Background and importance Special drug prescriptions and authorisation by the hospital medical director is a necessary but time consuming activity that could even delay the start of treatment in some cases. To avoid documents and improve traceability, since 2014 our third level hospital is using an internal application (Rafpharma). This works as a mailbox: the treatment request for a specific patient is created by the physician, his head of the service agrees, the pharmacy service assesses the suitability and the medical director (MD) authorises/denies the treatment requested.

Aim and objectives To optimise the individualised special treatments requests circuit.

Material and methods A multidisciplinary working team (MWT) was created, including five hospital pharmacists, the head of the pharmacy department (PD), an internal medicine physician, the hospital MD and a hospital informatic, aimed at analysing all requests, identifying inefficiencies and proposing solutions to optimise the circuit.

Results Nine work team meetings were held between February and June 2018. Each of the 1641 requests in 2017 were analysed. The main causes reducing the efficiency of the system were: high volume of requests, time spent in the application and lack of knowledge by the persons involved. With the aim of improving the efficiency of the system, the working group implemented the following measures.

1. Reduced the number of treatments that required authorisation from the MD, with the agreement of the pharmacy and therapeutics committee (FTC). This was possible by avoiding the need for special requests for certain drugs, affecting 39% of all the requests; encouraging three medical services to request approval for off–label use by the FTC, of which two did; and finally the group recommended that several medical services make a formal request to include 11 drugs in the hospital (only 3 have been requested).

2. Optimisation of Rafpharma application by the informatic department.

3. Development of Rafpharma user protocols by user profile.

4. Planning of specific training sessions in the departments involved.

Conclusion and relevance The optimisation process of the individualised request circuit led to improvement in the three main problems detected. The group reduced the circuit´s workload by nearly 40%. The creation of MWTs makes approaching any key process from all points of view possible, allowing proposals to be made for optimisation agreed upon.

Conflict of interest No conflict of interest