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EMERGENCY DEPARTMENT PHARMACY ROTATION, WHAT IS A PHARMACY RESIDENT DOING HERE?

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European Statement

Patient Safety and Quality Assurance

Author(s)

Nuria Monteagudo-Martínez, Ana Valladolid-Walsh, Gregorio Romero-Candel, Esther Domingo-Chiva, Jose Marco-del Río, Marca Diaz-Rangel, Francisca Sanchez-Rubio

Why was it done?

To acquire clinical skills in this setting and detect and prevent medication errors. It is also an area in which pharmacists had previously never participated in our hospital and it was an opportunity to integrate in this multidisciplinary team.

What was done?

Hospital pharmacy specialization programs include one year of rotations in clinical areas. The emergency department (ED) was chosen in order to develop a program to detect and prevent medication errors as a part of a multidisciplinary team.
Other tasks such as organizing drug storage, drug labelling and conservation, nurse counselling and education on issues related to medication were developed.

How was it done?

The pharmacy resident completed a rotation period based on the national educational program in clinical areas. Over a two month rotation period she reviewed treatments (61 patients, detecting 67 medication errors), organized and labelled drug storage, listed and identified thermolabile drugs, participated in a protocol design,…

What has been achieved?

The resident was able to improve care in acute patients in the ED. The most common errors found and prevented were: missed doses (25.3%); incorrect form to administer the drug (incompatibility diluent, infusion rate…) (13.4%); drug interaction/incompatibility (8.9%) and others.
The resident was able to organized refrigerator drug stored and developed a protocol to explain how to act in case of fridge failure.

What next?

To try to implement an ED-based clinical pharmacist program in order to detect and manage medication errors to improve safety in drug therapy, as well as to contribute to patient care with a different point of view from clinicians.

HOSPITAL PHARMACY CONTRIBUTION TO CLINICAL TRIALS: TYPIFICATION OF MEDICATION INCIDENTS AND PHARMACEUTICAL INTERVENTIONS IN A CLINICAL TRIAL UNIT

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European Statement

Patient Safety and Quality Assurance

Author(s)

Paula Arrabal-Durán, Carmen Herrero-Domínguez-Berrueta, María Norberta Sánchez-Fresneda, Ana Mur-Mur, Ana Herranz-Alonso, María Sanjurjo-Sáez

Why was it done?

MI and PI are normally recorded in Hospital Pharmacy Services as a method for evaluating safety. Nevertheless, classical methods for reporting MI do not allow for a correct classification in the field of clinical trials. The reason is their more complex processes involving drugs compared to the processes in daily clinical practice. If there are no specific categories, the information obtained by recording usually gets lost and could not reflect exactly what occurred. In September 2016, a clinical tool to notify MI and PI was implemented in the Pharmacy Service, with the aim of unifying their classification criteria and gathering complete information for analysis and further implementation of improvement measures.

What was done?

A database to notify medication incidents (MI) and pharmaceutical interventions (PI) in the Clinical Trials Unit was developed in the Pharmacy Service of a tertiary hospital.

How was it done?

All the processes involving drugs in clinical trials were evaluated by a Failure Mode and Effects Analysis (FMEA). For each process, the possible incidents and their resulting effects on the patient were recorded. After that, a database was designed in Microsoft® Access with defined lists of choices to allow pharmacists notify both MI and PI that occur in the Clinical Trials Unit.

What has been achieved?

A database with the following information has been implemented:

a) Identification of the MI:
1. Date of the MI.
2. Number of patient.
3. Clinical Trial protocol.
4. Investigational product.
b) Process in which the MI took place (16 options).
c) Process in which the MI was detected (16 options).
d) Process that caused the MI (24 options).
e) Person who detected the MI (9 options).
f) Did any PI take place? (Yes/No).
g) PI performed (12 options).
h) Did the MI reach the patient? (Yes/No).
i) MI that reached the patient (21 options).
j) Patient outcome (8 options).
k) Effect in the clinical trial (4 options).

What next?

The implemented notification system will be further expanded and adapted over time.
Future aim is to analyse MI for establishing improvement measures and checking their results.

COMPLETING SELF INSPECTION AUDITS IN THE PHARMACY ASEPTIC UNIT

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European Statement

Patient Safety and Quality Assurance

Author(s)

Louise Byrne

Why was it done?

H/PICs are guidelines of professional practice developed by pharmacists working in aseptic compounding units In Ireland in 2013. Chapter 9 advises that ‘a self -audit programme should be established and conducted in an independent and detailed way by designated trained competent people’. In order to adhere to these guidelines a self-audit of one section of the H/PICs was completed.

What was done?

A self-audit against one chapter of the H/PICs guideline was completed.
Changes were implemented where possible.
Issues were escalated to senior managers where required.

How was it done?

Obtain audit skills.
An audit checklist was prepared and an audit, for the premises and equipment section of the H/PICs guidelines was completed.
Non-conformances were identified and graded.
Corrective and preventative action (CAPA) was put in place where possible.
Major/critical non-conformances were escalated to higher management where necessary.

What has been achieved?

An audit training day was completed in November 2014. Skilled auditors in the laboratory were observed completing self-audits.
A checklist for the premises and equipment section of the H/PICs was prepared and an audit of that chapter was completed in March 2015. There were 32 statements in this chapter and non-conformances of various grades were identified. CAPA was put in place where possible. 9 non-conformances were rectified with internal changes. 10 major/critical non-conformances requiring capital/HR funding were presented to higher management, these were summarised into 4 main risks. Business cases were prepared to support the correction of these risks and a summary was added to the risk register. The remaining non-conformances were classified as minor deficiencies and will be corrected at a later date.

What next?

Self-audit is a useful tool and aids compliance with H/PICs guidelines. It allows the identification of high risk activities and grading non-conformances assists in the prioritisation of process improvement projects. It supports the feedback of performance against recognised guidelines to management. An annual self audit plan will be put in place and a peer audit group within a number of other hospitals has been established.

DEVELOPING A PROJECT FOR BROADCASTING INFORMATION ABOUT MEDICATION ERRORS

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European Statement

Patient Safety and Quality Assurance

Author(s)

Sergio Plata-Paniagua, Alfredo Montero-Delgado, Jose Javier Arenas-Villafranca

Why was it done?

Currently, with the extended use of social-networks (SN), information related to medication errors can be disseminated quickly and directly, and also provide interaction with professionals enhancing the information. This is very important to promote safety culture among health professionals to prevent medication errors.

What was done?

Two hospital pharmacy specialists from two spanish hospitals created a project based on web 2.0 to broadcast information about medication errors and how to prevent them.

How was it done?

First step was to create a website in which we could post information related to medication errors. The main part of the website is the blog, where we develop all information that we consider interesting. The website also has other sections containing useful resources: photo gallery with examples of look/sound-alike drugs, infographics, educational information, information about the authors and a section where readers can share content with the authors.

Second step was to create accounts on SN to spread the information posted in the website and also for sharing original content. We chose Twitter and Facebook as ideal SN. Twitter allows sharing information quickly and concisely and also is used by a different groups of healthcare providers by allowing us a wide spread. On the other hand, Facebook allows us to reach to a different audience, especially patients.

What has been achieved?

-Currently we have more than 16.000 followers on Facebook, 5.500 on Twitter and the website receives more than 3.500 monthly visits.
-Because of the multiple warnings that we have carried out about Look-Alike/Sound-Alike drugs, some pharmaceutical companies have considered changing the packaging of their drugs.
-We have achieved more than 70.000 signatures on change.org website requesting Spanish healthcare authorities to develop guidelines for the proper packaging and labeling of drugs. Because of this initiative, the Spanish press became interested in this problem and our project and the problem of drug packaging was mentioned in multiple media.

What next?

Currently, we have included another pharmacist in our project in order to enhance the quality and periodicity of our publications. On the other hand, we are trying to work together with institutions dedicated to preventing medication errors to carry out joint projects in order to improve patient safety.

EASE OF ACCESS TO INTRAVENOUS DRUG COMPATIBILITY INFORMATION FOR CLINICAL PRACTITIONERS

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European Statement

Patient Safety and Quality Assurance

Author(s)

K. Teimori, H. Colldén, R. Asadian Falahieh

Why was it done?

Therapy at an intensive care unit (ICU) involves co-infusion of multiple drugs into the same IV line. This may involve mixing of incompatible drugs resulting in particulates being infused, putting the patient at risk. In 2012, a local survey showed 65% (n=142) of participating nurses had co-administered drugs where they were unsure of their compatibility. Preventing incompatibilities by providing healthcare practitioners with point of care IV drug compatibility information fitted to local needs was deemed a necessity. Drug compatibility requires a thorough understanding of chemistry, and information from published studies must be evaluated and assessed to determine applicability to local clinical conditions. Clinics had requested the support of pharmacists for this work.

What was done?

An online intravenous (IV) compatibility database based on these data was created. A group of international clinical pharmacists interested in collaborating in improving the quality of the database was identified. Information material aimed at educating healthcare personal was developed.

How was it done?

Published drug compatibility data and information on physiochemical properties were collected and assessed by a team of hospital pharmacists for applicability to seven clinics. Support, guidance and expertise in the subject had been readily offered to clinical practitioners through telephone calls, email and meetings.

What has been achieved?

Six custom compatibility charts totaling 3600 drug pairs have been created, and procedure documents for IV compatibility have been implemented in each clinic. Over 30 educational lectures on IV compatibility have been held.

The database consisting of 2500 drug combinations presents accessible detailed information on compatibility. Its quality is continuously reviewed by international colleagues.

What next?

The database is fitted to national clinical traditions, providing accessible data to nurses and physicians to support decisions on which drugs to co-infuse. In the next few years, the database will become nationally available. If integrated into the electronic journal system, this could help doctors consider compatibility issues while prescribing, further improving patient safety.

NEW ORAL ANTICOAGULANTS – HOSPITAL PHARMACISTS IMPROVING THE SAFETY OF PATIENTS PRESCRIBED THESE AGENTS

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European Statement

Patient Safety and Quality Assurance

Author(s)

D. Lenehan, C. Meegan

Why was it done?

Due to the high risk nature of the NOACs, the PD has throughout 2014 and 2015 been committed to a comprehensive NOAC risk minimisation strategy, targeting all points of care to address the various safety concerns with these medicines.

What was done?

The following suite of activities were introduced in a drive to improve understanding, familiarity and awareness of new oral anticoagulant (NOAC) therapy.
1 – Medication Safety Alert – Outlines the relevant background information, risks and safety tips for prescribing and administering NOACs.
2 – Quiz – a novel and fun method to ascertain the level of knowledge staff had on NOACs by incentivising participation.
3 – Prescribing information sheet – summarises all the pertinent prescribing information on NOACs to aid selection and detail the relevant clinical cautions and risks.
4 – Point prevalence study (PPS) – captured data on all NOAC patients in the hospital to identify prescribing trends and appropriateness of prescribing.
5 – Clinical checklist algorithm – identifies the key prescribing decisions and risks when admitting a patient on a NOAC.
6 – Staff educational drive – a major innovative roll-out of education sessions to medical and nursing staff.
7 – Patient education – pharmacists now educate all patients newly started on NOAC therapy.

How was it done?

Introduction of this comprehensive suite of activities required collaboration and communication with our nursing and medical colleagues in the hospital.

What has been achieved?

Knowledge and awareness of NOAC therapy has improved significantly among clinical staff and this has been reflected in medication variance reporting. The safe use of this high risk group of medicines is of paramount importance in order to minimise patient risk with these agents.

What next?

The appropriateness of NOAC prescribing will continue to be assessed through the medication variance reporting process and a follow-up PPS will be completed. Rationalisation of NOAC therapies will be considered through the formulary process and the education of staff and patients will remain a priority.

INFLUENCE OF INTEGRATION OF A PHARMACIST IN MEDICATION ERRORS IN CRITICALLY ILL PATIENTS

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European Statement

Patient Safety and Quality Assurance

Author(s)

A. Valladolid-Walsh, E. Domingo-Chiva, P. Cuesta-Montero, J.A. Monsalve-Naharro, E.M. García-Martínez, S. Plata-Paniagua, M.D. Pardo-Ibañez, G. Romero-Candel, J.M. Jiménez-Vizuete, R. Peyró-García

Why was it done?

To determine the incidence of medication errors in our environment and implement enhancement systems to prevent them, which is a priority for the improvement of the drug treatment process in critically ill patients.

What was done?

A clinical pharmacist was integrated on a full time basis into the multidisciplinary team of an anaesthesia intensive care unit (ICU).

How was it done?

The project was carried out in 3 different stages:

– First stage: a prospective observational study was carried out over 1 month to detect medication errors in anaesthesia ICU and to determine the baseline situation before the pharmacist´s intervention. During this stage, 36.27% errors were detected in overall treatments.

– Second stage (intervention stage): Over 10 months, the pharmacist reviewed the prescriptions of all patients admitted to the anaesthesia ICU, performing the appropriate interventions regarding medications. Furthermore, to educate physicians and nursing staff, we organised educational meetings, and also pharmacotherapeutic protocols and guidelines of medication administration were created to standarise clinical practice. Finally, a system for reporting medication errors was introduced.

– Third stage: a prospective observational study was carried out for 1 month to detect medication errors after the pharmacist’s intervention. During this stage, 5.9% of errors were detected in overall treatments.

What has been achieved?

– Medication errors were reduced by more than 30%.
– A pharmacist is now part of the multidisciplinary team in the ICU.
– The experience has been broadcast to the national level to promote the implementation of clinical pharmacist activities in our environment.

What next?

We are still working on the same areas to improve safety in drug therapy in critically ill patients. Currently, improvement measures that are being developed are: new pharmacotherapeutic protocols specifically for this unit; drugs and drug-diluent compatibility guidelines; new training sessions; standarised medication kits in operating rooms and implementation of the computerised prescription; and a new labelling system for syringes.

National monitor for the quality of medication surveillance

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European Statement

Patient Safety and Quality Assurance

Why was it done?

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What was done?

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How was it done?

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What has been achieved?

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What next?

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Home Parenteral Nutrition (HPN) Safety and Quality Assurance Project

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European Statement

Patient Safety and Quality Assurance

Author(s)

Pietka Magdalena, Brniak Witold, Rozkocha Agata

Why was it done?

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What was done?

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How was it done?

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What has been achieved?

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What next?

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CONTINUITY IN PERIOPERATIVE MEDICATION MANAGEMENT

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European Statement

Patient Safety and Quality Assurance

Author(s)

A. Navarro-Ruíz, C. Matoses-Chirivella, J.M. Del Moral-Sánchez, M. Morante, F.J. Rodríguez-Lucena, R. Gutiérrez-Vozmediano, A. Martínez-Valero, A. Andújar, E. García-Iranzo, A. Martí-LLorca

Why was it done?

There is evidence of discontinuity medication between different health care levels. In fact, on admission to hospital, up to one in two patients has an incomplete medicine list , resulting in a medicine not being administered during the hospital stay. This situation could be associated with an increased risk of hospital readmission or adverse drug reaction (ADR). Some studies show that an elevated percentage of surgical patients take medications prior to surgery, cardiac medications principally, but almost 50% of the drugs are omitted on the day of surgery.

What was done?

To develop a guideline to achieve the continuity of quality use of medicines between hospital and community in surgical patients.

How was it done?

The lack of medical evidence is reflected by the large variation in perioperative management recommendations among several group of experts. The recommendations in this guideline are to a large degree expert opinion, based on information from other reviews and textbooks, along with clinical experience. After a thorough review, the guide has obtained the consent of the Commission of pharmacy and therapeutics of the hospital.

What has been achieved?

The guide of conciliation of the medication includes a medication review structured according to the classification made by WHO ‘Anatomical, Therapeutic, Chemical classification system’. In each one of them, including the benefits and risks of continuing with this therapy during the perioperative process. It also includes various annexes, on antihypertensive, glucocorticoids and medicinal plants.

What next?

In the future, we would recommend prioritising the conciliation to the discharge with respect to other points of transition assistance, since the potential severity of an error of conciliation not intercepted the discharge of the patient is greater than if it occurs within the hospital.

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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.