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DEVELOPING A MULTIFACETED PHARMACEUTICAL CARE MODEL: EXPERIENCE FROM A REGIONAL HOSPITAL IN TAIWAN

European Statement

Clinical Pharmacy Services

Author(s)

Jian-Ying Wang; Shan-Yu Hsu; Ming-Chia Lee

Why was it done?

We implemented pharmacist cognitive services with internal reimbursement and joined the National Health Insurance (NHI) pilot for a Pre-End Stage Renal Disease (Pre-ESRD) clinic and Intensive Care Unit (ICU) ward rounds. We launched a LINE official account to support patient queries, reminders, and follow-up, developed Podcast/YouTube education to enhance outreach, streamlined documentation using the Eliminate-Combine-Rearrange-Simplify (ECRS) approach with AI-assisted editing, and implemented an internal clinical communication platform.

What was done?

The growing complexity of chronic disease and intensive care requires pharmacists to provide professional services such as dose adjustment, drug–drug interaction management and patient counselling. These tasks are crucial for safety and quality, yet in the past they were often not formally recognised or reimbursed. Our hospital developed this model to ensure that such professional activities are acknowledged with institutional and NHI reimbursement, while also supported by digital and streamlined tools. Linking professional services with clear payment and measurable outcomes underscores the value of pharmacists in patient safety and sustainable healthcare.

How was it done?

We established the service fee in New Taiwan dollars (NT$): NT$100 (~€3) per cognitive record (institutional), NT$200 (~€6) per Pre-ESRD case, and NT$250 (~€7) per Intensive Care Unit (ICU) patient-day under the NHI pilot. Clinical activities were coded by drug-related problem (DRP) categories, and acceptance of pharmacist recommendations was tracked. Using ECRS, we modularised SOAP forms, removed duplicate entry and automated collation; AI-assisted editing further improved clarity and consistency. LINE was integrated as a platform for patient queries and consultations, with push notifications directing patients to Podcast/YouTube educational resources produced by pharmacists.
For the cost-benefit analysis (CBA) we used a hospital perspective. Cost was defined as the pharmacist service fee. Benefit had two parts: (i) direct medication-cost savings from accepted interventions, and (ii) avoided medical expenses estimated by DRP severity, such as additional laboratory tests, emergency visits or ICU days.

What has been achieved?

In 2024, pharmacist cognitive services comprised 1,354 records, accounting for 0.18% of all prescriptions, with an acceptance rate of 99.85%. The most common DRP was subtherapeutic exposure (35.6%). At the same time, ICU rounds involved 1,315 cases, and the Pre-ESRD clinic delivered 242 visits. From a hospital perspective, CBA demonstrated that cognitive services achieved a ratio of 1:13.3, while ICU services reached 1:1.84, confirming that pharmacist remuneration is cost-effective.
Patient communication and education were also strengthened. The LINE programme enrolled 1,897 members, with all queries resolved within 24 hours, while 17 Podcast/YouTube releases generated 59,760 video views and 30,926 podcast plays. Workflow efficiency improved markedly after the ECRS redesign in early 2024, with documentation steps reduced from 16 to 6 and average time per record shortened from 825 seconds to 98 seconds. The pharmacist Net Promoter Score (NPS) rose from 20 to 80, reflecting greater user satisfaction. These improvements were estimated to increase annual service capacity by 252 records and to reduce paper consumption, elevator use, and carbon emissions by 2,892 kg CO₂e.

What next?

The model has matured into a multi-faceted pharmaceutical care approach that enhances medication safety, enables real-time patient consultation, and extends reach through multimedia education. Although CBA has demonstrated the cost-effectiveness of pharmacist remuneration, outcomes will continue to be monitored and refinements pursued to ensure sustained improvement. With its comparability and reproducibility, the model provides a practical reference for other hospitals and healthcare systems.

USING PATIENT JOURNEY MAPPING TO IMPROVE CLINICAL PHARMACY SERVICES: A QUALITY IMPROVEMENT PROJECT

European Statement

Clinical Pharmacy Services

Author(s)

Cliona Hayden
David Lumsden
Aidan Morris
Darren Walsh

Why was it done?

Clinical pharmacy services are vital for medication safety and patient-centred care. However, in Ireland, the absence of a national strategy has led to inconsistent service delivery across hospitals. This initiative was undertaken to evaluate and improve the clinical pharmacy service in a Model 4 hospital, addressing structural, process, behavioural, and cultural challenges. The goal was to enhance service integration, reduce variability, and align with international standards such as the European Statements of Hospital Pharmacy.

What was done?

A quality improvement project was launched using patient journey mapping (PJM) to visualise medication-related touchpoints across the inpatient care pathway. The initiative aimed to identify service gaps and opportunities for improvement. Key interventions included stakeholder engagement, SWOT analysis, and the development of tools to support prioritisation, documentation, and training.

How was it done?

The PJM approach followed a six-step methodology, including problem definition, stakeholder consultation, and data analysis. Engagement activities involved structured interviews with pharmacy staff, consultations with nursing and medical teams, and completion of the HSE Workpositive survey. These inputs were synthesised to assess organisational health and identify barriers to effective service delivery. The analysis focused on the interaction between structure, processes, behaviours, and culture.

What has been achieved?

The initiative identified critical gaps in medication reconciliation, discharge planning, and interprofessional communication. Outcomes to date include the realignment of the clinical prioritisation tool, clearer MPAR endorsement guidance, and a tailored training framework to address role ambiguity and knowledge gaps. Positive behaviours such as pharmacist autonomy and peer support were reinforced, while structural and process inefficiencies were targeted for improvement.

What next?

Next steps include embedding standardised processes, implementing electronic prescribing, and evaluating the impact of these changes on patient outcomes. Further work will explore the role of advanced specialisation in clinical pharmacy and strengthen interprofessional collaboration. Leadership will focus on aligning structure and culture to support sustainable, patient-centred service improvement.

INTEGRATION OF THE PHARMACEUTICAL TEAM IN THE CAR-T CELL CARE PATHWAY: HEALTHCARE PROFESSIONALS’ FEEDBACK

European Statement

Clinical Pharmacy Services

Author(s)

RAZEYRE Charlotte, QUINTARD Adeline, BAROUX Gaëlle

Why was it done?

Since 2019, the pharmaceutical team (PT) dedicated to advanced therapy medicinal products (ATMPs) in our institution has been integrated into the care pathway of patients treated with CAR-T cells. The PT intervenes upstream of the first medical consultation through an optimized medication reconciliation (OMR), then 48 hours before apheresis to ensure its update and compliance with wash-out periods. Prior to CAR-T infusion, a pharmaceutical consultation is conducted to update the OMR, explain the different steps of the pathway, and address patients’ questions. All data are recorded in the electronic medical record. Quality support materials are also provided to healthcare teams. In this context, we aimed to assess healthcare professionals’ satisfaction with these interventions in order to identify opportunities for practice improvement.

What was done?

To collect and analyze feedback from healthcare professionals involved in the CAR-T pathway regarding the activities and tools implemented by the pharmaceutical team.

How was it done?

A questionnaire was designed using Google Forms by the ATMP-PT and disseminated by e-mail to professionals involved in the CAR-T pathway. It covered several domains: respondent’s role, knowledge and use of OMR and checklists, perceived relevance of pharmaceutical consultations, and satisfaction with quality documents.

What has been achieved?

All professionals involved in the pathway were contacted, with at least one response from each professional group except apheresis physicians. Only 42% of respondents reported being aware of and using OMR during their consultations. However, 86% considered pharmaceutical consultations relevant and were satisfied with their contribution to the CAR-T pathway. In addition, 71% were satisfied with the quality documents, while the remaining respondents reported not using them. Regarding potential improvements, one respondent suggested that the PT should be more involved during the patient’s hospitalization.

What next?

This study highlights the overall positive perception of the PT’s interventions. Nevertheless, the responses reveal limited use of some tools, particularly OMR and checklists, whose impact remains difficult to assess in the absence of feedback from apheresis physicians the main intended users. These findings underscore the need to further raise awareness among healthcare teams about these tools, in order to optimize their integration into the care pathway and strengthen interprofessional coordination.

DEVELOPING THE ROLE OF A BIOLOGICS PHARMACY TECHNICIAN

European Statement

Clinical Pharmacy Services

Author(s)

Megan Stevens

Why was it done?

The National Health Service (NHS) is under pressure due to workforce shortages. Staff numbers cannot match service demand. In our Trust, Specialist Biologic Pharmacists are not being fully utilised.

What was done?

Promoting the role of a Clinical Pharmacy Technician in a specialist service; releasing Specialist Pharmacists to expand their service.
Showing that Clinical Pharmacy Technicians, with relevant training and support, can safely screen biologic prescriptions and manage stock on BDU.
Reducing the number of items being returned from BDU, by allowing the Clinical Pharmacy Technician to be more present in BDU and make proactive interventions to prevent unnecessary dispensing.

How was it done?

The Specialist Biologics Pharmacist developed a list of tasks appropriate for a Clinical Pharmacy Technician.
A procedure was written to outline the screening process and returns process for biologics by a Clinical Pharmacy Technician. They are unable to screen prescriptions with a change of drug, dose or frequency.
Full training was provided, and competencies were used to assess capability.
Any errors in the screening process will be reported and monitored by Pharmacy Governance.

What has been achieved?

From April to June 2024, a total of 938 biologic prescriptions were screened. 750 of these were screened by a Clinical Pharmacy Technician. This equates to a 70% decrease in Pharmacist screening workload- that’s 9 hours per week of pharmacist screening time saved.
Within those three months, 17 items were returned from BDU. In the same three months the previous year, 64 items were returned. This shows a 73% decrease in returns.
There have been no Datix reports for screening errors on prescriptions screened by Clinical Pharmacy Technicians to date.

What next?

This service development shows that employing a Clinical Pharmacy Technician allows Specialist Pharmacists to be utilised more appropriately. It allows them to increase their outpatient activity; starting a Pharmacist-led Dermatology Biologics clinic and increasing patient numbers in Pharmacist-led Gastroenterology clinics.
The reduction in returns shows that Clinical Pharmacy Technicians can make proactive interventions and prevent unnecessary items being dispensed. This reduced unnecessary workload for the Dispensary and Aseptic Unit.
No Datix reports being submitted shows that Clinical Pharmacy Technicians are capable of screening biologic prescriptions when fully trained and supported

IMPLEMENTATION OF A CLINICAL PHARMACIST-LED ELECTRONIC MONITORING SYSTEM FOR SURGICAL ANTIBIOTIC PROPHYLAXIS

European Statement

Clinical Pharmacy Services

Why was it done?

Before this initiative, surgical antibiotic prophylaxis (SAP) monitoring was paper-based and mainly handled by nursing staff, with little pharmacist or surgeon engagement. Entries were often incomplete or inaccurate, with frequent confusion between prophylactic and therapeutic use. Critical parameters—timing, duration, and patient-specific factors—were inconsistently recorded, and data were rarely analysed, so protocol compliance went unmonitored. Consequently, surgeons paid limited attention to guideline adherence or to the contribution of suboptimal prophylaxis to antimicrobial resistance. These gaps exposed patients to unnecessary antibiotic exposure and avoidable infection risk. The project was therefore launched to create a reliable, accountable monitoring process that would improve data quality and enable systematic feedback and stewardship.

What was done?

A clinical pharmacist-led, electronic monitoring system for SAP was developed. A comprehensive data-capture form (demographics, surgery type and duration, wound class, antibiotic choice, dose, timing, and duration) was designed after benchmarking similar tools and implemented in the hospital information system (HIS). Clinical pharmacists reviewed all SAP entries, verified completeness before discharge, and generated reports shared with the Infection Control Committee and hospital management to support data-driven interventions.

How was it done?

A multidisciplinary team of pharmacists, infection control experts, IT staff, and surgeons collaborated under hospital leadership to design and implement the process. All patients undergoing surgery and receiving SAP were monitored by trained pharmacists in the wards, and data entries were completed before discharge to ensure accuracy. The collected information was analysed by clinical pharmacists, and discrepancies between clinical practice and established protocols were flagged. The Infection Control Team, in collaboration with hospital management, provided feedback to surgeons and developed targeted training programmes where needed. Initial barriers—limited familiarity with digital forms and resistance to workflow changes—were overcome through structured training, ongoing communication, and continuous on-ward support.

What has been achieved?

Documentation completeness and accuracy improved markedly, enabling routine compliance assessment across antibiotic choice, dose, timing, and duration. Analysis identified delays in administration; corrective actions, education, and protocol updates followed. Surgeon awareness of correct timing increased, and the pharmacist’s role in antimicrobial stewardship was strengthened.

What next?

Next steps include embedding the revised SAP protocol across all surgical units, regular audits, and continued pharmacist-led monitoring to sustain improvements. By integrating SAP monitoring data with patient readmission data for surgical site infections, we aim to evaluate whether improved documentation, training, and protocol revision lead to measurable reductions in infection-related readmissions. The model is effective, scalable, and transferable to other hospitals. Integration with AI-assisted decision-support tools within the HIS is being explored to further optimise prophylaxis management.

FACILITATED HOSPITAL PHARMACOVIGILANCE: A MULTIDISCIPLINARY MODEL WITH THE CLINICAL PHARMACIST AS OPERATIONAL SUPPORT TO REPORTERS

European Statement

Clinical Pharmacy Services

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 organizational 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 finalized 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.

PHARMACIST-LED SEVERE ASTHMA CLINIC: IMPROVING ACCESS AND OPTIMISING CARE

European Statement

Clinical Pharmacy Services

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.

PHARMACEUTICAL CARE PROGRAMME IN PAEDIATRIC PALLIATIVE CARE: INDIVIDUALISED AND SAFE MEDICINE COMPOUNDING

European Statement

Clinical Pharmacy Services

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.

IMPROVING INTRAVENOUS CHEMOTHERAPY ADMINISTRATION SAFETY VIA SMART INFUSION TECHNOLOGY: ONE-YEAR IMPLEMENTATION AT HYGEIA HOSPITAL

European Statement

Patient Safety and Quality Assurance

Author(s)

IOANNIDIS KONSTANTINOS
SCARLATINIS IOANNIS
KORRE OURANIA
BOTSIOU MARIA
NIKOLAOU KATERINA-ANGELIKI

Why was it done?

The integration of clinical pharmacists in oncology settings plays a critical role in ensuring the safe and effective administration of chemotherapeutic agents. At Hygeia Hospital, over the past five years, clinical pharmacists have identified and prevented 1,272 chemotherapy-related medication errors, corresponding to 2.4 errors per 100 chemotherapy days. Despite this substantial contribution, challenges persist in the administration process by nursing staff, particularly regarding infusion parameters. Common errors include incorrect infusion rates and the omission or improper use of required filters and light-sensitive infusion sets, and their prevention remains a persistent challenge.

What was done?

To mitigate these risks, Hygeia Hospital has implemented parameterized electronic infusion pumps as an additional safety mechanism.

How was it done?

These pumps are pre-programmed by clinical pharmacists with non-modifiable infusion time limits for each chemotherapeutic agent, preventing unauthorized alterations by nursing personnel. Furthermore, the pumps provide mandatory prompts regarding the use of filters or/and light sensitive infusion sets, as specified in the Summary of Product Characteristics (SPC) of each drug.

What has been achieved?

Since their introduction one year ago, these infusion pumps have facilitated the identification and correction of previously undetectable administration errors, with an observed rate of 0.15 errors per 100 chemotherapy days. The majority of these involved incorrect selection of infusion duration by nursing staff. These findings underscore the value of pump parameterization in uncovering latent errors and reinforcing adherence to safe administration practices.

What next?

Future steps include expanding the use of parametrized infusion pumps beyond oncology to other high-risk areas, such as intensive care units, where precise and safe administration is equally critical. By reducing reliance on manual intervention and standardizing administration protocols, this approach enhances the overall safety and efficacy of drug delivery across multiple clinical settings.

INTEGRATION OF PHARMACEUTICAL CONSULTATION IN A PNEUMOLOGICAL DIAGNOSTIC CENTER

European Statement

Clinical Pharmacy Services

Author(s)

André Maia; Maria Teixeira; Ana Catré; Inês Margalho; Joana Duque; Marisa Costa; Marta Susana; Miguel Paulo; Tomás Sousa; Vânia Pereira; Teresa Pereira

Why was it done?

Tuberculosis(TB) is an infectious disease caused by Mycobacterium tuberculosis, typically transmitted through the airborne route. Despite being a curable disease, 1.5 million people die from tuberculosis each year, making it the leading cause of infectious death worldwide.[1,2] In Portugal, the most recent data from the National TB Program indicate a notification rate of 14.5 cases per 100,000 population in 2023. Regarding multidrug-resistant tuberculosis cases, the number of cases has doubled.[3] There was a need to restructure the anti-tuberculosis drug management circuit in the Pneumology Diagnostic Centers(CDP), creating a Personalized Distribution of Anti-tuberculosis Therapy (DPTB), to facilitate administration, improving adherence to therapy and therapeutic reconciliation.

What was done?

Pharmaceutical consultation was implemented in a pulmonological diagnostic center and the interventions performed during the Pharmaceutical Consultation (FC) were analyzed.

How was it done?

The pilot project began in collaboration between Pharmaceutical Services and the responsible Physician. Each month, the pharmacist visits the CDP and validates the medical prescription and prepares the DPTB for one month. During the FC, the information recorded by the physician in the previous consultation is verified, patient compliance is assessed, and therapeutic reconciliation is structured. A manual and tools to support healthcare professionals were developed, essential for improving the efficiency of TB treatment.

What has been achieved?

Between April and August 2025, 38 FC were carried out, in which a total of 11 patients with median age 59 years, 7 (64%) female and 4 (36%) male. The patients monitored were divided into: 5(45.5%) with latent TB, 3(27.3%) with active TB, and 3(27.3%) with atypical mycobacteria. The TB infection, 1(33.3%) case of pulmonary TB, 1(33.3%) of lymph node, and 1 (33.3%) of ocular TB. During the FC, 7 interventions were carried out: 1 drug interactions, 3 teaching and promotion of adherence to therapy, and 3 on adverse reactions (AE).

What next?

Pharmacists’ interventions in educating patients, counseling on AEs, monitoring and alerting them to risk situations significantly contribute to reducing treatment abandonment, one of the greatest challenges in tuberculosis control. In the future, we plan to conduct these in-person consultations in Primary Care settings for patients referred to by their physician.