RESUMO
The purpose of this article is to report the experience of the Department of Hospital Pharmacy of a mid-size hospital during the peak of the COVID-19 pandemic. The human and material resources available in a mid-size hospital were more limited than in larger hospitals of the region. In this article, we describe how this Department of Hospital Pharmacy was reorganized to meet the increase in activity, the strategies developed and the lessons learned for future pandemics. The COVID-19 pandemic had a higher impact in Leganes, a city in the south of Madrid, with a population of 190,000. In the face of the dramatic increase in the proportion of patients attending our hospital between March and April 2020, the Severo Ochoa University Hospital increased the number of beds by 24.5% and fitted out new premises inside and outside the hospital (sports centers). The mean number of patients seen in our Emergency Department every day passed from 70-80 to a peak of 286 patients, with 652 hospitalized patients. The situation of emergency created by this infectious disease, with management protocols changing constantly, had a dramatic impact on the activity of hospital pharmacies. Thus, the pandemic has affected areas of economic management, magistral preparation, dispensing of medication to inpatients, ambulatory patients, patients monitored at home, institutionalized patients, and patients from private hospitals and field hospitals. Other areas affected include training, clinical trials, pharmacovigilance, and counseling boards. Two strategies were adopted to overcome these problems: a strategy centered on human resources (staff reinforcement, reallocation of responsibilities), and a strategy centered on processes (some processes were reinforced to meet the increase in activity, whereas other were temporarily suspended or reduced to the minimum).Conclusions: The Department of Hospital Pharmacy plays a key role in hospitals and has been significantly reinforced to meet the dramatic impact of the pandemic on this service. This Department has been able to reorganize its processes and take over new responsibilities such as telepharmacy and home dispensing. Hospital pharmacies play a crucial role in pharmacotherapeutic decisions in hospitals. As in other Departments, training is the area more significantly affected by the pandemic.
El objetivo de este artículo es describir la experiencia del servicio de farmacia de un hospital mediano, en el período álgido de la pandemia de COVID-19, con recursos humanos y materiales más limitados que otros hospitales de su entorno de mayor tamaño. Se analiza cómo afrontó su reorganización, debido al incremento de su actividad, así como las estrategias desarrolladas y las lecciones aprendidas para afrontar el futuro. La pandemia por COVID-19 tuvo especial repercusión en el municipio de Leganés, una ciudad de 190.000 habitantes al sur de Madrid. Ante el incremento de la afluencia de pacientes entre los meses de marzo y abril de 2020, el Hospital Universitario Severo Ochoa llegó a asumir un 24,5% más de camas, incluyendo nuevas ubicaciones tanto dentro como fuera del hospital (pabellón deportivo). Siendo la media de frecuentación del Servicio de Urgencias de 70-80 pacientes, se llegó a alcanzar un pico de 286 pacientes y 652 pacientes ingresados. Esta situación de emergencia y el abordaje de una patología infecciosa, con protocolos de tratamiento en continua revisión, impactó en todas las áreas y actividades del servicio de farmacia: adquisiciones, gestión económica, elaboración de medicamentos y dispensación a pacientes hospitalizados, pacientes externos y ambulantes, domiciliaria, a centros geriátricos, hospitales de gestión privada y hospitales de campaña. Se vieron afectadas áreas como la formación, los ensayos clínicos, la farmacovigilancia y las comisiones hospitalarias. Para superar los problemas, se aplicaron dos estrategias: una centrada en los recursos humanos (reforzamiento de áreas, reasignación de responsabilidades) y otra focalizada en los procesos (procesos que se reforzaron por un aumento de la actividad, procesos que se suspendieron temporalmente por la pandemia y procesos que se redujeron al mínimo).Conclusiones: El servicio de farmacia es una pieza clave en el hospital cuyas funciones principales son las primeras perjudicadas, pero a la vez las más reforzadas durante la pandemia. Ha tenido la capacidad de reorganizar sus procesos para asimilar nuevas actividades, como la telefarmacia y la dispensación domiciliaria. Juega un papel importante en las decisiones farmacoterapéuticas del hospital. Al igual que otros servicios clínicos, la formación ha sido el área más perjudicada.
Assuntos
Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Pandemias , Serviço de Farmácia Hospitalar/organização & administração , Pneumonia Viral/tratamento farmacológico , COVID-19 , Ensaios Clínicos como Assunto , Planejamento em Desastres , Composição de Medicamentos , Prescrições de Medicamentos/estatística & dados numéricos , Previsões , Necessidades e Demandas de Serviços de Saúde , Número de Leitos em Hospital , Hospitais Universitários/organização & administração , Hospitais Urbanos/organização & administração , Humanos , Pacientes Internados/estatística & dados numéricos , Sistemas de Medicação no Hospital/organização & administração , SARS-CoV-2 , Espanha , Desenvolvimento de Pessoal , Tratamento Farmacológico da COVID-19RESUMO
The COVID-19 pandemic is placing huge strain on health systems and professionals. Emergency departments and their pharmacy services have been the first to face this challenge before any other pharmacy units. This article provides a description of the experience of two public hospitals located in the Autonomous Community of Madrid, Spain. Team working and reciprocal trust have made it possible to meet the unprecedented demand for health services and has facilitated rapid decision making. Strategies have been developed to guarantee the availability, distribution and safe use of medications. Other strategies have included favoring communication within Emergency Departments pharmacy services, and between these services and Emergency Departments during the pandemic. Multidisciplinary cooperation and information sharing have traditionally formed the base for efficient and quality work, along with solid technologies that guarantee a safe use of medications. The crucial role of information and communication technologies during the pandemic may give rise to a new model of pharmaceutical care, which should not replace face-to- face Emergency Department pharmacist support and advice. Promoting the re- humanization of healthcare and pharmacy services is essential. An adequate technical training and the development of abilities such as flexibility, planning and coordination skills, and an assertive communication and management of emotions will be key to the successful management of unimaginable settings in the future.
La actual pandemia ha puesto al límite la capacidad de respuesta del sistema sanitario y a sus profesionales. Los primeros en enfrentarse a este reto han sido los servicios de urgencias y, con ellos, los farmacéuticos ligados a estas unidades, que han precedido a los del resto de áreas del servicio de farmacia. En este artículo se narra la experiencia en dos hospitales públicos de la Comunidad de Madrid. El trabajo en equipo y la confianza mutua han permitido abordar una demanda asistencial desorbitada y una rápida toma de decisiones. Se han desarrollado estrategias para garantizar la disponibilidad y la dispensación de medicamentos, y favorecer la mejora en la seguridad de su utilización. Fomentar la comunicación dentro del propio servicio y con urgencias ha sido otra de las estrategias imprescindibles potenciadas durante la pandemia. La cooperación multidisciplinar y la coordinación de la información siempre serán la base de un trabajo eficiente y de calidad, junto con sistemas informáticos bien desarrollados como pieza clave en la seguridad del proceso de utilización de medicamentos. El impulso de las tecnologías para la información y la comunicación durante la pandemia quizá permita un nuevo modelo de atención farmacéutica que no debería sustituir la actividad presencial del farmacéutico en urgencias; es imprescindible retomar e impulsar la humanización desde los diferentes estamentos. Una buena formación técnica y el desarrollo de habilidades como flexibilidad, capacidad de organización y coordinación, comunicación y gestión de las emociones serán imprescindibles para afrontar futuras e inimaginables situaciones.
Assuntos
Betacoronavirus , Infecções por Coronavirus , Serviço Hospitalar de Emergência/organização & administração , Unidades de Terapia Intensiva , Pandemias , Farmacêuticos , Pneumonia Viral , COVID-19 , Competência Clínica , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Tomada de Decisões , Gerenciamento Clínico , Prescrições de Medicamentos/estatística & dados numéricos , Previsões , Necessidades e Demandas de Serviços de Saúde , Hospitais Universitários , Humanos , Controle de Infecções/organização & administração , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Comunicação Interdisciplinar , Sistemas de Medicação no Hospital/organização & administração , Equipe de Assistência ao Paciente , Preparações Farmacêuticas/provisão & distribuição , Serviço de Farmácia Hospitalar/organização & administração , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , SARS-CoV-2 , Espanha/epidemiologiaRESUMO
In response to the SARS-CoV-2 pandemic, the Hospital Pharmacy Services have quickly adapted to respond to a critical situation characterized by the constant and continuous admission of patients with severe pneumonia who needed treatment, requiring a transformation of the hospital in order to increase the number of hospital and critical beds. Moreover, other out-ofhospital spaces have been transformed into hospitalization units to absorb the large number of patients that had to be treated and isolated. To guarantee the distribution of medicines and the quality of the pharmaceutical care, drug distribution systems, such as unit dose and automated dispensing systems, have undergone transformations. Standard stocks were assigned for COVID units, and different dispensing circuits to avoid the risk of cross-contamination between COVID and non-COVID units were created, as well as disinfection protocols for medication transport systems and medication return protocols. All this without forgetting COVID treatment protocol's changes that were affected by the availability of the drugs. The increase in the number of beds in out-of-hospital spaces, such as field hospitals, hotels, socio-medical centers and nursing homes, has challenged Pharmacy Services, since new medication dispensing and conciliation circuits have been created forcing the increase of pharmacy staff's presence and modifying work shifts, to afford all the new tasks successfully. Development of contingency plans for the different Pharmacy Service activities and providing fluent communication channels are key elements for crisis situations or health emergencies such as the current pandemic.
Ante la pandemia por SARS-CoV-2, los servicios de farmacia de los hospitales se han adaptado rápidamente para dar respuesta a una situación muy grave caracterizada por el ingreso constante y continuo de pacientes con neumonía que necesitaban tratamiento, siendo necesaria una transformación del hospital para poder aumentar el número de camas de hospitalización y de críticos que se requerían. Asimismo, otros dispositivos extrahospitalarios se han transformado en unidades de hospitalización para absorber el elevado número de pacientes que debían tratarse y aislarse. Para garantizar la distribución de los medicamentos y la calidad de la atención farmacéutica, los sistemas de distribución de fármacos, como la unidosis y los sistemas automatizados de dispensación, han sufrido a su vez transformaciones. Se diseñaron stocks estándar para las plantas COVID, y circuitos de dispensación diferentes para evitar el riesgo de contaminación cruzada entre plantas COVID y no-COVID, así como protocolos de desinfección de los sistemas de transporte de medicación y protocolos de gestión de las devoluciones de medicación. Todo esto sin olvidar los cambios en los protocolos de tratamiento de la COVID que se vieron afectados por la disponibilidad de los fármacos. El incremento del número de camas en dispositivos extrahospitalarios, como hospitales de campaña, hoteles, centros sociosanitarios y residencias geriátricas, ha sido un reto para los servicios de farmacia, ya que se han tenido que crear nuevos circuitos de dispensación y de conciliación de la medicación, obligando a reforzar la plantilla del servicio de farmacia y modificar los turnos de trabajo, estableciendo guardias presenciales para poder llevar a cabo todas las nuevas tareas con éxito. La elaboración de planes de contingencia de las diferentes actividades del servicio de farmacia y el establecimiento de canales de comunicación fluidos son elementos clave para situaciones de crisis o emergencias sanitarias como la actual.
Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Farmacêuticos , Serviço de Farmácia Hospitalar/organização & administração , Pneumonia Viral , COVID-19 , Desinfecção , Armazenamento de Medicamentos , Prescrição Eletrônica , Equipamentos e Provisões/provisão & distribuição , Previsões , Necessidades e Demandas de Serviços de Saúde , Número de Leitos em Hospital , Unidades Hospitalares , Humanos , Unidades de Terapia Intensiva , Sistemas de Medicação no Hospital/organização & administração , Alta do Paciente , Admissão e Escalonamento de Pessoal , SARS-CoV-2 , Recursos HumanosRESUMO
Hospital Pharmacy Service (HPS) in Spain have been impacted by the health crisis caused by the COVID-19 pandemic. Thus, the outbreak has forced HPSs to adapt their outpatient consultation services to Telepharmacy to optimize clinical outcomes and reduce the risk of contagion. The purpose of this article is to describe and analyze the experience of HPSs with outpatient Telepharmacy during the COVID-19 pandemic and expose the lessons learned. Measures have been adopted in on-site outpatient pharmacy clinics to prevent exposure of patients and professionals to the virus. These measures are based on national and international recommendations on social distancing and hygiene. With regard to remote outpatient pharmacy services, teleconsultation with drug dispensing has been promoted based on five basic procedures, each with its advantages and limitations: home drug delivery from HPSs, with the advantage of universal access and the limitation of entailing a substantial investment in resources; HPS coordination with primary care pharmacists, which requires no investments but with limited access to some geographic areas; HPS coordination with community pharmacists based on a large network of pharmacies, which requires the patient to go to the pharmacy, without confidentiality being guaranteed for any patient; geolocation and hospital-based medication dispensing, which provides universal access and direct traceability, but entails investment in human resources; and HPS coordination with associations of patients, which does not entail any additional cost but limits the information available on the diseases of society members. Three main lessons have been learned during the pandemic: the satisfactory capacity of HPS to provide outpatient pharmacy consultation services in the setting of a public health crisis; the usefulness of Telepharmacy for the clinical follow-up, healthcare coordination, outpatient counseling, and informed dispensing and delivery of medication (with a high level of satisfaction among patients); and the need to foster Telepharmacy as a complementary tool through a mixed model of outpatient pharmacy consultation service that incorporates the advantages of each procedure and adapts to the individual needs of each patient in a context of humanized healthcare.
Los servicios de farmacia hospitalaria (SFH) en España se han visto afectados por la crisis sanitaria provocada por SARS-CoV-2 y han tenido que adoptar sus procedimientos de atención farmacéutica (AF) al paciente externo (PE) mediante estrategias de Telefarmacia, con los objetivos de maximizar los resultados en salud y reducir el riesgo de contagio. El objetivo de ese artículo es describir y analizar los procedimientos AFPE durante la pandemia SARS-CoV-2 y comunicar las lecciones aprendidas en los SFH. En relación con las consultas externas de AF presenciales, se han adoptado medidas para minimizar el contagio viral de pacientes y profesionales, siguiendo las recomendaciones nacionales e internacionales de referencia de distanciamiento temporal, espacial y recomendaciones higiénicas. En cuanto a las consultas externas de AF no presenciales, se han potenciado las teleconsultas con dispensación del tratamiento en base a cinco procedimientos básicos, cada uno de ellos con sus ventajas y limitaciones: dispensación domiciliaria desde SFH que presenta las ventajas de la universalidad de acceso, pero requiere una elevada inversión en recursos; coordinación del SHF con farmacéuticos de atención primaria, que conlleva una nula inversión en recursos, pero limita el acceso a determinadas zonas geográficas; coordinación del SFH con farmacéuticos comunitarios, que utiliza una amplia red de oficinas de farmacia, pero exige el desplazamiento del paciente sin garantías de confidencialidad para todos los casos; geolocalización y dispensación hospitalaria, que permite un acceso universal y trazabilidad directa, pero requiere un incremento en recursos humanos; y coordinación del SFH con asociaciones de pacientes, que no requiere inversión económica, pero limita el acceso a las patologías de los asociados. Destacamos finalmente tres lecciones aprendidas: la capacidad de AFPE de SFH españoles ante una crisis sanitaria; la utilidad de la Telefarmacia para el seguimiento clínico, la coordinación asistencial, información al PE, dispensación y entrega informada (con elevada satisfacción de los pacientes); y la necesidad de potenciar la Telefarmacia como herramienta complementaria, en un modelo mixto de AFPE que incorpore las ventajas de cada uno de los procedimientos adaptándose a las necesidades individuales de los pacientes en un entorno de humanización de la asistencia sanitaria.
Assuntos
Assistência Ambulatorial/organização & administração , Betacoronavirus , Infecções por Coronavirus , Atenção à Saúde/organização & administração , Pandemias , Serviço de Farmácia Hospitalar/organização & administração , Pneumonia Viral , Telemedicina/organização & administração , COVID-19 , Atenção à Saúde/estatística & dados numéricos , Aconselhamento Diretivo/organização & administração , Aconselhamento a Distância/organização & administração , Previsões , Geografia Médica , Necessidades e Demandas de Serviços de Saúde , Serviços de Assistência Domiciliar/organização & administração , Hospitais Universitários/organização & administração , Humanos , Sistemas de Medicação no Hospital/organização & administração , Pacientes Ambulatoriais , Educação de Pacientes como Assunto/organização & administração , Serviço de Farmácia Hospitalar/estatística & dados numéricos , SARS-CoV-2 , EspanhaRESUMO
PURPOSE: The results of the 2018 ASHP national survey of pharmacy practice in hospital settings are presented. METHODS: Pharmacy directors at 4,897 general and children's medical-surgical hospitals in the United States were surveyed using a mixed-mode method of contact by mail and email. Survey completion was online using Qualtrics. IMS Health supplied data on hospital characteristics; the survey sample was drawn from IMS's hospital database. RESULTS: The response rate was 16.6%. The percentage of hospitals that routinely have pharmacists assigned to provide drug therapy management has increased. Transitions-of-care processes have generally increased over the last 6 years. The percentage of hospitals with pharmacists in a wide variety of clinic types and clinical practice areas has increased over the last 2 years. Opioid stewardship programs are emerging in many U.S. hospitals, with pharmacists participating or taking the lead in program implementation. Outsourcing of compounded sterile product preparation is common. The proportion of hospitals not using any technology when compounding sterile preparations has declined. Pharmacy departments commonly track and monitor trends for administrative, operational, quality, and outcome metrics. CONCLUSION: Pharmacists continue to improve drug therapy monitoring for patients in U.S. hospitals. They are also responding to public health issues related to medication use. These advancements include taking an active role in opioid stewardship programs, safe compounding of sterile medications for patients, and reducing the need for hospital-based care.
Assuntos
Educação de Pacientes como Assunto/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Monitoramento de Medicamentos/estatística & dados numéricos , Humanos , Sistemas de Medicação no Hospital/organização & administração , Sistemas de Medicação no Hospital/estatística & dados numéricos , Conduta do Tratamento Medicamentoso/organização & administração , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Educação de Pacientes como Assunto/estatística & dados numéricos , Transferência de Pacientes/organização & administração , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Sociedades Farmacêuticas , Inquéritos e Questionários/estatística & dados numéricos , Estados UnidosAssuntos
Assistência Ambulatorial/organização & administração , Registros Eletrônicos de Saúde/organização & administração , Alta do Paciente , Transferência de Pacientes/organização & administração , Medicamentos sob Prescrição/uso terapêutico , Implementação de Plano de Saúde , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Sistemas de Medicação no Hospital/organização & administração , Farmacêuticos/organização & administração , Medicamentos sob Prescrição/economia , Autorização Prévia/organização & administração , Papel Profissional , Desenvolvimento de Programas , UtahRESUMO
Unit-dose drug distribution systems provide optimal choices in terms of medication security and efficiency for organizing the drug-use process in large hospitals. As small hospitals have to share such automatic systems for economic reasons, the structure of their logistic organization becomes a very sensitive issue. In the research reported here, we develop a generalized multi-level optimization method - multi-level particle swarm optimization (MLPSO) - to design a shared unit-dose drug distribution network. Structurally, the problem studied can be considered as a type of capacitated location-routing problem (CLRP) with new constraints related to specific production planning. This kind of problem implies that a multi-level optimization should be performed in order to minimize logistic operating costs. Our results show that with the proposed algorithm, a more suitable modeling framework, as well as computational time savings and better optimization performance are obtained than that reported in the literature on this subject.
Assuntos
Sistemas de Medicação no Hospital/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Algoritmos , Automação , França , Humanos , Sistemas de Medicação no Hospital/economia , Modelos TeóricosRESUMO
Despite progress on patient safety since the publication of the Institute of Medicine's 1999 report, To Err Is Human, significant problems remain. Human factors and systems engineering (HF/SE) has been increasingly recognized and advocated for its value in understanding, improving, and redesigning processes for safer care, especially for complex interacting sociotechnical systems. However, broad awareness of HF/SE and its adoption into safety improvement work have been frustratingly slow. We provide an overview of HF/SE, its demonstrated value to a wide range of patient safety problems (in particular, medication safety), and challenges to its broader implementation across health care. We make a variety of recommendations to maximize the spread of HF/SE, including formal and informal education programs, greater adoption of HF/SE by health care organizations, expanded funding to foster more clinician-engineer partnerships, and coordinated national efforts to design and operationalize a system for spreading HF/SE into health care nationally.
Assuntos
Atenção à Saúde/métodos , Ergonomia/métodos , Erros Médicos/prevenção & controle , Sistemas de Medicação no Hospital/organização & administração , Segurança do Paciente/normas , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Atenção à Saúde/organização & administração , Humanos , Estados UnidosRESUMO
OBJECTIVE: Medication administration errors (MAEs) are a common risk to patient safety in mental health hospitals, but an absence of in-depth studies to understand the underlying causes of these errors limits the development of effective remedial interventions. This study aimed to investigate the causes of MAEs affecting inpatients in a mental health National Health Service (NHS) hospital in the North West of England. METHODS: Registered and student mental health nurses working in inpatient psychiatric units were identified using a combination of direct advertisement and incident reports and invited to participate in semi-structured interviews utilising the critical incident technique. Interviews were designed to capture the participants' experiences of inpatient MAEs. All interviews were transcribed verbatim and subject to framework analysis to illuminate the underlying active failures, error/violation-provoking conditions and latent failures according to Reason's model of accident causation. RESULTS: A total of 20 participants described 26 MAEs (including 5 near misses) during the interviews. The majority of MAEs were skill-based slips and lapses (n = 16) or mistakes (n = 5), and were caused by a variety of interconnecting error/violation-provoking conditions relating to the patient, medicines used, medicines administration task, health care team, individual nurse and working environment. Some of these local conditions had origins in wider organisational latent failures. Recurrent and influential themes included inadequate staffing levels, unbalanced staff skill mix, interruptions/distractions, concerns with how the medicines administration task was approached and problems with communication. CONCLUSIONS: To our knowledge this is the first published in-depth qualitative study to investigate the underlying causes of specific MAEs in a mental health hospital. Our findings revealed that MAEs may arise due to multiple interacting error and violation provoking conditions and latent 'system' failures, which emphasises the complexity of this everyday task facing practitioners in clinical practice. Future research should focus on developing and testing interventions which address key local and wider organisational 'systems' failures to reduce error.
Assuntos
Hospitais Psiquiátricos , Erros de Medicação/estatística & dados numéricos , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Recursos Humanos de Enfermagem Hospitalar , Adulto , Idoso , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Inglaterra/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hospitais Psiquiátricos/normas , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Masculino , Sistemas de Medicação no Hospital/organização & administração , Sistemas de Medicação no Hospital/normas , Sistemas de Medicação no Hospital/estatística & dados numéricos , Transtornos Mentais/enfermagem , Programas Nacionais de Saúde/normas , Programas Nacionais de Saúde/estatística & dados numéricos , Recursos Humanos de Enfermagem Hospitalar/normas , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Segurança do Paciente , Pesquisa Qualitativa , Fatores de Risco , Gestão de Riscos , Carga de Trabalho/estatística & dados numéricosRESUMO
INTRODUCTION: With a view to reinforcing the security of the drug distribution process, the hospital pharmacy has decided to automate the patient-specific unit dose distribution system which, up to now was performed manually, through the acquisition of a unit dose dispensing system: the ACCED S 300 (ECODEX®). The aim of this work is to realize a cartography of risks, focused on the dispensing stage, prior to the implementation of the automated system. MATERIALS AND METHOD: A multidisciplinary group applied the preliminary risk analysis (PRA) technique. The study was limited to the dispensing stage of unit doses within the hospital pharmacy. RESULTS: This analysis revealed 122 accident scenarii, including 18 with an initial unacceptable criticality (14.8 % of scenarii). In total, 140 risk management actions were proposed. These actions include: acquisition of equipment, communication and training of pharmacy staff, communication with services, human resources management and organization of working hours, writing and updating quality documents, programming the software and interfaces linked with the robot. CONCLUSION: The implementation of risk management actions should reduce the risk and contribute to avoiding the most critical scenarii. This will require the availability of human and financial resources and the implication of management.
Assuntos
Sistemas de Medicação no Hospital/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Automação , Humanos , Erros de Medicação , Gestão de RiscosRESUMO
The retrocession (out-patient dispensing of hospital-reserved drugs)is a pharmaceutical critical activity requiring a care security with a territorial approach. In this drug supply chain, the pharmacist is the last step before the drug administration and the economic profitability is questionable. In this context, a risk mapping and an economic evaluation seem necessary. METHODS: The risk analysis was conducted with the adverse events collected. The economic study was realised with the point of view of the hospital and with the microcosting method. RESULTS: Six never events were observed with the risk analysis. The economic study showed that the retrocession was profitable in usual situations with a net margin from 7 to 14. But, when an exceptional situation occurred as a troubleshooting or the creation of a public deal, the added costs became so important (76 and 85) that the retrocession was an unbeneficial activity. CONCLUSION: The retrocession is an activity with a health, legal and economic high risk. In order to improve the healthcare quality and safety, the retrocession must be considered as a coordinated process. It means that the different health professionals must communicate with each other and that the connection between the ambulatory and the hospital care must be efficient.
Assuntos
Sistemas de Medicação no Hospital/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Assistência Ambulatorial , Custos e Análise de Custo , Humanos , Sistemas de Medicação no Hospital/economia , Pacientes Ambulatoriais , Segurança do Paciente , Farmacêuticos , Serviço de Farmácia Hospitalar/economiaRESUMO
RATIONALE, AIMS, AND OBJECTIVES: Whilst many dose omissions cause no patient harm, inappropriate dose omissions have been associated with increased length of hospital stay, risk of sepsis, and mortality. This study aimed to comprehensively describe the prevalence and nature of omitted doses overall and of high risk medication dose omissions in an organization using an electronic Medication Management System. METHODS: A retrospective cross-sectional study was undertaken in an Australian tertiary referral health service. All routinely documented electronic inpatient dose administration records from 1st July 2014 to 30th June 2015 were included. Period prevalence and characteristics of dose omissions overall and of high-risk medication dose omissions were determined. RESULTS: During the study period, 3.3 million inpatient doses were scheduled for administration, with doses endorsed as "not given" comprising 6.2% of all scheduled doses. Non-valid dose omissions (medication not available or no justification documented) comprised 1.2% of scheduled doses. Patient refusal accounted for one third of all dose omissions, while for 12% no explanation was provided and 7% were endorsed "medication not available". High-risk medications accounted for 20% of all dose omissions. One in 20 antimicrobial doses scheduled were omitted, and of these, 17% were due to patient refusal. CONCLUSION: The period prevalence of dose omissions in this large study after electronic Medication Management System implementation is similar to that found when paper charts were used. Although most dose omissions appear appropriate, many orders were not given due to patient refusal or with no documented justification. Interventions to minimize unintentional dose omissions are indicated.
Assuntos
Sistemas de Informação em Farmácia Clínica/estatística & dados numéricos , Prescrição Eletrônica/estatística & dados numéricos , Erros Médicos , Sistemas de Registro de Ordens Médicas/estatística & dados numéricos , Erros de Medicação , Conduta do Tratamento Medicamentoso/organização & administração , Austrália/epidemiologia , Estudos Transversais , Humanos , Pacientes Internados/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Erros Médicos/prevenção & controle , Erros Médicos/estatística & dados numéricos , Erros de Medicação/prevenção & controle , Erros de Medicação/estatística & dados numéricos , Sistemas de Medicação no Hospital/organização & administração , Prevalência , Estudos RetrospectivosRESUMO
To secure medical devices' management, the implementation of automated dispensing system in surgical service has been realized. The objective of this study was to evaluate security, organizational and economic impact of installing automated dispensing system for medical devices (ASDM). The implementation took place in a cardiac surgery department. Security impact was assessed by comparing traceability rate of implantable medical devices one year before and one year after installation. Questionnaire on nurses' perception and satisfaction completed this survey. Resupplying costs, stocks' evolution and investments for the implementation of ASDM were the subject of cost-benefit study. After one year, traceability rate is excellent (100%). Nursing staffs were satisfied with 87.5% by this new system. The introduction of ASDM allowed a qualitative and quantitative decrease in stocks, with a reduction of 30% for purchased medical devices and 15% for implantable medical devices in deposit-consignment. Cost-benefit analysis shows a rapid return on investment. Real stock decrease (purchased medical devices) is equivalent to 46.6% of investment. Implementation of ASDM allows to secure storage and dispensing of medical devices. This system has also an important economic impact and appreciated by users.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Equipamentos e Provisões/estatística & dados numéricos , Sistemas de Distribuição no Hospital/organização & administração , Centro Cirúrgico Hospitalar/organização & administração , Automação , Procedimentos Cirúrgicos Cardíacos/economia , Análise Custo-Benefício , Equipamentos e Provisões/economia , Sistemas de Distribuição no Hospital/economia , Humanos , Sistemas de Medicação no Hospital/organização & administração , Centro Cirúrgico Hospitalar/economiaRESUMO
PURPOSE: A successful supply chain optimization project that leveraged technology, engineering principles, and a technician workflow redesign in the setting of a growing health system is described. SUMMARY: With continued rises in medication costs, medication inventory management is increasingly important. Proper management of central pharmacy inventory and floor-stock inventory in automated dispensing cabinets (ADCs) can be challenging. In an effort to improve control of inventory costs in the central pharmacy of a large academic medical center, the pharmacy department implemented a supply chain optimization project in collaboration with the medical center's inhouse team of experts on process improvement and industrial engineering. The project had 2 main components: (1) upgrading and reconfiguring carousel technology within an expanded central pharmacy footprint to generate accurate floor-stock inventory replenishment reports, which resulted in efficiencies within the medication-use system, and (2) implementing a technician workflow redesign and algorithm to right-size the ADC inventory, which decreased inventory stockouts (i.e., incidents of depletion of medication stock) and improved ADC user satisfaction. CONCLUSION: Through a multifaceted approach to inventory management, the number of stockouts per month was decreased and ADC inventory was optimized, resulting in a one-time inventory cost savings of $220,500.
Assuntos
Centros Médicos Acadêmicos/organização & administração , Almoxarifado Central Hospitalar/organização & administração , Erros de Medicação/prevenção & controle , Sistemas de Medicação no Hospital/organização & administração , Fluxo de Trabalho , Centros Médicos Acadêmicos/economia , Centros Médicos Acadêmicos/normas , Almoxarifado Central Hospitalar/economia , Almoxarifado Central Hospitalar/normas , Redução de Custos/economia , Redução de Custos/normas , Humanos , Inventários Hospitalares/economia , Inventários Hospitalares/organização & administração , Inventários Hospitalares/normas , Erros de Medicação/economia , Sistemas de Medicação no Hospital/economia , Sistemas de Medicação no Hospital/normasRESUMO
OBJECTIVE: This study was conducted to compare human resource requirement among manual, automated, and modified automated dispensing systems. METHODS: Data were collected from the pharmacy department at the 2100-bed university hospital (Siriraj Hospital, Bangkok, Thailand). Data regarding the duration of the medication distribution process were collected by using self-reported forms for 1 month. The data on the automated dispensing machine (ADM) system were obtained from 1 piloted inpatient ward, whereas those on the manual system were the average of other wards. Data on dispensing, returned unused medication, and stock management processes under the traditional manual system and the ADM system were from actual activities, whereas the modified ADM system was modeled. The full-time equivalent (FTE) of each model was estimated for comparison. RESULTS: The result showed that the manual system required 46.84 FTEs of pharmacists and 132.66 FTEs of pharmacy technicians. By adding pharmacist roles on screening and verification under the ADM system, the ADM system required 117.61 FTEs of pharmacists. Replacing counting and filling medication functions by ADM has decreased the number of pharmacy technicians to 55.38 FTEs. After the modified ADM system canceled the return unused medication process, FTEs requirement for pharmacists and pharmacy technicians decreased to 69.78 and 51.90 FTEs, respectively. CONCLUSIONS: The ADM system decreased the workload of pharmacy technicians, whereas it required more time from pharmacists. However, the increased workload of pharmacists was associated with more comprehensive patient care functions, which resulted from the redesigned work process.
Assuntos
Automação/estatística & dados numéricos , Sistemas de Medicação no Hospital/organização & administração , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Hospitais com mais de 500 Leitos , Hospitais Universitários , Humanos , Sistemas de Medicação no Hospital/tendências , Farmacêuticos/economia , Farmacêuticos/estatística & dados numéricos , Técnicos em Farmácia/economia , Técnicos em Farmácia/estatística & dados numéricos , Autorrelato , TailândiaRESUMO
AIM: Propofol is a widely used anesthesia induction agent and is easily accessible in most healthcare facilities. Unlike regulated or schedule drugs, propofol is inconsistently tracked, leading to inaccurate inventories, incorrect billing, and unrecognized diversion. The goal of this project was to implement a new method of tracking propofol in a single setting, with the aim of accounting for 100% of the drug. METHODS: For two, 2-week observation periods, data were extracted from an automated medication management system or pharmacy inventory system, anesthesia records, and pharmacy billing sheets for cases in a Gastrointestinal (GI) Endoscopy Unit, and compared pre-implementation and post-implementation of a new tracking and accounting protocol. Variables included amount of propofol inventoried, dispensed, administered, returned, billed, wasted, and missing. RESULTS: Pre-implementation (nâ=â300), 10% cases had no record of propofol removal from the automated medication system. Of the 90% that did, 25% had an amount signed out that did not match the amount administered. Thirty-one percent of all propofol was unaccounted for during this 2-week period. Furthermore, 19.7% of cases did not have a billing form located. Post-implementation of the process change, unaccounted for propofol decreased to 26% of all cases (Pâ=âns). The percentage of missing billing forms decreased from 19.7 to 5.8% (Pâ=â0.00). CONCLUSION: Data suggest notable amounts of propofol were unaccounted for and not billed for in the GI Endoscopy Unit prior to the protocol change. Post-protocol change data reveal modest improved accounting of the medication and significant cost-capture. Improvements may enhance inventory reconciliation, availability of drug stock, and potentially result in a decreased risk of unrecognized diversion.
Assuntos
Anestésicos Intravenosos/uso terapêutico , Sistemas de Medicação no Hospital/organização & administração , Propofol/uso terapêutico , Anestésicos Intravenosos/administração & dosagem , Sistemas de Informação em Farmácia Clínica/organização & administração , Endoscopia Gastrointestinal/economia , Humanos , Inventários Hospitalares/métodos , Sistemas de Medicação no Hospital/normas , Propofol/administração & dosagem , Propofol/economia , Estudos Prospectivos , Controle de QualidadeRESUMO
Purpose Medication management is a complex process, at high risk of error with life threatening consequences. The focus should be on devising strategies to avoid errors and make the process self-reliable by ensuring prevention of errors and/or error detection at subsequent stages. The purpose of this paper is to use failure mode effect analysis (FMEA), a systematic proactive tool, to identify the likelihood and the causes for the process to fail at various steps and prioritise them to devise risk reduction strategies to improve patient safety. Design/methodology/approach The study was designed as an observational analytical study of medication management process in the inpatient area of a multi-speciality hospital in Gurgaon, Haryana, India. A team was made to study the complex process of medication management in the hospital. FMEA tool was used. Corrective actions were developed based on the prioritised failure modes which were implemented and monitored. Findings The percentage distribution of medication errors as per the observation made by the team was found to be maximum of transcription errors (37 per cent) followed by administration errors (29 per cent) indicating the need to identify the causes and effects of their occurrence. In all, 11 failure modes were identified out of which major five were prioritised based on the risk priority number (RPN). The process was repeated after corrective actions were taken which resulted in about 40 per cent (average) and around 60 per cent reduction in the RPN of prioritised failure modes. Research limitations/implications FMEA is a time consuming process and requires a multidisciplinary team which has good understanding of the process being analysed. FMEA only helps in identifying the possibilities of a process to fail, it does not eliminate them, additional efforts are required to develop action plans and implement them. Frank discussion and agreement among the team members is required not only for successfully conducing FMEA but also for implementing the corrective actions. Practical implications FMEA is an effective proactive risk-assessment tool and is a continuous process which can be continued in phases. The corrective actions taken resulted in reduction in RPN, subjected to further evaluation and usage by others depending on the facility type. Originality/value The application of the tool helped the hospital in identifying failures in medication management process, thereby prioritising and correcting them leading to improvement.
Assuntos
Erros de Medicação/prevenção & controle , Sistemas de Medicação no Hospital/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Gestão de Riscos/organização & administração , Humanos , Índia , Erros de Medicação/classificação , Medição de RiscoRESUMO
CONTEXT: Alzheimer's disease is a common disease in nursing homes. Evolution is constantly negative and specific treatments, which are only symptomatic, are subject to controversy. In a context of media exposure, the Transparency Committee of the Haute Autorité de santé (HAS) downgraded their medical service in October 2011, seeing it as weak. AIM: Assess the evolution of the consumption of specific treatments for Alzheimer's disease; assess changes in the quality of monitoring in specific consultation. METHODS: This is a retrospective and descriptive study, cross-sectional in three times (T0 January 2011, T1 October 2011 and T2 June 2012), in 6 nursing homes of Lille and its surroundings. RESULTS: In total, 262 residents with dementia and present at least once during the three times of the study were included. Their mean age was 85.8 years. Among them, 40 % had Alzheimer's disease clearly identified. At T0, 76.7 % of patients present who were supposed to receive a specific treatment of Alzheimer's disease were actually receiving such treatment, 73.6 % at T1 and 71.6 % at T2. After 17 months of observation, the discontinuation rate of anticholinesterase was 34 %, 24 % for anti-glutamate. The monitoring in specific consultations decreased slightly between the three stages. CONCLUSION: Our work did not show major impact of the media campaign against specific drugs for Alzheimer's disease. There is however a trend towards a decrease of their consumption in people with dementia living in nursing homes with no obvious link between monitoring in specific consultation and specific prescription. This trend would ask to be confirmed by a study on a larger scale.
Assuntos
Doença de Alzheimer/tratamento farmacológico , Prescrições de Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Promoção da Saúde , Sistemas de Medicação no Hospital/normas , Casas de Saúde , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/epidemiologia , Inibidores da Colinesterase/uso terapêutico , Meios de Comunicação , Estudos Transversais , Prescrições de Medicamentos/normas , Prescrições de Medicamentos/estatística & dados numéricos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Antagonistas de Aminoácidos Excitatórios/uso terapêutico , Feminino , França/epidemiologia , Promoção da Saúde/métodos , Instituição de Longa Permanência para Idosos/organização & administração , Instituição de Longa Permanência para Idosos/normas , Humanos , Masculino , Sistemas de Medicação no Hospital/organização & administração , Sistemas de Medicação no Hospital/estatística & dados numéricos , Casas de Saúde/organização & administração , Casas de Saúde/normas , Estudos RetrospectivosRESUMO
PURPOSE: A multifaceted automated dispensing cabinet (ADC) optimization initiative at a large hospital is described. SUMMARY: The ADC optimization project, which was launched approximately six weeks after activation of ADCs in 30 patient care unit medication rooms of a newly established adult hospital, included (1) adjustment of par inventory levels (desired on-hand quantities of medications) and par reorder quantities to reduce the risk of ADC supply exhaustion and improve restocking efficiency, (2) expansion of ADC "common stock" (medications assigned to ADC inventories) to increase medication availability at the point of care, and (3) removal of some infrequently prescribed medications from ADCs to reduce the likelihood of product expiration. The purpose of the project was to address organizational concerns regarding widespread ADC medication stockouts, growing reliance on cart-fill medication delivery systems, and suboptimal medication order turnaround times. Leveraging of the ADC technology platform's reporting functionalities for enhanced inventory control yielded a number of benefits, including cost savings resulting from reduced pharmacy technician labor requirements (estimated at $2,728 annually), a substantial reduction in the overall weekly stockout percentage (from 3.2% before optimization to 0.5% eight months after optimization), an improvement in the average medication turnaround time, and estimated cost avoidance of $19,660 attributed to the reduced potential for product expiration. CONCLUSION: Efforts to optimize ADCs through par level optimization, expansion of common stock, and removal of infrequently used medications reduced pharmacy technician labor, decreased stockout percentages, generated opportunities for cost avoidance, and improved medication turnaround times.
Assuntos
Erros de Medicação/prevenção & controle , Sistemas de Medicação no Hospital/organização & administração , Preparações Farmacêuticas/provisão & distribuição , Serviço de Farmácia Hospitalar/métodos , Tecnologia Farmacêutica/métodos , Humanos , Sistemas de Medicação no Hospital/economia , Serviço de Farmácia Hospitalar/economia , Sistemas Automatizados de Assistência Junto ao LeitoRESUMO
The shared medication treatment plan is a key element for supporting the continuity of care. Indeed a substantial amount of emergency hospitalization is linked to medication - 5% to 10% according to some studies. Methods and tools helping all healthcare providers to have a better knowledge of the complete medication plan are therefore required in order to limit side effects linked to an insufficient knowledge of what the patient is taking. The workshop intends to present various initiatives and open the discussion about the limits, pros and cons of various initiatives.