Background Frailty is a clinical syndrome highly predictive of functional decline after a stress or a medical event, such as adverse drug events. Objective To describe the prevalence of potentially inappropriate prescribing in a population of frail elderly patients. Setting Geriatric day hospital for assessment of frailty and prevention of disability, Toulouse, France. Method A cross-sectional study performed from January to April 2014. Two pharmacists retrospectively analyzed the prescriptions of elderly patients who were sent to the day hospital to assess their frailty and to be given a personalized plan of care and prevention. Potentially inappropriate prescribing was defined by combining explicit criteria: Laroche list, screening tool of older people's prescriptions, and screening tool to alert to right treatment with an implicit method (drug utilization review for each medication). Prescriptions' optimizations were then suggested to the geriatricians of the day hospital and classified according to criteria defined by the French Society of Clinical Pharmacy. Main outcome measure Prevalence of potentially inappropriate prescribing. Results Among the 229 patients included, 71.2% had potentially inappropriate prescribing. 76 patients (33.2%) had at least one drug without any valid indication. 51 (22.3%) had at least one drug with an unfavorable benefit-to-risk ratio according to their clinical and biological data, 42 (18.3%) according to the Laroche list and 38 (16.6%) had at least one drug with questionable efficacy. Conclusion Our work shows that the incidence of PIP is high in the frail elderly and that, in most cases, it could be avoided with an adequate and regular reassessment of the prescriptions. In future, prescription optimization will be integrated into the personalized medical care plan to further prevent drug-related disability.
Background Carbapenems (CBPs) are being used more and more because of the increasing prevalence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. Due to the extensive misuse of these antibiotics, some bacteria have developed CBP-resistant mutations. This epidemiological situation should make us wonder about prescribing CBPs. Purpose To describe prescribing patterns of imipenem/cilastatin, ertapenem and meropenem in elderly inpatients: context and impact of an interdisciplinary approach to prescriptions analysis. Materials and MethodsA retrospective study of CBP prescriptions was performed over a ten-month period (March-December 2011) in geriatric departments (313 beds). Data were collected from the electronic medical records, bacteriological analysis results and email exchanges between the infectious diseases physician (IDP), bacteriologists and pharmacists (prescription monitoring system). The following items were noted: patients, prescriptions and bacteriological characteristics. Results 55 patients were included with a total of 61 CBP prescriptions. The mean age was 83 (sex ratio 0.72). 71% of patients accumulated between 2 and 5 risk factors of multidrug resistant bacteria. Imipenem was the most-used carbapenem (n = 35; 57%) compared to ertapenem (n = 23; 38%) and meropenem (n = 3; 5%). Major indications were urinary tract infections (n = 37; 61%) and pneumonia (n = 15; 25%). 59% of infections were nosocomial. 39% of CBP prescriptions were written after a first-line antibiotic had failed (ceftriaxone most of the time). The overall duration of carbapenem therapy was 11 days. Microbiologically-documented infections and ESBL bacteria accounted for 69% (n = 42) and 51% (n = 24) of prescriptions, respectively: 5 of the ESBL strains isolated were community-acquired bacteria. 61% (n = 38) of prescriptions were reassessed by an IDP: 29 (76%) were in accordance with recommendations; 7 (18%) were stopped or changed for a narrow-spectrum antibiotic. Conclusions CBP prescriptions seem relatively well controlled in geriatric care units due to multidisciplinary analysis of the prescriptions. Nevertheless, evaluation of the impact of monitoring prescriptions for use of CBPs requires longer follow-up. No conflict of interest.
Le syndrome de la poche à urine violette est un phénomène relativement méconnu dans lequel des patients sondés de faç on chronique voient leur poche à urine et le collecteur se colorer en violet ou bleu. Il touche plus volontiers les femmes que les hommes, et est essentiellement rapporté chez les sujets âgés. Le mécanisme semble être lié à l'apparition dans les urines de deux substances chimiques, aujourd'hui identifiées, l'indigo (bleu) et l'indirubine (rouge), qui vont se complexer aux composants de la poche et du collecteur. De multiples facteurs associés ont été évoqués tels que la constipation, le pH urinaire alcalin, l'alitement, l'institutionnalisation, la présence de troubles cognitifs. Il s'agit de facteurs favorisants. En revanche, la présence d'une infection ou d'une colonisation urinaire bactérienne est nécessaire et la concentration bactérienne urinaire semble être l'étape déterminante dans l'apparition du syndrome de la poche à urine violette. Nous rapportons les cas de deux patientes hospitalisées en unité de soins de longue durée, sondées à demeure, présentant respectivement une colonisation urinaire bactérienne à Escherichia coli et Pseudomonas aeruginosa et ayant développé le syndrome de la poche à urine violette.
Background In September 2012 Toulouse Hospital was inspected to evaluate its quality according to the French Health Authority standards. This process covers all aspects of the hospital including the medication system (MS) which is responsible for the prescription, distribution, pharmaceutical analysis and administration. Purpose To verify that the actions put in place before the audit were still in effect. Materials and methods From February to August 2012, risk mapping was conducted in 32 randomly selected units using a tool created by the National Agency for Quality and Performance. The tool, called “InterDiag Medicaments”, includes 160 questions that cover all steps of the MS. Corrective actions were put in place following the risk mapping analysis. From January to September 2013, the process was repeated, this time in 25 randomly selected wards. Results The analysis of the two sets of results (2012 and 2013) showed that there was no difference between the mean structural risk: 63% (50 to 92%) in 2012 and 63% (43 to 86%) in 2013. For the “Prevention” step, the mean risk rose from 51% in 2012 to 64% in 2013 (p = 0.068). This improvement is attributed to an increase in “Experience feedback” and an improvement in the knowledge of protocols between 2012 and 2013. Concerning the “Management of the medicines storage cabinets”, the risk control percentage increased from 58% in 2012 to 64% in 2013. Improvements were also seen in “Prescription and dispensing”, and “Preparation and administration”, from 51% to 56% and 68% to 73% respectively. Conclusions These results help to confirm the positive effects of certification. The self-assessment tool helps professionals to take a proactive and system-based approach to the MS. Risk mapping is currently being performed in other units. No conflict of interest.
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