Background: Dispensing medication is a chain of multiple stages, and any error during the dispensing process may cause potential or actual risk for the patient. Few research studies have investigated the nature and contributory factors associated with dispensing errors in hospital pharmacies. Aim: To determine the nature and severity of dispensing errors reported in the hospital pharmacies at King Saud Medical City (KSMC) hospital in Saudi Arabia, and at Luton and Dunstable University Hospital (L&D) NHS Foundation Trust in the UK; and to explore the pharmacy staff perceptions of contributory factors to dispensing errors and strategies to reduce these errors. Materials and Methods: A mixed method approach was used and encompassed two phases. Phase I: A retrospective review of dispensing error reports for an 18-month period at the two hospitals. The potential clinical significance of unprevented dispensing errors was assessed. Data was analysed using descriptive statistics in SPSS and A Fisher's test was used to compare the findings. Phase II: Self-administered qualitative questionnaires (open-ended questions) were distributed to the dispensary teams in KSMC and L&D hospitals. Content analysis was applied to the qualitative data using NVivo qualitative analysis software. Result: Dispensing the wrong medicine or the incorrect strength were the most common dispensing error types in both hospitals. Labelling errors were also common at the L&D pharmacy dispensary. The majority of the unprevented dispensing errors were assessed to have minor or moderate potential harm to patients. Look-alike/sound-alike medicines, high workload, lack of staff experience, fatigue and loss of concentration during work, hurrying through tasks and distraction in the dispensary were the most common contributory factors suggested. Ambiguity of the prescriptions was a specified factor in the L&D pharmacy, while poor pharmacy design and unstructured dispensing process were specified contributory factors in the KSMC pharmacy. Conclusions: Decreasing distractions and enhancing the pharmacy design and the dispensing workflow are necessary to reduce dispensing errors. Furthermore, monitoring and reporting errors and educating the dispensary team about these errors is also needed. Automation and e-prescribing systems may improve dispensing efficiency and safety. The findings of this study reemphasise the fact that dispensing errors are prevalent in hospital pharmacies. Efficient interventions need to be implemented to mitigate these errors.

No description available.

The thesis investigated nicotine levels and their effects on hypertensive subjects and whether aspirin could be used in the treatment of hypertension to bring about not only an anti thrombotic effect but reduce the systemic blood pressure especially in those individuals who smoke cigarettes. The study, which also audits the use of aspirin, was conducted in Kuwait and so provides an insight of hypertensive patients very rarely considered in the literature The thesis begins in Chapter One with an extensive literature review which analyses the properties and problems that nicotine causes and its ability to cause hypertensive changes along with its multitude of other events. The physiological and pathological problems caused by nicotine are reviewed on the basis of its chemistry and pharmacological properties using a worldwide perspective rather than just focus on Kuwait. The second Chapter uses extensive analysis of the literature to determine the pharmacological properties of aspirin and its use in cardiovascular disease. The pharmacokinetics and therapeutic effects are presented with emphasis to its inhibitory effects on platelet activation which is central to the development of serious cardiovascular consequences such as stroke and myocardial infarction. The third Chapter returns to consider the literature in detail and why nicotine has specific effects on the cardiovascular system in terms of receptor stimulation and how aspirin may be able to reduce nicotine¿s cardiovascular effects and concludes with the Aims and Objectives of the thesis. The fourth Chapter investigates urinary nicotine levels in smokers from cigarettes available in Kuwait to indicate the actual levels which could be achieved by smokers in this study. This established that the levels would cause pharmacological effects demonstrating also the effects of passive smoking. The number of cigarettes smoked per day has an unpredictable effect on metabolism and urinary output of nicotine. The fifth Chapter is the major investigational section of the thesis and considers if aspirin ability to reduce cardiovascular effects, may be useful in terms of diastolic blood pressure and lipid levels in the 4 blood. The effects were suggestive that aspirin did reduce the blood pressure in hypertensive subjects but was not universal and was limited to those suffering from mild - moderate hypertension. It was determined that aspirin should be sued at the earliest age possible in these patients. The sixth Chapter involved a large scale trial of the effectiveness of aspirin treatment in hypertensive patients over a one year period in Kuwait. This used ambulatory blood pressure measurements to determine the effectiveness of daytime and nightime changes in blood pressure in patients with and without aspirin treatment. The overall conclusion was a reduced relative risk of suffering cardiovascular events in mild to moderate hypertension when aspirin (75mg/day) was administered. Specifically in smokers, aspirin lowers the systolic daytime BP and diastolic nightime BP. To support this work a comprehensive audit is provided of the use of the current use of aspirin in Kuwait hospitals / Cultural Office in the Kuwait Embassy in London; Civil Service Commission of Kuwait; The Assistant Under Secretary for the Drugs and Medical Supplied Affairs

Yes / Background Interventions to reduce medicines discontinuity at transitions during and reinforced after discharge are effective. However, few studies have linked hospital-based counseling with onward referral for community pharmacy-based follow-up to support patients' medicines use. Objective To determine the effects of targeted hospital pharmacist counseling on discharge or targeted community pharmacy medicines reviews post-discharge on patients' knowledge of newly started medication. Methods The study was a controlled trial of targeted medicines discharge counseling provided by hospital pharmacists or follow-up post-discharge medicines review provided by community pharmacists compared with usual care (nurse counseling). Outcomes measured using a structured telephone survey conducted at two and four weeks after patients were discharged from hospital. Results Patients who received hospital pharmacist counseling were significantly more likely to report being told the purpose of their new medicine and how to take it versus those receiving usual care. Fewer than half of the patients who were allocated to receive a community pharmacy medicines review received one. Conclusions Patient knowledge of medicines newly prescribed in the hospital was increased by targeted counseling of hospital pharmacists. The findings suggest the need to improve the consistency of the information covered when providing counseling, perhaps by the implementation of a counseling checklist for use by all disciplines of staff involved in patient counseling. The potential of community pharmacy follow-up medicines review is currently undermined by several barriers to uptake.

Yes / Medicines management is only one part of NHS (UK) procurement and management, but essentially a very expensive part. According to the Commercial Medicines Unit (Department of Health, 2013), NHS hospitals in England currently spend around £3.6 billion annually on pharmaceuticals, having risen from £2.2. billion in 2005. The NHS continuously strives to promote excellence in what it does and justify how it does it. In undertaking this preliminary analysis 45 pharmacy staff members contributed to an online survey. The results presented a broad mix of views on how smart technology (e.g. iPhone, iPad) could be used and if it should be used at all in this setting. The outcome of this small scale study demonstrates the lack of knowledge as to if and how such technologies could be used in hospital pharmacy and therefore present grounds for testing out the broader application of smart technology via academic and practitioner consultations.

Ziel der vorliegenden Masterarbeit ist die Entwicklung von Qualitätsindikatoren für den Prozess „Empfehlungen der Apotheke zur Weiterführung der Medikation“ im Klinikum Mutterhaus. Damit soll ein Instrument entwickelt werden, das patientenbezogene Dienstleistungen der Krankenhausapotheker an der intersektoralen Schnittstelle im Hinblick auf das Qualitätsziel Arzneimitteltherapiesicherheit messen und bewerten kann. Schwachstellen und Verbesserungspotentiale über den Verantwortungsbereich der Apotheke hinaus sollen identifiziert und in einen kontinuierlichen Verbesserungsprozess eingebracht werden können. Methodik: Zur Entwicklung der Qualitätsindikatoren wurde ein mehrstufiges Verfahren gewählt. Zunächst wurden die Qualitätsziele des Prozesses definiert und eine Prozessanalyse durchgeführt. Die Literaturrecherche auf nationaler und internationaler Ebene gab Anhaltspunkte zur Ableitung von Qualitätsindikatoren. Basierend auf der Prozessanalyse und der Literaturrecherche wurden Qualitätsindikatoren für den Prozess „Empfehlungen der Apotheke zur Weiterführung der Medikation“ entwickelt. Anhand einer retrospektiven Datenerhebung wurden die entwickelten Qualitätsindikatoren auf ihre Aussagekraft und Eignung geprüft. Der Prozess wurde mit Hilfe der Qualitätsindikatoren gemessen und bewertet. Schlussfolgerung: Mit Hilfe von fünf Qualitätsindikatoren-Sets kann der Prozess „Empfehlungen der Apotheke zur Weiterführung der Medikation“ umfassend untersucht werden. Die entwickelten Qualitätsindikatoren sind geeignet, die pharmazeutische Dienstleistung im Hinblick auf das Qualitätsziel Arzneimitteltherapiesicherheit zu messen und zu bewerten. Sie ermöglichen die Evaluation des Prozesses und zukünftiger Verbesserungsmaßnahmen. Anhand der Qualitätsindikatoren wird zukünftig ein Monitoring der Dienstleistung möglich sein. / Purpose: The aim of this thesis is the development of quality indicators for the process "recommendations of the pharmacy to continue patient’s medication" at Klinikum Mutterhaus. An instrument is to be developed that can measure and rate the patient-related services of the hospital pharmacist at the intersectoral interface in terms of quality target in medication safety. Weaknesses and potential improvements should be identified and incorporated into a continuous improvement process. Methods: A multistage process is selected for the development of the quality indicators. First, the quality objectives of the process are defined and a process analysis is performed. A literature review on national and international level shall provide evidence for the derivation of quality indicators. Based on the process analysis and the literature review the quality indicators for the "Recommendations of the pharmacy to continue patient`s medication” are developed. In a retrospective data collection, the developed quality indicators are tested for their validity and suitability. The process is finally measured by the quality indicators and evaluated. Conclusion: With the help of five quality indicator sets the process "recommendations of the pharmacy to continue patient’s medication" can be fully investigated. The developed quality indicators are suitable to measure and evaluate the process in terms of the quality target medication safety. So the evaluation of the process and future improvements are possible. On the basis of the quality indicators a monitoring of the process can be established in the future.

[pt] Em organizações hospitalares há uma grande variedade de produtos e existe o compromisso de não se permitir as perdas e o fracasso operacional (Portela, 2001). Uma maneira de se evitar essas perdas é o emprego racional dos medicamentos através de uma padronização (Klugl et al, 1999). Desse modo é possível criar valor ao paciente de modo que a farmácia consegue administrar os produtos de forma adequada oferecendo serviços de qualidade (Barbieri e Machline, 2006). Nesse cenário, a gestão dos custos das organizações de saúde tem papel estratégico. Medicamentos representam parcela significativa destes custos e a sua logística interna, complexa e com muitas particularidades, deve funcionar da melhor maneira possível. Isso porque os processos, nos quais estão envolvidos, são parte fundamental para a assistência de qualidade tanto prezada pelos hospitais. Este trabalho tem como objetivo investigar e analisar a situação atual de dois processos, unitarização e a dispensação que afetam diretamente a farmácia, observando as práticas, adotadas no segmento hospitalar. Para isto, foi feito uma análise das farmácias hospitalares e dos fluxos de ambos os processos com o objetivo de entendê-los melhor. Em seguida, estudou-se em um caso real, diagnosticando os pontos de melhoria da operação. Assim, pôde-se chegar a algumas soluções, que tiveram como objetivo otimizar os processos estudados, para os pontos de melhoria levantados e comprovar a hipótese de que a centralização do estoque pode ser aplicados, com devidas adaptações respeitando as particularidades, às organizações hospitalares. / [en] In hospital organizations there is a wide variety of products and there is a commitment not to allow the losses and the operational failure (Portela, 2001). One way to avoid these losses is the rational use of medicines through standardization (Klügl et al, 1999). Thus you can create value to the patient so that the pharmacy handling the products properly offering quality services (Barbieri and Machline, 2006). In this scenario, the management of the health costs organizations have strategic role. Medicines represent a significant portion of these costs and their internal logistics, complex and with many details, should work in the best possible way. This is because the processes, in which they are involved, are fundamental parts to the quality of care both prized by hospitals. This study aims to investigate and analyze the current situation of two processes, unitarization and the dispensation that directly affect the pharmacy, observing the practices adopted in the hospital segment. For this, he was made an analysis of hospital pharmacies and flows of both processes in order to understand them better. Then studied in a real case, diagnosing the points of improvement of the operation. Thus, we could come up with some solutions that were designed to optimize the processes studied for improvement points raised and prove the hypothesis that the stock of centralization can be applied, with necessary adaptations respecting the individual, to hospitals.

No / There are 353 NHS hospitals in the United Kingdom, and within these hospitals there is wide variation in the electronic prescribing systems applied. Indeed, only one hospital uses a single system in all of its clinical areas. Medication error is the biggest issue in the health care profession in respect to patient safety—

A partir do método de custeio por absorção, com adaptação do custeio baseado em atividades, um sistema de informações foi modelado e implantado para monitorar custo de produção, dos produtos fabricados pela farmácia hospitalar do Hospital das Clínicas da Faculdade de Medicina da USP. Foram analisados os formulários dos produtos fabricados, insumos, gastos indiretos de fabricação, controle de qualidade e totalizados os tempos gastos da mão-de-obra direta de 100 produtos fabricados em julho de 2003. Os resultados mostraram que de 35 itens produzidos com similares, 28 apresentaram custo de produção inferior ao preço do fabricante no mercado, estimando que nesse mês o HC deixou de gastar, aproximadamente, 750 mil reais com a produção interna. Os 65 itens restantes eram produtos exclusivos e especiais. Os gastos com insumos corresponderam a 69% do custo total de produção. O modelo proposto mostrou que a farmácia hospitalar pode proporcionar redução de gastos à entidade. / On the basis of the absorption costing method, with a number of adaptations from activity based costing, an information system was modeled and implanted to monitor the production costs of products manufactured by the hospital pharmacy of Hospital das Clínicas, Faculty of Medicine, University of São Paulo. Were analysed manufactured products forms, raw material, indirect manufacturing costs, quality control, and added up direct labor time for 100 manufactured products in July 2003. The results showed that out of 35 items produced with similar products in the market, 28 presented a production cost below the price of the market manufacturer. Evaluations revealed that, during this month, the institution saved about 750 thousand reais through internal production. The 65 remaining items were exclusive and special products. Raw material expenses accounted for 69% of total production costs. The proposed model showed that the hospital pharmacy can lead to expense reduction for the entity.

A prática da reutilização de produtos médico-hospitalares de uso único vem sendo aplicada desde meados da década de setenta. A principal razão que tem contribuído para disseminação desta conduta pelas instituições hospitalares radicadas tanto nos países em desenvolvimento como naqueles considerados ricos, tem sido a aparente economia de custos. Apesar dos riscos relacionados com a prática da reutilização, como reações pirogênicas, danos ocasionados por bactérias consideradas patogênicas em pacientes imunologicamente comprometidos, danos na integridade fisica dos produtos, assim como aumento do período de permanência dos pacientes no hospital, têm despertado o interesse em avaliar aspectos fisicos e biológicos dos produtos médico-hospitalares reutilizados. Baseando-se nestas considerações foram aplicados desafios com esporos de Bacillus Subtilis varo niger ATCC 9372 e endotoxina bacteriana E. coli 055:B5. Os produtos desafiados foram cateteres intravenosos, torneira três vias e tubos de traqueostomia. A possível presença microbiana foi investigada após contaminação intencional dos esporos de B. Subtillis (107 ufc/unid.) com submissão das unidades contaminadas à limpeza e posterior esterilização, utilizando óxido de etileno/CFC na proporção 12:88. Os ciclos de reprocessamentos simulados de produtos médico-hospitalares consistiram de contaminação de cada unidade teste com carga microbiana, lavagem com detergente enzimático, secagem e esterilização. Ao término de cada ciclo de reprocessamento foram separadas unidades representativas para avaliação por contagem microbiana (pour plate), testes de esterilidade por inoculação direta e indireta, citotoxidade por cultura de células e microscopia eletrônica de varredura. A eficiência da esterilidade foi avaliada tanto por contagem microbiana como pelos testes de esterilidade, que resultaram em níveis microbianos de 103 ufc/unid. e detecção de contaminação até o 6° ciclo de reprocessamento nos cateteres intravenosos, tubos de traqueostomia e torneiras três vias. A segurança dos reprocessamentos dos produtos médico-hospitalares foi avaliada pela cultura de células de fibroblastos de camundongo (NCTC clone 929), as quais não apresentaram toxicidade. Entretanto, os resultados obtidos durante microscopia eletrônica de varredura comprovaram presença de carga microbiana após 10° ciclo de reprocessamento, assim como danos na superficie polimérica. Durante desafio com endotoxina bacteriana, que consistiu em contaminar as unidades com 200 UE, secagem e exposição ao ciclo de esterilização com óxido de etileno/CFC (12:88), verificou-se que após ciclos de reprocessamentos simulados, totalizando dez ciclos, foi possível detectar valores de recuperação de endotoxina em torno de 100%. Os cateteres-guia que foram adquiridos em instituição hospitalar após quatro reutilizações, apresentaram níveis de contaminação de 105 ufc/unid., assim como presença de bactérias consideradas patogênicas em pacientes comprometidos imunologicamente, já a detecção de endotoxina bacteriana nestes cateteres não foi considerada significativa. Logo, as avaliações aplicadas nas unidades submetidas aos ciclos de reprocessamentos simulados, assim como nos cateteres-guia reprocessados e reutilizados quatro vezes, refletiram a realidade de algumas instituições no âmbito nacional e internacional que praticam a reutilização de produtos médico-hospitalares de uso-único. Os resultados obtidos vêm enfatizar objeções quanto à prática da reutilização, considerando que a ausência de segurança pode ocasionar em danos ao paciente. / The practices of reutilization of single use hospital medical devices came into practice since mid seventies. The main reason that has contributed for dissemination of this practice by institutional hospitals in underdeveloped as well as those considered as rich countries has been the appellant economy of costs. Despite well known risks related with the practice of reutilization, such as pyrogenic reactions, damages caused by bacteria\'s considered pathogenic in patients immunologically compromised, damages to the physical integrity of the materials, as well as prolonged permanence of the patient in the hospital, has raised interests in the evaluation of physical and biological aspects of the reused medical device. Based on these considerations, challenges had been applied with spores of Bacillus Subtilis varo niger 9372 ATCC and bacterial endotoxin E. coli 055:B5. The selected materials includes, intravenous catheters, three-way stopcocks and traqueostomy tubes. The possible presence of bacteria was investigated after intentional contamination with spores of B. Subtillis (107 cfu/unit) followed by submission of the inoculated units to the cleaning process and posterior sterilization using ethylene oxide at 12:88. The simulated reprocessing cycles of the medical device had consisted of contamination of each test unit with predetermined microbial load, washing with enzymatic detergent, drying and sterilization. At the end of each reprocessing cycle, representative sarnples had been segregated to evaluate microbial count (pour plate), terility test through direct and indirect inoculation, cytotoxicity test through cell culture and scanning electron microscopy. The efficiency of the sterility was evaluated through microbial count, as for the sterility tests, that had resulted in microbial count of 103 cfu/unit and detection of contamination until the 6th cycle of reprocessing in the intravenous catheters, three-way stopcocks and traqueostomy tubes. The safety of these reprocessed medical devices was evaluated by mouse fibroblasts cell culture (NCTC clone 929), which didn\'t presented significant toxicity. However, the results obtained by scanning electron microscopy proved the presence of microbial load after 10th reprocessing cycle, as well as damages to the polymeric surface. During challenge with bacterial endotoxin, that consisted of contaminating the units with 200 EU, drying and submission to sterilization cycles with ethylene oxide/cfe (12:88), it was verified that after ten simulated reprocessing cycles, it was possible to recover around 100% of endotoxin. The catheter guide that were acquired from institutional hospital after four times reuse, had presented levels of contamination of 105 cfu/unit, as well as presenee of bacteria considered pathogenic in patients immunologically compromised, on the other hand the detention of bacterial endotoxin in these catheters was not considered significant. The evaluations studies condueted with the units submitted to the simulated reprocessing cycles, as well as the catheter guide reprocessed and reused four times, had reflected the reality of some national and foreign hospitais which reutilize single use medical device. The results obtained lead us to raise objections to the reusing practice, considering the absence of adequate patients safety.