OBJECTIVES:Centres for Medicines Information (CMIs) are core components in providing evidence-based recommendations to practitioners, thus reducing medication errors. This study examined the organisational and operational features of international CMIs and the types of inquiries they address. Its findings aim to support the development of new CMIs and to suggest recommendations for improvement. METHODS:A narrative review was conducted using PubMed as the database. In addition, an anonymous e-questionnaire was sent to hospital pharmacists through the European Association of Hospital Pharmacists. RESULTS:Findings from 20 studies and surveys from seven CMIs showed that most were hospital-based. The literature suggested that they provided regional services while survey data indicated they typically served a single institution. They mostly operated during regular working hours, with some offering 24/7 availability. CMIs primarily supported healthcare professionals by addressing medication-related queries. However, proactive information dissemination via newsletters and education is also important, as well as promoting the service. Digital documentation was more common in newer CMIs, while older ones lacked such integration. The use of Frequently Asked Question pages was limited across all CMIs. Electronic health record-based inquiry systems were rare, found in only three hospitals surveyed. Pharmacists were the main personnel, although the levels of training varied. To ensure effectiveness, quality assurance efforts focused on documenting references and responses, validating answers and ensuring timely replies. CONCLUSION:This study offers an overview of CMIs, aiming to guide their organisation and practice. The findings suggest that future CMIs should prioritise regional collaboration and digital integration to boost efficiency and cost-effectiveness.
OBJECTIVES:Patient safety in drug therapy depends on clear, rapidly comprehensible medication information in routine care. Pictograms depicting selected drug-related problems (DRPs) may support risk management and help healthcare workers reduce medication errors. To be effective, information provided by such pictograms should be intuitive and accessible to the entire healthcare workforce, requiring targeted change management strategies within healthcare professions. METHODS:We performed a prospective cross-sectional online survey asking for (1) existing measures and strategies to communicate DRPs, (2) assessments of general benefits and potential of pictograms within routine practice, (3) prioritised DRP categories for pictogram development, (4) intuitive recognisability and comparative evaluation of newly developed pictograms, and (5) ideas for optimising pictograms. All healthcare professions of a university hospital (1451 beds, 61 (poly)clinics, >6000 employees) were invited to participate. RESULTS:In total, n=193 participants took part in the survey (median age 38 years, 67% women; 28% physicians, 32% nurses, 22% other healthcare professionals; median total work experience 14 years). (1) Pictograms or (visual) warning labels were already actively used by 43% of participants. (2) 83% of the participants deemed pictograms as beneficial. Participants mentioned the main advantages were 'faster understanding' (81%) and 'simplified communication across language barriers' (70%). (3) drug-drug interactions' was rated most important overall (82%). (4) Newly developed pictograms achieved the highest correct interpretation rate for 'medication without indication' (90%). (5) The main measure for optimisation was using 'pictograms together with signal words' (56%). CONCLUSIONS:Healthcare professionals perceive pictograms as beneficial for DRP communication, yet the risk of misinterpretation is high. Therefore, newly developed pictograms require further optimisation and evaluation before they can be applied in clinical routine. Embedding such pictograms as tools within risk management and change management frameworks may improve DRP communication, help the healthcare workforce prevent medication errors and enhance patient safety.
OBJECTIVES:Intravenous immunoglobulin (IVIG) is a high-cost therapy that is widely used in paediatric care for its immunomodulatory effects. However, inappropriate prescribing contributes to resource waste and potential harm. This study aimed to evaluate the impact of clinical pharmacist-led supervision on the rational use of IVIG in a paediatric hospital setting. METHODS:A retrospective cross-sectional study was conducted at a paediatric hospital, comparing two 6 month periods: before and after the implementation of a clinical pharmacist-driven prescribing protocol. A total of 248 paediatric patients were systematically selected and assessed for IVIG indication appropriateness, dosing accuracy, and corticosteroid pre-treatment. Statistical analyses were performed to compare clinical variables across the two periods. RESULTS:Following clinical pharmacist intervention, the proportion of appropriate IVIG prescriptions significantly increased from 49.2% to 66.9% (p<0.001), and the number of vials used decreased from 837 to 451. Dosing improvements led to the saving of 199 vials, equating to approximately £15,694 in cost savings. Among patients with immune thrombocytopenic purpura (ITP), the rate of corticosteroid use, as the first-line therapy prior to IVIG administration, increased from 10.5 to 33.3%. Although IVIG use increased in certain departments, its administration became more evidence-based and targeted to appropriate indications. CONCLUSION:Clinical pharmacist-led supervision significantly improved the appropriateness of IVIG use in paediatric patients, reduced unnecessary dosing, and contributed to substantial cost savings, underscoring the critical role of clinical pharmacists in optimising high-cost medication use. Further prospective studies are recommended to assess long-term clinical outcomes of such interventions.
OBJECTIVE:To establish an internal system for the approval and monitoring of pharmaceutical product suppliers and, through this, to improve management efficiency and objectivity, reduce logistical incidents and stock shortages and carry out a transparent and objective selection of suppliers. METHODS:A multidisciplinary team was set up to define approval criteria and a biannual monitoring system based on the detection of eight agreed types of logistical incidents weighted according to their severity. Throughout the monitoring process, incidents were recorded electronically and downloaded for analysis. Those suppliers with the highest number of incidents, weighted and adjusted to the number of orders, were subjected to an evaluation rubric. RESULTS:In 2023, 200 suppliers and 43 393 orders were analysed, with 443 incidents. In 2024, 206 suppliers and 46 045 orders were evaluated, with 468 incidents. The most frequent incidents in both years were missing delivery notes, missing packages and stock shortages. The rubric was applied to a total of 20 suppliers. In 2023, 70% obtained a 'good' result, 20% an 'intermediate' result and 10% a 'poor' result. In 2024, 90% achieved the 'good' category and 10% obtained an 'excellent' result. The re-evaluated suppliers showed an improvement in their scores. DISCUSSION:The implementation of this system enabled structured monitoring of supplier performance. Despite an increase in order volume, incident rates remained stable, suggesting robustness. The model facilitates the identification of areas for improvement. However, potential subjectivity in the evaluation criteria and the descriptive study design should be considered. CONCLUSIONS:This model provides a practical framework for supplier evaluation in hospital pharmacy. It may support quality improvement and could be adaptable to other settings, although further validation is needed.
Voriconazole is commonly used for the treatment of invasive aspergillosis. Its metabolism is influenced by pharmacogenetic polymorphisms of CYP2C19 as well as by inflammatory states. We report a case of a 49-year-old Chinese woman with essential thrombocythaemia who was treated with voriconazole for possible invasive pulmonary aspergillosis. Despite possessing a CYP2C19 *1/*1 normal metaboliser genotype, she required unusually high doses (14.5 mg/kg/day), nearly twice the standard dose, to achieve therapeutic voriconazole concentrations without apparent adverse effects under therapeutic drug monitoring (TDM). Notably, increased C-reactive protein (CRP) levels are associated with decreased CYP2C19 activity and can inform cautious dose titration. Although pharmacogenetics plays an important role in voriconazole metabolism, this report highlights the lack of correlation between genotype and clinical pharmacokinetics, as reflected by TDM results.
OBJECTIVES:Hospital radiopharmacy plays a central role in ensuring the quality, safety and regulatory compliance of radiopharmaceuticals used for diagnostic and therapeutic purposes. Given the complexity and multidisciplinary nature of the radiopharmaceutical circuit, professional practice evaluation represents a key tool for continuous quality improvement. This study aimed to evaluate professional practices in hospital radiopharmacy using a structured process-based clinical audit and to identify priority areas for quality improvement. METHODS:A prospective professional practice evaluation was conducted in the radiopharmacy unit of a university hospital nuclear medicine department. Eleven audit grids comprising 156 criteria were developed based on national regulations, international guidelines and good radiopharmacy practice standards. The evaluation covered all major stages of the radiopharmaceutical circuit including reception and storage, preparation, quality control, dispensing, cleaning and disinfection and radioactive waste management. Data were collected through direct observation and document review and analysed descriptively. Identified non-conformities were prioritised and addressed through a quality improvement action plan structured according to the Plan-Do-Check-Act (PDCA) cycle. RESULTS:Overall compliance with professional practice standards was 87% across evaluated processes. High compliance was observed for workflow organisation, radiopharmaceutical preparation and quality control activities and radiation protection measures. However, recurrent non-conformities were identified, mainly related to hand hygiene practices, traceability of prepared radiopharmaceuticals, radiological controls at reception, equipment stabilisation procedures and radioactive waste management. Based on these findings, a structured and prioritised action plan was developed, including short-, medium- and long-term corrective measures. CONCLUSIONS:Professional practice evaluation using a process-based clinical audit is an effective approach for identifying strengths and areas for improvement in hospital radiopharmacy. Implementation of a structured PDCA-based action plan supports continuous quality improvement, enhances patient and staff safety and promotes compliance with professional and regulatory standards. This methodology may be transferable to other radiopharmacy settings.
OBJECTIVES:Advanced therapy medicinal products require storage at very low or cryogenic temperatures, creating major organisational challenges for hospital pharmacies. This national survey aimed to describe current practices and organisational models for low and ultra-low temperature storage of these medicines in French hospital pharmacies. METHODS:A descriptive national survey was conducted using an online questionnaire distributed to members of the French Society for Oncology Pharmacy and its advanced therapy working group. The questionnaire explored medicines managed, storage infrastructures, alternative storage solutions and organisational barriers. Results were analysed descriptively and reported as counts and proportions. RESULTS:Thirty-eight pharmacists responded, most of them working in university hospitals (86.8%). Advanced therapy medicinal products were managed in both routine care and clinical trials by 76.3% of respondents. Liquid nitrogen vapour storage was the most frequent modality (89.5%), followed by -80°C freezers (57.9%) and temporary dry shipper storage (31.6%). Storage at -150 °C was reported by 15.8% of respondents. Liquid nitrogen storage relied on a cell therapy unit convention in 47.4% of respondents, while an equal proportion (47.4%) managed it under direct pharmaceutical responsibility: a compliant on-site installation within the hospital pharmacy (31.6%), an autonomously managed tank hosted in a cell therapy unit (10.5%) or subcontracting to another hospital pharmacy (5.3%). CONCLUSIONS:Ultra-low temperature storage is a key organisational component of the pharmaceutical management of advanced therapy medicinal products. In this national survey of 38 pharmacists, diverse storage models combining cryogenic infrastructures, mechanical freezers and collaborative solutions were reported. Adapting infrastructures and organisational strategies will be essential for hospital pharmacies to support the expected expansion of these therapies while ensuring safe and efficient pharmaceutical management.
OBJECTIVE:To evaluate the efficiency, safety and economic impact of reattributing fixed-dose monoclonal antibody preparations in a chemotherapy reconstitution unit to reduce waste associated with anticipated preparation. METHODS:A retrospective, single-centre study was conducted over the period from April 2023 to April 2025, including 7524 fixed dose monoclonal antibody preparations. Primary outcomes were the rate of reuse versus destruction, temporal trends, molecular factors influencing reuse and direct cost savings. Safety was ensured via Chimio 6.0 traceability and validation by the hospital pharmacist. RESULTS:Of 7524 preparations, 290 (3.85%) were non-administered. Among these, 265 bags were successfully reattributed, corresponding to a 91.4% success rate and an overall reuse rate of 3.52%, with a significant increase over time (from 2.5% in 2023 to 4.6% in early 2025; p<0.001). Reuse avoided €1.19 million in drug expenditure, whereas 25 destroyed preparations (€113 381) were mainly lost due to cold chain breach. CONCLUSION:Reuse of fixed dose monoclonal antibody preparations in a chemotherapy reconstitution unit is safe, effective and economically impactful, providing a strategic tool for oncology pharmacy management.
OBJECTIVE:To investigate the chemical and visual compatibility of dexmedetomidine injection with 44 secondary intravenous (IV) drugs and six 2-in-1 parenteral nutrition (PN) solutions used in neonatal intensive care unit settings. METHODS:Dexmedetomidine (1 or 4 µg/mL) was mixed 1:1 with each secondary IV drug or PN solution to simulate Y-site co-administration. Visual compatibility was evaluated for 4 hours and chemical compatibility was determined from dexmedetomidine concentrations using a validated high performance liquid chromatography (HPLC) assay. Absorption/adsorption loss of dexmedetomidine was evaluated in three syringe filters and one in-line filter. RESULTS:Dexmedetomidine injection was visually compatible with all 44 secondary IV drugs and six PN solutions tested, and chemically compatible with 42 drugs. Due to interference by nine secondary drugs in the HPLC analyses of dexmedetomidine at 1 µg/mL, compatibility tests were conducted at a higher concentration of 4 µg/mL against ampicillin, benzylpenicillin, flucloxacillin, hydrocortisone, ibuprofen, indometacin and rifampicin, and the combinations were found to be chemically compatible. However, dexmedetomidine 4 µg/mL was chemically incompatible with ibuprofen lysine injection. Results for cloxacillin were inconclusive due to unresolved interference in the HPLC assay. Modest absorption/adsorption loss of dexmedetomidine (<20%) occurred in the first millilitre of filtrate with clinically relevant filters. CONCLUSION:Dexmedetomidine injection was chemically and visually compatible with 42 secondary IV drugs and six PN solutions for up to 4 hours. Dexmedetomidine injection should not be combined via Y-site administration with ibuprofen lysine injection. Due to inconclusive results, combining dexmedetomidine and cloxacillin injections via Y-site administration is not recommended.
OBJECTIVE:To investigate the chemical and visual compatibility of fluconazole injection with 44 secondary intravenous (IV) drugs and 6 two-in-one parenteral nutrition (PN) solutions used in neonatal intensive care unit settings. METHODS:Fluconazole (2 mg/mL) was mixed 1:1 with each secondary IV drug or PN solution to simulate Y-site co-administration. Visual compatibility was evaluated by observation for up to 4 hours and chemical compatibility was determined from fluconazole concentrations, using high performance liquid chromatography (HPLC). RESULTS:Fluconazole injection was visually compatible with all 44 secondary IV drugs and 6 PN solutions tested and chemically compatible with 42 IV drugs. Due to unresolved interference by the secondary drug in the HPLC assay, the chemical compatibility of fluconazole with ampicillin or flucloxacillin injections could not be confirmed. CONCLUSION:Fluconazole injection solution was chemically and visually compatible with 42 secondary IV drugs and 6 PN solutions for up to 4 hours.
BACKGROUND:Heart failure (HF) is a chronic syndrome where poor adherence undermines the benefits of pharmacological therapy. This study evaluated the 'Making Medicines Work for You' screener, a brief Capability, Opportunity, Motivation-Behaviour (COM-B) based tool used to identify adherence barriers in HF patients. METHOD:A retrospective cross-sectional single-site study was conducted in outpatient community and hospital pharmacist and nurse-led HF outpatient clinics between January-November 2024. Statistical analysis was undertaken to identify associations (Chi-squared, Analysis of Variance (ANOVA)) and differences (post-Hoc Tukey) between patient and clinical factors. RESULTS:Of 500 patients assessed (median age 69 years, range 17-98), 44.2% (n=221) had at least one adherence related barrier. The most common barrier identified was forgetfulness (21.2%, n=106). Older patients were more likely to experience adherence related barriers (p=0.006). More barriers were reported during pharmacist consultations compared with nurse-led consultations (p<0.001). CONCLUSION:The screener tool effectively identified adherence related barriers in patients. Screener responses may inform targeted, clinician-led interventions.
OBJECTIVES:Healthcare professionals who prescribe, prepare, and administer drugs to children must consider age-dependent pharmaceutical aspects. However, information on the age-appropriate use of authorised medicinal products is frequently incomplete within the Summary of Product Characteristics (SmPC). This study aims to improve the quality and completeness of the information provided by the SmPC for products with paediatric authorisation and to create greater awareness from both regulatory authority and market authorisation holders. METHODS:We created a list of topics that are particularly relevant for safe and effective drug use in paediatrics, but which were identified as either missing or incompletely reported. The list was compiled based on routine experience of clinical pharmacists specialised in paediatrics. Each topic was compared with the reporting obligations imposed by the statutory provisions in Switzerland. The problem of missing information for clinical practice was discussed for selected examples. RESULTS:We identified 16 missing or incompletely reported topics: 1) authorised child ages, 2) posology information, 3) age-specific contraindications, 4) update on change in state-of-the-art, 5) dissolution concentration, 6) solvents / diluents compatibility, 7) administration concentrations, 8) osmolarity / pH, 9) reconstitution / dilution stability, 10) shelf-life, 11) route of administration (central or peripheral vein), 12) infusion rates and administration duration, 13) dosing aids, 14) in-filter compatibility, 15) caution in case of extravasation, and 16) taste. Out of the 16 topics, four (25%) are not subject to any reporting obligations, seven (44%) require further clarification regarding the information to be reported under the statutory provisions, and five (31%) are subject to reporting obligations. CONCLUSION:We provide a list of topics as a proposal of indispensable paediatric-specific information that should be available for authorised products. Moreover, it is paramount that the safe and effective use of drugs with paediatric authorisation is appropriately described for all age populations within the label.
OBJECTIVE:To evaluate the introduction of locally configured standard concentration (StdC) intravenous drug infusions in critically ill children. METHODS:This two-year quality improvement retrospective cohort study (2018-20) examined post-implementation of 47 StdC drugs configured across three weight bands: <5 kg, 5-20 kg and >20 kg in a 26-bed, multispecialty paediatric intensive care unit. The main outcome measures were (1) adherence to StdC use (non-adherence defined as using a bespoke drug concentration), (2) attempts at dosing above the pre-set infusion rates, known as hard limit events (HLEs), (3) incidents related to infusions and (4) percentage of total fluid allowance available for nutrition. RESULTS:In total, 33 224 infusions were administered, with morphine, clonidine and milrinone representing 61%. Most of them (83.6%) were initiated in children in the lower weight bands. Adherence to StdCs was 96% and was similar across weight bands. A total of 204 498 pump programming events were examined, with 418 (0.2%) being HLEs. Only 21 HLEs (0.01%) were considered potentially clinically significant (defined as programming >2.5 times the maximum dose). Following investigation, 20/21 were found likely to be related to training episodes, rather than true errors. Twenty clinical incidents linked to StdC infusions were reported but none caused harm. The mean fluid allowance available for nutrition after accounting for StdC volumes was 38.8% in the <5 kg weight band, and 71% and 67.4% in the other two bands, respectively. CONCLUSIONS:Configured StdCs are effective and safe across all weight bands and allow for partial provision of nutritional needs in fluid-restricted patients. The high adherence rate facilitated pharmacy supplying infusions as Ready-To-Administer (RTA).
