Background Transition between different healthcare settings is a risk factor for medication discrepancies in the patient’s medication list. A large number of discrepancies has the potential to cause adverse drug events. Purpose Obtaining a complete medication list of a patient is very important to avoid unintentional medication discrepancies and medication related problems at admission. We aimed to evaluate the added value of a structured medication review in the emergency department by a pharmacy technician. Material and methods Well trained pharmacy technicians performed a medication review of patients admitted to the emergency department by using a structured form and different sources (patient, family, medication list, family doctor, etc). The physician acquired medication list was compared with that acquired by the technician to identify unintentional discrepancies (any difference between the two medication lists). The clinical impact was evaluated by a multidisciplinary team of pharmacists and pharmacologists. Results From February to April 2016, 279 (74.9%) medication discrepancies were identified in 113 medication lists. The most common discrepancies were omission of a drug (43.7%), omission of frequency (17.2%) and omission of dose (14.7%). Drugs belonging to the class of analgesics (21.1%) and obstructive airway disease (18%) were associated with the highest discrepancy rates. There was a positive association between the number of discrepancies and the number of drugs (p=0.002) and information sources (p=0.026) and the time needed to perform the reconciliation (p=0.001). 6.5% were evaluated as having a potentially very significant impact on the patient’s health; 30.6% were evaluated as having the potential to cause moderate clinical impact and 2.2% as potentially having a minor or no impact. Conclusion This study provides evidence that structured medication review is useful to obtain a complete medication history, to avoid medication related problems and to guarantee the patient’s safety. References and/or acknowledgements Mueller SK, et al. Arch Intern Med2012;172:1057–69. No conflict of interest

Introduction Pharmacists can be faced with pediatric patients treated for a hemato-oncological condition or patients who underwent a hematopoietic stem cell transplantation [HSCT). This study aims to identify the roLe of the pharmacist and master in pharmacy students as well as their knowLedge of pharmaceutical care for this specific patient population. In addition, their experiences of basic education and expectations of continued education in pediatric hemato-oncology and HSCT are analyzed. Methods Pharmacists in Flanders and pharmacy students [Ghent University] were requested to complete and online survey with (1) general questions, (2) questions about knowledge by means of theoretical examples and practical cases and (3) questions about education (past and future) related to this topic. Results A total of 156 pharmacists and 67 students completed the survey. Results demonstrated that 22.0% of pharmacists and students already delivered medication to this particular patient group. A total of 98.2% [pharmacists and students] found that they had insufficient knowledge and experience to give optimal pharmaceutical advice. The pharmacist scored only 34.0% [average] in the general knowledge section, students 44.0%. Both pharmacists [68.6%] and students [79.0%] agreed that this topic should be included in the basic curriculum. The vas majority [91.0% pharmacists, 89.6% of students] were asking for courses on this theme by means of and evening session or an e-learning tool. Conclusion Although the role of pharmacists and students in this patient group can be confirmed, the results of the survey demonstrate a lack of knowledge among pharmacists and students about pediatric hemato-oncology and HSCT. There is interest in education in the basic curriculum and the vast majority of pharmacists are interested in continuing education.

Biosimilar (B) uptake in Belgium is closely related to the hospital financing system. B are mainly distributed through hospitals and bilateral discount negotiations between the hospital pharmacy and company exist. This budget impact analysis (BIA) estimates the influence of different B uptake percentages & discount rates from a hospital perspective (Belgium). The current usage data 2015 (only originator (O); no B uptake) of infliximab, epoetin alfa, filgrastim and follitropine alfa in the tertiary care Ghent University Hospital for all authorized indications were retrieved. Potential discount%, future price reductions for both B & O and potential fluctuation in consumption are analyzed for 3 uptake scenarios: newly diagnosed patients (de novo), 20% and 100% switch of patients. The BIA uses the official Belgian tariff unit prices (NIHDI). A discount difference (in favour of B) of 10% is used for epoetin alfa and follitropine alfa; 20% for infliximab; 40% for filgrastim. Key variables (discount%, price, consumption) were tested in deterministic univariate sensitivity analyses [MIN, MAX]. Time horizon is 5 years. Infliximab showed the highest cumulative savings with de novo, 20% and 100% scenario of resp. €686.896,45 [€171.724,11- €1.373.792,90], €763.541,59 [€190.885,40 - €1.527.083,19] and €3.817.707,97 [€954.426,99 - €7.635.415,93], followed by filgrastim with resp. savings of €420.706,24 [€-29.213,72 € - €841.412,49], €105.637,35 [€-7.335,75 - €211.274,71] and €528.186,77 [€-36.678,73 - €1.056.373,54]. Follitropine alfa savings were €68.443,54 [€-12.271,96 - €136.887,09], €19.367,16 [€-3.472,54 - €38.734,32] and €96.835,80 [€-17.362,71 - €193.671,60] and epoetin alfa: €22.495,20 [€-1.649,00 - €44.990,40], €7.380,68 [€-541,36 - €14.761,36] and €36.903,39 [€-2.706,82 - €73.806,78]. Savings became in favour of O (negative MIN) if O-discount% increased 5% (filgrastim), 20% (follitropine alfa, epoetin alfa) above B-discount%. Increased consumption dominated the MAX values. All base-case simulated scenarios were in favour of the biosimilar. Only discount variation inverted the results pro originator.

Some infections require prolonged parenteral antimicrobial therapy, which can be continued in an outpatient setting. The Ghent University Hospital has fifteen years of experience with Outpatient Parenteral Antimicrobial Therapy [OPAT) in the patient own home setting. As a quality improvement initiative, this process was critically reviewed in a multidisciplinary approach. Several challenges and barriers were identified, including regulatory obstacles for OPAT in Belgium, such as Lack of uniformity in ambulatory reimbursement of parenteral antimicrobials. There is no financial incentive for the patient with OPAT, as costs for the patient of outpatient therapy can be higher as compared with hospitalization. Other barriers include delayed approval of the certificate for reimbursement, low availability of medicines in the community pharmacies and limited knowledge of the medical devices for administration in ambulatory setting. All critical steps in the revised OPAT program are summarized in a flowchart with a checklist for all stakeholders. Firstly, a list with specific criteria to include patients in an OPAT program is provided. Secondly, the Multidisciplinary Infection Team received a formal mandate to review all eligible OPAT patients. In order to select the most appropriate catheter a decision tree was developed and standardized packages with medical devices were developed. Thirdly, patients receive oral and written information about the treatment with practical and financial implications. Fourthly, information is provided towards the general practitioners, community pharmacists and home care nurses. Standardization of the OPAT-program aims at improving quality and safety of intravenous antimicrobial therapy in the home setting.

High-dose etoposide is used in conditioning regimens for allogeneic stem cell transplantation. The limited stability of the drug induces barriers for its use for pharmacists, nurses and patients. When using a concentration of 10 mg/mL etoposide in physiologic saline, limitations can be overcome. This study provides stability data for etoposide in a high concentration that can be used in conditioning regimens. The solution was stable for 48h at 5°C, for 48h at 5°C followed by 8h at 25°C and for 24 h at 25°C.