Author(s)

Christina Theil Schnor and Saranya Loganathan.

Why was it done?

In 2018, hospitals in Region Zealand (RZ), Denmark, transitioned to the electronic health record (EHR) system, EPIC. Following this, hospital pharmacists faced repeated medication order challenges causing adverse events such as inappropriate medication orders, dispensing and administration errors, and insufficient workflow coordination. These issues resulted in complex, time-consuming workflows impacting quality and patient safety. Additionally, collaboration between corporate IT and clinical staff was challenged by a lack of understanding of practical issues. To address this, pharmacists of RZ established the Clinical Pharmaceutical Service IT Team (CPS IT Team) to build specialized knowledge of the EHR medication module, aiming to assure quality, optimize workflows, strengthen interdisciplinary coordination, and support safer and more efficient clinical use.

What was done?

CPS IT Team standardized workflows, enhanced coordination of medication order tasks, and created a forum to effectively utilize professional knowledge and networks across areas.

How was it done?

To address diverse Clinical Pharmacy challenges, CPS IT Team became the bridge between internal organization (RZ Hospital Pharmacy and corporate IT) and external partners (EPIC and The Capital Region of Denmark (CRD)). For this reason, CPS IT Team was established with one team manager and two units: Internal and External unit. CPS IT Team continuously adapts to evolving Clinical Pharmacy needs.

What has been achieved?

The establishment of CPS IT Team has driven significant internal optimization and standardized workflows. Acting as a coordinating unit, it optimizes medication processes from ordering to dispensing and administration. Dialogue with IT has been strengthened, enabling more efficient, targeted communication across professional groups.
Collaboration with EPIC and CRD has enhanced quality assurance and optimized workflows. CPS IT Team efforts have helped prevent medication-related adverse events, improve workflows, and optimize medication processes. Interdisciplinary collaboration and professional consultation networks between regional clinics, hospital pharmacies, IT, and EPIC have been notably strengthened. These efforts have increased patient safety and fostered a safer, more coherent workflow in EPIC.

What next?

Fusion of RZ and CRD into Region Eastern Denmark will change CPS IT Team’s working conditions, opening new opportunities such as an expanded collegial network and broader range of tasks and needs. Systematic data use will support Hospital Pharmacy’s work, improving efficiency and quality in daily operations.

Author(s)

P.Chu, W.Short, L.Bailey, S.Williams, D.Moss and LA Bissell

Why was it done?

This improvement initiative addressed national recommendations following the United Kingdom Parliamentary Inquiry in 2023 into homecare services calling for improved processes and systems. Homecare represents over half of the medicines spend for Leeds Teaching Hospitals (LTH). Rheumatology serves the largest clinical cohort with over 3,500 patients receiving homecare medicines. This project aimed to address service gaps in safety, communication and efficiency to ensure delivery of high-quality, patient-centred care.

What was done?

Using the Kaizen-based Leeds Improvement Methodology (LIM) modelled through an intensive, week-long event, this project aimed to optimise the homecare process within Rheumatology. Objectives included improving workflow efficiency for prescription batching, query tracking and enhancing the patient-staff communication model, thereby increasing overall patient and staff satisfaction. Multiple process changes were implemented to improve overall efficiencies.

How was it done?

Triumvirate team buy in was crucial for the success and facilitation of this event because it required one week of multidisciplinary team (MDT) engagement from representatives in all stages of the process flow. Iterative Plan-Do-Study-Act (PDSA) cycles were used to test improvements. Value Stream Mapping supported the visualisation of workflow and identified non-value-adding activities. Quantitative data and emotional touchpoint surveys informed changes throughout this event and acted as ongoing metrics to monitor impact.

What has been achieved?

• A single, co-located MDT homecare hub was established, facilitating a streamlined, one-piece flow and minimised delays.
• An electronic text messaging system alerted patients to required blood tests to facilitate safe prescribing, this replaced postal notifications and supported the sustainability agenda.
• Prescription lead time decreased by 71% from 24 days to 7 days.
• Volume of work in progress reduced by 30%.
• Staff satisfaction relating to process efficiency rose from 24% to 65%.
• Staff satisfaction relating to morale rose from 0% to 60%.
• Incident reports and formal patient complaints were 0 by day 90.

What next?

The LIM framework and MDT approach resulted in significant enhancements in operational efficiency, communication and improved patient experience. The measured outcomes aligned with national recommendations for increased transparency and accountability. The project established a scalable and sustainable model by empowering staff to effect change. The next step is to review practice in other therapy areas to translate these improvements Trust wide.

Author(s)

Nonia Ferreras López, Irene de la Fuente Villaverde, Blanca de la Nogal Fernández, Virginia Martínez Fernández, Eva Martínez Álvarez, Zulema Rodríguez Fernández, Henar García Lagunar, Raúl Martínez, Miriam Rodríguez María.

Why was it done?

A Multidisciplinary Biological Therapy Committee for Airway Diseases (BTCAD) was established in a secondary-level hospital. The committee integrated pulmonologists, ENT specialists, allergists, pathologists, and hospital pharmacists (HPs) to optimize the use of biological therapies (BTs). Its main functions included patient evaluation, development of consensus-based protocols, and structured monitoring of treatment outcomes.

What was done?

The initiative was introduced in 2022 to address the absence of standardized decision-making processes for BTs in severe uncontrolled asthma and chronic rhinosinusitis with nasal polyps. Prior to implementation, therapeutic selection was fragmented and lacked uniform criteria. The primary aim was to improve appropriateness of BT use, reduce variability in clinical practice, and ensure optimal patient outcomes through a coordinated multidisciplinary approach.

How was it done?

The BTCAD defined clinical and laboratory criteria for patient selection, developed a consensus document for BT positioning, and designed workflows for dispensing and follow-up. Monthly meetings were held to evaluate cases, supported by a shared calendar and a structured database. Educational sessions were organized to update staff knowledge. Obstacles included the requirement for strong managerial support and the impact of staff turnover on continuity. These were mitigated by formalizing procedures and ensuring standardized documentation and training.

What has been achieved?

From March 2022 to March 2025, 54 patients were assessed: 49 with severe asthma and 5 with chronic rhinosinusitis with nasal polyps. Treatment was discontinued in two cases due to lack of efficacy, and seven patients were switched to alternative BTs. At follow-up, 52 patients remained on therapy (17 benralizumab, 20 mepolizumab, 7 omalizumab, 6 dupilumab, 2 tezepelumab). The HP contributed to patient evaluation, drafting of reports, pharmacovigilance, and adherence monitoring. A survey revealed that all members reported increased knowledge, 87,5% considered the pharmacist’s role essential, and overall satisfaction reached 4,38/5.

What next?

The BTCAD improved coordination, standardization, and professional development within the hospital. Its model is transferable to other healthcare settings, providing a framework for safe and efficient BT implementation. The high satisfaction and demonstrated value of multidisciplinary collaboration, particularly the HP’s role, support its consideration as an example of good practice.

Author(s)

RAZEYRE Charlotte, QUINTARD Adeline, BAROUX Gaëlle

Why was it done?

Since 2019, the pharmaceutical team (PT) dedicated to advanced therapy medicinal products (ATMPs) in our institution has been integrated into the care pathway of patients treated with CAR-T cells. The PT intervenes upstream of the first medical consultation through an optimized medication reconciliation (OMR), then 48 hours before apheresis to ensure its update and compliance with wash-out periods. Prior to CAR-T infusion, a pharmaceutical consultation is conducted to update the OMR, explain the different steps of the pathway, and address patients’ questions. All data are recorded in the electronic medical record. Quality support materials are also provided to healthcare teams. In this context, we aimed to assess healthcare professionals’ satisfaction with these interventions in order to identify opportunities for practice improvement.

What was done?

To collect and analyze feedback from healthcare professionals involved in the CAR-T pathway regarding the activities and tools implemented by the pharmaceutical team.

How was it done?

A questionnaire was designed using Google Forms by the ATMP-PT and disseminated by e-mail to professionals involved in the CAR-T pathway. It covered several domains: respondent’s role, knowledge and use of OMR and checklists, perceived relevance of pharmaceutical consultations, and satisfaction with quality documents.

What has been achieved?

All professionals involved in the pathway were contacted, with at least one response from each professional group except apheresis physicians. Only 42% of respondents reported being aware of and using OMR during their consultations. However, 86% considered pharmaceutical consultations relevant and were satisfied with their contribution to the CAR-T pathway. In addition, 71% were satisfied with the quality documents, while the remaining respondents reported not using them. Regarding potential improvements, one respondent suggested that the PT should be more involved during the patient’s hospitalization.

What next?

This study highlights the overall positive perception of the PT’s interventions. Nevertheless, the responses reveal limited use of some tools, particularly OMR and checklists, whose impact remains difficult to assess in the absence of feedback from apheresis physicians the main intended users. These findings underscore the need to further raise awareness among healthcare teams about these tools, in order to optimize their integration into the care pathway and strengthen interprofessional coordination.

Author(s)

Gilak G., Lakatos-Krepcik A., Breyer-Kohansal R., Sailer G.

Why was it done?

In Austria, people with Cystic Fibrosis (CF) receive interdisciplinary care from various professional groups at specialized treatment centers. The European Cystic Fibrosis Society recommends the integration of pharmacists into the multidisciplinary CF team, emphasizing medication management, patient education, and adherence support. Increased access to CF transmembrane conductance regulator modulator therapies in recent years has conferred significant benefits to patients in multiple ways. However, these highly effective drugs are known to have a high potential for drug–drug interactions.

What was done?

The current medication of adult patients was reviewed by a clinical pharmacist. Individualized medication counselling, education, and specialized support in cases of drug shortages were provided to patients. To evaluate the quality of the pharmaceutical consultation and the benefits derived from it, patients were invited to complete an anonymous questionnaire.

How was it done?

During their visit to our specialized CF outpatient clinic, patients were offered the opportunity to consult a CF pharmacist. Together with the patient, a comparison was conducted with the previously documented medication list. Additional or differently taken medications, as well as the results of the interaction analysis, were documented in the electronic patient record and logged in a specifically developed data collection tool. Once a week, the respective data of these patients were discussed within the multidisciplinary team.

What has been achieved?

37 patient consultations took place between 11/24 and 04/25. Patients took an average of 9.7 medications, additionally 1.6 medications were recorded following inquiry by the clinical pharmacist. In total 120 drug related issues were identified. These issues included adverse drug reaction management (25%), instructions for use (25%), formal criteria for written prescriptions and drug shortage (17%), patient adherence concerns (13%), indications/contraindications (13%), and dose adjustments (7%).
An average of 2.7 drugs per medication, which were not taken in accordance with the current prescription plan, were identified by the clinical pharmacist.
All patients stated that the consultation with the clinical pharmacist was very helpful or helpful and 96% of patients indicated that they now feel confident in taking their medications correctly.

What next?

In the future, pharmaceutical CF care will be formally established in the form of a periodic review at the CF center of our clinic.

Author(s)

Patricia Fumero Cruz, Emma Ramos Santana, Nuria Ramos Santana, Montserrat González García, Mónica Mederos Betancort, Álvaro Crespo González, Mª Pilar Díaz Ruiz

Why was it done?

Paediatric palliative care requires an integrated approach combining medical management with safe, effective and tailored pharmacotherapy for each child and family. Many essential medicines lack age-appropriate formulations, limiting symptom control and increasing the risk of dosing errors. To address this unmet need, the hospital pharmacy developed a structured pharmaceutical care programme ensuring the preparation, dispensing and follow-up of individualised compounded medicines, promoting safety, adherence and equitable access to treatment.

What was done?

A pharmacy-led programme was implemented for all paediatric patients cared for by the Paediatric Palliative Care Unit (PPCU). It integrates a specialised pharmacy consultation, individualised compounding, direct dispensing to families in the Outpatient Unit and continuous follow-up. The intervention, in collaboration with the PPCU team (three paediatricians and two nurses), ensures a coordinated and patient-centred approach.

How was it done?

All paediatric palliative patients were included. Pharmacists reviewed medical history, previous treatments and specific needs. The pharmacy prepares personalised formulations (gabapentin, clonidine, baclofen, levodopa/carbidopa, clobazam, topiramate, methadone, ondansetron, among others) adapted to age, weight and tolerance.
Dispensing frequency is adjusted to stability and expiry, mostly monthly, and accompanied by educational materials and visual guides for caregivers.
The programme covers all costs and records each dispensing to monitor adherence, stability and efficacy. Pharmacotherapeutic follow-up is conducted through in-hospital or home consultations coordinated with the PPCU.

What has been achieved?

– Better symptom control (pain, anxiety, nausea).
– Greater safety and fewer medication errors at home.
– Improved adherence and family satisfaction.
– Fewer avoidable hospital admissions.
– Enhanced role of hospital pharmacists within the multidisciplinary team.
The programme ensures equitable access to medicines unavailable in suitable paediatric forms, establishing a personalised, empathetic and patient-centred care model for children and families.

What next?

The next phase includes evaluating clinical outcomes and perceived wellbeing using indicators of safety, adherence and satisfaction. The model aims to be replicated in other hospitals with paediatric compounding capacity and to foster an inter-hospital collaborative network to share protocols and best practices.

Author(s)

Aparicio Lucas L, Somoza Fernández B, Collados Arroyo V, Baselga Soto I, Mayo López C.

Why was it done?

A Multidisciplinary Unit for Comprehensive Care of Complex Chronic Patients was implemented in our hospital to provide integrated, patient-centered care. The initiative established a structured process in which each patient is assessed during a single visit by a coordinated team involving Nursing, Pharmacy, and Internal Medicine.

What was done?

Complex chronic patients often experience frailty, polypharmacy, and fragmented follow-up across multiple specialties, increasing the risk of adverse events, poor adherence, and reduced quality of life. Prior to the initiative, care was delivered through separate consultations with limited communication between professionals. As a result, patients frequently missed appointments due to travel difficulties, became confused by medication changes, or received inconsistent instructions.

The project aimed to enhance the quality and continuity of care, optimize pharmacotherapy, and reduce complications through a coordinated, multidisciplinary model that streamlined hospital visits and minimized unnecessary referrals.

How was it done?

The project was developed in four stages:
1. Planning meetings with Internal Medicine and Nursing to define objectives
2. Design of a standardized operations procedure and patient circuit
3. Pilot implementation
4. Measurement of outcomes.
Patients were referred to the unit based on predefined criteria (frailty, polypharmacy, multiple medical follow-ups). Obstacles such as limited staff availability and coordination between departments were addressed through regular team meetings to streamline workflow and ensure communication.

What has been achieved?

Since its implementation in March 25, 68 patients have been assessed, with 123 drug-related problems identified. Pharmacist interventions achieved a 79% acceptance rate (97/123). The model improved communication among professionals, enhanced medication safety, and optimized patient visits by avoiding unnecessary appointments.

What next?

Long-term evaluation of clinical and financial outcomes is ongoing. The standardized, collaborative approach makes this model easily transferable to other hospitals, adaptable to their resources and organization. It represents a sustainable example of good practice in multidisciplinary management of complex chronic patients.

Author(s)

Virginie Deroche, Ilias Bensouna, Fanny Ponce, Karl-Dietrich Hatz, Nicolas Jauniaux, Amina Benomar, Isabelle Debrix, Florence Federspiel, Laure Raymond, Laurent Mesnard

Why was it done?

Within our hospital, exome sequencing is routinely performed for adults with unknown nephropathy or genetically-suspected Chronic Kidney Disease (CKD), offering not only molecular diagnosis but also underutilized PGx insights. Frequently polymedicated CKD patients could greatly benefit from PGx data to improve medication adherence and optimize their treatment proactively.

What was done?

We designed a pharmacogenetic (PGx) circuit to provide personalized care in nephrology and kidney transplantation.

How was it done?

Following nephrology medical examination and blood sampling, patients received medication reconciliation and counseling with a pharmacist to complete their current treatment list, and to gather past intolerance, adverse events, potential inefficiency and over-the-counter drugs. Meanwhile, a biologist and a bioinformatician analyzed their PGx profiles through exome sequencing data. A pharmacogenetic expert combined these data with medication reconciliation into a PGx report including dosing guidelines based on international recommendations (CPIC, DPWG guidelines). Patient cases were reviewed during multidiciplinary consultation meetings (MCM), to offer personalized treatment and ensure medication safety. MCM reports were integrated into eletronic health record and stored for later use.

What has been achieved?

Out of the 766 patients who underwent exome sequencing, 148 had a medication reconciliation. 88 patient cases were discussed during 27 MCM, which began in October 2024. 100% of these patients received at least one recommendation regarding drug dosing or contraindications, totaling 345 recommendations including immunosuppressants, analgesics and cardiovascular drugs.

What next?

To go further, we aim to efficiently share PGx information to healthcare providers including treating physician, to design a website to educate patient about PGx testing, and to deliver PGx results to patients during a dedicated consultation.

Author(s)

Noemi Tatti, Melania Rivano, Giacomo Bertolino, Valentina Mureddu, Raffaele Deidda, Arianna Cadeddu

Why was it done?

Patients are required to attend a follow-up visit every three months for viral load testing. A collaborative protocol has been implemented to facilitate treatment adherence, monitoring, and access to medication.

What was done?

Collaboration between the immunology department and the hospital pharmacy facilitated the management if drug therapy in HIV-positive patients, enhancing access to care and improving treatment adherence.

How was it done?

The visit schedule is shared monthly. Each patient is assigned an alphanumeric code to ensure anonymity. Any change in appointments, test results, visits, or therapy regimens is also communicated. Through the hospital’s electronic system, pharmacists can access each patient’s treatment plan, review the dates of medication pickups, and verify treatment adherence. In case of discrepancies, these are promptly reported to the physician before the patient’s next visit. Additionally, sufficient medication to cover three months of therapy is prepared in advance for each patient, simplifying the dispensing process and preventing unnecessary hospital visits.

What has been achieved?

This initiative has optimized adherence monitoring, which is particularly important for this category of patients. It has also facilitated the drug dispensing process. By reducing waiting times and hospital visits, it has improved treatment compliance and ensured the protection of their privacy. This project was implemented on 792 patients, and from 01/10/2024 to 01/10/2025, a total of 1,369 dispensations of antiretroviral drugs were carried out.

What next?

This approach has been used to improve the quality of care and overall experience of this patient group. We hope that it will soon be extended to all patients who collect their medication at our hospital.

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.