HUG pharmacy Hpitaux Universitaires Universitaires de Genve - - PDF document

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Hôpitaux Universitaires HUG pharmacy Universitaires de Genève services education research

Pr Pascal BONNABRY

Pharmacien-chef

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Visit from …

July 4, 2013

Geneva university hospitals (HUG)

1 out of 5 swiss university hospitals Consortium of public hospitals in Geneva county 1 central pharmacy

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See the movie HUG (4’)

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HUG missions, visions, values

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Facts and figures of HUG, 2012

Medical activities

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Annual report 2011

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Finances

Expenditure Income

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Budget ≈ CHF 1,7 billion

Drugs ≈ CHF 60 millions

Annual report 2011

Human resources

The larger employer in Geneva county

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Annual report 2011

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Men at work…

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Facts and figures of HUG, 2012

Pharmacy: Missions

Supply drugs to the entire hospital (purchase, stock management, distribution) Implement a full traceability of drugs up to the administration to the patient Ensure a production and the manufacture of personnalised preparation of drugs, when they

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p p p g y are not available on the market Contribute to a safe and rational use of drugs Services - Education - Research

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Pharmacy strategic priorities

Optimize safety, efficiency and traceability of the physical circuit of drugs Optimize the information flow during prescription dispensing

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during prescription, dispensing, preparation and administration

• f drugs

O ti i ti ithi th h

Axes of action

Optimisation within the pharmacy Services matching the institution’s needs Efficient organisation Quality management Reinforcement of decentralized activities

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activities Management of stocks in the wards Pharmaceutical assistance and clinical pharmacy

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Management by the quality

Certifications ISO 9001 Quality management system for hospital pharmacies (RQPH) … since june 2005

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GMP authorisation Swissmedic K

Values

Know

Scientific competencies in perpetual evolution

Know-how

A contribution to a rational and safe use of drugs (« the drug care ») A constructive and efficient interdisciplinary collaboration aiming the best care for patients

B i

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Being

A team spirit including a respect of other people and their work

Transmitting

A transfer of knowledge inside the service and to other professionals of the hospital and elsewhere

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Values

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Key numbers

2000 m2 facility 3 main activities, 4 sectors

Logistics Production Clinical use of drugs

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C ca use o d ugs

60 collaborators (50 FTE)

20 pharmacists

(including those in an education cursus)

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Organisation

Gl b l Pascal Bonnabry

Head of pharmacy

Quality and safety

link with services

Laurence Cingria Quality management Global pharmacy

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Research Education

Pharmaceutical assistance Quality control Logistics Production

Clinical pharmacy

Collaboration with clinical pharmacology

Nathalie Vernaz Sandrine Fleury Caroline Fonzo-Christe Lucie Bouchoud

Medication process

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Medication process organisation

Existing models Global distribution

The pharmacy delivers boxes of drugs and nurses dispense individual treatments from the ward stock

Nominal or individual

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Nominal or individual distribution

Drug dispensing is performed at the pharmacy, for each patient, based on a prescription

Medication process organisation

Individual distribution is more convenient in some conditions Few prescription modifications (chronic care) Pharmacy close to the wards At the HUG, the global model l t d

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was selected Acute care in majority Long distance between the pharmacy and some wards

(multi-sites hospital)

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Medication process organisation

An obsolete organisation ?

Errors’ distribution

Central pharmacy stock Industry stock Ward stock Prescription

39%

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Administration Bates DW, JAMA 1995;274:29

Avoidable adverse drug events: 6.5% of admissions

11% 38% The process of the future ?

Automated dispensing system Robotized distribution

EDI

Central pharmacy stock Industry stock Ward stock distribution CPOE

Clinical information system

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Logistic information system

Bedside scanning Distribution with scanning

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Automated dispensing system Robotized distribution

The process of the future ?

HUG situation 2013

Clinical information system

EDI

Central pharmacy stock Industry stock Ward stock distribution CPOE

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Logistic information system

Bedside scanning Distribution with scanning

Logistics

Missions Supply drugs to all HUG medical wards 24h/24 and 7d/7 Improve the traceability, the reliability and the safety of the process From the order to the supplier to the

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From the order to the supplier to the administration to patients, by integrating information technologies Contribute to the economics

• f drugs use

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Logistics

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Logistics

Key numbers The team 3 pharmacists (1,7 FTE) 1 superior technician (1 FTE) 1 stock manager (1 FTE) 10 pharmacy ancillaries

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p y (6,6 FTE) 1 logistician (1 FTE) 6 pharmacy clerks (5,5 ETP) 4 students logisticians

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Logistics

Robotized distribution

1200 drugs, 45’000 boxes in the robot 28’000 lines distributed in a month 55% of the total activity

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See the movie (4’) robot présentation

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Production

Missions Production of drugs Unavailable Available, but in an unadapted form

Dosage

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Risk of error during preparation Risk of microbial contamination

Toxics In developpment (clinical trials)

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Production

Activities Individualized preparation of cytotoxic Individualized and batch production of sterile and non sterile products Management and collaboration in clinical trials D l d i l i f

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Development and implementation of computer-assisted production management and automation Education and research in hospital production K b

Production

Key numbers The team

4 pharmacists (3 FTE) 11 superior technicians (9.35 FTE) 1 pharmacy ancillary (0.5 FTE) 4 pharmacy clerks (3.5 FTE)

Productions /year

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Productions /year 15’000 cytotoxic 40’000 other individualized preparations 300’000 units produced by batch 60 clinical trials

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≈ 15 products

Production

Ready-to-use syringes(CIVAS)

10000 20000 30000 40000 Nbre d'unités

Nutrition enfant Cytostatiques CIVAS séries

Vancomycin incident in neonatology Isolator / filling machine Subcontracting Stability studies (+ publications)

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10000 1996 1998 2000 2002 2004 2006 2008 2010

Clinical needs analysis BPF +++

Quality control

Missions To guarantee the quality and the safety of medications produced by the HUG pharmacy according to the actual norms

Routine analysis Research and development projects

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To contribute to the education

• f the laboratory professionals

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A ti iti

Quality control

Activities

Routine anlysis Physico-chemical analyses of raw materials and end-products Microbiological analyses of end-products Control of the production environment (cleanrooms)

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Research and development Development and validation of new analytical methods Stabilities studies of new HUG pharmacy formulations

Quality control

Key numbers The team 1 pharmacist 1 PhD student pharmacist 1 laboratory assistant 2 t d t l b t

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2 students laboratory assistant The activity

20’000 analyses/yr

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Quality control

Cytostatics in the environment Validation of a method (wiping+ LC-MS) to measure traces of 10 cytotoxic Study in swiss hospitals including HUG

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GSASA congress 2011

Pharmaceutical assistance

Missions Provide up-to-date, balanced and independent information Promote a rational and adequate use of drugs Develop multidisciplinar

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Develop multidisciplinar collaborations

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Pharmaceutical assistance

Activities Source of pharmaceutical information

A hot-line (31080) A website

Regular attendance in wards Strong involvment in the

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Strong involvment in the education of healthcare professionals

Pharmaceutical assistance

Key numbers The team 6 pharmacists (3.8 FTE) The activity

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2’000 questions/yr

Answered in an hour in 90% of cases

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Pharmaceutical assistance

Informations on drug use >150 documents available on the HUG pharmacy website (in french)

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website (in french)

http://pharmacie.hug-ge.ch/infomedic/utilismedic.html

Education

Academic Undergraduate Lectures on hospital pharmacy Master thesis and assistantship in hospital pharmacy

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Postgraduate MAS in hospital pharmacy

(+ preparation to FPH examination)

CAS in clinical pharmacy

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Education

Professional education Apprenticeships Logistician (4 positions) Laboratory assistant (chemistry) (2 positions)

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( p )

Education

Continuing education « Management of aseptic production in hospital pharmacy » Curriculum for nurses (HUG catalogue)

« Reliability of dispensation » « Drugs: from the ordering

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g g to the administration »

Certificate of operator in hospital production (GPHR) Numerous ponctual lectures

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Research

Research axes Management of medication risk Optimisation of clinical use of drugs Development of hospital pharmaceutical forms

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Pharmaceutical analysis Pharmacoeconomics et pharmacoepidemiology

For more information : http://pharmacie.hug-ge.ch/rd/recherche.html

Research

Management of medication risk Proactive risk analysis within hospital processes (FMECA method) Use of simulation to analyze factors influencing the occurrence of errors during dispensing and administration

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dispensing and administration Evaluation of pro and cons of information technologies

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Research

Key numbers (2008-2012) 30 peer-reviewed publications 20 teaching articles 100 communications in congresses 7 PhD th

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7 PhD theses 4 specialisation master theses (MAS) 12 end study master theses

Sustainable development

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Global pharmacy

Involvment for the hospital pharmacy in developing countries : Teaching at the Université of Bamako, Mali Development of a pedagogic tool : e-learning modules

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g Good practices procedures and other ressources Exchange of information in the hospital pharmacy community

globalhealthforum.net

Futur challenges

Ward stock management Increase the presence of pharmacists in wards Electronic traceability of the whole medication process Transition of pharmaceutical care at hospital

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Transition of pharmaceutical care at hospital discharge Evolution of under- and postgraduate education curricula

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For more information…

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http://pharmacie.hug-ge.ch Pascal.Bonnabry@hcuge.ch

See the movie (12’) of the pharmacy

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