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.
On-line education for pharmacists about one pill killers
European Statement
Education and Research
Author(s)
RAQUEL AGUILAR SALMERÓN, LÍDIA MARTÍNEZ SÁNCHEZ, ANNA MARIA JAMBRINA ALBIACH, NEUS RAMS PLA, MANEL RABANAL TORNERO, MARIA ÀNGELS GISPERT AMETLLER, MILAGROS GARCÍA PELÁEZ, NÚRIA PI SALA, SANTIAGO NOGUÉ XARAU
Why was it done?
HTDs in infants are defined as those that might cause severe or lethal poisoning in children. Some HTDs are considered “one pill killers”: those in which the ingestion of one unit, a single tablet or tablespoon, in an infant with a body weight of 10 kg, could be fatal. In Spain, there are 29 active ingredients (from seven therapeutic groups) considered “one pill killers”. Counseling and information are crucial activities developed by pharmacists that could help to avoid fatal intoxications.
What was done?
A virtual and interactive course for pharmacists was designed to improve knowledge about highly toxic drugs (HTDs) in infants and potentially fatal intoxications. The education platform integrates microlearning and gamification methodologies, and the course could be followed via web or smartphone.
How was it done?
A group of experts, including toxicologist paediatricians and clinical pharmacists, carried out a literature review and determined the toxic dose for HTDs. They also determined the number of units (considering the most concentrated presentation) needed to achieve the potentially fatal dose in a 10 kg infant. A virtual microlearning platform (Snackson®) was chosen, and specific training content was designed. It will be offered to community pharmacists by our Catalan Ministry of Health.
What has been achieved?
This project has enhanced the collaboration between the group of experts and the Catalan Ministry of Health. An agreement has been signed, and, in this frame, the educational activity has been offered (Autumn 2023) to 250 community pharmacists.
A list of HTDs has been published (DOI: 10.1016/j.anpede.2020.02.007).
A video was recorded, addressed to the general population to inform them about the existence of HTDs. This video is a divulgation tool with recommendations to prevent drug poisoning and is periodically broadcast in the waiting rooms of health centers.
(https://www.youtube.com/watch?v=uSHDRte7Nr8&t=14s).
What next?
The next objective will be to evaluate the impact of the training activity on community pharmacists and the usability of the virtual microlearning platform. Future plans also include the expansion of this education tool to other regions in Spain, and to explore the application of microlearning methodology to other areas of knowledge.
Electronic prescription protocols for personalised sterile preparations for the paediatric surgery department
European Statement
Production and Compounding
Author(s)
Isabel María Carrión Madroñal, Concepción Álvarez del Vayo Benito , Begoña Balboa Huguet , Santiago Lora Escobar , Paloma Barriga Rodríguez
Why was it done?
-Improve security, planning, and access to information for correct prescription, administration, and management.
-Guarantee the traceability of all processes.
-Improve the satisfaction of the services involved, preventing forgetfulness and therefore management of emergency calls, unjustified need for the prescribed preparations, and incorrect packaging.
-Improve communication and the work circuit from PD.
What was done?
To prepare a protocol with the processes of prescription, validation, preparation and dispensing of personalised sterile formulations in the Paediatric Surgery Department (PSD: Otorhinolaryngology, Ophthalmology and Neurosurgery) from the Pharmacy Department (PD).
How was it done?
1. Creation of a multidisciplinary team in which a circuit for the prescription, validation, preparation and dispensing of sterile preparations was agreed.
2. Analysis with the departments involved of the personalised sterile-medications prepared by PD for use in paediatric-surgical-rooms, and the most frequent doses used.
3. Bibliographic review: PubMed®, Cochrane®, Uptodate®, Stabilis® and other sources such as the Good Clinical Practices (GCP) and the book ‘Preparation of Drugs and Magistral Formulation for Ophthalmology (JM Alonso).
4. Creation of electronic prescription protocols in ATHOS-Prisma®, containing:
• help notes and preconditions for the prescription.
• information for the administration and management of waste.
• detailed brew sheet and custom label for the PD.
5. Review of the protocols created and the circuit proposed for the prescription, preparation and dispensing.
6. Start-up of the circuit: review and validation of prescriptions, preparation of sterile formulations centralised in PD through laminar flow hoods and dispensing directly to the surgical-room on the scheduled date.
What has been achieved?
Piloting began with sterile otorhinology formulations in 2021, expanding to ophthalmology and neurosurgery in 2022-2023.
– Creation of three groups of protocols that will contain those related to each specialty to facilitate location and prescription by surgeons:
*Paediatric ophthalmology:
• Mitomycin 0.2mg/ml intraoperative-solution-trabeculectomy
• Fluorouracil 5mg/0.1ml intraoperative-solution-trabeculectomy
• Intracameral-cefuroxime 2mg/0.2ml (antibiotic-prophylaxis)
*Paediatric otorhinology:
• Cidofovir 5mg/ml intralesional (laryngeal-papillomatosis)
• Bevacizumab 2.5mg/ml intralesional (laryngeal-papillomatosis)
• Mitomycin 0.5mg/ml (choanal-atresia)
*Paediatric neurosurgery:
• Interferon-alpha 3MIU/0.6ml intralesional (craniopharyngioma)
– Sixty-two preparations have been prepared and dispensed for a total of 30 children; average age of 4 years (1-10). No adverse events were reported in any patient after the administration of these sterile preparations.
– A study limitation was sample size. Circuit under development.
What next?
The protocol is applicable to any hospital with electronic-prescription and surgical-area.
Pharmacological support tool in the paediatric emergency room
European Statement
Patient Safety and Quality Assurance
Author(s)
IGNASI SACANELLA ANGLÈS, MARTA MARTIN MARQUÉS, HELENA SUÑER BARRIGA, DAVID PASCUAL CARBONELL, PILAR LÓPEZ BROSETA, JÚLIA BODEGA AZUARA, MARÍA VUELTA ARCE, Mª ÁNGELES ROCH VENTURA, ISABEL PLO SECO, ERIKA ESTEVE PITARCH, ANTONIO GARCÍA MOLINA, SÒNIA JORNET MONTAÑA, CARLA DAIANA CIUCIU, SILVIA CONDE GINER, LAURA CANADELL VILARRASA
Why was it done?
Drug dosages and treatment algorithms in paediatric emergencies must be precise and unambiguous to ensure the safety and well-being of patients. Therefore, the introduction of electronic prescription systems in the Paediatric Emergency Room (PER) has become essential to assist clinical staff in prescribing, preparing, and administering the most commonly used drugs.
What was done?
Design and implementation of pharmacological cards as a supporting tool to standardise and streamline the dosages, preparation, and administration of the most frequently used drugs in paediatric emergencies, ensuring a prompt and safe response.
How was it done?
Pharmacological cards were developed for paediatric emergencies, including scenarios such as cardiopulmonary resuscitation (CPR), seizures, sepsis, hypoglycaemia, anaphylaxis, and respiratory emergencies. These cards included the most commonly prescribed drugs, with input and agreement from paediatricians.
The files were organised based on weight categories (3.5-60 kg) and considered the age range of patients (0-15 years). Information collected included the active ingredient, commercial name and presentation, dose per kilogramme, total dosage, dose (expressed as volume for administration), maximum allowable dose, and administration technique. Certain specific conditions were highlighted in colour.
Both medical and nursing staff underwent training in the utilisation of these tools. An evaluation of the protocols was conducted 12 months after their implementation.
What has been achieved?
We developed a total of 21 pharmacological cards, categorised by weight range, encompassing 33 drugs commonly used in paediatric emergencies.
The pharmacological cards were designed in a tabular format, which included the following information: active principle (highlighted in black), commercial name (in red), drug concentration (in blue), standardised dose (in g, mg, mcg, ml, mEq) per kilogramme, total dosage, total volume for administration, maximum allowable dose, route of administration, and administration technique. Additionally, we used background colours to highlight specific situations, such as red for CPR, black for intravenous administration, green for intramuscular routes, and purple for intranasal administration.
During the 12-month evaluation period, we did not encounter any medication-related errors.
What next?
The development of pharmacological cards has helped to standardise practices and simplify the prescription, preparation, and administration of commonly used drugs in paediatric emergency situations. The protocolisation and implementation of this tool have enhanced drug safety in emergency scenarios by reducing human errors and minimising medication-related harm.
Checklist for optimal pharmaceutical validation in very low-birth-weight preterm newborns in the neonatal intensive care unit
European Statement
Patient Safety and Quality Assurance
Author(s)
IGNASI SACANELLA ANGLÈS, MARTA MARTIN MARQUÉS, JULIA BODEGA AZUARA, PILAR LÓPEZ BROSETA, DAVID PASCUAL CARBONELL, HELENA SUÑER BARRIGA, ALEJANDRO SANJUAN BELDA, CARLA DAIANA CIUCIU, SILVIA CONDE GINER, ERIKA ESTEVE PITARCH, ANTONIO GARCÍA MOLINA, SÒNIA JORNET MONTAÑA, ISABEL PLO SECO, Mª ÁNGELES ROCH VENTURA, MARÍA VUELTA ARCE, LAURA CANADELL VILARRASA
Why was it done?
The NICU is a complex area of paediatric hospitalisation that necessitates specialised healthcare professionals. The role of the NICU pharmacist is vital in ensuring the appropriate and optimised use of medications in various critical situations.
What was done?
To develop a checklist that facilitates pharmacotherapy validation for preterm newborns (PTNB) weighing less than 1000 g and hospitalised in the neonatal intensive care unit (NICU). The primary objective is to ensure a higher quality of hospital care in terms of pharmacotherapy.
How was it done?
We conducted a literature review to identify the pharmacotherapy requirements for preterm newborns (PTNB) weighing less than 1000 g during their first 30 days of life.
In order to design the checklist, we compiled various elements, including drugs, dosages, treatment duration, initiation date, and drug monitoring (when necessary). Additionally, we incorporated recommendations for specific scenarios.
What has been achieved?
The drugs considered for this supportive tool include: pulmonary surfactant, ampicillin, gentamicin, fluconazole, caffeine, ibuprofen, iron (ferrum), dexamethasone, nystatin, vitamin D3, and other vitamins. The checklist was designed to cover the first 30 days of life.
From day 0 to 1: Administer pulmonary surfactant and caffeine citrate. For antibiotic prophylaxis, use ampicillin and gentamicin, and fluconazole for antifungal prevention. In cases of an open ductus arteriosus, intravenous ibuprofen should be added.
Between day 10 to 15: Administer vitamin D3 and a multivitamin complex if the neonate tolerates oral administration. If there is a risk of bronchopulmonary dysplasia, which is characterized by more than 7 days of intubation and difficulty with extubation, consider adding dexamethasone and nystatin.
From day 15 onward: Monitor ferritin and vitamin D3 levels. Begin oral iron supplementation (ferrum) 30 days after birth. Both drugs should be continued for one year.
We have included dose adjustments in case of renal or hepatic dysfunction and pharmacokinetic monitoring for antibiotics. In cases where meningitis is suspected, we have provided recommendations for increasing the dose to ensure adequate penetration into the central nervous system.
What next?
This tool simplifies pharmaceutical validation, particularly for pharmacists who may not specialise in the care of these complex patients. By utilising this tool, we can reduce errors and enhance the quality of care provided to preterm newborns (PTNB) weighing less than 1000 g.
IMPLEMENTATION OF DRUG RECONCILIATION WITHIN THE DEPARTMENT OF PAEDIATRIC HEMATO-IMMUNOLOGY AT THE UNIVERSITY HOSPITAL CENTER ROBERT DEBRÉ (submitted in 2019)
European Statement
Clinical Pharmacy Services
Author(s)
Marguerite VAILLANT, Sophie GUILMIN CREPON, Benoit BRETHON , Julie ROUPRET-SERZEC
Why was it done?
In order to obtain a safe patient care pathway, we wish to implement proactive and/or retroactive DR for patients followed in the Hemato-Immunology Department of the University Hospital Center Robert Debre.
What was done?
Formalise and integrate drug reconciliation (DR). Evaluate the feasibility of the project, the impact of DR on the safety of patient care and the satisfaction of patients and health professionals.
How was it done?
Prospective cohort study. The different steps are: identification of eligible patients, collection of information on the patient’s drug history and ongoing treatments from the health partners involved in his or her care, entry drug reconciliation (EDR) during the entry pharmaceutical consultation, conciliation of exit drugs during the return pharmaceutical consultation, transmission of information to the local center and pharmacist or home hospitalisation, evaluation of stakeholder satisfaction and the impact of the intervention.
What has been achieved?
Thirty patients included between August and October 2019, or 30 conciliations performed. Concerning the EDR: all hospitalisation reports and previous prescriptions are consulted (100%), 6 EDR (20%) take place in pro-active mode, the average duration of an EDR is 43 minutes. Concerning the discharge drug reconciliation (DDR): 30 DDR (100%) take place in pro-active mode, the average duration of a DDR is 52 minutes, all prescriptions and intake plans are sent to community centres and pharmacists or home hospitalisation (100%). Of all the conciliations performed: 4 sources of information used by conciliation, 11 drugs prescribed on average per prescription, 8 intentional and 6 unintentional discrepancies identified by prescription. Concerning the evaluation of satisfaction: all community centres are satisfied (100%), 26 city professionals (87%), 21 hospital professionals (70%), 27 patients (90%).
What next?
In order to ensure that DR is permanently included in the service, a communication and information tool must be developed. This, made available to the entire team, will serve as a traceability support, decompartmentalise practices and improve patient care.
ESTABLISHING AN ACTIVE WORKING GROUP FOR PHARMACISTS WORKING WITHIN PAEDIATRIC ONCOLOGY AND HAEMATOLOGY IN SWEDEN, FINLAND, NORWAY AND DENMARK
European Statement
Clinical Pharmacy Services
Author(s)
Ranaa El Edelbi, Joacim Götesson, Sanna Veijalainen, Mari Vanhatalo, Taija Heikkinen, Ulla Taipale, Gunn-Therese Lund Sørland, Margrete Einen, Magnus Dahlander
Why was it done?
There is a great need for pharmaceutical expertise within the field of pediatric oncology and hematology, where chemotherapeutic regimens and supportive therapy often require intense treatment with drugs from many therapeutic groups. The complex drug environment created requires competence in diverse pharmaceutical subjects and many centers of pediatric oncology and hematology within NOPHO has concluded that hiring a pharmacist can cover the perceived knowledge gap and also increase the quality of the drug treatment. However, working as a single clinical pharmacist in a very specialized hospital setting such as pediatric oncology and hematology can be very difficult and time-consuming as everything depends on your own knowledge and experience. In most pediatric oncology and hematology centers it is not feasible to have more than one pharmacist and thus collaboration and discussion between different hospitals and countries are necessary.
What was done?
A working group for pharmacists was established within the Nordic Society of Paediatric Haematology and Oncology (NOPHO).
How was it done?
The need for a group of pharmacists working within pediatric oncology and hematology was raised by pharmacist Ranaa El Edelbi at Astrid Lindgren’s Children’s Hospital, Stockholm, during the autumn of 2014. She sent out an email to all the pediatric oncology and hematology centers within NOPHO and asked if they had any pharmacists involved in the care setting. She got a positive reply from a few centers and invited the pharmacists for at first meeting in Stockholm in November 2014 and a working group for pharmacists with NOPHO was created in early 2015. The network has since then grown to 17 pharmacists from 4 countries and 10 centers.
What has been achieved?
An active working group with regular email discussions as well as Skype and physical meeting to facilitate the exchange of knowledge and experience. The group has also undertaken and finished a project to develop a guideline for extravasation of chemotherapeutic drugs, which was published in December 2016.
What next?
Developing a guideline for safe and accurate administration of oral chemotherapeutic drugs to children.