Author(s)

to add

Why was it done?

The outpatient psychiatric clinic specializing in substance use disorders (SUD) faced challenges in providing sufficient follow-up care for patients prescribed central stimulants, particularly those with comorbid ADHD. The clinic was undergoing restructuring due to staffing shortages, and there was a need to integrate the clinical pharmacist into more aspects of patient care. The goal was to improve the management of stimulant treatment, monitor side effects, ensure compliance, and identify other comorbid conditions that may be overlooked.

What was done?

A clinical pharmacist was engaged to assess the Cs-treatment in ADHD-patients with SUD. The assessment included evaluating treatment effects, identifying side effects, and monitoring patient compliance. In addition to medication management, the pharmacist screened patients for improper use, reselling, and harmful use of stimulants. Somatic health was also assessed, with clinical chemistry tests and ECG referrals ordered when necessary.

How was it done?

Patients were asked to complete self-assessment questionnaires on treatment effectiveness and side effects. The pharmacist conducted follow-up visits to discuss the results, measure blood pressure, pulse, and weight, and screen for misuse. If necessary, clinical chemistry tests and ECG referrals were initiated. The pharmacist collaborated with psychiatrists to decide on any changes in treatment, such as medications adjustments and to address any non-compliance or adverse effects.

What has been achieved?

The initiative led to significant improvements in patient care. Nearly half of the patients experienced side effects, prompting medication adjustments or dose changes. Approximately 20% of patients showed poor compliance, which was addressed with targeted interventions. Clinical chemistry tests and ECG referrals were ordered for a substantial proportion of patients. In addition, new somatic diseases were identified in 37% of patients, and inappropriate stimulant use was detected in 2%. Overall, the intervention resulted in more individualized and safer treatment plans for patients.

What next?

The service integrated permanently into the clinic and expanded to other outpatient psychiatric care centers. Further research will be conducted to assess the long-term impact of pharmacist involvement in stimulant treatment follow-up, with a focus on interprofessional collaboration and improving patient outcomes in SUD treatment. Additionally, the model will be adapted to explore the role of clinical pharmacists in other areas of psychiatric care.

Author(s)

Martin Torrente. A; Picaza Iturricha. E; Carmona Oyaga. P; Lombera Sáez. L; Gemio Zumalave. PR; Illodo Becerra. JA; Ibarra Barrueta. O.

Why was it done?

The Hospital Pharmacy Department developed a unit to dispense medications in individualized dosing systems for residents of health and social centers with the aim of improving pharmaceutical care. This initiative seeks to ensure safe, efficient and patient‑centred medication supply managementin centers.

What was done?

A structured survey was designed and distributed to healthcare professionals to evaluate the service provided.

How was it done?

The questionnaire was created through a collaborative brainstorming session with the pharmaceutical team following literature review of existing tools. Thematic domains were defined based on practical experience and service priorities. Each section was assigned to a different pharmacist to ensure clarity, relevance and consistency. The final 36‑item survey, generated using Google Forms, included two descriptive questions (nursing home name and respondent’s professional role) and 34 evaluative questions grouped into four thematic areas: 14 questions on satisfaction with medication deliveries (blister-packed and non-blistered), 6 on incident resolution, 8 on logistics of transport and 6 on overall perception of the impact on professional workflow and patient safety. The survey combines Likert scales, multiple-choice items and open-ended fields to gather both quantitative and qualitative feedback.

What has been achieved?

The survey captures satisfaction with deliveries and labelling, completeness of orders, incident management and logistics aspects such as punctuality, packaging condition and integrity. It also gathers overall perceptions of the service’s impact on workflow and patient safety. Open‑ended fields encourage reporting of problems, suggestions and observations to ensure a comprehensive view of performance.

What next?

The questionnaire will be distributed to health and social centers. Data will be analysed to inform service improvements. Cronbach’s alpha is used to assess internal consistency and p‑values to examine significant differences. Findings will identify strengths and areas for improvement in the pharmaceutical care model, inform training strategies and support future policy decisions.

Author(s)

Elena López Lunar, Elena Rodríguez Del Río, Sonia Fraile Gil, Beatriz Fidalgo Hermida, David García Martínez, Eduardo Tejedor Tejada, Pablo González Carrera, José Diéguez Gómez, José Manuel Carrascosa Bernáldez

Why was it done?

To raise awareness and inform the professionals of a monographic mental health center about the impact of pharmacontamination on ecosystems and human health in order to:
– Analyze the need for training in pharmacontamination in our professionals.
– Generate a cultural change and the adoption of more sustainable practices in medication consumption.
– Take specific future measures that help to optimize high pollution potential drugs in our center.
– Establish improvement actions in waste management.

What was done?

An educational questionnaire on pharmacontamination was intended for the professionals of the center. Permission was requested to the Hospital Management for its distribution, working in conjunction the Pharmacy Service and the Environmental Management Committee, which includes a hospital pharmacist.

How was it done?

– Tool used: Google Drive forms.
– Dissemination method: intrahospital email.
– Intended for the professionals of the center.
– Duration: ~10-15 minutes
– Easy to understand, entertaining.
– Exclusively didactic function. Invites reflection.
– No prior knowledge is required.
– Possibility of adaptation in future versions for different professional profiles.
– Organized blocks: concepts, information and awareness; striking examples; possible solutions and prevention; impact and satisfaction of the questionnaire; suggestions.

What has been achieved?

Test diffusion time = 7 days; sample = 54
Gender: Female 39 (72.2%); Male 15 (27.8%)
Age: 20-65 years
Average score obtained from the test 17.5/21; average value 19/21

– Survey scores after taking the test
>98% believe that the presence of pharmaceuticals in the environment is a matter of high or very high relevance, potentially negatively affecting ecosystems and human health.
>97% believe that greater education is necessary in a high-very high degree.
≈90.7% would like to expand their training on pharmaceutical contamination at the center. 18.5% of them would also like to research on their own.
>96% would recommend this test (average score 4.4/5 points).
7 comments and suggestions, all of them positive.

What next?

– Potential to be replicated in other hospitals or target populations.
– High engagement, understanding, and interest in learning about pharmaceutical contamination.
– Educational questionnaires seem to be a rapid, useful, viable, effective, and highly accepted awareness tool in pharmaceutical contamination.

Author(s)

Jian-Ying Wang; Shan-Yu Hsu; Ming-Chia Lee

Why was it done?

We implemented pharmacist cognitive services with internal reimbursement and joined the National Health Insurance (NHI) pilot for a Pre-End Stage Renal Disease (Pre-ESRD) clinic and Intensive Care Unit (ICU) ward rounds. We launched a LINE official account to support patient queries, reminders, and follow-up, developed Podcast/YouTube education to enhance outreach, streamlined documentation using the Eliminate-Combine-Rearrange-Simplify (ECRS) approach with AI-assisted editing, and implemented an internal clinical communication platform.

What was done?

The growing complexity of chronic disease and intensive care requires pharmacists to provide professional services such as dose adjustment, drug–drug interaction management and patient counselling. These tasks are crucial for safety and quality, yet in the past they were often not formally recognised or reimbursed. Our hospital developed this model to ensure that such professional activities are acknowledged with institutional and NHI reimbursement, while also supported by digital and streamlined tools. Linking professional services with clear payment and measurable outcomes underscores the value of pharmacists in patient safety and sustainable healthcare.

How was it done?

We established the service fee in New Taiwan dollars (NT$): NT$100 (~€3) per cognitive record (institutional), NT$200 (~€6) per Pre-ESRD case, and NT$250 (~€7) per Intensive Care Unit (ICU) patient-day under the NHI pilot. Clinical activities were coded by drug-related problem (DRP) categories, and acceptance of pharmacist recommendations was tracked. Using ECRS, we modularised SOAP forms, removed duplicate entry and automated collation; AI-assisted editing further improved clarity and consistency. LINE was integrated as a platform for patient queries and consultations, with push notifications directing patients to Podcast/YouTube educational resources produced by pharmacists.
For the cost-benefit analysis (CBA) we used a hospital perspective. Cost was defined as the pharmacist service fee. Benefit had two parts: (i) direct medication-cost savings from accepted interventions, and (ii) avoided medical expenses estimated by DRP severity, such as additional laboratory tests, emergency visits or ICU days.

What has been achieved?

In 2024, pharmacist cognitive services comprised 1,354 records, accounting for 0.18% of all prescriptions, with an acceptance rate of 99.85%. The most common DRP was subtherapeutic exposure (35.6%). At the same time, ICU rounds involved 1,315 cases, and the Pre-ESRD clinic delivered 242 visits. From a hospital perspective, CBA demonstrated that cognitive services achieved a ratio of 1:13.3, while ICU services reached 1:1.84, confirming that pharmacist remuneration is cost-effective.
Patient communication and education were also strengthened. The LINE programme enrolled 1,897 members, with all queries resolved within 24 hours, while 17 Podcast/YouTube releases generated 59,760 video views and 30,926 podcast plays. Workflow efficiency improved markedly after the ECRS redesign in early 2024, with documentation steps reduced from 16 to 6 and average time per record shortened from 825 seconds to 98 seconds. The pharmacist Net Promoter Score (NPS) rose from 20 to 80, reflecting greater user satisfaction. These improvements were estimated to increase annual service capacity by 252 records and to reduce paper consumption, elevator use, and carbon emissions by 2,892 kg CO₂e.

What next?

The model has matured into a multi-faceted pharmaceutical care approach that enhances medication safety, enables real-time patient consultation, and extends reach through multimedia education. Although CBA has demonstrated the cost-effectiveness of pharmacist remuneration, outcomes will continue to be monitored and refinements pursued to ensure sustained improvement. With its comparability and reproducibility, the model provides a practical reference for other hospitals and healthcare systems.

Author(s)

Fajfarić Petković Maja, Vilić Katarina, Kuruc Poje Darija

Why was it done?

Antimicrobial resistance (AMR) is a global public health problem, associated with prolonged illness, increased transmission, extended hospitalization, higher treatment costs, and greater mortality. Although clinical pharmacists have been shown to play an important role in antimicrobial stewardship, data from southeastern Europe, including Croatia, are scarce.

What was done?

The aim was to assess the role of clinical pharmacist in pharmacotherapy management of patients receiving antimicrobial therapy.

How was it done?

A retrospective observational study was conducted in the period from 1st January 2018 to 31st December 2024. Data included adult patients treated with reserve antibiotics evaluated by an antimicrobial stewardship team (A-team), composed of infectious disease specialist, a clinical microbiologist and a clinical pharmacist. Collected data were patient characteristics, hospital wards where antimicrobial therapy was prescribed, indications for reserve antibiotics and the pharmacists interventions, including clinically significant drug interactions (categories X and D, UpToDate®). Descriptive statistics were used to analyse the data.

What has been achieved?

Between 2018 and 2024, the number of hospitalized adults receiving reserve antibiotics increased – from 492 to 798, with mean age rising from 68 to 70 years. Most patients (71-92%) had associated comorbidities and reserve antibiotics were predominately prescribed in internal medicine departments, most often for bacterial pneumonia. Pharmacist interventions increased: dose adjustments for renal/hepatic impairment – from 10 in 2018 to 116 in 2024, consultations on preparation, stability, storage, and administration of parenteral antibiotics – from 2 in 2018 to 731 in 2024. Clinically significant drug interactions (categories X and D) decreased over time from 52 interactions in 2018 to 17 interactions in 2024. The most common drugs involved were promazine, furosemide, indapamide, ciprofloxacin, piperacillin+tazobactam, clozapine, metoclopramide and amikacin.

What next?

Findings suggest increased physician awareness of clinically significant drug interactions in patients with multiple comorbidities and underscore the recognized role of clinical pharmacist within a multidisciplinary team. Their integration into multidisciplinary antimicrobial stewardship teams improves patient safety, reduces adverse effects, and promotes rational antimicrobial use.

Author(s)

Sam Coombes
Michael Jackson

Why was it done?

The project aimed to strengthen clinical pharmacy services by introducing a digital counselling model for commonly prescribed medicines. It focused on improving the quality and accessibility of medicines information, particularly for patients discharged outside pharmacy hours who might otherwise miss vital counselling. Embedding digital resources into routine practice promoted equity, consistency, and inclusivity.

What was done?

Structured counselling scripts were created for prednisolone, glyceryl trinitrate (GTN) spray, and metered dose inhalers (MDIs). These were reviewed, approved, and recorded using an AI voice generator, enabling rapid updates. Accessibility features were built in to support patients with sensory impairments. Finalised videos were hosted on YouTube and accessed via QR codes, while a telephone audio service was provided for patients without smartphones. Codes and numbers were placed directly on medicine boxes.

How was it done?

Quality improvement methodology guided the design. AI voice technology allowed quick production of professional-standard audio and easy updates when clinical guidance changed. Using QR codes and phone lines ensured patients with varying digital literacy could access information. Accessibility was prioritised to support inclusivity.

What has been achieved?

Analytics showed strong engagement: the GTN spray video gained 7,000 views, 40 likes, and 59% viewer retention halfway through. Prednisolone had 2,600 views and 8 positive interactions, while MDI reached 29 views during pilot testing. A fluoroquinolone video was launched in late 2025, with outcomes pending. A staff survey confirmed no undue administrative burden.

What next?

Digital counselling via video or audio is feasible, scalable, and well received by patients. It addresses barriers such as limited staffing, out-of-hours discharges, and health literacy. Unlike written leaflets, often above the UK reading age, multimedia resources provide clearer, more engaging support and may improve adherence. AI technology ensures efficiency, cost-effectiveness, and currency of content. This model is replicable and has strong potential for wider NHS adoption, supporting equitable and consistent medicines counselling.

Author(s)

Cliona Hayden
David Lumsden
Aidan Morris
Darren Walsh

Why was it done?

Clinical pharmacy services are vital for medication safety and patient-centred care. However, in Ireland, the absence of a national strategy has led to inconsistent service delivery across hospitals. This initiative was undertaken to evaluate and improve the clinical pharmacy service in a Model 4 hospital, addressing structural, process, behavioural, and cultural challenges. The goal was to enhance service integration, reduce variability, and align with international standards such as the European Statements of Hospital Pharmacy.

What was done?

A quality improvement project was launched using patient journey mapping (PJM) to visualise medication-related touchpoints across the inpatient care pathway. The initiative aimed to identify service gaps and opportunities for improvement. Key interventions included stakeholder engagement, SWOT analysis, and the development of tools to support prioritisation, documentation, and training.

How was it done?

The PJM approach followed a six-step methodology, including problem definition, stakeholder consultation, and data analysis. Engagement activities involved structured interviews with pharmacy staff, consultations with nursing and medical teams, and completion of the HSE Workpositive survey. These inputs were synthesised to assess organisational health and identify barriers to effective service delivery. The analysis focused on the interaction between structure, processes, behaviours, and culture.

What has been achieved?

The initiative identified critical gaps in medication reconciliation, discharge planning, and interprofessional communication. Outcomes to date include the realignment of the clinical prioritisation tool, clearer MPAR endorsement guidance, and a tailored training framework to address role ambiguity and knowledge gaps. Positive behaviours such as pharmacist autonomy and peer support were reinforced, while structural and process inefficiencies were targeted for improvement.

What next?

Next steps include embedding standardised processes, implementing electronic prescribing, and evaluating the impact of these changes on patient outcomes. Further work will explore the role of advanced specialisation in clinical pharmacy and strengthen interprofessional collaboration. Leadership will focus on aligning structure and culture to support sustainable, patient-centred service improvement.

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)

Netchanok Kanjana, Ratnaton Khangkhasuwan, Thumwadee Thongkamchum, Pitchaporn Tepsuone, Nawiga Plong-on, Siriwan Wongvarodom, Rungnapa Songsiriphan

Why was it done?

Assessment of adverse drug reactions (ADRs) in tuberculosis (TB) patients is complex due to the concurrent administration of multiple anti-TB agents and the 9–12 day process often required for rechallenge. At our tertiary referral center, frequent transitions of TB patients between inpatient wards and the outpatient clinic, exacerbated by persistent overcrowding and a bed occupancy rate of 138%, resulted in paper-based ADR documentation being vulnerable to loss or fragmentation. This compromised patient safety and increased the risk of repeated hypersensitivity reactions.

What was done?

A digital platform was developed and implemented to systematically document and monitor ADRs in TB patients, aiming to enhance patient safety, prevent recurrent hypersensitivity events, and significantly improve the continuity, completeness, and quality of ADR reporting across all care transitions.

How was it done?

Key data elements were identified through structured pharmacist interviews and literature review. An AppSheet-based application was designed to enable real-time documentation and centralized monitoring of ADR data. The system was deployed across relevant inpatient wards and the outpatient TB clinic during the 3-month pilot period (March 1 to May 31, 2025). Pharmacists were trained to record ADR reports directly into the application, ensuring seamless information access.

What has been achieved?

Complete ADR reporting increased substantially: 56 ADR entries for 21 TB patients were documented during the pilot. This includes 8 complete ADR assessments (e.g., 3 Augmented, 5 Bizarre), compared to only 3 and 4 complete reports recorded on paper in 2023 and 2024, respectively. Crucially, no recurrent hypersensitivity reactions were observed during the intervention period. The application significantly improved continuity of care and facilitated timely, comprehensive ADR reporting.

What next?

Future plans focus on strengthening data security and system stability by migrating the application to the hospital’s internal server and integrating login with the national health provider authentication system. Expansion will involve scaling the system to include ADR monitoring across network hospitals, ensuring complete information transfer when patients are referred back to their primary facilities.

Author(s)

Noe Garin Escriva, Borja Zarate Tamames, Unax Lertxundi Etxebarria, Jose Javier Martínez Simon, Rocio Tamayo Bermejo, Eguzkiñe Ibarra Garcia, Olaia Serna Romero, Anna Pelegri Pedret, Yolanda Torremorell Alos

Why was it done?

The GREEN BREATH Project aimed to reduce the environmental impact of inhaler use in Spain. It consisted of three components: (1) a sustainable inhaler prescription framework with a database on the environmental impact of inhalers, scenario projections to estimate benefits of alternative inhaler use and a decision-support algorithm for greener prescribing in Spain; (2) a nationwide patient education project across 40 hospitals focusing on proper inhaler disposal, assessing pharmacists interventions; and (3) a hospital pilot project for optimizing the disposal of used inhalers, reducing hydrofluorocarbon emissions.

What was done?

Inhalers contribute to global CO2 emissions, with over 15 million pMDIs used annually in Spain, generating 400,000 tonnes of CO2 equivalent. Prescription practices often ignore sustainability, and improper disposal exacerbates this problem. The project aimed to integrate environmental criteria into prescribing practices and raise awareness to improve disposal methods, without compromising patient care.

How was it done?

We contacted pharmaceutical companies to develop the carbon footprint database. The prescribing algorithm was designed by a multidisciplinary team. We used data from the Ministry of Health to calculate national projections. We also conducted a study across 40 hospitals focusing on asthma patients, using a questionnaire with a 3-month follow-up. Finally, we piloted an in-hospital inhaler waste management program in a single hospital.

What has been achieved?

The project demonstrated significant impact. We provided the first environmental database on inhalers in Spain. We estimate that shifting 10% of pMDI prescriptions could reduce CO2 emissions by 40,000 tonnes annually. Preliminary results show that over 50% of patients were unaware of inhaler disposal’s environmental impact, and that pharmacists interventions doubled proper inhaler waste disposal. Additionally, the hospital pilot project prevented up to 341 tonnes of CO2 emissions annually by optimizing inhaler waste management.

What next?

Educational resources have recently expanded to four languages used in Spain (Spanish, Catalan, Basque, Galician). We continue disseminating and collaborating with institutions to implement these and other activities. Additionally, sustainable prescribing should be integrated into electronic medical records to drive broader healthcare sustainability and reduce inhaler-related emissions. The project offers a replicable model for other healthcare systems.