Hospital Pharmacy Department Research Articles

Gene-eral survey to describe genomic education needs in hospital pharmacy departments in the West Midlands and Oxford

Abstract Introduction Genomic medicine is a rapidly developing field and a priority for the NHS to ensure it is embedded into Medicine Service Alliance is that the NHS staff have understanding and confidence to utilise genomics safely and effectively. Pharmacy professionals, as experts in medicines, will lead the implementation and delivery of pharmacogenomics and wider genomic medicine services across all healthcare sectors1. Aim To understand current levels of genomic education across NHS Trust Pharmacy Departments in the Central and South region, and preferences for types of future learning. Methods A MS Forms survey was distributed across the Pharmacy Departments of five NHS Trusts, emailed to all local pharmacy staff via the Education and Training lead pharmacists; all pharmacy staff were eligible to participate, and total numbers of staff were not available. The survey was based on a previously published national survey2, but reduced in content to allow completion within 5 minutes; content was agreed between the genomics specialist pharmacy team at C&S. Ethics approval was not sought as this baseline evaluation formed part of a planned service improvement. Results One hundred and twenty-nine respondents participated in the survey, including pharmacists (62%), pharmacy technicians (29%) and assistant technical officers (5%). Seventy-one out of 127 respondents (56%) had more than 10 years of experience since qualified. Given a scale of ’very low-low-medium -high-very high’, the majority of the 127 respondents (63%) considered their knowledge about Genomic Medicine to be medium or high, and no responder considered themselves to have a very high level of knowledge about Genomic Medicine. Most participants saw the relevance of Genomic Medicine to their professions, particularly in areas like personalised medicine and 82% expressed an interest in learning more about Genomic Medicine and 15% answered ’Maybe’; the cohort had a preference for in-person meetings and seminars (32%), followed by on-line meetings (27%). Discussion / Conclusion Respondents saw the relevance of Genomic Medicine to their professions, and showed a mixture of enthusiasm, curiosity, and uncertainty about Genomic Medicine, with no respondent feeling they had a very high level of knowledge of Genomic Medicine. Most pharmacy staff in the 5 departments surveyed have an interest in furthering their knowledge of Genomic Medicine, with a marked preference for in-person meetings and seminars. Respondents recognised the potential benefits such as personalized medicine, improved treatment outcomes and reduced trial-and-error approaches in medication selection, with expectations that Genomic Medicine will improve patient care and outcomes, reducing adverse events and informing treatment decisions Limitations to this study include an inability to judge response rate due to lack of denominator data, however relatively similar numbers were obtained from each Department, with a good mix of respondent roles. An in-person training event with hybrid online options is being planned as a result of this work.

Development of a self-assessment tool to evaluate the readiness of pharmacy departments for internship training in China: a two-phase study

ObjectivesInternships in the pharmacy departments of training hospitals represent a crucial stage in the professional development of pharmacy students. However, the quality of internship training varies significantly across training hospitals in China, and there is a lack of standardized readiness evaluation tools. Therefore, the purpose of this study was to develop a self-assessment tool to evaluate the preparedness of training hospitals for providing internship training.MethodsThis study employed an exploratory mixed-methods approach and was conducted in two phases. In the first phase, during 2021, focus groups were conducted with 16 interns from three tertiary hospitals in Henan Province. In 2022, 14 preceptors from tertiary hospitals in various provinces were interviewed either one-on-one or in focus groups. The interview data were analyzed using thematic analysis to compile a set of self-assessment indicators for internship training readiness. Subsequently, the initial draft of the self-assessment tool for internship training readiness was developed by integrating the indicators derived from the interviews and literature review. In the second phase, the Delphi method was utilized. In 2023, the experts participated in two rounds of correspondence (21 experts in the first round and 19 in the second round), and consensus was reached on the indicators of the self-assessment tool after the two rounds. Meanwhile, these experts assessed the current status of internship training in training hospitals across China.ResultsThe qualitative findings of the first phase included five themes and 22 sub-themes, which were integrated with the indicators derived from the literature review to develop an initial indicator framework for the second phase. This initial framework comprised five domains and 37 items. The second phase involved two rounds of expert surveys, with effective response rates of 90.48% and 89.47%, respectively. Ultimately, the self-assessment tool for evaluating the readiness of pharmacy departments in training hospitals for internships included five dimensions and 35 secondary indicators: (1) organizational structure, (2) training content, (3) training mode, (4) effectiveness evaluation, and (5) emergency management. Additionally, experts assessed the readiness of pharmacy departments in Chinese training hospitals for internships, yielding varied results. Emergency management preparedness scored the highest, followed by organizational structure and training content preparation. However, the modes of internship training and the evaluation of training effectiveness received lower scores.ConclusionThe developed tool provides a comprehensive self-assessment checklist for the pharmacy departments of training hospitals and possesses the potential to enhance the development of more effective internship training programs.

Risk analysis applied to the process of managing medical single use devices in a hospital pharmacy department

During the COVID-19 pandemic, single use medical devices' supply (SUMD) was marked by repetitive and unforeseen interruptions. The present study aimed to determine the risks related to the processes of management of medical devices in our CHU according to a method of failure mode, effect and criticality analysis (FMECA). Qualified healthcare professionals were recruited to form a multidisciplinary consensus committee. By analyzing the process map, all failure modes, causes and consequences were identified through brainstorming meetings. They were then classified taking into account the criticality index (CI) calculated according to three parameters: frequency, severity, and detectability. The prioritization was carried out by considering the mean and the median values of the CI as limits. Corrective and preventive actions were then proposed. A total of 49 failure modes were identified, accumulating 4466 criticality points. The most critical step is that relating to the inter-depot order with a CI equal to 783 points. An action plan was developed, allows us to control 64% of the overall criticality of the risks linked to the process. Three main lines of action have been proposed: continuous training, especially for managerial and administrative tasks, logistical improvement (architectural reorganization and implementation of systems for securing the circuit of SUMDs) and support for the digitization of hospital pharmacy. The FMECA is a consensual method, which makes it possible to propose actions in order to reduce the risks linked to the process of managing medical devices. Optimizing the estimation of needs, strengthening communication with stakeholders and securing the circuit are essential to guarantee the availability of SUMDs for the benefit of the patient.

[Translated article] Introducing artificial intelligence to hospital pharmacy departments

Artificial intelligence is a broad concept that includes the study of the ability of computers to perform tasks that would normally require the intervention of human intelligence. By exploiting large volumes of healthcare data, Artificial intelligence algorithms can identify patterns and predict outcomes, which can help healthcare organizations and their professionals make better decisions and achieve better results. Machine learning, deep learning, neural networks, or natural language processing are among the most important methods, allowing systems to learn and improve from data without the need for explicit programming. Artificial intelligence has been introduced in biomedicine, accelerating processes, improving accuracy and efficiency, and improving patient care.By using Artificial intelligence algorithms and machine learning, hospital pharmacists can analyze a large volume of patient data, including medical records, laboratory results, and medication profiles, aiding them in identifying potential drug–drug interactions, assessing the safety and efficacy of medicines, and making informed recommendations. Artificial intelligence integration will improve the quality of pharmaceutical care, optimize processes, promote research, deploy open innovation, and facilitate education. Hospital pharmacists who master Artificial intelligence will play a crucial role in this transformation.

Improving Efficiency in Hospital Pharmacy Services: An Integrated Strategy Using the OCTAGON-P Framework and Lean 5S Management Practices.

Background Hospital pharmacy departments have a critical role in the healthcare system, as they aim to provide excellent patient services while also ensuring cost-effectiveness. Lean methodologies are well-known for improving efficiency and quality in various industries, but their impact on healthcare, particularly in hospital pharmacy settings, has not been thoroughly investigated. Aim This quality improvement (QI) study aimed to assess the impact of implementing the sort, set in order, shine, standardize, and sustain (5S) methodology using the innovative orientation, coordination, training, awareness, governance, observation, normalization, and promotion (OCTAGON-P) framework on the operations of Mediclinic Parkview Hospital (MPAR) Pharmacy in Dubai, UAE. Methods The QI project spanned a period of six weeks, from December 18th, 2023, to January 28th, 2024. Throughout this period, a new novel OCTAGON-P framework's eight crucial elements were methodically integrated. Simultaneously, an extensive preparation processencompassing the five stages of the 5S methodwas carried out. Results The findings indicated a notable enhancement in organization, orderliness, cleanliness, medication storage, and workspace standardization. The significant improvement of 217% in terms of organization highlighted the effectiveness of resource arrangement. The orderliness of the workspace saw an increase of 800%, indicating a transformation in the systematic organization. Additionally, cleanliness improved by 138%, demonstrating a significant advancement in maintaining a spotless environment. The standardization of processes experienced a boost of 300%, reflecting a solidified approach to consistent operational methods. These refinements resulted in an overall improvement of 90% from the initial baseline of 20% on the 5S checklist scores. Efficiency gains were observed, with outpatient medication retrieval times reduced by 50%, inpatient times by 40%, emergency prescription serving by 16.7%, and pediatric prescription serving by 11%. The inpatient medication return process saw a 67% improvement. Patient counseling time increased by 23.3%, indicating a more patient-centered approach. Prescription verification and medication expiry checks increased by 50% and 200%, respectively, enhancing the quality of care. Inventory management efficiency improved by 36%, and medication label printing time decreased by 70% with the additional label printers. Installing extra medication label printers was done through the OCTAGON-P framework, specifically in the "orientation" and "coordination" phases. These two initial phases focused on leadership's 5S orientation, management support, and securing additional resources. Therefore, the OCTAGON-P framework provided a structured approach that promoted continuous improvement and sustained lean practices. Conclusion This research study presented the remarkable effectiveness of the OCTAGON-P framework in structurally implementing the 5S methodology into hospital pharmacy operations. The findings underscored the potential of lean 5S to enhance and optimize operational efficiency and overall quality within the critical environment of hospital pharmacy settings. Consequently, these improvements can conclusively result in the provision of superior and enhanced patient care, which is truly fundamental and central to the mission and objectives of any healthcare institution.

Evaluation of hospital pharmacists’ activities using additional reimbursement for infection prevention as an indicator in small and medium-sized hospitals

BackgroundHospitals in Japan established the healthcare delivery system from FY 2018 to 2021 by acquiring an additional reimbursement for infection prevention (ARIP) of category 1 or 2. However, research on outcomes of ARIP applications related to the practice of hospital pharmacists is scarce.MethodsThis study assessed the activities performed by hospital pharmacists in hospitals with 100 to 299 beds, using ARIP acquirement as an indicator, using data from an annual questionnaire survey conducted in 2020 by the Japanese Society of Hospital Pharmacists on the status of hospital pharmacy departments. Out of the survey items, this study used those related to hospital functions, number of beds, number of pharmacists, whether the hospital is included in the diagnosis procedure combination (DPC) system, average length of stay, and nature of work being performed in the analysis. The relationship between the number of beds per pharmacist and state of implementation of pharmacist services or the average length of hospital stay was considered uncorrelated when the absolute value of the correlation coefficient was within 0–0.2, whereas the relationship was considered to have a weak, moderate, or strong correlation when the absolute value ranged at 0.2–0.4, 0.4–0.7, or 0.7–1, respectively.ResultsResponses were received from 3612 (recovery rate: 43.6%) hospitals. Of these, 210 hospitals meeting the criteria for ARIP 1 with 100–299 beds, and 245 hospitals meeting the criteria for ARIP 2 with 100–299 beds, were included in our analysis. There was a significant difference in the number of pharmacists, with a larger number in ARIP 1 hospitals. For the pharmacist services, significant differences were observed, with a more frequency in ARIP 1 hospitals in pharmaceutical management and guidance to pre-hospitalization patients, sterile drug processing of injection drugs and therapeutic drug monitoring. In DPC hospitals with ARIP 1 (173 hospitals) and 2 (105 hospitals), the average number of beds per pharmacist was 21.7 and 24.7, respectively, while the average length of stay was 14.3 and 15.4 d, respectively. Additionally, a weak negative correlation was observed between the number of pharmacist services with “Fairly well” or “Often” and the number of beds per pharmacist for both ARIP 1 (R = -0.207) and ARIP 2 (R = -0.279) DPC hospitals. Furthermore, a weak correlation (R = 0.322) between the average number of beds per pharmacist and the average length of hospital stay was observed for ARIP 2 hospitals.ConclusionsOur results suggest that lower beds per pharmacist might lead to improved pharmacist services in 100–299 beds DPC hospitals with ARIP 1 or 2. The promotion of proactive efforts in hospital pharmacist services and fewer beds per pharmacist may relate to shorter hospital stays especially in small and medium-sized hospitals with ARIP 2 when ARIP acquisition was used as an indicator. These findings may help to accelerate the involvement of hospital pharmacists in infection control in the future.

Disaster Pharmacists' Support and Challenges Faced by Hospital Pharmacy Departments in the Disaster Response for the 2024 Noto Peninsula Earthquake.

Disaster Pharmacists' Support and Challenges Faced by Hospital Pharmacy Departments in the Disaster Response for the 2024 Noto Peninsula Earthquake.

Exploring the motivation of self-directed learning of hospital pharmacists: a multicentre qualitative study

ObjectiveSelf-directed learning (SDL) has been embraced by the medical community as a core professional competency, with motivation considered a crucial component of SDL. However, little is known about how hospital...

Development of an Environmental Audit Tool for Hospital Pharmacy.

Health care contributes significantly to greenhouse gas emissions, and pharmacy departments have many opportunities to reduce their emissions. To describe the development and implementation of an environmental audit tool for hospital pharmacy departments. A pharmacy environmental audit tool was developed by modifying a generic workplace audit tool to include pharmacy-specific content. The audit tool contained 22 categories, with scoring on a 4-point scale (from 0 to 3). Members of a volunteer committee completed the audit by observing practice areas. The lowest-scoring categories were then prioritized for action. Overall, the 4 main pharmacy sites in Regina, Saskatchewan, scored 23/66 (35%). Areas of strength identified in the audit included reuse of packaging materials, carpooling, and paperless meetings. Areas for improvement prioritized by the committee included paper use, plastic use, and recycling. The pharmacy environmental audit tool described here can facilitate reflection on current practice, benchmarking, and goal setting. Pharmacy professionals have a role in leading change for the benefit of planetary health.

Five Years Outpatients Antibiotics Consumption at Public Tertiary Hospital in Bengkulu According to Access, Watch and Reserve Classification

Background: Access, Watch, and Reserve (AWaRe) antibiotics classification was released in 2019 by the World Health Organization (WHO) to enhance antimicrobial stewardship programs in all healthcare facilities. As a result, WHO advises global action to increase the availability of antibiotics from the Access group by more than 60%.Objective: to determine antibiotics consumption for outpatients at a public tertiary hospital in Bengkulu, Sumatera-Indonesia, from 2018 to 2022, focusing on antibiotics from Access class according to the AWaRe classification from WHO and Ministry of Health Republic of Indonesia (MoHRI). Methods: This is a cross-sectional survey analyzing aggregate data on antibiotics use for outpatients at the hospital during the study period. Data on antibiotics were collected from the hospital pharmacy department, while data on patient visits were collected from the medical records department. The quantity of antibiotics used was calculated using the ATC/DDD method and expressed in DDD/1000 patient-day (PD), which was then converted into a percentage. Results: During the study period, 50-60% and 65-73% out of 14-19 antibiotic agents are from Access class according to WHO and MoHRI AWaRe classification, respectively. Quantitatively, according to the WHO and MoHRI AWaRe classification, the consumption of antibiotics from the Access class was 25-50% and 33-71% of total consumption, respectively. In addition, the segment of drug utilization 90% (DU90%) of antibiotics was dominated by antibiotics from Watch class. Conclusion: The hospital has not yet met the WHO target for antibiotic consumption from the Access class, highlighting the need for some effective efforts from Watch class to limit the usage of antibiotics.

ASHP and ASHP Foundation Pharmacy Forecast 2024: Strategic Planning Guidance for Pharmacy Departments in Hospitals and Health Systems.

The 2024 ASHP Pharmacy Forecast identifies and contextualizes emerging issues and trends that will influence healthcare, health systems, and the pharmacy profession and provides recommendations to inform long-term strategic planning that should prompt action by pharmacists and health-system leaders. Drawing on the “wisdom of crowds” concept, a survey was constructed with 6 general themes, each with 6 to 9 focused statements and a seventh theme on preparedness (58 survey items in total). The size of and representation within the survey panel were intended to capture opinions from a wide range of pharmacy leaders. The survey instructed panelists to consider the likelihood of the events/scenarios described in the statements occurring in the next 5 years as being likely, somewhat likely, somewhat unlikely, or very unlikely. Then, survey panelists assessed the preparedness (from very unprepared to very prepared) for 12 of the statements. The 6 survey themes identified were Urgent Public Health Priorities, Responding to the Mental Health Crisis, Achieving Care Equity, New Disease Paradigms and Treatment Innovations, Workforce: Focus on Culture for the Future, and Artificial Intelligence: Can Ethics and Regulators Catch Up? The survey was completed by 250 respondents, yielding an 88% response rate. Analysis of survey results was provided by chapter authors along with strategic recommendations to guide actions for each theme. The focus of the Pharmacy Forecast is on large-scale, long-term trends that will influence healthcare and the pharmacy profession over months and years and not on day-to-day situational dynamics. The report provides insight to stimulate thinking and discussion and provides a starting point to proactively position leaders, their teams, and departments for potential future events and trends.

Cysteamine Eye Drops in Hyaluronic Acid Packaged in Innovative Single-Dose Systems, Part II: Long-Term Stability and Clinical Ocular Biopermanence.

Cystinosis is a rare genetic disorder characterized by the accumulation of cystine crystals in several tissues and organs causing, among others, severe eye symptoms. The high instability of cysteamine eye drops makes it difficult to develop formulations with an acceptable shelf life to be prepared in hospital pharmacy departments. Previously, a new compounded formulation of cysteamine eye drops in hyaluronic acid (HA) packaged in innovative single-dose systems was developed. Long-term stability at -20 °C of this formulation was studied considering the content of cysteamine, pH, osmolality, viscosity, and microbiological analysis. The oxygen permeability of single-dose containers was also studied and an ocular biopermanence study was conducted in healthy volunteers measuring lacrimal stability and volume parameters. Data confirm that cysteamine concentration remained above 90% for 120 days, all parameters remaining within the accepted range for ophthalmic formulations. The permeability of the containers was reduced over time, while ocular biopermanence was maintained despite the freezing process and storage time. 0.55% cysteamine hydrochloride formulation in HA and packaged in single-dose containers preserved at -20 °C is stable for 120 days protected from light, presenting high potential for its translation into clinical practice when commercial presentations are not available.

Hospital pharmacy initiatives for improving the management of patients with congenital coagulopathies

ObjectiveTo identify and promote initiatives aimed at improving the management by hospital pharmacists of patients with congenital coagulopathies in the Spanish healthcare context. MethodA series of initiatives to improve the care of patients with congenital coagulopathies were identified, evaluated, and prioritized by a panel of hospital pharmacists. Prioritization was based on an assessment of each initiative's impact and feasibility on a scale of 1 to 5. Once initiatives were prioritized, those assigned the highest priority were grouped into three action areas. ResultsSeven areas of activity were identified in which the role of hospital pharmacists is key for the management of patients with congenital coagulopathies: coordination with the healthcare team; drug evaluation and selection; dispensing; patient information and education; pharmacotherapeutic follow-up; research and innovation in the field of congenital coagulopathies; and capacity-building and training of hospital pharmacists. Fifteen initiatives were considered a priority, with an average impact score ≥ 3.8 and a feasibility score ≥ 3.2. A total of, 29.4% of the prioritized initiatives corresponded to healthcare, 23.5% to patient information and education, 11.8% to drug evaluation and selection, 11.8% to pharmacotherapeutic monitoring, 11.8% to cross-sectional initiatives, 5.9% to dispensing and 5.9% to research and innovation in the field of congenital coagulopathies: In contrast, initiatives related to capacity-building and training were not prioritized. ConclusionsThree main action areas were proposed based on the initiatives identified as high priority for the management of patients with congenital coagulopathies by a panel of 16 hospital pharmacists. Action areas revolved around specific activities that hospital pharmacy departments can undertake to contribute to improving the healthcare situation in Spain.

SEFH National Survey-2019: general characteristics, staffing, material resources and information systems in Spain's hospital pharmacy departments

ObjectiveTo publicize the results regarding the general characteristics, human resources, materials and information systems of Spanish hospital pharmacy departments arising from SEFH's 2019 Survey on the Situation of Spanish Hospital Pharmacy Departments. MethodAn online questionnaire was sent to the heads of the 368 hospital pharmacy departments affiliated to SEFH. The questionnaire included 77 questions grouped into 8 dimensions. The information was collected between March and September 2019. ResultsThe overall response rate was 54.3%. Sixty-nine percent of hospitals were public and the most commonly reported hospital size was 101-250 beds. Nine percent of responding hospitals remained open round the clock and 57.5% did not offer a continued care service. A total of 41.9% of hospitals dispensed medications to outpatients in the afternoon and 52.7% of hospital pharmacy departments were accredited to some quality standard. The mean number of specialist pharmacists per pharmacy Department was 5.34 (SD: 6.22); 47% of pharmacists spent at least half their working day in a clinical unit. Hospital pharmacy departments had a mean of 0.3 (SD: 0.7) or 0:9 (SD: 1.4) automated storage and dispensing carousels, depending on whether they were horizontal or vertical, respectively. A total of 16.1% of beds were assisted by automated dispensing systems, a figure that reached 33.5% in hospitals with more than 1,000 beds. Three percent of hospital pharmacy departments had a robotized system for compounding chemotherapy medications and 24.8% had a traceability and safety system. Smart infusion pumps were used by 21.4% of hospitals. Electronic prescriptions were implemented in 98.8% of hospitals for inpatients and in 62% for outpatients. ConclusionsSpanish hospital pharmacy departments face a shortage of specialist pharmacists, although incorporation of such professionals to clinical units has doubled in the last few years. There has been an increase in the level of automation of the logistic processes involved in medication dispensing, but there is still significant room for improvement in the area of robotized dispensing and compounding traceability systems. This data could play an invaluable role in the design of future action plans.

Implementation of Specialized Pharmaceutical Care Hospital Outpatient Clinics in a Hospital Pharmacy Department

ObjectiveTo describe the organization of patient care into Specialized Pharmaceutical Care Hospital Outpatient Clinics in a Hospital Pharmacy Department, to evaluate their healthcare quality, and the quality perceived by outpatients. MethodA retrospective observational study in a High-Level Hospital Pharmacy Department during three periods (years 2010, 2013 and 2016); description of the organization at the levels of structure, human resources, material resources and working procedures; evaluation of healthcare quality through the analysis of three variables in terms of procedure: prior appointment compliance, waiting time and documentation of pharmaceutical care; evaluation of quality perceived by outpatients through a satisfaction survey; comparative statistical analysis of means (Student's t) and proportions (Pearson's chi square). ResultsFifteen (15) specialized outpatient clinics were opened and managed by 18 pharmacists; between the initial and final periods of the study (2010 vs. 2016), the compliance with previous appointments was of 61.3% vs. 88.8% (p <0001), waiting time was 27.6±12.1 vs. 12.1±5.4 minutes (p <0.0001), documentation of pharmaceutical care in the clinical record was of 2.3% vs. 9.81%% (p <0.0001), and the overall satisfaction perceived by the patients was 6.63±2.36 vs. 9.16±1.27 (p <0.01). ConclusionsThe model of Specialized Pharmaceutical Care Hospital Outpatient Clinics exposed, focused on the patient and with continuity of care, has improved the quality of care and the quality perceived by the patients and it's in optimal conditions to investigate its contribution on health outcomes and on the health system through a better quality, safety and efficiency of pharmacotherapy.

Evolution of the SEFH's “Proyecto 2020” in a Hospital Pharmacy Department

ObjectiveTo describe the evolution of our Pharmacy Service in relation to the objectives of Proyecto 2020 (Project 2020) of the Sociedad Española Farmacia Hospitalaria (Spanish Society of Hospital Pharmacy), to identify weak points, and to implement improvement actions to achieve the set objectives. MethodA 10-year prospective observational study. We analysed the initial situation of the Pharmacy Service and conducted follow-up reassessments. We developed a questionnaire comprising the 28 goals of the five strategic focus areas (blocks) of the project based on a 4-level quantitative classification of these goals: level A, implementation in all areas (3 points); level B, implementation in some areas (2 points); level C, not implemented, but formally discussed (1 point); or level D, not addressed (0 points). After each assessment, we identified the goals with the lowest scores and determined which improvement actions needed to be implemented. After each assessment, the targets with lower score were identified and improvement actions needed to be implemented were decided. ResultsThe initial assessment was conducted in 2010. The overall score was 42/84 and the highest score (7/9) related to the block scientific evidence. The follow-up reassessments (2014, 2019) and the final one (2020) showed an overall gradual increase in level A scores (18% vs 53%) and a decrease in level C (43% vs 4%) and D objectives (14% vs 4%). All blocks improved their score, obtaining a final score of 68/84 (31% increase). A total of 18 weak points were identified and appropriate improvement actions were implemented, which included automation, quality management, the creation of multidisciplinary working groups, the prevention of medication errors, the incorporation of intelligent pumps or therapeutic drug monitoring among other solutions. ConclusionsProjects promoted by scientific societies help to prioritize improvement actions in health organizations that contribute to improve their quality. Follow up conducted within Project 2020 has led to improvements in all blocks and positive impacts on the quality of pharmaceutical practice.

Survey on the situation of telepharmacy as applied to the outpatient care in hospital pharmacy departments in Spain during the COVID-19 pandemic

ObjectiveTo analyze the status of the implementation and development of telepharmacy as applied to the pharmaceutical care of outpatients treated at hospital pharmacy services in Spain during the COVID-19 pandemic. MethodSix weeks after the beginning of the confinement period, an online 10-question survey was sent to all members of the Spanish Society of Hospital Pharmacists. A single response per hospital was requested. The survey included questions on the provision of remote pharmaceutical care prior to the onset of the health crisis, patient selection criteria, procedures for home delivery of medications and the means used to deliver them, the number of patients who benefited from telepharmacy, and the number of referrals made. Finally, respondents were asked whether a teleconsultation was carried out before sending patients their medication and whether these deliveries were recorded. ResultsA total of 39.3% (n = 185) of all the hospitals in the National Health System (covering all of Spain's autonomous regions) responded to the survey. Before the beginning of the crisis, 83.2% (n = 154) of hospital pharmacy services did not carry out remote pharmaceutical care activities that included telepharmacy with remote delivery of medication. During the study period, 119,972 patients were treated, with 134,142 deliveries of medication being completed. Most hospitals did not use patient selection criteria. A total of 30.2% of hospitals selected patients based on their personal circumstances. Home delivery and informed delivery (87%; 116,129 deliveries) was the option used in most cases. The means used to deliver the medication mainly included the use of external courier services (470%; 87 hospitals) or the hospital's own transport services (38.4%; 71 hospitals). As many as 87.6% of hospitals carried out teleconsultations prior to sending out medications and 59.6% recorded their telepharmacy activities in the hospital pharmacy appointments record. ConclusionsThe rate of implementation of telepharmacy in outpatient care in Spain during the study period in the pandemic was high. This made it possible to guarantee the continuity of care for a large number of patients.

Centralization of the methadone maintenance plan in a hospital pharmacy department in the Community of Madrid

In February 2018, Resolution 189/2018 was published in the Autonomous Community of Madrid with the objective of centralizing the procedure for the acquisition, preparation, distribution, and dispensing of methadone to Centres for the Comprehensive Care of Drug Addiction Patients within the Madrid Health Service under the responsibility of a Hospital Pharmacy Service.The Hospital Pharmacy Service began this activity in March 2018. This is the first time that the comprehensive management of a methadone maintenance plan has been centralized in an Hospital Pharmacy Service for the care of drug-dependent patients in the Autonomous Community of Madrid.At the beginning of the Project, the previous workflow was analysed, the pharmaceutical laboratory was adapted, and the methadone acquisition procedure was designed. A communication channel with the Centres for the Comprehensive Care of Drug Addiction Patients was implemented and application forms were designed. Corresponding control procedures were established given that the medication under consideration was a narcotic.Standard procedures for the acquisition of methadone, of containers for personalized dosing in Centres for the Comprehensive Care of Drug Addiction Patients, and transport routes were designed and contracted out through public tender in compliance with the Public Administration Contract Law. A tender has also been awarded for the implementation of a computerized management system and automated dispensing systems, which are currently undergoing installation.The pharmacotherapeutic protocol of the Methadone Maintenance Plan of the Autonomous Community of Madrid is also being updated.Over 18 months, 5,300 L of methadone solution have been prepared and 2,844 individual prescriptions have been dispensed.High levels of perceived satisfaction were reported via a questionnaire administered to the Centre for the Comprehensive Care of Drug Addiction Patients staff. The response rate was 92%. Overall satisfaction was very satisfied/quite satisfied (91%) and satisfied (9%). These results highlight the high level of satisfaction (quite satisfied or very satisfied: 81.8%) with the effectiveness and speed of resolution of incidents by the Hospital Pharmacy Service staff.This process incorporates the knowledge and experience of hospital pharmacists into this healthcare field, as well as taking advantage of existing resources, facilities, and procedures. All these aspects lead to an efficient, effective, and safe approach to this clinical-care activity and enable a change in the pharmacotherapeutic health care model for opioid-dependent patients.

Mapping the clinical pharmacokinetics and pharmacogenetic units operating in Spanish hospitals

ObjectiveThe goal of this article is to analyze the situation of pharmacokinetics and pharmacogenetics units in the pharmacy departments of Spanish hospitals, evaluate their development both in the clinical and educational areas, and draw up a map reflecting their current status. MethodA 29-item survey structured in five blocks was designed with general questions about the respondents’ hospital and the clinical and educational activities carried out by their pharmacy department, in the fields of both pharmacokinetics and pharmacogenetics. ResultsSixty-nine hospitals answered the survey. The highest response rates corresponded to Catalonia, the Valencia region and Andalusia. The drug families subject to closest monitoring were classic antibiotics (93%), digoxin (57%), classic antiepileptics (51%) and biologicals (43%). The most frequently used computer programs included PKS and NONMEM (93% and 22% of hospitals, respectively). Regarding training in pharmacokinetics, second year residents were those who most frequently rotated through the pharmacokinetics unit (40%), while 44% of those units allowed external residents. As far as pharmacogenetics is concerned, in 42% of hospitals that engaged in pharmacogenetic work, the department in charge was pharmacy. The most frequent specialties covered were hemato-oncology (72%) and psychiatry (15%). Twenty-four percent of hospitals offered rotations through their pharmacogenetics unit but only seven of them allowed external residents. ConclusionsThe results of the survey showed an increase in the performance of pharmacokinetic and pharmacogenetic activities by Spanish hospital pharmacies as compared with the data from a 2009 baseline survey, with many hospitals introducing the performance of therapeutic drug monitoring of non-classical antibiotics, immunosuppressants and biologies. However, the percentage of hospitals that follow the ideal model based on analytical determinations and pharmacokinetic reporting has decreased the data obtained served as a basis to create an updated map of the pharmacokinetics and pharmacogenetics units operating in Spanish hospital pharmacy departments. This map, available at http://bit.ly/mapaPKGen, will be very useful to facilitate the training of residents in these disciplines and will help promote the development of pharmacokinetic and pharmacogenetic activities among hospital pharmacists.

Encuesta Nacional de la SEFH-2019: cartera de servicios, actividad asistencial, docencia e investigación en los Servicios de Farmacia Hospitalaria en España

ObjectiveTo report on the results obtained from the 2019 SEFH National Survey regarding the service portfolio, care activities, training programs and research work of Spanish hospital pharmacy departments. MethodIn March 2019, SEFH designed and distributed a questionnaire containing 77 questions grouped into 8 domains to its 368 affiliated hospital pharmacy departments. The questionnaire included an additional section on the activities carried out in 2017 and 2018. ResultsThe overall response rate was 54.3%. Sixty-nine percent of hospitals were public and 75% were general hospitals. A total of 88.6% of hospital pharmacy departments provided pharmaceutical care to inpatients, whereas 77.5% and 65% treated outpatients and ambulatory patients, respectively. Sterile formulations were prepared by 70.6% of pharmacy departments, while 12% measured drug levels in bodily fluids; 76.9% of hospitals with more than 1,000 beds prepared pharmacokinetic reports. In 2018, hospital pharmacies provided for a mean of 929 patients a month and 2,680 a year. The amount of formulations (sterile and non-sterile) prepared was 10,394,492, sterile formulations accounting for 62.6%. The average amount of clinical trials managed in hospitals with > 500 and > 1000 beds was of 186.2 and 421.8, respectively. The median of number of undergraduate tuition agreements between pharmacy departments and universities was 1 (IQR: 0-2); 21.5% of pharmacy departments had no agreements with any university. The mean number of undergraduate pharmacy students per hospital pharmacy was 4.12 (SD: 8,26). A total of 290 pharmacists were associate professors at some university. Fifteen percent of pharmacists held a certification from the Board of Pharmacy Specialties, 55.3% of them in the specialty of oncology. Hospital pharmacy departments employed a mean of 1.31(SD: 2,23) PhD holders. From those which reported the impact factor of their publications, 60% had an impact factor of zero while in 19.6% the impact factor was > 10. ConclusionsCare of out-patients and medication compounding are increasingly the main activities performed in Spanish hospital pharmacies, while there is still considerable room for improvement in the area of clinical pharmacokinetics. Pharmacy departments are generally committed to training as a key activity, while scientific output is still limited despite the increase in the number of PhD pharmacist.