DEVELOPMENT OF AN INFORMATIC HAZARD VULNERABILITY ANALYSIS TOOL TO MINIMISE MEDICINES SHORTAGES (submitted in 2019)
Pdf
European Statement
Selection, Procurement and Distribution
Author(s)
Daniele Leonardi Vinci, Enrica Di Martino, Rosario Giammona, Piera Polidori
Why was it done?
The 2018 Medicines Shortages Survey conducted by EAHP showed that 91% of responding pharmacists had experienced problems sourcing medicines, therefore it is important to use tools that identify early the shortage risk associated with each drug included in a hospital formulary in order to adopt appropriate countermeasures.
What was done?
We create an informatic HVA Tool (HVAT) to assess the risk associated with medicine shortage.
How was it done?
The HVAT created consists of an Excel spreadsheet subdivided into three macro areas: probability that the shortage will occur based on shortage in the last 2 years, magnitude factors which increase the risk of shortage, and mitigation factors which reduce it. A score was assigned to each item in each macro area. The score of the probability was: 1=no previous deficiency; 1.5=one deficiency; 2=two or more deficiencies. Magnitude was divided into: relevance of active substance (AS) (1= not life-saving and not High Risk Medicines (HRM); 2=not life-saving but HRM; 3=life-saving); budget impact (0=no alternative drug; 1=alternative drug costs equal to or less than the deficient one; 2=cost of the alternative drug higher than the deficient one but sustainable for all patients; 3=cost not sustainable for all patients); percentage of patients treated with the drug (1=less than 20%; 2=from 20% to 50%; 3=more than 50%). Mitigation factors were: therapeutic alternative (1=same AS and same route; 1.5=same AS and different route; 2=different AS and route not intravenous (IV); 2.5=different AS and route IV; 3=no alternative drug); stock available (1=for a month of autonomy; 2= autonomy between 1 week and one month; 3=autonomy less than 1 week); availability of the drug (1=drug available in EU; 2=drug available exclusively extra-EU; 3=drug not available).
What has been achieved?
The HVAT obtained allows us to calculate the value of the risk multiplying P by S, where P is the percentage of probability (value of probability obtained/2) and S is percentage of severity [(sum of values of magnitude obtained + sum of values of mitigation obtained)/18]. Based on the score obtained, drugs are classified as: low (60%) risk of shortage.
What next?
We will implement the HVAT in our hospital in order to reduce the impact of shortages.
SOFTWARE TOOL DEVELOPMENT FOR THE ASSISTANCE OF HOSPITAL PHARMACISTS IN MEDICINES’ SHORTAGES MANAGEMENT (submitted in 2019)
Pdf
European Statement
Introductory Statements and Governance
Author(s)
Eleni Rinaki, Marinos Petrongonas, Maria Fragiadaki, Leonidas Tzimis
Why was it done?
MSs are a frequent problem in our hospital. In a study carried out in 2018, we investigated reported shortages during one year and found that 56% of cases of unsatisfied wards’ requests were due to failure of pharmacy’s procedures to restore availability. In 70% of these cases, time to re-stock was more than 4 days and strong involvement of HPs in following up and taking measures was required. The purpose of this tool is to bring together all relevant information of shortages, aiming to improve hospital pharmacy’s response as well as following-up MSs for further investigation or research.
What was done?
A new software module in Hospital Information System (HIS) for monitoring medicines’ shortages (MSs) was conceived by hospital pharmacists (HPs), and it was designed, developed and integrated to the ICT system. This module helps HPs easily track which medicines were totally or partially substituted due to insufficient quantities and gives additional information (such as residual quantity of a medicine on prescription date, on inspection date, pending orders, known shortage) needed for managing MSs. In this tool, MSs and relevant information, such as causes, measures to re-stock and shortage’s impact, can be entered, centrally managed and regularly reported.
How was it done?
Implementation of the module in ICT system was made at zero cost by the ICT service provider, following technical specifications designed by HPs. The final product was multi-checked by HPs during development and all technical problems have been resolved accordingly.
What has been achieved?
• Quick intervention of HPs to restore medicines availability is feasible. • We can now have precise and easier follow up, with less human resources required. • MSs are collected, registered and easily utilised to draw conclusions. • HPs’ interventions to deal with MSs are easier to evaluate
What next?
ICT tools’ development is very important in facilitating hospital pharmacy’s practice, especially when human recourses are restricted. These software modules can be easily incorporated in every HIS. Pharmacists are competent and should have a central role in designing such tools. We are planning to evaluate our new MSs management procedure; in the long run, incorporating in this tool a risk assessment algorithm will be an asset.
ANTIMICROBIAL STEWARDSHIP: WHAT IF EVERYTHING IS ON YOUR SCREEN? (submitted in 2019)
Pdf
European Statement
Introductory Statements and Governance
Author(s)
Marinos Petrongonas, Maria Fragiadaki, Eleni Rinaki, Leonidas Tzimis
Why was it done?
Implementation of antimicrobial stewardship programmes in hospitals is part of the national strategy to promote prudent use of antimicrobials. As HPs chair stewardship teams, they are responsible for assessing prescription and monitoring antimicrobial use. Designing and developing automated informative tools facilitates HPs in their role.
What was done?
Hospital pharmacists (HPs) designed and developed software tools to support the antibiotic stewardship team’s work. Particular developments were: a) Α PC application (GrAD_calc), in Microsoft Excel, to calculate antimicrobial consumption, instead of ABC_calc tool. GrAD_calc takes advantage of the unique codes for each branded product and transforms aggregated data, provided by the Hospital Information System (HIS), into antibiotic consumption in DDDs/100 occupied bed-days. Results are presented in charts and figures, in a format that enables ease of comparative monitoring over time. b) Necessary indexes of the above calculator and documentation needed as justification for restricted antimicrobials dispensing have been integrated into the HIS; in result, data for national surveillance programme for antimicrobial consumption are automatically exported. Useful information for pre- and post-prescription review, like demographics, indication(s), co-morbidities, current and previous treatments, microbiology tests’ results, susceptibility reports, is available and easily accessible to prescribers, HPs, and infection disease specialists.
How was it done?
HPs created GrAD_calc on their own resources, while changes in HIS were made by ICT service provider, following technical specifications described by HPs. A number of technical problems have been resolved with the contribution of HPs.
What has been achieved?
• Monitoring of antimicrobial use by pharmacy is quicker and effortless. • Handwritten documentation included in restricted antimicrobials’ prescriptions has been replaced by an electronic decision support system, as tool to improve antimicrobial prescribing and stewardship. • Useful information from patient’s medical record is directly available to HPs and physicians, and facilitates hospital’s policy for assessing antimicrobial prescriptions. • Data, like indication, medicine, dosage scheme, microbiology results and susceptibility reports, are recorded electronically and update patients’ pharmaceutical records, permitting further use for pharmaco-epidemiology studies.
What next?
Next challenge is wide use of tools developed, to optimise pharmaceutical services provided and dispense restricted antibiotics only when accordingly justified. GrAD_calc is applicable in hospital setting and HIS’s tool is incorporated and can be used by all regional hospitals.
IMPLEMENTATION OF A NEW CENTRALISED FLOOR STOCK IN A SECURED AUTOMATED STORAGE CABINET
Pdf
European Statement
Selection, Procurement and Distribution
Author(s)
Chloé HERLEDAN, Laura BEAUMIER, Laurence MINISCHETTI, Marie-Christine ALBERTO-GONDOUIN
Why was it done?
Existing floor stocks are limited to usual psychiatric drugs. On-call resident pharmacists dispense additional treatments during pharmacy closing hours. Hence, extending the floor stocks would facilitate continuity of care. SASC centralisation enables simple and secured access to medication while saving space in care units.
What was done?
A new drug and medical device floor stock was implemented in our psychiatric hospital. The floor stock is contained in a secured automated storage cabinet (SASC) located in a protected area inside the pharmacy and accessible during its closing hours. Utilisation training was offered to nurses through multiple formats.
How was it done?
Floor stock composition has been established from frequent requests made during on-call time and can be consulted on the pharmacy website. Prescriptions and patient informations can be checked before removal on a computer in the SASC area. The SASC requires badge identification, unit and patient name entry and provides traceability of removals. Moreover, cold storage requiring drugs are housed in a refrigerator unlocked through the SASC. Regarding utilisation training, all night nurses had to attend a demonstration of the SASC performed by the resident pharmacists. This demonstration was also offered to day nurses and head nurses during weekly pharmacy open days for three months. In addition, an instruction manual and a video tutorial were produced and uploaded on the website.
What has been achieved?
60/67 (89.5%) night nurses, 80/256 (31.2%) day nurses and 10/20 (50.0%) head nurses have attended the SASC demonstration. A satisfaction survey conducted among trained nurses or head nurses had an 18.7% response rate. 26/28 (92.9%) of respondents attended the demonstration and all were satisfied by its quality. 2/28 (7.1%) only used the instruction manual. All respondents declared being able to use the SASC, however 7/28 (25.0%) would need assistance from the instruction manual or video tutorial.
What next?
Further utilisation training or assistance will be provided by the video tutorial. Removals and prescriptions will be checked by pharmacists to uncover picking errors. Impact on resident pharmacists’ workload will be assessed within six months. Finally, SASC centralised floor stock is an interesting approach for hospital pharmacies with limited staff to improve continuity of care.
Early-stage experiences of the implementation of a large-scale robotic storage and distribution system in a hospital pharmacy service within a large UK health authority
Pdf
European Statement
Selection, Procurement and Distribution