Author(s)

Calzavara E. (author); Battistutta C.; Zanella E.; Venturini F.

Why was it done?

Imported medicines are often used during national shortages or when certain drugs are unavailable in Italy. These products frequently lack documentation in Italian or English, increasing the risk of prescribing errors. To address this gap and enhance patient safety, the system was introduced in early 2024, providing immediate access to translated information at the point of care. Moreover, this system helps split packs with many doses.

What was done?

The Hospital Pharmacy of the University of Padua developed and implemented a system where imported medicines are labelled with a QR code linking to the Summary of Product Characteristics (SmPC) translated into Italian. Translations are generated using automatic tools and reviewed by pharmacists for accuracy. The QR code, placed directly on the packaging, allows healthcare professionals to access the translated SmPC instantly via mobile devices. Since 2024, 128 imports have been made, with labels created for 6 drugs: Catapresan tablets (Germany), Lysine Acetylsalicylate IV and Suxamethonium IV (Portugal), Rifampicin tablets and Neostigmine IV (India), flecainide IV (Japan).

How was it done?

Translations are stored on a secure internal cloud system. Each QR code, affixed by the Pharmacy to the medicine box, links directly to the corresponding SmPC translation. It was challenging to link translations to a QR code, but after several attempts, we succeeded using a specific cloud function. If there are any doubts about the translation’s accuracy, wards are warned to consult the original SmPC or contact the Pharmacy.

What has been achieved?

Requests from wards for SmPC translations have significantly decreased. This is particularly impactful when dealing with medicines labelled in non-Latin scripts (e.g., Chinese, Greek, Japanese), which can delay interpretation and increase the risk of medication errors, especially in urgent situations where rapid access to information is critical. The initiative has proven cost-effective, scalable, and beneficial to both safety and workflow. It offers a replicable model for other hospitals dealing with imported drugs.

What next?

A shared cloud folder is being created, containing both original and translated SmPCs, organized by internal code and drug name. This will allow staff to quickly retrieve documents using a simple search. A satisfaction survey will soon assess the system’s effectiveness from the wards’ perspective.

Author(s)

Pinzon Garcia, Viviana Andrea
Fajardo Escolar, Angelica Paola

Why was it done?

Since implementing the Opioid Stewardship Programme in 2018, we have improved the management of morphine and hydromorphone in our hospital. This has not only reduced medication waste, but also created a hospital culture that recognises the importance of standard single-dose in ensuring medication safety. Based on this, we extended the programme to include other controlled medicines, after identifying the need to limit the use of vials and ampoules of fentanyl, remifentanil and ketamine considering the available commercial presentations and the probability of using these products on multiple patients without maintaining their sterility.

What was done?

We extended the coverage and monitoring of the unit-dose system to include other controlled medications apart from morphine and hydromorphone, through interdisciplinary collaboration between the Anaesthesia and Pharmacy Departments, with the aim of reducing waste and the risk of misuse at San Ignacio University Hospital, a high-level hospital in Bogotá, Colombia.

How was it done?

As part of the annual Pharmacy and Therapeutic Committee operative plan, the pharmacy and anaesthesia departments evaluated the risks in the medication order cycle of opioids and other controlled medications, defining strategies using an improvement cycle model. We assessed the feasibility of preparing unit doses of these medications, as well as the storage, preservation conditions and logistics of medication inventory. We deployed the strategy through staff training, mainly in operating rooms, intensive care and resuscitation, and established a follow-up of consumption and adherence, records of remnant disposal, cases of naloxone use and events reported to the pharmacovigilance programme.

What has been achieved?

The average proportion of standard single-dose prescriptions in 2025 was 74% for hydromorphone, 77% for morphine, 84% for fentanyl and 50% for remifentanil. Through our compounding center, we prepared 143,854 doses of these medications in 2024 and 78,421 from January to August 2025. The inventory write-off percentage due to expiration was 1.06% in 2024 and 0.38% in the first eight months of 2025. The percentage of hospitalised patients who received naloxone was 0.20 in the first semester of 2024 and 0.17 in the first semester of 2025.

What next?

Conducting interdisciplinary rounds in services to identify on-site adherence to implemented practices and supportting Human Talent, maintaining the improvement cycle process.

Author(s)

Elisabetta Volpi, Hospital Pharmacy, Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio;
Irene Benassi, Specialisation school in Hospital Pharmacy, University of Pisa;
Sara Tonazzini, Hospital Pharmacy, Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio;
Giuseppa Lo Surdo, Hospital Pharmacy, Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio;
Mario Cossu, Information systems and information technologies, Fondazione Toscana Gabriele Monasterio
Maurizio Mangione, Information systems and information technologies, Fondazione Toscana Gabriele Monasterio
Mattia Lorenzini, Nursing, Technical and Rehabilitation Service, Fondazione Toscana Gabriele Monasterio;
Stefania Baratta, Nursing, Technical and Rehabilitation Service, Fondazione Toscana Gabriele Monasterio;
Pierantonio Furfori, Anesthesia and Resuscitation Unit, Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio;
Paolo Del Sarto, Anesthesia and Resuscitation Unit, Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio;
Stefania Biagini, Hospital Pharmacy, Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio.

Why was it done?

Most preventable adverse events occur during medication use, especially with intravenous (IV) drugs requiring preparation before administration. Furthermore, for infusions, proper labelling is critical to reduce the risk of medication errors.

What was done?

Our hospital has used an electronic therapeutic record (eSTU) for over 10 years. In 2020, a multidisciplinary team of anesthesiologists, pharmacists, nurses and health IT specialists developed a dedicated module to ensure traceability of drug prescribing and administration in the operating room, focusing on cardiac surgery. At the same time, infusion syringe labelling evolved from handwritten to computerized labels, improving safety and traceability. This study aimed to assess impact of a standardized electronic prescribing and labelling system.

How was it done?

All standardized IV prescriptions issued during cardiac surgeries between 2021 and June 2025 were included in the analysis. Prescriptions were categorized by administration mode (bolus or infusion) to assess healthcare professionals’ adherence to the standardized prescribing system. A qualitative evaluation of labels applied to infusions was also performed.

What has been achieved?

The standardized prescription system was used in 5.272 procedures (4.542 adults; 730 pediatric), averaging 1.009 adult and 162 pediatric surgeries per year. A total of 93.291 prescriptions were recorded (81.861 in adults, 18 per procedure; 11.430 in pediatric cases, 16 per procedure), with a progressive increase from 18.211 prescriptions in 2021 to 20.955 in 2024 (+15.1%). These results confirm the system’s usability and effectiveness of staff training. Qualitative analysis of labelling practices initially showed syringe labels were handwritten and included limited information (e.g., drug name, concentration). With the computerized system, printed labels now contain detailed data: drug name, identifying code, dose, diluent, concentration, preparation date and time.
Our data demonstrate, for the first time, that the adoption of a standardized prescription system in cardiac surgery is an effective strategy, offering a fast, safe and user-friendly approach. Furthermore, computer-generated labelling ensures complete traceability and reduces the risk of medication errors.

What next?

Growing adoption of standardized prescription in both adult and pediatric cardiac surgery confirms its feasibility in high-complexity settings. Extending this system to other surgical areas (e.g., Gynecology, Hemodynamics, Electrophysiology) may further enhance medication safety across the hospital.

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Author(s)

Sebastian Philip, Andreas Lundgaard

Why was it done?

The screening aimed to ensure the rational use of antibiotics, contributing to the fight against antibiotic resistance and potentially shortening hospital stays by optimizing treatment.

What was done?

A systematic screening of antibiotic treatments for patients was conducted as part of the daily tasks performed by clinical pharmacists at The Medical Acute Care Unit, Bispebjerg Hospital.

How was it done?

For each patient receiving antibiotic treatment in the emergency department, the chosen therapy was systematically reviewed against regional antibiotic guidelines, considering factors such as allergies, resistance profiles, renal function, clinical indication and overall condition of the patient. Recommendations of adjustment of treatment were discussed with the attending physician for potential changes in therapy, including changes to dosage, frequency, route of administration, alternative antibiotic drug, or discontinuation of treatment. All interventions were documented, including the details of the therapy, the recommendation, and whether the attending physician approved the suggested changes.

What has been achieved?

A large dataset has been collected, detailing the number of patients receiving antibiotic treatment, the number of interventions conducted, the specific antibiotic treatment each patient received, the type of intervention performed and its indication, and whether the intervention was approved or rejected by the responsible physician.
The project has laid the groundwork for understanding the clinical pharmacist’s role in enhancing rational antibiotic pharmacotherapy.

What next?

It is planned to analyze the collected data to determine the types of changes in therapy most commonly recommended by clinical pharmacists and to which degree the interventions were approved or denied by the attending physician.
This will provide insights into the pharmaceutical contributions to more rational antibiotic use, highlighting commonly observed ‘areas for improvement’ that could potentially be addressed through education.

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Author(s)

ANDREA RODRÍGUEZ ESQUÍROZ, AMAYA ECHEVERRÍA GORRITI, Mª CONCEPCIÓN CELAYA LECEA, MARTA MARÍN MARÍN, LOREA SANZ ÁLVAREZ, PATRICIA GARCÍA GONZÁLEZ, JAVIER GORRICHO MENDIVIL, JAVIER GARJÓN PARRA.

Why was it done?

A prescription alert system was developed in our region for the management of drugs in patients with hepatic cirrhosis.

What was done?

A preliminary study made in our region showed that around one in four prescribed medications in cirrhotic patients are contraindicated or overdosed. Besides, it is estimated that around 38% of cirrhotic patients suffer any adverse effect despite approximately 70% of them are preventable.
In addition, safety problems can emerge due to the lack of data regarding drugs management in patients with cirrhosis.
For these reasons, it was essential to develop a tool that helped clinicians during the prescription process and pharmacists while pharmaceutical validation and medication review.

How was it done?

A computer-generated prescription alert system was developed. This system provides security data and dosing recommendations according to Child-Pugh classification of each patient. Besides, the tool suggests safer alternatives when an unsafe drug is prescribed. These recommendations were extracted from the product information and three databases: UpToDate, RxCirrhosis and Geneesmiddelen bij.
According to last laboratory data available from the electronic medical records such as bilirubin, prothrombin time and albumin, this tool estimates the Child-Pugh score, that must be completed with ascites and encephalopathy grade.
At this time, this tool is only available for clinical pharmacists for validation, and it is expected to be implemented for physicians soon.

What has been achieved?

From May to September 2024, a total of 202 drugs were included, 59 (29.2%) were considered contraindicated in some degree of cirrhosis, so it was recommended not to use. Dose adjustment was proposed in 109 (54.0%) drugs, while in 13.9% the tool recommended a safer alternative drug.
In order to complement this issue, information and training sessions were given about safe management of drugs in cirrhotic patients.

What next?

We are working in order to include safety data about more drugs in this alert system.
We hope this tool can help professionals of other regions and countries.

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Author(s)

A. ALENTADO MATEU 1 , L. ALVAREZ ARROYO 1 , R. MARTINEZ GOZALBEZ 2 , O. PEREZ OLASO 3 , R. LIMÓN RAMIREZ 4, B. MONTAÑÉS PAULS 1 .
1 HOSPITAL UNIVERSITARIO LA PLANA, FARMACIA, VILA-REAL, ESPAÑA.
2 HOSPITAL UNIVERSITARIO LA PLANA, INFORMÁTICA, VILA-REAL, ESPAÑA.
3 HOSPITAL UNIVERSITARIO LA PLANA, MICROBIOLOGIA, VILA-REAL, ESPAÑA.
4 HOSPITAL UNIVERSITARIO LA PLANA, MEDICINA PREVENTIVA, VILA-REAL, ESPAÑA.

Why was it done?

For years, Antimicrobial Stewardship Programs (ASP) teams have been working to improve the quality of antimicrobial prescription by optimizing treatments, controlling bacteremia and managing infections caused by resistant or difficult to treat microorganisms.
It is essential to have a software tool that allows real-time monitoring of both treatments and certain cultures.

What was done?

The ASP team, in collaboration with the information technology unit designed, developed and implemented a computer application at our center to support the ASP team. This application screens inpatients, searching for any of the predefined parameter alerts based on the type of antibiotic prescribed, the microorganism causing the infection, positive blood cultures or patients who are difficult to manage.

How was it done?

This alert system is based on the integration of the various hospital clinical information systems. Admitted patients are selected after a medical prescription of certain predefined antibiotics (carbapenems, daptomycin, linezolid, piperacillin/tazobactam, ceftazidime/avibactam, etc); these data are obtained from the electronic prescription programme (Athos-Prisma®). Microbiological criteria (Gestlab@ programme) include multi-resistant microorganisms (Escherichia coli, Methicillin-resistant Staphylococcus aureus), positive blood cultures, Pseudomonas, etc. Based on clinical criteria, patients who are difficult to manage can be manually included in the computer programme, mainly by the internal medicine and intensive care unit departments. The antimicrobial and microbiological criteria are dynamic and can be modified as needed.

What has been achieved?

From June 1 st 2023 to February 1 st 2024, 300 different patients have underwent interventions. In the patient’s electronic medical record from the ASP application, 355 ASP recommendations were made for 236 patients. ASP interventions included recommended isolation measures (242), modifying or suspending antibiotic treatment (68), maintaining adequate antibiotic treatment (22), initiating antibiotic treatment (11) and requesting complementary tests (12), such as imaging, cultures or serology.

What next?

This application is a fundamental communication tool for ASP teams allowings different recommendations for optimizing antimicrobial treatment to be made in the application. It automatically generates a note in the patient’s clinical history, making it accessible to all healthcare professionals and allowings for easy extrapolation to other hospitals, enabling its implementation in daily clinical practice.

Author(s)

Solís-Cuñado S. (1), Sánchez-Cerviño A.C. (2), Martínez-Núñez M.E. (1), Gómez-Bermejo M. (1), Martín-Zaragoza L. (1), Rubio-Ruiz L. (1), Onteniente-González A. (1), Molina-García T. (1)
1. Hospital Pharmacy Service, Getafe University Hospital, Getafe (Madrid), Spain.
2. Hospital Pharmacy Service, Puerta de Hierro University Hospital, Majadahonda (Madrid), Spain.

Why was it done?

The implementation of multidisciplinary antimicrobial stewardship teams(AST) in hospitals optimizes antibiotic use in order to improve clinical results, reduce antibiotic toxicity and minimize the emergence and spread of multidrug resistant(MDR) bacteria.
The objective is to present targeted interventions for the improvement of the management of lower respiratory tract infections(LRTI) and to reflect the impact of these strategies through the presentation of antibiotic use results.

What was done?

Two main interventions have been implemented in LRTI:
-Protocolize the management of community-acquired pneumonia(CAP) in order to prioritize beta-lactam plus macrolide(bLM) combination versus fluoroquinolones(FQ) monotherapy. The aim is to decrease FQ consumption due to their safety issues and the major role of this antibiotics in the emergence of MDR bacteria.
-Identify patients with severe LRTI and/or risk factors of multi-drug resistant(RFMDR) bacterial infections to encourage nasal swab screening(NSS) for meticillin-resistance Staphylococcus aureus(MRSA) to promote de-escalation of anti-MRSA antibiotics.

How was it done?

Study period: 2023 and first semester of 2024.
-CAP guideline: we studied the bLM vs FQ consumption expressed as the ratio between bLM DOT/FQ DOT (Days Of Therapy; DOT) in all hospitalized patients. Analysis was carried out on forth-month period.
-NSS: we reviewed the total number of NSS performed and the impact on duration of antiMRSA antibiotics therapy. Analysis by semesters.

What has been achieved?

After protocolization, the BLM´s DOT/FQ´s DOT ratio increased 39.4% from the beginning of 2023 until 2024: 0.66 vs 0.92.
Our AST reviewed 378 episodes of LRTI. At least one nasal screening was performed in 60.6% of episodes (n=229/378) of which 29.2% were positive (n=67/229). The mean duration of treatment with anti-MRSA antibiotics in the positive cases was 7.42 days, while in the 214 negative cases it was 6.4 days.
69% of the patients with LRTI that have been reviewed in our AST meets at least one RFMDR.

What next?

The frequent lack of diagnostic value of respiratory samples, coupled with the high percentage of RFMDR patients, results in long-lasting broad-spectrum empirical antibiotic treatments.
It is therefore proposed that a polymerase chain reaction(PCR) test be performed on candidate patients for the purpose of screening for MRSA, with a view to obtaining rapid results that will facilitate earlier antibiotic de-escalations.

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Author(s)

Mafalda Cavalheiro 1
Maria José Rei 1
Ana Rita Silva 1
Patrícia Batalha Silva 1
Carolina Marques 1
Miriam Capoulas 1
1- Pharmacy Department, Hospital da Luz Lisboa, Portugal

Why was it done?

Low serum Infliximab are associated with lost of response and development of immunogenicity. Moreover, therapeutic levels without the control of the inflammatory activity may inform about the necessity of changing the therapeutic class. While monitoring serum levels in the absence of response is already well established, the proactive monitoring of serum levels at defined timings during the induction and maintenance phases of therapy is beginning to be recommended by several leading organizations.

What was done?

Establishment of a protocol for proactive serum monitoring of Infliximab in inflammatory bowel disease, to guide the interpretation of serum levels, optimize dosage and therapeutic response.

How was it done?

Implementation took place in several stages. 1) Theoretical and practical training culminating in the discussion and drafting of a technical guideline including a monitoring protocol with the Gastroenterology team. 2) Organization of the sample collection and analysis circuit. The analytical technique is a rapid test that allows the detection of infliximab levels and anti-infliximab antibodies. 3) Finally, dosage optimization (maintenance of the reference dosage or intensification – shortening the administration interval or increasing the dose) is carried out with the support of population pharmacokinetic models using the DoseMeRx software, interpreted in the context of the overall response assessment in conjunction with the clinical team. The main limitation identified had to do with awareness of the medical team to rational dosage adjustments based on the population model.

What has been achieved?

15 patients were included with a median age of 33 years; 11 of these were diagnosed with Ulcerative Colitis and 4 with Crohn’s Disease. A total of 24 tests were carried out (21 with a proactive strategy and three with a reactive strategy). Of the doses taken at week 6, 60% were below the reference range considered. The dosage regimen was intensified in 64% of the recommendations. Of the patients analyzed, 76% maintained their response, although the duration of treatment was less than a year in most cases.

What next?

The strategy of proactive monitoring and dose intensification may have contributed to achieving and maintaining the response to treatment with Infliximab, but the small number of patients and the duration of the analysis call for further analysis.

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Author(s)

Maibritt Skov Olsen, Bernd Utech

Why was it done?

Pharmacy technicians at the Medical Ward of Bornholm Hospital adjusted medication orders to align with the hospital’s medication assortment. Operating under delegated prescribing authority; they prescribed, paused, and discontinued specific medications within a framework agreement and documented changes in the Electronic Medication Module “Sundhedsplatform” system.

What was done?

Patients often bring medications outside of the hospital’s assortment. Adjustment of these medications is time-consuming and can lead to documentation challenges. Delegating this responsibility to pharmacy technicians aimed to enhance patient safety by ensuring scan-ready medications and freeing up physicians’ time for other tasks.

How was it done?

A medication adjustment list was created by the pharmacy and department physician, outlining which drugs the technicians could adjust or discontinue. Pharmacy technicians were trained, and annual audits were conducted by the department physician. In a period of 13 days, a time study was made to track interventions; consultations with physicians, and time spent adjusting medications in the Sundhedsplatform.Nurses and physicians were asked about their experience of the pharmacy technician’s work.

What has been achieved?

During the test period, 97 patients were dispensed medication, and interventions was made for 39 (40%) of those patients. Technicians performed 60 interventions, of which 11 were physician-consulted. They spent 220 minutes on adjustments and notes, saving physicians 160 minutes. Feedback from nurses and physicians was positive, with improvements in medication scanning and reduced interruptions for physicians.

What next?

The task will be expanded to include all patients in the medical and surgical wards. An extension of the pharmacy technicians’ prescribing authority is also planned.

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Author(s)

Amparo Valls-Lattur
Supervisor: Agostina Secchi

Why was it done?

Background
Introducing a pharmacist prescriber (PP) in the Community mental health services for older people (CMHSOP) to support with follow-up appointments for memory patients as a new strategy as part of the community mental health transformation (1). The aim of this Service Evaluation was to evaluate the views of patients with dementia (and/or their carers) on a pharmacist prescribing led clinic.

What was done?

After diagnosis of Alzheimer’s Dementia some patients will be started on medication to treat the disease symptoms in an effort to reduce the rate at which their cognitive abilities will deteriorate. This medication will need titrating and monitoring for compliance and side effects (2).
This new service will allow consultants to focus on diagnosis of dementia while improving waiting times for community mental health services for older people (3).

How was it done?

Methodology
The data was collected from a memory clinic within a community mental health team for older adults. Data was collected from patients’ and/or their carers’ feedback in the form of a survey. The purpose of the survey was explained to the patients and/or their carers and those who took part placed the questionnaire anonymously in a box at reception. The survey responses were collected on a weekly basis from the box, allowing patients and/or their carers to complete the survey in their own time.

What has been achieved?

Results
During the period of the survey (February until May 2024), 27 questionnaires were received. The majority (21) were completed by carer/family member, and 6 were completed by the person being treated (patient). Patients and/or their carers had to answer 10 questions using a 5-point likert scale: from strongly agree, to strongly disagree.
The majority of participants strongly agreed that the service provided was of high standard. For example:
• the majority agreed that the prescribing pharmacist was polite and considerate
• patients and their carers felt listened to and allowed them to ask questions
• their questions were answered
• everything was explained in a lay language
• they were provided with enough information about their medication
• patients and their carers or families felt involved in their care and treatment
• the majority of patients had confidence in the prescribing pharmacist
• they were given information on who to contact if they had any problems.

What next?

Conclusions
This project showed a positive impact of a new service introduced in the CMHSOP. The pharmacist prescribing role in mental health is a new service and has shown that both patients and their carers have all expressed a positive view of this new clinic. Both patients and carers found the pharmacist caring, professional and attentive to address their concerns.
Future work will look at quantifying how this new service has reduced the waiting time for these patients to be seen or followed up.