No abstract

A. Čufar et al.: Attitudes of physicians, nurses and pharmacists concerning the development of clinical pharmacy activities in a university hospital, Acta Pharm. 64 (2014) 447-461.

Background The increase in biological medicines prescribed for use in a Department of Rheumatology out-patient setting resulted in a need for the work of hospital pharmacists to be reorganised. In 2011, reconstitution and preparation were transferred from nursing to pharmacy staff. Purpose To evaluate the cost savings of pharmacy staff-based preparation of monoclonal antibody drug infusions. Materials and methods Records of the medicines prepared, including the prescribed dose and the amount of the drug actually used were analysed. Tocilizumab was chosen as the reference drug, since its dosing is based on the patient’s weight. The periods from May to September 2011 for nurse-based preparation and from May to September 2013 for pharmacy staff-based preparation were observed, the average dose per patient being 540 ± 133 mg (N = 274) and 537 ± 125 mg (N = 517), respectively. The location of preparation remained on the ward within already existing facilities with no additional equipment costs required. The associated materials reaching <0.5% of total preparation costs and pharmacy compounding time were excluded from the calculation as staff availability was achieved through internal reorganisation of work. Results Using the volumetric method of preparation and the ability to use the whole volume of the vial, including overfill provided by the manufacturer, pharmacy staff-based preparation produced no discarded drug leftovers compared to nurse-based preparation using the manufacturer’s graphic instructions. These factors contributed to savings estimated at €95 per 1000 mg tocilizumab prescribed, or €51 per application. Conclusions The implementation of pharmacy staff-based preparation lowered the drug costs significantly and ensured final product quality while increasing patients’ safety by including the pharmacists’overview and final check of the product solution. Factors contributing to the cost reduction were complete use of the entire filling volume of drug solution from each vial, use of all remnants, and use of large volume vials, which also simplified stock management. The estimated annual savings were up to 46,000 €. No conflict of interest.

Background Certain clinical pharmacy services had already been introduced at the University Medical Centre, Ljubljana (UMCL) in 2010. However, roles and responsibilities of clinical pharmacists had been unclear and not used to their full potential. Therefore, reorganisation of the clinical pharmacy work was needed, and the implementation process has started. Purpose To make a realistic financial and feasibility assessment of establishing a Clinical Pharmacy department (CPD) and to implement possible changes. Materials and methods Based on a proposed model that included structure/organisation, finance, marketing and quality assurance plan and assessment, a CPD was created. Results In a theoretical CPD model, yearly direct cost savings from additional services were estimated to be initially 300,000 € (achieved by optimising drug treatments) and start-up costs were assessed to be repaid in 23 months. A CPD, based at the UMCL Pharmacy, was formally established, with an expansion of pharmacy staff (increase from 29 pharmacists in January 2010 to 46 pharmacists in September 2013), provision of additional training and education (3 pharmacists newly specialised, 10 undergoing specialisation programme), stronger information technology support (additional equipment; new computer program for clinical pharmacy work currently under development) and higher level of organisation (regular weekly meetings; individual clinical pharmacy work and prioritisation of tasks currently under assessment). Overall number of tasks and/or information successfully provided by clinical pharmacists on the wards, increased from 3856 to 9059 for the same period (January–September, 2011 vs. 2013, respectively). Conclusions The establishment of a CPD has been demonstrated to be a feasible and financially justified project. No conflict of interest.:

In general, pharmacy services include: 1. Dispensing drugs and medical devices 2. Advice on selection and use of drugs and other products 3. Preparing "ex tempore" prescriptions for individual patients 4. Obtaining the assortment and quantity of drugs and medical devices relative to current needs 5. Storing drugs, medical devices, and other products in appropriate conditions 6. Replenishing stocks of drugs in accordance with dates of expiration, permission of approval, etc. 7. Professional eradication of expired drugs, pharmaceuticals, or other substances. The general population, health centers, and other facilities are supplied by community pharmacies. Supplying drugs, medical devices, and other nursing care products to hospitalized patients is performed by hospital pharmacies. Pharmacists also are trained to prepare demineralized water and other nursing care products. Some pharmacies have galenical and analytical laboratories. The galenical labs produce medicines and other products according to the appropriate regulations. Their main advantage is that they can tailor their production to the day's needs, and are capable of producing the majority of dosage forms. The production processes and drug testing are controlled by qualified specialists. Personnel in analytical laboratories are also trained in the qualitative and quantitative determination of substances not used in drugs. When planning a reasonably cost-effective program for a catastrophic or military situation, the current healthcare system should be taken into account, as well as the practical experiences of pharmacists with special governmental stocks (SLO) in case of dire need.