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IMPROVING INTRAVENOUS CHEMOTHERAPY ADMINISTRATION SAFETY VIA SMART INFUSION TECHNOLOGY: ONE-YEAR IMPLEMENTATION AT HYGEIA HOSPITAL

European Statement

Patient Safety and Quality Assurance

Author(s)

IOANNIDIS KONSTANTINOS
SCARLATINIS IOANNIS
KORRE OURANIA
BOTSIOU MARIA
NIKOLAOU KATERINA-ANGELIKI

Why was it done?

The integration of clinical pharmacists in oncology settings plays a critical role in ensuring the safe and effective administration of chemotherapeutic agents. At Hygeia Hospital, over the past five years, clinical pharmacists have identified and prevented 1,272 chemotherapy-related medication errors, corresponding to 2.4 errors per 100 chemotherapy days. Despite this substantial contribution, challenges persist in the administration process by nursing staff, particularly regarding infusion parameters. Common errors include incorrect infusion rates and the omission or improper use of required filters and light-sensitive infusion sets, and their prevention remains a persistent challenge.

What was done?

To mitigate these risks, Hygeia Hospital has implemented parameterized electronic infusion pumps as an additional safety mechanism.

How was it done?

These pumps are pre-programmed by clinical pharmacists with non-modifiable infusion time limits for each chemotherapeutic agent, preventing unauthorized alterations by nursing personnel. Furthermore, the pumps provide mandatory prompts regarding the use of filters or/and light sensitive infusion sets, as specified in the Summary of Product Characteristics (SPC) of each drug.

What has been achieved?

Since their introduction one year ago, these infusion pumps have facilitated the identification and correction of previously undetectable administration errors, with an observed rate of 0.15 errors per 100 chemotherapy days. The majority of these involved incorrect selection of infusion duration by nursing staff. These findings underscore the value of pump parameterization in uncovering latent errors and reinforcing adherence to safe administration practices.

What next?

Future steps include expanding the use of parametrized infusion pumps beyond oncology to other high-risk areas, such as intensive care units, where precise and safe administration is equally critical. By reducing reliance on manual intervention and standardizing administration protocols, this approach enhances the overall safety and efficacy of drug delivery across multiple clinical settings.

DEVELOPMENT OF AN INTERNAL GUIDELINE TO IDENTIFY THE ORIGIN OF LACTOSE EXCIPIENTS AND IMPROVE SAFETY IN PATIENTS WITH COW’S MILK PROTEIN ALLERGY

European Statement

Patient Safety and Quality Assurance

Author(s)

M. Echávarri de Miguel, C. Varela Guisasola, A. Sánchez Alonso, A. Abril Cabero, E. Nieto Martil, A. Merino Pardo, E. Algarra Sánchez, B. Riva de la Hoz, B. Márquez Arce, B. Leal Pino, M. Pozas del Río

Why was it done?

Lactose used as a pharmaceutical excipient is generally obtained from skimmed milk and purified to remove milk proteins. Pharmacopoeias specify that lactose must be free from protein contaminants; hence, it has been considered safe for patients with cow’s milk protein allergy (CMPA). However, in severe allergies, medicines containing natural lactose should be avoided due to the potential risk of protein contamination. Although rare, cases of anaphylaxis from contaminant milk proteins have been reported, particularly with dry-powder inhalers, injectables, and vaccines.
This initiative arose after a suspected allergic reaction in a patient with severe CMPA following administration of an injectable containing lactose as an excipient. Given limited evidence and lack of transparency about lactose origin, an internal guideline was developed to enhance patient safety.

What was done?

An internal hospital guideline was developed and implemented to verify the origin—natural or synthetic—of lactose used as an excipient in medicines. The guideline was created through systematic screening assisted by artificial intelligence, followed by verification with manufacturers.

How was it done?

With ChatGPT support, a Python-based code was created to analyze 3,278 pharmaceutical specialties for the presence of lactose. Manual validation of 360 medicines (95% confidence level, ±5% margin of error) confirmed the method’s reliability. The most dispensed medicines and all intravenous formulations, vaccines, and inhalers were reviewed due to higher risk described in literature. Manufacturers were contacted to determine whether lactose was natural or synthetic. Main challenges included delayed responses and limited data due to confidentiality.

What has been achieved?

Of the 3,278 medicines analyzed, 350 contained lactose or mentioned it in their product information, 1,522 did not, and 1,406 were inactive codes. Lactose origin was investigated for 152 products from 58 manufacturers, with responses in 92 cases (60.5%). Only five (5.4%) contained synthetic lactose. High-risk medicines included one inhaler and eight injectables (two vaccines) with natural lactose. Manual validation showed 100% concordance with automated results.

What next?

Next steps include expanding data to over 350 confirmed medicines, publishing results for open access, and developing an app for healthcare professionals. Integration into prescribing and dispensing systems is planned to generate automatic alerts for patients with severe CMPA.

APPROPRIATE GLOVE USE AND HAND HYGIENE: A COLLABORATIVE DEVELOPMENT OF AN INTERACTIVE AWARENESS TOOL

European Statement

Patient Safety and Quality Assurance

Author(s)

DEBROISE Madeleine, Dr GUELLEC Corrine, CHAMPEAUX Murielle, Dr PETIT Paul-Remi, Dr ROCHE Manon

Why was it done?

An innovative awareness-raising tool was developed to reduce glove misuse, strengthen hand hygiene practices, and promote the eco-design of healthcare procedures. The audit and feedback (A&F) strategy, known for improving practices, was at the core of this work (1). This initiative is part of the pharmacy project, implemented across the Territorial Hospital Group.

What was done?

Misuse of both sterile and non-sterile gloves has been widely described in the literature (2) . At the same time, the 2024 French Society for Hospital Hygiene guidelines emphasize that glove use is not recommended for intramuscular, subcutaneous or intradermic injections (3). In this context, the awareness tool was designed to limit misuse and promote good practices.

How was it done?

In addition to the audits carried out (before and after), a multidisciplinary team developed an escape game to make awareness training interactive and to enhance teamwork. Based on guidelines and field feedback, the game includes three modules addressing the appropriateness of glove use, sterile versus non-sterile glove use, compliance with standard precautions, the carbon footprint of different glove types, and waste management. Each session lasts 25 minutes and can take place directly in clinical units.

What has been achieved?

A total of 294 self-assessment questionnaires and 72 observation-based audit grids were collected. Since its launch, 48 workshops have gathered 210 participants, of whom 141 completed a satisfaction questionnaire. For 84% of them, this was their first participation in such an activity. More than 70% reported updated knowledge on hand hygiene and glove use, while 81% considered that environmental aspects could influence their practices. The word “playful” was mentioned in 69 out of 110 comments highlighting the game’s strengths.

What next?

The tool will continue to be rolled out across the region, including in training institutes, with the objective of achieving a 10% reduction in glove consumption at the territorial level.

IMPLEMENTATION OF AMS STANDARDS IN THE ELECTRONIC PRESCRIBING SYSTEM/HOSPITAL INFORMATION SYSTEM (HIS) OF THE UNIVERSITY HOSPITAL COLOGNE GERMANY

European Statement

Patient Safety and Quality Assurance

Author(s)

Dr. Tobias Leinweber1, Dr. Lukas Tometten2, Tobias Wingen1, Dr. Andrea Liekweg1, Prof. Dr. Norma Jung2
1 Hospital Pharmacy, University Hospital Cologne, Germany
2 Department I of Internal Medicine, Division of Infectious Diseases, University Hospital Cologne, Germany

Why was it done?

Standardized dosing tables for anti-infective agents, specifically vancomycin and piperacillin/tazobactam, were developed and integrated into the electronic prescribing system (hospital information system – HIS) of the University Hospital Cologne. The tables provide evidence-based, renal function–adjusted dosing recommendations within the clinical workflow, supporting clinicians in accurate and safe prescribing.

What was done?

Existing treatment standards for infectious diseases were often underutilized in daily practice due to limited accessibility and lack of integration into the electronic prescribing system/HIS. This led to dosing errors—particularly with vancomycin, where underdosing may cause therapeutic failure and overdosing toxicity. Additionally, EUCAST updates to piperacillin/tazobactam dosing required hospital-wide adaptation of practices. The initiative aimed to improve dosing accuracy, enhance antimicrobial therapy safety, and standardize prescribing practices through direct system integration.

How was it done?

The project was developed by an interdisciplinary team consisting of the Antimicrobial Stewardship (AMS) team, the Department of Infectious Diseases, and the hospital pharmacy. To ensure effective adoption and continuous improvement, a stepwise implementation approach was chosen, enabling feedback collection and iterative refinement. The rollout was supported by ward pharmacists who provided on-site guidance and assistance during initial implementation. Targeted training sessions and regular email communications informed and engaged prescribers. All relevant information was integrated into the hospital’s antibiotic guideline to ensure easy access and long-term consistency in clinical practice. Challenges such as differing user familiarity and workflow adjustments were addressed through ongoing training and direct support.

What has been achieved?

The implementation of the vancomycin dosing standard led to more consistent therapeutic drug monitoring (TDM), faster achievement of therapeutic levels, lower rates of toxicity, and reduced linezolid use, indicating improved prescribing behavior. The piperacillin/tazobactam dosing table was widely adopted, though further training remains necessary for full-scale use. Overall, the integration demonstrated improved medication safety, greater standardization, and enhanced clinical acceptance of the HIS-based prescribing system.

What next?

Training sessions, interdisciplinary experience exchange and interviews with clinicians are planned to ensure ongoing optimization.
This initiative illustrates how interprofessionally developed standards can be effectively embedded into clinical workflows. The approach can be easily transferred to other hospitals using similar prescribing software, offering a scalable model to strengthen antimicrobial stewardship, improve prescribing competence, and enhance patient safety.

CHATGPT-5 AS A POTENTIAL ALLY IN IDENTIFYING DRUG–DRUG INTERACTIONS?

European Statement

Patient Safety and Quality Assurance

Author(s)

Presenting author : H Decouvelaere
Co-author : C Lambert de Cursay

Why was it done?

Drug–drug interactions (DDIs) represent a major issue in clinical pharmacology, as they can lead to serious, sometimes fatal, adverse effects. The emergence of artificial intelligence models such as ChatGPT raises questions about their reliability in identifying DDIs. The literature reports that ChatGPT may generate nonexistent information (“hallucinations”) or provide inaccurate or incomplete data. However, evidence regarding its use in detecting DDIs remains limited.

What was done?

To evaluate the reliability of ChatGPT in detecting DDIs, particularly for recently marketed drugs or those under compassionate use authorization (CUA), for which conventional databases are sometimes incomplete.

How was it done?

Thirteen older drugs (marketed before 2010) and seven drugs marketed since June 2025 or under CUA were identified. All pairwise drug combinations were tested. A standardized script was used to query ChatGPT consistently, minimizing bias related to question phrasing. Results were checked using reliable sources (product characteristics summaries, scientific literature, DDI-Predictor, etc.). Searches were conducted between July and September 2025 using ChatGPT-5.

What has been achieved?

A total of 210 drug pairs were analyzed. ChatGPT’s responses were consistent with the literature for 72% of pairs (n=152). For 9% (n=18), the information was incomplete. Partial discrepancies were observed for 1% (n=2) and total discrepancies for 18% (n=38). Among these, 68% (n=26) corresponded to ChatGPT hallucinations and 32% (n=12) to undetected DDIs. Agreement with the literature was 65% (n=59) for older drug pairs, 95% (n=20) for pairs of two recent or CUA drugs, and 74% (n=73) for mixed pairs (old and recent drugs).

What next?

ChatGPT-5 can serve as a helpful tool for identifying DDIs, providing correct analysis in nearly 75% of cases. However, its performance remains limited due to the significant risk of hallucination or omission. ChatGPT’s responses were less reliable for older drugs, likely because of the vast and sometimes outdated documentation available. Conversely, newer or CUA drugs—although less documented—benefited from more recent and homogeneous sources, improving response quality. Therefore, ChatGPT-5 cannot replace human expertise or official databases. It should always be used as a complementary tool, with its outputs verified against trusted sources.

A MULTIDISCIPLINARY APPROACH TO HEALTHCARE-ASSOCIATED INFECTIONS’ PREVENTION IN A HOSPITAL SETTING

European Statement

Patient Safety and Quality Assurance

Author(s)

Furio Alessandro 5, Di Lorenzo Antonio 1, Noviello Chiara 4, Faggiano Maria Ernestina. 2, Bursomanno Beatrice 3, Cantalice Michele Alberto 5, Lobifaro Annamaria 5, Manicone Anna Lucia 5 , Spinelli Giuseppe 5, Parnoffi Nicoletta Francesca 5, Stefanizzi Pasquale 1, Tafuri Silvio 1
1 Dipartimento Interdisciplinare di Medicina – Università degli Studi di Bari Aldo Moro, Bari, Italia
2 Farmacia Ospedaliera – Azienda Ospedaliero Universitaria Policlinico di Bari, Bari, Italia
3 Scuola Di Specializzazione In Farmacia Ospedaliera – Università Degli Studi Di Bari Aldo Moro, Bari, Italia
4 Scuola Di Specializzazione In Igiene e Medicina Preventiva – Università Degli Studi Di Bari Aldo Moro, Bari, Italia
5 Unità di Programma Control Room / U.O.C. Igiene Universitaria – Azienda Ospedaliero Universitaria Policlinico di Bari, Bari, Italia

Why was it done?

Hospitals face a significant challenge from healthcare-associated infections (HAIs), which stem from a complex interplay of various risk factors and have serious implications for patient safety and public health. The initiative was undertaken to address these threats through a multidisciplinary organizational framework, recognizing that safeguarding patients requires coordinated efforts from multiple healthcare professionals.

What was done?

To tackle HAIs, the model implemented at Bari’s General Hospital combined systematic epidemiological surveillance with direct, onsite monitoring of healthcare practices, applying these strategies consistently using specifically designed checklists. This approach is fully in line with international recommendations, particularly the “One Health” strategy, which underscores the importance of integrated and multidisciplinary action in overcoming health challenges.

How was it done?

Prevalence studies, performed over a year, were recommended to improve understanding of infection risks related to invasive procedures, surgeries, and the use of antibiotics. These periodic surveys help to identify emerging trends and risk factors, enabling targeted interventions. Additionally, structured walkarounds within hospital facilities were implemented, allowing multidisciplinary teams to inspect environments, assess clinical records, and monitor drug storage methods. This approach not only prevents critical events but also highlights weaknesses and opportunities for improvement through focused staff training (audit).

What has been achieved?

Achievements from this combined strategy include a more integrated and thorough infection control program. By incorporating continuous audits, field surveillance, and ongoing education for healthcare staff, the hospital pharmacist’s role has evolved from being a background administrator to a frontline participant in infection prevention and stewardship. There has been a notable improvement in the management of both medications and medical devices, especially regarding their cleaning procedures and actual use. Additionally, significant progress has been made in the appropriateness of using anti-infective drugs—such as antifungals, antibiotics, disinfectants, and antivirals—resulting in more rational and safe pharmacological utilization throughout the hospital setting.

What next?

Further enhancements in infection control should focus on sustaining integrated surveillance, monitoring, and training programs. Moreover, it is essential to emphasize the importance of the hospital pharmacist within the corporate multidisciplinary team dedicated to the prevention of healthcare-associated infections, as their expertise is pivotal for the successful implementation of all strategic actions related to infection control and optimal medication use.

A MULTIDISCIPLINARY APPROACH TO THE COMPREHENSIVE CARE OF MULTICOMPROMISED HOSPITALIZED PATIENTS: A CASE REPORT

European Statement

Patient Safety and Quality Assurance

Author(s)

S. Ambrosini, V. Orlando, C. Provezza Provezza, A. Zaltieri, N. Zanini, N. Faroni

Why was it done?

Ensuring a multidisciplinary approach to the comprehensive care of hospitalized patients is a recognized indicator of healthcare quality. This strategy proved highly effective in the management of a patient with a multidrug-resistant Pseudomonas aeruginosa (PA) infection and a severe sacral pressure injury, requiring advanced antimicrobial therapy, targeted nutritional support, and specialized wound care to promote healing.

What was done?

Multicompromised patients increasingly challenge hospital care due to infections from multidrug-resistant (MDR) bacteria, which limit therapeutic options and complicate management. Prolonged hospitalization also raises the risk of pressure injuries, worsening metabolic stress and delaying recovery. This initiative aim to apply an integrated therapeutic strategy—combining a reserve antibiotic, advanced wound care and tailored nutritional support—to promote healing, control infection and restore nutritional balance in a highly vulnerable patient.

How was it done?

The patient received Cefiderocol (2 g every 8 hours) and Fosfomycin (4 g every 6 hours) for six weeks to treat the PA infection. The pressure injury was managed with an oxygen-enriched oleic matrix dressing from organic olive oil, allowing controlled release of reactive oxygen species (ROS) to stimulate microcirculation, cell proliferation, and antimicrobial activity. Dressings were changed two to three times weekly based on progress. Nutritional needs were supported with a high-calorie, high-protein oral supplement (ONS) containing arginine, zinc, vitamin C, selenium, and carotenoids, given once or twice daily to enhance collagen synthesis and tissue repair.

What has been achieved?

This multidisciplinary strategy enabled the prompt definition and implementation of an optimal diagnostic–therapeutic pathway. The intervention and collaboration of multiple healthcare professionals ensured a faster and more effective patient response to treatment. The active involvement of the infectious disease specialist, clinical dietitian, wound care nurse, and hospital pharmacist guaranteed comprehensive, high-quality patient management —from drug and medical device supply to the successful resolution of infection and wound healing, while preventing malnutrition.

What next?

Establishing structured treatment pathways through multidisciplinary teams contributes to a more efficient and sustainable healthcare system. This experience represents an example of best practice, highlighting how collaboration among healthcare professionals—including pharmacists as medication safety officers—can be effectively translated to other hospital settings.

ARTIFICIAL INTELLIGENCE AND AUTOMATION: TRANSFORMING HOW WE MANAGE DRUG RECALLS AND MEDICINE SUPPLY NOTIFICATIONS

European Statement

Patient Safety and Quality Assurance

Author(s)

Anna Lydon & Jonathan Day

Why was it done?

National drug recalls and Government issued Medicines Supply Notifications (MSNs) must be responded to promptly to minimise risk to patients and ensure stock safety. Within our Trust, comprising four hospital sites at different locations, an incident occurred where a recall email received over a bank holiday weekend which went unnoticed. The existing system relied solely on staff checking their emails, which posed a risk of delayed action—particularly during weekends, leave periods, and across multiple sites. This highlighted the need for a more robust and transparent process to ensure that all recalls and MSNs are received, actioned, and tracked in real time.

What was done?

A digital process was developed using Microsoft Power Automate and Artificial Intelligence (AI) to automate the handling of drug recalls and MSN emails. The flow triggers when a drug recall or MSN email is received. It extracts key information using AI, and automatically distributes the information across the relevant pharmacy and clinical teams across all Trust sites.

How was it done?

When a drug recall or MSN email is received, the attached PDF is analysed with an AI model trained with specific prompts to extract key fields including the drug name, MSN number, date, impact level and required actions. The extracted data automatically populates the MSN or drug recall Excel log – replacing what was a manual data entry process. Power Automate then initiates an approval process and posts a summarised Teams notification into a Teams channel for all relevant members. Each member receives the alert and one person from each site must acknowledge receipt. Following acknowledgement from a member of each site, Power Automate posts a confirmation in the Teams channel, enhancing transparency and providing assurance that the recall has been actioned. AI determines the appropriate clinical speciality for the drug and automatically directs a summary email to the corresponding pharmacists and clinicians working in that area.

What has been achieved?

The process ensures consistent and timely handling of recalls and MSNs, reducing reliance on individual inbox monitoring. It has improved visibility across all sites, eliminated missed notifications, and significantly reduced manual data entry time. Staff feedback has been positive, with greater confidence that all recalls and MSNs are captured and actioned promptly.

What next?

Future plans include integrating automatic escalation plans for unacknowledged alerts. The same model could also be expanded to other time-critical communications, such as National Patient Safety Alerts to further strengthen medicines governance across the organisation.

INCREASING SAFETY IN CRITICAL ILL PATIENTS THROUGH COMPUTER INTEGRATION OF MEDICAL PRESCRIPTIONS AND AUTOMATED DISPENSING DEVICES

European Statement

Patient Safety and Quality Assurance

Author(s)

C Gastalver Martin, O Serna Romero, I Escribano Valenciano, S Buendia Bravo, FJ Alonso Zazo, S Alvarez Atienza, D Garcia Gordillo, M Rubio Garcia, AM Iglesias Bolaños.

Why was it done?

Medications prescribed in hospital’s electronic prescribing programs are transferred to automated dispensing devices (ADDs) to prevent medication errors and increase patient safety. This allows nurses to withdraw drugs from ADDs according to the medical prescription, dosage and schedule. However, most intensive care units (ICUs) have their own prescribing systems, usually computerized vital signs charts, which operate independently from the rest of the hospital systems. This fact could be a risk for patient safety.
The objective of this project is to increase the safety of patients admitted to ICUs by integrating prescriptions recorded in the computerized ICU chart with medication withdrawals from the ADD, thereby reducing medication errors.
A secondary objective was to automatically detect medications prescribed in the ICU but not entered into the unit’s ADD, improving medication availability without the need for manual review of the ICU prescription by the pharmacist.

What was done?

This project increase the safety of patients admitted to the Intensive Care Unit by integrating prescriptions recorded in the automated ICU chart with medication withdrawals from the ADD.
This also permitted to detect automatically medications prescribed in the ICU but not available into the unit’s ADD, increasing medication availability without the need for manual review of the ICU prescription by the pharmacist.

How was it done?

This project was implemented in several phases:
1. Preparation Phase
a. Cleanup of the ICU chart medication database: review of standardized treatment lines, dose adjustments to medication presentations, and removal of duplicates.
b. Mapping of the medication database: assignment of the article codes contained in the ADD to the treatment lines in the ICU chart, so that both systems can communicate with each other.
2. Implementation Phase
a. Integration testing and troubleshooting.
b. Go-live.

What has been achieved?

The implementation of computer integration of medical prescriptions through automated dispensing devices increased patient safety and reduced medication errors.
It also decreased the need for manual review of the ICU prescription by the pharmacist to ensure medication availability in the ICU ADD.

What next?

Pharmaceutical validation of medical prescriptions for ICU patients remains essential to ensure the appropriate treatment of these patients

ARTIFICIAL INTELLIGENCE POWERED DOCUMENT MANAGEMENT FOR HOMECARE PRESCRIPTIONS

European Statement

Patient Safety and Quality Assurance

Author(s)

Anna Lydon & Jonathan Day

Why was it done?

Homecare prescriptions are physically sent to external homecare companies for dispensing, so the hospital must retain a copy for governance, audit and continuity of care. Previously, prescriptions were scanned in and manually moved to local folders with variable filenames, introducing risk of error, no audit trail and duplicated effort (pharmacy and clinical teams both scanning). This was a slow, manual process, with a typical delay of around 2-3 weeks before prescriptions were uploaded due to the high volume. We therefore needed a safer, faster and auditable process to retain copies of homecare prescriptions in the official patient record.

What was done?

We developed a Robotic Process Automation (RPA) which involved ustilising an Artificial Intelligence (AI) enabled workflow to capture homecare prescriptions, extract key fields, automatically file using standardised filenames, validate patient identifiers, and automatically upload documents into the patient record for all healthcare professionals (HCP) to view in real time.

How was it done?

We used Microsoft Power Automate and Azure AI to build an AI-driven RPA process to read scanned homecare prescriptions, extract key fields, standardise filenames, validate patient identifiers, and automatically upload documents into the official patient record. Within the automatic process, there are built-in validation checks to verify AI-extracted fields. If the AI confidence score is low or a check fails, the workflow prompts for human confirmation of the patient’s hospital number and then resumes processing.

What has been achieved?

To date, the solution has processed over 5,000 homecare prescriptions with 98% field-extraction accuracy. Average handling time has reduced from 3 minutes per prescription to 10 seconds per 50 prescriptions, equating to around 5 hours saved per 100 prescriptions. This novel process has released 7.5 hours of pharmacy staff time per week. Prescriptions are now available in the patient record in real time, improving information availability at the point of care and enabling staff to focus on higher value tasks. This has strengthened data quality and governance, and provides an audit trail whilst reducing duplication of work between pharmacy and multiple clinical teams.

What next?

We plan to extend the workflow so that all AI-extracted fields are written back to the Homecare Patient SQL database, creating a single, queryable source of truth and enabling automated checks, dashboards and reporting. We also plan to roll the solution out for other prescription types (outpatient and discharge), replacing off-site paper storage with searchable patient records, reducing storage costs, improving retrieval times, and strengthening governance.