An Interdisciplinary Dashboard to Streamline Medication Processing at Patient Discharge: A Quality Improvement Initiative

ABSTRACT Introduction The purpose of this quality improvement project was to develop and evaluate the use of an electronic medication request dashboard to reduce the amount of time required for medication processing and decrease time lost to workflow interruptions during patient discharge. Delayed discharges are associated with increased health care costs and adverse patient outcomes. Processing of medication requests at discharge contributes to these delays and to workflow interruptions for nursing and pharmacy staff at the project site. Electronic dashboards have been successfully implemented in multiple medical settings to streamline patient processing and enhance communication. Materials and Methods The Human Protections Office at Carl R. Darnall Army Medical Center (Fort Hood, TX) reviewed and approved the project with a non-human research determination. A multi-disciplinary workgroup with representatives from nursing, pharmacy, and health information technology (HIT) was formed to develop the dashboard. Based on a logic flow diagram of the desired communication, HIT created a medication request form and status dashboard using SharePoint and Nintex workflows. The dashboard was implemented for a 30-day pilot on a 25-bed medical/surgical nursing unit. The time required for medication processing, the time from discharge order to patient exit, the number of phone calls between nursing and pharmacy, and the usability of the medication request process were measured before and after implementation. The results were analyzed with descriptive statistics and evaluated for statistical significance with a P value ≤.05. Results With implementation of the dashboard, the average medication processing time decreased from 125 minutes to 48 minutes (P < .0001), and the average patient discharge time decreased from 137 minutes to 117 minutes (P = .002). The usability score of the medication request process increased from 40 to 87 for nursing (P < .0001) and from 62 to 85 for pharmacy (P = .003). The total number of voice calls between nursing and pharmacy decreased from 1,115 to 434, while the total time on voice calls decreased from 33 hours and 50 minutes to 13 hours and 19 minutes (P < .0001). Conclusions The electronic dashboard is an effective method to enhance interdisciplinary communication during patient discharge and significantly reduces medication processing times. However, despite the medication processing time decreasing by over an hour, the discharge time only decreased by 20 minutes. Additional investigation is needed to evaluate other contributors to delayed discharge. A key limitation of this study was the convenience sampling used over a 30-day pilot on a single unit. The process has since been adopted by the entire hospital, and additional analysis could better reveal the impact to the organization. This communication system shows high usability and reduces phone call interruptions for both nursing and pharmacy staff. Additionally, this technology could easily be applied to other communication pathways or request processes across military medicine.

The PrEP Up Pharmacies Study: Protocol for integrating and disseminating pre-exposure prophylaxis (PrEP) screening and dispensing in community pharmacies for Black men who have sex with men in Atlanta, Georgia (Preprint)

BACKGROUND Black men who have sex with men (BMSM) suffer from alarmingly high rates of HIV in the United States. Pre-exposure prophylaxis (PrEP) can reduce risk of HIV infection by 99% among MSM, yet profound racial disparities in the uptake of PrEP persist. Low PrEP uptake in BMSM is driven by poor access to PrEP including inconvenient locations of PrEP-prescribing physicians and distrust of physicians and stigma, which limit communication about PrEP and its side effects. Previous work indicates that offering HIV prevention services in pharmacies located in high poverty, racial minority neighborhoods is feasible and can reduce stigma because pharmacies offer a host of less stigmatized health services (e.g. vaccinations). We present a protocol for a pharmacy PrEP model that seeks to address challenges and barriers to pharmacy-based PrEP specifically for BMSM. OBJECTIVE To develop a sustainable pharmacy PrEP delivery model that can be implemented to increase PrEP access in high poverty, racial minority neighborhoods for BMSM. METHODS This study design is a pilot intervention to test a pharmacy PrEP delivery model among pharmacy staff and BMSM. We will examine the PrEP delivery model’s feasibility, acceptability and safety, and gather early evidence of its impact and cost with respect to PrEP uptake. A mixed methods approach will be performed including three study phases: 1) a completed formative phase with qualitative interviews from key stakeholders; 2) a completed transitional pilot phase to assess customer eligibility and willingness to receive PrEP in pharmacies during COVID-19; and 3) a planned pilot intervention phase which will test the delivery model in two Atlanta pharmacies in high poverty, racial minority neighborhoods. RESULTS Data from the formative phase showed strong support of pharmacy-based PrEP delivery among BMSM, pharmacists and pharmacy staff. Important factors were identified to facilitate implementation of PrEP screening and dissemination in pharmacies. During the transitional pilot phase, we identified 81 individuals who would have been eligible for the pilot phase. CONCLUSIONS Pharmacies have proven to be a feasible source for offering PrEP for White MSM, but have failed to reach the most at-risk, vulnerable population – BMSM. Increasing PrEP access and uptake will reduce HIV incidence and racial inequities in HIV. Translational studies are required to build further evidence and scale pharmacy-based PrEP services specifically for populations that are disconnected from HIV prevention resources.

ANALISIS PENYEBAB OBAT KADALUARSA DI INSTALASI FARMASI RUMAH SAKIT IBU DAN ANAK ERIA BUNDA PEKANBARU TAHUN 2020

Pelayanan kefarmasian merupakan pelayanan penunjang serta pusat pendapatan utama bagi rumah sakit. Instalasi farmasi merupakan salah satu unit pelaksanaan fungsional yang menyelenggarakan seluruh kegiatan pelayanan kefarmasian. Di instalasi farmasi Rumah Sakit Ibu dan Anak Eria Bunda Pekanbaru berpotensi menghasilkan obat kadaluarsa yang dapat menimbulkan kerugian bagi rumah sakit. Tujuan dari penelitian ini adalah untuk mengetahui penyebab obat kadaluarsa di instalasi farmasi Rumah Sakit Ibu dan Anak Eria Bunda Pekanbaru. Penelitian ini merupakan penelitian kualitatif deskriptif. Subjek penelitian ini terdiri dari Kepala Instalasi Farmasi, Penanggung Jawab Farmasi Rawat Inap, Koordinator Perbekalan Farmasi dan Alkes, Staf Farmasi Rawat Jalan, dan Staf Gudang Farmasi. Dengan metode pengumpulan data menggunakan observasi dan wawancara. Dari hasil penelitian dapat disimpulkan bahwa penyebab obat kadaluarsa di instalasi farmasi Rumah Sakit Ibu dan Anak Eria Bunda Pekanbaru disebabkan oleh perencanaan obat yang terlalu berlebih dari konsumsi pemakaian rata-rata rumah sakit, pengadaan obat yang tidak memperkirakan berapa banyak obat yang mau dipesan, serta penyimpanan obat dikarenakan human error dimana kesalahan pada saat penyimpanan yang tidak FIFO dan FEFO. Saran bagi instlasi farmasi Rumah Sakit Ibu dan Anak Eria Bunda Pekanbaru yaitu dengan mengadakan pelatihan dan sosialisasi terhadap perencanaan dan pengadaan obat, serta meningkatkan pengawasan dalam melakukan penyimpanan obat. Pharmaceutical services are support services as well as the main revenue center for hospitals. The pharmacy installation is one of the functional implementation units that organize all pharmaceutical service activities. The pharmacy installation at the Eria Bunda Mother and Child Hospital in Pekanbaru has the potential to produce expired drugs that can cause harm to the hospital. The purpose of this study was to determine the causes of drug expiration in the pharmacy installation of Eria Bunda Mother and Child Hospital Pekanbaru. This research is descriptive qualitative research. The subjects of this study consisted of the Head of the Pharmacy Installation, the Person in Charge of Inpatient Pharmacy, the Coordinator of Pharmacy and Medical Devices, the Outpatient Pharmacy Staff, and the Pharmacy Warehouse Staff. With the data collection method using observation and interviews. From the results of the study, it can be concluded that the cause of expired drugs in the pharmacy installation of Eria Bunda Mother and Child Hospital Pekanbaru is caused by excessive drug planning than the average hospital consumption, drug procurement that does not predict how many drugs to order, and storage. medicine due to human error where the error during storage is not FIFO and FEFO. Suggestions for the pharmacy installation of Eria Bunda Mother and Child Hospital Pekanbaru, namely by holding training and socialization of drug planning and procurement, as well as increasing supervision in carrying out drug storage.

Combining research and design: A mixed methods approach aimed at understanding and optimising inpatient medication storage systems

Background Almost every patient admitted to hospital will receive medication during their stay. Medication errors are an important cause of patient morbidity and mortality, as well as an economic burden for healthcare institutions. Research suggests that current methods of storing medication on hospital wards are not fit for purpose, contributing to inefficiency and error. Aim To improve medication storage in inpatient areas, by exploring variation and challenges related to medication storage and designing a prototype solution. Methods Set in four hospitals in an English teaching hospital trust, the study used a mixed methods approach comprising a quantitative descriptive survey of storage facilities and practices followed by mixed methods observations of medication rounds and interviews with patients, nurses and pharmacy staff. Quantitative data were presented descriptively and qualitative data analysed thematically and using a human-centered design approach. Results We identified wide variation in medication storage facilities and practices across 77 wards. Observations and staff interviews in six wards revealed five problem areas: poor management of multiple storage facilities; lack of visibility and organisation of medication within trolleys; inadequate size of storage; lack of ownership and knowledge of standard practice; and use of key locks. Patients were largely satisfied with receiving their medication. Systematic and consistent physical organisation of medication in medication trolleys, and integrating and implementing principles of best practice, were identified as areas for intervention. Discussion and conclusion Variation in medication storage facilities and practices existed both across the organization and on individual wards. Multiple challenges were identified in how medication was stored, which if addressed may improve the efficiency and safety of medication administration and in turn, staff and patient experience. The use of design principles alongside a research approach resulted in a rapid, iterative process for developing and refining potential solutions to improve inpatient medication storage.

Analysis of Performance of Pharmaceutical Drug Distribution Officers Using AHP and Rating Scale Methods in Hospital Bhayangkara Installation, Medan

Pharmacy staff is a health service that needs to improve the quality of its service to answering customer expectations and demands. AHP (Analytical Hierarchy Process) and Rating Scale are powerful instruments as evaluation tools in management because they can assess the performance of the Hospital Pharmacy Installation. This study aims to analyze the performance of pharmacy officers in drug distribution using the AHP (Analytical Hierarchy Process) method and the Rating Scale at Bhayangkara Hospital Medan in 2020. This type of research is quantitative research. The research design uses a correlation study with a retrospective approach equipped with a sheet. Observations are in the form of a table list. The sample in this research is all officers involved in the distribution of drugs in the inpatient room of the Bhayangkara Hospital Medan who receive drug distribution from the pharmacy. The sampling technique in this study used a total sampling technique, namely taking a sample of the entire population in the study. Based on the sampling technique, the total sample was 57 people. The results of the cross table between the performance of pharmacy officers in drug distribution using the Rating Scale method in the Bhayangkara Hospital Installation in Medan in 2020, which shows the p-value for each variable, namely the quality p-value = 0.000, the quantity value p = 0.006, the use time value p = 0.000, the cooperation value p = 0.000. This study concludes that there is an influence between the performance of pharmacy officers in drug distribution using the AHP method and the Rating Scale at the Bhayangkara Hospital Installation in Medan in 2020. It is recommended that pharmaceutical officers further improve health services, especially paying attention to drug distribution for each installation in the hospital. Keywords: Performance, AHP, Rating Scale, Pharmacy Officers.

Evaluasi Pengelolaan Sediaan Farmasi dan Bahan Medis Habis Pakai Pada Puskesmas di Kabupaten Pekalongan Berdasarkan Petunjuk Teknis Standar Pelayanan kefarmasian di Puskesmas Tahun 2019

Management of pharmaceutical preparations is a series of activities involving aspects of planning, procurement, receipt, storage, distribution, destruction and withdrawal, control and administration of drugs that are managed optimally to ensure the achievement of determination of the amount and type of pharmaceutical supplies. The purpose of this study was to evaluate the management of pharmaceutical preparations and medical consumables in health centers in Pekalongan Regency based on the Technical Instructions for Pharmaceutical Services at Puskesmas in 2019. The method used in this study was a quantitative method with descriptive quantitative analysis using simple techniques. random sampling consisting of 30 respondents from pharmacy staff in 17 health centers in Pekalongan Regency who met the inclusion criteria. The research instrument used a questionnaire with univariate analysis. The results showed that the management of pharmaceutical preparations and medical consumables (BMHP) in the planning category was very good (100%), the procurement category was very good (76.7%), the acceptance category was very good (100%), the storage category was very good (100 %), very good category distribution (90%), very good withdrawal and annihilation category (100%), very good category control (93.3%) and very good category administration stage (100%). The conclusion of this study is that the implementation of the management of pharmaceutical preparations and medical consumables (BMHP) in district health centers is in accordance with the Technical Guidelines for Pharmaceutical Service Standards at Health Centers in 2019, therefore pharmaceutical staff in each health center must always improve pharmaceutical service standards in order to prosper. high public health.Keywords: Technical Guidelines; for Pharmaceutical Services; Public health center AbstrakPengelolaan sediaan farmasi merupakan suatu rangkaian kegiatan yang menyangkut aspek perencanaan, pengadaan, penerimaan, penyimpanan, pendistribusian, pemusnahan serta penarikan, pengendalian dan administrasi obat yang dikelola secara optimal untuk menjamin tercapainya ketetapan jumlah dan jenis perbekalan farmasi. Tujuan dari penelitian ini adalah untuk mengevaluasi pengelolaan sediaan farmasi dan bahan medis habis pakai di puskesmas yang ada di Kabupaten Pekalongan berdasarkan Petunjuk Teknis Pelayanan Kefarmasian di puskesmas tahun 2019. Metode yang digunakan dalam penelitian ini adalah metode kuantitatif yang bersifat deskriptif analisis kuantitatif dengan menggunakan teknik simple rundom sampling yaitu sejumlah 30 responden tenaga kefarmasian dalam 17 puskesmas di Kabupaten Pekalongan yang memenuhi kriteria inklusi. Instrumen penelitian ini menggunakan kuesioner dengan analisis univariat. Hasil penelitian menunjukan pengelolaan sediaan farmasi dan bahan medis habis pakai (BMHP) pada perencanaan kategori sangat baik (100%), pengadaan kategori sangat baik (76,7%), penerimaan kategori sangat baik (100%), penyimpanan kategori sangat baik (100%), pendistribusian kategori sangat baik (90%), penarikan dan pemusnahan kategori sangat baik (100%), pengendalian kategori sangat baik (93,3%) dan tahapan administrasi kategori sangat baik (100%). Kesimpulan pada penelitian ini bahwa pelaksanaan pengelolaan sediaan farmasi dan bahan medis habis pakai (BMHP) di puskesmas Kabupaten telah sesuai dengan Petunjuk Teknis Standar Pelayanan Kefarmasian di Puskesmas Tahun 2019, oleh karena itu tenaga kefarmasian di setiap puskesmas harus selalu meningkatkan standar pelayanan kefarmasian guna untuk mensejahterakan kesehatan masyarakat yang tinggi.Kata kunci: Petunjuk; Teknis; Pelayanan; Kefarmasian; Puskesmas

602. Intravenous Push Versus Intravenous Piggyback Administration of Cephalosporin Antibiotics: Impact on Safety, Workflow, and Cost

Background IV piggyback (IVPB) infusion has been the standard method of administration of IV antibiotics since the 1970s. Literature has demonstrated that the IV push (IVP) method has similar pharmacokinetic exposures and risk for complications as short infusion IVPB, and may have potential benefits. The primary objective is to evaluate the incidence of infusion-related complications in patients receiving cefazolin, ceftriaxone, and cefepime administered via IVP versus short infusion IVPB at the Veteran Affairs Long Beach Healthcare System. The secondary objectives include evaluating the time-to-onset of complications, time-to-first-dose combination vancomycin in the emergency department (ED), cost, and nursing and pharmacy staff preference between IVP and IVPB. Methods This is a retrospective, single-center cohort study. Patients who received ceftriaxone, cefepime, or cefazolin between April 1st, 2019 – December 31st, 2019, and April 1st, 2020 – December 31st, 2020 were included. Patients who received the study antibiotics via IVPB during the IVP period were excluded. Statistical analyses were performed using the chi-square, fisher’s exact, Mann-Whitney U, and unpaired t-tests where appropriate. Complications associated with IVP or IVPB administration were assessed via chart review of electronic health records. Surveys to nursing and pharmacy staff were distributed using Microsoft Forms. Results 366 treatment episodes were evaluated for 355 unique patients. Complications occurred in 13 out of 183 (7.1%) treatment episodes in the IVP group compared to 18 out of 183 (9.8%) treatment episodes in the IVPB group (P = 0.35). The median time to complications was 2 days for both groups. IVP cefepime and ceftriaxone reduced the median time-to-first-dose vancomycin in the ED by 25 minutes. The use of cefazolin, ceftriaxone, and cefepime as IVP yielded a quarterly cost savings of &38,890.04. 55% of nursing staff and 85% of pharmacy staff prefer IVP administration for cefazolin, ceftriaxone, and cefepime. Conclusion Cefazolin, ceftriaxone, and cefepime given as IVP were observed to be as safe as IVPB while reducing time-to-first dose vancomycin in the ED and cost, and is the preferred method of administration among nursing and pharmacy staff. Disclosures All Authors: No reported disclosures

COVID-19 Vaccination Engagement and Barriers among Mississippi Pharmacists

After the emergency use authorization of coronavirus disease 2019 (COVID-19) vaccinations in the United States, existing pharmacy infrastructure was leveraged to disseminate vaccines. However, the national uptake of COVID-19 vaccines remains poor. This survey study of Mississippi pharmacists aimed to identify barriers to providing COVID-19 vaccination among pharmacists in practice settings that provided other vaccines. A thematic analysis was used to analyze open-ended survey responses. This study found that the greatest identified barrier to COVID-19 vaccination for pharmacists was patient willingness. The thematic analysis revealed logistical barriers, vaccine hesitancy, and rural pharmacy distribution concerns. These findings suggest that pharmacists require further training in overcoming vaccine hesitancy, and potentially indicate a need for the distribution of vaccination responsibilities to additional pharmacy staff members.