TY  - JOUR
AU  - Miljković, Nenad
AU  - van Overbeeke, Eline
AU  - Godman, Brian
AU  - Kovačević, Milena
AU  - Anastasi, Alison
AU  - Bochenek, Tomasz
AU  - Huys, Isabelle
AU  - Miljković, Branislava
PY  - 2020
UR  - https://farfar.pharmacy.bg.ac.rs/handle/123456789/3732
AB  - Objective: This study aimed to obtain a comprehensive overview on the perception, attitudes, and experience of European pharmacists with prospective risk assessment procedures in everyday practice, as well as to identify challenges and solutions. This is a follow-up study to the surveys on prospective risk assessment previously carried out within the COST Action 15105 among pharmacists across Europe.

Methodology: In-depth interviews were performed using an interview guide comprising 25 questions. Interviews were transcribed ad verbatim and imported into NVivo 10 for framework analysis. In NVivo, the interviews were coded through assigning text segments to a responding code from a coding tree, covering the full content of the interviews. Coded text segments were then charted into a matrix, and analyzed by interpreting all text segments per code.

Results: In total, 18 interviews were conducted. From the framework analysis, 6 codes and 12 sub-codes emerged. Overall, despite citing specific issues pertaining to its implementation, the interviewees considered multi-stakeholder and multi-disciplinary prospective risk assessment to be essential. While healthcare professionals reported being aware of the importance of risk assessment, they cited insufficient knowledge and skills to be a major obstacle in everyday practice. They also reported inadequate IT support since a paper-based system is still widely in use, thereby complicating data extraction to carry out prospective risk assessment.

Conclusion: While prospective risk assessment was found to be valuable, interviewees also found it to be a resource-intensive and time-consuming process. Due to resource constraints, it may not be possible or desirable to conduct prospective risk assessment for every shortage. However, for critical-essential drugs, it is crucial to have a ready-to-use substitute based on risk assessment. Moreover, potential risks of substitutes on patient health should be identified before a shortage occurs and the substitute is dispensed as an alternative.
PB  - Frontiers Media S.A.
T2  - Frontiers in Medicine
T1  - Practical Implications From European Hospital Pharmacists on Prospective Risk Assessment for Medicine Shortages
VL  - 7
EP  - 1-12
DO  - 10.3389/fmed.2020.00407
ER  - 

@article{
author = "Miljković, Nenad and van Overbeeke, Eline and Godman, Brian and Kovačević, Milena and Anastasi, Alison and Bochenek, Tomasz and Huys, Isabelle and Miljković, Branislava",
year = "2020",
abstract = "Objective: This study aimed to obtain a comprehensive overview on the perception, attitudes, and experience of European pharmacists with prospective risk assessment procedures in everyday practice, as well as to identify challenges and solutions. This is a follow-up study to the surveys on prospective risk assessment previously carried out within the COST Action 15105 among pharmacists across Europe.

Methodology: In-depth interviews were performed using an interview guide comprising 25 questions. Interviews were transcribed ad verbatim and imported into NVivo 10 for framework analysis. In NVivo, the interviews were coded through assigning text segments to a responding code from a coding tree, covering the full content of the interviews. Coded text segments were then charted into a matrix, and analyzed by interpreting all text segments per code.

Results: In total, 18 interviews were conducted. From the framework analysis, 6 codes and 12 sub-codes emerged. Overall, despite citing specific issues pertaining to its implementation, the interviewees considered multi-stakeholder and multi-disciplinary prospective risk assessment to be essential. While healthcare professionals reported being aware of the importance of risk assessment, they cited insufficient knowledge and skills to be a major obstacle in everyday practice. They also reported inadequate IT support since a paper-based system is still widely in use, thereby complicating data extraction to carry out prospective risk assessment.

Conclusion: While prospective risk assessment was found to be valuable, interviewees also found it to be a resource-intensive and time-consuming process. Due to resource constraints, it may not be possible or desirable to conduct prospective risk assessment for every shortage. However, for critical-essential drugs, it is crucial to have a ready-to-use substitute based on risk assessment. Moreover, potential risks of substitutes on patient health should be identified before a shortage occurs and the substitute is dispensed as an alternative.",
publisher = "Frontiers Media S.A.",
journal = "Frontiers in Medicine",
title = "Practical Implications From European Hospital Pharmacists on Prospective Risk Assessment for Medicine Shortages",
volume = "7",
pages = "1-12",
doi = "10.3389/fmed.2020.00407"
}

Miljković, N., van Overbeeke, E., Godman, B., Kovačević, M., Anastasi, A., Bochenek, T., Huys, I.,& Miljković, B.. (2020). Practical Implications From European Hospital Pharmacists on Prospective Risk Assessment for Medicine Shortages. in Frontiers in Medicine
Frontiers Media S.A.., 7.
https://doi.org/10.3389/fmed.2020.00407

Miljković N, van Overbeeke E, Godman B, Kovačević M, Anastasi A, Bochenek T, Huys I, Miljković B. Practical Implications From European Hospital Pharmacists on Prospective Risk Assessment for Medicine Shortages. in Frontiers in Medicine. 2020;7:null-1-12.
doi:10.3389/fmed.2020.00407 .

Miljković, Nenad, van Overbeeke, Eline, Godman, Brian, Kovačević, Milena, Anastasi, Alison, Bochenek, Tomasz, Huys, Isabelle, Miljković, Branislava, "Practical Implications From European Hospital Pharmacists on Prospective Risk Assessment for Medicine Shortages" in Frontiers in Medicine, 7 (2020),
https://doi.org/10.3389/fmed.2020.00407 . .

TY  - JOUR
AU  - Miljković, Nenad
AU  - Godman, Brian
AU  - van Overbeeke, Eline
AU  - Kovačević, Milena
AU  - Tsiakitzis, Karyofyllis
AU  - Apatsidou, Athina
AU  - Nikopoulou, Anna
AU  - Garcia Yubero, Cristina
AU  - Portillo Horcajada, Laura
AU  - Stemer, Gunar
AU  - Kuruc-Poje, Darija
AU  - De Rijdt, Thomas
AU  - Bochenek, Tomasz
AU  - Huys, Isabelle
AU  - Miljković, Branislava
PY  - 2020
UR  - https://farfar.pharmacy.bg.ac.rs/handle/123456789/3731
AB  - Introduction: Medicine shortages result in great risk for the continuity of patient care especially for antimicrobial treatment, potentially enhancing resistance rates and having a higher economic impact. This study aims to identify, describe, assess, and assign risk priority levels to potential failures following substitution of antimicrobial treatment due to shortages among European hospitals. Furthermore, the study investigated the impact of corrective actions on risk reduction so as to provide guidance and improve future patient care.

Methods: Health-care failure mode and effect analysis (HFMEA) was applied to hospitals in Austria (H-AT), Belgium (H-BE), Croatia (H-CR), Greece (H-GR), Spain (H-SP), and Serbia (H-SR). Multidisciplinary teams identified processes, failure modes, causes, and corrective actions related to antibiotic substitution following medicine shortages. Characteristics of study hospitals as well as severity, probability, and hazard scores (HSs) of failure modes/causes were analyzed using Microsoft Office Excel 2010 and IBM SPSS Statistics® via descriptive and inferential statistics.

Results: Through HFMEA, 74 failure modes were identified, with 53 of these scoring 8 or above on the basis of assigned severity and probability for a failure. Severity of failure modes differed before and after corrective actions in H-CR, H-GR, and H-SR (p < 0.005). Their probability differed in all study hospitals (p < 0.005) when compared before and after corrective actions aimed to be implemented. The highest number of failure-mode causes was detected in H-CR (46) and the lowest in H-SP (16). Corrective actions can address failure modes and lower HSs; therein, all teams proposed the following: structuring communication among stakeholders, introducing electronic prescribing, strengthening pharmacists' involvement, and increasing effectiveness of the ward stock assessment. These proposed actions led to HS reductions up to 83%.

Conclusion: There is a lack of structure in addressing risks associated with antibiotic substitution following shortages. Furthermore, lack of communication, data scarcity on availability of antibiotics, non-supportive information technology (IT) systems, and lack of internal substitution protocols hinder quick assessment of alternatives addressing patient needs. Nevertheless, the study shows that health-care professionals manage to secure optimal antimicrobial treatment for patients using available IT and human resources.
PB  - Frontiers Media S.A.
T2  - Frontiers in Medicine
T1  - Risks in Antibiotic Substitution Following Medicine Shortage: A Health-Care Failure Mode and Effect Analysis of Six European Hospitals
VL  - 7
DO  - 10.3389/fmed.2020.00157
ER  - 

@article{
author = "Miljković, Nenad and Godman, Brian and van Overbeeke, Eline and Kovačević, Milena and Tsiakitzis, Karyofyllis and Apatsidou, Athina and Nikopoulou, Anna and Garcia Yubero, Cristina and Portillo Horcajada, Laura and Stemer, Gunar and Kuruc-Poje, Darija and De Rijdt, Thomas and Bochenek, Tomasz and Huys, Isabelle and Miljković, Branislava",
year = "2020",
abstract = "Introduction: Medicine shortages result in great risk for the continuity of patient care especially for antimicrobial treatment, potentially enhancing resistance rates and having a higher economic impact. This study aims to identify, describe, assess, and assign risk priority levels to potential failures following substitution of antimicrobial treatment due to shortages among European hospitals. Furthermore, the study investigated the impact of corrective actions on risk reduction so as to provide guidance and improve future patient care.

Methods: Health-care failure mode and effect analysis (HFMEA) was applied to hospitals in Austria (H-AT), Belgium (H-BE), Croatia (H-CR), Greece (H-GR), Spain (H-SP), and Serbia (H-SR). Multidisciplinary teams identified processes, failure modes, causes, and corrective actions related to antibiotic substitution following medicine shortages. Characteristics of study hospitals as well as severity, probability, and hazard scores (HSs) of failure modes/causes were analyzed using Microsoft Office Excel 2010 and IBM SPSS Statistics® via descriptive and inferential statistics.

Results: Through HFMEA, 74 failure modes were identified, with 53 of these scoring 8 or above on the basis of assigned severity and probability for a failure. Severity of failure modes differed before and after corrective actions in H-CR, H-GR, and H-SR (p < 0.005). Their probability differed in all study hospitals (p < 0.005) when compared before and after corrective actions aimed to be implemented. The highest number of failure-mode causes was detected in H-CR (46) and the lowest in H-SP (16). Corrective actions can address failure modes and lower HSs; therein, all teams proposed the following: structuring communication among stakeholders, introducing electronic prescribing, strengthening pharmacists' involvement, and increasing effectiveness of the ward stock assessment. These proposed actions led to HS reductions up to 83%.

Conclusion: There is a lack of structure in addressing risks associated with antibiotic substitution following shortages. Furthermore, lack of communication, data scarcity on availability of antibiotics, non-supportive information technology (IT) systems, and lack of internal substitution protocols hinder quick assessment of alternatives addressing patient needs. Nevertheless, the study shows that health-care professionals manage to secure optimal antimicrobial treatment for patients using available IT and human resources.",
publisher = "Frontiers Media S.A.",
journal = "Frontiers in Medicine",
title = "Risks in Antibiotic Substitution Following Medicine Shortage: A Health-Care Failure Mode and Effect Analysis of Six European Hospitals",
volume = "7",
doi = "10.3389/fmed.2020.00157"
}

Miljković, N., Godman, B., van Overbeeke, E., Kovačević, M., Tsiakitzis, K., Apatsidou, A., Nikopoulou, A., Garcia Yubero, C., Portillo Horcajada, L., Stemer, G., Kuruc-Poje, D., De Rijdt, T., Bochenek, T., Huys, I.,& Miljković, B.. (2020). Risks in Antibiotic Substitution Following Medicine Shortage: A Health-Care Failure Mode and Effect Analysis of Six European Hospitals. in Frontiers in Medicine
Frontiers Media S.A.., 7.
https://doi.org/10.3389/fmed.2020.00157

Miljković N, Godman B, van Overbeeke E, Kovačević M, Tsiakitzis K, Apatsidou A, Nikopoulou A, Garcia Yubero C, Portillo Horcajada L, Stemer G, Kuruc-Poje D, De Rijdt T, Bochenek T, Huys I, Miljković B. Risks in Antibiotic Substitution Following Medicine Shortage: A Health-Care Failure Mode and Effect Analysis of Six European Hospitals. in Frontiers in Medicine. 2020;7.
doi:10.3389/fmed.2020.00157 .

Miljković, Nenad, Godman, Brian, van Overbeeke, Eline, Kovačević, Milena, Tsiakitzis, Karyofyllis, Apatsidou, Athina, Nikopoulou, Anna, Garcia Yubero, Cristina, Portillo Horcajada, Laura, Stemer, Gunar, Kuruc-Poje, Darija, De Rijdt, Thomas, Bochenek, Tomasz, Huys, Isabelle, Miljković, Branislava, "Risks in Antibiotic Substitution Following Medicine Shortage: A Health-Care Failure Mode and Effect Analysis of Six European Hospitals" in Frontiers in Medicine, 7 (2020),
https://doi.org/10.3389/fmed.2020.00157 . .