bluuebunny/crossref_metadata_2025_split huggingface dataset:
P35 An experience of switching paediatric inflammatory bowel disease patients on infliximab therapy to the biosimilar ‘remsima’
Authors: Mary Healy , Joanne Crook , Charlene Chavda , Elaine Smith 
Published: January 2018

IntroductionThe treatment of inflammatory bowel disease (IBD) with anti-tumour necrosis factor (anti-TNF) biologic therapies such as infliximab is expensive, due to the complex development and manufacturing processes involved with the drug. The number of paediatric patients (PP) receiving infliximab at our trust is increasing, leading to NHS cost pressures. The patent for the infliximab reference molecule Remicade has expired and considerably cheaper biosimilar products are now available, such as Remsima. The license for Remsima was based on adult rheumatology patients; this data was then extrapolated across all licenses. There are currently no long term safety studies of Remsima in children.A biosimilar drug can be defined as ‘a biotherapeutic product that is similar in terms of quality, safety and efficacy to an already licensed reference biotherapeutic product.’1AimWe wanted to switch all PP receiving infliximab for IBD at our trust from Remicade to a new biosimilar product – Remsima.MethodThe paediatric gastroenterology MDT agreed that all new patients started on infliximab since spring 2016 would be treated with Remsima.Information was gathered regarding the safety, switchability and efficacy of Remsima before the change was made.2 For existing patients, we also contacted other trusts who had already made the switch to gain from their experience. Our current patients on Remsima were reviewed, and no problems were reported.Existing patients were identified and a letter informing their parent/guardian of why we were changing from Remicade to Remsima was posted. An agreed date after which the switch in treatment would occur allowed any concerns or questions to be addressed on previous visits to the hospital.ResultsOverall, the method used was a success: all but one of the identified patients agreed to switch to Remsima – one family refused and the child continues to receive Remicade treatment. All patients on Remsima continue to be monitored closely for adverse reactions or a decline in their disease control. Infliximab levels and antibodies are checked as per local guidelines. Any adverse reactions are reported to the MHRA via the yellow card scheme; Remsima is a black triangle medicine.3ConclusionBiosimilar medicines present a considerable cost saving to the NHS, and by switching our paediatric IBD patients receiving treatment with infliximab from the reference molecule Remicade to the biosimilar Remsima, the Trust has been able to take advantage of this.The saving is substantial and across our 60+patients is somewhere in the region of £250,000 – £2 75 000 a year. This money can be reinvested into the paediatric IBD service to improve patient care. We hope that our experience of switching can be used to support other Trusts in following suit.As further biosimilar medications become available, the NHS could continue to benefit by switching patients receiving biologic treatment.
SP7 Development of a paediatric triage tool for use by pharmacists to aid clinical prioritisation of patients and delivery of pharmaceutical care
Authors: Jennifer Tait , Kirsten Thomson , Moira Kinnear , Gazala Akram , Caroline Souter 
Published: January 2018

AimTo gain consensus from an expert paediatric and neonatal clinical pharmacist panel on criteria to be applied in the design of a triage tool for use in paediatric and neonatal settings.MethodsThe ‘Delphi Technique’1 was used to identify pharmaceutical care issues, known as criteria, to aid in the prioritisation and targeting of pharmacists’ time to deliver pharmaceutical care to paediatric and neonatal patients. Criteria based ’statements’ based upon the literature2–4 were developed and put into a questionnaire format which was distributed amongst members of the Scottish Neonatal and Paediatric Pharmacy Group (SNAPP). A five point Likert-scale and option for free hand text was used to record responses. Responses were analysed and used to modify subsequent rounds of the Delphi technique.Results18 criteria were identified for use in the triage tool and were largely characterised upon time of review. Criteria pertaining to daily review included patients prescribed high risk medicines, psychotropic medication, continuous infusions and those with severe, acute kidney injury. Criteria pertaining to 48-hourly review included patients with stable chronic renal failure and mild kidney injury. Criteria for 72-hourly review included stable patients with no acute issues.ConclusionA triage tool to aid pharmaceutical prioritisation in paediatric and neonatal patients has been developed and will be piloted for use in clinical practice.ReferencesMcMillian S, King M, Tully M. How to use the nominal group and Delphi techniques. Int J Clin Pharm 2016;38:655–622.Abbas S. The sensitivity of the paediatric triage tool in identifying care issues. Abstracts from 21st Annual Conference of Neonatal and Paediatric Pharmacists Group, NPPG, 2015.Cottrell R, Caldwell M, Jardine G. Developing and implementing a pharmacy risk screening tool. Hospital Pharmacy Europe (Magazine) 2013;71.Stuart Z. The development and pilot evaluation of referral tool for pharmacy technicians to use within a paediatric medical acute receiving unit 2014. MSc Project submitted to the University of Strathclyde.
1 Developing consensus on hospital prescribing indicators of potential harm for infants and children
Authors: Fox Andy 
Published: January 2018

AimsTo develop a list of hospital based paediatric prescribing indicators that can be used to assess the impact of electronic prescribing or clinical decision support tools on paediatric prescribing errors.BackgroundMedication errors are a major cause for concern in the NHS. Prescribing is part of the medication use process and is a complex task requiring an understanding of medicines, disease processes, and patient parameters. Systematic reviews have reported that medication errors occur in as many as 50% of hospital admissions and prescribing error rates in the UK hospitals vary between 9% and 15%.Prescribing for children is further complicated by the need to take into account weight, altered physiology and pharmacokinetics. Prescribing error rates of 13.1% have been reported in children with a potentially greater impact due to the nature of the patients.Electronic prescribing (EP) while relatively uncommon in UK hospitals is an important tool in reducing prescribing errors. EP systems have been shown to have a positive impact on prescribing errors, however methodologies vary and the reduction in harm is rarely investigated. A standard tool to allow an evaluation of the harm reduction is desirable and currently does not exist for the paediatric setting.MethodsTwo rounds of an electronic consensus method (eDelphi) were carried out with 21 expert panellists from the UK. Panellists were asked to score each prescribing indicator for its likelihood of occurrence and severity of outcome should the error occur. The scores were combined to produce a risk score and a median score for each indicator calculated. The degree of consensus between panellists was defined as the proportion that gave a risk score in the same category as the median. Indicators were included if a consensus of 80% or higher was achieved and were in the high risk categories.ResultsAn expert panel consisting of 8 pharmacists and 13 paediatricians with a total of 437 years of clinical experience completed an exploratory round and two rounds of scoring. This identified 41 paediatric prescribing indicators with a high risk rating and greater than 80% consensus. The most common error type within the indicators was wrong dose (n=19) and the most common drug classes were antimicrobials (n=10) and cardiovascular (n=7).ConclusionsA set of 41 paediatric prescribing indicators describing potential harm for the hospital setting have been identified by an expert panel. The indicators provide a standardised method of evaluation of prescribing data on both paper and electronic systems. They can also be used to assess implementation of clinical decision support systems or other quality improvement initiatives.
P4 Outcome following switch between brand name and generic tacrolimus in paediatric population
Authors: Foxon Peter , Vijayan Swetha 
Published: January 2018

IntroductionGeneric preparations of drugs are often cheaper than brand names and offers significant cost benefits. For many medicines, a switch between preparations can be done with little or no monitoring. Tacrolimus prescription, however, provides an interesting challenge due to its narrow therapeutic window and requires careful medical supervision and therapeutic monitoring while switching. Adoport1 is a generic tacrolimus preparation introduced to the market after the exclusivity period for Prograf2 ended. At present there is limited evidence to show the effects of the switch between formulations in paediatric patients. In 2015, Nottingham Children’s Renal Unit undertook to switch all existing paediatric kidney transplant and nephrotic patients on Prograf to Adoport and we herewith present the effects on patients and their Tacrolimus levels.MethodPrescriptions for tacrolimus are dispensed and delivered by a homecare provider on a three monthly basis. Patients were given written and verbal advice to switch from Prograf to the same dose of Adoport two weeks before their next clinical appointment. After taking a stock of their existing Prograf supply, a prescription was given to ensure the patient did not run out of Prograf until their switch date and had enough Adoport until the following prescription was due. The Tacrolimus level was then reviewed by the patient’s doctor at their clinic appointment and dose adjustments were made if necessary as per standard of care. We reviewed data for Tacrolimus levels in the 3 months before and after the switch and assessed for any clinical variation in immunosuppression.Results36 patients were switched from Prograf to Adoport. One patient developed hair loss and requested to go back onto Prograf, all other patients tolerated the switch well. There was no significant change in the tacrolimus levels of the population following the switch (p=0.02). There was no significant change in creatinine of the population following the switch (p=0.02). One patient required a dose adjustment following the switch.ConclusionThis study assessed the clinical outcomes for paediatric patients switching from Prograf to Adoport. We noted stable Tacrolimus levels in most patients following the switch and similar therapeutic effectiveness. The majority of patients tolerated the switch well. This resulted in a cost saving for NHS England from which a gain share was negotiated to benefit Nottingham University Hospitals NHS Trust. Our outcome data therefore support the use of Adoport in place of Prograf as a potential cost-saving measure.ReferencesSummary of Product characteristics Astella Pharma Ltd. Prograf 0.5 mg, 1 mg, 5 mg Hard capsules 2 November 2015. www.medicines.org.uk [Accessed: 30 April 2016].Summary of Product characteristics Sandoz Ltd. Adoport 1 mg capsules 18 August 2015. www.medicines.org.uk [Accessed: 30 April 2016].
P10 To give, or not to give…
Authors: Lansdowne Zoe 
Published: January 2018

Aim‘Between September 2006 and June 2009, the NPSA (National Patient Safety Agency) received reports of 27 deaths, 68 severe harms and 21 383 other patient safety incidents relating to omitted or delayed medicines’.1 The Trust’s Medicines Code states that ‘critical’ medicines should be administered within one hour of the prescribed times, and all other medicines within 90 min.2 ‘Critical’ medicines relevant to NICU (Neonatal Intensive Care Unit) patients include injected antibiotics, anticoagulants, anticonvulsants, aminophylline infusions and strong opioid analgesics. The aim of this audit was to establish what proportion of medicines prescribed for patients on NICU were given outside of this policy.MethodData was downloaded for all NICU inpatients from the electronic prescribing system, ICCA, from 1/4/16 to 30/6/16 inclusive. It was then analysed using Excel. The data shows details of all regular drugs prescribed, the scheduled administration time and the time that the nurses recorded that the drug had been administered. Once only, when required and drug infusions longer than 4 hours were all excluded from this data capture. Scheduled doses of antibiotics that were intentionally delayed whilst awaiting levels, e.g. vancomycin and gentamicin, were excluded before data analysis.ResultsIt was found that over the 3 month period, 137 different patients were administered 10 642 regular doses of 51 different medications. 5.86% of these were classified as ‘delayed’ according to Trust policy. 97.6% of these delayed ‘critical’ medications were antibiotics, accounting for over 45% of the total delayed doses.Meropenem was found to be the antibiotic most frequently delayed, with over one quarter of all doses prescribed being administered more than 1 hour after the scheduled time. The delay in administration ranged from 65 mins to 6 hours. Ceftazidime was the next most frequently delayed, occurring 22.7% of the time, range 2.75 to 3.75 hours.The time of day when most drug delays occurred was between the times of 15:00 and 15:59, accounting for 8.2%. The percentage for each hourly time slot varied from 2.1% to 8.2%. Throughout the week, the percentage of delays on an individual day ranged from the most on Saturdays, 17.9%, to the least on Wednesdays, 9.6%.ConclusionsDelays in administering medicines can have significant detrimental effects for patient safety. Trust policy dictates that ‘critical’ medicines should be administered within 1 hour of the prescribed times.2 It can be seen from the results above that the administration of medications were delayed 5.86% of the time, with antibiotics accounting for over 45% of these delayed doses. The administration of meropenem was delayed over 25% of the time.ReferencesNational Patient Safety Agency. Rapid Response Report 009. Reducing harm from omitted and delayed medicines in hospital2010.Holmes, G. Chapter M09 policy for the administration of medicines [policy document]2016. University Hospitals Bristol NHS Foundation Trust.
P13 An evaluation of vitamin d supplementation to babies on the neonatal unit
Authors: Begum Razmin , Modha Jiten , Gaze Sian 
Published: January 2018

AimIn 2014, NICE guidance outlined the recommended amount of vitamin D in newborn infants.1 Such deficiency is associated with rickets, hypocalcaemia and seizures.2The aim of this study was to determine whether babies on the neonatal unit received the recommended daily amount of vitamin D by comparing national guidance against our local neonatal policy. To assess how babies obtained their source of vitamin D on the neonatal unit.MethodLocal policy stipulates for pre-term babies<1.8 kg a daily intake of 800–1000 units is recommended and for term babies (>37 weeks) 400 units is recommend. Pre-term and term babies>1.8 kg a dose of 400 units is recommend.Data collected over a 6 week period (1 week pilot study) included prescribed medication, milk volume, milk type (formula or fortifier) and demographics of the patient population. Inclusion criteria: babies with a postnatal age >2 weeks and enteral feeds >120 ml/kg/day. Exclusion criteria: babies with a postnatal age <2 weeks, on TPN, donor breast milk or on demand breast-feeding.Results30 babies identified of, which 21 were classified as pre term and 9 as term. 100% (9/9) of term babies and (3/3) pre-term babies weighing >1.8 kg received the recommended daily vitamin D intake (either as colecalciferol or abidec). The remaining 18 pre-term babies weighing <1.8 kg; 83% (15/18) received the recommended daily intake (either as colecalciferol, abidec, fortifier or milk formula). Overall, from the 30 babies identified in this study 90% (27/30) received their daily recommended intake of vitamin D.ConclusionThis is the first study conducted, which concluded that 90% of babies received the recommend daily intake of vitamin D as outlined in both national and local guidance. It demonstrated that there needs to be a greater focus on vitamin D supplementation on the unit to ensure that all babies are nutritionally optimised.ReferencesNICE Guidelines [PH56]. Vitamin D: Increasing supplement in at-risk groups November 2014.Parisaei M, GovindA, Clements J, etal. Prevalence of vitamin D deficiency in a North London antenatal population. Obstetric Medicine: The Medicine of Pregnancy 2011;4(3):113–116.
P14 Discord between patients’ general practitioner repeat prescriptions and the medication list held by a paediatric cf centre
Authors: Cunliffe Helen , Smith Rachel 
Published: January 2018

AimTo audit GP repeat prescription records in comparison with medication lists held in patients’ electronic notes (EMIS) in our centre, to identify any discrepancies and pharmacist interventions.MethodBetween October 2011 and June 2014, a pharmacist retrospectively reviewed the CF Centre medication lists, and compared them with the patient’s GP repeat prescription (accessed using Summary Care Record), identifying differences in doses, formulation, and directions. In addition, omissions from each list, drug-class duplications, drugs requiring cessation, and dosing errors were noted.The last date of dispensing was used as an indicator of adherence, and where necessary, GPs were contacted for further information.Pharmacist interventions requiring further action were recorded.ResultsDrugs (n=2009), were reviewed from 232 patient episodes. Total number of pharmacist interventions was 589 (29.3% drugs), with 20 prescribing errors identified as being clinically significant requiring immediate resolution. Dose and formulation discrepancies were noted in 141 (7.0%) and 48 (2.4%) drugs respectively. Omissions occurred on the GP prescription for 73 medications (3.6%), 30 of which were unlicensed. There were 69 (3.4%) omissions on the CF Unit medication list. Common drugs missed off the GP prescriptions were unlicensed medicines (ULM), accounting for 40% of GP omissions. Common drugs missed off the CF Centre drug list were dietary products and ‘acute’ courses (e.g. antifungals, eradication regimens) initiated by the CF Centre. The CF Centre was unaware of some GP prescribing of contraceptives and inhalers.25 patients were identified as having adherence issues.Only 35/232 (15%) prescriptions matched identically.ConclusionsThis audit identified the need for a more thorough medicine review and reconciliation in the clinic, which should at least include the GP repeat prescription. The audit identified areas of discrepancy between the CF Centre list and the GP prescription, that were previously unknown and had not been considered. It is essential that teams are aware of additional prescribing by GPs and the medication list at the CF Centre should be updated at each clinic visit. Communication regarding drug therapy needs to be improved between the CF Centre and GPs.A comprehensive medication review should to be completed before altering any drug/doses in response to poor clinical response, as it cannot be assumed that patients have access to, or are taking, medicines as perceived by the CF Team. A pharmacist in a CF clinic would be ideally placed to complete this.
P22 Using an elastomeric pump to administer continuous infusions of antibiotics as part of an outpatient parenteral antimicrobial therapy (opat) programme
Authors: Sharpe David , Crouch Claire , Porter David , Paulus Stephane 
Published: January 2018

AimsContinuous intravenous infusion using an elastomeric pump is an alternative delivery method in paediatric patients who need intravenous antibiotics (IVAB) which would otherwise need to be administered three times daily, such as piperacillin/tazobactam or ceftazidime.1 We describe our experience using elastomeric pumps in the OPAT setting.MethodsA retrospective case series of 5 children (aged 5–17 years) discharged home on IVAB continuous infusion administered via an elastomeric pump. One child received this mode of delivery twice therefore 6 patient-episodes are described in this case series. Outcomes were assessed using the BSAC p-OPAT (British Society of Antimicrobial Chemotherapy Paediatric-OPAT) criteria. Ethics approval was not required because the information was gathered retrospectively and patient data has been anonymised.ResultsIn 5 of the episodes the indication was lower respiratory tract infection treated with continuous IV piperacillin/tazobactam. All patients had a background of neurodisability, recurrent respiratory tract infections and Pseudomonas aeruginosa carriage. The remaining patient was treated for an infective exacerbation of cystic fibrosis with a regimen that included continuous IV ceftazidime. All episodes had an outcome defined as ‘Success’ according to the BSAC p-OPAT criteria; having an infection outcome of ‘improved’ or ‘cured’ with no adverse events reported.ConclusionsThe successful outcomes in this case series suggest that elastomeric pumps are a safe and effective option for administering selected antibiotics by continuous IV infusion to children, although central venous access is a requirement. This option should be considered to facilitate the early discharge of patients to be treated with IVAB such as piperacillin/tazobactam under the guidance of an OPAT service.ReferencePatel S, Abrahamson E, Goldring S, Green H, Wickens H, Laundy M. Good practice recommendations for paediatric outpatient parenteral antibiotic therapy (p-OPAT) in the UK: A consensus statement. J Antimicrob Chemother2015;70(2):360–73.
P34 Successful introduction of an outpatient parenteral antimicrobial therapy (opat) programme in a large uk paediatric hospital
Authors: Crouch Claire , Sharpe David , Porter David , Paulus Stephane 
Published: January 2018

IntroductionAn OPAT service was launched at large paediatric hospital in November 2014 to facilitate the safe and efficient discharge of patients from hospital into the community. The OPAT service is delivered by a multi-disciplinary team including a Consultant in Paediatric Infectious Diseases, an OPAT/Intravascular Access Nurse, an Antimicrobial Pharmacist, and involves collaborative working with community nursing teams across the region. We present an evaluation of our service based on audit data and patient feedback collected over a 12 month period.MethodsProspective audit using the BSAC p-OPAT (British Society of Antimicrobial Chemotherapy Paediatric Out-patient Parenteral Antimicrobial Therapy) database including data from 1 st January 2015 to 31 st December 2015.ResultsTwo hundred and thirteen patients were admitted to the OPAT service leading to 1749 bed-days saved for the trust. Seventy-four patients avoided admission. The most common conditions were: bronchiectasis/chronic respiratory tract infection (15.5%), bacteraemia (15%), pre-septal cellulitis (15%) and respiratory tract infection (11.2%). Complex infections were less common but they accounted for longer antibiotic courses, such as cerebral abscess (5 patients – 170 days of intravenous therapy) and endocarditis (3 patients – 75 days of intravenous therapy).Using the BSAC outcomes definitions, we reported a 90% infection cure rate with a further 6.5% showing clinical improvement. OPAT outcomes were: success in 87% and partial success in 8.5%. The remaining patients (n=6) were classified as OPAT failures due to worsening of infection, drug reactions or inability to re-establish lost vascular access.Feedback from children and parents showed overall satisfaction with the OPAT service. Completed feedback questionnaires (n=30) rated the support and care as satisfactory or better in all cases, with over 83% rating the service as excellent.ConclusionWe report a positive financial and clinical impact of a new paediatric OPAT service. The service expansion will focus on the involvement of new patient groups (oncology, general surgery) and the increase use of elastomeric devices allowing for an increase number of patients to be treated in their home environment.