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.

International guidelines limit the use of aminoglycosides in febrile neutropenia to severe situations. We retrospectively reviewed the use of aminoglycosides in adult acute myeloid leukaemia patients admitted in 2009. Our guidelines include precise indications (severe sepsis, shock, drug resistance), dosing regimens (once-daily 20 mg/kg/day amikacin, 5 mg/kg/day gentamicin), durations of treatment, drug monitoring timing, and target C(max) concentrations (40 mg/l amikacin, 20 mg/l gentamicin). Thirty-one patients received 46 aminoglycoside courses: 31 amikacin and 15 gentamicin. The mean prescribed dosage was 19 ± 2.8 mg/kg/day for amikacin and 4.7 ± 0.9 mg/kg/day for gentamicin. The mean duration of use was 2.9 days for both drugs. The mean C(max) for amikacin was 47 ± 13 mg/l and for gentamicin was 13.6 ± 7.5 mg/l. In compliant regimens, all amikacin patients and a third of gentamicin patients had adequate C(max). Among 23 isolated pathogens, 65.5% were susceptible to both drugs and 11.5% to amikacin only. This vindicates the 20 mg/kg/day amikacin dosage and suggests a need to increase the gentamicin dosage.

18% 'medium' and 3% 'critical' interventions. The main pharmaceutical problem was out of the formulary discharge proposal which represented 54% of PIs (796/1483). Dosage adaptation was recommended in 12% of cases; 9% of PIs were for stopping the treatment and other interventions were about the choice of route of administration, adding a treatment, therapeutic monitoring and optimization of administration. In total, 58% of PIs were accepted, the physician was not informed of 23% and 19% were not accepted; but 11% of the PIs accepted were not implemented. 135 PIs were discussed in pharmaceutical meetings. Among the subjects that arose, 3 were particularly highlighted: re-evaluation of renal failure and metformin, interaction between beta blockers and flecainide and recommendations on allergies. We have studied out of the formulary discharge proposal discrepancies about cardiology medicines (angiotensin converting enzyme inhibitors and angiotensin receptor antagonists). Conclusions Feedback on PIs is a key element to improve their relevance. Finally, a weekly pharmaceutical meeting can highlight recurrent prescription problems in order to propose and implement corrective measures. It is moreover a working base for our hospital to improve the quality of medical care.No conflict of interest. Background Forty to 50% of hospitalised patients with an acute medical illness have risk factors for venous thromboembolism (VTE) and it has been shown that thromboprophylaxis reduces the incidence of VTE events in these patients [1]. However, a large multinational survey, the ENDORSE study, showed that only 37% of medical patients with VTE risk factors currently received thromboprophylaxis [2]. Purpose To evaluate the impact over time of pharmacist-driven interventions aiming at increasing the appropriate use of thromboprophylaxis in acutely ill medical patients hospitalised in an urban academic tertiary care hospital. Materials and Methods First, medical and nurse reports of hospitalised medical patients were reviewed to evaluate the proportion of patients who were on prophylaxis according to clinical practise guidelines. Second, interventions were conducted and included unit-specific physician and nurse education, dissemination of educational tools summarising VTE prophylaxis guidelines, and reminders. Third, the effect of the interventions on the proportion of patients receiving appropriate thromboprophylaxis was evaluated after three and six months. Results The baseline evaluation showed that 36% (26/72) of the patients at risk of VTE received appropriate thromboprophylaxis. Three and six months after the interventions, 68% (55/81), and 72% (58/81) of the patients at risk of VTE received appropriate thromboprophylaxis. Pharmacist-Driven interventions imProve thromboProPhylaxis in acutely illOf the patients not at risk of VTE, 15% (21/141), 8% (24/290), and 8% (27/330) respectively at baseline evaluation, three and six months after the interventions, received thromboprophylaxis. Conclusions Pharmacist-driven interventions imp...

Background Medication management of older peoples is of special importance regarding to their sensitivity to adverse drugs effects. Purpose This study compared the medication error rates and the operating costs before and after implementation of an automated unit dose distribution system: before: ward stock system (WSS): prescriptions in paper record, medications prepared by nurses in the ward, after: computerised physician order entry including electronic medication administration record (eMAR), pharmacist interventions, unit dose delivering system robot, automated medications delivering systems. Materials and Methods Medication errors were identified using an observation-based method. Pharmacist attended drugs administration rounds in a randomly selected ward section. Administrations were compared to prescriptions. Error rates and error types were compared according to a chi square method. Clinical severity of errors was assessed. Drug consumptions, costs of pharmaceutical and nursing staffs and equipment were calculated for each period. Results During the WSS period, 28 rounds were attended (148 patients, 615 drugs administrations) versus 31 rounds (166 patients, 783 drugs administrations) during the UDDS period. The rate of medication errors significantly decreased between the WSS period and the UDDS period (12.6% vs 5.2%). During the WSS period, a medication error occurred by 30.4% of the patients (45 patients) compared to 19.9% (32 patients) during the UDDS period (p < 0.05). Most reduced errors during the UDDS period were wrong dose (16 vs 4) and wrong drug (19 vs 1). Drugs consumptions decreased of 11,527€ a year (11.5%) and cost of nurses time saved was assessed at 24,642€ a year. One dose delivered by robot cost 0.56€, 0.41€ excluding robot loan. Safety brought by the automated unit dose distribution system cost 90.4€ for one bed a month, including, staff and equipment. Conclusions Drug safety showed her necessity, this has an additional cost witch must be compared with consequences of medication errors and medicine-related illness. No conflict of interest.