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Abstract
OBJECTIVES Reliable reconciliation of medicines at admission and discharge from hospital is key to reducing unintentional prescribing discrepancies at transitions of healthcare. We introduced a team approach to the reconciliation process at an acute hospital with the aim of improving the provision of information and documentation of reliable medication lists to enable clear, timely communications on discharge. SETTING An acute 400-bedded teaching hospital in London, UK. PARTICIPANTS The effects of change were measured in a simple random sample of 10 adult patients a week on the acute admissions unit over 18 months. INTERVENTIONS Quality improvement methods were used throughout. Interventions included education and training of staff involved at ward level and in the pharmacy department, introduction of medication documentation templates for electronic prescribing and for communicating information on medicines in discharge summaries co-designed with patient representatives. RESULTS Statistical process control analysis showed reliable documentation (complete, verified and intentional changes clarified) of current medication on 49.2% of patients' discharge summaries. This appears to have improved (to 85.2%) according to a poststudy audit the year after the project end. Pharmacist involvement in discharge reconciliation increased significantly, and improvements in the numbers of medicines prescribed in error, or omitted from the discharge prescription, are demonstrated. Variation in weekly measures is seen throughout but particularly at periods of changeover of new doctors and introduction of new systems. CONCLUSIONS New processes led to a sustained increase in reconciled medications and, thereby, an improvement in the number of patients discharged from hospital with unintentional discrepancies (errors or omissions) on their discharge prescription. The initiatives were pharmacist-led but involved close working and shared understanding about roles and responsibilities between doctors, nurses, therapists, patients and their carers.
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Affiliation(s)
- Vanessa Marvin
- Pharmacy Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Shirley Kuo
- Pharmacy Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Alan J Poots
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North West London (NWL), Imperial College London, London, UK
| | - Tom Woodcock
- NIHR CLAHRC NWL, Imperial College London, London, UK
| | | | - Derek Bell
- Department of Acute Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Jacobi J, Ray S, Danelich I, Dodds Ashley E, Eckel S, Guharoy R, Militello M, O'Donnell P, Sam T, Crist SM, Smidt D. Impact of the Pharmacy Practice Model Initiative on Clinical Pharmacy Specialist Practice. Pharmacotherapy 2016; 36:e40-9. [PMID: 27118546 DOI: 10.1002/phar.1745] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This paper describes the goals of the American Society of Health-System Pharmacists' Pharmacy Practice Model Initiative (PPMI) and its recommendations for health-system pharmacy practice transformation to meet future patient care needs and elevate the role of pharmacists as patient care providers. PPMI envisions a future in which pharmacists have greater responsibility for medication-related outcomes and technicians assume greater responsibility for product-related activities. Although the PPMI recommendations have elevated the level of practice in many settings, they also potentially affect existing clinical pharmacists, in general, and clinical pharmacy specialists, in particular. Moreover, although more consistent patient care can be achieved with an expanded team of pharmacist providers, the role of clinical pharmacy specialists must not be diminished, especially in the care of complex patients and populations. Specialist practitioners with advanced training and credentials must be available to model and train pharmacists in generalist positions, residents, and students. Indeed, specialist practitioners are often the innovators and practice leaders. Negotiation between hospitals and pharmacy schools is needed to ensure a continuing role for academic clinical pharmacists and their contributions as educators and researchers. Lessons can be applied from disciplines such as nursing and medicine, which have developed new models of care involving effective collaboration between generalists and specialists. Several different pharmacy practice models have been described to meet the PPMI goals, based on available personnel and local goals. Studies measuring the impact of these new practice models are needed.
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Affiliation(s)
- Judith Jacobi
- Department of Pharmacy, IU Health Methodist Hospital, Indianapolis, Indiana
| | - Shaunta' Ray
- Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, Knoxville, Tennessee
| | | | - Elizabeth Dodds Ashley
- Div. of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Stephen Eckel
- Department of Pharmacy, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Roy Guharoy
- Ascension Health and University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Paul O'Donnell
- Department of Pharmacy Practice, Midwestern University, Downers Grove, Illinois
| | - Teena Sam
- Department of Pharmacy, Baylor University Medical Center, Sunnyvale, Texas
| | | | - Danielle Smidt
- University of California, Davis Medical Center, Sacramento, California
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Rao Y, Zhao Q, Zhang X, Yang H, Lou Y, Zhang X. Current status and future prospects of the development of clinical Pharmacy in China: A SWOT analysis. Pak J Pharm Sci 2016; 29:415-421. [PMID: 27087089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In many industrialized countries, clinical pharmacy has developed into a separate discipline and become a vital part of inpatient care in hospitals. However, as compared to many established branches of medicine, clinical pharmacy is still in its infancy, with much room for growth, improvement, and recognition by both the medical community and patients. In this study, a widely-recognized development strategy analysis tool, Strength, Weakness, Opportunity and Threat (SWOT), was used to systematically address several key issues to the development of clinical pharmacy in China. This analysis aims to provide feasible recommendations for the development of clinical pharmacy in China by identifying current problems and growth opportunities. Full development of clinical pharmacy as a mature clinical discipline will help promote the rational use of drugs by both clinicians and patients and lead to enhanced drug efficacy and safety.
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Affiliation(s)
- Yuefeng Rao
- School of Basic Medical Sciences, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Qingwei Zhao
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiangyi Zhang
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hongyu Yang
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yan Lou
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xingguo Zhang
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Abstract
BACKGROUND Cellulitis is a common infection with wide variation of clinical care. OBJECTIVE To implement an evidence-based care pathway and evaluate changes in process metrics, clinical outcomes, and cost for cellulitis. DESIGN A retrospective observational pre-/postintervention study was performed. SETTING University of Utah Health Care, a 500-bed academic medical center in Salt Lake City, Utah. PATIENTS All patients 18 years or older admitted to the emergency department observation unit or hospital with a primary diagnosis of cellulitis. INTERVENTION Development of an evidence-based care pathway for cellulitis embedded into the electronic medical record with education for all emergency and internal medicine physicians. MEASUREMENTS Primary outcome of broad-spectrum antibiotic use. Secondary outcomes of computed tomography/magnetic resonance imaging orders, length of stay (LOS), 30-day readmission, and pharmacy, lab, imaging, and total facility costs. RESULTS A total of 677 visits occurred, including 370 visits where order sets were used. Among all patients, there was a 59% decrease in the odds of ordering broad-spectrum antibiotics (P < 0.001), 23% decrease in pharmacy cost (P = 0.002), and 13% decrease in total facility cost (P = 0.006). Compared to patients for whom order sets were not used, patients for whom order sets were used had a 75%, 13%, and 25% greater decrease in the odds of ordering broad-spectrum antibiotics (P < 0.001), clinical LOS (P = 0.041), and pharmacy costs (P = 0.074), respectively. CONCLUSION The evidence-based care pathway for cellulitis improved care at an academic medical center by reducing broad-spectrum antibiotic use, pharmacy costs, and total facility costs without an adverse change in LOS or 30-day readmissions.
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Affiliation(s)
- Peter M Yarbrough
- Department of Internal Medicine, Division of General Medicine, University of Utah Medical Center, Salt Lake City, Utah
| | - Polina V Kukhareva
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah
| | - Emily Sydnor Spivak
- Department of Internal Medicine, Division of Infectious Diseases, University of Utah Medical Center, Salt Lake City, Utah
| | - Christy Hopkins
- Division of Emergency Medicine, University of Utah Medical Center, Salt Lake City, Utah
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah
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Schofield B, Cresswel K, Westbrook J, Slee A, Girling A, Shah S, Coleman J, Sheikh A. The impact of electronic prescribing systems on pharmacists' time and workflow: protocol for a time-and-motion study in English NHS hospitals. BMJ Open 2015; 5:e008785. [PMID: 26503390 PMCID: PMC4636672 DOI: 10.1136/bmjopen-2015-008785] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Electronic prescribing (ePrescribing) systems are rapidly being introduced into National Health Systems (NHS) hospitals in England following their widespread earlier adoption into primary care settings. Such systems require substantial changes in the way pharmacists organise their work and perform their roles. There is however as yet limited evidence on the extent to which these changes may support or compromise efficient and safe working practices by pharmacists. Identifying and quantifying these changes, and their effects, is central to informing system and work practice design, as well as informing training and implementation processes. This protocol describes a study to measure the impact of ePrescribing systems on pharmacists' time and workflow. METHODS AND ANALYSIS A direct observational controlled pre-post implementation time-and-motion study will be conducted in six wards at one NHS Trust over two observational periods. Pharmacists will be shadowed and details of all work tasks performed will be collected and time-stamped. Task distribution, frequency and duration will be measured and changes in these measures preimplementation and postimplementation, and between control and intervention wards will be measured. Interviews with pharmacists will investigate their perceptions of the impact of the ePrescribing systems on their work and will be conducted in both periods. The extent to which pharmacists' expectations of the impact of the ePrescribing systems on their work with postimplementation reports will be qualitatively explored, as will any differences between perceptions and results from the time-and-motion analysis. ETHICS AND DISSEMINATION Institutional research ethics approval has been obtained from The University of Edinburgh. Local approval from the participating NHS Trust and informed consent from participating pharmacists have been obtained, while also complying with local governance requirements. The results of the study will be presented at conferences, published in peer-reviewed journals, and shared with members of our Patient and Public Involvement Group, to facilitate wider dissemination.
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Affiliation(s)
- Behnaz Schofield
- Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, The Old Medical School,Edinburgh, UK
| | - Kathrin Cresswel
- Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, The Old Medical School,Edinburgh, UK
| | - Johanna Westbrook
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ann Slee
- Department of Strategic Systems and Technology, Patients and Information, NHS England, London, UK
| | - Alan Girling
- School of Health and Population Sciences, The Learning Centre, The University of Birmingham, Birmingham, UK
| | - Sonal Shah
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jamie Coleman
- University Hospitals Birmingham NHS Foundation Trust, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Aziz Sheikh
- Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, The Old Medical School,Edinburgh, UK
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Mahmoudi L, Karamikhah R, Mahdavinia A, Samiei H, Petramfar P, Niknam R. Implementation of Pharmaceutical Practice Guidelines by a Project Model Based: Clinical and Economic Impact. Medicine (Baltimore) 2015; 94:e1744. [PMID: 26496288 PMCID: PMC4620749 DOI: 10.1097/md.0000000000001744] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
All around the world a few studies have been found on the effect of guideline implementation on direct medications' expenditure. The goal of this study was to evaluate cost savings of guideline implementation among patients who had to receive 3 costly medications including albumin, enoxaparin, and pantoprazole in a tertiary hospital in Shiraz, Iran.An 8-month prospective study was performed in 2 groups; group 1 as an observational group (control group) in 4 months from June to September 2014 and group 2 as an interventional group from October 2014 to January 2015.For group 1 the pattern of costly medications usage was determined without any intervention. For group 2, after guideline implementation, the economic impact was evaluated by making comparisons between the data achieved from the 2 groups.A total of 12,680 patients were evaluated during this study (6470 in group 1; 6210 in group 2). The reduction in the total value of costly administered drugs was 56% after guideline implementation. Such reduction in inappropriate prescribing accounts for the saving of 85,625 United States dollars (USD) monthly and estimated 1,027,500 USD annually.Guideline implementation could improve the adherence of evidence-based drug utilization and resulted in significant cost savings in a major teaching medical center via a decrease in inappropriate prescribing of costly medications.
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Affiliation(s)
- Laleh Mahmoudi
- From the Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran (LM, RK, AM), Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran (HS), Department of Neurology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran (PP); and Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran (RN)
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Doerper S, Godet J, Alexandra JF, Allenet B, Andres E, Bedouch P, Desbuquois AC, Develay-Rambourg A, Bauge-Faraldi O, Gendarme S, Gourieux B, Grain A, Long K, Loulière B, Roudot M, Roussel-Galle MC, Roux-Masson C, Thilly N, Dufay E, Michel B. Development and multi-centre evaluation of a method for assessing the severity of potential harm of medication reconciliation errors at hospital admission in elderly. Eur J Intern Med 2015. [PMID: 26209101 DOI: 10.1016/j.ejim.2015.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Medication reconciliation is a powerful process to correct medication errors (ME) resulting from miscommunicated information at transitions of care. This study aims to develop and evaluate a scoring method for assessing the severity of potential harm of ME intercepted by medication reconciliation at hospital admission in elderly. METHODS The development of the scoring method was based on a literature search and the creation of a list of high-risk drugs used in outpatient care. The evaluation of the method was carried out in 7 French hospitals and was based on two criteria: the inter-rater reliability and acceptability. The assessment of the inter-rater reliability was based on intra-class correlation coefficient (ICC) calculations. Each hospital prospectively enrolled the 10 first patients aged 65 or older presenting with at least one ME. Seven blocks of 10 patients were formed. After randomization, each block was rated by practitioners from 3 hospitals. The assessment of the acceptability was based on a satisfaction questionnaire. RESULTS A clinical algorithm was developed. The inter-rater reliability of the method was validated by the overall agreement of the 7 hospitals ratings. The agreement was at least substantial (ICC>0.60) and in most of cases almost perfect (ICC>0.80). The acceptability of the method was judged as satisfactory. CONCLUSION This multi-centre project has validated an instrument for assessing the severity of potential harm of ME intercepted by medication reconciliation. This will allow studies to be conducted with large cohorts of patients in order to develop epidemiological databases of ME of potential clinical significance.
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Affiliation(s)
| | - Julien Godet
- Department of Medical Information, University Hospital of Strasbourg, France
| | - Jean François Alexandra
- Department of Internal Medicine, University Hospital of Bichat-Claude Bernard, Paris, France
| | - Benoit Allenet
- Department of Pharmacy, University Hospital of Grenoble, France
| | - Emmanuel Andres
- Department of Internal Medicine, University Hospital of Strasbourg, France
| | | | | | | | | | - Sophie Gendarme
- Department of Epidemiology and Clinical Evaluation, University Hospital of Nancy, France
| | | | | | - Kivan Long
- Department of Pharmacy, University Hospital of Bichat-Claude Bernard, Paris, France
| | | | | | | | | | - Nathalie Thilly
- Department of Epidemiology and Clinical Evaluation, University Hospital of Nancy, France
| | - Edith Dufay
- Department of Pharmacy, Lunéville Hospital, France
| | - Bruno Michel
- Department of Pharmacy and HuManiS (EA7308), University Hospital of Strasbourg, France.
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Soumoy L, Pirlot C, Decoster C, Gillet P, Hecq JD. [Preliminary study for the implementation of standardized rounded doses of cytotoxic druqs]. J Pharm Belg 2015:24-35. [PMID: 26513833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND "Dose-banding" is a concept of cytotoxic drugs standardization allowing the preparation in advance of standardized rounded doses (SRD covering the most frequently prescribed doses rounded to +/-5%. Standard doses will be prepared in advance by batch in order to increase production capacity and at the same time to regulate pharmacy workflow as well as to reduce patient waiting time. PURPOSE To identify anticancer drugs suitable for dose banding and to fix standardized doses. METHODS The interesting molecules are first selected in accordance with several criteria: preparations frequency, long-term physicochemical stability after reconstitution, repetition of the prescribed doses and savings opportunity. The selected molecules were: Carboplatin, Cetuximab, Cisplatin, Cyclophosphamide, Doxorubicin, 5-Fluorouracil, Gemcitabine, Oxaliplatine, Paclitaxel, Rituximab, Trastuzumab and Vinorelbine. We established an inventory of the prescriptions retrospectively for a period of six months in order to highlight the most often prescribed doses. For the analysis, we fixed bands with a standard deviation of +/- 5%, 7% and +/- 10%. RESULTS Standardization of doses of chemotherapy was deemed interesting if > or =60% of the doses were standardisable with a maximum of five SRD and a minimum of one delivery per week, in order to guarantee a good turnover of the batch. A maximum of 5% standard deviation is added to those three criteria, the deviation currently accepted among our medical staff. After analyzing 3506 prescriptions, 7 molecules are eligible: Doxorubicine, 5-Fluorouracil infusion, 5-Fluorouracil pump, Gemcitabine, Paclitaxel, Rituximab, Trastuzumab and Vinorelbine, with a percentage of standardisation of 77% [SRD: 30 mg), 61% [SRD: 700 mg, 750 mg, 800 mgl, 75% (SRD: 4000 mg, 4500 mg, 5000 mg), 72% [SRD: 1600 mg, 1800 mg, 2000 mg), 61% [SRD: 140 mg, 150 mg, 160 mgl, 64% (SRD: 600 mg, 700 mg, 750 mg], 71% (SRD: 350 mg, 400 mg. 450 mgl et 62% [SRD: 40 mg, 50 mg] respectively. CONCLUSION This preliminary study allows us to consider implementing the dose banding concept in order to optimize the chemotherapy circuit at our institution.
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Affiliation(s)
- L Soumoy
- Département de Pharmacie, CHU Dinant Godinne, UCL Namur
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Council on Credentialing in Pharmacy. Credentialing and privileging of pharmacists: a resource paper from the Council on Credentialing in Pharmacy. J Am Pharm Assoc (2003) 2014; 54:e354-64. [PMID: 25257963 DOI: 10.1331/JAPhA.2014.14545] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Processes for the credentialing and privileging of health professionals are of increasing importance and value to the U.S. health care system and to society. As efforts continue to provide and reward more efficient, affordable, and higher quality health care (the "triple aim" described by Berwick et al.1), the ability to ensure the capabilities and competence of the health professionals, including pharmacists, who practice within an increasingly complex and sophisticated system has become both more relevant and essential. Currently, all U.S.-educated pharmacists attain a fundamental set of credentials to qualify to enter practice-an accredited professional pharmacy degree and a license awarded upon successful completion of a national postgraduation examination administered by the National Association of Boards of Pharmacy on behalf of state boards of pharmacy. This process provides an established framework to assure stakeholders of the ability of pharmacists to provide care and services that reflect sound, entry-level practice. However, evolving patient care and health system needs and demands have heightened the requisite skills needed by pharmacists to deliver more complex services. Ongoing professional development and competency assessment are integral parts of health professionals' expectations to maintain a contemporary practice. This resource guide on the credentialing and privileging of pharmacists has been developed to supplement the Council on Credentialing in Pharmacy (CCP)a Guiding Principles for Post-licensure Credentialing of Pharmacists2 and to assist those who are introducing or enhancing a credentialing and privileging system for pharmacists within their health care settings. CCP does not provide the guide for use as a standard of practice nor intends to represent the content as best or expected practices.
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Wiens MO, Zed PJ, Lepik KJ, Abu-Laban RB, Brubacher JR, Gorman SK, Kent DA, Purssell RA. Adequacy of antidote stocking in British Columbia hospitals: The 2005 Antidote Stocking Study. CAN J EMERG MED 2015; 8:409-16. [PMID: 17209490 DOI: 10.1017/s1481803500014214] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTBackground:Inadequate hospital stocking and the unavailability of essential antidotes is a worldwide problem with potentially disastrous repercussions for poisoned patients. Research indicates minimal progress has been made in the resolution of this issue in both urban and rural hospitals. In response to this issue the British Columbia Drug and Poison Information Centre developed provincial antidote stocking guidelines in 2003. We sought to determine the compliance with antidote stocking in BC hospitals and any factors associated with inadequate supply.Methods:A 2-part survey, consisting of hospital demographics and antidote stocking information, was distributed in 2005 to all acute care hospital pharmacy directors in BC. The 32 antidotes examined (21 deemed essential) and the definitions of adequacy were based on the 2003 BC guidelines. Availability was reported as number of antidotes stocked per hospital and proportion of hospitals stocking each antidote. For secondary purposes, we assessed factors potentially associated with inadequate stocking.Results:Surveys were completed for all 79 (100%) hospitals. A mean of 15.6 ± 4.9 antidotes were adequately stocked per hospital. Over 90% of hospitals had adequate stocks ofN-acetylcysteine, activated charcoal, naloxone, calcium salts, flumazenil and vitamin K; 71%–90% had adequate dextrose 50% in water (D50W), ethyl alcohol or fomepizole, polyethylene glycol electrolyte solution, protamine sulfate, and cyanide antidotes; 51%–70% had adequate folic acid, glucagon, methylene blue, atropine, pralidoxime, leucovorin, pyridoxine, and deferoxamine; and <50% had adequate isoproterenol and digoxin immune Fab. Only 7 (8.9%) hospitals sufficiently stocked all 21 essential antidotes. Factors predicting poor stocking included small hospital size (p < 0.0001), isolation (p = 0.01) and rural location (p < 0.0001).Conclusion:Although antidote stocking has improved since the implementation of the 2003 guidelines, essential antidotes are absent in many BC hospitals. Future research should focus on determining the reasons for this situation and the effects of corrective interventions.
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Affiliation(s)
- Matthew O Wiens
- CSU Pharmaceutical Sciences, Vancouver General Hospital (VGH), Vancouver, BC
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Ruggiero J, Smith J, Copeland J, Boxer B. Discharge Time Out: An Innovative Nurse-Driven Protocol for Medication Reconciliation. Medsurg Nurs 2015; 24:165-172. [PMID: 26285371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
An innovative method for discharge medication reconciliation was developed by nurses to ensure safe transition of care and improved patient outcomes. The discharge time-out process has empowered nurses to take a more active role in discharging their patients, and has fostered a more collaborative relationship between nurses and physicians.
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Schwartz V, Kravitz MS. [A new joint approach to drug management: clinical pharmacy services and risk management unit]. Harefuah 2015; 154:228-281. [PMID: 26065215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION According to the "To Err is Human" report, medication-related errors are common in medicine and may have several and different effects. Clinical Pharmacy is a leading worldwide established pharmacy service which has been improving the quality of care for the last 30 years. The accumulated experience shows improved quality of care, improved patient safety and economic benefit. These understandings led to the definition and expansion of the Clinical Pharmacist Intervention Program and a joint project with the Risk Management Unit was created. METHODS A characterization process was conducted, parameters were defined for monitoring and surveillance and interventions were devised. The relevant data requiring pharmacist intervention was defined (e.g., dose adjustments, contraindications, side-effects); a report was devised, based on the patient's electronic medical record; daily follow-up included analysis, stratification, quantification and understanding of the different types of pharmacist interventions. The pharmacist interventions were summed up and assessed for performance and quality control. RESULTS Between March 2013 and February 2014 the medical records of 14,499 patients were examined in our hospital Only in 16% of the records an active pharmacist intervention was performed, according to the parameters defined. Interventions for potentially high risk events such as therapeutic duplication, drug administration in spite of contraindication and in spite of documented allergy were very rare, less than 2% of all the pharmacist interventions. DISCUSSION AND CONCLUSIONS This joint venture, which is based on an existing platform, reflects an up-to-date view of an important facet of the clinical work performed at the hospital, helps identify trends, potential failures and vulnerabilities with regard to medication treatment and allows the formulation of intervention programs to improve the quality and safety of drug therapy.
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Fernandes O, Gorman SK, Slavik RS, Semchuk WM, Shalansky S, Bussières JF, Doucette D, Bannerman H, Lo J, Shukla S, Chan WWY, Benninger N, MacKinnon NJ, Bell CM, Slobodan J, Lyder C, Zed PJ, Toombs K. Development of clinical pharmacy key performance indicators for hospital pharmacists using a modified Delphi approach. Ann Pharmacother 2015; 49:656-69. [PMID: 25780250 DOI: 10.1177/1060028015577445] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Key performance indicators (KPIs) are quantifiable measures of quality. There are no published, systematically derived clinical pharmacy KPIs (cpKPIs). OBJECTIVE A group of hospital pharmacists aimed to develop national cpKPIs to advance clinical pharmacy practice and improve patient care. METHODS A cpKPI working group established a cpKPI definition, 8 evidence-derived cpKPI critical activity areas, 26 candidate cpKPIs, and 11 cpKPI ideal attributes in addition to 1 overall consensus criterion. Twenty-six clinical pharmacists and hospital pharmacy leaders participated in an internet-based 3-round modified Delphi survey. Panelists rated 26 candidate cpKPIs using 11 cpKPI ideal attributes and 1 overall consensus criterion on a 9-point Likert scale. A meeting was facilitated between rounds 2 and 3 to debate the merits and wording of candidate cpKPIs. Consensus was reached if 75% or more of panelists assigned a score of 7 to 9 on the consensus criterion during the third Delphi round. RESULTS All panelists completed the 3 Delphi rounds, and 25/26 (96%) attended the meeting. Eight candidate cpKPIs met the consensus definition: (1) performing admission medication reconciliation (including best-possible medication history), (2) participating in interprofessional patient care rounds, (3) completing pharmaceutical care plans, (4) resolving drug therapy problems, (5) providing in-person disease and medication education to patients, (6) providing discharge patient medication education, (7) performing discharge medication reconciliation, and (8) providing bundled, proactive direct patient care activities. CONCLUSIONS A Delphi panel of hospital pharmacists was successful in determining 8 consensus cpKPIs. Measurement and assessment of these cpKPIs will serve to advance clinical pharmacy practice and improve patient care.
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Affiliation(s)
- Olavo Fernandes
- University Health Network Pharmacy Department, Toronto, ON, Canada University of Toronto, Toronto, ON, Canada
| | - Sean K Gorman
- Interior Health Pharmacy Services, Kelowna, BC, Canada The University of British Columbia, Vancouver, BC, Canada
| | - Richard S Slavik
- Interior Health Pharmacy Services, Kelowna, BC, Canada The University of British Columbia, Vancouver, BC, Canada
| | - William M Semchuk
- Regina Qu'Appelle Health Region Pharmacy Services, Regina, SK, Canada University of Saskatchewan, Saskatoon, SK, Canada
| | - Steve Shalansky
- The University of British Columbia, Vancouver, BC, Canada Lower Mainland Pharmacy Services, Providence Healthcare, Vancouver, BC, Canada
| | - Jean-François Bussières
- Département de pharmacie et unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, Montréal, QC, Canada Université de Montréal, QC, Canada
| | - Douglas Doucette
- Horizon Health Network Pharmacy Services, Moncton, NB, Canada Dalhousie University, Halifax, NS, Canada
| | | | - Jennifer Lo
- Sunnybrook Health Sciences Centre Pharmacy Department, Toronto, ON, Canada
| | - Simone Shukla
- Foothills Medical Centre Pharmacy Department, Calgary, AB, Canada
| | - Winnie W Y Chan
- St Michael's Hospital Pharmacy Department, Toronto, ON, Canada
| | - Natalie Benninger
- University Health Network-Toronto Rehabilitation Institute Pharmacy Department, Toronto, ON, Canada
| | - Neil J MacKinnon
- James L Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
| | - Chaim M Bell
- University of Toronto, Toronto, ON, Canada Mount Sinai Hospital, Toronto, ON, Canada Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada
| | - Jeremy Slobodan
- Alberta Health Services Pharmacy Services, Red Deer, AB, Canada
| | - Catherine Lyder
- Canadian Society of Hospital Pharmacists, Ottawa, ON, Canada
| | - Peter J Zed
- The University of British Columbia, Vancouver, BC, Canada
| | - Kent Toombs
- Capital District Health Authority Pharmacy Department, Halifax, NS, Canada
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Saghaeiannejad-Isfahani S, Sharifi-Rad J, Raeisi A, Ehteshami A, Mirzaeian R. An evaluation of adherence to society of pharmacists' standards care in pharmacy information systems in Iran. Indian J Pharmacol 2015; 47:190-4. [PMID: 25878380 PMCID: PMC4386129 DOI: 10.4103/0253-7613.153428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/05/2014] [Accepted: 02/21/2015] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Pharmacy information system (PIS) is a complex computerized system used for collecting, storing, and managing the medication therapy data in the course of patients' care. The purpose of this study was to evaluate the level of adherence to the standards established by the societies of pharmacists in the PISs employed in the hospitals in Isfahan, Iran. METHODS The present study was an applied, descriptive-analytical study conducted on the PISs of 19 teaching, private and social insurance hospitals in Isfahan in 2011. Study population consisted of the PISs available in the hospitals under study. Study sample was the same as the study population. The data collection instrument was a self-developed checklist based on the guidelines of the American Society of Health-System Pharmacists and Pharmaceutical Society of Australia, whose validity was assessed and confirmed by expert professors' views. Having been collected by observation and interview methods, data were analyzed by SPSS 18 software using Mann-Whitney statistical test. RESULTS The findings of the study revealed that the highest rank in adherence to the standards of societies of pharmacists was obtained by social services hospitals (32.75%), while the private hospitals obtained the lowest rank (23.32%). CONCLUSIONS Based on the findings, in the PISs in the hospitals under study, some standards of the society of pharmacists were ignored. Hence, prior to designing and implementing PIS, a needs analysis is required to increase its users' motivation to identify the system potentialities and to allow the system development in compliance with the world technology advancement.
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Affiliation(s)
| | - Javad Sharifi-Rad
- Zabol Medicinal Plants Research Center, Zabol University of Medical Sciences, Zabol, Iran
- Department of Pharmacognosy, Faculty of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran
| | - Ahmadreza Raeisi
- Department of Health Information Technology, Faculty of Health Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan, Shahrekord, Iran
| | - Asghar Ehteshami
- Department of Health Information Technology, Faculty of Health Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan, Shahrekord, Iran
| | - Razieh Mirzaeian
- Deputy of Research and Technology Shahrekord University of Medical Sciences, Shahrekord, Iran
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Duong M, Golzi A, Peytavin G, Piroth L, Froidure M, Grappin M, Buisson M, Kohli E, Chavanet P, Portier H. Usefulness of Therapeutic Drug Monitoring of Antiretrovirals in Routine Clinical Practice. HIV Clinical Trials 2015; 5:216-23. [PMID: 15472796 DOI: 10.1310/nxju-9erq-adww-uc5x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Clinical trials have shown that therapeutic drug monitoring (TDM) of antiretrovirals (ARV) improves patient care. However, little is known about the usefulness of TDM in routine practice. METHOD We reviewed all the trough concentrations of protease inhibitors and nonnucleoside reverse transcriptase inhibitors that were performed for therapeutic failure, suspected drug toxicity, or routine purposes. RESULTS Between 1998 and 2001, 146 TDMs were done in 109 HIV patients. Of the 48 patients with therapeutic failure, 62% had resistance to ARV with adequate ARV concentrations, 16% had insufficient drug exposure without any ARV resistance mutations, and 16% combined both resistance and suboptimal drug concentrations. Subsequent therapeutic interventions (increasing adherence and/or changing HAART) resulted in an undetectable viral load in 37.5% of the patients (14/48). Five (24%) of 21 patients with suspected drug toxicity had high drug concentrations associated with side effects. In all the cases, adverse events regressed after reduction of drug dosage. Of the 77 TDMs done for routine purposes, 26% were outside the therapeutic range. CONCLUSION The data show that TDM of ARVs in the clinical setting provides important information that can be used to improve the management of HIV patients receiving antiretroviral therapy.
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Affiliation(s)
- Michel Duong
- Division of Infectious Diseases, University Hospital, Dijon, France.
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Schencker L. Compounding pharmacy safety proposals lauded by experts. Mod Healthc 2015; 45:11. [PMID: 25671912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Keijsers CJPWK, Jansen PAF, Brouwers JRBJK, de Wildt DJ. [Need for improvement in education on appropriate prescribing in elderly patients]. Ned Tijdschr Geneeskd 2015; 159:A9609. [PMID: 26732217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Prescribing errors can cause great harm to patients. In the Netherlands, it is estimated that 7000 preventable medication-related hospitals admissions occur annually, caused in many cases by prescribing errors. Elderly patients are at greatest risk, since this patient demographic is most likely to be prescribed multiple medications. Robust education on appropriate prescribing is essential for all clinicians with the authority to prescribe. Currently, some issues still require improvement in the Netherlands: a) education continues to focus heavily on basic pharmacology knowledge instead of patient related pharmacotherapy skills, b) an appropriate assessment procedure on pharmacotherapy knowledge and skills is often lacking, c) there is no mandatory requirement for physicians to maintain their knowledge and skills in the field of pharmacotherapy during their working career. In this article we discuss means to improve this situation, with the overall aim to ensure that all vulnerable elderly patients are in safe hands with each physician.
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Tomaes LCOC, Poortvliet RKE, Kwint HF, Gussekloo J. [Medication review in older people: identification of a new risk group]. Ned Tijdschr Geneeskd 2015; 159:A8929. [PMID: 25990336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The Dutch multidisciplinary guideline on 'Polypharmacy in older people' advises performing an annual medication review for patients aged 65 or older who use five or more drugs and have at least one risk factor for negative outcomes of their drug usage. We describe a 79-year-old male patient with an indication for a medication review and identified drug-related problems (DRPs). Furthermore, we describe two female patients aged 97 and 91 who use fewer than five drugs, dispensed via an automated system, and also have DRPs. We suggest adding the use of a multidose drug-dispensing system as an indication for a medication review. This will also help to identify patients with undertreatment. In addition, we recommend improving collaboration with pharmacists, which may enhance the effect of a medication review by increasing the number of drug changes.
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Affiliation(s)
- Loes C O C Tomaes
- Leids Universitair Medisch Centrum, afd. Public Health en Eerstelijnsgeneeskunde, Leiden
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King D, Jabbar A, Charani E, Bicknell C, Wu Z, Miller G, Gilchrist M, Vlaev I, Franklin BD, Darzi A. Redesigning the 'choice architecture' of hospital prescription charts: a mixed methods study incorporating in situ simulation testing. BMJ Open 2014; 4:e005473. [PMID: 25475242 PMCID: PMC4256638 DOI: 10.1136/bmjopen-2014-005473] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To incorporate behavioural insights into the user-centred design of an inpatient prescription chart (Imperial Drug Chart Evaluation and Adoption Study, IDEAS chart) and to determine whether changes in the content and design of prescription charts could influence prescribing behaviour and reduce prescribing errors. DESIGN A mixed-methods approach was taken in the development phase of the project; in situ simulation was used to evaluate the effectiveness of the newly developed IDEAS prescription chart. SETTING A London teaching hospital. INTERVENTIONS/METHODS A multimodal approach comprising (1) an exploratory phase consisting of chart reviews, focus groups and user insight gathering (2) the iterative design of the IDEAS prescription chart and finally (3) testing of final chart with prescribers using in situ simulation. RESULTS Substantial variation was seen between existing inpatient prescription charts used across 15 different UK hospitals. Review of 40 completed prescription charts from one hospital demonstrated a number of frequent prescribing errors including illegibility, and difficulty in identifying prescribers. Insights from focus groups and direct observations were translated into the design of IDEAS chart. In situ simulation testing revealed significant improvements in prescribing on the IDEAS chart compared with the prescription chart currently in use in the study hospital. Medication orders on the IDEAS chart were significantly more likely to include correct dose entries (164/164 vs 166/174; p=0.0046) as well as prescriber's printed name (163/164 vs 0/174; p<0.0001) and contact number (137/164 vs 55/174; p<0.0001). Antiinfective indication (28/28 vs 17/29; p<0.0001) and duration (26/28 vs 15/29; p<0.0001) were more likely to be completed using the IDEAS chart. CONCLUSIONS In a simulated context, the IDEAS prescription chart significantly reduced a number of common prescribing errors including dosing errors and illegibility. Positive behavioural change was seen without prior education or support, suggesting that some common prescription writing errors are potentially rectifiable simply through changes in the content and design of prescription charts.
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Affiliation(s)
- Dominic King
- Imperial College London, St Mary's Hospital, London, UK
| | - Ali Jabbar
- School of Pharmacy, University College London, London, UK
| | - Esmita Charani
- Centre for Infection Prevention and Management, Imperial College London, London, UK
| | | | - Zhe Wu
- Imperial College Healthcare NHS Trust, London, UK
| | - Gavin Miller
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Ivo Vlaev
- Imperial College London, St Mary's Hospital, London, UK
| | - Bryony Dean Franklin
- Centre for Medication Safety, Imperial College Healthcare NHS Trust and UCL School of Pharmacy, London, UK
| | - Ara Darzi
- Imperial College London, St Mary's Hospital, London, UK
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Hospital pharmacists. Clin Privil White Pap 2014;:1-18. [PMID: 25890986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Khalil V, Li M, Hua QA. An audit of the pharmacological management of ischaemic stroke patients in a metropolitan Australian hospital. Int J Clin Pharm 2014; 37:8-11. [PMID: 25394833 DOI: 10.1007/s11096-014-0035-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 10/31/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND According to the Australian Bureau of Statistics, stroke is the second leading cause of death in Australia. The clinical Guidelines for stroke management published by the National Stroke Foundation provide a series of evidence based recommendations to assist clinicians in the management of stroke patients. Appropriate management of patients admitted to stroke units reduces death and disability by 20 %. Moreover, a multidisciplinary team approach also improves patient outcomes. OBJECTIVE To retrospectively review the pharmacological management of ischaemic stroke patients in a metropolitan Australian hospital, and to compare adherence with the guidelines for stroke management with the national stroke foundation data with and without pharmacist intervention. METHOD A retrospective audit of medical records was undertaken of all patients admitted to a large teaching hospital with the diagnosis of stroke or cerebral infarction from January 2013 to May 2013. RESULTS A total of 124 patients were included in the study. Most patients were discharged on appropriate pharmacological intervention for the prevention of secondary stroke: antihypertensive agents (71 %), lipid lowering agents (67 %) and antithrombotic (85 %) medications. CONCLUSION The majority of the cohort was discharged on the appropriate evidence based medications for the management of secondary stroke. Further improvement may be achieved by pharmacist intervening as part of a multidisciplinary team.
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Affiliation(s)
- Viviane Khalil
- Peninsula Health, Frankston Hospital, Pharmacy Department, Melbourne, Australia,
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Martín Conde MT, Monte Boquet E, Morillo Verdugo R. [Quality healthcare and pharmaceutical care practice indicators to HIV+ patient]. Farm Hosp 2014; 37:276-85. [PMID: 24010688 DOI: 10.7399/fh.2013.37.4.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify and to promote improvements in the quality of the sanitary attention to the HIV+ patients in the Clinical Units of the hospitals in our country, there being included and reinforcing the perspective of Pharmaceutical Care. METHODS To carry out the project, during the period January- June 2012, the following phases were defined. First, a bibliographical review was realized and reading criticizes related to the pathology HIV and quality criteria. Later, a presencial qualitative investigation phase was carried out with the expert participants. The first one was carried out by means of two technologies: the nominal group and a variant of groups of discussion. The application of the technologies was supported by an technical support that allowed the codification and valuation organized. The last phase of the project consisted of a meeting presencial, where there were outlined the aims of the first meeting and put jointly all the work that the subgroups of work had elaborated to agree on the contents. Of the first selection of ideas, the equipment of investigation worked and prioritized those elements that describe and give response to the raised aims. Concretely, the correct definition of the safety and quality indicators in the area of the hospital pharmacist, there being elaborated a card that was describing every aspect to bear in mind for the later measurement of the indicator. Finally, a plan of actions was elaborated to improve the clinical practice synthesized according to his level of priority. RESULTS Across the methodology of the project, the experts identified the quality criterias in pharmaceutical care procedure. The principal barriers identified were: asistencial pressure, personnel management system's, security and ignorance of the pharmacotherapy, lack of quality culture and difficulties of access to the information. Principals clinical risks identified were: mistakes in the guidelines with the changes of treatments, lack of information of the whole medication of the patient, lack in resources and time adapted to realize the processes, lack of communication between professionals, ignorance of interactions or adverse events. The principal results that were extracted from the analysis of situation were that the priority line of action had to happen for a link between patients, specialists and primary care. It should promote the clinical management of the units of HIV, the access to the information for all the professionals who realize pharmacoterapeutical follow-up to these patients and the major implication on the part of these. Finally, 29 quality indicators were defined in the pharmaceutical care to the HIV+ patient distributed in structure, processes and results and the plan of improvement for the attention and his level of priority considered. DISCUSSION This document gives response to the increasing demand for homogenizing the clinical practice and establishing common criteria of quality that result a benefit for the sanitary system and, in consequence, for the professionals and the patients.
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de Boer M, Ramrattan MA, Boeker EB, Kuks PFM, Boermeester MA, Lie-A-Huen L. Quality of pharmaceutical care in surgical patients. PLoS One 2014; 9:e101573. [PMID: 25006676 PMCID: PMC4090008 DOI: 10.1371/journal.pone.0101573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 06/07/2014] [Indexed: 11/26/2022] Open
Abstract
Background Surgical patients are at risk for preventable adverse drug events (ADEs) during hospitalization. Usually, preventable ADEs are measured as an outcome parameter of quality of pharmaceutical care. However, process measures such as QIs are more efficient to assess the quality of care and provide more information about potential quality improvements. Objective To assess the quality of pharmaceutical care of medication-related processes in surgical wards with quality indicators, in order to detect targets for quality improvements. Methods For this observational cohort study, quality indicators were composed, validated, tested, and applied on a surgical cohort. Three surgical wards of an academic hospital in the Netherlands (Academic Medical Centre, Amsterdam) participated. Consecutive elective surgical patients with a hospital stay longer than 48 hours were included from April until June 2009. To assess the quality of pharmaceutical care, the set of quality indicators was applied to 252 medical records of surgical patients. Results Thirty-four quality indicators were composed and tested on acceptability and content- and face-validity. The selected 28 candidate quality indicators were tested for feasibility and ‘sensitivity to change’. This resulted in a final set of 27 quality indicators, of which inter-rater agreements were calculated (kappa 0.92 for eligibility, 0.74 for pass-rate). The quality of pharmaceutical care was assessed in 252 surgical patients. Nearly half of the surgical patients passed the quality indicators for pharmaceutical care (overall pass rate 49.8%). Improvements should be predominantly targeted to medication care related processes in surgical patients with gastro-intestinal problems (domain pass rate 29.4%). Conclusions This quality indicator set can be used to measure quality of pharmaceutical care and detect targets for quality improvements. With these results medication safety in surgical patients can be enhanced.
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Affiliation(s)
- Monica de Boer
- Department of Hospital Pharmacy, Academic Medical Centre, Amsterdam, The Netherlands
- * E-mail:
| | - Maya A. Ramrattan
- Department of Hospital Pharmacy, Academic Medical Centre, Amsterdam, The Netherlands
| | - Eveline B. Boeker
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - Paul F. M. Kuks
- Department of Hospital Pharmacy, Academic Medical Centre, Amsterdam, The Netherlands
| | | | - Loraine Lie-A-Huen
- Department of Hospital Pharmacy, Academic Medical Centre, Amsterdam, The Netherlands
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Rabuñal-Álvarez MT, Calvin-Lamas M, Feal-Cortizas B, Martínez-López LM, Pedreira-Vázquez I, Martín-Herranz MI. [Quality indicators in the storage and dispensing process in a Hospital Pharmacy]. Rev Calid Asist 2014; 29:204-211. [PMID: 24815675 DOI: 10.1016/j.cali.2014.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 03/17/2014] [Accepted: 03/23/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To establish indicators for the evaluation of the quality of the storage and dispensing processes related to semiautomatic vertical (SAVCS) and horizontal (SAHCS) carousel systems. MATERIAL AND METHODS Descriptive observational study conducted between January-December 2012. Definition of quality indicators, a target value is established and an obtained value is calculated for 2012. RESULTS Five quality indicators in the process of storage and dispensing of drugs were defined and calculated: indicator 1, error filling unidose trolleys: target (<1.67%), obtained (1.03%); indicator 2, filling accuracy unidose trolleys by using an SAVCS: target (<15%), obtained (11.5%); indicator 3, reliability of drug inventory in the process of drug entries using an SAHCS: target (<15%), obtained (6.53%); indicator 4, reliability of drug inventory in the picking process of orders replacement stock of clinical units using an SAHCS: target (<10%), obtained (1.97%); indicator 5, accuracy of the picking process of drug orders using an SAHCS: target (<10%), obtained (10.41%). CONCLUSIONS Establishing indicators has allowed the quality in terms of safety, precision and reliability of semiautomatic systems for storage and dispensing drugs to be assessed.
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Affiliation(s)
- M T Rabuñal-Álvarez
- Servicio de Farmacia, Complexo Hospitalario Universitario A Coruña, A Coruña, España
| | - M Calvin-Lamas
- Servicio de Farmacia, Complexo Hospitalario Universitario A Coruña, A Coruña, España
| | - B Feal-Cortizas
- Servicio de Farmacia, Complexo Hospitalario Universitario A Coruña, A Coruña, España
| | - L M Martínez-López
- Servicio de Farmacia, Complexo Hospitalario Universitario A Coruña, A Coruña, España
| | - I Pedreira-Vázquez
- Servicio de Farmacia, Complexo Hospitalario Universitario A Coruña, A Coruña, España
| | - M I Martín-Herranz
- Servicio de Farmacia, Complexo Hospitalario Universitario A Coruña, A Coruña, España.
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Müller F, Dormann H, Pfistermeister B, Sonst A, Patapovas A, Vogler R, Hartmann N, Plank-Kiegele B, Kirchner M, Bürkle T, Maas R. Application of the Pareto principle to identify and address drug-therapy safety issues. Eur J Clin Pharmacol 2014; 70:727-36. [PMID: 24652477 DOI: 10.1007/s00228-014-1665-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 02/18/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE Adverse drug events (ADE) and medication errors (ME) are common causes of morbidity in patients presenting at emergency departments (ED). Recognition of ADE as being drug related and prevention of ME are key to enhancing pharmacotherapy safety in ED. We assessed the applicability of the Pareto principle (~80 % of effects result from 20 % of causes) to address locally relevant problems of drug therapy. METHODS In 752 cases consecutively admitted to the nontraumatic ED of a major regional hospital, ADE, ME, contributing drugs, preventability, and detection rates of ADE by ED staff were investigated. Symptoms, errors, and drugs were sorted by frequency in order to apply the Pareto principle. RESULTS In total, 242 ADE were observed, and 148 (61.2 %) were assessed as preventable. ADE contributed to 110 inpatient hospitalizations. The ten most frequent symptoms were causally involved in 88 (80.0 %) inpatient hospitalizations. Only 45 (18.6 %) ADE were recognized as drug-related problems until discharge from the ED. A limited set of 33 drugs accounted for 184 (76.0 %) ADE; ME contributed to 57 ADE. Frequency-based listing of ADE, ME, and drugs involved allowed identification of the most relevant problems and development of easily to implement safety measures, such as wall and pocket charts. CONCLUSIONS The Pareto principle provides a method for identifying the locally most relevant ADE, ME, and involved drugs. This permits subsequent development of interventions to increase patient safety in the ED admission process that best suit local needs.
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Affiliation(s)
- Fabian Müller
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Fahrstrasse 17, 91054, Erlangen, Germany,
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Pérez León M, Alonso Ramos H, González Munguía S, Marrero Penichet SM, Molero Gómez R. [Evaluation of the quality of scientific evidence of pharmaceutical interventions in an emergency department]. Farm Hosp 2014; 38:123-129. [PMID: 24669897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES To assess the quality of Pharmaceutical Interventions of starting a drug treatment based on the available scientific evidence, in an Emergency Department with a Clinical Pharmacist working full-time. To analyze the rate of Pharmaceutical Interventions over chronic or acute treatments and the ATC group of drugs involved. METHOD The pharmacotherapy recommendations on Clinical Practice Guidelines (CPG) were classified and for every Pharmaceutical Intervention was assessed the quality of scientific evidence, strength of clinical recommendation, morbidity/mortality reduction, chronic or acute treatment and ATC group of drug involved. RESULTS During the study period 2776 Pharmaceutical Interventions were performed of which 47% were starting-drug interventions, being 73% justified with scientific evidence. The 84% of starting-drug interventions were assessed with quality of evidence and strength of recommendation IA, 9% IC and 4% IB and 67% have been shown to reduce the morbidity/mortality according the CPG. 73% of interventions were related with patients' chronic treatment and ATC groups most frequently involved were N group (nervous system) and C group (cardiovascular system). In acute treatment the most frequent were B group and A group (Alimentary tract and metabolism). CONCLUSIONS The starting-drug Pharmaceutical Interventions performed by an emergency department clinical pharmacist show a high adherence to CPG for most frequent pathologies, with good quality of evidence and good strength of recommendation as well as an associated morbidity/mortality reduction. Most starting-drug interventions were related to chronic treatment reconciliation, being drugs of N and C ATC group the most frequent involved.
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Affiliation(s)
- M Pérez León
- Servicio de Farmacia. Hospital Universitario de Gran Canaria Doctor Negrín. Las Palmas de Gran Canaria. España..
| | - H Alonso Ramos
- Servicio de Farmacia. Hospital Universitario de Gran Canaria Doctor Negrín. Las Palmas de Gran Canaria. España
| | - S González Munguía
- Servicio de Farmacia. Hospital Universitario de Gran Canaria Doctor Negrín. Las Palmas de Gran Canaria. España
| | - S M Marrero Penichet
- Servicio de Farmacia. Hospital Universitario de Gran Canaria Doctor Negrín. Las Palmas de Gran Canaria. España
| | - R Molero Gómez
- Servicio de Farmacia. Hospital Universitario de Gran Canaria Doctor Negrín. Las Palmas de Gran Canaria. España
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Goodarzi N, Niknam S, Akbarzadeh T, Gholami K. Compounding practices in Iran. Int J Pharm Compd 2014; 18:112-116. [PMID: 24881113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This article has been presented by pharmacists of the Razi Hospital Pharmacy, which is located within the Dermatology Center of Tehran University of Medical Sciences in Tehran, Iran, and by members of the staff at the Tehran University of Medical Sciences. Discussed within this article are the legalization and regulation of pharmaceutical compounding in Iran, the restrictions on pharmaceutical compounding, the general equipment used in Iran pharmacies, beyond-use dating/expiration dating, the required pharmacy education, as well as information related specifically to Razi Hospital Pharmacy.
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O'Hanlon S. Technology. The e-prescribing future looks bright. Health Serv J 2014; 124:22-23. [PMID: 24730102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Bülow C, Winther M, Schjerling L, Bjeldbak-Olesen M, Tomsen DV. [Different models are used to obtain medication history and medication review in Danish hospitals]. Ugeskr Laeger 2014; 176:V11120680. [PMID: 25095860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The objective of the article is to characterize the models used by pharmacists to obtain medication history and medication review in Danish hospitals. The models are characterized based on the sources used to create an overview of the patient's medication as well as the time spent per patient. Currently pharmacists perform medication review at 16 departments. The sources frequently used are the patient journal (81%) and clinical data (81%). The patient contributes to the medication review in 25%.
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Affiliation(s)
- Cille Bülow
- Region Hovedstadens Apotek, Apoteksenhed Nord, Dyrehavevej 29, 3400 Hillerød.
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85
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Affiliation(s)
- Josep M Guiu Segura
- Pharmacy Practice Research Group, Faculty of Pharmacy, University of Barcelona, Barcelona, Spain
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Bujaldón-Querejeta N, Aznar-Saliente T, Esplá-González S, Ruíz-Darbonnéns S, Pons-Martínez L, Talens-Bolos A, Martínez-Ramírez M, Camacho-Romera D, Aranaz-Andrés JM. [Comprehensive drug safety plan in a health department]. Rev Calid Asist 2014; 29:43-50. [PMID: 24183871 DOI: 10.1016/j.cali.2013.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 09/05/2013] [Accepted: 09/05/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To develop and implement a comprehensive drug safety plan in a hospital for the years 2009-2011. MATERIAL AND METHODS Applying the Strengths Weaknesses/Limitations Opportunities Threats (SWOT) methodology, the baseline situation was analyzed and a broad strategy or plan was subsequently developed, defining the scope, responsibilities, objectives and strategic actions and indicators in order to measure the achievement of the results. RESULTS A comprehensive drug safety plan with the main objective of identifying and reducing the medication-related problems in patients treated in the Hospital de San Juan in Alicante has been developed. The plan contains five strategic objectives, twenty strategic actions and the indicators to assess its outcomes. It also contains a timetable for its establishment and evaluation. DISCUSION Developing a comprehensive strategic plan allows the current situation relating to drug safety to be determined. The results obtained after its introduction will define its applicability. Due to the lack of publications of similar plans and results, the evaluation of this plan will be useful whether it is favorable or not. As a side benefit of the development, the multidisciplinary team continues to work on improving patient safety in the care process, and the safety culture continues to grow among the professionals.
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Affiliation(s)
- N Bujaldón-Querejeta
- Servicio de Farmacia, Hospital Universitario Sant Joan de Alicante, Alicante, España.
| | - T Aznar-Saliente
- Servicio de Farmacia, Hospital Universitario Sant Joan de Alicante, Alicante, España
| | - S Esplá-González
- Servicio de Farmacia, Hospital Universitario Sant Joan de Alicante, Alicante, España
| | - S Ruíz-Darbonnéns
- Servicio de Farmacia, Hospital Universitario Sant Joan de Alicante, Alicante, España
| | - L Pons-Martínez
- Servicio de Farmacia, Hospital Universitario Sant Joan de Alicante, Alicante, España
| | - A Talens-Bolos
- Servicio de Farmacia, Hospital Universitario Sant Joan de Alicante, Alicante, España
| | - M Martínez-Ramírez
- Servicio de Farmacia, Hospital Universitario Sant Joan de Alicante, Alicante, España
| | - D Camacho-Romera
- Servicio de Farmacia, Hospital Universitario Sant Joan de Alicante, Alicante, España
| | - J M Aranaz-Andrés
- Servicio de Farmacia, Hospital Universitario Sant Joan de Alicante, Alicante, España
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McLaughlin M, Kotis D, Thomson K, Harrison M, Fennessy G, Postelnick M, Scheetz MH. Effects on patient care caused by drug shortages: a survey. J Manag Care Pharm 2013; 19:783-8. [PMID: 24156647 PMCID: PMC10437927 DOI: 10.18553/jmcp.2013.19.9.783] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Drug shortages pose a serious challenge for health care institutions, often interfering with patient care. A common practice during a drug shortage is to select an alternate therapeutic; however, these agents often present challenges and may create safety concerns. Patient harms including adverse events and medication errors may occur. Patients may also file complaints because of drug shortages. OBJECTIVE To measure the effect of drug shortages on patient outcomes, clinical pharmacy operations, patient complaints, and institutional cost. METHODS An e-mail link to an online survey was sent to pharmacy director members in the MedAssets Pharmacy Group Purchasing Organization. Data were collected within a 3-week period from October 2-23, 2012. The survey focused on 6 different domains: demographics, adverse events, medication errors, patient outcomes, patient complaints, and institutional cost. RESULTS The survey was sent to 1,516 directors of pharmacy. There were 193 respondents (response rate 13%) who participated in the survey. Approximately 40% of respondents reported between 1 and 5 adverse events probably or possibly associated with drug shortages at their institution. The majority of respondents reported between 1 and 10 medication errors. The most common types of medication errors reported were omission (n = 86, 55.5%), wrong dose dispensed/administered (n = 85, 54.8%), and wrong drug dispensed/administered (n = 54, 34.8%). The most common outcomes reported by respondents were alternative medication used (n=146, 85.3%), delay of therapy (n = 121, 70.8%), and increased patient monitoring necessary (n = 84, 49.1%). Patient complaints were reported by 38% of respondents. The majority of respondents reported an estimated quarterly institutional cost from shortages of less than $100,000, and approximately one quarter of respondents reported adding at least 1 full-time equivalent to manage drug shortages. The majority of participant comments mentioned the increasing institutional costs attributed to drug shortages. CONCLUSIONS Medication errors and adverse events continue to occur from drug shortages, often resulting in inadequate patient care, high institutional costs, and patient complaints. Delayed care and cancelled care have been reported from shortages. Further research is necessary to better classify medication errors and adverse events during a drug shortage.
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Affiliation(s)
- Milena McLaughlin
- Midwestern University Chicago College of Pharmacy, Department of Pharmacy Practice, 555 31st St., Downers Grove, IL, 60515, USA.
| | - Despina Kotis
- Midwestern University Chicago College of Pharmacy, Department of Pharmacy Practice, 555 31st St., Downers Grove, IL, 60515, USA.
| | - Kenneth Thomson
- Midwestern University Chicago College of Pharmacy, Department of Pharmacy Practice, 555 31st St., Downers Grove, IL, 60515, USA.
| | - Michael Harrison
- Midwestern University Chicago College of Pharmacy, Department of Pharmacy Practice, 555 31st St., Downers Grove, IL, 60515, USA.
| | - Gary Fennessy
- Midwestern University Chicago College of Pharmacy, Department of Pharmacy Practice, 555 31st St., Downers Grove, IL, 60515, USA.
| | - Michael Postelnick
- Midwestern University Chicago College of Pharmacy, Department of Pharmacy Practice, 555 31st St., Downers Grove, IL, 60515, USA.
| | - Marc H. Scheetz
- Midwestern University Chicago College of Pharmacy, Department of Pharmacy Practice, 555 31st St., Downers Grove, IL, 60515, USA.
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Bledsoe S, Little J, Wilkinson RS, Mick A. Using lean methodology to improve operational and clinical efficiency. Am J Health Syst Pharm 2013; 70:1476-7. [PMID: 23943175 DOI: 10.2146/ajhp120547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Romero Jiménez RM, Pernía López MS, Sánchez Fresneda MN, Sanjurjo Sáez M. [Validation of aseptic technique of parenteral nutrition compounding in a pharmacy service according to USP Chapter 797]. NUTR HOSP 2013; 28:1494-1497. [PMID: 24160206 DOI: 10.3305/nh.2013.28.5.6689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION During the process of parenteral nutrition preparation, aseptic techniques by nursing staff must be guaranteed. Chapter 797 of the United States Pharmacopeia classifies the risk levels of sterile compounding and defines the requirements that must be followed throughout the compounding. OBJECTIVE To describe the development of an aseptic technique validation procedure for nurses who compound parenteral nutrition at the compounding area Pharmacy Service according to Chapter 797 United States Pharmacopeia guidelines. MATERIAL AND METHODS Chapter 797 United States Pharmacopeia was reviewed and parenteral nutritions were classified as medium risk level compounded sterile preparations. RESULTS We adapted the United States Pharmacopeia guidelines for medium risk level compounded sterile preparations and we performed a procedure of aseptic technique validation for parenteral nutrition compounding. CONCLUSIONS The aseptic technique validation procedure allows the validation of aseptic management quality of nursing staff. The procedure has been incorporated into practice and is performed monthly by the nursing staff in the nutrition area.
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Kelly LS, Caulder CR, Bookstaver PB. Timely formulary management for preventing errors related to antiretroviral drugs. Am J Health Syst Pharm 2013; 70:1014-5. [PMID: 23719874 DOI: 10.2146/ajhp130078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Nascimento AD, Almeida RMVR, Castilho SRD, Infantosi AFC. [Multiple correspondence analysis in the evaluation of hospital pharmacy services in Brazil]. CAD SAUDE PUBLICA 2013; 29:1161-1172. [PMID: 23778548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 01/28/2013] [Indexed: 06/02/2023] Open
Abstract
This study aimed to evaluate associations among variables in hospital pharmacy services. Thirty variables were used from the project Diagnosis of Hospital Pharmacies in Brazil pertaining to the overall description of the hospital, overall characterization of the hospital pharmacy service, and stages in pharmaceutical care. The statistical techniques were multiple correspondence and cluster analysis. Dimension 1 of the multiple correspondence analysis explained 90.6% of variance, differentiating between hospital pharmacy services based on the presence of certain activities, thus suggesting an axis of characterization for the hospital pharmacy services. The results indicate a direct relationship between compliance with the activities and the type of hospital and pharmacists with specialized training. Cluster analysis identified six clusters related to hospital size; greater compliance with the activities was associated with large hospitals and those with a pharmacist (more time dedicated to the hospital pharmacy service and higher level of training). The study concludes that the techniques were able to identify associations and a concise range of variables for a comprehensive evaluation of hospital pharmacy services in Brazil.
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Affiliation(s)
- Aline do Nascimento
- Instituto Alberto Luiz Coimbra de Pós-graduação e Pesquisa de Engenharia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil.
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Barrueco N, Escobar Rodríguez I, García Díaz B, Gil Alegre ME, López Lunar E, Ventura Valares MG. [The stability of medicines en the clinical practice. From safety to efficiency]. Farm Hosp 2013; 37:175-177. [PMID: 23789794 DOI: 10.7399/fh.2013.37.3.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
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Nutescu EA, Wittkowsky AK, Burnett A, Merli GJ, Ansell JE, Garcia DA. Delivery of optimized inpatient anticoagulation therapy: consensus statement from the anticoagulation forum. Ann Pharmacother 2013; 47:714-24. [PMID: 23585642 PMCID: PMC3815430 DOI: 10.1345/aph.1r634] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To provide recommendations for optimized anticoagulant therapy in the inpatient setting and outline broad elements that need to be in place for effective management of anticoagulant therapy in hospitalized patients; the guidelines are designed to promote optimization of patient clinical outcomes while minimizing the risks for potential anticoagulation-related errors and adverse events. DATA SOURCES The medical literature was reviewed using MEDLINE (1946-January 2013), EMBASE (1980-January 2013), and PubMed (1947-January 2013) for topics and key words including, but not limited to, standards of practice, national guidelines, patient safety initiatives, and regulatory requirements pertaining to anticoagulant use in the inpatient setting. Non-English-language publications were excluded. Specific MeSH terms used include algorithms, anticoagulants/administration and dosage/adverse effects/therapeutic use, clinical protocols/standards, decision support systems, drug monitoring/methods, humans, inpatients, efficiency/ organizational, outcome and process assessment (health care), patient care team/organization and administration, program development/standards, quality improvement/organization and administration, thrombosis/ drug therapy, thrombosis/prevention and control, risk assessment/standards, patient safety/standards, and risk management/methods. STUDY SELECTION AND DATA EXTRACTION Because of this document's scope, the medical literature was searched using a variety of strategies. When possible, recommendations are supported by available evidence; however, because this paper deals with processes and systems of care, high-quality evidence (eg, controlled trials) is unavailable. In these cases, recommendations represent the consensus opinion of all authors and are endorsed by the Board of Directors of the Anticoagulation Forum, an organization dedicated to optimizing anticoagulation care. The board is composed of physicians, pharmacists, and nurses with demonstrated expertise and experience in the management of patients receiving anticoagulation therapy. DATA SYNTHESIS Recommendations for delivering optimized inpatient anticoagulation therapy were developed collaboratively by the authors and are summarized in 8 key areas: (1) process, (2) accountability, (3) integration, (4) standards of practice, (5) provider education and competency, (6) patient education, (7) care transitions, and (8) outcomes. Recommendations are intended to inform the development of coordinated care systems containing elements with demonstrated benefit in improvement of anticoagulation therapy outcomes. Recommendations for delivering optimized inpatient anticoagulation therapy are intended to apply to all clinicians involved in the care of hospitalized patients receiving anticoagulation therapy. CONCLUSIONS Anticoagulants are high-risk medications associated with a significant rate of medication errors among hospitalized patients. Several national organizations have introduced initiatives to reduce the likelihood of patient harm associated with the use of anticoagulants. Health care organizations are under increasing pressure to develop systems to ensure the safe and effective use of anticoagulants in the inpatient setting. This document provides consensus guidelines for anticoagulant therapy in the inpatient setting and serves as a companion document to prior guidelines relevant for outpatients.
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Affiliation(s)
- Edith A Nutescu
- Department of Pharmacy Practice, Center for Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.
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Kirwin JL, DiVall MV, Guerra C, Brown T. A simulated hospital pharmacy module using an electronic medical record in a pharmaceutical care skills laboratory course. Am J Pharm Educ 2013; 77:62. [PMID: 23610480 PMCID: PMC3631737 DOI: 10.5688/ajpe77362] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 10/29/2012] [Indexed: 05/21/2023]
Abstract
OBJECTIVES. To implement and evaluate the effects of a simulated hospital pharmacy module using an electronic medical record on student confidence and abilities to perform hospital pharmacist duties. DESIGN. A module was developed that simulated typical hospital pharmacist tasks. Learning activities were modified based upon student feedback and instructor assessment. ASSESSMENTS. Ninety-seven percent of respondents reported full-time hospital internship experience and 72% had electronic medical record experience prior to completing the module. Mean scores on confidence with performing typical hospital pharmacist tasks significantly increased from the pre-module survey to the post-module survey from 1.5-2.9 (low comfort/confidence) to 2.0-3.4 (moderate comfort/confidence). Course assessments confirmed student achievement of covered competencies. CONCLUSIONS. A simulated hospital pharmacy module improved pharmacy students' hospital practice skills and their perceived comfort and confidence in completing the typical duties of a hospital pharmacist.
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Bogomolova NS. [Chemotherapeutical department: surgical infection prevention and treatment in ICU]. Anesteziol Reanimatol 2013:66-73. [PMID: 24000656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The article discusses the issues of chemotherapeutical department organization and functioning in multidisciplinary surgical hospital. In connection with a worldwide spread of antibiotic-resistant agents of surgical infections, it becomes necessary to unite efforts of surgeons, resuscitation specialists, clinical pharmacologists - chemiotherapeutists and microbiologists. The main approaches in solving of surgical infection problems are: in-hospital epidemiological situation monitoring, the study ofmicroflora resistance to antibiotics used in the surgical and resuscitation practice, the study of antibacterial therapy clinical-pharmacological aspects (pharmacokinetics, pharmacodynamics, tolerance and efficacy of antimicrobial drugs). The development of pre-emptive antibiotics rotation principles curbs the spread ofnosocomial infections pathogens resistant strains. The 40-year experience of surgical infections prevention and treatment laboratory functioning professes this.
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Abstract
Objective. To determine if defined subgroups of pharmacists' have variability in their expectations for competency of entry-level practitioners.Methods. Rating scale data collected from the 2009 National Pharmacy Practice Survey were analyzed to determine to what extent pharmacists' degree, practice setting, and experience as a preceptor were associated with the ratings they assigned to 43 competency statements for entry-level practitioners. The competency statements determine the content on the North American Pharmacist Licensure Examination (NAPLEX).Results. Pharmacists with a doctor of pharmacy (PharmD) degree rated the co mpetency statements higher in terms of criticality to entry-level practice than did those with a bachelor of science (BS) degree (p< 0.05). Pharmacists working in inpatient settings gave slightly higher ratings to the competency statements than did pharmacists working in outpatient settings, pharmacists without direct patient care responsibilities, and those in academia. However, there were no significant differences among practitioner subgroups' criticality ratings with regard to practice setting. Preceptor pharmacists' criticality ratings of the competency statements were not significantly different from those of non-preceptor practitioners. Conclusion. Pharmacists exhibited a fair amount of agreement in their expectations for the competence of entry-level practitioners independent of their practice sites and professional roles. As the pharmacy profession embraces patient-centered clinical practice, evaluating practicing pharmacists' expectations for entry-level practitioners will provide useful information to the practitioners and academicians involved in training future pharmacists. Stakeholders in pharmacy education and regulation have vested interests in the alignment of the education of future practitioners with the needs of the profession.
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Affiliation(s)
- Maria Boyle
- National Association of Boards of Pharmacy, Mount Prospect, IL 60056, USA.
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Lee J. Investors buying compounders. Drug shortages are persisting, leading to the deals. Mod Healthc 2013; 43:12-13. [PMID: 23487975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Afolabi MO, Afolabi ERI, Faleye BA. Construct validation of an instrument to measure patient satisfaction with pharmacy services in Nigerian hospitals. Afr Health Sci 2012; 12:538-44. [PMID: 23513077 DOI: 10.4314/ahs.v12i4.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patient satisfaction is a multidimensional construct that reflects the type and quality of service provided by healthcare providers, how well it is delivered, and the extent to which the expectations and needs of patients are met. As a performance measure, patient satisfaction has been defined as the personal evaluation of health care services and providers. OBJECTIVE To develop a patient satisfaction scale, that could be used to assess the quality of pharmacy services provided in Nigerian hospitals and to determine the construct validity of the scale with a view to identifying the factors that may be considered relevant to the target users. METHODS The questionnaire was a 35-item inventory titled "Patient Satisfaction Survey (PSS)". This study was carried out in three university teaching hospitals located in Southwestern Nigeria. The patient satisfaction survey instrument (PSS) was administered on 506 clinic outpatients who patronised the hospital pharmacies. Participation in the study was voluntary with appropriate informed consent. Ethical approval was obtained for this study from the Medical and Ethics Committee of Obafemi Awolowo University Teaching Hospital Complex (OAUTHC). RESULTS Patients with post secondary education were in the majority with a frequency of 224 (44.3%) subjects. This was followed by a frequency of 116 (22.9%) for those with secondary education. Eighty-seven (17.2%) of those included in the main study had primary education 64 (12.7%) did not receive any formal education. Fifteen (3%) out of the 506 sampled did not indicate their level of education. CONCLUSION This study developed a scale to measure patient satisfaction with pharmaceutical services in selected Nigerian university teaching hospitals. The final 25 item scale presents significant and stable coefficients of correlation and yielded six derived dimensions of patient satisfaction.
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Affiliation(s)
- M O Afolabi
- Department of Clinical Pharmacy & Pharmacy Administration Unit, Obafemi Awolowo University, IIe Ife, Nigeria.
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