Optimización del circuito de medicación de Farmacia a Hospitalización a Domicilio en un hospital urbano / Optimization of the medication circuit from Pharmacy to Hospital at Home in a urban hospital

Introducción: Se detectaron severas ineficiencias en los circuitos entre el Servicio de Far-macia Hospitalaria (SFH) y el Servicio de Hospitalización a Domicilio (HAD), lo que motivó la realización de un análisis, con el soporte de Calidad, y la definición e implementación posterior de varias acciones de mejora. Método: Análisis del flujo de medicación entre los SFH y HAD del Hospital Dos de Maig. Los objetivos propuestos fueron reducir las interrupciones a los profesionales, aumentar la eficiencia de los circuitos, y garantizar la disponibilidad de la medicación. Se identificaron ineficiencias en el sistema de solicitud y dispensación de medicación, y desajustes en la dotación y revisión del stock. Se acordó un cambio de modelo de dispensación, se ajustó la dotación del stock, se agilizaron las revisiones del mismo, y se aplicó una nueva herramienta de solicitud vía informática de medicación. Resultados: El equipo de HAD consiguió mayor autonomía, se redujeron las interrupciones entre ambos servicios y la dispensación ganó en seguridad. La dispensación global de fármacos fuera de stock disminuyó en un 61%, y los técnicos del SFH ganaron casi media hora diaria. Conclusiones: El cambio en la logística entre el SFH y HAD ha sido muy positivo, obteniendo unos logros importantes, que repercuten positivamente en la organización y en la seguridad del paciente, con un flujo de medicación más fluido y eficiente, y el registro sistemático de las entregas que incrementa la seguridad en la dispensación. (AU)

Introduction: Severe inefficiencies were detected in the circuits between the Hospitalary Pharmacy Service (HPS) and the Home Hospital at Home Service (HaH), which led to an analysis, with the support of Quality, and the defini-tion and subsequent implementation of various improvement actions. Method: Analysis of the flow of medication between HPS and HaH at Hospital Dos de Maig. The proposed objectives were to reduce interruptions to professionals, increase the efficiency of circuits, and ensure the availability of medi-cation. Inefficiencies were identified in the sys-tem of requesting and dispensing medication, and mismatches in the supply and review of the stock. A change of dispensation model was agreed, the stock was adjusted, revisions of the same were expedited, and a new application tool was applied via computer medication. Results: The HaH team achieved greater au-tonomy, interruptions between both services were reduced and dispensing became safer. The overall dispensing of out-of-stock drugs de-creased by 61%, and HPS technicians gained almost half an hour a day.Conclusions: The change in logistics between HPS and HaH has been very positive, obtaining important achievements, which have a posi-tive impact on the organization and the safety of the patient, with a flow of medications more fluid and efficient, and the systematic recording of deliveries which increases the security of dispensing.

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.

Impact of selected clinical pharmacy services on medication safety and prescription cost of patients attending a selected primary healthcare setting: a translational experience from a resource-limited country.

PURPOSE OF THE STUDY: The impact of clinical pharmacy (CP) services on primary healthcare (PH) is less well studied in resource-limited countries. We aimed to evaluate the effect of selected CP services on medication safety and prescription cost at a PH setting in Sri Lanka. STUDY DESIGN: Patients attending a PH medical clinic with medications prescribed at the same visit were selected using systematic random sampling. A medication history was obtained and medications were reconciled and reviewed using four standard references. Drug-related problems (DRPs) were identified and categorised, and severities were assessed using the National Coordinating Council Medication Error Reporting and Prevention Index. Acceptance of DRPs by prescribers was assessed. Prescription cost reduction due to CP interventions was assessed using Wilcoxon signed-rank test at 5% significance. RESULTS: Among 150 patients approached, 51 were recruited. Nearly half (58.8%) reported financial difficulties in purchasing medications. DRPs identified were 86. Of them, 13.9% (12 of 86) DRPs were identified when taking a medication history (administration errors (7 of 12); self-prescribing errors (5 of 12)), 2.3% (2 of 86) during reconciliation, and 83.7% (72 of 86) during medication reviewing (wrong indication (18 of 72), wrong strength (14 of 72), wrong frequency (19 of 72), wrong route of administration (2 of 72), duplication (3 of 72), other (16 of 72)). Most DRPs (55.8%) reached the patient, but did not cause harm. Prescribers accepted 65.8% (56 of 86) DRPs identified by researchers. The individual prescription cost reduced significantly due to CP interventions (p<0.001). CONCLUSIONS: Implementing CP services could potentially improve medication safety at a PH level even in resource-limited settings. Prescription cost could be significantly reduced for patients with financial difficulties in consultation with prescribers.

Indicadores de qualidade para otimização da qualidade em farmácia hospitalar / Quality indicators for quality optimization in hospital pharmacy / Indicadores de calidad para la optimización de la calidad en farmacia hospitalaria

Objetivo: identificar, a partir de publicações científicas, indicadores de qualidade para a otimização da gestão em farmácia hospitalar. Método: revisão integrativa com levantamento bibliográfico nas bases de dados Scopus, Web of Science e Medline, entre 2019 e 2023, utilizando os descritores Patient Safety, Quality Indicators e Pharmacy Service. Foram incluídos documentos em português, inglês e espanhol, com os resumos disponíveis nas bases de dados selecionadas e disponíveis na íntegra sem custos. Para análise dos documentos, aplicou-se a ferramenta CASP adaptada. Resultados: foram identificados 15 documentos na Web of Science, 24 na Scopus e dois na Medline com a temática abordada no tópico. Conclusão: as ferramentas de gestão da qualidade mais frequentemente reportadas foram as relacionadas com a definição da causa raiz. Os indicadores de qualidade utilizados para monitorar os resultados foram, principalmente, satisfação da equipe de trabalho, tempo gasto na execução das atividades e redução de erros e custos.

Objective: to identify, from scientific publications, quality indicators for optimizing management in hospital pharmacy. Method:integrative review with bibliographic survey in the databases Scopus, Web of Science and Medline, between 2019 and 2023, using the descriptors Patient Safety, Quality Indicators and Pharmacy Service. Documents were included in Portuguese, English and Spanish, with abstracts available in the selected databases and available in full at no cost. The adapted CASP tool was used to analyze the documents. Results: 15 documents were identified in Web of Science, 24 in Scopus and two in Medline with the theme addressed in the topic. Conclusion: the most frequently reported quality management tools were those related to root cause definition. The quality indicators used to monitor the results were mainly satisfaction of the work team, time spent performing the activities, and reduction of errors and costs.

Objetivo: identificar, a partir de publicaciones científicas, indicadores de calidad para optimizar la gestión en farmacia hospitalaria.Método: revisión integrativa con levantamiento bibliográfico en las bases de datos Scopus, We of Science y Medline, entre 2019 y 2023, utilizando los descriptores Seguridad del Paciente, Indicadores de Calidad y Servicio de Farmacia. Se incluyeron documentos en portugués, inglés y español, con resúmenes disponibles en las bases de datos seleccionadas y disponibles en su totalidad sin costo. Para el análisis de los documentos se utilizó la herramienta CASP adaptada. Resultados: foram identificados 15 documentos na Web of Science, 24 na Scopus e dois na Medline com a temática abordada no tópico. Conclusión: las herramientas de gestión de la calidad más utilizadas fueron las relacionadas con la definición de la causa raíz. Los indicadores de calidad utilizados para monitorizar los resultados fueron principalmente la satisfacción del equipo de trabajo, el tiempo empleado en la realización de las actividades y la reducción de errores y costes.

How do patients prefer specialized clinical pharmacy service to other prevention of mother-to-child transmission of human immunodeficiency virus services? An evaluation of their willingness to pay and willingness to accept choices and ratios.

WHAT IS KNOWN AND OBJECTIVE: Donor agencies provide most of the funds for HIV services in developing countries. Due to the global economic downturn, there has been a reduction in funding for HIV-related services in Nigeria. This study compared the willingness to pay (WTP)-willingness to accept (WTA) ratios for prevention of mother-to-child transmission (PMTCT) services to specialized clinical pharmacy services among patients of two Nigerian hospitals. METHODS: This was a cross-sectional survey using contingent valuation method at Ahmadu Bello University Teaching Hospital (ABUTH) and University of Nigeria Teaching Hospital (UNTH). WTP and WTA were elicited using an interviewer-administered questionnaire and a payment card. The responses to the WTP and WTA questions were reported as frequencies and percentages, while the amounts were determined as mean. All costs were obtained in Nigerian Naira (N360 = $1). RESULTS AND DISCUSSION: Of the 219 mothers who participated in the study, 172 (78.5%) had no health insurance. Primary prevention of HIV (PPV) had the highest "yes" WTP response of 152 (69.4%) and the highest mean WTP amount of N6067.20. It also had the least "no" WTA response of 162 (74.0%) and the least WTA amount of N232.09. Specialized clinical pharmacy service (SCPS) had the highest WTA/WTP ratio of 4.0826 in ABUTH and 9.3750 at UNTH. Its income effect was -3.0826. A 1% increase in income led to 0.0550 (95% CI: -0.3068 to 0.1968) decreased odds to pay for PPV. WHAT IS NEW AND CONCLUSION: Most patients assessed in this study were willing to pay for PPV than other services. Majority of them were also willing to forgo PMTCT Drugs Only. SCPS had the highest value for the patients, but they did not want to pay a high amount for it. Employment status, health insurance status, educational level and age were predictors of patients' WTP and WTA.

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.

Unintentional guideline deviations in hospitalized patients with two or more antithrombotic agents: an intervention study.

PURPOSE: Treatment schedules for antithrombotic therapy are complex, and there is a risk of inappropriate prescribing or continuation of antithrombotic therapy beyond the intended period of time. The primary aim of this study was to determine the frequency of unintentional guideline deviations in hospitalized patients. Secondary aims were to determine whether the frequency of unintentional guideline deviations decreased after intervention by a pharmacist, to determine the acceptance rate of the interventions and to determine the type of interventions. METHODS: We performed a non-controlled prospective intervention study in three teaching hospitals in the Netherlands. We examined whether hospitalized patients who used the combination of an anticoagulant plus at least one other antithrombotic agent had an unintentional guideline deviation. In these cases, the hospital pharmacist contacted the physician to assess whether this deviation was intentional. If the deviation was unintentional, a recommendation was provided how to adjust the antithrombotic regimen according to guideline recommendations. RESULTS: Of the 988 included patients, 407 patients had an unintentional guideline deviation (41.2%). After intervention, this was reduced to 22 patients (2.2%) (p < 0.001). The acceptance rate of the interventions was 96.6%. The most frequently performed interventions were discontinuation of an low molecular weight heparin in combination with a direct oral anticoagulant and discontinuation of an antiplatelet agent when there was no indication for the combination of an antiplatelet agent and an anticoagulant. CONCLUSION: A significant number of hospitalized patients who used an anticoagulant plus one other antithrombotic agent had an unintentional guideline deviation. Intervention by a pharmacist decreased unintentional guideline deviations.

Impact of pharmacist consultation at clinical trial inclusion: an effective way to reduce drug-drug interactions with oral targeted therapy.

PURPOSE: Pharmacist consultation is unfrequently performed in oncology clinical trials that include patients who often have many co-treatments increasing the risk of drug-drug interactions (DDI). The aim of this study was to determine whether best possible medication history (BPMH) by hospital pharmacist at inclusion and therapeutic drug monitoring could be used for DDI risk evaluation and for current oral targeted therapy management. METHODS: A prospective clinical trial (ALCINA 2, NCT04025541) was carried out in metastatic breast cancer cohort treated by palbociclib to conduct pharmacokinetics-toxicity correlation study. BPMH was prospectively performed by the hospital pharmacist at each trial inclusion, followed by a contact to the patient's community pharmacy to complete the collected data. Pharmacokinetic analysis was performed on blood samples collected at day 15 of cycle 1 of palbociclib treatment. RESULTS: Pharmacist interventions indicated that at inclusion, current medications were incomplete for 63% of the enrolled patients (32/51). It allowed the real-time management of high-risk DDI detected in third of patients. The palbociclib Ctrough geometric median (min-max) was significantly higher in cohort with potential DDI [106 ng/mL (66.7-113)], than cohort without potential DDI [70.1 ng/mL (54.1-89.7)], p = 0.0284. CONCLUSION: This is the first prospective study evaluating the relevance of proactive BPMH by pharmacist with contact to the community pharmacy during the inclusion step of a clinical trial to ensure the efficacy and safety of the investigated drug. This investigation was thus able to highlight the statistically significant impact of these DDI on palbociclib plasma concentration variation during the clinical trial. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT04025541.

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.

Health-system implementation of a collaborative core curriculum for advanced pharmacy experiential education during the COVID-19 pandemic.

PURPOSE: A collaborative advanced pharmacy practice experience (APPE) education model established within a healthcare institution during the coronavirus disease 2019 (COVID-19) pandemic is described. SUMMARY: The COVID-19 pandemic caused a nationwide disruption of APPE pharmacy education. Healthcare institutions faced the challenge of educating APPE students while attempting to simultaneously de-densify work areas and reduce transmission risk for employees and patients. A pharmacist coordinator and pharmacist academic partners at a large teaching hospital created a collaborative common core curriculum model for resourceful implementation of APPE education. Healthcare network pharmacists, clinical pharmacist academic partners, and pharmacy residents delivered the curriculum to 35 pharmacy students over a 9-week time period. Main components of the curriculum included patient case discussions, topic discussions, journal club presentations, live continuing education (CE) webinars, and development of pharmacy technician CE programs. A majority of students reported positive experiences working with a variety of preceptors from different specialties (81%) and collaborating with students from other universities (62%). CONCLUSION: A health system can leverage institutional, network-wide, and academic partner resources to implement a collaborative APPE curriculum during challenging times such as those experienced during the COVID-19 pandemic.

Impact of an integrated medication reconciliation model led by a hospital clinical pharmacist on the reduction of post-discharge unintentional discrepancies.

WHAT IS KNOWN AND OBJECTIVE: There is no optimal standardized model in the transfer of care between hospitals and primary healthcare facilities. Transfer of care is a critical point during which unintentional discrepancies, that can jeopardize pharmacotherapy outcomes, can occur. The objective was to determine the effect that an integrated medication reconciliation model has on the reduction of the number of post-discharge unintentional discrepancies. METHODS: A randomized controlled study was conducted on an elderly patient population. The intervention group of patients received a medication reconciliation model, led entirely by a hospital clinical pharmacist (medication reconciliation at admission, review and optimization of pharmacotherapy during hospitalization, patient education and counselling, medication reconciliation at discharge, medication reconciliation as part of primary health care in collaboration with a primary care physician and a community pharmacist). Unintentional discrepancies were identified by comparing the medications listed on the discharge summary with the first list of medications prescribed and issued at primary care level, immediately after discharge. The main outcome measures were incidence, type and potential severity of post-discharge unintentional discrepancies. RESULTS AND DISCUSSION: A total of 353 patients were analysed (182 in the intervention and 171 in the control group). The medication reconciliation model, led by a hospital clinical pharmacist, significantly reduced the number of patients with unintentional discrepancies by 57.1% (p < 0.001). The intervention reduced the number of patients with unintentional discrepancies associated with a potential moderate harm by 58.6% (p < 0.001) and those associated with a potential severe harm by 68.6% (p = 0.039). The most common discrepancies were incorrect dosage, drug omission and drug commission. Cardiovascular medications were most commonly involved in unintentional discrepancies. WHAT IS NEW AND CONCLUSION: The integrated medication reconciliation model, led by a hospital clinical pharmacist in collaboration with all health professionals involved in the patient's pharmacotherapy and treatment, significantly reduced unintentional discrepancies in the transfer of care.

Impact of clinical pharmacist services on anticoagulation management of total joint arthroplasty: A retrospective observational study.

WHAT IS KNOWN AND OBJECTIVE: Even if total joint arthroplasty (TJA) patients have received conventional antithrombotic therapy, the incidence of thrombosis remains high. Clinical pharmacists have been involved in the multidisciplinary team of orthopaedics, but their roles and functions are not yet defined. The objective of this study was to assess the impact of clinical pharmacist services on the use of anticoagulant drugs, the rationality of medication and the incidence of thrombosis in patients with TJA. METHODS: This retrospective, observational cohort study was conducted for patients undergoing TJA procedures. Study variables were collected for a baseline period of 1 January 2016 to 30 June 2017 and an intervention period of 1 January 2018 to 30 June 2019, allowing for a 6-month run-in period. For demographic characteristics, the use of anticoagulant drugs and the incidence of thrombosis between the baseline and intervention periods, the data were statistically analysed. RESULTS AND DISCUSSION: During the 36-month study timeframe, a total of 591 TJA procedures were performed. A total of 577 participants were included in the study (240 in the baseline group and 377 in the intervention group). After clinical pharmacist participation, the prevention rate of anticoagulant drugs (p < 0.05), the proportion of oral anticoagulants (p = 0.000) and the course of preventive treatment (p = 0.004) increased significantly. The time of administration was shortened from after 24 h to within 24 h post-surgery (p = 0.000). Although the incidence of symptomatic DVT reduced in the intervention period, there was no statistical difference in either the hospital, 1-month follow-up, or 3-month follow-up after surgery (all p > 0.05). WHAT IS NEW AND CONCLUSION: Within the limitations of a retrospective study, clinical pharmacist intervention was associated with improvements in anticoagulation management of TJA procedures, likely conferring beneficial effects.

[COVID-19, drugs and hospital pharmacy]. / Évolution des traitements médicamenteux en cas de Covid-19.

Observation, interpretation, actions for improvement, questioning are all terms that echo the situation of caregivers since the outbreak of the COVID-19 epidemic in France at the beginning of 2020. All those involved in the healthcare chain have had to cope with the influx of patients and to show that they are capable of seeing their practices evolve on a daily basis. What was recommended a few weeks earlier could quickly become obsolete. It was necessary to be reactive and the question of drug treatments was at the heart of the concerns, requiring prescribers to keep themselves informed and pharmacists to be as mobilized as possible to respond to requests from the field as quickly as possible.

Evaluation of Chemotherapy Regimen Management Practice by Oncology-Specialized and Non-specialized Pharmacists Collaboration.

Chemotherapy regimen management is one of the most important oncology pharmacy practices, because chemotherapy is conducted according to the registered regimens. In this study, we evaluated the pharmaceutical practice that assumes the initial confirmation of chemotherapy regimens and the quality of practice sharing between oncology-specialized and non-specialized pharmacists in regimen management committee. Pharmacists initially confirmed the applied regimen prescribed by physicians regarding chemotherapeutic agents and prophylactic supportive care medicines. Following confirmation, the regimens were reviewed by the Hokkaido University Hospital Regimen Management Committee. A total of 233 regimens were reviewed by the committee over three years. In total, 110 pharmaceutical inquiries were conducted, 45% of inquiries were concerning chemotherapeutic agents, of which approximately half were regarding supportive care medicines. Most inquiries were regarding premedication, followed by those on administration time, solvent of infusion medicines, and dosage. Correction was performed for 84.5% of inquiries. There was no significant difference in inquiry rates between practice and trial regimens. We have entrusted the first basic regimen review according to the checklist, creation of the chemotherapy plan document, and registry of the adopted regimens in the ordering system from oncology-certified pharmacists to non-certified pharmacists. Basic regimen review was well conducted by a non-certified pharmacist, and a more advanced review was additionally performed by certified pharmacists. In conclusion, we demonstrated the utility of pharmaceutical confirmation in a chemotherapeutic regimen review, suitable review coverage, and quality practice sharing between oncology-certified and non-certified pharmacists, which is one of the recommended methods in chemotherapy regimen review.

Developing an Integrated Electronic Medication Reconciliation Platform and Evaluating its Effects on Preventing Potential Duplicated Medications and Reducing 30-Day Medication-Related Hospital Revisits for Inpatients.

The aims were to develop an integrated electronic medication reconciliation (ieMR) platform, evaluate its effects on preventing potential duplicated medications, analyze the distribution of the potential duplicated medications by the Anatomical Therapeutic and Chemical (ATC) code for all inpatients, and determine the rate of 30-day medication-related hospital revisits for a geriatric unit. The study was conducted in a tertiary medical center in Taiwan and involved a retrospective quasi pre-intervention (July 1-November 30, 2015) and post-intervention (October 1-December 31, 2016) study design. A multidisciplinary team developed the ieMR platform covering the process from admission to discharge. The ieMR platform included six modules of an enhanced computer physician order entry system (eCPOE), Pharmaceutical-care, Holistic Care, Bedside Display, Personalized Best Possible Medication Discharge Plan, and Pharmaceutical Care Registration System. The ieMR platform prevented the number of potential duplicated medications from pre (25,196 medications, 2.3%) to post (23,413 medications, 3.8%) phases (OR 1.71, 95% CI, 1.68-1.74; p < .001). The most common potential duplicated medications classified by the ATC codes were cardiovascular system (28.4%), alimentary tract and metabolism (26.4%), and nervous system (14.9%), and by chemical substances were sennoside (12.5%), amlodipine (7.5%), and alprazolam (7.4%). The rate of medication-related 30-day hospital revisits for the geriatric unit was significantly decreased in post-intervention compared with that in pre-intervention (OR = 0.12; 95% CI, 0.03-0.53; p < .01). This study indicated that the ieMR platform significantly prevented the number of potential duplicated medications for inpatients and reduced the rate of 30-day medication-related hospital revisits for the patients on the geriatric unit.