A Bennana

Drug Iatrogenesis: A Review

The Drug iatrogenesis corresponds to the pathology or any clinical manifestation undesirable for the patient induced by the administration of one or more medicines. Several studies have estimated that adverse drug reactions account for between 0.5% and 2% of outpatient consultations and are involved in 4% to 10% of hospital admissions Thus, we will present definitions essential to the understanding of drug-induced iatrogenesis before synthesizing the different epidemiological data available in this field.

Revue de la littérature sur l’impact du vieillissement démographique sur l’évolution des dépenses médicales: pays de l’Organisation de coopération et de développement économiques et Maroc

This study aims to offer an overview of literature published on the relationship between population aging and healthcare expenditure growth in countries where this phenomenon is already significant and in Morocco. The first 19 most cited articles published over the period 1995-2014 are concerned with Organisation for Economic Co-operation and Development member countries as well as with countries where the impact of aging on healthcare expenditures has been evaluated quantitatively. With regard to Morocco, our research focused on publications from national governments regarding medical consumption growth and its link with age. Reasearch studies on OECD member countries that include proximity of death in explanatory models for healthcare expenditures, conclude that this last can explain better than age healthcare expenditure growth. Four authors highlight that explanatory models for healthcare expenditures which do not take into consideration proximity of death overestimate projection results. Ten studies suggest that healthcare expenditure growth is attributable to factors other than population aging. With regard to Morocco, only a report on compulsory health insurance shows that there is a relationship between age and expenditures since the prevalence of chronic diseases that affect mostly older people entails significant expenditures for compulsory health insurance. Given the speed of the aging in Morocco, it is necessary to conduct studies in order to understand the dynamics of healthcare expenditures.

Detection and analysis of drugdrug interactions among hospitalized cardiac patients in the Mohammed V Military Teaching Hospital in Morocco

Introduction Drug-drug interactions (DDIs) are defined as two or more drugs interacting in such a manner that the effectiveness or toxicity of one or more drugs is altered. Patients with cardiovascular disorders are at higher risk for DDIs because of the types and number of drugs they receive. The aim of the present study was to assess the prevalence of DDIs in patients admitted to the cardiology department of a hospital in Morocco. Methods A prospective observational study from June 2016 to September 2016 was carried out in the cardiology department of a hospital in Morocco. Those patients who were taking at least two drugs and had a hospital stay of at least 48 hours were included in the study. The medications of the patients were analysed for possible interactions. All the prescriptions of the study population were screened for drug-drug interactions using a computerized DDI database system (Theriaque®). Results During the study period, 138 patients were included; 360 interactions were detected among 94 patients, with an average number of drugs taken of 5.2. The prevalence of DDIs was estimated at 68.11%, the most common of which concerned Kardegic/Plavix (12.22%), Kardegic/Heparin (8.33%), and Lasilix/Spironolactone (5.83%). Among the 726 prescribed drugs, (372 [51.24%]) were drugs of the cardiovascular system, followed by blood and hematopoietic organ drugs (288 [39.67%]) according to the Anatomical Therapeutic Chemical Classification codes. These interactions were categorized on the basis of level of severity: interactions with major severity accounted for 11.11% (40) of the total DDIs while those with moderate and minor severity accounted for 37.22% (134) and 51.66% (186), respectively. Conclusion This study reports the prevalence of DDIs in patients admitted to the cardiology department of a hospital in Morocco. This study shows that DDIs are frequent among hospitalized cardiac patients and highlights the need to screen prescriptions of cardiovascular patients for possible DDIs, as this helps in their detection and prevention. Pan African Medical Journal – ISSN: 1937- 8688 (www.panafrican-med-journal.com) Published in partnership with the African Field Epidemiology Network (AFENET). (www.afenet.net) Pan African Medical Journal – ISSN: 1937- 8688 (www.panafrican-med-journal.com) Published in partnership with the African Field Epidemiology Network (AFENET). (www.afenet.net)

GM-001 Role of the pharmacist in hospital: What is the perception of health professionals?

Background The pharmacist has a central role in a hospital. However, in the absence of regulation (law) that defines the role and prerogatives of the hospital pharmacist in developing countries, the missions of the pharmacists are many, and perceptions of other health professionals on the role played by pharmacists in hospital are disparate. Purpose To determine the perception of health professionals about the role of the hospital pharmacist. Three questions were asked of health professionals: (1) What is the role of the pharmacist in the hospital? (2) Can we run a hospital without a pharmacist? (30 What is the perception of hospital pharmacists in relation to their missions? Material and methods A survey was conducted among different categories of health professionals (pharmacists, physicians, nurses and technicians in three hospitals). Tables 1–3 were presented to health professionals to assess their perceptions on the role of hospital pharmacists. Results 120 responses were collected and analysed. The results are summarised in tables 1–3.Abstract GM-001 Table 1 Perception of health professionals on the role of the hospital pharmacist Mission % Pharmaceutical products procurement 98 Therapeutic monitoring 18 Pharmaceutical preparation 56 Pharmacoeconomics 72 Risk management 58 Development of hospital 62Abstract GM-001 Table 2 Perception of the indispensability of the pharmacist in relation to the tasks defined Mission Yes No All missions in table 1 x x  Conclusion Procurement is the most important function performed by pharmacists in hospitals in the eyes of health professionals. Therapeutic monitoring is the least. Other tasks of the hospital pharmacist that are perceived as important include application of pharmacoeconomics rules. The pharmacist is seen by health professionals as an essential and non-essential professional for all missions selected. The regulatory prerogatives of hospital pharmacists should be more specific and clarified. The illegal practice of hospital pharmacy should be severely punished.Abstract GM-001 Table 3 Perception of hospital pharmacists in relation to their missions Mission % Pharmaceutical knowledge <15 Work organisation 50–60 Address book (pharmaceutical manufacturers) and strategic position (dispensing of pharmaceutical products) 40–50 References and/or Acknowledgements Acknowledgements to the pharmacy team at Cheikh Zaid Hospital. No conflict of interest.

GM-008 Economic valuation of losses due to drug leftovers: Case of tenecteplase

Background Optimising resource management is a major stake in health economics. In this way, managing costly injectable medications which are administered ‘dose by weight’ is a considerable concern to hospital pharmacists. Tenecteplase is one of the drugs whose use is likely to generate losses as only the 10 000 IU presentation is marketed in our country, and vials are often not wholly used. Purpose To evaluate product losses at our hospital and the shortfall due to the non-commercialisation of other tenecteplase dosages in our country. Material and methods This was a prospective study over a period of 1 year (from 4 January 2014 to 3 January 2015), focusing on 10 000 IU tenecteplase vials that were reconstituted and used in our hospital’s cardiology and emergency departments. Evaluation of leftovers was performed both by volumetric method and by weighing. Results For the 50 vials studied over the study period, the volume of unused reconstituted drug leftovers varied between 0 ml and 4.8 mL per vial, with an average of 1.99 mL and a total volume of 99.32 mL. The financial study reported the results presented in table 1.Abstract GM-008 Table 1 Unit price (10 ml vial) (€) Total price (50 vials) (€) Total volume of drug leftovers (mL) Valued losses (€) Losses (%) 1364 68 200 99.32 13 545 19.86 Conclusion The losses estimated at 19.86% of the budget dedicated to the purchase of tenecteplase at our hospital reflects the need for marketing of other dosages that are already available in other countries (6000 IU and 8000 IU). In the meantime, as some studies have shown the possibility of aliquoting and conserving reconstituted tenecteplase, it would be advisable to set up a centralised unit for sterile preparation of customised doses that would achieve savings on tenecteplase as well as on other expensive injectable products. No conflict of interest.

PS-017 Quality and risk management in hospitals: Audit of surgical antibiotic prophylaxis

Background Infection is a risk for any surgery. The aim of surgical antimicrobial prophylaxis (SAP) is to reduce the risk of surgical site infection. Its prescription must obey certain rules, established on the basis of numerous studies on this subject. Indeed, the SAP, whenever it is recommended, must use an antibiotic adapted to both the bacteriological target and the relevant surgery, in order to obtain effective tissue concentrations on the potential site of infection throughout the operation. Compliance with these rules is an integral part of the quality improvement policy and the safety of care. Purpose To evaluate, through a prospective audit, compliance with SAP recommendations in the operating rooms as part of quality and risk management at our hospital. Material and methods This was a prospective study of the SAP conformity for all patients admitted for surgery in orthopaedics-traumatology, gynaecology, urology, visceral surgery, neurosurgery, ophthalmology, otolaryngology and maxillofacial surgery, over the period 28 September 2015 to 11 October 2015. SAP compliance was evaluated by comparison with the repository of the French Society of Anaesthesia and Intensive Care (2010 version), and objectivised by a combined overall compliance criterion (indication, choice of molecule and posology). Results Among the 308 included cases, a compliant prophylactic attitude was observed in 68% of cases. For the 177 patients who received SAP, the latter was compliant in 79% of cases, and the most prescribed antibiotic was cefazolin (53%). For the 131 patients who did not receive SAP, the decision was appropriate in 54% of cases. Conclusion SAP recommendations are imperfectly applied, in particular concerning the choice of antibiotic to be administered and the establishment or not of SAP. Efforts must be pursued in terms of adherence to these recommendations, and continually evaluated to improve the quality and to master the risk at our institution. References and/or Acknowledgements Société française d’anesthésie et de réanimation. Antibioprophylaxis in surgery and interventional medicine (adult patients), Actualization 2010. Annales Françaises d’Anesthésie et de Réanimation 2011;30:168–90 No conflict of interest.

CP-229 Is there an added value contribution of biological glue in surgery of cyanotic congenital heart diseases?

Background Biological glues are indicated in surgery to improve haemostasis when conventional techniques such as compression, sutures or electrocoagulation are insufficient. Indications for biological glues are reducing bleeding occurring after surgery, including particular contexts. Purpose Through this work, we evaluated the impact of using biological glue in surgical procedures for cyanotic congenital heart diseases on the cost of pharmaceuticals, postoperative intensive care, volume of postoperative bleeding and number of bags of blood and blood derivatives transfused. Material and methods A study of patient records who underwent surgery to treat a cyanotic congenital heart disease (tetralogy of Fallot, pulmonary atresia, transposition of the great arteries) was made between 2010 and 2014. All patients in whom the surgeon used biological glue were followed since the introduction of the glue to the hospital in 2012. Other patient records were randomly selected; they represent those treated by surgery for their cyanotic congenital heart diseases before the introduction of the biological glue to the hospital. A Mann-Whitney analysis was used to define differences between the two groups of patients. Statistical analysis was performed using SPSS V.13.0. Results 60 patient records were collected; the surgeon has used biological glue in 28 patients after the introduction of this product to the hospital.Abstract CP-229 Table 1 Parameter Biological glue No biological glue p Value Intensive care unit stay (day) 2 [2–4] 3 [2–4.7] 0.168 Volume of bleeding (ml) 190 [119–270] 116 [72–207] 0.059 No of blood bags 7 [5–10] 6 [5–8.7] 0.410 Conclusion Bleeding is an important factor for morbidity and mortality in surgical procedures. Bleeding can have serious consequences for patients at a young age, especially for cyanotic congenital heart diseases. The contribution of biological glue is already confirmed in intraoperative haemostasis. However, our results show that in our studied series, the use of the biological glue did not reduce the postoperative bleeding volume, did not reduce hospital stay in the ICU and did not reduce the number of bags of blood and blood derivatives transfused. These results should be confronted by other results from other series. References and/or Acknowledgements Cardiac surgery team. No conflict of interest.

Réactovigilance à l’Hôpital militaire d’instruction Mohamed-V de Rabat

Au Maroc, la reactovigilance n’a pas ete a ce jour introduite dans le systeme de soins. Pourtant plusieurs cas de declarations et de notifications de problemes lies a l’utilisation des reactifs ont ete rapportes dans le monde. Objectif : L’objectif du present travail est de rapporter l’experience de l’Hopital militaire d’instruction Mohamed V de Rabat (HMIMV-Rt) quant a l’implication des differents intervenants dans la gestion de la reactovigilance. Materiel et methodes : Cette etude, qui a dure quatre ans, de juillet 2009 a juillet 2013, s’est deroulee en 4 etapes : 1)Phase de conception : conception et validation d’une fiche de declaration etablie par le Pole pharmacie de l’HMIMV-Rt ; 2) Phase d’information et de sensibilisation des differents laboratoires et services concernes ; 3) Phase de distribution, collecte et etude des fiches de reactovigilance ; 4) Phase de realisation et du suivi des actionscorrectives decidees. Resultats : Seules 10 % des fiches distribuees ont ete remplies durant les quatre annees d’etudes. La reclamation orale reste predominante. On a note une augmentation des cas de reclamations au cours des quatre annees d’etudes ; 43 % des cas de reclamations ont concerne les reactifs de biologie medicale, 67,9 % de ces declarations emanaient des laboratoires de biologie. Conclusion : La maitrise du risque lie a l’utilisation des reactifs, a usage diagnostique in vitro dans nos etablissements de sante, impose la mise en place d’une organisation fiable. Cette demarche ne sera operationnelle que par la modification des comportements individuels et collectifs du personnel. Le developpement d’une demarche positive et non punitive de l’erreur, l’absence de jugement dans l’analyse de l’information, la responsabilisation de tous les acteurs et la modification des pratiques contribueraient a ameliorer la notification de la reactovigilance.

PS-036 The place of materiovigilance as tool of traceability in the quality management system (QMS) in hospital pharmacy

Background Materiovigilance aims to monitor the risk of incidents resulting from the use of Medical Devices. What is its role in the establishment of a QMS in the hospital pharmacy? Purpose To identify materiovigilance notifications within our hospital, to analyse them, to identify measures taken in each case and to establish a QMS that incldes the traceability of medical devices. Material and methods Materiovigilance statements that were collected between June 2012 and May 2014 were analysed. Decisions that had been taken were collected in order to make a synthesis of QMS implemented in our pharmacy. Incidents were classified into three categories according to the severity of the event (3 is the worst) and measures taken were classified into three categories (corrective, preventive and palliative). Results 75 notifications were collected, 27 (36%) first degree, 24 (32%) second degree and 24 (32%) the third degree of dangerousness. 24 notifications were from surgery units (gloves, sutures, infusion tubing), 19 from the haemodialysis service (vials of bicarbonate), 12 from ophthalmology (ocular implants) and 7 from the Intensive Care Unit (catheters, tracheal intubation tube, pressure sensors). Similar results have been found and published in EJHP by other national teams. The measures that have been taken were corrective in 16 (21%) of cases (definitive change of medical device), preventive in 6 (8%) of cases (compliance test before use) and palliative in 53 (71%) of cases (exchange of defective device). Conclusion All notifications were selected and sent to suppliers to request information and to exchange defective devices. Some incidents were very serious (coils and stents breaking). Materiovigilance is necessary for the traceability of adverse events related to the use of medical devices. It is essential for the adoption of the QMS that we introduced in our pharmacy. This is particularly important in the absence of a national medical devices industry and specific regulation for these products. References and/or acknowledgements Acknowledgements for Zakia Cheikh. No conflict of interest.

GM-006 Critical analysis of conventional customer satisfaction indicators in hospitals

Background Customer satisfaction is characterised by its complexity and highly subjectivity in hospitals. Indeed, experience has shown that Conventional Customer Satisfaction Indicators (CCSIs) which have proved their relevance in many areas, may not be suitable in hospitals. Purpose To determine the limits of CCSIs in hospitals. Material and methods This is a descriptive study of customers and their needs in hospitals followed by a critical analysis of CCSI. As the model presented, we studied direct customers of our Hospital Pharmacy (HP). Data on pharmacy customers, their needs and CCSIs for their evaluation were extracted from our pharmacy procedures booklet and quality manual, as well as from the complaints register and the satisfaction questionnaires completed by the customers concerned. Results Direct customers of HP are: Care Units (CUs), administrative department, financial department and suppliers. The table below illustrates pharmaceutical needs of the first category of customers (CUs), CCSIs used and their possible deficiencies: Conclusion Critical analysis of CCSIs in hospitals allowed us to identify many deficiencies. These findings will be used to develop new indicators that are more appropriate for the hospital context. For example we can imagine introducing an Index for Request Adequacy (IRA) to adjust the conventional RSR: Adjusted RSR = [Quantity of dispensed drugs/(Quantity of requested drugs × IRA*)] × 100. *0 < IRA ≤ 1 (The IRA must lie between 0 and 1).Abstract GM-006 Table 1 Needs HP has to satisfy CCSI designation CCSI description Limits Availability of pharmaceuticals Average duration of shortage Σ time out of stock/Number of items in shortage Concordance between prescribed and dispensed items Request Satisfaction Rate (RSR) (Quantity of dispensed drugs/Quantity of requested drugs) × 100 Does not take into account appropriateness of the request Rapidity of dispensing prescriptions Prescriptions execution time Time to dispense prescription lines/total number of prescription lines Pharmaceutical presence in CU Rate of pharmaceutical presence in CU (Number of CUs benefiting from pharmacist presence/total number of CU) × 100 Pharmaceutical presence is not required at the same level in all CUs References and/or acknowledgements No conflict of interest.