Figure 6: Storage room for pharmaceutical drugs and medical devices7.
therapeutic use of antibiotics. To prevent, or at least slow down, the development of resistance wherever possible, and to promote rational antibiotic use, an antibiotic stewardship (ABS) team has to be formed, whose legal basis can be found in the German Infection Protection Act. An important factor in making ABS programmes succeed is a multidisciplinary expertise. Therefore the ABS team has to be adequately equipped and tasked by hospital management to prepare guidelines for the treatment of infectious diseases together with the users and to ensure their implementation. The ABS team comprises an infectiologist and senior clinical pharmacist as well as a specialist for microbiology, virology and infectious disease epidemiology who is responsible for microbiological diagnostics and clinical and microbiological counselling, and the physician responsible for hospital hygiene. All team members have undergone antibiotic stewardship training and have gained relevant experience in the field. Figure 7: Discussing a pharmaceutical issue7.
Medication safety is frequently mentioned in connection with the use of medicinal products. According to estimates of several studies, adverse drug events (ADE) account for up to 5% of all hospitalizations, up to 30% of all hospitalizations in the elderly5, 6. To avoid these risks, medication process safety requires increased attention. The objective of medication safety is not to define the appropriate use of medicinal products. Thanks to a larger amount of available data, medication analyses facilitate the detection of problems related to the use of medicinal products. In contrast, such problems cannot be systematically identified during pharmaceutical counselling at the time of dispense. Depending on the source of information used, various problems arising from the use of medicinal products can be methodically examined by performing different types of medication analyses. The main objectives of medication analysis and management therefore also depend on which sources of information are available or used. The pharmaceutical team develops options for solutions to severe problems related to the use of medicinal products. The resulting treatment is then discussed with the attending physician and, if necessary, with the patient.
To optimize pharmaceutical services, a pharmaceutical room was set up in the Bundeswehr Hospital Ulm, where not only hospital staff, like physicians and nursing staff, but also patients may ask their questions about pharmacotherapy. For some time now, information on medication delivered in personal conversations, including during ward rounds, has become increasingly important. Only recently a question arised concerning the hygienic conditions and the professional environment related to the provision of medicinal products on the ward. Pharmaceutical counselling services in Ulm are supplemented by a medication information hotline. During normal working hours, one pharmacist is always available on the phone in order to answer the questions of physicians or nursing staff. The objective of all of these measures is to make the medication process safe. In order to manage the related workload, however, the pharmacists need help from a clinical decision support system (CDSS). This system gives a answers to numerous questions.
Meanwhile it is common knowledge that the development of resistance is a decisive factor in the rational
International Review of the Armed Forces Medical Services
Revue Internationale des Services de Santé des Forces Armées