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Emergency drug dispensing by pharmacist based on eprescription information system

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European Statement

Patient Safety and Quality Assurance

Author(s)

Olga Nedopilkova, Stanislav Gregor

Why was it done?

The project was created to increase quality and maintain continuity of a health care provided in the Czech Republic and to prevent any discontinuity which could endanger the patient. Emergency dispensing of a drug is enabled by new functionality which is the patient’s drug record (PDR) which was only launched in the CZE in June 2020. Last but not least it is about expanding existing competencies of pharmacists and strengthening pharmacists’ position in the healthcare system.

What was done?

The Association of Young Pharmacists, with support of the Czech Chamber of Pharmacists, created a project which is focusing on a possibility of dispensing a chronically used prescription drug in case a patient cannot obtain a prescription for various reasons (“emergency dispensing of a drug”). In hospital pharmacies in the Czech Republic (CZE), it is possible to dispense medicines to the public. A concept has been developed that describes all the essentials that must be followed.

How was it done?

A project proposal describing specific situations when the pharmacist can proceed to emergency dispensing, rules of the actual implementation and also cost analysis has been prepared). A search for experience from abroad has been conducted as well. Subsequently, a survey among pharmacists was conducted. The purpose of the survey was to determine whether pharmacists are interested in this competence and have comments on it. Then a comprehensive concept was submitted to the Ministry of Health. Specific legislative changes will now be needed.

What has been achieved?

Among pharmacists in the CZE, a considerable agreement was reached with the draft. According to the survey 94% of pharmacists agree with the prepared proposal, 3.2% disagree, and the remaining 2.8% agree with minor modifications to the request. Furthermore, we managed to develop a concept that describes detailed conditions for dispensing drugs in emergency mode. The concept was submitted to the Ministry of Health, with which the details of this proposal will now be gradually negotiated.

What next?

This project represents only one of the new competencies that pharmacists could achieve. We want to follow up on this step with another project that would enable pharmacists to prescribe chronically used drugs under specific conditions even outside emergency situations.

USE OF TECHNOLOGIES IN THE TRAINING OF PHARMACY STAFF

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European Statement

Education and Research

Author(s)

VIRGINIA SAAVEDRA QUIRÓS, BELÉN ESCUDERO VILAPLANA, ELVIRA SANTIAGO PRIETO, MARÍA BELLA CORREDERA GARRUDO, INÉS GUMIEL BAENA, MARÍA DOLORES GARCÍA CEREZUELA, AMELIA SÁNCHEZ GUERRERO

Why was it done?

It is important to provide continuous training to all professionals working in the healthcare system, especially when staff turnover is frequent, and when their job is directly related with drugs management, where a failure in the chain of drug utilization can have an impact on patient health.

What was done?

We developed a technology-training strategy of the Pharmacy Department to improve the training resources of the professionals working in it, through the support of information and communication technologies (ICTs), in order to achieve the highest quality in our actions.

How was it done?

The initiative was targeted at the nursing assistant staff of the Pharmacy Department, in the dispensation process to in-bed patients. The development period was between March and April 2017, focusing on activities related to the management, conservation, storage and dispensing of medicines.
This information-training material was developed as follows:
‐ By editing video-tutorials, which would be accessed after recognizing an associated QR code.
‐ Through the preparation of summary sheets in poster format that reflect in a schematic, concrete and visual way those key aspects in each of the processes.
After its implementation, a user satisfaction survey was conducted to evaluate the initiative.

What has been achieved?

Five training video-tutorials were made on different subjects: preparation of unit-dose dispensing carts, preparation of medication from automated dispensing systems (ADS) in Pharmacy, order reception, replenishment ADS in the wards and preparation of medication “on demand”. The average duration of the videos was 5 minutes 45 seconds.
In addition, 7 summary sheets were designed for the management of other types of activities: returns, expirations, special orders, priorities in normal situation – critical situation, management of medicines not included in pharmacotherapeutic guide, interhospital medication loans and calls procedure in the Unit-dose dispensing area.
Satisfaction surveys conducted by nursing assistants have positively valued the initiative.
The strategy developed allows the integration of ICTs in staff training, helping to manage the information of the Pharmacy Department, achieving a better optimization of available resources.

What next?

The degree of satisfaction of the users was good for what we consider important to promote this practice, making it extendible to the other areas and members of the Pharmacy Department.

SIMULATION LEARNING PROGRAMME FOR NURSES: A WAY TO SECURE THE PILLBOXES PREPARATION IN THE CARE UNITS

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European Statement

Patient Safety and Quality Assurance

Author(s)

Charlotte Ménage, Mickaël Le Barbu, Adrien Borowik, Christine Housset, Sandrine Voisin, Florence Lémann, Jean-Michel Descoutures

Why was it done?

An audit of the medication storage cabinets was performed in 2015 in 19 care units. Over a three month period, more than 5000 inappropriate medecines were found which are likely to alter the process of pillboxes prepation by the nurses. Our objective was to develop a training program for nurses to identify and avoid near miss events during the medication administration process.

What was done?

A simulation learning program for nurses was implemented to secure the drug pillboxes preparation.

How was it done?

A multiprofessional team (i.e., pharmacist, physician, pharmacist resident, head nurse, risk manager, hospital hygienist) collaboratively developed a simulation-based workshop. Two mobile cabinets were designed. They were composed of 28 medicine boxes, a patient pillbox and a laptop with a mock prescription. They included the use of a simulation scenario with errors (e.g., expired tablets, damaged blister packs, mixed pharmaceutical forms or dosages, non-formulary drugs). The nurses had to prepare the patient’s pillbox for one day and then were asked to solve five questions about good practices. A validated assessment grid was filled in by two team members, and finally discussed with the nurse about the successes and pitfalls as an education purpose. At the end of the simulation program, nurses had to answer a satisfaction survey.

What has been achieved?

47 nurses experienced the simulation-based workshop. It took 40 min for each nurse on the same week. 89% removed the deteriorated tablets remaining in the pillbox and did not unpack any unit dose. However, 81% were unable to prepare the right medicine, the right dose, the right route for the right patient at the right time, because of a lack of patient identification on the pillbox. Some critical procedures were considered not appropriately followed: i.e., detecting acetaminophen prescription duplicate (only 26%), throwing away medicines in the right disposable bin (21%), checking the tablet expiry dates (70%), using a drug for which the patient was not allergic (62%). The 47 nurses were all together satisfied (100%) with this workshop.

What next?

The simulation based program was adopted by the hospital department of nurse care. It is now integrated in the yearly re-assessment skills program of all nurses.

PRESCRIPTION-DISPENSING SYSTEM FOR WOUND DRESSINGS

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European Statement

Selection, Procurement and Distribution

Author(s)

A. Navarro-Ruiz, F.J. Rodriguez Lucena, C. Matoses-Chirivella, A.C. Murcia-López

Why was it done?

Ulcers imply a lower quality of life for patients and caregivers, and are considered a negative indicator of healthcare quality with increased costs. Global spending on wound dressings from our hospital in 2010 was 600,000 euro, for an estimated population of 300,000 habitants.In the Pharmacy Department there exists wide experience with the Unit Dose Drugs Distribution System (UDDDS) with decentralized stocks that are greatly reduced. It is for this, so it aims to make a management at our UDDDS of special wound dressings for wound care in hospitalized patients, under the same criteria for selection, adquisition, and clinical and financial management of medicines.

What was done?

To establish a rational and efficient use of medical devices for the prevention and advanced wound care, through a prescription dispensing system of wound dressings in hospitalised patients within the unit dose distribution system of the pharmacy department. Furthermore, to evaluate the effectiveness and continuity of process improvements, and extend it.

How was it done?

The Pharmacy Department, along with hospital nursing staff specialized in treatment of ulcers, developed a prescription-dispensing circuit for wound dressings (April 2012-January 2013). At internal medicine and surgery inpatients, the nursing staff of their hospital units (HU) prescribes dressings in medical orders and refers to our UDDDS where it validates, monitors and verifies the consumer. Dressings included in the project are: Class IIb for wounds to be healed by secondary intention, and Class III incorporating substances that can be considered drugs.

What has been achieved?

The prescription-dispensing dressings with UDDDS access contributes to a more efficient use and management thereof in the treatment of inpatients’ ulcers. Furthermore, the creation of a multidisciplinary group for the selection of health products included in the hospital and the development of protocols and guidelines, promotes continuous training of health personnel and improves the quality of care by standardizing the criteria.

What next?

The developed program is currently established and there is a continuous increase in other hospital clinical areas that benefit from this UDDDS for wound care.