January 24, 2024

Interview with pharmacist Kristina Gand

Kristina Gand will be the first pharmacist in Germany to supply nursing homes with fully automated card blisters. We spoke to her about the upcoming changes.

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Together with her team, Kristina Gand will break new ground in the field of blister packaging.

The pioneer in automated blister packaging

In close proximity to a general practitioner, many customers come and go from the Rathaus-Apotheke in Mainz-Finthen every day. For Kristina Gand and her team, this means fast, patient-oriented and effective care. Time is a precious resource here. 

This makes it all the more important for pharmacist Kristina Gand, who runs a total of seven branches together with her mother under the name Apothekenfamilie Mainz, to optimize work processes for future growth. Under the management of Nadine Röder, the Rathaus-Apotheke currently supplies 180 patients with manually filled weekly blister packs. The maximum has now been reached. A new solution is needed to meet future requests from nursing homes.

With the D³ Daily Dose Dispenser from KNAPP, this is now within reach. Kristina Gand will be the first pharmacist in Germany to move into the demo center in Klein-Winternheim in the coming weeks and start fully automated blister packaging. We spoke to the pharmacist from Mainz in advance about the upcoming changes.

The D³ Daily Dose Dispenser is a worldwide innovation - what was the decisive argument for you to take part in this unique project?

Kristina Gand: At first I really thought: Cool, a system that finally produces automatic card blisters and stores the tablets in their original blister until blistering - an incredibly good idea!  The chance of faultless blistering and a simplified final inspection are the decisive criteria for the system. We have already switched from tube blisters to card blisters, as the individual cups can be removed and are labeled with the relevant medication information. In the past, we have seen nursing homes transfer the tubular blister to pots without labeling. Even if these were then stored in a tray with the patient's name, the control and quality assurance were in principle no longer given.

Nadine Röder: Every blister that we deliver goes through the hands of a pharmacist again. It's impossible not to make mistakes when blistering by hand, so we check every dose for completeness. This means that we count every tablet that is in every cup on every day so that the number is correct. We also check that the correct tablets have ended up in the cup. This is done on the basis of color, shape and imprint. And this entire process takes up most of the time at the moment.

With the D³ system, you will be able to deal with your current number of 180 patients at lightning speed. What are your plans for the next one to two years in terms of supplying more nursing homes?

Kristina Gand: The automated process only pays off from 800 beds upwards. That's a figure we're definitely aiming for. How quickly we get there depends, of course, on how quickly we acquire other homes. As a rule, there are home contracts, usually with a term of one year. This means that you don't get another 200 beds straight away. Nevertheless, we would like to wait for the demo center to get started, as we are contractually obliged to supply our nursing homes and have to ensure this. If everything runs smoothly, we can of course increase the number of blisters.

You are in contact with the official pharmacist who is responsible for validating the premises and the D³ system. What is the current status here?

Kristina Gand: We are already in contact with the relevant authorities. As standard, they do not attend field service appointments prior to validation, but only come to inspect. They are also not an advisory body. As soon as we have finalized the validation documents, we will contact them again and hope for a visit to the system as soon as possible.

A process that currently takes us 3 days can be completed in 2.5 hours in future.

Pharmacist Kristina Gand

How will your work processes change with the demo center?

Kristina Gand: That depends on the future. With our current number of patients, we will be finished after 2.5 hours in the demo center. At the moment, we need three days.

So if there are more patients in the long term, we will of course also move our infrastructure. This means that our telephone will be permanently redirected, a computer with all patient data will be installed and, of course, a pharmaceutical  commercial employees and a pharmacist from our team will be permanently in the demo center. But this structure will now gradually build up and grow.

How do you rate the current cooperation between KIM participants when it comes to exchanging patient information?

Kristina Gand: The idea is that the doctors send the e-prescriptions to the care home via KIM, as we have a supply contract with the care homes. They then send the prescriptions on to the pharmacies. In reality, however, most nursing homes are not yet connected to the TI and therefore cannot use a KIM address.

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Together with pharmacist Maximilian Nikolic and branch manager Nadine Röder (right), Kristina Gand will put the demo center into operation.

Nadine Röder: We all hoped that KIM would significantly simplify prescription management. We thought that we would just send a request to the doctor via KIM and receive our e-prescription back a short time later. Technically, this would work, but a statement from Gematik - which has no legal relevance - has caused a certain amount of uncertainty among doctors. The Makelverbot is fundamentally important so that prescriptions do not migrate from the doctor's surgery to somewhere else. 

In my opinion, however, this does not violate the Zuweisungsverbot (Explanatory note: Practices are still prohibited from sending prescriptions directly to a pharmacy) if we as a pharmacy have concluded an officially approved supply contract with the nursing home operator and the respective resident has consented to being supplied by our pharmacy.

According to Gematik, we as the pharmacy should instead send the request to the care home, which must then forward the requests to the respective doctors. The doctor's practice can send the e-prescriptions to the care home via KIM and they finally forward them back to us as the pharmacy. However, the care home has no KIM address and no telematics infrastructure through which they could request this. This proposal is completely unrealistic.

Kristina Gand: Our wish is therefore quite simple: permission for the doctor's surgery to send e-prescriptions to the pharmacy. That would be ideal for us.