Author(s)

Sánchez Cerviño, AC; Rivera Ruiz, María; Sanabrias Fernández de Sevilla, R; Menchén Viso, B; Folguera Olias, C; López Fernández, A; Pérez García, E; Martín Santamaría, A; Guerrero Feria, I; Sánchez Guerrero, A.

Why was it done?

Informed medication delivery at home, managed by the Hospital Pharmacy Service and facilitated by information technologies, aims to improve access to medication and enhance patients’ quality of life by avoiding unnecessary trips to the hospital. Although it incurs additional costs, it is essential to carefully select and prioritize candidates for this service.

What was done?

1. Analyze the profile of patients requesting medication delivery to establish priority criteria.
2. Evaluate patient satisfaction with this service in a tertiary care hospital.

How was it done?

An observational, retrospective, non-interventional, descriptive study was conducted on patients receiving medication delivery at home for two months upon their request.

Information was collected from electronic medical records and prescription systems, recording gender, age, underlying conditions, prescribed medications, and employment status.

Patient satisfaction with the service was also evaluated, and descriptive statistical analysis was performed.

What has been achieved?

During the study, medication was delivered to 443 patients (55.1% women) with a mean age of 57.3 years. Central nervous system disorders accounted for 16.0% of deliveries, followed by rheumatological diseases (15.1%) and oncohematological patients (9.3%).

Specifically, patients with multiple sclerosis represented the highest demand for this service (12.9%), due to mobility limitations. Additionally, medication was sent to patients with HIV (6.1%), attributable to stigma-related issues.

Analyzing patients’ employment status, 61.2% were pensioners (retired or with permanent disability).

Satisfaction assessment was conducted with 122 patients, who rated the service with an average score of 6.9 out of 10.

What next?

The results indicate that most patients utilizing informed medication delivery at home face difficulties traveling to the hospital. These patients often have disabilities, reduced mobility, or are unable to attend the hospital due to age, work-life balance, or family responsibilities, demonstrating an acceptable level of satisfaction. This patient profile should be prioritized for informed medication delivery services.

Author(s)

Henrik Kjer, Christina Laustsen, Rasmus Riis, Caroline Rasmussen, Jeanette Bajrami, Christian Rubek, and Steffen Jørgensen

Why was it done?

An atypical medication room (AMR) was established at Herlev Gentofte Hospital, Denmark to centralize the storage and handling of medications not part of the standard assortment (i.e. atypical medication). The project aimed to improve the efficiency of medication management, reduce medication waste, and streamline workflows associated with the use of atypical medicines. To enhance the accuracy and efficiency of inventory control, the ScanPill technology was developed as a tool for digital tracking and updating of medication stock.

What was done?

Atypical medications are often stored across various departments with low turnover, leading to potential waste and time-consuming retrieval processes. Centralizing these medications in an AMR and using ScanPill aimed to reduce waste due to expiry, improve stock management, and simplify medication retrieval for healthcare professionals.

How was it done?

Atypical medications from multiple departments were collected and stored in the AMR. The ScanPill system was developed to facilitate the scanning of QR codes and barcodes on medication packaging, allowing for precise tracking of stock levels and easy updates to the atypical medication list. Staff were trained to use the AMR and ScanPill to ensure smooth transitions in retrieving, returning, and documenting atypical medicines. Regular inventory checks and updates were conducted to maintain an accurate database of available medications.

What has been achieved?

The AMR, supported by ScanPill, led to improved handling and management of atypical medications. The centralized storage reduced the need for duplicate stock across departments and enabled quicker access to necessary medications, reducing retrieval time and potential waste. The ScanPill technology improved inventory accuracy and streamlined the process of checking medication in and out, ensuring up-to-date records. Staff feedback has been positive, noting enhanced workflow efficiency and reduced medication waste.

What next?

Future steps include evaluating the economic impact of the AMR and its effectiveness in reducing medication waste. Efforts will be made to refine the use of ScanPill, enhance staff training, and explore potential applications of the AMR model across other departments. Continuous monitoring will ensure optimal performance and identify further areas for process improvement.

Author(s)

H. RIBES-ARTERO, MJ RUIZ-CALDES, E. MONTEAGUDO-SANTOLAYA, J. GARCIA-PELLICER, J.L. POVEDA-ANDRES

Why was it done?

We have implemented a quality management system (QMS) in the Pharmacy Advanced Therapies Unit for the management of advanced therapy medicinal products (acquisition, receipt, storage and dispensation) in accordance with ISO 9001:2015 standards.

What was done?

In the healthcare field, improving the quality of care is a fundamental objective. This involves a continuous and self-critical process of evaluation to identify problems and opportunities for improvement in care. The Spanish National Health System’s Quality Plan includes strategies such as external and periodic evaluation of the quality and safety of healthcare centres and services through audits, with the aim of achieving clinical excellence and improving patient safety and care. The rise of advanced therapies led to a change in the processes of acquisition, storage, and dispensing of medications, as these are cryopreserved therapies that require specific facilities. In our hospital, the Pharmacy Service was designated to carry out these processes.

How was it done?

The project was developed over 12 months in three phases: phase 1 (analysis of the current situation, establishment of a pharmacist working group and training of pharmacists), phase 2 (design documentation, and implementation of the QMS and certification), and phase 3 (analysis of the indicators after the implementation of the QMS, continuous evaluation of them and application of corrective measures).

What has been achieved?

To develop the QMS, we had to create 1 management manual, 8 work protocols, 25 records, 2 work instructions and 2 annexed documents. Once created, we obtained the ISO 9001:2015 certification for our QMS through an external auditing company. As quality indicators (after the certification) we have obtained favourable outcomes in 2 external audits from the pharmaceutical industry and recorded a total of 4 minor non-conformities. Regarding activity indicators, we have dispensed 18 therapies and 4 new work protocols have been created.

What next?

The pharmacist must be the healthcare professional responsible for managing advanced therapies, and implementing, certifying and recertifying a QMS in accordance with ISO 9001:2015 standards is a guarantee of the quality of our healthcare work at the hospital, recognized by other healthcare professionals, patients and the pharmaceutical industry.

Author(s)

(NFR) Nathalie Fogh Rasmussen
(MS) Maja Schlünsen
(JHPR) Joo Hanne Poulsen Revell
(LJK) Lene Juel Kjeldsen

Why was it done?

Exchanging medication stocks between hospital wards is a common method for reducing pharmaceutical waste at hospitals. However, the impact of such systems is unclear. Therefore, we aimed to calculate the annual economic cost savings after the establishment of a medication exchange system at the University Hospital of Southern Denmark in Aabenraa.

What was done?

A medication exchange system at a Danish hospital was evaluated according to avoidance of medication waste and potential economic impact.

How was it done?

For two weeks in February 2024, pharmaconomists registered all medications that were exchanged between six hospital wards representing 147 of 302 hospital beds. The quantity of the excess medications when returned was registered and the amount of pharmaceutical waste was calculated. This was compared to the amount of waste incurred by ordering a whole package for the ward. Moreover, the economic cost was calculated based on the value per package and compared to the economic costs of purchasing whole packages.

What has been achieved?

In total, 244 exchanges were registered. The pharmaceutical waste was estimated to 13-26%. The Department of Pulmonary Diseases, followed by the Department of Gastrointestinal Diseases, caused the greatest waste. The exchanged medicine had an economic cost of 3,566 DKK (478 euro). In comparison, the cost of purchasing whole packages was estimated to 21,042 DKK (2,822 euro). Thus, the total cost saving was ((21,042-3,566 DKK)x(52/2 weeks)=454,376 DKK (60,935 euro), corresponding to ((454,376/147) x 302)= 933,480 DKK (125,146 euro) for the entire hospital. The results led to establishment of a physical medication room to store the excess medication available for other clinical wards. All medications are registered electronically to support optimal use of excess medication throughout the hospital.

What next?

The economic evaluation may be replicated for comparable medication exchange systems at other hospitals, and thus, generate evidence for the economic and environmental impact of the system.

Author(s)

Sanjuan-Casanova, Iria; Cerdeira-Regueira, Elena; Fernández-Oliveira, Carla; Lago-Rivero, Natividad; Iglesias-Moreno, Jose Manuel; Alfonsín-Lara, María; Agra-Blanco, Iván, Martínez-López De Castro, Noemí.

Why was it done?

Dysphagia is a swallowing disorder that affects patients’ safety and quality of life. Within our healthcare area, patients regularly come to the Hospital Pharmacy Service (HPS) for nutritional assessments and dispensing of thickeners. This results in an increasing workload and the need for patients to come to the hospital. This presents an actual challenge particularly since many of them have reduced mobility. The establishment of EspesaNet aimed to reduce waiting times, to facilitate dispensing at other care points and to improve patients’ quality of life.

What was done?

A dispensing circuit for thickeners, EspesaNet, was implemented. We established an interdisciplinary, comprehensive and continuous care system for patients with dysphagia through the decentralization of nutritional follow-up, adjustment of pharmacological treatment, and dispensing of thickeners in health centers (HC) via primary care pharmacists (PCP).

How was it done?

The implementation of EspesaNet was achieved through the establishment of a multidisciplinary work team, the creation of a theoretical-practical training program from the HPS (which included three training sessions of two hours each), and a communication network through e-consultations between HPS and PCP.

What has been achieved?

From February to June 2024, 22 HC and 56 patients (12 with reduced mobility) were enrolled in the project. After the initial nutritional assessment (conducted via home visits and teleconsultations for immobilized patients) and with the premise of not requiring additional nutritional intervention, patients were referred via e-consultation to the PCP for ongoing follow-up and subsequent dispensing of the thickener.
The implementation of the circuit has resulted in:
-Access for all involved professionals to e-consultations and the electronic prescription software (Silicon®).
-Safekeeping of all patients’ clinical information in a single electronic medical record (Ianus®).
-Establishment of a remote evaluation service for immobilized patients.
-Development of standardized treatment adjustment criteria.
-Completion of 56 e-consultations
-An estimated savings of 2400 kilometers in travel distance for a single dispensing via FAP.

What next?

EspesaNet, since its implementation, has provided numerous benefits for patients and professionals. Our goal is to reach more HC, ensuring the correct identification and follow-up of patients with dysphagia. Moreover, we aim to facilitate patients’ collection of thickeners and improve their access to information and better-trained professionals.

Author(s)

Palacio-Lacambra, ME
Cabañas-Poy, MJ
Lalueza-Broto, MP
Florensa-Royo, E
Fernández-Polo, Aurora
Marrero-Álvarez, P
Juárez-Giménez, JC
Gabarro-Portella, G
Gorgas-Torner, MQ

Why was it done?

The problems caused by medication shortages are significant, pose a risk to patient care, and require good coordination between different levels of the healthcare system (primary care and hospital pharmacy services (PS)). Drug shortages can adversely affect drug therapy, compromise or delay medical procedures, and result in medication errors.

The objectives of the working group are to define the internal processes of the PS regarding the management of and communication between professionals about medication supply shortages and to coordinate the referral of primary care community patients for dispensing at the hospital.

What was done?

A multidisciplinary working group was established, including representatives from various pharmacy areas (management, outpatient dispensing, drug information center, pediatrics) and representatives from the Primary Care Medication Management Area in our Health Region, where our center serves as the reference hospital.

The “Supplier Shortage Working Instruction” has been updated, and a pathway has been established for referring patients from primary care to the outpatient pharmacies (adult and pediatric) of our hospital.

How was it done?

Internal meetings of the PS were held to update the “Supplier Shortage Working Instruction,” considering the different situations of medications in shortage (exclusive and/or non-substitutable, substitutable, and community pharmacy medications in shortage).

A meeting with Primary Care representatives was conducted to define the pathway for referring community patients with medications in shortage imported from abroad through the Spanish Agency of Medicines and Medical Devices.

What has been achieved?

The internal working instruction has been redefined, and a shared resource for the entire PS has been created to centralize relevant information for the management of medications in shortage, which is kept up-to-date.

A referral pathway has been established for Primary Care patients to the outpatient pharmacies of our hospital. Two pharmacists from the PS coordinate shortage information with Primary Care. Primary Care reports the number of patients with active prescriptions requiring medication, which ensures adequate stock levels and enables patient scheduling to enhance their experience.

What next?

Having an internal pathway has improved the management of medication shortages in the PS, as well as enabled the coordinated referral of community patients.

It is applicable to all PS involved in dispensing foreign medications due to shortages.

Author(s)

Ina Vierø Rinder, IVR

Why was it done?

Handling medication shortages in the hospital pharmacy are time-consuming, and a lot of resources are used to find alternatives. Though shortages are a national focus in Denmark, shortages are not a priority focus in the local hospital pharmacy. Shortages are often handled “on-the-go” locally and therefore not prioritized. The hospital pharmacy uses “Medication News”, posted on internal website, to broadcast information about long-term shortages to the hospitals. The aim was to determine the occurrence of shortages among commonly used medications at Copenhagen University Hospital, Amager and Hvidovre (AHH).

What was done?

A top 100-list of most bought packages of individual chemical substances (ATC5-level) was generated. The purchase data were obtained from the hospital pharmacy at AHH for the period from October 2023 to September 2024.

How was it done?

The list was analyzed to determine how many medications had experienced shortage during the specified period. The analysis was conducted by reviewing past “Medication News”, historical e-mails regarding shortages, and the hospital pharmacy’s own record of shortages.

What has been achieved?

The top 100-list of most bought packages of individual chemical substances (ATC5-level) revealed a total of 1149 item numbers. The 500 item numbers in ATC-level V07AZ** (Chemicals and reagents for analysis) were excluded due to their use. Of the remaining 649 item numbers, 43 item numbers had experienced shortage during the specified period. Of the 43 item number shortages, 22 (51 %) had resulted in a “Medication News” on the internal website. The shortages were distributed in the ATC-levels A (16 %), B (9 %), C (5 %), D (2 %), H (9 %), J (12 %), L (5 %), M (7 %), N (30 %), R (2 %) and S (2 %).

What next?

The generated data of the top 100-list of used chemical substances has given rise to more attention on shortages in the hospital pharmacy. In the future it is assumed that the number of shortages will rise, and it should be possible to increase the attention of short-term shortages by using the obtained data e.g., integrate the data in a daily status meeting. Thereby the shortages can be handled as a priority and not “on-the-go”.

Author(s)

ESTEBAN ALONSO, M TERESA; RODRIGUEZ FERNANDEZ, ZULEMA; ALAMO GONZALEZ, OLGA; GUTIERREZ FERNANDEZ, ISABEL; SANCHEZ LUQUE, LAURA; MARTINEZ TOMAS, PAULA; BENITO JUEZ, PILAR; ESPINOSA GOMEZ, M PAZ; GUEMES GARCIA, MAGDALENA.

Why was it done?

This initiative was arose from the need to improve the quality of pharmaceutical care (PC) and stock management to ensure adequate coverage for patients. Without appointments, it was challenging to align consultations with individual patient needs and to prepare medications for the time until the next visit, as patients arrived irregularly. Additionally, multiple patients on the same treatment would often visit on the same day, increasing the risk of stock shortages. This unpredictability led to inefficiencies in both patient care and stock management. The goal was to ensure a smoother patient flow, enhance PC quality, and improve stock control through scheduled visits.

What was done?

An initiative was developed to introduce a scheduled appointment system for Oncology and Hematology patients who need to collect medication from the hospital pharmacy. Previously, patients arrived without appointments, causing unpredictable patient flow and difficulties managing stock. The new system schedules patients around one hour after their medical consultations, with special arrangements for those on long-term stable treatments.

How was it done?

The main challenge was integrating the new appointment system into existing workflows in Oncology and Hematology. Close coordination between pharmacy staff, clinicians, and administrative personnel was essential. Patients were scheduled to pick up their medication around an hour after their consultations. Long-term patients, who need consultations every six months or more, were scheduled during less busy times, such as early mornings. This improved workload management in the pharmacy, ensuring more efficient and higher quality patient care. Effective communication with patients was key to overcoming early hesitation.

What has been achieved?

The system has resulted in a more predictable patient flow, leading to better PC quality through improved preparation and more efficient medication use, reducing shortages and surpluses. Patients now receive more personalized care, as workload is more balanced.

What next?

This initiative serves as an example of good practice, transferable to other hospital pharmacies and healthcare settings facing similar challenges. The next step is to verify patient satisfaction through surveys

Author(s)

SS Suvi Sivula, JN Jonna Niemi, KM Konsta Malmi, EA Elina Ahomäki

Why was it done?

In 2021, over 110,000 kilograms of pharmaceutical waste was produced at HUS Helsinki University Hospital, Finland (HUS). That was almost 2.5 million euros when the value of the medicines and the pharmaceutical waste management costs were considered. In 2022, HUS Pharmacy launched a project to reduce pharmaceutical waste, both for economic and environmental reasons.

What was done?

The goal was to reduce the annual pharmaceutical waste in euros and in kilograms at HUS, primarily at the Pharmacy. We also aimed to help departments to reduce their pharmaceutical waste.

How was it done?

The project group was formed of about 15 pharmacists and pharmacy technicians from different units of HUS Pharmacy, located in different areas in Southern Finland. The project team met monthly to review the costs and causes of pharmaceutical waste at the Pharmacy. The team discussed challenges, shared good practices and came up with ideas. In addition, departments were supported in reducing pharmaceutical waste with lectures, materials, videos etc.

During the project we found three main reasons for producing pharmaceutical waste: expired products, residues of cytotoxic drugs and compounding errors. To avoid these, we created a better overview on the whole stock of the Pharmacy, internal communication was increased, and products were moved more actively between units. Unit-specific procedures were also developed, collaboration with departments was increased, and published studies were used especially to reduce cytotoxic waste.

What has been achieved?

During the project, the annual value of wasted pharmaceuticals at the Pharmacy decreased from 928,000 euros (year 2021) to 507,000 euros (year 2023). In addition, the annual amount of pharmaceutical waste at HUS reduced from 112 000 kilograms to 101 000 kilograms. Also, the total cost of pharmaceutical waste at HUS, including the value of wasted pharmaceuticals, decreased.

What next?

The project team’s work has become a permanent part of our work instead of a project.
Collaboration between all healthcare workers is in a key role for reducing pharmaceutical waste. Waste cannot be completely avoided, but it can be reduced significantly, as our project has revealed.
Procedures must be developed further, for example early notifications from departments to the Pharmacy about changes in medical practices are critical for managing our stock.

Pdf

Author(s)

E. Volpi (1), F. Panizzi (2), B. Mastrelli (2), G. Lo Surdo (1), S. Tonazzini (1), S. Alduini (1), M. Mangione (3), S. Baratta (4), M. Baroni (5), S. Biagini (1)
1. Hospital Pharmacy, Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio
2. Postgraduate School of Hospital Pharmacy, University of Pisa
3. Information systems and information technologies, Fondazione Toscana Gabriele Monasterio
4. Nursing, Technical and Rehabilitation Service, Fondazione Toscana Gabriele Monasterio;
5. Clinical Risk Manager, Fondazione Toscana Gabriele Monasterio

Why was it done?

Medication safety practices are a cornerstone for reducing medication errors and patient harm.
Hospital pharmacist has been recognized as one of main healthcare providers that can support the physicians and the nurses in this item.
The computerized labeling of multidose medicines when they were opened is a good practice for safe medication use which is performed from the Fondazione Toscana G. Monsaterio (Italy) since 2022.

What was done?

The routine control activity of the department’s drug stocks includes the verification of drugs expiration date and the timely removal of drugs before they have expired their validity.
In the case of opened multidose medicines, this operation is more complex as their validity is often reduced.
Our aim was to provide to all healthcare professionals a quick and safe computerized labeling tool, which is constantly updated by the pharmacist based on availability of drugs in the hospital wards.

How was it done?

A multidisciplinary team (pharmacist, nurse and computer scientist) developed a multidose drug labeling system linked to the patient’s medical record which allows the generation of a label every time a prescription for a multidose drug is presented, before patient administration. The team discussed the content of the label and selected the categories of drugs that needs to be included.

What has been achieved?

The categories of drugs included in our program are syrups, oral suspensions, ophthalmological and otological preparations and oral drops. We used a computerized program to fill the information about the validity after opening such as days and storage temperature and indicating the source of the information.
The new system allows to easily check the validity after opening for all multidose drugs, before administration to the patient. This implementation not only guarantees patient safety, but also offers support to all nurses or physicians for any subsequent administration of the same drug and simplifies deadline checking operations of the department’s drug stocks.

What next?

We will continue to keep the labeling program updated by including new drugs available in our hospital. We would like that the information on post-opening shelf life was always included in drug SmPCs and that the good practice of computerized labeling was diffused also in other hospital settings.