Hospital Pharmacy Department Research Articles

Impact of round‐the‐clock pharmacist inpatient medication chart review on medication errors

AbstractIntroductionMedication errors are common causes of preventable adverse drug events and increase the risk of morbidity and mortality. Beginning in July 2014, Tan Tock Seng Hospital Pharmacy Department (Singapore) implemented the round‐the‐clock inpatient medication chart review service by pharmacists. We evaluated the impact of this service on medication errors and the consequences of these errors.MethodsPharmacy intervention data from 2013 to 2015 were accessed. Severity of medication errors was defined according to the National Coordination Council for Medication Error Reporting and Prevention (NCCMERP) categories. Interrupted time series analysis was used to assess the impact of the service on monthly error rates. Consequences of medication errors were investigated in a matched case‐control analysis comparing outcomes and costs between cases with “errors” (Category D to I) and controls who had “near‐misses” (Category B). A cost analysis was done in Singapore dollars (S$).ResultsThe mean number of “near‐misses” was 32.04 per 1000 patient‐days/month prior to the service. When the service was implemented, the interrupted time series analysis showed a level increase of 21.43 per 1000 patient‐days/month (95% confidence interval [CI], 14.21, 28.65, P < .01) with a positive trend change of 1.04 per 1000 patient‐days/month. Patients with “near misses” had lower median hospitalization costs (S$2673.60 interquartile range [IQR] [S$1365.70‐5336.20], vs S$6326.60 IQR [S$1926.20‐13 609.00], P = .002) and length of stay (10 days [4‐21] vs 17 days [5‐42], P = .025). No significant differences were observed for all other outcomes studied.ConclusionRound‐the‐clock pharmacist inpatient medication review service increased detection of “near misses” and prevented these errors from reaching patients, which may otherwise have resulted in increased hospitalization costs and length of stay.

Drugs supply and pharmaceutical care management practices at a designated hospital during the COVID-19 epidemic.

The coronavirus disease-19 (COVID-19) is caused by the novel severe acute respiratory syndrome coronavirus that was first detected at the end of December 2019. The epidemic has affected various regions of China in different degrees. As the situations evolve, the COVID-19 had been confirmed in many countries, and made a assessment that it can be characterized as a pandemic by the World Health Organization on March 11, 2020. Drugs are the main treatment of COVID-19 patients. Pharmaceutical service offers drug safety ensurance for COVID-19 patients.According to COVID-19 prevention and control policy and requirements, combined with series of diagnosis and treatment plans, pharmacists in the first provincial-level COVID-19 diagnosis and treatment unit in Jilin Province in Northeast China have established the management practices of drug supply and pharmaceutical care from four aspects: personnel, drugs supply management, off-label drug use management and pharmaceutical care. During the outbreak, the pharmaceutical department of THJU completed its assigned workload to ensure drug supply. So far, no nosocomial infections and medication errors have occurred, which has stabilized the mood of the staff and boosted the pharmacists' confidence in fighting the epidemic. For the treatment of COVID-19, pharmacists conducted adverse reaction monitoring and participated in the multidisciplinary consultation of COVID-19. Up to now, the COVID-19 patients admitted to THJU have not shown any new serious adverse reactions and been cured finally. The hospital pharmacy department timely adjusted the work mode, and the formed management practices is a powerful guarantee for the prevention and control of the COVID-19 epidemic. This paper summarized the details and practices of drug supply and pharmaceutical services management to provide experience for the people who involving in COVID-19 prevention and contain in other abroad epidemic areas.

Analysis and improvement of preparation and handling of hazardous oral drugs in a Hospital Pharmacy Department

RESUMEN Objetivos: Identificar de forma detallada las actividades en las cuales la exposición al riesgo es mayor por fallo en el manejo del medicamento peligroso (MP) o las medidas de autoprotección, y valorar su reducción tras llevar a la práctica una sesión formativa. Métodos: Estudio observacional y prospectivo, realizado en un hospital general de especialidades. Durante dos meses se lleva a cabo mediante el método de observación directa, un análisis de la manipulación y reenvasado de medicamentos peligrosos orales por personal técnico. Este periodo se dividió en dos etapas, tomando como punto de inflexión una sesión formativa al personal de farmacia al que se le explicaron los nuevos circuitos de trabajo para el manejo seguro de los medicamentos peligrosos, los protocolos elaborados, se informó sobre el manejo de los equipos de protección individual, y se entregó la documentación comentada. Posteriormente, las manipulaciones inseguras se categorizaron según la documentación de referencia: NIOSH y INSHT. Resultados: El número total de observaciones fue 181; 68 durante el primer periodo, de las cuales 11 (16,2%) correspondieron al reenvasado de MP orales. En todos los casos hubo una manipulación insegura. 113 observaciones en el segundo periodo, de ellas 16 (14,1%) fueron de reenvasado de MP. La probabilidad de error fue del 81,3%. En todos los casos la mayor probabilidad de error se asoció al empleo de los equipos de protección individual. Conclusiones: Mediante el método de la observación directa se han identificado los subprocesos donde es necesario incidir para disminuir el riesgo asociado al manejo de estos fármacos, que se han reducido parcialmente tras el empleo de una sesión formativa.

Assessing Limitations and Solutions in Developing Clinical Pharmacy Services in Sri Lankan Government Hospitals: A Report from a Hospital Pharmacists’ Workshop

Adverse events related to unsafe medication practices remains a leading cause of avoidable injury and mortality. Although there is vast evidence to support clinical pharmacy services in improving medication safety, pharmacy departments in Sri Lankan government hospitals still primarily manage the distribution and provision of medicines. Acknowledging this, a Hospital Pharmacists’ Workshop was organised to identify factors that may impede clinical pharmacy services and medication safety practices in Sri Lanka, and further, collate recommendations to overcome these factors. A representative sample of Chief Pharmacists from hospitals around the workshop location of Kandy, representatives of the Society of Government Pharmacists (SGP) and Pharmaceutical Society of Sri Lanka (PSSL) were invited as a sample of convenience attended the workshop hosted by the University of Peradeniya. The workshop was facilitated by experienced pharmacists visiting on behalf of the Collaboration of Australians and Sri Lankans for Pharmacy Practice, Education and Research (CASPPER) group. Delegates were divided into groups for facilitator led discussions. Issues, solutions and recommendations were discussed and agreed upon as one large cohort. The consensus objective identified by attendees was to support government pharmacists in recognising and improving identified patient, pharmacist and system factors that hinder the implementation of clinical pharmacy services. Developing and promoting the adherence to best practice standards, instituting competency standards for pharmacists, and streamlining current processes were the main modifiable recommendations proffered by attendees. It is acknowledged that service improvement is not an easy task. Actions from national groups, individual hospitals and universities are required to implement effective and sustainable changes as identified by attendees at this workshop.

Relationship between gastroenterologists and hospital pharmacists: the results of a national survey. The CONDIFA study.

project CONDIFA ("Consenso Digestivo-Farmacia Hospitalaria") aims to establish lines of agreement between both specialties in order to improve patient care and resource optimization. In this initial work our goal was to collect the views held by both fields on issues pertaining to their mutual cooperation in our country. an online survey was administered to members of the Sociedad Española de Patología Digestiva (SEPD) and Sociedad Española de Farmacia Hospitalaria (SEFH). It comprised 31 questions, and was developed by a task force established by both Societies. the survey was filled out by 241 gastroenterologists and 126 pharmacists. Of these, 55 % were women. A total of 76.8 % of gastroenterologists and 88.1 % of pharmacists answered that relations between both specialties are good/very good, without reaching statistically significant differences. For both groups pharmaceutical expenditure is a priority/annual objective in their department, albeit they do not agree on prescription freedom and industry influence. Biologics committees are considered to be useful by most respondents, and both groups think it appropriate that meetings/sessions be scheduled between both specialties, and that a reference pharmacist be appointed for gastroenterology. this institutional research, driven by SEPD and SEFH, demonstrates that, while cooperation between the gastroenterology and hospital pharmacy departments is close and adequate, some areas remain open to improvement, which will result in better, more effective patient care.

Pharmacoeconomic Evaluation on Treatment of Diabetic Patients in a Charitable Hospital

This study aimed to conduct a pharmacoeconomic evaluation of the treatment of diabetic patients in a charitable hospital. A retrospective study was carried out for a period of 8 months from August 2016-March 2017. Patients admitted in general medicine with age above 18 years diagnosed with diabetes and on at least one antidiabetic medication. Patient’s data was collected by referring patient’s treatment charts and case notes, hospital billing system, medical record department and hospital pharmacy department. In this study, the direct medical cost was analysed. A total number of 212 diabetic patients were enrolled in the study of which 131 (61.8 %) were males, and 81 (38.2 %) were females. It was found that 67 % of patients had comorbid conditions and 33 % without any complications. One hundred and eleven (52.35 %) patients were prescribed a combination of insulin and oral hypoglycaemic agents, 66 (31.13 %) patients received insulin alone and 35 (16.50 %) patients received only oral hypoglycaemic agents. The annual median cost incurred for the management of diabetes with and without complications per patient was INR 14 959.60 and INR 8619.90, respectively. The study revealed that the costs for males with and without diabetes complications were INR 21 095 and INR 11 644.70, respectively. The corresponding figure for females was INR 12 030 and INR 8515. The cost incurred for nephropathy and peripheral circulatory co-morbidities was the highest (INR 53 795.50), whereas the cost for managing diabetes with nephropathy, neuropathy, retinopathy and peripheral circulatory comorbidities was INR 37 888.00. The study concluded that the cost of treatment could be drastically reduced by early identification and treatment of diabetes thereby preventing the development of diabetes-associated comorbidities.

Case for antimicrobial stewardship pharmacy technicians in Australian hospitals.

The pharmacist's role in hospital antimicrobial stewardship (AMS) programs is known to improve patient safety and the quality of care. Despite this, many Australian hospitals struggle to provide adequate pharmacy AMS program resourcing and need to explore newer models of care. The Pharmacy Board of Australia's Guidelines for Dispensing Medicines permit suitably qualified, competent and experienced pharmacy technicians to assist pharmacists in 'tasks in a pharmacy department'. The pharmacy technician workforce is expanding, and there is growing interest in career advancement and expansion of the pharmacy technician role. We propose that the pharmacy technician, a well-integrated member of many Australian hospital pharmacy departments, can play an important role in hospital AMS programs. To bolster AMS initiatives in Australian hospitals, this paper explores the existing evidence for pharmacy technicians in AMS programs and describes how this role may be better supported in Australia.

Hepatitis C virus infection and the role of a pharmaceutical care program.

The design, implementation, and assessment of a comprehensive pharmaceutical care program (CPCP) for hepatitis C virus (HCV)-infected patients treated with direct-acting antivirals (DAA) are described. The advent of DAA regimens has caused the evolution of the role of hospital pharmacists, leading to the development of more specialized models of pharmaceutical care. Three clinical pharmacists were incorporated into the pharmacy department of a general tertiary teaching hospital in Madrid, Spain, with the aim of developing and implementing a CPCP for HCV-infected patients. Pharmacists were responsible for proposing standards and local guidelines to physicians, monitoring adherence to guidelines, managing drug interactions and adverse drug events (ADEs), providing patient education, and evaluating health outcomes and costs. Implementation steps included (1) estimation of the healthcare demand and pharmacy resources, (2) definition of the workflow of the CPCP, (3) definition of the treatment care plan, for which tools were developed to support pharmaceutical validation, detection, and management of ADEs and drug-drug interactions, and (4) program assessment in terms of safety and cost-effectiveness. The pharmacists' interventions performed, severity of errors intercepted, and patients' satisfaction with the CPCP were also assessed. This CPCP demonstrates that the involvement of the pharmacist throughout the care plan prevents harmful medication errors in this population (0.1 per patient) and prompts significant cost savings (€1.2 million for 1,930 treated patients). The implementation of a CPCP developed by hospital pharmacists for patients treated with DAA for HCV infection is an effective approach for preventing harmful medication errors and improving cost- effectiveness.

Time for a CHAT? A pilot study of the implementation of the Competency Handbook for Assistants and Technicians (CHAT)

AbstractBackgroundThe Logan Hospital Pharmacy Department implemented a training framework (TF) for pharmacy technicians.AimThis study determined whether implementation of a TF for pharmacy technicians improved knowledge and consistency in pharmacy technician ward‐based services in a large secondary teaching hospital.MethodsThe study was conducted in two phases. The first phase involved defining competencies and developing a supporting TF. The Competency Handbook for Assistants and Technicians (CHAT) TF consists of observations, case discussions, feedback sessions and education modules. Questionnaires were developed based on the defined competencies to assess the knowledge component of the TF. The second phase of the study saw the implementation of the TF within the department. Practice was observed for each pharmacy technician prior to and following 6–12 months of training against the framework.ResultsImplementation of the TF demonstrated an improvement in both knowledge and consistency of practice. Of the 109 competencies developed, 90 were included for statistical analysis. All participants demonstrated a significant (p < 0.05) improvement in the ward‐based clinical support domain, the core component of advanced‐scope practice. Participants also demonstrated improved performance in their everyday duties. Although all participants trended towards overall improvement in the knowledge domain, this did not reach statistical significance.ConclusionImplementation of the CHAT TF delivered improved pharmacy technician knowledge and fostered greater consistency of practice. The results of this pilot study have created a platform for further research into structured development programs and career advancement pathways for pharmacy technicians within Australia.

Prescription Audit in an Outpatient Pharmacy of a Tertiary Care Teaching Hospital-A Prospective Study

Background: Prescription audit aids in evaluating the quality of medical treatment offered to the patients. It helps to discern any effective changes that would support health care professionals to proffer superior quality of care to the patients. Aim of the study is to carry out prescription audit in the outpatient pharmacy department of a tertiary care teaching hospital. Methods: A prospective observational study was conducted on 500 prescriptions for a span of four months in the outpatient pharmacy department of a tertiary care teaching hospital in South Karnataka, India. All the prescriptions were analyzed based on WHO prescribing indicators and were evaluated for errors in prescription writing. Data were entered and analyzed using into SPSS. Graphic representation has been used for visual interpretation of the analyzed data. Results: Five hundred scripts comprising of 1,661 drugs were analyzed. The average number of drugs per prescription was three. The study encompassed 52% males and 48% females. Most patients were from the age group of 41-60 years. Only 3.6% (18) of medications were prescribed by generic names. Patients received 9% (145) medications contained in Essential Drug List and prescriptions containing antibiotics were 19% (97). Majority of the prescriptions were from Orthopaedics (18.6%) tailed by General Medicine (15.8%). Consecutively Analgesics (12.7%) were the most commonly prescribed drug class, among which Diclofenac and Paracetamol+Tramadol were usually prescribed, this was tailed by gastrointestinal medicines (11.7%). Conclusion: Prescription audit can be helpful to plan appropriate intervention to ensure the rational drug therapy and to evaluate the existing drug use pattern. It also reflects the perspectives of current prescribing pattern in hospitals. Key words: Prescription audit, WHO prescribing indicator, Essential drugs, Outpatient Pharmacy.

Use of the EFQM excellence model to improve hospital pharmacy performance.

Quality management systems are widely used to improve the quality and efficiency of healthcare services. However, evidence regarding the value of the European Foundation for Quality Management (EFQM) model in improving the performance of hospital departments is lacking. To describe the value of the EFQM model as a quality framework for improving the performance of a hospital pharmacy department (PD). A case study describing the development of the Enablers' criteria of the model and the results achieved. PD in a tertiary-care teaching hospital of the Madrid Public Health Service (Spain). Four self-assessments were conducted using the questionnaire "Perfil" during the period 2008-2017. A quality improvement plan was developed on the basis of the results of each self-assessment. A balanced scorecard was used to track progress. Improvement in quality management was externally evaluated by the Spanish Management Excellence Club in 2010, 2013, and 2017. Change in the scores obtained in the external assessments, the quality improvement initiatives implemented for each Enabler's criteria, and the results of key performance indicators. The EFQM was a useful framework for self-assessment and a good system for identifying improvement initiatives. The model progressively improved the services provided for patients, the safety and efficiency of pharmacotherapy, productivity of the PD, and customer and staff satisfaction. The external assessment scores exceeded 300 points in 2010, 400 points in 2013, and 500 points in 2017. Scores for all of the criteria progressively improved, particularly in 'people'. The EFQM was a practical tool for improvement of PD performance, especially in areas such as strategic planning, people management, and innovation. The main difficulties were the lack of decision-making capacity in relevant areas and benchmarking with other PDs.

Snapshot of antimicrobial stewardship programs in the hospitals of Pakistan: findings and implications

ObjectiveWe are unaware of the extent of antimicrobial stewardship programs (ASPs) among hospitals in Pakistan, which is a concern given the population size, high use of antibiotics across sectors and increasing antimicrobial resistance (AMR) rates. Consequently, we sought to address this by undertaking a comprehensive survey. MethodIn this cross-sectional observational study in Punjab, an instrument of the measure was developed based on health care facility characteristics and ASPs after an extensive literature review. The questionnaire was circulated by mail or through drop off surveys to medical superintendents or directors/heads of pharmacy departments of hospitals. ResultsOut of 254, a total of 137 hospitals fully completed the questionnaire - 11 primary, 65 secondary, 46 tertiary and 15 specialized hospitals. The use of antimicrobial prescribing guidelines (68.7%), provision of infectious diseases consultation services (66.4%), clinical pharmacy service (65.7%), use of drug and therapeutics committees to approve antimicrobial prescribing (65.5%), regular audit by doctors on antimicrobial prescribing (54.1%) and use of a restricted formulary for antimicrobial (50.4%) were the most common ASPs. However, most of these activities were only somewhat or moderately successful. Whereas, electronic antimicrobial prescribing approval systems (15.3%), using a sticker to notify prescribers regarding the need to obtain approval for the antimicrobial prescribed (16.1%) and participation in the national antimicrobial utilization surveillance program (19.7%) were only seen in a few hospitals. ConclusionStudy inferred that there are inadequate ASPs in the hospitals of Pakistan. A multidisciplinary approach, clinical leadership and availability of motivated and trained individuals are essential elements for the success of future ASPs.

Incorporation of a theme‐based research model into a pharmacy department research program

AbstractIn Australian hospital pharmacy departments, research programs are growing. Research is encouraged to be part of standard practice by many Society of Hospital Pharmacists of Australia (SHPA) Standards of Practice documents and, in 2017, the SHPA National Translational Research Collaborative was implemented. Traditionally, the postgraduate research degree format is one of a theme‐based research model. Theme‐based research has been implemented in the Pharmacy Department of St Vincent's Hospital (Sydney) and a body of work has been produced. To illustrate this process, our work in the area of anaphylaxis and allergy in the emergency department over 10 years is described. This model has also been implemented for other target areas with success. It is a model that could be implemented at other sites to promote a collaborative research culture in a pharmacy department and build a body of work in a targeted area.

Leadership Succession Preparedness and Sense of Urgency in Canadian Hospital Pharmacy

Leadership turnover is unavoidable in all organizations, including hospital pharmacy departments. Succession planning can promote organizational stability, among other benefits. To gather a contemporary, nationwide measure of the level of preparedness for department leadership succession and to gain related insight from a variety of pharmacy leaders. This study was an environmental scan of Canadian hospital pharmacy leaders. An online survey was conducted to identify the current rate of succession planning; to describe existing succession plans; to determine the perceived need for succession planning; and to describe strategies for, barriers to, and facilitators of succession planning. Eighty-three responses were received. Thirteen respondents (16%) reported that their hospital pharmacy departments had a succession plan, and 13 (16%) of individuals had known successors. Most respondents (64/75 [85%]) perceived succession plans to be rare or nonexistent across Canada. However, 72% (54/75) felt that succession planning was needed for their own leadership position. The most common barriers to succession planning were a lack of formal structure or tools, lack of plan implementation, unionization, and lack of career ladder positions. Select facilitators to succession planning identified by respondents were having a strong existing leadership and having an abundant pool of capable successors. Most Canadian hospital pharmacy departments and individual leaders represented in this survey were not prepared with succession plans. A collective effort to proactively enact succession planning in Canadian hospital pharmacy departments would have multiple benefits for existing and aspiring leaders and, ultimately, the profession as a whole.

Implementation of a pharmaceutical care program for patients with hepatitis C treated with new direct-action antivirals.

Background A pharmaceutical care program is necessary to improve the management of direct-acting antivirals in hepatitis C. Objective Describe health outcomes obtained with the implementation of a pharmaceutical care program in Hepatitis C patients treated with direct-acting antivirals. Setting This study was performed in a pharmacy department of a university hospital. Methods Retrospective study between 1st-April 2015 and 28st-February 2016. Hospital pharmacists implemented interventional measures for validation of antivirals prescriptions, detection of drug-interaction, adverse drug events, education and patient´s adherence to antiviral regimen. Main outcome measure Health and quality outcomes of the implementation of the pharmaceutical care program. Results A total 128 patients were enrolled. The overall sustained virologic response at week 12 post-treatment rate was 96.1% (95% CI 92.7-99.5). Adverse drug events occurred in 90.6% of the patients, and the majority were grade 1-2. Pharmacists made 334 pharmaceutical interventions. 35.5% of these interventions were aimed to resolve negative results of drugs. 80.9% of the negative results of drugs improved or were eliminated with the application of the measures proposed by the pharmacists (p ≤ 0.001). Pharmacists carried out 175 preventive interventions to avoid negative results of drugs. 97.3% of these interventions were accepted and managed to prevent the appearance of negative results of drugs (p = 0.453). Conclusion The implementation of a pharmaceutical care program in patients with hepatitis C treated with direct-acting antivirals has improved the safety in the use of these drugs.

Error Detection and Cost Savings With an Image-Based Workflow Management System Connected to a Computerized Prescription Order Entry Program for Antineoplastic Compounding.

The aim of the study was to analyze both the prevalence of errors with the implementation of an image-based workflow management system during the antineoplastic compounding process, and the estimated costs associated with the negative clinical outcome if the errors had not been intercepted. Three months after the implementation of Phocus Rx system at a hospital pharmacy department, the identification, classification (type, preparation stage, and cause), and potential severity degree (from negligible to catastrophic) of the errors intercepted were determined. The probability of an error causing an adverse event if it had reached the patient (from nil [0] to high [0.6]) and its consequences was estimated by a team of clinical pharmacists and physicians. Cost-effectiveness analysis from the hospital's perspective was performed. Overall, 9872 antineoplastic medications were prepared using Phocus Rx. The total compounding error rate was 0.8% (n = 78, 56 [69.2%] were related to incorrect dose, 20 [28.2%] to incorrect drug preparation or conditioning technique, and 2 [2.6%] were wrong drugs). Approximately 70% of the detected errors were classified as undetectable via the previous verification practice, with 11.55% judged to be potentially severe (n = 9) and 51.3% moderate (n = 29). Likelihood of occurrence of an adverse event was medium (0.4) to high (0.6) for 37.2% of the errors. Estimated cost ratio and return on investment were €4.21 and 321%, respectively. The implementation of Phocus Rx prevented antineoplastic preparation errors that would have reached the patient otherwise. In addition, acquisition of this technology was estimated to be cost-effective.

Pharmacological prophylaxis of venous thromboembolism in adult medical and surgical wards in the Gaza Strip: a multi-centre clinical audit

BackgroundHospital-acquired venous thromboembolism (VTE) has a reported worldwide prevalence of 0·8–11%. It is the most common cause of preventable death, underlining the importance of VTE prevention. MethodsThis clinical audit was conducted in adult medical and surgical wards of three hospitals in Gaza, from March to August, 2017. Patients were assessed prospectively using the modified Padua Prediction Score risk assessment model and the Caprini Score to categorise patients as having high or low risk of developing VTE. Approval was obtained from the General Directorate of Human Resources of the Ministry of Health. FindingsIn total, 300 medical patients were included, with a mean age of 54 years (SD 22 years) and a mean hospital stay of 4 days (SD 2·5 days). Of these patients, 49·7% (149 of 300) had a Modified Padua score of 4 or greater (anticoagulants indicated), of whom 84·6% (126 of 149) received anticoagulants in accordance with guidelines, whereas 15·4% (23 of 149) did not. Of the 50·4% of patients (151 of 300) with a score of less than 4 (anticoagulants not indicated), 64·2% (97 out of 151) had no VTE prophylaxis, whereas 35·8% (54 out of 151) received it without indication. In total, 150 surgical patients were included, with a mean age of 32 years (SD 14·7 years) and a post-operative stay of 3 days (SD 1·5 days). Of these patients, 43·3% (65 of 150) had a Caprini score of greater than 2 (anticoagulants indicated), 69·2% (45 of 65) received anticoagulants in accordance with guidelines, but 30·7% (20 of 65) did not. Of the 56·7% of patients (85 of 150) with a score of 2 or lower (anticoagulants not indicated), 82·3% (70 out of 85) had no VTE prophylaxis, whereas 17·7% (15 out of 85) received it without indication. InterpretationThe results reflect poor adherence to current standards of care for VTE prophylaxis, demonstrating that an action plan for appropriate heparin prescription is needed for each hospital. Action plans involving hospital pharmacy departments, multidisciplinary care, good communication within teams, and staff education are underway. A re-audit is planned following this action. FundingNone.

ASHP Foundation Pharmacy Forecast 2019: Strategic Planning Advice for Pharmacy Departments in Hospitals and Health Systems.

# Foreword {#article-title-2} The ASHP Research and Education Foundation (“the Foundation”) is pleased to present the seventh edition of the annual Pharmacy Forecast . We are again pleased to disseminate the Pharmacy Forecast through AJHP, providing readers with easy access to the report. The

Awareness and Acceptance of Use of Mobile Authentication Service by Patients

Background: Nigeria is one of the countries with the highest burden of fake and counterfeit drugs. Interventions such as Mobile Authentication Service (MAS) is being deployed by the National Agency for Food and Drug Administration and Control (NAFDAC) to assist patients in confirming the authenticity of their medications. Therefore, this study evaluates the acceptance of Nigerian patients of MAS. Objective: To investigate awareness and acceptance of MAS among patients visiting the outpatient pharmacy of the Lagos University Teaching Hospital.Method: This is a cross-sectional survey. The study was conducted in the outpatient pharmacy department of the Lagos University Teaching Hospital, Lagos State from May, 2017 – August, 2017. A structured questionnaire, developed using the Technology Acceptance Model (TAM) concept (α = 0.74), was used to assess acceptance of MAS among patients. Linear regression and correlation statistics wereused to determine predictors of MAS acceptance. Results: Significant association exist between Awareness of MAS and Use (X = 69.116, p = 0.000), Procurement at licensed community stores and Use (X =14.456, p = 0.001) as well as Acquisition at Hospital Pharmacy and Use (X = 46.053, p = 0.000). Also, Perceived Usefulness (PU) and Perceived Ease of Use (PEOU) had a strong association with respondents’ Attitude to Use (ATT) {PU and ATT, r = 0.719, p < 0.005; PEOU and ATT, r = 0.806, p < 0.005}. Conclusion: Though awareness and acceptance of mobile authentication service is high, its use is moderate in practice. Further studies on how to improve the use of this service among the Nigerian populace is necessary.

Development of Managerial Key Performance Indicators for A Hospital Pharmacy Digital Dashboard.

Pharmaceutical performance is a critical factor in the hospital operation. Hospital pharmacy activities require retrieving, processing, comparing, and updating the information. Dashboards are new tools that can track key performance indicators by displaying information to managers in order to improve the performance of the hospital pharmacy. We conducted this study to determine the performance indicators of hospital pharmacies in Iran. This qualitative research was conducted in 2016. The participants were hospital pharmacists and hospital managers. A semi-structured questionnaire was constructed to determine key performance indicators of the hospital pharmacy department. The questionnaire was used in face-to-face interviews and focus groups. The data were analyzed using Framework analysis. The indicators comprised three domains, including managerial indicators (satisfaction, education, staffing, and department management), clinical indicators (patient safety), and financial indicators (income, costs, and financial utilization). Traditionally, pharmacy services included provision and distribution of drugs in the hospital; however, today, with an increase in the complexity and diversity of the drugs, hospital pharmacy services include diverse fields beyond clinical affairs. It could be concluded that pharmaceutical performance has a vital role in successful hospital management. Hospital pharmacy management is not possible without monitoring performance indicators.