Background Pharmaceutical Interventions (PI) are part of pharmaceutical care process and aim to reduce drug-related negative results through early detection of drug related problems (DRP). They are mainly focused on renal/hepatic adjustment of drugs, and supervision of medicines with narrow therapeutic windows and unconventional regimen features. Purpose Evaluation of PI in separate departments during the first semester of 2011. This will allow a consistent and uniform record and classification of PI, aiming to raise doctors' awareness for the most frequent prescription-related DRPs. Materials and methods PI's were recorded on a database (Excel 2007) and classified according to the DÁDER method (Third Revision 2005-University of Granada), accepted as a tool to identify DRPs. DRPs are classified according to: Need: DRP1-Need of additional treatment and DRP2-Unnecessary drug; Efficacy: DRP3-Non-quantitative lack of efficacy and DRP4-Quantitative lack of efficacy; Safety: DRP5-Non-quantitative insecurity and DRP6-Quantitative insecurity. Results From a total of 1835 PI, 82% were accepted (AC). The DRP's distribution was: DRP1-17, 4%, DRP2-25, 4%, DRP3-2%, DRP4-16, 1%, DRP5-5, 1%, DRP6-33, 5%. Departments were analysed separately because of different specifications. The medicine department had a total of 795 PI, with an acceptance of 80, 4%. The most frequent DRP's were DRP6 (38%), DRP1 (20%) and DRP2 (19%). The surgical department had 470 PI, with an acceptance of 95, 5%. The most frequent DRP's were DRP2 (42,2%), DRP6 (19,9%), DRP1 (18,6%) and DRP4 (17,2%). Intensive care units had a total of 149 PI with 89, 3% accepted, the most frequent being DRP6 (40,4%) and DRP4 (31, 5%). The emergency department had a total of 421 PI with 67% accepted. The most frequent DRP's were DRP6 (37%) and DRP2 (24%). Conclusions This analysis showed that: The pharmaceutical interventions had high rates of acceptance (≥80%) The most frequent DRP were related to quantitative insecurity (DRP6), followed by the prescription of unnecessary drug (DRP2), despite some differences between different departments.
BackgroundLEAN philosophy in healthcare settings gives emphasis to performance improvement as a means of developing clinical quality and patient safety standards. It takes into account the expenditure of resources and eliminates/reduces waste. Several types of waste have been identified in the medication use process, namely waiting, motion, overproduction, errors, processing and transport.PurposeTo apply LEAN methodology to the medication distribution process in the pharmacy department, in terms of urgent medication requests from the clinical wards in a general hospital in Portugal, in order to improve inefficiencies.Material and methodsThe study took place in a hospital pharmacy of an 800 bed hospital in Lisbon. The selected process was the request/distribution of urgent medications to the wards. Nurses complete a paper form and send a healthcare operational (HO) to the pharmacy to be dispensed by the pharmacy technician (PT). The process was divided into several tasks and analysed with a timetable worksheet and spaghetti diagram. The LEAN team measured the times involved in each task, made a value stream map (VSM) and discussed the process. Tasks with no/little value added were identified. New measurements will be done after implementation of the improvement measures.ResultsThe VSM identified several tasks with no/little value added, such as requests in paper form, multiple transportations, waiting time in the pharmacy of the HO and continuous interruptions of the PT during allocation to other tasks.These results highlight the need to take appropriate measures, namely online requests and definitions of timetables with specific times for distribution throughout the day by the pharmacy HO. This will eliminate waiting time from the ward HO and reduce the time wasting, motion, processing and errors of the PT.ConclusionLEAN philosophy can be applied to healthcare systems with gains in performance. It can be highly effective in reducing waste and applying resources to other important tasks.The pharmacy team recognised the inefficiencies of the current medication distribution process and identified the necessary changes to improve it, releasing healthcare professionals for other specific and value added tasks.The pharmacy and hospital as a whole are committed to analysing the outcomes and applying LEAN to other activities.References and/or AcknowledgementsLEAN Pharmacy Team.No conflict of interest.
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