Hospital Pharmacy Department Research Articles

An Experience Feedback Committee for Improving Medication Process Safety: An Observational Study in a Hospital Pharmacy Department

Study objective: An experience feedback committee (EFC) is a management method for patient safety designed for a medical team. The aim of this study was to analyse the functioning of an EFC in a hospital pharmacy department and to explore its contribution to medication process safety. Design: We conducted a transversal, observational study based on the analysis of all the written documents produced by the EFC between January 2012 and December 2013. Setting: The study was conducted in the pharmacy department at Grenoble University Hospital in France. Measurements: We analysed all the documents related to incidents reported, the reports of meetings and the reports of event analysis. Patient outcomes (degree of harm) were assessed according to the Conceptual Framework for the International Classification for Patient Safety. The main outcome was the corrective actions decided by the EFC. Main Results: During the study period, there were 22 meetings attended by a total of 59 professionals including seven pharmacists. A total of 320 incidents were analysed. Most of them (92%) had no medical consequence for the patient. Twenty-two incidents were selected to be thoroughly analysed. One hundred and ten corrective actions were carried out including 32 training sessions, 32 guidelines written, 32 changes in organisation, nine changes in equipment and five changes in another category. Conclusions: The EFC is an attractive method to involve healthcare professionals in quality and safety management.

Why pharmacists should care about the marketing of unhealthy foods: Increasing our role in public health policy / Pourquoi les pharmaciens devraient-ils s’intéresser à la promotion des aliments néfastes pour la santé? Contribuons davantage aux politiques en matière de santé publique

As highly accessible health professionals, pharmacists have a unique opportunity to offer advice and care to patients across a variety of settings and therapeutic areas. Traditionally, pharmacists’ activities have focused on the care of individual patients, but recent scope of practice expansions, such as the administration of vaccines, highlight our profession’s ability to participate in larger public health initiatives. Research has also suggested that pharmacists view public health activities as important and as part of their role in addition to medication management activities.1 Indeed, the Blueprint for Pharmacy includes a statement calling on pharmacists to “empower patients in decision-making about their health, and play a prominent role in health promotion, disease prevention and chronic disease management.”2 Similarly, CSHP 2015 (an initiative from the Canadian Society of Hospital Pharmacists) calls for an “increase [in] the extent to which pharmacy departments in hospitals and related healthcare settings engage in public health initiatives on behalf of their communities.”3 Patients have also been shown to view pharmacists as respected providers of public health advice.1

Savings from incentive schemes should be reinvested in hospital pharmacy departments

Savings from incentive schemes should be reinvested in hospital pharmacy departments

Assessment of adherence to psychotropic medications among out-patients at the Pharmacy Department of a Psychiatric Hospital, in Benin City, Nigeria

Assessment of adherence to psychotropic medications among out-patients at the Pharmacy Department of a Psychiatric Hospital, in Benin City, Nigeria

Drug Shortages through the Decades: A Big-Picture Perspective

ospital pharmacy has enjoyed a long relationship with the pharmaceutical industry. In the late 1960s and 1970s, hospital pharmacists championed the development of group purchasing organizations (GPOs), pooling the purchasing power of individual institutions into larger, but still manageable, groups of hospitals. The GPOs developed reliable strategies for establishing the quantities of each pharmaceutical product that the group would purchase. Hospital pharmacy departments monitored inventory turns and minimized holding costs before this approach became the norm in the health care industry. Negotiations with industry were based on positive supplier

Optimising pharmacy input to medicines reconciliation at admission to hospital: lessons from a collaborative service evaluation of pharmacy-led medicines reconciliation services in 30 acute hospitals in England

ObjectiveTo compare pharmacy team input to medicines reconciliation (MR) in a variety of care areas in order to inform optimisation of service delivery.Methods30 acute hospital pharmacy departments evaluated their MR...

Ethical and methodological quality of non-interventional post-authorization studies promoted by Hospital Pharmacy Departments

To describe the ethical and methodological quality of non-interventional post-authorization studies promoted by Hospital Pharmacy Departments (HPD). HPD promoted studies in the 2009-2011 period included in the Spanish Agency of Medicines and Medical Devices (AEMPS) registry and/or published in "Farmacia Hospitalaria" were identified. The most relevant ethical and methodological characteristics were analyzed. Studies promoted by HPD were also compared with studies not promoted by HPD. Twenty two studies promoted by HPD, and registered in the AEMPS were identified. Within the registered studies HPD promoted studies had lower sample size estimation (41,5% vs 80%) and international scope (0% vs 24%) compared to non HPD promoted studies with significant differences (p < 0,05). None of the published studies in the journal Farmacia Hospitalaria have been registered in the AEMPS and had lower methodological quality than the registered studies promoted by HPD in characteristics such as presence of control group (3,8% vs 27,3%) (p = 0,0072) and the sample size estimation of (19,2% vs 42,8%) (p < 0,05). The management and the methodological and ethical characteristics of the studies promoted by HPD should be improved according to the regulation. The registration in the AEMPS might have a positive impact on the quality of these research protocols.

Pharmacy practice in small and rural hospitals in Illinois—2011

The results of a 2011 survey evaluating pharmacy services at small and rural Illinois hospitals are presented and compared with data from similar surveys in 2001 and 1991. A questionnaire modeled on the previous survey instruments but updated to reflect contemporary pharmacy practice was mailed to pharmacy directors at 86 small hospitals (i.e., <150 staffed beds) and rural hospitals (i.e., located outside metropolitan areas). The response rate was 46.5%. The survey data indicated that 57.5% of hospitals represented in the 2011 survey had a centralized drug distribution system, 35.0% had a hybrid system, and 7.5% had a decentralized system. The most commonly reported form of technology was automated dispensing cabinets, which were in use at 75.0% of hospitals in 2011, compared with 34.8% of hospitals represented in the 2001 survey. Barcode verification of medication doses before dispensing and at the time of administration was performed at 50% and 70% of hospitals, respectively. While the provision of clinical pharmacy services has risen sharply since 1991, substantial changes were not observed between 2001 and 2011 except in the provision of compliance and drug histories (67.6% of hospitals in 2011 versus 46.8% in 2001) and pharmacist participation in medical emergency responses (54.0% versus 34.0%). A 2011 survey of pharmacy departments in small and rural Illinois hospitals provided information on the use of automation and health information technologies and showed changes in the provision of many clinical pharmacy services since 1991.

Analysis of pharmaceutical intervention in outpatients pharmacy department

To analize the pharmaceutical interventions made in outpatients pharmacy department of a secondary hospital. Retrospective and observational study of pharmaceutical interventions made from October 1st 2010 to December 31st 2011. RECORDED DATA: Number of patients, age at the end of the study, diagnostic, prescribing departments, drug-related problems (DRP), negative outcomes associated with medication (NOM), type of pharmaceutical interventions. 231 DRP were found and a pharmaceutical intervention was performed for each DRP in 184 different patients. The main DRPs detected were: drugs interactions (26%), prescription mistakes (15, 6%) and non-compliance (15, 6%). Only 26 (11,2%) DRP caused a NOM. Most interventions were: recommendating treatment changes (35,6%), promoting the monitorization of the effectiveness of treatment (34,6%) and increasing adherence (15,6%). The pharmacist activity allows individualized monitoring and is crucial to avoid NOM.

A Preliminary Investigation into the Ability of Three Rapid Microbiological Methods To Detect Microorganisms in Hospital Intravenous Pharmaceuticals

This study investigated the capability of three rapid microbiological methods to detect microorganisms in aseptically prepared pharmacy preparations at National Health Service hospitals in the United Kingdom. BacT/ALERT 3D (bioMerieux), AKuScreen (Celsis), and BactiFlow ALS (AES Chemunex) technologies were used to detect levels of microorganisms in pharmaceutical products. Four products selected to represent the range of pharmaceuticals prepared in National Health Service hospital pharmacy departments were spiked with known levels of microorganisms. The presence of microorganisms in these products was then determined using each of the rapid microbiological methods and compared to the number determined by traditional total aerobic microbial count methodology. An evaluation of the performance parameters associated with each of the methods, including cost analysis, was also undertaken. There was good correlation between rapid microbiological methods and total aerobic microbial count for heparin and parenteral nutrition products. The rapid microbiological methods had difficulty recovering Gram-positive organisms from vancomycin and methotrexate products; however, protocol developments demonstrated that this was surmountable. The main differences between the rapid microbiological method systems were time-to-result, the initial equipment cost, and the skill required to operate the instruments. The main finding from this work is that rapid microbiological methods can detect microbial contamination of hospital pharmaceutical products in a reduced time when compared to traditional microbiological techniques. The instrument comparison showed that Celsis AKuScreen provided the most rapid result for detecting bacteria; BacT/ALERT was the least expensive instrument and the simplest system to use; and BactiFlow ALS was the most expensive and more complex to use and gave intermediate time to results. Traditional methods to assure quality and detect any microbial contaminants in intravenous products takes at least 2 weeks to complete. Hospital-prepared intravenous products are often high risk and have short shelf lives. This sometimes means that the traditional quality microbiological results are only available after the product has been administered to the patient. There have been some fatal incidents in which contaminated intravenous products have been used. Rapid microbiological methods have been used in the food, cosmetic, and pharmaceutical industries; however, they have not as yet been used in United Kingdom National Health Service pharmacy manufacturing. Rapid microbiological methods are able to detect contaminants in shortened periods of time. This study investigates the ability of three rapid microbiological methods to detect artificially contaminated, National Health Service-prepared intravenous products and compares the results to those obtained from traditional total aerobic microbial count methodology. The results show that there are differences between the methods; however, generally rapid microbiological methods are able to detect contaminants from pharmacy-prepared intravenous products quicker than current traditional methods.

Implementing standardized intravenous antibiotic desensitizations among hospital inpatients

Patient safety improvements and increased efficiencies achieved through the establishment of standardized protocols and order sets for selected antibiotic desensitization procedures are described. Errors in the ordering and administration of antimicrobial desensitization regimens can result in life-threatening complications. To enhance patient safety, the University of Colorado Hospital pharmacy department worked with allergy and immunology physicians (AIPs) to implement standardized desensitization protocols to reduce the potential for confusion surrounding the prescribing and administration of these complex regimens to acutely ill populations such as patients with cystic fibrosis, as many as 30% of whom develop one or more antimicrobial allergies. Nine i.v. antibiotics were identified as suitable for the standardization initiative; based on AIP experience and published guidelines, therapeutic doses of each targeted medication were determined. For each of the nine drugs, the interdisciplinary team developed an instruction sheet on preparing stock concentrations and compounding sequential doses for desensitization, with a corresponding preprinted order set detailing infusion procedures, monitoring requirements, guidance on the use of rescue medications and other steps for managing adverse reactions, and patient safeguards. Initial experience with the standardized protocols indicated that relative to previous practices (i.e., physician submission of handwritten patient-specific orders, with pharmacist calculation of required dilutions case by case), the standardization initiative (1) reduced the potential for errors, (2) sharply reduced order-entry and product preparation times, and (3) helped achieve antimicrobial stewardship goals. Standardized antimicrobial desensitization protocols helped to optimize patient care and antimicrobial stewardship while enabling more efficient use of pharmacy and AIP resources and fostering enhanced pharmacist-physician collaboration.

Pre-Post Pilot Study of Noise Levels at a University Hospital Center Pharmacy Department

Context: Noise interferes with attention, speech understanding, detection of other auditory stimuli, and leads to interruptions. Objectives: This is a pre-post cross-sectional observational study aimed at measuring noise levels in a 500-bed mother–child university hospital center pharmacy department after the implementation of corrective measures, such as work zone reorganization, digitization of the prescription process, and education about the impact of some work habits. Results: A total of 24 measurement points (70 noise level measurements) were taken in 2007 (pre) compared to 30 measurement points (59 noise level measurements) in 2012 (post). There was a statistically significant difference in the average values of the day and night noise measurements (day 59.4 ± 5.3 dB(A) vs night 52.3 ± 8.0 dB(A); P < .001). There were no statistically significant differences in the average values of the noise measurements taken during daytime between the prestudy and poststudy phases (pre 59.4 ± 5.3 vs post 58.07 ± 6.01 dB(A); P = .22). Conclusion: Few data exist on the noise levels in hospital pharmacy departments. In spite of the corrective measures implemented, reducing noise levels in pharmacy departments was difficult to achieve. Average values of approximately 60 dB(A) seem to be unacceptable for work that requires a high level of attention.

DSL-022 Simplification of Antiretroviral Treatment with Darunavir/Ritonavir. The Financial Impact of Monotherapy

Background Currently, drugs for HIV treatment have an important financial impact in our hospital Pharmacy Department. Protease Inhibitor (PI) monotherapy is a useful tool that can be used for selected...

Knowledge of the cost of the treatments delivered from the Hospital Pharmacy Department and perception of the health status

To assess the influence of the knowledge of the financial cost of the treatment and perception of the patient of his/her health status and the health care received from the Hospital Pharmacy Department (HPD). During a four-month period, from July to October of 2009, a questionnaire was provided to all the patients coming to the Hospital Pharmacy Department to gather their medications, except for those starting their therapies. The patients returning the completed questionnaire at a next visit were provided with the second part, in which they were informed on the monthly cost of their treatments and some questions from the main questionnaire were asked again. 682 questionnaires were provided, of which 240 (35.3%) were returned completed. 223 patients were given the second part, of which 151 (22.1%) were returned. In general, the patients were satisfied with their treatments (90.4%) and with the care provided at the HPD (95.4%), 69.2% had good knowledge of their treatment, and 59.2% considered themselves as good compliers, and 17.5% did not usually consult with the pharmacist at the HPD. The patient's satisfaction analysis before (7.75; SD: 1.90) and after knowing the treatment cost (7.80; SD: 1.91) did not show statistically significant differences, with the exception of those patients derived from the Infectious Disease Department (p = 0.015) that were less satisfied after knowing the cost. The knowledge on the treatment cost could not be related in general with changes in the attitude of the patients towards their treatments, being necessary the design of more profound studies. Besides, it should be recommended to undertake the improvement actions detected by the patients in order to increase the quality of the pharmacy care delivered.

Decentralization and hospital pharmacy services: the case of Iranian university affilliated hospitals.

The aim of this study was to evaluate the satisfaction rate of hospital managerial/clinical teams (HMCTs) including principles (chief executives), managers, supervisor pharmacists and head nurses from services presented by private sectors directing 10 pharmacy departments in hospitals affiliated to Shahid Beheshti University of Medical Sciences. This study is an observational and descriptive study in which a questionnaire containing 16 questions evaluating the satisfaction of the HMCTs from private sectors, and questions about demography of the responders was used for data collection. Collected data was applied to assign a satisfaction score (maximum 64) for each respondent. SPSS 17.0 and Microsoft Office Excel 2007 were used for statistical description and analysis of these information (where applicable). Overall, 97 people in charge of the hospitals (HMCTs) entered the study. The average satisfaction score was 26.38 ± 6.81 with the lowest satisfaction rate observed in Mofid children specialty hospital (19.5%) and the highest rate obtained for Imam Hussein (p.b.u.h) general hospital (65.3%). Generally, 59% of the HMCTs believed that the function of the private sector in the pharmacy of hospitals is satisfactory. Assuming that the satisfaction scores under 75% of the total obtainable score (i.e. 48 out of 64) could not be considered as an indicator of desired pharmacy services, our results revealed that the status of the services offered by private sectors are far behind the desired satisfactory level.

外来化学療法患者における薬薬連携の取り組み

外来化学療法患者における薬薬連携の取り組み

Quantitative study of controlled substance bedside wasting, disposal and evaluation of potential ecologic effects

Drugs in wastewater arise from many sources. For health care, these include excretion and direct disposal (bedside wasting). The present study reports on the dispensing and wasting of 15 controlled substances (CS) at two health care facilities in Albany, NY over a nearly two year period. The study considered measures of ecotoxicity, drug metabolism, excretion and disposal of these CS. Potential alternatives to flushing of CS into wastewaters from healthcare facilities are discussed.Drug medication and waste collection records (12,345) included: numbers of drugs dispensed, returned and wasted. Overall, 8528g of 15 CS were wasted. Three (midazolam, acetaminophen-codeine and fentanyl) accounted for 87.5% of the total wasted. Wasting varied by hospital, 14 CS at the academic medical center hospital and 8 at the surgical care center were wasted. Liquids were more frequently wasted than tablets or pills. Some combination drugs (acetaminophen (APAP)–codeine) were frequently (50% of drug dispensed) wasted while others were less wasted (APAP–hydrocodone—6.3%; APAP–oxycodone—1.3%). The 8 CS judged more hazardous to aquatic life were: APAP-codeine, APAP-hydrocodone, APAP-oxycodone, alprazolam, diazepam, fentanyl, midazolam, and testosterone. Ketamine, morphine, oxycodone and zolpidem were of lesser acute toxicity based on available LC50 values. These CS might provide a therapeutically equivalent alternative to the more environmentally harmful drugs.In health care facilities, professionals dispose of CS by bedside wasting into water or other receptacles. This can be avoided by returning CS to the hospital's pharmacy department, thence to a licensed distributor. Study of this process of drug wasting can identify opportunities for process improvements. We found 3 CS (APAP-codeine, midazolam and testosterone) where ½ to 1/3 of the drug was wasted and 5 others with 30 to 13% wasted. Knowledge of the adverse impacts from the release of highly toxic drugs into the environment might influence CS selection and disposal alternatives.

Should Hospital Pharmacy Departments Commit a Larger Proportion of Their Clinical Resources to Ambulatory and Primary Care Services?

Should Hospital Pharmacy Departments Commit a Larger Proportion of Their Clinical Resources to Ambulatory and Primary Care Services?

Pharmacy Forecast 2013–2017: Strategic planning advice for pharmacy departments in hospitals and health systems

In this time of economic uncertainty and turmoil in health care, it would be unthinkable for a hospital or health system not to plan for the future. The same can be said for the components of health care institutions, including the pharmacy department. From the perspective of the pharmacy

PRM3 Standard Cost List for Economic Evaluation in Thailand

To develop standard unit costs of medical services provided by different health facilities, cost of patients coming for treatments, and reference values used in the economic evaluation. The project was conducted as a number of sub-projects. Analysis of unit cost of medical services was conducted in 5 hospitals employing the relative value unit method. Cost of health center services was calculated in 19 health centers employing standard costing and micro-costing methods. Cost of pharmaceutical services was analysed in 11 hospitals. Logistics cost of vaccines under the national vaccination program covered the supply chain from the central supplier to provincial health offices. Cost of patients coming to have treatments was collected by interviewing 900 patients from 6 health centers, 3 district hospitals and 3 provincial/regional hospitals. Reference values were obtained from documentary research. The results were published in a book, and can be accessed via the Health Intervention and Technology Assessment (HITAP) website (http://db.hitap.net/). They are composed of 3091 items of hospital medical services in two categories of hospitals: district and provincial/regional hospitals. Services of hospital pharmacy departments, and health services provided by health centers, include 9 and 68 items, respectively. Logistics cost of vaccines is presented as cost per dose of the vaccine supplied. Cost of patients is composed of distance, time, transportation cost and meal cost. Reference values are useful years of capital assets (i.e. buildings, vehicles, furniture and equipment), minimum wage, and gross domestic product per capita. This standard cost menu and reference values should make economic evaluations faster and more convenient. This is the first standard cost menu to be developed for Thailand. Some limitations exist, which will be improved upon in the next revision.