DEPLOYMENT OF FLASH TRAINING SESSIONS ON HIGH-RISK MEDICATIONS IN CARE UNITS AS PART OF MEDICATION SAFETY
European Statement
Clinical Pharmacy Services
Author(s)
Cartaillac-Julien C.(1), Danjean S.(1), Demazière V.(1)
Why was it done?
As part of the 2026 HAS certification, the “Medication Safety” group launched short training sessions for nurses on high-risk medications. Designed by a pharmacy resident and validated by a nurse, these sessions were implemented despite limited resources and 12-hour shifts.
What was done?
To strengthen medication safety by maintaining a consistent level of knowledge among nurses through regular, unit-based sessions.
How was it done?
These 20-minute “flash” trainings, integrated into continuing education, are conducted by a pharmacy resident directly within care units to optimize staff time. An anonymous 12-question MCQ is completed before and after each session to measure impact. The interactive slideshow format promotes discussion, and participants receive a pocket summary of key points. Satisfaction questionnaires assess the program’s quality in line with QUALIOPI standards. The first module focused on anticoagulants, high-risk drugs frequently involved in “Never Events.” Developed from official and nursing references and reviewed by a frontline nurse, it covers indications, side effects, contraindications, interactions, interprofessional communication, and patient counseling.
What has been achieved?
Seventeen sessions were delivered across eight departments, involving 45 nurses. Small-group formats required several sessions per unit. Knowledge improved, with mean scores rising from 14.2/20 to 16.3/20 (+14.8%). The least-known topics were bleeding signs, indications, and management of missed doses.
Nurses valued the practical content and on-site format, which saved time. Opinions on duration were mixed—some found 20 minutes too short, others saw it as the only feasible format. Unit managers praised the pharmacy team’s adaptability. Participants requested new topics such as antibiotics, antidotes, insulins, potassium, and adverse drug effects, as well as stronger physician involvement.
What next?
These successful short trainings foster collaboration between nurses and pharmacists, standardize practices, and improve medication safety. The initiative will continue with additional modules and expanded participation from other professionals, contributing to a shared culture of safe medication use.
THERAPEUTIC SEQUENCING IN MULTIPLE MYELOMA: THE ROLE OF INNOVATIVE THERAPIES
European Statement
Clinical Pharmacy Services
Author(s)
Cristina Soares
Ana Margarida Dias
Inês Seabra
Patrocínia Rocha
Why was it done?
Multiple myeloma has evolved significantly, as reflected in the latest international guidelines from the International Myeloma Working Group, which underscore the incorporation of novel pharmacological classes—such as proteasome inhibitors, immunomodulatory drugs, monoclonal antibodies, and T-cell redirecting therapies (e.g., CAR T-cell therapy, bispecific antibodies) which have revolutionized treatment paradigms.These therapeutic advances have led to: Improved progression-free and overall survival;Reduced toxicity profiles compared to conventional chemotherapy; Enhanced personalization of treatment, guided by cytogenetic and molecular risk stratification. The strategic sequencing and combination of therapies are now central to clinical decision-making.
What was done?
Following the clinical case of a 54-year-old male patient with IgA/K multiple myeloma, stage II (ISS), undergoing fifth-line therapy with a bispecific monoclonal antibody, the hospital pharmacist key responsibilities included: Therapeutic Optimization; Pharmacovigilance and Safety Monitoring; Support in Advanced Therapies; Collaborating in supportive care strategies; Patient Education and Adherence; Interdisciplinary Collaboration.
How was it done?
The hospital pharmacist played a key role in the validation of protocols, preparation of advanced therapies, pharmacovigilance, and documentation of the patient’s perspective. In this case, the first administration of talquetamab was conducted during hospitalization, following protocol guidelines. The patient developed cytokine release syndrome (CRS), which was successfully managed with two doses of tocilizumab, an anti–IL-6 agent. The pharmacist actively contributed to the preparation, administration, and monitoring of talquetamab, including dose escalation, and coordinated efforts to improve the patient’s quality of life. Additionally, the pharmacist provided counseling on treatment goals, administration routes, and adherence strategies, particularly in outpatient settings and during transitions between therapeutic lines, while serving as a liaison between hematology, pharmacy, and nursing teams.
What has been achieved?
This study demonstrates the importance of a clinical follow up in a patient with MM treated with a innovative therapy and added value of integrating a clinical pharmacist in a multidisciplinary healthcare team to optimize therapeutics outcomes and patient care.
What next?
The future of multiple myeloma treatment presents challenges in selecting innovative therapies, particularly in therapeutic sequencing, toxicity management, access and equity, and real-world data integration. These complexities underscore the essential role of the hospital pharmacist within multidisciplinary teams, ensuring safe, effective, and patient-centered care.
DETERMINATION OF THE PH OF SELECTED ANTI-INFECTIVES FOR SAFE INTRAVENOUS ADMINISTRATION
European Statement
Clinical Pharmacy Services
Author(s)
L. Čermanová, V. Slezáková, J. Babiaková, D. Fábiánová, S. Porubcová
Why was it done?
Phlebitis is one of the most common complications of infusion therapy. Intravenous drugs with extreme pH values (9) may chemically irritate or damage the venous endothelium, triggering an inflammatory response. Understanding the pH of intravenous anti-infectives is essential for clinical decision-making to prevent infusion-related complications.
What was done?
The aim of this work was to determine the pH values of selected intravenous anti-infectives administered at the National Institute of Cardiovascular Diseases, Bratislava (NÚSCH, a. s.) due to their potential to cause endothelial damage.
How was it done?
A literature review was performed to collect available data on the pH of reconstituted and diluted anti-infectives used at NÚSCH, a. s. Sources included Summaries of Product Characteristics, ASHP Injectable Drug Information®, pharmaceutical recommendations of Hôpitaux Universitaires de Genève, and relevant scientific publications.
The criteria used to select anti-infectives for pH analysis were a complete lack or insufficient information on the drug’s pH, reported pH values approaching the extreme thresholds of 5 or 9, and excessively wide pH ranges exceeding these limits.
Subsequently, the pH of 21 selected drugs was measured at 37 commonly administered concentrations (including ready-to-use formulations) using a glass-electrode pH meter (XS pH 7 Vio portable pH meter; electrode CHS ChemFlex). The diluents used were 0.9% sodium chloride solution, 5% glucose solution, and water for injection.
What has been achieved?
A table summarising selected anti-infectives at commonly administered concentrations, along with their mean pH values (± standard deviation) was compiled. Dilution volumes used in clinical settings with either 0.9% sodium chloride or 5% glucose solution for extremely acidic or alkaline medications did not appear to significantly modify pH in a way that would affect vascular access choice.
The pH values enable the identification of anti-infectives with a higher potential risk of phlebitis and support the selection of the most appropriate vascular access device.
What next?
The results will be applied in developing institutional recommendations for the dilution and administration of anti-infectives, supporting safer infusion practices and the prevention of chemically induced phlebitis across NÚSCH, a. s. wards. They will also inform staff training and may contribute to the reduction of medication errors.
MAKING ANTIBIOTIC DAYS OF TREATMENT ESTIMATION HAPPEN IN UNCOOPERATIVE SYSTEMS: TURNING ROUTINE DATA INTO STEWARDSHIP METRICS
European Statement
Clinical Pharmacy Services
Author(s)
Héctor Rodríguez-Ramallo, Nerea Báez-Gutiérrez, Alicia Melgar-Sánchez, José María Pastor-Martínez, Marta GÓNZALEZ-MARTÍNEZ, Jesus Francisco SIERRA-SÁNCHEZ.
Why was it done?
We designed and implemented a semi-automated method to estimate Days of Therapy for inpatient antibiotic use by leveraging routinely available Athos Prisma prescription exports. The workflow extracts daily prescription data and processes it with an automated script (Stata/Python/R) to generate DOT by antibiotic and hospital unit.
What was done?
DOT is a widely accepted measure of antibiotic exposure, and it is especially useful in paediatrics, where Defined Daily Doses (DDD) are unreliable due to weight variation across ages and heterogeneous “standard” dosing across centres.
Aim: to enable reliable, reproducible DOT measurement from data already available to all Athos Prisma users, facilitating stewardship dashboards and unit-level benchmarking.
How was it done?
Baseline capability: Athos Prisma supports DDD estimation but not DOT.
Data discovery: We identified a standard, centre-agnostic daily prescription export that contains the fields needed to compute DOT.
Processing pipeline: A one-click script parses the daily file, standardises drug names, groups by patient/day, and outputs DOT by antibiotic and unit.
Obstacles & solutions:
• DOT function is not integrated in Athos Prisma → built an external script that any site can run.
• Manual file export burden → consolidated to a single daily export; runtime <1 minute.
• Availability: The code is available on request and can be used by any Athos Prisma-using unit after minor local configuration.
What has been achieved?
We achieved a working code pipeline and measured DOT from June–September 2025 across the hospital. Highlights below:
Antibiotic DOTs Share of total DOT (%)
Amoxicillin/clavulanic 2608 9%
Ceftriaxone 4033 14%
Cefepime 611 2%
Piperacillin 3507 13%
Meropenem 1858 7%
Ciprofloxacin 970 3%
Levofloxacin 1495 5%
Cotrimoxazole 2443 9%
Cloxacillin 207 1%
Cefazolin 993 4%
Linezolid 751 3%
Daptomycin 678 2%
What next?
• Normalize to DOT per 100 patient-days at hospital and unit level.
• Automate the export (scheduled job) and publish weekly dashboards to stewardship teams.
• Set guardrails: prospective alerts for sustained increases in broad-spectrum DOT.
• Validate against a manual audit sample and report inter-method agreement.
• Share pack: provide a turnkey bundle to other centres.
IMPLEMENTATION OF A CLINICAL PHARMACY ACTIVITY IN RADIOPHARMACY: A TRIPARTITE CONSULTATION HOSPITAL APPROACH FOR PLUVICTO® RADIOLIGAND THERAPY IN ELDERLY PATIENTS
European Statement
Clinical Pharmacy Services
Author(s)
J. BERGÉ, S. BRILLOUET, C. LAMESA
Why was it done?
Tripartite consultation (TC) activities are well established in oncology for chemotherapy, and are progressively emerging in radiopharmacy, where there is a clear need to support elderly and polymedicated patients receiving RLT. This therapy is costly and complex, with additional radioprotection requirements, making multidisciplinary coordination essential.
What was done?
A new activity of clinical pharmacy in radiopharmacy is developed as TC for Pluvicto® radioligand therapy (RLT) in our comprehensive cancer center.
This activity was set as TC with the nuclear physician, radiopharmacist, and nuclear medicine technologist. The initiative was done on our institutional software, with dedicated templates creation and harmonized tools.
How was it done?
Three main axes guided implementation: (1) integration into institutional software with customized reporting templates; (2) reorganization and structuring of the patient pathway; (3) harmonization of practices and training, with the involvement of pharmacy residents under senior supervision. Moreover, specific supports were developed to structure patient counseling, including interview templates and patient-oriented documents (radioprotection instructions, explanatory treatment diagrams).
What has been achieved?
The initiative enabled the standardization of reporting, the improvement of patient pathway coordination, and the reinforcement of their educational support. The integration of patient counseling tools strengthened patients’ understanding of a complex therapy, sensitization to radioprotection, and adherence to their care, while improving overall coordination. It also made possible the systematic performance of medication reviews, particularly relevant for an elderly and polymedicated patient population. Since its implementation, 40 patients have already been managed within this framework by residents under systematic senior supervision. Finally, the TC allowed the institutional financial valorization of this activity.
What next?
This activity represents an interesting and transposable example of good practice. Its implementation demonstrates that such an TC structure can be extended to other RLT to improve efficiency and harmonization of both professional practices and patient management. In parallel, we are currently driving a French multicenter study (Pharma-RIV) assessing the impact of pharmaceutical consultations in the management of patients receiving RLT. A broader preliminary effort is in progress to structure the RLT care pathway at the national level, in collaboration with the French Society of Nuclear Medicine.
THE CRUSHING FACTORY SAFE PHARMACOTHERAPY THROUGH ENTERAL FEEDING ACCESS – EXPERIENCES AND GOOD PRACTICES FROM THE UNIVERSITY CLINICAL CENTRE IN GDAŃSK
European Statement
Clinical Pharmacy Services
Author(s)
Ewelina Lubieniecka – Archutowska, Bogusława Szmaja, Dorota Świtkowska, Agnieszka Prusko, Magdalena Jaśkowska, Marzena Mielczarek – Kęska, Urszula Dobrzycka – Magulska, Wioletta Kaliszan
Why was it done?
Enteral nutrition therapy plays a crucial role in the management of patients who cannot meet their nutritional needs orally. Besides providing essential nutrients, enteral feeding access often serves as a route for drug administration, which requires specific knowledge about drug compatibility and pharmacotherapy safety among healthcare professionals.
The aim of this project was to improve the safety and effectiveness of pharmacotherapy administered through enteral feeding access at the University Clinical Centre in Gdańsk (UCC).
What was done?
Based on literature review and institutional experience, the main challenges identified were related to the selection of appropriate medicines and pharmaceutical forms, as well as to the preparation and administration techniques used by nursing staff. To address these issues, several measures were implemented within UCC to enhance pharmacotherapy safety in patients with artificial enteral access.
How was it done?
A procedure titled “Principles of Administering Medicinal Products to Patients Receiving Enteral Nutrition via Feeding Tube or Gastrostomy” was developed and implemented. Within the hospital information system (Clininet), a dedicated list of medicines that must not be crushed or administered via enteral routes was introduced and made visible to physicians and nurses to support safe prescribing. Clininet also allows physicians, nurses, and dietitians to request pharmacotherapeutic consultations from hospital pharmacists. Pharmacists analyze and, when necessary, modify patients’ therapy. Medicines suitable for administration through enteral access were added to the hospital formulary, enabling physicians to choose formulations appropriate for crushing or alternative routes of administration. The hospital pharmacy introduced the so-called “Crushing Factory” – a centralized service where pharmacists prepare R.PEG-labeled medicines in safe forms and doses for enteral administration. Each administration is recorded in the patient’s medical documentation.
What has been achieved?
The implemented system led to:
• fewer prescribing and administration errors
• reduced drug loss and preparation mistakes
• fewer interactions and adverse effects
• compliance with accreditation standards for medication safety
• lower treatment costs and fewer pharmacological interventions
• reduced nursing workload and improved efficiency
What next?
Expand staff education on enteral pharmacotherapy, standardize training materials, monitor outcomes, introduce patients pharmaceutical discharge summaries and implement solutions hospital -wide to improve safety and continuity of care.
PHARMACOKINETIC-GUIDED HIGH-DOSE METHOTREXATE PROTOCOL: MULTIDISCIPLINARY COLLABORATION AND OUTCOMES IN REAL-WORLD PRACTICE
European Statement
Clinical Pharmacy Services
Author(s)
Anais Carrillo Burdallo
Cristina Villanueva Bueno
Maria del Pilar Montero Antón
Isabel Regalado-Artamendi
Beatriz Torroba Sanz
Jose Luis Revuelta Herrero
Eva González-Haba Peña
Daniel Gomez Costas
Yeray Rioja Díez
Antonio Prieto Romero
María Martín Bartolomé
Xandra García Gonzalez
Ana Herranz Alonso
Maria Sanjurjo Saez
Why was it done?
High-dose methotrexate (HD-MTX) carries substantial toxicity risk. Safety hinges on timely, appropriately dosed leucovorin rescue plus high-volume hydration and urinary alkalinisation. Pharmacokinetic monitoring with proactive follow-up enables early detection of delayed clearance and better-informed decisions.
What was done?
A protocol for the administration and pharmacokinetic monitoring of HD-MTX was developed and implemented in a tertiary hospital in coordination with the Haematology Department.
How was it done?
Standardised procedures for administration were defined (hydration/alkalinisation strategies; rescue timing/dose; infusion start; sampling schedule). Adults with leukaemia/lymphoma received short (5µmol/L; long: 42h, >1µmol/L).
Pharmacist-led interventions were classified as: enhanced elimination (intravenous fluids/furosemide; bicarbonate/acetazolamide; cholestyramine), rescue optimisation (dose guided by the prediction, readjusted after the measured level, and withheld when appropriate), and monitoring (additional levels and duration).
Continuous accuracy was assessed with the individual percentage error (IPE)=[(predicted−observed)/observed]×100; we report MDIPE (median IPE; accuracy), MAIPE (median absolute IPE; precision), and the proportion within 1.5-fold. Classification against thresholds was summarised with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).
What has been achieved?
In 24 administrations (13 short, 11 long), pharmacist-led interventions were implemented in every cycle: enhanced elimination 88%, rescue optimisation 54%, monitoring 71%.
Continuous accuracy: MDIPE +35% (IQR 9–80), MAIPE 38% (IQR 11–80); 54% within 1.5-fold. Threshold performance (short/long): accuracy 69/91%; sensitivity 100/100%; specificity 67/86%; PPV 20/80%; NPV 100/100%.
Protocolised monitoring improved safety by standardising decisions and reducing errors. The predictive tool achieved 100% sensitivity and NPV, supporting early rule-out of delayed clearance; positive alerts should be interpreted cautiously given moderate overprediction and false positives near thresholds, with confirmation and close follow-up.
What next?
Next steps are full rollout, recalibration and threshold tuning in larger cohorts, and extension to Oncology and Paediatrics, tracking efficiency endpoints (time to <0.05-0.2 µmol/L, length of stay).
IMPLEMENTATION OF PRIORITIZATION CRITERIA IN MEDICATION REVIEW ACTIVITY IN GERIATRIC MEDICINE: AN EIGHT-MONTH STUDY
European Statement
Clinical Pharmacy Services
Author(s)
A. GHORBEL, C. KONN, J. CATROUX, J. TISSERAND, P. ROCANIERES
Why was it done?
Polypharmacy and multimorbidity make medication safety a major challenge in geriatric medicine. Medication reconciliation and review are essential but time-consuming processes that cannot be systematically performed for all patients. Prior, we made a systematic review of the French literature which identified multiple prioritization approaches – empirical, statistical, and consensus-based – but no harmonized tool. Common criteria included advanced age, polypharmacy, psychotropic use, high-risk medications, and chronic diseases such as heart failure. Then, we aimed to translate these findings into a pragmatic, locally adapted prioritization grid to improve targeting and workflow efficiency.
What was done?
An initiative was developed in the geriatric department of a French University Hospital to introduce prioritization criteria for medication review (MR) at admission. The aim was to optimize pharmacists’ clinical activity by identifying high-risk patients most likely to benefit from a MR, given the limited available resources.
How was it done?
A prospective, observational, comparative study was conducted over 13 months (early June 2024 – end June 2025) in neuro-geriatrics and onco-geriatrics. During the 8 last months, pharmacists applied a prioritization grid daily based on clinical and pharmacological criteria (≥ 5 medications, renal impairment, psychotropics, high-risk drugs). Indicators before and after its implementation were compared using a two-sample Z-test (α = 0.05).
What has been achieved?
After implementation, 295 admission and 48 discharge MR were performed (vs 272 and 31 before prioritization). The initiative allowed the targeted inclusion of patients with a mean age of 87 ± 6 years and an average of 10 ± 4 chronic medications. The most frequent prioritization criteria identified were renal impairment, use of “never-event” drugs (methotrexate, insulin, colchicine, oral chemotherapy and anticoagulant drugs), antibiotic therapy, electrolyte disorders, and diabetes. Average MR time rose (113 vs 105 min; 89 vs 47 min), reflecting higher case complexity.
What next?
Defining common prioritization criteria could support national recommendations and enable the development of digital tools integrated into hospital information systems to automatically identify high-priority patients. In the future, it is planned to use these results to create decision rules from artificial intelligence software: it could generate dynamic prioritization models based on real-time clinical, biological, and therapeutic data, embedded into dispensing software to improve patient safety and optimize pharmaceutical care.
TOOL FOR OPTIMIZING START-UP MANAGEMENT IN CLINICAL TRIALS: DEVELOPMENT AND IMPLEMENTATION OF A STANDARDIZED FORM
European Statement
Clinical Pharmacy Services
Author(s)
I. GUMIEL BAENA1, L. ARMENDARIZ PATIER1, P. RIOS ESTEBAN1, R. VIZCAYA CORTÉS1, S. SANTOS MUÑOZ1, R. SANABRIAS FERNANDEZ DE SEVILLA1, A. SANCHEZ GUERRERO
Why was it done?
Efficient management of clinical trial start-up is essential to ensure timely initiation and compliance with regulatory and operational requirements. Hospital pharmacy services play a central role in handling, preparation, and accountability of investigational medicinal products (IMPs). However, information provided by sponsors is often incomplete or inconsistent, leading to delays, miscommunication, and additional workload at trial initiation. To address these challenges, a standardized approach was needed to collect pharmacy-related requirements proactively and optimize communication with sponsors.
What was done?
A standardized electronic form was developed to collect critical information from sponsors prior to the initiation of a clinical trial. The objective was to anticipate logistical, technical, and operational needs of the pharmacy service and to improve coordination during the start-up phase.
How was it done?
An electronic form (Jotform®) was created and sent to sponsors before the initiation visit. It included the following sections: (1) general study data (title, phase, code, investigator, department, duration, and enrollment); (2) investigational and auxiliary medication (description, dosing, and supply details); (3) logistical requirements (storage, shipping, and custody); (4) preparation and dispensing (procedures, need for pharmacy compounding, and prescribing system details); (5) returns and expiry management; and (6) additional pharmacy tasks (e.g., completion of sponsor platforms). The form was completed electronically and returned before pharmacy service approval.
What has been achieved?
Implementation of the form improved communication with sponsors, ensured early identification of specific requirements (such as special storage conditions or sample conservation), and clarified responsibilities regarding delegated pharmacy tasks. The process allowed more efficient planning and reduced start-up delays associated with missing or inconsistent information.
What next?
The standardized form will be regularly updated based on user feedback and extended to additional hospital departments involved in clinical research. This experience demonstrates a replicable strategy that can be implemented in other hospitals to enhance efficiency and quality in clinical trial management.
ACUTE AND SUBACUTE INFECTIVE ENDOCARDITIS MANAGEMENT IN A CLINICAL EMERGENCY HOSPITAL
European Statement
Clinical Pharmacy Services
Author(s)
S. FIRULESCU, T.F. VRABIE, M.A. MIHAI, C.D. ROTARESCU, S.R. DILIMOT, F. PETRUC, D.E. DRANCA, C. ANDREI, S. NEGRES.
Why was it done?
Infective endocarditis represents one of the most severe cardiovascular pathologies, with a mortality rate up to 30%, further complicated by rising antimicrobial resistance. The purpose of this study was to identify the most frequently encountered pathogens and to evaluate the influence of implantable cardiac devices or prosthetic heart valves. As clinical pharmacists, we also assessed treatment concordance with the European Guidelines for the management of endocarditis and hospital antibiotic policy.
What was done?
A retrospective analysis was conducted over the period January 2024-August 2025, by clinical pharmacists and residents of this specialty.
How was it done?
We evaluated patient records, focusing on the pharmacological treatment of infective endocarditis.
What has been achieved?
From a total of 104 hospitalized patients (67 males, 37 females), 66 patients were diagnosed with infective endocarditis as a primary diagnosis, while 38 patients had endocarditis as a secondary diagnosis. The patients were aged between 26 and 86 years, 60% of them being over 65 years old. Furthermore, the presence of implantable cardiac devices or valve prostheses represented a major risk factor, as it was also confirmed in this study (discovered at 55% of patients). The principal identified pathogens from blood cultures were Gram-positive cocci, such as Staphylococcus (67%) – mainly Staphylococcus aureus, both MSSA and MRSA (27%), Staphylococcus epidermidis (22%) – and Streptococcus (19%), mostly Streptococcus gallolyticus (7%). Other less common pathogens included Coxiella burnetii, Serratia marcescens, Enterococcus spp., and Stenotrophomonas maltophilia. The most commonly used antibiotics were: Vancomycin (56%), Ceftriaxone (53%), Ampicilin (42%) and Rifampicin (37%). In this study, antibiotics were used from all three AWaRe categories, as follows: 41% of patients received Access antibiotics, 41% Watch and 17% Reserve. Considering the used antibiotics and their posology, it could be estimated that in 65.4% cases, the recommendations of the current guidelines were strictly followed.
What next?
The evaluation of the guidelines concordance regarding the antimicrobial medication by clinical pharmacists as part of a multidisciplinary team is of the utmost importance for an optimized therapeutic management.