Análise das ações tomadas pela comissão de farmácia e terapêutica do Instituto Dante Pazzanese de Cardiologia em 2021 e 2022 / Analysis of the actions taken by the pharmacy and therapeutics committee of the Instituto Dante Pazzanese de Cardiologia in 2021 and 2022

INTRODUÇÃO E OBJETIVOS: A Comissão de Farmácia e Terapêutica (CFT) é uma instância de caráter consultivo e deliberativo que assessora a Diretoria Geral com objetivo de formular diretrizes e promover uso racional de medicamentos. O objetivo foi mensurar decisões tomadas pela CFT que impactem positivamente para economia de recurso orçamentário sem prejuízo assistencial. MÉTODOS: Estudo descritivo realizado no período de janeiro de 2021 a dezembro de 2022 sobre as ATAS mensais da CFT e sistema de gestão hospitalar eletrônica. Os dados coletados foram: assuntos discutidos, deliberação, valor unitário do medicamento. Foi considerado assuntos com impacto financeiro: substituição da padronização, despadronização, inclusão de medicamento com dosagem de melhor manejo, inclusão de restrição de prescrição para itens de alto valor. Os dados foram coletados em planilha Excel. RESULTADOS E DISCUSSÃO: Foram avaliadas 24 ATAS de CFT, em que foram selecionados temas voltados para farmacoeconomia. Do total, havia 5 pautas (21%) focadas no assunto: despadronização: 2 (40%): metoprolol 100 mg (tem de 50 mg), bosentana 62,5 mg (pertence ao Componente Especializado e o paciente já faz uso domiciliar e passa a ser orientado a trazer de casa), substituição: 1 (20%) sildenafila de 20 mg para 50 mg (preço unit de $12,20 para $0,49), inclusão de dosagem: 1 (20%) alteplase 10 mg ($491,19) sendo que o alteplase 50 mg custa $ 2.356,55 (dose depende do peso e havia desperdício) e inclusão de restrição 1 (20%): levosimendana ($4.900,00). Baseado no consumo anual, fizemos o cálculo de economia: metoprolol e bosentana ($4.373,37), sildenafila ($109.383,11), alteplase ($17.971,22), levosimendana ($ 88.200,00). Essa mudança não deixou o paciente desassistido, pois foi considerado substituições viáveis envolvendo o corpo clínico para adequação de prescrições médicas e apoio da Diretoria Clínica. CONCLUSÃO: Na busca de diminuir gastos com medicamentos sem afetar a assistência do paciente, a Comissão de Farmácia e Terapêutica possibilitou meios para economizar recurso orçamentário, promovendo reuniões extras com alguns setores estratégicos para demonstrar gastos com determinados itens e propor medidas que pudessem minimizar esse impacto financeiro. Houve uma compreensão e aceitação das áreas envolvidas. No montante, o hospital conseguiu economizar R$ 219.927,70. Financiamento e agradecimento: Aos membros da Comissão de Farmácia e Terapêutica que opinaram e sugeriram alternativas terapêuticas plausíveis.

Actualización 2022 de los indicadores para la calidad asistencial y la atención farmacéutica a las personas que viven con el virus de la inmunodeficiencia humana / 2022 update of the indicators for quality of care and pharmaceutical care for people living with human immunodeficiency virus

Objetivo: actualizar y definir los indicadores para la mejora de la calidad asistencial y la atención farmacéutica a las personas que viven con infección por VIH en España. Método: el presente proyecto, que actualiza la versión anterior del documento de 2013, se desarrolló en 4 fases de trabajo realizadas entre enero y junio de 2022.En la fase 1, de organización, se creó un grupo de trabajo conformado por 7 especialistas en farmacia hospitalaria con amplia experiencia en atención farmacéutica y procedentes de distintos servicios del territorio nacional. Adicionalmente otros 34 especialistas, participaron en la valoración de los indicadores a través de 2 rondas de evaluación online para generación del consenso.Para la fase 2, inicialmente, se llevó a cabo una revisión bibliográfica con el objetivo de establecer una base a partir de la cual poder definir una propuesta de criterios de calidad e indicadores. A continuación, se realizó una propuesta preliminar de criterios y se establecieron revisiones para su ajuste en varias reuniones de trabajo telemáticas.En la fase 3 se estableció el consenso basado en la metodología de consenso Delphi-Rand/UCLA.Adicionalmente todos los indicadores clasificados como adecuados y necesarios fueron agrupados según 2 niveles de recomendación de monitorización, de manera que pueda orientar a los servicios en la prioridad de su medición: claves y avanzados.Por último, en la fase 4 se elaboró el documento final del proyecto, junto con las fichas descriptivas correspondientes para cada indicador con la finalidad de facilitar su medición y evaluación por parte de los servicios de farmacia hospitalaria. Resultados: se obtuvo un listado consensuado de ítems conformado por 79 indicadores adecuados y necesarios que permiten establecer un seguimiento y monitorización de la calidad y actividad de la atención farmacéutica a las personas que viven con VIH. De los mismos, 60 fueron establecidos como clave y 19 avanzados. Conclusiones: (AU)

Objective: To update and define indicators for improving the quality of care and pharmaceutical care for people living with HIV infection in Spain. Method: The present project, which updates the previous version of the 2013 document, was developed in four work phases carried out between January and June 2022.In phase 1, the organization phase, a working group was created, made up of seven hospital pharmacy specialists with extensive experience in pharmaceutical care and from different SFHs in Spain. In addition, another 34 specialists participated in the evaluation of the indicators through two rounds of online evaluation to generate consensus.For phase 2, initially, a review of the identified reference literature was carried out with the aim of establishing a basis from which to define a proposal for quality criteria and indicators. Then, a preliminary proposal of criteria was made and revisions were established for their adjustment in several telematic work meetings.In phase 3, consensus was established based on the Delphi-Rand/UCLA consensus methodology.In addition, all the indicators classified as appropriate and necessary were grouped according to two levels of monitoring recommendation, so as to guide the hospital pharmacy services in the priority of their measurement: key and advanced.Finally, in phase 4, the final project document was prepared, along with the corresponding descriptive sheets for each indicator in order to facilitate the measurement and evaluation of the indicators by the hospital pharmacy services. Results: Following the consensus methodology used, a list of items made up of 79 appropriate and necessary indicators was drawn up to establish a follow-up and monitoring of the quality and activity of pharmaceutical care for people living with HIV. Of these, 60 were established as key and 19 advanced. Conclusions ... (AU)

Evaluación de la implantación de prácticas seguras con los medicamentos en los Servicios de Medicina Intensiva / Assessment of the implementation of safe medication practices in Intensive Medicine Units

Objetivo Conocer el grado de implantación de las prácticas seguras con los medicamentos en los Servicios de Medicina Intensiva e identificar oportunidades de mejora. Diseño Estudio descriptivo multicéntrico. Ámbito Servicios de Medicina Intensiva. Participantes/procedimiento Cuarenta Servicios de Medicina Intensiva que voluntariamente cumplimentaron el «Cuestionario de autoevaluación de la seguridad del uso de los medicamentos en los Servicios de Medicina Intensiva» entre marzo y septiembre del 2020. El cuestionario contiene 147 ítems de evaluación agrupados en 10 elementos clave. Variables principales de interés Puntuación media y porcentaje medio sobre el valor máximo posible en el cuestionario completo, en los elementos clave y en los ítems de evaluación. Resultados La puntuación media del cuestionario completo en los Servicios de Medicina Intensiva fue de 436,8 (49,2% del valor máximo posible). No se encontraron diferencias según dependencia funcional, tamaño del hospital y tipo de servicio. Los elementos clave referentes a la incorporación de farmacéuticos en estos servicios, así como a la competencia y la formación de los profesionales en prácticas de seguridad, mostraron los valores más bajos (31,2% y 33,2%, respectivamente). Otros tres elementos clave relativos a la accesibilidad a la información sobre los pacientes y los medicamentos; a la estandarización, el almacenamiento y la distribución de los medicamentos, y a los programas de calidad y gestión de riesgos mostraron porcentajes inferiores al 50%. Conclusiones Se han identificado numerosas prácticas seguras efectivas cuyo grado de implantación en los Servicios de Medicina Intensiva es bajo y que es preciso abordar para reducir los errores de medicación en el paciente crítico (AU)

Objective To assess the level of implementation of medication safety practices in Intensive Care Units (ICUs) and to identify opportunities for improvement. Design A descriptive multicenter study was carried out. Setting Intensive Care Units. Participants/procedure A total of 40 ICUs voluntarily completed the “Medication use-system safety self-assessment for Intensive Care Units” between March and September 2020. The survey comprised 147 items for evaluation grouped into 10 key elements. Main variables Calculation was made of the mean scores and mean percentages based on the maximum possible values for the overall survey, for the key elements and for each individual item for evaluation. Results The mean score of the overall questionnaire among the participating ICUs was 436.8 (49.2% of the maximum possible score). No differences were found according to functional dependence, size of the hospital or type of ICU. The key elements referred to the incorporation of clinical pharmacists in these units, as well as the competence and training of the professionals in safety practices yielded the lowest values (31.2% and 33.2%, respectively). Three other key elements related to accessibility to information about patients and medicines; to the standardization, storage and distribution of medicines; and to the quality and risk management programs, yielded percentages below 50%. Conclusions Numerous effective safety medication practices have been identified with a low level of implementation in ICUs. This situation must be addressed in order to reduce medication errors in critically ill patients (AU)

Multi-center survey on the training status of staff working in pharmacy intravenous admixture services (PIVAS) in mainland China: Perspectives of PIVAS staff.

ABSTRACT: The technical level and comprehensive quality of pharmacy intravenous admixture services (PIVAS) staff are central to ensure the safety and effectiveness of intravenous infusions. However, these aspects are lacking in traditional pharmacy education. This study aimed to investigate the training status of staff working in PIVAS and explore factors that affected training status, which might contribute to the establishment of a comprehensive, standardized training system.A multi-center cross-sectional survey was conducted via a WeChat Group targeting PIVAS staff in hospitals to investigate the differences of current training status between different regions, hospital levels, genders, job titles, educational degrees, employment types, and working years.In total, 501 participants completed the questionnaires. The main contents of training for PIVAS staff included: professional theoretical knowledge (99.40%, 498/501), practical operation abilities (97.01%, 486/501), pre-job training (92.61%, 464/501), and standard operating procedures (90.22%, 452/501). The most common frequency of staff training was 1-2 times a month (51.9%, 260/501). Overall, 56.5% (283/501) of participants thought staff training was sufficient and 60.1% (301/501) of participants thought PIVAS attached importance to staff training. However, only 45.7% (229/501) of the participants were satisfied with the training modes.The contents of training for PIVAS staff in mainland China were relatively rich, but the aspects of management tools, comprehensive ability development, and career development planning tend to be relatively weak. It is necessary to develop training standards for PIVAS staff to improve employee capabilities and job satisfaction.

Time to review how injectable medicines are prepared and administered in European hospitals.

It has been known, for decades, that the use of injectable medicines in European hospitals has been associated with frequent medication errors, some of which cause preventable severe harms and deaths. There  have been national and European inquiries and reports concerning  improving patient safety by recommending greater use of pharmacy  aseptic preparation services and provision of ready-to administer  injectables, which have not been widely implemented.In England experience of treating patients with COVID-19 infections has  brought into focus other benefits of significantly extending pharmacy aseptic preparation services. These benefits include saving  nursing time, having systems in place which have resilience and capacity,  reducing variation in practice, improving clinical staff and patient  experience, and enabling more injectable medicines to be administered to  patients at home. It has also been recognised that more action is required  to standardise policies and procedures for injectable medicines and  mplement the use of smart infusion devices with dose error reduction  software, to help minimise drug administration errors.Hospital pharmacists have a key role in developing these services to bring  European hospitals more in line with those provided by hospital pharmacies in North America.

Desde hace décadas se conoce que el uso de los medicamentos  nyectables en los hospitales europeos se encuentra asociado a numerosos  errores de medicación, algunos de los cuales provocan daños graves y  muertes prevenibles. Se han publicado investigaciones e informes  nacionales y europeos sobre la mejora de la seguridad del paciente que  recomiendan una mayor utilización de las unidades de preparación  aséptica de los servicios de farmacia y la provisión de los medicamentos  inyectables listos para su administración, recomendaciones que apenas se  han implementado.En Inglaterra, la experiencia de tratar a los pacientes con infección por  COVID-19 ha puesto de manifiesto otros beneficios que conlleva la ampliación de las unidades de preparación aséptica de los servicios de farmacia. Estos beneficios incluyen ahorrar tiempo de enfermería,  disponer de sistemas con mayor resiliencia y capacidad, reducir la  variabilidad en la práctica, mejorar la satisfacción del personal clínico y del paciente, y facilitar la administración de más medicamentos inyectables a  los pacientes en sus domicilios. También se ha reconocido que se precisan  actuaciones dirigidas a estandarizar las directrices y procedimientos de  utilización de los medicamentos inyectables e implementar el uso de  dispositivos de infusión inteligentes con software de reducción de errores  de dosis, con el fin de minimizar los errores en la administración de estos  medicamentos. Los farmacéuticos de hospital tienen un papel clave en el desarrollo de  stas actividades para que los servicios que prestan las farmacias  hospitalarias europeas estén más en consonancia con los que se  proporcionan en Norteamérica.

Pharmacist-led, prescription intervention system-assisted feedback to reduce prescribing errors: A retrospective study.

WHAT IS KNOWN AND OBJECTIVE: Prescribing errors are prevalent in hospital settings, with provision of feedback recommended to support prescribing by doctors. To evaluate the impact of a pharmacist-led prescription intervention system on prescribing error rates and to measure intervention efficiency. METHODS: All prescribers in Shandong Provincial Third Hospital received feedback from ward pharmacists using a pharmacist-led prescription intervention system. The prescribing error rate was calculated from Oct 2019 to December 2020. After the intervention was applied, the rates of PASS 1 (System pass), PASS 2 (Pharmacist pass) and PASS 3 (Pharmacist-doctor pass) events and the feedback time were calculated each month. RESULTS AND DISCUSSION: Irrational use of drugs was reduced and the prescription rate increased significantly. The error rate reduced from 6.94% to 1.96%, representing an estimated 71.76% decrease overall (p < 0.05). The PASS 1 rate gradually increased from 88% to 96% (p < 0.05), the PASS 2 rate gradually decreased from 5.06% to 2.04% (p < 0.05), the PASS 3 rate gradually decreased from 6.94% to 1.96% (p < 0.05). WHAT IS NEW AND CONCLUSION: The pharmacist-led prescription intervention system has the potential to reduce prescribing errors and improve prescribing outcomes and patient safety.

Impact of pharmacist involvement on medication safety in interprofessional transfer of care activity.

AIM: Any transition of patient care is a high-risk time for communication error. This paper explores whether the presence of a pharmacist as part of an interprofessional group provides additional benefit and safety in transitions of care. METHOD: Six pharmacy interns and newly qualified pharmacists joined participants from seven other health professional training programmes to take part in an interprofessional education activity. Participants were assigned to 24 mixed-professional groups. Each group was required to craft a discharge summary for the same simulated patient. Groups without a pharmacist were given additional written documentation, including medication reconciliation, discharge prescription and discharge recommendations. The 24 discharge summaries were assessed for any medication-related information, both positive and negative. Groups with a pharmacist (6) were compared with groups who did not have a pharmacist (18) for completeness and accuracy of medication management. RESULTS: An in-person pharmacist provided more thorough, comprehensive, accessible and accurate information for the community team (p=0.003). Although there was no difference in the absolute number of medication errors between the groups (p=0.057), the groups with a pharmacist showed a significant reduction in the severity of the errors (p=0.009). This result happened despite the groups without a pharmacist being provided with all the required medication information for safe transition of care. CONCLUSION: These findings support the case for greater involvement from a pharmacist in a patient's healthcare team, particularly for any transition of care. Healthcare teams that include a pharmacist are more likely to exceed minimum safety expectations and make less severe errors.

Alignment of diagnosis and pharmacy claims data coding of medication adherence among patients with diabetes or hypertension.

BACKGROUND: ICD-10-CM codes exist that facilitate provider designation of patients as "nonadherent to therapy"; however, it is unclear whether this label accurately reflects patient behavior according to widely accepted medication adherence metrics using pharmacy claims data. OBJECTIVE: To determine the extent to which patients are accurately coded for and have calculated rates of nonadherence using ICD-10-CM codes and claims, respectively. METHODS: This was a retrospective cohort study using commercial insurance and Medicare Advantage claims data from 2015 to 2016. The analysis focused on adults aged 18 years and older who had been diagnosed with and were being treated for hypertension and/or diabetes and had been coded as nonadherent by a provider during an outpatient encounter. Adherence (proportion of days covered [PDC]) to oral antihypertensive and/or antidiabetic therapy was calculated 6 months before and after the first nonadherence diagnosis identified in outpatient encounters, using 2 distinct calculation methods. Inferential statistics and multivariable logistic regression were used to determine predictors of coding agreement and changes in adherence after the nonadherence diagnosis controlling for available patient characteristics. RESULTS: A total of 1,142 patients who had been coded as nonadherent were identified, of which between 5.3% and 22.0% (depending on metric and condition) had PDCs before the nonadherence code deeming them adherent according to claims, conflicting with nonadherence diagnosis codes documented by their providers. Mean PDCs increased significantly (20.5%-24.3%, all P < 0.001) among both conditions following the nonadherent code, as did the proportion adherent (PDC > 80%), irrespective of disease (all P < 0.01). The odds of being correctly labeled nonadherent according to claims decreased with age (diabetes odds ratio [OR]: 0.82, 95% CI = 0.694-0.976; hypertension OR: 0.86, 95% CI = 0.773-0.944) but were higher among those taking more medications (diabetes OR: 2.97, 95% CI = 1.658-5.326; hypertension OR: 3.0, 95% CI = 2.095-4.305). Following the nonadherence coding, the odds of being adherent increased with age in both models (diabetes OR: 1.17, 95% CI = 1.012-1.363; hypertension OR: 1.13, 95% CI = 1.048-1.223) yet decreased with increasing medications (diabetes OR: 0.25, 95% CI = 0.138-0.468; hypertension OR: 0.47, 95% CI = 0.368-0.592) and were lower if the patient was observed to be nonadherent before the index encounter (diabetes OR: 0.33, 95% CI = 0.146-0.760; hypertension OR: 0.25, 95% CI = 0.152-0.423). CONCLUSIONS: In general, providers are properly classifying patients as nonadherent using ICD-10-CM codes, but additional assessment is needed to determine the reasons for the remaining mismatch between claims- and diagnosis-based nonadherence. In addition, the correct claims-based metric needs to be established to improve alignment with provider interpretation of patient medication use. DISCLOSURES: No outside funding supported this study. Gatwood reports grants from GlaxoSmithKline, Merck & Co., and AstraZeneca, outside the submitted work. Kovesdy reports consulting fees from Amgen, Sanofi, Fresenius Medical Care, Keryx, Bayer, Abbott, Abbvie, Dr. Schar, Astra-Zeneca, Takeda, Tricida, and Reata and grants from Shire, outside the submitted work. The other authors have nothing to disclose. Findings described in this article were presented as a poster at the American College of Clinical Pharmacy Annual Meeting in New York City, October 2019.

Multi-center investigation on personnel training and scientific research status of pharmacy intravenous admixture services (PIVAS) in mainland China based on the perspectives of PIVAS leaders.

ABSTRACT: We sought to analyze the current situation of personnel training and scientific research regarding pharmacy intravenous admixture services (PIVAS), to provide evidence-based medical knowledge to inform personnel training for PIVAS in mainland China.A cross-sectional survey was used to examine the current status of PIVAS personnel training, research capabilities, needs, and research output of PIVAS personnel based from the perspective of leaders in PIVAS in China. The survey period was from March to April 2019.A total of 137 hospitals in China participated in this survey. The main training content areas of PIVAS staff in each hospital were professional theoretical knowledge (100.00%, 137/137) and practical operation ability (98.54%, 135/137). The frequency of training was typically 1 to 2 times/month (56.9%, 78/137). The average duration of a single training session was typically 1 h or less (68.6%, 94/137). The most common forms of PIVAS training were lectures (94.89%, 130/137) and practical operations (79.56%, 109/137). A total of 51.8% (71/137) of PIVAS leaders believed that PIVAS personnel had a high degree of scientific research needs, but 61.3% (84/137) believed that few personnel had mastered scientific research methodology, and 41.6% (57/137) believed that the scientific research ability of personnel was relatively poor. Among PIVAS personnel, only 38.7% (53/137) had specialized scientific training. The annual total SCI output was 0 to 18 articles (median 0 articles) and the total number of national-level funding grants was 0 to 2 (median 0). There were no significant differences in the training of PIVAS personnel and scientific research between different provinces and hospital levels.The training content of PIVAS personnel in China was found to be relatively rich, but management tools, career development, and training in scientific research were found to be relatively weak, and the scientific research output was very low. It is necessary to build a comprehensive training system for career development among PIVAS personnel.

Developing statewide remdesivir use criteria.

PURPOSE: This report describes our process of 4 health systems coming together to agree on standard use criteria for remdesivir as a coronavirus disease 2019 (COVID-19) treatment for patients in Utah. We hope our process provides a framework for remdesivir use in other states and insights on future use of other therapeutic agents that may also be in short supply, such as vaccines and monoclonal antibodies. SUMMARY: Emergency use authorization (EUA) criteria for COVID-19 treatments often allow for broad use of a treatment relative to limited supplies. Without national criteria, each health system must develop further rationing criteria. Health systems in Utah worked together as part of the state's crisis standards of care workgroup to develop a framework for how to limit the EUA criteria for remdesivir to match available supplies. The 4 largest health systems were represented by infectious diseases specialists, chief medical officers, and pharmacists. The group met several times online and communicated via email over a 9-day period to develop the criteria. The clinicians agreed to use this framework to develop criteria for future therapeutics such as monoclonal antibodies. CONCLUSION: The unique collaboration of the 4 health systems in Utah led to statewide criteria for use of remdesivir for patients with COVID-19, ensuring similar access to this limited resource for all patients in Utah.

Clinical pharmacy interventions in intensive care unit patients.

WHAT IS KNOWN AND OBJECTIVE: The drug therapy of critically ill patients requires intensive evaluation and management due to their severity of illness. These patients often require complex medication regimens. This study analysed the pharmaceutical care provided by clinical pharmacists (CPs) in a single medical centre in Taiwan. In addition, we explored the drug-related problems (DRPs) experienced by patients in intensive care units (ICUs) to determine how to improve the quality and safety of drug therapy. METHODS: This retrospective study was conducted from February 2019 to January 2020. The CPs implemented Taiwan's National Health Insurance (NHI) Scheme for Improving Hospital Drug Safety and Quality programme to improve the safety and quality of drug therapy. The CPs included in the study had at least 2 years' clinical experience and had participated in an ICU team for at least 6 consecutive months. They provided individualized drug treatment evaluation and intervention. Content of care was documented in the Clinical Pharmacy Service Record. RESULTS AND DISCUSSION: A total of 4374 pharmacy care records were evaluated by 12 CPs. The major category of ICU pharmaceutical care was medication reconciliation (n = 2938; 67.2%). Most of the medication interventions were for errors in dosing or dosing frequency (n = 218; 55.8%). Patients with renal dysfunction required more pharmaceutical interventions than did patients with normal renal function (odds ratio = 1.63; 95% confidence interval 1.31-2.01). The main interventions were related to antimicrobial agents (n = 386; 81.3%). During the study period, 99.2% of interventions were accepted and 90.8% were changed within 24 hours. WHAT IS NEW AND CONCLUSION: Increased pharmaceutical interventions for patients with renal dysfunction compared with patients with normal renal function were observed. Most cases of inappropriate frequency of dosing or dosing of antimicrobial agents required intervention.

Clinical Pharmacist-Led Impact on Inappropriate Albumin Utilization and Associated Costs in General Ward Patients.

BACKGROUND: Inappropriate albumin use in clinical practice remains problematic. Health-systems face continued challenges in promoting cost-appropriate use. OBJECTIVE: To evaluate the clinical and economic impact of a clinical pharmacist-led intervention strategy targeting inappropriate albumin use in general ward patients. METHODS: A retrospective cohort study evaluated all adult (≥18 years) general ward patients administered ≥1 dose of albumin at a university medical center over a 2-year period. The intervention consisted of a clinical pharmacist-led strategy intervening on all albumin orders not in accordance with institutional guidelines. The primary end point was to compare inappropriate albumin utilization before and after implementation. Secondary end points compared the rates of inappropriate albumin use adjusted for hospital admission and patient-days as well as associated costs by appropriateness between study periods. RESULTS: A total of 4420 patients were screened, with 1971 (44.6%) patients meeting inclusion criteria. The clinical pharmacist strategy significantly reduced inappropriate albumin (grams) utilization by 86.0% (P < 0.001). A 7-fold reduction of inappropriate albumin administered adjusted for the number of patient admissions was found from the preimplementation period following clinical pharmacist intervention strategy implementation (415.3 ± 83.2 vs 57.5 ± 34.2 g per 100 general ward hospital admissions, respectively; P < 0.001). Also, the adjusted inappropriate albumin rate was reduced from 62.2 ± 12.3 to 8.6 ± 5.2 g per 100 patient-days in the preimplementation and postimplementation periods, respectively (P < 0.001). Annual cost savings were $421 455 overall, with $341 930 resulting from mitigation of inappropriate use. CONCLUSION AND RELEVANCE: Clinical pharmacist-led interventions significantly reduced inappropriate albumin use and costs in hospitalized patients.

Impact of interventions targeting the inappropriate use of proton-pump inhibitors by clinical pharmacists in a hepatobiliary surgery department.

WHAT IS KNOWN AND OBJECTIVE: At present, studies on the usage of proton-pump inhibitors (PPIs) have universal significance. In clinical practice, PPIs are widely used to treat a variety of acid-related diseases, but they can be inappropriately prescribed, leading to increased medical costs and patient harm. The study comprehensively evaluated the clinical effects of a clinical pharmacist intervention on inappropriate PPI prescriptions in a tertiary general hospital hepatobiliary surgery ward. METHODS: A retrospective, single-centre intervention study covering the periods of July-December 2018 and July-December 2019 was conducted. In the intervention group, clinical pharmaceutical care was initiated by a clinical pharmacist in the hepatobiliary surgery ward. Outcomes, including the clinical pattern of PPI utilization, the rate of inappropriate PPI use and safety outcomes, were compared between the two periods. RESULTS AND DISCUSSION: In total, 1150 patients were admitted to the hepatobiliary surgery ward in our hospital in the study periods. Of these, 717 patients met the inclusion criteria for this study, and 420 and 297 patients were included in the preintervention and post-intervention groups, respectively. The PPI utilization rates before and after the intervention were 82.0% and 55.0%, respectively. The rates of inappropriate PPI use before and after the intervention were 48.9 and 22.7 per 100 patient-days, respectively. Clinical safety outcomes were nearly identical between before and after the intervention, but patients treated with PPIs were more likely to experience nosocomial pneumonia (2.4% vs. 0.6%). WHAT IS NEW AND CONCLUSION: The implementation of a clinical pharmacist intervention for PPI use decreased inappropriate PPI use during hospitalization without sacrificing clinical safety outcomes.

Skin disorder management in oral anticancer drugs by collaboration of hospital pharmacists and community pharmacists.

BACKGROUND: In Japan, the multidisciplinary team approach in cancer chemotherapy has become quite widespread. However, patients treated with oral anticancer drugs in outpatient clinics usually receive short medical examinations from doctors without any intervention of pharmacists. To improve this medical circumstance, we made a skin disorder manual for community pharmacists and evaluated its feasibility. METHODS: Patients who underwent oral skin toxic chemotherapy from May 1, 2017, to October 31, 2017, were enrolled. The severity of skin toxicities was evaluated based on NCI-CTCAE ver4.0. Skin care and skin disorders were assessed by community pharmacists based on the assessment document arranged by the investigator. Numbers of patients who replied to the assessment, numbers of replies, numbers of assessments and instructions for skin care, and numbers of prescription proposals were evaluated to assess the value of intervention of community pharmacists. RESULTS: Sixty-two patients were enrolled in this study. Community pharmacy responded to 55 patients (88.7%), for a total of 335 replies. The data described in the replies were as follows: 317 assessments of skin disorders (94.6%), 307 assessments of skin care (91.6%), 248 instructions for skin care (74%), and 19 prescription proposals (5.7%). CONCLUSIONS: Community pharmacists have high motivation for prevention and early detection of skin disorders. Although the number of prescription proposals is small, some proposals have contributed to improving side effects. Collaboration of hospital pharmacists and community pharmacists is important for prevention, early detection, and treatment of skin disorders caused by oral anticancer drugs.

Prescrições e aprazamentos de medicamentos endovenosos em pediatria: estudo descritivo / Prescripciones y horarios de fármacos endovenosos en pediatría: estudio descriptivo / Prescriptions and scheduling of endovenous medications in pediatrics: descriptive study

RESUMO Objetivos: analisar as prescrições e o aprazamento de medicamentos endovenosos a crianças e adolescentes hospitalizados, de acordo com as recomendações do Protocolo de Segurança na Prescrição, Uso e Administração de Medicamentos. Métodos: estudo descritivo, documental, com análise de 352 prescrições de medicamentos endovenosos, em unidades de internação pediátrica. A faixa etária das crianças era de 29 dias até 16 anos de idade completos. Coleta dos dados ocorreu de agosto a novembro de 2017. Utilizou-se instrumento do tipo checklist. A análise foi realizada por meio da estatística descritiva, obedecendo aos preceitos éticos. Resultados: constatou-se que o desempenho foi satisfatório em relação às prescrições e estavam de acordo com o recomendado pelo Ministério da Saúde do Brasil. Os itens essenciais nas prescrições medicamentosas apresentaram as seguintes incidências: data (98%), nome genérico (95,2%), concentração (98,6%), dose (99,7%), via de administração (95,7%), posologia (98,9%), orientações (87,5%), assinatura do médico (99,1%), carimbo médico (97,7%), assinatura do enfermeiro (93,2%) e carimbo do enfermeiro (84,7%). Nas 352 prescrições, analisaram-se 1.069 medicamentos, dos quais 1.059 (99,06%) apresentaram dados satisfatórios quanto à checagem dos medicamentos endovenosos. Conclusões: a maioria dos itens da prescrição foi satisfatória, contudo, alguns itens foram considerados insatisfatórios, tendo ações não realizadas corretamente.

RESUMEN Objetivos: analizar la prescripción y programación de medicamentos endovenosos para niños y adolescentes hospitalizados, de acuerdo con las recomendaciones del Protocolo de Seguridad en la Prescripción, Uso y Administración de Medicamentos. Métodos: estudio descriptivo, documental, con análisis de 352 prescripciones de medicamentos endovenosos en unidades de hospitalización pediátrica. El rango de edad de los niños fue de 29 días a 16 años. La recolección de datos se llevó a cabo de agosto a noviembre de 2017. Se utilizó un instrumento tipo lista de verificación. El análisis se realizó mediante estadística descriptiva, cumpliendo con los preceptos éticos. Resultados: se encontró que el desempeño fue satisfactorio con relación a las prescripciones y estuvo de acuerdo con lo recomendado por el Ministerio de Salud de Brasil. Los ítems esenciales en la prescripción de medicamentos tuvieron las siguientes incidencias: fecha (98%), nombre genérico (95,2%), concentración (98,6%), dosis (99,7%), vía de administración (95,7%), posología (98,9%), directrices (87,5%), firma del médico (99,1%), sello médico (97,7%), firma de la enfermera (93,2%) y sello de la enfermera (84,7%). En las 352 prescripciones se analizaron 1.069 medicamentos, de los cuales 1.059 (99,06%) presentaron datos satisfactorios en cuanto a la verificación de medicamentos endovenosos. Conclusiones: la mayoría de los ítems de prescripción fueron satisfactorios, sin embargo, algunos ítems se consideraron insatisfactorios, con acciones no realizadas correctamente.

ABSTRACT Objectives: to analyze the prescriptions and scheduling of intravenous medications for hospitalized children and adolescents, following the recommendations of the Safety Protocol in the Prescription, Use, and Administration of Medicines. Methods: descriptive, documentary study, with analysis of 352 prescriptions for intravenous medications in pediatric inpatient units. The age range of the children was 29 days up to 16 years old. Data collection took place from August to November 2017. A checklist-type instrument was used. The analysis was performed using descriptive statistics, in compliance with ethical precepts. Results: we found that the performance was satisfactory concerning the prescriptions and followed the recommendations of the Ministry of Health of Brazil. The essential items in medication prescriptions had the following incidences: date (98%), generic name (95.2%), concentration (98.6%), dose (99.7%), route of administration (95.7% ), dosage (98.9%), guidelines (87.5%), physician's signature (99.1%), medical stamp (97.7%), nurse's signature (93.2%) and nurse's stamp (84.7%). In the 352 prescriptions, 1,069 medications were analyzed, of which 1,059 (99.06%) presented satisfactory data regarding the verification of intravenous medications. Conclusions: most of the prescription items were satisfactory; however, some items were considered unsatisfactory, with actions not performed correctly.

Development of a sterile compounding training and competency program at a large academic medical center.

PURPOSE: This article is one of the 5 articles describing steps taken to enhance sterile compounding compliance at a large, multisite academic medical center. This article focuses on the development of a comprehensive personnel training and assessment program for sterile compounding. SUMMARY: Increased regulatory oversight and the release of new United States Pharmacopeia chapters motivated the reenvisioning of the medical center's sterile compounding personnel training and assessment program. The main challenges facing any entity undertaking sterile compounding include identification of compounding staff, development of policies and procedures, and baseline and ongoing training including observational competency assessments and record keeping. These challenges are exacerbated by high work volumes and variation in compounding practices encountered within a large multisite institution. Our organization developed a team of specialized pharmacists and pharmacy technicians to implement and enforce changes promoting the safe production and use of compounded sterile products and meet rising regulatory requirements. This team worked within various operational areas to customize purchased policies and procedures and group compounding staff based on training needs. The team performs ongoing personnel monitoring and training of new compounders in a shared training space. Challenges encountered and future considerations for program enhancement are described. CONCLUSION: Implementation of standards and enforcement of staff behaviors in a large academic medical center is perhaps best completed by a team of highly trained experts working in collaboration with supervisors and using a dedicated training and testing space, as evidenced by the success of the described program in overecoming past challenges.

Effectiveness of a decontamination procedure in a pharmacy buffer room contaminated by 5 antineoplastic agents.

PURPOSE: Healthcare facilities are obligated to implement strategies to protect healthcare workers from exposure to hazardous drugs, including any real or potential risk from contaminated surfaces. Guidelines are broad and lack sufficient detail for healthcare facilities to establish clear effectiveness targets for their decontamination procedures. Our goal in this analysis was to measure the effectiveness of a decontamination procedure in a pharmacy buffer room contaminated with 5 antineoplastic drugs. METHODS: Six rounds of contamination, decontamination, and wipe sampling were performed in a pharmacy buffer room designated for hazardous drug (HD) compounding. Ten locations in the buffer room were contaminated with 5-fluorouracil, carboplatin, cyclophosphamide, paclitaxel, and doxorubicin. Pharmacy staff were blinded to contamination sites. After contamination, 3 pharmacy technicians following the same decontamination procedure decontaminated the buffer room. To assess the impact of decontamination, residual hazardous drug levels were assessed after contamination and after decontamination using a commercially available wipe sampling product. RESULTS: The mean (SD) residual contamination levels for the 239 wipe samples taken before and after decontamination were 63 (60) ng and 3.9 (8.2) ng, respectively, representing a 94% reduction in residual HD contamination. Residual contamination was not detectable (<5 ng) in 221 (~93%) of the samples after decontamination. CONCLUSION: The employed decontamination procedures effectively reduced residual HD surface contamination.

Hospital Radiopharmacy in Argentina during the COVID-19 pandemic. Criteria and rationale for the organization of work. / Radiofarmacia Hospitalaria en Argentina durante la pandemia de COVID-19. Criterios y fundamentos para la organización del trabajo.

This publication presents criteria and bases for the work organization in the safe practice of Hospital Radiopharmacy, in order to minimize the risk of viral transmission during the COVID-19 pandemic, in a reference facility of the National Energy Commission Atomic of Argentina, while continuing to perform essential services for the health system. For this purpose, documents from the National Energy Commission Atomic, IAEA, WHO and other scientific publications were consulted as reference. These recommendations are under constant review and are permanently updated. Within this framework, the present model of work organization for this essential activity is proposed, including general and specific recommendations and its epidemiological and immunological basis.

Quality Improvement Incorporating a Feedback Loop for Accurate Medication Reconciliation.

OBJECTIVES: Medication reconciliation errors on hospital admission can lead to significant patient harm. A pediatric intermediate care unit initiated a quality improvement project and aimed to reduce errors in admission medication reconciliation by 50% in 12 months. METHODS: From August 2017 to December 2018, a multidisciplinary team conducted a quality improvement project with plan-do-study-act methodology. Continuous data collection was achieved by reviewing medications with home caregivers within 18 hours of admission to identify errors. Cycle 1 consisted of nursing training in accurate and thorough medication history documentation. Cycle 2 was aimed at improving data collection. Cycle 3 was aimed at improving pediatric housestaff processes for medication reconciliation. In cycle 4 intervention, the reconciliation process was redesigned to incorporate the bedside nurse reviewing final medication orders with the patient's home caregivers once the medication reconciliation process was complete. Intermittent maintenance data collection continued for 12 months thereafter. RESULTS: Cycle 1 and 2 interventions resulted in improvement in the medication reconciliation error rate from 9.8% to 4.7%. In cycle 2, the data collection rate improved from 61% to 80% of admissions sustained. Cycle 3 resulted in a further reduction in the medication error rate to 2.9%, which was sustained in cycle 4 and over the 12-month maintenance period. A patient's number of home medications did not correlate with the error rate. CONCLUSIONS: Reductions in admission medication reconciliation errors can be achieved with staff education on medication history and process for medication reconciliation and with process redesign that incorporates active medication order review as a closed-loop communication with home caregivers.

Screening for expired medications in automated dispensing cabinets.

PURPOSE: Results of a study to quantify rates of identification of expired medications in automated dispensing cabinets (ADCs) are reported. METHODS: A pre-post analysis was conducted to determine the effect of various types of ADC audits on rates of finding expired medications in ADCs. For the experimental phase of the study, 4 ADCs at the main campus of an academic medical center were randomly assigned to receive one of 4 interventions: (1) monthly audits of all ADC pockets, (2) monthly audits of matrix (open pocket) drawers only, (3) monthly audits of unassigned pockets only, and (4) no additional intervention. RESULTS: At baseline, rates of finding expired medication doses in the 4 ADCs ranged from 0.4% to 0.7%. During the 3-month experimental period, rates of finding expired medication doses ranged from 0.1% to 0.3%. During a final audit 1 month later, the ADC targeted for monthly audits of all pockets was found to contain no expired doses, with an overall improvement in expired-dose rates for all audited ADCs observed over the course of the 4-month study. The average time to perform a full audit for an ADC with about 340 pockets was 1 hour, or 15 seconds per pocket. The average time to perform matrix drawer-only audits averaged around 45 minutes, or 11 seconds per pocket. The average time to perform audits of unassigned matrix drawers averaged 30 minutes, or 10 seconds per pocket. CONCLUSION: Auditing of all ADC pockets on a monthly basis appears to be an effective method of reducing the rate of identification of expired medications in ADC pockets.