gms | German Medical Science

Patient Oriented Automated Drug Distribution System (Patientenbezogene Arzneimittel Versorgung - PAV) is currently in use on 51 wards at LBK Hamburg, providing approx. 1500 patients with unit dose distribution combined with a daily ward visit by the pharmacist.

The Service Centre APONOVA has basically adopted PAV to pursue two objectives crucial to the economics of pharmacotherapy:

• the reduction of medication errors

• the optimisation of hospital pharmacotherapy

Studies have demonstrated that pharmaceutical practice which works with the patient as part of hospital routine reduces the incidence of medication errors.

This effect is achieved by improved pharmacotherapy documentation (the electronic patient file), an automation of unit dose distribution and an active reduction of ward medication errors with the help of daily pharmacist's rounds [Ref. 1], [Ref. 2], [Ref. 3].

The pharmacist's day-to-day ward routine consists essentially in verifying the choice of drug, dose, method of administration and any potential interactions.

This approach to pharmaceutical service means that decisions taken by the Medication Committee of the seven hospital sites (AMK G) can be implemented rapidly at patient level.

The following example, showing the procedure for heparin-induced thrombocytopenia (HIT II), serves to illustrate the clinical pharmacy, counselling described above.

Whenever Orgaran^® (Danaparoid) is prescribed, the following factors are verified:

1. Is there a known history of HIT II? - Administration necessary

2. Are there clinical indications of HIT II in response to the current (provisional) heparin therapy? - Administration necessary

3. Has the HIT II diagnosis been requested and have nursing staff passed it on? - If necessary draw attention to this

4. After 1-2 days: Has the result of the HIT II diagnosis arrived? - If necessary ask

5. Has the prescription been modified or upheld as a result of the findings? - If necessary check

6. After 1 week of therapy: Has the modification been implemented? - If necessary check

In this manner all patients with established HIT II can benefit from the treatment, but all unnecessary therapies are prevented (cost savings approx. € 300). PAV is helping to resolve over 1500 drug-related problems a month [Ref. 3].

Various measures are being discussed to enhance the pharmacist's work on the wards further:

1. Electronic records of resolved drug-related problems at drug, patient and Diagnoses Related Groups level

2. Implementation of team supervision and Balint groups (both instruments serve quality assurance and also exchange of experience between pharmacists in PAV)

3. Improvements to information management systems

By 2006 all peripheral wards (170) in LBK Hamburg are to implement PAV. It would be desirable for all hospitals in Germany to introduce a similar format of unit dose distribution combined with the pharmaceutical ward round. This type of provision, which incorporates working with the patient into hospital routine, can also be implemented within outpatient formats, such as in nursing homes.