Author(s)

S. Ambrosini, V. Orlando, C. Provezza Provezza, A. Zaltieri, N. Zanini, N. Faroni

Why was it done?

Ensuring a multidisciplinary approach to the comprehensive care of hospitalized patients is a recognized indicator of healthcare quality. This strategy proved highly effective in the management of a patient with a multidrug-resistant Pseudomonas aeruginosa (PA) infection and a severe sacral pressure injury, requiring advanced antimicrobial therapy, targeted nutritional support, and specialized wound care to promote healing.

What was done?

Multicompromised patients increasingly challenge hospital care due to infections from multidrug-resistant (MDR) bacteria, which limit therapeutic options and complicate management. Prolonged hospitalization also raises the risk of pressure injuries, worsening metabolic stress and delaying recovery. This initiative aim to apply an integrated therapeutic strategy—combining a reserve antibiotic, advanced wound care and tailored nutritional support—to promote healing, control infection and restore nutritional balance in a highly vulnerable patient.

How was it done?

The patient received Cefiderocol (2 g every 8 hours) and Fosfomycin (4 g every 6 hours) for six weeks to treat the PA infection. The pressure injury was managed with an oxygen-enriched oleic matrix dressing from organic olive oil, allowing controlled release of reactive oxygen species (ROS) to stimulate microcirculation, cell proliferation, and antimicrobial activity. Dressings were changed two to three times weekly based on progress. Nutritional needs were supported with a high-calorie, high-protein oral supplement (ONS) containing arginine, zinc, vitamin C, selenium, and carotenoids, given once or twice daily to enhance collagen synthesis and tissue repair.

What has been achieved?

This multidisciplinary strategy enabled the prompt definition and implementation of an optimal diagnostic–therapeutic pathway. The intervention and collaboration of multiple healthcare professionals ensured a faster and more effective patient response to treatment. The active involvement of the infectious disease specialist, clinical dietitian, wound care nurse, and hospital pharmacist guaranteed comprehensive, high-quality patient management —from drug and medical device supply to the successful resolution of infection and wound healing, while preventing malnutrition.

What next?

Establishing structured treatment pathways through multidisciplinary teams contributes to a more efficient and sustainable healthcare system. This experience represents an example of best practice, highlighting how collaboration among healthcare professionals—including pharmacists as medication safety officers—can be effectively translated to other hospital settings.

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.

Author(s)

E Biringer1,2, K Skaare-Fatland1, E Tverborgvik3
1Helse Fonna Local Health Trust, Haugesund, Norway, eva.biringer@helse-fonna.no
2Western Norway University of Applied Sciences, Stord, Norway
3Sjukehusapoteka Vest HF, Stord, Norway

Why was it done?

Why was it done?
The aim was to reduce the risk of medication errors arising during the registration and reconciliation of patients’ medication lists in the electronic charting system MEONA (Mesalvo GmbH, Freiburg, Germany) at patient admission. Prior to the intervention, medication errors were frequent, most likely due to limited MEONA proficiency among newly employed staff and a complex procedure for importing information about patients’ current medications from multiple sources, i.e. the electronic patient records, the Summary Care Record («Kjernejournal») and the Prescription Intermediary («Reseptformidleren»). The initiative was made in 2022 in a mental health hospital in Norway.

What was done?

What was done?
A concise pocket guide was developed for use by health personnel responsible for the registration and reconciliation of medication lists at the acute mental health ward.

How was it done?

The process of registration and reconciliation of medication lists was standardised and visually illustrated by simplified step-by-step illustrations of the user-interfaces of MEONA. The illustrations were included in a two-page pocket-sized brochure along with illustrations pertaining to electronic registrations of patient information in the electronic patient administrative- and laboratory systems. The hospital pharmacist advised the development of the brochure. The communications department of the health trust created the illustrations and lay-out of the brochure.

What has been achieved?

A qualitative evaluation was conducted based on feedback from end-users of the brochure, i.e. the physicians regularly performing medication-related operations in MEONA. They all reported a reduction in erroneous registrations and less time spent on hazzles related to medication reconciliation after the pocket guide was implemented. A newly employed junior doctor stated:
“I think the brochure is excellent! I would have had significantly more trouble during my shifts if I hadn’t had this little guide with me.”

What next?

This simple intervention likely contributed to reducing the risk of medication-related errors in the mental health hospital. Hospital pharmacists could develop similar brochures in other hospitals with electronic charting systems subject to user errors. The efficiency of such pocket guides in terms of reducing erroneous registrations and time spent on registrations should be measured prior to and after their introduction.

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)

Vanusa Barbosa Pinto, Cleuber Esteves Chaves, Andréa Cássia Pereira Sforsin, , Priscila Faria França, Mayara Araújo Dias, Erik Magnus Lindh, Caroline Sandoli de Almeida Souza, Maria Cleusa Martins, Maristela Barros De Sousa, Rafael Alves de Souza,

Why was it done?

We implemented a structured, interprofessional Innovation Committee within the hospital pharmacy to systematically manage the entire innovation pipeline. The team, comprising pharmacists, nutritionists, physicians, and Information Technology (IT) specialists, established a formal process to guide high-potential projects from initial ideation to final submission for competitive funding. This governance model was successfully applied in 2025 at the pharmacy of a public teaching hospital.

What was done?

Innovation often lacks strategic coordination in hospital pharmacy, limiting the translation of valuable ideas into robust projects. Our objective was to overcome this unstructured environment by creating a governance framework. The committee began its work by specifically focusing on identifying deep clinical “pain points,” such as fragmentation in antimicrobial management, difficulty in customizing medication dosages, and low adherence to training programs for Generation Z staff.

How was it done?

Projects were prioritized based on a methodology that weighed clinical impact, economic feasibility, and technical executability. The team utilized agile management tools, including the value-versus-effort matrix and the problem-solution canvas, complemented by sprint rituals to ensure progress and alignment. The committee successfully generated and developed three large, scalable proposals, validating the model’s capacity to identify and mature high-impact ideas. These proposals were submitted to a competitive institutional innovation grant (In.Cube-InovaHC).

What has been achieved?

The structured process resulted in a robust innovation pipeline with three high-potential proposals: PrintPharma (3D-printed personalized medications), FarmáciaLab (a gamified platform for team training), and Sentinela-ATB (an antimicrobial stewardship hub). The PrintPharma project, which aimed to develop an in-hospital 3D printing solution for personalized medicines, was ranked 8th among 134 highly competitive proposals in a major institutional innovation grant (In.Cube-InovaHC). This ranking validated the quality and maturity of the committee’s output.

What next?

This structured, pharmacy-managed innovation pipeline is a feasible and high-impact strategy that significantly strengthens the institution’s capacity to drive change. It should be considered a best practice example because the governance model and its agile tools are fully replicable and adaptable by any other hospital pharmacy, establishing the pharmacist as a protagonist in healthcare innovation.

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.

Author(s)

Laura Morgan

Why was it done?

Inhalers are the largest single contributor among medicines to the NHS carbon footprint, accounting for 3% of total NHS emissions. In 2020, the NHS became the first health system globally to commit to Net Zero, later formalised through the Health and Care Act 2022 and the Delivering a Net Zero National Health Service report, which provides statutory guidance to ICBs. This project responds to that call-to-action and aligns with South East London’s Green Plan, which pledges to reduce emissions within its footprint. It also serves as a proof-of-concept to inform NHS England’s assessment of the viability of nationwide, routine inhaler recycling.

What was done?

Developed as an innovative sustainable project in response to NHS Net Zero ambitions and SEL Integrated Care System’s (SEL ICS) Green Plan, SEL ICS launched the first fully NHS-funded, ICS-wide inhaler recycling pilot in England. The scheme is fully integrated across primary and secondary care and enables the public to recycle used inhalers at any participating site. The inhalers are then transported to a recycling facility (Grundon Waste Management) for up to 99.9% recovery of propellants, plastics, and aluminium. This pilot serves as a proof-of-concept to assess the feasibility of business-as-usual inhaler recycling in the NHS.

How was it done?

An inhaler recycling pilot is being delivered across 20 community pharmacies and five acute/mental health trusts in SEL. A project working group (PWG) and formal memorandum of understanding was established between South East London Integrated Care Board, NHSE, King’s College Hospital (KCH), SEL Pharmacy Alliance, Guy’s and St Thomas’ (Essentia), and other stakeholders to ensure structured, cross-sector collaboration. The project leveraged existing NHS clinical waste infrastructure to recycle pressurised metered dose inhalers (pMDIs), ensuring operational efficiency with minimal disruption. The PWG collaborated with behavioural science colleagues and patient engagement groups to develop public-facing communications that encouraged appropriate inhaler disposal. All activities were embedded into routine workflows without additional staffing. Monthly data submissions from participating sites enabled continuous monitoring and will inform a fully commissioned evaluation.

What has been achieved?

Over 16,000 inhalers have been collected so far, with more than 11,000 returned through community pharmacies. The current recoupment rate at community pharmacies is approximately 15%, i.e., the number of pMDIs reported returned is around 15% of the high-carbon pMDIs dispensed by that pharmacy in the same month. This figure will undergo further scrutiny in the final evaluation, after corroboration by Grundon data following the project’s last recycling cycle. The project has also seen strong patient and public involvement. A live public-facing survey on the SEL website has received more than 100 responses to date. Themes identified include low awareness of proper disposal routes, strong interest in inhaler recycling, and improved understanding and willingness to return inhalers after campaign exposure. These results demonstrate meaningful public input and are informing ongoing communication strategies. In terms of reach and influence, the pilot has attracted national and international interest with over 25 NHS providers across the country having contacted the SEL team for support with replication, and a Canadian research group has requested to learn best practice from the model. The project demonstrated high operational feasibility, environmental impact potential, and strong appetite for scale-up. Complete evaluation is ongoing.

What next?

This innovative project shows inhaler recycling can be embedded in existing NHS systems. It presents a replicable and scalable national model, supporting medicines optimisation, waste reduction, and sustainability; it stands apart by being completely publicly owned, leveraging existing NHS contracts and infrastructure, without the need to rely on external sponsorships. This pilot offers a practical blueprint for embedding environmental sustainability into medicines optimisation across the NHS and the outcomes will inform future commissioning and advance the NHS’s Net Zero goals.
An evaluation of the pilot is currently being developed with the last inhaler collection at all sites due January 2026; the evaluation is due to be published in the Spring of 2026.

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)

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.

Pdf

Author(s)

Julen Montoya Matellanes, María Sánchez Argáiz, Pablo González Moreno, Sister Jacinta Wajinku, Ana Soler-Rodenas, Luis Ortega Valín, David Roca Biosca

Why was it done?

The goal of this initiative was to address the challenges faced in medicine management at the hospital, including low adherence to the HDF and the presence of numerous medicines not listed in the guideline. These issues hindered effective treatment options for patients and highlighted the need to improve compliance with national guidelines.

What was done?

We conducted a comprehensive review of the hospital drug formulary (HDF) in a rural Ugandan hospital to optimize pharmacotherapy and improve local access to essential medicines. This initiative involved assessing adherence levels to the HDF, identifying therapeutic needs, and evaluating drug availability.

How was it done?

A mixed-methods approach was used, combining qualitative and quantitative data. We compared the medicines available in the storage facilities s with those listed in the current HDF (published in 2016). Key indicators, such as adherence to the HDF and the number of available medicines not included in the guideline, were calculated. In addition, interviews with the responsible pharmacist provided insights into the causes of medicine shortages. We also compared the HDF with the 2023 Uganda Clinical Guidelines and the Essential Medicines and Health Supplies List for Uganda to identify therapeutic gaps.

What has been achieved?

The review revealed that out of 234 medications listed in the HDF, only 127 (54%) were available at the hospital pharmacy, while 107 (46%) were unavailable or out of stock. Adherence to the HDF was 63%, and 164 available medications were not included in the guideline. Ninety-nine potential therapeutic gaps were identified and it was highlighted that the main reasons for drug shortages included discontinuation of compounded drugs preparation and expiry of medicines due to low usage. This initiative provided a clear picture of the severity and causes of the issues related to access to medications.

What next?

To address these challenges, we recommend implementing staff training in medication management, systematizing stock and ordering processes, updating the HDF based on clinical and economic criteria, and reactivating the magistral formulation laboratory. With these measures we aim to improve medication availability and ensure better patient outcomes in this rural hospital. Additionally, the method employed can be standardized as a valid approach to assess drug availability in any hospital, with particular relevance in low-resource countries facing economic challenges and lacking electronic inventory control systems.