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Author(s)

A. Frisch, D. Scharlemann-Moenks, K. Heinitz, R. Frontini

Why was it done?

Limited resources require optimisation of pharmacists’ interventions (EAHP Statement 1.3). Due to the limited number of clinical pharmacists (5/1350 beds) only a few wards were served by the pharmacy. We aimed to improve the effectiveness by covering selected patients in all wards and compared the results with a classic visit.

What was done?

Instead of visiting all patients in selected wards, pharmacists focused on patients with critical renal insufficiency across all wards.

How was it done?

The central laboratory identified patients as high risk when their glomerular filtration rates were <30 ml/min, and alerted the pharmacy via email. For those patients, the renal pharmacist analysed the prescribed medication at least twice weekly throughout their hospital stay for medication errors, dosing and interactions, and suggested alternatives where necessary. Interventions were discussed either directly with the doctors or by written advice. The major obstacle was the fact that clinical services by pharmacists were unknown in most wards and that some of the doctors were sceptical about the pharmacist`s competency. We overcame these obstacles by intensive collaboration with the nephrology department.

What has been achieved?

Over 20 months involving 4229 visits, the renal pharmacist analysed the medication of 2125 patients who had 11 different drugs on average. The pharmacist assessed 47 584 medications, resulting in 2900 interventions, of which 1292 were renal and 1608 other. The most common interventions for renal patients were dosage adjustments (20%), contraindications (16%) and interactions (10%). Overall, the number of interventions (6.1% of medication items) and their severity across all renal insufficiency patients exceeded those on the visceral surgical ward (2.4%) over the same time as a comparator, confirming the higher effectiveness of the intervention.

What next?

To conduct further studies on medication safety, we established a centre for drug therapy safety in collaboration with the faculty of pharmacy with the aim of discovering valid criteria for identifying other high risk patients.

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Author(s)

T. De Rijdt

Why was it done?

Medication errors find their origin mostly in prescribing, transcribing and administration of medication. Only 4 % of the errors occurs in the pharmacy process. As we covered the major reasons by deployment of a electronic prescribing system with decision support and bedside scanning before administration the next step in augmenting patient safety is preventing dispension errors in the pharmacy.

What was done?

All medication orders from the electronic prescribing system are revised by a hospital pharmacist for appropriateness and send to a set of handheld barcode scanners for guiding the pharmacy technicians through the picking process. They identify themselves, the ship label, the picking location and the medication by scanning. The scanner checks if the right drugs are dispensed for the right patient.

How was it done?

Due to bedside scanning all orders are electronically available and all medication have barcodes on the single dose. All locations are barcoded for reasons of replenishment of stock. By simply sending the orders to handheld terminals it’s a small effort to verify the picking.

What has been achieved?

All electronic medication orders are checked by barcode scanning or a second hospital pharmacist resulting in a diminishment of picking errors to (nearly) zero. We can show an online status of the medication order to nurses and physicians and we shifted pharmacist time from checking drugs to checking appropriateness of therapy.

What next?

In a next step we will also check retour medication by barcode scanning preventing possible misplacement.

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Why was it done?

Hospitals are facing strong economic constraints and increasing requirements in terms of quality and safety of care. To address these difficulties, a solution could be to reorganise processes and relocate resources through the use of industrial engineering Business Process Improvement approaches such as Lean.

What was done?

An original Lean method for business process improvement was designed and tested in an acute general medicine department in order to improve the mediation management process.

How was it done?

A Lean method for the hospital setting was elaborated based on a triangulation between literature data, semi-structured interviews and a case study. This method, relies on 5 operational activities (Understand the process, Measure, Analyse, Improve, Implement) and 6 support activities (Establish top management support, understand the environment, Organize a project team, Manage change, Monitor and continuously improve). A multidisciplinary project team (nurses, head nurses, pharmacists, physicians, pharmacy technicians, nurse’s aide) was then formed to experiment this method in the acute general medicine ward.

What has been achieved?

This project allowed improving the efficiency and quality of the medication management process. Medication errors at admission and risk for medication errors during administration were reduced (46% vs 12%), non -value added activities during administration were eliminated (25 minutes/nurse/day saved), ward stock management was streamlined (double bin system) and medication delivery was secured. More than 80% of the stakeholders surveyed (45) considered that the changes made to the process improved their working conditions (no impact for the others) and all the participants to the project team were satisfied or very satisfied with the project. The team now meets once a month to continuously improve the process.

What next?

The top management of the hospital has decided to promote this method and is currently creating and training a specific improvement team to support other improvement projects in the hospital.

Why was it done?

So far, only pharmacists could access the pharmaceutical care record. The creation of the electronic medical record in the Health System has allowed patient data to be centralised and can be accessed easily and quickly. It is an opportunity to integrate our care service as pharmacists within the multidisciplinary care as well as to facilitate data consultation to other professionals that care for the same patient.

What was done?

Integrate the outpatient pharmaceutical care record to the electronic patient record via an application form included in the process of each pathology.

How was it done?

First question was where the application form should be included when the patient came in for a consultation. In order to unify all the actions relating to the process, it was decided to include the form in the main process instead of creating a specific process for the pharmacy department. For example, a form for an HIV patient should be included in his Infectious Disease Consult process.

Another issue was to define what items should be taken into account for the follow up.

Finally, the following items were included: reason for the visit, pathology, clinical data, outpatient treatment, regular treatment, drug-related problems, adverse drug allergies/past issues, adherence, checks to mark whether the patient has received the oral and written information, the leaflet from the host to the Outpatient Pharmacy Service and a free text to write down given recommendations.

What has been achieved?

Improvement of patient care, increased safety in the use of drugs and in the avoidance of medical errors has all been achieved, as well as the promotion of teamwork amongst professionals who attend to the patient. From the information technology perspective, data export can be provided for future researches.

What next?

All professionals should integrate their activities to take advantage of collaboration and increasing synergies.