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Background According to the World Health Organisation, selection of drugs is a participatory, ongoing and multidisciplinary process which should be based on efficiency, security, quality and cost of the drugs to ensure rational use of them. As the result of the selection process of medicines, some tools have been developed in specialised areas that are essential. These are called pharmacotherapeutics guides (PG) and show the political use of medicines in medical environments, such as hospitals. The PG is a dynamic and consensual reflection of the centre’s pharmacotherapeutic culture. Purpose To evaluate the economic impact of revision of the PG in a private hospital with 80 beds. Material and methods A review was conducted by the pharmacy and therapeutics committee of the drugs (PTCD) available in the hospital based on criteria of effectiveness, safety and cost. After reviewing the PG, the inventory data and drug purchases were analysed between October 2014 (a month before the edition of the guide) and August 2015. Results The PCTD, composed of a multidisciplinary team of 8 doctors of various specialties and a hospital pharmacist, met on 6 occasions. The initial number was 1304 pharmaceutical specialties. After reviewing the therapeutic arsenal, it was reduced to 925 drugs. Coverage ratio=inventory/purchases x 30 days Conclusion This review has shown the economic impact, reducing the cost of the inventory and the coverage ratio. The increase in purchases in June and August responds to a higher activity in the centre in the summer months, as it is located in a holiday destination area. A review of the PG provides an opportunity to give visibility to the pharmacy department in the hospital and initiate relationships for new joint projects. Further studies will be performed, as an impact in terms of quality of care and patient safety is also expected. References and/or Acknowledgements Pharmacy and therapeutics committee of the drugs committee, Hospital Quiron Marbella. No conflict of interest.

Background Vitamin K (VK), whose recommended daily intake is easily achieved by food, enteral or parenteral nutrition, is mainly indicated as an antidote against hypoprothrombinaemia due to excessive coumarin anticoagulation. It’s activity correlates with the international normalised ratio (INR), which is also influenced by other conditions affecting the extrinsic coagulation pathway (liver disease, intravascular diffuse coagulation, antiphospholipid syndrome). According to benchmarking data, VK expenses are 9 times higher than the country’s average. Purpose Our aim was to assess if VK is being used according to the available clinical evidence, estimating the impact of unnecessary prescriptions and checking if pharmacists’ interventions could modify doctors’ prescription habits. Material and methods We included all VK prescriptions written during July 2015, studying how posology evolved until treatment interruption or patient discharge. Gathered demographic and clinical data were coded in a Filemaker database, using SPSS 22 for statistical treatment. When necessary, by leaving a note in the patient’s history, doctors were required to make changes in order to fit clinical evidence. Results 66 patients (47 male, average age 65.1 ± 17.2 years) received VK, emergencies being the area with the most prescriptions (16). Only 10 were signed by an haematologist. The main indication (anticoagulant hypoprothrombinaemia) had the lowest expense (204.05€) and better compliance with evidence (54.0% of the doses unnecessary). 1245.55€ were spent on management of malabsorption, liver disease and prolonged antibiotic use, poorly supported by evidence (78.7% doses unnecessary). We proved no correlation between VK dosing changes and INR evolution in a complex cirrhotic patient (Spearman’s rho, p > 0.05). Perioperative hypoprothrombinaemia (INR Conclusion Unnecessary VK prescription, worrying because of its high incidence, has an important impact on health system budget (up to 34 000€ yearly if we extrapolate our results). Considering how pharmacists succeeded in optimising prescriptions, our conclusions will be presented to the next Pharmacy and Therapeutics Committee. We will remark on the main role of pharmacist intervention, and propose formative activities for doctors in order to improve VK prescription quality. References and/or Acknowledgements 15 references. No conflict of interest.

Early in the morning, our hospital admits the first outpatients of the day and the cancer centre opens its doors. The pharmaceutical department must be ready by 08:00 h when patients, families, caregivers and employees start to arrive. The first task of the day in the pharmaceutical department is to prepare the agents used in chemotherapy. A pharmacist organises the preparation of cytostatic drugs for intravenous administration and transfers them to the relevant departments; speed of response is very important as most of the drugs are destined for outpatients. The pharmacist is responsible for using safe routines and integrated procedures to ensure physical, chemical and microbiological quality, and operator safety. One laminar flow cabinet is used initially, with up to three more recruited during the morning. The centralisation of chemotherapy production to one location in our hospital has resulted in several advantages including greater accuracy and better operator safety. Closer coordination between the pharmaceutical department and clinical care services was also necessary to ensure the timely delivery of chemotherapy drugs. Efficient inventory management is also important as staff work on preparing orders and delivering products. The pharmacy and therapeutics committee meets frequently to select the portfolio …

Background After the Pharmacy and Therapeutics Committee of a tertiary hospital had evaluated ranibizumab and bevacizumab for the treatment of macular oedema secondary to retinal vein occlusion (RVO) based on the available evidence, the two drugs were considered equivalent therapeutic alternatives and ‘off label’ bevacizumab use was approved (1.25 mg intravitreal prefilled syringe prepared by the Pharmacy department, administered every 6 weeks for four doses and subsequently as required). Purpose To quantify the financial impact of the use of bevacizumab as anti-VEGF of choice in the treatment of macular oedema secondary to RVO. Materials and methods Data were collected from patients diagnosed with macular oedema secondary to RVO from November 2012 to April 2013, and from the treatment given. In order to calculate the savings generated by using bevacizumab, rather than ranibizumab, during this period, the direct cost difference between the two alternatives was used. Results 18 patients with macular oedema secondary to RVO were treated, with a total of 46 doses. In all the cases, we used intravitreal bevacizumab as the antiangiogenic drug. The saving generated by using a dose of intravitreal bevacizumab rather than intravitreal ranibizumab was 1,291 €. The impact of cost savings for the hospital during the six months studied was 11,626 €. According to the established protocol, the incremental cost of one year’s treatment is 7,767–15,534 € (depending on the number of injections). Therefore, the annual impact on the hospital budget (assuming 36 patients/year) would be around 280,000–560,000 €. Conclusions Selecting bevacizumab as the antiangiogenic drug in patients with macular oedema secondary to RVO generates significant cost savings for the healthcare system. No conflict of interest.

Background The clinical pharmacist’s role has grown considerably in recent years due to its prominence in coordinating with healthcare professionals to achieve optimal health outcomes. Few studies have been published regarding clinical pharmacist interventions in Lebanese hospitals, and none have been done concerning remote hospitals. Purpose To evaluate the impact of a clinical pharmacist as a member of the healthcare team and as a drug information source, and to evaluate the acceptance rate of clinical pharmacist interventions at the Centre Hospitalier du Nord (CHN) University Hospital located in a rural region of Lebanon. Materials and methods A 12-month prospective analysis was conducted in the Internal Medicine department of CHN where a clinical pharmacist attended daily rounds for 3–4 h and spent the rest of the working hours checking prescriptions and answering drug information questions. All interventions performed were documented on a ‘Pharmacist Intervention Form’. After data entry, the statistics were analysed by the clinical pharmacist, reported and discussed every 2 months at the Pharmacy and Therapeutics committee. Results 1631 interventions were performed by the clinical pharmacist; 91% were accepted and 9% were rejected. The types of interventions made were as follows: order clarification (26%), alternate route (19%), therapeutic consultation (14%), drug information (11%), dose adjustment in renal impairment (8%), followed by the other 7 categories. These results expose both a high acceptance rate and versatility in intervention types not shown in previously published studies concerning this topic. Conclusions This study shows the effect of including a clinical pharmacist in the healthcare team for all the added value that he/ she offers in the different areas of interventions while achieving a high approval rate. The significance of the results is more pronounced because it took place in a remote hospital where the clinical pharmacist has scarce human, financial and logistical resources. No conflict of interest.

Background Adverse drug events related to anticoagulants are common and clinically significant. Computerized physician order entry (CPOE) and clinical decision support systems (CDSSs) are widely viewed as crucial for reducing prescribing errors. Purpose To make prescriptions safer and to promote good practise, by developing CDSSs focused on oral and injectable anticoagulants. Materials and Methods A review was carried out of existing guidelines and practise in the units. About ten meetings with clinicians (cardiologists, thrombosis specialists) and pharmacists from the Pharmacy and Therapeutics Committee (PTC) were required to write these CDSSs. The CDSSs were presented and tested in the cardiology units. New discussions and improvements in the CDSSs were made with prescribers, nurses and pharmacists. The final CDSSs were validated by the Pharmacy and Therapeutics Committee (PTC). Results Nine CDSSs had already been validated by the PTC: Vitamin K Antagonist (VKA), heparin sodium, heparin calcium, Low Molecular Weight Heparins (LMWHs) in prophylactic and curative treatment of deep-vein thrombosis and pulmonary embolism, LMWHs for acute coronary syndrome ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction, LMWHs for cardiac arrhythmia, and treatment of heparin-induced thrombocytopenia. There are still regular meetings to develop CDSSs on new anticoagulants: dabigatran, rivaroxaban and apixaban. Each CDSS provides: Information on the choice of a therapeutic strategy based on the indication and the clinical context. Usual doses and rates of administration. A dose calculation based on weight (heparins). Overrun alerts when the dose is exceeded. Regular laboratory tests at the recommended frequency. Protocols for dosage adjustments based on the biological values. Administration modalities for the nurses. Since the implementation of the CDSS on VKA, annual fluindione prescriptions have decreased by 17% and annual warfarin prescriptions have increased by 53% in accordance with the recommendation to prescribe warfarin as the first-line oral anticoagulant. Conclusions Development of CDSSs referred to by the CPOE system takes a lot of time but is a good way of disseminating PTC guidelines to all prescribers, pharmacists and nurses. CDSSs can assist clinicians in the management of patients requiring anticoagulant treatment by improving compliance with care standards. These CDSSs are updated following changes in guidelines and clinical practise. Other CDSSs focused on high-alert medicines will be introduced when computerised prescribing is implemented for the entire hospital. No conflict of interest.