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PROJECT TO IDENTIFY MEDICATIONS ACCORDING TO JOINT COMMISSION STANDARDS

European Statement

Patient Safety and Quality Assurance

Author(s)

Cruz Pardos, S. González Andrés, D. López San Román, MA

Why was it done?

One of the standards established by the Joint Commission (JC) involves the identification of medications that may have risk to patients and/or be a potential source of error during its dispensation or administration. This includes look-alike/sound-alike (LASA) medications, high-risk medications (HRMs) defined by the Institute for Safe Medication Practices (ISMP), concentrated electrolytes, and hazardous drugs (HD) according to NIOSH classification.

What was done?

A tag system was designed using color-coded stickers with specific text to identify each of the medication groups defined above:
• Red stickers with the statement “High risk medication” for HRMs.
• Red stickers with the statement “Dilute before administration” for concentrated electrolytes.
• Yellow stickers with the statement “Reproductive risk” or “Hazardous drug – handle with care” for HD.
• LASA medications: Red stickers were used for those that are also high-alert, while green stickers were applied to non-high-alert LASA drugs.
In addition, for medications requiring repackaging, the repackaging protocol was modified. The changes included:
• Labelling the medication profile with either HIGH-ALERT MEDICATION or HAZARDOUS DRUG.
• Using different photoprotective packaging paper: red for HRMs and yellow for HD

How was it done?

At first, two working protocols were developed:
1. Labelling protocol, detailing the characteristics of each type of sticker used to identify the different medication categories.
2. Repackaging protocol, ensuring proper identification of these medications during the repackaging process.
Secondly, lists of every category were compiled of the hospital’s available medications.
For LASA medications, brand names and images were included to improve differentiation and minimize errors.

What has been achieved?

• Identification of each medication according to their category at every stage of the medication use process: reception, storage, dispensing, and administration.
• Increased awareness among nursing staff regarding the safe and appropriate handling of these medications.
• The impact of these labelling project among all medicaments available in our hospital was: MAR: 18,6% , MP: 6,1% and LASA: 15,24%

What next?

• Develop a procurement protocol aimed at reducing the number of LASA medications.
• Raise awareness within the pharmaceutical industry about the importance of clearly differentiating pharmaceutical products.
• Automate the labelling process as much as possible, to avoid repetitive work.

SHORT, TARGETED NEWSLETTERS IMPROVE ADHERENCE TO NATIONAL TREATMENT GUIDELINES

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European Statement

Introductory Statements and Governance

Author(s)

Ane Hornbaek Mortensen

Why was it done?

Previously, a quarterly report showing adherence to national treatment guidelines was issued to all hospital administrations in our region. It was their responsibility to forward this to the appropriate specialists/consultants. This often failed and even when it was done, our experience showed that it wasn’t read by the consultants. Consequently, prescription patterns didn’t change despite the report highlighting the wards that weren’t complying with the national treatment guidelines.

What was done?

Short newsletters including graphs/tables showing the ward’s degree of adherence to national treatment guidelines were emailed to the chief consultant of the specific ward.

How was it done?

In our region a 6-person analytical team, which includes 3 hospital pharmacists, monitors adherence to national treatment guidelines issued by our national council for the use of expensive hospital medicines (RADS). Based on the results, the analytical team decides which newsletters to write. The hospital pharmacists in the analytical team are responsible for writing the newsletters and emailing them direct to the relevant specialist/consultant.

What has been achieved?

It seems as if the introduction of more targeted information has led to more rapidly changing prescription patterns. One example is oral iron chelating agents to hematological patients where a RADS guideline was issued recommending that all new patients should receive deferipron instead of deferasirox. This information was initially issued through the usual channels (via hospital administration) but no change in the use of deferipron/deferasirox was seen. This only happened after emailing a newsletter directly to the chief consultants of the three hematology wards in our region, showing the current use of deferipron/deferasirox and the potential cost reduction. Nine months and three newsletters later the percentage of deferipron use on the hematology wards increased from 2% to 27%, leading to a 22% cost reduction. Target was 25% deferipron (the guideline only covered new patients). The total increase in the percentage of deferipron use on hospitals in our region was 351% compared to an increase of between 0 and 19% in the other four national regions.

What next?

Continued and increased use of targeted communication in the health care system is required to ensure that specific information reaches the relevant players.