Author(s)

Nabaa Dhuhaibawi, Cristin Ryan, Fionnuala Kennedy

Why was it done?

Climate change is a major global health threat, and healthcare contributes approximately 4–5% of global greenhouse gas emissions. Pharmaceuticals account for around one-quarter of this total through production, packaging, distribution, and disposal. Hospitals are under increasing pressure to reduce medicine waste and their associated carbon footprints. Automated Dispensing Cabinets (ADCs) — electronic systems for storing and issuing medicines at the point of care — improve medication safety and efficiency, but their environmental benefits have not been well studied. Understanding whether ADCs can reduce the carbon footprint of dispensed medicines is therefore essential for promoting sustainable healthcare practices.

What was done?

This study evaluated the impact of ADC implementation on the carbon footprint of dispensed oral medicines in an acute hospital in Dublin. A secondary objective was to examine the carbon footprint distribution of all single-ingredient oral medicines in the hospital formulary, identifying future opportunities for reducing medicine-related emissions.

How was it done?

A retrospective before-and-after study was conducted across six inpatient wards where ADCs were introduced between December 2023 and May 2024. Dispensing data were collected for equivalent two-week periods before and after the intervention using the Isoft® system. Only oral active pharmaceutical ingredient (API) medicines were included. Each medicine’s carbon footprint (gCO₂eq) was obtained from the Ecovamed® database and analysed using descriptive statistics and the Wilcoxon signed-rank test (α = 0.05). For the secondary analysis, all single-ingredient oral APIs from the hospital formulary were classified by their Medicine Carbon Footprint (MCF) rating using the YewMaker® database.

What has been achieved?

The total carbon footprint of dispensed medicines decreased from 262.58 kg CO₂eq before ADC implementation to 176.94 kg CO₂eq after. Among 99 medicines dispensed in both periods, the median carbon footprint per medicine fell significantly from 644 to 352 g CO₂eq (p < 0.001; r = –0.37). In the formulary analysis, most medicines had low (31.7%) or medium (35.2%) MCF ratings, while only two items—abiraterone acetate and methenamine hippurate—had very high (>1000 g CO₂eq) values.

What next?

ADCs appear to significantly reduce medicine-related carbon emissions, suggesting that digital automation supports sustainable pharmacy practice. Future efforts should target high-MCF drugs, promote greener procurement, and expand environmental life-cycle data to maximise carbon reduction across hospital pharmacy services.

Author(s)

Salvador Llana, I; Sánchez Pascual, B; Vicente Ayuso, MdC; Martín García, V; Sánchez León, MdR; Adeva Antona, S; Pérez Encinas, M

Why was it done?

Our main objective was to optimize donor screening by analyzing the compatibility of L04-immunosupresants(including monoclonal antibodies(mAbs)) with blood donation(BD), addressing the questions raised by donors. It was attended to reduce unnecessary exclusions, improve transfusion safety, and streamline decision-making for healthcare staff in Donor Units(DU) and Pharmacy Services(PS), while also providing open access to information for both healthcare professionals and donors.

What was done?

From the hospital’s PS, a database was created compiling all L04-immunosupresants in Spain up to 2025. The medications were classified according to their compatibility with BD. A color-coded system was implemented for easy interpretation:
-Green: compatible with donation(CD)
-Yellow: requires individual assessment(IA)
-Orange: donation deferred after a washout period(DD)
-Red: incompatible with donation(ID)
Each medication entry also includes an “observations” section to provide additional details.

How was it done?

A detailed literature review was conducted, covering national and international guidelines, scientific articles, and official websites, complemented by direct consultations with pharmaceutical laboratories. To ensure reliability, the database was reviewed and validated by the Hematology Service(HS) and the Regional Blood Bank.

What has been achieved?

-A guide was created (67 drugs, 54 of which were mAbs). Individual information was not found for the vast majority of mAbs, but data were available for the mAbs group as a whole.
-It was concluded that, during active treatment, mAbs are ID(100%). After treatment discontinuation, patients with chronic conditions that contraindicate BD(active cancer, multiple sclerosis, solid organ transplant, gastrointestinal diseases, and other conditions deemed excludable by medical criteria) remain permanently deferred. If the underlying condition does not contraindicate BD, donation may be allowed one year after completing treatment.
-Regarding the rest of the immunosuppressants, 61.5%(8) were ID, 7.7%(1) IA, and 30.8%(4) DD.
-For medications classified as DD, in cases of discrepancies in the consulted literature, the most restrictive deferral period was selected.
-Exact information can be now provided to donors, making it clear whether they are not currently eligible for BD and, if they may be eligible in the future, giving them the exact deferral period.

What next?

The objective is to continue expanding/updating the database and to make this information available to all DU across the country.

Author(s)

Salvador Llana, I; Sánchez Pascual, B; Vicente Ayuso, MdC; Martín García, V; Sánchez León, MdR; Adeva Antona, S; Pérez Encinas, M

Why was it done?

Our main objective was to optimize donor screening by analyzing the compatibility of ATC code J-Antiinfectives for systemic use with blood donation(BD), addressing the questions raised by donors. It was attended to reduce unnecessary exclusions, improve transfusion safety, and streamline decision-making for healthcare staff in Donor Units(DU) and Pharmacy Services(PS), while also providing open access to information for both healthcare professionals and donors.

What was done?

From the hospital’s PS, a database was created compiling all ATC code J-Antiinfectives for systemic use in Spain up to 2025. The medications were classified according to their compatibility with BD. A color-coded system was implemented for easy interpretation:
-Green: compatible with donation(CD)
-Yellow: requires individual assessment(IA)
-Orange: donation deferred after a washout period(DD)
-Red: incompatible with donation(ID)
Each medication entry also includes an “observations” section to provide additional details.

How was it done?

A detailed literature review was conducted, covering national and international guidelines, scientific articles, and official websites, complemented by direct consultations with pharmaceutical laboratories. To ensure reliability, the database was reviewed and validated by the Hematology Service(HS) and the Regional Blood Bank.

What has been achieved?

– A guide was created with 122 ATC code J drugs(J01-antibacterials for sistemic use(50), J02-Antimycotics for systemic use(10), J04-Antimycobacterials(3), J05-Antivirals for systemic use(34), J06-Immune sera and immunoglobulins(6) and J07-Vaccines(19).
– J01, J02, J04 and J06 were all cassified as DD.
– Ribavirine(J05), amantadine(J05) and sofosbuvir(J05) were ID. The rest of J05 were classifed as DD.
– Live-attenuated vaccines(7) represented the 36.8% of all vaccines and were classifed as DD(1 month). The other vaccines(12) require IA. BD is possible if the donor is afebrile and feels good.
-For medications classified as DD, in cases of discrepancies in the consulted literature, the most restrictive deferral period was selected.
-Exact information can be now provided to donors, making it clear whether they are not currently eligible for BD and, if they may be eligible in the future, giving them the exact deferral period.

What next?

The objective is to continue expanding/updating the database and to make this information available to all DU across the country.

Author(s)

Z. Ćetković, I. Popović

Why was it done?

Due to the specific mechanism of action of oral oncology medicines, these patients require advanced clinical pharmacy services facilitated by information technology to deliver better person-centred healthcare. The purpose of this database is to gather all important information on oral oncology medicines and make them easily accessible, to educate patients and improve their treatment outcomes.

What was done?

A hospital pharmacy team created a national database of oral oncology medicines, which was further integrated into a mobile application compatible with both iOS and Android device. This database included 79 medicines grouped by therapeutic indications, along with indications and dosage, information on administration and storage, interactions with other medicines and food, as well as precautions for the use in special populations.

How was it done?

The initiative was first developed during our national Symposium of hospital pharmacists, and within six months, it resulted in a national database of oral oncology medicines, supported by our Ministry of Health. After selecting a list of medicines, the next step involved creating a database in Excel. All information was straightforward and easy to comprehend for the general population. The final version of the database was thoroughly evaluated, and all issues were carefully addressed. In collaboration with the IT sector, the database was incorporated into the mobile application, available for all patients and healthcare professionals.

What has been achieved?

· Oral oncology medicines database provides evidence-based information on oral oncology medicines and offers medical support to patients taking these medicines at home, thus improving adherence and patient safety. · This database improves patient knowledge. · Situations with different scenarios are available to help manage interactions and various adverse reactions. · Instructions for the use of oral oncology medicines in special populations are available with just one click. · Continuous update by the hospital pharmacists is required to ensure data accuracy and optimal use.

What next?

Our next mission is to promote this database to a broader population of patients through the development of specialised pharmaceutical services, and further expand into interactive communication between patients and healthcare professionals. We intend to regularly update it, as new medicines and information become available.

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Author(s)

Margot DESCHAMPS, Nejib BORGAAOUI, Jimmy ROSE, Jennifer LE GRAND, Louise NICOLAS

Why was it done?

One of the clinical pharmacy activities in the thoracic oncology department is the analysis the interactions between chemotherapy and Complementary and Alternative Medicine (CAM). Cancer patients often seek alternative treatments which requires a rigorous evaluation of potential interactions. The goal of this study is to assess the methods used to analyze these interactions.

What was done?

To ensure traceability of the analysis, a tracking table for requests was created. The requests, coming from doctors, nurses, or patients, are recorded with key information such as name, date of birth, and the purpose of the analysis. Five information sources were selected, including the Herbal Medicine section of MedlinePlus, the website of the Memorial Sloan Kettering Cancer Center (MSKCC), a database of plants and dietary supplements published by the French National Agency for Food, Environmental and Occupational Health Safety, a database from the European Scientific Cooperative on Phytotherapy, and a publication from the journal Medical Oncology (Vol 36, number 45, 2019).

How was it done?

In nine months, 25 interaction requests were processed, 70% of which were from doctors. The analysis took an average of 30 minutes and were completed within 24 to 48 hours. The interactions mainly concerned oral chemotherapies (n=18), particularly Osimertinib (n=13). The requests involved various CAM (essential oils, medicinal plants, dietary supplements), with an average of four products per request. Desmodium was the most frequently analyzed product (n=5). In total, for 24 CAM, including Desmodium, was not recommended for use after analysis due the drug interaction risk and modification of liver metabolism of chemotherapies.

What has been achieved?

It is difficult to prohibit CAM to patients, and most substances can be taken at recommended doses. However, determining the precise dosage at which an interaction with chemotherapy occurs is complex due to the lack of a single reference. Using various sources allows for cross-referencing expertise and obtaining complementary information. For instance, MedlinePlus offers a generalist approach, while MSKCC focuses on interactions in oncology. Using international sources broadens the analysis and fills geographical or cultural gaps.

What next?

For the future, we would like to develop a tool that compiles the five data sources in order to be exhaustive in our future analysis.

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Author(s)

Hilde Omestad, Maria Grønkjær Abrahamsen, Fatima Afif Mouaanaki, Charlotte Mosbæk Dybdahl, Anne Wulff Petersen, Emil Dalsgaard Züricho, Philip Hojrizi, Charlotte Arp Sørensen

Why was it done?

The sustainability strategy of the Central Denmark Region include less consumption and less waste. Our Pharmacy delivers an increasing amount of high-cost homecare medications, requiring refrigerator storage. In case of an accidental temperature exposure, patients may ask whether their medicine can be used or not. There may be a delay during transport or a breakdown of their refrigerator at home. During these medicines’ shelf-lives, most products can be kept at room temperature for days, weeks or months. When SmPC and the insert package leaflet says that the product should not be returned to the refrigerator, high-cost medicines sometimes are wasted, only because of this warning, instead of giving them a shorter shelf-life. When we hesitate to return packages to the refrigerator, time can elapse while waiting for the manufacturer’s or pharmacist’s answers to the patient’s questions after storage incidents.

What was done?

The Hospital Pharmacy categorized 47 Blood Coagulation Factors and Monoclonal Antibody Products requiring storage at 2-8 °C if Summary of Product Characteristics (SmPC) had any warning of returning a product to the refrigerator or not, after an unwanted time at room temperature

How was it done?

We asked manufacturers if a return of their product to the refrigerator would cause any harm. Should their product be disposed of because it has been put back into a refrigerator after being left out? Our findings were documented in a local guideline and in the Danish national information database (SAID).
Drug Information Pharmacists discussed several cases of real-world handling situations to be more confident to reduce medicine wastage.

What has been achieved?

Being aware of the reasons for these warnings, reduced medicine wastage in certain cases of incidental storage. The pharmacists have been given tools for pharmaceutical professional assessments in cases of temperature challenges.

What next?

Spread the good news. Improve communication between manufacturer and pharmacy, because manufacturer can’t be responsible for storage different from their SmPC. Inspire manufacturers to improve their storage warnings in SmPC

Author(s)

Joana Pinto, José Feio, Sebastião Silva, Francisco Machado, Ana Dinis, Margarida Abreu, João Peres, Mariana Guia

Why was it done?

Clinical decision support systems comprising information on DDI improve DDI risk detection, avoiding preventable patient harm. The resulting DDI alerts can change prescribers’ behaviour to benefit patient care. However, an excessive number of alerts can lead to alerts’ desensitisation by prescribers.

What was done?

We monitored the drug-drug interactions (DDI) alerts displayed in the prescription system through three subsequent homologous periods, occurring after the integration of a DDI database in the prescribing software system of a teaching hospital to assess its impact on the prescribing pattern.

How was it done?

We developed a DDI database – MedH® – to be integrated into the prescribing software system to support hard stop DDI alerts. only the higher clinical risk DDIs were included in this database in order to restrain the burden of alerts and warrant acceptance by health professionals.
Data of all inpatient hospital prescriptions over a 12-month period prior to MedH® implementation were extracted and intersected with MedH® DDI BD to identify the top 10 co-prescribed binomials at risk of severe DDI. The number of alerts for the same binomials was then monitored through three subsequent, post-implementation, homologous periods.

What has been achieved?

Considered the TOP10 observed in the pre-implementation period, the number of alerts for all binomials has consistently reduced over the three post-implementation periods analysed.
The integration of MedH® DDI BD into the prescribing system, resulted in changes in the prescribing pattern, translated by a decrease, between 67% and 100%, in the number of alerts for a sample of control risk binomials coinciding with the top 10 co-prescribed risk binomials observed in the pre-implementation period. These results reflect the good acceptance by the professionals and the didactic effect achieved by the exposure to alerts.
More importantly, these results are indicative of the effectiveness of the implementation of MedH® Alerts in reducing patient exposure to high-risk combinations of medicines, thus promoting patient safety.

What next?

It will be important to ensure that data from IDD alerts are rigorously analysed to recognise clinical situations in which the co-administration of risk binomials is justified, to ensure consistent application of recommended risk minimisation measures, and the availability of safer therapeutic alternatives whenever possible.

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Author(s)

Zora Ćetković, Dragana Rajinac, Ivana Baralić , Jelena Marković, Darija Kuruc Poje, Miroslav Kota, Špela Urh, Irina Tegelj, Vesna Bizjak, Dragana Mitrić, Tijana Kovačević, Andrej Pečet, Irena Radivojša, Sanja Filkova, Vesna Bašić-Milošević

Why was it done?

Medication errors regarding reconstitution and administration of parenteral antibiotics are frequent in hospitals. In our study conducted in 12 Southeastern European hospitals in 2021, we demonstrated the need of parenteral antibiotic reconstitution/dilution database in hospital pharmacy practice. Moreover, according to European Statements of Hospital Pharmacy (statement 5.5.), implementation of electronic decision support system by HPs should help to decrease the risk of medication errors. The purpose of software tools is to gather all relevant information regarding parenteral antibiotic reconstitution/dilution and make them easily accessible.

What was done?

A group of hospital pharmacists (HPs) from 6 Southeastern European countries created new software tools (a mobile-responsive website and mobile applications for Android and iOS) for providing information on reconstitution and administration of parenteral antibiotics in collaboration with software developer. These tools contain parenteral antibiotic reconstitution/dilution database in seven different languages (English, Serbian, Croatian, Slovenian, Bosnian, Macedonian and Montenegrin).

How was it done?

Technical requirements for website and mobile applications were designed by HPs. The development of these software tools was carried out by a software developer and funded by European Association of Hospital Pharmacists (EAHP). The final version of the software went through a rigorous evaluation, conducted by HPs during development and all technical problems were resolved consequently.

What has been achieved?

· Designing and developing these software tools helps HPs to provide evidence-based information about parenteral antibiotic reconstitution/dilution at the point of care, thus improving decision-making process and patient safety. · Reconstitution of parenteral antibiotics in wards is efficient and smooth. · Oral and written instructions for parenteral antibiotic reconstitution/dilution are replaced by electronic decision support tools, designed to prevent medication errors. · HP’s interventions are required to support the use of these software tools.

What next?

Our next challenge is wider use of these software tools in order to ensure the appropriate reconstitution/dilution of parenteral antibiotics in wards by nurses and physicians. These software tools are applicable in hospital setting and can be used by all regional hospitals. Additionally, they can be easily incorporated in hospital information system. We also plan to update periodically antibiotic reconstitution/dilution database, as new information becomes available.

Author(s)

MOHAMMED ADNANE EL WARTITI, WAFAA ENNEFFAH, BOUCHRA MEDDAH, MUSTAPHA BOUATIA

Why was it done?

The GPG was developed in a concern of practices standardization to guarantee the safety and efficacy of parenteral antibiotics, especially those stored in vials which reuse in possible only if conditions of administration and stability are respected.

What was done?

We developed a Good Practice Guide (GPG) for the usage of major available parenteral antibiotics.

How was it done?

After we listed all parenteral antibiotics available at the hospital pharmacy, we selected the most used ones and we synthesized all manufacturers’ data to establish a GPG for their administration. We also used literature data to complete missing information in “Summaries of Product Characteristics” related to pediatric use of these drugs. Finally we determined the most antibiotics consuming units according to their defined daily doses, where GPG recommendations will be implemented, before their extension to all other units.

What has been achieved?

The GPG concerned the most used antibiotics, which mainly belong to the following classes: Beta-lactam, Glycopeptide and Imidazole antibiotics, Aminoglycosides and Quinolones. It specifies the galenical presentation, used solvents, volume and duration of administration, stability after reconstitution as well as incompatibilities and special measures relating to the use of these drugs. The most antibiotics consuming units are pediatric intensive care units, “IIB” pediatric unit and pediatric surgical emergency department.

What next?

The approach used in this work can be adopted in other similar structures in order to establish GPGs within the framework of a quality control policy aiming to raise the standard of care.

Author(s)

Belén Serna Serrano, Victoria Lerma Gaude, Ana Valladolid Walsh, Cristina Del Pozo Carlavilla, Juan Manuel Collado Sanz, Héctor Alabort Ayllón, Eduardo Tébar Martínez, Andrea Drozdz Vergara

Why was it done?

In the pharmacist-patient clinical interview (CI), DP-I revision is frequent due to consumption increase of phytotherapy in recent years. The aim of the initiative was to study the degree of discrepancy (DD) based on the severity criteria (SC) found about the recommendations on the management of DP-I. Nowadays there are multiple databases with lack of unification. Patients diagnosed of Multiple Sclerosis (MS) are frequently interviewed by the pharmacist and they often take herbal medicines (HM).

What was done?

We unified the information collected from the commonly consulted databases of drug-plant interactions (DP-I) whose information could be scarce or contradictory, by creating a tool based on the most consulted plants in our clinical practice (CP).

How was it done?

To create our own DP-I tool, the sources consulted were:
– Our own plant database based on CP. A total of 56 plants.
– Six official databases of DP-I: (A)-Phytotherapy official monographs, (B)-MedInteract®, (C)-Micromedex®, (D)-UpToDate-Lexicomp® (E)-Medscape®.

In order to unify the DP-I information consulted and to be able to identify the DD (0 to 2), the SC for all databases were unified in 3 levels: if the database had 5 levels (1=1-2; 2=3-4; 3=5) or 4 levels (1=1-2; 2=3; 3=4). In first place we decided to test this tool with a small sample size of drugs (6 drugs commonly used for the treatment of MS) to check whether the discrepancy between the databases usually consulted was significant or not.

What has been achieved?

Finally, 6 DP-I were detected with Hypericum perforatum (HP) and Echinacea angustifolia (EA):

The DD seems to be similar between A-B databases and greater respect to the rest of them. Depending on the database consulted the pharmacist’s performance could change and consequently, pharmaceutical care may be affected. Since this tool was implemented in our CP, none of our MS patients have taken HP or EA, therefore, it has not been necessary to modify their treatment because of DP-I.

What next?

This tool could speed up the pharmacological review of possible DP-I and improve decision-making for the care of MS patients. Our next step is to increase the sample of analysed drugs commonly used in other pathologies, such as antiretroviral drugs.