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
Leukemia treatment has evolved rapidly over the past decade, with the introduction of targeted therapies, immunotherapies, and increasingly complex pharmacotherapeutic regimens. Many antileukemic agents and supportive medications exhibit substantial pharmacokinetic variability and have narrow therapeutic windows. Therefore, therapeutic drug monitoring (TDM) has emerged as an important strategy for optimizing individualized pharmacotherapy, improving treatment efficacy, and reducing drug-related toxicity. However, the overall research landscape, development trajectory, and emerging trends of TDM in leukemia have not been systematically evaluated. This study aimed to systematically analyze global research trends and hotspots in TDM for leukemia between 2001 and 2025 using bibliometric methods and to provide insights into future research directions and clinical pharmacotherapy applications. Publications related to TDM in leukemia published between January 1, 2001, and December 31, 2025, were retrieved from the Web of Science Core Collection database. A topic-based search strategy was used to identify the relevant articles. Bibliometric analysis and visualization were conducted using VOSviewer and CiteSpace to evaluate publication output, collaboration networks among countries, institutions, and authors, journal distribution, highly cited publications, citation bursts, and keyword co-occurrence. A total of 859 papers were retrieved, with the highest output (58 papers) observed between 2024 and 2025. The United States and China contributed the most publications. The University of Texas MD Anderson Cancer Center ranked first among the institutions. Highly cited papers primarily focused on pharmacotherapy for hematologic malignancies, pharmacodynamics and pharmacokinetic studies, and pre-transplant medication regimens. Burst analysis indicates that TDM in leukemia treatment has progressively evolved from early preliminary studies on exposure–response relationships to the implementation of precision dosing strategies and clinical guidelines, continuously expanding to cover an increasing number of therapeutic agents in leukemia treatment. Current research hotspots include tyrosine kinase inhibitors (particularly Bcr-Abl inhibitors), asparaginase, drug interactions, and safety management issues. From 2001 to 2025, research activities on TDM in leukemia treatment have shown continuous growth, with substantial expansion in both scope and depth. TDM is gradually becoming an increasingly important component of leukemia pharmacotherapy and may play a key role in supporting precision medicine and optimizing treatment outcomes in leukemia patients.
