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)

O’Boyle, N; Currie, P; O’Hare, R; McCrory, R; Leonard, N; Kirk, S.

Why was it done?

Undergraduate curricula across a number of healthcare professions have increased their focus on interprofessional education. The aim of the study was to assess the impact of an interprofessional education programme on student self-reported interprofessional collaboration as well as how the interprofessional education programme supported their clinical skills development.

What was done?

We developed a full-day interprofessional education programme focused on medical admissions, incorporating role exchange to improve history taking and prescribing skills in medical student and pharmacy student groups.

How was it done?

In the first session, interprofessional pairs of medical and pharmacy students completed four simulation-based case scenarios. Followed by a second session of collaborative working with real patients on the hospital wards. A post programme questionnaire was completed by participants. Descriptive statistics were used to evaluate the student overall experience and skill development, and thematic analysis was used to evaluate student free text comments.

What has been achieved?

The questionnaire response rate was 88% (n=22) for medicine and 91% (n=31) for pharmacy. The mean score for the overall student impression of the programme was 4.75 out of 5. 94% (n=50) of students reported that the simulation activities improved their confidence in completing the in-situ activities with real patients. 96% (n=51) of respondents reported that they will be able to use the skills and knowledge gained within the programme in their future career as a registered healthcare professional.

Thematic analysis of the benefits of the programme identified five themes: interprofessional collaboration, professional identity, social and academic congruence, development of a holistic practitioner and simulation to prepare for clinical practice. Student suggestions for future development identified four themes: improved organisation, increased academic alignment, expanded opportunities for interprofessional education and developing more authentic clinical experiences.

What next?

There is evidence that simulation will be a core component in undergraduate interprofessional education efforts to address learning needs across both disciplines as it provides the opportunity to create scenarios with collaborative learning outcomes in a controlled environment. This study has highlighted how simulation can further be utilised to develop rapport and understanding within interprofessional student cohorts before in-situ experiential learning.

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)

Noe Garin Escriva, Borja Zarate Tamames, Unax Lertxundi Etxebarria, Jose Javier Martínez Simon, Rocio Tamayo Bermejo, Eguzkiñe Ibarra Garcia, Olaia Serna Romero, Anna Pelegri Pedret, Yolanda Torremorell Alos

Why was it done?

The GREEN BREATH Project aimed to reduce the environmental impact of inhaler use in Spain. It consisted of three components: (1) a sustainable inhaler prescription framework with a database on the environmental impact of inhalers, scenario projections to estimate benefits of alternative inhaler use and a decision-support algorithm for greener prescribing in Spain; (2) a nationwide patient education project across 40 hospitals focusing on proper inhaler disposal, assessing pharmacists interventions; and (3) a hospital pilot project for optimizing the disposal of used inhalers, reducing hydrofluorocarbon emissions.

What was done?

Inhalers contribute to global CO2 emissions, with over 15 million pMDIs used annually in Spain, generating 400,000 tonnes of CO2 equivalent. Prescription practices often ignore sustainability, and improper disposal exacerbates this problem. The project aimed to integrate environmental criteria into prescribing practices and raise awareness to improve disposal methods, without compromising patient care.

How was it done?

We contacted pharmaceutical companies to develop the carbon footprint database. The prescribing algorithm was designed by a multidisciplinary team. We used data from the Ministry of Health to calculate national projections. We also conducted a study across 40 hospitals focusing on asthma patients, using a questionnaire with a 3-month follow-up. Finally, we piloted an in-hospital inhaler waste management program in a single hospital.

What has been achieved?

The project demonstrated significant impact. We provided the first environmental database on inhalers in Spain. We estimate that shifting 10% of pMDI prescriptions could reduce CO2 emissions by 40,000 tonnes annually. Preliminary results show that over 50% of patients were unaware of inhaler disposal’s environmental impact, and that pharmacists interventions doubled proper inhaler waste disposal. Additionally, the hospital pilot project prevented up to 341 tonnes of CO2 emissions annually by optimizing inhaler waste management.

What next?

Educational resources have recently expanded to four languages used in Spain (Spanish, Catalan, Basque, Galician). We continue disseminating and collaborating with institutions to implement these and other activities. Additionally, sustainable prescribing should be integrated into electronic medical records to drive broader healthcare sustainability and reduce inhaler-related emissions. The project offers a replicable model for other healthcare systems.

Author(s)

A.M. AGUI CALLEJAS1, C. REDONDO GALÁN1, S. MANRIQUE RODRIGUEZ1, C. MARTINEZ FERNANDEZ-LLAMAZARES1, Y. RIOJA DIEZ1, L. MORENO OCHOA2, F. PEREZ MILAN, A. HERRANZ ALONSO1, M. SANJURJO SAEZ1.
1 GREGORIO MARAÑON UNIVERSITY GENERAL HOSPITAL, PHARMACY, MADRID, SPAIN.
2 HOSPITAL GREGORIO MARAÑON, OBSTETRICS AND GYNAECOLOGY, MADRID, SPAIN.

Why was it done?

Patients undergoing AR treatments face a substantial information burden and complex drug regimens, including injectable self-administration, which complicate understanding and adherence while increasing the risk of errors. A single-visit care programme was developed, integrating medical consultation, nursing-led administration training, pharmaceutical care, and treatment dispensing. This coordinated model aims to enhance follow-up, reduce patient burden, and improve healthcare quality, resulting in safer, more effective, and efficient outcomes.

What was done?

A pharmaceutical care programme was developed and implemented to monitor treatment and dispense medication to patients undergoing assisted reproduction (AR) procedures.

How was it done?

A multidisciplinary team was established, including gynaecologists, clinical pharmacists, and advanced practice nurses. Patients were selected according to local healthcare criteria. The programme addressed logistical coordination, pharmacotherapeutic monitoring, and patient support. A mobile application (including medication management, adverse events and bidirectional messaging) was developed from March to August 2025 and launched in the final month. Medication was dispensed in exact patient-specific amounts, following quality and traceability protocols, to reduce costs and minimise home waste. Main limitations were the short implementation period and small sample size, related to the app’s recent launch.

What has been achieved?

93 patients were included (mean age: 40 years, SD=3.9). 102 treatment initiation consultations and 194 follow-up visits were recorded (7 patients with > 1 cycle). Medication dispensing was based on Madrid Health Service criteria: In Vitro Fertilisation (IVF) in women over 40 years (45%) or with previous children (30%), fourth IVF cycle (7%), artificial insemination (AI) in patients with previous children (13%), and oocyte preservation (OP) in patients with previous offspring (5%). Eight patients were enrolled in the app: 12.5% sought supplement compatibility advice, 37.5% reported adverse effects, and 50% recorded medication intake. Median treatment duration was 8 days [interquartile ranges: 4–10 (IVF and AI); 8-10 (OP)]. The estimated savings, derived from the difference between the units supplied in full medication packs and those actually consumed by patients, amounted to €15,441.

What next?

This initiative exemplifies good practice by integrating medical consultation, nursing-led training, pharmaceutical care, and dispensing in one visit, reducing burden while improving safety and efficiency. A digital tool enhanced monitoring and communication, making the model transferable to other outpatient settings.

Why was it done?

Before this initiative, surgical antibiotic prophylaxis (SAP) monitoring was paper-based and mainly handled by nursing staff, with little pharmacist or surgeon engagement. Entries were often incomplete or inaccurate, with frequent confusion between prophylactic and therapeutic use. Critical parameters—timing, duration, and patient-specific factors—were inconsistently recorded, and data were rarely analysed, so protocol compliance went unmonitored. Consequently, surgeons paid limited attention to guideline adherence or to the contribution of suboptimal prophylaxis to antimicrobial resistance. These gaps exposed patients to unnecessary antibiotic exposure and avoidable infection risk. The project was therefore launched to create a reliable, accountable monitoring process that would improve data quality and enable systematic feedback and stewardship.

What was done?

A clinical pharmacist-led, electronic monitoring system for SAP was developed. A comprehensive data-capture form (demographics, surgery type and duration, wound class, antibiotic choice, dose, timing, and duration) was designed after benchmarking similar tools and implemented in the hospital information system (HIS). Clinical pharmacists reviewed all SAP entries, verified completeness before discharge, and generated reports shared with the Infection Control Committee and hospital management to support data-driven interventions.

How was it done?

A multidisciplinary team of pharmacists, infection control experts, IT staff, and surgeons collaborated under hospital leadership to design and implement the process. All patients undergoing surgery and receiving SAP were monitored by trained pharmacists in the wards, and data entries were completed before discharge to ensure accuracy. The collected information was analysed by clinical pharmacists, and discrepancies between clinical practice and established protocols were flagged. The Infection Control Team, in collaboration with hospital management, provided feedback to surgeons and developed targeted training programmes where needed. Initial barriers—limited familiarity with digital forms and resistance to workflow changes—were overcome through structured training, ongoing communication, and continuous on-ward support.

What has been achieved?

Documentation completeness and accuracy improved markedly, enabling routine compliance assessment across antibiotic choice, dose, timing, and duration. Analysis identified delays in administration; corrective actions, education, and protocol updates followed. Surgeon awareness of correct timing increased, and the pharmacist’s role in antimicrobial stewardship was strengthened.

What next?

Next steps include embedding the revised SAP protocol across all surgical units, regular audits, and continued pharmacist-led monitoring to sustain improvements. By integrating SAP monitoring data with patient readmission data for surgical site infections, we aim to evaluate whether improved documentation, training, and protocol revision lead to measurable reductions in infection-related readmissions. The model is effective, scalable, and transferable to other hospitals. Integration with AI-assisted decision-support tools within the HIS is being explored to further optimise prophylaxis management.

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)

Carlota Mestres Gonzalvo
Juan José Lázaro Alcay
Ángela Pieras López
Marta Duero Adrados
Carlos Javier Moreno Pérez

Why was it done?

Children with ASD frequently reject standard oral medications due to sensory sensitivities, which increases distress and drives the use of invasive routes (intramuscular and/or intravenous), undermining safety, family wellbeing, and perioperative efficiency. Current forms are not adapted to ASD needs; the aim is to maximize acceptability and minimize distress through patient-friendly formulations and calming environments, ensuring equitable, high‑quality preanesthesia care.

What was done?

The project is creating and preparing to clinically evaluate novel, palatable oral formulations—such as sensory-friendly gummies—co-designed by hospital pharmacists, anesthesiologists, and university formulation experts using advanced flavor–texture modification. In parallel, dedicated sensorial rooms with direct street-access entry, adjustable lighting and sound, and tactile comfort features are being incorporated to reduce overstimulation during preanesthetic preparation.

How was it done?

The first phase addresses obstacles such as heterogeneity in ASD sensory profiles and stringent pharmaco-technical and safety requirements. The team is overcoming these through stakeholder engagement with families, sensory mapping, iterative prototyping with in‑house stability and sensory testing, and multidisciplinary collaboration for rapid, compliant development. Hospital infrastructure supports integration, regulatory documentation, and implementation of sensorial rooms and staff training.

What has been achieved?

A multidisciplinary team has been established, equipment and consumables planned, and formulation development initiated, alongside design parameters for sensorial rooms and workflow integration. Expected outcomes include improved medication acceptance, reduced preanesthetic distress, fewer invasive interventions, greater perioperative efficiency, and higher staff confidence in ASD care, with internal dissemination and readiness for pilot evaluation.

What next?

The ADAPTA initiative is developing tailored oral drug formulations and implementing sensorial rooms to improve preanesthesia care for children with autism spectrum disorder (ASD), integrating pharmaceutical innovation with patient-centered strategies in a multidisciplinary hospital setting.
ADAPTA represents good practice by uniting pharmaceutical innovation with environmental and behavioral adaptations, offering a scalable, replicable model for inclusive pediatric anesthesia. Next steps include completing prototype validation, pilot clinical and sensory acceptability studies within sensorial rooms, standardizing operating procedures, and preparing for scale‑up across additional services and pediatric populations.

Author(s)

daruni sitthikan

Why was it done?

Warfarin management is complex due to its narrow therapeutic index and wide interpatient variability. Although the physician–pharmacist collaborative clinic (PPCC) model has improved anticoagulation outcomes, genetic variability remains a key challenge, as pharmacogenomic (PGx) testing is rarely available in Thai hospitals. To overcome this, an AI-based dosing tool (WarfaWise web application) was developed to assist clinicians in personalizing warfarin therapy without genetic testing.

What was done?

To evaluate the effectiveness of an AI-assisted dosing tool (WarfaWise web application) integrated into the PPCC model (PPCC–AI Model) for optimizing warfarin therapy at Takuapa Hospital, Thailand.

How was it done?

This quasi-experimental study included patients (≥18 years) who received warfarin for ≥3 months (January 2023–May 2025). The WarfaWise web-based AI dosing application was incorporated into the PPCC workflow to predict individualized weekly warfarin doses based on patient-specific parameters (age, sex, weight, comorbidities, concomitant drugs, adherence, and INR trends). The primary outcome was the percentage of Time in Therapeutic Range (%TTR). Secondary outcomes included dosing accuracy (Mean Absolute Error: MAE) and incidence of bleeding or thromboembolic complications. Statistical significance was set at p<0.05.

What has been achieved?

A total of 230 patients were enrolled. The AI-assisted PPCC demonstrated superior dosing precision (MAE=2.09±1.20 mg/week) and significantly improved mean %TTR (primary outcome) from pre-intervention 65.10±1.09% to post-intervention 71.4±8.6% (p<0.02). The incidence of minor bleeding decreased by 69.5%, and no major bleeding or thromboembolic complications occurred during the study period. Pharmacists also reported enhanced workflow efficiency and a reduction in dosing calculation errors. In conclusion, the study showed that the PPCC-AI model demonstrated superior dosing precision, enhanced INR control, and improved patient safety. This pragmatic digital innovation facilitates the scalable adoption of AI-assisted clinical decision-making tools in resource-limited settings where PGx testing is inaccessible, underscoring the evolving role of pharmacists in precision anticoagulation management.

What next?

To develop a mobile application that is easily accessible and free of charge, and can be used in hospitals at all levels.

Author(s)

Federica Pieri, Barbara Crivelli, Beatrice Faitelli

Why was it done?

Desflurane is an inhalational anaesthetic agent with an extremely high global warming potential (GWP100 ≈ 2,540), representing a major contributor to greenhouse gas emissions from operating theatres. The 2024 European F-gas Regulation mandates a progressive phase-out of fluorinated gases, including a complete ban on desflurane from January 2026. In anticipation of this regulation, our hospital sought to reduce its environmental impact by eliminating desflurane use and promoting more sustainable anaesthetic techniques.

What was done?

A multidisciplinary sustainability programme was launched to achieve complete phase-out of desflurane by December 2025, replacing it with sevoflurane and total intravenous anaesthesia (TIVA) using propofol. The goal was to maintain clinical effectiveness and patient safety while engaging anaesthetists in environmentally responsible practices.

How was it done?

A task force composed of Pharmacy, Anaesthesiology, Biomedical Engineering and Environmental Safety departments developed a structured plan that included:
Baseline assessment of desflurane, sevoflurane, and nitrous oxide consumption; Educational sessions on environmental impact and low-flow anaesthesia (<1 L/min); Gradual removal of desflurane vaporizers from operating theatres; Monitoring of TIVA adoption and evaluation of gas-scavenging systems. Environmental impact was quantified as CO₂ equivalent (CO₂e) using GWP100 factors (Desflurane = 2540, Sevoflurane = 130, N₂O = 298).

What has been achieved?

Between 2024 and 2025, desflurane use was reduced by more than 85%, replaced by sevoflurane and TIVA. This resulted in an estimated >80% reduction in anaesthetic gas-related CO₂ emissions, equivalent to several tonnes of CO₂ avoided annually. No adverse clinical outcomes were observed and staff feedback highlighted increased awareness and acceptance of environmentally sustainable practices.

What next?

The next steps include full desflurane disposal by December 2025, continuous monitoring of sevoflurane and TIVA use and expansion of the sustainability programme to other anaesthetic and perioperative practices. This structured approach demonstrates the pivotal role of hospital pharmacists in climate-conscious healthcare and provides a replicable model for other institutions preparing for the 2026 EU ban.