INFLUENCE OF INTEGRATION OF A PHARMACIST IN MEDICATION ERRORS IN CRITICALLY ILL PATIENTS
Pdf
European Statement
Patient Safety and Quality Assurance
Author(s)
A. Valladolid-Walsh, E. Domingo-Chiva, P. Cuesta-Montero, J.A. Monsalve-Naharro, E.M. García-Martínez, S. Plata-Paniagua, M.D. Pardo-Ibañez, G. Romero-Candel, J.M. Jiménez-Vizuete, R. Peyró-García
Why was it done?
To determine the incidence of medication errors in our environment and implement enhancement systems to prevent them, which is a priority for the improvement of the drug treatment process in critically ill patients.
What was done?
A clinical pharmacist was integrated on a full time basis into the multidisciplinary team of an anaesthesia intensive care unit (ICU).
How was it done?
The project was carried out in 3 different stages:
– First stage: a prospective observational study was carried out over 1 month to detect medication errors in anaesthesia ICU and to determine the baseline situation before the pharmacist´s intervention. During this stage, 36.27% errors were detected in overall treatments.
– Second stage (intervention stage): Over 10 months, the pharmacist reviewed the prescriptions of all patients admitted to the anaesthesia ICU, performing the appropriate interventions regarding medications. Furthermore, to educate physicians and nursing staff, we organised educational meetings, and also pharmacotherapeutic protocols and guidelines of medication administration were created to standarise clinical practice. Finally, a system for reporting medication errors was introduced.
– Third stage: a prospective observational study was carried out for 1 month to detect medication errors after the pharmacist’s intervention. During this stage, 5.9% of errors were detected in overall treatments.
What has been achieved?
– Medication errors were reduced by more than 30%.
– A pharmacist is now part of the multidisciplinary team in the ICU.
– The experience has been broadcast to the national level to promote the implementation of clinical pharmacist activities in our environment.
What next?
We are still working on the same areas to improve safety in drug therapy in critically ill patients. Currently, improvement measures that are being developed are: new pharmacotherapeutic protocols specifically for this unit; drugs and drug-diluent compatibility guidelines; new training sessions; standarised medication kits in operating rooms and implementation of the computerised prescription; and a new labelling system for syringes.
IMPLEMENTATION OF A SAFETY AND HEALTH PROGRAMME FOR THE MANAGEMENT OF PATIENTS WITH HEPATITIS C RECEIVING TREATMENT WITH DIRECT ACTING ANTIVIRAL AGENTS
Pdf
European Statement
Clinical Pharmacy Services
Author(s)
S. IBAÑEZ GARCIA, C.G. RODRIGUEZ-GONZALEZ, A. GIMENEZ-MANZORRO, E. CHAMORRO DE VEGA, R. COLLADO-BORELL, E. LOBATO-MATILLA, A. DE LORENZO-PINTO, M. TOVAR-POZO, A. HERRANZ-ALONSO, M. SANJURJO-SAEZ
Why was it done?
CHC affects approximately 3% of the world’s population. The development of well tolerated and effective AADs has changed the therapeutic landscape. These therapies have a high efficacy with a good safety profile. Numerous challenges in terms of patient education, monitoring, medication errors, drug interactions and adherence exist. Our National Health System launched a strategy plan for proper CHC management in April 2015, establishing, among other things, measures to optimise AAD use.
What was done?
We have developed a pharmaceutical care programme.
I. The following protocols were defined:
– A case selection and treatment guideline, following the recommendations from health authorities.
– A protocol for the management of drug interactions.
– A protocol with recommended dosages and administration techniques.
– A protocol with potential adverse drug events and recommendations about how to prevent and manage them.
– A protocol about clinical interview to ensure patient literacy and co-responsability.
– Patients information leaflets.
II. The pharmacy department was provided with:
– 3 full time pharmacists.
– 2 patient information offices.
– a queue management system.
III. Appointment scheduling:
Pharmacy visits were scheduled after the hepatologist/infectious disease specialist appointments every 28 days.
IV. The clinical interviews were documented in the electronic health record.
How was it done?
A multidisciplinary team was formed with two hepatologists, one infectious disease specialist, three clinical pharmacists and one nurse to:
– Address the key points associated with the safe and efficient use of AADs.
– Create a useful clinical guideline.
– Identify staffing and logistics needs.
What has been achieved?
No of patients included in the programme: 674
No of initial visits: 674
No of follow-up visits: 1750
No of patients attended/day: 19.9
No (%) adherent patients at the end of treatment: 412/412 (100%)
No of pharmacist interventions: 195
No (%) pharmacist interventions accepted: 194 (99%)
Average waiting time to be attended by the pharmacist: 15 min
No of queries made to the hospital pharmacist: 84
No of adverse drug events reported to the pharmacovigilance centre: 31
Cost savings (€): 121 194
What next?
This initiative provides a set of recommendations regarding CHC management and a support guide to standardise and guarantee high quality pharmaceutical care.
The next step is to develop pharmaceutical care programmes for the management of other pathologies following the same methodology that we have used for this initiative.
Medication reviews conducted by clinical pharmacist in emergency ward
Pdf
European Statement
Clinical Pharmacy Services
What has been achieved?
.
CONTINUITY IN PERIOPERATIVE MEDICATION MANAGEMENT
Pdf
European Statement
Patient Safety and Quality Assurance
Author(s)
A. Navarro-Ruíz, C. Matoses-Chirivella, J.M. Del Moral-Sánchez, M. Morante, F.J. Rodríguez-Lucena, R. Gutiérrez-Vozmediano, A. Martínez-Valero, A. Andújar, E. García-Iranzo, A. Martí-LLorca
Why was it done?
There is evidence of discontinuity medication between different health care levels. In fact, on admission to hospital, up to one in two patients has an incomplete medicine list , resulting in a medicine not being administered during the hospital stay. This situation could be associated with an increased risk of hospital readmission or adverse drug reaction (ADR). Some studies show that an elevated percentage of surgical patients take medications prior to surgery, cardiac medications principally, but almost 50% of the drugs are omitted on the day of surgery.
What was done?
To develop a guideline to achieve the continuity of quality use of medicines between hospital and community in surgical patients.
How was it done?
The lack of medical evidence is reflected by the large variation in perioperative management recommendations among several group of experts. The recommendations in this guideline are to a large degree expert opinion, based on information from other reviews and textbooks, along with clinical experience. After a thorough review, the guide has obtained the consent of the Commission of pharmacy and therapeutics of the hospital.
What has been achieved?
The guide of conciliation of the medication includes a medication review structured according to the classification made by WHO ‘Anatomical, Therapeutic, Chemical classification system’. In each one of them, including the benefits and risks of continuing with this therapy during the perioperative process. It also includes various annexes, on antihypertensive, glucocorticoids and medicinal plants.
What next?
In the future, we would recommend prioritising the conciliation to the discharge with respect to other points of transition assistance, since the potential severity of an error of conciliation not intercepted the discharge of the patient is greater than if it occurs within the hospital.
INTEGRATED ONCOLOGY PHARMACY UNIT IN MULTIDISCIPLINARY TEAM
Pdf
European Statement
Clinical Pharmacy Services
Why was it done?
There was a previous collaboration between the pharmacy and medical oncology but with many problems due to the physical separation between the two units. There was a lack of knowledge of the needs of both services.
What was done?
To provide integral cancer care to the patients. We prepare the standard or investigational treatments the day of analysis and medical consultation. In the pharmacy consultation, we provide information and training to patients and their caregivers about the use of antineoplastic, evaluate their polytherapy and complementary and alternative therapy, drug interactions, conciliation, dispense doses and adjusted to help improve treatment and adherence and tolerance amounts.
How was it done?
Change of hospital, creation of new onco-hematology unit(2003), good feedback, and integration in clinical sessions.
What has been achieved?
The pharmacist reviews each chemotherapy order in relation to all known factors concerning the patient. If questions arise, the physician originating the order is contacted. Orders are verified with a protocol, standard regimen or standard dosing guidelines. The oncology pharmacist contributed to the design of chemotherapy protocols by electronic prescribing program (Farmis_Oncofarm®) and supportive care protocols. Activity (2013):22.770 preparations of intravenous chemotherapy, 9.651 patients consulting pharmacy. Reusing cytostatics in a centralized pharmacy preparation unit (Nplate®saving:129.910€(31.7%)), the preparation of parenteral mixtures at the pharmacy department minimises costs compared to preparation on wards (estimated saving 2.500.000€).The unit is also actively engaged in clinical trials (166 trials) and other research projects (pharmacogenetics and adherence with electronic monitoring system) with several publications (∑IF=84). It is a reference model clinical and teaching, oncology pharmacy unit is a preceptor to residents, staffs of other hospitals. Realisation of the annual attendance course. Unit Growth: 2 oncology pharmacist(BCOP),1 haematology pharmacist (BCOP),1 paediatric pharmacist, 3 nurses,1 technician and 1 investigator. Implantation of Standard UNE 179003 on Risk Management for Patient and ISO9001. 0.5 % errors and avoiding incidents. High average patient satisfaction(93%).
What next?
Allow direct patient interaction through a econsultation platform and twitter. A staff preceptorship and traceability system for the preparation and administration(barcode) implement.