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Objective: The objective of this study was to assess the results of applying Lean Methodology in the design of a standardized medication storage model in hospitalization departments.Method: Descriptive and retrospective study conducted between September 2017 and January 2019 in a tertiary level hospital. The Pharmacy Service led the creation of a multidisciplinary team. Lean Methodology was used to establish the components and organization and identification criteria that made up the standardized medication storage model. The stocks of each hospitalization department were reviewed and quantified, the final amount of stock needed was agreed with the supervisor of each department, and the economic impact of the implementation of the standardized medication model was assessed. A questionnaire was designed and sent to nursing staff to determine their level of satisfaction with the new model.Results: The standardized medication storage model was scaled up to 20 nursing departments, leading to an overall reduction of 56.72% in the number of pharmaceutical dosage forms available (5,688 vs 2,462). The number of high-risk drugs was reduced by 40.73% (631 vs 374). This elimination of wastage achieved a saving of €25,357.98. A total of 58 nurses returned the questionnaires (20.70% of the total): 22.40% worked a fixed shift and 77.60% worked a rotating shift. The mean score on overall satisfaction was 5.79 ± 3.61 (scores ranged from 1 to 10).Conclusions: The application of Lean Methodology is very useful for the management of medication stocks in hospitalization departments. The implementation of a standardized medication storage model leads to economic savings and a marked reduction in the number of active ingredients and high-risk medications. The nursing staff were satisfied with the implementation of the model, suggesting that we should continue to pursue this effective line of action.

Introduction: The aims of the study were to quantify adherence, determine the factors that can predict adherence and identify the consequences of poorer adherence in patients with chronic inflammatory arthropathies treated with biological therapies in daily clinical practice. Method: A descriptive, observational and retrospective study was carried out. Patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis who started a biologic therapy between 1 January 2009 and 31 December 2016 were included. Variables related to socioeconomic status, the disease, the biological therapy and hospital resources were included. Adherence was calculated by using the medication possession ratio. Results: Three hundred and sixty-two patients and 423 lines of biological therapy were included. Mean age ± standard deviation was 50.3 ± 13.9 years, and 228 (53.9%) were women. The percentage of adherent patients was 187 out of 216 (87%) in rheumatoid arthritis, 91 out of 107 (85%) in ankylosing spondylitis and 84 out of 100 (84%) in psoriatic arthritis. Greater adherence was associated with more frequent visits to the pharmacy service (odds ratio 1.2, 95% confidence interval: 1.1-1.3 [p < 0.001]) and poorer adherence with a failure to attend scheduled appointments at the rheumatology clinic (odds ratio 0.2, 95% confidence interval: 0.1-0.9 [p = 0.030]). There were no differences between adherent and non-adherent patients in terms of the number of hospital resources used. Conclusions: There are no differences in adherence to biological therapies among patients with chronic inflammatory arthropathies. Adherence correlates with attendance at outpatient appointments, but this does not imply an increase in the use of hospital resources.

Objective:To classify hospital units into three risk levels in order to define and prioritise improvement and training measures in each of them. Method: The risk map was developed in two phases: First phase involved the setting up of a multidisciplinary team, a bibliographic search, the identification of medications and of the criteria to design the map: (1) Location: number of high-alert medications; (2) Staff turnover: the units were classified in low turnover units = 1, medium turnover units = 2 and high turnover units = 3 according to data provided by the human resource department; (3) Frequency: quotient between the number of high alert medicactions in each unit and the total of medications used, and (4) Severity: voluntary survey of professionals. An accumulated risk of severity of each unit was calculated: Σ (severity of the drug x number of its units). The Neperian logarithm was applied to this value to reduce the variability of the values. Thus a risk probability index was established = staff turnover x frecuency x Neperian logarithm of severity. In a second phase, the units were classified into three groups and the risk map of high-alert medication was elaborated in the hospital. In it, the units that had a risk probability index higher than 2.9 were classified as high risk units, those that had between 1-2.9 as intermediate risk units and those that had less than 1 as low risk units. According to the risk probability index, improvement measures were defined and priorities were set for each of them. Results: A total 447 high-risk medications corresponding to 227 active ingredients were identified during the study period. The units showing a higher risk were: Intensive Care Medicine (10.51), Reanimation (4.01), and Palliative Care (3.90). Improvement actions (informative poster, visual identification, alerts, training and double checks) were defined and prioritised in accordance with the risk probability index. Conclusions: Knowing the degree of risk of hospitalization units in the management of high- alert medications allows for the implementation of improvement plans in relation to the degree of vulnerability detected.

Objective: Describe the phases of implementation, scaling and integration of a pharmacy teleconsultation model in electronic history, to coordinate the care transition of patients. Method: Descriptive and retrospective study in a health area of 500,000 inhabitants (3 years). In the first phase, a working group was created, a communication platform was designed and a continuity program was piloted between a hospital pharmacist and the 13 primary care pharmacists. The objective was to solve problems related to medications (especially those of sanitary approval) in polymedicated patients hospitalized in the Short Stay Unit- Emergency. In a second phase, the program included all the patients in any unit and all the pharmacists in the hospital. In the third phase, the program was extended to the teleconsultation format within the corporate information systems of the Health Service. Quantitative descriptive variables were recorded (number, motives and resolution of the teleconsultations). Results: In total, more than 470 consultations were registered (118 in the first phase, 158 in the second and 194 in the third), which were resolved in 90% of the cases. The main reasons were discrepancies in type approval drugs, prescribed in the care transition and nutritional assessment. Conclusions: Teleconsultation allows the coordination of pharmaceutical care between levels, quickly and easily. Increase the visibility and access of professionals. Problems are resolved without displacements or time delays for patients.

Objective: To quantify Drug-Related problems (DRPs) by establishing a Strategic Continuity of Care Program (e-Conecta- Concilia Program; e-CC) focused on the drug therapy of patients within an Integrated Management Structure, in order to guarantee the therapeutical efficiency, safety and traceability of patients. Method: A prospective study at 8 months. The project included 22 Hospital Pharmacists and 12 Primary Care Pharmacists. Electronic clinical records were used, which can be accessed by all healthcare levels. Those interventions required in order to create a Standard Operating Procedure (SOP) were carried out (creation of working groups, computing, meeting points), for coordination among pharmacists in different care levels through a common communication system. The working groups formed by pharmacists of both care levels established the following inclusion criteria: patients with chronic diseases and polymedicated, patients for whom drug-related problems (DRP) had been detected, detection of any off-label use in Primary Care, or discrepancies in the standardization of medical prescriptions. Results: In the setting of the e-CC program, interventions were unified and discrepancies were identified. During this project, 245 drug-related problems were detected; the majority regarding inadequate dosing, regimen, or duration (24%), and involving Group B medications (33%), according to the ATC classification. Conclusions: The implementation of a Continuity of Care SOP between pharmacists allowed to detect and solve DRPs and discrepancies in patient pharmacotherapy, with a high rate of acceptance (84.1%) of interventions