Jean Calop

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.

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.

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).

Pharmaceutical care in chronic kidney disease: experience at Grenoble University Hospital from 2006 to 2010.

BACKGROUND Clinical pharmacists (CPs) specifically manage lab-test follow-up, adapt drug dosage according to guidelines and evaluate cardiovascular risk factors and decline in renal function. The aim of this study was to assess the impact of clinical pharmacy services in outpatient nephrology clinics. METHOD For each patient, medical history and current treatment were obtained. Each intervention was classified according to the Act-IP document of the French Society of Clinical Pharmacy. This tool contains identifications and guidelines for prevention and resolution of drug-related problems (DRPs). RESULTS From January 2008 until April 2009, 42 patients seen by the CP on at least 2 visits were included in the study. We observed 350 pharmaceutical consultations and 263 interventions. The pharmaceutical interventions concerned: untreated indication (30%), underdosage (25.9%) and overdosage (18.3%). The CP interventions consisted of: adapting doses (42.2%) and adding treatments (31.9%). The main drugs involved concerned the cardiovascular (33.1%), digestive-metabolic (28.6%) and hematopoietic (21.6%) systems. CONCLUSION The inclusion of a CP in the management of chronic kidney disease (CKD) patients is necessary for identification and prevention of DRPs. Besides the medical improvement of CKD patients, the CP participates in the development of prescription recommendations and therapeutic education programs for patients. Moreover, redefining roles and practices of members of a clinical team proved its efficiency in optimizing the medical care of CKD patients. Furthermore, patient entry into dialysis is postponed, which leads to a reduction in costs for health care insurance.

Le pharmacien a-t-il une place au sein de l'unité de soins ? Expérience du centre hospitalier universitaire de Grenoble

La securisation du circuit du medicament a l’hopital represente une priorite de sante publique qui implique une demarche collective. Cette demarche associe l’ensemble des professionnels de sante, parmi lesquels le pharmacien occupe une place centrale. Le pharmacien intervient non seulement au niveau de la politique generale du circuit du medicament de l’etablissement, mais aussi par son implication dans des activites cliniques au sein des unites de soins. La pharmacie clinique vise l’accompagnement par le pharmacien, au sein de l’unite de soins, de la securisation du patient et de l’optimisation de sa therapeutique medicamenteuse. Pour ce faire, le pharmacien, en lien avec le patient et les autres professionnels de sante, documente les pratiques medicamenteuses du patient (observation pharmaceutique), pour aider a la mise en place du traitement (validation des prescriptions), puis au suivi du patient (suivi therapeutique, suivi d’observance, offre d’interventions educatives, consultation de sortie). L’objectif de cet article est de situer le positionnement du pharmacien a l’hopital, de definir les differentes activites de pharmacie clinique, illustrees par l’experience du CHU de Grenoble, et d’en decrire l’impact.

Pharmacy Education in Vietnam

Pharmacy education programs in Vietnam are complex and offer various career pathways. All include theory and laboratory modules in general, foundation, and pharmaceutical knowledge; placements in health facilities; and a final examination. The various pharmacy degree programs allow specialization in 1 or more of 5 main fields: (1) drug management and supply, (2) drug development and production, (3) pharmacology and clinical pharmacy, (4) traditional medicine and pharmacognosy, and (5) drug quality control, which are offered as main specialization options during the reformed undergraduate and postgraduate programs. However, pharmacy education in Vietnam in general remains product oriented and clinical pharmacy training has not received adequate attention. Only students who have obtained the bachelor of pharmacy degree, which requires a minimum of 5 years of study, are considered as fully qualified pharmacists. In contrast, an elementary diploma in pharmacy awarded after 1 year of pharmacy study permits entry into more junior pharmacy positions. Since the 2000s, there has been a surge in the number and types of schools offering pharmacy qualifications at various levels.

Physicians' Acceptance of Pharmacy Residents' Recommendations on Drug Therapy

The objective of this study was to evaluate the impact of a training program delivered to pharmacy residents. During their clinical pharmacy training program, the residents have to learn more about how to deal with drug related problems, develop clinically relevant recommendations, and develop communication skills to make therapeutic recommendations acceptable for the prescriber. Six pharmacy residents, working in different clinical wards, collected data during six consecutive weeks every time they gave a recommendation to a prescribing physician. The main issue was the prescribers’ level of acceptance of pharmacy residents’ recommendations. The items taken into account were the type of recommendation, the physician’s status and the mode of interaction between pharmacy residents and prescribers. Two hundred and twenty one interventions were collected. The major recommendations were changing drug regimen (39%) and enhancing monitoring (31%). The rate of prescribers’ acceptance of recommendations made by pharmacy residents was 47% (higher for senior prescribers (59%) than junior prescribers (41%)). Oral recommendations of around 80% were accepted.