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IMPLEMENTATION OF A SAFETY AND HEALTH PROGRAMME FOR THE MANAGEMENT OF PATIENTS WITH HEPATITIS C RECEIVING TREATMENT WITH DIRECT ACTING ANTIVIRAL AGENTS

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European Statement

Clinical Pharmacy Services

Author(s)

S. IBAÑEZ GARCIA, C.G. RODRIGUEZ-GONZALEZ, A. GIMENEZ-MANZORRO, E. CHAMORRO DE VEGA, R. COLLADO-BORELL, E. LOBATO-MATILLA, A. DE LORENZO-PINTO, M. TOVAR-POZO, A. HERRANZ-ALONSO, M. SANJURJO-SAEZ

Why was it done?

CHC affects approximately 3% of the world’s population. The development of well tolerated and effective AADs has changed the therapeutic landscape. These therapies have a high efficacy with a good safety profile. Numerous challenges in terms of patient education, monitoring, medication errors, drug interactions and adherence exist. Our National Health System launched a strategy plan for proper CHC management in April 2015, establishing, among other things, measures to optimise AAD use.

What was done?

We have developed a pharmaceutical care programme.

I. The following protocols were defined:
– A case selection and treatment guideline, following the recommendations from health authorities.
– A protocol for the management of drug interactions.
– A protocol with recommended dosages and administration techniques.
– A protocol with potential adverse drug events and recommendations about how to prevent and manage them.
– A protocol about clinical interview to ensure patient literacy and co-responsability.
– Patients information leaflets.

II. The pharmacy department was provided with:
– 3 full time pharmacists.
– 2 patient information offices.
– a queue management system.

III. Appointment scheduling:
Pharmacy visits were scheduled after the hepatologist/infectious disease specialist appointments every 28 days.

IV. The clinical interviews were documented in the electronic health record.

How was it done?

A multidisciplinary team was formed with two hepatologists, one infectious disease specialist, three clinical pharmacists and one nurse to:
– Address the key points associated with the safe and efficient use of AADs.
– Create a useful clinical guideline.
– Identify staffing and logistics needs.

What has been achieved?

No of patients included in the programme: 674
No of initial visits: 674
No of follow-up visits: 1750
No of patients attended/day: 19.9
No (%) adherent patients at the end of treatment: 412/412 (100%)
No of pharmacist interventions: 195
No (%) pharmacist interventions accepted: 194 (99%)
Average waiting time to be attended by the pharmacist: 15 min
No of queries made to the hospital pharmacist: 84
No of adverse drug events reported to the pharmacovigilance centre: 31
Cost savings (€): 121 194

What next?

This initiative provides a set of recommendations regarding CHC management and a support guide to standardise and guarantee high quality pharmaceutical care.

The next step is to develop pharmaceutical care programmes for the management of other pathologies following the same methodology that we have used for this initiative.

PHARMACEUTICAL INITIATIVE FOR APPROPRIATE HANDLING WITH CYTOTOXIC DRUG ON NON-ONCOLOGY DEPARTMENT AT OUR CLINICAL HOSPITAL

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European Statement

Introductory Statements and Governance

Author(s)

T. DIMITROVSKA MANOJLOVIKJ

Why was it done?

To highlight the classification of this drug, its dangerous side effects even to those patients not receiving it, due to intoxication when handled inappropriate, and the precautions and measures that should be undertaken to minimise the risk/danger of occupational exposure and environmental pollution with inappropriate managing of the waste and spill.

What was done?

These 4 written statements were created: (1) Notification/instructions for handling cytotoxic agentS, (2) instructions for hygienic use of the toilets by patients receiving cytotoxic therapy and disposal of toxic waste on gynaecology and obstetrics wards, (3) instructions for a woman receiving methotrexate injection and (4) standard operating procedure for intramuscular application of methotrexate for nurses in the gynaecology-obstetric ward.

All statement were copied and disseminated to all departments on the ward. In November 2014 during verification of daily drug supplies to the gynaecology-obstetrics ward, I detected a package of methotrexate injections in the transporting container together with other drugs. I immediately contacted the head ward nurse and took control of the handling of the drugs on the ward, especially in the department for pathological pregnancy. The young departmental nurse responsible nurse was not aware of the classification of nethotrexate as a hazardous cytotoxic drug that should be handled with special care. Even though a drug is not given for cancer, it should still be treated as hazardous. Explanations were given to all those present at the time: nurses, gynaecologists and hygiene maintenance staff in the department.

How was it done?

Difficulties in persuading departmental staff of the occupational hazard, intoxication by other patients not receiving the drug and environmental pollution, particularly the danger of extravasation in this class of drugs when handled inappropriately, were overcome by repeating the explanations several times and disseminating the 4 statements.

What has been achieved?

Appropriate handling of cytotoxic drugs, improvement in patient care and protection from pollution of the environment.

What next?

Frequent controls on drug handling on all hospital wards for prevention of irregularities and to ensure safe medicines application.

eLearning Environment for Ensuring the Competence in Pharmacotherapy

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European Statement

Education and Research

Author(s)

Susanna Saano, Tiina Koskinen, Hillevi Rautiainen, Minna Taam-Ukkonen

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!

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BOOST is where visionaries, innovators, and healthcare leaders come together to tackle one of the biggest challenges in hospital pharmacy — the shortage of medicine and medical devices.

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Problems caused by shortages are serious, threaten patient care and require urgent action.

Help us provide an overview of the scale of the problem, as well as insights into the impact on overall patient care.

Our aim is to investigate the causes of medicine and medical device shortages in the hospital setting,  while also gathering effective solutions and best practices implemented at local, regional, and national levels.

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Join us in Prague for the 2nd edition of BOOST!

Secure your spot in the Movement for Shortage-Free World

BOOST is where visionaries, innovators, and healthcare leaders come together to tackle one of the biggest challenges in hospital pharmacy—medicine shortages.