SELECTING AND ALLOCATING REPACKAGING TECHNOLOGY FOR UNIT-DOSE MEDICATIONS IN HOSPITAL PHARMACIES

2013 ◽  
Vol 10 (03) ◽  
pp. 1340011
Author(s):  
JENNIFER A. PAZOUR ◽  
SARAH E. ROOT ◽  
RUSSELL D. MELLER ◽  
LISA M. THOMAS ◽  
SCOTT J. MASON
Keyword(s):  
Mathematical Model ◽  
Hospital Pharmacy ◽  
Point Of Care ◽  
Medication Administration ◽  
Technology Selection ◽  
Sensitivity Analyses ◽  
Multiple Constraints ◽  
Hospital Pharmacies ◽  
Unit Dose ◽  
Dose Form

To increase patient safety and support bedside-point-of-care medication administration, millions of unit-dose medications are dispensed in hospitals and health systems daily. Because not all medications are available in unit-dose form directly from the manufacturer, hospitals must repackage medications in unit-dose form themselves. We develop a mathematical model that simultaneously determines which level of technology is warranted and how each medication that is not delivered to the pharmacy in unit-dose form should be repackaged subject to multiple constraints. This model has been integrated into a free Excel-based tool available to pharmacy directors. We test our model with data based on small, medium, and large hospitals and conduct sensitivity analyses to gain further insight. We illustrate how the results from our model can aid in incorporating qualitative aspects into technology selection. Our results show that a semi-automated repackaging system is the most economical technology alternative for most hospital pharmacy in-house repackaging operations. This result, however, is sensitive to the number of unit-dose medications to repackage and the available labor.

The Practice of Pharmacy in England

1986 ◽  
Vol 20 (10) ◽  
pp. 808-811
Author(s):  
Simon Cronin
Keyword(s):  
Health Service ◽  
Clinical Pharmacy ◽  
Hospital Pharmacy ◽  
Pharmacy Practice ◽  
Master Of Science ◽  
Staffing Levels ◽  
Department Of Health ◽  
Hospital Pharmacies ◽  
Unit Dose ◽  
Unit Dose Dispensing

The practice of pharmacy in England is described. Community pharmacies have a contract with the Department of Health and Social Security to fill National Health Service prescriptions. A large proportion of the general public obtain their prescriptions free. Funding for the health service comes from taxes and automatic contributions from employers and employees. Aspects of hospital pharmacy practice and salaries are discussed, e.g., a junior pharmacist may expect to earn between $9000 and $12 000. There is very little unit-dose dispensing, and many hospitals are unable to provide 24-hour services. Hospital pharmacies function with fewer pharmacists than their U.S. counterparts, utilizing larger numbers of technicians. Clinical pharmacy practice centers around drug monitoring (ward pharmacy). Pharmocokinetic services are provided in a few places. Master of science degrees in clinical pharmacy are available. However, the future of clinical pharmacy practice in England depends on staffing levels and competition between and acceptance from other health disciplines.

A model to account for the consequences of host nutrition on the outcome of gastrointestinal parasitism in sheep: model evaluation

Parasitology ◽  
2007 ◽  
Vol 134 (9) ◽  
pp. 1279-1289 ◽  
Author(s):  
D. VAGENAS ◽  
S. C. BISHOP ◽  
I. KYRIAZAKIS
Keyword(s):  
Mathematical Model ◽  
Worm Burden ◽  
Management Strategies ◽  
Sensitivity Analyses ◽  
Sheep Model ◽  
Host Nutrition ◽  
Gastrointestinal Parasitism ◽  
Different Characteristics ◽  
Nutritional Strategies ◽  
Different Levels

SUMMARYThis paper describes sensitivity analyses and expectations obtained from a mathematical model developed to account for the effects of host nutrition on the consequences of gastrointestinal parasitism in sheep. The scenarios explored included different levels of parasitic challenge at different planes of nutrition, for hosts differing only in their characteristics for growth. The model was able to predict the consequences of host nutrition on the outcome of parasitism, in terms of worm burden, number of eggs excreted per gram faeces and animal performance. The model outputs predict that conclusions on the ability of hosts of different characteristics for growth to cope with parasitism (i.e. resistance) depend on the plane of nutrition. Furthermore, differences in the growth rate of sheep, on their own, are not sufficient to account for differences in the observed resistance of animals. The model forms the basis for evaluating the consequences of differing management strategies and environments, such as breeding for certain traits associated with resistance and nutritional strategies, on the consequences of gastrointestinal parasitism on sheep.

Robotic chemotherapy compounding: A multicenter productivity approach

2021 ◽  
pp. 107815522199284
Author(s):  
Ana C Riestra ◽  
Carmen López-Cabezas ◽  
Marion Jobard ◽  
Mertxe Campo ◽  
María J Tamés ◽  
...  
Keyword(s):  
Mathematical Model ◽  
Correlation Analysis ◽  
Hospital Pharmacy ◽  
Multiple Regression Model ◽  
Key Factors ◽  
Independent Variables ◽  
Specific Factors ◽  
Automated Process ◽  
Productivity Indicators ◽  
The Mathematical Model

Introduction The aim of this study is to compare productivity of the KIRO Oncology compounding robot in three hospital pharmacy departments and identify the key factors to predict and optimize automatic compounding time. Methods The study was conducted in three hospitals. Each hospital compounding workload and workflow were analyzed. Data from the robotic compounding cycles from August 2017 to July 2018 were retrospectively obtained. Nine cycle specific parameters and five productivity indicators were analysed in each site. One-to-one differences between hospitals were evaluated. Next, a correlation analysis between cycle specific factors and productivity indicators was conducted; the factors presenting a highest correlation to automatic compounding time were used to develop a multiple regression model (afterwards validated) to predict the automatic compounding time. Results A total of 2795 cycles (16367 preparations) were analysed. Automatic compounding time showed a relevant positive correlation (ǀrs|>0.40) with the number of preparations, number of vials and total volume per cycle. Therefore, these cycle specific parameters were chosen as independent variables for the mathematical model. Considering cycles lasting 40 minutes or less, predictability of the model was high for all three hospitals (R2:0.81; 0.79; 0.72). Conclusion Workflow differences have a remarkable incidence in the global productivity of the automated process. Total volume dosed for all preparations in a cycle is one of the variables with greater influence in automatic compounding time. Algorithms to predict automatic compounding time can be useful to help users in order to plan the cycles launched in KIRO Oncology.

scholarly journals 2158. Cost-Effectiveness and Budget Impact of a Point-of-Care Nucleic Acid Amplification Test for Diagnosis of Group A Streptococcal Pharyngitis in the United States

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S732-S732
Author(s):  
James Karichu ◽  
Mindy Cheng ◽  
Joanna Sickler ◽  
Julie Munakata ◽  
S Pinar Bilir ◽  
...  
Keyword(s):  
United States ◽  
Cost Effectiveness ◽  
Nucleic Acid ◽  
Budget Impact ◽  
Point Of Care ◽  
Cost Savings ◽  
The United States ◽  
Nucleic Acid Amplification ◽  
Sensitivity Analyses ◽  
Group A

Abstract Background Group A streptococcal (GAS) pharyngitis is common in the United States (US). Each year, approximately 12 million people seek medical care for pharyngitis, accounting for ~2% of ambulatory care visits. The gold standard method for diagnosing GAS is culture. However, because culture is time intensive, rapid antigen detection tests (RADTs), with or without culture confirmation, are commonly used. Although RADTs provide results quickly, test sensitivity has been shown to be sub-optimal, which can lead to inappropriate treatment decisions. Recently, highly sensitive point-of-care nucleic acid amplification tests (POC NAAT), such as the cobas® Liat® System, have emerged. The objective of this study was to evaluate the cost-effectiveness (CE) and budget impact (BI) of adopting POC NAAT compared with RADT+culture confirmation to diagnose GAS pharyngitis from the US third-party payer perspective. Methods A decision-tree economic model was developed in Microsoft Excel to quantify costs and clinical outcomes associated with POC NAAT and RADT+culture over a one-year period. All model inputs were derived from published literature and public databases. Model outputs included costs and clinical effects measured as quality-adjusted life days (QALDs) lost. One-way and probabilistic sensitivity analyses were performed to assess the impact of uncertainty on results. Results CE analysis showed that POC NAAT would cost $44 per patient compared with $78 with RADT+ culture. POC NAAT was associated with fewer QALDs lost relative to RADT+ culture. Therefore, POC NAAT may be considered the “dominant” strategy (i.e., lower costs and higher effectiveness). Findings were robust in sensitivity analyses. BI analysis showed that adopting POC NAAT for diagnosis of GAS could yield cost-savings of 0.3% vs. current budget over 3 years. This is due to savings associated with testing, GAS-related complications, antibiotic treatment and treatment-associated complication costs. Conclusion Results suggest that adopting POC NAAT to diagnose GAS would be considered cost-effective and yield cost-savings for US payers relative to RADT+culture. Access to POC NAAT would be important to optimize appropriate GAS diagnosis and treatment decisions. Disclosures All authors: No reported disclosures.

Organizational learning and patient safety: hospital pharmacy settings

2019 ◽  
Vol 33 (6) ◽  
pp. 695-713
Author(s):  
Wael Abdallah ◽  
Craig Johnson ◽  
Cristian Nitzl ◽  
Mohammed A. Mohammed
Keyword(s):  
Patient Safety ◽  
Organizational Learning ◽  
Safety Culture ◽  
Hospital Pharmacy ◽  
Patient Safety Culture ◽  
Partial Least Square ◽  
Equation Modeling ◽  
Content Type ◽  
Hospital Pharmacies ◽  
The Relationship

Purpose The purpose of this paper is to explore the relationship between organizational learning and patient safety culture in hospital pharmacy settings as determined by the learning organization survey short-form (LOS-27) and pharmacy survey on patient safety culture instruments, and to further explore how dimensions of organizational learning relate to dimensions of pharmacy patient safety culture. Design/methodology/approach This study is a cross-sectional study. Data were obtained from three public hospital pharmacies and three private hospital pharmacies in Kuwait. Partial least square structural equation modeling was used to analyze the data. Findings A total of 272 surveys (59.1 percent response rate) were completed and returned. The results indicated a significant positive relationship between organizational learning and patient safety culture in hospital pharmacy settings (path coefficient of 0.826, p-value <0.05 and R2 of 0.683). Several dimensions of the organizational learning showed significant links to the various dimensions of the pharmacy patient safety culture. Specifically, training (TRN), management that reinforces learning (MRL) and supportive learning environment (SLE) had the strongest effects on the pharmacy patient safety culture dimensions. Moreover, these effects indicated that MRL, SLE and TRN were associated with improvements in most dimensions of pharmacy patient safety culture. Originality/value To the best of the authors’ knowledge, this is the first attempt to assess the relationship between organizational learning, patient safety culture and their dimensions in hospital pharmacy settings.

scholarly journals Patient Misidentifications Caused by Errors in Standard Bar Code Technology

2010 ◽  
Vol 56 (10) ◽  
pp. 1554-1560 ◽  
Author(s):  
Marion L Snyder ◽  
Alexis Carter ◽  
Karen Jenkins ◽  
Corinne R Fantz
Keyword(s):  
Point Of Care ◽  
Data Integrity ◽  
Medication Administration ◽  
Error Rates ◽  
Healthcare Applications ◽  
Worst Case ◽  
Bar Code ◽  
Bar Codes ◽  
Glucose Testing ◽  
Code Identification

BACKGROUND Bar code technology has decreased transcription errors in many healthcare applications. However, we have found that linear bar code identification methods are not failsafe. In this study, we sought to identify the sources of bar code decoding errors that generated incorrect patient identifiers when bar codes were scanned for point-of-care glucose testing and to develop solutions to prevent their occurrence. METHODS We identified misread wristband bar codes, removed them from service, and rescanned them by using 5 different scanner models. Bar codes were reprinted in pristine condition for use as controls. We determined error rates for each bar code–scanner pair and manually calculated internal bar code data integrity checks. RESULTS As many as 3 incorrect patient identifiers were generated from a single bar code. Minor bar code imperfections, failure to control for bar code scanner resolution requirements, and less than optimal printed bar code orientation were confirmed as sources of these errors. Of the scanner models tested, the Roche ACCU-CHEK® glucometer had the highest error rate. The internal data integrity check system did not detect these errors. CONCLUSIONS Bar code–related patient misidentifications can occur. In the worst case, misidentified patient results could have been transmitted to the incorrect patient medical record. This report has profound implications not only for point-of-care testing but also for bar coded medication administration, transfusion recipient certification systems, and other areas where patient misidentifications can be life-threatening. Careful control of bar code scanning and printing equipment specifications will minimize this threat to patient safety. Ultimately, healthcare device manufacturers should adopt more robust and higher fidelity alternatives to linear bar code symbologies.

scholarly journals Diagnosing heart failure with NT-proBNP point-of-care testing: lower costs and better outcomes. A decision analytic study

BJGP Open ◽  
2018 ◽  
Vol 2 (3) ◽  
pp. bjgpopen18X101596 ◽  
Author(s):  
Christoffer Bugge ◽  
Erik Magnus Sether ◽  
Andreas Pahle ◽  
Sigrun Halvorsen ◽  
Ivar Sonbo Kristiansen
Keyword(s):  
Heart Failure ◽  
Clinical Diagnosis ◽  
Point Of Care ◽  
Adult Population ◽  
Delayed Diagnosis ◽  
Clinical Findings ◽  
Sensitivity Analyses ◽  
Tree Model ◽  
Diagnostic Strategies ◽  
Point Of Care Test

BackgroundAfflicting 1–2% of the adult population, heart failure (HF) is a condition with considerable morbidity and mortality. While echocardiography may be considered the gold standard diagnostic test, GPs have relied on symptoms and clinical findings in diagnosing the condition.AimThe aim of this study was to estimate 1-year health outcome and costs of three diagnostic strategies: 1) history and clinical findings ('clinical diagnosis'); 2) clinical diagnosis supplemented with NTproBNP point-of-care test ('POC test') in the GP’s surgery; or (3) in hospital laboratory ('hospital test').Design & settingA decision tree model was developed to simulate 1-year patient courses with each strategy in Norway.MethodSensitivity and specificity of clinical diagnosis (56% and 68%), and of N-terminal pro B-type natriuretic peptide test ([NT-proBNP] 90% and 65%), were based on published literature. The probabilities of referral to hospital were based on a survey of Norwegian GPs (n = 103). The costs were based on various Norwegian fee schedules. Sensitivity analyses were conducted to examine the uncertainty of the results.ResultsThe 1-year per person societal costs were €543, €505, and €607 for clinical diagnosis, POC test, and hospital test, respectively. Even though POC entails higher laboratory costs, the total primary care costs were lower because of fewer re-visits with the GP and less use of spirometry. While 38% of patients had a delayed diagnosis with clinical diagnosis, the proportions were 22% with both POC test and hospital test. Results were most sensitive to the probability of use of spirometry.ConclusionPOC testing results in earlier diagnosis and lower costs than the other diagnostic modalities.

Computerized Pharmaceutical Algorithm Reduces Medication Administration Errors During Simulated Resuscitations

2010 ◽  
Vol 15 (4) ◽  
pp. 274-281
Author(s):  
Girish G. Deshpande ◽  
Adalberto Torres ◽  
David L. Buchanan ◽  
Susan C. Shane Gray ◽  
Suzanne C. Brown ◽  
...  
Keyword(s):  
Critical Care ◽  
Medication Errors ◽  
Point Of Care ◽  
Pediatric Population ◽  
Correct Recall ◽  
Medication Administration ◽  
High Rate ◽  
Controlled Study ◽  
Usual Practice ◽  
Clinical Scenarios

ABSTRACT OBJECTIVE Medication errors involving intravenous medications continue to be a significant problem, particularly in the pediatric population due to the high rate of point-of-care and weight-adjusted dosing. The pharmaceutical algorithm computerized calculator (pac2) assists in converting physician medication orders to correct volumes and rates of administration for intravenous medications. This study was designed to assess the efficacy of the pac2 in simulated clinical scenarios of point-of-care dosing. Methods The study design was a within-subject controlled study in which 33 nurses from pediatrics, pediatric critical care, or critical care (mean nursing experience of 10.9 years) carried out various point-of-care medication-dosing scenarios with and without the aid of the pac2. RESULTS Use of the pac2 resulted in a significantly higher percentage (mean [95% CI]) of medication volumes calculated and drawn accurately (91% [87–95%] versus 61% [52–70%], p&lt;0.0001), a higher percentage of correct recall of essential medication information (97% [95–99%] versus 45% [36–53%], p&lt;0.0001), and better recognition of unsafe doses (93% [87–99%] versus 19% [12–27%], p&lt;0.0001) as compared to usual practice. The pac2 also significantly reduced average medication calculation times (1.5 minutes [1.3–1.7 minutes] versus 1.9 minutes [1.6–2.2 minutes], p=0.0028) as compared to usual practice. CONCLUSIONS The pac2 significantly improved the performance of drug calculations by pediatric and critical care nurses during simulated clinical scenarios designed to mimic point-of-care dosing. These results suggest that the pac2 addresses an area of safety vulnerability for point-of-care dosing practices and could be a useful addition to a hospital's overall program to minimize medication errors.

Letters

2006 ◽  
Vol 25 (3) ◽  
pp. 187-187
Author(s):  
Lorraine Harbold ◽  
Julie Appel ◽  
David Copelan
Keyword(s):  
Enteral Nutrition ◽  
Safety Concern ◽  
Medication Administration ◽  
Contributing Factors ◽  
Administration System ◽  
Feeding Tubes ◽  
Oral Medications ◽  
Unit Dose

I read with interest, the January/February, 2006 (Vol. 25, No. 1) article, “Implementation of an Enteral Nutrition and Medication Administration System Utilizing Oral Syringes in the NICU.” The inadvertent administration of an enteral product intravenously is certainly a safety concern for all NICUs. Our institution began addressing this more than a decade ago by first converting all oral medications to a unit dose system dispensed only in oral syringes. I was surprised by the incompatibility between oral syringes and orogastric, nasogastric, or nasojejunal tubes, cited by the authors, as one of the contributing factors in preventing them from making this conversion. Over the years we have used several brands of NG/OG tubes that easily accommodate the intermittent use of oral syringes. They do not have luer-lok hubs that preclude the use of an oral syringe. The feeding tubes that we generally use for transpyloric placement (duodenal/jejunal), often have a medication port that easily accommodates an oral syringe.

scholarly journals Potential effect of antiseptic mouthwash on the incidence of Neisseria gonorrhoeae among men who have sex with men: a mathematical modelling study

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e052823
Author(s):  
Xianglong Xu ◽  
Eric P F Chow ◽  
Mingwang Shen ◽  
Zhuoru Zou ◽  
Chongjian Wang ◽  
...  
Keyword(s):  
Mathematical Model ◽  
Neisseria Gonorrhoeae ◽  
Health Centre ◽  
Potential Effect ◽  
Sensitivity Analyses ◽  
Secondary Outcome ◽  
Anatomical Site ◽  
Total Incidence ◽  
The Usa ◽  
Sex With Men

ObjectivesThe incidence of Neisseria gonorrhoeae and its antimicrobial resistance is increasing in many countries. Antibacterial mouthwash may reduce gonorrhoea transmission without using antibiotics. We modelled the effect that antiseptic mouthwash may have on the incidence of gonorrhoea.DesignWe developed a mathematical model of the transmission of gonorrhoea between each anatomical site (oropharynx, urethra and anorectum) in men who have sex with men (MSM). We constructed four scenarios: (1) mouthwash had no effect; (2) mouthwash increased the susceptibility of the oropharynx; (3) mouthwash reduced the transmissibility from the oropharynx; (4) the combined effect of mouthwash from scenarios 2 and 3.SettingWe used data at three anatomical sites from 4873 MSM attending Melbourne Sexual Health Centre in 2018 and 2019 to calibrate our models and data from the USA, Netherlands and Thailand for sensitivity analyses.ParticipantsPublished available data on MSM with multisite infections of gonorrhoea.Primary and secondary outcome measuresIncidence of gonorrhoea.ResultsThe overall incidence of gonorrhoea was 44 (95% CI 37 to 50)/100 person-years (PY) in scenario 1. Under scenario 2 (20%–80% mouthwash coverage), the total incidence increased (47–60/100 PY) and at all three anatomical sites by between 7.4% (5.9%–60.8%) and 136.6% (108.1%–177.5%). Under scenario 3, with the same coverage, the total incidence decreased (20–39/100 PY) and at all anatomical sites by between 11.6% (10.2%–13.5%) and 99.8% (99.2%–100%). Under scenario 4, changes in the incidence depended on the efficacy of mouthwash on the susceptibility or transmissibility. The effect on the total incidence varied (22–55/100 PY), and at all anatomical sites, there were increases of nearly 130% and large declines of almost 100%.ConclusionsThe effect of mouthwash on gonorrhoea incidence is largely predictable depending on whether it increases susceptibility to or reduces the transmissibility of gonorrhoea.

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