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ENVIRONMENTAL SUSTAINABILITY AS A COMPLEMENT TO THE STAGES OF THE PHARMACOTHERAPEUTIC PROCESS

European Statement

Selection, Procurement and Distribution

Author(s)

AI IDOATE GRIJALBA, P GARCÍA GONZÁLEZ, L CABIA FERNÁNDEZ

Why was it done?

Environmental, social, and economic sustainability has become increasingly important in all sectors, including the healthcare sector and, more specifically, in hospital pharmacy.

What was done?

Analyze and prioritize the sustainability strategies proposed by the pharmacy service at all stages of the pharmacotherapeutic process.

How was it done?

Within the framework of clinical decision-making and planning sustainable pharmacotherapeutic strategies within the 2030 Agenda of the Spanish Society of Hospital Pharmacy, it is essential to analyze and prioritize different proposals. Two key criteria were considered: resource availability and the relevance of pharmaceutical intervention. Both criteria were scored from 1 (low) to 3 (high) by the service pharmacists. To stratify the proposals, both criteria were multiplied, establishing priority 1 (7-9 points), priority 2 (5-6 points), and priority 3 (1-4 points).

What has been achieved?

Priority 1 strategies were: in the management area, prioritizing the purchase of drugs with a lower carbon footprint and exchanging drugs with a short expiration date with the referral hospital. In the validation area: actions promoted by the PROA team: deprescribing antibiotics in general and specifically those with a high environmental impact (macrolides and quinolones), de-escalation, sequential therapy, and limiting the duration of treatments. Automation and digitization of on-demand drug ordering processes and pharmacotechnical processes (registration of raw materials and packaging materials). Promoting telepharmacy, with the dispensing of outpatient drugs to pharmacies, especially relevant for patients living in scattered villages in the area, to improve treatment adherence and reduce transport. In the dispensing area, prioritizing the KANBAN system to reduce immobilized medication stocks in primary care and hospital wards and facilitate the transport of medication in care transitions. In the training area, teach patients how to use mobile apps to view outpatient dispensations.
Priority 2 or 3 strategies whose score is conditioned by a lack of resources will be evaluated by the service together with hospital management, and those with a high impact will be given priority.

What next?

Priority 1 strategies will be fully implemented in the short term (6 months) and will be reviewed periodically, priority 2 strategies (1 year) and priority 3 strategies (5 years).

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.

GREEN BREATH PROJECT: A COMPREHENSIVE APPROACH TO REDUCING THE ENVIRONMENTAL IMPACT OF INHALER USE IN SPAIN

European Statement

Clinical Pharmacy Services

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.

IMPLEMENTATION OF A PHARMACEUTICAL VALIDATION SUPPORT PROGRAM THROUGH AN ALERT SYSTEM INTEGRATED INTO THE ELECTRONIC HEALTH RECORD

European Statement

Patient Safety and Quality Assurance

Author(s)

Laura Rueda Montes, David Tomás González, Iker Muñoz Delgado, María Fernández-Vázquez Crespo, Jesús Airam Domínguez Cháfer, Rocío Manzano Lorenzo, José Carlos Tallón Martínez, Cristina González Pérez, María Ángeles Campos Fernández, Susana Sánchez Suárez, María Teresa Benítez Giménez

Why was it done?

One of the core responsibilities of hospital pharmacists is the validation of inpatient medication prescriptions. Our goal was to identify medication errors that could compromise patient safety, and to optimize and standardize pharmaceutical recommendations, ensuring consistent validation practices across pharmacists. This initiative serves as a tool for quality assurance and patient safety.

What was done?

Design and implementation of an automated alert system for pharmaceutical validation of prescriptions integrated into the Electronic Medical Record (EMR), which generates real-time pop-up alerts based on a database parameterized with clinical rules. During validation, the pharmacist decides whether the alert is appropriate and if accepted, a notification is added to the medical prescription, as well as a record of this intervention in the EMR.

How was it done?

Key pharmaceutical interventions (PIs) were established to optimize prescription validation, grouped into two categories:
• Drug-dependent interventions: 577 PIs classified into 9 groups: maximum dose, therapeutic duplication, drug interactions, gastroprotection, laxative prophylaxis with opioids, incorrect administration techniques, treatment duration, potentially inappropriate medications in older adults, and sequential therapy.
• Patient-specific interventions based on lab data: 398 PIs classified into 7 groups: renal failure, electrylite (magnesium, potassium, and sodium) levels, neutropenia, thrombocytopenia, and anemia.
With support from the IT department, an algorithm was configured using a total of 975 rules that we established for 386 drugs. When a prescription meets any of these rules, an alert pops up in the EMR, displaying a predefined pharmaceutical recommendation tailored to the patient.

What has been achieved?

Implementation of the alert system in the pharmacist’s EMR profile in order to detect medication errors in patients who meet one or more of the rules set in the created algorithm.
Moreover, a dashboard was created displaying the number of interventions by prescribing department, drug, and type of intervention.
Since its launch in April 2025, a total of 3,547 PIs were made for 2,411 patients within six months.

What next?

Ongoing review of existing alerts based on feedback from the pharmacy team, along with the incorporation of new rules to maximize medication safety for hospitalized patients.

MODERNIZING CYTOSTATIC PRODUCTION: A DATA-DRIVEN APPROACH TO DECISION-MAKING FOR SELECTING A COMPOUNDING SYSTEM

European Statement

Production and Compounding

Author(s)

Stefanie Fuchs, Michele Tadiotto

Why was it done?

Compounding cytotoxic therapies in hospital pharmacies is a complex and safety-critical process. As part of a planned modernization of the production site, which handles around 40.000 preparations annually, the project was launched to investigate the impact of integrating an automated compounding technology (ACT).
This project also provided decision-makers with structured, data-driven insights to support the selection of the most appropriate technology for the specific production needs.

What was done?

A comprehensive analysis to identify the most suitable ACT for our chemotherapy production was conducted.
The approach taken was twofold: first, production data was used to run simulations, allowing for the evaluation of how the different ACTs would perform in our environment.
Second, interviews with international ACT users with hands-on experience were conducted to gather valuable, pragmatic insights.

How was it done?

A detailed examination of the production data was conducted, assessing each ACT’s compatibility with our portfolio (approx. 100 chemotherapy substances). Customized MS-Excel calculation sheets were developed and used to cross-reference drug-specific production metrics (for each drug: total annual preparations, average production time, average transferred volume, other critical parameters). Based on this analysis, the drugs best suited for compounding with each ACT candidate were identified.
Simulations were then run to compare theoretical performance both against current manual compounding and among ACT candidates.
Additionally, the information collected during the interviews was used to develop a comprehensive evaluation of process impacts including: maintenance of quality standards, personnel requirements, potential contamination risks, software integration, microbiological and cleaning aspects, and GMP compliance requirements.

What has been achieved?

This dual methodology enabled a robust evaluation of both theoretical and practical aspects of each system.
Critical technical limitations that could hinder system applicability were identified and the potential proportion of the total compounding workload realistically manageable by ACTs was assessed.
Furthermore actionable, data-driven insights were collected and provided to decision makers to guide strategic decisions.

What next?

The findings are tailored for management decision-makers, enabling them to select the ACT best suited to the pharmacy’s needs without requiring in-depth pharmacy expertise.
Additionally, the methodology from this project can serve as a replicable framework for other hospital pharmacies interested in adopting an ACT.

FROM RISK TO RELIABILITY: ADVANCING HEALTHCARE SAFETY INNOVATIVE WITH SEMI-IV PREMIXED

European Statement

Patient Safety and Quality Assurance

Author(s)

Naila Aljahdali, Hala Al-Buti, Rana AlKhanbashi, Afaf Almalki, Basem Elbehiry, Mohammed El-Kholi, Ahmed Albariqi, Sara Dabab

Why was it done?

Medication errors, particularly in intravenous preparation, delivery, and administration, pose a significant safety concern in healthcare settings. At King Fahd Armed Forces Hospital in Jeddah, delays in IV antibiotic preparation and delivery were identified as critical issues affecting patient outcomes and pharmacy services. The project aimed to decrease the turnaround time between the order and delivery of IV antibiotics to < 20 minutes by December 2025. Also, reduces medication errors and associated costs, and increases healthcare practitioners’ satisfaction with the new Inpatient/IV Pharmacy workflow.

What was done?

Key strategies included tracking short stability and fixed-dose IV antibiotic utilization, configuring the Health Information System for premixed diluent products, incorporating new stock numbers in automated dispensing cabinets, conducting comprehensive training for healthcare practitioners, and satisfaction surveys.

How was it done?

This project implemented semi premixed IV antibiotic bags from August 2023 to August 2025 in Obstetrics and Gynecology, Medical, and Surgical units for Cefazolin 1GM and Meropenem 1GM. Utilized Lean methodology and Plan-Do-Study-Act (PDSA) cycles to optimize workflows. Baseline assessments were conducted to evaluate order-to-delivery times, medication errors, and wastage cost pre/post intervention.

What has been achieved?

The intervention resulted in a significant reduction in turnaround times from an average of 48 minutes to 17 minutes. Medication errors decreased from an average of 47 to 17 incidents, and the number of returned IV medications dropped to zero. The estimated cost savings from reduced waste amounted to approximately 113,382.324 SAR.

What next?

The implementation of semi premixed IV antibiotics significantly improved turnaround time of the medication order and delivery, enhanced patient safety, and increased practitioner satisfaction. The successful application of Lean methodology underscores the potential for broader implementation of this approach across the hospital to further optimize healthcare delivery.

DELIVERY OF COST-FREE HOSPITAL MEDICINES VIA MEDICINE BOXES – THE PATIENT PERSPECTIVE

European Statement

Selection, Procurement and Distribution

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.

DEVELOPMENT OF RECOGNITION PATHWAY FOR ADVANCED SPECIALIST PHARMACISTS IN THE HEALTH SERVICE EXECUTIVE THROUGH TRIPARTITE WORKING BETWEEN EMPLOYER, UNION AND PROFESSIONAL ASSOCIATION.

European Statement

Clinical Pharmacy Services

Author(s)

Richard Sykes – Pharmacist Executive Manager, Portiuncula University Hospital/ Hospital Pharmacists Association Of Ireland
Muriel Pate – Chief II Pharmacist, Health Service Executive
Prof. Judith Strawbridge – School of Pharmacy and Biomolecular Sciences (PBS), Royal College of Surgeons in Ireland

Why was it done?

The development of hospital clinical pharmacy in Ireland has steadily progressed over recent decades. Historically, pharmacists working in the Health Service Executive (HSE) lacked a career structure that recognised specialist-level practice.

What was done?

Following extensive stakeholder negotiations, a validation model was introduced to assess pharmacists’ practice against internationally recognised standards. Pharmacists submitted evaluation forms to a validation panel, which reviewed their evidence. Those meeting the criteria were regraded as Advanced Specialist Pharmacists.

How was it done?

The validation criteria were aligned with the International Pharmaceutical Federation (FIP) Advanced Stage 2 framework, covering six domains: Expert Professional Practice, Working with Others, Leadership, Management, Education, Training and Development, and Research and Evaluation. A panel of pharmacists assessed electronic applications and scored them accordingly. Over 300 Acute Hospital Pharmacists submitted evidence, and those meeting the threshold were deemed to demonstrate advanced practice. These individuals were regraded to the newly created Advanced Specialist Pharmacist grade.

What has been achieved?

The HSE has now formally recognised that pharmacists in acute hospital settings are working at an advanced level. This recognition allows for the direct creation of advanced roles within the health system. A job specification outlining responsibilities and educational requirements has been published, ensuring transparency. Over 200 pharmacists successfully demonstrated specialist practice across a range of specialties and were regraded.

What next?

The creation and appointment of Pharmacists to the grade of Advanced Specialist has now prompted the need for further development. 1. The utilisation of existing Hospital Pharmacists Association Specialist Interest Groups to facilitate peer support for Pharmacists in their specialist roles.
2. A plan to establish a pipeline of Pharmacists to fill new and replacement Advanced Specialist Pharmacist vacancies.
3. Further negotiation to apply the same structures within the service in non acute hospital roles
References
1 .Advanced Specialist Pharmacist resources, Health Service Executive, July 2024, (online) https://www.hse.ie/eng/staff/resources/hr-circulars/hr-circular-016-2024-phase-2-implementation-of-the-mc-loughlin-report-in-hospital-pharmacies.html

CYBER RISK ANTICIPATION: HOW TO GET YOUR HOSPITAL PHARMACY PREPARED IN (ALMOST) 2 HOURS?

European Statement

Introductory Statements and Governance

Author(s)

C. Delage1, P. Troude2, U. Gouot3, V. Bloch1, B. Isabey4, A. Desmons5.
1 Pharmacy Department, Lariboisière-Fernand Widal Hospital, GHU APHP.Nord, Assistance Publique – Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 PARIS
2 Public Health Department, Lariboisière-Fernand Widal Hospital, GHU APHP.Nord, Assistance Publique – Hôpitaux de Paris, 200 rue du faubourg Saint-Denis, 75010 PARIS
3 Information Systems Department, Lariboisière-Fernand Widal Hospital, GHU APHP.Nord, Assistance Publique – Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 PARIS
4 Hospital Executive Management, Lariboisière-Fernand Widal Hospital, GHU APHP.Nord, Assistance Publique – Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 PARIS
5 General Affairs Department, Lariboisière-Fernand Widal Hospital, GHU APHP.Nord, Assistance Publique – Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 PARIS

Why was it done?

With the 2024 Olympic Games approaching, French healthcare institutions faced an elevated cyberattack risk. Preparing healthcare services for such events is essential but often time-consuming, leading sometime to postpone or abandon this work. A rapid, pragmatic methodology was therefore needed to efficiently assess vulnerabilities and define concrete preparedness measures without overburdening teams.

What was done?

A fast-track business continuity plan (BCP) approach was developed by the management department of our university hospital and implemented in the pharmacy department to rapidly assess preparedness for cyber risks and IT disruptions. The structured process mapping allowed each sector to produce an operational continuity plan in only a few hours, evaluating process vulnerability, defining measures to maintain operations during a cyberattack, and identifying needs (new IT equipment, human resources, backup materials).

How was it done?

Dedicated meeting (1-4 hours) were held for each pharmacy sector (medicines, medical devices, sterilisation, radiopharmacy), involving the cyber risk pharmacist referent and sector head. The plan took the form of a table describing all sector processes (eg., procurement, storage, dispensing), their normal functioning and IT requirements (applications, devices, networked medical equipment…). Subsequent columns described degraded functioning and required resources (staff, equipment, premises) at three time horizons: 3 hours, 3 days, and 3 weeks after the start of a cyberattack.

What has been achieved?

Nine BCPs identified 64 processes. In just a few hours, the method provided a clear picture of which sectors/processes were resilient and which were unprepared. It revealed vulnerabilities such as reliance on IT systems and automation, lack of printed procedures, and absence of backup equipment. Simple measures were identified to improve preparedness: printing key documents (eg. hospital formulary), identifying critical data for regular backup, training staff, etc. This rapid diagnostic approach raised awareness among hospital management of resources needed to sustain pharmacy operations during cyber disruption.

What next?

Based on their BCP, each sector took measures to get prepared to IT shutdown. Using professionals’ deep process knowledge to design practical solution to ensure continuity of clinical activity makes preparedness for IT disruption more accessible. Given its simplicity, the methodology was generalised by hospital management to all departments.

RATEC PLATFORM: A REGIONAL DIGITAL SYSTEM FOR THE REQUEST PURCHASE AND HEALTH TECHNOLOGY ASSESSMENT OF MEDICAL DEVICES AND AND IN VITRO DIAGNOSTICS

European Statement

Introductory Statements and Governance

Author(s)

E. Santarossa, F.F. Faccioli, L. Dal Cin, M.C. Libralato, M. Saia, A. Cavazzana
Governo Clinico, Azienda Zero, Padova, Italy
elisabetta.santarossa@gmail.com

Why was it done?

In Italy, regions frequently fail to comply with the spending cap for medical devices (MDs) and in vitro diagnostics (IVDs). Guided by the principles of Regulation (EU) 2021/2282, the RATEC platform employs HTA to facilitate timely access to innovation, promote efficient resource allocation through uniform HTA criteria, and foster collaboration among healthcare organizations (HCOs) to avoid duplicative assessments.

What was done?

The RATEC platform digitizes the regional process for the request and health technology assessment (HTA) of new MDs and IVDs. It was developed within the framework of the NET 2018-12368077 ministerial program, funded by the Ministry of Health and the Veneto Region.

How was it done?

The process starts with the healthcare professional completing a specific form (Non-Urgent MDs/IVDs, Urgent MDs/IVDs, Biomedical Equipment,). After validation by the head of the department, the request is evaluated by the Multidisciplinary Hospital Unit for MDs/IVDs assessment (called UVA-DM). RATEC provides to UVA-DM an HTA methodology with a clearly defined PICO (Population, Intervention, Comparator, Outcome) and includes a Multi-Criteria Decision Analysis (MCDA). The model graphically displays the evaluation outcome (Y: Value, X: Risk) and suggests a decision orientation: innovative technologies for central reporting, technologies to be approved or technologies to be rejected. Technologies defined as innovative are forwarded to the central phase for HTA reports, which will be available to all regional HCOs.

What has been achieved?

By October 2025, 1054 MDs/IVDs purchase requests had been submitted to RATEC, with 695 evaluated by UVA-DM and 13 reaching the central phase for the HTA report. The approved requests are estimated to have an economic impact of € 4,181,740, excluding biomedical equipment. From 2025 onwards, all regional public HCOs must use RATEC for evaluation of MDs/IVDs.

What next?

The RATEC platform is not only a tool for regional governance but a scalable digital infrastructure that fosters transparency, equity, and value-based decision-making in healthcare. Its continuous enhancement aims to expand the model beyond regional borders, positioning RATEC as a best practice for integrating HTA into procurement processes and ensuring rapid, sustainable access to innovation.