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.

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.

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.

Pdf

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.

Pdf

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.

Pdf

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.