W Enneffah

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.

DI-071 In vitro comparison of antacid drugs: Application to six marketed formulations

Background Antacids are intended to neutralise the gastric H+ ions without interfering with the secretory process. They are generally administered 1 h 30 min after the beginning of a meal. Given the multitude of antacids on the market, it would be interesting to have quantitative techniques to compare these products and to demonstrate their physiological behaviour. Purpose To evaluate the behaviour of antacids in the presence of an increasing amount of acidity in vitro and to predict their use depending on the importance and periodicity of gastric acidity in vivo. Material and methods We studied the in vitro behaviour of six antacid drugs. For this, a therapeutic dose was diluted in 100 ml of distilled water, to which were added increasing amounts of 0.1 N HCl in increments of 0.2 ml every 30 s up to a total acid volume of 25 ml. The variation in pH of the mixture was followed by pH-metry. Each test was repeated three times. The composition of the studied antacids is shown in table 1.Abstract DI-071 Table 1 Drug A For 100 ml of oral suspension:-Aluminium hydroxide (3.49 mg)-Magnesium hydroxide (3.99 mg) Drug B For a 20 g sachet of oral suspension:-Aluminum phosphate gel at 20% (12.38 g)-Magnesium oxide (152 mg) Drug C For a 20 g sachet of oral suspension:-Colloidal aluminum phosphate at 17% (14.4 g) Drug D For a 10 ml sachet of oral suspension:-Aluminium alginate (500 mg)-Sodium bicarbonate (267 mg) Drug E For one effervescent tablet:-Sodium bicarbonate (170 mg)-Sodium sulfate (285 mg)-Sodium dihydrogen phosphate (195 mg) Drug F For one suckable tablet:-Calcium carbonate (680 mg)-Magnesium carbonate (80 mg) Results The in vitro behaviour of the six antacid drugs in the presence of increasing amounts of 0.1 N HCl is represented in figure 1.Abstract DI-071 Figure 1 Conclusion The proposed method allowed us to quantitatively compare the studied antacids. According to the results, drug C slightly neutralised stomach acid without an extended effect. It can be prescribed for low and temporary gastric acidity. Drugs A, B and F had an average and extended neutralising action (pH stabilisation around 5). They can be prescribed for moderate and prolonged gastric acidity. Regarding drugs D and E which had a strong neutralising and long acting action that stabilised the pH around 7.5, they can be prescribed for high and prolonged gastric acidity. No conflict of interest.

GM-005 Financial evaluation of cataract surgery in a public health hospital

Background With more than 1,000 cataracts operations performed per year, our hospital is considered one of the national reference centres for this surgery. In contrast to Extracapsular Cataract Extraction (ECCE), phacoemulsification is the most used technique at our hospital (84% of cataracts operated on) and requires costly consumables contributing to the overall cost of care. Purpose To compare the proportion of Pharmaceutical Products (PPs) costs in the amounts billed according to cataract surgery types and to patients’ Medical Tariff Categories (MTC). Material and methods To evaluate the cost of the PPs used in uncomplicated cataract surgery with lens implantation by both standard techniques, and its impact on the amount billed to patients’ MTC, we studied data from 1,073 patients operated on in 2013 (901 by phacoemulsification and 172 by ECCE). Information relating to the cost of PPs and billing packages was collected from our hospital’s financial department. Results Our study results (table 1) reveal that for phacoemulsification, the cost of PPs consumes 64% of the billing package in insured patients and 93% of the billing package in uninsured patients, in contrast to the ECCE for which the cost of PPs consumes only 20% of the billing packages in both patients’ MTC.Abstract GM-005 Table 1 Cost per patient of PPs compared to the overall billing package MTC ECCEPPCost ECCEBillingpackage PhacoemulsificationPPCost PhacoemulsificationBillingpackage Insured patients (15%) €45 €227 €203 €318 Uninsured patients (85%) €45 €218* €203 €218* * Excluding hospitalisation fees (€9 per day), radiology and medical biology fees. Conclusion Phacoemulsification is the most used technique, preferred for its many advantages. However it requires costly PPs that consume the greatest share of billing packages, especially in uninsured patients. These findings require the billing of this surgical act to be re-evaluated and a revision downwards of the necessary PP acquisition prices. References and/or acknowledgements No conflict of interest.

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.

DSL-013 Evaluation of the Limits of Automation and Impact on Drug Management at Mohammed V Military Teaching Hospital Pharmacy, Rabat, Morocco

Background Nowadays, hospitals tend to automate medicines management to increase quality, efficiency and safety of drug dispensing. At Mohammed V Military Teaching Hospital (MVMTH), a centralised Automated Drug Dispensing System (ADDS) was installed at the duty pharmacy. We expect this experience will be decentralised to all hospital services. Purpose To evaluate the impact of automation on medicines management at our duty pharmacy, and to determine its limits in order to improve them. Materials and Methods We analysed the organisational aspects from the database of the ADDS deposited at the MVMTH duty pharmacy. The study lasted one year (2010). We also used a questionnaire completed at the end of the study period by the 12 Pharmacy Technicians (PharmTs) working at our hospital pharmacy (6 juniors with less than 5 years of professional experience and 6 seniors with more than 10 years of professional experience, all performing the same tasks during duty hours), in order to evaluate their view of automation. Results 5444 transactions were accomplished (63% by juniors and 37% by seniors); injection forms were the most delivered (68%) followed by oral forms (29%); anti-inflammatories, analgesics and antispasmodics were the most required on duty hours (26%) followed by antibiotics and antiviral drugs (25%); according to PharmTs: the main advantages were: saving time in locating medicines (≈83 minutes saved per week, reallocated to other tasks): 8 PharmTs; limiting personal drug use: 5 PharmTs. the main constraints were: the irregular machine resupply (poorly done or not done at all) by the technician on duty whose job it is to replenish drugs consumed during the previous day: 10 PharmTs; the reduced capacity for storing all medicines, especially refrigerated and oversized ones: 6 PharmTs. Conclusions The automated drug dispensing system offers many advantages. However, there are still things to improve concerning machine resupply, storage capacity and storage conditions before decentralisation to hospital services. No conflict of interest.

GRP-112 Medical Devices in Morocco: What Guarantees of Quality and Safety?

Background Nowadays, all over the world, many medical devices, initially considered as non-risk or low risk, have been proved to be extremely dangerous to human health, as evidenced by the latest scandal of PIP implants. Purpose To report the experience of Mohammed V Military Teaching Hospital of Rabat in evaluating the quality and safety of medical devices and to analyse elements that can compromise the quality of these products in our country. Materials and Methods 30-month prospective study (January 2010–June 2012). We collected claims relating to the quality of medical devices at our hospital, in normal conditions of acquisition, dispensing and use. We also analysed the processes of placing on the market medical devices, the systems governing their use in hospitals and the main Moroccan rules regulating them. Results 30 claims were collected. They concerned: catheters (40%), surgical drapes (20%), gloves (17%) and other medical devices (23%). 47% of their defects were discovered before they were used in patients, 13% presented a risk of incident and 40% caused an incident in patients. The process of marketing a medical device, ensuring its quality and safety, must satisfy several cheques regarding the design, manufacture, import, sale purchase and use, before Ministry of Health certification can be obtained. Conclusions Claims concerned several categories of medical devices. Abnormalities detected compromise the quality and the safety of our patient care. Checks must take place at all levels of the distribution chain to avoid these risks. Abstract GRP-112 Table 1 Medical devices Types of claim Catheters · urinary catheters: too flexible or too rigid, balloon hernia;· haemodialysis catheters: thrombogenic, insufficient blood flow;· infusors tubes: tube bending. Surgical drapes low impermeability, a blue tint was released in the operating field. Gloves · clean gloves: poorly talc-powdered, low impermeability, break easily;· sterile gloves: poor resistance, difficult unpacking in sterile conditions. Others · trocars: mandrel hard to remove, difficult screwing and unscrewing;· needles: difficult handling, nonconformity of the tip;· sticking plaster: poor adhesion. No conflict of interest.

CPC-080 Management of Postoperative Pain at Mohammed V Military Teaching Hospital, Rabat, Morocco

Background Management of postoperative pain is a subject of interest as we believe that pain is still inadequately relieved in this population. Purpose To describe methods of postoperative pain management in anaesthesia-resuscitation and surgery services of Mohammed V Military Teaching Hospital in Rabat. Materials and Methods A questionnaire was distributed to our hospital anaesthesia-resuscitation doctors and surgeons. The questionnaire was designed to explore the evaluation, treatment and provision of postoperative pain prevention. Results 27 answers (78%) were obtained. 9 services stated that this was making them aware of the problem of postoperative pain management. 81.5% of the professionals didn’t have a written protocol. Postoperative pain was only evaluated in 32% of the patients. Among the methods used for postoperative pain measurement in post-surgical care units, simple verbal scales were the most used by professionals (29.6%), followed by an analogue visual scale (25.9%). Paracetamol was the drug most used in pain treatment. Conclusions Although our investigation generated fairly satisfactory results, our hospital professionals must give greater importance to postoperative pain management in order to improve their patients’ pain relief. No conflict of interest.