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.

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.

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.

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.

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.

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).

To assess the impact of a comprehensive pharmaceutical care programme on medication adherence in allo-HSCT patients. Early survival and clinical and patient-reported outcomes will also be explored.

Prospective interventional study with a historical control group. The primary outcome is medication adherence. Secondary outcomes will include the incidence of grade I–IV acute graft-versus-host disease (aGVHD); acute graft-versus-host disease-free, relapse-free survival (aGRFS); relapse-free survival (RFS) and overall survival (OS) by day+100; hospital readmissions; acute renal and liver failure; engraftment time; drug-related problems (DRPs); pharmaceutical interventions and patient-reported outcomes. Patients will be enrolled over a 12-month period in the intervention group and compared with a historical cohort of patients undergoing allo-HSCT. The intervention will include a structured pharmacist-led programme including: (1) a pre-admission interview, (2) in-hospital follow-up with daily medication review and DRP identification, (3) patient education at discharge and (4) post-transplant pharmaceutical follow-up to day+100.

The study protocol was approved by the hospital Clinical Research Ethics Committee (CEIm code: 245/23). Written informed consent will be obtained from all participants. Data will be handled in accordance with the EU General Data Protection Regulation (2016/679) and Spanish Organic Law 3/2018 on Data Protection and Digital Rights.

This study was a single centred, multiphase mixed-methods study carried out at a tertiary-care teaching hospital. A structured medication analysis approach for patients with ileostomy was developed using a modified Delphi process with an interprofessional expert panel and piloted in an exploratory evaluation of retrospective medication case records from 25 patients. Subsequently, a controlled intervention study was performed using a standardised ileostomy patient case distributed to 40 pharmacists, who were assigned to an intervention group (using the structured approach) or a control group (standard practice). Pharmacists identified DRPs and proposed interventions, which were evaluated using a predefined scoring system.

The final approach, organised into six key domains, was based on the (patho)physiological changes following ileostomy creation and designed as a decision-tree tool to guide systematic medication analysis. A total of 36 pharmacists from 20 institutions completed the case study. The intervention group achieved significantly higher total scores than the control group (mean 11.4 vs 7.3, p<0.001), driven primarily by improved detection of stoma-specific DRPs (6.6 vs 1.6 out of 8, p<0.001).

The structured medication analysis approach substantially improved the recognition of stoma-specific DRPs and facilitated appropriate pharmaceutical interventions. It offers a reproducible, practice-oriented framework to optimise drug therapy and improve patient safety in individuals with ileostomy, particularly benefiting pharmacists with limited prior experience in this specialised area.

This implementation study was performed in a university hospital. The dashboard was developed by a multidisciplinary team consisting of hospital pharmacists, pharmacy technicians, nurses and data analysts. Data from 2018 to 2024 were compared in three periods: prior implementation (2018–2019), during implementation (2020–2022) and after implementation (2023–2024) of the dashboard. Monitored CS medications were limited to oral solids. The data for dispenses and administrations were validated against the electronic health record (EHR) and electronic delta calculations were manually recalculated. The dashboard was piloted on a single ward by shadow running the dashboard for 6 months. Processes were optimised before hospital-wide implementation.

The dispense and administration data in the dashboard accurately reflected the registrations in the EHR and all predefined validation criteria were met. Subsequently, the paper process for accounting for CS was successfully digitised, allowing nurses to discontinue the double registration workflow. The CS accountability showed a slight upward trend from 88% prior to implementation to 91% after implementation. Furthermore, use of the dashboard resulted in a more efficient workflow and facilitated evaluation between the pharmacy and the wards, contributing to optimisation of prescribing, administration and the logistical processes.

The dashboard provided an accurate and reliable reflection of CS-related dispenses and administrations documented in the EHR, supporting its hospital-wide implementation for CS monitoring. The CS accountability dashboard reduced the administrative workload for nurses and the pharmacy and improved traceability.

We conducted a single-centre retrospective study in a tertiary university hospital in Barcelona including patients aged 70 years and older who were admitted to hospital. Sociodemographic, clinical and pharmacological variables were collected. Prevalence of PIMs was calculated separately for each set of criteria and comparative analysis was performed across the three tools.

We included 638 patients (mean age 86.1 years; 58.3% women). Overall, 75.2% had at least one PIM at discharge. Polypharmacy was highly prevalent (>90%). The most frequent PIMs belonged to Anatomical Therapeutic Chemical (ATC) group N (45.0%; anxiolytics, antipsychotics, hypnotics and sedatives, and opioid analgesics), followed by ATC group C (18.3%; mainly cardiac therapy agents, loop and thiazide diuretics, and lipid-lowering agents) and ATC group A (16.4%; proton pump inhibitors). PIMs prevalence varied by criteria: 73% (95% CI 69.6% to 76.4%) with STOPP, 56.6% (95% CI 52.7% to 60.4%) with AGS Beers and 55.6% (95% CI 51.8% to 59.5%) with PRISCUS.

PIMs at hospital discharge are highly prevalent among older patients. Systematic medication review and deprescribing, supported by explicit criteria, are needed to improve prescribing quality and potentially reduce adverse outcomes. Across tools, the STOPP criteria appeared to be the tool that detected more PIMs in this population.

Oxycodone solution (1 mg/mL) and three oxycodone–S-ketamine mixtures (0.25, 0.50, 0.75 mg/mL) and three oxycodone–dexmedetomidine mixtures (2.5, 5.0, 10 µg/mL) were compounded under validated European Union Good Manufacturing Practice (GMP) Class A/B aseptic conditions and filled into PCA reservoirs. Reservoirs (n=42 for physicochemical studies, n=21 for sterility, n=4 for antimicrobial activity testing) were stored at 2–8°C for 28 days, then at 20–25°C for 2 days. Sterility was assessed by membrane filtration according to European Pharmacopoeia Section 2.6.1 (Ph. Eur. 2.6.1). Physical stability was evaluated by visual inspection, pH, weight and osmolality. Chemical stability was assessed using a validated high-performance liquid chromatography with ultraviolet detection (HPLC-UV) method developed in accordance with US Food and Drug Administration (FDA) and International Conferenece on Harmonisation (ICH) Q2(R1) guidelines.

All antimicrobial activity tests showed growth of the six reference strains, indicating no inhibition by the drug mixtures. All 21 sterility-test reservoirs remained free of turbidity throughout 30 days. No visual changes, precipitation or discolouration were observed. Weight loss was ≤0.3%, pH changes were within the required range of 4.5–7 and osmolality increased by <1.4% during the study. Measured oxycodone, S-ketamine and dexmedetomidine concentrations remained within ±5% of initial values, and no degradation products were detected.

Oxycodone PCA solutions containing S-ketamine or dexmedetomidine remained sterile, physically stable and chemically stable for 28 days at 2–8°C followed by 2 days at room temperature at 20–25°C. These findings support the potential for extended shelf life and centralised batch preparation of opioid–adjuvant PCA reservoirs in hospital pharmacy practice.

Forty-six binary 1:1 test admixtures of 28 medicinal products and concentrations taken from the German standardised concentration list for continuous infusion in intensive care patients were prepared. Test admixtures were stored at ambient temperature without light protection over a maximum period of 4 hours. Directly after mixing (t0), after 1 hour (t1) and after 4 hours (t4), admixtures were inspected for visible changes, subvisible particles were counted according to Ph. Eur. 2.9.19, pH values were measured and UV spectroscopy was performed at wavelengths 350 nm, 410 nm and 550 nm. Specifications for compatibility were set to no visible change, maximum 0.5 pH deviation from t0 to t4, maximum 0.1 deviation in UV absorbance from t0 to t4 at each wavelength, and subvisible particles ≤6000 (≥10 µm) and ≤600 particles (≥25 µm) at t0, t1 and t4. Admixtures were categorised as compatible when all specifications were fulfilled or incompatible when at least one specification was not fulfilled.

In the experimental setting chosen, 30 of the 46 admixtures fulfilled all compatibility specifications set over the 4-hour observation period and were categorised as compatible. Sixteen admixtures, mostly containing dexmedetomidine, flucloxacillin, furosemide, heparin, ketamine and metamizole, failed the predefined specifications and were categorised as incompatible. In seven admixtures immediate precipitation/haze occurred and one became opalescent. Four admixtures showed noticeable deviations in pH and UV absorption.

Y-site administration of 16 binary admixtures identified as incompatible is not recommended. The preparatory study results are suitable to complete incompatibility-reducing infusion schemes. Clinical pharmacists should implement incompatibility-reducing tools in intensive care patients.

This observational study collected information on items available at admission for patients admitted to six French psychiatric hospitals between June and August 2021. Based on the international literature and personal experience feedback, a multidisciplinary committee network and a psychiatry-mental health research federation elaborated a list of items potentially valuable for prioritisation and proposed a specific tool for psychiatric settings, named O-PsyConcil. Medication reconciliation (MR) was performed, and UMDs were identified. Items associated with UMDs were investigated through a backward stepwise logistic regression model, calculating adjusted ORs and their 95% CIs. The prioritisation rules were proposed using the more efficient combination in terms of feasibility and psychometric characteristics.

The study included 513 patients (median age 48 years, IQR 33–68; 48% women). Factors associated with UMDs were comorbidities (OR 1.49 for one more comorbidity; 95% CI 1.23 to 1.82), psychiatric high-risk medications (HRMs) (2.64; 1.68 to 4.16), and somatic HRMs (3.43; 1.70 to 7.06). Based on these results, the prioritisation rule combining one comorbidity and/or one psychotropic HRM and/or one somatic HRM led to assessing 61% of the total population, with median performances of 82% (IQR 78-85%) for sensitivity and 48% (43-52%) for specificity.

The O-PsyConcil tool demonstrated satisfactory performance, suggesting it could enhance the efficiency of psychiatric MR compared with standard non-prioritised MR.

We reviewed available PN formulas in France for premature newborns, including market authorised drugs and standardised formulas from our hospital and those proposed for the French national formulary. We collected data on 280 individualised PN prescriptions produced in our hospital over a 4 month period. Critical nutritional parameters for premature newborns—administered volume, amino acids, carbohydrates, sodium, potassium, calcium, and phosphorus—were identified based on European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines.

An algorithm was created to compare individualised PN prescriptions to available formulas, proposing an alternative if all critical nutritional intakes did not deviate by more than 15% from the prescribed intakes. The algorithm was then applied to the extracted prescriptions. Out of 280 individualised PN prescriptions, only 23 (5%) concerning six patients had a suitable alternative. The formulas most frequently identified as alternatives were Prem2C (17 occurrences) and Premend (seven occurrences).

The developed algorithm can be used to audit prescription practices or as a routine tool for pharmaceutical validation. Integrating such a tool into prescription software could provide real-time support for prescribers and pharmacists. The results confirm that while some individualised PN prescriptions can be substituted, individualised PN remains essential for meeting the complex and specific nutritional needs of premature newborns in paediatric intensive care units.

The aim of this work was to characterise this implementation through the prism of permanent care service, and to describe the activity of this particularly high risk period.

Prospective data collection was extracted from computerised on-call reports from March 2021 to March 2024. The primary endpoint was the proportion of shifts for continuity of pharmaceutical care affected by emergency operative room requests (considered as at higher risk), before (period 1, until December 2022) and after (period 2, from January 2023) the introduction of the new emergency rooms.

A total of 1109 pharmaceutical after hours shifts were carried out. During period 1, 24% of the shifts (n=156) were involved in at least one call from the operating room. A significant increase was recorded during period 2, involving 31% of pharmaceutical after-hours shifts (n=140) (p=0.012). Most requests were made between 18:00 and 24:00 and during the winter season (p=0.021). On average, two units of medical devices were needed by request (1–34) and most were re-sterilisable ones (61–75% of requests). Fifteen per cent of requests were urgent, with the patient already on the operating table, requiring a dispensing time of <1 hour. The average resolution time was 23 min and difficulties in responding to the demand were found in half of them, with potential impact on patients faced with emergency surgery.

This study allowed better characterisation of the surgical and pharmaceutical activity of a teaching hospital outside of working hours, enabling a better understanding of this period of high iatrogenic risk and reflection on areas for improvement.

A list of clinical if-then rules was adapted following discussions with local clinical experts from different fields. The final set of rules was then determined based on available clinical data. The rules were retrospectively and manually applied to electronic health record (EHR) data from 765 patients aged ≥65 years in a large Swedish hospital. The generated alerts were analysed descriptively, and their clinical relevance was assessed by a senior clinical pharmacist.

A total of 50 if-then rules were developed and applied to patient data. The participants had a median age of 76 (IQR 71–82) years. Of the 765 included patients, 145 (19%) triggered at least one alert, resulting in a total of 181 alerts. Nearly half (47%) of these alerts were deemed clinically relevant; and, of these, 72% persisted after 48 hours or until discharge.

The guideline-based, locally informed clinical rules could identify clinically relevant and persistent risk prescriptions in older adult inpatients in a large Swedish hospital. The findings support the feasibility of SAPVAL as a pharmacist-led CDSS intervention. However, since half of the alerts were assessed to be clinically non-relevant, the study highlights the need for ongoing refinement of rules to improve specificity and service efficiency.

In this retrospective single centre cohort study, we analysed 543 meropenem concentrations from 331 patients. Targets were defined as 100% fT>MIC (duration of time the drug concentration remains above the minimum inhibitory concentration) and 100% fT>4xMIC. A predictive scoring system was developed using logistic regression and validated via receiver operating characteristic (ROC) analysis. Propensity score matching (PSM) and inverse probability treatment weighting were applied.

The target was reached in 73.8% of measurements for 100% fT>MIC and 48.8% for 100% fT>4xMIC. While the clinical cure rates were not different in patients with pharmacokinetic/pharmacodynamic (PK/PD) target attainment, microbiological cure rates were higher in case of achieving 100% fT>MIC and 100% fT>4xMIC (p<0.001). According to the multivariate logistic regression analysis, the best predictors of achieving the meropenem PK/PD target of 100% fT>MIC and >4xMIC were 6 g/24 hour loading dose, estimated glomerular filtration rate (eGFR) and age. While a 6 g/24 hour loading dose and older age were associated with higher target attainment, elevated eGFR correlated with lower serum levels. The prediction score derived by using these parameters had a sensitivity of 71.2%, specificity of 67.6%, positive predictive value of 86.1%, negative predictive value of 45.5% and accuracy of 70.2%. There is a trend towards clinical cure and target attainment according to PSM analysis.

Three-quarters of the measurements achieved the PK/PD target of 100% fT>MIC, while half achieved the more stringent target of 100% fT>4xMIC, highlighting the need for optimised dosing strategies. Target achievement rates can be improved with therapeutic drug monitoring and personalised dosing approaches are needed.

Published evidence evaluating the effects of IPP on cNCDs was reviewed. English language studies evaluating IPP for adults with these conditions and published since 2000 were included. Two reviewers independently evaluated papers for inclusion, IPP effectiveness and risk of bias.

A total of 11 studies were included, which examined IPP for three metabolic targets related to cNCDs—namely, blood glucose, blood pressure and cholesterol. Seven randomised controlled trials (RCTs) provided robust support for IPP in the treatment of hypertension compared with usual prescriber care. For diabetes there was modest support for glycaemic control including one RCT and two non-randomised evaluations. For hypercholesterolaemia, there were two RCTs, both of which were not specifically targeted at cholesterol reduction and yielded unclear results.

Given that hypertension is one of the major risk factors for morbidity and mortality, expansion of care for this condition to include IPPs embedded in both hospital and community settings has marked potential for public health benefit. Although available evidence supports the feasibility of IPP for glycaemic control, more adequate evaluations are needed to determine safety and efficacy. Finally, IPP for hypercholesterolaemia likely requires additional investigation, including studies specifically targeting change in cholesterol.

Prednisolone is a widely used drug for adult patients but also in paediatrics where tablets are manipulated to facilitate smaller doses and/or oral administration.

Prednisolone tablets of 2.5 mg and 5 mg from Orifarm and Alternova, as well as a pharmacy compounded suspension of 1 mg/mL, were tested. Quantification of prednisolone in various fragments and volumes related to the manipulations were carried out using a validated ultra high-pressure liquid chromatography (UHPLC) method.

When tablets were split into halves and quarters, the accuracy of the best halves and the best quarters were within ±15%. When the fragments were further dispersed in an oral syringe to aid oral administration, 6% of prednisolone was lost on average. The syringes could be stored for at least 6 hours without any further loss. The more laborious method of first dispersing tablets, followed by withdrawing a fraction, did not improve neither accuracy nor precision compared with simple splitting. But by focusing on some crucial steps, this method could produce doses as low as 0.25 mg with an accuracy of ±20%. Nevertheless, the accuracy improved to ±10% when the compounded suspension was used. The precision was also higher.

When tablets were split into two and four fragments, the accuracy of the largest half and second largest quarter were within a clinically acceptable range. In cases of tapering before discontinuing prednisolone, a higher accuracy might be required, and pharmacy compounded suspensions should then be considered, if available.

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 criteria and was registered in PROSPERO. The final literature search was conducted in February 2024 covering the period 2000–2023. Only peer-reviewed studies considering the effects of pharmacist-conducted medication order verification in hospital settings were included. Study selection, data extraction and quality assessment were carried out by two individual reviewers. The findings describing the effects of pharmacist-conducted medication order verification were synthesised and categorised according to the Economic, Clinical, and Humanistic Outcomes (ECHO) model.

A total of 35 studies met the inclusion criteria. All of the studies (n=34) reporting clinical outcomes showed positive results. Pharmacist-conducted medication order verification could detect a wide variability in drug-related problems, with dose-related issues being the most common (n=33 studies). The physician acceptance rate in the pharmacist intervention studies (n=27) varied from 26% up to 100%. Of the verifications, 0.8–45.2% led to a pharmacist intervention. Economic outcomes were reported in seven studies and all showed positive results. None of the included studies reported humanistic outcomes.

Pharmacist-conducted medication order verification is associated with prevention of drug-related problems and cost savings in hospital settings. Further research is needed on the quality of pharmacist-conducted medication order verification, high-quality studies investigating the economic benefits, the effects on the patient perspective and outpatient medication prescriptions.

This single-centre service evaluation was delivered remotely by a cardiometabolic pharmacist using a structured 7-step medication review process. Patients referred from hospital and primary care services were screened against predefined criteria. Process measures included referral uptake, review completion and initiation of SGLT2i therapy. In an exploratory subset, prescribing appropriateness was examined using the Person-Centred Medicines Appropriateness Index (PCMAI) and pharmacist interventions were classified using the Eadon scale. Estimated potential cost implications were modelled using the Sheffield Centre for Health and Related Research economic framework. Patient acceptability was assessed through an anonymous postal questionnaire.

Of 274 referrals, 98 patients were eligible and 75 (77%) completed a pharmacist-led review. Overall, 32/75 patients (43%) were started on SGLT2i therapy according to guideline criteria. In the exploratory subset, PCMAI scores decreased in five patients and 41 pharmacist interventions were Eadon-graded, corresponding to a modelled potential cost avoidance range of £8062–£17 384. Patient feedback (58% response rate) indicated high acceptability, with respondents highlighting clear communication, opportunity to ask questions and involvement in decision making.

The pharmacist-led service was feasible to deliver, acceptable to patients and supported the operationalisation of guideline-directed SGLT2i prescribing. Further longitudinal studies are needed to determine clinical and economic outcomes.

Vancomycin concentration was controlled using high-performance liquid chromatography with an ultraviolet detector stability-indicating method, developed and validated in accordance with International Conference on Harmonization guidelines. Limpidity, non-visible particles, pH and osmolality controls were performed. Eye drop sterility and efficacy of antimicrobial preservation with different bacterial strains were also tested. Different temperature excursion times (from 0.5 to 12 hours) were tested.

After 3 months of freezing at –20°C followed by 7 days storage at temperature between 2°C and 8°C, vancomycin concentration, visible and non-visible particles, osmolality and pH remained in accordance with the initial specifications. No degradation products appeared. After a transient temperature excursion from –20°C to 25°C for a maximum of 12 hours, the eye drops remained stable for 7 days between 2°C and 8°C. No microbial contamination occurred when the drops were used daily for 7 days (mimicking patient conditions).

The new vancomycin eye drop formulation remains stable even in cases of temperature excursion.

In this retrospective study, all patients genotyped for CYP2C19 between June 2020 and October 2020 and treated with clopidogrel for stroke prevention were included. Genotyping was performed for the CYP2C19 *2, *3 and *17 alleles. Data were collected on CYP2C19 genotype and phenotype, the indication for clopidogrel, and any therapy adjustments made. Results are presented as proportions (%).

Between June and October 2020, 382 patients with stroke were genotyped for CYP2C19. Phenotypes included the following: extensive metabolisers 64.7% (n=247), intermediate 26.9% (n=103), poor 5.0% (n=19), and ultra-rapid 3.4% (n=13). In patients with impaired metabolism (intermediate metabolisers and poor metabolisers), therapy was adjusted in 94.2% of cases. Among intermediate metabolisers, 68.0% were switched to acetylsalicylic acid (ASA)/dipyridamole, 20.4% to double-dose clopidogrel, 3.9% to ASA monotherapy, and 1.9% to other therapies. For poor metabolisers, 89.2% received ASA/dipyridamole, 5.3% ASA monotherapy and 5.3% other therapies. The phenotypes did not differ between first and recurrent strokes. Additional gene–drug interactions were seen, especially with proton pump inhibitors and antidepressants.

In the ETZ cohort, 31.9% of genotyped patients (26.9% intermediate metabolisers and 5% poor metabolisers) had impaired CYP2C19 metabolism. Genotype and phenotype information led to changes in clopidogrel therapy in nearly all of these patients, with the most common adjustment being a switch to ASA and dipyridamole combination therapy.

To assess the prevalence and quality of recommendations for treatment discontinuation in European guidelines for chronic diseases published between 2019 and 2024.

A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 standards using the Trip Medical Database. All European clinical practice guidelines on chronic disease management for adults were included, excluding those related to oncology, acute care, paediatrics, obstetrics and palliative care. Data were extracted on the presence, rationale and strength of recommendations for discontinuing or avoiding treatments.

Of 3551 records retrieved, 724 guidelines met inclusion criteria. Only 49 contained any mention of treatment discontinuation, most often linked to toxicity or lack of efficacy. A single guideline—from the European AIDS Clinical Society—provided explicit deprescribing algorithms and criteria. Personalised, patient-centred approaches to deprescribing and structured decision frameworks were rarely described.

Deprescribing remains underrepresented in European clinical guidelines. There is an urgent need to shift from a disease-centred model to patient-centred care, with guidelines that provide clear, evidence-based strategies to discontinue medications that no longer offer clinical benefit. Scientific societies should lead to the development of recommendations that promote safe, rational and personalised prescribing, ensuring real benefits for patients while minimising risks. The entire process must be individualised and necessarily involve shared decision-making with patients, families and caregivers.

Three batches (n=1000) of 75 mg ambroxol HCl capsules were produced and stored in climate chambers for 6 months under accelerated (40±2°C and 75% relative humidity (RH)±5% RH) and long-term (25±2°C and 60% RH±5% RH) conditions. At 0, 3 and 6 months, appearance, identity, related substances, assay, uniformity of dosage units (content uniformity (CU)), dissolution and microbiology were evaluated. The specifications and acceptance criteria were derived from the European Pharmacopoeia and the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use guidelines.

All parameters met the predefined specifications from t=0 to t=6 months for both the accelerated and long-term stability studies. There were no visible changes in appearance of the capsule content, no degradation products above 0.05%, and no decrease in ambroxol content. Furthermore, the capsules met the criteria for CU with an acceptance value ≤15.0. The dissolution was rapid, with ≥80% of ambroxol released from the capsules within 30 min, and no microbiological growth was observed.

The 75 mg ambroxol HCl capsules are stable for at least 6 months at room temperature. This paper provides guidance to pharmacies for compounding of high-dose ambroxol HCl capsules to ensure the availability of ambroxol for patients in need.

Three sessions were conducted to assess the effectiveness of four decontamination solutions (Surfa’Safe, Septalkan, ethanol 70% and Versol water) on areas contaminated with antineoplastic drugs. Ten areas were tested: one negative and one positive control area and eight contaminated areas followed by decontamination: four ‘wet’ (decontaminated immediately) and four ‘dry’ areas (decontaminated after 1 hour). The effectiveness of decontamination (Eff_q) and the impact of drying time were analysed using Kruskal–Wallis and Wilcoxon tests.

Negative controls showed very low levels of contamination. Septalkan and Surfa’Safe, both quaternary ammonium-based solutions, were the most effective for decontamination (Eff_q >95%), with greater effectiveness in the ‘wet’ protocol than in the ‘dry’ protocol (Surfa’Safe: 95.3% vs 97.3%; Septalkan: 95.3% vs 98%). Despite a lower value, decontamination was not statistically significant between the two methods of decontamination (immediate and after drying; p=0.125).

Quaternary ammonium-based solutions appear to be the best options for limiting chemocontamination. Despite the similar effectiveness of Septalkan and Surfa’Safe, the latter seems to be a more efficient option for routine use of an appropriate cleaning solution.

An expert panel comprising hospital chief pharmacists, deputies or quality managers conducted a two-round Delphi study. Participants were recruited from civilian HPs in Switzerland and from two civilian and one military HP in each of Austria, Belgium, France, Germany and Italy. Recommendations were structured around the ‘all-hazards’ framework and practical examples were developed based on the literature and investigators’ experiences in disaster simulation. A five-member multidisciplinary steering committee refined the recommendations before each round of voting. Experts rated recommendations on a scale from 1 to 9, and the RAND/UCLA method was used to determine consensus. In Round 2, recommendations without consensus in Round 1, newly proposed recommendations and recommendations with comments in Round 1 requiring rephrasing were submitted.

Of 71 experts contacted, 24 participated, with 18 responding in Round 1 (75% response rate) and 15 responding in Round 2 (83% response rate). Most experts came from Switzerland (78%) and civilian hospitals (94%). Half were chief pharmacists and only 17% had no BCP available in their HP. In Round 1, 41 recommendations were submitted, of which 100% were validated. Eleven recommendations were submitted in Round 2, including one new proposal and 10 rephrased recommendations from Round 1. Experts had to select their preferred version. The new recommendation was validated and all the rephrased recommendations were preferred. The final list comprised 42 recommendations for developing BCPs for HPs.

Our consensus-based BCP guidelines provide practical recommendations for civilian and military HPs and will help them develop BCPs for future crises and major business disruptions.

Adenosine (12 µg/mL) solutions were prepared by aseptic dilution of commercial adenosine injection (3 mg/mL) in 0.9% sodium chloride and 5% dextrose bags, transferred into sterile polypropylene syringes, and stored in the dark at 4°C, 25°C and 35°C for up to 49 days. Stability was assessed at predefined intervals using a validated stability-indicating high-performance liquid chromatography (HPLC) assay. Physical stability was monitored by pH measurement, visual inspection for colour change and microscopic evaluation of particulate matter.

Throughout the 49-day storage period, no visible particle formation, colour change or notable pH variation (greater than ±0.15 units) was observed in any of the samples. HPLC analysis confirmed that adenosine remained chemically stable, with more than 97% of the initial concentration retained in both diluents at all three storage temperatures.

Our findings support the prior preparation of adenosine for intracoronary administration in polypropylene syringes using 0.9% sodium chloride or 5% dextrose as diluents, with storage under tested conditions for up to 49 days. When required, the prepared syringes can be readily used during cardiac catheterisation. This approach would streamline workflow, minimise procedural delays and reduce the workload associated with on-site preparation.

A survey was co-constructed by the French Pharmaceutical Society of Medical Devices (SPFDM), the French Society for Sterilisation Sciences (SF2S), the French Society for Hospital Hygiene (SF2H), and the National Association of State-Certified Operating Room Nurses (UNAIBODE). The questionnaire was distributed electronically to healthcare professionals working in operating theatres across France.

A total of 130 respondents completed the survey, including 72 operating room and registered nurses (55.5%), 30 pharmacists (23%), 20 managers (15.5%) and eight others (6%). Most participants worked in public health establishments (80.8%) with established waste sorting systems (83.1%), mainly for paper/cardboard, metal and plastic. Daily use of single-pack SMD was reported by 61.5% of respondents, although only 11.3% applied this to implantable MD. Packaging was considered an environmental criterion by 71.5% of participants, mainly based on the number of packages. Safety concerns were prevalent, with 66.9% indicating that single packaging alone was insufficient for SMD. A majority (70.8%) supported transitioning to single-pack MD where appropriate, whereas the trend reversed for implantable SMD, with 60.0% opposing single packaging. Most respondents (75.4%) favoured wider availability of dematerialised records, and 97% supported a pictogram indicating recyclability of SMD packaging.

This national survey provides valuable insights into SMD packaging practices in French operating theatres. While safety remains the primary concern—particularly for implantable SMD—there is strong environmental awareness and willingness to adapt practices when clinical safety is not compromised. Based on these findings, professional societies plan to develop recommendations promoting single-pack SMD where clinically appropriate, while maintaining double packaging for high-risk implantable SMD.

Diluted 5-FU infusion solutions were aseptically prepared by further dilution of a 5-FU stock solution with 0.9% sodium chloride in POF bags, at banded doses between 500 mg and 800 mg. The POF bags were stored under refrigeration (4°C) in the dark (long-term stability conditions) or at room temperature (25°C) in daylight for a short period of 24 hours (simulated in-use conditions).

The long-term stability of 5-FU at selected standardised rounded doses (500–800 mg) in NaCl 0.9% in POF bags was confirmed for 3 months at 4°C in the dark. Additionally, during the simulated in-use study, no signs of chemical instability were observed.

A stability-indicating HPLC method was developed to determine 5-FU concentrations in dose-banding conditions associated with colour variation investigations. This study supports a centralised production of 5-FU at standardised dose banding.

All DRESS reports submitted to FAERS between 1 January 2003 and 13 October 2025 were extracted. Patient characteristics were analysed descriptively according to severity, sex, age group and suspected drugs.

A total of 26 831 patients with DRESS were identified, of which 99.67% were classified as having a serious adverse reaction. Overall mortality was 6.9% (1846 deaths). Female patients were more frequently affected than male patients. Adults aged 18–64 years represented the largest group. Allopurinol, lamotrigine and vancomycin were the most frequently suspected drugs, accounting for over 30% of reports.

DRESS remains a severe adverse drug reaction. Early recognition and continuous pharmacovigilance are essential to reduce associated morbidity and mortality.

To clarify the concept of stratification in pharmaceutical care by identifying its defining attributes, antecedents, consequences and empirical referents.

A structured concept analysis was conducted using the Walker and Avant framework. A comprehensive literature search was performed across major biomedical databases covering the period from January 2000 to May 2025. Empirical studies, theoretical articles, conceptual frameworks and models addressing stratification or patient prioritisation in pharmaceutical care and related health services were included. Relevant publications were screened independently by both authors and analysed thematically.

Eleven publications were included in the concept analysis. Four defining attributes of stratification in pharmaceutical care were identified: patient-centred segmentation, prioritisation of care intensity, resource-sensitive allocation and structured re-stratification over time. Key antecedents included increasing clinical complexity, limited pharmacist availability and the need for value-based care. Consequences and empirical referents were also identified, allowing stratification to be distinguished from related constructs such as triage or risk scoring.

This concept analysis establishes a theory-based conceptual foundation for stratification in pharmaceutical care. Clarifying its meaning may support greater conceptual consistency and inform the development, implementation and evaluation of structured patient prioritisation models across healthcare settings.

A retrospective cross-sectional study was conducted on 323 patients with TDT at the Center of Hereditary Blood Diseases, Karbala, Iraq. Data on demographics, ferritin, LFTs, transfusion history and chelation regimen were collected. Mann-Whitney U test, Fisher’s exact test, Spearman’s correlation and multiple linear regression were used to explore predictors of ferritin, including interaction terms. Receiver operating characteristic (ROC) analysis assessed aspartate aminotransferase (AST) and alanine aminotransferase (ALT) cut-offs for predicting ferritin>2500 ng/mL.

Median ferritin was 2214ng/mL. AST (=0.581) and ALT (=0.516) showed strong positive correlations with ferritin (p<0.001). Gender-stratified analyses revealed consistent AST–ferritin associations, with females demonstrating additional links involving bilirubin and alkaline phosphatase (ALP). Patients on deferasirox (DFX)+deferoxamine (DFO) had higher ferritin, AST and ALT than DFX alone (p<0.001). In regression models, AST and DFX+DFO were independent predictors overall, while subgroup models identified bilirubin and interaction effects in females, and bilirubin–treatment interactions in the DFX+DFO group. ROC analysis showed AST cut-offs were lower in females and combination therapy, though predictive accuracy remained high (AUC>0.79 in all subgroups).

Gender and the chelation regimen modify the ferritin–LFT relationship in TDT. AST is a consistent predictor of ferritin across all groups, while bilirubin and interaction terms contribute in specific subgroups. These findings highlight the need for gender- and regimen-specific interpretation of biochemical markers, especially where advanced iron assessment is unavailable.

This was a retrospective propensity score (PS)-matched cohort study using data from the Veterans Affairs healthcare records. Patients with AUD who were started on acamprosate or gabapentinoids after being diagnosed with AUD were identified. The primary outcome was the composite outcome of ALD progression (alcoholic hepatitis, compensated cirrhosis, decompensated cirrhosis and hepatocellular carcinoma). The secondary outcome was alcohol-related admission. A PS encompassing 80 variables was created and patients who used acamprosate and gabapentinoid were matched into pairs. Another PS-matched cohort was created that was restricted to patients who continued their medications for ≥120 days (persistent cohort).

24 477 pairs of patients who used acamprosate and gabapentinoid were PS matched. The primary outcome occurred in 15.78% of patients using acamprosate and 13.37% of those using gabapentinoid (OR 1.21; 95% CI 1.15 to 1.27). Alcohol-related admission occurred in 24.73% of patients using acamprosate and 18.01% of those using gabapentinoid (OR 1.50; 95% CI 1.43 to 1.56). Similar outcomes were observed in a PS-matched persistent cohort of 12 258 pairs.

Gabapentinoids were associated with a decreased risk of ALD progression and alcohol-related admission compared with acamprosate. Gabapentinoids may be a viable tool to decrease progression of ALD in AUD. Further studies are needed to examine whether gabapentinoids are associated with less heavy drinking only or with higher abstinence.

Quantitative intervention study.

A total of 221 patients were selected from 6000 attendees at West Middlesex University Hospital’s pre-assessment clinic. Participants were allocated into three groups. Study 1 was a randomised controlled pilot trial with 40 patients assigned to either a PCC intervention group (n=20) or a usual care group (n=20) over 6 months. Study 2 involved 41 patients receiving a pharmacist/nurse-led collaborative PCC intervention for 6 months. Study 3 included 140 patients enrolled in a 6-month community-based PHM lifestyle programme integrated with PCC. Data collection involved patient questionnaires and hospital records, focusing on clinical and behavioural outcomes.

In study 1, the PCC group showed a significant reduction in glycated haemoglobin (HbA1c) (mean decrease 23.2 mmol/mol, 95% CI 4.3 to 42.1) and improved medication adherence compared with controls. The number needed to treat (NNT) was 1.8 (95% CI 1.3 to 7.6). Study 2 participants experienced significant reductions in systolic (27.5 mm Hg) and diastolic (9.1 mm Hg) blood pressure, and HbA1c (23.1 mmol/mol) (all p<0.001). In study 3, 90% of patients with elevated body mass index achieved 5–10% weight loss, and 82% reported an increase in moderate or higher physical activity levels.

PCC and PHM integration led to substantial improvements in glycaemic control, blood pressure, weight management and physical activity. These findings support the adoption of community-based PCC models to manage chronic conditions effectively and improve public health outcomes.

We performed a retrospective observational study of patients treated with systemic chemotherapy at a tertiary hospital. All medications prescribed during chemotherapy were recorded. Potential DDIs were identified using the Lexicomp database and classified by risk level, clinical severity, quality of evidence and mechanism of action. Associations between patient-related factors and DDIs were analysed.

A total of 273 patients were included (median age 52 years) and 56% had at least one comorbidity. Overall, 2842 drugs were prescribed (median 10 per patient), resulting in 2287 potential DDIs. All patients presented at least one DDI; 89% had at least one type D interaction and 14.6% at least one type X interaction. Most DDIs were classified as type C (75.3%), followed by type D (21.7%) and type X (3.0%). The total number of DDIs was significantly associated with age, comorbidity burden and number of prescribed drugs.

Potential DDIs are highly prevalent in patients with early-stage breast cancer receiving chemotherapy, with a substantial proportion involving clinically significant or contraindicated combinations. Polypharmacy, age and comorbidities are key risk factors, highlighting the importance of systematic medication review and interdisciplinary collaboration to improve treatment safety.

In 2024, an online survey with 45 questions was carried out among chief pharmacists, organised within the German Federal Association of Hospital Pharmacists (ADKA) e.V. (n=328). The survey collected structural data (eg, beds and workforce), as well as information on the extent and range of clinical pharmacy services.

The survey received 135 responses, resulting in a response rate of 41%. The provision of clinical pharmacy services (CPS) was already well established in 114 pharmacies (85.7%), meaning at least 32.4% of all German hospital pharmacies offer CPS. The average number of full-time equivalents dedicated to these services per hospital pharmacy is 4.3, which is an increase of1.9 full-time equivalents compared with the first survey. Regular visits (at least once a week) are reported in the range of 80% for most surgical disciplines, haematology/oncology and critical care/anaesthesia. The regular patient-centred services were offered daily or 2–3 times weekly, respectively.

This follow-up survey provides a comprehensive overview of the developments since the initial survey, offering a detailed analysis of the current status of CPS in German hospitals. A general improvement has been observed regarding the range of services offered, utilisation of workforce resources and frequency of service delivery. Despite this positive development, further measures are necessary to ensure the enhancement and improvement of CPS in all hospitals.

A 1% (w/v) propofol solution was prepared using hydroxypropyl-β-cyclodextrin (HP-β-CD). The association constant (Ka) was calculated using the Higuchi and Connors method. The solution was sterilised by 0.22 µm filtration or by autoclaving at 121°C for 15 min. Stability was assessed over 90 days at 2–8°C and 20–25°C. A validated HPLC-UV method was used to quantify propofol and detect degradation products. Additional quality controls included pH, osmolality, subvisible particles, sterility and endotoxin levels.

The Ka was 1288±32 M^–¹. A clear 1% (w/v) solution was obtained with 17% (w/v) HP-β-CD and 0.35% (w/v) sodium chloride, without pH adjustment. Both sterilisation methods preserved drug integrity. The formulation remained stable for 3 months under refrigeration. At room temperature, degradation occurred after 14 days.

This study demonstrates the feasibility of a hospital-based preparation of a sterile injectable propofol solution using cyclodextrins. These results support the role of hospital pharmacies in addressing drug shortages by enabling locally controlled and resilient production capacity.

To determine the in-hospital mortality rate among patients with MRSA bacteraemia receiving vancomycin. The secondary objectives were to (1) evaluate the association between patient characteristics and in-hospital mortality, (2) examine the relationship between in-hospital mortality and secondary treatment outcomes, and (3) assess the impact of vancomycin AUC/MIC target attainment on in-hospital mortality.

A retrospective cohort study was conducted at a tertiary hospital in Malaysia involving adults with MRSA bacteraemia treated from 2014 to 2024. AUC/MIC data were analysed for patients receiving intermittent vancomycin dosing. Multivariable logistic regression identified independent predictors of mortality.

Among 148 patients included, the in-hospital mortality rate was 32.4% (n=48/148). Four factors were independently associated with in-hospital mortality: organ failure (adjusted OR (aOR) 19.28, 95% CI 5.14 to 72.26), recent antibiotic exposure (aOR 5.24, 95% CI 1.90 to 14.51), hypoalbuminaemia <30 g/L (aOR 4.56, 95% CI 1.69 to 13.06) and cerebrovascular disease (aOR 4.24, 95% CI 1.15 to 15.60). Subgroup analysis of patients on intermittent dosing revealed six independent predictors of in-hospital mortality: cerebrovascular disease (aOR 26.9, 95% CI 2.76 to 261.98), hypoalbuminaemia <30 g/L (aOR 10.68, 95% CI 1.54 to 74.29), organ failure (aOR 48.15, 95% CI 4.27 to 542.81), polymicrobial bacteraemia (aOR 24.28, 95% CI 3.09 to 190.64), persistent bacteraemia (aOR 90.08, 95% CI 2.85 to 2845.83) and intensive care unit admission (aOR 0.09, 95% CI 0.01 to 0.91), the latter showing a protective effect. Only 22.2% (n=26/117) achieved the target AUC/MIC, which was not significantly linked to mortality reduction.

Vancomycin AUC/MIC attainment was suboptimal, and mortality was primarily influenced by host factors and disease severity. Early risk stratification and timely intervention are critical to improve outcomes and guide resource prioritisation, particularly in settings with limited access to AUC-guided dosing.

The aim of this study was to evaluate the clinical and financial implications of a pharmacist discharge service on a surgical ward in an Irish hospital setting.

A prospective single-centre pilot study was conducted to evaluate the impact of a clinical pharmacist discharge medication reconciliation service. The study was conducted over 8 weeks on a 31-bed surgical ward. Eligible patients were discharged during pharmacy working hours, on ≥3 medications, with pharmacist admission medicines reconciliation completed. A clinical pharmacist reviewed draft discharge prescriptions and communicated interventions to prescribers prior to discharge. Identified discrepancies were assessed by an expert panel for severity (visual analogue score), probability of adverse drug events and potential remedial healthcare use. Financial impact was estimated using cost avoidance modelling.

Of 50 discharge prescriptions reviewed (646 medications), 184 discrepancies were identified in 40 prescriptions (126 prescribing and 58 communication errors). Most errors (84.8%) were rated as having moderate potential harm; 2.2% were classified as severe. Expert panel assessments indicated that pharmacist interventions prevented adverse drug events likely to result in additional healthcare utilisation by 74.7%. A potential annual net cost benefit of 554 921.53 and a cost-benefit ratio of 52.5 was calculated for the provision of a clinical pharmacist discharge service when all discharge prescriptions from the surgical ward (n=665) are reviewed.

The results show the clinical and financial benefits of a pharmacist-led discharge medication reconciliation service, resolving high-risk prescribing errors and reducing downstream healthcare utilisation. This represents a highly cost-effective intervention with potential for substantial system-wide savings by enhancing patient safety and resource efficiency at transitions of care.

This retrospective cohort study was conducted at a single academic medical centre. Adult patients with an initial sodium concentration of <125 mmol/L who received desmopressin were included. The primary outcome was the rate of sodium overcorrection (>8 mmol/L) 24 hours after desmopressin in patients with renal dysfunction (CrCl <50 mL/min) versus those with no renal dysfunction. Secondary outcomes included proportion of patients achieving a 5–10 mEq/L increase within 24 hours and overcorrection rates at 24 and 48 hours. Data were analysed using the test ², t test and Mann–Whitney U test.

72 patients were included in the study and 20 had renal dysfunction. The most common desmopressin dosing strategy in both groups was rescue. Baseline sodium was comparable between the groups: 113.8±7.5 versus 115.6±3.73 mmol/L. However, sodium before desmopressin administration was more elevated in the renal dysfunction group (124.1±9.8 vs 129.3±7.8 mmol/L; p=0.04) who also received more sodium through intravenous fluids (284.2 vs 90.7 mEq; p=0.001). There was no significant difference in overcorrection by >8 mmol/L, 24 hours post-desmopressin (9.6% vs 20%; p=0.43), but patients with renal dysfunction had higher rates of overcorrection at 24 hours post-admission (11.5% vs 35%; p=0.048).

This study did not show a significant difference in sodium overcorrection after desmopressin in patients with renal dysfunction. Further studies assessing the safety and efficacy of desmopressin in renal dysfunction are needed.

To create an ICU-specific, concentration-matched Y-site compatibility chart aligned to standardised infusion concentrations and to identify compatible, conditional, incompatible and no-data drug-pairs.

We performed a PRISMA (preferred reporting items for systematic reviews and meta-analyses) guided, method-stratified synthesis (1970–2025) of in-vitro Y-site evidence from PubMed, Trissel’s and Micromedex. Classifications privileged instrumented endpoints (pH, turbidimetry, sub-visible particles, high-performance liquid chromatography) over visual inspection. Drug–drug pairs were mapped to our tertiary adult ICU formulary; medicines with an established ward standard were deemed ICU standardised. Outcomes: compatible (C), compatible in saline only (Csf), conditional (concentration/diluent dependent; applied only when at least one medicine was ICU standardised), incompatible—physical (Ie/Ip/It) or chemical (Iq)—or no data (ND).

Among 4465 mapped drug-pairs, 43.94% were compatible (C 42.37%, Csf 1.57%); 2.53% were conditional; 8.24% were incompatible—predominantly physical; and 45.29% lacked eligible evidence. High-risk clusters included lipid emulsions (eg, propofol, clevidipine), extreme-pH agents (eg, amiodarone, furosemide), phenytoin and calcium salts. For morphine hydrochloride, evidence was sparse (76% ND, 21% compatible, 1% conditional, 2% incompatible). Amiodarone exemplified concentration non-concordance; with an ICU concentration of 15 mg/mL, 34% of amiodarone drug-pairs had compatibility that was concentration dependent.

At standardised ICU concentrations, fewer than half of potential Y-site pairings are unequivocally compatible and nearly half have no concentration-matched data. A conservative, method-stratified framework anchored to exact concentration and diluent mitigates risk and exposes evidence gaps. Applying a conservative, method-stratified framework anchored to exact concentration and diluent mitigates risk while revealing priority evidence gaps—especially for lipid emulsions, calcium-containing solutions, extreme-pH drugs and opioids. Embedding the chart within the electronic prescribing and medicines administration (EPMA) system can deliver checks, standardise line allocation, reduce uncertain Y-site mixing and prioritise dedicated lumens for high-risk agents.

To evaluate the impact of clinical variables on therapeutic enoxaparin dosing and assess the effectiveness of anti-Xa monitoring in real-world clinical practice.

A retrospective, single-centre, descriptive study was conducted in adults admitted to hospital and receiving therapeutic enoxaparin with correctly timed peak anti-Xa measurements (4 hours after dose) between December 2021 and January 2023. Demographic, clinical and dosing data were extracted from medical records. Predictors of peak anti-Xa concentration were identified using multiple linear regression. Dose–concentration correlations were examined overall and by obesity status.

A total of 146 patients were included (mean age 67±12.3 years; 56.2% male; mean body mass index 29.6±7.5 kg/m²; 30.1% with obesity). Enoxaparin dose (p<0.001) and obesity (p=0.007) were independent predictors of peak anti-Xa concentration; renal impairment and critical illness were not. The correlation between dose and concentration was strong in patients without obesity (r=0.56) but weak in those with obesity (r=0.16). Only 46.6% achieved therapeutic concentrations; 40.4% were subtherapeutic and 12.9% supratherapeutic. Among patients with out-of-range values, dose adjustments were made in 67.9%, but follow-up anti-Xa measurement occurred in only 45.3%; 79.2% of these achieved target concentrations.

Obesity significantly influences enoxaparin pharmacokinetics, reducing predictability of anti-Xa concentrations with actual body weight dosing. Targeted anti-Xa monitoring in high-risk groups, particularly patients with obesity, and structured dose-adjustment protocols may improve therapeutic achievement and safety.

89 anonymised medication error reports, and empirical data from the SIG members’ daily practice, were analysed to identify root causes, classified into system-level and individual errors. Expert subgroups then linked root causes to targeted preventive measures. A literature review was conducted, searching PubMed and Embase databases, to assess existing standards and identify gaps in medication safety practices, which informed the analysis.

Analysis revealed that governance deficiencies and inconsistent implementation of existing legal standards contribute significantly to medication errors. System-level issues, including inadequate oversight, understaffing and insufficient technical infrastructures, along with individual errors from cognitive lapses, were prevalent. The literature review supported these findings and highlighted the variability in medication safety practices across systems, underscoring the importance of strategic improvements in healthcare policies.

Findings highlight the critical need for robust governance, comprehensive policy frameworks and enhanced safety cultures to prevent medication errors. Automation and improved human–machine interfaces are recommended to mitigate active failures and enhance system reliability. This systems-thinking approach, supported by strengthening legislation and better resource allocation, is essential for reducing medication errors and improving patient safety.

Alglucosidase alfa infusions (2 and 4 mg/mL in 0.9% sodium chloride) were prepared and samples were drawn on days 1 to 7 and 11. Enzyme activity was determined using 4-methylumbelliferyl-α-D-glucoside (4MU-αGlc) and glycogen as substrates. Additionally, enzyme uptake in cultured fibroblasts was investigated.

There was no difference in enzyme activity after 11 days as compared with day 1 using 4MU-αGlc (2 mg/mL: 352 vs 331 nmol/h/mL; 4 mg/mL: 657 vs 662 nmol/h/mL) or glycogen (2 mg/mL: 183 vs 176 nmol/h/mL; 4 mg/mL: 352 vs 357 nmol/h/mL). Uptake of alglucosidase alfa in fibroblasts remained stable over 11 days, with activity ranging from 90 to 104 nmol/h/mL at 2 mg/mL and from 233 to 238 nmol/h/mL at 4 mg/mL. Linear regression analysis confirmed no statistically significant association between time and enzyme activity or uptake.

Ready-to-administer alglucosidase alfa infusion in 0.9% sodium chloride at 2–4 mg/mL is stable for 11 days when stored at 2–8°C or –20°C and protected from light. Extending the stability could enhance efficiency and flexibility for infusion preparation and home delivery, while minimising pharmaceutical waste.

We conducted a retrospective cohort study, following the TRIPOD statement, using a Flemish linked database combining primary care and national health insurance data. Adults aged ≥75 years with an all-cause hospital admission in 2014 were included. The primary outcome was UHR, defined as emergency department visits or unplanned hospital admissions within 6 months post-discharge. We used multivariable logistic regression to identify predictors for UHR and develop a risk prediction model. Model performance was assessed using balanced accuracy. Missing data were handled using multiple imputation by chained equations. The model was validated on a held-out test set and a k-nearest neighbour classifier was used to cross-validate risk categories.

Among 3133 patients, 309 (10%) experienced UHR. The best-performing model had a balanced accuracy of 0.56, with a sensitivity of 58% and a specificity of 54%. Predictors were polypharmacy, male sex, haemoglobin level, number of general practitioner contacts and multimorbidity. Excessive polypharmacy (>9 medications) was associated with a 55% increase in UHR odds. Three UHR risk groups were identified: low-risk (5.1%), medium-risk (8.8%) and high-risk (11.6%).

UHR are common in older adults, with excessive polypharmacy emerging as a key predictor. The pragmatic model described here provides a valuable tool to stratify older adults into distinct risk groups, identifying a high-risk group that may benefit from targeted interventions.

The case originated when a combination of midazolam hydrochloride, clonidine hydrochloride and fentanyl citrate with Numeta G16E was administered in a central venous catheter line. Following an alarm from the syringe pump, a precipitate in the catheter line was visually observed.

The actual catheter line, with the precipitate still inside, was removed from the clinic and brought to the laboratory. Raman spectra of the precipitate, both when still inside the catheter line (in situ) and after removal, were recorded and analysed for similarity using our in-house database. Additionally, to validate the method, dry powders of midazolam, clonidine and fentanyl were mixed in the ratio of ~300:1:1. This tailor-made mixture was subjected to Raman analysis with the aim of validating the ability of the method to identify all components in a mixture, even if some of the components were present only in small amounts.

The precipitate was successfully identified as midazolam. Measuring in situ caused some additional peaks in the Raman spectra, attributed to the plastic of the catheter line. The influence of these additional peaks was eliminated by a two-component search or by demixing the spectra. The spectra of the precipitate indicated no traces of either clonidine or fentanyl. The experimental results were in line with the results from the theoretical calculations. The ability of Raman spectroscopy to identify both midazolam and small amounts of clonidine and fentanyl in a powder mixture was successfully demonstrated by scanning the tailor-made mixture.

Raman spectroscopy in combination with a database was used for rapid and non-invasive bulk identification in situ. However, to confirm or refute small amounts of a second drug substance in the precipitate, a large area scan of the particle on a flat surface is recommended.

Caffeine citrate concentrations were measured using a high-performance liquid chromatography method with ultraviolet detection (HPLC-UV). Solutions were stored at room temperature (22°C) and at 8°C for up to 48 hours. Two solvents for caffeine citrate were studied: normal saline (0.9% w/v sodium chloride), and 5% w/v glucose. The calibration curves of the HPLC-UV method were linear over the range of 0.1–12.5 mg/mL for both types of intravenous fluid. The stability criterion was defined according to International Council for Harmonisation (ICH) M10 (±15% of nominal concentration), and compliance with the stricter United States Pharmacopeia (USP) criterion (±10%) was also assessed.

All samples remained within the ICH M10 acceptance limits. Most results also complied with the USP±10% threshold; however, three values (12.5 mg/mL in 0.9% w/v sodium chloride at 24 hours refrigerated, and 1 mg/mL in 5% w/v glucose at 24 hours and 48 hours refrigerated) exceeded 110% (112.9%, 111.3%, and 111.4%, respectively).

Caffeine citrate diluted in 0.9% w/v sodium chloride or 5% w/v glucose is chemically stable at concentrations of 1 mg/mL and 12.5 mg/mL for up to 48 hours when stored at room temperature, meeting ICH and USP acceptance criteria in all cases. Caffeine citrate solutions did not meet the USP±10% criterion if stored at 8°C for 24 hours.

In 2020, pharmacists started educating rheumatologists via medical meetings and online surveys. When the substitution rate plateaued (63%), we initiated a prospective cohort study. A senior pharmacist interviewed patients and gave them oral and written information during their infusions with the originator infliximab (o-IFX). A semi-structured questionnaire assessed patients’ beliefs, knowledge and experiences to identify barriers to switching to biosimilars. Pharmacists’ recommendations were transmitted to physicians. Patients were categorised into ‘Switch-failure’ (≥1 b-IFX infusion administered but restarted o-IFX), ‘Switch-refusal’ (refused the switch) and ‘Switch-omission’ (switch neither suggested nor made) groups. Pharmacist follow-up continued for 3 years after the interviews, with regular reminders sent to rheumatologists.

From 1 October 2021 to 31 January 2022, 16 of 18 patients treated using o-IFX were interviewed and three, six and seven patients were categorised into the Switch-failure, Switch-refusal and Switch-omission groups, respectively. Nine patients agreed to switch during their interviews, including one patient in the Switch-failure group. Seven patients refused to switch because they were stable or had previously discontinued b-IFX due to a perceived loss of efficacy. The 3-year post-interview assessment showed that five patients had switched but one had switched back, resulting in annual savings of 44 000 and a final switch rate of 71%, a positive return on investment in pharmacist time. Four accepted switches were not performed due to coordination issues between other healthcare professionals or health-related cancellations. No o-IFX initiations occurred during the study and no rheumatologists refused substitution.

Sustained pharmacist involvement in providing targeted education to prescribers and patients was essential to identifying barriers to change and enhancing the adoption of biosimilars.

The switch from intravenous to oral antibiotic therapy was evaluated in adults (≥18 years) admitted to hospital with CAP. The primary outcome was a switch within 72 hours (early switch). Secondary outcomes included duration of hospital stays, readmissions, changes in inflammatory markers and mortality within 30 days after discharge. Furthermore, information on healthcare providers’ decisions was gathered.

The cohort comprised 214 patients with CAP, of which 187 (87.4%) underwent a switch and 146 (68.2%) of these had an early switch. Early switching was frequent in younger patients (18–49 years) and those with low Pneumonia Severity Index (PSI I and II). Hospital stay was longer in the late and non-switch groups compared with the early switch group, and the total duration of antibiotic therapy was the highest in the late switch group. No reasons were documented for 76.5% (n=52) of the patients who did not undergo an early switch. Almost no early switches were advised during the weekends.

A high overall switch rate of 87.4% was observed with a 68.2% early switch rate. Early switch was associated with shorter duration of hospital stay and antibiotic therapy. Reasons for not applying an early switch were underreported, and weekends served as significant barriers to an early switch.

This study aimed to evaluate the physicochemical stability of nefopam solutions at 0.2 and 3.33 mg/mL diluted in 0.9% NaCl in silicone portable elastomeric devices at 32°C in the dark.

Three portable elastomeric devices were prepared for each condition. Chemical stability was assessed by pH measurement and high-performance liquid chromatography (HPLC). The method was validated according to the International Conference on Harmonisation Q2(R1). Stability was tested after preparation and after 6 and 24 hours of storage. At each time of analysis, the pH values were measured, and three samples from each device were analysed via HPLC. The solution is chemically stable if it retains more than 90% of its initial concentration, with the appearance of any degradation products monitored, and if the pH variation is less than one unit. Physical stability was evaluated by visual and subvisual inspection using a particle counter following the European Pharmacopoeia guidelines.

Nefopam solutions at both concentrations maintained more than 93% of their initial concentration after 6 and 24 hours at 32°C, with no pH variation exceeding one unit, demonstrating chemical stability. For both concentrations, visual inspection was compliant at each analysis time, and subvisual inspection was consistent at 24 hours. Physical stability was therefore demonstrated for both concentrations after 24 hours.

The physicochemical stability of nefopam solutions at 0.2 and 3.33 mg/mL was demonstrated for 24 hours at 32°C in portable elastomeric infusion devices. This attribute allows continuous administration at home, particularly in cases of difficulty with oral administration, or minimises the side effects of discontinuous administration.

The literature data were reviewed systematically and independently by two investigators and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Any differences of opinion were resolved by a third investigator. Four online databases (PubMed, Embase, ScienceDirect and Web of Science) were searched for articles published in English or French between 1 January 2004 and 31 December 2024. Only publications that address sustainable development and infusion medical devices were included. The following data were extracted: country, hospital department(s), and the study’s objectives, methods, main results and conclusions. The robustness of the selected studies was assessed using the Mixed Methods Appraisal Tool.

In all, 1938 publications were screened, and eight were included. Four publications concerned overconsumption and/or waste analysis, one compared single-use devices with reusable devices, and three were concerned with intravenous drug administration and wastage. The topics addressed in life cycle assessments were procurement, supply, storage, overconsumption of medical devices, the wastage of intravenous drugs and waste management.

The results highlighted some areas for improvement at various points in the medical device life cycle—from manufacturing to recycling. Collaboration between hospital stakeholders is essential for the promotion of environmentally friendly infusion practices.

Three independent batches of each formulation (BSS, NS and GS) were aseptically prepared in a laminar flow cabinet and stored under three conditions: room temperature (25±4°C), refrigeration (4±3°C) and freezing (–20±5°C). Three samples from each batch were analysed for each condition and time point. LP concentrations were measured on days 0, 7, 15, 22 and 30 using high-performance liquid chromatography with photodiode-array detection (HPLC-DAD) and ultraviolet (UV) – visible spectrophotometry. Visual inspection was performed to identify macroscopic changes and physicochemical parameters — including pH, osmolality and refractive index — were evaluated. Microbiological quality was assessed on days 0, 10, 20 and 30.

BSS and NS formulations maintained 90–110% of their initial LP concentration under all storage conditions. The GS formulation remained stable when refrigerated or frozen but showed a marked decline at 25°C, with turbidity and concentrations falling below 50% by day 20. pH, osmolality and refractive index remained within acceptable physiological ranges for ophthalmic solutions. All samples tested negative for microbial growth.

LP eye drops prepared with BSS or NS were stable in closed sterile eye drop bottles for at least 30 days under all tested conditions. Frozen and refrigerated conditions are preferred for storage. Because the formulation does not contain preservatives, its use is recommended for no longer than 7 days after opening. GS-based formulations are not recommended for ophthalmic use. The conducted stability study provides hospital pharmacies with data supporting the safe preparation, storage and use of non-commercial ophthalmic formulations.

A total of 200 patients (>18 years) were included across two hospitals. In supply strategy 1, both new and resupplied medications were provided for 14 days. In strategy 2, new medications were provided for 14 days, while resupplied medications were provided for 28 to 30 days. The primary outcome was the difference in overpaid costs between the two budgets, calculated per patient per admission.

For strategy 1 (the provision of resupply medication for 14 days), the median cost difference per patient per admission was -3.48 (range -198.27 to 293.40), indicating a small overpayment by the hospital. When resupply medication was provided for 28 to 30 days, the median overpayment per patient per admission increased slightly to -4.12 (range -315.87 to 293.40).

Implementing POM results in only a small difference in overpaid costs between home and hospital medication budgets, regardless of the supply strategy. Consequently, this does not hinder the implementation of POM in hospitals.

Container integrity testing was performed according to YCD requirements "Protocols for the Integrity Testing of Syringes" for ChemoClave and ChemoLock syringe adapters (CH2000S/CL2000S) and for ChemoClave and ChemoLock vented bag spikes (CH-14/CL-14) as terminal closure devices. Microbiological integrity was assessed according to Method 1, Part 1.4 using Brevundimonas diminuta at 32°C for 14 days. Physical integrity was assessed using the following dye intrusion methods: YCD Method 3 and European Pharmacopoeia 3.2.9 "Rubber closures for containers". Readout for dye intrusion was reported visually and using a spectrophotometer. Positive (n=2) and negative (n=1) controls were assessed according to YCD for both arms of the test.

ChemoClave and ChemoLock syringe adapters and vented bag spikes/IV bags were shown to be free of microbiological contamination (n=160) and free of dye intrusion (n=80 in total). The data support both ChemoClave and ChemoLock CSTD components as closure for aseptic preparations of pharmaceutical drug products in PTS. 100% closure integrity was demonstrated.

ChemoClave and ChemoLock CSTD components showed 100% container integrity in accordance with YCD requirements as terminal closure for LL syringes and IV bags in PTS. ChemoClave and ChemoLock syringe adapters and vented bag spike components can be used for the preparation of chemotherapeutic drug products prepared in advance in UK PTS.

An observational and retrospective study was undertaken in hospitalised adult patients treated with intravenous vancomycin. Patients with serum creatinine (Scr) >2 mg/dL and <0.5 mg/dL, body mass index >40 kg/m², need for extracorporeal clearance techniques and unstable renal function were excluded. Bayesian analysis was used to obtain individual pharmacokinetic parameters. Vancomycin clearance (CLvan) was calculated by means of CG (eCLvan_CG), CKD-EPI (eCLvan_CKD-EPI) and MDRD (eCLvan_MDRD) and used to obtain Cmin estimates (eCmin). eCmin and observed Cmin were compared using an intraclass correlation coefficient (ICC). A post-hoc analysis by subgroups (age, sex, weight, Scr and estimated glomerular filtration rate (eGFR)) was performed. From each eCLvan, the area under the curve (AUC) was calculated and categorised as AUC <400 mg*hour/L, AUC 400–600 mg*hour/L and AUC >600 mg*hour/L. The kappa coefficient was applied to study AUC concordance.

A total of 228 patients (69.3% men) were included. eCmin_CG had a statistically significant better agreement with Cmin (ICC >0.7) and showed good agreement in almost all subgroups. Patients with Scr >1.1 mg/dL were the only subgroup in which eCmin_MDRD and eCmin_CKD-EPI had an adequate ICC with no statistically significant differences compared with eCmin_CG. eCmin_MDRD had a similar ICC to eCmin_CG in the eGFR <60 mL/min and age 46–75 years subgroups. Kappa values showed regular agreement in all subgroups: 0.32 (AUC <400 mg*hour/L), 0.24 (AUC 400–600 mg*hour/L) and 0.41 (AUC >600 mg*hour/L).

The CG formula provides the most accurate prediction of vancomycin Cmin. In patients with eGFR <60 mL/min and aged 46–75 years, MDRD also shows a good predictive capacity. However, in low weight and elderly patients, Cmin predictions are superior with CG. Therefore, renal function estimation equations should not be considered interchangeable for vancomycin dose adjustments.

We conducted a retrospective observational study in 69 patients with CD receiving vedolizumab maintenance therapy. Plasma trough concentrations were measured by ELISA. Clinical remission (Harvey-Bradshaw Index <5) and biochemical remission (faecal calprotectin (FCP) <250 µg/g) were evaluated 6 months after trough level measurement. Patients were stratified according to administration route (intravenous and subcutaneous). Statistical analyses included Mann-Whitney tests, receiver operating characteristic (ROC) curves to determine predictive ability, and multiple linear regression to identify factors associated with vedolizumab exposure.

Median vedolizumab trough concentrations were higher in patients achieving clinical remission compared with those without remission in both intravenous (16.4 vs 10.95 µg/mL, p=0.067) and subcutaneous (37.45 vs 23.05 µg/mL, p=0.134) groups, although differences were not statistically significant. ROC analyses revealed modest predictive capacity for the intravenous group (area under the curve (AUC)=0.676, optimal threshold=11.3 µg/mL, sensitivity=85.7%, specificity=58.3%) and strong predictive ability for the subcutaneous group (AUC=0.813, optimal threshold=25.35 µg/mL, sensitivity=83.3%, specificity=75%). Biochemical remission was not significantly associated with trough concentrations. In multivariable regression analysis, subcutaneous administration, higher albumin and lower FCP were significantly associated with increased vedolizumab concentrations, whereas C-reactive protein (CRP) showed a positive association.

Vedolizumab trough concentrations were numerically higher in patients achieving clinical remission, with stronger predictive ability for remission in the subcutaneous group. While isolated trough levels alone may not predict remission, interpretation alongside biomarkers and clinical context can inform therapeutic decisions. Further prospective studies are warranted to validate optimal therapeutic thresholds.

Hospitalised patients receiving TAZ/PIPC therapy for >2 days were included. The primary endpoint was the incidence of hypokalaemia (serum potassium level ≤3 mEq/L) and identification of associated risk factors. Survival classification and regression tree (CART) analyses were used to estimate HR (95% CI) and cut-off values for continuous variables.

Of the 224 patients treated with TAZ/PIPC during the study period, 168 were included. The median time (min–max) to the incidence of hypokalaemia was 3 (2–14) days. Hypokalaemia was observed in 30 patients. Survival CART analysis identified baseline serum potassium level (cut-off value of 3.7 mEq/L) and diarrhoea as risk factors.

Monitoring serum potassium levels is recommended after treatment initiation of TAZ/PIPC therapy for patients with baseline serum potassium levels ≤3.7 mEq/L and diarrhoea.

In the laboratory, a high-performance liquid chromatography method for evaluating furosemide in tablets was validated with the simulation of the hospital protocol involving dispersing furosemide tablets in 10 mL of bottled water using syringes. The content was evaluated before and after passage through enteral feeding tubes made of three different materials (polyvinyl chloride—PVC, polyurethane and silicone). The sorption of furosemide in the tubes was evaluated by infrared spectrophotometry.

The developed analytical method demonstrated selectivity, linearity within the 30–60 µg/mL range, as well as precision and accuracy. The stability of the furosemide in the syringes was also assessed, and no significant decay in content or formation of degradation products was observed during the 180 min exposure before passing through the enteral feeding tube. The simulation demonstrated that the furosemide content remained stable after passing through PVC (100.90%), polyurethane (98.58%) and silicone (99.56%) tubes. Furthermore, no sorption of furosemide was detected in any of the materials.

These results confirm the safety and stability of the hospital’s protocol for administering furosemide via enteral feeding tube to the patient.

A single-centre retrospective observational study was conducted, analysing PICC requests from April 2018 to October 2021. Pharmaceutical interventions (PIs) were categorised based on their targets: applicants, installers or users. A national survey was also conducted to assess PICC practices across French hospitals.

Of the 5503 requests over a 42-month period, 59.9% (3297) required at least one PI, totalling 4406 PIs. Most were directed at installers (69.2%), followed by applicants (18.4%) and users (12.4%). Pharmacists refused 4.1% (223) of requests, mainly due to alternative functional access or contraindications. Despite pharmacist validation, 14.0% (771) of PICC placements were later cancelled by the medical team (ie, transfer of the patient). The national survey revealed limited adoption of pharmaceutical validation, with only two centres (5%) implementing it out of 37 respondents, even though 40 centres (98%) had over 2 years of experience with PICCs.

Pharmacist-led PICCs validation improves patient safety and optimises device use, demonstrating its value and sustainability in clinical practice. The percentage of refusals has remained stable since our pilot study in 2018 in the same centre, probably due to fast staff turnover. Wider implementation of this practice requires addressing resource limitations, raising awareness about the pharmacist’s role in managing medical devices, and frequent training.

A Web of Science Core Collection search (2000–2025) yielded 258 English-language publications on IT applications in hospital AMS. A bibliometric analysis, utilising CiteSpace and Bibliometrix, quantitatively evaluated domain evolution through temporal analysis, network mapping, keyword clustering, burst detection and examination of highly cited publications.

The bibliometric analysis reveals a fluctuating yet overall increasing trend in annual publications, peaking at 49 articles in 2024. The US (131 publications) and European nations demonstrate significant research output (centrality >0.2), with major collaborative networks coalescing around institutions including Harvard University and Imperial College London. Keyword analysis identifies ‘AMS’ as a core theme, closely associated with technological keywords such as ‘machine learning (ML)’, ‘clinical decision support systems (CDSS)’, ‘electronic health records (EHR)’ and ‘artificial intelligence (AI)’. Emerging trends suggest a shift in research focus from foundational strategies to data-driven prediction of antimicrobial resistance (AMR) and precision interventions. Highly cited literature emphasises the integration of EHR and ML technologies for optimising prescriptions and predicting resistance patterns.

IT-driven AMS research has shifted from empirical management to data science. Despite EHR integration, and ML and CDSS support, challenges remain in data standardisation, technical deployment and ethics. Future work must emphasise global collaboration, standardisation, design refinement and ethical guidelines, and provide clear algorithm explanations to enhance AMR mitigation.

This exploratory cross-sectional study was co-designed with YP living with chronic conditions, conducted at a district general hospital in Northwest London between April and September 2023. Participants were those aged 11–16 years admitted to the paediatric ward with long-term conditions requiring regular medication. YP self-completed a questionnaire on medication-related aspects of transition, including knowledge of medication names, dosages, reordering, side effects, adherence and their ability to manage medications independently.

Of 41 eligible YP, 30 completed the questionnaire (73% response rate). Most knew the names and dosages of their medications (24/30) and why they were prescribed (25/30). However, only half (15) knew how their medicines worked, and fewer (10) were aware of potential side effects. Just 12 participants knew how to reorder their medication. Fifteen reported missing doses, mostly due to forgetfulness. Most relied on parents or carers to manage medicines (23), with only four managing independently. YP reported healthcare professionals (17) and family (19) as their main sources of medication information.

This study suggests that while YP often have good foundational medication knowledge, many lack the deeper understanding and practical skills required for independent self-management. Knowledge of side effects, reordering processes and shared decision-making was limited, areas which could undermine transition readiness if unaddressed. Pharmacists, working as part of the multidisciplinary team, are well placed to support YP through targeted, age-appropriate education and regular review.

A retrospective analysis was conducted on all antibiotic-treated hospitalised cases during the study period, with a total of 123 patients. The study employed a consecutive enrolment design. Of these, 62 cases were managed under a pharmacist-led antibiotic stewardship programme as the intervention group, while the remaining 61 cases served as controls. Primary outcomes included hospitalisation stays, hospitalisation costs, antibiotic consumption, the duration of antibiotic use and the efficacy of antibiotic therapy.

The intervention group exhibited a lower number of defined daily doses (DDDs) per patient between their stay compared with the control group (13.18±1.25 DDDs vs 20.03±2.15 DDDs, p=0.007). Moreover, the duration of single antibiotic treatment was notably reduced in the intervention group (10.40±0.75 days vs 13.16±1.16 days, p=0.047), as was the duration of the single longest empirical therapy with broad-spectrum antibiotics (6.77±0.55 days vs 10.29±1.15 days, p=0.007).

Pharmacist-led antibiotic stewardship effectively optimised antibiotic use in geriatric neurology patients, reducing unnecessary broad-spectrum antibiotic exposure and improving treatment efficiency.

This rapid review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A literature search of the PubMed database was performed on 8 October 2024. Studies were selected based on predefined eligibility criteria defined by the PICO framework- Population: adult emergency patients (aged ≥18 years) admitted to the emergency department; Intervention: medication reconciliation conducted by pharmacy staff; Comparator: standard medication reconciliation or standard care; Outcome: risk factors for unintentional medication discrepancies identified through pharmacy staff-led medication reconciliation in the emergency department. All included studies were qualitatively assessed.

The literature search yielded 433 citations, of which 15 studies met the eligibility criteria. The included studies primarily investigated patient, medication and setting-related risk factors, encompassing a total of 15 264 patients who received pharmacy staff-led medication reconciliation in emergency departments across seven countries. A consistent pattern of risk factors emerged, including advanced age and polypharmacy. Only one study found that admissions during night-time or weekend hours were significantly associated with medication discrepancies. Differences in health IT systems and reconciliation practices were also noted across countries.

Advanced age and polypharmacy were consistently associated with unintentional medication discrepancies. Future research should address variations in health IT systems and focus on developing robust prioritisation models to optimise medication reconciliation processes and improve patient safety. Increasing pharmacy staff capacity may further support this goal.

This systematic review aims to evaluate studies specifically focused on the impact of automated UDDSs in reducing medication errors and streamlining processes.

A literature search was performed on PubMed, Scopus, and Web of Science, focusing on peer-reviewed articles published between 2019 and 2024. The search, concluded on 24 September 2024, included studies conducted in inpatient hospital settings that assessed automated UDDS effects on medication errors, therapy management and inventory control. Outcomes examined included effects on patient safety, cost-effectiveness and inventory management. Results were synthesised qualitatively.

From 3346 references, four studies met the inclusion criteria: a cost-effectiveness analysis, an uncontrolled before-and-after study, and two observational studies. UDDS improved medication processes, reducing drug-related problems, medication handling and dispensing time by 50% per patient per day. Integrated with barcode scanning, UDDS lowered medication administration errors (MAEs) from 19.5% to 15.8% and harmful MAEs from 3.0% to 0.3%. Overall, medication errors dropped by 45–70%, enhancing safety and reducing manual handling risks. UDDS demonstrated cost-effectiveness by significantly reducing MAEs. The study estimated a reduction in MAEs, with a cost-effectiveness ratio of 17.69 per avoided MAE. For potentially harmful MAEs, the cost-effectiveness ratio was estimated at 30.23 per avoided error. These findings suggest substantial long-term savings potential, though the exact magnitude may vary depending on hospital size and implementation specifics

Automated UDDSs improve patient safety by significantly reducing medication errors and delivering cost savings through better inventory management. Challenges such as high initial costs and workflow adjustments can be mitigated through gradual implementation and staff training. Further integration with other healthcare technologies, such as barcoding, real-time tracking, artificial intelligence (AI)-driven error prevention tools and fully automated restocking systems could enhance UDDS benefits and further support hospital processes.