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LEARNING FROM RETURN: HOW RETURNS CAN HELP TO IMPROVE THE PROCESS OF DISTRIBUTION

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European Statement

Selection, Procurement and Distribution

Author(s)

Claudia Wunder, Szabolcs Tobi

Why was it done?

To introduce returns to supply chain is a critical process in distribution of medicinal products, as non-compliance with storage conditions or inappropriate handling can impair the quality and hence endangers patient safety. In terms of a continous improvement process we considered a standardization and a supervision of this field as mandatory.

What was done?

A standard form for handling of returns was developed. It was designed to ensure that important process steps are done and documented. Furthermore it should offer the opportunity to learn about the reasons why users return medicinal goods to the pharmacy. After one year of usage (2015) the forms were evaluated with the objective of validation and improving the process. According to PDCA-cycle measures were deduced based on the results.

How was it done?

The standard form guides the process and assures
– that medicinal products are stored under quarantine until approval by pharmacist,
– that storage conditions are proved for the time the goods were out of pharmacy,
– that the quality of each returned medicinal product is checked carefully and
– that the reason for return is documented.
The standard forms were collected and evaluated concerning
– number of returns,
– reasons for returns,
– value of returns.

What has been achieved?

The standard form proved to be a useful tool to gain information about gaps in the process of distribution. The evaluation demonstrated that users had problems with ordering due to article changes and unclear names in the warehouse management system. It showed the need for education of trainees and pointed out lacks of communication between pharmacy and wards. The analysis also presented the money-saving potential of re-utilization of returns. What was achieved is an improvement of distribution process by
– implementing an intensive and standardized education for trainees,
– optimizing main data in warehouse management system,
– sensitizing the responsible persons and
– getting in closer communication with nurses on wards.
Besides that the economic benefit of the process could be proved.

What next?

At the end of 2016 the impact of the measures shall be reviewed. Benchmarks shall be deduced to audit the functionality of the process in future.

COMPUTERISATION OF THE REQUEST MANAGEMENT OF MEDICAL PRODUCTS UNDER SPECIAL CIRCUMSTANCES

European Statement

Selection, Procurement and Distribution

Author(s)

A. Navarro Ruíz, A. Martínez Valero, R. Gutiérrez Vozmediano, A. Andújar Mateos, A. Martí Lorca, I. Jiménez Pulido

Why was it done?

The purpose was to increase the efficiency of this management process involving a high workload due in part to the absence of information.

What was done?

In Spain, the availability of drugs under special circumstances is regulated by the Spanish Royal Decree 1015/2009 of 20 June, which established three instances: (1) use of investigational medicinal product undergoing a clinical trial, (2) use of medical products for a medical purpose not in accordance with the authorised product information (off-label use) and (3) access to unauthorised medicines in our state but which are legally marketed in other states. Also, each region has its own regulatory system for medicines. In the pharmacy department, we have developed a software application for managing requests for medicinal products in the situations described above, and in accordance with our region’s regulations. It is organised in different sections that collect patients, prescribing physician details, medicinal products and diagnostic information. It has restricted access through user accounts and a menu for multiple search parameters.

How was it done?

In the pre-design phase, we held individual meetings with pharmaceutical and administrative staff involved in this process to identify their specific needs and priorities, and to assess these once the software application was created. The database management system used for the development of the computer application was Microsoft Access 2003. Once finished, it was tested for 2 months to help pinpoint specific errors and improvement opportunities.

What has been achieved?

Computerisation of this process has improved the efficiency in requests management, facilitating the use of information, increasing speed and reliability, allowing the possibility of analysing large volumes of data, providing greater confidentiality and increasing security through backups.

What next?

The next step will be to assess the usefulness of this software application using a satisfaction survey. To incorporate this initiative into other hospitals in our area requires only compatible software able to run the application.To extend its use to other regions would need adaptation of this software application to the existing regulations in each region.

IS IT POSSIBLE TO TURN AROUND THE TREND ON INCREASING AMOUNT OF BACKORDERS AT THE NATIONAL LEVEL

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European Statement

Selection, Procurement and Distribution

Author(s)

L. Munck

Why was it done?

Globally, we are facing an increasing amount of drug shortages, even though international regulatory authorities take initiatives to improve this.

We have national order data available through one national organisation that manages all tenders and backorders for drug supplies to all hospital pharmacies.

Access to order data enabled us to start this improvement initiative in May 2014, and hence fight the backorder challenge at the national level.

What was done?

We applied LEAN and Supplier Collaboration to turn around the trend of increasing amount of drug backorders to hospital pharmacies.

Our initiative consisted of tight follow-up and continuous improvements with ‘TOP6-suppliers’, (ie, the 6 suppliers with currently the most negative impact on our national drug supply).

‘TOP6-suppliers’ are selected each week at LEAN board meetings.
Tight supplier follow-up, by e-mail, weekly:
We informed the ‘TOP6-suppliers’ that they currently are among the suppliers with the most backorders, and asked them to:

• Confirm/update delivery dates for all open backorders
• Inform us of the underlying reason for each backorder

The suppliers continue to receive weekly emails, as long as they are selected as ‘TOP6-supplier’.

Continuous improvement meetings, face-to-face, quarterly:
We had meetings with the 3 suppliers with the highest level of backorders/poorest level of improvements.

Meeting agenda: Reasons behind current backorder situation and actions to improve.

How was it done?

Obstacles—>Our solutions:
Too busy managing actual backorders and no time to drive improvements—>Added one dedicated resource to drive this initiative.

How to manage our effort—>Develop leading key performance indicators (KPIs) that ensure focus on influence and improvements.

We were not always confident that our effort would provide the expected results—>Continue to focus on the agreed approach and KPIs, even if it takes approximately 12 months before we achieve improvements.

What has been achieved?

• Backorder amount decreased by 25%.
• 3rd quarter2014: On average, 99 item-numbers in backorder (range 87-117).
• 3rd quarter 2015: On average, 74 item-numbers in backorder (range 67-99).
• Closer dialogue and improved cooperation with our suppliers with most/critical backorders.

What next?

1. Share achievements.
2. Start an international network to share best practices.
3. Together achieve further improvements in drug supply.

IMPLEMENTATION OF A PHARMACY TECHNICIAN COORDINATED MEDICATION SUPPLY SERVICE IN A PAEDIATRIC ELECTIVE TREATMENT CENTRE

European Statement

Selection, Procurement and Distribution

Author(s)

H. Thoong

Why was it done?

PETC admits approximately 15 000 patients per year and is a high user of high cost drugs. Traditionally, a pharmacist provided a clinical and supply service with no technical support. Frequently, prescriptions were written late, dispensed items were lost and patients waited unnecessarily to receive treatment. Furthermore, patient non-attendance and medication re-supply due to misplacement of original dispensed items led to stockpiling of medicines.

What was done?

A pharmacy technician (PT) coordinated medication service was introduced onto the Paediatric Elective Treatment Centre (PETC) to decrease patient waiting time (PWT) and drug wastage.

How was it done?

Prior to admission, patients requiring medication were identified by a PT. If medication had been prescribed, this was transcribed onto a pharmacy order form. The prescription chart and order form were clinically checked by a pharmacist. If the drug had not been prescribed, prescribers were contacted. The medication was dispensed and delivered to the ward in advance. The PT ensured all required medication was readily available on the ward. Data on PWT, time to process medication orders, cost of unused drugs and number of items available prior to attendance were collected for a 6 month period.

What has been achieved?

Total cost savings achieved due to returned unused medication amounted to £82 074.

What next?

To extend the role of the PT in PETC. Therefore, the PT will undertake basic medication reconciliation, assessment of patients’ own drugs and notify the clinical pharmacist of patients requiring a full medication review.

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

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European Statement

Selection, Procurement and Distribution

BARCODESCANNING IN THE PHARMACY FOR A SAFER THERAPY

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European Statement

Selection, Procurement and Distribution

Author(s)

T. De Rijdt

Why was it done?

Medication errors find their origin mostly in prescribing, transcribing and administration of medication. Only 4 % of the errors occurs in the pharmacy process. As we covered the major reasons by deployment of a electronic prescribing system with decision support and bedside scanning before administration the next step in augmenting patient safety is preventing dispension errors in the pharmacy.

What was done?

All medication orders from the electronic prescribing system are revised by a hospital pharmacist for appropriateness and send to a set of handheld barcode scanners for guiding the pharmacy technicians through the picking process. They identify themselves, the ship label, the picking location and the medication by scanning. The scanner checks if the right drugs are dispensed for the right patient.

How was it done?

Due to bedside scanning all orders are electronically available and all medication have barcodes on the single dose. All locations are barcoded for reasons of replenishment of stock. By simply sending the orders to handheld terminals it’s a small effort to verify the picking.

What has been achieved?

All electronic medication orders are checked by barcode scanning or a second hospital pharmacist resulting in a diminishment of picking errors to (nearly) zero. We can show an online status of the medication order to nurses and physicians and we shifted pharmacist time from checking drugs to checking appropriateness of therapy.

What next?

In a next step we will also check retour medication by barcode scanning preventing possible misplacement.

PRESCRIPTION-DISPENSING SYSTEM FOR WOUND DRESSINGS

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European Statement

Selection, Procurement and Distribution

Author(s)

A. Navarro-Ruiz, F.J. Rodriguez Lucena, C. Matoses-Chirivella, A.C. Murcia-López

Why was it done?

Ulcers imply a lower quality of life for patients and caregivers, and are considered a negative indicator of healthcare quality with increased costs. Global spending on wound dressings from our hospital in 2010 was 600,000 euro, for an estimated population of 300,000 habitants.In the Pharmacy Department there exists wide experience with the Unit Dose Drugs Distribution System (UDDDS) with decentralized stocks that are greatly reduced. It is for this, so it aims to make a management at our UDDDS of special wound dressings for wound care in hospitalized patients, under the same criteria for selection, adquisition, and clinical and financial management of medicines.

What was done?

To establish a rational and efficient use of medical devices for the prevention and advanced wound care, through a prescription dispensing system of wound dressings in hospitalised patients within the unit dose distribution system of the pharmacy department. Furthermore, to evaluate the effectiveness and continuity of process improvements, and extend it.

How was it done?

The Pharmacy Department, along with hospital nursing staff specialized in treatment of ulcers, developed a prescription-dispensing circuit for wound dressings (April 2012-January 2013). At internal medicine and surgery inpatients, the nursing staff of their hospital units (HU) prescribes dressings in medical orders and refers to our UDDDS where it validates, monitors and verifies the consumer. Dressings included in the project are: Class IIb for wounds to be healed by secondary intention, and Class III incorporating substances that can be considered drugs.

What has been achieved?

The prescription-dispensing dressings with UDDDS access contributes to a more efficient use and management thereof in the treatment of inpatients’ ulcers. Furthermore, the creation of a multidisciplinary group for the selection of health products included in the hospital and the development of protocols and guidelines, promotes continuous training of health personnel and improves the quality of care by standardizing the criteria.

What next?

The developed program is currently established and there is a continuous increase in other hospital clinical areas that benefit from this UDDDS for wound care.

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

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Deadline extended to July 15th

Problems caused by shortages are serious, threaten patient care and require urgent action.

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.