A MULTIDISCIPLINARY APPROACH TO THE COMPREHENSIVE CARE OF MULTICOMPROMISED HOSPITALIZED PATIENTS: A CASE REPORT
European Statement
Patient Safety and Quality Assurance
Author(s)
S. Ambrosini, V. Orlando, C. Provezza Provezza, A. Zaltieri, N. Zanini, N. Faroni
Why was it done?
Ensuring a multidisciplinary approach to the comprehensive care of hospitalized patients is a recognized indicator of healthcare quality. This strategy proved highly effective in the management of a patient with a multidrug-resistant Pseudomonas aeruginosa (PA) infection and a severe sacral pressure injury, requiring advanced antimicrobial therapy, targeted nutritional support, and specialized wound care to promote healing.
What was done?
Multicompromised patients increasingly challenge hospital care due to infections from multidrug-resistant (MDR) bacteria, which limit therapeutic options and complicate management. Prolonged hospitalization also raises the risk of pressure injuries, worsening metabolic stress and delaying recovery. This initiative aim to apply an integrated therapeutic strategy—combining a reserve antibiotic, advanced wound care and tailored nutritional support—to promote healing, control infection and restore nutritional balance in a highly vulnerable patient.
How was it done?
The patient received Cefiderocol (2 g every 8 hours) and Fosfomycin (4 g every 6 hours) for six weeks to treat the PA infection. The pressure injury was managed with an oxygen-enriched oleic matrix dressing from organic olive oil, allowing controlled release of reactive oxygen species (ROS) to stimulate microcirculation, cell proliferation, and antimicrobial activity. Dressings were changed two to three times weekly based on progress. Nutritional needs were supported with a high-calorie, high-protein oral supplement (ONS) containing arginine, zinc, vitamin C, selenium, and carotenoids, given once or twice daily to enhance collagen synthesis and tissue repair.
What has been achieved?
This multidisciplinary strategy enabled the prompt definition and implementation of an optimal diagnostic–therapeutic pathway. The intervention and collaboration of multiple healthcare professionals ensured a faster and more effective patient response to treatment. The active involvement of the infectious disease specialist, clinical dietitian, wound care nurse, and hospital pharmacist guaranteed comprehensive, high-quality patient management —from drug and medical device supply to the successful resolution of infection and wound healing, while preventing malnutrition.
What next?
Establishing structured treatment pathways through multidisciplinary teams contributes to a more efficient and sustainable healthcare system. This experience represents an example of best practice, highlighting how collaboration among healthcare professionals—including pharmacists as medication safety officers—can be effectively translated to other hospital settings.
Securing the management of experimental product in investigator services in case of non-nominative dispensing: a risk based approach
Pdf
European Statement
Patient Safety and Quality Assurance
Author(s)
Mélanie Hinterlang, Mona Assefi, Pauline Glasman, Delphine Brugier, Meriem Charfi, Fanny Charbonnier-Beaupel, Marie Antignac, Carole Metz
Why was it done?
Clinical trials in critical care sometimes demand swift inclusion and administration, often occurring at any hour of the day or night. To enhance patient care, the experimental drug may be provided in a non-nominative manner directly from the pharmacy unit to the care unit for storage before any inclusion as a stock. This dispensing pathway is considered less secure than the conventional named dispensing but can be necessary. The objective of this risk analysis for this dispensing process was to identify the risks, determine the number of them with unacceptable criticality, and propose actions to reduce criticality of these risks.
What was done?
A risk analysis of non nominative dispensation of experimental drugs process was conducted to streamline, secure, optimize, and standardize this dispensing process.
How was it done?
Following a preliminary investigation, three pilot services were chosen: surgical intensive care, post-interventional recovery room (SSPI), and cardiology. The Failure Mode, Effects, and Criticality Analysis (FMECA) method was applied to the non-nominal dispensing circuit of experimental drugs from reception at the pharmacy unit to the administration of the drug to patient. Investigators, clinical research associates, nurse, and pharmacists participated.
What has been achieved?
Following the FMECA, 281 risks were identified. The majority were either acceptable (123 or 44%, 110 or 39%, 147 or 52%) or tolerable (139 or 49%, 148 or 53%, and 130 or 46%) for the intensive care, SSPI, and cardiology services, respectively. Unacceptable risks numbered 19 (7%), 23 (8%), and 4 (1%) for intensive care, SSPI, and cardiology services, respectively. The process identified as most critical for all three services was communication. After risk prioritization, a plan comprising 17 actions was implemented.
What next?
This risk analysis demonstrated that control over the non-nominal dispensing circuit is achievable. Once the actions are in place, a reduction in criticality is anticipated due to a decrease in the frequency. Theoretically unacceptable risks are now at 0%. In the long term, this project has the potential to participate to improve the care of patients enrolled in emergency clinical trials and boost research in the concerned units.
Nationwide German standardised concentration list for continuous infusions in intensive care patients
Pdf
European Statement
Patient Safety and Quality Assurance
Why was it done?
In intensive care patients, numerous drugs are continuously administered. Standardised concentrations and dose adjustment by infusion rate are recommended to minimise medication errors, e.g., by the EAHP Special Interest Group for investigating Medication Errors in Intensive Care Units. This principle is also followed more and more in German hospitals. However, there is a lack of a national standardised concentration list.
What was done?
The joint working group aimed to develop and implement a nationwide standardised concentration list for continuously administered infusions in intensive care patients in German hospitals.
How was it done?
A joint working group of the German Society of Hospital Pharmacists (ADKA e.V.) and the German Interdisciplinary Association of Intensive and Emergency Care (DIVI e. V.) compiled a nationwide continuous infusion standard for intensive care patients. Based on a national survey conducted in 2021, a list of plausible, commonly used drugs and concentrations was compiled. Drugs and concentrations to be listed were further evaluated in a multi-stage process based on predefined criteria (e.g. volume sparing concentration, one concentration per drug [where applicable], preferring ready-to-use medication, operational considerations).
What has been achieved?
A joint working group of the German Society of Hospital Pharmacists (ADKA e.V.) and the German Interdisciplinary Association of Intensive and Emergency Care (DIVI e. V.) compiled a nationwide continuous infusion standard for intensive care patients. The national continuous infusion standard encompasses 41 drugs and 49 standard concentrations, recommended vehicle solutions and data on the physicochemical stability of the infusions during administration. Thirty-seven active substances are listed with one concentration, heparin with two concentrations, epinephrine and sufentanil with three concentrations, and norepinephrine with four.
What next?
Healthcare professionals in German intensive care units are encouraged to adopt this standardised concentration list to improve medication safety. Flowcharts provided by the working group will facilitate the implementation of the defined standard concentrations.