Location-settings: PC AREA 3 public hospital and 2 other structure linked in the same provincial network.

About more than 700 beds

Organization: Departmental, wards, complex units, simple units

Central Organization: General Director, Health Directors, Administrative Director, HR Director, Other Technical Office, SPP prevention protection service

Staff: ICT, Budget Control, Economy Buying Office and other

Many Wards: Emergencies, ICU, medical and surgical, ambulatory

Different kind of medical specialty: Surgery, hematology, oncology, infectious disease, cardiology, nephrology Obstetrics-gynecology, pediatrics, trauma, orthopedic, neurology, psychiatry, Otorino, oculistic, allergology, imaging, med lab and, addictions services and  many other. Also transplant are performed (staminal cells- molecular biology and other)

Time of Observation: from 2015 – 2020

Kind of service managed: Public Hospital Gas Management

Position Observed: Hospital pharmacist involved officially in medicinal gas management

Role: Execution Director of Hospital Medical Gases Contract with External Provider- Quality Control of Medical Gases Officially – Pharmacist Responsible for Gas Management

Title of Observed Position: Applied Pharmacologist, Ward Clinical Pharmacist University Title, Hospital Pharmacist Manager

Director of Execution Contract Dec: Medical Gases Providing System and Dec for Contract Internal Transport of Mobile Container of Gases.

Qualified As: Hospital pharmacist and territorial manager level, Complex Structure Directoship Level (Idoneita Alle Funzioni) 2020 Public Selection Cremona   Hosp.

Updating and Formative Management Courses Followed During 2015 – 2020: Several courses relate management topics like: strategic management project management, TQM, Risk management, MBO, problem solving, time management, budget analysis, economic and financiary, Healthcare economy, pharmaco-economy, economic analysis, ICT, gas medical management - regional level courses), communication techinque, team building topics, SWOT anlalisys, DATA management and many other COMPLETE LIST is reported after reference).

Risk Analysis: In the observed period from 2014 – 2020 NO adverse event or incident or other relevant was observed Cost Analysis: During the period 2016-2020 THE  MEDICNAL GASES BUDGET WAS APPROVED BY GENERAL MANAGER, and monitoring of the amount ordered was performed and no overload of ordered products. The cost of medicinal gases was according the rules accepted in official buying procedure of AREA VASTA. No any kind of official contrast between hospitals direction ship and external private gas Provider Company.

Clinical Results: In the observed period NO ANY CLINICAL ADVERSE EVENT WAS OBSERVED AND REGISTERED about medicinal gases used in this hospital.

Quality Control: In the observed period NO any periodic analysis on quality of gases provided was out of OFFICIAL ITALIAN PHARMACOPEIA specific. Only 1 cases related medical air due to also pre-analytical problem but solved in few time.

Control of Documentation: In the observed period all documentation for archive was done. Certificate of analysis, written memorandum, contract, recall, communications and all related.

Revision of Documentation: During this period was introduced DGO operative gestional document or medicinal gases system (in collaboration with TECHNICAL OFFICE AND PREVENTCION PROTECTION SYSTEM OFFICE AND MEDICAL DIRECTOS) officially adopted on going the producing of other related procedure but cited in the DGO.

Emergency Management: Related COVID-19 emergency it was needed to increase the availability of medical gases like oxygen introducing other new TANK near the poli-chirurgic of the HOSPITAL and to add to the central system VARIOUS PACKS UNITS. All this measure added to a great increase in provided medical gases mobile container. And liquid oxygen or concentrators make possible to overcome the great emergencies.

Decription of Role Observed: According Italian rule named CODICE DEGLI APPALTI  there is  a specific position named DEC EXECUTION DIRECTOR OF CONTRACTS that have a substantial PROJECT MANAGER ROLE. This figure is a real link between the extern provider of medical gases and the hospital management. This fugure must EXECUTE the official contract with the winner of the buying procedure of AREA VASTA (an association of various provincial hospital). All this according principle of transparency, equal condition, celerity, under economic and risk evaluation. With the aim to keep the continuity of patient therapy for their need of medical gases and oxigenotherapy. This figure is related so whit buying office, the hospital general managers, directors of clinical units, technical offices, prevention protection service and external provider.

Other Function Officially Played:  QUALITY CONTROL OF PROVIDED GASES. Analysis was performed every 6 month for OXIGEN and medical air and AZOTE. The sample was sended to officially recognized laboratory and the final report was accepted and then under archive procedure.

Updating Procedure:  It was organized a FIRST COURSE for TOP MANAGERS OF HOSPITAL, Related medicinal gases management (co–organized whit technical office engineer and director of prevention protection system) this future also performed as: HOSPITAL PHARMACIST MANAGER RESPONSIBLE FOR MEDICINAL GASES. (Ordering procedure, buying procedure, internal transport of mobile tanks of oxygen. Recall, tracing system of mobile tanks and other related activity). In the first phase of this last contract of providing gases it was needed to change all the big tanks of criogenic oxygen in the 3 principal hospital. It was officially assigned an ENGINEER to DEC medical gases as technical support for system problems. After this complex change procedure was written and signed officially a report for CENTRAL OFFICE OF HOSPITAL. To adequately manage this systems it was needed a 24/24 HOURS every day and for all the year to cover the emergencies. A rapid communication system was adopted to communicate with all the players.

Control Activities: During this period was centrally and peripherically controlled the amount of gases provides also using Informatic on distance system named TELEMETRIE: in this way by REMOTO was possible to verify the data about the tank level added.

Day By Day Activity: contacts with clinical wards, external provider, buying office, medical ventral office, technical office and other related. Verify or ADR adverse event reaction due by medical gases before send it to pharmacology-vigilance center of the hospital. Recall activity according the alert provided by authorities or by manufactures industries.

Official Visit: Activity with written report to verify correct condition of stoking of mobile containers in wards and in central storage.

Cost Managed: About 350.000 euro by year related cost of provide gases (1.750 .000 EUROS BY 5 YEARS), about more the 50.000 euro by year for internal transport by year of mobile container. Other service managed as dec mobile tanks verify and expiration data for 2020 about 40.000 euros. Total costs managed in 5 year: about 2.200.000 euro. But it must be added also cost avoided due by   a safety use of medical gases management system without risks (explosion, burn and other are very expensive and difficult to evaluate before).

Gases Managed: Oxygen (compressed, liquid and cryogenic), Medical air (produced inside hospital with compressor, AZOTE liq, argon, CO2, NO, helio. Kind of physical gases COMPRESSED for mobile tanks for acute therapy or transport LIQUID for chronic therapy CIOGENIC: for central system of providing

Use: therapeutic (oxygen, NO, medical air), imaging HELIO for RM, Laboratory Co2, Surgery (Argon), Crioconservation of Sample N2, Mixture Of Gases For Otorino And Spirometry, Oxigenoterapy, Ventilation In ICU, Diagnostic And Surgery Procedure  (Criosurgery, Laparoscopic Procedure), Motor Gases For Instruments, To Refrigerate Magnete Resonance, Medicine Laboratory.

For all this Activates was used Various Managerial Techniques Like: Project management, Time management, HR MANAGEMENT, Budget analysis, Risk analysis, ICT management, MBO, TQM, Soft Skills Management, Communication Management and many management techniques : like problem solving, brainstorming, what if analysis, zero vision, Heisenower matrix, FMECA,  ishikawa diagram , critical path methods. Using not also an historic way but also a prospectic approach.

Financiary Aspect: This practical experience is related a public setting of a provincial hospital PC AREA and related other presidium so the patient involved are under the cover of public financial providing.

Reimbursement Policy: According national Italian RULES a national system regulate LEA essential level of cure for all patient and then from national level was decide level of financiary cost reimbursed to the single regions. The regional institution provide to the local hospital the amount needed of money.

Monitoring Activity:  During observed period was performed various activity

• Monitoring of Amount Provided of Gases
• Monitoring of Quality of Gases
• Monitoring of Total Costs Of Gases- Economic Evaluation- Budget Impact
• Monitoring of Adr
• Monitoring of Recall and Non Conformty
• Monitoring of Official Documents
• Monitoring of Revision Of Procedure
• Monitoring of Official Data Flux for Region
• Monitoring of Correct Informatics Codify of Products
• Reimbursement Procedure

Periodic Management Evaluation: In the global period observe: every year POSITIVE EVALUATED BY THE CENTRAL HOSPITAL MANAGEMENT OF HR.

The Budged: For medicinal gases was respected. NO any controversy with external providers. NO ANY written report related ADR on near miss event and other.