INTEGRATING ARTIFICIAL INTELLIGENCE: STREAMLINING MEDICATION HISTORY DOCUMENTATION WITH CHATGPT AT ODENSE UNIVERSITY HOSPITAL
European Statement
Clinical Pharmacy Services
Author(s)
Fjóla Høg Nielsen, Gine Cecilie Stobberup
Why was it done?
The initiative was driven by the need to support a growing number of patients who require medication history. To ensure that pharmacy technicians could complete as many medication histories as possible, have enough time to thoroughly investigate potential issues, and maintain the desired quality of medication history, we initiated the use of ChatGPT to handle the journal note-writing aspect. This initiative was launched in January 2024 and implemented in August 2024.
What was done?
At Odense University Hospital, pharmacists and pharmacy technicians conduct daily reviews of hospitalized patients’ regular medication based on data from the Danish Medicines Agency’s system “The Shared Medication Record”, prescription deliveries, and patient statements. The patient’s usual medications are reviewed to determine what they are taking at home and to identify potential issues, such as compliance problems. A note is written in the medical journal for the attending physician, providing an overview of the patient’s regular medications and any concerns. To improve efficiency and consistency in this process, we implemented the use of ChatGPT to write these notes after the pharmacy technician has completed the medication history, ensuring standardized documentation, increased safety, and for saving time.
How was it done?
ChatGPT was programmed to document the medication history following the standard note format previously used. One of the key challenges was ensuring that ChatGPT could meet the specific documentation needs and minimizing errors in the generated notes. After the initial programming, pharmacy technicians were asked to use ChatGPT and keep track of how many medication histories were written with its assistance, as well as to identify any recurring errors. Based on their feedback, ChatGPT was adjusted to reduce the occurrence of similar errors in future notes.
What has been achieved?
Pharmacy technicians have reported that the time required to complete a medication history has decreased, particularly for patients with long medication lists. The system also ensures that the notes are always written in a consistent manner, reducing the likelihood of missing important information.
What next?
Moving forward, we will continue refining the system to further eliminate errors and improve accuracy. This initiative showcases the successful integration of advanced technology into healthcare, with potential applications across other healthcare settings.
COMPUTER DEVELOPMENT OF THE MAGISTRAL FORMULATION MODULE FOR UNIFICATION OF THE PRODUCTION AREA
European Statement
Production and Compounding
Author(s)
A. Henares-López, V. Collados-Arroyo, C. Mayo-López, R. Fernández-Caballero, L. Carrasco-Piernavieja
Why was it done?
A new magistral formulation and mixes management program was developed in the Farmatools® software to optimize the procedures and records of this area.
What was done?
The correct management of compounded formulation is important for the labor of a pharmacy service, ensuring safe preparation and adequate traceability. In our pharmacy service we only had a simple formula registration program that only allowed formulas to be added to the stock but the rest of the work (protocols, batches, preparation staff, validation) was recorded on paper.
How was it done?
Taking advantage of the implementation of the Farmatools® software in our pharmacy service that already had a simple compounding module, it was necessary to carry out a development to add improvements such as registration of raw materials, quarantine states, expiration notices, creation of manufacturing protocols for each preparation, formula programming calendars, improvement of the traceability system (new batch records and other necessary data in the case of biological material), quality controls such as mass uniformity control for capsules, validation section of the formula prepared for the pharmacist, registration of manufacturing staff, improvement of data present on the manufacturing label.
This work was possible thanks to the help of the farmatools® IT staff with whom we held regular meetings.
What has been achieved?
A correct stock of the amount of real raw materials existing in the pharmacy was achieved, complete computerization of the registry of preparations of magistral formulation, including batches, expiration dates, quarantines and necessary quality control records, creation of an electronic recipe book, approval or rejection of elaborate formulas and eliminating any paper records.
What next?
There are still new developments to be implemented, such as the creation of a calendar of scheduled work and a list that allows viewing the preparations pending validation by the pharmacist. Finally, it would be necessary to implement tablets that contain work protocols to avoid the use of paper.
With this program it has been possible to unify the work of the production area in a single program, which results in an improvement in traceability and fluidity in the work.
Design, implementation and impact on patient safety of a mobile application for patients on antiretroviral therapy
Pdf
European Statement
Patient Safety and Quality Assurance
Author(s)
Esther Chamorro de Vega, Carmen Rodriguez Gonzalez, Belen Mayo Canaleja, María Pilar Montero Anton, Sergio Herrera Bermejo, Rosa Romero Jimenez, Vicente Escudero Vilaplana, Roberto Collado Borrell, Ana Herranz Alonso, María Sanjurjo Sáez
Why was it done?
The profile of patients receiving antiretroviral therapy (ART) has changed. Patients are more active, autonomous and have greater information and communication needs.
Mobile health, especially apps, can help to healthcare professionals to optimize pharmacotherapeutic follow-up and provide patients greater autonomy facilitating communication with healthcare professionals and contributing to the humanization of their care.
Through this application we seek to achieve the following objectives:
– Allow patients to participate in their illness and/or treatment, promoting their compliance and safety and communication with the healthcare professional.
– Strengthen pharmacotherapeutic monitoring of patients receiving ART, avoiding visits to the emergency room and hospital consultations.
– Generate pioneering evidence on the impact of mobile applications on the pharmacotherapeutic monitoring of patients on ART.
What was done?
FarMCuida® is a mobile application designed for a closer and better pharmacotherapeutic monitorization of patients on antiretroviral therapy (ART). Through this app the patient can actively participate in his or her disease and treatment.
How was it done?
A multidisciplinary group was created to design and develop an app called FarMCuida® for patients on ART in a tertiary hospital. Once the app was designed and developed, we offered the app to patients starting or undergoing ART. Identification and inclusion of candidate patients was performed in the Pharmaceutical Care Consultation of the Pharmacy Service. The pharmacists responsible for the Infectious Diseases area performed real-time pharmacotherapeutic follow-up of the patients.
Records of adverse effect (AE) and Safety-related messages received (Adverse effects, interactions, drug administration) can be analyzed. All data can be exported from FarmCuida®. Informed consent is requested from all the patients included.
What has been achieved?
FarMCuida® was designed as a digital health mobile application that allows our patients to participate in their disease and/or treatment, promoting treatment safety, as well as making available a source of information and bidirectional communication, in real-time, between patients and healthcare professionals.
During a period of 13 months, a total of 152 patients were included in FarMCuida®. Seventy-two percent of the patients were diagnosed with HIV infection while 27.6% of them were included in the HIV pre-exposure prophylaxis programme.
In AE module, 58 adverse events (AEs) were registered. Twenty-two percent of the patients registered at least one AE.
Thirty-two percent of patients used the Messages module to communicate with healthcare professionals.
One hundred and twenty-six telematic consultations were carried out. Two hundred and five messages were exchanged between the patient and the pharmacist.
Forty-three percent of the consultations corresponded to doubts about interactions: 66.7% interactions with other drugs, 28.5% with herbal products and 4.8% with vitamin supplements. Three type D interactions and one type X interaction were identified.
In addition, 11% of the consultations corresponded to doubts about the administration of ART while 5.2% were related to adverse effects experienced by the patient.
At least three visits to the emergency department were avoided, resulting in health care and economic savings for the health system.
What next?
Based on the limited studies on the impact of mobile applications on the pharmacotherapeutic follow-up of patients, the results obtained will allow us to generate evidence in this regard. It is worth highlighting the flexibility of FarMCuida® design, being easily adaptable to different pathologies and hospital centres.
Too good to go – sharing medication near expiry with a digital solution
Pdf
European Statement
Clinical Pharmacy Services
Author(s)
Charlotte Sørensen, Karin Aagot Møller Jørgensen, Anne Grethe Nørgaard Kyndi, Charlotte Lund Madsen, Line Scriver Poulsen, Charlotte Hjorth, Gitte Slyngborg Morbjerg, Janni Østergaard Jensen, Mette Juul-Gregersen, Rune Dalsenni Rask
Why was it done?
A sustainability project in 2020 highlighted manual and time-consuming workflows when checking expiry dates in hospital medicine rooms. For example, manual reading, interpretation and notation of expiry dates in paper forms every half year. Therefore, a smartphone application was developed and implemented in a large university hospital in 2022. The application was a huge success and colleagues from other Clinical Pharmacy departments in other hospitals within the same region wanted to be part of the success of the initiative.
What was done?
A smartphone application for managing expiry dates in medicine rooms was applied in one hospital in 2022 and in four other hospitals in 2023. The data-matrix of medicine packages is scanned with a smartphone camera and the application gives a sorted overview of medication near expiry. In the application you can register a medicine package as either used, discarded or released. By releasing medicine packages, the medicine is made available to colleagues in other medicine rooms.
How was it done?
The smartphone application was implemented in Clinical Pharmacy departments in four other hospitals, one by one from February 2023. After implementation the application is used in 373 medicine rooms.
What has been achieved?
Clinical Pharmacy staff are happy with the application. It takes significantly less time to check and scan expiry dates with the digital solution.
From February to September 2023 (five hospitals)
• 47491 packages were scanned
• 5251 packages were released (11%)
• 2664 packages were moved between medicine rooms to avoid medicine wastage (51%; 147000 €). Most activity (78%) was seen at the hospital that had been using the application since 2022. Most packages were moved between medicine rooms at the same hospital; however, in 215 cases (8%), medicines were exchanged between hospitals as well (20.000 €)
• 10918 packages were discarded due to expiry (743168 €; 0.5% of bought medicine).
What next?
The full potential of the digital solution remains to be achieved.
Pharmaconomists have to release medicine in the application a few months earlier than they do now. To go shopping in the application before ordering from the pharmacy, will probably also result in discarding less medicine. Sharing medication across hospitals to a greater extent will also be relevant to consider.
Design, build and implementation of electronic prescribing and medicines administration in neonatal units across four UK hospital trusts
Pdf
European Statement
Introductory Statements and Governance
Author(s)
Holly Jones, Nicola Vosser
Why was it done?
Neonatal units were out of scope during the initial EPMA go-lives due to the complexities in prescribing and the specialist resource required for implementation. This project therefore brought neonatal units in line with all other areas, transitioning from paper drug charts to EPMA. In addition, it supported an ICS wide goal to align practice between trusts, standardising prescribing and facilitating effective use of digital systems in healthcare.
What was done?
A neonatal formulary was developed on an existing Electronic Prescribing and Medicines Administration (EPMA) system shared by four hospital trusts that make up a regional Integrated Care System (ICS). This involved interdisciplinary collaboration and shared decision making to align practice and prescribing guidelines. Complex protocols included continuous variable rate drug infusions, intravenous fluids and parenteral nutrition.
How was it done?
Key guidelines were shared with a collaborative approach to identify and harmonise differences in local practice, including syringe volumes and dose calculation ‘factors’. The EPMA team (comprising specialist pharmacists and medicines management technicians) completed a thorough gap analysis of the existing adult and paediatric drug catalogue and managed all new build work for neonates. Clinical decision making and validation were multidisciplinary tasks with input from specialist clinicians, pharmacists and nurses. Training, go-live planning and implementation were led by the EPMA team.
What has been achieved?
A bespoke neonatal medication build has been successfully implemented, supporting safe and efficient prescribing in neonates across the ICS. The development provides the ability to prescribe medications and document administration clearly and safely, including adjustment of infusion rates. Clinical pharmacists have full visibility of this information and are able to accurately complete pharmacy reviews, interventions and verification. In addition, alignment of practice and standardisation of care has been reached across the ICS, with benefits to both staff and patients.
What next?
The neonatal build is updated and optimised based on feedback from users to maintain the usability and safety of the system. Development of electronic fluid balance charts for neonates, including drug infusion volumes, is also in progress. Details of the neonatal project are being shared with other UK hospital sites using the same EPMA system.
Digital transformation of injectable ophthalmic medication circuit: enhancing safety and efficiency
Pdf
European Statement
Patient Safety and Quality Assurance
Author(s)
Catarina Diogo, Rui Caceiro, Maria Helena Duarte, Armando Alcobia
Why was it done?
The core objective of healthcare institutions is to ensure patient safety and maintain the highest quality of care throughout every medical procedure.
This principle must extend to the drug circuit as well. Within our hospital, pharmaceutical services have a dedicated route for producing injectable ophthalmic medications, serving 795 patients and yielding 3720 solutions, in 2022. However, the existing paper-based procedure for medication management is laborious, time consuming and error-prone, demanding full-time constant pharmacist involvement to ensure the secure progression of these medications.
What was done?
A software application was developed on the Power Apps platform to streamline medication management for injectable ophthalmic medications. This application aimed to replace manual paper-based procedures with digital solutions, enhancing efficiency, reducing errors, and providing a comprehensive platform for patient registration, prescription tracking, schedule management, and oversight of injectable solutions’ production.
How was it done?
Over two months, needs of pharmaceutical and ophthalmology services were assessed, soliciting input from pharmacists, ophthalmologists, nurses and administrative personnel. Subsequently, a software application was developed featuring four distinct interfaces, customised for each professional group involved. This application enables patient registration, medical prescription, schedule management and monitoring the injectable solutions’ production – prescription and agenda validation, batch management and generation of identification labels.
This project is presented, therefore, as a customised digital solution, the result of a multidisciplinary collaboration.
What has been achieved?
It is the authors’ belief that this software has allowed for the development of a safer, more efficient, and integrated workflow, as an alternative to paper – which is more prone to errors. In this manner, from a pharmaceutical perspective, it simplifies the workflow, freeing the pharmacist to focus on other important tasks and optimizing personnel management. Furthermore, it is also valuable for ophthalmologists, enabling prescription repetition and access to patient history, as well as for administrative staff, streamlining schedule management. In conclusion, this software is set to transform our injectable ophthalmic medication circuit.
What next?
Further studies confirming its advantages are needed. Its validation would establish its potential and applicability across healthcare settings.
Towards e-documentation of clinical pharmacist interventions
Pdf
European Statement
Clinical Pharmacy Services
Author(s)
Andrea Bor, Nóra Gyimesi, Eszter Erika Nagy
Why was it done?
Intervention-oriented classification systems are helpful tools to document the CPIs in a structured manner. Our aim was to develop a clinical pharmacy platform in the e-documentation system at our institution. This CPI data enables healthcare providers to track medication history, and to systematically analyse the effectiveness and the pharmacoeconomic benefits.
What was done?
A pilot survey was conducted on the traumatology wards to analyse and describe our clinical pharmacist interventions (CPI) based on severity and clinical relevance.
How was it done?
Three clinical pharmacists collected data on the changes of drug therapy at two 31-bed traumatology wards during pre- and postoperative period. We adopted the CPI classification system to our daily practices. This is challenging since the narrow time frame between patient admission and discharge often limits the opportunity to provide clinical pharmacy services. Raw data was previously screened and classified into 5 categories, drug related problems (DRP), clinical pharmacist intervention (CPI), significance (S), outcome (O) and acceptance (A).
What has been achieved?
We have established a data collection process, which allows us to record CPIs in our daily clinical environment in an efficient manner.
The most significant DRPs were incorrect dosage regimen (n=47), untreated indication (n=28), contraindication (n=25), excessive dose (n=19), subtherapeutic dose (n=17), drug interaction (n=15), no indication (n=11), experiencing adverse drug reaction (n=8), failure of drug administration due to shortages (n=5).
CPIs were divided into four groups:
1. Pharmacokinetic cause (dose adjustment, changes of drug dosage regimen, drug discontinuation, drug switch, etc.)
2. Pharmacodynamic cause (adding new drug, drug switch, – discontinuation, etc.),
3. Providing drug information (patient education, new drug, changes of administration route, etc.) and
4. Miscellaneous.
Significance were categorised as major (e.g. oral anticoagulant – LMWH switch, postoperative opioid use), moderate (e.g. loop diuretics – ion supplementation), minor.
Outcomes were therapeutic success, prevention of potential harm (e.g. adverse drug reaction) or cost saving.
73% of the interventions were accepted, the rest were rejected for the first time, but nearly half of them were admitted after minor modifications.
What next?
This CPI platform should be shared in the national digital health system.
Implementing machine learning techniques to estimate the impact of underdosed DOACs, and aim patients at high bleeding risk in an elderly frail population treated for atrial fibrillation
Pdf
European Statement
Clinical Pharmacy Services
Author(s)
Dorian Protzenko, Vincent Hoang, Guillaume Hache
Why was it done?
We unveiled during an audit that, in the past 2 years, 19% of our hospital DAOCs prescriptions were underdosed: due to the population profile (old, frail), the conventional bleeding risk scores were consistently high and, as such, not informative. To avoid a hypothetical bleeding risk, physicians were randomly underdosing patients beyond guidelines, without any evidence regarding the efficacy.
What was done?
Using machine learning, we unveiled that underdosing direct oral anticoagulants [DAOCs] to prevent bleeding risk in an old and frail population had no significant impact on drug-related hospitalization [DRH] nor death, and cannot be supported. To help targeting patients for whom extra care would be more beneficial rather than underdosed DAOCs, we built a predictive model of bleeding events and provided risk factors among our population.
How was it done?
We performed a retrospective study, based on data collected during the audit, of patients treated between October 2020 and April 2022 with Apixaban or Rivaroxaban for atrial fibrillation [AF]. Demographic and clinical criterias (i.e., GFR, polypathology, co-medications, prescribed DAOC, respecting dosage and scheduling) were collected. The occurrence of specific outcomes (i.e., bleeding and thrombosis that led to medical care and drug seizure, DRH and death) were retrieved from the patients’ medical records. Machine learning explorations were performed using RStudio®.
What has been achieved?
119 patients were included. We modeled using logistic regression the impact on selected outcomes of underdosing DAOCs. We found out that underdosed DAOCs were associated with a lower bleeding risk (OR=0.30, CI95%[0.07;0.95]), a higher thrombosis risk (OR=6.67, CI95%[1.23;50.0]), but without any impact on DRH nor death. Unsupervised algorithms unveiled that DAOC choice (Rivaroxaban: OR=2.80, CI95%[1.15;7.13]), sex (Male: OR=0.44, IC95%[0.16;1.12]) and using dosages from guidelines (OR=3.32, CI95% [1.05;14.80]) were predominant explanatory variables regarding bleeding risk. The choice of DAOC was the only covariate that impacted DRH (Rivaroxaban: OR=2.78, CI95%[1.22;6.56]). Finally, using a gradient-boosting algorithm, bleeding risk was predicted with a 0.73 roc-auc, superior to conventional models.
What next?
Therapeutic education of patients and caregivers, telephone follow-up or pharmaceutical consultations will be implanted for patients at high bleeding risk. An audit will be performed next year to measure underdosed prescriptions rate, and improve the model with new data.
Smartphone application for managing expiry dates in medicine rooms and reduction of medicine wastage
Pdf
European Statement
Clinical Pharmacy Services
Author(s)
Charlotte Arp Sørensen, Karin Aagot Møller Jørgensen, Anne Lund Sørensen, Rune Dalsenni Rask
Why was it done?
Clinical Pharmacy pharmaconomists perform a wide range of tasks at the hospital for example, medicine service with medication ordering, placement and checking of expiry dates. A sustainability project in 2020 highlighted manual and time consuming workflows, for example, manual reading, interpretation and notation of expiry dates in paper forms, when medicine rooms are reviewed for medicine that expires within the next half year. The dream of an easily accessible digital solution arose to make workflows more flexible, modern and sustainable.
What was done?
A smartphone application for managing expiry dates in medicine rooms and reduction of medicine wastage was applied.
With the application, the smartphone camera can be used to scan the data-matrix of medicine packages and get a sorted overview of medicine and its expiry dates. In the application you can register a medicine package as either used, discarded or released. By releasing medicine packages, the medicine is made available to colleagues in other medicine rooms at the hospital.
How was it done?
A smartphone application was developed in close and synergistic collaboration between software engineers, pharmaconomists and pharmacists. The smartphone application was initially tested in small scale, and then adjusted and implemented among pharmaconomists and pharmacists to be used in up to 129 medicine rooms at the hospital from January 2022.
What has been achieved?
The application creates value for the Hospital Pharmacy, the Hospital and the society because:
– It takes significantly less time to check and scan expiry dates
– We avoid misinterpretation of expiry dates; and
– By releasing medicines to be used in other medicine rooms, the application makes it easier for us to work sustainably. In nine months, 1700 packages with a total cost of
€121.000 has been moved between medicine rooms in an attempt to avoid medicine wastage.
At the hospital we have a mutual medicine budget. Therefore, it makes good sense to move medicine between medicine rooms to get the most health for the money.
What next?
Implementation of the smartphone application among pharmaconomists in other hospitals within the same region is considered. Also other hospital pharmacies in the country have shown their interest. In addition, a similar application for utensils is under development.
Software tool development for reconstitution and administration of parenteral antibiotics in hospitals: an international project
Pdf
European Statement
Patient Safety and Quality Assurance
Author(s)
Zora Ćetković, Dragana Rajinac, Ivana Baralić , Jelena Marković, Darija Kuruc Poje, Miroslav Kota, Špela Urh, Irina Tegelj, Vesna Bizjak, Dragana Mitrić, Tijana Kovačević, Andrej Pečet, Irena Radivojša, Sanja Filkova, Vesna Bašić-Milošević
Why was it done?
Medication errors regarding reconstitution and administration of parenteral antibiotics are frequent in hospitals. In our study conducted in 12 Southeastern European hospitals in 2021, we demonstrated the need of parenteral antibiotic reconstitution/dilution database in hospital pharmacy practice. Moreover, according to European Statements of Hospital Pharmacy (statement 5.5.), implementation of electronic decision support system by HPs should help to decrease the risk of medication errors. The purpose of software tools is to gather all relevant information regarding parenteral antibiotic reconstitution/dilution and make them easily accessible.
What was done?
A group of hospital pharmacists (HPs) from 6 Southeastern European countries created new software tools (a mobile-responsive website and mobile applications for Android and iOS) for providing information on reconstitution and administration of parenteral antibiotics in collaboration with software developer. These tools contain parenteral antibiotic reconstitution/dilution database in seven different languages (English, Serbian, Croatian, Slovenian, Bosnian, Macedonian and Montenegrin).
How was it done?
Technical requirements for website and mobile applications were designed by HPs. The development of these software tools was carried out by a software developer and funded by European Association of Hospital Pharmacists (EAHP). The final version of the software went through a rigorous evaluation, conducted by HPs during development and all technical problems were resolved consequently.
What has been achieved?
· Designing and developing these software tools helps HPs to provide evidence-based information about parenteral antibiotic reconstitution/dilution at the point of care, thus improving decision-making process and patient safety. · Reconstitution of parenteral antibiotics in wards is efficient and smooth. · Oral and written instructions for parenteral antibiotic reconstitution/dilution are replaced by electronic decision support tools, designed to prevent medication errors. · HP’s interventions are required to support the use of these software tools.
What next?
Our next challenge is wider use of these software tools in order to ensure the appropriate reconstitution/dilution of parenteral antibiotics in wards by nurses and physicians. These software tools are applicable in hospital setting and can be used by all regional hospitals. Additionally, they can be easily incorporated in hospital information system. We also plan to update periodically antibiotic reconstitution/dilution database, as new information becomes available.