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Introduction It has long been felt that many contributions made by the ICU Pharmacy team, are not well showcased by the yearly regional network multi-speciality contributions audit. Themes specific to ICU are diluted amongst Trust and region wide data, and valuable learning for the multi-disciplinary team (MDT) is subsequently overlooked. Objective(s): The aims of this project were to: * Develop and pilot a MicrosoftTM Access © database for the ICU pharmacy team to record significant contributions. * Enable the production of reports to the ICU Quality & Safety board, to raise awareness, disseminate concerns, and influence future quality improvement projects. * Provide examples to contribute to the training of the whole MDT. * Generate evidence of team effectiveness and encourage further investment. * Provide team members with a means to recall contributions, for revalidation, appraisal, prescribing re-affirmation and framework mapping. Method(s): * A database was built with a user-friendly data-entry form to prevent overwriting. Fields were agreed with peers who would be using the database. * The team were invited to voluntarily enter their contributions which they thought added value and provided useful learning. * The pilot phase ceased with the emergence of the Omicron SARS-CoV-2 variant, due to staffing pressures and surge planning. Result(s): * Between 12/07/2021 and 25/11/2021, a total of 211 contributions were recorded. * Pharmacists entered 88.6% and a single technician entered 11.4% of these. * Independent Prescribing was utilised in 52.13% of contributions, and deprescribing in 25.12%. * Figure 1 demonstrates the contributions by drug group * The top 5 drugs associated with contributions were: ? Dalteparin ? Vancomycin ? Voriconazole ? Meropenem ? Co-trimoxazole * Treatment optimisation was an outcome for 76.3% of all contributions. Figure 2 stratifies these by type. Contributions. * Drug suitability was a cause for intervention in 12.8% of all contributions, encompassing allergies, contraindications, cautions and interactions and routes. * Medicines reconciliation accounted for 17.54% of all contributions, which almost half were Technician led. Admission was the most common stage to intervene (81.08%), followed by transcription. * Of all contributions, 37.91% were classified as patient safety incidents. Reassuringly 76.25% of these were prevented by the Pharmacy team. Themes have been extracted from these incidents and are presented in Table 1. Conclusion(s): PROTECTED-UK1 demonstrated the value pharmacists contribute to the quality and safety of patient care on ICU. Studies of similar quality and scale including Pharmacy Technicians are lacking, but even in this pilot study, it is evident how important their input is. Independent prescribing is a fundamental and well utilised part of our ICU Pharmacist skillset, supporting the GPICS2 recommendation that ICU pharmacists should be encouraged to become prescribers. Compiling a team interventions database is a useful tool to highlight local priority areas for guideline development;training;and ensuring that appropriate decision support is built into electronic prescribing systems. To improve the usefulness of the data, further stratification of contributions according to the Eadon Criteria3 may be worthwhile, to expand its use as a medication safety thermometer for ICU.
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Background: As cystic fibrosis (CF) lung disease progresses, the airways become colonized with opportunistic pathogens such as Pseudomonas aeruginosa secondary to airway surface liquid depletion. Acquisition of P. aeruginosa is associated with decline in lung function and increase in treatment burden and mortality. In October 2019, the Food and Drug Administration approved elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA), a highly effective modulator therapy (HEMT) for individuals aged 12 and older with one copy of the F508del CFTR mutation. ELX/TEZ/IVA increases the amount of and function of CF transmembrane conductance regulator (CFTR) in the respiratory epithelium, increasing mucociliary clearance (MCC) and reducing static airway mucous, a major trigger for chronic infection and inflammation. Method(s): A retrospective analysis of inhaled tobramycin (iTOB) prescriptions prescribed between January 1, 2016, and December 31, 2021, was performed. This captured data before and after ELX/TEZ/IVA approval at Children's Mercy Kansas City (CMKC). The number of individuals with new P. aeruginosa acquisition was determined by identifying electronic prescriptions for iTOB eradication courses. An eradication course was defined as a first lifetime prescription for iTOB or a new prescription for iTOB submitted at least 1 year after a previous prescription. The number of individuals considered chronically infected with P. aeruginosa was determined by identifying individuals receiving chronic iTOB prescriptions and confirmed by respiratory cultures indicating chronic infection based on the Leeds criteria (P. aeruginosa recovered in >=50% of airway cultures in the previous 12 months). Result(s): Eradication courseswere prescribed to 34 individuals in 2016 (15% of people receiving care at CMKC). The number of eradication prescriptions declined in 2020 and 2021, with only 15 (7%) individuals prescribed eradication therapy in 2020 and 12 (5%) in 2021. A similar pattern was observed for prescriptions for chronic infection. In 2016, 57 individuals (25% of our patient population) were receiving iTOB for chronic P. aeruginosa infection. Reductions were seen in 2020 and 2021, with 28 (13%) and 20 (9%) individuals prescribed chronic therapy, respectively. The number of individuals prescribed iTOB for P. aeruginosa eradication and chronic infection per year is represented in Figure 1.(Figure Presented)Conclusions: CMKC experienced a decrease in the number of courses of iTOB prescribed over the last 6 years. HEMT use is associated with greater MCC and anti-inflammatory effects affecting the airway microbiome. The decrease in respiratory cultures growing P. aeruginosa likely reflects these phenomena. A confounding factor is the SARS-CoV-2 pandemic and widespread use of HEMT. Clinic closures and implementation of telemedicine limited in-person patient visits during 2020 and 2021. Despite limited in-person visits, the average number of respiratory cultures per individual at CMKC in 2020 was 3.5, which is consistent with previous years.Wewere able to obtain frequent surveillance cultures through implementation of a drive-through respiratory specimen collection process. Hence, the decrease in number of iTOB courses cannot be attributed to a decrease in frequency of respiratory cultures, although we cannot assess the impact of school closures and a decrease in social gatherings on new P. aeruginosa acquisition or chronic infection. Looking at all these variables, the widespread use of HEMT likely played a significant role in reducing new P. aeruginosa acquisition and chronic P. aeruginosa infection.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved
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Background (Dr Rahul Patley, Assistant Professor of Psychiatry- Goldman Sachs project, NIMHANS) The Government of India announced the National Tele Mental Health Programme (Tele MANAS) in the Union Budget in February 2022 to handle the aftermath of mental health issues arising out of the COVID-19 pandemic. It was launched on 10 Oct 2022 on World Mental Health Day as a 24X7 two-tier tele-mental health facility across India. Functioning of Tele Manas (Dr. Suchandra H H Assistant Professor of Psychiatry - Tele MANAS, NIMHANS & Dr C Naveen Kumar, Professor of Psychiatry, Principal Investigator of Tele MANAS, NIMHANS) A total of 51 Tele MANAS cells will be established across India to provide a broader range of mental health services (counselling, consultations, e-prescriptions, follow-ups, and linkages to in-person services) by various mental health specialists with five Regional Coordinating centres and 23 Mentoring Institutes. The NIMHANS function as the apex centre, NHSRC for resource mapping, and IIIT-B for technological support. Each Tele MANAS cell shall provide online services to callers through a trained counsellor and escalates to a mental health professional when needed. It also offers a linking service for inperson referrals to existing mental health resources. The curriculum of Tele MANAS (Dr Madhuri H Nanjundaswamy Assistant Professor of Psychiatry - Tele MANAS, NIMHANS & Dr Suresh Bada Math, Professor of Psychiatry, NIMHANS) The content of the curriculum includes components of training, manual preparation and accreditation courses for Tele MANAS Counsellors. The first edition of manuals were prepared and recently released by MoHFW. The training will be conducted in hybrid mode with both on-site and online components for Tele MANAS Counsellors. A selflearning module for counsellors is also planned. The concept of mental health in Tele MANAS (Dr Nileswar Das, Assistant Professor of Psychiatry- Goldman Sachs project, NIMHANS and Dr N Manjunatha, Additional Professor of Psychiatry, NIMHANS) Mental health in Tele MANAS is a spectrum concept that ranges from mental wellness to mental distress to mental illness. COVID-19 has increased mental distress exponentially compared to mental illness, emphasizing the need to focus on distress.
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Purpose: Exacerbated by the COVID-19 pandemic, adolescents from structurally marginalized communities face barriers to accessing sexual and reproductive health (SRH) care. Mobile health units (MHUs) may be effective in reaching these adolescents but few studies have assessed their feasibility in this population. Methods: We assessed the feasibility of an MHU to provide SRH care to adolescents in community settings. Adolescents were invited to community demonstrations of hypothetical MHU care ("Demonstration events”). Adolescents completed surveys (demographics, likelihood of future MHU-based care, and access to health care) and staff documented field notes. We then partnered with adolescents, health care providers, and community leaders to create adolescent-centered SRH care for MHU delivery ("Clinical events”). Free and confidential services provided on the MHU included contraceptive care, condoms, testing for pregnancy, Neisseria gonorrhea (GC), Chlamydia trachomatis (CT), Syphilis, and Human Immunodeficiency virus (HIV). Initially, we provided electronic prescriptions for contraception during MHU visits. We later designed a system to dispense contraception [I.e., emergency contraception (EC) for future use, combined hormonal oral contraceptives (CHOCs), patches and Medroxyprogesterone] in the MHU. After MHU care, adolescents completed surveys to report satisfaction while staff documented feedback through field notes. Results: At 8 community "Demonstration events”, 98 teens (mean age 15.8 years, 67% female at birth, 17% Genderfluid/Non-Binary/Trans, 49% heterosexual, 24% Hispanic, 49% Black, 40% White) were enrolled. Most (70%) reported no previous vaginal/penile sex. Many (46%) had forgone needed health care in the previous year. Most (77%) said they were very/somewhat likely to get care on the MHU if available in the future and 82% would recommend it to friends. Most thought the MHU would be a great way to increase access to SRH care because it eliminated transportation obstacles and appointment delays. Many felt the MHU would provide adequate privacy and advised bringing the MHU to school or community events. Teens recommended collecting urine specimens in nearby restrooms and using a brown bag to transport them to the MHU. Utilizing their feedback, we partnered with teen-serving community organizations and schools to host the MHU. At two "Clinical events”, we provided care for five patients (4 biologic females, 1 biologic male). Accepted health services included condom provision (n=5) and, pregnancy (n=3), GC/CT (n=4), and Syphilis/HIV (n=2) testing. Two MHU patients received contraceptive prescriptions, one received contraception onsite (EC and CHOCs), and one with a positive CT test was contacted and treated. Four adolescents completed a post-care survey. All (100%) were very satisfied with MHU care and said they would recommend it to a friend. All (100%) agreed/strongly agreed they learned something new about SRH and reported the information was helpful. Field notes revealed patients communicated appreciation for the care, felt comfortable on the MHU, and found school-based SRH care acceptable. We plan to host five additional MHU "Clinical events” (Fall 2022). Conclusions: As COVID-19 continues to negatively impact adolescent SRH care-seeking, our work offers key insights to customizing MHU-based SRH care to meet the unique needs of adolescents from structurally marginalized communities. Sources of Support: Institutional expansion of NIH-funded KL2 program (RB), 3R21HD098086-02S1 (MM), K23HD098299 (KM).
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BACKGROUND: Little is known about the duration of antibiotic use in hospital settings. We evaluated the duration of hospital antibiotic therapy for four commonly prescribed antibiotics (amoxicillin, co-amoxiclav, doxycycline, and flucloxacillin) including the assessment of COVID-19 impact. METHODS: A repeated, cross-sectional study using the Hospital Electronic Prescribing and Medicines Administration system (January/2019-March/2022). Monthly median duration of therapy/duration categories was calculated, stratified by routes of administration, age, and sex. The impact of COVID-19 was assessed using segmented time-series analysis. RESULTS: There were significant variations in the median duration of therapy across routes of administration (P < 0.05), with the highest value among those antibiotic courses composed of both oral and IV antibiotics ('Both' group). Significantly higher proportions of prescriptions within the 'Both' group had a duration of >7 days compared to oral or IV. The duration of therapy differed significantly by age. Some small statistically significant changes in the level/trends of duration of therapy were observed in the post-COVID-19 period. CONCLUSIONS: No evidence for prolonged duration of therapy were observed, even during COVID-19 pandemic. The duration of IV therapy was relatively short, suggesting timely clinical review and consideration of IV to oral switch. Longer duration of therapy was observed among older patients.
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COVID-19 , Humans , Interrupted Time Series Analysis , Cross-Sectional Studies , Pandemics , Anti-Bacterial Agents , Scotland/epidemiology , HospitalsABSTRACT
Introduction: The Cross-Border Healthcare Directive is applicable in all European Union (EU) Member States. Medical prescriptions are an important resource for the provision of health care and efficient pharmaceutical care for the patient. EU countries are gradually replacing existing paper medical prescriptions with electronic prescriptions (e-Prescriptions). The EU aims to have a cross-border electronic healthcare system that will enable EU citizens to obtain e-Prescriptions anywhere in Europe. Method(s): Medical prescription templates and national rules for prescription medication were collected from selected EU countries between June and December 2020. The most common prescription forms were obtained mainly by contacting National Contact Points for cross-border healthcare and members of the Pharmaceutical Group of the EU. It was not possible to identify patients, prescribers, or places of issue. Result(s): Every country has its own rules for prescription medication and at least two types of prescriptions - paper prescription and e-Prescription. National prescription forms in EU countries differ formally and visually. The common differences are the various content of the form, the validity of the prescription and the number of available forms. Conclusion(s): Even though the ongoing COVID-19 pandemic sped up the process of introducing electronic prescriptions significantly, it is still a requirement to either have a paper medical prescription or a paper copy of the electronic prescription to collect medicine from a pharmacy in the majority of the EU countries.
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Introduction: The Cross-Border Healthcare Directive is applicable in all European Union (EU) Member States. Medical prescriptions are an important resource for the provision of health care and efficient pharmaceutical care for the patient. EU countries are gradually replacing existing paper medical prescriptions with electronic prescriptions (e-Prescriptions). The EU aims to have a cross-border electronic healthcare system that will enable EU citizens to obtain e-Prescriptions anywhere in Europe. Method(s): Medical prescription templates and national rules for prescription medication were collected from selected EU countries between June and December 2020. The most common prescription forms were obtained mainly by contacting National Contact Points for cross-border healthcare and members of the Pharmaceutical Group of the EU. It was not possible to identify patients, prescribers, or places of issue. Result(s): Every country has its own rules for prescription medication and at least two types of prescriptions - paper prescription and e-Prescription. National prescription forms in EU countries differ formally and visually. The common differences are the various content of the form, the validity of the prescription and the number of available forms. Conclusion(s): Even though the ongoing COVID-19 pandemic sped up the process of introducing electronic prescriptions significantly, it is still a requirement to either have a paper medical prescription or a paper copy of the electronic prescription to collect medicine from a pharmacy in the majority of the EU countries.
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Introduction: Curricular external internships are a compulsory element of Pharmacy degrees, by the European directive, of 30 ECTS. In the 2019/20 academic year, Specific Training Sessions were organised for the first time for fifth year students prior to their internships. A programme divided into five practical/theoretical workshop presential modules was proposed (electronic prescription, pharmaceutical care, magistral formulation, pharmacovigilance and research in pharmacy). During the 2020/21 academic year, due to the health emergency caused by SARS-Cov-2, it was necessary to hold it in a hybrid mode (face-to-face and online, 20/80%). The third edition (conducted in the 2021/22 academic year) has returned to face-to-face attendance but kept some virtual sessions. The objective of this study is to evaluate the experience of the implementation and subsequent virtualisation of the Pharmacy Degree Internship Initial Sessions and assess the satisfaction of the participants after three years of experience. Method(s): Evidence has been collected through a satisfaction questionnaire completed both by students and speakers. The questionnaire was carried out using Google Forms tool with 26 questions in the first edition, 20 in the second and third, on a Likert-type scale. In addition, open questions were included to allow participants to express suggestions. Result(s): During the first initial sessions, retransmission of virtual sessions at specific times was adopted to refresh access to electronic prescriptions and actions of pharmaceutical technicians. The use of this technology received a positive evaluation from 70% of the students. The good acceptance of this methodology, as well as the pandemic situation in the second year, made this tool essential for more virtualisation. Conclusion(s): The answers received after the first and second edition of the programme made it possible to introduce improvements that contributed to improved overall evaluation from students. The Initial Sessions have been, both in the face-to-face and virtual modalities, a very satisfactory experience for students, teachers and organisers. This initiative has made it possible to integrate knowledge, acquire skills and develop abilities, helping to establish a frame of reference and increase the interest of students in collaborating with pharmaceutical professionals before their internships and their insertion into the world of work.
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OBJECTIVES: The COVID-19 pandemic triggered rapid, fundamental changes, notably increased remote delivery of primary care. While the impact of these changes on medication safety is not yet fully understood, research conducted before the pandemic may provide evidence for possible consequences. To examine the published literature on medication safety incidents associated with the remote delivery of primary care, with a focus on telemedicine and electronic prescribing. METHODS: A rapid review was conducted according to the Cochrane Rapid Reviews Methods Group guidance. An electronic search was carried out on Embase and Medline (via PubMed) using key search terms 'medication error', 'electronic prescribing', 'telemedicine' and 'primary care'. Identified studies were synthesised narratively; reported medication safety incidents were categorised according to the WHO Conceptual Framework for the International Classification for Patient Safety. KEY FINDINGS: Fifteen studies were deemed eligible for inclusion. All 15 studies reported medication incidents associated with electronic prescribing; no studies were identified that reported medication safety incidents associated with telemedicine. The most commonly reported medication safety incidents were 'wrong label/instruction' and 'wrong dose/strength/frequency'. The frequency of medication safety incidents ranged from 0.89 to 81.98 incidents per 100 electronic prescriptions analysed. SUMMARY: This review of medication safety incidents associated with the remote delivery of primary care identified common incident types associated with electronic prescriptions. There was a wide variation in reported frequencies of medication safety incidents associated with electronic prescriptions. Further research is required to determine the impact of the COVID-19 pandemic on medication safety in primary care, particularly the increased use of telemedicine.
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COVID-19 , Electronic Prescribing , Humans , Pandemics , Patient Safety , Medication ErrorsABSTRACT
Aims: Cancer clinical trials have traditionally been conducted inperson. The COVID-19 pandemic accelerated changes across the entire cancer care continuum, including in clinical trials and teletrials. This study aimed to investigate how telehealth was used in cancer clinical trials during the pandemic, including benefits and barriers to use;and to identify how telehealth can be further enhanced and routinely integrated into cancer clinical trials in Australia. Method(s): A mixed methods approach was used, involving a scoping review of literature, surveys of staff from 14 multi-site Collaborative Cancer Clinical Trial Groups across Australia (n = 98), and qualitative interviews with trial administrators and clinicians (n = 21). Result(s): The literature showed exponential increase in the use of telehealth in cancer trials internationally during the pandemic. Most study participants agreed that telehealth enabled continuation of trials which may have otherwise been postponed or terminated due to the pandemic. Participants indicated strong willingness to use telehealth for certain aspects of trials due to benefits including improved efficiencies in recruitment and consent processes;improved equity of access for people in rural and regional areas;expedited ethics reviews;convenience of e-prescriptions and reduced need for travel. Barriers included technology issues, inequitable access, activities requiring inperson attendance, regulatory obstacles, remote site capabilities, data quality and security issues, lack of training, and resistance to change. Conclusion(s): The rapid shift to telehealth models during the pandemic was viewed positively by participants, with increased innovation and efficiencies.Many, but not all, aspects of cancer clinical trials are appropriate to be delivered via telehealth. Telehealth is most appropriate in later phase trials;for oral (not IV) drugs;and for activities not requiring physical examinations or invasive interventions. Participants preferred hybrid models which include both telehealth and in-person methods, tailored by cancer type, interventions and patient preferences;supported by clear guidelines and staff training.
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Aim: Efficient analgesia administration is paramount to delivering good patient care and is an important factor in The safe assessment of patients. The aim of this audit was to assess analgesia prescribing and administration in The local Surgical Assessment Unit (SAU) and compare it with The standard of care set out by The Royal College of Emergency Medicine guidelines. Method(s): A retrospective audit was performed. Paper and electronic notes, including electronic prescribing data via HEpMA and pain scores were analysed for all patients referred with abdominal pain to SAU by Gp's between The 21st of October and The 30th of October 2021. Data was compared with The RCEM best practice guidelines. Result(s): A total of 33 patients were included. 39% of patients had a documented first pain score within 15 minutes of arrival, with a median time of 20 minutes. of all patients presenting with moderate to severe pain, none received analgesia within 20 minutes. Earliest analgesia administration for this group was 1 hour 42 minutes. Overall median time to first analgesia prescription was 2 hours and 4 minutes and median time to administration was 4 hours and 8 minutes. Conclusion(s): Since The COVID pandemic, NHS hospital staff-and bed shortages have put increased pressure on The delivery of safe patient care. This audit has found significant delays in both prescribing and administering analgesia for patients presenting to SAU. An electronic prescribing protocol was developed to increase efficiency in prescribing and another audit will be conducted to assess impact.