UNASSIGNED: Pharmacy services in hospitals are designed to meet the needs of all patients. This is undoubtedly one of the most complex services provided by hospitals. In government hospitals, including those in Ethiopia, pharmacies mainly serve as drug stores and dispensaries. To the best of our knowledge, this study is the first to assess and ensure better quality assurance for hospital pharmacy services in Ethiopia. Therefore, the objective of this article was to assess the current status of the quality assurance of pharmacy services in hospitals.
UNASSIGNED: A cross-sectional survey was conducted. The data were collected from hospital pharmacy heads using the Kobo Collect mobile application and then exported to the Statistical Package for Social Science (SPSS) version 25 for analysis. Descriptive statistics for categorical variables are presented as percentages and frequencies.
UNASSIGNED: All (100%) of the studied hospital pharmacies had a qualified pharmacy director and worked in the pharmacy full-time. Only 40% had a drug information center and a functional drug formulary committee. All pharmacies had their own disposal facilities but did not regularly dispose of expired or unfit medications. The results revealed that all hospital pharmacies did not have a responsible body delegated for quality evaluation.
UNASSIGNED: The findings of this study clearly show that quality assurance services in hospital pharmacies are compromised. The findings can be used to identify areas of improvement and develop strategies to enhance the quality of hospital pharmacy services.

Background and objective Drugs that act on the central nervous system have a high potential to cause drug-related problems (DRPs). A clinical pharmacist aided by collaborative efforts within an interdisciplinary healthcare team can prevent, detect, and resolve DRPs, thereby contributing to the promotion of medication safety and improving the quality of life of individuals under care. This study aimed to assess DRPs identified in the neurology ward of a tertiary hospital from February 2016 to November 2019. Methods This was a descriptive study with a cross-sectional and retrospective design involving secondary data collected from pharmaceutical care (PC) records. Student\'s t-tests, Pearson correlation coefficients, Poisson models, and logistic regression models were used to analyze the associations between age, number and type of medications, duration of hospitalization, and the occurrence of DRPs. Results A total of 130 patients were included in the study, and a total of 266 DRPs were detected, with 93 patients experiencing more than one DRP and 37 not presenting any DRPs. Necessity-related DRPs were the most prevalent (46.6%) type, followed by safety-related DRPs (28.6%). The prevalence of safety-related DRPs was higher in individuals older than 60 years (p<0.001). Conclusions Of note, 84.6% of the interventions suggested by pharmacists to resolve DRPs were accepted by the healthcare team. The high number of DRPs found underscores the importance of the clinical role of the pharmacist and interprofessional collaboration in the care of neurological patients, especially in the pharmaceutical follow-up of elderly individuals.

Drug information (DI) provided by hospital pharmacies aims to promote rational and safe drug therapy. While quality assessment for this task is recommended, more knowledge on the factors determining the quality is needed. We aimed to evaluate the impacts of different factors on the quality of DI provided by hospital pharmacies to healthcare professionals. Retrospectively, answers on fictitious enquiries about annual DI tests for German hospital pharmacies over five years were evaluated for content-related and structural requirements. Multivariate analysis was performed for the impact of the enquiry complexity, DI organization (specialized DI center; pharmacist responsible per day; DI on top of other routine tasks), and quality measures (second look; experience of answering pharmacist in DI/on ward; use of documentation database). In 2017-2021, 45, 71, 79, 118, and 122 hospital pharmacies participated. The enquiry complexity had a statistically significant impact on the content-related quality, with poor results for a higher complexity (years 2018/2021, OR 0.25/0.04, p < 0.01). The DI centers achieved better results regarding content-related quality than for a pharmacist responsible per day (OR 0.76/p = 0.65) or DI on top of routine tasks (OR 0.35/p = 0.02). The DI centers scored better in structural quality. The second look showed an overall trend of a better content-related and structural quality. In conclusion, specialized DI centers and second looks are recommended as quality-improving measures. Training for answering complex enquiries should be intensified.

UNASSIGNED: To describe the experience of a dispensing model of outpatient hospital medicines (OHM) via collaboration of hospital and community pharmacies, and to explore patient satisfaction with the strategy as compared with the hospital pharmacy only service.
UNASSIGNED: Patient satisfaction is an important component of the quality of health care.
UNASSIGNED: A new model of dispensing OHM was conducted in the Outpatients Unit of the Service of Hospital Pharmacy of Hospital del Mar, in Barcelona, Spain. Participants were patients on stable chronic treatment with clinical or social fragility, immunocompromised patients, and those whose residence was located at a distance from the hospital that justified drug delivery through the community pharmacy. A cross sectional study was done using an ad hoc 14-item questionnaire collecting demographic data, duration of treatment, usual mode of collecting medication, and the degree of satisfaction regarding waiting time for the collection of medication, attention received by professionals, information received on treatment, and confidentiality.
UNASSIGNED: The study population included a total of 4,057 patients (66.8% men) with a mean age of 53 (15.5) years, of whom 1,286 responded, with a response rate of 31.7%. Variables significantly associated with response to the survey were age over 44 years, particularly the age segment of 55-64 years (odds ratio [OR] 2.51) and receiving OHM via the community pharmacy (OR 12.76). Patients in the community pharmacy group (n = 927) as compared with those in the hospital pharmacy group (n = 359) showed significantly higher percentages of \'satisfied\' and \'very satisfied\' (p < 0.001) in the waiting time for the collection of OHM (88.1% vs. 66%), attention received by professionals (92.5% vs. 86.1%), and information received on treatment (79.4% vs. 77.4%). In relation to confidentiality, results obtained were similar in both pharmacy settings.
UNASSIGNED: Dispensing OHM through the community pharmacy was a strategy associated with greater patient satisfaction as compared with OHM collection at the hospital pharmacy service, with greater accessibility, mainly due to close distance to the patient\'s home. The participation of community pharmacists could further optimize the care received by patients undergoing OHM treatment.

Liposomal amphotericin B (Ambisome®) is the gold standard for the treatment and prevention of fungal infections both in the adult and pediatric populations. The lyophilized dosage form has to be reconstituted and diluted by hospital staff, but its management can be challenging due to the spontaneous tendency of amphotericin B to form aggregates with different biological activity. In this study, the colloidal stability of the liposomes and the chemical stability of amphotericin B were investigated over time at storage conditions. Three liposomal formulations of amphotericin B at 4.0 mg/mL, 2.0 mg/mL, and 0.2 mg/mL were prepared and assayed for changes regarding the dimensional distribution, zeta potential, drug aggregation state, and onset of by-products. Our analyses highlighted that the most diluted formulation, kept at room temperature, showed the greatest changes in the aggregation state of the drug and accordingly the highest cytotoxicity. These findings are clinically relevant since the lower dosages are addressed to the more vulnerable patients. Therefore, the centralization of the dilution of AmBisome® at the pharmacy is of fundamental importance for assuring patient safety, and at the same time for reducing medication waste, as we demonstrated using the cost-saving analysis of drug expense per therapy carried out at the G. Gaslini children hospital.

(1) Background: As part of the Scottish Government\'s five-year recovery plan to address the backlog in NHS care following the COVID-19 pandemic, community pharmacies in Scotland are planned to provide a Hospital Discharge Medicines Supply and Medicines Reconciliation Service. We aimed to qualitatively explore patients\' experiences with this new service. (2) Method: Adult patients (≥18 years age) who consented to participate in the Community Pharmacy Hospital Discharge and Medicines Reconciliation Service were invited for an interview within 21 days of discharge from hospital. Qualitative, one-to-one, semi-structured patient interviews were conducted by telephone and audio-recorded using Microsoft Teams®. The interview audio recordings were transcribed verbatim and underwent thematic analysis. (3) Results: Twelve patients were interviewed, evenly split by sex and with a median age of 62 years (range 36 to 88 years). Our analysis generated main five themes: patient engagement, stakeholder communication, practical factors, human factors, and comparative experiences. Many of these were interdependent. (4) Conclusions: Patients appreciated that the service ensured a quicker discharge from hospital. Good stakeholder communication, practical factors (including choice, location, and the realities of obtaining their medication from the community pharmacy), and a pre-existing and trusted relationship in their usual community pharmacy were the key factors that regulated the patient experience. Generally, patients were positive about the introduction of this new service. However, the lack of a previous relationship or trust with a community pharmacy, and previous experiences with medication supply problems were factors which had the potential to negatively impact patient experiences.

Background Hospital pharmacy departments have a critical role in the healthcare system, as they aim to provide excellent patient services while also ensuring cost-effectiveness. Lean methodologies are well-known for improving efficiency and quality in various industries, but their impact on healthcare, particularly in hospital pharmacy settings, has not been thoroughly investigated. Aim This quality improvement (QI) study aimed to assess the impact of implementing the sort, set in order, shine, standardize, and sustain (5S) methodology using the innovative orientation, coordination, training, awareness, governance, observation, normalization, and promotion (OCTAGON-P) framework on the operations of Mediclinic Parkview Hospital (MPAR) Pharmacy in Dubai, UAE. Methods The QI project spanned a period of six weeks, from December 18th, 2023, to January 28th, 2024. Throughout this period, a new novel OCTAGON-P framework\'s eight crucial elements were methodically integrated. Simultaneously, an extensive preparation process encompassing the five stages of the 5S method was carried out. Results The findings indicated a notable enhancement in organization, orderliness, cleanliness, medication storage, and workspace standardization. The significant improvement of 217% in terms of organization highlighted the effectiveness of resource arrangement. The orderliness of the workspace saw an increase of 800%, indicating a transformation in the systematic organization. Additionally, cleanliness improved by 138%, demonstrating a significant advancement in maintaining a spotless environment. The standardization of processes experienced a boost of 300%, reflecting a solidified approach to consistent operational methods. These refinements resulted in an overall improvement of 90% from the initial baseline of 20% on the 5S checklist scores. Efficiency gains were observed, with outpatient medication retrieval times reduced by 50%, inpatient times by 40%, emergency prescription serving by 16.7%, and pediatric prescription serving by 11%. The inpatient medication return process saw a 67% improvement. Patient counseling time increased by 23.3%, indicating a more patient-centered approach. Prescription verification and medication expiry checks increased by 50% and 200%, respectively, enhancing the quality of care. Inventory management efficiency improved by 36%, and medication label printing time decreased by 70% with the additional label printers. Installing extra medication label printers was done through the OCTAGON-P framework, specifically in the \"orientation\" and \"coordination\" phases. These two initial phases focused on leadership\'s 5S orientation, management support, and securing additional resources. Therefore, the OCTAGON-P framework provided a structured approach that promoted continuous improvement and sustained lean practices. Conclusion This research study presented the remarkable effectiveness of the OCTAGON-P framework in structurally implementing the 5S methodology into hospital pharmacy operations. The findings underscored the potential of lean 5S to enhance and optimize operational efficiency and overall quality within the critical environment of hospital pharmacy settings. Consequently, these improvements can conclusively result in the provision of superior and enhanced patient care, which is truly fundamental and central to the mission and objectives of any healthcare institution.

UNASSIGNED: Expansion of the scope of pharmacists\' activities in hospital is associated with reductions in adverse events and drug-related readmissions. However, the breadth of hospital pharmacists\' clinical activities varies widely across Ontario due to provisions in the provincial Public Hospitals Act. Few data exist defining expanded scope in institutions across Ontario.
UNASSIGNED: The primary objective was to describe the scope of practice of hospital pharmacists in Ontario who were undertaking expanded clinical activities based on policies or medical directives. The secondary objectives included determining benefits, limitations, facilitators, and barriers associated with implementing these activities.
UNASSIGNED: A survey was sent to the pharmacy leadership of Groups A and B public hospitals across Ontario. The survey contained quantitative and qualitative questions focused on 3 domains of expanded-scope activities: adaptation, discontinuation, and renewal of medication orders; prescriptive authority; and drug monitoring.
UNASSIGNED: Of 56 hospitals invited, 46 (82%) submitted a survey response, with 1 exclusion (due to no response on some mandatory questions). The most common expanded-scope activity was independent performance of therapeutic drug monitoring (71%, 32/45). Pharmacists had the authority to independently adapt, discontinue, or renew inpatient medication orders in 60% (27/45) of hospitals, and could independently initiate medication orders in 20% (9/45). Barriers to implementing expanded-scope activities included limited time and staffing. Facilitators included proactive leadership, demonstrated clinical value, and strong rapport with other health care providers.
UNASSIGNED: Many institutions in Ontario have established polices to expand pharmacists\' clinical activities, but there is a great deal of variability in scope of practice. Advocacy at the provincial level to unify scope of practice will help to optimize patient outcomes.
UNASSIGNED: L’expansion du champ d’activité des pharmaciens à l’hôpital est associée à une réduction des événements indésirables et des réadmissions liées aux médicaments. Cependant, l’étendue des activités cliniques des pharmaciens d’hôpitaux en Ontario varie considérablement en raison des dispositions de la Loi sur les hôpitaux publics de l’Ontario. Il existe peu de données définissant une portée élargie dans les établissements de l’Ontario.
UNASSIGNED: L’objectif principal consistait à décrire le champ d’exercice des pharmaciens d’hôpitaux en Ontario qui entreprenaient des activités cliniques élargies en fonction de politiques ou de directives médicales. Les objectifs secondaires comprenaient la définition des avantages, des limites, des facilitateurs et des obstacles associés à la mise en œuvre de ces activités.
UNASSIGNED: Un sondage a été envoyé aux responsables des pharmacies des hôpitaux publics des groupes A et B de l’Ontario. Il comprenait des questions quantitatives et qualitatives axées sur 3 domaines d’activités liés à une portée élargie: l’adaptation, l’interruption et le renouvellement des ordonnances de médicaments; le pouvoir prescriptif; et la surveillance des médicaments.
UNASSIGNED: Sur 56 hôpitaux invités, 46 (82 %) ont soumis une réponse au sondage, avec 1 exclusion (en raison de l’absence de réponse à certaines questions obligatoires). L’activité à portée élargie la plus courante était la réalisation indépendante de la surveillance thérapeutique des médicaments (32/45, 71 %). Les pharmaciens avaient la capacité d’adapter, d’interrompre ou de renouveler de manière indépendante les ordonnances de médicaments pour les patients hospitalisés dans 60 % (27/45) des hôpitaux, et pouvaient les initier de manière indépendante dans 20 % (9/45) des hôpitaux. Les obstacles à la mise en œuvre d’activités à portée élargie comprenaient le manque de temps et de personnel. Les éléments facilitant la mise en œuvre d’activités à portée élargie comprenaient le leadership proactif, la valeur clinique démontrée et les relations solides avec les autres prestataires de soins de santé.
UNASSIGNED: De nombreux établissements en Ontario ont établi des politiques liées à l’expansion des activités cliniques des pharmaciens, mais il existe une grande variabilité dans le champ d’exercice. Le plaidoyer au niveau provincial pour unifier le champ de pratique contribuera à optimiser les résultats pour les patients.

Biopharmaceuticals are complex biological molecules that require careful storage and handling to ensure medication integrity. In this study, a work system analysis of real-world protein drug (PD) handling was performed with the following goals: identify main barriers and facilitators for successful adherence to accepted recommendations in PD handling, analyse differences in two organizations, and define a Best Current Practice in the real-life handling of PDs based on the results of the work system analysis. Observational study was held in two university hospitals in Spain and Sweden. Based on the Systems Engineering Initiative for Patient Safety (SEIPS) model, the tools chosen were: the PETT scan, in order to indicate the presence of barriers or facilitators for the PETT components (People, Environment, Tools, Tasks); the Tasks and tools matrices to construct a checklist to record direct observations during the real-life handling of biopharmaceuticals, and the Journey map to depict the work process. Observations were performed between March and November 2022. Each episode of direct observation included a single protein drug in some point of the supply chain and considered all the elements in the work system. Based on the results of the work system analysis and the literature review, the authors propose a list of items which could be assumed as Best Current Practice for PDs handling in hospitals. There were a total of 34 observations involving 19 PDs. Regarding People involved in the work process, there was a diversity of professionals with different previous training and knowledge, leading to an information gap. With respect to Environment, some structural and organizational differences between hospitals lead to risks related to the time exposure of PDs to room temperature and mechanical stress. Some differences also existed in the Tools and Tasks involved in the process, being especially relevant to the lack of compatibility information of PDs with new technologies, such as pneumatic tube system, robotic reconstitution, or closed-system transfer devices. Finally, 15 suggestions for best current practice are proposed. Main barriers found for compliance with accepted recommendations were related to the information gap detected in professionals involved in the handling of protein drugs, unmonitored temperature, and the lack of compatibility information of protein drugs with some new technologies. By applying a Human Factors and Systems Engineering Approach, the comparison of two European hospitals has led to a suggested list of Best Current Practices in the handling of protein drugs in a hospital.

UNASSIGNED: Medication-related problems are a top concern of clinical pharmacists. Medication-related problems can cause patient harm and increase the number of visits, hospital admissions, and length of hospital stay. The objective was to assess clinical pharmacy medication-related problem-related interventions in a tertiary care setting.
UNASSIGNED: A retrospective cohort study was conducted at King Fahad Armed Forces Hospital in Jeddah (Saudi Arabia) between June 2021 and June 2022. The data were extracted monthly from a new web-based Microsoft Excel application documenting medication-related problems during any stage of the medication use process.
UNASSIGNED: A total of 5310 medication-related problem-related interventions in 1494 patients were performed. The departments associated with the highest frequency of medication-related problem-related interventions were the critical care unit (26.9%), intensive care unit (23.8%), anticoagulation clinic (17.1%), medical ward (11.3%), and nephrology unit (6.8%). The most common type of medication-related problem-related interventions included inappropriate dosage regimens (25.6%), monitoring drug effect or therapeutic drug monitoring (24.4%), requirement of additional drug therapy (21.9%), and inappropriate drug selection (14.1%). The proposed interventions were accepted by physicians in 97% of the incidents. The most frequent medication classes associated with medication-related problem-related interventions were cardiovascular agents (47.6%), antimicrobial agents (27.2%), and nutrition and blood substitute agents (11.4%). The most frequent medication groups associated with medication-related problem-related interventions were anticoagulants (25.6%) and antibiotics (25.2%).
UNASSIGNED: The current findings characterize the medication-related problem-related interventions addressed in clinical pharmacy at a tertiary care setting. The high rate of physician acceptance emphasizes the integral patient safety role of clinical pharmacy services.