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.
BackgroundNew antiviral drugs used in hepatitis C treatment show better efficacy and safety. However, their adverse events (AEs) and interaction (IT) profiles require careful review of all concomitant therapy and patient education. As medication experts and due to their privileged access to patients, hospital pharmacists can monitor concomitant therapy as well as AE incidences, preventing potential risks and contributing to a reduction in morbidity and mortality associated with treatment.PurposeAnalysis of AE incidences and IT, with concomitant therapy, of ledipasvir/sofosbuvir (LDV/SOF), with or without ribavirin (RBV), in patients with chronic hepatitis C virus infection treated at Hospital Prof Doutor Fernando Fonseca (HFF).Material and methodsIn January 2015, we began a prospective study in patients receiving LDV/SOF, with or without RBV. At every visit to the HFF ambulatory pharmacy department, patients were interviewed during their pharmaceutical appointment and all AEs were identified as well as all concomitant therapy. Patients rated the AEs as mild, moderate or severe. IT profile was evaluated at Micromedex and hepdruginteractions.org. Clinical records were also considered (Soarian, Siemens). Data were analysed in Excel, Microsoft and will be collected until January 2016.ResultsOf all 107 patients presently under therapy, 44% were polymedicated. Among those, 79% had drug-drug IT potential and maintained treatment after clinical review and 21% had changes in concomitant therapy. IT with sporadic therapy was also detected in 15% of patients. Treatment related AEs occurred in 73% of all patients. Among patients receiving LDV/SOF, 53% had AEs not described in the Summary of Product Characteristics, namely visual disturbances (26%), nausea (14%), asthenia (8%), dizziness, insomnia, loss of appetites and abdominal pain (6%). In patients receiving RBV, 8% confirmed appetite increase. Among all non-described AEs, 16% were rated as severe.ConclusionPolymedication is a potential risk to ITs which will have a negative impact on efficacy and safety treatment outcomes. To date, among 210 pharmacy appointments, there were 62 (30%) interventions, all of them accepted. Active pharmacovigilance will allow pharmacists to act immediately on problem recognition.References and/or AcknowledgementsAlqahtani, et al. Safety and tolerability ledipasvir/sofosbuvir with and without ribavirin in patients with chronic hepatitis C virus genotype 1 infection: Analysis of phase III ION trials. Hepatology 2015:6:25-30No conflict of interest.
Background Controlling and preventing tuberculosis (TB) continues to be a major public healthcare challenge. Pharmacy and clinical records can thus contribute with important information concerning newly-diagnosed inpatients, treatment regimens and resistant strains. Purpose To identify new tuberculosis (TB) cases through prescription records in a Portuguese General Hospital. Materials and MethodsThis study took place in 2012, in Hospital Prof Dr Fernando Fonseca EPE (HFF), an 800-bed hospital. Patients were identified from Pharmacy dispensing records (Hosix v7.1; SIVSA) and clinical information was collected from the electronic medical records (Soarian Clinicals 3.1; Siemens). This data covered: age, sex, signs and symptoms, risk factors, outcomes of chest X-ray, diagnosis, respiratory isolates, therapeutic and microbiology results. Results To the end of September 2012 75 new cases of TB were identified. 38 diagnoses were made up to 24 h after hospital admission. The most frequent symptoms were non-productive cough 65.8%, weight loss 55.3% and fever 50%. There were 26 cases of pulmonary TB and 12 of extrapulmonary TB. 23 patients tested positive to the Ziehl Neelsen stain. 2 of the patients had resistant TB. 37 patients were diagnosed up to a maximum period of 10 weeks after hospital admission. The most frequent symptoms were non-productive cough 40.5%, weight loss 40.5% and fever 37.8%. There were 16 cases of pulmonary TB, 13 extrapulmonary and 8 strictly clinical and imaging diagnoses. 3 patients tested positive to Ziehl Neelsen. 2 of the patients had resistant TB. By the time of the congress data will be updated for the year 2012. Conclusions The high rate of delayed-diagnosis TB contributes to an increase risk for the health care workers and other patients exposed to it. The hospital OHD used this study to demonstrate the importance of early diagnosis in the Emergency Department and faster microbiology results and of putting suitable isolation measures in place. No conflict of interest.
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