Several posters described aspects of unit dose systems ( UDDS ).
Düpmeier and colleagues reported a survey involving 11 hospitals using UDDS . They noted that although such systems have been much discussed as a means of reducing the costs of healthcare personnel in relation to medication administration , reliable evidence is still lacking . This study compared the time input required for medication administration in the classical system and with a UDDS . The results showed that a total of 11.23 minutes per patient was required in the classical system compared with 4.55 minutes when a UDD system was in operation . They calculated that this corresponds to a saving of 2.61 full-time nurses per 100 beds , equivalent to a saving of € 162,800.28 per 100 beds . The authors commented that the implementation of UDD led to a significant reduction in nursing time while also improving medication safety . Recognition of the impact on the use of nurse time might spur hospitals that have been hesitant about UDDS because of the high initial costs of IT systems and adjustments to care processes , they suggested .
Giesel-Gerstmeier and colleagues from Helios hospital in Erfurt undertook a survey four weeks after the introduction of a UDDS to determine doctors ’ views on the UDDS . A total of 49 responses were received ; about 90 % valued the input of pharmacists and felt that collaborative working would make drug therapy safer . About half the doctors said they would recommend UDDSs . The authors commented that UDDS would most likely be the norm in future .
Michael Baehr and Steffen Härterich ( University Hospital Eppendorf , Hamburg ) described the development of a database for expiry data for de-blistered unit doses . This information is required for UDDS that rely on repackaging of de-blistered doses in individual sachets because the ‘ use-by ’ periods are variable . The software that has been developed provides accurate information about inventory , usage and quantities of de-blistered doses together with estimates of the length of time that current supplies will last before more de-blistered doses need to be packed . The authors noted that having this information readily available has proved useful in day-to-day practice to manage workflow and avoid bottlenecks .
Injectable therapy Kreysing and colleagues presented a suggested standard list of 45 ready-to-use ( RTU ) 50ml injections for use in adult intensive care , noting that the use of standardised concentration in an RTU form minimises the risk of errors . This very detailed work is the result of a survey of senior intensivists and a comparison with similar lists in the US and UK . The authors noted that the standardised concentrations represent the first step in the preparation of prefilled syringes or RTU vials .
Kostadinova and colleagues from the University Hospital of Freiburg reported a new and simple method for the detection of leachable components from disposable syringes by using the DrugLog system . The authors commented that results can be obtained much more quickly using DrugLog than with HPLC .
Top papers A longstanding – since 2012 – feature of the ADKA programme is ‘ Top Papers ’ – a session in which expert pharmacists present the details of a few landmark papers that could be useful to all pharmacists . Papers selected for inclusion in this session must be current , evidence-based and of practical relevance . It has often been described as ‘ covering the papers that pharmacists should have read but might not have had time ’.
Professor Dr Martin Hug ( Director of Pharmacy , University
Hospital Freiburg , Germany ) discussed anti-hypertensive treatment and dietary salt consumption . In 2007 , a study had shown that persistence with beta-blockers was poor , reaching only 13.6 % after 12 months . In contrast , 52.7 % of patients continued to take angiotensin II receptor AT1 blockers after 12 months . There have been no new antihypertensive drugs in recent years but the Quadpill , which contains low doses of four different agents ( bisoprolol 2.5mg . irbesartan 37.5mg , amlodipine 1.25mg and indapamide 0.625mg ), has been developed , he said . The QUARTET study ( Quadruple UltrA-lowdose tReaTment for hypertension ) 1 compared the Quadpill with irbesartan monotherapy in 591 participants . At least one additional antihypertensive treatment was needed more often in the irbesartan group than in the Quadpill group . The results showed that the Quadpill successfully reduced systolic blood pressure by about 7mmHg and this was sustained over a 12-month period .
The implementation of UDD led to a significant reduction in nursing time while also improving medication safety
Furthermore , because doses of all the drugs were low , the product was well-tolerated , said Dr Hug .
Dietary salt intake can have a major impact on blood pressure and salt intake varies considerably around the world . Most countries exceed the recommended 5g per day , with the highest levels seen in Asia . Intake was highest in China at 11g per day , noted Dr Hug . In Germany and England , the average daily intake was just over 8g .
The Salt Substitute and Stroke Study ( SSaSS ) in China examined the impact of using a salt-substitute comprising 75 % sodium chloride and 25 % potassium chloride compared with continued use of regular salt in participants with histories of stroke or high blood pressure . 2 The results showed that the intervention significantly reduced blood pressure , stroke frequency and cardiovascular morbidity and mortality . However , Dr Hug emphasised the study was carried out in an area of exceptionally high salt consumption so the results may not be generalisable . Furthermore , it was unclear whether the higher intake of potassium also played a role . It was of interest that a recent study ( SODIUM-HF ) has shown that salt substitutes offered no advantage in heart failure , he added .
Gut microbiota and checkpoint inhibitor action Professor Dr Hans Peter Lipp ( Director of Pharmacy , University Hospital of Tübingen , Germany ) drew attention to the emerging interrelationship between the gut microbiota and the response to immunotherapy with checkpoint inhibitors . He noted that checkpoint inhibitors are usually thought of as being PD-1 and PD-L1 inhibitors but there are , in fact , many more including , for example , LAG-3 and TIGIT . Checkpoint inhibitors can be combined for greater effect according to a 2022 study that compared combined relatlimab and nivolumab with nivolumab alone in untreated advanced melanoma , 3 he explained .
The gut microbiota plays an important role in the response to immunotherapy . Gut dysbiosis caused by antibiotics impairs response to immune checkpoint blockers ( ICB ), suggesting that intact gut microbiota is essential for the optimal function of ICBs . The probiotic Clostridium butyricum therapy ( CBT ) is routinely used in Japan to treat antibiotic-induced dysbiosis . A retrospective survival analysis of patients with advanced non-small cell lung cancer who were given CBT before and / or after ICB therapy showed that CBT significantly prolonged progression-free survival and overall survival . 4
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