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ESPESANET: MULTIDISCIPLINARY PHARMACEUTICAL CARE IN PATIENTS WITH DYSPHAGIA

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European Statement

Clinical Pharmacy Services

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.

PHARMACEUTICAL CARE AND CHARACTERIZATION OF PATIENTS WAITLISTED FOR KIDNEY TRANSPLANTATION IN A THIRD LEVEL HOSPITAL

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European Statement

Clinical Pharmacy Services

Author(s)

M. López López-Cepero, H. Padilla Castaño, G. Arrufat Goterris, P. Clares Rubio, T. Bonnin Garau, A. Tugores Vázquez, C. Martorell Puigserver.

Why was it done?

A pharmaceutical care consultation (PCC) was implemented for patients waitlisted for kidney transplantation (PWKT). The PCC focuses on transplant medication education, accurate medication history, allergy review, adherence assessment and self-perception of therapeutic complexity.

What was done?

Medication non-adherence is the major issue in transplantation, and it is associated with increased risk rejection, allograft loss and patients’ death.
Medication education after the transplant was not enough. Intervening before the transplant enabled pharmacists to know the patients and develop an individualized therapeutic plan, so the patients arrive as prepared as possible on the day of the transplant.

How was it done?

PWKT were scheduled in PCC and the pharmacist review their medical history and prescriptions. Patients were contacted by telephone for an interview. A face-to-face consultation was also possible.
PCC evaluate:
1) Clinical variables: etiology of renal pathology, comorbidities, previous transplantation, current renal replacement therapy (TRR), CYP3A5 genotype.
2) Medication: allergies, current medication plan, adherence (Morisky-Green test and electronic prescription record), organization and self-perception complexity.
3) Pharmaceutical interventions (PI): deprescribe or update current treatment, reinforce adherence, propose Monitored Dosage System (MDS) or pillbox, immunosuppressants education, arrange for a second PCC, contact with their community pharmacy, send to Pharmacogenetics Committee.

What has been achieved?

The PCC was implemented in June 2024. Among the first 4 months, 28 of the 58 PWKT have been evaluated.
Analyzing the clinical variables has allowed us to describe PWKT profile. Knowing how patients manage medication, as well as the perception they have about the importance of their treatment, helps to create an action plan and better prepare the patient for the transplant.
Given that one third of the patients were non-adherent, most of the PI focused on adherence reinforce, including additional monitoring, propose MDS or pillbox pillbox and resolve medication doubts.

What next?

The next step is to include a PCC in our clinical practice and get to visit all PWKT before the transplant.
It is needed to evaluate the impacts of PCC and PI as regards clinical outcomes. Detecting improvement actions will be enriching for patients care.
The PCC can be extended to other types of solid organ transplants.

PHARMACY TECHNICIANS’ DELEGATED ROLE IN MEDICATION ADJUSTMENT FOR HOSPITALIZED PATIENTS: IMPLEMENTATION OF THERAPEUTIC SUBSTITUTIONS AND DISCONTINUATIONS IN THE ELECTRONIC MEDICATION MODULE

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European Statement

Clinical Pharmacy Services

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.

PATIENTS AND CARERS’ EVALUATION OF MEMORY CLINIC FOLLOW-UP APPOINTMENTS

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Clinical Pharmacy Services

Author(s)

Amparo Valls-Lattur
Supervisor: Agostina Secchi

Why was it done?

Background
Introducing a pharmacist prescriber (PP) in the Community mental health services for older people (CMHSOP) to support with follow-up appointments for memory patients as a new strategy as part of the community mental health transformation (1). The aim of this Service Evaluation was to evaluate the views of patients with dementia (and/or their carers) on a pharmacist prescribing led clinic.

What was done?

After diagnosis of Alzheimer’s Dementia some patients will be started on medication to treat the disease symptoms in an effort to reduce the rate at which their cognitive abilities will deteriorate. This medication will need titrating and monitoring for compliance and side effects (2).
This new service will allow consultants to focus on diagnosis of dementia while improving waiting times for community mental health services for older people (3).

How was it done?

Methodology
The data was collected from a memory clinic within a community mental health team for older adults. Data was collected from patients’ and/or their carers’ feedback in the form of a survey. The purpose of the survey was explained to the patients and/or their carers and those who took part placed the questionnaire anonymously in a box at reception. The survey responses were collected on a weekly basis from the box, allowing patients and/or their carers to complete the survey in their own time.

What has been achieved?

Results
During the period of the survey (February until May 2024), 27 questionnaires were received. The majority (21) were completed by carer/family member, and 6 were completed by the person being treated (patient). Patients and/or their carers had to answer 10 questions using a 5-point likert scale: from strongly agree, to strongly disagree.
The majority of participants strongly agreed that the service provided was of high standard. For example:
• the majority agreed that the prescribing pharmacist was polite and considerate
• patients and their carers felt listened to and allowed them to ask questions
• their questions were answered
• everything was explained in a lay language
• they were provided with enough information about their medication
• patients and their carers or families felt involved in their care and treatment
• the majority of patients had confidence in the prescribing pharmacist
• they were given information on who to contact if they had any problems.

What next?

Conclusions
This project showed a positive impact of a new service introduced in the CMHSOP. The pharmacist prescribing role in mental health is a new service and has shown that both patients and their carers have all expressed a positive view of this new clinic. Both patients and carers found the pharmacist caring, professional and attentive to address their concerns.
Future work will look at quantifying how this new service has reduced the waiting time for these patients to be seen or followed up.

THE OCCURRENCE OF SHORTAGES AMONG COMMONLY USED MEDICATIONS AT COPENHAGEN UNIVERSITY HOSPITAL, AMAGER AND HVIDOVRE (AHH)

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European Statement

Clinical Pharmacy Services

Author(s)

Ina Vierø Rinder, IVR

Why was it done?

Handling medication shortages in the hospital pharmacy are time-consuming, and a lot of resources are used to find alternatives. Though shortages are a national focus in Denmark, shortages are not a priority focus in the local hospital pharmacy. Shortages are often handled “on-the-go” locally and therefore not prioritized. The hospital pharmacy uses “Medication News”, posted on internal website, to broadcast information about long-term shortages to the hospitals. The aim was to determine the occurrence of shortages among commonly used medications at Copenhagen University Hospital, Amager and Hvidovre (AHH).

What was done?

A top 100-list of most bought packages of individual chemical substances (ATC5-level) was generated. The purchase data were obtained from the hospital pharmacy at AHH for the period from October 2023 to September 2024.

How was it done?

The list was analyzed to determine how many medications had experienced shortage during the specified period. The analysis was conducted by reviewing past “Medication News”, historical e-mails regarding shortages, and the hospital pharmacy’s own record of shortages.

What has been achieved?

The top 100-list of most bought packages of individual chemical substances (ATC5-level) revealed a total of 1149 item numbers. The 500 item numbers in ATC-level V07AZ** (Chemicals and reagents for analysis) were excluded due to their use. Of the remaining 649 item numbers, 43 item numbers had experienced shortage during the specified period. Of the 43 item number shortages, 22 (51 %) had resulted in a “Medication News” on the internal website. The shortages were distributed in the ATC-levels A (16 %), B (9 %), C (5 %), D (2 %), H (9 %), J (12 %), L (5 %), M (7 %), N (30 %), R (2 %) and S (2 %).

What next?

The generated data of the top 100-list of used chemical substances has given rise to more attention on shortages in the hospital pharmacy. In the future it is assumed that the number of shortages will rise, and it should be possible to increase the attention of short-term shortages by using the obtained data e.g., integrate the data in a daily status meeting. Thereby the shortages can be handled as a priority and not “on-the-go”.

DEVELOPMENT OF A CENTRALIZED CLINICAL TRIALS UNIT: THE STRATEGIC IMPORTANCE FOR HOSPITAL PHARMACY

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European Statement

Clinical Pharmacy Services

Author(s)

Mafalda Cavalheiro 1
Joana Simões 1
Carolina Marques 1
Patrícia Batalha Silva 1
Miriam Capoulas 1
Cláudia Santos 1
1 – Pharmacy Department, Hospital da Luz Lisboa, Portugal

Why was it done?

Due to the connection with the clinical area and innovation, trials in our pharmacy services were previously assigned to each pharmacist specialized in the corresponding therapeutic area. In the beginning of 2024, the increasing number of clinical trials, coordination and investigational drug management challenges emerged and proved that the previous model was inefficient. Our aim is to develop a centralized unit that is the key to coordinate pharmaceutical activity and improve patient care in clinical trials. In addition to dispensing process, pharmacists become responsible for ensuring therapeutic reconciliation, patient education and treatment adherence, improving medication safety.

What was done?

During a time of continued growth in clinical trials number, it was defined as a pharmacy services’ goal the creation of a centralized clinical trial unit. Additionally, the need to structure a pharmaceutical consultation has arisen.

How was it done?

The process unfolded in three phases: team structuring, logistical reorganization and consolidation of the pharmaceutical care process. A lead pharmacist was appointed as coordinator, supported by a backup and three pharmacists in oncology and three in non-oncology. The major limitation was the establishment of the pharmaceutical team and their training for the several ongoing trials. The unit was reorganized into a larger area, including workstations, medication storage and a meeting room. The pharmaceutical consultation was structured into an initial evaluation and follow-ups. During the first consultation, the pharmacist conducts patient assessments, medication education, toxicity management information and drug/herbal interactions checking. Follow-up consultations focused on medication dispensing, compliance, adverse effects and patient concerns.

What has been achieved?

The centralized unit currently manages 66 clinical trials (37 oncologic; 29 non-oncologic). Seven oncologic trials regularly include pharmaceutical consultations, representing an average of 10 appointments per month. Given the benefits of pharmaceutical intervention, particularly in terms of increased adherence, reports of drug safety and compliance, the importance of this centralization is clear.

What next?

Due to logistical challenges, pharmaceutical consultations have only been implemented for oncologic oral medications. With the robustness of the centralized unit, the next goal is to expand pharmaceutical consultations to oral non-oncologic trials, following the successful model used for oncologic trials.

ANALYSIS OF MOTIVATED REQUESTS FOR ANTIBIOTIC MONITORING

European Statement

Clinical Pharmacy Services

Author(s)

Lanzone E. (1), Baldessarelli D. (2), Tinebra A. M. (1), Albini E. M. E. (1), Panarotto A. (1), Rossi C. (1) – (1) SC Farmacia Ospedaliera ASL Novara, (2) Scuola di Specializzazione Farmacia Ospedaliera Novara.

Why was it done?

A comprehensive analysis of systemic antibiotic use in hospitals during the first half of 2024 was conducted, revealing a significant increase in the consumption of WATCH class drugs, specifically carbapenems (ATC J01DH) and fluoroquinolones (J01MA). This prompted the implementation of rigorous monitoring for prescriptions of these drug classes.

What was done?

These antibiotics are key targets of the National Plan Against Antimicrobial Resistance (PNCAR 2022-2025), which mandates a reduction of at least 10% in consumption by 2025 compared to 2022. The initiative aimed to address the rising consumption and enhance antibiotic stewardship.

How was it done?

Data were extracted from the regional IT system, with consumption expressed in Defined Daily Doses (DDD) per 100 patient days. The project monitored the use of systemic antibiotics (ATC J01), focusing on carbapenems and fluoroquinolones. Motivated requests received by the Hospital Pharmacy (FO) were reviewed for therapeutic indications, dosage, treatment duration, and the availability of an antibiogram. All requests were recorded in an Excel sheet for effective data analysis and management.

What has been achieved?

In the first half of 2024, the Hospital Pharmacy received a total of 277 motivated requests for antibiotic prescriptions. Among these, 177 requests were aligned with the objectives of the PNCAR. Specifically, there were 54 requests for fluoroquinolones, including 35 for ciprofloxacin and 19 for levofloxacin. Within this subset, 16 requests included an antibiogram, while 27 were based on empirical data. Additionally, there were 6 requests for surgical prophylaxis, 1 for continuation of therapy, 1 accompanied by a positive urine culture, and 3 that were incorrectly filled out.
The analysis of requests also highlighted a significant number related to carbapenems, with a total of 123 submissions. Of these, 120 were for meropenem, 2 for imipenem in combination with cilastatin, and 1 for ertapenem. Notably, 80 of these requests included an antibiogram, with 74 deemed appropriate based on the established criteria.

What next?

Based on the collected data, modifications to the personalized motivated request form were proposed, introducing stricter criteria for empirical use of these antibiotics. This aims to limit their use to serious and well-defined cases, representing a significant step toward more effective antibiotic therapy and improved clinical outcomes while reducing the risk of resistance. The new form specifies that ciprofloxacin and levofloxacin requests can only be made under certain conditions, and carbapenems are restricted to cases of hemodynamic instability or severe respiratory failure.

SIDE EFFECTS OF CHEMOTHERAPY: INFORMING TO ACT BETTER

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European Statement

Clinical Pharmacy Services

Author(s)

Margot DESCHAMPS, Nejib BORGAAOUI, Jimmy ROSE, Jennifer LE GRAND, Louise NICOLAS

Why was it done?

Digestive cancers represent about 25% of new cancer cases diagnosed in France each year. The medical management of these cancers mainly relies on cytotoxic drugs. Side effects of these medications (fatigue, hair loss, nausea, or digestive issues) can affect negatively patients quality of life. These symptoms can make daily life challenging.

What was done?

As part of a patient therapeutic education program, the goal of our project was to develop an innovative educational tool to help patients better understand these side effects and find ways to manage them.

How was it done?

As part of the implementation of a multidisciplinary therapeutic education program, bringing together oncologists, pharmacists, sophrologists, osteopaths, and nutritionists, designed for patients treated for digestive cancers, the pharmacy is responsible for a workshop focused on the side effects of chemotherapy. The main molecules used to treat digestive cancers were listed, along with their most common side effects. Based on this analysis, playing cards were created, each corresponding to a specific side effect.

What has been achieved?

The developed tool is an educational and interactive board game, consisting of a board, a dice, and 56 cards. These cards are divided into 6 categories: general symptoms, neurology-psychology, heart-lungs, gastroenterology, dermatology, and real-life scenarios. The cards were designed to be understandable and accessible to all patients. The workshop takes place in two parts, with the pharmacist as the main facilitator. In the first part, patients are encouraged to share their personal experiences related to the drawn card. Then, the scenario cards are presented to help patients manage these challenges in their daily lives.

What next?

The decision was made to limit the number of participants to 6, in order to allow everyone to express themselves and exchange freely. The duration of the workshop was theoretically set at 1.5 hours but will need to be adjusted during the first workshops. It will be necessary to implement satisfaction surveys and patient follow-up on various criteria, such as emergency room visits, the number of calls after the session, and the rating of side effects.

INTERNSHIP OF RESIDENT PHARMACISTS IN NEONATOLOGY CARE UNIT AT ULSSA: A COLLABORATIVE APPROACH

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European Statement

Clinical Pharmacy Services

Author(s)

Rita Sofia Conde Lopes, Rita Manuel Neves Lopes, Ana Paula Barbeita, Teresa Cunha, Patrocínia Rocha

Why was it done?

Improving the training of PRs and supporting the neonatal medical team by addressing their needs.

What was done?

The Pharmaceutical Residency (PR) lasts four years, during which the Resident Pharmacist (RP) must acquire skills in various areas. In the PR, one of the longest functional areas is pharmacotechnics, which includes the handling of sterile and non-sterile medicines. At the Unidade Local de Saúde de Santo António (ULSSA), which includes the Centro Materno Infantil do Norte (CMIN), this type of preparation is crucial due to the type of population it serves — pediatrics. With this in mind, the RP had the opportunity to complete a one-month internship in the neonatology unit (NU), where, in addition to familiarizing with the unit’s routine, they assisted with various needs of the service.

How was it done?

PRs attended morning routine specialist doctors during the morning routine, participating in both the night-morning and morning-afternoon shift handovers and follow-ups. The schedule was coordinated between the Pharmaceutical Services (PS) and the NU to ensure this was the most productive time for both parties. During shift changes, any issues from the previous period were discussed. When these topics involved the FS, the PR provided assistance.

What has been achieved?

During their presence NU, PR were able to intervene in several key areas, including expediting Pharmacy and Therapeutics Committee authorizations (e.g., everolimus for a neonate with rhabdomyoma), managing the logistics for obtaining non-commercialized medication in Portugal (e.g., erythromycin oral suspension for prokinetic use), supporting clinical decisions regarding the prescription of parenteral nutrition bags, updating the medical prescription system for dressing materials (e.g., maltodextrin powder dressings) and creating a spreadsheet for prescribing protein supplements.

What next?

This collaboration has fostered a stronger connection between pharmaceutical and clinical services and underscores the vital role of multidisciplinary teams in healthcare, where experts from different fields contribute with their specialized knowledge. Such collaboration not only enhances patient outcomes but also optimizes workflows by reducing service duplication, increasing productivity, and saving valuable time. In the future it is expected continue this collaboration.

72-HOUR TREATMENT RESPONSIBILITY AFTER DISCHARGE: CHARACTERIZATION OF MEDICATION-RELATED CALLS

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European Statement

Clinical Pharmacy Services

Author(s)

Daniel Rasmussen* and Morten Baltzer Houlind

Why was it done?

72-hour treatment responsibility (72H-TR) after hospital care is established to create a safe transition for the patient between hospital treatment and their home. After the implementation of 72H-TR, Copenhagen University Hospital, Amager and Hvidovre (AHH), experiences many calls from the municipalities related to patients’ medications. The purpose of this was to characterize calls related to medication in relation to 72H-TR.

What was done?

We reviewed logs from incoming calls made by Copenhagen and Høje-Taastrup municipalities regarding 72H-TR.

How was it done?

Calls related to patients discharged from the orthopedic or pulmonary medicine departments from AHH during the period from September to November 2023 were included. Further, two senior clinical pharmacists assessed whether calls related to medication was potentially preventable. In case of disagreement, consensus was reached between the reviews.

What has been achieved?

The results showed that 27 out of 50 (54%) calls were medication-related, and 22 out of 27 (82%) were potentially preventable. Of the medication-related calls that were potentially preventable, suboptimal communication was responsible for 11 out of 22 cases (50%), lack of a prescription accounted for 8 out of 22 cases (36%), and incomplete medication reconciliation accounted for 3 out of 22 cases (14%).

What next?

The next step will involve cross-sectoral and interdisciplinary workshops to identify barriers and facilitators and optimize the discharge process. We will also continue improving the online medication discharge reports available to municipalities to eliminate any ambiguities.

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Problems caused by shortages are serious, threaten patient care and require urgent action.

Help us provide an overview of the scale of the problem, as well as insights into the impact on overall patient care.

Our aim is to investigate the causes of medicine and medical device shortages in the hospital setting,  while also gathering effective solutions and best practices implemented at local, regional, and national levels.

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BOOST is where visionaries, innovators, and healthcare leaders come together to tackle one of the biggest challenges in hospital pharmacy—medicine shortages.