Sweden

1
Sweden

• 9,3 million inhabitants
• 20 county councils
• 90 hospitals
• The state-owned National Corporation of Swedish
  Pharmacies (Apoteket AB) has the sole and
  exclusive right to retail medicines, both to the
  general public and to hospitals.

2

• Medical Products Agency (Läkemedelsverket), is
  the government authority responsible for the
  control of pharmaceutical preparations.
• The National Board of Health and Welfare is
  responsible for the quality controll of health
  care.They also gather the results of error
  reporting.They publish root-cause analysis made
  by those involved. They will not make a report to
  the discipline board if you start a root cause
  analysis within 7 days of the event.
• Under the terms of the social insurance scheme,
  the patient never has to pay more than SEK 1,800
  in any twelve-month period.
• The Pharmaceutical Benefits Board
  (Läkemedelsförmånsnämnden) decides which
  pharmaceutical preparations should be subsidised
  and then, through negotiations with the
  manufacturers, how much they should cost. A
  prescribed drug which qualifies for subsidy shall
  be exchanged for the cheapest comparable generic
  alternative available at the pharmacy.

3
Patient case

• Prescription for Tradolan 2x20 .Generic
  substitution was performed at the pharmacy.
  Patient got 20 tabletts of "Nobligan", and 20
  tabletts of "Tramadol". The precription was for
  "Tradolan", which he had some at home.

4

• Decision support is lacking or of low quality
• There have been problems with electronic
  prescriptions pharmacy. 34 cases of mix-ups
  (may 2006) between drugs and dosing.
• (Aspirin 75 mg 3 times daily and Metronidazol 400
  mg 1 daily). Premature IT-systems for example
  Insulin was standardized to be dosed in ml
  instead of units.
• Technology many different devices
• Staff controlled PCA

5
Jönköping county council

• Collaboration with IHI Boston
• Patient safety officers education for Sweden
• Measuring ADE
• Standardization of concentrations
• Building "ready to use prescriptions". How to
  reconstitute, standard dosing, rate, monitoring
  recomendations.

6

• Last week Annsofie attended a meeting invited by
  the pharmaceutical industry to talk about look
  a-like and sound-a-like drugs
• Media - supportive
• The medical product agency
• The national board of health and welfare
• Cowriters for a book about the death of a child
  in Kalmar 2002 (lidocain)

7

• How do we involve patients
• How do we get rid of old standards, drugs seldom
  used, old litterature?
• How do we get the pharmacist to work in the
  clinical setting instead of in the pharmacy?

8
Vincristin

• Interviews with the 10 leading physicians in the
  childrens oncology of Sweden were conducted in
  the spring of 2006. They now agree to order
  vincristin in infusion bags instead of syringes.
  Adult patients in Sweden has already received
  vincristin in minibags. Swedish pharmacies
  implement this new standards in 2007. Annsofie
  Fyhr

9
KCL - Sweden

• 1000 ml Glucos 50 mg/ml or 100 mg/ml with Na 40
  mmol and K 20 mmol is standard for peripheral
  IV infusions.
• ICU use 1 mmol/ml for some patients (central iv)

• Oral administration in NICU
• One death in the homecare setting in 2002 through
  mix-up
• Goals Get industry to provide ready to use
  infusions containing KCL

10
What has been done?

• 1 mmol/ml KCL in 50 ml has been registered in
  Norway a year a ago.
• We are waiting for the same product in Sweden

• We have asked ICU physicans what ready to use
  products they need. 37 of 70 responded. Most wish
  to use1 mmol/ml in the ICU setting.
• Lack of "urgency" from physicians. It will not
  happened here!