EAHP represents over 30,000 hospital pharmacists across 37 member countries. EAHP represents and develops the hospital pharmacy profession within Europe in order to ensure the continuous improvement of care and outcomes for patients in the hospital setting. This is achieved through science, research, education, practice, as well as sharing best-practice and responsibility with other healthcare professional
The EAHP Board, elected for three-year terms, oversees the association’s activities. Comprising directors responsible for core functions, it meets regularly to implement strategic goals. Supported by EAHP staff, the Board controls finances, coordinates congress organization, and ensures compliance with statutes and codes of conduct.
The EAHP staff supports the Board in executing EAHP’s mission. The Staff assists in financial management, events organisations, policy activities and all EAHP projects. The EAHP staff works closely with EAHP’s members and ensures the effective communication all relevant stakeholders.
The first member countries were Belgium, Britain, Denmark, France, the Federal Republic, Germany, Italy and The Netherlands in 1972. EAHP has now 36 EAHP members and 2 Associate Members. EAHP is open to countries members of the Council of Europe and since 2022 to organisations representing the interests of hospital pharmacists from outside the Council of Europe (Associate Membership)
EAHP’s structure is also composed by different standing committes: EAHP Scientific Committee, EAHP Education Executive Committee and the EAHP CTF Steering Committee.
At EAHP, we are committed to transparency in our governance, ethical standards, and funding practices. This section provides open access to our foundational documents, including the EAHP Statutes, Code of Conduct, and Funding Sources. By sharing these resources, we aim to uphold accountability and foster trust with our members, partners, and the public.
Keep up with all EAHP’s events and webinars. Contact the team at info@eahp.eu should you have any questions about upcoming events or activities.
Here you can find all upcoming events organised by EAHP and by all its members and associate members. Do not hesitate to contact the events team at events@eahp.eu should you have any questions about the organisation of these events.
Hospital pharmacists conduct a critical role in the care of patients in hospitals. Learn more about what they do here and in all the pages under Hospital Pharmacy practice and Policy.
Self-Assessment
SILCC
Closed SIGs
EAHP brings together experts from many areas of hospital pharmacy practice providing and highlighting good local sustainable practices as that can be up-scaled and shared with other countries. The EAHP Working Group on Sustainability has the aim of reducing the environmental burden of the hospital pharmacy services.
The European Association of Hospital Pharmacists (EAHP), and its 36 member country platforms are creating a Common Training Framework for the hospital pharmacy education in Europe. The goal of this project is to allow the free movement of hospital pharmacists within the European Union.
The European Association of Hospital Pharmacists (EAHP) and the European Society of Clinical Pharmacy (ESCP) have collaboratively developed the Oath to Society. The Oath to Society is all encompassing and acts as a contract for excellence in providing compassionate patient care, working as part of the healthcare team and advancing the pharmacy profession, and showcasing how clinical and hospital pharmacists work every day
A day created to highlight the importance and to celebrate the work done by hospital pharmacies. This day celebrates all hospital pharmacy teams.
Catch up with EAHP’s press releases
Find all EAHP relevant publication like the EAHP Surveys, annual reports and the history books.
The European Journal of Hospital Pharmacy (EJHP) is the only official journal of the European Association of Hospital Pharmacists (EAHP) and is committed to advancing the science, practice and profession of hospital pharmacy. As the premier communication platform for hospital pharmacists worldwide, EJHP is a major source for continuing education as well as updates on advances in the practice and standard of pharmaceutical care for patients.
When EAHP and Hospital pharmacists appear in the news.
EAHP publishes a monthly EU monitor with updates about the latest EAHP initiatives and information relevant for the hospital pharmacy profession.
Sponsor Channel
The Sponsor Channel is designed to maximise visibility and engagement, allowing sponsors to connect with the hospital pharmacy community and partners in a dynamic and interactive environment. From product demonstrations to networking sessions, the Sponsor Channel offers a range of opportunities for sponsors to showcase their offerings and generate leads in the new EAHP Website.
Production and Compounding
Giorgio Penocchio, Irene Restivo, Francesca Caravaggio, Carla Galloni, Tullio Elia Testa
Harlequin ichthyosis (HI) is a rare congenital disorder of keratinisation characterised by hyperkeratosis and scaling, often associated with underlying inflammation. On 18 April 2022, a newborn diagnosed with HI was hospitalised and clinicians have established, among other procedures and therapies and after dermatological consultation, the prescription of acitretin per os (1 mg/kg/d). However, the drug is not available in an appropriate dosage and formulation for a newborn with orogastric tube. The aim of this report is to show the development of an oral suspension of acitretin that allows the administration by orogastric tube.
This case report presents the development of an extemporaneous preparation of acitretin from the commonly available capsule form. The drug was dispensed to nurses in prefilled syringes and administered enterally through the orogastric tube to treat a preterm neonate with a diagnosis of Harlequin ichthyosis.
In consideration of the teratogenic risk and extreme photosensitivity, the oral suspension was prepared without direct light under a biological safety cabinet. A 2 mg/mL 10 mL oral suspension was prepared from two capsules of 10 mg acitretin and using 10 mL of a suspending agent based on water, microcrystalline cellulose, sodium carboxymethylcellulose, xanthan gum, carrageenan, stabilising agents and preservatives The procedure involves attaching the Luer lock syringe to the arm with a clamp, capping with a combi-stopper and emptying the contents of the capsules required, transferring the powder quantitatively. Next, add the suspending agent to reach the final volume of 10 mL, close the end of the syringe with the plunger, connect a second syringe using a connector and mix by transferring the contents from one to the other.
The suspension was packaged in pre-filled syringes based on the required dose, closed with combi stoppers and placed in a UV bag. Given the lack of stability data, the validity period conferred was 5 days with storage at 2-8°C. The suspension was administered by attaching the syringe to the nasogastric tube and then washing down with water, limiting invasive procedures and consequently the associated skin infections.
Magistral galenic preparation made it possible to obtain a personalised therapy for a critical patient. Clinical galenics, put into practice thanks to the experience of the preparer pharmacist, represented the only possibility of treatment.
Production and Compounding
Leila Costa, Rui Marques, Ana Castro, João Paulo Cruz
Cytotoxic medicines are drugs used mainly in the treatment of neoplasms. Their preparation is a key activity of Hospital Pharmacy, carried out in a Class II Type B2 Vertical Flow Chamber (VFC). With the emergence of new cytotoxic drugs, the increase in the number of patients (2100 in 2010 to 3168 in 2021), and preparations (from 30000 in 2010 to 40000 in 2021), the time spent by Pharmacists in routine work and in the organisation and research of information also increased, and innovative approaches in terms of resources optimisation are deemed.
Evaluate the performance of cytotoxic compounding after the implementation of relevant operational interventions designed to optimise drug preparation and delivery, between 2018 and 2021 in a University Hospital Centre.
Retrospective analysis of the average waiting times of patients for treatment delivery in some day hospitals (DH), after implementation of the operational interventions.
We began with the computerisation of the chemotherapy protocols, in order to standardise the prescribed treatments, which allows to reduce transcription and prescription time and associated errors. A comprehensive database was also created with the main characteristics of cytotoxic drugs and their physicochemical stability, in order to support pharmaceutical validation. In partnership with DH nursing team, every patient’s treatment schedule was determined beforehand, which allowed an enhanced organisational workflow, and the grouping of more complex drugs to prepare at the same time, and the preparation of drugs with adequate stability in the day before. This resulted in a reduction of average waiting times from 2 hours to only 30 minutes. The DH that benefited the most from these changes was Haematology, which adopted all proposed changes from the start after a multidisciplinary team meeting. Currently, about 45% of treatments are prepared the day before. Since the compounding unit is structured in rotating shifts, this practice allows to minimise drug wastage and to reduce preparation time, which improves the organisational capacity and agility in response to patient needs. When available, preference was given to ready-to-use drug solutions instead of powder formulations, e.g. pemetrexed and bortezomib, reducing preparation time and increasing operator safety. Also, in Gastroenterology DH, we promoted switch from original infliximab to its biosimilar by centrally preparing the biosimilar. We used two pharmacy technicians in the same cabinet instead of one, increasing the preparation yield. The last intervention was in the transportation of the compounded preparations, through the implementation of the delivery of treatments via a pneumatic tube system. This system ensures the integrity of the material and the conformity of the transport, thus allowing the safety and stability of the material transported, without bumps and avoiding changes in physical properties. It was possible to obtain a higher frequency of transportation and better workflow at peak times.
With the same human resources and the operational changes described, it was possible to improve the compounding unit performance, and to reduce patient waiting times in 75%, saving time and money.
With the increasing number of patients and cytotoxic preparations, it was necessary to reorganise the compounding unit in several key features.
Production and Compounding
Mateja Ljubičić, Mirela Sadiković Tvorić, Mirela Ganza, Mirna Alebić
Minimising quality and safety differences between commercially available medicines and compounded pharmacy preparations depends on the pharmacists’ professional education and skills. The purpose of this initiative is to specify the most common pharmacists’ adjustments of the commercially available medicines and to determine the level of quality assurance and safety measures which should be applied to the hospital pharmacy throughout planning the procurement of installations and equipment.
Our existing computer system does not have the ability to provide information on the compounded pharmacy preparations made in the hospital pharmacy from raw material or commercially available medicines. We have introduced a database for keeping up-to-date records of pharmacy preparations compounded by pharmacists for special needs of paediatric population in the University Hospital Centre Zagreb in a period of 6 months.
The following information on pharmacy preparations were added to the new database: dosage form, dosage strength, shelf life and serial number of the commercial drug or raw material that was used; patient data: name and hospital department unit; and identification of the pharmacist. Data was structured as presented in Table 1. and Table 2.
Pharmacists’ adjustments Total Number
dosage strength Oral divided powders (DPs) 628
dosage form Extemporaneous oral liquids 473
In total 1101
Preparations with HD Aseptic processing Containment Complexity of process
0.05% Cyclosporine eye drops + + 2
1% 5-FU eye drops + + 2
1% Voriconazole ear drops – + 1
Vemurafenib DPs – + 1
Imatinib DPs – + 1
Capecitabine DPs – + 1
Hydroxycarbamide oral suspension – + 1
Tretinoin oral solution – + 1
Keeping up-to-date records improved the traceability inpatient care and reduced the incidence of adverse events. Specific requirements for procurement of equipment for aseptic processing and containment of Hazardous Drug (HD) were successfully recognised.
Harmonisation of standards of pharmacy preparations throughout the country could be enabled by creating a national portfolio of preparations from all hospital pharmacies. This initiative of creating an overview of the pharmacy preparation practice should be considered in other hospitals to guide the pharmacy departments in the developing quality assurance programme.
Production and Compounding
Randi Hamre Svendsen, Vilde Pettersen, Theo Dogbeten
Endotoxin testing by the gel-clot method is a limit test and relies on the operator’s subjective evaluation of the results. The procedure itself contains several steps and dilutions, and it is time and resource consuming. The availability of the amoebocyte lysate reagent can also vary since it is harvested from the endangered horseshoe crab. The recombinant factor C method (rFC) is a fluorimetric method based on the gene sequence of the horseshoe crab, providing quantitative results with no interpretation by an operator. The rFC method consists of less handling and is less susceptible to human error.
The hospital pharmacy implemented a modern system for testing of bacterial endotoxins as a part of the quality control of raw materials (i.e. water for injection (WFI)) and sterile pharmaceuticals manufactured at the pharmacy, replacing the old gel-clot test.
All sterile pharmaceuticals manufactured at the hospital pharmacy were evaluated for maximum valid dilution (MVD) and endotoxin limit. Firstly, the optimal dilution of the products was established, and then tested with three different batches to ensure valid results regardless of any batch-to-batch variation. WFI was validated undiluted with batches from three separate days. Validation started with the most frequently manufactured products, and subsequently continued over the next year with the rest. To expedite the full validation of some products, expired batches were used simultaneously with at least one recently produced batch due to infrequent production times, otherwise a full transfer of method would not be achieved for up to six years.
In total, 25 sterile pharmaceuticals and raw materials were successfully validated for endotoxin testing by rFC during 2021 and 2022. The gel-clot method is no longer in use at the hospital pharmacy, reducing the negative impact on the horseshoe crab population. The rFC method streamlined the testing for endotoxins, reducing the time spent on performing the analysis by 50% with less handling and increased capacity. Results are quantitative and objective, not relying on observations by the operator, thereby improving the quality.
The rFC method increases both quality and capacity of testing, opening up for expanded testing in pharmacy, and of samples from other departments or hospitals.
Production and Compounding
Mette Lethan, Tove Hansen, Louise Rasmussen Duckert, Trine Schnor
In the clinic, a need for a NEP, as either a change in an existing product or a new formulation, may arise. Requests are risk assessed by the Hospital Pharmacy Drug Information Centre (DIC) before production is initiated. However, there was no clear process for handling requests, resulting in prolonged process times. NEP may require searching for new raw materials, new packaging or developing of a new formulation, which are time consuming tasks. Therefore, the wish to optimise the process arose.
A procedure for handling requests for new extemporaneous products (NEP) in a Good Manufacturing Practice (GMP) regulated production was developed to improve success rate and aligning the process.
A small unit was formed with the purpose of handling requests for NEP. The unit consists of academics employed in the production department with expert knowledge about both sterile and non-sterile production.
A standard operating procedure was formed, in collaboration with DIC, which included a form, to be filled out with information needed for handling the request. This includes drug formulation, strength and dosage, along with any specific requirements.
The unit evaluates the request – is it possible for us to manufacture, sterile or non-sterile, are raw materials available in appropriate quality, analysis requirements, and stability of the product. The evaluation is made in communication with departments like Purchasing, Quality Control/Assurance, Stability as well as the relevant production department.
If a positive outcome, the request is given to the production department, to finalise production. If the outcome is negative a rejection is sent to the requester with a reason.
Based on data from the last three years, we now know how many requests we receive, which type of products are requested, processing times, and which products were made and why/why not.
There is a clear path of communication into the pharmacy and between relevant departments, ensuring that essential pharmaceuticals will be developed in a timely manner or a justified rejection is sent enabling the clinic to look for alternatives.
Some products are difficult to handle, such as cytostatics, antibodies and hormones. Next step is to investigate these product types.
Production and Compounding
Clara Estaún-Martínez, Catalina Perelló-Alomar, Ángela Bueno, Naiara Tellería, Olga Delgado-Sánchez
Automated compounding emerges as an alternative for manual compounding, making possible the centralisation of standardised compounded medications in hospital pharmacy aseptic services at a larger scale. This provides sterile, high-quality, safe, traceable ready to administer products to clinical units. Additionally, it could free up nursing time for patient care instead of performing pharmaceutical work.
We evaluated productivity, dose accuracy and environmental monitoring of KIRO Fill®, a robotic compounding system (RCS). We also assessed the microbiological results of the sterility tests performed.
We implemented a RCS equipped with ISO 5 aseptic environment, horizontal airflow with HEPA filters and continuous monitoring of: air flow operation, non-viable particle counts (limits for ISO Class 5 are 0.5μm and larger size: not more than 3.520 particles/m3, and 5μm and larger size: not more than 20 particles/m3) and temperature (not more than 25°C). Two automated units work in parallel handling transfer syringes to withdraw solutions from source containers (SC) and fill final containers (syringes or infusion bags) via Luer Lock connections. This technology allows barcode/data matrix verification of source and final containers used and RFID for in-process tracking. An integrated scale is responsible for gravimetric control of the compounded preparations within an acceptable ± 5% error range. Gri-Fill® filling system was used for the preparation of SC.
Drug verification was assured through drug workflow management system and datamatrix verification in RCS.
We performed sterility test of all batches and physicochemical stability studies were developed when not available in the literature.
Between January 2022 and September 2022, we have prepared with RCS 2.813 syringes of norepinephrine (base) 0,2 mg/ml in normal saline for critical care unit syringe pumps and 395 morphine hydrochloride 1mg/ml normal saline 250 ml infusion bags for patient-controlled analgesia (PCA) administered in the surgical area.
The average dose accuracy errors for syringes and infusion bags were 0.23% and –0.09%, respectively. Environmental monitoring results and temperature controls met our standards at all times.
Results from sterility tests demonstrated the absence of microbial growth in all tested preparations
Overall satisfactory results when compounding sterile preparations using KIRO Fill and the positive feedback received from nurses in clinical units, have led us to incorporate new batches, such as morphine syringes for critical care unit syringe pumps, to the production with the RCS. Stability studies are currently being performed for this purpose.
Production and Compounding
Louise Rasmussen Duckert, Marianne Kjettrup Jensen, Mette Lethan, Trine Schnor
The hospital pharmacy wishes to support the implementation of OPAT and during the process the need for standardised kits with utensils was identified. The availability of kits with necessary utensils for aseptic handling of parenteral infusion would simplify and standardise the work for hospital and home nurses. Considerations regarding patient safety and sustainability were also in favour of the kits, as choice of utensils could secure compliance to regional guidelines considering use of closed systems and rinse of the line after infusion. Kits containing the exact needed utensils for an administration also reduces the possible waste.
The hospital pharmacy has composed standard kits with utensils for outpatient parenteral antibiotic therapy (OPAT).
The kit is composed in collaboration between the pharmacy, hospital nurses and home nurses. The best suited infusion set was chosen – a closed system with two spikes for antibiotic mixing and infusion. Hereby nurses avoid direct contact with antibiotics and avoid antibiotic aerosols in the citizen’s home. The infusion set contains no PVC, phthalates or latex. When fully emptied the infusion set can be discarded as regular waste.
The kit also contains a sterile cover for the workstation, sterile ethanol swabs, gloves, pre-filled saline syringes for rinse of the line after infusion and a written manual. All is packed and labelled by the hospital pharmacy and lot numbers are registered for traceability.
The kits have been tested in selected municipalities and the content of the kit has been adjusted. As a result of the feedback a film has been recorded showing the handling of the infusion set. The video is used for training and a QR code on the written manual guides the home nurse to the video if needed. The kit is now used widely in the region and response is positive. With the set-up being identical in all municipalities in the region, handling antibiotics and utensils is simpler for the hospital nurse at discharge.
As the number of patients in home-based OPAT rises, experiences with the kits will probably result in wishes for adjustments. A new kit with utensils for changing PVK is under development.
Production and Compounding
Peder Nygard, Helle-Brit Fiebrich-Westra, Elise Smolders
The aim of this project was to reduce paclitaxel waste caused by cancellation of administrations. Standardised dose bands make interchangeability of already reconstituted paclitaxel bags easier, as more patients use the same dose. This could potentially save drug- and material waste and costs even as manpower.
Paclitaxel fixed dose bands were created for patients treated with a weekly dose of 80 mg/m2.
In consultation with prescribers the dose bands for paclitaxel where created (see table). These dosages were implemented as a dose-rounding rules in the drug preparation software (Hix 6.2, ChipSoft BV). The maximum deviation for dose-rounding rules for paclitaxel in our hospital is 10% of the prescribed dose. Dosage ≤72mg or >200mg were rounded as normal.
Prescribed dose (mg) Dose-band (mg) m2 (dose 80 mg/m2
>72 ≤88 78 1.0
>88 ≤102 96 1.2
>102 ≤116 114 1.4
>116 ≤136 126 1.6
>136 ≤152 144 1.8
>152 ≤168 162 2.0
>168 ≤184 174 2.2
>184 ≤200 192 2.4
These rules were implemented in April 2022. Data from 1 May 2022 to 31 August 2022 is compared with the same time period in 2021. In 2022, a total of 729 infusions where prepared compared with 872 infusions in 2021.
In this 4 month time period in 2022 a total of 14 different dosages were prescribed, compared with 24 in the same time period in 2021. Additionally, interchangeability was improved as the top 3 dosages prepared by the pharmacy were: 144 mg (36%), 162 mg (22%), and 126 mg (19%) compared with 144 mg (17%), 138 mg (14%), and 126 mg (10%) in 2021.
Furthermore, in 2021 we discarded 33 prepared dosages of paclitaxel of which three infusions could be reused. Compared to 13 discarded dosages in 2022 of which eight were reused giving a reduction of 25 infusions less waste (83% reduction, savings ~2500 euros).
Pharmacists need to be instructed to adapt these rounding rules, which must decrease the variation in dosages and thus waste. Secondly, this project will be monitored the upcoming year and evaluated together with prescribers. The aim is to implement dose bands for paclitaxel dosages 175 mg/m2 and other chemotherapeutic drugs (eg, oxaliplatin, docetaxel, cyclophosphamide).
Production and Compounding
Caterina Donati, Giulia Moroni, Matteo Federici , Paolo Silimbani
To evaluate the performances of automated preparation in the oncology pharmacy by assessing productivity, errors interception, and waste reduction achieved by managing vials overfill.
Automated preparation, operated by two robots and one gravimetric-assisted workflow system, was introduced to improve productivity and working efficiency [1,2], while reducing the risk of human errors. Furthermore, to optimize resources utilization and reduce waste, a procedure for managing overfill of drug vials during automated preparations was implemented. Indeed, manufacturers fill injectable drug vials with a volume that slightly exceeds the nominal volume (overfill) to ensure proper withdrawing and patient dosing.
The annual throughput in terms of preparations was calculated for automated and manual preparation. Human errors intercepted during automated preparation were clustered into four groups: loading of wrong component (i.e. final container, solvent, drug product), multiple barcodes reading, failed manual reconstitution, wrong expiration date. Overfill was calculated for 17 high-cost drug vials by volumetric verifications performed by experienced pharmacy technicians. The annual number of vials used and the corresponding waste reduction due to the overfill management was determined. All data were taken from the production management software and examined over a two-year period (2019-2020).
In total, 82,216 preparations were compounded over two years, 72% of which with robotic systems and 28% manually prepared, either with gravimetric-assisted workflow (13%) or conventional volumetric technique (15%). Overall, automated preparation covered 85% of the total production. The human errors intercepted during automated preparation amounted to 701 in 2019 and 662 in 2020. Most errors were intercepted by robotic systems and were related to loading of wrong component (83%). Vials overfill ranged from 0.2mL (ramucirumab, eribulin, trastuzumab-emtansine, pembrolizumab, nivolumab) to 2.5mL (ipilimumab). The total waste reduction due to overfill management resulted in 1331 vials saved corresponding to 855,013€.
The study showed that automated preparation of oncology products represents a well-established practice in terms of productivity, and moreover ensuring interception of potential medication errors and waste reduction thanks to the overfill management
Production and Compounding
Different automated production systems (APS) are now available on the market. It is essential not to make a mistake due to the impact on the organization, investments and architecture. Comparative tables of each equipment are not enough to properly make a good choice.
We determined a decision tree to choose the most suitable equipment for the cytotoxic drugs production unit.
Based on our experience of using APS and interviews or visits of other users of the equipment, we have compared the different systems by classifying them according to the items that are the most efficient: productivity, precision, diversity of preparations and drugs, installation constraints, autonomy, maintenance of sterility of preparations, chemical contamination. We also used a French calculator, published by the ARS IDF, to determine the cost of a preparation, taking into account the purchase price, personnel, consumables, maintenance, personnel equipment, and operating costs. Then we defined our present and future needs (dose banding, nominative advance preparation, type and quantity of preparation (infusers, syringes, bags), architectural and air treatment constraints. Then we classified the needs and constraints by importance and then determined for each one which equipment was the best answer.
We classified the needs and constraints by importance and for each one we determined which equipment was the best answer. From most important to least we had: headroom, floor load, air handling, dose banding, sterility maintenance, productivity, autonomy and calculated price of the preparation. The results for preparation price showed that the highest price per preparation is not the most expensive equipment but one of the cheapest because of the very expensive captive consumables. Unexpectedly, the most expensive equipment has an average price per preparation because it is very productive, autonomous and has few captive consumables. To validate this tree, we applied it to another cytotoxic production unit.
Using this decision tree, the choice of equipment will be the most suitably adapted for each hospital.
