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Author(s)

Nina Kærgaard Hansen

Why was it done?

The initiative was performed to investigate the accessibility and usability of the current intranet in order to improve intranet information and communication from the hospital pharmacy to the clinic.

What was done?

Workshops with usability tests were performed with four different professions who are expected to use the intranet information and communication from the hospital pharmacy.

How was it done?

Workshops for selected professionals including pharmacists, pharmaconomists and nurses were held. The workshops consisted of four parts:
1. Video capture and recording test: Participants were asked to find specific information on the intranet. Comments, clicks and movements of the mouse were recorded during the task.
2. Sorting and prioritization the pages: Participants were given screen shots of 57 pages from the intranet. The participants were asked to sort the pages in three categories: need to know, nice to know and insignificant.
3. Evaluation of selected texts: Participants were given 5 examples of texts from the intranet and asked to assess if the text was relevant and understandable.
4. Structured focus group interview: Using a structured interviewguide the use and challenges experienced by the participants were explored.

What has been achieved?

From the present initiative it was found that the structure of the intranet was not optimal and did not reflect the daily needs from the users. The results from the workshops provided a clear guideline on how to restructure the intranet. It is important to make short cuts and optimize search function.
In addition, the initiative revealed how to improve texts:
– Write shortly, concisely and action oriented: “Tell us what to do”.
– Write the most important first, then elaborate and insert links to learn more.
– Use subheadings for skimming the text.

What next?

A campaign is planned to advertise the new intranet structure. Number of users and subscribers on the intranet pages is followed to see if the activity increases. Editors have been educated to write texts that are short, concise and written in an action oriented language

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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.

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Author(s)

Charlotte Ménage-Anjuère, Rakiba Belkir, Elisabeth Bergé, Audrey Decottignies, André Rieutord, Xavier Mariette, Raphaèle Séror

Why was it done?

We needed to assess the impact of our patient education program on Sjogren’s syndrome (SESAME) in order to continuously improve it.

What was done?

A playful online questionnaire was designed and implemented to assess patients’ knowledge about Sjogren’s syndrome.

How was it done?

A interprofessional team (3 rheumatologists, 3 pharmacists) and a 4-patient group who participated in the education program together proceeded to the questionnaire design: 1) definition of a competency framework for patients with Sjogren’s syndrome; 2) from literature review, identification of quality requirements for a questionnaire (scientific quality, opportunity to interact, means of expression, logical chaining of questions, simplicity, utility, shortness, bias prevention, playfulness, variety, online diffusion). To fulfill these criteria, we used a clear vocabulary and concise questions, included open-ended questions on patient experience, focused on the artwork, randomized the order of answer choices, and shared the questionnaire online. Once the SESAME quiz was established, a scoring system was defined by the expert group. Face validity, feasibility and reproducibility were assessed to validate the questionnaire. 25 patients were contacted to complete the questionnaire twice. Patients also evaluated the content, structure and feasibility using 12 items (understandable language, unambiguous sentences, length of the questionnaire, difficulty, web access). Reproducibility was calculated using intraclass correlation coefficient (ICC) on patient answers separated by 48 hours.

What has been achieved?

The questionnaire includes 28 questions divided into 4 parts: Sjogren’s signs, Sjogren’s causes, treatment, daily life with the disease. The 25 patients filled in the questionnaire twice (96% women, 54 years min-max[23;74], 4 years since the diagnosis min-max[1;20]). The questionnaire was filled in from a computer (n=38), a tablet (n=3) or a smartphone (n=9). The average response time was 19 minutes. The median score was 34 points min-max[22;46] out of 50. 18 patients evaluated the questionnaire. 15 patients or more regarded its content, organization and feasibility as “very good”. 5 patients found it difficult. The reproducibility was very high (total ICC = 0.87 IC95% [0.74-0.94], ICC on each part between 0.61 et 0.87).

What next?

The SESAME quiz is now freely available (https://etp-rhumato.typeform.com/to/qsVhR1) and all the Hospital centers caring for Sjogren patients can use it for their follow up.

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Author(s)

Caroline Hache, Stéphane Honoré, Guillaume Hache

Why was it done?

The development of clinical pharmacy allows pharmacists to take patient-centered roles and responsibilities. However, patient-centered care requires a specific set of skills and training, such as patient-focused communication and conducting structured interviews. Thus, improvement of pharmacist-patient communication may lead to better clinical outcomes.

What was done?

We developed a workshop involving patients within the training programme of residents in hospital pharmacy. The workshop focused on communication skills needed to improve the quality and effectiveness of a pharmaceutical interview.

How was it done?

The workshop was developed jointly by two senior clinical pharmacists and a lecturer in education and communication science. The learning process integrated: working on participants’ perception of pharmacists-patient communication, didactic learning, training activities and evaluation. The assessment of the learning effect was performed by self-, peers-, and patient-scored charts. Patients’ feedback during the training activities and assessments was highlighted as the cornerstone of the learning process.

What has been achieved?

First, we built a competency chart on communication skills needed to perform a structured pharmaceutical interview. This tool has been validated by the patients and well accepted by the learners. It was used to assess the learning effect of the workshop, and may serve as a guide for the continuous development of junior practitioners. Secondly, the workshop has actually been implemented, with both the learners and patients expressing a high general acceptance and satisfaction. Finally, preliminary results show a learning effect assessed by both peers and patients.

What next?

The involvement of patients needs to be further expanded to the training programmes of undergraduate students, residents and clinical pharmacists. A future action planned is to develop a model with the French Society of Clinical Pharmacy (SFPC) for a national systematic training module: “Improving pharmaceutical interviews’ performance through effective communication”, involving patients.

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Author(s)

Fionnuala Nevin, Gail Melanophy, Aisling Collins, Miriam Moriarty, Grainne Courtney, Tamasine Grimes, Gaye Stephens

Why was it done?

The available literature strongly advocates the importance of training for users of electronic prescribing systems to ensure their safe and effective use. However, there is a lack of evidence to demonstrate the effect that ongoing training has on the use and impact of these systems. This study was carried out to strengthen the case for staff training resources for electronic prescribing systems.

What was done?

A study was carried out to investigate the effect of a training intervention on the prevalence of prescribing errors found in an outpatient electronic prescribing system currently in use. Audit and feedback methods were used. Prescription audits were carried out before and after the delivery of a classroom-based training intervention. The audits were used to measure and analyse the effect of the intervention on prescribing errors found in the electronic prescribing system. A questionnaire and clinician observations were carried out with prescribers. The pre-intervention audit results, questionnaire, and clinician observations were used to inform the prescriber training intervention.

How was it done?

Key stakeholders were recruited and assisted in the planning and delivery of the study methods. This was to ensure participate buy-in and study success. The audit tools and questionnaire were initially piloted to test their design, and allow adjustments to be made based on feedback received.

What has been achieved?

The prevalence of prescribing errors was significantly reduced, following the delivery of the training intervention. Statistically significantly more medications prescribed during the pre-intervention audit contained one or more errors when compared with the post-intervention audit (28.6% versus 9.2%, p < 0.05). Most errors found were deemed to be system-related errors.

What next?

The study demonstrates the positive impact that ongoing training can have on users’ interactions with an electronic prescribing system. Electronic prescribing systems are being increasingly considered and implemented in healthcare settings internationally. The results of this study could be used to inform the planning for training interventions to be delivered as part of ongoing system maintenance. The study stands to inform those managing electronic prescribing projects that, despite initial training, errors can still occur and must be addressed. This study supports the need to provide adequate training resources for users of electronic prescribing systems.

Author(s)

María Mar Alañón Pardo, Sacramento Corral Vinuesa, Raúl Pérez Serrano, Isabel Benet Giménez, Alfonso Ambrós Checa, Álvaro Díaz Castro, Miguel Ángel García Cabezas, Élida Vila Torres, Carmen Encinas Barrios, Marta Rodríguez Martínez

Why was it done?

Acute intoxications cause significant morbidity-mortality worldwide, and their rapid treatment is vital.
APP-Antídotos is the first free Spanish mobile application for toxicology research, designed to facilitate immediate access to relevant information on antidote applications in toxicological emergencies.

What was done?

The “Antídotos” application for mobile devices (APP) was developed by our Departments of Pharmacy, Emergencies, Intensive Medicine and Paediatrics to facilitate consultations by healthcare professionals on the pharmacological treatment of the most frequent acute intoxications in our setting.

How was it done?

The APP contains toxicological data from the “Antidote Guidelines” developed in our third-level university hospital, based on primary (drug information sheets, original scientific articles), secondary (Medline results, using “antidotes”, “poisoning”, “hospital pharmacy department” and “guideline” as search terms) and tertiary (toxicology databases) sources of information.
The Pharmacy Department was responsible for the graphic design, structural development and programming of the APP for mobile devices (smartphones, tablets) with Android or IOS9 operating systems, which could be downloaded free from Google Play or Apple Store.
APP-Antídotos is organized in 31 chapters on different types of intoxication and their definition, mechanism and symptoms, with recommendations on antidotes and references. It is structured in seven sections: “Information”, “Intoxication index”, “Antidote index” (37 antidotes), “Toxin index”(>240 toxins), “Notes”, “See Antidote Book in PDF” and “Telephone for Toxicological Emergencies”.

What has been achieved?

Between April and August 2016, users downloaded 2091 installations from Google Play (72.5%-Android) and Apple Store (27.5%-iOS9); 73.6% of devices were smartphones and 26.4% tablets.
The APP was downloaded from Android in Spain, 55.8%; Brazil, 5.7%; India, 5.5%; Columbia, 4.3%, Mexico, 4.0%; Ecuador, 2.7%; others, 22.0%. The distribution by language/country was: Spanish/Spain, 60.2%; Spanish/USA, 11.1%; English/USA, 7.9%; Portuguese/Brazil, 5.0%; English/UK, 4.7%; Spanish/Mexico, 1.2%; others, 9.9%. The geographic distribution of iOS9 installations was: Europe, 90.5%; Latin-America/Caribbean, 5.9%; USA/Canada, 1.4%; Africa/Middle-East/India, 0.4%, Asia/Pacific, 1.8%.
Mean user evaluations were 4.6 (Android) and 5.0 (iOS9) stars (maximum of 5 stars).
Fifty-four publications were found on social networks (48.2%-Facebook, 51.8%-Twitter), 444 shares, 1094 “I like” and 1045 video plays.

What next?

The APP will be regularly updated by the authors taking user suggestions into account, and it will be translated into English to extend its reach to other healthcare.

Author(s)

Sophie Renet, Florian Le seigneur, Ratiba Haddad, Andre Rieutord, Marie Camille Chaumais

Why was it done?

The high turn over rate of medical and pharmacy residents (every 6 months) could jeopardize the patient’s care management as they generally lack of appropriate skills upon arrival. Our former process medication review was relying on individual and heterogeneous competencies of pharmacy residents likely to lead to sub-optimal medication review and treatment optimisation. We had to design a training program for residents according to the constraints of time and characteristics of related treatment of the considered clinical ward recruited patients.

What was done?

A training program for pharmacy residents was developed and implemented. The aim was to develop the skills of the residents to allow them to perform, after 72 hours, a secure, optimized and standardized (SOS) medication review orders, according to the specificities and the “real-life practice” of the clinical department.

How was it done?

Through a collaborative approach (residents and seniors pharmacists, physicians, PhD student in education sciences), ADDIE (Analyse, Design, Development, Implantation, Evaluation) method was used. First, the most frequent pathologies and drugs prescribed in the cardiology department were identified to define specificities and thus custom the educational needs and skills that residents have to acquire to ensure a SOS medication review orders. The program included a 3 steps process over 3 days: (1) recognize the organisation and learning tools; (2) practice 3 clinical medication review orders simulation; (4) assess and feed-back with a senior clinical pharmacist. Some learning tools were developed: a training tool kit to guide the learners ; an aid kit, including a SOS medication review orders algorithm to follow throughout the whole process. Two years after implementation, 4 pharmacy residents have used this training program.

What has been achieved?

Our 72-hours-training program is routinely used for new pharmacy residents. It has been implemented successfully with a high acceptance. They also felt more comfortable to suggest therapeutic advices to the physicians.

What next?

The proof of concept of SOS was successfully done. We are currently extending it for 5th year pharmacy students and develop similar training program for other clinical wards (Surgery, oncology, immunology). In 2017, we expect to share it with our pharmacist colleagues working in the two closest hospitals.

Author(s)

F. Reidy, M. Duggan, A. Mathew, G. Duignan, S. Nasim, H. Ryder, B. Giblin, B. O’Connell, J. Corcoran

Why was it done?

The management of patients on oral anticoagulant drugs in the perioperative period has become confusing due to the introduction of:
– Newer oral anticoagulant and antiplatelet drugs
– Increased number of day case surgeries and early discharge, leading to lack of optimum care of patients, with anticoagulation and thrombophylaxis measures being undermanaged, resulting in prolonged hospital stays and cancellations of procedures.

What was done?

Following informal discussions with pre-assessment clinic (PAC) nursing staff, anaesthetists, pharmacists and surgeons, an evidence based management plan for thrombophylaxis and anticoagulation in the perioperative period for surgical patients was developed comprising of:

Thromboembolism risk assessment and bleeding risk stratification tool, to risk stratify all patients being admitted for surgery.

Prescribing guidelines on the management of anticoagulant drugs in the perioperative period.

Patient information leaflets on the management of anticoagulant drugs and thrombophylaxis measures pre and post procedure.

Preprocedure and discharge pharmaceutical plans to facilitate patients’ anticoagulation drugs to be managed effectively in the community.

How was it done?

Draft guidelines were disseminated to relevant staff and an opportunity was given for feedback over a period of 1 month. Following these recommendations, the guideline was introduced at the weekly surgical meeting. Information was then disseminated to the relevant departments.

One year later an audit demonstrated that these guidelines provided clarity with the decision making process regarding anticoagulation and thrombophylaxis, resulting in improved patient safety outcomes in the perioperative period. The need for educational training on the guidelines and simplification of the risk assessment tool was highlighted.

What has been achieved?

• Patients’ anticoagulation needs pre and post procedure can be managed with clear instructions in the perioperative period across the hospital/community interface.

What next?

The tool will be adapted to help with the decision making process regarding anticoagulation and thrombophylaxis for medical patients.
The complexities of perioperative anticoagulation are addressed in a simple way that the development of an App would benefit patient safety.

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Author(s)

S. Walk-Fritz, T. Hoppe-Tichy

Why was it done?

To improve drug safety, it is crucial to develop and maintain core competencies in a multidisciplinary medical team. Current clinical pharmacy education may provide some exposure to ward based clinical pharmacy, but so far there is no structured prerequisite training for pharmacists practising clinical medication management.

What was done?

A training framework for clinical pharmacists practising medication management was developed and implemented. The area of activity included medication reconciliation, participation in medical rounds, discharge counseling, etc. The novel curriculum was designed in order to (1) support junior hospital pharmacists in acquiring clinical pharmacy skills, communication skills and personal skills and (2) help senior clinical pharmacists to maintain and improve their skills.

How was it done?

Senior clinical pharmacists developed a training framework:

– Initial skill adaptation for junior hospital pharmacists (eg, observe an experienced clinical pharmacist participating in medical rounds, patient case presentation and evaluation, and participation in the drug information centre).

– Maintain and improve the skills of all clinical pharmacists performing patient centred care (eg, Jour Fixe (presentation and discussion of clinical treatment guidelines, patient case presentations), journal club, supervision discussion (patient case discussion with two senior clinical pharmacists) and supervision of participation in medical rounds by senior clinical pharmacists).

What has been achieved?

The training framework has been implemented successfully with a high general acceptance. Particularly, the Jour Fixe has allowed junior staff to acquire appraisal skills and senior staff to achieve continuing professional development. The supervision discussion of patient cases has also been well appreciated as a mean of acquiring additional skills. Parts of the training programme have been implemented in the training of pharmacy interns, such as performing medication reconciliation on admission.

What next?

The implemented training programme needs to be further expanded and adapted over time. A future aim is to establish a model with the German Association of Hospital Pharmacists (ADKA) for a national systematic training module (eg, for performing medication reconciliation).

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Author(s)

E. Past, C. Hofer-Dueckelmann, U. Porsche, G. Fellhofer

Why was it done?

The increasing demand for clinical pharmacy services was combined with the will of the MI pharmacists to expand their roles and become advanced practitioners. There is no formal clinical pharmacy education in our country. Studying abroad is costly and often incompatible with private life. The head of our department promoted the introduction of the teaching bundle as a form of quality assurance for new clinical services.

What was done?

A clinical pharmacy training scheme was founded for and by pharmacists of the medicines information (MI) department. Over 1 year, four UK trained clinical pharmacists facilitated: 10 workshops on clinical topics focusing on pharmaceutical care planning; monthly discussions on patient cases collected in our hospital; and bedside teaching on two wards.

How was it done?

The main drivers were the pharmacists´ willpower to become more clinically orientated and the prospect of being able to offer new clinical services. The instructors incorporated the preparation of the educational activities into their routine workload. There were no monetary incentives. The workshops lasted 1 h with any further discussions held after work, a challenge for parents.

Instructors presented the newest insights of the respective clinical area, alternating with group activities. Continuous evaluation led to a stronger focus on real patient cases. This approach was continued during the monthly coffee break case studies. Incorporation of bedside teaching into the rota was a challenging task.

What has been achieved?

Two pharmacists set up a clinical service on an intensive care unit. Another pharmacist started to attend ward rounds on a neurosurgery ward. Medicines reconciliation will be introduced with pharmacy involvement in a pilot project.

What next?

This training scheme is transferable to any hospital setting. Prerequisites are idealistic and formally trained clinical pharmacists combined with highly motivated colleagues wishing to take on more responsibility and willing to learn from their peers. Workshops, a journal club and bedside teaching are ongoing.