B. Allenet

Validation of an instrument for the documentation of clinical pharmacists' interventions.

ObjectiveTo validate an instrument for documentation of clinical pharmacy interventions in French speaking hospitals in France and outside of France.MethodA panel of 12 French speaking clinical pharmacists (six from France; six from French speaking countries) was asked to analyse a set of 60 pharmacist’s interventions on drug prescription. They used a form including (1) the identification of the drug related problems (DRPs) (10 items), (2) the pharmacist’s intervention (7 items). We assessed the level of agreement between the 12 pharmacists on the test DRPs and on the interventions.Main outcome measuresKappa coefficient of concordance was used to assess the level of agreement between experts for DRPs and interventions. We also assessed the userfriendliness of the instrument using Likert scales.ResultsThe level of concordance observed in the validation was 0.76 for DRPs and 0.89 for the type of intervention. Eleven experts out of 12 were “very satisfied” or “satisfied” and one “not satisfied” with the tool. Ten out of the 12 experts were ready to use it in daily practise.ConclusionThe present instrument proposed by the French Society of Clinical Pharmacy (SFPC) is the first coding system for pharmacist’s interventions with a French interface. The validation process using a standard statistical methodology helps support the external validity of our tool. The level of concordance between users can be considered as satisfactory, allowing the use of the tool in daily clinical pharmacy practise. To enhance the diffusion of the instrument and of the general process of routine documentation of interventions, a spreadsheet is provided on the French Society of Clinical Pharmacy website.

EDUC'AVK: Reduction of Oral Anticoagulant-related Adverse Events After Patient Education: A Prospective Multicenter Open Randomized Study.

BackgroundLong-term oral anticoagulation treatment is associated with potential morbidity. Insufficient patient education is linked to poorly controlled anticoagulation. However the impact of a specific educational program on anticoagulation related morbidity remains unknown.ObjectiveTo evaluate the effect of an oral anticoagulation patient education program in reducing both hemorrhagic and recurrent thrombotic complications.Design/ParticipantsWe conducted a prospective, multicenter open randomized study, comparing an interventional group who received a specific oral anticoagulation treatment educational program with a control group. Eligible patients were older than 18 and diagnosed as having deep vein thrombosis or pulmonary embolism requiring therapy with a vitamin K antagonist for 3 months or more. Our primary outcome was the occurrence of hemorrhagic or thromboembolic events.ResultsDuring the 3-month follow-up the main outcome criteria were observed 20 times (6.6% of patients), 5 (3.1%) in the experimental and 15 (10.6%) in the control group. Consequently, in multivariate analysis, the cumulative risk reduction in the experimental group was statistically significant (OR 0.25, 95% CI 0.1 – 0.7, p < 0.01).ConclusionsPatient education using an educational program reduced VKA-related adverse event rates.

Automated drug dispensing system reduces medication errors in an intensive care setting.

Objectives:We aimed to assess the impact of an automated dispensing system on the incidence of medication errors related to picking, preparation, and administration of drugs in a medical intensive care unit. We also evaluated the clinical significance of such errors and user satisfaction. Design:Preintervention and postintervention study involving a control and an intervention medical intensive care unit. Setting:Two medical intensive care units in the same department of a 2,000-bed university hospital. Patients:Adult medical intensive care patients. Interventions:After a 2-month observation period, we implemented an automated dispensing system in one of the units (study unit) chosen randomly, with the other unit being the control. Measurements and Main Results:The overall error rate was expressed as a percentage of total opportunities for error. The severity of errors was classified according to National Coordinating Council for Medication Error Reporting and Prevention categories by an expert committee. User satisfaction was assessed through self-administered questionnaires completed by nurses. A total of 1,476 medications for 115 patients were observed. After automated dispensing system implementation, we observed a reduced percentage of total opportunities for error in the study compared to the control unit (13.5% and 18.6%, respectively; p < .05); however, no significant difference was observed before automated dispensing system implementation (20.4% and 19.3%, respectively; not significant). Before-and-after comparisons in the study unit also showed a significantly reduced percentage of total opportunities for error (20.4% and 13.5%; p < .01). An analysis of detailed opportunities for error showed a significant impact of the automated dispensing system in reducing preparation errors (p < .05). Most errors caused no harm (National Coordinating Council for Medication Error Reporting and Prevention category C). The automated dispensing system did not reduce errors causing harm. Finally, the mean for working conditions improved from 1.0 ± 0.8 to 2.5 ± 0.8 on the four-point Likert scale. Conclusions:The implementation of an automated dispensing system reduced overall medication errors related to picking, preparation, and administration of drugs in the intensive care unit. Furthermore, most nurses favored the new drug dispensation organization.

A dynamic exercise programme to improve patients’ disability in rheumatoid arthritis: a prospective randomized controlled trial

OBJECTIVE To evaluate the functional, clinical, radiological and quality of life outcomes of a 4-week dynamic exercise programme (DEP) in RA. METHODS Patients matched on the principal medico-social parameters were randomly assigned to either the DEP or the conventional joint rehabilitation group. Primary end point for judging effectiveness was functional status assessed by HAQ. Secondary outcomes included Nottingham Health Profile (NHP), Arthritis Impact Measurement Scale 2-Short Form (AIMS2-SF) and radiological worsening measured by Simple Narrowing Erosion Score (SENS). Clinical evaluation consisted of disease activity score (DAS 28), cycling aerobic fitness and dexterity. Dexterity was measured using Sequential Occupational Dexterity Assessment (SODA) and Duruoz Hand Index (DHI). Data were collected at baseline 1, 6 and 12 months. RESULTS Fifty patients were enrolled. HAQ improved throughout the length of the trial in the DEP group. This improvement was greater in DEP than in the standard joint rehabilitation group at 1 month (-0.2 vs no variation from baseline, P = 0.04), but not at 6 months (-0.2 vs -0.1 in control group, P = 0.25) or 12 months (-0.1 vs no variation in control group, P = 0.51). DEP improved NHP (-23 vs + 7% in control group, P = 0.01) and aerobic fitness (+0.3 vs + 0.1 km per 5 min in control group, P = 0.02) at 1 month but the progress was not statistically significant thereafter. DEP also improved DHI, SODA, DAS 28 and AIMS2-SF, although not significantly. CONCLUSION DEP was effective on functional status assessed by HAQ, quality of life and aerobic fitness at 1 month.

Drug-related problems in medical wards with a computerized physician order entry system.

Objective:  Identification and estimation, by clinical pharmacists participating in routine medical rounds, of drug‐related problems (DRPs), arising despite the use of a computerized physician order entry (CPOE) system.

Compliance with guidelines on antibiotic prophylaxis in total hip replacement surgery: Results of A retrospective study of 416 patients in A teaching hospital

OBJECTIVE To assess compliance of anesthesiologist practices in antibiotic prophylaxis during total hip replacement (THR) surgery with the French Society of Anesthesiology and Intensive Care consensus-based guidelines. DESIGN Retrospective review of medical records. Compliance of anesthesiologist practices with the guidelines was assessed according to antibiotic prophylaxis use, antimicrobial agent, dosage of first injection, time from first dose to incision, and total duration of antibiotic prophylaxis. SETTING Orthopedic surgery wards in a 2,200-bed French teaching hospital. PATIENTS A random sample of 416 patients undergoing THR from January 1999 to December 2000. RESULTS Three hundred eighty-six (93%) of the sampled medical records were usable. Antibiotic prophylaxis was used for 366 (95%) of the patients. Total duration of prophylaxis did not exceed 48 hours in 98% (359 of 366) of the patients. Drug selection complied with national guidelines in 259 (71%) of the patients. Dosage and timing of the first injection were appropriate in 98% (290 of 296) and 80% (236 of 296) of the patients, respectively, who received one of the recommended antibiotics. Overall, 53% (203 of 386) of the patients met all five criteria. In multivariate analysis, there was a significant anesthesiologist effect on overall compliance with the guidelines (likelihood ratio chi-square with 9 degrees of freedom, 25.7; P < .01). Undergoing surgery during 2000 was the only patient characteristic associated with an increased rate of appropriate practices (adjusted OR, 1.56; CI95 1.02-2.38). CONCLUSION The overall compliance rate should be improved by disseminating the guidelines and the results of this study following audit and feedback.

Antipsychotic drugs and risk of pulmonary embolism.

Antipsychotic drugs (APs) expose users to several adverse effects. Some reports describe an increased risk of venous thromboembolism for particular drugs in this family.

Physicians and community pharmacists collaboration in primary care: A review of specific models

BACKGROUND Since 2008, French healthcare reform encourages community pharmacists (CP) to develop collaborative care with other health care providers through new cognitive pharmacy services. OBJECTIVES This review is aimed to identify theoretical models that have been developed to understand the physician-CP collaboration (PCPC) and to identify the associated determinants. METHODS English-written abstracts research was conducted on Pubmed/Medline, PsycINFO, Sociological Abstracts, and CINAHL from January 1990 to June 2013. Keywords were based on common terminology of inter-professional relations and community pharmacy. RESULTS Of the 1545 single articles identified, the final review was conducted on 16 articles. Four specific models of collaboration centered on PCPC were identified: (i) the Collaborative Working Relationship Model (CWR), (ii) the Conceptual model of GPCP collaboration, (iii) the CP Attitudes towards Collaboration with GPs Model (ATC-P), (iv) the GP Attitudes towards collaboration with CPs (ATC-GP). The analysis of these four PCPC models shows that their respective factors might cover the same concepts, especially for relational and interactional determinants. These key elements are: trust, interdependence, perceptions and expectations about the other HCP, skills, interest for collaborative practice, role definition and communication. CONCLUSION A meta-model for PCPC has been postulated. It can be used for qualitative exploration of PCPC, in a context of implementation of collaborative practice including CPs, in the primary care.

La sécurisation du circuit du médicament dans les établissements de santé : données actuelles et expérience du centre hospitalier universitaire de Grenoble☆

Drug supply chain safety has become a priority for public health which implies a collective process. This process associates all health professionals including the pharmacist who plays a major role. The objective of this present paper is to describe the several approaches proven effective in the reduction of drug-related problem in hospital, illustrated by the Grenoble University Hospital experience. The pharmacist gets involved first in the general strategy of hospital drug supply chain, second by his direct implication in clinical activities. The general strategy of drug supply chain combines risk management, coordination of the Pharmacy and Therapeutics Committee, selection and purchase of drugs and organisation of drug supply chain. Computer management of drug supply chain is a major evolution. Nominative drug delivering has to be a prior objective and its implementation modalities have to be defined: centralized or decentralized in wards, manual or automated. Also, new technologies allow the automation of overall drug distribution from central pharmacy and the implementation of automated drug dispensing systems into wards. The development of centralised drug preparation allows a safe compounding of high risk drugs, like cytotoxic drugs. The pharmacist should develop his clinical activities with patients and other health care professionals in order to optimise clinical decisions (medication review, drug order analysis) and patients follow-up (therapeutic monitoring, patient education, discharge consultation).

Impact d’un programme d’éducation thérapeutique sur les attitudes de prévention vis-à-vis du risque iatrogène : étude pilote contrôlée visant les patients sous anticoagulants oraux pour maladie thromboembolique veineuse

Resume Objectif L’iatrogenie induite par les antivitamines K (AVK) represente un probleme de sante publique. L’integration, dans la strategie de prevention, d’actions d’education ciblees sur le patient pourrait contribuer a l’amelioration de l’efficacite et la securite des soins. L’objectif de ce travail etait d’evaluer un programme d’education therapeutique s’inspirant des recommandations de l’AFSSAPS et developpant une pedagogie de type « guidance individuelle ». Methode Nous avons opere une comparaison historique, a l’inclusion (avant intervention) puis 3 mois plus tard, de 2 cohortes de patients hospitalises traites par AVK pour une maladie thromboembolique (MTE), l’une experimentale (une seance d’education avant la sortie de l’hopital) et l’autre temoin (pratique courante). L’evaluation porte sur l’acquisition 1) de connaissances, 2) de comportements d’anticipation du risque et de comportements d’observance (caracterisee par la stabilite de l’INR et la survenue d’incidents hemorragiques sur la periode d’observation). Resultats Cinquante-neuf patients d’âge moyen 65 ans, ont ete inclus dans l’analyse (29 experimentaux contre 30 temoins). Un modele multivarie integrant les facteurs susceptibles d’impacter sur l’incidence des hemorragies sous AVK (socio-demographie, antecedents de MTE, stabilite de l’INR, groupe de reference du patient) met en evidence que seul le fait d’appartenir au groupe experimental induit une difference significative de frequence des incidents hemorragiques (p = 0,05 ; odds-ratio = 4,5, intervalle de confiance : [1-21]). Conclusion La probabilite d’avoir une hemorragie sous AVK est en moyenne 4 fois plus elevee chez un patient n’ayant pas suivi le programme d’education (en analyse multivariee). Un essai randomise de plus grande ampleur visant a valider ces resultats preliminaires est en cours de developpement dans la region Rhone-Alpes.