[Preparation and administration of injectable antibiotics: a tool for nurses]. / Préparation et administration des antibiotiques injectables, un outil au service des infirmiers.

Nurses, the main caregivers to administer medications, often find themselves lacking the information which is nevertheless essential for the preparation of injectable antibiotics. This problem, frequent in hospitals, impacts on patient safety. On the initiative of the pharmacy and nursing staff, a tool has been created in the Percy Army Teaching Hospital in Clamart.

[The nurse as the last line of defence against quality defects in medicines]. / L'infirmier, dernier rempart face aux défauts de qualité des médicaments.

The administration of medicines, the last stage in the process, is mainly carried out by the nurse. She is therefore the last person to be able to intercept any quality defects in the medication which, despite the stringent safety measures taken by pharmaceutical laboratories throughout their manufacturing processes, remain unavoidable. These interceptions are vital for the patient's safety.

Managing the risk of shortages and medication errors with curares during the COVID-19 pandemic: a hospital pharmacy experience.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has spread rapidly around the world. Like many clinical teams, hospital pharmacies have widely contributed in preventing and containing the COVID-19 pandemic. Pharmacies were thus involved in the management of overuse of specific drugs, medication shortages and risk of medication errors. OBJECTIVES: To assess the use of curares during the COVID-19 crisis and to highlight the lessons to be learnt from this overuse. METHODS: The use of curares (Atracurium, Cisatracurium and Rocuronium) was compared with the usual use levels in our hospital. Supply issues have been identified and investigated. The risk of medication errors was clearly established and considered. RESULTS: Despite an increased demand, our hospital has not experienced any disruption in the supply of curare medications. But the risk of curare shortages has led to the registration of new pharmaceutical forms and dosages never used before. We also observed necessary switches between different curares. All of this has contributed to an increased risk of medication errors. CONCLUSIONS: During the COVID-19 pandemic, the pharmaceutical management of curare medications has been particularly critical. The risk of medication errors and unsafe medication practices was high. This analysis must lead to a high level of vigilance in the next few months.

Severe bleeding secondary to misuse of fondaparinux: a case report.

Venous thromboembolism (VTE) remains a great challenge because of its frequency and of its potential severity. However, VTE treatment can also lead to iatrogenic complications. We report a case of thigh haematoma by a 83-year-old woman under fondaparinux for a solear thrombosis. Then we discuss the indications of Unfractionated Heparin (UFH), Low-Molecular-Weight Heparins (LMWH) and Fondaparinux, which are the three classes of rapidly acting anticoagulant treatments nowadays available. As their efficacy is comparable, the choice between these classes relies on the risk of adverse effects, which depends on some patient's characteristics. LMWH and fondaparinux are contra-indicated by the patients with a renal clearance under 30 ml/min. Only UFH are authorized during the whole pregnancy even though LMWH are more and more used. Fondaparinux has proven its safety by patients over 100 kg. UFH requires a daily biological management whereas it is optional for LMWH and fondaparinux, as long as their contra-indications are taken into account. No Heparin-induced-thrombocytopenia Syndrome (HIT-Sd) has been proven yet under fondaparinux so that platelets management seems not necessary, contrary to UFH and LMWH which require a twice-weekly platelets count. The accuracy of the therapeutic indication should result in the best benefit/risk assessment.

Medication dispensing errors in a French military hospital pharmacy.

OBJECTIVE: To determine the rate and the primary types of medication dispensing errors detected by pharmacists during implementation of a unit dose drug dispensing system. SETTING: The central pharmacy at the Percy French military hospital (France). METHOD: The check of the unit dose medication cassettes was performed by pharmacists to identify dispensing errors before delivering to the care units. From April 2006 to December 2006, detected errors were corrected and recorded into seven categories: unauthorized drug, wrong dosage-form, improper dose, omission, wrong time, deteriorated drug, and wrong patient errors. MAIN OUTCOME MEASURE: Dispensing error rate, calculated by dividing the total of detected errors by the total of filled and omitted doses; classification of recorded dispensing errors. RESULTS: During the study, 9,719 unit dose medication cassettes were filled by pharmacy technicians. Pharmacists detected 706 errors for a total of 88,609 filled and omitted unit doses. An overall error rate of 0.80% was found. There were approximately 0.07 detected dispensing errors per medication cassette. The most common error types were improper dose errors (n = 265, 37.5%) and omission errors (n = 186, 26.3%). Many causes may probably explain the occurrence of dispensing errors, including communication failures, problems related to drug labeling or packaging, distractions, interruptions, heavy workload, and difficulties in reading handwriting prescriptions. CONCLUSION: The results showed that a wide range of errors occurred during the dispensing process. A check performed after the initial medication selection is also necessary to detect and correct dispensing errors. In order to decrease the occurrence of dispensing errors, some practical measures have been implemented in the central pharmacy. But because some dispensing errors may remain undetected, there is a requirement to develop other strategies that reduce or eliminate these errors. The pharmacy staff is widely involved in this duty.

[Drug use process and nurses practices: evaluation in a French military hospital in 2006]. / Circuit du médicament et pratiques infirmières: evaluation dans un hôpital des armées en 2006.

The study carried out at Percy hospital (Clamart, France) gives a description of nurses' practices for each stage of the drug use process. Their knowledge about drugs risk was also evaluated. Results of this background give an assessment of practices before hospital accreditation and will be used to define the priority actions of improvement. Recent implementation of unit dose drug dispensing system and simplification of adverse drug event report illustrate these actions to enhance safety and to decrease iatrogenic risk. In addition, pharmacists proposed a training for nurses about drug iatrogenic disease.

[Photodegradation of chlorpromazine, a drug-related adverse event]. / La photodégradation de la chlorpromazine, un événement indésirable médicamenteux.

The photodegradation of an active substance during treatment is a rare drug-related adverse event which can sometimes have serious consequences. Health professionals must be aware of the specific storage and administration instructions with regard to chlorpromazine and ensure that they are respected.

[Results and lessons of an innovating chemotherapy-induced nauseas and vomiting management strategy]. / Résultats et enseignements d'une stratégie innovante de prise en charge des nausées et vomissements chimio-induits.

Current chemotherapy-induced nausea and vomiting management guidelines recommend taking into account the emetogenic potential of the chemotherapy employed as well as individual risk factors to such effects. We performed an interventional prospective study to assess the impact of an innovating therapeutic optimization strategy. The latter combines current guidelines application to a specific consultation in order to individualize the treatment. This study included 170 patients and covered a total of 1,746 days of various chemotherapies. Among these patients, 86.5% never vomited and 53.8% never had any nausea or vomiting. These results seem generally better than the ones found in the literature with all kinds of chemotherapies. Regarding them, we have attempted to highlight the determining criteria for a successful antiemetic treatment.

Frequency, types, and potential clinical significance of medication-dispensing errors.

INTRODUCTION AND OBJECTIVES: Many dispensing errors occur in the hospital, and these can endanger patients. The purpose of this study was to assess the rate of dispensing errors by a unit dose drug dispensing system, to categorize the most frequent types of errors, and to evaluate their potential clinical significance. METHODS: A prospective study using a direct observation method to detect medication-dispensing errors was used. From March 2007 to April 2007, 'errors detected by pharmacists' and 'errors detected by nurses' were recorded under six categories: unauthorized drug, incorrect form of drug, improper dose, omission, incorrect time, and deteriorated drug errors. The potential clinical significance of the 'errors detected by nurses' was evaluated. RESULTS: Among the 734 filled medication cassettes, 179 errors were detected corresponding to a total of 7249 correctly fulfilled and omitted unit doses. An overall error rate of 2.5% was found. Errors detected by pharmacists and nurses represented 155 (86.6%) and 24 (13.4%) of the 179 errors, respectively. The most frequent types of errors were improper dose (n = 57, 31.8%) and omission (n = 54, 30.2%). Nearly 45% of the 24 errors detected by nurses had the potential to cause a significant (n = 7, 29.2%) or serious (n = 4, 16.6%) adverse drug event. CONCLUSIONS: Even if none of the errors reached the patients in this study, a 2.5% error rate indicates the need for improving the unit dose drug-dispensing system. Furthermore, it is almost certain that this study failed to detect some medication errors, further arguing for strategies to prevent their recurrence.

Frequency, types, and potential clinical significance of medication-dispensing errors

INTRODUCTION AND OBJECTIVES: Many dispensing errors occur in the hospital, and these can endanger patients. The purpose of this study was to assess the rate of dispensing errors by a unit dose drug dispensing system, to categorize the most frequent types of errors, and to evaluate their potential clinical significance. METHODS: A prospective study using a direct observation method to detect medication-dispensing errors was used. From March 2007 to April 2007, "errors detected by pharmacists" and "errors detected by nurses" were recorded under six categories: unauthorized drug, incorrect form of drug, improper dose, omission, incorrect time, and deteriorated drug errors. The potential clinical significance of the "errors detected by nurses" was evaluated. RESULTS: Among the 734 filled medication cassettes, 179 errors were detected corresponding to a total of 7249 correctly fulfilled and omitted unit doses. An overall error rate of 2.5 percent was found. Errors detected by pharmacists and nurses represented 155 (86.6 percent) and 24 (13.4 percent) of the 179 errors, respectively. The most frequent types of errors were improper dose (n = 57, 31.8 percent) and omission (n = 54, 30.2 percent). Nearly 45 percent of the 24 errors detected by nurses had the potential to cause a significant (n = 7, 29.2 percent) or serious (n = 4, 16.6 percent) adverse drug event. CONCLUSIONS: Even if none of the errors reached the patients in this study, a 2.5 percent error rate indicates the need for improving the unit dose drug-dispensing system. Furthermore, it is almost certain that this study failed to detect some medication errors, further arguing for strategies to prevent their recurrence.