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Evaluation of pre-splenectomy vaccination compliance in a large London teaching hospital.

European Statement

Patient Safety and Quality Assurance

Why was it done?

Due to the increased risk of infection to asplenic patients by encapsulated bacteria, national guidance states the following vaccinations should be administered at least two weeks prior to elective splenectomy: influenza, meningococcal (meningitis B and meningitis ACWY), Neisseria meningitides group B, and pneumococcal. Anecdotally this does not happen, resulting in administration in the hospital setting. This adds complication to the discharge process and leaves the patient with follow-up to arrange at home, whilst also having a cost burden to the hospital.

What was done?

An audit was carried out to assess compliance with national guidance on administration of vaccinations in primary care prior to elective splenectomy.

How was it done?

A report was run to generate a list of all patients who underwent a splenectomy over a 5-year period between 2015 and 2020. The records of patients admitted for elective splenectomy were investigated. It was ascertained whether medication and vaccination histories had been completed by pharmacy, whether vaccinations were given whilst in the secondary care setting, and whether the appropriate follow-up information was given to the general practitioner (GP) on discharge.

What has been achieved?

Only 6% of patients admitted for elective splenectomies across the 5-year period had received the required vaccinations in primary care prior to admission. If not administered by their GP prior to admission, only 69% of patients received the required vaccinations following splenectomy before discharge from hospital. Inclusion of the required information regarding long-term management in the discharge notification was completed in 76% of cases. Often this was included by the screening pharmacist in the pharmacy section of the discharge summary, where this was omitted by the discharging doctor. These results were submitted to the quality improvement team with recommendations to improve future practice.

What next?

This audit highlighted the need for a substantial improvement in communication between hospital and GP settings, utilising the new electronic era. In the hospital setting, poster reminders and regular teaching sessions for new and regular staff on the importance of these vaccinations will be implemented. Re-audit should then take place, with an additional component looking at communication processes and implementation by GPs of suggestions made on discharge.

IMPROVING THE CONTINUITY OF CARE IN CASE OF EXTRATEMPORANEOUS MEDICINES FOR CHILDREN

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European Statement

Clinical Pharmacy Services

Author(s)

Stefanie Sauer, Michael Ober, Jürgen Backhaus, Torsten Hoppe-Tichy

Why was it done?

Patients of the Children’s Hospital at the Heidelberg University Hospital are regularly supplied with extratemporaneous medicines from the hospital pharmacy. This often leads to issues in continuity of care in the outpatient setting as patients are required to access ongoing treatment through local pharmacies, which in turn must develop the formulations and procure the necessary raw materials. Therefore, it is not uncommon for interruptions in patients’ therapy to occur.

What was done?

The aim was to improve continuity of care by discussing the medication with the responsible pharmacy before the patient was discharged. Allowing missing raw materials to be procured and clarify any uncertainty about the prescription.

How was it done?

We designed a document that is available on the Intranet. While the child is still on the ward the discharge medication should be noted. The parents had the opportunity to indicate a retail pharmacy of their choice, preferably near the place of residence. This document could be sent to the hospital pharmacy. A hospital pharmacist contacted the specified pharmacy to discuss the extemporaneous medications before the child was discharged. If necessary, the pharmacist can forward the hospital pharmacy manufacturing instructions. Furthermore, the compositions plus further information were then made available on the homepage of the pharmacy in an area to which only experts have access. A telephone number on the hospital pharmacy homepage is available for queries, including those about the formulations.

What has been achieved?

In the discussions with the retail pharmacies, the colleagues were very pleased and grateful about the service provided by the hospital pharmacy. They saved time in preparing patients’ prescriptions. Concerns or doubts were cleared up at an earlier stage of the discharge process, leading to the patient receiving their medicine on time.

What next?

Provision of the document and manufacturing instructions on the homepage serve as a valuable aid for ensuring that the outpatient therapy functions smoothly. It is important that the information is kept current. In the future, further information will be linked to the homepage in the hope of reducing the number of incoming telephone enquiries.

PROTOCOL FOR MEDICATION RECONCILIATION AT DISCHARGE

European Statement

Patient Safety and Quality Assurance

Author(s)

Álvaro Caballero Romero, Enrique Galindo Sacristán, Fernando Malpica Chica , Enriqueta González González, Ana María Manzano Bonilla, Marcos Camacho Romera

Why was it done?

Medication errors (ME) are often identified in transitions of patients at admission to and discharge from the hospital. Medication reconciliation at discharge is an effective process to decrease the morbidity, mortality and healthcare expenses.

What was done?

A protocol for a medication reconcialiation project was designed by hospital and primary health care pharmacists.

How was it done?

The protocol has the following steps. To identify all the patients from the hospital at discharge daily. To select the polimedicated (5 or more prescribed medicament) and elderly (over 65 years old) patients. To review the discharge report in the clinical history patient in order to compare whether doctor prescriptions of medicaments (medicine, dose, posology, duration) correspond to the prescriptions included in the report at discharge. To identify discrepancies between both the discharge report and doctor prescriptions of medicaments. The discrepancies were clasified in justified and unjustified. The unjustified discrepancies were categorised as omissions, unnecesary addition, wrong medications, wrong drug frequency/dose, duplicities, pharmacological interacctions and inappropiated medicine regarding to the current clinical practice guidelines. The discrepancies are classified as high and low priority. Finally, both types of discrepancias are reported by sending emails to the specific physicians for each patient along the primary health care system. Some specific cases are discussed on phone calls by doctors and the pharmacists in order to achieve the best clinical goal for the patient.

What has been achieved?

The project was evaluated from June 2016 to May 2017. Total of discharges: 2788. Included patients: 863. Patients with discrepancies: 309 (35%). Detected discrepancies: 470. Rate discrepancies/patient: 1.52. Omissions: 122 of 470. (25.96%). Unnecesary addition: 60 of 470 (12.76%). Wrong medicine: 3 (0.63%). Wrong frequency/dose: 167 (35.53%). Duplicities: 92 (19.57%). Pharmacological interactions: 13 (2.65%). Inappropiated medicine: 13 (2.77%). Reported emails: 309/309 (100%).

What next?

Polimedicated and over 65 years old patients play an extremely important role in the current health care systems. The ME are frequent and may be particullary severe in this type of patients. To develope a protocol for medication reconciliation at discharge in order to identify potencial prescriptions problems is an oppotunity for the multidisciplinar care team to improve the patient care and decrease the expenses associated to primary health care.

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

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