The EAHP Board, elected for three-year terms, oversees the association’s activities. Comprising directors responsible for core functions, it meets regularly to implement strategic goals. Supported by EAHP staff, the Board controls finances, coordinates congress organization, and ensures compliance with statutes and codes of conduct.
INTEGRATING CLINICAL PHARMACY INTO DAILY WARD OPERATIONS: A TAILORED APPROACH ACROSS SPECIALTIES
European Statement
Clinical Pharmacy Services
Author(s)
Adina Elihu, Claudia Wunder
Why was it done?
In Austria, there is growing recognition of the vital role clinical pharmacists play in healthcare teams. However, the current structure of the Austrian healthcare system does not adequately support the establishment of sufficient clinical pharmacist positions. Consequently, it is imperative to strategically integrate the limited available resources into patient-centered medication processes and fully harness their potential to enhance drug therapy safety.
The initial project was conducted in 2018/2019, and the present retrospective study was completed in 2022.
What was done?
This study explores the efficient integration of clinical pharmaceutical services across various medical disciplines, including both surgical and conservative fields. It specifically addresses how the integration of clinical pharmacy in surgical settings differs from that in conservative settings, and what success factors and obstacles need to be considered.
How was it done?
Through a retrospective analysis of outcomes from a comprehensive polypharmacy project, coupled with surveys of participating pharmacists and physicians, we delineate the procedures and methodologies essential for effective implementation.
What has been achieved?
It was demonstrated that a “one size fits all” approach, or a single process for all departments, is not practical. The study highlights specialty-specific considerations, such as the necessity for written communication on surgical wards and the inappropriateness and appropriateness of accompanying ward rounds in some cases.
Groundbreaking considerations for the approach were developed, including preparation, differences in approaches between surgical and conservative specialties, information sharing, communication pathways, necessities in the implementation phase and prerequisites for de-escalation.
The initiative paved the way for the introduction of electronic consultation systems to improve information transfer and documentation.
What next?
By identifying pitfalls and essential success factors, this initiative stands as a model for establishing clinical pharmacy services across various medical specialties, particularly in the context of limited personnel resources. It provides valuable guidance for colleagues involved in establishing these services.
SYSTEMATIC SCREENING OF ANTIBIOTIC TREATMENTS BY CLINICAL PHARMACISTS
European Statement
Clinical Pharmacy Services
Author(s)
Sebastian Philip, Andreas Lundgaard
Why was it done?
The screening aimed to ensure the rational use of antibiotics, contributing to the fight against antibiotic resistance and potentially shortening hospital stays by optimizing treatment.
What was done?
A systematic screening of antibiotic treatments for patients was conducted as part of the daily tasks performed by clinical pharmacists at The Medical Acute Care Unit, Bispebjerg Hospital.
How was it done?
For each patient receiving antibiotic treatment in the emergency department, the chosen therapy was systematically reviewed against regional antibiotic guidelines, considering factors such as allergies, resistance profiles, renal function, clinical indication and overall condition of the patient. Recommendations of adjustment of treatment were discussed with the attending physician for potential changes in therapy, including changes to dosage, frequency, route of administration, alternative antibiotic drug, or discontinuation of treatment. All interventions were documented, including the details of the therapy, the recommendation, and whether the attending physician approved the suggested changes.
What has been achieved?
A large dataset has been collected, detailing the number of patients receiving antibiotic treatment, the number of interventions conducted, the specific antibiotic treatment each patient received, the type of intervention performed and its indication, and whether the intervention was approved or rejected by the responsible physician.
The project has laid the groundwork for understanding the clinical pharmacist’s role in enhancing rational antibiotic pharmacotherapy.
What next?
It is planned to analyze the collected data to determine the types of changes in therapy most commonly recommended by clinical pharmacists and to which degree the interventions were approved or denied by the attending physician.
This will provide insights into the pharmaceutical contributions to more rational antibiotic use, highlighting commonly observed ‘areas for improvement’ that could potentially be addressed through education.
CONSULTATION SESSIONS WITH BARIATRIC SURGERY PATIENTS: A PHARMACIST INTERVENTION AT ZUYDERLAND HOSPITAL
European Statement
Clinical Pharmacy Services
Author(s)
Vera Hoebregts, Evert-Jan Boerma, Mark Reinders
Why was it done?
The initiative was introduced to address the complex medication needs of bariatric surgery patients, particularly those using risk medication. More and more research is available about the effect of bariatric surgery on medication. Before this initiative, there was a gap in personalized medication management for this patient population. The aim was to optimize medication regimens, enhance patient safety and create awareness about the influence of bariatric surgery on specific medication among bariatric patients.
What was done?
In response to the growing need for personalized care among bariatric surgery patients, Zuyderland Medical Center and the Dutch Obesity Clinic South initiated consultation sessions with a pharmacist for patients scheduled for bariatric surgery using risk medication. A scoring list was developed to identify patients eligible for these consultations. Additionally, a survey was conducted to assess patient perceptions of the consultation’s usefulness.
How was it done?
Our developed risk medication screening list for bariatric patients was used to identify patients eligible for pharmacist consultations. Notable medications on the list included lithium, oral antipsychotics, antiepileptics, direct oral anticoagulants, levothyroxine, and tamoxifen. Approximately 10% of bariatric patients met the consultation criteria. Eligible patients were informed by their surgeon during pre-operative consultations and subsequently scheduled a session with the pharmacist. These consultations centered on discussing the patient’s specific risk medications and how bariatric surgery might impact their efficacy or toxicity. If relevant, issues such as medication-related weight gain, ingestion challenges, and compliance were addressed. Pharmacists’ recommendations were shared with the patient’s physician or other relevant healthcare professionals (e.g. a neurologist regarding a patient with epilepsy).
What has been achieved?
Increased awareness about the effect of bariatric surgery on medication is created both among staff and patients. Patients reported high satisfaction levels (average score of 9,3 out of 10 (n=20)) with the consultations, mentioning enhanced understanding of their medication regimens. Furthermore, an increased confidence in managing their health postoperatively was precepted. Patients found this consultation of added value.
What next?
This initiative serves as an exemplary model of personalized care delivery in bariatric surgery settings. Its success underscores the value of pharmacist involvement in optimizing medication therapy for complex patient populations.
INTEGRATING ARTIFICIAL INTELLIGENCE: STREAMLINING MEDICATION HISTORY DOCUMENTATION WITH CHATGPT AT ODENSE UNIVERSITY HOSPITAL
European Statement
Clinical Pharmacy Services
Author(s)
Fjóla Høg Nielsen, Gine Cecilie Stobberup
Why was it done?
The initiative was driven by the need to support a growing number of patients who require medication history. To ensure that pharmacy technicians could complete as many medication histories as possible, have enough time to thoroughly investigate potential issues, and maintain the desired quality of medication history, we initiated the use of ChatGPT to handle the journal note-writing aspect. This initiative was launched in January 2024 and implemented in August 2024.
What was done?
At Odense University Hospital, pharmacists and pharmacy technicians conduct daily reviews of hospitalized patients’ regular medication based on data from the Danish Medicines Agency’s system “The Shared Medication Record”, prescription deliveries, and patient statements. The patient’s usual medications are reviewed to determine what they are taking at home and to identify potential issues, such as compliance problems. A note is written in the medical journal for the attending physician, providing an overview of the patient’s regular medications and any concerns. To improve efficiency and consistency in this process, we implemented the use of ChatGPT to write these notes after the pharmacy technician has completed the medication history, ensuring standardized documentation, increased safety, and for saving time.
How was it done?
ChatGPT was programmed to document the medication history following the standard note format previously used. One of the key challenges was ensuring that ChatGPT could meet the specific documentation needs and minimizing errors in the generated notes. After the initial programming, pharmacy technicians were asked to use ChatGPT and keep track of how many medication histories were written with its assistance, as well as to identify any recurring errors. Based on their feedback, ChatGPT was adjusted to reduce the occurrence of similar errors in future notes.
What has been achieved?
Pharmacy technicians have reported that the time required to complete a medication history has decreased, particularly for patients with long medication lists. The system also ensures that the notes are always written in a consistent manner, reducing the likelihood of missing important information.
What next?
Moving forward, we will continue refining the system to further eliminate errors and improve accuracy. This initiative showcases the successful integration of advanced technology into healthcare, with potential applications across other healthcare settings.
DEPRESCRIBING FOR OLDER PATIENTS IN AN EMERGENCY DEPARTMENT DURING CARE TRANSITIONS
European Statement
Clinical Pharmacy Services
Author(s)
M.Sc.Pharm., Hanne Fischer; M.Sc.Pharm., Sarah Daaskov Egelund; M.Sc.Pharm., Amalie Bruno-Johansen; Cand.Med. Rune Pihl; M.Sc.Pharm., Ph.D., Charlotte Vermehren.
Why was it done?
Deprescribing for older patients is proposed to mitigate the risks of harm associated with polypharmacy. Deprescribing initiated in the ED is effective only if maintained across healthcare sectors with patient adherence. Some ED pharmacists in Denmark have the authority to approve medication changes in electronic records, potentially enhancing implementation. We aimed to elucidate the degree of implementation of recommended deprescribing interventions across sectors for older patients, facilitated by ED pharmacists. Additionally, we explored differences in implementation based on whether deprescribing was authorized by pharmacists or delegated to an ED doctor or general practitioner (GP).
What was done?
The pilot study was conducted to explore the recommendation and implementation of deprescribing for older patients across sectors, facilitated by pharmacists in a Danish Emergency Department (ED).
How was it done?
Pharmacists initiated deprescribing interventions, ensured consensus with the patient and/or ED doctor, respectively, and were assigned responsibility for authorizing medication changes. Pharmacists checked for implementation in the shared medication record (FMK) after 14 and 30 days and contacted, if possible, self-administrated patients 14 days post-discharge to assess adherence. The following were registered:
• Who held the responsibility to authorize?
• What kind of medication was deprescribed?
• To what extent were the changes implemented in FMK after 14 and 30 days?
• What was the adherence for the contacted patients?
What has been achieved?
The study involved pharmacist-led interventions for 39 patients. Twenty-three patients (59%) had their change implemented in FMK after 14 days. Two more patients had their FMK changed between day 14 and day 30. Changes authorized by a pharmacist (nine patients) resulted in an implementation rate of 100%, whereas it was 62% and 27% respectively when delegated to the ED doctor (20 patients) or GP (11 patients). Ten patients were contacted, of which seven confirmed adherences. The deprescribed medication included 43 drugs, corresponding to 35 different generic drugs.
What next?
Pharmacist-led interventions in the ED improve implementation of deprescribing across care transitions. When pharmacists are authorized to make changes themselves rather than delegate to an ED or GP, the degree of implementation may increase. This finding supports the involvement of clinical pharmacists in the ED to promote more extensive deprescribing in clinical practice.
TELEPHARMACOLOGICAL OUTPATIENT CLINIC: DEVELOPMENT OF A CROSS-SECTIONAL VIRTUAL POLYPHARMACY COUNSELLING SERVICE
European Statement
Clinical Pharmacy Services
Author(s)
Lærke Karner Overgaard, Daniel Pilsgaard Henriksen
Why was it done?
Multimorbidity and polypharmacy pose significant challenges for healthcare systems. In Denmark, general practitioners (GPs) play a crucial role in coordinating patient care but also rely on specialist support for complex cases. The aim of this intervention was to provide easily accessible multidisciplinary counseling on polypharmacy for GPs.
What was done?
A virtual polypharmacy outpatient clinic was developed to provide cross-sectional specialist counseling for GPs.
How was it done?
The intervention was developed through a multidisciplinary approach, involving specialists in clinical pharmacology, GPs, and healthcare planners. The service provides virtual consultations to GPs in the Region of Southern Denmark (1.2 million inhabitants), offering multidisciplinary specialist counseling for patients on five or more medications. The multidisciplinary team consists of clinical pharmacists, consultants in clinical pharmacology and consultants in geriatrics. The process includes referral, medication review, video conference, and follow-up.
What has been achieved?
The outpatient clinic received 376 referrals comprising 366 unique patients (median age 73 years, IQR 65-81; 61.2% female) over five years (March 2019 to February 2024). The median number of drugs per patient at referral was 17 (IQR 13-21). Referrals increased from a median of 3.5 (IQR 1-5) per month in 2019-2020 to a median of 9 (IQR 6-13) per month in 2023-2024. GPs from 21 of 22 municipalities in the Region of Southern Denmark referred patients. The median time from referral to video conference was 15 days (IQR 8-26). The three most common weekdays for video conferences were: Thursday: 96 referrals (25.5%), Monday: 71 referrals (18.9%), and Wednesday: 71 referrals (18.9%)
The service was well-received by patients and GPs and recognized by national health authorities as a valuable model for managing multimorbidity. The Telepharmacological outpatient clinic thus demonstrates a successful model for integrating specialist support into primary care management of polypharmacy.
What next?
The effects of the outpatient clinic on the health outcomes of referred patients will be evaluated in a scientific study. Future efforts will focus on sharing experiences with national and international stakeholders to further develop the intervention and inspire new research in rational pharmacotherapy.
DEPRESCRIBING IN OLDER ADULTS: LET’S TALK!
European Statement
Clinical Pharmacy Services
Author(s)
Steffy LEFAKOUONG, Mohamed MOSTEFA, Sarah BARBIEUX, Sophie VERNARDET, Isabelle LEFORT
Why was it done?
Institutional and multidisciplinary work has been carried out in the hospital since 2022 on reducing prescriptions of potentially inappropriate medications (PMIs) in older population (OP), in accordance with french recommandations.
What was done?
Our aim is to raise awareness among medical staff on the prescription of PMIs in OP through continuing education (CE) courses.
How was it done?
A PMI-specialized team composed of 2 geriatricians, 1 pharmacist and 1 pharmacy intern was formed.
CE is planned in the form of a structured medication review describing clinical cases based on discharge prescriptions of hospitalized patients, selected according to several criterias: >75 years old, ≥1 PMI on the prescription.
These prescriptions are analyzed by the specialized team using various reference documents, with a relevance audit grid provided by the regional drug authority as a basis.
The first MR was presented to the doctors and residents of the establishment’s various departments during a joint session.
A satisfaction survey was created to assess the interest and relevance of the course.
What has been achieved?
For our first session, we selected 3 prescriptions : two containing 4 PMIs each and one containing 2 PMIs.
A detail of each PMI was carried out with a focus on two main themes : deprescribing long-acting benzodiazepines and proton pump inhibitors.
Besides PMIs, a comprehensive prescription analysis was done by mentioning inadequate prescriptions from a geriatric medical view.
In total, we have a participation of 100% of the pharmacists, 89% of the geriatricians and 100% of pharmacy residents. Among the other departments, only 3 other physicians participated in the course.
According to the survey, 100% of participants said they were satisfied with the session and 44% wanted more interactive training.
What next?
The high participation of pharmacists and geriatricians, 2 teams of interest in the process of deprescribing MPIs, highlights the usefulness of this CE among healthcare professionals.
The structure of the session encourages constructive and collaborative exchanges while comparing visions of different professionals.
Nonetheless, a reflection on our approach’s appeal is necessary in order to increase the participation rate of physicians and medical residents absent during the session.
The satisfaction rate remains encouraging, and pushes us to renew this training periodically.
IMPROVING ACCESS TO CARE: PATIENT PROFILES AND SATISFACTION IN HOME MEDICATION DELIVERY SERVICES
European Statement
Clinical Pharmacy Services
Author(s)
Sánchez Cerviño, AC; Rivera Ruiz, María; Sanabrias Fernández de Sevilla, R; Menchén Viso, B; Folguera Olias, C; López Fernández, A; Pérez García, E; Martín Santamaría, A; Guerrero Feria, I; Sánchez Guerrero, A.
Why was it done?
Informed medication delivery at home, managed by the Hospital Pharmacy Service and facilitated by information technologies, aims to improve access to medication and enhance patients’ quality of life by avoiding unnecessary trips to the hospital. Although it incurs additional costs, it is essential to carefully select and prioritize candidates for this service.
What was done?
1. Analyze the profile of patients requesting medication delivery to establish priority criteria.
2. Evaluate patient satisfaction with this service in a tertiary care hospital.
How was it done?
An observational, retrospective, non-interventional, descriptive study was conducted on patients receiving medication delivery at home for two months upon their request.
Information was collected from electronic medical records and prescription systems, recording gender, age, underlying conditions, prescribed medications, and employment status.
Patient satisfaction with the service was also evaluated, and descriptive statistical analysis was performed.
What has been achieved?
During the study, medication was delivered to 443 patients (55.1% women) with a mean age of 57.3 years. Central nervous system disorders accounted for 16.0% of deliveries, followed by rheumatological diseases (15.1%) and oncohematological patients (9.3%).
Specifically, patients with multiple sclerosis represented the highest demand for this service (12.9%), due to mobility limitations. Additionally, medication was sent to patients with HIV (6.1%), attributable to stigma-related issues.
Analyzing patients’ employment status, 61.2% were pensioners (retired or with permanent disability).
Satisfaction assessment was conducted with 122 patients, who rated the service with an average score of 6.9 out of 10.
What next?
The results indicate that most patients utilizing informed medication delivery at home face difficulties traveling to the hospital. These patients often have disabilities, reduced mobility, or are unable to attend the hospital due to age, work-life balance, or family responsibilities, demonstrating an acceptable level of satisfaction. This patient profile should be prioritized for informed medication delivery services.
IMPLEMENTATION OF AN ATYPICAL MEDICATION ROOM TO OPTIMIZE MEDICATION MANAGEMENT AND REDUCE WASTE AT HERLEV GENTOFTE HOSPITAL, DENMARK
European Statement
Clinical Pharmacy Services
Author(s)
Henrik Kjer, Christina Laustsen, Rasmus Riis, Caroline Rasmussen, Jeanette Bajrami, Christian Rubek, and Steffen Jørgensen
Why was it done?
An atypical medication room (AMR) was established at Herlev Gentofte Hospital, Denmark to centralize the storage and handling of medications not part of the standard assortment (i.e. atypical medication). The project aimed to improve the efficiency of medication management, reduce medication waste, and streamline workflows associated with the use of atypical medicines. To enhance the accuracy and efficiency of inventory control, the ScanPill technology was developed as a tool for digital tracking and updating of medication stock.
What was done?
Atypical medications are often stored across various departments with low turnover, leading to potential waste and time-consuming retrieval processes. Centralizing these medications in an AMR and using ScanPill aimed to reduce waste due to expiry, improve stock management, and simplify medication retrieval for healthcare professionals.
How was it done?
Atypical medications from multiple departments were collected and stored in the AMR. The ScanPill system was developed to facilitate the scanning of QR codes and barcodes on medication packaging, allowing for precise tracking of stock levels and easy updates to the atypical medication list. Staff were trained to use the AMR and ScanPill to ensure smooth transitions in retrieving, returning, and documenting atypical medicines. Regular inventory checks and updates were conducted to maintain an accurate database of available medications.
What has been achieved?
The AMR, supported by ScanPill, led to improved handling and management of atypical medications. The centralized storage reduced the need for duplicate stock across departments and enabled quicker access to necessary medications, reducing retrieval time and potential waste. The ScanPill technology improved inventory accuracy and streamlined the process of checking medication in and out, ensuring up-to-date records. Staff feedback has been positive, noting enhanced workflow efficiency and reduced medication waste.
What next?
Future steps include evaluating the economic impact of the AMR and its effectiveness in reducing medication waste. Efforts will be made to refine the use of ScanPill, enhance staff training, and explore potential applications of the AMR model across other departments. Continuous monitoring will ensure optimal performance and identify further areas for process improvement.
DRIVING CHANGE IN ANTIBIOTIC STEWARDSHIP: A PHYSICIAN-PHARMACIST COLLABORATION IN THE ICU AND SURGICAL WARDS (IN VIENNA)
European Statement
Clinical Pharmacy Services
Author(s)
Lisa Wimmer, Beata Laszloffy, Tamara Clodi-Seitz, Doris Haider
Why was it done?
Antibiotic resistance poses a serious threat to global health, and Austria’s National Action Plan on Antibiotic Resistance (NAP-AMR) highlights the urgency of robust antibiotic stewardship, especially with the 2024 implementation of new antimicrobial quality standards. In response, a 700-bed hospital in Vienna has launched an ambitious initiative, forming a dedicated Antibiotic Stewardship (ABS) team. This interdisciplinary collaboration between physicians and clinical pharmacists is designed to revolutionize antibiotic use, curb resistance, and elevate patient care standards starting in the ICU and associated surgical units.
What was done?
The ABS team took decisive action by targeting one intensive care unit (ICU) and two surgical wards (64 beds in total) for weekly screenings. Infectious disease specialists and clinical pharmacists worked hand-in-hand, meticulously reviewing every patient’s case. This dynamic collaboration ensured not only the highest level of medication safety but also the relentless optimization of antibiotic use, pushing boundaries to meet and exceed best-practice standards.
How was it done?
The ICU and surgical wards—hotspots for antibiotic overuse—were strategically chosen for weekly reviews. In these high-risk areas, an interdisciplinary collaboration of physicians and clinical pharmacists joined forces, taking swift action to assess and fine-tune prescriptions. Pharmacists played a hands-on role, actively reviewing antibiotics and other medications, making recommendations, adjusting dosages, and halting unnecessary treatments. This collaboration was crucial in driving evidence-based decisions that directly elevated patient care to new heights.
What has been achieved?
After just four months, the project has already made significant strides, affecting a substantial number of patients. The majority of interventions have centered on refining antibiotic use, while additional recommendations on other medications have strengthened overall treatment safety. This close collaboration between physicians and pharmacists has directly improved adherence to national guidelines and sharpened prescribing practices.
What next?
Building on early successes, the ABS team will expand screening to additional departments, establishing a pivotal role for clinical pharmacists. This initiative serves as a model for other hospitals, demonstrating that significant improvements in antibiotic stewardship are possible, even with limited resources. The key takeaway: small steps can drive substantial gains in patient care and antibiotic use. As the program progresses, measurable effects on resistance patterns and antibiotic consumption are anticipated.