The development of an integrated system for the management of pharmaceutical and surgical consumable products across a group of private hospitals : innovation report

Continued pressure to reduce costs and manage healthcare delivery in risk-based reimbursement environments, has, internationally, resulted in hospitals adopting different methods to manage pharmaceutical and surgical consumable products. An initial review of systems of management of these products showed that the trend is to manage them separately. Pharmaceutical products are managed using dedicated resources and structures in each hospital, which may be difficult to establish and sustain in smaller, non-academic hospitals. Amongst other factors, the absence of a classification system and a lack of utilisation information hindered the development of management systems for surgical consumable products. In addition, traditional materials management processes applied to these products, often do not adequately address the impact that these products have on clinical care. In this study, the decision was made to develop an integrated system for both pharmaceutical and surgical consumable products and to adopt a systems approach in which all hospitals in the group were included as a single system. The study was multi-methodological with the design being contextual and qualitative and the research strategy, exploratory and descriptive. A multi-phased, action research approach was used, comprising of three (3) cycles, two (2) in which the integrated system was developed and enhanced and a third in which it was independently tested in 19 newly acquired hospitals. The result of the three (3) cycles was an implemented integrated system across 43 acute-care hospitals in the group comprising six (6) processes namely: a product selection process, information technology (IT) support system, a hospital implementation process, measurement and management tools, pharmacy capability and a supplier strategy and interface process. These processes included several key unique features, such as one (1) product selection team for all hospitals, a surgical classification system based on functional therapeutic uses, a single IT system and utilisation review capability for all products, extending the role of pharmacy departments in hospitals to include the management of surgical consumable products and an integrated quality assessment process for both types of products. By the end of the three (3) cycles (September 1999), the product selection process covered 66,5% of value of product spend, the percentage reduction in the number of products used was 68% and the value of products purchased that complied with specified products and suppliers was 90%. Ongoing and further application showed that the integrated system could be sustained in existing hospitals, applied to a further four (4) newly acquired hospitals and expanded to include specialised pharmaceutical and surgical consumable products in cardiac catheterisation laboratories. By September 2003, the total spend on pharmaceutical and surgical consumable products had reached R1,7 billion. The product selection process covered 67,6% of total spend, the compliance value reached 95% and there were additional financial improvements realised. Following a further literature review, limitations and improvements to the approach were identified and further adaptations were added as concepts in the graphic representation of system. One (1) of these was to show the integrated system as an open system. The second adaptation highlighted the systems-based input-process-outcomes feedback concept that is critical to continuous improvement of the system. In the final progression, a systems approach to strategic planning and management was incorporated in order to provide a structured approach for adapting to the rapid and ongoing changes in healthcare and aligning the system of management of pharmaceutical and surgical consumables to the overall business strategy. Overall, this research study succeeded in bringing new perspectives and an innovative approach to the management of pharmaceutical and surgical consumable products by developing and implementing an integrated system for both products, establishing essential processes with key unique features and tools, and the application of a systems thinking approach. Four (4) areas of further research are suggested, namely testing the integrated system in other contexts, improved methods of measurement of quality of care, extension to other areas of healthcare and use of the systems approach in other areas of the business

The development of an integrated system for the management of pharmaceutical and surgical consumable products across a group of private hospitals : innovation report

Continued pressure to reduce costs and manage healthcare delivery in risk-based reimbursement environments, has, internationally, resulted in hospitals adopting different methods to manage pharmaceutical and surgical consumable products. An initial review of systems of management of these products showed that the trend is to manage them separately. Pharmaceutical products are managed using dedicated resources and structures in each hospital, which may be difficult to establish and sustain in smaller, non-academic hospitals. Amongst other factors, the absence of a classification system and a lack of utilisation information hindered the development of management systems for surgical consumable products. In addition, traditional materials management processes applied to these products, often do not adequately address the impact that these products have on clinical care. In this study, the decision was made to develop an integrated system for both pharmaceutical and surgical consumable products and to adopt a systems approach in which all hospitals in the group were included as a single system. The study was multi-methodological with the design being contextual and qualitative and the research strategy, exploratory and descriptive. A multi-phased, action research approach was used, comprising of three (3) cycles, two (2) in which the integrated system was developed and enhanced and a third in which it was independently tested in 19 newly acquired hospitals. The result of the three (3) cycles was an implemented integrated system across 43 acute-care hospitals in the group comprising six (6) processes namely: a product selection process, information technology (IT) support system, a hospital implementation process, measurement and management tools, pharmacy capability and a supplier strategy and interface process. These processes included several key unique features, such as one (1) product selection team for all hospitals, a surgical classification system based on functional therapeutic uses, a single IT system and utilisation review capability for all products, extending the role of pharmacy departments in hospitals to include the management of surgical consumable products and an integrated quality assessment process for both types of products. By the end of the three (3) cycles (September 1999), the product selection process covered 66,5% of value of product spend, the percentage reduction in the number of products used was 68% and the value of products purchased that complied with specified products and suppliers was 90%. Ongoing and further application showed that the integrated system could be sustained in existing hospitals, applied to a further four (4) newly acquired hospitals and expanded to include specialised pharmaceutical and surgical consumable products in cardiac catheterisation laboratories. By September 2003, the total spend on pharmaceutical and surgical consumable products had reached R1,7 billion. The product selection process covered 67,6% of total spend, the compliance value reached 95% and there were additional financial improvements realised. Following a further literature review, limitations and improvements to the approach were identified and further adaptations were added as concepts in the graphic representation of system. One (1) of these was to show the integrated system as an open system. The second adaptation highlighted the systems-based input-process-outcomes feedback concept that is critical to continuous improvement of the system. In the final progression, a systems approach to strategic planning and management was incorporated in order to provide a structured approach for adapting to the rapid and ongoing changes in healthcare and aligning the system of management of pharmaceutical and surgical consumables to the overall business strategy. Overall, this research study succeeded in bringing new perspectives and an innovative approach to the management of pharmaceutical and surgical consumable products by developing and implementing an integrated system for both products, establishing essential processes with key unique features and tools, and the application of a systems thinking approach. Four (4) areas of further research are suggested, namely testing the integrated system in other contexts, improved methods of measurement of quality of care, extension to other areas of healthcare and use of the systems approach in other areas of the business.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Passing the baton to pharmacists and nurses: New models of antibiotic stewardship for South Africa?

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A pharmacist-led prospective antibiotic stewardship intervention improves compliance to community-acquired pneumonia guidelines in 39 public and private hospitals across South Africa

Introduction: Pharmacists in low-middle-income countries (LMIC) are few and lack antibiotic stewardship (AS) training. The ability was assessed of non-specialised pharmacists to implement stewardship interventions and improve adherence to the South African community-acquired pneumonia (CAP) guideline in public and private hospitals. Methods: This was a multicentre, prospective cohort study of adult CAP patients hospitalised between July 2017 and July 2018. A CAP bundle was developed of seven process measures (diagnostic and AS) that pharmacists used to audit compliance and provide feedback. CAP bundle compliance rates and change in outcome measures [mortality, length of stay (LOS) and infection-related (IR)-LOS] during pre- and post-implementation periods were compared

International train the trainer neonatal antibiotic stewardship program for South African pharmacists

Hospital-acquired antimicrobial-resistant infections are a leading cause of neonatal mortality in South African (SA) neonatal intensive care units (NICU). There is an urgent need for NICU Antibiotic Stewardship Programs (ASP). We describe the development of an international Train-the-Trainer (TTT) NICU-ASP mentoring program for SA pharmacists. A partnership between the South Africa Antimicrobial Stewardship in 2019. A baseline assessment of four SA NICUs was done to guide the development of a TTT NICU-ASP mentoring of SA pharmacists utilizing the existing workforce. The program included bilateral site visits. Pre-post surveys were used to assess SA mentee's NICU experiences, barriers to clinical pharmacy services and confidence to train additional pharmacists in NICU ASP. Four mentees from private (n = 1) and public hospitals (n = 3) completed a 2-week TTT NICU-ASP in the US that included; education, patient care rounds, role-playing, peer-to-peer sessions and behavioral interventions followed by ongoing support and mentoring by SAASP mentors. None of the hospitals had pharmacists participating in daily patient care rounds or had multidisciplinary NICU-ASPs due to lack of NICU trained pharmacists and dedicated time for ASP. Post surveys showed improved confidence to train additional pharmacists in NICU-ASP. Subsequently, these SA mentees provided NICU-ASP education to over 700 health care professionals and trained six additional pharmacists in NICU-ASP. Mentors and mentees developed a comprehensive NICU ASP toolkit for ongoing training of additional pharmacists. A new research collaboration between TTT NICUASP mentors, mentees and physician members of the South Africa National Neonatal Sepsis Task Force has formed and the first national NICU-ASP study is underway in 12 hospitals. Shared leadership between U.S. and SA mentors led to developing a TTT NICU-ASP for pharmacists tailored to existing resources and local needs.Merck; Pfizer; Bill and Melinda Gates Foundation grant.http://wileyonlinelibrary.com/journal/jac5am2022Pharmacolog

Antimicrobial stewardship across 47 South African hospitals:an implementation study

BACKGROUND : The available data on antimicrobial stewardship programmes in Africa are scarce. The aims of this study were to assess the implementation of an antimicrobial stewardship programme in a setting with limited infectious disease resources. METHODS : We implemented a pharmacist-driven, prospective audit and feedback strategy for antimicrobial stewardship on the basis of a range of improvement science and behavioural principles across a diverse group of urban and rural private hospitals in South Africa. The study had a pre-implementation phase, during which a survey of baseline stewardship activities was done. Thereafter, a stepwise implementation phase was initiated directed towards auditing process measures to reduce consumption of antibiotics (prolonged duration, multiple antibiotics, and redundant antibiotic coverage), followed by a post-implementation phase once the model was embedded in each hospital. The effect on consumption was assessed with the WHO index of defined daily doses per 100 patient–days, and the primary outcome (change in antibiotic consumption between phases) was assessed with a linear mixed-effects regression model. FINDINGS : We implemented and assessed the antimicrobial stewardship programme between Oct 1, 2009, and Sept 30, 2014. 116 662 patients receiving antibiotics at 47 hospitals during 104 weeks of standardised measurement and feedback, were reviewed, with 7934 interventions by pharmacists recorded for the five targeted measures, suggesting that almost one in 15 prescriptions required intervention. 3116 (39%) of 7934 pharmacist interventions were of an excessive duration. The antimicrobial stewardship programme led to a reduction in mean antibiotic defined daily doses per 100 patient–days from 101·38 (95% CI 93·05–109·72) in the pre-implementation phase to 83·04 (74·87–91·22) in the post-implementation phase (p&#0600·0001). INTERPRETATION : Health-care facilities with limited infectious diseases expertise can achieve substantial returns through pharmacist-led antimicrobial stewardship programmes and by focusing on basic interventions. FUNDING : None.http://www.thelancet.com/infection2017-09-30Family Medicin