[Evaluation of a self-administration of medication practice in a rehabilitation unit]. / Évaluation d'une pratique d'auto-administration médicamenteuse mise en place dans un service de rééducation.

OBJECTIVES: Self-administration consists in the administration of medications by the patient himself during his hospitalization. The order of October 10, 2022 (Arrêté du 10 octobre 2022 modifiant l'arrêté du 6 avril 2011) modified the April 6, 2011 regulation to allow and regulate self-administration practices in hospital units. This evolution opens new perspectives for patient autonomy. The objective of this study is, firstly, to evaluate the rate of medication errors from patients under self-administration and secondly, to evaluate the satisfaction of patients and caregivers. MATERIAL AND METHODS: Eligible patients were recruited from a locomotor and polyvalent rehabilitation unit. After verification of eligibility, explanation given to the patient about the hospital self-administration of medication procedure and signature of the compliance agreement, patients started self-administration. Medication errors were reported during seven days. Evaluations of patient and staff satisfaction were also carried out. RESULTS: Of the 83 patients admitted to the care service, 32 were able to experiment self-administered medication procedure during their hospitalization. To assess the safety of this practice, 1235 drug intakes were analyzed. Ninety-four administration errors were noted: 98% of them concerned analgesic drugs. All of these errors were omissions and none of them were rated as serious. The 20 patients questioned were all satisfied with self-administration. The 14 carers interviewed were satisfied with this change in practice. CONCLUSION: The medication self-administration process set up in the rehabilitation unit did not lead to serious medication errors. Patients and caregivers reported being satisfied with this new hospital practice.

Ethanol Exposure During the Intravenous Administration of Chemotherapeutic Drugs: An Analysis of Clinical Practice and a Literature Review.

PURPOSE: Injectable cytotoxics may be formulated with ethanol. This study sought to quantify the amount of ethanol exposure during chemotherapy infusions. MATERIALS AND METHODS: We first reviewed the antineoplastic drugs (Anatomical Therapeutic and Chemical code L01) and oncologic supportive care drugs (eg, antiemetics) currently available in France, to identify preparations containing ethanol. The amount of ethanol in the final chemotherapy preparation was calculated. Next, we performed a 2-year, single-center, retrospective analysis of injectable antineoplastic drug compounding in routine clinical practice in a French university medical center. Finally, we reviewed our results with regard to the literature data. RESULTS: Ten of the 60 cytotoxic products on the market contained ethanol at concentrations of up to 790 mg/mL, depending on the drug, formulation, and supplier. Several final preparations contained more than 3 g of ethanol per infusion (the maximum recommended by the European Medicines Agency); this was notably the case for gemcitabine, paclitaxel (up to 20 g ethanol per injection, for both), and etoposide (up to 50 g ethanol per infusion). The analysis of our compounding activity showed that 3,172 (4.99%) of the 63,613 chemotherapy preparations (notably paclitaxel) contained more than 3 g of ethanol. None of the oncologic supportive care drugs contained ethanol. CONCLUSION: Patients are exposed to ethanol during the infusion of antineoplastic drugs. With a view to better patient care, physicians and pharmacists should carefully evaluate the risk of ethanol exposure throughout the course of cytotoxic drug treatment.