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DEVELOPMENT AND IMPLEMENTATION OF GUIDELINES FOR THE SAFETY MANAGEMENT OF INTRATHECAL CHEMOTHERAPY IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES

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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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A ROBUST LEAN METHOD FOR IMPROVING THE MEDICATION MANAGEMENT PROCESS

European Statement

Patient Safety and Quality Assurance

Why was it done?

Hospitals are facing strong economic constraints and increasing requirements in terms of quality and safety of care. To address these difficulties, a solution could be to reorganise processes and relocate resources through the use of industrial engineering Business Process Improvement approaches such as Lean.

What was done?

An original Lean method for business process improvement was designed and tested in an acute general medicine department in order to improve the mediation management process.

How was it done?

A Lean method for the hospital setting was elaborated based on a triangulation between literature data, semi-structured interviews and a case study. This method, relies on 5 operational activities (Understand the process, Measure, Analyse, Improve, Implement) and 6 support activities (Establish top management support, understand the environment, Organize a project team, Manage change, Monitor and continuously improve). A multidisciplinary project team (nurses, head nurses, pharmacists, physicians, pharmacy technicians, nurse’s aide) was then formed to experiment this method in the acute general medicine ward.

What has been achieved?

This project allowed improving the efficiency and quality of the medication management process. Medication errors at admission and risk for medication errors during administration were reduced (46% vs 12%), non -value added activities during administration were eliminated (25 minutes/nurse/day saved), ward stock management was streamlined (double bin system) and medication delivery was secured. More than 80% of the stakeholders surveyed (45) considered that the changes made to the process improved their working conditions (no impact for the others) and all the participants to the project team were satisfied or very satisfied with the project. The team now meets once a month to continuously improve the process.

What next?

The top management of the hospital has decided to promote this method and is currently creating and training a specific improvement team to support other improvement projects in the hospital.

HIGHLY ACTIVE ANTIRETROVIRAL THERAPY PRESCRIPTIONS IN NAIVE PATIENTS: IMPROVEMENT PLAN

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European Statement

Patient Safety and Quality Assurance

Author(s)

A. Rodríguez-Perez, M.I. Sierra-Torres, M.D. Toscano-Guzmán, A. Monzón-Moreno, M. Soriano-Martinez, A. Lluch-Colomer, M.D. Santos-Rubio

Why was it done?

According to the guidelines and recommendations for the rational use of medication, prescriptions of HAARTs must be standardised following the principles of efficiency and based on the best evidence available.

What was done?

A multidisciplinary group of clinical pharmacists and physicians made an easy-to-read handout that summarised the main recommendations of GESIDA for the treatment of naive patients, treated with highly active antiretroviral therapy (HAART). The hand-out consisted of a table with the allowed and not-allowed antiretroviral combinations and the exceptions. The multidisciplinary group disseminated the handout to the prescribers through clinical sessions. The multidisciplinary group made a 6 month study to evaluate the adherence to GESIDA, previous and after the implementation of the easy-to-read handout.

How was it done?

We did not have any problem implementing these recommendations or organizing the clinical sessions.

What has been achieved?

The multidisciplinary group made a retrospective study of the 6-months previous the implementation of the handout, by a chart review of the prescriptions. One hundred naive patients were evaluated. We found an eleven per cent of deviations of the recommendations, none of them justified. The multidisciplinary group made a prospective study during a 6-months period after the implementation of the handout, by a chart review of the prescriptions. Seventy-one naive patients were evaluated. We found a 7% of deviations of the recommendations, three of them were justified because of co-morbidity that contraindicated the recommended medication. We also made a follow-up of the treatment of the patients of the retrospective study, six of the eleven patients of that group changed their HAART to the recommended ones.

What next?

The multidisciplinary team has periodic meetings to evaluate the adherence to the recommendations and to study news reported by GESIDA. The economic impact of the practice is planned to be evaluated.

INTEGRATION OF THE PHARMACEUTICAL CARE RECORD INTO THE MULTIDISCIPLINARY ELECTRONIC OUTPATIENT RECORD

European Statement

Patient Safety and Quality Assurance

Why was it done?

So far, only pharmacists could access the pharmaceutical care record. The creation of the electronic medical record in the Health System has allowed patient data to be centralised and can be accessed easily and quickly. It is an opportunity to integrate our care service as pharmacists within the multidisciplinary care as well as to facilitate data consultation to other professionals that care for the same patient.

What was done?

Integrate the outpatient pharmaceutical care record to the electronic patient record via an application form included in the process of each pathology.

How was it done?

First question was where the application form should be included when the patient came in for a consultation. In order to unify all the actions relating to the process, it was decided to include the form in the main process instead of creating a specific process for the pharmacy department. For example, a form for an HIV patient should be included in his Infectious Disease Consult process.

Another issue was to define what items should be taken into account for the follow up.

Finally, the following items were included: reason for the visit, pathology, clinical data, outpatient treatment, regular treatment, drug-related problems, adverse drug allergies/past issues, adherence, checks to mark whether the patient has received the oral and written information, the leaflet from the host to the Outpatient Pharmacy Service and a free text to write down given recommendations.

What has been achieved?

Improvement of patient care, increased safety in the use of drugs and in the avoidance of medical errors has all been achieved, as well as the promotion of teamwork amongst professionals who attend to the patient. From the information technology perspective, data export can be provided for future researches.

What next?

All professionals should integrate their activities to take advantage of collaboration and increasing synergies.

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BOOST is where visionaries, innovators, and healthcare leaders come together to tackle one of the biggest challenges in hospital pharmacy—medicine shortages.