THE IMPLEMENTATION OF INDONESIA HEALTH MINISTER REGULATION RELATED TO STERILIZED DISPENSING IN "X" HOSPITAL IN GIANYAR-BALI

Background: The application of Regulation of the Minister of Health Number 72 of 2016 is very important to be implemented in every Pharmacy Installation in a hospital, one of which is in the clinical pharmacy service section, namely dispensing sterile preparations to avoid the possibility of medication errors. Objective: The research aimed to find out how the implementation of Regulation of the Minister of Health Number 72 of 2016 stipulated in the basic guidelines of aseptic techniques related to space, equipment, and the implementation of dispensing sterile preparations with its practice in Hospital "X" Gianyar, Bali. Methods: This research used Sequential Explanatory design by combining quantitative and qualitative methods. Results: The results of quantitative research with a checklist found the percentage of completeness of the room and equipment by 100%, while the conformity of the practice with the guidelines of 76.48% is appropriate. The results of qualitative research with triangulation matrices that practice is by the guidelines. Conclusion: Dispensing sterile preparations at the Hospital "X" is following the basic guidelines of aseptic techniques that refer to Regulation of the Minister of Health Number 72 of 2016. Keywords: Implementation, regulation, dispensing, sterile preparations, guidelines, medication errors

“This is streets ahead of what we used to do”: Staff perceptions of virtual clinical pharmacy services in rural and remote Australian hospitals

Background: The use of medications is the most common intervention in healthcare. However, unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in healthcare systems across the world. A Virtual Clinical Pharmacy Service (VCPS) was introduced in rural and remote New South Wales public hospitals to support safe and effective use of medications. In this model clinical pharmacy services are delivered via a telehealth cart at the patient’s bedside and through electronic medical and pharmaceutical record systems. The aim of this research was to understand healthcare staff perspectives of the VCPS and identify areas for improvement. Methods: A qualitative approach informed by Appreciative Inquiry was used to investigate healthcare staff perceptions of the VCPS. Focus group discussions (n=15) with hospital staff and medical officers were conducted via videoconference at each study site. Focus groups explored issues, benefits and barriers three months after service implementation. Transcribed data was analysed using thematic analysis and team discussion to synthesise themes. Results: Focus group participants identified the value of the VCPS to patients, to the health service and to themselves. They also identified enhancements to increase value for each of these groups. Perceived benefits to patients included access to specialist medication advice and improved medication knowledge. Staff valued access to an additional, trusted workforce who provided back-up and guidance. Staff also reported confidence in improved patient safety and identification of medication errors. Enhanced compliance with antimicrobial stewardship and hospital accreditation standards were beneficial to the health service. Suggested improvements included extending virtual service hours and widening patient eligibility to include aged care patients. Conclusions: The VCPS brought a positive, collegiate culture regarding medications. Healthcare staff perceived the VCPS was effective and an efficient way for the health service to supply pharmacy services to smaller hospitals. The ease of use, model of delivery, availability, local knowledge and responsiveness of highly skilled pharmacists was the key to user satisfaction.

Measuring the proportion of time spent on work activities of clinical pharmacists using work sampling technique at a public hospital in Malaysia

Background: The clinical pharmacy service to the ward was established in 2005 in Malaysia, as the number of pharmacists working in the public service sector began to grow. Yet, there has been little local research done on reporting the range of work activities of clinical pharmacists and the amount of time that they spent on their work activities. Objective: This study aimed to identify the range of work activities of clinical pharmacists by observation and to estimate the proportion of time spent on different work activities by using the work sampling technique. Methods: The time spent by clinical pharmacists on various activities was measured using the work sampling technique over 30 working days. The work activities of clinical pharmacists were pre-identified and customized into an activity checklist. Two observers were placed at the study site and took turns recording the activities performed by the clinical pharmacists by following a randomly generated observation schedule. Results: 1,455 observations were made on five clinical pharmacists with a total of 3493 events recorded. Overall, clinical pharmacists spent 78.8% (n=2751) of their time providing clinical services whereas 12.3% (n=433) of their time was spent on non-clinical activities. They were found to be idle from work for 8.9% of the time. There was no difference in bed occupancy rate in the study site regardless of the presence of the observer (p=0.384). Clinical pharmacists were found to report a higher average daily cumulative work unit of 9.8 (SD=4.3) when under observation compared to an average daily cumulative work unit of 6.5 (SD=4.6) when no observer was present (p=0.005). Conclusions: The results revealed that clinical pharmacists spent a significant amount of time on non-clinical work. Their responsibilities with non-clinical work should be properly taken care of so they can allocate more time to providing patient care.

Impact of expanding the clinical pharmacy service in the emergency department at Hamad General Hospital, a tertiary hospital in Qatar: A cross-sectional audit

Background: The emergency department (ED) is a complex environment presenting unique challenges for high-risk populations such as critically ill patients who often require the use of high-risk medications. One study suggests that clinical pharmacists (CPs) may improve the fulfillment of safety goals for the ED patient as per the Joint International Commission. Some published reports have asserted that ED-based CPs would have the potential to increase patient safety. In our hospital, the number of CPs covering the ED increased from 2 to 9 starting from November 2019. Methods: This is a retrospective audit covering the period from January 1st 2019 till October 25th 2020 at Hamad General Hospital (HGH) in Doha, Qatar, to determine the impact of increasing the number of CPs covering the ED on the number of identified, solved, and documented drug related problems (DRPs) on the electronic medical records of ED patients. The interventions retrieved from pharmacy reports were analyzed and evaluated in terms of numbers by classification and percentages by the investigators. Results: A total number of 8,946 interventions covering 6,284 patients were carried out in 2020 compared with 1,515 interventions covering 1,001 patients in 2019 which represents a 6-fold increment by increasing the CPs from 2 to 9. Even the detection of adverse drug reactions increased by 1.5 times with only 38 documented in 2019 compared to 64 in 2020. Classifications and quantities of interventions were also analyzed in detail. Conclusion: This audit demonstrates that pharmaceutical intervention can positively contribute to the identification and resolution of DRPs. The benefit of CP involvement in patient care was observed based on the number of interventions that occurred. Studies are needed to assess the impact of those interventions on patients’ outcomes and cost effectiveness.

Implementation of on-call clinical pharmacy service in an emergency department during COVID 19: New initiative in Hamad General Hospital, Qatar

Background: Throughout COVID-19, complex therapeutics and medication protocols left clinicians overwhelmed by contradicting information leading to drug-related problems (DRPs) potentially leading to ineffective pharmacotherapy and drug-related morbidity and mortality. DRPs queries are time consuming, utilize numerous resources, and require skills and experience to provide accurate answers. Quick answers are paramount in the Emergency Department (ED) especially during a pandemic period. Clinical pharmacists (CP) can identify and resolve DRPs but are only available in the ED during daytime hours. We set up an out-of-office CP service for ED DRPs. This study aimed to assess the capacity of the service to capture 100% of calls received and to measure the time taken to resolve DRP queries compared to the international standard. Methods: A dedicated ED CP on-call phone line and rota until 10 pm daily was arranged by the Hamad General Hospital Pharmacy (Doha, Qatar). Data was documented in a logbook and within the Electronic Medical Records (EMR) and analysed using predefined parameters. Results: Between March-September 2020, 133 DRPs calls were received and resolved by a CP. 38% were related to drug interaction/safety (often about medications used in COVID-19 treatment protocols), adverse drug reactions, dose-adjustments, drug allergies and drug in pregnancy. 30% were about medication administration, such as infusion rates, titration, and intravenous compatibility. Those questions were mostly from nurses. Appropriate dose selection and appropriate indication represented 21% and 11% respectively . Caller's acceptance rate to responses provided by CP was 100%. Responses were documented in the patients’ EMR. The call-history-log showed an average duration of 4.66 minutes per call which is below the average standard of 15-30 minutes. Conclusion: The availability of clinical pharmacists to provide quick, acceptable, responses to DRPs queries is crucial given the complexity and diversity of ED patients. During COVID-19, an on-call clinical pharmacy service has proven its capability to resolve DRPs and support the clinical decision-making process in a relatively short time.

Does drug dispensing improve the health outcomes of patients attending community pharmacies? A systematic review

Background Drug dispensing is a clinical pharmacy service that promotes access to medicines and their rational use. However, there is a lack of evidence for the impact of drug dispensing on patients’ health outcomes. Thus, the purpose of this study was to assess the influence of drug dispensing on the clinical, humanistic, and economic outcomes of patients attending community pharmacies. Methods A systematic literature search was performed in April 2021 using PubMed, Web of Science, Cochrane Library, LILACS, and Open Thesis. Two reviewers screened titles, abstracts, and full-text articles according to the eligibility criteria. Methodological quality was assessed using tools from the Joanna Briggs Institute, and the literature was synthesized narratively. Results We retrieved 3,685 articles and included nine studies that presented 13 different outcomes. Regarding the design, they were cross-sectional (n = 4), randomized clinical trials (n = 4), and quasi-experimental (n = 1). A positive influence of drug dispensing on health outcomes was demonstrated through six clinical, four humanistic and three economic outcomes. Eight studies (88,9 %) used intermediate outcomes. The assessment of methodological quality was characterized by a lack of clarity and/or lack of information in primary studies. Conclusions Most articles included in this review reported a positive influence of drug dispensing performed by community pharmacists on patients’ health outcomes. The findings of this study may be of interest to patients, pharmacists, decision makers, and healthcare systems, since they may contribute to evidence-based decision-making, strengthening the contribution of community pharmacists to health care. Trial registration Registration: PROSPERO CRD42020191701.

Clinical Pharmacy Services Provided in Public Sector Hospitals in Nigeria: A National Survey

Background: Studies show that clinical pharmacy services are effective in optimizing medicines use and patients outcomes. This study aimed to determine the clinical pharmacy services provided in public sector hospitals in Nigeria. Methods: This was an online survey of 296 primary, secondary and tertiary care hospitals sampled purposively across the 36 States and Federal Capital Territory in Nigeria. Data analysis was conducted descriptively, and via Chi-square test and multivariate analysis of variance (MANOVA). Key findings: Complete responses were obtained from 272 hospitals in the country with a survey completion rate of 88%. This included 55 tertiary, 72 secondary, and 145 primary healthcare centres (PHCs). Pharmacists provided pharmaceutical care services in all the tertiary care hospitals, 94% of the secondary, and in only 6% of the PHCs surveyed. The composition of the pharmacy department per level of care was similar across the six geopolitical regions (V = 0.383, F = 1.453, p = 0.06) with more pharmacy staff employed in the tertiary care hospitals compared to the secondary care facilities. The majority (>=75%) of the tertiary and secondary care hospitals in the survey provided medicines information, patient education and counselling, alongside in- and outpatient dispensing services. However, fewer than 30% reported routine pharmacist involvement in multidisciplinary ward rounds, medication chart review, therapeutic guidelines development, antibiotic stewardship programmes, and drug therapy monitoring. Pharmacists routinely provided medication error reporting services in only about half of the hospitals in the sample, and this was not associated with the level of care (p>0.05). Conclusions: The findings of this study demonstrate disparity in clinical pharmacy service availability across the various levels of care in Nigeria. It also highlights the need to scale up and prioritize their integration within the primary care sector.

Drug-related problems and its determinant among hospitalized neonates with sepsis at Jimma University Medical Center, Ethiopia: a prospective observational study

Background Neonatal populations are quite susceptible to drug-related problems (DRPs) because of clinical heterogeneity and clinical practice trends. However, studies reporting DRPs in the neonatal population are quite limited. Objective This study aimed to assess the magnitude and types of DRPs and determinant factors among neonates admitted with neonatal sepsis at the Neonatal Intensive Care Unit (NICU) of the Jimma University Medical Center (JUMC), Ethiopia. Methods A hospital-based prospective observational study was conducted involving 201 neonates with sepsis admitted to the NICU from May to August 30, 2018. DRPs were classified using Cipolle’s classification method. Statistical Package for Social Science Version 22 was employed for data analysis. Logistical regression was carried out to determine the determinants of DRPs. A p-value < 0.05 was considered to be statistically significant. Results Of 201 neonates with sepsis included in this study, 125 (62.2%) were males and the median age of the neonate was 5 days. The mean (±standard deviation) number of medications taking during their hospital stay was 2.6 ± 0.7. DRPs were identified in 98 neonates, at a rate of 48.8% (95% CI, 41.7–55.9). Dose too high (42, 35.8%) and need additional drug therapy (40, 34.1%) were the commonly identified DRPs. Taking antibiotics plus other medications (Adjusted Odds Ratio (AOR) =5.2, 95%CI [1.2–22.0], p = 0.02) was a determinant factor for the occurrence of DRPs. Conclusion The burdens of DRPs occurrence were high in hospitalized neonates with sepsis. The most common DRPs identified were dose too high and need additional drug therapy. Combined use of other medicines with antibiotics was a predictor of DRP occurrence. The innovative way to tackle the occurrence of DRPs, such as the incorporation of clinical pharmacy service provider into the neonatal care team, which will prevent, detect and/or minimize the occurrence of DRPs, is highly recommended.