The study included clinical and hospital pharmacists working in 8 hospitals in 8 Latin American countries: Argentina, Chile, Costa Rica, Uruguay, Colombia, Peru, Brazil, and Mexico. The countries were selected based on the presence of prominent hospitals, the diversity of their health systems, and the professional networks accessible to the authors, all of which facilitated the distribution of the questionnaire. Out of the 20 countries and 14 territories in Latin America, these 8 were chosen for their robust hospital pharmacy infrastructure and accessibility to participants, ensuring a feasible and representative assessment. Only 1 hospital was selected in each country; therefore, the results reflect the pharmacy services of those institutions only and cannot be considered representative of hospital pharmacy practice at the national level.

The study included clinical and hospital pharmacists from the selected countries. Participants were invited via professional networks and local pharmacy associations to achieve a broad representation of those practicing in hospital pharmacy services. We prioritized professionals with active experience in medium- and high-complexity hospitals to ensure that responses reflected clinical pharmacy practice in settings relevant to the Basel Statements. In each hospital, we attempted to include a diverse sample of pharmacists from across the pharmacy service—including clinical, logistical, and administrative areas—in order to capture a range of perspectives on the implementation of the Basel Statements. However, participation was voluntary and contingent on the availability and willingness of staff in each hospital.

We used two IPF-validated instruments: the BSSAQ and a reliability and validity testing questionnaire (RVTQ).

The BSSAQ comprises 33 questions divided into 3 sections and assesses pharmacists' knowledge and practices in relation to international standards. The first section collects demographic data, including age, educational level, and professional experience; the second examines participation in health teams and clinical decision-making; and the third assesses medication preparation and delivery practices in accordance with safety protocols. These 33 questions were selected by the authors from the current statements, prioritizing those with the greatest operational applicability and relevance to the study objectives. The selection was based on alignment with measurable aspects of daily hospital practice and was validated by local clinical pharmacy experts.

We used the 10-question RVTQ to evaluate the clarity, comprehensibility, relevance, and suitability of the BSSAQ for professional practice across different countries. Both questionnaires were administered in Spanish to ensure accessibility and comprehension.

The questionnaires were distributed electronically in July 2024, and data were collected over 3 months. We used descriptive statistics to summarize demographic characteristics, pharmacists' involvement in patient care, medication practices, and perceptions of the clarity and applicability of the BSSAQ.

Countries were compared to identify similarities, regional differences, and potential barriers to implementing international standards, thereby providing a comprehensive overview of pharmaceutical practices in Latin America.

To optimize the understanding and analysis of the results, the wording of some BSSAQ questions was adapted and grouped into specific thematic categories. This approach allowed for the development of more comprehensive and contextualized items, thereby improving the organization, interpretation, and comparability of the data obtained.

The main activities of hospital pharmacists include providing consultations to clinical teams, accessing patient medical records, and overseeing the quality of purchased medicines (see Fig. 1). Access to medical records allows a comprehensive evaluation of treatment, enabling dosage adjustments and the prevention of adverse reactions. Likewise, verification of quality standards in the procurement of medications ensures that products are safe, effective, and traceable, reduces medication errors, and improves risk management in hospital pharmacotherapy.15

Furthermore, direct interaction with other healthcare team members allows pharmacists to actively contribute to drug therapy selection, identify potential drug interactions, and personalize treatments according to patient needs.16

In this regard, integrating pharmacists into hospital care would not only improve patient safety but also promote a multidisciplinary approach to healthcare delivery.16 Their active participation in healthcare processes facilitates better coordination with other healthcare staff, optimizes the use of therapeutic resources, and supports the implementation of evidence-based strategies for the continuous improvement of medical care.17

Despite these aspects, compliance with collaborative prescribing remains low (Fig. 1). Currently, pharmacists play a limited role in decision-making related to patient prescriptions. This level of participation may compromise patient safety, resulting in suboptimal treatments, an increased risk of drug interactions, and delayed detection of medication errors.16,17 This situation may stem from the absence or limitations of legal frameworks supporting collaborative prescribing in many countries in the region. Although some countries, such as Brazil and Mexico, have begun to recognize limited forms of collaboration, others still lack clear regulations allowing pharmacists to participate in therapeutic decisions, which hinder their effective integration into clinical teams.

Similarly, the low level of pharmacist participation in research, auditing, and pharmacovigilance, as observed in the study, limits the optimization of medication use and resource management. These aspects hinder evidence generation, error identification, and continuous improvement in prescribing. Better integration is crucial to optimizing treatments and improving patient safety.18

The procurement and distribution of medications are essential activities in hospital pharmacy, with pharmacists playing a key role in purchasing, transporting, storing, and dispensing them. Some drugs require special handling, such as thermolabile drugs, which must be maintained in a cold chain, or cytotoxic drugs, which require strict protocols to minimize risks during handling and administration.19

The results reveal shortcomings in medication management and safety, with low compliance in areas such as storage, preparation, handling, and administration (Fig. 2). These shortcomings pose a risk to patient and healthcare staff safety and increase the risk of medication errors and preventable adverse events.20

In addition, the identification and prevention of medication errors were inadequate in this category, highlighting the need to strengthen surveillance and risk management systems associated with medication use in hospitals. Based on these findings, corrective measures should be implemented to optimize pharmaceutical management procedures and enhance the training of personnel involved in these tasks.

These results underscore the importance of conducting more detailed studies to investigate the factors that limit the correct implementation of the Basel Statements in Latin America. More reliable data will enable the development of specific strategies to improve medication management safety and advance the consolidation of international standards in hospital pharmacy, thereby contributing to optimized pharmaceutical care and patient safety.

Any score of less than 70% on questions in Sections 2 and 3 was considered inadequate, indicating a potential area for improvement.

The 70% threshold defines a compliance limit indicating the need to optimize specific processes or practices. This threshold is a widely accepted standard for identifying areas for intervention in performance evaluation across multiple disciplines.21

As shown in the results section, responses to survey questions that scored below the 70% threshold were categorized (Fig. 3). These areas include functions such as collaborative participation, which achieved a compliance rate of only 25% in the hospitals surveyed.

The optimization of drug therapy requires the collaborative participation of pharmacists within healthcare teams. Their absence from clinical discussions can result in prescribing errors and the inefficient use of therapeutic resources. This situation is a challenge worldwide, and there is a recognized need to integrate pharmacists more fully into clinical decision-making and hospital management. The IPF has highlighted the need for pharmacists to collaborate with health authorities and administrators to ensure that adequate resources are provided and medicines are used optimally.22

In addition, traceability in hospital pharmacies is crucial to ensuring the quality and safety of medicines, as it allows tracking them from purchase to administration. A lack of traceability can lead to misplacement, dispensing errors, and treatment delays. In Latin America, automated drug dispensing and control systems that integrate technologies such as barcodes and radio frequency are needed to minimize prescription and drug administration errors.23,24

Hospital pharmacies should be strengthened by integrating pharmacists into clinical decision-making, designing efficient traceability systems, and establishing clear guidelines for the off-label use of medicines. These improvements would optimize safety and therapeutic efficacy and align pharmaceutical practice with international standards and the Basel Statements.

The study has several limitations. In some countries, local standards or accreditation programs, such as national quality standards or internal certifications, may conflict with or overlap with the implementation of the Basel Statements. This situation may affect both institutional prioritization and the perceived utility of the framework proposed by the IPF. The selection of countries was based on accessibility and professional networks, excluding regions with different healthcare structures. Participants were unevenly distributed by country, which may have introduced bias. Although hospitals of different types and sizes were included, they cannot be assumed to be fully representative of hospital pharmacy practice in their respective countries. Local conditions may vary significantly between urban and rural regions, public and private institutions, and the size and complexity of hospitals. As the questionnaire was self-reported, the responses may be biased. Furthermore, the questionnaire was translated from English to Spanish, which may have led to variations in how questions were interpreted. In addition, as the analysis was purely descriptive and did not include inferential statistical tests, no causal relationships can be inferred. Future research should include more representative samples and more rigorous statistical analyses.

This study identified the advances and challenges involved in implementing the Basel Statements in Latin American hospitals. The results show that there is considerable variability in the extent to which pharmacists are integrated into hospital care and medication management. Although positive outcomes were observed in activities such as quality supervision and medical record consultation, deficiencies persist in key areas, including collaborative prescribing, drug traceability, and the regulation of off-label medicine use. The limited participation of pharmacists in clinical decision-making negatively impacts treatment optimization and patient safety. In addition, the lack of traceability systems and robust regulations increases the risk of medication errors. Latin America faces greater challenges than other regions in adopting pharmacotherapeutic safety technologies and policies. To improve pharmaceutical care, we recommend strengthening professional training, enhancing access to resources, and standardizing processes.