[Contribution of a hospital pharmacy team to critical care of patients infected with SARS-CoV-2]. / Contribution d'une équipe de pharmacie hospitalière à la prise en charge en réanimation des patients infectés par le SARS-CoV-2.

With regard to the hospital drug supply chain, the safest system is the individual automated drug dispensing one provided by the pharmacy. For several years we have been trying to convince hospital decision-makers to set it up. In the meantime, to mitigate the risks of medication errors incurred by patients and caregivers, we have set up several work teams within the care units. These teams, made up of one pharmacist and one or two hospital pharmacy technicians, who notably manage the medicine cabinets in care units. The close collaboration with doctors and nurses developed over the years was a determining factor when it became necessary to provide the newly created additional intensive care units with drugs and medical devices (MDs) in order to cope with the crisis triggered by the SARS-CoV-2 epidemic. Daily monitoring of the drugs consumed by each patient, particularly neuromuscular blocking agents and MDs was a key element in managing stocks and anticipating changes of drugs, packaging and/or devices references. These facts give weight to the Claris report published in France which recognizes that the interactions of pharmacy technicians and pharmacists in the care units have positive effects in terms of quality and safety of patient care. They highlight the dangers to which patients and caregivers are exposed on Saturdays, Sundays and holidays when the pharmacy is closed. They legitimize the question of extending the opening of the pharmacy with a full team 365 days a year.

[Automation of the medication circuit to ensure patient safety]. / Automatisation du circuit du médicament dans la sécurisation du patient.

The medication circuit is a complex, transversal and risky process. It involves interdependent clinical and logistical stages. Its automation and computerisation are real levers for securing the patient's medication management and optimising the organisation of care. It allows care staff to free up precious time to provide care, particularly in geriatrics.

[Compliance of nursing professional practices related to drug preparation and administration: A cross-sectional and longitudinal descriptive study]. / Observations des pratiques des professionnelles en soins infirmiers liées à la préparation et à l'administration des médicaments : une étude descriptive transversale et longitudinale.

OBJECTIVES: Evaluate the compliance of practices of nursing professionals related to the preparation and administration of drugs in 2018. Discuss the evolution of compliance practices from 2014 to 2018. METHODS: Prospective transversal observational study. Based on an observation grid with 55 compliance criteria, we conducted direct observation of medication doses prepared and administered by nursing professionals. For each compliance criterion, the auditor could indicate whether the practice was compliant, non-compliant or not applicable. A convenience target of 250 observations has been set. RESULTS: A total of 252 doses of drugs were observed between March 1, 2018 and April 29, 2018. Drug doses were observed by day (52 %), evening (30 %) or night (18 %) mainly nurses (80 %) working on regular shifts (94 %). Just over half of the doses required preparation by a nurse (58 %) and almost half of the doses were administered parenterally (48 %). In 2018, the observed compliance rate of the drug circuit ranged from 25.0 % to 86.3 %. CONCLUSION: This descriptive study shows a compliance rate of practices of nursing professionals related to the preparation and administration of drugs, which varies from 25.0 % to 86.3 % by observed stage of the drug circuit. 2018. The study identified 15 action actions for continuous improvement.

[Nurse-pharmacist collaboration for the prevention of medication errors]. / La collaboration infirmier-pharmacien pour la prévention des erreurs médicamenteuses.

As part of a process to improve the safety of medication management on the wards, designated nurses in each department work in close collaboration with the pharmacist to prevent medication errors on a daily basis. In an isolated facility situated in a remote environment where the rate of replacement of team members is high, their role is essential and helps to reduce the risk of errors favoured by the high turnover of medical and paramedical staff.

[Retrocession, a profitable but risky activity]. / La rétrocession, une activité rentable mais à risques.

The retrocession (out-patient dispensing of hospital-reserved drugs)is a pharmaceutical critical activity requiring a care security with a territorial approach. In this drug supply chain, the pharmacist is the last step before the drug administration and the economic profitability is questionable. In this context, a risk mapping and an economic evaluation seem necessary. METHODS: The risk analysis was conducted with the adverse events collected. The economic study was realised with the point of view of the hospital and with the microcosting method. RESULTS: Six never events were observed with the risk analysis. The economic study showed that the retrocession was profitable in usual situations with a net margin from 7 to 14€. But, when an exceptional situation occurred as a troubleshooting or the creation of a public deal, the added costs became so important (76 and 85€) that the retrocession was an unbeneficial activity. CONCLUSION: The retrocession is an activity with a health, legal and economic high risk. In order to improve the healthcare quality and safety, the retrocession must be considered as a coordinated process. It means that the different health professionals must communicate with each other and that the connection between the ambulatory and the hospital care must be efficient.

Description and analysis of hospital pharmacies in Madagascar.

OBJECTIVE: Madagascar's health care system has operated without formal hospital pharmacies for more than two decades. The gradual integration of pharmacists in public hospitals since 2012 will allow the structuring of this field. This study was conducted to characterize the current situation regarding all aspects relating to the general functioning of hospital pharmacies and the services provided. METHODS: This qualitative research used semi-structured interviews. Interviewees' perceptions about the general organization and functioning of hospital pharmacies and details on services provided were collected. The 16 interviewees were Ministry of Health staff members involved in hospital pharmacy, hospital directors, medical staff members and hospital pharmacy managers. Interviews were recorded, translated into French if conducted in Malagasy, and fully transcribed. Verbatim transcripts were coded according to the themes of hospital pharmacy and topical content analysis was performed. RESULTS: The principal issue perceived by interviewees was the heterogeneity of the system in terms of technical and financing management, with a main impact on the restocking of pharmaceutical products. The drug supply chain is not under control: no internal procedure has been established for the selection of pharmaceutical products, the quantification of needs is complex, stock management is difficult to supervise, a standard prescription protocol is lacking, dispensing is performed by unqualified staff, no pharmaceutical preparation is manufactured in the hospitals and administration occurs without pharmaceutical support. CONCLUSIONS: Progressive structuring of efficient hospital pharmacy services using the Basel statements for the future of hospital pharmacy is urgently needed to improve health care in Madagascar.

[Patient's own medications in a Swiss regional hospital: where are we and where should we go?] / Gestion du traitement personnel des patients dans un hôpital régional suisse : état des lieux et propositions d'actions à mettre en œuvre.

OBJECTIVE: The use of patient's own medications (POMs) during inpatient admissions may represent a risk if not adequately supervised. The objective of this work was: (i) to assess the management of POMs in our hospital, and (ii) to identify actions to assure this practice. METHODS: A questionnaire survey was conducted among caregivers of the medical, surgery and geriatric units of a Swiss regional hospital. Six criteria for appropriate management of POMs were identified from the literature and internal consensus. Based on this survey and data from literature, the investigators identified relevant actions to be implemented for optimizing the management of POMs. RESULTS: Out of the 21 included units, 3 already set an inner written POMs policy, and 3 managed POM in accordance with selected criteria. The main issues were that POMs were mainly stored in the patient's room, and that quality criteria were not systematically checked before POMs' administration. POMs were mainly used to ensure continuity of treatment. Two thirds of the units systematically returned POMs to the patients upon discharge, but rarely sorted them out before recovery. Ten actions were identified to secure the management of POMs. CONCLUSION: These results confirm that POMs are commonly used and indicate a potential for improvement in the management of POMs in our hospital. An institutional guideline is now planned to support the implementation of the identified actions.

[Connected tablets, tracking care and sharing patient records]. / Tablettes, traçabilité des soins et partage du dossier patient.

A hospital at home team shares its experience of the use of connected tablets to enable caregivers to track the care provided and have shared access to the patient's records. An effective and modern solution which forms part of the extension of the computerisation of the hospital's medication pathway.

[Management of outpatient medications in care units: An audit of clinical practices]. / Traitement personnel du patient hospitalisé : audit de pratiques.

OBJECTIVES: To assess the outpatient medication management in care units two years after the release of an institutional procedure. To assess the patients' satisfaction with their treatment and with the information transmitted by healthcare professionals. METHODS: An audit of clinical practices was conducted in 23 units of our universitary hospital - general, surgery, emergency departments. Questionnaires were developed and validated by an institutional working group and were composed of three themes: management of the outpatient medication at the admission, awareness of tools and information transmission. Two physicians (a senior and a resident), a registered nurse, a head nurse and a patient were interviewed. RESULTS: Eighty-one medical and paramedical team members and 21 patients were interviewed for the study. According to statements collected, the procedure was unknown by 100% of the interviewed surgeons and 69% of the interviewed physicians. The practices being used by the medical units were more in line with recommendations than the surgery units. Among the patients interviewed, 19 (86%) were satisfied with the information they received during their hospitalization and 4 (19%) managed their own medication treatment with the help of a nurse in only 36% of the cases according to their statements. CONCLUSIONS: The management of outpatient medications during hospitalization is representative of the difficulties to master the continuity of pharmaceutical care at the various transition points. Coordination and cooperation between the different healthcare professionals and patients are the major key success to ensure an optimized healthcare procedure.

[Medication errors with concentrated potassium intravenous solutions: Data of the literature, context and prevention]. / Erreurs médicamenteuses avec les solutés concentrés de potassium injectable: données de la littérature, état des lieux et prévention.

Accidental direct intravenous injection of a concentrated solution of potassium often leads to patient death. In France, recommendations of healthcare agencies to prevent such accidents cover only preparation and intravenous infusion conditions. Accidents continue to occur in French hospitals. These facts demonstrate that these recommendations are insufficient and ineffective to prevent such deaths, especially those occurring during a catheter flushing. This article reviews the measures able to reduce the number of accidents. Countries which removed concentrated ampoules from ward stocks observed a decrease of the number of accidental deaths. This withdrawal, recommended by the World Health Organization, is now part of standards in studies aimed at determining the safety of care in hospitals. However, removal alone is insufficient to eliminate the risk. The combination with other measures should be considered. These measures are the provision of a combination of diluted intravenous ready to use solutions, the promotion of the oral route with tablets and oral solutions for potassium replenishment and to make available products with safeguards to prevent single shot intravenous injection. Studies aimed at determining the consequences on preventing concentrated potassium accidents of a widespread distribution of isotonic sodium chloride pre-filled ready-to-use syringes for catheter flushing should be performed.

[The medicine use pathway in paediatrics]. / Le circuit du médicament en pédiatrie.

The medicine use pathway is a process which is constantly evolving in order to comply with intangible rules. As in other therapeutic fields, the drug regimen in paediatrics must tolerate no error and must be able to detect all warning signs, however minor, in order to optimise this approach.

[Assessing and making safe the medicine use pathway in paediatrics]. / Évaluation et sécurisation du circuit du médicament en pédiatrie.

Based on an assessment of adverse events in a follow-up care and rehabilitation unit in paediatrics, audits were carried out of the medicine use pathway. The evaluation grid taken from this study today serves as a basis for the audits carried out on the medicine use pathway on a national level.

[Mapping of risks related to medication care in nursing homes: An overview in Alsace - France]. / Cartographie des risques liés à la prise en charge médicamenteuse en EHPAD : état des lieux en région Alsace - France.

BACKGROUND: Medication care of patients in nursing homes involves a complex circuit whose related risks need to be identified. The aim of this study was first to map risks related to medication care in a representative panel of nursing homes under contract with community pharmacies in Alsace, then to propose improvement action plans to remedy the weaknesses identified. METHODS: This study was conducted on a representative sample of 23 nursing homes in Alsace in 2014. A self-assessment questionnaire (Interdiag EHPAD), divided into 7 fields and made up of 198 questions, was completed by each of the 23 nursing homes during multidisciplinary meetings that were organized by the OMEDIT (observatoire du médicament, des dispositifs médicaux et de l'innovation thérapeutique of Alsace). The percentages of controlled risks were calculated for each of the 7 fields of the medication circuit, both at nursing home and regional levels. Similarly, the percentages of non-controlled risks were calculated for each of the 198 items. RESULTS: Considering the 7 fields, regional percentages of controlled risks varied from 63% to 85%. The field relative to drug supply was the best controlled, while that relative to prevention was the least controlled. Considering the 198 items, 30 important vulnerability points were identified, among which stand out: failure to report and to analyze adverse drug events, lack of involvement of general practitioner in nursing homes through collaborative approaches and transcription by nurse staff of oral or handwritten prescriptions in medical software. The analysis of those items led to the proposal of 13 improvement actions. CONCLUSION: The study pointed out mainly difficulties linked to the absence of suitable risk management policies and the lack of adjustment between nursing home staffs and general practitioners. In contrast, it revealed that the collaboration between nursing homes and community pharmacies was successful overall. Finally, we hope that this multi-center study, that led to identify concrete proposals, will help nursing homes to improve the quality of medication care for their residents.

[Integration of a hospital pharmacist in the ICU]. / Intégration d'un pharmacien hospitalier en service de réanimation.

The French regulatory system strongly encourages strict regulation of health products' production and distribution, especially concerning risk management and economic aspects. An ICU is an unusual environment for a local pharmacy practice (a nurse for every 2.5 patients, continuous adaptation of therapeutics…). However, a literature review reports interesting data concerning risk management and economics. This article aims to relate the experience of a pharmacist integration in a French teaching hospital ICU (half-time position).

[Work interruptions among nurses, experience of a hospital]. / Interruptions de tâches chez les infirmières, expérience d'un centre hospitalier.

The objectives of this study were to map task interruptions (TIs), to measure the impact of corrective measures and to compare nurses' perceptions with observations. It was found that nurses' aides were the main initiators of task interruptions, which were generally brief, for information purposes; and that task interruptions were more frequent in the 14-bed wards than in the 28-bed wards and during the visit.

Rôle du pharmacien hospitalier dans le circuit d'une catégorie de Médicament de Thérapie Innovante : les lymphocytes T exprimant un Récepteur Chimérique à l'Antigène.

ROLE OF THE HOSPITAL PHARMACIST IN THE MANAGEMENT OF A CATEGORY OF ADVANCED THERAPY MEDICINAL PRODUCT: CHIMERIC ANTIGEN RECEPTOR T-CELLS: Chimeric Antigen Receptor T-cells (CART) belongs to a new class of medicine, Advanced Therapy Medicinal Product, such as define by the European Regulation 1394/2007, and more exactly to the category of gene therapy medicinal product. Their status of medicine, as well as genetically modified organisms, imposes a particular circuit at hospital while maintaining a way over the Hospital Pharmacy. The manipulation of genetically modified cells is not usual in pharmacy. It requires, besides the acquisition of new skills, a not insignificant reorganization of the teams and the rooms of the pharmacy as well as an adapted training of the staff. A good communication is essential between the various actors of the circuit. The hospital pharmacist plays a key role in the implementation of a circuit adapted to this new type of medicine. This article aims to identify the roles of the hospital pharmacist and more generally of the pharmacy in the management of CART. We shall detail the specificities of this type of medicine in every stage of the circuit and the adaptations necessary to realize to guarantee the quality and the safety of the treatment by CART. Beyond the implementation of the circuit in the hospital, the pharmacist has an important role to be played in the follow-up of the patients after administration in view of the complexity of the side effects and a certain role in the training of the teams to this new medicine. Cet article fait partie du numéro supplément Les cellules CAR-T : une révolution thérapeutique ? réalisé avec le soutien institutionnel des partenaires Gilead : Kite et Celgene.