Analysis of the implementation of an innovative IT solution to improve waiting times, communication with primary care and efficiency in Rheumatology.

OBJECTIVE: To describe in detail an innovative program based on telemedicine for semi-automated prioritization of referrals from Primary Care (PC) to Rheumatology, for reproducibility purposes, and to present the results of the implementation study. METHODS: The context and situation were carefully analyzed, paying attention to all processes in place, referral numbers, waiting times, and number of complementary tests prior to discharge from Rheumatology. The composition of the team, aims, users, scope, and implementation phases were defined. Eight process indicators were established and measured before and 32 months after the program implementation. RESULTS: The program, which includes IT circuits, algorithms based on response to specific guideline-based checklists, e-consultation, and appointments based on priority, was fully implemented in our health area after a pilot study in two PC centers. After implementation, 6185 rheumatology referrals showed an e-consultation response delay of 8.95 days, and to first face-to-face visit (after e-consultation) of 12.6 (previous delay before program implementation was 83.1 days). Resolution by e-consultation reached 20% (1195 patients did not need seeing the rheumatologist to have the problem solved), and 1369 patients (32%) were discharged after the first visit. The overall resolution rate was 44.0% (2564 discharges/5830 e-consultations). From a random sample of 100 visits, only 10% of patients needed additional complementary tests to make a diagnosis and decision by Rheumatology (20.9% decrease from previous period). CONCLUSION: A careful analysis of the situation and processes, with implementation of simple IT circuits, allows for the improvement of the efficiency and resolution of problems in Rheumatology.

LEAN methodology: design and assessment of a standardized medication storage model.

OBJECTIVE: The objective of this study was to assess the results of applying  Lean Methodology in the design of a standardized medication storage model in  hospitalization departments. METHOD: Descriptive and retrospective study conducted between September 2017 and January 2019 in a tertiary level hospital. The Pharmacy Service led the creation of a multidisciplinary team. Lean Methodology was used to establish the components and organization and  identification criteria that made up the standardized medication storage model.  The stocks of each hospitalization department were reviewed and quantified, the final amount of stock needed was agreed with the supervisor of each department, and the economic impact of the implementation of the  standardized medication model was assessed. A questionnaire was designed and sent to nursing staff to determine their level of satisfaction with the new model. RESULTS: The standardized medication storage model was scaled up to 20  nursing departments, leading to an overall reduction of 56.72% in the number of pharmaceutical dosage forms available (5,688 vs 2,462). The number of high-risk drugs was reduced by 40.73% (631 vs 374). This elimination of wastage  achieved a saving of €25,357.98. A total of 58 nurses returned the  questionnaires (20.70% of the total): 22.40% worked a fixed shift and 77.60%  worked a rotating shift. The mean score on overall satisfaction was 5.79 ± 3.61  (scores ranged from 1 to 10). CONCLUSIONS: The application of Lean Methodology is very useful for the  management of medication stocks in hospitalization departments. The implementation of a standardized medication storage model leads to  economic savings and a marked reduction in the number of active ingredients and high-risk medications. The nursing staff were satisfied with the  implementation of the model, suggesting that we should continue to pursue this effective line of action.

Objetivo: El objetivo del estudio es evaluar los resultados de la aplicación de la  metodología Lean en el diseño de un modelo estandarizado de almacenaje de  medicación en las unidades de hospitalización. Método: Estudio descriptivo y  retrospectivo desarrollado entre septiembre de  2017 y enero de 2019 en un  hospital de tercer nivel. Se creó un  equipo multidisciplinar liderado por el  Servicio de Farmacia. Se empleó la  metodología Lean para establecer los  elementos y criterios de organización e identificación que conformaron el modelo estandarizado de almacenaje de  medicación. Se revisaron y cuantificaron los stocks de cada unidad de hospitalización, se consensuó la medicación con la supervisora de cada unidad y se estimó el impacto económico de la implantación del modelo estandarizado. Se diseñó y envió una encuesta para evaluar la  satisfacción de enfermería con el nuevo modelo.Resultados: El modelo estandarizado de almacenaje se aplicó en 20 unidades de enfermería y supuso una reducción global del 56,72% en el número  de presentaciones de principios activos disponibles (5.688 versus 2.462). Se disminuyó el número de presentaciones de principios activos  de medicamentos de alto riesgo en un 40,73% (631 versus 374). La eliminación de este despilfarro supuso un ahorro económico de 25.357,98 €. Se recibieron 58 respuestas a la encuesta de satisfacción del personal de enfermería (20,70%  del total de encuestas enviadas), de las que un 22,40% correspondieron al turno fijo y 77,60% al turno rotativo. La media de la satisfacción global (valorada  entre 1 y 10) fue de 5,79 ± 3,61.Conclusiones: La aplicación de la metodología Lean es útil para la gestión de  stocks de medicación de las unidades de hospitalización. La implantación del  modelo estandarizado de almacenaje conlleva un ahorro económico y una  reducción del número de presentaciones de principios activos y de  medicamentos de alto riesgo. El personal de enfermería está conforme con la  implantación del modelo, lo que nos plantea seguir en esta línea de mejora.

Pharmacotherapeutic Reports as Tools for Detecting Discrepancies in Continuity of Care.

BACKGROUND: The care transition is the time when more medication errors occur. The aim of this study is to analyze the usefulness of a pharmacotherapeutic report model at hospital discharge to prevent medication errors and to simplify pharmacotherapy during a patient's transition from the hospital to primary care. METHODS: Prospective study including patients diagnosed with chronic obstructive pulmonary disease who were admitted to a short-stay unit or an emergency room. Relevant variables were extracted from the patients' clinical history and SPSS software was used to carry out the statistical analysis. Direct costs were also calculated. RESULTS: 79.3% of patients were polymedicated, 15.5% of patients were identified as nonadherent to the treatment, 12.1% were users of alternative therapies, and 10.3% had been prescribed drugs that could be monitored. In 32.8% of the reports, reference was made to the primary care pharmacists with a view to resolve any pharmacotherapeutic discrepancies. A total of 132 discrepancies were identified, the majority being related to medicinal requirements (necessary/unnecessary medication). The major cause of drug-related problems (DRPs) were prescription errors. The drugs that were mainly involved in the onset of DRPs belonged to the R group, and the degree of simplification of the pharmacotherapy was 7.6%. The total cost avoided with the reconciliation was 200€/patient. CONCLUSION: A continuity program was implemented based on the drafting of a pharmacotherapeutic report, which allowed for detecting discrepancies and updating the patients' pharmacotherapeutic history, resulting in financial savings after its implementation.