CLOSED-LOOP DIGITAL TRACEABILITY OF DOSE BANDING BAGS
European Statement
Production and Compounding
Author(s)
Paola Cristina Cappelletto, Linda Cappellazzo
Why was it done?
Ensure complete digital tracking in closed loop of batches and expiry dates of anticancer drugs prepared in dose banding. Software Medical80© must be able to identify quickly the batches of the drug and solvent used to prepare the bag in dose banding and administered later to a specific patient, following a medical prescription.
What was done?
In 2018, the Pharmacy Unit of Bolzano Hospital introduced automated preparation of fixed-dose anticancer drugs (gemcitabine, paclitaxel, rituximab, pembrolizumab) using Apoteca Chemo© [3]. Until now, the batches prepared have been partially tracked by the Bolzano hospital’s internal software (Indaco©). In 2025, new software called Medical80© was purchased. To digitalize the entire process of prescribing cytostatic drugs by the departments, it was developed a complete batch tracking in closed loop within the Medical80© software including also dose banding preparations. The hospital pharmacist collaborated with the software developers to ensure a safe and complete batch tracking system, in accordance with current regulations [1] and pharmacovigilance requirements [2].
How was it done?
The pharmacist responsible for the galenic area coordinated the activity. Initially, she requested the coding of dose banding preparation within a national database to assign a unique code to each preparation. Specific records for the individual bags prepared in dose banding were then coded, both in the warehouse software and in the prescription and medical record software. The codes automatically assigned by the warehouse program were then entered into Medical80©.
What has been achieved?
This process has enabled to fully track batches and check stock levels directly from the prescription and validation software. Once the batches have been set up, labels were printed and affixed to the bags, and the technician loaded the preparations into Medical80©, recording the batch and expiry date of the starting drug. This information was also recorded and tracked through barcode. At the time of prescription, the bag set up in advance was associated and tracked until administration to the patient.
What next?
Complete tracking from preparing dose-banded bags to delivery to the patient, ensured safe dispensing of the cytostatic drugs. The future goal is to digitalize the load of batches prepared in dose banding using an optical scanner in Medica80©.
IMPROVING THE SAFETY, USE AND WASTE OF CONTROLLED MEDICATIONS IN SAN IGNACIO UNIVERSITY HOSPITAL
European Statement
Patient Safety and Quality Assurance
Author(s)
Pinzon Garcia, Viviana Andrea
Fajardo Escolar, Angelica Paola
Why was it done?
Since implementing the Opioid Stewardship Programme in 2018, we have improved the management of morphine and hydromorphone in our hospital. This has not only reduced medication waste, but also created a hospital culture that recognises the importance of standard single-dose in ensuring medication safety. Based on this, we extended the programme to include other controlled medicines, after identifying the need to limit the use of vials and ampoules of fentanyl, remifentanil and ketamine considering the available commercial presentations and the probability of using these products on multiple patients without maintaining their sterility.
What was done?
We extended the coverage and monitoring of the unit-dose system to include other controlled medications apart from morphine and hydromorphone, through interdisciplinary collaboration between the Anaesthesia and Pharmacy Departments, with the aim of reducing waste and the risk of misuse at San Ignacio University Hospital, a high-level hospital in Bogotá, Colombia.
How was it done?
As part of the annual Pharmacy and Therapeutic Committee operative plan, the pharmacy and anaesthesia departments evaluated the risks in the medication order cycle of opioids and other controlled medications, defining strategies using an improvement cycle model. We assessed the feasibility of preparing unit doses of these medications, as well as the storage, preservation conditions and logistics of medication inventory. We deployed the strategy through staff training, mainly in operating rooms, intensive care and resuscitation, and established a follow-up of consumption and adherence, records of remnant disposal, cases of naloxone use and events reported to the pharmacovigilance programme.
What has been achieved?
The average proportion of standard single-dose prescriptions in 2025 was 74% for hydromorphone, 77% for morphine, 84% for fentanyl and 50% for remifentanil. Through our compounding center, we prepared 143,854 doses of these medications in 2024 and 78,421 from January to August 2025. The inventory write-off percentage due to expiration was 1.06% in 2024 and 0.38% in the first eight months of 2025. The percentage of hospitalised patients who received naloxone was 0.20 in the first semester of 2024 and 0.17 in the first semester of 2025.
What next?
Conducting interdisciplinary rounds in services to identify on-site adherence to implemented practices and supportting Human Talent, maintaining the improvement cycle process.
Implementation of an opioid stewardship programme (OSP) at San Ignacio University Hospital
Pdf
European Statement
Patient Safety and Quality Assurance
Author(s)
Viviana Andrea Pinzon Garcia, Paula Camila Murcia Jaramillo, Reinaldo Grueso Angulo
Why was it done?
In 2018, concerned with the opioid crisis in USA, the pharmacy and therapeutic committee began to work on safer opioid use; an initial diagnosis showed an increase in the use of in hospital opioids and a lack of protocol for the disposal of the resultant remnants. Standard single-dose syringes (SSDS) were devised to avoid remnants, subsequently noticing that the strategies to be used should involve the whole medication order cycle (MOC). This gave rise to the OSP, which involves physician’s pain management and prescribing practices, pharmacy preparing and dispensing process, nurse’s custody, administration and disposing protocols.
What was done?
An Opioid Stewardship Programme (OSP) led by a multidisciplinary team: scientific direction, pharmacy and pain clinic, was implemented to ensure adequate and safe opioid prescription, dispensation, administration and disposing practices in San Ignacio University Hospital (HUSI), a tertiary level hospital in Bogota, Colombia.
How was it done?
Institutional pain practice guidelines were assessed, unifying the titration doses with SSDS and developing disposal protocols in which care staff is constantly being trained ever since. To trace the impact of the OSP, indicators for IV opioid consumption, SSDS prescription, naloxone use and guideline adherence were created.
Main obstacles on SSDS: <10% prescribing adherence, availability failures and dose expiration. In response, the whole ampoule prescription was narrowed to only pain specialists to face SSDS expiration costs and avoid shortage.
What has been achieved?
SSDS prescription proportion above 70% by July 2022, decreased milligram morphine equivalent (MME) consumption per hospital discharge (January 2019: 37, January 2020: 47, January 2021 (COVID 2nd surge): 39, January 2022: 25, July 2022 (COVID 3rd surge):16) and monthly costs decrease in 1997 USD, between 2019 and 2022.
An opioid shortage during the COVID surges, deepened in Colombia due to a hydromorphone recall, was avoided.
What next?
The OSP initiative could be replied in healthcare institutions considering our achievements. To keep working in a safer opioid MOC, our OSP has formulated new strategies with an active role of pharmacists, pain specialists and nurses oriented to: remnants disposal protocol, prescribing policies, medication error detection and healthcare staff and patient education.
DELIVERY OF SPECIALISED MEDICINES IN MEDICINE POST BOXES – A PILOT STUDY
Pdf
European Statement
Clinical Pharmacy Services
Author(s)
Maja Kirstine Brøns, Gitte Borup
Why was it done?
The purpose was to move medicine collection from the outpatient clinics to a MPB in order to reduce CO2-emission, due to less kilometers traveled by patients, to increase equal access to healthcare services, and to reduce physical patient contact during a global pandemic.
What was done?
This was a pilot study that investigated a method for, and patient satisfaction with, delivery of specialized cost-free hospital medicines via Medicine Post Boxes (MPB) in rural areas.
How was it done?
The project was initiated by clinical pharmacists, who acted as interdisciplinary liaisons, who understood the clinical aspect of the medical treatment, the importance of good distribution practice and the logistic capacity at the hospital pharmacy. Having completed clinical controls via telephone, the clinic forwarded the information needed to the hospital pharmacy. Initially, all requisition forms were checked by clinical pharmacists to ensure complete information was given, and that documentation was performed properly. Once fully implemented, a task shifting onto pharmaconomist was done concerning the control of the requisitions, however initiation of cooperation and problem solving with the clinic was maintained as a pharmacist task.
What has been achieved?
Focus group interviews with doctors and nurses from the clinics expressed satisfaction with the flexibility of conducting clinical controls over the phone, and not having to handle the practical part of ordering, documenting and handing out medicines. No concerns of patient safety were expressed, and a wish for full coverage for medicine delivery via MPB was stated. A survey among the patients using the MPB was conducted: A total of 148 respondent participated of whom 98 % stated being ’very pleased’ or ’pleased’ with the service. Also, 98 % felt safe to ’a very high degree’ or ’high degree’ with using the MPB and 99 % wished to use the MPB again. Estimates of CO2 reduction have not yet been calculated.
What next?
MPB’s should be available in urban areas also, as it increases flexibility for the patients and healthcare professionals. The goal is to include all suitable clinics and patients who receive long term treatment with hospital medicines