had a starting meeting and an

evaluation meeting, which were supported by dedicated working

materials and an advisor. Every review was performed by a couple of

a GP and a pharmacist, depending on the patient. Process and effect of

the reviews were evaluated. Furthermore, key members of profes-

sional bodies and national registrations were interviewed to

investigate possibilities an limitations of registration IT systems.

Findings Almost all patients received one or more proposals for a

medication change (mean 2.3 per patient). The most common changes

were proposed discontinuation or starting a drug. 58 % of the possible

medication changes were achieved throughout the duration of the

project. Both GPs and pharmacists believe that medication reviews

are helpful and benefit the patient. Major problems in the practical

implementation of the medication reviews were • patient selection •the process of the medication analysis • monitoring the continuity of

the process • the evaluation of the medication initiated by a medical

specialist • the substantial time investment The limited opportunities

in the current registration IT systems of GPs and pharmacists com-

plicate the selection of patients, the monitoring of the continuity of

the process and the capturing and sharing of information and agree-

ments between GPs and pharmacists.

Conclusion Recommendations were made to all chain parties. Good and

practical reporting in the IT systems of GPs and pharmacists and exchange

of information are critical. It will reduce time investment of the profes-

sionals involved per patient and ensure the continuity of the process.

Abstract 1463

Evaluation of drug related problems in Belgium: focuson corticosteroids

Melanie Lelubre1, Majda Koubaity1, Isabel De Wulf2, K.Boussery3, G.R.Y. De Meyer4, Veerle Foulon5, V. Lacour6,Stephane Steurbaut7, T. Van Hees8, Amighi Karim1, CarineDe Vriese1

1Laboratoire de Pharmacie Galenique et de Biopharmacie, Faculte de

Pharmacie, Universite Libre de Bruxelles (ULB), Brussels, Belgium,2APB, Centrum wetenschappelijk Ontwikkeling voor Apothekers,3UGent, Universiteit Gent, 4UA, Universiteit Antwerpen,5KU Leuven, Katholieke Universiteit Leuven, 6UCL, Universite

Catholique Louvain, 7VUB, Vrij Universiteit Brussel, 8ULg,

Universite de Liege (melanie.lelubre@gmail.com)

Background Pharmacists have an important role to play in detecting

and resolving drug-related problems (DRPs). Most studies have

shown that DRPs have a negative impact on clinical results and

quality of life as well as on health care costs. Corticosteroids are often

implicated in DRPs, in particular because of their side effects,

incorrect use of the inhalation device or lack of adherence to the

prescribed regimen.

Purpose The purpose of this work is to identify causes of DRPs and

interventions performed by pharmacists on corticosteroid-related

problems and to distinguish between problems related to inhaled and

general corticosteroids.

Int J Clin Pharm (2014) 36:847–857 855

123

Methods During 5 days of their internship, 530 final year students of

pharmaceutical sciences in six Belgian universities collected DRPs

encountered in community pharmacies, as well as related interven-

tions performed by pharmacists. The DRPs’ electronic registration

was done through an adapted tool based on the classification of

Pharmaceutical Care Network Europe (PCNE—v 6.2). This tool was

validated by pharmacists and allowed to measure the frequency and

nature of DRPs.

Findings Pharmacists detected 16 733 DRPs in total. 555 DRPs

(3.3 %) related to corticosteroids, of which 115 were inhaled corti-

costeroids. The most common causes of corticosteroid-related

problems (55 %) were administrative and logistical factors and fraud.

More than a half of the technical causes were incomplete prescrip-

tions. Concerning clinical causes, 28 % related to drug/device-use

problems for inhaled corticosteroids, with 88 % related to incorrect

use of the inhalation device. For general corticosteroids, the most

common clinical causes were drug choice (37 %), including medi-

cation interaction (58 %) and inappropriate medication (contra-

indications, side effects: 14 %). Pharmacists’ intervention was similar

for inhaled and general corticosteroids. Pharmacists intervened with

the patient orally in 38 % of total interventions, and in writing in

more than 14 % of interventions. Pharmacists did not react in 14 %

(inhaled corticosteroids) and 16 % (general corticosteroids) of corti-

costeroid-related problems. These non-interventions covered, for

example, interactions and incomplete prescriptions.

Conclusion Several corticosteroid-related problems were detected

and solved. However, pharmacists barely intervened for non-obser-

vance and drug interactions. The introduction of a structured

interview between the patient and the pharmacist would enable the

patient to be educated and informed about his disease and treatment.

Therefore, pharmacists’ training is essential to performing these

interviews. More randomized studies should be done in community

pharmacies to evaluate the impact of these interviews on patients and

on therapeutic adherence in real time.

Abstract 1464

Evaluation of a drug related problem classification toolin community pharmacy daily practice

Majda Koubaity1, Melanie Lelubre1, Isabelle De Wulf2,Karim Amighi1, Carine De Vriese1

1Laboratory of Pharmaceutics and Biopharmaceutics, Faculte de

Pharmacie, Universite Libre de Bruxelle. 2Service Projets

Scientifiques, CDSP-CWOA-APB, Bruxelles (mkoubait@ulb.ac.be)

Background An adapted PCNE DRP classification tool has been

validated by Belgian pharmacists. The tool was reliable and had

adequate validity to measure the frequency and the nature of DRP

detected in Belgian community pharmacies.

Purpose In 2012, a study was initiated to collect the different DRPs

by pharmacy student during 5 days of their internship. The aim of this

study was to evaluate the daily use of the PCNE classification tool by

community pharmacists and their perception of this classification tool.

Method A self-completion questionnaire, in a web-based format, was

send to 210 pharmacy students from the French-speaking universities

of Belgium. It was organized into 3 different parts. The first one

revealed the prescription analysis method at the moment of dispens-

ing or a posteriori, for a new or a repeat prescription. The second part

aimed to identify if some complementary information sources are

necessary for an optimal DRP detection. The third part identified

barriers to the tool‘s use and its advantages in the DRP detection.

Findings In total, 79 students completed the questionnaire. For

optimal DRPs detection, they needed complementary information

about the patients (54 and 75 % for unknown patients and known

patients by the pharmacist, respectively) but also information from

scientific sources, which are mainly Belgian publications (96 %). This

study also showed that scientific international sources like PubMed

are rarely used in the detection of DRPs (15 %). The drug dosage in

patient pharmaceutical file (PF) was checked in 48 and 56 % of cases

at the moment of dispensing and a posteriori, respectively. Similarly,

medication adherence was checked in 44 and 55 % of cases at the

moment of dispensing and a posteriori, respectively. This suggested

that the patient PF was underused while its consultation allowed to

identify DRPs (78 %). Finally, DRPs detection could promote the

profession (84 %), strengthen the pharmacist patient relationship

(91 %) and improve patients monitoring by the pharmacy team

(92 %). Lake of time seems to be the major barrier to the use of this

tool in daily practice (79 %), as the necessity to consult comple-

mentary information sources (70 %).

Conclusion The PCNE classification tool is very helpful to identify

nature and frequency of DRPs and interventions performed by phar-

macists. Besides, pharmacists used substantially the same analysis

method at the moment of dispensing and a posteriori allowing to

establish a protocol that would facilitate the registration of DRPs.

However, the time required to complete the tool is too long for a daily

use.

Abstract 1465

Development of the PCNE standards for medication reviews

Markus Messerli1, Nina Griese2, Kurt E. Hersberger1

1Pharmaceutical Care Research Group, University of Basel,

Switzerland. 2Federal Union of German Associations of Pharmacists,

Berlin, Germany (markus.messerli@unibas.ch)

Background In 2009 the Pharmaceutical Care Network Europe

(PCNE) started to discuss a definition and terminology for medication

reviews (MR) performed by pharmacists in ambulatory and clinical

setting. At various meetings and workshops the PCNE definition and

terminology of MR was further developed.

Purpose This work aims at summarizing the development and the

agreements achieved during PCNE meetings organised by the special

interest group (SIG) MR from 2009 until 2013, focusing on the

definition, different types and characteristics of MR.

Method We conducted a review of presentations and workshop

reports retrieved from the workshop moderators and from the PCNE

website from initiation of the SIG MR in 2009 until 2013.

Findings The first definition of a medication review by PCNE was

prepared in a brainstorming in Vimeiro (PT) and discussed 2009 in

Geneva (CH): ‘A MR is an evaluation of patient‘s medicines with the

aim of optimizing the outcome of medicine therapy by detecting,

solving and preventing drug-related problems’. Three different types

were distinguished. The terminology followed the available number

of information resources: (I) a simple MR only uses dispensing data

from patient history, (II) an intermediate MR additionally uses the

patient’s information from a patient interview, and (III) an advanced

MR combines dispensing data, patient’s information and clinical data.

In 2011, the definition was modified and the main goal of a MR was

amended with the term ‘managing the risk’ (Manchester, UK),

highlighting an active role and responsibility with respect to patient

safety. In addition, the definition was expanded in such way that MR

should be part of the medication therapy management. In 2013

(Berlin, DE) discussions about specific opportunities and limitations

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in primary or secondary care settings the intermediate MR was split

into two subtypes: in primary care, medication history of the phar-

macy and patient information is available (IIa), while in secondary

care the medication history and clinical information is used (IIb).

Discussions of the process of performing MR concentrated on the

ability of the different types to detect drug therapy problems and

patient selection. However, results from these discussions are not

translated into a statement, yet.

Conclusion The PCNE terminology takes into account, that the

amount of available information sources defines the type of a MR.

Specific expertise and skills are required to perform the different

types of MR properly. Standardised structures and documentation

forms are needed to achieve appropriate reviews and to translate the

findings into an efficient care process.

Abstract 1466

The analysis of drug-related problems identified by the Polishcommunity pharmacists participating in Pharmaceutical Carein Arterial Hypertension and Diabetes (PCAHD) Project

Agnieszka Skowron1, Wioletta Polak1

1Department of Social Pharmacy, Jagiellonian University Collegium

Medicum, Krakow, Poland (wpolak@cm-uj.krakow.pl)

Background Polish law defines pharmaceutical care as one of the

professional duties of pharmacists. However pharmaceutical care has

not yet been widely implemented in community pharmacies. Our

Department conducts Pharmaceutical Care in Arterial Hypertension

and Diabetes Project (PCAHD Project), which focuses on popular-

izing the idea of pharmaceutical care among Polish community

pharmacists.

Purpose The analysis of drug-related problems identified by the

Polish community pharmacists participating in PCAHD Project.

Method Pharmacists, who voluntarily joined our Project, were

obliged to conduct pharmaceutical care in accordance with the

guidelines delivered by our Department. Drug-related problems

(DRPs) were identified and classified by the pharmacists based on the

PCNE classification (version 5.01 from November 2009 to June 14,

2010 and version 6.2 from June 15, 2010 to December 31, 2013).

Classification of the identified DRPs was then revised by the research

team.

Findings From November 2009 to June 14, 2010, 36 DRPs were

identified in 11 patients. Contraindications (P2.4), lack of adminis-

tration of the drug (P4.1) and interactions (P5.1, P5.2) were most

common DRPs (19.4 % of DRPs, each). The most common cause was

C1.1 inappropriate drug selection (36.7 % of DRPs) and C1.7 new

symptom or indication revealed, C2.1 inappropriate timing of

administration and/or dosing intervals and C4.3 suspicion of side-

effect (11.1 % of DRPs, each). 24 DRPs (66.7 % of DRPs) were

associated with drugs used in cardiovascular disorders and 8.3 % of

DRPs—with drugs used to treat diabetes. From June 15, 2010 to

December 31, 2013 77 DRP were identified in 30 patients. The most

often identified DRP was not optimal therapy effect P1.2 (57.1 % of

DRPs) and untreated indication P1.4 (14.3 % of DRPs). 68.8 % of

DRPs were associated with drugs used in cardiovascular disorders and

19.5 % of DRP—with drugs used in diabetes.

Conclusion Polish community pharmacists are able to identify drug-

related problems.

Abstract 1467

National pharmacy practice standards and evidence basedguidelines in pharmaceutical care; developmentand methodology in Hungary

Reka Viola1, Attila Horvath-Sziklai2, Ildiko Csoka1,Gyongyver Soos1

1University of Szeged, Faculty of Pharmacy, Institute of Drug

Regulatory Affairs. 2Hungarian National Committee of

Pharmaceutical Care (viola@pharm.u-szeged.hu)

Background Country-specific pharmacy practice standards based on

Good Pharmacy Practice (FIP) provide the professional background

and framework for high quality pharmacy services. Evidence based

clinical guidelines are defined as systematic statements developed to

assist decisions by health care providers on appropriate healthcare for

specific pathological conditions. The development of standards and

evidence-based guidelines in pharmaceutical care is essential in order

to ensure patient safety and also cost-effective pharmacy-manage-

ment practice.

Purpose To give an overview about the method development, in

order to form standards, and evidence-based guidelines in the field of

pharmaceutical care.

Method A careful combination of the GPP and the country-specific

environment was the first step of standard development; followed by

an extensive consultation with pharmacy organisations and practi-

tioners, mapping the critical points regarding pharmaceutical care

process. ‘‘Swiss cheese model’’ was used to reveal the patients safety

risk points of the process. Finally, the main domains of standards

were determined by root cause analysis (RCA). Guidelines’ topics

were selected regarding the prevalence of health care conditions

present in the community pharmacy. The classic process of guideline

development, consistent with AGREE criteria were followed. Where

external evidence based pharmaceutical care guidelines were avail-

able, adaptation was preferred after critical appraisal. Development

process in lack of external guidelines was based on the systematic

literature searching method in order to find the available evidences.

Standards and guidelines were reviewed by a multidisciplinary expert

group and refined by a ‘‘pilot study’’ before release.

Findings According to the results of RCA, pharmaceutical practice

standards were formulated on 12 domains. These are in accordance

with FIP/GPP recommendation. Guidelines (16) were developed for

the most common cases of self-medication (common cold, acne, low-

back-pain, allergic rhinitis, GERD) and for common public health

problems (metabolic disorders, asthma, COPD, BPH). Safe medica-

tion in pregnancy and in geriatrics were among the selected topics as

well. The structured questions in the evidence–based pharmaceutical

care guidelines developed by our expert team focus on the following

fields: (1) the patient asking for an OTC (self-medication) or the

patient brings a prescription; (2) adequate and safe use of medicine;

(3) improve the adherence of patients; (4) need for referral. Unfor-

tunately, only a few external evidence-based pharmaceutical care

guidelines were found in the literature, therefore recommendations

from medical guidelines were adapted in many cases.

Conclusion The adaptation of the evidence-based guideline devel-

opment into the field of pharmaceutical care was aggravated by

numerous methodological issues.

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