ASSORTMENT COUNCIL SECURES THAT MEDICAL PRODUCT AND INFORMATION IS AVAILABLE TO NURSES, PHYSICIANS AND PHARMACISTS (submitted in 2019)
Pdf
European Statement
Selection, Procurement and Distribution
Author(s)
Katja Heikkinen, Charlotta Vinterflod
Why was it done?
AC’s mission is to secure that the right product and product information is available as well as in case of shortages assist with alternative products and information. Correct information is fundamental to achieve an effective and secure supply chain of medical products. This reduces time spent on ordering, delivery time is shortened and finding information is more efficient.
What was done?
The hospital pharmacy in Region Västra Götaland, Sweden (VGR) established an assortment council (AC) that assists buyers of medical products within the region. By creating a defined assortment the goal was to direct healthcare professionals to order procured, recommended and cost-efficient medicines and enable structured availability monitoring.
How was it done?
A counsel of pharmacists was formed to administer a defined assortment consisting of 95% of the most commonly used medical products. The availability is monitored daily and every disruption of supply is handled in a structured way. Alternative marketed or unlicensed medical products are identified and information about these are communicated through VGR’s ordering system or by newsletters. If an equivalent product is available, it will be delivered automatically without the need for placing a new order. The AC also collaborates with the region’s medical specialists and drug and therapeutics committee (DTC) when searching for alternatives.
What has been achieved?
Defined assortment has been reduced from 6000 products to approximately 3000. In 2018 in addition to the daily updated availability information, 14,300 orders out of 410,000 were automatically replaced with an equivalent product and 41 newsletters about shortages were published. Nurses get more time for patient care when shortages information is readily available, and replacement of equivalent products can be delivered automatically
What next?
By implementing this way of working in other hospital regions or on a national level, caregivers would be able to free up resources and focus on patient care and at the same time be able to find quality assured information about shortages and alternatives in an efficient manner.
PROGRAMME OF PHARMACOTHERAPEUTIC BENEFIT TO THE SOCIO-SANITARY CENTRES OF A SPECIFIC HEALTH AREA THROUGH THE HOSPITAL PHARMACY SERVICE
European Statement
Clinical Pharmacy Services
Author(s)
Gregorio Romero Candel, Maria Jesus Sanchez Cuenca , Nieves Cano Cuenca, Jose Marco del Rio , Julian Castillo Sanchez, Luna Carratala Herrera
Why was it done?
The healthcare provided in the SSC is not fully integrated into the structures of the National Health System. These patients present a higher risk of adverse events related to pharmacotherapy, due to patient factors, with the treatment, the health system and the institutionalisation. The integral approach of the pharmaceutical benefit was necessary for improving the efficiency, safety, health and economic results due to the process using drugs and other health products in the SSC.
What was done?
A pharmacotherapeutic benefit model has been started through the hospital pharmacy to the Socio-Sanitary Centres (SSC) of our health area. A pharmacotherapeutic management system based on the evaluation and selection of drugs and diet therapy items has been established.
How was it done?
An adherence protocol was made to the hospital pharmacy service, with the benefits that were to be provided to them. A guide was prepared with drugs and nutritional supplements that were available to them according to the Pharmacotherapeutic Guide of the Hospital Pharmacy Service, thus guaranteeing the most efficient products. A request model of both drugs and dietotherapics was developed for the SSC, assigning each centre one day per month to request the order and another day of dispensation. Finally, a calendar of distribution routes for each SSC was prepared.
What has been achieved?
For 12 months, eight SSC have been assigned to this programme, with 538 patients. Twelve shipments have been made to each centre, which have been provided with a total of 682,484 units of 223 active ingredients. The dispensation in diet therapy contained 28,045 units of 13 specialties. It has been possible to improve the pharmacotherapeutic coverage of these patients and reduce the expenditure on drugs in the area through centralised supply.
What next?
Development of follow-up programmes for patients with high health or economic impact drugs. Also, the adherence of new SSC, as well as increasing the dispensing portfolio, and achieving the integration of information systems, to have a total traceability from the patient to the different assistance levels.
USE OF TECHNOLOGIES IN THE TRAINING OF PHARMACY STAFF
Pdf
European Statement
Education and Research
Author(s)
VIRGINIA SAAVEDRA QUIRÓS, BELÉN ESCUDERO VILAPLANA, ELVIRA SANTIAGO PRIETO, MARÍA BELLA CORREDERA GARRUDO, INÉS GUMIEL BAENA, MARÍA DOLORES GARCÍA CEREZUELA, AMELIA SÁNCHEZ GUERRERO
Why was it done?
It is important to provide continuous training to all professionals working in the healthcare system, especially when staff turnover is frequent, and when their job is directly related with drugs management, where a failure in the chain of drug utilization can have an impact on patient health.
What was done?
We developed a technology-training strategy of the Pharmacy Department to improve the training resources of the professionals working in it, through the support of information and communication technologies (ICTs), in order to achieve the highest quality in our actions.
How was it done?
The initiative was targeted at the nursing assistant staff of the Pharmacy Department, in the dispensation process to in-bed patients. The development period was between March and April 2017, focusing on activities related to the management, conservation, storage and dispensing of medicines.
This information-training material was developed as follows:
‐ By editing video-tutorials, which would be accessed after recognizing an associated QR code.
‐ Through the preparation of summary sheets in poster format that reflect in a schematic, concrete and visual way those key aspects in each of the processes.
After its implementation, a user satisfaction survey was conducted to evaluate the initiative.
What has been achieved?
Five training video-tutorials were made on different subjects: preparation of unit-dose dispensing carts, preparation of medication from automated dispensing systems (ADS) in Pharmacy, order reception, replenishment ADS in the wards and preparation of medication “on demand”. The average duration of the videos was 5 minutes 45 seconds.
In addition, 7 summary sheets were designed for the management of other types of activities: returns, expirations, special orders, priorities in normal situation – critical situation, management of medicines not included in pharmacotherapeutic guide, interhospital medication loans and calls procedure in the Unit-dose dispensing area.
Satisfaction surveys conducted by nursing assistants have positively valued the initiative.
The strategy developed allows the integration of ICTs in staff training, helping to manage the information of the Pharmacy Department, achieving a better optimization of available resources.
What next?
The degree of satisfaction of the users was good for what we consider important to promote this practice, making it extendible to the other areas and members of the Pharmacy Department.
LEARNING FROM RETURN: HOW RETURNS CAN HELP TO IMPROVE THE PROCESS OF DISTRIBUTION
Pdf
European Statement
Selection, Procurement and Distribution
Author(s)
Claudia Wunder, Szabolcs Tobi
Why was it done?
To introduce returns to supply chain is a critical process in distribution of medicinal products, as non-compliance with storage conditions or inappropriate handling can impair the quality and hence endangers patient safety. In terms of a continous improvement process we considered a standardization and a supervision of this field as mandatory.
What was done?
A standard form for handling of returns was developed. It was designed to ensure that important process steps are done and documented. Furthermore it should offer the opportunity to learn about the reasons why users return medicinal goods to the pharmacy. After one year of usage (2015) the forms were evaluated with the objective of validation and improving the process. According to PDCA-cycle measures were deduced based on the results.
How was it done?
The standard form guides the process and assures
– that medicinal products are stored under quarantine until approval by pharmacist,
– that storage conditions are proved for the time the goods were out of pharmacy,
– that the quality of each returned medicinal product is checked carefully and
– that the reason for return is documented.
The standard forms were collected and evaluated concerning
– number of returns,
– reasons for returns,
– value of returns.
What has been achieved?
The standard form proved to be a useful tool to gain information about gaps in the process of distribution. The evaluation demonstrated that users had problems with ordering due to article changes and unclear names in the warehouse management system. It showed the need for education of trainees and pointed out lacks of communication between pharmacy and wards. The analysis also presented the money-saving potential of re-utilization of returns. What was achieved is an improvement of distribution process by
– implementing an intensive and standardized education for trainees,
– optimizing main data in warehouse management system,
– sensitizing the responsible persons and
– getting in closer communication with nurses on wards.
Besides that the economic benefit of the process could be proved.
What next?
At the end of 2016 the impact of the measures shall be reviewed. Benchmarks shall be deduced to audit the functionality of the process in future.
IS IT POSSIBLE TO TURN AROUND THE TREND ON INCREASING AMOUNT OF BACKORDERS AT THE NATIONAL LEVEL
Pdf
European Statement
Selection, Procurement and Distribution
Why was it done?
Globally, we are facing an increasing amount of drug shortages, even though international regulatory authorities take initiatives to improve this.
We have national order data available through one national organisation that manages all tenders and backorders for drug supplies to all hospital pharmacies.
Access to order data enabled us to start this improvement initiative in May 2014, and hence fight the backorder challenge at the national level.
What was done?
We applied LEAN and Supplier Collaboration to turn around the trend of increasing amount of drug backorders to hospital pharmacies.
Our initiative consisted of tight follow-up and continuous improvements with ‘TOP6-suppliers’, (ie, the 6 suppliers with currently the most negative impact on our national drug supply).
‘TOP6-suppliers’ are selected each week at LEAN board meetings.
Tight supplier follow-up, by e-mail, weekly:
We informed the ‘TOP6-suppliers’ that they currently are among the suppliers with the most backorders, and asked them to:
• Confirm/update delivery dates for all open backorders
• Inform us of the underlying reason for each backorder
The suppliers continue to receive weekly emails, as long as they are selected as ‘TOP6-supplier’.
Continuous improvement meetings, face-to-face, quarterly:
We had meetings with the 3 suppliers with the highest level of backorders/poorest level of improvements.
Meeting agenda: Reasons behind current backorder situation and actions to improve.
How was it done?
Obstacles—>Our solutions:
Too busy managing actual backorders and no time to drive improvements—>Added one dedicated resource to drive this initiative.
How to manage our effort—>Develop leading key performance indicators (KPIs) that ensure focus on influence and improvements.
We were not always confident that our effort would provide the expected results—>Continue to focus on the agreed approach and KPIs, even if it takes approximately 12 months before we achieve improvements.
What has been achieved?
• Backorder amount decreased by 25%.
• 3rd quarter2014: On average, 99 item-numbers in backorder (range 87-117).
• 3rd quarter 2015: On average, 74 item-numbers in backorder (range 67-99).
• Closer dialogue and improved cooperation with our suppliers with most/critical backorders.
What next?
1. Share achievements.
2. Start an international network to share best practices.
3. Together achieve further improvements in drug supply.