Author(s)

J. MORISOT(1), C. CHASTANG-CHUNG(1), C. GELLIS(1), R. LARNAUDIE(1)
(1) Pharmacie à Usage Intérieur, Centre Hospitalier Dubois, 1 boulevard du Dr Verlhac, 19100 Brive-la-Gaillarde, France.

Why was it done?

Serious Advert Events (SAE) related to medication account for 32,9 % of SAEs associated with healthcare in France, 51,2 % of which are considered preventable. Nurses are the last line of defence before treatments are administered to patients. Therefore, Educational Training Programmes (ETPs) for healthcare workers are vital to improve patient safety and global quality of care.

What was done?

The main objective was to create and implement training workshops for nurses led by a hospital pharmacist. The secondary objectives were to measure short-term impact on knowledge and global satisfaction.

How was it done?

The creation of the PTDs took place in three stages. First, we conducted a survey of nurses to select 3 subjects which would become the main themes for our ETP. Then we imagined and constructed the workshops (one for each theme), in the form of pedagogical games. Finally, we organised and led the training sessions. We also created pre- and post-training questionnaires to measure short-term knowledge evolution and global satisfaction.

What has been achieved?

Three workshops have been built up according to the survey’s results: one on high-risk medicines (HRM), one on blood-derived medicines (BDM) and one on medical gases (MG). We developed the HRM workshop based on the ‘PUIzzle’ tool, an educational question-answer game designed by l’Hôpital d’Instruction des Armées de Bégin. The BDM workshop was a crossword puzzle with ‘clue cards’ to guess each word of interest. The MG workshop was an interactive presentation with WOOCLAP quizzes and demonstrations. Those last two ones were homemade. In the end, twenty identical PTDs were held in 2024, training 200 nurses from all wards (out of 600). All sessions were led by the same pharmacist. Short-term knowledge significantly improved (gaining an average 2,9 points out of 20 from pre- to post-training) and global satisfaction was high.

What next?

Following this success, the PDTs returned in 2025, training 115 additional nurses. We wish to renew the PTDs in 2026 by adding new themes. To do so while optimising time and resources, we are currently discussing with other neighbouring hospitals to share ETPs. And why not creating a local ‘mobile ETP team’ that could train nurses all across the area?

Author(s)

Richard Sykes – Pharmacist Executive Manager, Portiuncula University Hospital/ Hospital Pharmacists Association Of Ireland
Muriel Pate – Chief II Pharmacist, Health Service Executive
Prof. Judith Strawbridge – School of Pharmacy and Biomolecular Sciences (PBS), Royal College of Surgeons in Ireland

Why was it done?

The development of hospital clinical pharmacy in Ireland has steadily progressed over recent decades. Historically, pharmacists working in the Health Service Executive (HSE) lacked a career structure that recognised specialist-level practice.

What was done?

Following extensive stakeholder negotiations, a validation model was introduced to assess pharmacists’ practice against internationally recognised standards. Pharmacists submitted evaluation forms to a validation panel, which reviewed their evidence. Those meeting the criteria were re-graded as Advanced Specialist Pharmacists.

How was it done?

The validation criteria were aligned with the International Pharmaceutical Federation (FIP) Advanced Stage 2 framework, covering six domains: Expert Professional Practice, Working with Others, Leadership, Management, Education, Training and Development, and Research and Evaluation. A panel of pharmacists assessed electronic applications and scored them accordingly. Over 300 Acute Hospital Pharmacists submitted evidence, and those meeting the threshold were deemed to demonstrate advanced practice. These individuals were regraded to the newly created Advanced Specialist Pharmacist grade.

What has been achieved?

The HSE has now formally recognised that pharmacists in acute hospital settings are working at an advanced level. This recognition allows for the direct creation of advanced roles within the health system. A job specification outlining responsibilities and educational requirements has been published, ensuring transparency. Over 200 pharmacists successfully demonstrated specialist practice across a range of specialties and were regraded.

What next?

The creation and appointment of Pharmacists to the grade of Advanced Specialist has now prompted the need for further development. 1. The utilisation of existing Hospital Pharmacists Association Specialist Interest Groups to facilitate peer support for Pharmacists in their specialist roles.

2. A plan to establish a pipeline of Pharmacists to fill new and replacement Advanced Specialist Pharmacist vacancies.
3. Further negotiation to apply the same structures within the service in non-acute hospital roles

References

1 .Advanced Specialist Pharmacist resources, Health Service Executive, July 2024, (online) https://www.hse.ie/eng/staff/resources/hr-circulars/hr-circular-016-2024-phase-2-implementation-of-the-mc-loughlin-report-in-hospital-pharmacies.html

Author(s)

Dr Sian Williams & Mr Connor Thompson-Poole

Why was it done?

Podcasting has been shown to enhance engagement and reflection among healthcare students by connecting taught content to real-world practice. The MUGHUB podcast, established by the Medicines Use Group (MUG) at the University of Brighton, was designed to increase student pharmacists’ access to current issues in medicines use and promote awareness of diverse career pathways. Following initial positive feedback, MUGHUB has now been embedded within each year of the new Master of Pharmacy (MPharm) programme to support an integrated and spiral learning curriculum focused on professional identity and experiential learning.

What was done?

The updated MUGHUB initiative aligns podcast and video content with the Clinical and Professional Skills (CAPS) modules delivered across all four years of the MPharm. Each year features a curated mix of episode formats—Meet the Team, Peer2Peer, and Bitesize Learning—to reinforce professional themes and competencies relevant to students’ stage of development. Episodes include topics such as Introduction to placements, Sustainability in pharmacy, and Transitioning to practice, featuring pharmacists, academics, and students.

How was it done?

Academic and clinical staff collaborated with student partners through a university digital learning initiative to co-create content. Topics were mapped to module learning outcomes and professional standards to ensure curricular alignment. Episodes were recorded in the university’s sound and TV studio, edited using Adobe Audition, and disseminated monthly via the virtual learning environment and Spotify. Structured integration points within the CAPS modules and placement preparation sessions were established to encourage active student reflection and discussion.

What has been achieved?

Over 30 episodes have been produced with close to 2500 plays amassing over 200 hours of listening. With each episode linked to learning themes across the MPharm, students report using the series to reinforce understanding of professional roles, placement preparation, and communication skills. The initiative has enhanced digital literacy, self-directed learning, and engagement with the wider pharmacy community.

What next?

Future plans include expanding student-led content creation and integrating reflective podcast-based assignments to further embed digital and professional competencies within the MPharm curriculum.

Pdf

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.

Pdf

Author(s)

Beatriz Somoza-Fernández, Vicente Escudero-Vilaplana, Cristina Ortega-Navarro, Ana de Lorenzo-Pinto, Ana Herranz-Alonso, María Sanjurjo-Sáez

Why was it done?

HH units have experienced an extraordinary period of growth over the past few years and are already considered the preferred option of care model for most patients. However, its full potential is actually limited by some challenges both demanding and ripe with opportunities for pharmacy engagement, such as patient clinical complexity (usually elderly and chronic patients at greater risk of poor adherence and suffering from medication errors) and lack of medical staff physically available for monitoring patients’ evolution.

What was done?

We developed and implemented a comprehensive pharmaceutical care programme in a home hospitalisation (HH) unit.

How was it done?

The project was conceived by a multidisciplinary team (physicians, pharmacists, and nurses) that conducted a literature review and developed a new home medication management standardised operating procedure. The team worked in the design of a HH pharmaceutical care guideline and the implementation of an e-health care tool for remote patient monitoring.

What has been achieved?

1. HH pharmaceutical care guideline: it included the directions for the following measures: (1) a comprehensive pharmaceutical assessment and medication reconciliation, (2) standardised recommendations for optimising acute and chronic treatments at home, (3) daily interviews with patients or caregivers to explain medication changes, and (4) follow-up calls 7 days after discharge in order to assess medication adherence.
2. HH monitoring app: this new tool ensures pharmacotherapeutic monitoring by setting medication schedules and intake notifications. The platform includes a patient recording for vital signs, side effects, medication intake, and health status (functional status and quality of life). The system enables online access for pharmacists and physicians in real-time and continuous two-way communication.

What next?

Since our programme is easily applicable to any HH unit, we are working on implementing it in other hospitals in our country, in order to overcome HH medication management complexity nationally. We aim to conduct a multicentre study to evaluate its external validity in terms of increasing medication errors detected and optimising hospital resources.

Author(s)

Irene Centeno López, Eva M Legido Perdices, Maria José Cano Cano, Salvador Benlloch Pérez, Federico Peydró Tomás, José Manuel Ventura Cerdá

Why was it done?

Acetaminophen is the most used antipyretic and analgesic drug around the world. Intentional and non-intentional acetaminophen overdose is related to acute liver failure and it is important to start the treatment during the first hours after the intake to reduce liver injury. The main treatment to prevent liver failure is n-acetilcysteine (NAC) and it is administered depending on acetaminophen plasmatic concentrations using Rumack-Matthew nomogram during the first 24 hours. Variability in sampling time and duration of NAC administration was detected when acetaminophen intake was unknown or above the first 24h. Moreover, different NAC administration protocols were used in our institution.

What was done?

An interdisciplinary team involving Hospital Pharmacy, Emergency, Gastroenterology Department and Critical Care Unit was created to establish an agreed protocol for the management of acute acetaminophen poisoning.

How was it done?

The interdisciplinary team agreed the following procedures:
– To change the traditional NAC protocol of three intravenous infusions (150 mg/kg over 1 h, 50 mg/kg over 4h and 100 mg/kg over 16h) to the SNAP protocol of two bags (100 mg/kg over 2h and 200 mg/kg over 10h) reducing duration of administrations from 21 to 12 h.
– To establish the sampling times for the determination of acetaminophen serum concentrations: the extraction will be 4h after the ingestion during the first 24h of the intake. When time is unknown or greater than 24h, two samples separated by at least 2h will be extracted to calculate acetaminophen half-life to assess the probability of liver damage (high probability when half-life (t1/2)>4h).
– Define NAC discontinuation when INR<1.3, transaminases are in normal range and acetaminophen concentration<10 mcg/ml. If one of these parameters remains altered, the last NAC perfusion must be repeated.

What has been achieved?

– Reduce the duration of NAC treatment in the Emergency and hospitalization rooms if all analytical parameters are normalised.
– Reduce the variability in the management of acetaminophen poisoning and sampling time.
– To perform a closer clinical follow up of intoxicated/over-medicated patients.

What next?

Measure the reduction of hospital admissions and safety improvement by modifying NAC administration protocol and therapeutic drug monitoring of acetaminophen.

Pdf

Author(s)

Trine R. H. Andersen

Why was it done?

In Region Zealand, 1 of 5 regions in Denmark, clinical pharmacist services have been developed and implemented for the past decade. Especially in the acute wards, clinical pharmacists are an integrated part of the team when receiving, assessing and admitting patients to the hospital. As stated by the EAHP, “Clinical pharmacy services should continuously evolve to optimise patients’ outcomes” (EAHP statement 4.8), and a new approach was taken to further optimise the existing collaboration between the physicians and pharmacists on patients’ medication.

What was done?

The clinical pharmacy department of Region Zealand Hospital Pharmacy engaged a project with a senior year anthropology student. The anthropology student observed clinical pharmacists working with clinical pharmacist services in three acute wards. The observations on the collaboration of patients’ medication processes were disseminated to the pharmacists and physicians at the wards. This will aid in further strengthening of the collaboration and utilisation the healthcare professionals’ individual competencies in the hospital wards.

How was it done?

A senior year anthropology student was engaged to do objective observations of the pharmacists and physicians when collaborating in the acute wards. An anthropologist is trained to suppress subjective opinions and has no previous inception of the healthcare professionals’ work in the acute ward, and hence can do low biased observations. For 4 months the anthropologist made objective observations several times a week at each ward, and towards the end of the studies also supplemented the observations with individual interviews to further understand observed situations.

What has been achieved?

After the field observations and interviews, recurrent observation points were extracted from data and presented to the pharmacist and physicians in plenum. Discussions on the presented observations was found enlightening and strengthened the teamwork by better understanding the differences in the pharmacists’ and physicians’ responsibilities in the medication process respectively. Take home messages were visibility as well as accessibility of the pharmacist, and respect of each other’s contributions to the team.

What next?

The data will further be analysed and processed during the anthropology student’s final year and master’s thesis. The take home messages will be combined in a short introduction leaflet aimed for newly employed clinical pharmacists.

Pdf

Author(s)

MARIA DE LA TORRE ORTIZ, ESTEFANIA ROSON, LIDIA YBAÑEZ, NATALIA SANCHEZ-OCAÑA, JAVIER CORAZON, PALOMA PASTOR, MARIA FERNANDEZ-VAZQUEZ, JOSE MANUEL MARTINEZ SESMERO

Why was it done?

The demand and use of immunoglobulins (IgGs) is growing, and there are many difficulties in obtaining supplies. This situation has been worsened during and especially after COVID-19 pandemic. A low number of blood donations and apheresis procedures, caused a shortage of IgGs worldwide. The measures implemented (dose and period optimisation) ensured the achievement of an adequate balance between supply and demand, enabling an increase of plasma fractionation industry.

What was done?

A rationalisation plan of human IgGs use was implemented in a tertiary hospital through the multidisciplinary groups, in which Pharmacy Department (PD) participated.

How was it done?

Inside hospital working groups were created between the different IgGs prescribing departments (paediatrics, haematology, immunology and neurology) and PD during a period between 1 May 2021 and 31 October 2021. All patients on regular treatment with IgGs were identified and each one was reviewed: indication, dose, regimen and treatment alternatives. Based on the document “Criteria for the rational use of human immunoglobulins” published by the Madrid Health Service in 2021 and taking into account the clinical circumstances of each patient, decisions were made regarding: continuation or discontinuation of treatment and dose or regimen adjustments.

What has been achieved?

After identifying 184 patients treated with IgGs, a set of pharmaceutical policies has been drawn up in conjunction with stakeholders. Evidence-based intervention focused on assessing the clinical adequacy of actual treatments, optimising indications and dosing, to ensure an equitable supply was done. A total of 34 patients (%) discontinued IgGs, 24 patients reduced doses and 15 increased time between administrations.
As a result, it has been possible to continue the treatment in those patients for whom its use was a vital urgency during shortage period.

What next?

Long-term follow-up is necessary to better analyse the impact of the established measures. Registries play an important role in collection of systematic data to analyse, synthetise, and obtain valuable information for decision support. five patients had to restart IgGs treatment and seven patients had to come back to the initial regimen. Even so, politic rationalisation in special situations is a key factor of pharmaceutical activity to ensure treatments for patients who need it the most.

Pdf

Author(s)

Alexandre Benaiche, Mickael Tachon, Nathalie Arnouts, Amandine Gradelle, Kadidja Gribi, Remi Parsy

Why was it done?

The ‘Agrippal’ programme was created to strengthen the anti-influenza herd immunity in our hospital and reduce the risk of nosocomial influenza. It was then necessary to improve both the vaccination rate of the staff and the inhabitants of the institution’s living area who were potential users. The vaccines were previously distributed in departments and injections made by the nursing staff without any traceability. The purpose was also to improve knowledge about anti-influenza vaccination among staff and users.

What was done?

Our Healthcare-Associated Infectious Risk Prevention Unit (made up of hygienist pharmacists and nurses) launched a programme to fight against nosocomial influenza in our institution in winter 2018 to promote vaccination among staff and users and inform them about vaccination inside and outside the hospital.

How was it done?

Information conferences were held inside and outside the walls of the hospital for staff and residents of the city thanks to a partnership with the municipality to finance these events and communicate about their occurrence. Information materials (flyers) have also been made available to departments and some key departments (Emergency, Consultations, Obstetrics) were encouraged to inform patients at risk and their families about the positive impact of vaccination with provision of Health Insurance reimbursement forms. Our Healthcare-Associated Infectious Risk Prevention Unit created a Mobile Vaccination Team to vaccinate staff directly in the departments and encourage those who have not been vaccinated to do so.

What has been achieved?

The staff flu vaccination rate increased sharply, from 19% and 17% respectively in 2016 and 2017 to 34% in 2018 and 39% in 2019. Among vaccinated staff, 25% in 2018 and 17% in 2019 were primary vaccinated. Although the impact of actions aimed at users is difficult to measure, the number of nosocomial flu has been reduced in our hospital from 3.14 per 10,000 days of hospitalisation in 2017 to 0.58 and 0.61 respectively in 2018 and 2019.

What next?

This initiative has made it possible to double the rate of vaccinated staff in our institution and strengthen patient protection by reducing the risk of nosocomial flu. It only required a period of consultation between different actors without creating additional financial and human resources.

Author(s)

Marie Guedon, Maëliss Laurent, Thibault Vallecillo, Catherine Mennesson, Mélanie Jennesson Lyver, Dominique Hettler, Céline Mongaret

Why was it done?

In March 2021, the “Agence Nationale de Sécurité du Médicament” initiated an experiment to evaluate the relevance and feasibility of the availability of MC as a narcotic drug, in France. In our hospital, we included children to treat drug-resistant epilepsy, and performed a dispensing process to secure the patient care pathway and strengthen collaboration between hospital pharmacists and primary care professional.

What was done?

The aim of this study is to secure the care pathway of patients included in a national experimentation of medical cannabis (MC) by developing pharmaceutical interviews. Thus, to optimize the continuity of patient care, a pharmaceutical report was developed, and addressed to the community pharmacists of the patient.

How was it done?

A working group was created including clinical pharmacists, a neuropediatrician and a coordination nurse. During medical consultations, pharmaceutical interviews were conducted and led to pharmaceutic reports, sent to the community pharmacies of the patients. In order to evaluate this report, a satisfaction survey was carried out.

What has been achieved?

During the first six months of the experimentation, three children were included. The clinical pharmacist team (two senior pharmacists and two pharmacy residents) performed ten dispensing processes. During the eight pharmaceutical interviews, four pharmaceutical interventions were performed. Firstly, the interaction between clobazam and MC (noticed in one patient) required a dosage adjustment. Then, the association between MC and hepatotoxic drugs (found in two patients) requires hepatic monitoring. A pharmacovigilance statement was also drafted to report side effects (digestive disorders). The satisfaction survey of community pharmacists showed that the transmitted information, mostly related to the medication review, was considered as useful for the community pharmacies of the patients. This data helped to guide the pharmaceutical interviews during their dispensing process.

What next?

Pharmaceutical interviews and their reports lead to secure the patient care pathway and improve the communication amongst health care professionals. Those measures provide an optimal case management and avoid therapeutic breakdown. Nevertheless, difficulties have been reported, mostly due to delay in the supply chain of the community pharmacies. Therefore, this system requires some adjustments before it can be applied on a larger scale. One of the suggestions is a provisional calendar of consultations and dispensations.