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.
IMPLEMENTATION OF A SERUM MONITORING PROTOCOL FOR INFLIXIMAB IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE
European Statement
Clinical Pharmacy Services
Author(s)
Mafalda Cavalheiro 1
Maria José Rei 1
Ana Rita Silva 1
Patrícia Batalha Silva 1
Carolina Marques 1
Miriam Capoulas 1
1- Pharmacy Department, Hospital da Luz Lisboa, Portugal
Why was it done?
Low serum Infliximab are associated with lost of response and development of immunogenicity. Moreover, therapeutic levels without the control of the inflammatory activity may inform about the necessity of changing the therapeutic class. While monitoring serum levels in the absence of response is already well established, the proactive monitoring of serum levels at defined timings during the induction and maintenance phases of therapy is beginning to be recommended by several leading organizations.
What was done?
Establishment of a protocol for proactive serum monitoring of Infliximab in inflammatory bowel disease, to guide the interpretation of serum levels, optimize dosage and therapeutic response.
How was it done?
Implementation took place in several stages. 1) Theoretical and practical training culminating in the discussion and drafting of a technical guideline including a monitoring protocol with the Gastroenterology team. 2) Organization of the sample collection and analysis circuit. The analytical technique is a rapid test that allows the detection of infliximab levels and anti-infliximab antibodies. 3) Finally, dosage optimization (maintenance of the reference dosage or intensification – shortening the administration interval or increasing the dose) is carried out with the support of population pharmacokinetic models using the DoseMeRx software, interpreted in the context of the overall response assessment in conjunction with the clinical team. The main limitation identified had to do with awareness of the medical team to rational dosage adjustments based on the population model.
What has been achieved?
15 patients were included with a median age of 33 years; 11 of these were diagnosed with Ulcerative Colitis and 4 with Crohn’s Disease. A total of 24 tests were carried out (21 with a proactive strategy and three with a reactive strategy). Of the doses taken at week 6, 60% were below the reference range considered. The dosage regimen was intensified in 64% of the recommendations. Of the patients analyzed, 76% maintained their response, although the duration of treatment was less than a year in most cases.
What next?
The strategy of proactive monitoring and dose intensification may have contributed to achieving and maintaining the response to treatment with Infliximab, but the small number of patients and the duration of the analysis call for further analysis.
Implementation of an opioid stewardship programme (OSP) at San Ignacio University Hospital
European Statement
Patient Safety and Quality Assurance
Author(s)
Viviana Andrea Pinzon Garcia, Paula Camila Murcia Jaramillo, Reinaldo Grueso Angulo
Why was it done?
In 2018, concerned with the opioid crisis in USA, the pharmacy and therapeutic committee began to work on safer opioid use; an initial diagnosis showed an increase in the use of in hospital opioids and a lack of protocol for the disposal of the resultant remnants. Standard single-dose syringes (SSDS) were devised to avoid remnants, subsequently noticing that the strategies to be used should involve the whole medication order cycle (MOC). This gave rise to the OSP, which involves physician’s pain management and prescribing practices, pharmacy preparing and dispensing process, nurse’s custody, administration and disposing protocols.
What was done?
An Opioid Stewardship Programme (OSP) led by a multidisciplinary team: scientific direction, pharmacy and pain clinic, was implemented to ensure adequate and safe opioid prescription, dispensation, administration and disposing practices in San Ignacio University Hospital (HUSI), a tertiary level hospital in Bogota, Colombia.
How was it done?
Institutional pain practice guidelines were assessed, unifying the titration doses with SSDS and developing disposal protocols in which care staff is constantly being trained ever since. To trace the impact of the OSP, indicators for IV opioid consumption, SSDS prescription, naloxone use and guideline adherence were created.
Main obstacles on SSDS: <10% prescribing adherence, availability failures and dose expiration. In response, the whole ampoule prescription was narrowed to only pain specialists to face SSDS expiration costs and avoid shortage.
What has been achieved?
SSDS prescription proportion above 70% by July 2022, decreased milligram morphine equivalent (MME) consumption per hospital discharge (January 2019: 37, January 2020: 47, January 2021 (COVID 2nd surge): 39, January 2022: 25, July 2022 (COVID 3rd surge):16) and monthly costs decrease in 1997 USD, between 2019 and 2022.
An opioid shortage during the COVID surges, deepened in Colombia due to a hydromorphone recall, was avoided.
What next?
The OSP initiative could be replied in healthcare institutions considering our achievements. To keep working in a safer opioid MOC, our OSP has formulated new strategies with an active role of pharmacists, pain specialists and nurses oriented to: remnants disposal protocol, prescribing policies, medication error detection and healthcare staff and patient education.
Partnership of Specialist Nurse and Specialist Pharmacist roles improves quality of care of IBD patients
European Statement
Clinical Pharmacy Services
Author(s)
Fernando Fuertes
Why was it done?
Monitoring of patients on immunomodulators increases the workload of consultants in gastroenterology outpatient clinics. Pharmacist-led monitoring clinics reduces the number of patients who had to discontinue treatment due to myelosuppression, optimises dosage by therapeutic drug monitoring (TDM), and increases adherence to blood monitoring.
What was done?
A creation of a outpatient pharmacist-led Inflammatory Bowel Diseases (IBD) clinic to monitor and optimised immunomodulators and biologic therapy. The role of the specialist pharmacist has added value and clinical oversight to the care of IBD patients as treatment with biologic therapy has become more prevalent. In addition, the pharmacist routinely participate in IBD multidisciplinary team meetings to help with decision-making and treatment optimisation.
How was it done?
The Department of Gastroenterology at Barnsley Hospital, developed the twin roles of a Specialist Gastroenterology Pharmacist and an IBD Specialist Nurse/Non-medical endoscopist in 2012 to augment IBD care. Both roles require accreditation for independent prescribing. The pharmacist has responsibility for therapeutic drug monitoring, the prescription of biologic treatment following induction and immunosuppressants, participate at MDT, patient support and patient education. The nurse oversees the clinical and endoscopic surveillance of patients including the running of the IBD telephone helpline service
What has been achieved?
Robust clinical, biochemical and endoscopic surveillance is crucial for the delivery of effective treatments and quality of care in IBD. Telemedicine and virtual clinics have become part of our mainstream clinical practice to allow our IBD patients rapid access to healthcare services, pathway-driven treatment decision-making processes and endoscopy. IBD specialist Nurse and pharmacist clinics allow efficient management of the Gastroenterology workload and show extremely high levels of patient acceptability and satisfaction.
What next?
IBD is a life-long condition associated with considerable ongoing morbidity. Patient’s social and psychological wellbeing can be affected if the disease is poorly controlled. It is proven the specialist role of the pharmacist adds value to the gastroenterology teams and improves patient’s care. However, there is a need to standardise the specialist IBD pharmacist like in others specialities such as haemato-oncologist pharmacist or anticoagulation pharmacist. A Continuous Professional Development (CPD) course has been launched in partnership with the School of Pharmacy at the University of Bradford (United Kingdom) to initiate this goal. Further recognition and awareness of the role is required with our profession to achieve the goal and improve patients’ quality of care.