Rationale, aims and objectivesTo assess the impact of an automated drug distribution system on medication errors (MEs).MethodsBefore-after observational study in a 40-bed short stay geriatric unit within a 1800 bed general hospital in Valenciennes, France. Researchers attended nurse medication administration rounds and compared administered to prescribed drugs, before and after the drug distribution system changed from a ward stock system (WSS) to a unit dose dispensing system (UDDS), integrating a unit dose dispensing robot and automated medication dispensing cabinet (AMDC).ResultsA total of 615 opportunities of errors (OEs) were observed among 148 patients treated during the WSS period, and 783 OEs were observed among 166 patients treated during the UDDS period. ME [medication administration error (MAE)] rates were calculated and compared between the two periods. Secondary measures included type of errors, seriousness of errors and risk reduction for the patients. The implementation of an automated drug dispensing system resulted in a 53% reduction in MAEs. All error types were reduced in the UDDS period compared with the WSS period (P < 0.001). Wrong dose and wrong drug errors were reduced by 79.1% (2.4% versus 0.5%, P = 0.005) and 93.7% (1.9% versus 0.01%, P = 0.009), respectively.ConclusionAn automated UDDS combining a unit dose dispensing robot and AMDCs could reduce discrepancies between ordered and administered drugs, thus improving medication safety among the elderly.

The overarching goals of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) are to enable European citizens to lead healthy, active and independent lives whilst ageing. The EIP on AHA includes 74 Reference Sites. The aim of this study was to transfer innovation from an app developed by the MACVIA-France EIP on AHA reference site (Allergy Diary) to other reference sites. The phenotypic characteristics of rhinitis and asthma multimorbidity in adults and the elderly will be compared using validated information and communication technology (ICT) tools (i.e. the Allergy Diary and CARAT: Control of Allergic Rhinitis and Asthma Test) in 22 Reference Sites or regions across Europe. This will improve the understanding, assessment of burden, diagnosis and management of rhinitis in the elderly by comparison with an adult population. Specific objectives will be: (i) to assess the percentage of adults and elderly who are able to use the Allergy Diary, (ii) to study the phenotypic characteristics and treatment over a 1-year period of rhinitis and asthma multimorbidity at baseline (cross-sectional study) and (iii) to follow-up using visual analogue scale (VAS). This part of the study may provide some insight into the differences between the elderly and adults in terms of response to treatment and practice. Finally (iv) work productivity will be examined in adults.

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Highlights The COPIL allowed the restructuring of the ICU in record time to double its capacity. The CCP, integrated in the COPIL and already a member of the ICU team for a few years, provided an essential link between the ICU and the pharmacy during the COVID-19 pandemic. The CCP implemented actions to avoid health products shortages, to secure practices and played a key role in the critical analysis of emerging published data in COVID-19 potential treatments.

BACKGROUND The antidepressant escitalopram is widely prescribed for the treatment of depression. It is generally well-tolerated, and cholestasis is not mentioned in its summary of product characteristics (SmPC). We present a case of cholestatic and cytolysis liver injury due to escitalopram and a VigiBase ® study. CASE SUMMARY A 68-year-old man was admitted to our emergency unit due to clinical jaundice associated with hepatitis, pruritus and dark urine. We tested the patient for the most common etiologies of jaundice, including hemolysis, viral hepatitis, cirrhosis, carcinoma, cholangitis, cholelithiasis and intrahepatic or extrahepatic obstruction. The etiological study was negative, and an adverse drug reaction was the sole possible explanation. The patient was receiving treatment with escitalopram. Two days after its withdrawal, pruritus was resolved. Ten days after withdrawal, clinical jaundice disappeared. It took a month and three weeks after withdrawal for the patient to have normalized liver function tests. To our knowledge, this is the first reported case of cholestasis where treatment with escitalopram was the only possible cause, with a highly probable causality. In addition, we determined whether escitalopram is associated with hepatotoxicity and cholestasis by performing a disproportionality analysis. All cases of hepatobiliary disorders induced by escitalopram and reported in the World Health Organization pharmacovigilance database (VigiBase ® ) were analyzed to characterize this toxicity. We found that patients treated with escitalopram had an increased risk of hepatitis [odds ratio (OR) = 1.938 (1.186-3.166) ] and cholestasis [OR = 1.866 (1.279-2.724) ] [OR (95% confidence interval)]. The median duration between the introduction of escitalopram and the occurrence of acute hepatitis and/or cholestasis was ten days +/- seven days. CONCLUSION Although extremely rare, this case report, the review of the literature and the pharmacovigilance update confirm that escitalopram can cause drug-induced hepatotoxicity and cholestasis, generally within a week after initiation. Thus, escitalopram should be withdrawn immediately if an iatrogenic cause cannot be excluded. If its responsibility is ascertained, escitalopram should be consequently contraindicated. In addition, serotoninergic antidepressants in patients with non-severe depression are ineffective and harmful. Finally, the SmPC of escitalopram should be updated to alert for this risk and give clear clinical guidelines.

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BackgroundProthrombin complex concentrate (PCC) can be used for replacement of congenital or acquired vitamin K dependent clotting factor deficiency. Its main indication is to obtain a rapid reversal of oral anticoagulation therapy: vitamin K antagonist (VKA).PurposeIn the light of an increase in PCC consummation in our hospital (2019 beds) during the past 2 years (maybe due to a new use of reversal of new oral anticoagulants (NOACs)) and to promote the respect of recommended indications (AMM, marketing authorisation), we evaluated the clinical use of PCC for the reversal of oral anticoagulation.Material and methodsWe retrospectively recorded orders of PPC between January and December 2014. We evaluated the pertinence of the indication for anticoagulation reversal according to national recommendations on management of haemorrhage risk or haemorrhage treatment with anticoagulated patients.We also assessed prescription quality according to dosage, initial INR (international normalised ratio), patient’s weight, vitamin K association and initial anticoagulation therapy of every patient in accordance with national recommendations, literature recommendations and medication label.ResultsThere were 106 patients included in this study; 95% were associated with VKA treatment. The majority of indications were justified (80%): 50% for serious haemorrhage and 38% for patients who needed surgery in an emergency. However, there were concerns about PPC dosage used: 41% were not adjusted for weight or initial INR, principally sub-therapeutic doses in 80% of cases. Only 55% of PPC prescriptions were associated with vitamin K; 45% of administrations of PPC were not associated with vitamin K.ConclusionThanks to this retrospective evaluation, we have realised that the majority of PPC prescriptions are well justified and within recommended situations; only 5% were used for NOAC reversal. But the study also shows a lack of knowledge about the best dosage of PPC to administrate and the correct associated therapeutics in these situations. The role of the pharmacist is very important in order to promote good clinical drug use and to alert prescribers about PCC prescription recommendations, notably dosage adjustment with the patient’s weight or INR. The results of this study will be presented to main prescribers of PPC and new recommendations will be posted in the care unit.References and/or AcknowledgementsSurdosage VKA HAS 2008No conflict of interest.