The EAHP Board, elected for three-year terms, oversees the association’s activities. Comprising directors responsible for core functions, it meets regularly to implement strategic goals. Supported by EAHP staff, the Board controls finances, coordinates congress organization, and ensures compliance with statutes and codes of conduct.
PROTOCOL IMPLEMENTATION FOR PRESCRIBING AND DISPENSING POSTEXPOSURE PROPHYLAXIS KITS FOR HUMAN IMMUNODEFICIENCY VIRUS IN A THIRD-LEVEL HOSPITAL
European Statement
Patient Safety and Quality Assurance
Author(s)
Clara Estaún-Martínez, Isabel Moya-Carmona, Laila Dani-Ben Abdel-lah, Jose Manuel Fernández-Ovies
Why was it done?
This initiative was taken in order to improve uptake and completion rates of PEP, and to homogenise the healthcare circuit for these patients and the prescribed drugs.
What was done?
A protocol was implemented in order to standardise the prescription and dispensation of postexposure prophylaxis (PEP) after occupational or nonoccupational exposure to human immunodeficiency virus (HIV).
How was it done?
A multidisciplinary team including Infectious Diseases and Preventive Medicine (PM) doctors, pharmacists and Emergency Room (ER) staff developed the following protocol for PEP according to World Health Organisation and national guidelines: – standard three-drug regimen for PEP: Tenofovir disoproxil fumarate/Emtricitabine + Raltegravir for 28 days. The pharmacy service (PS) repackages kits for five, 23 or 28 days that include antiretroviral drugs (AD) and written information about the treatment (use, length of the treatment, main interactions and side effects, contact number). Only 5-day PEP kits will be located in the ER. – Twenty-four-hour access granted to PEP kits as it is strongly recommended to initiate PEP as early as possible (ideally within 72h). –
Established healthcare circuit for patients in the ER:
• Monday–Fridays (8h00–15h00): patients will be immediately referred to PM, then they will go the PS in order to receive a 28-day PEP kit and pharmaceutical care.
• Out of this schedule and bank holidays: ER doctors will give patients a 5-day PEP kit and they will be referred to PM the next working day. After visiting PM, the patient will go to the PS in order to receive the rest of PEP (23-day kit) and pharmaceutical care. –
Several meetings took place in order to explain this new circuit to the health professionals involved and written copies were available on the ER as well as on the intranet.
What has been achieved?
The implementation of this protocol was well embraced by all the staff involved, since it allowed a more efficient healthcare circuit for the patients. It also optimises the evaluation and monitoring of these patients by PM and the pharmacist, and grants prompt PEP initiation and 24h access to the AD. The 28 days (or 5+23 days) kits help to accomplish the proper length of treatment, without using the regular packages which include 30 days of treatment (saving €43.17 per treatment).
What next?
We will monitor the compliance with this protocol and the drugs prescribed for PEP.
HIGHLY ACTIVE ANTIRETROVIRAL THERAPY PRESCRIPTIONS IN NAIVE PATIENTS: IMPROVEMENT PLAN
European Statement
Patient Safety and Quality Assurance
Author(s)
A. Rodríguez-Perez, M.I. Sierra-Torres, M.D. Toscano-Guzmán, A. Monzón-Moreno, M. Soriano-Martinez, A. Lluch-Colomer, M.D. Santos-Rubio
Why was it done?
According to the guidelines and recommendations for the rational use of medication, prescriptions of HAARTs must be standardised following the principles of efficiency and based on the best evidence available.
What was done?
A multidisciplinary group of clinical pharmacists and physicians made an easy-to-read handout that summarised the main recommendations of GESIDA for the treatment of naive patients, treated with highly active antiretroviral therapy (HAART). The hand-out consisted of a table with the allowed and not-allowed antiretroviral combinations and the exceptions. The multidisciplinary group disseminated the handout to the prescribers through clinical sessions. The multidisciplinary group made a 6 month study to evaluate the adherence to GESIDA, previous and after the implementation of the easy-to-read handout.
How was it done?
We did not have any problem implementing these recommendations or organizing the clinical sessions.
What has been achieved?
The multidisciplinary group made a retrospective study of the 6-months previous the implementation of the handout, by a chart review of the prescriptions. One hundred naive patients were evaluated. We found an eleven per cent of deviations of the recommendations, none of them justified. The multidisciplinary group made a prospective study during a 6-months period after the implementation of the handout, by a chart review of the prescriptions. Seventy-one naive patients were evaluated. We found a 7% of deviations of the recommendations, three of them were justified because of co-morbidity that contraindicated the recommended medication. We also made a follow-up of the treatment of the patients of the retrospective study, six of the eleven patients of that group changed their HAART to the recommended ones.
What next?
The multidisciplinary team has periodic meetings to evaluate the adherence to the recommendations and to study news reported by GESIDA. The economic impact of the practice is planned to be evaluated.