Author(s)

Laura Rueda Montes, David Tomás González, Iker Muñoz Delgado, María Fernández-Vázquez Crespo, Jesús Airam Domínguez Cháfer, Rocío Manzano Lorenzo, José Carlos Tallón Martínez, Cristina González Pérez, María Ángeles Campos Fernández, Susana Sánchez Suárez, María Teresa Benítez Giménez

Why was it done?

One of the core responsibilities of hospital pharmacists is the validation of inpatient medication prescriptions. Our goal was to identify medication errors that could compromise patient safety, and to optimize and standardize pharmaceutical recommendations, ensuring consistent validation practices across pharmacists. This initiative serves as a tool for quality assurance and patient safety.

What was done?

Design and implementation of an automated alert system for pharmaceutical validation of prescriptions integrated into the Electronic Medical Record (EMR), which generates real-time pop-up alerts based on a database parameterized with clinical rules. During validation, the pharmacist decides whether the alert is appropriate and if accepted, a notification is added to the medical prescription, as well as a record of this intervention in the EMR.

How was it done?

Key pharmaceutical interventions (PIs) were established to optimize prescription validation, grouped into two categories:
• Drug-dependent interventions: 577 PIs classified into 9 groups: maximum dose, therapeutic duplication, drug interactions, gastroprotection, laxative prophylaxis with opioids, incorrect administration techniques, treatment duration, potentially inappropriate medications in older adults, and sequential therapy.
• Patient-specific interventions based on lab data: 398 PIs classified into 7 groups: renal failure, electrylite (magnesium, potassium, and sodium) levels, neutropenia, thrombocytopenia, and anemia.
With support from the IT department, an algorithm was configured using a total of 975 rules that we established for 386 drugs. When a prescription meets any of these rules, an alert pops up in the EMR, displaying a predefined pharmaceutical recommendation tailored to the patient.

What has been achieved?

Implementation of the alert system in the pharmacist’s EMR profile in order to detect medication errors in patients who meet one or more of the rules set in the created algorithm.
Moreover, a dashboard was created displaying the number of interventions by prescribing department, drug, and type of intervention.
Since its launch in April 2025, a total of 3,547 PIs were made for 2,411 patients within six months.

What next?

Ongoing review of existing alerts based on feedback from the pharmacy team, along with the incorporation of new rules to maximize medication safety for hospitalized patients.

Author(s)

A. VARAS PEREZ1, MJ. LOPEZ MUÑOZ1, C. RODRIGUEZ MORETA1.
1HOSPITAL SERRANIA DE RONDA, FARMACIA, RONDA, SPAIN.

Why was it done?

Long-acting injectable antiretroviral therapy represents a major advancement in HIV management. This method of administration is novel, and as such, a process must be defined that involves different healthcare professionals and that must provide the patient with the training related to the administration in the best way. The intramuscular combination of cabotegravir and rilpivirine (CAB/RPV IM) offers an alternative to daily oral regimens, potentially improving adherence and patient quality of life. To ensure safe and efficient implementation, a multidisciplinary protocol was developed in a primary hospital.

What was done?

A coordinated protocol was established for the prescription, validation, dispensing, and administration of CAB/RPV IM, involving hospital pharmacy, nursing, and medical teams. Outcomes were assessed after one year of implementation.

How was it done?

A retrospective, cross-sectional descriptive study was conducted, analyzing CAB/RPV IM administrations recorded since March 2024. Inclusion criteria included virologic suppression, stable oral regimen, absence of resistance mutations to CAB/RPV, no hepatitis B coinfection, and patient commitment to scheduled visits. Electronic prescribing via Farmatools® triggered appointments with pharmacy and nursing. Pharmacists provided individualized care and scheduled doses within the ±7-day window, aligned with nursing availability. Patients received automated email reminders; missed appointments prompted follow-up calls. Delays beyond seven days were reported to the physician. Data on administration dates, discontinuations and reasons, viral load, and dosing intervals were extracted from the External Patient Module PRISMA and electronic health records.

What has been achieved?

A total of 518 doses were administered to 138 patients. Nine patients (6.5%) discontinued treatment due to adverse effects, personal/work conflicts, pregnancy, anticoagulation, or lack of appropriate needles. No virologic failures occurred. All doses were administered within the ±7-day window (mean deviation: -1.9 ± 2.0 days). The average number of doses per patient was 3.6 (range: 1–7). Nursing intervened in 4.5% of follow-up visits due to missed appointments. Email reminders reached 81.9% of patients. The protocol enabled integrated care, improved adherence, and ensured safe delivery of CAB/RPV IM therapy.

What next?

Expansion of the protocol to new candidates is planned, along with enhanced interprofessional coordination and digital tools for active follow-up. This experience may serve as a model for other centers implementing CAB/RPV IM in HIV care.

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Author(s)

Pascaline Hubot , Elise Francq, Guy Stichelbaut

Why was it done?

Hospital pharmacy is a constantly evolving field that requires ongoing training. New teaching strategies based on the gamification of educational objectives have been making headlines for several years. These include EG.

What was done?

An educational escape game (EG) has been designed and implemented for hospital pharmacists and pharmaceutical-technical assistants (Apth) working in one of Chirec’s distribution departments (Belgium). The objectives were : to provide continuing education and to improve various cross-disciplinary skills such as communication, team cohesion and critical thinking.

How was it done?

After considering the various constraints (dedicated time per session, number of players, etc.), a non-linear scenario was constructed. Distribution-specific themes were chosen for the creation of 12 enigmas, some in paper format and others in virtual format using Genially platform (November 2022 version). To ensure that the training sessions ran smoothly, hint envelopes containing the updated procedures were provided. Finally, the EG was pilot tested to get an idea of the game’s timing, to identify and correct any practical problems, and to adapt certain enigmas deemed too complex if necessary.

What has been achieved?

Nine sessions were held between December 2022 and September 2023. Each session included : briefing (5’), EG session (45’), debriefing (10’) and the distribution of an anonymous satisfaction survey at the end of the session (2’). Pharmacists (n = 24) and Apth (n = 15) respectively agreed (37.5% (n = 9) ; 66.7% (n = 10)) and strongly agreed (54.2 % (n = 13) ; 20% (n = 3)) that the EG improved their knowledge, and all participants found the EG to be a good teaching tool. Feedback was also very positive on cross-functional skills such as communication, team cohesion and critical thinking.

What next?

Futures sessions will be planned for newcomers to the pharmacy. Given the popularity of this educational tool and the suggestions for new topics, a new EG theme will certainly be on the agenda for 2024 pharmacy continuing education.

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Author(s)

Eleonora Castellana, Simonetta Felloni, Matilde Scaldaferri, Giuseppina Bonfante, Elena Maggiora, Francesco Cresi, Maria Francesca Campagnoli, Alessandra Coscia, Maria Rachele Chiappetta, Francesco Cattel

Why was it done?

The purpose was to provide the Neonatal-Intensive-Care-Unit (NICU) with ready-to-use bags that could improve patient safety by minimizing procedural incidents and maximize resource efficiency while providing clinically appropriate nutrition for the single PP.

What was done?

Seven standard bags (SSB), ready-to-use, have been formulated and developed for parenteral nutrition (PN) in preterm patients (PP). An assisted prescribing software was developed for selecting the most appropriate standard bags (SB).

How was it done?

The project was carried out in collaboration between pharmacists, nurses and neonatologist of NICU.
The composition of the SB was identified from the retrospective analysis of the types of individualized bags requested from the Pharmacy and from the analysis of the recommended ESPGHAN-Paediatric-Parenteral-Nutrition-2018 contributions.

What has been achieved?

SSB ready-to-use were identified:

The bags have been produced by an industrial partner according to Good Manufacturing Practice-Annex 1. The shelf life is 90 days.

The SSB were implemented successfully on the PP. Starting from 2021, approximately 250 bags/month have been used, with a reduction in individual preparations by the Pharmacy of approximately 80%.

This approach showed results in terms of clinical results and economic outcomes. The computer program guided the physician to the most appropriate standardized solution.

Early and timely administration of ready-to-use PN showed reduced weight loss and a shorter duration of PN than individualized bags (21 vs 25 days).

What next?

The project described has shown benefits including improved nutrient supply, fewer prescribing and administration errors, lower risk of infection, cost sav-ings, ready availability of the bags 24/7 and safe and effective supply of SB. This project will be strengthened in our hospital.

Author(s)

Irene Centeno López, Eva M Legido Perdices, Maria José Cano Cano, Salvador Benlloch Pérez, Federico Peydró Tomás, José Manuel Ventura Cerdá

Why was it done?

Acetaminophen is the most used antipyretic and analgesic drug around the world. Intentional and non-intentional acetaminophen overdose is related to acute liver failure and it is important to start the treatment during the first hours after the intake to reduce liver injury. The main treatment to prevent liver failure is n-acetilcysteine (NAC) and it is administered depending on acetaminophen plasmatic concentrations using Rumack-Matthew nomogram during the first 24 hours. Variability in sampling time and duration of NAC administration was detected when acetaminophen intake was unknown or above the first 24h. Moreover, different NAC administration protocols were used in our institution.

What was done?

An interdisciplinary team involving Hospital Pharmacy, Emergency, Gastroenterology Department and Critical Care Unit was created to establish an agreed protocol for the management of acute acetaminophen poisoning.

How was it done?

The interdisciplinary team agreed the following procedures:
– To change the traditional NAC protocol of three intravenous infusions (150 mg/kg over 1 h, 50 mg/kg over 4h and 100 mg/kg over 16h) to the SNAP protocol of two bags (100 mg/kg over 2h and 200 mg/kg over 10h) reducing duration of administrations from 21 to 12 h.
– To establish the sampling times for the determination of acetaminophen serum concentrations: the extraction will be 4h after the ingestion during the first 24h of the intake. When time is unknown or greater than 24h, two samples separated by at least 2h will be extracted to calculate acetaminophen half-life to assess the probability of liver damage (high probability when half-life (t1/2)>4h).
– Define NAC discontinuation when INR<1.3, transaminases are in normal range and acetaminophen concentration<10 mcg/ml. If one of these parameters remains altered, the last NAC perfusion must be repeated.

What has been achieved?

– Reduce the duration of NAC treatment in the Emergency and hospitalization rooms if all analytical parameters are normalised.
– Reduce the variability in the management of acetaminophen poisoning and sampling time.
– To perform a closer clinical follow up of intoxicated/over-medicated patients.

What next?

Measure the reduction of hospital admissions and safety improvement by modifying NAC administration protocol and therapeutic drug monitoring of acetaminophen.

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Author(s)

Jesper van Breeschoten, Chang Chui, Bert Storm, Grootswagers-Sobels Annemieke

Why was it done?

After the introduction of new medications in a hospital, it is uncommon for local treatment and administration protocols to be reevaluated in light of the latest scientific evidence. Infusion units are facing numerous challenges today, including staffing shortages and a growing number of patients receiving intravenous treatments. It may prove beneficial to periodically conduct a comprehensive review of the current protocols, with the objective of minimizing the time patients spend in the infusion unit and to prevent unnecessary use of medication while upholding the delivery of high-quality care.

What was done?

We performed an extensive review of treatment protocols for all medications administered at our infusion unit.

How was it done?

We performed an extensive review of treatment protocols for all medications administered at our infusion unit, drawing insights from the most recent literature. Our evaluation covered a range of factors, including premedication, infusion rates, observation periods, line flushing, administration routes, hydration strategies, and anti-emetic regimens. To provide additional data supporting protocol refinements, we utilized an electronic health record text mining tool known as CTcue, which facilitated the collection of retrospective patient information. Subsequently, these protocol modifications received unanimous approval from both pharmacist and attending specialist.

What has been achieved?

Treatment and administration protocols of 17 medications were optimized. We decreased infusion times for atezolizumab, bevacizumab, carboplatin, doxorubicine, durvalumab, folinic acid, irinotecan, panitimumab, vinblastine and vincristine. Vital sign assessment during infusion were omitted from protocols. Premedication and anti-emetic medication were converted to oral administration. Intravenous administration was converted to subcutaneous administration for abatacept, daratumumab, infliximab, tocilizumab, trastuzumab + pertuzumab and vedolizumab. Observation time after infusion was omitted for daratumumab, infliximab and vedolizumab. Based on the current literature, hydration schemes of cisplatin were shortened from 20 hours to 4 hours. The implementation of all optimization measures resulted in a reduction of ± 6000 hours of bed occupancy by patients annually. Based on our estimation, this has resulted in a reduction of approximately 16% in total time that beds were occupied.

What next?

We aim to periodically review our treatment and administration protocols and share our experiences with other hospital pharmacists. Other infusion units that also face challenges in shortness of staff may copy this blueprint to mitigate these problems.

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Author(s)

Sophia Hannou, Cristina Nicorici, Patricia Spitz, Samuel Cotte, Wanda Bosshard, Nancy Perrottet, Pierre Voirol, Farshid Sadeghipour

Why was it done?

Medication use process is at high risk especially for opioids. In our geriatric rehabilitation unit, self-reporting incidents are submitted regularly to our quality system. Among the 44 drugs incidents reported in 2021, 11 included opioids. Prevention with training is a way to reduce these errors. However, theoretical teaching covering the “5 rights” rule remains insufficient. Therefore, an interactive learning with a room of horrors focused on opioids was selected by our unit to prevent these errors. The objective was to cartography and identify the most risky steps and to introduce specific actions to reduce these risks.

What was done?

A room of horrors with a specific focus on opioids has been developed and implemented to reduce errors in medication circuit.

How was it done?

An interprofessional group created the room of horrors based on real incidents. Fictional patient, clinical situation and opioid prescription were created in the medical software. Several drugs and medical devices were available. A model wore an identification bracelet. Ten errors, covering the five rights, were hidden in the room. A pair of healthcare givers had 20 minutes to realise the simulation (5 for the briefing, 10 for the exercise and 5 for debriefing).

What has been achieved?

During the World Patient Safety Day 2022, 38 healthcare professionals (19 nurses, 10 assistant nurses, 9 geriatricians) participated to this training. Errors were detected in variable proportions. For example, 58% of the participants uncover the patient identification error, 53% the pharmaceutical form, 53% the expired date, 47% the allergy contraindication and 47 % used the oral syringe.

What next?

Results and theoretical notions will be presented to all professionals of the unit. This room of horrors is transposable and can be used in other units of the hospital. A video of this simulation was created as an e-learning. It will be implemented as a continuous training or for new collaborators in our unit and can be shared to other units of the institution. Incidents will be continuously monitored and the training will be adjusted in the future. Based on the success of the room of horrors, this interactive learning will be used in other areas with other clinical or technical dimension.

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Author(s)

Cathrine Noergaard Peulicke, Michelle Lyndgaard Nielsen

Why was it done?

The process of building a new hospital has led to development and rethinking the drug concept. At the hospital we always have “the patient first” in mind. This is our codex. That is why we are changing the concept for delivery, dispensing and administration of medication. We wanted to ensure that the concept functioned from a patient safety perspective, patient flow perspective, patient involvement perspective, professional development perspective and perspective of a healthy operation. The vision is the right medication, from the right hand at the right time.

What was done?

At the new hospital, the medication logistics will undergo major changes. There will only be medication for acute use at the wards, the rest will be delivered ready-to-use from the main pharmacy or from a decentralised unit, called Pharmaservice. Here IV-solutions with short expiration are being reconstituted and oral solutions are dosed according to the prescription. Tablets and capsules are dispensed in the multi-dose robot at the main pharmacy. The multi-dose medication is equipped with a bar code which is scanned at administration and full electronic documentation is obtained. The majority of the medication will be dispensed daily for 24 hours and delivered in boxes for each patient to the wards.
In order to ease the transformation, we have built a mock up of a Pharmaservice unit where this set-up is enrolled to all inpatient wards in the hospital on the geriatric ward, children’s ward and gynaecology and obstetrics ward.

How was it done?

A steering group was founded and membered by managers from the involved wards including the hospital Pharmacy. Frequent meetings with the involved wards has been necessary to ensure competences and communication. Post-implementation we are closely evaluating the initiative.

What has been achieved?

Patient safety is in focus and with the multi-dose dispensing robot we have achieved full electronic documentation from the prescription, dispensing and administration process, and thereby have reached closed loop medication.

What next?

Having implemented the initiative on three wards, we are now working on enrolling this to the entire new hospital when it is ready in 2024. At the new hospital, we will have five Pharmaservice units servicing all inpatient wards.

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Author(s)

Trine Birkholm, Trine Rune Høgh Andersen

Why was it done?

The Danish Ministry of Health has declared which healthcare professionals should handle medication such as dispensing and administration to patients in hospitals. Traditionally, primarily nurses and physicians handle administration of medicines in the Danish hospitals. In recent years a massive shortage of nurses in Danish healthcare has called for other professions to participate in administration of medicines. As Denmark has employed less than one clinical pharmacist per 100 beds in hospitals, pharmacists are not able to contribute to the task. However, clinical pharmacists can have an important role in educating other healthcare professionals e.g. HCAs in handling medicines.

What was done?

Because of massive lack of nurses and thereby healthcare professionals to administer medicine in psychiatric wards in Region Zealand, Denmark, the pharmacists developed and implemented a training course for social and healthcare assistants (HCAs) to participate in the task.

How was it done?

As hospital pharmacists should ensure that the information needed for safe medicines use, including both preparation and administration, is accessible at the point of care (EAHP statement 5.9), aiding in the development of a training course for HCAs was ideal for the clinical pharmacists. The training course has a duration of 3 days followed by a mentored trainee period. The course includes psychopharmacology lessons to teach HCAs to observe and react to overdoses, lack of effect or side effects as declared in medicine handling guidelines.

What has been achieved?

Approximately 150 HCAs have attended the course since 2020. Eight out of ten state that the course has enabled them to take on the new work tasks. Nine out of ten believe that they can use the newly acquired knowledge and practical skills for their new work tasks. Today, the administration of medicines in the psychiatry ward is also managed by HCAs, thus relieving the nurses’ time needed for more specialised tasks.

What next?

There is also a shortage of nurses in the somatic hospitals. To ensure patient safety and enough staff to dispense and administer medicines, several hospital wards have requested similar training for HCAs. It is believed that similar training courses with modifications can target somatic wards as well.

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Author(s)

Betânia Abreu Faria, Sara Barroso, Antonieta Silva, Olga Martins

Why was it done?

Portuguese legislation “The Basic Health Law (No. 95/2019) and the National Plan for Patient Safety 2021-2026 (NPPS 2021-2026) and the goals of the World Health Organization (WHO) are fundamental pillars of healthcare safety. The NPPS has promoted patient safety in the Portuguese National Health Service, focusing on specific issues such as safety culture, unambiguous identification of patients, safe surgery, pressure ulcer prevention, prevention of falls, infections associated with healthcare and incident reporting and drug safety. Thus, it is essential to ensure the training of health professionals (HP) in the field of patient safety and the safe and rational use of medicines. The objectives of the training actions focused on the safe use of medication, promoting patient safety and sharing experiences between the various HP, in order to optimise the circuits and procedures already implemented.

What was done?

Multidisciplinary training actions were carried out within the scope of safe medicine practices.

How was it done?

A team of four pharmacists and one nurse carried out training actions in the context of Safe Medicines Practices. The following topics were addressed: medicine circuit; good practices in drug preparation; identification of medicines: Look-Alike Sound-Alike (LASA) and High-Alert Drugs; physicochemical incompatibilities; factors that modify stability after reconstitution/dilution; fractionation and crushing of Solid Oral Pharmaceutical Forms (SOPF); drug information sources; reporting adverse drug reactions and other incidents; good practices in medication administration. 

What has been achieved?

Training actions were carried out with a total of 29 hours of training and 357 participants. Suggestions for improvement were presented: optimisation of drug signage, compliance with established circuits, logistical aspects, on time drug information, improvement of communication channels, increase in the frequency of training actions. The trainees expressed receptiveness and interest in this initiative, which provided content that was little discussed and very relevant to their daily practice. 

What next?

The correct preparation and administration of medicines is essential to safeguard their effectiveness and patient safety, which is the ultimate goal of every health professional’s daily activity. The Pharmacist, as part of the multidisciplinary team, must promote strategies that safeguard Safe Practices throughout the drug circuit. Hence it is important to ensure the continuity of these trainings.