Author(s)

Delphine BODEN, Laura RODRIGO, Rachel MAHE, Olivier SELLAL, Maxime PARE, François RONDEAU

Why was it done?

The main objective was to test the activation of our Pharmacy-Sterilization-Operational-Unit (PS-OU), established in December 2022, and to work on its interaction with the others OU of the different hospital services. The second aim was to continue the training of pharmaceutical teams on exceptional health situations (EHS).

What was done?

In March 2024, our hospital pharmacy (HP) took part in an inter-departmental exercise based on the scenario of managing a massive influx of polytrauma victims at our hospital. The quick engagement of mobile medical units and sterilization department, dependent on the HP, is indeed a key element in the optimal care of victims, whether in hospital or pre-hospital.

How was it done?

Two interns and one pharmacy technician, with an analysis framework, were in attendance as observers through the exercise. During the PS-OU activation, various points were observed: global crisis management, task assignment and communication between the members, data centralization and communication with the others OU, efficiency and speed of response to problems… A feedback questionnaire was then sent to the 9 main players (PS-OU members, on-call pharmacist…). Intra-HP and inter-departmental feedback were provided immediately, then a posteriori.

What has been achieved?

For 3 hours, our HP had activated its OU to provide the best possible response to this exercise. The observation of this exercise pointed out the rapid activation and efficiency of the PS-OU (by the on-call pharmacist, on the order of the head of department), so a great intern and extern communication. Areas for improvement were raised, such as the optimization of available tools. 89% of players answered the feedback questionnaire. The communication was considered operational and the PS-OU essential by all the respondents. They also feel that this type of exercise is needed (75%) and helps prepare them for EHS (88%).

What next?

Aims of this exercise were achieved. Preparing, hosting and then analyzing this kind of exercise, although seemingly time-consuming, enables us to validate and, where required, consolidate the intended organization for EHS. These results also strengthen our determination to pursue our annual exercise program. Shortly, an exercise with the supply members of our PS-OU will be organized, in order to train the less experienced members as well.

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Author(s)

MARTÍNEZ LLIBERATO, A; COMPANY ALBIR, MJ; VICENTE ESCRIG, E; VALLEJO GARCÍA, R; RUBIO ORTOLÁ, L; GARCÍA MONTAÑÉS, S; BELLÉS MEDALL, MD; FERRANDO PIQUERES, R

Why was it done?

It was carried out to ensure the best monitoring, traceability and conservation of long-acting antiretroviral drugs, as well as to improve adherence and patient quality of life and reduce stigma in HIV patients.

What was done?

A program was developed for the administration and pharmacotherapeutic monitoring of patients who are candidates for long-acting antiretroviral treatment (LA-ART), coordinated with the infectious diseases unit (IDU) and the Hospital Pharmacy Outpatient Unit (HPOU).

How was it done?

After the inclusion of the drugs in the pharmacotherapeutic guide, the following program was designed:
1. Identification and communication to the HPOU by the IDU of patients who are candidates for LA-ART and electronic prescription.
2. Initial visit (week 0):
• Review and validation of the treatment by the pharmacist: indication, dosage regimen, interactions, contraindications.
• Planning of the annual administration calendar, providing two dates within the window period allowed by these drugs. Patients are scheduled for pharmaceutical care (PC) and administration on working Thursdays, in the HPOU Health Education Consultation agenda, which has a nurse.
• Information to the patient by the pharmacist, orally and in writing, about administration and adverse reactions. In addition, the annual appointment schedule is provided.
• Appointment of the patient for the first successive visit, if the patient accepts the start.
3. SMS sent the day before, to remind the patient of the follow-up visit. If the patient cannot attend the scheduled appointment, he/she will contact the HPOU to schedule an alternative date according to the calendar.
4. Successive visits (week 4 and every 8 weeks):
• PC
• Intramuscular administration by a nurse.
In all visits, the information is recorded in the patient’s computerized medical history.

What has been achieved?

Of 18 candidate patients in 18 months, 15 accepted ART after the initial visit. 89 PC and administration consultations have been carried out. Adherence was 100%, all reported local discomfort at the injection site between 1 and 7 days after administration and only 1 patient reported pyrexia.

What next?

A program applicable to all HPOU that have nursing and a Health Education consultation to implement adherence in these patients.

Author(s)

Cristina González Pérez, María de la Paz Pacheco Ramos, María de la Torre Ortiz, Virginia Puebla García, Jesús Airam Domínguez Cháfer, Alba de Diego Peña, Nuria Fernández Piñeiro, José Julio Gómez Castillo, María Fernández-Vázquez Crespo, María Teresa Benítez Giménez

Why was it done?

The official hospital pharmacy training program, established in 1999, includes outdated and incomplete content on research. This update aims to ensure essential R&I knowledge, create a reference framework for evaluating research competencies, and promote impactful R&I projects.

What was done?

Design a specific research and innovation (R&I) training program for Internal Resident Pharmacists (IRP) as a cross-disciplinary area that integrates theoretical knowledge and practical skills.

How was it done?

In March 2024, a team of tutors, the R&I head, residents, the Pharmacy Department head, in collaboration with a project manager and the Innovation Unit, reviewed the official program, training plan, and competency evaluations. They selected the most relevant and accessible skills for residency.

What has been achieved?

Competencies (evaluation system)
1. Basic competence: Research Methodology
1a. Knowledge (exam):
1ai. Bibliographic search. Reference managers
1aii. Epidemiology. Evidence-based medicine
1aiii. Clinical research. Good clinical practice
1aiv. Real-life evidence
1av. Introduction to statistics
1b. Skills (direct observation + practical cases):
1bi. Bibliographic management
1bii. Critical reading
1biii. Statistics interpretation
1c. Attitudes (direct observation):
1ci. Proactive research attitude, critical thinking
2. Advanced competence: Project management
2a. Knowledge (exam):
2ai. Innovation project conceptualization
2aii. Research protocol writing
2aiii. Schedule and budget management
2aiv. Patient information sheet and informed consent writing
2av. Research Ethics Committee documentation
2avi. Public/private competitive calls search
2b. Skills (portfolio):
2bi. R&I project management
2c. Attitudes (direct observation):
2ci. Leading innovative projects in multidisciplinary teams
3. Advanced competence: Data processing and dissemination
3a. Knowledge (exam):
3ai. Data protection. Case Report Form (CRF)
3aii. Scientific writing
3aiii. Scientific communication publication
3b. Skills (portfolio, direct observation):
3bi. CRF design and implementation using REDCap®
3bii. Data management with business Intelligence and statistics software
3biii. Publications, conference communications, research grants, or doctoral thesis
3c. Attitudes (Direct observation):
3ci. Responsibility in data protection
3cii. New technology implementation

What next?

Reorganize content for phased implementation over the four-year residency period, ensuring that the curriculum evolves to incorporate emerging trends in pharmacy practice and R&I methodologies.

Author(s)

Steffy LEFAKOUONG, Mohamed MOSTEFA, Sarah BARBIEUX, Sophie VERNARDET, Isabelle LEFORT

Why was it done?

Institutional and multidisciplinary work has been carried out in the hospital since 2022 on reducing prescriptions of potentially inappropriate medications (PMIs) in older population (OP), in accordance with french recommandations.

What was done?

Our aim is to raise awareness among medical staff on the prescription of PMIs in OP through continuing education (CE) courses.

How was it done?

A PMI-specialized team composed of 2 geriatricians, 1 pharmacist and 1 pharmacy intern was formed.
CE is planned in the form of a structured medication review describing clinical cases based on discharge prescriptions of hospitalized patients, selected according to several criterias: >75 years old, ≥1 PMI on the prescription.
These prescriptions are analyzed by the specialized team using various reference documents, with a relevance audit grid provided by the regional drug authority as a basis.
The first MR was presented to the doctors and residents of the establishment’s various departments during a joint session.
A satisfaction survey was created to assess the interest and relevance of the course.

What has been achieved?

For our first session, we selected 3 prescriptions : two containing 4 PMIs each and one containing 2 PMIs.
A detail of each PMI was carried out with a focus on two main themes : deprescribing long-acting benzodiazepines and proton pump inhibitors.
Besides PMIs, a comprehensive prescription analysis was done by mentioning inadequate prescriptions from a geriatric medical view.
In total, we have a participation of 100% of the pharmacists, 89% of the geriatricians and 100% of pharmacy residents. Among the other departments, only 3 other physicians participated in the course.
According to the survey, 100% of participants said they were satisfied with the session and 44% wanted more interactive training.

What next?

The high participation of pharmacists and geriatricians, 2 teams of interest in the process of deprescribing MPIs, highlights the usefulness of this CE among healthcare professionals.
The structure of the session encourages constructive and collaborative exchanges while comparing visions of different professionals.
Nonetheless, a reflection on our approach’s appeal is necessary in order to increase the participation rate of physicians and medical residents absent during the session.
The satisfaction rate remains encouraging, and pushes us to renew this training periodically.

Author(s)

M. SIEGWART, A. BENDJAMA, D. KAROUBY, T. MARTIN, L. CITTADINI, MG. MARTINS, P. COLIAT

Why was it done?

Two automated preparation robots were implemented at ICANS in a context of increased activity in oncology, the need to maintain quality assurance in the preparation process and to reduce pharmacy technician’s exposure to cytotoxic agents. Preliminary professional training is crucial to understand this new technology, master the equipment and interfaces, and adapt to the new circuit and procedures.

What was done?

This work was the development of an educational virtual tour of an automated production unit, enriched by feedback, accessible to any professional interested in implementing an automated preparation robot.

How was it done?

The project was developed in collaboration with the Grand Est regional oncology network (NEON). Scripts were written based on a plan, detailing texts and scenarios to create short videos, each addressing a different theme with a voice-over narration. A professional team from NEON shot the film and edited according to the scripts. Location scouting and filming were completed over 3 days, with voice-over recording and editing done afterward.

What has been achieved?

Six scripts were produced. The first introduces the centre, while 4 others detail the management of an automated unit, including the organization and operation of storage areas, decontamination SAS, personal SAS, and the cleanroom (functional parameters, particulate class, airflow schema, dressing and hygiene rules, microbiological controls, cleaning, and the composition of the “breakage kit”). The robots are covered in a dedicated script that discusses the context of automation, their operation, the software used, possible interfaces, preparation procedures, and cleaning. The final script reviews the entire circuit, linking each area and stage of production: pharmaceutical validation, automated production management, material and vial preparation, manufacturing, and pharmaceutical release.

What next?

The virtual tour presents the circuit and the role of each involved personnel, highlighting precautions and subtleties compared to a non-automated circuit according to the most recent french guidelines. Although the practices shown may not be applicable to all centres due to differences in production area layouts, structures, staffing, and equipment, these videos aim to clarify the functioning of an automated unit while adhering to the guidelines. This online training can promote the standardization of practices, helping professionals from other centres install production automation systems. It encourages innovation and supports pharmacists during this critical transition.

Author(s)

Mia Pavelics Rehn
Trine Rune Høgh Andersen

Why was it done?

Clinical Pharmacists (CPs) in the Region Zealand Hospital Pharmacy (30 CPs) are scattered over great geographical distances on multiple hospital wards. When working with Clinical Pharmacist Services (CPS), usually just one CP is present per ward. All 30 CPs have different knowledge, seniority and specialization. To enhance the professionalism of the individual pharmacist on duty, digital communication such as chat functions are implemented for quick and easy intra-pharmacist consults.

What was done?

The ward physicians and nurses experience the combined specialty knowledge of 30 CPs from each CP when engaging CPS. This is highly relevant to maintain the position of having CPS through the hospital pharmacy instead of employing one individual CP directly on the ward, which has become more common over recent years.

How was it done?

To illuminate how the CPs from the hospital pharmacy share knowledge by using each other in their clinical operation, data was collected during three weeks of daily work. The CPs at 10 department wards registered each time they consulted a CP colleague. Furthermore, they recorded what type of communication they used (Microsoft Teams®, telephone or face-to-face) and what the inquiry was about. Written communication in Teams chat was saved for qualitative analysis.

What has been achieved?

The collected data illustrate the utilization of collective knowledge. In the three weeks 34 consults were made using primarily Microsoft teams. In 9 cases the contact was face-to-face and in 6 cases by phone. Most common was pharmacological discussion about specific cases during medication reviews (23), followed by questions about technical issues in the electronic patient record (11), general professional discussions (7) and consults about medication shortages and alternatives (8).

What next?

This initiative illustrates how using easy and available digital communication such as Teams chat functions across geographical distances will increase professionalism and harness the collective knowledge of many CPs working in collaboration for the benefit of improved CPS.

Author(s)

V. LE BIGOT, A. BROS, F. NATIVEL, T. ADNET, D. CABELGUENNE, F. LINDENBERG, S. GENAY, P. BESNIER, S. RODIER

Why was it done?

Creation of a training tool for infusion set-ups in a digital 360° virtual reality, utilizing a fun format based on learning from errors. It is specifically designed for novice professionals, with a focus on pharmaceuticals teams.

What was done?

Errors in infusion set-ups are common and can have serious consequences on patient care. Adhering to best practices in infusion is essential to mitigate these risks. Therefore, comprehensive training for both healthcare staff on proper techniques and procedures, is crucial to ensure safe and effective infusion management. Choosing a digital navigating environment allows a remote or a mobile use and enhances interactivity between the trainer and learners when used for in-person training.

How was it done?

A multicenter working-group of 9 pharmacists with expertise in infusion and healthcare simulation was formed, divided into three subgroups: two for content creation and one for reviewing. Firstly, the priority issues were selected, drawn on the guidelines issued by learned societies. An illustrated presentation of the most frequently encountered infusion errors was developed using an online Learning Management System platform, integrating the teaching content into a 360° virtual reality environment.

What has been achieved?

A virtual patient pathway was designed in 3 different environments: an operating room, a post-operative recovery room and a ward. Within the virtual spheres, 12 “points of interest” (POIs) were defined as a clickable elements, focusing on predefined key themes. Each POI was illustrated with photos or videos and included errors that required learners to answer up to three multiple choice questions (MCQs). In total, there were 25 MCQs. Additionally, each POI featured an explanatory debriefing slide that was presented afterwards.

What next?

This training tool will be tested under real-life conditions at a national pharmacy congress. It will be approved by a panel of experts/learned societies, then evaluated by trainers/learners, so that it can find its place in the training programs of all healthcare professionals involved with infusion set-up.

Author(s)

Elisa Vitale, Quentin Perrier, Arnaud Tanty, Claire Chapuis, Armance Grevy, Agathe Landoas, Dorothée Lombardo, Prudence Gibert, Lénaik Doyen, Benoit Allenet, Pierrick Bedouch, Sébastien Chanoine

Why was it done?

In France, during their 5th year of study, pharmacy students complete a six-month full-time equivalent internship in a hospital setting. At our hospital, most students spend six months in a care unit to perform pharmaceutical care and promote quality use of medicines. These missions are carried out in collaboration with all healthcare professionals, either under the direct supervision of a pharmacy resident, senior pharmacist, or independently. While tasks assigned to pharmacy students in the care unit with direct pharmaceutical supervision were well known, other students reported difficulties in understanding what was expected of them, as well as a lack of confidence when integrating an established interprofessional team.

What was done?

The aim was to create and evaluate a specific training session for all pharmacy students joining a care unit for the first time.

How was it done?

Four hospital pharmacists collaborated to define the learning objectives and select the appropriate teaching tools. A pre- and post-training self-assessment questionnaire consisting of seven questions was created to evaluate students’ self-efficacy regarding the learning objectives and their satisfaction with the training.

What has been achieved?

A four-hour training session, divided into five sequences, was created. The objectives were: 1) Highlighting the challenges of joining an interprofessional team, 2) identifying the tasks and learning opportunities for pharmacy students, 3) simulating a medication reconciliation, 4) managing pharmaceutical issues through problem-solving exercises.
Regarding the evaluation, students reported that they: a) were more enthusiastic about the idea of working in a care unit after the training course (85% vs. 74%, p=0.001); b) had a clear understanding of their mission (84% vs. 53%, p<0.001); c) felt more confident in performing a medication reconciliation (93% vs. 35%, p<0.001); d) were more aware of the pharmaceutical resources available to them (95% vs. 27%, p<0.001); e) had a better understanding of how hospital pharmacy is organized (58% vs. 19%, p<0.001). Additionally, 99% found the training useful, and 94% felt that the training methods aligned with the training objectives.

What next?

Assess the long-term impact of the training and its effectiveness in ensuring that pharmacy students perform pharmaceutical care successfully and confidently

Author(s)

Margot DESCHAMPS, Nejib BORGAAOUI, Jimmy ROSE, Jennifer LE GRAND, Louise NICOLAS

Why was it done?

Digestive cancers represent about 25% of new cancer cases diagnosed in France each year. The medical management of these cancers mainly relies on cytotoxic drugs. Side effects of these medications (fatigue, hair loss, nausea, or digestive issues) can affect negatively patients quality of life. These symptoms can make daily life challenging.

What was done?

As part of a patient therapeutic education program, the goal of our project was to develop an innovative educational tool to help patients better understand these side effects and find ways to manage them.

How was it done?

As part of the implementation of a multidisciplinary therapeutic education program, bringing together oncologists, pharmacists, sophrologists, osteopaths, and nutritionists, designed for patients treated for digestive cancers, the pharmacy is responsible for a workshop focused on the side effects of chemotherapy. The main molecules used to treat digestive cancers were listed, along with their most common side effects. Based on this analysis, playing cards were created, each corresponding to a specific side effect.

What has been achieved?

The developed tool is an educational and interactive board game, consisting of a board, a dice, and 56 cards. These cards are divided into 6 categories: general symptoms, neurology-psychology, heart-lungs, gastroenterology, dermatology, and real-life scenarios. The cards were designed to be understandable and accessible to all patients. The workshop takes place in two parts, with the pharmacist as the main facilitator. In the first part, patients are encouraged to share their personal experiences related to the drawn card. Then, the scenario cards are presented to help patients manage these challenges in their daily lives.

What next?

The decision was made to limit the number of participants to 6, in order to allow everyone to express themselves and exchange freely. The duration of the workshop was theoretically set at 1.5 hours but will need to be adjusted during the first workshops. It will be necessary to implement satisfaction surveys and patient follow-up on various criteria, such as emergency room visits, the number of calls after the session, and the rating of side effects.

Author(s)

Rita Sofia Conde Lopes, Rita Manuel Neves Lopes, Ana Paula Barbeita, Teresa Cunha, Patrocínia Rocha

Why was it done?

Improving the training of PRs and supporting the neonatal medical team by addressing their needs.

What was done?

The Pharmaceutical Residency (PR) lasts four years, during which the Resident Pharmacist (RP) must acquire skills in various areas. In the PR, one of the longest functional areas is pharmacotechnics, which includes the handling of sterile and non-sterile medicines. At the Unidade Local de Saúde de Santo António (ULSSA), which includes the Centro Materno Infantil do Norte (CMIN), this type of preparation is crucial due to the type of population it serves — pediatrics. With this in mind, the RP had the opportunity to complete a one-month internship in the neonatology unit (NU), where, in addition to familiarizing with the unit’s routine, they assisted with various needs of the service.

How was it done?

PRs attended morning routine specialist doctors during the morning routine, participating in both the night-morning and morning-afternoon shift handovers and follow-ups. The schedule was coordinated between the Pharmaceutical Services (PS) and the NU to ensure this was the most productive time for both parties. During shift changes, any issues from the previous period were discussed. When these topics involved the FS, the PR provided assistance.

What has been achieved?

During their presence NU, PR were able to intervene in several key areas, including expediting Pharmacy and Therapeutics Committee authorizations (e.g., everolimus for a neonate with rhabdomyoma), managing the logistics for obtaining non-commercialized medication in Portugal (e.g., erythromycin oral suspension for prokinetic use), supporting clinical decisions regarding the prescription of parenteral nutrition bags, updating the medical prescription system for dressing materials (e.g., maltodextrin powder dressings) and creating a spreadsheet for prescribing protein supplements.

What next?

This collaboration has fostered a stronger connection between pharmaceutical and clinical services and underscores the vital role of multidisciplinary teams in healthcare, where experts from different fields contribute with their specialized knowledge. Such collaboration not only enhances patient outcomes but also optimizes workflows by reducing service duplication, increasing productivity, and saving valuable time. In the future it is expected continue this collaboration.