Lucien Roulet

A questionnaire to document self‐medication history in adult patients visiting emergency departments

To develop the first questionnaire to obtain a complete medication history by documenting self‐medication history in adult patients admitted to a medical emergency department (ED).

Assessment of adverse drug event recognition by emergency physicians in a French teaching hospital

Objectives The frequency and the severity of drug-related visits in emergency department (ED) make the improvement of adverse drug event (ADE) recognition a crucial issue. As part of a research project aiming to improve the diagnosis and the management of ADEs in ED, the authors conducted a pilot study whose primary objective was to assess ADE recognition by emergency physicians. Methods The patients presenting to the ED were included at randomised time periods between 1 October 2007 and 31 March 2008 in this prospective cross-sectional study. The primary outcome was the frequency of ADEs that were attributed to a medication-related problem by the emergency physician. Results A total of 423 patients met the inclusion criteria, of which 95 experienced an ADE (22.5%; 95% CI 18.6% to 26.7%). Emergency physicians correctly attributed 33 of these cases (34.7%; 95% CI 25.3% to 45.2%) to a medication-related problem. Of the 28 cases in which the ADE was considered as a ‘direct drug effect’ (29.5%; 95% CI 20.6% to 39.7%), 16 were correctly identified by emergency physicians (57.1%; 95% CI 37.2% to 75.5%). Of the 67 cases in which the ADE was considered as a ‘drug involvement in a multifactorial pathological condition’ (70.5%; 95% CI 60.3% to 79.4%), 17 were correctly attributed (25.4%; 95% CI 15.5% to 37.5%). Conclusions ADEs are frequent in EDs and are not well recognised by emergency physicians, especially when the drug is involved in a multifactorial pathological condition.

Establishing a pharmacy presence in the emergency department: opportunities and challenges in the French setting

Overview of clinical pharmacy practice around the world shows that pharmaceutical services in emergency departments (EDs) are far less common in Europe than in North America. Reported experiences have shown the impact of a clinical pharmacy service on drug utilisation and safety issues. This commentary presents the implementation of a pharmacy presence in the ED of a French tertiary care hospital. Our experience helps to define the role of the clinical pharmacist in the ED, including patient interviewing, providing medication reconciliation, promoting drug safety, and supporting specific interventions to improve quality of care and patient safety. The role of ED pharmacists in the improvement of quality of care is not necessarily limited to drug therapy, e.g. by helping outpatients to access care and treatment facilities as best suits their needs. Challenges of implementing ED pharmacy services have been identified well, but still require developing strategies to be overcome.

Étude des comportements d’automédication chez les patients admis dans un service d’urgences médicales

OBJECTIVE To describe the self-medicating behaviours (SMBs) in patients admitted to a tertiary care medical emergency department (ED); to study the factors associated with SMBs. METHODS Observational cross-sectional study conducted in 2009. Included patients were interviewed about their SMBs using a standardized questionnaire. The search for factors associated with SMBs used multivariate logistic regression analysis. RESULTS Among the 315 patients who were interviewed, 239 (75.9%) reported one SMBs or more in their lives and 105 (43.9%) within 7 days of admission to the ED. Some of the medications reported during interviews are known to be associated with adverse drug events. After adjustment, SMBs were conversely associated with an age ≥80 years, a number of prescribed medications ≥4 and a social vulnerability condition. CONCLUSION The description of SMBs and the analysis of their determinants are necessary to improve the recognition of adverse events related to self-medication in ED patients.

Letter: Medication administration via enteral feeding tube

Joos et al. [1] recently published the results of an observational study investigating the community pharmacists’ knowledge on current international guidelines for medication administration through an enteral feeding tube (EFT). This evaluation was based on a 15-item self-administered questionnaire reflecting the key aspects of guideline recommendations on medication administration via EFT. The authors concluded that community pharmacists had insufficient required knowledge to provide good advice to EFT patients or their caregivers. Despite the constant increase in the use of EFT for drug administration, drug product licences still provide little data on this subject. Healthcare professionals are thus obliged to find information on their own and administrate drugs via EFT under their own responsibility [2]. In this context, we appreciate the effort of the authors to address this issue and contribute to the dissemination of good practices. Nevertheless, based on our experience in the intensive care unit, we concluded that not all recommendations are suitable for all clinical situations and should be adapted, depending on the case. The first item of the questionnaire states that when a patient needs multiple drugs at one time, these drugs should be administered separately. This measure can be read in all guidelines for medication administration via EFT, and yet we found no compelling justification for this statement. The potential for an interaction between drugs and enteral feeding formulae or delivery devices has been well documented [2]. However, no concrete data is found in the literature to illustrate any interaction between two drugs that have been mixed together just before administration. Furthermore, physicochemical reactions occurring in a solution 30 s before administration via an EFT are unlikely to differ significantly from those occurring in gastric fluid after sequential administration. From a practical point of view, sequential administration of multiple drugs leads to logistical requirements that can be difficult to overcome in the ambulatory setting, in particular if patients self-manage EFT drug administration. In our opinion, the most important consideration at this stage is preparation of a solution whose viscosity is compatible with EFTs, avoiding obstruction of the tube. The fifth question focuses on the risks created by exposure to substances hazardous to health, and states that protective equipment is required during the crushing of amoxicilline and levothyroxine. However, these drugs are not identified as requiring special precautions, either in the Handbook of Drug Administration via EFTs [2] or in the last NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings [3]. More generally, choosing to apply a maximum ‘principle of precaution’ in the absence of supporting data can increase the risk of poor compliance with essential safe handling procedures. It is important to recommend simple and easy-to-apply safety measures for healthcare professionals [4]. The use of more relevant examples, such as methotrexate and mycophenolate mofetil [3, 4], would be more judicious. Question number 12 states that a minimum volume of 15 mL is needed to flush the EFT. A 15–30 mL flush volume is generally recommended [2]. In practice, the choice of flush volumes should take several factors into & Lucien Roulet lucien.roulet@gmail.com

Informatisation de la gestion des stupéfiants : de la législation à la pratique

En regard de la reglementation des stupefiants et de la reforme de la legislation, le CHU de Poitiers a adapte et mis en place une application de gestion informatisee de ces substances GESTUP ® PLUS. Probablement une evolution necessaire compte tenu du recours croissant aux antalgiques opioides et de la multiplication des references presentes sur le marche.