Croatian hospital pharmacists managing earthquake(s) medical consequences during lockdown(s)
European Statement
Clinical Pharmacy Services
Author(s)
Mirna Momcilovic, Anita Simic, Petra Turcic
Why was it done?
Croatia was hit by 2 big earthquakes in 2020, both happened just right after 1st and 2nd lockdown due to high number of COVID-19 cases. Since most of the hospitals were strategically built on the hills, it was more destructive for them. It also hit a number of community pharmacies responsible for drugs supply to specific areas in the country. There was no electricity, no heating, no drugs supply, no fridge to store drugs, for days, so quick back-up plan was needed to provide minimal healthcare.
What was done?
Croatian hospital pharmacists organised a temporary pharmacy in a tent, filled it with drugs and medical products donated from community pharmacies, hospitals and wholesalers from Croatia and other European countries and started supplying patients with it.
How was it done?
It was modified way of dispensing, without prescription because there was no doctors and no place to prescribe it, based on patient’s medical documentation, if available, and patient’s medication history according to what patient said only. Pharmacists needed to use their knowledge about dosing, duration of action – difference between immediate release or modified release formulations, possibility of splitting tablets into equal parts to get the needed dose and, most important, substituting drugs from the same pharmacologic class (ex. switching from one inhaler for treatment of asthma containing ICS + LABA to another one that was available at the moment), taking into consideration patient’s needs and avoiding drug to drug interactions. Pharmacists provided patients with OTC drugs, free of charge, followed by an advice of how to use it. Non having prescription problem was solved afterwards by Croatian Health Insurance Fund. Also, all the supply of vaccine against COVID-19 available in Croatia at that point, was sent to an area hit by the earthquake. Vaccination was done by doctors, and pharmacists assisted by supplying them with all the equipment needed (needles, alcohol, cotton wool, etc.).
What has been achieved?
Patients were supplied by all the drugs/medical products needed in the first, critical week after an earthquake.
What next?
Following the Croatian example of handling an earthquake situation, there is an idea of organising a medical crisis team, would include pharmacist, in each European country.
GUIDE TO SUPPORT THE VALIDATION OF PHARMACOLOGICAL TREATMENT IN LUNG TRANSPLANTATION
European Statement
Clinical Pharmacy Services
Author(s)
ANA SANGRADOR, MARIA RIOJA, VICTOR MORA, MARTA VALERO
Why was it done?
reduce the variability of the process, standardize decisions, reduce medication errors, and quantify and measure results, among pharmacists who care for lung transplant patients in the hospital.
What was done?
Prepare a guide to support the pharmaceutical validation of treatment in lung transplantation
How was it done?
The circuit that has served as the script to develop the guide has been the Manual for the Preparation of Clinical Practice Guidelines in the Spain National Health System.
• Initial meeting of pharmacists with the LTx team: presentation of the need and definition of the desirable contents according to the proposals of pharmacists and pulmonologists.
• Task assignment meeting among participating pharmacists.
• Subsequent pharmacist-pulmonologist meetings to outline the aspects that could generate more doubts and controversies.
• Inclusion of the pharmacist in the TX team, to know in situ all the phases of the TX process (from the visit during the pre-TX study, going through the surgery and its subsequent recovery stage in the plant, until the subsequent follow-up in consultations).
• Put in common of the elaborated contents.
• Review by the multidisciplinary team of Ltx.
• Publication of the guide.
What has been achieved?
• Introduction to lung transplantation (LTx): idiosyncrasies of it and transplanted patients, inclusion on the waiting list, common diseases that lead to LTx.
• Most common pretransplant Disease : cystic fibrosis, autoimmune diseases, occupational diseases, obstructive diseases, etc …
• Reference laboratory values and most common deviations in LTx.
• Clinical pharmacokinetics: immunosuppressants and other drugs monitored.
• Clinical immunology of LTx.
• Pharmacology of LTx: Immunosuppression (induction and long-term), antibacterial, antiviral and antifungal infectious prophylaxis, pain treatment, prevention of osteoporosis and treatment of the most common comorbidities in post-PTx: arterial hypertension, supraventricular fibrillation, hyperglycemia and post-transplant dyslipidaemia.
• Inclusion of current pharmacological treatment protocols: initial and subsequent treatment of LTx, cytomegalovirus infection according to the donor-recipient pairing, humoral and cellular rejection, anticoagulation and osteoporosis.
• Treatment validation criteria.
• Drug-drug and drug-food interactions with clinical significance.
• Most common chronological complications in post-LTx.
• Nutrition in the post-LTx.
• Reconciliation of medication.
• Information on medicines and healthy lifestyle habits.
• Usual documentation: informed consents, uses outside the technical data sheet, etc …
What next?
This guide will help to other pharmacist.
RESHAPING OF CLINICAL PRACTICE AND REORGANISATION OF CHEMOTHERAPEUTIC PROTOCOLS DURING COVID-19 PANDEMIC: THE INITIATIVE OF THE NATIONAL INSTITUTE OF TUMORS
Pdf
European Statement
Clinical Pharmacy Services
Author(s)
Giuliana Lo Cricchio, Margherita Galassi, Ernesto Ruffino, Claudia Tirone, Vito Ladisa
Why was it done?
In accordance with regional provisions and national guidelines, the initiative has had the dual objective of reducing hospital access, and potential infections, and ensuring therapeutic continuity for cancer patients.
What was done?
Some therapy protocols have been modified for the treatment of blood, gastrointestinal, lung, breast, head and neck tumors, in order to obtain equally effective patterns but with longer intervals between doses.
How was it done?
Patients have been stratified on the basis of the neoplasia location and biology, the general conditions and the treatments characteristics and they have been shifted to modified treatment regimes, even outside the indications temporarily authorized by regional decision: Nivolumab from 240 mg Q2W to 480 mg Q4W for Hodgkin lymphoma, non-small-cell lung-cancer, squamous cell carcinoma of the head and neck; from weekly Paclitaxel to Docetaxel Q3W for breast cancer; Pembrolizumab from 200 mg Q3W to 400 mg Q6W for lung cancer and melanoma; remodulation of protocols including fluoropyridines and platinum coordination compounds for gastroenteric tumors.
What has been achieved?
The schedule modification allowed a reshaping of agendas to reduce the frequency of day-hospital access and the risk of infection with Sars-Cov-2 for patients, carers and health professionals, in addition to reducing the costs of outpatient services. Treatment interruption rate, with possible consequent progression of disease, as reported by early Chinese data in the literature, has been reduced.
What next?
The extraordinary health emergency changed the clinical practice and aroused interest especially in oncology, where the evaluation of the relationship between benefits and risks associated with therapies has required greater attention because they are life-saving therapies that cause immunosuppression in patients for which the adverse course of viral infection is more frequent than that of the non-neoplastic population.
The possibility of using the modified therapy schemes has been limited only to the emergency period and has not yet resulted in an extension of the indications. The achievement of the therapeutic objective, together with the feedback that the new dosages have not led to a significant increase in adverse events compared to normal clinical practice, encourage us to hope that the indications can be extended in Italy, as has already happened in Canada and USA for the Nivolumab.
NATIONAL CONSENSUS ON CORE COMPETENCIES FOR CLINICAL PHARMACISTS IN NORWAY
Pdf
European Statement
Clinical Pharmacy Services
Author(s)
Eliln Trapnes, Nina Carstens, Merethe Nilsen, Solveig Vist, Margareth Wiik, Janne Kutschera Sund
Why was it done?
In 2012 all the regional hospital pharmacy trusts in Norway decided to implement the IMM-model as a national method for clinical pharmacy practice in hospital settings. Although an extensive amount of training and education has been provided locally and regionally, there was a lack of defined core competencies for clinical pharmacists in Norway. Furthermore, a complete post graduate education program for clinical pharmacists did not exist. Based on this, the managements of the regional hospital pharmacy trusts requested defined skills sets and identification of relevant educational needs and opportunities.
What was done?
A joint national overview of core competencies for clinical pharmacists working in Norwegian hospitals has been compiled. Learning objectives have been defined for each of the steps in the Integrated Medicines Management (IMM)-model (Medication Reconciliation, Medication Review, Patient Counseling and Discharge Service). Relevant education opportunities were identified and recommendations on courses, practical training and other educational activities were described.
How was it done?
A group of six experienced clinical pharmacists representing all the hospital pharmacy trusts in Norway agreed upon core competencies needed to perform the main steps in the Integrated Medicines Management (IMM)-model (Medication Reconciliation, Medication Review, Patient Counseling and Discharge Service) in Norwegian hospitals. Existing education opportunities were compared to the defined learning objectives and a recommended time schedule for the training was made.
What has been achieved?
A national consensus on core competencies in clinical pharmacy services has been reached among all hospital pharmacies in Norway. The consensus, including the evaluation and recommendation of educational activities, makes it easier for leaders of clinical pharmacists to decide on which educational activities to prioritize, and for the Universities to know what educational areas they should cover.
What next?
The report with the identified core competencies will be adjusted according to local requirements and implemented in all Norwegian hospital pharmacies. Hopefully, our work will encourage further cooperation on educational activities between regions. An initiative has already started towards Norwegian Universities to try to integrate relevant competencies into the curricula of pharmacists, and this will continue.
Development of a guide intravenous administration
European Statement
Clinical Pharmacy Services
Author(s)
Gregorio Romero Candel, Esther Domingo Chiva, Jose Marco del Rio, Marca Diaz Rangel, Wals Valladolid, Sergio Plata Paniagua, Nuria Maryinez Monteagudo
Why was it done?
Critically ill patients often require the administration of several intravenous drugs. Besides, we have many times limited intravenous accesses in which the administration of drugs and other intravenous compounds such as parenteral nutrition must be shared.
Because of that, it is very important to have drug administration guides standarizing every-day clinical practice.
This guide was developed in order to reduce the health care workers burden and promote patient’s safety.
What was done?
We developed an updated guide on direct intravenous administration of drugs for health care workers of both critical care and emergency departments.
How was it done?
A database with every intravenous drug that is included in the Pharmacotherapeutic Guide in our hospital was prepared, alphabetically organized by Active Pharmaceutical Ingredient (API). The following data were collected: API, tradename, available dosage forms and recommendations for direct intravenous administration.
For each API, a bibliographic research of information was conducted, among other hospital administration guides, manufacturer´s product information, drug databases (BOT plusR, Micromedex) and requests of information to the technical departments of the manufacturer.
In case of a discrepancy in the information, the guide with higher evidente or more recent was selected.
The antineoplastic drugs were not included in this guide because they are not used or prepared in critical care or emergency departments.
What has been achieved?
This guide promotes safe administration of drugs in critically ill patients, being a useful, accesible and easy-to-use tool for nurses.
Its elaboration allows us to standarize the direct intravenous drug administration, to inform every health care worker and make them aware about its importance. Besides, the Pharmacy Department actively participated in the process of safe drug administration in our hospital
What next?
We are still working on the same departments to improve safety in drug therapy in critically ill patients. Currently, improvement measures that are being developed are: new pharmacotherapeutic protocols specifically for this unit; drugs and drug-diluent compatibility guidelines and new training sessions.
Obtaining patient feedback via a forum group
European Statement
Clinical Pharmacy Services
Author(s)
Ishrat Saddiq Ali, Gemma Harris
Why was it done?
The idea behind setting up this group was inspired by passionate Pharmacy Team members who wanted to ensure that the Department was abiding by the Trust’s promises and standards for patient care, making sure that patients feel welcomed, cared for and in safe hands, and to raise the profile of the work carried out by the Hospital Pharmacy Team.
What was done?
In October 2014, the Pharmacy department set up a Pharmacy Patient Forum Group (PPFG).
The main aim of PPFG was to discuss ideas and share experiences from patients to support the Pharmacy Department, regarding implementing new changes to enhance patient safety and experience. This would support in delivering the Trust’s objectives for becoming best in class for patient experience.
How was it done?
Meetings are arranged approximately every 6 weeks and attended by:
• Trust Membership and Engagement Manager
• Pharmacy staff – Senior Pharmacist and Ward Based Services Technical Manager
• Trust members
Patient representatives were given a complementary tour of the Pharmacy Department where they could see the workforce in action and appreciate the workload of the team. The tour included:
• Dispensary
• Aseptic Unit
• Out of hours Medication Area
• And a visit to the Admissions ward where they saw the Ward Based Pharmacy team in action.
What has been achieved?
Several projects are being carried out simultaneously. The main project arose when patient representatives raised concerns about correctly identifying indications of medicines due to polypharmacy. We have designed a universal sticker images to enable patients to identify indications when faced with language barriers or vision problems. We have successfully developed a cardiology, indigestion/heartburn and pain specific sticker.
We have gained approval from other specialities regarding the images.
Another project focussed on tackling patients’ negative perceptions about discharge delays regarding medication. Patient representatives were invited to view the MEDI-365 automated dispensing machine which are utilised by Ward Based Clinical teams. This led to patient representatives viewing the pharmacy Prescription Tracking System (PTS) which is used to provide live information to all ward staff about pharmacy workload and track patients’ medication. The PTS has been further refined to produce a label which is attached to discharge medication detailing the time taken to process the prescription.
Patient representatives reported that they welcomed the opportunity to see a Pharmacy Department functioning within a busy District General Hospital
What next?
• We are looking to involve local primary schoolchildren/college students in the design of future images. This will aid in helping strengthen local community relations and raise awareness of the projects.
• We are currently working on producing a Discharge Leaflet explaining the Pharmacy Discharge Pathway.
• We find it extremely beneficial to meet via PPFG. We are keen to pursue with these meetings so we can work in collaboration on future initiatives to improve patient experience and safety
We have currently showcased our work in the following:
• Article published in Membership Connect Magazine in September 2015
• Article published in the PJ recently(http://www.pharmaceutical-journal.com/opinion/correspondence/obtaining-patient-feedback-via-a-forum-group/20201596.article)
• Presentation given to ‘Friends of Expert Patients Programme’ September 2016
• We have submitted an application to West Midlands Innovation Day to consider our work
• Article published in the Trust Connect Magazine in October 2016