NEW WEB 2.0. TECHNOLOGIES FOR ANTIDOTE CONSULTATIONS: ACTIVITY AND REACH OF AN APPLICATION FOR MOBILE DEVICES
European Statement
Education and Research
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.
A 72 hours training program for pharmacy residents to perform secure, optimized and standardized medication review orders: a proof of concept
European Statement
Education and Research
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.
SEAMLESS PHARMACEUTICAL CARE OPTIMISING ANTICOAGULATION MANAGEMENT IN THE PERIOPERATIVE PERIOD
European Statement
Education and Research
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.
SYSTEMATIC APPROACH FOR TRAINING HOSPITAL PHARMACISTS TO PRACTICE CLINICAL MEDICATION MANAGEMENT
Pdf
European Statement
Education and Research
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).
INTRODUCTION OF A PATIENT CENTRED CLINICAL PHARMACY TRAINING SCHEME IN A LARGE UNIVERSITY HOSPITAL PHARMACY
Pdf
European Statement
Education and Research
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.
eLearning Environment for Ensuring the Competence in Pharmacotherapy
Pdf
European Statement
Education and Research
Author(s)
Susanna Saano, Tiina Koskinen, Hillevi Rautiainen, Minna Taam-Ukkonen