Managing the risk of shortages and medication errors with curares during the COVID-19 pandemic: a hospital pharmacy experience.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has spread rapidly around the world. Like many clinical teams, hospital pharmacies have widely contributed in preventing and containing the COVID-19 pandemic. Pharmacies were thus involved in the management of overuse of specific drugs, medication shortages and risk of medication errors. OBJECTIVES: To assess the use of curares during the COVID-19 crisis and to highlight the lessons to be learnt from this overuse. METHODS: The use of curares (Atracurium, Cisatracurium and Rocuronium) was compared with the usual use levels in our hospital. Supply issues have been identified and investigated. The risk of medication errors was clearly established and considered. RESULTS: Despite an increased demand, our hospital has not experienced any disruption in the supply of curare medications. But the risk of curare shortages has led to the registration of new pharmaceutical forms and dosages never used before. We also observed necessary switches between different curares. All of this has contributed to an increased risk of medication errors. CONCLUSIONS: During the COVID-19 pandemic, the pharmaceutical management of curare medications has been particularly critical. The risk of medication errors and unsafe medication practices was high. This analysis must lead to a high level of vigilance in the next few months.

How COVID-19 has impacted the role of pharmacists around the world.

All over the world pharmacists are standing up to the challenge of COVID- 19 and showing their commitment to the communities they serve. As the COVID-19 pandemic has tested global health systems to their limits, pharmacy professionals have shown themselves to be an integral part of them. Community pharmacists have supported government initiatives to control the pandemic and have ensured patients continued to receive their medicines. Hospital pharmacists have been moving beyond their specialties to help provide critical care to patients while dealing with ICU drug shortages. Pharmaceutical scientists have been involved in finding effective vaccines and identifying effective treatments. In short, the pharmacy profession has been demonstrating expertise, strength, courage and dedication to care at the highest level. The International Pharmaceutical Federation (FIP), which represents the pharmacy profession globally, has a mission to advance pharmacy worldwide by sharing best pharmacy practice and innovation with the world. In this article, it describes how pharmacy has stepped up during the COVID­19 crisis by giving examples from several countries. It highlights, for example, how virtual practice became more prominent as face-to-face meetings became impossible, how pharmacists' scope of practice has been extended, and how pharmacy educators have embraced digital technologies to teach and assess students remotely. In particular, the article highlights pharmacists' involvement in the COVID-19 vaccination programmes in Australia, Canada, Germany, Ireland, Switzerland, the UK and the USA. As a result of all this, FIP sees an exciting future for the profession. Health ministers and heads of state have been praising pharmacists for their service, and FIP wants governments to translate this recognition into support for expanded roles and scientific research. It continues to gather data and intelligence to support an expansion of pharmacy practice, education and pharmaceutical workforce that builds on the profession's scientific base. All these advances are supported by scientific studies about our specialty. Finally, FIP expresses its worries about equity of access to medicines during the pandemic, as younger, healthier people in rich countries are vaccinated before people at greater risk in poor countries. It insists it will continue to advocate on this topic as a core component of its global vision. In this article, we share with readers a snapshot of how our profession around the world has adapted to the challenges posed by the COVID-19 pandemic, and our thoughts on the how it is affecting the evolution of pharmacy practice.

Los farmacéuticos de todo el mundo están enfrentándose al desafío planteado por la COVID-19 y demostrando su compromiso para con las comunidades a las que sirven. A medida que la pandemia pone al límite los sistemas sanitarios de todo el mundo, los farmacéuticos están demostrando hasta qué punto son parte integral de dichos sistemas. Los farmacéuticos de las oficinas de farmacia han respaldado las iniciativas gubernamentales contra la pandemia y garantizado que los pacientes puedan disponer de sus medicamentos. Los farmacéuticos hospitalarios han tenido que ir más allá de su ámbito de actuación habitual para proporcionar cuidados a los pacientes al tiempo que intentaban gestionar la escasez de medicamentos en las unidades de cuidados intensivos. Los investigadores en farmacia han trabajado con denuedo en el desarrollo de vacunas eficaces y en identificar tratamientos efectivos. En resumen, la profesión farmacéutica en su conjunto ha demostrado su pericia, fortaleza, coraje y alta dedicación al paciente.La Federación Internacional de Farmacéuticos, que representa a la profesión a nivel mundial, tiene la misión de contribuir al avance de la farmacia en todo el mundo compartiendo buenas prácticas e iniciativas innovadoras con farmacéuticos de todo el planeta. Este artículo evidencia hasta qué punto los farmacéuticos han estado implicados durante la crisis de la COVID-19, proporcionando ejemplos procedentes de varios países. Pone de manifiesto, por ejemplo, cómo la telefarmacia ha adquirido mayor protagonismo al resultar imposibles las consultas presenciales; cómo se han ampliado las responsabilidades del farmacéutico; y cómo los profesores de farmacia han sacado partido a las tecnologías digitales para impartir clases y evaluar al alumnado de forma remota. El artículo destaca en especial la participación del farmacéutico en los programas de vacunación contra la COVID-19 en Australia, Canadá, Alemania, Irlanda, Suiza, el Reino Unido y los Estados Unidos. Lo observado durante la pandemia hace que en la Federación Internacional de Farmacéuticos vislumbremos un futuro apasionante para nuestra profesión. Aunque es verdad que varios ministros de sanidad y jefes de estado han alabado a los farmacéuticos por el servicio que han prestado, desde la Federación Internacional de Farmacéuticos deseamos que ese reconocimiento se traduzca en un mayor número de competencias para los farmacéuticos y en un apoyo más decidido a la investigación en farmacia. Seguimos recogiendo datos e información en defensa de la ampliación de las competencias del farmacéutico, de la mejora de los programas académicos y de la potenciación de la formación continua de los farmacéuticos en ejercicio. Todos estos avances están avalados por los estudios científicos sobre nuestra especialidad. Por último, desde la Federación Internacional de Farmacéuticos deseamos expresar nuestra preocupación en relación con la equidad en el acceso a los medicamentos durante la pandemia, puesto que estamos viendo que, en muchos casos, las personas más jóvenes y saludables de los países ricos reciben la vacuna antes que las personas con mayor riesgo de los países pobres. Seguiremos con nuestra labor de sensibilización en relación con esta cuestión, que es una de las grandes prioridades dentro de nuestra visión global. En este artículo presentamos cómo los farmacéuticos de todo el mundo se han adaptado a los desafíos planteados por la COVID-19, compartiendo nuestras reflexiones sobre cómo la pandemia está condicionando la evolución de la práctica farmacéutica.

The nine-year sustained cost-containment impact of swiss pilot physicians-pharmacists quality circles.

BACKGROUND: Six pioneer physicians-pharmacists quality circles (PPQCs) located in the Swiss canton of Fribourg (administratively corresponding to a state in the US) were under the responsibility of 6 trained community pharmacists moderating the prescribing process of 24 general practitioners (GPs). PPQCs are based on a multifaceted collaborative process mediated by community pharmacists for improving compliance with clinical guidelines within GPs' prescribing practices. OBJECTIVE: To assess, over a 9-year period (1999-2007), the cost-containment impact of the PPQCs. METHODS: The key elements of PPQCs are a structured continuous quality improvement and education process; local networking; feedback of comparative and detailed data regarding costs, drug choice, and frequency of prescribed drugs; and structured independent literature review for interdisciplinary continuing education. The data are issued from the community pharmacy invoices to the health insurance companies. The study analyzed the cost-containment impact of the PPQCs in comparison with GPs working in similar conditions of care without particular collaboration with pharmacists, the percentage of generic prescriptions for specific cardiovascular drug classes, and the percentage of drug costs or units prescribed for specific cardiovascular drugs. RESULTS: For the 9-year period, there was a 42% decrease in the drug costs in the PPQC group as compared to the control group, representing a $225,000 (USD) savings per GP only in 2007. These results are explained by better compliance with clinical and pharmacovigilance guidelines, larger distribution of generic drugs, a more balanced attitude toward marketing strategies, and interdisciplinary continuing education on the rational use of drugs. CONCLUSIONS: The PPQC work process has yielded sustainable results, such as significant cost savings, higher penetration of generics and reflection on patient safety, and the place of "new" drugs in therapy. The PPQCs may also constitute a solid basis for implementing more comprehensive collaborative programs, such as medication reviews, adherence-enhancing interventions, or disease management approaches.

Improving Vaccination Coverage in All Age Groups is a Global imperative: Our Profession Must Be Prepared.

Vaccination is a global imperative, and the pharmacy profession must be prepared. International pharmacy organizations defined the administration of medicines, vaccines, and injectable medications as a key role of our profession. Vaccines are second only to clean water in terms of their impact on public health.

Immunisation coverage of adults: a vaccination counselling campaign in the pharmacies in Switzerland.

OBJECTIVE: To assess vaccination coverage for adults living in Switzerland. METHODS: Through a media campaign, the general population was invited during 1 month to bring their vaccination certificates to the pharmacies to have their immunisation status evaluated with the software viavac©, and to complete a questionnaire. RESULTS: A total of 496 pharmacies in Switzerland participated in the campaign, of which 284 (57%) submitted valid vaccination information. From a total of 3,634 participants in the campaign, there were 3,291 valid cases (participants born ≤ 1992) and 1,011 questionnaires completed. Vaccination coverage for the participants was 45.9% and 34.6% for five and six doses of diphtheria, 56.4% and 44.0% for tetanus and 66.3% and 48.0% for polio, respectively. Coverage estimates for one and two doses of measles vaccine were 76.5% and 49.4%, respectively, for the birth cohort 1967-1992 and 4.0% and 0.8%, respectively, for the cohort ≤ 1966. There was a significant difference in coverage for most vaccinations between the two aforementioned birth cohorts. A plot of the measles vaccine coverage over time shows that the increase in coverage correlated with policy changes in the Swiss Immunisation Schedule. CONCLUSIONS: Despite selection bias and low participation, this study indicates that vaccination coverage for the basic recommended immunisations in the adult population in Switzerland is suboptimal. More efforts using various means and methods are needed to increase immunisation coverage in adolescents before they leave school. An established method to determine vaccination coverage for the general population could provide invaluable insights into the effects of changes in vaccination policies and disease outbreaks.