In the Intensive Care Unit (ICU), substantial quantities of medication are wasted, negatively affecting ecological and economic sustainability. This study aimed to develop, implement, and evaluate an ecologically and economically sustainable medication-use process to reduce medication waste in the ICU of a Dutch academic hospital. This lean-based quality improvement study comprised three phases: (I) Three-week baseline medication waste assessment in terms of quantity (i.e., disposed medication units) and economic value per 100 ICU beds per day. (II) Development and implementation of a sustainable medication-use process using lean principles. Causes of medication waste were identified among hospital staff using qualitative methods, and targeted interventions were identified and implemented accordingly. (III) Post-implementation effect evaluation of the sustainable medication-use process on medication waste. At baseline, a mean total of 113 units, worth €1037, were wasted daily per 100 ICU beds. Causes for medication waste were: insufficient knowledge among hospital staff about quantities and impacts of medication waste; suboptimal medication ordering, supplying and preparing, resulting in unnecessary medication waste; and patient’s therapy changes/discontinuation. Interventions implemented were: awareness campaigns on medication waste; adjustment of protocols and work processes to prevent excess order, supply and preparation of medication; and dispensing individually labelled medication to the patient following transfer or discharge. Implementing these interventions reduced medication waste by 31.8
Community pharmacists play a crucial role in medication counselling, which includes side effect counselling (SEC), helping support informed decision-making, patients’ adherence, and medication safety. Despite its recognised importance, deficiencies in SEC provision have been reported, and limited research has investigated the behavioural determinants underpinning pharmacists’ SEC practices. This qualitative study aimed to explore community pharmacists’ views on the factors influencing prescription medication SEC. Semi-structured interviews were conducted with community pharmacists in Ireland. Transcripts were analysed using conventional content analysis and directed content analysis by using the Theoretical Domains Framework (TDF). Predominant domains were determined based on the frequency of the beliefs, presence of conflicting beliefs, and perceived strengths of those beliefs. From eleven interviews, six predominant TDF domains were identified in influencing SEC provision: environmental context and resources, social professional role and identity, memory, attention and decision-making, skills, beliefs about consequences, and social influences. While SEC was considered a core professional responsibility, time pressures and workload were dominant environmental barriers. Pharmacists employ cognitive heuristics to prioritise SEC for new and high-risk medications and tailor their language and information quantity based on patients’ health literacy and emotional state to balance the need to inform against the risk of hindering adherence by overwhelming patients—skills which they believed they refined with experience. This study provides unique insights into the behavioural determinants influencing pharmacist SEC. The findings offer a foundation for developing targeted interventions to enhance SEC in community pharmacy, ultimately helping to improve patient safety and therapeutic outcomes.
Medication-related readmissions are a significant and preventable cause of patient harm. Patients living in rural and remote areas may face inequitable access to healthcare and fragmented continuity of care, increasing their vulnerability to medication-related harm. Despite this, the burden and drivers of medication-related readmissions in these settings remain poorly understood. Determining the current burden and identifying factors associated with medication-related readmissions is essential to inform targeted strategies to improve medication safety. To determine the proportion of adult patients with a medication-related readmission within 30 days of discharge from rural and remote hospitals, and to identify factors potentially associated with these readmissions. A retrospective cohort study was conducted using medical records of adults admitted to rural and remote hospitals in New South Wales, Australia, between June 1, 2022 and August 31, 2023. Readmissions within 30 days were assessed for medication-related causes using the AT-HARM10, a validated 10-item tool based on admission notes, medication lists, inpatient pathology results, and discharge summaries. Patient demographics, comorbidities and admission details were extracted. Comorbidity burden was calculated using the Charlson Comorbidity Index (CCI). Medication lists were based on medications charted 12 h before discharge. Univariable logistic regression was performed to explore factors associated with 30-day medication-related readmissions, with results reported as unadjusted odds ratios (uOR). Of the 2220 patients admitted during the study period, 6
Structured preceptorship programmes may support pharmacists working towards the advanced career stage, yet evidence on feasibility remains limited. The aim of this study was to evaluate the feasibility of a pilot preceptorship programme for pharmacists working towards the advanced career stage. An embedded mixed-methods pilot study was conducted in primary care practices within one territorial health board in NHS Scotland, recruiting four preceptor–preceptee pairs for a 16-week preceptorship programme. Quantitative data assessed programme delivery, including joint clinical sessions, shadowing sessions and changes in preceptee-reported self-efficacy and competence from baseline to 16 weeks. Qualitative data from semi-structured interviews with preceptors, preceptees, and senior pharmacy management explored perceptions of implementation barriers and enablers. Data were analysed using the COM-B framework, which considers Capability, Opportunity, and Motivation as key influences on behaviour. Feasibility assessment demonstrated incomplete implementation, with preceptee-reported delivery of 14 of 60 anticipated joint clinical sessions (including both preceptee led clinics and shadowing sessions) and 3 of 12 anticipated structured review meetings over the 16-week programme. Self-reported self-efficacy and competence data were collected over the study period; however, due to incomplete implementation, these data are not interpreted as evidence of programme effect. Qualitative analysis identified participants’ perceptions of barriers to implementation, including competing workload priorities, lack of protected time, logistical challenges, limited stakeholder engagement, and insufficient holistic feedback (as feedback primarily focused on clinical rather than practical aspects), alongside enablers such as access to resources and the perceived value of preceptorship. The pilot preceptorship programme was not fully feasible in this professional context, highlighting important considerations for future implementation. Despite incomplete delivery, participants reported perceived changes in self-reported self-efficacy and competence; however, these findings do not provide evidence of programme effect, highlighting the need for further refinement and evaluation of preceptorship models in advanced pharmacist practice.
