The Impact of the Clinical Pharmacy in the Belgian Hospitals First conclusions of the national Pilot Project and prospectives

Transcription

1 The Impact of the Clinical Pharmacy in the Belgian Hospitals First conclusions of the national Pilot Project and prospectives Hugo Robays Network Medical Pharmaceutical Committees FPS Health, Food Chain Safety and Environment Eurostation II -1D234 Place Victor Horta 40 box 10 B-1060 Brussels

2 Summary Introduction Evolution Objective of the project Definition Pilot project Method Fields Discussion Participant s task 1. Periodical Reporting 2. Activities and Interventions 3. Case reports Further developments Conclusion 2

3 The Clinical pharmacist in a multidisciplinary team october 2010 UZ Gent H.Robays - M.Dhoore

4 Evolution of the hospital pharmacy in Belgium Traditional hospital pharmacy The hospital pharmacist provides services to patients and healthcare professionals in hospitals. Centralized Clinical Pharmacy MFC Drug information Farmacovigilance Decentralized Clinical Pharmacy Analysis of medicine profile Anamnesis Drug effects on the patient Dose adjustment, interaction, ways of administration Medicine information to the patient Seamless-care 4

5 The focus moves from the drug to the single patient or population receiving drugs. 5

6 Objective of the Project Development of Clinical Pharmacy in Belgian hospitals fund by the Belgian government Demonstrate the importance of the hospital pharmacist for the direct care of the patient Set up the knowledge and experience of the hospital pharmacists In the pharmacotherapy area With individual patients In close cooperation with doctors and nurses 6

7 Definitions Clinical Pharmacy is a pharmaceutical activity centered on the patient. Its primary goal is to ensure the most appropriate and safe use of medicines. In this activity, the pharmacist uses his/her knowledge and skills relative to pharmacology, pharmacotherapy and communication with other health care professionals and patients in order to promote the effective use of medicines in hospitals and in primary care. The pilot project has to evaluate the added value of the Clinical Pharmacy services in a group of selected hospitals. 7

8 Pilot Projects Budget Period 07/ / /year Since 07/ /year selection criterion Patient orientated and contact with the patient Documentation of the activities Clinical pharmacist = member of a multidisciplinary team of healthsuppliers Consent by the MFC, medical council hospitalboard 8

9 Method Working Group Clinical Pharmacy : R. Degives, M. Dhoore, A. Dupont, F. Fivez, J.D. Hecq, F. Heller, H. Robays, P. Tulkens, I. Vanden Bremt, L. Willems, L. Wilmotte Financing of the activities of the clinical pharmacist(s) in 54 Belgian hospitals by the Federal Public Service Support and follow-up of the activities by the Network MPC Evaluationusing activity and intervention reports by the Network MPC 9

10 Fields Anamnesis(ask for information about homemedication) General follow up during hospital stay Follow up of the specific indicators (ex. INR, antibiotics) Discharge support 10

11 Discussion The evaluation of the activities of the Clinical Pharmacy in the pilot hospitals shows : the commitment and purpose the multidisciplinary character the motivation to structure the Clinical Pharmacy Efficient Clinical Pharmacy services need : continued training in Clinical Pharmacy more financial resources better registration of and more communication on the activities 11

12 Participant s tasks 1. Periodical Reporting Project in accordance with the application document Evolution of the project 2. Activities and interventions Documentation of the daily activity of the clinical pharmacist 4 x /year a structured report of 1 week activity 3. Case reports Reflection of the intrinsic additional value of the clinical pharmacist to the therapeutical process 12

13 1. Periodical Reporting 1/year activity report State of the Pilot Project in the hospital 13

14 General goal in the projects Maximizingthe clinical effect of medicines Minimizing the risk of treatment-inducedadverse events Minimizingthe expenditures for pharmacological treatments Tryingto provide the best treatment for the greatest number of patients. 14

15 To ensure the 7 Rights are respected Right patient Right dose Right route Right time Right drug Right information Right documentation We need to work within a therapeutical multidisciplinary team 15

16 Specific goal of the projects 1. Optimizing the medication plan during admission and discharge. 2. Adjustment of medication dosage based on disease, response or pharmacokinetic monitoring. 3. Review of medication orders before the first dose is administrated. 16

17 4. Monitoring of response to therapy through laboratory test values progress notes and observation. 5. Follow up of high risk patients/medications 6. Pursuit an continuous medication care for the patient in a transmural way. Medication errors happens most frequently during transfer. 17

18 Example of an enquiry document Implementation of the experiences of the clinical pharmacist in the hospital organisation october 2010 UZ Gent H.Robays - M.Dhoore 18

19 Overview projects

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23 Conclusion periodical reporting The activity reports help us to define the areas of competence of the clinical pharmacist Confirmation of the added value of the clinical pharmacy discipline in intra- and transmurales health care Clinical and economical relevance become apparent 23

24 2. Activities and Interventions Contribution of the Clinical Pharmacist to the therapeutical proces Qualitative and Quantitative reporting 24

25 Activities Activities are clinical pharmaceutical acts and observations that have been agreed beforehand within the project. Deviations give cause for... 25

26 Interventions An intervention is a proposal or advice to modify or adapt a therapy or a therapeutical scheme and its monitoring and follow-up. 26

27 Examples of activities acquiring medication history information to physicians, nurses and patients follow-up of health indicators like INR and antibiotics detection of drug-related problems (DRP) supporting care at discharge 27

28 Reporting about Activities with regard to patients Activities with regard to the nursery-unit Activities with regard to the hospital Activities with regard to students Activities with regard to codification/data input 28

29 Procentual division lenght of time/group of activity Procentuele verdeling Gemiddelde van het totaal van de aantal twee minuten weken : per activiteitengroep Procentuele verdeling van het totaal aantal minuten per activiteitengroep Activiteiten patiënt Activiteiten verpleegeenheid Activiteiten ziekenhuis Activiteiten studenten Activiteiten encodage Activiteiten patiënt Activiteiten verpleegeenheid Activiteiten ziekenhuis Activiteiten studenten Activiteiten encodage 100% 100% 90% 90% 80% 80% 70% 70% 60% 50% 60% 40% 50% 30% 40% 20% 10% 0% 30% 20% 10% 29 AZ Monica St Nikolaas St Blasius Groeninge UZ Brussel UZ Leuven Damiaan Virga Jesse GZA OLV ZH AALST St Lucas Imelda UZ Gent ZOL CHP Liège CHU Tivoli Cl. Uni St Luc CHBAH Cl Uni Godinne Peltzer Tourelle Erasme Vésale CHU Charleroi Ambr Paré CHU Liège Tubize - Nivelles 0%

30 Examples of interventions giving advice on medication in the medication history proposal for modification of a prescription monitoring the medication : correct use, correct administration,... information on administration of drugs, indicators like INR and antibiotics, drug interactions proposals on discharge procedure and letter of discharge 30

31 3. Case Reports october 2010 UZ Gent H.Robays - M.Dhoore 31

32 Results Soorten interventies % Medicatie stoppen 19 Aanpassing dosis 15 Monitoring 13 Medicatie starten 10 Informatie verstrekken 10 Aanpassing geneesmiddel 10 Aanpassing toedieningswijze 7 Switch: andere therapie 5 Medicatie hervatten 3 Aanpassing toedieningstijdstip 2 Aanpassing frequentie 2 Medicatie afbouwen 2 IV-PO switch 1 Andere 2 october 2010 UZ Gent H.Robays - M.Dhoore In 260 case reports: 378 interventions Meer klinische info nodig voor correcte beoordeling casus Aanpassing formulier nodig Toekomst: per project 4 maal per jaar 1 case report 32

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39 Conclusion Clinical Pharmacy interventions are a multidisciplinary working tool that... makes the patient s pathway of care more efficient, safer and more comfortable streamlines the activities of the medical team 39

40 The added value of the intervention of the clinical pharmacist and the legitimacy of his cost in the healthcare fully depend of the previous analysis of the prescription and the collected patient-information. The fundamental aim that is expected from the clinical pharmacist is the professional practice which put the patient central is result-oriented is organized in consultation with the other healthcare professionals 40

41 Further developments Further evaluation and coaching of the 54 pilot projects Follow-up meeting April 7, 2011 with active participation of the 54 pilot projects. Evolution to an independent clinical pharmacy in each Belgian hospital. Sept 2010: Start 3 additional years of specialisation in hospital pharmacy Year 1 and 2: all aspects of hospital pharmacy Year 3: specialisation october 2010 UZ Gent H.Robays - M.Dhoore 41

42 Conclusion The financial support by the Belgian authorities of clinical pharmacy and the results of the projects could trigger a further integration of the hospital pharmacist into a patient care team. Many hospital administrators take the opportunity to enhance more economical and rational use of drugs. october 2010 UZ Gent H.Robays - M.Dhoore 42

43 Thank you for your attention. 43