The Swedish pharmacy market has been state regulated for many years. In early 21st century, the Swedish government made a proposal to deregulate the pharmacy market in order to make a reform that would make privatization of pharmacies a possibility. The reason behind this change of the pharmacy market from state perspective was to create better service for the public. The Swedish government hoped that the change would result in increasing service selection, increased accessibility and a lower cost of non-prescription and prescription medicine. Private operators need approval from the Swedish Health Department before they can pursue their own establishment. When deregulation was finalized, many private operators opened privately owned pharmacies. The purpose of this study is to create insight on how the organizational change has evolved since the deregulation of the pharmacy market. It is also important to find out how the organizational change of the pharmacy market has affected the framework of pharmacists as an occupation. The perception of Pharmacist’ labour and changes on the profession as a whole is also studied. The study has been conducted using qualitative method to collect empirical data. Interviews have been made by conducting structured interviews with six local pharmacists. The empirical data has been analyzed by using the theory of professions. The theories of profession is used to explain pharmacists as a professions. In addition to organizational change, the study reviews pharmacist perspective, interpretation and valuation of their everyday life on the work arena. The pharmacists reveal several changes in their work life. Today they have bigger opportunities to choose employer, where before it was only one, today there are a lot of private pharmacies. That means they also can decide working hours because all the pharmacies have different working hours. Their perspectives are formulated in ways that show new routines and way of work. Due to the free market and competition between pharmacies, focus has shifted towards increased sale perspective. Pharmacist acknowledge that even though they are a profession, they feel that they have a higher workload, often less time with clients and sense of being a sales person.

A general nurse may, without clinical supervision, administer medicinal products with the exception of intravenous injections (IV) or infusions in newborns and children under 3 years of age and with the exception of radiopharmaceuticals. This activity is regulated in Decree No. 55/2011 Coll. by Ministry of Health of the Czech Republic. The preparation and administration of the medicinal product is an integral part of the everyday practice of a l nurse; however, the dimensions of this procedure are very broad, and it does not start and end with the administration of the prescribed medicinal product. In the wider context, this is a multi-disciplinary process, in which other health professionals can participate with their well-founded roles. Determining individual roles and collaboration in the multi-disciplinary team composed of a doctor, a nurse and a clinical pharmacist has an effect on the correct pharmacological treatment of the patient. Of all professions, nurses spend time with patients. 40 % of their time administering medications; therefore, they play a key role in the reduction of medication errors. (Miller et all, 2016). The aim of the research is to analyze the current role of the nurse in the administration of medicinal products from the perspective of a clinical pharmacist. The research...

Pharmacists' attitudes towards direct anticoagulants Author: Tereza Mertová Supervisor: doc. PharmDr. Josef Malý, Ph.D. Consultant: PharmDr. Kateřina Malá, Ph.D. Charles University, Faculty of Pharmacy in Hradec Králové Department of Social and Clinical Pharmacy Introduction and Objective: Pharmacists are involved in providing of professional information about direct oral anticoagulants (DOAC) treatment during DOAC dispensation to patients. Their attitudes and knowledge about DOAC treatment are therefore crucial for optimisation of pharmaceutical care of patients taking DOAC. The objective of this thesis was to analyze attitudes, experience, habits and opinions of pharmacists regarding the DOAC treatment. Methodology: Pharmacists from three District Pharmacists' Associations (OSL) were addressed to participate in an electronic anonymous questionnaire between March and May 2021. Questionnaire consisted of 32 items focusing on the frequency of DOAC dispensation, pharmacist self-confidence about DOAC, information provided to patients during DOAC dispensation, benefits and limits of DOAC treatment compared to treatment with warfarin, and patient adherence to DOAC treatment. The results were processed using descriptive statistics and further analyzed by parametric and nonparametric tests. Results: A...

Background and Objective: Providing proper medication management of oral pharmaceutical dosage forms for patients with Percutaneous endoscopic gastrostomy (PEG) is a challenge, therefore this study was conducted to identify the need for pharmaceutical reviews in the context of PEG insertion and the need for medication review. The objective of this study was to identify patients who are on inappropriate medication for PEG insertion and what these medications are, by mapping the medication taken by patients before and after PEG insertion.  Method: A quantitative study with analysis of retrospective data. The project included 99 patients who had undergone a PEG surgery between 2017 and 2021, at one of the hospitals in Gävleborg.The study was conducted using data from Cyklop, a program that Region Gävleborg can use to produce statistics for health care. The statistical measures used to describe the data were mean, percent, 95% confidence interval and standard deviation. Setting: The hospital in Gävle.  Main outcome measures: The number of patients who remained on potentially inappropriate medications after the PEG insertion and the number of patients who received a changed medication list after the insertion. Results:  A total of 99 patients undergoing PEG surgery were included. The majority of the patients 56% (n = 55) remained on potentially inappropriate drugs after PEG, 27,3% (n = 27) of which had remained partially on inappropriate drugs and had some prescription changes after PEG.23.2% of the patients did not remain on potentially inappropriate drugs after PEG surgery because they received a modified medication list. Conclusions: The majority of patients were on inappropriate drugs after PEG. This demonstrates a problem that should be addressed within Region Gävleborg. The fact that a large proportion of patients were identified as being on inappropriate medication after PEG indicates the need for pharmacist reviews of medication as well as educational efforts for health care staff in the Region.

The word communication originates from the Latin word communicare that means to do something in common. When human beings communicate with each other, we share thoughts, emotions, values and actions. The foundation in communication is found within the interpersonal communication, which is the act of communication between two persons. All types of communications include of verbal and nonverbal acts of communication. The verbal communication consists of words either in speech or writing, the nonverbal act implies gestures, frequency of the tone and facial expressions. Within the pharmaceutical profession, good communication between the pharmacist and the customer is important and can affect the customer’s health and quality of life in both direct as well as indirect ways. In recent years, the pharmacist's role in the pharmacy has drastically changed. Nowadays the care of the customer has gained more significance than before. To improve customer health and quality of life it is important that the pharmacist acts to promote a good relationship with the customer and the foundation for this relationship should be built on good terms of communication. The purpose of this study was to study how common it is with communication errors between pharmacist and customer, and to demonstrate probable underlying causes. Secondary questions were, how is the drug advice the pharmacist provides affected by communication errors? Collection of data for the study was done with structured observation charts, where the customer and pharmacist were strictly observed. A total of 316 meetings were observed and the data collected referred to prescriptions. In more than one-third of the observed meetings, there were communication errors between the pharmacist and the customer. Communication errors that arose concerned lack of eye contact, language barriers, choice of questions, background noise from colleagues and customers and discussions from generic exchanges. To reduce future communication errors, the pharmacist's actions should be strengthened, such as eye contact, clear follow-up questions and improved feedback.

Background: Vaccination is one of the most cost-effective preventive measures against infectious diseases. A proper administration of the vaccine is critical. Therefore, only authorized and trained health care personnel including pharmacists can administrate vaccines safely and effectively. However, in Sweden, several laws and regulations prevent pharmacists to perform vaccinations. Aim: The aim was to elucidate the conditions and regulations of influenza vaccination administration by pharmacists at pharmacies in other countries compared to Sweden. Methods: A literature review were performed. Two different databases, PubMed and Web of Science were used. In addition, reports of governmental and various organizations were used. Interviews have been used as a complement. Results: Involving pharmacists in vaccination administration improves the vaccine coverage. This result was confirmed by pharmacist performing vaccine administration in other countries such as the USA, Canada, UK and Norway. However, these benefits are limited in Sweden due to the regulation HSLF-FS 2017:37, which hampers vaccines administration by pharmacists. Nevertheless, the regulation SOSFS 1997:14 could be interpreted as allowing clinical doctors to delegate vaccination to pharmacists. However, this needs to be further investigated. All Swedish representatives interviewed in this report, supported the idea that pharmacists should be able to perform vaccines at Swedish pharmacies. Conclusions: Modification of the regulation HSLF-FS 2017: 37 as well as proper education and training are required to allow pharmacists to perform vaccinations in Swedish pharmacies.

Läkare, sjuksköterskor, farmaceuter, patienter och patienters anhöriga är alla delar av den kedja som ska se till så att läkemedelsanvändning sker på ett säkert sätt. Så många inblandade och i så många olika sammanhang gör att läkemedelsanvändning kan vara svårt att hantera. 2014 skrevs det ut 102 913 130 recept i Sverige (1). Fram till 2014 hade ca 850 000 felaktiga recept korrigerats av farmaceuter varje år (2). Att korrigera recept är en nödvändig del som ingår i farmaceutens skyldighet och ansvar vilket regleras i svensk lagstiftning (3). Farmaceuten är en del av vårdkedjan som skall tillse att patienten har en korrekt och säker behandling med läkemedel (4). Tillgång till en nationell gemensam läkemedelslista för alla berörda parter, förskrivare, farmaceut, patient och övrig vårdpersonal skulle kanske kunna komma tillrätta med felaktigheter i förskrivningar och därmed öka patientsäkerheten (4). Tidigare studier har genomförts som behandlar läkarens syn på en gemensam lista och även patientens syn på eHälsoarbete vilket till viss del belyser en gemensam lista (5)(6) men inga studier har hittats om hur en gemensam lista kommer att påverka farmaceuternas vardag vilket ett av syftena med detta arbete har varit. För att uppnå syftet genomfördes en enkätundersökning med farmaceuter verksamma på ett antal apotek där de fick delge sina tankar både kring den information om patienters aktuella läkemedel som finns tillgänglig idag, bland annat genom receptdepån och sina tankar kring en nationell gemensam läkemedelslista. Resultat av undersökning gör gällande att det förekommer fel i receptdepån både med avseende på saknad information, felaktigheter i recept och att recept förekommer mer än en gång och att de finns med trots att patienten inte skall använda dem mer. Majoriteten av farmaceuterna var eniga om att en nationell gemensam läkemedelslista skulle hjälpa dem i deras arbete för att öka patientsäkerheten men huruvida den kommer att lösa alla problem som förekommer i receptdepån får framtiden utvisa. / Doctors, nurses, pharmacists, patients and next of kin are all parts of the chain that is needed to make sure that the use of medication is safe and appropriate for the patient. That many people involved and in many different settings can make the use of medication difficult to manage. In the year 2014 there were 102 913 130 prescriptions made out to patients in Sweden. Up to the year 2014 850 000 corrections had been made to prescriptions with faults in them by pharmacists each year. To correct prescriptions is an essential part of the pharmacist’s obligations and responsibility, a responsibility that is regulated in Swedish law. The pharmacist is the last part of the chain that has the possibility to adjust anything that is wrong with medications and the use of it before it is in the patient’s own hands. The access to a nationally shared medication list for all involved parties might solve some of the problems that faces the responsible parties when it comes to dealing with patients and their new and ongoing medications and in that way be able to increase the safety around mediation for the patient in need. Although the survey conducted as part of this paper focuses on pharmacists the background tries to explain in what way the different professions come in contact with medicines and how they would perhaps benefit from a shared list. The paper also tries to give a little insight to what kind of problems there could be related to prescriptions. In Sweden we have come a rather long way in the use of computers and the use of internet in the field of eHealth compared to other countries. The paper tries to show how the problem surrounding prescription of medicine is handled in the other countries of Scandinavia. Earlier studies have been conducted that looks at shared lists from the doctors view and also studies have been conducted that looks upon eHealth for patients partly in view of shared medication lists. No studies have been found that looks specifically at how pharmacists feel about it and how such a list would benefit them in their work to secure patient safety, hence this paper. In order to reach the papers purpose a survey was performed with pharmacists employed at different pharmacies in the southern part of Sweden. The result of the survey showed that there are indeed problems with prescriptions in the prescription repository and the majority of the pharmacists agreed that a shared medication list could help them in their work to secure patient safety when releasing prescribed medication. Although the pharmacist agreed for the most part in the benefits of such a list they did not know if it would solve all problems, which is for the future to decide.

Abstract [en] Title: Discrepancies in medication lists at hospital wards identified by medication reconciliation Authors: Anderberg M. Institute: Uppsala University, Uppsala, Sweden Background and objective: An accurate medication list is essential for a correct assessment of a patient´s condition at hospitals. Previous studies have shown that patients in emergency departments often are affected by discrepancies in medication lists at hospital admission. Less research has been done regarding discrepancies after transferring patients to medical wards. The aim of this study was to identify discrepancies in the electronic medical record in hospital wards for patients admitted via the emergency department. Design: Observational study. Medication reconciliation was performed by a pharmacist shortly after the arrival of patients from the emergency department. This included a patient interview and the investigation of the patient’s medical record. The discrepancies identified at the wards were classified as either omitted drug, wrong dose, additional drug, incorrect frequency or duplicate therapy. Descriptive statistics were used and the proportion of medication lists with at least one discrepancy was presented with 95 % confidence interval. Setting: Three medical wards at Capio S:t Görans Hospital in Stockholm.  Main outcome measures: The proportion of medication lists with at least one discrepancy. The mean value of discrepancies among all patients. Classification and categorization of discrepancies regarding type and ATC index.  Results: In total, 63 patients were included with a mean age of 63 years. At least one discrepancy was identified in 43 % (95 % CI 31-55) of the medication lists. 52 discrepancies were found in total generating a mean value of 0,83 ± 1,17 discrepancies per medication list. The two most common categories were Omitted drug(33%) and Wrong dose(33%). The most frequent drug class associated with medication discrepancies was Drugs for obstructive airway diseases.  Conclusion: 43 % of the patients had at least one discrepancy in the medication list. This indicates the importance of medication reconciliations at medical wards even though the medication list has been updated at the emergency department.

Background: The purpose of drug treatment is to reduce morbidity and mortality, and to improve health-related quality of life. However, there are frequent problems associated with drug treatment, especially among the elderly. The aim of this thesis was to investigate the impact of clinical pharmacy services within a multiprofessional healthcare team on quality and safety of patients’ drug therapy, and to study the frequency and nature of medication history errors on admission to hospital. Methods: A model for clinical pharmacy services within a multiprofessional healthcare team (the Lund Integrated Medicines Management model, LIMM) was introduced in three hospital wards. On admission of patients to hospital, clinical pharmacists conducted medication reconciliation (i.e. identified the most accurate list of a patient’s current medications) to identify any errors in the hospital medication list. To identify, solve and prevent any other drug-related problems, the clinical pharmacists interviewed patients and performed medication reviews and monitoring of drug therapy. Drug-related problems were discussed within the multiprofessional team and the physicians adjusted the drug therapy as appropriate. Results: On admission to hospital, drug-related problems, such as low adherence to drug therapy and concerns about treatment, were identified. Different statistical approaches to present results from ordinal data on adherence and beliefs about medicines were suggested. Approximately half of the patients were affected by errors in the medication history at admission to hospital; patients who had many prescription drugs had a higher risk for errors. Medication reconciliation and review reduced the number of inappropriate medications and reduced drug-related hospital revisits. No impact on all-cause hospital revisits was demonstrated. Conclusion: Patients admitted to hospital are at high risk for being affected by medication history errors and there is a high potential to improve their drug therapy. By reducing medication history errors and improving medication appropriateness, clinical pharmacy services within a multiprofessional healthcare team improve the quality and safety of patients’ drug therapy. The impact of routine implementation of medication reconciliation and review on healthcare visits will need further evaluation; the results from this thesis suggest that drug-related hospital revisits could be reduced. / Läkemedelsgenomgångar och läkemedelsavstämning - LIMM-modellen