PREPARATION OF A COMPATIBILITY CHART IN “Y” FOR AREAS OF CRITICALLY ILL PATIENTS
European Statement
Clinical Pharmacy Services
Author(s)
Gregorio Romero Candel, Esther Domingo Chiva, Laura Rodenas Herraez, Cristina Urbano, Jose Marco del Rio, Nieves Cuenca Cano, Maria Jesus Sanchez Cuenca, Antonio Sanz Arrufat, Ana Valladolid Wals, Angel Escudero Jimenez
Why was it done?
In the areas of critically ill patients such as emergency, intensive care and resuscitation, the use of intravenous drugs (IV) in “Y” are common in clinical practice. Stability and physical-chemical compatibility of IV drugs admistered in “Y” are important, affecting directly the safety of patients and the therapeutic efficacy of medicines, which can lead to medication errors (ME). A quick reference chart was developed in order to facilitate the administration of these drugs and reduce errors in these areas.
What was done?
A chart for quick reference of compatibility of drugs in “Y” for the most commonly used drugs in the areas of critically ill patients of our hospital.
How was it done?
It was a team composed of a doctor specializing in emergency medicine, a nurse and two hospital pharmacists. Economic management of pharmacy program Farmatools® was used to obtain the list of drugs most consumed and those most relevant and specific of these areas were selected.
A chart was made where the header of the rows and the columns was the list of drugs in the study. Finally, we conducted a systematic research on Micromedex® “Y” compatibility with each drug with the remaining, completed the chart with a visual color code: green (compatible), red (incompatible), white (not tested) and orange (precaution, existence of various stability dilutions and consult your pharmacist).
What has been achieved?
The elaboration and implementation of this table will provide a fast and visual consultation instrument to nurses before the administration of drugs in “Y”. This tool intended to facilitate decision-making, contributing to increase the effectiveness of the drugs and avoid possible adverse reactions in patients, increasing the quality of care and lowering the ME.
What next?
We are still working on the same areas to increase safety in drug therapy in critical care. Currently, that improvement measures that are being developed are: new pharmacotherapeutic protocols specifically for those units: high risk medications perfusion protocols and new safety guidelines.
PIM-CHECK: DEVELOPMENT OF THE FIRST ELECTRONIC PRESCRIPTION-SCREENING CHECKLIST TO SUPPORT HEALTHCARE PROFESSIONALS IN THE DETECTION OF POTENTIALLY INAPPROPRIATE MEDICATION
Pdf
European Statement
Clinical Pharmacy Services
Author(s)
Aude Desnoyer, Anne-Laure Blanc, Christian Skalafouris, Rolf Hauri, Alain Lorenz, Pascal Bonnabry, Bertrand Guignard
Why was it done?
PIM (i.e. over-/under-/mis-prescriptions, and drug interactions) occurs frequently and is a well-known risk factor for adverse drug events and morbi-mortality (1). Its incidence is high and underestimated in internal medicine (2). While many paper checklists, providing explicit statements, related to PIM in geriatrics exist (3), none had been developed for adults in internal medicine. Moreover, as all these tools are only available as paper versions, they are not easily accessible in daily practice (4). Therefore, we decided to develop an electronic checklist, dedicated to adults in internal medicine.
What was done?
We developed an electronic screening checklist to detect potentially inappropriate medication (PIM) in internal medicine.
How was it done?
We conducted a 4-step study including literature review, 17 semi-structured interviews, a 2-round Delphi survey, and a forward/back-translation process (French English) to develop PIM-Check (5). Sixty-five medical specialists and pharmacists, from 22 hospitals in Belgium, Canada, France, and Switzerland were enrolled. Experts agreed on 160 statements, in 17 medical domains, and 56 pathologies. These statements were then integrated in a specifically developed web-based electronic tool. Each statement is associated with at least one pathology and one medication (1600 ATC encoded).
What has been achieved?
The application is available in French and in English on a website (www.pimcheck.org). A “Screening” function allows users to select for a specific patient, his/her co-morbidities and medications to switch on statements that are the most relevant. A “Favourites” function, gives quick access to selected statements, and a “Learning” function gives access to the list of all statements, those unread and those already read. Details regarding the conception of the tool, direct access to the references (n=333) and useful links (n=29), publications related to the tool and a contact section, are also available. Between February and September 2016, PIM-Check has been visited more than 75.000 times, in over 66 countries.
What next?
Several studies assessing the impact of PIM-Check are ongoing. The algorithm and content of the tool are constantly updated. Thanks to the English version, PIM-Check can be used in different European countries and healthcare settings (6), and will be helpful to support clinical pharmacists’ education in appropriate prescription analysis.
COMPUTERISATION OF THE REQUEST MANAGEMENT OF MEDICAL PRODUCTS UNDER SPECIAL CIRCUMSTANCES
European Statement
Selection, Procurement and Distribution
Author(s)
A. Navarro Ruíz, A. Martínez Valero, R. Gutiérrez Vozmediano, A. Andújar Mateos, A. Martí Lorca, I. Jiménez Pulido
Why was it done?
The purpose was to increase the efficiency of this management process involving a high workload due in part to the absence of information.
What was done?
In Spain, the availability of drugs under special circumstances is regulated by the Spanish Royal Decree 1015/2009 of 20 June, which established three instances: (1) use of investigational medicinal product undergoing a clinical trial, (2) use of medical products for a medical purpose not in accordance with the authorised product information (off-label use) and (3) access to unauthorised medicines in our state but which are legally marketed in other states. Also, each region has its own regulatory system for medicines. In the pharmacy department, we have developed a software application for managing requests for medicinal products in the situations described above, and in accordance with our region’s regulations. It is organised in different sections that collect patients, prescribing physician details, medicinal products and diagnostic information. It has restricted access through user accounts and a menu for multiple search parameters.
How was it done?
In the pre-design phase, we held individual meetings with pharmaceutical and administrative staff involved in this process to identify their specific needs and priorities, and to assess these once the software application was created. The database management system used for the development of the computer application was Microsoft Access 2003. Once finished, it was tested for 2 months to help pinpoint specific errors and improvement opportunities.
What has been achieved?
Computerisation of this process has improved the efficiency in requests management, facilitating the use of information, increasing speed and reliability, allowing the possibility of analysing large volumes of data, providing greater confidentiality and increasing security through backups.
What next?
The next step will be to assess the usefulness of this software application using a satisfaction survey. To incorporate this initiative into other hospitals in our area requires only compatible software able to run the application.To extend its use to other regions would need adaptation of this software application to the existing regulations in each region.
IMPLEMENTING CHEMOTHERAPY DOSE-BANDING USING RETROSPECTIVE DATA ANALYSIS AND EXPONENTIAL CALCULUS
Pdf
European Statement
Production and Compounding
Why was it done?
Chemotherapies are generally prescribed and produced as a function of Body Surface Area (BSA). The most recent literature recommends that marketed drugs continue to use BSA-based dosing supported by clinical evidence. If not, it recommends DB with adjustments for other important parameters.
What was done?
Determine which of the drugs compounded in our centralised chemotherapy production unit were potential candidates for dose banding (DB) for adults, whilst guaranteeing patient safety and meeting the needs of physicians, pharmacists and nurses.
How was it done?
The database of chemotherapy doses produced between 2010 and 2013 was analysed to define a Top 10 chart of the most common protocols and compounds. Dosage patterns were analysed and new bands were modelled using exponential calculus in order to aid in DB decision-making. Discussions with interdisciplinary teams and senior physicians took place in order to promote acceptance of the project and its deployment.
What has been achieved?
Oncology professionals requested an integration of bands into the electronic prescription system, the possibility to prescribe doses above those suggested using BSA and a maximum 5% margin of difference to the usual prescribed dose. They highlighted the necessity of maintaining “ready for administration” doses. For example, in 2013, 613 infusion bags of gemcitabine were produced in 111 different doses, ranging from 266 to 2900 mg. Following the new specifications, just two bands (2000 mg and 1805 mg) already fulfil 50% of annual production needs; producing five band doses streamlines 90% of annual production needs.
What next?
Chemotherapeutic doses can now be prepared in bands and the pharmacy activity can be rationalised by producing doses in batches. The imminent introduction of automation should ensure accuracy of the doses delivered. Future studies should examine product stability so that chemotherapy production planning becomes highly efficient.
IMPLEMENTING PHARMACIST PRESCRIBING AT SCALE ACROSS A UNITED KINGDOM NHS HOSPITAL TRUST
European Statement
Introductory Statements and Governance
Author(s)
D. Campbell, W. Baqir, O. Crehan, R. Murray, N. Wake, R. Copeland
Why was it done?
Supplementary prescribing was implemented as an attempt to reduce prescribing errors at the point of admission. Pharmacists working in more ‘traditional’ clinical roles would identify errors and then ask junior doctors to correct the mistakes made. Not only did this expose patients to unnecessary risks but this was an inefficient use of resources. Prescribing allowed pharmacists to work much more autonomously.
What was done?
Our initiative was to implement pharmacist prescribing across an NHS hospital trust. We focused on developing and using generalist prescribing pharmacists to enhance their current ward based role. We have adopted an “anytime, anywhere” approach to prescribing, where the prescribing pharmacist, like their medical counterparts, can prescribe any medicine, for any patient, for any condition and in any setting.
How was it done?
Pharmacist supplementary prescribing commenced on a single ward, with staff working within a care plan, managing patients. Independent prescribing allowed prescribing service to be rolled out across the Trust. We now expect all pharmacists to obtain a prescribing qualification as a condition of employment. The pace of development was very much dependent on the rate at which pharmacists could be trained.
What has been achieved?
Supplementary prescribing on the admissions unit showed 39% (127/326) of patients audited were prescribed medication that otherwise would have been omitted. In 2014, of the 49 pharmacists employed, 29 (59.2%) are actively prescribing, with seven also having specialist roles. Seven pharmacists (14.3%) are currently in training. An audit of prescribing showed that pharmacists prescribed for 40% (182/457) patients accounting for 13% (680/5279) of all items. In a separate audit, 4 (0.3%) errors from 1413 items prescribed were detected.
What next?
This process has become embedded across our Trust. Regionally, other Trusts agreed a workforce strategy which included the development and deployment of prescribing pharmacists in the way we have described above.