Professor Patricia Ging is the Chief 2 pharmacist for transplant and pulmonary hypertension in the Mater Misericordiae University Hospital. The COVID-19 pandemic has disproportionally affected solid organ transplant recipients and created numerous challenges. During the pandemic she has contributed her expertise at a local, national and international level to guide healthcare staff and empower self-care.

Patricia has risen to the challenge of COVID-19 through her membership of the International Society of Heart and Lung Transplant (ISHLT) COVID–19 advisory group. She is one of two pharmacists on this committee advising specifically on COVID-19 treatment and vaccine strategies. These guidelines are updated regularly and disseminated internationally. Two particular concerns that Patricia addressed were to ensure that transplant patients did not receive experimental COVID-19 treatments known to strongly interact with transplant immunosuppression and providing advice about vaccine efficacy, choice and availability. At a local level, she prepared an information leaflet for organ transplant recipients to answer their questions and concerns.

Ongoing education of transplant patients has had to change due to the pandemic and Patricia was part of the local team who have just redesigned our education materials to help patients adhere to the lifestyle changes following transplant. Her contribution was the redesign of the medication education materials to make them more person-centric.

In August, she was appointed as the incoming chair of the Standards and Guidelines committee of the ISHLT. ISHLT engages in the regular development and update of Professional Practice Guidelines and Consensus Statements to improve the care of patients with advanced heart and/or lung disease. These documents are used internationally to guide on best possible patient care for these patients. Patricia is the first pharmacist to be chosen for this role. She has already organised streamlining of the entire process of document review to make the roles and responsibilities clearer to improve the quality of the finished documents.

Patricia is the pharmacist appointed to the Cystic Fibrosis Post Transplant Model of Care Group for Ireland. This committee are currently finalising recommendations to ensure that the best model is proposed and that appropriate resources are put in place to enable it to be delivered. She has been a passionate advocate for the role of the multidisciplinary team and in particular the benefit to patients from having pharmacist input at all stages of their transplant journey.
She was an invited expert contributor, completing several drug monographs to the recently published “Critical Illness” which presents the latest data on drug handling in critical care to improve drug dosing.

Patricia took the opportunity this year to complete a post graduate course in quality improvement in healthcare and used this learning to lead a multidisciplinary project to change the antibiotic regimen at time of transplant to one which will better cover the organisms seen at this hospital as well as reducing the use of restricted antimicrobials.

The past 12 months have seen continued changes in how healthcare is delivered and how patients access care. Patricia has continued to provide patient facing care to transplant candidates and recipients but has also contributed to improving patient care at a national and international level through impactful work with national and international societies.

Since 2002, Dr. António Melo Gouveia has assumed functions as chief pharmacist at IPO Lisboa, one of the major oncology centres in Portugal. He is involved in management, purchasing and decisions concerning drugs used in the hospital. He also worked as chief pharmacist at the Hospital da Marinha (1989 – 2002). He was a member of the scientific committee of the EAHP and integrated the common training framework for hospital pharmacy.

He was a President of the College of Specialty in Hospital Pharmacy of the Ordem dos Farmacêuticos between 2012 and 2019. He was Head of Division of Medicines and Sanitary Products (1997-2001) at INFARMED. He has been a member of the Medicines Evaluation Committee of INFARMED since 1991. He was a member of the Executive Committee of the Ethics for Clinical Investigation from 2005 to 2011. He is a member of the National Committee of Pharmacy and Therapeutics. He is Vice-President of the Health Technology Assessment Committee at INFARMED.

His role has been fundamental for the introduction of medicines that are not included in the National Form, with the aim of getting the medicine that cancer patients need in the right time. In addition, he has contributed strongly to issuing opinions on the use of medicines, guiding and evaluating their consumption. In keeping with ethical rules, he has helped to save many lives, thanks to his vast knowledge of specific therapeutic options for cancer patients.

He is not only a specialist in Hospital Pharmacy but also in regulatory matters and this multivalence makes him pay special attention to Health Technology Assessment, with particular focus on Economic Assessment, epidemiological studies, and the evolution of the framework regulation in Portugal, putting their knowledge into practice in the daily clinical activity, in a multidisciplinary context. The Portuguese Association of Hospital Pharmacists (APFH) recognizes in Dr. Melo Gouveia the security and stability of a leader that any institution would like to have.

At the political level, he is a defender of the profession and in the last year he has collaborated with APFH in various training actions where he has always stimulated discussion of what he considers to be important for the future of the profession. He is a man of word and actions, values and missions. We recognize his excellence, enormous work for the health of the Portuguese, in an exceptionally difficult year.

This recognition is a vote of confidence and hope that the future of the profession can be illuminated and led by people who are up to it. By people who are not afraid to break the routine for the greater good. Dr. Melo Gouveia is a victory for all Hospital Pharmacists, for having chosen this profession.

He is a man who doesn´t like being under the spotlight but has proof his excellency with his work. That's why it deserves this distinction, so that younger people can have as their reference distinguished pharmacists with exemplary resumes and experience.

Carla Alonso finished her residency in Hospital Pharmacy in May 2020 and is now the responsible for the new Advanced Therapies Unit and works as clinical pharmacist in the Haematology Unit within the Hospital Pharmacy Department in the Vall d’Hebron University Hospital.

Carla works intensively with the Haematology Department collaborating with clinicians, nurses and patients; she visits patients with the Haematology ward and has daily meetings with nurses. She invests her passion, time and effort in improving treatments quality, safety, efficacy and efficiency. Carla participates in the weekly Clinical Meetings for different pathologies including myeloid and lymphoid disease, bone marrow transplant and CART infusion.

Moreover, she is the secretary of the Haematological Advanced Therapies Multidisciplinary Committee that includes haematologist, nurses, neurologists and intensivists. During the last year, Carla has obtained the CART Therapies Specialization Diploma for Hospital Pharmacists and Haematologists (University of Valencia) and Immunotherapy in Clinical Pharmacy (University of Vitoria).

Carla has become the pharmacist of reference for the Haematology Department, is responsible for the training of Hospital Pharmacy residents from the hospital and other centres who visit this unique and innovative unit to complete their education. She has designed a multicentre observational study called “Analysis of mesenchymal cells use for post halogenic stem cell transplant complications in Hospitals in Spain” - this project has been awarded with a competitive research grant from The Spanish Society of Hospital Pharmacy (SEFH).

She is leading this project, which involves a group of 50 Hospital Pharmacists from 12 different hospitals in the country. Moreover, she collaborates with other investigators in research projects, including “Long term safety follow up in patients treated with CART cells in the clinical practice” and “OPTIFLU-CAR-T Study-Optimization of chemolinfodeplective treatment with fludarabin prior to infusion of chimeric antigen receptor (car) t-cell therapy”, which has been awarded with a Spanish Ministry of Health grant.

Carla has created and consolidated the Unit of Pharmaceutical Haematology and Advanced Therapy, she has detected new needs and room for improvement in the management of these highly complex and costly, as well as establish new protocols and workflows to standardize and improve the quality of the Pharmacy Service. The quality of the Unit of Pharmaceutical Haematology and Advanced Therapy has been certified by the ISO 9001. Moreover, Carla has become a referent in Advanced Therapies in the SEFH and is actively involved in educational events and focus groups of experts about her area of expertise.

She is currently leading the creation of a new Advanced Therapies Focus Group within SEFH, in collaboration with the Oncohaematology focus group in the same society. She has published her research about advanced therapies in numerous conferences including EBMT-EHA 4th European CAR T-cell Meeting and 17th Congress of European Chron and Colitis Organization.

In the near future, Carla plans to take the Board Certified Oncology Pharmacist and the Board of Pharmaceutical Specialties in order to enhance her specialization in these areas.

Laura has worked as a clinical pharmacist in the Mater Misericordiae University Hospital (MMUH) for over 5 years and is dedicated to consistently putting the patient at the centre of her work. She has always gone the ‘extra mile’ for patients by enhancing service delivery and pharmaceutical care. Nowhere is this more evident than the crucial role she played in the establishment and development of the newly formed MMUH Frailty Intervention Team (FIT). Laura introduced a number of innovative ideas to enhance the pharmaceutical care of patients reviewed by FIT.

The WHO has reported that improving communication at transition of care is vital to avoiding medication-related harm. Laura used her innovation and forward thinking to get the FIT Pharmacist documentation uploaded on to the hospital electronic healthcare record. One of the main advantages of the electronic documentation is that the best medication history can be ensured through information sharing, i.e. the documentation can be accessed by all healthcare professionals in the hospital at any time.

This electronic support is essential for reducing patient harm caused by medication discrepancies across care transitions. Laura also designed and implemented a patient medication review form which is used to communicate medication changes to the patient’s General Practitioner (GP) and Community Pharmacy on discharge to support a seamless transition of care. Since the COVID-19 pandemic legislation has been implemented in Ireland to facilitate the safe supply of medicines.

This includes the introduction of the electronic transfer of prescriptions via an approved Health Service Executive Healthmail® system. Laura has utilised this system to transfer the medication review form to the patients’ GP and community pharmacy. Frail patients are transferred home, to acute wards or off site facilities with a documented pharmaceutical plan, ensuring appropriate and efficient handover of care without error or duplication, mitigating against adverse outcomes.

Laura also developed a podcast to facilitate education of polypharmacy and medication management in the Emergency Department. This information helps to strengthen clinical communication between acute and primary care resulting in improved patient outcomes. The podcast is available for free on Soundcloud and Twitter.

Laura’s development of the FIT pharmacist role follows on from her recent MSc in Hospital Pharmacy research project where Laura developed a high quality educational video for patients on how to manage their medicines on discharge from hospital. The video has the potential to drive patient education forward and to promote communication, comprehension and decision making for patients.

The video is currently playing on the television monitors around the hospital and it is available on the MMUH website www.mater.ie. The video is not specific to the MMUH patient cohort and the Health Information Quality Authority (HIQA) in Ireland have shared the video on their social media platforms. This project is undoubtedly innovative in service delivery as there is no educational video on medication management available to patients for free in the Irish Healthcare Service. It is evident from these examples that Laura has shown a dedication and commitment to enhancing service delivery and pharmaceutical care. She has always gone the ‘extra mile’ to improve patient care and outcomes.

During 2020 and 2021 the Pharmacy Cancer Services Team has led and transformed the processes used for the delivery of cancer therapy within St. Vincent's Private hospital:

Introduction of BD CATO:

• electronic prescribing
• electronic processes for aseptic compounding preparations
• bar code administration of chemotherapy

This project required also the replacement and validation of 2 Isolators.

During this time the Challenge of COVID-19 pandemic could have derailed the ambitious plans but the team of pharmacists and technicians kept pushing forward during this time.

The overall duration of project spanned over 13 months, an overrun of only 4 months considering the unprecedented times and challenges during which it took place.

Turn-around and waiting times

• 83.7% vs 89.3% (before vs after) of Items released from ACU within 60 min of patient go-ahead.
• 78.7% Administered within 90mins after implementation (not measurable before).

Medication Safety

An audit on prescriptions errors before and after implementation was also carried out. All parenteral chemotherapy prescriptions were reviewed during the defined audit period.

A 4.7% reduction in prescribing errors was found. At least 1 error was found in 34.4% of handwritten prescriptions compared with 29.7% of electronic prescriptions.

Going forward, the next optimisation of the system will consist of the introduction of gravimetric compounding of IV SACT.

A re-audit of prescriptions errors will be conducted in Feb 2022 to assess the impact of system after the bedding in period after the change.

Outcomes

• All patients’ prescriptions are now electronic (see attached example of patient history).
• Decision support in place for prescribing (e.g. Zoledronic Acid).
• All requirements for calculation of doses can be entered into CATO e.g. Height, Weight, Creatinine. Lab values are automatically transferred from the lab system to CATO using an interface.
• All compounding of IV SACT now completed using CATO which is electronically recorded.
• Barcode administration of IV SACT implemented. The use of the Readymed device has allowed for a change from a 2 person check to a 1 person check creating efficiencies for the nursing staff.
• Improved management of Oral Chemotherapy with all High Tech prescriptions scanned to the patient folder and comments on the patient’s therapy plan when dose changes occur. This has improved patient safety in prescribing these medications.
• Improved ability to track the patient journey as can monitor time from “go-ahead” to chemotherapy release from the ACU to administration. This will be monitored monthly with targets set as key performance indicators.
• Direct communication from the ward to the ACU relating to out of range blood results using the comments improving efficiency.
• Reduction on prescriptions errors.