The use of anti-hyperlipidemia in a private hospital in Yogyakarta during 2013-2019

Background: Lipid modifying agents have an important role in the primary and secondary prevention of cardiovascular diseases such as coronary heart disease and stroke. The use of lipid-modifying agents tends to increase along with the increasing prevalence of these diseases. Objectives: To determine the utilization of lipid modifying agents for hospitalized patients in a private hospital in Yogyakarta during the period of 2013 - 2019 in regard to the agents used and their quantity. Methods: The main data for this study were aggregate data on the use of lipid modifying agents for hospitalized patients during 2013-2019 obtained from the hospital pharmacy department. After identification of the names of lipid modifying agents, the quantities of these drugs were then calculated in units of defined daily dose (DDD) and the final quantity was expressed in DDD/100 bed days (BD). The R2 value from linear regression was used to determine the trend of use of individual agents over the period. Results: There were two pharmacological subgroups of lipid modifying agents used during the period of 2013 – 2019 with an average of total quantity of 14.81 DDD/100 BD. Utilization of statins was approximately 90% of the total use, and utilization of fibrates tended to decrease over the period. Individually, simvastatin use decreased significantly over the period (R2 = 0.885), but atorvastatin use continued to increase (R2 = 0.908) with 10-fold increase from 2013 to 2019. Conclusion: The lipid modifying agents used during the period 2013 - 2019 were predominantly statins, and the utilization of atorvastatin increased significantly during this period. Keywords: lipid modifying agents, ATC/DDD, fibrates, statins

Prevalence of and incentives for board certification among hospital pharmacy departments in California

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Board of Pharmacy Specialties (BPS) certification is endorsed to distinguish pharmacists for advanced practice areas, yet perceived value to stakeholders remains poorly described. This study characterized how board certification is integrated in hospital pharmacy departments across California. Methods A prospective, cross-sectional study was conducted in which a survey was administered to all hospital pharmacy directors in California between November 2019 and March 2020. Licensed institutions and corresponding pharmacy directors were identified from the California State Board of Pharmacy. The survey queried for institution and pharmacy director characteristics and if/how board certification was integrated. Multivariable logistic models identified predictors of institutions with at least 25% full-time board-certified pharmacists and those that reward board certification. Results Surveys were completed by 29% of institutions. Most of these institutions were urban (81%) and nonteaching (57%), with fewer than 325 hospital beds (71%), and with fewer than 50 full-time pharmacist positions (86%). The majority reported that less than 25% of their pharmacists were board certified. Currently, 47% consider board certification during hiring and 38% reward board-certified employees. Predictors of institutions with 25% or more board-certified pharmacists included being a teaching institution (odds ratio [OR], 2.96; 95% confidence interval [CI], 1.24-7.06), having 325 or more beds (OR, 7.17; 95% CI, 2.86-17.97), and having a pharmacy director who was previously or currently board certified (OR, 3.69; 95% CI, 1.46-9.35). Hospitals with 100 or more pharmacist positions predicted institutions that reward board certification (OR, 16.69; 95% CI, 1.78-156.86). Conclusion Board certification was an employment preference for almost half of the hospital survey respondents in California. Institutions more likely to reward board-certified pharmacists are larger, urban, and teaching hospitals and have pharmacy directors who have been board certified.

Prescription Audit and Dispensing Errors in the Outpatient Pharmacy of Tertiary Care Multispecialty Teaching Hospital

Background: Although errors occurring during the process of dispensing may affect the goal of the treatment, they also can be the significant cause of morbidity and mortality. There are only few published evidences which focuses on the errors of dispensing that occurs in the pharmacy. This study focuses on identifying the dispensing errors, impact of brand substitution on cost and DDIs. Objective: To identify the dispensing errors, impact of brand substitution on cost and DDIs. Methodology: Prospective observational study conducted over a period of eight weeks in outpatient hospital pharmacy of tertiary care multispecialty teaching hospital, Tamil Nadu. Prescriptions and medication bills and dispensed medicines are collected from the hospital pharmacy to obtain data required for the study. Prescription containing only medical devices were excluded from the study. Results: Out of 1010 prescriptions, dispensing errors were present in 419 (41.48%) prescriptions which consist of 557 errors. The errors include dispensing multi-pills to make the required dose is 3.77%,tablet splitting is 0.8%, incorrect strength is 1.07%, omission error due to unavailability is 31.4%,dispensing drugs with brands other than prescribed brands is 63.7%. Prescriptions which had more than three drugs were analyzed for drug-drug interactions (n=389). DDIs were present in 156(40.1%) prescriptions which had a total of 281 interactions. Conclusion: The brand substitution and omission errors are the major causes of dispensing errors. Brand substitution is not always recommended as it may have some adverse effects because of salt and excipients variation. Pharmacists are in the position to identify and reduce DDIs by discussing with the physicians.

Implementation of Lean Kaizen to Reduce Waiting Time for the Indonesian Health Social Security Agency Prescription Services in Hospital Pharmacy InstallationImplementation of Lean Kaizen to Reduce Waiting Time for the Indonesian Health Social Security Agency Prescription Services in Hospital Pharmacy Installation

BACKGROUND: The second largest Health Social Security Agency (BPJS) outpatients visits in Hospital Pharmacy Installation, Indonesia, has reached 450-600 visits / day between 2017 and 2018. This has an impact on the number of prescriptions to be served. Simultaneous doctor practice schedule and less human resources are the reasons for not achieving the service standard time set by the Ministry of Health (≤60 minutes for concoctions and ≤30 minutes for non-concoctions). AIM: The purpose of this study was to determine the waiting time for BPJS prescription services in the current state and future state after the implementation of lean kaizen through Plan-Do-Check-Act (PDCA) approach at Grha Permata Ibu (GPI) Hospital. METHODS: The research method is operational research with qualitative and quantitative approaches through direct observation and in-depth interviews. RESULTS: The implementation of lean kaizen decreased the lead time from 135.31 minutes to 9.11 minutes in scenario-1 and 7.49 minutes in scenario-2 and a decrease in lead time from 185.17 minutes to 31.09 minutes in scenario-1 and 29,15 minutes in scenario-2 for the concoctions. PDCA in lean kaizen is for use in conditions where waste is most closely related to human behavior, but there is still a waste motion that has not been intervened. CONCLUSION: This study suggests an updating information to prioritize changes in pharmaceutical layout, carry out continuous monitoring, and encourage IT to develop IT-based pharmaceutical services.

Formulary Drug Review: Belumosudil

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the needs of a facility. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433.

Low-cost SARS-CoV-2 vaccine homogenization system for Pfizer-BioNTech covid-19 vials

<p>The current SARS-CoV-2 pandemic has been affecting all sectors worldwide, and efforts have been targeting the enhancement of people’s health and labour conditions of collaborators belonging to healthcare institutions. The recent vaccines emerging against covid-19 are seen as a solution to address the problem that has already killed up to two million people. The preparation of the Pfizer-BioNTech covid-19 vaccine requires a specific manipulation before its administration. A correct homogenization with saline solution is needed and, therefore, a manual process with a predefined protocol should be accomplished. This action can endanger the operators’ ergonomics due to the repetitive movement of the process. This paper proposes a low-cost prototype incorporating an arduino based embedded system actuating a servomotor to perform an autonomous vials’ homogenization allowing to redirect these healthcare workers to other tasks. Moreover, a contactless start order process was implemented to avoid contact with the operator and, consequently, the contamination. The prototype was successfully tested and recognised, and is being applied during the preparation of the covid-19 vaccines at the hospital pharmacy of <em>Centro Hospitalar de Vila Nova de Gaia/Espinho</em>, <em>E.P.E.</em>, Portugal. It can be easily replicated since the source files to assemble it are provided by the authors.</p>

INVENTORY CONTROL OF DISPOSABLE MEDICAL MATERIALS AT THE BALI MANDARA EYE HOSPITAL

Background: As a health service institution, hospitals have characteristics and management complexities which have an impact on their financing aspects. Controlling the supply of pharmaceutical supplies aims to create a balance between supply and demand in order to realize effective and efficient health services.Aims: This study aimed to design a method for controlling the optimal supply of disposable medical materials at the Bali Mandara Eye Hospital, Bali. Methods: This is a qualitative study based on in-depth interviews with three informants, and involving 11 doctors (users) to determine the critical value of disposable medical materials.Results: ABC analysis was used to classify all types of goods based on their importance to determine priorities based on the value of use. The budget allocation was dominated by only a small portion or only a few types of pharmaceutical supplies. The results show that there was a decrease in the total cost of inventory by 19.14% after the application of the EOQ method. The application of the reorder point (ROP) method can anticipate the occurrence of stock outs or vacancies.Conclusion: The EOQ method is more efficient than the conventional method applied at the Bali Mandara Eye Hospital Pharmacy Installation. The EOQ and ROP methods greatly affect the efficiency and effectiveness of controlling the inventory of medical disposable materials at the Bali Mandara Eye Hospital.Keywords: : inventory control, effective and efficient, medical disposable materials