Antidiabetics' usage in type 2 diabetes mellitus: Are prescribing guidelines adhered to? A single centre study

AIM

The primary aim of this study was to examine the prescribing patterns of antidiabetic agents (AA) in this hospital according to current prescribing contraindications (PCI). The secondary aims are to assess factors affecting the prescribing of AA and to evaluate the pharmacist impact on their prescribing.

METHOD

A retrospective cross sectional study was performed to review all prescribed AA over a 3 month period. Data extracted from medical records included: patients' demographics, management and pharmacists' interventions. Appropriateness of prescribing was determined according to the AA prescribing information of the Medical Index of Medical Specialities (MIMS).

RESULTS

A total of 314 AA were examined, of which 74(23%) orders were prescribed despite contraindications. Metformin was the AA to have the most PCI in dosage adjustments in renal impairment (RI). Logistic regression analysis showed patients with severe RI were less likely to be prescribed metformin (OR = 0.115 95%CI(0.048-0.274) P < 0.01), instead insulin was preferred (OR = 2.210 95%CI (1.028-4.751) P < 0.05). Insulin was also more likely to be prescribed in patients with hypertension and hyperglycaemia (OR=2.005 95%CI(1.005-4.001) P < 0.05, OR = 3.535 95%CI(1.756-7.113) P < 0.01) respectively. Sulphonylureas were less likely to be prescribed in patients with cardiovascular disease (OR = 0.339 95%CI(0.163-0.708), P < 0.01. There was low PCI in the other AA. Pharmacists reviewed 89% of AA. PCI was lower in this group compared to those with no pharmacist input (23% vs 28%).

CONCLUSION

The audit showed good adherence to PCI. Pharmacist involvement has a positive impact on AP. Prescriber education is required in relation to dosage adjustments of AA in RI.

Pharmacy quality improvement project to enhance the medication management process in pediatric patients

BACKGROUND

Improvement in the quality of the medication management process is a crucial component of twenty-first-century medicine.

AIM

To improve the quality of medication management process within pediatric specialty through designing a quality improvement project for the pharmaceutical care services in a children' hospital to solve the drug-related problems during drug prescribing, administration, and monitoring.

METHODS

A total of 900 medical files were evaluated (100 file/month) from the pediatric medical ward to detect any medication errors during prescribing, administration, or monitoring of the drugs. Three pharmacy quality indicators were designed to detect any medication errors during prescribing, administration, or monitoring of the drugs, then a collective datasheet was designed to record any defect in the system during drug management process within the hospital. A quality improvement project was designed using many quality improvement techniques to decrease the rates of medication errors in each drug handling stage. Brainstorming, fishbone chart, questionnaire, and voting were the main quality tools used to detect the causes of medication errors problem in pediatric patients. Certain actions were implemented which included educational program, implementation of clinical pharmacy, intravenous admixture, and drug information services.

RESULTS

The quality improvement interventions succeeded in decreasing the rates of medication errors in each stage. These interventions succeeded in decreasing the rates of medication errors in prescribing, administration, and monitoring stages from 47, 60, and 56% respectively to ≤ 15% within 9 months.

CONCLUSION

Pharmacists can have a key role in improving the health-care system's quality in developing countries' health-care systems.

Pharmacist interventions during patient rounds in two intensive care units: Clinical and financial impact

INTRODUCTION

The risk of prescribing errors and related adverse drug events (ADE) on the intensive care unit (ICU) is high. Based on studies carried out in North America or the UK, a clinical pharmacy service can reduce ADEs and lower overall costs. This study looks into the clinical and financial impact of interventions made by pharmacists during patient rounds in two ICU settings in the Netherlands.

MATERIALS AND METHODS

A quality improvement study was performed in a general teaching hospital (GTH) and a university hospital (UH) in the Netherlands. The improvement consisted of a review of medication orders and participation in patient rounds by an ICU-trained pharmacist. The main outcome measure was the proportion of accepted pharmacist interventions. Secondary outcome measures were the clinical relevance of the accepted interventions, the proportion of prevented potential ADEs (pADE) and a cost-benefit ratio.

RESULTS

In the GTH 160 patients and in the UH 174 patients were included. A total of 332 and 280 interventions were analysed. Acceptance of the interventions was 67.3% in the GTH and 61.8% in the UH. The accepted interventions were mostly scored as clinically relevant, resulting in 0.16 and 0.11 prevented pADEs per patient. The cost benefit was €119 (GTH) and €136 (UH) per accepted intervention.

CONCLUSION

This clinical pharmacy service in two ICUs resulted in high numbers of accepted and clinically relevant interventions. Our model appeared to be cost-effective in both ICU settings.

Modelling interactions between procedures and resilience skills

Although work in complex socio-technical systems needs support from several "resources for action", the interactions between these are not usually managed systematically. This study introduces a six-step framework for analyzing the interactions between two key resources for action, namely the use of standardized operating procedures and resilience skills (RSs). The main steps for applying the framework involve: (i) a content analysis of the procedure, which allows for the identification of underspecified rules and situations that could be emphasized in scenario-based training focused on developing RSs; and (ii) the identification of factors that set the stage for the emergence of RSs, which could be accounted for by procedures and the broader work system design. An application of the framework is presented in the preparation and administration of intravenous medications in an emergency department. Data collection involved 98 h of observations, 14 interviews, and document analysis. Based on this field study, a model of the interactions between procedures and RSs is proposed as well as the lessons learned from applying the framework are discussed.

Treatment of tobacco dependence in UK hospitals: an observational study

Over a million smokers are admitted to hospitals in the UK each year. The extent to which tobacco dependence is identified and addressed in this population is unclear. Data on 14,750 patients from 146 hospitals collected for the British Thoracic Society smoking cessation audit were analysed to determine smoking prevalence, attempts to ask smokers about quitting, and referrals to smoking cessation services. Associations with hospital organisational factors were assessed by logistic regression. Overall hospital smoking prevalence was 25%. Only 28% of smokers were asked whether they would like to quit, and only one in 13 smokers was referred for treatment of tobacco dependence. There was a higher chance of smokers being asked about quitting in organisations with smoke-free sites, dedicated smoking cessation practitioners, regular staff training, and availability of advanced pharmacotherapy. Treatment of tobacco dependence in smokers attending UK hospitals is poor and could be associated with organisational factors.

[Reduction of inappropriate prescriptions and adverse effects to medications in hospitalized elderly patients]

Together, potentially inappropriate prescribing of medications (PIP) and appropriate prescribing omission (APO) constitute a problem that requires multiple interventions to reduce its size and the occurrence of adverse drug events (ADE). This study aims to assess PIP, APO, ADE before and after the intervention of a clinical pharmacist over medical prescriptions for elderly hospitalized patients. In a before-after study, a total of 16 542 prescriptions for 1262 patients were analyzed applying the criteria defined in both STOPP- START (screening tool of older people's prescriptions and screening tool to alert to right treatment). The intervention consisted in lectures and publications on STOPP-START criteria made available to all the areas of the hospital and suggestions made by the clinical pharmacist to the physician on each individual prescription. Before intervention, PIM was 48.9% on admission and 46.1% at discharge, while after the intervention it was 47.4% on admission and 16.7% at discharge. APO was 10% on admission and 7.6% at discharge, while after intervention it was 12.2% on admission and 7.9% at discharge. ADE were 50.9% before and 34.4% after intervention. The frequency of return to emergency was 12.2% and 4.7% before and after intervention. PIM, EAM, conciliation error, clinically serious drug interaction, and delirium were reduced to statistically significant levels. In line with various international studies, the intervention showed to attain positive results.

Advances in clinical pharmacy education in Germany: a quasi-experimental single-blinded study to evaluate a patient-centred clinical pharmacy course in psychiatry

BACKGROUND

The pharmacy profession has shifted towards patient-centred care. To meet the new challenges it is necessary to provide students with clinical competencies. A quasi-experimental single-blinded teaching and learning study was carried out using a parallel-group design to evaluate systematically the benefits of clinical teaching in pharmacy education in Germany.

METHODS

A clinical pharmacy course on a psychiatric ward was developed and implemented for small student groups. The learning aims included: the improvement of patient and interdisciplinary communication skills and the identification and management of pharmaceutical care issues. The control group participated only in the preparation lecture, while the intervention group took part in the complete course. The effects were assessed by an objective structured clinical examination (OSCE) and a student satisfaction survey.

RESULTS

The intervention group achieved significantly better overall results on the OSCE assessment (46.20 ± 10.01 vs. 26.58 ± 12.91 of a maximum of 90 points; p < 0.0001).The practical tasks had the greatest effect, as reflected in the outcomes of tasks 1-5 (34.94 ± 9.60 vs. 18.63 ± 10.24 of a maximum of 60 points; p < 0.0001). Students' performance on the theoretical tasks (tasks 6-10) was improved but unsatisfying in both groups considering the maximum score (11.50 ± 4.75 vs. 7.50 ± 4.00 of a maximum of 30 points; p < 0.0001). Of the students, 93% rated the course as practice-orientated, and 90% felt better prepared for patient contact. Many students suggested a permanent implementation and an extension of the course.

CONCLUSIONS

The results suggest that the developed ward-based course provided learning benefits for clinical skills. Students' perception of the course was positive. Implementation into the regular clinical pharmacy curriculum is therefore advisable.

Auditing Safety of Compounding and Reconstituting of Intravenous Medicines on Hospital Wards in Finland

On the hospital wards in Finland, nurses generally reconstitute intravenous medicines, such as antibiotics, analgesics, and antiemetics prescribed by doctors. Medicine reconstitution is prone to many errors. Therefore, it is important to identify incorrect practices in the reconstitution of medicine to improve patient safety in hospitals. The aim of this study was to audit the compounding and reconstituting of intravenous medicines on hospital wards in a secondary-care hospital in Finland by using an assessment tool and microbiological testing for identifying issues posing patient safety risks. A hospital pharmacist conducted an external audit by using a validated 65-item assessment tool for safe-medicine compounding practices on 20 wards of the selected hospital. Also, three different microbiological samples were collected to assure the aseptics. Practices were evaluated using a four-point rating scale of "never performed," "rarely performed," "often performed," and "always performed," and were based on observation and interviews with nurses or ward pharmacists. In addition, glove-, settle plate-, and media fill-tests were collected. Associations between microbial sample results and audit-tool results were discussed. Altogether, only six out of the 65 items were fully implemented in all wards; these were related to logistic practices and quality assurance. More than half of the wards used incorrect practices ("rarely performed" or "never performed") for five items. Most of these obviated practices related to aseptic practices. All media-fill tests were clean but the number of colony forming units in glove samples and settle- plate samples varied from 0 to >100. More contamination was found in wards where environmental conditions were inadequate or the use of gloves was incorrect. Compounding practices were [mostly] quite well adapted, but the aseptic practices needed improvement. Attention should have been directed particularly to good aseptic techniques and compounding environment on the wards. These results can be used for updating the guidelines and for training nurses involved in compounding.

Exploring the challenges for clinical pharmacists in Sudan

Background Clinical pharmacy practice in hospitals is a new role for pharmacists in Sudan. Pharmacists have to face the challenge of moving from their traditional roles within the pharmacy premises to new roles on the wards with direct contact with patients and other healthcare professionals. Objectives To explore the role and challenges facing the clinical pharmacists of Sudan. Settings Two of the main government hospitals in Sudan and an online survey. Method This study applied a two phase mixed method, a focus group discussion and a survey. A FGD was conducted with the clinical pharmacists in two of the main government hospitals in Sudan. This was followed by an on-line survey among the clinical pharmacists of Sudan. Main outcome measure The role of the clinical pharmacists of Sudan and the challenges facing clinical pharmacy practice. Results Four pharmacists participated in the focus group and 51 out of 140 pharmacists (34%) completed the on-line survey. The roles that were perceived by the majority of pharmacists as part of their duties in hospitals in Sudan were identifying drug-related problems (100%, n = 51), providing drug-related information to healthcare professionals by (96%, n = 47), and educating patients about their medicines (96%, n = 48). The pharmacists identified a number of obstacles that hindered their progress in practice. These obstacles were related to the pharmacists themselves, the lack of senior clinical pharmacists for leadership, the environment they were working in and the training they had received in clinical pharmacy. Conclusion The new clinical pharmacists in Sudan faced several challenges that need to be overcome in order to move forward in their clinical practice. To do so they will require support from pharmacy educational institutions, other healthcare professionals and the healthcare institutions they are working within.

Quality indicators for technologies applied to the hospital pharmacy

The TECNO group of the Sociedad Española de Farmacia Hospitalaria (Spanish Society of Hospital Pharmacy) has addressed the definition of a catalogue of indicators for performance, quality and safety in the use of technologies applied to the logistic activity of Hospital Pharmacy Units.The project was developed with a methodology of qualitative techniques by consensus, with the members of the TECNO Group participating as experts. Once indicators had been defined, a validation phase was conducted, and standards were established based on the result of the sampling carried out in the hospitals of the group members.A total of 28 indicators were obtained, with their corresponding quality standards applied to the use of technologies in the processed for medication storage, dispensing and preparation.The definition of quality indicators and their standards for measuring technologies in the use of medication represents a step forward in the improvement of their safety.

Association of Inpatient Antimicrobial Utilization Measures with Antimicrobial Stewardship Activities and Facility Characteristics of Veterans Affairs Medical Centers

BACKGROUND

Antimicrobial stewardship programs (ASPs) have been advocated to improve antimicrobial utilization, but program implementation is variable. Antimicrobial stewardship programs (ASPs) have been advocated to improve antimicrobial utilization, but program implementation is variable.

OBJECTIVE

To determine associations between ASPs and facility characteristics, and inpatient antimicrobial utilization measures in the Veterans Affairs (VA) system in 2012.

DESIGN

In 2012, VA administered a survey on antimicrobial stewardship practices to designated ASP contacts at VA acute care hospitals. From the survey, we identified 34 variables across 3 domains (evidence, organizational context, and facilitation) that were assessed using multivariable least absolute shrinkage and selection operator regression against 4 antimicrobial utilization measures from 2012: aggregate acute care antimicrobial use, antimicrobial use in patients with non-infectious primary discharge diagnoses, missed opportunities to convert from parenteral to oral antimicrobial therapy, and double anaerobic coverage.

SETTING

All 130 VA facilities with acute care services.

RESULTS

Variables associated with at least 3 favorable changes in antimicrobial utilization included presence of postgraduate physician/pharmacy training programs, number of antimicrobial-specific order sets, frequency of systematic de-escalation review, presence of pharmacists and/or infectious diseases (ID) attendings on acute care ward teams, and formal ID training of the lead ASP pharmacist. Variables associated with 2 unfavorable measures included bed size, the level of engagement with VA Antimicrobial Stewardship Task Force online resources, and utilization of antimicrobial stop orders.

CONCLUSIONS

Formalization of ASP processes and presence of pharmacy and ID expertise are associated with favorable utilization. Systematic de-escalation review and order set establishment may be high-yield interventions. Journal of Hospital Medicine 2017;12:301-309.

A Time and Motion Study of Pharmacists and Pharmacy Technicians Obtaining Admission Medication Histories

Pharmacists' admission medication histories (AMHs) are known to reduce adverse drug events (ADEs). Pharmacist-supervised pharmacy technicians (PSPTs) have also been used in this role. Nonetheless, few studies estimate the costs of utilizing PSPTs to obtain AMHs. We used time and motion methodology to study the time and cost required for pharmacists and PSPTs to obtain AMHs for patients at high risk for ADEs. Pharmacists and PSPTs required 58.5 (95% confidence interval [CI], 46.9-70.1) and 79.4 (95% CI, 59.1-99.8) minutes per patient, respectively (P = 0.14). PSPT-obtained AMHs also required 26.0 (95% CI, 14.9-37.1) minutes of pharmacist supervision per patient. Based on 2015 US Bureau of Labor Statistics wage data, we estimated the cost of having pharmacists and PSPTs obtain AMHs to be $55.91 (95% CI, 44.9-67.0) and $45.00 (95% CI, 29.7-60.4), respectively, which included pharmacist supervisory cost, per patient (P = 0.32). Thus, we found no statistically significant difference in time or cost between the two provider types. Journal of Hospital Medicine 2017;12:180-183.

Transition of care: A set of pharmaceutical interventions improves hospital discharge prescriptions from an internal medicine ward

BACKGROUND

Continuity of care between hospitals and community pharmacies needs to be improved to ensure medication safety. This study aimed to evaluate whether a set of pharmaceutical interventions to prepare hospital discharge facilitates the transition of care.

METHODS

This study took place in the internal medicine ward and in surrounding community pharmacies. The intervention group's patients underwent a set of pharmaceutical interventions during their hospital stay: medication reconciliation at admission, medication review, and discharge planning. The two groups were compared with regards to: number of community pharmacist interventions, time spent on discharge prescriptions, and number of treatment changes.

RESULTS

Comparison between the groups showed a much lower (77% lower) number of community pharmacist interventions per discharge prescription in the intervention (n=54 patients) compared to the control group (n=64 patients): 6.9 versus 1.6 interventions, respectively (p<0.0001); less time working on discharge prescriptions; less interventions requiring a telephone call to a hospital physician. The number of medication changes at different steps was also significantly lower in the intervention group: 40% fewer (p<0.0001) changes between hospital admission and discharge, 66% fewer (p<0.0001) between hospital discharge and community pharmacy care, and 25% fewer (p=0.002) between community pharmacy care and care by a general practitioner.

CONCLUSION

An intervention group underwent significantly fewer medication changes in subsequent steps in the transition of care after a set of interventions performed during their hospital stay. Community pharmacists had to perform fewer interventions on discharge prescriptions. Altogether, this improves continuity of care.

Patients with diabetes are at high risk of serious medication errors at hospital: Interest of clinical pharmacist intervention to improve healthcare

BACKGROUND

Medication errors (ME) are major public health issues in hospitals because of their consequences on patients' morbi-mortality. This study aims to evaluate the prevalence of ME at admission and discharge of hospitalization in diabetic and non-diabetic patients, and determine their potential clinical impact.

METHOD

This prospective observational study was conducted at the Endocrinology-Diabetology-Nutrition Department. All adult patients admitted were eligible. A total of 904 patients were included, of which 671 (74.2%) with diabetes mellitus. Clinical pharmacists conducted medication reconciliation: they collected the Best Possible Medication History and then compared it with admission and discharge prescriptions to identify medication discrepancies. ME were defined as unintended medication discrepancies if corrected by the physician.

RESULTS

Clinical pharmacists allowed correcting ME in 176/904 (19.5%) patients at admission and in 86/865 (9.9%) patients at discharge. More than half of ME were omissions. Diabetic patients were more affected by ME than non-diabetic patients, both at admission (22.1% vs 12.0%, p<0.001) and at discharge (11.4% vs 5.7%, p=0.01). The diabetic group also had more potentially severe and very severe ME. Diabetic patients had on average twice more medications than non-diabetic patients (8.7±4.5 vs 4.4±3.4, p<0.001). The polypharmacy associated with diabetes, but not diabetes mellitus itself, was identified as a risk factor of ME.

CONCLUSIONS

The intervention of clinical pharmacists allowed correcting 378 ME in 25.8% of the cohort before they caused harm. Clinicians, pharmacists and other health care providers should therefore work together to improve patients' safety, in particular in high-risk patients such as diabetic patients.

Implementation of Ward-Based Clinical Pharmacy Services in Belgium—Description of the Impact on a Geriatric Unit

Background:

Patient-centered clinical pharmacy services are still poorly developed in Europe, despite their demonstrated advantages in North America and the UK. Reporting European pilot experiences is, therefore, important to assess the usefulness of clinical pharmacy services in this specific context.

Objective:

To report the results of the first implementation of Belgian clinical pharmacy services targeting patients at high risk of drug-related problems.

Methods:

An intervention study was conducted by a trained clinical pharmacist providing pharmaceutical care to 101 patients (mean age 82.2 y; mean ± SD number of prescribed drugs 7.8 ± 3.5) admitted to an acute geriatric unit, over a 7 month period. All interventions to optimize prescribing, and their acceptance, were recorded. An external panel (2 geriatricians, 1 clinical pharmacist) assessed the interventions' clinical significance. Persistence of interventions after discharge was assessed through telephone calls.

Results:

A total of 1066 interventions were made over the 7 month period. The most frequent drug-related problems underlying interventions were: underuse (15.9%), wrong dose (11.9%), inappropriate duration of therapy (9.7%), and inappropriate choice of medicine (9.6%). The most prevalent consequences were to discontinue a drug (24.5%), add a drug (18.6%), and change dosage (13.7%). Acceptance rate by physicians was 87.8%. Among interventions with clinical impact, 68.3% and 28.6% had moderate and major clinical significance, respectively. Persistence of chronic treatment changes 3 months after discharge was 84%.

Conclusions:

Involving a trained clinical pharmacist in a geriatric team led to clinically relevant and well-accepted optimization of medicine use. This initiative may be a springboard for further development of clinical pharmacy services.

Medication reconciliation as a medication safety initiative in Ethiopia: a study protocol

INTRODUCTION

Medication related adverse events are common, particularly during transitions of care, and have a significant impact on patient outcomes and healthcare costs. Medication reconciliation (MedRec) is an important initiative to achieve the Quality Use of Medicines, and has been adopted as a standard practice in many developed countries. However, the impact of this strategy is rarely described in Ethiopia. The aims of this study are to explore patient safety culture, and to develop, implement and evaluate a theory informed MedRec intervention, with the aim of minimising the incidence of medication errors during hospital admission.

METHODS AND ANALYSES

The study will be conducted in a resource limited setting. There are three phases to this project. The first phase is a mixed methods study of healthcare professionals' perspectives of patient safety culture and patients' experiences of medication related adverse events. In this phase, the Hospital Survey on Patient Safety Culture will be used along with semi-structured indepth interviews to investigate patient safety culture and experiences of medication related adverse events. The second phase will use a semi-structured interview guide, designed according to the 12 domains of the Theoretical Domains Framework, to explore the barriers and facilitators to medication safety activities delivered by hospital pharmacists. The third phase will be a single centre, before and after study, that will evaluate the impact of pharmacist conducted admission MedRec in an emergency department (ED). The main outcome measure is the incidence and potential clinical severity of medication errors. We will then analyse the differences in the incidence and severity of medication errors before and after initiation of an ED pharmacy service.

Participation of a coordinating center pharmacy in a multicenter international study

PURPOSE

The activities of a coordinating center pharmacy (CCP) supporting a multicenter, international clinical trial are described.

SUMMARY

Serving in a research support role comparable to that of a commercial clinical trial supply company, a CCP within the Johns Hopkins Hospital Investigational Drug Service (JHH IDS) uses its management expertise and infrastructure to support multicenter trials, such as the recently completed Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage, Phase III (CLEAR III) trial. The role of the CCP staff in supporting the CLEAR III trial was overall investigational product (IP) management through coordination of IP-related operations to ensure high-quality care for study participants at study sites in the United States and abroad. For the CLEAR III trial, the CCP coordinated IP supply activities; provided education to site pharmacists; developed study-specific documents, including pharmacy manuals; communicated with trial stakeholders, including third-party IP distributors; monitored treatment assignments; and performed quality assurance monitoring to ensure compliance with institutional, state, federal, and international regulations regarding IP procurement and storage. Acting as a CCP for a multicenter international study poses a number of operational challenges while providing opportunities for the CCP to contribute to research of global importance and enrich the skill sets of its personnel.

CONCLUSION

The development and implementation of the CCP at JHH IDS for the CLEAR III trial included several responsibilities, such as IP supply management, communication, and database, regulatory, and finance management.

Development and content validation of an assessment tool for medicine compounding on hospital wards

Background Medicines should be compounded by using an aseptic technique to assure patient safety. The parenteral administration of microbiologically contaminated doses can result in bacteriaemia, other morbidity and even death. Objective The purpose was to develop and content validate an assessment tool for medicine compounding on hospital wards suitable for self-assessment and external audit to ensure the safety of medicine compounding on wards. Setting Finland as setting. Method The first draft of the tool was based on ISMP "Guidelines for safe preparation of sterile compounds" and a systematic literature search. The tool was validated by using a two-rounded Delphi-method with a panel of 19 experts. Suitability and feasibility of each item was evaluated. Main outcome measure An agreement of ≥70% on each item was required. Results The final tool comprises of 64 items under the following topics: (1) general principles of good compounding practices (23 items), (2) recording and confirming medicine orders on the wards (5 items), (3) storage of medicines on the wards (7), (4) aseptic compounding of intravenous medicines (25 items) and (5) quality assurance (4 items). Most items related to General principles of good compounding practices and Compounding of IV medicines (36 and 38% of the items, respectively). Conclusion It was possible to develop and content validate, by the Delphi method, an assessment tool for safe aseptic compounding on hospital wards. A two-round Delphi process yielded consensus on 64 items for this purpose.

The Development of the Croatian Competency Framework for Pharmacists

Objective. To adjust and validate the Global Competency Framework (GbCF) to be relevant for Croatian community and hospital pharmacists. Methods. A descriptive study was conducted in three steps: translation, consensus development, and validation by an expert panel and public consultation. Panel members were representatives from community pharmacies, hospital pharmacies, regulatory and professional bodies, academia, and industry. Results. The adapted framework consists of 96 behavioral statements organized in four clusters: Pharmaceutical Public Health, Pharmaceutical Care, Organization and Management, and Personal and Professional Competencies. When mapped against the 100 statements listed in the GbCF, 27 matched, 39 were revised, 30 were introduced, and 24 were excluded from the original framework. Conclusions. The adaptation and validation proved that GbCF is adaptable to local needs, the Croatian Competency Framework that emerged from it being an example. Key amendments were made within Organization and Management and Pharmaceutical Care clusters, demonstrating that these issues can be country specific.

A call for a statewide medication reconciliation program

In the outpatient setting, it is exceedingly difficult to know what medications our patients have been prescribed and are taking. Each encounter with a specialist, hospital, or pharmacy can generate a change to a patient's list of medications, and in most systems, this information is not communicated back to the primary care practice's electronic health record-the exception being opiate prescriptions. Prescription drug monitoring programs in 48 states list every opiate prescription, the name of the prescriber, and the date and location the prescription was picked up. We propose that policy makers act to expand these programs to all medications, thus improving the likelihood that any provider prescribing a new medication would know what medicines their patient is already taking.

Use of Six Sigma to Improve Pharmacist Dispensing Errors at an Outpatient Clinic

Hospital pharmacists have been challenged to face the paradigm shift in their model of services in the 21st century in Taiwan. Patients are increasingly concerned about drug safety and medication errors. Because of the financial crisis of our national insurance bureau, pharmacists are required to care for more patients, use fewer resources, and work faster, better, and more efficiently than ever before while striving to enhance customer satisfaction and quality of care. Under these circumstances, patient safety needs to be a priority of pharmacists. According to a preliminary report on medication error announced by the nonofficial medication error reporting system, pharmacist dispensing error ranked second in the list of errors in Taiwan. In our drive to improve quality, reduce costs, and enhance financial performance, our department has tried the traditional quality-improvement strategy with varying degrees of success. We wanted to achieve a breakthrough result, hence we implemented Six-Sigma methodology. This program is the catalyst needed to combine quality, cost, and patient safety. This article describes our experience using Six-Sigma methodology to reduce dispensing error in our pharmacy department.