The year is 2023. SpaceX is creating a telecommunications system in space, artificial intelligence can diagnose a patient, and yet the third reason for death of patients are medical errors. Many of them concern the preparation of drugs or irregularities during their administration. There is a good solution, as described by Dr. Hab. Maciej Stawny, assistant professor at the Department and Department of Pharmaceutical Chemistry of the Karol Marcinkowski Medical University in Poznań.
Development. This is an essential process required by the health service in Poland. Patients, but also nurses, doctors and pharmacists, talk about it loudly. It is this last group that is responsible for medicines in hospitals, and its potential is still not fully used.
The patient should come first. Meanwhile, it seems that it is more about money than his well-being. That’s true?
We should look at the health care system through the prism of the patient and his well-being. This is undoubtedly the most important thing. …but is this really the case in practice? The implementation of accreditation standards, i.e. a set of quality requirements relating to all aspects of hospital functioning, is considered to be a factor that significantly increases the quality of hospital treatment. In practice, an accredited hospital operates according to the principles set out by the Center for Monitoring Quality in Health Care.
Accreditation standards greatly improve the quality of medical services provided in hospitals. Their introduction often requires increased financial outlays and significant staff involvement. It is therefore necessary that, along with obtaining an accreditation certificate, the hospital receives additional financial resources that will allow it to work in accordance with the developed standards.
One of the important elements of accreditation standards is ensuring safe pharmacotherapy and the quality of administered drugs. This can only be achieved by preparing medicines in hospital pharmacies and the presence of clinical pharmacists on hospital wards. Such solutions involve the need to adapt the pharmacy infrastructure, increase the number of staff, and logistic changes, which result in large financial outlays for the hospital. At first glance, it may seem that the participation of hospital pharmacists in the therapeutic process is not necessary to save human lives.
And yet! – pharmacists and statistics thunder. Irregularities and mistakes in the preparation and administration of medicines in hospital wards are nothing more than medical errors that have a real impact on the effectiveness of treatment and the length of hospitalization, resulting from the lack of an appropriate number of pharmacists in the hospital.
How does this compare to Western standards?
Since the 1980s, in Western Europe and the United States, a team of professionals has been responsible for treating patients, including doctors, nurses and pharmacists, who actively participate in the decision-making process regarding pharmacotherapy. The pharmacists in this team are considered drug experts and are largely responsible for the pharmacotherapy used.
Unfortunately, the profession of clinical pharmacist does not yet exist in Poland. Only in a few hospitals can you meet representatives of this professional group actively involved in the treatment of patients. Currently, the main task of pharmacists in hospitals is to manage the warehouse of medicines and medical devices and, to a limited extent, to prepare medicines in individual doses.
By default, all medicines should be prepared in hospital pharmacies. There is still a problem with this in Poland. Unfortunately, many of them, including high-risk drugs, are prepared on wards by nursing staff. There is a dissonance between what the Pharmaceutical Law and the Act on the Pharmacist’s Profession say and what is actually happening in hospitals. Only increasing awareness of safe pharmacotherapy and systemic solutions can make a difference.
What I am talking about does not result from the reluctance of pharmacists, but rather from the underfunding of hospital pharmacies, staff shortages and the lack of support from hospital management to introduce changes. There are many small hospitals where only the pharmacy manager works in the hospital pharmacy. Is he or she able to single-handedly ensure the functioning of the pharmacy, prepare medications and supervise the safety of pharmacotherapy in the ward?
Is it that bad everywhere?
The situation is not so tragic everywhere. Hospital pharmacy in Poland operates dynamically in two areas – cytotoxic drugs and parenteral nutrition. Ph.D. Maciej Stawny reminds that oncological pharmacy standards and standards for the preparation of mixtures for parenteral nutrition have been in place for years. However, this is a drop in the ocean of needs.
There are still no rules for handling infusion medicines. This problem brings together pharmacists and nurses. Typically, these two professions work side by side, and do not cooperate closely enough in the field of pharmacotherapy safety as global recommendations would suggest. This is a big problem. The head of the hospital pharmacy is the person responsible for all pharmacotherapy in the hospital, including aspects related to administering drugs in the ward.
We come to the obvious truth: is the solution to the problem a change in the system?
Yes, changing the system is striving for development. Even though the pharmacy manager does not always participate in drug therapy on the ward, he or she is still responsible for this part of the patient’s treatment. And that is why every hospital should regulate such situations with specific procedures. They should be authorized by the pharmacy manager for all pharmacotherapy.
Pharmacists are the untapped potential of Polish hospitals. With their knowledge and skills, they could support doctors in treating patients. In the United States and Canada, pharmacists have the authority to prescribe medications. In this way, they relieve the burden on doctors who can devote themselves to diagnostics and treatment activities. Additionally, transferring activities related to preparing medications from nursing stations to hospital pharmacies would not only improve the safety and quality of prepared preparations, but would also reduce activities unrelated to patient care and performed by nursing staff.
What about the marriage of health and economics?
Incomplete drug administration is a tragedy for the patient and a tragedy for the health care system. Medicinal products intended for infusion are most often administered in slow infusions over a specified period of time. This is necessary to maintain patient safety. It turns out that in many cases, an unused part of the drug remains in the tubing of the transfusion device after the infusion, which may affect the effectiveness of patients’ treatment. Wasted medicine also costs money. If the drug costs PLN 1 and 10% of the dose remains in the tubing, the loss is 10 groszy. However, if its cost is PLN 50,000. PLN per dose, PLN 5,000 will be wasted. zlotys.
The solution is to change the approach to how the drug is administered. When using drugs with a narrow therapeutic index and high-cost preparations, supraventricular flushing can be used after the infusion. This is a very simple solution and allows you to administer the full dose of the prescribed drug.
Identification of this type of drug problems requires an infusion service in the hospital, i.e. an interdisciplinary team ensuring the safety of infusion therapy. This type of teams functioning in hospitals is a guarantee of quality.
How to become a hospital pharmacist?
One of the possible career paths for pharmacy graduates is employment in a hospital pharmacy. However, few universities implement a curriculum that includes vocational subjects related to hospital pharmacy. This means that when young pharmacists graduate, they do not feel prepared to practice in a hospital setting. This is one of the reasons for less interest in hospital pharmacy than in work in other areas of pharmacy. However, pharmacists employed in a hospital pharmacy can deepen their knowledge by participating in specialization courses in hospital pharmacy.
A systemic solution that may influence the development and changes in the health care system is to change the directions and scope of education for medical professions. Work is currently underway on amendments to the specialization education programs for doctors and pharmacists. The new specialization program in hospital pharmacy draws from global teaching standards for this profession and covers both theoretical and practical aspects. Additionally, there was a provision requiring at least 50% of classes to be conducted by practitioners. Application? The world has changed in the last 20 years. But we need further changes urgently – that’s what pharmacists are calling for.
Ph.D. Maciej Stawny, assistant professor at the Department and Department of Pharmaceutical Chemistry of the Karol Marcinkowski Medical University in Poznań. His research interests include issues related to the preparation of infusion fluids in a hospital pharmacy, the occurrence of allergic reactions in patients after administration of medicinal substances, and the radiochemical stability of active substances.
The interview was conducted by Sandra Jankowska