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ELECTRONIC PRESCRIPTION INTEGRATION: ACHIEVING 98% COVERAGE AND REDUCING TRANSCRIPTION ERRORS

European Statement

Patient Safety and Quality Assurance

Author(s)

VB Pinto, CSA Souza, NL Mizutani, RP Santos, MA Dias, ACP Sforsin

Why was it done?

The unification of two outpatient prescription platforms into a single, institutional electronic system was carried out. The initiative was led by a multidisciplinary team (pharmacists, physicians, and systems analysts) from a public, tertiary care hospital.

What was done?

Despite the high rate of electronic prescribing (92%), the coexistence of the two systems generated data fragmentation, rework, and exposed patients to unnecessary risks of transcription errors. The central objective was, therefore, to unify the process to universalize the use of electronic prescribing and, consequently, reduce transcription errors, strengthening patient safety and pharmaceutical care.

How was it done?

The intervention took place between July and September 2025. Actions included the technical integration of the systems into a single platform, the development of new standardized prescribing protocols, and training for prescribers. The impact was evaluated by monitoring the electronic prescribing coverage percentages and transcription errors rates at the outpatient level before and after implementation.

What has been achieved?

The integration demonstrated fast and significant results. Electronic prescription coverage increased from 92% to 98% in just one month after unification. In parallel, there was a progressive and sharp reduction in transcription errors: from 8.5% (pre-implementation) in July to 2.7% in September (after integration), representing a 68% decrease in the manual correction rate.

What next?

This initiative demonstrates the importance of technological unification for the advancement of Hospital Pharmacy. The model is highly replicable for other institutions dealing with fragmented electronic prescribing systems. The integration of systems has a direct and measurable impact on patient safety, establishing universal electronic prescribing as an efficient care standard and proof against transcription errors.

IMPLEMENTATION OF PRIORITIZATION CRITERIA IN MEDICATION REVIEW ACTIVITY IN GERIATRIC MEDICINE: AN EIGHT-MONTH STUDY

European Statement

Clinical Pharmacy Services

Author(s)

A. GHORBEL, C. KONN, J. CATROUX, J. TISSERAND, P. ROCANIERES

Why was it done?

Polypharmacy and multimorbidity make medication safety a major challenge in geriatric medicine. Medication reconciliation and review are essential but time-consuming processes that cannot be systematically performed for all patients. Prior, we made a systematic review of the French literature which identified multiple prioritization approaches – empirical, statistical, and consensus-based – but no harmonized tool. Common criteria included advanced age, polypharmacy, psychotropic use, high-risk medications, and chronic diseases such as heart failure. Then, we aimed to translate these findings into a pragmatic, locally adapted prioritization grid to improve targeting and workflow efficiency.

What was done?

An initiative was developed in the geriatric department of a French University Hospital to introduce prioritization criteria for medication review (MR) at admission. The aim was to optimize pharmacists’ clinical activity by identifying high-risk patients most likely to benefit from a MR, given the limited available resources.

How was it done?

A prospective, observational, comparative study was conducted over 13 months (early June 2024 – end June 2025) in neuro-geriatrics and onco-geriatrics. During the 8 last months, pharmacists applied a prioritization grid daily based on clinical and pharmacological criteria (≥ 5 medications, renal impairment, psychotropics, high-risk drugs). Indicators before and after its implementation were compared using a two-sample Z-test (α = 0.05).

What has been achieved?

After implementation, 295 admission and 48 discharge MR were performed (vs 272 and 31 before prioritization). The initiative allowed the targeted inclusion of patients with a mean age of 87 ± 6 years and an average of 10 ± 4 chronic medications. The most frequent prioritization criteria identified were renal impairment, use of “never-event” drugs (methotrexate, insulin, colchicine, oral chemotherapy and anticoagulant drugs), antibiotic therapy, electrolyte disorders, and diabetes. Average MR time rose (113 vs 105 min; 89 vs 47 min), reflecting higher case complexity.

What next?

Defining common prioritization criteria could support national recommendations and enable the development of digital tools integrated into hospital information systems to automatically identify high-priority patients. In the future, it is planned to use these results to create decision rules from artificial intelligence software: it could generate dynamic prioritization models based on real-time clinical, biological, and therapeutic data, embedded into dispensing software to improve patient safety and optimize pharmaceutical care.

DEVELOPMENT OF DEDICATED INFORMATION BROCHURES TO IMPROVE THE MANAGEMENT AND SAFETY OF PAEDIATRIC GALENIC MEDICINAL PREPARATIONS

European Statement

Patient Safety and Quality Assurance

Author(s)

S. GAMBA1, M. FRANCHINA1, M. GIACONIA1, C. INTRA1, M. CASTIGNONE1, E. PANETTA1, G. D’ARENA1, C. PERASSO1, P. BARABINO1, G. SPIGA2.
1IRCCS GASLINI, HOSPITAL PHARMACY, GENOVA, ITALY.
2IRCCS GASLINI, CLINICAL GOVERNANCE, GENOVA, ITALY

Why was it done?

Paediatric galenic preparations are essential for neonates, patients with rare diseases, and those requiring highly individualised treatments or unable to swallow solid dosage forms, for whom no commercial alternatives exist. Despite widespread use, there is a significant need for accessible, user-friendly guidance to support correct home administration. Lack of clear instructions increases the risk of dosing errors—particularly during dose conversion or with multi-dose containers—a safety concern highlighted by regulatory bodies such as the Italian Medicines Agency (AIFA). To address this, the initiative aims to improve the safety and effectiveness of home administration through a personalised educational brochure for patients, caregivers, and healthcare professionals.

What was done?

A personalised brochure was created to guide patients and caregivers in the safe home administration of paediatric galenic medicines. It covers therapeutic indications, composition, storage, dosage and conversion, posology, management of missed doses, potential interactions and side effects, and instructions for medicine collection from the hospital pharmacy. A satisfaction questionnaire is distributed at dispensing to gather feedback for iterative improvements.

How was it done?

The brochure was developed collaboratively by pharmacists and prescribing physicians to ensure accuracy and consistency, so that all patients receive standardised information. Written in plain language and supported by icons, it is easy to understand. A QR code linking to a digital version allows continuous access via smartphone. Feedback from the questionnaire informs ongoing refinements.

What has been achieved?

This initiative reflects the evolving role of hospital pharmacies toward a clinical, patient-centred, and collaborative model. The brochure serves as both an informative resource and a practical tool for patient empowerment, improved communication, and enhanced care quality. In paediatrics—where treatments require heightened attention—this tool bridges the information gap, supporting patients and caregivers and increasing medication safety.

What next?

Ongoing feedback will be used to refine the brochure and digital resources. The initiative will expand to additional paediatric units and be adapted for other patient groups requiring complex or individualised therapies. Collaboration between healthcare professionals and families will continue to ensure accuracy, usability, and patient-centred design. Long-term monitoring will assess the impact on medication safety, adherence, and clinical outcomes, with potential wider application across other therapeutic areas and hospital settings.

ERRORS IN MEDICATION RECONCILIATION : A COLLECTIVE RISK ANALYSIS APPROACH TO DEVELOP A PRODUCTION-TYPE SAFETY SYSTEM WITHIN A CONTINUOUS IMPROVEMENT FRAMEWORK IN CLINICAL PHARMACY

European Statement

Patient Safety and Quality Assurance

Author(s)

E. WILLIAM1, K. TLILI1, L. WANG1, A. TARRE1, A. BENOMAR1, M. EL HUSSEINI1, S. OUABDELKADER2, I. DEBRIX1, F.FEDERSPIEL1
1 : HÔPITAL TENON, PHARMACIE À USAGE INTÉRIEUR, PARIS, FRANCE.
2 : HÔPITAL TENON, DIRECTION QUALITÉ ET GESTION DES RISQUES, PARIS, FRANCE.

Why was it done?

Medication reconciliation (MR) is a widely recognized process for preventing medication errors (ME). However, the step involving the preparation of the” Best Possible Medication History (BPMH) is a complex process, itself subject, like any production process, to potential errors. This means that inaccurate or incomplete BPMHs can be generated, in contradiction with the high level of reliability implicitly expected of the final product. However, to our knowledge, current recommendations do not describe a dedicated risk management model for this process, and published studies addressing ME potentially induced by MR itself are scarce.

What was done?

The aim of this work was to consider the BPMH preparation process as a full-fledged production process and, as such, to develop a dedicated safety model by identifying potential or previously described error risks, existing safety measures, and actions to be implemented within a continuous quality improvement framework.

How was it done?

A systemic analysis method, FMECA (Failure Modes, Effects, and Criticality Analysis) was chosen to collectively assess the relative criticality of each identified risk, with the aim of establishing specific safety principles for this process.

What has been achieved?

Seven analysis meetings took place over six months, bringing together 3 to 5 senior pharmacists, 1 to 3 junior pharmacists, and one quality manager. The analysis identified 49 generic hazards and 62 associated risks. The most critical risks were related to identity vigilance, the completeness and reliability of sources used, the specificity of high-risk drugs, data recording, and the pharmacotherapeutic consistency of the final BPMH. Discussions confirmed the role of common cognitive biases in the occurrence of potential, often overlooked errors. The proposed safety system therefore mainly focused on strengthening awareness of typical error risks during MR, formalizing a self- and double-check checklist, and developing a dedicated non-conformity reporting form.

What next?

This systemic analysis contributed to a collective awareness of the persistent risk of errors in a process that may appear, at first glance, to be well controlled. The analysis of non-conformities through a dedicated experience feedback committee (CREx) will confirm the value of a dynamic and collective approach in the more global management of errors in clinical pharmacy.

OPTIMIZING STERILE AND IMPLANTABLE MEDICAL DEVICE CIRCUITS: CONTRIBUTION OF THE INTERDIAG DMS® TOOL

European Statement

Patient Safety and Quality Assurance

Author(s)

Khalil MEDDINE, Yasmine EL YOUSSOUFI, Madiha ALAMI CHENTOUFI, Houda ATTJIOUI, Driss TANANI, Abdelhafid BENOMAR

Why was it done?

To identify performance gaps and critical points within the sterile and implantable medical device circuits, with the aim of guiding targeted improvements and ensuring safer, more reliable management of these devices.

What was done?

A multidisciplinary self-assessment of the sterile and implantable medical device circuits was carried out using the Interdiag DMS® evaluation tool.

How was it done?

The evaluation was conducted using the Interdiag Excel file, which includes dedicated modules for sterile and implantable medical devices. The analysis focused on the tool’s implementation, the objectives of the self-assessment, the resulting action plans, and feedback obtained throughout the process.

What has been achieved?

The assessment highlighted strong performance in information systems and traceability for implantable devices, but weaknesses were identified in their documentation management. For sterile medical devices, major deficiencies were observed in quality management, transport, and return/disposal processes (10–20% compliance), while pharmacy premises and demand management showed moderate performance (50–60% compliance). These findings allowed for the implementation of targeted corrective actions.

What next?

The findings will guide ongoing targeted improvements, enhance coordination among healthcare stakeholders, and foster a sustainable culture of quality and safety in medical device circuits.

MEDICAL DEVICE HUNT: A PLAYFUL LEARNING APPROACH IN A HOSPITAL PHARMACY DEPARTMENT

European Statement

Education and Research

Author(s)

S. EL BOURY, B. CHAVENT, C. DUSSART, L. DERAIN

Why was it done?

Recognising medical devices is a key skill for hospital pharmacy professionals to ensure correct management and optimal patient safety. However, traditional training sessions were often theoretical and failed to stimulate engagement or long-term retention. This initiative was therefore developed to promote active learning, improve device recognition, and strengthen team collaboration in a fun and motivating way.

What was done?

A playful educational activity called “Medical device hunt” was created within the hospital pharmacy department. Inspired by an Easter egg hunt, this initiative encouraged staff to explore, identify, and learn about medical devices through an interactive and engaging game.

How was it done?

Over three days, sixteen medical devices (e.g. vascular stent, guedel airway, cardiac pacemaker) were hidden within a defined area of the pharmacy, each carrying a letter to form a mystery word. Participation was open to all pharmacy staff, including technicians, pharmacists, residents, students, and logistics agents, either individually or in teams. The top hunters were rewarded. A debriefing session, open to both participants and non-participants, presented informative cards on each device’s function and clinical use were, followed by a satisfaction questionnaire.

What has been achieved?

A total of 13 staff members participated, mainly pharmacy technicians (76.9%), with a success rate of 69.2%. All participants discovered at least one device and reported learning new information about its use. Satisfaction was high, with 92,3% declaring themselves “very satisfied.” Engagement extended beyond the game itself, as seven non-participants joined the debriefing session; among them, 85.7% were “very satisfied” and 71.4% reported having learned through the informative cards. The initiative strengthened awareness and knowledge of medical devices while fostering teamwork, communication and curiosity across the department.

What next?

The Medical Device Hunt demonstrated the benefits of gamified learning in a hospital pharmacy setting. Future editions will feature improved communication and longer participation time. The concept could also be adapted to other educational topics such as medication errors or risk management, further supporting a culture of continuous learning and safety within the department.

QUALITY MANAGEMENT SYSTEM: INTERNAL AUDITS. RESULTS OF THE AUDIT ACTIVITY CONDUCTED AT THE FACILITIES OF A UNIVERSITY HOSPITAL

European Statement

Patient Safety and Quality Assurance

Author(s)

Francesca Cammalleri, Giorgia Bo, Roberta Cutaia, Maria Laura Savi

Why was it done?

This project was initiated to institutionalize auditing as a standard, effective quality and safety tool. Our motivation was twofold, reflecting our commitment to patient care: first, to define and standardize audit procedures consistent with UNI EN ISO 9001; second, and most critically, to ensure safety action by verifying that correction plans drive real, measurable changes in medicine management, directly enhancing patient safety on the wards

What was done?

Between January 2024 and March 2025, a total of 14 structured internal audits were conducted. The verification cycle systematically assessed quality and safety compliance using a specific Checklist (incorporating UNI EN ISO 9001 requirements) and targeted inspection tools for pharmaceuticals specific areas. All findings and critical issues were formally documented in the ‘Internal Audit Report’ to ensure official follow-up

How was it done?

The auditing process utilized a systematic, structured approach. After distributing the comprehensive annual audit plan, verification was conducted using a checklist integrated with UNI EN ISO 9001 requirements. Recognizing drug management risks, pharmacist managers utilized the ‘Department Ward Cabinets Inspection Report’ for in-depth checks on storage conditions and restricted access. Findings were consolidated in the ‘Internal Audit Report’, initiating a resolution phase where minor non-conformities were resolved immediately, while others were formally scheduled for verified follow-up during the subsequent 2025 inspection cycle

What has been achieved?

The assessment established a high level of safety compliance, with all audited units demonstrating full compliance regarding optimal storage conditions and restricted access. Crucially, the audit cycle proved effective in identifying high-risk issues: three units were flagged for failing to separate narcotic drugs and concentrated potassium solutions, alongside two units maintaining excessive drug stock. Only one major non-conformity was identified across all units. This systematic approach resulted in a clear, actionable plan for continuous quality enhancement

What next?

The program is undergoing systematic follow-up and has led to immediate expansion: audits are continuing into 2025, with verification cycles already initiated in new, complex areas like surgical units. Furthermore, we have scheduled the full revision and update of the Pharmaceutical Management Document by the end of 2025. This continuous audit cycle is now a permanent cornerstone of our Quality System, driving sustained improvement and formal policy reinforcement

IMPLEMENTATION OF A TECHNICAL PLATFORM IN A PHYSICOCHEMICAL CONTROL LABORATORY : OPERATIONAL OUTCOMES AND FUTURE OPTIMIZATION

European Statement

Patient Safety and Quality Assurance

Author(s)

B.Ben Houria, F.ElKara , M.Ben Messaoud, M.Bizid, A.Tabbabi, S.Gmati

Why was it done?

Improving the performance of quality control laboratories is crucial to ensure the quality, safety and regulatory compliance of medicines. Ongoing challenges, including fragmented workflows and limited traceability, highlighted the need for a structured and harmonized operational model. To address this, a technical platform was established within the physicochemical control laboratory of a National Agency for Medicines and Health Products to consolidate resources, streamline work organization and align analytical activities with international standards and best practices.

What was done?

A technical platform was implemented to reorganize analytical activities, restructure laboratory areas by function and strengthen quality assurance practices. The initiative included assessing the existing system, defining functional analytical zones (e.g. spectroscopy, High Performance Liquid Chromatography (HPLC)…), optimizing equipment allocation and appointing an equipment manager to coordinate scheduling, oversee maintenance and ensure operational traceability. Then, a performance evaluation matrix was developed and applied to objectively assess the effectiveness of the newly implemented technical platform and identify areas requiring further improvement.

How was it done?

This descriptive and comparative study combined documentary analysis, on-site observation and review of international guidelines. The methodological approach comprised three steps:
1-Assessment of the existing system : Review of the laboratory’s organization, equipment, analytical processes and human resources to identify factors influencing overall performance.
2-Structuring of the technical platform and performance evaluation: Organization by instrument specialization and the use of structured matrix.
3-Comparison with international standards : Scientific literature and reports from European reference laboratories were reviewed to benchmark the implemented technical platform against international standards.

What has been achieved?

The platform was implemented in July 2025 through a spatial and functional reorganization that improved methodological coherence, reduced unnecessary sample manipulation and increased equipment utilization. The designation of an equipment manager contributed to better planning, coordinated instrument scheduling and enhanced workflow oversight, thereby reinforcing operational continuity. Performance matrix results indicated satisfactory compliance across key domains: infrastructure (100%), human resources (50%), equipment (75%) and quality assurance (50%). These outcomes confirm the solid implementation of the technical platform while highlighting the need to strengthen documentation, staff training and performance monitoring.

What next?

Future developments will focus on digital integration through paperless analytical workflows, automated test scheduling and real-time electronic traceability to enhance data integrity and predictive performance analysis. Gradual introduction of artificial intelligence, while respecting regulatory data confidentiality, offers promising opportunities to predict analytical deviations, optimize equipment use and improve resource management. Ongoing monitoring of Key Performance Indicators (KPIs) and continuous staff development will be essential to maintain and sustain long-term performance improvements.

IDEA BOX: INVOLVING HOSPITAL PHARMACY ASSISTANTS IN A QUALITY APPROACH

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European Statement

Patient Safety and Quality Assurance

Author(s)

Adeline HERLIN, Hermine ZIGA, Pauline PAYOT

Why was it done?

The aim is to continuously improve quality and efficiency.

What was done?

In the interests of continuous quality improvement, we have set up a suggestion box in the pharmacy’s unit repackaging sector.

How was it done?

We have set up a suggestion box for technician and pharmacists.
Each person can submit ideas or questions, anonymously or not.
After one month, the box was unpacked. The ideas and queries were analysed and discussed.

What has been achieved?

Eight points were raised.
 One point concerns procedures.
The existing procedures on the intranet network are not well known to users. We have provided an easy-to-access binder.
 Three points relate to packaging methods (list of products according to packaging method, removal of expired packaged products, mismatch of the Eticonform® label with the blister pack).
A decision tree was made (Euraf®: large quantities, multi-dose vials, magistral formula, small blister packs). The printing of the ledgers indicates the packaged products and their expiry dates. The removal of expired products is done according to the ledgers. A precaution must be taken when editing labels Eticonform® “laboratory” labels. Indeed, the size of the blister packs differs from one laboratory to another.
 The fifth point concerns the organization.
Technicians wish a storage area dedicated to repackaged specialties to compensate for stock errors.
After discussion, we did not retain this proposal.
 The other point concerns the lack of equipment.
A stool and a ruler were provided.
 The penultimate point concerns the use of returns from services in multi-dose vials.
We propose the packaging of small units with expiry dates < 3 months with the Euraf® bagging machine.
Otherwise (e.g. Carbimazole), we propose the packaging of sufficient quantities for 7 days in the vials with pre-printed labels with an expiry date of one week.
 The last point concerns the labelling of blisters with desiccant capsule (e.g. Nicorandil).
We offer Eticonform® re-labelling with a statement: USE BY xx/xx/202x (30 days after re-labelling).

What next?

The involvement of the technician team in a proactive approach to risk management is essential. We wanted to harness their practical expertise and energize the team.
The box will be integrated into our current practice.

EXCEPTIONAL HEALTH SITUATIONS: OBSERVATION OF AN IMMERSIVE EXERCISE IN THE HOSPITAL PHARMACY AND FEEDBACK

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European Statement

Patient Safety and Quality Assurance

Author(s)

Delphine BODEN, Laura RODRIGO, Rachel MAHE, Olivier SELLAL, Maxime PARE, François RONDEAU

Why was it done?

The main objective was to test the activation of our Pharmacy-Sterilization-Operational-Unit (PS-OU), established in December 2022, and to work on its interaction with the others OU of the different hospital services. The second aim was to continue the training of pharmaceutical teams on exceptional health situations (EHS).

What was done?

In March 2024, our hospital pharmacy (HP) took part in an inter-departmental exercise based on the scenario of managing a massive influx of polytrauma victims at our hospital. The quick engagement of mobile medical units and sterilization department, dependent on the HP, is indeed a key element in the optimal care of victims, whether in hospital or pre-hospital.

How was it done?

Two interns and one pharmacy technician, with an analysis framework, were in attendance as observers through the exercise. During the PS-OU activation, various points were observed: global crisis management, task assignment and communication between the members, data centralization and communication with the others OU, efficiency and speed of response to problems… A feedback questionnaire was then sent to the 9 main players (PS-OU members, on-call pharmacist…). Intra-HP and inter-departmental feedback were provided immediately, then a posteriori.

What has been achieved?

For 3 hours, our HP had activated its OU to provide the best possible response to this exercise. The observation of this exercise pointed out the rapid activation and efficiency of the PS-OU (by the on-call pharmacist, on the order of the head of department), so a great intern and extern communication. Areas for improvement were raised, such as the optimization of available tools. 89% of players answered the feedback questionnaire. The communication was considered operational and the PS-OU essential by all the respondents. They also feel that this type of exercise is needed (75%) and helps prepare them for EHS (88%).

What next?

Aims of this exercise were achieved. Preparing, hosting and then analyzing this kind of exercise, although seemingly time-consuming, enables us to validate and, where required, consolidate the intended organization for EHS. These results also strengthen our determination to pursue our annual exercise program. Shortly, an exercise with the supply members of our PS-OU will be organized, in order to train the less experienced members as well.