IMPLEMENTATION OF AN ATYPICAL MEDICATION ROOM TO OPTIMIZE MEDICATION MANAGEMENT AND REDUCE WASTE AT HERLEV GENTOFTE HOSPITAL, DENMARK
European Statement
Clinical Pharmacy Services
Author(s)
Henrik Kjer, Christina Laustsen, Rasmus Riis, Caroline Rasmussen, Jeanette Bajrami, Christian Rubek, and Steffen Jørgensen
Why was it done?
An atypical medication room (AMR) was established at Herlev Gentofte Hospital, Denmark to centralize the storage and handling of medications not part of the standard assortment (i.e. atypical medication). The project aimed to improve the efficiency of medication management, reduce medication waste, and streamline workflows associated with the use of atypical medicines. To enhance the accuracy and efficiency of inventory control, the ScanPill technology was developed as a tool for digital tracking and updating of medication stock.
What was done?
Atypical medications are often stored across various departments with low turnover, leading to potential waste and time-consuming retrieval processes. Centralizing these medications in an AMR and using ScanPill aimed to reduce waste due to expiry, improve stock management, and simplify medication retrieval for healthcare professionals.
How was it done?
Atypical medications from multiple departments were collected and stored in the AMR. The ScanPill system was developed to facilitate the scanning of QR codes and barcodes on medication packaging, allowing for precise tracking of stock levels and easy updates to the atypical medication list. Staff were trained to use the AMR and ScanPill to ensure smooth transitions in retrieving, returning, and documenting atypical medicines. Regular inventory checks and updates were conducted to maintain an accurate database of available medications.
What has been achieved?
The AMR, supported by ScanPill, led to improved handling and management of atypical medications. The centralized storage reduced the need for duplicate stock across departments and enabled quicker access to necessary medications, reducing retrieval time and potential waste. The ScanPill technology improved inventory accuracy and streamlined the process of checking medication in and out, ensuring up-to-date records. Staff feedback has been positive, noting enhanced workflow efficiency and reduced medication waste.
What next?
Future steps include evaluating the economic impact of the AMR and its effectiveness in reducing medication waste. Efforts will be made to refine the use of ScanPill, enhance staff training, and explore potential applications of the AMR model across other departments. Continuous monitoring will ensure optimal performance and identify further areas for process improvement.
RISK ANALYSIS OF THE ADMINISTRATION CIRCUIT FOR ANTICANCER PREPARATIONS USING THE C-LOG® SYSTEM
European Statement
Patient Safety and Quality Assurance
Author(s)
S. Arraki Zava (1), A. Kandel (1), S. Herioux (1), C. Monpagens (1), L. Capayrou (2), C. Tailhades (1), V. Grenouilleau (1), S. Ferrari (1)
(1) Pharmacy Department, Pau Hospital Center, 64000, France
(2) Quality Department, Pau Hospital Center, 64000, France
Why was it done?
In the current context of rising production of anticancer preparations (AP), our hospital has adopted the C-log® tool to improve the safety and traceability of AP administration.
What was done?
Evaluation of the integration of the C-log® solution into the AP administration circuit in the oncology day ward.
How was it done?
From June to September 2024, a risk mapping (RM) using FMEA (Failure Mode and Effect Analysis) for the AP administration circuit was conducted by a multidisciplinary team (quality and IT departments, hospital pharmacists, pharmacy technicians, logisticians, nurses, and healthcare managers). After evaluating the circuit, failures, their causes and effects were identified. A residual criticality score was calculated (C=F*S*M) for each failure, considering its frequency F, severity S, and level of control M, and classified into 3 categories: acceptable (C<4), vigilance (4≤C<10), unacceptable (C≥10). An action plan was developed with corrective measures (CM).
What has been achieved?
RM identified 39 failures: 34 acceptable, 4 unacceptable, and 1 classified as vigilance. First unacceptable risk was related to disruptive patient episode identifier (PEI) scanning due to wristband opacity. Another came from mismatches between the wristband PEI and that on the AP label, when patients had multiple administration days with different PEIs for each, while AP labels only contained the first PEI. Third one is related to nurse’s lack of training which led them to miss important administration information on the software. The last unacceptable risk was increased time to trace all protocol administrations (checkpoints, premedication, AP…). The vigilance risk was due to the inability to trace anticipated premedication intake on the software.
CM includes the use of clearer wristbands and permanent ID number instead of PEI solving unacceptable failures. We decided to use C-log® for AP administration traceability only, while CHIMIO® remains to trace all other protocol administrations. New training sessions for nurses will be scheduled.
What next?
RM highlighted C-log’s contribution to reinforce identity vigilance. It demonstrated the importance of nurse’s acceptance of the software and therefore the need for sufficient training time on the tool. Focusing on an entire protocol administration traceability, C-log® couldn’t replace CHIMIO® yet. Once all the CM are implemented, the RM will be re-evaluated to assess their impact.
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.
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.
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.
Case-study: Pharmaceutical teleconsultation using a mobile application
European Statement
Clinical Pharmacy Services
Author(s)
Joana Russo, Maria João Ribeiro, Humberto Gonçalves, Joana Ribeiro, Silva Cristina, António Gouveia
Why was it done?
In our country the oncology medication for ambulatory patients is dispensed by the hospital pharmacist (HP). Due to several aspects (i.e., COVID-19 pandemic) the process of distribution of said medication has changed in that the HP and the patient no longer meet face to face (Drive-thru systems, proximity projects in which the medication is sent to a nearby pharmacy of the patients living area). A tool was required that enabled the HPs to continue to monitor the relevant clinical aspects (patient education; medication adherence (MA), drug interactions (DI) and adverse events (AE) evaluation).
What was done?
We used a mobile application (App) to conduct the pharmaceutical evaluation of clinical aspects that need to be considered when dispensing oncology medication.
How was it done?
In collaboration with the Information Technologies department of our hospital, an App was developed. It integrates the patient’s hospital prescriptions and their answers to an adaptive query that identifies cases that need further clinical data We selected a specific drug (ibrutinib) and developed an algorithm that presented the extended questions accordingly. The App was announced to patients that required hospital medication and wanted to receive it through an alternative method of distribution.
What has been achieved?
In little over a year, a total of 1720 requests were received (668 patients). The algorithm was successful in differentiating patients whose evaluation needed to include additional clinical information. In 22 requests, further data was automatically gathered (9 patients) enabling us to evaluate MA, DI and AE. These teleconsultations do not require additional professionals (ie an assistant to register the request) nor a compatible time slot for a pharmacist-patient phone call.
What next?
The results showed that the concept of pharmaceutical teleconsultations through an App is viable and we intend to extend its range to other drugs and to dissociate the teleconsultation from the dispensing request. This approached also showed that proximity between HP and patients was positively affected allowing patients to consult their hospital pharmacist whenever they need to and wherever the patient was.
NEW WEB 2.0. TECHNOLOGIES FOR ANTIDOTE CONSULTATIONS: ACTIVITY AND REACH OF AN APPLICATION FOR MOBILE DEVICES
European Statement
Education and Research
Author(s)
María Mar Alañón Pardo, Sacramento Corral Vinuesa, Raúl Pérez Serrano, Isabel Benet Giménez, Alfonso Ambrós Checa, Álvaro Díaz Castro, Miguel Ángel García Cabezas, Élida Vila Torres, Carmen Encinas Barrios, Marta Rodríguez Martínez
Why was it done?
Acute intoxications cause significant morbidity-mortality worldwide, and their rapid treatment is vital.
APP-Antídotos is the first free Spanish mobile application for toxicology research, designed to facilitate immediate access to relevant information on antidote applications in toxicological emergencies.
What was done?
The “Antídotos” application for mobile devices (APP) was developed by our Departments of Pharmacy, Emergencies, Intensive Medicine and Paediatrics to facilitate consultations by healthcare professionals on the pharmacological treatment of the most frequent acute intoxications in our setting.
How was it done?
The APP contains toxicological data from the “Antidote Guidelines” developed in our third-level university hospital, based on primary (drug information sheets, original scientific articles), secondary (Medline results, using “antidotes”, “poisoning”, “hospital pharmacy department” and “guideline” as search terms) and tertiary (toxicology databases) sources of information.
The Pharmacy Department was responsible for the graphic design, structural development and programming of the APP for mobile devices (smartphones, tablets) with Android or IOS9 operating systems, which could be downloaded free from Google Play or Apple Store.
APP-Antídotos is organized in 31 chapters on different types of intoxication and their definition, mechanism and symptoms, with recommendations on antidotes and references. It is structured in seven sections: “Information”, “Intoxication index”, “Antidote index” (37 antidotes), “Toxin index”(>240 toxins), “Notes”, “See Antidote Book in PDF” and “Telephone for Toxicological Emergencies”.
What has been achieved?
Between April and August 2016, users downloaded 2091 installations from Google Play (72.5%-Android) and Apple Store (27.5%-iOS9); 73.6% of devices were smartphones and 26.4% tablets.
The APP was downloaded from Android in Spain, 55.8%; Brazil, 5.7%; India, 5.5%; Columbia, 4.3%, Mexico, 4.0%; Ecuador, 2.7%; others, 22.0%. The distribution by language/country was: Spanish/Spain, 60.2%; Spanish/USA, 11.1%; English/USA, 7.9%; Portuguese/Brazil, 5.0%; English/UK, 4.7%; Spanish/Mexico, 1.2%; others, 9.9%. The geographic distribution of iOS9 installations was: Europe, 90.5%; Latin-America/Caribbean, 5.9%; USA/Canada, 1.4%; Africa/Middle-East/India, 0.4%, Asia/Pacific, 1.8%.
Mean user evaluations were 4.6 (Android) and 5.0 (iOS9) stars (maximum of 5 stars).
Fifty-four publications were found on social networks (48.2%-Facebook, 51.8%-Twitter), 444 shares, 1094 “I like” and 1045 video plays.
What next?
The APP will be regularly updated by the authors taking user suggestions into account, and it will be translated into English to extend its reach to other healthcare.