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RE-HALE: TRANSFORMING INHALER RECYCLING IN THE UK

European Statement

Selection, Procurement and Distribution

Author(s)

Sam Coombes
Cath Cooksey

Why was it done?

Re-Hale was launched in 2023 by a hospital pharmacist and technician to address the lack of a national inhaler recycling programme, despite a Parliamentary advisory recommendation in 2018. Over 73 million inhalers are dispensed annually, and their propellant gases account for an estimated 3–4% of the NHS carbon footprint. The initiative aimed to deliver a scalable recycling model aligned with the NHS Net Zero 2040 target.

What was done?

A logistics system was designed using existing medicines wholesaler infrastructure. Recycling bins were distributed alongside routine deliveries, then collected once full. Inhalers were transported to a depot and on to a recycling partner, where plastics were separated, aluminium canisters recycled, hydrofluoroalkane (HFA) gases captured, and medicines safely destroyed.

How was it done?

The programme embedded recycling into existing supply chains to minimise costs and disruption. Engagement was driven through posters, text messaging, social media, press releases, and a dedicated website where patients could locate drop-off points.

What has been achieved?

The pilot achieved record collection rates and significant stakeholder engagement
• 54% of community pharmacies
• 100% of acute hospital trusts
• 86% of dispensing GP practices
• 70% of all potential sites engaged
Over 40,000 inhalers were recycled during the pilot. With further funding, the scheme expanded across Kent and Medway (population 1.9 million, up to 400 sites). Since launch, more than 100,000 inhalers have been recycled.

What next?

Re-Hale has shown that inhaler recycling within pharmaceutical supply chains is feasible, cost-efficient, and effective. By capturing gases, recycling materials, and disposing of medicines safely, it reduces environmental impact. The model is replicable nationally and offers the NHS a practical route to cut inhaler-related emissions and support its Net Zero 2040 commitment.

DEVELOPING A MULTIFACETED PHARMACEUTICAL CARE MODEL: EXPERIENCE FROM A REGIONAL HOSPITAL IN TAIWAN

European Statement

Clinical Pharmacy Services

Author(s)

Jian-Ying Wang; Shan-Yu Hsu; Ming-Chia Lee

Why was it done?

We implemented pharmacist cognitive services with internal reimbursement and joined the National Health Insurance (NHI) pilot for a Pre-End Stage Renal Disease (Pre-ESRD) clinic and Intensive Care Unit (ICU) ward rounds. We launched a LINE official account to support patient queries, reminders, and follow-up, developed Podcast/YouTube education to enhance outreach, streamlined documentation using the Eliminate-Combine-Rearrange-Simplify (ECRS) approach with AI-assisted editing, and implemented an internal clinical communication platform.

What was done?

The growing complexity of chronic disease and intensive care requires pharmacists to provide professional services such as dose adjustment, drug–drug interaction management and patient counselling. These tasks are crucial for safety and quality, yet in the past they were often not formally recognised or reimbursed. Our hospital developed this model to ensure that such professional activities are acknowledged with institutional and NHI reimbursement, while also supported by digital and streamlined tools. Linking professional services with clear payment and measurable outcomes underscores the value of pharmacists in patient safety and sustainable healthcare.

How was it done?

We established the service fee in New Taiwan dollars (NT$): NT$100 (~€3) per cognitive record (institutional), NT$200 (~€6) per Pre-ESRD case, and NT$250 (~€7) per Intensive Care Unit (ICU) patient-day under the NHI pilot. Clinical activities were coded by drug-related problem (DRP) categories, and acceptance of pharmacist recommendations was tracked. Using ECRS, we modularised SOAP forms, removed duplicate entry and automated collation; AI-assisted editing further improved clarity and consistency. LINE was integrated as a platform for patient queries and consultations, with push notifications directing patients to Podcast/YouTube educational resources produced by pharmacists.
For the cost-benefit analysis (CBA) we used a hospital perspective. Cost was defined as the pharmacist service fee. Benefit had two parts: (i) direct medication-cost savings from accepted interventions, and (ii) avoided medical expenses estimated by DRP severity, such as additional laboratory tests, emergency visits or ICU days.

What has been achieved?

In 2024, pharmacist cognitive services comprised 1,354 records, accounting for 0.18% of all prescriptions, with an acceptance rate of 99.85%. The most common DRP was subtherapeutic exposure (35.6%). At the same time, ICU rounds involved 1,315 cases, and the Pre-ESRD clinic delivered 242 visits. From a hospital perspective, CBA demonstrated that cognitive services achieved a ratio of 1:13.3, while ICU services reached 1:1.84, confirming that pharmacist remuneration is cost-effective.
Patient communication and education were also strengthened. The LINE programme enrolled 1,897 members, with all queries resolved within 24 hours, while 17 Podcast/YouTube releases generated 59,760 video views and 30,926 podcast plays. Workflow efficiency improved markedly after the ECRS redesign in early 2024, with documentation steps reduced from 16 to 6 and average time per record shortened from 825 seconds to 98 seconds. The pharmacist Net Promoter Score (NPS) rose from 20 to 80, reflecting greater user satisfaction. These improvements were estimated to increase annual service capacity by 252 records and to reduce paper consumption, elevator use, and carbon emissions by 2,892 kg CO₂e.

What next?

The model has matured into a multi-faceted pharmaceutical care approach that enhances medication safety, enables real-time patient consultation, and extends reach through multimedia education. Although CBA has demonstrated the cost-effectiveness of pharmacist remuneration, outcomes will continue to be monitored and refinements pursued to ensure sustained improvement. With its comparability and reproducibility, the model provides a practical reference for other hospitals and healthcare systems.

OPTIMIZATION OF THE CLINICAL TRIAL CLOSURE PROCESS IN A CLINICAL RESEARCH UNIT OF A HOSPITAL PHARMACY DEPARTMENT (PUI) : VEGACE PROJECT

European Statement

Patient Safety and Quality Assurance

Author(s)

Debaisieux C. (1) ; Gilles M-A. (1) ; Fernando S. (1) ; Zeggagh N. (1) ; Ngeussong A. (1) ; Antignac M. (1) ; Metz C. (1) ; Charbonnier Beaupel F. (1)

Why was it done?

The closure process is a critical stage in clinical trials, ensuring the financial sustainability of the clinical research unit and enabling archiving and relocation to free up storage space. The VEGACE project was designed to reorganize and streamline this process.

What was done?

The initiative aimed to optimize trial closure to improve efficiency, safeguard financial viability, and enhance space management. A structured action plan was developed, focusing on visual management, daily planning, and staff training.

How was it done?

A working group composed of a pharmacy resident, a pharmacy student, and a quality management student implemented the plan between June and August 2025. Visual management was redesigned through a dedicated tracking board displaying each trial’s name, if the closure is urgent or not, and cloture’s status (to do, to validate). Daily scheduling ensured that at least one staff member was consistently assigned to closure tasks. Training sessions involved newly recruited staff, expanding the team’s expertise and engagement.

What has been achieved?

Since the launch of VEGACE, the unit has recorded a substantial increase in productivity. From January to May 2025, only 4 studies were closed, compared with 73 between June and August (4 in June, 13 in July, 56 in August). Over the same period, additional costs amounted to €22,953 before VEGACE versus €239,351 afterwards (€22,138 in June, €77,775 in July, €139,438 in August). In parallel, 3,196 linear meters of clinical trial documentation were archived, freeing valuable storage space. Staff engagement also improved, with 10 members trained compared to only 3 before VEGACE.

What next?

This reorganization has reinforced financial sustainability, optimized space management, and promoted broader staff involvement. The next step will be to ensure continuity by monitoring efficiency through systematic use of the tracking board, cost analysis, and ongoing training of new staff members.

ELECTRONIC PRESCRIPTION INTEGRATION: ACHIEVING 98% COVERAGE AND REDUCING TRANSCRIPTION ERRORS

European Statement

Patient Safety and Quality Assurance

Author(s)

VB Pinto, CSA Souza, NL Mizutani, RP Santos, MA Dias, ACP Sforsin

Why was it done?

The unification of two outpatient prescription platforms into a single, institutional electronic system was carried out. The initiative was led by a multidisciplinary team (pharmacists, physicians, and systems analysts) from a public, tertiary care hospital.

What was done?

Despite the high rate of electronic prescribing (92%), the coexistence of the two systems generated data fragmentation, rework, and exposed patients to unnecessary risks of transcription errors. The central objective was, therefore, to unify the process to universalize the use of electronic prescribing and, consequently, reduce transcription errors, strengthening patient safety and pharmaceutical care.

How was it done?

The intervention took place between July and September 2025. Actions included the technical integration of the systems into a single platform, the development of new standardized prescribing protocols, and training for prescribers. The impact was evaluated by monitoring the electronic prescribing coverage percentages and transcription errors rates at the outpatient level before and after implementation.

What has been achieved?

The integration demonstrated fast and significant results. Electronic prescription coverage increased from 92% to 98% in just one month after unification. In parallel, there was a progressive and sharp reduction in transcription errors: from 8.5% (pre-implementation) in July to 2.7% in September (after integration), representing a 68% decrease in the manual correction rate.

What next?

This initiative demonstrates the importance of technological unification for the advancement of Hospital Pharmacy. The model is highly replicable for other institutions dealing with fragmented electronic prescribing systems. The integration of systems has a direct and measurable impact on patient safety, establishing universal electronic prescribing as an efficient care standard and proof against transcription errors.

QUALITY MANAGEMENT SYSTEM: INTERNAL AUDITS. RESULTS OF THE AUDIT ACTIVITY CONDUCTED AT THE FACILITIES OF A UNIVERSITY HOSPITAL

European Statement

Patient Safety and Quality Assurance

Author(s)

Francesca Cammalleri, Giorgia Bo, Roberta Cutaia, Maria Laura Savi

Why was it done?

This project was initiated to institutionalize auditing as a standard, effective quality and safety tool. Our motivation was twofold, reflecting our commitment to patient care: first, to define and standardize audit procedures consistent with UNI EN ISO 9001; second, and most critically, to ensure safety action by verifying that correction plans drive real, measurable changes in medicine management, directly enhancing patient safety on the wards

What was done?

Between January 2024 and March 2025, a total of 14 structured internal audits were conducted. The verification cycle systematically assessed quality and safety compliance using a specific Checklist (incorporating UNI EN ISO 9001 requirements) and targeted inspection tools for pharmaceuticals specific areas. All findings and critical issues were formally documented in the ‘Internal Audit Report’ to ensure official follow-up

How was it done?

The auditing process utilized a systematic, structured approach. After distributing the comprehensive annual audit plan, verification was conducted using a checklist integrated with UNI EN ISO 9001 requirements. Recognizing drug management risks, pharmacist managers utilized the ‘Department Ward Cabinets Inspection Report’ for in-depth checks on storage conditions and restricted access. Findings were consolidated in the ‘Internal Audit Report’, initiating a resolution phase where minor non-conformities were resolved immediately, while others were formally scheduled for verified follow-up during the subsequent 2025 inspection cycle

What has been achieved?

The assessment established a high level of safety compliance, with all audited units demonstrating full compliance regarding optimal storage conditions and restricted access. Crucially, the audit cycle proved effective in identifying high-risk issues: three units were flagged for failing to separate narcotic drugs and concentrated potassium solutions, alongside two units maintaining excessive drug stock. Only one major non-conformity was identified across all units. This systematic approach resulted in a clear, actionable plan for continuous quality enhancement

What next?

The program is undergoing systematic follow-up and has led to immediate expansion: audits are continuing into 2025, with verification cycles already initiated in new, complex areas like surgical units. Furthermore, we have scheduled the full revision and update of the Pharmaceutical Management Document by the end of 2025. This continuous audit cycle is now a permanent cornerstone of our Quality System, driving sustained improvement and formal policy reinforcement

DESIGNING A 360° IMMERSIVE VIRTUAL REALITY TOOL FOR TRAINING IN INFUSION SET-UP

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European Statement

Education and Research

Author(s)

V. LE BIGOT, A. BROS, F. NATIVEL, T. ADNET, D. CABELGUENNE, F. LINDENBERG, S. GENAY, P. BESNIER, S. RODIER

Why was it done?

Creation of a training tool for infusion set-ups in a digital 360° virtual reality, utilizing a fun format based on learning from errors. It is specifically designed for novice professionals, with a focus on pharmaceuticals teams.

What was done?

Errors in infusion set-ups are common and can have serious consequences on patient care. Adhering to best practices in infusion is essential to mitigate these risks. Therefore, comprehensive training for both healthcare staff on proper techniques and procedures, is crucial to ensure safe and effective infusion management. Choosing a digital navigating environment allows a remote or a mobile use and enhances interactivity between the trainer and learners when used for in-person training.

How was it done?

A multicenter working-group of 9 pharmacists with expertise in infusion and healthcare simulation was formed, divided into three subgroups: two for content creation and one for reviewing. Firstly, the priority issues were selected, drawn on the guidelines issued by learned societies. An illustrated presentation of the most frequently encountered infusion errors was developed using an online Learning Management System platform, integrating the teaching content into a 360° virtual reality environment.

What has been achieved?

A virtual patient pathway was designed in 3 different environments: an operating room, a post-operative recovery room and a ward. Within the virtual spheres, 12 “points of interest” (POIs) were defined as a clickable elements, focusing on predefined key themes. Each POI was illustrated with photos or videos and included errors that required learners to answer up to three multiple choice questions (MCQs). In total, there were 25 MCQs. Additionally, each POI featured an explanatory debriefing slide that was presented afterwards.

What next?

This training tool will be tested under real-life conditions at a national pharmacy congress. It will be approved by a panel of experts/learned societies, then evaluated by trainers/learners, so that it can find its place in the training programs of all healthcare professionals involved with infusion set-up.

TRANSFORMING PHARMACY WORKFLOWS: APPOINTMENT-BASED CARE FOR ONCOLOGY AND HAEMATOLOGY PATIENTS

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European Statement

Patient Safety and Quality Assurance

Author(s)

ESTEBAN ALONSO, M TERESA; RODRIGUEZ FERNANDEZ, ZULEMA; ALAMO GONZALEZ, OLGA; GUTIERREZ FERNANDEZ, ISABEL; SANCHEZ LUQUE, LAURA; MARTINEZ TOMAS, PAULA; BENITO JUEZ, PILAR; ESPINOSA GOMEZ, M PAZ; GUEMES GARCIA, MAGDALENA.

Why was it done?

This initiative was arose from the need to improve the quality of pharmaceutical care (PC) and stock management to ensure adequate coverage for patients. Without appointments, it was challenging to align consultations with individual patient needs and to prepare medications for the time until the next visit, as patients arrived irregularly. Additionally, multiple patients on the same treatment would often visit on the same day, increasing the risk of stock shortages. This unpredictability led to inefficiencies in both patient care and stock management. The goal was to ensure a smoother patient flow, enhance PC quality, and improve stock control through scheduled visits.

What was done?

An initiative was developed to introduce a scheduled appointment system for Oncology and Hematology patients who need to collect medication from the hospital pharmacy. Previously, patients arrived without appointments, causing unpredictable patient flow and difficulties managing stock. The new system schedules patients around one hour after their medical consultations, with special arrangements for those on long-term stable treatments.

How was it done?

The main challenge was integrating the new appointment system into existing workflows in Oncology and Hematology. Close coordination between pharmacy staff, clinicians, and administrative personnel was essential. Patients were scheduled to pick up their medication around an hour after their consultations. Long-term patients, who need consultations every six months or more, were scheduled during less busy times, such as early mornings. This improved workload management in the pharmacy, ensuring more efficient and higher quality patient care. Effective communication with patients was key to overcoming early hesitation.

What has been achieved?

The system has resulted in a more predictable patient flow, leading to better PC quality through improved preparation and more efficient medication use, reducing shortages and surpluses. Patients now receive more personalized care, as workload is more balanced.

What next?

This initiative serves as an example of good practice, transferable to other hospital pharmacies and healthcare settings facing similar challenges. The next step is to verify patient satisfaction through surveys

EXPREM PROJECT: TRANSFORMING THE PHARMACEUTICAL EXPERIENCE FOR MULTIPLE SCLEROSIS PATIENTS

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European Statement

Clinical Pharmacy Services

Author(s)

Ranz Ortega P; Martín Barbero ML; Escudero Vilaplana V; Lobato Matilla E; Carrillo Burdallo A; Del Barrio Buesa S; Herranz Alonso A; Sanjurjo Sáez M.

Why was it done?

The EXPREM project aimed to enhance the patient experience for individuals with Multiple Sclerosis (MS) undergoing pharmacotherapeutic follow-up at our hospital.The project involved designing a Patient Journey Map,conducting patient interviews at key touchpoints,and identifying strategies to improve service quality and patient satisfaction.

What was done?

Due to the chronic and complex nature of MS,patients often fase challenges throughout their healthcare journey.The fluctuating symptoms and long-term treatment regimens require frequent interactions with healthcare providers,making the patient experience a critical component of disease management.This project aimed to identify gaps in pharmaceutical care,improve service efficiency,and create a more patient-centered healthcare environment.

How was it done?

The project was conducted in five phases from January-April 2024:
1.Defining the pharmaceutical care process:a detailed map was designed to outline the pharmaceutical care process,including:before arriving at the pharmacy service(PS), patient visit and post-visit
2.Patient Interviews:three MS patients receiving treatment—one newly diagnosed,one with stable chronic treatment,and one with a recent medication change—were interviewed by a pharmacist in semi-structured,open-ended conversations to capture their perceptions and experiences with the Pharmacy Service
3.Direct Observation(SAFARI Method):the pharmacist working group simulated the patient experience to understand what patient hear,see and feel during their journey, identifying areas for improvement in the facility
4.Designing the Patient Journey Map:information from interviews and observations was used to create the Patient Journey Map,highlighting key areas for enhancement
5.Proposals for Improvement:based on the findings,specific actions were proposed to improve the patient experience

What has been achieved?

The project identified areas for improvement, such as:
Before arriving at PS
•The need for a digital appointment management system to reduce waiting times and and improve medication dispensing efficiency.
•Improvements in the physical infrastructure ensuring privacy,better signage,accessible facilities and developing health education programs,such as audiovisual health material for waiting times.
Patient visit and follow-up
•Expanding the use of health apps,videoconsultation to improve real-time communication and ensure the efficacy and safety of medication at home
•Home medication dispensing to save time and reduce costs for patients

What next?

The methodology will be shared with other pharmacy services for broader implementation and the impact of these improvements on patient satisfaction and health outcomes will be systematically evaluated

Analysis of quality indicators in the compounding area through a mobile application

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European Statement

Patient Safety and Quality Assurance

Why was it done?

To identify improvement opportunities in the Pharmacy Compounding Area through the analysis of indicators obtained from a traceability App.

What was done?

In 2022, a mobile application (App) was designed and implemented to facilitate the traceability of preparations compounded in the Pharmacy (parenteral nutrition, chemotherapy and other individualized sterile preparations). In addition, the analysis of data registered in the App has provided valuable information about the compounding unit performance.

How was it done?

Monthly reports from May to December 2022 were analysed, focusing only on chemotherapy preparations. The indicators selected were: the average number of monthly preparations, weekly workload distribution, daytime distribution of compounded preparations, preparations returned to the Pharmacy, percentage of treatments prepared on the same day of administration, and percentage of preparations compounded after the scheduled administration time.

What has been achieved?

An average of 139 chemotherapy preparations per day was recorded. The daily distribution highlights that Thursdays and Fridays are the busiest days with the 45% of the total weekly preparations. Furthermore, the morning shift carries out most of the compounding work, with 79% of the preparations being compounded before 3 PM. This information might be useful to the management team to better distribute tasks and resources. Data analysis indicates that 62% of the preparations are compounded in advance, while the remaining 38% are prepared on the same day of administration, which is also valuable information to organize the compounding workflow. On average, 59 preparations were returned per month. Finally, we found that 8.1% of the chemotherapy drugs were prepared with a median delay of 47 minutes from the expected time of administration. All these items are currently being monitored as quality indicators in order to find the way to minimize them.

What next?

The analysis of data recorded in the App provides us valuable management indicators for organizing work in the preparation area.
Tracking these indicators serves as a quality tool for the area and helps us identify opportunities for improvement.

« S’cape Pharm: Can you keep your cool? » Design and implementation of an educational escape game in Chirec’s distribution departments

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European Statement

Education and Research

Author(s)

Pascaline Hubot , Elise Francq, Guy Stichelbaut

Why was it done?

Hospital pharmacy is a constantly evolving field that requires ongoing training. New teaching strategies based on the gamification of educational objectives have been making headlines for several years. These include EG.

What was done?

An educational escape game (EG) has been designed and implemented for hospital pharmacists and pharmaceutical-technical assistants (Apth) working in one of Chirec’s distribution departments (Belgium). The objectives were : to provide continuing education and to improve various cross-disciplinary skills such as communication, team cohesion and critical thinking.

How was it done?

After considering the various constraints (dedicated time per session, number of players, etc.), a non-linear scenario was constructed. Distribution-specific themes were chosen for the creation of 12 enigmas, some in paper format and others in virtual format using Genially platform (November 2022 version). To ensure that the training sessions ran smoothly, hint envelopes containing the updated procedures were provided. Finally, the EG was pilot tested to get an idea of the game’s timing, to identify and correct any practical problems, and to adapt certain enigmas deemed too complex if necessary.

What has been achieved?

Nine sessions were held between December 2022 and September 2023. Each session included : briefing (5’), EG session (45’), debriefing (10’) and the distribution of an anonymous satisfaction survey at the end of the session (2’). Pharmacists (n = 24) and Apth (n = 15) respectively agreed (37.5% (n = 9) ; 66.7% (n = 10)) and strongly agreed (54.2 % (n = 13) ; 20% (n = 3)) that the EG improved their knowledge, and all participants found the EG to be a good teaching tool. Feedback was also very positive on cross-functional skills such as communication, team cohesion and critical thinking.

What next?

Futures sessions will be planned for newcomers to the pharmacy. Given the popularity of this educational tool and the suggestions for new topics, a new EG theme will certainly be on the agenda for 2024 pharmacy continuing education.