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1.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31753910

RESUMO

BACKGROUND: Asthma exacerbations in children are a leading cause of missed school days and health care use. Patients discharged from the hospital often do not fill discharge prescriptions and are at risk for future exacerbations. METHODS: A multidisciplinary team aimed to increase the percentage of patients discharged from the hospital after an asthma exacerbation with their medications in-hand from 15% to 80%. Tools from the model of improvement were used to establish a process map, key driver diagram, and iterative plan-do-study-act cycles. Statistical process control charts were used to track the proportion of patients discharged with their medications in-hand as the primary outcome. Initiating multidisciplinary daily discharge huddles on the unit was the key intervention that facilitated change in the system. RESULTS: During the study period, the percentage of patients with asthma who received their medications in-hand increased from 15% to >80% for all eligible children and >90% for children with public insurance. Children had a median age of 6.7 years, 47% were female, and 83.8% identified as non-Hispanic African American. Through iterative meetings and mapping with the multidisciplinary team, a process map for bedside delivery and a key driver diagram were created. Balancing measures, specifically length of stay and discharge medications forgotten at the hospital, remained constant. CONCLUSIONS: Improvements in increasing medication possession at the time of discharge for children hospitalized with asthma were facilitated by multidisciplinary engagement. Standardizing discharge initiatives may play a key role in improving discharge transitions for children with asthma.


Assuntos
Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Prescrições de Medicamentos , Adesão à Medicação , Equipe de Assistência ao Paciente , Serviço de Farmácia Hospitalar/organização & administração , Asma/epidemiologia , Criança , Progressão da Doença , District of Columbia/epidemiologia , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Masculino , Alta do Paciente , Cuidado Transicional/organização & administração
2.
Am J Health Syst Pharm ; 76(1): 34-43, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31603982

RESUMO

PURPOSE: The development of an inpatient antimicrobial stewardship program (ASP) in an integrated healthcare system is described. SUMMARY: With increasing national focus on reducing inappropriate antimicrobial use, state and national regulatory mandates require hospitals to develop ASPs. In 2015, BJC HealthCare, a multihospital health system, developed a system-level, multidisciplinary ASP team to assist member hospitals with ASP implementation. A comprehensive gap analysis was performed to assess current stewardship resources, activities and compliance with CDC core elements at each facility. BJC system clinical leads facilitated the development of hospital-specific leadership support statements, identification of hospital pharmacy and medical leaders, and led development of staff and patient educational components. An antimicrobial-use data dashboard was created for reporting and tracking the impact of improvement activities. Hospital-level interventions were individualized based on the needs and resources at each facility. Hospital learnings were shared at bimonthly system ASP meetings to disseminate best practices. The initial gap analysis revealed that BJC hospitals were compliant in a median of 6 ASP elements (range, 4-8) required by regulatory mandates. By leveraging system resources, all hospitals were fully compliant with regulatory requirements by January 2017. CONCLUSION: BJC's ASP model facilitated the development of broad-based stewardship activities, including education modules for patients and providers and clinical decision support, while allowing hospitals to implement activities based on local needs and resource availability.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Desenvolvimento de Programas , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/estatística & dados numéricos , Gestão de Antimicrobianos/estatística & dados numéricos , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Illinois , Missouri , Modelos Organizacionais , Equipe de Assistência ao Paciente/organização & administração , Educação de Pacientes como Assunto/organização & administração , Educação de Pacientes como Assunto/estatística & dados numéricos , Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Lacunas da Prática Profissional/organização & administração , Lacunas da Prática Profissional/estatística & dados numéricos
4.
Am J Health Syst Pharm ; 76(19): 1521-1531, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31532502

RESUMO

PURPOSE: Common bacterial infections in pediatric patients that the hospital pharmacist may encounter are reviewed, and guidance on the safe and effective use of antibiotics to treat those infections is provided. SUMMARY: Pharmacists play a key role in evaluating and creating antibiotic treatment plans for patients with infections. Bacterial infections are a common reason for hospital admission in pediatric patients, and pharmacists working in hospitals may be consulted to provide treatment and monitoring recommendations. It is important for pharmacists to be aware of similarities and differences in adult and pediatric populations with regard to presenting signs and symptoms of bacterial infections, common causative pathogens, and antibiotic selection, dosing, and monitoring. This article reviews current approaches to treatment of common bacterial infections in pediatric patients and also provides general suggestions for antibiotic use. CONCLUSION: Pharmacists have an opportunity to positively impact the care of pediatric patients with bacterial infections. Especially at facilities where pediatric patients are not regularly treated, pharmacists can potentially improve care through provision of recommendations for optimal antibiotic selection, dosing, and monitoring.


Assuntos
Antibacterianos/administração & dosagem , Infecções Bacterianas/tratamento farmacológico , Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Papel Profissional , Adulto , Fatores Etários , Antibacterianos/efeitos adversos , Infecções Bacterianas/diagnóstico , Criança , Relação Dose-Resposta a Droga , Cálculos da Dosagem de Medicamento , Rotulagem de Medicamentos/normas , Monitoramento de Medicamentos/normas , Humanos , Conduta do Tratamento Medicamentoso/organização & administração , Conduta do Tratamento Medicamentoso/normas , Serviço de Farmácia Hospitalar/normas , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta
5.
Am J Health Syst Pharm ; 76(19): 1481-1491, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31532506

RESUMO

PURPOSE: Risks and vulnerabilities of the medication-use process in nonpediatric institutions that also serve pediatric patients are reviewed, and guidance on risk mitigation strategies is provided. SUMMARY: There are many risks and vulnerabilities in the medication-use process as it relates to pharmacotherapy for pediatric patients admitted to adult institutions. Mitigation of these risks is critical and should encompass various available resources and strategies. Special emphasis should be placed on use of technology to improve overall safety. Available literature recommends optimization of technology and resource use, institutional support for pediatric pharmacists' involvement in managing pediatric medication use, and provision of early exposure to pediatric patients in pharmacist training programs as additional methods of mitigating risks associated with pediatric medication use in adult institutions. Adult hospitals that provide care for pediatric patients should assess their processes in order to identify hospital-specific interventions to promote pediatric medication safety. CONCLUSION: Pediatric medication safety frameworks in U.S. adult institutions vary widely. Treating pediatric patients involves risks in all areas of the medication-use process. Optimizing technology, utilizing external resources, supporting a pediatric pharmacist, and providing early-career exposure to pediatric patients are methods to mitigate risks in institutions that primarily serve adult patients.


Assuntos
Erros de Medicação/prevenção & controle , Conduta do Tratamento Medicamentoso/organização & administração , Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Gestão da Segurança/normas , Adulto , Fatores Etários , Criança , Sistemas de Informação em Farmácia Clínica/organização & administração , Sistemas de Informação em Farmácia Clínica/normas , Composição de Medicamentos/normas , Cálculos da Dosagem de Medicamento , Educação em Farmácia , Educação Continuada em Farmácia , Humanos , Sistemas de Registro de Ordens Médicas/organização & administração , Sistemas de Registro de Ordens Médicas/normas , Conduta do Tratamento Medicamentoso/normas , Farmacêuticos/normas , Serviço de Farmácia Hospitalar/normas , Guias de Prática Clínica como Assunto , Papel Profissional
6.
Am J Health Syst Pharm ; 76(19): 1492-1510, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31532507

RESUMO

PURPOSE: Current clinical practice guidelines on management of enteral nutrition (EN) and parenteral nutrition (PN) in pediatric patients are reviewed. SUMMARY: The provision of EN and PN in pediatric patients poses many unique considerations and challenges. Although indications for use of EN and PN are similar in adult and pediatric populations, recommended EN and PN practices differ for pediatric versus adult patients in areas such as selection of EN and PN formulations, timing of EN and PN initiation, advancement of nutrition support, and EN and PN goals. Additionally, provision of EN and PN to pediatric patients poses unique compounding and medication administration challenges. This article provides a review of current EN and PN best practices and special nutrition considerations for neonates, infants, and other pediatric patients. CONCLUSION: The provision of EN and PN to pediatric patients presents many unique challenges. It is important for pharmacists to keep current with pediatric- and neonatal-specific guidelines on nutritional management of various disease states, as well as strategies to address compounding and medication administration challenges, in order to optimize EN and PN outcomes.


Assuntos
Desenvolvimento Infantil/fisiologia , Nutrição Enteral/normas , Necessidades Nutricionais/fisiologia , Nutrição Parenteral/normas , Serviço de Farmácia Hospitalar/organização & administração , Adulto , Fatores Etários , Criança , Pré-Escolar , Composição de Medicamentos/normas , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro/fisiologia , Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/normas , Guias de Prática Clínica como Assunto
7.
Am J Health Syst Pharm ; 76(1): 26-33, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31381096

RESUMO

PURPOSE: The results of a study to assess the effectiveness and safety of hyperglycemia management provided by clinical pharmacy specialists (CPSs) versus usual care in outpatients with diabetes from 53 Veterans Affairs (VA) medical centers are reported. METHODS: An historical cohort study of outpatients with baseline glycosylated hemoglobin (HbA1c) values of >9% who were referred to a CPS for management of hyperglycemia and primary care patients who were not referred to a CPS was conducted. The primary outcomes were change in HbA1c over time and time to reach an HbA1c value of <8%. Secondary outcomes included the number of visits to achieve an HbA1c value of <8%, proportion of patients with an HbA1c value of <6% who were receiving secretagogues, and proportion of patients with serious hypoglycemia. RESULTS: After propensity score matching by baseline characteristics, there were 12,327 patients in each group. The mean ± S.D. number of visits to reach an HbA1c value of <8% was 2.46 ± 1.58 in the pharmacist-managed group and 1.82 ± 1.27 with usual care (p < 0.001). The proportion of patients with an HbA1c value of <6% who were receiving secretagogues was 39.9% with pharmacist-managed care and 38.6% with usual care (p = 0.73). Serious hypoglycemia was noted in 4.3% of pharmacist-managed patients and 3.1% of usual care patients (p < 0.001). CONCLUSION: Data from 53 VA medical centers revealed that CPSs managed the care of ambulatory care patients with hyperglycemia as well as primary care providers.


Assuntos
Diabetes Mellitus/tratamento farmacológico , Hiperglicemia/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Conduta do Tratamento Medicamentoso/organização & administração , Farmacêuticos , Idoso , Assistência Ambulatorial , Estudos de Coortes , Diabetes Mellitus/sangue , Feminino , Hemoglobina A Glicada/análise , Hospitais de Veteranos/organização & administração , Humanos , Hiperglicemia/sangue , Masculino , Pessoa de Meia-Idade , Serviço de Farmácia Hospitalar/organização & administração , Papel Profissional , Avaliação de Programas e Projetos de Saúde , Secretagogos/uso terapêutico
8.
Am J Health Syst Pharm ; 76(Supplement_3): S74-S78, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31418772

RESUMO

PURPOSE: The development and implementation of centralized mail-order pharmacy services in an academic healthcare system are described. SUMMARY: The use of mail-order pharmacy services continues to increase, as mail-order services offer patient benefits such as reduced copayments and improved clinical outcomes. Prior to undertaking an initiative to improve its mail-order pharmacy services, the University of Utah Health system's pharmacy department offered decentralized mail-order pharmacy services at all of its retail pharmacies, but there was no standardized process for processing mail-order prescriptions or providing phone support to mail-order patients. Centralized mail-order pharmacy services were developed and implemented by creating (1) a standard process for mail-order pharmacy services, (2) a centralized mail-order prescription filling center, and (3) a call center to support mail-order pharmacy services. Implementation of centralized mail-order pharmacy services resulted in an almost 50% reduction in time spent by pharmacy team members on mail-order prescription filling and packaging tasks. Use of a central call center resulted in a decreased call abandonment rate and contributed to a decreased pharmacy workload resulting from an overall reduction in call volume due to an increased rate of first-call issue resolution. CONCLUSION: Establishment of a centralized mail-order pharmacy service along with operational and infrastructure improvements resulted in improved quality and regulatory compliance and enhanced labor efficiency and patient communication.


Assuntos
Implementação de Plano de Saúde , Farmácias/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Serviços Postais , Call Centers/organização & administração , Hospitais Universitários/organização & administração , Hospitais Universitários/estatística & dados numéricos , Humanos , Farmácias/estatística & dados numéricos , Farmacêuticos/organização & administração , Farmacêuticos/estatística & dados numéricos , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Carga de Trabalho/estatística & dados numéricos
9.
Am J Health Syst Pharm ; 76(17): 1296-1304, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31418790

RESUMO

PURPOSE: The development of a tool to measure medication safety, therapeutic efficacy, and other quality outcomes in patients receiving self-injectable biologic therapy for the management of inflammatory bowel disease (IBD) at a health-system specialty pharmacy is described. SUMMARY: Through a collaborative initiative by pharmacists, gastro-enterologists, and representatives of a pharmacy benefit manager and a pharmaceutical company, a set of clinical and specialty pharmacy quality measures was developed. The clinical measures are intended for use in assessing patient safety, disease status, treatment efficacy, and healthcare resource utilization during 3 assessments (pre-treatment, on-treatment, and longitudinal). The specialty pharmacy measures can be used to assess medication adherence, medication persistence, specialty pharmacy accreditation, and patient satisfaction. The proposed quality measures provide a foundation for evaluating the quality of IBD care and improving patient outcomes within a health-system specialty pharmacy. Future efforts to validate and implement the tool in clinical practice are planned. CONCLUSION: The proposed quality measures provide a foundation for future inquiry regarding the appropriateness and feasibility of integrating the measures into clinical care. Further work is needed to implement and validate these quality measures and determine their impact in optimizing health outcomes.


Assuntos
Produtos Biológicos/administração & dosagem , Doenças Inflamatórias Intestinais/tratamento farmacológico , Serviço de Farmácia Hospitalar/organização & administração , Autoadministração/normas , Terapia Biológica/métodos , Terapia Biológica/normas , Comportamento Cooperativo , Indústria Farmacêutica/organização & administração , Gastroenterologistas/organização & administração , Humanos , Farmacêuticos/organização & administração
10.
Am J Health Syst Pharm ; 76(2): 108-113, 2019 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-31408091

RESUMO

PURPOSE: The stages of development of a health system-wide antimicrobial stewardship program (ASP) using existing personnel and technology are described. SUMMARY: Small hospitals with limited resources may struggle to meet ASP requirements, particularly facilities without onsite infectious disease physicians and/or experienced infectious disease pharmacists. Strategies for ASP development employed by Avera Health, a 33-hospital health system in the Midwest, included identifying relevant drug utilization and resistance patterns, education and pathway development, and implementation of Web-based conferencing to provide pharmacists throughout the system with access to infectious disease expertise on a daily basis. These efforts resulted in an evolving single-system ASP that has leveraged existing resources to overcome some system barriers. Program outcomes to date include a reduction in the use of a targeted agent, improved pathogen susceptibility trends, and rates of hospital-associated Clostridium difficile infection below national benchmarks. CONCLUSION: The Avera Health ASP grew from a collaborative project targeting levofloxacin overuse and resistance among key bacteria to a formal, health system-wide ASP in a rural setting. This program used existing personnel to provide standardized processes, educational campaigns, and antimicrobial expertise through the use of technology. This ASP program may provide helpful examples of ASP strategies for other rural health systems with similar resources.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/organização & administração , Infecções por Clostridium/tratamento farmacológico , Hospitais Rurais/organização & administração , Desenvolvimento de Programas , Antibacterianos/farmacologia , Gestão de Antimicrobianos/economia , Infecções por Clostridium/microbiologia , Clostridium difficile/efeitos dos fármacos , Clostridium difficile/isolamento & purificação , Clostridium difficile/fisiologia , Farmacorresistência Bacteriana/efeitos dos fármacos , Uso de Medicamentos , Hospitais Rurais/economia , Humanos , Levofloxacino/farmacologia , Levofloxacino/uso terapêutico , Testes de Sensibilidade Microbiana , Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/economia , Serviço de Farmácia Hospitalar/organização & administração , Papel Profissional , Avaliação de Programas e Projetos de Saúde , Serviços de Saúde Rural/economia , Serviços de Saúde Rural/organização & administração
11.
Am J Health Syst Pharm ; 76(7): 470-477, 2019 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-31415682

RESUMO

PURPOSE: The development and implementation of a team-based pharmacy practice model is described. METHODS: In January 2016 a transition from a staff-specialist to a team-based pharmacy practice model was implemented. The overall goal of the model change was to enhance the pharmacist's clinical roles and further integrate pharmacists into the healthcare team. Before implementation of the new staffing model, a formalized metric evaluation process was created. The aim of this metric evaluation was to gauge model success, determine areas of model revision, and objectively communicate pharmacist impact. Objective metrics were evaluated before implementation and 1 year after implementation. In addition, surveys were distributed to pharmacists, physicians, nursing and hospital administration before and after model implementation. RESULTS: At 1-year postimplementation, the pharmacist:patient bed ratio decreased from 1:87 to 1:47, the number of rounds/huddles with pharmacist attendance increased by 63% to 80 per week, and the number of clinical interventions and new clinical consultations increased from 57 to 62 and from 12 to 16 per day, respectively. Nonformulary medication use also decreased from 1.77 to 0.623 per 1000 patient days, and compliance with therapeutic initiatives increased from 77%to 91%. Overall, 72% of pharmacist survey responses indicated satisfaction with the model change. CONCLUSION: A team-based pharmacy practice model was designed and successfully implemented over a 3-year period. Data analysis revealed improvements in clinical and operational endpoints and enhanced pharmacist, physician, and nursing satisfaction.


Assuntos
Modelos Organizacionais , Equipe de Assistência ao Paciente/organização & administração , Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Papel Profissional , Centros Médicos Acadêmicos/organização & administração , Atitude do Pessoal de Saúde , Implementação de Plano de Saúde , Humanos , Satisfação no Emprego , Enfermeiras e Enfermeiros/psicologia , Farmacêuticos/psicologia , Farmacêuticos/estatística & dados numéricos , Médicos/psicologia , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Visitas com Preceptor/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos
12.
Am J Health Syst Pharm ; 76(6): 398-402, 2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-31415683

RESUMO

PURPOSE: This study describes a change in pharmacy practice to expand pharmacy technician roles to allow dispensing without a pharmacist check, thereby enhancing the pharmacist role in direct patient care. SUMMARY: In an effort to optimize patient care with limited resources, we set out to change our pharmacy practice model. We transferred duties that did not require clinical judgment in the dispensary from the pharmacist to the regulated technician. The transferred roles included order entry, order entry verification, and final check of medications and preparations. The changes in roles were well received by the pharmacy staff. The pharmacist practice changed from a reactive process, where the pharmacist waited for orders to be sent to the pharmacy, to a proactive process where the pharmacist collaborated directly with patients and the health care team. The pharmacists were able to provide daily medication therapy management for every inpatient in the new practice model compared with only reactive targeted care in the former practice model. Implementation of the new practice model at our site led to a reduction in time for medications to be delivered to the patient and reduced pharmacy-related medication errors. CONCLUSION: A new pharmacy practice model was successfully implemented whereby the pharmacy technician roles were expanded to the point where they perform all the distribution roles in the dispensary. This, in turn, allowed a change in the pharmacist role, which was focused on daily proactive direct patient care and medication therapy management.


Assuntos
Modelos Organizacionais , Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Técnicos em Farmácia/organização & administração , Papel Profissional , Humanos , Erros de Medicação/prevenção & controle , Conduta do Tratamento Medicamentoso/organização & administração , Segurança do Paciente , Avaliação de Programas e Projetos de Saúde , Fatores de Tempo , Carga de Trabalho
13.
Am J Health Syst Pharm ; 76(13): 992-997, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31415686

RESUMO

PURPOSE: To describe the methods used in the development of an intravenous chemotherapy workload and productivity dashboard and its impact on symptoms of burnout and technician turnover. SUMMARY: In February 2017, chemotherapy sterile preparation pharmacy technicians reported symptoms of burnout as a result of perceived increase in workload. In response, an i.v. chemotherapy workload and productivity dashboard was developed at an academic medical center to validate workload in comparison to the reported job stress of pharmacy technicians. The dashboard provided pharmacy leadership objective data to validate staff concerns and leveraged lean principles to level-load the work prior to requesting additional full-time equivalents (FTEs) to senior leadership. The rate of turnover of i.v. chemotherapy technicians was assessed before (December 2016-June 2017) and after (July 2017-January 2018) dashboard implementation and approval of an additional i.v. chemotherapy technician FTE. The addition of the new FTE resulted in a decrease in productivity from an average of 106% (range 67%-151%) to 84% (range 65%-110%). The interventions allowed for the ability to leverage a staffing-to-demand model, resulting in the observed improvement in technician symptoms of burnout and a notable decrease in the overall turnover rate of i.v. chemotherapy technicians. CONCLUSION: The i.v. chemotherapy workload and productivity dashboard confirmed frontline staff perception and provided data to support the addition of labor resource and an opportunity to leverage a staffing-to-demand model to decrease symptoms of burnout and technician turnover.


Assuntos
Eficiência Organizacional , Reorganização de Recursos Humanos/estatística & dados numéricos , Serviço de Farmácia Hospitalar/organização & administração , Técnicos em Farmácia/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos , Administração Intravenosa , Antineoplásicos/administração & dosagem , Atitude do Pessoal de Saúde , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/prevenção & controle , Esgotamento Profissional/psicologia , Implementação de Plano de Saúde , Humanos , Neoplasias/tratamento farmacológico , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Técnicos em Farmácia/psicologia , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Carga de Trabalho/psicologia
14.
Am J Health Syst Pharm ; 76(15): 1158-1164, 2019 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-31408513

RESUMO

PURPOSE: The purpose of this study was to demonstrate the utility of failure modes and effects analysis (FMEA) for systematically identifying potential sources of controlled substance diversion and developing solutions in an academic health system. METHODS: The FMEA was conducted by an 18-member cross-functional team from the department of pharmacy. The team developed scoring criteria specifically for controlled substance diversion, outlined the controlled substance processes from procurement to administration or disposal, and identified ways in which each step of the medication supply process might fail (failure modes) and result in diversion of controlled substances. Failure modes with a vulnerability score of 48 or 64 were considered highest risk and were immediately intervened on by the FMEA team. RESULTS: The FMEA outlined a total of 10 major steps and 30 substeps in the controlled substance supply process. From this, 103 potential failure modes were identified, with 24 modes (23%) receiving a vulnerability score of 48 or 64. Development of specific reports addressed 15 failure modes, while 9 involved pharmacy workflow alterations. Notable reports included controlled substance activity under temporary patients and discrepancy trends by user, medication, and patient care area. Notable workflow alterations included expanded use of cameras in high-risk areas and additional verification checks. CONCLUSION: FMEA allowed for systematic identification of controlled substance diversion opportunities, prioritization by level of vulnerability, and the development of targeted strategies to reduce risk of diversion.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Análise do Modo e do Efeito de Falhas na Assistência à Saúde , Serviço de Farmácia Hospitalar/organização & administração , Desvio de Medicamentos sob Prescrição/prevenção & controle , Melhoria de Qualidade , Estados Unidos
16.
Am J Health Syst Pharm ; 76(16): 1226-1230, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31369114

RESUMO

PURPOSE: A national survey performed in 2007 found that only 23% of American College of Surgeons (ACS) trauma centers involved pharmacists in trauma resuscitation. This study describes interval change in use, perceptions, and responsibilities from 2007 to 2017. METHODS: Of the 419 trauma centers identified from the ACS website, contact information was available for 335. In March 2017, a survey assessing hospital demographics, pharmacist coverage and services, and perception of pharmacist value and use was emailed to the identified trauma representatives. Data were analyzed using descriptive statistics and chi-square analysis, as appropriate. RESULTS: The response rate was 33% (110/335). Pharmacist involvement with trauma resuscitation increased significantly from 23% in 2007 to 70% (p < 0.001) and in 71% of trauma centers was provided by pharmacists practicing within the emergency department. Pharmacist involvement was greatest in the Midwest (p < 0.01), but with similar distribution with regards to ACS designation, institution type, and patient volume. Common bedside responsibilities include calculating dosages (96%), preparing medications (89%), and providing medication information (79%), while trauma program/administrative responsibilities (45%) include trauma team education, pharmacy operations, medication safety, quality improvement data collection, research, review of quality assurance cases, ACS accreditation preparation, and others. The primary reason for not considering pharmacist involvement was unfamiliarity with these roles/benefits. CONCLUSION: Pharmacists are an increasingly important component of the trauma team, as evidenced by growth over the last decade. In addition to clinical benefit at the bedside, pharmacists can support the regular activities of a trauma program in many meaningful ways.


Assuntos
Equipe de Assistência ao Paciente/organização & administração , Farmacêuticos/organização & administração , Papel Profissional , Ressuscitação , Ferimentos e Lesões/terapia , Adulto , Criança , Estudos Transversais , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Seguimentos , Humanos , Masculino , Equipe de Assistência ao Paciente/estatística & dados numéricos , Serviço de Farmácia Hospitalar/organização & administração , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Centros de Traumatologia/organização & administração , Centros de Traumatologia/estatística & dados numéricos , Estados Unidos
17.
Am J Health Syst Pharm ; 76(16): 1248-1253, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31369117

RESUMO

PURPOSE: Results of a study to determine the proportion of anticoagulation clinic workload that could be performed by clinical pharmacy technicians (CPTs) and the potential impact on operational efficiency of pharmacist-managed anticoagulation clinics (ACCs) are reported. METHODS: In a quality improvement project involving 11 Veterans Affairs (VA) medical centers, investigators conducted a 3-day time study in pharmacist-managed ACCs followed by scoring of task appropriateness for CPTs via the RAND/UCLA appropriateness method by the VA Anticoagulation Subject Matter Expert (SME) Workgroup. The primary outcome was the percentage of tasks deemed appropriate for a CPT to perform. RESULTS: The Anticoagulation SME Workgroup determined that a wide variety of mainly administrative ACC tasks could be completed by a CPT. At the 11 VA ACCs, an average of 53.4% (range, 39.9-76.1%) of tasks being performed by pharmacists were deemed appropriate for CPTs. The average percentage of total clinic time associated with performing tasks appropriate for a CPT equated to an estimated 1,111 hours per year. Shifting that portion of the annual work hours to a CPT could potentially result in cost avoidance of $55,302. CONCLUSION: At the ACCs evaluated, a significant proportion of tasks (53.4% on average) may be appropriate to assign to CPTs to improve the operational efficiency of these clinics. This finding supports development of business plans for the addition of CPTs in ACCs along with elements to inform crafting of an effective template for ACC structure, including clearly defined CPT roles.


Assuntos
Anticoagulantes/uso terapêutico , Transtornos da Coagulação Sanguínea/prevenção & controle , Hemorragia/prevenção & controle , Ambulatório Hospitalar/organização & administração , Técnicos em Farmácia/organização & administração , Transtornos da Coagulação Sanguínea/sangue , Monitoramento de Medicamentos/métodos , Monitoramento de Medicamentos/estatística & dados numéricos , Eficiência Organizacional , Hemorragia/sangue , Hemorragia/induzido quimicamente , Hospitais de Veteranos/organização & administração , Hospitais de Veteranos/estatística & dados numéricos , Humanos , Coeficiente Internacional Normatizado , Ambulatório Hospitalar/estatística & dados numéricos , Serviço de Farmácia Hospitalar/organização & administração , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Técnicos em Farmácia/estatística & dados numéricos , Papel Profissional , Avaliação de Programas e Projetos de Saúde , Varfarina/uso terapêutico , Carga de Trabalho/estatística & dados numéricos
18.
Ann Pharm Fr ; 77(5): 435-442, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31266629

RESUMO

OBJECTIVE: To describe current pharmaceutical practice in French hospitals regarding fecal microbiota transplantation in terms of prescription, preparation and compounding, as well as local legislation. MATERIAL AND METHODS: A national survey was conducted at 28 French university hospital centers followed by the sending of a GoogleForm® questionnaire from June to August 2018 in the 16 respondent centers either performing or subcontracting fecal microbiota transplant. RESULTS: All hospitals performing or subcontracting fecal transplant (n=16,%57) report prescription indication of recurrent Clostridium difficile infection treatment, and 6 of them also as part of a clinical trial protocol. In hospitals performing fecal transplant themselves (n=11), the number of pre-donation consultations with donors varies from one (n=6) to two (n=5). Fecal sample is collected at the donor's home in 45% of cases. Route of administration for transplant is either naso-gastric administration (n=4), rectal (n=4) or both (n=5). Fecal samples for transplant are compounded either in the hospital pharmacy (n=73%) or in the laboratory (27%). Thawing methods include refrigeration between 2-8°C (50%), room temperature (25%) and water bath (25%). Billing system and reporting to health authorities are highly heterogeneous from one hospital to another. CONCLUSION: This survey shows significant pharmaceutical practice heterogeneity within French hospitals regarding fecal microbiota transplantation despite the existence of national and European recommendations.


Assuntos
Transplante de Microbiota Fecal/métodos , Fezes/microbiologia , Serviço de Farmácia Hospitalar/organização & administração , Infecções por Clostridium/microbiologia , Infecções por Clostridium/terapia , Enterocolite Pseudomembranosa/microbiologia , Enterocolite Pseudomembranosa/terapia , Transplante de Microbiota Fecal/economia , França , Pesquisas sobre Serviços de Saúde , Humanos , Microbiota , Serviço de Farmácia Hospitalar/economia , Manejo de Espécimes
19.
Farm Hosp ; 43(4): 128-133, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31276445

RESUMO

OBJECTIVE: To describe our pharmacovigilance program and to analyze the reported adverse drug  reactions. METHOD: Observational longitudinal study conducted from 2008 to 2016. The Pharmacy Department  leads the pharmacovigilance program and performs prospective, retrospective, intensive, and  spontaneous reporting of inpatients and outpatients (emergencies, day hospital, external consultations, and nursing homes). Each adverse drug reaction is incorporated in the  electronic health record of the patient along with an alert. RESULTS: A total of 2,631 adverse drug reactions were reported in 2,436 patients. Of these patients,  52% were men with a mean age of 63.3 [0-98] years. A total of 92.8% drug events were reported by the pharmacists and 7.2% by doctors, nurses, and technicians. A total of 63.7% were reported in  inpatients, 19.2% in emergencies, 10.6% in external consultations, 6.2% in the day hospital, and  0.3% in diagnostic radiology. There was an increase in adverse drug reactions detected by  prospective and intensive pharmacovigilance. Principal therapeutic groups involved in adverse drug  events were antineoplastic agents (21.3%), antibacterials (12.3%), antithrombotics (7.7%),  analgesics (6.7%), corticosteroids (5.2%), psycholeptics (5.2%), diuretics (4.9%),  antivirals (4.9%),  antiinflammatories and antirheumatics (4.2%), and immunosupressants (3.3%). Adverse  drug reactions mainly affected the skin and appendages (19.7%) and gastrointestinal tract (19.1%).  Adverse drug reactions were mild (38.7%), severe (30.8%), and moderate (30.5%). In total, 60.9%  of patients recovered from drug events and 31.7% were in recovery. The most frequent response was reatment interruption in 65% of cases and the patients received additional specific treatment in 56%  of cases. CONCLUSIONS: The incorporation of the pharmacovigilance program within the daily routine of the  hospital pharmacist provides added value to the safety and pharmacotherapy of the patient.


Assuntos
Farmacovigilância , Serviço de Farmácia Hospitalar/organização & administração , Adolescente , Adulto , Sistemas de Notificação de Reações Adversas a Medicamentos , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Registros Eletrônicos de Saúde , Feminino , Humanos , Lactente , Recém-Nascido , Pacientes Internados , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Adulto Jovem
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