Medication Safety programs: a tale of three cities

Linda V. Graudins

BPharm, DipHospPharm, PostGradDipPharmacoepid, FSHP, FANZCAP (MedSafety)

[Pharmacy GRIT article no: 20261425; published online 20 March 2026]

The AdPha Medication Safety Standards1 are now published, featured in a special issue and released as the first issue of the Journal of Pharmacy Practice and Research (JPPR)’s 60th anniversary year.

The Medication Safety Leadership Committee is proud of the Standards being a framework for supporting pharmacists and their medication safety collaborators to advance safer healthcare. As a Medication Safety pharmacist, my commitment and interest in medication safety doesn’t stop at the end of the workday, so I was sure to plan visits to colleagues during my recent long service leave.

In 2025, I had the privilege of living in Europe and while there, I took the opportunity to connect with pharmacists in Paris, London, and Rīga to discuss medication safety and investigate what was a priority for pharmacists and their departments in each city. Did we speak the same safety language? In what were pharmacy clinicians interested? What have they implemented to improve safety?

What follows is my interpretation of our meetings.

Paris: ensuring safe supply

My first visit was in Paris where I met Dr Clement Delage and Professor Olivier Bourdon at Hôpital Lariboisière, Fernand-Widal. The 1000+ bed hospital was built in 1854 following the Paris cholera pandemic and is situated near the infamous Gare du Nord district. Accordingly, it has a renowned clinical toxicology unit, and a separate psychiatry facility. As a teaching hospital, it also has many other specialty clinical units. A new hospital, Nouveau Lariboisière, is currently under construction, to be opened in 2026. Clement and Olivier are clinical pharmacists at the hospital and lecturers at the Unité pédagogique de Pharmacologie – Faculté de Pharmacie de Paris [Faculty of Pharmacy, City of Paris University].

Pictured: Linda Graudins (left), Dr Clement Delage (middle), Professor Olivier Bourdon (right) at Hôpital Lariboisière, Fernand-Widal with distribution machines.

Pharmacies in French hospitals manage not only medicines distribution, but also medical instruments, gases, and even blood products. Although we ventured to a small outpatient’s area and I was shown where the clinical pharmacists check patients’ pathology and medicines lists on their computers, discussions with Clement and Olivier mostly occurred amongst the pharmaceutical distribution machines, reflecting the emphasis placed on medicines supply. To ensure supply efficiencies and safe product selection Lariboisière pharmacies have automated pharmaceutical distribution machines in both dispensaries.

When asked what is expected beyond supply, I was sent the Good Practices for Hospital Pharmacy (Bonnes Pratiques pour la Pharmacie Hospitalière).2 The document is a set of standards intended to ensure the quality, safety, and efficiency of pharmacy services within hospitals. However, it has not been updated since 2001 and doesn’t mention ‘medication safety’.  Instead, the quality of products, storage, and supply is emphasised. Hospital pharmacists are expected to oversee and review the quality of sterile medications, products for monitoring therapy, and medical devices. Technicians do the majority of dispensing and distribution.  I was interested in the pharmacists’ clinical work, which include performing medication reviews, developing personalised pharmaceutical plans, conducting pharmaceutical interviews, undertaking education activities with patients, and monitoring therapy.

Pictured: Toxicologists Professor Bruno Megarbane (left), Professor Andis Graudins (right), Linda Graudins (middle) at the Chapel of Lariboisière Hospital.

I asked Clement to send me some of his medication safety-related publications. He selected papers on optimising psychotropic pharmacotherapy by genetic phenotyping,3 game-based learning for pharmacology education,4 and pharmacist-led educational intervention on clinical outcomes in patients with hypertension, type 2 diabetes and hypercholesterolaemia.5

The UK: broad scope of activity

Moving on from French pharmacy, it was apparent that medication safety programs in the UK have very similar priorities to ours in Australia. Unlike the varying databases available in Australia (e.g. PBS, SafeScript, My Health Record), researchers in the UK have access to large, linked databases, such as the ’Medicines in acute and chronic care in Scotland’ resource, enabling linkage of medicines use with patient outcomes.6

In Birmingham, I attended the Medicines Driver Programme — Acute & Chronic Care — Conference 2025, held at Birmingham University. The conference was chaired by renowned pharmacovigilance and medicines safety expert, Professor Sir Munir Pirmohamed, and offered a fascinating look at how both patient outcomes and evidence of medicines safety are being measured using large, linked health databases referred to as Research Driver Programmes.7

Health Data Research UK (HDR UK), the national institute for health data science, aims to improve the safe use of health data between institutions to improve patient care and safety.8 HDR UK comprises a network of researchers,9 working across 31 locations. Research projects are many and varied such as linking the increase in soft drink levies to decreasing admissions for childhood asthma,10 and the effect of anticonvulsant use during pregnancy on infant outcomes. Professor Marion Bennie, a research pharmacist from the University of Strathclyde, Glasgow and principal investigator for the HDR-UK Health Driver Programme, presented her group’s recent findings, which are now published.11

My next stop in the UK was the safety program at London’s  Guy's and St Thomas' NHS Foundation Trust, a network of five hospitals in central London. I met Dr Virginia Aguado Lorenzo and Dr Alice Oborne, — two medication safety senior pharmacists — in their meeting room. Virginia and Alice explained their 2025 priorities including injectable medicines and extravasation, dose omissions, wrong dose incidents, anticoagulants, insulins, and opioids. Their July 2025 Medicines Safety bulletin outlined the safe use of prolonged release opioids.12

Pictured: Linda Graudins (left), Dr Virginia Aguado Lorenzo (middle), Dr Alice Oborne (right) at Guy’s and St Thomas’ NHS Foundation Trust.

Of particular interest was Virginia’s innovative position as the Safety Injectable Medicines Senior Pharmacist; a position established after investigation of serious incidents involving IV medications. Virginia is now the go-to pharmacist for all injectable medicines’ guidelines, procurement of pumps and related devices, implementing standard concentrations for continuous infusions, such as milrinone and clonidine, and providing reports to medication safety committees.13 I was invited to attend their Pharmacy Incident Review and Shared Learning Committee (PIRSLC) Zoom meeting. The multidisciplinary discussion closely reflected our network ‘s medication safety committee. However, in contrast to a central governance review of incidents, each clinical team reviewed and presented their own reports. At this meeting learnings were discussed resulting from investigations of several incidents by the renal and maternity teams.

Unlike European health services, the NHS provides resources to support medication safety programs, such as The Patient Safety Incident Response Framework (PSIRF). The PSIRF aims to promote a “significant cultural shift towards systematic patient safety management” by providing a data driven approach to incident response.14

Pictured: Dr Bianca Levkovic and colleagues at King's College, London.

At King’s College Hospital Kalika Puri and Dr Bianca Levkovic discussed their current project, which is investigating ways to decrease the risk of patient harm from omitted medications,15 a long-standing safety issue in the UK as it is in Australia.16 They have instigated a series of “Tea trolley teaching” moments to encourage face to face communication with ward staff about safety issues, such as medicines supply and use of Omnicell automated dispensing machines.

Latvia: struggling to expand clinical pharmacy

The final stop on my medication safety city tale was Rīga, the capital of Latvia. With a small population — 1.7 million people — Latvia supports two pharmacy faculties, the Rīga Stradins University (RSU) and the University of Latvia, each providing four-year courses in Latvian or English. Hospital pharmacists are members of the Pharmacists Society of Latvia [Latvijas Farmaceitu Biedrība] and in 2024, a subgroup was established for Clinical, hospital and oncology pharmacists. Clinical pharmacists have gained a master’s degree at RSU,17 yet receive little additional remuneration.

Pictured: Rīgas Austrumu klīniskā universitātes slimnīca (RAKUS), Latvia's second largest hospital.

During recent renovations at the Rīgas Austrumu klīniskā universitātes slimnīca (Rīga East Clinical University Hospital) (RAKUS), Mrs Laila Eglīte, the Director of Pharmacy, insisted that the pharmacy department have their own three storey building. Impressive! Two stories are dedicated to storing and distributing pharmaceuticals to the 1000+ bed hospital network. The third storey contains offices and an expansive staff area. Little manufacturing is carried out here, apart from supplying oncology therapy. Up to 300 chemotherapy products are prepared daily by three pharmacists and a technician, using the latest Scandinavian robotic equipment.  

Pictured: RAKUS oncology preparation suite.

However, in contrast to Australian practice, hospital pharmacists do not visit inpatients and do not dispense individual patient prescriptions. On discharge, prescriptions are given to patients to have dispensed at community pharmacies or more commonly, patients need to see their GPs for further prescriptions. This practice often results in delays in therapy and therapy disruption on discharge. The hospital’s only clinical pharmacist — attached to the Department of Pulmonology — is employed part-time in a research role. However, the issue is larger than lack of staff or resources, as by law, hospital pharmacies are not permitted to dispense prescriptions for individual patients.

As clinical pharmacists are still struggling with recognition of their skills, medication safety is a stretch target and there is no coordinated activity, undergraduate education, or national Latvian standards in medication safety. However, when presenting at the hospital’s grand rounds, I was pleased to see a packed hall with doctors, nurses and pharmacists, all interested in the topic; “Risk reduction – for medication and patient safety”. Questions after the presentation reflected the state of play: a pulmonologist asked, “I couldn’t find the specific drug interaction in Google, who do I ask?” and a nurse enquired “Can I cut a tablet in half, do I keep the other half?” After the meeting, I met with six clinical pharmacists attending from other hospitals and promised to keep in touch.

Pictured: Clinical pharmacists attending medication safety lecture at RAKUS.

For Dr Inese Sviestina, the clinical pharmacist at Rīga’s Children’s Clinical University Hospital, her days are busy, stretched between hospital rounds, antibiotic stewardship, and teaching at RSU. Inese is also interested in the reasons behind the gaps in medication incident management in Latvia. Her paper highlights the struggle in changing negative attitudes due to punitive culture from error reporting, still lingering from the times of Soviet occupation, which ended in the 1990s.18

An illustration of the existing punitive culture was recently reported in the Latvian media. In November 2025, an oncology patient being treated at the Children’s Hospital was given the wrong medication, resulting in the child's death. Although no further information about the causes of the error have been published, a news report quoted a State Police representative as saying "the State Police initiated criminal proceedings under Chapter 13 of the Criminal Law, namely, for criminal offences against a person's health”.19

Support for hospital pharmacists in Latvia and 36 other member countries, comes from the European Association of Hospital Pharmacists (EAHP). Their annual meeting showcases medication safety projects, they provide networking and professional exchange visits to facilitate European collaborations, and they undertake benchmarking surveys, including aspects of medication safety such as prescription review, medication reconciliation and multidisciplinary teamwork.20 Apart from the UK, coordinated programs in other member countries are in their infancy. The European Statements of Hospital Pharmacy,21 are not legally binding but give recommendations regarding hospital pharmacy practices across Europe.

Medication safety: ‘the best of times’ in Australia

Reflecting on this ’tale of three cities’ and the hospital pharmacy community; we speak different languages and key priorities vary, yet we are united in having common medication safety goals.

In Australia, we are fortunate that medication safety has a prominent place in healthcare, included in both accreditation21 and AdPha updated Standards.1

I will be sharing AdPha’s new Medication Safety Standards with my overseas colleagues in 2026, to highlight the best of times in Australian medication safety.

References

  1. Howell T, Ewing W, Fitzgerald C, Fitzsimons K, Giles C, Graudins L, et al. Advanced Pharmacy Australia medication safety standards. J Pharm Pract Res 2026; 56: 126–143.
  2. Direction de L’Hospitalisation et de L’Organisation des Soins. Bonnes pratiques de pharmacie hospitaliere. Paris: Ministere de L’Emploi et de la Solidraite; 2001. Available from https://www.omedit-centre.fr/Formationnouveauxarrivants_web_gen_web/res/BPPH.pdf. Accessed 24 February 2026.
  3. Darnaud L, Delage C, Daali Y, Trouvin A-P, Perrot S, Khoudour N, et al. Phenotyping indices of CYP450 and P-Glycoprotein in human volunteers and in patients treated with painkillers or psychotropic drugs. Pharmaceutics 2023; 15: 979.
  4. Delage C, Palayer M, Lerouet D, Besson VC. "Pharmacotrophy": a playful tournament for game- and team-based learning in pharmacology education — assessing its impact on students' performance. BMC Med Educ 2024; 24: 219.
  5. Delage C, Lelong H, Brion F, Blacher J. Effect of a pharmacist-led educational intervention on clinical outcomes: a randomised controlled study in patients with hypertension, type 2 diabetes and hypercholesterolaemia. Eur J Hosp Pharm 2021; 28 (Suppl 2): e197–e202.
  6. Goswami C, Mueller T, Ferguson E, Pearson E, Bedair K, Bennie K, et al. Medicines in acute and chronic care in Scotland (MACCS): a new research data resource [abstract]. European Drug Utilization Research Group Conference 2025 (EuroDRUG); 1–4 July 2025, Upssala, Sweden; 2025.
  7. Health Data Research UK (HDR UK). Research driver programmes. London: HDR UK; 2026. Available from https://www.hdruk.ac.uk/research/research-driver-programmes/. Accessed 16 February 2026.
  8. Health Data Research UK (HDR UK). Medicines in acute and chronic care. London: HDR UK; 2026. Available from https://www.hdruk.ac.uk/research/research-driver-programmes/medicines-in-acute-and-chronic-care/. Accessed 2 March 2026.
  9. Health Data Research UK (HDR UK). Research projects. London: HDR UK; 2026. Available from https://www.hdruk.ac.uk/research/projects/. Accessed 16 February 2026.
  10. Rogers NT, Cummins S, Jones CP, Mytton OT, Roberts CH, Shaheen SO, et al. The UK Soft Drinks Industry Levy and childhood hospital admissions for asthma in England. Nat Commun 2024; 15: 4934.
  11. Moore E, Millar M, Merrick R, Mueller T, Stark V, Jarvis L, et al. Pregnancy, baby, and childhood outcomes from using anti-seizure medication during pregnancy. Commun Med (Lond) 2025; 6: 28.
  12. Pharmaceutical Sciences Clinical Academic Group. Medicines safety bulletin: July 2025. London: King’s Health Partners; 2025. Available from https://www.kcl.ac.uk/scps/assets/khp-meds-safety-bulletin-july-2025.pdf. Accessed 17 February 2026.
  13. Aguado Lorenzo V, Jones MD. Evaluation of NHS Injectable Medicines Guide users’ information needs related to the co-infusion of intravenous medicines: user survey and Delphi consensus study. BMJ Open 2025; 15: e094211.
  14. National Health Service (NHS). Patient safety incident response framework [updated 23 September 2025]. London: NHS England; 2022. Available from https://www.england.nhs.uk/long-read/patient-safety-incident-response-framework/. Accessed 17 February 2026.
  15. Health Services Safety Investigations Body (HSSIB). Medication not given: anticoagulation before and after a procedure. Dorset: HSSIB; 2025. Available from https://www.hssib.org.uk/patient-safety-investigations/medication-related-harm/second-investigation-report/pdf/. Accessed 2 March 2026.
  16. Graudins LV, Ingram C, Smith BT, Ewing WJ, Vandevreede M. Multicentre study to develop a medication safety package for decreasing inpatient harm from omission of time–critical medications. Int J Qual Health Care 2015; 27: 67–74.
  17. Muceniece R, Riekstina U, Maurina B, Enina V, Atkinson J. Pharmacy practice and education in Latvia. Pharm 2018; 6: 9.
  18. Sviestina I, Mozgis, D. 5PSQ-106 Analysis of the medication incident reports at the university children’s hospital. Eur J Hosp Pharm 2018; 25 (Suppl 1): A213–A214.
  19. Spundina L. Medical error leading to child’s death suspected at Rīga Children’s Hospital. 10 December 2025. LSM.lv. Rīga: State Limited Liability Company; 2025. Available from https://eng.lsm.lv/article/society/health/10.12.2025-medical-error-leading-to-childs-death-suspected-at-riga-childrens-hospital.a625750/?utm_source=inbox&utm_campaign=newsen&utm_medium=frontpag. Accessed 3 March 2026.
  20. Keele University, Centre for Medicines Optimisation. Investigation of the hospital pharmacy profession in Europe: assess and advance hospital pharmacy! Results 2022/2023. Brussels: European Association of Hospital Pharmacists; 2024. Available from https://eahp.eu/wp-content/uploads/2024/11/2022_2023_eahp_investigaton_report.pdf. Accessed 2 March 2026.
  21. European Association of Hospital Pharmacists (EAHP). European statements of hospital pharmacy. Brussels: EAHP; 2024. Available from https://eahp.eu/hospital-pharmacy-practice/statements/from-the-president/european-statements-of-hospital-pharmacy/. Accessed 2 March 2026.
  22. Australian Commission on Safety and Quality in Health Care (ACSQHC). National safety and quality health Service standards.  2nd edition. Sydney: ACSQHC; 2021. Available from https://www.safetyandquality.gov.au/sites/default/files/2021-05/national_safety_and_quality_health_service_nsqhs_standards_second_edition_-_updated_may_2021.pdf.  Accessed 2 March 2026.

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