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IMPROVING OCCUPATIONAL HEALTH AND PATIENT SAFETY THROUGH AN AUTOMATED MULTIDOSE DISPENSING SYSTEM

European Statement

Clinical Pharmacy Services

Author(s)

P. Frandsen
M. Nissen
C. Olesen

Why was it done?

Medicines dispensed by an automatic multidose dispensing system (ADS) was introduced on an orthopaedic surgery ward to improve the occupational health of pharmacy technicians. The hope was to release time for medication reconciliation, allowing pharmacy technicians to use their professional skills in supporting the orthopaedic surgeons and enhancing patient safety.

What was done?

In the orthopaedic surgery ward, pharmacy technicians manually dispensed medication to inpatients and upon discharge. Prior to dispensing, they compared prescriptions in the hospital electronic patient journal to prescriptions patients receive at home. In case of discrepancies, the orthopaedic surgeon was contacted to make any necessary changes.
Due to pharmacy technicians’ occupational health being affected by long hours dispensing medicines, medicines dispensed by an ADS was introduced. Per agreement with the chief surgeon, pharmacy technicians took on expanded responsibilities, including authority to independently adjust certain prescriptions.

How was it done?

Pharmacy technicians were asked to register time used dispensing medicines and time used reviewing prescriptions before the workflow changes and again after six months.
Semi-structured interviews were conducted with the six pharmacy technicians involved before the workflow changes and again after six months.

What has been achieved?

Total pharmacy technician time spent dispensing medicines per day was reduced from 326 minutes (range: 175–546) to 203 minutes (range: 105–358).
Time spent on prescription review per day increased from 44 minutes (range: 18–77) to 93 minutes (range: 30–170).
Before introducing the ADS, several pharmacy technicians reported physical strain in their hands and mental fatigue after long hours of dispensing.
After the introduction of the ADS, there was a marked improvement in occupational health. Pharmacy technicians, who had experienced strain in their hands noticed improvement, and half of them also reported reduced mental fatigue.
Collaboration with surgeons was mentioned by pharmacy technicians as problematic before the new workflows but significantly improved, with pharmacy technicians feeling their expertise was appreciated by surgeons and ward staff.

What next?

Across Denmark, pharmacy technicians spend hours dispensing medicines in hospital wards. Implementing an ADS could relieve pharmacy technicians, improve occupational health and allow pharmacy technicians to focus on other tasks such as medication reconciliation, which would enhance patient safety.

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.

IMPROVING INTRAVENOUS CHEMOTHERAPY ADMINISTRATION SAFETY VIA SMART INFUSION TECHNOLOGY: ONE-YEAR IMPLEMENTATION AT HYGEIA HOSPITAL

European Statement

Patient Safety and Quality Assurance

Author(s)

IOANNIDIS KONSTANTINOS
SCARLATINIS IOANNIS
KORRE OURANIA
BOTSIOU MARIA
NIKOLAOU KATERINA – ANGELIKI

Why was it done?

The integration of clinical pharmacists in oncology settings plays a critical role in ensuring the safe and effective administration of chemotherapeutic agents. At Hygeia Hospital, over the past five years, clinical pharmacists have identified and prevented 1,272 chemotherapy-related medication errors, corresponding to 2.4 errors per 100 chemotherapy days. Despite this substantial contribution, challenges persist in the administration process by nursing staff, particularly regarding infusion parameters. Common errors include incorrect infusion rates and the omission or improper use of required filters and light-sensitive infusion sets, and their prevention remains a persistent challenge.

What was done?

To mitigate these risks, Hygeia Hospital has implemented parameterized electronic infusion pumps as an additional safety mechanism.

How was it done?

These pumps are pre-programmed by clinical pharmacists with non-modifiable infusion time limits for each chemotherapeutic agent, preventing unauthorized alterations by nursing personnel. Furthermore, the pumps provide mandatory prompts regarding the use of filters or/and light sensitive infusion sets, as specified in the Summary of Product Characteristics (SPC) of each drug.

What has been achieved?

Since their introduction one year ago, these infusion pumps have facilitated the identification and correction of previously undetectable administration errors, with an observed rate of 0.15 errors per 100 chemotherapy days. The majority of these involved incorrect selection of infusion duration by nursing staff. These findings underscore the value of pump parameterization in uncovering latent errors and reinforcing adherence to safe administration practices.

What next?

Future steps include expanding the use of parametrized infusion pumps beyond oncology to other high-risk areas, such as intensive care units, where precise and safe administration is equally critical. By reducing reliance on manual intervention and standardizing administration protocols, this approach enhances the overall safety and efficacy of drug delivery across multiple clinical settings.

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.

NATIONAL FOCUS LIST FOR MEDICINE CHANGES: ENHANCING SAFETY AND EFFICIENCY IN TENDER TRANSITIONS

European Statement

Selection, Procurement and Distribution

Author(s)

Susanne Weng Rømer, Hospital Pharmacy North Denmark Region, Aalborg, Denmark
Alissa Maria Kloppenburg, Hospital Pharmacy Funen, OUH, Svendborg, Denmark
Tania Truelshøj, Hospital Pharmacy Central Denmark Region, Aarhus, Denmark
Benene Rguez, Capital Region Pharmacy, Copenhagen, Denmark
Sine Thagaard Wermuth, Region Zealand Hospital Pharmacy, Roskilde, Denmark
Karen Suhr Lausten, Amgros I/S, Copenhagen, Denmark
Katrine Fridthjof Hougaard, Amgros I/S, Copenhagen, Denmark
Mikala Vasehus Holck, Amgros I/S, Copenhagen, Denmark
Thomas Loof Hedegård, Amgros I/S, Copenhagen, Denmark

Why was it done?

Amgros conducts national tenders for medicines on behalf of Hospital Pharmacies in Denmark. The tenders often result in medicine changes. Previously, each of the eight Danish Hospital Pharmacies assessed every change individually. A national study showed this was time-consuming, duplicative, and produced variable quality. A more coordinated process was needed. The project aimed to centralize the workflows to ensure systematic identification of relevant differences while using fewer resources and supporting safe medicine changes. The Focus List was implemented in August 2025.

What was done?

A national decision support tool – the Focus List for Medicine Changes – was developed to make medicine changes following tenders easier, safer, and more efficient for Danish Hospital Pharmacies. By comparing Summaries of Product Characteristics (SPCs), the Focus List provides a structured overview of clinically relevant differences requiring attention during consumption estimation and clinical implementation.
By centralizing and standardizing assessments, the Focus List improves efficiency by reducing duplication of work, saving resources, and ensuring consistent quality. Ultimately, it supports patient safety by ensuring that potential clinical consequences are identified and addressed proactively.

How was it done?

A working group with representatives from Hospital Pharmacies and Amgros collected experiences and mapped existing workflows. Key parameters for comparison, such as storage conditions, therapeutic indications, and unwanted excipients, were identified. These formed the basis of the Focus List, which systematically presents relevant differences between outgoing and incoming tendered medicines. The Focus List was tested and validated by Hospital Pharmacy staff across all regions, supported by templates and guidance documents to ensure consistent use.

What has been achieved?

The Focus List was well received. Hospital pharmacies reported expected time savings, improved support for estimation processes, and higher quality consistency in identifying clinically relevant changes. The Focus List, including 273 medicine switches, was implemented and replaced the decentralized approach with a more streamlined national workflow.

What next?

A formal evaluation will follow once more experience has been gathered. Future work aims to automate SPC comparisons using AI and expand the Focus List to cover all tender-related changes. This initiative could be replicated in other settings through cross-functional collaboration.

TAKE A BREATH, MAKE IT MULTI! INVOLVEMENT OF A CLINICAL PHARMACIST IN THE MULTIDISCIPLINARY CARE OF PATIENTS WITH CYSTIC FIBROSIS.

European Statement

Clinical Pharmacy Services

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.

DEVELOPMENT OF A NATIONAL ORAL ONCOLOGY MEDICINES DATABASE: ADVANCING TREATMENT OUTCOMES THROUGH DATA INTEGRATION

European Statement

Patient Safety and Quality Assurance

Author(s)

Z. Ćetković, I. Popović

Why was it done?

Due to the specific mechanism of action of oral oncology medicines, these patients require advanced clinical pharmacy services facilitated by information technology to deliver better person-centred healthcare. The purpose of this database is to gather all important information on oral oncology medicines and make them easily accessible, to educate patients and improve their treatment outcomes.

What was done?

A hospital pharmacy team created a national database of oral oncology medicines, which was further integrated into a mobile application compatible with both iOS and Android device. This database included 79 medicines grouped by therapeutic indications, along with indications and dosage, information on administration and storage, interactions with other medicines and food, as well as precautions for the use in special populations.

How was it done?

The initiative was first developed during our national Symposium of hospital pharmacists, and within six months, it resulted in a national database of oral oncology medicines, supported by our Ministry of Health. After selecting a list of medicines, the next step involved creating a database in Excel. All information was straightforward and easy to comprehend for the general population. The final version of the database was thoroughly evaluated, and all issues were carefully addressed. In collaboration with the IT sector, the database was incorporated into the mobile application, available for all patients and healthcare professionals.

What has been achieved?

· Oral oncology medicines database provides evidence-based information on oral oncology medicines and offers medical support to patients taking these medicines at home, thus improving adherence and patient safety. · This database improves patient knowledge. · Situations with different scenarios are available to help manage interactions and various adverse reactions. · Instructions for the use of oral oncology medicines in special populations are available with just one click. · Continuous update by the hospital pharmacists is required to ensure data accuracy and optimal use.

What next?

Our next mission is to promote this database to a broader population of patients through the development of specialised pharmaceutical services, and further expand into interactive communication between patients and healthcare professionals. We intend to regularly update it, as new medicines and information become available.

ENHANCING SAFETY IN CYTOTOXIC DRUG PREPARATION THROUGH SIMULATION-BASED TRAINING

European Statement

Production and Compounding

Author(s)

Bennani I.,Cherif Chefchaouni A.,Alaoui S., Hajjaj S., El Deeb S., Boufaress S., Hafidi Y., El Merrakchi S., Moukafih B., Bandadi F., El Kartouti A.

Why was it done?

A structured training programme was established to improve cytotoxic drug preparation in our hospital pharmacy. The initiative combined updated Standard Operating Procedures (SOPs), simulation sessions using non-hazardous substitutes, and debriefings focused on error prevention and occupational safety.

What was done?

Cytotoxic preparation carries significant risks: dosage errors compromise patient safety, while inadequate protective measures expose staff to hazardous drugs. Audits in our unit revealed inconsistent practices and insufficient adherence to safety protocols. A reproducible, safe method of training was needed to harmonise techniques and reduce risks.

How was it done?

The initiative was implemented through a structured program combining simulation sessions, observation checklists, and debriefing meetings. Teams were trained using standardized SOPs and dummy materials, allowing safe practice of aseptic techniques. Performance indicators were measured before and after simulation training to assess impact on safety and compliance.

What has been achieved?

More than 60 pharmacists and technicians have completed the programme. Error rates in cytotoxic preparations decreased by about 30%, and environmental monitoring showed a 25% reduction in contamination markers. Surveys confirmed improved confidence (92%) and adherence to protective measures (95%). The training is now part of our hospital’s continuous education system.

What next?

The programme will be extended to all new pharmacy staff and residents. Plans include developing e-learning modules and inter-hospital workshops to spread the model nationally and internationally.

FROM COLLABORATION TO AUGMENTATION: INTEGRATING AN ARTIFICIAL INTELLIGENCE (AI)-POWERED DOSING TOOL INTO A PHYSICIAN–PHARMACIST COLLABORATIVE WARFARIN CLINIC (PPCC-AI MODEL) — A QUASI-EXPERIMENTAL STUDY AT TAKUAPA HOSPITAL, THAILAND.

European Statement

Clinical Pharmacy Services

Author(s)

daruni sitthikan

Why was it done?

Warfarin management is complex due to its narrow therapeutic index and wide interpatient variability. Although the physician–pharmacist collaborative clinic (PPCC) model has improved anticoagulation outcomes, genetic variability remains a key challenge, as pharmacogenomic (PGx) testing is rarely available in Thai hospitals. To overcome this, an AI-based dosing tool (WarfaWise web application) was developed to assist clinicians in personalizing warfarin therapy without genetic testing.

What was done?

To evaluate the effectiveness of an AI-assisted dosing tool (WarfaWise web application) integrated into the PPCC model (PPCC–AI Model) for optimizing warfarin therapy at Takuapa Hospital, Thailand.

How was it done?

This quasi-experimental study included patients (≥18 years) who received warfarin for ≥3 months (January 2023–May 2025). The WarfaWise web-based AI dosing application was incorporated into the PPCC workflow to predict individualized weekly warfarin doses based on patient-specific parameters (age, sex, weight, comorbidities, concomitant drugs, adherence, and INR trends). The primary outcome was the percentage of Time in Therapeutic Range (%TTR). Secondary outcomes included dosing accuracy (Mean Absolute Error: MAE) and incidence of bleeding or thromboembolic complications. Statistical significance was set at p<0.05.

What has been achieved?

A total of 230 patients were enrolled. The AI-assisted PPCC demonstrated superior dosing precision (MAE=2.09±1.20 mg/week) and significantly improved mean %TTR (primary outcome) from pre-intervention 65.10±1.09% to post-intervention 71.4±8.6% (p<0.02). The incidence of minor bleeding decreased by 69.5%, and no major bleeding or thromboembolic complications occurred during the study period. Pharmacists also reported enhanced workflow efficiency and a reduction in dosing calculation errors. In conclusion, the study showed that the PPCC-AI model demonstrated superior dosing precision, enhanced INR control, and improved patient safety. This pragmatic digital innovation facilitates the scalable adoption of AI-assisted clinical decision-making tools in resource-limited settings where PGx testing is inaccessible, underscoring the evolving role of pharmacists in precision anticoagulation management.

What next?

To develop a mobile application that is easily accessible and free of charge, and can be used in hospitals at all levels.

IMPROVING INTRAVENOUS CHEMOTHERAPY ADMINISTRATION SAFETY VIA SMART INFUSION TECHNOLOGY: ONE-YEAR IMPLEMENTATION AT HYGEIA HOSPITAL

European Statement

Patient Safety and Quality Assurance

Author(s)

IOANNIDIS KONSTANTINOS
SCARLATINIS IOANNIS
KORRE OURANIA
BOTSIOU MARIA
NIKOLAOU KATERINA-ANGELIKI

Why was it done?

The integration of clinical pharmacists in oncology settings plays a critical role in ensuring the safe and effective administration of chemotherapeutic agents. At Hygeia Hospital, over the past five years, clinical pharmacists have identified and prevented 1,272 chemotherapy-related medication errors, corresponding to 2.4 errors per 100 chemotherapy days. Despite this substantial contribution, challenges persist in the administration process by nursing staff, particularly regarding infusion parameters. Common errors include incorrect infusion rates and the omission or improper use of required filters and light-sensitive infusion sets, and their prevention remains a persistent challenge.

What was done?

To mitigate these risks, Hygeia Hospital has implemented parameterized electronic infusion pumps as an additional safety mechanism.

How was it done?

These pumps are pre-programmed by clinical pharmacists with non-modifiable infusion time limits for each chemotherapeutic agent, preventing unauthorized alterations by nursing personnel. Furthermore, the pumps provide mandatory prompts regarding the use of filters or/and light sensitive infusion sets, as specified in the Summary of Product Characteristics (SPC) of each drug.

What has been achieved?

Since their introduction one year ago, these infusion pumps have facilitated the identification and correction of previously undetectable administration errors, with an observed rate of 0.15 errors per 100 chemotherapy days. The majority of these involved incorrect selection of infusion duration by nursing staff. These findings underscore the value of pump parameterization in uncovering latent errors and reinforcing adherence to safe administration practices.

What next?

Future steps include expanding the use of parametrized infusion pumps beyond oncology to other high-risk areas, such as intensive care units, where precise and safe administration is equally critical. By reducing reliance on manual intervention and standardizing administration protocols, this approach enhances the overall safety and efficacy of drug delivery across multiple clinical settings.