Drug closed-loop management system using mobile technology.

BACKGROUND: Drug closed-loop management reflects the level of hospital management and pharmacist service. It is a challenge for hospital pharmacists to realize the whole-process closed-loop management of drugs in hospital pharmacies. Therefore, this study aimed to evaluate the operational effect of using mobile technology to build a closed-loop drug management system. METHODS: Using mobile technology, replacing the traditional paper dispensing model and constructing a multinode information collection system according to the Healthcare Information and Management Systems Society Standard, we reformed the hospital information system and inpatient pharmacy workflow and then evaluated the new approach using statistical methods. RESULTS: After the transformation, the entire process of drug data can be traced. Closed-loop management, as well as real-time data verification and control, thereby improves the work efficiency and reduces the drug dispensing time. By reducing the work error rate, the number of dispensing errors decreased from 5 to 1 case/month. The comprehensive dispensing process can achieve the whole workflow of paperless operation and reduce the use of paper A4 by 180,000 pieces per year. CONCLUSIONS: Mobile technology can improve the service level of pharmacies, enhance the level of drug management and hospital quality management, ensure the safety of medication for inpatients, and significantly reduce the amount of paper used.

Impact of Dispense Tracking Software on Inpatient Pharmacy Operations.

Background: When medications dispensed from a hospital inpatient pharmacy aren't able to be found at their intended destination (ie, a missing dose), this can result in delayed medication administration and rework to redispense the medication. Technology advancements in the medication use process have led to development of dose-tracking software that has the capability to track medication doses throughout the medication use cycle and document a medication's location to its destination. Objective: The primary objective of this study was to evaluate the impact of dose-tracking software on the number of inpatient pharmacy redispenses and nursing requests for missing medications. Secondary objectives included pharmacy staff satisfaction with dose-tracking software, its impact on workflow and patient safety, and compliance with dose-track scanning. Methods: The study design was a prospective, pre-post implementation to compare the requests for missing doses and associated dispenses of injectable medications during the set evaluation period. Dose-track scanning compliance data was collected and evaluated. A survey was also administered to staff to evaluate employee perception and satisfaction with usability and value of the software. Results: During the preimplementation period, 40 021 injectable doses were dispensed, and 9841 (24.6%) were documented as redispensed doses. After dose-tracking implementation, 42 975 total injectable doses were dispensed with 9839 (22.9%) being redispensed. The count of medication messages was 10 661 in the preperiod and 11 475 in the postperiod. The data were normalized using case mix index (CMI) and patient days to account for variation in severity of illness. Conclusion: Implementation of dose-tracking software showed a decrease in the percentage of redispensed injectable medications.

Pharmacist Prescribing at Inpatient Discharge in Alberta.

Background: Pharmacists in the province of Alberta may apply for additional prescribing authorization (APA), which allows them to independently prescribe medications. Currently, no literature exists about pharmacist prescribing for inpatients at the time of discharge. Objectives: The primary objective was to report the proportion of patients for whom inpatient pharmacists with APA prescribed at discharge across Alberta, Canada. Secondary objectives were to describe discharge interventions other than prescribing that were provided, enablers of and barriers to discharge prescribing, and differences in discharge prescribing by facility or population type, clinical area, and health care charting system. Methods: A descriptive, cross-sectional web-based survey of inpatient pharmacists with APA across Alberta was conducted over a 6-week period in early 2022. Results: A total of 104 respondents met the inclusion criteria. Under half (45/102, 44.1%) of the participants reported prescribing at discharge. Those that reported prescribing at discharge did so for only a median 14.5% of their patients. The most common enabler of discharge prescribing was a supportive care team, and the most common barrier was the presence of other prescribers. Pharmacists who did not report prescribing at discharge selected "discomfort with being responsible for the prescription" and "fear of professional liability" as barriers more often than those who did report discharge prescribing (51.0% [26/51] vs 33.3% [13/39] and 43.1% [22/51] vs 25.6% [10/39], respectively). The proportion of pharmacists who reported prescribing at discharge was greater with increasing population/facility size (30% [6/20] of pharmacists in settings that served small populations vs 50% [29/58] of those in settings that served large populations). Conclusions: Inpatient pharmacists who use APA at discharge reported prescribing for only a minority of patients, and discharge prescribing practices varied widely across the province. Future areas of research include how pharmacists can overcome barriers to prescribing at discharge.

Contexte: Les pharmaciens de la province de l'Alberta peuvent demander une autorisation supplémentaire de prescrire des médicaments de manière indépendante. À l'heure actuelle, aucune documentation n'existe sur la prescription de médicaments destinés aux patients hospitalisés au moment de leur congé par les pharmaciens. Objectifs: L'objectif principal visait à rendre compte de la proportion de patients à qui les pharmaciens en milieu hospitalier titulaires d'une autorisation supplémentaire de prescrire prescrivaient des médicaments au moment du congé en Alberta, au Canada. Les objectifs secondaires visaient quant à eux à décrire : les interventions au moment du congé, autres que la prescription; les obstacles et les facilitateurs de la prescription au moment du congé; et les différences en matière de prescription au moment du congé par type d'établissement ou de population, domaine clinique et système de dossiers de soins de santé. Méthode: Une enquête en ligne descriptive et transversale a été menée auprès de pharmaciens en milieu hospitalier titulaires d'une autorisation supplémentaire de prescrire en Alberta, sur un intervalle de 6 semaines au début de 2022. Résultats: Au total, 104 répondants satisfaisaient aux critères d'inclusion. Moins de la moitié (45/102, 44,1 %) des participants ont déclaré prescrire au moment du congé. Ceux-ci le faisaient pour seulement une médiane de 14,5 % de leurs patients. Le facteur le plus courant favorisant la prescription au moment du congé était une équipe de soins de soutien; l'obstacle le plus courant était la présence d'autres prescripteurs. Les pharmaciens ayant déclaré ne pas prescrire au moment du congé ont plus fréquemment indiqué comme obstacle le fait d'être « mal à l'aise à l'idée d'être responsable de la prescription ¼ et la « crainte de la responsabilité professionnelle ¼ que les pharmaciens ayant indiqué prescrire au moment du congé (51,0 % [26/51] contre 33,3 % [13/39] et 43,1 % [22/51] contre 25,6 % [10/39], respectivement). La proportion de pharmaciens ayant déclaré prescrire au moment du congé était plus élevée lorsque la taille de la population/de l'établissement était plus importante (30% [6/20] des pharmaciens dans des milieux desservant de petites populations contre 50 % [29/58] de ceux dans des milieux desservant de grandes populations). Conclusions: Les pharmaciens en milieu hospitalier titulaires d'une autorisation supplémentaire de prescrire ont déclaré prescrire pour seulement une minorité de patients au moment du congé, et les pratiques en la matière variaient largement dans la province. Les futurs domaines de recherche comprennent la manière dont les pharmaciens peuvent surmonter les obstacles les empêchant de prescrire au moment du congé.

Impact of an inpatient order verification simulation on student perceived preparedness and confidence.

BACKGROUND AND PURPOSE: The ability to effectively and efficiently navigate an electronic health record (EHR) to complete an inpatient prospective drug review is a vital skill that entry level practitioners must possess. The purpose of this study was to evaluate the impact of an EHR-based inpatient order verification simulation on students' perceived preparedness and confidence when reviewing the accuracy of an inpatient medication order and providing a verbal recommendation to a health care prescriber. This was evaluated by comparing survey scores pre- and post-simulation. EDUCATIONAL ACTIVITY AND SETTING: An educational series utilizing EHR technology was designed to simulate the sequence of tasks an inpatient pharmacist completes when processing an inpatient mediation order. This includes performing a prospective drug utilization review to identify medication-related problems, forming alternative recommendations, and verbalizing recommendations to prescriber. FINDINGS: A total of 89 students across two cohorts (99%) completed the pre-survey; 31 students (34%) completed the post-survey. Comparison of pre- and post-survey scores resulted in significant findings for all categories: increased perceived preparedness, efficiency, and accuracy when processing or reviewing a medication order (P < .001); increased confidence when efficiently and effectively utilizing EHR technology (P < .001); increased confidence when efficiently (P < .001) and effectively (P < .001) providing a verbal recommendation to a health care prescriber. SUMMARY: Incorporating a series of EHR-based activities simulating medication order verification and prescriber communication into the doctor of pharmacy curriculum positively impacts student perceived preparedness and confidence.

The use of Lean tools to reduce inpatient waiting time in a Thai public hospital: an action research study.

PURPOSE: The aims of this paper are to illustrate the use of Lean tools to reduce inpatient waiting time and to evaluate critical success factors of Lean implementation in an inpatient pharmacy in a Thai public hospital. DESIGN/METHODOLOGY/APPROACH: This study was carried out through action research methodology by following four key phases: identification of problems; planning action; taking action; and evaluation. In the "taking action" phase, Lean tools, including value stream mapping and 5S were implemented to improve dispensing process in an inpatient pharmacy. In the "evaluation phase", the critical success factors of Lean implementation in an inpatient pharmacy were evaluated by the participants. FINDINGS: Lean methodology was successfully implemented to reduce the waiting time associated with a three days dose distribution system. As a result of Lean application, the average process time reduced from 8.81 to 7.2 min and the standard deviation reduced from 5.49 to 4.45 min. Moreover, the support of middle management and the leadership were the key success factors of Lean implementation in an inpatient pharmacy. PRACTICAL IMPLICATIONS: Hospitals can improve the dispensing process by using Lean tools which are easy to apply and use. This study is appropriate for hospital managers looking for changes in pharmacy services or other departments. ORIGINALITY/VALUE: This is the first study that has applied Lean tools to improve the dispensing process in an inpatient pharmacy in Thai hospitals. This study offers important insights into the critical success factors of Lean employment in the inpatient pharmacy.

Response to COVID-19 Pandemic: Managing Inpatient Pharmacy Services at King Abdulaziz Medical City - Jeddah.

Since early December 2019, the coronavirus disease 2019 (COVID-19) has been relentlessly spread worldwide and has hit the healthcare systems with terrible force. Pharmacists play a vital role in the healthcare system in providing medicines, therapeutics, vaccines, clinical services, and other pharmaceutical care services to patients. Therefore, to ensure all these services continued at King Abdulaziz Medical City - Jeddah during the COVID-19 pandemic, the Department of Pharmaceutical Care initiated a departmental crisis preparedness plan, as a part of general hospital preparedness plan. It started with adjusting medication dosing time, instituting a daily medication refill process, working remotely, expanding the use of automation, and modifying employee schedules. Other actions included the following: handling drug shortages, placing restrictions on some medications, using personal protective equipment, changing routine practices of pharmacy aides, revising the medication delivery process, starting a contingency training program, and restricting pneumatic tube operation. We took guidance from the Ministry of Health, our own institute's experience, World Health Organization recommendations, updated scientific research, and the American Society of Health-System Pharmacists regulatory updates. This article aims to describe how health services, policies, and systems were applied and adapted to address a specific problem while maintaining all pharmacy employees' safety. This article reviews the inpatient pharmacy's particular needs and responses to these needs to meet the COVID-19 pandemic challenges.

Implementation and exploration of administration of anesthesia and psychotropic drugs by electronic account books / 药学实践杂志

Objective To explore the effect and significance of electronic account books on the management of anesthesia and psychotropic drugs. Methods The data of electronic account books from January 2020 to June 2020 in the inpatient pharmacy of the hospital (observation group), and manual account books from July 2019 to December 2019 (control group) were collected respectively. The data of daily accounting time, monthly settlement accounting time and accounting accuracy between the two groups were compared and analyzed. Results The daily average time for pharmacists to manually accounting was (162.8±22.5) min, and the daily average time for pharmacists to make accounts electronically was (33.2±7.0) min. It took (245.5±7.2) min for manual accounting of monthly settlement and (46.8±2.5) min for electronic accounting of monthly settlement. The accuracy rate of daily counting records, special account books, special register and empty ampoule waste paste recovery records included in electronic accounting is up to 100%. Conclusion The implementation of electronic account books not only significantly improved the work efficiency of pharmacists, but also strengthened drug supervision, formed a comprehensive traceability system, which could ensure the safety of clinical medication, and make the management of narcotic psychotropic drugs more efficient and standardized.

Application of Quality Control Circle in Shortening Drug Dispensing Time in the Inpatient Pharmacy of Our Hospital / 中国药房

OBJECTIVE: To shorten drug dispensing time of inpatient pharmacy in our hospital, and to enhance the quality of pharmaceutical care.METHODS: The activity of quality control circle (QCC) was carried out by using "shorten drug dispensing time of inpatient pharmacy" as subject. According to the steps of QCC activity, key links and factors that influence the of drug dispensing time in the inpatient pharmacy were found out. Countermeasures were formulated and implemented according to practical reasons. The activity was evaluated by using the drug dispensing time in every 100 medical orders before and after QCC activity. RESULTS: According to the links of "dispensing medical order" and "checking medical order" that spent longest time, the countermeasures were put forward to improve work efficiency, such as rational drug distribution and design, opmitization of the dispensing route, realizing electronic large infusion prescription by strengthening system informatization, strengthening the management of confusing drugs, strengthening staff training and establishing performance appraisal system. The drug dispensing time was shortened from 43. 99 min (before QCC) to 21. 77 min (after QCC), and target achievement rate was 99. 24％. QCC staff showed positive growth in means, responsibility, team cohesion and other aspects. CONCLUSIONS: QCC activity can shorten the time of drug dispensing, improve work efficiency and pharmacist' s ability of solving problem, and help to improve pharmaceutical care in the inpatient pharmacy.

Design and Application of Oral Dispensing Desk in the Inpatient Pharmacy in Our Hospital / 中国药房

OBJECTIVE:To strengthen the management of dismounting drugs in hospital and improve pharmacist working effi-ciency by designing and mading an oral dispending desk. METHODS:In order to solve the small number of placing dismounting drugs induced by small capacity of the desk and disorder placement of placing medicines in inpatient pharmacy,our pharmacists de-signed a new kind of oral dispensing desk that can solve the above problems,produced it and put it in the daily clinical work. The application effects were evaluated by comparing the number of placing drugs and deployment time of medical orders before and af-ter applying it. RESULTS:The designed oral dispensing desk included square slots in the bench,round slots on the side,operating table,multi-panel drawer and ordinary drawer,in which,the first two parts could be used for placing drugs with different shapes and different sizes,multi-panel drawer could place oral liquid,granules,etc. The total number of placing drugs was increased from 237 to 290,and the average deployment time of each medical order was shortened from(4.55±0.38)s to(3.52±0.16)s. CON-CLUSIONS:Application of new dispensing desk has not only solved the limited capacity of the desk,disorderly placing dismount-ing drugs,being difficult to locate and manage and other problems,but also improved the deployment speed of pharmacists and promoted standardized management of dismounting drugs.

Application of RFID Medicine Logistic Box in the Inpatient Pharmacy of Our Hospital / 中国药房

OBJECTIVE:To achieve the drug intelligent supervision in transportation within hospital and storage process,and promote quality safety of drugs. METHODS:The function and operation of Radio frequency identification(RFID)medicine logis-tic box was introduced,its application in one year in inpatient pharmacy of our hospital since Sept. 2013 was summarized,and its application effect and deficiency were analyzed. RESULTS:RFID medicine logistic box showed heat preservation and locking func-tions,which can be used for the cold-chain medicine and lock packing transportation for the ward. It can achieve information bind-ing after connecting with corresponding platform,record real-time record temperature,logistic box opening and closing information and data,as well as a variety of ways to alarm by SMS and mail,etc. However,failed login server and unpacking caused by unsta-ble wireless signals were found when applying the box,also drug damage and other defects were caused by unreasonable box struc-ture. And the daily average incidence dropped from the initial period (Nov. 2013) 11.9 times (cases) to the late period (Sept. 2014) 3.3 times (cases) after continuous improvement. CONCLUSIONS:Applying of medicine logistic box can strengthen cold-chain transport integrity and regulatory information in our hospital,ensure the safety of drug transport and query traceability of information.

Exploration of carrying out responsible pharmacists system in inpatient pharmacy / 中国药学杂志

OBJECTIVE: To explore service model of inpatient pharmacy department for clinical department after medical reform and let the common pharmacists playing an active role. METHODS: "Responsible Pharmacists System" had built. Every pharmacists in the inpatient pharmacy department is responsible for several clinical departments. They communicate with doctors, nurses and patients regularly and solve the problems timely. They also guild the medication of patients and do pharmaceutical knowledge training for the nurses. RESULTS: A good interaction relations between inpatient pharmacy department and clinical department had built. The patients know more about the pharmacists and the workload of the doctors and nurses is reduced. It could also improve pharmacy service level and promote self-enhancement of the pharmacists. CONCLUSION: This service model is affirmed by both the medical staff and the patients, and provides more active pharmacy service for medical staff and patients. It could provide a new model for hospital pharmacy service.

Construction of Automation and Informatization in the Inpatient Pharmacy of Our Hospital / 中国药房

OBJECTIVE:To discuss the mode and feasibility of informatization and automation construction in the inpatient pharmacy. METHODS:The practice of informatization and automation construction of inpatient pharmacy in our hospital was intro-duced,as well as the change of drug dispensing model. The influence of them on drug dispensing process was analyzed. RESULTS&CONCLUSIONS:2 automatic single dose tablets dispense packing machines,2 rapid dispensing machines and 2 automatic injec-tion chests are introduced in automatic inpatient pharmacy of our hospital. The informatization construction contain the establish-ment of inpatient pharmacy database,drug dispensing and recheck,the application of code,etc. Due to the implementation of auto-matic drug dispensing information system,drug dispensing mode have changed,i.g. drug dispensing by area instead of wards;in-jection and large volume transfusion are dispensed by wards;oral preparation and discharge medication are dispensed by prescrip-tion;dispensed drugs are distributed to wards with professional logistics. The implementation of informatization and automation of inpatient pharmacy in our hospital improve pharmaceutical administration and pharmaceutical care,and add automatic expiry date management and code tracking to guarantee the accuracy,timeliness and high efficiency of drug dispensing.

THE MANAGEMENT OF THE MEDICINES IN WARD PHARMACY OF PRIMARY HOSPITALS / 现代医院

Objective To discuss on the management of the medicines in ward pharmacy of primary hospitals and ex-plore effective measures to improve the quality of medicines management .Methods Based on the real situation , managing the quantity of medicines in inpatient pharmacy, including the setting of the reasonable quantity, the procedures of storing and de-livering, the quality control on the general medicines and the management of high -risk medicines, to improve the quality of management of the medicines in ward pharmacy .Conclusion The use of medicines in ward pharmacy of primary hospitals is becoming more and more standardized and rationalized by strengthening the management of the medicines in inpatient pharmacy .

Improvement Effects of Automatization on Standardized Management of Inpatient Pharmacy / 中国药房

OBJECTIVE: To facilitate automatization in pharmacy of inpatient departments and promote the management level and quality of pharmaceutical service.METHODS: The transformation of operation mode and administration mode were observed after developing automatization in the inpatient pharmacy departments.RESULTS & CONCLUSIONS: The intelligent location storage and auto single-dose dispenser were combined with electronic information transmission technology to facilitate the automatization of inpatient pharmacy.The dispensing process of inpatient pharmacy is optimized and improved and standardized management of drugs is consummated.The efficiency and accuracy of the dispensing of tablets and injections are improved.Error rates of drug dispensary and costs of storage are cut down.Labor intensity and the number of staff are also reduced and the quality of pharmaceutical service in the inpatient pharmacy departments is upgraded roundly.

The Way for Inpatient Pharmacy Staff to Provide Pharmaceutical Care for Clinical Needs / 中国药房

OBJECTIVE: To study the how's for pharmacists at inpatient pharmacy to provide pharmaceutical care for improved safe and effective use of drugs. METHODS: Pharmacists at inpatient pharmacy can provide pharmaceutical care as per specific clinical needs, and start from such details as preparing the booklet of commonly-used chemotherapy drugs, offering face-to-face advises on drug use for diabetics, and helping nurses to manage the medicine cabinets. RESULTS & CONCLUSION: Pharmacists at inpatient pharmacy should provide the right pharmaceutical care that can meet actual clinical needs.