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1.
Einstein (Sao Paulo) ; 17(4): eGS4621, 2019 Jul 01.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31271589

RESUMO

OBJECTIVE: To calculate the cost and assess the results on implementing technological resources that can prevent medication errors. METHODS: A retrospective, descriptive-exploratory, quantitative study (2007-2015), in the model of case study at a hospital in the Brazilian Southeastern Region. The direct cost of each technology was calculated in the drug chain. Technological efficacy was observed from the reported series of the indicator incidence of medication errors. RESULTS: Thirteen technologies were identified to prevent medication errors. The average cost of these technologies per year in the prescription stage was R$ 3.251.757,00; in dispensing, R$ 2.979.397,10; and in administration, R$ 4.028.351,00. The indicator of medication error incidence decreased by 97.5%, gradually between 2007 to 2015, ranging from 2.4% to 0.06%. CONCLUSION: The average cost per year of the organization to implement preventive technologies in the drug chain totaled up R$ 10.259.505,10. There was an average investment/year of R$ 55,72 per patient and its association with smaller indicator of incidence of medication errors confirms a satisfactory result in this reported series regarding such investment.


Assuntos
Erros de Medicação/economia , Erros de Medicação/prevenção & controle , Sistemas de Medicação no Hospital/economia , Brasil , Análise Custo-Benefício , Sistemas de Informação Hospitalar , Humanos , Segurança do Paciente/economia , Preparações Farmacêuticas , Serviço de Farmácia Hospitalar , Estudos Retrospectivos , Tecnologia
3.
Expert Opin Drug Saf ; 18(8): 745-752, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31232612

RESUMO

Objectives: Adverse drug reactions (ADRs) are a pervasive global problem, and its management is integral to patient safety and healthcare quality. Pharmacists play a pivotal role in monitoring and reporting ADRs, which has a direct impact on patient care. The aim of this study was to identify potential factors that facilitate pharmacists in community and hospital settings to report ADRs. Methods: A cross-sectional, online survey using a validated questionnaire was administered to pharmacists working in community and hospital pharmacies in Saudi Arabia. Results: 1,717 community and 153 hospital pharmacists participated in this study. Only 10.2% and 26.8% of community and hospital pharmacists, respectively, admitted ever reporting an ADR. The most reported factors that may facilitate ADRs reporting have included ongoing improvements in therapeutic knowledge about ADRs, attending educational programs with continuous medical education credits, the seriousness of the experienced ADRs and accessibility to patients' medical profile. The impact of peers by seeing colleagues reporting ADRs and ADRs due to herbal or traditional medicine were the least important factors reported by pharmacists. Conclusion: The study identified factors that can effectively address the under-reporting of ADRs by pharmacists. A multi-stakeholder, multi-pronged approach of ADR reporting is needed to develop greater awareness of this issue among pharmacists.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Farmacêuticos/estatística & dados numéricos , Adulto , Serviços Comunitários de Farmácia/organização & administração , Estudos Transversais , Feminino , Humanos , Masculino , Farmacovigilância , Serviço de Farmácia Hospitalar/organização & administração , Papel Profissional , Arábia Saudita , Inquéritos e Questionários
4.
BMC Health Serv Res ; 19(1): 325, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31118002

RESUMO

BACKGROUND: Of the various types of medication administration error that occur in hospitals, dose omissions are consistently reported as among the most common. It has been suggested that greater involvement from pharmacy teams could help address this problem. A pilot service, called pharmacy TECHnician supported MEDicines administration (TECHMED), was introduced in an English NHS hospital for a four-week period in order to reduce preventable medication dose omissions. The objective of this study was to evaluate the implementation, delivery and impact of the pilot TECHMED service using qualitative methods. METHODS: Semi-structured interviews with pharmacy technicians, nursing staff and senior management involved with the pilot service were undertaken to evaluate TECHMED. Interviews were transcribed verbatim and analysed using the framework approach, guided by Weiss's Theory Based Evaluation model. RESULTS: Twenty-two stakeholder interviews were conducted with 10 ward-based pharmacy technicians, nine nurses and three members of senior management. Most technicians performed a range of activities in line with the service specification, including locating drugs from a variety of sources, and identified situations where they had prevented missing doses. Nurses reported positive impacts of TECHMED on workload. However, not all technicians fully adhered to the service specification in regard to directly following nursing staff during each medication round, citing reasons related to productivity or perceived intrusiveness towards nursing staff. Some participants also reported a perceived lack of impact of TECHMED on medicine omissions. Seventeen of the 22 interviewees supported an extension of the service. There were however, concerns about the impact on technician workload and some participants advocated support for targeted service extension to wards/rounds with high schedule dose volumes and omitted dose rates. CONCLUSIONS: The findings of this study suggest that the implementation of a pharmacy technician-supported medicines administration scheme to reduce omitted doses may be acceptable to staff in an NHS hospital, and that issues with service fidelity, staff resource/capacity and perceived interventions to avoid dose omissions have important implications for the feasibility of extending the service. The study has identified targets for future development in relation to individual and system factors to improve operationalisation of technician-led initiatives to reduce medicines omissions.


Assuntos
Erros de Medicação/prevenção & controle , Serviço de Farmácia Hospitalar/organização & administração , Técnicos em Farmácia/estatística & dados numéricos , Inglaterra , Feminino , Hospitalização , Hospitais/estatística & dados numéricos , Humanos , Masculino , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Medicina Estatal , Carga de Trabalho/estatística & dados numéricos
5.
J Oncol Pharm Pract ; 25(4): 954-960, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30975067

RESUMO

INTRODUCTION: The development of immune checkpoint inhibitors has revolutionized cancer treatment and is now a part of the treatment paradigm for several malignancies. Although immune checkpoint inhibitors are generally well tolerated, treatment is associated with immune-related adverse events, some serious and potentially life threatening. Early identification and prompt appropriate management of immune-related adverse events are crucial to prevent morbidity and mortality. The complexity and severity of immune-related adverse events require interdisciplinary collaboration to optimize care. Patient and caregiver education and continued communication between patients and members of the oncology care team are vital for timely recognition and successful management of immune-related adverse events. The objective of this program is to provide a proof of concept; a pharmacist-led immune checkpoint inhibitor management program will increase early recognition and management of immune-related adverse events through patient and caregiver education and proactively assessing patients for toxicities. METHODS: At the University of Wisconsin Carbone Cancer Center, we developed and implemented a pharmacist-driven program, referred to as the immune checkpoint inhibitor program, which aimed to ensure patient and caregiver education and continuous monitoring of immune-related adverse events. This program utilized pharmacist-patient encounters to improve patient and caregiver education and follow-up monitoring. The design and implementation are detailed. Pharmacist interventions and patient outcomes were evaluated. RESULTS: At interim analysis, 47 patients were enrolled in the program and pharmacists completed 34 interventions on 26 patients. Pharmacists are well positioned to educate patients and caregivers on immune checkpoint inhibitor therapy and provide proactive monitoring to detect immune-related adverse events. We hypothesize that the interventions made by pharmacist may lead to earlier recognition and treatment of immune-related adverse events.


Assuntos
Antineoplásicos/efeitos adversos , Antígeno B7-H1/antagonistas & inibidores , Antígeno CTLA-4/antagonistas & inibidores , Neoplasias/tratamento farmacológico , Farmacêuticos , Serviço de Farmácia Hospitalar , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Farmacêuticos/organização & administração
6.
Clin Interv Aging ; 14: 587-600, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30962679

RESUMO

Purpose: Aging increases the prevalence of diseases. The elderly population is consequently often exposed to complex medication regimens. Increased drug use is one of the main reasons for drug-related problems (DRPs). The primary objective of this study was to define and classify DRPs, pharmacist interventions, and frequently prescribed medications in relation to possible DRPs in patients admitted to the geriatric ward of a teaching hospital in Turkey. Patients and methods: Pharmacist medication review reports for 200 orders of 91 patients (mean age: 80.33±0.46) were analyzed retrospectively. Results: A total of 1,632 medications were assessed and 329 interventions were proposed for possible DRPs in 156 orders. A total of 87.5% of the patients used five or more drugs (mean: 8.17±0.23). The number of DRPs per order was higher when polypharmacy was present (1.04±0.15 vs 1.66±0.11, P<0.05). In 71.31% of the cases, adverse drug events were recognized as the problem. The principal cause of possible DRPs was determined as drug interactions (40.12%). Only 22 potentially inappropriate medications were prescribed. The most common interventions included monitoring drug therapy (31.0%), stopping the drug (20.06%), and changing dosage (13.98%). The acceptance rate of pharmacist interventions by treating geriatrician was 85.41%. The most frequently prescribed drugs were for the nervous system, alimentary tract and metabolism, and cardiovascular system (n=358, 314, and 304, respectively). The pharmaceutical forms of 23 drugs were deemed inappropriate by pharmacists. Conclusion: Clinical pharmacy services are still not properly implemented in Turkey. The study highlights ways in which clinical pharmacy services can be instrumental in a geriatric ward. The high acceptance rates of pharmacist recommendations concerning a wide variety of DRPs and different classes of drugs indicate that advanced collaboration among geriatricians and pharmacists is possible in interdisciplinary geriatric assessment teams in Turkey.


Assuntos
Prescrição Inadequada , Farmacêuticos/normas , Serviço de Farmácia Hospitalar , Idoso de 80 Anos ou mais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Feminino , Serviços de Saúde para Idosos , Hospitais de Ensino/estatística & dados numéricos , Humanos , Prescrição Inadequada/efeitos adversos , Prescrição Inadequada/prevenção & controle , Prescrição Inadequada/estatística & dados numéricos , Masculino , Conduta do Tratamento Medicamentoso/organização & administração , Determinação de Necessidades de Cuidados de Saúde , Serviço de Farmácia Hospitalar/métodos , Serviço de Farmácia Hospitalar/normas , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Polimedicação , Prevalência , Estudos Retrospectivos , Turquia/epidemiologia
7.
San Salvador; s.n; abr. 2019. 66 p. graf, tab, ilus.
Tese em Espanhol | LILACS | ID: biblio-1007277

RESUMO

OBJETIVO: Caracterizar la atención farmacéutica en pacientes poli medicados con enfermedades crónicas no transmisibles, del Hospital Nacional Especializado Rosales, atendidos en la farmacia especializada del MINSAL. Agosto 2017 - Agosto 2018. METODOLOGÍA: Se realizó un estudio descriptivo de corte transversal; La muestra fue 378 expedientes de pacientes diagnosticados con Enfermedades Crónicas no Transmisibles, con seguimiento en el área de atención farmacéutica; Se diseñó una matriz para recolectar la información y facilitar su análisis haciendo uso de frecuencias de variables múltiples de SPSS. RESULTADOS: el 40% de las edades estaban en el rango de 66 años o más, el sexo femenino predominó con el 69%, más del 50% de los participantes estaban solteros, la ocupación más frecuente del estudio, fue ama de casa con un 43%, el 56% de las personas sabían leer, pero no habían realizado estudios de nivel básico, Las características personales fueron el PRM que predominó en el estudio con un 39% de los casos, la educación en medidas no farmacológicas fue la intervención que más se realizó de parte de los profesionales farmacéuticos con un 50% del total de casos, y el 71% de los casos reportados logró una mejoría en el control de su presión arterial con el seguimiento farmacoterapéutico. CONCLUSIONES: Se encontró que las características personales son el problema relacionado con la medicación más frecuente en pacientes con Enfermedades Crónicas no Transmisibles, la educación en medidas no farmacológicas es la intervención que más se realiza en atención farmacéutica y los logros en pacientes se evidenciaron en un mejor control de la presión arterial


Assuntos
Humanos , Farmácia , Serviço de Farmácia Hospitalar , Assistência Farmacêutica , Doenças não Transmissíveis , Saúde Pública , Epidemiologia Descritiva
8.
Med Lav ; 110(2): 93-101, 2019 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-30990471

RESUMO

BACKGROUND: Current Italian regulations and procedures for surface decontamination of antineoplastic drugs (ADs) are not clear. Therefore, most hospital pharmacies follow internal procedures as an interpretation of the recommended handling guidelines. OBJECTIVES: Our study compared 7 different cleaning procedures after controlled contamination of the work surface of a biological safety cabinet workbench in an Italian hospital oncology pharmacy (HOP) to determine which of them is more efficient and practical. Moreover, in order to approximate operative routine and improve risk awareness, cleaning procedures were carried out by the personnel that usually operate in the HOP. METHODS: Measured quantities, i.e. a drop (100 µL) of 5-FluoroUracil, IPhosfamide, CycloPhosphamide and Gemcitabine, were deposited on the work surface within precisely delimited areas. Following the wipe-test analysis using UPLC-MS/MS, the cleaning efficacy was calculated based on the ratio of the residual concentration of the AD, after the cleaning procedure, to the concentration of each AD before the procedure. RESULTS: Tested cleaning procedures were: 1) Hypo-Chlor®, hot water and Farmecol70®; 2) Hypo-Chlor® and hot water; 3) Farmecol70®; 4) Surfa'Safe SH® and hot water; 5) Amuchina® 10%, hot water and Farmecol70®; 6) Incidin® Oxyfoam and hot water; 7) liquid Marseille soap, hot water and Farmecol70®. Within the studied HOP, the Marseille soap was evaluated to be the optimal choice due to its efficacy, low cost, and the very short contact time needed before rinsing. DISCUSSION: The application of the protocol for procedure validation suggested here could be used in every HOP as a reliable industrial hygiene tool to demonstrate the validity of the chosen cleaning procedure.


Assuntos
Antineoplásicos , Exposição Ocupacional , Saúde do Trabalhador , Serviço de Farmácia Hospitalar , Cromatografia Líquida , Descontaminação , Contaminação de Equipamentos , Itália , Espectrometria de Massas em Tandem
9.
Ann Pharm Fr ; 77(3): 232-240, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-30961889

RESUMO

OBJECTIVES: As a university teaching hospital, the call for tender for dental medical devices (dental implants and consumables) is done with the help of a team of hospital pharmacists and users. In order to optimize the definition of needs and evaluation criteria, an exhaustive review of the products was carried out. METHODS: Dental medical devices suppliers were consulted in 2017 for reviewing their products. Their technical, clinical and economic data were compared. The products have been gathered into categories and its results had been submitted to a commission of dental experts of our university hospital for clinical opinion. RESULTS: More than 30,000 references from 30 different suppliers were analyzed (orthodontics, dental implants, membranes and bone substitutes, various dental consumables). Relating to oral implantology, the opinions converged on clinical studies. On the contrary, diverging opinions have been proffered on the systematic use of single-use drills and customized guides for surgery and on the implant's choice. The definition of needs has been specified for orthodontics and consumables. Other criteria played a great role: single packaging (unit doses), product's sterility, paediatric needs, presence of allergens, traceability of devices and supplier diversity. CONCLUSIONS: This review led to the identification of new needs in more precise terms. The complexity and diversity of dental products and techniques requires this careful review and a better collaboration with practitioners.


Assuntos
Odontologia/normas , Equipamentos e Provisões/normas , Alérgenos/análise , Substitutos Ósseos , Implantes Dentários , Instrumentos Odontológicos , França , Hospitais Universitários , Humanos , Ortodontia/instrumentação , Farmacêuticos , Serviço de Farmácia Hospitalar , Esterilização/normas , Cirurgia Bucal/instrumentação
10.
Yakugaku Zasshi ; 139(3): 405-410, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-30828019

RESUMO

The 6-year education system for pharmacists was introduced in Japanese schools of pharmacy in 2006, after which a 4-year doctoral course system was established for advancing clinical pharmaceutical research. The roles of hospital pharmacists and community pharmacists have been expanded from drug dispensing to patient care. Clinical pharmacists practice patient care daily using evidence-based medicine and shared decision making. Clinical pharmacists also carry out research proactively for resolving clinical questions encountered in practice. The Japanese Society of Pharmaceutical Health Care and Sciences (JSPHCS) was established in June 1990, and its membership has expanded significantly. The society has over 12000 members including clinical pharmacists and those in pharmacies who participate in practice, research, and education. The JSPHCS functions as the main platform for pharmacy professionals. It holds annual meetings, publishes an academic journal, supports overseas study, and confers awards on exceptional individuals. It also authorizes JSPHCS-Certified Clinical Pharmacists, Board-Certified Oncology Pharmacists, and Board-Certified Pharmacotherapy Specialists. Recently, clinical pharmacy educational seminars and conferences for newly qualified pharmacists have been held to improve the quality of clinical research performed. Several subcommittees under the JSPHCS were newly established for promoting clinical pharmacy research. The mission of the JSPHCS is to promote clinical pharmacy research and systematize the evidence and information, thereby contributing to the healthcare of all.


Assuntos
Serviços Comunitários de Farmácia , Assistência Farmacêutica/organização & administração , Farmacêuticos , Serviço de Farmácia Hospitalar , Sociedades Farmacêuticas/organização & administração , Educação em Farmácia , Humanos , Japão , Papel Profissional , Pesquisa
11.
BMC Health Serv Res ; 19(1): 156, 2019 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-30866925

RESUMO

BACKGROUND: The increasing adoption of hospital electronic prescribing and medication administration (ePA) systems has driven a wealth of research around the impact on patient safety. Yet relatively little research has sought to understand the effects on staff, particularly pharmacists. We aimed to investigate the effects of ePA on pharmacists' activities, including interactions with patients and health professionals, and their perceptions of medication safety risks. METHODS: A mixed methods study comprising quantitative direct observations of ward pharmacists before and after implementation of ePA in an English hospital, and semi-structured interviews post-ePA. Quantitative data comprised multi-dimensional work activity sampling to establish the proportion of time ward pharmacists spent on different tasks, with whom and where. These data were extrapolated to estimate task duration. Qualitative interviews with pharmacists explored perceived impact on (i) ward activities, (ii) interactions with patients and different health professionals, (iii) locations where tasks were carried out, and (iv) medication errors. RESULTS: Observations totalled 116 h and 50 min. Task duration analysis suggested screening inpatient medication increased by 16 mins per 10 patients reviewed (p = 0.002), and searching for paper drug charts or computer decreased by 2 mins per 10 patients reviewed (p = 0.001). Pharmacists mainly worked alone (58% of time pre- and 65% post-ePA, p = 0.17), with patient interactions reducing from 5 to 2% of time (p = 0.03). Seven main themes were identified from the interviews, underpinned by a core explanatory concept around the enhanced and shifting role of the ward pharmacist post-ePA. Pharmacists perceived there to be a number of valuable safety features with ePA. However, paradoxically, some of these may have also inadvertently contributed to medication errors. CONCLUSION: This study provides quantitative and qualitative insights into the effects of implementing ePA on ward pharmacists' activities. Some tasks took longer while others reduced, and pharmacists may spend less time with patients with ePA. Pharmacists valued a number of safety features associated with ePA but also perceived an overall increase in medication risk. Pharmacy staff demonstrated a degree of resilience to ensure 'business as usual' by enhancing and adapting their role.


Assuntos
Prescrição Eletrônica , Farmacêuticos/organização & administração , Inglaterra , Pessoal de Saúde/organização & administração , Pessoal de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Humanos , Erros de Medicação/prevenção & controle , Erros de Medicação/estatística & dados numéricos , Segurança do Paciente , Percepção , Farmacêuticos/estatística & dados numéricos , Serviço de Farmácia Hospitalar/organização & administração , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Papel do Médico , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/estatística & dados numéricos
12.
J Manag Care Spec Pharm ; 25(3): 411-416, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30816815

RESUMO

BACKGROUND: The establishment of a formulary management system ensures that health care professionals work together in an integrated patient care process to promote clinically sound, safe, and cost-effective medication therapy. Pharmacists have a foundational role within this system. A pharmacist-adjudicated prior authorization drug request (PADR) consult service has the potential to optimize drug therapy by decreasing medication misuse, minimizing adverse drug events (ADEs), and preventing medication errors. OBJECTIVES: To (a) determine cost avoidance associated with pharmacist-adjudicated PADR safety interventions within the Durham Veterans Affairs Health Care System and (b) evaluate cost savings associated with pharmacist-adjudicated PADRs not approved due to a safety intervention, evaluate cost avoidance and direct cost savings based on clinical specialty of pharmacist adjudicating PADR, and characterize severity of avoided ADEs. METHODS: Pharmacist-adjudicated PADRs not approved between July 1, 2016, and June 30, 2017, because of safety interventions were retrospectively reviewed. Cost avoidance was determined by multiplying the probability of ADE occurrence in the absence of PADR safety intervention by the estimated cost avoided based on the type of intervention. Direct cost savings was calculated by totaling the cost of requested medications not approved for each PADR and subtracting the cost of recommended alternative therapies and cost of pharmacist PADR review. All potential ADEs avoided were reviewed by a panel of 3 clinical pharmacists to validate ADE classification and ADE probability and severity scores. Descriptive statistics were used for all analyses. RESULTS: Of the 910 PADRs that were not approved during the study period, 96 met inclusion criteria. Pharmacist-adjudicated PADR safety interventions resulted in a total cost avoidance of $24,485.34 (mean = $255.06) and a direct cost savings of $288,695.63 (mean = $3,007.25). The practice settings of anticoagulation and infectious diseases PADRs resulted in the largest contribution to cost avoidance and direct cost savings, respectively. Prevented ADEs were classified as major for 64.6% of the PADRs. CONCLUSIONS: Pharmacist-adjudicated PADR safety reviews resulted in substantial economic benefit and prevention of major ADEs. This analysis supports the pharmacist's role in a formulary management system to optimize medication therapy. DISCLOSURES: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for profit sectors. The authors have nothing to disclose.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Autorização Prévia/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Consultores , Redução de Custos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/economia , Feminino , Formulários de Hospitais como Assunto , Hospitais de Veteranos/economia , Hospitais de Veteranos/organização & administração , Humanos , Masculino , Erros de Medicação/economia , Erros de Medicação/prevenção & controle , Pessoa de Meia-Idade , Farmacêuticos/economia , Serviço de Farmácia Hospitalar/economia , Autorização Prévia/economia , Papel Profissional , Estudos Retrospectivos
13.
Artigo em Inglês | MEDLINE | ID: mdl-30893906

RESUMO

Patient satisfaction can identify specific areas of improvement in public sector hospitals. However, the Pakistani healthcare system, and quality of service delivery is rarely assessed through the perspective of patient satisfaction. Our study demonstrated the performance of public healthcare systems in Pakistan by interacting with physical services (tangible and environmental), doctor⁻patient communication, and pharmacy and laboratory services based on patient satisfaction. Primary data were collected from the patients by using a random sampling method. Patients who participated in the study were visitors of public hospitals' outpatient departments. A total of 554 questionnaires were circulated, and 445 were received. The confirmatory factor and multiple regression analyses were employed to analyze the collected data. The results revealed that laboratory, as well pharmacy services, had positive significant effects (p = 0.000) on patient satisfaction, while doctor⁻patient communication (p = 0.189) and physical facilities (p = 0.85) had an insignificant relationship with patient satisfaction. Therefore, it is suggested that a significant communication gap exists in the doctor⁻patient setting, and that Pakistan's healthcare system is deprived of physical facilities. Consequently, such services need further improvements.


Assuntos
Hospitais Públicos/organização & administração , Satisfação do Paciente/estatística & dados numéricos , Adulto , Feminino , Hospitais Públicos/normas , Humanos , Laboratórios Hospitalares/organização & administração , Laboratórios Hospitalares/normas , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Paquistão , Serviço de Farmácia Hospitalar/organização & administração , Serviço de Farmácia Hospitalar/normas , Relações Médico-Paciente , Inquéritos e Questionários
14.
Pak J Pharm Sci ; 32(1(Special)): 471-475, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30852487

RESUMO

.Patient safety is considered a critical aspect for the healthcare industry, which is significantly affected by the attitude of the undergraduate healthcare professionals. For this purpose, the current study is focused on analysing the patient safety attitudes of Pharmacy Students attending the undergraduate program at King Faisal University. In order to fulfil the research purpose, primary data has been collected from the 76 undergraduate students of King Faisal University. All the selected respondents have provided a survey questionnaire and the responses have been recorded in the Excel files. The questionnaire included 21-items regarding the patient's safety. The response of participants has been recorded on a 4-point Likert scale. Statistical Package of Sciences (SPSS) have been utilised to analyse the responses of participants collected in the survey process. In addition to this, findings of primary data have been analysed through the descriptive statistics and binomial logistic regression. The response of study participants describes that Pharmacists should report errors to of an affected patient and their family even if it does not harm to the patients. Moreover, it has been identified that good pharmacy workplace and effective training programmes can be used by the universities to develop the understanding of pharmacy students towards patient's safety concern.


Assuntos
Atitude do Pessoal de Saúde , Educação em Farmácia/métodos , Segurança do Paciente/normas , Farmacologia Clínica/educação , Estudantes de Farmácia , Conhecimentos, Atitudes e Prática em Saúde , Serviço de Farmácia Hospitalar/normas , Arábia Saudita , Inquéritos e Questionários , Universidades
15.
BMC Med Inform Decis Mak ; 19(1): 29, 2019 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-30744674

RESUMO

BACKGROUND: To improve medication surveillance and provide pharmacotherapeutic support in University Hospitals Leuven, a back-office clinical service, called "Check of Medication Appropriateness" (CMA), was developed, consisting of clinical rule based screening for medication inappropriateness. The aim of this study is twofold: 1) describing the development of CMA and 2) evaluating the preliminary results, more specifically the number of clinical rule alerts, number of actions on the alerts and acceptance rate by physicians. METHODS: CMA focuses on patients at risk for potentially inappropriate medication and involves the daily checking by a pharmacist of high-risk prescriptions generated by advanced clinical rules integrating patient specific characteristics with details on medication. Pharmacists' actions are performed by adding an electronic note in the patients' medical record or by contacting the physician by phone. A retrospective observational study was performed to evaluate the primary outcomes during an 18-month study period. RESULTS: 39,481 clinical rule alerts were checked by pharmacists for which 2568 (7%) electronic notes were sent and 637 (1.6%) phone calls were performed. 37,782 (96%) alerts were checked within four pharmacotherapeutic categories: drug use in renal insufficiency (25%), QTc interval prolonging drugs (11%), drugs with a restricted indication or dosing (14%) and overruled very severe drug-drug interactions (50%). The emergency department was a frequently involved ward and anticoagulants are the drug class for which actions are most frequently carried out. From the 458 actions performed for the four abovementioned categories, 69% were accepted by physicians. CONCLUSIONS: These results demonstrate the added value of CMA to support medication surveillance in synergy with already integrated basic clinical decision support and bedside clinical pharmacy. Otherwise, the study also highlighted a number of limitations, allowing improvement of the service.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Prescrições de Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Serviço Hospitalar de Emergência , Sistemas de Registro de Ordens Médicas , Serviço de Farmácia Hospitalar , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Eur J Pharm Sci ; 130: 181-185, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30710619

RESUMO

BACKGROUND: Compounding of cytostatic drugs requires strict aseptic procedures, while exposure to toxic drugs and repetitive manual movements should be minimized. Furthermore, reuse of vials is desirable to lower the costs. To assess if all this might be safely achieved with a robot, this study aimed at qualifying the aseptic preparation process with the robotic system APOTECAchemo. METHODS: The aseptic compounding of patient-individual cytostatic solutions was simulated with media fill simulation tests to qualify the performance according to European GMP Annex 1. The contamination in the environment was measured in critical places using settle plates, contact plates, active air sampling and particle counting. Media-fill simulation tests were prepared in 3 production batches. The second part of the study evaluated the microbiological shelf-life of commercial drug vials after repeated puncturing. On six days, fifty syringes of 15 ml media were prepared from the same 50 vials with the robot. After each preparation, vials were covered with an IVA seal upon unloading from the robot to protect them from microbiological contamination. RESULTS: No microbiological contamination was found in any of the 96 media fill preparations, nor in any of the 300 syringes that were prepared with repeated puncturing. The compounding area met class A limits, while class A criteria were not fulfilled by the contact plates and settle plates placed on the right side of the loading area. There, the average colony forming units (cfu) were 3 and 1.17, respectively, meeting class B criteria. CONCLUSIONS: Robotical compounding of cytostatic drugs with APOTECAchemo meets the microbiological requirements of the European GMP. In addition, the robot can reuse vials repeatedly and safely, thereby enabling extended usage.


Assuntos
Assepsia/métodos , Citostáticos/síntese química , Composição de Medicamentos/métodos , Contaminação de Medicamentos/prevenção & controle , Serviço de Farmácia Hospitalar/métodos , Robótica/métodos , Assepsia/instrumentação , Composição de Medicamentos/instrumentação , Fenômenos Microbiológicos , Robótica/instrumentação
17.
Am J Health Syst Pharm ; 76(4): 225-235, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30715186

RESUMO

Purpose: The purpose of this project was to develop a set of valid and feasible quality indicators used to track opioid stewardship efforts in hospital and emergency department settings. Methods: Candidate quality indicators were extracted from published literature. Feasibility screening excluded quality indicators that cannot be reliably extracted from the electronic health record or that are irrelevant to pain management in the hospital and emergency department settings. Validity screening used an electronic survey of key stakeholders including pharmacists, nurses, physicians, administrators, and researchers. Stakeholders used a 9-point Likert scale to rate the validity of each quality indicator based on predefined criteria. During expert panel discussions, stakeholders revised quality indicator wording, added new quality indicators, and voted to include or exclude each quality indicator. Priority ranking used a second electronic survey and a 9-point Likert scale to prioritize the included quality indicators. Results: Literature search yielded 76 unique quality indicators. Feasibility screening excluded 9 quality indicators. The validity survey was completed by 46 (20%) of 228 stakeholders. Expert panel discussions yielded 19 valid and feasible quality indicators. The top 5 quality indicators by priority were: the proportion of patients with (1) naloxone administrations, (2) as needed opioids with duplicate indications, and (3) long acting or extended release opioids if opioid-naïve, (4) the average dose of morphine milligram equivalents administered per day, and (5) the proportion of opioid discharge prescriptions exceeding 7 days. Conclusion: Multi-professional stakeholders across a health system participated in this consensus process and developed a set of 19 valid and feasible quality indicators for opioid stewardship interventions in the hospital and emergency department settings.


Assuntos
Analgésicos Opioides/uso terapêutico , Revisão de Uso de Medicamentos/normas , Serviço Hospitalar de Emergência/normas , Pessoal de Saúde/normas , Serviço de Farmácia Hospitalar/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Analgésicos Opioides/efeitos adversos , Revisão de Uso de Medicamentos/métodos , Humanos , Serviço de Farmácia Hospitalar/métodos , Inquéritos e Questionários/normas
18.
Ann Pharm Fr ; 77(3): 241-249, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-30799017

RESUMO

OBJECTIVES: The pharmaceutical analysis of drug prescriptions is one of the key steps in the drug circuit. This mandatory regulatory practice in France and Quebec is based on national standards. The main objective of this work was to compare the practical methods of pharmaceutical analysis performed in French and Quebec university hospitals. METHODS: This is a prospective comparative survey conducted in 2 French and Quebec university hospital centres among pharmacists and pharmacy residents. RESULTS: The response rate to the survey was 60% (45/75). Between 16 and 22 elements were deemed necessary to structure the centralized, decentralized or mixed pharmaceutical analysis. The chronological ranking of these elements was comparable between the French and Quebec participants. All participants were in favour of the development of initial and continuing training in pharmaceutical analysis. Finally, the majority of participants were against using individual pharmaceutical analysis performance indicators to optimize the process (82%; 37/45). CONCLUSIONS: The French-Quebec practice of prescription analysis by a ward-pharmacist complies with national standards. The main differences in the practice of pharmaceutical analysis are related to the types of organization, the tools available and the length of time pharmacists have been deployed in care units in France and Quebec.


Assuntos
Prescrições de Medicamentos/normas , Instalações de Saúde/estatística & dados numéricos , Sistemas de Medicação no Hospital , Atitude do Pessoal de Saúde , França , Hospitais Universitários , Humanos , Farmacêuticos , Serviço de Farmácia Hospitalar , Estudos Prospectivos , Quebeque , Inquéritos e Questionários
19.
Am J Health Syst Pharm ; 76(Supplement_1): S28-S33, 2019 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-30689695

RESUMO

Purpose: The implementation of a commercially available, Web-based, barcode-enabled workflow management system for filling and checking patient-specific oral syringes at the Cleveland Clinic is described. Summary: Historically, the process for preparing oral syringes has been a manual, repetitive procedure at Cleveland Clinic. Within this process, paper logs are the sole source of information. These logs can be difficult to locate or interpret. It remains a rote process with numerous manual steps offering opportunity for human error. Traditionally, automation, such as barcode scanning, has not been available during oral syringe preparation and checking. Based on increasing regulatory demands and documentation gaps identified, solutions were explored in the pharmacy's nonsterile compounding environment. An electronic verification workflow system was developed, implemented, and evaluated with a focused assessment of throughput and patient safety relative to oral syringe preparation. This was a retrospective study conducted in an academic, tertiary, acute care medical center. Analysis was completed at 3 months to evaluate efficiencies. Data regarding experiences at the Cleveland Clinic shows promising benefits with regards to United States Pharmacopeia chapter 795 compliance, the pursuit of incorporating advanced informatics and automation in manual processes, and standardization of workflow within an enterprise setting. Conclusion: Implementation of an electronic workflow verification system that integrates barcode verification and image-capture capabilities has maintained regulatory compliance in the nonsterile compounding environment including preparation of oral syringe doses without impacting throughput.


Assuntos
Serviço de Farmácia Hospitalar/organização & administração , Seringas , Fluxo de Trabalho , Administração Oral , Humanos , Sistemas de Registro de Ordens Médicas/organização & administração
20.
BMC Health Serv Res ; 19(1): 27, 2019 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-30634970

RESUMO

BACKGROUND: Given the documented benefits of Patient Own Drugs (PODs) in most developed countries and scanty data on PODs management in developing countries the aim of the study was to evaluate the assessment, quality and extent of PODs use among hospitalised patients. Furthermore the perceived benefits and challenges in executing PODs management by the pharmacy staff in the hospital setting were explored. METHOD: This was a cross-sectional descriptive study. Three hundred patients with chronic diseases admitted in a teaching hospital were purposively sampled. Quality assessment criteria was developed as part of the data collection tool for assessing the quality of PODs. Furthermore, two ward pharmacists and two in-charge nurses at the medical ward were purposively sampled for a face to face interview using an interview guide to find out the hospitals' medicines management system and policy for PODs. In addition, 130 pharmacy staff were interviewed using a structured questionnaire to find out how PODs were managed. Data was analysed with SPSS version 17. RESULTS: The study showed that 140 (46.6%) of patients brought their PODs on admission. Of these, only 38 (12.7%) were told to bring them whenever they were on admission. Of the 115 (38.3) patients whose PODs were documented as part of medication history, 28 (24.3%) of them had their PODs continued whilst on admission and 11(9.5%) of discharged prescription included PODs. In assessing the quality of PODs 61.6% of 845 PODs were suitable for reuse. Only 19.8% of pharmacy staff attested to the fact that all PODs identified were assessed. The common benefit of PODs cited by pharmacy staff was improving medication history taking whilst the major challenge was difficulty in determining the expiry dates of PODs without original packages. CONCLUSION: About a half of patients with chronic diseases brought PODs with them on admission. The majority of PODs appeared to be suitable for use as presented but only a few were actually used for the patients. Most pharmacy staff were not involved in patients own drugs management at the hospital. There is the need for a policy to streamline PODs management in the teaching hospital.


Assuntos
Doença Crônica/tratamento farmacológico , Hospitalização/estatística & dados numéricos , Adolescente , Adulto , Idoso , Estudos Transversais , Confiabilidade dos Dados , Coleta de Dados , Países Desenvolvidos , Países em Desenvolvimento , Embalagem de Medicamentos , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Gana , Hospitais de Ensino/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Propriedade , Alta do Paciente , Farmacêuticos/estatística & dados numéricos , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Medicamentos sob Prescrição/uso terapêutico , Prática Profissional , Adulto Jovem
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