Author(s)

Richard Sykes – Pharmacist Executive Manager, Portiuncula University Hospital/ Hospital Pharmacists Association Of Ireland
Muriel Pate – Chief II Pharmacist, Health Service Executive
Prof. Judith Strawbridge – School of Pharmacy and Biomolecular Sciences (PBS), Royal College of Surgeons in Ireland

Why was it done?

The development of hospital clinical pharmacy in Ireland has steadily progressed over recent decades. Historically, pharmacists working in the Health Service Executive (HSE) lacked a career structure that recognised specialist-level practice.

What was done?

Following extensive stakeholder negotiations, a validation model was introduced to assess pharmacists’ practice against internationally recognised standards. Pharmacists submitted evaluation forms to a validation panel, which reviewed their evidence. Those meeting the criteria were re-graded as Advanced Specialist Pharmacists.

How was it done?

The validation criteria were aligned with the International Pharmaceutical Federation (FIP) Advanced Stage 2 framework, covering six domains: Expert Professional Practice, Working with Others, Leadership, Management, Education, Training and Development, and Research and Evaluation. A panel of pharmacists assessed electronic applications and scored them accordingly. Over 300 Acute Hospital Pharmacists submitted evidence, and those meeting the threshold were deemed to demonstrate advanced practice. These individuals were regraded to the newly created Advanced Specialist Pharmacist grade.

What has been achieved?

The HSE has now formally recognised that pharmacists in acute hospital settings are working at an advanced level. This recognition allows for the direct creation of advanced roles within the health system. A job specification outlining responsibilities and educational requirements has been published, ensuring transparency. Over 200 pharmacists successfully demonstrated specialist practice across a range of specialties and were regraded.

What next?

The creation and appointment of Pharmacists to the grade of Advanced Specialist has now prompted the need for further development. 1. The utilisation of existing Hospital Pharmacists Association Specialist Interest Groups to facilitate peer support for Pharmacists in their specialist roles.

2. A plan to establish a pipeline of Pharmacists to fill new and replacement Advanced Specialist Pharmacist vacancies.
3. Further negotiation to apply the same structures within the service in non-acute hospital roles

References

1 .Advanced Specialist Pharmacist resources, Health Service Executive, July 2024, (online) https://www.hse.ie/eng/staff/resources/hr-circulars/hr-circular-016-2024-phase-2-implementation-of-the-mc-loughlin-report-in-hospital-pharmacies.html

Author(s)

Supparat Chanprasert, Watsa Charoenwaiyachet, Thanawan Chuenjit , Katemanee Udomkiattikul, Anut Sakulsupsiri, Thanayu Techa-in.

Why was it done?

Among 3,500 PLHIV treated at KCMH, only one-third accessed infectious disease clinics where clinical pharmacists provide criteria-based pharmaceutical care. The remaining 70% received treatment at other clinics, where medications were dispensed without adherence assessment. Addressing this gap was essential to improve quality of care.

What was done?

A standardised protocol for pharmaceutical care of people living with HIV (PLHIV) was implemented. The initiative introduced structured adherence assessment at outpatient dispensing units and an integrated referral process to clinical pharmacists.

How was it done?

Outpatient HIV care was streamlined by coordinated efforts among physicians, nurses, HIV coordinators, and pharmacists. A clinical pharmacist developed two new tools for dispensing process: ‘Short Screening’ for regimen choice, dosage adjustment, and detection of drug interaction or adverse effect, and ‘Short Check’ for adherence and barrier identification. Any concerns from screening pharmacists were informed to dispensing pharmacists for further review. Simple issues were addressed at the counter with respect to patient rights, while complex cases or PLHIV with poor adherence were referred to clinical pharmacists for in-depth interventions. Cases were evaluated and classified as needed urgent intervention, planned intervention, or no intervention for clinically stable patients or with viral suppression. Pharmacists enhanced a resolute EMR system for follow-up scheduling and monitoring documentation. Training sessions were conducted prior to implementation to promote consistency in practice.

What has been achieved?

From October 2024 to March 2025, 2,732 PLHIV received structured adherence assessment, increasing coverage from 31% to 69%. Ninety-seven percent were good adherence and achieved viral suppression. A small percentage (2.9%) was identified as poor adherence and referred to clinical pharmacist-led interventions. Among the patients reviewed, 54% were clinically stable and needed no further intervention, 28% percent were found at risk of poor adherence and were scheduled for interventions, and 19% needed urgent counselling which half of them experienced virological failure. After intervention, the majority demonstrate improved adherence. Dispensing pharmacists provided essential counselling on ARV timing, food-drug interactions, and safe ARV use per guidance.

What next?

This model shows a scalable approach for high volume super tertiary hospitals by embedding pharmacists into HIV services. This framework can be adapted for other chronic diseases like diabetes to expand its public health benefits.

Author(s)

Gilak G., Lakatos-Krepcik A., Breyer-Kohansal R., Sailer G.

Why was it done?

In Austria, people with Cystic Fibrosis (CF) receive interdisciplinary care from various professional groups at specialised treatment centres. The European Cystic Fibrosis Society recommends the integration of pharmacists into the multidisciplinary CF team, emphasising medication management, patient education, and adherence support. Increased access to CF transmembrane conductance regulator modulator therapies in recent years has conferred significant benefits to patients in multiple ways. However, these highly effective drugs are known to have a high potential for drug–drug interactions.

What was done?

The current medication of adult patients was reviewed by a clinical pharmacist. Individualised medication counselling, education, and specialised support in cases of drug shortages were provided to patients. To evaluate the quality of the pharmaceutical consultation and the benefits derived from it, patients were invited to complete an anonymous questionnaire.

How was it done?

During their visit to our specialised CF outpatient clinic, patients were offered the opportunity to consult a CF pharmacist. Together with the patient, a comparison was conducted with the previously documented medication list. Additional or differently taken medications, as well as the results of the interaction analysis, were documented in the electronic patient record and logged in a specifically developed data collection tool. Once a week, the respective data of these patients were discussed within the multidisciplinary team.

What has been achieved?

37 patient consultations took place between 11/24 and 04/25. Patients took an average of 9.7 medications, additionally 1.6 medications were recorded following inquiry by the clinical pharmacist. In total 120 drug related issues were identified. These issues included adverse drug reaction management (25%), instructions for use (25%), formal criteria for written prescriptions and drug shortage (17%), patient adherence concerns (13%), indications/contraindications (13%), and dose adjustments (7%).

An average of 2.7 drugs per medication, which were not taken in accordance with the current prescription plan, were identified by the clinical pharmacist.

All patients stated that the consultation with the clinical pharmacist was very helpful or helpful and 96% of patients indicated that they now feel confident in taking their medications correctly.

What next?

In the future, pharmaceutical CF care will be formally established in the form of a periodic review at the CF centre of our clinic.

Author(s)

Beatrice Faitelli, Barbara Crivelli, Federica Pieri

Why was it done?

Underreporting of adverse drug reactions (ADRs) in hospitals is often due to administrative complexity and organisational barriers. Simplifying reporting procedures and fostering interprofessional collaboration are essential to strengthen pharmacovigilance and improve patient safety. A proactive model was therefore designed, with the clinical pharmacist acting as facilitator to support physicians and nurses.

What was done?

A pharmacist-facilitated pharmacovigilance model was implemented, integrating the clinical pharmacist into the multidisciplinary team as operational support for physicians and nurses. The initiative aimed to increase the number and quality of ADR reports by reducing the administrative workload of healthcare staff and ensuring more complete, timely, and traceable submissions. It also sought to promote a shared culture of drug safety within the hospital setting.

How was it done?

When a suspected ADR occurred, the healthcare professional contacted the pharmacist via institutional email or entered minimal information into the national portal (event description, timing, suspected/concomitant drugs, essential clinical details). The pharmacist finalised the report by reviewing medical records, laboratory results, and clinical documentation, liaising with the clinical team when required. Completed reports were submitted to the national pharmacovigilance network and archived in an internal database for monitoring.

What has been achieved?

From January to September 2025, 17 reports were collected, compared with 10 and 5 in the corresponding periods of 2023 and 2024. Overall ADRs increased (29 in the first nine months of 2025 vs. an average of 13–14 in the same intervals of previous years). Report completeness improved, with more suspected drugs identified (20) and, for the first time, systematic inclusion of concomitant medications (19), enabling more accurate causality assessment. Timeliness also improved, with a peak of reports in the month after implementation. Physicians and nurses valued the pharmacist’s role as practical and supportive.

What next?

Although absolute numbers remain modest, they already represent a clear improvement compared with previous years. The model has proven feasible, sustainable, and transferable to other wards. Future efforts will combine support for reporters with targeted training and awareness initiatives to further embed pharmacovigilance in routine hospital practice.

Author(s)

Carlota Mestres Gonzalvo
Juan José Lázaro Alcay
Ángela Pieras López
Marta Duero Adrados
Carlos Javier Moreno Pérez

Why was it done?

Children with ASD frequently reject standard oral medications due to sensory sensitivities, which increases distress and drives the use of invasive routes (intramuscular and/or intravenous), undermining safety, family wellbeing, and perioperative efficiency. Current forms are not adapted to ASD needs; the aim is to maximise acceptability and minimise distress through patient-friendly formulations and calming environments, ensuring equitable, high‑quality preanesthetic care.

What was done?

The project is creating and preparing to clinically evaluate novel, palatable oral formulations—such as sensory-friendly gummies—co-designed by hospital pharmacists, anaesthesiologists, and university formulation experts using advanced flavour–texture modification. In parallel, dedicated sensorial rooms with direct street-access entry, adjustable lighting and sound, and tactile comfort features are being incorporated to reduce overstimulation during preanesthetic preparation.

How was it done?

The first phase addresses obstacles such as heterogeneity in ASD sensory profiles and stringent pharmaco-technical and safety requirements. The team is overcoming these through stakeholder engagement with families, sensory mapping, iterative prototyping with in‑house stability and sensory testing, and multidisciplinary collaboration for rapid, compliant development. Hospital infrastructure supports integration, regulatory documentation, and implementation of sensorial rooms and staff training.

What has been achieved?

A multidisciplinary team has been established, equipment and consumables planned, and formulation development initiated, alongside design parameters for sensorial rooms and workflow integration. Expected outcomes include improved medication acceptance, reduced preanesthetic distress, fewer invasive interventions, greater perioperative efficiency, and higher staff confidence in ASD care, with internal dissemination and readiness for pilot evaluation.

What next?

The ADAPTA initiative is developing tailored oral drug formulations and implementing sensorial rooms to improve preanesthetic care for children with autism spectrum disorder (ASD), integrating pharmaceutical innovation with patient-centre ed strategies in a multidisciplinary hospital setting.

ADAPTA represents good practice by uniting pharmaceutical innovation with environmental and behavioural adaptations, offering a scalable, replicable model for inclusive paediatric anaesthesia. Next steps include completing prototype validation, pilot clinical and sensory acceptability studies within sensorial rooms, standardising operating procedures, and preparing for scale‑up across additional services and paediatric populations.

Author(s)

Irene Márquez-Gómez, Vicente Escudero-Vilaplana, Fernando Bustelo Paz, José Luis Revuelta Herrero, Roberto Collado-Borrell, Laura Maldonado Yagüe, Alberto Ruiz López-Alvarado, Ana Herranz Alonso, Juana Benedí González, María Sanjurjo Sáez

Why was it done?

Patient experience has been recognised as a critical determinant of healthcare quality, directly influencing adherence, safety, and clinical outcomes. In clinical trials, where investigational drugs and complex protocols often create uncertainty and stress, patients face unique challenges. Enhancing their experience is critical to ensure safety, and engagement throughout the trial. This project aimed to mitigate these vulnerabilities and to foster a more humanised and supportive care environment.

What was done?

A patient-centred model was developed to incorporate patient experience into the pharmaceutical care of clinical trial patients. The initiative sought to redesign care processes within the Pharmacy Department to better address patients’ expectations, needs, and vulnerabilities.

How was it done?

The project followed four phases: (1) Current workflows were mapped to detect bottlenecks in pharmaceutical care (2) Semi-structured interviews with trial participants explored their perceptions, concerns, and unmet needs; thematic analysis was applied to identify key insights. (3) The SAFARI observational method was used to document real-world interactions and organisational dynamics in the drug dispensation area. (4) A Patient Journey Map was created to visualise the care pathway and highlight critical touchpoints requiring improvement.

What has been achieved?

Analysis revealed several unmet needs: insufficient practical information on trial medication, limited visibility of pharmacy as a clinical resource, logistical barriers such as poor signage and physical distance from clinics, and confusion about dispensing procedures. Patients valued close monitoring by the research team but expressed interest in receiving additional pharmaceutical support. Overall, the hospital pharmacy was perceived primarily as a logistical space rather than a clinical partner, underscoring the need to reposition its role within clinical trial care.

What next?

Two key strategies have been defined. First, the establishment of a dedicated pharmaceutical care consultation for trial participants, focusing on critical milestones (pre-screening, treatment initiation, therapy changes), providing structured explanations, written reference materials, and systematic review of interactions and adverse effects. Second, the functional planning of a new Clinical Trials Unit, with improved physical spaces, closer proximity to the research team, and simplified patient circuits. These interventions aim to transform the pharmacy service into a patient-centre ed and supportive environment, and future evaluation will measure their impact on safety, adherence, and patient-reported outcomes.

Author(s)

E.Ikidde

Why was it done?

Patients with severe asthma often experience poor outcomes, repeated oral corticosteroid use, and delays in accessing biologic treatment. Existing referral pathways created inequity and long waits for review and initiation of biologics. The pharmacist-led service aimed to improve outcomes, optimise medicines use, enhance safety, reduce waste, and shorten delays through streamlined pathways and multidisciplinary collaboration.

What was done?

A pharmacist-led severe asthma clinic was established within hospital practice. The pharmacist assessed patients by correcting inhaler technique, reviewing adherence, evaluating eligibility for biologic therapy, providing patient counselling, ensuring medicines were available for clinic use, and coordinating safe transition to homecare services. This demonstrated the unique contribution of hospital pharmacists in severe asthma management.

How was it done?

A retrospective review of patients managed in the pharmacist-led clinic was conducted over 12 months. Each patient received a structured consultation including inhaler technique, adherence, and asthma management plan review. Biologic eligibility was assessed against national guidance by the hospital pharmacist, with applications approved by the multidisciplinary team. The pharmacist streamlined prescribing, ensured timely ordering of high-cost medicines, and conducted safety checks before administration. Initial challenges—patient unfamiliarity with pharmacist-led clinics and limited capacity—were addressed through education, collaboration with Respiratory Consultants, and phased appointment introduction.

What has been achieved?

Eighty-eight patients were reviewed. Inhaler technique was corrected in 67 patients (76%), and 41 patients (47%) were initiated on biologic therapy following multidisciplinary approval. Pharmacist involvement ensured timely supply of high-cost medicines and immediate support for medicine-related queries, improving patient safety and confidence. The service reduced delays to clinic review and biologic initiation, in line with Accelerated Access Collaborative (AAC) guidance to improve equity.

What next?

This initiative highlights the pharmacist’s vital role in severe asthma services, with measurable benefits for medicines optimisation, safety, and equitable access. Other specialties, such as interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD), are now requesting pharmacist support. The model is scalable, transferable, and cost-efficient, offering a safe framework for replication in other healthcare systems.

Author(s)

Vera Pires, Maria João Teixeira, Rui Marques

Why was it done?

Ifosfamide-induced encephalopathy (IIE) is a serious and often underdiagnosed adverse effect of ifosfamide, with variable incidence and no standardised approach to prevention or treatment. The project aimed to improve patient safety and clinical outcomes by developing a standardised, evidence-based institutional protocol to guide prophylaxis and management of IIE.

What was done?

An institutional protocol for the prevention and treatment of IIE was developed and implemented, defining clear recommendations for methylene blue and thiamine use, standardising dosing regimens, and providing practical instructions for clinical teams.

How was it done?

A comprehensive literature review was carried out, current local practices were analysed, and a multidisciplinary team collaborated to design the protocol. The final version was reviewed and approved by the Pharmacy and Therapeutics Committee (PTC) before implementation.

What has been achieved?

The protocol reduced variability in prescribing practices, increased medication safety, and enhanced the pharmacist’s involvement in monitoring and managing adverse events. It established consistent dosing, preparation, and administration procedures for both adult and paediatric patients, improving overall care quality and coordination.

What next?

The next step is to evaluate the clinical and organisational impact of the protocol from both patient and institutional perspectives, with a focus on outcomes such as incidence reduction, safety indicators, and staff adherence.

Author(s)

Kamila Urbańczyk1,2, Przemysław Kardas3, W. Witkiewicz1, A. Hogg4, M. Scott4, A. Wiela-Hojeńska2
1) Department of General, Vascular and Oncological Surgery, Regional Specialist Hospital in Wroclaw
2) Department of Clinical Pharmacology, Wroclaw Medical University
3) Medication Adherence Research Center, Department of Family Medicine, Medical University of Lodz, Lodz, Poland
4) Medicines Optimisation Innovation Centre, Antrim, Northern Ireland

Why was it done?

Clinical pharmacy services are poorly developed in Central and Eastern Europe [1]. One of the consequences of this fact is that medication adherence remains insufficiently addressed in these countries. This leads to poorer health outcomes, preventable hospitalisations, and significant costs. In Poland, legislative change is needed to introduce such services, but decisions require solid evidence. Therefore, a pilot clinical pharmacists’ service was launched to provide an objective assessment of its value.

What was done?

A pilot randomised controlled trial was carried out at the Regional Specialist Hospital in Wroclaw. Patients admitted to vascular and general surgery wards were assigned to either standard care or an integrated medicines management (IMM) service. The IMM model comprised medicines reconciliation and review at admission, inpatient monitoring and counselling, and reconciliation with education at discharge, followed by post-discharge follow-up at 1, 3, and 6 months.

How was it done?

Sixty patients were randomised, and 58 completed follow-up. Clinical pharmacists identified drug related problems, intervened, and collaborated with physicians to optimise pharmacotherapy. Outcomes included unplanned healthcare visits, length of stay, appropriateness of treatment, and economic impact.

What has been achieved?

Patients in the IMM group had significantly fewer additional healthcare visits (6 vs. 39; p<0.05) and shorter hospital stays (median 5 vs. 7 days; p=0.0372). Pharmacists identified 273 drug- related problems, and all interventions were accepted by physicians. Medication appropriateness improved markedly during hospitalisation. Economic analyses showed substantial savings through reduced hospitalisations, shorter stays, and optimised treatment, with a favourable cost–benefit ratio. Patients and healthcare professionals valued the service positively.

What next?

The pilot demonstrated clinical, economic, and organisational benefits of pharmacist-led services in Poland. These results confirmed their feasibility and relevance. The findings are currently being used by the Parliamentary Group for Improving Medication Adherence. There is an intention to incorporate the services of clinical pharmacists into the national strategy for the management of medication adherence currently being designed in Poland. Proposed legislative alterations are expected to create political and professional momentum to scale up the initiative nationally.

Author(s)

Patricia Fumero Cruz, Emma Ramos Santana, Nuria Ramos Santana, Montserrat González García, Mónica Mederos Betancort, Álvaro Crespo González, Mª Pilar Díaz Ruiz

Why was it done?

Paediatric palliative care requires an integrated approach combining medical management with safe, effective and tailored pharmacotherapy for each child and family. Many essential medicines lack age-appropriate formulations, limiting symptom control and increasing the risk of dosing errors. To address this unmet need, the hospital pharmacy developed a structured pharmaceutical care programme ensuring the preparation, dispensing and follow-up of individualised compounded medicines, promoting safety, adherence and equitable access to treatment.

What was done?

A pharmacy-led programme was implemented for all paediatric patients cared for by the Paediatric Palliative Care Unit (PPCU). It integrates a specialised pharmacy consultation, individualised compounding, direct dispensing to families in the Outpatient Unit and continuous follow-up. The intervention, in collaboration with the PPCU team (three paediatricians and two nurses), ensures a coordinated and patient-centred approach.

How was it done?

All paediatric palliative patients were included. Pharmacists reviewed medical history, previous treatments and specific needs. The pharmacy prepares personalised formulations (gabapentin, clonidine, baclofen, levodopa/carbidopa, clobazam, topiramate, methadone, ondansetron, among others) adapted to age, weight and tolerance.

Dispensing frequency is adjusted to stability and expiry, mostly monthly, and accompanied by educational materials and visual guides for caregivers.

The programme covers all costs and records each dispensing to monitor adherence, stability and efficacy. Pharmacotherapeutic follow-up is conducted through in-hospital or home consultations coordinated with the PPCU.

What has been achieved?

– Better symptom control (pain, anxiety, nausea).

– Greater safety and fewer medication errors at home.

– Improved adherence and family satisfaction.

– Fewer avoidable hospital admissions.

– Enhanced role of hospital pharmacists within the multidisciplinary team.

The programme ensures equitable access to medicines unavailable in suitable paediatric forms, establishing a personalised, empathetic and patient-centred care model for children and families.

What next?

The next phase includes evaluating clinical outcomes and perceived wellbeing using indicators of safety, adherence and satisfaction. The model aims to be replicated in other hospitals with paediatric compounding capacity and to foster an inter-hospital collaborative network to share protocols and best practices.