EAHP represents over 30,000 hospital pharmacists across 37 member countries. EAHP represents and develops the hospital pharmacy profession within Europe in order to ensure the continuous improvement of care and outcomes for patients in the hospital setting. This is achieved through science, research, education, practice, as well as sharing best-practice and responsibility with other healthcare professional
The EAHP Board, elected for three-year terms, oversees the association’s activities. Comprising directors responsible for core functions, it meets regularly to implement strategic goals. Supported by EAHP staff, the Board controls finances, coordinates congress organization, and ensures compliance with statutes and codes of conduct.
The EAHP staff supports the Board in executing EAHP’s mission. The Staff assists in financial management, events organisations, policy activities and all EAHP projects. The EAHP staff works closely with EAHP’s members and ensures the effective communication all relevant stakeholders.
The first member countries were Belgium, Britain, Denmark, France, the Federal Republic, Germany, Italy and The Netherlands in 1972. EAHP has now 36 EAHP members and 2 Associate Members. EAHP is open to countries members of the Council of Europe and since 2022 to organisations representing the interests of hospital pharmacists from outside the Council of Europe (Associate Membership)
EAHP’s structure is also composed by different standing committes: EAHP Scientific Committee, EAHP Education Executive Committee and the EAHP CTF Steering Committee.
At EAHP, we are committed to transparency in our governance, ethical standards, and funding practices. This section provides open access to our foundational documents, including the EAHP Statutes, Code of Conduct, and Funding Sources. By sharing these resources, we aim to uphold accountability and foster trust with our members, partners, and the public.
Keep up with all EAHP’s events and webinars. Contact the team at info@eahp.eu should you have any questions about upcoming events or activities.
Here you can find all upcoming events organised by EAHP and by all its members and associate members. Do not hesitate to contact the events team at events@eahp.eu should you have any questions about the organisation of these events.
Hospital pharmacists conduct a critical role in the care of patients in hospitals. Learn more about what they do here and in all the pages under Hospital Pharmacy practice and Policy.
Self-Assessment
SILCC
Closed SIGs
EAHP brings together experts from many areas of hospital pharmacy practice providing and highlighting good local sustainable practices as that can be up-scaled and shared with other countries. The EAHP Working Group on Sustainability has the aim of reducing the environmental burden of the hospital pharmacy services.
The European Association of Hospital Pharmacists (EAHP), and its 36 member country platforms are creating a Common Training Framework for the hospital pharmacy education in Europe. The goal of this project is to allow the free movement of hospital pharmacists within the European Union.
The European Association of Hospital Pharmacists (EAHP) and the European Society of Clinical Pharmacy (ESCP) have collaboratively developed the Oath to Society. The Oath to Society is all encompassing and acts as a contract for excellence in providing compassionate patient care, working as part of the healthcare team and advancing the pharmacy profession, and showcasing how clinical and hospital pharmacists work every day
A day created to highlight the importance and to celebrate the work done by hospital pharmacies. This day celebrates all hospital pharmacy teams.
The Early Career Network aims to empower early-career pharmacists by sharing opportunities, insights, and success stories from across 25 member countries.
Together, we’re building a stronger, more connected hospital pharmacy community: one story, one country, one pharmacist at a time.
Catch up with EAHP’s press releases
Find all EAHP relevant publication like the EAHP Surveys, annual reports and the history books.
The European Journal of Hospital Pharmacy (EJHP) is the only official journal of the European Association of Hospital Pharmacists (EAHP) and is committed to advancing the science, practice and profession of hospital pharmacy. As the premier communication platform for hospital pharmacists worldwide, EJHP is a major source for continuing education as well as updates on advances in the practice and standard of pharmaceutical care for patients.
When EAHP and Hospital pharmacists appear in the news.
EAHP publishes a monthly EU monitor with updates about the latest EAHP initiatives and information relevant for the hospital pharmacy profession.
The Sponsor Channel is designed to maximise visibility and engagement, allowing sponsors to connect with the hospital pharmacy community and partners in a dynamic and interactive environment. From product demonstrations to networking sessions, the Sponsor Channel offers a range of opportunities for sponsors to showcase their offerings and generate leads in the new EAHP Website.
Clinical Pharmacy Services
Fajfarić Petković Maja, Vilić Katarina, Kuruc Poje Darija
Antimicrobial resistance (AMR) is a global public health problem, associated with prolonged illness, increased transmission, extended hospitalization, higher treatment costs, and greater mortality. Although clinical pharmacists have been shown to play an important role in antimicrobial stewardship, data from southeastern Europe, including Croatia, are scarce.
The aim was to assess the role of clinical pharmacist in pharmacotherapy management of patients receiving antimicrobial therapy.
A retrospective observational study was conducted in the period from 1st January 2018 to 31st December 2024. Data included adult patients treated with reserve antibiotics evaluated by an antimicrobial stewardship team (A-team), composed of infectious disease specialist, a clinical microbiologist and a clinical pharmacist. Collected data were patient characteristics, hospital wards where antimicrobial therapy was prescribed, indications for reserve antibiotics and the pharmacists interventions, including clinically significant drug interactions (categories X and D, UpToDate®). Descriptive statistics were used to analyse the data.
Between 2018 and 2024, the number of hospitalized adults receiving reserve antibiotics increased – from 492 to 798, with mean age rising from 68 to 70 years. Most patients (71-92%) had associated comorbidities and reserve antibiotics were predominately prescribed in internal medicine departments, most often for bacterial pneumonia. Pharmacist interventions increased: dose adjustments for renal/hepatic impairment – from 10 in 2018 to 116 in 2024, consultations on preparation, stability, storage, and administration of parenteral antibiotics – from 2 in 2018 to 731 in 2024. Clinically significant drug interactions (categories X and D) decreased over time from 52 interactions in 2018 to 17 interactions in 2024. The most common drugs involved were promazine, furosemide, indapamide, ciprofloxacin, piperacillin+tazobactam, clozapine, metoclopramide and amikacin.
Findings suggest increased physician awareness of clinically significant drug interactions in patients with multiple comorbidities and underscore the recognized role of clinical pharmacist within a multidisciplinary team. Their integration into multidisciplinary antimicrobial stewardship teams improves patient safety, reduces adverse effects, and promotes rational antimicrobial use.
Selection, Procurement and Distribution
Collada VL1, Villamañán E1., Mallón S1., Laorden D2, Domínguez-Ortega J.3 García Lopez L1, Soto A1., Villaroya E1, Bueno S1, Herrero A1.
1. Pharmacy deparment. Hospital Universitario La Paz
2. Pneumology deparment. Hospital Universitario La Paz
3. Allergy deparment. Hospital Universitario La Paz
The healthcare sector is responsible for 4–5% of global greenhouse gas emissions, with medications contributing up to 35%. pMDIs, widely used in asthma, contain hydrofluorocarbon propellants with high global warming potential. In Spain, 46% of inhalers prescribed in 2023 were pMDIs, with rescue therapies (SABAs) only available in this format. The aim was to explore substitution with lower-emission devices without compromising adherence or asthma control.
An observational initiative was conducted in a severe asthma multidisciplinary group to evaluate the type of inhalers prescribed and their environmental impact. Prescription patterns, adherence and CO₂ emissions were analysed to identify opportunities for replacing pressurised metered-dose inhalers (pMDIs) with more sustainable alternatives.
The study included 223 adult patients with severe asthma followed during 2024. Inhaler prescriptions, adherence (medication possession ratio) and estimated CO₂ emissions were assessed. Barriers included lack of non-pMDI rescue inhalers and entrenched prescribing habits. These were addressed through multidisciplinary collaboration, identification of equivalent alternatives and education on sustainability.
Out of the 297 inhalers prescribed, 43.4% were pMDIs. Triple therapy (LABA–ICS–LAMA) was predominantly prescribed as pMDIs (66.7%). Acceptable adherence (>70%) was observed for both pMDIs and non-pMDIs, with no clinically significant differences. Over half of patients using rescue inhalers were high-frequency users, all of whom received SABA pMDIs (20–30 kg CO₂ per canister). For most maintenance prescriptions, non-pMDI equivalents with a much lower footprint (<2 kg CO₂ per canister) were available. These findings demonstrate that many pMDI prescriptions could be replaced without affecting treatment adherence.
This initiative shows that integrating environmental considerations into asthma care is feasible and clinically safe. It highlights the urgent need to introduce sustainable rescue inhalers and adopt new low-GWP propellants. The model can be scaled to other respiratory conditions and European healthcare systems, contributing to decarbonisation strategies while maintaining high-quality patient care.
Patient Safety and Quality Assurance
Laura Rueda Montes, David Tomás González, Iker Muñoz Delgado, María Fernández-Vázquez Crespo, Jesús Airam Domínguez Cháfer, Rocío Manzano Lorenzo, José Carlos Tallón Martínez, Cristina González Pérez, María Ángeles Campos Fernández, Susana Sánchez Suárez, María Teresa Benítez Giménez
One of the core responsibilities of hospital pharmacists is the validation of inpatient medication prescriptions. Our goal was to identify medication errors that could compromise patient safety, and to optimize and standardize pharmaceutical recommendations, ensuring consistent validation practices across pharmacists. This initiative serves as a tool for quality assurance and patient safety.
Design and implementation of an automated alert system for pharmaceutical validation of prescriptions integrated into the Electronic Medical Record (EMR), which generates real-time pop-up alerts based on a database parameterized with clinical rules. During validation, the pharmacist decides whether the alert is appropriate and if accepted, a notification is added to the medical prescription, as well as a record of this intervention in the EMR.
Key pharmaceutical interventions (PIs) were established to optimize prescription validation, grouped into two categories:
• Drug-dependent interventions: 577 PIs classified into 9 groups: maximum dose, therapeutic duplication, drug interactions, gastroprotection, laxative prophylaxis with opioids, incorrect administration techniques, treatment duration, potentially inappropriate medications in older adults, and sequential therapy.
• Patient-specific interventions based on lab data: 398 PIs classified into 7 groups: renal failure, electrylite (magnesium, potassium, and sodium) levels, neutropenia, thrombocytopenia, and anemia.
With support from the IT department, an algorithm was configured using a total of 975 rules that we established for 386 drugs. When a prescription meets any of these rules, an alert pops up in the EMR, displaying a predefined pharmaceutical recommendation tailored to the patient.
Implementation of the alert system in the pharmacist’s EMR profile in order to detect medication errors in patients who meet one or more of the rules set in the created algorithm.
Moreover, a dashboard was created displaying the number of interventions by prescribing department, drug, and type of intervention.
Since its launch in April 2025, a total of 3,547 PIs were made for 2,411 patients within six months.
Ongoing review of existing alerts based on feedback from the pharmacy team, along with the incorporation of new rules to maximize medication safety for hospitalized patients.
Patient Safety and Quality Assurance
Furio Alessandro 5, Di Lorenzo Antonio 1, Noviello Chiara 4, Faggiano Maria Ernestina. 2, Bursomanno Beatrice 3, Cantalice Michele Alberto 5, Lobifaro Annamaria 5, Manicone Anna Lucia 5 , Spinelli Giuseppe 5, Parnoffi Nicoletta Francesca 5, Stefanizzi Pasquale 1, Tafuri Silvio 1
1 Dipartimento Interdisciplinare di Medicina – Università degli Studi di Bari Aldo Moro, Bari, Italia
2 Farmacia Ospedaliera – Azienda Ospedaliero Universitaria Policlinico di Bari, Bari, Italia
3 Scuola Di Specializzazione In Farmacia Ospedaliera – Università Degli Studi Di Bari Aldo Moro, Bari, Italia
4 Scuola Di Specializzazione In Igiene e Medicina Preventiva – Università Degli Studi Di Bari Aldo Moro, Bari, Italia
5 Unità di Programma Control Room / U.O.C. Igiene Universitaria – Azienda Ospedaliero Universitaria Policlinico di Bari, Bari, Italia
Hospitals face a significant challenge from healthcare-associated infections (HAIs), which stem from a complex interplay of various risk factors and have serious implications for patient safety and public health. The initiative was undertaken to address these threats through a multidisciplinary organizational framework, recognizing that safeguarding patients requires coordinated efforts from multiple healthcare professionals.
To tackle HAIs, the model implemented at Bari’s General Hospital combined systematic epidemiological surveillance with direct, onsite monitoring of healthcare practices, applying these strategies consistently using specifically designed checklists. This approach is fully in line with international recommendations, particularly the “One Health” strategy, which underscores the importance of integrated and multidisciplinary action in overcoming health challenges.
Prevalence studies, performed over a year, were recommended to improve understanding of infection risks related to invasive procedures, surgeries, and the use of antibiotics. These periodic surveys help to identify emerging trends and risk factors, enabling targeted interventions. Additionally, structured walkarounds within hospital facilities were implemented, allowing multidisciplinary teams to inspect environments, assess clinical records, and monitor drug storage methods. This approach not only prevents critical events but also highlights weaknesses and opportunities for improvement through focused staff training (audit).
Achievements from this combined strategy include a more integrated and thorough infection control program. By incorporating continuous audits, field surveillance, and ongoing education for healthcare staff, the hospital pharmacist’s role has evolved from being a background administrator to a frontline participant in infection prevention and stewardship. There has been a notable improvement in the management of both medications and medical devices, especially regarding their cleaning procedures and actual use. Additionally, significant progress has been made in the appropriateness of using anti-infective drugs—such as antifungals, antibiotics, disinfectants, and antivirals—resulting in more rational and safe pharmacological utilization throughout the hospital setting.
Further enhancements in infection control should focus on sustaining integrated surveillance, monitoring, and training programs. Moreover, it is essential to emphasize the importance of the hospital pharmacist within the corporate multidisciplinary team dedicated to the prevention of healthcare-associated infections, as their expertise is pivotal for the successful implementation of all strategic actions related to infection control and optimal medication use.
Clinical Pharmacy Services
A Wagner, D Weixler, C Waidinger, M Josl
A pharmacist, integrated in the palliative care team, reviewed preselected patients with advanced disease to identify potentially inappropriate medications (PIMs). When appropriate, a team of physicians deprescribed PIMs in accordance to patient preferences, clinical status and rationale. The initiative aimed to identify PIMs, reduce pill burden and align pharmacotherapy with individual treatment goals.
Up to 96% of geriatric oncological palliative care patients experience polypharmacy (>5 medications) (1), with up to 70% receiving at least one PIM referring to Lindsay J et al. (2).
Deprescribing is considered appropriate in certain clinical situations, including for example:
– presence of polypharmacy
– patient’s wish
– shift in treatment strategy or goals
– limited life expectancy
– when potential harm outweighs benefits
– Weekly interdisciplinary meetings
– Eligible patients were identified by the palliative care physicians based on prognosis, symptom burden, medication profile (polypharmacy), and patient wishes
– Pharmacist reviewed medications using medical records, identified potential deprescribing opportunities and provided tailored deprescribing recommendations (what and how to deprescribe)
– Recommendations were collaboratively discussed and documented
– If deprescribing was implemented, follow-up was conducted at the next patient visit and was subsequently monitored during regular consultations
During observation period, three patients (all male, median age 80) received a structure deprescribing review. A total of 59 drugs were targeted, 20 PIMs have been identified.
Commonly deprescribed medication groups were gastroprotective drugs (A02B), urological agents (G04B, G04C) antihypertensives (C02A, C09A, C08C, C03C) and vascular or miscellaneous agents (C05B, N06DX, N07A). Typical reason for discontinuation included stable blood pressure, presence of indwelling urinary catheter, patient-driven deprescribing request, therapeutic futility.
Other drug classes such as psychotropics (N06A, N04B), cognitive enhancers (N06D) and bone-metabolism agents (M05B, A12A) were occasionally discontinued when adverse drug effects outweighed potential benefit or did not align with palliative goals (long-term preventive therapy). Main drivers for deprescribing were patient wishes to reduce pill burden, complex symptom management and avoidance of adverse effects.
The initiative demonstrated feasibility, safety, and transferability of pharmacist-supported deprescribing as part of a multidisciplinary team. Next steps could include the development of interprofessional training sessions and expansion to other clinical settings.
Clinical Pharmacy Services
Ana Puebla Villaescusa, Elena Rodríguez del Río, Elena López Lunar, Sonia Fraile Gil, Eduardo Tejedor Tejada, José Diéguez Gómez, José Manuel Carrascosa Bernáldez
Due to the high interindividual variability in response to psychiatric treatments (age, weight, comorbidities, polypharmacy, diet, addictions, genetic polymorphism), pharmacokinetic monitoring is essential to individualize and optimize drug dosages, improve clinical efficacy, and reduce adverse effects.
A pharmacokinetic monitoring unit for psychiatric medications was established in a specialized mental health hospital.
• Design: Prospective study of plasma psychiatric drug levels in patients from a specialized mental health hospital between June and September 2025.
• Drugs monitored: valproic acid, lithium, clozapine, carbamazepine, risperidone+9-hydroxy-risperidone, olanzapine.
• Data collection: anthropometric and laboratory data, comorbidities, plasma levels, dosing history, drug interactions, addictions, dosage adjustment recommendations.
• Pharmacokinetic software: Bayesian and population pharmacokinetic models.
n= 129 patients (and 284 level measurements): 12 patients (9.3%) had levels above the established therapeutic ranges, and 35 (27.1%) had levels below range in at least one measurement.
• Valproic acid (n = 49): 5 (10.2%) above range (4 due to hypoalbuminemia); 14 (28.6%) below range. Among those, 5 using it as a mood stabilizer remained clinically stable without dose increase; 2 reduced their doses due to adverse effects while remaining stable. The rest had low levels due to different factors (drug interactions, clinical circumstances, poor adherence).
• Lithium (n = 34): 6 (16.7%) below range, half of them clinically stable; 1 (2.7%) above range due to an interaction with enalapril.
• Clozapine (n = 14): 9 (64,3%) below range due to several factors (poor adherence, adverse reactions that requires lower doses, possible genetic polymorphism). Despite below range, some patients remained clinically stable. The majority of patients were smokers, which significantly increases the drug’s metabolism, complicating dose adjustment without pharmacokinetic monitoring.
• Carbamazepine (n = 2): both within therapeutic range.
• Risperidone + 9-hydroxy-risperidone (n = 19): 2 (10.5%) below range; 7 (36.8%) above range, three of whom required monitoring for renal impairment, and the rest needed dose reductions to avoid supratherapeutic levels.
• Olanzapine (n = 9): 2 (22.2%) below range, one due to suspected non-adherence.
Ongoing optimization of pharmacokinetic monitoring of psychiatric medications, in which individualized dosage adjustment is required in a high percentage of patients to improve treatment efficacy and reduce adverse reactions in these patients.
Patient Safety and Quality Assurance
E Biringer1,2, K Skaare-Fatland1, E Tverborgvik3
1Helse Fonna Local Health Trust, Haugesund, Norway, eva.biringer@helse-fonna.no
2Western Norway University of Applied Sciences, Stord, Norway
3Sjukehusapoteka Vest HF, Stord, Norway
Why was it done?
The aim was to reduce the risk of medication errors arising during the registration and reconciliation of patients’ medication lists in the electronic charting system MEONA (Mesalvo GmbH, Freiburg, Germany) at patient admission. Prior to the intervention, medication errors were frequent, most likely due to limited MEONA proficiency among newly employed staff and a complex procedure for importing information about patients’ current medications from multiple sources, i.e. the electronic patient records, the Summary Care Record («Kjernejournal») and the Prescription Intermediary («Reseptformidleren»). The initiative was made in 2022 in a mental health hospital in Norway.
What was done?
A concise pocket guide was developed for use by health personnel responsible for the registration and reconciliation of medication lists at the acute mental health ward.
The process of registration and reconciliation of medication lists was standardised and visually illustrated by simplified step-by-step illustrations of the user-interfaces of MEONA. The illustrations were included in a two-page pocket-sized brochure along with illustrations pertaining to electronic registrations of patient information in the electronic patient administrative- and laboratory systems. The hospital pharmacist advised the development of the brochure. The communications department of the health trust created the illustrations and lay-out of the brochure.
A qualitative evaluation was conducted based on feedback from end-users of the brochure, i.e. the physicians regularly performing medication-related operations in MEONA. They all reported a reduction in erroneous registrations and less time spent on hazzles related to medication reconciliation after the pocket guide was implemented. A newly employed junior doctor stated:
“I think the brochure is excellent! I would have had significantly more trouble during my shifts if I hadn’t had this little guide with me.”
This simple intervention likely contributed to reducing the risk of medication-related errors in the mental health hospital. Hospital pharmacists could develop similar brochures in other hospitals with electronic charting systems subject to user errors. The efficiency of such pocket guides in terms of reducing erroneous registrations and time spent on registrations should be measured prior to and after their introduction.
Patient Safety and Quality Assurance
Sandra Oliver, Chief Clinical Information Officer, Pharmacy and Medicines.
Chris Green, Director of Pharmacy and Medicines Optimisation
We describe how our hospital experienced a cyber-attack which resulted in the electronic patient record and other systems being taken offline, including our electronic prescribing system.
We describe our response to the cyber-attack and the considerations necessary to replace an entire hospital’s electronic prescribing system with paper. We also describe the co-dependencies with other previously electronic departments and systems, and communications with partner organisations.
The conversion from electronic to paper prescribing was led by the pharmacy team. Initially, this was via a printed downtime solution from the electronic prescribing system, which then required transcription to a paper prescribing chart. This generated a number of logistic, practical and safety issues which were managed by the pharmacy team. We then describe how the hospital was converted back to electronic prescribing over the course of one day, and how the pharmacy team was pivotal to that.
We were able to successfully take our hospital off electronic prescribing and initiate a paper-based downtime solution that ran over several days, and then return the hospital to electronic prescribing. Recovery efforts involved pairing prescribers with pharmacists across wards, establishing a pharmacy command centre, coordinating medication administration on ePMA, and communicating service updates across the Trust. Third-party services were reinstated, and recovery was prioritised by acuity, with the least acute wards addressed first. During the downtime period, we actively encouraged the pharmacy team to log patient safety concerns, or ideas to improve the downtime process which were reviewed and acted on in real time and as part of the post-recovery review.
We have learned several valuable lessons from the downtime experience which we have taken forward as part of our revised business continuity plan. This includes a review of specialist prescribing situations for example insulin, how we contact and work with partner organisations, the robustness of our downtime printer setup, and training material for clinical staff who at the time of the cyber-attack, had never used a paper based prescribing system. This case study serves as a valuable resource for healthcare organisations seeking to strengthen their cybersecurity and business continuity strategies.
Education and Research
Dr Fernando Perez
Connor Thompson-Poole
Dr Konnie Basu
Recent changes in UK pharmacy education standards by the General Pharmaceutical Council (GPhC) have emphasised the need for pharmacists to graduate with the confidence and competence to undertake independent prescribing roles. This requires proficiency in physical assessment and diagnostic skills, traditionally outside the scope of undergraduate pharmacy education. To address this gap, the University of Brighton has integrated a structured simulation-based physical assessment training package into the MPharm curriculum, preparing future pharmacists for enhanced clinical responsibility and interprofessional practice.
A series of simulated physical assessment sessions was introduced across all years of the MPharm programme. The training focuses on developing students’ competence and confidence in performing fundamental physical assessment techniques, including cardiovascular, respiratory, gastrointestinal, and neurological examinations, as well as accurate recording and interpretation of vital signs through a spiralled curriculum over the course of four years.
The simulation package was designed collaboratively by clinical academic staff and prescribing pharmacists, supported by colleagues from medicine and nursing to ensure cross-disciplinary alignment. Each session was structured around case-based clinical scenarios, encouraging students to follow a patient’s journey through different healthcare settings.
Sessions were delivered in the university’s clinical simulation suites using simulated patients, high-fidelity manikins, and digital monitoring tools. Each workshop included a short demonstration, guided practice, peer feedback, and reflection activities. Students benefit from this approach as they can individually work through real clinical scenarios, which better prepares them for future independent clinical practice.
Student learning was assessed through Objective Structured Clinical Examinations (OSCEs) and reflective portfolios. Staff feedback and student evaluations were collected to guide ongoing improvement.
Over two academic years, over 400 pharmacy students have participated in the programme. Student feedback indicates a marked increase in self-reported confidence in patient examination, clinical communication, and integration of physical findings into clinical reasoning. Staff observed improved engagement and enhanced preparedness for prescribing training. The initiative has also fostered stronger collaboration across disciplines.
Future plans include developing interprofessional simulation days with medical and nursing students, and exploring digital tools for remote clinical assessment practice. The model demonstrates a scalable and sustainable approach to embedding clinical examination competence within undergraduate pharmacy education.
Clinical Pharmacy Services
Anais Carrillo Burdallo
Cristina Villanueva Bueno
Maria del Pilar Montero Antón
Isabel Regalado-Artamendi
Beatriz Torroba Sanz
Jose Luis Revuelta Herrero
Eva González-Haba Peña
Daniel Gomez Costas
Yeray Rioja Díez
Antonio Prieto Romero
María Martín Bartolomé
Xandra García Gonzalez
Ana Herranz Alonso
Maria Sanjurjo Saez
High-dose methotrexate (HD-MTX) carries substantial toxicity risk. Safety hinges on timely, appropriately dosed leucovorin rescue plus high-volume hydration and urinary alkalinisation. Pharmacokinetic monitoring with proactive follow-up enables early detection of delayed clearance and better-informed decisions.
A protocol for the administration and pharmacokinetic monitoring of HD-MTX was developed and implemented in a tertiary hospital in coordination with the Haematology Department.
Standardised procedures for administration were defined (hydration/alkalinisation strategies; rescue timing/dose; infusion start; sampling schedule). Adults with leukaemia/lymphoma received short (5µmol/L; long: 42h, >1µmol/L).
Pharmacist-led interventions were classified as: enhanced elimination (intravenous fluids/furosemide; bicarbonate/acetazolamide; cholestyramine), rescue optimisation (dose guided by the prediction, readjusted after the measured level, and withheld when appropriate), and monitoring (additional levels and duration).
Continuous accuracy was assessed with the individual percentage error (IPE)=[(predicted−observed)/observed]×100; we report MDIPE (median IPE; accuracy), MAIPE (median absolute IPE; precision), and the proportion within 1.5-fold. Classification against thresholds was summarised with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).
In 24 administrations (13 short, 11 long), pharmacist-led interventions were implemented in every cycle: enhanced elimination 88%, rescue optimisation 54%, monitoring 71%.
Continuous accuracy: MDIPE +35% (IQR 9–80), MAIPE 38% (IQR 11–80); 54% within 1.5-fold. Threshold performance (short/long): accuracy 69/91%; sensitivity 100/100%; specificity 67/86%; PPV 20/80%; NPV 100/100%.
Protocolised monitoring improved safety by standardising decisions and reducing errors. The predictive tool achieved 100% sensitivity and NPV, supporting early rule-out of delayed clearance; positive alerts should be interpreted cautiously given moderate overprediction and false positives near thresholds, with confirmation and close follow-up.
Next steps are full rollout, recalibration and threshold tuning in larger cohorts, and extension to Oncology and Paediatrics, tracking efficiency endpoints (time to <0.05-0.2 µmol/L, length of stay).
