PREPARATION OF A COMPATIBILITY CHART IN “Y” FOR AREAS OF CRITICALLY ILL PATIENTS
European Statement
Clinical Pharmacy Services
Author(s)
Gregorio Romero Candel, Esther Domingo Chiva, Laura Rodenas Herraez, Cristina Urbano, Jose Marco del Rio, Nieves Cuenca Cano, Maria Jesus Sanchez Cuenca, Antonio Sanz Arrufat, Ana Valladolid Wals, Angel Escudero Jimenez
Why was it done?
In the areas of critically ill patients such as emergency, intensive care and resuscitation, the use of intravenous drugs (IV) in “Y” are common in clinical practice. Stability and physical-chemical compatibility of IV drugs admistered in “Y” are important, affecting directly the safety of patients and the therapeutic efficacy of medicines, which can lead to medication errors (ME). A quick reference chart was developed in order to facilitate the administration of these drugs and reduce errors in these areas.
What was done?
A chart for quick reference of compatibility of drugs in “Y” for the most commonly used drugs in the areas of critically ill patients of our hospital.
How was it done?
It was a team composed of a doctor specializing in emergency medicine, a nurse and two hospital pharmacists. Economic management of pharmacy program Farmatools® was used to obtain the list of drugs most consumed and those most relevant and specific of these areas were selected.
A chart was made where the header of the rows and the columns was the list of drugs in the study. Finally, we conducted a systematic research on Micromedex® “Y” compatibility with each drug with the remaining, completed the chart with a visual color code: green (compatible), red (incompatible), white (not tested) and orange (precaution, existence of various stability dilutions and consult your pharmacist).
What has been achieved?
The elaboration and implementation of this table will provide a fast and visual consultation instrument to nurses before the administration of drugs in “Y”. This tool intended to facilitate decision-making, contributing to increase the effectiveness of the drugs and avoid possible adverse reactions in patients, increasing the quality of care and lowering the ME.
What next?
We are still working on the same areas to increase safety in drug therapy in critical care. Currently, that improvement measures that are being developed are: new pharmacotherapeutic protocols specifically for those units: high risk medications perfusion protocols and new safety guidelines.
EMERGENCY DEPARTMENT PHARMACY ROTATION, WHAT IS A PHARMACY RESIDENT DOING HERE?
Pdf
European Statement
Patient Safety and Quality Assurance
Author(s)
Nuria Monteagudo-Martínez, Ana Valladolid-Walsh, Gregorio Romero-Candel, Esther Domingo-Chiva, Jose Marco-del Río, Marca Diaz-Rangel, Francisca Sanchez-Rubio
Why was it done?
To acquire clinical skills in this setting and detect and prevent medication errors. It is also an area in which pharmacists had previously never participated in our hospital and it was an opportunity to integrate in this multidisciplinary team.
What was done?
Hospital pharmacy specialization programs include one year of rotations in clinical areas. The emergency department (ED) was chosen in order to develop a program to detect and prevent medication errors as a part of a multidisciplinary team.
Other tasks such as organizing drug storage, drug labelling and conservation, nurse counselling and education on issues related to medication were developed.
How was it done?
The pharmacy resident completed a rotation period based on the national educational program in clinical areas. Over a two month rotation period she reviewed treatments (61 patients, detecting 67 medication errors), organized and labelled drug storage, listed and identified thermolabile drugs, participated in a protocol design,…
What has been achieved?
The resident was able to improve care in acute patients in the ED. The most common errors found and prevented were: missed doses (25.3%); incorrect form to administer the drug (incompatibility diluent, infusion rate…) (13.4%); drug interaction/incompatibility (8.9%) and others.
The resident was able to organized refrigerator drug stored and developed a protocol to explain how to act in case of fridge failure.
What next?
To try to implement an ED-based clinical pharmacist program in order to detect and manage medication errors to improve safety in drug therapy, as well as to contribute to patient care with a different point of view from clinicians.
HOSPITAL PHARMACY CONTRIBUTION TO CLINICAL TRIALS: TYPIFICATION OF MEDICATION INCIDENTS AND PHARMACEUTICAL INTERVENTIONS IN A CLINICAL TRIAL UNIT
Pdf
European Statement
Patient Safety and Quality Assurance
Author(s)
Paula Arrabal-Durán, Carmen Herrero-Domínguez-Berrueta, María Norberta Sánchez-Fresneda, Ana Mur-Mur, Ana Herranz-Alonso, María Sanjurjo-Sáez
Why was it done?
MI and PI are normally recorded in Hospital Pharmacy Services as a method for evaluating safety. Nevertheless, classical methods for reporting MI do not allow for a correct classification in the field of clinical trials. The reason is their more complex processes involving drugs compared to the processes in daily clinical practice. If there are no specific categories, the information obtained by recording usually gets lost and could not reflect exactly what occurred. In September 2016, a clinical tool to notify MI and PI was implemented in the Pharmacy Service, with the aim of unifying their classification criteria and gathering complete information for analysis and further implementation of improvement measures.
What was done?
A database to notify medication incidents (MI) and pharmaceutical interventions (PI) in the Clinical Trials Unit was developed in the Pharmacy Service of a tertiary hospital.
How was it done?
All the processes involving drugs in clinical trials were evaluated by a Failure Mode and Effects Analysis (FMEA). For each process, the possible incidents and their resulting effects on the patient were recorded. After that, a database was designed in Microsoft® Access with defined lists of choices to allow pharmacists notify both MI and PI that occur in the Clinical Trials Unit.
What has been achieved?
A database with the following information has been implemented:
a) Identification of the MI:
1. Date of the MI.
2. Number of patient.
3. Clinical Trial protocol.
4. Investigational product.
b) Process in which the MI took place (16 options).
c) Process in which the MI was detected (16 options).
d) Process that caused the MI (24 options).
e) Person who detected the MI (9 options).
f) Did any PI take place? (Yes/No).
g) PI performed (12 options).
h) Did the MI reach the patient? (Yes/No).
i) MI that reached the patient (21 options).
j) Patient outcome (8 options).
k) Effect in the clinical trial (4 options).
What next?
The implemented notification system will be further expanded and adapted over time.
Future aim is to analyse MI for establishing improvement measures and checking their results.
ELECTRONIC RECORDING OF MEDICATION RECONCILIATION AS A RELIABLE REFERENCE FOR MULTIDISCIPLINARY CARE
Pdf
European Statement
Clinical Pharmacy Services
Author(s)
C. Bilbao Gómez-Martino, M.I. Borrego Hernando, A. Santiago Pérez, M.P. Pacheco Ramos, A.E. Arenaza Peña, L. Zamora Barrios, E. Rodríguez del Río, J.C. Tallón Martínez, Á. Nieto Sánchez, M.L. Arias Fernández
Why was it done?
MR has been proven to reduce medication errors at admission. If there are no electronic records of PCM, the information obtained by MR usually gets lost and could lead to repetition of errors.
What was done?
We provided electronic updated reports of patients’ current medications (PCM) after performing medication reconciliation (MR) at admission, although the electronic medical record (EMR) is not yet developed in our hospital.
How was it done?
The procedure, designed in the framework of a pilot MR programme, was gradually implemented in three hospitalisation units: internal medicine, geriatrics and oncology.
In order to make the medication reconciliation reports (MRR) reliable, the pharmacist consulted primary care prescriptions and at least two other independent sources of information, such as: emergency department’s admission report, previous clinical reports, self-reported medication list or the medication itself, if possible. The information was confirmed by a standardised clinical interview. Medication discrepancies were clarified by specific closed ended questions. The rest of treatment was investigated by open ended questions.
MRR included current chronic medication, relevant medications administered on demand, herbal medicines used for therapeutic purposes and other relevant data (inappropriate medications, interactions, dysphagia, adherence). Sources of information were also detailed.
MRR were integrated within the electronic hospitalisation reports, which were easily accessible via the hospital intranet.
At discharge, printed copies of reports were handled to patients.
What has been achieved?
99 MRR were recorded. 751 PCM were registered and 183 MR errors (MRE) were detected.
We contribute to the ‘best possible medication history’ of patients. This initiative might have improved patient safety by reducing discharge and readmission MRE, although it has not yet been measured.
We enhanced the pharmacist’s role in the multidisciplinary team.
What next?
This model of electronic MRR could become a useful reference for healthcare professionals, until the EMR is implemented. The next aim is to register MRR and all pharmaceutical care information in the EMR to improve our patients’ healthcare.