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IMPLEMENTATION OF AN ATYPICAL MEDICATION ROOM TO OPTIMIZE MEDICATION MANAGEMENT AND REDUCE WASTE AT HERLEV GENTOFTE HOSPITAL, DENMARK

European Statement

Clinical Pharmacy Services

Author(s)

Henrik Kjer, Christina Laustsen, Rasmus Riis, Caroline Rasmussen, Jeanette Bajrami, Christian Rubek, and Steffen Jørgensen

Why was it done?

An atypical medication room (AMR) was established at Herlev Gentofte Hospital, Denmark to centralize the storage and handling of medications not part of the standard assortment (i.e. atypical medication). The project aimed to improve the efficiency of medication management, reduce medication waste, and streamline workflows associated with the use of atypical medicines. To enhance the accuracy and efficiency of inventory control, the ScanPill technology was developed as a tool for digital tracking and updating of medication stock.

What was done?

Atypical medications are often stored across various departments with low turnover, leading to potential waste and time-consuming retrieval processes. Centralizing these medications in an AMR and using ScanPill aimed to reduce waste due to expiry, improve stock management, and simplify medication retrieval for healthcare professionals.

How was it done?

Atypical medications from multiple departments were collected and stored in the AMR. The ScanPill system was developed to facilitate the scanning of QR codes and barcodes on medication packaging, allowing for precise tracking of stock levels and easy updates to the atypical medication list. Staff were trained to use the AMR and ScanPill to ensure smooth transitions in retrieving, returning, and documenting atypical medicines. Regular inventory checks and updates were conducted to maintain an accurate database of available medications.

What has been achieved?

The AMR, supported by ScanPill, led to improved handling and management of atypical medications. The centralized storage reduced the need for duplicate stock across departments and enabled quicker access to necessary medications, reducing retrieval time and potential waste. The ScanPill technology improved inventory accuracy and streamlined the process of checking medication in and out, ensuring up-to-date records. Staff feedback has been positive, noting enhanced workflow efficiency and reduced medication waste.

What next?

Future steps include evaluating the economic impact of the AMR and its effectiveness in reducing medication waste. Efforts will be made to refine the use of ScanPill, enhance staff training, and explore potential applications of the AMR model across other departments. Continuous monitoring will ensure optimal performance and identify further areas for process improvement.

GOOD PRACTICES TO MINIMIZE PHARMACEUTICAL WASTE IN HOSPITALS

European Statement

Selection, Procurement and Distribution

Author(s)

SS Suvi Sivula, JN Jonna Niemi, KM Konsta Malmi, EA Elina Ahomäki

Why was it done?

In 2021, over 110,000 kilograms of pharmaceutical waste was produced at HUS Helsinki University Hospital, Finland (HUS). That was almost 2.5 million euros when the value of the medicines and the pharmaceutical waste management costs were considered. In 2022, HUS Pharmacy launched a project to reduce pharmaceutical waste, both for economic and environmental reasons.

What was done?

The goal was to reduce the annual pharmaceutical waste in euros and in kilograms at HUS, primarily at the Pharmacy. We also aimed to help departments to reduce their pharmaceutical waste.

How was it done?

The project group was formed of about 15 pharmacists and pharmacy technicians from different units of HUS Pharmacy, located in different areas in Southern Finland. The project team met monthly to review the costs and causes of pharmaceutical waste at the Pharmacy. The team discussed challenges, shared good practices and came up with ideas. In addition, departments were supported in reducing pharmaceutical waste with lectures, materials, videos etc.

During the project we found three main reasons for producing pharmaceutical waste: expired products, residues of cytotoxic drugs and compounding errors. To avoid these, we created a better overview on the whole stock of the Pharmacy, internal communication was increased, and products were moved more actively between units. Unit-specific procedures were also developed, collaboration with departments was increased, and published studies were used especially to reduce cytotoxic waste.

What has been achieved?

During the project, the annual value of wasted pharmaceuticals at the Pharmacy decreased from 928,000 euros (year 2021) to 507,000 euros (year 2023). In addition, the annual amount of pharmaceutical waste at HUS reduced from 112 000 kilograms to 101 000 kilograms. Also, the total cost of pharmaceutical waste at HUS, including the value of wasted pharmaceuticals, decreased.

What next?

The project team’s work has become a permanent part of our work instead of a project.
Collaboration between all healthcare workers is in a key role for reducing pharmaceutical waste. Waste cannot be completely avoided, but it can be reduced significantly, as our project has revealed.
Procedures must be developed further, for example early notifications from departments to the Pharmacy about changes in medical practices are critical for managing our stock.

EXPERIENCE OF PATISIRAN OPTIMIZATION BUILDING HEALTHCARE TEAM

European Statement

Clinical Pharmacy Services

Author(s)

CRISTINA GONZALEZ PEREZ, LUCIA GALÁN DAVILA, MARTA ORTIZ PICA, ELENA GARCIA SUAREZ, MARIA MOLINERO MUÑOZ, LIDIA YBAÑEZ GARCIA, NATALIA SANCHE-OCAÑA MARTIN, MARIA DE LA TORRE ORTIZ, JAVIER CORAZON VILLANUEVA, JOSE MANUEL MARTINEZ SESMERO

Why was it done?

Our hospital is a reference in our community for this rare disease. Since patisiran was approved, we have treated 19 patients. Due to the high cost of patisiran and the few patients treated, it is necessary to optimize patient treatments in the most efficient way.

What was done?

Transthyretin (TTR) amyloidosis is a rare disease caused by mutations in the TTR gene. These mutations alter the normal function of TTR protein, creating slowly progressive condition characterized by the buildup of abnormal deposits of amyloid in body’s organs and tissues.
Patisiran is a TTR specific small interfering RNA (siRNA) formulation in lipid nanoparticles, which has been shown to substantially reduce the production of abnormal TTR in patients with hereditary amyloidosis TTR.
With this project we look for achieve the greatest possible savings from patisiran drug without affecting the patient’s efficacy.

How was it done?

We created a working group with neurology department, to define patient’s groups according to:
– Prescribed doses (doses per patient weight; 0.3 mg/kg).
– Preparation’s losses because of the filters
– Losses of the extraction process.
– Other individual conditions as posology or personal preferences.
Patients belonging to the same group have to administrate patisiran the same days.
As the patient’s weight can change along the time, we agree with doctors and nurses to weight the patients every six months to perform doses adjustments. Therefore, every six months we should regroup the patients to optimize the most.

What has been achieved?

These clusters have made possible to reduce wasting vials and therefore to permit significant savings. We estimate around 208.115 € savings/year.

What next?

With this practice we look for a more efficient and sustainable rational health system. The savings achieved can be used to treat other patients or promote new investigations. Also, it makes possible a better healthcare team performance, working together for a better attention, health quality, security, and treatments efficiency. Monitoring weights to adjust doses and closer follow-up of patients by the different members of the multidisciplinary team are examples of the achievements.

Preparing for disaster – ensuring and optimizing the supply of medicines to a regional acute Hospital in the event of a major accident

European Statement

Patient Safety and Quality Assurance

Author(s)

Fabrizia Negrini, Giorgia Vella

Why was it done?

The aims of this project were firstly to optimize the content of the stock (choice of medicines and quantity) so that it is suitable for various potential events of different nature that may occur in the region. The second aim was to optimize the management processes in order to reduce costs.

What was done?

To manage extraordinary events (short-lasting phenomenon without contamination) in a region with 1.5 million inhabitants, the hospital pharmacy, in collaboration with a major acute Hospital, manages a designated stock containing medication that may be required during unplanned emergencies.

How was it done?

To achieve these two aims, the first step was to define which major events are possible and most likely to occur in the region. To do this we utilized a risk-based analysis of all disasters and emergencies relevant in the area that was performed by an external company that specializes in developing risk management projects in the context of civil protection1. Based on the identified events, we determined which types of injuries were more likely to occur. The medicine stock was subsequently updated and a process for minimizing the management cost was defined.

What has been achieved?

The hazards that were identified as being of particular importance for the analyzed region are likely to mainly result in blunt, perforating, and burn injuries. In collaboration with the Hospital, a list of 61 different medicines used to treat these types of injuries was established. In order to reduce costs, only drugs which were part of the main stock of the pharmacy were chosen. In this way, it is possible to exchange products with a longer shelf life from the main stock 6 months before expiring and use them without having to discard them.

What next?

In case of extraordinary events in a restricted region, the major acute hospital has an increased need for certain medicines. It is task of the hospital pharmacy to always be ready to supply them with such medicines. This is only possible if the probable emergency scenarios are well understood, and the stock and management processes are well-defined and communicated at all levels.

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