18.02.2014 HUG pharmacy Hôpitaux Universitaires Universitaires de Genève services education research Pr Pascal BONNABRY Pharmacien-chef Etre les premiers pour Visit from … vous July 4, 2013 Geneva university hospitals (HUG) � 1 out of 5 swiss university hospitals � Consortium of public hospitals in Geneva county � 1 central pharmacy + Info See the movie HUG (4’) 18.02.2014 2 1
18.02.2014 HUG missions, visions, values 18.02.2014 Facts and figures of HUG, 2012 3 Medical activities 18.02.2014 Annual report 2011 4 2
18.02.2014 Finances � Income � Expenditure Drugs ≈ CHF 60 millions Budget ≈ CHF 1,7 billion 18.02.2014 Annual report 2011 5 Human resources � The larger employer in Geneva county 18.02.2014 Annual report 2011 6 3
18.02.2014 Men at work… 18.02.2014 Facts and figures of HUG, 2012 7 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 p personnalised preparation of drugs, when they p p g y are not available on the market � Contribute to a safe and rational use of drugs Services - Education - Research 18.02.2014 8 4
18.02.2014 Pharmacy strategic priorities � Optimize safety, efficiency and traceability of the physical circuit of drugs � Optimize the information flow during prescription dispensing during prescription, dispensing, preparation and administration of drugs 18.02.2014 9 Axes of action � Optimisation within the pharmacy O ti i ti ithi th h � Services matching the institution’s needs � Efficient organisation � Quality management � Reinforcement of decentralized activities activities � Management of stocks in the wards � Pharmaceutical assistance and clinical pharmacy 18.02.2014 10 5
18.02.2014 Management by the quality � Certifications � ISO 9001 � Quality management system for hospital pharmacies (RQPH) … since june 2005 � GMP authorisation Swissmedic 18.02.2014 11 Values � Know K � 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 � Being B i � 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 18.02.2014 12 6
18.02.2014 Values 18.02.2014 13 Key numbers 2000 m 2 facility 3 main activities, 4 sectors � Logistics � Production � Clinical use of drugs C ca use o d ugs 60 collaborators ( 50 FTE) 20 pharmacists (including those in an education cursus) 18.02.2014 14 7
18.02.2014 Organisation Global Gl b l pharmacy Quality and safety Head of Pascal Bonnabry link with services pharmacy Quality management Laurence Cingria Nathalie Vernaz Lucie Bouchoud Sandrine Fleury Caroline Fonzo-Christe Pharmaceutical Research Logistics Production Quality control assistance Education Clinical pharmacy Collaboration with clinical pharmacology 18.02.2014 15 Medication process 18.02.2014 16 8
18.02.2014 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 Nominal or individual distribution Drug dispensing is performed at the pharmacy, for each patient, based on a prescription 18.02.2014 17 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 was selected l t d � Acute care in majority � Long distance between the pharmacy and some wards (multi-sites hospital) 18.02.2014 18 9
18.02.2014 Medication process organisation An obsolete organisation ? Errors’ distribution 39% Prescription Industry Central Ward stock pharmacy stock stock 11% 38% Avoidable adverse drug events: 6.5% of admissions Administration 18.02.2014 Bates DW, JAMA 1995;274:29 19 The process of the future ? Automated Robotized dispensing system distribution distribution CPOE Clinical EDI information Industry Central Ward system stock pharmacy stock stock Logistic information system Bedside Distribution scanning with scanning 18.02.2014 20 10
18.02.2014 The process of the future ? HUG situation 2013 Automated Robotized dispensing system distribution distribution CPOE Clinical EDI information Industry Central Ward system stock pharmacy stock stock Logistic information system Bedside Distribution scanning with scanning 18.02.2014 21 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 From the order to the supplier to the administration to patients, by integrating information technologies � Contribute to the economics of drugs use 18.02.2014 22 11
18.02.2014 Logistics 18.02.2014 23 Logistics � Key numbers � The team � 3 pharmacists (1,7 FTE) � 1 superior technician (1 FTE) � 1 stock manager (1 FTE) � 10 pharmacy ancillaries p y (6,6 FTE) � 1 logistician (1 FTE) � 6 pharmacy clerks (5,5 ETP) � 4 students logisticians 18.02.2014 24 12
18.02.2014 Logistics � Robotized distribution � 1200 drugs, 45’000 boxes in the robot � 28’000 lines distributed in a month � 55% of the total activity + Info See the movie (4’) robot présentation 18.02.2014 25 Production � Missions � Production of drugs � Unavailable � Available, but in an unadapted form � Dosage � Risk of error during preparation � Risk of microbial contamination � Toxics � In developpment (clinical trials) 18.02.2014 26 13
18.02.2014 Production � Activities � Individualized preparation of cytotoxic � Individualized and batch production of sterile and non sterile products � Management and collaboration in clinical trials � Development and implementation of D l d i l i f computer-assisted production management and automation � Education and research in hospital production 18.02.2014 27 Production � Key numbers K b � 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 � Productions /year � 15’000 cytotoxic � 40’000 other individualized preparations � 300’000 units produced by batch � 60 clinical trials 18.02.2014 28 14
18.02.2014 Production ≈ 15 products � Ready-to-use syringes(CIVAS) 40000 Isolator / filling machine Nutrition enfant Cytostatiques Nbre d'unités CIVAS séries 30000 Subcontracting 20000 Vancomycin incident in neonatology Stability studies (+ publications) 10000 10000 BPF +++ 0 1996 1998 2000 2002 2004 2006 2008 2010 Clinical needs analysis 18.02.2014 29 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 � To contribute to the education of the laboratory professionals 18.02.2014 30 15
18.02.2014 Quality control � Activities A ti iti � Routine anlysis � Physico-chemical analyses of raw materials and end-products � Microbiological analyses of end-products � Control of the production environment (cleanrooms) � Research and development � Development and validation of new analytical methods � Stabilities studies of new HUG pharmacy formulations 18.02.2014 31 Quality control � Key numbers � The team � 1 pharmacist � 1 PhD student pharmacist � 1 laboratory assistant � 2 students laboratory 2 t d t l b t assistant � The activity � 20’000 analyses/yr 18.02.2014 32 16
18.02.2014 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 18.02.2014 GSASA congress 2011 33 Pharmaceutical assistance � Missions � Provide up-to-date, balanced and independent information � Promote a rational and adequate use of drugs � Develop multidisciplinar Develop multidisciplinar collaborations 18.02.2014 34 17
18.02.2014 Pharmaceutical assistance � Activities � Source of pharmaceutical information � A hot-line (31080) � A website � Regular attendance in wards � Strong involvment in the Strong involvment in the education of healthcare professionals 18.02.2014 35 Pharmaceutical assistance � Key numbers � The team � 6 pharmacists (3.8 FTE) � The activity � 2’000 questions/yr � Answered in an hour in 90% of cases 18.02.2014 36 18
18.02.2014 Pharmaceutical assistance � Informations on drug use >150 documents available on the HUG pharmacy website (in french) website (in french) 18.02.2014 http://pharmacie.hug-ge.ch/infomedic/utilismedic.html 37 Education � Academic � Undergraduate � Lectures on hospital pharmacy � Master thesis and assistantship in hospital pharmacy � Postgraduate � MAS in hospital pharmacy (+ preparation to FPH examination) � CAS in clinical pharmacy 18.02.2014 38 19
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