RESUMEN

OBJECTIVES: To establish a consensual and coherent ranking of healthcare programmes that involve the presence of ward-based and clinic-based clinical pharmacists, based on health outcome, health costs and safe delivery of care. METHODS: This descriptive study was derived from a structured dialogue (Delphi technique) among directors of pharmacy department. We established a quantitative profile of healthcare programmes at five sites that involved the provision of ward-based and clinic-based pharmaceutical care. A summary table of evidence established a unique quality rating per inpatient (clinic-based) or outpatient (ward-based) healthcare programme. Each director rated the perceived impact of pharmaceutical care per inpatient or outpatient healthcare programme on three fields: health outcome, health costs and safe delivery of care. They agreed by consensus on the final ranking of healthcare programmes. KEY FINDINGS: A ranking was assigned for each of the 18 healthcare programmes for outpatient care and the 17 healthcare programmes for inpatient care involving the presence of pharmacists, based on health outcome, health costs and safe delivery of care. There was a good correlation between ranking based on data from a 2007-2008 Canadian report on hospital pharmacy practice and the ranking proposed by directors of pharmacy department. CONCLUSIONS: Given the often limited human and financial resources, managers should consider the best evidence available on a profession's impact to plan healthcare services within an organization. Data are few on ranking healthcare programmes in order to prioritize which healthcare programme would mostly benefit from the delivery of pharmaceutical care by ward-based and clinic-based pharmacists.

Asunto(s)

Costos de la Atención en Salud/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud/economía , Seguridad del Paciente/estadística & datos numéricos , Servicio de Farmacia en Hospital/estadística & datos numéricos , Canadá , Técnica Delphi , Humanos , Pacientes Internos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Pacientes Ambulatorios

RESUMEN

CONTEXT: Few data are available on the use and consequences of decentralized automated dispensing cabinets (ADCs) in institutional settings. METHOD: This descriptive study examined compliance with published guidelines on the implementation of decentralized ADCs. The primary objective was to evaluate overall compliance, as well as compliance with specific steps in the medication cycle. The study was carried out at the Centre hospitalier universitaire (CHU) Sainte-Justine, a 500-bed mother-and-child hospital. The 2008 guidelines of the Institute for Safe Medication Practices (US) concerning the safe use of decentralized ADCs and the associated self-assessment tool (2009) were used to evaluate compliance at 30 days and at 120 days after implementation. RESULTS: From November 2009 to April 2010, 7 decentralized ADCs were brought into service at the CHU Sainte-Justine. Overall compliance with published guidelines increased from 66% to 74% between January and April 2010. For each process related to the safe use of the ADCs, the criteria were briefly described, along with the non-compliance components related to technological or organizational aspects of implementation. For each component for which practice was noncompliant with guidelines, the actions required to modify the equipment (i.e., technological aspects) were determined and conveyed to the manufacturer; similarly, modes of use requiring modification (i.e., organizational aspects) were determined and conveyed to the institution. CONCLUSION: This study has described the compliance of practices at the CHU Sainte-Justine with published guidelines of the Institute for Safe Medication Practices. The use of published guidelines can help to guide both the technological and organizational aspects of implementing decentralized ADCs. [Publisher's translation].

RESUMEN

BACKGROUND: There are few data comparing the drug management standards of the US and Canadian agencies that accredit health care institutions. OBJECTIVE: To evaluate the clarity and assessability of criteria in the drug management standards adopted by Accreditation Canada and the Joint Commission (United States). METHODS: A pilot study was conducted to compare the clarity and assessability of the criteria listed in the 2 standards. Criteria that were common to the 2008 versions of the Canadian and US drug management standards were identified. A panel of 12 health care professionals was assembled to independently rate the clarity (i.e., clear or unclear) and the assessability (i.e., assessable or not assessable) of each statement, using a validated comparative grid. RESULTS: In total, there were 143 Canadian standards and 103 US standards. Sixty-two (43%) of the 143 Canadian criteria could be directly paired with a US criterion, whereas 70 (68%) of the 103 US criteria could be paired with one or more Canadian criteria. Six of the US criteria were paired with more than one Canadian criterion, and 12 of the Canadian criteria could be paired with more than one US criterion. Four of the 22 themes in the Canadian standards had no equivalent criteria in the US standards. Panel members from the pharmaceutical practice group evaluated the clarity and assessability of the Canadian criteria more severely than panel members from the nursing practice group: 86% versus 95% of individual ratings were deemed "clear" by these two groups, respectively (p < 0.001) and 64% versus 88% of individual ratings were deemed "assessable" (p < 0.001). There were no criteria that were considered unclear or unassessable by all of the panel members. CONCLUSIONS: Few data are available on drug management standards and their impact on health care. A better understanding of these standards, as well as comparisons of Canadian standards with those of other countries, might help in determining their clarity and assessability. A larger-scale study is required to validate the observations reported here.

RESUMEN

BACKGROUND: In 2004, the US Food and Drug Administration issued a new rule requiring most prescription and some over-the-counter pharmaceutical products to carry bar codes down to the level of individual doses, with the intent of reducing the number of medication errors. Despite these regulatory changes in the United States, Health Canada has not yet adopted any mandatory bar-coding of drugs. OBJECTIVE: To evaluate the feasibility of using commercial bar codes for receipt and preparation of drug products and to evaluate the readability of the bar codes printed on various levels of drug packaging. METHODS: This cross-sectional observational pilot study was conducted in the Pharmacy Department of a Canadian mother-child university hospital centre in July 2010. For the purposes of the study, research drugs and cytotoxic drugs in various storage areas, as well as locally compounded medications with bar codes generated in house, were excluded. For all other drug products, the presence or absence of bar codes was documented for each level of packaging, along with the trade and generic names, content (i.e., drug product), quantity of doses or level of packaging, therapeutic class (if applicable), type of bar code (1- or 2-dimensional symbology), alphanumeric value contained in the bar code, standard of reference used to generate the alphanumeric value (Universal Product Code [UPC], Global Trade Item Number [GTIN], or unknown), and readability of the bar codes by 2 scanners. RESULTS: Only 33 (1.9%) of the 1734 products evaluated had no bar codes on any level of packaging. Of the 2875 levels of packaging evaluated, 2021 (70.3%) had at least one bar code. Of the 2384 bar codes evaluated, 2353 (98.7%) were linear (1-dimensional) and 31 (1.3%) were 2-dimensional. Well over three-quarters (2112 or 88.6%) of the evaluated bar codes were readable by at least 1 of the 2 scanners used in the study. CONCLUSIONS: On the basis of these results, bar-coding could be used for receipt of 80.9% of the drug products at this Canadian hospital and for the preparation and dispensing of 70.1% of the products.