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1.
Eur J Hosp Pharm ; 28(1): 10-15, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33277234

RESUMO

INTRODUCTION: Hospital admissions from COVID-19 initially increased rapidly within the UK. National Health Service (NHS) field hospitals are part of a capacity building response built at great scale and speed to respond to the anticipated increased demand the NHS faces during this time. NHS Nightingale Hospital Birmingham (NHB) is modelled to treat mild to moderate (non-critical care) COVID-19 disease, to provide step-down capacity for patients in recovery, or for palliating patients in the dying phase of their disease in the Midlands. Opportunities and challenges presented for optimal medicines management (MM) during the development of the NHB are investigated, and a framework developed to support future NHS field hospitals of this model. METHODS: A team, comprised of an associate medical director, trust chief pharmacist and senior pharmacists iteratively developed a framework to convert the large non-hospital setting into a functioning NHS field hospital with standardised MM processes adjusted appropriately to cope with operational constraints in the pandemic situation. NHB has, because of its repurposing, both challenges and advantages affecting MM that influence development of the framework. Throughout implementation, a 7-week period between announcement and opening, there was continuous evaluation, external stakeholder validation and peer review. RESULTS: The PESTLE model, a mechanism of analysis to identify elements of a project environment (Political, Environmental, Social, Technological, Legal and Economic), was applied to identify influencing factors and support detailed project planning. Compliance with medicines legislation was at the forefront of all MM process development for the NHB field hospital. Internal factors were identified by the core MM team, resulting in a workforce, education & training and clinical pharmacy MM plan. DISCUSSION: MM processes are extensive and integral to NHS field hospitals. The presented framework of influencing factors may support future NHS field hospital development. It is pertinent to have a broad team working approach to any large-scale project such as outlined here, and suggest the identified factors be used as a core framework for development of any future MM processes in NHS field hospitals.


Assuntos
Administração Hospitalar/tendências , Conduta do Tratamento Medicamentoso/organização & administração , Unidades Móveis de Saúde/organização & administração , Pandemias , Medicina Estatal/organização & administração , Planejamento de Instituições de Saúde , Número de Leitos em Hospital/estatística & dados numéricos , Humanos , Sistemas de Medicação no Hospital , Conduta do Tratamento Medicamentoso/legislação & jurisprudência , Modelos Organizacionais , Política Organizacional , Farmacêuticos , Serviço de Farmácia Hospitalar , Medicina Estatal/legislação & jurisprudência , Reino Unido , Recursos Humanos
2.
Texto & contexto enferm ; 29: e20180358, Jan.-Dec. 2020. tab
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-1139739

RESUMO

ABSTRACT Objective: to investigate the compliance to safety barriers adopted in the preparation and administration of intravenous drugs in Pediatric and Pediatric Intensive Care Units. Method: exploratory, observational descriptive study, conducted with the nursing team of a pediatric intensive care unit and a pediatric clinic of a large public hospital in Belo Horizonte, from August to November 2017. Results: the sample consisted of 334 opportunities to observe the preparation and administration of medications in pediatric patients. Most of the actions were performed by female professionals, nursing technicians and civil servants. The professionals did not perform all the necessary safety barriers in any of the procedures. The hygiene of the preparation site, disinfection of the ampoule, connection, conference of the drug/dose/route administered with the prescription and double checking of the drugs were those that had the lowest compliance. Conclusion: the study highlights the fragility regarding compliance to safety barriers in the preparation and administration of medicines, resulting in a risk to the safety of hospitalized children. Continued education based on good practice is believed to be an important strategy for security.


RESUMEN Objetivo: investigar la adherencia a las barreras de seguridad adoptadas en la preparación y administración de fármacos intravenosos en unidades de cuidados intensivos pediátricos y pediátricos. Método: estudio exploratorio, observacional, descriptivo realizado con el equipo de enfermería de una Unidad de Cuidados Intensivos Pediátricos y una clínica pediátrica en un gran hospital público de Belo Horizonte, en el período de agosto del nuevo 2017. Resultados: la muestra consistió en 334 oportunidades para observar la preparación y administración de medicamentos en pacientes pediátricos. La mayoría de las acciones fueron realizadas por mujeres profesionales, técnicas de enfermería y candidatas. En ninguno de los procedimientos el profesional realizó todas las barreras de seguridad necesarias. Las acciones de higiene del sitio de preparación, desinfección de la ampolla, conexión, control del medicamento / dosis / vía administrada con la prescripción y doble control de los medicamentos fueron los que tuvieron menor adherencia. Conclusión: el estudio apunta a la fragilidad en la adherencia a las barreras de seguridad en la preparación y administración de medicamentos, lo que se traduce en un riesgo para la seguridad de los niños hospitalizados. Se cree que la educación continua basada en buenas prácticas es una estrategia importante para la seguridad.


RESUMO Objetivo: investigar a adesão das barreiras de segurança adotadas no preparo e na administração de medicamentos endovenosos em unidades de Pediatria e Terapia Intensiva Pediátrica. Método: estudo descritivo exploratório, observacional, realizado com a equipe de enfermagem de uma Unidade de Terapia Intensiva Pediátrica e uma clínica pediátrica de um hospital público de grande porte de Belo Horizonte, no período de agosto a novembro de 2017. Resultados: a amostra foi constituída por 334 oportunidades de observação do preparo e administração de medicamentos em pacientes pediátricos. A maior parte das ações foi realizada por profissionais do sexo feminino, técnicos de enfermagem e concursados. Em nenhum dos procedimentos o profissional executou todas as barreiras de segurança necessárias. As ações de higienização do local do preparo, desinfecção da ampola, conexão, conferência do medicamento/dose/via administrada com a prescrição e checagem dupla dos medicamentos foram as que tiveram menor adesão. Conclusão: o estudo aponta para a fragilidade quanto à adesão das barreiras de segurança no preparo e na administração de medicamentos, resultando em risco para a segurança das crianças hospitalizadas. Acredita-se que a educação continuada pautada nas boas práticas seja uma estratégia importante para a segurança.


Assuntos
Humanos , Criança , Enfermagem Pediátrica , Pediatria , Qualidade da Assistência à Saúde , Segurança do Paciente , Sistemas de Medicação no Hospital , Cuidados de Enfermagem
3.
Nursing (Säo Paulo) ; 23(268): 4589-4607, set.2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1145305

RESUMO

Objetivos: Descrever a percepção do graduando de enfermagem sobre a segurança do paciente no Sistema de distribuição de Medicamentos por Dose unitária - SDMDU. Método: Pesquisa de campo exploratória, quantitativa, qualitativa, não probabilística intencional. Realizada em um hospital infantil que utiliza o SDMDU. Foram entrevistados 126 graduandos de enfermagem. Resultados: Percepção positiva para 99(78,57%) dos graduandos de enfermagem, categorizado por Sistema Seguro 45 (45,45%) e, 30(30,30%) relatam que o SDMDU diminui erros. Entretanto 21(16,67%) referiram percepção negativa, afirmam que o Preparo e Administração dos medicamentos 10(47,61%) devem ocorrer pela enfermagem e, consideram o Sistema inseguro, 9(42,85%) entrevistados. Considerações Finais: O SDMDU é um processo que traz maior segurança ao paciente. O enfermeiro deve conhecer a responsabilidade sobre a administração de medicamentos como algo importante dentro do conjunto de atividades que realiza, uma vez que a implantação do SDMDU reflete diretamente nas atividades da equipe de enfermagem.(AU)


Objectives: To describe the perception of nursing students on patient safety in the Distribution System of Medicines by Unit Dose - SDMDU. Method: Exploratory, quantitative, qualitative, non-probabilistic, intentional field research. Held in a children's hospital that uses the SDMDU. 126 nursing graduates were interviewed. Results: Positive perception for 99 (78.57%) of nursing students, categorized by Sistema Seguro 45 (45.45%) and 30 (30.30%) report that the SDMDU decreases errors. However, 21 (16.67%) reported a negative perception, affirm that the Preparation and Administration of medicines 10 (47.61%) must be performed by nursing staff and, considering the System unsafe, 9 (42.85%) interviewed. Final Considerations: The SDMDU is a process that brings greater safety to the patient. The nurse must know the responsibility for medication administration as something important within the set of activities that he performs, since the implementation of the SDMDU reflects directly on the activities of the nursing team.(AU)


Objetivos: Describir la percepción de los estudiantes de enfermería sobre la seguridad del paciente en el Sistema de Distribución de Medicamentos por Unidad Dosis - SDMDU. Método: Investigación de campo exploratoria, cuantitativa, cualitativa, no probabilística e intencional. Se lleva a cabo en un hospital de niños que utiliza la SDMDU. Se entrevistaron 126 graduados en enfermería. Resultados: La percepción positiva para 99 (78.57%) de estudiantes de enfermería, categorizados por Sistema Seguro 45 (45.45%) y 30 (30.30%) informan que el SDMDU disminuye los errores. Sin embargo, 21 (16,67%) informaron una percepción negativa, afirman que la preparación y administración de medicamentos 10 (47,61%) debe ser realizada por personal de enfermería y, considerando que el sistema no es seguro, 9 (42,85%) entrevistados. Consideraciones Finales: SDMDU es un proceso que brinda mayor seguridad al paciente. La enfermera debe conocer la responsabilidad de la administración de medicamentos como algo importante dentro del conjunto de actividades que realiza, ya que la implementación de la SDMDU se refleja directamente en las actividades del equipo de enfermería.(AU)


Assuntos
Humanos , Prescrições de Medicamentos/enfermagem , Estudantes de Enfermagem , Segurança do Paciente , Erros de Medicação/prevenção & controle , Medicamentos Fracionados , Sistemas de Medicação no Hospital
4.
BMJ Open Qual ; 9(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32958472

RESUMO

INTRODUCTION: In the USA over 30% of medication errors occur at the point of administration. Among non-surgical patients in US hospitals exposed to opioids, 0.6% experience a severe opioid-related adverse event. In September 2018, Sierra View Medical Center identified two areas of opportunity for quality improvement: bedside bar code medication administration (BCMA) and pain reassessments. At baseline (April 2018 to September 2018) only 81% of medications were scanned prior to administration with pain reassessments completed only 41% of the time 1 hour postopioid administration. OBJECTIVE: To improve BCMA scanning rates (goal ≥95%) and pain reassessments within 1 hour postopioid administration (goal ≥90%). METHODS: Implementation methods included data transparency, weekly dashboards, education and plan-do-study-act (PDSA) cycles informed by feedback from key stakeholders. RESULTS: Following a series of PDSA cycle implementations, barcode medication administration (BCMA) scanning rates improved by 14% (from 81% to 95%) and pain reassessments improved by 50% (from 41% to 91%), sustained 17 months postproject implementation (October 2018 to February 2019). The number of adverse drug events (ADEs) related to administration errors decreased by 17% (estimated annual cost savings of $120 750-239 725 per year) and opioid-related ADEs decreased by 2.6% (estimated annual cost savings of $72 855-80 928 per year). CONCLUSION: Adopting John Kotter's model for change, developing performance dashboards and sustaining engagement among stakeholders on a weekly basis improved bar code medication scanning rates and pain reassessment compliance. The stakeholders created momentum for change in both practice and culture resulting in improved patient safety with a favourable financial impact.


Assuntos
Processamento Eletrônico de Dados/métodos , Sistemas de Medicação/normas , Medição da Dor/normas , Segurança do Paciente/normas , Processamento Eletrônico de Dados/normas , Processamento Eletrônico de Dados/tendências , Hospitais Comunitários/estatística & dados numéricos , Hospitais Comunitários/tendências , Humanos , Erros de Medicação/prevenção & controle , Sistemas de Medicação/estatística & dados numéricos , Sistemas de Medicação no Hospital/normas , Sistemas de Medicação no Hospital/estatística & dados numéricos , Sistemas de Medicação no Hospital/tendências , Medição da Dor/métodos , Medição da Dor/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos
5.
Am J Health Syst Pharm ; 77(22): 1874-1884, 2020 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-32710774

RESUMO

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has created unprecedented challenges for health systems around the world. We describe our approach to adapting the pharmacy leadership structure to address critical medication shortages through innovative data analysis, procurement strategies, and rapid implementation of medication policy. SUMMARY: Yale New Haven Health deployed a system incident management command structure to effectively respond to the COVID-19 crisis. System pharmacy services adopted a similar framework to enable efficient communication and quick decision-making in key domains, including drug procurement and policy. By refining a model to project health-system medication needs, we were able to anticipate challenges and devise alternative treatment algorithms. By leveraging big data and creating a system knowledge base, we were able to consolidate reporting and coordinate efforts to ensure system success. Various procurement strategies were employed to ensure adequate supply, including frequent communication with our wholesaler, sourcing direct from suppliers, outsourcing of sterile products compounding to registered 503B outsourcing facilities, and acquisition of active pharmaceutical ingredients for compounding of essential medications. Strategic positioning of pharmacists within the health system's incident command response teams and rapid adaption of drug use policy governance fueled accelerated response and nimble implementation. Communication was streamlined and executed via multiple outlets to reach a broad audience across the health system. CONCLUSION: With medication shortages posing a threat to patient care, dynamic pharmacy leadership proved essential to providing patient care at the height of the COVID-19 pandemic. System alignment and the rapid adaption of the existing framework for drug shortage management and medication use policy were crucial to success in crisis response.


Assuntos
Infecções por Coronavirus , Formulários de Hospitais como Assunto/normas , Liderança , Pandemias , Assistência ao Paciente/tendências , Preparações Farmacêuticas/provisão & distribução , Serviço de Farmácia Hospitalar/organização & administração , Farmácia/tendências , Pneumonia Viral , Centros Médicos Acadêmicos , Connecticut , Formulários Farmacêuticos como Assunto , Humanos , Comunicação Interdisciplinar , Sistemas de Medicação no Hospital , Farmacêuticos
6.
Am J Health Syst Pharm ; 77(21): 1763-1770, 2020 10 14.
Artigo em Inglês | MEDLINE | ID: mdl-32705115

RESUMO

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


Assuntos
/epidemiologia , Formulários de Hospitais como Assunto , Unidades Móveis de Saúde/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Humanos , Sistemas de Medicação no Hospital/organização & administração , Michigan
7.
Stud Health Technol Inform ; 270: 1405-1406, 2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-32570681

RESUMO

Automated dispensing cabinets in clinical wards may contribute to improving safety by reducing the likelihood of medications not being available when needed. However, achieving this safety benefit is dependent on a 'back office' sociotechnical infrastructure that combines semi-automated processes with mindful, resilient work practices.


Assuntos
Tecnologia , Automação , Sistemas de Medicação no Hospital , Serviço de Farmácia Hospitalar
8.
Stud Health Technol Inform ; 270: 1036-1040, 2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-32570539

RESUMO

Health information systems (HIS) and clinical workflows generate medication errors that affect the quality of patient care. The rigorous evaluation of the medication process's error risk, control, and impact on clinical practice enable the understanding of latent and active factors that contribute to HIS-induced errors. This paper reports the preliminary findings of an evaluation case study of a 1000-bed Japanese secondary care teaching hospital using observation, interview, and document analysis methods. Findings were analysed from a process perspective by adopting a recently introduced framework known as Human, Organisation, Process, and Technology-fit. Process factors influencing risk in medication errors include template- and calendar-based systems, intuitive design, barcode check, ease of use, alert, policy, systematic task organisation, and safety culture Approaches for managing medication errors also exert an important role on error reduction and clinical workflow.


Assuntos
Sistemas de Informação em Saúde , Processamento Eletrônico de Dados , Humanos , Erros de Medicação , Sistemas de Medicação no Hospital , Fluxo de Trabalho
9.
Farm Hosp ; 44(7): 11-16, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32533662

RESUMO

The purpose of this article is to report the experience of the Department of Hospital Pharmacy of a mid-size hospital during the peak of the COVID-19 pandemic. The human and material resources available in a mid-size hospital were more limited than in larger hospitals of the region. In this article, we describe how this Department of Hospital Pharmacy was reorganized to meet the increase in activity, the strategies developed and the  lessons learned for future pandemics. The COVID-19 pandemic had a higher  impact in Leganes, a city in the south of Madrid, with a population of 190,000.  In the face of the dramatic increase in the proportion of patients attending our  hospital between March and April 2020, the Severo Ochoa University Hospital  increased the number of beds by 24.5% and fitted out new premises inside and  outside the hospital (sports centers). The mean number of patients seen in our  Emergency Department every day passed from 70-80 to a peak of 286 patients, with 652 hospitalized patients. The situation of emergency created by  this infectious disease, with management protocols changing constantly, had a  dramatic impact on the activity of hospital pharmacies. Thus, the pandemic has  affected areas of economic management, magistral preparation, dispensing of  medication to inpatients, ambulatory patients, patients monitored at home,  institutionalized patients, and patients from private hospitals and field hospitals.  Other areas affected include training, clinical trials, pharmacovigilance, and  counseling boards. Two strategies were adopted to overcome these problems: a  strategy centered on human resources (staff reinforcement, reallocation of  responsibilities), and a strategy centered on processes (some processes were  reinforced to meet the increase in activity, whereas other were temporarily suspended or reduced to the minimum).Conclusions: The Department of Hospital Pharmacy plays a key role  in hospitals and has been significantly reinforced to meet the dramatic impact of  the pandemic on this service. This Department has been able to reorganize its  processes and take over new responsibilities such as telepharmacy and home  dispensing. Hospital pharmacies play a crucial role in  pharmacotherapeutic decisions in hospitals. As in other Departments, training is  the area more significantly affected by the pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Pandemias , Serviço de Farmácia Hospitalar/organização & administração , Pneumonia Viral/tratamento farmacológico , Ensaios Clínicos como Assunto , Planejamento em Desastres , Composição de Medicamentos , Prescrições de Medicamentos/estatística & dados numéricos , Previsões , Necessidades e Demandas de Serviços de Saúde , Número de Leitos em Hospital , Hospitais Universitários/organização & administração , Hospitais Urbanos/organização & administração , Humanos , Pacientes Internados/estatística & dados numéricos , Sistemas de Medicação no Hospital/organização & administração , Espanha , Desenvolvimento de Pessoal
10.
Farm Hosp ; 44(7): 43-48, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32533670

RESUMO

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


Assuntos
Assistência Ambulatorial/organização & administração , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Casas de Saúde/organização & administração , Pandemias , Serviço de Farmácia Hospitalar/organização & administração , Pneumonia Viral/tratamento farmacológico , Idoso , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/prevenção & controle , Infecções Comunitárias Adquiridas/transmissão , Comorbidade , Infecções por Coronavirus/enfermagem , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Surtos de Doenças , Interações Medicamentosas , Feminino , Idoso Fragilizado , Humanos , Controle de Infecções/organização & administração , Masculino , Sistemas de Medicação no Hospital/organização & administração , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Admissão e Escalonamento de Pessoal , Pneumonia Viral/enfermagem , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Polimedicação , Espanha/epidemiologia
11.
Farm Hosp ; 44(7): 36-39, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32533668

RESUMO

The COVID-19 pandemic is placing huge strain on health systems and professionals. Emergency departments and their pharmacy services have been the first to face this challenge before any other pharmacy units. This article provides a description of the experience of two public hospitals  located in the Autonomous Community of Madrid, Spain. Team working and  reciprocal trust have made it possible to meet the unprecedented demand for  health services and has facilitated rapid decision making. Strategies have been  developed to guarantee the availability, distribution and safe use of medications. Other strategies have included favoring communication within Emergency  Departments pharmacy services, and between these services and Emergency  Departments during the pandemic. Multidisciplinary cooperation and information  sharing have traditionally formed the base for efficient and quality work, along  with solid technologies that guarantee a safe use of medications. The crucial role of information and communication technologies during the pandemic may give  rise to a new model of pharmaceutical care, which should not replace face-to- face Emergency Department pharmacist support and advice. Promoting the re- humanization of healthcare and pharmacy services is essential. An adequate  technical training and the development of abilities such as flexibility, planning  and coordination skills, and an assertive communication and management of  emotions will be key to the successful management of unimaginable settings in  the future.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Serviço Hospitalar de Emergência/organização & administração , Unidades de Terapia Intensiva , Pandemias , Farmacêuticos , Pneumonia Viral , Competência Clínica , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Tomada de Decisões , Gerenciamento Clínico , Prescrições de Medicamentos/estatística & dados numéricos , Previsões , Necessidades e Demandas de Serviços de Saúde , Hospitais Universitários , Humanos , Controle de Infecções/organização & administração , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Comunicação Interdisciplinar , Sistemas de Medicação no Hospital/organização & administração , Equipe de Assistência ao Paciente , Preparações Farmacêuticas/provisão & distribução , Serviço de Farmácia Hospitalar/organização & administração , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Espanha/epidemiologia
12.
Farm Hosp ; 44(7): 53-56, 2020 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-32533672

RESUMO

In response to the SARS-CoV-2 pandemic, the Hospital Pharmacy Services have  quickly adapted to respond to a critical situation characterized by the constant  and continuous admission of patients with severe pneumonia who needed  treatment, requiring a transformation of the hospital in order to increase the  number of hospital and critical beds. Moreover, other out-ofhospital spaces have  been transformed into hospitalization units to absorb the large number of  patients that had to be treated and isolated. To guarantee the distribution of  medicines and the quality of the pharmaceutical care, drug distribution systems,  such as unit dose and automated dispensing systems, have undergone  transformations. Standard stocks were assigned for COVID units, and different  dispensing circuits to avoid the risk of cross-contamination between COVID and  non-COVID units were created, as well as disinfection protocols for medication  transport systems and medication return protocols. All this without forgetting  COVID treatment protocol's changes that were affected by the availability of the  drugs. The increase in the number of beds in out-of-hospital spaces, such as  field hospitals, hotels, socio-medical centers and nursing homes, has challenged  Pharmacy Services, since new medication dispensing and conciliation circuits  have been created forcing the increase of pharmacy staff's presence and  modifying work shifts, to afford all the new tasks successfully. Development of  contingency plans for the different Pharmacy Service activities and providing  fluent communication channels are key elements for crisis situations or health  emergencies such as the current pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Farmacêuticos , Serviço de Farmácia Hospitalar/organização & administração , Pneumonia Viral , Desinfecção , Armazenamento de Medicamentos , Prescrição Eletrônica , Equipamentos e Provisões/provisão & distribução , Previsões , Necessidades e Demandas de Serviços de Saúde , Número de Leitos em Hospital , Unidades Hospitalares , Humanos , Unidades de Terapia Intensiva , Sistemas de Medicação no Hospital/organização & administração , Alta do Paciente , Admissão e Escalonamento de Pessoal , Recursos Humanos
13.
Farm Hosp ; 44(7): 61-65, 2020 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-32533674

RESUMO

Hospital Pharmacy Service (HPS) in Spain have been impacted by the health  crisis caused by the COVID-19 pandemic. Thus, the outbreak has forced HPSs to adapt their outpatient consultation services to Telepharmacy to optimize clinical  outcomes and reduce the risk of contagion. The purpose of this article is to  describe and analyze the experience of HPSs with outpatient Telepharmacy  during the COVID-19 pandemic and expose the lessons learned. Measures have  been adopted in on-site outpatient pharmacy clinics to prevent exposure of  patients and professionals to the virus. These measures are based on national  and international recommendations on social distancing and hygiene. With  regard to remote outpatient pharmacy services, teleconsultation with drug  dispensing has been promoted based on five basic procedures, each with its  advantages and limitations: home drug delivery from HPSs, with the advantage  of universal access and the limitation of entailing a substantial investment in  resources; HPS coordination with primary care pharmacists, which requires no  investments but with limited access to some geographic areas; HPS coordination with community pharmacists based on a large network of pharmacies, which  requires the patient to go to the pharmacy, without confidentiality being  guaranteed for any patient; geolocation and hospital-based medication  dispensing, which provides universal access and direct traceability, but entails  investment in human resources; and HPS coordination with associations of  patients, which does not entail any additional cost but limits the information  available on the diseases of society members. Three main lessons have been learned during the pandemic: the satisfactory capacity of HPS to provide outpatient pharmacy consultation services in the setting of a public health crisis; the usefulness of Telepharmacy for the clinical follow-up, healthcare coordination, outpatient counseling, and informed dispensing and delivery of  medication (with a high level of satisfaction among patients); and the need to  foster Telepharmacy as a complementary tool through a mixed model of  outpatient pharmacy consultation service that incorporates the advantages of  each procedure and adapts to the individual needs of each patient in a context of humanized healthcare.


Assuntos
Assistência Ambulatorial/organização & administração , Betacoronavirus , Infecções por Coronavirus , Assistência à Saúde/organização & administração , Pandemias , Serviço de Farmácia Hospitalar/organização & administração , Pneumonia Viral , Telemedicina/organização & administração , Assistência à Saúde/estatística & dados numéricos , Aconselhamento Diretivo/organização & administração , Aconselhamento à Distância/organização & administração , Previsões , Geografia Médica , Necessidades e Demandas de Serviços de Saúde , Serviços de Assistência Domiciliar/organização & administração , Hospitais Universitários/organização & administração , Humanos , Sistemas de Medicação no Hospital/organização & administração , Pacientes Ambulatoriais , Educação de Pacientes como Assunto/organização & administração , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Espanha
17.
BMC Health Serv Res ; 20(1): 312, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32293426

RESUMO

BACKGROUND: Issuing of correct prescriptions is a foundation of patient safety. Medication errors represent one of the most important problems in health care, with 'look-alike and sound-alike' (LASA) being the lead error. Existing solutions to prevent LASA still have their limitations. Deep learning techniques have revolutionized identification classifiers in many fields. In search of better image-based solutions for blister package identification problem, this study using a baseline deep learning drug identification (DLDI) aims to understand how identification confusion of look-alike images by human occurs through the cognitive counterpart of deep learning solutions and thereof to suggest further solutions to approach them. METHODS: We collected images of 250 types of blister-packaged drug from the Out-Patient Department (OPD) of a medical center for identification. The deep learning framework of You Only Look Once (YOLO) was adopted for implementation of the proposed deep learning. The commonly-used F1 score, defined by precision and recall for large numbers of identification tests, was used as the performance criterion. This study trained and compared the proposed models based on images of either the front-side or back-side of blister-packaged drugs. RESULTS: Our results showed that the total training time for the front-side model and back-side model was 5 h 34 min and 7 h 42 min, respectively. The F1 score of the back-side model (95.99%) was better than that of the front-side model (93.72%). CONCLUSIONS: In conclusion, this study constructed a deep learning-based model for blister-packaged drug identification, with an accuracy greater than 90%. This model outperformed identification using conventional computer vision solutions, and could assist pharmacists in identifying drugs while preventing medication errors caused by look-alike blister packages. By integration into existing prescription systems in hospitals, the results of this study indicated that using this model, drugs dispensed could be verified in order to achieve automated prescription and dispensing.


Assuntos
Aprendizado Profundo , Rotulagem de Medicamentos , Erros de Medicação/prevenção & controle , Modelos Teóricos , Humanos , Sistemas de Medicação no Hospital , Segurança do Paciente , Taiwan
18.
PLoS One ; 15(2): e0228868, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32027720

RESUMO

OBJECTIVE: Limited evidence concerning the burden and predictors of omitted medication doses within mental health hospitals could severely limit improvement efforts in this specialist setting. This study aimed to determine the prevalence, nature and predictors of omitted medication doses affecting hospital inpatients in two English National Health Service (NHS) mental health trusts. METHODS: Over 6 data collection days trained pharmacy teams screened inpatient prescription charts for scheduled and omitted medication doses within 27 adult and elderly wards across 9 psychiatric hospitals. Data were collected for inpatients admitted up to two weeks prior to each data collection day. Omitted doses were classified as 'time critical' and 'preventable' based on established criteria. Omitted dose frequencies were presented with 95% confidence intervals (CI). Multilevel logistic regression analyses determined the predictors of omitted dose occurrence, with omission risks presented as adjusted odds ratios (OR) with 95% CI. RESULTS: 18,664 scheduled medication doses were screened for 444 inpatients and 2,717 omissions were identified, resulting in a rate of 14.6% (95% CI 14.1-15.1). The rate of 'time critical' omitted doses was 19.3% (95% CI 16.3-22.6%). 'Preventable' omitted doses comprised one third of all omissions (34.5%, 930/2694). Logistic regression analysis revealed that medicines affecting the central nervous system were 55% less likely to be omitted compared to all other medication classes (9.9% vs. 18.8%, OR 0.45 (0.40-0.52)) and that scheduled doses administered using non-oral routes were more likely to be omitted compared the oral route (inhaled OR 3.47 (2.64-4.57), topical 2.71 (2.11-3.46), 'other' 2.15 (1.19-3.90)). 'Preventable' dose omissions were more than twice as likely to occur for 'time critical' medications than non-time critical medications (50.4% vs. 33.8%, OR 2.24 (1.22-4.11)). CONCLUSIONS: Omitted medication doses occur commonly in mental health hospitals with 'preventable' omissions a key contributor to this burden. Important targets for remedial intervention have been identified.


Assuntos
Hospitais Psiquiátricos , Erros de Medicação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fármacos do Sistema Nervoso Central/administração & dosagem , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Modelos Logísticos , Masculino , Erros de Medicação/prevenção & controle , Sistemas de Medicação no Hospital/estatística & dados numéricos , Transtornos Mentais/tratamento farmacológico , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Medicina Estatal , Reino Unido , Adulto Jovem
19.
J Clin Nurs ; 29(9-10): 1477-1487, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32045059

RESUMO

AIMS AND OBJECTIVES: To systematically locate, assess and synthesise research to describe methods used to examine technology in relation to the quality of nursing work in acute care. Specific objectives were to (a) describe the types of nursing work examined; (b) describe methods used to examine technology in nursing work; (c) identify outcomes used to evaluate technology in relation to the quality of nursing work; and (d) make recommendations for future research. BACKGROUND: New technologies can offer numerous benefits to nurses; however, it is challenging to evaluate health information technologies in relation to the quality of nurses' complex day-to-day work. DESIGN: A systematic integrative review using a five-step process. METHODS: Five databases were searched using search terms "nurs*," "workload," "task," "time." Data screening, extraction and interpretation were conducted independently by at least two authors and agreement verified by discussion. Data extraction followed PRISMA guidelines. RESULTS: Of the 41 studies included, most (87.8%, n = 36) examined physical dimensions of nursing work; 31.7% (n = 13) organisational dimensions; 17.1% (n = 8) cognitive dimensions; and only 12.2% (n = 5) emotional dimensions. More than half (58.5%, n = 24) examined only one dimension; one captured all four dimensions. Most frequently examined technologies were electronic medical/health records (36.5%) and electronic medication management (19.5%). Direct observation (58.8%, n = 28) and multiple methods (19.5%, n = 8) were the most common methods; nurse tasks, frequency, duration and time distribution were variables most often measured. CONCLUSIONS: Examinations of technology in nursing work often failed to capture the multiple dimensions of this work nor did they recognise the complexity of day-to-day nursing work in acute care. There is a paucity of literature to inform how and what technology should be measured in relation to the quality of nursing care. RELEVANCE TO CLINICAL PRACTICE: The outcomes inform useful research methods to comprehensively examine technology to enhance the quality of complex nursing work.


Assuntos
Enfermagem de Cuidados Críticos/normas , Recursos Humanos de Enfermagem no Hospital/normas , Qualidade da Assistência à Saúde/normas , Registros Eletrônicos de Saúde , Humanos , Sistemas de Medicação no Hospital , Tecnologia , Carga de Trabalho
20.
J Manag Care Spec Pharm ; 26(3): 296-304, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32105180

RESUMO

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


Assuntos
Adesão à Medicação , Sistemas de Medicação no Hospital/organização & administração , Alta do Paciente , Readmissão do Paciente/estatística & dados numéricos , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Maryland , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos
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