Author(s)

P.Chu, W.Short, L.Bailey, S.Williams, D.Moss and LA Bissell

Why was it done?

This improvement initiative addressed national recommendations following the United Kingdom Parliamentary Inquiry in 2023 into homecare services calling for improved processes and systems. Homecare represents over half of the medicines spend for Leeds Teaching Hospitals (LTH). Rheumatology serves the largest clinical cohort with over 3,500 patients receiving homecare medicines. This project aimed to address service gaps in safety, communication and efficiency to ensure delivery of high-quality, patient-centred care.

What was done?

Using the Kaizen-based Leeds Improvement Methodology (LIM) modelled through an intensive, week-long event, this project aimed to optimise the homecare process within Rheumatology. Objectives included improving workflow efficiency for prescription batching, query tracking and enhancing the patient-staff communication model, thereby increasing overall patient and staff satisfaction. Multiple process changes were implemented to improve overall efficiencies.

How was it done?

Triumvirate team buy in was crucial for the success and facilitation of this event because it required one week of multidisciplinary team (MDT) engagement from representatives in all stages of the process flow. Iterative Plan-Do-Study-Act (PDSA) cycles were used to test improvements. Value Stream Mapping supported the visualisation of workflow and identified non-value-adding activities. Quantitative data and emotional touchpoint surveys informed changes throughout this event and acted as ongoing metrics to monitor impact.

What has been achieved?

• A single, co-located MDT homecare hub was established, facilitating a streamlined, one-piece flow and minimised delays.
• An electronic text messaging system alerted patients to required blood tests to facilitate safe prescribing, this replaced postal notifications and supported the sustainability agenda.
• Prescription lead time decreased by 71% from 24 days to 7 days.
• Volume of work in progress reduced by 30%.
• Staff satisfaction relating to process efficiency rose from 24% to 65%.
• Staff satisfaction relating to morale rose from 0% to 60%.
• Incident reports and formal patient complaints were 0 by day 90.

What next?

The LIM framework and MDT approach resulted in significant enhancements in operational efficiency, communication and improved patient experience. The measured outcomes aligned with national recommendations for increased transparency and accountability. The project established a scalable and sustainable model by empowering staff to effect change. The next step is to review practice in other therapy areas to translate these improvements Trust wide.

Author(s)

Munksø D., Cramer C., Eriksen M., Bertelsen G.

Why was it done?

Around 30,000 patients in the region receive cost-free medicines from hospitals. Boxes were implemented to improve patient flexibility, reduce workload at wards and hospital pharmacies, enhance sustainability, and create a more patient-centered delivery model. However, little was known about patients’ experiences.

What was done?

Medicine boxes for cost-free hospital medicines were introduced in the Central Denmark Region in 2018. These boxes function like parcel lockers: patients order their medicines and collect them at a box within reasonable distance using a personal code. In 2025, a patient survey was conducted to evaluate satisfaction with the model, identify improvement needs, and explore preferences for future delivery solutions.

How was it done?

A structured questionnaire was distributed to 1000 patients using medicine boxes across the region. Flyers with a QR code linking to the electronic survey were included in medicine deliveries. The questionnaire addressed ordering and collection processes, satisfaction, and improvement suggestions. Responses were analyzed descriptively.

What has been achieved?

A total of 122 patients responded (12%). Most (97%) ordered via the “My Appointments” app; 75% rated it good/very good.
92% collected medicines themselves, and 90% rated box collection as good/very good. 98% found boxes easy to operate.
Patients valued short distance (66%), flexible collection times (62%), nearby parking (57%), and autonomy regarding time (45%) and place (43%). Overall satisfaction was 4.4/5 stars; most did not miss personal contact.
Main suggestions included shorter waiting time from order to collection, more boxes at new sites, better parking, and free short-term parking.

What next?

Focus on expanding capacity at existing box sites and establishing additional locations to improve accessibility. Cooled boxes are already in use but will be rolled out to all sites, ensuring that temperature-sensitive medicines can be handled everywhere. Furthermore, establishing boxes on a non-mainland island is planned, replacing postal delivery and enhancing equal access (max. ~25 km from home) for patients living in remote areas.

Author(s)

D. AUDEGEAN, C. HAMELIN, C. CONTENT, C-H. BLANCHER

Why was it done?

The care of patients receiving home hospitalization is complex. These patients experience multiple transitions throughout the care process and are treated by many health professionals, both in hospitals and private practitioners. This increases the risk of losing important information.

What was done?

To improve safe medication management and make treatment delivery more efficient, new clinical pharmacy activities were implemented.

How was it done?

A medication review and a pharmaceutical consultation were added to pre-admission visits. Unintended discrepancies in patients’ treatment lists and the corresponding pharmaceutical interventions were identified and analysed. A French program, Patient Self-Administration of Medications, to support patients in managing their own medications was introduced following an initial assessment of autonomy by a clinical pharmacist. Information collected during these pharmacy activities was shared with community healthcare providers. The satisfaction of the home hospitalization medical team was also assessed.

What has been achieved?

Over six months, 41% (n = 34) of patients admitted to home hospitalization from our hospital received the new pharmacy service. A total of 38 medication reviews were done. At least one unintended discrepancy was found in 55% (n = 21) of these reviews. The most frequent problem was unintentional treatment omission. In total, 39 pharmaceutical interventions were made. Their clinical value was rated as “moderate” in 69% (n = 27) of cases. Most patients (47.5%) had an autonomy score of 0. Liaison letters were sent to community healthcare providers using secure messaging. All physicians (100%, n = 4) said they were “completely satisfied” with the new clinical pharmacy activities.

What next?

These new clinical pharmacy services helped ensure the safe use of medications in home care patients. Sharing information with community providers improved the link between hospital and community care and supported continuous medication management. However, current staffing levels do not allow all patients to benefit. Involving pharmacy technicians in medication reconciliation may help increase the number of reviews performed. The unanimous satisfaction of the medical team supports continuing these activities in the home hospitalization service.

Author(s)

Ciuciu David, CD; Campabadal Prats, C; Salom Garrigues, C; Romero Denia, M; Suñer Barriga, H; Pascual Carbonell, D; Bejarano Romero, F; Canadell Vilarrasa, L.

Why was it done?

The integration of Hospital Pharmacy Residents (HPr) into primary care (PC) services represents an essential step toward strengthening the continuity of care between hospital and community health centers. Through this collaboration, safe, efficient, and evidence-based pharmacotherapy is promoted, while keeping the patient at the center of the healthcare system. By involving HPr in multidisciplinary teams, the program aims to enhance medication management, optimize therapeutic outcomes, and reduce the incidence of adverse drug events.

What was done?

To describe the role of the HPr in PC services and demonstrate the importance of their contribution to well-keeping relationships between primary and specialized care.

How was it done?

The involvement of the HPr in PC services was classified into clinical, educational, and management activities. To develop their activities, a HPr rotation was scheduled and carried out within a Healthcare Management area, responsible for overseeing 20 PC centers and 20 nursing homes (NH). Within this area, the PC pharmacy team consists of eight pharmacists who perform medication reviews across.
Rotation steps:
Training: HPr receives instruction on PC protocols, quality indicators, and digital tools, including prescription management and indicators recording systems.
Clinical review: HPr evaluates prescriptions, modify treatments based on clinical evidence, and apply a person-centered approach, focusing on complex chronic and institutionalized patient’s guidelines.
Multidisciplinary collaboration: Take an active part in meetings with general practitioners (GP), nurses, and PC pharmacists to discuss patient cases and optimize pharmacotherapy.
Health education: Provide training to nurses and GP residents on rational drug use, adverse reactions, and sustainability.
Evaluation: Oversee the impact of pharmaceutical interventions and suggest continuous improvement measures.

What has been achieved?

A total of 416 interventions were recorded, distributed as follows:
56.7%: Drug discontinuation due to non-adherence, not indication or therapeutic simplification.
23.1%: Therapeutic switches for efficiency.
7.7%: Changes to another molecule.
6.7%: Regimen deintensification.
4.8%: Regimen intensification.
Additionally, 46 interventions were conducted in NH:
52.2%: Drug discontinuation due to overcontrol or lack of indication.
23.9%: Regimen deintensification due to overcontrol.
17.4%: Therapeutic switches for efficiency.
6.5%: Drug initiation due to lack of control.

What next?

The participation of HPr in PC resulted in a significant increase in pharmaceutical interventions, which contribute to safer, more effective and efficient pharmacotherapy and promotes superior coordination between healthcare levels. Also contributed to the education of family and community medicine residents, enhancing their skills in managing complex chronic patients. This experience demonstrates the value of integrating pharmacy residents into primary care and may be replicated in other hospital pharmacy services with similar organizational structures.

Pdf

Author(s)

D. PROTZENKO (1) (2), Y. GONZALEZ (2), M. TASHAN (2), J. CARDI (2), A. PLAN (1) (2).

(1) CHICAS, CLINICAL PHARMACY, GAP, FRANCE.
(2) CHICAS, HOME-HOSPITALIZATION, GAP, FRANCE.

Why was it done?

Our service area spans four departments in France, encompassing numerous mountain valleys with weather-dependent access, making deployment challenging. Additionally, some patients are over two hours’ drive from our hospital.

What was done?

We developed a territorial network by integrating hospital and extra-hospital structures into our home-hospitalization logistics circuit. This integration allowed us to strategically place equipment storage points across our region, enhancing the speed of care in emergencies.

How was it done?

We utilized a computerized tool to map areas accessible within 30 minutes by car and identified strategic points (both hospital and extra-hospital) to maximize coverage with minimal investment.

To optimize operations and improve response times, we established equipment storage points with ready-to-use kits. These kits, created through multi-disciplinary meetings to address key emergency scenarios, are designed to address a range of situations, including post-operative treatments, pressure sores, and end-of-life care, which are particularly prevalent in our population. The variability of care settings—such as patients’ homes, short-term rehabilitation facilities, and long-term care facilities— is also considered. This approach ensures that nurses and doctors can access the necessary equipment at all time, regardless of their location or the specific care requirements. We formalized partnerships to ensure the presence of these kits at designated sites, which are now referenced on a map accessible to our team. Quality processes were implemented to maintain kit quality and prevent expiry.

What has been achieved?

Immediate deployment of equipment for home hospitalization is now possible, regardless of patient location or weather conditions.

What next?

We are expanding our network by recruiting additional partners to enhance our local coverage. This strategy will also apply to areas with shared medical and paramedical skills, improving our responsiveness, particularly in end-of-life care situations. We will also forge new partnerships to broaden our capabilities, enabling other hospitals to prepare patient materials or medications, or to be used as parcel delivery service.

Pdf

Author(s)

Eva Gómez-Costa; María Begoña Feal-Cortizas; María Mateos-Salvador; Sandra Rotea-Salvo; Andrea Luaces-Rodríguez; Laura Caeiro-Martínez; Clara Fernández-Diz; Andrés Torres-Pérez; Luis Margusino-Framiñán; María Isabel Martín-Herranz

Why was it done?

Implementation of a circuit for the preparation and dispensing of elastomeric infusion pumps (EIPs) prepared in a Hospital Pharmacy Service, designed for the continuous intravenous administration of antimicrobial agents in coordination with Home Hospitalization Units (HHU).

What was done?

The purpose of this initiative is to provide an effective and safe alternative for treating infections in patients who would otherwise require prolonged hospital stays. The use of EIPs improves patients’ quality of life and reduces treatment costs by decreasing hospital admissions.

How was it done?

The Pharmacy Service contributed to the development of this initiative by studying the stability of antimicrobial agents in the EIPs, determining dilution volumes based on the maximum possible concentration, and assessing storage conditions, among other factors. The appropriate EIP was selected for each antibiotic to ensure effective and safe infusion rates. EIPs are prepared in laminar flow hoods to maintain a sterile environment during medication preparation. Additionally, educational materials for healthcare professionals were developed, and training sessions were conducted for HHU staff.

What has been achieved?

In 2023, a total of 2,223 EIPs were prepared to treat 123 patients, resulting in a reduction of 1,426 hospital days. Compared to previous years, there was a 243% increase in the number of infusers and a 131% increase in the number of patients between 2017 and 2019. Between 2019 and 2023, there was an 11.9% increase in infusers and a 36.7% increase in patients.
The antimicrobials used were: meropenem (59.6%), piperacillin/tazobactam (19.9%), cefazolin (6.8%), ceftazidime (5.6%), ceftaroline (2.2%), penicillin G (2.1%), tobramycin (1.5%), ampicillin (0.7%), acyclovir (0.6%), ceftolozane/tazobactam (0.6%), and ceftriaxone (0.4%).

What next?

Future research is expected to expand on the efficacy and safety of this methodology by studying stability times at different concentrations of agents antimicrobials to establish a sustainable model that can benefit an increasing number of patients. Additionally, patient surveys will be conducted to gather insights into their experiences and enhance their quality of life.

Pdf

Author(s)

Andrés Sánchez Ruiz, Rocío Contreras Collado, Lucía Gutiérrez Lucena, Juan Jerez Rojas

Why was it done?

The programme began to be developed in March 2020 as an emergency solution to the COVID-19 pandemic, but over time it was refined due to the benefits seen in different areas, especially for pharmacy patients.

What was done?

A hospital drug dispensing programme was created with the collaboration of a community pharmacy and its pharmaceutical distributor. A daily delivery was conducted from the hospital pharmacy, covering the entire province, with a population area of 622,000 inhabitants and an area of 13,500 km2 that includes widely dispersed population centres with complicated communication.

How was it done?

Interlevel collaboration between hospital pharmacy, official college of pharmacists, pharmaceutical distributor and community pharmacy. After the first year, in which the process was more manual and marked by the pace of the pandemic, the programme began to develop. A web application with two-way communication hospital-community pharmacy was created. Hospital Pharmacy reviews and dispenses these requests, with daily shipments to all community pharmacies in the province through the distributor, which ensures safe transportation of the medication with adequate conditions of humidity and temperature.

What has been achieved?

A total of 57,130 dispensations have been made since 2020 (8,089 in 2020, 14,996 in 2021, 16,629 in 2022 and 17,416 in the first half of 2023). Pharmacy Service has dispensed at least once to 5,091 patients. Thanks to the reduction of individual trips (a total of 3,529,022 kms, 52,669 hours travel time, since 2020), it is estimated that the discharge into the atmosphere of 500 tonnes of CO2 in total has been avoided, which is equivalent to the emission of 500 round-trip Spain to Denmark flights (1,000 medium-sized trees are needed for 50 years to absorb that amount of CO2). Eighty-seven percent of private car use was estimated. We did not take into account movements of patients residing in the urban centre of the hospital. The development of ICTs will allow a more clinical approach and an improvement in patient care. We also expect the improvement of the process with the creation of Patient Reported Outcomes (PROs) protocols, already underway for migraine and psoriasis, and Patient Reported Experience Measures (PREMs) protocols.

What next?

The development of ICTs will allow a more clinical approach and an improvement in patient care. We also expect the improvement of the process with the creation of Patient Reportes Outcomes (PROs) protocols, already underway for migraine and psoriasis, and Patient Reported Experience Measures (PREMs) protocols.

Pdf

Author(s)

Suzanne Al-Rawi, Sadeer Fhadil, Sotiris Antoniou, Rodnie Oro, Paul Wright

Why was it done?

It is suggested that 40-80% of information provided by healthcare professionals is forgotten immediately by patients (1). The trust has a checklist of counselling requirements for anticoagulants, completed in consultations with patients before discharge. Recognising the complexity of anticoagulation counselling and its time constraints, we sought to assess the use of pre-recorded counselling videos for use at ward level and as a resource for patients to refer to post discharge.

What was done?

We sought to develop anticoagulation counselling videos for ward use, with hyperlinks for patient access post-discharge. We aimed to improve information provided to patients and optimise pharmacists’ time undertaking counselling.

How was it done?

Using a patient focused questionnaire, feedback was sought on patient satisfaction as well as time totality following anticoagulation counselling. A series of short and digestible video clips (1-2minutes each) that reflected the trust checklist were recorded. The videos were played to the patient and then a follow-up face-to-face consultation was undertaken to answer any questions. Patient satisfaction and time taken was assessed through the use of the questionnaires and compared to consultations without the pre-recorded clips.

What has been achieved?

Over 4 weeks, 121 patients received anticoagulation counselling. 77 patients were counselled using videos and compared to 45 patients counselled without videos. There was a 70% reduction in time spent; an average face-to-face counselling required 24 minutes, compared to only 7 minutes if the patient had seen the videos. There was an overall increase in patient satisfaction with use of videos to 86% from 70%.

What next?

We have shown optimisation of the anticoagulation counselling process through the use of pre-recorded videos. Time spent counselling has been significantly reduced and feedback from pharmacy staff has suggested more patient-centric counselling is achieved. It has allowed for information to be standardised, with an increase in patient satisfaction and understanding. Patients have access to the videos on discharge to improve patient safety. There have not been any reported incidences since switching methods. There has been a reduction in patient queries related to anticoagulation post- discharge. Areas for further development include dubbing of the videos to several languages to improve access to all.

Author(s)

Elena Bazzoni, Roberto Pane, Claudia Montanari, Giulia Rocca, Camilla Ercoli, Maurice Oriente De Ponzio, Thérèse Gregori, Simonetta Radici

Why was it done?

Piacenza is one of the most hardly hit cities in Italy during the first wave of COVID-19. Due to the severe impact that this pandemic had in the area, hospitals were saturated with patients with respiratory failure. We thus needed to rapidly set strategies that allowed a fast dismissal of patients from the hospital without interrupting their oxygen therapies or avoid their hospitalization in case of mild respiratory failure.

What was done?

Starting from COVID-19 pandemic, our pharmaceutical unit cooperated with medical doctors of the area to allow home-delivery of oxygen therapies and grant continuity between hospital and territory. We thus developed a structured system that allowed fast activation, efficient tracking, prompt variations, and dismissal of patients from oxygen therapies at their house.

How was it done?

Since February 2020, all the oxygen therapy prescriptions from the hospital and the territory converged to the pharmaceutical service. In collaboration with the pneumology unit, we set up a database collecting patient generalities who needed oxygen therapy to grant the proper follow-up during the pandemic. In April 2020 the database was shared also with medical doctors belonging to the newly formed Special Unit for Assistential Continuity (USCA). This team was in charge of visiting patients at their houses. In collaboration with USCA and the IT service, we developed a web-based system that allowed real-time communication between Pharmacy, USCA teams, and some hospital units granting the continuity between hospital and territory.

What has been achieved?

From the beginning of the pandemic, the pharmaceutical unit has handled more than 960 requests of oxygen therapies regarding more than 900 patients. Our database is updated with all of the patients granting the tracking of each one of them as well as the therapies assigned. Our system also allowed USCA to follow patients on the territory reducing the pressure on hospitals. In 2020, indeed, more than 75% of oxygen prescriptions were requested by hospital units while in 2021, 81% of them came from USCA and territorial units.

What next?

Our currents efforts aim to reduce procedural complexity to grant access to pharmacological therapies. This new web-based system represents, indeed, an versatile and key tool to reach our goal. We are currently extending its use to the whole hospital for oxygen therapies independently of the underlying pathologies. This will allow an easy and complete transfer of these therapies on the territory. Moreover, we are implementing the possibility to prescribe drug-based pharmacological therapies in an in-home context.

Author(s)

MV VILLACAÑAS PALOMARES, CM VALENCIA SOTO, A GARCIA-AVELLO FERNANDEZ-CUETO, M MARTIN LOPEZ, S BARBADILLO VILLANUEVA, M OCHAGAVIA SUFRATEGUI, V MARTINEZ CALLEJO, M RIOJA CARRERA, P DEL RIO ORTEGA, M VALERO DOMINGUEZ

Why was it done?

This drug is administered continuously during a 28 days infusion. Due to the risk of cytokine release syndrome (CRS) it is initially administered in the inpatient setting and then transitioned to the outpatient, requiring an important interdisciplinary coordination to optimize the process.
Home-based chemotherapy offers several potential benefits: reduced exposure to hospital infections, less disruption of routine and family life, lower health care cost, …

What was done?

Pharmacy and haematology services designed a workflow for the outpatient administration of blinatumomab, a bispecific T-cell engager approved for relapsed ALL.
Here, we describe our experience transitioning from inpatient to outpatient setting.

How was it done?

First step was to review blinatumomab stability, as well as material compatibility and transfer set necessaries for both hospital and domiciliary administration.
Reconstituted blinatumomab may be stored at refrigerated (2-8°C) for up to 24 hours. Prepared infusion bag (with preservative) may be stored at room temperature (up to 27°C) for up to 96 h and for up to 10 days refrigerated (2-8ºC).
Second step was to establish with the haematology service the patient´s scheduled visits to the hospital to ensure maximum stability of the blinatumomab preparation.
We decided to prepare the blinatumomab infusion bag every three- or four-days beginning on Monday, Thursday or Friday avoiding visits on weekends.
In order to take advantage of the rest of the vial, we diluted itn a new bag with stabilizer solution but without in-line filter for the next preparation. We noted the date of elaboration and the amount of medication remaining.
We used this preparation initial in each new visit add the dose necessary and an in-line filter. We primed the filter with the prepared solution for infusion

What has been achieved?

Out of the four patients who have received blinatumomab in our hospital(May 2020 – September 2021), three have benefited from this circuit.18 doses were administered at home, avoiding 68 days of hospital admission.

What next?

Outpatient administration could reduce health expenditure, therefore allowing for additional investments in new therapies.
Since the use of blinatumomab is not very common and there is not much evidence at this respect, our experience can help other Pharmacy Services to implement this circuit.