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Author(s)

A Schils, S Pochet, B Allenet

Why was it done?

The aim of this study was to test the ‘self-efficacy’ concept in order to assess the impact of the session on self-management, once the patient finishes the workshop. The evaluation took place from 1 March 2018 to 31 May 2018.

What was done?

The Grenoble University Hospital Centre has set up a therapeutic education programme in the after-care and cardiac rehabilitation department. Indeed, different educational workshops are offered to the patients on various subjects such as disease, treatment and prevention. The workshop ‘medication’ run by the pharmacist addresses the concept of benefit-risk balance, self-medication, drug mechanisms of action and daily medication. Each group integrates 10 to 15 patients, once a week.

How was it done?

Before and after each workshop, a questionnaire evaluating self-efficacy was filled out by each patient, on 10 modalities likert scales: I felt capable of…:
1. Explaining why I am hospitalised.
2 Explaining to my friends and family what my different medications work on.
3 Taking my medication as prescribed.
4 Manipulating each of my medications (reading instructions, opening bottles, breaking blisters…).
5 Explaining to my friends and family the hazards of self-medication.
6 Discussing freely with my physician all of my problems.

What has been achieved?

Fifty-two patients answered the questionnaire. Statistically significant difference before and after the workshop were observed for questions 2, 5 and 6 using a Student’s t-test. Individual results helped us target patients with specific difficulties, who were seen afterwards, during an individual consultation.

What next?

Self-efficacy assessment can be used as a ‘normative’ way of testing an educational sequence (what works and what doesn’t work?) and also as a ‘clinical pharmacy follow-up tool’, selecting patients experiencing specific difficulties with their treatment.

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Author(s)

Francesca Vecchione, Melania Rivano, Patrizia Tadini

Why was it done?

The new process was developed in order to face the significant increase of ID management assigned to the Pharmacy, along with the logistic problems due to the several areas of storage, dispensing and administration. Additionally, it allowed to assure the effective use of ID reducing the risk of failure and improving the patient safety.

What was done?

The Good Clinical Practice guidelines establish that the principal investigator (PI) can delegate the investigational drug management to a pharmacist. In our university teaching hospital with a large amount of clinical trials (CT), pharmacy service proposed an optimisation of ID (investigational drug) management through the elaboration of a form to request the ID. Along with this, we assigned each protocol to a specific type of management and we created an intranet site from where healthcare professionals can download the form.

How was it done?

The pharmacy service created for each CT a specific form organized into 5 sections. Section A, B and C were filled up with protocol information (name, centre code, PI) patient data (initials, patient code) and the treatment schedule. Section C, completed by data manager, showed the quantity of drug to be dispensed and the expected day of administration. Section D was completed with batch and expiry date. The form had to be signed by the pharmacist at the moment of the dispensation and signed back by the committed person who took it. Section E reminded the type of management assigned to the protocol. Five different types of management had been identified, based on the characteristics of storage, the activities required by the protocol (IWRS, unblinded pharmacist, drug preparation) and the dispensing method.

What has been achieved?

Data from January to June 2017 attested 60 ongoing protocols, 722 dispensations for patient, 237 drugs prepared by pharmacists and 986 in Chemotherapy preparation unit. The development of the new procedure ensured the ID tracking, the overcoming of logistical difficulties and an increase of the safety.

What next?

We are going to keep on improving the pharmacist role in CT by ensuring ID are handled, stored and correctly managed. The objective is to enhance the collaboration of clinical research professionals in the management of CT.

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Why was it done?

It is now usual to dispense hepatitis C DAA to outpatients, whose virological success rate is high in the general population. However, subpopulations are at risk of re-infection or noncompliance for which an individualized approach with TPE is required. Role of the pharmacist is to transmit skills for starting and to assist the patient during treatment. SE are sometimes more easily disclosed to pharmacist, thereby allowing to take them into account so that the treatment can be adapted until completion. TPE benefits for these subpopulations are expected in the short term with regards to compliance and empowering the patient during treatment and in the long term to eliminate risky practices and leaving additions.

What was done?

setting up and running TPE sessions for hepatitis C by pharmacists

How was it done?

Hepatology department, based on multidisciplinary team (hepatologist physicians, psychiatrists, addiction specialists, pharmacists, nurses and psychologists), developed a TPE program on viral hepatitis in april 2016. Following written consent, entry into the program was systematically offered to vulnerable patients (background of substance abuse, active alcohol consumption, risk of non-compliance).
Pharmacists were involved in individual sessions concomitantly to DAA dispensing, since the day when patient started TPE program. Pharmaceutical sessions aimed outpatients to acquire following competencies:
– DAA’s name, action mechanism,
– Terms of administration, what to do if forgotten,
– Side effects (SE) and their management,
– Drug interactions (adapted to outpatient treatment).

Pharmacists also answered to questions concerning the patient and monitored compliance and SE.
Interactive practical tools were developed: treatment logbook (also allowed evaluating objectives at each session), cards about known and preconceived SE, timetable for drug intake. Patients fulfilled a satisfaction survey at last session.

What has been achieved?

31 outpatients were included. Pharmacists conducted 65 sessions, 2 or 3 individual meetings per patient (one hour-long total per pharmaceutical session) depending on treatment length (8-24 weeks). 6 patients were still ongoing and 25 achieved the program. Among them, 12 had an undetectable viral load after 12 weeks (Sustained Virological Response 12) and 1 relapsed. 100% of goals were achieved as from the first pharmaceutical session. 100% of patients were satisfied about pharmaceutical session

What next?

Evaluation of program’s benefits in terms of virological success need to be continued.

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Author(s)

Nina Kærgaard Hansen

Why was it done?

The initiative was performed to investigate the accessibility and usability of the current intranet in order to improve intranet information and communication from the hospital pharmacy to the clinic.

What was done?

Workshops with usability tests were performed with four different professions who are expected to use the intranet information and communication from the hospital pharmacy.

How was it done?

Workshops for selected professionals including pharmacists, pharmaconomists and nurses were held. The workshops consisted of four parts:
1. Video capture and recording test: Participants were asked to find specific information on the intranet. Comments, clicks and movements of the mouse were recorded during the task.
2. Sorting and prioritization the pages: Participants were given screen shots of 57 pages from the intranet. The participants were asked to sort the pages in three categories: need to know, nice to know and insignificant.
3. Evaluation of selected texts: Participants were given 5 examples of texts from the intranet and asked to assess if the text was relevant and understandable.
4. Structured focus group interview: Using a structured interviewguide the use and challenges experienced by the participants were explored.

What has been achieved?

From the present initiative it was found that the structure of the intranet was not optimal and did not reflect the daily needs from the users. The results from the workshops provided a clear guideline on how to restructure the intranet. It is important to make short cuts and optimize search function.
In addition, the initiative revealed how to improve texts:
– Write shortly, concisely and action oriented: “Tell us what to do”.
– Write the most important first, then elaborate and insert links to learn more.
– Use subheadings for skimming the text.

What next?

A campaign is planned to advertise the new intranet structure. Number of users and subscribers on the intranet pages is followed to see if the activity increases. Editors have been educated to write texts that are short, concise and written in an action oriented language

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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.

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Author(s)

Charlotte Ménage-Anjuère, Rakiba Belkir, Elisabeth Bergé, Audrey Decottignies, André Rieutord, Xavier Mariette, Raphaèle Séror

Why was it done?

We needed to assess the impact of our patient education program on Sjogren’s syndrome (SESAME) in order to continuously improve it.

What was done?

A playful online questionnaire was designed and implemented to assess patients’ knowledge about Sjogren’s syndrome.

How was it done?

A interprofessional team (3 rheumatologists, 3 pharmacists) and a 4-patient group who participated in the education program together proceeded to the questionnaire design: 1) definition of a competency framework for patients with Sjogren’s syndrome; 2) from literature review, identification of quality requirements for a questionnaire (scientific quality, opportunity to interact, means of expression, logical chaining of questions, simplicity, utility, shortness, bias prevention, playfulness, variety, online diffusion). To fulfill these criteria, we used a clear vocabulary and concise questions, included open-ended questions on patient experience, focused on the artwork, randomized the order of answer choices, and shared the questionnaire online. Once the SESAME quiz was established, a scoring system was defined by the expert group. Face validity, feasibility and reproducibility were assessed to validate the questionnaire. 25 patients were contacted to complete the questionnaire twice. Patients also evaluated the content, structure and feasibility using 12 items (understandable language, unambiguous sentences, length of the questionnaire, difficulty, web access). Reproducibility was calculated using intraclass correlation coefficient (ICC) on patient answers separated by 48 hours.

What has been achieved?

The questionnaire includes 28 questions divided into 4 parts: Sjogren’s signs, Sjogren’s causes, treatment, daily life with the disease. The 25 patients filled in the questionnaire twice (96% women, 54 years min-max[23;74], 4 years since the diagnosis min-max[1;20]). The questionnaire was filled in from a computer (n=38), a tablet (n=3) or a smartphone (n=9). The average response time was 19 minutes. The median score was 34 points min-max[22;46] out of 50. 18 patients evaluated the questionnaire. 15 patients or more regarded its content, organization and feasibility as “very good”. 5 patients found it difficult. The reproducibility was very high (total ICC = 0.87 IC95% [0.74-0.94], ICC on each part between 0.61 et 0.87).

What next?

The SESAME quiz is now freely available (https://etp-rhumato.typeform.com/to/qsVhR1) and all the Hospital centers caring for Sjogren patients can use it for their follow up.

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Author(s)

Caroline Hache, Stéphane Honoré, Guillaume Hache

Why was it done?

The development of clinical pharmacy allows pharmacists to take patient-centered roles and responsibilities. However, patient-centered care requires a specific set of skills and training, such as patient-focused communication and conducting structured interviews. Thus, improvement of pharmacist-patient communication may lead to better clinical outcomes.

What was done?

We developed a workshop involving patients within the training programme of residents in hospital pharmacy. The workshop focused on communication skills needed to improve the quality and effectiveness of a pharmaceutical interview.

How was it done?

The workshop was developed jointly by two senior clinical pharmacists and a lecturer in education and communication science. The learning process integrated: working on participants’ perception of pharmacists-patient communication, didactic learning, training activities and evaluation. The assessment of the learning effect was performed by self-, peers-, and patient-scored charts. Patients’ feedback during the training activities and assessments was highlighted as the cornerstone of the learning process.

What has been achieved?

First, we built a competency chart on communication skills needed to perform a structured pharmaceutical interview. This tool has been validated by the patients and well accepted by the learners. It was used to assess the learning effect of the workshop, and may serve as a guide for the continuous development of junior practitioners. Secondly, the workshop has actually been implemented, with both the learners and patients expressing a high general acceptance and satisfaction. Finally, preliminary results show a learning effect assessed by both peers and patients.

What next?

The involvement of patients needs to be further expanded to the training programmes of undergraduate students, residents and clinical pharmacists. A future action planned is to develop a model with the French Society of Clinical Pharmacy (SFPC) for a national systematic training module: “Improving pharmaceutical interviews’ performance through effective communication”, involving patients.

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Author(s)

Antonios Markogiannakis, Georgios Pegkas, Calliope Allagianni, Stavroula Efstathiou, Despoina Makridaki

Why was it done?

The term of AST has been introduced in Greek legislation since 2014 and should become the driving force to optimize antimicrobial therapy, especially for the protected antibiotics (PA): carbapenems, colistin and tigecycline. Unfortunately Greece ranks first in Europe in the consumption of the mentioned PA in hospitals, consequently the activation of AST constitutes national priority. The existing law frame defines that AST consists of four key member physicians (experienced in infectious diseases) plus the hospital pharmacist as coordinator of the group. As the number of serving pharmacists in Greece remains critically low, very few hospitals have actually activated the AST. The Panhellenic Association of Hospital Pharmacists (PEFNI) decided to organize regional meetings to enhance the involvement of pharmacists by sharing the practice of experienced colleagues running antibiotic stewardship programs (ASP) in their hospitals since fall of 2016.

What was done?

We have described the sequential steps for the establishment of multidisciplinary Antibiotic Stewardship Team (AST) in Greek hospitals and prepared training material to increase involvement of hospital pharmacists.

How was it done?

We combined the strategies and procedures implemented in the three hospitals during last year, in a flowchart presenting the establishment, activation and feedback of the AST. We have developed an ASP for hospitals, with initial target to minimize the use of PA:. Functional options in each step have been described, making it flexible for the colleagues to selectively implement them in their hospitals. We also created specific educational material to use in regional meetings that PEFNI organizes.

What has been achieved?

The application of ASP and the education of hospital pharmacists as coordinators results in: • Reliable reporting of controlled use for the PA • Safer antimicrobial management practice • Economy on restricted pharmacotherapy budgets • Acknowledgement of the critical role of pharmacists by other healthcare professionals, the hospital manager and the authorities

What next?

• The basic flowchart can be broadened to include subsequent stewardship activities such as recording proper surveillance of more classes of antibiotics, assessment of antimicrobial surgical chemoprophylaxis and/or antifungal pharmacotherapy.
• Connection of local ASP reports to a national network for all hospitals will help towards the creation of a real-time antibiotics’ consumption database in Greece.

Author(s)

Alison Anastasi, Karl Farrugia

Why was it done?

This was done as a tender was being issued also for medicines that still had a patency and had no competition and the prices quoted for were higher than other international external reference prices. Thereby a new pricing reimbursement system was undertaken and items procured were studied intensively before choosing the right procurement model. The main point was thinking outside the box inducing interest in international companies who were willing to support and assist the innovative local systems by participating in the new systems leading to improved access and better value for money.

What was done?

In September 2016, a workshop and strategy meeting was organised at WHO Denmark to discuss global procurement strategy and share country practices. Malta was one of the facilitators and invited speakers. In the past years tendering was the main system for procurement. However, on having a thorough understanding of medicines and non-pharmaceuticals, market strategy, and patency other processes have been studied and adopted. The models involve negotiations, pay per use systems, and pay per performance models.

How was it done?

This was done by setting multidisciplinary teams within the hospitals and by having good research methodology skills. This led to smoothing the gaps between the actual horizon scanning, health technology assessments and final choice of procurement strategy. International liaison, partnership with the industry, and relevant focus groups with annual seminars made this possible as mixed experts met and gave their best shot at this new system. The fact that no one size fits all made procurement more interesting and from one cycle to the other there is a learned curve that brings successful results.

What has been achieved?

Malta achieved better competition, uninterrupted sourcing, investments and stable pricing with continuous yearly reductions. From negotiations of patented medicines Malta saved approximately 1.5-2 Million Euro per year since 2013. With respect pay per use systems such as the total knee replacements Malta gave a capped price and ended up paying half of what is used to pay and companies managed to bid for the set price. In renal dialysis the cycle involved payment per patient service thereby reducing wastage, storage, and ordering of consumables and this will render a cost saving of 5Million Euro throughout cycle. The new processes launched for multiple sclerosis will dictate that whoever reaches the cheapest price ranking will be used to start the patients clinically and the pay per cure cycle for Hepatitis C will lead to savings and complete eradication in five years time.

What next?

Malta is one of 6 small EU Member States so besides its size and geography there are other elements were it triggers the procurement department to think of innovative ways to treat our patients and as yet remaining sustainable. There are other projects in the pipeline however, Malta is sharing its good practice with the industry, with the WHO and other international fora so that certain elements are taken on board as standardised systems for equality of service and treatment in all countries.

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Author(s)

Elise Deyaert, Hilde Collier, Pieter-Jan Cortoos, Claudine Ligneel

Why was it done?

Medication errors are often caused by insufficient knowledge among healthcare professionals. Given limited clinical pharmacists’ presence on Belgian hospital wards, a pharmacy-led MIS can efficiently provide fast, accurate and objective medication-related information.

What was done?

We implemented the first Belgian Medicines Information Service (MIS) in our university hospital. In several countries, a MIS is common in most hospitals but until our project, no such MIS was available
in Belgian hospitals.

How was it done?

Best practices were researched through literature review and site visit at Charing Cross Hospital (London, UK). Secondly, in order to customize activities, all nurses and physicians were surveyed on medicines information needs. Our MIS was set up to centrally (1 dedicated pharmacist, phone number and e-mail address) receive medication-related questions from healthcare workers with the option to request additional clinical-pharmaceutical interventions (e.g. drug review). Implementation was accompanied by mailings, posters, business cards and presentations. All enquiries were registered in the MiDatabank® (UKMi National Medicines Information) and evaluated after 4 months, together with user satisfaction.

What has been achieved?

221 respondents (113 physicians, 103 nursing) to our survey found ‘drug administration/dosing’ (79.7%), interactions (69.6%) and ‘tablet crushing’ (49.7%) major problematic topics. Physicians rated the MIS to be useful for drug review, counselling and interactions while nursing preferred support on drug administration and tablet crushing. 96.8% intended to use the MIS.
Between 09/01 and 09/05/2017, our MIS received 247 enquiries (45.5% residents, 34.0% nursing, 13.8% clinical staff). Drug administration/dose-related questions (43.3%) was the most important category, followed by drug choice/indication (10.5%) and interactions (9.7%). 80.2% were answered within 1 hour (median: 11min). 81% of users mentioned the MIS improving their knowledge, with 59% and 56% reporting positive patient outcomes and time savings. Our MIS scored high on accessibility, timeliness, comprehensiveness and quality (average 4.34, 4.29, 4.42 and 4.47 on 5-point scale). MIS activity corresponded to 0.4FTE pharmacist with an average cost of €15.4/enquiry.

What next?

Our project shows that fast and reliable medication-related information is greatly needed. For the future, this service should be organized with other hospitals as to optimally use resources, share information and increase expertise. Also providing such service to primary care and patients will have be explored.