BackgroundAntiseptic products are currently supplied at random over the week. Wards send their orders when their stock is almost used.PurposeThe objectives are a) to standardise the drug chain supply (DCS) of antiseptic products to weekly replenishment by the pharmacy, b) to validate the method of calculating the quantities needed, and c) to set the quantities to have in stock in each ward in collaboration with the nursing team using the LEAN principles.Material and methodsThe time taken by the pharmacy to supply antiseptics was recorded per ward for four weeks before standardisation. After calculating the quantities of products required by the “Kanban” calculation method and validation with the nursing team, one ward tested the new method of supply. Finally, time data were again collected for four weeks to compare them with those collected before standardisation.ResultsFirst, the total time spent on supplying antiseptics was 2 h, 31 min and 19 s for all wards included. Before standardisation, we counted 5 prescriptions for the test ward over a 4-week period spread over Wednesday, Thursday and Friday. The total time spent for this ward by the pharmacy was 26 min 37 s. After standardisation and explanations to the nursing and pharmacy teams, we received 4 prescriptions over 4 weeks and spent 12 min 49 s on this activity.ConclusionThis method is suitable for the supply of antiseptics in our institution. The calculation method is appropriate. Moreover, a considerable time saving was observed for the pharmacy and assigned to other activities. It has therefore been decided to standardise the whole institution using this method.References and/or acknowledgements1 Mille Y, L’ordonnancement « Total Productive Kanban »: synthèse de 10 années d’expériences vécues. Logistique et Management 1998;6(2):45–60No conflict of interest.
BackgroundPotential inappropriate use of direct oral anticoagulants (DOACs) increases the risk of thromboembolic and haemorrhagic events.PurposeTo determine the net cost benefit of clinical pharmacy interventions on the prescription of DOACs.MethodWe constructed a decision tree model using a public payer perspective. The appropriateness of the prescription was assessed using the Medication Appropriateness Index. The theoretical risks were collected from the literature and the individual potential risks were calculated using the Nesbit risk assignment conducted by two independent clinical pharmacists. Different costs were included based on diagnosis-related group coding and data in the literature. A univariate sensitivity analysis was performed.ResultsThirty-six of 75 patients had an inappropriate prescription of DOACs. The saved difference between avoided costs (7954€) and annualised medication costs and pharmacist cost (4323€) was 3631€ for 75 patients.ConclusionsIn addition to the enhancement of the quality of the prescription, our results indicate that pharmacist interventions provide a positive net cost benefit.
BackgroundDirect oral anticoagulants (DOAC) are widely used in patients with atrial fibrillation. However, inappropriate use is prevalent, and this potentially increases the risk of thromboembolic and haemorrhagic events. These events also imply an important economic burden. In our institution, a clinical pharmacist is dedicated to performing medication review for all DOAC patients.PurposeTo determine the net cost avoidance of pharmaceutical interventions on the DOAC prescription.Material and methodsWe constructed a decision tree model, using a public payer perspective. We included hospitalised medical patients taking a DOAC. The appropriateness of the prescription was assessed using nine items of the Medication Appropriatenes Index1. The theoretical thromboembolic and haemorrhagic risks of patients under DOAC were collected from the literature. Evaluation of the individual potential risks was based on the Nesbit risk assignment conducted by two independent clinical pharmacists2. Based on diagnosis related group coding and literature data, different costs were included: institutional disease costs of complications, annualised ambulatory stroke costs, drugs costs and pharmacist costs. In the reference case we did not add consultancy fees for the pharmacist. A univariate sensitivity analysis was performed to evaluate the robustness of our results and key assumptions.Results75 patients met the inclusion criteria. 36 (48%) had an inappropriate DOAC prescription. The net cost benefit analysis showed that the saved difference between avoided costs (7954€) and annualised medication costs and pharmacist costs (4 323€) was 3631€ for 75 patients. The univariate sensitivity analysis enlightened a net cost benefit if the prevalence of inappropriate prescribing and disease costs decreased to 28% and 45%, respectively.ConclusionBesides enhancement of the prescription’s quality by the clinical pharmacist, our results provide evidence that this intervention brings positive economic benefits.A complete economic analysis should be considered to demonstrate the cost effectiveness of a clinical pharmacist.References and/or AcknowledgementsLarock AS, et al. Appropriateness of prescribing dabigatran etexilate and rivaroxaban in patients with nonvalvular atrial fibrillation: a prospective study, Ann Pharmacother 2014;48:1258Nesbit, et al. Implementation and pharmacoeconomic analysis of a clinical staff pharmacist practice model, Am J Health Syst Pharm 2001;58:784No conflict of interest.
BackgroundIn the High Risk Medicines (HRM) field, intravenous potassium chloride (IV KCl) has an important role.PurposeTo assess nursing and medical practices in the management of hypokalaemia, to evaluate the accreditation norms of the hospital and define potential actions to make the use of IV KCl safe and standardised.Material and methodsA first audit of IV KCl prescriptions and administration practices was conducted, based on 33 electronic patient records regarding appropriateness of use (kalaemia during hospitalisation, administration rate, etc.). A second audit based on the “Adverse Drug Event Trigger Tool” was conducted to determine the number of iatrogenic hyperkalaemia events per 100 patients who received sodium or calcium polystyrene sulfonate, Kayexalate,during their hospitalisation. Finally, a list of the applicable measures was written with relevant actions depending on different actors.ResultsThe first audit indicated that 49% of the IV KCl administrations were inappropriate, 19% were appropriate because of patients’ kalaemia and the other 32% also if the patient was unable to tolerate oral route. It is noticed from the second audit that 19% of Kayexalateprescriptions stemmed from iatrogenic hyperkalaemia caused by intravenous or oral KCl. Therefore, we decided to prioritise redaction and publication of internal guidelines about KCl use. Rationalisation of the KCl availability should be the second step to implement.ConclusionRegarding the results, a key issue relates to the health professionals’ training as well as the standardisation of hospital practices. Hypokalaemia and KCl administration management procedures have been validated by the Pharmaceutical and Therapeutic Committee. The availability of the different types of KCl in the Institution will be reviewed. Several improvements can be made in the near future.ReferencesHemstreet BA, Stolpman N, Badesch DB, et al. Potassium and phosphorus repletion in hospitalized patients: implications for clinical practice and the potential use of healthcare information technology to improve prescribing and patient safety. Curr Med Res Opin 2006;22(12):2449–55Crop MJ, Hoorn EJ, Lindemans J, et al. Hypokalaemia and subsequent hyperkalaemia in hospitalized patients. Nephrol Dial Transplant 2007;22:3471–7No conflict of interest.
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