Françoise Brion

Analysis of overridden alerts in a drug-drug interaction detection system

OBJECTIVE The aim of this study was to evaluate the relevance of the signals generated by a computerized drug-drug interaction detection system and to design a classification of overridden drug-drug interaction alerts. STUDY DESIGN Prospective study over two months. SETTING Five hundred and ten-bed university paediatric hospital. MAIN OUTCOME MEASURES In Robert Debré Hospital physicians generate drug orders online using a computerized physician order entry system that also detects drug-drug interactions in real time. We analysed the relevance of a sample of alerts overridden by physicians. RESULTS We analysed a sample of 613 overridden alerts. We defined three categories of overridden alerts: informational errors (35); system errors (244) and accurate alerts (334). Two reasons account for 40% of false-positive alerts: an inability of the system to recognize real conflicts between drug treatments and guidelines stating that the two drugs can be used together, because the benefit outweighs the risk of side effects due to the drug-drug interaction. CONCLUSIONS We created a classification of overridden alerts, in the context of computerized physician order entry system coupled with a drug-drug interaction detection system. There is clearly room for improvement in the development of drug-drug interaction software. This classification should make it possible to break this work down into smaller tasks, making it possible to decrease the sensitivity to background noise of drug-drug interaction detection systems.

Comparison of hospital pharmacy practice in France and Canada: can different practice perspectives complement each other?

ObjectiveTo compare hospital pharmacy practice in France and Canada by identifying similarities and differences in the two institution’s pharmacy activities, resources, drug dispensing processes and responsibilities.SettingCentre hospitalier universitaire Sainte-Justine (SJ), Montréal, Québec, Canada and Hôpital Robert Debré (RD), Paris, France, are two maternal-child teaching hospitals. They share a similar mission focused on patient care, teaching and research.MethodThe data were gathered from annual reports, department strategic plans and by direct observation.Main outcome measureThe description and comparison of the legal environment, hospital demographics, pharmacy department data, drug dispensing processes and pharmacist activities in the two institutions.ResultsThe Centre hospitalier universitaire Sainte-Justine and Hôpital Robert Debré are similar with respect to their mission and general demographics; number of beds, annual hospital expenditures, number of admissions, visits and childbirths. The respective pharmacy departments differ in allocated resources. The main operational differences concern compounding, quality control programs and clinical activities. The French department also manages medical devices, medical gases, blood derivatives and the sterilisation unit. These comparisons highlight the more patient-oriented Canadian hospital pharmacy practice against the more product-oriented French hospital practice Factors contributing to these differences include academic curriculum, the attention paid to the legal environment by professional bodies, staffing patterns and culture.ConclusionThere are differences between the hospital pharmacy practice in the studied hospitals in Canada and France. Hospital pharmacy practice in France seems to be more product oriented, and the practice in Canada seems more patient oriented.

The role of community pharmacists in the management of hematopoietic stem cell transplant recipients: knowledge and training.

Introduction: The patients receiving hematopoietic stem cell transplantation (HSCT) require routine management: the role of the pharmacist has not been extensively considered. This study had 2 aims: to explore the knowledge of community pharmacists relating to pediatric HSCT and to evaluate their expectations in terms of training needs. Materials and Methods: We interviewed 40 community pharmacists in May and June 2010 in Paris (France) with a 3 parts questionnaire: information concerning the community pharmacy, analysis of 2 pediatric prescriptions and knowledge about HSCT and professional training. Results: Twenty-nine (72.5%) of the 40 community pharmacies agreed to participate in the study. When asked what pharmacological advice they would give for an episode of fever, 13% of the pharmacists asked said that they would deliver acetaminophen without asking any further questions. Concerning hypertrichosis in patients treated with corticosteroids and ciclosporin, none mentioned the role of ciclosporin. The erroneous indications for HSCT given included road accidents (1 pharmacist; 3.4%) and hemophilia (3 pharmacists; 10.3%). Almost 80% of the pharmacists questioned considered their HSCT knowledge insufficient for their professional practice. An E-learning session adapted to their needs was of interest to almost three quarters of the pharmacists questioned.

Standardisation du coût des préparations injectables de médicaments cytotoxiques et antiviraux injectables en unité centralisée

Resume La PUI de l’hopital Robert Debre fabrique, chaque annee, 3 000 preparations de medicaments anticancereux et antiviraux injectables. La centralisation, meme partielle, permet de realiser des economies sur les principes actifs (PA) par une meilleure gestion des reliquats. Cependant, elle requiert un equipement adequat et du personnel qualifie, ce qui entraine des depenses supplementaires. Notre objectif etait de calculer le cout d’une preparation en tenant compte des couts du PA, du materiel, du personnel, de la maintenance et de l’amortissement. Les couts exacts de 694 preparations fabriquees de janvier a mars 2005 ont ete calcules retrospectivement. La faible variabilite de ces couts en fonction du type de preparation (seringue de 1 mL, autre seringue ou poche) a conduit a la determination de trois forfaits selon le type de conditionnement utilise (seringue ou poche). Le prix de la reconstitution des lyophilisats a ete estime separement, et celui du PA a ete isole dans le calcul. Les forfaits par type de preparation, etablis a partir de l’analyse des couts des 694 preparations, etaient de 25,55 euros pour les seringues de 1 mL, 28,35 euros pour les autres seringues et 27,15 euros pour les poches. Cette methode peut etre appliquee, en routine, pour le calcul du cout des preparations dans le cadre de conventions ou d’hospitalisations a domicile.

Unlicensed and off-label medicines and prescriptions: A descriptive analysis of the medicines formulary and of the 56,800 prescriptions in a paediatric hospital

Introduction: There are not enough medicines approved for paediatric use. A very large number of prescriptions are unlicensed or off-label in different countries, diseases and patient ages. Methods: The aim of our retrospective observational study was to analyse the proportion of unlicensed and off-label prescriptions in a paediatric University Hospital Centre (UHC) over a period of six months and to compare this to the alternatives available in the medicines formulary. Results: Of the 1,865 medicines in the formulary, 8.0% were approved for paediatric use without age or weight limit and 47.1% were approved for paediatric use with an age or weight limit. Of the 56,820 prescriptions examined, 30.7% were off-label and 4.5% were unlicensed medicines. 53.6% of the 5,803 patients received at least one unlicensed or off-label prescription. This study has enabled us to identify situations (1 to 30 months old, Haematology unit, pantoprazole and folic acid prescription for example), which are more commonly associated with off-label prescribing. Discussion: Our study is original as it examines in parallel those medicines which are available and the prescriptions which are issued. It has analysed a large number of prescriptions for hospitalised patients in sixteen different specialist departments. Off-label or unlicensed prescribing paediatric use raises a safety and efficacy problem for the treatments given. For this reason it is important to target situations and to produce reference standards which can be used in everyday practice by doctors in order to limit their use of these prescriptions. Correspondence to: Sonia Prot-Labarthe, Department of Pharmacy, RobertDebré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; Sorbonne Paris Cité, Université Paris Descartes, Pharmacie Clinique, Service de Pharmacie 48 boulevard Sérurier, 75935 Paris Cedex 19, France, Tel: 33 (1) 40 03 57 41; Fax: 33(1) 40 03 24 81; E-mail: sonia.prot-labarthe@aphp.fr