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Medicine pickup lockers offer patients a new way to pick up medicine prescribed at outpatient clinics

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European Statement

Selection, Procurement and Distribution

Author(s)

Line Jarvig, Louise Konradsen Refsgaard

Why was it done?

The medicine pickup lockers were implemented to offer patients in the outpatient clinics a more flexible and accessible way to receive their medication e.g., 24-hour access close to home.

What was done?

Patients who are receiving medicine free of charge from outpatient clinics traditionally pick up the medication by face-to-face contact with the nurses in the clinic every third month. Patients, who are in remission and already well-informed about their medication are offered to receive their medication in one of seven medicine pickup lockers in the capital region of Denmark. To ensure adherence, safety and optimal outcome of treatment, the healthcare professionals carefully pick out the patients, who are suited for this method. Regular contact between the healthcare professional and the patient is also continued, primarily by using digital contacts through the EPJ-system and by telephone.

How was it done?

The implementation of this new direct-to-patient distribution method was carried out by the Capital Region Hospital Pharmacy in close collaboration with the region’s hospitals and outpatient departments. The implementation requires that the clinical staff rethink their practice and accept that dispensing is no longer their responsibility. Dispensing and distribution of the medication is now handled by pharmacy staff at the hospital pharmacy’s warehouse. From here the medication is transported to the requested location and the patient will receive a text message when the medicine is ready for pickup in the medicine pickup locker.

What has been achieved?

Patients find medicine pickup lockers accessible, safe, and easy to use. Importantly, the quality of medicine dispensing is increased due to hospital pharmacy staff dispensing the medicine rather than nurses. Changing the workflow so that nurses do not dispense medicine also alleviates the shortage of nurses. In addition, this method is without doubt environmentally optimal compared to the traditionally pick up method, since transportation of both patients and the medicine is decreased.

What next?

Next step will be to offer prescription pickups at private pharmacies, which can ensure that patients can pick up their medicine at several different locations around the region and make it possible for the patients to communicate any concerns to a healthcare provider.

IMPLEMENTATION OF A NEW MODEL OF MEDICATION DELIVERY AND CLINICAL PHARMACY FOLLOW-UP IN A TERTIARY HOSPITAL

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European Statement

Clinical Pharmacy Services

Why was it done?

Due to the COVID-19 lockdown, many patients could not attend to hospital pharmacy for medication supply. To ensure treatment effectiveness, tolerance and therapeutic adherence, we developed this new model of medication dispensing as well as additional routes of patient follow-up, such as the use of mobile Health (mHealth).

What was done?

In 2024/03 we started to approach hospital medication (mainly onco-haematology oral treatments, subcutaneous monoclonal antibodies and clotting factors) to the patient’s home. We developed an alternative model of medication supply through the collaboration with community pharmacies (CPs) and a logistics partner.

How was it done?

The collaboration with CPs was coordinated by the Barcelona College of Pharmacists, who developed a new digital platform to manage and track delivery orders. A pharmaceutical wholesaler delivered these medications to CPs in 48–72 hours. In case of requiring a faster dispensation, we used a logistics operator which guaranteed a delivery time to the patient’s home of 24 hours.
Considering that our hospital pharmacy attends more than 8,000 patients, we prioritised this service to those with a complex socio-functional situation or who lived far from the hospital.
Pharmacy technicians were the key managers in this process. Through a telephone interview, they detected possible medication related problems (adverse effects, administration errors, inadequate dose/route of administration/duration of therapy and lack of treatment adherence). They also checked for in-person medical appointments that could justify dispensing direct to the patient. If any incident was detected, the technician referred the case to the pharmacist for further assessment and resolution.
Additionally, for some health conditions (heart transplant, colorectal and breast cancer, haematopoietic stem cell transplant, chronic migraine or HIV infection), we developed a mHealth programme in which patients were empowered by using a smartphone and tablet app to promote self-care management and contact with their healthcare professionals.

What has been achieved?

In 2020, 4,793 shipments were made to 1,814 patients. This meant 12.4% of the total hospital pharmacy dispensations (N=38,527). Of these shipments, 61.0% went to CPs and 39.0% to patients at home. In 2021, there were 4,171 shipments to 1,248 patients, 90.0% of which were sent to CF, which implies a decrease of the shipments of 12.9% compared to the previous year.
In our setting, mean time of virtual dispensing was 10 minutes versus 3 minutes of in-person dispensing. This additional time was due to the preparation of drug shipments and tracked delivery orders. The assessment of this model was positive for both patients and pharmacy staff. However, it was not exempt from some incidents, such as delivery delays or errors in package identification.
As for telepharmacy follow-up, 257 patients are using mHealth applications. In 2021, they performed 4,387 consultations with the pharmaceutical team.

What next?

The COVID-19 pandemic forced us to rethink the care model for outpatient care in hospital pharmacy services. Our assessment is positive and we believe that this model should continue in the future for a selected group of patients.

CIRCUIT FOR THE IMPROVEMENT OF THE INTRA-HOSPITAL DISTRIBUTION OF MEDICINES

European Statement

Selection, Procurement and Distribution

Author(s)

PATRICIA ORTIZ FERNANDEZ, Alba Maria Martinez Soto, PILAR FERNANDEZ-VILLACAÑAS FERNANDEZ

Why was it done?

1.Reduce the stocks of drugs in the medicine cabinets of the hospitalization units (HU). 2. Adapt scheduled drugs dispensing to those of preparation and administration at the HU. 3. Reduce the number of returns of dispensed drugs, as the main indicator of improved efficiency.

What was done?

Optimize the drug distribution circuits within the hospital, adapting them to the changes produced in the organization to increase the quality and efficiency of the drug use process.

How was it done?

1. Constitute an improvement group (pharmacy service (PS), supervisors oh HU and nursing address.
2. Define and propose stock agreements by the PS
3. Call meetings to review the agreement and circuit of drug dispensing
4. Incorporation of agreements in the corporate program and implementation of the agreed circuit changes.
5. Publish the updated drug distribution circuit
6. Restructuring of medicine cabinets
7. Evaluation of indicators: a) Decrease types and amounts of drugs in HU. b) Decrease in drug returns of drugs to PS

What has been achieved?

A total of 6 meetings have been held, reaching the following agreements:
1. Mantain a reduced stock of drugs in the HU
2. Establishment of the medicine cabinets agreements for the 14 HU.
3. Limitation of request for medication by stock. Ant other request will be made individually for each patient.
4. Circuit changes:
a. Partial modification of the medication dispensing schedule in the unit dose dispensing system
b. Streamlining the comunication system between the pharmacy service and hospitalization units.
c. Dispatch of medication dispensed in patient transfers
d. Establishment of criteria for urgent requests
5. Written dissemination of the changes to all pharmacy and nursing staff

What next?

Quality indicators will be avaluated 6 months after implementation.
We hope to avoid ineficiencias derived from the existencce of double circuits and to optimaze the control and preservation of drugs in the HU
The establishes drugs is not static, modifications are posible.

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