471 / Implementing a system for monitoring and improving prescription appropriateness

ITALY
Classification of the PSP
Type of Patient Safety Practice Safe
 
Clinical Risk Management Practice (CRMP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Surveillance of Patient Safety
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Topic of the reported practice
Quality improvement project
Aim and the benefit of the Patient Safety Practice
 
The elements causing increasing interaction risks are the growing number of drugs available on "health market", and people progressive aging chronically assuming drugs. Using polytherapies may lead to severe clinical risks. It is, thus, important: 1. to identify possible risks of drug interaction, 2. to improve level of attention of general practitioners and pediatricians towards drug therapies, especially in elderly patients subjects to polytherapies 3. to enhance prescription appropriateness, 4. to reduce (private and public) costs related to drug therapies (-9% interactions reported following the issue of reports for each general practitioner and paediatrician; 150.797 EURO saved on health costs- see below, 3rd report available).
Description of the Patient Safety Practice
 
Drugs prescriptions issued by general practitioners and paediatricians (who are part of the Italian Public Health System) were analyzed from2009 on. The analysis concerned the province of Bergamo (one million people; 8.335.083 prescriptions analyzed,; 1.258 general practitioners and pediatricians involved). Prescriptions were matched with Micromedex Drug-reax data to point out and emphasize possible high severity drug interactions and contraindications. The analysis is repeated every six months. The reports currently available are: 1. report on drug interaction where contraindicated interactions are listed in descending order by number and severity 2. report on each drug, where the focus is put on the most severe interactions for couples of drugs (attached); 3. a report for each general practitioner and paediatrician that provides a list of patients for whom possible drug interaction was highlighted.
103_WP4_Totale_1302_BG.pdf
Attachment of relevant written information and/or photos, as appropriate
103_WP4_Totale_1302_BG.pdf
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Institution level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Quantitative
Enclosure of a reference or attachment in case of published evaluation's results
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Health care context where the Patient Safety Practices was implemented
 
Primary care
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
No
Specification of implementation in another health care setting(s)
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Successful implementation's level  of this Patient Safety Practice across settings
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Involved health care staff
 
Physicians
Pharmacists
Quality manager
Risk manager
Other or not relevant
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
No
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
There is no specified text here
Point of time in which service user or their reprasentatives' involvement takes place
There is no specified text here
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
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Short description of the service users' level of involvement
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Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
Yes
List of sources where public information is accessible
http://buonepratiche.agenas.it/practicesdetail.aspx
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
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List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Regular data feed back to involved staff
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
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Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
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Contact information
 
Name: Giuliana Mazzoleni
Country: ITALY
Organisation: ASL BERGAMO
E-mail: gmazzoleni@asl.bergamo.it
Phone: 035/385241
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