Golniški simpozij 2011 Zbornik povzetkov

Improving medication management
on a hospital level - our experience
Maja Joøt, Tina Morgan
University Clinic of Respiratory and Allergic Diseases Golnik
The rough beginnings
The story of a comprehensive medicine management on a hospital level began with the decision of
top hospital management to implement clinical pharmacy. Before that the major task of hospital pharmacists
was to provide wards with medicines, at a reasonable time and price. The first step towards
better medicine management was made by the identification of drawbacks in the existing process.
Present state
Quality, effective and safe medicines are the base for successful treatment. Therefore it was essential
to assure proper storage conditions and to establish suitable transport within our hospital (e.g.
cold chain). Stability of diluted solutions and compatibility of admixtures was revised according to the
literature. Special focus was put on safe, centralized preparation of high risk medications (e.g. cytostatics).
A progress was made in the perspective of medicines reaching the patient. Accessibility was upgraded
by ensuring a continuous and controlled access to medicine stocks in the hospital pharmacy.
Rare and expensive medicines are now dispensed per patient for pre-defined medical
indications. Drug administration was unified among wards.
Further on, recommendations and protocols for the treatment of certain diseases or with certain drugs
(e.g. LMWH, chemotherapy) were prepared and implemented in routine clinical practice. This was
upgraded with new pharmacy services: chemotherapy prescription screening and provision of a
medication history for each patient, starting cancer drug therapy.
Substantial improvements in the continuity of care of patients with certain diseases (e.g. TB) was
made: pharmacists perform medication reconciliation at admission, medication review during hospitalization,
patient counselling before discharge and provide patients with medicines for home treatment.
For all other patients, these services are offered to a various extent on some of the wards or
for selected patients.
The definition, identification and monitoring of high risk medications and patients at a high risk for adverse
drug events are objectives of a high priority, on-going process, led by a pharmacist.
Where to?
Medicine management is now being improved in a systematic way to ensure continuity of care for
all patients. The emphasis should be given on the safety, efficacy and quality of drug treatment. A
logistic reorganization of drug dispensing, guaranteeing efficient, safe and recordable unit dose dis-
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