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During the exceptional health crisis caused by the COVID-19 pandemic, a program of telepharmacy consultations, associated with dematerialized dispensing of treatments with delivery to the home or drive, was set up by the pharmacy department of our institution. The system has concerned 25 % of the ambulatory dispensations of the PUI over the period of the first containment, and allowed 351 patients to avoid coming to the hospital pharmacy, while maintaining a quality pharmaceutical service. Although certain limitations were identified, such as access to technology or the increase in dedicated pharmaceutical time, this system, appreciated by patients and physicians, has enabled a privileged relationship to be maintained with many patients. Expert clinical pharmacists now also perform PT, and treatments are now sent to patient's pharmacies.Copyright © 2022 Elsevier Masson SAS
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The availability of the first Covid-19 vaccine in December 2020 has led to a major reorganization of the pharmaceutical's activities in order to allow the rapid deployment of the vaccination throughout the country. This cross-functional and multi-professional vaccination campaign is characterized by many factors of complexity. Securing the circulation of these new vaccines was one of the crucial points, both in terms of specific storage conditions and compliance with good preparation and administration practices. The diversity of the actors involved, the nature of the centers practicing this vaccination, the emergency of the situation and the important quantity of vaccines dispensed have demonstrated the value of the support provided by the pharmaceutical team in order to limit the risk of errors. New tasks for the pharmacist and new challenges have emerged from this exceptional vaccination campaign. We would like to provide a feedback here.Copyright © 2022 Elsevier Masson SAS
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PURPOSE: Antithrombotic agents have a role in coronavirus disease 2019 (COVID-19) treatment, but the pandemic disrupted medication supply. This study examined changes in the volume of oral and parenteral anticoagulant and antiplatelet medications at US hospitals during the pandemic. METHODS: IQVIA National Sales Perspective (NSP) data was used to determine the monthly volume of anticoagulants and antiplatelets purchased at US hospitals between January 2018 and February 2021. Mean monthly medication volumes, reported as extended units (EUs), and year-over-year changes in medication volume were determined. A single-group interrupted time series analysis was used to evaluate changes in the rate of growth of monthly medication volumes before (January 2019-February 2020) and during (March 2020-February 2021) the COVID-19 pandemic. RESULTS: Overall, there was a 43.4% decline in the total volume of anticoagulants and antiplatelets at US hospitals in March 2020, driven by a decrease in heparin volume. Mean monthly volumes decreased significantly (P < 0.05) for parenteral anticoagulants (-106,691,340 EU [95% CI, -200,033,910 to -13,348,780]), oral anticoagulants (-354,800 EU [95% CI, -612,180 to -97,420]), and parenteral antiplatelets (-391,880 EU [95% CI, -535,420 to -248,330]). During the pandemic, the monthly volume of oral anticoagulants, parenteral anticoagulants, and parenteral antiplatelets grew significantly more than in the prepandemic period. This growth was primarily seen in volumes of apixaban, argatroban, enoxaparin, heparin, eptifibatide, and tirofiban. Apixaban and heparin volumes continued a prepandemic uptrend, while argatroban and eptifibatide volumes reversed trend. CONCLUSION: Rapid changes in anticoagulant and antiplatelet volume at US hospitals during the COVID-19 pandemic highlight the need for institutional protocols to manage fluctuating medication volume demands.
Subject(s)
Anticoagulants , COVID-19 , Humans , Platelet Aggregation Inhibitors/therapeutic use , Pandemics , Eptifibatide , COVID-19/epidemiology , Heparin , HospitalsABSTRACT
Asthma is a chronic respiratory disease with a high health, social and economic impact, particularly in the case of Severe Uncontrolled Asthma (SUA). For this reason, new strategies are especially necessary to improve its approach, with a personalized approach to each patient and from a multidisciplinary perspective, in addition to integrating the new telemedicine and telepharmacy practices promoted as a result of the COVID-19 pandemic. In this context, the TEAM 2.0 project ("Work in Multidisciplinary Asthma Teams") has been developed, following the TEAM project carried out in 2019, with the aim of updating and prioritizing good multidisciplinary work practices in SUA in a post pandemic context and analyze the progress made. A coordinating group, made up of eight multidisciplinary teams of hospital pharmacists, pulmonologists, and allergists, carried out an updated bibliographic review, sharing of good multidisciplinary practices, and analysis of advances. Through five regional meetings with other experts with experience in SUA, the good practices identified were shared and subjected to debate, evaluation and prioritization. In total, 23 good multidisciplinary work practices in SUA, grouped into five work areas: 1) Organization of work in multidisciplinary teams, 2) Patient education, self-management and adherence, 3) Health results, data monitoring and persistence, 4) Telepharmacy and experiences implemented during the COVID-19 pandemic and 5) Training and research, were evaluated and prioritized by 57 professionals from the field of Hospital Pharmacy, Pulmonology, Allergology and Nursing. This work has made it possible to update the roadmap of priority actions to continue advancing in optimal models of care for patients with AGNC in a post-COVID-19 context.
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Background: Pharmacists are integral members of the multidisciplinary healthcare team who, with their skills, knowledge, and training, are well positioned to prevent, identify, and manage medication-related issues. Many published articles related to COVID-19 management have highlighted the important role of the pharmacists in assuring the safe, effective, and cost-effective use of medications. During such challenging times of COVID-19 pandemic that resulted in a high demand on medical resources and healthcare providers, pharmacists are well positioned to contribute and add more efforts to the healthcare system to achieve best use of the available resources including medications and providing high quality pharmaceutical care to help the patients and support the healthcare providers. Methods: This is a retrospective chart review included all admitted adult patients with confirmed COVID-19 diagnosis from 1 March 2020 till 30 June 2020. The documented clinical pharmacist interventions were extracted from the EMR and reviewed by multiple clinical pharmacists to identify type, number, frequency, outcome, and physician's acceptance rate of documented interventions. Results: A total of 484 pharmacist interventions included in the final analysis. Antimicrobial stewardship interventions were the most reported (149, 30.8%) and antibiotics were the most reported class of medication, constituting 31.1% of the total interventions. "Optimized therapy" was the most commonly reported outcome (58.8%). Overall, 50.8% (246) of the interventions were rated as having "moderate" clinical significance using the clinical significance scoring tool. The physicians' acceptance rate was 94.7%.Conclusion: Pharmacist interventions are associated with improved communication and medication use in admitted adult patients with COVID-19. Clinical pharmacists can play a crucial role in optimizing medication use in patients with COVID-19 through prevention, identification, and resolving existing or potential drug-related problems.
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Background and Importance In 2020 Spain was involved in the SARS-CoV-2 pandemic. This situation entailed in the dispensing of drugs from pharmacy services to patients' homes. This way of reaching the patient facilitated the access to antiretroviral treatment (ART) in this difficult situation. However, due to the social stigmas, certain patients did not consent to access this dispensing system. Aim and Objectives The objective is to study how adherence to antiretroviral treatment was affected in HIV-positive patients during the months of the first alarm state in Spain (March 14 to June 21 2020);because during those period ART was home dispensation. Material and Methods Observational retrospective study, included patients HIV-positive who received ART during the first alarm state in Spain during COVID-19 pandemic and in the same period of 2019. Collected data were: sex, age and variables related to pharmacological treatment (ART in the selected periods, number of dispensations made, galenic units dispensed). To measure adherence, an indirect method was used, comparing the dispensations made in the hospital pharmacy of the hospital of Leon during the studied period and the same dates of the previous year. % adherence = [dispensed galenic units/planned galenic units] x100 Results We analyse 444 patients with a median age of 54 years (45-59) being 77.93% (n=346) men. During the study period 83 patients (18.69%) changed their ART. 38.55% (n=32) carried out a simplification of ART in 2020 (from a treatment based on several pharmaceutical forms to a treatment based on a single one). The mean adherence in the periods studied in 2019 and 2020 was 91.89% (CI 90.44-92.90) and 90.25% (CI 87.61- 92.90), respectively. In 2019, 67.12% (n=298) of patients had adherence greater than 95%, compared to 86.71% (n=385) in 2020. For 38 patients there are no medication dispensations during the 2020 period. Of the majority (n=27) the reason for the absence is unknown;6 were not disposed of from the hospital of Leon for spending the confinement outside the city;4 have died and 1 did not accept home dispensation. Conclusion and Relevance The implementation of home dispensing could have positively influenced adherence in HIVpositive patients. It is necessary to evaluate in the future that the implementation of new telepharmacy programmes can have a positive influence on adherence.
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Background and Importance After the rise of telemedicine with the COVID-19 pandemic, a telepharmacy consultation has been implemented in our hospital in the pharmacy outpatient area, sending medicines to community pharmacies within a population area of 600,000 inhabitants. Aim and Objectives The purpose of this study is to analyse the medication errors (ME) that have occurred during a specific period of time, throughout the process of medication delivery. The aim is finding causes and possible improvements. Material and Methods We carried out a retrospective descriptive study. The errors that occurred between January 2021 and August 2022 (20 months) in the telepharmacy process were analysed, taking into account everything from the preparation in the hospital pharmacy to the collection of the medication by the patient in the community pharmacy. The MEs were collected in a local database. We described date, personal data of the patient, codes assigned to the single shipping route and destination community pharmacy, type of error and step in which the ME was detected. Results In the period studied, a total of 69 MEs were recorded. We break them down into the following types: 20 cases with a quantitative lack of medication (28.99%), 19 cases in which a different medication was sent (27.54%), 15 with another patient's medication (21.74%), 10 with medicine with wrong dose (14.49%), 2 cases in which the medicine was not sent (2.90%) and another 2 in which the medicine was sent badly packaged (2.90%), 1 case in which the one in which the misidentified medicine was sent (1.45%) and 1 case in which a larger quantity was sent (1.45%). 48 MEs were detected by the patient (69.56%), 15 were detected in the community pharmacy (21.74%), 4 were detected in the hospital pharmacy (5.80%) and 2 cases were detected during the transportation of the medication (2.90%). None of the errors detected had consequences for the patient to our knowledge. Conclusion and Relevance Among the MEs detected, the most common were those related to a quantity defect or lack of a medication and those in which a different medication was sent. In general, they are errors that could be avoided by automating processes that are currently carried out manually.
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The use of pharmacogenetics to optimize pharmacotherapy is growing rapidly. This study evaluates the feasibility and operability of a collaborative circuit involving hospital and community pharmacists to implement clopidogrel pharmacogenetics in Barcelona, Catalonia, Spain. We aimed to enroll patients with a clopidogrel prescription from cardiologists at the collaborating hospital. Community pharmacists collected patients' pharmacotherapeutic profiles and saliva samples, which were then sent to the hospital for CYP2C19 genotyping. Hospital pharmacists collated the obtained data with patients' clinical records. Data were analyzed jointly with a cardiologist to assess the suitability of clopidogrel. The provincial pharmacists' association coordinated the project and provided IT and logistic support. The study began in January 2020. However, it was suspended in March 2020 due to the COVID-19 pandemic. At that moment, 120 patients had been assessed, 16 of whom met the inclusion criteria and were enrolled in the study. The processing of samples obtained before the pandemic had an average delay of 13.8 ± 5.4 days. A total of 37.5% patients were intermediate metabolizers and 18.8% were ultrarapid metabolizers. No poor metabolizers were detected. Pharmacists rated their experience with a 7.3 ± 2.7 likelihood of recommending that fellow pharmacists participate. The net promoter score among participating pharmacists was +10%. Our results show that the circuit is feasible and operable for further initiatives.
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BACKGROUND: Seven-day clinical pharmacy services in the acute sector of the National Health Service are limited. There is a paucity of evidential patient benefit. This limits investment and infrastructure, despite United Kingdom wide calls. AIM: To optimise medicines seven-days a week during surge-2 of the COVID-19 pandemic through implementation of a seven-day clinical pharmacy service. This paper describes service development, evaluation and sustainability. SETTING: A tertiary-referral teaching hospital, London, United Kingdom. DEVELOPMENT: The seven-day clinical pharmacy service was developed to critical care, acute and general medical patients. Clinical leads developed the service specification and defined priorities, targeting complex patients and transfer of care. Contributing staff were briefed and training materials developed. IMPLEMENTATION: The service was implemented in January 2021 for 11 weeks. Multidisciplinary team communication brought challenges; strategies were employed to overcome these. EVALUATION: A prospective observational study was conducted in intervention wards over two weekends in February 2021. 1584 beds were occupied and 602 patients included. 346 interventions were reported and rated; 85.6% had high or moderate impact; 56.7% were time-critical. The proportion of medicines reconciliation within 24-h of admission was analysed across the hospital between November 2020 and May 2021. During implementation, patients admitted Friday-Sunday were more likely to receive medicines reconciliation within 24-h (RR 1.41 (95% CI 1.34-1.47), p < 0.001). Rostered services were delivered sustainably in terms of shift-fill rate and medicines reconciliation outcome. CONCLUSION: Seven-day clinical pharmacy services benefit patient outcome through early medicines reconciliation and intervention. Investment to permanently embed the service was sustained.
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Introduction: The COVID-19 pandemic forced the Hospital Pharmacy Service (HPS) to adapt the outpatient pharmaceutical care services to ensure continuity and prevent exposure of onco-haematology outpatients to the virus. This situation was used to optimize clinical outcomes, accessibility and security through the establishment of a telepharmacy program (TP). Two years later, we describe the experience and analyse the impact. Material(s) and Method(s): The HPS coordinated with the Oncology and Haematology Services a TP that included: - Adaptation of schedules to make appointments. - Database in Excel. - Organization with delivery company. - Acquisition of resources. - Implantation and extension to all candidate patients. - Analysis of results and quality control. TP was implemented on March 23, 2020 and continues today. The patients have an appointment for: first telematic consultation (start of treatment), successive consultation (continuation or switch) or successive home delivery. Results and discussion: 533 deliveries were performed to a total of 142 patients in 2 years, since the implementation of the TP: 408 deliveries to 136 patients during the first year and 125 to 51 during the second year. The maximum activity was in April 2020, which represented 43%. 120 visits to the HPS were avoided. Virtual pharmaceutical care was carried out for initiations or changes to 112 patients and 53 calls were answered by telephone consulting interactions, adverse effects, dosage or requesting deliveries. On the first 3 months, home deliveries did not suppose cost since Civil Protection carried them out voluntarily. After that, the rate was 14 euros/shipment, whichmeant a total of 3.400 euros in the studied period. Satisfaction surveys were conducted on 64 random patients: 97% rated the service received as excellent;the remaining 3% as good. The medication arrived in optimal conditions in 98% of shipments. In those cases that needed to contact the HPS, 91% always did;9% usually. Conclusion(s): 100% of patients would like to maintain this service in the future. However, in the last year, shipments have decreased by 70% compared to the previous year. TP has changed the practice of outpatient pharmacy and allows to adapt the pharmaceutical care during the COVID-19 pandemic.
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The current situation of healthcare units is characterised by the increasing cost of providing the respective care, the consequent deterioration of the financial situation, and the complicated and time-consuming processes. Together with rising demand, they may become factors contributing to a decrease in service demand. Due to this situation, more efficient and effective logistics and supply chain management are widely recognised as one of the main areas for improvement. To provide insight on which areas to improve, several objectives were looked at in this work, including the analysis of the methods and criteria for the selection of medicines in hospital pharmacies, the definition of obstacles to the rational management of stocks, and the analysis of historical data to forecast future demand for a Portuguese public hospital. The study revealed that some of the 1346 products present on the pharmacy's ERP do not have sufficient historical data to create an accurate forecast. In this context, and with a service level of 95%, 41% of products have a stock higher than what should be the maximum stock, amounting to approximately € 147.908.87 in fixed assets, and 11% of products were at risk of being out of stock at the time. The importance of the evolution of the core information system of hospitals was at stake, ensuring the technological sustainability of the ongoing digital transformation, alignment with ICT rationalisation measures, improvement of customer service, and improvement of the quality of information available to the user. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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BACKGROUND: The recent SARS-CoV-2 pandemic has resulted in significant morbidity and mortality worldwide. The healthcare systems, including pharmacies, faced unique challenges, such as managing an overwhelming patient influx, clinical workforce management, transitioning to remote or online work, medication procurement and several others. The purpose of this study is to describe our hospital pharmacy's experience dealing with the COVID-19 pandemic and to present solutions to the challenges that arose. METHODOLOGY: We retrospectively reviewed and consolidated strategies, interventions, and solutions that were implemented by our pharmaceutical institute in response to the challenges that arose during the COVID-19 pandemic. The study period was from March 1 to September 30, 2020. RESULTS: We reviewed and organized our hospital pharmacy response to the COVID-19 pandemic into different categories. In inpatient and outpatient satisfaction surveys, physicians and patients expressed a high level of satisfaction with pharmacy services. The close collaboration between the pharmacy team and other clinicians was demonstrated through the number of pharmacist interventions, participation in the COVID-19 guidelines reviews, involvement in local and international research, and innovative solutions to inpatient and outpatient pharmacy medication management challenges. CONCLUSIONS: This study highlights the crucial role that our pharmacists and pharmaceutical institute played in ensuring continuity of care during the COVID-19 pandemic. We implemented several key initiatives, innovations, and collaborations with other clinical disciplines to successfully overcome the challenges faced.
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Background: On March 16, 2020, because of the COVID-19 pandemic, the Swiss Federal Council declared an 'extraordinary situation' in terms of the Epidemics Act. Purpose(s): To assess the roles of an inter-hospital pharmacy in the fight against SARS-CoV-2. Method(s): All missions performed by our pharmacy were systematically collected and evaluated. They were also compared to its official duties. Result(s): Specific missions, which have been mainly managed by the crisis unit and the four departments of the pharmacy (Pharmaceutical Logistics, Drug Manufacturing, Clinical Pharmacy and Nursing Homes Supply), were: 1) human resources continuity;2) specific drug supply (for both hospitals and nursing homes;e.g. anaesthetics, sedatives, antiviral drugs, incl. for clinical trials);3) clinical assistance (especially in the ICU of the main acute hospital);4) individual drug manufacturing (e.g. hydroxychloroquine oral solution);5) on-site pharmacies management;6) own infrastructure securing (especially in term of hygiene);7) hand disinfectant production;and 8) hygienic masks supply for healthcare professionals in the area. The two last missions were out of the traditional duties of our pharmacy and have been achieved with the support of staff from the Swiss civil protection. A particular challenge was the management of the shortage of various products and the identification of alternative therapeutic options. Conclusion(s): Our pharmacy has faced various challenges during the acute pandemic situation. Some missions performed were even beyond our traditional ones. The disaster plan of our pharmacy has to be further developed, as well as the associated training of the staff, based on the lessons learned from this pandemic.
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Background: Dr Gray's Hospital Elgin provides an outpatient chemotherapy service as a satelite unit to Aberdeen Royal Infirmary (65 miles away). Treatment is ordered at Dr Gray's by a suitably trained and experienced clinical pharmacist, pending patient blood test results. Purpose(s): The COVID-19 pandemic has brought with it many challenges. Anticipated staff shortages, coupled with the complete removal of shielded staff from the department, have necessitated changes to normal working practices. Method(s): Remote access to the NHS Grampian network was enabled for a pharmacist, working at home on an NHS Grampian device. Subsequently it was possible to access Chemocare, the chemotherapy prescribing and administration system, and Trakcare, the electronic patient records system. Following patient toxicity screening and reporting of their blood test results, the Macmillan nurses authorise the prescription, allowing final verification by the pharmacist. The technician then accuracy checks the chemotherapy and releases it for delivery to the unit, ready for administration to the patient. Result(s): The clinical pharmacy service to the outpatient chemotherapy clinic has been safely maintained by an appropriately qualified pharmacist, while minimising the level of input required from pharmacy technicians. Conclusion(s): There have been minimal alterations to the service. This has been possible through small adaptations to access existing electronic resources, and frequent communication between the pharmacist and technician. Through full utilisation of remote access to NHS systems it has been possible to implement this alteration to service whilst maintaining at all times patient confidentiality and full professional accountability.
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INTRODUCTION: Resilience assists healthcare professionals in negotiating challenges, remaining positive when experiencing adversity, and in constructively dealing with difficult work situations and environments. There is increasing research about how early career healthcare professionals, understand and maintain resilience but little is known about support early career pharmacists may need and value. AIMS: To explore early career pharmacists' understanding of resilience, their strategies to enhance and maintain resilience as healthcare professionals and to identify resilience-fostering programmes they perceive could be implemented to support them. METHODS: Three focus groups and 12 semi-structured interviews with a total of 15 hospital pharmacists and 10 community pharmacists (both less than 3 years post-registration) were conducted. An inductive thematic analysis of transcripts was performed to identify main themes and subthemes. RESULTS: Pharmacists understood resilience as the capability to adapt to and learn from challenges and setbacks, which they can build through experience and exposure. Resilience in the workplace was challenged by their working environment and workload, which could lead to ego depletion, the transition from intern to registered pharmacist and working during the COVID-19 pandemic, which both added pressure and uncertainty to their role. Professional resilience was supported on individual, social and organisational levels and through self-care strategies. Pharmacists perceived mentorship and sharing experiences, experiential placements and constructive but challenging role play as potentially beneficial in building resilience during undergraduate studies and internship. DISCUSSION: Pharmacists defined resilience constructively and identified challenges testing but also strategies supporting their resilience in the workplace. Workplaces can support pharmacists by monitoring workload and workplace relationships, creating opportunities for peer and mentor support and by allowing pharmacists to implement their personal, individualised resilience maintaining strategies. Early career pharmacists' experiences and insights would be valuable when considering the design and implementation of resilience-fostering programmes.
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The availability of the first Covid-19 vaccine in December 2020 has led to a major reorganization of the pharmaceutical's activities in order to allow the rapid deployment of the vaccination throughout the country. This cross-functional and multi-professional vaccination campaign is characterized by many factors of complexity. Securing the circulation of these new vaccines was one of the crucial points, both in terms of specific storage conditions and compliance with good preparation and administration practices. The diversity of the actors involved, the nature of the centers practicing this vaccination, the emergency of the situation and the important quantity of vaccines dispensed have demonstrated the value of the support provided by the pharmaceutical team in order to limit the risk of errors. New tasks for the pharmacist and new challenges have emerged from this exceptional vaccination campaign. We would like to provide a feedback here. Copyright © 2022 Elsevier Masson SAS
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Service or Program: The Community Outreach Intervention Projects (COIP) Mobile Unit is a unique collaboration between a community harm reduction program, an opioid treatment program, and mobile medical unit organization. The goal is to provide medication-assisted recovery (MAR) via low-threshold buprenorphine initiation, methadone referral, and primary care with harm reduction services to reach people who use drugs, are at risk for overdose, and/or could benefit. from medical care in Chicago. The interprofessional team consists of physicians, clinical pharmacists, peer recovery specialists, and outreach workers. Clinical pharmacists are integral to this operation by providing COVID vaccinations, testing, medication inductions and counseling, and wound care. Justification/Documentation: A chart review was conducted for patients seen by the COIP Mobile Unit between June 1, 2021 and January 31, 2022 to describe services provided. A total of 398 unique patients were seen across 565 visits. Of the visits, 70% (n=398) and 30% (n=167) were initial and follow-up visits, respectively. Most visits provided one service (84%, n=477) versus two or more (16%, n=88). The typical patient was Black (65%), male (66%), and 46 years old (mean). The most common service provided was COVID-19 vaccination (43%, n=244) followed by MAR (25%, n=143), COVID-19 testing (14%, n=81), wound care (11%, n=63), medication refill (7%, n=41), and vitals assessment (2%, n=13). Adaptability: The unit adjusts its service location based on monthly overdose data from the Chicago Department of Public Health to meet the patients where they are. The outreach model employed is an Indigenous Leader Outreach Model that hires from the target population for shared experience and enhanced value. This model can be adopted by other street medicine teams to further integrate into high need areas. Significance: The COIP Mobile Unit is an innovative, interprofessional harm reduction program increasing access to MAR and primary care in a street medicine environment with integrated clinical pharmacy services.