[Reducing the environmental impact of inhalers dispensed in France. From diagnosis to sustainable action]. / Réduire l'impact environnemental des inhalateurs dispensés en ville et à l'hôpital en France. Du diagnostic à l'action durable.

OBJECTIVES: While inhaled drugs are mainly used to treat chronic respiratory diseases, they are also responsible for greenhouse gas (GHG) emission. To highlight this issue, a dispensed analysis and a carbon footprint evaluation of inhalers in France have been conducted. METHODS: A national qualitative and quantitative analysis of dispensed inhalers in community pharmacies (CP) and hospitals (H) was conducted in France for 2019. A data review from the literature led to the determination of the inhalers carbon footprint, expressed in carbon dioxide equivalent (CO2e) during the inhaler life cycle. RESULTS: Close to 40 million inhalers were dispensed by community pharmacies and one million by hospitals in 2019. It concerned three types of inhalers: metered-dose inhalers (MDI) [CP: 49%; H: 45%], dry powder inhalers (DPI) [CP: 47%; H: 51%], and soft mist inhalers (SMI) [CP: 4%; H: 4%]. According to the literature, MDI have the highest carbon footprint, ranging from 11 to 28 kgCO2e versus less than 1 kgCO2e for DPI/SMI. In 2019, the national carbon footprint of salbutamol (MDI), the most dispensed inhaler, was estimated to be over 310 million kgCO2e (CP+H) corresponding to more than 310,000 round-trip Paris-New York. CONCLUSIONS: This study shows the involvement of MDI in GHG emissions. Taking actions as part of a global and coordinated approach to limit their environmental impact is possible and thus is a priority.

[French national overview of the inclusion of environmental criteria in the public purchasing of health products (drugs and sterile medical devices)]. / Prise en compte des critères environnementaux dans la commande publique des produits de santé.

OBJECTIVES: Healthcare products (HP) have a significant carbon footprint that must be included by regulation in the facility's purchasing policy. A national overview of the inclusion of environmental criteria (EC) in the public procurement (PP) of HP in hospitals has been carried out. METHODS: Thirty EC were identified in the literature. Two questionnaires were proposed: (i) for buyers that analyze the level of "importance" and "ease of application" for public tenders (PT), and (ii) for suppliers that declare their commitments and evidence. RESULTS: Six regional buyers and 28 suppliers participated. Buyers recognize the "importance" of sustainable development (SD) but are more reticent about the "applicability" of EC in PT. The environmental rating remains low: on average 4.38 (0.25-10.00) % of the total rating. Only 12 EC are integrated within some PT. Suppliers report a high and diversified commitment to SD: 18 suppliers sent 474 evidence. Buyers and suppliers converge on the optimization of primary packaging and the establishment of a minimum order or delivery group. CONCLUSIONS: Since the efficiency of PP is inevitable, EC that combines SD and savings should be prioritized. The integration of additional EC, simple and easily documented, allowing cost containment for both suppliers and buyers, is possible to promote sustainable purchasing.

[Performances of an automated dispensing system combined with a computerized prescription order entry]. / Performances d'une solution associant l'automate de délivrance Pillpick au logiciel de prescription Pharma utilisée pour une activité de dispensation à délivrance nominative dans une unité de consultation et de soins ambulatoire.

INTRODUCTION: Performances of an automated dispensing system Pillpick (Swisslog) coupled with the computerized-prescribing - order-entry software and dispensing software Pharma (Computer Engineering) implemented at the opening of a new prison facility in Meaux were quantitatively and qualitatively evaluated. Pillpick allows the treatment of different and varied pharmaceutical forms without imposing bulk handling or depackaging. METHOD: This study conducted between July and September 2006 focused on the performances of the automated dispensing system in terms of single dose packaging, single dose dispensing, dispensing error rate and security of the medication circuit. RESULTS: Seventy-six plus or minus five percent of the prescribed medications were automated dispensed. Packaging working flow rate was 377 units doses per hour, dispensing working flow rate was 537 doses per hour. Dispensing error rate was 0.5%, due to wrong delivery orders mainly generated by the Pharma computer-order entry software. DISCUSSION: Automated dispensing systems Pillpick ensure safe drug dispensing. Potential drug errors can possibly be generated by the computerized-prescribing - order-entry software and dispensing software. CONCLUSION: The robot-software combination constitutes the key performance parameter.

[Impact of hospital infection on medical expenditures in a continuing care and rehabilitation service at a geriatric hospital]. / Impact de l'infection nosocomiale sur les consommations médicales en service de soins de suite et réadaptation dans un hôpital gériatrique.

The costs of medical expenditures such as drugs, medical devices (MD), biological assays and nurses workload, were measured, before and after the onset of nosocomial infection (NI), in rehabilitation care departments of a 1000-beds geriatric teaching hospital. Data were collected retrospectively in medical records and nursing records. Nurse's workload was measured by the French indicator "Soins Infirmiers Personnalisé à la Personne Soignée" (SIIPS). A week before and a week after the diagnosis of hospital-acquired infection, medical consumptions were compared. During the study 38 of the 206 patients admitted in rehabilitation care wards presented hospital-acquired infection. Data were collected for 31 of these 38 patients. Nosocomial infections are associated with an increased pharmaceutical dispensing: medication (mainly antibiotics) and medical device's cost; and an increased nurse's workload. This study suggests that infection surveillance may be helpful to a better understanding of pharmaceutical dispensing variation in geriatric rehabilitation care departments.