Author(s)

T. SANKAR, O. LASNE, E. REMY, G. BRETOT
CENTRE HOSPITALIER INTERCOMMUNAL ELBEUF-LOUVIERS-VAL DE REUIL, PHARMACIE – STERILIZATION, SAINT-AUBIN-LÈS-ELBEUF, FRANCE.

Why was it done?

Without outsourcing, HA’s sterilization department would have closed, jeopardizing surgical interventions and patient care. Therefore, the collaboration with HB was chosen as a cost-effective solution because private providers were expensive. The aim of the initiative was to guarantee continuous sterilization services, maintain patient safety, and ensure uninterrupted surgical activity despite the renovation.

What was done?

The sterilization department of Hospital A (HA) must make renovations to comply with standards. During six weeks of renovation work in 2024, a temporary outsourcing initiative was implemented to guarantee the continuity of surgical and care activities. During this time, the sterilization was subcontracted to Hospital B (HB), located 50 km away and operating with similar activity profile.

How was it done?

A formal agreement defined the activity volume, distribution of resources, responsibilities, and invoice procedures. Anticipated challenges included logistics, equipment shortages, management of urgent requests, and maintaining instrument-level traceability. These were addressed through regular communication with hospital management, technical services, and end-users. A site visit and staff meetings prepared the teams. IT department enabled secure remote access to maintain full traceability. In practice, washing in washer-disinfectors and preparation of surgical sets were performed at HA, followed by three daily shuttle transports to HB, where sterilization was carried out by three HA agents working on-site.

What has been achieved?

The initiative ensured:
• Complete maintenance of instrument traceability.
• Processing of 207,310 instruments, either individually or as part of surgical sets, over six weeks.
• An average turnaround time of 24 hours.
• No surgery cancellations, no instrument loss/breakage, and no major logistics incidents, only minor same-day delays of some surgeries.
• A total cost of €71,977 for transport and subcontracting
• High satisfaction: 17/18 service beneficiaries and 12/13 staff judged the experience positively.

What next?

This initiative demonstrates that inter-hospital cooperation, even across different hospital groups, is feasible and safe to manage temporary shutdowns. The initiative maintained high standards of quality while optimizing costs. Its success relied on strong preparation, effective communication, and staff commitment. This model can be transferred to other healthcare settings facing similar situations, offering a sustainable alternative to private outsourcing.

Author(s)

Scarlett Wise, Pharmacy
Sandrine Gotty, Infectious risk prevention
Sylvain Auvity, Pharmacy
Robert Ratiney, Pharmacy
Caroline Chirk, Pharmacy
Aude Boyer, Clinical investigation center

Why was it done?

Inhalation GTMP’s nature are various, such as mRNA vectorized in lipid nanoparticles and virus GMO therapies. Hospital staff needs reassurance and protective equipment (PE) facing the management of these new ATMPs.

What was done?

Before administrating a new advanced therapy medicinal product (ATMP), including gene therapy medicinal product (GTMP), precaution measures must be implemented for the safety of health care personal at every step of the pharmaceutical process. Administration of GTMP by inhalation generates volatile active substance particles in the air during and after inhalation.
As a result, protection measures were established to secure hospital personal during administration and all through patient hospitalisation.

How was it done?

The dedicated ATMP pharmacist and healthcare manager, identified each key parameter: GTMP nature, persistence on surfaces and types of contamination: airborne, droplet or contact.
The exposition phases in patient’s room were cut down to 3 periods:
1) Administration and instant post administration
2) Hospitalisation post administration
3) Patient discharge
For each period, precautionary measures for entering and exciting patients’ room were discussed:
a. PE
b. Safety distance between personal and patient
c. Bio-cleaning
d. Waste management
Isolation signs for each ATMP were created, approved by the hygiene department and displayed at the entrance of every patient’s room. These signs summarized the good behaviour for every period and detailed the necessary PE.

What has been achieved?

Two isolation signs were created: mRNA and virus-vectorized GTMP.
For 1st period:
Entering: FFP2 mask (airborne), gown, covering glasses, mobcap, gloves and 1.5m distance during administration were identified for both GTMPs. Virus-vectorized GTMP required additional doubled gloves, overshoes and disposable pants.
Room exit: all objects needed decontamination when brought out of patient’s room (contact) for virus-vectorized GTMP.
For 2nd period:
Entering: surgical mask, gown and gloves were identified for both GTMPs. Virus-vectorized GTMP required a surgical mask for the patient (droplets).
For 3rd phase: floor and wall bio-cleaning were necessary and furniture for virus-vectorized GTMP. PE was thrown away in usual waste for mRNA. For virus-vectorized GTMP, PE follows biohazard waste and laundry is identified.
Room exit in all periods required hand washing with hydroalcoholic solution.

What next?

Isolation signs will be created to accompany each new ATMP handling and administration.

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.

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Author(s)

R. Malberger
A. Shinawi
M. Hamed said
C. Hamza

Why was it done?

We developed a unique ambulatory medical and pharmaceutical service providing treatment for children with autoimmune diseases at Carmel hospital.

What was done?

The ambulatory children’s clinic in Carmel hospital provides several medical services for children including those with autoimmune fever diseases, treated with canakinumab (ILARIS), a monoclonal antibody drug .
The ILARIS is given individually at the clinic during morning hours simultaneously with other treatments. The dosage is calculated individually, the remaining drug goes to waste. The treatment is not supplied by a permanent medical team.
Our initiative aims to establish a specific multidisciplinary service for ILARIS patients which will increase the quality, safety and economic efficiency of the treatment.

How was it done?

1. The current medical service was analyzed including all needs and goals, infrastructures and obstacles.
2. The pharmacy presented a multidisciplinary plane addressing all goals and difficulties suggesting a specific time scheduled for ILARIS treatments exclusively, involving a personal rheumatologist, a trained nursing team and a pharmacist dispensing process.
3. Assessment tools including financial formulas and patients’ questionnaire were established before implementation began.

What has been achieved?

1. The patient receives the services of a personal rheumatologist and a familiar trained nursing staff.
2. From the pharmacy perspective the intervention led to a decrease in prescription, preparation and administration errors as well as an impressive economical decrease in the cost of drug waste, saving more than 400,000$ over 13 months.
3. Questionnaires collected show increase in patients and family satisfaction.
4. Patients do not loose school or work days.
5. Community bonds between families of ILARIS patients were formed.

What next?

creating a unique treatment plan for ILARIS patients, collaboration of nursing, pharmacy and medical teams led to a significant improvement in the quality of care, economic efficiency and an increase in the satisfaction of patients. Our initiative achieved its aim in a short time and can be
applied to a verity of medical services in diverse settings in any clinic or hospital worldwide.

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Author(s)

Elena Blanco Saiz

Why was it done?

It is estimated that over 80% of patients receiving treatment with cetuximab experience acneiform eruptions and/or skin dryness and flaking. Approximately 15% of these cutaneous reactions are severe, including cases of skin necrosis.
These skin lesions may predispose patients to secondary infections, potentially leading to complications such as cellulitis, erysipelas, staphylococcal scalded skin syndrome, necrotizing fasciitis, or sepsis, which can result in death.

What was done?

A kit consisting of an alcohol-free moisturizing cream, an alcohol-free gel, and a sunscreen with a sun protection factor of 100 was provided to patients undergoing treatment with cetuximab for daily skin care.

How was it done?

When the oncology department prescribes cetuximab, the patient is informed that a kit will soon be dispensed.
The pharmacy service reviews daily the patients who will initiate treatment with cetuximab in the day treatment center. If there is a patient starting treatment, nursing staff notify us when they arrive at the center, and the pharmacy dispenses a kit while explaining its contents.
We periodically call the patient to check whether they are continuing to use it correctly, if they have noticed any changes in their skin, what changes they have observed, and whether they have needed to take antibiotics and/or topical corticosteroids.

What has been achieved?

• To date, the kit has been dispensed to 21 patients undergoing treatment with cetuximab.
• It empowers patients by actively involving them in their care.
• It prioritizes the overall well-being of the patient, as it may prevent the onset of dermatological side effects and the use of topical corticosteroids and oral antibiotics.
• The process facilitates the pharmacist’s engagement with the patient in the day treatment center and throughout the treatment, allowing for addressing concerns, answering questions, and providing information about adverse effects.
• It promotes the creation of a multidisciplinary team by involving collaboration between oncology, nursing, and pharmacy.

What next?

We present a practical approach that enhances patient safety during the oncology process.
This practice can be adopted by any center.
It is necessary to continue collecting data to obtain reliable results regarding its impact on improving patient safety.

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Author(s)

Carine Schuurmans

Why was it done?

• The use of gloves in medication administration can vary depending on several factors, including the specific healthcare hygienic policies, local guidelines, and the type of medication being administered. There is no uniform practice across all of Europe.
• According to the Dutch guideline on administration of parenteral medication disposable gloves are traditionally used during parenteral medication administration.
• Most parenteral medications do not pose a significant hazardous risk and the administration of ready to use preparations does not pose a significant infection risk.

What was done?

• Re-evaluation of the Dutch guideline on administration of parenteral medication from a sustainability point of view.
• Reducing unnecessary glove usage in medication administration.

How was it done?

• Re-evaluating the need for disposable gloves from both an infection prevention and medication hazard point of view.
• Discussion with experts and users.
• Implementation of findings both in the inpatient and outpatient departments.

What has been achieved?

• Overall growing attention to correct glove usage.
• Reduction of use of disposable gloves during parenteral medication administration and other medical procedures
• CO2-, land occupation and water reduction by respectively 6000 CO2 eq, 600m2, 300m3 and 3500 €/month

What next?

• Revision of the Dutch guidelines on administration of parenteral medication

Pdf

Why was it done?

This service emerged as a result of the COVID-19 pandemic, when the collection of hospital medication posed patients, many of whom were immunocompromised, at higher risk for COVID-19 and other infections, as they had to enter the hospital facilities. Over time, it was observed that this service was not only beneficial during periods of high SARS-CoV-2 transmission. RutiCar enabled medication pickup from the patient’s own private vehicle, avoiding necessity for parking as well as entering the hospital.

What was done?

In June 2021, the Pharmacy Department of Germans Trias i Pujol University Hospital(HUGTP) established an outpatient medication dispensing point located outside the hospital premises, “RutiCar”. This initiative facilitated patients in collecting their chronic treatments without entering the hospital, enabling direct access from their vehicles.

How was it done?

A new preparation and dispensing circuit was established. The patients specify their preferred date for medication pickup by telephone, e-mail or by a form after scanning a QR code. Pharmacy technicians undertake the responsibility of scheduling the appointment and preparing the medications one day prior to the designated dispensing day. The prepared medications are transported early in the morning to a temporary medication storage facility situated within the hospital’s parking area. Finally, the patient arrives at RutiCar at their scheduled appointment time and, without the need to exit their vehicle, collects their medication.

This service is aimed at patients with chronic treatments who have been on their medication for an extended period (>6 months) and show adherence. Pharmacists play an important role in this context, by ensuring that patients meet the criteria to initiate RutiCar service, reviewing treatments to validate their continuation and overseeing medication pickups to enhance patient adherence.

What has been achieved?

This service has led to an improvement in the medication dispensing process, assisting 10.46%(282) of the monthly average of patients who collect hospital medication(2695) and extending the hours for medication pickup, facilitating the work-life balance for patients and enhancing access to patients from remote areas.

What next?

In the future, improvements can be considered, such as implementing reminders for patients who have not yet scheduled their appointments and are projected to run out of medication soon, or automated appointment systems.

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Author(s)

MARCELO DOMINGUEZ CANTERO, CARMEN MARIA DOMINGUEZ SANTANA, MARCELINO MORA CORTES, ESMERALDA RIOS SANCHEZ, JUAN MANUEL BORRERO RUBIO

Why was it done?

Patients who withdraw medication from outpatient pharmacies in Spanish hospitals are provided with pharmaceutical care and pharmaceutical care stratification tools in specific outpatient pharmacy consultations. These patients are usually multi-pathological with multiple drug interactions, contraindications, and important adverse effects. Therefore, during the hospital admission of these outpatients, it was appropriate to provide continuous care from the hospital pharmacy. Before the implementation of the protocol, there was no specific and systematic follow-up of hospitalized outpatients.

What was done?

Implementation of a protocol that provides pharmaceutical care to outpatients during hospitalization, ensuring continuity of care through the pharmacy service.

How was it done?

The main problem with the implementation was the real-time detection of hospitalized outpatients. The development of a software tool to facilitate the location of patients provided an impetus for the implementation of the project. The computer tool selected patients who met the inclusion criteria (hospitalized outpatients with medication withdrawal in the outpatient unit in the last two months). Patients treated with erythropoietin and colony stimulants were excluded.

What has been achieved?

Seventy-nine patients were included in the study between April and September 2023; 62.1% were male. Main pathologies included 41.9% oncohaematologic diseases, 18.9% human immunodeficiency virus, and 17.7% immune-mediated inflammatory diseases.
The reason for admission was related to the pathology for which outpatient medication was withdrawn in 27 patients (34.2%), and six patients (7.6 %) were admitted due to an AE of the medication withdrawn in outpatients. Pharmaceutical interventions (PI) were performed in 21.5% of the patients reviewed, and 76.5% were accepted. PI reasons included discontinuation of treatment (64.7 %), modification (17.7 %), initiation (11.8 %) and monitoring (5.9 %).

What next?

With our protocol, we want to show that outpatients within the pool of patients admitted to a hospital are a priority target group. For these patients, the hospital pharmacist can improve treatment during hospitalization with a high degree of pharmaceutical intervention.

Pdf

Author(s)

Outi Lapatto-Reiniluoto, Suvi Sivula, Elina Ahomäki

Why was it done?

Price has been the most prominent criteria in procurement quality being the second. Environmental aspects haven’t been assessed earlier. Differences between the pharmaceuticals’ environmental burden can be considerable and by choosing wisely we would be more sustainable.

What was done?

Environmental criteria have not been used in Finland in hospital procurements earlier. We created the criteria which would be acceptable to all parties (hospitals, suppliers), would be reliably assessed, and easily copied to other hospitals.

How was it done?

Our tender had six questions for everyone and two more questions for antibiotics or hormones. The common questions were answered by yes / no / we do not know. Points given were 0, 1, 2. An example of the common question is: Does the company have a plan how to reduce CO2 emissions caused by itself?
Questions for antibiotics and estrogen hormones were: Company has told in which country and in which plant the API is produced and the formulation happens.

What has been achieved?

132 providers answered so far. Quality of answers varied considerably, from 0 to 12 points, mean 7 points. Questions for antibiotics created the most discrepancies: 41 providers; 15 were not able to answer these questions acceptably. The answers showed that the questions were not too difficult, these questions could be answered, and the answers can be analysed.

What next?

The criteria were very simple and assessing the answers was not difficult. Only one question was widely misunderstood. Questions were universal and can be used in other hospitals, too, which is the wish from the industry (same questions everywhere). Wide range of results showed differences between the companies. During this round we did not give any credit for the best products but in the future more responsible products should be rewarded. Antimicrobial resistance e.g., is a global problem but if the company does not know where its products are manufactured how can they look after wastewater treatment of their products.

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Author(s)

Rik Stuurman, Sofie Hessels, Chantal Kats, Chantal van Egmond, Kim Gombert-Handoko

Why was it done?

The administration of intravenous medication directly into the drip chamber has several benefits: 1) it saves time during preparation and administration for the nursing staff, 2) the patient has a shorter and controlled administration of the medication, often with less fluid and 3) the reduction of the use of infusion bags is sustainable and reduces costs.

What was done?

Administration of intravenous medication into the drip chamber using the integrated needle-free injection adapter is a good alternative to bolus injections and parenteral infusion. We conducted two pilot experiments at four wards, where we injected the 30 most frequently administered medications directly into the drip chamber instead of using an additional infusion bag via a sideline, which is the common practice in our hospital.

How was it done?

For the most frequently administered medications, we assessed whether it was possible to inject directly into the drip chamber. For these medications, we also defined the pump speed and the volume to rinse the system after each infusion. This information is explicitly described in our local parenteral handbook. In addition the nursing staff was fully trained and the procedures were updated.

What has been achieved?

During the evaluation of the first pilot after three months of the implementation, about 90% of the nurses indicated that they were satisfied with this alternative way of administration, that they did not experience any problems during the procedure and that they saved time compared to the old method. The second pilot will also evaluate the real-world reduction in infusion bags and costs (results are expected in December).

What next?

This alternative way of administration is now fully implemented and will be rolled out over the other wards with a “starter package”, which includes a guide for implementation, training material and frequently asked questions. In addition, the method will be fully integrated into the local parenteral handbook and the list of medications will be expanded.