CIVAS IN SWITZERLAND 2002

Transcription

1 CIVAS IN SWITZERLAND 2002 William Griffiths Pharmacy September 13th, 2002 Lugano, Switzerland. William Griffiths, Pharmacie des HUG, Lugano sept

2 INTRODUCTION HOSPITAL PHARMACY General orientation towards quality assurance of drug processes. Pharmaceutical Services and Clinical Pharmacy. Ready to use injectable drugs: Parenteral Nutrition Cytotoxics CIVAS (Centralized IntraVenous Additive Services) William Griffiths, Pharmacie des HUG, Lugano sept

3 INTRODUCTION CIVAS ARE A REPLY TO PROBLEMS OF: SECURITY for the patient: - Errors: wrong drug, wrong dose, wrong time - Risk of infection:multiple adjunctions:long administration - High risk administration route i.e. Intrathecal for the health care worker (HCW) : - Acute or chronic toxicity due to drugs! COST HCW S MISSION : TAKE CARE OF THE PATIENT William Griffiths, Pharmacie des HUG, Lugano sept

4 William Griffiths, Pharmacie des HUG, Lugano sept CIVAS IN SWITZERLAND 2002 CIVAS began in the UK in In Belgium in Switzerland in 2001 (first steps)

5 CIVAS IN SWITZERLAND 2002 THE GENEVA APPROACH Determine the needs. Determine the priorities (risk levels). Determine the feasibility (stability). Develop industrial partnerships whenever possible. Begin manufacture according to a staff capacity plan. Contact other Swiss hospitals William Griffiths, Pharmacie des HUG, Lugano sept

6 CIVAS IN SWITZERLAND 2002 THE GENEVA APPROACH Determine the needs. Determine the priorities (risk levels). Determine the feasibility (stability). Develop industrial partnerships whenever possible. Begin manufacture according to a staff capacity plan. Contact other Swiss hospitals William Griffiths, Pharmacie des HUG, Lugano sept

7 William Griffiths, Pharmacie des HUG, Lugano sept DETERMINING THE NEEDS A questionnaire was sent out to the senior nursing and medical staff.

8 William Griffiths, Pharmacie des HUG, Lugano sept DETERMINING THE NEEDS Would you be interested in a service of «ready to use»iv preparations supplied by the pharmacy? Yes: for what reasons? No: for what reasons? Would you like more information before deciding?

9 DETERMINING THE NEEDS 60% 50% REPLY LEVEL yes 40% 30% 20% 10% 0% no Info Yes/No No/info SENT OUT:190 RETURNED : 81 PERCENT: 43 William Griffiths, Pharmacie des HUG, Lugano sept

10 DETERMINING THE NEEDS TENDENCIES FOR THE ANSWER : NO ( 136 remarks taken from 47 replies) Competence and Responsibilities 48% Logistic 30% Manpower 7% Miscellaneous remarks 15% 100% William Griffiths, Pharmacie des HUG, Lugano sept

11 DETERMINING THE NEEDS TENDANCIES FOR THE ANSWER : NO Competence and Responsibilities 48% Responsibilities (who controls who?) 19% Nurses competence 14% Loss of skills 13% Particularisation 2% William Griffiths, Pharmacie des HUG, Lugano sept

12 DETERMINING THE NEEDS TENDANCIES FOR THE ANSWER : NO Logistic 30% Emergency supplies 24h/24h 19% Last minute prescription changes 7% Distance from the pharmacy 3% Time lag between order/delivery 2% Stability: Expiry date 2% Stock control (space) 2% William Griffiths, Pharmacie des HUG, Lugano sept

13 William Griffiths, Pharmacie des HUG, Lugano sept DETERMINING THE NEEDS TENDANCIES FOR THE ANSWER : NO Manpower 7% Loss of nursing staff 4% Cost 3%

14 DETERMINING THE NEEDS TENDANCIES FOR THE ANSWER : NO Miscellaneous 15% See no reason for this service 5% Not adapted to a particular ward 3% Ask the pharmaceutical industry 3% Only for very difficult preparations 1% Great variety of paediatric dosages 1% What is the added value for the patient? 1% Quality of the pharmacy service? (mistakes) 1% William Griffiths, Pharmacie des HUG, Lugano sept

15 DETERMINING THE NEEDS TENDANCIES FOR THE ANSWER : YES (10%) More reliable Less risk Reduction of preparation time Better hygiene More practical Reduces errors of dosage and calculation Aseptic ( less manipulation and stock on the wards) Security Products not available on the market William Griffiths, Pharmacie des HUG, Lugano sept

16 William Griffiths, Pharmacie des HUG, Lugano sept DETERMINING THE NEEDS A meeting was arranged with the senior nursing staff to allow the pharmacy to reply to the doubts raised by the negative results obtained from the questionnaire

17 DETERMINING THE NEEDS (REPLY) Competences and responsibilities Only high risk drugs and expensive products will be taken into account Protection of the healthcare workers Patient security (bacteriology and errors) Cost William Griffiths, Pharmacie des HUG, Lugano sept

18 DETERMINING THE NEEDS (REPLY) Competence and responsibility Content= label: Responsibility of the Pharmacy No difference from the pharmaceutical industry (in house manufacturing) Some legal questions to be resolved William Griffiths, Pharmacie des HUG, Lugano sept

19 DETERMINING THE NEEDS (REPLY) RESPONSIBILITY/PHARMACY Licensed clean rooms Trained staff Validated working methods Documentation (SOP s) Trace - back Quality control William Griffiths, Pharmacie des HUG, Lugano sept

20 DETERMINING THE NEEDS (REPLY) Logistic Choice of products sufficiently stable Place in the refrigerator? William Griffiths, Pharmacie des HUG, Lugano sept

21 DETERMINING THE NEEDS (REPLY) Logistic Individualised dosages. Whenever its necessary to adapt the dosage: eg cytotoxics, antivirals, paediatric dosages etc.. Will be avoided if possible William Griffiths, Pharmacie des HUG, Lugano sept

22 DETERMINING THE NEEDS (REPLY) Logistic Batch production. Manufacture and stocking of small batches Stability from one to several months Exactly like other drugs (orders and supply) William Griffiths, Pharmacie des HUG, Lugano sept

23 William Griffiths, Pharmacie des HUG, Lugano sept DETERMINING THE NEEDS Outcome The OK has been given to collect hospital needs

24 CIVAS IN SWITZERLAND 2002 THE GENEVA APPROACH Determine the needs. Determine the priorities (risk levels). Determine the feasibility (stability). Develop industrial partnerships whenever possible. Begin manufacture according to a staff capacity plan. Contact other Swiss hospitals William Griffiths, Pharmacie des HUG, Lugano sept

25 William Griffiths, Pharmacie des HUG, Lugano sept CIVAS IN SWITZERLAND 2002 THE GENEVA APPROACH Determine the priorities (risk levels).

26 DETERMINE THE PRIORITIES Work has begun in the following high risk services: Anaesthesiology Paediatrics Intensive care units Emergency room Transplant unit William Griffiths, Pharmacie des HUG, Lugano sept

27 DETERMINE THE PRIORITIES Examples of products already made: Isoprenalin 0.1mg/ml syringes 50ml Midazolam bags and syringes Apomorphine cassettes Gancylovir syringes from 6,5-400mg William Griffiths, Pharmacie des HUG, Lugano sept

28 CIVAS IN SWITZERLAND 2002 THE GENEVA APPROACH Determine the needs. Determine the priorities (risk levels). Determine the feasibility (stability). Develop industrial partnerships whenever possible. Begin manufacture according to a staff capacity plan. Contact other Swiss hospitals William Griffiths, Pharmacie des HUG, Lugano sept

29 William Griffiths, Pharmacie des HUG, Lugano sept CIVAS IN SWITZERLAND 2002 THE GENEVA APPROACH Determine the feasibility (stability).

30 William Griffiths, Pharmacie des HUG, Lugano sept DETERMINE THE FEASABILITY Several products on test: Vancomycine for neonatal use: syringes 50mg/10ml Midazolam syringes for ICU s

31 CIVAS IN SWITZERLAND 2002 THE GENEVA APPROACH Determine the needs. Determine the priorities (risk levels). Determine the feasibility (stability). Develop industrial partnerships whenever possible. Begin manufacture according to a staff capacity plan. Contact other Swiss hospitals William Griffiths, Pharmacie des HUG, Lugano sept

32 William Griffiths, Pharmacie des HUG, Lugano sept CIVAS IN SWITZERLAND 2002 THE GENEVA APPROACH Develop industrial partnerships whenever possible.

33 INDUSTRIAL PARTNERSHIP Products already available : Bupivacain bags Bupivacain/Fentanyl bags Morphine 100mg bags In preparation: Heparin bags William Griffiths, Pharmacie des HUG, Lugano sept

34 CIVAS IN SWITZERLAND 2002 THE GENEVA APPROACH Determine the needs. Determine the priorities (risk levels). Determine the feasibility (stability). Develop industrial partnerships whenever possible. Begin manufacture according to a staff capacity plan. Contact other Swiss hospitals William Griffiths, Pharmacie des HUG, Lugano sept

35 William Griffiths, Pharmacie des HUG, Lugano sept CIVAS IN SWITZERLAND 2002 THE GENEVA APPROACH Begin manufacture according to a staff capacity plan.

36 BEGIN CIVAS MANUFACTURE A capacity plan* is being developed in order to begin high risk projects. Actual CIVAS production: Individualised 1500/year Batch 2800/year Total 4300/year *Determine volume and type of workload/ /ressources necessary/strategy when inadequate William Griffiths, Pharmacie des HUG, Lugano sept

37 CIVAS IN SWITZERLAND 2002 THE GENEVA APPROACH Determine the needs. Determine the priorities (risk levels). Determine the feasibility (stability). Develop industrial partnerships whenever possible. Begin manufacture according to a staff capacity plan. Contact other Swiss hospitals William Griffiths, Pharmacie des HUG, Lugano sept

38 William Griffiths, Pharmacie des HUG, Lugano sept CIVAS IN SWITZERLAND 2002 THE GENEVA APPROACH Contact other Swiss hospitals

39 OTHER SWISS HOSPITALS Questionnaire sent to 50 Chief Pharmacists (30 replies = 60%) Are you considering going over to CIVA services? YES : 21 70% NO : 9 30% In the near future % Middle term < 4 years % Long term > 4 years % William Griffiths, Pharmacie des HUG, Lugano sept

40 OTHER SWISS HOSPITALS Questionnaire sent to 50 Chief Pharmacists (30 replies = 60%) Do you actually prepare some aseptic preparations? YES : 21 70% NO : 9 30% William Griffiths, Pharmacie des HUG, Lugano sept

41 OTHER SWISS HOSPITALS Questionnaire sent to 50 Chief Pharmacists(30 replies = 60%) Have you recieved requests for preparations from the nursing and medical staff? YES : 18 60% NO : 12 40% William Griffiths, Pharmacie des HUG, Lugano sept

42 OTHER SWISS HOSPITALS Questionnaire sent to 50 Chief Pharmacists (30 replies = 60%) DO YOU ALSO PREPARE CYTOXICS and/or EPIDURALS? CYTOS EPIDURAL YES: % % NO: % % NO REPLY: 2 6.7% % William Griffiths, Pharmacie des HUG, Lugano sept

43 OTHER SWISS HOSPITALS Questionnaire sent to 50 Chief Pharmacists (30 replies = 60%) DO YOU THINK THAT A CIVAS GROUP SHOULD BE FORMED IN SWITZERLAND AS IN THE UK? YES: % NO : 1 3.3% NO REPLY : % William Griffiths, Pharmacie des HUG, Lugano sept

44 OTHER SWISS HOSPITALS Questionnaire sent to 50 Chief Pharmacists (30 replies = 60%) WOULD YOU BE INTERESTED IN ASEPTIC PREPARATION TRAINING MODULES IN SWITZERLAND? YES: % NO : 2 6.7% William Griffiths, Pharmacie des HUG, Lugano sept

45 OTHER SWISS HOSPITALS Questionnaire sent to 50 Chief Pharmacists (30 replies = 60%) WOULD YOU BE INTERESTED IN «READY-TO-USE» SOLUTIONS SUPPLIED BY INDUSTRY? YES: % NO : % NO REPLY: % William Griffiths, Pharmacie des HUG, Lugano sept

46 OTHER SWISS HOSPITALS Questionnaire sent to 50 Chief Pharmacists (30 replies = 60%) WHAT PRODUCTS DO YOU PREPARE OR HAVE BEEN ASKED FOR? LOCAL ANAESTHETICS 19 ( ex: Bupivacain/fentanyl) 10 PCA: 18 (ex: Morphine bags) 10 ANTIBIOTICS 7 ANTIVIRALS 4 William Griffiths, Pharmacie des HUG, Lugano sept

47 CIVAS IN SWITZERLAND 2002 CONCLUSIONS A turning point for hospital pharmacy. High added value production for the hospital. Contributes to the security of drug processes. Be aware of doubts shown by the nursing profession. Work together : (Clinical Services and Production). William Griffiths, Pharmacie des HUG, Lugano sept

48 CIVAS IN SWITZERLAND 2002 Acknowlegements: PD. Dr P Bonnabry, Mrs B Matthey Pharmacy, University Hospitals of Geneva Download at and for more CIVAS details William Griffiths, Pharmacie des HUG, Lugano sept