pediatric satellite pharmacy in princess margaret hospitalmedication incidents collected from airs...
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PEDIATRIC SATELLITE
PHARMACY IN PRINCESS
MARGARET HOSPITAL
CANDY LAU
PHARMACIST
PRINCESS MARGARET HOSPITAL
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SERVICE
INTRODUCTION
Medication error is a common cause of morbidity and
mortality in NICU
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SERVICE
INTRODUCTION
Pediatric Satellite Pharmacy with success
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PEDIATRIC SATELLITE
PHARMACY
Set up in Princess Margaret Hospital in June, 2011
Located in NICU
Targets: NICU and SCBU patients
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SERVICES
Clinical Pharmacy Service
(Monday to Sunday)
• Ward-round with doctors
• Clinical screening of medication orders
• Drug information service
• TPN consult and review
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SERVICES
Clinical Pharmacy Service
• Drug reference charts compilation
• Pharmacokinetics consult and therapeutic drug monitoring
• Protocols and guidelines development
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SERVICES
Medication Management Service
• Individual patient dispensing
• Pharmacy Intravenous Admixture Service (PIVAS)
• Drug cart management
• Ward stock management
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SERVICE EVALUATION
July, 2011 to December, 2012 (18months)
Database for documentation of workload, interventions, drug
information
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SERVICE EVALUATION
Medication incidents collected from AIRS (Advance Incident
Report System)
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SERVICE EVALUATION
Satisfaction Survey in September, 2012
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WORKLOAD
STATISTICS
Medications reviewed
• 18,305 patient days
Medication orders screened
• 22,008
TPN orders reviewed
• 4394
Drug information provided
• 166
Unit dose injections prepared by PIVAS
• 102,816
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MEDICATION INCIDENT
PREVENTION
Before Satellite
Pharmacy
After Satellite
Pharmacy
“near miss” per 1000-
neonatal-activity-days
prevented
7 28
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INTERVENTIONS
352 interventions documented
28%
27% 16%
3%
17%
3% 6%
Interventions
TPN
Regimen(Dose, Freq, Route)
Drugs to be added/discontinued
Monitoring
Vaccination
Dilution and Administration
Others
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EXAMPLE OF
INTERVENTIONS
Patient on Fluconazole for systemic fungal
infection
Erythromycin added for feeding
intolerance
Potential drug-drug interaction
• Fluconazole: CYP 3A4 inhibitor
increase level of erythromycin
QTc prolongation
• This drug-drug interaction was not prompted by computer-
checked function
If not prevented, medication incident with severity index ≥ 3
Severity Index
0: Incident occurred but stopped before reaching patient. No consequence.
1: Incident occurred (reached patient) but no injury sustained.
2: Minor injury
3: Temporary morbidity 5: Major permanent loss of function/disability
4: Significant morbidity 6: Death
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EXAMPLE OF
INTERVENTIONS
Patient was on Hydrochlorothiazide for Bronchopulmonary
dysplasia
Hydrocortisone was written when
transcribing medication orders
Discovered by pharmacist
during medication
order screening
• Dosage of both drugs are similar
• Both are common medications used in NICU
Error may be missed out
If not prevented, medication incident with severity index ≥ 3
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EXAMPLE OF
INTERVENTIONS
Morphine infusion of initial dose 10mcg/kg/hr was intended to be ordered by doctor
Dilution calculation problem occurred, 20mcg/kg/hr was prescribed
On dosage checking, discrepancy found before drug was administered
Dose doubled
Increased risk of respiratory depression, hypotension
If not prevented, medication incident with severity index ≥ 3
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EXAMPLE OF
INTERVENTIONS
NICU Infusion calculator
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EXAMPLE OF
INTERVENTIONS
NICU Infusion calculator
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EXAMPLE OF
INTERVENTIONS
NICU Infusion calculator
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SHORTEN
DISPENSING TIME
Before Satellite
Pharmacy
After Satellite
Pharmacy
Turn around time for
routine orders 3 hr 20 min
Turn around time for
urgent orders 30 min 8 min
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MEDICATION
INCIDENTS
Medication Incidents
During operation hours During non-operation hours
None 11
• 9 discovered by clinical
pharmacist during
medication order
screening
• 7 dose omissions
• 1 transcription error
• 1 wrong dose
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SATISFACTION
SURVEY
Overall Satisfaction
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Clinical Pharmacy Service
Drug Information Service
Drug Dispensing Service
Pharmacy Intravenous
Admixture Service
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CONCLUSION
Reduce medication errors
Reduce time for drug dispensing
Save nursing time for drug preparation
Well-accepted by most doctors and nurses
Improve overall patient quality and safety
Pediatric Satellite Pharmacy
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THANK YOU!!