Author(s)

Sarah Veldeman, Katrin Kootz, Thomas de Haas, Emma Palmen, Marnik Stragier, Andreas Follmann

Why was it done?

Emergency and disaster situations put extreme pressure on hospital pharmacy capacities. Rapid and reliable transport of critical medical supplies between institutions can improve resilience of hospital pharmacies across borders. The EDEN-Medical project aims to establish a cross-border drone network connecting hospitals and emergency medical services in Germany, Belgium and the Netherlands.

What was done?

This study aims to identify relevant use cases for urgent drone transport of medical goods and to integrate both hospital and prehospital perspectives into the project process.

How was it done?

Structured interviews (n=24) were conducted with key stakeholders in three countries (Nl, B, DE). Participants included representatives from hospital pharmacy, laboratory, anesthesiology, intensive care, emergency departments, crime response teams, surgical team, pathology and logistics. Interviews were analyzed to develop a catalog of potential use cases , also specifying transport conditions ( temperature, vibration, weight and volume). In addition , a qualitative focus group with prehospital professionals explored opportunities, barriers and requirements for system integration in emergency care.

What has been achieved?

Hospital stakeholders identified 24 potential use cases for drone transport, ranging from medication and blood products to surgical kits and tissue samples. Next cases were directly relevant : defibrillators, blood products and pharmacy emergencies. The prehospital focus group confirmed the relevance of these scenario’s, while emphasizing barriers such as regulatory limitations, telemedical challenges and interoperability.
The EDEN-Medical study highlights the potential of drone logistics.

What next?

Next steps will be deploying logistical capacity with drone partners, exploring legal issues concerning inter-country transport of medical products, blood and medication. The further development of the use cases will lay the groundwork for future pilot operations and integration into both emergency and disaster response systems.

Author(s)

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

Why was it done?

Hospital pharmacies frequently face drug shortages due to unpredictable demand, long lead times, and budget constraints. Traditional reorder point policies are insufficient for handling stochastic consumption, and shortages can impact patient care. Applying predictive and probabilistic control methods allows for optimized decision-making, reduces unnecessary orders, and ensures higher service levels.

What was done?

A predictive inventory management framework based on CC-MPC is being developed and assessed through simulation to optimize hospital pharmacy stock levels under uncertainty .

How was it done?

The approach combines:
1. Data collection: Weekly consumption data of strategic drugs over a defined period, including average delivery times and historical stockout events.
2. Probabilistic modeling: A normal distribution is used to characterize demand uncertainty, with mean (μ) and standard deviation (σ) based on historical consumption data.
3. CC-MPC model parameterization: includes Safety stock thresholds, probabilistic stockout risk levels, constraints (storage,order, operational and economical) adapted to the hospital’s context.
4. Prospective simulation: generates optimized ordering plans over 6–12 month horizons, using rolling-horizon updates.
5. Practical integration: daily recalculation of optimal orders based on updated consumption data.

What has been achieved?

Based on previous simulation studies, the CC-MPC approach has the potential to reduce the number of orders by 40% and average stock levels by approximately 10%, while preventing stockouts over extended periods. Estimated annual budget savings ranged from 1 000 € to over 27 000 €, highlighting the possible benefits of implementing this predictive framework in hospital pharmacies.

What next?

Once the method tested and data collected,the next step is to transform the method into a software application, which can be integrated into pharmacy operations. This program is designed for practical hospital use. It aims to optimize stock management under real-world conditions.

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Author(s)

Sanjuan-Casanova, Iria; Cerdeira-Regueira, Elena; Fernández-Oliveira, Carla; Lago-Rivero, Natividad; Iglesias-Moreno, Jose Manuel; Alfonsín-Lara, María; Agra-Blanco, Iván, Martínez-López De Castro, Noemí.

Why was it done?

Dysphagia is a swallowing disorder that affects patients’ safety and quality of life. Within our healthcare area, patients regularly come to the Hospital Pharmacy Service (HPS) for nutritional assessments and dispensing of thickeners. This results in an increasing workload and the need for patients to come to the hospital. This presents an actual challenge particularly since many of them have reduced mobility. The establishment of EspesaNet aimed to reduce waiting times, to facilitate dispensing at other care points and to improve patients’ quality of life.

What was done?

A dispensing circuit for thickeners, EspesaNet, was implemented. We established an interdisciplinary, comprehensive and continuous care system for patients with dysphagia through the decentralization of nutritional follow-up, adjustment of pharmacological treatment, and dispensing of thickeners in health centers (HC) via primary care pharmacists (PCP).

How was it done?

The implementation of EspesaNet was achieved through the establishment of a multidisciplinary work team, the creation of a theoretical-practical training program from the HPS (which included three training sessions of two hours each), and a communication network through e-consultations between HPS and PCP.

What has been achieved?

From February to June 2024, 22 HC and 56 patients (12 with reduced mobility) were enrolled in the project. After the initial nutritional assessment (conducted via home visits and teleconsultations for immobilized patients) and with the premise of not requiring additional nutritional intervention, patients were referred via e-consultation to the PCP for ongoing follow-up and subsequent dispensing of the thickener.
The implementation of the circuit has resulted in:
-Access for all involved professionals to e-consultations and the electronic prescription software (Silicon®).
-Safekeeping of all patients’ clinical information in a single electronic medical record (Ianus®).
-Establishment of a remote evaluation service for immobilized patients.
-Development of standardized treatment adjustment criteria.
-Completion of 56 e-consultations
-An estimated savings of 2400 kilometers in travel distance for a single dispensing via FAP.

What next?

EspesaNet, since its implementation, has provided numerous benefits for patients and professionals. Our goal is to reach more HC, ensuring the correct identification and follow-up of patients with dysphagia. Moreover, we aim to facilitate patients’ collection of thickeners and improve their access to information and better-trained professionals.

Author(s)

Piter Oosterhof, Jelmer Hein Faber, Lieke van Kerkhoven, Rob Haenen

Why was it done?

PharmaSwap is a response to the significant issue of medication waste in the healthcare sector. The problem of medication waste was well-documented, with scientific research indicating that annually, a minimum of €100 million worth of prescribed medications was being discarded in the Netherlands. These medications were being wasted when they reached their expiration dates, resulting in both financial losses and environmental pollution. PharmaSwap was introduced to tackle the problem of medication waste by creating an online platform that enables pharmacists and pharmaceutical wholesalers to list and sell medications with approaching expiration dates at discounted rates. Our initiative sought to improve the situation by not only reducing the financial losses associated with medication waste but also by addressing the environmental concerns linked to the disposal of medications. By promoting the reuse of medications and encouraging a shift toward sustainability in the pharmaceutical sector, PharmaSwap aimed to make a positive impact on healthcare and the environment.

What was done?

The initiative that has been developed and implemented is https://www.PharmaSwap.com. PharmaSwap is an online marketplace established in 2018 by pharmacists Piter Oosterhof and Jelmer Faber. This platform facilitates the exchange and sale of medications among (hospital) pharmacies and pharmaceutical wholesalers that are nearing their expiration dates at discounted rates.

How was it done?

The introduction of PharmaSwap faced several obstacles:

1) Regulatory barriers: initially, regulations didn’t allow medication redistribution. We collaborated with regulatory bodies to find a legal solution.
2) Legal adjustments: we worked with authorities to amend regulations, creating a legal framework for PharmaSwap.
3) Building trust: gaining trust from pharmacists and wholesalers required transparent communication and showcasing benefits.
4) Technical development: developing the platform required the right tech partners and resources.
5) Awareness and adoption: we conducted awareness campaigns and partnered with (inter)national associations to promote PharmaSwap.

Through these efforts, we successfully overcame obstacles and implemented PharmaSwap, reducing medication waste and promoting sustainability.

What has been achieved?

1) Medication waste reduction: PharmaSwap has significantly reduced medication waste, preventing the disposal of medications, while pioneering a unique and innovative approach.
2) Environmental impact: PharmaSwap has saved 9,719 packaging units, leading to a substantial reduction in environmental pollution from medication disposal.
3) Cost Savings: healthcare systems have saved €1,165,115 by recovering the value of otherwise discarded medications.
4) Network growth: PharmaSwap connects 836 out of 2,000 Dutch pharmacies and collaborates with 8 pharmaceutical wholesalers, including one partner compliant with Good Distribution Practice (GDP).

These outcomes highlight PharmaSwap’s impactful contributions to waste reduction, cost savings, and sustainability in healthcare, supported by its expanding network of participants.

What next?

PharmaSwap’s success in reducing medication waste, saving costs, and promoting sustainability makes it a compelling example of good practice in healthcare. Its transferability to other healthcare settings involves replication, regulatory adaptation, education, partnerships, technology integration, data management, and a commitment to continuous improvement. Moreover, we are currently in advanced meetings with several other European countries, exploring the potential for international expansion and collaboration to further extend the positive impact of PharmaSwap.

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Author(s)

Lykke Henriette Sandholt, Charlotte Kok Fredslund

Why was it done?

Early in the COVID-19 pandemic, it became apparent that backorders for many medicines could arise worldwide. In Denmark, the same medicines are used in all hospitals for 1 or 2 years. As hospitals report estimates for the same drugs, it was possible to establish a national safety stockpile.

What was done?

In March 2020, Amgros established a national pharmaceutical safety stockpile for the Danish health authorities. The facility partner was approved, and the warehouse was constructed within a few months. Experience over the past three years has led to a national strategic stockpile run by Amgros on behalf of the Danish regions and Amgros.

How was it done?

Working with clinicians, clinical pharmacists, hospital pharmacies, and the Danish Medicines Agency, the range for the safety stock was identified based on defined criteria. Hospital pharmacies were also required to purchase from the safety stock. The warehouse was replaced every three to six months depending on criticality, and therefore was the risk of waste minimized. A procurement team was set up in Amgros, which established a good working relationship with pharmaceutical suppliers to identify backorders. The purchasing pharmacist regularly met with health professionals regarding drug numbers and quantity adjustments.

What has been achieved?

Throughout the COVID-19 pandemic, security of supply remained intact, mainly due to collaboration between healthcare actors, suppliers, and Amgros. The experience gained over the past three years has resulted in establishment of a national strategic stockpile. Danish regions run this stockpile in cooperation with Amgros. Selection of warehouse partner is among other things based on profitability and sustainability.

What next?

After establishing the strategic stockpile, the Danish regions and Amgros took over financial responsibility from the Danish authorities. A working group has been established, including hospital pharmacies and Amgros, to assess stock volumes at the warehouse. Medicines with unstable security of supply are stocked. Input from suppliers is highly valued. All tenders are monitored so the working group can add or delete medicines. We ensure supply when consumption is high (seasonal fluctuations). The goal of the strategic stockpile is to maintain security of supply and, thus, treatment of patients at Danish hospitals. As well as act promptly on announced and urgent backorders.

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Author(s)

Catarina Diogo, Rui Caceiro, Maria Helena Duarte, Armando Alcobia

Why was it done?

The core objective of healthcare institutions is to ensure patient safety and maintain the highest quality of care throughout every medical procedure.
This principle must extend to the drug circuit as well. Within our hospital, pharmaceutical services have a dedicated route for producing injectable ophthalmic medications, serving 795 patients and yielding 3720 solutions, in 2022. However, the existing paper-based procedure for medication management is laborious, time consuming and error-prone, demanding full-time constant pharmacist involvement to ensure the secure progression of these medications.

What was done?

A software application was developed on the Power Apps platform to streamline medication management for injectable ophthalmic medications. This application aimed to replace manual paper-based procedures with digital solutions, enhancing efficiency, reducing errors, and providing a comprehensive platform for patient registration, prescription tracking, schedule management, and oversight of injectable solutions’ production.

How was it done?

Over two months, needs of pharmaceutical and ophthalmology services were assessed, soliciting input from pharmacists, ophthalmologists, nurses and administrative personnel. Subsequently, a software application was developed featuring four distinct interfaces, customised for each professional group involved. This application enables patient registration, medical prescription, schedule management and monitoring the injectable solutions’ production – prescription and agenda validation, batch management and generation of identification labels.
This project is presented, therefore, as a customised digital solution, the result of a multidisciplinary collaboration.

What has been achieved?

It is the authors’ belief that this software has allowed for the development of a safer, more efficient, and integrated workflow, as an alternative to paper – which is more prone to errors. In this manner, from a pharmaceutical perspective, it simplifies the workflow, freeing the pharmacist to focus on other important tasks and optimizing personnel management. Furthermore, it is also valuable for ophthalmologists, enabling prescription repetition and access to patient history, as well as for administrative staff, streamlining schedule management. In conclusion, this software is set to transform our injectable ophthalmic medication circuit.

What next?

Further studies confirming its advantages are needed. Its validation would establish its potential and applicability across healthcare settings.

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Author(s)

BEATRIZ MONTERO LLORENTE, ELENA GEMENO LÓPEZ, CARMEN PALOMAR FERNÁNDEZ, ANA MARÍA ÁLVAREZ DÍAZ

Why was it done?

To avoid stock breaks of medication due to unforeseeable fluctuations in their regular consumption. To reduce claims to the Pharmacy Service (PS) for medication shortages in automated dispensing systems (ADS) and other dispensing circuits. To achieve economic savings by avoiding unnecessary loans. To manage these loans in the morning when needs are detected in advance, with the consequent reduction in the time it takes for the pharmacist to manage it during on-call hours (approximately 2 hours per loan).

What was done?

We designed and implemented a tool to control in advance the stock of medication dispensed to hospitalisation and outpatient units and thus be able to forecast needs based on current prescriptions and associated habitual consumption.

How was it done?

1. An Excel file was developed in which the information on automated storage systems (ASS), ADS and prescriptions were integrated. It included maximum, minimum and current amount, and estimated coverage (in days) according to the consumption forecast associated with current prescriptions. We established the minimum amount based on a coverage threshold of 7 days.
2. Basic drug needs were studied (adjustment of maximum and minimum in the ASS and ADS, a dynamic process periodically reassessed according to demand).
3. The order information was added: order status, request date, last receipt date, order number and laboratory. These items allowed us to quickly locate old orders so we could address the reason for the delay in procurement.
4. We included medications stored externally to the ASS to control their stock electronically.

What has been achieved?

Loans requested annually from other hospitals were quantified as an indicator of improvement in acquiring medicines stored in the ASSs.
We obtained an annual reduction in the number of loans of 34.4% between 2019 and 2020 (125 loans vs 82) and 56.1% between 2020 and 2021 (82 loans vs 36). This result represented an average decrease in the time to manage loans of approximately 7 hours/month between 2019 and 2021.

What next?

The tool can be applied to all PS with ADS and ASS, intending to have the necessary medication available at the necessary time and thus avoid possible clinical damage to patients’ health derived from the delay in their treatment.

Why was it done?

The purpose of the report was to investigate and share what benefit opportunities exist because of the introduction of the EU FMD barcode.

What was done?

EFPIA, the industry association, commissioned a report to investigate what benefits had occurred in the hospital setting, following the introduction of the EU Falsified Medicines Directive (EU FMD).

www.be4ward.com/benefits-beyond-eu-falsified-medicines-directive/

How was it done?

The author worked directly with Guy’s and St Thomas’ NHS Foundation Trust in the UK and AZ Sint-Maarten in Belgium. In addition, he reviewed various relevant case studies and publications.

What has been achieved?

The report demonstrates benefits exist at all points in the hospital supply chain, where packs are handled, stored and processed. Opportunities also exist to web enable the product to provide digital content and services to healthcare providers and patients.

The introduction of standardised barcodes and product identification enables hospitals to leverage benefits opportunities which were difficult to realise before this level of harmonisation and barcoding prevalence.

• The costs of operating the EU FMD can be minimised, integrating with normal operations and leveraging the use of conveyor systems and robotics are successfully reducing the workload impact by up to an expected 80%.

• Barcodes and product identification brings impressive financial benefits to those hospitals which leverage them. In one hospital they were able to save £4 million through the reduction of over ordering products. In another, the improved accuracy and speed in the recharging of procedures identified £840K in lost revenues in a single year.

Scanning barcodes, is being used to deliver value across all three of the benefit opportunity areas: Improved Patient Safety, Enhanced Clinical Effectiveness and Operational Efficiencies. It is possible to offset the costs of EU FMD implementation and operation through the additional benefits.

What next?

Share the report findings to enable hospitals to leverage the opportunities of the EU FMD barcode.

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Author(s)

Daniele Leonardi Vinci, Enrica Di Martino, Rosario Giammona, Piera Polidori

Why was it done?

The 2018 Medicines Shortages Survey conducted by EAHP showed that 91% of responding pharmacists had experienced problems sourcing medicines, therefore it is important to use tools that identify early the shortage risk associated with each drug included in a hospital formulary in order to adopt appropriate countermeasures.

What was done?

We create an informatic HVA Tool (HVAT) to assess the risk associated with medicine shortage.

How was it done?

The HVAT created consists of an Excel spreadsheet subdivided into three macro areas: probability that the shortage will occur based on shortage in the last 2 years, magnitude factors which increase the risk of shortage, and mitigation factors which reduce it. A score was assigned to each item in each macro area. The score of the probability was: 1=no previous deficiency; 1.5=one deficiency; 2=two or more deficiencies. Magnitude was divided into: relevance of active substance (AS) (1= not life-saving and not High Risk Medicines (HRM); 2=not life-saving but HRM; 3=life-saving); budget impact (0=no alternative drug; 1=alternative drug costs equal to or less than the deficient one; 2=cost of the alternative drug higher than the deficient one but sustainable for all patients; 3=cost not sustainable for all patients); percentage of patients treated with the drug (1=less than 20%; 2=from 20% to 50%; 3=more than 50%). Mitigation factors were: therapeutic alternative (1=same AS and same route; 1.5=same AS and different route; 2=different AS and route not intravenous (IV); 2.5=different AS and route IV; 3=no alternative drug); stock available (1=for a month of autonomy; 2= autonomy between 1 week and one month; 3=autonomy less than 1 week); availability of the drug (1=drug available in EU; 2=drug available exclusively extra-EU; 3=drug not available).

What has been achieved?

The HVAT obtained allows us to calculate the value of the risk multiplying P by S, where P is the percentage of probability (value of probability obtained/2) and S is percentage of severity [(sum of values of magnitude obtained + sum of values of mitigation obtained)/18]. Based on the score obtained, drugs are classified as: low (60%) risk of shortage.

What next?

We will implement the HVAT in our hospital in order to reduce the impact of shortages.

Author(s)

TRISTAN TERNEL, MELINDA PLACE, BERENICE GILLOTEAU, ELODIE DECHAMBENOIT, EMELINE DEVOS, FATEN ABOU-DAHER, ANAELLE DECOENE, THOMAS QUERUAU LAMERIE, FREDERIQUE DANICOURT

Why was it done?

The main purpose of developing this tool is the need to provide centralised product parameters through a unique summary screen that permits a regular monitoring of inventory, enabling us to identify the glitches before things get out of control, resolve issues the soonest to improve the stock control system (order threshold, market), maintaining compliance and documenting usage to prevent sudden shortages, in a harmonised way in order to reduce the time spent to order.

What was done?

Development of a dynamic stock management tool plugged into a computerised model (Excel©), to integrate all data needed for a stock forecast in terms of specialties, providers, therapeutic classes, last order date, supply disruptions, market, restocking time, turnover, stock, orders, security threshold, average daily consumption, average time of supply, and delivery estimated time for all pharmaceutical products in hospital.

How was it done?

It’s important to know how much you have from each product, and each dosage of the same product, through a dynamic database that’s collecting all data (product code and average daily consumption) and highlighting the order quantity threshold. This reliable inventory is updated on a daily basis with data extracted from our economic and financial management coupled with Business Object©. Using specific formulas and filters, and referring to the decision flowchart, such data allow adjusting and optimising our stock management in real time.

What has been achieved?

First, this tool has allowed us to gather all required data and, subsequently, reduced the need to another application (such as NEWAC© and MAGH2©). Second, it has allowed us to understand the mechanism of order suggestions by displaying characteristics of some sectors (such as expensive products and chemotherapy). Moreover, it improved the management of supply disruptions by showing the solution of each disrupted product in a summary table, which results in significant time saving along the drug supply chain.

What next?

An organised supply chain, a fast response to overcome and handle sudden supply shortages, as well as a huge time saving are the main reasons to rely on this efficient system, which lead to an optimised and secure patient care. Moreover, it fits any computer software, and its application is very friendly to be used in every hospital pharmacy.