We observed no risk reduction associated with the implementation of smart pumps in a 500 bed mother-child hospital. Further studies are required to explore the details of the potential risk reduction associated with the use of smart pumps.
No abstract
All patients Mean AUC24h 21 days (ng.h/mL) Mean C0 21 days (ng/mL) 12 581 Minimum 6531 Maximum 20168 202 Minimum 78 Maximum 430 With GVHD 12 561 p ¼ 0.98 193 p ¼ 0.64 No GVHD 12 590 205 With nephrotoxicity 12 345 p ¼ 0.611 214 p ¼ 0.360 No nephrotoxicity 12 765 193
Aurélie Guérin est candidate au D. Pharm. et assistante de recherche à l'Unité de recherche en pratique pharmaceutique, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec. Elle est aussi interne en pharmacie,
BackgroundThe teaching hospital in this study is a reference centre for the management of patients with bone and joint infections. In this dedicated unit, a pharmacist is present on a daily basis.PurposeThe aim of this study was to assess the value and complementarity of different missions of the pharmacist.Material and methodsPharmaceutical activity is organised into three steps: medication reconciliation at patient admission, analysis of the first hospital prescription and daily analysis of prescriptions during hospitalisation. For each step, pharmaceutical time was estimated. Pharmaceutical interventions (PI) carried out were recorded and classified according to the pharmaceutical validation step and the ATC (Anatomical Therapeutic Chemical) classification of the drug.ResultsThe study was performed on 52 patients hospitalised in the trauma unit between November 2015 and January 2016. On average, 1 PI per hour was proposed during the reconciliation step, 3.46 PI per hour during the first analysis and 3.59 PI per hour during daily analysis of prescriptions. Most of the PI were proposed when analysing the prescriptions, whatever this was the first or a follow-up. Nevertheless, they were feasible only when reconciliation had already been made so as to establish a ‘medical check-up’ and to facilitate subsequent analysis. PI made during reconciliation concerned, in 55% of cases, cardiovascular and respiratory medicinal products. PI made during the first prescription analysis and during daily analysis of prescriptions concerned, respectively, in 60% and 56% of cases, anti-infectives and analgesics. Reconciliation primarily targets chronic treatments. It is complementary to the third level of prescription analysis which targets treatments introduced during hospitalisation. The large number of PI carried out during hospitalisation begs the question as to whether therapeutic protocols proposed by prescription software, widely used in the unit, can be a source of error due to lack of personalisation of drug management.ConclusionAll pharmaceutical activity steps are complementary and essential to patient care. A global pharmaceutical management system from hospital admission to hospital discharge must be considered.References and/or acknowledgementsThanks to the trauma unit team.No conflict of interest
BackgroundIn 2015, approximately 1500 cataract surgeries were performed in our teaching hospital. Currently, surgeons use single use (SU) medical devices (MD) and multiple use (MU) instruments for cataract operation without vitrectomy. In the context of development of ambulatory care, optimisation is key. Several pharmaceutical laboratories offer an ‘SU cataract kit’ with all MD including instrumentation.PurposeTo perform a medicoeconomic analysis comparing current practices versus practices with the ‘SU cataract kit’.Material and methodsA cost minimisation study was conducted during the summer of 2016 in the ophthalmic surgical unit. Firstly, practical observations were performed by a pharmacy resident to describe the kit contents. Then, this listing was approved by surgeons. Several pharmaceutical laboratories were contacted to offer a price for this kit. In a second investigation, the cost of this kit was compared with the unit price of each SU-MD and the cost of instrument sterilisation. The preparation time by nurses and pre-disinfection time by care assistants were also measured.ResultsCurrently, surgeons used 15 SU-MD in unitary bag and 4 MD-MU in sterilised boxes. All 15 SU-MD cost €20.03. The mean cost per sterilised box, for 4 instruments (speculum, bonn clip, capsulorhexis clip, micromanipulator) was €17. Therefore, MD used for one cataract operation cost €37€. The cataract kit should contain 19 MD. 3 pharmaceutical laboratories responded to our request and the best kit selected cost €52.5. The preparation time by nurses and pre-disinfection time by care assistants were, respectively, 30 min and 5 min per operation. Using the kit, preparation time would be reduced to 5 min and no pre-disinfection would be required. Thus time savings of 30 min would mean operation on more than 4 patients per day. In France, the diagnosis related group (02C05J) tariff for cataract surgery is €1265.74. Therefore, our hospital could hope to obtain more revenues.ConclusionThe SU kit had a higher purchase cost than the SU-MD and MU instruments currently used. However, the use of the SU kit would provide gains due to an increase in the number of operated patients. Furthermore, the use of the SU kit could facilitate ambulatory care.No conflict of interest
BackgroundComplete or partial drug shortages are harmful for patients. Their number has been increased by 10 in 5 years. In this context, a quantitative and descriptive analysis of these shortages was performed.PurposeIncreasing drug shortages have been reported in several studies. This analysis aimed to confirm this rise from 2007 to 2015 and to characterise the shortages in our hospital in 2014.Material and methodsThe pharmacy supply chain team (1 pharmacist, 2 pharmacy residents, 2 pharmacy technicians) gathered, selected and analysed shortages data from health authorities, purchase groups and pharmaceutical factories. Shortages impacting our stock were pointed out and listed in an Excel worksheet, updated daily since 2007. This file could be consulted by the whole hospital pharmacy team. To keep.caregivers (physicians, health managers, nurses, pharmacists) informed, briefing notes, including a strict alternative drug, substitution by a non-strict alternative drug (different dosages or administration routes) and complete shortages without alternative treatments, were sent.ResultsBetween 2007 and 2015, shortages increased up to 122% in our hospital. In 2014, we were short of 223 references among 2868 available drugs (eg, 8% of our drug formulary), the amount of purchases account was 145 000€. Over the same period, the most represented Anatomical Therapeutic Chemical classifications were nervous system (22%), anti-infectives for systemic use (21%), and blood and blood forming organs (8%). Average duration of a shortage was 64 days (1–720 days) for drugs not subjected to quotas and 180 days (11–792 days) for drugs with quotas. In 43% of cases, shortages impacted essential medicines according to the WHO classification and 38% had no alternative. Moreover, 38 briefing notes were sent to care units.ConclusionThe number of drug shortages increased every year. The use of an updated file of current shortages shared among the pharmacy team and health information management by writing briefing notes could be solutions to deal with such a challenge.References and/or AcknowledgementsBogaert P. A qualitative approach to a better understanding of the problems underlying drug shortages, as viewed from Belgian, French and the European Union’s perspectives. PLOS One May 2015WHO Model List of Essential Medicines, 19th list (April 2015)No conflict of interest.
BackgroundMedication reconciliation at patient admission is performed for all patients hospitalised in the internal medicine unit at a teaching hospital in this study. Optimising pharmaceutical activities is a key issue.PurposeThe aim of this study was to assess the adequacy of pharmaceutical analysis after medication reconciliation at patient admission according to iatrogenic risks factors (IRF).Material and methodsPharmaceutical interventions (PI) were carried out by the pharmacist for each potentially inappropriate prescription. The following IRF were researched in hospitalised patients: severe renal impairment, cirrhosis, pregnancy, age ≥75 years, polypharmacy (≥ 5 drugs), not scheduled hospitalisation (through emergency or direct admission), immunosuppressive therapies, oral chemotherapy or other high risk medications.Results151 inpatients were included in the study between November 2015 and May 2016. We achieved an average of 0.55, 0.32, 0.53, 0.78, 1.25 and 2.4 PI for patients with, respectively, 0, 1, 2, 3, 4 and 5 IRF. We identified 3 IRF that were more often associated with PI: severe renal impairment, age ≥75 years and polypharmacy with, respectively, 64%, 57% and 40% of patients having at least 1 PI. This study showed that if we have selected patients with at least 1 of these 3 risk factors (who represent 64% of admitted patients to the internal medicine unit), we would reconciled 90% of patients with at least 1 PI.ConclusionPharmacists are more likely to suggest medicines optimisation to the elderly, to patients affected by polypharmacy or those suffering from severe renal dysfunction. Reducing our activities by 36%, 90% of patients who need at least 1 PI still benefit from pharmaceutical analysis. The clinical impact of the 10% of unrealised PI should be considered and compared with the benefits of the extra time setting up new activities, such as output information or therapeutic education of patients.References and/or acknowledgementsAcknowledgements to the internal medicine unit.No conflict of interest
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