[Education program for cardiac rehabilitation: Impact of the "Drugs" multidisciplinary workshop on the patients' knowledge in the short- and long-term]. / Éducation thérapeutique en réadaptation cardiaque : impact d'un atelier pluridisciplinaire « Médicaments ¼ sur les connaissances des patients à court et long terme.

OBJECTIVE: The aim of this study is to assess the impact of the "Drugs" workshop of a therapeutic education program for cardiac rehabilitation on the patients' knowledge in the short and long term. METHODS: This observational study includes patients who participated in the workshops from June 2016 to June 2017 (10 workshops). The scores obtained on the knowledge assessment survey submitted before (S1), after (S2) and at a distance (S3) from the workshops were compared (total scores and scores per question). The existence of a link between the patients' characteristics and the overall progression was assessed. RESULTS: The mean total S1 (4.46/10) and S2 (7.98/10) scores were statistically different (n=62; P<0.0001) as well as the S1 (4.46/10) and S3 (7.53/10) scores (n=46; P<0.0001). A significant difference was observed for five out of six questions (P<0,0001) in the first sequence and for four out of six in the second one (P<0,0001). Initially, the best progress was made in terms of actions to be taken if a dose of medication has been missed; the worst one was the role of platelet inhibitors. Among the patients, 93.5% had a higher distance score than initially obtained. None of the chosen patient characteristics had a significant influence on the progression. CONCLUSION: The workshop significantly improved patients' knowledge in the short and long term, regardless of their profile. This study identified areas for improvement for future workshops.

[Pharmaceutical record's use in drugs sales service: Analysis of five months of experimentation]. / Utilisation du dossier pharmaceutique en rétrocession : analyse de 5 mois d'expérimentation.

OBJECTIVE: The pharmaceutical record integrated in the health insurance card is now exploitable by hospital pharmacists. The aim of this study is to assess the impact of pharmaceutical record's use in hospital drugs sales service and the relevance of this tool to secure the ambulatory dispensing of drugs. METHOD: All patients admitted in hospital drugs sales service between June and October 2016 were included. With the patient's consent, pharmaceutical record was created and/or consulted and implemented. When it included the city pharmacy's treatment, a pharmaceutical analysis was carried out to research drug interaction with hospital drugs sales service's treatment. If a contraindicated or not recommended association was detected, a pharmaceutical intervention was sent to the general practitioner, by secured mail. Each stage was timed. RESULTS: For the 183 included patients, 40 pharmaceutical records have been created and 74 completed. For the 69 remaining patients, pharmaceutical record could not be used. At the end of these 5 months, 86 pharmaceutical records included city pharmacy's and hospital treatments. The pharmaceutical analysis performed have shown 24 drugs interactions related to hospital treatment; seven inappropriate associations were transmitted to the general practitioner. Five minutes were required for both the use and the analysis of pharmaceutical record. CONCLUSION: Now, the pharmaceutical record is systematically used in the hospital drugs sales service, and its content is systematically analyzed. It represents one of the tool improving communication between town-hospital networks, and helps secure the ambulatory drugs dispensation.

[Targeted pharmacist-led medication order review in hospital: Assessment of a selection method for drug prescriptions]. / Analyse pharmaceutique ciblée des prescriptions à l'hôpital : évaluation d'une méthode de sélection des ordonnances.

OBJECTIVES: The aim of this study was to assess a selection method for drug prescriptions developed at the hospital level that allows to target pharmacist-led medication order review for at-risk patients and drugs. METHODS: A one-month study has been conducted on all targeted medication orders in 19 care units. Selection criteria have been identified: biological criteria, alert medications and drug interactions. Pharmacists' interventions proposed during medication order review were listed and the possible links to the selection criteria were determined. RESULTS: A total of 1612 prescriptions were analysed and 236 pharmacists' interventions were performed (14.6 interventions per 100 prescriptions). Physicians' acceptance rate was 60.6%. The percentage of pharmacists' interventions linked to the selection criteria was 35.6%. The relevance of the biological criteria was identified, particularly the one identifying patients with creatinine clearance below 30ml/min. Six alert medications were also relevant selection criteria: dabigatran, morphine, gentamicin, methotrexate, potassium chloride and trimethoprim sulfamethoxazole. Drug interactions criteria was irrelevant. CONCLUSIONS: This study allowed a first assessment of the selection criteria used. A largest study seems necessary to continue the analysis of this selection method for prescriptions, especially the assessment of the alert medications list, in order to refine the prescriptions targeting.

[Medication errors related to computerized physician order entry at the hospital: Record and analysis over a period of 4 years]. / Erreurs médicamenteuses induites par l'informatisation de la prescription à l'hôpital: recueil et analyse sur une période de 4 ans.

OBJECTIVES: Computerized physician order entry (CPOE) can generate medication errors. It is necessary to identify them and analyse their causes in order to secure the medication use system. METHODS: Errors were recorded during the pharmaceutical analysis of prescriptions over a period of 4 years on 425 beds. A code frame was provided. Errors were classified according to type, causes and time of detection. The most often drug implicated and the error correction rate were studied. Deep causes were determined and contributing factors were listed. RESULTS: Among 99,536 prescriptions analyzed, 2636 errors were detected (2.65 errors per 100 orders analyzed). The most common error was omission (31.49%). The most represented cause was redundancy requirement (11.34%). Antibacterials were most commonly involved (224 errors). Exactly 65.9% of the prescriptions were modified by physicians. Three root causes were identified: (1) configuration issues; (2) misuse; (3) design problem. Three types of contributing factors have also been detailed: economic, human and technical factors. CONCLUSIONS: Identifying root causes has targeted three types of improvement actions: (1) software settings; (2) training of users; (3) requests for improvements. Contributing factors have to be identified to control the generated risk. Some errors related to CPOE may lead to serious side effects for the patient. That is why it is necessary to identify these errors and analyze them in order to implement improvement actions and prevention to secure the prescription.