Author(s)

Nabaa Dhuhaibawi, Cristin Ryan, Fionnuala Kennedy

Why was it done?

Climate change is a major global health threat, and healthcare contributes approximately 4–5% of global greenhouse gas emissions. Pharmaceuticals account for around one-quarter of this total through production, packaging, distribution, and disposal. Hospitals are under increasing pressure to reduce medicine waste and their associated carbon footprints. Automated Dispensing Cabinets (ADCs) — electronic systems for storing and issuing medicines at the point of care — improve medication safety and efficiency, but their environmental benefits have not been well studied. Understanding whether ADCs can reduce the carbon footprint of dispensed medicines is therefore essential for promoting sustainable healthcare practices.

What was done?

This study evaluated the impact of ADC implementation on the carbon footprint of dispensed oral medicines in an acute hospital in Dublin. A secondary objective was to examine the carbon footprint distribution of all single-ingredient oral medicines in the hospital formulary, identifying future opportunities for reducing medicine-related emissions.

How was it done?

A retrospective before-and-after study was conducted across six inpatient wards where ADCs were introduced between December 2023 and May 2024. Dispensing data were collected for equivalent two-week periods before and after the intervention using the Isoft® system. Only oral active pharmaceutical ingredient (API) medicines were included. Each medicine’s carbon footprint (gCO₂eq) was obtained from the Ecovamed® database and analysed using descriptive statistics and the Wilcoxon signed-rank test (α = 0.05). For the secondary analysis, all single-ingredient oral APIs from the hospital formulary were classified by their Medicine Carbon Footprint (MCF) rating using the YewMaker® database.

What has been achieved?

The total carbon footprint of dispensed medicines decreased from 262.58 kg CO₂eq before ADC implementation to 176.94 kg CO₂eq after. Among 99 medicines dispensed in both periods, the median carbon footprint per medicine fell significantly from 644 to 352 g CO₂eq (p < 0.001; r = –0.37). In the formulary analysis, most medicines had low (31.7%) or medium (35.2%) MCF ratings, while only two items—abiraterone acetate and methenamine hippurate—had very high (>1000 g CO₂eq) values.

What next?

ADCs appear to significantly reduce medicine-related carbon emissions, suggesting that digital automation supports sustainable pharmacy practice. Future efforts should target high-MCF drugs, promote greener procurement, and expand environmental life-cycle data to maximise carbon reduction across hospital pharmacy services.

Author(s)

Dr Sian Williams, Dr Ella Graham-Rowe, Dr Sarah Chapman and Prof John Weinman

Why was it done?

Non-adherence contributes significantly to preventable harm and waste across health systems. Although pharmacy professionals are well placed to intervene, evidence suggests that current approaches are limited in effectiveness. The aim of this initiative was to provide multi-sector professionals with a shared framework and tools to support adherence, improving patient care and consistency across services.

What was done?

A training programme was developed to improve pharmacy professionals’ confidence and capability in identifying and addressing medication non-adherence. The training was delivered to qualified pharmacists, foundation pharmacists, and pharmacy technicians across NHS Sussex, with a focus on practical skills and evidence-based behavioural change strategies.

How was it done?

The training, developed in collaboration between the University of Brighton and the Centre for Adherence Research and Education at King’s College London, consisted of three components. First, participants completed an online module introducing the causes, types, and consequences of non-adherence. This was followed by a four-hour interactive face-to-face workshop, where attendees were trained in the COM-B (Capability, Opportunity, Motivation – Behaviour) model, the ‘Making Medicines Work for You’ screener, and five practical adherence support strategies based on evidence-based behaviour change techniques. A follow-up online session four weeks later allowed participants to reflect on applying the screener in practice and to share experiences. Cross-sector representation enabled peer learning and discussion of implementation in diverse settings.

What has been achieved?

The initial training reached 26 pharmacy professionals who completed pre- and post-surveys on confidence and practice in identifying and supporting adherence. Analysis showed improved perceived skills and access to tools. A follow-up session revealed early successes alongside barriers, including time pressures in busy settings and challenges embedding the tool into systems that support routine practice.

What next?

This initiative provides an evidence-based model for embedding adherence support into pharmacy practice. It is transferable across integrated care systems and healthcare settings. Future plans include ongoing evaluation and extending training to other clinical teams and policy decision-makers.

Author(s)

Ella Graham-Rowe, Sian Williams, Sarah Chapman and John Weinman

Why was it done?

Non-adherence to prescribed medicines remains a global problem, associated with poor health outcomes and increased healthcare costs. Despite pharmacists’ central role in addressing adherence, undergraduate education often lacks practical, evidence-based training. This initiative aimed to equip students early in their professional development with the skills and confidence to identify and support patients with adherence challenges.

What was done?

A structured programme on medication adherence was developed and embedded into the second year of the Master of Pharmacy (MPharm) degree at the University of Brighton. The training introduced students to an adherence screening tool, key behavioural frameworks, and practical support strategies, with opportunities to practise in simulated scenarios and while on placement.

How was it done?

Academic staff were first trained by the Centre for Adherence Research and Education (King’s College London) to deliver their structured programme. The training was then delivered to undergraduates over three two-hour face-to-face workshops. Workshop one explored types and causes of non-adherence using the COM-B (Capability, Opportunity, Motivation – Behaviour) model. Workshop two introduced five evidence-based behaviour change strategies. Workshop three allowed students to apply these skills using the ‘Making Medicines Work for You’ screener in simulated consultations. Learning materials and scenarios were co-developed with practising pharmacits to reflect authentic pharmacy practice.

What has been achieved?

All second-year students completed the training in the 2024–2025 academic year and were assessed in end of year OSCEs. Feedback highlighted notable improvements in students’ consultation and communication skills, along with greater empathetic engagement with patients. Learners described the tools and exercises as engaging and supportive, boosting their confidence in supporting patient adherence.

What next?

This initiative demonstrates that evidence-based adherence training can be effectively integrated into the undergraduate pharmacy curriculum. The approach is transferable to other institutions and may improve medicines optimisation in future clinical practice. In 2025–2026, these students will apply their learning during practice placements across multiple sectors. Further evaluation will explore impact on student performance during placements.

Author(s)

Ciuciu David, CD; Campabadal Prats, C; Salom Garrigues, C; Romero Denia, M; Suñer Barriga, H; Pascual Carbonell, D; Bejarano Romero, F; Canadell Vilarrasa, L.

Why was it done?

The integration of Hospital Pharmacy Residents (HPr) into primary care (PC) services represents an essential step toward strengthening the continuity of care between hospital and community health centers. Through this collaboration, safe, efficient, and evidence-based pharmacotherapy is promoted, while keeping the patient at the center of the healthcare system. By involving HPr in multidisciplinary teams, the program aims to enhance medication management, optimize therapeutic outcomes, and reduce the incidence of adverse drug events.

What was done?

To describe the role of the HPr in PC services and demonstrate the importance of their contribution to well-keeping relationships between primary and specialized care.

How was it done?

The involvement of the HPr in PC services was classified into clinical, educational, and management activities. To develop their activities, a HPr rotation was scheduled and carried out within a Healthcare Management area, responsible for overseeing 20 PC centers and 20 nursing homes (NH). Within this area, the PC pharmacy team consists of eight pharmacists who perform medication reviews across.
Rotation steps:
Training: HPr receives instruction on PC protocols, quality indicators, and digital tools, including prescription management and indicators recording systems.
Clinical review: HPr evaluates prescriptions, modify treatments based on clinical evidence, and apply a person-centered approach, focusing on complex chronic and institutionalized patient’s guidelines.
Multidisciplinary collaboration: Take an active part in meetings with general practitioners (GP), nurses, and PC pharmacists to discuss patient cases and optimize pharmacotherapy.
Health education: Provide training to nurses and GP residents on rational drug use, adverse reactions, and sustainability.
Evaluation: Oversee the impact of pharmaceutical interventions and suggest continuous improvement measures.

What has been achieved?

A total of 416 interventions were recorded, distributed as follows:
56.7%: Drug discontinuation due to non-adherence, not indication or therapeutic simplification.
23.1%: Therapeutic switches for efficiency.
7.7%: Changes to another molecule.
6.7%: Regimen deintensification.
4.8%: Regimen intensification.
Additionally, 46 interventions were conducted in NH:
52.2%: Drug discontinuation due to overcontrol or lack of indication.
23.9%: Regimen deintensification due to overcontrol.
17.4%: Therapeutic switches for efficiency.
6.5%: Drug initiation due to lack of control.

What next?

The participation of HPr in PC resulted in a significant increase in pharmaceutical interventions, which contribute to safer, more effective and efficient pharmacotherapy and promotes superior coordination between healthcare levels. Also contributed to the education of family and community medicine residents, enhancing their skills in managing complex chronic patients. This experience demonstrates the value of integrating pharmacy residents into primary care and may be replicated in other hospital pharmacy services with similar organizational structures.

Author(s)

Lorenzo Di Spazio, Daniele Mengato, Andrea Ossato, Vera Damuzzo, Marco Chiumente, Giulia Dusi, Sabrina Trippoli, Andrea Messori, Maria Cecilia Giron, Maria Chiara Silvani, Francesca Venturini

Why was it done?

Pharmacist’s activities on MDs are mainly linked to governance, management and vigilance but little to clinical pharmacy practice. In order to study and develop interventions aimed at optimizing the use and compliance of medical devices on patients, a national survey was conducted to identify the clinical pharmacy experiences already consolidated in this field.

What was done?

Clinical pharmacy activities that demand specialized expertise in medical devices (MD) constitute a relatively uncharted territory for hospital pharmacists. Our aim, through a nationwide survey, was to delineate the clinical responsibilities overseen and handled by hospital pharmacists that necessitate a specific focus on MDs.

How was it done?

A 54-question survey, available from 1 October 2022 to 31 December 2022, was created by a pool of experts from an Italian scientific society (Italian Society of Clinical Pharmacy and Therapeutics – SIFaCT) and shared through Google Forms. The questions, divided into six sections, were related to five clinical areas defined by the working group: surgery room (SR), wound care (WC), vascular access management (VAM), patient education on diabetes treatment technologies (DTT) and MD in oncology and artificial nutrition (ON).
The questionnaire allowed us to define the state-of-the-art of clinical pharmacy on MDs, highlighting the activities and training needs of the participants.

What has been achieved?

We received 142 responses. In particular, emerged that 42% of participants adopted standard kits in the SR and 76% of them declared the pharmacist involvement.
A specific team for WC was created for 35% of participants, with the involvement of the pharmacist in 90% of cases, in particular as consultant role in 22%.
37% of participants declared the presence of a team dedicated to VAM, with the involvement of the pharmacist in 40% of cases and patient counselling in 9%. Finally, in DTT and ON the pharmacist was involved in 8% and 10% of the responses, respectively.

What next?

This first national survey shows that the pharmacist is often involved in multidisciplinary groups in the five analyzed areas, but less involved in patient’s counselling probably due to the sub-optimal training in the field of MDs. Indeed, almost all the participants declared the need to improve their knowledge in this field and create a network among colleagues.

Author(s)

Ana Helena Ulbrich, Amanda Fonseca, Catherine Isoppo, Henrique Dias

Why was it done?

The motivation behind NoHarm stemmed from the time-consuming nature of the prescription review process, which required clinical pharmacists to assess not only drug interactions but also factors such as appropriateness, effectiveness, safety, adherence, and affordability of drug therapies. NoHarm was envisioned as a solution to systematize the workflow and provide cross-referencing of essential drug and inpatient information, thereby addressing these issues.

What was done?

The NoHarm initiative was developed to address challenges faced by clinical pharmacy teams during the prescription review process in a hospital setting. This open-source intelligent system was introduced to enhance the medication review process. The initiative was executed in a 420-bed public hospital in Brazil over a 17-month period to evaluate its impact on prescription reviews.

How was it done?

The implementation of NoHarm involved integrating the system with the hospital’s electronic health records to collect and compute all inpatient data. NoHarm utilized a drug knowledge base and intelligent algorithms to identify and alert healthcare professionals about inpatient risks. The algorithms were designed to cross-reference patient laboratory results with drug thresholds, adjust for liver and renal function, analyze drug usage patterns at the hospital, and extract patient risk factors from clinical notes, including diseases, adverse events, symptoms, and biometric data.

What has been achieved?

The number of medications assessed increased dramatically from 17,000 to 2,643,957 within the 17-month period, all while maintaining the same team size. Improved prescription review rates, rising from 65% to 94%, demonstrate the effectiveness of the system. Furthermore, these improvements in prescription reviews resulted in better clinical pharmacy services and contributed to reducing medication errors and associated risks in patient care at the hospital.

What next?

NoHarm is an open-source solution and an example of good practice in healthcare due to its achievements in streamlining prescription reviews and enhancing patient safety. Its successful implementation led to increased efficiency, higher prescription review rates, and substantial cost savings, showing its potential as a model for other healthcare settings. Its prospective global applicability makes it a solution to address medication errors and elevate the standard of care in healthcare institutions worldwide.

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Author(s)

Pilar Lalueza Broto, Laura Domenech Moral, Alba Pau Parra, Ángel Arévalo Bernabé, Danae Anguita Domingo, Anna Rey Pérez, Jacinto Baena Caparrós, Marcelino Baguena Martínez, María Queralt Gorgas Torner, Mónica Rodriguez Carballeira

Why was it done?

The four-year specialist training program for Hospital Pharmacy in Spain includes one year of clinical training, involving rotations through various medical units where residents develop their clinical skills. This forms an essential component of clinical proficiency and integration into the healthcare team.

The Intensive Care Unit (ICU) was chosen because the presence of a pharmacist during rounds as a full member of the care team has been associated with a reduced rate of adverse drug events.

What was done?

We developed a standardized medication audit tool to ensure uniform pharmaceutical care delivery, aligned with the Hospital Pharmacy Specialty training program.

How was it done?

We designed a pharmacotherapeutic monitoring chart containing biodemographic and clinical data, analytical parameters, and clinical issues for each patient. A multidisciplinary team, comprising staff physicians and pharmacy resident tutors, identified the most common clinical problems or key issues for different types of patients admitted to critical care units, as well as specific clinical problems related to particular pathologies. Pharmacotherapeutic recommendations were based on clinical evidence or internal protocols. Common key issues included nutritional support, fluid resuscitation, thromboembolic prophylaxis, hemodynamic monitoring, infection management, drug monitoring, and sedative and analgesic therapy. We defined specific efficacy and safety indicators for each clinical problem. Additionally, we monitored specific outstanding problems in particular patient types.

We also implemented a model for recording and coding pharmaceutical interventions.

What has been achieved?

The pharmacotherapeutic monitoring chart has enabled us to establish standards for pharmaceutical care in the ICU, promoting consistency among the entire care team and optimizing pharmacotherapy outcomes in patients. It also facilitates the assessment of residents’ skill acquisition during their training.

What next?

In the future, assessing the tool’s usefulness and its impact on residents’ training benefits will be of interest. Moreover, it may serve as a reference model for other clinical rotations.

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Why was it done?

A wide range of women sustain a perineal tear after delivery with a need of perineal repair. If the suture material fails to last as expected, women might experience wound rupture, impaired healing, and inferior functional outcome.
A clinical observation of increased risk of early breakage of the suture material in women anaesthetized with Xylocaine spray for perineal tear repair, compared with women anaesthetized with Xylocaine gel led to this study. Thus, in an observation period of 9 months 79% of the women who had to go through early secondary wound repair due to suture failure, had received local anesthesia in the form of Xylocaine spray.
The Clinical Pharmacy was contacted by the Obstetric Department with the following inquiry; whether there is a pharmaceutical interaction between local anaesthetics and the suture material.

What was done?

An in-vitro experiment to compare the tensile strength of fast absorbable suture material when impregnated with various agents for local anaesthesia was performed.

How was it done?

An in-vitro experiment was performed in collaboration between midwives, pharmacists and the Danish Technological Institute. We impregnated 120 suture materials divided in four groups (Xylocaine Spray, Xylocaine gel, Isotonic Sodium Chloride and Ethanol 96%) for 72 hours at 37 degrees and then measured the tensile strength of the suture material.

What has been achieved?

In the experiment we saw that Ethanol and Xylocaine spray weakened the tensile strength of fast absorbable sutures. Use of Xylocaine spray containing ethanol for local anesthesia might lead to early breakdown of the suture material and wound rupture.
After the experiment the majority of obstetric departments in Denmark changed their procedure for local analgesia/anaesthesia during perineal repair from Xylocaine Spray to Xylocaine gel.

What next?

Observing and registering the suture breakage percentage in a period of 9 months after application of Xylocaine gel.
Publishing the results at a broader level.

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Author(s)

NOELIA VICENTE-OLIVEROS, CARMEN PALOMAR FERNANDEZ, TERESA GRAMAGE-CARO, PAULA BURGOS BORDEL, MARÍA DEL CARMEN CALATAYUD SÁNCHEZ, SANDRA CASADO ANGULO, ANA MARTÍN ÁLVARO, MARÍA BEGOÑA RIVERA MARCOS, SONALI KARNANI KHEMLANI, MANUEL VELEZ-DIAZ-PALLARES, ANA ALVAREZ-DIAZ

Why was it done?

Patients with moderate-severe psoriasis require systemic hospital-dispensed treatments. Hospital pharmacists look for actions to anticipate patients’ needs for achieving health outcomes and the system’s sustainability.

What was done?

We stratified psoriasis patients according to the pharmaceutical care needed and established their pharmaceutical care plan. We calculated the time needed in pharmaceutical care after stratification.

How was it done?

An observational, prospective, cross-sectional study was conducted in a university hospital. One hundred psoriasis patients who received medication in the outpatient hospital pharmacy were randomly chosen between March-May 2022.
Capacity-Motivation-Opportunity (CMO) pharmaceutical care model (SEFH, 2018) was used to stratify patients. This model consisted of 23 variables (demographic, clinical, pharmacological, socio-sanitary, cognitive and functional). Each variable scored between 1-4, depending on patient risk. Patients were classified on three levels which determined the subsequent pharmaceutical care to be provided to each patient:
1. global score≥31 points,
2. 18-30 points and
3 ≤17 points.
Information was collected through patients’ interviews and electronic health records review.
A group of nine pharmacists were set up to adapt the CMO pharmaceutical care model to our hospital.
Total time spent in pharmaceutical care was obtained through patient visits before and after stratification. The scheduled average time for each visit was 10 minutes. The number of visits pre-stratification was the sum of all the visits scheduled for the patients, and for post-stratification was the sum of all the visits with the new CMO model (level 1 (biannual), 2 (annual), 3 (as needed).

What has been achieved?

Most patients were stratified on level 3. A pharmaceutical care plan has been designed to meet the needs of each patient.
Stratification has improved the time pharmacists have to accomplish the needs of each patient (16.3 hours/year (98 visits)). Sixty-two percent of patients had as needed visits (level 3), 36% needed annual visits (level 2) and 2% biannual (level 1). However, during pre-stratification, most the patients (70%) had every nine months visits, 18 % every 12 months, 9% every six months and 3% every three months.

What next?

We will expand the stratification to the rest of the psoriasis patients and other outpatient pathologies.
We will coordinate strategies with Social and Psychological Services, Primary care and Community pharmacy to improve pharmaceutical care.

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Author(s)

Andrea Bor, Nóra Gyimesi, Eszter Erika Nagy

Why was it done?

Intervention-oriented classification systems are helpful tools to document the CPIs in a structured manner. Our aim was to develop a clinical pharmacy platform in the e-documentation system at our institution. This CPI data enables healthcare providers to track medication history, and to systematically analyse the effectiveness and the pharmacoeconomic benefits.

What was done?

A pilot survey was conducted on the traumatology wards to analyse and describe our clinical pharmacist interventions (CPI) based on severity and clinical relevance.

How was it done?

Three clinical pharmacists collected data on the changes of drug therapy at two 31-bed traumatology wards during pre- and postoperative period. We adopted the CPI classification system to our daily practices. This is challenging since the narrow time frame between patient admission and discharge often limits the opportunity to provide clinical pharmacy services. Raw data was previously screened and classified into 5 categories, drug related problems (DRP), clinical pharmacist intervention (CPI), significance (S), outcome (O) and acceptance (A).

What has been achieved?

We have established a data collection process, which allows us to record CPIs in our daily clinical environment in an efficient manner.
The most significant DRPs were incorrect dosage regimen (n=47), untreated indication (n=28), contraindication (n=25), excessive dose (n=19), subtherapeutic dose (n=17), drug interaction (n=15), no indication (n=11), experiencing adverse drug reaction (n=8), failure of drug administration due to shortages (n=5).
CPIs were divided into four groups:
1. Pharmacokinetic cause (dose adjustment, changes of drug dosage regimen, drug discontinuation, drug switch, etc.)
2. Pharmacodynamic cause (adding new drug, drug switch, – discontinuation, etc.),
3. Providing drug information (patient education, new drug, changes of administration route, etc.) and
4. Miscellaneous.
Significance were categorised as major (e.g. oral anticoagulant – LMWH switch, postoperative opioid use), moderate (e.g. loop diuretics – ion supplementation), minor.
Outcomes were therapeutic success, prevention of potential harm (e.g. adverse drug reaction) or cost saving.
73% of the interventions were accepted, the rest were rejected for the first time, but nearly half of them were admitted after minor modifications.

What next?

This CPI platform should be shared in the national digital health system.