We followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines for systematic reviews. Studies investigating algorithm-managed and pharmacist-managed dosing of ESA in adult patients with renal anaemia were evaluated for inclusion. No restrictions were set on outcome parameters. Observational and interventional studies available as full-text articles with a control group and follow-up ≥6 months were eligible for inclusion. Relevant databases were searched from their inception through August 2024. Two independent reviewers evaluated all studies. The risk of bias was assessed by the ROBINS-I and RoB1 tools. The protocol of this study was registered in PROSPERO (CRD42021243678).

After screening 140 articles, 17 articles and 4313 patients could be included. Available evidence was of low to moderate quality with a high risk of bias. Data were summarised and tabulated. Meta-analysis was not possible due to the substantial heterogeneity in participants, study design, interventions, comparisons, and outcome parameters. However, standardised metrics could be identified and calculated for haemoglobin and ESA dose. The percentage in target range for haemoglobin varied between 3.5% lower (95% CI –18.67% to +11.67%) to 32.0% higher (95% CI 14.07% to 49.93%) in the pharmacist-managed group versus the control group (n=1401). The range in reduction in ESA dose was 5.45% (95% CI –7.97% to +18.87%) to 49.97% (95% CI 20.32% to 79.61%) in the pharmacist-managed group versus the control group (n=2115).

Low-quality data with high risk of bias suggest that pharmacist-managed renal anaemia may improve the percentage of haemoglobin within target range and reduce the ESA dose. However, meta-analysis was impossible due to substantial heterogeneity. Therefore, no definite conclusions could be drawn on the effectiveness of pharmacist-managed dosing of ESA in renal anaemia.

CRD42021243678.

A retrospective cross-sectional study was conducted to assess the resolution of prescribing errors, based on the analysis of electronic prescriptions. A prescribing error was defined as an alert that required intervention of the pharmacist to prevent harm or to optimise therapy. To identify prescribing errors, a medical doctor and hospital pharmacist analysed all alerts that were retained to be checked by a pharmacist. Resolution of a prescribing error was defined as resolution of the error within 24 hours after detection.

In total, 145 574 medication prescriptions were analysed and 448 prescribing errors were detected. Of these prescribing errors, 94.0% were resolved within 24 hours. No differences were found between the resolution rate of prescribing errors after advice from a specialised hospital pharmacists and their substitutes (94.4% vs 91.9%, p=0145 (² test)). Administrative prescribing errors, prescribing errors for patients aged >80 years and prescribing errors handled during weekends showed a relatively low-resolution rate. No other characteristics of the pharmacist, prescriber, patient, the drug involved or the intervention itself were associated with the resolution of the prescribing error.

In the temporarily absence of a specialised hospital pharmacist, the resolution rate of prescribing errors remains high when advice about prescribing errors is provided by a substitute hospital pharmacist.

A grounded theory approach was used to design, evaluate and develop the framework. Participants included healthcare professionals and laypersons with experience using narrow therapeutic index medications, as well as individuals recommended by them. Two focus group discussions were conducted (N₁=6 and N₂=5), each lasting approximately 2 hours and following the same agenda. In one case, a follow-up one-on-one interview was held because the participant indicated further insights at the end of the session.

Participants identified key decision-making questions for the framework, including the evidence base for interacting drugs, severity and documentation level of the interaction, availability of safer alternatives, and the presence of confounding factors. The framework was considered useful and, following refinement, potentially suitable for clinical implementation. A key insight was that integration into healthcare curricula is essential for achieving long-term impact. Overall, the proposed tool may assist in managing interaction risks in diverse clinical scenarios and reduce alert fatigue among healthcare professionals.

Although further clinical validation is needed, the framework provides a foundation for improving the management of database-detected drug interactions.

This observational study was conducted over 6 months. In the first 2 months, patients collecting CFM were invited to participate in an unused medication monitoring programme by completing an inclusion questionnaire. Those who consented were followed for four additional months and asked to report on unused medication during subsequent visits. Data on dispensed medication and patient-reported unused medication were collected using structured survey forms and analysed using descriptive statistics.

Thirteen per cent of patients reported unused medication from approximately 100 enrolled participants. Collecting CFM for themselves, the unused medication rate was 15%, compared with 8% among those collecting on behalf of others. No unused medication was reported by first-time collectors. Reported reasons included clinical changes (eg, dose adjustments, treatment discontinuation, adverse effects) and administrative errors (eg, excess quantities, incorrect formulations). The total value of unused medication was estimated at 83 000 Kr (11 100). Extrapolated to the annual distribution volume at the St Thomas Pharmacy, the annual loss from unused medication would be 900 000 Kr (120 000).

The small sample size in this project is a limitation and associated with an uncertain outcome. Unused medication related to CFM is a measurable and economically significant issue, primarily driven by clinical and administrative factors. While reducing pack sizes could help mitigate unused medication, this may increase logistical burdens on patients and healthcare providers. A larger distribution model, such as dispensing through all local community pharmacies under hospital tender agreements, may offer a more efficient solution but would require legislative reform. Broader, multi-site studies are needed to validate findings and inform future policy interventions.

This multicentre retrospective observational study included patients aged ≥18 years during a 3-year period with an estimated glomerular filtration rate of <60 mL/min/1.73 m² or on renal replacement therapy, receiving ≥7500 IU dalteparin daily. Only correctly sampled plasma anti-Xa levels were included and stratified into intensive care unit (ICU) and non-ICU patients. Stratum-adjusted odds ratios were determined to compare the likelihood of achieving adequate anti-Xa levels between a 75% and 100% dose. Bleeding events were classified into minor and major events.

A total of 167 anti-Xa levels were included, with 148 anti-Xa levels belonging to patients receiving a 75% or 100% dose. Anti-Xa levels were highly scattered: 55% below and 6% above the anti-Xa ranges. In all patients the probability that anti-Xa levels fell within the range was higher for patients receiving a 100% dose than for those receiving a 75% dose (OR 2.66, 95% CI 1.24 to 5.70, p=0.012). Eight bleeding events occurred, including one minor event in a patient with an anti-Xa level above range and five events in patients on renal replacement therapy with anti-Xa levels within or below range.

In renally impaired patients a 100% dalteparin dose increases the likelihood of achieving adequate anti-Xa levels compared with a 75% dose, without leading to over-exposure. The occurrence of bleeding events did not differ between the 75% and 100% dose groups and appeared unrelated to anti-Xa levels. Pre-emptive dose reduction of dalteparin in renally impaired patients is likely to be unnecessary.

The programme addressed challenges in operations, logistics, technology, legality, training and information. A protocol was developed defining the collaborative dispensing circuit, including criteria for patient selection and prioritisation.

Over 39 months, 13 310 shipments were made to 1039 patients, averaging 17 daily. Each patient received about 13 deliveries. A total of 14 283 medications from 258 specialties were dispensed. The programme saved 512 534 km and 542 164 min (356 days) in travel. Each patient saved approximately 493 km and 522 min, reducing CO2 emissions by 58–116 kg per patient, or 72–145 tonnes overall. A survey of 130 patients revealed a 93% preference for this model over home or healthcare facility delivery.

The implementation of telepharmacy programmes for dispensing hospital medication to community pharmacies marks a significant advancement in patient care. Initially rare, telepharmacy is now widespread, overcoming previous barriers. Programmes show similar effectiveness to home delivery, improving workflow and safety. Future improvements may include remote monitoring tools and video calls. Despite some limitations, such as economic analysis and tracking, telepharmacy has proven beneficial for patients, offering cost savings and enhanced confidentiality.

The collaborative telepharmacy circuit was efficiently and safely implemented, offering an innovative approach that meets the needs and expectations of patients in the OPCU.

This study aimed to assess the value of STs in an integrative cancer centre to address the treatment of patients with suspicion of HSRs to platinum salts (carboplatin, oxaliplatin, cisplatin), and taxanes (paclitaxel, docetaxel).

This single-centre, retrospective study was conducted on data collected from hospital medical records between August 2018 and December 2023. STs (prick tests and intradermal tests) were performed according to the recommendations of the European Network for Drug Allergy and the European Academy of Allergy and Clinical Immunology. The concordance between the allergist’s recommendations and the therapeutic strategies implemented in clinical practice following ST results was evaluated.

Among the 105 patients included (76 females, 29 males), the positive ST rate was 61%. In total, 71% of the reactions to platinum salts (n=82) were identified as allergies versus 26% for taxane reactions (n=23). We found a cross-reactivity of 34.5% for platinum salts and 66.7% for taxanes. The allergist’s recommendations were carried out in practice for a total of 56 patients (53%). For 47 patients (45%), a clinical reason justified not following the allergist’s recommendations and discontinuing treatment.

This study confirms the relevance of STs to help oncologists guide treatment strategies after a presumed allergy. As part of the allergological work-up, STs help prevent unnecessary changes to chemotherapy lines in patients with unproven allergies and facilitate the identification of alternative treatments following HSRs. In practice in our centre, allergists’ propositions are carried out as much as possible to guide the re-exposure strategy in patient care.

This prospective, cross-sectional study was conducted over a 2-month period among ambulatory patients with CML monitored at one of the country’s leading hospitals for diagnosing, treating and monitoring CML in Bulgaria.

Among 70 participants, 91.4% showed high medication adherence, with only 1.4% reporting low adherence. No significant differences in adherence between therapy groups (imatinib vs nilotinib, p=0.1830), gender (p=0.0887) or age groups (p=0.8748) were revealed. Education level was associated with adherence, with lower adherence observed in patients with primary education (p<0.0001). Quality of life, measured using utility values (median=0.8770) and visual analogue scale (mean=80), did not significantly differ based on adherence levels, therapy type or education level. Logistic regression showed that men had 1.9 times higher odds of high adherence compared with women (p>0.05). Patients under 65 had 3.3 times higher odds of adherence compared with those over 65 (p>0.05), and those on imatinib had 22.86% of the adherence odds compared with those on nilotinib. The findings suggest that maintaining high medication adherence is crucial for positive therapeutic outcomes in patients with CML.

Patients with CML in Bulgaria show high medication adherence, likely contributing to their overall quality of life. These findings emphasise the importance of maintaining adherence for optimal treatment outcomes in CML. Future research should explore the factors influencing adherence in this population and assess the role of hospital pharmacists in supporting medication management.

Risk analysis, conducted using the ‘failure modes and effects analysis’ approach, took place in 2024. It focused on the sterile medical devices supply chain within an operating room pharmaceutical unit. A multidisciplinary working group developed a risk map for stock discrepancies in four stages: identification of risks, risk rating based on occurrence and severity, listing of control measures and prioritisation of risks.

The risk analysis identified 52 risks across seven subprocesses, with 10% of these risks classified as priority. These priority risks mainly involved the emergency dispensing of equipment in the operating room, the scheduled provision of medical devices through the preparation of case carts, and the storage of products in the pharmaceutical unit. Key areas for improvement included staff training, enhancing software expertise and strengthening quality assurance.

This study presents the first risk map of stock errors for health products in a hospital setting. This approach is applicable to other supply chains in healthcare. Effective risk management depends on a collective effort and the engagement of all stakeholders. Optimising stock management is critical in enhancing the quality and safety of care provided to patients.

We conducted a multicentre, cross-sectional electronic survey inviting one pharmacy professional response per UK centre providing hepatology pharmacy services. We collated information on workforce, service provision and pharmaceutical care activities provided by pharmacy teams in hepatology specialities.

Seventeen centres responded to this survey, which was composed of five (29%) district general hospitals, two (12%) providing both secondary and tertiary level hepatology services, three (18%) secondary care centres and seven (41%) centres providing tertiary level care. There are a greater number of posts in tertiary level care centres irrespective of inpatient beds covered. Consultant pharmacists were only present in tertiary level care centres. A large portion of pharmacy time is spent on indirect pharmaceutical care, which ranged from 10% to 50%. Overall, 75% of respondents felt that their team’s workload was safe, though this was only 45% in district general hospitals.

Clinical hepatology pharmacy staffing levels vary across the UK. Recognition and benchmarking are key across all levels of care to ensure this workforce remains sustainable given the increasing incidence of liver disease in the UK.

Residual amounts of infusion solutions prepared and administered at the adult intensive care unit were examined for visible and subvisible particles according to the recommendations of the European Pharmacopoeia monographs 2.9.19 and 2.9.20.

Samples from 169 infusion solutions were collected, 149 of which could be analysed. The Pharmacopoeia requirements for visible particles were not fulfilled in 42.9% (n=64/149) of the samples, while the requirements for subvisible particles were not met in 4.7% (n=7/149). A specific correlation between the pharmaceutical drugs or within the infusion set (bottle vs connected infusion line) and particulate contamination was not possible as the sample was too small for a correlation analysis. A Spearman rho analysis showed no correlation between particle contamination and administration mode (subvisible (10 µm): p=0.969, r=–0.005; subvisible (25 µm): p=0.834, r=–0.026; visible: p=0.711, r=–0.047) and particle contamination and dosage form (subvisible (10 µm): p=0.291, r=–0.092; subvisible (25 µm): p=0.513, r=0.057; visible: p=0.415, r=0.071).

This study showed that residuals of intravenously administered solutions have particulate contaminations. A specific causal factor was not identified.

Three bevacizumab 25 mg/mL vials (CT-P16) were stored punctured either light protected at 2–8°C or at 25±2°C for 28 days. Samples were withdrawn on day 0, 1, 7, 14, 21, 28 and analysed by size-exclusion chromatography (SE-HPLC), ion-exchange chromatography (IE-HPLC), and dynamic light scattering (DLS). In parallel, pH values were measured and test vials visually inspected for visible particles and colour changes.

After the 28-day storage period, the quantitative SE-HPLC analysis indicated bevacizumab concentrations above 95% of the initial concentration in each test vial. IE-HPLC analysis revealed no signs of instability. DLS measurements showed no significant variation in the mean hydrodynamic diameter and no appearance of small-sized aggregates. The pH values of all samples remained constant, and no visible particles or colour changes were observed.

CT-P16 25 mg/mL concentrate was found to be physicochemically stable in the original glass vial after first opening for at least 28 days when stored light protected at 2–8°C or at 25±2°C.

Samples were analysed immediately on compounding and then 1, 3, 6, 9 and 12 months after storage at –20°C (immediately after thawing, and also 1 month later keeping the vials at 2–8°C). The assays included a visual examination, measurement of the pH, osmolality, sub-visible particulate contamination, the concentration of PS80, and the concentration of oleic acid and peroxides (both major markers of PS80 degradation). Quantification of PS80 was challenging due to the substance’s molecular heterogeneity and the lack of a good chromophore. The strategy adopted consisted of hydrolysis in a strong base and then liquid-liquid extraction of the oleic acid (PS80’s hydrolysis product). The oleic acid content was determined using reversed phase high performance liquid chromatography with ultraviolet detection. The peroxide content was determined spectrophotometrically using a ferrous oxidation with xylenol orange assay.

Over 12 months, there was no significant change in the samples’ visual appearance, pH and osmolality. The PS80 concentration remained above 90% of the initial value. The subvisible particle counts remained far below the European Pharmacopoeia thresholds. The oleic acid content of the non-hydrolysed samples remained constant, and no peroxide was detected.

A PS80-containing solvent is stable for 1 year when stored at –20°C (±5°C) in amber glass vials. Moreover, the solvent is stable for up to 1 month after thawing if stored at 2–8°C.

This study involved determining the content of CEF, PAN and OND in infusion solutions, NS and 5D under varied temperature conditions, including 2°C to 8°C, 25°C, and 37°C at different time intervals using high performance liquid chromatography, visual description of solution mixture, pH measurement, osmolality, particulate matter (both visible and subvisible), as well as assessing the colour and clarity of the solution (measured by absorbance at 420 nm and % transmittance at 650 nm).

No significant changes were observed in pH, osmolality, particulate matter, colour and clarity of admixture in NS up to 48 hours at all conditions. CEF, PAN and OND retained more than 90% of their initial concentration at 2°C to 8°C for 48 hours, 25°C for 8 hours, and 37°C for 8 hours. Also, no significant changes were observed in pH and osmolality of admixture in 5D up to 48 hours at all conditions. CEF, PAN and OND retained more than 90% of their initial concentration at 2°C to 8°C for 4 hours, 25°C for less than 2 hours, and 37°C for less than 2 hours.

This study concludes that the physicochemical stability of a ternary admixture containing CEF, PAN and OND is diluent and temperature dependent. NS ensures acceptable stability, whereas 5D causes rapid degradation. For safety and efficacy, NS is recommended, with refrigerated storage preferred. Based on physicochemical stability data, the use of this parenteral admixture with 5D is not recommended.