IMMPACT: A THERAPEUTIC EDUCATION PROGRAM TO SUPPORT SEAMLESS CARE FOR PATIENTS LIVING WITH CANCER
Pdf
European Statement
Clinical Pharmacy Services
Author(s)
A. Decottignies, D. Bouchoucha, S. Lévêque, S. Barthier, J.F. Morere, A. Marfaing, A. Rieutord
Why was it done?
Cancer has become a chronic disease. However, the impact of the disease and related treatments on patients’ everyday life remain poorly addressed all along the patient clinical pathway. The objective was to customise support to the patient to be able to better understand and control the disease and treatment consequences.
What was done?
An integrated care model based on a therapeutic education programme (TEP) was designed to better support patients living with cancer in their everyday life. The hospital pharmacy led the project, launched in October 2013 and implemented for patients in March 2015. It is called IMMPACT (impact of illness and medication in patients undergoing chemotherapy). This TEP was accredited by the National Authority (ref No ETP 13/30 in August 2013).
How was it done?
A transprofessional working group was formed. Our concern was to propose a smooth and safe transition from hospital to home. To do so, the hospital set up a partnership with the health network to facilitate seamless care. A prospective survey was conducted in October 2013 including 41 ambulatory patients. Three priority themes were identified: tiredness, haematological problems and digestive disorders management. According to the results, educational sessions have been collaboratively designed and implemented.
What has been achieved?
The patients group workshops began in January 2014. To date, 31 group workshops have been run. These group workshops are facilitated by trained healthcare professionals using educational tools such as Barrows Cards, mosaic characters or metaplan. 83 patients have already experienced this programme. Patient global satisfaction is >92%.
What next?
Given the success of this programme and to fulfil the growing expectations of patients, new sequences are being designed about pain, chemotherapy related neurotoxicity, socio-aesthetics and lymphoedema management as well as developing a serious game for the patient. Finally, IMMPACT extension to community pharmacists is being considered to further sustain patients empowerment and continuity of care.
BREAKING BARRIERS: MEDICATION SAFETY IN TRANSITIONS OF CARE
Pdf
European Statement
Clinical Pharmacy Services
Author(s)
M. Cabré Serres, T. Aguilella Vicente, E. Julián Avila, D. Rodríguez Cumplido, J.M. Pepió Vilaubí, M. Muñoz-García
Why was it done?
As a part of a multicentric medication reconciliation (MR) study in the fragile patient, one of the phases of the project included primary care reconciliation so we had to create alliances and enable effective communication channels between the two levels of care.
What was done?
During 2015, we started using direct messaging between hospital pharmacist (HP) and primary care physician. The messaging tool, which is available in SIRE and ECAP programs, allows you to send messages to all physicians caring for the patient. It also allows you to contact the usual pharmacy of the patient. Physicians receive messages automatically during the patient’s clinical course.
How was it done?
When patients were medically discharged, the HP performed MR. The HP contacted the next provider to inform them of changes in the medication list and safety alerts. When the patient visited the doctor, he already had the pharmacotherapy summary and pharmaceutical recommendations in the patient’s electronic clinical course. Afterwards, the HP assessed if the pharmaceutical interventions (PIs) had been accepted.
What has been achieved?
We started using the tool in January 2015. We performed 205 discharge reconciliations and have sent 143 messages. This would be 0.7 PIs/patient. PIs have been: 26.6% (n=38) remove medication, 21.0% (n=30) monitor treatment, 21.0% (n=30) increase adherence, 11.2% (n=16) modify dose, 8.4% (n=12) add medication, 6.3%(n=9) modify posology and 5.6% (n=8) replace medication. Finally, 72.7% (n=104) of PIs have been accepted and 27.3% (n=39) rejected. We can also analyse population characteristics and the drugs involved in the PIs.
What next?
We are breaking barriers between hospital and primary care with nexus of the HP, who has begun to be part of the medical team. We want to continue in this direction to improve the results of our PIs. We want to determine if our PIs improve health outcomes. Another current problem in the transition of care is hyperprescription treatments with proton pump inhibitors or benzodiazepines. A de-prescription programme could be the next step.
RENAL PHARMACIST OPTIMISES HEALTH OUTCOMES FOR PATIENTS
Pdf
European Statement
Introductory Statements and Governance
Author(s)
A. Frisch, D. Scharlemann-Moenks, K. Heinitz, R. Frontini
Why was it done?
Limited resources require optimisation of pharmacists’ interventions (EAHP Statement 1.3). Due to the limited number of clinical pharmacists (5/1350 beds) only a few wards were served by the pharmacy. We aimed to improve the effectiveness by covering selected patients in all wards and compared the results with a classic visit.
What was done?
Instead of visiting all patients in selected wards, pharmacists focused on patients with critical renal insufficiency across all wards.
How was it done?
The central laboratory identified patients as high risk when their glomerular filtration rates were <30 ml/min, and alerted the pharmacy via email. For those patients, the renal pharmacist analysed the prescribed medication at least twice weekly throughout their hospital stay for medication errors, dosing and interactions, and suggested alternatives where necessary. Interventions were discussed either directly with the doctors or by written advice. The major obstacle was the fact that clinical services by pharmacists were unknown in most wards and that some of the doctors were sceptical about the pharmacist`s competency. We overcame these obstacles by intensive collaboration with the nephrology department.
What has been achieved?
Over 20 months involving 4229 visits, the renal pharmacist analysed the medication of 2125 patients who had 11 different drugs on average. The pharmacist assessed 47 584 medications, resulting in 2900 interventions, of which 1292 were renal and 1608 other. The most common interventions for renal patients were dosage adjustments (20%), contraindications (16%) and interactions (10%). Overall, the number of interventions (6.1% of medication items) and their severity across all renal insufficiency patients exceeded those on the visceral surgical ward (2.4%) over the same time as a comparator, confirming the higher effectiveness of the intervention.
What next?
To conduct further studies on medication safety, we established a centre for drug therapy safety in collaboration with the faculty of pharmacy with the aim of discovering valid criteria for identifying other high risk patients.
eLearning Environment for Ensuring the Competence in Pharmacotherapy
Pdf
European Statement
Education and Research
Author(s)
Susanna Saano, Tiina Koskinen, Hillevi Rautiainen, Minna Taam-Ukkonen
IMPROVING STAFF TRAINING IN A CYTOTOXICS PREPARATION UNIT
Pdf
European Statement
Production and Compounding
Author(s)
S. Sernache, H. Goncalves, A. Gouveia
Why was it done?
Improved processes were required due to new CPU facilities, PIC & acute requirements and workplace safety legislation. The training program started in 2013. Our aim was to change from an informal training to a program where minimal qualification standards were achieved despite heavy workload and budget constraints.
What was done?
Implementation of a training program for the Cytotoxics Preparation Unit (CPU) focusing on product and staff safety. Key steps were hand washing with fluorescent gel, media fill and simulated preparations with fluorescent dye. Wipe sampling of cytotoxic contamination and microbiological control were performed.
How was it done?
Absence of national experience required literature review and support from other hospital in Europe. Lack of commercial products and budget constraints led to adoption of more affordable solutions like in-place compounding of fluorescein vials, and use of standard sodium chloride IV bags for media fill. Other resources were procured externally and adapted.
We enhanced motivation with involvement of staff in the goals and open discussion of results.
What has been achieved?
All relevant staff went through the training and reached the qualification thresholds. All technicians successfully performed media fill test (no microbial growth), and fluorescein test (no dye spots counted). Hand wash results had median of 5 spots of inadequate washing. Results were discussed with staff and new session implemented afterwards. Only 9% of staff (n=33) did not improve, median of results was 1 spot . Regular microbiological monitoring results meet GMP criteria for the laminar flow cabinets, and cytotoxic contamination (8 drugs tested in 5 locations) is in line with reference values except for 5-FU storage shelf.
What next?
Training program is to be repeated yearly, as well as the monitoring processes. Despite budgetary and staff constraints, a sustainable training program can be implemented with adaptation of published sources, resulting in adhesion to good practice.
A TARGETED STRATEGY AND TRAINING PROGRAM TO IMPROVE THE MEDICATION RECONCILIATION PROCESS
European Statement
Clinical Pharmacy Services
Why was it done?
Medication reconciliation at admission was implemented in our hospital in 2011 and since then we could hardly meet the expectations of clinicians (completion of a Best Possible Medication History (BPMH) for 70% of patients in less than 24 hours). We also observed that the high patient volume decreased the quality of our BPMH completion process.
What was done?
We developed a strategy and an organisational thinking to remove human and technology barriers in performing medication reconciliation (MR). We designed a program to improve the overall quality of MR and increase the added value of MR for clinicians, nurses and pharmacists.
How was it done?
Our approach included four steps:
(1) “customer approach”; by conducting semi-structured interviews with students, clinicians and nurses to get their feedback, needs, expectations about medication reconciliation,
(2) literature review with Pubmed® and Embase®and benchmarking of other similar practices in France and Canada
(3) set a task force including pharmacists and students to define a strategy and metrics
(4) design solutions and assess them.
What has been achieved?
First, we defined and chose to target “High risk” admission inpatients only. Second, a training program based on two e-learning modules was implemented to develop skills of pharmacy students and residents. This program explores the “why” of conducting MR based on real life examples. It also defines the “what” (what is MR) and the “how” (i.e the different steps to run a MR and how to appropriately interact with the patient).
What next?
At each student rotation, the efficacy of the training program will be evaluated by comparing the concordance of BPMHs performed separately by a student and a pharmacist. A survey will be conducted to evaluate the level of learners’ satisfaction.