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DEVELOPMENT OF PATIENT EDUCATION MATERIALS ON WARFARIN AND DIRECT ORAL ANTICOAGULANTS: A NATIONAL PATIENT SAFETY AND QUALITY IMPROVEMENT COLLABORATIVE

European Statement

Patient Safety and Quality Assurance

Author(s)

Purcell A, Crowley M, Silvari V, O Leary C, Ní Áinle F, Bury E, Savage M, O Neill AM, Garvey S.

Purcell A, Crowley M, Silvari V, O Leary C, Ní Áinle F, Bury E, Savage M, O Neill AM, Garvey S.

Why was it done?

Warfarin and Direct Oral Anticoagulants (DOACs) are internationally recognised as high-alert medicines. The Irish National Health Services Executive (HSE) Clinical Programme for Venous Thromboembolism (VTE) identified the need for standardised, national, patient education materials on these high-alert medicines.

What was done?

This national patient safety initiative was actioned through the National Clinical Programme Patient Information Panel. The panel aimed to develop standardised, national, patient education booklets on warfarin and DOACs, that are trustworthy, easy to read, patient-centric, involve end-users, equitable, sustainable, and accessible for patients and clinical staff.

How was it done?

A multidisciplinary patient information panel including clinical experts and a patient partner was recruited. Panel members were diverse in geography, hospitals, discipline, and expertise. The panel included representation from hospital Chief Pharmacists, Consultant Haematologists, Advanced Nurse Practitioners, and a patient partner.
The panel adopted the principles of Quality Improvement, co-design, plain English guidelines, and used expert -panel consensus methodology followed by iterative cycles of national, expert-panel review and feedback. The prototypes were reviewed by the Irish Medication Safety Network, The Irish Haematology Consultants’ Special Interest Group and the National VTE Clinical Advisory Group.

What has been achieved?

The two patient education booklets contain important safety information for patients including risk-stratified information on side-effects with appropriate actions. The Warfarin booklet contains 17 prioritised questions and the DOAC booklet contains 14 prioritised questions. The two booklets were implemented nationally in July 2025 by the Irish HSE and are freely accessible for patients and clinical staff on the HSE website. These are the first national patient education booklets in Ireland on Warfarin and DOACs, co-designed by iterative cycles of expert panel and patient consensus. They are intended to empower patients with safety information , reduce preventable harm, and support clinical staff with provision of standardised information.

What next?

These booklets are intended to undergo research evaluation using a Patient Education Material Assessment Tool (PEMAT) in conjunction with patient evaluation, followed by continuous cycles of improvement. These booklets may also serve as the basis for adoption or adaptation by regional, national and international patient safety and education panels.

AWARENESS ON PHARMACONTAMINATION AMONG PROFESSIONALS OF A MONOGRAPHIC MENTAL HEALTH CENTER

European Statement

Clinical Pharmacy Services

Author(s)

Elena López Lunar, Elena Rodríguez Del Río, Sonia Fraile Gil, Beatriz Fidalgo Hermida, David García Martínez, Eduardo Tejedor Tejada, Pablo González Carrera, José Diéguez Gómez, José Manuel Carrascosa Bernáldez

Why was it done?

To raise awareness and inform the professionals of a monographic mental health center about the impact of pharmacontamination on ecosystems and human health in order to:
– Analyze the need for training in pharmacontamination in our professionals.
– Generate a cultural change and the adoption of more sustainable practices in medication consumption.
– Take specific future measures that help to optimize high pollution potential drugs in our center.
– Establish improvement actions in waste management.

What was done?

An educational questionnaire on pharmacontamination was intended for the professionals of the center. Permission was requested to the Hospital Management for its distribution, working in conjunction the Pharmacy Service and the Environmental Management Committee, which includes a hospital pharmacist.

How was it done?

– Tool used: Google Drive forms.
– Dissemination method: intrahospital email.
– Intended for the professionals of the center.
– Duration: ~10-15 minutes
– Easy to understand, entertaining.
– Exclusively didactic function. Invites reflection.
– No prior knowledge is required.
– Possibility of adaptation in future versions for different professional profiles.
– Organized blocks: concepts, information and awareness; striking examples; possible solutions and prevention; impact and satisfaction of the questionnaire; suggestions.

What has been achieved?

Test diffusion time = 7 days; sample = 54
Gender: Female 39 (72.2%); Male 15 (27.8%)
Age: 20-65 years
Average score obtained from the test 17.5/21; average value 19/21

– Survey scores after taking the test
>98% believe that the presence of pharmaceuticals in the environment is a matter of high or very high relevance, potentially negatively affecting ecosystems and human health.
>97% believe that greater education is necessary in a high-very high degree.
≈90.7% would like to expand their training on pharmaceutical contamination at the center. 18.5% of them would also like to research on their own.
>96% would recommend this test (average score 4.4/5 points).
7 comments and suggestions, all of them positive.

What next?

– Potential to be replicated in other hospitals or target populations.
– High engagement, understanding, and interest in learning about pharmaceutical contamination.
– Educational questionnaires seem to be a rapid, useful, viable, effective, and highly accepted awareness tool in pharmaceutical contamination.

DIGITAL COUNSELLING

European Statement

Clinical Pharmacy Services

Author(s)

Sam Coombes
Michael Jackson

Why was it done?

The project aimed to strengthen clinical pharmacy services by introducing a digital counselling model for commonly prescribed medicines. It focused on improving the quality and accessibility of medicines information, particularly for patients discharged outside pharmacy hours who might otherwise miss vital counselling. Embedding digital resources into routine practice promoted equity, consistency, and inclusivity.

What was done?

Structured counselling scripts were created for prednisolone, glyceryl trinitrate (GTN) spray, and metered dose inhalers (MDIs). These were reviewed, approved, and recorded using an AI voice generator, enabling rapid updates. Accessibility features were built in to support patients with sensory impairments. Finalised videos were hosted on YouTube and accessed via QR codes, while a telephone audio service was provided for patients without smartphones. Codes and numbers were placed directly on medicine boxes.

How was it done?

Quality improvement methodology guided the design. AI voice technology allowed quick production of professional-standard audio and easy updates when clinical guidance changed. Using QR codes and phone lines ensured patients with varying digital literacy could access information. Accessibility was prioritised to support inclusivity.

What has been achieved?

Analytics showed strong engagement: the GTN spray video gained 7,000 views, 40 likes, and 59% viewer retention halfway through. Prednisolone had 2,600 views and 8 positive interactions, while MDI reached 29 views during pilot testing. A fluoroquinolone video was launched in late 2025, with outcomes pending. A staff survey confirmed no undue administrative burden.

What next?

Digital counselling via video or audio is feasible, scalable, and well received by patients. It addresses barriers such as limited staffing, out-of-hours discharges, and health literacy. Unlike written leaflets, often above the UK reading age, multimedia resources provide clearer, more engaging support and may improve adherence. AI technology ensures efficiency, cost-effectiveness, and currency of content. This model is replicable and has strong potential for wider NHS adoption, supporting equitable and consistent medicines counselling.

GREEN BREATH PROJECT: A COMPREHENSIVE APPROACH TO REDUCING THE ENVIRONMENTAL IMPACT OF INHALER USE IN SPAIN

European Statement

Clinical Pharmacy Services

Author(s)

Noe Garin Escriva, Borja Zarate Tamames, Unax Lertxundi Etxebarria, Jose Javier Martínez Simon, Rocio Tamayo Bermejo, Eguzkiñe Ibarra Garcia, Olaia Serna Romero, Anna Pelegri Pedret, Yolanda Torremorell Alos

Why was it done?

The GREEN BREATH Project aimed to reduce the environmental impact of inhaler use in Spain. It consisted of three components: (1) a sustainable inhaler prescription framework with a database on the environmental impact of inhalers, scenario projections to estimate benefits of alternative inhaler use and a decision-support algorithm for greener prescribing in Spain; (2) a nationwide patient education project across 40 hospitals focusing on proper inhaler disposal, assessing pharmacists interventions; and (3) a hospital pilot project for optimizing the disposal of used inhalers, reducing hydrofluorocarbon emissions.

What was done?

Inhalers contribute to global CO2 emissions, with over 15 million pMDIs used annually in Spain, generating 400,000 tonnes of CO2 equivalent. Prescription practices often ignore sustainability, and improper disposal exacerbates this problem. The project aimed to integrate environmental criteria into prescribing practices and raise awareness to improve disposal methods, without compromising patient care.

How was it done?

We contacted pharmaceutical companies to develop the carbon footprint database. The prescribing algorithm was designed by a multidisciplinary team. We used data from the Ministry of Health to calculate national projections. We also conducted a study across 40 hospitals focusing on asthma patients, using a questionnaire with a 3-month follow-up. Finally, we piloted an in-hospital inhaler waste management program in a single hospital.

What has been achieved?

The project demonstrated significant impact. We provided the first environmental database on inhalers in Spain. We estimate that shifting 10% of pMDI prescriptions could reduce CO2 emissions by 40,000 tonnes annually. Preliminary results show that over 50% of patients were unaware of inhaler disposal’s environmental impact, and that pharmacists interventions doubled proper inhaler waste disposal. Additionally, the hospital pilot project prevented up to 341 tonnes of CO2 emissions annually by optimizing inhaler waste management.

What next?

Educational resources have recently expanded to four languages used in Spain (Spanish, Catalan, Basque, Galician). We continue disseminating and collaborating with institutions to implement these and other activities. Additionally, sustainable prescribing should be integrated into electronic medical records to drive broader healthcare sustainability and reduce inhaler-related emissions. The project offers a replicable model for other healthcare systems.

THE IMPACT OF AUTOMATED DISPENSING CABINETS ON THE MEDICINE CARBON FOOTPRINT IN AN ACUTE HOSPITAL: A BEFORE AND AFTER STUDY.

European Statement

Selection, Procurement and Distribution

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.

CREATION OF A DATABASE ON THE COMPATIBILITY OF IMMUNOSUPPRESSANTS AND MONOCLONAL ANTIBODIES WITH BLOOD DONATION

European Statement

Patient Safety and Quality Assurance

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.

CREATION OF A DATABASE ON THE COMPATIBILITY OF ANTIINFECTIVES FOR SYSTEMIC USE WITH BLOOD DONATION

European Statement

Patient Safety and Quality Assurance

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.

DEVELOPMENT OF A NATIONAL ORAL ONCOLOGY MEDICINES DATABASE: ADVANCING TREATMENT OUTCOMES THROUGH DATA INTEGRATION

European Statement

Patient Safety and Quality Assurance

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.

INTEGRATION OF PHARMACEUTICAL CONSULTATION IN A PNEUMOLOGICAL DIAGNOSTIC CENTER

European Statement

Clinical Pharmacy Services

Author(s)

André Maia; Maria Teixeira; Ana Catré; Inês Margalho; Joana Duque; Marisa Costa; Marta Susana; Miguel Paulo; Tomás Sousa; Vânia Pereira; Teresa Pereira

Why was it done?

Tuberculosis(TB) is an infectious disease caused by Mycobacterium tuberculosis, typically transmitted through the airborne route. Despite being a curable disease, 1.5 million people die from tuberculosis each year, making it the leading cause of infectious death worldwide.[1,2] In Portugal, the most recent data from the National TB Program indicate a notification rate of 14.5 cases per 100,000 population in 2023. Regarding multidrug-resistant tuberculosis cases, the number of cases has doubled.[3] There was a need to restructure the anti-tuberculosis drug management circuit in the Pneumology Diagnostic Centers(CDP), creating a Personalized Distribution of Anti-tuberculosis Therapy (DPTB), to facilitate administration, improving adherence to therapy and therapeutic reconciliation.

What was done?

Pharmaceutical consultation was implemented in a pulmonological diagnostic center and the interventions performed during the Pharmaceutical Consultation (FC) were analyzed.

How was it done?

The pilot project began in collaboration between Pharmaceutical Services and the responsible Physician. Each month, the pharmacist visits the CDP and validates the medical prescription and prepares the DPTB for one month. During the FC, the information recorded by the physician in the previous consultation is verified, patient compliance is assessed, and therapeutic reconciliation is structured. A manual and tools to support healthcare professionals were developed, essential for improving the efficiency of TB treatment.

What has been achieved?

Between April and August 2025, 38 FC were carried out, in which a total of 11 patients with median age 59 years, 7 (64%) female and 4 (36%) male. The patients monitored were divided into: 5(45.5%) with latent TB, 3(27.3%) with active TB, and 3(27.3%) with atypical mycobacteria. The TB infection, 1(33.3%) case of pulmonary TB, 1(33.3%) of lymph node, and 1 (33.3%) of ocular TB. During the FC, 7 interventions were carried out: 1 drug interactions, 3 teaching and promotion of adherence to therapy, and 3 on adverse reactions (AE).

What next?

Pharmacists’ interventions in educating patients, counseling on AEs, monitoring and alerting them to risk situations significantly contribute to reducing treatment abandonment, one of the greatest challenges in tuberculosis control. In the future, we plan to conduct these in-person consultations in Primary Care settings for patients referred to by their physician.

IMPLEMENTATION OF A CLINICAL PHARMACY ACTIVITY IN RADIOPHARMACY: A TRIPARTITE CONSULTATION HOSPITAL APPROACH FOR PLUVICTO® RADIOLIGAND THERAPY IN ELDERLY PATIENTS

European Statement

Clinical Pharmacy Services

Author(s)

J. BERGÉ, S. BRILLOUET, C. LAMESA

Why was it done?

Tripartite consultation (TC) activities are well established in oncology for chemotherapy, and are progressively emerging in radiopharmacy, where there is a clear need to support elderly and polymedicated patients receiving RLT. This therapy is costly and complex, with additional radioprotection requirements, making multidisciplinary coordination essential.

What was done?

A new activity of clinical pharmacy in radiopharmacy is developed as TC for Pluvicto® radioligand therapy (RLT) in our comprehensive cancer center.
This activity was set as TC with the nuclear physician, radiopharmacist, and nuclear medicine technologist. The initiative was done on our institutional software, with dedicated templates creation and harmonized tools.

How was it done?

Three main axes guided implementation: (1) integration into institutional software with customized reporting templates; (2) reorganization and structuring of the patient pathway; (3) harmonization of practices and training, with the involvement of pharmacy residents under senior supervision. Moreover, specific supports were developed to structure patient counseling, including interview templates and patient-oriented documents (radioprotection instructions, explanatory treatment diagrams).

What has been achieved?

The initiative enabled the standardization of reporting, the improvement of patient pathway coordination, and the reinforcement of their educational support. The integration of patient counseling tools strengthened patients’ understanding of a complex therapy, sensitization to radioprotection, and adherence to their care, while improving overall coordination. It also made possible the systematic performance of medication reviews, particularly relevant for an elderly and polymedicated patient population. Since its implementation, 40 patients have already been managed within this framework by residents under systematic senior supervision. Finally, the TC allowed the institutional financial valorization of this activity.

What next?

This activity represents an interesting and transposable example of good practice. Its implementation demonstrates that such an TC structure can be extended to other RLT to improve efficiency and harmonization of both professional practices and patient management. In parallel, we are currently driving a French multicenter study (Pharma-RIV) assessing the impact of pharmaceutical consultations in the management of patients receiving RLT. A broader preliminary effort is in progress to structure the RLT care pathway at the national level, in collaboration with the French Society of Nuclear Medicine.