The European Association of Hospital Pharmacists (EAHP) has launched a search for examples of successful European initiatives to improve hospital pharmacy practice. The exercise is part of a project led by the EAHP Scientific Committee to create an inventory map of good practice initiatives, which they hope will provide practical support and inspiration for hospital pharmacists in EAHP member countries to embark on fresh improvement projects of their own.

The EAHP says a good practice initiative is any service improvement or innovation in hospital pharmacy conducted in the past ten years that has the possibility of transfer to other hospital pharmacy settings in Europe and encourage hospital pharmacists to take part.

Launching the exercise, Prof. Dr. Cees Neef, Chairman of the EAHP Scientific Committee, said: ‘By creating a European map of completed service development initiatives, we believe we can go some way to inspiring the next generation of innovation and improvement in hospital pharmacy across the continent. We hope all hospital pharmacies that have implemented change and improvement in the past ten years will give consideration to making a short submission for inclusion and help to build an open and accessible database of lasting value in terms of both developing new services, and enhancing the quality and safety of existing services.’

Two examples of good practice initiatives can be found on the EAHP website, one relating to a pharmacogenetics education programme in Leiden, and another a parenteral drug compounding initiative in Maastricht. The EAHP says that all examples of good practice initiatives submitted will be considered for inclusion in the inventory map, although some category areas hospital pharmacists may wish to consider include: 

• clinical pharmacy and other HP role development 
• clinical trials and research 
• communication and leadership 
• compounding/medicines production
• education and training  
• inter-professional and inter-sector collaboration 
• patient safety 
• pharmacotherapy 
• process improvement
• procurement, logistics and distribution 
• resource management
• use of technology  

The EAHP requests that initial submissions be made via their website (www.eahp.eu) by close of Friday 7th June 2013. 

Triple therapy combination consisting of diuretics with angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) and NSAIDs is associated with an increased risk of acute kidney injury according to a UK study.

In a retrospective cohort study researchers assessed whether double therapy consisting of a diuretic or an ACE inhibitor or an ARB with the addition of a NSAID, and triple therapy consisting of a diuretic plus an ACE inhibitor or an ARB in addition to a NSAID increased the risk of acute kidney injury. A total of 487 372 people using antihypertensive drugs between 1 January 1997 and 31 December 2008 were identified from the UK Clinical Practice Research Datalink (CPRD). Reporting their finding in the British Medical Journal the researchers say that during a mean follow-up of 5.9 years, 2215 cases of acute kidney injury were identified (incidence rate 7/10 000 person years). ‘Current use of a triple therapy combination was associated with an increased rate of acute kidney injury (rate ratio 1.31, 95% confidence interval 1.12 to 1.53). In secondary analyses, the highest risk was observed in the first 30 days of use (rate ratio 1.82, 1.35 to 2.46),’ say the researchers. However, double therapy combination was not associated with an increased rate of acute kidney injury.

The researchers say that, to their knowledge, it is the first large population based study of patients using antihypertensive drugs to have investigated the association between the use of different combinations of antihypertensive drugs with NSAIDs on the risk of acute kidney injury. ‘Increased vigilance may be warranted when diuretics and ACE inhibitors or ARBs are used concurrently with NSAIDs. In particular, major attention should be paid early in the course of treatment, and a more appropriate use and choice among the available anti-inflammatory or analgesic drugs could therefore be applied in clinical practice,’ they suggest. BMJ 2013;346:e8525.

In a new initiative for the journal, EJHP is now publishing podcasts. The first set were recorded at the 18^th EAHP Congress in Paris, and include a selection of interviews with speakers from the Congress. In an introductory podcast Phil Wiffen, editor in chief of EJHP, explains the thinking behind the podcasts, outlines the direction the journal is heading in and encourages those thinking of writing for the Journal to contact him.

One of the keynotes at the Congress, on the topic of multidisciplinary teams, was given by Dr Fiona Reynolds (pediatric intensivist and deputy chief medical officer at Birmingham Children’s Hospital) and in a podcast interview she discusses how a multidisciplinary team can be set up, how it can work in practice and what benefits it can bring to hospital pharmacy. In another podcast Joanna Correa West, medicines management nurse from Birmingham Children’s Hospital Foundation Trust considers how hospital pharmacists and nurses can work better together and ways in which they can help and support each other.

Following on from their seminar at the Congress entitled ‘Team challenges in cancer: from cytotoxics to supportive care’ Jørn Herrstedt, professor in clinical oncology, Odense University Hospital, Denmark, and João Oliveira, medical director, Instituto Portugues de Oncologia, Lisbon, share their thoughts about oncology pharmacy, improving patient safety and the role pharmacists can have in supportive care. Medication errors occur in all health settings, but there is particular vulnerability at the interface between care settings, especially at the time of admission to hospital. In an interview Jean-Hughes Dalle (professor in pediatrics, Robert-Debré Hospital, Paris) Julie Rouprêt-Serzec (clinical pharmacist, Robert-Debré Hospital) and Anthony Sinclair (director of pharmacy, Birmingham Children’s Hospital) share their thoughts  about how to improve patient safety in this area.

European healthcare system managers and policy makers need to take proactive measures to meet the growing problem of multidrug-resistant tuberculosis (MDR-TB) and the emergence of extensively drug-resistant TB (XDR-TB) warns Dr Roberto Frontini, President of the European Association of Hospital Pharmacists (EAHP). Following on from World TB Day (March 24^th) Dr Frontini said it was a time to pause and reconsider the policy options and highlighted five hospital pharmacy related measures currently available to policy-makers:

1. Ensure hospital pharmacists are involved in medicines counselling for tuberculosis patients starting new courses of treatment in order to improve adherence
2. Expand the role of hospital pharmacists in Therapeutic Drug Monitoring for patients with drug-resistant TB on long term courses of treatment
3. Concentrate efforts on improving the systems for communication between hospital and community based healthcare professionals to deliver integrated and joined up care for TB patients
4. Give hospital pharmacists a leading role in antimicrobial stewardship to help prevent further resistance to existing antibiotic treatments
5. Redouble attention on the provision of fresh incentives for the development of new antibiotic treatments for the treatment of TB

‘The evidence is stark. There are over 380,000 reported new cases of TB in Europe each year, and the growing problem of multi-drug resistant TB is exacerbated by people not continuing their treatment for the full six months. By ensuring all professions are able to maximise the contribution of their expertise, we can reverse some of the concerning trends in the area of tuberculosis’, said Dr Frontini.

In support of the fight against TB, the BMJ Group has made its latest tuberculosis related content and products free until the end of April (www.rebelmouse.com/Thorax). 

Benzodiazepines are associated with an increased risk of, and mortality from, community-acquired pneumonia (CAP) suggesting further research is required into the immune safety profile of benzodiazepines, according to a study published in Thorax. Using data from The Health Improvement Network (THIN) database, British researchers identified 29,697 controls and 4964 cases of CAP. They used conditional logistic regression to investigate the association between benzodiazepines and pneumonia occurrence, and Cox regression to determine the impact of benzodiazepines on mortality in the 4964 cases of CAP.

The researchers report that: ‘Exposure to benzodiazepines was associated with an increased risk of pneumonia (OR 1.54, 95% CI 1.42 to 1.67). Individually diazepam, lorazepam and temazepam, but not chlordiazepoxide, were associated with an increased incidence of CAP’. They also found that, as a class, benzodiazepines were associated with increased 30-day (HR 1.22 [95% CI 1.06 to 1.39]) and long-term mortality (HR 1.32 [95% CI 1.19 to 1.47]) in patients with a prior diagnosis of CAP. Individually diazepam, chlordiazepoxide, lorazepam and temazepam affected long-term mortality in these patients. ‘Given the widespread use of benzodiazepine drugs, further studies are required to evaluate their safety in the context of infection’, add the researchers. Thorax 2013;68:163-170.

A study carried out in the Netherlands suggests that statin treatment could decrease the risk of recurrent pulmonary embolism (PE) and might be an alternative to anticoagulant treatment in the long-term treatment of PE. Researchers identified patients hospitalized with an acute episode of PE between 1998 and 2008 by using data from a Dutch population-based registry of pharmacy records linked with hospital discharge records. Prescription-based use of statins and vitamin K antagonist (VKA) were identified starting at hospital discharge and during follow-up.  The researchers used Cox regression analysis to assess the incidence of recurrences, cardiovascular events and death.

The median duration of VKA treatment after acute PE was 199 (45–3793) days. Twenty-four per cent of the patients (n = 737) had at least one prescription of statins during the follow-up period and the median duration of statin therapy was 1557 (5–4055) days.

Reporting their findings in the European Heart Journal the researchers say that during a median follow-up of 1529 (1–4155) days, 285 (9.2%) patients experienced a recurrence. Treatment with statins was associated with a reduced risk of recurrent PE (adjusted hazard ratio [HR] 0.50, 95% CI: 0.36–0.70), both during and after stopping VKA treatment. A dose–response relationship was shown for potency, with the largest reduction in those with the most potent statins. ’Statin treatment also reduced the risk for cardiovascular events and all-cause mortality’, add the researchers. Eur Heart J (2013)doi: 10.1093/eurheartj/eht046.

Regular aspirin use is associated with an increased risk for developing neovascular age-related macular degeneration (AMD), according to a study published in JAMA Internal Medicine.  Researchers analysed data from an Australian population-based cohort. Four examinations were carried out over a 15-year period with participants completing a detailed questionnaire at baseline assessing aspirin use, cardiovascular disease status, and AMD risk factors. Retinal photographs were taken at each study visit to assess the incidence of neovascular (wet) AMD and geographic atrophy (dry AMD) according to the international AMD classification.

Of 2389 participants at baseline, 257 (10.8%) were regular aspirin users and 63 of the 2389 developed neovascular AMD. ‘Persons who were regular aspirin users were more likely to have incident neovascular AMD: the 15-year cumulative incidence was 9.3% in users and 3.7% in nonusers’, report the researchers. They add that the association was independent of potential confounders such as cardiovascular disease, age, sex, smoking, systolic blood pressure, and body mass index. A link was not, however, found between aspirin use and geographic atrophy. The researchers conclude that: ‘Regular aspirin use is associated with increased risk of incident neovascular AMD, independent of a history of cardiovascular disease and smoking’. JAMA Intern Med. 2013;173(4):258-264.

A survey focusing on the prevalence of medicines shortages found that 99% of responding hospital pharmacists had experienced difficulties with medicines shortages in the past year. The survey was carried out by the European Association of Hospital Pharmacists (EAHP) and 346 hospital pharmacists from 25 countries took part. Sixty-three per cent of hospital pharmacists reported medicines shortages to be a weekly, sometimes daily, occurrence. Areas commonly experiencing shortages were identified as oncology (71% of respondents), emergency medicine (44%) and cardiovascular medicine (35%).

Announcing the results at an event in the European Parliament on access to medicines EAHP President Roberto Frontini said: ‘These headline results confirm what I have increasingly heard from our members across Europe: that the shortages problem is widespread, doesn’t respect national borders, and urgently requires attention if patient care and health services are not to suffer’. EAHP will present the full results of its survey at the EAHP Congress in Paris (March 13-15th, 2013).