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Author(s)

Erica Cusumano, Giorgia Nairi, Cristina Baiamonte, Chiara Schimmenti, Lo Verso Clelia, Carolina Scaccianoce, Marcello Vitaliti, Sceila Affronti, Marco Benanti, Paolo Amari, Patrizia Marrone

Why was it done?

Until 2020, pavilizumab, refunded by National Health System for Respiratory Sincytial Virus (RSV) infection prophylaxis of paediatric patient at risk, was dispensed in 50 mg (FL 50) and/or 100 mg (FL 100) unit packs, regardless of the prescribed dose, with subsequent preparation on the ward and waste of any residual drug. Therefore, the project’s purpose, from November 2021, was to overcome the past distributive criticalities of pavilizumab.

What was done?

In our Hospital, Early Start 2.0 project (E.S-2.0) was implemented in collaboration with the neonatal intensive care unit. The E.S-2.0 purpose was to increase quality and safety of Pavilizumab galenic preparation to guarantee the patient’s health and generate an economic saving with an optimisation of hospital resources.

How was it done?

The E.S.-2.0 involved weekly drug days for the delivery to department staff of personalised galenic preparations of pavilizumab, prepared by hospital pharmacy service in a contamination-controlled environment. Through the hospital management system, prescriptions for the period November 2021 to April 2022 were extrapolated to verify the validity of the project. There were 85 patients. A palivizumab consumption database was created to evaluate the mg saved after E.S.-2.0 and the related economic savings.

What has been achieved?

Project implementation allowed us to obtain an economic saving of 9.33% related to 2339.01 mg that would have been dispensed and wasted without E.S-2.0. The results obtained considering the costs of pavilizumab (FL-50: 10.79 €/mg and FL-100: 8.96 €/mg) and our saving indicators: mg saved= mg that would have been delivered before E.S-2.0 – mg after E.S-2.0; € saved = (mg residues that would have been dispensed and wasted before E.S-2.0 from FL 100 x 8.96 €/mg) + (mg residues that would have been dispensed and wasted before E.S-2.0 from 50 x 10.79 €/mg). In addition, the personalised galenic preparations in controlled contamination pharmacy premises guaranteed a sterile pharmacological manipulation process.

What next?

E.S.-2.0 represents a cost saving policy safeguarding patient security. Practice described is worthy of implementation in hospitals not just for prophylaxis of RVS infection but also for the management of all patients undergoing treatment with therapies that can be prepared in galenical laboratory.

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Author(s)

BEATRIZ TORROBA-SANZ, CRISTINA ORTEGA-NAVARRO, ANA DE LORENZO-PINTO, CARMEN REDONDO-GALAN, JUAN ANTONIO ANDUEZA-LILLO, MARTA SANCHEZ-CELAYA POZO, ANA HERRANZ-ALONSO, MARÍA SANJURJO-SAEZ

Why was it done?

Almost half of the patients discharged from the ED receive incomplete information at discharge and they forget approximately 60% of the medical information received when they leave the hospital. All these hinders the proper management of medication at home, generating anxiety to patients and favoring the appearance of adverse events and new visits to the hospital.

What was done?

We have designed, implemented and evaluated a tool to resolve pharmacotherapeutic queries of patients discharged from the Emergency Department (ED).

How was it done?

Patients with doubts about the pharmacological treatment prescribed upon discharge can contact FarmaCenter through the instructions included in the discharge report (telephone/email). The pharmacist will then analyze each query, gathering information from the clinical history and, if necessary, contact the care-team for resolution. Finally, the pharmacist will contact the patient, resolve the query and offer the opportunity to complete a satisfaction survey.

What has been achieved?

766 consultations were received (November 2022- 31 August 2023), mean age was 49.8 years and 49.3% were men. The majority (96%) contacted by telephone and the mean time of resolution was 1.5 hours. Half of the cases (53.7%) were resolved by the hospital pharmacist without the necessity of contacting the rest of the healthcare team. The main reasons for consultation were: medication not prescribed (28.3%), drug administration (8.7%), management of adverse reactions (6.9%), shortages (6.8%), dosage (5.9%) and duration of treatment (5.7%). 15.5% of consultations were not related to medication. The satisfaction survey was sent to 288 patients and 40% responded. The overall rating was 4.9/5 and the most highly valued aspects were the individualized attention, fast resolution of the query and the pharmacist’s kindness. In addition, 95% of patients considered that FarmaCenter had helped them to avoid a visit to a healthcare center.

What next?

Developing improvement strategies to reduce the number of patients with medication-related concerns from the ED.

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Author(s)

Hilde Omestad, Maria Grønkjær Abrahamsen, Fatima Afif Mouaanaki, Charlotte Mosbæk Dybdahl, Anne Wulff Petersen, Emil Dalsgaard Züricho, Philip Hojrizi, Charlotte Arp Sørensen

Why was it done?

The sustainability strategy of the Central Denmark Region include less consumption and less waste. Our Pharmacy delivers an increasing amount of high-cost homecare medications, requiring refrigerator storage. In case of an accidental temperature exposure, patients may ask whether their medicine can be used or not. There may be a delay during transport or a breakdown of their refrigerator at home. During these medicines’ shelf-lives, most products can be kept at room temperature for days, weeks or months. When SmPC and the insert package leaflet says that the product should not be returned to the refrigerator, high-cost medicines sometimes are wasted, only because of this warning, instead of giving them a shorter shelf-life. When we hesitate to return packages to the refrigerator, time can elapse while waiting for the manufacturer’s or pharmacist’s answers to the patient’s questions after storage incidents.

What was done?

The Hospital Pharmacy categorized 47 Blood Coagulation Factors and Monoclonal Antibody Products requiring storage at 2-8 °C if Summary of Product Characteristics (SmPC) had any warning of returning a product to the refrigerator or not, after an unwanted time at room temperature

How was it done?

We asked manufacturers if a return of their product to the refrigerator would cause any harm. Should their product be disposed of because it has been put back into a refrigerator after being left out? Our findings were documented in a local guideline and in the Danish national information database (SAID).
Drug Information Pharmacists discussed several cases of real-world handling situations to be more confident to reduce medicine wastage.

What has been achieved?

Being aware of the reasons for these warnings, reduced medicine wastage in certain cases of incidental storage. The pharmacists have been given tools for pharmaceutical professional assessments in cases of temperature challenges.

What next?

Spread the good news. Improve communication between manufacturer and pharmacy, because manufacturer can’t be responsible for storage different from their SmPC. Inspire manufacturers to improve their storage warnings in SmPC

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Author(s)

Charlotte Sørensen, Karin Aagot Møller Jørgensen, Anne Grethe Nørgaard Kyndi, Charlotte Lund Madsen, Line Scriver Poulsen, Charlotte Hjorth, Gitte Slyngborg Morbjerg, Janni Østergaard Jensen, Mette Juul-Gregersen, Rune Dalsenni Rask

Why was it done?

A sustainability project in 2020 highlighted manual and time-consuming workflows when checking expiry dates in hospital medicine rooms. For example, manual reading, interpretation and notation of expiry dates in paper forms every half year. Therefore, a smartphone application was developed and implemented in a large university hospital in 2022. The application was a huge success and colleagues from other Clinical Pharmacy departments in other hospitals within the same region wanted to be part of the success of the initiative.

What was done?

A smartphone application for managing expiry dates in medicine rooms was applied in one hospital in 2022 and in four other hospitals in 2023. The data-matrix of medicine packages is scanned with a smartphone camera and the application gives a sorted overview of medication near expiry. In the application you can register a medicine package as either used, discarded or released. By releasing medicine packages, the medicine is made available to colleagues in other medicine rooms.

How was it done?

The smartphone application was implemented in Clinical Pharmacy departments in four other hospitals, one by one from February 2023. After implementation the application is used in 373 medicine rooms.

What has been achieved?

Clinical Pharmacy staff are happy with the application. It takes significantly less time to check and scan expiry dates with the digital solution.
From February to September 2023 (five hospitals)
• 47491 packages were scanned
• 5251 packages were released (11%)
• 2664 packages were moved between medicine rooms to avoid medicine wastage (51%; 147000 €). Most activity (78%) was seen at the hospital that had been using the application since 2022. Most packages were moved between medicine rooms at the same hospital; however, in 215 cases (8%), medicines were exchanged between hospitals as well (20.000 €)
• 10918 packages were discarded due to expiry (743168 €; 0.5% of bought medicine).

What next?

The full potential of the digital solution remains to be achieved.
Pharmaconomists have to release medicine in the application a few months earlier than they do now. To go shopping in the application before ordering from the pharmacy, will probably also result in discarding less medicine. Sharing medication across hospitals to a greater extent will also be relevant to consider.

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Author(s)

Elisabetta Volpi, Giuseppa Lo Surdo, Sara Tonazzini, Stefania Alduini, Maurizio Mangione, Umberto Paradossi, Monica Baroni, Sergio Berti, Stefania Biagini

Why was it done?

Several data suggest that pharmacists and physician collaboration, direct pharmacist interaction with patients or caregivers through medication reconciliation and discharge counselling decreases the number of adverse drug events (ADEs) and plays an overall positive role in transitional care. Our aim is to demonstrate the constant necessity of pharmacist led medication reconciliation in order to maintain a high standard of care and safe medication use.

What was done?

Medication reconciliation at hospital discharge is essential for the prevention of medication discrepancies and patient harm. Hospital pharmacists are recognised as one of main healthcare providers that can support the physicians in this activity.
Since 2016, the medication reconciliation process has been performed by physicians and clinical pharmacists before home discharge from the Heart Hospital, Fondazione Toscana G.Monsaterio in Italy.

How was it done?

We analysed the medication reconciliation activity performed in our hospital over time and we observed that the number of unintentional discrepancies was always around 20%.
A shared pre-discharge prescription review programme has been activated with all doctors, so when the final lists of drug prescriptions are ready, the pharmacist examines them and suggests improvements or corrections to the doctor before the discharge letter is delivered to patients. Among the unintentional discrepancy observed, the most frequent were omissions of chronic therapy, lack of information about suspension for low molecular weight heparin or antibiotics.

What has been achieved?

A strong collaboration between physicians and clinical pharmacists has been achieved as we shared the results of this improvement. The same activity has been required and extended to the paediatric ward where the demand of simple, clear and complete information is even more crucial given the particular inter-individual variability and fragility of this population.

What next?

We would like to improve the prescription review programme also at admission in order to minimise drug omissions and at transition between different wards or different hospitals with the aim of improving communication between health care settings.

Author(s)

Maria Gregori, Eva Legido, Marta Bellver, Inmaculada Seguí, Amando Mengual, Jose Manuel Ventura

Why was it done?

In Spain hospital pharmacy services dispense specific medications to outpatients. Nevertheless, some patients have difficulties in getting to the hospital due to disabilities, displacement problems or work reconciliation. In this sense, the objectives of the programme were as follows: Improve patient access to healthcare professionals and reduce visits to the hospital. Promote patient autonomy, responsibility, and participation in decision making regarding pharmaceutical care and dispensing of medicines. Increase patient satisfaction with the healthcare provided. To expand the portfolio of services of the OPCUs. Promote the integration and continuity of pharmaceutical care between the OPCU and CP.

What was done?

Implementation of a programme in the Outpatient Pharmaceutical Care Unit (OPCU) that includes telematic pharmaceutical care (telepharmacy) as well as the dispensing of hospital medications in proximity through our health structures (primary care centres) or community pharmacy (CP).

How was it done?

We took the following steps:
– Establish inclusion and prioritisation criteria for the selection of patients who are candidates to participate in the telematic pharmaceutical care and proximity dispensing programme.
– Establish the procedures for the development of telematic pharmacotherapeutic follow-up: telephone consultation at the beginning of inclusion and successive ones prior to each dispensation.
– Establish the processes, procedures, and resources for the performance of drug dispensing in CP.
– Coordination of all participants in the process.
– Establish indicators and variables to measure and improve the results obtained.
– Guarantee patients’ rights in terms of confidentiality, authorisation, and information.

What has been achieved?

From January 2022 to August 2023, a total of 376 patients have been included in the programme, which translates to 2,041 telephone consultations and 2,306 dispensations of medication from hospital to CPs or primary care centres. A total of 36 incidences were resolved.
Of these patients, 68% were included because of having reduced mobility or dependence, 18% due to work-life balance, and 14% due to distance or problems getting to the hospital.

What next?

– Inclusion of at least 15-20% of patients from face-to-face modality to telepharmacy and proximity program.
– Evaluate indicators and detect opportunities for improvement in the processes.
– Determination of patient reported outcomes.

Author(s)

Nina RANJIT, Matthieu GALLET, Anthony TRIPLET, Myriam QUERMONNE , Alexandre COCHET

Why was it done?

The rise of RLT is seeing the emergence of new treatments, using radioisotopes such as 177Lu or 223Ra. The radioactive nature of these treatments raises questions from patients. The aim of pharmaceutical consultations (PCs) is to respond to them by providing appropriate information on treatment modalities, adverse effects (AEs) and radiation protection rules. Thus, we carry out a PC at the initiation of an RIV for all new patients from January 2022 for PLUVICTO.

What was done?

Radioligand therapy (RLT) consists of the administration of a radioactive drug. It makes it possible to treat cancer patients by specifically targeting tumour cells and destroying them using ionising radiation.
These particular treatments raise questions from patients. This is why we have implemented pharmaceutical interviews since 2022 and the beginning of RLT by PLUVICTO® during the first treatment, for all patients concerned. Subsequently, these consultations were extended to other therapies (lutathera, xofigo).

How was it done?

Before initiating RLT to a new patient, radiopharmacists check the eligibility of patients and the conformity of the indication. A few days before the first treatment, the patient’s file is consulted and important information is noted (urinary or fecal incontinence, digestive problems, biological assessment, co-medications). The day of the treatment, a personalized care plan is drawn up by the radiopharmacist and an information sheet bringing together information on the treatment (interval of treatments, dose, etc.), side effects and their management and the rules of radiation protection are provided. to the patient.

What has been achieved?

Collaboration with nuclear doctors has been set up to optimise patient care and information.
When necessary, pharmaceutical interventions are formulated directly to the clinician and plotted in a table.
Facing the success of these PCs we implement them for lutathera and xofigo, the two other RLT available.
In case of side effects, we also declare it to the pharmacovigilance service and give advice to patients and/or clinicians for manage them.
All documents are recorded in the computerised patient file.

What next?

The next step is to evaluate patient’s comprehension before the first interview to adapt its content to the patient.
We also would like to evaluate the patient’s satisfaction and expectations.
Discussions are underway to financially promote these tripartite consultations as exists for oral chemotherapy consultations.

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Author(s)

Pilar Lalueza Broto, Laura Domenech Moral, Alba Pau Parra, Ángel Arévalo Bernabé, Danae Anguita Domingo, Anna Rey Pérez, Jacinto Baena Caparrós, Marcelino Baguena Martínez, María Queralt Gorgas Torner, Mónica Rodriguez Carballeira

Why was it done?

The four-year specialist training program for Hospital Pharmacy in Spain includes one year of clinical training, involving rotations through various medical units where residents develop their clinical skills. This forms an essential component of clinical proficiency and integration into the healthcare team.

The Intensive Care Unit (ICU) was chosen because the presence of a pharmacist during rounds as a full member of the care team has been associated with a reduced rate of adverse drug events.

What was done?

We developed a standardized medication audit tool to ensure uniform pharmaceutical care delivery, aligned with the Hospital Pharmacy Specialty training program.

How was it done?

We designed a pharmacotherapeutic monitoring chart containing biodemographic and clinical data, analytical parameters, and clinical issues for each patient. A multidisciplinary team, comprising staff physicians and pharmacy resident tutors, identified the most common clinical problems or key issues for different types of patients admitted to critical care units, as well as specific clinical problems related to particular pathologies. Pharmacotherapeutic recommendations were based on clinical evidence or internal protocols. Common key issues included nutritional support, fluid resuscitation, thromboembolic prophylaxis, hemodynamic monitoring, infection management, drug monitoring, and sedative and analgesic therapy. We defined specific efficacy and safety indicators for each clinical problem. Additionally, we monitored specific outstanding problems in particular patient types.

We also implemented a model for recording and coding pharmaceutical interventions.

What has been achieved?

The pharmacotherapeutic monitoring chart has enabled us to establish standards for pharmaceutical care in the ICU, promoting consistency among the entire care team and optimizing pharmacotherapy outcomes in patients. It also facilitates the assessment of residents’ skill acquisition during their training.

What next?

In the future, assessing the tool’s usefulness and its impact on residents’ training benefits will be of interest. Moreover, it may serve as a reference model for other clinical rotations.

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Author(s)

MARCELO DOMINGUEZ CANTERO, CARMEN MARIA DOMINGUEZ SANTANA, MARCELINO MORA CORTES, ESMERALDA RIOS SANCHEZ, JUAN MANUEL BORRERO RUBIO

Why was it done?

Patients who withdraw medication from outpatient pharmacies in Spanish hospitals are provided with pharmaceutical care and pharmaceutical care stratification tools in specific outpatient pharmacy consultations. These patients are usually multi-pathological with multiple drug interactions, contraindications, and important adverse effects. Therefore, during the hospital admission of these outpatients, it was appropriate to provide continuous care from the hospital pharmacy. Before the implementation of the protocol, there was no specific and systematic follow-up of hospitalized outpatients.

What was done?

Implementation of a protocol that provides pharmaceutical care to outpatients during hospitalization, ensuring continuity of care through the pharmacy service.

How was it done?

The main problem with the implementation was the real-time detection of hospitalized outpatients. The development of a software tool to facilitate the location of patients provided an impetus for the implementation of the project. The computer tool selected patients who met the inclusion criteria (hospitalized outpatients with medication withdrawal in the outpatient unit in the last two months). Patients treated with erythropoietin and colony stimulants were excluded.

What has been achieved?

Seventy-nine patients were included in the study between April and September 2023; 62.1% were male. Main pathologies included 41.9% oncohaematologic diseases, 18.9% human immunodeficiency virus, and 17.7% immune-mediated inflammatory diseases.
The reason for admission was related to the pathology for which outpatient medication was withdrawn in 27 patients (34.2%), and six patients (7.6 %) were admitted due to an AE of the medication withdrawn in outpatients. Pharmaceutical interventions (PI) were performed in 21.5% of the patients reviewed, and 76.5% were accepted. PI reasons included discontinuation of treatment (64.7 %), modification (17.7 %), initiation (11.8 %) and monitoring (5.9 %).

What next?

With our protocol, we want to show that outpatients within the pool of patients admitted to a hospital are a priority target group. For these patients, the hospital pharmacist can improve treatment during hospitalization with a high degree of pharmaceutical intervention.

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Author(s)

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

Why was it done?

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

What was done?

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

How was it done?

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

What has been achieved?

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

What next?

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