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PharmaSwap: a pioneering healthcare initiative reducing medication waste and promoting sustainability

European Statement

Selection, Procurement and Distribution

Author(s)

Piter Oosterhof, Jelmer Hein Faber, Lieke van Kerkhoven, Rob Haenen

Why was it done?

PharmaSwap is a response to the significant issue of medication waste in the healthcare sector. The problem of medication waste was well-documented, with scientific research indicating that annually, a minimum of €100 million worth of prescribed medications was being discarded in the Netherlands. These medications were being wasted when they reached their expiration dates, resulting in both financial losses and environmental pollution. PharmaSwap was introduced to tackle the problem of medication waste by creating an online platform that enables pharmacists and pharmaceutical wholesalers to list and sell medications with approaching expiration dates at discounted rates. Our initiative sought to improve the situation by not only reducing the financial losses associated with medication waste but also by addressing the environmental concerns linked to the disposal of medications. By promoting the reuse of medications and encouraging a shift toward sustainability in the pharmaceutical sector, PharmaSwap aimed to make a positive impact on healthcare and the environment.

What was done?

The initiative that has been developed and implemented is https://www.PharmaSwap.com. PharmaSwap is an online marketplace established in 2018 by pharmacists Piter Oosterhof and Jelmer Faber. This platform facilitates the exchange and sale of medications among (hospital) pharmacies and pharmaceutical wholesalers that are nearing their expiration dates at discounted rates.

How was it done?

The introduction of PharmaSwap faced several obstacles:

1) Regulatory barriers: initially, regulations didn’t allow medication redistribution. We collaborated with regulatory bodies to find a legal solution.
2) Legal adjustments: we worked with authorities to amend regulations, creating a legal framework for PharmaSwap.
3) Building trust: gaining trust from pharmacists and wholesalers required transparent communication and showcasing benefits.
4) Technical development: developing the platform required the right tech partners and resources.
5) Awareness and adoption: we conducted awareness campaigns and partnered with (inter)national associations to promote PharmaSwap.

Through these efforts, we successfully overcame obstacles and implemented PharmaSwap, reducing medication waste and promoting sustainability.

What has been achieved?

1) Medication waste reduction: PharmaSwap has significantly reduced medication waste, preventing the disposal of medications, while pioneering a unique and innovative approach.
2) Environmental impact: PharmaSwap has saved 9,719 packaging units, leading to a substantial reduction in environmental pollution from medication disposal.
3) Cost Savings: healthcare systems have saved €1,165,115 by recovering the value of otherwise discarded medications.
4) Network growth: PharmaSwap connects 836 out of 2,000 Dutch pharmacies and collaborates with 8 pharmaceutical wholesalers, including one partner compliant with Good Distribution Practice (GDP).

These outcomes highlight PharmaSwap’s impactful contributions to waste reduction, cost savings, and sustainability in healthcare, supported by its expanding network of participants.

What next?

PharmaSwap’s success in reducing medication waste, saving costs, and promoting sustainability makes it a compelling example of good practice in healthcare. Its transferability to other healthcare settings involves replication, regulatory adaptation, education, partnerships, technology integration, data management, and a commitment to continuous improvement. Moreover, we are currently in advanced meetings with several other European countries, exploring the potential for international expansion and collaboration to further extend the positive impact of PharmaSwap.

An algorithm for the process of selecting pharmaceutical companies in a pharmacy department

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European Statement

Clinical Pharmacy Services

Author(s)

Moisés Couñago-Fernández, Marisol Samartín-Ucha, Ana María Regueira-Arcay, Sonia González-Costas, María Alfonsín-Lara, Paula Prado-Montes, Iván Agra-Blanco, Elena Cerdeira-Regueira, Noemí Martínez-López de Castro

Why was it done?

When a new pharmaceutical product should be introduced in a hospital, a multitude of factors must be considered in order to choose a specific brand. A lack of uniformity in the criteria for the selection of new medicines has been detected. To avoid selection errors or arbitrary decisions, a selection structured algorithm was developed using quality tools according to management quality system ISO 9001-2015.

What was done?

To ensure that the process of selecting from several pharmaceutical companies fulfil the requirements of quality and lower cost, a decision-making process for these purchases was designed, through a structured method for the evaluation of new pharmaceutical products based on standardised evaluation criteria.

How was it done?

A multidisciplinary group was created focused on making decisions about criteria. All stakeholders were represented (management pharmacist, quality experts, management assistant and pharmacy director). Also, a survey was given to different specialist pharmacists to complete the criteria. Second, criteria were categorised according to their importance or potential impact in pharmacy practice or patient.

What has been achieved?

The algorithm took into account aspects related to: a)pharmaceutical company and b)aspects related to the pharmaceutical product. Each of these aspects is valued as a percentage.

a)Pharmaceutical company: 40% of the score was based on not having a repeated history of stock-outs, 45% on the evaluation of the provider according to an internal file based on incidences registered, and 15% if the provider was already a known supplier.

b)Pharmaceutical product: 50% was based on the cost of the medicine, 15% unit dose presentation (if applicable), 10% expiry conditions of the medicine, 5% allergens, 5% if it was presented in a pre-filled pen (if applicable), 5% if it could be stored at room temperature, 5% if the drug is supplied in diluted vials (in the case of parenteral medicines) and 5% if it had all the possible indications in the technical data sheet.

This methodology has been used successfully in recent months with the pharmaceutical supplier changes of abiraterone and sugammadex.

What next?

This tool will be used for all changes of medicine brands and new drugs purchased in the hospital, enabling uniformity in the purchasing process for all new drugs.

Optimising medication procurement through integrated database

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European Statement

Selection, Procurement and Distribution

Author(s)

Irene Ruiz-Jarabo Gómez, Marcos Gómez Bermejo, Rocío Vázquez Sánchez, Antonio Illescas Bermudez, Elena Martín Suarez, Teresa Molina García

Why was it done?

Digitization was considered essential in reducing costs related to inventory management and improving responsiveness in critical situations, such as supply shortages. Traditional manual inventory checks and order verifications were time-consuming and error-prone, prompting the need for a digital transformation.

What was done?

In our quest for enhanced medication procurement efficiency within our Hospital Pharmacy Service, we have developed an integrated database.

How was it done?

We have developed a database by consolidating data from two primary sources: our automated medication storage system, Smart Ulises®, and the Economic Management software, Farmatools®. This database encompassed information related to medications falling below predefined minimum stock levels, historical acquisition records, pending medication orders, and warehouse capacities for each medication. Additionally, it seamlessly integrated data obtained from the Spanish Agency of Medicines and Medical Devices (AEMPS) regarding medication shortages.
This database enabled several essential functionalities:
It generates reports suggesting orders for medications below the minimum stock levels, recommending quantities based on historical acquisitions and available storage space.
By considering the suppliers for medications at minimum stock levels, it also identifies medications in alert status (1/3 above the minimum stock) for these suppliers.
Cross-referencing with AEMPS’ medication supply problem database swiftly detects critical medications during shortages
It permits agile identification of pending medication orders.
It identifies locations with incomplete medication inventories and propose medication grouping within our automated medication storage system.

What has been achieved?

The outcomes of our project were transformative:
  We streamlined medication procurement significantly and maximized each medication supply request while promoting sustainability by reducing laboratory-specific medication orders.
  We optimized storage space within our automated medication storage system, aligning medication orders precisely with storage capacities for each medication, leading to more efficient space utilization and reduced storage costs.
  Early detection of medication shortages enabled proactive preparation of alternative solutions to effectively mitigate shortages.
  Simplification of tracking pending medication orders enhanced operational efficiency in claim processing or supplier changes.

What next?

Our next phase focuses on continuous system improvement. This involves incorporating additional data sources to refine medication supply predictions and exploring the potential for complete automation of the medication ordering process. We will also enhance performance measurement to evaluate the effectiveness of our improvements.

90% reduction of medication waste by reusing returned medication from medical wards

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European Statement

Selection, Procurement and Distribution

Author(s)

Douwe van der Meer, Peder Nygard

Why was it done?

In our hospital 30% of the daily distributed medication for individual patients was not administered. Reasons for not administering were for example lack of need because of patients clinical performance, discontinuation of prescriptions or early discharge. Because of safety concerns, like mix-ups, our standard procedure was to discard all returned medication. This resulted in a waste of about 220.000 pills annually.

What was done?

We reduced medicine waste by 90% by reusing returned medication from our medical wards. With this result we made an important step for our hospital to meet the national sustainability goals in the Dutch ‘Healthcare Green Deal (3.0)’.

How was it done?

Reusing returned medication brings multiple safety concerns. By performing a prospective risk analysis we identified three major risks: mix-ups, expired medication and accepting non-qualitative packages (like slightly opened blisters or incomplete labels). With these risks identified we redefined our distribution process on four key elements: 1) Every medication has a barcode on unit level and if not, is labelled by our team through duplicating the ‘Falsified Medicine Directive’-barcodes to small 2D barcode labels which includes expiration date. 2) All returned medication is checked by a pharmacy employee on major quality aspects. 3) Returned medication is placed in a separate ‘return-box’ in front of the original stock inside the distribution cabinet. 4) Expiration dates are checked more frequently and are checked upon distribution and administration through barcode scanning.

What has been achieved?

The new distribution process was implemented in all of our eight distribution cabinets and resulted in saving 90% of the returned medication; witch amount to 200.000 pills and 70.000 euro savings annually. On average we work with 6 employees daily, who need 15 minutes extra per person per day to process returned medication.

What next?

Our goal is to save all returned medication that meets our quality standards. 5% of the returns that are not reused are medicines not included in the assortments of the specific distribution cabinet, so extra logistic and administrative steps are needed to place them back in the pharmacy stock. We are exploring new ways to make this next step in reducing medication waste further.

Centralised DataMatrix reading for drug authenticity verification

European Statement

Selection, Procurement and Distribution

Author(s)

Leonor Romero, Paloma Lozano, Veronica Canales, Vanesa Dechado, Marta Puebla, Ricardo Villarubia, Isamar Gomez, Estefanía Ramírez, Juan Rodríguez, Belén Soto

Why was it done?

According to Directive 2011/62/EU, one of the measures is the inclusion in the secondary packaging of the drug of a Unique Identifier that allows the recognition of a unitary case at any point in the supply chain until it is dispensed to the patient. Another is the development of a European repository that allows the traceability of medicinal products for human use within the European market. In Spain, in accordance with Article 84.1 of Royal Decree 717/2019 of 5 December 2009, the SNSFarma Node was established as an instrument for technological integration and information exchange with the national repository known as the SEVeM.

What was done?

The logistics company of our hospital aggregates several codes corresponding to the Datamatrix of the individual containers in an electronic file, in order to send the reading automatically to Spanish Medicines Verification System (SEVeM).

How was it done?

The shipment of the drugs and the electronic file will be linked by the Seria Shipping Container Code (SSCC), which will univocally guarantee traceability between the two. The Pharmacy Service staff receive the delivery notes by reading the barcode without the need to scan the Datamatrix of each container.
Since the implementation of this project between July 2023 to September 2023, a total of 61 delivery notes have been registered under the code aggregation system with 27 suppliers involved. The number of packages read was 2151.

What has been achieved?

This project ensures the automatic sending of readings to SEVeM and to facilitate the reception of delivery notes at the Pharmacy Services by barcode reading.
This has allowed pharmacy staff to save time in receiving delivery notes, to improve traceability of batches and expiry dates of medicines, to improve stock control thanks to the confirmation of quantities received and to verify the medicines in accordance with European regulations to fight medicine falsifications and ensure that medicines are safe and that the trade in medicines is rigorously controlled.

What next?

A limitation is the existence of suppliers that are not involved in this project since their delivery is not done through the logistics company. In these cases, the datamatrix reading must be performed on each container individually.

Medication waste in a hospital setting; counts, concerns and considerations

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European Statement

Selection, Procurement and Distribution

Author(s)

Minke Jongsma, Marja Bogaards

Why was it done?

The use of medication is related to almost one-fifth of the total CO2 emission caused by the public health sector. Conservative estimates reveal that the amount of medication distributed by public pharmacies but wasted (thrown away unused) by patients in the Netherlands equalizes a total amount of 100 million euro. Data regarding medication waste in Dutch hospitals is not yet available.

What was done?

We analyzed the stream of medication waste in our hospital and tried to reduce this by addressing the main causes.

How was it done?

In our hospital setting, medication for each in-hospital patient is distributed daily for the next 24 hours by the hospital pharmacy. All unused medication is returned to the hospital pharmacy. We quantified and analyzed all returned unused medication in our hospital on 9 separate days.

What has been achieved?

On average, 27,9% of all medication distributed to in-hospital patients is daily returned to the hospital pharmacy. The largest part of this returned medication, 83.5% (23.3% of all medication distributed to in-hospital patients) is wasted daily. This equalizes a total amount of 87.500 counts yearly, representing a value of 41.000 euro. In terms of waste, 60 medical waste bins of 50 liter (a total volume of 3000 L) are needed to dispose of this medical waste.
Analysis of the main causes reveal that distributing both parenteral medication and medication prescribed ‘as needed’ to in-hospital patients contribute largely to medication waste, as well as the inability to adequately anticipate on the discharge of patients.

What next?

By addressing the main causes we can decrease medication waste by 45%. Further reduction can be achieved by considering re-uptake of returned medication in our main stock. Our medication distribution process, however, is mainly based on financial and quality based decisions, which excludes re-uptake. But should impact on planetary health not also be considered? To realise this, though, both ecotoxicologic data as well as information related to environmental impact of medication production should be available and easily accessible.

Setting up automated dispensing cabinets in a cardiac surgery intensive care unit: what impact for the nursing team and the pharmacy?

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European Statement

Selection, Procurement and Distribution

Author(s)

MARIANNE DE LACROIX DE LA VALETTE

Why was it done?

Managing medications in hospitals is both a health and an economic issue.
Hospital pharmacists are working to improve supply, traceability, safety and stock management in order to meet these challenges.
Healthcare staff must be able to administer the medications prescribed to patients in complete safety, with the products available at the time of order. The management of medications within the department represents a significant amount of time that needs to be reduced.

What was done?

The objective of this study was to analyse the impact of deploying automated dispensing cabinets (ADC) in a cardiac surgery intensive care unit within a university hospital in France.

How was it done?

In 2022, an on-site study was conducted in the cardiac intensive care unit (18 beds) at Rennes University Hospital. The aim was to quantify the time allocated to manage medications before and after the installation of the automated dispensing cabinet.
Several types of measurable metrics were identified and compared. These include picking time for nurses of medications for administration to the patient; time allocated for ordering and storing medications; time to respond to emergency orders; management of narcotics; and time in the management of expired medications.

What has been achieved?

A comparison of the pre and post installation of the automated dispensing cabinet showed nursing time savings in the picking of controlled drugs of 53%. Overall restocking time was decreased by 9%. The number of urgent order requests to pharmacy was decreased by 51%.
The time allocated towards removing expired medications was reduced by 3.8 days / year (nurse FTE). Lastly, the implementation of automated dispensing cabinets reduced the value of the department’s stock by 26%.

What next?

The time spent by nurses in managing medications was significantly reduced after the installation of automated dispensing cabinets. However, some of this time is transferred to the central pharmacy towards restocking the medications into the automated dispensing cabinets.
The automated dispensing cabinets makes it possible to monitor the stock of medicines in a department on a daily basis. This enables for data driven decision making on selection of decentralized stock and respective quantities to maintain.
The deployment of automated dispensing cabinets improves overall efficiencies and allows more time for nurses to provide direct patient care.

Can my medicine be returned to the refrigerator? Minimisation of wastage in case of storage incidents of cold-chain homecare medications

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European Statement

Clinical Pharmacy Services

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

Medicine pickup lockers offer patients a new way to pick up medicine prescribed at outpatient clinics

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European Statement

Selection, Procurement and Distribution

Author(s)

Line Jarvig, Louise Konradsen Refsgaard

Why was it done?

The medicine pickup lockers were implemented to offer patients in the outpatient clinics a more flexible and accessible way to receive their medication e.g., 24-hour access close to home.

What was done?

Patients who are receiving medicine free of charge from outpatient clinics traditionally pick up the medication by face-to-face contact with the nurses in the clinic every third month. Patients, who are in remission and already well-informed about their medication are offered to receive their medication in one of seven medicine pickup lockers in the capital region of Denmark. To ensure adherence, safety and optimal outcome of treatment, the healthcare professionals carefully pick out the patients, who are suited for this method. Regular contact between the healthcare professional and the patient is also continued, primarily by using digital contacts through the EPJ-system and by telephone.

How was it done?

The implementation of this new direct-to-patient distribution method was carried out by the Capital Region Hospital Pharmacy in close collaboration with the region’s hospitals and outpatient departments. The implementation requires that the clinical staff rethink their practice and accept that dispensing is no longer their responsibility. Dispensing and distribution of the medication is now handled by pharmacy staff at the hospital pharmacy’s warehouse. From here the medication is transported to the requested location and the patient will receive a text message when the medicine is ready for pickup in the medicine pickup locker.

What has been achieved?

Patients find medicine pickup lockers accessible, safe, and easy to use. Importantly, the quality of medicine dispensing is increased due to hospital pharmacy staff dispensing the medicine rather than nurses. Changing the workflow so that nurses do not dispense medicine also alleviates the shortage of nurses. In addition, this method is without doubt environmentally optimal compared to the traditionally pick up method, since transportation of both patients and the medicine is decreased.

What next?

Next step will be to offer prescription pickups at private pharmacies, which can ensure that patients can pick up their medicine at several different locations around the region and make it possible for the patients to communicate any concerns to a healthcare provider.

From national security stockpile to national strategic stockpile

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European Statement

Selection, Procurement and Distribution

Author(s)

Lykke Henriette Sandholt, Charlotte Kok Fredslund

Why was it done?

Early in the COVID-19 pandemic, it became apparent that backorders for many medicines could arise worldwide. In Denmark, the same medicines are used in all hospitals for 1 or 2 years. As hospitals report estimates for the same drugs, it was possible to establish a national safety stockpile.

What was done?

In March 2020, Amgros established a national pharmaceutical safety stockpile for the Danish health authorities. The facility partner was approved, and the warehouse was constructed within a few months. Experience over the past three years has led to a national strategic stockpile run by Amgros on behalf of the Danish regions and Amgros.

How was it done?

Working with clinicians, clinical pharmacists, hospital pharmacies, and the Danish Medicines Agency, the range for the safety stock was identified based on defined criteria. Hospital pharmacies were also required to purchase from the safety stock. The warehouse was replaced every three to six months depending on criticality, and therefore was the risk of waste minimized. A procurement team was set up in Amgros, which established a good working relationship with pharmaceutical suppliers to identify backorders. The purchasing pharmacist regularly met with health professionals regarding drug numbers and quantity adjustments.

What has been achieved?

Throughout the COVID-19 pandemic, security of supply remained intact, mainly due to collaboration between healthcare actors, suppliers, and Amgros. The experience gained over the past three years has resulted in establishment of a national strategic stockpile. Danish regions run this stockpile in cooperation with Amgros. Selection of warehouse partner is among other things based on profitability and sustainability.

What next?

After establishing the strategic stockpile, the Danish regions and Amgros took over financial responsibility from the Danish authorities. A working group has been established, including hospital pharmacies and Amgros, to assess stock volumes at the warehouse. Medicines with unstable security of supply are stocked. Input from suppliers is highly valued. All tenders are monitored so the working group can add or delete medicines. We ensure supply when consumption is high (seasonal fluctuations). The goal of the strategic stockpile is to maintain security of supply and, thus, treatment of patients at Danish hospitals. As well as act promptly on announced and urgent backorders.

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