28 dezembro, 2017

Increasing the number of Pharmacy Technicians, increases the clinical interventions made by Pharmacists.

Patel, S. Mathews, J. and Kelly, D. (on behalf of the RLH pharmacy team), Barts Health NHS Trust, London

Introduction: Prescribing errors occur in a wide variety of inpatient settings; the EQUIP study showed that rates amongst junior doctors was 9%1. Pharmacists are relied upon to identify and correct errors before they can cause harm to patients. Interventions by ward pharmacists contribute to patient safety and cost savings by reducing spending on associated litigation costs.

Method and results: Details of interventions were recorded by the pharmacy team on one day across adult wards at one hospital within a multi-site Trust. Ethical approval was not required as this was an audit. 147 interventions were recorded, an increase of 83.75% compared to the previous audit. Approximately 40% of interventions related to high risk medicines. 24% of interventions were associated with antibiotics, due to an emphasis on stewardship. Furthermore, whilst the majority of interventions were classified as ‘minor’, several interventions of moderate significance were made. According to figures quoted in the Sheffield Model2, an estimated £14,497 of cost avoidance was achieved on the data collection day.

Discussion and conclusion: Since the last audit, there has been an increase in ward-based pharmacy technicians. This was to increase the efficiency of medicines management tasks and patient discharges. As a result, pharmacists have more time to carry out clinical tasks, including making interventions and acting upon medicines optimisation opportunities. This is reflected in the data collected as the number of interventions and their complexity has increased. This falls in line with recommendations made by the Carter review of ‘utilising more than 80% of pharmacists’ time for medicines optimisation, governance and safety remits’3.

Interventions can be made earlier and more frequently by continuing current schemes and creating new clinical roles for pharmacists. This will allow the pharmacy department to increase efficiency in medicines management.

References:

(1) Dornan T, Ashcroft D, Heathfield H, et al. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education. EQUIP study. Manchester, England. General Medical Council; 2009.
(2) Campbell F, Karnon J, Czoski-Murray, C et al. A systematic review of the effectiveness and cost-effectiveness of interventions aimed at preventing medication error (medicines reconciliation) at hospital admission. Journal of Evaluation of Clinical Practice. 2009;15(2):299-306.
(3) Lord Carter of Coles. Operational productivity and performance in English NHS acute hospitals: Unwarranted variations. Department of Health, February 2016.

26 dezembro, 2017

Use of simulation training to prepare pharmacy residents for medical emergencies

Purpose The use of high-fidelity simulation training for preparing pharmacy residents for various high-stress and high-impact medical emergencies and the impact of this training on pharmacy residents’ perception of preparedness are described.
Summary During the 2015–16 residency year at the University of Kentucky Medical Center, simulation training, in addition to lecture-based orientation training, was chosen as a method to reinforce skills and knowledge learned throughout the orientation, before residents began working on-call shifts. Three different simulation exercises were developed to cover five selected topics over the course of 3 different days: sepsis as its own session, a surgical-themed session combining bleeding reversal and malignant hyperthermia, and a neurologic-themed session combining stroke and status epilepticus. Postgraduate year 2 (PGY2) specialty residents in critical care and emergency medicine helped facilitate the cases. The specialty residents played the role of the physician or nurse for the case and were allowed to answer questions asked of the pharmacy residents, appropriate to their respective roles. Following completion of the simulation exercise, a survey tool was sent to pharmacy residents to rate their perception of preparedness before and after the training for each scenario and again at 6 months after the simulation training to assess sustainability of the training. Participants generally responded that the simulations met their expectations and that the PGY2 residents facilitated the simulations fairly well (scores of 68.5–80 on a scale of 0–100). The resident-reported that beneficial effects of simulation training persisted at 6 months following the simulation exercises.
Conclusion Simulation training increased pharmacy residents’ self-reported preparedness for high-stress, high-impact clinical scenarios and medical emergencies.
Melissa L. Thompson BastinAaron M. Cook and Alexander H. Flannery