Background The integration of 3D printing technology in hospitals is evolving toward production models such as point-of-care manufacturing. This study aims to present the results of the integration of 3D printing technology in a manufacturing university hospital. Methods Observational, descriptive, retrospective, and monocentric study of 907 instances of 3D printing from November 2015 to March 2020. Variables such as product type, utility, time, or manufacturing materials were analyzed. Results Orthopedic Surgery and Traumatology, Oral and Maxillofacial Surgery, and Gynecology and Obstetrics are the medical specialties that have manufactured the largest number of processes. Working and printing time, as well as the amount of printing material, is different for different types of products and input data. The most common printing material was polylactic acid, although biocompatible resin was introduced to produce surgical guides. In addition, the hospital has worked on the co-design of custom-made implants with manufacturing companies and has also participated in tissue bio-printing projects. Conclusions The integration of 3D printing in a university hospital allows identifying the conceptual evolution to “point-of-care manufacturing.”
BackgroundThe introduction of robotic dispensing systems in outpatient pharmacies (OP) has increased in recent years. However, there are no data available on its impact on patient safety using a prospective risk analysis.PurposeTo evaluate safety after implementation of a robotic dispensing system in an OP, and stratification of residual risks to drive future developments.Material and methodsSetting: OP of a 1300 bed tertiary teaching hospital provided with a computerised prescription order entry program and online pharmacy validation. Before the implementation of the robot, dispensing was performed entirely manually by nursing assistants using barcode technology.Design: Comparative risk analysis of the drug dispensing process before and after implementation of the robotic dispensing system (Rowa Vmax), according to the failure modes, effects and criticality analysis method.Measurements: The failure modes were defined and their critically index (CI) calculated on the basis of the likelihood of occurrence, potential severity for patients and detection probability. CI of manual and robotic dispensing were compared, and new measures were proposed.ResultsIn the pre-implementation phase, the sum of CI of 17 identified failure modes was 1141. After implementation of the robot, 23 failure modes were identified and the CI was reduced to 780 (31.64% reduction). The major safety improvements were observed for the following errors during the dispensing process: incorrect drug because of barcode control omission (-100), omission of dispensing due to lack of stock (-90), insufficient quantity (-81) and expired drug (-52). Of the 6 failure modes exclusively detected after implementation of the robot, only failure to deliver the drug to the correct dispensing point achieved a significant risk (CI=48).Improvement actions identified included: (1) monitoring during robotic dispensing on a monthly basis (drug delivered to the wrong point, interruptions of robotic dispensing and stock-outs), (2) establishing periodic maintenance checks and (3) establishing a double-checking system for manual dispensing of drugs that cannot be managed by the robot.ConclusionA robotic dispensing system has increased the safety of the process. FMECA is a useful method for evaluating the impact of robotic implementation, and identifying further improvement strategies.References and/or AcknowledgementsComplying with the FMEA requirements of the new patient safety standards. No conflict of interest.
BackgroundThe new direct acting antiviral (DAA) agents mean a breakthrough in the treatment of hepatitis C virus. However, these DAA agents are not free of drug-drug interactions (DDI), which can significantly reduce their effectiveness or produce adverse events.PurposeThe aim of this study was to describe the type and severity of DDI between DAA and concurrent patient medication, and resolve them through pharmacist interventions.Material and methodsAn observational, descriptive, prospective study was carried out in the outpatients pharmacy consults of a university hospital. Every patient starting treatment from April to September 2015 was included.The patients’ concurrent medications were screened by the pharmacist during the interviews carried out on a monthly basis, as part of an intensive pharmaceutical care programme. Potential interactions between DAA and concurrent medications were checked through the Lexi-comp application and the website of the University of Liverpool. Those interactions were classified according to severity, defined by FDA (B, C, D, X).Recommendations were made by pharmacists to avoid clinically significant DDI.Results694 patients were included (63.4% men); mean age 56.7 (SD 12.9) years. 54.5% of patients were treated with ombitasvir/paritaprevir/ritonavir±dasabuvir, 40.6% with sofosbuvir/ledipasvir and 4.9% with others. The mean number of concurrent medication per patient was 4.7(SD 3.3).471 DDI were recorded: 52.3% with ombitasvir/paritaprevir/ritonavir±dasabuvir, 46.1% with sofosbuvir/ledipasvir and 1.6% with others. At least one DDI was identified in 310 patients (44.7%). According to FDA severity, DDI were classified as follows: type B (2.3%), type C (43.1%), type D (47.6%) and type X (7%).The most frequent DDI were as follows: cardiovascular agents (35.9%), proton pump inhibitors (11.9%) and antidepressants (7.4%). In most cases the drug interacting with ombitasvir/paritaprevir/ritonavir±dasabuvir was amlodipino, and with sofosbuvir/ledipasvir was omeprazole.In 141 (29.9%) interactions, pharmaceutical intervention was required: 69 (48.9%) interventions were necessary to correct the technique of administration, 31 (22%) interventions to improve safety or effectiveness monitoring and 25 (17.7%) to withhold any of the treatments for contraindication.ConclusionPatients treated with DDA are polymedicated and almost half of them suffered at least one moderate/severe drug interaction. The most relevant DDI were cardiovascular agents, proton pump inhibitors and antidepressants. The intensive pharmaceutical care programme has proved to be important to detect DDI and improve safety and effectiveness of clinically significant DDI.References and/or AcknowledgementsLexi-Comp. Available from: Drug interactions charts. Available from: No conflict of interest.
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