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Page 1 of 17 10/11/2017 File:///C:/Users/Henadzi.Sobal/Documents Page 1 of 17 GOT18-0018. Impact of Clinical Pharmacist Analysis to Clinical Decision-Making for Drug Therapy Management in the Hospital Care Setting Background A deeper understanding of pharmacist clinical decision-making should provide the influence that pharmacists have on patient health care, should guide pharmacy policy and education, should contribute to educating less experienced pharmacists on decision-making processes, should promote more interprofessional work, and should encourage pharmacist decision-making toward the wisest selections of patients’ medication therapy. Purpose The overarching objective of this research study was to document drug therapy decision-making processes of clinical pharmacists in the hostital care setting. The specific aims of this study were to examine the current clinical decision-making of clinical pharmacists in the context of the hospital care clinic setting, to compare and contrast pharmacist clinical decision-making with current decision-making models. Material and methods We used a quasi-randomized design to evaluate a quality improvement project in three hospitals in Kazakhstan. Three audio-taped data collection methods of participant observation and semi-structured interview were utilized and exactly transcribed to provide textual data for analysis. Thematic analysis provided emerging themes of clinical pharmacist-led medication and clinical decision-making which were further subdivided into subsuming themes after much reflection and interpretation of the entire study data. Results Other health professions have identified experienced clinical decision-aking to encompass the Decision Analysis, intuition and pattern recognition. Clinical pharmacists’ clinical decision-making processes are considered in light of other health professionals’ decision-making techniques; however the results show that clinical pharmacists use a different model of clinical decision-making using constant dialogue between two different types of knowledge (objective and context-related). The analysis suggests that the enabling factors and barriers to clinical decision-making are unique for each context. The availability of time to spend with patients and the effort in consulting with other health professional colleagues have enabled clinical pharmacists to ensure more patientcentered decisions in the general hospital care clinic setting. Conclusion This research study demonstrated significant similarity between clinical pharmacists’ and other health professionals’ experienced clinical decision-making. The cross-communication between different health professions may further improve decision-making processes and collaborative practice agreements. This study provides evidence for better understanding of the current clinical pharmacy practice, which may further expand the success of clinical pharmacists’ contributions to improving patient care. References and/or Acknowledgements N/a Conflict of Interest No conflict of interest GOT18-0027. USING QUALITY IMPROVEMENT METHODOLOGY TO IMPLEMENT A PHARMACIST- LED MEDICINES RECONCILIATION SERVICE Background Improving the quality and safety of health care services remain a priority reflected in national strategy and reforms. The purpose of a quality improvement project is to implement evidence based standards to improve outcomes in clinical care or processes which are measurable and sustained over time. Provision of medicines reconciliation (MR) is an international healthcare priority. MR is one of the World Health Organisation’s (WHO) High 5s patient safety priorities. This is reflected nationally through MR inclusion in national health service policies and guidelines. file:///C:/Users/henadzi.sobal/Documents/cmOffice/Temp/TempF120607604.html 10/11/2017 Page 2 of 17 Pharmacists are the preferred profession internationally for undertaking MR, however, it is recognised that this is a resource intensive activity. Purpose To utilise quality improvement methodologies to implement and measure a pharmacist-led MR service. Material and methods • Drugs and Therapeutics Committee assessment of the strategic MR requirements. • Business case and service scoping document development for Chief Executive Officer (CEO) evaluation • Appointment of a dedicated MR pharmacist • Stakeholder engagement pre-implementation. • Identification of Key Performance Indicators for measurement and review to ensure on-going evaluation Results CEO approval was obtained for phased implementation of a pharmacist-led MR service. The MR service commenced in July 2016 with one dedicated MR pharmacist. The service is modelled on WHO Guidance which specify; - The priority patient cohort; Patients aged ≥ 65 years admitted through the Emergency Department. - Service measures, sampling criteria and targets to quantify service capacity and quality. Conclusion MR services are recognised to improve medication and patient safety. MR is a priority practice in the hospital's strategy and reforms. A quality improvement MR project was proposed. Phase one of a resourced pharmacist-led MR service was implemented in 2016. Service quality and expansion requirements are assessed using internationally recognised measures to enable on-going review of service performance. References and/or Acknowledgements [i] Health Service Executive (2015) National Service Plan 2015 [ii] Stausmire, J. (2006). Quality Improvement or Research Worksheet. Health Care, 34(6). [iii] World Health Organisations High 5 Medication Reconciliation Project. [iv] Health Information and Quality Authority; Guidance for Health and Social Care Providers, Principles of Good Practice in Medicines Reconciliation, May 2014. [vi] Integrated Care Guidance: A Practical Guide to discharge and transfer from hospital, Jan 2014. [viii] ASHP statement on the Pharmacist’s Role in Medication Reconciliation, 2013. Conflict of Interest No conflict of interest GOT18-0030. PRODUCTS IN KNEE PROSTHESIS: A SISTEMATIC REVIEW Background Purpose To realize a review of knee arthroplasty, and to identify and summarize the characteristics of the different prosthetic components involved. Material and methods file:///C:/Users/henadzi.sobal/Documents/cmOffice/Temp/TempF120607604.html 10/11/2017 Page 3 of 17 A search of electronic databases was performed until March 2017, to identify randomized clinical trials, cohort studies, cases and controls studies, case series, clinical practice guidelines, systematic reviews or evaluation reports of health technologies on Knee Arthroplasty. Inclusion criteria: studies that represented the original investigation, ≥ 18 years, any diagnosis of knee arthroplasty indication, partial or complete replacement without establishing fixation technique and with or without comparator. Exclusion criteria: authors declare that they have competing interests. A total of 653 studies were identified, of which 15 primary studies were selected for analysis. Results Knee prosthesis components are: tibial, femoral and patellar. They can be used alternately with or without cement depending on patient characteristics, age and bone quality. Partial arthroplasties may be unicompartmental or patellofemoral.All implants used in knee arthroplasty must meet: biocompatibility, resistance to mechanical stresses, friction and corrosion. Materials: Ultra high molecular weight and crosslinked polyethylenes: very high degree of hardness and resistance to friction, used for most tibial inserts. Cobalt, vanadium or titanium alloys known as Ti6AI4V: used for femoral components. Chromium-cobalt and titanium alloys: used for some tibial components. Polymethylmethacrylate: the so-called bone cement with which the femoral and tibial components are placed.Vitallium (30% chromium + 7% molybdenum and a mixture of cobalt, nickel and other materials): for joint surfaces of the knee. Zirconium implants: They are made of a metal that has gone through a process that allows the metal to absorb oxygen, creating a ceramic surface. They can potentially last up to 20 or 25 years and also metal allergic personnel can use them. Conclusion Considerable advances in the understanding of knee kinematics over the last decades have led to improvements in the design of prosthetic knee implants and an explosion in the number of options for each scenario. Current trends show a growing direction on appropriate timing of arthroplasty, coupled with improved prosthesis designs as the respect for the set of intrinsic stabilizing structures increases, along with finding the right balance between design and the anatomical kinematic functionality. References and/or Acknowledgements Conflict of Interest No conflict of interest GOT18-0089. USE OF DALBAVANCIN AS A CONSEQUENCE OF HEMATOLOGICAL TOXICITY DUE TO LINEZOLID IN A PATIENT WITH PROSTHETIC INFECTION AORTOILIAC Background Dalbavancin has been approved for the treatment of acute bacterial skin infection and skin related structures in adults. Infections of the skin and soft tissue infections are one of the most prevalent both in the community and in hospitals infections. Actually, the medical literature doesn't contemplate the use of this antibiotic outside of this indication. Purpose To evaluate the efficacy and safety of dalbavancin in a patient with prosthetic infection aortoiliac Material and methods The information was obtained across of dispense program outpatient (Dominion®) from where collected all patient evolution. We did track of every medical consultation (analytical controls of blood and blood cultures) in a total period of 13 weeks.
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