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Author(s)

VC Lamprecht, J Pont, SD Brugger, M Dunic, T Stutz, AR Burch

Why was it done?

The preparation of parenteral medication on wards pose a hygienic challenge. It is however imperative that parenteral solutions remain aseptic, as they evade the primary barrier of the human immune defense.
The bioburden of non-preserved parenteral medications after manipulation depends on the setting. Therefore, manufacturers cannot provide guidelines on microbial stability after manipulation and hence limit the retention period to immediate use.
National recommendations concerning this issue range from cautious to restrictive, but often allow exceptions e.g. for emergency medication. These recommendations, are difficult to implement universally due to the non-transferable framework conditions from one hospital to another.

What was done?

A practical framework for the determination of retention time of manipulated parenteral medication was developed, as economic and ecological perspectives stand in contrast to the hygienic ideal.

How was it done?

International recommendations were sighted. Recommendations of the German Commission for Hospital Hygiene and Infection Prevention (KRINKO), as well as the American Society of Anesthesiologists (ASA) and The Society for Healthcare Epidemiology of America (SHEA) were used as references, as well stated sources.

What has been achieved?

Key points were identified to create a directory that enables clinical professionals to use standardized cornerstones while adapting to their individual clinical setting.
The following are indicators for the retention period in which the parenteral medication may be used: (1) primary packaging; (2) type of manipulation; (3) physicochemical properties and (4) storage temperature.

What next?

A collaboration with the Department of Infectious Diseases and Hospital Epidemiology of the University Hospital of Zurich was established to record the hospital specific conditions and to subsequently adapt the clinical practice as well as evaluate cost-effectiveness and patient safety.
Further collaborations with Swiss hospitals are being sought.

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Author(s)

Lucie Malečová, Daniela Seberová, Blanka Zelená, Markéta Hanulíková, Kornélia Chrapková, Stanislav Gregor, Michal Hojný

Why was it done?

Adherence to immunosuppressive medication is crucial for long-term graft survival. Patients receive substantial information from various healthcare professionals regarding new medications and lifestyle choices during hospitalisation and post-discharge. Frequent non-adherence indicated that the existing educational approach led by physicians was insufficient. Our objective was to create optimal conditions for providing these instructions to patients before discharge.

What was done?

In collaboration with the cardiology department, hospital pharmacists created and implemented a new educational project to improve adherence among heart transplant patients. The main activity involves hospital pharmacists conducting educational visits at the patient’s bedside, supported by new educational brochures, materials, and questionnaires.

How was it done?

We created a questionnaire and collected baseline data by assessing the knowledge of transplant patients educated by the existing educational approach. Afterwards, we designed and implemented a six-visit educational program and prepared new educational materials and brochures. A new record system was integrated into the hospital information system to facilitate communication between doctors and pharmacists, documenting educational visits and questionnaire results. The initial three visits, scheduled during hospitalisation, cover the correct use of immunosuppressants and other medications, their interactions, and potential adverse effects. Guidance on recommended lifestyle changes post-transplantation, such as hygiene, diet, and infection prevention, is also included. The remaining three visits occur within one year post-discharge to assess patient knowledge with the previously mentioned questionnaire and adherence to the treatment plan with BAASIS©. During these visits, the pharmacist conducts a comprehensive review of adherence, addresses any drug-related issues, and guides medication changes.

What has been achieved?

Since the project’s initiation, 120 visits have been completed, involving more than 30 patients. The education significantly improved patient knowledge, with educated patients scoring an average of 94% correct answers on the knowledge questionnaire compared to 59% correct answers of patients educated by the existing educational approach. Only three educated patients were non-adherent, with the most common type of non-adherence being failure to take medication at the prescribed time.

What next?

As more patients participate in the project, we aim to correlate their knowledge and adherence with tacrolimus levels and the incidence of rejection. Additionally, we intend to extend this educational initiative to other departments within the hospital.

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Author(s)

Tea Stiplošek, Alenka Kovačič

Why was it done?

The growing misuse of antimicrobials, resulting in resistant microorganisms and more adverse reactions, has been identified as a significant concern. To tackle this issue, a system was put in place to systematically monitor the hospital’s dispensing and use of reserve antimicrobials.

What was done?

We established a system where each reserve antimicrobial prescription in the hospital is reviewed by a pharmacist, who decides whether to dispense the drug or suggest therapy adjustments. The dispensation of antimicrobial drug to the patient is then recorded in the patient’s medical documentation.

How was it done?

A special prescription form has been prepared, used exclusively for ordering reserve antimicrobials from the pharmacy in our hospital, separate from other medications. The form is reviewed by a pharmacist, who calculates the patient’s creatinine clearance, examines inflammatory markers, checks the alignment of treatment with the antibiogram, and reviews potential interactions with other therapies before deciding whether to dispense the drug. If necessary, the pharmacist suggests modifications to the antimicrobial treatment. Each time the antimicrobial is dispensed, it is recorded in the patient’s medical documentation for easier treatment tracking.

What has been achieved?

This approach has established systematic control over the prescription of reserve antimicrobial drugs, with a clinical pharmacist introducing an additional prescription checkpoint. Analysis of data from our work between 2020 and 2023 shows that during this period, we dispensed 16,464 courses of reserve antimicrobials, with pharmacists recommending therapy adjustments in 2,211 cases (13.6%). On average, we recommended dose reductions in 43.5% of cases due to impaired kidney function and dose increases in 23.5% due to improved kidney function or the need for appropriate dosing for specific indications. Pharmacokinetic monitoring (TDM) interventions, including those for vancomycin, amikacin, and gentamicin, accounted for 29.75% of the interventions, while 3.35% of our recommendations involved therapy changes due to inappropriate treatment based on antibiograms or the patient’s impaired kidney function.

What next?

We are digitizing the ordering system, allowing departments to request antimicrobial drugs directly through the hospital information system. We are also developing an application to calculate kidney function and verify the correct antibiotic dosage for each patient, all in one place.

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Author(s)

Dückelmann Christina C., Landwehr Frauke

Why was it done?

According to the World Health Organization, interprofessional education and collaborative practice are leading to improved health outcomes. Interprofessional education occurs when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes.

What was done?

A cohort of two medical and two pharmacy students as well as four nursing trainees were selected to take over ward mangement and patient care for up to four real patients in a real hospital setting during a five weeks´ period. They were supervised by experienced professionals who “sit on their hands and look out of the window” only interfering when patients are endangered or situations are getting risky for patients.

How was it done?

To find out what the benefit was for pharmacy students, all six of them that where included in this year´s interprofessional wards on a cardiology and a neurology department, were interviewed using guided, problem-centred interviews. Their experiences were qualitatively explored and evaluated with regard to structure, supervsion, feedback and interprofessionality of this training.

What has been achieved?

Pharmacy students reported that the current structure, supervision and feedback enabled them to learn clinical pharmacy in a very profound way. On the other hand, it made other health care professionals aware of how they could benefit from clinical pharmacists and what the role of clinical pharmacists really is. The experience of being responsible for patients together with medical students and nursing trainees in this interprofessional setting was extremely helpful for their learning success and made them realize which influence on patients´ outcome working together in a team like that could have.

What next?

The Interprofessional Training Ward will be continued and rolled out on further departments of the hospital. In 2025, the surgery department will be part of the project. There, clinical pharmacists are badly needed. This qualitative research revealed the potential for further optimization of this programme in order to meet the learning objectives and expectations of the students even better. This will be aimed for in the next interprofessional training wards.

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Author(s)

A. HERREROS FERNÁNDEZ, P. FERNÁNDEZ-VILLACAÑAS FERNÁNDEZ, R. AÑEZ CASTAÑO, P. ORTIZ FERNÁNDEZ, M.A. MEROÑO SAURA, I. GARCÍA MASEGOSA, R. GUZMÁN LAIZ, P. SELVI SABATER, C. CABALLERO REQUEJO, L. RENTERO REDONDO, E. URBIETA SANZ.

Why was it done?

The preparation of sterile magistral formulas involves significant risks due to complex processes, material handling, and sterility requirements. A systematic risk assessment was essential to identify vulnerabilities, classify risk levels, and implement preventive measures to improve safety and compliance with regulatory standards.

What was done?

Sterile magistral formulas are personalized medications prepared in hospital pharmacy services to meet individual patient needs. In 2023, a risk matrix was implemented to systematically evaluate the risks associated with their preparation. This initiative aimed to enhance patient safety and ensure compliance with the “Guide to Good Practices for the Preparation of Medications in Hospital Pharmacy Services” (GGP).

How was it done?

Sterile magistral formulas prepared in the pharmacotechnics area of a hospital during 2023 were identified from a Microsoft Access® database. A Microsoft Excel® database was specifically designed to apply the GGP-based risk matrix, categorizing formulas into low, medium, or high risk. Each formula was evaluated across six key criteria: preparation process, route of administration, drug safety profile, number of units prepared, preparation vulnerabilities, and distribution process. Risk levels were assigned using a combination of letters (A-D) based on the matrix. Challenges included standardizing data collection and ensuring multidisciplinary collaboration to refine the matrix and ensure its applicability.

What has been achieved?

A total of 80 sterile magistral formulas were assessed. Of these, 38.75% were classified as medium risk, 36.25% as high risk, and 25% as low risk. Among medium-risk formulas, 67.7% included a “C” in the matrix, while 96.6% of high-risk formulas contained at least one “D.” The most frequent risk combinations were “BBAAAA” (11.25%) and “BBBAAA” (10%). The preparation process and administration route were the primary contributors to overall risk. Medium- and high-risk formulas, primarily intravenous mixtures of antibiotics and biological drugs, required preparation in a cleanroom environment, as recommended by the GGP.

What next?

This initiative demonstrated the value of a risk matrix in identifying and managing risks in the preparation of sterile magistral formulas. It represents a best practice model with significant potential for adaptation in other healthcare settings, enhancing patient safety and standardizing risk management in hospital pharmacy operations.

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Author(s)

Marco Gambera; Alessandra Grotto; Isabella Martignoni

Why was it done?

Periodic audits in hospital settings play a crucial role in identifying non-conformities and areas for improvement, ensuring that departments meet the required operational standards. During a routine inspection of the intensive care unit (ICU), the hospital pharmacy team discovered an outdated Y-site drug compatibility chart, which had not undergone prior review or approval. This non-conformity underscored the need for updated and reliable resources for managing drug compatibility in critical care settings. Addressing this issue became an opportunity to strengthen collaboration between the pharmacy and the ICU, with the aim of improving patient safety and clinical workflows

What was done?

The primary objective was to update and optimize the Y-site drug compatibility management in the ICU by revising the existing chart and educating the medical staff on real-time, evidence-based tools for accessing drug stability and interaction data integrating these tools into the daily practices of the ICU, ensuring that staff could access the most current information quickly and efficiently

How was it done?

ICU staff received dedicated training on using up-to-date software tools such as Stabilis, Micromedex, and Lexidrug. These tools provide real-time information on drug stability and interactions. Following the training, a comprehensive review of the ICU’s most frequently used medications was conducted and a new Y-site compatibility chart was developed, incorporating the latest stability data. The chart was tailored to meet the specific needs and operational practices of the ICU team, ensuring it was both practical and user-friendly

What has been achieved?

The revised chart and the associated training program significantly enhanced collaboration among healthcare professionals in the ICU, improving communication and awareness of each team member’s expertise. This project highlights the value of expanding the clinical role of hospital pharmacists, their expertise can directly improve patient care and support the management of complex drug therapies.

What next?

Further support measures will be implemented, such drug-specific tables outlining stability, interactions, storage, and handling instructions. These tables align with recommendations on medication management and provide an essential resource for clinical decision-making. The initiative not only enhanced the quality and safety of medication administration but also fostered a culture of continuous professional development and collaboration, ultimately benefiting the ICU’s clinical operations and patient outcomes

Author(s)

Ignacio Javier Tamboleo Sánchez, Julia Fernández Vela, Fernando Lago Ballester, Mª CARMEN MIRA SIRVENT, Elena Conesa Nicolas

Why was it done?

The initiative started in October 2022, it was a response to the challenges associated with prolonged intravenous antibiotic use. The overarching goals were to enhance patient care, mitigate unnecessary intravenous antibiotic prescriptions, and foster a culture of responsible antimicrobial stewardship. Recognizing the need for a systematic and collaborative approach, the Antimicrobial Stewardship Program (ASP) pharmacist played a central role in implementing interventions across various medical specialties, with a clear focus on improving patient outcomes.

What was done?

The initiative promoted the adoption of sequential antibiotic therapy among hospitalised patients undergoing intravenous treatment for more than three days. Leveraging the Wise Antimicrobial Stewardship Support System® (WASPSS®) and detailed analysis of medical records, the programme identified eligible patients based on criteria such as clinical stability, oral bioavailability, infection specifics, and antibiotic suitability.

How was it done?

The ASP pharmacist’s central role proved instrumental, with 74% of alerts resulting in actionable recommendations. WASPSS® detects every patient with intravenous antibiotic more than 3 days and the ASP pharmacist decides which patients will benefit from sequential therapy. Choosing the recommendation criteria is essential to have a good response from medical specialties ensuring a more efficient and tailored approach to intervention implementation. The main obstacles to the introduction of this initiative were the establishment of refined communication routes and the targeted training to the different specialties which are not yet fully implemented.

What has been achieved?

Results revealed that 74% of alerts met the criteria for transitioning from intravenous to oral administration. Among the 573 alerts reviewed, 45.1% witnessed a successful switch to oral antibiotics, 21.2% showed no change, and 16.7% of patients were discharged. Notably, higher acceptance rates were observed in specific specialties, such as pneumology (61.3%) and general medicine (54.4%). Nevertheless, oncology (35,3%) general and digestive surgery (25,8%) had the lowest acceptance rate. In conclusion, the global acceptance rate was lowest than expected (43,8%) but there are many improvements measures that are being carried out.

What next?

This initiative serves as a beacon for responsible antibiotic management, making noteworthy contributions to patient safety, cost-effectiveness, and the overall quality of healthcare delivery. Recommending ongoing collaboration, continuous training, and regular analysis of recommendation criteria will enhance its impact.

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Author(s)

Agnese Bosio, Chiara Carcieri, Sixberth Bugeraha, Silvia Scalpello, Giovanna Fazzina, Maria Carmen Azzolina, Gianluca Miglio, Annalisa Gasco

Why was it done?

Drug dispensing and patient monitoring are institutional activities of hospital pharmacists worldwide. Nevertheless, the enhancement of managerial capabilities, hard and soft skills is crucial to tackle the critical challenge arising from geographical, epidemiological, demographic, cultural and legislative differences between different countries.

What was done?

An initiative for cooperation and interaction between hospital pharmacists from different income countries has been developed.

How was it done?

The initiative was led by a pharmacist from an Italian hospital who was hosted by a hospital in southern Tanzania and spent a month collaborating with local hospital pharmacists, in order to streamline integrated workflows and optimise clinical care outcomes and professional training.

What has been achieved?

A Strengths Weaknesses Opportunities Threats (SWOT) matrix was developed to assess the impact on three main areas: drug management, clinical pharmacy and pharmaceutical care.

Strengths: attitude for workflow standardisation, multidisciplinary and multicultural teamwork, sharing of expertise and best practice, speed up of limiting processes in order to develop activities in support of patients and clinicians, time and effectiveness in qualified staff training.

Weaknesses: complexity of procedures for drug import, hospital staff shortage (both pharmacists and physicians), absence of primary care and hospital-territory continuity of care network, clinical severity of patients admitted to hospital, imbalance between clinical pharmacy/pharmaceutical care in favour of drug management.

Opportunities: professional growth due to new healthcare challenges facing, soft skills improvement (problem solving, versatility, working under stress, teamwork, integration, overcoming prejudices), hard skills enhancement (logistics, international legislation, scientific English), budget optimisation for new investments (equipment/staff), improvement of patient safety and overall level of care.

Threats: language/cultural barriers, variable learning curve and resistance to change, barriers in social/professional relationships, individual variability in adaptation period, different patient perceptions of health and medical care.

What next?

Professional integration of hospital pharmacists from different educational and cultural backgrounds could enhance their ability to address different clinical, environmental and socio-economic issues, with the following outcomes: strengthening the professional pathway; optimising outcomes with consequent cost savings; improving the quality of healthcare for patients.

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Author(s)

AMINE BAYEN, OUMAIMA KHARKHACH, HICHAM EL HORR, LHOUSSAIN ZARAYBY, SANAE DERFOUFI

Why was it done?

It has been observed that within the gastroenterology, neurology, internal medicine, rheumatology, and dermatology departments, there exist inconsistencies and disparities. These include extended transportation times averaging 8 minutes, a lack of isothermal bags for transportation, and refrigerators not connected to the main hospital generator.
Strict adherence to storage guidelines is crucial, as any breach in the cold chain could compromise the drug’s therapeutic effectiveness, increase the risk of adverse effects, and lead to significant financial losses for healthcare institutions.

What was done?

Ensuring optimal storage and transportation conditions for biotherapy drugs in various medical departments within a university hospital by assessing and improving cold chain compliance.

How was it done?

Implemented corrective actions and recommendations have been primarily directed towards minimizing transportation duration and procuring thermal bags for all departments handling biotherapy products. These initiatives encompass enhancing staff awareness in the cold chain process through sensitization campaigns and regularly evaluating refrigerator temperatures. Moreover, a strategic plan is underway to establish their connectivity to the generator system in the near term.

What has been achieved?

A notable reduction in the transportation time of biotherapeutic drugs has been achieved, decreasing the average duration from 8 minutes to 6 minutes. Additionally, the widespread adoption of thermal bags across audited departments has substantially bolstered the stability of biotherapeutic drugs, mitigating temperature fluctuations and enhancing patient safety. Moreover, our efforts in sensitising medical and pharmaceutical staff within these departments have yielded a significant increase in awareness and adherence to stringent cold chain protocols.

What next?

The inconsistencies and disparities identified during the assessment of the biotherapy drug cold chain within our hospital suggest a potential lack of adherence to procedural standards. This situation poses a considerable risk to patient safety, warranting further investigation and action.
Our focus will extend beyond the cold chain assessment to evaluate other pharmaceutical procedures. Specifically, we will investigate the adherence to autoclave sterility cycles for medical devices and the robustness of the preparation process for oncology medicines.

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Author(s)

Xabier Larrea Urtaran, Elisabet Nogué Pujadas, Alba Couso Cruz, Guillem Pla Escriva, Carol Batlle Perales, Carla Subirana Batlle, MIreia Bruguera Teixidor, Carmen Ortí Juan, Anna Dordà Benito, Mireia Vila Curris

Why was it done?

The aim of the study is to analyze pharmaceutical interventions (PI) carried out by a hospital pharmacist in a Resuscitation Unit (RU) in terms of number and degree of acceptance.

What was done?

The integration of a pharmacist in the critical care unit allows optimizing pharmacotherapy, prevent s medication errors in critical patients and working in a multidisciplinary methodology .

How was it done?

It is a prospective study carried out from 1 August 23 to 15 September 23 on weekdays, in which patients with a minimum of 48 hours of admission were included, recording the PIs conducted during the daily clinical activity of a pharmacist at the RU. The variables collected were: age, sex, type of PI, medication involved, acceptance of PI and day since admission. The percentage of acceptance of the PIs and activity indices (PI/patient, PI/days and day of PI in respect to admission to the RU were calculated. For the descriptive analysis, the means and standard deviation (SD) were used.

What has been achieved?

80 patients were included during a total of 31 weekdays, mean age ± SD of 59.6 ± 18.4, 46.3% were women (n=37). Patients had 8.9 ± 3.0 drug prescriptions and 3.8 ± 2.0 infusions and on-demand drugs. There were 5.9 patients admitted per day in the RU .107 IPs were carried out, with activity indices of 1.3 IP/patient, 3.45 IP/day and 3.21 IP days compared to admission to the RU.
The groups of drugs with the highest IP were: anti-infective agents for systemic use (n=57), blood and hematopoietic organs (n=17) and nervous system (n=15).
The interventions carried out were: adjustment of anti-infective therapy (n=21); pharmacokinetic adjustment (n=18); administration (n=17); conciliation (n=16); dose adjustment by glomerular filtration rate (n=16); dose adjustment (n=10); duplicity (n=5); no need (n=2); compounding (n=1) and allergy (n=1).
The degree of acceptance of the IP was 92.5% (n=99).

What next?

The acceptance of PIs in the RU is very high , being greater than 90%, with an activity of more than 3 PIs per day, reinforces the integration of a hospital pharmacist in a multidisciplinary team to ensure patient safety and improve the pharmacotherapeutic profile. It is necessary to have a pharmacists integrate in the RU.