Clinical pharmacy key performance indicators for hospital inpatient setting: a systematic review.

BACKGROUND: Key performance indicators (KPIs) are quantifiable measures used to monitor the quality of health services. Implementation guidelines for clinical pharmacy services (CPS) do not specify KPIs. AIM: To assess the quality of the studies that have developed KPIs for CPS in inpatient hospital settings. METHOD: A systematic review was conducted by searching in Web of Science, Scopus, and PubMed, supplemented with citation analyses and grey literature searches, to retrieve studies addressing the development of KPIs in CPS for hospital inpatients. Exclusions comprised drug- or disease-specific studies and those not written in English, French, Portuguese, or Spanish. The Appraisal of Indicators through Research and Evaluation (AIRE) instrument assessed methodological quality. Domain scores and an overall score were calculated using an equal-weight principle. KPIs were classified into structure, process, and outcome categories. The protocol is available at https://doi.org/10.17605/OSF.IO/KS2G3 . RESULTS: We included thirteen studies that collectively developed 225 KPIs. Merely five studies scored over 50% on the AIRE instrument, with domains #3 (scientific evidence) and #4 (formulation and usage) displaying low scores. Among the KPIs, 8.4% were classified as structure, 85.8% as process, and 5.8% as outcome indicators. The overall methodological quality did not exhibit a clear association with a major focus on outcomes. None of the studies provided benchmarking reference values. CONCLUSION: The KPIs formulated for evaluating CPS in hospital settings primarily comprised process measures, predominantly suggested by pharmacists, with inadequate evidence support, lacked piloting or validation, and consequently, were devoid of benchmarking reference values.

Análisis 2016-2021 del desarrollo del proyecto de atención farmacéutica al paciente externo MAPEX por Comunidades Autónomas / Analysis 2016-2021 of the development of the MAPEX outpatient pharmaceutical care Project by regions in Spain

Objetivo: analizar la evolución del proyecto «Mapa Estratégico de Atención Farmacéutica al Paciente Externo» (MAPEX) por comunidades autónomas en España, a través del análisis de los resultados de la encuesta de situación comparativa entre los años 2016 y 2021. Métodos: un comité de expertos nacionales pertenecientes a la Sociedad Española de Farmacia Hospitalaria elaboró la Encuesta MAPEX sobre la situación de las unidades de pacientes externos, que constó de 43 preguntas específicas de aspectos relacionados con estructura, contexto, integración, procesos, resultados y formación, docencia e investigación. Se llevó a cabo en 2 periodos, uno en 2016 y otro en 2021 (con 3 preguntas adicionales en 2021, relacionadas con los avances de la iniciativa MAPEX y las líneas prioritarias a seguir). Se realizó un análisis comparativo de resultados a nivel nacional y por comunidad autónoma. Resultados: participaron 141 hospitales en 2016 y 138 en 2021, con representación de las 17 comunidades autónomas. El análisis de los resultados mostró mejoras significativas en todas las dimensiones de la encuesta, con variabilidad entre las diferentes regiones. De entre las mejoras más importantes, destacó el desarrollo y consolidación de la telefarmacia, la mayor especialización del farmacéutico por áreas de conocimiento y su integración en equipos multidisciplinares. La mejora del modelo asistencial se consideró el mayor avance a nivel general (65%) y la atención farmacéutica no presencial a nivel de centro (48,2%). Se consideraron líneas prioritarias de trabajo la expansión y aplicación práctica de la metodología de atención farmacéutica (66,4%), la investigación (58,4%) y la formación en todas las iniciativas MAPEX (53,3%). Conclusiones: la implantación y desarrollo de las iniciativas MAPEX ha supuesto un impacto positivo en la evolución en todos los ámbitos asistenciales de la atención farmacéutica al paciente externo. La encuesta permite identificar...(AU)

Objective: Analyse the evolution of the MAPEX Project (Strategic Map of Pharmaceutical Care for Outpatients) by regions in Spain, through the results of the comparative situation survey between the years 2016 and 2021. Methods: A committee of national experts belonging to the Spanish Society of Hospital Pharmacy prepared the MAPEX Survey on the situation of Outpatient Units, which consisted of 43 specific questions on aspects related to structure, context, integration, processes, results and training, teaching and investigation. It was carried out in two periods, one in 2016 and another in 2021 (with 3 additional questions in 2021, related to the progress of the MAPEX initiative and the priority lines to follow). A comparative analysis of results was carried out at the national level and by regions in Spain. Results: 141 hospitals participated in 2016 and 138 in 2021, with representation from the 17 autonomous communities. The analysis of the results shows significant improvements in all the dimensions of the survey, with variability between the different regions. Among the most important improvements, the development and consolidation of telepharmacy stood out, the greater specialization of pharmacists by areas of knowledge and their integration into multidisciplinary teams. The improvement of the healthcare model was considered the greatest advance at a general level (65%), and remote pharmaceutical care at the hospital level (48.2%). Priority lines of work were considered the expansion and practical application of the pharmaceutical care methodology (66.4%), research (58.4%), and training in all MAPEX initiatives (53.3%). Conclusions: The implementation and development of the MAPEX initiatives has had a positive impact on the evolution in all healthcare areas of pharmaceutical care for outpatients. The situation survey makes it possible to identify by regions the significant points for improvement...(AU)

Analysis 2016-2021 of the development of the MAPEX outpatient pharmaceutical care Project by Regions in Spain / Análisis 2016-2021 del desarrollo del Proyecto de atención farmacéutica al paciente externo MAPEX por Comunidades Autónomas en España

Objetivo: analizar la evolución del proyecto «Mapa Estratégico de Atención Farmacéutica al Paciente Externo» (MAPEX) por comunidades autónomas en España, a través del análisis de los resultados de la encuesta de situación comparativa entre los años 2016 y 2021. Métodos: un comité de expertos nacionales pertenecientes a la Sociedad Española de Farmacia Hospitalaria elaboró la Encuesta MAPEX sobre la situación de las unidades de pacientes externos, que constó de 43 preguntas específicas de aspectos relacionados con estructura, contexto, integración, procesos, resultados y formación, docencia e investigación. Se llevó a cabo en 2 periodos, uno en 2016 y otro en 2021 (con 3 preguntas adicionales en 2021, relacionadas con los avances de la iniciativa MAPEX y las líneas prioritarias a seguir). Se realizó un análisis comparativo de resultados a nivel nacional y por comunidad autónoma. Resultados: participaron 141 hospitales en 2016 y 138 en 2021, con representación de las 17 comunidades autónomas. El análisis de los resultados mostró mejoras significativas en todas las dimensiones de la encuesta, con variabilidad entre las diferentes regiones. De entre las mejoras más importantes, destacó el desarrollo y consolidación de la telefarmacia, la mayor especialización del farmacéutico por áreas de conocimiento y su integración en equipos multidisciplinares. La mejora del modelo asistencial se consideró el mayor avance a nivel general (65%) y la atención farmacéutica no presencial a nivel de centro (48,2%). Se consideraron líneas prioritarias de trabajo la expansión y aplicación práctica de la metodología de atención farmacéutica (66,4%), la investigación (58,4%) y la formación en todas las iniciativas MAPEX (53,3%). Conclusiones: la implantación y desarrollo de las iniciativas MAPEX ha supuesto un impacto positivo en la evolución en todos los ámbitos asistenciales de la atención farmacéutica al paciente externo. La encuesta permite identificar...(AU)

Objective: Analyse the evolution of the MAPEX Project (Strategic Map of Pharmaceutical Care for Outpatients) by regions in Spain, through the results of the comparative situation survey between the years 2016 and 2021. Methods: A committee of national experts belonging to the Spanish Society of Hospital Pharmacy prepared the MAPEX Survey on the situation of Outpatient Units, which consisted of 43 specific questions on aspects related to structure, context, integration, processes, results and training, teaching and investigation. It was carried out in two periods, one in 2016 and another in 2021 (with 3 additional questions in 2021, related to the progress of the MAPEX initiative and the priority lines to follow). A comparative analysis of results was carried out at the national level and by regions in Spain. Results: 141 hospitals participated in 2016 and 138 in 2021, with representation from the 17 autonomous communities. The analysis of the results shows significant improvements in all the dimensions of the survey, with variability between the different regions. Among the most important improvements, the development and consolidation of telepharmacy stood out, the greater specialization of pharmacists by areas of knowledge and their integration into multidisciplinary teams. The improvement of the healthcare model was considered the greatest advance at a general level (65%), and remote pharmaceutical care at the hospital level (48.2%). Priority lines of work were considered the expansion and practical application of the pharmaceutical care methodology (66.4%), research (58.4%), and training in all MAPEX initiatives (53.3%). Conclusions: The implementation and development of the MAPEX initiatives has had a positive impact on the evolution in all healthcare areas of pharmaceutical care for outpatients. The situation survey makes it possible to identify by regions the significant points for improvement...(AU)

Analysis 2016-2021 of the development of the MAPEX outpatient pharmaceutical care Project by regions in Spain. / Análisis 2016-2021 del desarrollo del proyecto de atención farmacéutica al paciente externo MAPEX por Comunidades Autónomas.

OBJECTIVE: Analyse the evolution of the MAPEX Project (Strategic Map of Pharmaceutical Care for Outpatients) by regions in Spain, through the results of the comparative situation survey between the years 2016 and 2021. METHODS: A committee of national experts belonging to the Spanish Society of Hospital Pharmacy prepared the MAPEX Survey on the situation of Outpatient Units, which consisted of 43 specific questions on aspects related to structure, context, integration, processes, results and training, teaching and investigation. It was carried out in two periods, one in 2016 and another in 2021 (with 3 additional questions in 2021, related to the progress of the MAPEX initiative and the priority lines to follow). A comparative analysis of results was carried out at the national level and by regions in Spain. RESULTS: 141 hospitals participated in 2016 and 138 in 2021, with representation from the 17 autonomous communities. The analysis of the results shows significant improvements in all the dimensions of the survey, with variability between the different regions. Among the most important improvements, the development and consolidation of telepharmacy stood out, the greater specialization of pharmacists by areas of knowledge and their integration into multidisciplinary teams. The improvement of the healthcare model was considered the greatest advance at a general level (65%), and remote pharmaceutical care at the hospital level (48.2%). Priority lines of work were considered the expansion and practical application of the pharmaceutical care methodology (66.4%), research (58.4%), and training in all MAPEX initiatives (53.3%). CONCLUSIONS: The implementation and development of the MAPEX initiatives has had a positive impact on the evolution in all healthcare areas of pharmaceutical care for outpatients. The situation survey makes it possible to identify by regions the significant points for improvement, as well as those areas to be developed through strengthening and corrective actions. The expansion of the project in the coming years will mean progress towards excellence in care and in the improvement of health results.

[Translated article] Analysis 2016-2021 of the development of the MAPEX outpatient pharmaceutical care Project by Regions in Spain.

OBJECTIVE: To analyse the evolution of the MAPEX Project (Strategic Map of Pharmaceutical Care for Outpatients) by regions in Spain, through the results of the comparative situation survey between 2016 and 2021. METHODS: A committee of national experts belonging to the Spanish Society of Hospital Pharmacy prepared the MAPEX Survey on the situation of Outpatient Units, which consisted of 43 specific questions on aspects related to structure, context, integration, processes, results and training, teaching, and investigation. It was carried out in 2 periods, one in 2016 and another in 2021 (with 3 additional questions in 2021, related to the progress of the MAPEX initiative and the priority lines to follow). A comparative analysis of results was carried out at the national level and by regions in Spain. RESULTS: 141 hospitals participated in 2016 and 138 in 2021, with representation from the 17 autonomous communities. The analysis of the results shows significant improvements in all the dimensions of the survey, with variability between the different regions. Among the most important improvements, the development and consolidation of telepharmacy stood out, the greater specialisation of pharmacists by areas of knowledge and their integration into multidisciplinary teams. The improvement of the healthcare model was considered the greatest advance at a general level (65%), and remote pharmaceutical care at the hospital level (48.2%). Priority lines of work were considered the expansion and practical application of the pharmaceutical care methodology (66.4%), research (58.4%), and training in all MAPEX initiatives (53.3%). CONCLUSIONS: The implementation and development of the MAPEX initiatives has had a positive impact on the evolution in all healthcare areas of pharmaceutical care for outpatients. The situation survey makes it possible to identify by regions the significant points for improvement, as well as those areas to be developed through strengthening and corrective actions. The expansion of the project in the coming years will mean progress toward excellence in care and in the improvement of health results.

Comprehensive Pharmacist-led Transitions-of-care Medication Management around Hospital Discharge Adds Modest Cost Relative to Usual Care: Time-and-Motion Cost Analysis.

Optimal medication management is important during hospitalization and at discharge because post-discharge adverse drug events (ADEs) are common, often preventable, and contribute to patient harms, healthcare utilization, and costs. Conduct a cost analysis of a comprehensive pharmacist-led transitions-of-care medication management intervention for older adults during and after hospital discharge. Twelve intervention components addressed medication reconciliation, medication review, and medication adherence. Trained, experienced pharmacists delivered the intervention to older adults with chronic comorbidities at 2 large U.S. academic centers. To quantify and categorize time spent on the intervention, we conducted a time-and-motion analysis of study pharmacists over 36 sequential workdays (14 519 min) involving 117 patients. For 40 patients' hospitalizations, we observed all intervention activities. We used the median minutes spent and pharmacist wages nationally to calculate cost per hospitalization (2020 U.S. dollars) from the hospital perspective, relative to usual care. Pharmacists spent a median of 66.9 min per hospitalization (interquartile range 46.1-90.1), equating to $101 ($86 to $116 in sensitivity analyses). In unadjusted analyses, study site was associated with time spent (medians 111 and 51.8 min) while patient primary language, discharge disposition, number of outpatient medications, and patient age were not. In this cost analysis, comprehensive medication management around discharge cost about $101 per hospitalization, with variation across sites. This cost is at least an order of magnitude less than published costs associated with ADEs, hospital readmissions, or other interventions designed to reduce readmissions. Work is ongoing to assess the current intervention's effectiveness.

Optimización del circuito de medicación de Farmacia a Hospitalización a Domicilio en un hospital urbano / Optimization of the medication circuit from Pharmacy to Hospital at Home in a urban hospital

Introducción: Se detectaron severas ineficiencias en los circuitos entre el Servicio de Far-macia Hospitalaria (SFH) y el Servicio de Hospitalización a Domicilio (HAD), lo que motivó la realización de un análisis, con el soporte de Calidad, y la definición e implementación posterior de varias acciones de mejora. Método: Análisis del flujo de medicación entre los SFH y HAD del Hospital Dos de Maig. Los objetivos propuestos fueron reducir las interrupciones a los profesionales, aumentar la eficiencia de los circuitos, y garantizar la disponibilidad de la medicación. Se identificaron ineficiencias en el sistema de solicitud y dispensación de medicación, y desajustes en la dotación y revisión del stock. Se acordó un cambio de modelo de dispensación, se ajustó la dotación del stock, se agilizaron las revisiones del mismo, y se aplicó una nueva herramienta de solicitud vía informática de medicación. Resultados: El equipo de HAD consiguió mayor autonomía, se redujeron las interrupciones entre ambos servicios y la dispensación ganó en seguridad. La dispensación global de fármacos fuera de stock disminuyó en un 61%, y los técnicos del SFH ganaron casi media hora diaria. Conclusiones: El cambio en la logística entre el SFH y HAD ha sido muy positivo, obteniendo unos logros importantes, que repercuten positivamente en la organización y en la seguridad del paciente, con un flujo de medicación más fluido y eficiente, y el registro sistemático de las entregas que incrementa la seguridad en la dispensación. (AU)

Introduction: Severe inefficiencies were detected in the circuits between the Hospitalary Pharmacy Service (HPS) and the Home Hospital at Home Service (HaH), which led to an analysis, with the support of Quality, and the defini-tion and subsequent implementation of various improvement actions. Method: Analysis of the flow of medication between HPS and HaH at Hospital Dos de Maig. The proposed objectives were to reduce interruptions to professionals, increase the efficiency of circuits, and ensure the availability of medi-cation. Inefficiencies were identified in the sys-tem of requesting and dispensing medication, and mismatches in the supply and review of the stock. A change of dispensation model was agreed, the stock was adjusted, revisions of the same were expedited, and a new application tool was applied via computer medication. Results: The HaH team achieved greater au-tonomy, interruptions between both services were reduced and dispensing became safer. The overall dispensing of out-of-stock drugs de-creased by 61%, and HPS technicians gained almost half an hour a day.Conclusions: The change in logistics between HPS and HaH has been very positive, obtaining important achievements, which have a posi-tive impact on the organization and the safety of the patient, with a flow of medications more fluid and efficient, and the systematic recording of deliveries which increases the security of dispensing.

Patient-reported outcomes and pharmacist actions in patients with multiple sclerosis managed by health-system specialty pharmacies.

PURPOSE: This study evaluated patient-reported outcomes (PROs) and pharmacist actions for patients on disease-modifying therapies (DMTs) for multiple sclerosis (MS) through health-system specialty pharmacies (HSSPs). METHODS: A multisite, prospective cohort study of patients utilizing an HSSP for DMT fulfillment was performed. Primary outcomes were affirmative answers to PRO questions regarding impacted productivity, hospitalization, and relapse and pharmacist actions. Rates of pharmacist actions were reported as the number of person-years of treatment per action. Univariate and multivariate logistic regression were used to evaluate the association between each PRO and covariates, including the number of pharmacist actions performed, age, sex, insurance, site, and route of administration. RESULTS: The 968 patients included had 10,562 fills and 6,946 PRO assessments. The most common affirmative PRO was impacted productivity (14.6%). Pharmacists performed 3,683 actions, most commonly general medication education (42.6%) and safety (33.3%). Rates of general medication education and nonfinancial coordination of care actions were similar across medication classes; other pharmacist actions varied by medication class. Insurance type was significantly associated with reporting impacted productivity; patients with Medicare and Medicaid were 2.2 and 3.1 times more likely to have reported impacted productivity, respectively (P < 0.001) than commercially insured patients. Patients who reported impacted productivity had more pharmacist actions (P < 0.001). CONCLUSION: Patients on DMTs through an HSSP reported low rates of impacted productivity, relapse, and hospitalization due to MS, although patients with noncommercial insurance were more likely to have impacted productivity. Patients reporting impacted productivity and those taking certain DMTs may require more frequent pharmacist actions.

Provision of primary care pharmacy operated by hospital pharmacist.

A primary care pharmacy (PCP) is operated by hospital pharmacists in Thailand. This study aims to explore the level of PCP provisions operated by hospital pharmacists, to identify health service components that affect PCP operation and to collect opinions from pharmacists regarding factors influencing PCP operation. A postal survey was conducted in northeastern Thailand. A questionnaire included: (1) the PCP checklist (36 items), (2) questions investigating the health service components required for PCP operation (13 items), and (3) queries to pharmacists concerning factors influencing PCP operation (16 items). Questionnaires were mailed to 262 PCP pharmacists. The PCP provision score was calculated with a max score of 36, and reaching at least 28.8 points was deemed as having 'met expectation'. Multivariate logistic regression with a backward approach was used to determine health service components which affected PCP operation. Most respondents were female (72, 60.0%), aged 36.0 years (IQR 31.0-41.0) and PCP work experience of 4.0 years (IQR 2.0-10.0). Overall, the PCP provision score had met expectation (median = 29.00, Q1-Q3 = 26.50-32.00). Tasks that met expectation involved managing the medicine supply, a home visit with a multidisciplinary team and protecting consumer health. Improving medicine dispensary and promotion of self-care and herbal use were below expectation. PCP operation depended on doctor involvement (OR = 5.63 95% CI 1.07-29.49) and public health practitioner involvement (OR = 3.12 95% CI 1.27-7.69). The pharmacist's responsibility, i.e., a good relationship with the community, likely increased PCP provision. The PCP has been widely instituted in Northeast Thailand. Doctors and public health practitioners should get involved regularly. Further research is needed to monitor the outcomes and value of PCPs.

Changes in anticoagulant and antiplatelet drug supply at US hospitals before and during the COVID-19 pandemic (2018-2021).

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.

Development, implementation and evaluation of a seven-day clinical pharmacy service in a tertiary referral teaching hospital during surge-2 of the COVID-19 pandemic.

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.

A hospital at home case report: Prolonged amphotericin B therapy via elastomeric pump.

PURPOSE: Hospital at home is an alternative means of providing inpatient care for a patient requiring prolonged liposomal amphotericin B therapy. SUMMARY: Hospital at home is a unique care model that allows patients to receive inpatient hospital care within the comfort of their home and can be seen as an alternative care site for patients with complex treatment regimens that may require prolonged hospitalization. Hospital systems have increasingly begun incorporating hospital at home programs into their inpatient service lines. We present the case of a patient with disseminated histoplasmosis requiring a prolonged course of intravenous liposomal amphotericin B therapy. Because of the complex administration and stability of this medication, care is often provided in an inpatient setting. The Vanderbilt University Medical Center Hospital at Home team was able to coordinate resources and services to allow for this patient to receive acute hospital care at home and continue to receive amphotericin B infusion. CONCLUSION: This experience spotlights how hospital at home can be considered for patients requiring ongoing inpatient care for prolonged intravenous treatment courses.

Uso y optimización de una metodología para la priorización de la validación de métodos analíticos basada en la evaluación de riesgos en Servicios de Farmacia Hospitalaria / Implementation and optimisation of a tool for the prioritisation of analytical method validation based in risk management in Hospital Pharmacies

Objetivo: Poner en práctica y optimizar una metodología para evaluar los riesgos implicados en la elaboración de medicamentos en Servicios de Farmacia Hospitalaria con el fin de priorizar la validación de métodos analíticos de control de calidad. Método: Se han diseñado dos métodos para el cálculo del Número de Prioridad de Riesgo. Para el análisis y comparación entre ambos, se seleccionaron 3 parámetros a evaluar en cada medicamento: vía de administración, frecuencia de dispensación y complejidad del proceso de elaboración. A cada uno se asignó 4 niveles de gravedad, siendo 1 el más bajo y 4 el más alto. Se modificaron los criterios para la asignación de la gravedad en cada parámetro evaluado en el Método 2 con respecto al Método 1. Ambos métodos se han ensayado sobre 65 fórmulas. Resultados: El Método 1 segrega las formulaciones en 8 grupos según su Número de Prioridad de Riesgo. El Método 2 las separa en 14 grupos de 16 posibles. La frecuencia, en el Método 1 agrupa el 92,31% de las fórmulas en el primer nivel; la complejidad acumula el 86,15% en los niveles 2 y 4. Mientras el Método 2 separa el 25% de fórmulas en cada nivel según frecuencia, al segregar por cuartiles. La complejidad, al diferenciar las fórmulas asépticas con esterilización final de las elaboradas mediante llenado aséptico, separa las formulaciones en grupos más homogéneos. Conclusiones: El Método 2 es capaz de priorizar de forma más eficaz la validación de los métodos analíticos de las fórmulas analizadas, mejorando la consecución del objetivo propuesto. (AU)

Aim: To implement an optimise a methodology to evaluate the risks involved in the compounding of drug products in Hospital Pharmacy Services with the objective of prioritise the validation of analytical methods for quality control. Method: Two different methods were designed to assess the Risk Priority Number. For their analysis and comparison, 3 parameters were evaluated in each drug product: administration route, dispensing rate and compounding process complexity. To each parameter 4 levels of severity were allotted, being 1 the lowest and 4 the highest. The criteria to assign the level of severity for each parameter differ in both methods used. 65 drug products were evaluated with each method. Results: The use of Método 1 segregates drug products in 8 groups as per the Risk Priority Number, whilst Método 2 separates them in 14 groups out of the 16 feasible ones. Dispensing rate in Método 1 lumps together in the first level 92,31% of the drug products; complexity, by its side, clusters 86,15% in levels 2 and 4. On the other hand, Método 2 divides drug products in groups of 25% per severity level according to dispensing rate, since they are distributed in quartiles. Complexity, since it separates aseptic drug products exposed to final sterilisation from the ones compounded by aseptic processing, sets products apart in a more homogeneous groups. Conclusions: Método 2 is capable to prioritise in a more effective way the validation of analytical methods for quality control of analysed drug products; with a slightly higher convolution, it accomplishes the aim of these methods to a larger extent. (AU)

Conciliação medicamentosa em hospital universitário: estratégia de segurança em pacientes neurocirúrgicos / Medication reconciliation in a university hospital: safety strategy in neurosurgical patients / Conciliación de medicamentos en un hospital universitario: estrategia de seguridad en pacientes neuroquirúrgicos

Esse trabalho teve como objetivo identificar as discrepâncias medicamentosas, por meio do serviço de conciliação de medicamentosa, em pacientes admitidos na clínica cirúrgica de uma unidade especializada no atendimento de doença relacionadas ao sistema neuromuscular na cidade de Manaus, Amazonas. Trata-se de um estudo descritivo e prospectivo, realizado no período de setembro a dezembro de 2020 em pacientes submetidos a conciliação medicamentosa. Na primeira etapa realizou-se a anamnese farmacêutica em formulário semiestruturado e foi elaborada a melhor história possível de medicamentos (MHPM). Os medicamentos prescritos na admissão foram comparados com a MHPM e as discrepâncias foram identificadas e classificadas quanto a intencionalidade e tipo. Ao total 54 pacientes foram incluídos no estudo, sendo que para 32 foi realizada a conciliação medicamentosa por usarem medicamentos de uso contínuo. Foram identificadas 20 discrepâncias intencionais, 3 discrepâncias intencionais não documentadas e 12 discrepâncias não intencionais. Omissão de medicamentos foi o tipo de discrepância mais comum (86%). Diante do exposto, concluímos que a conciliação medicamentosa mostrou-se um importante recurso para identificação de discrepâncias na transição de cuidado de pacientes com doenças neurológicas, principalmente no que se refere à omissão de medicamentos. As intervenções farmacêuticas a partir das discrepâncias encontradas, conseguiram mitigar erros de medicação e possíveis eventos adversos, aumentando a segurança do paciente.

This work aimed to identify medication discrepancies, through the medi- cation reconciliation service, in patients admitted to the surgical clinic of a unit special- ized in treating diseases related to the neuromuscular system in the city of Manaus, Ama- zonas. This is a descriptive and prospective study, carried out from September to Decem- ber 2020 in patients undergoing medication reconciliation. In the first stage, the pharma- ceutical anamnesis was carried out in a semi-structured form and the best possible medi- cation history (MHPM) was prepared. Medications prescribed on admission were com- pared with the MHPM and discrepancies were identified and classified according to in- tentionality and type. 54 patients were included in the study, and for 32 medication rec- onciliation was performed because they used continuous medication. A total of 20 inten- tional discrepancies, 3 intentional undocumented discrepancies and 12 unintentional dis- crepancies were identified. Medication omission was the most common type of discrep- ancy (86%). We conclude that medication reconciliation proved to be an important re- source for identifying discrepancies in the transition of care for patients with neurological diseases, especially with regard to medication omission. Pharmaceutical interventions, based on the discrepancies found, managed to mitigate medication errors and possible adverse events, increasing patient safety.

Este estudio tuvo como objetivo identificar las discrepancias de medicación a través del servicio de reconciliación de medicamentos, en pacientes internados en la clínica quirúrgica de una unidad especializada en el tratamiento de enfermedades relacio- nadas con el sistema neuromuscular en la ciudad de Manaus, Amazonas. Este es un estu- dio descriptivo y prospectivo, realizado de septiembre a diciembre de 2020 en pacientes en conciliación de medicación. En la primera etapa se realizó la anamnesis farmacéutica de forma semiestructurada y se elaboró el mejor historial de medicación posible (MHPM). Los medicamentos prescritos al ingreso se compararon con el MHPM y se identificaron las discrepancias y se clasificaron según la intencionalidad y el tipo. Un total de 54 pacientes fueron incluidos en el estudio, y a 32 se les realizó conciliación de medi- cación por utilizar medicación continua. Se identificaron un total de 20 discrepancias in- tencionales, 3 discrepancias intencionales no documentadas y 12 discrepancias no inten- cionales. La omisión de medicamentos fue el tipo más común de discrepancia (86%). Concluimos que la conciliación de medicamentos demostró ser un recurso importante para identificar discrepancias en la transición de la atención a pacientes con enfermedades neurológicas, especialmente en lo que respecta a la omisión de medicamentos. Las inter- venciones farmacéuticas, en base a las discrepancias encontradas, lograron mitigar errores de medicación y posibles eventos adversos, aumentando la seguridad del paciente PALABRAS CLAVE: Conciliación de Medicamentos; Seguridad del Paciente; Servicio de Farmacia Hospitalaria; Neurología.

Redução de custos hospitalares após implementação de ferramentas informatizadas na logística de um serviço de farmácia hospitalar Hospital / Hospital costs reduction after implementation of informatized tools in the logistics of a hospital pharmacy service

A farmácia hospitalar é atualmente uma unidade hospitalar que tem, entre outros objetivos, garantir o uso seguro e racional dos medicamentos e atender às demandas dos pacientes hospitalizados; para tanto, deve possuir um sistema eficiente de informações e dispor de um sistema de controle e acompanhamento de custos. As diversas inovações tecnológicas na informação e controle de dados aplicados aos serviços de saúde trazem agilidade no processo, maior segurança para os pacientes e melhor gerenciamento no processo logístico, reduzindo custos como aqueles associados à expiração da validade de produtos. Nessa perspectiva de análise de custo, o presente trabalho avalia os impactos que um processo de informatização da rastreabilidade e o uso de ferramentas informatizadas proporcionaram a um serviço de farmácia hospitalar, com o objetivo de descrever os impactos financeiros após a implementação dessas ferramentas. Realizamos um estudo observacional, longitudinal e retrospectivo a partir de dados financeiros relacionados a perdas por expiração de validade de medicamentos e produtos para a saúde e de compras emergenciais desses insumos em um período de seis anos. Os dados foram coletados em dezembro de 2021 referentes aos anos de 2015 a 2020 a partir de relatórios extraídos do Smart (Pixeon). Observamos que os custos com perdas por expiração de validade dos produtos para a saúde caíram substancialmente em 2019, com o menor custo em 2020, correspondendo a uma redução média de 47,9% nesses dois últimos anos em relação à média dos quatro anos anteriores. Também houve redução média de 70% nos custos com compras emergenciais ao longo desse período. Assim, quando avaliamos esses resultados, percebe-se que a informatização da rastreabilidade e o uso de ferramentas informatizadas para suporte no processo de trabalho logístico permitem contribuir significativamente para reduzir custos hospitalares.

The hospital pharmacy is currently a hospital unit that has, among other objectives, to guarantee the safe and rational use of drugs and to provide for the demands of inpatients; for such, it must have an efficient information system and have a cost control and monitoring system. The various technological innovations in information and data control applied to health services bring agility to the process, greater security for patients, and better management in the logistics process, reducing costs such as those associated with the expiration of product shelf life. In this perspective of cost analysis, the present study evaluates the impacts that a traceability informatization process and the use of informatized tools provided to a hospital pharmacy service with the objective of describing the financial impacts after the implementation of the process. We conducted an observational, longitudinal and retrospective study from financial data related to expiration losses of medicines and health products and emergency supplies purchases over a six-year period. The data was collected in December 2021 for the years 2015 to 2020 from reports extracted from Smart (Pixeon). We note that health product expiration loss costs fell substantially in 2019, with the lowest cost in 2020, corresponding to an average reduction of 47.9% in these last two years from the previous four-year average. There has also been an almost 70% reduction in emergency purchasing costs over this period. Thus, when we evaluate these results, it can be seen that the informatization of traceability and the use of informatized tools to support the logistical work process can contribute significantly to reducing hospital costs.

TELEA-Farmacia: Atención farmacéutica mediante Telefarmacia a pacientes oncológicos desde un servicio de farmacia hospitalaria / TELEA-Farmacia: Pharmaceutical care by Telepharmacy to oncology patients from a hospital pharmacy service

Objetivo: Describir la implantación de un proyecto piloto de Telefarmacia (TELEA-Farmacia) en el paciente oncológico adulto y analizar losresultados recabados, así como identificar las oportunidades de mejora,desde un servicio de farmacia hospitalario.Método: Entre octubre y diciembre de 2021, los pacientes oncológicosa tratamiento con antineoplásicos orales citados en la consulta de farmaciaoncológica del servicio de farmacia de hospital fueron estratificados a travésdel modelo MAPEX. Se consideraron susceptibles de inclusión en TELEA-Farmacia a quienes requerían atención farmacéutica con “prioridad media-alta”y a aquellos que, según criterio farmacéutico, pudieran beneficiarse de laherramienta. A través del aplicativo TELEA se programaron semanalmentebiomedidas y cuestionarios de adherencia y evaluación del dolor, y mensualmente un cuestionario de calidad de vida. Accediendo a TELEA mediantela aplicación móvil SERGAS-MÓBIL o un navegador web, los pacientesoncológicos respondieron a los indicadores de salud programados, de cuyoseguimiento fue responsable la Unidad de Farmacia Oncológica del serviciode farmacia de hospital.Resultados: Se incluyeron 29 pacientes oncológicos (48% hombres),con una media de 59 años (44-75). Un 31% fueron de prioridad baja,62% media y 7% alta según el modelo de estratificación, siendo la brecha. digital existente en edades avanzadas el principal impedimento para lainclusión. Se realizó un seguimiento diario de las notificaciones, recibiéndose un total de 364 respuestas. A partir de las consideradas alarmantesy de los valores fuera de rango, se procedió al seguimiento activo y/ocontacto telefónico, proporcionando atención farmacéutica adaptada alproblema de salud detectado en función de las necesidades. (AU)

Objective: To describe the implementation of a pilot Telepharmacy project (TELEA-Farmacia) in adult patients with cancer, analyze the resultsobtained, and identify opportunities for improvement, from a hospital pharmacy service.Method: Between October and December 2021, oncology patients,collecting their oral antineoplastic drugs at the Unit of Oncology Pharmacy of the hospital pharmacy service were stratified using the MAPEXmodel. Oncology patients candidates for inclusion in the TELEA-Farmaciaproject included “medium-high priority” hospital pharmacy patients, alongwith oncology patients who, according to pharmacist’s opinion, couldbenefit from Telepharmacy. On a weekly basis, oncology patients recorded on the TELEA platform their biological measurements and completedthe questionnaires on medication adherence and pain. Questionnaires onquality of life were completed on a monthly basis. To score health indicators, oncology patients accessed TELEA through the SERGAS-MOBIL appor a web browser. Follow-up of health indicators was performed by theUnit of Oncology Pharmacy of the hospital pharmacy service.Results: The study sample included 29 oncology patients (48% weremale) with a mean age of 59 years (44-75). According to the stratificationmodel, 31% were low-priority patients, 62% had medium-priority, and 7%. had high priority. The digital gap in patients with advanced ages was themain obstacle to inclusion. Reports were monitored daily, and a total of364 responses were received. In the presence of alarming reports and/orout-of-range values, active monitoring and/or telephonic follow-up wereinitiated. Pharmaceutical care was adapted to the health problem detected according to individual patient needs. (AU)

Inteligencia empresarial para la visualización y análisis de datos de indicadores de actividad de Telefarmacia en un cuadro de mando de un servicio de farmacia de hospital / Business intelligence for the visualization and data analysis of Telepharmacy activity indicators in a hospital pharmacy service scorecard

Objetivo: La consolidación de la Telefarmacia en el contexto de la pandemia por la COVID-19 exige manejar a tiempo real un gran volumen dedatos de actividad mediante análisis de datos. El objetivo de este trabajofue diseñar un cuadro de mando ágil, personalizable y dinámico para lavisualización y análisis de indicadores de actividad en Telefarmacia en unservicio de farmacia de hospital, mediante el empleo de herramientas avanzadas de inteligencia empresarial (business intelligence).Método: Un equipo de trabajo multidisciplinar desarrolló una herramienta de software entre abril y mayo de 2021 impulsado desde el servicio de farmacia de hospital. Una vez consensuados los indicadoresde interés en Telefarmacia, se extrajeron los datos a partir de bases dedatos brutas (base de datos de Telefarmacia, programa de dispensación de pacientes externos, bases de datos administrativas, catálogosde fármacos) mediante análisis de datos. La integración de las diferentesfuentes de datos en el cuadro de mando se realizó mediante PowerBI®.Se definió el manejo de los datos perdidos y duplicados y se aplicópreprocesamiento, normalización y transformación de los datos. Una vez validado el piloto por diferentes tipos de usuarios, se diseñó la estructurapara actualización automática de los paneles con las sucesivas actualizaciones de las fuentes de datos.Resultados: Diseño e implementación de un cuadro de mando de laactividad en Telefarmacia: panel descriptivo general (perfil demográficode pacientes, recuento y condiciones de envíos, programa y serviciomédico); geolocalización de destino; perfil farmacológico; análisis relativo de los pacientes beneficiarios de Telefarmacia respecto del totalde pacientes externos. En el último corte, a enero de 2022, se habíanincluido datos de 16.000 dispensaciones con entrega informada a másde 4.000 pacientes, lo que supone que el 21,93% de los pacientes externos han estado en algún momento en el programa de Telefarmacia. (AU)

Objective: The consolidation of Telepharmacy during the COVID-19pandemic has raised the need for managing large volumes of real-timeactivity data through data analysis. The aim of this project was to designa dynamic, user-friendly, customizable scorecard in a hospital pharmacyservice for the visualization and analysis of Telepharmacy activity indicators through the use of advanced business intelligence technology.Method: The software tool was developed by a multidisciplinary teambetween April and May 2021, driven from the hospital pharmacy service.Once the Telepharmacy indicators of interest were established, datasetswere extracted from raw databases (administrative databases, Telepharmacy database, outpatient dispensing software, drug catalogues) throughdata analysis. The different data sources were integrated in a scorecardusing PowerBI®. The criteria for processing missing and duplicated datawere defined, and data pre-processing, normalization and transformationwere performed. Once the pilot scorecard was validated by differentprofiles of users, the structure was designed for the panels to automaticallyupdate as databases were updated. Results: Design and implementation of a scorecard of Telepharmacyactivity: general descriptive panel (demographic profile of patients, countand delivery conditions, program and medical service); geolocation ofdestination; pharmacological profile; relative analysis of patients involvedin the Telepharmacy program with respect to the total of outpatients. Inthe last updating as of January 2022, data from 16,000 dispensations tomore than 4,000 patients had been collected. This means that 21.93%of outpatients had benefited at some time point from the Telepharmacyservice. (AU)

Aplicación informática de Telemedicina parala vigilancia del soporte nutricional de personas institucionalizadas en residencias de ancianos desde un servicio de farmacia hospitalaria / Telemedicine informatics application for nutritional support surveillance of instutionalized persons in nursing homes from a hospital pharmacy service

Introducción: Los pacientes institucionalizados que requieren soporte nutricional artificial acuden de forma periódica a las consultas de la Unidad deSoporte Nutricional del Servicio de Farmacia. En ellas se realiza una valoración nutricional inicial, a partir de la cual se establece la pauta nutricional y elplan de seguimiento. La Telemedicina y la Telefarmacia se han expandido enlos últimos años para la monitorización remota de personas institucionalizadas.Objetivo: Evaluar la implementación de una aplicación informática deTelemedicina para la vigilancia del soporte nutricional de personas institucionalizadas en residencias de ancianos desde un servicio de farmaciahospitalaria.Método: Se formó un equipo multidisciplinar liderado por el Servicio deFarmacia. Los datos de pacientes institucionalizados que requieren soportenutricional artificial se obtuvieron del programa SILICON y de los registrosinternos del Servicio de Farmacia. Se eligieron las primeras residenciascandidatas según la experiencia previa en el manejo de la aplicación informática de asistencia domiciliaria. Se analizaron llas variables de soportenutricional necesarias para el seguimiento nutricional: Mini NutritionalAssessment, recordatorio de ingestas de las últimas 24 horas, control deúlceras por presión y parámetros analíticos. Se analizó el flujo de información existente entre las residencias sociosanitarias y la atención hospitalariay se valoraron las opciones disponibles a través de la plataforma tecnológica de asistencia domiciliaria.Resultados: El Servicio de Farmacia realizó seguimiento nutricional amás de 300 pacientes institucionalizados en 28 residencias sociosanitariasen el año 2021. (AU)

Introduction: Institutionalized patients who require nutrition supportregularly visit the Unit of Nutrition Support of the Hospital Pharmacy Service. During these visits, prior to establishing a nutrition regime and followup scheme, an initial nutritional status assessment is performed. Telemedicine and Telepharmacy have expanded in recent years for remotemonitoring of institutionalized persons.Objective: To evaluate the implementation of a Telemedicine informaticsapplication for nutritional support surveillance of instutionalized persons innursing homes from a hospital pharmacy service.Method: A multidisciplinary team led by the Hospital Pharmacy Servicewas created. Data of institutionalized persons in nursing homes needingartificial nutritional support was extracted from the SILICON prescriptionsystem and the internal ecords of the hospital pharmacy service. Nursing homes were selected on the basis of their previous experience usingthe Telemedicine informatics application TELEA. The following nutritional support variables were assessed: score on Mini-Nutritional Assessmentquestionnaire; a 24-h food record; pressure ulcer control; and laboratoryparameters. The existing information flow between nursing homes andhospital specialists was analyzed. The functionalities available on TELEAwere considered.Results: In 2021, over 300 institutionalized persons from 28 nursinghomes were incluided for nutritional support surveillance program of thehospital pharmacy service. The project was implemented in two nursinghomes serving 38 patients, although only 13 were involved in the nutrition surveillance program of the Nutrition Support Unit. Nutritional statusassessment and nutritional support surveillance reports were adapted tothe Telemedicine informatics application. (AU)