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IMPROVING STAFF TRAINING IN A CYTOTOXICS PREPARATION UNIT

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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.

WHY NOT CHANGING PDCA BY PTDCA FOR REALIZING HOSPITAL PHARMACY PROJECTS

A NATIONALLY COORDINATED APPROACH TO DEVELOPING HOSPITAL PHARMACY SERVICES IN DENMARK

European Statement

Introductory Statements and Governance

Author(s)

L. Jeffery

Why was it done?

Approximately 450 people work within clinical and ward pharmacy in hospitals in Denmark. Despite Denmark being a relatively small country, these services have developed at differing paces, and sometimes in different directions. The initiative was set up to coordinate development and innovation in this field, across the whole country.

What was done?

A national group was established to coordinate and develop clinical and ward pharmacy services throughout Denmark. The working group consists of pharmacists and pharmaconomists representing the eight hospital pharmacies in Denmark.

How was it done?

In 2012/2013 fifteen people representing pharmacists and pharmaconomists from the five Danish regions were selected to the working group. These people were typically known to be experienced drivers of innovation and development in the field of clinical and ward pharmacy. The working group meets quarterly and additional work is carried out between meetings. There are no extra resources available to members of the group or their workplaces.

What has been achieved?

The group has produced and implemented minimum standards for ward pharmacy across Denmark. Benchmarking has been carried out using these standards and the baseline has been set. Progress will be measured regularly.

New standards for how often medicine shelf-life checks should be carried out on wards have been developed, resulting in the task being carried out less frequently on most wards, thus releasing resources to more clinically related tasks, at a time where extra resources are scarce.

Two national networking days for pharmacists and pharmaconomists have been held, where good initiatives are shared to all the regions and hospital pharmacies in Denmark.

What next?

The group is working on national standards for competency development of clinical pharmacy staff. Other logistics tasks will be scrutinized to see whether resources can be found for further investment in clinically related activities.

More benchmarking will be carried out, measuring other clinical and ward pharmacy activities throughout Denmark.

The work has just begun!

IMPLEMENTING PHARMACIST PRESCRIBING AT SCALE ACROSS A UNITED KINGDOM NHS HOSPITAL TRUST

European Statement

Introductory Statements and Governance

Author(s)

D. Campbell, W. Baqir, O. Crehan, R. Murray, N. Wake, R. Copeland

Why was it done?

Supplementary prescribing was implemented as an attempt to reduce prescribing errors at the point of admission. Pharmacists working in more ‘traditional’ clinical roles would identify errors and then ask junior doctors to correct the mistakes made. Not only did this expose patients to unnecessary risks but this was an inefficient use of resources. Prescribing allowed pharmacists to work much more autonomously.

What was done?

Our initiative was to implement pharmacist prescribing across an NHS hospital trust. We focused on developing and using generalist prescribing pharmacists to enhance their current ward based role. We have adopted an “anytime, anywhere” approach to prescribing, where the prescribing pharmacist, like their medical counterparts, can prescribe any medicine, for any patient, for any condition and in any setting.

How was it done?

Pharmacist supplementary prescribing commenced on a single ward, with staff working within a care plan, managing patients. Independent prescribing allowed prescribing service to be rolled out across the Trust. We now expect all pharmacists to obtain a prescribing qualification as a condition of employment. The pace of development was very much dependent on the rate at which pharmacists could be trained.

What has been achieved?

Supplementary prescribing on the admissions unit showed 39% (127/326) of patients audited were prescribed medication that otherwise would have been omitted. In 2014, of the 49 pharmacists employed, 29 (59.2%) are actively prescribing, with seven also having specialist roles. Seven pharmacists (14.3%) are currently in training. An audit of prescribing showed that pharmacists prescribed for 40% (182/457) patients accounting for 13% (680/5279) of all items. In a separate audit, 4 (0.3%) errors from 1413 items prescribed were detected.

What next?

This process has become embedded across our Trust. Regionally, other Trusts agreed a workforce strategy which included the development and deployment of prescribing pharmacists in the way we have described above.