Background In Morocco, since the neutralisation of the last outbreak of Plasmodium vivax in 2004, only imported malaria cases have been recorded, the majority from sub-Saharan Africa. At Mohammed V Military Teaching Hospital in Rabat, patients are mostly military, often called to perform missions in malaria endemic areas. Purpose To report the incidence, origins, symptoms and treatment of malaria at Mohammed V Military Teaching Hospital. Materials and Methods A prospective study performed from 1 January 2000 to 15 November 2009. All patients who had travelled to a country where malaria is endemic and diagnosed positive for Plasmodium spp in our hospital were included. The data collected concerned the epidemiology, symptoms, diagnosis and treatment of malaria. Results 145 patients had a thick blood smear positive for malaria parasites. 84% were Moroccan, the sex ratio Male/Female was 19.71 and the age varied from 6 to 60 years with a median of 34 years. Countries at the origin of the infection were classified in zone 3 in 92% of cases. All malaria patients were symptomatic at admission, with often one or more of the following symptoms: fever (99%), chills (57%), sweats (41%), headaches and various pains (80%), vomiting (67%), nausea (44%), anaemia (44%) and thrombopenia (73%). We distinguished 19 cases of severe malaria and 3 cases of probable evolutive visceral malaria unconfirmed by serology. Plasmodium falciparum was responsible for most cases, alone in 68% of cases and in combination with other Plasmodium species in 10% of cases. A diagnosis was made within three months of returning from the endemic malaria area for 97% of cases. The drugs most commonly used for treatment were mefloquine (25%), quinine (17%) and the combination of the two (50%). Conclusions This study allowed us to better understand the profile of our malaria patients in order to improve their management in our hospital. No conflict of interest.
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 MethodsWe 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.
BackgroundInfection 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.PurposeTo 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 methodsThis 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).ResultsAmong 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.ConclusionSAP 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 AcknowledgementsSociété française d’anesthésie et de réanimation. Antibioprophylaxis in surgery and interventional medicine (adult patients), Actualization 2010. Annales Françaises d’Anesthésie et de Réanimation 2011;30:168–90No conflict of interest.
BackgroundCustomer 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.PurposeTo determine the limits of CCSIs in hospitals.Material and methodsThis 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.ResultsDirect 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:ConclusionCritical 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 1Needs HP has to satisfy CCSI designationCCSI descriptionLimitsAvailability of pharmaceuticals Average duration of shortageΣ time out of stock/Number of items in shortageConcordance between prescribed and dispensed itemsRequest Satisfaction Rate (RSR)(Quantity of dispensed drugs/Quantity of requested drugs) × 100Does not take into account appropriateness of the requestRapidity of dispensing prescriptionsPrescriptions execution timeTime to dispense prescription lines/total number of prescription linesPharmaceutical presence in CURate of pharmaceutical presence in CU(Number of CUs benefiting from pharmacist presence/total number of CU) × 100Pharmaceutical presence is not required at the same level in all CUsReferences and/or acknowledgementsNo conflict of interest.
BackgroundWith 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.PurposeTo 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 methodsTo 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.ResultsOur 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 1Cost per patient of PPs compared to the overall billing packageMTCECCEPPCostECCEBillingpackagePhacoemulsificationPPCostPhacoemulsificationBillingpackageInsured patients (15%)€45 €227 €203 €318 Uninsured patients (85%)€45 €218* €203 €218* *Excluding hospitalisation fees (€9 per day), radiology and medical biology fees.ConclusionPhacoemulsification 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 acknowledgementsNo conflict of interest.
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