W2 – Check of compounding appropriateness

Link to EAHP Statements

• Section 3 – Production and Compounding: Statements – 3.1, 3.3
• Section 5 – Patient Safety and Quality Assurance: Statements – 5.2, 5.5, 5.7

Abstract

In 1999, the Institute of Medicine published their famous report ‘To Err is Human’, in which it was shown that medication errors (MEs) contribute to mortality in an important way. It was highlighted that optimisation of pharmacotherapy, with an emphasis on avoiding MEs, is the key element to improve patient safety. Serving as a bridge between clinical decision support systems (CDSS) at the moment of prescribing and front office clinical pharmacy services, clinical validation of medical prescriptions has gained importance in many European countries, as it offers possibilities to add significantly to patient safety in an efficient and cost-effective manner. Different hospitals therefore implemented the Check of Medication Appropriateness (CMA). Within most clinical validation services, electronic patient records are screened (based on clinical rules integrated in the hospital information system (HIS)) for potentially inappropriate prescriptions, generating a worklist to be reviewed by a clinically trained hospital pharmacist. The system helps to reduce the number of potentially adverse drug events (ADE’s) and stimulate patient safety.

Next to performing clinical pharmacy services, hospital pharmacists are responsible for the compounding of drugs. Although the benefit of clinical validation has been proved in several studies, this service is often only implemented for commercially available drugs and yet missing for prescriptions of compounded drugs. Patient incident reports and implicit checks reveal the potential of inappropriate prescriptions for compounded drugs, most certainly regarding wrong dosing. But also, galenic issues (e.g. solubility, osmolarity, precipitation, physicochemical reactions, …) can impact stability or biological availability and therefore the outcome and patient safety. Therefore, a similar service as CMA is developed, called the Check of Compounding Appropriateness (CCA) to screen for potentially inappropriate prescriptions of compounded drugs.

At the start of this workshop, the concept, development, and results of CCA are highlighted. Different cases with compounded prescriptions will be presented and participants will be asked to analyse these for appropriateness. Implicit checks suggested by the participants will be discussed. Next, an explicit screening tool checking for clinically relevant medication problems will be applied. Participants will be asked to identify/prioritise relevant aspects for CCA and discuss facilitators and barriers when it comes to implementation in their own hospital based on the hospital needs.

Learning objectives

After the session, the participant should be able to: 

• Identify the need, possibilities and limitations of a CCA programme
• Setup a CCA programme in their own hospital including the aspects relevant within the own hospital setting
• Critically appraise screening tools for CCA

Educational need addressed

Hospital Pharmacists contribute to an optimal therapy and patient safety by performing clinical validation of medical prescriptions. Expanding this service to compounding adds an extra challenge and opportunity. Hospital pharmacists must be aware of the possibilities and limitations of check of compounding appropriateness.

Keywords

Check of compounding appropriateness program, clinical validation, compounding, preparation