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FROM PAPER TO PLATFORM: STRENGTHENING ADVERSE DRUG REACTION REPORTING IN TUBERCULOSIS CARE VIA A PHARMACIST-LED DIGITAL SYSTEM IN AN OVERCROWDED HOSPITAL SETTING

European Statement

Clinical Pharmacy Services

Author(s)

Netchanok Kanjana, Ratnaton Khangkhasuwan, Thumwadee Thongkamchum, Pitchaporn Tepsuone, Nawiga Plong-on, Siriwan Wongvarodom, Rungnapa Songsiriphan

Why was it done?

Assessment of adverse drug reactions (ADRs) in tuberculosis (TB) patients is complex due to the concurrent administration of multiple anti-TB agents and the 9–12 day process often required for rechallenge. At our tertiary referral center, frequent transitions of TB patients between inpatient wards and the outpatient clinic, exacerbated by persistent overcrowding and a bed occupancy rate of 138%, resulted in paper-based ADR documentation being vulnerable to loss or fragmentation. This compromised patient safety and increased the risk of repeated hypersensitivity reactions.

What was done?

A digital platform was developed and implemented to systematically document and monitor ADRs in TB patients, aiming to enhance patient safety, prevent recurrent hypersensitivity events, and significantly improve the continuity, completeness, and quality of ADR reporting across all care transitions.

How was it done?

Key data elements were identified through structured pharmacist interviews and literature review. An AppSheet-based application was designed to enable real-time documentation and centralized monitoring of ADR data. The system was deployed across relevant inpatient wards and the outpatient TB clinic during the 3-month pilot period (March 1 to May 31, 2025). Pharmacists were trained to record ADR reports directly into the application, ensuring seamless information access.

What has been achieved?

Complete ADR reporting increased substantially: 56 ADR entries for 21 TB patients were documented during the pilot. This includes 8 complete ADR assessments (e.g., 3 Augmented, 5 Bizarre), compared to only 3 and 4 complete reports recorded on paper in 2023 and 2024, respectively. Crucially, no recurrent hypersensitivity reactions were observed during the intervention period. The application significantly improved continuity of care and facilitated timely, comprehensive ADR reporting.

What next?

Future plans focus on strengthening data security and system stability by migrating the application to the hospital’s internal server and integrating login with the national health provider authentication system. Expansion will involve scaling the system to include ADR monitoring across network hospitals, ensuring complete information transfer when patients are referred back to their primary facilities.

WHEN CRISIS BECOMES COLLABORATION: A NATIONAL RESPONSE TO COMPOUNDED MEDICINES SHORTAGES

European Statement

Introductory Statements and Governance

Author(s)

F.H. Nielsen
A.G Pedersen
L. Jensen
M. Kristoffersen
P. Stoffersen
T. P Dahl

Why was it done?

The shutdown significantly increased the risk of shortages for 271 compounded medicines, many vital for specialised treatments. To secure patient safety and equal access, a coordinated national approach was required to mobilise production capacity and set priorities. Due to the short shelf life of compounded medicines, it was crucial to establish a rapid national response to prevent critical shortages.

What was done?

Following the sudden shutdown of a compounding pharmacy, a national response was initiated. A joint online platform was established between the National Group for Compounded Medicines and the National Task Force for Medicine Shortages, both composed of representatives from hospital pharmacies. This platform consolidated data and decisions, ensuring planning through a national perspective. Based on the merged data, production was coordinated between remaining compounding pharmacies, both public and private, to ensure supply.

How was it done?

An online platform was established to track stock levels across hospital pharmacies, and clinical criticality was assessed on a 1–3 scale visualised with a colour code showing national coverage in days or weeks. Oral solutions with short shelf life were identified as top priority due to imminent stock depletion. Each product was reviewed for possible substitution, therapeutic alternatives, or justification for compounding. Short-term measures included extemporaneous preparation, while long-term strategies involved outsourcing, substitution, and redistribution of stock. Regular national meetings ensured the remaining two compounding pharmacies developed joint production plans, distributing workload and adjusting capacity.

What has been achieved?

This initiative demonstrates how hospital pharmacies, through national collaboration, can ensure resilience in crises. Within two months, nearly all medicines were reintroduced, substituted, or outsourced, and supply maintained without major safety incidents. The national approach included both public and private pharmacies, and their collaboration was strengthened.

What next?

The model provides a transferable framework for future shortages, proving that collaboration, shared data, and prioritisation tools can ensure patient safety and equity of access. The same model has since been applied to other critical shortages, confirming its broader value.

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.

TRACE AROUND THE BLOCK! VALIDATION OF AUTOMATED INTEGRATION OF IMPLANTABLE MEDICAL DEVICE TRACEABILITY DATA INTO AN ELECTRONIC PATIENT RECORD

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European Statement

Patient Safety and Quality Assurance

Author(s)

L. Scherer(1), L. Lassara(1), A. Choquer(1), D. Delaitre(2), E. Maguer(2), L. Papin(3), O. Chauvel(1), G. Nicolaos(1), C. Dupont(1)
(1) Hospital Pharmacy, Hôpital Fondation A. de Rothschild, Paris, France
(2) Information Systems and Medical Technologies Department, Hôpital Fondation A. de Rothschild, Paris, France
(3) Operative unit, Hôpital Fondation A. de Rothschild, Paris, France
leontine-scherer@hotmail.fr

Why was it done?

French regulations require traceability of Implantable Medical Devices (IMDs) to be recorded on discharge documents and in the Electronic Patient Record (EPR). An audit carried out in 2023 showed that only 69.5% of patients’ EPRs mentioned the type of IMD used. We aimed to validate the data transfer automation from the Pharmaceutical Management Software (PMS) to the EPR via an interface.

What was done?

We developed an HL7 interface between our PMS and our EPR. It automatically uploads to the EPR, a file specifying the traceability data of IMDs entered in the PMS.

How was it done?

A “single day” audit was carried out by a single observer on three independent days (August and September 2024). Surgical program data were extracted via the medical management software (Web100T®, Dedalus): name, administrative file number (AFN), date and type of surgery, surgical specialty. Traceability data provided by the pharmacy were extracted from the PMS (PHARMA®, Computer Engineering): name, AFN, number of IMDs tracked. The presence of a traceability document in the EPR (DxCare®, Dedalus) was objectivized and the traceability delay was collected.

What has been achieved?

Over this period, 259 patients underwent surgery: (ophthalmology (74.5%, n=193), otolaryngology (9.3%, n=24), neurosurgery (9.3%, n=24), neuroradiology (5.4%, n=14), cardiology (1.5%, n=4)). At least one IMD was traced for 56.4% (n=146) of patients, with an average of 1.2±0.6 implants per patient ([1;5]; median=1). In all, traceability was achieved in the PMS for 146 patients (170 implants traced), including 139 patients within 48 hours after implantation (95.2% of patients, 150 implants). For these 146 patients, a traceability document was found in the EPR in 99.3% of cases (n=145). It was associated with the correct AFN for 143 patients. The presence of several traceability documents (2) was found for 2 patients, indicating that traceability had been carried out on 2 occasions (dispensing on different departments: common supply and specialized depot).

What next?

Opening up the interface between the PMS and the EPR automated the traceability data transfer (99.3%). The result is a complete EPR with exhaustive health traceability. These results encourage us to implement the final stage in the data transfer automation between the EPR and the shared digital medical record.

ENHANCING PROFESSIONALISM IN CLINICAL PHARMACIST SERVICE THROUGH DIGITAL COMMUNICATION

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European Statement

Clinical Pharmacy Services

Author(s)

Mia Pavelics Rehn
Trine Rune Høgh Andersen

Why was it done?

Clinical Pharmacists (CPs) in the Region Zealand Hospital Pharmacy (30 CPs) are scattered over great geographical distances on multiple hospital wards. When working with Clinical Pharmacist Services (CPS), usually just one CP is present per ward. All 30 CPs have different knowledge, seniority and specialization. To enhance the professionalism of the individual pharmacist on duty, digital communication such as chat functions are implemented for quick and easy intra-pharmacist consults.

What was done?

The ward physicians and nurses experience the combined specialty knowledge of 30 CPs from each CP when engaging CPS. This is highly relevant to maintain the position of having CPS through the hospital pharmacy instead of employing one individual CP directly on the ward, which has become more common over recent years.

How was it done?

To illuminate how the CPs from the hospital pharmacy share knowledge by using each other in their clinical operation, data was collected during three weeks of daily work. The CPs at 10 department wards registered each time they consulted a CP colleague. Furthermore, they recorded what type of communication they used (Microsoft Teams®, telephone or face-to-face) and what the inquiry was about. Written communication in Teams chat was saved for qualitative analysis.

What has been achieved?

The collected data illustrate the utilization of collective knowledge. In the three weeks 34 consults were made using primarily Microsoft teams. In 9 cases the contact was face-to-face and in 6 cases by phone. Most common was pharmacological discussion about specific cases during medication reviews (23), followed by questions about technical issues in the electronic patient record (11), general professional discussions (7) and consults about medication shortages and alternatives (8).

What next?

This initiative illustrates how using easy and available digital communication such as Teams chat functions across geographical distances will increase professionalism and harness the collective knowledge of many CPs working in collaboration for the benefit of improved CPS.

How robotics improved safety and working efficiency in a European premium cancer institute

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European Statement

Production and Compounding

Author(s)

Mathilde Roche, Annabelle Angapin, Vincent Blazy, Alexandre Hyvert, Loretta Moriconi, Matteo Federici, Bintou Diawara, Cindy Monnel, Lison Ferreol, Assia Mitha, Hail Aboudagga, Romain Desmaris

Why was it done?

Initially, robot’s operations required prescription re-transcription and chemotherapy relabelling by technicians, leading to manual data entry risks. Robots are known for high-standardised procedures, great repeatability and limited human intervention: adding bidirectional interface enabled improvement of patient safety. Moreover, it shows significant benefits during the compounding process, streamlining pharmacy workflows and ensuring full and paperless traceability.

What was done?

In 2018, our chemotherapy production unit implemented an automated anticancer drugs compounding platform, embedding two APOTECAchemo robots. This aims to meet the increasing patient-specific chemotherapy demands (78,000 preparations/year). In order to minimise human risk and optimise work efficiency, implementation of a bidirectional interface between the robots and the hospital’s Electronic Prescribing Software (EPS) was considered as mandatory, to allow exchange and clinical information retrieval.

How was it done?

In 2020, pharmacists and the IT team defined the interface specifications. Bidirectional information flow was implemented using Health Level Seven (HL7) standards. Interface between EPS and APOTECAmanager was developed and a comparative robot performance analysis was undertaken by evaluating processed drug products, compounded preparation numbers and actual average usage time per day. The staff (i.e. two technicians) remained identical. Data were retrieved from robot’s embedded statistical tool over three months, before (March-May 2020) and after interface implementation (July-September 2020).

What has been achieved?

During these six months, 13,746 preparations were compounded, with 95% infusion bags and 5% elastomeric pumps. Most of these preparations were produced in advance (administration on day+2 or day+3). After interface implementation, the average production raised by 40.5% (from 1,905 to 2,676/month). Interface implementation increased also the average robot operating hours from 3.6 hours/day/robot to 5.8 hours/day/robot (+61.1%). In total, 19 different molecules were compounded, including conventional anticancer drugs and monoclonal antibodies with the number of reconstituted drug vials increasing by 38.1% (from 625 to 863).

What next?

Interface between robots and the EPS was successfully implemented, thereby enabling improved safety and efficiency. Today, syringes and paediatric preparations are still made manually. They require visual and analytical controls to verify their conformity. Mid 2021, a third robot customized for syringes and paediatric preparations will be installed in the compounding unit, to secure these preparations in a more efficient way.

SOFTWARE TOOL DEVELOPMENT FOR THE ASSISTANCE OF HOSPITAL PHARMACISTS IN MEDICINES’ SHORTAGES MANAGEMENT (submitted in 2019)

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European Statement

Introductory Statements and Governance

Author(s)

Eleni Rinaki, Marinos Petrongonas, Maria Fragiadaki, Leonidas Tzimis

Why was it done?

MSs are a frequent problem in our hospital. In a study carried out in 2018, we investigated reported shortages during one year and found that 56% of cases of unsatisfied wards’ requests were due to failure of pharmacy’s procedures to restore availability. In 70% of these cases, time to re-stock was more than 4 days and strong involvement of HPs in following up and taking measures was required. The purpose of this tool is to bring together all relevant information of shortages, aiming to improve hospital pharmacy’s response as well as following-up MSs for further investigation or research.

What was done?

A new software module in Hospital Information System (HIS) for monitoring medicines’ shortages (MSs) was conceived by hospital pharmacists (HPs), and it was designed, developed and integrated to the ICT system. This module helps HPs easily track which medicines were totally or partially substituted due to insufficient quantities and gives additional information (such as residual quantity of a medicine on prescription date, on inspection date, pending orders, known shortage) needed for managing MSs. In this tool, MSs and relevant information, such as causes, measures to re-stock and shortage’s impact, can be entered, centrally managed and regularly reported.

How was it done?

Implementation of the module in ICT system was made at zero cost by the ICT service provider, following technical specifications designed by HPs. The final product was multi-checked by HPs during development and all technical problems have been resolved accordingly.

What has been achieved?

• Quick intervention of HPs to restore medicines availability is feasible. • We can now have precise and easier follow up, with less human resources required. • MSs are collected, registered and easily utilised to draw conclusions. • HPs’ interventions to deal with MSs are easier to evaluate

What next?

ICT tools’ development is very important in facilitating hospital pharmacy’s practice, especially when human recourses are restricted. These software modules can be easily incorporated in every HIS. Pharmacists are competent and should have a central role in designing such tools. We are planning to evaluate our new MSs management procedure; in the long run, incorporating in this tool a risk assessment algorithm will be an asset.

SESAME QUIZ: A PLAYFUL ONLINE QUESTIONNAIRE TO ASSESS PATIENTS’ KNOWLEDGE ABOUT SJOGREN’S SYNDROME

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European Statement

Education and Research

Author(s)

Charlotte Ménage-Anjuère, Rakiba Belkir, Elisabeth Bergé, Audrey Decottignies, André Rieutord, Xavier Mariette, Raphaèle Séror

Why was it done?

We needed to assess the impact of our patient education program on Sjogren’s syndrome (SESAME) in order to continuously improve it.

What was done?

A playful online questionnaire was designed and implemented to assess patients’ knowledge about Sjogren’s syndrome.

How was it done?

A interprofessional team (3 rheumatologists, 3 pharmacists) and a 4-patient group who participated in the education program together proceeded to the questionnaire design: 1) definition of a competency framework for patients with Sjogren’s syndrome; 2) from literature review, identification of quality requirements for a questionnaire (scientific quality, opportunity to interact, means of expression, logical chaining of questions, simplicity, utility, shortness, bias prevention, playfulness, variety, online diffusion). To fulfill these criteria, we used a clear vocabulary and concise questions, included open-ended questions on patient experience, focused on the artwork, randomized the order of answer choices, and shared the questionnaire online. Once the SESAME quiz was established, a scoring system was defined by the expert group. Face validity, feasibility and reproducibility were assessed to validate the questionnaire. 25 patients were contacted to complete the questionnaire twice. Patients also evaluated the content, structure and feasibility using 12 items (understandable language, unambiguous sentences, length of the questionnaire, difficulty, web access). Reproducibility was calculated using intraclass correlation coefficient (ICC) on patient answers separated by 48 hours.

What has been achieved?

The questionnaire includes 28 questions divided into 4 parts: Sjogren’s signs, Sjogren’s causes, treatment, daily life with the disease. The 25 patients filled in the questionnaire twice (96% women, 54 years min-max[23;74], 4 years since the diagnosis min-max[1;20]). The questionnaire was filled in from a computer (n=38), a tablet (n=3) or a smartphone (n=9). The average response time was 19 minutes. The median score was 34 points min-max[22;46] out of 50. 18 patients evaluated the questionnaire. 15 patients or more regarded its content, organization and feasibility as “very good”. 5 patients found it difficult. The reproducibility was very high (total ICC = 0.87 IC95% [0.74-0.94], ICC on each part between 0.61 et 0.87).

What next?

The SESAME quiz is now freely available (https://etp-rhumato.typeform.com/to/qsVhR1) and all the Hospital centers caring for Sjogren patients can use it for their follow up.