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Good Practice Initiatives EAHP 2015

Learn about the successful implementation of pharmacist prescribing in a United Kingdom NHS hospital trust, including improved efficiency, staff development, and future expansion plans.

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Good Practice Initiatives EAHP 2015

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  1. Good Practice Initiatives EAHP 2015

  2. The 6 overall EAHP Statements 2014 • Introductory Statements and Governance • Selection, Procurement & Distribution • Production & Compounding • Clinical Services • Patient Safety and Quality Assurance • Education and Research GPI Session 2014

  3. 1. Introductory Statements and Governance • IMPLEMENTING PHARMACIST PRESCRIBING AT SCALE ACROSS A UNITED KINGDOM NHS HOSPITAL TRUST / Campbell, David (UK) • A NATIONALLY COORDINATED APPROACH TO DEVELOPING HOSPITAL PHARMACY SERVICES IN DENMARK / Jeffery, Linda (Denmark) 2. Selection, Procurement & Distribution • BARCODESCANNING IN THE PHARMACY FOR A SAFER THERAPY / De Rijdt, Thomas (Belgium) The first 3 overall EAHP Statements 2014 GPI Session 2014

  4. 3. Production & Compounding • IMPLEMENTING CHEMOTHERAPY DOSE-BANDING USING RETROSPECTIVE DATA ANALYSIS AND EXPONENTIAL CALCULUS / Fleury, Mapi (Switzerland) • INTEGRATION OF THE PHARMACEUTICAL CARE RECORD INTO THE MULTIDISCIPLINARY ELECTRONIC OUTPATIENT RECORD / Crespo, Paloma (Spain) The first 3 overall EAHP Statements 2014 GPI Session 2014

  5. Implementing Pharmacist Prescribing at Scale Across a United Kingdom NHS Hospital Trust David Campbell Clinical Director for Medicines Optimisation

  6. Catalysts for change • Improve efficiency – avoid rework associated with correcting other prescribers’ mistakes/omissions • Staff & service development – opportunity to make a significant proactive contribution to direct care of patients

  7. How did we do it? • Piloted and developed within admissions units • Roles then developed on general inpatient wards • 83% clinical pharmacists qualified or in training • Expansion across Trust and primary care

  8. Results within inpatient setting • Prescribing across three district general hospitals • Part 1: • Pharmacists prescribed 680/5,274 items (12.9%) for 182/457 patients (39.8%) • Part 2: • 1415 medicines prescribed by Pharmacists with an error rate of 0.3% (4 items) Baqir W, et al. Eur J Hosp Pharm 2015; 22: 79-82

  9. Where next? • Pharmacist prescribing not now routinely validated by another pharmacist • New emergency care hospital opening 2015 • Extended 7 day clinical working • Pharmacists routinely prescribing for all admissions • Exploring new advanced clinical roles e.g. in A&E • Expansion of primary care services • Running clinics in general practice • Care home services • Prescribing for vulnerable patients in their own home

  10. Thank you for listening david.campbell@nhct.nhs.uk

  11. A nationally coordinated approach to developing hospital pharmacy services in Denmark Linda Jeffery European Statements af Hospital Pharmacy: Section 1 - Introductory statements and governance

  12. Why? European Statements af Hospital Pharmacy: Section 1 - Introductory statements and governance Linda Jeffery

  13. What? European Statements af Hospital Pharmacy: Section 1 - Introductory statements and governance Linda Jeffery

  14. How? • National decision • Members selected • Terms of reference written • Meeting • Resources European Statements af Hospital Pharmacy: Section 1 - Introductory statements and governance Linda Jeffery

  15. Outcomes • Minimum standards for ward pharmacy • Benchmarking • National networking days • Standards for non-clinical tasks European Statements af Hospital Pharmacy: Section 1 - Introductory statements and governance Linda Jeffery

  16. Transferability? GPI Section 1: Introductory statements and governance Linda Jeffery

  17. Thank you… Linda Jeffery European Statements af Hospital Pharmacy: Section 1 - Introductory statements and governance

  18. BARCODESCANNING IN THE PHARMACYFOR A SAFER THERAPY Thomas De Rijdt, PharmD. No conflict of interest

  19. Background andopportunities • Prevention of medicationerrors • CPOE withclinicaldecision support (60 %) • Bedsidescanning (36 %) • Process of dispensing (4 %) • Medication orders electronicallyavailable &allmedicationbarcoded on the single dose. • Hardware andknow-how present in the hospital

  20. Methodology • Hospital pharmacistvalidatesmedication orders after screening therapyforappropriateness • Orders are sent to handterminals andshippinglabels are printed.

  21. Methodology • Pharmacy techniciansoperate the pickingprocess: • Identifythemselvesby scanning ID-card • Scanning shipping label triggers guidancetolocation • Scanning bin confirmslocation • Scanning barcode on single dose checks product • Allmedication in separate bagswithshipping label

  22. Results • Reduction of pickingerrorsto (nearly) zero • Optimized workflow (managing peaks) • Realtimedocumentation of actions • Opportunity toimplement “check of appropriateness”

  23. Implementing chemotherapy dose-banding using retrospective data analysis and exponential calculus Mapi Fleury Hospitalpharmacist Dr Ludivine Falaschi Prof. Pascal Bonnabry EAHP, Hamburg26 March 2015

  24. Providing patients with the best possible care • … and thatshouldstartwith an analysis of the facts

  25. Facts • Calculating body surface area iseasy. It provideseach patient with the best fixedreference value withwhich to determine a chemotherapeutic dose, and itallows us to predictresponse to treatment and toxicity. • The dose prescribed by the physicianisexactly the same as thatmanufactured by the pharmacy’schemotherapy unit for the infusion bag. • Pharmacies financialresources are unlimited. • For gemcitabine, dosing at 1845.89 mg or at 1846 mg canmake all the difference in treatmentoutcome. • Humansnevermakemistakes.

  26. Mathijssen, R.H.J., Sparreboom, A. and Verweij, J., 2014. Determining the optimal dose in the development of anticancer agents. Nat Rev ClinOncol, 11(5): 272-281.

  27. So, let’sbe efficient and offer the patient the best possible care. Let’s use dose-banding.

  28. Yes, but how?

  29. 2013 : 613 infusion bags of gemcitabine • 111 different doses (266 mg-2900 mg)

  30. Prescribing doses abovethosesuggestedusing BSA! We’realreadybanding doses whenwe round-off a calculation! Let’spleasekeepusing"ready to administer" doses! Integration of dose bands into the electronicprescribing system. Max. 5% margin of errorfrom the usualprescribed dose.

  31. 50% 1805 2000 90%

  32. Take home messages

  33. Dose-banding • Improvedquality, safety and efficacy • Reducedcosts • Automation

  34. Thankyou! • PharmacyDepartment, Prof. P. Bonnabry, Dr L. Falaschi, & Chemo-Unit ! • OncologyDepartment, Prof. P.-Y. Dietrich • Haemo-Oncology Unit, Prof. Y. Chalandon

  35. INTEGRATION OF THE PHARMACEUTICAL CARE RECORD INTO THE MULTIDISCIPLINARY ELECTRONIC OUTPATIENT RECORD Paloma Crespo Robledo Hospital PharmacyResident Hospital University of Móstoles. Madrid. Spain GOOD PRACTICE INICIATIVES. ORAL PRESENTATION. HAMBURG, 26thMarch 2015

  36. Why did you do this GPI? • Background of Hospital Departments of Pharmacy in Spain. • Creation of the Electronic Medical Record in the Health System • Pharmaceutical Care record

  37. I am a wholeperson INTEGRATION OF OUR PHARMACEUTICAL CARE RECORDS TO THE EMR VIA AN APPLICATION FORM

  38. How did you do this GPI? • Answeringtwomainquestions: Where the application form should be included when the patient came in for a consult? What items should be taken into account for the follow up

  39. Where the application form should be included when the patient came in for a consult? • Toavoidhavingmanyongoingprocesses and facilatethe doctor tochecktheapplicationform • Aplicationformisincluded in themostrelevantprocess • Forexample: an HIV+ patient has hisPharmaceuticalCareConsultApplicationform in “InfectiousDiseaseConsultProcess”

  40. ID. NAME OF PATIENT ONGOING PROCESSES Doctor House Doctor House Applicationform PharmaceuticalCareConsult

  41. ITEMS APLICATION FORMS BY DATE

  42. What items should be taken into account for the follow up • Reason for the visit • Age • Weigth • Pathology • Relevant clinical data • Outpatient treatment • Comorbidities • Regular treatment • Drug interactions • Drug-related problems, • Adverse drug allergies/past issues • Adherence (0-100%) • Checks to mark whether if the patient has received: • oral and written information • Outpatient Pharmacy’s leaflet • Free text to write down given recommendations or other information

  43. What are the outcomes, the practice improvements of this GPI? WE ARE STILL IN EARLY STAGES OF THE PROJECT • Increased safety in the use of drugs Anaimistoavoidmedicalerrorsduetoignorance of regular treatment at EmergencyDepartment. • Promotion of teamworkamongstprofessionalswhoattendthesamepatient • Data export can beprovided.

  44. Thankyouverymuch foryourattention Thanksto: • My PharmacyDepartmentforsupporting my project. • InformaticDepartmentfortheirtechniciansupport and patience.

  45. 4. Clinical Services • A TARGETED STRATEGY AND TRAINING PROGRAM TO IMPROVE THE MEDICATION RECONCILIATION PROCESS - Bataille, Julie (France) 5. Patient Safety and Quality Assurance • A ROBUST LEAN METHOD FOR IMPROVING THE MEDICATION MANAGEMENT PROCESS / Curatolo, Niccolo (France) The last 3 overall EAHP Statements 2014 GPI Session2014

  46. 6. Education and Research • CONTINUING EDUCATION FOR PHARMACY RESIDENTS THROUGH CASES DISCUSSION / Fernandez de Gamarra, Edurne(Spain) • INNOVATING AND COLLABORATING - SYNERGY BETWEEN THE HOSPITAL PHARMACY AND THE UNIVERSITY / Ging, Patricia (Ireland) The last 3 overall EAHP Statements 2014 GPI Session2014

  47. A targeted strategy and training program to improve the medication reconciliation process J. Bataille, N. Curatolo, S. Roy, A. Rieutord Pharmacy unit – BeclereHospital - France 20th Congress of the European Association of Hospital Pharmacists in Hamburg

  48. Why ? • In a precedent study1: • 3 PDSA (plan-do-study-act) cycles • Implementation and sustain medication reconciliation (MR) process • At admission in two surgery units Sustainability 3 PDSA cycles Quantity Quality 1 year 1 month 1 month 1 month 2012 2013 2014 2011 1.N. Curatolo. Reducingmedicationserrors at admission: 3 cycles to implement, improve and sustainmedicationreconciliation, Int J Clin Pharm 2014

  49. How ? Semi-structured interviews : • “Customers approach”: physicians (anesthesists, surgeons) and nurses • Quantitative to Qualitative • “Customers approach”: Pharmacists and pharmacy students • Training of clinical pharmacist 20th Congress of the European Association of Hospital Pharmacists in Hamburg

  50. Outcomes of the “Customersapproach” : Surgeons, anesthesists, nurses • Quantitative to the qualitative • Analysis of the comments : • to determine their needs • to purpose sustainable and safe solutions BPMH: best possible medication history

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