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 specialised knowledge of the EHR medication module, aiming to assure quality, optimise workflows, strengthen interdisciplinary coordination, and support safer and more efficient clinical use.

What was done?

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

How was it done?

To address diverse Clinical Pharmacy challenges, CPS IT Team became the bridge between internal organisation (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 optimisation and standardised workflows. Acting as a coordinating unit, it optimises 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 optimised workflows. CPS IT Team efforts have helped prevent medication-related adverse events, improve workflows, and optimise 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)

Naila Aljahdali, Hala Al-Buti, Basem Elbehiry, Mohammed AlZahrani, Hani AlZahrani, Jalal Alharbi, Raien Algaidi, Ali AlZahrani, Wael AlZahrani

Why was it done?

Medication adherence is a global challenge, with nearly half of patients failing to take prescribed therapies consistently. This issue contributes to avoidable hospitalisations, treatment failures, and increased healthcare costs. At King Fahd Armed Forces Hospital (KFAFH) in Jeddah, medication refills are identified as a critical issue affecting both patient outcomes and pharmacy workload, and as key barriers to optimal care. This project aimed to improve patient medication adherence and satisfaction while also reducing pharmacy staff workload.

What was done?

ADHERE Initiative was implemented as value-added services (VAS) include: home medication delivery services (HMDS) integrated with digital health tools (delivery refill tracking, telepharmacy consultations) and streamlined logistics, patient education, and feedback loops. A multidisciplinary team oversaw implementation. Performance was monitored and evaluated.

How was it done?

This Quality Improvement (QI) project was conducted from November 2023 to June 2025, using the Plan Do-Study-Act (PDSA) methodology. Baseline data were collected on patient adherence, satisfaction, and pharmacy workload. Root cause analysis was performed using a fishbone tool. ADHERE Initiative was introduced as an intervention to address identified barriers.

What has been achieved?

The real-world data shows that Patients’ Medication Adherence improved by 51%, and HMDS uptake grew substantially from a negligible start (1%) to sustained levels around 30–44%, surpassing the target in several months. Waiting times improved to around 7 minutes after interventions, indicating reduced in-person demand. Delivery performance was strong inside Jeddah with rapid same-day/24-hour delivery for most patients, while outside Jeddah deliveries reliably reached patients within 2–3 days. Estimated refill-related counter workload reduced by ~40%, freeing staff for clinical duties.

What next?

ADHERE Initiative significantly improves patient medication adherence, enhance patient satisfaction, and reduces pharmacy workload. It highlights the dual benefit of technology-enabled pharmacy services for both patients and healthcare providers. Also, it represents a scalable model for healthcare institutions to transform patient-centre ed care in Saudi Arabia.

Author(s)

Supparat Chanprasert, Watsa Charoenwaiyachet, Thanawan Chuenjit , Katemanee Udomkiattikul, Anut Sakulsupsiri, Thanayu Techa-in.

Why was it done?

Among 3,500 PLHIV treated at KCMH, only one-third accessed infectious disease clinics where clinical pharmacists provide criteria-based pharmaceutical care. The remaining 70% received treatment at other clinics, where medications were dispensed without adherence assessment. Addressing this gap was essential to improve quality of care.

What was done?

A standardised protocol for pharmaceutical care of people living with HIV (PLHIV) was implemented. The initiative introduced structured adherence assessment at outpatient dispensing units and an integrated referral process to clinical pharmacists.

How was it done?

Outpatient HIV care was streamlined by coordinated efforts among physicians, nurses, HIV coordinators, and pharmacists. A clinical pharmacist developed two new tools for dispensing process: ‘Short Screening’ for regimen choice, dosage adjustment, and detection of drug interaction or adverse effect, and ‘Short Check’ for adherence and barrier identification. Any concerns from screening pharmacists were informed to dispensing pharmacists for further review. Simple issues were addressed at the counter with respect to patient rights, while complex cases or PLHIV with poor adherence were referred to clinical pharmacists for in-depth interventions. Cases were evaluated and classified as needed urgent intervention, planned intervention, or no intervention for clinically stable patients or with viral suppression. Pharmacists enhanced a resolute EMR system for follow-up scheduling and monitoring documentation. Training sessions were conducted prior to implementation to promote consistency in practice.

What has been achieved?

From October 2024 to March 2025, 2,732 PLHIV received structured adherence assessment, increasing coverage from 31% to 69%. Ninety-seven percent were good adherence and achieved viral suppression. A small percentage (2.9%) was identified as poor adherence and referred to clinical pharmacist-led interventions. Among the patients reviewed, 54% were clinically stable and needed no further intervention, 28% percent were found at risk of poor adherence and were scheduled for interventions, and 19% needed urgent counselling which half of them experienced virological failure. After intervention, the majority demonstrate improved adherence. Dispensing pharmacists provided essential counselling on ARV timing, food-drug interactions, and safe ARV use per guidance.

What next?

This model shows a scalable approach for high volume super tertiary hospitals by embedding pharmacists into HIV services. This framework can be adapted for other chronic diseases like diabetes to expand its public health benefits.

Author(s)

Cruz Pardos, S. González Andrés, D. López San Román, MA

Why was it done?

One of the standards established by the Joint Commission (JC) involves the identification of medications that may have risk to patients and/or be a potential source of error during its dispensation or administration. This includes look-alike/sound-alike (LASA) medications, high-risk medications (HRMs) defined by the Institute for Safe Medication Practices (ISMP), concentrated electrolytes, and hazardous drugs (HD) according to NIOSH classification.

What was done?

A tag system was designed using color-coded stickers with specific text to identify each of the medication groups defined above:
• Red stickers with the statement “High risk medication” for HRMs.
• Red stickers with the statement “Dilute before administration” for concentrated electrolytes.
• Yellow stickers with the statement “Reproductive risk” or “Hazardous drug – handle with care” for HD.
• LASA medications: Red stickers were used for those that are also high-alert, while green stickers were applied to non-high-alert LASA drugs.
In addition, for medications requiring repackaging, the repackaging protocol was modified. The changes included:
• Labelling the medication profile with either HIGH-ALERT MEDICATION or HAZARDOUS DRUG.
• Using different photoprotective packaging paper: red for HRMs and yellow for HD

How was it done?

At first, two working protocols were developed:
1. Labelling protocol, detailing the characteristics of each type of sticker used to identify the different medication categories.
2. Repackaging protocol, ensuring proper identification of these medications during the repackaging process.
Secondly, lists of every category were compiled of the hospital’s available medications.
For LASA medications, brand names and images were included to improve differentiation and minimize errors.

What has been achieved?

• Identification of each medication according to their category at every stage of the medication use process: reception, storage, dispensing, and administration.
• Increased awareness among nursing staff regarding the safe and appropriate handling of these medications.
• The impact of these labelling project among all medicaments available in our hospital was: MAR: 18,6% , MP: 6,1% and LASA: 15,24%

What next?

• Develop a procurement protocol aimed at reducing the number of LASA medications.
• Raise awareness within the pharmaceutical industry about the importance of clearly differentiating pharmaceutical products.
• Automate the labelling process as much as possible, to avoid repetitive work.

Pdf

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.

Pdf

Author(s)

Boglárka Lengyel
Nadine Haubenwalllner
Ingrid Sattlecker

Why was it done?

The global shortage of nursing staff increases the risk for medication errors due to higher workload and stress. The intravenous (I.V.)-service, launched in March 2020, alleviates nurses’ workload and minimizes application errors by standardizing concentrations and providing pharmaceutical training. Producing all infusions with producing pumps in the hospital pharmacy’s clean rooms improves microbiological quality and dosing accuracy. Standardized concentrations with defined stability and proper documentation practices ensure consistent quality.

What was done?

We implemented the production of patient-specific I.V.-infusions and total parenteral nutrition (TPN) for neonatal intensive care units (NICU) to meet the specialized needs of neonates and enhance individualized care. Additionally, pharmacy staff assembles patient infusion sets daily, focusing on Y-Site compatibility and catheter types tailored to each patient.

How was it done?

After discussing demand with physicians and nurses, data on NICU medications and dosages were systematically collected. Standard infusion concentrations were harmonized, considering fluid intake and physical-chemical stability. Protocols for automated compounding of continuous infusions and TPN were established, alongside standard operating procedures for additional volumetric preparation. I.V. compatibility of the drugs was researched, and compatibility tables were created.

What has been achieved?

The project successfully implemented individualized compounding of infusions and TPN with established standards in the hospital pharmacy’s clean rooms. Complete traceability and continuous monitoring during production ensure high product quality. The initiative enhanced interprofessional collaboration, strengthening confidence among physicians, nurses, and pharmacists and significantly reduced nurses’ workload for preparing medications, TPN, and assembling patient sets. The service currently supports five wards, producing an average of 98 infusions and TPN daily. The assembly of patient sets is provided for 44 care beds across NICU and Intermediate Care (IMC) wards, averaging 25 sets daily.

What next?

The service aims to maximize automated production by implementing new compounding pump plans, increasing output to supply more wards. Plans also include expanding the service to the Pediatric Intensive Care Unit (PICU), where both intermittent infusions and patient set assembly will be offered in addition to the existing continuous infusion supply.

Pdf

Author(s)

Maibritt Skov Olsen, Bernd Utech

Why was it done?

Pharmacy technicians at the Medical Ward of Bornholm Hospital adjusted medication orders to align with the hospital’s medication assortment. Operating under delegated prescribing authority; they prescribed, paused, and discontinued specific medications within a framework agreement and documented changes in the Electronic Medication Module “Sundhedsplatform” system.

What was done?

Patients often bring medications outside of the hospital’s assortment. Adjustment of these medications is time-consuming and can lead to documentation challenges. Delegating this responsibility to pharmacy technicians aimed to enhance patient safety by ensuring scan-ready medications and freeing up physicians’ time for other tasks.

How was it done?

A medication adjustment list was created by the pharmacy and department physician, outlining which drugs the technicians could adjust or discontinue. Pharmacy technicians were trained, and annual audits were conducted by the department physician. In a period of 13 days, a time study was made to track interventions; consultations with physicians, and time spent adjusting medications in the Sundhedsplatform.Nurses and physicians were asked about their experience of the pharmacy technician’s work.

What has been achieved?

During the test period, 97 patients were dispensed medication, and interventions was made for 39 (40%) of those patients. Technicians performed 60 interventions, of which 11 were physician-consulted. They spent 220 minutes on adjustments and notes, saving physicians 160 minutes. Feedback from nurses and physicians was positive, with improvements in medication scanning and reduced interruptions for physicians.

What next?

The task will be expanded to include all patients in the medical and surgical wards. An extension of the pharmacy technicians’ prescribing authority is also planned.

Pdf

Author(s)

Afke van de Plas, Judith Baars-Timmermans, Hanneke Goossens, Ellen Frankfort

Why was it done?

This initiative aimed to improve:
1. Personalized Healthcare and Patient Satisfaction: In the pursuit of strict regulatory compliance, pharmacy employees sometimes overlooked the pharmacy’s fundamental mission. With limited direct patient interactions, staff were often unaware of patients’ unique needs and preferences.
2. Employee Satisfaction: The program aimed to empower employees by reducing excessive regulations and allowing them to make decisions that aligned with the overarching mission, with the expectation that this would enhance their job satisfaction.
3. Enhancing Awareness of the Pharmacy’s Mission: By connecting all activities to the pharmacy’s core mission, the program attempts to improve personalized healthcare and patient and employee satisfaction.

What was done?

Maastricht University Medical Centre’s hospital pharmacy introduced the “All Activities in Alignment with Underlying Aim” program.

How was it done?

The program’s implementation involved several key steps:
1. Defining the Underlying Aim and Key Principles: The program team identified the overarching aim as “Happy Patients and Employees” and established four key principles: “See the Person Behind the Patient,” “Focus on What Is Possible,” “Take the Lead Yourself,” and “From Rules to Self-Regulation.”
2. Employee Engagement: The new policy was presented and discussed in detail during a meeting with all employees.
3. Communication: Periodic newsletters and monthly team meetings were used to share illustrative examples and foster discussions about initiatives.
4. Evaluation: Customer and employee satisfaction were measured through surveys before and after program implementation.

What has been achieved?

The outcomes of the program were highly encouraging:
• The adoption of “Happy Patients and Employees” as the guiding aim resulted in numerous instances of personalized healthcare and enhanced collegiality.
• The four key principles empowered employees to align their actions with the program’s aim. The empowerment to decide in the patient’s interest increased from 58% to 73%.
• Surveys indicated improved customer and employee satisfaction.
• Enhanced awareness of the pharmacy’s mission (from 47% to 66%) led to stronger connections between activities and the overarching aim (from 73% to 85%).

What next?

The “All Activities in Alignment” program serves as a successful model for other hospital pharmacies seeking to elevate personalized healthcare, patient and employee satisfaction. Its simplicity and effectiveness make it a valuable initiative worth considering for broader implementation.

Pdf

Author(s)

IGNASI SACANELLA ANGLÈS, MARTA MARTIN MARQUÉS, JULIA BODEGA AZUARA, PILAR LÓPEZ BROSETA, DAVID PASCUAL CARBONELL, HELENA SUÑER BARRIGA, ALEJANDRO SANJUAN BELDA, CARLA DAIANA CIUCIU, SILVIA CONDE GINER, ERIKA ESTEVE PITARCH, ANTONIO GARCÍA MOLINA, SÒNIA JORNET MONTAÑA, ISABEL PLO SECO, Mª ÁNGELES ROCH VENTURA, MARÍA VUELTA ARCE, LAURA CANADELL VILARRASA

Why was it done?

The NICU is a complex area of paediatric hospitalisation that necessitates specialised healthcare professionals. The role of the NICU pharmacist is vital in ensuring the appropriate and optimised use of medications in various critical situations.

What was done?

To develop a checklist that facilitates pharmacotherapy validation for preterm newborns (PTNB) weighing less than 1000 g and hospitalised in the neonatal intensive care unit (NICU). The primary objective is to ensure a higher quality of hospital care in terms of pharmacotherapy.

How was it done?

We conducted a literature review to identify the pharmacotherapy requirements for preterm newborns (PTNB) weighing less than 1000 g during their first 30 days of life.

In order to design the checklist, we compiled various elements, including drugs, dosages, treatment duration, initiation date, and drug monitoring (when necessary). Additionally, we incorporated recommendations for specific scenarios.

What has been achieved?

The drugs considered for this supportive tool include: pulmonary surfactant, ampicillin, gentamicin, fluconazole, caffeine, ibuprofen, iron (ferrum), dexamethasone, nystatin, vitamin D3, and other vitamins. The checklist was designed to cover the first 30 days of life.

From day 0 to 1: Administer pulmonary surfactant and caffeine citrate. For antibiotic prophylaxis, use ampicillin and gentamicin, and fluconazole for antifungal prevention. In cases of an open ductus arteriosus, intravenous ibuprofen should be added.

Between day 10 to 15: Administer vitamin D3 and a multivitamin complex if the neonate tolerates oral administration. If there is a risk of bronchopulmonary dysplasia, which is characterized by more than 7 days of intubation and difficulty with extubation, consider adding dexamethasone and nystatin.

From day 15 onward: Monitor ferritin and vitamin D3 levels. Begin oral iron supplementation (ferrum) 30 days after birth. Both drugs should be continued for one year.

We have included dose adjustments in case of renal or hepatic dysfunction and pharmacokinetic monitoring for antibiotics. In cases where meningitis is suspected, we have provided recommendations for increasing the dose to ensure adequate penetration into the central nervous system.

What next?

This tool simplifies pharmaceutical validation, particularly for pharmacists who may not specialise in the care of these complex patients. By utilising this tool, we can reduce errors and enhance the quality of care provided to preterm newborns (PTNB) weighing less than 1000 g.