Ocorrência de erros no preparo e na administração de medicamentos em unidade de pronto atendimento / Occurrence of errors in the preparation and administration of medications in an emergency care unit

Objetivo: caracterizar os erros durante o preparo e a administração de medicamentos injetáveis em unidade de pronto atendimento. Método: estudo transversal descritivo realizado em unidade de pronto atendimento. Foi realizada a coleta de dados por observação direta, não participante, durante 30 dias consecutivos e os dados foram analisados por estatística descritiva. Resultados: foram observadas 751 doses durante o processo de preparo e administração de medicamentos. Os principais erros foram ausência de higienização das mãos, desinfecção de frascos ampola e bancada, falha na informação sobre o medicamento administrado e na identificação do paciente e verificação de alergia medicamentosa. Conclusão: os erros no processo de preparo e administração de medicamentos ocorrem frequentemente em unidade de pronto atendimento. O estudo indica e reforça a necessidade de reestruturação do serviço de emergência para uma prática segura e oferece subsídios para planejar a educação permanente e a formação de novos profissionais.

Objective: to characterize errors during the preparation and administration of injectable drugs in an emergency care unit. Method: descriptive cross-sectional study carried out in an emergency care unit. Data collection was performed by direct non-participant observation, for 30 consecutive days and the data were analyzed using descriptive statistics. Results: 751 doses were observed during the drug preparation and administration process. The main errors were lack of hand hygiene, disinfection of vials and countertops, failure to provide information on the administered drug and patient identification and verification of drug allergy. Conclusion: errors in the medication preparation and administration process often occur in an emergency care unit. The study indicates and reinforces the need to restructure the emergency service for a safe practice and offers subsidies to plan permanent education and the training of new professionals.

Erros de medicação e implicações na assistência de enfermagem / Medication errors and implications for nursing care / Errores de medicamentos e implicaciones en la atención de enfermería

Introdução: Erro de medicação é definido como qualquer evento evitável que ocorra em qualquer fase da terapia medicamentosa, podendo ou não a prescrição, a dispensação ou a administração causarem algum dano ao paciente. Objetivo: Identificar, com base em uma revisão de literatura, os erros mais frequentes associados ao processo medicação e quais suas causas. Método: Estudo realizado por meio de uma revisão integrativa da literatura onde foram usadas as bases de dados eletrônicas: SciELO, LILACS, BDENF e MEDLINE. Resultados: Diversos fatores podem estar associados aos erros na administração de medicamentos pela equipe de enfermagem. Os estudos analisados apontam como fatores de risco a sobrecarga de trabalho, falta de atenção e qualificação, erros na prescrição médica, dispensação errada do medicamento e o próprio sistema de trabalho. A enfermagem desempenha papel fundamental nas fases do que é compreendido como processo de medicação. Conclusão: É importante que os erros possam ser relatados pela equipe, para que ocorra o planejamento de medidas colaborativas junto a instituição de saúde a fim de implantar meios de capacitação e protocolos voltados a segurança do paciente.(AU)

Introduction: El error de medicación se define como cualquier evento prevenible que ocurre en cualquier etapa de la terapia con medicamentos, ya sea que la prescripción, dispensación o administración pueda o no causar daño al paciente. Objetivo: Identificar, a partir de una revisión de la literatura, los errores más frecuentes asociados al proceso de medicación y sus causas. Método: Estudio realizado mediante revisión integradora de la literatura donde se utilizaron bases de datos electrónicas: SciELO, LILACS, BDENF y MEDLINE. Resultados: Varios factores pueden estar asociados con errores en la administración de medicamentos por parte del personal de enfermería. Los estudios analizados señalan como factores de riesgo la sobrecarga laboral, la falta de atención y calificación, los errores en la prescripción médica, la dispensación incorrecta de medicamentos y el propio sistema de trabajo. La enfermería juega un papel fundamental en las fases de lo que se entiende por proceso de medicación. Conclusión: Es importante que los errores sean reportados por el equipo, de manera que se puedan planificar acciones colaborativas con la institución de salud para implementar medios de capacitación y protocolos orientados a la seguridad del paciente.(AU)

Introducción: El error de medicación se define como cualquier evento prevenible que ocurre en cualquier etapa de la terapia con medicamentos, ya sea que la prescripción, dispensación o administración pueda o no causar daño al paciente. Objetivo: Identificar, a partir de una revisión de la literatura, los errores más frecuentes asociados al proceso de medicación y sus causas. Método: Estudio realizado mediante revisión integradora de la literatura donde se utilizaron bases de datos electrónicas: SciELO, LILACS, BDENF y MEDLINE. Resultados: Varios factores pueden estar asociados con errores en la administración de medicamentos por parte del personal de enfermería. Los estudios analizados señalan como factores de riesgo la sobrecarga laboral, la falta de atención y calificación, los errores en la prescripción médica, la dispensación incorrecta de medicamentos y el propio sistema de trabajo. La enfermería juega un papel fundamental en las fases de lo que se entiende por proceso de medicación. Conclusión: Es importante que los errores sean reportados por el equipo, de manera que se puedan planificar acciones colaborativas con la institución de salud para implementar medios de capacitación y protocolos orientados a la seguridad del paciente.(AU)

[Contribution of a hospital pharmacy team to critical care of patients infected with SARS-CoV-2]. / Contribution d'une équipe de pharmacie hospitalière à la prise en charge en réanimation des patients infectés par le SARS-CoV-2.

With regard to the hospital drug supply chain, the safest system is the individual automated drug dispensing one provided by the pharmacy. For several years we have been trying to convince hospital decision-makers to set it up. In the meantime, to mitigate the risks of medication errors incurred by patients and caregivers, we have set up several work teams within the care units. These teams, made up of one pharmacist and one or two hospital pharmacy technicians, who notably manage the medicine cabinets in care units. The close collaboration with doctors and nurses developed over the years was a determining factor when it became necessary to provide the newly created additional intensive care units with drugs and medical devices (MDs) in order to cope with the crisis triggered by the SARS-CoV-2 epidemic. Daily monitoring of the drugs consumed by each patient, particularly neuromuscular blocking agents and MDs was a key element in managing stocks and anticipating changes of drugs, packaging and/or devices references. These facts give weight to the Claris report published in France which recognizes that the interactions of pharmacy technicians and pharmacists in the care units have positive effects in terms of quality and safety of patient care. They highlight the dangers to which patients and caregivers are exposed on Saturdays, Sundays and holidays when the pharmacy is closed. They legitimize the question of extending the opening of the pharmacy with a full team 365 days a year.

Disappearing expertise in clinical automation: Barcode medication administration and nurse autonomy.

OBJECTIVE: Using the case of barcode medication administration (BCMA), our objective is to describe the challenges nurses face when informatics tools are not designed to accommodate the full complexity of their work. MATERIALS AND METHODS: Autonomy is associated with nurse satisfaction and quality of care. BCMA organizes patient information and verifies medication administration. However, it presents challenges to nurse autonomy. Qualitative fieldwork, including observations of everyday work and interviews, was conducted during the implementation of BCMA in a large academic medical center. Fieldnotes and interview transcripts were coded and analyzed to describe nurses' perspectives on medication safety. RESULTS: Nurses adopt orienting frames to structure work routines and require autonomy to ensure safe task completion. Nurses exerted agency by trusting their own judgment over system information when the system did not consider workload complexity. Our results indicate that the system's rigidity clashed with adaptive needs embodied by nurses' orienting frames. DISCUSSION: Despite the fact that the concept of nurse as knowledge worker is foundational to informatics, nurses may be perceived as doers, rather than knowledge workers. In practice, nurses not only make decisions, but also engage in highly complex task-related work that is not well supported by process-oriented information technology tools. CONCLUSIONS: Information technology developers and healthcare organization managers should engage and better understand nursing work in order to develop technological and social systems to support it.

Risk reduction in a cancer chemotherapy production unit: Contribution of an automated drug dispensing system.

OBJECTIVE: The purpose of our study was to evaluate the contribution of an automated drug dispensing system in securing cancer chemotherapy production process at the pharmacy of the National Institute of Oncology in Rabat. METHODS: The failure modes and effects analysis method was applied to the chemotherapy production process in two phases: Phase 1, using an open shelf for storage then phase 2, using an automated drug dispensing system. The failure modes were defined and their criticality indexes was calculated on the basis of the likelihood of occurrence, the potential severity for the patients and/or the impact on the process and the detection probability. The criticality indexes of the two phases were prioritized and compared. RESULTS: We identified 35 failure modes for phase 1 and 37 for phase 2. The sum of criticality indexes was 5957 and 4586, respectively, for phase 1 and phase 2, corresponding to a criticality reduction of -23%. The greatest improvements concerned that the needed drug is missing during the picking, storage of potential expired drugs, and double compounding. CONCLUSION: Our study highlighted the contribution of automated drug dispensing system in risk minimization. The use of automated drug dispensing system is a part of security improvement in chemotherapy production unit.

Uso de tarjetas de medicación en el manejo de estado epiléptico en un servicio de emergencias. Mejoras en prescripción, preparación y administración de drogas / Use of medication cards in the management of statu epilepticus at an emergency department. Improvements in drug prescription, preparation and administration

Introducción: Los errores de medicación (EM) causan una elevada morbimortalidad y generan costos innecesarios. El servicio de emergencias (SE) presenta un mayor riesgo de EM que otras áreas. El desarrollo de una herramienta que estandarice el uso de fármacos podría mejorar la seguridad y el proceso de medicación. Objetivos: Evaluar las mejoras en el proceso de medicación mediante el uso de tablas de medicación (TM) durante la atención del estado epiléptico (EE). Materiales y métodos: Se realizó un estudio de tipo antes y después no controlado. La intervención fue el desarrollo e implementación de TM. Se relevó in situ la prescripción, preparación y administración de fármacos incluidos en las TM durante segunda quincena de Octubre y mes de Noviembre 2016, previo a la implementación de la herramienta, y en el mismo período de 2017, luego de la inducción e implementación de las tablas. Se registraron los EM y se categorizaron de acuerdo a la etapa del proceso en que ocurrieron. Resultados: En el período pre-intervención se realizaron 14 registros, 86% (12) tenía al menos un error; 57% (8) errores en la etapa de prescripción, 57% (8) en la de preparación y 21% (3) en la de administración. En el período post-intervención se realizaron 17 registros, 12% (2) tenía por lo menos un EM. No se registraron errores en la fase de prescripción, hubo 12% (2) de errores de preparación y 6% (1) de administración. Conclusión: La implementación de las TM para la estandarización del uso de fármacos en EE resultó una medida muy positiva, mejorando la seguridad en el proceso de medicación (AU)

Introduction: Medication errors (ME) are associated with high morbidity mortality and lead to unnecessary costs. The risk of ME is higher at the emergency department (ED) than in other areas. Developing a tool that standardizes drug use may improve safety and medication processes. Objectives: To evaluate improvements in the medication process by using medication cards (MCs) during status epilepticus (SE) care. Materials and methods: An uncontrolled before-and-after study was conducted. The intervention was the development and implementation of MCs. The in situ prescription, preparation, and administration of drugs included in the MCs was recorded during the second half of October and November 2016, prior to the implementation of the tool, and in the same period of 2017, after the introduction and implementation of the MCs. ME were recorded and categorized according to the stage of the process in which they occurred. Results: In the pre-intervention period 14 episodes were recorded; in 86% (12) at least one error occurred; 57% (8) were ME in the prescription stage, 57% (8) were ME in the preparation stage, and 21% (3) were ME in the administration stage. In the post-intervention period 17 errors were recorded, in 12% (2) at least one ME occurred. No errors were recorded in the prescription stage, 12% (2) were preparation errors, and 6% (1) administration errors. Conclusion: The implementation of MCs for the standardization of medications used in the RU was successful, improving safety in the medication process (AU)

The Effect of Implementing Bar-Code Medication Administration in an Emergency Department on Medication Administration Errors and Nursing Satisfaction.

INTRODUCTION: Bar-code medication administration has been shown to reduce medication errors in inpatient settings with limited studies on its use in emergency departments. In addition, no studies have evaluated nursing satisfaction with implementing bar-code medication administration in an emergency department. This study was designed to determine the impact of implementing bar-code medication administration in an emergency department on medication errors and nursing satisfaction. METHODS: This is a before-and-after study, with no control group, of a bar-code medication administration intervention conducted in a community hospital emergency department. Direct observation was used to compare medication error rates before and 3 months after implementing bar-code medication administration. The Medication Administration System-Nurses Assessment of Satisfaction survey was used to assess the impact on nursing satisfaction before and 1 month after bar-code medication administration implementation. RESULTS: A total of 676 medication administrations were observed in the period before bar-code medication administration implementation and 656 after. The medication administration error rate preimplementation was 2.96% with "wrong dose" errors being the most common. After bar-code medication administration implementation, the medication administration error rate fell to 0.76%, a relative reduction of 74.2% (Fisher exact P < 0.01). The average (SD) Medication Administration System-Nurses Assessment of Satisfaction score preimplementation was 2.60 (0.75) and improved to 2.29 (0.66) (t = 2.00, P = 0.05) 1 month post implementation. DISCUSSION: Implementing bar-code medication administration in a community emergency department was associated with a decrease in medication administration errors and an improvement in Medication Administration System-Nurses Assessment of Satisfaction scores. The results of this study suggest a benefit of bar-code medication administration in reducing medication administration errors and improved nursing satisfaction in the emergency department.

Using change management to implement barcode medicines administration technology.

Confirming the patient's identity is one of the most important elements in medicines administration, with research showing that medication errors are one of the most common sources of harm caused to patients. This article discusses the implementation of a barcode medicines administration system using two change management models. A complex project such as the implementation of barcode medicines administration technology, requires staff engagement at all levels. The adoption rates of the new workflow patterns in this project showed the benefits of using various change management models during different phases of a project. The project also demonstrated how nurse leaders must use a range of resources to effectively implement a new project.

Insights on developing a field hospital formulary and medication distribution process in preparation for a second surge of COVID-19 cases.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has caused health systems across the country to plan for field hospitals to care for patients outside of traditional healthcare settings in the event of a second surge. Here we describe key considerations for the implementation of pharmacy operations and a field hospital formulary at an offsite location within a 2-week time frame. SUMMARY: Development of an offsite field hospital formulary is first dependent on the location and patient population defined for the field hospital. Creation of a limited formulary for a planned field hospital in Michigan involved reviewing physical space limitations and drug distribution workflows, assessing current prescribing trends, creating drug categories, and creating formulary guidelines to limit formulary options in each therapeutic category. Ultimately, our institution developed a 140-medication field hospital formulary, a process to enable appropriate use of nonformulary drugs, and a mixed operations model including automated dispensing cabinets and a manual cart-fill process. Although the institution did not have to open the field hospital, the process used for developing the formulary and determining distribution models will allow for an immediate implementation if a second surge occurs. CONCLUSION: A methodical approach to developing limited formularies and pharmacy operations in a field hospital setting will allow health systems to establish efficient and effective medication distribution services in the event of a second surge of COVID-19 cases.

Pharmaceutical management of the COVID-19 pandemic in a mid-size hospital.

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.

Hospital pharmacist experience in a multidisciplinary team in special care settings.

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.

Specialized pharmaceutical care in social health centers in the times of COVID-19.

The COVID-19 pandemic is having a devastating effect on the nursing homes for dependent older people. The difficulty of management of this crisis is aggravated by the frailty of the people served and by the specific characteristics of the care  area, mainly the fact of not being integrated into the health system. The  objective of this work is to describe the pharmaceutical care developed by a  hospital pharmacy service established in a nursing home and, from a more  global perspective, analyze the strengths and weaknesses found from the  various experiences of hospital pharmacy in all spanish autonomous  communities to deal with this pandemic. Specialized pharmaceutical care has  provided rigor in the validation and treatments review processes from a  comprehensive perspective, maximizing safety and collaborating in the  establishment of the therapeutic intensity degree most appropriate to the  individual situation, has ensured the availability of all necessary medications,  has collaborated in the acquisition and management of personal protective equipment, has been able to adapt the dispensation processes to the internal  nursing homes sectorization and has facilitated the coordination between the  nursing home and the health system. It is clear that the crisis casued by COVID- 19 has put relevance of the need to integrate the social-health level into the  health system. And also, the contribution of specialized pharmaceutical care in  improving healthcare coverage and coordination with health services has  highlighted the urgency of developing the current legislation, prioritizing the  establishment of pharmacy services able to provid specialized and specific care  for this area, so that it meets healthcare needs and is integrated into the health  system.

La pandemia COVID-19 está teniendo un efecto devastador en las residencias de personas mayores dependientes. La dificultad de la gestión de la crisis se ve  agravada por la fragilidad de las personas atendidas y por las propias  características del ámbito asistencial, principalmente el hecho de no estar  integrado en el sistema de salud. El objetivo del presente trabajo es describir la  atención farmacéutica especializada desarrollada por un servicio de farmacia  hospitalario establecido en un centro sociosanitario y, desde una perspectiva  más global, analizar las fortalezas y debilidades encontradas desde las diversas experiencias de la farmacia hospitalaria en el conjunto de comunidades autónomas para hacer frente a esta pandemia. La atención  farmacéutica especializada ha aportado rigor en los procesos de validación y  revisión de los tratamientos desde una perspectiva integral, maximizando la  seguridad y colaborando en el establecimiento del grado de intensidad  terapéutica más adecuado a la situación individual de la persona afectada, ha  asegurado la disponibilidad de todos los medicamentos necesarios, ha  colaborado en la adquisición y gestión de los equipos de protección individual, ha  sido capaz de adaptar los procesos de dispensación a la sectorización interna de las residencias y ha facilitado la coordinación entre la residencia y el sistema  de salud. Resulta evidente que la crisis provocada por la COVID-19 ha puesto de relevancia la necesidad de integrar el ámbito sociosanitario en el sistema de  salud. Y asimismo, la contribución de la atención farmacéutica especializada en  la mejora de la cobertura asistencial y de la coordinación con los servicios  sanitarios ha puesto de manifiesto la urgencia de desarrollar la legislación  vigente, priorizando el establecimiento de servicios de farmacia capaces de  proporcionar una atención especializada y específica para este ámbito  asistencial, de forma que cubra las necesidades asistenciales y quede integrada  en la estructura sanitaria.

The pharmacist facing the logistics of safely dispensing, storing and preserving drugs in healthcare units.

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.

Pharmaceutical care to hospital outpatients during the COVID-19 pandemic. Telepharmacy.

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.

Alert Types and Frequencies During Bar Code-Assisted Medication Administration: A Systematic Review.

BACKGROUND: Existing literature explores the effectiveness of bar code-assisted medication administration (BCMA) on the reduction of medication administration error as well as on nurse workarounds during BCMA. However, there is no review that comprehensively explores types and frequencies of alerts generated by nurses during BCMA. PURPOSE: The purpose was to describe alert generation type and frequency during BCMA. METHODS: A systematic review of the literature using PRISMA guidelines was conducted using CINAHL, PubMed, EMBASE, and Ovid Medline databases. RESULTS: After screening for inclusion and exclusion criteria, a total of 8 articles were identified and included in the review. Alert types included patient mismatch, wrong medication, and wrong dose, though other alert types were also reported. The frequency of alert generation varied across studies, from 0.18% to 42%, and not all alerts were clinically meaningful. CONCLUSIONS: This systematic review synthesized literature related to alert type and frequency during BCMA. However, further studies are needed to better describe alert generation patterns as well as factors that influence alert generation.

Evaluation of Bedside Delivery of Medications Before Discharge: Effect on 30-Day Readmission.

BACKGROUND: This study is an evaluation of a discharge intervention that occurred in multiple hospitals across Maryland. In this program, patients received medications at their bedside before discharge with the goal of reducing the risk of primary nonadherence to prescribed medications. OBJECTIVE: To test if the intervention reduced the risk of 30-day readmission for the patients who received bedside medication delivery relative to comparable patients who did not receive bedside medication delivery. METHODS: This was a retrospective cohort study. Patients who received the intervention were linked to their claims data in the Maryland Health Information Exchange. These patients were matched on age, sex, diagnosis-related group, and hospital to a set of patients who did not receive the intervention. We used propensity score matching, as well as inverse-probability weighting, to account for residual differences between the treated and comparison patients. With robust Poisson regression, adjusting for hospital, we generated risk ratios for 30-day readmission and explored risk ratios in key subgroups. RESULTS: The cohort included 6,167 inpatients who received medications at bedside and 28,546 who did not from 10 Maryland hospitals. They were 60% female, 61% white, and 31% African American; the average age was 56 years. The risk ratio for readmission, comparing the intervention group to the propensity score-matched comparison group, was 1.21 (95% CI = 0.96-1.5). Inverse-probability weighting yielded a similar result (1.19 [95% CI = 0.98-1.45]). CONCLUSIONS: In this study, the isolated intervention of bedside medication delivery did not reduce 30-day readmission risk. We expect it may have favorable outcomes on other metrics such as primary nonadherence and patient satisfaction. It may also have a favorable effect when bundled with other care transition activities. As an isolated intervention, however, bedside medication delivery is unlikely to affect 30-day readmission rates. DISCLOSURES: This study was funded by Walgreen Co. through unrestricted funds to Johns Hopkins University, which has received fees from Walgreens for providing consultation as an institution to Walgreens. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies. Segal received a grant from the National Institute on Aging during the conduct of this study. The other authors have nothing to disclose.

Experiencias del farmacéutico de hospital en el equipo pluridisciplinar en unidades especiales / Hospital pharmacist experience in a multidisciplinary team in special care settings

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

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