EVIDENCE-BASED STANDARDISATION OF RECOMMENDATIONS AND PATIENT INFORMATION FOR HANDLING EXCRETA AFTER CHEMOTHERAPY
European Statement
Patient Safety and Quality Assurance
Author(s)
S. ADEVA ANTONA, E. ZHAN ZHOU, J.J. MARTINEZ SIMON, S. RISCO MARTÍNEZ, O. GUERRA GOMEZ, S. LOPEZ LOPEZ.
Why was it done?
A multidisciplinary initiative between Hospital Pharmacy and Onco-haematology nursing team was carried out to review and standardise recommendations provided to patients and caregivers regarding precautions with urine and faeces wastes after oral/intravenous chemotherapy.
A pharmacokinetic-based model was developed to determine the length of time during which such precautions should be maintained and all patient information leaflets were subsequently updated. Additionally, a general recommendations leaflet was created to be delivered to the patient at treatment initiation.
What was done?
Antineoplastic drug residues have been detected inside patients’ homes, especially on toilet and bathroom surfaces¹. Due to the scarce literature available, the information provided to patients on excreta handling precautions after chemotherapy varied considerably, leading to unsafe handling of excreta, with the risk of exposure to cohabitants and caregivers.
The project aimed to review the literature, establish evidence-based precaution periods grounded in pharmacokinetic principles, and standardise patient information across the hospital to improve safety and ensure consistency.
How was it done?
A structured literature review was performed to collect data on drug half-lives, renal and biliary excretion rates, metabolite activity, and their excretion and half-lives. Based on these data, a model was designed to estimate the period during which excreta might contain significant cytotoxic substances, defined as 4 to 5 half-lives(90% excreted). A 48-hour precaution period was set as standard, extended up to 7 days for drugs with longer half-lives or active metabolites, as no evidence supported longer periods.
140 drugs were reviewed, including 73 oral agents. Recommendations were established for the management of urine in 29 drugs and for faeces in 36.
What has been achieved?
Patient information leaflets were updated to include a section on excreta handling precautions, specifying the duration and safety measures. A general leaflet was also introduced at treatment initiation. This standardisation improved the consistency of information provided by healthcare professionals and enhanced safety for patient and caregiver.
What next?
This initiative provides a pragmatic, evidence-based framework adaptable to other hospitals to harmonise recommendations and improve safety. Future steps include formal auditing of adherence and exploring publication to support broader implementation. The methodology could be extended to other hazardous drugs and newly introduced anticancer agents into clinical use.
EMBEDDING INHALER RECYCLING INTO THE NHS
European Statement
Education and Research
Why was it done?
Inhalers are the largest single contributor among medicines to the NHS carbon footprint, accounting for 3% of total NHS emissions. In 2020, the NHS became the first health system globally to commit to Net Zero, later formalised through the Health and Care Act 2022 and the Delivering a Net Zero National Health Service report, which provides statutory guidance to ICBs. This project responds to that call-to-action and aligns with South East London’s Green Plan, which pledges to reduce emissions within its footprint. It also serves as a proof-of-concept to inform NHS England’s assessment of the viability of nationwide, routine inhaler recycling.
What was done?
Developed as an innovative sustainable project in response to NHS Net Zero ambitions and SEL Integrated Care System’s (SEL ICS) Green Plan, SEL ICS launched the first fully NHS-funded, ICS-wide inhaler recycling pilot in England. The scheme is fully integrated across primary and secondary care and enables the public to recycle used inhalers at any participating site. The inhalers are then transported to a recycling facility (Grundon Waste Management) for up to 99.9% recovery of propellants, plastics, and aluminium. This pilot serves as a proof-of-concept to assess the feasibility of business-as-usual inhaler recycling in the NHS.
How was it done?
An inhaler recycling pilot is being delivered across 20 community pharmacies and five acute/mental health trusts in SEL. A project working group (PWG) and formal memorandum of understanding was established between South East London Integrated Care Board, NHSE, King’s College Hospital (KCH), SEL Pharmacy Alliance, Guy’s and St Thomas’ (Essentia), and other stakeholders to ensure structured, cross-sector collaboration. The project leveraged existing NHS clinical waste infrastructure to recycle pressurised metered dose inhalers (pMDIs), ensuring operational efficiency with minimal disruption. The PWG collaborated with behavioural science colleagues and patient engagement groups to develop public-facing communications that encouraged appropriate inhaler disposal. All activities were embedded into routine workflows without additional staffing. Monthly data submissions from participating sites enabled continuous monitoring and will inform a fully commissioned evaluation.
What has been achieved?
Over 16,000 inhalers have been collected so far, with more than 11,000 returned through community pharmacies. The current recoupment rate at community pharmacies is approximately 15%, i.e., the number of pMDIs reported returned is around 15% of the high-carbon pMDIs dispensed by that pharmacy in the same month. This figure will undergo further scrutiny in the final evaluation, after corroboration by Grundon data following the project’s last recycling cycle. The project has also seen strong patient and public involvement. A live public-facing survey on the SEL website has received more than 100 responses to date. Themes identified include low awareness of proper disposal routes, strong interest in inhaler recycling, and improved understanding and willingness to return inhalers after campaign exposure. These results demonstrate meaningful public input and are informing ongoing communication strategies. In terms of reach and influence, the pilot has attracted national and international interest with over 25 NHS providers across the country having contacted the SEL team for support with replication, and a Canadian research group has requested to learn best practice from the model. The project demonstrated high operational feasibility, environmental impact potential, and strong appetite for scale-up. Complete evaluation is ongoing.
What next?
This innovative project shows inhaler recycling can be embedded in existing NHS systems. It presents a replicable and scalable national model, supporting medicines optimisation, waste reduction, and sustainability; it stands apart by being completely publicly owned, leveraging existing NHS contracts and infrastructure, without the need to rely on external sponsorships. This pilot offers a practical blueprint for embedding environmental sustainability into medicines optimisation across the NHS and the outcomes will inform future commissioning and advance the NHS’s Net Zero goals.
An evaluation of the pilot is currently being developed with the last inhaler collection at all sites due January 2026; the evaluation is due to be published in the Spring of 2026.
MEDICATION ERROR IN A CLINICAL TRIAL: ROOT CAUSE ANALYSIS AND IMPROVEMENT ACTIONS
European Statement
Patient Safety and Quality Assurance
Author(s)
Cristina Garcia Fernandez, Estela Alamino Arrebola, Bárbara Lopez Bautís, Carmen Gallego Fernandez, Begoña Tortajada Goitia.
Why was it done?
Patient safety in clinical trials relies on the correct management of both investigational and auxiliary/comparator medications. While investigational products are usually managed through automated systems (e.g., IWRS) ensuring traceability and standardization, auxiliary medications often lack similar oversight from sponsors. A preventable medication error in an oncology clinical trial—caused by the preparation of an incorrect drug concentration due to the absence of automated supply and harmonization—highlighted the need to analyze system gaps and implement corrective actions to strengthen patient safety and medication traceability.
What was done?
A Root Cause Analysis (RCA) was conducted following the detection of a medication error involving the preparation of hospital stock (20 mg/mL) instead of the clinical trial formulation (10 mg/mL). The objective was to identify systemic weaknesses and design a Corrective and Preventive Action (CAPA) plan aimed at preventing recurrence and improving management of auxiliary medication in clinical trials.
How was it done?
The RCA was performed in July 2025 using the “5 Whys” methodology, supported by:
-Document review, staff interviews, and chronological reconstruction of the event.
-Analysis of human, technical, communicative, and organizational factors.
-Classification of the incident (NCC MERP category D — no patient harm).
Corrective measures implemented included:
– Creation of a pre-trial pharmacy checklist to ensure drug availability and concentration verification.
– Mandatory pharmaceutical validation after any protocol amendment.
– Formal requests to sponsors to standardize drug concentrations across sites.
– Improved communication channels between sponsors, pharmacy, and clinical teams
What has been achieved?
-Identification of the main root cause: lack of automation in auxiliary drug supply requiring manual requests.
-Prevention of similar future events through harmonized pharmacy processes.
-Reinforcement of patient safety culture and traceability of clinical trial medications.
-Strengthened collaboration among hospital pharmacy, clinical teams, and sponsors.
-No patient harm resulted from the event, confirming the importance of early detection and system review.
What next?
-Extend IWRS automation and standardization practices to include auxiliary medications in all clinical trials.
-Share the initiative with other hospital pharmacies and sponsors to promote harmonization at institutional and multicenter levels.
-Continue monitoring the implemented CAPA and evaluate its impact on error prevention.
-Foster continuous improvement in pharmacy oversight and communication workflows for clinical research.
PHARMACY TECHNICIANS SATISFACTION SURVEY ABOUT PROCEDURE IMPROVEMENT PROCESS IN SAFE DISPENSING MEDICATION
European Statement
Patient Safety and Quality Assurance
Author(s)
L. DE AGUSTIN SIERRA, P. FLOX BENITEZ, B. MONTERO PASTOR, A. SUCH DIAZ, P. TEJEDOR PRADO, E.A. ALVARO ALONSO, E. IZQUIERDO GARCIA, N. FONT TARRES, M. SANCHEZ LORENZO, I. ESCOBAR RODRIGUEZ.
Why was it done?
Medication dispensing errors were detected more frequently in our Pharmacy Department. This errors were related with procedures among pharmacy technicians (PT).
Formation programs bettween PT are implemented in our Pharmacy Department in other critical areas such as compounding or cytotoxic drugs but not dispensing.
It its known that a lack of knowledge of established work procedures among pharmacy technicians (PT) can contribute to a potential increase in medication dispensing errors. On the other hand, medication dispensing errors are preventable incidents in the process of distributing and administering drugs that can cause avoidable harm to patients.
What was done?
Implementation of a procedure manual to define operative procedures carried out by PT that need improvement in the safe dispensing medications and establish appropriate measures for safer and efficient work.
How was it done?
Observational, prospective, descriptive study conducted by pre and post survey (1-5) during July and september 2025 among PT. The total number of surveys was 28 (15 pre and 13 post).
A structured questionnaire was developed with closed question (pre and post) about: (1) medication distribution and dispensing, (2) knowledge of stablished operative procedures, (3) clinical pharmacy services and medicine information, (4) personal abillities and skilss and (5) necesity for training and information.
Surveys included 11 questions using Google Forms Likert scale of 1-5, being 5 maximum score.
Post-survey was conducted after three-months period training for PT.
What has been achieved?
In pre-survey, medication distribution and dispensing received the lowest score (3 on five-point scale). The rest of responses showed a satisfaction degree (4) also for necesity for training and information.
After manual implementation, post-survey questionnaire shows that manual enhanced work procedures and medication distribution, dispensing (3 pre Vs 4 post), self-confidence and autonomy in established procedures. (4 on five-point scale). Moreover, overall satisfaction about was satisfied (4).
What next?
The implementation of a procedure manual has enhanced generally satisfied between PT. Although our survey shown this enhances, we are conscious about importance and necessity of reglated formation in Pharmacy Department in order to safe dispensing medications and safer and efficient work. For that reason, reglated formation has been scheduled among PT.
MEDICAL DEVICE HUNT: A PLAYFUL LEARNING APPROACH IN A HOSPITAL PHARMACY DEPARTMENT
European Statement
Education and Research
Author(s)
S. EL BOURY, B. CHAVENT, C. DUSSART, L. DERAIN
Why was it done?
Recognising medical devices is a key skill for hospital pharmacy professionals to ensure correct management and optimal patient safety. However, traditional training sessions were often theoretical and failed to stimulate engagement or long-term retention. This initiative was therefore developed to promote active learning, improve device recognition, and strengthen team collaboration in a fun and motivating way.
What was done?
A playful educational activity called “Medical device hunt” was created within the hospital pharmacy department. Inspired by an Easter egg hunt, this initiative encouraged staff to explore, identify, and learn about medical devices through an interactive and engaging game.
How was it done?
Over three days, sixteen medical devices (e.g. vascular stent, guedel airway, cardiac pacemaker) were hidden within a defined area of the pharmacy, each carrying a letter to form a mystery word. Participation was open to all pharmacy staff, including technicians, pharmacists, residents, students, and logistics agents, either individually or in teams. The top hunters were rewarded. A debriefing session, open to both participants and non-participants, presented informative cards on each device’s function and clinical use were, followed by a satisfaction questionnaire.
What has been achieved?
A total of 13 staff members participated, mainly pharmacy technicians (76.9%), with a success rate of 69.2%. All participants discovered at least one device and reported learning new information about its use. Satisfaction was high, with 92,3% declaring themselves “very satisfied.” Engagement extended beyond the game itself, as seven non-participants joined the debriefing session; among them, 85.7% were “very satisfied” and 71.4% reported having learned through the informative cards. The initiative strengthened awareness and knowledge of medical devices while fostering teamwork, communication and curiosity across the department.
What next?
The Medical Device Hunt demonstrated the benefits of gamified learning in a hospital pharmacy setting. Future editions will feature improved communication and longer participation time. The concept could also be adapted to other educational topics such as medication errors or risk management, further supporting a culture of continuous learning and safety within the department.
EXCEPTIONAL HEALTH SITUATIONS: OBSERVATION OF AN IMMERSIVE EXERCISE IN THE HOSPITAL PHARMACY AND FEEDBACK
Pdf
European Statement
Patient Safety and Quality Assurance
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.
DESIGN AND IMPLEMENTATION OF A PROGRAM FOR THE ADMINISTRATION AND FOLLOW-UP OF PHARMACOTHERAPEUTIC DRUGS IN PATIENTS WITH LONG-ACTING ANTI-HIV DRUGS
Pdf
European Statement
Clinical Pharmacy Services
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.
RESEARCH AND INNOVATION TRAINING ITINERARY FOR RESIDENT INTERNAL PHARMACISTS
Pdf
European Statement
Education and Research
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.
DEPRESCRIBING IN OLDER ADULTS: LET’S TALK!
Pdf
European Statement
Clinical Pharmacy Services
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.
VIDEO CONTENT: FEEDBACK ON THE IMPLEMENTATION AND THE MANAGEMENT OF AN AUTOMATED CYTOTOXIC PRODUCTION UNIT
Pdf
European Statement
Production and Compounding
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.